At Briggs - Humana reneges and Compcare
gets out early
Since the July 8th ratification of the Briggs & Stratton Contract,
two insurance companies have effectively dumped the employees of Briggs &
Stratton, including the members of Local 7-232.
Humana, a carrier new to Briggs, that had quoted service and rates for
the new contract, failed to keep the terms of the agreement that was ratified.
Compcare, who had provided insurance for Briggs and Local 7-232 members
for over 30 years, was not being renewed as the HMO provider, but had an
agreement to continue service through the end of 2001. They chose to end the
relationship on a sour note by trying to gouge our members.
Humana reneges
During negotiations, Compcare came in with a proposal that would have
raised insurance rates prohibitively. It was decided to find another source of
insurance for the HMO option. Briggs contracted with Aurora to provide services
for our members in an EPO (Exclusive Provider Option). An EPO provides benefits
in a manner similar to an HMO, but it is self insured by the employer rather
than insured by an insurance carrier. An agreement was reached with Humana to
provide HMO insurance at Briggs & Stratton for providers not included in the
Aurora network.
This agreement was reached prior to the July 8th meeting. We had agreed
on premium prices, including the portions to be paid by Briggs and the Local
7-232 members. We had extensive details about the providers and coverage
provided and Humana had even offered to send representatives to the contract
ratification meeting to explain their plan. This was not done, we had adequate
details at the meeting, including Craig Reynolds from Briggs to explain all
plans.
Less than a week after the ratification meeting, Humana notified Briggs
that they would not honor the quotes used in negotiations. Instead, they
proposed rates considerably higher than those agreed to.
This came as a total shock, since there was an agreement in place and it
had been presented to the membership. The Company refused to accept higher
rates, since they knew that the cost of insurance and how it had been handled
was a major consideration of the members in their decision to accept the
contract. The Company is investigating possible legal action that may be taken
against Humana for not honoring the original agreement.
To provide the negotiated benefits, the Company went to work and set up
another EPO to provide services for the members who choose providers outside of
the Aurora network. The Company agreed to maintain the rates quoted for Humana
and take the risk for any cost in excess of the quoted premium.
EPO to replace Humana
The EPO to replace the Humana network is called the Custom Premier EPO.
It allows members to use providers in the HCN network in an eight county area in
Southeastern Wisconsin, except for those in the Aurora network.
Benefits will be provided as agreed in the July 8th contract. The biggest
difference is in the pharmacy network available under the EPO.
Prescriptions for the Custom Premier EPO , the Aurora Premier EPO and the
Aurora Family EPO will be available only through Aurora Pharmacies if the member
wants to pay only the $14.00 co-pay. Members who choose not to use the Aurora
Pharmacies, may use pharmacies in the broader PERxCare network. This network
includes many providers, but does not include Walgreens. Members who use the
PERxCare pharmacies will have a benefit that provides 85%, 75%, or 65% of the
cost of the prescription after a $70 per calendar year deductible, as was
described in the July 8th agreement. Express Scripts will be the provider for
maintenance drugs by mail order.
Compcare forces Briggs out
As the insurance department at Briggs was scrambling to be sure that they
could provide the negotiated level of benefits for members who had planned on
using Humana next year, another bomb was dropped. On August 27th, Briggs
received a notice from Compcare that they were not going to live by the agreed
to prices for the rest of the year. Instead, effective October 1st, Compcare
intended to increase rates 24.9%. They inferred that this could happen again on
November 1, and December 1st. Compcare claims to have the right to increase
rates up to 25% at any time with 30 days notice. This is because of some
provision in the State insurance code and a reference to that code in their
standard contract.
Action delayed until December
Briggs strenuously objected to this increase. After heated objections,
discussions and negotiations, they got Compcare to agree to forego the increase
as long as Briggs left Compcare by December 1st with the Premier benefit
packages. (Aurora Premier, Aurora Family Premier and Compcare Blue Premier) The
Special Edition and Point of Service benefit packages will continue until the
end of the year at the current rates.
This means that members that are currently under one of the Premier plans
will need different insurance on December 1st. Briggs has set up EPOs to provide
the benefits of the Compcare HMO Premier Plans for the month of December.
Members in those plans should not have to make any changes in providers, but
they will have to use the narrower network of pharmacies. Maintenance drugs will
be available through Express Scripts. Members in the Premier plans will receive
two new identification cards, one for insurance and one for prescriptions, in
late November. Members using non Aurora providers should double check to be sure
that their doctor is in the HCN Network, but all of the major clinics and most
other providers that were in the Compcare Network are also in the HCN network.
Open enrollment for 2002
During November, open enrollment is also underway for the medical plans
for 2002. That is for changes effective January 1st. This process will not
affect the changes that will happen in December.
Because of the significant changes being made to the insurance plan, the
Company set up meetings in October for all members on Company time so that
everyone would hear about all the changes and have a chance to ask questions
about the changes.
Through this process, the Union was kept informed and we believe that
Briggs made every effort to be sure that the agreed to benefits are in place at
the agreed to rates.
Membership Meeting
