Even though he's married and a father/ Beardstown firefighter and paramedic Randy Robeson is not enrolled in the city's family medical insurance plan, which carries a hefty monthly premium of about $1,200.

Instead, Mr. Robeson is enrolled for individual coverage, while his wife, who is employed by a hospital, carries family medical insurance coverage for herself and the couple's children because her plan is cheaper. The monthly premium for the city's family insurance plan provided by Blue Cross-Blue

Shield of Illinois has jumped more than $400 over the past two years, according to Beardstown City Clerk Brian "Petie" Ruck. “The family plan is just out of control," said Mayor Bob Walters, referring to the cost.

"That's why we have no one working for the city who is getting complete family coverage," Mr. Robeson said. Complete family coverage would include both spouses and any children.

Of the city's 50 employees on the medical plan, 24 have selected cheaper family coverage options also offered through the city's plan, including covering just the spouses or the employee plus any children, Mr. Ruck said.

Others have gotten their own family insurance plans at a cheaper rate, but offer less benefits and carry a higher out-of-pocket deductible than the $500 deductible under the city's plan, Mr. Robeson said.

The problem isn't isolated just to Beardstown. "It's a national problem," said Mayor Walters. "Everybody is having a problem with attaining affordable health insurance."

A comparison of rates for several area businesses and small agencies supports the mayor's conclusion.

 

Elm City Rehabilitation Center                                                  I

This Jacksonville non-profit agency's President and CEO Tom Frederick is enrolled in the family plan to provide health insurance coverage for himself, his wife and children.

On May 1 his family insurance premium jumped from $868 to $1,158 per month. With the agency paying two-thirds of the cost its employees' individual coverage, that leaves Mr. Frederick paying $895 per month for his family's medical insurance

That's equal to about $10,500 a year that Mr. Frederick pays our of his own pocket. "I've got staff who question their ability to afford health insurance for their families," Mr. Frederick said.

The agency provides vocational services for people with disabilities. The agency's health insurance provider also is Blue-Cross-Blue Shield of Illinois. Mr. Frederick is enrolled in a PPO plan which enables his family to choose a primary care physician outside of the insurance provider's network of doctors. The monthly premiums for individual coverage also have increased: from $329 to $398, according to Mr. Frederick. The HMO option also rose, from $292 to $375 monthly.

The bulk of the ageny's staff of 46 is enrolled in the PPO plan under individual coverage. Mr. Frederick said the agency has seen a $18,000 a year increase to provide the health insurance benefit for its employees.

"Our insurance costs this year is going to be over $100,000. "That's the part that Elm (3 pays for employees." After reviewing other options, the agency's employee-based health committee decided to stay with its current health insurance provider because they felt the plan best fit their situations, Mr. Frederick said.

About 10 employees, however, are not insured through Elm City, either because they are insured through their spouses plans or have found their own insurance, Mr. Frederick said|

Among those dropping out of the agency's plan are employees who have healthy families. "They are going back to the exact same plan where we're getting our plan through to gel/ plans for their families, but, of course, they have to be healthy," Mr. Frederick said. "By  doing that, they'll knock $400 a month off their payments."

Eli Bridge Co.

This Jacksonville firm has been fortunate that its 25 employees' health histories have been fairly good, said its President and CEO Patty Sullivan.

That factor and a higher deductible of $1,000 have kept the monthly premiums for the PPO plan provided by Health Alliance Family relatively low in comparison. Even so, the company, which builds amusement rides, saw its health insurance costs increase 30 percent last August, she said.

Family plan premiums range up to $600 per month, while the individual premiums vary anywhere from $50 to $200 a month, depending on options selected by the employee. Eli Bridge pays more than half of its employees' monthly premiums for individual coverage.

The firm reviewed six different health insurance plans before selecting its current insurance provider, which they have been with for about two years, Ms. Sullivan said. The company also attempts to keep its insurance costs down by encouraging its employees to participate in wellness activities, Ms. Sullivan said. The increases in health insurance are being driven by factors outside her firm's control, she added.

She cited the cost of delivering the high-tech quality of medical care now available, as well insurance companies passing along their losses stemming from the Sept. 11, 2001 terrorist attacks. Sullivan said.

"Malpractice lawsuits are another thing that kicks them up," Ms. Sullivan added. She also sees increased health insurance costs resulting from new federal rules regarding privacy that change the way hospitals, nursing homes and other healthcare providers share information about patients. The regulations, known as HIPAA, will require extensive training and those costs will more than likely be passed on users of healthcare systems, Ms. Sullivan said.

The rising insurance rates are impacting the ability of small industries to remain competitive, she said.

"If I'm paying more for these kinds of costs, my competitors out of Europe can come over and sell for less than the U.S. manufacturers can," Ms. Sullivan said. "It's eroding the whole manufacturing base in the U.S.

Bound to Stay Bound Books

With about 310 employees. Bound to Stay Bound Books in Jacksonville has managed to keep its healthcare premiums down through a Blue Cross-Blue Shield of Illinois managed- care system, also known as HMOs, said the company's Human Resources Director Andy Smith.

The firm's HMO plan has three tiers of rates: Individual coverage at slightly more than $200 a month, of which the companies pays 100 percent; individual plus one dependent, costing slightly more than $410 a month; or single plus two or more dependents at little more than $550 per month

"The PPO is by its nature more expensive than an HMO because you do not have the "gatekeeper's system' of referrals,” Mr. Smith said.

In an HMO plan the employee must chose a primary care physician from the roster of doctors in the insurance provider's network. To see doctors outside of the network, the employee must first get a referral from the primary care physician.

"Having to select a doctor in the network is something that people have a difficult time accepting at first, but after a while, when they understand the system and are comfortable with their primary care physician, it's no longer a really big issue," Mr. Smith said.

He has been able to compare the rate differences between the two types of plans because the company has 15 out of the area sales people who are on a PPO plan through the company.

The PPO rate per individual is $300 a month; an individual plus one dependent, about $590 monthly; and an individual plus two or more dependents, about $800 per month, according to Mr. Smith.

"We've been very fortunate to come in with some excellent renewals the last two or three years in combination of having a few good years of low claims," Mr. Smith said.

When there are illnesses, those costs can be spread over the larger number of members in the plan without a noticeable increase, he said.

The firm also tries to promote active, health-conscious employees by sponsoring Health Awareness Month every May, offering employees free blood pressure, cholesterol and bone density screenings, as well as body fat analysis.

"We also try to encourage that really throughout the year. So those are some of the things you can do outside of just trying to negotiate a good renewal rate."