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AGENDA ITEM REVIEW FORM |
3.A.
Employee Benefit Trust Board Meeting
- Meeting Date:
- 06/14/2023
- Department Head:
- Adela Cortez
- Submitted By:
- Maria Barajas Gutierrez, Human Resources Coordinator, Human Resources Department
ITEM:
Discussion and possible action on any and all matters regarding Document Plan amendment. (Susan Posada, Broker, and Consultant)
SUMMARY:
As part of the Third-Party Administrator transition, HealthComp, Human Resources, and the Broker/Consultant have been meeting on a weekly basis to discuss the implementation process. These meetings are fundamental to complete system setups, writing Plan Documents, and the Summary of Benefits and Coverage (SBCs). During the meeting held on May 31, 2023, HealthComp suggested some revisions to our current plan. The intent of these changes is to provide detailed information regarding covered services, limitations, and exclusions.
The recommendations provided by HealthComp are:
The recommendations provided by HealthComp are:
- Preventive Dental Services
- Sealants: Currently, our US Plan does not specify an age limit for the application of sealants. I, along with HealthComp are recommending offering this benefit to “dependents up to the age of 16”.
- Durable Medical Equipment/Prosthetics/ Orthotics
- Wigs are covered in both plans; however, our plan does not set an amount limit. The recommendation is to limit it to $500 per calendar year and for chemotherapy only. Alopecia will be covered for treatment only.
- Preventive Care Services
- Sterilization: In our current plan, sterilization is limited to employees and covered spouses only. Female sterilization is a preventive benefit that must be covered; hence, the recommendation is to extend this benefit to dependents.
- Dental Carryover:
- One of the benefits offered by the City of San Luis (COSL) is the option to roll over unused benefit dollars into the following year, which is available for members who do not exceed 75% of the yearly maximum benefit in one calendar year. HealthComp has indicated that they are not able to administer Dental Carryover. As a solution to this matter, the recommendation is to increase Calendar Year Maximum Benefit amounts for Dental services as follows:
- US Plan from $2,000 to $2,250.
- Mexico Plan from $1,000 to $1,125.
- One of the benefits offered by the City of San Luis (COSL) is the option to roll over unused benefit dollars into the following year, which is available for members who do not exceed 75% of the yearly maximum benefit in one calendar year. HealthComp has indicated that they are not able to administer Dental Carryover. As a solution to this matter, the recommendation is to increase Calendar Year Maximum Benefit amounts for Dental services as follows:
RECOMMENDATION / SUGGESTED MOTION:
I MOVE TO APPROVE PROPOSED CHANGES TO EMPLOYEES BENEFIT PLAN AS PRESENTED.