State to rule on HMSA plan
| • | Measure to clarify insurer rules |
By Deborah Adamson
Advertiser Staff Writer
The fate of a new health plan that would lead to lower healthcare costs for employers but raise the co-payment contribution from workers is in the hands of the state Department of Labor and Industrial Relations.
Earlier this week, the Prepaid Health Care Advisory Council rejected the new preferred provider health plan proposed by HMSA, the state's largest medical insurer. The plan would lower monthly premium costs to companies by 5.7 percent but boost the patient co-payments from 10 percent to 20 percent for in-network medical services. In-network services are those offered by providers participating in the plan.
The council turned down HMSA's plan as a "7A" preferred provider plan but approved it as a comprehensive plan. Under "7A" plans, employers are not required to offer coverage to dependents of workers.
Unlike preferred provider plans, which let patients choose between in and out-of-network services, comprehensive plans only have one option.
Paul Tom, council chairman, said HMSA's new plan offered fewer benefits than the most standard-setting prevalent preferred provider plan. The prevalent preferred provider plan in the market is HMSA's, for which members pay a 10 percent co-payment for services.
While HMSA's proposed plan would boost coverage of preventive care to 100 percent and treat mental issues like other illnesses, the council said it did not believe the enhancements were enough.
The lower premiums of the new plan would also be offset by increases in healthcare costs, he added. The result is businesses would still have to pay higher premiums, but not as high as they would have if they adopted a higher-cost health plan.
The Labor Department is expected to make a decision in one or two weeks.
Reach Deborah Adamson at 525-8088 or dadamson@honoluluadvertiser.com.
