Government of The Virgin Islands of the United States Central Government & GERS Group Health Projected Budget Projected Fiscal Year: October 1, 2019 ‐ September 30, 2020 WITH CIGNA Optional Product Offering 2018‐2019 Estimated FY 2018‐2019 Estimated FY 2018‐2019 Estimated FY 2019‐2020 Projected FY 2019‐2020 Projected FY 2019‐2020 Projected FY Plan Coverage Type Total Premium Employer Share Employee Share Total Premium Employer Share Employee Share Active Employees Employee $ 26,706,909 $ 17,359,491 $ 9,347,418 $ 30,138,747 $ 19,590,185 $ 10,548,561 Medical Family $ 63,037,712 $ 40,974,513 $ 22,063,199 $ 71,138,058 $ 46,239,738 $ 24,898,320 Employee $ 667,166 $ 433,658 $ 233,508 $ 687,181 $ 446,668 $ 240,513 Dental Family $ 2,276,253 $ 1,479,565 $ 796,689 $ 2,344,541 $ 1,523,951 $ 820,589 Basic $ 156,791 $ 156,791 $ ‐ $ 156,791 $ 156,791 $ ‐ Voluntary $ 1,517,981 $ ‐ $ 1,517,981 $ 1,517,981 $ ‐ $ 1,517,981 Life Spouse $ 111,084 $ ‐ $ 111,084 $ 111,084 $ ‐ $ 111,084 Child(ren) $ 22,752 $ ‐ $ 22,752 $ 22,752 $ ‐ $ 22,752 Employee $ 117,960 $ ‐ $ 117,960 $ 117,960 $ ‐ $ 117,960 Vision Family $ 301,671 $ ‐ $ 301,671 $ 301,671 $ ‐ $ 301,671 TOTAL ‐ Active Employees $ 94,916,279 $ 60,404,017 $ 34,512,262 $ 106,536,765 $ 67,957,333 $ 38,579,432 $ Amount Increase/(Decrease) $ 11,620,487 $ 7,553,316 $ 4,067,170 % Amount Increase/(Decrease) 12.2% 12.5% 11.8% Retirees Retiree or Family $ 25,448,793 $ 16,541,716 $ 8,907,078 $ 28,718,963 $ 18,667,326 $ 10,051,637 Under 65 Medical Retiree Dependents $ 4,140,504 $ 2,691,328 $ 1,449,176 $ 4,672,559 $ 3,037,163 $ 1,635,396 Disabled Retirees $ 26,896 $ 17,483 $ 9,414 $ 30,352 $ 19,729 $ 10,623 Plan N $ 1,704,324 $ 1,107,810 $ 596,513 $ 1,768,236 $ 1,149,353 $ 618,883 Over 65 Medical Plan F + $ 7,592,560 $ 3,639,841 $ 3,952,719 $ 7,877,281 $ 3,776,335 $ 4,100,946 (Territory) Rx Plan $ 7,536,898 $ 4,898,984 $ 2,637,914 $ 7,819,532 $ 5,082,696 $ 2,736,836 Standard $ 841,239 $ 546,805 $ 294,434 $ 904,837 $ 567,311 $ 305,475 Over 65 Medical Premium + (Stateside) $ 2,348,681 $ 1,552,640 $ 796,041 $ 2,483,085 $ 1,610,864 $ 825,892 Retiree $ 1,053,113 $ 684,524 $ 368,590 $ 1,084,706 $ 705,059 $ 379,647 Dental Family $ 1,138,302 $ 739,896 $ 398,406 $ 1,172,451 $ 762,093 $ 410,358 Basic $ 527,546 $ 527,546 $ ‐ $ 527,546 $ 527,546 $ ‐ Voluntary $ 5,510,424 $ ‐ $ 5,510,424 $ 5,510,424 $ ‐ $ 5,510,424 Life Spouse $ 1,573,784 $ ‐ $ 1,573,784 $ 1,573,784 $ ‐ $ 1,573,784 Child(ren) $ 4,104 $ ‐ $ 4,104 $ 4,104 $ ‐ $ 4,104 Retiree $ 41,807 $ ‐ $ 41,807 $ 41,807 $ ‐ $ 41,807 Vision Family $ 37,908 $ ‐ $ 37,908 $ 37,908 $ ‐ $ 37,908 TOTAL ‐ Retirees $ 59,526,883 $ 32,948,572 $ 26,578,311 $ 64,227,575 $ 35,905,475 $ 28,243,720 $ Amount Increase/(Decrease) $ 4,700,692 $ 2,956,903 $ 1,665,410 % Amount Increase/(Decrease) 7.9% 9.0% 6.3% TOTAL ‐ Active Employees & Retirees $ 154,443,162 $ 93,352,589 $ 61,090,573 $ 170,764,340 $ 103,862,808 $ 66,823,153 $ Amount Increase/(Decrease) $ 16,321,178 $ 10,510,219 $ 5,732,580 % Amount Increase/(Decrease) 10.6% 11.3% 9.4% Notes: A. Projected Budget assumes +15% Active & Under 65 Retiree Medical; +3% Dental; +5/10/8% Over 65 Medical; 0% Life; and 0% Vision B. Over 65 Medical (+5%) is 9‐months of the fiscal year (effective January 1, 2020) + Plan F & Premium Plans are Buy‐Up Plans; Retirees pay the difference in cost between Plan N & Standard Plans 1. Estimated FY Total Premium may vary based upon actual enrollment for the remainder of current Fiscal Year & proposed Fiscal Year 2. Costs do not account for any (if any) Senate funded subsidies of member contributions 3. Assumes that CIGNA will retain all funds in the PSR through 9/30/2020 & CIGNA Optional Products will be offered Page 12
Government of The United States Virgin Islands Accidental Injury Insurance Policy Proposal Effective Date: October 1, 2019 Accidental Injury Plan 1 Accidental Injury Plan 2 Initial Care & Emergency Care Plan Pays Fixed Benefit Below Plan Pays Fixed Benefit Below Emergency Care Treatment $100 (1 per accident) $200 (1 per accident) Physician Office Visit $50 (1 per accident) $100 (1 per accident) Diagnostic Exam (x‐ray or lab) $10 (1 per accident) $50 (1 per accident) Ground/Water Ambulance $300 (nearest hospital) $400 (nearest hospital) Air Ambulance $1,200 (1 per accident) $1,400 (1 per accident) Follow‐Up Physician Office Visit $25 (10 visits per accident) $50 (10 visits per accident) Follow‐Up Physical Therapy Visits $25 (10 visits per accident) $50 (10 visits per accident) Hospitalization Plan Pays Fixed Benefit Below Plan Pays Fixed Benefit Below Hospital Admission $500 (1 per accident) $1,000 (1 per accident) Hospital Stays $100 per day (365 days maximum) $200 per day (365 days maximum) Intensive Care Unit Stay $200 per day (365 days maximum) $400 per day (365 days maximum) Physical Therapy $25 $50 Accident Follow Up Treatment Physician Visit $50 Physician Visit $75 Fractures/Dislocations (Sample Listing) Non‐Surgical / Surgical Non‐Surgical / Surgical Skull/Hip/Thigh/Pelvis $2,000 / $4,000 $4,000 / $8,000 Upper Arm/Shoulder/Collarbone/Leg $500 / $1,000 $1,000 / $2,000 Ankle/Kneecap/Lower Arm/Foot/Hand $400 / $800 $800 / $1,600 Jaw/Face/Nose/Vertebral Processes $300 / $600 $600 / $1,200 Ribs (2 ribs maximum)/Coccyx $100 / $200 $200 / $400 Finger/Toe (2 digits maximum) $50 / $100 $100 / $200 Multiple Fractures 200% of the single fracture benefit 200% of the single fracture benefit Enhanced Accident Benefits Plan Pays Fixed Benefit Below Plan Pays Fixed Benefit Below Burns (2nd/3rd degree) (20% or more) $750 / $7,500 $1,000 / $10,000 Lacerations (based on size) $50 ‐ $400 $100 ‐ $600 General Anesthesia $50 $100 Abdominal or Thoracic Surgery $1,000 $1,250 Ruptured Disc Surgery $500 $750 Eye Injury Surgery $200 $400 Emergency Dental (2 maximum) $100 $150 Coma $5,000 $10,000 Paralysis (Paraplegia / Quadriplegia) $1,000 / $2,000 $5,000 / $10,000 Transportation (100+ miles one‐way) $400 $400 Family Lodging (100+ miles one‐way) $100 per day (30 days maximum) $150 per day (30 days maximum) Accidental Death & Dismemberment Spouse 50% & Children 25% of Benefit Shown Spouse 50% & Children 25% of Benefit Shown Loss of Life $25,000 $50,000 Common Carrier Accidental Death $75,000 $100,000 Loss of Eyes/Hands/Arms/Feet/Legs $20,000 $30,000 Speech & Hearing in Both Ears $20,000 $30,000 Speech or Hearing in Both Ears $10,000 $15,000 Loss of One Member (Hand/Arm/Leg/Foot) $10,000 $15,000 Wellness Screening $50 per year $50 per year Premium (Bi‐Weekly) (36‐month Gurantee) Guaranteed Issue Guaranteed Issue Employee Only $5.55 $7.02 Employee + Spouse $8.39 $10.74 Employee + Children $9.55 $12.34 Employee + Family $12.39 $16.05 Page 13
Government of The United States Virgin Islands Critical Illness Insurance Policy Proposal Effective Date: October 1, 2019 Summary of Benefits Benefit Amount Employee $20,000 Spouse $10,000 $10,000 Child (Birth to 26; 26+ if disabled) Pays the lump sum benefit direct to the insured. Each covered condition will be payable one time Initial Critical Illness Benefit per person, subject to a maximum lifetime limits. A 180 day separation period between the dates of diagnosis is required per condition. Benefits will be paid for the diagnosis of a subsequent and same covered condition that has already received a benefit payout under this policy after a 12 month separation period from the previous Recurrence Critical Illness Benefit diagnosis, subject to maximum lifetime limits. Skin Cancer Benefits Pays a flat dollar amount. See below for Benefit Amount. $100,000 (does not apply to Skin Cancer or Optional Benefits) Maximum Lifetime Benefit Coverage Amounts Initial Benefit Recurrence Benefit Cancer Invasive Cancer 100% 100% Carcinoma in Situ 25% 25% Skin Cancer $250 (1 per lifetime) $0 Vascular Heart Attack 100% 100% Stroke 100% 100% Coronary Artery Disease 25% 25% Nervous System Advanced Alzheimer's Disease 25% $0 ALS 25% $0 Parkinson's Disease 25% $0 Multiple Sclerosis 25% $0 Other Conditions Benign Brain Tumor 100% 100% Blindness 100% $0 Coma 25% 25% End‐Stage Renal (Kidney) Disease 100% 100% Major Organ Failure 100% 100% Paralysis 100% 100% Wellness Screening $50 per year $50 per year Premium (Bi‐Weekly) (36‐Month Guarantee) Guaranteed Issue Guaranteed Issue Attained Age as of Policy Year Employee Only Employee & Family 0‐24 $3.55 $5.46 25‐29 $4.05 $6.17 30‐34 $5.40 $8.08 35‐39 $7.58 $11.32 40‐44 $9.76 $14.58 45‐49 $13.66 $20.81 50‐54 $18.46 $29.00 55‐59 $24.70 $36.13 60‐64 $30.69 $49.61 65‐69 $37.31 $59.87 70‐74 $51.87 $82.40 75‐79 $69.81 $108.11 80‐84 $84.87 $132.17 85+ $115.73 $179.55 Page 14
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