HEALTH BENEFITS UPDATE
On the continuing question of co-pays
In the 24 hours prior to writing this article, I
have been approached by four State Delegates
who all questioned me on the increased emergency room copays for the State Health Benefits
Plan.
Please refer back to the August 2015 issue of NJ
COPS Magazine whereby I advised our membership of the changes the State Health Benefits Plan
KEVIN C.
Design Committee adopted that included the
LYONS
increase in emergency room copays in plans that
did not already have copays of $100 or more. This
was also sent out via email to all presidents and
delegates on July 7, 2015, via the intranet. On that same date, it was
posted on the front page of the NJSPBA website, not to mention I
advised the board of delegates several times on the meeting floor.
The resolution increased these copays by $25 in 2016, and if
emergency room utilization does not decrease in 2016 by 35 percent, they will then increase again in 2017 by $25.
In order to explain why this was done, we have to talk about one
of the greatest expenses in health care: hospitals.
Let me first let our membership know that due to Chapter 78
contributions, it is important that we focus on premiums, since a
great number of our members are paying 35 percent of the costs. It
has been our philosophy that small copay increases that may
change behavior, may in the future positively affect premiums.
When a member goes to the emergency room, it costs on
average 10 times more than what a primary care or specialist
would cost for an office visit. In addition to that, if an out-of-network specialist is called in, they can charge almost anything they
want for their services. This is a huge driver in healthcare costs, and
ultimately, insurance premiums.
We need to change the way we think and utilize primary care
whenever possible. The utilization of an urgent care center if you
can’t get in to see your primary care physician will still cost you the
copay of an office visit (this is why we are avidly exploring the integrated model that is explained in my other article).
It was the hope of the Plan Design Committee to start to change
behaviors that will save us all money. That being said, no one is
telling you that if you have a serious episode that you shouldn’t go
to the hospital. The fact of the matter is that, if you are admitted,
the ER copay is waived!
We have to be in this effort together. We have to realize that
healthcare is not what it was. We have to start thinking about efficiency and cost and become consumers in healthcare.
Please take the time and absorb the information that is disseminated from the State Office so we can all be educated about
extremely important choices.
www.njcopsmagazine.com
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APRIL 2016
17