Five HMOs have reached agreement with the state on an overhaul of the state-employee health insurance program — while UnitedHealthcare of Florida continues to battle the changes in court.
The agreements, announced Wednesday, would tinker with a plan by the Florida Department of Management Services to offer only one HMO in each county to state employees. That plan touched off a legal battle, as United and two other HMOs stood to lose thousands of customers.
Under the agreements, six counties — including Miami-Dade, Broward and Palm Beach — would be served by two HMOs.
United would be the biggest loser under the plan, as it would be limited to 18 counties, after offering HMO coverage to state employees throughout Florida. An administrative law judge tossed out United’s legal challenge last week, but the company has taken the case to the 1st District Court of Appeal.
Kris Purcell, a spokesman for the Department of Management Services, said Wednesday the state’s offer remains open to United.
“They have a contract on the table ready to be signed, if they choose to sign it,” Purcell said.
But United contends that the process of awarding the contracts was flawed and doesn’t take into consideration discounts that the giant insurer could get from health providers. In a prepared statement late Wednesday, it also said the appeals court had issued a stay on finalizing contracts until the legal dispute is resolved.
“UnitedHealthcare is complying with a district court of appeals mandate that presently prohibits any party from entering into a contract with the state,” company spokeswoman Elizabeth Calzadilla-Fiallo said in the statement. “United continues to stand firmly behind the merits of its protest and all of its contentions.”
The contracts are worth hundreds of millions of dollars and would take effect Jan. 1. DMS contends that the overhaul will save an estimated $400 million over two years, in part because of the competition for contracts.
Purcell said the agreements reached with the HMOs will still yield similar savings. Those agreements are with Coventry Health Care of Florida, Florida Health Care Plans, Aetna, AvMed and Capital Health Plan.
Coventry and Florida Health Care Plans also filed legal challenges against the original version of the plan. But they dismissed those cases Saturday and negotiated agreements with DMS.
Under the original version of the plan, AvMed would have received contracts in 38 counties. Under the new plan, it would serve 37 counties — but also would share Broward, Miami-Dade, Palm Beach and St. Lucie counties with Coventry. Also it would share Volusia and Flagler counties with Florida Health Care Plans.
AvMed would give up Brevard County to Aetna, which did not file a legal challenge to the original plan but sought to intervene in the case.
Florida Health Care Plans only serves Volusia and Flagler counties. Without the new agreement with DMS, it would have been shut out of serving state employees.
Like in the original proposal, Capital Health Plan would be the only HMO in Leon County and six nearby counties that are loaded with state employees and retirees.
DMS expects the overhaul to take effect Jan. 1, with an enrollment period starting Nov. 7 for thousands of employees who will face choosing different health plans.
The changes apply only to employees enrolled in the HMO portion of the insurance program. Employees enrolled in the state’s preferred-provider organization plan (PPO), which is administered by Blue Cross and Blue Shield of Florida, are not affected.
By Jim Saunders
