Early retiree in plan 1 and im actually not getting any of the service that i had contracted for, particularly for my out of Network Payments or out of network coverage. I have a i am covered by medicare. And what i understand is irrespective of the medicare coverage, for my out of Network Payments or coverage excuse me, im really nervous. It should be at the 50 of the ucl rates. Is that correct . As im understanding it . Yes, okay. What united is telling me now is they will only cover 50 of what a medicare physician would cover if i were seeing a medicare physician. But i am not seeing medicare physicians and, so, for example excuse me i see a doctor who charges 225 for a visit. So, rather than paying me 50 of 225, united is now paying me 37. Which, if that continues, i can no longer see my physician and i would like to be change policies or out of the open Enrollment Period if i can no longer see my physician. And paying 1700 a month for the privilege of seeing an out of plan provide
Consultants do a review of any federal or state changes that need to be brought to [speaker not understood] on the rates and benefits and this was missed. So, we do have a process for it, we miss it had, and i think it wasnt until kaiser let us know this was occurring, really last week and saying this is now part of the rates benefits that we were alerted to the fact. I think its fair to say we should also be working as a doublecheck with our Health Care Benefits to make sure they arent aware of anything as well. Thank you. When did kaiser and blue shield remove it . The kaiser notice was it was removed essentially immediately because its a legislative mandate. So, it has to be done immediately. Any other comments . We have a motion. I move the adoption of the removal of the cap on transgender benefits. Second it. This is for plan 1. Plan 1. Okay, its been moved and seconded. Any Public Comment on this item . Seeing none, all those in favor. Aye. Opposed . Its unanimous. Madam secretar
Same benefit this person with two kids is getting because thats a benefit theyre getting. And if im not getting that same benefit in monetary amount, then i am being discriminated against because why should Somebody Just because theyre married get more benefits . One of the reasons why the city always kept the single employee at zero because it was to offset any benefits that the other people, married plus 1, married plus 2 got. And as i look at these rates, besides plan 1, its going to leave the city as far as i can tell open for someone to say, i want the same monetary amount as this other employees getting because just because hes married shouldnt affect why i dont get it as well. So, i think the city is leaving them self open for problems. Im not saying an employee couldnt have done that prior to this, but theres going to be more incentive to do it now because its costing them money out of their pocket. Thank you. Any other Public Comment . Seeing none. Madam secretary, item number
Lisa ghotbi. Thank you, lisa ghotbi acting director. This is something we usually deal with during the rates benefits process, but this issue didnt come to light to the Health Service system until last week. We wanted to make sure we brought it to your attention now so we can make sure we get it into our guides and its clear for our members going forward. It was actually a memo issued by the department of managed health care on april 9th of 2013 which essentially says that no lifetime limits are allowed under any plan thats licensed under the department of managed health care when it comes to any kind of gender reassignment benefits. So, the two plans we have that are administered through the department of managed health care blue shield and kaiser, this is a legislative change thats mandated. For the one plan that is not covered, it was the board decision to decide to make benefits equivalent across all of our products. So, the recommendation to the board is that we do maintain consis
Always kept the single employee at zero because it was to offset any benefits that the other people, married plus 1, married plus 2 got. And as i look at these rates, besides plan 1, its going to leave the city as far as i can tell open for someone to say, i want the same monetary amount as this other employees getting because just because hes married shouldnt affect why i dont get it as well. So, i think the city is leaving them self open for problems. Im not saying an employee couldnt have done that prior to this, but theres going to be more incentive to do it now because its costing them money out of their pocket. Thank you. Any other Public Comment . Seeing none. Madam secretary, item number 4, please. Item 4, discussion item, update on Financial Reporting as of may 31, 2013, gregg sass. Good afternoon. This might be my last hearing here before the commission. So, im smiling because i get to go back to retirement. But i have really enjoyed my time here. I have really appreciated th