Whitman County 2014 Benefit Renewal and Planning Medical/Re… · Whitman County 2014 Benefit...

Whitman County 2014 Benefit Renewal and

Planning Becky Byrne, Licensed Benefit Consultant

PayneWest Insurance August 19, 2013

1. 2014 Carrier, Rates and Plan Options and Funding

2. Health Improvement - Wellness

3. Affordable Care Act Impact

Top Three Goals

2014 Carrier Review/Analysis Funding Strategy’s – HRA, HSA’s Reform Impact to the County Wellness Program Streamline Benefits Benchmarking Completed 2015 ACA Updates/Changes Marketplace options Target Specific Risks through Wellness Carrier Review/Analysis 2016 Gold Level Wellness Program One Health Plan For All Online enrollment and administration

Three Year Strategy Outline

Membership › Employees – 65% › Spouses – 12.2% › Dependents – 19.3%

Paid Medical/Rx Claims 1/1/13-6/30/13 - $896,797 › Average Payment Per Member - $3,447 (Norm - $717) › Average Payment Per Employee - $5,037 (Norm - $1,630)

Claims over $25,000 › As a % of total payments – 47.2% (Norm – 47.5%) › Claimants per 1,000 – 30.2% (Norm – 4.5%)

Main Cost Drivers › Inpatient and Outpatient Facility – 42.9% › Pharmacy – 21.3%

5/1/12 – 4/30/13 › Adjusted Incurred Claims $1,962,596.22 › Billed Premium $1,450,822.25 › Adjusted Incurred Loss Ratio 131.38%

Utilization Statistics

Carriers Providing Proposals o Cigna (incumbent) o WCIF – Washington Counties Insurance Fund o PEBB – Public Employees Benefits Board o United Healthcare (ETA – end of August) o Teamsters Status for Whole Group?

Carriers That Declined to Quote o Aetna o Asuris o Group Health o Premera o Moda

2014 Medical Plan RFP Results

Initial renewal – subject to negotiations › All Plans 51% increase › $750 Deductible Plan Plan Changes: Increased Out of Pocket to

$2,500/$5,000 (2014 includes office visit and Rx co pays)

› $3,500 Deductible Plan – no changes › $0 Deductible Plan Plan Changes: Increased Out of Pocket to

$2,250/$4,500(2014 includes office visit and Rx co pays)

Cigna cannot provide composite rates for all plans – only Sheriff/Deputy

Cigna Renewal

Current Medical/Dental/Vision/Life/LTD County Contribution $695

Employee Group

Medical Dental Vision Life LTD Total

Courthouse, Solid Waste & Non-Represented

$625.42 $392.58

$53.42 $8.93 $2.20 Base – ER paid

$687.77 $457.13

Deputy Sheriff Association

$955.44 Composite

$39.85 $8.93 $.15/$1000 1 x ann. salary

Base – ER paid

$1004.22 (life varies)

Correction Officers & Support Staff (Teamsters)

$1038.65 $39.85 $14.90 $1.60

Base – ER paid

$1094.80

Road Dept. $625.42 $392.58

$53.42 $14.90 $2.20 Base – ER paid

$695.95 $463.10

Medical - All Cigna, except for COSS/Teamsters Dental – All WA Dental Service (WCIF), COSS/Teamsters – No rate changes for Dental/Vision/Life – WCIF for 2014 Vision - All VSP (WCIF), COSS/Teamsters, Road - Teamsters Life – All Standard Life (WCIF $12,000), COSS addtl $5,000 Teamsters, Deputies (WCIF – 1x annual salary)

Cigna Proposed Renewal Medical/Dental/Vision/Life/LTD County Contribution $695 Employee Group



$944.33 $592.76

$53.42 $8.93 $2.20 Base – ER paid

$1008.88 $ 657.31


$1442.64 Composite

$39.85 $8.93 $.15/$1000 1 x ann. salary

Base – ER paid



$1038.65 (not in yet)

$39.85 $14.90 $1.60

Base – ER paid

$1094.80

Road Dept. $944.33 $592.76

$53.42 $14.90 $2.20 Base – ER paid

$1014.85 $ 663.28

Medical - All Cigna, except for COSS/Teamsters Dental – All WA Dental Service (WCIF), COSS/Teamsters - – No rate changes for Dental/Vision/Life – WCIF for 2014 Vision - All VSP (WCIF), COSS/Teamsters, Road - Teamsters Life – All Standard Life (WCIF $12,000), COSS addtl $5,000 Teamsters, Deputies (WCIF – 1x annual salary)

WCIF is a multi-employer, not-for-profit trust, established 1958

100 participating employers and 30,000 enrollees Single digit renewals last 3-5 years (pooled trust) Two carriers: Group Health (numbers available mid-

September) & Premera (provided) Employer Services:

› Combined billing, On-line Eligibility, On-Site Open Enrollment support

› Flex & H.S.A administration (Flex/H.S.A $5.25 pmpm) › Cobra administration included in rates

No Composite rate available for whole group (only for Sheriff)

Utilization reporting not available to WCIF groups Deadline for notification of move: 10/15/2013

Washington Counties Insurance Fund (WCIF)

$750 Plan – 12% increase over current › Premera Plan Differences:

Out of pocket $5,750/$11,500 vs. current at $1,500/$3,000 Specialty Office Visit co pay: $25 vs. $35 current RX co pays: $5, $20, 50% vs. $10, $20, $40 current

$3,500 H.S.A Plan – 44% increase over current › Group Health (rates available mid-September) – same H.S.A option as

Premera › Premera Plan Differences:

$1,500/$3,000 Deductible, $5,000/$10,000 OOP Adds Preventive RX at $0 co pay RX paid according to co insurance once deductible met vs. co pays after

deductible $0 Deductible plan – Only offered through Group Health

(numbers pending until mid-September) › Option (Premera): $500/$1,000 Deductible plan – 1.25% over current › Premera Plan Differences:

$500/$1,000 Deductible & $2,750/$5,000 OOP Hospitalization – deductible/co insurance ER - $150 co pay + deductible/co insurance Specialist office visit co pay $35 RX co pays up front: $5, $20, 50%

WCIF

WCIF Proposed Renewal Medical/Dental/Vision/Life/LTD County Contribution $695 Employee Group



$695.52 $567.21

$53.42 $8.93 $2.20 Base – ER paid

$760.07 $631.76


$967.40 Composite $500 Ded.

$39.85 $8.93 $.15/$1000 1 x ann. salary

Base – ER paid



$1038.65 (not in yet)

$39.85 $14.90 $1.60

Base – ER paid

$1094.80

Road Dept. $695.52 $567.21

$53.42 $14.90 $2.20 Base – ER paid

$766.04 $637.73


Provides insurance to state, higher –education institutions & eligible (county) employer groups › 6 counties currently participating › 339,000 enrollees (approximately 181,000 employees)

Provides either 1) medical only or 2) bundled: medical, dental, vision, life ($25,000), LTD (60% to $400/month, 90 day wait, buy-up)

$1,500 initial set up fee County applies to join

› Details provided once Whitman determines. Majority of information includes letters of authorization to pursue, benefit direction and census

2014 Implementation of surcharges: › Tobacco $25 (details to follow from PEBB) › Spousal surcharge of $50 if spouse has access to other employer

coverage but elects PEBB Utilization reporting not available to PEBB groups Cobra administration included in rates Flex/H.S.A Administration:

› PEBB does not provide flex administration › No H.S.A fee if member enrolled on CDHP plan

Public Employers Benefit Board (PEBB)

$750 Plan – 2.39% increase over current › PEBB Plan Differences:

$350/$1,050 Deductible $2,000/$4,000 OOP Hospitalization: $200 co pay per day up to $1,000 max, ER: $300 co pay Office Visits: Deductible then $20 & $40 co pays RX $20, $40, 50% to $250 Vision included: deductible then co pays per services

$3,500 Plan – 50% increase over current › PEBB Plan Differences:

$1,400/$2,800 Deductible $5,100/$10,200 OOP 90/10 co insurance for in network RX $20, $40, 50% to $250 Vision included: deductible then coinsurance

$0 Plan – 68% increase over current › PEBB Plan Differences:

$250/$750 Deductible 80/20 co insurance ER co pay $250 vs $100 currently Office Visits: Deductible then $15 and $30 co pays RX $20, $40, 50% to $250 Vision included: deductible then coinsurance

PEBB Dental/Life/LTD › Included in rates – 2 plans to choose from › $25,000 – Life/AD & D › LTD – 60% to $400/month with Buy-up

PEBB (rates include health, dental, vision, life and ltd)

PEBB Proposed Renewal Medical/Dental/Vision/Life/LTD County Contribution $695

Employee Group



$673.00 ($350 Ded) $636.65

Incld Incld Incld Incld $ 637.00 $636.65


$1,609.32 Composite Est.

Incld Incld

Incld Incld $1609.32 (life varies)


$1038.65 (not in yet)

Incld Incld

Incld

Incld

$1038.65

Road Dept. $673.00 $636.65

Incld

Incld

Incld

Incld

$673.00 $636.65


CIGNA/$750 Current Proposed Employee $ 0.00 $ 249.33 EE/spouse $ 618.37 $1,288.08 EE/children $ 493.29 $1,099.22 Family $1,181.25 $2,137.99 Deputies $ 95.54 $ 144.26

Employee Estimated Monthly Contribution - Cigna

WCIF/$750 Current Proposed Employee $ 0.00 $ 0.52 EE/spouse $ 618.37 $ 831.67 EE/children $ 493.29 $ 554.55 Family $1,181.25 $1,385.70 Deputies $ 95.54 $ 96.74

Employee Estimated Monthly Contribution - WCIF

PEBB/$350 Current Proposed Employee $ 0.00 $ 0.00 EE/spouse $ 618.37 $ 508.82 EE/children $ 493.29 $ 376.12 Family $1,181.25 $ 906.94 Deputies $ 95.54 $ 160.90 (estimate)

Employee Estimated Monthly Contribution – PEBB (all lines)

WCIF Dental, Vision and Life are experiencing a rate pass for 2014. Rates will remain the same.

Dental Options: › Met Life -6% savings › Guardian – 15% savings Plan differences: Type II (Basic) services currently 90%/10% coverage with

participating provider. Guardian unable to provide 90% coverage – so 80% offered.

Guardian offers Maximum Roll Over Feature – if member uses less than $800 in the calendar year, $400 will roll over and accumulate towards the Annual Maximum Benefit.

WCIF Dental, Vision, Life Renewal

A Health Reimbursement Arrangement (HRA) is an employer-funded account that is designed to reimburse employees for qualified medical expenses that are paid for out-of-pocket. The employer usually sets the contribution below the annual deductible. HRAs are often designed to operate with a high deductible health plan (HDHP), thereby reducing premium costs while encouraging employees to spend wisely.

What is an HRA?

$5,000/$10,000 Deductible $6,350/$12,700 Out of Pocket › No Office Visit, ER or Facility Copays › Rx subject to Deductible

Employee Deductible and Out of Pocket with HRA Buy-Down › $500 Deductible, 80/20 Coinsurance, $1,670

Out-of-Pocket

OPTION: High Deductible Health Plan with Health Reimbursement Arrangement

HRA Analysis Health Reimbursement Arrangement (HRA) - Employer Funded

Savings/Cost Analysis for Whitman County Estimated Rates - $5,000 80/20 $6350 OOP, No OV Copay or Rx

Assumptions: Current Deductible $750.00 New Plan Deductible $5,000.00 Annual Premium With Renewal - Current Plan $2,298,119.00 Annual Premium Utilizing HRA $1,380,480.00 Annual Savings From Plan Design Change = $917,639.00

Employer HRA Levels:

Single Employee + 1 Employee +

children Family Total Number of employees 142 13 5 8 168 Total Plan deductible $5,000.00 $10,000.00 $10,000.00 $10,000.00 Employee Responsibility $750.00 $1,500.00 $1,500.00 $1,500.00 Employer Responsibility $4,250.00 $8,500.00 $8,500.00 $8,500.00 Total $603,500.00 $110,500.00 $42,500.00 $68,000.00 $824,500.00 HRA Plan Administrative Fees First Year Setup Fee $500.00 Monthly Administration Fee $4.50 $9,072.00 Monthly Banking & EFT Fee $30.00 $360.00 Total $9,932.00 Annual Employer Savings/Cost Assuming 100% Utilization = $83,207.00 Annual Employer Savings/Cost Assuming 80% Utilization = $248,107.00 Annual Employer Savings/Cost Assuming 60% Utilization = $413,007.00 Annual Employer Savings/Cost Assuming 40% Utilization = $577,907.00 Note: The employer retains any unused HRA dollars not utilized by the employees.

Illustration Only – final rates subject to final underwriting

Source: Goetzel RZ, et. al. (1998, October). The relationship between modifiable health risks and health care expenditures: An analysis of the multi-employer HERO health risk and cost database. JOEM, 40(10):843-54.

Percent Higher Annual Health Plan Costs

N = 46,000+ X 3 years

Health Risks Increase Health Costs

2014 – Biometrics, Health Coaching, Activities/Nutrition, Self Care and Education – 5 point improvement goal

2015 Premium differential based upon improved outcomes

2015 Health Contingent Program with premium differential opportunity

Wellness and Prevention

Existing Reform Changes Summary of Benefits and Coverage

Women’s Preventive Services

Unlimited Lifetime Maximum

Annual Preventive Services Covered @ 100%

Dependent children coverage to age 26

Notice of Rescission

No pre-ex for Dependents less than 19

Essential Benefits

Research Fees

W-2 Reporting

2014 Health Care Reform Financial Regulations

Full Time Eligibility Requirements – delayed to 2015

Employer Shared Responsibility Rules – delayed to 2015

Minimum Value and Affordability

Medicaid Eligibility (138% of FPL – State Decision to Expand)

Patient-Centered Outcomes Research Fee

Reinsurance Fees Health Insurer Fees – fully-

insured only Medicare Payroll Tax

Plan Design Regulations Pre-Existing Condition

Exclusion 90 Day Waiting Period 30 hour/week Eligibility

Requirement OV copay accumulation

toward Out of Pocket and Max Out of Pocket Limit

Individual Requirement to Have Insurance

Wellness Program Rewards and Health Related Standards and Reasonable Accommodations

Narrow Carriers, Plan Design options, Funding and Wellness

Final Decision Deadline – › PEBB – 10/1/13 › WCIF Requires – 10/15/13 › Cigna – 30 days out

Implementation and Communication Timeline

Comprehensive Employee Education

Next Steps

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