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

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

3. 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

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

5. 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COPES data out of date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

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

7. 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

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

9. 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

10. 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

11. 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

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

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

14. 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

15. 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”

16. 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

17. 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.