Health Benefits: Why Did Our Out-of-Pocket Increase?

By Denise Jennex

Below is a chart of the health benefits contributions from the District and out-of pocket cost to our employees for the last four years. The chart shows what we are currently paying out-of-pocket for health benefits as compared to what we would be paying out of pocket if we had stayed in CalPERS. The dollar amounts in brackets [$] are what employees would be paying if we had remained in CalPERS and not changed to Blue Shield in 2004.

So, why did our out-of-pocket cost increase so much from last year? Last year in negotiations the District’s contribution was changed from a floating CAP based on the highest family HMO to a dollar CAP. The current CAP is $9438 and is negotiable as a health benefits increase. Last year in negotiations BTA agreed to a CAP that would cover more than the highest family HMO, so employees in PPO plans saw a decrease in premiums. This year the CAP is still more than the highest HMO [$9236.30], however the PPO plans have increased and are closer to the CAP which has caused these out-of-pocket to increase.

Over the past four years the cost of health benefits has skyrocketed and BTA has currently negotiated a health benefits plan that has a no premium cost for employees for two HMO plans for single, two party or family plan, PPO 80-20 plan for single or two party and PPO 90-10 plan for single. The PPO 90-10 plans two party and family have decreased since 2002 and the PPO 80-20 plan has only increased $4.02 a month since 2002.

By looking at the chart above you can see that BTA made the right decision to leave CalPERS because in both 2004 and 2005 all employees are or will be paying less out-of-pocket costs with Blue Shield than they would have been with CalPERS. Please know that BTA monitors this continuously and will always strive to keep the best benefit package at the lowest cost.