TITLE
Title
2017 HEALTH PLAN UPDATES
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SPONSOR
Sponsor
John Dean (Carol Campbell)
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BACKGROUND
Background
While there are no significant proposed plan changes for 2017, and no medical or dental rate increases for employees or pre-65 retirees are recommended, there are a few changes made necessary due to statutory and plan issues that may affect a very limited number of employees that need to be addressed, including the following:
1. Currently, treatment of Autism Spectrum Disorder is specifically excluded in the Guilford County health plan. Last year NCGS 2015-271 set forth the requirement that such exclusions be removed and that Adaptive Behavior Treatment for Autism Spectrum Disorder be a covered benefit for plan years beginning on or after July 1, 2016. According to the statute, the same deductible, copayment and coinsurance percentages should apply as those currently in place for mental and physical health services for in and out of network services, but may be limited to $40,000 per year (to be indexed in future years). The statute allows for coverage of these services to be discontinued when the person reaches age 18.
2. Discrimination in certain health programs or activities on the basis of race, color, national origin, sex, age or disability has long been prohibited by federal law. Section 1557 of the Affordable Care Act sets forth that the application of long-standing civil rights nondiscrimination laws applies to health plans and extends to gender transition services. The Guilford County plan currently excludes coverage for these services. It is recommended that this exclusion be removed and replaced with notification and pre-authorization criteria as set forth in the attached.
3. Diseases that require treatment with specialty medications are particularly difficult to manage. Specialty pharmacy costs continue to rise, with some medications costing as much as $100,000 for a 3-month course of treatment. United Healthcare (UHC...
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