The 350,000 South Carolinians receiving state health insurance are about to see premiums increase by double digits for the fourth year in a row.

But this year, there could be a twist.

The State Budget and Control Board is considering allowing employees to opt for a low-cost, high-deductible health plan aimed at making employees approach health care the way they consume other products and services.

“With high deductibles, people will see the actual costs of doctors visits and prescription drugs,” said State Health Plan director Rob Tester. “The philosophy behind it is to make people more active consumers and more careful consumers.”

The budget board — composed of the governor, the state treasurer, the comptroller general and the chief House and Senate finance committee members — will consider the proposal at their meeting Tuesday.

Their decision — affecting almost one in 10 South Carolinians — would take effect Jan. 1.

The rising number of retirees, combined with escalating drug prices and health care costs, forced the state to come up with $132.7 million more for health insurance for 2005.

The General Assembly contributed $13.4 million in the $5.5 billion 2004-05 budget, leaving employees to make up the rest. That comes out to an average $38.80 per enrollee per month, either through increased premiums or decreased services.

The proposal the budget board will consider would increase standard plan rates by $16 to $40 per month, depending on coverage. In addition:

• The annual deductible would increase to $450 from $350.

• Prescription co-payments would increase $2 per prescription.

• The state would stop covering gastric bypass surgery, an expensive procedure chosen by 370 people each year.

News that costs again will be passed on to employees and retirees had some irate.

“Many of our members have worked for the state for very low wages,” said Kent Phillips, president of the Association of S.C. State Retirees. “They always said to us, ‘Don’t worry, you’ll get good benefits,’ and now we’re seeing the good benefits slide away from us.

“I have to tell you, we’re not real happy with what’s going on.”

The high-deductible health plans and health savings accounts — initially suggested by Gov. Mark Sanford — likely will be the more controversial proposal for board members.

The new high-deductible plans would replace the “economy plan,” which had slightly lower premiums but were used by only 6 percent of employees.

The plan would cost $9 monthly for an individual or up to $108 for a family, compared to $85 to $275 in the standard plan. Employees also would be responsible for the first $3,000 of routine medical care.

Employees who opt for the high-deductible plans would be able to create tax-favorable savings accounts to use for medical expenses.

Tester said he did not know how many people would take advantage of the new plan.

Sanford began the discussion about the high-deductible plan and savings accounts out of frustration with increasing premiums and what he saw as a lack of choice in the State Health Plan.

“The governor believes ... giving state employees more choice will lead to lower costs,” said Sanford spokesman Will Folks. “That’s what happens when you inject a market-, as opposed to a government-driven, dynamic into a situation.”

But not everyone on the budget board is convinced.

State Rep. Bobby Harrell, R-Charleston, chairman of the House Ways and Means Committee, said he looks forward to learning more about the plan in a conference Monday with staff members.

State Treasurer Grady Patterson said he was not ready to comment because he had not made up his mind whether to vote for it.

“The state treasurer is trying to make a decision that places less of a burden on the backs of the employees of South Carolina,” spokesman Trav Robertson said.

Reach Talhelm at (803) 771-8339 or jtalhelm@thestate.com