The State Group Insurance Program in 2006 Benefit Plans and the transition to People First

The Changes DSGI – New roles and responsibilities People First – Benefits Administration New Benefit Plans and new vendors

The Challenges Coordination and cooperation between DSGI and People First to effectively manage complex processes and serve employees and retirees within a complex regulatory environment Enrollment in and implementation of new types of benefit plans and new vendors

People First System of record (data) Customer Service Correspondence Transaction Processing Open Enrollment Fiscal Administration Eligibility Files to vendors

People First as System of Record End of COPES Insurance COPES data out of date Transfer of COPES data to People First New enrollment in PF SAP system Historical data t o Data Warehouse Transfer of DSGI historical data SAP data and DSGI data in the People First Data Warehouse

DSGI Policy Analysis Product Management Procurement Policy and rule determinations Financial management and residual accounting functions

DMS People First Project Benefits Team Facilitates the implementation of system and operational processes in People First Assists employees and agencies with People First Issues Receives direction regarding laws, rules and policies from DSGI

Changes in roles, changes in Processes, coordination and cooperation-Examples Underwriting approval process Exceptions and appeals

Underwriting approval Underwriting approval process Old procedure Deductions began prior to approval Cancellations and refunds required when underwriting denied New procedure New enrollment records “locked” until approved Deductions begin after approval is received

Appeals and “Exceptions” “Agency error” letters to People First (coordinates with DSGI in complex cases) Employee appeals “Level 1 appeals by employee (not agency) sent to People First If denied, employee has right to Level 2 appeal People First sends Level 2 appeals to DSGI If denied, employee is notified by registered mail of his right to Administrative Hearing

2006 Benefit Plans Health Plan “Redesign” Expansion of HMO offerings Statewide HMO Contract Rates (no “service area” codes Open Access HMO Plans Prescription Drug Program and Medicare Part D

Health Plan “Redesign Health Investor Health Plans PPO HMO Health Savings Accounts Limited Purpose Medical Reimbursement Accounts

Health Investor Plans Lower premiums Higher deductibles Coinsurance rates Medical Prescriptions Eligibility for Health Savings Account Election decision based upon utilization

Health Savings Accounts Tax exempt employee contributions Employer contributions Ineligible for “regular” Medical Reimbursement Account Eligible for Limited Purpose Medical Reimbursement Account Employee managed account

HMO Changes New HMOs under contract More counties have HMO options employee contributions Statewide contract rates no more “service area” codes” “Open Access” HMOs no “gatekeeper”

Medicare Part D Federal requirement to coordinate enrollment with Medicare Notification to participants Retirees who choose Medicare D subject to Coordination of Benefits Data interfaces to monitor enrollment in State Plan and Medicare D

The future of benefits administration and the State Group Insurance Program DSGI and People First will continue to work cooperatively to provide the State’s employees and retirees with a comprehensive package of quality benefits, meeting their needs in the most cost effective manner and using the latest technology to provide ready access to information and election opportunities.