Sept. 28, 2001 – Coming in just under the wire, the Senate approved a new health insurance package for government workers Friday in a special session called by Gov. Charles Turnbull to ratify the contract.
The government's current contract with Blue Cross-Blue Shield expires Sunday. Under the new plan, Connecticut General Life Insurance Co. (CIGNA) will supply medical insurance, and Metropolitan Life Insurance Co.( MetLife) will provide dental coverage. The contract takes effect at 12:01 a.m. Sunday, when the previous contract expires.
The plan covers about 30,000 government employees, retirees and dependents.
Paulette Rabsatt, chair of the Government Employees Service Commission/Health Insurance board, testified on the contract. So did other board members, representatives of the insurance carriers and the Division of Personnel, and Ira Mills, director of the Office of Management and Budget.
Rabsatt called the new plan "the best the market has to offer." The GESC is responsible for drawing up insurance contracts and for the operation of the government health insurance plan.
Most of the senators complained about having only two days to study the new contract. It was delivered to the Senate at mid-day Tuesday, four and a half days before the current coverage would expire. It arrived with Gov. Charles W. Turnbull's message that "It is imperative that we ratify the new contracts to avoid any disruption of service to our employees."
Rabsatt gave a lengthy, detailed explanation, which Senate President Almando "Rocky" Liburd later referred to as her "dissertation." She compared the old and new contracts and reviewed the history of the negotiations, characterizing this year as having been a "perpetual state of negotiations."
The new contract, estimated at $59.4 million, represents premiums for medical and prescription drugs under a fully insured arrangement of $55.4 million, plus dental coverage of $4 million. Turnbull ordered that there be no increases in employee premiums, a decision consistent with what he did last year.
The contract includes prescription drug coverage, something that the government had to administer separately before. CIGNA offers the same deductible for services on the mainland or in Puerto Rico as it does for services in the territory — $50 to $150 within network services. The current plan has a deductible of $250 to $500 both in and out of "network" — the group of doctors the carrier recognizes.
The territory has had a long and rocky ride with Blue Cross/Blue Shield, winding up in court at one juncture in August when a class-action lawsuit was filed against the company alleging that the it was wrongfully rejecting claims of retired public workers.
The suit was filed in the St. Thomas district by Maria Tankenson Hodge, a partner at the law firm of Hodge & Francois, on behalf of Gloria Davis, Gerald Hodge Sr. and Lawrence Hodge, who is Tankenson Hodge’s husband. She said the action was triggered by Blue Cross/Blue Shield's refusal to pay claims to retired workers receiving Social Security who are eligible for Medicare. The case, which could impact on some 4,000 people aged 65 and older, including spouses, is pending.
The Blue Cross/Blue Shield contract was to have expired Sunday, the last day of the 2001 fiscal year. But is has been extended several times because of the failure of the government and the company to negotiate a new contract.
The board learned a year ago that it would be facing a $9 million increase because of increasing claims in the territory, and this set off the series of negotiations.
Last January, the governor approved a revised plan design that the board had worked on with Blue Cross/Blue Shield. The target date was moved to April 2001, and then July 2001.
Finally, in the face of escalating Blue Cross/Blue Shield terms, the board obtained permission to shop for a new carrier. Although barely three months remained before the current contract expired, Rabsatt said, this step was the "lesser of two evils."
None of the board members wanted to be back before the Legislature to explain that a scaled-down Blue Cross/Blue Shield plan was the best they could do, Rabsatt said.
The board sent out 19 requests for bids on June 28. They got 11 responses, which they narrowed down to four before deciding on CIGNA, she said.
James White, CIGNA national account executive, told the senators his company will not only assure the appropriate level of care and intervention but also simplify administrative processes. Responding to questions from Sen. Emmett Hansen II, he said CIGNA, a Fortune 500 company, would be willing to initiate public health education programs, but they would be neither free nor part of the contract.
Asked which carrier would have responsibility for patients now in the midst of a treatment program, White and Rabsatt said Blue Cross/Blue Shield would cover current commitments and CIGNA would pick up where other policies left off.
White said the economic effects of the Sept. 11 terrorist attacks on the mainland would not affect the Virgin Islands coverage. "I know the insurance companies are covering huge losses," Sen. David Jones said. White said policies are individually rated, not a "pool product," and the territory wouldn't be affected.
Jeff Trinkwon, regional manager for MetLife institutional sales, said his company's turnaround time for in-house claims is less than 10 business days — and 70 to 90 percent of those claims are adjudicated within two to four business days.
Rabsatt said the new plan is very close to the current plan, with some enhancements, including these:
– A flat co-pay of $15 for standard office visits and preventive care. Within the CIGNA network, this means the total responsibility of the insured for services is limited to $15, and the insurer pays 100 percent of the scheduled benefit payments for those services.
– Waiving of the $15 co-pay for pediatric immunizations up to age 2.
– No deductible for X-ray and laboratory services if billed by a separate provider within the network.
– Inclusion of an annual eye examination.
The contract was approved on a 12-0 vote with three absent. Sens. Adlah "Foncie" Donastorg and Vargrave Richards were excused; Sen. Adelbert Bryan was absent.
Liburd is yet to act on filling the two Senate posts from which Bryan resigned on Tuesday — vice president of the 24th Legislature and chair of the Economic Development, Agriculture and Consumer Protection Committee. Bryan quit after his proposal to form a new economic commission headed by himself was voted down.


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