The University of Miami created a new HMO healthcare plan last month for faculty and employees that features three main provisions, one of which is no increase in the monthly cost compared to the original version for one of the plans offered.
Joe Natoli, senior vice president for business and finance, announced the changes in an email to UM employees in November.
Natoli and William Donelan, vice president of the Miller School of Medicine, organized town hall meetings on all three university campuses for employees to attend and discuss the available healthcare plans in November. In December, the university implemented some of the suggested changes.
“When concerns were expressed, we acted quickly,” Natoli said. “We wanted to find smart ways to offer high quality healthcare while keeping prices affordable.”
Cristina Elgarresta, director of the benefits administration at UM, said an HMO, or health maintenance organization, plan requires referrals for a patient to contact their primary care physician before receiving any medical service by an “in-network” doctor.
Previously $50 per month, the first HMO (HMO1) plan maintains the same coverage but is $42.50 more expensive, bringing the total monthly premium for 2007 to $92.50 for one employee.
The second HMO’s monthly premium continues to be $50 per month to cover one employee.
Also, the cost for covering an employee plus a spouse or family members was not raised.
The costs for covering a spouse or family members in the other available healthcare plans were increased, some by about $100 per month.
In the revised plan, the maximum amount of money any employee can pay out-of-pocket stays the same as HMO1’s 2006 plan: $3,000 for an individual, $6,000 for a family.
Kelly Kaufhold, a senior media relations officer for the medical school, said the out-of-pocket maximum was slashed by $1,000 for an individual and $2,000 for a family.
Kaufhold said he was impressed with the university’s ability to keep last year’s costs and accomplishing the changes before the end of 2006.
Another feature in the HMO2 plan was a $250 to $500 deductible for certain outpatient services, which include surgery and testing. It also includes the use of an accredited nursing facility, ambulance, medical equipment, home health care, diabetes equipment and private duty nursing.
After the deductible, there is a 10 percent fee regularly charged for outpatient procedures.
However, the last feature is that the fee is automatically waived under the HMO2 when seeing a UM doctor in UM facilities.
Elgarresta, the director of the benefits administration, said that the university is self-insured and pays Humana Inc., a health benefit company, $2 million per year to administer its plans.
For the 17,000 employees under one of UM’s five plans, more than 70 percent signed up for the HMO. The cost for all those insured was about $73 million in 2006, which was given to Humana to pay all claims, Elgarresta said.
Out of the average $70 million spent, 80 percent is paid by the university and the rest by employees, Elgarresta said.
“The issue is broader than healthcare. It’s everything that confronts a person living in South Florida today,” Natoli said referring to the high cost of living in Florida. “[UM] wants to be in a position to hire and retain.”
Natoli, as vice president for business and finance, is working with Elgarresta to establish a task force and lead focus groups on each of the university’s three campuses.
“The task force is looking at the total compensation of the employees,” Elgarresta said, adding that the task force will compare benefits of various employers and study the attitudes of workers with certain compensations.
Motivated by a concern of affordability, the university initiated a program called UMatter. The program offers the following for free: routine physicals/lab services, routine immunizations and osteoporosis screening in addition to breast, cervical, prostate and colorectal cancer screening.
The Well Child Care Exam, which includes newborn examinations and the annual physical thereafter, and the Well Woman Exam, which includes the annual physical, pap smears and other women exams, are also free.
“Instead of the cost going up, it stayed the same,” Kaufhold said. “In general, there’s still frustration, but what UM is doing seems like a very good measure, fairly quickly.”
Walyce Almeida may be contacted at w.almeida@umiami.edu.