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Operations Subcommittee, April 11, 2006
Public Employees’ Benefit Board
Operations Subcommittee
Tuesday, April 11, 2006, 9:30 to 11:45 a.m. - Minutes
Room 125, Transportation Building
355 Capitol St NE, Salem OR
Approved May 9, 2006

Subcommittee Members Present
David Hartwig
Diane Lovell
 
Paul McKenna
PEBB Staff Present
Bobbie Barott
Dena Comer
Isabel Joslen
 
Lydia Lissman
Susan Pritt
Jean Thorne
Guests Present
Dotha Canning, Samaritan Health Systems
Ryder Eggleston, Willamette Dental
Gordon Hoberg, ODS
Megan Myrick, Willamette Dental
 
Paul Pfinster, AFLAC
Sara Rengler, Willamette Dental
Barb Sandoval, BenefitHelp Solutions
Kim Waldroff, BenefitHelp Solutions
 
Agenda
Welcome
Approval of Minutes: December 13, 2005
Customer Service Team Update
Policy Option Packages
HIPAA and PEBB
Advisory Group Report
Kaiser Incentive
Budget Update
Contract Discussion
Public Comment
 
Welcome and Approval of Minutes
Diane Lovell called the meeting to order.
 
Paul McKenna moved to approve the December 13, 2005 meeting minutes.
Diane Lovell seconded the motion.
Hearing no further discussion, the motion passed unanimously.
 
Customer Service Team Update
Bobbie Barott reported that the appeal process has been modified to include member notification that the appeal has been received and assigned a reference number. Additionally, once a decision has been made, the appeal will be taken from the analysts to be closed by other staff. This will speed the process and help to identify which appeals are still open from those which are only needing clerical follow-up.
 
Incoming calls received through PEBB’s automated phone system can now be categorized in order to determine the types of calls and concerns from members. The categories can be changed as concerns are no longer “hot” issues and new issues become apparent. Currently, PEBB receives an average of 85-100 calls daily coming in through the automated system.
Policy Option Packages
Lydia Lissman referred to Ops attach.2 and provided an overview of the administrative policy option packages for 2007-09.
 
The Subcommittee discussed contracting a part-time (15%) Medical Consultant for PEBB.
PEBB staff will prepare the necessary information for the Board’s consideration.
 
HIPAA and PEBB
Lydia Lissman explained that the current self-funded contracts define PEBB as the Plan Administrator. In order for PEBB to remain as a Sponsor it must:
  • Define the entity that is legally responsible for plan administration;
  • Clearly articulate Aon, self-funded plan, and PEBB’s roles; and,
  • Have a clear firewall between PEBB as a sponsor and the plan administrative functions.
 
The current contract language must be revisited to clarify PEBB’s role as a Sponsor rather than an Administrator. PEBB has historically not been required to be HIPAA compliant. PEBB is working with DOJ to ensure that the Administrative Rule is clear regarding PEBB’s role in processing claims. This clarification will provide more structure for both PEBB staff and members regarding what medical information is shared as claims are processed.
 
Advisory Group Report
Isabel Joslen reported that the first meeting of the PEBB Advisory Committee occurred in March. The group is comprised of a good representation of the state agencies and OUS payroll staff. The Committee will provide an opportunity to examine how benefits are administered with all entities so that members are served consistently. The Committee will be advising PEBB regarding the development of educational opportunities regarding eligibility as well as process reviews.
 
Referring to Ops attach.3, she explained that the Committee has a charter and minutes are taken at each meeting, so the work is very structured. PEBB is considering creating a special email address for pebb.benefits administration so that systems issues don’t have to go through the appeals process. She will return to provide monthly reports to the Subcommittee.
 
Kaiser Incentive
Isabel Joslen explained the concern regarding how to prorate the $250 Kaiser incentive for part-time employees as approved by the Board last year. The Board decided last year to include part-time employees in a one-time payment of $250, to be prorated according to the amount of hours worked per month, into the employee’s FSA as incentive to enroll in the Kaiser HMO. PEBB is recommending that 50% of the incentive be deposited for part-time employees, rather than utilizing the prorating system. This will provide a fair and consistent method for incentives for all part-time employees.
 
Lydia Lissman explained that the system is not set up to examine the FTE in order to apply the proration. It becomes a workload issue for PEBB staff to determine, and it is difficult to offer an incentive when the actual amount cannot be determined until after the part-time member is enrolled.
 
Paul McKenna moved to adopt the staff recommendation to deposit a one-time payment of $125 (50% of the amount for full-time employees) into the part-time employee’s FSA if they switch from their current provider and enroll in the Kaiser HMO.
David Hartwig seconded the motion
Hearing no further discussion, the motion passed unanimously.
 
Budget Update
Susan Pritt referred to Ops attach.4 and provided an overview of the current budget summary. She reported that the closing of the Wellness Center incurred additional costs, and that PEBB now has to pay for the lease of the whole space, which is paid monthly (formerly 58% had been paid by the Health Center according to their contract). Additionally, DOJ costs have been higher than expected with the contracts being different this year. PEBB is working with DOJ to address the way the work is done and how the agency is billed, and PEBB is hopeful that the cost will go down.
 
Contracts Discussion
Lydia Lissman referred to Ops attach.5 and explained that PEBB is seeking approval by the Subcommittee to amend the Aon contract.
 
Paul McKenna moved to adopt staff recommendation to amend the Aon contract ending 12/31/2006 by increasing the not-to-exceed amount for the current 2005-2006 period to $310,000.
David Hartwig seconded the motion.
Hearing no further discussion, the motion passed unanimously.
 
Lydia Lissman explained that contracts with Aon and BHS will be expiring in 2006, and the Board will need to decide whether to renew. Issues for BHS have been turn-around time and response time from agencies and members, though these have improved and PEBB is comfortable with the current working relationship. PEBB will look into some method for measuring BHS’ performance with the initiation of pebb.benefits. PEBB’s experience with Aon has been good, though the costs have been high and there is no current Aon staff identified for PEBB.
 
Jean Thorne stated that unless the Subcommittee disagrees, PEBB would enter into a discussion with Aon regarding a renewal. If an RFP were needed, it would need to occur around June.
 
PEBB staff will prepare an analysis and a recommendation regarding Aon and BHS for the Subcommittee’s consideration at its May meeting.
 
Public Comment
None.
 
Other Business
Jean Thorne reminded the Subcommittee that the Board will need to consider a Kaiser incentive for next year. It was decided that this item should go directly to the Board, and PEBB staff will prepare an analysis and recommendation for the May Board meeting.
 
Meeting Adjourned