It is a new insurance world, with the Oregon Educators Benefit Board offering health insurance plans beginning October 1.

Insurance has long been challenging in bargaining and this has not changed with the creation of OEBB. Pay additional attention to these areas:

Plans - Collective bargaining agreements still reference specific benefit plans by name. While this practice has been discouraged, with districts transitioning to OEBB plans, it is especially important now not to name specific plans or benefit levels. Rather, consider language limiting the number of plans that may be offered. In the past, the carriers themselves usually limited the plans a district could have. Under OEBB, each employee group can have up to four medical plans. Districts should consider how health plans will be chosen for each employee group. Earlier OEBB publications and rules indicated that each employee group would choose plans. The current draft of proposed

OAR 111-030-0005, however, states "Districts and employee groups will select the medical, pharmaceutical, dental and vision plan options to be offered to each employee group."

OEBB representatives have explained that the intention is for districts and employee groups to choose plans as they have in the past. Collective bargaining agreement language may delegate the choice to the employer or the union. If every employee group selected different plans, a district could conceivably offer nine plans, which could present an administrative challenge. Districts can bargain to limit the number of plans each employee group may select.

If a contract does not address this topic, the choice should be subject to mutual agreement.

Keep in mind that plan selections for medical, pharmaceutical, dental and vision coverage must be submitted in writing to OEBB no later than June 30 for the 2008-09 plan year.

Opt-outs - Many collective bargaining agreements contain language regarding opt-outs, or employees who elect not to take insurance benefits. Some districts provided a contribution to a Section 125 account in lieu of an insurance contribution, or simply allowed employees who had other coverage to not take any benefits providing no benefit. OEBB rules allow employees to receive the full cap amount as cash. Districts should consider if this is acceptable and if not, specifically spell out in the contract that no cash will be paid in lieu of benefits. To align with the OEBB administrative rules, it is also advisable to refer to a "waiver of benefits" rather than an "opt-out."

Caps - District caps have traditionally applied to premiums for medical, dental (including orthodontia) and vision insurance. Eventually, OEBB may offer additional supplemental coverage, and districts should consider whether they are willing to have district dollars go toward such coverage. If not, districts should bargain specific language about the types of coverage cap dollars may be used for, i.e., primary medical, dental and vision. Districts with percentage caps, in particular, need this clarification to prevent them from having to pay, for example, 95 percent of all elected benefits. As noted in the previous section on plans, percentage caps may become more challenging to manage with more plan options, which could result in higher district costs.

Pooling - Several districts have pooling arrangements that set aside funds from employees who opt out to have their cap dollars placed in a pool to reduce the out-of-pocket expenses for employees who take coverage. While this is still acceptable, it is important to make sure the issues discussed above in opt-outs and caps are resolved. Increasing costs of insurance and the transition to OEBB have caused many employee groups to evaluate purchasing insurance using tiered rates. In most cases, tiered rates would result in substantially larger out-of-pocket contributions for employees electing to take family coverage. Districts may want to consider pooling the dollars up to the cap amount that employees who elect single and two-party coverage don't use to offset the out-of-pocket expenses of the other employees.

Regardless of insurance carrier, districts should keep language about coverage being subject to carrier rules, regulations and underwriting guidelines. This will protect districts if OEBB or the carrier change plans in the future. Districts may want to consider other protections against changes or losses that result from OEBB administrative rule changes or enrollment processes, as this is uncharted territory.

Change is always difficult - especially when it deals with individuals' health care. Now is the time to focus on getting facts and seeking clarification to facilitate good decision-making.