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Insurance Committee Meeting Minutes 2/24/16
Posted by Kyndall Jirasek on 3/10/2016
Meeting Date: February 24, 2016
Meeting Location: Administration Meeting Room
Recorded By: Kristin Baum
21 of the 34 Campus/Departments were represented at the meeting.
1. Delta Dental Update – Ida Kelly and Chris Hinds with Delta Dental presented 2014 & 2015 utilization review. Discussed the importance of utilizing a contracted Delta Dental dentist vs. a non-contracted dentist to receive the best pricing/discounts. We have been educating employees and did see a small amount of movement. In 2014 35% of employees went to a non-contracted dentist and in 2015 this went down to 32.6%. However, best practice would be at 23%. Utilizing a Delta Dental Dentist provides a bigger discount for the employee as well as the plan. Will have a good idea of renewal rates by next committee meeting.
2. Compass – Madelon Parker presented a review of 2015 utilization. Very positive results. Employees called in for the following:
46.7% - Doctor Recommendation
19.2% - Insurance Benefit Question
13.2% - Cost Estimate
11.5% - Bill Review
3.7% - Prescription Review
2.7% - Coordination of Care
1.8% - Schedule Appointment
1.2% - Other
The highest savings opportunity is for employees seeking cost estimates and prescription reviews.
The standout claims from 2015 came from employees utilizing emergency rooms instead of urgent care facilities. The free-standing ERs have caused confusion as to what are true urgent care facilities. Email addresses have been provided to Compass and an education flyer will be emailed to all employees and an English/Spanish postcard will be mailed to all auxiliary employees with helpful information about local ERs vs. Urgent Cares. They will specifically state “this” is an urgent care and “this” is not.
3. Humana Update – Jared Moss with MHBT present a review of 2015. PfISD averaged 3418 members with the average age being 42. 67% are female and 33% are male. In 2014 the cost per member per month was $310.75 and increased to $311.08 in 2015. There were 6 claims that were more than $100,000 which was down from 12 claims in 2014. The top diagnosis in 2015 was the musculoskeletal system. Emergency room visit costs increased from $737,802 in 2014 to $1,335,139 in 2015. For more information email benefits@pfisd.net for the summary to be sent to you.
4. Open Enrollment – requested comments and feedback about the open enrollment process. Four campuses responded that there were sensitivity issues as well as a differential in blood pressure readings. Response from four campuses that they were pleased with their enrollment and had no issues. The addition of the “gatekeeper” to direct the flow to the enrollers worked very well and received a positive response.
5. Employee Assistance Program – we continue to receive inquiries about this program. Information is available about the EAP on the PfISD website under the Employee Benefits page. Employees are able to access this program and have 3 face to face counseling sessions and unlimited 24/7 phone support.
6. Airrosti - we have extended the Airrosti program through December 31, 2016. If you or your dependents are covered under the Districts medical plan you can treat with Airrosti at no cost to you. We are also conducting on-campus injury assessments at 15 locations for the spring semester. An assessment is a brief complimentary evaluation to determine if further treatment options are necessary and then employees are scheduled a follow up appointment. We are definitely interested in any feedback you have to this program. One concern that was brought to our attention was the clinic hours. The last appointment for the day was at 4:00 pm. The Pflugerville location on 685 has adjusted their appointment times and added a 5:30 appointment on Monday and Tuesdays. In the future they hope to extend to 6:00 pm.
7. Colonoscopy and BRCA Testing –
a. Colonoscopy – employees that go in for a preventative colonoscopy that is covered at 100% will no longer be charged their deductible/co-insurance if a polyp is found during this visit. Insurance companies cannot change the coding from preventative to diagnostic and charge the employee. If the employee goes in originally for a diagnostic test then it is subject to their deductible/co-insurance
b. BRCA Genetic Testing - For some women a genetically inherited trait puts them at very high risk for developing breast cancer (BRCA Mutation). This testing is now covered under preventative services. Group discussed 3D and MRI mammogram coverage. Currently both are not covered. We will look into considering the cost to add for next year.
8. 403b and 457 TPA Change - There have been questions about the change PfISD made to The OMNI Group as out third party administrator for 403b and 457 plans as well as how to handle financial advisors requesting to solicit business on campus. Effective January 1, 2016 PfISD moved from National Plan Administrators for the 403b plans and VOYA for 457 plans to The OMNI Group as our third party administrator. Nothing has changed except that the employee’s financial advisor will send their salary reduction agreements to The OMNI Group. This information can be found under the employee benefits link on the PfISD webpage under employee benefits.
Additionally, there are specific guidelines set by TRS regarding what an educational institution MAY NOT do in regards to 403(b) plans. Educational institutions cannot give exclusive access to any company offering investment products. What this means is that if you allow one company onsite (such as AXA Advisors, Capital Advisors, Edward Jones) then you must allow any other company offering financial/retirement planning products onsite as well. PfISD does not endorse any financial advisor and will not recommend one company over another. It is the employee’s responsibility to contact a financial advisor of their choice, and meet with them outside of work hours. If the employee enrolls in a 403b or 457 plans then their financial advisor will contact The OMNI Group for processing.
Questions should be directed to their advisors or The OMNI Group.
Mailing Address:
The OMNI® Group
Water Tower Park
1099 Jay Street, Building F
Rochester, NY 14611-1153
ATTN: Service Provider Team
Website/Phone/Fax:
Phone: 877.544.6664
Fax: 585.672.6194
9. IRS Form 1095c - Form 1095c is an annual reporting form used in connection with the Affordable Care Act. Form 1095c includes information about the health insurance coverage offered to you and, if applicable, your family. The IRS extended the deadline from February 1 until March 31. The forms have been mailed to all employees employed with PfISD from January 1 – December 31, 2015. Employees do not need to wait on this form to file their 2015 taxes. Every employee will receive this form whether they were enrolled in the district medical plan or not. More information about this required reporting can be found on the PfISD website under Employee Benefits.
10. Employee Question/Coordination of Benefits – It is an industry practice for insurance companies to ask if you or your dependents have other medical coverage. They typically do so by sending a letter that you must respond to. Failure to respond to the letter will result in the denial of claims payment until you respond. PfISD is working with Humana to coordinate this during our open enrollment process so that employees are not faced with this throughout the year. This will go into effect next year (2016) so please respond to the letters if you should receive them through the end of this year.
Next Meetings:
April 13, 2016 at 4:30 p.m.
May 17, 2016 at 4:30 pm
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