1. Benefit Plan Enhancement Recommendations
Employee benefits advisory committee

2. 2018 Benefits Plan Year
After the shortened 2017 plan, we are moving to a calendar plan year starting January 1, 2018
We are changing our Third Party Plan Administrator (TPA) from EBMS to PacificSource
PacificSource currently administers our Flexible Spending Accounts
Taking this opportunity to review our current plan document
Make any changes required by law
Recommend plan changes that will improve the quality and cost of care for Deschutes County and plan members.

3. Summary of Plan Enhancements
Item to Consider
Current Plan
Recommendation for ’18
Reasoning
Hearing Aid Benefit
Currently Excluded
For adults: Paid at 50%, one hearing aid per ear every 24 months, with a max of $2,500 every 24 months.
This is a highly requested benefit that is now being covered on most standard plans. Estimated impact to funding rates +0.23%
Defining Progressive Lenses Benefit
Not defined in vision benefits
Progressive lenses will be paid the same as Lenticular Lenses =
No charge up to $220 maximum then 100% coinsurance
The plan currently pays for Progressive lenses at the same rate as Lenticular. This updates existing plan language for this type of lens.
Air Ambulance Benefit Limit
Limited up to a 400 mile per trip maximum
Remove the language that states the benefit limited to a 400 mile maximum
ACA does not allow annual limits on emergency services.

4. Summary of Plan Enhancements (cont.)
Item to Consider
Current Plan
Recommendation for ’18
Reasoning
Global Maternity Benefit (normal pregnancy and delivery)
In Network: 40% of covered charges are paid at 100%; and 60% of covered charges are paid at 80%
In Network: 100% of covered charges are paid at 88%
According to the ACA, some maternity services are covered by deductible, copay, and coinsurance. Some prenatal services are covered at 100%. This change streamlines Global Maternity billing and allows claims to be auto adjudicated.
Preauthorization for coverage of certain medical services, surgical procedures, and prescription drugs
No preauthorization required
Follow the standard preauthorization guidelines provided by PacificSource (see attached document)
Does not change access to covered plan benefits. Protects members from engaging in services that are not covered in the plan. Moves claim review for certain items to the before billing stage.

5. Clarification of Plan Language – No change to benefits
As we prepare to transition to our new TPA, we have taken the opportunity to clean up some of the language in our benefits plan document. These clarifications do not change any benefits. It does help our TPA manage enrollment and process claims more efficiently. Some of the areas we are clarifying are:
Transitioning between COIC and DC with no lapse in coverage.
Methods used to determine retiree benefits termination date.
Benefits coverage when both employee and spouse work for the county.
Dependents that are excluded from coverage under the plan

6. FSA – “Carry Over” Rule Recommendation
Item to Consider
Current Plan
Recommendation for ’18
Reasoning
FSA “grace period” rule
Employees forfeit unused balances of their Health FSA at the end of the plan year unless they use it during the grace period (2.5-month extension)
Allow employees to carry over up to $500 of their unused Health FSA balances to use in the next plan year.
Employees have greater control over their unused Health FSA benefit. Able to “bank” larger FSA dollars for planned out of pocket expenses. Employees will save up to $500 if they over defer into their FSA.
What this means for you:
The $500 carryover doesn’t affect the $2,600 FSA salary reduction maximum. In other words, if an employee elects $2,650 for the new plan year FSA, and they have $500 that carries over, they will have $3,150 in their FSA “bank” for the new year.
Employees do not have to enroll in the subsequent year to access the carryover.
Unused funds are carried over after the claim filing period. (In most cases, there is a 90-day claim filing period at the end of the plan year).

7. Required Legislative Update – House Bill 3391
Gov. Brown recently signed HB This bill creates a mandate requiring health benefit plans to cover specific services, Rx, devices, products and procedures related to reproductive health.
Deschutes County Legal and HR, in coordination with our Benefit Consultants, are reviewing this new legislation with PacificSource to see how it will affect our benefits plan. We will update you as soon as we have more definitive answers.

8. PacificSource Health Management – Value Add Services
As our TPA, PacificSource provides many other “value add” services as part of our plan administration.
Medical
Complex Case Management: Dedicated to working with the top 1-3% of the member population based on a combination of three key drivers; severity of illness, the expected need for resources, and the utilization of resources.
Special Functions Team: Consists of Registered Nurses and HSR’s who conduct retrospective reviews, medical claim reviews, manage internal Policies, Procedures, Appeals, and Grievances.
Condition Support (Disease Management) Team: Manages members with the five chronic diseases. Offers support programs such as Think Nourish Move (weight management), juvenile diabetics and pre-natal programs (both high risk and normal pregnancies).

9. PacificSource Health Management – Value Add Services (cont.)
Behavioral Health
Behavioral Health Team: Consists of BH Professionals (LCSW’s and LPC’s) as well as Utilization Management Specialists who review BH claims, manage inpatient stays, review Prior Authorization requests and review treatment plans for medical appropriateness.
Provide care coordination when initiated by member or PCP/provider to find appropriate level of care.
Pharmacy
Partner with pharmacy benefits management team and DOC Rx to address medication adherence issues.
Assist in medication therapy management

10. PacificSource Health Management – Value Add Services (cont.)
Wellness
PacificSource wellness consultant will partner with County Wellness Coordinator to determine were they can add value to our existing wellness program.
PacificSource wellness will supplement our existing weight management, tobacco cessation, healthy lifestyle and on-line resource programs.