Meeting Minutes for April 24, 2001

Present: Jake Baggott (ex officio), Kathy Blackwell (ex officio), Brian Chapman (Chancellor's Representative), Kevin Dorsey (Dean's Council), Patricia Hopkins-Price (Faculty Senate), Jim Hunsaker (ex officio), Worthen Hunsaker (Chancellor's Representative), Aslam Kassimali (Faculty Association), Steve Kraft (Graduate Council), Andy Morgan (A/P Staff Council), Roland Person (Faculty Association), Ruth Pommier (Civil Service Council), James Swisher (Emeritus Association).

Absent: Art Aikman, (ex officio), Vicki Benson (ex officio), Joann Marks (Civil Service Council), David Marx (A/P Staff Council), Doug McEwen (Faculty Senate), Thomas Stitt (ex officio).

I. Guest 
Becky Rolape from the Medicare Outreach Office in Marion provided an overview of Medicare and answered questions. She indicated she works for Wisconsin Physician Service, the carrier for Wisconsin, Illinois, Michigan and Minnesota. Her office works with Medicare Part B. She has worked with Medicare for 12 years and at one point actually worked on Medicare secondary payer files, so she is very familiar with secondary payers. Ms. Rolape stated that to be eligible for Medicare, most people are 65 and have been employed and paid into social security for at least 40 quarters (10 years). Some people under the age of 65 can also be eligible for Medicare if they are social security disabled or have end-stage renal disease. The people on end-stage receive benefits twice weekly after they have been diagnosed (first day, fourth month after starting dialysis). Disabled persons who have received disability checks for 24 months are automatically enrolled.

There are two parts to Medicare Part A and Part B. Part A covers hospitalization (inpatient hospital, skilled nursing facility, hospice care). Part A services are measured in a benefits period. A benefits period begins the first time a person enters the hospital after her/his insurance has begun and continues until s/he has been out of the facility for at least 60 days in a row. In each period, a person has 90 days of coverage while an inpatient. For the first 60 days, Medicare covers everything except for the deductible. From day 61 through 90 all charges are covered except for the daily co-insurance. That deductible and co-insurance changes each year. If a person is in the hospital for more than 90 days, s/he has 60 life-time reserve days that can be used on a one-time basis. The first 90 days are renewed each time the person enters a new benefit period. The 60 life-time reserve days are not renewable.

A person has 100 days of coverage if s/he goes into a skilled nursing facility. To quality, the person would had to have been in the hospital for at least three days in a row and entered the nursing facility generally 30 days within the date of discharge. The physician would have to certify the person needs that type of care in that facility, and the person would have to go to a Medicare-approved facility and need some type of skilled care on a daily basis. If the person is just going into a nursing home and the only type of care needed is custodial, then there would be no coverage. The person needs to receive some type of skilled care. For first 20 days, Medicare pays 100%; from day 21 through day 80, there is a deductible, a co-insurance for each day. Home health care is also covered by Medicare Part A. Each time a person needs these types of things, s/he needs to meet certain criteria. For home health, the person has to be home-bound, unless s/he leaves to receive medical care. Medicare has expanded that to say a person can go to an adult day care facility if s/he is receiving some type of care in that facility. Medicare pays for part-time nursing as long as the person is receiving some type of skilled care. It will also pay for a home health aide to cover doing some type of custodial care. Hospice is paid for at 100%. Under home health, a person does not have to have any co-insurance. Co-insurance and deductible are not needed for a hospice care [worker] or any kind of [durable] medical equipment. Medicare does not pay for prescription drugs other than oral chemotherapy drugs or if the person is in hospice.

Jim S. indicated it was his understanding that if retirees are not eligible for Medicare Part A, they can enroll for Medicare Part B if they pay for Part B. Ms. Rolape responded a person cannot buy Part B without being eligible for Part A. There are some people that can get Medicare Part B without Part A, but they first have to qualify and pay a premium for Part A; however, the premium for Part A is very expensive. She noted that people who become eligible for Medicare can delay enrolling in Part B without having to pay a penalty as long as they are either actively employed or are covered by a group health plan through a spouse who is actively employed. However, if the employee is retired and not covered through an active employee or group health plan and s/he decides not to take Part B but then decides later down the road s/he wants to take it, that person will have to pay a 10% higher premium for every 12 months s/he could have been enrolled and was not.

There are several instances when Medicare is secondary payer. Most generally it is age 65 or over, what is called the "working age," and those persons are employed or have a group health plan either through their current employer or their spouse's. If the employer employs more than 20 employees, they have to be primary [to Medicare]. Beneficiaries can choose not to participate in that plan and go ahead and start their Medicare; however, if they do that, the employer cannot offer them any supplemental insurance through Medicare. They can only offer a plan that covers what Medicare does not (such prescription drugs). If the person is on renal, s/he is entitled to Medicare because of end- stage renal disease and they are in an employer plan. That plan, regardless of the number of employees, has to be primary for 30 months and then Medicare kicks in again as primary. Medicare covers all needs for those with end-stage renal disease. If a person is no longer employed (retired) then Medicare would be the primary and the employer plan would be the supplemental.

Jim S. stated there are employees at SIUC who started prior to 1986 that did not go into the system at all (i.e., pay into social security or Medicare). Those employees who started after 1986 had payroll deduction for Medicare. Ms. Rolape stated that after 10 years of employment, if that was the only time they paid in, then they would be eligible to receive Medicare benefits once they reached the age of 65. Some people under the age of 65 can be covered if they are disabled, but they have to be deemed by the Social Security Administration to have met their criteria to receive the disability benefit. If that is so, and the employer employs more than 100 employees, then that plan has to be primary to Medicare provided it is through active employment. In all cases, except for the end-stage renal, it is through active employment. Anytime a plan comes in to Medicare and Medicare is secondary payer, there has to be an explanation of benefits from their primary insurer. If that is not with the claim, then the claim will be denied. Anytime there is a change in the status of the employee's group plan, Medicare and Social Security should be notified of that change.

With respect to physicians accepting assignments, every physician or supplier that signs up with Medicare applies for a Medicare number. They have the option of whether or not they want to become a participating provider. Physicians who sign an agreement with Medicare agree that for their services they will only accept the Medicare-approved amount regardless of the billed amount. Medicare will pay 80%, and the supplemental pays the other 20%. If they are non-participating, then they can collect more than the Medicare-approved amount; however, they are still limited to only collecting 115% of that approved amount, so the most they could bill for their services if Medicare approved $100 would be $115. If they try to collect over that, the Medicare beneficiary gets a message that tells them the limiting charge is violated, and they should get a reduction in charges or a refund.

[The names of participating physicians] go into the Medicare participating provider directory, which can be found on the web site www.medicare.gov. The reimbursement rate for non-participating physicians is 5% less than what a participating provider would receive. Currently, the state of Illinois is at 92% in participation by physicians. Most of them do accept assignment; the ones that do not probably are more of the speciality group (non-physician services). Beneficiaries are responsible for the full billed amount no matter what the cost. The limiting charge also applies when Medicare is secondary payer. When a claim comes into Medicare, if the physician is non-participating, s/he can collect up to the limiting charge from the primary, secondary, and beneficiary, provided s/he has not received up to the limiting charge. A lot of times when Medicare calculates its payment for Medicare secondary payer, it is approved. However, depending on the primary paid amount, what Medicare will look at is the primary approved amount and the Medicare approved amount, whichever pays higher, then subtract the primary payer's payment. That number is compared to what Medicare would have paid if Medicare had been primary, and then Medicare pays the lesser of the two amounts. It is possible to still collect from the beneficiary even on an assigned basis up to the Medicare [approved] amount. Whenever Medicare processes its claim, the approved services are applied toward a person's deductible so later in the year if s/he has retired and that plan becomes her/his supplemental, then the person would have already met her/his deductible.

Everyone reaching the age of 65 is automatically enrolled in Medicare if they are receiving social security benefits. They can then choose whether they want to enroll in Medicare Part B. Jim S. indicated retirees are penalized in terms of state coverage if they are eligible for Part B and choose not to enroll. Ms. Rolape stated there are no laws to regulate what an employer can offer to a retiree as a supplemental policy. It would be the employee's choice to go into supplementary insurance program. Medicare never advises people but give options. Ms. Rolape stated she actually works in the Medicare Outreach department, and until this year what they have always done is go out and speak to groups of retirees and pre-retirees, especially, to explain what the Medicare benefits are, how it works with the supplemental policy, and whether or not they should purchase Medigap. Because of budget cuts, the office has had to scale back on its [informational workshops]. However, people may go to the Medicare office and ask questions. They can also access the website and the help line (1-800-Medicare). There are insurance counselors with the Senior Health Insurance Program who can counsel and answer questions about Medicare and supplemental insurance.

Steve asked what Human Resources is doing in terms of making employees aware of their options. Jim H. responded there is a good interface between Human Resources and employees. If someone retires before age 65, CMS will notify that retiree about a month prior to her/his birthday that the person needs to sign up for Part B. If the person does not sign up, s/he will be notified that her/his benefits will be reduced by only the difference that Medicare Part B would have paid. If someone is retiring after age 65 and they go through Human Resources, then they are told that by Human Resources.

Steve asked if SIU has some kind of decision tree set up for retiring faculty and staff that would tell them their options if they were employed before 1986 and their spouse is not qualified for social security. Kathy stated it is something that is discussed when the employee come in for pre-retirement counseling, although there is nothing on paper. Ruth indicated that SURS is not addressing this issue in their retirement sessions. Ms. Rolape stated Medicare set up a booth at the benefits fair last year and was giving out information. If a benefits fair is held again, this information could be given out. In addition, the retirement package could include the www.Medicare.gov website. There are all kinds of links and information employees could use to help them know what their benefits are.

Jim S. stated there have been some problems where Medicare is the primary and the state is the secondary because the state will not pay anything until the Medicare claim has been processed. Ms. Rolape indicated if a claim comes in on paper, Medicare cannot pay the claim until it has been in-house for 28 days. If the claim comes in electronically, Medicare has 14 days to pay the claim. A lot of people are going electronic, and a lot of supplemental [insurers] are cross-over companies. It is called a cross-over company because Medicare sends send them a copy of its explanation, whereas before a patient would have to make a copy and send it in to her/his supplemental insurance. Now, as long as that company has a contract with Medicare and says they want to be involved, then they can give Medicare a tape that it can use to send [employees] all the explanations of benefits for which they have policies. A lot of people take advantage of that. Jim S. indicated many people get [dumped] unmercifully because the insurance companies, mainly the state, are so slow [to pay]. Some of these people are in ill health, and it just shatters them. It is hard to know how to help those people. Ms. Rolape stated all of Medicare's guidelines derive from the government. They decide what Medicare can and cannot pay. Very few things are left up to the carrier. Medicare audits every year to make sure its directives are correctly implemented. All of those directives can be found on the Healthcare Financing Administration web site https://www.federalregister.gov/agencies/health-care-finance-administration. Jim S. asked if a physician with assignment can force a patient to pay the bill prior to Medicare filing their claim. Ms. Rolape responded that the only thing they can collect at the date of service is any unmet deductible or the 20% co-insurance. They can collect that at the time of service, though most physicians do not do that. They actually have 12 months from the date of service if they are assignment. Doctors that are non-assigned can collect the full billed amount up front the day of service, and they have 12 months to submit that claim. Until that 12 months passes, Medicare cannot say anything to them. An assigned doctor who waits more than 12 months to submit the claim has her/his reimbursement reduced by 10%. In addition, depending on the date of service, the doctor can have anywhere from 15-18 months before it is late filing. If it is late filed and denied by Medicare because of that, then the only thing the doctor can collect would be 20% of the approved amount.

II. Announcements - None.

III. Approval of Minutes of February 27, 2001 
The minutes were approved as presented.

IV. Approval of Agenda of April 24, 2001 
The agenda was approved as presented.

V. Updates from Human Resources 
A) Kathy introduced Jim Hunsaker as the new benefits manager. He can be contacted on any benefits- related questions.

B) Jim H. reported he went to Springfield on April 11 for a benefits choice meeting. There will be two main changes to the benefits offered this year. First, the life insurance carrier is changing from John Handcock to Minnesota Life. The premiums will be reduced dramatically. Second, there will be another option for a managed care plan, known as an open access plan, through HealthLink. It is a three-tiered health insurance program that will offer employees the flexibility of Quality Care with the premium and benefit of an HMO if they choose to go to an HMO doctor. The tiers break down into an HMO network, a PPO network, and an out-of-service network. Benefits vary on each tier. The premium is between the Health Alliance HMO and the Quality Care Plan. Kathy noted that benefits choice books will be mailed out to employees and will include premium rates. Meetings have been scheduled for May 10 and 23 with representatives from both Health Link and Health Alliance to give overviews of their plans. The new life insurance booklets will also be mailed shortly. Steve asked if there will be another benefits fair. Kathy responded she hoped to have one in the fall in conjunction with flu shots.

VI. Subcommittee on Health Benefits 
A) Steve reiterated the need for a chair of the committee. Jim S. reported he received a copy of a press release from AFSCME on dental benefits. That group filed a grievance because they believe CMS violated their contract in terms of what is being paid on Unicare dental claims. AFSCME won their grievance, and step-wise over next three years there will be big increases in what dental insurance will pay. Jim S. indicated he was told there will be some increases next year, but he was unsure if this is part of a three year step-up plan. Jim H. stated he was told it only applies to the AFSCME employees covered by the master contract (Council 31); it does not cover any employees affiliated with SIU. Jim S. indicated it is the general feeling on campus that whatever AFCME gets in their contract, SIU gets also. Jim H. stated that is incorrect. Jim S. indicated the Faculty Association can put benefits on the collective bargaining table, but they have not chosen to do it so far. He believed if things get bad enough, the unions could put that on the agenda. Steve questioned whether there are sources that could be tapped by the committee on a regular basis to keep informed on this and other issues. Jim S. indicated there are ways to infiltrate AFSCME. It is possible to join AFSCME. However, he was unsure how much that would help. Ruth stated that aside from SIU, there is not another university in the state that has representation by a major bargaining unit. Steve indicated the committee has tried in the past to encourage the administration to be more involved in the CMS negotiating process to no avail. Ruth noted there are lobbyists in Springfield connected with the Illinois Education Association that are in constant communication with CMS and know everything that is going on. At least they are in the loop. Roland asked if it was possible to find out if AFCME is the exclusive agent by [benefits choice period]. Ruth stated she could check. Aslam stated he did not believe AFCME is legally entitled to bargain on SIU's behalf. Also, whatever act that allows the University to negotiate, he believes, gave [the Association] the right to negotiate anything that has effect on wages, working conditions, etc. That theoretically does give the Association the right to negotiate fringe benefits. The question is, does the Association really want to, and does it have that right or not. Ruth believes the Governor is recognizing AFCME as the sole bargaining organization at this time.

B) Jim S. reported there is a long-term health care program that employees 50 years and over are eligible to take out if they join the Emeritis Association. There will be a workshop on May 25 if anyone interested in attending.

Because of the lateness of the day, Steve requested the remaining items on the agenda Subcommittee on Retirement Benefits and Annuities, Old Business (Sick Leave Pool Proposal) and New Business be tabled and picked up at next meeting. Roland asked Ruth if she would be willing to ask about AFCME and whether it is true or not that whatever they bargain for is what the University also gets. Ruth indicated she could check on this. Steve asked Brian to check into the matter from the position of the Vice Chancellor for Administration. Brian stated it is important to know that it is not just SIU but all state employees [who are non members]. A motion was approved to table the remaining agenda items until next meeting.

VII. Adjournment 
The next meeting of the committee is scheduled for June 26.