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Members Only Info-Base > Health Insurance

Previous Updates on Changes to Our Health Insurance

On April 1, the Wareham Education Association Board of Directors unanimously voted to pursue an adjustment in the split in premium payments between the town and employees. Currently, employees pay 25% of the health care premiums charged by insurers. The town pays the rest. If all eleven public-sector unions agree, then the revenue sought by the town could be found by changing the 25/75 split to 32.5/67.5. The town would commit to a legally binding contract for a fixed period of years that would keep co-pays where they are, avoid a deductible, and put in place quarterly reports on the state of the health insurance trust fund. Some procedural questions remain on the implementation of such a plan, so nothing is a done deal. This site will be updated if it is.

Given that the premium split is not part of any WEA contract, this vote was in reference to negotiations alongside other public-sector unions. Thus, this vote represents the extent of consultation that will be carried out on this question. For reference, the earlier explanation of the possibilities is preserved below.

By invoking recent changes to Massachusetts law, the Wareham Board of Selectmen has directed the Town Administrator to seek to effect significant changes to the health insurance of all town employees of Wareham, including WEA members.
Any changes would not take effect until July 1, 2013.

The intention of this law is to shift health care costs from employer to employee. One way or the other, members of the WEA and other public-sector unions will pay more. The question is how.

Change the split, or change the payments? Recently, discussion has centered on changing the split in premium payments between the town and employees. Currently, employees pay 25% of the health care premiums charged by insurers. The town pays the rest. If all eleven public-sector unions agree, then the revenue sought by the town could be found by changing the 25/75 split to 32.5/67.5. In such an agreement, the 30/70 split would exist for years one and two, and 67.5/22.5 would exist for year three on. The town would commit to a legally binding contract for a fixed period of years that would keep copays where they are, and not introduce a deductible.

If any union (including ours) does not agree to change the split, then the raised revenue will come from higher copays and the introduction of deductibles. To reiterate, we will be paying more, the question is how: paying more for medical care when you need it, or paying more a set amount through higher deductions from your paycheck? This draft of changed payment schedules compares our current plans (leftward columns) with the proposed changes ("benchmark plans" in the center) that would result if the split did not change. Major changes are:

Higher co-pays across the board for prescriptions, office visits, specialist visits, and hospital care;
Introduction of a deductible of $250 for an individual, and $750 for a family plan per year as of July 1, 2013. This is in addition to co-pays for emergency room visits, labs, and tests.
No co-pay for an annual physical, regular pediatrician appointments, or regular maternity visits.

Recent changes in state law move alterations to our health insurance outside of mandatory bargaining. As long as the town can demonstrate savings of 5% compared to the current system there is no true bargaining process per the changed laws. The chart below compares the three options:
Wareham managed Lookalike GIC after 6 months Split change

Deductibles $750/ yr (family), $250/ yr (individual) $0

Deductible periods 7/1/13-6/30/14 (one year periods afterward) 7/1/13-12/31/13
1/1/14-12/31/14 (annual afterward) No deductible

Hospital copays All hospitals: $500
Tobey/St. Luke’s $500 or $700*

Jordan: $500

Mass General: $700

South Shore: $300 or 700*

*depending on plan $0

Members 600 220,000 600

Premiums Average of $50 more per person per year Average of $200 more per person per year Average of $600 more per year

# plans offered 3 active, 2 Medicare 12 active, 8 retired 3 active, 2 Medicare

Providers
Blue Cross Blue Shield
Harvard Pilgrim

Tufts
Harvard Pilgrim
Unicare
Fallon
Health New England
Neighborhood Health Care

Blue Cross Blue Shield
Harvard Pilgrim

Management Town of Wareham Massachusetts Group Insurance Commission Town of Wareham

NB: About 95% of medical care providers (doctors, hospitals, etc.) covered by Blue Cross/Blue Shield are covered by insurers within the GIC. This Tufts website lets you see if your current provider is within the GIC: choose "Spirit" or "Navigator" as the plan.

The WEA Board will take a vote on this question at the April 1 Board Meeting.

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