Hazy Shade of Winter continued

Regulations Reform

As part of the Administration’s request to streamline regulations – our rules for eligibility, procedures, and processes – the GIC undertook a comprehensive approach to ensure the new regulations would address operational and financial concerns, while also making them easy to understand.  Staff met to determine needs for operational clarification.  The legal department drafted proposed changes that incorporated those changes and complied with statutory changes made since the regulations that had been last promulgated in 2013.  A public hearing was held at the end of January, and the legal department participated in a series of listening sessions held across the state.  Improvements included consistency between offline agency and municipal procedures; incorporation of health care reform changes; and clearer instructions of when members can enroll outside of the new hire and Annual Enrollment cycle in accordance with Internal Revenue Service pre-tax health insurance benefit rules. The Commission adopted the new regulations in March and staff conducted training on the changes with GIC Coordinators. The new regulations were promulgated by the Secretary of State at the beginning of April.

Philanthropy and Support of Supplier Diversity

One hundred percent of GIC staff participated in this year’s Commonwealth of Massachusetts Employee Charitable Campaign (COMECC). For the 26th year, the GIC also supported a local charitable organization with a holiday giving tree.  This FY16 recipient was the Victim Witness Assistance Program that serves approximately 450 victim-related cases at the West Roxbury District Court.  GIC staff helped to make the holidays a little brighter for some of the children affected by abuse or trauma by purchasing items on their wish list — including toys, games, and coats.

The GIC and our carriers supported the Commonwealth’s supplier diversity program. The agency and its subcontracted vendors exceeded the Operational Services Division Supplier Diversity purchasing benchmarks for women-owned businesses, minority-owned businesses, and for the small business purchasing program.

Comings and Goings

Since 2007 and the advent of Municipal Reform, County Reform, and Transportation consolidation laws, the GIC has implemented seventeen waves of new groups.  In addition to these groups’ effect on our budget, adding groups has a major impact on the operations, public information, legal, information technology, and communications departments.  Fortunately, we’ve become implementation experts, and this helps ensure smooth transitions: data exchanges, training sessions, customized communications, programming changes, health fairs, data entry and billing reconciliation procedures. 

Effective July 1, 2016: Over 1,150 New Members Added

Town of Winchendon

Pentucket Regional School District

Essex Technical High School

Effective July 1, 2016: Over 2,600 Members Withdrew

City of Peabody

Town of Orange

Hampden-Wilbraham retirees covered under the Retired Municipal Teacher (RMT) Program

Effective July 1, 2016: New Group Joining the Retiree Dental Plan

Town of Westwood

Audit Vendor

Each year the GIC audits half of its major vendors, with the other half audited the following year. In FY16, the GIC entered into a contract with a new vendor, Truven Health Analytics, which would for the first time conduct an audit of 100% of claims. The audit vendor procurement determined that this method would help test all claims for modeled attributes, such as eligibility, plan design features, compliance with an administrator’s policies and procedures, and industry practices. This 100% claims audit approach identifies hard-to-discover, systemic processing errors and potential overpayment recoveries. In FY16, the GIC began work with Truven on auditing three of the GIC’s health plans and our pharmacy benefit carve-out manager.

This information provided by the Group Insurance Commission .