Pace University Town Hall Presentation Medical Plan Renewal - PowerPoint PPT Presentation

Pace University Town Hall Presentation Medical Plan Renewal Effective January 1, 2019

Town Hall Meeting • 5 minute Introduction – Pace Administration • Three finalist invited to present and answer questions • Aetna, Cigna and EmblemHealth • Each carrier will have a total of 25 minutes • Questions will be asked by moderators based on questions submitted by faculty and staff (via email or cards) • The final 15 minutes will be an open discussion 2

Renewal – Three Carriers – Cost and Basic Plan Design Emblem Proposed Current Cigna Plans Cigna Proposed Aetna Proposed [Community Rated (July 1, 2018 – [Experienced Rated [Experienced Rated HMO; Experienced December 31, 2018) Plans] Plans] Rated Plan PPO] HMO/In-Network Monthly Rate & Point of Service Costs: Employee Only $222.20 $222.20 $222.20 $161.07 Employee Plus One $737.46 $737.46 $737.46 $487.77 Family $1,088.04 $1,088.04 $1,088.04 $776.61 Co-Payment (Primary/Specialist) $30/$50 $30/$50 $30/$50 $40/$40 Deductible and Co-Insurance Not Applicable – Copayments only $2,000/$4,000 $2,000/$4,000 $2,000/$4,000 $2,600/$5,200 In-Network Out-o-f Pocket Max (individual/family) Out-of-Network Benefits None None None None Employee PPO Monthly Rate & Point of Service Costs: Employee Only $290.88 $290.88 $290.88 $801.00 Employee Plus One $904.00 $904.00 $904.00 $2,027.07 Family $1.352.04 $1.352.04 $1.352.04 $3,054.51 Co-Payment (Primary/Specialist) $30/$50 $30/$50 $30/$50 $40/$40 In-Network Deductible (individual/family) $250/$500 $750/$1,500 $750/$1,500 $750/$1,500 In-Network Coinsurance 90% 85% 85% 85% $1,200/$2,400 $2,000/$4,000 $2,000/$4,000 $2,000/$4,000 In-Network Out-o-f Pocket Max (individual/family) Out-of-Network Deductible (individual/family) $1,200/$2,400 $2,000/$4,000 $2,000/$4,000 $2,000/$4,000 Out-of-Network Coinsurance 70% 65% 70% 70% Out-of-Network Out-of-Pocket Max (individual/family) $2,500/$5,000 $5,000/$10,000 $5,000/$10,000 $5,000/$10,000 3

Renewal – Three Carriers – Basic Plan Features Plan Feature Cigna Aetna Emblem HMO is reasonably predictable; Unpredictable - 100% Unpredictable - 100% PPO is unpredictable - Annual Renewal Pricing based on Pace claims based on Pace claims 100% based on Pace claims for those enrolled in that plan Regional with national Network National National option (EPO/PPO) HDHP, Open Access In- Gatekeeper HMO, EPO Mirror of current Pace Plans Offered Network Plan, 90/70 PPO (HMO with no gatekeeper Plans with Cigna Plan and wider network), PPO Network Compared to Current Plan (healthcare) 100% 94% 86% Network Compare to Current Plan (hospitals) 100% 96% 90% See following page for See following page for See following page for Find a Doctor instructions instructions instructions Mostly drugs covered Mostly drugs covered Prescription Coverage Same as current with some tier changes with some tier changes Prescription Cost (Generic/Brand/Non-Formulary) $20/$45/$70 $20/$40/$70 $25/$50/$100 Emergency Room $85 $75 $100 In-vitro Fertilization (IVF) Coverage Yes Yes Yes ($1,000 co-pay) 30 days HMO; 90 days Physical Therapy 90 days 60 days PPO 4

How to Find a Doctor/Provider Cigna: • Go to https://hcpdirectory.cigna.com/web/public/providers • Click on “Doctor” tab • Enter your zip code (or where your provider is located) • Click under “Select a Plan” PICK, click on Medical Plan • Then select under OAP Open Access Plus, OA Plus, Choice Fund OA Plus (the first one) then select Choose Aetna: • Go to https://www.aetna.com/dsepublic/#/contentPage?page=providerSearchLanding&site_id=dse&language=en • Under, “Continue as Guest” enter your zip code and adjust distance filter • Select under Aetna Open Access Plans, OA Elect Choice EPO and then Continue Emblem: • Go to www.emblemhealth.com. • Select “Find a Doctor” • Enter a zip code – click “Search Providers” • Click on “I know the specific plan I am looking for” (at the bottom) • If searching for the HMO network which consists of the HMO PRIME network in NY, Qualcare in NJ and Connecticare in CT, select under the HMO column at the bottom “HIP PRIME HMO” • If searching for the PPO select EmblemHealth PPO (GHI). This provides access to the GHI network in NY, Qualcare in NJ, Connecticare in CT and then Multiplan for outside the Tri-State region • If searching for the EPO plan which is the same network for the Tri-State region, they would select under the EPO/PPO column towards the bottom EmblemHealth EPO Value. That will also provide access to the Multiplan network for those residing in states outside the Tri-State area. • If you are searching for providers outside of NY, change the state to the applicable one since it defaults to NY. 5

Medical Plan Renewal – Action & Engagement Plan Completed: • Quotes from five providers: Cigna, Emblem, Empire/Anthem, Aetna & United Healthcare • First week September: Initial proposals due using August claims data/last 12 mo. Second week of September: Final proposals due Friday September 14 th (leverage bids) • • Third week of September: Final adjustments/plan design change recommendations due • Third week of September: Benefits Advisory Committee meeting (Friday September 21 st ) • Thursday 9/27, University Budget Committee Discussion • Friday 9/28, Update to Westchester Faculty Council • Friday 10/5, Update to Westchester Administrative Staff Council • Monday 10/8, Benefits Advisory Committee Meeting • Tuesday, 10/9, Meeting with Marvin, HR, Finance & Cigna senior management • Wednesday, 10/10, Update to New York City Faculty Council • Monday, 10/15, Update to New York Administrative Staff Council • Wednesday, 10/17 Meeting with Marvin, HR, Finance & Emblem senior management Town Hall Meetings: • Tuesday, 10/23 Town Hall Pleasantville, Wednesday, 10/24 Town Hall, Law School, Thursday, 10/25 Town Hall, NYC Scheduled: • Monday, 10/29 Budget Committee Discussion • Tuesday, 10/30 Operations Committee Discussion • Friday 11/2, Benefits Presentation to Westchester Faculty Council • Friday 11/2, Benefits Presentation to Westchester Administrative Staff Council • Monday, 11/12, Benefits Presentation to New York Administrative Staff Council Wednesday, 11/14, Benefits Presentation to New York City Faculty Council Open Enrollment – Thursday November 15 to Friday November 30 th (Tentative) 6