The executives of a healthcare organization with over 1200 employees have renegotiated the health insurance plan terms and costs for the new fiscal year. There are several plans offered by this employer, one plan (HMO) has by far the lowest monthly premiums and is the plan that over 95% of the employees opt for. The employer contributes significantly to the cost of the premiums, making it very affordable: A single person pays a monthly premium of only $35, a full family pays $103 monthly. In comparison, the monthly premiums of this popular HMO plan are roughly one-half of the next plan offered (POS) and only one-tenth of the most expensive plan offered (PPO).
In an effort to keep the total cost of the premiums of the popular HMO plan (and the employee’s share of the premium as well) to a minimum, all deductibles and co-pays have increased as would be expected. For instance, co-pays to the Primary Care Physicians are now $15 and Specialists $20, an increase of $5 each. Emergency Room co-payments, however, have increased from $35 to $100. Undoubtedly, this is an effort to decrease inappropriate utilization of the ER as a “clinic.” Furthermore, under the prior plan, the $35 ER co-pay would be waived or refunded if the ER visit resulted in a hospital admission. This has now changed with the new policy; the person pays $100 whether or not they are admitted to the hospital.
The majority of employees in this organization are CNAs, aides, housekeepers, etc. who make far less than $30,000 and many of whom are single parents struggling to make ends meet. The higher ER co-payment may very well cut down on “inappropriate use” but will it have any negative unintended outcomes?Anonymous