Sharon Kovarik, Benefits Specialist
Office of Insurance
Department of Finance and Administration
455 North Lamar Street
Barefield Complex
Jackson, MS 39201
 

Dear Ms Kovarik -
 

I recently received a "HEALTH PLAN UPDATE for participants of the: State Employees' Health Insurance Plan and Public School Employees' Health Insurance Plan" dated September 1999. The newsletter included information about the changes in the way insurance will be handled in 2000. Based on the newsletter, I have enclosed a list of questions I would like the Department of Insurance to answer.
 

Thank you for your help in this matter, I look forward to your reply.
 

Sincerely,
 

Anne M. Klingen
Public Services Law Librarian
University of Mississippi Law Library

1. How can we be expected to sign up for an insurance plan that has no physicians? We are supposed to sign up for benefits the week of October 11-15 and as of September 20, 1999, Mickey Brown, Manager, State Network Contracting, Advanced Health Systems, Inc. (AHS) still has no list of Physicians, Hospitals or Clinics that have signed on to the plan. When can we expect to get a list of health care providers that have signed up for the plan. If there are no health care providers signed up with AHS in the geographic area that a patient lives in, will we have the option of going to a non-networked physician and still be reimbursed at the networked percentage? And by the same token, if a patient has a pre-existing illness which has been treated by a specialist for a number of years, and no physician with that speciality has signed up with AHS, will that patient have the option of going to a non-networked specialist and still be reimbursed at the networked percentage?
 

2. Please provide information about why Advanced Health Systems, Inc. (AHS.) was selected by the State Office of Insurance over the previous network groups or any other groups that provided proposals to the State Office of Insurance? What were the selection criteria that was used by the State Office of Insurance and the Health Insurance Management Board? Please provide a copy of the contract AHS has with the State Office of Insurance to provide insurance coverage for state employees.
 

3. Please provide background information about AHS, including information about how long AHS, Inc. has been in business; where they are incorporated; and do they operate in other states, and if so which ones?
 

4. What are AHS's recruiting methods for Physicians, Hospitals, and Clinics in the Oxford and the Memphis area? As of September 27, 1999, many of the doctors and clinics used by staff members of the Law Library had not received any information about the changes in the MS State Health Plan and had not received any information or notification from AHS. I am concerned that AHS is not being pro-active in contacting these groups.
 

5. What are the contract terms AHS is offering to health care providers? Or more specifically are the terms that are being offered for 2000, similar to the contract terms offered and
accepted by health care providers last year (1999)?

Note: Sharon Kovarik in her October 7, 1999 address to the University of Mississippi Staff Council stated that the terms being offered were similiar to the terms offered to Key Network Physicians last year, so that in all probablility all Physicians in the Key Netowrk should become part of AHS State Network.  But she would not address whether doctors in the Baptist & Physicians PPO and the Mississippi Health Connection had similiar contracts and whether they would by part of the AHS State Network.

6. What is the probability of offering an insurance plan option that allows state employees better coverage and lower deductibles with the state employees paying a portion of the cost in monthly deductibles?
 

7. Has the State Department of Insurance and the Health Insurance Management Board ever considered getting input from a representative group of state employees that are covered under the State Health plan? And if not why don't you start?
 

8. My understanding is that the only Network available under the State Health Insurance plan will be the AHS State Network - that we will no longer have the option of choosing the Baptist & Physicians PPO, the Key Network, or the Mississippi Health Connection, but are instead
limited to AHS only. Is that correct?

Note: Sharon Kovarik in her October 7, 1999 address to the University of Mississippi Staff Council stated that this was correct.

9. I am very concerned about the lack of a consistent list of health care providers for state employees. For the last several years there have been major changes in the health plan almost every year. Being able to keep the same health care provider usually results in better overall health care coverage for the patient, since the health care provider is aware of the patient's continuing history. I am sure that the State Office of Insurance wants to provide consistent health care for state employees. Is there a plan in place to work toward stabilizing the plan or should we look forward to another major change in health care providers next year?
 

10. What is the justification for the change in the co-payment method for prescription medications? Specifically why was it necessary to increase generic co-pay amounts by 62% and single source prescriptions by 66%? Please be explicit in the cost breakdown of the decision.

NOTE:   Sharon Kovarik in her October 7, 1999 address to the University of Mississippi Staff Council statedthe costs of prescription drugs to the Health Insurance Plan have risen by 116% between 1996 and 1999.  This dramatic increase in cost is the reason behind the change in the co-payment method for prescription medications.

11. Why is the cost of diabetic supplies rising so dramatically? Under the present Pharmacy Co-Payment system if a doctor prescribes a large number of units of insulin to a patient, (which would require then to receive multiple vials of insulin) then the diabetic would only pay $12
for a 30 day supply/one months prescription, no matter how much insulin they are taking. Under this new plan, a state employee who is a diabetic taking insulin will be charged $8 for every vial of insulin they use, no matter how many vials/units the physician includes in the prescription - is this correct??? If this is correct, what is your justification in increasing the cost of insulin when an estimated 240,000 Mississippians have diabetes, and approx 2,000 Mississippians die from complications from this disease every year, many of which are covered by this health care plan?

NOTE:  Sharon Kovarik in her October 7, 1999 address to the University of Mississippi Staff Council stated that this has been interpreted incorrectlyt and that the $8 charge for one vial, really menas an $8 charge for one month worth of Insulin prescribed by the Physician.  She also said that the Office of Insurance will be sending out something clarifying that statement.

12. In the September 1999 Health Plan Update there is a list of Co-Pay Amounts for diabetic Supplies. On that list it states that purchasers of disposable insulin needles/syringes will be charged $8 Per 100 Units. (See accompanying photocopy) Exactly what does that mean?? Disposable insulin needles/syringes come in several different 'unit' sizes - 25 units, 50 units and 100 units. (See accompanying photocopies of 2 syringe boxes) Are you saying that each syringe/needle that can inject 1cc or 100 units of insulin will cost $8? While I can only hope that this is an error in language and that the State Insurance Board really means that the cost will be $8 for 100 single use syringes/needles, I must admit that having seen the radical cost changes of over 60% for pharmacy benefits, I feel I need clarification.

NOTE:  Sharon Kovarik in her October 7, 1999 address to the University of Mississippi Staff Council stated that 100 units meant 100 single use insulin needles or syringes, and that the Office of Insurance will be sending out something clarifying that statement.

13. Considering the large number of diabetics in the state of Mississippi, which would correlate to an equally large number of state employees with the disease, is there any plan to include physician sponsored weight, diet and exercise management programs in the health insurance coverage in the future?