HomeMy WebLinkAboutHealth Benefit Plan Renewal Discussion2008/2009 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).
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 '/2% 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
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Reason: Benefit allowances do not reflect current trend in coverage.
Could possibly hinder patient being considered for transplant.
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
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.
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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.
• 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.
In estignte 1"tirtiter ro.a ,ian m-) 9t rtiri `rune
committee on 06,12012008,
• Add marriage and family counseling as a benefit in the outpatient mental
health benefit
Reason: Multiple requests for this benefit
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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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