RD309 - Annual Report on Ombudsman Activities and Services Fiscal Year 2007


Executive Summary:
This annual report on the activities of the Ombudsman for the Office of State and Local Health Benefits Programs covers the period from July 1, 2006 through June 30, 2007. During this time, the Ombudsman’s team consisted of the Ombudsman, four (4) Senior Health Benefits Specialists, two (2) Health Benefits Specialists, one (1) Retiree Specialist and one (1) Medical Appeals Examiner. The Ombudsman’s team assists covered employees in understanding their rights and the processes available to them according to their state health plan. Furthermore, the Ombudsman’s team assists covered employees in using the procedures and processes available to them from their health plan, including all appeal procedures. The Ombudsman’s team handled 9,881 formal case-specific inquiries and assisted with 53 formal appeals to the Director of the Department of Human Resource Management. The Ombudsman and his team continue to provide a valuable service to state employees and retirees and functions in accordance with the legislation that created the role in 2000.