GIC approves health plan changes; MTA opposition will continue

The Group Insurance Commission approved plan design changes on Friday, February 13, that will effectively shift costs for GIC health insurance coverage to subscribers beginning July 1. These changes will mean higher out-of-pocket expenses for hundreds of thousands of Massachusetts workers, retirees and their families. At its next meeting on March 4, the GIC will set premium rates for each of the health plans for the coming fiscal year.

The MTA has vigorously opposed — and will continue to oppose — these plan design changes.

In the past month, MTA members have sent close to 80,000 e-mails to GIC commissioners urging them to reject plan design changes, lobby for a supplemental budget for fiscal 2015 and adopt a budget for fiscal 2016 that fully funds current benefits for subscribers.

Most state employees are enrolled in GIC health insurance coverage, as are municipal workers in 50 communities and regional school districts. Many other public workers and retirees are affected because their cities and towns — while not participating in the GIC — have the ability to shift costs to reflect GIC plan designs.

Friday’s vote resulted from budget shortfalls that are largely due to chronic underfunding by the state, as well as increased claims costs.

The most significant changes approved Friday are:

  • The Tufts Navigator PPO and Harvard Pilgrim Independence PPO plans will be eliminated and replaced with Tufts Navigator POS (Point of Service) and Harvard Pilgrim Independence POS plans. Much like an HMO, a POS plan requires a primary care physician and referrals for specialists. The POS plans also have an out-of-network option similar to PPO plans.
  • Examples of plan design changes:
    • Deductibles will increase for individuals from $250 to $300 per year and for families from $750 to $900 per year.
    • Co-pays for office visits to specialists will rise from $25/$35/$45 to $30/$60/$90.
    • Outpatient surgery co-pays will increase from $125/$150 per occurrence to $250 per occurrence.
    • Inpatient hospital admissions will increase from $250/$500/$750 to $275/$500/$1,500.
  • Pharmacy co-pays for active and Medicare-eligible subscribers will increase from $10/$25/$50 to $10/$30/$65 for 30-day retail prescriptions and from $20/$50/$110 to $25/$75/$165 for 90-day mail-order prescriptions.

For higher education members: These plan design changes and rate increases affect all higher ed members. Premium percentage splits are set by the governor and the Legislature. The MTA will stay abreast of the state budget process and fight increases to the employee share of premium splits.

For GIC municipal members:  It's likely that the move from PPO plans to POS plans will require bargaining at the local level. Local leaders and their MTA field representatives will be discussing this soon.

For non-GIC municipal members: Under Massachusetts General Law chapter 32B, Sections 21-23, municipalities may change your health insurance plans to reflect GIC health coverage. GIC co-pay and deductible increases may be presented at the local level as changes to your current health plans. Local leaders and their MTA field representatives will be discussing this soon.

The MTA will continue to oppose closing the GIC’s shortfall on the backs of educators, other public employees and retirees. We are actively involved in this situation and will be communicating with you as events unfold. Updates will be posted at massteacher.org/gic.