Denominational Health Plan: General Convention’s Winners and Losers

Bishop: “This is a Justice issue”
Inigo Montoya: ” You keep using that word. I do not think it means what you think it means…”

35k is ridiculous.  Do you see any saving graces of this policy in its disposition towards families?

Moot - the plan is a good one as far as the coverage it provides.  That’s all I can say.  The premiums for families with kids are obscene.

35K! Sounds more like an injustice issue to me.

They talk a Prius game but it’s a Cadillac plan.  That’s TEc in a nutshell.

LOL well said, polycarp.  That’s classic.

$35K for a family?  I’m assuming for that kind of $, for a doctor appointment, they send a limo?

[1] Stefano,

I think that’s the single best blog comment I’ve seen…ever…in the history of blogging. In our parish, we were able to get far cheaper and perfectly good insurance (our little “group” of two priests and a secretary) by walking across the street to BCBS-TX on our own…which is ridiculous.

(Diocese of Dallas, 8 of 10 on the “cost scale”, even in the megalopolis of Texarkana.)

As a healthy 29 year old priest, I certainly don’t want my insurance to be any more of a burden on parish resources than necessary.

RE:  “The premiums for families with kids are obscene. “

In other words, no.  :(

Several years ago, The Episcopal Church (TEC) put in place a Denominational Health Plan (DHP) that was pitched as a way to reduce premiums and take some stress off of congregational budgets.  The idea seemed prudent and practical.  By mandating that all churches pay into one national plan, the pool of participants would increase, causing premiums to go down. 

Mus admit the idea does seem sensible as a way to control premiums. As the old adage goes no good deed goes unpunished. This is punishing the very groups we should be wanting to help. 

Tim+,Any idea as to why the resolutions to modify, opt out,  or otherwise modify/temper the impact of this did not pass?  Also, did not anyone take a look at thing before it was approved? I realize insurance coverage/policies are notoriously hard to and nearly impossible to understand but surely someone could have given a warning about the consequences??  DId this policy have to be approved by GC before implementation?  If not, why not? Strange is the decision making process of TEC.

An organization like TEC should be buying a self-funded plan that can be run by 815, administered by a large national carrier (like Empire Blue or United Healthcare or CIGNA) so they can get access to a national network, and then set up a private closed exchange for all eligible participants nationwide that would make available local options for all the clergy and employees around the country. 

That would allow the option of letting premiums be locally priced, or lumping them together and making a uniform national rate that applies across all 50 states.  This is NOT rocket science, it’s the same sort of arrangement all multi-state corporations domiciled in New York have today.

The Church would hold the risk itself on the smaller cases, buy reinsurance from the many carriers out there for specific claims that exceed, say $100k per year, and let the entire size of the Church be felt by a carrier who would then negotiate lower administrative fees to do all the paperwork for them.  Then the Administrator/TPA/ASO carrier would give the members all over the country access to their national network of docs and hospitals at the best discounts they could get.  No big deal, happens every day.

But let me scare you a bit more.  The most expensive health insurance available in the U.S. by state goes like this (from most to least expensive)

Group 1:  Tightest Underwriting standards, most onerous mandates, most heavily regulated states (naturally have the most expensive insurance)
New York
Vermont

Group 2:  Slightly less UW standards, slightly fewer mandates, heavily regulated
Washington
Oregon
Colorado
Michigan
Pennsylvania
Maryland
New Jersey
Rhode Island
Massachusetts
New Hampshire
Maine

Group 3:  Moderate mandates, industry standard UW, regulated but not heavily
Nevada
Utah
New Mexico
North & South Dakota
Iowa
Minnesota
West Virginia
Louisiana

Group 4:  Very few mandates, large allowable risk spreads, light regulation
Montana, Alaska, Wyoming, Nebraska, Kansas, Oklahoma, Texas, Arkansas, Missouri, Wisconsin, Illinois, Indiana, Ohio, Tennessee, Mississippi, Alabama, Georgia, North & South Carolina, Florida, Delaware

Group 5:  The WILD WILD WEST of health insurance regulation.  Almost no rules at all
Arizona, Idaho, Kentucky, Virginia.

So you see, If you are equalizing Group 1 premiums with Group 5 premiums, you are punishing the heck out of Group 5.  In general, it is not unexpected to see a group 5 health plan cost 25% of a Group 1 plan.

This should not be so hard, and JUSTICE has nothing to do with it.

mrb

Thanks, Mike Bertaut,mrb,  I figured someone must know about health insurance and could explain more about how TEC could have gone about it.

Well, I just checked with a couple of my buddies in the Dakotas and they confirmed for me that the average family policy in North Dakota is $13, 461 annually and in South Dakota is $14,510 per year.  (http://www.statehealthfacts.org)

This means if TEC is hitting those families for $35k or something like that, they are absolutely making out like bandits back in NYC. 

Shameful.

mrb

Mike Bertaut thanks for all of that very helpful info and insight into the insurance business.  I’ve talked to several folks who work for national companies and all of them say similar things - there is no need for the plan to be carried out in the way that TEC is doing it.