1985-11-06 adj November 6, 1985 (Afternoon-Adjourned from October 16, 1985)
__£Paqe 1}
An adjourned meeting of the Board of Supervisors of Albemarle County, Virginia, was held
on November 6, 1985, at 3:00 p.m., in Meeting Room 5, County Office Building, Charlottes-
ville, Virginia; said meeting being adjourned from October 16, 1985.
Present: Mr. F. R. Bowie, Mrs. Patricia H. Cooke, Messrs. Gerald E. Fisher,
J. T. Henley, Jr., C. Timothy Lindstrom (arrived at 4:55 p.m.), and Peter T. Way.
Officers Present: County Executive, Guy B. Agnor, Jr.; County Attorney, George R. St.
John; and Deputy County Executive, Robert W. Tucker, Jr.
Agenda Item No. 1. The meeting was called to order by the Chairman, Gerald E. Fisher.
Agenda Item No. 2. Work Session: Soil Erosion Ordinance Amendment. This was a contin-
uation of this subject which began at the Board's meeting on October 9, 1985.
Mr. Elrod again explained the revisions to the Board in detail. He said the definition
of "agent" is interpreted as the individual authorized by the landowner to apply for the
permit. This person may be a consulting engineer, contractor, etc. According to the State
statute, the agent can be any person who is involved in a project which disturbs more than
10,000 square feet of land. He said that because of the way bonds are set up, the County
requires the name of the applicant to be the landowner or his agent (the person who has
actually submitted the plans and whose name is on the bond).
Mr. Elrod said that Section 7-5 which refers to the Advisory Committee has been deleted
because the Soil and Water Conservation District wishes to have representation in the County
so it can be kept aware of soil erosion matters and have some input in how plans are
approved. Members of the District agreed that since 75 percent of Mr. Tom Trevillian's
salary (Engineering Department Conservation Engineer) is paid by funds from the Chesapeake
Bay Clean-Up Program through the District, his reporting to the District at its monthly
meetings regarding County activities and in turn, relating the District's input back to the
County, would serve the same purpose as a District member reviewing site and erosion control
plans. Mr. Fisher asked what happens when the grant funds run out. Mr. Elrod said engineers
will still be involved in reviewing plans; he does not know of any objections in having the
engineers report to the Soil and Water Conservation District.
Mr. Elrod noted that the revisions contain a definition of "Director of Engineering."
He said the definition given for an Erosion and Sediment Control Plan came out of the
Virginia Erosion and Sediment Control Handbook. He said according to this plan, surveyors
and consulting engineers who prepare the plans will make a copy of the approved site plan and
mark on it the measures that have to be provided in order to control erosion. Also, a part
of the plan is a narrative report describing types of soils on the site, whether they are
easily eroded or can withstand steep grades. This report will specify necessary phasing for
contractors during the time the land is disturbed.
Mr. Fisher asked who is responsible if soil erosion does occur. Mr. Elrod said the
person who disturbs the soil. Mr. Fisher asked who is responsible if the problem occurs
after that person has completed his work. Mr. Elrod said that generally the landowner will
be contacted first, however if there is an immediate problem and the landowner cannot be
contacted, the contractor is just as responsible to take measures to protect the soil as the
landowner is once the land is disturbed.
Mr. Elrod referred to Section 7-3(c) which clarifies the agricultural exemption under
the Erosion Control Ordinance. He said that~basically anything that involves disturbing over
10,000 square feet of land that is not d~rectly related to tilling, planting or harvesting
crops is not exempt, therefore a permit is required. A race track for horses may be built on
a farm, but it does not involve agricultural products, so it is not exempt. A road built to
haul cattle on and off a farm is not exempt; a road built to allow planting to get from one
field to another is exempt. Mr. Henley asked if the language contained in Section 7-3(c)
came from the Virginia Erosion Sediment Control Handbook. Mr. Elrod said yes.
Mr. Elrod said usually land is cleared to get more fields for crops - that is not exempt
under State statute. He asked Mr. Robert Shaw, Soil Erosion Inspector, for a clarification
regarding this exemption. Mr. Shaw said it is not clear in the statute.
Mr. Bowie said he believes the CouNty is over-stepping a fine line in telling people
what they can and cannot do, particularly in light of the comment that it is not clear in
State law. Mr. Henley said he believes the non-exemption applies to forest land being
cleared for crops. Mr. Shaw said he feels that land cleared and immediately planted in
agricultural crops, is exempt from the Soil Erosion Control Ordinance. However, when land
is cleared, left and not reseeded for long periods of time, it is not clear whether this is
agricultural activity or a violation of
to use their discretion when such event
have more control over the land in these
exempt, the landowner has to stabilize t
Mr. Fisher asked what is meant by "stabi
when land is left in raw soil for more t
erosion occurs, the land does not fall u
the ordinance. Mr. Fisher said the inspectors have
s arise. Mr. Shaw said the inspectors are trying to
circumstances. Mr. Elrod said if the land is not
he soil within sixty days after grading is completed.
lize". Mr. Elrod said this means to plant. He said
han sixty days (sometimes as long as six months) and
nder the agricultural exemption if it includes more
than 10,000 square feet. Mr. Fisher said it sounds as if the inspectors only become involved
after the fact. He asked if it is correct to say that grading, stumping, etc. can be done
without a permit, but inspectors have the right to require that something be planted if the
land is left without planting for more than sixty days. Mr. Elrod said that is correct. The
inspectors do not know the intent of the landowner. Inspectors can ask the landowner why
land is being cleared if there is any qdestion in their minds, but the land is usually so far
out that the inspectors are responding to a complaint.
88
November 6, 1985 (Afternoon-Adjourned from October 16, 1985)
Mr. Bowie asked if a landowner is required to present a soil erosion plan prior to
planting land. Mr. Elrod said not if the landowner intends to plant crops immediately.
However, if he is clearing land to have a better view or fill a ravine, an inspector can
issue a stop-work order until the landowner obtains a permit. Mr. Fisher asked if the
inspectors encounter many problems with landowners in this regard. Mr. Shaw said yes,
approximately once or twice a year. Mr. Fisher asked if the inspectors generally get compli-
ance within a reasonable amount of time. Mr. Shaw said they get compliance but not soon. In
his opinion "soon" means right away in terms of erosion control because damage occurs right
away. He said sometimes it takes months to get compliance and the inspectors have to be
persistent. Mr. Fisher asked how these Erosion Control Ordinance amendments will help. Mr.
Shaw said landowners who have a legitimate farm will sometimes clear land, not for agricul-
tural purposes, but just to make it look nice. These areas often lay for long periods of
time which causes erosion. Sometimes people who are beginning a farm do not stabilize all
the land for a long time. Mr. Elrod pointed out that some people believe that building feed
locks, agricultural structures and roads is exempt because it is associated with raising
corps, but under the State ordinance these activities are not exempt.
Mr. Henley referred to the second sentence in Section 7-3(c) which reads: "Clearing of
areas of greater than 10,000 square feet whether or not such areas are tilled and planted
with agricultural .... " He said this statement seems opposite of what he understood the
inspectors to have said today. Mr. Fisher said he believes the word "not" is missing in the
sentence. Mr. Elrod said the wording was changed based on suggestions from the County
Attorney's office, however it was not reworded correctly. He said the sentence should read
as follows: "Clearing of areas of greater than 10,000 square feet when such areas are not
tilled and planted with agricultural and horticultural or forest crops .... " Mr. Elrod said
he had originally added language specifying that sixty days shall be deemed to be a
violation. Mr. Henley said he has no problem with that wording. He said there may be
circumstances where seeding is not possible if there is a long drought. Mr. Henley said a
good farmer will take care of his land - he is wasting his money if he lets his land wash
away. ~
Mr. Bowie asked if land zoned RA (Rural Areas), is considered agricultural or does this
ordinance only apply to working farms. Mr. Shaw answered that tilling and plowing refers to
a legitimate farm. Mr. Henley said RA includes schools, houses, etc., so the ordinance
~annot apply under that zoning. Mr. Shaw said private residences are exempt.
Mr. Elrod said subject to the County Attorney's ruling, he would like to change the
sentence in question to read: "Clearing of areas greater than 10,000 square feet when such
~reas are not tilled and planted .... " Mr. Bowie asked if the language regarding a sixty
Say violation period will be added. Mr. Elrod said Mr. Frederick Payne, Deputy County
~ttorney, deleted that language, however it is in the State code. Mr. Fisher said since this
is a work session, there is time to clarify the language before the Ordinance amendments are
~dvertised. He said however, it appears to be the general consensus that the Board and staff
~oncur that the suggested language is better than the language presented.
Mr. Bowie asked if a farmer plans to clear land to plant crops, if he is required to
~resent a plan and drawing to the County. Mr. Elrod said if he plants within sixty days, a
~lan is not necessary. Mr. Bowie requested that language to that effect be included in the
~rdinance. Mr. Fisher noted that the language exists in the first sentence of Section
?-3(c).
Mr. Elrod noted in Section 7-3(d), the words "zoning administrator" should be replaced
)y "Director of Engineering". Next Mr. Elrod referred to Section 7-3(g) which he said can be
~eleted because it applies to projects commencing prior to June 30, 1975. After researching
~he files it was discovered that there were no projects prior to that time.
Mr. Elrod said adding Paragraphs (1) and (2)(a)(b) to Section 7-4(b) is an attempt to
:larify for developers (particularly regarding subdivisions) that the County will decide
~hether an erosion control permit is required for the entire subdivision or only for the
roads. When someone applies for a building permit in a subdivision, that person will sign a
~orm letter stating that he/she will comply with the Erosion Control Ordinance. If there are
~ny erosion problems, that person is responsible for taking whatever measures are necessary
~o control the erosion. Mr. Fisher said in that way, each lot does not have to have an
~rosion control plan. This puts the burden on the inspectors to determine whether there is a
~roblem and if so, to obtain enforcement of the ordinance. Mr. Elrod said the Engineering
~epartment staff has reviewed most of the major subdivisions and located on maps certain lots
~hat may have problems. When someone applies for a building permit for one of those lots,
~he building inspector will hold the permit until an erosion control plan is submitted. It
~epends on how severe the problem is as to whether a formal or informal plan will be
3equested.
Mr. Henley asked if every lot is actually looked at when a building permit is applied
~or. Mr. Elrod said no. Mr. Fisher asked if problem lots are identified in a filing system
~o they can be recognized in case someone applies for a building permit on one of them. Mr.
~lrod said he believes the building inspector has the lots flagged on the tax maps. Mr.
?ucker said a copy of every subdivision plat is kept in the Inspections Department as it is
~pproved by the Planning Commission. Whenever a permit is issued, staff fills out the permit
~ith the tax map, parcel number and lot number. Every lot number may not be shown on the tax
~aps, however they are on the subdivision plat. If the plat is flagged on a particular lot,
.t will be recognized.
Mr. Elrod referred to the first sentence in Section 7-4(c), reading: "Ail plans and
~pecifications submitted pursuant to this chapter relating to land ~-~he-wa~e~she~-~-~he
~h-R~am~a-R~e~-Rese~? within any public drinking water supply impoundment, .... " Mr.
~isher questioned the use of the word "impoundment". Mr. Elrod said "watershed" should be
[sed instead.
November 6, 1985 (Afternoon-Adjourned from October 16, 1985)
( P a._qe 3) _~ --
Section 7-5 was discussed next. Mr. Elrod said the language deleted in this section is
shown in other sections. The intention is to no longer require review of plans in the
presence of the applicant at the time of their submission. This is because seldom can time
be taken to review plans when they are submitted. Mr. Elrod pointed out that in revised
Paragraph (b), a time limit of 45 calendar days is specified for approval or disapproval by
the director of engineering, which protects the applicant from his/her plans being held
indefinitely. He also noted that language concerning plans being referred to an Advisory
Committee has been deleted.
Mr. Fisher said he is concerned that 45 days is too long to make an applicant wait for
an answer. He said he has heard many complaints from applicants that they would like to know
all the problems of a plan at its first submission, rather than going back with resubmissions
in order to correct one or two problems at a time. Mr. Fisher said he is worried that the
45-day limit for approval will become a standard rather than the absolute maximum of time.
Mr. Elrod said the average time between when plans are submitted and when they are approved
is close to 45 days. But the average length of time before an applicant got the first
comments was two weeks because the Advisory Committee was meeting on a two-week cycle. One
of the reasons for deleting the committee was to save the applicant time. Mr. Fisher said
the problem of resubmissions should be discussed in order to decrease the number of back-
and-forth transactions. Mr. Elrod said applicants often change the whole plan to correct one
problem, which creates new problems that must be dealt with. Also, if the engineering
department overlooks a problem or something that is required by the ordinance, it is still
obligated to point this out upon resubmission. In some instances, the Highway Department
gives advice to an applicant without coordinating same with the engineering department, which
also causes problems.
Mr. Henley asked whether a time limit should be placed on the engineering department
giving its comments. Mr. Bowie suggested that the initial response be required within ten
working days. Mr. Trevillian said that is a reasonable time according to current procedure.
Mr. Bowie suggested that language to that effect be written in the ordinance. Mr. Henley
agreed that ten days to two weeks should be specified for response time, in addition to the
45-da¥ limit for approval or disapproval. Mr. Elrod agreed and said he will propose wording
to that effect for the ordinance.
Mr. Elrod then referred to revised Section 7-5(e), explaining that the former Section
7-5(e) has been deleted and Section 7-5(f) has been relettered as (e) showing a change in the
first sentence from "zoning administrator" to "director of engineering".
Mr. Bowie asked about Section 7-5(b)(6), concerning borrow, fill or waste areas. Mr.
Elrod said the Zoning Ordinance was modified last year to define borrow, fill, or waste
areas. The ordinance specifies that these areas can be located in zones other than rural
areas. Section 7-5(b)(6) is a cross reference to other sections that mention borrow, fill,
or waste areas in the ordinance because a contractor must go through the Erosion Control
Ordinance to obtain a permit for one of these areas.
Mr. St. John left the meeting at 4:00 p.m.
Mr. Elrod went on to explain Section 7-6, paragraph (b). This paragraph gives an
inspector the right to deliver a handwritten letter to a contractor who is not in compliance,
giving instructions to be followed immediately. Mr. Bowie said he had circled "handwritten"
to be deleted on his copy of the ordinance because he questioned whether the letter must
actually be handwritten.
Mr. Fisher asked what process the revised Erosion Control Ordinance had been through for
review by the applicant pool. Mr. Elrod said the ordinance has been discussed informally,
but had not been sent to anyone for review. He said it would be sent to the Blue Ridge Home
Builders Association so they can forward it to their members. Contractors, surveyors,
landscape architects, developers, etc. will be informed that there will be changes in the
ordinance and if interested, they will be sent a copy. Mr. Fisher suggested that copies be
sent with a request for written comments. Mr. Bowie suggested that copies also be sent to
agricultural organizations. Mr. Fisher said the Board has developed a practice of trying to
involve citizens in public interest matters before these matters go to public hearing. He
then asked for a motion to recommend that the staff proceed with its review and solicit
comments on the Erosion and Sedimentation Control Ordinance amendments. Mrs. Cooke made a
motion to that effect, which was seconded by Mr. Way. Mr. Henley asked if the changes
discussed today would be reflected in the amended ordinance that will be sent out. Mr. Elrod
said yes. Roll was called and the motion carried by the following recorded vote:
AYES: Mr. Bowie, Mrs. Cooke, Messrs. Fisher, Henley, and Way.
NAYS.: None.
ABSENT: Mr. Lindstrom.
Mr. Fisher referred to the Engineering Department's consideration of an Erosion Control
Enforcement Policy that would offer qualified contractors and developers the right to proceed
with their projects if they meet certain conditions without having to submit a formal plan.
Mr. Fisher said he did not understand how the Engineering Department will deal with diffi-
culties. Mr. Elrod distributed a five-page document to the Board that he said is not final
and could use some improvement. He said he has discussed it with several contractors, but
does not believe the County will be able to participate in the policy. However, he has
searched for some incentive for contractors to help obtain better results in erosion control
efforts, and this is the only thing anyone has come up with.
Mr. Elrod said erosion control plans are now drawn up by the consulting engineers who
often do not know which contractor will be doing the work. The person who can best plan
erosion control is the contractor, if he has qualified personnel and if he knows the County
Code as well as he knows construction. Also, having drawn up the plan, the contractor will
probably be more inclined to comply with it.
November 6, 1985 (Afternoon-Adjourned from October 16, 1985)
(Page 4)
Mr. Fisher asked how the Engineering Department will know that the contractor has an
erosion control plan. Mr. Elrod said the contractor would notify the Engineering Department
that he has an approved site or subdivision plan; that he has marked a copy of the plan with
the necessary erosion control measures; has had the bonds posted, and plans to begin work
within 48 hours. Mr. Shaw would then check the plan for any peculiarities or problems,
confirm the bond, etc. Within five days, the contractor and Mr. Shaw would examine the plan
together, to make any necessary changes, after which time the contractor could begin work.
The advantage to the contractor is that he can get to work and begin quickly. The
Engineering Department will not have to follow up and/or tell the contractor everything to
do.
Mr. Fisher suggested the Board members read the policy and schedule it for some response
at the next Board meeting.
Mr. Elrod said the County Attorney, Mr. St. John, and Deputy County Attorney, Mr. Payne,
have advised that the policy should not be adopted because the County might be accused of
showing favoritism.
Agenda Item No. 3. Board of Supervisors and School Board:
discussion re. "KeyCare".
Blue Cross/Blue Shield
School Board-Members Present: Messrs. Charles S. Armstrong, John E. Baker, Walter F.
Perkins, Robert E. Taylor, and Charles R. Tolbert.
School Board Members Absent:
Marshall, Jr.
Mrs. Jessie C. Haden and Mr. Forrest R.
Mr. Agnor introduced Mr. Shelton who was present representing Blue Cross/Blue Shield.
Mr. Shelton introduced Mr. Carl Omohundro, the County's Blue Cross/Blue Shield representa-
tive, and Ms. Carolyn Payne, KeyCare Account Executive, who was present to make the "KeyCare"
presentation.
Mr. Omohundro said on October 1, 1978, Albemarle County purchased group health insurance
for its eligible employees. This program is administered by Blue Cross/Blue Shield of
Virginia. Currently there are 1,499 contracts for 2,700 participants. The is essentially a
self-insurance program with the County at full risk. The financial arrangement should pay
enough premium dollars to pay all claims and administrative costs. The role of Blue Cross/
Blue Shield is to administer payment of claims, provide a quarterly and end-of-contract-year
financial accounting, and act as a consultant in making beneficial design of financial
recommendations based on the most recent available statistical information. Mr. Omohundro
said the goal of Blue Cross/Blue Shield is to offer the best possible benefit package at the
most affordable premium. They respond to the needs of the greatest number of employees.
Mr. Omohundro went on to explain the experience period from July 1, 1984 to July 1,
1985, and give an up-date through the contract period ending September 30, 1985. He said
there was a credit balance of $312,743 in July 1, 1984 that has been reduced to $186,738 by
October 1, 1984. Having anticipated the decrease in reserves, Blue Cross/Blue Shield recom-
mended a 21.7 percent increase for the new contract year at the annual meeting held in
September, 1984. On January 1, 1985, the following recommendations to the County Insurance
Committee became effective: Preadmission Review Program, addition of licensed professional
counselors and licensed social workers for out-patient counseling, and conversion of all
billing to twelve equal monthly installments. Although Blue Cross/Blue Shield felt the 21.7
percent increase was appropriate, the committee elected to increase the employee rates by
only ten percent. Mr. Omohundro showed a graph that indicated a reserve credit balance of
$22,000 on October 1, 1985. He said it has taken the monthly premiums plus $290,743 of the
reserve balance to pay claims. Mr. Omohundro said action needs to be taken soon to reverse
this process.
Next Mr. Omohundro discussed data trend analysis findings in recent Blue Cross/Blue
Shield recommendations. He said the Preadmission Review Program is a cost containment
measure that has saved 78 in-patient days, which realized a savings of $54,600. Mr.
Omohundro then compared 1983-84 to 1984-85 on in-patient charges. The claims were divided
into four categories: surgical, medical, obstetrics, and nervous and mental. There were
reductions in the surgical, medical and obstetric categories; specifically, $146,675 or 27
percent. The nervous and mental category increased by $28,929 or 38 percent. This category
represents approximately 20 percent of all claims during the 1984-85 experience period, but
only 4.6 percent of the total employee dependent population. In-patient psychiatric analysis
indicates a total of 18 individual admissions, an average length of stay of 19.6 days with
two admissions exceeding 30 days. The average cost per admission was $5,000. The out-
patient psychiatric claims represent an additional $114,242, which represents 55 percent of
all major medical claims. Four percent (108 individuals) of the total dependent population
used this benefit.
At the September, 1985, renewal meeting this information was summarized and the
following recommendations were made: increase rates by no less than 16.4 percent; redesign
benefits package with cost containment in mind, specifically consider alternative health care
delivery systems or the KeyCare product; consider adding deductibles; 80 percent coverage
versus the 100 percent coverage; and address the areas that appear to be vulnerable due to
the increase cost of utilization. The County elected to raise rates by eight percent with
the idea of implementing the KeyCare program by January 1, 1986, change the in-patient
psychiatric care to 30 days per calendar year, and place a $2,000 calendar year limit on
out-patient psychiatric counseling.
November 6, 1985 (Afternoon-Adjourned from october 16, 1985)
(~a_~q~ 5)
Mr. Omohundro said according to available information, the County's insurance program is
not being adequately funded. Judging from trends, the program is moving into a deficit
position. Recommendations have been made that Blue Cross/Blue Shield feels will improve this
situation. Blue Cross/Blue Shield supports implementation of an employee assistance program
and stress management workshops. One category of claims will not always be responsible for
increased cost of utilization. Mr. Omohundro said the KeyCare program attempts to address
all areas of vulnerability, contain costs, and offers affordable comprehensive benefits
package.
Ms. Payne said until about five years ago Blue Cross/Blue Shield was a full-service
hospital plan that was like an open-ended credit card for its participants. Also, about five
years ago health care costs began rising from 25 to to 50 percent per year. A group of
Richmond citizens and employers contacted Blue Cross/Blue Shield to find a way to keep these
costs down. As a result, the KeyCare program was established.
Ms. Payne went on to describe benefits of the KeyCare program as a packet of information
was distributed to the Board and School Board members. She said KeyCare is a preferred
provider organization which means physicians in the local area are contracted to provide
services for any groups who choose KeyCare, at a lower cost to the employer and employees
than the current program. Out-patient benefits include home and office doctor visits for
medical reasons, with those doctors contracted with KeyCare (a directory of local KeyCare
providers was included in the information packet). There is a $10 deductible for these
visits. Blue Cross/Blue Shield is charged for the rest of the bill and the KeyCare provider
is under contract to accept that payment as payment in full for that office visit. There is
a $30 deductible for the hospital out-patient department. This deductible also applies to
use of the emergency room in order to encourage employees to use their physicians' offices
whenever possible. If the physician is not on staff at the hospital, he can also charge the
$10 deductible. Minor emergency centers have a $10 deductible like a doctor's visit.
The KeyCare program does not impose a calendar year maximum for X-ray and laboratory
work, Ms. Payne said. Blue Cross/Blue Shield pays 90 percent of all X-ray, laboratory, and
therapeutic injection charges under the KeyCare program. Well-baby care is also included
under out-patient benefits. This means check-ups, immunizations, and laboratory work for
children from birth to five years of age are covered 100 percent after the $10 deductible.
Home health care is covered without a deduction.
Ms. Payne then went on to explain in-patient benefits covered under KeyCare. Each
hospital confinement requires a $100 deductible. However, no deductible is required if an
individual is readmitted within 90 days of discharge. After the $100 deductible, coverage is
paid 100 percent by Blue Cross/Blue Shield in a KeyCare facility. There is a major medical
category under the KeyCare program, which takes effect after an individual has used 365 days
of regular coverage. Prescription drugs are filed under major medical, as they are under the
current program. In-patient nervous and mental coverage is for 30 days. Out-patient nervous
and mental has a $10 deductible for each visit with 100 percent coverage up to a maximum of
$2,000 in a calendar year.
For maternity coverage under the KeyCare program, Ms. Payne said the physicians have
agreed to bill the prenatal, postnatal, and delivery services as one charge, which is paid
100 percent.
Ms. Payne said Martha Jefferson Hospital is participating in the KeyCare program in the
Charlottesville area. At this time, 145 local physicians are participating in the program
and agreements are being received daily from other physicians. Ms. Payne suggested that if
an employee is a patient of a physician who is not on the providers list, Blue Cross/Blue
Shield will contact that physician regarding participation in the KeyCare program.
Mr. Charles Tolbert, a School Board member, said as he understands it, there is no
difference, between KeyCare and the current program regarding coverage for nervous and mental.
Ms. Payne said there is a maximum of 30 days coverage for in-patient care with KeyCare.
Under the current program, claims exceeding $2,000 must be filed under major medical after
satisfying, a $100 deductible; coverage is 80 percent. Under the KeyCare program (with
services of a KeyCare participating physician), there is a $10 deductible per visit; the
physician bills the rest to Blue Cross/Blue Shield, however there is a $2,000 maximum
reimbursement.
Mr. Lindstrom arrived at 4:50 p.m.
Mr~ Fisher asked about the coverage for an individual traveling out of the area. Ms.
Payne said if there is a medical emergency or accidental injury under those circumstances, go
to the nearest facility for treatment. Blue Cross/Blue Shield will pay up to what is
considered usual, customary, and reasonable for services in that area. There is a special
form that must be filled out by an individual who has dependents covered by the KeyCare
program who live out of the area. Payment for claims of those dependents will be made on the
same basis. Mr. Fisher asked if there is a $10 deductible under those circumstances.
Ms. Payne said yes, however they are not restricted to a KeyCare network of physicians and
hospitals because there is none outside of Virginia.
Mr. Robert Taylor, Chairman of the School Board, said there is great concern among most
school employees regarding the nervous and mental coverage. He asked if the KeyCare plan can
be altered to give different mental health benefits. Mr. Shelton said the program is
designed for cost containment, but Blue Cross/Blue Shield will be glad to address any
features that are of concern. Ms. Payne said the program as presented today is the same that
approximately 98 percent of the KeyCare groups have.
November 6, 1985 (Afternoon-Adjourned from October 16, 1985)
(Page 6)
Mr. Taylor questioned figures on a graph (shown in a slide presentation) that indicated
a net gain in FY 1984-85 over the previous year, yet a decrease in the current reserve
balance. Mr. Shelton said there are other medical categories not shown on the graph that
represent approximately 45 percent of the expenses. Mr. Taylor said he needs figures showing
usage in the other medical categories as well as nervous and mental, for an up-coming
meeting. Mr. Shelton said he believes those figures are available.
Dr. Tolbert asked the status of University of Virginia Hospital regarding its partici-
pation in the KeyCare program. Ms. Payne said at this time Blue Cross/Blue Shield does not
have a contract with that hospital, however there was a news release in the newspaper
recently saying it will participate in KeyCare.
Mr. Bowie asked about out-patient benefits under the KeyCare program. Ms. Payne said
there is a $10 deductible for the physician's office visit, the rest is covered by KeyCare.
Mr. Fisher said he assumes the KeyCare concept is that of a cost-sharing system designed
to make the employee realize there is some cost to medical insurance coverage. Ms. Payne
said it is to educate people to better utilize their health care benefits. Mr. Shelton said
many people did not use their health insurance last year because they probably did not have
enough doctor office visits. He point out that KeyCare benefits are effective with the first
office visit.
Dr. Brennan, associated with Blue Cross/Blue Shield, said active negotiations are
presently taking place with University of Virginia Hospital. He said that hospital is
attempting to segregate services which are most competitive in price with Martha Jefferson
Hospital, as compared to tertiary (intensive) treatment.
Mr. Fisher said both the Board of Supervisors and the School Board appreciated the
presentation today.
Agenda Item No. 4. Joint Executive Session: Personnel.
Mr. Bowie offered a motion for the Board of Supervisors to enter into executive session
for personnel matters. The motion was seconded by Mrs. Cooke. Roll was called. The motion
carried by the following recorded vote:
AYES:
NAYS:
Mr. Bowie, Mrs. Cooke, Messrs. Fisher, Henley, Lindstrom and Way.
None.
Motion was offered by Dr. Tolbert, seconded by Mr. Armstrong, for the School Board to
enter into executive for personnel matters. The motion carried by the following recorded
vote:
AYES: Messrs. Tolbert, Armstrong, Taylor, Baker, and Perkins.
ABSENT: Mrs. Haden and Mr. Marshall.
Agenda Item No. 5. Executive Session: Property Acquisition.
The Board of supervisors reconvened at 5:20 p.m. Mr. Bowie made a motion to go into
Executive Session for property acquisition and personnel matters. The motion was seconded by
Mrs. Cooke and carried by the following recorded vote:
AYES:
NAYS:
Mr. Bowie, Mrs. Cooke, Messrs. Fisher, Henley, Lindstrom, and Way.
None.
Agenda Item No. 6.
adjourned.
Adjourn.
The Board reconvened at 7:29 p.m. and immediately
Chairman