Page 6 - Services Rules News Today

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 the medicare coverage, for my out of Network Payments or coverage excuse me, im really nervous. It should be at the 50 of the ucl rates. Is that correct . As im understanding it . Yes, okay. What united is telling me now is they will only cover 50 of wha...

Consultants do a review of any federal or state changes that need to be brought to [speaker not understood] on the rates and benefits and this was missed. So, we do have a process for it, we miss it had, and i think it wasnt until kaiser let us know this was occurring, really last week and saying this is now part of the rates benefits that we were alerted to the fact. I think its fair to say we should also be working as a doublecheck with our Health Care Benefits to make sure they arent aware of...

Same benefit this person with two kids is getting because thats a benefit theyre getting. And if im not getting that same benefit in monetary amount, then i am being discriminated against because why should Somebody Just because theyre married get more benefits . One of the reasons why the city 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 th...

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...

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 don...

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 boar...

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...

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 y...

Rates go, especially from 4 to 7. 79 from a thousand 78 to 1500 and from 2000 to over 2300. ~ so, thank you very much and i hope that you consider subsidizing. Thank you. President breslin . Yes. I wanted to acknowledge the importance of that question and to also state that plan 1 has been a plan for hss since hss has existed in the 40s and we are dedicated to bringing an alternative model to the board that will save that plan and actually help turn it into a healthy plan again. So, that will be...

Care, but it seems like we had a hole here to get this done and id like to know how we plan to solve it. Thats a very good question. We did have one of our steps in preparing for the rates and benefits to have our consultants do a review of any federal or state changes that need to be brought to [speaker not understood] on the rates and benefits and this was missed. So, we do have a process for it, we miss it had, and i think it wasnt until kaiser let us know this was occurring, really last week...