CalPERS Committee OKs Plans for Changes to Health Care Benefits
The CalPERS Health Benefits Committee on Tuesday approved recommendations to revise health insurance plan options and reduce costs, including a proposal to increase copayments for physician visits, the Sacramento Bee reports.
The higher copays are expected to reduce premium costs for state and local government employers by $59 million in 2008.
CalPERS trustees on Wednesday will consider the panel's recommendations. If approved, the copay rate increase will be the first in five years.
The committee also approved a proposal by Blue Shield of California to drop its HMO coverage for CalPERS members in El Dorado, Napa, Lake and Plumas counties (Chan, Sacramento Bee, 5/16).
The four counties are considered among the most costly for health care services (California Healthline, 4/18). CalPERS officials estimate that the withdrawal would generate $30 million in premium savings for the remaining 356,000 Blue Shield HMO members in other counties.
The committee also recommended adoption of a new low-cost physician network for HMO and PPO CalPERS members in 17 counties.
The network would have fewer physicians than other plans, but members would face lower premiums. Adding the smaller network is projected to save $2 million to $17 million.
The committee also recommended that CalPERS trustees approve:
- Adopting a $15 copay for urgent care for all HMO plans;
- Increasing the copay from $10 to $15 for a physician's visit, excluding preventive care;
- Increasing the copay for a 30-day supply of brand-name medications from $5 to $20 at retail drug stores, while a 90-day supply of name-brand drugs from mail-order pharmacies would increase to $40 from $25;
- Maintaining existing copays for generic drugs from retail and mail-order pharmacies; and
- Capping out-of-pocket payments, excluding prescription drug costs, at $1,500 for individuals with HMO coverage and $3,000 for families (Sacramento Bee, 5/16).