MESSA’s Generous Insurance Benefits

What is it about MESSA that keeps the costs of its programs so unusually high? For the most part, it is the design of MESSA's benefit packages. In simplest terms, the more insured expenses MESSA is willing to cover, the higher its costs are going to be. Given its purpose of providing the maximum possible benefits to MEA members, MESSA is not averse to accepting higher costs, so long as it can pass them on to school districts. At the present time, the benefit structures of MESSA's most often purchased health insurance plans are extremely generous, covering most health-related expenses in full. Consequently, these benefit levels are driving up the cost of MESSA insurance at a quicker than usual pace. Consider that the average premium for MESSA full family insurance increased at an average annual rate of 15.34 percent between 1986 and 1991, based upon the latest available data.38 Yet in the school employee market as a whole (with MESSA factored in), the average annual increase in premiums was 13.76 percent. For Blue Cross/Blue Shield, the average annual increase was a "mere" 9.63 percent.

And just how generous are the health insurance benefits offered by MESSA? The most frequently purchased MESSA plans are the Super Care and Super Med programs. A sample of the medical expenses covered by these plans includes:39

  • 100 percent of all in-patient and almost all out-patient hospitalization charges,

  • 100 percent of all surgery and anesthesia charges;

  • 100 percent of all in-hospital medical visit charges including pregnancies;

  • 100 percent of diagnostic x-ray and laboratory charges;

  • 100 percent of charges for cancer screening exams and tests;

  • 100 percent of prescription drug charges (Type I plans require a $2.00 co-payment and Type H plans require a $.50 co-payment);

  • 100 percent of home health care charges;

  • 100 percent of human organ transplants including related expenses;

  • 100 percent of allergy testing expenses;

  • 90 percent of miscellaneous medical charges, such as ambulance service, physician office visits, blood transfusions, and prosthetic devices (Type I plans require an annual deductible);

  • 90 percent of out-patient psychiatric treatment.

MESSA also provides a family "stop loss" provision that covers all out-of-pocket medical expenses in excess of $1,000 per year. This is in addition to a $2 million lifetime maximum benefit for major medical expenses. Furthermore, all Super Med and Super Care plans provide additional benefits for life insurance and accidental death and dismemberment.

The cost implications of generous insurance benefits are simple to comprehend. Suppose, for example, that a person was in need of a liver transplant costing $10,000. If an insurance administrator is not willing to cover organ transplants, it will not assume any costs for the operation. Yet if MESSA offers to cover 100 percent of the cost, it must come up with $10,000. MESSA compensates for the additional cost burden of this benefit by spreading it among all customers and adjusting premiums accordingly. It follows that insurance premiums are almost entirely dependent on the expected amount of claims and the anticipated extent of accompanying costs. When cost predictions are high as a result of greater willingness to accept certain claims, premiums are naturally going to be much larger.

Without question, public school employees deserve reasonable insurance benefits. MESSA has made a commendable effort at providing its members with generous benefits, but benefits that are too generous create budgetary problems for those school districts that are actually paying for MESSA insurance. If benefit levels were restructured to a responsible level, premiums rates would decrease, and school districts would save more on their purchase of MESSA insurance. What is a "responsible" level? First off, the public should take notice that the state's employee health insurance program costs $1,000 less per person than MESSA insurance.40 In any event, so long as the insurance now provided by MESSA is diverting huge amounts of public funds away from classrooms, more reasonable insurance programs are certainly worth considering.