Guest Article: Retiree Benefit Carve-Outs: A Remedy for Rising Healthcare Costs?

Guest Article: Retiree Benefit Carve-Outs: A Remedy for Rising Healthcare Costs?

01 Nov 2019

A career in public school education typically promises rich, lifelong health insurance benefits. But the increasing retiree population, coupled with constantly rising healthcare costs, makes it difficult for school districts to manage their retiree health plans. You may have heard that carving out these benefits—especially from NYSHIP—could be a remedy. But is it true?

Many states have no funds set aside to pay for retiree healthcare benefits, and, until recently, had not calculated what their obligation to retirees would be. States do not have funds for 93.4% of other post-employment benefits, which also include things like life or disability insurance.1

Health benefit plans for retirees aren’t as efficient as they can be, which puts pressure on administrators and former employees who use those benefits. State benefit health plans haven’t lived up to their promise. Retirees move out of state, or to another county or city in their school district’s home state, triggering out-of-network healthcare costs. These higher costs, coupled with increasing copays, are burdensome for retirees living on fixed incomes. Administrators feel the pain, too, as they spend a large part of their time answering questions about health plans from retirees.

Retiree benefit carve-outs can provide a number of advantages for all stakeholders such as meeting the needs of retirees that may no longer live near the school district. Here’s an example: A Long Island school district leveraged a carve-out that offered lower copays, eliminated in-network and out-of-network costs, and eliminated deductibles. This gave the retiree members the freedom to see any provider across the country so long as their provider accepted Medicare. This was all possible because the District turned over the benefits administration to a third-party administrator (“TPA”). The TPA handled everything from negotiating contracts to enrollment, day-to-day management, compliance, reporting, and member and call center services. In the end, the District saved $2.2 million in one plan year, all while continuing to offer rich benefits to its retired workers.

Here’s an important caveat: The transition to a retiree benefit carve-out won’t be successful without careful planning and information sharing. Because of the spotlight that’s shone on school districts and other public entities, it’s important to go to retirees and those hoping to retire soon with clear information on what to expect from their new benefits plan. Ideally, communication should begin when the plan is introduced and continue three to six months after rollout to help ease the transition.

The first question that employees will ask is, “Will I lose the quality of benefits I’ve grown accustomed to?” An employee education and communications campaign is an ideal opportunity to tout the advantages of the retiree transition, such as savings on copays, no network and no deductible, plus dedicated support for their healthcare claims and benefit questions.

1 Pew Trusts, “Update: 50-State Survey of Retiree Health Care Liabilities.”


Bryan McManaway

Benefits Consultant

Corporate Synergies

With a careful rollout strategy and focused member services, retiree benefit carve-outs can provide savings for public school districts and retirees; with extra savings, districts have the opportunity to invest in other education-related programs, and retirees will benefit by having lower copays and out-of-pocket costs. I call this a win-win.

This article was also featured in our newsletter Lesson Plan Vol. 21