stethoscope and hundred dollar bills health care costs illustration iStock photo


iStock photo illustration

State workers and their families will pay more for medical care starting Jan. 1 under the latest changes to emerge from a state law that wiped out most public employee union rights.

The changes in the state health plan require 183,000 participants to pay 10 percent of their bills for doctor visits, tests, surgeries and hospitalizations up to an annual maximum of $500 for single people and $1,000 for families.

Health plan administrators have explained the new system previously, but they expect to get a lot more questions when workers begin reaching into their pockets.

"I think the reality will hit when the bill comes in the mail," said Lisa Ellinger, insurance services administrator for the state Department of Employee Trust Funds.

Part of budget repair bill

The changes are part of a 5 percent reduction in the state health insurance system required under Act 10, the so-called budget repair bill that set off weeks of mass demonstrations at the Capitol before it was passed by the Republican majority in the Legislature and signed by Gov. Scott Walker.

The law stripped most public sector workers of collective bargaining rights, and since August reduced their take-home pay to cover more of the costs of premiums for pension and health insurance.

The pension change reduced paychecks by 5.8 percent, while health plan participants pay 12 percent of their premiums. Monthly health premiums that are deducted from paychecks increased to $208 from $89 for the most popular family coverage, according to the Legislative Fiscal Bureau. The premium decreases slightly in 2012 to $201 because of changes in costs, said Bill Kox, state director of health benefits and insurance plans.

$60 million cut

The new 10 percent coinsurance payments for treatment of illness and injury helped cut about $60 million from the cost of the benefits plans, Kox said.

"Over the years as the cost of insurance has gone up, cost sharing, either through monthly premiums or through additional cost sharing at the point of service, have been increased regularly in the private sector," Kox said.

"We haven't had as much in the public sector," he added, "but that's what Act 10 essentially required - a 5 percent reduction in the value or cost of those benefits. And that's what we did with the coinsurance."

Federal law prevents co-payments for some preventive services including immunizations, Ellinger said.

Plan participants will continue to pay for a portion of the cost of emergency room service, equipment such as wheelchairs and prescription drugs, she said.

The state health program administers 18 self-funded and health maintenance organization plans.

About 35,000 municipal employees and dependants are covered by the state health program, but they are in a separate pool that isn't affected by the changes, Kox said.