GIC Benefits to Change for Employees and Non-Medicare Retirees and Survivors Effective February 1, 2010

To help meet the GIC’s projected FY10 deficit of $35 million, the Commission voted on November 20, 2009, to implement benefit changes effective February 1, 2010.  These changes affect all employee and Non-Medicare retiree/survivor health plans.  While it is not unheard of for there to be a need for a supplemental appropriation when costs exceed planned levels, it is rare that benefit changes are needed mid year.  Given the state’s bleak revenue forecast, however, there is no expectation that a supplemental budget will be submitted this year to make up the projected deficit.

Meanwhile, health care expenses continue to skyrocket due to increased utilization coupled with increasing prices charged by providers – doctors, hospitals, imaging centers and prescription drug manufacturers.  For every $1.00 of GIC health plan premium, $0.90 is paid to providers.  In other words, provider payments are where almost all the dollars are going and new laws are adding members in January, February, and the spring, further adding to our expected costs.

Benefit Changes Effective February 1, 2010:

• Primary Care Physician Office Visit Copay: $5 increase across all tiers
• Specialist Office Visit Copay: $5 increase across all tiers
• Retail Clinic Copay: $5 increase
• Physical Therapy, Chiropractic, Routing Eye Exam, Speech Therapy, and Occupational Therapy Copay: $5 increase
• Outpatient Surgery Copay: $10 increase – no increase for Fallon Select, Harvard Independence, and Tufts Navigator
• Hi-tech Imaging Copay (e.g., MRI, PET and CT scans): $25 increase
• Emergency Room Copay: $25 increase
• Mental Health/Substance Abuse Outpatient Visit Copay: $5 increase
• New calendar year deductible of $250 per member to a maximum of $750 per family.  This is a fixed dollar amount you must pay before your health plan begins paying benefits for you or your covered dependent(s).  The deductible will not be applied to office visits, mental health/substance abuse benefits or prescription drug benefits.  Ancillary tests and procedures performed at an office visit, however, are subject to the deductible.

One bit of good news is that, as a result of these benefit changes, your health plan premiums will go down slightly effective February 1, 2010. 

The GIC certainly regrets having to make these benefit changes.  All GIC health plans (Non-Medicare) will have the same increases and it is not known at this time whether these changes will carry into FY11.  Additional details about health plan benefits for FY11 will be included in your GIC Benefit Decision Guide, that is delivered before annual enrollment, April 12-May 10, 2010.  Annual enrollment gives you the opportunity to change health plans, if you wish to do.