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IDB Medical Insurance Program: Update

por Angela Rivera Saettone
The following is an update from the HRD/COB Division on important aspects of our Medical Insurance Program. Of course, the Association will continue to maintain its relationship with that Division to guarantee the timely attention of specific cases of retirees, as well as the resolution of systemic issues in the administration of our program.
Financial performance
  • After five years of consecutive deficits, the IDB Group Medical Insurance Program recorded surpluses in 2018 and 2019.
  • As a result of a more proactive management of the Program, and the Bank’s contributions to the Large Claims Reserve, overall Program reserves increased from just under US$22 million at the end of 2016 to nearly US$29 million at the end of last year.
  • The Program changes introduced at the beginning of 2016, and the transition of administrators that took place on July 1, 2018, have helped contain the growth of medical expenditures to more sustainable rates than experienced in the recent past, and have resulted in a significant reduction in prescription drug costs.
  • Although these are positive results, Management continues to closely monitor the performance of the Medical Benefits Program under current healthcare market conditions to ensure its medium-term financial viability.
Medical Insurance Program Committee
  • The first meeting of the MIPC was held on November 15, 2019. The members were informed of the purposes of the new Committee and agreed upon its rules of operation. While it is understood that the minutes of the meetings of the Committee are confidential, it was agreed that members could share with their respective interested parties the substance of the meetings, based on a summary agreed upon with the Chair.  Key points from the meeting include:
  • The Committee has an advisory role on 3 important topics:
            i) fundamental terms of coverage;
           ii) premium structure changes; and
           iii) changes that would have a material impact on the terms of participation in the Program.
  • The Committee operates by consensus. Minutes can take note of fundamental differences in views within the Committee.
  • Proposals presented by HRD to get the advice and recommendations of the Committee will be backed up by relevant analytical and technical work prepared by specialized consultancy firms engaged by HRD.
  • The issue of defining a procedure for the review and setting of annual premiums was raised by the Committee for future consideration.
Performance of Aetna
The recent performance of Aetna International in terms of the processing of member-submitted claims seems to have improved and should result in a better member experience in terms of response times and service quality. According to HRD/COB, not only the current status of the following indicators, but also their recent trends, seem to support that conclusion.
  • Although claim processing turnaround times deteriorated for a period in late 2019 and early 2020, turnaround has now returned to a more satisfactory level. As of March 29, 2020, there were no member-submitted claims being processed with more than seven days from their date of submission.
  • The number of open/unresolved cases brought to the attention of the Employee Well-being and Medical Benefits Team has fallen from an average of 120 cases in March 2019 to an average of 14 cases in March 2020.
  • Moreover, the average amount of time required to resolve these later cases has decreased from 30 days at the beginning of 2019 to 8 days at the end of March 2020.
Regarding the enhancement of Aetna’s IT platform, Aetna estimates a delivery date of June 30, 2020, for a traceability function that will tie the assigned “UAG” number to the “Claim ID” that is generated later. The delivery date is dependent on successful testing of the programming work, given priority demands on Aetna IT staff due to required programming work related to COVID-19 system changes.
As an added service, Aetna’s vHealth telemedicine offering is now accessible to members of the IDB Group plan as a pilot program. The vHealth service allows members to access primary care physicians through a mobile or a desktop app for video or phone consultations in English or Spanish, and for phone consultations in French or Portuguese. Members and all eligible dependents need not leave their homes to handle many non-emergency primary care interventions by using vHealth.

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