Joint Committee on Health Benefits. (a) The State and PEF agree to continue the Joint Committee on Health Benefits.
(b) The Joint Committee on Health Benefits shall meet within 14 days after a request to meet has been made by either side.
(c) The Joint Committee shall work with appropriate State agencies to review and oversee the various health plans available to employees represented by PEF.
(d) The Joint Committee on Health Benefits shall work with appropriate State agencies to monitor future employer and employee health plan cost adjustments.
(e) The Joint Committee shall be provided with each carrier rate renewal request upon submission and be briefed in detail periodically on the status of the development of each rate renewal.
(f) The State shall require that the insurance carriers for the State Health Insurance Plan submit claims and experience data reports directly to the Joint Committee on Health Benefits in the format and with such frequency as the Committee shall determine.
(g) The State shall provide to the PEF designees to the Joint Committee, a quarterly summary of hospital carrier paid claims (number of charges, amount of covered expenses and amount of benefits) by type of service for PS&T Unit enrollees and New York State Actives; New York State Empire Plan Medical Carrier and Prescription Drug Program paid claims (number of charges, amount of covered expenses and amount of benefits) by type of service for PS&T Unit enrollees and New York State Actives; number of enrollees, spouses or domestic partners, and dependents for PS&T Unit enrollees and New York State Actives.
(h) The Joint Committee on Health Benefits shall work with appropriate State agencies in an ongoing review of the Medical Flexible Spending Account. The Medical Flexible Spending Account shall provide a direct debit card to all enrollees as permitted pursuant to Internal Revenue Code Section 125 and related regulations.
(i) The Joint Committee on Health Benefits shall work with appropriate State agencies to review the impact of coverage for adult immunizations in the Empire Plan, and to consider additions to the list of immunizations.
(j) The Joint Committee on Health Benefits shall work with appropriate State agencies to make mutually agreed upon changes in the Plan benefit structure through such initiatives and activities as:
1. The annual HMO Review Process;
2. The ongoing review of the Managed Mental Health and Substance Use Care Program;
3. Ongoing review of the Benefits Management Program and an annual rev...
Joint Committee on Health Benefits. 41.1 a. The State and UUP agree to continue a Joint Committee on Health Benefits. The Committee shall consist of no more than five representatives selected by UUP and no more than five representatives selected by the State.
Joint Committee on Health Benefits. A Joint Committee on Health Benefits (Joint Committee) shall be composed of three (3) representatives selected by the Fairbanks Education Association, three (3) representatives selected by the Education Support Staff Association, one (1) representative selected by the Fairbanks Principals' Association, the Fairbanks North Star Borough Risk Manager as a non-voting member, and three (3) representatives selected by the Superintendent. The Joint Committee shall select a chairperson from its membership. A quorum for the meetings shall require no fewer than seven (7) committee members. The Joint Committee will conduct a formal vote on any proposed changes in benefits. Passage of motions requires a super majority vote of seventy-five percent (75%). Minutes shall be taken of the meetings. The Joint Committee shall be empowered to determine health care benefits to be provided, which shall be formalized through a memorandum of agreement between the District and a designated representative of each affected employee group. "Health care benefits" shall include dates of eligibility for coverage, benefit schedules, deductibles, co-payment provisions, preferred provider programs, wellness programs, and other options designed to enhance benefit options while containing costs. The District shall not be required to adopt changes made by this committee which would:
a. result in violations of established laws or regulations;
b. alter the administration or management of health care benefits;
c. result in a cost increase to the Plan of more than five percent (5%); or
d. be detrimental to the financial interests of the District, as determined by the Superintendent. The District agrees to work with the Joint Committee to provide reasonable time for meetings and provide adequate support, including an expert health care consultant for plan design. Administrative leave will be provided for all participants.
Joint Committee on Health Benefits a. The State and CSEA agree to continue the Joint Committee on Health Benefits.
b. The State shall seek the appropriation of funds by the Legislature to support committee initiatives and to carry out the administrative responsibilities of the Joint Committee in the amount indicated for each year of the agreement: $1,150,000 in 2007-2008, 1,207,000 in 2008-2009, 1,268,000 in 2009-2010, and 1,331,000 in 2010-2011.
c. The Joint Committee on Health Benefits shall work with appropriate State agencies to make mutually agreed upon changes in the Plan benefit structure through such initiatives as:
1. The annual HMO Review Process;
2. The ongoing review and oversight of the Empire Plan Medical Program, Hospital Program, Prescription Drug Program, and the Managed Mental Health and Substance Abuse Treatment Program;
3. The ongoing review and oversight of the Managed Physical Medicine Program;
4. The continuation of the Benefits Management Program and annual review of the list of procedures requiring Prospective Procedure Review.
5. The Joint Committee on Health Benefits will work with the State and medical carrier to solicit and contract with credentialed radiological providers to provide mammography screening, according to the American Cancer Society's medical protocols, at the worksite and/or predetermined location. Reimbursement will be provided in accordance with the participating provider program, subject to the diagnostic copayment.
6. The continuation of the ambulatory surgery benefit and monitoring of participating centers. The Joint Committee on Health Benefits will work with the State to oversee the solicitation by the medical/surgical/basic medical carrier of Ambulatory Surgical Centers in bordering states and in those states where retirees commonly reside.
7. The continuation of the Home Care Advocacy Program (HCAP) and the ongoing review of services offered. The JCHB shall work with the State to review and monitor the utilization of DME under HCAP, specifically requests, approvals and denials of duplicate equipment. If necessary the State and CSEA Joint Committee will take appropriate action to address the issue.
8. The Joint Committee on Health Benefits will continue to review the impact of Domestic Partner coverage.
9. The Joint Committee on Health Benefits will work with the State in the development of a Specialty Drug Program. Implementation of a Specialty Drug Program will not take place without the agreement of the CSEA Joint Committee.
10. Upon ra...
Joint Committee on Health Benefits. (JCHB) Charges • JCHB to work with State to implement, oversee and monitor Guaranteed Access Program for PCPs and “core” specialists. • Once established, no change in access standards without agreement of State and PEF. • JCHB to work with State to establish and implement voluntary Health Risk Assessment Article Gains Trade Offs Program and educational endeavors to encourage healthier lifestyles. • JCHB to meet and confer with State on evaluation of possible transition to GHI Preferred Plus dental plan. • JCHB will review radiology pre-notification requirement and review viability and cost effectiveness of implementing pre-authorization program for those services and for non-urgent/non-emergent cardiologic procedures and testing. • JCHB to work with State to implement and oversee a “Healthy Back” voluntary disease management program. • JCHB to work with State to implement and oversee a Bariatric Surgery management program. • If found advantageous and feasible, an “Alternative Prescription Drug Program” will be offered to PS&T Unit enrollees on a voluntary basis. • State will develop and release RFP for self- insured Prescription Drug Program. • JCHB will work with State in development of RFP and review proposals received. • State will evaluate ability/timetable to expand self-insurance to remaining components of Empire Plan and dental plan.
Joint Committee on Health Benefits. A Joint Committee on Health Benefits (Joint Committee) shall be composed of three (3) representatives selected by the Fairbanks Education Association, three
Joint Committee on Health Benefits. The State and GSEU agree to establish a Joint Committee on Health Benefits relating to the Student Employee Health Plan (SEHP). The Committee shall consist of no more than five representatives selected by GSEU and no more than five representatives selected by the State. Both parties shall prepare and present a list of the permanent members of the Joint Committee. The Joint Committee on Health Benefits for the SEHP shall meet within 14 days, or as soon as practicable, after a request has been made in writing by either side. Within three working days of this written request to meet, the entity making such request shall submit a written agenda for the proposed meeting to the Joint Committee members. The Joint Committee shall work with appropriate State agencies to review and oversee various aspects of the SEHP. The review shall include:
1. The review of access to providers and coverage under the SEHP.
2. The review and development, in conjunction with the carrier, of communications such as the handbook and the certificate of insurance for the SEHP.
3. The study of recurring subscriber complaints and recommendation for the resolution of those complaints.
4. The Joint Committee on Health Benefits for the SEHP shall establish methods and procedures for review of disputed medical claims.
Joint Committee on Health Benefits. The State and GSEU agree to establish a Joint Committee on Health Benefits relating to the Student Employee Health Plan (SEHP). The Committee shall consist of no more than five representatives selected by GSEU and no more than five representatives selected by the State. Both parties shall prepare and present a list of the permanent members of the Joint Committee.
Joint Committee on Health Benefits. 1. In recognition of the mutual interest and concern over increasing costs associated with health benefits to both PEF and USW, a Joint Committee on Health Benefits shall be established.
2. The Joint Committee on Health Benefits shall consist of an equal number of designees of the President of PEF and of the President of USW Local 9265.
3. The Committee shall meet at least quarterly.
4. The Committee shall review the utilization data provided by the PEF Healthcare Plan administrators, study and make recommendations about possible cost effective methods for providing existing or enhanced health benefits to bargaining unit members and/or retirees, and study and make recommendations concerning further development of the retiree health insurance benefit as provided in Article 22 of this Agreement.
5. The Committee is authorized to review and analyze dental utilization data, research new dental insurance options and meet and agree on improvements to PEF’s dental coverage during this contract period.
6. The Committee is authorized to research and analyze possible voluntary wellness programs and/or initiatives designed to encourage preventive health care and promote healthy lifestyle and behavior choices. The Committee shall have the authority to meet and agree on the implementation of voluntary wellness programs which may include the development of appropriate rewards and/or incentives for participation in such programs.
7. The Committee is authorized to explore the possible utilization of a copayment waiver program for office visits and/or prescription drugs for treatment of chronic conditions. If the committee jointly determines that copayment waivers may remove disincentives to obtaining appropriate care and/or treatment compliance, the Committee may jointly agree to the implementation of an appropriate co-payment waiver program.
8. The Committee is authorized to review and analyze the possible utilization of copayment waivers as an incentive for voluntary participation in a prescription drug step therapy program. If the committee jointly determines that implementation of such a program is administratively feasible and jointly beneficial, the Committee may meet and agree on the terms of participation and the implementation of an appropriate co- payment waiver program.
Joint Committee on Health Benefits. The State and GSEU agree to establish a Joint Committee on Health Benefits relating to the Student Employee Health Plan (SEHP). The Committee shall consist of no more than five representatives selected by GSEU and no more than five representatives selected by the State. Both parties shall prepare and present a list of the permanent members of the Joint Committee. The Joint Committee on Health Benefits for the SEHP shall meet within 14 days, or as soon as practicable, after a request has been made in writing by either side. Within three working days of this written request to meet, the entity making such request shall submit a written agenda for the proposed meeting to the Joint Committee members. The Joint Committee shall work with appropriate State agencies to review and oversee various aspects of the SEHP. The review shall include:
1. The review of access to providers and coverage under the SEHP.
2. The review and development, in conjunction with the carrier, of communications such as the handbook and the certificate of insurance for the SEHP.
3. The study of recurring subscriber complaints and recommendation for the resolution of those complaints.
4. The Joint Committee on Health Benefits for the SEHP shall establish methods and procedures for review of disputed medical claims.
5. The Joint Committee shall request administrative and technical assistance from appropriate State agencies and/or other sources deemed necessary and approved by the Joint Committee.
6. The Joint Committee shall be provided with the carriers’ rate renewal request and shall be briefed on the status of the development of such rate renewal.
7. The Joint Committee shall work with appropriate State agencies to monitor future employer and employee SEHP cost adjustments.
8. The Joint Committee will work with appropriate State agencies to make mutually agreed upon changes to the SEHP.
