The unions at the Times Union agreed Thursday to switch to MVP for next year’s health care after a deal was struck where the Company will pay the difference if two people in a household exceed the current $6,850 out-of-pocket maximum.

Rather than face the potential $8,000 maximum – although $3,250 of that is reimbursed by the company – the members would not have to pay any more than they do now.

The potential risk of that higher out-of-pocket maximum for families with multiple people facing serious illness was the major concern the Teamsters union and the Guild had with the proposal.

The company’s insurance manager said of the 7 people who hit the top of the out-of-pocket maximum this year, two were individuals and 5 were in family plans. In all five cases, one person in the family was the large claimant and no one else in the family spent more than $1,000 on health care. That means that no family would have faced the $8,000 out-of-pocket maximum as proposed by MVP. Still, the past is no predictor of the future so there was no guarantee.

Credit goes to Stefan Krueger of the Teamsters union, who hit upon the idea of asking the Company to pay the difference if that scenario were to arise. The Company had said keeping Blue Cross would cost it $68,000 more a year, a cost it would look to make up elsewhere like cutting another reporter or press worker.

Moving to MVP would cause a weekly increase out of paychecks of $4.04, from $58.90 a week to $62.94.If we stayed with Blue Cross, the weekly premium would rise $5.54 to $64.44.

MVP is also willing to guarantee that the health care increase next year would start at no more than 14.5 percent. While that is larger than we would like, Blue Cross this year started at 29 percent. Given the great uncertainty as to what will happen next year, it is a benefit to have some limit for 2018.

Nine of the 16 Guild-covered employees who applied for the buyout have had their offers accepted.

Of the nine, seven work in the editorial department and two in advertising.

While the Company has informed the employees of their selection, the workers have 45 days from when they are given the release to decide whether to take the buyout or decline.

Once an employee signs the buyout agreement, that person then has 7 days to rescind it. After that, the agreement is complete. Employees who get the buyout are expected to leave by year’s end.

A few non-Guild employees are also leaving and will be counted toward the Company’s stated goal of 10 to 15 staff reductions. We don’t yet know how many.

Union leaders met with the Company late last week to continue the conversation about health care for 2017.

The Guild’s Executive Board will discuss this further and decide what to do next at its regular monthly meeting at 5:30 p.m. Wednesday at its office on the second floor of the Albany Labor Temple, 890 Third St., in Albany. Members are always welcome to attend and give their input.

The union leaders sought information on the differences in the maximum out-of-pocket costs under the two plans. The shortest version is: MVP would be less expensive than Blue Cross if an individual gets sick within a family. It would be more expensive if an individual gets sick in an individual plan or if two people within a family get sick and both hit their individual maximums.

Under the current plan, the aggregate maximum is $3,425 for an individual and $6,850 for a family. Under the MVP plan, an individual faces an embedded maximum of $4,000 and the family embedded maximum is $8,000.

The best way to understand this is to share examples of a family affected by illness or injury.

FAMILY COVERAGE, ONE INDIVIDUAL HITS THE TOP OF THEIR DEDUCTIBLE

Under the Empire plan, the deductible is $4,000. (Employees pay the first $750, the Times Union reimburses the rest.) Once an individual hits that $4,000, that person becomes liable for 10 percent of medical costs up to $2,850. The maximum out of pocket, then, is $6,850 minus the company reimbursement of $3,250 for a total of $3,600.

Under the MVP plan, the individual would not face additional expenses after hitting that initial $4,000. The total out-of-pocket would be $4,000 minus the $3,250 reimbursement for a total of $750. That’s the best scenario. The cost is $2,850 less.

FAMILY COVERAGE, SECOND FAMILY MEMBER HITS TOP OF DEDUCTIBLE

Under the Empire plan, the result would be exactly the same as above, for a total of $3,600.

Under MVP, the second family member would also have a $4,000 maximum deductible. (A family would have a total maximum of $8,000.) So the cost of two very sick people in a family would be the original $4,000 deductible then paying 10 percent of medical expenses up to another $4,000. Of that $8,000, a total of $3,250 would be reimbursed by the company. The total out-of-pocket is $4,750 or $1,150 more than Blue Cross.

INDIVIDUAL WITHOUT FAMILY HITS TOP OF DEDUCTIBLE

The deductible for an individual is $2,000 under both plans. Under the Blue Cross plan, once a person started paying 10 percent of health care, their maximum liability would be $1,425. That’s $3,425 minus the Company reimbursement of $1,250 for a total cost to the individual of $2,175.

Under the MVP plan, the individual has the $2,000 deductible. The person would then be liable for up to $2,000 more once they hit the 90/10 split. That’s a total cost of $4,000 minus the $1,250 company reimbursement for a total cost of $2,750. That’s $575 higher than under Blue Cross.

So far in 2016, three individuals and 7 families hit the maximum out-of-pocket cost.

If we stayed with Blue Cross, the weekly premium taken from paychecks would rise $5.54 from $58.90 to $64.44. Moving to MVP would cause a weekly increase of $4.04 to $62.94.

Eight Guild members opted last year to take a new option the Company presented. Under that program, employees pay for the first $3,000 of medical expenses out of pocket for a lower weekly payroll deduction for individuals and couples. Under that plan, the weekly cost would rise from the current $20.54 for singles to $23.93 and from $40.06 for couples to $46.66. (The rate for families would be $69.40, higher than the main plan.)

Sixteen employees covered by the Guild applied for the buyouts offered by the Company.

The workers will learn Monday which ones the Times Union has approved. The individuals will then have 45 days to decide whether to accept the buyout offer or to stay. Once employees sign the paperwork,  they have seven days to change their minds and rescind the decision.

Some of the employees who applied for the buyout did so because they are on the bottom of the seniority scale, would prefer to stay but wanted the extra pay and/or health care if forced to go. Others applied to keep their options open while looking to see if they could find another job within the 45-day period. And many applied because they have already decided to take advantage of the extra pay and health-care coverage to leave voluntarily.

We expect there will also be some non-Guild employees who leave and whose departure will be counted toward the Company’s stated goal of reducing the staff by 10 to 15 employees.

We’ll share more details next week once we learn how many buyout offers the Company has made.

The annual discussion of health care costs for next year kicked off Thursday, with the Company proposing a move to MVP because it provided a less expensive rate than Empire Blue Cross.

f we stayed with Blue Cross, the weekly premium for most workers would rise from the current $58.90 a week to $64.44. Moving to MVP would cause a weekly increase of $4.04 to $62.94. The deductible would remain at $750. Dental would remain with Cigna, which also would become the provider if you needed health care outside the area.

Eight Guild members opted last year to take a new option the Company presented, and the Guild agreed to support as long as it was an option and not the main choice. Under that program, employees pay for the first $3,000 of medical expenses out of pocket for a lower weekly payroll deduction for individuals and couples.

Under that plan, the weekly cost would rise from the current $20.54 for singles to $23.93 and from $40.06 for couples to $46.66. (The rate for families would go from $59.58 to $69.40, more than the plan with a lower deductible so no families should take that plan.)

The Company also provided a side by side comparison of the current Blue Cross and MVP plans. You can see that document here.

The biggest difference is the out-of-pocket maximum. Under the current plan, the aggregate maximum is $3,425 for an individual and $6,850 for a family. Under the MVP plan, an individual faces an embedded maximum of $4,000 and the family embedded maximum is $8,000.

Here’s a handout from the Company explaining the difference between an embedded and an aggregate maximum.

(An earlier version of this post confused an embedded deductible and an embedded maximum. My apologies for the confusion.)

UPDATE: The Company offered this further description of the difference:

“The current out-of-pocket maximum with Empire BC’s plan is aggregate.  This means if someone is enrolled in family coverage, the entire $6,850 has to be met before the plan will pay 100%.  It doesn’t matter if one person hits the $6,850 on their own or if a combination of family members hit the $6,850 out-of-pocket maximum.  The MVP plan has an embedded out-of-pocket maximum.  Therefore, if 1 family member reaches $4,000 the plan pays 100% for that family member and the entire family would not pay more than $8,000 total.  With Empire any family member with claims would accumulate toward the $6,850 out-of-pocket maximum.  With MVP no one family member would ever pay more than $4,000 out-of-pocket.”

The only other substantive difference appears to be a $5 increase in the coinsurance after deductible for brand medications to $30. Generics would still have a $10 copay after deductible, and non-preferred brands would still carry a $50 co-pay after deductible.

The Guild is examining the differences to determine whether the two plans meet the test of being “comparable.” If they are not, a vote of the membership is required to approve the change. If they are comparable, then no vote is required.

Please let your Guild officers know what you think or what questions you have by contacting us directly or emailing us at office@albanyguild.org.