2016 2:00:00 PM

Monday, June 27, 2016 2:00 PM
Council Chambers, Legislative Building 745 Fourth Street, Sparks, NV

General Business: 9.5

Title: Consideration, discussion and possible approval to make changes to the City of Sparks Group Health Plan Document as recommended by the City of Sparks Group Health Committee.

Petitioner/Presenter: Neil Krutz/Mindy Falk

Recommendation: To make changes to the City of Sparks Group Health Plan Document as recommended by the City of Sparks Group Health Committee

Financial Impact: Based on a total of 12 total claims in 2013, 2014 and 2015, the anticipated increase to the plan based on the proposed change is expected to have minimal financial impact at this time. Rates are being negotiated in-network to reduce liability and the Group Health Committee is increasing the co-insurance for out-of-network providers to help minimize financial impact.

Business Impact (Per NRS 237):
A Business Impact Statement is not required because this is not a rule.

Agenda Item Brief:

A language change to the current hearing aid benefit in the City of Sparks Group Health Plan Document as recommended by the City of Sparks Group Health Committee is required to ensure compliance with the Affordable Care Act (ACA) and Nevada State Law.

Background:

Based on recommendations from our Broker, LP Insurance; and our Account Executives at Hometown Health, the City of Sparks Group Health Committee was asked to review the current benefit structure for hearing aids to ensure legal compliance.

The Affordable Care Act, which implemented rules to employer group health plans beginning in January of 2014, states that plans may not place dollar amount maximums on essential healthcare benefits. The State of Nevada defines essential health care benefits and defines hearing aids as an essential healthcare benefit.

Current Plan Document language places a dollar limitation on the hearing aid benefit. It has therefore been determined by the Group Health Committee that the current benefit design is not in compliance with Nevada State law defining essential healthcare benefits and the requirements of the Affordable Care Act (ACA).

Analysis:

For the City of Sparks Group Health Plan to remain in legal compliance the plan must eliminate the $2,000.00 lifetime benefit for hearing aids.

Current Benefit Plan:

Hearing Aids	Deductible	In-Network	Out-of-Network
Hearing Aid benefit limited to a lifetime benefit of $2,000.00; Testing and fitting for the hearing aid is covered. Batteries are not covered.	Yes	80%	80%

After review, discussion and vote at an open meeting of the Group Health Committee on April 20, 2016, the following inclusion and change to the plan will prevent future liability and ensure legal compliance:

Proposed Language:

Hearing Aids	Deductible	In-Network	Out-of-Network
Hearing Aid benefit limited to a maximum of two hearing aid appliances in any three year period. Testing and fitting for the hearing aid is covered. Batteries are not covered.	Yes	80%	60%

Alternatives:

1. The Council could modify the recommendations of the Group Health Committee;

2. Council could direct the Group Health Committee to not make modifications to the City of Sparks Group Health Plan Document.

3. Council could direct staff to find other solutions to address this group health benefit.

Recommended Motion:

I move to approve the change to the City of Sparks Group Health Plan document to include the revised language for hearing aids as recommended by the City's Group Health Care Committee effective July 1, 2016.

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