RD372 - Annual Report on Ombudsman Activities and Services for the Office of State and Local Health Benefits Programs - Fiscal Year 2009


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, 2008 through June 30, 2009. The Ombudsman’s team helped to resolve issues encountered by employees and their covered dependents involving access and eligibility for health care under the Commonwealth’s Health Benefits Program. As part of its responsibilities, the team assisted covered employees in understanding their rights and the processes available to them through the program. The team also guided covered employees in using the procedures and processes available to them through their health plan, including all appeal procedures.

In fiscal year 2009, the Ombudsman’s team handled 5,573 formal case-specific inquiries and assisted with 65 formal appeals. The team’s goal of continuous improvement was achieved by working to resolve issues and solve problems as they arose and by carefully examining the facts to identify and correct systemic issues. 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 five significant systemic issues during this year.

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