Marc Gousse, superintendent of the MDI Regional School System, believes that a gap plan can lower costs for health care systemwide without reducing benefits. ISLANDER FILE PHOTO

Plan offered to lower teacher benefit costs

BAR HARBOR — Lowering the cost of health insurance for teachers and other school employees without reducing the level of coverage is a goal of Mount Desert Island Regional School System officials.

Superintendent Marc Gousse thinks they may have found a way to do it.

He’s suggesting something called a “gap plan,” which lowers premiums and patient co-payments in exchange for raising the deductible that the employee has to meet.

Two representatives of Cross Insurance described the gap plan for MDIRSS teachers and other personnel at a forum Sept. 11 at MDI High School.

They said school employees would keep their current Anthem Blue Cross coverage. But the gap plan, provided by another company, would cover costs in excess of the deductible amount.

A majority of school system employees currently have a $200 deductible for individual coverage and $400 for a family plan, according to Nancy Thurlow, the MDIRSS business manager.

The deductible under the gap plan would be $1,000 for individuals and $2,000 for families. With those higher deductibles, premiums would be reduced and employees would be subject to lower co-payments.

Donna Power, senior account executive with Cross Insurance, gave several examples of the difference in the amount employees would pay out of pocket with a $200-deductible plan versus a $1,000-deductible plan.

In one example, an MRI exam, the employee’s cost would drop from $380 to $40. Outpatient laboratory tests would go from $215 to zero. With a hospital stay plus an MRI, the employee would pay $460 rather than $1,200.

However, with a hospital stay alone, the employee’s out-of-pocket expenses would increase with the $1,000-deductible plan, from $1,200 to $1,500.

Currently, the MDIRSS schools pay 82 percent of the cost of insurance for employees and their dependents; employees pay 18 percent. Both would pay less for premiums under the plan.

Thurlow said the percentage of the schools’ annual budgets that goes for health insurance varies somewhat from school to school. But overall, it’s about 14 percent.

Power said the health insurance premiums for MDIRSS employees this year total $6.26 million. If all of the covered employees enrolled in a gap plan with a $1,000 deductible, the Anthem Blue Cross premium total would drop to $5.65 million, a saving of $610,025.

After paying the gap premium, employees would save a total of $129,339; the school district would save $159,172.

Cross Insurance Vice President Allen Robbins said the gap company can afford to offer lower premiums because a large percentage of employees in most companies and organizations never reach the $1,000 deductible.

He said teachers and other school employees in Bucksport, where he previously served on the school board, are enrolled in a gap plan, and it is working well.

Gousse said gap plans are used widely in the private sector, but schools have been slower to embrace them. One reason for that, he said, is probably that “people are skeptical of change.”

But he said he believes a gap plan would benefit both MDIRSS schools and their employees.

“It doesn’t take away the Anthem Blue Cross plan, and it doesn’t compromise the coverage in any way,” he said. “It moves the deductible to a higher level, which … results in premium savings for both the district and the employee.”

Gousse said the next step is for school officials and school employees and their union representatives to study the gap plan.

“We know it works; it is legit. That said, folks on both sides need to look at the implications.”

This fall, representatives of the MDIRSS board and the unions are starting to negotiate a new three-year contract. Typically, salaries and health insurance costs are major factors in those discussions.

“I’m not trying to settle a contract by [proposing the gap plan],” Gousse said. “But health insurance cost comes up all the time in the communities. I want people to know we are paying attention and trying to do something about it.”



Dick Broom

Dick Broom

Reporter at Mount Desert Islander
Dick Broom covers the towns of Mount Desert and Southwest Harbor, Mount Desert Island High School and the school system board and superintendent's office. He enjoys hiking with his golden retriever and finding new places for her to swim. [email protected]
Dick Broom

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