OFFICE OF GROUP INSURANCE CEC COMMITTEE ~ JANUARY 3, 2020 - - PowerPoint PPT Presentation

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OFFICE OF GROUP INSURANCE CEC COMMITTEE ~ JANUARY 3, 2020 - - PowerPoint PPT Presentation

May 06, 2023 115 likes •280 views

DEPARTMENT OF ADMINISTRATION OFFICE OF GROUP INSURANCE CEC COMMITTEE ~ JANUARY 3, 2020 Jennifer Pike, Group Insurance Administrator Bryan Mooney, Dept of Administration Director Keith Reynolds, Deputy Director 2 OFFICE OF GROUP

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DEPARTMENT OF ADMINISTRATION

OFFICE OF GROUP INSURANCE

CEC COMMITTEE ~ JANUARY 3, 2020

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SLIDE 2
  • Jennifer Pike, Group Insurance Administrator
  • Bryan Mooney, Dept of Administration Director
  • Keith Reynolds, Deputy Director

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OFFICE OF GROUP INSURANCE

 5 full-time employees

  • Administrator
  • Benefit Manager
  • Group Insurance Specialist
  • Employee Benefits Specialist
  • Employee Benefits Technician

 Annual personnel and operating budget for FY2020 $852,000

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ENABLING STATUTES AND RULES

 I.C. 67-5760 – 67-5772

  • Powers and duties
  • Objectives and considerations
  • Retiree medical eligibility and subsidy
  • Perpetual appropriation
  • Group Insurance Advisory Committee (GIAC)
  • Website: https://ogi.idaho.gov/group-insurance-advisory-committee/

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BENEFITS PACKAGE

 Active employee medical & dental

  • Vision benefit
  • Prescription drug coverage
  • Employee assistance program (EAP)
  • Disease management programs

 Retiree medical  Basic life insurance

  • Short and long-term disability
  • Accidental death and dismemberment
  • Voluntary term life (VTL)

 Flexible spending accounts (FSA)

  • Telemedicine (MDLive)
  • Case Management
  • Cost Advisor/Transparency Tools
  • Wellness/well-being resources

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FY2020 SIGNIFICANT PLAN/ADMINISTRATION CHANGES

  • Relinquished “Grandfathered” status
  • Implemented 4-tier pharmacy and $2,000 out-of-pocket maximum for Rx
  • Increased individual and family deductibles
  • Musculoskeletal (MSK) Management Program
  • Improved Physical Therapy (Increase 20 covered visits up to 40 covered visits)
  • Incentivized telehealth with a lower PPO copay
  • Introduced elements of value-based payment arrangements with providers
  • Made the High Deductible Plan HSA compatible
  • Increased the Dental maximum allowance to $1,500

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MILLIMAN MEDICAL CLAIMS ACTUALS & PROJECTIONS

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220 240 260 280 300 320

FY2018 FY2019 FY2020 FY2021

Millions Nov-18 May-19 Nov-19

FY2018 & FY2019 show actual claims. FY2020 & FY2021 show projected claims.

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SLIDE 8

MEDICAL PLAN MEMBERSHIP OVERVIEW

ACTIVE EMPLOYEES 8 RETIREES

46,808 Members as of June 2019 855 Members as of June 2019

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FUTURE PLAN DESIGNS INITIATIVES

 FY2020

  • New PBM – IngenioRx
  • Working with SCO on the LUMA project

 FY2021

  • Enhance the Vision benefit with a traditional in-network VSP plan and continue the same out-
  • f-network reimbursement model
  • Implement a wellbeing platform that provides engagement and ability to communicate with

employees

  • Implement an E.R. copay of $100
  • Increase the specialist PPO copay to $40
  • Incentivize use of ChoiceDocs program with lower PPO copays for PCP and specialists
  • Continue working with SCO on the LUMA project

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PROJECTION METHODOLOGY

  • Actual claims experience
  • Industry trend (Milliman Health Cost Guidelines™ blended with state of Idaho trend experience)
  • Reserve requirements
  • Reserve balance (funds held by OGI)
  • Enrollment
  • Benefit changes
  • Health Care Reform related fees – H.R. 1865, Further Consolidation Appropriations Act, 2020
  • Projections conducted in May and November

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PROJECTED MEDICAL PLAN COSTS

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$294 $303 $318 $322

50 100 150 200 250 300 350 Millions Other* Employee Contributions ACA Fees State Contributions Total Plan Costs 5% 1.5% 3%

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2 4 6 8 10 12 14 16

FY 2019 2020 Projected 2021 Projected

Millions Other* Employee Contributions ACA Fees State Contributions Total Plan Costs 0.5% $13.8M $13.9M

PROJECTED DENTAL PLAN COSTS

7.5% 12 $12.9M

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MEDICAL & DENTAL RESERVES

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10 20 30 40 50 60 70 80 90 100

Millions

$75.3M $29.1M $94.2M $64.5M $30.1M $27.1M

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MILLIMAN NOVEMBER PROJECTIONS – APPROPRIATION OPTIONS

FY2020 Medical & Dental Appropriation = $11,650

  • 10% Drawdown Appropriation

$10,690

($32 million medical & dental reserve balance)

  • 90th Percentile Appropriation

$11,630

($52 million medical & dental reserve balance)

  • Not to exceed the Federally Allowed Reserve

$11,760

($54.5 million medical & dental reserve maximum)

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FY2021 Options

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Office of Group Insurance 650 W. State Street, Ste 145 Boise, ID 83720-0035 (208) 332-1860 (800) 531-0597

  • gi@adm.Idaho.gov

https://ogi.Idaho.gov

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