Medical Insurance FAQ
To Our Members:
Since the email went out announcing the change in medical benefits, there have been questions and comments that we would like to address. The Board and staff of VCDSA understand a transition this significant is disruptive and frustrating. Many of you have important questions regarding how you can continue the best care for your families. Although we are unable to adequately and personally speak to each and every one of you, we are sending out this FAQ to address some of the issues However, we encourage all of you to attend one of the benefits fairs as they will be the best sources of information regarding the plans. Additionally, there will be Board members at each of the events so you will be able to discuss with them the process that went in to this decision.
The VCDSA Board
Is there any chance to convince the Board of VCDSA to get Kaiser and VCHCP back as an option for the 2019?
No. There is a contract in place and many of the components of implementing the plans already moving forward. Based on their extensive research, the Board is confident that they made the best decision for the long term sustainability of medical benefits for all VCDSA members.
If we are supposed to be getting long term sustainability, why did my rates go up?
The answer is twofold. First, for the 2019 year, the Board voted to end rate blending. What does that mean? We have three groups – employee only, employee plus one, and employee plus multiple (families). With rate blending in place, the members who insured their entire family were receiving premium subsidies from the two other groups, with employee only members carrying the bulk of that burden. This was done in part because the Affordable Care Act was supposed to implement rate blending as a mandate, but that mandate has now been removed and we have returned to a true tiered plan. Unfortunately, while two of our tiers see a benefit in 2019 because their rates are where they should be, the families are no longer receiving premium subsidies from the other tiers which makes their rate increases this one year much more dramatic.
The second reason is the unfortunate reality of medical insurance in this Country. It would be best to budget for your future to expect that your medical insurance costs are going to increase every year. The national average rate of medical insurance inflation is 9%. Please do not expect anything other than rate increases. However, because of the ending of the rate blending, some members received a larger rate increase this year when they lost their premium subsidy afforded to them by rate blending. The reason the VCDSA Board voted for such a dramatic change in service for the members is that we are attempting to keep the rates from going up in the high double digits and bring it down to a manageable level.
Why did VCDSA eliminate the choice of Kaiser and the VCHCP?
The first consideration was the manner in which medical insurance rates are calculated by the carriers. Breaking up a group our size in to three different carriers leads to a situation where some of the carriers are losing money. That meant that this year and last year, VCDSA has had a difficult time getting carriers to even quote us a rate because they did not want to take us on as a partial client. We have learned through this process that Kaiser’s current low premiums were leading us in the direction of having no viable carriers who would provide us insurance outside of Kaiser and VCHCP. The problem with that is that Kaiser would then have us in a position to raise our rates exponentially without us having leverage, and we would be left with no option that could provide coverage to our out of state retirees. We have always and will always continue to provide insurance that can be used by our out of state retirees. That is part of what is meant when we say that the decision is complicated because we consider and support ALL members of VCDSA.
While some members are very committed to both of Kaiser and VCHCP, others are not. Additionally, neither of those plans are adequate on their own to provide insurance to all of our members because they have limited networks and do not provide coverage to our out of state retirees.
But I loved Kaiser (or VCHCP) and there were no hidden costs!
The Board was aware that 65% of our members were in Kaiser and did everything that they could to keep it as an option this year. We had an option that would have allowed for us to keep Kaiser for a less disruptive transition, and that option was the preferred option in the eyes of the VCDSA Board because it provided some transition toward sustainability with a much smaller amount of disruption. However, there were components to that option which required the cooperation of the County, but we were unable to secure the County’s approval. This denial by the County happened at the last minute (we have deadlines to choose our plans) and was a big disappointment to the Board. They were then forced, with a looming deadline, to decide between leaving the plans exactly as they were in 2018, with huge rate increases and worsened position for negotiating rates in the future, or the all Anthem plan that we offer for 2019. Although most of the Board members were negatively impacted by the decision, they voted to do what they felt was right for all VCDSA members.
As for hidden costs, we do not expect there to be any hidden costs with any of our plans, and strongly encourage all to come to the Benefits Fairs to speak with the Anthem reps and other vendors so you can make a truly informed decision.
Why didn’t we get to vote on this change?
The VCDSA Board members participate in multiple committees that are responsible for issues concerning our members. It is the Insurance and Benefits Committee of the VCDSA that makes the decisions regarding medical benefits (see VCDSA Bylaws on the venturacountydsa.com website). They are the people who spent dozens of hours being educated on how the rates for medical benefits work and how VCDSA could create a situation where they could obtain long-term, sustainable costs for all of their members. It is because of that expertise that they are tasked with making a recommendation to the entire Board regarding medical benefits. It was only after their recommendation and a great deal of discussion that the decision was made by the Board. Asking the general membership to vote on the plans to choose is not practical because they would need to receive the same information and education as the Insurance and Benefits Committee in order to make an educated vote that would benefit all members.
One way to get a vote on the insurance benefits that you are offered as members is to run for the Board of Directors. Getting a spot on the Board would afford you the opportunity to receive the education and be fully immersed in the insurance process.
Why did we not know earlier about the change?
The decision was voted on unanimously by the Board only a few days prior to the information being put out to the members, and right up against our deadline to advise the County of our decision. This was an issue we had been researching but the negotiations with different plans were all evolving right up until the vote was taken. The decision by the County to not support the plan preferred by the VCDSA was made just as we were facing the deadline of a decision. There was not an attempt to hide the information to the members and the Board would receive no benefit by doing such a thing, but we attempted to hold out a few days to try and have complete information in place so that you could have some information when you heard about the changes.
Why did we not know about this change when we agreed to ratify the contract?
Because we had not even received any proposals to have any idea what insurance changes, if any, would be occurring. We were still in the research stage. Insurance companies do not begin providing quotes that early.
Why didn’t the Board ask for our permission to change before they did it as we are the people affected?
The VCDSA Bylaws direct that the decision regarding medical benefits is the sole responsibility of the VCDSA Board after recommendation from the Insurance and Benefits committee. The Board was very concerned about the impact of such a significant disruption on a large percentage of the members and tried everything in their power to avoid the disruption. Most of the Board members were negatively impacted by the decision themselves but put their individual needs on the back burner to try and bring the VCDSA medical benefits back in to the sustainable realm. For more information, please review the VCDSA Bylaws that are posted at www.venturacountydsa.com under the Member Documents section.
What if I have a family member who has a chronic condition and has been seeing specialists, or I am pregnant and am in Kaiser?
This is a significant concern that the VCDSA Board considered and has been working with Anthem to make sure all transitions go smoothly for our members. There is a Transition of Care form lined here to facilitate transition of care. Please fill out this form and bring it to one of the Benefits Fairs so that the Anthem Benefits Advocates can start working on getting all of your care transitioned in the manner that is best for you and your family.
Why are you pushing the Benefits Fair so hard?
The Benefits Fairs are for you. We recognize and sympathize with the significant disruption to many of our members’ lives caused by this change in benefits. Groups are the best way to convey the most information in the most efficient way possible. Please take a few hours out of your day to attend one of the events so that you can make the best decision for your family.