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Board clarifies lap‑band coverage: employee‑only, 5‑year requirement reinstated; current cases grandfathered
Summary
After review of minutes and forms, the committee confirmed the gastric bariatric benefit is employee‑only and reinstated a 5‑year employment/coverage requirement going forward; employees already moving through the process under a prior 2‑year waiver will be grandfathered.
The Self Insurance Board clarified eligibility for the county’s bariatric (lap‑band/gastric sleeve) benefit and voted to apply a 5‑year employment and coverage requirement going forward while grandfathering employees already in process under a prior waiver.
Staff told the board that plan documents and the explanation of coverage reference the procedure and direct members to the benefits office for criteria; discussion revealed at least one form in circulation misstated a 2‑year eligibility waiver given during the COVID‑era for a single employee. Legal and benefits staff reviewed minutes and concluded the committee did not intend a standing reduction to a 2‑year requirement. The board agreed the program is an employee‑only benefit (dependents not covered) and that the original intent — a 5‑year continuous employment/coverage requirement — should be reinstated in the plan documents.
Board members directed benefits staff to add clear, controlled forms (with revision control and a superseding clause) and to clarify the plan documents (procedure coverage only; no routine coverage for post‑operative cosmetic or unrelated procedures). The committee also asked staff to explore contracting options with bariatric centers or third‑party program managers to obtain firm pricing and clinical criteria, and agreed existing active cases that commenced under the 2‑year waiver will be honored (grandfathered) while future approvals will follow the reinstated 5‑year rule.
