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HAGATNA, Guam (Pacific Daily News, Aug. 6) – Karen Sablan said she has to carefully consider each year where to put her healthcare dollars when the government of Guam open enrollment period rolls by.

In the 20 years she has worked for GovGuam, she has seen her health plan choices dwindle as insurance providers over recent years have opted to no longer sell plans to the GovGuam market.

"And even with that, the coverage has reduced over the years," Sablan said. "You're limited to the services you can receive and it becomes fewer and fewer each year."

There may only be one health insurance choice for thousands of GovGuam employees, retirees, survivors and dependents by September. The Department of Administration last week confirmed that StayWell has decided to end coverage with the government.

SelectCare would be the sole provider for GovGuam.

StayWell and SelectCare officials couldn't be reached for comment yesterday.

StayWell's departure - which could have been triggered by the escalating cost of insuring the high-risk GovGuam retirees - could mean higher premiums for SelectCare members, according to insurance industry experts.

The health-care crisis isn't new to the government, said Dr. Thomas Shieh, who owns the Shieh Clinic in Tamuning.

The government has always struggled to pay health-care companies, which has forced some to pull out of the government.

Shieh said he recently ended a battle with the government on the Medically Indigent Program and Medicaid, programs he has accepted for the past eight years.

Just as it has with health insurance companies, GovGuam has continued to have trouble paying doctor's offices for MIP visits.

Three months ago, Shieh said he stopped accepting patients under the program.

Jerry Crisostomo, plan administrator of Moylan's NetCare Life and Health plans, which used to be known as MultiCover, said MultiCover pulled out of the local government's health plan in 2000.

Crisostomo said the pullout was necessary because the plan was no longer profitable and that MultiCover's underwriter, Allianz, wouldn't cover GovGuam employees.

Crisostomo said as long as GovGuam continues to structure its plan the way it does -- by placing both active employees and retirees together -- insurance providers will continue to leave.

According to Crisostomo, retirees represent a substantial cost to the plan.

Federal Medicare -- which would be about $150 per month for comprehensive coverage -- is out of the question for most GovGuam retirees because they never paid Social Security while they were working.

It was mandatory for GovGuam employees to be part of the local retirement system, which means they did not contribute to Social Security, according to the Department of Administration. That changed in 1986, when Social Security contributions became mandatory.

Because only one provider may now be serving all of GovGuam's policyholders, Crisostomo said that provider will now also absorb the risks of the entire GovGuam program.

"Does this increase the cost of premiums? I think it does," Crisostomo said last week.

While GovGuam continues to look for ways to provide for its current employees, Sablan said the government shouldn't dismiss retirees even if they are the reason for insurance company pullouts.

"These were servants to the people of Guam, and it's like because they're too expensive, we're going to dump them," Sablan said. "Many of these people worked years and years for the government paying into insurance."

Even with her current health-care plan with StayWell, Sablan said she saves extra money on the side to pay for health expenses not covered under her plan.

"I'm disappointed because we might have to figure out what are we going to do next," Sablan said. "I guess we won't know until we start getting those presentations that tell us what's going to be covered and what's it going to cost."

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