AUGUSTA — With the help of her daughter, 92-year-old Florence Hartley reviewed her health insurance options from Aetna, selected the one closest to her previous plan and submitted her paperwork within 10 days, as requested.

The step was necessary after the Augusta Board of Education switched carriers for school district administrators, including retired ones from Aetna to Anthem Blue Cross Blue Shield.

Hartley, who retired from the school department at age 70 after working as the lunch program director for 37 years, soon received a letter stating that her prescription coverage had been denied because she lives outside the coverage area.

Hartley lives in Manchester, which borders Augusta.

Hartley has macular degeneration, so she relies on her daughter, Sandra Picard, to help understand her health coverage. The letter, which came in early June, stated that, starting July 1, Hartley would no longer be in a union-affiliated plan provided by Anthem Blue Cross Blue Shield.

“Anthem has been wonderful with us,” Picard said. “They communicate with us. Aetna hasn’t done that; (the) Augusta School Department hasn’t done that.”

Picard has since confirmed that her mother is covered by the plan, but she is still concerned, as are many retirees who were affected by the change, which was agreed to by the school board in May.

Several retirees have complained of administrative hassles and say they worry their new plan is inferior to the Anthem plan administered by the Maine Education Association Benefits Trust, which covers nearly all school employees and retirees in the state.

Augusta Superintendent Cornelia Brown said the school board wanted to contain costs and give employees access to more types of plans than what MEA Benefits Trust offers.

She said the board has always said publicly it wants “to get the best plan at the most competitive rate, both for their employees and for the taxpayers.”

MEA officials, however, argue that school department leaders are trying to weaken the MEA Benefits Trust and warn that the issue has implications in school districts throughout Maine.

Susan Campbell, chairwoman of the Augusta Board of Education, is president of the Maine School Boards Association and on its policy committee. Brown is also the Kennebec County representative on the executive committee of the Maine School Superintendents Association.

Union representatives see the changes in Augusta as a pilot program that could lead to a statewide shift.

“I think they’re looking at this, quite frankly, and saying, ‘See, we can make this happen. We can pull away from the Benefits Trust,'” said Rob Walker, MEA’s executive director.

Contract fight

Last year the Legislature passed a law intended to make it easier for school districts to solicit competitive bids on health insurance by forcing the MEA Benefits Trust to release claims data for individual districts.

The Benefits Trust sued the state in federal court to block implementation of the law, saying that releasing data would allow competitors to cherry-pick districts with the healthiest employees, raising premiums for those left in the pool, which now spreads risk among more than 70,000 people.

The Augusta School Department and the Maine School Boards Association have joined the lawsuit on the state’s side.

Augusta’s administrators are not represented by the union. Their contract does not specify MEA Benefits Trust as the insurance provider, which made it easy for the Augusta school board to make the switch.

In addition, because the group is small — about 50 active workers, retirees and spouses, according to MEA Benefits Trust — the school department’s broker did not need past claims information to solicit proposals.

According to the MEA website, 75 school districts requested their claims information from MEA Benefits Trust between October and April.

“They’re really interested in seeing what options are available and comparing them to what the MEA has with their situation,” said Dale Douglass, executive director of Maine School Management Association. “Given the status of budgets and the unlikelihood of huge increases in revenues, school boards are being responsible in investigating other options.”

After MEA Benefits Trust’s request for an injunction was denied by the district court in Bangor, they appealed to the U.S. First Circuit Court of Appeals in Boston. Douglass said a decision may be made by late August.

The Maine School Management Association administered its own health insurance program with Aetna for more than 20 years, but it will cease operating this month. A couple of years ago, Douglass said, members were faced with a huge rate increase, so the management association advised them to look for other options. Most chose the MEA Benefits Trust.

The Benefit’s Trust increase in premiums was 4 percent this year, far less than the 10 percent that Augusta school leaders initially budgeted.

The rate increase was 6.5 percent last year and 4 percent the year before.

Brown said she was not certain how much the school department saved by switching providers because employees have just finished choosing among plans with different costs.

At an April personnel committee meeting, Brown projected that the cost for Aetna would be $180,000 less than for Anthem.

MEA officials warn that Augusta could be hit with a large rate increase when the current rates expire next year because one serious illness could mean major expenses spread among a small pool.

Changes protested

Picard, Hartley’s daughter, and several retirees shared their stories of frustration at last week’s school board meeting and questioned why the board changed their insurance and asked for them to reconsider.

Former Cony High School Principal Gerry Massey said she felt secure on the Anthem plan, which carried her through several health emergencies with barely any out-of-pocket costs.

“That’s all over with now,” she said. “Because, totally unbeknownst to me, it was wiped out right from under me. I’m one of the ones who never received notification.”

Although some retirees attended presentations before the school board approved the Aetna agreement, and others received 10 days notice before having to enroll, Massey didn’t find out about the change until running into a friend at the grocery store.

The retirees had a premium for Anthem deducted from their June pension checks.

“I’ve had to cancel my appointments and my doctor’s appointments because they’ve deducted for Anthem, but they have not deducted for Aetna,” said Mary Barnes, former adult education director. “I have no idea if I have insurance or not.”

Former curriculum coordinator Joane Lebel, 62, was not able to attend the meeting, but she said later in an interview that she cannot find any in-network providers near Palm Springs, Calif., where she spends part of the year.

“I’d had Blue Cross Blue Shield or Anthem all my life, and I thought this was the plan I would have until I died,” Lebel said.

Like many of the retirees, Lebel reached out to MEA Benefits Trust for help parsing her options. She said she received conflicting or inaccurate information when she called the school department.

The school department contracted with Aetna through Hub International, a large brokerage firm. Joe Russo, senior vice president in the New England office, said contacting retirees can be difficult.

Russo acknowledged that there were tight deadlines and problems with the transition but said he and an Aetna representative will meet with the retirees as soon as next week to explain their benefits.

“I think there’s been a lot of drama around this because Anthem has been in place forever,” Russo said. “I think human nature is people get uncomfortable whenever there’s change.”

At the school board meeting, Campbell also said that the board will try to get answers within two weeks for a list of questions the retirees submitted about the school department’s decision-making process.

Picard hopes the board will decide to switch back to the MEA Benefits Trust Plan. Although her mother has received an insurance card, she doesn’t know why she was initially denied and fears other problems may arise.

“I’m getting frustrated at this point,” Picard said. “We’ve been doing this since last month and we haven’t gotten any further. I’ve faxed, I’ve emailed, I’ve scanned, and I’ve done everything else you can do.”

Susan McMillan — 621-5645

[email protected]

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