Don't rush change in medical coverage


POSTED: Friday, November 13, 2009

Thousands of county and state workers converged on the state Capitol this week, worried about the potential disruption of their medical insurance come January.

They are correct to be concerned, and the state board that governs the public workers health fund should act swiftly to resolve the multi-layered problem, including canceling this “;off-cycle”; open-enrollment period if that's what it takes to ensure seamless health coverage.

The administrator of the Hawaii Employer-Union Health Benefits Trust Fund has warned state and county personnel officers that a “;serious workload and resource issue”; makes it unlikely that all the paperwork for state and county workers' medical plans can be processed in time to avert gaps in coverage.

The EUTF staff usually handles 4,000 calls a month but has received more than 3,000 calls in the first three days of November; the open-enrollment period is supposed to run through Nov. 30, for policies that take effect Jan. 1.

But the main reason the workload is so heavy is that the board changed the “;default”; health plan. That means that many people who are happy with their current plan, and don't want to change it, must file paperwork stating that or be automatically switched to a different plan.

Poor communication from the EUTF compounds the problem. The EUTF states on its Web site that “;due to a computer programming error”; the open-enrollment notice normally generated for each active member, describing enrollment and dependent status, was not distributed; members are advised to get the information from their employers.

And the Web site goes on to give conflicting information about who must process paperwork and what will happen to their insurance policies if they don't.

It's no wonder that throngs of people packed the Capitol this week — about 3,000 packets were picked up — seeking information and reassurance. They got plenty of the former, but not much of the latter.

Officials from the insurance company Hawaii Medical Services Association have called the process “;fatally flawed”; and are especially worried about 65,000 members on its PPO plan, which is no longer a default. HMSA members happy with that plan have to actively select it to retain it.

The much-smaller Health Management Association (HMA), by contrast, is not complaining, as it stands to gain new members as the provider of the new default plan for PPO members.

But rather than seeing this as a competition between insurance companies, the focus should be on the policyholders: in this case tens of thousands of state and county workers in Hawaii.

With the EUTF administrator acknowledging that he cannot guarantee them uninterrupted insurance coverage, it seems prudent to consider scrapping this off-cycle enrollment and doing a better job in April, the usual open-enrollment period.