The Department of Employee Trust Funds is looking to bring in a new expert to research coverage in the state.
The Georgia Department of Employee Trust Funds (ETF) is now working to hire a new consultant in Atlanta who will be able to research potential reforms to the $1.5 billion worker benefits program in the state, including the use of self insurance in order to replace the current competitive HMO model.
The ETF plans to award this consultation contract to the Segal Company, according to recent insurance news.
Spokesperson for the ETF, Mark Lamkins recently revealed that the department has intentions to give the contract award to Segal Company. That organization will then be responsible for conducting an evaluation of the ten various aspects of the worker benefits program among other tasks. Primary among those responsibilities will be to gain a better understanding of how to go about using self insurance as an alternative to the current system.
Self insurance has become a considerable focus for the health care reform in the state in this specific area.
The consultant that is hired will be evaluating such areas as wellness, pharmacy, disease management, mental health, as well as the use of plans that are consumer driven. It will look into certain efforts for steering patients toward certain specific preferred providers, and will consider the process of providing its own coverage.
If the department decides to provide its own coverage, it will mean that it will be responsible for making the payments of benefits directly to those who are covered and who have made claims. This would make it responsible for the risk of facing losses, instead of having to pay an insurance company for this type of coverage.
At the moment, the state purchases coverage from about 18 HMOs from which the employees have the choice. With self insurance this system would be different as the department would be paying the workers directly for their claims and would not be limited to specific providers based on the traditional programs as is currently the case. This type of coverage model is becoming increasingly popular for consideration in many areas.