Commission works on details of health reimbursement account expenses

The Cape Girardeau County Commission on Thursday worked on the details of whether $1,000 set aside for each county employee to cover medical costs would be paid out to workers who leave county employment and whether the county would keep adding to the fund each year.

Under the health insurance plan adopted by the county in December, each employee must pay a $2,000 deductible before the insurance pays anything. To soften the impact of the high deductible, commissioners established health reimbursement accounts in the county treasury to cover the first $1,000 in expenses.

But at the time, they left open the question of how the money would be treated in future years, but suggested that unused portions could accumulate, with employees who retire or resign receiving a large payout.

This week, County Clerk Kara Clark and insurance broker Jack Greene met to hash out the details, and realized that numerous issues complicate the accounts. For example, Clark told commissioners Thursday if premiums with the insurance plan rise dramatically and the county changes carriers the accounts may not be part of a new arrangement.

And Greene said another question that arises is if employees accumulate more than enough to cover their full deductible, the county must decide whether to keep putting $1,000 in the account annually or pay out the excess.

The county adopted a "consumer-driven" insurance plan that is designed to make workers be careful with their health-care expenses, Greene said. The reimbursement accounts defeat that purpose if employees feel they must use the money or lose it, he said.

"It is best that the employees feel that it is their money," he said.

Capping the total that the county would allow any employee to accumulate was another idea considered Thursday. County Treasurer Roger Hudson, who listened in on the discussions, said a cap could be a good idea, but not if it encourages employees to spend money they would otherwise lose. "A cap is only useful if it cuts costs to the county," he said.

In the end, Presiding Commissioner Gerald Jones directed Clark to write a plan for the money that only deals with how it is to be used in 2007, leaving out any cap on county contributions. The commission will review Clark's plan at a meeting Jan. 29.

rkeller@semissourian.com

335-6611, extension 126