Health insurance in tangle at EUTF
BY Greg Wiles
Advertiser Staff Writer
As many as 1,500 state and county workers and their dependents may have been assigned to the wrong health insurance plan as a result of tardy processing of forms and upheaval at the Hawai'i Employer-Union Health Benefits Trust Fund.
The state said it is working to resolve the issue and yesterday sent out letters to personnel officers saying the problem is in the process of being resolved and that no one's health care coverage or payments will be disrupted.
"They're covered and they will be covered under their chosen health plan," said Barbara Annis, deputy director of the state Department of Budget and Finance, which has administrative oversight of the agency.
The problem, while not entirely of the EUTF's making, caps what's been a bruising year for the agency that administers health benefits for state and county workers, their dependents and retirees.
Currently it's operating without a head administrator, who recently retired, along with the agency's No. 2 official. Its board of trustees could not meet in January because of a lack of quorum, and today's meeting may be canceled for the same reason.
The EUTF also has come under fire from members for changes in the administration of pharmacy benefits and increases in costs. It also has been undertaking a changeover to a new computer system and audit of member eligibility while trying to cope with employee furloughs.
The current problem grew out of the annual open enrollment period, during which people can change health plan coverage, add beneficiaries or opt out of the benefits.
But the recent open enrollment period differed in that it offered a so-called 80/20 health insurance plan with lower premiums and higher co-payments for members than the traditional 90/10 plan the EUTF offered.
Both plans are owned by the EUTF, but a third party is brought in to administer the claims.
HMSA AND HSA
HMSA got the contract to process claims for the 80/20 plan, under which members pay 20 percent of the cost of visits to doctors and emergency rooms and other health care bills.
HMA, an affiliate of Summerlin Life & Health Insurance Co., is processing claims for the 90/10 plan.
But the open enrollment period was marred by controversy and confusion over what members were supposed to do. The problem was compounded by charges by the EUTF that HMSA was making misleading statements to scoop up more member claims to processs.
Members were to turn in their open enrollment forms by Dec. 7 if they wanted the 80/20 plan or to make other changes. But not all departments, notably the state Department of Education, delivered the forms to the EUTF on time.
That resulted in some people being notified they were enrolled in the 90/10 plan with claims administration through HMA.
"I'm concerned," said Cheryl Bartlett, a speech-language pathologist with the Department of Education. Bartlett, a former Miss Hawaii, said she had not received anything saying she will be covered under the 80/20 plan, or if a family member that she is attempting to add will be covered as well.
She's also worried about what happens with bills in the interim until her coverage is straightened out.
"I'm getting two different stories now."
1,500 FORMS WAITING
HMSA spokeswoman Elisa Yadao said the insurer was aware of the problem and had received calls from people who had been switched to the plan administered by HMA. HMSA and HMA had been called in to lend a hand in open enrollment form processing because of the EUTF's staffing problems.
"We processed everything we got from them," Yadao said. "We just process what they give us."
Annis said the people will be covered under their desired plans and the correct payments and coverage will eventually be made. As of last Thursday there were about 1,500 open-enrollment forms to be processed.
Annis said many but not all of the forms were coming from the Department of Education and that a batch was turned in Jan. 19, well past the deadline. She said the EUTF staff, which has been hit hard by furloughs and other work, is rushing to get the forms taken care of.
"It's all going to get resolved and no one is going to be without medical coverage," said Annis.
SEEKING NEW CHIEF
Meanwhile, applicant interviews are under way to replace Jim Williams, who retired as EUTF administrator at the end of December and is now heading the Hawaii State Teachers Association. Annis said the state also has moved to fill other vacancies and to make some temporary hires.
Annis said the EUTF's day-to-day functions have been handled since the start of the year by three capable division chiefs within the agency and that Georgina Kawamura, state budget director, has provided administrative guidance when needed.
Annis said the trustee quorum problem may also be solved shortly. She said there had been departures of some of the union representatives on the board and that Gov. Linda Lingle had been unable to appoint replacements because she had not received a list of possible candidates from unions.
Annis said she understood a list of names was forthcoming from the unions.