Town of Halifax, Vermont
MINUTES
November 17, 2011
Special Meeting on Health Insurance
Call to Order
The meeting was called to order at 10:04 AM. Board members in attendance were John LaFlamme, Lewis Sumner, and Edee Edwards. Others in attendance were Brad Rafus, Ben Barnett, Travis Briggs, Mike Fournier, Keith Stone, and Board Secretary Phyllis Evanuk.
The purpose of this meeting was to review the options available to the town for health insurance coverage for employees. The town has been notified that the plan they had subscribed to last year is no longer available because CIGNA will no longer offer coverage for employee groups with less than 50 members.
The employees and the Board reviewed the various options and it was noted that if they chose a traditional plan without the Health Savings Account they would be able to use the money currently in the HSA for deductibles and co-pays but they could not contribute any new money into the existing accounts.
Ms. Edwards advised that a phone call was scheduled for noon with Tania from VLCT so all of their questions could be asked at that time.
Mr. Stone advised that he was upset at the short notice they have had about this important decision and has questions regarding coverage. He was informed by a representative at last year’s insurance meeting that certain things were covered, but when those services were performed and the insurance company was billed they refused, advising it was not a covered procedure. Further he advised that when he contacted VLCT for assistance he got no help there either.
One of the major drawbacks to the Health Savings Account plans is the extensive bookkeeping required of the participants, and the additional bills that are sent. As far as the choices available now, it was the general feeling of the employees that a return to a traditional plan with co-pays would be preferred if there is one that is reasonable and covers more than what the HSA plan did.
The plan that they seemed to be leaning toward was one offered by Associated Industries of Vermont Insurance Services (AIVIS). They were definitely not in favor of the BC/BS Plan D or MVP plans.
AIVIS VHP POS 10/20 Option #1 for small groups
Ms. Edwards read them some of the specifics of this plan. Regarding prescriptions it was noted there is a “step plan for drugs” which means that generic drugs available for certain conditions will be covered and should be prescribed first. If these are not effective then the next level drug can be prescribed and covered and so on.
Because they seemed to have completed their review Ms. Edwards called Tania Chambers (with VLCT) at 11:35 AM and left a message that they were ready for her call.
At 11:50 AM Ms. Chambers returned Ms. Edwards’ call and was prepared to answer questions.
- Will the health screenings, flu shots and other such programs still be available with other insurers?
- These are through VLCT not through insurers so yes they will continue.
Q. Are operations and MRI’s covered?
A. Depending on the reason for the operation and depending on what area of the body the MRI is covering, prior approval may be required. Many things in Vermont are state mandated that coverage be provided. If an insured person seeks out of state care for something mandated in Vermont to be covered, it may not be covered out of state as many states do not have these mandates. Some procedures are specifically not covered so the list may vary depending on the insurer. Each insurer lists those conditions that require prior approval and also those conditions or services that are specifically prohibited for coverage. If there is no lapse in coverage (which there will not be if they continue with VLCT) pre-existing conditions will be covered.
Q. Is there a “Gotcha!” to these plans that are not obvious?
A. VLCT realized that the limited range of plans they had been offering for the past twenty years was not necessarily cost effective for those communities with older workers (considering that the older population usually uses the health services more, and thus costs the insurers more) so in order to give more choice and to spread the risks over a more diverse age group, they decided to give more choice of options to the municipalities. There is no “gotcha” in the plans, just more choice.
Q. Are diabetic medications and supplies covered at 100%?
A. That depends on the specific plan that is chosen. Under the AIVIS POS 10/20 plan the insulin cost along with any other prescription costs would go toward the $100 deductible. Once the deductible is met there would be co-pays of $5 for generic, $20 for preferred list insulin, and $45 for non-preferred list insulin. Test strips, needles, and other supplies would come under durable medical supplies which is a separate $100 deductible. Once the deductible has been met it will be covered at 80% with 20% being the responsibility of the insured as co-insurance.
There is no out of pocket maximum for co-pays or co-insurance. In other words there will always be a co-pay or co-insurance for those services requiring it.
Q. Are membership fees required for the AIVIS plans, and what are they?
A. AIVIS is an association that requires being a member. VLCT is going to pay the fees required so that there will be no cost to the town.
Q. Will the Health Advocate program still be available?
A. Yes.
Q. Will the premium rebate program offered last year continue?
A. No, because the VLCT will no longer be collecting the premiums from the towns therefore they will not have the funds to give back.
Ms. Edwards moved that the Town of Halifax choose the AIVIS VHP POS 10/20 plan, small group option #1, for the coming calendar year for our employees.
Mr. Sumner seconded the motion, which carried 3-0.
The Board spent the next few minutes starting to complete the actual application for submittal by December 1, 2011.
Adjournment
The meeting was adjourned at 12:28 PM.
Respectfully submitted,
Phyllis H. Evanuk
Secretary