teacher insurance

FILE — Graciella Hernandez, a third-grade teacher at Barge-Lincoln Elementary School, rolls up a map while preparing her classroom for her first day of school on Aug. 18, 2018.

School employees in Yakima County could pay as little as $13 a month for health insurance if a state board approves new health care premium suggestions.

The new state health insurance system for K-12 school employees has been in the works for years, and was funded during this year’s legislative session. It is scheduled to take effect in January.

On Thursday, the state Health Care Authority presented proposed health care plans and premiums to the School Employee Benefits Board overseeing the new system — providing details about the coverage and what it will cost employees.

Any employee who works at least 630 hours a year is eligible for full health care coverage. The new system caps the cost of a family plan at three times the amount of an individual plan.

The employee price for a single person in Yakima County to be covered ranges from $13 to $98 a month, while the most it will cost an entire family to be covered if the plans are approved is $294.

Dental, vision and basic life and long-term disability premiums would be entirely covered by the employer.

“That sounds definitely less expensive by more than a dip,” said Yakima Education Association President Steve McKenna, compared to current costs.

“But you have to check what they cover to make a legitimate comparison,” he said, adding that he hadn’t seen the prospective plans yet.

McKenna said that coverage of vision and dental premiums could be a tremendous benefit to school workers, as premiums for various insurance plans add up quickly.

For employees, the cost is kept low by a negotiation to have employers pay 85 percent of the cost of an average plan — a sliding rate based on whether an employee wanted a more or less comprehensive plan. It’s based off an option offered statewide, which costs roughly $653, making the employer contribution a flat $555, regardless of plan. Applied to another plan, the employee pays just 2 percent of their coverage cost.

Varies by county

Proposed health care plans vary from county to county, and school employees will be able to choose a plan based on where they live.

In Yakima, plans would include three core options by Kaiser, two Premera Blue Cross plans and four Uniform Medical Plan options, including one previously created specifically for state employees: UMP Plus.

The Kaiser plan costing employees $13 a month, or $39 for a full family, would have an annual deductible of $1,250, or $2,500 for a family. The maximum out-of-pocket cost would be $4,000 for an individual or $8,000 for a family before insurance would fully cover costs.

The standard plan has a $250 deductible for a single member. The out-of-pocket maximum would be half that of the least expensive Kaiser plan.

The most costly plan would be just $98 a month for an individual.

UMP Plus, the plan created for the school health care system to encourage better health, better care and lower costs by placing more responsibilities on the provider rather than the insurer, would cost $68 for an individual or just over $200 for a family. The deductible on this plan would be $125 for an individual and out-of-pocket costs would max out at $2,000.

Perks of this system would include full coverage of primary care visits and no prescription drug deductible or referral for a specialist needed.

A small group of Yakima County school employees may not be eligible for this option.

“If a member works in a county but doesn’t live in the county were UMP Plus is available, they can’t enroll in the UMP Plus (plan),” said Lauren Johnston, senior account manager for the state board.

The state board is scheduled to vote on the plans next week. Detailed information on plans, premiums and enrollment are expected to be sent to school staff in September.

The cost to districts could be significant. It’s something school officials are weighing now as they work toward wrapping up annual budgets, said Tom Fleming, chief financial officer for Educational Service District 105, a Yakima-based regional school support agency.

The Legislature approved earlier this year for schools to pay $1,056 per employee for the 2019-20 school year, which Fleming said is the actual employer contribution rate that helps cover the low cost of family plans.

While the state pays districts to cover most employees, it will not compensate districts exactly when multiple part-time staff fill one full-time position. It also does not cover federal- or grant-funded staff.

“Districts are kind of finishing their budgets up last week and this week, and I’ve been hearing a little bit that they’re surprised by how much more (insurance) is going to cost,” he said.

This story has been edited to clarify that UMP Plus was created specifically for state employees, which now include School Employee Benefits participants.

Reach Janelle Retka at jretka@yakimaherald.com or on Twitter: @janelleretka