Topics of CUCFA’s conversations with the UCOP have been on the fate of UC Care, Pru-High (especially as an affordable Medigap policy) , the development of risk adjustment policies in pricing, the need for greater freedom in out-of-area coverage and in pharmacy policies, and the continued desirability of a 3-tiered point-of-service alternative to HMOs.
Over most of the last decade, as medical costs through HMO containment has declined, the administration’s contribution to employee health care has also declined. Yet employee contributions have increased over this period for lower quality, restricted-choice health care. Thus it is gratifying that UC’s contribution in 1999 has increased $7 for singles (to $146 monthly), $14 for couples (to $299), and $19 for families (to $405).
The administration is moving towards a risk adjustment policy (as CUCFA has advocated), but it will not be fully implemented this year. UC will try to get health plans to reduce premiums proportional to the number of low risk employees enrolled and raise them for high-risk enrollees. Those numbers are will be available after Open Enrollment.
UC Care, with its 3-tier options, is at risk because its price is higher than standard HMOs. Employees sensitive to increases in yearly premiums, largely younger, lower users of healthcare, may opt out of UC Care into cheaper HMOs, leaving older employees who demand more healthcare, driving up premiums. Currently enrollees of UC Care tier 2 use it as a conventional fee-for-service plan with a $500 deductible (1 person) and an 80% reimbursement plan. This practice, ignoring the tier-one doctors, drives up the cost of the plan. Currently the fees are $17.23 (1 person), $35.33 for couples, $48.25 for families.
But the danger of driving up rates can be seen in Pru-High, used primarily by older retirees as a Medicare supplement. Its rates are $757.97 for one, $1406.70 for couples, and $1791.45 a month for families. Yet it and UC Care the only plans offered that provide non-emergency out-of-district health care, for faculty on sabbatical or for employees’ children going to out-of-state schools.