Retiree Health Care
Third Party Administrator Transition 2014
A Note From Your Medical Information Committee
On January 1/1/14, the State implemented an Amendment to the retiree Medical and Dental/Vision/Audio (DVA) plans. This Amendment rescinded parts of the 2003 Retiree Benefit Book, and replaced them with language that significantly and fundamentally changed the retiree Medical and DVA plans.
Also on January 1, 2014, the state hired two new third-party administrators (TPAs). Aetna was hired to manage the Medical, Vision/Audio plans, and Moda Health was hired to manage the Dental plan.
The Commissioner continues to insist that nothing in the Medical plan has been changed, yet RPEA is asked daily to help retirees understand the changes, help them get mistakes corrected, and for advice about how to appeal denials for services that have always been covered under our Medical plan by all previous TPAs.
The Commissioner acknowledges that the Dental/Vision/Audio plan (DVA) was intentionally changed.
One of the most egregious and punitive changes made was to the retiree dental plan. We now have a dental network, and although some dentists are willing to join, many are not. In an attempt to force all dentists into network, the State has authorized Moda Health to impose a 25% penalty on all claims from out-of-network dentists, and this penalty applies to Alaskan residents only. We have been told that the reason for this severe penalty is to encourage retirees to encourage dentists who are not in-network to join the Delta Dental network.
This penalty is being imposed even when the out-of-network dentist's fee is the same as, or lower than, a network dentist's fee. For example, a retiree recently told us that her dentist is not in-network, and his fee for a cleaning is $95.00. After the 25% penalty, she was reimbursed only $62.00. Prior to 1/1/14 this service was always reimbursed at 100%.
In contrast, another retiree told us that her dentist's cleaning fee is $130.00. Because this dentist is in-network, the claim was paid at 100%.
RPEA has been advocating for retirees about the many changes and reductions to all of our benefits that took effect on January 1, 2014. We have sent the Commissioner several letters requesting that the DVA reductions be rescinded and benefit levels be restored to what they were prior to January 1, 2014. He has responded to each letter of request stating he will not rescind any of the changes.
We have posted the communications between RPEA and the Commissioner since the beginning of the year on this page, and will continue to post future communications for you to see. If you have any questions please let us know.