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BRAINTREE -- After decades, Tufts will no longer serve as the administrator of the Archdiocese of Boston Lay Health Plan, the archdiocese announced.
Effective Oct. 1, Blue Cross Blue Shield of Massachusetts will take over as administrator of the plan, which covers about 4,200 lay employees in parishes, schools, and organizations of the archdiocese across the archdiocese. The change was announced this month through the Trustees of the RCAB Health Benefit Trust.
This is the first time the archdiocese will not be using Tufts for its Lay Health Plan in about 30 years, Carol Gustavson, the archdiocese's director of Benefits Trusts, told The Pilot May 14.
No changes have been announced for the health plan of archdiocesan clergy, which is separate from the lay employee plan and managed through the Clergy Health and Retirement Trust. Tufts is the administrator for that plan, as well.
The change for lay employees comes after increasing concerns over the rapidly rising costs of the existing plan for employees and the archdiocesan entities that employ them.
According to Gustavson, those costs are associated with the structure of the plan remaining largely the same for so long. The plan as it was "paid for just about everything and employees paid for very little out of pocket, and it meant that premiums, the full cost of the plan, was going up, up, up."
It was becoming "just not affordable for our employees," she said.
Under many health plans in the U.S., employers cover a part, or even the majority, of the premium, before passing on remaining costs to employees. In the archdiocese, each school, parish, and organization acts as a separate employer under the health plan, and the costs in recent years have simply become too much for both employers and employees.
"A lot of parishes and schools split the cost for family coverage 50-50, so employees pay 50 percent and the parish or the school pay 50 percent," said Gustavson. "The full family premium is almost $2,000 (a month), so you're asking teachers basically to pay $1,000 a month" for family coverage.
It was a "huge burden," she said, and the archdiocese was seeing people unenroll from the plan.
Adding to the issue, Gustavson explained that each year, about 15 to 20 percent of those on the plan don't use the benefits of the plan, while others might use hundreds of thousands of dollars' worth of benefits, creating a scenario where someone could be using the plan far more than someone else, but be paying only a fraction of the premium.
The Trustees of the RCAB Health Benefit Trust took note of the issues, and "did a lot of research" and brought in numerous outside consultants. In the end, they decided the best course of action, which would benefit the greatest number of people, was to switch administrators and introduce cost-sharing.
When debating how to lower costs, Gustavson said the Trustees didn't want to cut the number of covered services drastically, nor did they want to decrease the number of in-network providers.
With Blue Cross, employees will now have increased co-pays for certain services and a deductible for in-network care where there wasn't one before. The change will lower the cost of premiums, so that employers will ideally be able to, in-turn, lower costs for employees.
Lay employees will be able to choose between an "Enhanced Plan," which offers a higher premium but lower deductibles and co-pays, and a "Basic Plan," offering a lower premium but higher deductibles and co-pays. The options allow for people who rarely use the benefits to ideally pay less overall.
Currently, employees do not yet know how much their individual premiums will cost, but Gustavson said that information will become available in the coming weeks and months. Without that information, Gustavson said there hasn't been a lot of feedback yet from lay employees, mostly just questions which she noted she gladly answers.
Still, she said she has heard a few negative comments concerning the deductible and the increased co-pays, and she understands that.
"It's not as rich a plan as it has been, that's true," she said. "But, I think the thinking was ... let's try and make this a plan that's more affordable to more people."
Gustavson noted that one of the ways lay employees can help offset increased out-of-pocket expenses is through the archdiocese's Wellness Plan. Started about five years ago, the plan encourages people to be proactive in their health, rewarding them for simple things that range from answering a health question, to watching an educational video, to taking part in a "monthly challenge," such as drinking a certain amount of water a day or walking a certain amount. Rewards come in the form of non-taxable health credits, which can be applied to costs like co-pays and deductibles. With enough work, a person could earn hundreds in credits a year, Gustavson said.
She noted that the change to Blue Cross will not negatively impact the amount of credits that can be earned, and said that for those who already have a positive balance, that balance will carry over to Blue Cross.
Lay employees will be able to enroll in the health plan during the open enrollment period in August and September. After Oct. 1, the start date of the plan year will then change to July 1, which will correspond with start the start of the fiscal year employers.