Faculty Senate Discussion

Health Self-Insurance

Filed under Health Self-Insurance by salvers@ufl.edu on January 23, 2012 | 35 Comments

Discussion of Health Self-Insurance

The first full discussion of UF’s self-insurance study took place at the Faculty Senate meeting at 3-5pm on January 26, 2012 in the Reitz Union Auditorium.  David Guzick, Senior Vice-President for Health Affairs, introduced the project to invite discussion by all faculty.

As you may know, self-insurance is a major issue this year, and moving quickly is necessary. The legislature is now in session, and if as expected they make substantial changes in state employee health coverage, UF will need to have a self-insurance plan ready to be considered as an alternative.  In the future, self-insurance may provide the best coverage for faculty at the lowest cost.

Faculty may review the discussion on the Faculty Senate website by clicking on “Faculty Senate,” then “Agendas/Minutes,” then “2011-12,” then “Webcast” for January 26, 2012. An outline of Dr. Guzick’s Gator Care presentation is also available.

Since health insurance is a complex topic, understanding the diversity of faculty interests and concerns will be important for self-insurance to be successful.

Human Resources (HR) has a website on the self-insurance study at http://www.healthplan.ufl.edu. Faculty are encouraged to send their comments to HR as well as psting them here.

To post a comment, scroll down to the bottom of the page to “Add a Comment” and click on “You must be logged in to post a comment”.

Please note that comments are invited here as a fact-finding process, and that debate of issues that might come before the Senate are reserved for public meetings. Accordingly, independent statements are encouraged, but not replies to other comments. Since comments are routed through the Faculty Senate office, there may be a brief delay before your comment is posted.

Scott Nygren
Chair, Faculty Senate

35 Responses to “Health Self-Insurance”

  1. The governor’s veto message for HR 5009 mentions a study for UF by Buck Consultants, Inc., entitled “Report on the Feasibility of Establishing an Employee Health Benefits Plan for the University of Florida and Shands HealthCare Separate from the State Group Health Insurance Program.” As far as I know, this report has not been made available to faculty. I think it should be.

    The veto message also states (based on the above report) that most of the predicted savings from GatorCare depend on ignoring the cost of subsidies to retirees. This suggests to me that retirees under GatorCare might be required to pay the full cost of their coverage, which would be much higher than the current rates. Even though faculty will not be included in GatorCare immediately, I assume that the university will try again next year to include faculty. Therefore, we should continue to seek information about the program.

  2. I just started at UF about 2 months ago and I was so happy to get away from the UAB-sponsored health insurance and be able to use BCBS. However soon after I arrived at UF I hear the talk about GatorCare. UAB did the same thing in the mid-90s and they started with similar promises as being done with GatorCare. When I started at UAB in 1998, I was able to choose between the UAB program called VivaUAB, or Blue Cross or a third insurer. At that time the monthly employee contribution for all three plans was very similar. Over the years the UAB Hospital needed to increase the number of patients to be profitable, so Viva/UAB slowly made their insurance policy the only policy an employee could afford. For 2012, the monthly employee contribution for a family plan was $292 for Viva UAB, $500 for Viva Access and $927 for BCBC. The Viva UAB plan was very restrictive, using only UAB physicians except for OB/GYN and Pediatrics and using their hospital. The Viva Access plan was a response to complaints about losing BCBS so it is similar to BCBS in that you can make your own appointments for Specialist instead of getting a referral from your PCP. I found the biggest problem with all these plans was the restrictions to have your medical care within the network. When you traveled outside the network and your family needs medical care you have to be sure it is considered an emergency in order to be reimbursed for the charges. I had some major medical expenses in another country and I was one step away from appealing to the Dept for Health before I was finally reimbursed by Viva.

    I have not lived in Florida long enough to know how long the GatorCare debate has been going on but I have not heard enough specifics about GatorCare to want to support this plan.

  3. I am particularly concerned about how dependents between 18 and 26 of age attending colleges and universities outside of Gainesville will be covered.

  4. Retirees must pay the full cost of health insurance under the current state plans, but retirees are combined with active employees to determine this cost. Because retirees on average cost more than active employees, this creates an implicit subsidy to them. Ending this subsidy has been suggested (by a group advising GatorCare) as a way to save the state money, but this would greatly increase retirees’ premiums.

    Since I plan to retire at some point (and I have been paying the extra cost of the subsidy my whole career), it is very important to me that the current system be continued under the new plan. The bill that authorizes GatorCare says that employees retiring after the start of GatorCare will be included in the plan (and the plan should be offered to earlier retirees), but the amount the state pays will not include the implicit subsidy to retirees. Therefore, I am concerned that this cost will be imposed on retirees.

  5. Have you considered the repercussions of the new plan on international graduate students?
    Also, in terms of diversity of health care, I would recommend adding so-called alternative practices such as acupuncture and homeopathy to the health coverage.

  6. As in most cases, details are important. The statement “You will be able to keep your doctor” is not adequate. Who will determine who can be an outside-Shands provider, and by what criteria will that be decided? Will there be a cost penalty for using services from professionals outside Shands? Clearly, Shands does not have enough professional personnel to serve adequately the large number of new insureds (I think, for example, of mental-health services. Will Gator Care value service by in-training personnel over experienced professionals?

  7. drreba says:

    My husband and I (both UF employees) are quite happy with the state PPO plan for us and our baby daughter’s needs. We are extremely concerned about the following:

    1. Our extended family has a 30-year history with our daughter’s highly regarded private practice pediatrician. He opened his office for us on Labor Day weekend after her birth; and called in another physician for a consult during the holiday. There is no way we would get this kind of immediate personal care at Shands. Any plan that would require us to change pediatricians or pay significantly higher co-pays for her visits would not be acceptable to us.
    2. Our family has a 30-year relationship with my private practice opthomologist, who has extensive knowledge of my family’s history with age-related eye disorders. Again, I would not be willing to switch physicians to one who has no knowledge of me or my family history, nor pay significantly higher co=pays.
    3. I went to North Florida for the birth of our daughter, as they have a 5-star rating for maternity. The personalized attention we received, ease of getting appointments, high-quality labor room, etc. is not something I would have received at Shands. I would not be willing to switch to a program that does not offer us North Florida as a choice for physicians (such as OB/GYN) and services at the same rates of co-pay as we currently have for them with the PPO.
    4. My husband and I both have our general practice physicians at Shands already. While we like our doctors, it is an extremely long wait to get an appointment (weeks-months). This situation will only worsen if the entire UF community suddenly has to switch to Shands. Emergency or urgent problems are only treated at the ER (huge wait) or with appointments with whichever resident happens to be on call, rather than a doctor who knows me. The resulting care is thus wildly uneven at best. I am unwilling to submit my daughter to that kind of care, and have significant frustration with that kind of huge wait time even prior to any potential change.
    5. As academics we both travel a lot for work, both nationally and internationally. I have seen nothing that addresses how the new plan will provide coverage of any medical expenses incurred worldwide by its employees, and with reasonable co-pays and timely billing and reimbursement for out of pocket expenses in those cases.

    In sum, while Shands is excellent for specialist care, it does not have the capacity to absorb a huge influx of new general practice, preventative, and maintenance care that we all use (e.g. of the types I describe above). Gainesville has a huge number of high quality private physicians and a second excellent hospital, all of which are extensively used by UF employees. Any new program must ensure the same choice access to all of those providers as the current state PPO.

  8. I am concerned about the ability of the Shands system to absorb additional volume when it already seems strained. Also, it is very difficult to navigate the scheduling departments to get to see the right person at the right time. I have a recent personal example of waiting weeks to see a physician, only to find the appointment people had sent me to the wrong person, and then had to wait weeks more to see someone else. By which time I went outside Shands and got my problems fixed promptly by staff who actually care.

  9. Disabled dependent coverage.

    1. It is important that the GatorCare coverage includes faculty policy holders’ dependent adults (over age 26) who are qualified as ‘disabled’.

    2. Furthermore, the plan should integrate seamlessly with Medicaid (note: this is MediCAID in this particular argument, not medicare) such that the GatorCare plan would be the primary coverage and MediCAID would be the secondary, which means GatorCare would cover 100% of the co-pays for any items paid by Medicaid, resulting in zero payment by the faculty policy holder. This is the current arrangement with BCBS.

  10. Part of wellness is trusting your doctors and having a good relationship with them. Why should we change the doctors that we trust? Also, how long will we have to wait for an appointment, if Shand’s doctors will not only see their already established patients, plus UF patients?

  11. As foreign teaching assistant at UF, how will this new policy affect my department paying for my health insurance? Would all Teaching Assistants be now required to pocket 3000 dollars for a full-year coverage for their own health insurance when TAs usually receive a stipend of anywhere from $ 8,000 to 15,000 over a period of 9 months?
    If it is so, I am sure you realize many of us would not find it sustainable to stay at UF.
    Has this been considered?

  12. I am based at a research center in south Florida and have been seeing physicians in the West Palm Beach area. My worry is that will I be able to see the same physicians with Gator Care or will I pay more. Will I have the same benefits like I have with my Coventry HMO?

  13. I am currently not dissastified with my State PPO and do not see the need to change to a new system. Once this decision is made there is no “going back”. The university is not in the insurance business – it’s mission is education.

  14. Is it true that “The Self-Insurance Program may not sue or be sued. The claims files of the Self-Insurance Program are privileged and confidential, exempt from the provisions of Section 119.07(1), Florida Statutes, and are only for the use of the Program in fulfilling its claims, underwriting and risk management duties.” ?

  15. The question that keeps coming to me is about cost. If the Gainesvile folks are pulled out of the pool of employees covered by an administered plan i.e. BCBS or others, the rest of the employees employed around the state or country will pay more for coverage or higher co-pays.
    Also being asked about coverage for college aged kids and how they will be covered if out of town or state or country.

  16. A dominant question is, of course: how will non-Shands physicians and facilities be brought into the network? An equally important and related question is: how do you deal with the conflict of interest that is set up when the entity determining who is in the network (Shands) *is* the network? It seems an entity in this situation will have no incentive to bring competing physicians or facilities into the network. How are our interests as faculty and staff protected in this situation?

  17. Many members of my department travel extensively to give CE so some explanation of coverage in foreign parts would be much appreciated. A colleague has also asked whether mental health would be covered as a standard part of the package.

  18. My question regards working with multiple doctors that specialize in rare diseases. We currently see many doctors at Shands, but we are also required to see a set of physicians in Houston TX that are specialists in this disease. The care we get from the team in Houston is critical and the Shands physicians fully support and recommend these doctors. If we go to GatorCare, will it be possible to continue with these doctors in Houston? If this is not possible under GatorCare, what will be the cost of staying with Blue Cross?

  19. I am particularly concerned about how dependents between 18 and 26 of age attending colleges and universities outside of Florida will be covered.

  20. The University of Michigan was mentioned as an example of another university that created its own impressive health care/insurance provider system. In a brief look at health care benefits, http://benefits.umich.edu/plans/medical/info.html, it would appear that the UM-Premier Care option is one of several offerred by that institution, including HMO and PPO options. The UM-Premier option also includes 32 hospitals. I am concerned that the Gator Care plan provides no options. I would like to know how coverage would apply for those who are away from Gainesville, especially abroad for an extended time.

  21. I, too, am concerned about cost and physician choice. I do not see any way that this plan will feasibly allow me to keep my doctor, or my children’s pediatrician without a drastic increase in cost.

    – My doctor is nearing retirement; what incentive would he have to join the “panel” at Shands? I don’t think his practice includes many UF people, so what incentive would he have to do this just to keep me there for another few years?

    – My children (ages 9 and 12) have been with their pediatrician their entire lives. She has more patients, and new patient requests, than she can handle. Why would she want to add another level of paperwork/administration when it would just be easier to take new patients?

    – I currently have the AvMed HMO as my insurance provider. If the self-insured plan requires annual deductibles and only covers 80% of charges, it will be much more expensive than the HMO. What percentage of UF eligible employees are insured by AvMed? Why would someone in an HMO want to change to a plan that costs significantly more? (It wouldn’t surprise me if UF discontinued AvMed insurance next year for this very reason.)

    Another concern I have is cost containment. Traditionally, the insurance company is a third party that negotiates lower rates with doctors and other medical service providers. If the insurance company and the doctors all work for the same company, who will protect the interest of the consumer?

  22. Primary care providers and facilities must be included in areas that are throughout the state – not just the Gainesveille area. My Extension office, which includes numerous UF employees, is six hours from Gainesville and we certainlly cannot be expected to drive six hours to go to the doctor. These providers should definitely be addressed and posted somehwere so that all UF employees throughout the state know what will be available to them.

  23. After listening to the online video presentations by the health care administrators, I have two questions, one which is to emphasize a question very briefly raised at the senate meeting.

    Question 1. When pressed on the urgent need for getting the details of the plans rather than just the intent, Director Pelfry indicated that the legislation that would be sought in this next session is simply the enabling legislation, not the actual implementation of the plan. She clearly implied that we have have an opportunity to have input on the detailed plan at a later date. But Vice President Guzick seemed make it very clear in his presentation that the plan would be implemented as of January 13 – I believe his words were something like the plan would take effect in 2013. This sounds like the legislation would be not be just implementation, but the final product. This confusion just makes reassurance of us all more difficult!

    Question 2. As a retired and emeritus faculty member, I’ve heard no discussion of how this would affect retired faculty. Would we fall under the same plan as the current faculty, or might this all be irrelevant to us? What would the costs to us be if we are in this plan? Would we have the option to continue our current BCBS plans if we now are in the program? Please address the concerns of the many retired faculty members. If you have not had any retired faculty on your focus and discussion groups, please do include them.

  24. clguy says:

    There is a great need for the self- insurance project to get as much information out to the UF community in as timely fashion as possible. The university community needs to be able to see how the self-insurance plan and overall health care system will compare to what is currently in place in the State health care plans. I quickly came up with a set of questions that need to be well answered in order for me to determine how the self-insurance plan will compare to what is presently available.

    1. What health care services will be covered?

    2. What will be excluded, or what are the exclusions?

    3. What will be the lifetime limits?

    4. What will be the co-pays?

    5. What will the annual deductibles be?

    6. What is the cost per pay period to the enrollee for individual and family coverage?

    7. What will the provider network look like, doctors, allied health services and hospitals?

    8. Will medical service providers in the community not currently affiliated with Shands/UF be able to freely join the “in the network” provider system? Will joining the preferred provider network make financial sense to the community providers, or will they elect not to join because of financial disincentives?

    9. What will the cost be to use providers outside the preferred provider network?

    10. Will there be a prescription program? What will be the copays? Who will be the prescription service provider? What pharmacies will be included in the prescription program?

    11. How will the UF self-insurance health care system work for UF employees in Pensacola and Homestead and elsewhere outside of Alachua and Duval counties? How will the same questions above apply to employees outside of Alachua county?

    12. How will dependents <26 years of age attending colleges and universities outside of Alachua county and outside of Florida be covered?

    13. What will be the coverages and costs available to UF retirees? What about retirees outside of Florida?

    14. What emergency rooms and urgent care centers will be available under the self-insurance system?

    15. Who will handle all the billing, claims and servicing of the insured and the health care service providers?

    Another very important set of question that wasn’t on my list of 15, has to do with mental health benefits and services? This is an area where I hope an enlightened university centric health care delivery system could do way better than what is currently available in the State health insurance plans. I would be willing to bet in a university community, there would be a willingness to pay more in monthly enrollment costs, to have better mental health coverage.

  25. The GatorCare plan presented at the last two Senate meetings is very vague without adequate details about cost, access, choice of provider, and extent of coverage. The rush to get this approved by summer 2012 and implemented by January 2013 is unwarranted when so many details about the plan are not developed and it is unclear what the legislature will do. Health care insurance is complex and I doubt than more than a handful of people participating in the process have knowledge to make adequate decisions. Quality is never assured when development is rushed, even with over 200 faculty participating in the process.

    Personal choice appears to be a significant issue. Dr. Guzick stated that “..existing relationships with current health care providers will be maintained” but never directly answered the question about whether new health care providers must be from the UF & Shands system and facilities. Encouraging community health care providers to partner with UF & Shands may not be enough. Politics and competition within the Gainesville health care community are complex and present unique barriers and opportunities.

    Gator Advantage is a good first step in timely access to care that is important in patient satisfaction and access to care. With GatorCare, there will be significantly more people trying to access the system and I am not sure that the UF & Shands system can accommodate the increase. Yes, you can call and get a next day appointment with the resident on call. Two months before there is first available appointment for follow-up should not be necessary. Two months for the next available appointment is annoying when the original one had to be cancelled because of the physician was out of town. Yes, these experiences were as a Gator Advantage patient. Information is needed on the ability of the UF & Shands system to easily accommodate timely access to care that is essential to patient satisfaction and quality of care.

    At UF, we can spend a considerable amount of time studying new initiatives, developing them and obtaining approval before implementation. I am not clear that we have had enough time to do due diligence in the self-insurance initiative. We have required much more information to move on new programs than is being provided for GatorCare. Why do we have make such an important decision on such little information and vetting of this important and complex insurance initiative?

  26. As an Extension faculty member over 2 hours away from Gainesville, I am not in favor of a Shands-centric health care system. I would like to know what is being done to ensure that county faculty are being taken care of? We deserve equal benefits to faculty on campus, especially when it comes to health care. This will be the third health plan in as many years for me and I am not pleased that it is being proposed with no outline of cost, benefits, or facilities up front. How are we supposed to provide valuable comments without first seeing a plan? Simply saying there will be “choices” is not specific enough to ease our anxieties.

    Please include information related to IFAS Extension faculty when you post an information bulletin.

  27. greggac says:

    I continued to have real concerns about this proposed action and the speed at which it seems to be going.
    1. We have been told that the state is targeting state benefits. While this may be true, there is no bill so far that I am aware of that would do this. IF one emerges, I know there will be a tremendous backlash. Given this, I must believe that this move to self insure is being driven from a Shand’s need for paying patients rather than a beneficent act of UF.
    2. I have heard good things about some of the changes recently made to the shands system in an effort attract UF employees. This should be continued! My concern is that such motivation will decline if we are all mandated to be part of the system [closed system actually]. I believe SLOWING this process down and doing true due dilligence will benefit the gator nation in the long run.
    3. One question no one appears to be asking is WHAT OTHER HOSPITALS WILL BE IN THE NEW SELF INSURANCE PLAN?? I hope folks realize that so far it appears that we will NOT HAVE A CHOICE of hospitals. THIS IS VERY CONCERNING.
    4. Has anyone considered the impact of creating a closed health system on our ability to recruit new faculty and retain current faculty? Health and retirement benefits are very personal and people do consider these as a major component in their decision to come and to stay. If we are not thoughtful and deliberate in this move, shands healthcare may grow at the cost of UF colleges.
    Andrea Gregg, DSN, RN
    College of Nursing

  28. One of the primary reasons I’ve stayed at UF is the quality and diversity of health care available in our community. In 23 years I’ve not only chosen some of the best doctors in the community, but I’ve also established good relationships with them. I most emphatically do not wish to give them up (and the mere thought of transferring my many records to someone I do not know in a huge impersonal clinic makes me sick!). Such concerns were raised at the Senate meeting yesterday, and Dr. Reznick stressed that we would have “choice,” but that took on a smokescreen like quality when details were not provided. We always have that choice, especially if we are willing to pay. So the question is choice at what cost? If the co-payment is elevated appreciably for services rendered outside of Shands, then this is no real “choice.” Doctor’s fees aren’t the only costs—what about annual tests or bloodwork or new tests that may be needed that are outside the Shands network? Who pays for that, and will the costs there be elevated too?

    The idea that our local physicians will be invited to participate is not comforting, in itself. Our medical community has a complex political landscape. If they do not participate with Shands now, they will not be inclined to do so merely because they are invited (though I could see some doing that, if they stand to lose many patients). Some of my own physicians actually dislike or hate Shands; some actually left Shands because of bad experiences with them.

    Other concerns pertain to the use of other facilities, perhaps out of the city, or state depending on the nature of the illness. And how about those of us who do research within the country, but out of state or city? To make Shands the center of one’s health care raises a whole set of other worries that need to be addressed.

    Last point: I’m all for brick and mortar pharmacies, but that also includes a significant price raise too. How much?

  29. I understood that the major motivation to move to self-insurance was because the state insurance plans are going to increase significantly and a self-insurance plan will save UF and its employees money.

    However at the January Senate meeting, I believe I heard a different message: that employee insurance premiums are determined at the state level and UF employees will be charged the same premium as state employees (on BCBS, etc) regardless of the UF self-insurance plan. Is this correct?

    If it is, will UF leaving the state insurance plan cause our premiums to rise even more because we’re pulling UF employees out of the health insurance pool?

  30. As county faculty, residing outside of the Gainesville area, I am afraid this change will limit my access to providers, increase my out-of-pocket expenses and just complicate my health coverage. There has not been any concrete discussion as to how you plan to cover faculty residing outside of the Gainesville area.

  31. This plan seems to be all about Shands — Dr. Guzick said “Shouldn’t we all be able to go there?” What about those of us who primarily use North Florida physicians? We don’t have any desire to go to Shands and change our health care providers. This whole idea that we all want to go to Shands is quite confusing. From the Faculty Senate meeting, there was no information regarding any other health provider — I do NOT want to change from North Florida Regional hospital or physicians. How would this be handled with “Gator Care”? How could Shands possibly handle the entire UF community and their patients? Finally — the healthcare provided by North Florida is quick, efficient and excellent — even without a special phone number as Dr. Guzick mentioned is needed for optimal service at Shands.

  32. How will the Shands/UF system handle the long wait times of the emergency room (typically 10-12 hour wait), the quality of emergency room care (often by residents) ? Will there be a choice to go to North Florida Regional Hospital ER?

  33. I would simply like to comment on behalf of those county extension faculty members like myself who reside and work outside of Gainesville. From what I understand at this point, we will in no way benefit from having to change our care to a Shands-based or self-insured system and will basically lose the benefit of health insurance in our individual locations. If the decision is made to change the structure of our health coverage completely, please consider how non-campus based faculty will be affected. We deserve the same benefits as campus-based faculty and have sincere concerns that these are in jeapardy.

  34. It would be helpful if some outline of what is being considered was posted somewhere. If we can come up with a plan that saves both employees and the university money, while retaining or improving the quality of our coverage and our options for choosing providers, then fine. I suspect that there will be a push for getting people to use our excellent health care system in UF&Shands, but this should not become the default. Many people have long established relationships with other providers that should not be severed because of a change in our health plan. Again, a little information up front would go a long way to alleviate anxiety.

  35. If by self-insurance you mean that all faculty will get a “raise” and be then expected to go to various health insurers and buy their own policy tailored to their needs, then I think this simple approach is a bad idea. I went through the transition from faculty benefits to the new post-doc care package. It is possible that post-docs have gotten substantially better health coverage. But what mattered to me was the dental plan. I had to go to a private insurer and overall health benefits now cost more and I have substantially poorer benefits as measured by the out-of-pocket cost for each visit. Part of this is not quite understanding the insurance I was buying, and partly this was the cost of the different plans being offered. Some of this issue could be solved if there were “Insurance advisors” who could walk people through the various plans and make suggestions about what are good options and possible consequences of other choices. Of course this is difficult to do because then UF may become legally vulnerable for giving advice that doesn’t work out. What I remember from my first day was “here are the options, choose one” and being given a large stack of paper where each company described the overwhelming benefit of their plan. Without several weeks reading and searching, there was no real way to select the best plan or understand the long term consequence of my choice. It seemed to work out ok, and showed me what I lost in moving to Post-doc care. So while self-insurance may save UF a great deal of money, I would be careful that this savings doesn’t come out of the hide of all the faculty.

    Run the numbers for the cost to UF, then run the same set of numbers as if each faculty member would buy and use their benefits. In either case different individuals will benefit, but what is the overall cost to the UF community? If you cannot get the medical/dental/visiion records from faculty, ask for volunteers to submit some records or be creative. Use expected ailment incidence records from hospitals/insurers/others to populate a fictional faculty body of the size of UF. Run a simulation based on these numbers.

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