Bariatric surgery, hearing aids and a Weight Watchers benefit are among the changes anticipated in 2012
April 21, 2011--The Oregon Educators Benefit Board is headed toward increasing the benefits for school district employees and their dependents starting in 2012 and expects to make a final decision on April 28.
The recommendations include covering bariatric surgery, hearing aids and bone anchored hearing aids, hip arthroplasty, hip and knee resurfacing, and adding a Weight Watchers benefit for dependents.
At its April 14 meeting, the board also discussed expanding a cost tier category to include varicose vein stripping and surgery and spinal injections for pain. There was no discussion about the cost impact of these new benefits.
Spinal injections for pain will not become part of the benefit design because board members were concerned about the various billing codes for diagnostic and imaging procedures related to spinal injections, as well as the code for the injections.
“What’s included in these codes?” asked Peter Tarzian, PhD, superintendent of schools for the Falls City School District and legislative chair of the Oregon Small Schools Association. “There really is a mixture.”
“I need to see the codes and descriptions” before voting, said Dr. Allison Little, medical director of the Center for Evidence-based Policy at Oregon Health & Science University.
The board also heard from the Mosier Group, a consulting firm that reviewed the actuarial values of OEBB’s benefit plans developed by its consultants, Towers Watson. The board wanted to know whether savings existed, and the amount, as a result of consolidating the health plans of school and educational service districts.
Those savings are estimated to be between $42 and $45 million for the 2010-2011 benefit year, assuming that healthcare costs rise between 8 and 12 percent.
Towers Watson’s calculations were accurate, James Mathieson, an actuary with the Mosier Group, told the board. “All of the results were very, very consistent.”
During a discussion regarding the insurance pool and the number of people needed in that pool to achieve 30 percent savings, Joan Kapowich, administrator of OEBB, asked if there was anything other states had done to make those savings.
Mathieson said that he was not aware of any states that had done so yet. Such savings might be found if OEBB “really digs into administrative simplification” at all levels of its health plan, Mathieson said. But he added that other states haven’t been able to come up with such a model.
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