HMSA plan bumped by limitation (a bug?) in new EUTF computer system

Silly me. I thought I would drop by the State Capitol yesterday afternoon for the information session about changes in the public employee health insurance plan choices. Just me and thousands of others, it turned out.

There was no parking anywhere near the capitol. The capitol auditorium turned out to be a limited venue for the demand. Hallways were clogged with lines wandering up and back, elevators were running at their normal slow speed, and it was generally chaos.

The basic change is that the Hawaii Employer-Union Health Benefits Trust Fund decided to offer the choice of a slightly lower cost health plan that provides a lower level of benefits.

In the past, employees covered under the default plan paid 10 percent of medical costs, with 90 percent paid by the insurance. They will now have the choice of an 80/20 plan with lower monthly premiums.

In addition, HMSA, the local not-for-profit provider, has been displaced as administrator of the primary 90/10 insurance option by a for-profit mainland company, Summerlin Life & Health Insurance Company, after EUTF decided it could not offer competing 90/10 plans.

And that decision was based on a technical requirement of the EUTF’s newly upgraded computer system rather than a more substantive reason, according to an explanation provided by the University of Hawaii Professional Assembly

When the EUTF decided to add a lower cost 80/20 benefit plan, they felt they need to eliminate one of the 90/10 providers; either HMA or HMSA for technical reasons having to do with the number of code spaces on the EUTF computers.

Did I read that right? The number of spaces on a form utilized by the EUTF’s fancy new computers dictated the shape of the coverage offered to the tens of thousands of public workers? Whew.

This is the same computer system that was recently upgraded, causing a two-week hiatus in EUTF’s processing of enrollments and claims.

UHPA also offers the following observation:

However, there are differences in the panels of participating physicians between HMA and HMSA. Further, if you travel to the mainland, the Blue Cross system of the hospitals and physicians will not require any up-front cash payment for services; they’ll accept your HMSA card. HMA also has a panel of participating hospitals and medical facilities on the mainland, but it is not as extensive. Hospitals or doctors may be required to get telephone approval for your charges you incur, or you may have to pay for the medical services and then submit them for reimbursement upon returning to the Hawaii.

Las Vegas-based Summerlin Life and Health Insurance Company was founded in 2003, and licensed in Hawaii in 2004. It is owned by the privately-held i/mx Companies (www.imxinc.com).

The company announced in December 2008 that it was pulling out of the commercial preferred provider insurance business in Nevada.

9 responses to “HMSA plan bumped by limitation (a bug?) in new EUTF computer system

  1. interesting… i’ve seen the HMSA ads on TV recently warning folks about this.

  2. Essentially, gov’t employees are having to fill out EC-1 forms and potentially lose benefits temporarily due to an impending backlog that, lo and behold, may have been created because the EUTF’s computer system can only handle a limited number of code spaces.

    My head is about to explode. I wonder what my copay will be under the 80/20 option?

  3. So in order for the state to try to cut its cost of doing business by what maybe 10%, they are penalizing a local company that is not for profit and pays Hawaii taxes, so they can go with a Mainland for-profit company that cant deliver as good a product/service and which will in the process inflict all this chaos and hassle on their employees? And, the excuse is their new computer system which cant handle the changes…auwe. Sounds like the EUTF management has lost site of the bigger picture and mis-managed this whole effort!

  4. Hubby’s plan is HMSA-HMO. He works for a private company that pays his premium. All we pay is $15 co-payment for dr visits and a little extra for ER and lab work.

    • that’s pretty much the same plan/arrangement i have, but the doctors i am limited to pretty much suck in general and i’m often “guided” away from procedures/testing that would offer a real diagnosis and appropriate treatment and am instead offered a “best guess” and treatments that equal “let’s throw X number of things at this and see what will stick.” i hope that by the time i actually need real and important medicine, i will have a better health plan.

  5. Thanks for running with this story. I really wonder if Hawaii isn’t going to melt down. What’s left? A December hurricane?

  6. Thanks for the wake up message on this.

    One has to wonder how much this “cost savings” plan will cost the public in lost state employee time on task as everyone scrambles to figure what they need to do in the next two and a half weeks.

    But the real question is whether these are unintended or intended consequences of a governor who wants to show how bad government is.

  7. I have COBRA through EUTF and recently received a letter from HMSA that my COBRA was canceled. The lower rate thru the ARRA had expired, but my COBRA has another seven months. HMSA acknowledged the error and hopefully I will get another letter this week stating that i still have COBRA and setting the new rate. I still don’t know if I have to make changes during the open enrollment period. I got a flyer from HMSA but no info from EUTF.

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