The Official Web Site For The State of New Jersey - Department of Treasury
Global Navigation
FAQs Departments/ Agencies Services A to Z NJ Home Page
Disclaimer
Twitter YouTube Facebook
Pensions and Benefits
STATE HEALTH BENEFITS COMMISSION
MEETING MINUTES 2016
 
  • July 13, 2016 (Rate Renewal)* - CANCELLED
  • August 22, 2016 (2:00 p.m.)
  • August 30, 2016 - Rate Renewal*
  • September 14, 2016
  • November 16, 2016
Unless otherwise noted, meetings are held at 10:00 a.m. at the Division of Pensions and Benefits, 50 West State Street, Trenton, NJ.

*RENEWAL MEETINGS - START TIME IS 1:00 P.M.

To view 2014 Health Benefit Commission Meeting Minutes (and prior years), click here


State Health Benefits Commission
Minutes, Meeting No 562
January 13, 2016; 10:00 AM

Adequate notice of this meeting was provided through the annual notice of the schedule of regular meetings of the Commission filed with and prominently posted in the offices of the Secretary of State.  The 2015 annual meeting schedule was mailed to the Secretary of State, Star Ledger and the Trenton Times on January 6, 2016.

The meeting of the State Health Benefits Commission of New Jersey was called to order on Wednesday, January 13, 2016 at 10:10 AM. The meeting was held at 50 West State Street, Trenton, New Jersey, and was attended by the following members of the Commission and Division staff:

Roll Call

Susanne Culliton, Chairperson, representing Acting State Treasurer Ford M. Scudder
Robert M Czech, Chair, Civil Service Commission
Holly Gaenzle, representing Acting Commissioner Richard J. Badolato, Department of Banking & Insurance
Dudley Burdge, Representative for Local Government Employees
Debra Davis, Representative for State Government Employees

Also present: 

Danielle Schimmel, Deputy Attorney General
Kierney Corliss, Acting Secretary
Mark Cipriano, Division of Pensions and Benefits
Donna Ruotola, Horizon Blue Cross Blue Shield of New Jersey
Dr. Steven Wolinsky, Horizon Blue Cross Blue Shield of New Jersey

Resolutions A (Closed Session) and B (Executive Session) – were read in their entireties.

Chairperson Culliton made a motion to go into Closed Session to hear member appeals. Commissioner Davis seconded the motion. All voted in favor.

The following cases, due to HIPAA regulations, are heard in closed session.

Case #011601 — This Horizon appeal concerned the denial of expenses related to a procedure code considered dental in nature. The member had an impacted wisdom tooth removed, which was covered by NJ DIRECT. The denied charge was for the administration of nitrous oxide during the procedure, in lieu of general anesthesia. Dr. Steven Wolinsky, Medical Director, Horizon, explained that the procedure code for nitrous oxide is a dental code because it is typically used only for dental procedures. Some anesthesia is usually billed separately, such as general anesthesia. Some is considered incidental to the procedure and is not billed separately, such as Novocain injections. Nitrous Oxide falls somewhere between those two forms of anesthesia.

Chairperson Culliton made a motion to deny the appeal for payment of the nitrous oxide as a separate procedure. Commissioner Davis seconded the motion. All voted in favor.

Case #011602  — This Division appeal concerned eligibility for reimbursement of Medicare B premiums for a retired State employee. The employee had been laid off on July 7, 1995 and rehired on December 23, 1996. Commissioner Burdge asked if the member was subject to a collective bargaining agreement. Commissioner Davis stated that the layoff should be considered continuous service.

Chairperson Culliton made a motion to go into Executive Session to seek advice from the Deputy Attorney General. Commissioner Burdge seconded the motion. All voted in favor. Upon return from Executive Session, Commissioner Czech made a motion to table the appeal to determine whether or not the member was covered by a collective bargaining agreement, and if so, whether it contained provisions that would apply to this situation. Commissioner Burdge seconded the motion. All voted in favor.

Commissioner Burdge made a motion to return to Public Session. Commissioner Davis seconded the motion. All voted in favor.

Case #011603  — Chairperson Culliton made a motion to deny the request for a hearing with the Office of Administrative Law (OAL) and to direct the Acting Secretary to prepare a Final Administrative Determination (FAD). Commissioner Czech seconded the motion. All voted in favor.

Case #011604  — Chairperson Culliton made a motion to approve the draft FAD as presented. Commissioner Burdge seconded the motion. All voted in favor.  

Case #011605  — Chairperson Culliton made a motion to authorize Socrates to settle for the amount presented. Commissioner Czech seconded the motion. All voted in favor.

Case #011606  — Chairperson Culliton made a motion to authorize Socrates to settle for the amount presented. Commissioner Davis seconded the motion. All voted in favor.

Case #011607  — Chairperson Culliton made a motion to authorize Socrates to negotiate settlement within the range presented. Commissioner Burdge seconded the motion. All voted in favor.

Case #011608  — Chairperson Culliton made a motion to authorize Socrates to settle the matter within the range  presented. Commissioner Burdge seconded the motion. All voted in favor.

Case #011609  — Chairperson Culliton made a motion to authorize Socrates to settle for the amount presented. Commissioner Davis seconded the motion. All voted in favor.

Chairperson Culliton made a motion to adjourn. Commissioner Davis seconded the motion. All voted in favor.

The State Health Benefits Commission meeting was adjourned at 11:37 AM.
                                                     

  Respectfully submitted,
 

 

 

  Kierney Corliss
Acting Secretary
State Health Benefits Commission

 


State Health Benefits Commission
Minutes, Meeting No 563
March 9, 2016; 10:00 AM

Adequate notice of this meeting was provided through the annual notice of the schedule of regular meetings of the Commission filed with and prominently posted in the offices of the Secretary of State.  The 2016 annual meeting schedule was mailed to the Secretary of State, Star Ledger and the Trenton Times on January 6, 2016.

The meeting of the State Health Benefits Commission of New Jersey was called to order on Wednesday, March 9, 2016 at 10:20 AM.  The meeting was held at 50 West State Street, Trenton, New Jersey, and was attended by the following members of the Commission and Division staff:

Roll Call

Susanne Culliton, Chairperson, representing Acting State Treasurer Ford M. Scudder
Robert M Czech, Chair, Civil Service Commission
Holly Gaenzle, representing Acting Commissioner Richard J. Badolato, Department of Banking & Insurance
Dudley Burdge, Representative for Local Government Employees

Absent:

Debra Davis, Representative for State Government Employees

Also present: 

Danielle Schimmel, Deputy Attorney General
Kierney Corliss, Acting Secretary
Mark Cipriano, Division of Pensions and Benefits
Douglas Martucci, Division of Pensions and Benefits
Donna Ruotola, Horizon Blue Cross Blue Shield of New Jersey

Resolutions A (Closed Session) and B (Executive Session) – were read in their entireties.

Chairperson Culliton made a motion to approve the minutes for the March 11, 2015 meeting. Commissioner Burdge seconded the motion. Commissioner Gaenzle asked Acting Secretary Kierney Corliss to check on the timing of the appointment of Acting Commissioner Richard J. Badolato. All voted in favor, pending that adjustment, if necessary.  

Chairperson Culliton made a motion to approve the minutes for the May 13, 2015 meeting. Commissioner Burdge seconded the motion. All voted in favor.

Chairperson Culliton made a motion to go into Closed Session to hear member appeals. Commissioner Burdge seconded the motion. All voted in favor.

The following cases, due to HIPAA regulations, are heard in closed session.

Case #031601 (member present) — This tabled appeal concerned eligibility for reimbursement of Medicare B premiums for a retired State employee. The employee had been laid off on July 7, 1995 and rehired on December 23, 1996. The case had been tabled in order for the Commission to review the union contracts that were in effect when the member was first hired and upon her retirement.

Chairperson Culliton asked the member if she had worked anywhere during the time period that she was laid off. The member responded that she may have worked at a private company for a short time but she would need to check her records. The member had originally been hired in 1984. She had a break in service in 1987 and was retired in 1988. Chairperson Culliton asked the member what kind of health coverage she had during the layoff period. She responded that she had enrolled in COBRA coverage through the Division of Pensions and Benefits. She may have records at home of her COBRA enrollment.

Commissioner Czech noted that a special reemployment list can be open for many years and it is difficult to establish a cutoff point. This is why continuous employment is required.

Chairperson Culliton made a motion to go into Executive Session to seek advice from the Deputy Attorney General. Commissioner Burdge seconded the motion. All voted in favor.

Upon return from Executive Session, Chairperson Culliton made a motion to table the matter. Commissioner Burdge seconded the motion. All voted in favor. Chairperson Culliton asked the member to provide any records she could find to support her enrollment in COBRA during her layoff period.

Case #031602  — This Division appeal concerned the denial of eligibility to enroll a disabled dependent who was over the age of 26. The member had recently obtained legal guardianship of his disabled sister who was 34 years old. Chairperson Culliton questioned what kind of health coverage the dependent had previously. Ms. Corliss noted that the member had indicated that his sister has Medicare coverage as a result of receiving Social Security Disability. Chairperson Culliton made a motion to deny the appeal. Commissioner Burdge seconded the motion. All voted in favor.

Case #031603  — This Horizon appeal concerned the denial for expenses above the reasonable and customary allowance for procedures rendered by an out-of-network provider. Donna Ruotola, Horizon Blue Cross Blue Shield of New Jersey, stated that the expenses were related to a surgeon who was called in to assist during a planned, non-emergent procedure. The main surgeons were also out-of-network, the member was aware prior to the surgery that they were out-of-network, and the member was aware prior to the procedure that another surgeon might be called in to assist. Chairperson Culliton made a motion to deny the appeal. Commissioner Burdge seconded the motion. All voted in favor.   

Case #031604  — Chairperson Culliton made a motion to go into Executive Session to discuss this case, which was pending before the Office of Administrative Law (OAL). Commissioner Burdge seconded the motion. All voted in favor. Upon return from Executive Session, Chairperson Culliton made a motion to not accept the settlement proposal by the petitioner. Commissioner Czech seconded the motion. Commissioner Burdge abstained.  (3-0-1).

Case #031605  — Chairperson Culliton made a motion to deny the request for an OAL hearing and direct the Acting Secretary to prepare a Final Administrative Determination. Commissioner Czech seconded the motion. All voted in favor.

Case #031606  — Chairperson Culliton made a motion to approve the draft Final Administrative Determination as presented. Commissioner Czech seconded the motion. All voted in favor.

Chairperson Culliton made a motion to adjourn. Commissioner Burdge seconded the motion. All voted in favor.

The State Health Benefits Commission meeting was adjourned at 11:10 AM.
                                                     

  Respectfully submitted,
 

 

 

  Kierney Corliss
Acting Secretary
State Health Benefits Commission

State Health Benefits Commission
Minutes, Meeting No 564
April 1, 2016; 10:00 AM

Adequate notice of this meeting was provided through the annual notice of the schedule of regular meetings of the Commission filed with and prominently posted in the offices of the Secretary of State.  The 2016 annual meeting schedule was mailed to the Secretary of State, Star Ledger and the Trenton Times on January 6, 2016 and a revised notice was sent on March 28, 2016.

The meeting of the State Health Benefits Commission of New Jersey was called to order on Friday, April 1, 2016 at 10:12 AM.  The meeting was held at 50 West State Street, Trenton, New Jersey, and was attended by the following members of the Commission and Division staff:

Roll Call

Susanne Culliton, Chairperson, representing Acting State Treasurer Ford M. Scudder
Robert M Czech, Chair, Civil Service Commission
Holly Gaenzle, representing Acting Commissioner Richard J. Badolato, Department of Banking & Insurance
Dudley Burdge, Representative for Local Government Employees

Absent:

Debra Davis, Representative for State Government Employees

Also present: 

Danielle Schimmel, Deputy Attorney General
Kierney Corliss, Acting Secretary
Mark Cipriano, Division of Pensions and Benefits
David Pointer, Division of Pensions and Benefits
Resolution B (Executive Session) – was read in its entirety.

Issues

The only item on the agenda was the Amended State Health Benefits Program (SHBP) Regulations. Acting Secretary Kierney Corliss stated that Commissioner Davis was unable to attend but had sent her comments, which were provided to all members of the Commission. Ms. Corliss stated that a copy of Commissioner Davis’s comments had also been provided to the court reporter to be incorporated into the transcript.

Chairperson Culliton noted that the regulations were to expire on April 6th. Commissioner Davis had expressed concerns about the Policemen’s Benevolent Association (PBA) having a chance to review the changes to the sections regarding Chapter 330 coverage. Chairperson Culliton noted that any union, including the PBA, would have the opportunity to review the regulations and make any comments and suggestions during the public comment period.

Several of Commissioner Davis’s comments addressed employee and retiree health benefits premium contributions and the expiration of Chapter 78. David Pointer, Deputy Director, Division of Pensions and Benefits, stated that not all local employers have fully implemented the cost-sharing provisions of Chapter 78. The language in the regulations is meant to address those employers who have not fully implemented that law. Chairperson Culliton noted that the statutes will always supersede the regulations; the intent of the regulation is to express terms that are unclear or ambiguous. Commissioner Czech suggested adding language that said “unless otherwise provided by statute, the following would apply.” Chairperson Culliton made a motion to go into Executive Session to seek advice from the Deputy Attorney General. Commission Gaenzle seconded the motion. All voted in favor.

Upon return from Executive Session, Mr. Pointer addressed Commissioner Davis’s comments regarding the definition of a full-time employee of the State. He stated that the Patient Protection and Affordable Care Act (ACA) requires the State to offer coverage to 95 percent of employees that work at least 30 hours per week. Currently, 98 percent of State employees that work at least 30 hours per week are offered coverage. Commissioner Burdge stated that he felt that the ACA sets a clear standard for full time employees and that the State should accept that standard.

Commissioner Davis’s next comment proposed that the language of the regulations be updated to include layoff periods with reference to continuous employment. Mr. Pointer noted that a layoff could be for an open ended period of time. Chairperson Culliton stated that the Commission is free to interpret continuous employment based on the facts of a particular case without having to add language to the regulations.

The next comment was a suggestion that waiver forms should include a statement indicating that waiving coverage may impact future eligibility for a disabled dependent child over the age of 26. Mr. Pointer agreed that the waiver form will be revised to include that information.

Commissioner Davis’s next comment was regarding the section addressing Local Employers who have left the SHBP with outstanding premium charges. Mr. Pointer explained that the language in the regulations requires that these employer pay off any previous outstanding balance before the employer is permitted to request a premium delay.

Chairperson Culliton addressed the next comment regarding how cost sharing is calculated for Medicare Advantage plans. She stated that this was not an issue for the regulations but that questions regarding the calculation could be posed to the Division’s health benefits consultants.

The next comment was in reference to a section regarding premium sharing in retirement for State employees. Chairperson Culliton noted that the requirements for retirees from Local Employers were set forth in a different section of the regulations. 

Commissioner Davis’s next comments were regarding prescription drug copayments and supply limits, which may be changed by action of the Plan Design Committee (PDC). Chairperson Culliton noted that every change to the regulations must be justified, and the regulations describe the current plan provisions. In the event that the PDC modifies these items, the regulations could be updated at that time.

The last comment was regarding the name of the freestanding prescription drug plan. Mr. Pointer responded that it is called the “State” prescription plan to differentiate it from a private prescription plan offered by a Local Employer.

Commissioner Czech made a motion to approve the proposed regulations for promulgation. Commissioner Gaenzle seconded the motion. Motion was approved (3: 1: 0; Commissioner Burdge voted No).

Chairperson Culliton made a motion to adjourn. Commissioner Burdge seconded the motion. All voted in favor.

The State Health Benefits Commission meeting was adjourned at 10:45 AM.

  Respectfully submitted,
 

 

 

  Kierney Corliss
Acting Secretary
State Health Benefits Commission

 


State Health Benefits Commission
Minutes, Meeting No 565
May 11, 2016; 10:00 a.m.

Adequate notice of this meeting was provided through the annual notice of the schedule of regular meetings of the Commission filed with and prominently posted in the offices of the Secretary of State.  The 2016 annual meeting schedule was mailed to the Secretary of State, Star Ledger and the Trenton Times on January 6, 2016 and a revised notice was sent on March 28, 2016.

The meeting of the State Health Benefits Commission of New Jersey was called to order on Wednesday, May 11, 2016 at 10:10 a.m.  The meeting was held at the Division of Pensions and Benefits, 50 West State Street in Trenton, and was attended by the following members of the Commission and Division staff:

The text of Resolutions A (Closed Session) and B (Executive Session) – were read in their entireties in the event that the Board desires, at any point in the meeting, to approve a motion to go into closed session.

The Secretary took Roll Call and established that a quorum was present.

ROLL CALL

Dudley Burdge, Representative for Local Government Employees
Susanne Culliton, Chairperson, representing acting State Treasurer Ford M. Scudder
Debra Davis, Representative for State Government Employees  
Holly Gaenzle, representing Acting Commissioner Richard J. Badolato, Department of Banking & Insurance

Absent:

Robert M. Czech

Also Present:

Mark Cipriano, Division of Pensions and Benefits
Kierney Corliss, Acting Secretary
Andrew Lawson, Division of Pensions and Benefits
Cheryl Eagan, Horizon
Dr. Claudia Hanson, Horizon
Donna Ruotola, Horizon
Danielle Schimmel, Deputy Attorney General

Issues

Minutes –

Commissioner Davis made a motion to accept the minutes of July 8, 2015.  Chairperson Culliton seconded the motion and all voted in favor.

Commissioner Burdge made a motion to accept the minutes of July 17, 2015.  Commissioner Davis seconded the motion and all voted in favor.

Commissioner Davis made a motion to accept the minutes for August 2015.  Commissioner Burdge seconded the motion and all voted in favor.

Commissioner Burdge made a motion to accept the minutes for September 2015.  Commissioner Davis seconded the motion and all voted in favor. 

Commissioner Davis made a motion to accept the minutes for November 2015.  Commissioner Burdge seconded the motion and all voted in favor.

Commissioner Burdge made a motion to accept the minutes for January 2016. Commissioner Davis seconded the motion and all voted in favor.

Chairperson Culliton made a motion to accept the minutes of March 2016.  Commissioner Burdge seconded the motion and all voted in favor.

Chairperson Culliton made a motion to accept the minutes of April 2016.  Commissioner Burdge seconded the motion and all voted in favor. 

At this time, Chairperson Culliton made a motion to go into Executive session to seek the advice of the Deputy Attorney General regarding a citizen’s OPRA request. Commissioner Burdge seconded the motion and all voted in favor.

Upon return from Executive Session, Chairperson Culliton made a motion to direct the OPRA officer to exclude the Executive session minutes, due to their confidential nature. Commissioner Davis seconded the motion and all voted in favor.

Commissioner Burdge made a motion to go into Closed session to hear member appeals.  Commissioner Davis seconded the motion and all voted in favor.

The following cases, due to HIPAA regulations, were heard in Closed session.

Case #051601 – Division Appeal -

This tabled appeal concerned a denial of Medicare Part B reimbursement.   At issue was the hire date for this member.    

Commissioner Davis made a motion to go into Executive session to seek advice from the DAG. Commissioner Burdge seconded the motion and all voted in favor.

Upon return from Executive session, Commissioner Burdge made a motion to grant the appeal and pay the Medicare Part B reimbursement. Commissioner Davis seconded the motion.  Motion passed. (3: 1: 0; Chairperson Culliton voted no).

Case #051602 & #051603 Division Appeals - (member representative present)

These two cases concerned a denial of eligibility of coverage for elected officials who assumed office after the effective date of Chapter 2, P.L. 2010 (May 21, 2010). The elected officials are not serving in a full-time capacity.

Commissioner Burdge made a motion to deny both appeals.   Commissioner Davis seconded the motion and all voted in favor.   

Case #051604 – Division Appeal – (member present)

This case concerned a denial of eligibility for active coverage for a part-time employee.  The employer had certified that the member worked 11 hours per week.    

Commissioner Davis made a motion to go into Executive session to seek advice from the DAG.   Chairperson Culliton seconded the motion and all voted in favor.

Upon return from Executive Session, Commissioner Burdge made a motion to deny this appeal based on information provided by the certifying officer. Chairperson Culliton seconded the motion and all voted in favor.

Case #051605 & 151606 – Aetna Dental Appeals (DMO) – (member present)

These two cases concerned denials of coverage for a non-DMO provider.  Incorrect information was given to the provider when coverage was confirmed. 

Chairperson Culliton made a motion to deny both claims. Commissioner Davis seconded the motion and all voted in favor. 

Case #051607 – Horizon Appeal –

This case concerned denial of coverage for bronchial thermoplasty .  This procedure was considered to be investigational and not covered under the plan.  The case had been reviewed by an Independent Review Organization (IRO) and Horizon’s denial was upheld.

Chairperson Culliton made a motion to deny this appeal, but asked that Horizon reach out to offer assistance in the event this member qualified for a clinical trial. Commissioner Davis seconded the motion and all voted in favor.

Case #051608 – Horizon Appeal -

This case concerned a denial of coverage for private duty nursing considered not medically necessary.   The case had been reviewed by an IRO and Horizon’s denial was upheld.

Commissioner Burdge made a motion to deny this appeal.   Chairperson Culliton seconded the motion and all voted in favor. 

After the appeals had concluded, Commissioner Burdge made a motion to return to Public session.   Commissioner Gaenzle seconded the motion and all voted in favor. 

Case #051609 – Worker’s Compensation - Horizon -

Chairperson Culliton made a motion to authorize SOCRxATES to negotiate between the amounts requested. Commissioner Davis seconded the motion and all voted in favor.

Case # 051610 – Worker’s Compensation- Horizon –

Chairperson Culliton made a motion to authorize SOCRxATES to negotiate between the amounts requested. Commissioner Davis seconded the motion and all voted in favor.

Case # 051611 – Worker’s Compensation- Horizon –

Chairperson Culliton made a motion to authorize SOCRxATES to accept the offer from Respondent and negotiate with Petitioner between the amounts requested. Commissioner Davis seconded the motion and all voted in favor.

Case # 051612 – Worker’s Compensation – Horizon -

Chairperson Culliton made a motion to authorize SOCRxATES to accept the settlement proposed. Commissioner Davis seconded the motion and all voted in favor.

Commissioner Davis made a motion to adjourn.   Chairperson Culliton seconded the motion and all voted in favor.   The meeting was adjourned at 1:15 p.m.

  Respectfully submitted,
 

 

 

  Kierney Corliss
Acting Secretary
State Health Benefits Commission

 


State Health Benefits Commission
Minutes, Meeting No 566
August 22, 2016; 2:00 p.m .

Adequate notice of this meeting was provided through the annual notice of the schedule of regular meetings of the Commission filed with and prominently posted in the offices of the Secretary of State. 

A special meeting notice was mailed to the Secretary of State, Star Ledger and the Trenton Times on August 18, 2016.  

The meeting of the State Health Benefits Commission of New Jersey was called to order on Monday, August 22, 2016 at 2:32 pm. The meeting was held at the Division of Pensions and Benefits, 50 West State Street in Trenton.

The text of Resolution B (Executive Session) – was read in its entirety in the event that the Board desires, at any point in the meeting, to approve a motion to go into closed session.

Acting Secretary Kierney Corliss took Roll Call and established that a quorum was present.

ROLL CALL

Dudley Burdge, Representative for Local Government Employees (via telephone)
Robert M. Czech, Chairperson, Civil Service Commission (via telephone)
Susanne Culliton, Representing Acting State Treasurer Ford M. Scudder
Debra Davis, Representative for State Government Employees  
Holly Gaenzle, representing Commissioner Richard J. Badolato, Department of Banking & Insurance
                                                                                                                       
Also Present:

Eileen Schlindwein Den Bleyker, Senior Deputy Attorney General
Christin Deacon, Deputy Attorney General
Florence Sheppard, Acting Director, Division of Pensions and Benefits
Mark Cipriano, Division of Pensions and Benefits
Kierney Corliss, Acting Secretary
Mary Reilly, Aon Hewitt
Jim Christ, Aon Hewitt

Issues

Minutes –

Commissioner Davis made a motion to approve the regular and executive session minutes of May 11, 2016.  Chairperson Culliton seconded the motion. Motion passed (4: 0: 1; Commissioner Czech abstained).

Medicare Advantage –Jim Christ and Mary Reilly from Aon Hewitt gave a presentation regarding Medicare Advantage (MA) plans. 

Mr. Christ and Ms. Reilly explained that the current plans administered by Horizon are Medicare supplement plans. This means that that the plan pays after traditional Medicare pays. With a MA plan, the plan administrator receives a payment from the Centers for Medicare and Medicaid Services (CMS) in exchange for assuming the full risk of coverage. Therefore, the MA plans are fully insured by the carrier instead of being self-insured as the other SHBP plans are. Mr. Christ stated that the network and plan designs would remain the same as in the existing plans. If both the SHBP and SEHBP were to adopt full replacement MA Plans, the SHBP savings would be approximately $27M for Plan Year 2017. Commissioner Davis asked if the MA plans would result in a different level of benefits than the current plans. Mr. Christ responded that there is an increased level of care coordination provided by the plans.

Commissioner Davis made a motion to go into Executive session to seek the advice of the Deputy Attorney GeneralChairperson Culliton seconded the motion and all voted in favor.

Upon return from Executive session, Commissioner Davis voiced concern over plan design for the PPO plans.  Mr. Christ stated that the Commission could implement a MA PPO that has the same in and out of network benefits as the current Horizon plans. Mr. Christ also explained that the MA plans were included as a priced option in the most recent Medical Request for Proposal (RFP) but at that time MA plans were not implemented for Horizon. Commissioner Burdge asked if the care coordination available under the MA plans is something that is available to Horizon subscribers now. Mr. Christ responded that it is not. Commissioner Davis again expressed concern regarding plan design. Mr. Christ reiterated that the network and cost-sharing provisions would remain the same. There are no additional pre-authorization requirements and no barriers to member care.

Commissioner Davis made a motion to go into Executive Session for advice from the DAG.   Chairperson Culliton seconded the motion and all voted in favor. 

Upon return from Executive session, Commissioner Davis made a motion to postpone the vote on the MA plans until the August 30, 2016 meeting, pending review by the SHBP PDC.   Commissioner Burdge seconded the motion.   The motion failed (2: 3: 0; Commissioners Czech, Culliton, and Gaenzle voted no).

Commissioner Burdge asked if the anticipated savings would be reduced for Plan Year 2018 if the Health Insurer Fee were to be reinstated. Mr. Christ said yes, that if the tax were the only factor, the savings would be reduced, but there are other items that affect the overall cost, including CMS reimbursements, plan experience, and the ability of the vendors to manage the care.

Ms. Corliss read the full text of Resolution No. 1 , which is attached and incorporated into these minutes. 

Chairperson Culliton made a motion to accept the recommendations of Aon and adopt the draft resolution that had been distributed to the Commission. Commissioner Gaenzle seconded the motion.  Motion passed (3: 1: 1; Commissioner Burdge voted no, Commissioner Davis abstained).

Tiered Network Incentive – Ms. Corliss read the full text of Resolution No. 2, which is attached and incorporated into these minutes. 

Commissioner Davis made a motion to go into Executive session to seek advice from the DAG.  Chairperson Culliton seconded the motion.  All voted in favor.   

Upon return from Executive session, Chairperson Culliton made a motion to adopt the resolution and implement its terms. Commissioner Gaenzle seconded the motion. Motion passed (3: 2: 0; Commissioners Burdge and Davis voted no).

There being no further business to discuss, Commissioner Davis made a motion to adjourn.  Chairperson Culliton seconded.  All voted in favor and the meeting was adjourned at 4:20pm.

 

  Respectfully submitted,
 

 

 

  Kierney Corliss
Acting Secretary
State Health Benefits Commission

 


 

 

 
spacer

Pensions and Benefits: Home | Employer Manual | Health Benefits | Forms and Publications | Counseling Appointments
Treasury: Home | ServicesPeopleBusinesses | Divisions/AgenciesFormsContact Us
Statewide:
NJ Home | Services A to Z | Departments/Agencies | FAQs
Copyright © State of New Jersey, 1996 -
This site is maintained by the Division of Pensions and Benefits.
 

Reports Accessibility Statement Legal Statement Privacy Notice Contact Us Open Public Records Act Proposed Rules and Amendments Comment or Petition for new Rule Division/Ageny Statutes and Rules Electronic Notification Twitter YouTube Facebook