Meeting of the Group Benefits Advisory Committee October 7, 2019 - - PowerPoint PPT Presentation

October 7, 2019

Meeting of the Group Benefits Advisory Committee

• 1. Opening Remarks
• Dr. Janet Bezner, Chair

• 2. Legislation Impacting the GBP

Diana Kongevick, Director of Group Benefits Blaise Duran, Actuarial and Reporting Services, Group Benefits

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 HB 170 – Requires coverage of diagnostic mammography at the same

benefit level as screening mammography.

 HB 392 – Relates to ERS establishment of an individual long term care

insurance program.

 HB 1584 – Prohibits the use of step therapy for drugs prescribed for the

treatment of stage four, advanced, metastatic cancer.

86th Legislative Session Summary Update

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 SB 1264 – Applies to GBP health plans (except Medicare Advantage plans) and prevents

surprise billing (also known as balance-billing) for:

• ut-of-network emergency services,
• ut-of-network facility-based provider performing services at an in-network facility,

and

• ut-of-network diagnostic imaging provider or laboratory provider performing

services in conjunction with an in-network provider. The law does NOT apply to non-emergency health care services when a health plan participant has chosen to:

 seek care from an out-of-network provider and  received a written disclosure in advance about all the out-of-network providers who will

be involved with the service and the estimated costs.

86th Legislative Session Summary Update

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 Rider 10.06 – Directs the University of Texas Health Science Center in

Houston to provide data analysis and individual agency benchmarking for HHSC, ERS, TRS, and TDCJ.

 Rider 15 – Directs ERS to maintain competitive and favorable contracted

provider rates with Health Related Institutions receiving appropriations.

 Rider 16 – Directs ERS to incentivize participants to shop for lower cost

healthcare through the use of shared savings.

86th Legislative Session Summary Update

Questions & Discussion

• 3. Wellness Discussion:

Assess, Manage, Prevent

Lacy Wolff, Health Promotion Administrator

Health and Wellness Report Cards

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Why?

 Shows ERS’ commitment to improving health and wellness  Gives directors data to understand the health of their agency or higher

education institution

 Provides goals to increase engagement in wellness initiatives  Measures change

Health and Wellness Report Cards

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 Assess - % of participants that have taken online health

assessment

 Manage - % of participants that have enrolled in weight

management program

 Prevent- % of participants that have completed annual

preventive screening

AMP Wellness Campaign

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Assess health online

Goal: 25% FY18: 3%

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Where to take an assessment

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Manage and Prevent Obesity

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Manage and Prevent Obesity

Manage

FY18: 1.7% Goal: 10%

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18 Source: Centers for Disease Control: “Selected health conditions and risk factors by age, Table 53.”

Healthy Weight: BMI ≤24.9 Overweight: BMI = 25-29.9 Obese: BMI ≥ 30

40% of U.S. adults live with obesity

2015-2016, age 20 and older

40% 28% 32%

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Preventive screenings yearly

Prevent

FY18: 51% Goal: 70%

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 Assess - % of participants that have taken online health

assessment

 Manage - % of participants that have enrolled in weight

management program

 Prevent - % of participants that have completed annual

preventive screening

AMP Wellness Campaign

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 What would motivate our plan participants to complete a health

assessment?

 What barriers might prevent participants from getting their

recommended screenings?

 How do we encourage participants to engage in weight

management programs?

Discussion Questions

• 4. Tobacco Certification Policy

Keith Yawn, Director of Strategic Initiatives

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TOBACCO USER PREMIUM DIFFERENTIAL (a) The board of trustees shall assess each participant in a health benefit plan provided under the group benefits program who uses one

• r more tobacco products a tobacco user premium differential, to be

paid in monthly installments.

Texas Insurance Code, Section 1551.3075

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“Tobacco Product” is defined as cigarettes, cigars, pipe tobacco, chewing tobacco, snuff, dip or any other products that contain

• tobacco. The term does not include an electronic cigarette or e-

cigarette that does not contain tobacco and is designed expressly for the purpose of smoking cessation.

Tobacco Certification Policy Approved August 2011

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“Tobacco Products” are cigarettes, cigars, pipe tobacco, chewing tobacco, snuff, dip or any other products that contain tobacco and a “Tobacco User” is a person who has used any Tobacco Products five (5) or more times within the past three (3) consecutive months. 43,272 certified tobacco users (8% of population) More than 69,000 potential tobacco users (based on national statistics)

Tobacco Certification Statement

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 E-cigarettes produce an aerosol by heating liquid that can contain nicotine,

flavorings, and other chemicals. Users inhale this aerosol into their lungs.

 E-cigarettes are sometimes called “e-cigs,” “e-hookahs,” “mods,” “vape

pens,” “vapes,” “tank systems,” and “electronic nicotine delivery systems (ENDS)” and can resemble regular cigarettes, pens, or USB sticks.

E-Cigarettes Definition

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The Food and Drug Administration (FDA) defines “tobacco product” to include e-cigarettes (electronic nicotine delivery systems), but does not include e-cigarettes as a tobacco cessation product or plan. HealthSelect plans offer:



Self-directed and interactive tobacco cessation and education programs through Well on Target



44 participants engaged in a Well on Target tobacco program in FY19



16% completion rate



Pharmacy benefits covering a variety of prescription and over-the-counter products to assist with tobacco cessation

Tobacco Cessation

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 Should ERS consider any updates to the Tobacco Certification

Policy and/or Tobacco Certification Statement language?

 Is it appropriate to fully include e-cigarettes in the definition of

tobacco products, triggering a premium differential?

 How should ERS communicate any potential change to our

participant population?

Discussion Questions

• 5. Group Benefits Program Updates

Diana Kongevick, Director of Group Benefits Blaise Duran, Actuarial and Reporting Services, Group Benefits Bernie Hajovsky, Enterprise Planning

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HealthSelect

Continues to perform well

• Cost trends for HealthSelect plans (HealthSelect) medical

and pharmacy plans are performing better than expected

• For FY19, combined medical and pharmacy trend is

projected at 6%

• HealthSelect provider networks are broad and larger than

in previous years

• Member cost-share remains flat (see next slide)

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Members’ Cost Share Is Steady

The state is picking up most of the increase

$0 $1,000 $2,000 $3,000 $4,000 $5,000 $6,000 $7,000 $8,000 2010 2013 2016 2019

Total Cost Health Plan's Share Member's Share

$5,815 $7,178 17.2% $5,239 $7,147 82.8% 83.7% 87.3% 87.7% 16.3% 12.7% 12.3%

Fiscal Year

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HealthSelect

HealthSelect Network continues to grow

HealthSelect PCPs December 2017 % of POP July 2019 % of POP

Participants who select a PCP 347,762 86% 351,603 88% Participants who do not select a PCP 56,576 14% 48,172 12% Total Population 404,338 100% 399,775 100%

• Participant access to closest PCP is, on average:
• 2 miles to 1st closest PCP
• 2.9 miles to 2nd closest PCP
• 3.4 miles to 3rd closest PCP
• 99.9% of participants have access to a specialist

within 75 miles

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GBP Optional Add-On (Voluntary) Plans

Background

* Actives and retirees are pooled together with same rating ** State contributes $45 / $90 month to each HSA

Enrolled members pay 100% of the premium for voluntary benefit programs.

Coverage Plan Type TPA / Insurer August 2019 Enrollment # States That Offer

Dental

PPO Delta Dental 332,476

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HMO DeltaCare USA 115,660

n/a

Vision

Vision benefits Superior Vision Services 224,276

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Optional Life *

(not including dependent life)

Group term insurance Minnesota Life Insurance Co. 216,891

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Voluntary AD&D

Group term insurance Minnesota Life Insurance Co. 129,076

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Texas Income Protection Plan

(disability insurance)

Short-term ReedGroup 112,632

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Long-term 86,014

TexFlex accounts

Flexible savings accounts WageWorks 48,289

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HSA accounts for

CDHS members**

Health Savings Account Optum Bank 1,518

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GBP offerings

• Current health-related voluntary plans complement the benefit

design of the health plans, including basic life insurance that is part of your benefits package

• ERS carefully considers the role and/or value any new

coverage might have when evaluating options

• ERS is exploring options for offering individual long-term care

insurance

GBP Optional Add-On (Voluntary) Plans

Background

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Other states’ supplemental coverages

Type of Coverage Number of states Universal life (with or without a long-term care rider)

3

Hearing aid benefit

2

Specified / critical illness*

1

Cancer*

2

Accident*

4

Hospital indemnity or hospitalization*

3

ICU*

1 * Event-specific supplemental insurance that typically pays a flat amount upon occurrence

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 What requests for supplemental coverage do you hear?  How important is it to offer supplemental coverages through

the GBP versus the Discount Purchase Program?

Discussion Questions

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• The ERS Board of Trustees requested ERS staff develop a policy for the

Texas Employees Group Benefits Program (GBP) similar to the funding policy adopted for the ERS Pension plan in May 2018.

• Program structure and goals were discussed at the December 2018 Board

meeting and a more detailed outline was provided at the March 2019 Board meeting based on comments received.

• The draft document was shared with the Board and this committee earlier

this year for comments and suggestions. Thanks for your input!

Group Benefits Funding Policy

Background

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The purpose of the GBP policy is to:

• formalize the Policy Goal and establish guidelines to be followed to

assist in effectively setting contribution rates and managing the plans for GBP participants, including guidelines for consideration of changes in Member Cost Share (MCS);

• establish priorities to guide the development of the GBP Legislative

Appropriation Request (LAR); and

• provide legislators, elected officials and other stakeholders with clear

and accurate information on the impact of proposed legislation and/or policy initiatives on GBP costs and operations.

GBP Policy Document

Purpose and Scope

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• The draft policy applies to programs funded through the legislative

appropriation process.

• This currently includes the GBP employee and retiree basic term life and

health plans.

• The policy does not apply to optional add-on (voluntary) benefit plans.

GBP Policy Document

Applicability

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• The ERS Board adopted the policy document at its August 2019

meeting.

• The adopted version reflects input provided by Board members,

the GBAC and changes made through internal review.

• A copy of the adopted policy was forwarded to GBAC members.

GBP Policy Document

Policy update

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On May 22, 2019, ERS Board of Trustees awarded service contracts for the Texa$aver program.

 New Contract’s lower rates represent a savings projection of $28.5 million

for fiscal years 2020 through 2025.

 Participant-paid fees were reduced 39.67%.  Communication strategy to notify participants of the lower fees:

 Pop-up notification on Texa$aver website: June 2019  Email notifications sent to registered email accounts: July 2019 – August

2019

 Quarterly statement insert: Q3 2019 (October 2019)

Texa$aver Program

Reduced participant fees

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• Purpose
• Gauge membership’s perception of the value of retirement and

benefits programs

• Provides mechanism to collect feedback on benefits to inform

decisions

• Updates
• Split survey into two separate surveys (retirement, benefits)
• Sending pre-survey email to increase awareness
• Survey launch is targeted for later this month
• Thanks for your input!

Membership Benefits Survey

Overview

• 6. Discussion of Topics for Future Meetings
• Dr. Janet Bezner, Chair

• 7. Committee Member Recognition

Porter Wilson, Executive Director

• 8. Set Date of Next Committee Meeting
• Dr. Janet Bezner, Chair

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Wednesday, March 25, 2020 Thursday, March 26, 2020 Monday, March 30, 2020 Tuesday, March 31, 2020 Spring 2020 Meeting

Possible Dates

Meeting Adjourned

Thank you for attending!