VOLUSIA COUNTY SCHOOL BOARD HEALTH INSURANCE RENEWAL/UPDATE - - PowerPoint PPT Presentation

February 26, 2014

HEALTH INSURANCE RENEWAL/UPDATE

VOLUSIA COUNTY SCHOOL BOARD

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Highlights

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 Acronyms and definitions  Historical rate review and enrollment  Federal and Local Marketplace  Preliminary Projection

Acronyms

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

ACA – Affordable Care Act



CAT Plan – Catastrophic Plan



EAP – Employee Assistance Program



HMO – Health Maintenance Organization



HCR – Health Care Reform



HRA – Health Reimbursement Account



OPEB – Other Post Employee Benefits Liability



OPPAGA – Office of Program Policy Analysis and Government Accountability



POS – Point of Service (Triple Option)



PPACA – Patient Protection and Affordable Care Act



PPO – Preferred Provider Organization



RFP – Request for Proposal



WAT – Wellness Action Team

Definitions

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 Medical Trend

 The projected cost of medical inflation

 Retention

 The projected cost to administer the plan – including network access,

claims processing and administration

 Target Loss Ratio

 The projected amount of total claims divided by total premiums

 Claims

 The amount paid by the carrier for the cost of services for an insured

member of the plan

Insurance Committee & Meetings



Rita Ware (AFSCME)



Laura Cloer (VESA)



Diane Vaissiere (VESA)



• Dr. Maryann Bull (Non-barg)



Russ Tysinger (Non-barg)



Joe Zaffuto (AFSCME)



Carol Sawyer (replacing Mr. Zaffuto 3/6)



John Darby (VTO)



Jacqueline Sadler (VTO)



Denise Dietrich (Non-barg)

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 Volusia County School Board Insurance Committee (union representation and voting members as required by contracts)  Insurance Committee meetings for 2013-2014

(monthly during school year, * indicates Wellness Action Team meeting as well)

• September 5, 2013

January 9, 2014

• October 3, 2013*

February 6, 2014

• November 7, 2013
• December 5, 2013*

Next meeting March 6, 2014

Revisiting April 23, 2013

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 Significant increases to the Florida Health Care Plans –

 Increased deductibles  Copays  Maximum Out of Pocket  In / Out Patient  Emergency Room  Lab

 No changes to the Florida Blue Plans  Renewal rates were 9.5% for Florida Blue and 4% for Florida Health Care

for a blended rate increase of 5.4%

 Projected financial impact - $3.5M

Revisiting April 10, 2012

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 Plan Design Changes to the Florida Blue Plans –

 Increased deductibles  Maximum Out of Pocket

 No changes to the Florida Health Care Plans  Plan design changes kept rate renewal down to 0%

Review of Rates and Renewals

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VCSB Renewals National Trend (blended) (blended)

2004-2005 3.91% 14.83% 2005-2006 12.80% 14.24% 2006-2007 3.05%* 12.97% 2007-2008 10.40% 11.18% 2008-2009 9.30% 10.94% 2009-2010 8.54% 10.50% 2010-2011 6.36%** 8.00% 2011-2012 6.10% 10.50% 2012-2013 0% 9.06% 2013-2014 5.40% 6.00% 2014-2015 U p to 7.6%*** 7.00%

Prior RFP was done in March, 2002 *RFP was done in November, 2005 (remained with BCBS/FHC) **Vote against RFP in November, 2009 and March, 2010 ***Subject to potential plan design adjustments

Enrollment

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

Health Enrollment Totals

• As of 10/1/2007

8,286*

• As of 10/1/2008

7,867*

• As of 10/1/2009

7,512*

• As of 10/1/2010

7,585*

• As of 10/1/2011

7,402*

• As of 10/1/2012

7,079*

• As of 10/1/2013

6,739*



Health Enrollment by Plan

10/ 1/ 07 10/ 1/ 08 10/ 1/ 09 10/ 1/ 10 10/ 1/ 11 10/ 1/ 2012 10/ 1/ 2013 Pre fe rre d Pro vide r Organizatio n (PPO) 2,809 1,484 1,436 1,525 1,434 1,283 1,215 He alth Re imburse me nt Ac c o unt (HRA) 126 1,231 943 646 489 410 355 T riple Optio n (Po int o f Se rvic e ) 2,869 2,946 3,117 3,550 3,723 3,706 3,581 He alth Mainte nanc e Organizatio n (HMO) 2,482 2,206 2,016 1,848 1,737 1,659 1,554 Catastro phic Plan 16 19 21 34

(*Numbers do not include dependents or retirees) (These numbers include both husband & wife that are enrolled under split family – approx. 230 couples)

Marketplace/Volusia Comparison

FEDERAL MARKETPLACE



Platinum



Gold



Silver



Bronze



Catastrophic VOLUSIA COUNTY SCHOOLS PLANS:



Florida Health Care HMO – Platinum



Florida Health Care Triple Option – Platinum



Florida Health Care POS (Catastrophic) – Gold



Florida Blue PPO – Gold



Florida Health Care HRA - Gold

Higher Premiums / Lower Out of Pocket Costs Lower Premiums / Higher Out

• f Pocket

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Local Marketplace School District Comparisons



Brevard County Schools (Self-Insured)



Lake County Schools (Fully-Insured)



Lee County Schools (Self-Insured)



Manatee County Schools (Fully-Insured)



Pasco County Schools (Self-Insured)



Seminole County Schools (Self-Insured)

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HMO

Classic VP-1, L-43

In-Network only In Ntwk Opt 1 Opt 2 Opt 3 In HMO Network In BC PPO Network & OOA In Network Out of Network In Network Out of Network

Deductible HRA Single Family Annual Deductible Single $0 $0 $250 $500 $1,500 $4,500 Family $0 $0 $500 $1,000 Per Person Per Person Coinsurance (Plan Pays) 100% 100% 70% 50% 90% 50% 85% 70% 85% 70% Out of Pocket Max Single $2,000 $2,000 $3,000 $6,000 $5,000 $10,000 Family $4,000 $4,000 $6,000 $12,000 $10,000 $20,000 Physician Services PCP Copay $20 $20 $30 50% AD $35 50% AD 15% AD 30% AD 15% AD 30% AD Specialist Copay $35 $35 30% AD 50% AD $50 50% AD 15% AD 30% AD 15% AD 30% AD Preventive Care Routine Physical Exam, Well Child, Immunization $0 $0 $0 50% AD $0 50% AD $0 30%, Ded Waived $0 30%, Ded Waived Hospital Services Inpatient $250/Day (Days 1-5) $250/Day (Days 1-5) N/A 50% AD 10% AD 50% AD 15% AD $300 + 30% AD 15% AD $300 + 30% AD Outpatient $100 $100 N/A 50% AD 10% AD 50% AD 15% AD 30% AD 15% AD 30% AD Emergency Services Emergency Visit $100 $100 $100 $100 10% AD 10% AD 15% AD 15% AD 15% AD 15% AD Urgent Care $60 $60 $60 $60 10% AD 10% AD 15% AD 30% AD 15% AD 30% AD Lab, Xray, & Diagnostics Lab and Radiology $0 $0 N/A 50% AD $0 lab, $50 X-ray 50% AD 15% AD 30% AD 15% AD 30% AD Advanced Imaging $0 $0 N/A 50% AD 10% AD 50% AD 15% AD 30% AD 15% AD 30% AD Prescription Drugs Retail (31 Day Supply)

FHCP pharmacies; Select Walgreens / Select Hours

Preferred Generic $3 NA NA Non-Pref Generic $10 / $15 $10 50% $10 50% Preferred Brand $30 / $35 $25 50% $25 50% Non-preferred Brand $55 / $60 $40 50% $40 50% $3 (FHCP pharmacies only) $3 (FHCP pharmacies only) $10 FHCP Pharmacy $15 Walgreens or Publix Pharmacy $10 FHCP Pharmacy $15 Walgreens Pharmacy $30 FHCP Pharmacy $35 Walgreens or Publix Pharmacy $30 FHCP Pharmacy $35 Walgreens Pharmacy $55 FHCP Pharmacy $60 Walgreens or Publix Pharmacy $55 FHCP Pharmacy $60 Walgreens Pharmacy $2,250 AD $2,850 (Incl. Gap and HRA) $4,500 AD $5,700 (Incl. Gap and HRA)

FHCP pharmacies, Walgreens (nationwide), and Publix (Volusia and Flagler Co. only) FHCP pharmacies and Walgreens (nationwide) Retail 30-day supply Retail 30-day supply

$600 $600 $600 $1,650 ($1,050 Gap) $1,200 $2,400 ($1,800 Gap)

Florida Health Care Plans BCBSFL Plans

Triple Option

Classic L03

POS Plan

Balance LQ16 - MOD 3

PPO

Plan 117

HRA

Plan 0317

Local Marketplace

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Local Marketplace - Brevard (In-network benefits only)

Benefit Feature VCSB Triple Option L03 Cigna PPO

Annual Deductible

$0 $150/$300

Coinsurance

0% 20%

Out of Pocket Maximum

$2,000 / $4,000 $3,000 / $6,000

Office visit copay

$20 PCP $35 Spec $25 PCP $45 Spec

Inpatient

$250 / day (Days 1-5) $500 +20% AD

Outpatient

$100 20% AD

Emergency Room

$100 $150 + 20% AD

Prescription

(30-day, Retail)

$3/10/30/55 $15/40/70

Employee cost is $72 per month for single coverage

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Lake County Schools

(In-network benefits only)

Benefit Feature VCSB Triple Option L03 Florida Blue Blue Choice 3359 PPO Florida Blue Blue Choice HSA

Annual Deductible

$0 $500 / $1,500 $1,500 / $3,000

Coinsurance

0% 20% 20%

Out of Pocket Maximum

$2,000 / $4,000 $3,000 / $6,000 $4,000 / $8,000

Office visit copay

$20 PCP $35 Spec $25 PCP $60 Spec $35 PCP $85 Spec

Inpatient

$250/day (Days 1-5) $100 +20% AD $300 +20% AD

Outpatient

$100 $100 + 20% AD 20% AD

Emergency Room

$100 $300 $350

Prescription

(30-day, Retail)

$3/10/30/55 $0/25/40 (Mandatory Generic / Mandatory Mail Order) $0/25/40 (Mandatory Generic / Mandatory Mail Order)

Employee cost is $25 per month for single coverage

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Lee County Schools (In-network benefits only)

Benefit Feature VCSB Triple Option L03 Florida Blue

BlueOptions 3769

Florida Blue

BlueOptions 5773 Annual Deductible

$0 $500/$1,500 $1,000/$3,000

Coinsurance

0% 20% 20%

Out of Pocket Maximum

$2,000 / $4,000 $3,000/$6,000 $4,000 / $8,000

Office visit copay

$20 PCP $35 Spec $25 PCP $60 Spec $35 PCP $85 Spec

Inpatient

$250/day (Days 1-5) $100 +20% AD $300 + 20% AD

Outpatient

$100 $100 + 20% AD 20% AD

Emergency Room

$100 $300 $350

Prescription

(30-day, Retail)

$3/10/30/55 $0/$25/$40 (Mandatory Generic / Mandatory Mail Order) $0/$25/$40 (Mandatory Generic / Mandatory Mail Order)

Employee cost is $0 per month for single coverage

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Manatee County Schools (In-network benefits only)

Benefit Feature VCSB Triple Option L03 Florida Blue BlueChoice PPO 117 Florida Blue BlueOptions PPO 3359 Florida Blue Blue Care HMO 59 Florida Blue BlueChoice HMO 52

Annual Deductible

$0 $1,500/$3,000 $1,250/$2,500 $250/$500 $1,500 per person

Coinsurance

0% 20% 20% 20% 30%

Out of Pocket Maximum

$2,000 / $4,000 $3,000 / $6,000 $3,500/$7,000 $4,500/$9,000 $10,000/$10,000

Office visit copay

$20 PCP $35 Spec 20% AD $25 PCP $50 Spec $30 PCP $60 Spec $40 PCP $65 Spec

Inpatient

$250/day (Days 1-5) $200 + 20% AD $250 + 20%AD $300 + 20% AD 30% AD

Outpatient

$100 20% AD 20% AD 20% AD 30% AD

Emergency Room

$100 $200 + 20% AD $250 + 20% AD $100 + 20% $300

Prescription

(30-day, Retail)

$3/10/30/55 $4/25/50 $4/$25/$50 $8/50/100 $8/50/100

Employee cost is $20 per month for single coverage

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Pasco County Schools (In-network benefits only)

Benefit Feature VCSB Triple Option L03 Florida Blue BlueCare Premium HMO Florida Blue BlueOptions Standard PPO Florida Blue Basic HMO

Annual Deductible

$0 $0 $250/$750 $2,000/$6,000

Coinsurance

0% 0% 20% 20%

Out of Pocket Maximum

$2,000 / $4,000 $3,000 / $9,000 $3,000 / $6,000 $5,500 / $11,000

Office visit copay

$20 PCP $35 Spec $30 PCP $50 Spec $30 PCP $50 Spec $35 PCP $65 Spec

Inpatient

$250/day (Days 1-5) $500 / day (Max $2,500) 20% AD $100 + 20% AD

Outpatient

$100 $500 $300 $20% AD

Emergency Room

$100 $200 $100 $300

Prescription

(30-day, Retail)

$3/10/30/55 $10/25/40 $10/25/40 $10/25/40

Employee cost is $0 per month for single coverage

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Seminole County Schools (In-network benefits only)

Benefit Feature VCSB Triple Option L03 UHC Wellness HMO UHC Standard HMO UHC Family HMO

Annual Deductible

$0 $400 / $800 $1,500 / $3,000 $5,000 / $10,000

Coinsurance

0% 20% 20% 20%

Out of Pocket Maximum

$2,000 / $4,000 $5,000 / $10,000 $6,350 / $12,700 $6,350 / $12,700

Office visit copay

$20 PCP $35 Spec $25 PCP $50 Spec $35 PCP $45 Spec $35 PCP $45 Spec

Inpatient

$250/day (Days 1-5) 20% AD 30% AD 30% AD

Outpatient

$100 20% AD 30% AD 30% AD

Emergency Room

$100 $250 copay $250 copay $250 copay

Prescription

(30-day, Retail)

$3/10/30/55 $7/30/60 $7/$30/$60 $7/30/60

Employee cost is $0 per month for single coverage

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December 2013 Preliminary Renewal Projection

Prepared by Aon Hewitt (Based on Claims through October

, 2013)

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Trend 9% Trend 9% Retention 11% Retention 11% Target Loss Ratio 88.9% Target Loss Ratio 88.9%

Projected Increase

8.17%

Approximately 6.1% of this is Health Care Reform taxes and fees Projected Increase

8.17%

Approximately 6.1% of this is Health Care Reform taxes and fees

Trend 9% Trend 9% Retention 13% Retention 13% Target Loss Ratio 80.9% Target Loss Ratio 80.9%

Projected Increase

7.73%

Approximately 5.5% of this is Health Care Reform taxes and fees Projected Increase

7.73%

Approximately 5.5% of this is Health Care Reform taxes and fees

December 2013 Preliminary Renewal Projection

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 Large claimant costs (claims in excess of $100,000)

 Total enrollment (employees and dependents) in all plans

continues to decrease however, large claimant costs are continuing to increase, Florida Blue by 13% and Florida Health Care by 2%.

 Pharmacy Costs are up by 10% over the prior 12

month period

Prepared by Aon Hewitt (VCSB Consultant)

December 2013 Projected Financial Impact

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Current Premium Projected Renewal Premium Increase Florida Blue $17M $18M $1.4M Florida Health Care Plans $46M $50M $3.5M TOTAL Projected Increase $63M $68M $4.9M (All Funds)

Based on the current active enrollment (excluding retirees) as of November 2013, the estimated increase to the total premium are projected to be approximately $4.9M.

2014 Medical Renewal As Of February 2013 Florida Health Care Plans

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Florida Health Care Plans delivered the initial renewal to the Triple Option, HMO, and POS medical plans with an increase of 9.3%. After Aon negotiations around the method used to calculate the renewal, FHCP reduced the 9.3% increase to 6.9% for the current plans.

Initial Renewal

• 9.3% Increase
• Trend 8%

Aon Negotiation

• 2.4%

reduction Final Renewal

• 6.9% as is

Increase of $3,169,259 Increase of $4,267,107 Decrease of $1,097,848

2014 Medical Renewal As Of February 2013 Florida Blue

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Florida Blue delivered the initial renewal to the PPO and HRA medical plans with an increase of 13.6% using a trend of 9.6%. After Aon negotiations around the method used when calculating the renewal, Florida Blue reduced the renewal to 9.7% above the current rates including Health Care Reform plan design changes.

Initial Renewal

• 13.6%

Increase

• Trend 9.6%

Aon Negotiation

• 3.9%

reduction

Final Renewal

• 9.7% as is

Total Increase $1,607,872 Increase of $2,265,148 Decrease of $657,306

Projected Financial Impact – 2014 Renewal

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The exhibit below illustrates the estimated financial impact to VCSB and employees for the 2014- 2015 Plan Year based on the current active enrollment, excluding retirees.

Total Annual Premium District Paid Portion (Net) Employee Portion 2013-2014 Plan Year $62,812,506 $52,413,750 $10,398,756 2014–2015 Plan Year (Estimated) $67,589,637 $56,547,565 $11,042,072 $ Increase over Current $4,777,131 $4,133,815 (all funds) $643,315 % Increase over Current 7.6% 7.9% 6.2%

Aon Negotiated Total Decrease of $1,755,154 from Initial to Final Renewal

What’s Next?

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 March, 2014

 Insurance Committee will meet on March 6th and make a

recommendation to the Superintendent on health insurance plans for the 2014-2015 plan year

 Renewals for other employee benefit

Other Employee Benefit Renewals

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 Delta Dental & Delta Care – no plan changes

 5.68% rate change for two (2) years ending 9/30/2016

 Hartford Personal Accident Insurance – Waiting on renewal from carrier  Humana Vision Insurance – Waiting on renewal from carrier  UNUM Disability Insurance – Waiting on renewal from carrier  UNUM Life Insurance – Waiting on renewal from carrier

Conclusion of the Health Insurance Renewal/Update Presentation Questions?

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