Virginia public health care systems and policy

Economics

Virginia Public Health Care

All full-time, part-time, salaried and classified state employees including regular, full-time or part-time, salaried faculty members are eligible for Virginia's health benefits program. Certain family members may also be covered, comprising legally married spouses and dependents children. State employees have a number of plan alternatives depending upon where they live and in some instances where they work. Full-time employees pay the employee piece of the total monthly premium, with the state paying the rest of the cost. These premiums are subtracted from workers paychecks before taxes are paid. Part-time classified employees who work a minimum of twenty hours, but less than thirty two hours, per week or salaried employees in comparable positions in legislative, judicial and independent agencies pay the total premium, which may be subtracted from their paychecks on a pre-tax basis (About Your Benefits, 2010).

There are three plan types that employees have to chose from. The first is known as COVA Care/COVA Connect. Determination of coverage in COVA Care or COVA Connect is based on the zip code of the member's address of record. This plan includes four different benefit components: medical, dental, outpatient prescription drug, and behavioral health with the Employee Assistance Program (EAP). For COVA Care, each benefit is managed by a dissimilar company and for COVA Connect all benefits except dental are managed by the same company. Some covered services are subject to a plan year deductible, coinsurance or copayments. in-network wellness and preventive care services are obtainable at no cost to members. One may also select, at an extra cost to them, additional choices that offer improved coverage for dental, out-of-network, and vision and hearing services. Premiums for this plan range from $43 for a full time employee to $80 for single coverage. Part time employees pay $500 to $537 for single coverage. These costs go up proportionally as more dependants are added to the policy (About Your Benefits, 2010).

Another plan that has recently been added as a choice is that of the COVA HDHP (High Deductible Health Plan) is a particular type of health care plan that allows one to set up a Health Savings Account (HSA). With this plan one utilizes the tax-deductible funds that are put into the HSA to help pay for medical expenses. The COVA HDHP has a higher plan year deductible that must be met before the plan pays for any medical, behavioral health and prescription drug benefits. Once the deductible is met, the patient must pay twenty percent coinsurance for most covered services. Under the HDHP, one pays no more out of pocket for in-network services than $5,000 for one person and $10,000 for two or more people. The deductible pertains to this limit. The COVA HDHP includes full dental benefits. On the other hand, there is no out-of-network coverage for medical or behavioral health benefits except in the case of an emergency. All components of this plan are managed by Anthem and plan members must use Anthem participating providers. A full time employee pays nothing for this plan for any coverage no matter how many dependants are on the plan. Part time employees on the other hand pay $400 for a single person and go up considerably with dependants (About Your Benefits, 2010).

The last plan is that of Kaiser Permanente Regional HMO. This plan includes certain counties where one lives or works in Virginia and Maryland and in some cases, certain zip codes within those areas and the District of Columbia.

The Virginia Counties include: Arlington, Caroline (partial), Culpeper (partial), Fairfax, Fauquier (partial), Hanover (partial), King George, Louisa (partial), Loudoun, Orange (partial), Prince William, Stafford, Spotsylvania, Westmoreland (partial)

The Virginia Cities include: Alexandria, Fairfax, Falls Church, Fredericksburg, Manassas, Manassas Park

The Maryland Counties include: Anne Arundel, Baltimore, Calvert (partial), Carroll, Charles (partial), Frederick (partial), Harford, Howard, Montgomery, Prince Georges

The Maryland Cities include: Baltimore

The Kaiser Permanente HMO has no deductible for in-network services, but one must utilize Kaiser HMO participating providers except in an emergency situation and must choose a PCP for each enrolled family member. Premiums are paid by worker and retiree, co-payments and deductibles, coverage by plan. Full time members of this plan pay $42 and part time members pay $518 (About Your Benefits, 2010).

Current employees also enjoy wellness program benefits. The CommonHealth employee wellness program attempts to make a difference in the health of workers and the workplace by incorporating health into the work culture. More than forty dissimilar health promotion services are obtainable to state agencies, comprising on-site health screenings, fitness and stress management, personal health and safety, and weight control and nutrition. Additionally CommonHealth offers the special Future Moms prenatal program intended to help women have healthy pregnancies (Benefits Descriptions, 2010).

The State Retiree Health Benefits Program is divided into two categories of coverage:

Plans accessible to retirees and covered dependents that are not eligible for Medicare, Plans accessible to retirees and covered dependents that are entitled for Medicare.

All members, retirees and dependents, must pick a plan based on Medicare eligibility. Two or more non-Medicare-eligible family members must pick the same non-Medicare plan. All Medicare-eligible family members will have individual coverage and may select dissimilar plans. Nevertheless, no family will be mandated to pay a premium higher than the family membership premium for the non-Medicare plan in which the non-Medicare family members are enrolled. Non-Medicare enrollees are entitled to the same plans that current employees are. Medicare enrollees are eligible for Advantage 65 (Eligibility, Enrollment and Plan Choices, 2010). Rates for Advantage 65 range from $132 to $258 for single coverage (State Retiree Health Benefits Program Medicare- Eligible Plans, 2010). Rates for non-Medicare enrollees range from $401 to $537 for single coverage (Monthly Premiums for Non-Medicare Eligible Retiree Group, 2010).

In 2010 there were rate hikes on average of fourteen percent for five health insurers in Virginia: Humana, Prudential, Golden Rule Insurance Co., Anthem and Optima. The rate increases followed several by the same insurers in 2009. Four of these companies received initial approval from the Virginia State Corporation Commission for their original increase. The fifth, Prudential, asked for a fifty percent increase. But the SCC denied it and in its place approved a twenty percent increase. These rates took effect between April 1 and July 1 of last year. Insurers say the augments are essential for the reason that more people are utilizing health care, so insurers are getting more claims, therefore increasing medical costs. It is supposed that indigent care is also a factor. This care is given to the poor that hospitals and providers receive little or no payment for services and expenditure. This burden is then moved to people who have the resources to pay or have insurance. It is no secret that medical expenses are growing faster than inflation. More people are utilizing medical care because of an maturing population, lifestyles that result in more medial care, new treatments and more intensive diagnostics (Five health insurers raise rates in Virginia, 2010).