PARKERSBURG - The Camden Clark Medical Center is planning to drop the spouses of employees currently covered under its medical plan if the spouse is able to obtain coverage through their own employer.
In an affidavit to employees that went out Wednesday, hospital officials said the rules covering spouses on the Camden Clark Medical Plan are changing.
"Your spouse will no longer be eligible for medical coverage under our plan if they have other employer-based coverage offered...," the affidavit said.
Employees are being asked if their spouse in employed, are they eligible for medical insurance through their employer and if they can, can they obtain single medical coverage that has an employee contribution of $125 or less per month. If employees answer yes to all three parts, the employee's spouse will not be eligible for the CCMC medical plan in 2014.
If they answered no to one part of it, the spouse is eligible for coverage under the plan. The CCMC employee will be responsible for the employee contribution for the medical plan option and coverage level that is chosen.
"This year several factors outside our control (the Affordable Care Act) have impacted our premium structure and plan design for 2014," said Tim Brunicardi, director of marketing and public affairs for the Camden Clark Medical Center. "All employer-sponsored medical benefit plans now have to pay two additional fees to the federal government.
"The Patient Centered Outcomes Research Institute fee and the Transitional Reinsurance fee are based on the number of covered lives in our plan."
The hospital's medical benefit plan is self-insured. The hospital pays Highmark Blue Cross Blue Shield a fixed fee to administer the claims and for access to their provider network. In the past, the hospital's premium structure only needed to support our members utilization of health care resources and the administrative fees.
Due to the Affordable Care Act, Camden Clark's medical plan can no longer afford to allow employees' spouses who have the option of being covered on their employer's plan to be covered on Camden Clark's plan, Brunicardi said.
"Spouses who are eligible to receive single medical coverage at an employee contribution cost of $125 or less per month will no longer be eligible to be covered by our plan," he said. "Open enrollment will begin next week at the hospital.
"At that time, employees have the opportunity to make adjustments to their plans."
Employed spouses will still be eligible to be enrolled in the hospital's vision and dental plans. Dependent children under the age of 26 will continue to be offered coverage in the plan. Regular part-time employees who work 40 hours or more per two-week pay period will continue to be eligible to enroll in the plan.
The changes will become effective January 2014.
There are no estimates right now on how many employees will be impacted by this change or what kind of savings the hospital is expected to make by doing this, Brunicardi said.
"The savings gained by making the change to our benefits package will allow us to offset the new ACA fees," he said. "Again, the key is that this change will allow us to continue to offer the outstanding/quality benefit package to our employees."