Deductibles of up to $4,500 urged for some family policies

Small-employer coverage addressed

Health insurance

September 08, 2000|By M. William Salganik | M. William Salganik,SUN STAFF

Insurance agents and brokers called yesterday for state regulators to approve higher deductibles - as much as $4,500 a year for a family - on some health policies offered by small employers.

Also represented at the public hearing, doctors' groups opposed the higher deductibles, with a spokesman for the state medical society calling it "Draconian." And advocacy groups, including parents who brought along hard-of-hearing toddlers to press for coverage for hearing aids, urged additions to the state's standard small-employer benefits package.

The Maryland Health Care Commission, which regulates health insurance offered by small employers, is charged both with establishing a benefits package that is "comprehensive" and with keeping the premiums affordable. While the commission's staff is recommending adding coverage of colorectal cancer screening, it is also suggesting higher deductibles as a way of meeting the affordability test.

Under state law, the average premium for the small-employer policy cannot exceed 12 percent of the state's average wage. Actuaries project that the costs could bump against the ceiling next year, so the commission is looking for ways to chip away at costs. The commission is scheduled to take action next week on how to modify the benefits package, with the changes to take effect in July.

About 475,000 Marylanders are covered under the state-regulated policies, which may be purchased by employers with between two and 50 workers. The average premium per employee last year was $3,648. Without changes to lower premiums on basic policies, fewer employers will offer health coverage, increasing the number of uninsured, Dennis B. Mather, regional manager for Benefit- Mall.com, an online benefits company, told the commission.

Maryland employers need a lower-cost alternative to make it more affordable," Mather said. "We have hit the wall."

One of the recommendations would raise the deductible on preferred-provider plans from the current $600 for individuals and $1,200 for families to $2,250 for individuals and $4,500 for families. An alternate calls for $1,000 for individuals and $2,000 for families.

Jay Schwartz, speaking for the Medical and Chirurgical Faculty of Maryland, said such out-of-pocket charges are "Draconian."

Robert Enten, representing the Maryland Association of Health Plans, an insurers' trade group, said, "Our experience has been that no one will buy those products when you increase the deductibles."

Emily and Scott Levin brought along their 13-month-old son Ryan. Testifying while Ryan fussed in her lap, Emily Levin said Ryan had been able to develop normally because he received a hearing aid before he was 7 weeks old, and that insurers should make sure other children with hearing problems have the same opportunity.

Anne Dorsey, a Baltimore County teacher, brought her 2-year-old daughter, Jada. When her insurer would not cover $4,000 for a hearing aid, she said, "I wiped out my retirement fund to meet my daughter's needs."

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