In our conversations with members, we get a lot of good questions regarding your coverages with CountyChoice. Common sense says that 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, don't hesitate to call TAC'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?
· Will
we have dental open enrollment?
· Who
will service 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?
After considering several options, the Boards voted
to keep what works and change only those parts that
needed it. The biggest change is that the pool will
now take some risk as a partially self-insured plan.We
did this to gain control and flexibility, which is necessary
to ensure that our program will continue to serve members
now and in the future. As a fully insured group, the
pool was subject to some state regulations that were
detrimental to the pool's financial health. The new
funding method will make this pool like the others that
TAC has successfully operated.
We also moved to adopt a stand-alone prescription drug
program, which allow us to purchase drugs at volume
discounts. We will now be able to 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.
TAC has also taken the reigns of
the membership and eligibility program (billing) by utilizing an online administration system we call OASys. In
addition to seeing faster and more accurate service,
you will be able to submit your changes and applications
electronically to cut down on paperwork hassles at your
county. These changes took place in early 2002 and improvements continue year after year.
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 TAC pool has grown, we have come to have hundreds
of plan designs to accommodate our members' needs. From
administering so many unique plan designs, TAC HEBP has learned that the approcach proved too complicated and
expensive. Earlier this year, 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 have even added several features that have not been
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 counties to provide
healthcare benefits to help their employees when the
need is greatest.
Will we have dental open
enrollment?
Although several groups have requested an annual dental
open enrollment, we are not able to offer such a benefit.
Because 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 will service our group?
You will continue to receive service from both TAC and
Blue Cross Blue Shield of Texas (BCBSTX). For routine
customer service, such as claims questions, continue
to call the toll free number at BCBSTX 1(800) 521-2227.
Your TAC Employee Benefits Specialist, BCBSTX Marketing
Service Representatives as well as your TAC Billing and Eligibility Specialists' will continue in much the same
capacity.
Can we use CountyChoice Silver for
our retirees instead of BCBSTX?
Absolutely. Interested members must choose to offer
their retirees either CountyChoice Silver 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% 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 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 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.
Finally, TAC makes it a priority to carefully evaluate and select a provider
network that not only has a surplus of doctors, but also
delivers substancial discounts on medical bills. Our methods to control costs
save you an average of 46% on claims.
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 tend to also
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 - 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. |
