Health Insurance FAQ
NAGE has received a number of emails from members expressing confusion and concern over the Group Insurance Commission's (GIC) changes to health insurance co-pays and deductibles. We hope that the questions and answers below clear up some of the misunderstanding.
But first, we want to clarify that NAGE does not "allow changes," negotiate with or have control over what the GIC does. The GIC is a quasi-independent organization with a board that sets premiums, as well as co-pays and deductibles. When NAGE learned the GIC was considering raising co-pays and instituting new deductibles, the union fought for and won an agreement from the state that NAGE members would be reimbursed on any co-pay and deductible increases instituted, up to June 30, 2011.
Q: Why did NAGE allow the GIC to increase our co-pays and institute deductibles?
A: We didn't "allow" it! The GIC board sets rates, as well as co-pays and deductibles. We cannot negotiate over premiums, co-pays, or deductibles and they are not part of our contract. We also can’t negotiate over the premium split; by law, the legislature determines the premium split. NAGE has, and always will, lobby legislators to limit any increases to the premium split. We have been very successful in pushing back these increases.
Q: When will my co-pays change?
A: Changes to co-pays will be effective February 1, 2010. However, NAGE members will be reimbursed the difference between their existing co-pay and the new co-pay.
Q: Why do we have to be reimbursed? Why can’t we just be exempt from the increased co-pay?
A: By law, the GIC has to treat all plan participants the same. The GIC can't offer one level of co-pays to one group and a different level of co-pays to other groups. The only way to "get around" the law is to have NAGE members pay what everyone else pays, and then reimburse them.
Q: How long will this special deal on reimbursements last?
A: The reimbursement program applies to any increases instituted up to June 30, 2011.
Q: How does the reimbursement program work? Where do I send my bills/receipts for reimbursement? A: The Commonwealth has not yet determined the mechanics of the reimbursement process. They haven't told us yet if the process will be automatic at the time of service, or if you will need to submit paperwork for reimbursements. At this time, we urge you to keep any receipts/bills you receive for health services. We will let you know as soon as possible how the reimbursement program will work.
Q: Why is the state offering this special deal to NAGE members?
A: The "deal" is part of the contract agreement reached between the Commonwealth and NAGE, and ratified by the membership in January 2010. The state agreed with NAGE that if our members were going to accept a furlough program, then they should get something in return. While NAGE members will receive co-pay and deductible reimbursements, many state employees will not.
Q: When will NAGE members be subject to deductibles?
A: Like co-pays, deductibles will be effective February 1, 2010. Also like co-pays, NAGE members will be reimbursed for their deductible expenses incurred up to June 30, 2011.
Q: My question isn't answered here; where can I get additional information?
A: The GIC has posted information on its web site www.mass.gov/gic. If you still have questions, you should contact the GIC directly at (617) 727-2310.