By Tim Bonfield
The Cincinnati Enquirer

For many employees of Greater Cincinnati companies, the bad news has arrived: You'll pay more for health benefits next year and get less coverage in return.

But this year there may be more you can do about it.

More employers are offering health plan choices that allow workers to pay lower monthly premiums. You save money if you stay healthy. You may have sudden, big bills if you get really sick.

"Our message is resonating with employers. Consumerism is the next tool they will be using to control health care costs," says Larry Savage, president and CEO of Humana Health Plan of Ohio Inc. "The fact is, many people are overinsured. About 70 percent of people spend less than $500 a year on health care" after monthly payroll deductions.

As many as 60 percent of area employers face Jan. 1 renewal dates for their health benefit plans. Workers at some of the biggest companies already have gone through the process. Employees at smaller companies will be making decisions into December. Many mid-sized employers are sending out re-enrollment information now.

Every company's situation varies, depending on the type of plan it has and the amount of health claims its employees made the previous year. Cincinnati employers are paying about 15 percent more to provide health benefits in 2004 to employees.

Employers are passing on much of the cost to workers. They are taking more out of paychecks for coverage, requiring higher payments for those who seek medical care, reducing coverage, or all of the above.

For people in health maintenance organizations, or HMOs, doctor visits that cost $10 as recently as two years ago now cost $15 or $20. Hospital visits that once were covered 100 percent often come with a $250 to $500 co-payment today. Some plans now expect people to pay 10 to 20 percent of hospital bills.

For the relatively healthy average employee, higher rates add up to $289 more per year coming out of a paycheck, according to Hewitt Health Value Initiative.

But people with health problems feel a double hit because they also face paying higher deductibles and co-payments when they seek medical service.

Feeling the strain

In Colerain Township, the Foley family is feeling that double pinch, even though they have pretty good health benefits and they get help from a government program.

The family gets coverage through the printing company where Bill Foley, 46, works. Cindy Foley, 41, works as a waitress. Together they earn about $50,000 a year.

They have three children, a 17-year-old son, Ryan, and 9-year-old twins Megan and Kyle. Megan was born with Rubinstein-Taybi Syndrome, a genetic disorder similar to Down Syndrome.

The Foleys' health plan pays 80 percent for covered services, leaving the family to pay the other 20 percent, up to an annual spending cap. In recent years, the deductibles the family must pay before the insurance kicks in have risen from $50 to $250 per person.

Even so, they consider themselves lucky. The printing company hasn't charged workers any share of the monthly insurance premium - a perk that the Foleys fear might change soon.

"If we had to depend on insurance through my work, we'd be in worse shape. People at my work are paying $50 a week, plus all the deductibles, and the coverage isn't as good," Cindy Foley says.

Megan has needed lots of care, including regular physical therapy and speech therapy sessions since she was diagnosed with her condition at age 4. She's already hit the lifetime maximum benefits for speech and occupational therapy, her mother says.

Most bills not covered by Bill's health plan have been covered by Ohio's Bureau for Children with Medical Handicaps.

But that program doesn't cover other family health bills, such as the two days that Kyle spent in the hospital two years ago after breaking his leg in three places during a baseball game.

"We've owed as many as six places at a time, now we're down to two," Cindy Foley says. "We pay $150 a month until we work them all down."

Still, the Foleys manage to get by. They have a house, thanks to some inheritance money that covered the down payment. They've made do for years driving "junker cars." They rarely go to movies.

"The girls at work keep saying, you need to take a vacation," Cindy Foley says. "I say, 'Yeah, one of these years.' "

A new approach

Locally, Humana Inc. and Anthem are aggressively promoting plans that allow employees to choose

The concept: a menu of choices that forces employees to make trade-offs between paying more per month for full coverage or paying more at the doctor's office when someone gets sick.

More people, including some families with children, are willing to risk paying as much as $2,000 or $3,000 should illness strike in return for sharply lower payroll deductions.

In July, Host Communications, a 350-employee sports-marketing firm based in Lexington was one of the first companies to buy into Humana Inc.'s "SmartSuite" line of health plans.

Of four choices offered, the lowest-cost option allowed employees to cut their payroll deduction more than 50 percent in return for taking the risk of paying up to $2,500 a year in co-payments and deductibles. People who opted to keep an HMO-like plan with flat fees for doctor visits and minimal payments for hospital care saw paycheck deductions go up 18 percent.

The company has been pleased with the results, says J.J. Noval, senior vice president of human resources. The company had absorbed rate increases for five straight years without increasing what employees had to pay. But facing a 26 percent increase next year to keep the old health coverage meant things had to change, Noval says.

"The nice thing about it was that we contained costs and employees got choices," Noval says. "Health care has become so complex that it's presumptuous for a company to assume we know the needs of each employee. This way, employees get to make the trade-offs."

About 6 percent of the 400,000 members Humana covers in Greater Cincinnati will be covered by such plans next year. More than 200 other employers in Ohio have signed up for Anthem By Design, Anthem's version of a consumer-choice plan.

In Cincinnati, the new health plans have attracted attention at Union Central Life Insurance Co. About 1,100 employees, including 700 locally, will be checking out Humana's online comparison service starting this week.

The company has seen its health benefit costs rise about 10 percent a year for the past few years. Now, Union Central hopes it can control costs by letting employees pick their coverage.

"We're not sure how this will work out. We've seen some projections. It seems like a good idea. But this is a whole new concept for us," says Connie Retherford, Union Central's manager of compensation and benefits.

E-mail tbonfield@enquirer.com