How will each regional service center identify and analyze three alternative health care options within their region?
By Bill Rusteberg
Texas Senate Bill 1444 requires each regional service center to establish an Advisory Committee of nine (9) superintendents to conduct a study assessing:
1. Health care needs of and health coverage options currently available to employees of member school districts to include an overview of current health coverage plans made available to district employees and including for each plan:
- The amount paid by districts and by district employees for premium under the plan; and
- The schedule of benefits; and
- Deductibles and other cost-sharing amounts; and
- A survey of district employees to indicate the level of satisfaction of health insurance coverage
2. Alternative health coverage options that may be available to include an assessment of three alternative health coverage options that are available on the open market or through self-funding of school district health care expenses, including for each alternative:
- The amount that would be paid by the district and district employees for premium under the alternative; and
- The schedule of benefits available under the alternative; and
- Whether, in obtaining the alternative, some or all of the districts in the region should jointly seek health coverage under that alternative as a group.
Note the bold, highlighted bullet point. This points to a risk pool arrangement, risk sharing among districts under a common umbrella. Or it could point to an association sponsored plan. Or it could be as simple as procuring coverage by way of an interlocal agreement for “approved” vendors each of which would offer each district coverage through an “approved” carrier, or a third party administrator and not to be construed as a risk pool with no sharing of risk between districts.
To properly evaluate an existing risk pool a Regional Service Center would be prudent to review the following without which they cannot conclude a proper analysis:
- Audited financials
- Independent actuary analysis
- Review of stop loss policy terms and conditions
- Governance
- General underwriting requirements
- Requirements to enter the pool
- Requirements to exit the pool
How will each regional service center identify and analyze three alternative health care options within their region? What criteria will be utilized in the evaluation process? Will a regional service center be wise to issue a Request for Qualifications for alternative health plan options for districts in their respective regions?
Each Regional Service Center’s Advisory Committee study must be submitted to the Texas legislature by November 2022.
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