8 NOVEMBER 1, 2010
Smoke Signals
Skookum: It's your Tribe's money let's keep it that way
Dy Mark Johnston
Tribal Health ServietM A'xwuu Director
Every time a Grand Rondo Tribal member visits a doctor, hospital or receives
other types of care covered by the Tribal member health plan Skookum
your medical, dental, optical bills get paid with your Tribal money.
It's true. It's your Tribe's money that is used to pay these medical bills,
diverting funds from other Tribal programs, such as educational scholar
ships, pensions and per capita.
The Skookum plan is self-funded. Tribal members might ask, "Why don't
we just purchase a plan from a commercial vendor like Blue Cross?" The
answer is simple: It saves your Tribe millions of dollars to run the plan and
access available discounts rather than pay a big middleman.
That being said, we can still do better. How? Originally, the Tribal mem
ber health plan (now Skookum) was designed to be the secondary payer,
which means if a Tribal member had access to another insurance (Medicare,
Medicaid, Blue Cross, a spouse's health plan from their employer, etc.), that
plan would pay first and the Tribal member health plan would pick up the
balance, up to the plan benefit limits.
However, due to discrepancies regarding who is the legal primary payer,
the Tribal member health plan (Skookum) in many cases has paid as pri
mary despite that original intent.
Recent health care reform has clarified the situation, stating that Tribally
funded health plans are considered a payer of last resort. Considering this,
the Grand Ronde Tribal Council has determined that it is essential for the
long-term attainability of the Tribal member health plan, which is your
Tribe's money, that Skookum become a secondary payer whenever another
potential payer is available.
This decision is critical as the Skookum plan currently has a budget of $22
million annually. Calculating in the annual cost of medical inflation, it won't
be long before your Tribal member health plan expenses eat up the vast ma
jority of Tribal revenues available, potentially reducing the funds available
for other Tribally funded programs, like per capita and Elder pensions.
But there is good news. We have a chance to significantly save your Tribe's
money without affecting a Tribal member's overall out-of-pocket expense
for health care costs. It can be accomplished by moving the Skookum plan
into a secondary payer status and letting other entities cover the lion's
share of medical costs.
Obviously, this is easier said than done and it won't be a simple or easy
process. We will need every Tribal member's assistance as we gather infor
mation regarding other potential primary payers.
Tribal Council has asked that the changes to the Skookum plan for sec
ondary payer status become effective Jan. 1 , 20 1 1 . This gives us six months
to gather information, plan, make process change recommendations and
share information with the Tribal membership.
It is a lot to accomplish, but with your help and support, it can be done.
After all, it is your Tribe's money. B
Confidential Health Care Resource Survey
DMtoc'4
tort
EnMradby:.
First Name:
Tribal Roll :
Last Name:
Best Contact Number:
No
1. Are you enrolled in the Skookum Health Plan? Yes .
2. Do you have any other insurance (e.g. Medicaid, Medicare)? Yes.
If yes, what is the name of your insurance?
3. Are you currently employed? Yes No
Employers name & address if applicable:
Employer Name: '
Address:
Citv:
No
State:
Zip:.
4. If employed, does your employer OFFER health care insurance to you?
Yes No Ineligible
If yes, is there a cost to you? Yes No How much?
Can your immediate Skookum eligible family be enrolled? Yes
Cost per month:
monthly
No
Is there an enrollment period andor open enrollment? ,
Name of employers health care insurance:
Please describe reason for ineligibility? (e.g. part time work only, temporary employee.)
5. If you are married, does your spouse's employer OFFER employee health care insurance?
Yes No Ineligible
If yes, is there a cost to you? How much? monthly
Can your Skookum eligible immediate family be enrolled? Yes No
Cost per month:
Is there an enrollment period andor open enrollment?:
Name of employers health care insurance:
Please describe reason for spouse's ineligibility? (e.g. part time work only, temporary employee.)
Spouse's employers name & address if applicable:
Employer Name:
Address: ; -
City: ; : State: Zip:.
J