Get Full Government Meeting Transcripts, Videos, & Alerts Forever!
Get email alerts on the Dental Coverage topic
No spam. Unsubscribe anytime.
Board approves dental rate passes; retirees urge review of benefit interpretation
Summary
HSS approved several dental plan rate passes for actives and most retiree plans; retirees urged the board to investigate reports that HMO dental benefits may be interpreted in a way that denies promised cleanings and other services.
The Health Service System board approved recommended rate passes for multiple dental plans for 2015 (DeltaCare HMO retiree and active, Pacific Union HMO retiree and active, and the active Delta Dental PPO) while deferring the retiree PPO renewal for further review.
Aon Hewitt’s Gabriel Briggs told the board that case‑specific trends and utilization data supported either modest decreases or a rate pass as a conservative approach. “It would be justifiable to decrease the premiums by 1.4, but Aon Hewitt recommends a rate pass for 2015 to mitigate possible negative claims experience,” Briggs said.
During public comment Claire Zvonsky, representing RECCSF retirees, reported confusion and concerns from retirees who say HMO dental booklets and the benefits booklets distributed by HSS do not always match. Zvonsky said some members believe the HMO interpretation limits routine cleanings to once per year instead of two cleanings a year and that some retirees are being billed for fillings and other services they expected to be covered. She said she will submit specific names and cases to staff for follow‑up.
The board and staff agreed to return the retiree PPO renewal to a future meeting and asked staff to incorporate the survey feedback and specific case follow‑ups into the next presentation.
Next steps: Staff will bring back the retiree PPO item and additional pricing/options, and will review the reported cases sent by RECCSF for potential plan or vendor clarification.
