Health care change for state workers

The state of South Dakota developed a Tier 1 plan of healthcare for state employees. The Tier 1 health care went into effect on April 14. SDSU full-time employees are impacted by this change because they are considered state employees.

“Those [Tier 1 facilities] are facilities that the states has connected with to provide procedures at a lower rate,” said Marc Serrett.

 The Tier 1 plan is used for individuals who need to have complex procedures. The main function of Tier 1 is to conduct cardiac, orthopedic, bariatric, gastroenterology and renal care procedures.

“The reason the change occurs was because they [the state] had several years of back to back going over the budget for the state health plan,” Steckle said.

The Tier 1 facilities were implemented to try save the state and the state employees money.

“The Tier 1 services are not developed for more routine types of care; they are designated for specific procedures,” said Tom Steckle from the Bureau of Human Resources.

The people who are going to be impacted by this change are people who need to undergo complex procedures. Yearly check–ups are not included in the Tier 1 services. SDSU students will not be impacted by this change; unless, they are a full–time state employee.

 “They [state employees] have choice to use a Tier 1 plan or a non–Tier 1 provider. They can use a non–Tier 1 provider but there is going to be a cost.” Steckle said.

 State employees have a choice whether or not to use a Tier 1 facility. If state employees choose to not use a Tier 1 facility, they will pay higher out of pocket costs.

 “We have had some complaints for some employees,” Steckle said.

The Tier 1 change has received mixed reactions. One issue that state employees living on the western side of the state  have encountered is that there are no Tier 1 facilities; these state employees face long travel distances to receive care from a Tier 1 facility or they are going to have to pay large out of pocket costs for the procedures. 

“The Tier 1 benefits is all dictated at the state level,” Serrett said.

 The Tier 1 change has impacted local communities because residences have health providers in their area that are not Tier 1 facilities.

   “It will save state employees money, if you are willing to drive,” Serrett said.

Brookings Health System is not a Tier 1 facility. If any Brookings residents are state employees they will have to travel to Sioux Falls in order to receive any Tier 1 procedures without having high out of pocket costs.

“We do have some data that looks at individuals who are using Tier 1 provider and we are seeing that individuals are choosing to not using Tier 1 provider,” Seckle said.

This program was only implemented four months ago so there is not a large amount of data about the feedback for the Tier 1 change.

“The idea of a narrow network is something that is utilized throughout the country,” Steckle said.