Another year, another new health care plan

The company’s proposal on health care for next year would involve another switch of plans, this time to one run by Blue Shield of Northeastern New York.

The proposed plan for next year is a Blue Shield of Northeastern New York plan, which is a switch from the current Empire Blue Cross plan. It has the same $750 deductible for employees and the same 90/10 split of some medical expenses with one exception.

For office visits, once you pass the top of the total deductible ($2,000 for a single, $4,000 for a family) you’d pay a co-pay for office visits instead of the 90/10 split. (Preventative care visits, like well child and annual physicals, are completely covered now and under the new plan.) Medical treatments at that point would still require the 90/10 split.

That copay would be $20 for a doctor visit, $50 for an urgent care visit and $75 for an emergency room visit. Again, this is only if you’ve passed the top of the deductible and it is in lieu of, not on top of, the 90/10.

Whether the 10 percent or the flat payment is more expensive varies. Office visits average $60-70 for a general practitioner and $225 for a specialist. Emergency room visits can average $600 to $1,000. Urgent care visits average $250.

After the meeting, the Guild emailed the company to ask if those office payments would fall under the maximum under the 90/10 share or if people who reached the maximum would still be expected to pay for office, urgent care and emergency room visits. We are awaiting that answer.

Under the proposal, the weekly cost out of your check would rise $2.06 a week, or a little over $107 a year.

That would include our share of medical costs rising from 21 to 23 percent. When the company imposed conditions, it originally proposed to increase our share to 23 percent in 2011 and 25 percent in 2012. Last year, the company agreed to freeze our share at 21 percent for an added year.

To keep the same plan we have now would have increased the weekly copay $11.70 a week. The main reason cited is one employee amassed medical bills this year of more than $400,000, a catastrophic case Blue Cross was not willing to write off as an exception.

Last year, 40 people passed  the top of the deductible and had to pay 10 percent of some medical expenses. We’ve asked the company for details on how many hit the top maximum.

Another 43 people didn’t even reach the top of the $750 as of October 4.

We’ll continue to keep you posted on details as we get answers to our questions.


  • elzic

    What would happen with those of us being bankrupted by our prescription costs? Would we pay 10 percent for drugs after the deductible, or would there be a co-pay?

    • Tim O'Brien

      That’s a good question. We are awaiting answers to questions we’ve asked, and we’ll get an answer for that one for you too.

    • Tim O'Brien

      We do have an answer. Under the new plan, prescription drugs would count toward the cap on the 90/10 split of $2,000 for an individual and $4,000 for a family. That is not the case under the current plan.

Leave a Reply

Your email address will not be published. Required fields are marked *