Benefits Advisory Committee - August 8, 2008

HISD brought forward it's recommendation's for the 2009 benefit year. The good news is that there will be no premium increase for employees. The bad news is there will be higher out of pocket and point of service costs for many employees. The changes are as follows: (from the 8/14/08 HISD board agenda item G-12)

• Implement a fee schedule for non participating (non-network) medical facilities.
  


• Pre-certification required for certain high technology radiology services.
  


• Modify the co-pay amounts for all medical plans. For the fifteen specialty areas where Aetna has designated Axcel certified specialists, the co-pay amount will remain the same as is currently in place if the participant utilizes an Axcel certified specialist. For other in-network specialists in these categories, the plan co-pay will be reduced by 10 percent.

What this means is for in-network specialists, Aetna has designated a certain number of them as Aexcel certified specialists. In order to continue to receive the same benefits, a participant must use these doctors. If a participant use non-certified in-network specialists, the district will reduce it's coinsurance contribution by 10% and for open-access participants (there are over 7000 of these) the co-pay will increase from $40 to $50. We asked the district for two things:

1. What was the criteria used by Aetna to designate Aexcel certified specialists?



2. How many of the total in-network doctors will be certified?

HISD agreed to get us that specific information and the representative from Aetna stated that the information will be available on Aetna Navigator. They did state however, that no Kelsey doctor will be a certified specialist.

The district is also going to stop paying the full amount billed by several non-network facilities. This is a real problem. It seems several of these facilities charge an outrageous amount for their procedures. Far more than the market norm. In the past HISD has paid these bills in full. The proposed change will only pay these facilities the market norm. If the facility continues to charge the higher rates, the participant will be responsible. It is the thinking of the district, Aetna, and Mercer, that in all likelihood these facilities will lower their rates and possibly join the network. The Federation cannot oppose a plan that is intended to eliminate price gouging.

These changes are proposed in order to make up a projected $9 million deficit. We are extremely uncomfortable with the Aexcel designation. It forces participants into a preferred network of even fewer doctors, will likely force participants to give up a doctor who is familiar with them in exchange for a stranger, and saves only around one million dollars. We suggest that instead, the district look at eliminating the Choice POS II option entirely. There are only around 900 participants and can save up to $2.25 million. These participants can move to the Consumer Plus plan with very little disruption in their service and receive improved benefits in several areas.