09-06-07 Chapter 172 Employee Retiree Insurance and Benefits Board Meeting

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Kathy Clark: I apologize for the quickness that we had to call this meeting. However, we are getting down to the wire and had to move forward with all the things we needed to do to get things completed with Aetna to put a system in place. We can conduct the Open Enrollment in October but we do need to get the Aetna system prepared for implementation. Tonight we will compare the similarities of Humana to Aetna to look at the difference between the two as we conduct Plan Design. Here are copies of all four of the plans that we have with Humana now for your review. I will now ask Sabina to go over this with you. Sabina Leins: Point Of Service Plan (POS) is what Aetna has which is similar to the Humana PPO Plan. By and large, the deductibles are the same, the out-of-pocket cost are the same and so are the co-pays. Both have two PPO Plans one with a $500 and the other has a $300 deductible which are essentially the same. What I wanted to point out is under the "not urgent use of an Urgent Care Provider." Aetna standard is not to cover that claim. Most importantly, if you don't like that you need to determine how you would want it handled. EXAMPLE: Suppose you had a child with a really high fever. You don't have to go to an Emergency Room or Urgent Care Facility. If either one of these are used there is a higher Co-Pay. Therefore, you might want to consider having it covered the same as it is currently covered under Humana as a Specialist visit. Comment Matt Daeumer: Personally, I would have no problem paying the same Co-pay for using an Urgent Care Facility or Emergency Room at the same amount we pay for seeing a specialist. Question Michael Dolby: Is there a reason why you didn't start with the deductibles and work your way back? Sabina Leins: No, for the most part all ofthem are the same. I just wanted to concentrate on the items that are different, as we look at Plan Design. This way you are not wasting time looking at everything, just those things that are different. Comments Juliane Graham: So, are we saying we are pretty good with the cost right now and are not looking at saving money? Comments Robert Swanagan: We are certainly looking at controlling cost, however, we are looking to enhance the service to employees and retirees wherever we can. We also realize this is an estimate. and things can happen. Question Karen Beerman: I just noticed this, what is Preferred Care? Is that like in network, out of network?