HomeMy WebLinkAboutEBAC Recommendations2008/2009 Health Benefit Plan Renewal Considerations
EBAC Recommendations for consideration of vote by BOCC
• Modify preventative care benefit to $750 annual allowance, with no age or
frequency limitations.
Reason: Highly encourage employees to utilize the preventative care benefit in
order keep employees healthy and plan expenses minimized.
Estimate of financial impact to plan: An additional $280,000 would be paid
based on last year’s claims. Additional claims could be expected based on the
increase in the benefit. The intent would be that this additional expense in
preventative care would offset further invasive treatments for conditions
previously undiscovered.
Approved by EBAC 06/17/2008.
• Modify the Colonoscopy/ EBT benefit to 80/20 no deductible regardless of reason
for acquiring service.
Reason: Eliminate the two different ways for these services to be paid. This has
been very confusing since the Alternative care benefit was opened up to include
the screening of Colonoscopies and EBTs. Most common misunderstanding
about our coverage. The out of pocket payment for the patient can vary greatly
depending on the way the claim is billed.
Estimate of financial impact to plan: It is unknown if this benefit would
increase expenses given the current way the claims are paid with the alternative
care benefit. A total of 67 colonoscopies and 10 EBTs have been performed since
08/01/07. Again, the intent with eliminating the deductible and alternative care
issue from this benefit would to encourage proper early screening for early
detection of issues.
Approved by EBAC 06/17/2008.
• Remove CoPay from Well Baby Care and increase number of allowed visits to be
consistent with the American Academy of Pediatric recommendations (10).
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Reason: CoPays are not required for other preventative care visits (those age two
and over). Interest in consistency. Current plan limitation of eight visits requires
employees to pay 100% of the two additional visits.
Estimate of financial impact to plan: An additional $2,025 would be spent
based the 135 visits that were paid since 08/01/07. It is unknown how much the
expense of the two additional visits would be to the plan as it is unknown how
many services are not being billed based on the plan limitation.
Approved by EBAC 06/17/2008.
• Remove 24 month waiting period for Organ Transplants for newborns.
Reason: The intent of this restriction is on new people coming to the plan
through employment or dependency. The intent is not to require a newborn to
wait 24 months for a lifesaving transplant.
Estimate of financial impact to the plan: Deschutes County has had no
experience with an organ transplant, while these cases are rare; they are costly
once a transplant is required.
Approved by EBAC 07/15/2008.
• Remove Alternative Care benefit from Stop Loss coverage.
Reason: Realize premium savings on stop loss coverage. Treat the Alternative
Care benefit the same as Vision and Dental.
Estimate of financial impact to the plan: Estimated at a 3% savings to the
Aggregate premium and ½% to the Specific premium. In this current plan year
we would have saved $9,300.00 in the Aggregate premium and $21.65 to the
Specific premium.
Approved by EBAC 06/17/2008.
• Increase to the Organ Transplant benefit
Reason: Benefit allowances do not reflect current trend in coverage. Could
possibly hinder patient being considered for transplant.
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Increase from $250,000 lifetime max to $500,000. Also add $30,000 benefit for
organ procurement and $10,000 for travel and lodging.
Estimate of financial impact to plan: Possibility to increase individual claim
payout significantly.
Approved by EBAC 07/15/2008
• Increase Orthodontic benefit
Reason: Multiple requests for this increase. Increase benefit from $1,000 lifetime
max to $2,000.
Estimate of financial impact to plan: Based on claims paid in current plan year,
plan would have realized $23,000 in additional expenses. Further expenses could
be incurred based on attracting more people to the benefit.
Approved by Renewal EBAC 07/15/2008.
• Add language to the plan to allow for termination of coverage for fraud/
misrepresentation.
Reason: Protection of the plan assets
Estimate of financial impact to the plan: None
Approved by EBAC 07/15/2008.
Informational items for BOCC that require no action
• Stop Loss Renewal
Approved by Renewal Committee 06/20/08. Contacted HCC and locked in
rates.
Total Possible plan benefit expenses based on current plan year data: $330,000. This does
not include an estimate for increased claims expense related to the increase to the organ
transplant benefit, not the adjustment of the colonoscopy/ EBT benefit.
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• Add State-Mandated Benefits
Reason: Required as a health insurer in the state of Oregon
Items to be added:
Pervasive Developmental Disorders ORS 743A.190
Prostate Specific Antigen tests and Prostate exams ORS 743A.120
Colonoscopy/Sigmoidoscopy ORS 743A.124
Cochlear Implants ORS 743A.140
Estimate of financial impact to the plan: Unknown
• Change in Preferred Provider Organization
Reason: Some significant errors with our current PPO. The possibility for ease
of administration and reported additional discounts received by the plan.
Estimate of financial impact to the plan: Currently unknown- will report back.
Investigate further for January effective date at instruction of renewal
committee on 06/20/2008.
• Add marriage and family counseling as a benefit in the outpatient mental health
benefit
Reason: Multiple requests for this benefit
Estimate of financial impact to plan: Currently unknown- will report back.
Pended by renewal committee 06/20/2008 for further investigation into EAP
alternatives
• Coverage for Chinese herbs and supplements
Reason: Request from employee
Estimate of Financial impact to plan: Unknown
Renewal Committee declined to consider addition of benefit on 06/20/2008
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