LITTLE ROCK — City employees in North Little Rock who pay extra for certain insurance coverage will be able to catch a break under the new federal healthcare law if they so choose.
A portion of the city’s health plan charged to employees currently provides a higher maximum amount paid by insurers over a customer’s lifetime, a cap that is eliminated under President Barack Obama’s health-care changes.
North Little Rock’s City Council will consider a proposed renewal of health insurance coverage for its employees at its meeting today. The city has coverage with QualChoice of Arkansas through Stephens Inc.
North Little Rock, as is common with other municipal governments, pays 100 percent of health coverage for employees and 75 percent of the cost for their dependents, city Finance Director Bob Sisson said.
However, employees who have opted for QualChoice’s “enhanced” policy for their families, paid $26.88 more per bimonthly pay period out-of-pocket for that coverage this year than those paying the core plan’s cost. The difference would rise to $27.98 for the enhanced plan next year.
The enhanced plan offers benefits such as paying only two deductibles in family coverage instead of a deductible for each family member, a larger percentage of medical bills from out-of-network providers, and placing fewer limits on maximum benefits paid over a patient’s lifetime.
Among provisions in the federal health-care law that took effect last week is a ban on insurers placing lifetime caps on how much they will pay for their customers’ medical expenses.
The limit on lifetime medical bills paid out by the insurer has been $5 million under the city’s plan, a limit that goes away under Obama’s health-care package. The $1 million maximum on the core, or basic, health plan was also eliminated.
Maximums come into play for those with catastrophic illness or injury and long-term care.
“The health-care law took away some of the benefits from the enhanced plan,” said Stephanie Thomas, the city’s assistant finance director. “So that maximum benefit is no longer a benefit of the enhanced plan.
“I think a lot of those who were on the enhanced plan because of the maximum benefit will drop off,” she said. “The ones who went on for the two deductibles will stay for that.”
Others may abandon the extra coverage for another reason, Thomas added. Medical specialists cost an insured individual a $40 co-pay, while the core plan carries only a $10 co-pay for the same visit after the deductible is met, she said.
“I don’t think a lot of people realized this,” Thomas said. “A lot of employees have had questions about the specialist provision. Most doctors you go to are specialists, except your primary-care physician.
“I think we will have several come off the enhanced because of this, also.”
The core plan for families this year is $57.60 per pay period, rising next year to $59.73 per pay period, under the proposal to the city council. The enhanced plan would rise from $84.48 to $87.71 per pay period. Enhanced plans for individuals would go up from $11.94 to $12.43 if the proposal is approved.
North Little Rock has 141 workers who use the enhanced coverage for themselves over the basic health plan and 281 who opted for enhanced family coverage out of 459 covered employees.
The renewed proposal by QualChoice will cost the city $224,521 next year, Sisson said, a 3.93 percent increase over 2010.
The medical plan’s cost to North Little Rock, if approved, will go up 4.1 percent overall, Sisson said, with vision and dental coverage holding steady.
“The [3.93 percent] is what everything went up when counted together,” Sisson said.
Arkansas, Pages 9 on 09/27/2010