City workers facing options in health care plans

mgaytan@losbanosenterprise.comOctober 3, 2013 

— City employees have one more week to decide on a health care plan.

The most popular plan, according to city officials, is Blue Shield HMO (Health Maintenance Organization), which requires a preauthorazation referral from a primary care physician.

Lucy Mallonee, human resources director for the city, said more than 80 percent of city employees use Blue Shield HMO.

The new options are Anthem Blue Cross Select HMO, Anthem Blue Cross Traditional HMO and Unitedhealthcare Alliance HMO. Memorial Hospital Los Banos, a Sutter Health affiliate, accepts Anthem Blue Cross Traditional HMO, but it has a higher premium than Blue Shield HMO, Mallonee said. Unitedhealthcare Alliance HMO is not available in Merced County.

Mallonee said since employees don’t want to pay higher out-of-pocket expenses for a plan that would allow them to use the Sutter Health affiliate, they choose Blue Shield HMO.

The 140 city employees are insured through the California Public Employees’ Retirement System (CalPERS), .

“It’s all the employee’s choice on what health plan they choose,” she said. “We provide employees information about the health plans offered but we can’t actually help employees decide on a plan. It’s totally their decision.”

As in the private sector, open enrollment lets city employees choose a different health care plan. The new plan would be effective Jan. 1.

Craig Baize, marketing and communications manager for Sutter Health, Central Valley region, said CalPERS offers health insurance options to participating employer groups in their system and that Sutter Health facilities and physicians are available as “in-network” for some of the health plans and “out of network” for others. He said the option varies by county.

“In Merced County, Los Banos is and has been available to CalPERS members through the PERSCare and PERSChoice PPO plans,” Baize said.

These plans are less popular, according to the city, even though they allow city employees to use the local hospital without a physician’s referral.

Bill Madison, information officer for CalPERS said CalPERS doesn’t negotiate directly with the hospital but instead with health insurances.

“We don’t negotiate. That would be up to the providers,” Madison said.

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