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Committee considers raising ER copay to curb nonemergent use
Summary
Benefits consultant recommended increasing emergency-room copays from $300 to $500 (waived if the member is admitted) to discourage nonemergent ER visits; consultants said Cigna can administer the change and the committee will monitor the impact.
As part of the 2027 plan design recommendations, Gallagher advised raising the emergency-room copay from $300 to $500 for specified plans, with the copay waived if the member is admitted on the same visit.
"When someone uses the emergency room... if they are admitted from the emergency room in that same visit, then this copay would be waived," Marissa Combs Smith said, describing the change as designed to encourage members to consider urgent care alternatives for nonemergent needs while preserving coverage for true emergencies. She added that Cigna can administer the $500 copay and staff would monitor ER usage to see if the change reduces nonemergent ER claims.
Committee members asked about stand‑alone ER clinics and member education; Combs Smith said the county will need to educate members that smaller stand‑alone ERs are still ERs and will bill accordingly. The copay change was included in the bundled motion the committee approved to forward to purchasing and budget.
