RD360 - Annual Report on Ombudsman Activities and Services for the Office of State and Local Health Benefits Programs - Fiscal Year 2010


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, 2009 through June 30, 2010. 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 appeals procedures.

In fiscal year 2010, the Ombudsman’s team handled 5,680 formal case-specific inquiries and assisted with 77 formal appeals. The team achieved its goal of continuous improvement by working to resolve issues and solve problems as they arose and by carefully examining the facts to identify and correct systemic issues.

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