The state Board of Examiners on Tuesday approved contracts funding the employee benefits program HMO plans.
Hometown Health Plan in the north won a contract totaling $347 million and Health Plan of Nevada in the south $231 million to provide Health Maintenance Organization services to state workers and their families.
But Ed Epperson, head of Carson Tahoe Health, charged the newly developed alternative HMO plan completely cuts them out of serving state workers who choose that option.
Most state workers are in the state’s Consumer Driven Health Plan (CDHP). But of the more than 58,000 state workers, retirees and family members covered by the Public Employee Benefits Program nearly 16,000 are in the HMOs.
PEBP Executive Officer Damon Haycock said unfortunately prices for participants continue to increase — in this upcoming plan year by anywhere from 7-9 percent. He said to meet the different needs of plan members and reduce some of those costs, they’re offering not only the standard HMO plan but an alternative plan. The alternative plan, he said, costs less per month in premiums but has higher costs for emergency room visits, outpatient surgery and prescription drugs. He said patients can expect to be required to use Renown managed specialists and hospital services under the alternative plan.
Epperson said Haycock made it abundantly clear enrollees in the new alternative will have to have a primary care physician employed by Renown who must refer those patients to Renown operated facilities and specialists.
“Many people in this town like the primary care doctor they have and essentially none of those doctors are owned or employed by Renown,” he said.
He said he’s concerned if enrollees aren’t adequately informed, they may not know they’re going to have to seek a new doctor and other providers.
Haycock said that new alternative HMO plan is one of three plans PEBP offers. The others are the standard HMO plan which can be used at Carson Tahoe and the Consumer Driven Health Plan most state workers enroll in.
“It’s a decision made by the participant at the time they enroll in a health plan,” he said adding that if all Carson City HMO enrollees move to the alternative plan, that would be a total of just 1,992 people.
Plan participants can make their choice of the available plans during May.
Haycock said standard HMO rates begin at $179.85 a month for participants, an $11.76 or 7 percent increase. At the other end of the scale, the rate for a participant and family goes up $54.20 to $664.11.
In contrast, the alternative plan is about $10 cheaper for a participant and $40 less for participant and family.
Haycock said he and his board are “not at all happy with the HMO increased rates.”
“We’re looking for creative ways to reduce them, trying to find cost effective solutions.”
He said they’re hoping to reduce those increases by the time the board approves the rates in March.
“I can’t guarantee we’ll be able to pull that rabbit out of our hat but we’re trying,” he said.