Informational Meeting Q&A
What are we doing to make sure that we have the right information to make the decision whether or not to leave CalPERS as the third-party administrator for our health plans?
The negotiating team for CSEA 262 has outlined an comprehensive process for analyzing third-party health plan administrators, which includes retaining the services of CECHCRs (California Education Cooperative for Healthcare Reform), an independent consulting organization which specializes in analyzing and negotiating health plans for educational institutions. Additionally, we are reaching out to other colleges and school districts who use the third-party plan administrators we are looking at in order to get an idea of what their experiences have been before we make this decision.
What will happen to the unit members who only insure themselves and are currently getting money back in their checks because the premium is less than the district contribution?
One of the main goals of this negotiations process is to not harm unit members. Therefore, the goal with regard to these unit members would be to “grandfather” those currently receiving cash back from a surplus. Bear in mind that if we were to stay with CalPERS medical plans, single-party plan premiums would exceed the district contribution within the next 2-3 years.
How does this decision impact those unit members who work less than 50% (19 hours or less)?
Currently, those working less than 50% have no access to district health plans. Even if they wanted to pay the entire premium to have a CalPERS health plan, CalPERS will not let them participate. The other third-party plan administrators we have been looking at all allow less than 50% employees to participate in their health plans. We won’t know what, if any, district contribution they would get, but they would at least be allowed to participate. Other third-party administrators also offer more flexibility in the plans that they offer, so we could potentially offer a low-premium “bronze” plan for those who want or need to minimize their monthly premiums.
What is the negotiations team doing between now and when we vote so that we can make an informed decision?
The negotiations team has set up a detailed timeline to make sure that we stay on track and don’t have to rush anyone to decide without having enough information. We have also identified plan comparison tools that unit members can use to look up how their plans might be impacted prior to voting. We are going to be holding an advisory vote to narrow down the list of potential third party administrators, and then select plans that best match the survey data. Cost structure and benefit contribution will be provided well in advance of the final vote.
What about retirees?
Retiree lifetime medical benefits are defined in our collective bargaining agreement, our “contract”, and are guaranteed based on what is in the contract when you retire (or was in the contract when you retired). Those who are already retired won’t see a change in benefit, although just like active unit members, plans might change based upon the third-party plan administrator we end up select.
What if I’m currently under care for a serious medical issue? How can I be sure my treatment won’t be interrupted?
There are statutory guidelines for continuity of care in California, more information on this requirement can be found here: http://www.dmhc.ca.gov/healthcareincalifornia/yourhealthcarerights/continuityofcare.aspx and how one of the possible third-party administrators, SISC, handles this can be found here: https://www.cfmcnet.org/sisc/.
Additionally, the CSEA 262 Insurance Task Force is researching tools to find providers and has already provided links to the tools for the first third-party administrator to respond to our RFPs, SISC: the Blue Cross (Anthem) tool can be found here: https://www.anthem.com/ca/sisc/ , and the Blue Shield tool is here: https://blueshieldca21-prod.modolabs.net/find_provider/, CECHCRs assistance is going to be very valuable in this regard as well, as they are able to navigate the complex health care provider structures much better than our own HR or insurance task force folks are able to do. Finally, the district is still willing to set up a “true up” fund to financially assist those who might have an extra cost related to moving to a new plan.