Sealy proceeds with insurance changes

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Sealy City Council members held a special meeting Dec. 4 to discuss the employee insurance plan after rumors swirled that there were complaints among city workers, but after hearing from provider Entrust’s director of client services, the council appeared satisfied to move forward with the new plan.

“We had to make some adjustments to the plan to keep the cost in line so that it wouldn’t be a burden on city finances to cover it,” said City Manager Lloyd Merrell. “We did make a few changes but they were not that significant.”

Human Resources Director Kim Kaiser reviewed the changes, such as combining the top two plans into one. There is now one preferred provider organization (PPO) plan and one high–deductible plan, she said.

“This year, Plan A becomes our base plan, which basically means co-pays for those participants will drop $10. They will go from $35 per visit to $25,” Kaiser said. “Co-pays on generic prescription medications will drop from $15 to $5. Mail orders will be $15 for three months as opposed to $45. Co-pay on emergency room visits went from $100 to $300. We also dropped the coverage of specialty medications, which are typically medications that are in the range of $1,000 to $8,000 per month.”

There were 44 emergency room visits over the past year and only about three or four were admitted to the hospital, Kaiser said.

“That’s the reason they chose to increase it that much,” Merrell said. “When you only have three or four out of 44 that tells me that they were using the emergency room for things they could have gone to urgent care for and saved the city money.”

Entrust Director of Client Services Eric Schulman outlined the changes and answered questions from council members.

He confirmed for Councilman Larry Koy that just a few city employees were using specialty drugs, which was driving prices up for other employees. Those who need the specialty drugs can now apply for them at a reduced price.

Councilwoman Dee Anne Lerma wanted to make sure that the two city employees who use the specialty drugs are aware that they could receive financial assistance. Kaiser said the employees would be provided guidance on how to go through the application process.

“Based on the facts and talking with everything that surrounds that and other people I’ve worked with, I don’t see an issue that they wouldn’t get [financial assistance],” Schulman said. “We have an advocacy team for all the employees. There haven’t been a whole lot of calls to the advocacy team. If we need to negotiate prices on anything … We can get them steered in the right direction to whatever programs are out there. It’s instantaneous once they submit all the paperwork.”

Kaiser added that currently there are 18 employees enrolled in Plan A, 35 in Plan B and two in the high-deductible.

“For the majority of the employees the rate is going to go up less than $10,” she said. “For those in Plan A it’s actually a reduction. In Plan B, their co-pays are dropping so that’s going to be a benefit to them as well.”

Schulman added that Entrust has been educating Sealy employees about the changes in service all year long.

“I think the most important thing to remember is that as a council we’re trying to provide insurance or benefits for the employees,” Councilman Koy said. “You’ll never satisfy the different wants and needs of each individual, but if you’re going to provide 90 percent through one company the needs of all the employees, that’s a pretty good percentage … Insurance to me is more important than how much I make in a salary.”

Mayor Janice Whitehead said the council operates within the confines of a budget and needs to know when high-risk matters come up that might influence those numbers.

“If we’re going to make major insurance plan adjustments, we need to know about that,” she said. “We need to know if we need to change companies. That’s something that council needs to be aware of … not that we want to micromanage the insurance portion of this but I think it’s important because we do have a vested interest in each of our employees and we want to make sure that their safety and well-being is taken care of.”

Councilman Chris Noack said the council should not be responsible for deciding the best insurance plan for employees; that should be in the hands of Human Resources.

“I think HR had the best interests of the city in mind when they put this together,” he said.

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