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

1 VOLUSIA COUNTY SCHOOL BOARD HEALTH INSURANCE RENEWAL/UPDATE February 26, 2014

Highlights 2  Acronyms and definitions  Historical rate review and enrollment  Federal and Local Marketplace  Preliminary Projection

Acronyms 3 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 4  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 5  Volusia County School Board Insurance Committee (union representation and voting members as required by contracts) Rita Ware (AFSCME) Joe Zaffuto (AFSCME)   Laura Cloer (VESA) Carol Sawyer (replacing Mr. Zaffuto 3/6)   Diane Vaissiere (VESA) John Darby (VTO)   Dr. Maryann Bull (Non-barg) Jacqueline Sadler (VTO)   Russ Tysinger (Non-barg) Denise Dietrich (Non-barg)    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 6  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 7  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 8 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 9 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 10 Higher FEDERAL MARKETPLACE Premiums / Platinum  Lower Out of Gold  Silver  Pocket Costs Bronze  Catastrophic  VOLUSIA COUNTY SCHOOLS PLANS: Lower Premiums Florida Health Care HMO – Platinum  Florida Health Care Triple Option – Platinum / Higher Out  Florida Health Care POS (Catastrophic) – Gold  of Pocket Florida Blue PPO – Gold  Florida Health Care HRA - Gold 

Local Marketplace School District Comparisons 11 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) 

Local Marketplace Florida Health Care Plans BCBSFL Plans HMO Triple Option POS Plan PPO HRA Classic VP-1, L-43 Classic L03 Balance LQ16 - MOD 3 Plan 117 Plan 0317 In BC PPO Network In Network Out of Network In Network Out of Network In-Network only In Ntwk Opt 1 Opt 2 Opt 3 In HMO Network & OOA Deductible HRA Single $600 $600 Family Annual Deductible Single $0 $0 $250 $500 $1,500 $4,500 $600 $1,650 ($1,050 Gap) Family $0 $0 $500 $1,000 Per Person Per Person $1,200 $2,400 ($1,800 Gap) 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 $2,250 AD $2,850 (Incl. Gap and HRA) Family $4,000 $4,000 $6,000 $12,000 $10,000 $20,000 $4,500 AD $5,700 (Incl. Gap and HRA) 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 30%, Ded 30%, Ded Routine Physical Exam, Well Child, $0 $0 $0 50% AD $0 50% AD $0 $0 Immunization Waived Waived Hospital Services $250/Day $250/Day $300 + 30% $300 + 30% Inpatient N/A 50% AD 10% AD 50% AD 15% AD 15% AD (Days 1-5) (Days 1-5) AD 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 FHCP pharmacies; FHCP pharmacies, Walgreens (nationwide), and FHCP pharmacies and Walgreens Retail 30-day supply Retail 30-day supply Retail (31 Day Supply) Select Walgreens / Publix (Volusia and Flagler Co. only) (nationwide) Select Hours Preferred Generic $3 $3 (FHCP pharmacies only) $3 (FHCP pharmacies only) NA NA $10 FHCP Pharmacy $10 FHCP Pharmacy Non-Pref Generic $10 / $15 $10 50% $10 50% $15 Walgreens or Publix Pharmacy $15 Walgreens Pharmacy $30 FHCP Pharmacy $30 FHCP Pharmacy Preferred Brand $30 / $35 $25 50% $25 50% $35 Walgreens or Publix Pharmacy $35 Walgreens Pharmacy $55 FHCP Pharmacy $55 FHCP Pharmacy Non-preferred Brand $55 / $60 $40 50% $40 50% $60 Walgreens or Publix Pharmacy $60 Walgreens Pharmacy 12

Local Marketplace - Brevard (In-network benefits only) 13 Benefit Feature VCSB Triple Option L03 Cigna PPO Annual Deductible $0 $150/$300 Coinsurance 0% 20% Out of Pocket $2,000 / $4,000 $3,000 / $6,000 Maximum $20 PCP $25 PCP Office visit copay $45 Spec $35 Spec $250 / day Inpatient $500 +20% AD (Days 1-5) Outpatient $100 20% AD Emergency Room $150 + 20% AD $100 Prescription $3/10/30/55 $15/40/70 (30-day, Retail) Employee cost is $72 per month for single coverage

Lake County Schools (In-network benefits only) 14 Florida Blue VCSB Triple Option Florida Blue Benefit Feature Blue Choice L03 Blue Choice 3359 PPO 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 $20 PCP $25 PCP $35 PCP Office visit copay $35 Spec $60 Spec $85 Spec $250/day Inpatient $100 +20% AD $300 +20% AD (Days 1-5) Outpatient $100 $100 + 20% AD 20% AD Emergency Room $100 $300 $350 Prescription $0/25/40 $0/25/40 $3/10/30/55 (Mandatory Generic / Mandatory Mail Order) (Mandatory Generic / Mandatory Mail Order) (30-day, Retail) Employee cost is $25 per month for single coverage

Lee County Schools (In-network benefits only) 15 Florida Blue Florida Blue Benefit Feature VCSB Triple Option L03 BlueOptions 3769 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 $20 PCP $25 PCP $35 PCP Office visit copay $35 Spec $60 Spec $85 Spec $250/day Inpatient $100 +20% AD $300 + 20% AD (Days 1-5) Outpatient $100 $100 + 20% AD 20% AD Emergency Room $100 $300 $350 $0/$25/$40 $0/$25/$40 Prescription $3/10/30/55 (Mandatory Generic / Mandatory Mail (Mandatory Generic / Mandatory Mail (30-day, Retail) Order) Order) Employee cost is $0 per month for single coverage