"Gap" health insurance plan to soon be implemented in Sullivan County

September 1st, 2014 4:00 pm by Rick Wagner

BLOUNTVILLE - If you're a Sullivan County school employee or taxpayer, the 'gap' is not a play for teenagers or young adults to buy clothes.

Instead, it's a supplemental health insurance that could save school teachers and other employees money as well as keep school health insurance expenses down for taxpayers.

During a Board of Education work session Thursday evening, Director of Schools Jubal Yennie explained to the board the gap insurance that Five Points, an insurance broker, will tell teachers about in mandatory meetings in late September.

The idea is that the system and most of its employees can save money by going from the Partnership plan to the Limited PPO or preferred provider organization.

Two Tennessee school systems offered gap plans starting Jan. 1, 2014, but come Jan. 1, 2015, 30, including Sullivan and Washington counties, plan to offer them.

The limited plan has higher deductibles, higher maximum out of pocket expenses and high pharmaceutical costs for employees.

But the key is that the gap insurance - to be paid 100 percent by the county - would cover the difference and save individuals on the plan $27 to $54, depending on a decision of the school board, and save those with family policies almost $200 a month.

The question is whether the county will keep paying 95 percent of individual parntership policies and 70 percent of family ones or might reduce the reimbursement to 90 percent.

The plan is to pay 100 percent of individual limited policy costs, saving $27 a month compared to the partnership plan.

Rolling back the partnership reimbursement would increase that cost to $54 a month, which Yennie said might not be too bad for teachers and other professional employees but could hurt professional staff who chose to stay.

Among people who might benefit from staying in the preferred program include those with high drug costs.

Yennie said that the family plan under the limited plus gap policies would sell themselves with a $200 monthly savings.

Of 1,127 health policies among school sytem employees, more than 50 percent are individual policies.

Yennie said Five Points, an insurance broker to find a gap plan, will hold mandatory teacher meetings in late September to explain the pluses and minuses of switching to the limited plus gap plans.

If 10 percent of employee switched, it would save the county a little more than $45,000 for the half of the fiscal year starting Jan. 1 and would saving the school system about $57,000 for that same half a year.

The school system balanced its 2014-15 budget by estimating $350,000 in revenue from employees switching to the limited plan.

It was first offered as an option in open enrollment Oct. 1-31, 2013, but few employees took it because not much information was available about it.

'I'll look at it pretty heavily this year, but I've got a lot of questions as well,' said Yennie, who stayed with the partnership plan last year. 'Folks, it's a personal decision. Find out the facts.'

One issue is that employees would have to pay deductibles and out-of-pocket expenses - which can run more than $12,000 for families - up front and wait four days for reimbursement, although Yennie said medical providers may be willing to take direct payments knowing they will come four days after the claim is filed.

However, finance director Leslie Bonner took the limited plan and sang its praises even without the gap insurance. During an Aug. 26 collaborative conferencing session, Bonner said the lower premiums have more than made up for some higher costs not covered by the limited plan.

Collaborative conferencing with teachers, which replaced the old contract negotiations, is seeking a memorandum of understanding on the gap plan. However, Yennie said it was not required since the school board could unilaterally decide to change the insurance policy payment percentages.

'If I were sitting across the table from me saying I want you to have a 5 percent reduction in insurance, I wouldn't agree with that,' Yennie said.

But BOE member Todd Broughton said many private sector employees, including Eastman Chemical Co., have offered new employees a lesser health insurance plan that exiting ones.

BOE member-elect Michael Hughes said he's getting a lot of questions from people who don't understand the gap sytem, questions Yennie said would be addressed during the Five Points meetings before open enrollment Oct. 1-31.

'We are not trying to save $350,000 with this decision,' Yennie said. 'We do not need to get there.'

He said getting half that much savings would be good.

BOE member Randall Jones said leaving the insurance pay percentages as is for another year and putting employees on notice changes would come in 2016 might be an option.

Sullivan County Education Association President Lloyd 'Sport' Putney in a recent interview said he was concerned why incentives were needed at all if the plan was so great and said he wondered why Blue Cross Blue Shield, the insurance company providing the regular health insurance, did not offer a gap plan.

Bonner said BCBS and other insurance companies are considering offering such plans, which are modeled after the 'medigap' plans that would with federal Medicare insurance for retirees.

Collaborative conferencing is set to resume 4 p.m. Thursday in Room 212 of central office in Blountville.

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