CUHRE – DSGI Presentation Summary 7/28/17 Upcoming Changes for Plan Year 2018 – This is a brief overview of changes that we will see for the 2018 plan year. More information will be released about these changes in August in preparation for our upcoming Open Enrollment. Open Enrollment this year is Oct. 16 – Nov. 3 and the correction period is from Nov. 6 – Nov. 17. Dental Plan Changes – DSGI launched a dental plan procurement in 2017 for the 2018 plan year. As a result of the procurement four plans currently available will not be available in 2018, United Healthcare Solstice, Humana Network Plus 4004, Humana Preferred Plus 4054 and Ameritas Preventive Plus 4064. MetLife and Ameritas were awarded contracts. Each new carrier will offer an Indemnity PPO, a Standard PPO and a Preventive PPO so we will have 6 new plans to offer. Employees are that enrolled in the one of the discontinued plans mentioned above will be required to enroll in a new plan. If they do not enroll in a new plan during open enrollment they will not have dental coverage for the 2018 plan year. HMO Changes – DSGI launched a procurement for HMOs in 2017. As a result of the procurement we will see some changes in HMO coverage areas. Florida Health Care Plan formally withdrew from the process therefore we will not be offering a FHCP HMO. We are in the process of signing contracts with Aenta, AvMed, CHP and UnitedHealthcare. As soon as the contracts are signed we will be able to release HMO coverage areas. Employees that are affected by an HMO coverage area change will be mapped to the HMO that is contracted to provide coverage for their home county in 2018. If the employee experiences an HMO change they will see the change on their Annual Benefits Statement sent as part of the Open Enrollment packet. We will release more information about the HMO mapping in our OE Kickoff Meeting for HR offices. Because we have some many changes coming up in the next several plan years we are in the process of updating the myBenefits website. We hope that the changes we are making will make navigation easier for our members and all them to make informed decisions regarding their benefits. Assurant dental plans will continue to be offered in 2018 and they are changing their name from Assurant to Sun Life. OPS eligible for Healthcare FSA beginning Jan. 1, 2018. HSA contribution increase – The IRS announced an increase for HSA contribution limits for plan year 2018. Individual limits increased to $3,450 (increase of $50); Family increased to $6,900 (increase of $150). State employer contribution will not change. IRS also increased annual maximum out-of-pocket limit and annual minimum deductible limit for the High Deductible Health Plan; maximum out-of-pocket limit for individual increased $6,650 (increase of $100) and family increased to $13,300 (increase of $200); minimum deductible limit for individual increased to $1,350 (increase of $50) and family increased to $2,700 (increase of $100).
Beginning Jan. 1, 2018, Occupational Therapy will be a covered service. Medication Synchronization or “Med Sync” is a great addition to our pharmacy benefits. Med Sync allows members to save time and reduce the number of trips to their retail pharmacy by allowing the member to request their retail pharmacist to “synchronize” their medication refills so prescriptions can be picked up on the same day. Some medications are not eligible for synchronization. Vision Rate Changes – Humana remains our vision plan provider. Employees will see a slight increase in monthly premiums for each coverage tier. Employee Only $ 6.96 Employee + Spouse $13.74 Employee + Child(ren) $13.60 Family $21.36 Obesity Pilot – details will be provided by Agata later in this presentation Dependent Eligibility Verification Audit (DEVA) – The legislature passed and Gov. Scott signed into law SB 2508. This bill directs DSGI to procure a third party vendor to conduct a 100% dependent eligibility verification audit. Stefanie will provide more details later in this presentation. We have several different ways that we plan to communicate all the upcoming changes and initiatives to employees however we are going to need an extra boost from HR offices this open enrollment to make sure know and understand the changes for dental and HMO coverage. As we near open enrollment DSGI will begin sending out reminders and notifications to HR offices. Please make sure this information is passed on to your employees so that we have a smooth transition from 2017 to the 2018 plan year. SB 7022 What to Expect Legislature passed and Gov. Scott signed into law SB 7022 during the last legislative session. This bill requires DSGI to procure and contract with entities to offer several new services to our members. Transparency, Bundled Services and Shared Savings all work together. These sections of the bill requires services be provided to enrollees to allow them access to comprehensive pricing for surgeries and other health care services, allows enrollees to shop for health care services and providers and rewards enrollees by sharing savings generated by enrollee’s choice of service or provider. While the Transparency and Bundled Services may be offered sometime in 2018, shared saving will not be offered until 2019. Additional Benefit Offerings – This portion of the bill lists several benefit offerings that DSGI may offer such as prepared limited health plans, discount medical plans, prepaid health clinics,
service contracts offered by licensed providers, hospitals, and clinics; service contracts and bundled arrangements offered by service networks, group practices and professional associations; and entities that offer health care services and bundled arrangements through a bidding process. If any of you have any suggestions on additional benefits that we should be offering please let us know. Metal Tiers – We will not know anything about Metal Tiers until plan year 2019. Shared Savings will be a part of the metal tiers as well. QA Program – Currently the State Group Insurance Program covers 175,000 enrollees, and 367,000 covered lives. Our Program relies on an honor system for enrolling dependents rather than requiring documentation to verify dependent eligibility. According to industry estimates, 7 to 10 percent of dependents are ineligible in a program like ours that does not require documentation. Assuming a conservative 6 percent of our dependent were not eligible, that would be approximately 9,200 dependents, and at a per dependent cost of about $4,886, that’s nearly $45 million a year in claims that we could be paying for dependents who should not be covered. DSGI has a three-pronged approach to verifying dependent eligibility. Phase I is the QA review already in progress. In May we began taking a random sample of 20% qualifying status change events. Enrollees included in the random sample are required to submit documentation to DSGI that verifies their dependents eligibility. Enrollees have 60 days from the date of the request to submit documentation. If the enrollee does not submit documents within the timeframe that prove dependent eligibility their dependents coverage will be terminated prospectively. Three notices go out to enrollees before termination. On day 50 our office works with HR offices to reach out to employees that have not responded to the initial notification. Phase I will continue until Fall 2017. Phase II is the Dependent Eligibility Verification Audit (DEVA) which is the 100% audit by a third party vendor. Stefanie will give you all the details about DEVA. Dependents that we verified as eligible by DSGI in phase I will be exempt from Phase II. Phase III After the 100% audit is completed DSGI will start the QA Review again. We will continue ongoing quality assurance review of the QSCs each month. Dependent Eligibility Verification Audit (DEVA) During the 2017 Legislative session, legislature passed and the Governor signed into law Senate Bill 2508. SB2508 requires the Division of State Group Insurance to conduct a full Dependent Eligibility Verification Audit. During this audit, subscribers will receive communications requesting specific documentation to validate the eligibility of their dependents.
SB2508 also requires that DSGI notify all subscribers by September 1, 2017 regarding the eligibility rules for dependents. An amnesty period will be held through November 30, 2017. Subscribers that remove ineligible dependents from plan membership before December 1, 2017 will be held harmless for past claims of ineligible dependents. Audit activities are expected to begin December 1, 2017. DSGI is currently procuring for an audit vendor.
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