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| A Report from the Joint Health Care Committee |
April, 1997 |
| OHIO DEPARTMENT OF ADMINISTRATIVE
SERVICES Human Resources Division Benefits Administration Services 1-800-409-1205 |
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OCSEA/AFSCME Local 11 FOP/OLC 1199/SEIU UFCW SCOPE/OEA |
Because of changes in healthcare benefits brought about by collective bargaining, open enrollment will be delayed until fall.
Your health care rates will remain the same until after the next health care enrollment.
This year, HMOs offered to state employees are required to be NCQA accredited (the most recognized measure of quality in the healthcare industry). The State will be seeking bids from accredited plans and will strive to offer 2 but no more than 5 health plans per county.
The Office of Benefits Administration is currently exploring options for dental benefits for exempt employees. We are hopeful we will be providing exempt employees a choice of dental plans. Dental enrollment for exempts will also be delayed until fall.
During the May 5 to May 23 enrollment period, eligible exempt employees who do not have vision or dental insurance may enroll for coverage or may enroll eligible dependents.
From May 5 to May 23, 1997, the OCSEA Benefits Trust will be conducting enrollment for vision, dental, and life insurance for bargaining unit employees. The Trust will be mailing their open enrollment materials to employees' homes.
If you are not enrolled in an HMO or Ohio Med, you may enroll between May 5 - 23. You may also enroll eligible dependents during this period. This health plan enrollment opportunity is only for employees or dependents who are not currently enrolled in a health plan. Employees already enrolled may not change plans at this time.
The State and OCSEA have agreed to require all health plans to provide the following benefits:
age 40-59, one every two years
age 60+, one every year
Remember, these changes will not be effective until the next benefit period (in the fall).
You may have heard that the Ohio Bureau of Workers' Compensation has developed a system to insure that injured workers receive the highest quality of health care. Health care services for employees injured on the job will now be provided through a managed care organization (MCO). BWC has contracted with over 40,000 providers in the state to provide medical treatment under this new system.
After initial treatment, you must receive services from one of the BWC certified providers. A special payroll stuffer is being distributed to employees advising what procedures to follow in the case of a workers' compensation injury. Please contact your agency workers' compensation designee with any questions.
The Ohio Med PPO has added two more hospitals into its network. They are:
The Office of Benefits Administration is pleased to announce that its customer service unit now has a dedicated toll-free telephone number: 1-800-409-1205. The Customer Service representatives staff this number from 7:30 a.m. to 5:00 p.m. They are available to answer questions regarding your health care benefits.
Effective January 1, 1997, U.S. Behavioral Health (USBH) changed its name to United Behavioral Health (UBH).
This name change will not affect your benefit levels, access to care, provider network, or procedures for obtaining authorization for services. You may still reach UBH at 1-800-852-1091.
Effective January 1, 1997, National Rx, (the mail-order prescription service of the Ohio Med plan), changed its name to Merck-Medco Rx Services.
If you have filled a prescription through Merck-Medco since January, you should have received a notification slip in your mail service package explaining this change. The National Rx name change will not affect your benefit levels or copays. You may still reach Merck-Medco at 1-800-533-3578.
United Health Care (UHC) has chosen to discontinue the UHC Clinicare product. Employees in Crawford, Delaware, Marion, Morrow, and Union counties will need to select another health plan during the May enrollment period.
If you have moved recently, or are going to move in the near future, be sure to give your payroll officer your new address as soon as you move. The State of Ohio provides employee information to health plans via computer tape. If you just send your address change to your health plan and not your payroll officer, you may not receive important health care information from both your health plan and the state.
You may have recently seen newspaper articles about Blue Cross Blue Shield of Ohio (BCBSO). Although BCBSO has recently suffered some setbacks, employees enrolled in the Ohio Med plans are not likely to be affected and should not experience any change in service or benefits.
BCBSO administers the Ohio Med PPO and Traditional Plus plans. Being self-funded, Ohio Med claims are paid with State and employee premiums, and are not dependent on BCBSO funds. BCBSO provides customer service for Ohio Med, cost-containment activities, maintains the provider network and administers claims payment activities.
Over the last
year, BCBSO has been in the process of being purchased by Columbia-HCA, the
nation's largest hospital chain. Recent developments include a ruling by the
Department of Insurance and a decision by the Blue Cross Association (which
licenses Blue Cross plans) that the purchase could not take place. Blue Cross
is no longer pursuing the Columbia deal.
Because of the proposed sale, the Blue Cross Association, which licenses Blue Cross/Blue Shield plans has said it will take away the cross and shield trademarks from BCBSO, which would then be forced to change its name. (If that happens, new Ohio Med ID cards would have to be issued, but the current ID cards would remain valid until new ones were distributed).
The Office of Benefits Administration staff has been monitoring this situation as it unfolds. Ohio Med members will be kept apprised of any changes which may affect them.
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