The State Group Insurance Program in 2006

1. The State Group Insurance Program in 2006 Benefit Plans and the transition to People First

2. The Changes • DSGI – New roles and responsibilities • People First – Benefits Administration • New Benefit Plans and new vendors

3. The Challenges • Coordination and cooperation between DSGI and People First to effectively manage complex processes and serve employees and retirees within a complex regulatory environment • Enrollment in and implementation of new types of benefit plans and new vendors

4. People First • System of record (data) • Customer Service • Correspondence • Transaction Processing • Open Enrollment • Fiscal Administration • Eligibility Files to vendors

5. People First as System of Record • End of COPES Insurance • COPES data out of date • Transfer of COPES data to People First • New enrollment in PF SAP system • Historical data t o Data Warehouse • Transfer of DSGI historical data • SAP data and DSGI data in the People First Data Warehouse

6. DSGI • Policy Analysis • Product Management • Procurement • Policy and rule determinations • Financial management and residual accounting functions

7. DMS People First Project Benefits Team • Facilitates the implementation of system and operational processes in People First • Assists employees and agencies with People First Issues • Receives direction regarding laws, rules and policies from DSGI

8. Changes in roles, changes in Processes, coordination and cooperation-Examples • Underwriting approval process • Exceptions and appeals

9. Underwriting approval • Underwriting approval process • Old procedure • Deductions began prior to approval • Cancellations and refunds required when underwriting denied • New procedure • New enrollment records “locked” until approved • Deductions begin after approval is received

10. Appeals and “Exceptions” • “Agency error” letters to People First (coordinates with DSGI in complex cases) • Employee appeals • “Level 1 appeals by employee (not agency) sent to People First • If denied, employee has right to Level 2 appeal • People First sends Level 2 appeals to DSGI • If denied, employee is notified by registered mail of his right to Administrative Hearing

11. 2006 Benefit Plans • Health Plan “Redesign” • Expansion of HMO offerings • Statewide HMO Contract Rates (no “service area” codes • Open Access HMO Plans • Prescription Drug Program and Medicare Part D

12. Health Plan “Redesign • Health Investor Health Plans • PPO • HMO • Health Savings Accounts • Limited Purpose Medical Reimbursement Accounts

13. Health Investor Plans • Lower premiums • Higher deductibles • Coinsurance rates • Medical • Prescriptions • Eligibility for Health Savings Account • Election decision based upon utilization

14. Health Savings Accounts • Tax exempt employee contributions • Employer contributions • Ineligible for “regular” Medical Reimbursement Account • Eligible for Limited Purpose Medical Reimbursement Account • Employee managed account

15. HMO Changes • New HMOs under contract • More counties have HMO options employee contributions • Statewide contract rates • no more “service area” codes” • “Open Access” HMOs • no “gatekeeper”

16. Medicare Part D • Federal requirement to coordinate enrollment with Medicare • Notification to participants • Retirees who choose Medicare D subject to Coordination of Benefits • Data interfaces to monitor enrollment in State Plan and Medicare D

17. The future of benefits administration and the State Group Insurance Program DSGI and People First will continue to work cooperatively to provide the State’s employees and retirees with a comprehensive package of quality benefits, meeting their needs in the most cost effective manner and using the latest technology to provide ready access to information and election opportunities.