This information applies to members of AFSCME Local 88 and the Juvenile Custody Services Specialists (JCSS).
With 4500 employees and nearly 11,000 covered lives (employees plus dependents), medical, dental and vision benefits are a significant priority and expense for Multnomah County and its employees. Prior to 2007, there were various attempts to coordinate and plan health benefit changes between County unions and management -- with mixed success. Recognizing that increasing costs of healthcare are of major concern to both parties, Local 88 and County management agreed in successor labor agreement negotiations in 2007 to form the Employee Benefits Team (EBT), and have been meeting since that time.
The EBT now meets regularly to collaborate on maintaining quality coverage while controlling costs. Over time, the EBT has shifted focus to a holistic approach incorporating prevention and employee wellness, while also beginning to address changes established by the Affordable Care Act. In 2012 successor labor agreement negotiations, the Oregon Nurses Association (ONA) and the County mutually agreed to participate in a County-wide Employee Benefits Advisory Team (EBAT) to commence January 2013, and in the interim agreed to begin attending Local 88/County EBT meetings as well.
Given the increasing costs in the healthcare industry, and the changes occurring at the state and federal level, it will take significant strategic thinking and creativity to control costs; some changes will be advantageous, and others difficult, for employees and their dependents. The EBT approach to this challenge has been to make smaller, incremental changes over a longer time horizon, in order to minimize impacts on employees in any one year. Starting with the January 1, 2013, there several changes to the Kaiser Medical plan and ODS Pharmacy plan, which are outlined below.
Change for Kaiser Standard plan
The Affordable Care Act (ACA) allowed all health plans in existence at the time the law passed (these are called “grandfathered” plans) to avoid making certain changes to plan terms. All County plans up to this point have remained grandfathered. The EBT has decided to relinquish grandfathered status for the regular Kaiser plan available to members because it will provide a positive enhancement for the wellness of enrollees.
Beginning January 1, 2013, enrollees in the regular Kaiser plan will no longer have to pay a co-pay for preventive care and recommended screenings. Additionally, FDA-approved contraception methods dispensed by Kaiser will be covered at no-cost to the patient.
Adding Alternative Care for Kaiser and Kaiser Maintenance Plan
The EBT requested that Kaiser Permanente provide a quote to add alternative care coverage to both available Kaiser plans. Kaiser has agreed to provide a basic level of coverage as a pilot at no cost for one year. This offering may or may not be extended in future years, depending on member interest and utilization, and potential cost.
Alternative care coverage will include self-referral access to acupuncture, naturopathy, chiropractic care and massage therapy. There is a $500 annual limit and a copay is required for each visit. Some additional restrictions or limitations may apply. Full coverage details will be available from Kaiser Membership Services in 2013 or view the sample flyer .
ODS Prescription Coverage Changes
In July, the County changed administrators from CVS/Caremark to ODS. ODS can provide enhanced services for formulary management that the County has not previously included in ODS plans. The EBT has discussed ways to preserve access to safe and effective medications for members, reduce barriers to medication compliance, support wellness and prevention and streamline administration to contain plan costs overall. After reviewing several optional elements, the EBT decided to adopt the following modifications:
- Elected to incorporate a "value-tier" to the prescription package for medications that have been demonstrated as safe and effective for the management of chronic conditions. This tier will have a flat dollar copay in both retail and mail order settings. Members may find medications in this tier are more cost effective than medications at Tier 1 or Tier 2. 2013 Value Tier Flyer
- Eliminate coinsurance for recommended preventive immunizations received in either the pharmacy or in a medical office. A list of immunizations covered at no cost will be available from ODS in 2013. View the sample 2012 drug list (list may be updated for 2013.)
- Incorporate prior authorizations for select medications to ensure safe and effective utilization. Members will receive additional information about what their provider will need to do when writing a prescription for these drugs. 2013 Prior Authorization Flyer .
- Standardize the supply quantity available in a retail setting. Members will be able to fill up to a 30-day supply in retail only. Previously, some prescriptions may have been filled up to a 100 pill limit.
These and other plan changes will be communicated in the open enrollment packets which will be mailed to all employees in October. More information will be added to this site as it becomes available. If you have any questions about plan coverage, contact the Employee Benefits Office at email@example.com.