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KERR COUNTY COMMISSIONERS COURT
Special Session
Friday, December 17, 2004
1:30 p.m.
Commissioners' Courtroom
Kerr County Courthouse
Kerrville, Texas
~i
PRESENT: PAT TINLEY, Kerr County Judge
H. A. "BUSTER" BALDWIN, Commissioner Pct. 1
WILLIAM "BILL" WILLIAMS, Commissioner Pct. 2
JONATHAN LETZ, Commissioner Pct. 3
DAVE NICHOLSON, Commissioner Pct. 4
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I N D E X
December 17, 2004
1.1 Consider and discuss recently adopted employee
health benefit plan
1.2 Consider and discuss applications for stop loss
and life insurance for employee health benefits
program, requesting and authorizing payment for
binder(s) on same, and authorizing County Judge
to execute applications
--- Adjourned
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On Friday, December 17, 2004, at 1:30 p.m., a special
meeting of the Kerr County Commissioners Court was held in the
Commissioners' Courtroom, Kerr County Courthouse, Kerrville,
Texas, and the following proceedings were had in open court:
P R O C E E D I N G S
JUDGE TINLEY: Let me call to order, if I
may, the special Commissioners Court meeting posted for this
time and date, Friday, December 17th, 2004, at 1:30 p.m.
It's a few minutes past that now. The issues on the agenda
today are insurance issues, and our county consultant --
health benefits consultant, Mr. Gary Looney with Catto and
Catto, I was informed, is en route from Fredericksburg. He
was in Austin this morning, and should be here in a few
minutes. The first item on the agenda is consider and
discuss recently adopted employee health benefit plan.
There have been some questions, concerns, dilemmas -- call
them what you like -- with regard to the recently adopted
employee health benefits plan. And what I'd like to do in
order to try and stay focused on the issues that we need to
consider today is to first find out what those questions,
issues, concerns are. First, identify them all, and try and
categorize them so that we can determine whether they're
plan issues or plan design issues, or whether they're
coverage issues, or whether they're strictly cost issues.
And then, once we get all the issues or concerns or
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questions identified, depending upon the nature of the
question, concern, or issue, call upon our respective
consultants or -- or plan administrator, as the case may be,
to answer and resolve those questions or issues. So, as I
say, the first thing I'd like to do is to ascertain what the
issues or the questions are that we need to focus on here
today. So, if we could, could we start over here? Who's --
who's got an issue? Question? Concern? If they'll
identify themselves. Yes, ma'am?
MS. LARA: I'm here on behalf of Family
Practice Associates.
JUDGE TINLEY: All right.
MS. LARA: Dr. John Davis, William O'Donnell.
We've had several of our patients call and inquire. They
were told there's an 18-month preexisting clause on any
health issues if they've been there less than 12 months.
We're talking diabetes, hypercholesterolemia, hypertension.
Can you fill me in on that, please?
JUDGE TINLEY: So, we have an issue as to
preexisting conditions?
MS. LARA: Right. Evidently, if the
employee's not been employed 12 months or more, if they have
a problem, they're going to have to wait 18 months. That
seems to be a pretty big issue.
JUDGE TINLEY: Okay, thank you. Any other
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issues, questions, concerns over here on this side of the
room? Yes, ma'am?
AUDIENCE: I'd like to know, how dependable
are these people? They couldn't show up for the first
meeting at the Sheriff's Office. Now they didn't take out
the insurance money from our checks; they're going to double
up on the next check. They're going to have two payments
instead of one. Are we covered by insurance now?
JUDGE TINLEY: Well, the coverage in place
now is under the plan that expires December 31.
AUDIENCE: But they didn't take anything out
of our check.
JUDGE TINLEY: Okay.
COMMISSIONER BALDWIN: Mr. Lopez.
JUDGE TINLEY: Yes, sir?
MR. LOPEZ: My question is in regards to what
she said about the preexisting condition.
JUDGE TINLEY: Yes.
MR. LOPEZ: I've been employed with the
County for six months, and my wife's going to have a baby in
June, and I was told that since I haven't been employed
there for a year, that all of my expenses towards the birth
of my newborn is going to be all out-of-pocket. I want to
know how they consider that a preexisting condition, 'cause
that's what I was told, that's what it's considered.
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JUDGE TINLEY: Okay.
MS. LARA: I can tell you why. It's not
cheap to have a baby any more. It's going to cost from
$5,000 to $6,000.
COMMISSIONER LETZ: Please.
MS. LARA: I'm just letting you know.
JUDGE TINLEY: Anybody else over here on this
side of the room? Yes, ma'am?
JUDGE WRIGHT: I'm Dawn Wright, and my
concern is the increase in the prescription costs. Right
now, my prescriptions are $350. When I have them filled,
this means it's going to be $700. This is just strictly for
blood pressure since I broke my leg, and I'm really
concerned about that, and I'm wondering how I'm going to
come up with $700 every three months.
JUDGE TINLEY: Anybody else on this side?
COMMISSIONER NICHOLSON: Just for
understanding, Judge.
JUDGE TINLEY: Yes?
COMMISSIONER NICHOLSON: What does that mean?
It means that the co-pay is going up?
JUDGE TINLEY: Yes.
COMMISSIONER WILLIAMS: Yes.
COMMISSIONER NICHOLSON: Thanks.
JUDGE TINLEY: Increase in prescription
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co-pay is what I have it identified as. Yes, ma'am?
MS. HARRIS: I just need a clarification on
the prescriptions, if we're going to be able to get a 90-day
supply through the mail-order, and how it -- if that's so,
how that process is going to work exactly. I think there's
a difference in -- in comparison to the old insurance. And
the second thing is, on this preexisting conditions, if you
show an affidavit that you have had continuous coverage
through an insurance company medical for yourself and your
dependents for the past 12 months, if that will satisfy that
preexisting condition clause.
JUDGE TINLEY: Thank you.
COMMISSIONER WILLIAMS: Another one right
there, Judge.
JUDGE TINLEY: Yes, ma'am.
MS. HALL: What happens -- I've been in the
hospital for kidney stones, and I've got to go back to the
doctor in January. Well, who's going to cover what and
when? Is -- am I covered on December the 31st through then
for what I've had done to me? Which wasn't fun. And then I
have to go back. Well, then it's sort of a continuation --
you see what I mean? -- of the treatment. Well, how does --
how do I know what to tell my doctor who to bill?
JUDGE TINLEY: Okay.
MS. HALL: Other than me.
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JUDGE TINLEY: Okay. Basically, a
continuation of course of treatment, and the plan changes in
the meantime.
MS. HALL: That's right, yes.
JUDGE TINLEY: Okay.
MS. HALL: You're getting something done,
and...
JUDGE TINLEY: Okay. Anybody else over here
on this side? Okay. Let's come over here to this side.
Yes, ma'am?
MS. MEEKER: Prescription co-pay is my
greatest concern.
JUDGE TINLEY: Okay.
MS. MEEKER: It's almost unreasonable. And I
did learn that you did have before you an option for our
co-pay on -- oh, you know, the deductible and co-pay to stay
the same. But the option you chose just kills us. The --
on the co-pay, it just kills us.
JUDGE TINLEY: It's prescription --
MS. MEEKER: Formulary, nonformulary. I
don't know where they made that up, but -- and you can't get
any answers.
JUDGE TINLEY: It's prescription co-pay and
categorization issue also?
MS. MEEKER: That's my main concern.
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JUDGE TINLEY: Okay.
MS. MEEKER: Or has that already been
mentioned? It hurts when, you know, hey, you could have
chosen for us to stay the same on these out-of-pocket stuff,
but you chose to hit us with this.
JUDGE TINLEY: Do we have any more issues
over here on this side of the room? Yes, ma'am?
AUDIENCE: No, you go ahead.
AUDIENCE: I have something to say about
the --
JUDGE TINLEY: I'm sorry, I cannot hear you.
AUDIENCE: -- about the meds. About the
co-pay.
JUDGE TINLEY: Okay.
AUDIENCE: They had been 20, and now they're
30. And the -- some of the meds are 35, co-pay. That makes
a difference. I was paying 180. Now it will be $315.
JUDGE TINLEY: So it's a co-pay issue on the
prescription.
AUDIENCE: Co-pay.
JUDGE TINLEY: Okay.
AUDIENCE: Co-pay on the prescriptions only,
yeah.
JUDGE TINLEY: Okay.
AUDIENCE: And also -- also, the -- the
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doctor's office call, you know, have gone from 20 to 30.
JUDGE TINLEY: The -- the office visit
co-pay?
AUDIENCE: Yes, sir.
JUDGE TINLEY: Okay.
AUDIENCE: It was at 10.
MS. NEMEC: 10 to 30.
JUDGE TINLEY: Okay. Anybody else over here
on this side of the room?
MS. EVANS: I'm sorry, I came in late, so I'm
not sure if anyone's talked about the amount coming out of
our checks on the 30th.
JUDGE TINLEY: That issue's been raised.
MS. EVANS: Okay. I just wanted to make
sure, 'cause I've got three kids and it's Christmas, and all
my big bills are due on the 1st, and I really -- it's -- it
was already going to be hard for me to even pay the -- the
deductible for my children to be on it, but I have to have
insurance for them, 'cause they're, you know, kids. So, I
am very concerned about that. I'm concerned that I'm not
going to be able to make my house payment or my van payment
or one of those.
JUDGE TINLEY: Okay. Is that --
MS. EVANS: That was my main concern, that I
wasn't for sure --
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JUDGE TINLEY: Okay. Yes, ma'am?
MS. GORDON: Me?
JUDGE TINLEY: Yes, ma'am.
MS. GORDON: My concern also is the co-pay on
the insurance. I -- for the medications. I have quite a
few, and it's just -- you know, it really knocks me down for
that much difference. And I found it very difficult to find
out anything, because the agent was so rude, and when he
found out that I would be retiring and mine would be a
supplemental policy, he spent more time arguing with me over
whether I was using the correct term, "supplemental" or
"secondary." And I couldn't get any answers at all from
him, and he merely handed me a piece of paper and said,
"Just sign this. You're just a retiree." And I was rather
offended by that.
JUDGE TINLEY: But your issue is the
prescription co-pay?
MS. GORDON: The main issue, sir, is the
prescription co-pay.
JUDGE TINLEY: Okay, thank you. Anyone else?
Yes, ma'am?
MS. NEMEC: I would say my main issue is the
amount of complaints that I have received from employees as
to exactly what Nell just said, as to how they were treated.
When we started this enrollment process, the first few
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meetings that we had, I made it a real big point to be very
positive and open-minded about this enrollment, and I
thought it was going along okay, and then all of a sudden --
I mean, there's no way this room could fill up with
employees -- the amount of employees that called me with
that complaint.
JUDGE TINLEY: Your issue is attitude?
MS. NEMEC: Yes.
JUDGE TINLEY: Okay.
MS. NEMEC: Employees -- a lot of employees'
issues were attitude.
JUDGE TINLEY: Okay. Yes, ma'am?
MS. LAVENDER: I'm a part-time county
employee, but my husband is a full-time employee, and has
been for 17 years. And he and I, and about five other
people on the County's payroll, are beneficiaries of state
employment benefits already. We've retired from one job and
are on either state health care through the Department of
Public Safety, or teacher retirement. We were told that we
had to take one of these plans. We were not given a third
option. And when I checked, I discovered that you all were
under the impression that the third option was still in
place. I served 20 years on the school district's insurance
committee. I know and I understand self-funded or partially
self-funded insurance, and I -- I felt like I had been
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insulted. They were very condescending to me when I tried
to talk to them about it. And they were -- I was told by
someone who talked to them that they told them that if we
did not take the county insurance, that our primary carrier
would cancel our insurance. And I called Aetna and I called
the Teacher Retirement System, and that's not true.
JUDGE TINLEY: Okay. So, your issue is a --
MS. LAVENDER: Misrepresentation. Failure to
disclose perhaps would be an issue.
COMMISSIONER BALDWIN: Secondary insurance.
MS. LAVENDER: Secondary insurance issues.
COMMISSIONER WILLIAMS: For alternative
coverage.
JUDGE TINLEY: Okay. Employees with existing
outside coverage?
MS. LAVENDER: Correct, sir.
JUDGE TINLEY: Okay. And I think I heard
another issue about primary-slash-secondary coverage and
coordination of benefits?
MS. LAVENDER: Right.
JUDGE TINLEY: Okay.
MS. LAVENDER: The concern that those of us
that are on state retirement and state health benefits are
concerned is, if you cancel -- if we go in there and cancel
and make it our secondary insurance, there's no guarantee we
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can get back as a state -- as a state employee or former
state employee to having that as our primary insurance, and
we're very concerned about that. And most of us have chosen
the third option under the old plan, and gone with the AFLAC
and the medical reimbursement policy for the past three
years that that was available.
JUDGE TINLEY: Okay. Okay.
Primary/secondary coverage issues and coordination of
benefits. Okay. Anyone else over here on this side?
Anyone else?
MS. McELHANNON: Yes, ma'am. Can I say
something?
JUDGE TINLEY: Yeah.
MS. McELHANNON: My concern is having to have
your blood test, X rays, whatever, done inside -- in the
doctor's office or the insurance won't cover it.
AUDIENCE: What?
MR. BARYON: That's on the physicals.
SHERIFF HIERHOLZER: No more labs.
MS. McELHANNON: Yeah, no more lab, no more
anything. Has to be done in the doctor's office.
JUDGE TINLEY: Okay. Is that it?
MS. McELHANNON: Yes, sir. Thank you.
JUDGE TINLEY: Okay. Anyone else? Okay. I
have broken these down into plan design issues, coverage
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issues, and premium or cost issues. The plan design issues
I have are inability to opt out, mandatory inclusion,
employees with existing outside coverage -- and that's
really shades of the same question, and then secondary --
primary/secondary coverage issues and coordination of
benefits. Under coverage issues, I have preexisting
conditions, and we've got some sub-questions under there.
Then -- then we have the lab work issue on the coverage
issue. The continuation, of course, of treatment in
midstream is -- that could be either a plan issue or a
cover -- a preexisting condition issue, but I've got it
under preexisting condition. And then premium and cost
issues are the premium deduction for this month, increase in
prescription co-pay, mail-order prescriptions, and I'm going
to put out there, "90-day." Categorization of
prescriptions. Formulary/nonformulary, generic and so
forth, and the office visit co-pay. The -- the premiums
this month, the Treasurer circulated a memo, I think, to all
department heads earlier this week that, because some of the
things had not been completely finalized, she was not able
to make the deductions, and therefore any deductions to
occur in December would have to occur, if at all, of course,
at -- at the final pay period. So, I think that's the
answer to that question. Am I incorrect in that, Ms. Nemec?
MS. NEMEC: Well, I would like to add that
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the reason is -- is because I did not get the rates from the
insurance company.
JUDGE TINLEY: Okay.
MS. NEMEC: In order to deduct it. And I
still haven't gotten them.
JUDGE TINLEY: Okay.
MS. NEMEC: And I have given them a deadline
before the enrollment and told them when I needed it in
order for me to be able to deduct for the 15th payroll, and
that was not met.
JUDGE TINLEY: Okay. Okay. Let's start with
the plan design issues, if we might.
COMMISSIONER BALDWIN: Judge, I want to say
something before you get into the Q and A part of it. I
just wanted to say that I think that, personally, I have a
great amount of confidence in the insurance program. I
think in the long run, I think it's going to be a good thing
for me and my family, as well as all the employees, and I
think that, as grown people, that we can sit down and work
these issues out, dealing with co-pays and medications and
all those things. I think that the -- that all can be
worked out. However, this bad attitude and condensation
(sic) and rudeness, arrogance, et cetera, whatever all that
was, I don't think -- I, personally, and I don't think
anybody at this table right here will tolerate that toward
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our employees. So, we want to -- if there is any of that,
I'd really like to see it laid down immediately so that we
can get on with government business here, and -- and get
that out of the way. We're not -- we're not going to allow
anybody to treat our employees in a -- in an ugly manner or
in an ugly way, so that's all I have to say about that.
JUDGE TINLEY: Thank you, Commissioner. I
appreciate that.
COMMISSIONER LETZ: Judge, I might add a
comment. And I think -- I mean, I was concerned to hear
about the attitude issues and the rudeness, especially after
a comment that I made when we selected the insurance company
and the benefits provider that that wouldn't be tolerated.
So, I am concerned that that did happen; at least there's a
perception that it happened. The other thing is that, you
know, I don't know that the -- maybe the employees do or
don't understand this, but we change our insurance every
year. We rebid it and change the -- you know, we did it a
lot different this year. We changed the administrator of
it. Every year we go out for new coverage, so a lot of the
questions, I think, that they are -- are questions that
would come up every year, and there are always slight
modifications to the plan.
This year, I think we probably did make some
more, and hopefully Mr. Looney will address this a little
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bit more, but I think a lot of the changes that are in the
plan now are directions that the country is going, the whole
nation is going with their insurance. And we don't have a
whole lot of choice. We can't say we refuse to change in
Kerr County. I mean, it doesn't work that way. The
industry is changing; it changes continuously, and this was
a -- a year that we, you know, corrected course a little bit
with the insurance, as the whole nation is doing, because
the cost of health care is going up so rapidly. I think
what we did try to do is come up with a plan that was very
similar to last year's. It's -- there's some different ways
of calculating that are, in my opinion, confusing, but I
think once people understand it, a lot of the concerns that
I think that were addressed, you know, will be resolved;
partially, anyway, if not totally. But, hopefully
Mr. Looney can maybe -- rather than me try to explain a lot
of those issues, I'm going to leave it to an expert.
COMMISSIONER NICHOLSON: The -- what the
other two Commissioners said, I fully agree with both of
them. And I think for us, as leaders, and other elected
officials and supervisors as leaders, what we need to do is
focus on problem-solving and not being part of the problem.
Focus on solving, to the best extent we can, these issues
that have been raised. And I appreciate people being
willing to come in here and say what their concerns and --
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and issues are. We'll deal with them.
COMMISSIONER BALDWIN: I agree.
COMMISSIONER WILLIAMS: I appreciate the
comments of my colleagues. Judge, I'll reserve my comments
till after I've heard the answers to the problems. I'm
ready to get on with the answers.
JUDGE TINLEY: Okay. As Commissioner Letz
said, there's -- there's a concern among all employees of
the rising cost of health care and how that affects employee
benefits, and a part of our charge to our consultant in
designing a plan was to do what we can, recognizing that we
have traditionally in the past paid the full cost for
employees. There was no employee participation in the cost
of the coverage, and the country's kind of passed us by in
that respect. I think -- I think, if you'll look around,
you'll find that most employers have either adopted plans
which have materially reduced benefits, increased
deductibles, whatever, or have -- have tailored plans such
that their employees participate, some to a smaller extent
and some to a significantly larger extent in the costs of
the program and the premiums paid, depending on whether it's
fully insured or not. But part of the charge that we gave
to Mr. Looney, our consultant, with Catto and Catto was to
try and design a plan which kept up with what the tax laws
and -- and federal laws allowed in that respect, and also
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attempted, to the degree possible, to minimize the effects
of this rapidly increasing health care costs in employee
benefit plans. So, that's what he started with, and he
brought us some plans, and we adopted a plan. And some of
the items that -- that you've raised are items that really
he should properly speak to, so I'm going to call on
Mr. Gary Looney with Catto and Catto, our insurance
consultant, and ask him -- I guess you've got down the --
MR. LOONEY: I've taken some notes, Judge,
thank you. Commissioners, good to see you again, even --
even in this circumstance, because I think we'll be able to
resolve questions and be able to resolve some of the
problems. There's one thing that -- that I can't control,
and that is when the presentations are being made by someone
other than myself, I can't really control the attitudes that
are taking place in the meetings themselves. But, as I told
you last time, as you said, you know, this is something that
we hold the companies and the agent accountable for. So,
there are going to be individuals in the organization that
are going to hear things from the presentations that they
don't want to hear, so we need to resolve those questions
and make sure they get resolved properly.
There's one thing I want to -- to address
initially, and then I do want to make note that, because of
certain HIPAA regulations, I will not be able to discuss
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anybody's individual circumstance in a public forum. We
have no names or no reference to any one specific
individual. If, in fact, individuals would like to discuss
about your situation outside the courtroom, I'll be glad to
set up a situation where we can talk privately about it, but
because of the HIPAA regulations and such as that, we have
to be very careful about discussion in any open forum about
anyone's past medical history and otherwise. So --
MS. HALL: Well, my medical history was just
kidney stones. I mean, it's a painful thing, but I don't
care if people know.
JUDGE TINLEY: Ms. Hall, we -- we can talk
about general situations, an ongoing course of treatment,
and -- and a change of plans in midstream. We can talk
about that, but we can't talk about your situation, okay?
MS. HALL: Okay.
MR. LOONEY: Unfortunately, I can't answer
your question specifically unless we leave the room and go
have a quiet talk, which we can do. And do you still have
your stones? Did they give them to you?
MS. HALL: No, they didn't give them to me.
MR. LOONEY: Okay. (Laughter.)
MS. HALL: I didn't really want them.
MR. LOONEY: I didn't think you would.
Didn't want them in the first place, did you? I didn't
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think so. But --
(Cell phone rang.)
(Discussion off the record.)
MR. LOONEY: But when we designed the plan
and when we were working on the design of the plan, I had
information that said that there was a credit that was given
to the individuals who opted out of different plans and
opted into another plan. One of the things I was told was
that there was a differential between the high-cost plan and
the other two plans, and that differential was credited
forward. Well, apparently that was not the full extent of
the -- of the credit. Apparently, there was also a
potential -- or people were totally waiving out of the plan,
and then being given the full amount of the funded amount
for a credit to be used for the purchase of insurance, and
that is something that is totally against underwriting rules
and everything else that we look at, because the plan
document essentially says that the County will provide
health insurance for every employee, and that they will
provide that amount based on this funded amount.
So, when we did our calculations on rates,
participation, plan design issues and everything else, the
assumption was that every employee would be covered by the
County making contributions for every employee. That when
Option B was determined, then there was a credit given for
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the employee-only portion of that, which was the difference
between the funding for the employee under A and B, and that
credit was approximately a little over $100 a month. Well,
that employee-only credit was what was then allowed to be
used for the outside purchase, because that blended into the
funding. If they waived out of the plan completely, then
the amount of dollars that we use to calculate that premium,
or the contribution is a funded amount. That's not pure
premium. Pure premium in a self-funded plan is based on
fixed costs plus claims cost.
So, what that number was is a funding amount
for the County to fund per-employee, so that amount was
five -- over $500 a month. And now I'm told that that
person that wants to waive out of the plan completely would
be given a $500 credit to be used to spend toward -- and
that is just -- I'm a consultant, and from a consulting side
of it, that's totally unacceptable as an underwriting
practice, because it's not a premium amount. It's a funding
level, and that funding level anticipates that that balance
of premium will be put into a fund to pay claims with. If
you yank those dollars out of that process, then you're
talking about a significant reduction in the claims fund
that's available to pay claims. Twenty people? That's over
$100,000 a year that you pull out of the plan that you've
funded from the -- from the standpoint of funding should be
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in the plan you pay claims with. So, from that standpoint,
initially, opting out of the plan or waiving out of the plan
was not part of the funding requirements, not part of the
funding mechanism that we built in.
Now, as far as primary and secondary
coverages are concerned, the employee -- primary and
secondary quite often is determined by where they are
insured, if they have current insurance. And I talked to
T.R.S. and had a discussion with them and said that, you
know, they were -- if they -- I believe if you totally opted
-- if you canceled their plan -- notice, you had a
coordination of benefits process if, in fact, you are
covered by the County. So, as to coordination, they become
secondary, they become primary. So, the coverage doesn't
cease or terminate; it just changes the nature from primary
to secondary. According to T.R.S., if you then lose the
County plan, then you're back in their plan as primary.
MS. LAVENDER: That wasn't --
MS. NEMEC: That wasn't her question.
MR. LOONEY: Well, that was -- I'm sorry.
What -- the question, then, was?
MS. NEMEC: She's on their plan as primary.
She chose to keep their plan, so, therefore -- or -- so,
therefore, the -- she's one of those that -- or her husband
is one of those that the whole insurance amount, the $505 in
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this case, has been allocated to them to use for other
insurance.
MR. LOONEY: Okay. So, again, from -- from
an underwriting standpoint, you pull those dollars out of
the total fund balance that we -- that we had calculated
into the system as part of the fund balance to be used to
pay claims with. So, if -- if that's a change that the
County wants to make, then I've got to go back in and build
those dollars back into the funding for the balance of the
employees to pay the claims that are existing in that
circumstance, so that would change the whole nature of the
funding process.
COMMISSIONER LETZ: And what is that --
what's that going to do? I mean, what's that -- if that was
done, if we --
MR. LOONEY: It's going to increase the cost
to enter the plan itself, and either you absorb it as a
county, or you build it back into the premiums that the
other employees are paying for their coverage.
COMMISSIONER LETZ: It increases the costs if
you allow people out, okay.
MR. LOONEY: Right. Preexisting condition
circumstance. Your plan document initially, originally,
from the very beginning, has had a clause in it that the
County, at some point in the past, opted out of HIPAA.
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"HIPAA" meaning, as -- as you asked about, you know, a
certificate of coverage.
MS. HARRIS: Yes.
MR. LOONEY: If you provided a certificate of
coverage as a new employee, did, in fact that cancel your
preexisting condition? That's a HIPAA law, the HIPAA
portability. You have opted out of that. And, as a county,
you opted out of that at some time in the past, and it was
assumed that that was going forward in the plan. That
protects a self-funded plan from employees coming in with
preexisting conditions, and it -- there's a six-month period
for which, if they had care and treatment prior, then they
have to go 12 full months without treatment under that
circumstance to receive benefits under the plan from the
self-funded basis. Now, if you opt out of HIPAA, then the
notifications are given to employees upon enrollment, or
should be given to them upon enrollment, notifying them of
the status of the fact that you have opted out of HIPAA.
HIPAA means that new employees coming in, if they have an
existing illness, a new employee, that they will have a
restriction on claims that they're being paid for something
that existed when they came to you as an employee. Now, a
pregnancy, if the pregnancy occurred after the date of
employment, then the pregnancy is covered as any other
illness. That is not preexisting. I don't know whether
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that happened before or after.
MS. LARA: Mr. Ochoa answered that question.
Jaime Ochoa answered that question.
MS. NEMEC: Pregnancy was after employment.
MR. LOONEY: After employment, so that is not
-- that is not a preexisting exclusion. Any employee who's
been employed by the -- the County who has satisfied the
previous employer's definition of "preexisting" is a current
employee is covered -- is covered under the plan in the same
manner that they were covered under the previous plan.
There's no additional preexisting exclusions or limitations
placed on any employee who is a current active employee.
The status that they were in as an employee at the time the
plan changes is the status it moves forward.
COMMISSIONER LETZ: So, there's no change.
MR. LOONEY: There's no change in the
preexisting condition in the manner in which it was done in
the past. The manner in which it was in the past.
COMMISSIONER WILLIAMS: Does that apply to
prescription drugs? 'Cause I imagine everybody in here has
prescription drugs. I'm seeing a shake of the head back
there.
MR. MALEK: No, it's not going to apply to
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everybody has to get precertification for the continuation
of prescription drugs?
MR. LOONEY: There's no preexisting condition
elimination on prescription drugs for an employee. There's
not any.
COMMISSIONER WILLIAMS: Okay.
MS. NEMEC: I'd like to ask for
clarification. If someone has been employed here for a
year, they have diabetes, that diabetes has been ongoing, is
that employee going to have to wait 18 months before the
diabetes medical part is covered? 'Cause that's what we
were told.
MR. LOONEY: Twelve months, I believe.
MR. MALEK: Well, yeah. Depends if it's an
employer -- it's 6/12/18. Six months for the condition
prior to the time, and then 12 months if it's an employee,
18 months if it was a dependent.
MR. LOONEY: That was the way the plan was --
MS. NEMEC: That was my next question. I
checked with the plan prior, and that's not -- that was not
our plan.
MR. LOONEY: Whatever way the plan was prior
is the way it's going to go forward. So --
MS. NEMEC: That's not what -- that's not
what was said to everyone, so we need clarification.
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MR. LOONEY: Well, that's -- we'll get that
clarified in writing.
MS. NEMEC: And you said that we opted out of
HIPAA. Do you know where you got that info?
MR. LOONEY: It was in the plan document.
MS. NEMEC: It's in the plan document?
MR. LOONEY: It was.
MS. NEMEC: Okay. I'd like to see that.
COMMISSIONER WILLIAMS: You're under the
impression we did not opt out?
MR. ROTHWELL: To my acknowledge, they've
never opted out of HIPPA. Our plan is pretty clear on the
preexisting conditions also, the plan documents.
MR. LOONEY: Six, 12, and -- what is it in
the plan document currently right now?
MR. ROTHWELL: I don't remember specifically.
MR. LOONEY: Whatever that preexisting
condition --
MR. ROTHWELL: It's a six-month look-back, I
know that.
MR. LOONEY: Six-month look-back. I think
it's -- I think it's 12 per employee, and then 18 for
dependents, what was in the contract. When did the HIPAA --
were the HIPPA notification -- when was that done?
MR. ROTHWELL: There was never an opt-out of
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HIPAA notification that I'm aware of.
MR. LOONEY: There's not any HIPAA
notification that Mr. Bothwell was aware of. Mr. Malek?
MR. MALEK: That's not what the plan document
has. It has a pre --
(Court reporter interrupted, asked Mr. Malek
to stand up so he could be heard.)
MR. MALEK: Sorry. The plan document that I
was given by someone has preexisting language in it. That's
what we used for the basis of --
MR. LOONEY: So the assumption was that the
preexisting language in the plan document, then --
MR. MALEK: That's correct.
MR. LOONEY: -- precipitated the HIPPA, so
it's not actually written into the plan document. So --
MR. ROTHWELL: The preexisting language
that's in the document is there for someone that comes to
the County, often happening with no prior coverage.
MR. LOONEY: That's not --
MR. ROTHWELL: It's a clarification of
what --
COMMISSIONER WILLIAMS: We can't hear the
cross-dialogue here.
MR. LOONEY:	Excuse me.	We'	ve got	a -- we've
got a conflict, then, of --	of issue in	the	plan	document
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interpretation by Mutual of Omaha and the current carrier.
Because the current carrier's language has a restriction,
then, that it has a six-month waiting period for preexisting
conditions, and according to Mr. Bothwell, that's a -- a
notification to employees that had no previous coverage
coming to the county. That language normally is used in a
circumstance where HIPAA has been opted -- where you've not
been a participant in HIPAA. So, the HIPAA regulations say
that you -- if you do a certificate of continuous coverage,
then there is no preexisting condition applied. I will get
with these two gentlemen, make sure we get that clarified in
the plan document language. And if HIPAA -- if the County
has not opted out of HIPAA, then HIPAA will be applied and
you will not have any preexisting condition for an employee
that comes to work that shows their certificate of credible
coverage from their previous employer. We'll get that
resolved immediately.
MS. HARRIS: That certificate also covered
the dependents.
MR. LOONEY: Yes.
MR. BARYON: Excuse me. What about
medication, if you're on medication prior to employment, and
then you've been on it for, like --
MR. LOONEY: If you were covered under a
previous employer where that was a covered element, and you
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have a certificate of credible coverage from the previous
employer, then that will not be a preexisting condition.
MR. BARYON: And our last company has been
covering it.
MR. LOONEY: Then it's covered going forward.
MR. BARYON: Okay.
MS. HALL: What if the only health insurance
we've had has been through the County?
MR. LOONEY: I think we've been very lucky.
MS. HALL: We have been. And my husband has
paid for mine, so then mine wouldn't be a preexisting, would
it? He's been employed for -- since 1976 in law
enforcement.
MR. LOONEY: You'd better stay married to
him, ma'am. I think he's pretty valuable.
MS. HALL: Well, I've got used to him.
MR. LOONEY: I think that's a valuable asset
right there.
MS. MEEKER: Mr. Looney, you haven't answered
all the questions, and I apologize for interrupting, because
it kind of came to my mind, we had the same coverage for,
what, seven years? The same carrier. And we've all been so
happy with that carrier. That carrier. So -- but you
recommended that the -- that the Court move to this other
coverage; is that right? Is that how it came about?
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MR. LOONEY: Mm-hmm.
MS. MEEKER: Well, would you tell us what it
was about this proposal and our old coverage that caused you
to recommend to them that you take up this plan which we are
MR. LOONEY: About $370,000 in additional
costs.
MS. MEEKER: To whom, taxpayers?
MR. LOONEY: To the County.
MR. HALL: That's the cost to the employees
to make up for it.
COMMISSIONER LETZ: Before -- the plans that
were bid were identical. This -- this change would have
been in place either way. I mean, we bid -- Mr. Looney put
together a plan. That was what we bid on.
MR. LOONEY: Yeah. The plan design itself
is -- is -- you know, the administration of the plan design
is one aspect of it, one piece of it, but the plan design is
a major change in plan design.
MS. MEEKER: Why?
MR. LOONEY: I think -- well, one thing is
it's a modernization of that plan. You've been in the same
place for seven years. Once you see how the plan functions
and how its benefits are able to carry forward for you, once
you're able to see how you accumulate the benefits in the
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plan, the plan design really is going to be more beneficial
to a majority of the employees that are here. And I'll be
glad to take another time and another -- another
circumstance when we've got more time, be glad to go over it
with you.
MS. MEEKER: If I could work the budget,
which I have for many years, I could fix it. In a
heartbeat.
MR. LOONEY: But you'd build fewer roads and
have fewer law enforcement officers.
MS. MEEKER: No, no, no, no, no. No, there
are other places I could get it.
MR. LOONEY: Oh.
COMMISSIONER NICHOLSON: I'd like to put
the --
MS. NEMEC: I have a question.
MR. LOONEY: Y'all got a bucket of money
somewhere that we're not aware of.
COMMISSIONER NICHOLSON: I'd like to put the
preexisting conditions thing to bed. Do I understand that
benefits that are currently being paid under the current
plan for current employees will continue to be paid?
MR. LOONEY: That's right.
COMMISSIONER NICHOLSON: No restrictions on
preexisting conditions for current employees?
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MR. LOONEY: That's correct.
MS. NEMEC: I have a question to follow that.
When -- when this plan was bid, did Mutual of Omaha bid on
excluding preexisting conditions to be covered, and did
E.B.A. bid that way also? Because if they didn't, then I
would think the amounts would be different at this time.
MR. LOONEY: I'll have to find out.
MS. NEMEC: If that's the case, I think the
only fair way is to rebid the two. It's nothing funny.
That is common sense. There's nothing to laugh about that
statement, Mr. Nicholson.
MR. LOONEY: I'll --
solution.
COMMISSIONER NICHOLSON: Would be part of the
MR. LOONEY: I'll find out if there is -- if
there is a differential.
MS. NEMEC: I think that was a very good
question.
AUDIENCE: Yes, I do too.
MR. MALEK: I can solve that problem right
now. It's going to be the same; it's not going to change.
MS. NEMEC: That's not what you told me last
MR. MALEK: I didn't have this conversation
23 week.
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MS. NEMEC: You didn't have a lot of
conversations with a lot of these employees, it seems like.
JUDGE TINLEY: Ms. Nemec?
MS. NEMEC: Yes, sir?
JUDGE TINLEY: If you've got any more
questions other than the preexisting, I think we've resolved
those. And do you have any other questions -- any other
comments, Mr. Looney?
MR. LOONEY: I need to --
JUDGE TINLEY: With regard to the plan
design, or issues under --
MR. LOONEY: One of the things I need to do a
little more investigation on is some of the questions that
have been asked about the differential in the prescription
drugs, and to find out what the -- what the differential --
I need to find out more specific information so that I can
answer that question better.
MS. LARA: Mr. Looney? I'm coming from a
doctor's office, and I know we're talking about being out of
HIPAA right now. So, if I have a patient that presents to
me January 3rd, 4th, that used to have E.B.A., but hasn't
been employed 12 months, but has diabetes, is that still
going to be pending on what y'all decide if it's in HIPAA or
not on how to treat that patient? Are they going to have
coverage or no coverage? Does that mean we collect their
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co-pay? We charge them the full office fee? What advice
would you give me?
MR. LOONEY: If -- if the Court -- if we
determine that HIPAA is in place, then that person is
covered fully.
MS. LARA: Okay. So, basically, we just need
to give you some time to determine whether --
MR. LOONEY: And I'll know -- I'll know this
afternoon.
MS. LARA: And then we can get in touch with
Ms. Nemec to find out in the next week or so?
MR. LOONEY: You can hopefully be able to
find out later this afternoon.
AUDIENCE: What is HIPAA?
MR. LOONEY: It's this big fat animal that
chews a lot of grass. (Laughter.)
COMMISSIONER WILLIAMS: Drinks a lot of water
too.
MR. LOONEY: HIPAA is a federal regulation;
that is, the Health Insurance Portability Act, which allows
for employees to move between employers and not have the
preexisting condition. That's one -- that's the piece of it
that we're actually talking about. The law is considerably
more extensive than that, but that's the piece that we're
talking about. The certificate of credible coverages.
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JUDGE WRIGHT: When will the discussion about
the pharmaceuticals take place?
MR. LOONEY: I need to get more information
on the specifics of the pharmaceuticals, about what you're
talking about.
MS. LARA: 'Cause that will affect the doctor
also, whether -- sometimes you can write a prescription for
a generic if the patient doesn't have coverage to help.
MR. LOONEY: We hope that the doctors are
writing prescriptions for generics on a regular basis.
MS. LARA: We hope so too, but if -- if we
can get them better medicine and they've got a great co-pay,
why not?
MR. LOONEY: Generic's not better medicine?
MS. LARA: I don't know.
AUDIENCE: Tylenol versus H.E.B.
MR. LOONEY: I'm not going to go there,
because we could spend the next two weeks in that discussion
about whether a generic is equivalent or not.
MS. MEEKER: Yeah. If it were equivalent, it
wouldn't be cheaper.
COMMISSIONER NICHOLSON: I think one issue --
COMMISSIONER WILLIAMS: No, that's not true.
MS. MEEKER: You know, we don't check our
common sense at the door, either.
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COMMISSIONER NICHOLSON: I think one issue's
been resolved, and that's the issue of the flexibility to
take the County contribution to the insurance costs and use
it for another product.
JUDGE TINLEY: I think Mr. Looney's spoken to
that, the opting out that you're speaking of. The plan is
designed so that no one opts out.
MR. LOONEY: Correct.
JUDGE TINLEY: Correct?
MR. LOONEY: Not opting out for full
reimbursement of the funded amount. An employee that opts
out and takes Plan B, the secondary plan, it shows a credit
of approximately, I think, $100 for --
MS. NEMEC: In that circumstance. But there
is no opt-out in general.
MR. LOONEY: In general nature, no, not to
receive the full funding of the $500 a month to be used for
personal insurance.
JUDGE TINLEY: Based upon -- based upon the
plan as designed, the Treasurer said she didn't have the
premium rates; therefore, couldn't make the deductions.
Did -- did you not calculate those premium rates?
MR. LOONEY: I presented those. I sent that
to the Court.
MS. NEMEC: I did not have the enrollments to
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know who had -- who chose what premiums. I have the rates.
I don't know who chose dependent coverage, who chose Plan A,
who chose Plan B. I don't have that information from Mutual
of Omaha.
JUDGE TINLEY: Okay.
MS. NEMEC: And they were given the deadline,
but we probably didn't have that conversation either. So --
COMMISSIONER WILLIAMS: Sheriff?
JUDGE TINLEY: That's something you need from
the plan administrator relative to the enrollment, okay.
COMMISSIONER WILLIAMS: Sheriff has a hand
up.
SHERIFF HIERHOLZER: Just for clarification,
from some of the questions I'm getting on -- from other
employees, since there's not an opting out, the deductible
on this plan is $1,000 as they take pay. The deductible on
their retirement plan may only be $500. Now, if this plan
all of a sudden becomes their primary, and the one that they
had as their retirement is now their secondary, where do
they stand insurance-wise on having to meet deductibles?
Are they now having to meet the $1,000 instead of the $500
they've been used to, or where does that stand?
JUDGE TINLEY: That's probably a coverage
issue, and I'm going to -- probably ought to defer that
under the coverage issues, I think.
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MR. LOONEY: That will be fine. The -- the
$600 credit that's provided under the plan can be used to
offset the expenses of that individual.
SHERIFF HIERHOLZER: But that's a credit.
What if they don't want to use this $600 credit when they
have primary insurance with only a $500 deductible to begin
with?
MR. LOONEY: They get to accumulate it, then.
It stays in their account; they can carry it forward.
SHERIFF HIERHOLZER: But can they -- will
they be under an actual $500 deductible that they can use
with their old plan, or is their old plan going to say no,
you got to meet that $1,000 deductible, because now they're
your primary?
MR. MALEK: You want me to address that?
MR. LOONEY: Be glad to -- I mean, it's still
MR. MALEK: What he's talking about is
coordination of benefits, and the way that works is you
cannot get any worse than what the best plan pays. Now, one
may pay first and one may pay second, but in this scenario
that you just used, a $500 deductible is going to be your
worst-case scenario under the plan. Okay? So, if you have
two plans, they just have to coordinate with each other, and
so your worst-case scenario in that instance is a $500
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deductible.
SHERIFF HIERHOLZER: Okay.
MR. MALEK: Okay? That's how it works. In
addition to that scenario, he now has a $600 credit, this --
this individual, to use for expenses incurred under the
Mutual of Omaha plan. Not the other plan, the Mutual plan,
all right? Or the -- the HSA plan. And so expenses
incurred under that plan then can be offset. So, in that
case scenario, that person is going to be better off than
most employees who just have one plan, so that's very
positive for someone who has two coordinating plans, is that
they not only coordinate and have the best benefit that that
plan offers; it can be no worse or no better than that, but
then you have that $600 in the HRA account that then you can
spend on the plan that you have here that is primary. So,
let's say you use a drug card for Blue Cross, and it was a
different co-pay. You can't use that HRA to pay that
co-pay, but you can use it if you use the other plan. Okay?
But on the deductibles and the out-of-pockets, that can be
no worse, and in this scenario, again, that they said, than
$500. Hope that answers that question.
JUDGE TINLEY: Does that apply to all facets
of the plan? For example, you've got Blue Cross/Blue Shield
over here on this side, and it's got a $5 co-pay on drugs,
for example.
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MR. MALEK: That's probably going to be an
exception. That's going to be probably the only exception,
because drugs are very difficult to coordinate, and
typically, once the card is used, it's going to be --
whatever card you use is going to be the one that you're
going to pay on that. You know, we have a very difficult
time coordinating and collecting on those, so most plans do
not coordinate the drugs, but they coordinate everything
else. Does that answer that question?
AUDIENCE: No.
COMMISSIONER WILLIAMS: Let me direct a
question to you on a different topic. An employee who may
have an outpatient surgery scheduled in the new plan year,
your plan year; it was determined in the current plan year,
and the -- and it was scheduled, what is the procedure for
precertification review? Does that hold, or has he got to
go through the process all over again?
MR. MALEK: No, we honor the prior
precertification, and they just go on just like they never
changed carriers. That's the idea when you switch. It's
called a no loss, no gain. You can't lose a benefit by
changing carriers, so the idea is that we are going to say
okay to that if it's been precertified. Now, the new
benefits will take place in the new plan year, right?
Because you now have a different -- different basic schedule
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of benefits than you had before. But if it's been approved
and they're going to have that outpatient surgery, then they
-- in the new year, then that applied -- then that
precertification will be honored.
COMMISSIONER WILLIAMS: Let's talk for a
moment about lab X rays, CAT scans, et cetera, that may be
ordered by a physician for a particular employee or a -- or
coverage. What's required then? A doctor says, "I want you
to go to the hospital and get a CAT scan or whatever the
purpose.
MR. MALEK: I don't think --
COMMISSIONER WILLIAMS: Does the patient or
the employee have to go through the precertification for
that?
MR. MALEK: No. The only precertification
that you'll have is for a hospital stay, some outpatient
stays. We don't require them on every one of them, but
those are the only times a precertification comes into play.
In terms of the -- for the -- for going to the hospital,
really, is what we're talking about.
COMMISSIONER WILLIAMS: Outside of emergency
room treatment?
MR. MALEK: Yeah, emergency room treatment is
totally separate than everything. If it's an emergency,
it's an emergency. There's nothing you can change about
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MS. MEEKER: What about pre-cert? What does
that mean? What, does it call the doctor? The hospital?
MR. MALEK: Typically, the doctor's calls,
since we have an office -- an office staff person here,
she'll tell you, 99 percent of the time they're going to
make the call. The result -- however, you are responsible
for that call. They're going to make it, because they know
that if they don't make that call, then they don't get their
money, or get it delayed, so they're going to make that call
for you in almost every circumstance. So -- but you do know
that you have a responsibility for that.
MS. MEEKER: And what does precertification
mean? Just advising that this is going to happen? Or does
that give the insurance company the option to say, "We're
not going to cover that"?
MR. MALEK: It doesn't give you the option to
say that you're not going to cover it. It -- they are -- it
has to do with the necessity of the surgery. If it's
necessary -- and I don't think I know of too many
situations, and she may be able to confirm this --
MS. MEEKER: Cosmetic.
MR. MALEK: Yeah, that would be one.
MS. MEEKER: Yeah, we understand that.
MR. MALEK: I guess that's the general idea,
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is they're -- they're trying to say that if you're going to
go to the hospital, it's necessary, and that's all they're
checking on. And they're trying to prevent unnecessary
surgeries or length of stay.
MS. MEEKER: Whoa. Length of time?
MR. MALEK: That's another thing.
MS. MEEKER: I hate that. You know doctors
are going to say --
COMMISSIONER LETZ: Before you sit down, a
question here about lab work in the doctor's office.
MR. MALEK: I think there's some confusion
about how that benefit actually works. The pre-cert --
under the preventive benefits, that's all covered at 100
percent. It's not -- there's no deductible, there's no
co-pay involved. That was part of what we are -- what may
be a little different. Maybe it's not. But lab work, if it
is done in the physician's office, it is covered under the
co-pay. If you have a doctor who does his lab work and
bills it in his office, then it is covered under the co-pay.
If that lab work is sent outside -- let's say it's sent to
the hospital for them to do it. Then a deductible comes
into play -- or, actually, it goes straight into the
percentage, the co-insurance. That's the difference. And I
believe it was administered that way prior to this time.
AUDIENCE: No.
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MS. McELHANNON: It sure was not.
SHERIFF HIERHOLZER: CPL lab's right next
door to, like, Family Practice. If you went over to their
labs and did their lab work, then it was all -- there was no
charge at all for the lab work. Okay?
MR. MALEK: Is that part of the same
doctor's --
MS. LARA: It's like my doctor would say,
"Now, Rusty, let's go next door and let's do a CBC," but the
plan covered it with the lab with CPL. CPL would then bill
it out to E.B.A.
MR. MALEK: What's the relationship with CPL
and --
SHERIFF HIERHOLZER: Just happened to be next
door to their --
MR.
billing separate?
MS.
currently can have
1980, that can own
SHE
an inside lab.
MALEK: Same tax ID number? Is their
LARA: There's no physician that
-- because of Medicare rules back in
their own lab any more.
RIFF HIERHOLZER: There's no office with
COMMISSIONER WILLIAMS: They all send them
out.
MR. MALEK: I'm just administering it off of
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the way I read the plan document, so I'm trying to keep it
the same.
MS. LARA: According to E.B.A. in the past,
Employee Benefits Administrators, we could send our patients
next door -- it's really nice for them -- to Clinical
Pathology Lab, and they could have their blood work. C.P.A.
would bill it out to E.B.A., and it would be get paid
because it was part of their plan. The $20 co-pay would
apply as an encounter fee instead.
MR. MALEK: Our intent was to try to keep
that the same. It's not in that plan document that I have,
unless there's something I'm missing, which could be. I
don't have -- I don't have a plan document that says that.
And if they're administering it differently, I -- I don't --
I don't know.
MR. LOONEY: Part of the claims experience
relationship. I should be able to resolve that.
MR. MALEK: It's something that we can
accommodate. It's not reflected in the plan document, is
all I'm telling you.
SHERIFF HIERHOLZER: I hear a lot of "should"
and things like that. What I'm wondering for my 94
employees, because a lot of them use it and I use it all the
time on lab work, is due to certain things, are we going to
have the same coverage through Clinical Pathology Labs that
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we've had in the past? Yes or no?
MR. LOONEY: I'll get that answer to you.
SHERIFF HIERHOLZER: Thank you.
MS. HALL: What about, though, if you use a
doctor at Guy Griggs and he sends you downstairs to the lab
in the hospital? 'Cause that's the only one you can go to.
You know what I'm saying?
AUDIENCE: Should be the same.
MR. MALEK: Under the cost --
COMMISSIONER BALDWIN: Let me say something.
Let me say something. We have a court reporter in this
room, and she can only take one voice at a time. And she
can't take it if it's real quiet. So, just play along with
our game of government here.
MR. BARYON: Do you need Ms. Hall to repeat
her question?
MR. HALL: Do you need me to repeat my
question?
COURT REPORTER: No, ma'am.
JUDGE TINLEY: Mr. Looney, there's one
remaining issue that I'm not sure that we've gotten
resolved. The premium on retiree coverage. Have you done
any calculation on that?
MR. LOONEY: No.
JUDGE TINLEY: Okay. Well, we really need to
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get that resolved, I think.
MR. LOONEY: I can have that to you early
next week.
JUDGE TINLEY: Okay.
MR. LOONEY: I need to look at some numbers.
JUDGE TINLEY: Okay. 'Cause I know that was
one question that was outstanding, wasn't it, on retiree
premium? Okay.
MR. MALEK: We weren't -- we weren't able to
answer that question for people who had asked us, 'cause we
didn't know what that was.
JUDGE TINLEY: Okay. Okay. We had the other
numbers, but we didn't have that. Okay.
MR. LOONEY: If it tracks in the same manner
that the other one tracks, it'll be an increase of 5 percent
over and above what it was previously.
JUDGE TINLEY: So, for benchmarking purposes,
we could approximate 5 percent?
MR. LOONEY: Approximately 5 percent greater
than what it was previously.
JUDGE TINLEY: Okay. Okay.
COMMISSIONER LETZ: I guess while you're
looking through your notes, Judge, I have a question on --
there's several things that you're going to look back at the
plan document between Mutual of Omaha and the current plan.
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How is that information going to be distributed back to the
Court and to the employees? I mean --
MR. LOONEY: What's your best means of
communication?
COMMISSIONER BALDWIN: Pigeons. (Laughter.)
COMMISSIONER WILLIAMS: No, the best means of
communication is something that's understandable through the
Personnel office, distributed to all the employees so they
understand it and they see it in writing.
MR. LOONEY: Okay.
COMMISSIONER WILLIAMS: To me, that's the
best form of communication, in writing.
MR. LOONEY: Okay.
COMMISSIONER LETZ: But, you know, clear,
simple, plain. If it's -- not a book. Not a handbook. I
mean --
MR. LOONEY: Try and --
MR. MALEK: If I can address that, maybe -- I
don't know. That booklet, if that is okay, we will make
those changes in there of some of the things that I've heard
that are different, and we can redistribute those books.
But, at some point in time, everyone will get a new coverage
document booklet, and that will come shortly; January,
February, that time when they're printed. That -- everybody
gets a new booklet, and all that information is disseminated
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at that time. But until that time, we can send out some
clarifications on some of these issues that we're having
right here so that they can be sent out to employees, either
through written memo or through e-mail, however it works
best for the County.
COMMISSIONER LETZ: I think the main issue,
as I say -- I mean, I think every employee needs to get a
booklet, but I also think that, you know, when you start
reading these books, it's very confusing. So, I mean, I
think what needs to -- you know, basically, the concern that
I hear the most is that -- besides the co-pay on
prescriptions, is that if someone is currently covered under
the current plan, is that coverage going to continue on with
no changes, no worries, nothing like that? That's the issue
that I'm hearing from -- you know, other than the co-pay.
MR. LOONEY: There's going to potentially be
some change in the manner in which it's paid.
COMMISSIONER LETZ: Well, the manner --
MR. LOONEY: But as far as it being eligible
-- eligible to be paid, yes, it'll be eligible to be paid.
Now, the manner in which it's paid may change, based on the
plan changes that we've made and the plan design.
COMMISSIONER LETZ: Sure, I understand that.
But I think it's -- I mean, it's -- that coverage is the key
issue that I'm hearing from -- especially people on this
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side of the room. They want to know that if they have a --
a situation, whether it's pregnancy, whether it's diabetes,
whatever, they have -- you know, they're current employees;
they're currently being covered for that illness. Is that
being -- you know, going to be covered January 1st?
MR. LOONEY: I think that it might be
beneficial to the employees to set up times where
representatives are available here, and -- on this site or
their site or wherever it is, set up times where they can
come and meet with Mr. Wallace or Mr. Malek and his
associates. And anything that's printed to be sent to the
Treasurer, I will review going forward. Won't be anything
that goes out that I haven't had a chance to review. I want
to make sure that that is done properly.
MS. EVANS: There was one issue, though, that
this young lady had asked about the lab at the hospital,
whether that was going to be the same as going to the lab by
Family Practice. Because my doctor for my children is based
at Guy Griggs, and when she sends me to the lab, it's to the
hospital, 'cause that's the only lab close to their
facility. So, I'm also very curious about that also, 'cause
when -- when your child gets sick and they want to do blood
work, that's where they're going to send you; they're going
to send you down to the hospital laboratory. And I think
that was an issue that she was also wondering about, 'cause
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her doctor is at Guy Griggs.
MR. HALL: Yeah, one of them's there and one
of them's in Family Practice.
MS. EVANS: I mean Family Practice. That
was -- was real easy, 'cause it was always taken care of
really easy, but that was an issue that I would like maybe
something --
COMMISSIONER WILLIAMS: I think the issue is,
we need to know the answer. Is the lab work covered? Yes
or no.
MS. EVANS: Right.
COMMISSIONER LETZ: And how is it -- to what
amount? What percentage?
JUDGE TINLEY: What deductibles/co-pays apply
or don't apply?
COMMISSIONER WILLIAMS: Am I hearing an
answer? I'm seeing a head nod.
MR. MALEK: Lab work is covered. How it's
covered, that seems to be yet to be determined, based on the
way I'm hearing -- I'm hearing something different from what
has been presented to the employees in their booklet.
MR. LOONEY: Right. How was it paid before?
How was it paid before?
MR. ROTHWELL: I think our plan document
is -- schedule of benefits is pretty clear on it. We have a
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direct contract with CPL at 80 percent of Medicare-approved.
MR. LOONEY: And the contract with the
hospital, is it also --
MR. ROTHWELL: No, it also deals with CPL or
Lab One in another location.
MR. LOONEY: Lab One?
MR. ROTHWELL: But CPL doesn't accept that.
COMMISSIONER WILLIAMS: Well, then, can the
employees expect that to continue? A working arrangement
with CPL?
MR. LOONEY: CPL working arrangement will
continue, yes.
COMMISSIONER LETZ: But what you just -- what
Mr. Rothwell just said, if you went to the lab at the
hospital, it's -- it's covered, but it's covered at a --
MR. LOONEY: At a different --
COMMISSIONER LETZ: -- at a deductible.
MR. ROTHWELL: Deductible coinsurance, much
like their lab is.
COMMISSIONER LETZ: Right.
MR. ROTHWELL: If you go anywhere other than
CPL.
COMMISSIONER LETZ: So, no change in the
current policy.
JUDGE TINLEY: Yes, ma'am?
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AUDIENCE: You can always ask your doctor if
you can go to CPL if they want you to go to the hospital.
You have a choice.
JUDGE TINLEY: Good point. The patient can
request that --
AUDIENCE: Yes.
JUDGE TINLEY: -- service provider. Good
point, thank you.
COMMISSIONER WILLIAMS: There is one issue
that I don't think has been totally resolved, Judge. It was
raised by this lady right here with respect to how the
County's going to deduct their portion of their insurance,
and here we are coming up on the last pay period of the
month, Barbara. Correct?
MS. NEMEC: Christmas, at that.
COMMISSIONER WILLIAMS: And insurance
typically is paid for in advance, I believe; is that right?
Coverages?
MS. NEMEC: Right.
COMMISSIONER WILLIAMS: So, how's that issue
going to be addressed? Everybody needs to know that.
MS. NEMEC: Well, if -- if I get the
enrollments and -- before the next payroll, then I'm going
to have to double-deduct. I'm going to have to double up on
everybody's deductions in order to have the funds to pay
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when the January invoice comes in.
COMMISSIONER BALDWIN: Well --
COMMISSIONER NICHOLSON: That doesn't mean
that people are going to pay twice as much this month as
they should have. Just means it's going to come out of one
check instead of two; is that right?
MS. NEMEC: Right.
COMMISSIONER WILLIAMS: Yes.
COMMISSIONER BALDWIN: Yeah, but that's a
damaging --
MS. EVANS: It's a big chunk out of one
check. House payment, van payment, all your big bills are
due. You can't call them and say, "I'm sorry, our insurance
company didn't get any information to my employer and it's
all coming out of one check, and can you hold my bill?"
MR. LOONEY: Has there been one deduction
made?
MS. EVANS: No, sir.
COMMISSIONER WILLIAMS: No, sir.
COMMISSIONER BALDWIN: At no fault to the
county employees.
COMMISSIONER LETZ: But their check -- the
check was higher -- should have showed more -- more this
last month.
MS. EVANS: No, sir, I've never had my
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children on my -- so I've never paid a deductible. This is
going to be the first time. That's why I said it's already
going to hurt me as it is.
COMMISSIONER LETZ: I see.
MS. EVANS: It's going to be tight.
MR. LOONEY: First-time enrollment.
MS. EVANS: You know, so it's going to be
even harder, 'cause it's a double whammy in one paycheck.
JUDGE TINLEY: Okay. Is that all the issues
we got with you, Mr. Looney?
MR. LOONEY: I think so.
JUDGE TINLEY: I think so. Okay. If we
could -- yes?
MR. MALEK: We're still missing 40 enrollment
forms. Forty people haven't turned their forms in. And
I've been getting -- over the last week, I've gotten in
about 60 -- you know, a little bit at a time from -- you
know, we're not getting them in all -- all at one time.
There are a lot of people, because of the hostile situation,
are not wanting to -- they didn't enroll. We've still got a
lot of people who are refusing to enroll, and it's made it
very difficult for us to get the information to Barbara so
they can deduct those from her pay -- I mean, she -- she
doesn't know, honestly, because she hasn't gotten the
enrollment, because we don't have it. And I can't give
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her -- I'll give her an incomplete enrollment at this point
in time, but there will be 40 people who don't -- haven't
done anything.
JUDGE TINLEY: Well, of course, all you can
give her is what you got. And she can -- she can contact
the --
MR. MALEK: I'll give you the list.
JUDGE TINLEY: -- elected officials and
department heads and ask them to be certain that anybody in
their department who's not completed their enrollment get it
in A.S.A.P., and probably give them a pretty short deadline,
I would hope.
COMMISSIONER WILLIAMS: This raises another
potential question. Is our enrollment open all the time, or
is there a window here that's going to close on those 40?
MR. LOONEY: Normally, Commissioner, in a
situation where the employer pays 100 percent of the
employee cost and has designated a particular plan to fund,
that employee is defaulted into that plan.
COMMISSIONER WILLIAMS: They can enroll at
any time?
MR. LOONEY: No, sir.
COMMISSIONER LETZ: Automatically enrolled.
COMMISSIONER WILLIAMS: Automatically
enrolled.
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MR. LOONEY: Automatically enrolled in.
MR. MALEK: Each year you have a window of 30
days that you're allowed to make changes.
COMMISSIONER WILLIAMS: So, your problem is
not the 40, but the dependents' coverage.
MR. LOONEY: Correct.
COMMISSIONER WILLIAMS: Whatever it may be
for some of the 40.
MR. MALEK: That's right. If they've decided
not to enroll, for whatever reason -- you know, some people
are not here, and that's one reason.
COMMISSIONER WILLIAMS: So, employee's
covered. And if, for whatever their reasons, they're
holding back in terms of enrollment of their -- of their
family members or whatever, spouse or whatever, is there a
window that's closing on them?
MR. MALEK: Yes, there is.
COMMISSIONER WILLIAMS: What is the window?
MR. MALEK: Well, technically, by the end of
this month, which then creates a deduction issue again,
because you're deducting one month ahead of time, and so
then that person would actually get double deducted twice.
COMMISSIONER WILLIAMS: Well, which then
leads to me to suggest to those elected officials and
department heads in the audience that if you have employees,
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for whatever their reason, misunderstanding or whatever, who
haven't done their enrollments, they better get on with it.
MS. EVANS: My thing is, why should someone
like me be penalized because they didn't get the information
to Barbara so that she could take it out of my check when it
should have come out? Why should I or the County be
penalized for that?
COMMISSIONER NICHOLSON: You're not being
penalized. You may be inconvenienced.
MS. EVANS: Well, no, sir, I'm not being
inconvenienced. I'm looking at not being able to make my
house payment. We work three jobs.
COMMISSIONER NICHOLSON: Yeah, but you're not
going to pay any more money this month for insurance than
you would have.
MS. EVANS: Well, yeah, but it's going to
have to come out of one check.
COMMISSIONER NICHOLSON: I understand.
MS. EVANS: So I am kind of being penalized,
since it's right at Christmas.
COMMISSIONER NICHOLSON: That's a --
MS. EVANS: You know. I mean, it's going to
be hard. I don't know how I'm going to make --
COMMISSIONER NICHOLSON: That's a reality.
There's nothing we can do about that. You've already gotten
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your paycheck.
MS. EVANS: Well, yeah. But if they would
have turned it in like they should have -- I turn my stuff
in on time.
JUDGE TINLEY: Okay, is that it? Time to
work on --
MS. McELHANNON: Did we settle the deductible
-- I mean the co-insurance on the medication? Did I miss
that?
JUDGE TINLEY: The co-pay?
MR. LOONEY: Co-pay.
JUDGE TINLEY: That's the plan.
MR. LOONEY: That's the plan.
MS. McELHANNON: Okay. So, is it just
because it's -- we've changed plans and we've modernized
that the co-pay has gone up?
MR. LOONEY: Right, gone up.
COMMISSIONER LETZ: But not the credit to
offset some of that. So, could you explain that?
MS. McELHANNON: I understand that.
MR. LOONEY: The debit card can be used for
the prescription drug purposes.
MS. McELHANNON: That's good for one month.
AUDIENCE: Yeah.
MS. MEEKER: It will help a little bit.
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MR. LOONEY: Good for $600.
COMMISSIONER WILLIAMS: Good for as long as
your money holds out.
MR. LOONEY: Good for $600.
MS. McELHANNON: That's what I need to know.
Thank you.
COMMISSIONER NICHOLSON: Actually, this is a
pretty understandable document. I just read it for the
first time today, and it answered a lot of my questions.
COMMISSIONER BALDWIN: That's easy for you to
say.
COMMISSIONER NICHOLSON: Unlike some
insurance documents, I can understand this one.
COMMISSIONER LETZ: One -- let's go back to
your issue. I think if you'd get with either Mr. Looney or
Mr. Malek or Wallace today, they can tell you pretty close
what the deduction is going to be in your situation.
MS. EVANS: I know what it's going to be.
It's going to be close to $200 out of one check.
COMMISSIONER LETZ: Okay. Well, then --
MS. EVANS: I mean, and that's -- to be quite
frank, that's a lot. I mean, I was already trying to figure
out how I was going to deal with the 80-something coming out
of every check. And then, of course, now, like I said, we
just had Christmas. I've got three kids. Do I just take
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all my Christmas back and say, "I'm sorry, baby, but I got
to have at least 200 extra dollars 'cause I got bills to
pay, and it's all coming out of one check"? Like I said,
why should -- you know, if it would have been turned in
properly, I wouldn't have been hit all at one time. I can
-- I'm not griping about the paying it. I understand that.
I have no problem paying my bills. I'm just worried about
it all coming out of one check; my house, insurance -- you
know, they're not going to take, "I'm sorry. Can we wait?"
MS. MEEKER: May I just make one final
statement?
JUDGE TINLEY: You have a question?
MS. MEEKER: You are choosing this plan and
we're going to save taxpayer money, 300-something thousand
dollars of taxpayer money. At the end of the year, we can
see if we really did save that money. So, taxpayers are
doing okay. The employees, there's not a single one of them
that has not been hurt badly by this choice.
COMMISSIONER WILLIAMS: Let me make a comment
about that.
MS. MEEKER: Anyway, --
COMMISSIONER WILLIAMS: Let me make --
MS. MEEKER: -- financially.
COMMISSIONER WILLIAMS: -- make a comment
about that, Ms. Meeker, and others who had that same
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concern. I've done six budgets, and every one of those
budgets since I've been on the Court, the insurance costs
have risen anywhere from 10 to 25 percent annually for the
employee group. There comes a time when the County can no
longer afford to take 20 or 25 percent increases in the
total amount of coverage for 240 employees. And you take
the necessary steps you can to stabilize the amount of
dollars you're going to spend. This happens to be the year
we're stabilizing.
MS. MEEKER: I understand.
COMMISSIONER LETZ: I think the other thing,
there are clearly going to be some employees that are not as
-- maybe as good off, maybe, as they were in the other plan.
There are many other employees that are better. I mean, it
depends on the --
COMMISSIONER NICHOLSON: I'm one of them.
I've got $600 to spend before --
COMMISSIONER LETZ: It depends a lot on the
situation, but it's not that it's bad for all employees.
So, please, you know, if you're using -- you know, have a
prescription drug under a certain type that, you know, it is
possible that you are going to pay more. That's true.
MS. EVANS: Like I say, I'm not upset about
having to pay a premium. I'm okay with that. I'm just
upset that it's all going to come out --
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JUDGE TINLEY: We understand your issue,
ma'am. We understand it.
COMMISSIONER WILLIAMS: Not much we can do
about it, but we understand.
MS. McELHANNON: Can you explain right quick
what the difference between nonformulary and formulary is?
JUDGE TINLEY: That's an issue for the other
gentleman. I'm going to get to that.
MS. McELHANNON: I'm sorry, excuse me.
MR. LOONEY: Formulary is a medication that's
been identified by the prescription drug management company
as being a medication that is favored to be used on an
either price basis, or a -- the diagnosis for that
particular medication has been proven to be very positive.
Other nonformulary medications may be medications that have
a common generic or another formulary medication that is
potentially being able to be used, but the difference in
cost is significant, and so it becomes a nonformulary. Or
it might -- may not be totally approved by -- the medication
may not have been totally proven as being efficient or
sufficient, or -- I don't know. Our lady left that was back
here with the physician's office. But the formulary
medications quite often have to do with their ability to
perform as a medication and the cost of that medication, and
that is looked at consistently and constantly by the
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prescription drug management company.
MS. McELHANNON: Thank you.
JUDGE TINLEY: Okay.
MS. NEMEC: Judge, I'd like to address the
Court, please. We've been here for almost an hour and a
half talking about the problems, benefits, and the attitude
and everything, and not once have we heard "I'm sorry if
your employees misunderstood us," or "I'm sorry or whatever
if we did come across..." Instead, I'm sitting back here,
and we're discussing all these problems, and she's
discussing having to -- us having to double-take on her
paycheck, and I hear a comment from back here saying, "Well,
blame the 40 employees who did not turn in their
applications." That is not her fault. And that's the kind
of attitude that these employees have been dealing with, and
that's the kind of attitude that we're talking about here
today. And, so, if it's not fixed and that's been coming
out of this courtroom, I'm really scared of what's going to
happen in the next year.
JUDGE TINLEY: Well, I would only respond by
mentioning what Mr. Nicholson said, that let's try and be
part of the solution.
MS. NEMEC: We need --
JUDGE TINLEY: I would urge your
cooperation --
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MS. NEMEC: We need both people's --
JUDGE TINLEY: -- to work with these people
in order to make this thing work.
MS. NEMEC: Judge, everyone --
JUDGE TINLEY: I hope that you would. Thank
you.
MS. NEMEC: Judge, I have said that I would.
Everyone in this courtroom knows that I do.
JUDGE TINLEY: Good.
MS. NEMEC: But when you have comments like
this, they do not seem to be working with us. Let's --
let's be open-minded about this.
JUDGE TINLEY: I am. Mr. Wallace -- no,
Mr. -- where's Mr. Malek? He's probably talking one-on-one
to somebody. We've got -- we handled the
formulary/nonformulary generic thing, I think, just a minute
ago. The mail-order, 90-day. That's obtainable under this
plan, is it not?
MR. MALEK: Yes, that is correct. Ninety
days.
JUDGE TINLEY: Okay. Okay.
MR. MALEK: Is it Express Scripts?
MS. HARRIS: What?
MR. MALEK: It's two times -- the
deductibles, again, are different. They're -- I don't have
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the plan in front of me, but it's two times the normal
retail deductible -- or co-pay, excuse me. Co-pay is the
word.
MS. HARRIS: I'm sorry, can you explain that?
I didn't understand that.
MR. MALEK: It's different. Okay, you
have -- your current program has different co-pays for each
different -- for the -- that we just have three different
co-pays for retail, meaning if you go to your regular
pharmacy. And then if you use the mail-order, it's two
times that co-pay. That means if it was a $10 co-pay and
you go to mail-order, it's $20 for a 90-day --
MS. HARRIS: For a 90-day supply.
MS. UECKER: You get three for the price of
two.
MR. MALEK: What she asked is what company do
we use. It's Express Scripts. They're the company that we
sub with, or -- related to Mutual of Omaha, basically.
MS. HARRIS: Every time we want to do a
mail-order for a 30-day supply, do we have to go to our
physician to get a new scrip for that, or is it an automatic
refill?
MR. MALEK: It depends on what your physician
writes. Typically, they're going to give you -- on a
mail-order, you typically get 90 days.
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MS. HARRIS: Mm-hmm, right.
MR. MALEK: And what they'll give them is
typically a prescription for a year. It just depends on
your physician. Sometimes he'll say three refills, which
is --
MS. HARRIS: Got you.
MR. MALEK: -- nine months worth of supply.
MS. HARRIS: Okay.
MR. MALEK: So it just depends, but you do
have to do it -- the feds require that you file a
prescription once during that year.
MS. HARRIS: Mm-hmm.
MR. MALEK: And the next year, when it comes
back around, you're going to have to do it again.
MS. HARRIS: Right.
MR. MALEK: Okay?
SHERIFF HIERHOLZER: In reality, this co-pay
on the prescriptions is actually a little bit lower than
what we are currently paying, isn't it?
MR. MALEK: Just depends on what plan you
were on, but in most cases, no. Some cases, yes. It just
depends on which plan you were on. What -- you know, what
-- you know, there's three different options that you had,
and now we only have just one option -- or now two plan
options. And so, yes, there are differences.
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AUDIENCE: Mine's doubled.
MR. MALEK: It just depends on, again, which
plan you're on.
COMMISSIONER WILLIAMS: Judge Brown.
JUDGE TINLEY: Judge Brown?
JUDGE BROWN: That deal that I signed the
other day, is it in effect right now?
JUDGE TINLEY: January 1.
JUDGE BROWN: So, my deductible is for this
year. If I used it all up, I could get a major operation
and it wouldn't cost me nothing, right?
AUDIENCE: Jump in there, Judge.
JUDGE TINLEY: I sharpened my pocketknife
earlier today, if you'd like to come on in.
JUDGE BROWN: I didn't know. But, in other
words --
COMMISSIONER WILLIAMS: What did you have in
mind, Judge?
JUDGE BROWN: If you mentioned deductible
already, then it still counts for this year?
COMMISSIONER LETZ: Right.
SHERIFF HIERHOLZER: For the rest of this
month.
JUDGE BROWN: I feel a big attack coming on.
(Laughter.) Just kidding, I'm sorry. I just wanted to --
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MS. McELHANNON: What about the prescriptions
that are due in January to be refilled?
MR. MALEK: Are you asking -- say that again,
please?
MS. McELHANNON: If your prescriptions are
going to be refilled January the lst, what do we do? Where
do --
MR. MALEK: Are you talking about for the
mail-order program?
MS. McELHANNON: Yes, sir.
MR. MALEK: Or talking about retail?
MS. McELHANNON: Yes, the mail-order.
MR. MALEK: In mail-order, you're going to
be, again, required to send one prescription every year,
okay? We're startling all over in the year, so it's a new
plan; you would have to send a new prescription in.
MS. McELHANNON: Right.
MR. MALEK: So, you are going to have to get
a scrip from your doctor.
MS. McELHANNON: Right.
MR. MALEK: And then there is a form in the
back of that book that you have right there, and you send it
in with that. Okay, once that's done, you don't have to
register back again, but you may have to send another
prescription in from the physician if you change it; if, you
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know, he says you have to do that. And then you give them
either a credit card -- you can do it online, however you
decide you want to do it on the renewal side of it. Let's
say you're going to do it for 90 days. Come March, you've
got to get another prescription filled. Then you can go
online and say, "Here's my credit card number, and it's
automatically filled and mailed back to you.
MS. McELHANNON: About how long does it take?
MR. MALEK: Probably similar to what you are
doing now. I'm --
MS. McELHANNON: About how long does it take
for them to get your shipment to you?
MR. MALEK: All depends on which kind of drug
you get. When the drugs are available, a few days.
Sometimes five days. I think that's fairly common. Most of
them are all about the same.
MS. McELHANNON: Thank you.
MS. UECKER: I just have one question, Judge.
And I think I understand this correct from what you
previously said, but take me, for instance. Last week I got
three prescriptions -- three 3-month prescriptions from my
doctor, so that's not going to take me over to the three
months. Okay. Is my doctor going to be very happy about
writing another three-month prescription when he just gave
me one four weeks ago, or three weeks ago?
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AUDIENCE: Is she going to have to redo it on
the first of the year, is what she's asking.
MR. MALEK: The answer to that question is,
you're going to have to do it one time every year.
AUDIENCE: She just got it several weeks ago.
MR. MALEK: This is a different plan. Your
-- your plan year goes from January to January. And,
unfortunately for you, in December, that's just when it
happened. But in the new plan year, you would have had to
do it again anyway.
MS. UECKER: Well, I just have to explain it
to the doctor.
MR. MALEK: You do it once a year. And
they're used to it. That's -- docs are used to doing it and
they're -- and they understand how it works.
MS. UECKER: Sure.
MR. MALEK: And they're really pretty good.
I haven't run into a lot of problems with docs not wanting
to give another prescription out.
MS. UECKER: Okay.
MS. LARA: You know, if they know that you're
going from one plan to another, by all means --
AUDIENCE: She just got her prescriptions.
Wouldn't she have to wait another three months before she
got it refilled?
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MR. MALEK: Yeah, that's correct. She's
going to wait another -- she'll be in the new plan year, and
so --
AUDIENCE: Three months.
MR. MALEK: After three months -- it was in
March, she'd just have to start that process all over again.
JUDGE TINLEY: Whoa.
JUDGE BROWN: This is not for the insurance
people; this is for the Commissioners Court. I understand
that -- from the grapevine that some of the coverage that we
currently have is not carried over into the new policy.
JUDGE TINLEY: We resolved those issues
earlier today.
JUDGE BROWN: I understand you resolved it,
but if they say it's going to cost more money, why don't we
rebid it?
JUDGE TINLEY: We resolved those issues
earlier today, I think. Those are preexisting issues --
condition issues, I think is what you're speaking of.
JUDGE BROWN: Yeah.
JUDGE TINLEY: Yeah. I think we've resolved
those issues.
JUDGE BROWN: Well, you get my point, though.
If it's going to cost us more money, then it wasn't the low
bid.
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COMMISSIONER LETZ: If it's still -- if it
comes in $400,000 or $500,000 higher, I'll rebid it.
JUDGE BROWN: Just wanted to make sure you
didn't miss that.
JUDGE TINLEY: Okay. I think we've
identified all the issues and -- and concerns that were
mentioned here earlier today. Any member of the Court have
any additional ones that we didn't touch on and get
addressed here today?
COMMISSIONER WILLIAMS: No.
COMMISSIONER BALDWIN: I just have a
question. Mr. Lopez, are you happy?
MS. LARA: Are you in HIPAA or not?
MR. MALEK: We don't know yet.
MS. LARA: If he's in HIPAA, he's going to be
happy.
COMMISSIONER BALDWIN: Mrs. Lavender, are you
happy?
MS. LAVENDER: No.
COMMISSIONER BALDWIN: Well, I have two
constituents; one's not sure and one's not happy, so I don't
know that we've arrived at the answer yet.
MS. LAVENDER: You know, if you're not going
to reinstitute that third option, there's no way to make any
solution to it.
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COMMISSIONER BALDWIN: And you can't do that
without charging it to the rest of the employees.
MS. LAVENDER: Well, that's what they're
telling you, yeah.
COMMISSIONER BALDWIN: Well, if that's not
true, I want to know about it today, while we're in this
room.
MS. LAVENDER: I mean I can't see how four
people or five people are going to make a major difference
in that.
COMMISSIONER WILLIAMS: How many people opted
for other coverages, Barbara?
MS. NEMEC: In the past year?
COMMISSIONER WILLIAMS: Currently, right now.
MS. NEMEC: I want to say there's around
five.
COMMISSIONER WILLIAMS: Four or five.
COMMISSIONER NICHOLSON: I think Judge
Tinley's one of them.
JUDGE TINLEY: Yeah, I'm one of them.
Obviously, it would be in my best personal interests to have
a total opt-out, but that's not the way the plan was
designed, and that's not what I see to be in the best
interests of the County, and/or, more particularly, the
taxpayers of this county and the overall composition of the
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plan.
MS. LAVENDER: There's one other option. You
could at least, for those five people, offer something if
they don't want to take the health insurance.
JUDGE TINLEY: Well, we -- we'd create an
entirely different class under the plan, and we get
discriminatory issues, we get into all sorts of things. And
I don't see that as a viable alternative. Do you,
Mr. Looney?
MR. LOONEY: No.
JUDGE TINLEY: Okay.
COMMISSIONER WILLIAMS: There's a question.
JUDGE TINLEY: Mr. Malek?
MR. MALEK: Judge, I think we can address the
issue of the HIPAA. They have not -- you have not opted out
of HIPAA, to the best of our knowledge. And --
MR. LOONEY: Not opted out.
MR. MALEK: -- if that is the case, and a
person has credible coverage from a prior employer, then --
and, you know, I don't want to get into specifics. I hope
I'm dancing around this -- if that person had coverage,
continuous coverage from a prior employer, then that person,
if they're -- let's just use an example of somebody being
pregnant, and they're -- before they came to work, and they
had continuous coverage, then they would be covered for that
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pregnancy in the policy that we are going to put into place.
Okay? So, I hope that answers the question, Commissioner.
MS. LARA: Now he's happy.
MR. LOPEZ: Now I'm happy.
MS. LARA: Everybody's happy.
MR. MALEK: I hope I didn't use anybody's
HIPAA privacy information in my example.
MS. LARA: For what it's worth, working in a
doctor's office, Mutual of Omaha is pretty good at paying
their claims pretty quick. So, for whatever it's worth,
you've chosen a good plan.
COMMISSIONER WILLIAMS: That's good news.
JUDGE TINLEY: We got all the issues covered.
COMMISSIONER NICHOLSON: Yeah, all my issues
are covered. I'd just say to Mutual of Omaha, do the best
you can at communicating with people and -- and treating
them respectfully and trying to resolve our concerns. It's
like any -- any of us; when we're faced with change, we
sometimes resist -- resist change. So, I'm confident you'll
work with us on that.
COMMISSIONER WILLIAMS: I want to just add on
to what you just said, Commissioner. Our employee group is
used to a level of service which was enhanced by the agent
being two blocks down the street, and that creates for you
fellows somewhat of a disadvantage, because you're 60 miles
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down the street, or more. Ninety, maybe. And that means
you've got to work a little harder. I just want to make you
understand our level of expectation.
JUDGE TINLEY: Okay. We'll go to the next
item on the agenda, consider and discuss the application for
stop loss and life insurance for employee health benefits
program, requesting and authorizing payment for the binders
on the same, and authorizing Judge to execute the
applications. This was on our agenda this past Monday. We
have the applications for -- for those coverages, and the
binders, and my recollection is -- I don't have it in front
of me -- it's something just under $22,000, I believe, is
the payment that's got to be remitted. Is that essentially
correct, Mr. Wallace?
MR. WALLACE: I couldn't hear.
JUDGE TINLEY: Just under 22,000, if I
recall?
MR. WALLACE: Yes.
JUDGE TINLEY: It's 21,000 and change.
MR. WALLACE: 456 or something like that.
JUDGE TINLEY: Okay.
COMMISSIONER WILLIAMS: All the things that
we discussed here today, Judge, are they -- do they in any
way affect our premium?
JUDGE TINLEY: I don't think so.
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MR. MALEK: No.
COMMISSIONER WILLIAMS: I move adoption of
the -- of the plan, authorize the payment for binder, and
authorize the County Judge to execute the application.
COMMISSIONER NICHOLSON: Second.
JUDGE TINLEY: Motion made and seconded to
adopt the plan and the agenda item. Any further question or
discussion? All in favor of that motion, signify by raising
your right hand.
(The motion carried by unanimous vote.)
JUDGE TINLEY: All opposed, same sign.
(No response.)
JUDGE TINLEY: That motion does carry.
Gentlemen, that's the only agenda items that I have, and
that being the case, there being no further business, I'll
declare the meeting adjourned. Thank you.
(Commissioners Court adjourned at 3:15 p.m.)
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STATE OF TEXAS ~
COUNTY OF KERR ~
The above and foregoing is a true and complete
transcription of my stenotype notes taken in my capacity as
County Clerk of the Commissioners Court of Kerr County,
Texas, at the time and place heretofore set forth.
DATED at Kerrville, Texas, this 22nd day of December,
2004.
JANNETT PIEPER, Kerr County Clerk
BY: __ _ _ `___ ____ _ _
Kathy B nik, Deputy County Clerk
Certified Shorthand Reporter
12-17-09
ORDER N0.28949
STOP LOSS AND LIFE INSURANCE FOR EMPLOYEE HEALTH BENEFIT'S
PROGRAM.
Came to be heard this the 17th day of December 2004 with a motion made by
Commissioner Williams seconded by Commissioner Nicholson. The Court unanimously
authorized payment for binder (s) on same and authorizing County Judge to execute
applications.