Lee County Manager ron Rabun (left) and Commission Chairman Rick Muggridge have been reviewing changes to the county government’s insurance plan. (Staff Photo: Danny Carter)
LEESBURG — If you’re a smoker and you work for Lee County, your paycheck likely will be about $30 smaller each payday next year.
And, there may be a discussion in the future about adding a surcharge to workers who are obese.
“Tobacco is a real problem,” said County Administrator Ron Rabun, in explaining some of the changes that are being tossed about by the County’s Personnel Committee. “It’s all about fairness…Tobacco is a choice people make, and they can still have that choice.”
Rabun noted that some companies or entities have plans that make the employee ineligible of they use tobacco while other plans just make it more expensive.”
Rabun said statistics show that smoking is responsible for 87 percent of all lung cancer cases. Lee workers who cover just themselves would pay $30 extra per pay period if they smoke. Workers with family coverage would have to pay the surcharge if any member of the family uses tobacco.
“We want to minimize the effect on the monthly paycheck deduction,’ said Commission Chairman Rick Muggridge, who is on the Personnel Committee along with Commissioner Luke Singletary and Rabun. “With these changes, the people that are using the plan are paying for it.”
Commissioner Dennis Roland raised the issue of comparing the high risk of overweight employees to those who smoke.
“This will probably make some people mad or upset…but obese people create as much risk with their eating habits as a man who smokes cigarettes,” he said. “A man who is overweight is going to have all kinds of health problems, especially as he gets older. I don’t know if there is a way to deal with that or not.”
Rabun said next year’s plan possibly will beef up the wellness program that requires employees to take a more active role in managing their health.
Rabun said one change would increase the deductible from $500 to $750. In researching the issue, Rabun said he learned the average deductible in the South is $1,253.
Presently, Lee County employees have a $25 co-pay charge when they see a physician or a specialist.
“That does not reflect the economic reality in what these services costs and what others are doing,” Rabun said. “We’ve recommended $35 co-pay for seeing primary care physicians and, if you go to a specialist, you have to pay $50.”
Rabun said the committee is also proposing changes in the two-tier co-pay for prescription drugs. Currently county workers pay $15 co-pay for generic drugs and $30 for non-generic drugs in a plan that encourages participants to use generic drugs. That would remain the same, but a co-pay of $60 for specialty drugs would be added.
County employees can expect a change in the two-tier rate system for health coverage. The county currently offers one plan which covers the employee only, and another that covers the employee and his or her family
Two new tiers are expected to be added, Rabun said, noting that it is “unusual” to have just the two options.
The new plan likely will have four coverage options including one for the employee only, one for the employee and full family, one for employee and spouse and one for employee and child. Having the additional tiers will allow the county to set a rate structure that more closely resembles the coverage provided.
Another likely change will see the upfront charge for a visit to the emergency room increase from $100 to $250.
“We want to encourage people to not use the emergency room unless they really need it,” Rabun said. “There should be an extra cost. ER billing is very expensive and that comes back to us to pay.
However, if a person is admitted to the hospital after visiting the emergency room, the $100 rate would apply.
No decisions have been made, but Rabun said it is likely there will be an increase in the monthly deduction for health coverage. Now, a Lee County employee pays $49 a pay period for coverage that includes just the employee, assuming he participates in an optional wellness program. The cost is $86 otherwise.
The costs for employee is family coverage is $111 under the wellness plan and $148 for those not in the wellness program.
Lee employees are paid every two weeks.
Rabun noted that overall health costs are increasing nationally by 11 to 14 percent.
Muggridge said the county is self insured and has experienced unusually high claims this year, specifically “20 to 25” huge claims.
‘We’re looking at about $300,000 in unbudgeted expenses,” Muggridge said.
The commission is expected to adopt specific changes at its December meeting.