Skip to content Accessibility info

History of the Plan

The Jefferson-Lewis et. al. Healthcare Plan (“Plan”), a self-insured Plan made up of school districts in the Jefferson-Lewis BOCES, except for South Jefferson, Adirondack, Inlet, and Town of Webb, was established during the school year 1978-1979. The plan also includes Jefferson Community College (JCC). Prior to its establishment, most of the Districts belonged to the Statewide Plan, and some belonged to Blue Cross/Blue Shield. The impetus to form a self-insured plan was the increase in premium costs faced by Districts and employees who shared in the premium cost pursuant to negotiated contracts. It was believed that a self-insured plan would be less costly. The goal of the creators of the Plan was to provide a benefit plan equal to or greater than the plans currently subscribed to. This goal was necessary to achieve union and employee approval of the change to self insurance, which was eventually achieved. The Plan, created in 1979, was a total indemnity plan, except for minimal employee deductibles. The Plan paid 100% of medical expenses after deductibles were met. The executive director of the Plan was a retired superintendent, and the Board of Trustees was made up of district superintendents and business officials. The Trustees established the annual premium and, from 1979 through 1996, some changes were made to the benefits offered by the Plan. These changes were minimal, and were accepted without objection by the unions. In the 1995-1996 school year, the Plan was faced with substantial losses for various reasons, including costly medical procedures, mandated Federal and State benefit coverage changes, and mandated Reserve Funds. To cover the losses, a 52% premium increase over two years was required, or the Plan would face bankruptcy. From 1996 to 1998 the plan experienced turmoil and change with the evolution of the addition of a new Point of Service(POS) Plan option. The Plan contracted with POMCO, a third party administrator headquartered in Syracuse, New York for both processing of claims and utilization of a participating provider network. Since 1998 the plan has continued to develop network participation and benefit structure improvements. The result has been the Plan returning to a strong financial position and a comprehensive benefit structure for the benefit of covered employees and their families. The plan is now fully certified with the New York State Insurance Department and in compliance with all regulatory requirements. Several committees focus on individual areas of plan responsibility. A finance committee oversees plan investments; A benefits review committee evaluates expanded benefits; An appeals committee considers direct enrollee requests for special exception to claims that are denied. The Board of Trustees is composed of the superintendent from each participating school district or their business official designee. Three additional board members are members of the enrollee population each serving three year terms elected on an annual staggered basis.