Here comes the sun and I say it’s alright.
“Here comes the sun (doo doo doo doo)
Here comes the sun, and I say
It's all right
Little darling, it's been a long cold lonely winter
Little darling, it feels like years since it's been here
Here comes the sun
Here comes the sun, and I say
It's all right”
Lyrics by George Harrison
Deductible and Flexible Spending Account Transition to Fiscal Year
The GIC completed the transition of the calendar year deductible for employee and non-Medicare members to a fiscal year, eliminating the deductible barrier for changing carriers during Annual Enrollment. We also completed the move of the pre-tax Flexible Spending Account to the fiscal year, aligning it to the other benefit options to make it easier for members to determine their Health Care Spending Account election.
Benefit Changes Were Primarily Enhancements
For Fiscal Year 2017, the Commission elected not to make major benefit changes, particularly since for FY16, we had made some significant copay and deductible changes. Besides the Harvard Independence Plan freeze, most benefit changes were to comply with the Affordable Care Act (additional services covered); improve parity between plans (preventive care schedule frequency for UniCare plans); incentivize members to use urgent care instead of the emergency room; and bring the out-of-network out-of-pocket maximum in line with in-network benefits. Additionally, the GIC introduced a SmartShopper program for UniCare employee and non-Medicare members to encourage them to shop for care. Members receive a check of $25-$500 (depending on the procedure) if they call or use the website to find a provider and then visit that lower-cost provider.
Life Insurance Vendor
The GIC awarded a new contract to The Hartford to continue as the life insurance carrier. Under the new contract, the rates stayed the same or went down, depending on age. The Accelerated Death Benefit maximum also increased to 80%.
The GIC awarded a new contract to Davis Vision to continue as the vision provider. Members who purchase their glasses at a Visionworks store had a modest enhancement with more frame options without a copay and an increased allowance for non-plan frames.
Information Technology Upgrades
GIC staff, in collaboration with Boston Data Group (an IT consulting company), is preparing for the rollout of its new benefits administration system in the first quarter of 2017.
Where FY15 focused on development of functions to maintain information on over 436,000 people and their coverages, the past year saw the following accomplishments:
- A billing module for insured parties with their associated agencies and municipalities was built;
- A set of integrated portals that will enable GIC Coordinators to manage information about their enrollees was developed; and
- The GIC’s system was integrated with external systems including multiple payroll systems, Medicare and Medicaid systems, and numerous vendor eligibility systems.
The new system is replacing a legacy mainframe-based application that was developed more than 30 years ago. It offers numerous operational efficiencies and flexibility for future programs and requirements.
With a rapidly changing marketplace and even more challenges to come, staying engaged with others in the health care and benefits industry is critical. GIC staff participates in a variety of national and state organizations. The GIC’s Executive Director served as a board member of the following national organizations:
- National Committee for Quality Assurance (NCQA) – the national accrediting organization for managed care plans, physicians, and medical homes.
- National Quality Forum and its Measures Applications Partnership and Affordability Task Force – advises the federal Secretary of Health and Human Services on patient safety and quality measurements.
The Executive Director, or her designee, is also a board member of the following state organizations:
- Massachusetts Health Connector Authority – the Massachusetts exchange that runs Commonwealth Care and Commonwealth Choice.
- State Retiree Benefit Trust Fund – funds and pays for the state share of retiree health insurance premiums.
- Statewide Quality Advisory Committee) – makes recommendations to the Department of Public Health for promulgation of quality-related measures.
In addition, GIC staff collaborate with others to implement health reform legislation (Employer Shared Responsibility), consolidating and sharing databases (Inter-Agency Quality Work Group and All-Payer Claims Database Data Release Committee), staying abreast of trends in the employee benefits field (New England Employee Benefits Council, on which the GIC’s Communications Director serves as a member of its board), and improving health care safety (The Leapfrog Group).
This information provided by the Group Insurance Commission .