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A public entity in the Southwest and one in the East are taking contrasting approaches to extending health benefits for domestic partners to their employees.

The City Council of Tucson, Ariz., has approved offering health benefits to the same-sex domestic partners of city employees beginning July 1.

In Arlington County, Va., opposite- and same-sex partners of county employees may obtain health coverage through the county's self-insured plan and dental coverage through a Blue Cross/Blue Shield plan beginning July 1. Alternatively, employees may cover an adult-such as a parent, a sibling, or a nephew-who is financially dependent on them.

In unanimously approving only same-sex domestic partners coverage, the Tucson City Council on April 28 did not rule out eventually extending coverage to opposite-sex partners, said Lynn Greenawalt, human resources administrator for employee benefits and records. But, for now, the city limited the benefit to same-sex partners because gay and lesbian employees cannot legally marry and earn spousal coverage.

The city estimates that 23 of its 4,700 employees will select the partners coverage at an annual cost to the city of $27,000.

About 105 employees would opt for the coverage if Tucson had extended it to all domestic partners, and the city's costs would have more than quadrupled to $126,000, the city estimated.

Tucson contracts with four health care providers that offer four health maintenance organizations and two point-of-service plans. For all covered employees, the city contributes 100% of the employee premium charged by the cheaper of the two plans with the largest employee enrollments. For dependent coverage, the city contributes 85% of the premium charged by the cheaper of the two largest plans.

The providers have agreed not to increase rates when they begin covering domestic partners, Ms. Greenawalt said.

About 3,200 Arlington County employees could become eligible to claim health and dental benefits for a domestic partner or a dependent adult as a result of the county board's April 12 action, a county spokeswoman said.

The coverage is available only through the county's self-insured plan, which now covers about 60% of county employees. The remaining 40% enrolled in the HMO offered by Kaiser Permanente are not eligible for the expanded coverage, but open plan enrollment begins later this month.

Based on other public entities' experience, the expanded coverage could cost the county an additional $100,000 to $400,000 annually, it estimates. The county pays 80% of employees' plan premiums.

But, the county expects its costs will be closer to $100,000, because many partners are covered by their own employer health plans, the county spokeswoman said.

Employees more likely will elect to cover an aging parent or an immigrant relative who has moved in with them, the spokeswoman said. To be eligible for coverage, non-domestic partners must meet the Internal Revenue Service definition of a dependent, and employees must claim them as dependents on federal tax returns.

Even with the expanded coverage, the county still plans on giving self-insured plan participants a premium holiday in August, as it has for the past few years, the spokeswoman said.

Both Tucson and Arlington County will require that employees with domestic partners show they are in a committed relationship before they can obtain the expanded benefits.

-By Dave Lenckus

State managed care

Like private employers, state governments increasingly are deciding managed care can save them and employees money and are becoming more successful at drawing workers into state-sponsored plans, a study says.

Benefit consulting firm Segal Co.'s 1996 survey of state employee health benefit plans found that the percentage of state employees in health maintenance organizations or point-of-service plans was 50% or more in 18 states, and that participation levels in HMOs or POS plans reached 75% in half of those 18 states.

Enrollment in preferred provider organizations was not included in the calculations.

Affordability clearly has been a major cause of the continued trend, Segal analysts say. The average premium for traditional indemnity plan coverage for state employees was $128.56 in 1990 but had risen to $201 in the 1996 survey, up 56%, said Clark Yaggy, senior vp of Segal in Atlanta. Family coverage premiums increased by an average of 51% during the same period.

During that time, the number of states paying 100% of the premium for employees' indemnity coverage also dropped to 21 from 25 for single coverage, he said. States with multiple health plans often are reducing the proportion of the premium they pay to indemnity plan enrollees as an inducement for workers to select managed care options, Mr. Yaggy said.

The survey found that enrollment in state HMOs or POS plans was highest-75% or greater-in Arizona, California, Connecticut, Delaware, Kansas, Maine, Missouri, Washington and Wisconsin. State governments with the lowest enrollment in managed care were Alabama, Alaska, Idaho, Montana, New Mexico, North Dakota, South Dakota, Utah and Wyoming, all with less than 10%.

Nineteen states said they have a formal policy to measure the quality of care provided for all their plans. Six said they measure the quality of only some of their plans.

Tools used for quality assessment varied and included: surveys sponsored by health plans, 19 states; surveys sponsored by employers, 13 states; and surveys by the states themselves, 12 states. Several plans also reported using Health Plan Employer Data and Information Set, or HEDIS, data from the National Committee for Quality Assurance as well as other quality report cards and NCQA accreditation status.

A free copy of the study, "1996 Survey of State Employee Health Benefit Plans," may be obtained by contacting Mary L. Feldman, vp-public affairs, 212-251-5029.

Robert Kazel