Dear Denise--we are formally requesting that our original email to you  and Scott (listed below in memo
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Dear Denise--we are formally requesting that our original email to you and Scott (listed below in memo

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Attachment #12a July 31, 2008 Dear Denise--we are formally requesting that our original email to you and Scott (listed below in memo form) be entered into the official public record at the June 12th OEBB Board meeting and a note of it referenced during the public comment period. We further request that this memo be read aloud during the public comment period as I am unable to attend this meeting. Please advise if you have questions or concerns with this request. We understand from your email response last week that you are looking into the concerns we listed below with OEBB staff. Sincerely, Debbie Johnson Beaverton School District ********* Date: June 9, 2008 TO: OEBB Board Members FROM: Sue Robertson, Chief HR Officer, Beaverton School District Debbie Johnson, RN, Health Resource Coordinator, Beaverton School District RE: Summary of ODS benefits posted on May 30, 2008 for plans 3-9 This email was originally sent to Denise Hall and Scott Rupp on June 2, 2008. We have requested that this memo be shared with the OEBB Board and read aloud during the public comment period at the June 12, 2008 OEBB Board meeting in Medford, Oregon. Dear Scott and Denise, We have reviewed the Summary of Benefits: ODS Health Plans document recently posted on the OEBB website. There are a few benefits listed which have a lifetime maximum that are inconsistent with current OEA, OSBA, and other public sector medical ...

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Attachment #12a July 31, 2008 Dear Denise--we are formally requesting that our original email to you and Scott (listed below in memo form) be entered into the official public record at the June 12th OEBB Board meeting and a note of it referenced during the public comment period.We further request that this memo be read aloud during the public comment period as I am unable to attend this meeting. Please advise if you have questions or concerns with this request. We understand from your email response last week that you are looking into the concerns we listed below with OEBB staff. Sincerely, Debbie Johnson Beaverton School District ********* Date: June 9, 2008 TO: OEBBBoard Members FROM: Sue Robertson, Chief HR Officer, Beaverton School District  DebbieJohnson, RN, Health Resource Coordinator, Beaverton School District
RE: Summary of ODS benefits posted on May 30, 2008 for plans 3-9 This email was originally sent to Denise Hall and Scott Rupp on June 2, 2008.We have requested that this memo be shared with the OEBB Board and read aloud during the public comment period at the June 12, 2008 OEBB Board meeting in Medford, Oregon. Dear Scott and Denise, We have reviewed the Summary of Benefits: ODS Health Plans documentrecently posted on the OEBB website. There are a few benefits listed which have a lifetime maximum thatare inconsistent with current OEA, OSBA, and other public sector medicalbenefits. Duringthe past 10 months, these benefit limitations were not discussed in public before this summary was posted. Hereare the ones of most concern:
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Attachment #12a July 31, 2008 1. Under"Other Care/Treatments":1-1Transplants ($250,000 lifetime maximum)--this benefit would not go very far if someone actually needed an organ transplant.A kidney transplant is one of the few transplants that may fall under this limitation. We believe that this is grossly insufficient and will be damaging to any OEBB members that need this level of care. Our current plan does not limit transplant coverage--it is subject to the medical $2 million dollar lifetime maximum. In an interesting twist, there is no limit on the kidney dialysis benefit, so, a member can have unlimited claim costs for dialysis, (up to the $2 million dollar max), but not have appropriate medical management of the condition (which is medically established to be a transplant in most cases) because he/she may be afraid that the bills would exceed their lifetime limit on the transplant procedure. 1-2 TemporomandibularJoint Syndrome (TMJ)--$3,000 lifetime maximum.Most public sector policies do not restrict TMJ coverage and it is treated like any other medical condition.There are rare cases where TMJ surgery may be necessary, but this is addressed through medical necessity review--not through placing a dollar limit on the benefit.A $3,000 lifetime maximum would not address the conservative treatment needed to preserve function for these patients (physical therapy, splints, dentist visits, etc.) Our current plan treats TMJ as any other medical condition. 1-3 Cosmeticand Reconstructive Surgery (when medically necessary-service authorization required)-when I attended the early OEBBBoard meetings in September 2007--this was listed as a benefit (with much laughter from the audience) and then moved to an exclusion; now, it is listed as both an exclusion and a benefit. We believe that this is very misleading to members who may think that their cosmetic surgery is medically necessary (at least in their perception) but does not meet the usual medical necessity guidelines.You may want to drop the word "cosmetic" in the description. 2. UnderEmergency & Urgent Care:Ambulance Transportation--$5,000 annual maximum--either ground or air ambulance. This benefit would gravely impact those using air ambulance (e.g. Lifeflight) and appears even more troubling for members in rural areas who must be taken to the nearest certified trauma center. Our benefits are based upon a mileage limit, not a dollar limit.
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Attachment #12a July 31, 2008 3. UnderHospital Benefit:Service Authorization penalty (inpatient and residential) 50% up to $2,500. This authorization penalty needs to be defined--there are situations when a member or member's family may not be able to contact the carrier due to an emergency or urgent situation. Based upon many carriers' contracts, they have limited the pre-auth requirement to specific types of hospitalizations/procedures--not just any inpatient hospitalization, because it adds to the administrative expense of the plan and it has not proven to result in very many denials. Based upon their provider contracts, the preferred provider would take the responsibility of contacting the health plan as necessary for inpatient hospitalization and the member is not penalized.This penalty would be a huge shift for many new OEBB members because their previous carrier would not have had this type of penalty in place. 4. UnderGeneral Exclusions:4-1 MentalExamination and Psychological testing and evaluation--under the state mental health parity law, I believe that this exclusion would not be permitted. There are many appropriate medical situations where psychological testing by a licensed psychologist is medically necessary, especially in the case of defining a diagnosis for a child.Our current plan would not exclude this type of medical care. 4-2 Nutritionalcounseling--in order to provide service to those members who are newly or currently diabetic, it would be wise of OEBB to design a diabetic education benefit which would include nutritional counseling.There are other medical conditions as well that benefit from the services of a registered dietician (e.g. cardiac disease).I believe it is short-sighted and will be difficult for your disease management staff to assist members if they do not have some type of specific nutritional counseling benefit for certain conditions. We hope that you and the OEBB Board review these concerns and discuss them before these benefits become final. As we have stated in the past to the OEBB Board regarding certain proposed administrative rules, this type ofbenefit language will adversely impact your HMO plan (Kaiser)because they are unable to limit the benefits as written. It will, more importantly, adversely impact your members and their dependent children and that is our greatest concern.
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