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 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 3
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/ 4
BENEFITS PACKAGE Active employee medical & dental Vision benefit Telemedicine (MDLive) Prescription drug coverage Case Management Employee assistance program (EAP) Cost Advisor/Transparency Tools Disease management programs Wellness/well-being resources Retiree medical Basic life insurance Short and long-term disability Accidental death and dismemberment Voluntary term life (VTL) Flexible spending accounts (FSA) 5
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 6
MILLIMAN MEDICAL CLAIMS ACTUALS & PROJECTIONS 320 300 Nov-18 280 Millions May-19 260 Nov-19 240 220 FY2018 FY2019 FY2020 FY2021 7 FY2018 & FY2019 show actual claims. FY2020 & FY2021 show projected claims.
MEDICAL PLAN MEMBERSHIP OVERVIEW ACTIVE EMPLOYEES 46,808 Members as of June 2019 RETIREES 855 Members as of June 2019 8
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- of-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 9 Continue working with SCO on the LUMA project
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 10 Projections conducted in May and November
PROJECTED MEDICAL PLAN COSTS 5% 1.5% 3% Other* 350 $322 $318 $303 $294 300 Employee 250 Contributions Millions ACA Fees 200 150 State Contributions 100 50 Total Plan Costs 0 11
PROJECTED DENTAL PLAN COSTS 7.5% 0.5% Other* 16 $13.8M $13.9M 14 $12.9M Employee 12 Contributions 10 ACA Fees Millions 8 State Contributions 6 4 Total Plan Costs 2 0 12 FY 2019 2020 Projected 2021 Projected
MEDICAL & DENTAL RESERVES 100 $94.2M 90 80 $75.3M 70 60 $64.5M Millions 50 40 $30.1M $27.1M $29.1M 30 20 10 0 13
MILLIMAN NOVEMBER PROJECTIONS – APPROPRIATION OPTIONS FY2020 Medical & Dental Appropriation = $11,650 FY2021 Options 10% Drawdown Appropriation $10,690 ($32 million medical & dental reserve balance) 90 th Percentile Appropriation $11,630 ($52 million medical & dental reserve balance) $11,760 Not to exceed the Federally Allowed Reserve ($54.5 million medical & dental reserve maximum) 14
Office of Group Insurance 650 W. State Street, Ste 145 Boise, ID 83720-0035 (208) 332-1860 (800) 531-0597 ogi@adm.Idaho.gov https://ogi.Idaho.gov 15
Recommend
More recommend
