RD385 - Annual Report on Ombudsman Activities and Services for the Office of State and Local Health Benefits Programs - Fiscal Year 2008


Executive Summary:
This annual report on the activities of the Ombudsman for the Office of State and Local Health Benefits Programs (OHB) covers the period from July 1, 2007 through June 30, 2008. The Ombudsman’s team worked diligently to resolve issues encountered by employees and their covered dependents involving access and eligibility for health care under the State’s Health Benefits Program. Furthermore, the team assisted covered employees in understanding their rights and the processes available to them through their State Health Benefits Program. The team also assisted covered employees in using the procedures and processes available to them through their health plan, including all appeal procedures.

This report will detail the key accomplishments of the Ombudsman and his team during Fiscal Year 2008 (FY 2008). In this year, the Ombudsman’s team handled 6,522 formal case-specific inquiries and assisted with 58 formal appeals. The team worked constantly to resolve issues and solve problems as they arose and, in every case, carefully examined the facts to identify and correct systemic issues, because this was the most effective way to achieve the team’s goal of continuous improvement. Working with employees, retirees, OHB staff, and the Health Benefits Program’s third-party vendors, the Ombudsman’s team identified and facilitated the correction of at least eight significant systemic issues during this year.

The Ombudsman’s team continued to provide a valuable service to State employees and retirees and functioned in accordance with the legislation that created the role in 2000.