In our conversations with members, we get a lot of good questions regarding your coverage with TAC HEBP. Naturally, if one person is asking, others are probably wondering the same thing. So, we've compiled a list for your benefit. If you have any further questions or would like more information regarding your coverage, please call TAC HEBP's Employee Benefits staff at (800)
456-5974.
· What
changes were made to the program? Why?
· Can our
county be self-funded and still participate in the pool?
· Why
do we have to choose a standard plan?
· We need
a catastrophic plan. Will that be available?
· Why don't we have an annual dental open enrollment?
· Who
provides service to our group?
· Can we
use CountyChoice Silver for our retirees instead of
BCBSTX?
· Why do
we have a 3-tier drug card?
· What
is TAC doing to help control costs?
· What
can counties do to save money?
What changes were made to the
program? Why?
In 2001, the Board voted
to have the pool take some risk as a partially self-funded plan. This was done to gain control and flexibility, as well as long-term financial advantages, which is necessary
to ensure that our program will continue to serve members
now and in the future. As a fully-funded group, the
pool was subject to some state regulations that were
detrimental to the pool's financial health. The new
funding method has made this pool like the others that
TAC has successfully operated.
We also adopted a stand-alone prescription drug
program, which allow us to purchase drugs at volume
discounts. We can now offer mail order service
to all groups, regardless of size. It also gives us
the flexibility to have prescription drug deductibles,
which so many counties have requested.
In addition, in early 2002, TAC HEBP began utilizing an online administration system called OASys. Through OASys, you have direct access to all the tools you need to administer your employees' health benefits; efficiently and accurately. It provides on-line, real-time access to membership and billing saving time and money.
Can our county be self-funded
and still participate in the pool?
Yes. In fact, we have made some improvements to our
self-funded arrangements that will lower the administrative
costs for most of our existing self-funded counties.
However, since the pool itself is now a self-funded
group, many counties will find it more advantageous
to be pooled with the other members. This will provide
the benefits of self-insurance with much less risk than
self-funding on your own. To discuss your county's options,
contact the Employee Benefits Department at TAC.
Why do we have to choose
a standard plan?
As the pool has grown, we have come to have hundreds of
plan designs to accommodate our members' needs. TAC HEBP has learned from administering so many unique plan designs, that the approcach proved too complicated and
expensive. So, we polled our members
to see if they would like to adopt standard plans, resulting
in lower administrative costs. The unanimous response
was in favor of standardization. We created a broad range
of choices that mirror the most popular current plans,
and even added several features that were not
previously available.
We need a catastrophic plan.
Will that be available?
YES! In response to several Counties' requests, we now
have a plan that will provide a high deductible major
medical coverage for their employees. These plans offer
a reasonable premium that allows groups to provide
healthcare benefits to help their employees when the
need is greatest.
Why don't we have an annual dental open
enrollment?
Although several groups have requested an annual dental
open enrollment, we are not able to offer such a benefit.
Most dental work is something that people can
put off until sometime in the future, annual open enrollments
would subject the pool to a tremendous amount of adverse selection. In other words,
many people would only sign up for dental long enough
to get their work done, then they would drop out again…until
the next time they needed something done. To keep our
prices low, we cannot allow annual open enrollments, but as always family members
can be added for qualifying events.
Who provides service to our group?
Customer service is provided from both TAC HEBP and
Blue Cross Blue Shield of Texas (BCBSTX). For routine
customer service such as claims questions, call the toll-free number at BCBSTX (800) 521-2227.
For day-to-day questions, call your TAC HEBP Employee Benefits Specialist, and for billing questions call the TAC HEBP Billing and Eligibility Supervisor.
Can we use CountyChoice Silver for
our retirees instead of BCBSTX?
Absolutely. Interested pool members must choose to offer
their retirees either CountyChoice Silver retiree program or BCBSTX.
You must meet minimum contribution guidelines in order
to keep your Medicare eligible retirees on the BCBSTX
plan. Groups can make the change at their anniversary
date. To get the details about eligibility for CountyChoice
Silver, please contact the Employee Benefits Department
at TAC.
Why do we have a 3-tier drug
card?
Statistics show that a 3-tier drug card controls spending
by encouraging consumers to choose the less expensive
preferred drugs (midtier) or generics when they are
available. The State of Texas moved to a 3-tier program
last year and it has proven to be highly cost-effective.
The prices continue to rise for medication (at a rate
of 21 percent this year) which requires us all to pay more
out of our pockets in order to maintain the same level
of benefits. For the first time, we will be able to provide
a prescription deductible that many counties have been
interested in offering.
Find out about the national average wholesale price
for drugs on our website: www.county.org/services/grouphealth
What is TAC doing to help
control costs?
TAC HEBP is very aware of the difficulties counties face
in balancing a tight budget. While the high cost of health
care is, in many ways, beyond anyone's control, there
are several ways that TAC helps to ease the burden.
First, we bring together over a hundred counties to
negotiate together, increasing your purchasing power.
TAC HEBP starts by negotiating the best possible deal for
the pool as a whole. Historically, we have saved $1-2
million each year through these negotiations.
In the
pooling process, we help offset the inevitable bad claims
year that all counties experience sooner or later. By
streamlining administration, we are also able to keep our
fixed costs low, about half of what you would expect to pay in the open market.
TAC HEBP makes it a priority to carefully evaluate and select a provider
network that not only has a surplus of doctors, but also
delivers substantial discounts on medical bills. Our methods to control costs
save you an average of 46 percent on claims.
Finally, TAC HEBP created the Healthy County wellness program exclusively for Texas Counties and their employees. Health County is a comprehensive wellness package that offers a variety of ways to get- and stay- healthy using tools and programs chosen specially for you. To get details about this program, please contact the Wellness department at TAC.
What can counties do to save
money?
Each year the price of the medical services and prescription
drugs continue to rise as new and more expensive technology and pharmaceuticals
become available. As our population ages, health problems also
tend to increase. In addition, employees are making multiple doctor visits and obtaining more prescriptions than ever
before. These are a few of the primary factors that drive the
costs so high. But, there are proactive steps counties
can participate in to control claims, thus lowering overall costs.
· As TAC pool members, small and large groups
alike get the advantage of our programs that can help
save counties money including the Healthwise® Handbook, Disease Management (for fully funded
members) and CountyChoice Silver.
· Organize annual health fairs or periodic screenings
in conjunction with your health department, extension
office and local health care providers. Flu shots have
been proven to reduce health care costs and absenteeism.
Why not schedule shots at the courthouse?
· Be willing to shape your healthcare benefits
to adequately provide the coverage your employees need,
yet inspire wise choices that result in reasonable utilization.
· Promote use of mail-order prescriptions and/or
use of generic drugs.
The best thing members can do is to stick together. Counties working as one cohesive group creates great negotiating and purchasing power for all members of the Pool. |
