The Commonwealth continues to face challenging budget times.  Many worthy initiatives including education, local aid and transportation are competing for scarce resources as health care costs crowds out the state budget.  For this fiscal year, a $765 million shortfall is projected; the GIC has a $165 to $190 million deficit.  Most of the GIC’s budget shortfall is structural – we have been underfunded for the last three years because the budget base was not updated for the additional members that we have added, the end of federal funds, and the supplemental budgets we’ve received.  The Fiscal Year 2016 premium requests we received from the plans, especially two of the larger ones, were not realistic given the budget situation. Additionally, too many patients use expensive academic medical centers for routine care, further increasing costs for all of us. 

The Administration has committed to making the GIC’s current budget whole.  However, despite the new budget base, there’s no room for increased spending next year.  With many pressing concerns, agencies have been asked to come in with level funding.   The GIC has been pushing hard through the Centered Care Initiative to change the way providers are paid: moving from fee for service payment arrangements that reward providers for ordering unnecessary tests and procedures to global payments.  This has been a tough slog and progress has been slower than we would like.  We will continue to push for these changes, but in the meantime, the Commission has had to make some difficult decisions.  These were not easy decisions and they will affect all of us who work for the state and local communities. 

We encourage you to take charge of your health and take advantage of ways to lower your out-of-pocket costs. 

All members:

  • Work with your Primary Care Provider (PCP) to navigate the health care system.
  • Use urgent care facilities and retail minute clinics instead of the emergency room for urgent (non-emergency) care.
  • Make copies and bring the prescription drug formulary from your plan’s website with you to all doctor visits.
  • Read about ways to take charge of your health; the GIC’s website has a wealth of articles and links to additional resources:
  • Eat healthy, exercise regularly, don’t smoke, and find ways to de-stress.

If you are an Employee or Non-Medicare Retiree/Survivor:

  • Seek care from Tier 1 and Tier 2 specialists.  Over 164 million claims have been analyzed for differences in how physicians perform on nationally recognized measures of quality and/or cost efficiency.  You pay the lowest copay for the highest-performing doctors:

««« Tier 1 (excellent)

  «« Tier 2 (good)

     « Tier 3 (standard)

  • If you are in a tiered hospital plan and have a planned hospital admission, talk with your doctor about whether a Tier 1 hospital would make sense.
  • Use your health plan’s online cost comparison tool to shop for health care services in advance.
  • Consider enrolling in a Limited Network Plan to save money on your monthly premium.

This information provided by the Group Insurance Commission .