2016 Employee Health Benefits Update CHALLENGING YOU TO MAKE A - - PowerPoint PPT Presentation

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2016 Employee Health Benefits Update CHALLENGING YOU TO MAKE A - - PowerPoint PPT Presentation

Mar 12, 2023 109 likes •339 views

2016 Employee Health Benefits Update CHALLENGING YOU TO MAKE A DIFFERENCE Where we are today. Low Rate Increase: 3% No changes to the Plan design or Schedule of Benefits Same low deductible, co insurance and co payments

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2016 Employee Health Benefits Update

CHALLENGING YOU TO MAKE A DIFFERENCE

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SLIDE 2

Where we are today.

  • Low Rate Increase: 3%
  • No changes to the Plan design or Schedule of

Benefits

  • Same low deductible, co‐insurance and co‐payments
  • State of Ohio lowered dependent eligibility from

age 28 to age 26

  • Affordable Care Act (ACA) Mandates
  • Major changes to Plan
  • Play or Pay – Shared Responsibility Assessments
  • Results in employee eligibility rules changes
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SLIDE 3

Plan Costs 2011 to 2015 YTD (9/30)

$0 $2,000,000 $4,000,000 $6,000,000 $8,000,000 $10,000,000 2011 2012 2013 2014 2015 Health Prescription Vision Dental Life Wellness Administration

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SLIDE 4

2016 Monthly Rates

Coverage Total Employer Employee* Health & Rx $ 609.48 $ 518.06 $ 91.42 Vision $ 7.84 $ 6.66 $ 1.18 Dental $ 31.62 $ 26.88 $ 4.74 Life $ 7.22 $ 7.22 $ 0__

Total Single $656.16 $558.82 $97.34

2015 Rates $ 635.92 $ 541.76 $ 94.16 Health & Rx $ 1,584.62 $ 1,346.92 $ 237.70 Vision $ 20.42 $ 17.36 $ 3.06 Dental $ 82.18 $ 69.86 $ 12.32 Life $ 7.22 $ 7.22 $ 0__

Total Family $1,694.44 $1,441.36 $253.08

2015 Rates $ 1,640.38 $ 1,395.56 $ 244.82

Single Family

* Split between first and second pay dates of the month. May be deducted on a pre-tax basis. Employees are responsible to pay 15% of the total cost for coverage. Spousal Premium rates are in addition to a family contract.

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SLIDE 5
  • ACA mandates changes to Employee Eligibility
  • Based on 30 Hours of Service per week
  • Hours worked
  • Paid leave
  • County to apply new

rules to all benefits

  • Health/Prescription
  • Vision, Dental & Life
  • Create new processes

effective 2016 plan year

  • New hires
  • Ongoing employees

Hours of Service Do Not include Hours of Service Includes All Paid Hours Plus

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SLIDE 6

Measurement Period Administrative Period Stability Period

Look‐back Measurement Method

  • ALL employees hours are measured each year
  • Standard Look‐back Method (Oct‐Oct)
  • Coverage offered for next calendar year
  • New non‐full time hires: part time, seasonal or variable hour
  • Initial Look‐back Method (12 mo. from date of hire)

Two Types of Look‐back: Initial and Standard

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SLIDE 7

Monthly Measurement Method

  • New Hires with 30 or more Hours of Service hours

per week (non‐seasonal)

  • Applies to hires after Oct. 6, 2014
  • Measures until they complete a full standard measurement period
  • Measure each month to determine eligibility
  • Eligibility may change monthly based on hours of service

Looks at employee’s hours each month until placed in a Standard Stability Period.

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SLIDE 8

Sign‐off on determination form due to Insurance Group Rep by Nov. 23 Newly Eligible Employee Meeting 3 pm at Wood Haven

  • n Nov. 24
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SLIDE 9

ACA Challenges

  • Additional federal reporting requirements
  • 1095‐C distributed in 2016 – shows coverage offered

and enrollment for employee & dependents

  • Ongoing changes in federal guidance
  • Measurement methods may change based on

employment status change

  • Insufficient Wages for Payroll Deductions
  • If an employee fails to make payment, coverage will

terminate for the remainder of the stability period (calendar year or 12 mo.)

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SLIDE 10

What we are up against.

$0 $1,000,000 $2,000,000 $3,000,000 $4,000,000 $5,000,000 $6,000,000 $7,000,000 $8,000,000 2014 2013 2012 2011 Health Prescription

▪ Increased Costs Health & Prescription Market ▪ ACA Eligibility Changes

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SLIDE 11

We challenge you to….

  • Know your Plan – review your SPD
  • Be wise consumers save money for you & the Plan
  • Select Quality Outcome Providers
  • Price Shopping for Best Value
  • Improve/Maintain your current health status
  • Participate in the monthly wellness programs

Payment

  • f Claims

Employee

15%

Employer

85%

Our Health Benefits Trust

Be an engaged consumer when pulling money out

  • f our pocket.
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SLIDE 12

Identifies useful data on providers that deliver quality care.

  • Cost Reports
  • Composite Condition

& Procedure Ratings

  • Composite Overall

Ratings

  • Composite Surgical

Ratings

  • Detailed Quality

Rating and Score

  • Inpatient Medical

Ratings

  • Inpatient Surgical

Ratings

  • Patient Satisfaction

Survey Ratings

FrontPath Healthcare Quality Improvement Program

How we can tackle increased costs to the Plan?

Choose quality providers

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SLIDE 13
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SLIDE 14

Username: wood Password: WCMER003

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SLIDE 15
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SLIDE 17

How we can tackle increased costs to the Plan?

  • Have a Primary Care Physician
  • Avoid Urgent Care and ER when not necessary
  • Choose lower costs options
  • These bill at a Doctor’s office rate
  • Pharmacy services provided
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SLIDE 18

How we can tackle increased costs to the Plan?

Price Shop for Lowest Cost Medications

  • Co‐payments may not

change, but you can save the Plan money by switching to a different pharmacy.

  • Utilize the Database of

Low Cost or Free Medications Available at Pharmacies

  • Link on employee website
  • Mobile app available

Lantus Solostar 15ml Pharmacy A Pharmacy B Pharmacy C Pharmacy D Total Claim Charge $373.36 $377.49 $381.46 $75.46 Employee Co‐Payment $35 $35 $35 $27.09 Plan Payment Amount $343.36 $342.49 $346.46 $48.37 Atorvastatin 20mg Tab Pharmacy A Pharmacy B Pharmacy C Pharmacy D Total Claim Charge $51.98 $0 $10.61 $6 Employee Co‐Payment $5 $0 $5 $5 Plan Payment Amount $46.98 $0 $5.61 $1

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SLIDE 19

Participate in Wellness Programs

WE CHALLENGE YOU TO TAKE AN ACTIVE ROLE IN YOUR HEALTH

Monthly Challenges Earn a Deductible Credit Win Monthly Prizes

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SLIDE 20

Make/Break the Habit! Shake the Salt! Reduce Your Stress! Stand Up for Heart Health! Get 5! Stay Hydrated! Couch to 5K! Catch Some ZZZs! Focus on Fitness! Brown Bag It! Stretch & Flex! Walk It Off!

Program features monthly challenges to help you focus on healthy habits.

Form a team within your office or participate on your

  • wn.

Monthly tracking logs will be posted on the employee

  • website. Challenges must be started and completed

within the same calendar month. Each month will feature a different challenge, but you can complete them in any order you like. Monthly prizes are draw from employees completing a monthly challenge. More challenges = more entries.

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SLIDE 21

Earn a Deductible Credit

$50 $100

Complete at least 5 Challenges Complete at least 10 Challenges

In addition to monthly challenges, benefit eligible employees can earn

  • ne challenge credit

for the following completed programs:

Wellness Screening Fitness Program Nutrition for Life Tobacco Termination Summer Swim See Summary Plan Description for additional information

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SLIDE 22

It takes everyone working together to keep the Plan running smoothly.

Employee Engagement Plan Design Wellness Representatives Available for Questions Mercer Consultants Jason Beaver, Gauri Airi Network & Third Party Administrators Nick Strausbaugh, FrontPath Susan Allen, Meritain Health Jocelyn Bolling, PDMI Karen Chapman, Delta Dental Administrative Support Andrew Kalmar, Pamela Boyer, Janese Diem, Cheryl Albrecht, Rachel Richmond, Steve Puffer Special Thanks Employee Health Benefits Committee Wellness Subcommittee