ABOUT THE PENNSYLVANIA PUBLIC SCHOOL HEALTH CARE TRUST PLAN OF HEALTH INSURANCE.
-
Upload
janice-whitehead -
Category
Documents
-
view
214 -
download
0
Transcript of ABOUT THE PENNSYLVANIA PUBLIC SCHOOL HEALTH CARE TRUST PLAN OF HEALTH INSURANCE.
BACKGROUND
• Planned for years• Officially constituted as non-profit
organization in March 1999• Endorsed by PaFT, PSBA, PSEA, PASA, and
PASBO• Functions as Taft-Hartley Trust
Labor/Management• Initial funding provided by Heinz Family
Foundation• First Managing Director hired July 2000
HOW DOES THE TRUST WORK?
• Acts as the Benefit Provider
• Uses panel of Participating Physicians and Hospitals
• Negotiates Discounts from Providers’ Fees
ORGANIZATION• Trustees: oversight responsibility• Managing Director: day to day activity
responsibility• State divided into 4 regions
– Western Pennsylvania (80,000)– Central Pennsylvania/Lehigh Valley (75,000)– Southeastern Pennsylvania (50,000)– Northeastern Pennsylvania (25,000)
• Solicitor• Independent auditor• Access to consultants as necessary
Organizational Structure
Officers/Trustees
Philip A. Smalley Managing Director
Levin Legal Group, P.C. General Counsel
Trustees Barbara Frankhouser, PSBA
Albert Fondy, PaFT Edward W. Godin, PSBA
James Weaver, PSEA *Alex Matthews, PSBA Bernard Murray, PaFT
James P. Testerman, PSEA Barbara Andrews, PSBA *Gerald L. Fowler, PASA
*Timothy J. Shrom, PASBO Barbara L. Bolas, PSBA *Patsy Tallarico, PSEA
*Carolyn Dumaresq, PSEA *Tom Gentzel, PSBA
Carol Kaufman Consultant
Field Office Affairs
Alt. Health Care Options Alternative Medicine
Employee Benefit Data Svc Fiscal Agent
HealthCare Strategies Utilization Management
The Loomis Company Third Party Administrator
CONTRACTED SERVICES
Alex Matthews, PSBA President
Patsy Tallarico, PSEA Vice President
Carolyn C. Dumaresq, PSEA
Secretary Tom Gentzel, PSBA
Treasurer
Revised June 2001
John Brunette Senior Consultant
Central/East
Tatiana Gazarh Data Input Tech
Coordinator
Advisory Committee
Marketing Consultant
Western/Central
Express Scripts Pharmacy Benefit Mgmt.
Tra-Tech, Inc. Network Development
William M. Mercer Actuarial Services
PPSHCT 1-01-02
*Denotes Executive Committee Members
Who is Eligible?
• School Districts
• Intermediate Units
• Vocational/Technical Schools
• Community Colleges
The Stakes Statewide
• Over 230,000 employees/550,000 members
• Approximately $800,000,000 being spent annually on health care
Immediate Goals of the PPSHCT
• Maintain quality health care benefits
• Seek competitive advantages
• Promote Labor/Management cooperation
• Control cost to taxpayers
Health Insurance Issues in Bargaining
• Hinder the Process
• Raise issues that the Parties can’t control
• Force hard-line positions
Typical PPSHCT Client Services
• Technical– Define and monitor terms and arrangements with third party administrators– Analyze utilization trends– Generate regular insurance summaries/reports
• Customer Service– Resolution of participant claim matters– Promotion of optimal labor management climate– Facilitate formation and operation of regional advisory committee
• Educational/Developmental– Develop and present health care seminars and symposiums to promote health
care awareness– Conduct product briefings
• Consultative
PPSHCT Enhanced Choice Plan
• Development of Enhanced Choice Plan – a self-funded option.
• Self-funding is not new. Currently 60% of all employers are in self-funded plans.
What is Self-funding?
• The Trust collects premiums from the employer
• The Trust contacts with a third Party Administrator to pay claims
• The Trust manages risk with stop/loss insurance
What Is Stop/Loss Insurance?
• Limits Liability– Creation of a reserve fund– Purchase Individual Stop/loss– Purchase Aggregate Stop/loss
Advantages of self-funding
• Cash flow
• Lower Administrative Costs
• More Plan Flexibility
• Better data on Utilization
Health Care Strategies Inc.
• Allows you to actively participate in your healthcare– Provides information about Doctors and
Hospitals
– Provides specific disease and condition Protocols
– Provides wellness experts for proactive health care
• Reduced retention/administrative fees• No carrier reserve requirement; interest on excess funds
accrues to Trust• As Trust grows, need for extra funding to stabilization
Fund decreases• Marketing fees minimized• Greatly expanded provider network that can be
customized to meet the needs of a specific group (In and out of state)
• Leveraging the numbers to obtain the best possible discounts with providers and rates with re-insurance carriers
The Advantages of An Affiliation With The PPSHCT
The Advantages of An Affiliation With The PPSHCT
• Avoidance of network development expense• Commitment to managed care (versus managed cost)• Access to Centers of Excellence• Best health interest of members stressed• No brokerage fees built in to premium deposits• Greater flexibility to affect benefit design• Health Insurance “Off” the bargaining table• Significant resources available to clients through the Trust
affiliates• Your Insurance; Your Trust – PPSHCT works for you.
To Affiliate with the PPSHCT
• $1,000 per district application fee plus 1% of premium on monthly basis
• Commitment to Labor/Management philosophy
• Authorization to receive, review, and analyze three years of utilization data
• Three year commitment/execute a Participation Agreement
What is Group Health Insurance?
• A Large number of people paying to provide health care to those that need it
• The 6% - 60% Rule Applies
• Chronic and Catastrophic
“There is nothing more difficult to execute, nor more dubious of success, nor more dangerous to administer than to introduce a new system of things: for he who introduces it has all who profit from the old system as his enemies, and he has only lukewarm allies in all those who might profit from the new system”
Niccola Machiavelli