SOUTHERN NEW JERSEY REGIONAL EMPLOYEE BENEFITS FUND OPEN MINUTES NOVEMBER 24, 2014 BROOKLAWN BOROUGH 6:15 PM

Transcription

1 SOUTHERN NEW JERSEY REGIONAL EMPLOYEE BENEFITS FUND OPEN MINUTES NOVEMBER 24, 2014 BROOKLAWN BOROUGH 6:15 PM Meeting of Executive Committee called to order by Michael Mevoli. Open Public Meetings notice read into record. PLEDGE OF ALLEGIANCE AND MOMENT OF SILENCE ROLL CALL OF 2014 EXECUTIVE COMMITTEE: Michael Mevoli, Chairman Borough of Brooklawn Present M. Joseph Wolk, Secretary Borough of Mt. Ephraim Present Richard Michielli Borough of Magnolia Present Louis Di Angelo Borough of Bellmawr Present Terry Shannon Borough of Barrington Present Jack Lipsett Gloucester City Present Neal Rochford Haddonfield Present EXECUTIVE COMMITTEE ALTERNATES: Joseph Collins Delsea Regional BOE Present Gene Mercoli Cumberland Cty Tech Ed Present APPOINTED PROFESSIONALS PRESENT: Executive Director/Adm. PERMA Risk Management Services Paul Laracy Emily Koval Program Manager Attorney Medical TPA Aetna Medical TPA Amerihealth Conner Strong & Buckelew Brandon Lodics Jason Edelman J. Kenneth Harris, Esq. Kim Ward Lisa DiDio Dental TPA Delta Dental Prescription TPA Express Scripts Fund Auditor Treasurer Richard Schwab (1) SOUTHERN NEW JERSEY REGIONAL

2 Fund Coordinator (Coastal group) Robert Allen Subgroup Coordinator PRESENT FUND COMMISSIONERS: Ken Verrill, Leap Academy Anthony Stagliano, Sr., Mt. Holly MUA ALSO PRESENT John Cobb, JCobb Insurance Group Greg Grimaldi, Conner Strong & Buckelew Kim Porter, CHB Group WELCOME: Mayor Branella welcomed the commissioners to Brooklawn. APPROVAL OF MINUTES: October 22, 2014 MOTION TO APPROVE OPEN MINUTES OF OCTOBER 22, 2014: Moved: Commissioner DiAngelo Unanimous CORRESPONDENCE NONE EXECUTIVE DIRECTOR/ADMINISTRATOR: PRO FORMA REPORTS Fast Track Financial Reports - Revised September & October 31, 2014 o Historical Income Statement o Consolidated Balance Sheet o Indices and Ratios Report Executive Director said that the Fund showed a loss in the month of October. The primary driver was preterm twins in August that were paid during October. In addition, there were a few Amerihealth large claimants, which is being looked into further. PPACA FEE TRANSITIONAL REINSURANCE - In December, each Fund will be making its 2014 payment for the transitional reinsurance free. SNJHIF s amount due is $1,326,696. In response to Chairman Mevoli, Executive Director said that the PPACA fees are dropping. The transitional reinsurance fee is phasing out. The Cadillac Tax in 2018, which is much more severe, will be on the employer, not the Fund. Further discussion about the Cadillac Tax ensued. Program Manager said he has developed language that members can include in the next round of collective bargaining contracts to allow contracts to be reopened for negotiation if certain plans do not pass the test of being under this threshold. A task force has been set up to assist HIF members. (2) SOUTHERN NEW JERSEY REGIONAL

3 ADMINISTRATION PRO FORMA REPORTS Regulatory Compliance Checklist as of November 18, 2014 COASTAL NEW MEMBERSHIP BUENA REGIONAL BOE & LOWER CAPE MAY REGIONAL - The Coastal Fund is requesting the membership of two new members: Buena Regional BOE and Lower Cape May Regional BOE. They have both passed a resolution to join the SNJHIF Coastal subgroup on 1/1/2015. A summary of key characteristics is below and the rates have been certified by the Fund Actuary. In response to Chairman Mevoli, Commissioner Mercoli said the Coastal members were fine with both new members. (3) SOUTHERN NEW JERSEY REGIONAL

4 MOTION TO APPROVE THE MEMBERSHIP OF THE BUENA REGIONAL BOARD OF EDUCATION AND LOWER CAPE MAY REGIONAL BOARD OF EDUCATION EFFECTIVE JANUARY 1, 2015 WITH THE RATES CONTAINED WITHIN THIS REPORT. Moved: Commissioner Lipsett 7 Ayes, 0 Nays PHARMACY BENEFITS MANAGER RFQ - RFQ responses for the pharmacy benefit manager were due Thursday, November 13, We received 8 responses from the following companies. Currently, the pricing portions of the responses are being reviewed by a third party. A committee will be meeting on November 25 to further review the content. We hope to have a recommendation for the MRHIF meeting on December 10, Navitus Aetna Envision Catamaran Express Scripts MedImpact CVS Caremark Optimum Rx In response to Commissioner Shannon, Executive Director said that CVS has a strong, aggressive response, superficially. The pharmacy network is close to that of Execpress Scripts. We will outline the details for the (4) SOUTHERN NEW JERSEY REGIONAL

5 next meeting. The MRHIF will make the recommendation and adopt a resolution, but each local Fund will also have to accept. Chairman Mevoli said he is happy to see so many responses. INDEMNITY AND TRUST AGREEMENTS - A few months ago, PERMA sent Indemnity and Trust Agreements and Resolutions to be adopted by the governing body to renew membership with the Fund for an additional 3 years. Below is a list of members who have renewing agreements due by January 1, 2015 and older: PRO FORMA REPORTS Member Activity Report Page 12 Claim Appeals none BENEFITS OPERATIONS OPEN ENROLLMENT - This year s Open Enrollment is November 3 24, This is a passive Open enrollment and only members who would like to make changes to their current plan elections should complete an enrollment form. Members who are making changes need to return their enrollment forms to HR contacts by November 24 th. HR contacts can start entering Open Enrollment elections in the online enrollment system, starting on November 3 rd. If any assistance or guidance is needed entering Open Enrollment elections, HR reps should reach out to PERMA s dedicated SNJ Benefit Administrator, Elizabeth Cronrath. Liz can be reach by phone at or any questions can be sent to the SNJ enrollment team s address at southernnj_enrollments@permainc.com. All enrollments forms need to be entered in the online enrollment system by December 5 th to ensure ID cards are received by January 1, MANDATORY USAGE OF THE ONLINE ENROLLMENT SYSTEM - The Executive Committee voted and approved mandatory usage of the online enrollment system for all entices. PERMA has offered several training sessions through out the year to educate and train HR representatives on the online enrollment system. As of 10/31/2014, PERMA stopped accepting paper enrollment forms. If (5) SOUTHERN NEW JERSEY REGIONAL

6 you were not able to attend one of the training sessions or you need additional training, please contact Karen Kidd at PERMA by at or by phone at CONTACT INFORMATION - Please direct any eligibility, enrollment, billing or system related questions to our dedicated SNJREBF Team. The team can be reached by at southernnj_enrollments@permainc.com or by fax at AETNA NEW ID CARDS Aetna will be migrating the entire SNJREBF member base to a new platform effective This will cause all members to receive new ID Cards for ; not just members who made changes during Open Enrollment. All communications regarding the issuance of Aetna New ID Cards were distributed electronically on October 10 th. HEALTH CARE REFORM UPDATE- OUT OF POCKET MAXIMUM - In accordance with the Affordable Care Act in 2015 The SNJREBF will be implementing a Maximum Out of Pocket for all Rx plans that do not currently have a payment limit. The combined Maximum Out of Pocket for both Medical and Rx will not exceed the Maximum amount allotted by Health Care Reform of $6,600 Ind/$13,200 Family. In response to Comissioner Mercoli, Program Manager said this out of pocket expense includes copays, deductibles and remaining balances. EXPRESS SCRIPTS-MEDICATIONS FOR RISK REDUCTION OF PRIMARY BREAST CANCER - The Express Scripts (ESI) Patient Protection and Affordable Care Act (PPACA) Preventive Items and Services Offering includes the coverage of select medications that are the subject of category A or B recommendations made by the United States Preventive Services Task Force (USPSTF) in accordance with the PPACA mandate. The USPSTF recommendations include statements regarding a broad range of clinical preventive health care services such as screening and counseling. In some select cases the USPSTF recommendation statements provide information to prescribers regarding medication therapy. In September 2013 the USPSTF updated its recommendation, previously released in 2002, which focused on preventive medications for breast cancer. The revised recommendation statement suggests that clinicians engage in shared, informed decision making with women who are at increased risk for breast cancer about medications to reduce their risk. On July 1, 2014, the ESI Preventive Items and Services Offering will be enhanced to include the coverage of tamoxifen and raloxifene when prescribed for use in primary prevention of invasive breast cancer in women at high risk. HEALTH PLAN IDENTIFIERS (HPID) under HIPPA UPDATE - The Fund has applied for and received it HPID. According to an announcement issued late on October 31, the Department of Health and Human Services (HHS) is delaying enforcement of health plan identifier (HPID) regulatory requirements, including the requirement that large health plans (including self-insured health plans) obtain an HPID by November 5, (6) SOUTHERN NEW JERSEY REGIONAL

7 Effective October 31, 2014, the Centers for Medicare & Medicaid Services (CMS) Office of E-Health Standards and Services (OESS) will delay, until further notice, enforcement of the regulations pertaining to health plan enumeration and use of the HPID in HIPAA transactions. This enforcement delay applies to all HIPAA covered entities, including healthcare providers, health plans, and healthcare clearinghouses. WELLNESS UPDATE - Delsea BOE and Black Horse Pike Regional are scheduled to conduct onsite biometric screenings in December and January. Collingswood BOE and Bellmawr BOE have filled the position of Wellness Champions and we are in the process of implementing the program. Woodstown-Pilesgrove and Rancocas Regional High School are in the process of posting for the Wellness Champion and should have this position filled by The Lance Group has been working directly with Shape Up and will begin the program for their groups Mr. Edelman introduced Carol Nash from Conner Strong and Buckelew, who has been coordinating the wellness initiatives with the members in the Conner Strong program. The wellness committee will meet on December 2. TREASURER: Fund Treasurer reviewed the November bills list and cash reconciliation report. Resolution 24-14: Payment of November Bills 2014 $1,332, TOTAL $1,332, MOTION TO APPROVE RESOLUTION OCTOBER BILLS LIST, AS PRESENTED. Motion: Commissioner DiAngelo 7 Ayes, 0 Nays MOTION TO APPROVE THE CASH RECONCILIATION REPORT, INVESTMENT AND CASH TRANSACTION REPORT FOR THE SOUTHERN NEW JERSEY REGIONAL EMPLOYEE BENEFITS FUND Motion: Commissioner Michielli 7 Ayes, 0 Nays AETNA - Ms. Ward reviewed the September claims report. The average claims are lower than the prior year. There were two high claimants in the month of September. In addition, Aetna is working on the migration to the new platform and ID cards will be sent shortly. In response to Commissioner Shannon, Ms. Ward will look into the high claimant costs to ensure that they are accurate. (7) SOUTHERN NEW JERSEY REGIONAL

8 AMERIHEALTH Chairman Mevoli reviewed the claim report and high claimant reports for Amerihealth NJ and Administrators. DENTAL TPA - No report. FUND ATTORNEY: Fund Attorney said the only impact the PPACA changes will have on members is the out of pocket minimums that are changing to $6600. He said plans cannot use an artificial mechanism, like reference pricing, against out of network providers. In addition, the SNJHIF has been sued for an auto accident which the member was sent a subrogation letter. The suit is for sending our typical letter of subrogation efforts. The Fund has determined that it is eligible for subrogation, unlike health insurance companies. Brown & Connery is handling the suit. He believes the complaint should be dismissed. The amount of subrogation the Fund would be looking for is approximately $100,000. OLD BUSINESS: none NEW BUSINESS: None PUBLIC COMMENT: Mr. Linker said he is attempting a new clinical trial and may not be available for a while. He thanked the board for supporting the Fund professionals in an attempt to make the Fund successful. Chairman Mevoli thanked Mr. Linker for being a professional and being a supporter of the Fund. Chairman Mevoli said to please return ballots for quorum for January s reorganization meeting. MOTION TO ADJOURN: Moved: Commissioner Michielli Unanimous MEETING ADJOURNED: 7:00pm NEXT MEETING: January 26 Berlin Borough Community Center Emily Koval, Assisting Secretary for JOSEPH WOLK, SECRETARY (8) SOUTHERN NEW JERSEY REGIONAL