College Benefits Council
Meeting Minutes
September 12, 2013, 2:00pm-4:00pm
Human Resources Training Room
Members present: Dana Williams (Chair), Rich Howarth, Patty Bacon, Tricia Cornelius, Allan Gulledge, Virginia Hazen, Patricia Pioli, Kate Soule, Andrea Tarnowski, Rob Shumsky
Members Absent: Katrina Davis, Kim Cooper, Jill Savage, Lora Thompson
Also present: Rick Mills, Myron McCoo, Mike Wagner, Alice Tanguay, Tricia Spellman, Melissa Miner
Minutes: Yvonne Pelletier
A PowerPoint presentation was used to guide the rest of the meeting.
1. Welcome and Introductions
· New members Rich Howarth and Rick Mills were introduced.
· Rick thanked the group for their dedication, and for the importance of their service, noting that it impacts the lives of the entire campus community. He also gave an overview of his background. Retiring members were thanked for their commitment over the years.
· The membership and role of the CBC was reviewed.
2. Medical Plan Design Changes
· Due to the ACA regulations, all medical copayments (office visits, emergency room, etc.) must count towards a global medical Out-of-Pocket maximum starting in 2014
· In addition to ACA compliance requirements, the CBC had considered additional changes to the OAP 2 and HDHP plans. The CBC had decided against any changes to the HDHP.
· Presentation slides also illustrated a chart of the medical plan design, coinsurance changes, out of pocket maximums, and out of network changes.
3. New Tier for Adult + Child(ren)
· Dartmouth current pricing is based on a 3-tier rate structure: Single, 2-Person and Family.
· The CBC asked the Benefits team to look into adding a tier for single parents with more than one child.
· Benchmarking data shows that many employers have moved to a 4-tier rate structure, including an employee + child(ren) tier. Aon Hewitt provided an analysis and CBC recommended moving toward a four tier plan.
4. 2014 Premium Equivalent
· Premium assumptions were shared with the CBC.
· Based on these assumptions, the actuaries calculate a 3.5% increase for the Active/Pre-65 group and a 5% decrease for the Post 65 group.
5. Coverage Concerns
· The CBC reviewed concerns that faculty and staff have brought forward to HR and Benefits.
· The concerns include: the limited mental health provider network, required prior authorization for physical therapy, limited provider network under Vision benefit (VSP), and the forumulary with CVS Caremark.
· Additional concerns that have been raised include Autism coverage, international coverage, and domestic partners benefits.
· The CBC continues to be concerned with whether employee out-of-pocket cost sharing is too high and individuals are foregoing necessary care.
6. Benefits Survey Preliminary Results
· All benefits eligible employees were invited to participate in the anonymous survey
· Invitation sent to 4,334 employees. 1,813 responded for a response rate of 42%.
· Survey included questions regarding Cigna, CVS Caremark, wellness programs and Dartmouth Health Connect
7. 2014 Coverage Items
The following coverage options were discussed. The direction to the group was to identify funding for any additional benefit costs.
· Vision - Address network issue by expanding out-of-network reimbursement for OAP1 & OAP2. The out-of-network benefit is currently $45 reimbursement. The proposal was to move it to a 70% coinsurance.
· Physical Therapy -
o Respond to concerns about prior authorization by expanding number of visits before medical necessity determination is made from 8 to 24. Benefits individuals who have chronic conditions who may not meet medical necessity definition. Continue to have $20 copay per visit for OAP1 and OAP2.
o A council member asked for clarification on who determines medical necessity; Cigna determines medical necessity. It was explained there is an appeal process if there is a disagreement.
· Domestic Partners –
o Allow opposite sex domestic partners access to the health plans. This approach eliminates the current disparate treatment of opposite-sex domestic partners given the recent DOMA ruling.
o A council member asked how a domestic partnership is defined. The group discussed various scenarios of partnerships: married vs. non married, same sex vs. opposite sex, etc. It was noted that some of our Ivy+ peers offer coverage to opposite sex domestic partners.
· Gender Reassignment Surgery - Expand coverage for Gender Reassignment Surgery based increased data and support regarding this matter including the recent tax court ruling. The coverage is also now provided under the Dartmouth Student Group Health Plan.
· Autism - Expand coverage for autism and developmental delay services for children based on NH state mandate for fully insured plans
· Pharmacy
o Implement voluntary maintenance choice program, allowing members to fill a 90 day prescription at a CVS Caremark pharmacy and be charged the mail order co-payment.These members will no longer be able to fill 90 day prescriptions at other retail pharmacies.
o Some members expressed concern about limiting access to medication exclusively to CVS pharmacies. Mandating use of CVS Pharmacy in order to gain cost savings did not seem fair. The group did not like the idea of limiting people's choices and feared this would have a negative impact on local community pharmacies.
o Implement specialty pharmacy management program for individuals newly prescribed specialty drugs (Specialty drugs currently account for 1.1% of scripts and 34% of drug costs)
o Specialty drugs were defined as unique, highly specialized, high cost drugs for specialized treatment. There was a lively discussion about this benefit. Concerns were raised about medical necessity; patients requiring this type of medication tend to be very ill, perhaps too ill to navigate a complicated claims process. Concerns were raised about the insurance bureaucracy affecting providers' clinical decisions, putting the insurance company in-between the patients and the providers. More information was requested.
o Perform a market check process, where the Aon Hewitt national pharmacy team compares the Rx deal that Dartmouth is getting with Caremark (discounts, dispensing fees, rebates etc.) and compare that deal with other 2014 deals for similar sized clients and negotiate a one year deal with the PBM.
· The CBC did not make any final decisions about these coverage options at the meeting. Members were polled after the meeting.
8. Wellness at Dartmouth
· Time expired before this topic could be covered.
The meeting adjourned at 4:15pm.
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