The State Group Insurance Program for Plan Year 2007
description
Transcript of The State Group Insurance Program for Plan Year 2007
HR Conference 2006Tallahassee, Florida November
14 &15
Programs ~ Processes ~ Partnerships ~ Programs ~ Processes ~ Partnerships
The State Group Insurance
Program for Plan Year 2007
Presenter
Verla Lawson Division of State Group
Insurance DMS People First Team
The Changes
•DSGI’s – Role and Responsibilities
•People First – Benefits Administration
•New Benefit Plans and New Vendors
The Challenges
• Coordination and cooperation between DSGI and People First to effectively manage complex processes that serve employees and retirees within a complex regulatory environment
• Enrollment in and implementation of new types of benefit plans and new vendors
DMS People First Benefits Team
• Contact the team at 850-921-4500• The People First Benefits Team
consists of the following members:• Tom Lockridge – Team Lead• Verla Lawson• Janice Lowe • Jackie Ward• Lenora Williams• Mike Waller
DSGI Reductions
•Downsizing and staff reductions
•Client Services outsourced
•Administrative Services outsourced
DSGI Today
•Agency Liaison•Policy Analysis•Product Management•Procurement•Policy and Rule
Determinations•Financial Management and
Residual Accounting Functions
People First
• System of Record (data)• Customer Service• Correspondence• Transaction Processing• Open Enrollment• Fiscal Administration• Eligibility Files to Vendors
Customer Interfaces
•Bureau of State Payrolls•State Agencies•Universities
–Devolved –Not yet devolved
•Division of Retirement•“Benefits Only” Entities
People First as System of Record
• COPES Insurance phased out• COPES data out of date • Transfer of COPES data to People
First (PF)• New enrollment in PF SAP system• Historical data to Data Warehouse• Transfer of DSGI historical data• SAP data and DSGI data in the
People First Data Warehouse
DMS People First Benefits Team
• Facilitates the implementation of system and operational processes in People First
• Assists employees and agencies with People First Issues
• Receives direction regarding laws, rules and policies from DSGI
Changes in roles and processes
Changes in roles and processes, coordination and cooperation.
Two Examples are:
• Underwriting approval process
• Exceptions and appeals
Underwriting Approval
• Underwriting approval process• Old procedure
– Deductions began prior to approval
– Cancellations and refunds required when underwriting was denied
• New procedure– New enrollment records “locked”
until approved– Deductions begin after approval is
received
Escalations and Appeals
• Escalated Issues – Pertain to People First
Processes– Submitted to PF Client
Services Team– Submitted by Agencies or
DMS Project Team• Employee Appeals and Agency
Errors
Appeals and “Exceptions”
• “Agency error” letters to People First (coordinates with DSGI in complex cases)
• Employee appeals – “Level 1 appeals by employee (not
agency) sent to People First”– If denied, employee has right to Level 2
appeal– People First sends Level 2 appeals to
DSGI– If denied, employee is notified by
registered mail of his right to an Administrative Hearing
2007 Benefit Plans
•HMO Service Area Expansions
•Open Access HMO Plans•Prescription Drug Program and Medicare Part D
Retiree Life Insurance
•Effective January 1, 2007 Retirees will have two benefit levels to choose from:
$2,500 & $10,000•Cost to Retiree: $ 4.20 & $ 35.79
Retiree Life Insurance
•Actual Premium paid to Prudential$4.20 + $6.36 = $10.56
for $2,500 and
$35.79 + $6.36 = $42.15 for $10,000
Retiree Health Insurance
Retirees who are not eligible for Medicare
pay the same premium for both the PPO and HMO plans.
Effective April 1, 2007
• Effective April 1, 2007 for May coverage monthly premiums will increase.
• Retirees who are not eligible for Medicare and members of the Standard PPO/HMO plans the premiums will increase as follows:
• Individual Coverage - $427.86• Family Coverage - $967.60
Medicare I
•A Retiree/Surviving spouse who is eligible for Medicare.
•For the Standard PPO Plan, coverage will increase to $227.18.
Medicare II
•Retirees/spouse or surviving spouse who are eligible for Medicare and one or more dependents are not eligible.
•In this case the premium will increase to $655.04.
Medicare III
•Two Medicare eligible participants and no other dependents.
•The premium will increase to $454.36
Health Investor PPO Plan
Medicare I•Premiums for those retirees enrolled in the Health Investor PPO Plan and not Medicare eligible, will increase to:
Individual Coverage - $351.20
Family Coverage - $768.56
Health Investor PPO Plan Medicare I
•Premium for a Retiree enrolled in the Health Investor Health Plan who is eligible for Medicare.
Individual Coverage - $169.46
Health Investor PPO Plan
Medicare IIRetiree/spouse or surviving spouse
eligible for Medicare with other
dependents.Premium amount
$562.34
Health Investor PPO Plan
Medicare IIIA Retiree and spouse eligible for Medicare
with no other dependents or a retiree or a surviving spouse
with a disabled dependent.
Premium amount $338.92
Retiree HMO’s
•Retirees who are eligible for Medicare and enrolled in one of the HMO Plans pay monthly premiums which vary by HMO and county.
Retiree HMO’s• For Plan Year 2007, some
premiums have increased while others have decreased or remained the same. (There is a chart showing all retiree premiums, by county on the People First web site at
https://peoplefirst.myflorida.com)
Health Investor Health Plans
•Health Investor Health Plans–PPO–HMO
•Health Savings Accounts•Limited Purpose Medical
Reimbursement Accounts
Health Investor Plans
• Lower premiums• Higher deductibles • Coinsurance rates
– Medical– Prescriptions
• Eligibility for Health Savings Account
• Election decision based upon utilization
Health Savings Accounts
• Tax exempt employee contributions
• Employer contributions • Ineligible for “regular” Medical
Reimbursement Account• Eligible for Limited Purpose
Medical Reimbursement Account• Employee managed account
HMO Changes
• HMO Service area expanded• Mail order Rx drug plans• Statewide contract rates
–no more “service area codes”
• “Open Access” HMOs –no “gatekeeper”
Medicare Part D
• Federal requirement to coordinate enrollment with Medicare
• Notification to participants• Retirees who choose Medicare D
subject to Coordination of Benefits• Data interfaces to monitor
enrollment in State Plan and Medicare D
The Future of Benefits Administration and the State Group Insurance
Program• DSGI will continue to work with
People First cooperatively to provide the State’s employees and retirees with a comprehensive package of quality benefits, meeting their needs in the most cost effective manner and using the latest technology to provide ready access to information and election opportunities.