INTRODUCTIONS / REVIEW AGENDA

Transcription

1 Washington State Health Insurance Pool Board Meeting Minutes, Thursday, November 10, 2005, 8:30 a.m. to 12:30 p.m. Westin Hotel, St. Helen s Room DRAFT Board Members Present: Bob Appel, Michael Arnis, Patti Carter, Sean Corry, Bernie Dochnahl, Bob Jaffe, M.D., Rob Kuecker, Bob Moore, Bill Perkins, Beth Pitt, and Norm Seabrooks. Board Members Absent: None Also Present: Kären Larson, WSHIP Executive Director; Anne Mackie, WSHIP Executive Assistant; Brad Berg, Foster Pepper & Shefelman, Legal Counsel; Liz Leif, Leif Associates; Liz Muktarian and Cathy Peda, Gilmore Research; and by telephone Judi Johnson, WSHIP Account Manager, BMI, and Chad Somers, Vice Pres., BMI Guests: Mary Childers, OIC; Sally Clark, LifeLong AIDS Alliance; Maxine Lucas, Kidney Disease Program; Sharon Moore, Northwest Kidney Centers; Jodi Suminski, Regence Blue Shield; Laura Treadway, Evergreen Health Insurance Program; Nancee Wildermuth, Attorney Chair Bob Moore called the meeting to order at 8:35 a.m. I. INTRODUCTIONS / REVIEW AGENDA The 2006 Board Agenda and Work Plan agenda item was moved to agenda item III, under the Executive Director s Report. II. MINUTES OF SEPTEMBER 8 and 22, 2005 MOTION: It was moved and seconded to approve the minutes of the September 8 and 22 board meetings. The motion passed unanimously. III. EXECUTIVE DIRECTOR S REPORT / REVIEW BOARD AGENDA and WORK PLAN A. Executive Director s Report. In addition to a written report, the following was reported: 1. Plan 2 enrollees will continue to have their current prescription drug copayment rate after January 1. A new coinsurance cost-sharing, in compliance with the statute, applies only to the new Medicare plans, Basic and Basic Plus. 2. Ms. Carter has been reappointed by the Governor to serve another term as the WSHIP board s small business representative. 3. WSHIP has been approved to be an SPAP. Chair Moore acknowledged Ms. Larson s diligence on this, which means millions of dollars in savings to WSHIP. She and Mr. Berg are continuing to explore organizational issues related to the SPAP status. Page 1 of 5

2 B Board Agenda and Work Plan The board discussed the 2006 Agenda and Work Plan and made the following changes: (1) move the annual benefit review to standing activity items; (2) correct the date for product reviews to 2007; (3) include notations of what has been added to the work plan and what has been dropped; (4) add the TPA RFP to January 2006; and (5) add an item called new world discussions to address changes in the insurance environment with the Legislature; include this new world topic in the 2005 Annual Report. IV. TREASURER S REPORT A. Review Preliminary 2006 Budget Key issues discussed were: 1. Enrollment and PMPM costs for 2006 are estimated based on actuarial calculations for what enrollment might be, given the changes with Medicare Part D and the introduction of new plans. Ms. Leif provided enrollment scenarios, upon which the 2006 budget projections have been based. 2. The Standard Health Questionnaire (SHQ) recertification will require professional fees in An audit of BMI and an RFP for a TPA will be 2006 high cost items. 3. WSHIP will exceed its 2005 estimated budget because of costs associated with Medicare Part D and implementation of new plans. 4. Approval to become an SPAP was received November 3; the 2006 budget was recalculated based on this new information. 5. The board will vote on the 2006 budget at its January 12 meeting. B Interim Assessment III MOTION: It was moved and seconded to approve the Interim Assessment III of $5.2 million. The assessment is to be issued within the next two weeks. The motion passed unanimously. The carriers assessment letters will include information about 2006 assessment projections. V. ADMINISTRATIVE REPORT A. Review the September Operating Reports A written report was provided. BMI was congratulated for continuing to meet all service levels. B. Customer Satisfaction Survey Report A written report was provided. Approximately customers are surveyed via telephone per month. The survey will be ongoing. C. System Conversion Report The conversion project is on schedule. There were no issues to report. Page 2 of 5

3 VI RATES The board discussed the various rate scenarios for Plans 1 and 3 presented by Ms. Leif. MOTION: It was moved and seconded to use a Plan 1 maximum multiplier of 140% of the standard risk rate (SRR) and a Plan 3 maximum multiplier of 117%. The motion failed. MOTION: It was moved and seconded to use a Plan 1 maximum multiplier of 120% of the SRR and a Plan 3 maximum multiplier of 110%. The motion failed. MOTION: It was moved and seconded to continue with the current 150% multiplier of the SRR for Plan 1 and 125% for Plan 3. The motion failed. MOTION: It was moved and seconded to approve the proposed 2006 rates for Plan 1 based on the 140% maximum multiplier of the standard risk rate (SRR) and for Plan 3 based on the 110% lowest multiplier of the SRR. The motion passed. The board discussed rates for WSHIP s Medicare plans Plan 2, Basic, and Basic Plus. MOTION: It was moved and seconded to accept the 2006 Plan 2 rates as presented. The motion passed unanimously. MOTION: It was moved and seconded to accept the 2006 Basic Plan and Basic Plus Plan rates as presented. The motion passed unanimously. VII. SURVEY OF REJECTED APPLICANTS Ms. Liz Muktarian and Ms. Cathy Peda with Gilmore Research were introduced. Ms. Muktarian presented the 2005 survey of rejected applicants report. RECOMMENDATION: Future surveys should clarify what different individual insurance means and should determine if the person was applying for different insurance while a current plan was in place. VIII. MARKETING AND PLANNING COMMITTEE REPORT A. Review and Approve Basic and Basic Plus contract forms Mr. Kuecker presented the committee s report and recommendations. MOTION: It was moved and seconded to approve the Basic and Basic Plus plan documents as presented with the exception that the Basic Plus stop-loss amounts in the Summary of Benefits are to be $500 medical and $500 pharmacy; if postmeeting, any additional typos or corrections are noted, the Executive Committee will review and approve changes, or in its discretion, refer substantive changes to the Board of Directors. The motion passed unanimously. Page 3 of 5

4 The issue of guaranteed renewability for the Basic Plus Plan was discussed. B. Comparison of Current to Proposed Benefit and Relevant Statutory Provisions MOTION: It was moved and seconded to adopt the benefit changes: (1) For Plans 1, 2, and 3 -- Remove the 30% coinsurance for non-preauthorized hospital confinements; no penalty will apply. (2) Out-of-pocket expense limitations for the Basic Plan will be $850 for medical and $150 prescription drug; out-of-pocket expense limitations for the Basic Plus Plan will be $500 medical and $500 prescription drug. (3) For Plans 1, 2, and 3 the diabetes education benefit will have a 20% coinsurance, not 10%. (4) Prescription drugs for the Basic plan will be paid at 100% for Parts A and B drugs and 0% for all other drugs; for the Basic Plus Plan 100% coverage for drugs covered by Medicare Parts A, B, and D and 80% for all other drugs (exclusions apply). The motion passed unanimously. Corrections to the Basic Plus Plan documents were noted and revisions would be made and refiled with the OIC. Mr. Perkins asked that the Marketing & Planning Committee to assess the viability of offering a Health Savings Account eligible product. IX. TOOL COMMITTEE REPORT The committee met to discuss the RFP s for the Standard Health Questionnaire (SHQ) actuarial services. The committee recommended Milliman USA be selected. MOTION: It was moved and seconded that the proposal from Milliman USA to do the actuarial services for the 2006 SHQ recertification be approved. The motion passed unanimously. X. EXECUTIVE COMMITTEE REPORT A Auditor Engagement Letter The Executive Committee recommended that WSHIP maintain its contract with John Leemhuis of Peters, Browning & Co. P.C. for financial auditing services. MOTION: It was moved and seconded to approve continuation with Peters, Browning & Co. P.C. for financial auditor services for The motion passed unanimously. XI. GRIEVANCE COMMITTEE REPORT The committee met to review two grievances. One pertained to enrollment reinstatement, which was granted. Ms. Larson has been given authority to approve reinstatements within certain parameters. The second grievance related to the issue of preauthorization for inpatient psychiatric care. The committee approved medical inpatient care. Page 4 of 5

5 XII. GOVERNANCE COMMITTEE REPORT The board was reminded of the December 2 board retreat. ADJOURNMENT: The meeting adjourned at 12:27 p.m. NEXT MEETING: Thursday, January 12, 2006, 8:30 a.m. to 12:30 p.m. at the Westin Hotel, Seattle. Page 5 of 5