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Board goes with Aspirus after deductible change

Board goes with Aspirus after deductible change Board goes with Aspirus after deductible change

School to offer three-tier Aspirus plan as well as an Aspirus-only option

In a move that will save district taxpayers at least $380,000 in insurance premium expenses, the Medford School Board on Monday approved making the switch from Security Health Plan to broad plan Aspirus Arise for employee health insurance.

Board members approved the recommendation from Cory Toth-LaPointe and Becky Gorst of Spectrum Insurance Group to switch to a three-tier broad provider plan offered by Aspirus. The plan will allow those covered by the district’s insurance to see the provider of their choice regardless of if they are affiliated with Aspirus, Marshfield Clinic or elsewhere. Employees choosing to only go outside of Aspirus providers would be subject to a slightly higher deductible and a 10% coinsurance payment after the deductible is met. If they use Aspirus providers, the deductible is lower and there is no co-insurance payments.

According to Gorst the district has 67 members, or about 8% of those covered by the district’s insurance, who see providers exclusively at Marshfield Clinic. Most others who use Marshfield providers see specific doctors or specialists, but do the bulk of their healthcare through Aspirus providers. Gorst noted that depending on when in the calendar year visits to providers took place, those going outside the Aspirus network for their providers could still fall under the lower deductible level. The additional deductible and coinsurance only comes into play when the lower Aspirus-only deductible has been met. This plan option had initially been discarded during a July 13 special school board meeting, but came back under consideration as an option because the insurance provider clarified that the three deductible “pools” were not separate, but rather could be commingled. In addition to the three-tier broad plan, the district will offer staff an Aspirus-only plan for those who only want to see Aspirus affiliated providers. Gorst suggested the district may want to look at an incentive to encourage employees who are already only using Aspirus providers to switch to this plan as a cost savings to the district.

Further sweetening the pot, Gorst said Aspirus would waive the fee for the district wellness program in 2021 to match the wellness benefit that Security Health Plan (SHP) has built into their insurance proposal.

The district was faced with a $651,365 increase in its initial insurance renewal with SHP, the district worked with Spectrum to get that renewal to $507,913, about 10% higher than the current premium for a plan that runs through December. The decision was made to seek proposals. SHP offered numerous options with the board narrowing them to consider one with a nearly 6% increase coupled with an increase in the single/family deductible from $1,500/$3,000 to $2,000/$4,000 this plan would have resulted in an increase to the district of $301,855.

In counter to this, the Aspirus three-tier plan is a 2.51% increase over current premiums, or about $127,707. With Aspirus willing to waive the fee for the wellness program, this would be an additional savings of about $50,000. The Aspirus-only option with $2,000 individual and $4,000 family deductibles would have had the district reducing its insurance by $388,351, a 7.65% drop, with the trade off of limiting provider options for members.

Board member Steve Deml noted that if 20% of the employees took the narrow network option, the net insurance cost to the district would be under 1%.

Board president Dave Fleegel cautioned about there being “sour cherries” over the three-tier plan.

“Consumers are all about the power of choice even though they go to the grocery store and buy the same cereal every week,” Fleegel said.

Board member John Zuleger said regardless, any other potentials due to changes on the Health Savings Account or wellness program, the district would see a $174,000 savings versus the comparable SHP offering.

A driving factor in the district’s insurance rate increase is the district’s loss ratio. The district is currently at 103.1% which means that for every premium dollar collected, the insurance company is paying out $1.03. Generally the lower the usage, the better the rates will be.

In its proposed budget for the 2020-2021 school year, the district built in a 10% increase in premium costs. Reducing that amount will allow the district to use those funds elsewhere.