Lisa ghotbi. Thank you, lisa ghotbi acting director. This is something we usually deal with during the rates benefits process, but this issue didnt come to light to the Health Service system until last week. We wanted to make sure we brought it to your attention now so we can make sure we get it into our guides and its clear for our members going forward. It was actually a memo issued by the department of managed health care on april 9th of 2013 which essentially says that no lifetime limits are allowed under any plan thats licensed under the department of managed health care when it comes to any kind of gender reassignment benefits. So, the two plans we have that are administered through the department of managed health care blue shield and kaiser, this is a legislative change thats mandated. For the one plan that is not covered, it was the board decision to decide to make benefits equivalent across all of our products. So, the recommendation to the board is that we do maintain consis
Always kept the single employee at zero because it was to offset any benefits that the other people, married plus 1, married plus 2 got. And as i look at these rates, besides plan 1, its going to leave the city as far as i can tell open for someone to say, i want the same monetary amount as this other employees getting because just because hes married shouldnt affect why i dont get it as well. So, i think the city is leaving them self open for problems. Im not saying an employee couldnt have done that prior to this, but theres going to be more incentive to do it now because its costing them money out of their pocket. Thank you. Any other Public Comment . Seeing none. Madam secretary, item number 4, please. Item 4, discussion item, update on Financial Reporting as of may 31, 2013, gregg sass. Good afternoon. This might be my last hearing here before the commission. So, im smiling because i get to go back to retirement. But i have really enjoyed my time here. I have really appreciated th
It was actually a memo issued by the department of managed health care on april 9th of 2013 which essentially says that no lifetime limits are allowed under any plan thats licensed under the department of managed health care when it comes to any kind of gender reassignment benefits. So, the two plans we have that are administered through the department of managed health care blue shield and kaiser, this is a legislative change thats mandated. For the one plan that is not covered, it was the board decision to decide to make benefits equivalent across all of our products. So, the recommendation to the board is that we do maintain consistent benefits with our United Healthcare plan. And, again, this is just our active and early retiree plan not our ppt plan [speaker not understood]. And the lifetime that will be lifted on all three products. Commissioner scott. Im in favor of the concept of doing this, but i want to talk a little bit about the process. To have this come up, you know, it h
During the rates and benefits. Actually in december so the board can give us direction on whether that is something to pursue for the rates and benefits. Hello, my name is gail bloom and id like to talk about plan 1. I dont know if this is the right time. I have a problem with plan 1 and id be happy to hold the question till later in the agenda when it looks like you have open discussion about the different plans. Up to you. Well yeah, you can Say Something now about it. Its about plan 1. If you want to hear it now, id be happy to bring it up. Maybe you could talk to the staff. I have talked to your staff. Okay. And they told me to come to the commission meeting, to the Board Meeting. Id be happy to hold the thought. Okay, im here because im an early retiree in plan 1 and im actually not getting any of the service that i had contracted for, particularly for my out of Network Payments or out of network coverage. I have a i am covered by medicare. And what i understand is irrespective of
Understood], how much a. M. Was put in the reserve . 5 million or 21 20 million, okay. So, less than what we put in the service i thought when i took the rates that were in the rate setting process, the rates that were expected in terms of pmpm expenses and applied that to the membership, it would have produced about a 25 million ibnr june this year. But the 25 million is really the difference between claims that are actually settled between, you know, by june 30 and those claims that have not yet been submitted and adjudicated. So, it might have been an estimate of more like 20 million. But the reality is it depends really on how quickly claims are paid and how many claims are deferred into future months. But 25 million is where we would have been had those actuarial rates held up at that low cost. Thank you. Any other comments, any other questions . Seeing none, thank you very much. Thank you. Madam secretary, item number 5. Item 5, action item, eliminate 75,000 lifetime cap on uhc t