3.E.
Employee Benefit Trust Board Meeting
- Meeting Date:
- 09/08/2021
- Department Head:
- Maria Munoz
- Submitted By:
- Maria Munoz, HR Benefits Coordinator, Human Resources Department
ITEM:
Discussion and possible action on any and all matters regarding the proposed change to employee preventative service coverage. (Susan Posada, Broker and Consultant)
SUMMARY:
The current benefits plan document for preventative services covers only those mandated by the Affordable Care Act ("ACA") which are listed under the U.S. Preventative Services Task Force ("USPSTF"), A and B plus mandated immunizations, Pediatric and Well-Woman Care. Grades A and B are both suggested for preventative practice.
Payment under the current benefits plan document:
On the current plan document, other services outside grades A and B are denied and are paid 100% out of pocket by the employee.
Proposed payment change under the benefits plan document:
Continue coverage at 100% for the ACA mandated preventive care grades A and B.
All other preventive care payable as any other illness, subject to deductibles and co-pays.
Payment under the current benefits plan document:
On the current plan document, other services outside grades A and B are denied and are paid 100% out of pocket by the employee.
Proposed payment change under the benefits plan document:
Continue coverage at 100% for the ACA mandated preventive care grades A and B.
All other preventive care payable as any other illness, subject to deductibles and co-pays.
RECOMMENDATION / SUGGESTED MOTION:
I MOVE TO AMEND THE BENEFITS PLAN DOCUMENT FOR PREVENTIVE CARE NOT MANDATED BY ACA AND NOT LISTED IN THE USPSTF GRADE A AND B, TO BE PAYABLE AS ANY OTHER ILLNESS, SUBJECT TO DEDUCTIBLES AND COPAYS.
Fiscal Impact
Fiscal Impact:
N/A
Fiscal Impact:
Under the current plan:
If a medical provider includes services not mandated by ACA in a wellness visit, the employee pays 100%.
For the deductibles and copays to apply to the services not included in the ACA mandate, they would have to come back for another appointment.
Under the proposed plan change, all services can be provided in the wellness visit and deductibles and copays will apply to those not covered by the ACA mandates.
If a medical provider includes services not mandated by ACA in a wellness visit, the employee pays 100%.
For the deductibles and copays to apply to the services not included in the ACA mandate, they would have to come back for another appointment.
Under the proposed plan change, all services can be provided in the wellness visit and deductibles and copays will apply to those not covered by the ACA mandates.