Federal Employees Have 205 Consumer-Driven Plans to Choose From

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> washingtonpost.com

>

> In FEHBP, Steering Attention to 'Consumer-Driven' Insurance Plans

>

> By Stephen Barr

>

> Thursday, December 4, 2003; Page B02

>

> In contrast to many private-sector employers, the government offers its

> workers a wide choice in health insurance plans, including coverage for

> prescription drugs.

>

> For 2004, the Federal Employees Health Benefits Program will offer 205

> health care options, up from 188 this year. Washington area government

> employees and retirees will have a choice of 17 plans, up from 11.

>

> FEHBP, in particular, has made a point of drawing attention to

> " consumer-driven " plans in the last two years. These plans take a

different

> approach from the more traditional choices and, in theory, give employees

> and retirees an opportunity to more directly manage the money they spend

on

> health care.

>

> This year, Kay Coles James, director of the Office of Personnel

Management,

> singled out consumer-driven plans added to FEHBP by Humana and Aetna in

her

> remarks kicking off the 2004 " open season, " which ends Monday. Last year,

> she announced that the American Postal Workers Union had introduced the

> first consumer-driven option for FEHBP enrollees.

>

> The consumer-driven options provide a spending allowance for health care,

a

> free checkup and some other preventive care. But they also are designed to

> encourage enrollees to hold down their medical spending, because they

> include substantial deductibles when the spending allowance has been used

up.

>

> The Aetna HealthFund, which will be available to Washington area employees

> and retirees, provides a good example of how the new FEHBP consumer-driven

> options work. Tom Bernatavitz, the company's vice president for federal

> government business, describes the HealthFund as built around three

primary

> components.

>

> The first is a medical fund of $1,000 for individuals and $2,000 for

> families. Enrollees can use money in the fund -- which is set up at the

> start of each year -- to pay for their heath care expenses. No referrals

> are needed for doctor appointments, and enrollees can use Aetna's

physician

> and hospital network to lower their costs. Enrollees also receive an

> additional $300 for preventive care obtained inside the Aetna network.

>

> Enrollees who do not use up the entire medical fund can roll it over to

the

> next plan year. The maximum amount that can be kept in the fund is $4,000

> for individuals and $8,000 for families.

>

> The second major component in the Aetna HealthFund is its deductible. If

> the medical fund is exhausted in any given year, the deductible kicks in

> and enrollees pay for all their health care expenses until they reach

> $1,000 for individuals and $2,000 for families.

>

> After the deductible has been met, the third component in the coverage, a

> traditional cost-sharing arrangement, takes effect. Enrollees pay 15

> percent of the cost of health care services obtained through the Aetna

> network and 40 percent of costs incurred out of network. When

out-of-pocket

> costs (including the deductible) reach $5,000 for individuals and $10,000

> for families, Aetna covers 100 percent of any remaining expenses that

year.

>

> In the Washington area, nonpostal employees will pay a biweekly premium of

> $32.36 for individual coverage and $74.43 for family coverage, according

to

> OPM.

>

> The medical fund in the Aetna plan can be used to pay for prescription

> drugs. Pharmacies deduct the contract cost of the drug from the enrollee's

> fund at the time of purchase. If the fund is depleted, the enrollee pays

> the contract cost of the drug until the medical deductible is met. After

> that, the enrollee pays $10 for a generic drug and $25 for a brand name.

>

> Aetna also offers a separate dental fund for its federal enrollees, worth

> $300 for individuals and $600 for families. Unspent money cannot roll over

> to the next year. If the fund is used up, enrollees may get a discount for

> dental services by going to a network provider.

>

> " It is not for everyone, " Bernatavitz said of the Aetna HealthFund. " I

> think it attracts the individual or family who wants to be placed at the

> center of the health care equation. "

>

> Such plans, he said, " allow individuals to be a consumer. We have online

> tools that we will make available to federal employees that let them price

> a drug or medical procedure so they can analyze what their expected costs

> are for the coming year. At the same time, we want to be there for serious

> problems. We do have out-of-pocket maximums so people don't suffer

> catastrophic losses. "

>

> E-mail: <barrsbarrs.

>

> http://www.washingtonpost.com/wp-dyn/articles/A33464-2003Dec3.html

>