- The Progressive Pulse - http://pulse.ncpolicywatch.org -

A State Employee’s $8,000 Baby: Decent health plan or just limited catastrophic coverage?

In the current debate over the changes to the NC State Employees and Teachers’ health plan, some policymakers have asserted that the NC State Plan is as good or much better than plans available in the private sector.  A look at the data from the most recent comprehensive survey of private employers shows this simply isn’t true.

State employees and teachers pay much higher cost sharing amounts than the average worker in private industry at a large firm in the South.  In this context, whether state employees pay a new monthly premium or not – one of the more visible issues – is increasingly irrelevant.  The real cost in the plan is the enormous cost sharing required.  For example, if a state employee decides to have a baby and has the bad judgment to be pregnant in July and so must meet cost sharing in two plan years, total costs to the employee could easily be $8,000 for a birth with a few complications in the hospital.

Type of Cost Sharing Average PPO Plan in the South (large firm)

Proposed changes to NC State Employees’ Health Plan (S265)

Annual deductible $460 $700
Annual out-of-pocket maximum coinsurance Less than $2,500 for most workers $3,210
Primary care co-pay $22 $30
Specialty co-pay $31 $52-$70
ER visit co-pay $109 $233
Average monthly premium $71/mo $22/mo

Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2010 http://ehbs.kff.org/ [1]; NC Senate Bill 265, NCGA 2011;  NC State Health Plan Benefits Booklet 2010.