Present: Lynette Chandler, Abby Chemers, Dennis
Davito, Michael Duffy, Ray Foster, Deborah Haliczer, Jim Lockard, Judith
Malen, Pam Rosenberg and Jerry Zar
I. CALL TO ORDER
The meeting was called to order at 10:00 a.m.II. ADOPTION OF THE AGENDA
The proposed agenda was approved.III. APPROVAL OF DECEMBER MINUTES
The minutes were approved.IV. OLD BUSINESS
Concerns about insurance reimbursementV. NEW BUSINESS
The new HIPAA law has made it cumbersome for the Benefits Office to follow up on denied claims on behalf of the employees. Due to HIPAA, an employee who wants help from the Benefits Office must sign a permission form authorizing them access to information. Permission is required for each inquiry. Regardless, when claims are denied, the Benefits Office will help an employee write a draft of an appeal letter.
When a claim is denied, the employee must file an appeal with the company administering the claims. If the appeal is denied and the employee still wants to pursue reimbursement, he/she must file a second appeal with the company. After the second appeal is denied, the employee can file an appeal with CMS. If CMS denies the appeal, the employee can file an appeal with the Bureau of Benefit. There is no recourse when the Bureau of Benefit denies an appeal.
A number of employees have reported problems with claims that were supposed to be processed by Unicare. Unicare was the claims administrator through June 30, 2001. For example, the provider says Unicare did not pay on a claim while Unicare claims the provider was paid. Unicare cannot provide proof of the payment because the local office closed after CMS contracted with another company to administrator claims. The provider is suing the employee. This is just one type of problem that can occur when the claims administration changes.
Medical necessity does not necessarily flow from one administrator to the next. For example, CIGNA may not approve a medical treatment/prescription that Unicare had approved. A number of employees have reported this problem.
CMS will be negotiating a multi-year contract for claims administration starting fiscal year 2005. Given our experience, the UBC felt that it would be worthwhile to lobby CMS to address transition issues in the contract for services. Committee members asked that Deborah and Abby meet with President Peters to seek his advice on what would be the most effective method to lobby CMS.
457 Plans and 403(b) Plans
HRS is working to make additional 457 plans available to employees. Legal Counsel is reviewing the materials. Currently, employees have access to one 457 plan through CMS.
A review committee was established to review the 457 options. Ken Davidson and Steve Cunningham are responsible for establishing the procedures. An email or memo will be distributed when the plans become available.
Retirement Planning programs
A number of retirement planning programs are available to assist employees.
Deborah will be sending out a pamphlet to campus explaining each program and the intended audience. The SURS estimator workshop is given on a different day each month to make it easier for employees to attend. HRS has held retirement programs at the satellite campuses.VI. INSURANCE AND BENEFITS OFFICE UPDATE
One area of confusion for employees is their right to social security benefits. Deborah would like to see some sort of program established to address employees’ questions about the possibility of receiving Social Security benefits, related to previous employment.
Domestic Partner Benefits
Copies of University of Illinois domestic partner materials were distributed. It appears that the U of I domestic partner Health Insurance Premium Reimbursement Procedure is going to be of minimum benefit. The maximum out-of-pocket reimbursement is the amount the State would pay for dependent coverage under the State of Illinois CMS plan.
U of I requires a number of documents, including a Domestic Partner Affidavit. NIU’s Committee is looking to come up with alternate forms of documentation for a Domestic Partner Plan. A copy of the documentation required for processing various benefit transactions was distributed. For example to add a spouse, a copy of a marriage license has to be provided.
One faculty member claimed that his domestic partner’s dependent child should be entitled to a tuition waiver. The Committee agrees that domestic partnership benefits should be available to both same-sex and opposite-sex couples.
Western Illinois University is moving ahead with their Domestic Partner Program. NIU’s Committee would like our domestic partner benefits to be on par with the other universities. Deborah said she would invite the committee members to a UBC meeting when they are farther along in their work.
An employee requested that we consider supporting coverage for hearing aids. It was noted at a CMS meeting that hearing aid coverage would never be approved. Deborah said she might assign her new intern the task of researching if any health insurance plans include hearing aid coverage. The intern would be asked to report to the UBC at its March meeting.
The meeting adjourned at 11 a.m.
Meetings for the spring semester will fall in January, March and May.
NEXT MEETING: January 8, 2003, Founders Library, Room 409 at