Frank,
This is still being sorted out; so if you put this up on your BLOG, I would appreciate it if you would NOT put my name on it.
A number of retirees are having difficulty with Hewitt and the 2009 LANL Health Insurance Plans. Those of us who are located outside the United Health Care (UHC) service area and are currently covered by the "Options PPO Out-of-Area" plan are being told we cannot get this plan for 2009 Every year, Hewitt has tried to move us to the "Options PPO National" plan which has twice the deductible and vastly higher copays for services obtained outside of the UHC service area. In the past, Hewitt would 'research' the eligibility for us and put us back on the Out-of-Area plan. This year, Hewitt refuses to put anyone back on the Out-of-Area plan saying that it is no longer available. Of course, LANL Benefits says that it is available for the eligible and the plan appears on the literature mailed to retirees by LANL and the LANL web pages.
Dealing with Hewitt on this matter is frustrating, time consuming, and of no avail. They string along callers saying they will call back in 2 days or 5 days which truncates the retiree's available time in Open Enrollment. They have apparently misled some retirees claiming that the National plan has the same deductible and copays for out of area services. In other cases, within a few sentences, they have alternately blamed LANL and UHC for the unavailability of the plan.
The bottom line is that the "Options PPO Out-of-Area" plan is advertised as available by LANL and should be available to those of us who are outside the UHC service area. We currently understand that between 100 and 200 retirees have been moved from the Out-of-Area plan to the National plan by Hewitt, and that Hewitt cannot or will not put us back on the proper plan which we all currently have. Hewitt claims that only LANL Benefits may make this change. We are currently trying to resolve this matter with LANL Benefits at 877-667-1806. So far we have not been successful in getting LANL to intervene. I can let you know if we get a resolution.
-Anonymous
Thanks Anonymous. We have a reader in HR who helps with these issues. Greg, help!
Okay - just to clear up something in defense of Hewitt real quick, this is NOT Hewitt's decision. They are only a record keeper and administrator, THEY aren't "deciding" anything in this regard.
ReplyDeleteThe Issue: there are two PPO plans available to LANL employees and retirees. The PPO National and the PPO Out of Area. Both are based on criteria of access developed and maintained by UHC based on guidance from the Lab.
In a nutshell, if you live in a remote area with little/no access to a UHC network (based on UHC's data) then you will be eligible for the cheaper UHC PPO Out of Area plan. Why? Because you don't have a lot of choice, we charge you less for your limited options.
If, however, you live in a zip code that has more accessible care according to UHC's network, then you should be in the PPO National. By the way, still a good PPO plan, just not as insanely cheap as the Out of Area plan ("insanely cheap" as PPO plans, go).
IF the UHC file data is accurate, and you have "reasonable access" to care (defined by number of participating providers with 20 mile radius) then you may be forced into the National PPO when you previously had the Out of Area.
If the UHC file data is inaccurate, and you believe you do not have the appropriate access to care, you contact Hewitt to request research. Hewitt cannot make decisions to grant an exception - they have to research the issue with UHC and request an exception from the Lab.
The Lab WILL allow this exception if the data supports it. We have in the past, and we have this year, but we are no longer allowing a "blanket exception."
I'm sorry that there is a wait on resolution. Part of that has been LANL trying to figure out how to validate a person's claim that they really don't have the access that UHC says they do in a fair and impartial manner.
So, if you wish to challenge your network "placement" please have as much data as possible to defend that. Example: YES - there are x number of PCPs within 20 miles, but the roads require travel of more than 35 mi. because the roads don't run "as the crow flies."
If you really DO have reasonable access, though - it wouldn't be fair to give you cheaper PPO coverage than anyone else with the same access. It might be a change, but it might be a very fair change. If it's NOT a fair change, I hope we can validate that and correct it for you.
Thanks,
Greg
benefits@lanl.gov
gsclose@lanl.gov
Here is the criteria, by the way:
ReplyDeleteUrban Zip Codes:
1 Hospital within 10 miles; and
2 Adult PCPs within 8 miles; and
2 OB/GYNs within 8 miles; and
2 Pediatricians within 8 miles
Suburban Zip Codes:
1 Hospital within 15 miles; and
2 Adult PCPs within 15 miles; and
2 OB/GYNs within 15 miles; and
2 Pediatricians within 15 miles
Rural Zip Codes:
1 Hospital within 30 miles; and
1 Adult PCP within 30 miles
They should embrace change like they were told to.
ReplyDeleteGreg's comments comprise more information than we or our friends have been able to get after 2 weeks of phone calls to both Hewitt and LANL Benefits. Thank you, Greg. The Lab has treated this matter like "Double Secret Probation" from the "Animal House" movie. Had the Lab been forthcoming about the policy change from the beginning, it would have made for much less anxiety and less time wasted on phone calls attempting to get information. Why the secrecy especially when the plan is included in the literature given retirees?
ReplyDeleteOn the other hand, what Greg described is exactly the pathway we have been on for the past 2 weeks. We live in a rural zip code over 30 miles away by public road from the nearest UHC PCP and UHC Hospital and are still denied the Options PPO Out-of-Area plan. Yesterday, a LANL Benefits Specialist we've been working with called us and informed us that no one is being approved for the Options PPO Out-of-Area plan period and than any formal appeal to LANL would also be denied. Moreover, we were told by Hewitt that there is no distance criterion this year which contrary to the information provided by Greg.
Questions for Greg: Is the distance criterion you cite applicable to this year? If it is applicable, how do we get our case reopened?
There is a confounding problem at which Greg hints; the UHC database contains inaccurate information. For example, for us, it lists one PCP within the distance criterion he cites, but, in fact that, physician is a specialist and does not take Primary Care patients. The UHC mapping facility is wildly incorrect; it has us driving over private ranch driveways (marked as "no name road" on their maps) to get to the next nearest physicians and hospital at a 20 mile by-the-crow-flies distance. By legal roads, the distance is over 30 miles; mapquest.com correctly plots the route. We gave this information to Hewitt, but it seemed to make no difference to them.
Years of envy and jealousy of UC retiree benefits by Tyler P. and his fellow Federal Employees in DOE culminated in the "substantially equivalent" (in the aggregate)scam and the limitation of new-hire retirement medical benefits to "access only." It is only a matter of time before all retiree medical benefits will be eliminated. It is already happening at LLNL.
ReplyDeleteTo 11/11/08 7:05 AM: please email me and I'll see what I can do (gsclose@lanl.gov).
ReplyDeleteTo 11/11/08 11:42 AM: I understand that you have no idea what you're talking about, so let me clarify:
a) this network issue is not specific to retirees - it's the same UHC network for our actives, too. This is equal opportunity insurance aggravation, and by the way - certainly not unique to the lab.
b) LLNS isn't eliminating retiree medical. Please educate yourself on what Extend Health is and how it works before commenting. You don't have to like the new offering they provide, but it's still a retiree medical offering. I have no experience with Extend Health in practice, so why don't we all reserve judgement until we hear how it really works for people. It might be okay; it might be awful - would be sort of interesting to base our analysis on actual data, don't you think?
c) LANS just added retiree benefits for vision and passed along a 0% increase on rates. Oh no! The sky is falling! Let's concentrate on the real issues at hand (like this zip code/access issue) instead of inventing new ones that don't exist yet.
Here's some solid proof about just how lousy Hewitt is at handling employee benefits...
ReplyDelete*****
Federal Computer Week - Oct 20, '08:
"Retire? What's that?"
While private-sector workers watch their 401(k) values decline and wonder whether they'll be able to stop working this side of the tomb, federal employees have another challenge: The Office of Personnel Management has TERMINATED its 10-year, $290 million contract with Hewitt Associates to modernize the federal employees retirement system because the company failed to deliver a functioning benefits calculator. (Page 3)
In its letter of termination for default sent to Hewitt, OPM said the contractor was unable to meet the acceptable quality levels for accurancy in test scenarios. (Page 8)
*****
It makes you wonder how accurate Hewitt has been with the poorly designed benefits calculator that they provided to LANS for the TCP1 pension.
Even the federal government knows that Hewitt sucks!
Thanks 11/11/08 2:48 PM,
ReplyDeleteIt looks like you are quoting from the print version of this story.
Hewitt's presence in our personal livelihood is a concern. Hewitt is an international company that carries quite a clout in watering down our benefits package to match that of the world-wide median. Hewitt's interests are in the One-World Order, which is unnerving once recognized for what it is.
ReplyDeleteThis insightful Oct 2005 article from Time magazine on hijacked pensions and broken retirement promises makes an interesting read. It's still relevant today.
ReplyDeletewww.time.com/time/
magazine/article/0,9171,1122017,00.html
*_*_*_*_*_*_*_*
The Broken Promise - Time Magazine
...Through no fault of her own, Whitehouse had found herself thrust into the ranks of workers and their spouses--previously invisible but now fast growing--who believed the corporate promises about retirement and health care, often affirmed by the Federal Government: they would receive a guaranteed pension; they would have company-paid health insurance until they qualified for Medicare; they would receive company-paid supplemental medical insurance after turning 65; they would receive a fixed death benefit in the event of a fatal accident; and they would have a modest life-insurance policy.
They didn't get those things. And they won't.
*_*_*_*_*_*_*_*
The failure of the University of California to keep its commitment to provide "substantially equivalent" health benefits in our retirement and pass te but to Hewitt sucks. It anyone aware of a "class-action" lawsuti that might bring LANL and LLNL retirees back under the UC plans? UC seems to have washed their hands of us!
ReplyDelete11/11/08 9:23 PM... I am really not sure what you're talking about. Hewitt has no say in "watering down" any benefits. The consulting arm of Hewitt does provide a comparison tool in which data is plugged in to determine the BenVal data that DOE/NNSA requires for TCP2 benefits - is that what you're referring to? Please understand this is only a benchmarking function, not a "recommend to drop benefits" function. Also, keep in mind it only applies to the market-driven TCP2 plan, and does not affect TCP1, or the retiree medical benefits.
ReplyDeletePlease feel free to forward specific comments about Hewitt customer service issues to myself or benefits@lanl.gov so that we can deal with the concrete day to day issues and try to help resolve them.
11/12/08 12:08 PM - scary article, but good reading.
11/12/08 4:27 PM - I think the onus is on LANS to provide substantially equivalent benefits, not on UC. I believe that UC divesting itself of the retiree medical liability was part of the contract transition to the new entity. You could sue LANS, but so far I can't think of any major take-aways from the old UC plans. We've added more benefits than we've taken away (increased Dental exams, provided new retiree Vision, increased hearing aid benefit in the works, no rate increase). Hewitt only handles the billing and file updates and other basic administrative functions, nothing to do with determining the benefits etc. - they are primarily customer service, so please keep the Hewitt complaints rightly targeted to their actual sphere of influence. Preferably with enough detail that we can fix it.
What time is it, and why am I still typing?
Greg,
ReplyDeleteMy understanding is that the UC never had the liability for providing the LANL and LLNL retiree medical benefit, i.e, they only served as the administrator of the benefit.