Charles Breitsman of cds talks about the transition to the new network. Seated from left are fund attorney Martin R. Ganzglass; fund Co-Chair Andrew Douglas, Philadelphia 14M; Patti Talleur, acting co-chair and employer trustee for Seattle 767M, Graphic Arts Center; and GCIU Vice Pres. Robert Lacey.

Premiums go up 11.2 percent nation- wide

Access to the largest preferred provider network in the United States and low premium increases are expected to produce significant growth for the Graphic Communications National Health and Welfare Fund.

That was the conclusion of fund leaders during the annual trustees' meeting in November. The national fund, which was established in the 1950s as a pooling fund for jointly trusteed union and employer Taft-Hartley funds, changed its structure in 1997 to become primarily self-insured and to offer benefits to other GCIU local and employer groups.

The national fund now offers six model medical PPO plans; two HMO plans through CIGNA; six prescription drug plans through ExpressScripts; three dental plans; two Medicare supplement plans; three vision plans through National Vision Administrators; and life and accidental death and dismemberment insurance plans.

Teresa Bauer of cds, which administers the Graphic Communications National Health and Welfare Fund, talks with Joliet-Ottawa 471M Pres. Joseph Alves during a break.

Getting advice, from left, are Seattle Secy.-Treas. Steven Aldrich, William Rivers of The Segal Company, and Kelley Frengle of the Graphic Arts Center, employer representative of the Seattle 767M fund.

Fund Co-Chairman Andrew Douglas of Philadelphia 14M said the switch to the CareFirst Blue Cross Blue Shield network as of Jan. 1, 2005, and the low premium increases "will make a tremendous change to the trustees of the fund. . . . And I think [these changes] are going to be productive to the fund. Local unions and employers may see the advantage of having the 'Blue' card. I think the fund will benefit from the larger discounts" offered by CareFirst.

Fund trustees approved an increase in medical premiums of 4 percent for the coming year. According to the annual survey by the Kaiser Family Foundation, insurance premiums nationwide in 2004 rose an average of 11.2 percent [see sidebar]. The increase in medical premiums for fund groups last year was 9.9 percent, compared with a national average of 13.9 percent.

Premiums for prescription drugs, which is one of the fastest-growing inflation factors in health care in the United states, were increased by 15.6 percent for participating groups in the fund. All other areas of coverage–dental, vision, Medicare supplement, and life and accidental death and dismemberment remained the same.

GCIU Vice Pres. Robert Lacey, who serves as fund secretary, urged local unions to "look at the fund over the long haul. As you will see over time, this fund will help you lower your health care costs."

Lacey noted that the national fund doesn't "lowball quotes the way the larger insurance companies do."

The practice by health insurance providers of offering a low initial premium has complicated health insurance issues for GCIU local unions over the years, according to fund trustees. Employers tend to grab the lowest rate for the first year, only to experience very large premium increases in ensuing years. For local unions and employers alike, this struggle, compounded by soaring health care inflation, has meant that health care issues seem to stay "on the table" almost constantly.

William Rivers of The Segal Company, which serves as the consultant to the fund, reported that the fund is in excellent financial condition–better than in previous years and in better condition than many other self-insured funds. He reported that the reserve for pending and unrevealed claims is 100 percent funded, while the other reserves are making progress.

CareFirst

Charles Breitsman and Teresa Bauer of cds, which administers benefits for participants, outlined the transition plans to the CareFirst network. They stressed that members with pre-certifications for planned treatments will receive special attention during the transition. They also stressed that basic benefits will not be changed by the switch to CareFirst.

Presenting information on the new network to the trustees were Joe Pedone, Leonard Phillips, and Kelly Lynam of CareFirst.

Pedone explained that CareFirst is an independent licensee of the Blue Cross Blue Shield (BCBS) association. The BCBS association is made up of 43 independent regional plans in the United States.

Phillips noted that 90 percent of all institutional health care providers participate in CareFirst. CareFirst claims participation by 80 percent of all professional health care providers.

Benefits to members of the new CareFirst PPO network include:

• Freedom of choice: Freedom to choose any doctor in or out of the network. Choosing a doctor in the network will significantly reduce costs for the member.
• No paperwork: Participating providers complete the necessary paperwork and submit claims. Payment is made directly to the preferred or participating providers.
• No balance billing: Preferred or participating providers agree to accept the fees negotiated by CareFirst as payment in full so members are not responsible for excess balances. Members are responsible only for their usual co-payments, deductibles, and co-insurance.

Joe Pedone of CareFirst provides details of the fund's new network. Seated are Leonard Phillips and Kelly Lynam of CareFirst, a Blue Cross Blue Shield subsidiary.

Sharing information are Kelley Frengle, left, and Patti Talleur of the Graphic Arts Center and Evansville 571M Pres. Mike Wohlhueter. Frengle and Talleur are employer representatives of the Seattle 767M fund.

CareFirst and Blue Cross Blue Shield maintain website lists of doctors, hospitals, labs, and other providers that participate in the network.

Members in the Washington, D.C., and Delaware areas can locate providers by going to the CareFirst website. Members in all other parts of the country can locate providers by going to the Blue Cross Blue Shield website.. Enter the alpha prefix on the membership card or log in as a guest. Or telephone 1-800-BLUE (2583) to locate providers.

For questions about benefits and claims, members can call the member service telephone number on the front of the card, which connects to national fund representatives at cds.

Phillips explained that members can create their own accounts on the secure CareFirst website and access claim status and other information. Also available on the website are personal tools for managing health care problems, information on wellness programs, and health care news.

Other actions

In other action, trustees amended the health and welfare fund plan to increase the number of in-network well child doctor office visits to nine for children during the first 24 months of their lives. The amendment applies to some of the model medical plans.

Stuart Wohl of The Segal Company outlined provisions of the new Medicare prescription drug plan–"Part D"–and what it means to drug plans provided to retirees by fund member groups.

GCIU local unions and contract employers that wish to obtain quotes for health insurance coverage from the national fund can e-mail Robert Lacey at rlacey@gciu.org or phone (202) 462-1400. Or telephone Teresa Bauer of cds at (412) 201-2233.

Premiums swell 11.2 percent in 2004 nation-wide

Health insurance premiums sponsored by employers rose an average 11.2 percent in 2004–the fourth consecutive year of double-digit increases. According to the annual survey by the Kaiser Family Foundation and Health Research and Education Trust, the 2004 increase in health insurance premiums was about five times the rate of inflation–2.3 percent–and workers' earnings–2.2 percent. In 2003, the Kaiser foundation found that health insurance premiums rose 13.9 percent. The Kaiser foundation report said that premiums in 2004 cost an average of $9,950 per year or $829 per month for family coverage. Premiums averaged $3,695 per year or $308 per month for single coverage. Family premiums for preferred provider organizations (PPOs), which cover most workers, rose to $10,217 per year on average or $851 per month in 2004. In 2003, PPO premiums averaged $9,317 per year or $776 per month. The study found that about 61 percent of workers received health insurance coverage through their employers in 2004, down slightly from 62 percent in 2003. There are at least 5 million fewer jobs providing health insurance in 2004 than in 2001, when coverage peaked at 65 percent of workers, the report said. Drew Altman, president and CEO of the Kaiser Family Foundation, said: "The cost of family health insurance is rapidly approaching the gross earnings of a full-time minimum wage worker. If these trends continue, workers and employers will find it increasingly difficult to pay for family health coverage and every year, the share of Americans who have employer-sponsored health coverage will fall." The study found that some 55 percent of employees with health care coverage were enrolled in a PPO in 2004. About 25 percent of workers were enrolled in a health maintenance organizing (HMO). Only 5 percent of covered workers had conventional or indemnity benefit plans.

Standing from left are Stuart Wohl of The Segal Company; Steve Bearden, president of Linemark Printing and employer trustee for Local 144B; and Washington 449S Pres. Kenneth Gaines. Seated from left are Mike Frazier, employer trustee for Washington 144B, and Local 144B Pres. Gerald Weikel.