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PEBB Operations Subcommittee Minutes, June 13, 2006
Public Employees’ Benefit Board
Operations Subcommittee
Tuesday, June 13, 2006, 9:30 to 11:30 a.m. - Minutes
Board Room, PEBB
775 Court St NE, Salem OR
Approved 08/08/2006

Subcommittee Members Present
Paul McKenna, Chair
 
Diane Lovell
 
PEBB Staff Present
Bobbie Barott
Dena Comer
Isabel Joslen
 
Lydia Lissman
Jean Thorne
Guests Present
Dotha Canning, Samaritan Health Systems
Gordon Hoberg, ODS
Megan Myrick, Willamette Dental
 
Paul Pfinster, AFLAC
Kim Waldroff, BenefitHelp Solutions
 
Agenda
Call to Order and Approval of Minutes: May 9, 2006
Customer Service Team Update
Budget Update
Advisory Group Report
Status of Contracts
Public Comment
July Agenda
 
Call to Order and Approval of Minutes
Paul McKenna called the meeting to order. The minutes from the May 9, 2006 meeting were approved.
 
Customer Service Team Update
Bobbie Barott provided an overview of categorized calls received in May. She reported that PEBB received 58 appeals in May, and at the beginning of June there were 107 open appeals. 172 appeals were closed in May.
 
Lydia Lissman explained that when Bobbie first joined PEBB there were 400 open appeals. She complimented Bobbie on the incredible impact she’s made since her arrival in February.
 
Appeals
 
Appeal #1
The member lives near the Oregon coast in a Regence only medical area, however the member’s enrollment for the past two and a half years is with Kaiser. The employing agency discovered the error and reported the address/plan issue to a PEBB Benefit Analyst in February 2006. The member requests to remain with Kaiser medical coverage through the 2006 plan year and enroll with Regence for the 2007 plan year during open enrollment.
 
Diane Lovell moved to deny the member’s request.
Paul McKenna seconded the motion.
Hearing no further discussion, the motion passed unanimously.
 
Appeal #2
Recently the member received appointment to state service. The member has a son who is 25 years of age. Member’s son suffered traumatic brain injury resulting in acquired cerebral palsy at 22 months of age and today he is a quadriplegic. Member’s son is totally dependent on member and husband for care and lives at home. A private Kaiser health policy has covered the son since 1981. Kaiser allowed the son to remain on the private policy when he turned 23 and he remains covered today. The Department of Human Services has encouraged the member to continue the private coverage and not rely on the Oregon Health Plan for coverage because of his need for extensive care, medications, and supplies each month. Member is requesting her 25 year-old son be included as a dependent on her PEBB sponsored health insurance.
 
The member was present and explained that there is no longer a private policy and the only option is the Oregon Health Plan.
 
Diane Lovell moved to delay a decision on this appeal until the Board has an opportunity to review the overarching policy issues. The Board will do everything they can to make the transition as smooth as possible for the member.
Paul McKenna seconded the motion.
Hearing no further discussion, the motion passed unanimously.
 
Appeal #3
The member has a dependent child between the age of 19 and 24; however the child turns 24 in June. The child was diagnosed with a major mental illness, is not capable of self-sustaining support, and relies on the member for support.  The member is requesting the dependent be permitted to remain on PEBB sponsored coverage after the June birthday. Currently, because the dependent is between the ages of 19 and 23, the child receives health care coverage through the member’s PEBB coverage. PEBB health care coverage will terminate at age 24 on the last day of the birthday month because the child is not mentally retarded or have a physical disability that makes them incapable of self-sustaining support. The dependent needs to continue on a health care coverage plan. Member believes and states that PEBB policy is discriminating on two levels:
  1. Mental illness is not receiving parity with physical illness; and
  2. Mental retardation is a mental illness and therefore PEBB is discriminating between one form of mental illness against another.
As quoted by the member, “(e.g. Chronic Mental Illness) If the intent is to give insurance to disabled person unable to acquire their own insurance then the intent is not being manifested. Also, the federal employee’s handbook in FHEB (PEBB equivalent) states any dependent unable to acquire health insurance due to a medical disability qualifies for dependent status!”
 
(Member first contacted PEBB in May 5, 2006 with a letter to PEBB Administrator, the Operations Manager responded to the letter May 9, 2006 providing the member with options other than PEBB coverage and appeal rights. May 24 member sent e-mail to PEBB Inquiries requesting if it was discriminatory to exclude mental illness. Analyst referred inquiry to Benefit Manager and Operations Manager.)
 
Diane Lovellmoved to deny the request until the Board had an opportunity to review the policy issues and consider any necessary action.
Paul McKenna seconded the motion.
Hearing no further discussion, the motion passed unanimously.
 
Lydia Lissman will inform the member of the Subcommittee’s decision so they might consider other options such as COBRA or portability.
 
Budget Update
Lydia Lissman reported that PEBB has submitted all Policy Option Packages (POPs) as previously discussed, and is currently working on the agency request budget (Ops attach.2 doc). She will keep the Subcommittee informed of the progress, but explained that DAS’ decisions may not be made public until September.
 
PEBB will be conducting interviews during the next week for the Financial Coordinator position following Susan Pritt’s departure on June 9.
 
Advisory Group Report
Isabel Joslen reported that the Agency Advisory Committee met for an entire day last week to review the open enrollment packet. The Committee recommended a simplified version of only one book that would include key eligibility information. PEBB is now on a fast track to make the changes. In the meantime, the Committee reported that recent updates to pebb.benefits have been very successful and that the program is quicker and easier to use.
 
Additionally, the Committee approved a comprehensive training outline for agencies, to include pebb.benefits and eligibility rules for PEBB.
 
Future plans include two additional rounds of changes to pebb.benefits, the first to be implemented this summer.
 
Status of Contracts
Lydia Lissman reported that the Aon amendment has been completed. PEBB is working on renewals with Aon and BenefitHelp Solutions per the recommendation of the Board. PEBB will begin work on the medical plan renewals for 2007 according to the Board’s approval at next week’s meeting.
 
At the Subcommittee’s request, she will provide a matrix of all PEBB contracts, including their duration and not-to-exceed amounts.
 
Public Comment
None.
 
July Agenda
Lydia Lissman reported that the July meeting agenda will include a presentation on the Flexible Spending Accounts, including member usage and the associated costs.
 
Meeting Adjourned