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Legislation Details
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On agenda:
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10/15/2024
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Final action:
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10/15/2024
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Title:
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Approve and authorize the Chair to sign an amendment to the Self-Funded Group Medical and Dental Benefits Preferred Provider Organization (PPO) Plan among Clark County, Clark County Water Reclamation District, University Medical Center of Southern Nevada, Las Vegas Convention and Visitors Authority, Las Vegas Valley Water District, Clark County Regional Flood Control District, Regional Transportation Commission of Southern Nevada, Southern Nevada Health District, Henderson District Public Libraries, Mount Charleston Fire Protection District, Las Vegas Metropolitan Police Department, Moapa Valley Fire Protection District and Eighth Judicial District Court adopting an amended Self-Funded Group Medical and Dental Benefits PPO Plan, effective January 1, 2025. (Also sitting as Clark County Water Reclamation District Board of Trustees, University Medical Center of Southern Nevada Board of Hospital Trustees, Mount Charleston Fire Protection District Board of Fire Commissioners and Moapa Valley Fire Protection District Board of Fire Commissioners) (For possible action)
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CLARK COUNTY BOARD OF COMMISSIONERS
AGENDA ITEM
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Petitioner: |
Les Lee Shell, Deputy County Manager Jessica L. Colvin, Chief Financial Officer |
Recommendation:
title
Approve and authorize the Chair to sign an amendment to the Self-Funded Group Medical and Dental Benefits Preferred Provider Organization (PPO) Plan among Clark County, Clark County Water Reclamation District, University Medical Center of Southern Nevada, Las Vegas Convention and Visitors Authority, Las Vegas Valley Water District, Clark County Regional Flood Control District, Regional Transportation Commission of Southern Nevada, Southern Nevada Health District, Henderson District Public Libraries, Mount Charleston Fire Protection District, Las Vegas Metropolitan Police Department, Moapa Valley Fire Protection District and Eighth Judicial District Court adopting an amended Self-Funded Group Medical and Dental Benefits PPO Plan, effective January 1, 2025. (Also sitting as Clark County Water Reclamation District Board of Trustees, University Medical Center of Southern Nevada Board of Hospital Trustees, Mount Charleston Fire Protection District Board of Fire Commissioners and Moapa Valley Fire Protection District Board of Fire Commissioners) (For possible action)
body
FISCAL IMPACT:
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Fund #: |
6520.000 |
Fund Name: |
Self-Funded Group Insurance |
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Fund Center: |
1020520000 |
Funded PGM/Grant: |
N/A |
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Amount: |
No Fiscal Impact |
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Description: |
Self-Funded Group Medical and Dental Benefits PPO Plan Changes |
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Additional Comments: |
N/A |
BACKGROUND:
Clark County established a self-funded group medical and dental benefits program in 1984 to provide group medical and dental benefits to the employees of Clark County and affiliated entities. The program consists of a preferred provider organization (PPO) plan and an exclusive provider organization (EPO) plan. Annually, the Plan is put before the Board of County Commissioners for approval.
Following are the proposed modifications for the PPO plan for the upcoming Plan Year, effective January 1, 2025:
• The clarification of a benefit rule pertaining to the child of a surviving spouse.
• Changing the employee timeframe to provide documents from 90 days to 45 days. This is in alignment with
the eligibility timeframe.
• The addition of a $30 specialist copay for University Medical Center of Southern Nevada outpatient clinics.
• The addition of copays for walk-in retail health clinics.
• The addition of copays for hospice care services.
• The removal of the 60-day benefit limitation for inpatient rehabilitation care.
• The removal of a pharmacy benefit for GLP-1-FSA approved weight loss medication(s).
• The addition of genetic testing to the Care Management program (prior authorization process).
• The addition of maximum benefit amounts for Center of Excellence facilities.
• The removal of "no benefit" for residential treatment facilities.
• The addition of a $35 insulin cost to the Employer Group Waiver Plan, which covers Medicare retirees.
• The change from 20 days to 30 days for the Plan Administrator to respond to second level appeals. This is in alignment with the timeframe for first level appeals.
The amended Plan has been discussed with represented members, as required by governing bargaining agreements.
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