CNMI Government Health Insurance Limited To One Carrier

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Governor says workers must go with AETNA, or have no coverage

By Emmanuel T. Erediano

SAIPAN, CNMI (Marianas Variety, Feb. 11, 2014) – CNMI government employees will have to enroll with AETNA Life Insurance Company or else they won’t have health insurance coverage the price of which has increased by 40 percent, Gov. Eloy S. Inos said yesterday.

The administration released the new health plan coverage rates that will become effective on March 1.

In an interview, Inos told reporters government employees who want health insurance coverage have to go with AETNA.

As far as any other options, he said there are none.

The government’s contract is only with one health insurance carrier, which is AETNA.

The governor said other insurance carriers like StayWell and Calvo’s SelectCare are not authorized to acquire new members. They can only renew existing policies, he said.

"So those folks who have coverage with those carriers will be okay if they are renewed by the same carriers," Inos said.

He said those who are not government employees cannot get insurance health coverage from AETNA. "Government employees will be covered by AETNA which will be holding an open enrollment," he said.

Asked what he could say about the increase in insurance health premiums, the governor acknowledged that providing health insurance policies under the Affordable Care Act or Obamacare will cost carriers a lot of money especially here in the CNMI "where a majority of members are retirees who are at an age that requires constant medical care." Medical expenses will be very high and that means adjustment of premium rates, "unfortunately upward."

So government employees who opt out of AETNA won’t have health insurance coverage.

"AETNA is the carrier that the government has selected. So if you want to be part of that government program, AETNA is the only one the government contracted with so you are going to have to go with that," he said.

Supplemental budget

Inos said his administration will have to tap a portion of the supplemental budget to pay for the 40 percent increase in the cost of health insurance for government employees.

He said $8 million to $9 million in the supplemental budget will be used to satisfy the payment to the settlement agreement and the increase in the government’s health insurance costs.

"Hopefully we will be able to go down and communicate with the Legislature. But again we need to satisfy the required payment for to the settlement fund and also cover the increased cost of health insurance," Inos said.

He added that the government now expects to pay $14 million a year for the employer share while the employees will pay $14 million in health insurance premiums, for a total of $28 million. Prior to the 40 percent increase, the government paid about $22 million to $24 million.

New health insurance premiums

The government announced the new rates that will take effect on March 1.

The new premiums will increase by at least 15 percent compared to the premiums last year.

According to a notice issued by the Group Health and Life Insurance Trust Fund yesterday, the open enrolment period will run from Feb. 12 to March 14.

For government employees, the employee share of the premium will be $97.70 for the low option and $123.65 for the high option.

The employer will be paying the same rates.

Government pays 50 percent of the premium while the employee or retiree shoulders the other 50 percent.

In the single plan, the applicable annual deductible rose to $500 compared to $300 last year.

As explained by Aetna last year, before the plan pays for any healthcare expenses, a member must pay a certain amount or deductible.

Last year, an individual had to pay $300 in deductible before he or she was covered 80-20 percent by the plan.

In the plan for couples, the new employee share and employer share will be $201.72 for the low option and $253.48 for the high option. The deductible is set at $1,000.

For the family plan, the employee and employer share will be $314.87 under the low option and $395.67 under the high option.

The deductible for the family plan is $1,500.

Last year, Aetna explained that everyone started at zero in terms of the deductible every year.

Aetna cited as an example a family of nine with a $900 deductible. Each family member pays $100 for healthcare expenses.

Each family member has his or her own deductible.

After paying the $900 deductible, the family is covered 80 percent – 20 percent by the plan for the rest of the year.

This year, the new rates for retirees will be as follows: single, low option, $105.84, and $133.95, high option.

The employer’s share is the same.

Deductible is $500 for single.

Under the couple plan, the employee share for the low option is $218.53 and $274.60 for the high option.

The deductible is $1,000.

For the family plan, a retiree’s share is $341.11 under the low option and $428.64, high option.

Last year, the rates were $89.32 for single; $183.10, retiree with one dependent; and $285.81, retiree and family.

According to yesterday’s notice, retiree premiums appear higher than those of active government employees because retirees have fewer pay periods: 24 pay periods for retirees and 26 for employees.

Further, the notice indicated that those already enrolled in the group health program will be automatically defaulted to the low-option plan.

Those who would like to enroll in the high-option plan will have to fill out forms indicating the change before March 14, 2014.

In the open enrolment period, employees not currently covered have the opportunity to apply for coverage for himself or herself and dependents.

Those already covered will be afforded the opportunity to amend his or her plan by adding or removing dependents.

Retirees who are also in the plan can elect to make changes.

Those who do not wish to make any changes do not need to do anything as coverage will automatically continue.

Those who opt to terminate their coverage must fill out and submit GGHI Enrolment/Waiver/Change request form.

The approved changes and enrolments, according to the notice, will take effect on March 1.

The new premiums will be reflected beginning in employees’ March 8 paychecks and in retirees’ March 15 pension checks.

Public forum at Governor’s Office

It has been announced that Aetna representatives will be coming to discuss the plan further with the CNMI employees and retirees on Feb. 12 in the conference room at the Governor’s Office.

Sessions are as follows: 8 a.m. to 9:30 a.m.; 10 a.m. to 11:30 a.m.; 1 p.m. to 2:30 p.m. and 3 p.m. to 4:30 p.m.

Those on Tinian and Rota will be able to participate via video teleconference.

Tinian employees and retirees are advised to go to Northern Marianas College, Room C of Tinian Campus.

On Rota, videoteleconferences will be held in NMC’s Room A2.

The Legislature has also set a public forum at the House of Representatives’ chamber on Feb. 14 at 9 a.m.

‘Wait and see’

Retiree and Commonwealth Retirement Association director Alvaro A. Santos said, "It’s exorbitant."

He said, in general, health care is expensive with the Affordable Care Act or Obamacare.

He said he learned the governor has been communicating with U.S. Health and Human Services Secretary Kathleen Sebelius and that the Affordable Care Act will be more closely monitored in the territories.

"It will be more expensive here in the insular areas than in the U.S.," said Santos adding that the governor was asking for a delay in the implementation of the law in the CNMI or a waiver perhaps.

"Healthcare costs here are already very high," he said.

But the new premiums for him represent a "double punch" for the retirees.

He lamented that retirees have been getting 25 percent less in retirement benefits with the settlement agreement.

"Some have opted to get out of the government health insurance program," he said.

He wondered what recourse retirees would have if they opted out of the program.

"Will they go online to apply for some kind of health insurance coverage in the U.S.?" he wondered.

Asked if he is staying in the plan, Santos said, "I am staying in until I have a clearer picture how the Affordable Care Act will come into play," he said.

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