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Pensions and Benefits
SCHOOL EMPLOYEES' HEALTH BENEFITS PROGRAM PLAN DESIGN COMMITTEE
MEETING MINUTES 2012

 

SCHOOL EMPLOYEES' HEALTH BENEFITS PROGRAM (SEHBP)
PLAN DESIGN COMMITTEE MINUTES, BY DATE


 


Meeting No. 9
Minutes
August 22, 2012
10:00 AM
School Employees’ Health Benefits Program (SEHBP) Plan Design Committee

Adequate notice of this meeting has been provided filed with and prominently posted in the offices of the Secretary of State.  The meeting notice was mailed to the Secretary of State, Star Ledger and the Trenton Times on August 14, 2012.  The meeting of the SEHBP Plan Design Committee was called to order on Thursday, August 22, 2012 at 10:05 AM. The meeting was held at the Division of Pensions and Benefits, 50 West State Street, Trenton, New Jersey, and was attended by the following members of the Committee, Representatives from Aon Hewitt, and Division staff:

Kevin Kelleher, NJEA
Kenneth E. Kobylowski, Department of Banking and Insurance
James Leonard, Department of Treasury
Jean Pierce, AFT/AFL CIO
David Ridolfino, Department of Treasury
Wendell Steinhauer, NJEA

Diane Weeden, Deputy Attorney General
Florence J. Sheppard, Secretary
David Pointer, Division of Pensions and Benefits
Jean Williamson, Division of Pensions and Benefits
Susan Barrett, Division of Pensions and Benefits
Edward W. Fox, Aon Hewitt Consultants
Susan Marsh, Aon Hewitt Consultants
James Christ, Aon Hewitt Consultants

Sunshine Act Statement: The Sunshine Act Statement and the Executive Session Resolution were read by Susan Barrett.

Roll Call: Ms. Barrett took the roll call; all Committee members were present.

Minutes: Committee member Kobylowski made a motion to approve the minutes of October 6, 2011. The motion was seconded by Committee member Steinhauer. Approved (4:0:2, Committee members Leonard and Ridolfino abstained).

Committee member Steinhauer made a motion to open nominations for a Chairperson. Committee member Pierce seconded the motion. Committee member Steinhauer nominated Kevin Kelleher as Chairperson. Committee member Pierce seconded. Committee member Leonard asked for advice on the process of voting for a chairperson. DAG Weeden explained that C78, P.L.2011 dictates that each chairperson serves a term of one year with no members serving more than one term until all members of the committee have served a term. The selection of chair should alternate each year between labor and management. Committee member Steinhauer made a motion to close the nominations, seconded by Committee member Pierce, all were in favor. The nomination of Committee member Kelleher was put to a vote and all voted in favor.

Ms. Sheppard introduced Mr. Fox from Aon Hewitt, who introduced his team. Mr. Christ provided an overview of a document prepared by Aon Hewitt for the Committee: School Employees’ Health Benefits Plan Design Committee, Retiree Prescription Drug Co-pays for PY 2013, dated August 22, 2012. Mr. Christ explained the historical process of indexing drug co-pays. He reminded the Committee that 2012 retiree prescription drug co-pays had been frozen due to a substantial reduction in retiree prescription drug costs due the implementation of the Employee Group Waiver Program (EGWP). The document included the cost-savings of indexing the co-pays by either one or two years of indexing.

A discussion regarding the impact of acting to change the co-pays followed. Committee member Kelleher asked if the SHBP/SEHBP is on target to save the projected $90 million projected in savings by switching to EGWP. Mr. Christ confirmed that the savings are on track to be slightly greater than that projection. Susan Marsh explained that the SEHBP is projected to save $55 million for Plan Year 2013. The Committee members posed several questions of clarification to Aon Hewitt in an effort to understand their options.

Committee member Steinhauer made a motion to go into executive session.  The motion was seconded by Committee member Kelleher.

Upon return from executive session, Committee member Steinhauer made a motion to approve two years of indexing, seconded by Committee member Leonard. A roll call vote was taken. The motion failed to receive the necessary 4 votes for approval (3:3:0, Kelleher, Pierce, Steinhauer, nay). Committee member Steinhauer then made a motion to approve one year of indexing, seconded by Committee member Pierce. A roll call vote was taken. The motion failed to receive the necessary 4 votes for approval (3:3:0, Kelleher, Pierce, Steinhauer, nay). Committee member Leonard then asked DAG Weeden what happens in a stalemate. DAG Weeden explained that there is a superconciliator process in Chapter 78 that can be used to resolve a stalemate.  .

Committee member Leonard made a motion to go into executive session.  The motion was seconded by Committee member Ridolfino.

Upon returning from executive session, Committee member Steinhauer asked Aon Hewitt what the savings impact would be if they were to change the co-pays to numbers other than what was listed on the charts. Several scenarios were discussed and Aon Hewitt gave approximate savings based on each example. The Committee agreed upon a compromise that Aon Hewitt estimated would result in a $4 million dollar savings. Committee member Leonard made a motion to accept one-year indexing with the following modifications: PPO 10 and 15 plan retail, non-preferred brand changing to $40, mail generic from $10 to $5, mail non-preferred brand $51 to $50. Committee member Ridolfino seconded the motion. A roll call vote was taken. The motion passed with all in favor.

Committee member Steinhauer made a motion to have the Attorney General’s office research whether the federal waiver for mental health parity is a SEHBP PDC issue, or that of the SEHBP. Committee member Pierce seconded the motion. All were in favor.

Committee member Kelleher requested that the Committee meet earlier in the year next year. Mr. Pointer suggested monthly meetings from October through April. Committee member Steinhauer made a motion that the Division schedule these meetings, seconded by Committee member Pierce. All were in favor.

Committee member Steinhauer made a motion to adjourn, seconded by Committee member Kobylowski, all voted in favor. The meeting adjourned at 11:53. 

  Respectfully submitted,
 

 

 

  Florence J. Sheppard
Secretary, SEHBP Plan Design Committee

 


Meeting No. 10 Minutes
November 19, 2012, 10:00 AM
School Employees’ Health Benefits Program (SEHBP)
Plan Design Committee

Adequate notice of this meeting has been provided and filed with and prominently posted in the offices of the Secretary of State.  The meeting notice was mailed to the Secretary of State, Star Ledger and the Trenton Times on November 15, 2012.  The meeting of the SEHBP Plan Design Committee was called to order on Monday, November 19, 2012 at 10:04 AM. The meeting was held at the Division of Pensions and Benefits, 50 West State Street, Trenton, New Jersey, and was attended by the following members of the Committee, Representatives from Aon Hewitt, Horizon Blue Cross Blue Shield of New Jersey, Aetna, and Division staff:

Present:

Kevin Kelleher, NJEA
Kenneth E. Kobylowski, Department of Banking and Insurance
James Leonard, Department of Treasury
David Ridolfino, Department of Treasury (left at 11:25 AM)
Wendell Steinhauer, NJEA (left at 11:40 AM)
Absent:
Jean Pierce, AFT AFL/CIO

Also in Attendance:

Diane Weeden, Deputy Attorney General
Florence J. Sheppard, Division of Pensions and Benefits
David Pointer, Division of Pensions and Benefits
Susan Barrett, Acting Secretary
Edward W. Fox, Aon Hewitt Consultants
Susan Marsh, Aon Hewitt Consultants
James Christ, Aon Hewitt Consultants
David Perry, Horizon Blue Cross Blue Shield of New Jersey
Katherine Impellizzeri, Aetna

Sunshine Act Statement: The Sunshine Act Statement and the Executive Session Resolution were read by Ms. Barrett.

Minutes: Committee member Steinhauer made a motion to approve the minutes of August 21, 2012 and August 29, 2012. The motion was seconded by Committee member Kobylowski, approved (5:0:0).
 
Ms. Barrett introduced Mr. Fox from Aon Hewitt, who introduced his team. Mr. Christ provided an overview of a document prepared by Aon Hewitt for the Committee regarding Mental Health Parity. The Health Insurance Portability and Accountability Act (HIPAA) includes a “mental health parity” requirement, wherein group health plans that provide mental health benefits must do so in no more a restrictive way than for all other medical and surgical services. He explained that self-insured, non-federal government health plans may file for an exemption from mental health parity requirements on an annual basis. Prior to Federal Health Care Reform, the State Health Benefits Commission (SHBC) had previously filed for an exemption for the SEHBP for non-biologically-based mental health benefits (non-BBMI), allowing it to impose both dollar and day limits to these benefits. Federal Health Care Reform now precludes the SEHBP from an exemption for dollar limits, but still allows for day limits.

Committee member Steinhauer made a motion to go into Executive Session to seek legal counsel as to whether the Committee or the SEHBC was required to take action on the mental health parity exemption. Committee member Leonard seconded the motion. All voted in favor and the meeting convened in Executive Session.

Upon returning to Open Session, there was discussion regarding the cost impact of not applying for the exemption. Mr. Christ responded that the projected increase to the SEHBP would be between $2.4 and $4 million dollars for plan year 2013 if the exemption is not filed. The total cost projection for the entire program is $2.6 billion. Committee member Kelleher asked if it could be looked at again next year if no action was taken this year. Mr. Pointer said he would look into that.

Committee member Kelleher asked for examples of non-BBMI. Mr. Fox spoke of post-traumatic stress disorder and eating disorders. Mr. Fox asked if Horizon and Aetna representatives present at the meeting could list other examples. Mr. Perry cited anxiety disorders, unspecified paranoia, and depression resulting from environmental triggers. Ms. Impellizzeri added adjustment and personality disorders.

Committee member Ridolfino asked for more details on usage and Committee member Steinhauer asked for associated dollar amounts. Mr. Christ replied that he would provide them with estimates based on figures from other clients who do not impose limits.

Mr. Christ then gave a presentation entitled “Wellness Program Considerations”. He indicated that the costs of the SEHBP are growing rapidly and that this growth is largely fueled by certain chronic conditions. Developing a wellness program encouraging better health practices is one possible option to keep members from developing these chronic conditions. In turn, costs would theoretically decrease. The material included possible program designs, including examples of what other states are offering.

There was discussion about cost, participation, and implementation challenges. Committee member Kelleher expressed concerns about promoting such a program for boards of education, which typically have several locations within each district. He also thought that it would be difficult to convince employers to pay the up-front costs associated with such programs. If forced to do so, many employers may leave the SEHBP.

Mr. Pointer offered to request Express Scripts to do a presentation on member engagement through pharmacy outreach at the next meeting, to which the members agreed.

Mr. Pointer advised the Committee that the Pension and Health Benefits Review Commission (PHBRC) voted to recommend against enactment of three proposed bills, partly because the passage of the bills would usurp the authority of the Committee. The PHBRC asked that the bills be forwarded to the Committee, along with explanations as to their basis for recommendation against enactment. Mr. Pointer provided the Committee members copies of the following bills for consideration: A-1278 (Coughlin); A-2863 (McKeon); and S-481 (Thompson). The PHBRC asks that the Committee take whatever action it deems appropriate. It was agreed that bills referred by the PHBRC would be considered at a future meeting when the Committee decides on final plan designs for PY 2014.

There being no further business, Committee member Kobylowski made a motion to adjourn, seconded by Committee member Leonard. All voted in favor and the meeting adjourned. 

  Respectfully submitted,
 

 

 

  Susan Barrett
Acting Secretary, SEHBP Plan Design Committee

 


Meeting No. 11 Minutes
December 3, 2012, 10:00 AM
School Employees’ Health Benefits Program (SEHBP)
Plan Design Committee

Adequate notice of this meeting has been provided and filed with and prominently posted in the offices of the Secretary of State.  The meeting notice was mailed to the Secretary of State, Star Ledger and the Trenton Times on November 28, 2012.  The meeting of the SEHBP Plan Design Committee was called to order on Monday, December 3, 2012 at 10:10 AM. The meeting was held at the Division of Pensions and Benefits, 50 West State Street, Trenton, New Jersey, and was attended by the following:

Present:

Kevin Kelleher, NJEA
Kenneth E. Kobylowski, Department of Banking and Insurance
James Leonard, Department of Treasury
David Ridolfino, Department of Treasury (left at 11:35 AM)
Wendell Steinhauer, NJEA

Absent:

Jean Pierce, AFT AFL/CIO

Also in Attendance:

Diane Weeden, Deputy Attorney General
Danielle Schimmel, Deputy Attorney General
Florence J. Sheppard, Division of Pensions and Benefits
David Pointer, Division of Pensions and Benefits
Susan Barrett, Acting Secretary
Bart Gerber, Express Scripts
Stacey Decembrele, Express Scripts
Ken Vander Pyl, Express Scripts
Kristen Plauschinat, Express Scripts
David Perry, Horizon Blue Cross Blue Shield of New Jersey
Edward W. Fox, Aon Hewitt Consultants
James Christ, Aon Hewitt Consultants

Sunshine Act Statement: The Sunshine Act Statement and the Executive Session Resolution were read by Ms. Barrett.

Minutes: Committee member Steinhauer made a motion to approve the minutes of November 19, 2012. The motion was seconded by Committee member Kelleher, approved (5:0).
 
Ms. Barrett introduced Mr. Gerber from Express Scripts, and his team introduced themselves. Mr. Gerber gave a presentation on the Socrates program, a quality-care initiative designed to deliver electronic medication-related gap-in-care alerts to specially-trained community pharmacists. The objectives of the program are to reduce medical costs for patients and plan sponsors and to improve the health of patients with chronic conditions by addressing adherence and omission gaps in therapy. Following the presentation, the Express Scripts team answered several questions from Committee members. Committee member Leonard asked what the total coverage gap costs are considering all members, not just ones using independent pharmacists. Mr. Gerber said that they will research that information. Committee member Kelleher asked if members remained adherent for a period of time if counseled on gaps. Ms. Decembrele said that she would research to see if there were any studies on that matter.

Mr. Pointer then introduced Mr. Perry from Horizon, who gave a brief presentation on their Member Engagement Programs. He detailed the progress of the Patient Centered Medical Home (PCMH) initiative, which currently has 80,000 State members. In the PCMH model, a Patient Care Coordinator working with the primary care physician’s office tracks and coordinates each aspect of a member’s care, resulting in a reduction in utilization and significant total cost of care savings.

Aon was present to respond to questions regarding their presentations on mental health parity and wellness programs from the November 19, 2012 meeting. Regarding mental health parity, Mr. Christ informed the Committee that the law would allow the SHBC to reapply for an exemption next year if it did not apply this year. Regarding wellness programs, Mr. Fox advised that program success could be achieved with 50 percent participation. Committee Member Kobylowski asked what the participation rate of the Oregon Wellness Program was. Mr. Christ said that he would research that information. Committee Member Steinhauer made a motion to go into Executive Session. Committee Member Leonard seconded, all were in favor.

Upon returning to Public Session, Committee member Kelleher made a motion to adjourn, seconded by Committee member Leonard. All voted in favor and the meeting adjourned at 11:50 a.m. 

  Respectfully submitted,
 

 

 

  Susan Barrett
Acting Secretary, SEHBP Plan Design Committee

 


 
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