While the existence of a health plan and the company’s percentage share of premium costs are delineated in the union contract, the annual rates are not, and are largely dictated by negotiations between the insurance plan and Post management.
Premiums for dental, vision and life insurance/disability will stay the same as 2013.
Premiums for the Kaiser DHMO plan most of us have will increase by an average of 3.8 percent.
That plan would have required a 16 percent average increase, management representatives say, if they had not agreed to changes in the plan design.
Here is a summary of the changes in the plan design that Kaiser says are required to keep the premium increase to 3.8 percent:
- The deductible will increase from $500 for an individual/$1,500 for a family to $1,000 for an individual/$3,000 for a family. The deductible is what you pay for nonroutine procedures, such as surgeries and hospitalizations, before Kaiser’s insurance portion kicks in. Obviously this increase is not ideal — however, it reflects a trend by most large employers and insurance plans to save costs by sharply raising deductibles and out-of-pocket caps.
- The out-of-pocket maximum (excluding deductible), or cap, will increase from $1,000 for individuals/ $2,000 for families to $2,000 for individuals/$6,000 for families. The one good change in this is that currently co-payments for routine office visits do not apply to the out-of-pocket total, but in 2014, they will. (Co-payments for prescriptions will continue to be excluded from credit toward the out-of-pocket maximum.)
As always, the terms are extremely confusing, so here’s a brief recap:
- Co-payments are a set cash amount you pay for routine visits or office exams, and prescriptions, say $20 for a doctor’s office visit.
- Deductible is the amount you have to pay, excluding co-pays, before Kaiser pays.
- Co-insurance is your share of the costs of services (excluding co-payments) after you reach the deductible but before you reach the out-of-pocket maximum.
- Out-of-pocket maximum is the annual limit on what you pay for all these different payments collectively, excluding monthly premiums and prescriptions.
How it all works together
For example purposes only; actual costs could be different.
|Example||You pay||Cost of procedure||Notes|
|You go to your doctor for a knee issue||$20 co-payment||n/a|
|You get referred to a surgeon (specialist) and have an appointment||$40 co-payment||n/a|
|You have knee surgery||$1,000 deductible||$11,000||You pay your annual deductible before Kaiser pays anyting|
|$10,000||Balance of procedure cost after deductible|
|Total you pay for procedure||$1,940||You pay 20% co-insurance up to your out-of-pocket maximum, less any co-payments you’ve made|
|Kaiser pays||$8,060||Kaiser pays the balance|
You then have a follow-up appointment — you pay nothing because you have met your deductible and you have also met your out-of-pocket maximum. Kaiser now pays 100 percent of office visits, x-rays, hospitalization, etc. through the end of the year.
The premium share you pay each month and the cost of prescriptions is outside the out-of-pocket maximum and does not count toward that number.
There are a few employees who take the Kaiser Multi-Choice plan, allowing them to use doctors outside of the Kaiser network for a higher premium. The Post pays only the same premium amount it would pay for the main Kaiser DHMO plan, the employee pays the extra costs for the Multi-Choice plan. This year, that premium will go up 16 percent; under the Post formula, the company will pay only the increase in the main Kaiser DHMO plan. That means the employee share of the premium will increase more than 25 percent.
Open enrollment will be completed online only through your Workday account at dfmworkday.com, and goes from Nov. 4 to Nov. 13. Plan details and premium rates will be available on the Benefits/Human Resources website at mybensite.com/dna no later than Oct. 18. The Post will be mailing out enrollment information packets by Oct. 18.
• 3.8% average premium increase
• Deductible increase:
Individual: From $500 to $1,000
Family: From $1,500 to $3,000
• Out of pocket maximum increase:
Individual: From $1,000 to $2,000
Family: From $2,000 to $6,000×