Alseib.org

PLAN CHANGES
LEGISLATIVE CHANGES
Premium changes were:
Legislative Changes:
1. Increased employee monthly premium to $90.
- Authorized Board to offer a High
2. Increased non-tobacco user’s monthly discount to $50.
Deductible Health Plan with a
3. Increased non-Medicare retiree premium $15 for single
federally qualified Health Savings
coverage and $25 for family coverage.
Account and Health
4. Increased Medicare retiree premium $5 for single and $5
Reimbursement Arrangement to
for family coverage.
eligible state employees, state
5. Increased surviving spouse premium $20 for single and
retirees and their dependents.
$25 for family coverage.
6. Dental coverage became a separate plan. Premiums
were $3 for single coverage and $8 for family coverage
for Blue Cross Blue Shield or Southland coverage.
7. Spousal Surcharge of $50 per month implemented.
8. Implemented a Health Reimbursement Arrangement
(HRA), referred to as State Employees Premium Only
Plan (SEPOP), providing up-to $150 monthly toward
other employer group health coverage.
2014 Medical Benefit Changes:
1. No copay for some preventive services and women’s
health services
2. Increased Outpatient Surgery copay from $100 to $150
3. Increased Emergency Room copay from $50 to $150
4. Increased Major Medical Deductible from $100 to $300
5. Lowered Lab Test copay from $10 to $7.50
6. Increased Urgent Care facility copay from $35 to $50
7. Reduced Wellness Center copay from $20 to $0
(effective October 1, 2013)
8. Increased maximum out of pocket member costs to
match Affordable Care Act limits.
Pharmacy Benefit Changes:
1. Implemented the Generic First program
2. Allowed 90 day generic supply (Tier I at 1.5 times copay)
3. Moved High Cost Generics to Tier II
4. Increased Medicare Rx EGWP copays $5 per script
There were no benefit changes made for 2013.

Premium changes were:
1. Increased employee monthly premium to $85.
2. Increased non-tobacco user’s monthly discount to $45.
2013 3. Increased non-Medicare and surviving spouse premium
$15 for single coverage and $25 for family coverage.
4. Increased Medicare retiree premium $5 for single and $5
for family coverage.
5. Increased Medicare surviving spouse premium $15 for
single and $25 for family coverage.
1. Increased employee monthly premium to $80.
Legislative Changes:
2. Increased non-tobacco user’s monthly discount to $40.
- Board can adjust premiums for
3. Increased non-Medicare and surviving spouse premium
spouse’s eligibility for other
$15 for single coverage and $25 for family coverage.
coverage
2012 4. Increased Medicare retiree premium $5 for single and $5 - Retirees must have at least 10
for family coverage.
years of creditable coverage to be
5. Effective for the October 1, 2011 coverage, changed the
eligible for retiree health coverage.
timing of the member's premium payments to the State
- Creditable coverage for health care
Employees' Insurance Board from the 16th of each
eligibility further defined.
month for coverage effective the first of the following
- Cancellation of coverage for
month to the 16th of the coverage month.
fraudulent claims
- FPL discount increased to 300%
- Retiree premiums increased 1% per
year for every year prior to
Medicare age
- Sliding scale adjusted to charge a
4% per year penalty for less than 25
years of creditable coverage
- Contribution for non-Medicare
retirees cannot exceed contribution
for active employees by 10/1/2016
1. Increased employee monthly premium to $75.
Federal Legislative Changes:
2. Increased non-tobacco user’s monthly discount to $35.
- Annual and life-time benefits
3. Increased non-Medicare surviving spouse premium $10
eliminated
for single coverage and $20 for family coverage.
- Dependent coverage extended to
4. Increased physician office visit copay to $35.
age 26 with no student verification
5. Increased lab copays to $10 per test.
required
6. Prescription Drug Program Changes:
- Pre-existing conditions for
Changed the Tier 2 (preferred brand name)
children eliminated
prescription copay to 20% of the cost of the
prescription with a $25 minimum or the cost of the
prescription, whichever is less, not to exceed a $40
maximum;
- Changed the Tier 3 (non-preferred brand name)
prescription copays to 20% of the cost of the
prescription with a $55 minimum or the cost of the
prescription, whichever is less, not to exceed a $105
maximum.
7. Implemented annual wellness screenings for all active
employees to receive the Wellness Participation
Discount.
1. Initiated premium for State employees.
2. Retirees reverted to traditional Medicare plan.
3. Added coverage for weight management and nutrition
programs.
4. Effective for the October 1, 2010 coverage, changed the
timing of the State's premium payments to the State
Employees' Insurance Board from the 15th of each
month for coverage effective the first of the following
month to the 1st day of the coverage month.
5. Increased non-tobacco user’s monthly discount to $30.
6. Increased physician office visit copay to $30.
7. Increased lab copays to $5 per test.
8. Increased hospital deductible to $200.
9. Increased hospital daily rate, days 2-5 to $25.
10. Increased Emergency Room copay to $100.
1. Southland Optional Vision Plan added.
2. Wellness Participation Discount Program adopted. All
employees screened during 2009 will receive the
Wellness Participation Discount of $25 per month in
3. Increased non-tobacco user’s monthly discount to $25.
4. Added YMCA discount/payroll deduction.
5. Increased non-Medicare retiree single rates by 2.4%.
6. Increased non-Medicare retiree family rates by 2.0%.
1. Increased Dental maximum from $1000 to $1500 per
Legislative Changes
covered member.
- State authorized Board to exclude
2. Increased non-tobacco user’s monthly discount to $24.
from years of service any years and
3. Increased non-Medicare retiree rates by 10%.
months of creditable service not
4. Prescription Drug Program Changes:
specifically defined as State
- Changed the Tier 2 (preferred brand name) prescription
copay from $20 to 20% or the cost of the prescription
with a $20 minimum or the cost of the prescription,
whichever is less, not to exceed a $35 maximum;
- Changed the Tier 3 (non-preferred brand name)
prescription copays from $50 to 20% of the cost of the
prescription with a $50 minimum or the cost of the
prescription, whichever is less, not to exceed a $100
maximum;
- Eliminated non-preferred prescriptions from the
maintenance list (60-day supply); and
- Implemented a maximum amount of annual
prescription drug copays to $2500 per individual.
5. Medicare Retirees enrolled in Medicare Advantage Plan
(effective 3/1/08).
1. Increased the pharmacy network discount.
2. Established the Alabama Retiree State Employees’
Health Care Trust Fund.
3. SHPS awarded Utilization and Disease Management
contracts (effective 10/01/06).
4. Bid Claims Administrative Services:
- BCBS awarded 5-year Administrative Service Contract
for medical, dental and prescription drug services,
effective (1/01/07)
- Admin. Fee: Lesser of $13.10 to $15.85 per contract or
4.2% of claims, plus $.13 to $.17 per prescription.
Effective October, 2007:
5. Implemented the generic drug copay waiver program.
6. Implemented pharmacy flu shot network.
7. Added Tamiflu ® to the preferred drug list.
8. Increased non-tobacco user’s monthly discount to $22.
2006 Limited the $75 copay on outpatient diagnostic procedures
to a maximum of two copayments per visit.
2005 1. Added TRICARE Supplemental Coverage.
Legislative Changes:
2. Added Blue Cross Blue Shield Supplemental.
State authorizes Board to offer
3. Added Southland Optional Insurance.
supplemental coverage in lieu of
4. Implemented Retiree Premium Sliding Fee Scale.
the basic medical plan
5. Retirees required to use other-employer insurance if
State requires retirees to take
available.
other-employee coverage if
6. SECHIP coverage added for children of low income State
employees.
State extends supplemental and
7. Discounted coverage offered to active and retired State
optional coverages and provides a
employees and their dependents (Federal Poverty Level
sliding premium fee scale to
discount).
retirees, based on years of service
8. Non-tobacco user discounts implemented.
State requires Board to provide
discounted coverage for low
income active and retired State
employees and their dependents
State implements non-tobacco
user discounts
2004 1. Increased the PMD office copayment from $20 to $25
- Includes minor surgery
- $20 Nurse Practitioner network
- Establish worksite nurse pilot project
2. Increased outpatient surgical facility copay from $75 to
3. Prescription Drug Program Changes:
- Eliminated $50 deductible per member per year;
- Moved non-life-sustaining drugs to non-preferred list
and increased non-preferred copay to offset cost of
eliminating deductible;
- Increased generic copay from $5 to $10;
- Increased preferred copay from $15 to $20;
- Increased non-preferred copay from $35 to $50;
- Maximum 30-days supply on non-maintenance drugs.
4. Reduced gastric bypass surgery from full coverage to
5. Contracted with Intracorp to implement disease
management program.
Legislative Changes:
No significant benefit changes.
- Federal "HIPAA Privacy Compliance"
1. Bid Claims Administrative Services:
- BCBS awarded 5-year contract, effective
January 1, 2002;
- Adm. Fee: Lesser of $10.30 to $12.50 per contract or
3.05% of claims;
2. Intracorp awarded Utilization Review contract (effective:
10/1/2001);
3. Allow half-month prescription drug purchases;
4. Contraceptive coverage;
5. Add $100 annual Hearing Aid coverage;
6. Cover students through age 25;
7. Add corrective eye surgery to Routine Vision Network;
8. Added BlueCard Program;
2001 1. Changed definition of dependent to include grandchild,
Legislative Changes:
nephew, and niece. Subject to additional premium.
- State "JPO Coverage"
2. Hearing Aid Discount Network established.
2000 Prescription Drug Program Changes:
- Added $50 deductible per member per year;
- Changed the non-preferred retail copay from $20 to $35;
- BCBS increased pharmacy network discount;
- Increased infertility drug copayment to 50%;
- Non-par pharmacy not covered;
- Maximum 34-days supply on non-maintenance drugs;
1999 No significant benefit changes.
1998 1. Dental program changes:
Legislative Changes:
- Added Orthodontic coverage.
- Federal "Mental Health Parity Act"
- Increased Dental maximum from $750 to $1000.
- Federal "Newborn and Mothers
2. Dropped Viagra coverage.
Health Protection Act"
3. Enhanced Routine Vision Discount network to cover
- Federal "Women's Health & Cancer
contact lenses.
Rights Act"
4. Changed Non-PMD physician reimbursement from UCR
- Federal "Health Insurance
to PMD Fee Schedule.
Portability & Accountability Act"
5. Included Brand Name maintenance drugs at $20
- State "Early Retiree Incentive
copayment for 60 days supply and cut pharmacy network
Package”
reimbursement.
1997 1. Bid Claims Administrative Services:
- BCBS awarded 5-year contract, effective
January 1, 1997;
- Adm. Fee: Lesser of $7.25 to $9.70 per contract or
2.9% of claims;
2. Disease State Management programs implemented.
3. Smoking Cessation program implemented.
4. Personal Health Advisor 24-hour nurse line implemented.
5. Birth Control Pill Discount network established.
6. Added contact lens mail-order through Lens Express.
1996 1. Changed Dental COB policy from "non-duplication" to
100% maximum coverage.
2. Added routine preventive coverage.
3. Prescription Drug program changes:
- Increased the pharmacy network discount;
- Implemented drug formulary management;
4. Routine Vision Discount network established.
5. Extended full-time student age through 23 (was 22).
6. Bid UM Services:
- Cost Care awarded 5-year contract, effective October 1,
Legislative Changes:
1. Preferred Chiropractic Network established.
- State " Alabama Sports Hall of Fame
2. Work Related Injuries (WRI) carved out of plan.
Board Officers & Employees
covered"
1994 1. Bid Claims Administrative Services:
Legislative Changes:
- BCBS awarded 3-year contract, effective January 1,
- State "Retired Judges of Probate &
Legislators covered"
- Adm. Fee: Lesser of $7.25 per contract or 2.9% of
2. Increased the PMD office copayment from $15 to $20;
3. Added $75 diagnostic procedure copayment;
4. Prescription Drug program changes:
- Increased Brand Name copayments from $10 to $15
- Increased Dispensed as Written (DAW) copayment
from $10 to $20
- Implemented drug starter program
- Brand Name drugs dropped off maintenance list
5. Added Worksite Wellness program
6. Preferred Dental Network established
1993 Cost Care awarded Utilization Review contract (effective:
10/1/93)
1. Utilization Review program changes:
- Mandatory precertification ($500 noncompliance
penalty)
- Maternity program
- SSO waiver
2. HMO copayments & deductibles increased
3. Dropped BC/BS miscellaneous riders:
- 1964 California Relative Value Surgical Schedule
- $5 per day non-participating hospital payment
- $8 per radiation treatment
- $150 per year for X-Ray services
4. Changed COB policy to "Pursue then Pay"
1. Mandatory generic Rx Policy
2. ER copayment increased from $25 to $50
3. PPO copayment structure changed
4. Case Management added
1992 5. Mammogram screenings covered
6. Radial Keratotomy coverage dropped 8/31/92
1991 1. William Ashmore appointed Executive Director
Legislative Change:
2. Medicare retiree enhancements:
- State "Soil & Water Conservation
- $3 lab copayment eliminated
Officers & Employees covered"
- $75 Part-B deductible covered
- $100 hospital deductible and daily copayments covered
1990 1. Bid Claims Administrative Services:
Legislative Change:
- BCBS awarded 3-year contract effective October 1,1990
- State added coverage for Captive
- Adm. Fee: Lesser of $6.60 per contract or 2.9% of claims
County Employees
-BCBS customer service representative stationed in the
SEIB office.
2. Military leave policy adopted
1989 1. Renegotiated BCBS Administrative Fee effective Oct.
1,1989:
- Cost plus 3.5% hospital and 3% other medical services
2. Started independent UR program, April, 1989
3. TMJ benefits limited to $3,000
4. William Ashmore appointed as Acting Director
1988 1. SEIB becomes an independent agency, effective Oct. 1,
2. No significant benefit changes
1987 1. Renegotiated BCBS Administrative Fee:
- Hospital claims minus 19% retention plus 3% other
medical services.
2. PMD office visit increased from $5 to $15.
3. Added $3 lab copay.
4. Increased hospital deductible from $50 to $100.
5. Added $15 daily hospital copay for days 2 - 5.
6. Added $25 outpatient hospital copayment.
7. Increased Rx copayments to $5 generic and $10 brand
8. Chiropractic services limited to 12 visits or $400 per year.
9. Increased major medical maximum from $500,000 to
$1,000,000.
10. Required precertification of all hospital admissions.
11. Added $75 surgical copay.
12. Added $25 Urgi-Care clinic copay.
13. Increased Rx copays to:
- $5 Generic Copay;
- $10 Brand Name Copay;
14. TMJ services limited to:
- Non-surgical maximum of $450;
- Surgical maximum of $1,000;
1986 1. Added sealants to dental coverage.
2. Added mental health PPO Network.
3. Medicare retiree premium paid 100% by State.
4. Added Rx Card Program:
- $3 Generic Copay;
- $5 Brand Name Copay;
1985 1. Added family Dental coverage;
Legislative Changes:
2. Added HMO coverage;
- State retirees receive premium
3. Added PMD Network;
-$5 Office Visit Copay;
4. Negotiated a claims exposure cap of $56,322,573. Actual
claims were $63,430,858.
1984 Employees on educational leave may continue coverage.
1983 1. Recovered liquidated damages for slow claims
processing
2. Added single Dental coverage
1982 Negotiated a claims exposure cap of $33,176,000. Actual
claims were $36,411,633.
1981 1. Employee may continue insurance coverage while on
leave without pay (LWOP).
2. Spouse of a deceased employee may continue insurance
coverage.
3. Employee survey on insurance and services.
4. Negotiated a claims exposure cap of $29,723,000. Actual
claims were $31,068,023.
1980 Bid health plan administration:
- Negative management fee of 6.29%;
- Outpatient surgery 100%, no deductible;
- X-Ray and lab up to $150, no deductible;
- Negotiated return of deposit.
1979 1. Personnel Department accepts management
responsibility for SEIB effective April 5.
2. RSA accepted management responsibility for SEIB
effective September 13.
3. Board self-insures Plan.
- $25 Hospital Deductible
- $100 Major Medical Deductible
- 80%, first $2,000
- $250,000 maximum benefit
4. Blue Cross and Blue Shield awarded ASO Agreement.
5. Blue Cross and Blue Shield returns $3 (m) in reserves to
6. Adopted a "Cost Plus" financial arrangement with BCBS.
7. Required timely payment of premiums.
8. Began bumping claims.
1978 1. Blue Cross Blue Shield contract renewed.
2. Attorney General’s Opinion allows the plan to self-insure
(no action taken).
1977 Blue Cross Blue Shield contract renewed.
1976 Blue Cross Blue Shield contract renewed.
1975 Blue Cross Blue Shield contract renewed.
1974 Blue Cross Blue Shield awarded contract (effective Oct. 1).
1973 1. Travelers Insurance Company granted 2-months’
extension (till October 28).
2. Travelers Insurance Company awarded contract
(effective October 28 - September 30).
3. High Option dropped.
4. Changed maximum coverage to:
- $20,000 per calendar year
- $100,000 lifetime
1972 1. Travelers Insurance Company granted 3-months
extension (till July 28).
2. Travelers Insurance Company granted 1-month
extension (till August 28).
3. Travelers Insurance Company awarded contract
(effective Aug. 28).
4. Offer High/Low Benefits.
1971 1. Travelers Insurance Company awarded contract
Legislative Change:
(effective April 28).
- State two active employee
2. Increased maximum coverage per member to:
representatives added to the Board
- Active Employee $50,000
- Retired Employee $15,000
3. Provisional employees treated the same as a regular new
employee.
1970 Protective Life granted a 6-month extension.
1969 Protective Life awarded contract (effective October 1).
1968 Travelers Insurance Company awarded contract.
1967 No significant benefit changes.
1966 1. Dorothy Hitchcock appointed Executive Director.
2. Travelers Insurance Company awarded contract:
- $25 Hospital Deductible;
- $100 Major Medical Deductible;
- 80%/20% (50%/50% Outpatient Mental Health, $250
maximum);
- $15,000 maximum coverage per member.
1965 1. Alabama Legislature approves Act #833 that creates the
State Employees' Insurance Board (Code of AL,
Section 36-29-1)
2. September 8, first organizational meeting of the Board
Study Committee establishes bid specifications.

Source: http://www.alseib.org/PDF/SEHIP/SEHIPChangeSummary.pdf