Impact
WARD: Citywide
COMMITTEE:
$ IMPACT:
Title
Approval for proposed Smyrna Plan Document language change for coordination of medical coverage with Medicare
Body
ISSUE: The change will add the proposed Language to the Plan document which is detailed in the attached document.
BACKGROUND: Current Status: End-Stage Renal Disease (ESRD) is approximately 200% more frequent and represents about $4.50 PMPM, affecting 10 members with 2 on dialysis. Dialysis costs increased by 20% in the last 12 months with ESRD accounting for about 5.4% of last year's medical expenses. The city has the ability to contain these costs by modifying the plan documents so the City will be the secondary provider after Medicare at the end of the first 30 months.
RECOMMENDATION/REQUESTED ACTION: Modify the group health plan's coordination with Medicare to pay secondary after the 30 month waiting period. If the Medicare eligible member does not elect Medicare Part A & B, the plan will still pay secondary as if the election was made.