2022-418-Minutes for Meeting October 19,2022 Recorded 11/4/2022BOARD OF
COMMISSIONERS
1300 NW Wall Street, Bend, Oregon
(541) 388-6570
Recorded in Deschutes County
Steve Dennison, County Clerk
Commissioners' Journal 11/04/2022 11:57:40 AM
CJ2022-418
FOR RECORDING STAMP ONLY
BOCC MEETING MINUTES
10:00 AM
WEDNESDAY October 19, 2022
Barnes Sawyer Rooms
Live Streamed Video
Present were Commissioners Patti Adair, Anthony DeBone, and Phil Chang. Also present were Nick
Lelack, County Administrator; Kim Riley, Assistant Legal Counsel; and Brenda Fritsvold, BOCC Executive
Assistant.
This meeting was audio and video recorded and can be accessed at the Deschutes County
Meeting Portal website www.deschutes.org/meetings
CALL TO ORDER: Chair Adair called the meeting to order at 10:00 a.m.
PLEDGE OF ALLEGIANCE
CITIZEN INPUT:
• A voicemail was received from a resident questioning the effectiveness of public
funds spent to address homelessness.
• An email was received from Joe Yetter, the Democratic nominee for Congressional
District 2, regarding infrastructure needs and economic development opportunities.
• A voicemail was received from a resident expressing dissatisfaction with the Sheriffs
Office.
• Rondo, a resident of Bend, expressed his support for expanding the Board of
Commissioners to five members.
Further Discussion: none
BOCC MEETING
OCTOBER 19, 2022 PAGE 1 OF 9
CONSENT AGENDA: Before the Board was Consideration of the Consent Agenda
Commissioner DeBone requested that the draft minutes of the October 5, 2022 BOCC
Meeting be edited to clarify that the County's employee health plans do not cover
discretionary abortions.
DEBONE: Move Board approval of the Consent Agenda with the requested change
CHANG: Second
VOTE: CHANG: Yes
DEBONE: Yes
ADAIR: Chair votes Yes. Motion Carried.
1. Approval of Minutes of the October 5, 2022 BOCC Meeting
ACTION ITEMS:
2. Legislative Update from Senator Findley
Chair Adair welcomed Senator Findley and commented that the upcoming
legislative session will be challenging.
Senator Findley expressed appreciation for the opportunity to address and
confer with the Board in person, in addition to the many other communications
which are shared throughout the year. He offered his assistance with advancing
the County's legislative priorities.
Commissioner DeBone appreciated the Senator's visit and his advocacy at the
state level. Commissioner Adair also voiced appreciation for the Senator's
presence and the opportunity to engage with him.
Senator Findley referred to the Eastern Oregon Caucus, which has allowed for
active, informal dialogue since early 2020. Noting the information -sharing value
of the group, he said the goal is to have regular communication and he looked
forward to resuming weekly calls as the legislature convenes in January.
Continuing, Senator Findley spoke of upcoming leadership changes in the form
of a new governor, new presiding officers in the House, and new leadership in
the Senate. He spoke to budget concerns amid lackluster revenue forecasts and
said balancing the budget will be difficult.
The senator said the 2023 legislature will be faced with major issues, including
the negative financial consequences experienced by counties as a result of
BOCC MEETING OCTOBER 19, 2022 PAGE 2 OF 9
Measure 110. Other concerns relate to SB 762, which modified how the State
manages wildfires and wildfire suppression. Although some of the changes were
good, the legislation involved the development of a wildfire risk map with no
local involvement or control. Senator Findley characterized the map as a failure
and said it must be redone to give local planners an integral role in its
development and to ensure that landowners receive credit for work they have
done to harden their properties against wildfire risk.
Commissioner DeBone acknowledged that Deschutes County is a forested, drier
area and thus naturally in a "high" risk category, particularly on hot days when
subject to wind -driven events.
Commissioner Adair commented that the Wildfire Advisory Committee was
established to evaluate the effects of 762. Noting broad support for some of the
changes, such as requiring new construction to include fire-resistant materials,
she said designating irrigated croplands as high risk is a concern. She shared
information on an open house offered by Forestry and OSU for property owners
whose land has been designated as high or extreme risk, and agreed that those
who have done everything they can to mitigate their risk cannot be required to
do more.
Senator Findley added that attention must also be directed to the issue of
insurance rates, especially for those who have proactively hardened their
property. Commissioner Adair was concerned about rising insurance rates and
companies possibly deciding to not issue wildfire coverage. The senator agreed
that the State must protect against companies increasing rates or cancelling
policies based on the risk map.
Commissioner Chang concurred that property owners should receive credit for
having taken steps to address or mitigate the risk from wildfire damage. With
respect to SB 391, he shared a proposal that persons wanting to build a new
ADU before it's determined if their property is in a high or extreme risk area be
allowed to proceed by conforming to the applicable fire-resistant requirements
for the presumed classification. Senator Findley supported this idea and offered
to put it forward at the legislative level.
Continuing, Senator Findley touched on the matters of homelessness, mental
health and the housing crisis. Commissioner Chang said while land supply is a
factor in housing availability and affordability, so are regulatory constraints and
the lack of adequate funding for infrastructure.
Commissioner DeBone said that the County's new courthouse project has been
affected by inflation, with the result that its cost has escalated beyond the initial
OCTOBER 19, 2022 PAGE 3 OF 9
BOCC MEETING
estimate. He announced that for the next legislative session, Deschutes County
will be represented by lobbyist Doug Riggs.
Referring to Measure 110, Commissioner Chang agreed that some changes are
warranted, particularly with respect to incentivizing treatment for persons with
substance abuse problems. He referred to delays in funding behavioral health
specialists and said the effects of this treatment support have yet to be
determined.
3. Consideration of Document No. 2022-762, a License Agreement with the
Ike Abbas Trust for Right of Way Encroachments on 11th Street
(Terrebonne)
Cody Smith, County Engineer, explained that the Ike Abbas Trust owns property
at 925 Central Ave in Terrebonne, where several privately -owned items such as
structures, fences and propane tanks encroach on the adjacent 11th Street right-
of-way. After meeting with a representative of the property owner, staff
prepared a revocable license agreement that would require the removal of items
whose presence conflicts with the planned 11th Street improvements and/or the
Tong -term operation of 11th Street as a public road. The agreement, which allows
for certain unoffending encroachments to remain within the right-of-way, has
been accepted and signed by the property owner.
Commissioner DeBone said the proposal appears to be a good compromise.
Commissioner Chang inquired regarding the length of time that these
encroachments were present and the possibility of other encroachments on
County right-of-ways. In response, Smith said while he could not speak to the
entire history of this specific encroachment, it appeared that the 60-foot right-of-
way had been established many decades ago but went unused because the
highway later. followed a different alignment. Smith added that modern GIS
technology has made it possible to research and identify these kinds of
boundaries with much greater ease and accuracy.
DEBONE: Move Board approval of Document No. 2022-762
CHANG: Second
VOTE: DEBONE: Yes
CHANG: Yes
ADAIR: Chair votes yes. Motion Carried
4. Deschutes County Benefits Renewal for the 2023 Plan Year
BOCC MEETING OCTOBER 19, 2022 PAGE 4 OF 9
Whitney Hale, Deputy County Administrator, and Trygve Bolken, Human
Resources Analyst, presented the matter of employee benefits for Deschutes
County for the 2023 plan year. Hale reviewed the recommended vendors and
renewal rates for the plan's stop loss coverage, third party administrator, life and
disability insurances, employee assistance program and flexible spending
accounts. Hale and Bolken then explained the seven proposed changes for the
2023 plan year, which the Employee Benefits Advisory Committee voted 14-1 to
support.
Commissioner DeBone did not support the proposed change to remove the plan
exclusion for abortion services.
Commissioner Chang said employees have indicated they want this benefit and
the cost would be minimal. He added that not offering this benefit makes the
County out of step with other employers.
Commissioner DeBone accepted making this decision at the Board level based
on the values that he brings to the office. Commissioner Adair agreed with the
reference to values and supported continuing this section of the plan as
grandfathered to exclude coverage for abortion services unless certain
condition(s) are met.
Commissioner Chang said denying this benefit will not affect the number of
abortions undergone by employees or their dependents; rather, it would only
serve to send the inappropriate message that the County will not extend
financial support in the face of this hard and difficult decision.
Saying that the County offers excellent health care benefits, Commissioner Adair
noted that in 2014, the Affordable Care Act made all birth control free of charge.
Commissioner DeBone agreed that the County has a robust self -funded health
care plan which is very cost-effective and operates with a healthy reserve.
Commissioner Adair added that the overall cost of the employee health care
program in 2023 will rise by 9.1 %, which is a much lower increase than is being
experienced by other plans.
DEBONE: Move Board approval of the recommended changes to the
plan with the exception of the recommended change to
remove the plan exclusion for abortion services
ADAIR: Second
Additional Discussion: Commissioner Chang reiterated that the County has the
opportunity to add a benefit which would mirror that offered by other
BOCC MEETING OCTOBER 19, 2022 PAGE 5 OF 9
employers, and which County employees have asked for. He was disappointed
this would not be approved.
VOTE: DEBONE: Yes
CHANG: No
ADAIR: Chair votes yes. Motion Carried
CHANG: Move Board approval to renew stop Toss coverage services
with Sunlife, the current provider, and deductible limits for the
2023 plan year.
DEBONE: Second
VOTE: DEBONE: Yes
CHANG: Yes
ADAIR: Chair votes yes. Motion Carried
DEBONE: Move Board approval to renew third party administrator
services with PacificSource, the current provider, for the 2023
plan year.
CHANG: Second
VOTE: DEBONE: Yes
CHANG: Yes
ADAIR: Chair votes yes. Motion Carried
CHANG: Move Board approval of County Administrator signature of the
final Deschutes County Employee Benefits Health Plan
documents and service agreements for the 2023 plan year.
DEBONE: Second
VOTE: DEBONE: Yes
CHANG: Yes
ADAIR: Chair votes yes. Motion Carried
5. Consideration of Board Signature of Document No. 2022-790, an
amendment to SunWest Builders Contract No. 2022-197 to establish the
Guaranteed Maximum Price for the remodel of 244 Kingwood Avenue in
Redmond, OR, and related site improvements
BOCC MEETING
OCTOBER 19, 2022 PAGE 6 OF 9
Lee Randall, Facilities Director was joined by Briana Manfrass and Shaun Clifford
from Pinnacle Architecture and Kevin Link and Adam Bowles from SunWest
Builders.
Lee Randall explained this amendment to the contract is specific to the 244
Kingwood Avenue property; staff will return in four to six weeks for further
action on the property at 236 Kingwood. Randall shared the background of
this project and said this amendment would establish the guaranteed
maximum price for the remodel of 244 Kingwood and related site changes to
address accessibility issues. He stated that efforts will be made to maximize
the number of parking spaces for visitors.
With respect to the project budget, Randall said the team worked hard to find
efficiencies and secure guarantees on the costs. He reviewed the proposed
funding sources and said Mosaic Medical, which will occupy just over 1300
square feet, will contribute $215,000 towards the needed tenant improvements.
Commissioner DeBone appreciated that this investment will result in a
professional remodel and offer work opportunities for persons in various trades.
Saying this facility is needed to provide mental health services in the north
county, Commissioner Chang emphasized the money saved by repurposing
existing buildings for this use.
Responding to Commissioner Adair, Mr. Randall anticipated a six-month
construction schedule with completion in May.
DEBONE: Move Board approval of Document No. 2022-790 amending
Deschutes County Contract No. 2022- 197 with SunWest
Builders for the Remodel of 244 Kingwood, Redmond, Oregon
and related site improvements
CHANG: Second
VOTE: DEBONE: Yes
CHANG: Yes
ADAIR: Chair votes yes. Motion Carried
OTHER ITEMS:
• Commissioner DeBone encouraged property owners to conduct fuels
reduction/defensible space efforts while the weather allows.
BOCC MEETING
OCTOBER 19, 2022 PAGE 7 OF 9
• Commissioner DeBone said current property tax information is now available online
and shows updated rates and collection amounts.
• Commissioner Chang announced that the Community Renewable Energy Program
Advisory Board awarded $1 million to the Mount Bachelor rough chip boiler project.
He hoped that the County will consider resubmitting for renewable energy projects
in the new grant cycle that will soon open up.
• Commissioner Chang attended a meeting of the Local Government Advisory
Committee convened by the Association of Oregon Counties where the discussion
focused on how to solve aid & assist population challenges.
• Commissioner Chang reported that the Oregon Finance Authority facilitates
financing for nonprofits for capital projects at 79% of the interest rate charged by
commercial banks.
• Commissioner Chang attended a City Club presentation on ranked choice voting.
• Commissioner DeBone attended the Redmond Economic Development Board
meeting where the Heart of Oregon Corps presented information on their work.
• Commissioner DeBone participated in the Association of Oregon Counties'
exchange program and said he will attend the AOC conference in Eugene next
month.
• Commissioner Chang shared that the Oregon Conservation Corps, which provided
$1 million to support youth workforce development, will offer field trips to showcase
current projects.
• Commissioner Adair attended the Mothers Against Drunk Driving fundraising walk.
She emphasized the importance of not driving impaired and reminded that ride
sharing services are available.
• Commissioner Adair said she and Kristie Bollinger walked the neighborhood near
the possible safe parking site and talked with residents about the proposal.
• Commissioner Adair recognized the Fair Association as an amazing group of
volunteers who do great work.
• County Administrator Nick Lelack announced that the first community open house
on the 2040 Rural Deschutes County Update will take place tonight at the Deschutes
County Services Center. To follow are open houses in Sisters on October 20th;
Sunriver on October 24th; and Redmond on October 25th
EXECUTIVE SESSION:
At the time of 11:50 a.m., the Board went into Executive Session under ORS 192.660 (2)(e)
Real Property Negotiations. The Board came out of Executive Session at 12:20 p.m. to
direct staff to proceed as directed.
BOCC MEETING OCTOBER 19, 2022 PAGE 8 OF 9
At the time of 12:25 p.m. the Board went back into Executive Session under ORS 192.660
(2)(i) Employee Evaluation. The Board came out of Executive Session at 1:30 p.m. with no
action taken.
ADJOURN: Being no further items to come before the Board, the meeting was adjourned
at 1:30 p.m.
DATED this d' Day of kkielh\-kfiA. 2022 for the Deschutes County Board of
Commissioners.
ATTEST:
RECORDING SECRETARY
PATTI ADAIR, CHAIR
ANTHONY DEBONE, VI —CHAIR
PHIL CHANG, COMMISSIONER
BOCC MEETING
OCTOBER 19, 2022 PAGE 9 OF 9
BOARD OF
COMMISSIONERS
BOARD OF COUNTY COMMISSIONERS MEETING
10:00 AM, WEDNESDAI(, OCTOBER 19, 2022
Barnes Sawyer Rooms - Deschutes Services Bldg - 1300 NW Wall St - Bend
(541) 388-6570 I www.deschutes.org
AGENDA
MEETING FORMAT: The Oregon legislature passed House Bill (HB) 2560, which requires that public
meetings be accessible remotely, effective on January 1, 2022, with the exception of executive
sessions. Public bodies must provide the public an opportunity to access and attend public
meetings by phone, video, or other virtual means. Additionally, when in -person testimony, either
oral or written is allowed at the meeting, then testimony must also be allowed electronically via,
phone, video, email, or other electronic/virtual means.
Attendance/Participation options are described above. Members of the public may still view the
BOCC meetings/hearings in real time via the Public Meeting Portal at www.deschutes.org/meetings
Citizen Input: Citizen Input is invited in order to provide the public with an opportunity to comment
on any meeting topic that is not on the current agenda. Citizen Input is provided by submitting an
email to: citizeninput@deschutes.org or by leaving a voice message at 541-385-1734. Citizen input
received by noon on Tuesday will be included in the Citizen Input meeting record for topics that are
not included on the Wednesday agenda.
Zoom Meeting Information: Staff and citizens that are presenting agenda items to the Board for
consideration or who are planning to testify in a scheduled public hearing may participate via Zoom
meeting. The Zoom meeting id and password will be included in either the public hearing materials
or through a meeting invite once your agenda item has been included on the agenda. Upon
entering the Zoom meeting, you will automatically be placed on hold and in the waiting room. Once
you are ready to present your agenda item, you will be unmuted and placed in the spotlight for your
presentation. If you are providing testimony during a hearing, you will be placed in the waiting room
until the time of testimony, staff will announce your name and unmute your connection to be invited
for testimony. Detailed instructions will be included in the public hearing materials and will be
announced at the outset of the public hearing.
For Public Hearings, the link to the Zoom meeting will be posted in the Public Hearing Notice as
well as posted on the Deschutes County website at https://www.deschutes.org/bcc/page/public-
hearing-notices.
CALL TO ORDER
PLEDGE OF ALLEGIANCE
CITIZEN INPUT: Citizen Input may be provided as comment on any topic that is not on the
agenda.
Note: In addition to the option of providing in -person comments at the meeting, citizen input comments
maybe emailed to citizeninput@deschutes.org or you may leave a brief voicemail at 541.385.1734. To be
timely, citizen input must be received by noon on Tuesday in order to be included in the meeting record.
CONSENT AGENDA
1. Approval of the Minutes of the October 5, 2022 BOCC Meeting
ACTION ITEMS
2. 10:05 AM Legislative Update from Senator Findley
3. 10:35 AM Consideration of Document No. 2022-762, a License Agreement with the Ike
Abbas Trust for Right of Way Encroachments on 11 th Street (Terrebonne)
4. 10:45 AM Deschutes County Employee Benefits Renewal for the 2023 Plan Year
5. 11:05 AM Consideration of Board Signature of Document No. 2022-790, an
amendment to SunWest Builders contract No. 2022-197 to establish the
Guaranteed Maximum Price for the remodel of 244 Kingwood Avenue in
Redmond, OR, and related site improvements
OTHER ITEMS
These can be any items not included on the agenda that the Commissioners wish to discuss as part of
the meeting, pursuant to ORS 192.640.
EXECUTIVE SESSION
At any time during the meeting, an executive session could be called to address issues relating to ORS
192.660(2)(e), real property negotiations; ORS 192.660(2)(h), litigation; ORS 192.660(2)(d), labor
negotiations; ORS 192.660(2)(b), personnel issues; or other executive session categories.
Executive sessions are closed to the public; however, with few exceptions and under specific guidelines,
are open to the media.
6. Executive Session under ORS 192.660 (2) (e) Real Property Negotiations
7. Executive Session under ORS 192.660 (2) (i) Employee Evaluation
ADJOURN
October 19, 2022 BOARD OF COUNTY COMMISSIONERS MEETING Page 2 of 3
Deschutes County encourages persons with disabilities to participate in all programs
and activities. This event/location is accessible to people with disabilities. If you need
accommodations to make participation possible, please call (541) 617-4747.
October 19, 2022 BOARD OF COUNTY COMMISSIONERS MEETING Page 3 of 3
BOARD OF COMMISSIONERS' MEETING
REQUEST TO SPEAK
• Citizen Input can be given regarding any topic that is NOT on the agenda
• Public Testimony can be given during Public Hearings only
Topic of Input or Testimony: _
aLrk? Co M lrn i 5� ion
Is this topic an item on today's agenda?
Yes (please see description of Citizen Input above)
Name
Address
Phone #s
Rondo
Pad
Date: O ( 9 Zz
E-mail address rrn •t7Oi aY) a , Co
ce, fl ouV (Vr,SSlow &?
THIS FORM IS TURNED IN TO RECORDING SECRETARY
BEFORE MEETING BEGINS
ouir-ceo-Fy ae5oirki-, -P j kj& rn 6/4) err -
Are you submitting written documents as part of testimony? Yes No
If so, please give a copy to the Recording Secretary for the record.
\4-4 om( k-kje
A-CC7rA
pQ he)]
Angie Powers
To:
Subject:
Citizen Input Voicemail:
Do Not Reply; citizeninput
RE: Mitel voice message from WIRELESS CALLER, +15417888140 for mailbox 1734
"Hello, my name is Jake my number is 541-788-8140. You guys and me, we're going to be dealing with some stuff,
particularly your Sheriffs Department, which is a bunch of lazy bigots that discriminate. And I mean that, every word.
Literally. And I've had enough of it. The law in the city is one thing. The law outside of the city "oh, no no... we don't
want to deal with that, it's inconvenient." And I'm getting sick of it. People are living at risk because of it. You are at risk
of a lot of things going bad and wrong that everybody's going to be real upset for or apologize for rather than dealing
with things in the first place. It's ...bigotry and gross irresponsibility and I've had enough of it. I've got a cleaner record
than most of your cops, and so I have earned the right to speak up about it and I have had enough. I have had enough.
And something's gotta be done about it and we need a new Sheriff in this county for starters. I am already in contact
with you people about this and other matters and I am not putting up with this crap anymore."
Original Message
From: Do Not Reply <DoNotReply@deschutes.org>
Sent: Monday, October 17, 2022 7:19 PM
To: citizeninput <citizeninput@deschutes.org>
Subject: Mitel voice message from WIRELESS CALLER, +15417888140 for mailbox 1734
You have received a voice mail message from WIRELESS CALLER, +15417888140 for mailbox 1734.
Message length is 00:01:06. Message size is 521 KB.
1
Angie Powers
From: Joe Yetter <joeleeyetter@yahoo.com>
Sent: Tuesday, October 18, 2022 8:31 AM
To: Board; citizeninput; Patti Adair; Phil Chang; Tony DeBone
Subject: Joe Yetter seeks to serve Oregon Counties, Businesses, and all of our people
Some people who received this message don't often get email from joeleeyetter@yahoo.com. Learn why this is important
[EXTERNAL EMAIL]
Joe Yetter here. I am the Democratic Nominee for Congress in Oregon's Congressional District 2. I look forward to serving
you.
Your county must not miss out on important infrastructure and economic development. Twice in the last several months, I
have had discussions with Peter DeFazio, Chair of the Transportation and Infrastructure Committee in the US House of
Representatives. He related to me that he had offered on several occasions the opportunity for Representative Cliff Bentz
to provide input into transportation and infrastructure bills. Bills like the Bipartisan Infrastructure Act, and the Inflation
Reduction Act and the CHIPS and Science Act all included funding for infrastructure. Mr. Bentz declined the offer: No,
No, and No. (And then, naturally, he betrayed veterans with another No! on the PACT Act.)
Millions of dollars have already come to your county and to your neighboring counties, because of such legislation, and
millions more should follow. Cliff Bentz voted against every dollar; he'll vote against them again if he gets the chance.
Every county in Oregon needs money for roads, bridges, electricity transmission, hospitals, schools, and so on; the list is
long. Counties' governments and their business communities must have a seat at the table when investment plans are
developed. If I am fortunate enough to be elected your representative in Congress, I will always listen to what the
communities' needs are; and I will always have shovel -ready projects ready to go the moment funding appears on the
horizon. The opportunities to develop our infrastructure, and to provide high paying jobs cannot be wasted. I would like
very much to know what your needs are at this moment, and I'd like to continue this dialogue in the years to come.
Joe Yetter, Democratic Nominee
Oregon Congressional District 2
* Veteran * Physician * Farmer * Teacher
(541) 450-7643 (Cell)
(541) 837-8596 (Home)
(541) 415-1013 (Campaign)
www.JoeForOregon.com
Facebook * Instagram * Twitter
#Joe4Oregon #BetterVoteYetter
* Honor *Protect *Build
i
Angie Powers
To:
Subject:
Citizen Input Voicemail:
Do Not Reply; citizeninput
RE: Mitel voice message from WIRELESS CALLER, +15415985835 for mailbox 1734
"Yes, this is Robert Cooper. I live at 950 SE Third St. #8 and I'm sitting here watching the news here, at 10:05 and there's
a homeless person being interviewed. I was down there today, saw them cleaning up after again. Another $49,000
probably. "Where are they gonna go?" the guy says. What happened to the two hotels that the city of Bend bought?
Neither one of them are functioning, okay? That is $500,000 that the good citizens of Bend donated. Where did that
money go? Why aren't those rooms occupied? What's really going on with this homeless situation, you know? You guys
need to get out on the streets, on a bicycle on a daily basis. Go into Bi-Mart, talk to the people that are in their 60's and
70's while you're in line paying for your food, that you work for that you get a check for - not given. You guys are the
most enabling people on the planet. I can speak for fact, okay? I've been homeless four times, twice by choice so I could
get high, okay? I'm going straight now. As far as my values. I'm not even a liberal anymore. I took my name off the
voter's registration list here in Bend because of what I voted for. People like Philip Chang, that wants to tear down a
beautiful park, okay? We don't talk about that no more, do we. We got animals there, deer there, people that go there.
Anyways, this is my input. My main input is for the thing I saw in the news. Because I'm just curious where all of that
money went, and you're getting ready to spend another $750,000 on 27th and Bear Creek Road. Like I said, I've been
homeless four times. Twice by choice. You should see where I live now. When I came back to Bend two years ago,
nobody would help me. If it weren't for hadn't been for my friend giving me a camper to sleep in...but I got it done,
okay? You guys need to wake up. Thank you.
Original Message
From: Do Not Reply <DoNotReply@deschutes.org>
Sent: Tuesday, October 18, 2022 10:09 PM
To: citizeninput <citizeninput@deschutes.org>
Subject: Mitel voice message from WIRELESS CALLER, +15415985835 for mailbox 1734
You have received a voice mail message from WIRELESS CALLER, +15415985835 for mailbox 1734.
Message length is 00:02:55. Message size is 1372 KB.
1
BOARD OF
COMMISSIONERS
AGENDA REQUEST & STAFF REPORT
MEETING DATE: October 19, 2022
SUBJECT: Legislative Update from Senator Findley
ATTENDANCE:
Senator Lynn P. Findley
BOARD OF
COMMISSIONERS
AGENDA REQUEST & STAFF REPORT
MEETING DATE: October 19, 2022
SUBJECT: Deschutes County Employee Benefits Renewal for the 2023 Plan Year
RECOMMENDED MOTION:
1. Move to approve renewing with Sunlife, the current Stop Loss provider, and deductible
limits for the 2023 plan year.
2. Move to approve renewing with PacificSource, the current Third Party Administrator (TPA),
for the 2023 plan year.
3. Move to approve the staff recommended Employee Benefit Plan changes #1-7
4. Approve County Administrator signature of \he final Deschutes County Employee Benefits
Health Plan documents and service agreements for the 2023 plan year.
BACKGROUND AND POLICY IMPLICATIONS:
The Deschutes County Employee Health Benefits Plan is set to renewJanuary 1 for the 2023 Plan
Year. This annual renewal period requires the County to evaluate the health benefits plans and
vendor contracts supporting the plans. Deschutes County has established the Deschutes,County
Group Health Plan (referred to as the "Plan") to provide health care coverage for eligible
employees and their dependents. Deschutes County is the Plan Sponsor. This Plan Document
contains both the written Plan Document and the Summary Plan Description ("SPD') which will
be administered by PacificSource, the Third Party Administrator, and will be effective on
1/1/2023.
The attached memo and matrix provide additional detail on the recommended changes and
proposed contract renewals.
BUDGET IMPACTS:
None
ATTENDANCE:
Kathleen Hinman, Director Human Resources
Trygve Bolken, Human Resources Analyst
HUMAN RESOURCES
Date: October 19, 2022
To: Deschutes County Board of County Commissioners
From: Trygve Bolken, HR Analyst and Kathleen Hinman, HR Director
Re: Deschutes County Employee Benefits Renewal for the 2023 Plan Year
The Deschutes County Employee Benefits Plan is set to renew for the 2023 Plan Year.
The following is a summary of program renewals and considerations for the period of January 1, 2023 -
December 31, 2023.
In preparation for the annual renewal period, staff meets with the County's legal team, benefit
consultant, and Third Party Administrator (TPA) to review proposed changes to the plan. This includes
an analysis of changes due to legislative requirements, industry standards, new offerings in the
industry, benchmarking against comparable plans, cost of the change, and the impact on the health
care needs of our employees and their dependents.
It is the County's approach to consider changes that have proven effectiveness, are mandated by law,
fiscally responsible, and competitive with benchmarking against other health plans.
After review, staff develop recommended renewal changes, and present them to the County's Employee
Benefits Advisory Committee (EBAC) for consideration. EBAC makes recommendations to the Board
regarding employee benefits.
On Tuesday, September 27, EBAC voted 14 -1 in support of the following proposed plan changes for
the 2023 Plan Year:
The summary of the health and benefit program renewal, including:
• Employee Health Benefits Plan (Medical/DentalNision/Prescription Drugs)
• Flexible Spending Accounts (FSA)
• Employee Assistance Program (EAP)
• Life Insurance, Accidental Death & Dismemberment Insurance, and Long Term Disability
Based on current claims trends and proposed plan changes and, overall combined annual employer
costs are expected to rise 9.1 % or $2,072,296. This renewal recommendation includes retaining the
same vendors, the same employee contribution rate, and includes the changes to the health plan
1300 NW Wall Street, Suite 201 Bend, Oregon 97703
S (541) 388-6553 @hr@deschutes.org www.deschutes.org
design as recommended below.
The following vendors and renewal rates are recommended:
• Employee Health Benefits Plan
✓ Includes Sunlife Stop Loss Premium: 5% increase; estimated $52,611 annual cost
✓ Includes TPA PacificSource Services Fee: 3.1 % increase; estimated $17,885 annual
cost
• Life and Disability Insurances with New York Life: No increase (guaranteed until 1/1/2025)
• Employee Assistance Program with Canopy: No increase
• Flexible Spending Accounts with PacificSource Administrators: No increase
Stop Loss Coverage: The plan has not experienced as many high costs claims this year compared to the
prior year and the plan's future projections are looking more favorable. Last year, staff sought
competitive bids for renewal however, most firms declined to bid and we experienced a 45% rate
increase. Given our more favorable claims year, we were able to negotiate a 5%. rate increase with our
current. vendor. Additionally, we received a few other competitive bids, however 5% with our current
vendor is the most competitive.
➢ Staff recommends and EBAC supports renewing with the current Stop Loss provider and
deductible limits for the 2023 plan year.
Third Party Administrator (TPA): Last year a 3% rate was negotiated for TPA services with our current
vendor, PacificSource. This year, PacificSource has proposed a 3.1% rate increase for TPA services.
➢ Staff recommends and EBAC supports renewing with the current TPA vendor for the 2023 plan
year.
Employee Health Benefits Plan: This year continued to present challenges in forecasting claims costs
due to delayed medical care and increased health care costs in general. In total, overall plan costs are
on the rise and are estimated to increase by 9.1 % resulting in an anticipated $2,072,296 increase cost to
the plan. This includes the increases associated with the Stop Loss and TPA services mentioned above.
➢ Staff recommends and EBAC supports the following Employee Benefit Plan changes, #1-7, for
the 2023 plan year.
1. Enrollment wait period: Adopt temporary amendment language allowing enrollment to be
effective first of the month after hire date.
The current plan language states that enrollment is first of the month after 30 days of
employment.: The amendment, which shortens the enrollment wait period, has been in place
during the pandemic to help avoid a break in coverage for new staff. The shorter enrollment
wait period is competitive with other employers. The current plan amendment expires
12/31/2022.
➢ HR Staff recommends and EBAC supported making this change to the wait period.
There is no estimated impact to the cost of the plan.
1300 NW Wall Street, Suite 201 Bend, Oregon 97703
OZN(541) 388-6553 i,hr@deschutes.org r' www.deschutes.org
2. COVID-19 Testing and Diagnosis & Early Prescription Refills: Revert to regular plan
language.
• The current plan amendment expiring on 12/31/2022 waives deductibles, copayments and/or
coinsurance for COVID-19 related services. The amendment was required during the pandemic
and is now no longer required. In benchmarking with other plans, staff sees most plans ending
this enhanced coverage and covering services for COVID illness under standard plan language,
similar to other illness.
➢ HR Staff recommends and EBAC supported allowing the current amendment to
expire. With this recommendation, the estimated cost impact to the plan is a
savings of $72,100 annually.
3. PacificSource Provider Network: Change medical provider network to Navigator.
Change from the PacificSource Voyager network to the PacificSource Navigator network for
medical providers. There is very minimal impact and disruption to members and the change will
result in savings to the plan. (Dental network will continue as Advantage Dental network).
> HR Staff recommends and EBAC supported making this change to the provider
network. The estimated cost impact to the plan is a savings of $917,580 annually.
4. Benefit Exclusions: Remove the plan exclusion for abortion services.
PacificSource identifies abortion services as a State mandated covered benefit and recommends
removing the exclusion to be in compliance. However, Deschutes County is self -insured and DC
Legal believes our plan to be in compliance with the exclusion. Benchmarking shows other
comparable plans cover the service and the cost impact to the plan is minimal.
> Due to plan benchmarking and minimal cost, HR Staff and EBAC supports removing
the exclusion. The estimated cost impact for this change is an annual increase of
$8,000 to $12,000.
5. Update plan language to align with current plan interpretation and TPA best practices.
In partnership with our TPA, HR staff have made efforts to clarify plan language. Proposed
changes area clarifications to the plan document and do not change benefit coverage.
➢ HR Staff recommended and EBAC supports making the corrections, clarifications
and changes as described on the PacificSource Notice of Change PY23 sheet.
6. Update plan language - Rx Drug Benefit Max OOP Accumulation.
Northwest Pharmacy Services (NWPS) our pharmacy benefit manager, recommended adding
additional language to the plan document clarifying when the difference in cost from when a
1300 NW Wall Street, Suite 201 Bend, Oregon 97703
(541) 388-6553 @hr@deschutes.org ®www.deschutes.org
member requests brand name and generic is available does not go towards OOP max. Proposed
changes area clarifications to the plan document and do not change benefit coverage.
➢ HR Staff recommended and EBAC supports adding this language.
7. Change mail order pharmacy option with NWPS to Walmart Home Delivery.
NWPS changed mail order pharmacy from Kelley -Ross Union Pharmacy to Walmart Home
Delivery.
➢ HR Staff recommends and EBAC supported change to the mail order pharmacy
provider. There is no estimated impact to the cost of the plan.
The following plan changes were discussed with EBAC and are not being recommended for
consideration by staff and EBAC for this plan year:
8. Telehealth Copay: Change plan to $0 co -pay for telehealth visits
PacificSource is changing their plans to a $0 co -pay for telehealth visits. PacificSource fully.
insured plans utilize Teladoc for their telehealth visits at a discounted rate. The County plan pays
the same cost for telehealth and in office visits, there is no reduced rate for telehealth.
9. Weight Loss Drugs: Adding weight loss drugs to Rx Formulary
The current plan formulary does not include use of off -label drugs for weight Toss purposes. The
recent and pending reviews and outcomes for off -label drug use for weight loss are trending
positively, benchmarking shows a significant cost impact, lack a history of proven effectiveness,
and limited coverage by comparable plans at this time. The estimated cost impact of this change
would be an annual increase of $655,200.
10. Musculoskeletal (MSK) Solutions: New Virtual Physical Therapy program
Davidson Benefits Planning presented a new virtual physical therapy program. Benchmarking
shows a cost impact to the plan, lack a history of proven effectiveness, and limited coverage by
comparable plans at this time. The estimated cost impact for this change is an annual increase
of $137,000.
11. Chronic Condition Support: Livongo Chronic Care Complete Program
Livongo proposed increasing their program offerings to include more Chronic Care services. Staff
does not support as these services can be performed through our current Wellness program at
the doc. The estimated cost impact for this change is $75.00 per participant per month.
12. Infertility Services: Add basic coverage for infertility services
Staff continued to review consideration to add basic coverage ($20,000 lifetime benefit) for
1300 NW Wall Street; Suite 201 Bend, Oregon 97703
t (54.1) 388-6553 @hr@deschutes.org ' www.deschutes.org
infertility services to the plan. Benchmarking shows a cost impact to the plan, Tacks history of
effectiveness, and limited coverage by comparable plans. The estimated cost impact of adding
this benefit would be an annual increase of $292,000.
13. Top Doctor Search Tool: Garner Health - Quality Analytics
Garner uses healthcare transparency data to rate doctors on multiple points of care. The app
and concierge service help members identify the highest -quality, in -network, available doctors
for their care. HR staff will continue to gather information and review for consideration in future
plan years.
14. Employee Cost Share and Tiers
Consider moving from one tier to two or more tiers (ex: Employee Only and Employee +
Dependents) for employee cost share contributions for the health benefits plan. HR staff will
continue to gather information and review for consideration in future plan years.
1300 NW Wall Street, Suite 201 Bend, Oregon 97703
(541) 388-6553 @hr@deschutes.org 3' www.deschutes.org
HUMAN
RESOURCES
Changes to Deschutes County Employee
Benefits Plan for,2023 Plan Year
Changes effective 1/1/2023
Recommended Changes — Benefits Plans
Plan Change
Recommended Change
Reason For Change
1. Enrollment Wait
Period - to First of
the Month After
Hire
Amendment #1 —
Medical and Dental
EBAC supports HR Recommendation.
Adopt the temporary amendment language
allowing enrollment to be effective first of the
month after hire date.
(Current plan language states enrollment is first of
the month after 30 days of employment.)
*Current plan amendment expires 12/31/2022
and staff supports adopting the amended
language.
Estimate no impact to the cost of the
plan. The amendment has been in
place during the COVID pandemic to
avoid a break in coverage for new
staff. The shorter wait period is
completive with other employers.
Current plan language states
enrollment is first of the month after
30 days of employment.
Plans
2. COVID-19 Testing
and Diagnosis &
Early Prescription
Refills
Amendment #1 —
Medical Only
EBAC supports HR Recommendation.
Revert to regular plan language and end current
medical plan amendment waiving deductibles,
copayments and/or coinsurance for COVID-19
related services.
Current plan amendment expires 12/31/2022 and
staff supports ending the amendment.
Estimate -$72,100 annually by letting
the amendment expire.
Amendment required during the
pandemic, now no longer required.
Services would be covered similar to
any other illness.
3. Provider Network -
Change Medical
provider network
to Navigator
EBAC supports HR Recommendation.
Change from the PacificSource Voyager network
to the PacificSource Navigator network for medical
providers.
(Dental network will continue as Advantage Dental
network)
Staff supports this change.
Estimate -$917,580 (-6.1%) annually
by moving to new medical network.
The estimated savings is from
improved rates with providers.
Disruption with members/providers is
very minimal. Disrupted members will
be notified.
4. Benefit Exclusions
- Abortion
EBAC supports HR Recommendation.
Remove the plan exclusion for abortion services.
PacificSource identifies this as a State mandated
covered benefit and recommends adding to be in
compliance. Due to plan benchmarking and
minimal cost, staff supports removing the
exclusion. However, Deschutes County is self-
insured and DC Legal believes our plan to be in
compliance with the exclusion.
Estimated +$8,000 to $12,000 cost to
plan for abortion services.
Benchmarking shows all other
comparable plans as covering the
service.
Current Plan Excludes: Abortion —
services, supplies, care or treatment in
connection with an abortion unless the
life of the mother is endangered by the
continued pregnancy or the pregnancy
is the result of rape or incest.
Page 1 of 2
5. Document Wide -
Plan language
updates
EBAC supports HR Recommendation.
Language to be added or changed throughout the
plan documents to clarify benefits, the
administration of benefits, or to align with
These changes are clarification and
clean-up of plan language. Not a
change to the benefit or coverage.
Deschutes County Legal has reviewed
(Medical and Dental
PacificSource core plan language.
the changes.
Documents Wide)
6. Plan language
EBAC supports HR Recommendation.
These changes are clarification and
update — Rx Drug
NWPS recommended additional language
clean-up of plan language. Not a
Benefit Max OOP
clarifying that the difference in cost when a
change to the benefit or coverage.
Accumulation
'member requests brand name and generic is
available does not go towards OOP max.
7. Mail Order
EBAC supports HR Recommendation.
Estimate no impact to the cost of the
Pharmacy - option
NWPS changed mail order pharmacy from Kelley-
plan. Currently one member is using
with NWPS to
Ross Union Pharmacy to Walmart Home Delivery.
the mail order pharmacy service and
Walmart Home
they have been notified of the change.
Delivery
Page 2 of 2
PacificSource
HCALM PLAN$
Oregon Public Self -Funded
Notice of Change to Your Medical and Dental Administration
Your Plan administration may change in 2023 to comply with the Affordable Care Act (ACA), federal legislation, state legislation or PacificSource best practices. The
following outline will guide you on the changes that will be made to the PacificSource core Plan Document and Administrative Services Agreement. If you have questions, you
should seek legal counsel for how these apply to your Plan.
Required Changes:
Language Updates
Old Language New Language Why are these changes occurring?
Section
Plan Document
throughout
Medical and
Dental
N/A _
•
We have updated the Plan Document
to assist with readability and ease of
understanding the benefits provided.
The overall organization further
provides clarity on services and
administration.
The Plan Document is updated to assist with
member understanding and to provide clarity
on benefits offered. Additionally, the content
of the document has been adjusted and
sections expanded or included to address
benefit coverages and exclusions. Your final
Plan Document will also contain additional
updates that do not affect benefits or
administration but rather are core template
updates.
Plan Document
throughout
Medical and
Dentai
Defined terms not capitalized.
Defined terms are capitalized.
Clarity and consistency. These will not show
as redline
Additional
Information —
both Medical
and Dental
documents.
Introduction
paragraph, no
page number,
but third page of
word doc.
As used in this Plan Document, the word 'year'
refers to the contract year, which is the 12-month
period beginning January 1st and ending
December 31st. The word lifetime as used in this
document refers to the period of time you or your
eligible family members participate in this Plan or
any other plan offered by the Plan Sponsor.
-
Paragraph has been removed in full.
Core language now refers to "Benefit Year",
and "Lifetime Maximum" is a defined term.
Plan Document
throughout
Medical and
Dental
documents —
First
appearance is
Page 1
calendar year
Benefit Year
-
Benefit Year is now defined as Calendar
Year.
OR_NOC_LG_Medical_Dental_
2023_Self-Funded_Public
1
Plan Document
throughout —First
appearance is
Page 2
Telemedicine
Telehealth
Clarity and consistency.
Plan Document
throughout -
First
appearance is
Page 1
NA
Allowable fee is expanded to define
fees for all providers.
Administrative clarification.
Medical Plan
Document —
Throughout First
appearance is
Page 1
Voyager
Navigator
Network change
Medical and
Dental Benefit
Summaries. - —
Page 5 —
Medical Plan
Document
Page 3 —Dental
Plan Document
NA
Discrimination is against the law
Both the Plan Sponsor and
PacificSource Health Plans comply
with applicable federal civil rights laws
and do not discriminate on the basis of
race, color, national origin, age,
disability, or sex. The Plan Sponsor
and PacificSource do not exclude
people or treat them differently
because of race, color, national origin,
age, disability, or sex.
Core Language Update.
Becoming
Covered —
Dependents
Page 64 —
Medical Plan
Document. It is
also in the
Dental Plan
Document.
Separate explanations were included for adoption,
foster care, and guardianship.
Adoption, foster care, and
guardianship have been wrapped into
the Dependent Child explanation.
Clarification and a simplification of language,
not a change to the administration of
eligibility.
Special
Enrollment Rule
#2
Page 67 —
Medical Plan
Document. It is
also in the,
Dental Plan
Document.
Language called out every specific qualifying
event.
Language has been simplified to
reference qualifying events as a whole.
Clarification and simplification of language.
Specific qualifying events are already
addressed in the Enrolling New Dependents
section.
O R_N OC_LG_Medi cal_Dental_
2023_Self-Funded_Public
2
Medical Changes
Why are these changes occurring?
r Prescription Drugs —Pages
13 through 16.
Please review the Prescription Drug Benefit Summary and Prescription
Drug section with your Pharmacy Benefit Manager and provide any
updates as needed.
Please review your Prescription Drug Benefits
with your Pharmacy Benefit Manager.
Medical Benefit Summary-
Professional Services —
Surgery - Page 7
Deschutes County Onsite Clinic Providers — Surgery Benefit for
Professional Services has been corrected from "Not Available" to "No
Deductible, 0%"
Correction to the Plan Document, not a change to
the administration of benefits.
Vision Benefit Summary-
Page 11
Removed language for charges greater than/less than the allowed
amount.
Clarification and a simplification of language, not a
change to the administration of benefits.
Vision Benefit Summary-
Page 11
Exclusions list has been alphabetized.
Clarity and consistency.
Preventive Care Services- Added language to indicate that this Plan is subject to state mandated 1 Core Language Update.
Page 19 benefits.
Colorectal Cancer Preventive services colorectal cancer screening now include follow up USPSTF update
Screening - Page 20 colonoscopies performed after a positive non-invasive stool based
screening or direct visualization.
Immunizations — Page 20 Callouts of specific covered immunizations has been removed. Simplification of language, not a change to the
administration of benefits.
Preventive Physicals — Page Added language regarding depression screening for all adults. Clarification, not a change to the administration of
20 benefits.
Dietary or Nutritional Added language regarding ACA-required obesity coverage. Clarification, not a change to the administration of
Counseling — Page 23 benefits.
Blood Transfusions — Page Updated language to clarify services covered under Blood Transfusion Clarification, not a change to the administration of
23 benefits. benefits.
Diagnostic and Therapeutic
Radiology/Laboratory-(non-
advanced) — Page 26
Clarified language for out -of -network non -preventive colonoscopies
Clarification, not a change to the administration of
benefits.
Durable Medical Equipment
— Page 28
Simplification of language, for the DME prior authorizations.
Core language Update.
Durable Medical Equipment
— Page 28
Simplified the language for obstructive sleep apnea.
Core Language Update.
Inpatient Habilitation and
Rehabilitation
— Page 30 and 31
; Updated language to allow medical necessity for all diagnoses. PacificSource standard practice and industry
standard. Please note that these services will be
outlined separately in the Plan Document and is
not a combined benefit.
Maternity Services — Page
31
This plan covers labor and delivery services at an out -of -network
facility when a Member is unable to be treated by an in -network
facility during a declared public health emergency. These services
will be paid at the in -network cost sharing amount.
; Oregon regulation
i
1
OR_NOC_LG_Medical_Dental_
2023_Self-Funded_Public
3
Outpatient Services — Page
31
Added new section for Applied Behavioral Analysis (ABA) for Autism,
Asperger's, or Pervasive Development Disorder.
Clarification, not a change to the administration of
benefits.
Outpatient Habilitation and
Rehabilitation — Page 32
Updated language to allow medical necessity for all diagnosis.
PacificSource standard practice and industry
standard. Please note that these services will be
outlined separately in the Plan Document and is
not a combined benefit.
Benefit Exclusions — Page
39
The benefit exclusion of abortion has been removed, due to the NOC 1
requiring it to be covered.
State Mandated covered benefit.
Benefit Exclusions — Page
39
The benefit exclusion for phone consultations has been removed, due to
Telehealth benefits.
Clarification, not a change to the administration of
benefits.
Benefit Exclusions — Page
40
The benefit exclusion for Infertility has been added, Language for the
previous version of Family Planning was rewritten and simplified.
Clarification, not a change to the administration of
benefits.
Benefit Exclusions— Page 41
The benefit exclusion of Narcosynthesis has been removed, This update
was made due to Mental Health Parity requirements.
Mental Health Parity
Benefit Exclusions— Page 42
The benefit exclusion for Orthognathic surgery has been updated for
clarification.
Clarification, not a change to the administration of
benefits.
Benefit Exclusions— Page 43
The benefit exclusion Services/supplies provided by domestic or foreign
government has been removed, as this is a custom client benefit offering.
Correction to the Plan Document, client covers
these benefits as a custom benefit offering.
Prior Authorization - Page
45
Language regarding treatment received without a Prior Authorization in
place has been updated.
I PacificSource has rewritten this section related to
internal processes for clarification. Not a change
to administration.
Using the Provider Network
- Page 48
Language has been added to clarify that services do not require referrals
and that Members can obtain healthcare outside of the Plan if they
choose.
Clarification, not a change to the administration of
benefits.
Your Primary Care a
Provider/Shared Decision
Making - Page 46
These two sections pertain to the Navigator Network
Language added for the new network.
Allowable Fee for Out -of-
Network Providers - Page
50
Section has been rewritten for clarity and simplicity, and in accordance
with the new Allowable Fee Definition.
Clarification, not a change to the administration of
benefits.
Your Rights and Protections
Against Surprise Medical
Bills and Balance Billing
Page 47
New section has been added.
Clarification, not a change to the administration of
benefits.
Example of Provider
Payment Page 48
Example has been updated for clarity and to reflect the Allowable Fee
change.
Clarification, not a change to the administration of
benefits.
Finding an In -network
Provider Page 49
Language has been added to clarify that providers on the nationwide
network are only considered in -network when the member is out of the
service area.
Clarification, not a change to the administration of
benefits.
Epidemic/Dependent
Children Residing Outside
the Service Area Page 50
Two new sections have been added due to Navigator Network.
Language added for the new network.
Claim Handling Procedures
This section has been rewritten to include more specific information on the
PacificSource has rewritten this section related to
OR_NOC_LG_Medical_Dental_
2023_Self-Funded_Public
4
Page 51
claims handling process and timelines.
a
internal processes for clarification. Not a change
to administration.
"
Legal Procedures Page 57
The reference to a specific timeline has been removed. Language limiting
legal action after the expiration of the applicable statute of limitations
remains.
Clarification, not a change to administration.
Eligibility —Dependents
Page 66 Medical
Page 26 - Dental
Adoption, foster care, and guardianship now fall under the definition of
Dependent Children. ,
Clarification, not a change to administration.
Special Enrollment Rule #2
Page 70
Specific qualifying events are already addressed in the Enrolling New
Dependents section. -
Clarification, not a change to administration.
Definitions Page 76
Allowable Fee has been updated and rewritten.
Core Language Update.
Definitions Page 77
Balance Billing definition has been added per the new federal requirement.
Core Language Update.
Definitions Page 78
Benefit Year definition has been added.
Core Language Update.
Definitions Page 78
Chemotherapy definition has been added.
Core Language Update.
Definitions Page 78
Custodial Care definition has been added.
Core Language Update.
Definitions Page 78
Dependent definition has been added.
Core Language Update.
Definitions Page 79
Eligible Employee definition has been updated.
Clarification, not a change to the administration of
benefits.
Definitions Page 82
Hospice Care definition has been added.
Core Language Update.
Definitions Page 84
Provider definition has been added.
Core Language Update.
Definitions Page 85
Radiation Therapy definition has been added.
Core Language Update.
Definitions Page 85
Service Area definition has been added.
Core Language Update.
Definitions Page 87
Telehealth definition has been updated.
Core Language Update.
Definitions Page 87
Women's Healthcare Services definition has been added.
Core Language Update.
Dental Changes
Section Summary of Change Why are these changes occurring?
Dental Benefit Summary
Page 3
Added row for Night guards under Class III services. -I
Clarification, not a change to the administration of
benefits.
Cosmetic Orthodontic
Benefit Summary Page 4
Added language to clarify that enrollment in orthodontia coverage must
match enrollment in the dental Plan.
Clarification, not a change to the administration of
eligibility.
Cosmetic Orthodontic --
Benefit Summary Page 4
Added language to communicate that internet/web based providers are not
eligible.
Clarification, not a change to the administration of
benefits.
Understanding
Experimental, -
Investigational, or Unproven
Services Page 6
This is a new section explaining Experimental, Investigational, or,
Unproven services and how PacificSource reviews coverage for services
that fall in this category.
-
Core Language Update.
OR_NOC_LG_Medical_Dental_
2023Self-Funded Public
5
Class I Services Page 7
Added language to call out that Class I services do not apply to the benefit
maximum for Members age 18 and younger.
Clarification of custom benefit, not a change to the
administration of benefits.
Class II Services Page 7
Bullet point for fillings has been rewritten.
Clarification, not a change to the administration of
benefits.
Class 11 Services Page 7
Bullet point for fillings has had language added for gold fillings reducing to
amalgam.
Clarification of custom benefit, not a change to the
administration of benefits.
Using the Dental Network
Page 14
Language has been added to clarify that services do not require referrals.
Clarification, not a change to the administration of
benefits.
Example of Provider
Payment Page 15
This section has been removed.
Clarification and simplification of language, not a
change to the administration of benefits.
BalanceClarification,
Billing Page 14
New section has been added.
not a change to the administration of
benefits.
Claims Payment Page 16
This section has been expanded to include more specific information on
the claims handling process and timelines.
PacificSource has rewritten this section related to
internal processes for clarification. Not a change
to administration.
Definitions Pages 42-45
The following definitions have been added as a clarification:
• Dependent
• Experimental, Investigational, or Unproven ..
• Illness
• Injury
• Lifetime Maximum
• Post -service Claim
• Pre -service Claim
• Urgent Care Claim
Clarification, not a change to the administration of
benefits.
Definitions Page 40
Definition for Accident has been added
Core Language Update.
Definitions Page 40
Definition for Allowable Fee has been updated
Clarification, not a change to the administration of
benefits.
Definitions Page 41
Definition for Balance Billing has been added
Core Language Update.
Definitions Page 41
Definition for Benefit Year has been added
Core Language Update.
Definitions Page 42
Definition for Concurrent Care Claim has been added
Clarification, not a change to the administration of
benefits.
Definitions Page 42
Definition for Dependent has been added
Clarification, not a change to the administration of
benefits.
Definitions Page 43
Definition for Eligible Employee has been updated.
Clarification, not a change to the administration of
benefits.
Definitions Page 43
Definition for Emergency Dental Condition has been added.
Clarification, not a change to the administration of
benefits.
Definitions Page 43
Definition for Experimental, Investigational, or Unproven has been added.
Clarification, not a change to the administration of
benefits.
Definitions Page 44
Definition for Illness has been added.
Clarification, not a change to the administration of
benefits.
Definitions Page 44
Definition for Injury has been added.
Clarification, not a change to the administration of
O R_N O C_L G_M e d i ca l_D e n to l_
2023_Self-Funded_Public
6
benefits.
Definitions Page 44
Definition for Lifetime Maximum has been added.
Clarification, not a change to the administration of
benefits.
Definitions Page 44
Definition for Post -service Claim has been added.
Clarification, not a change to the administration of
benefits.
Definitions Page 45
Definition for Pre -service Claim has been added. •
Clarification, not a change to the administration of
benefits.
Definitions Page 45
Provider definition has been added.
Core Language Update.
Definitions Page 45
Definition for Urgent Care Claim has been added.
Clarification, not a change to the administration of
benefits.
Definitions Page 45
Definition for X-ray has been added.
Optional Changes:
Medical Changes
Yes
o Section.
Summary of Change
Why are these changes occurring?
Covered Expenses —
Coverage for elective abortions
To comply with ORS 743A.067
Other Covered Services,
Supplies, and Treatments
— Page 25
Medical Benefit Summary
Standard Plan - Telehealth visit copayment change to $0.
PacificSource best practices.
— Standard Plan
Page 2
Employer Plan Document
Your PacificSource Sales and Service Team will provide you a 'redlined' version of your Plan Document with the applicable changes for you to review. Please note
that minor changes, including formatting, grammatical or cosmetic are not included in the NOC summary. Once the changes and updates have been approved a final
Plan Document will be provided to you for signature. You will be able to access your signed Plan Document online. You can also enroll new members, update
existing member information, print temporary ID cards, and view your current census information and enrollment totals.
https://intouch.pacificsource.com/ITE/Login
Member Materials
After your Plan changes have been processed, new ID cards will be mailed to your covered employees and their dependents only if there is a change that
impacts ID cards. Participants under the plan will have 24/7 access to the approved Plan Document and Summary of Benefit Coverages (SBCs) through InTouch for
Members at PacificSource.com, as well as access to our provider directory and other information.
We're here to help.
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PacificSource
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