Escambia County School District School Board Presentation Group - PowerPoint PPT Presentation

Escambia County School District School Board Presentation Group Medicare Medical and Pharmacy Plans August st 14, 2014 Presen sented ted by: John D. R Robinso son, CEBS Robinso sonBush sh

IBC Retiree Program Initiative Overview 1. Organizational Structure 2. How the Program Works 3. Retiree Program Benefits and Features 4. Medicare and Non-Medicare Plan RFP 5. Results RFP Recommendations for Award 6. Timeline and Next Steps 7. Questions 8. 2

 Formed in 2001 to Assist School Districts with Benefit and Retirement Related Initiatives  Member Organizations and Board Members ◦ Florida School Boards Association (Wayne Blanton, Chairperson) ◦ Florida Association of District School Superintendents (Bill Montford and Don Griesheimer) ◦ Florida Association of School Administrators (Juhan Mixon) ◦ Florida Education Association (Clara Cook)  Decisions on Initiatives Reached Through Consensus of Organizations  Transparency of Operations 3

 Established Under Fl. Statute 163.01 as The Florida Retired School Employee Benefit Program (Retiree Program)  Consortium Responsibilities ◦ Outlined in their Bylaws ◦ Consortium Procures Health Plan Benefits Through a Host District, Polk Schools ◦ Select, Implement and Manage the Retiree Program ◦ Execute Contracts with Third Parties as Needed to Provide Benefits and Administer the Retiree Program, FBMC ◦ Execute Participation and Interlocal Agreements With School Districts  Governed by Nine (9) Member Board of Directors 4

Name Office ce District ct Appointment tment Lee Swift Chairperson Charlotte FSBA Marianne Capoziello Member Polk FEA Kathryn LeRoy Member Polk FADSS (or Her Alternate) Vanessa Tillman Member St. Lucie FEA Debra Pace Member Brevard FASA Daneen Regna Member Retiree IBC Consensus David Ford Member Duval IBC Consensus Kevin Windham Member Escambia IBC Consensus Nuri Ayres Member Retiree IBC Consensus 5

District ct Reti tiree rees Brevard Public Schools 1,200 Duval County Public Schools 1,250 Escambia County School District 700 Miami-Dade Public Schools 3,200 Orange County Public Schools 1,900 (2015) Polk County Public Schools 1,750 Total 10,000 6

 Retirees Will Have Guarantee Issue, More Benefit Choices, Same or Better Premiums, and Can Change Coverage if They Move  Non-Medical Benefits, Specifically Designed for the Retirees, Will be Provided and Expanded  Cost of the Active Employee Health Plan Will be Positively Impacted by the Retiree Program  Additional Retiree Benefits Assistance Will be Provided by FBMC  Retirees Who Left the District Health Plan Will Have the Option to Re-join Next Year 7

 Medicare Supplement (Medigap) Plans on a Statewide and National Basis ◦ Two (2) Companies Have Been Approved  Cigna  United Healthcare ◦ Best Premium Option for ECSD is United Healthcare  Medicare Part D (EGWP) Pharmacy Plans (Comprehensive and Premier) on a Statewide and National Basis ◦ United Healthcare Has Been Approved  Medicare Advantage Plans Specifically Selected to Meet ECSD Needs ◦ United Healthcare Low Premium and Option 3 Plan 8

Plan N Mediga gap Benefi nefits ts Plan A Plan F Part A A Coinsuran rance ce and Hospita tal Costs √ √ √ Medicare re Part B C Coinsu suran rance e or Plan N pays 100% of the Part B coinsurance, except for a Copayment copayment of up to $20 for √ √ some office visits ts and up to a $50 copay payment t for emergen gency y room visits ts that don’t result in an inpatient admission Blood (First t 3 P Pints) s) √ √ √ Part A Hospi pice e Care Coinsuran rance e or √ √ √ Copayment Skilled ed Nursing g Facility Care √ √ Coinsuran rance Medicare re Part A Deductib tible e ($1,184 84) √ √ Medicare re Part B Deducti tible ble ($147) √ Medicare re Part B E Excess ess Charges es (15%) √ Foreign gn Travel el Emergenc gency (To Limits ts) √ √ 9

United ted Healthcare thcare 2014 14 Plan N Plan A Plan F Issue ue Age Age 65 $135.69 $186.76 $134.61 Age 66-69 69 $145.12 $145.12 $201.73 $201.73 $145.25 $145.25 Age 70-74 74 $160.79 $160.79 $225.12 $225.12 $161.54 $161.54 Age 75-79 79 $174.92 $174.92 $244.90 $244.90 $175.90 $175.90 Age 80 + $191.29 $266.10 $191.29 10

Comprehe hens nsive ve Rx Benefit fit Enhanced ed Drug Cover erage Drug List 100% + Bonus 100% + Bonus Initial Coverage rage Period od Deducti ctibl ble $0 $0 Generic $2 to $10 $2 to $7 Brand Prefer ferre red/ d/Non on-prefer preferre red $45/$75 $30/$60 Specialty ty 33% $75 Gap Generic ric Prefer ferred ed $2 to $10 $2 to $7 Brand Prefer ferre red/ d/Non on-prefer preferre red 50% Discount $30/$60 Specialty ty 50% Discount $75 Catastro troph phic Generic ric $2.55 or 5% $2.55 or 5% Brand $6.35 or 5% $6.35 or 5% Month thly Premium $84.18 $84.18 $155.31 $155.31 11

Premier ier Pharmacies es Compreh ehens ensive ve Costco co No Yes CVS CVS No Yes K M Mart No Yes Kroger er Yes Yes Publix No Yes Rite Aid Yes Yes Sam's Yes Yes Target Yes Yes The Medicine e Shoppe pe Yes Yes Walgreen eens Yes Yes Wal-Mart rt Yes Yes Winn Dixie No Yes 12

Benefit efit Low Premium Comprehensive Option 3 Medic ical National PPO OON Same National PPO OON Same Annu nual Deduc uctib ible $400 Med & $320 Rx $0 $0 $6,700 $2,500 Annu nual OOP OOP Hosp spital tal Admit mit $230/Day to $230/Day to $175 $175 7 Days 7 Days $25/$50 $25/$50 $5/$15 $5/$15 Offi fice ce Visi sits ts Emergenc rgency Care re $65 $65 $65 $65 Outp tpati tient nt Surge rgery ry 20% 20% $15 $15 Rx Rx 25% $5 Gene neric ric Brand nd 25% $30/$60 Spec ecia ialt lty 25% $80 Applies No Gap Covera erage ge Gap Month thly ly Prem emiu ium $25.00 5.00 $232. 2.00 00 13

In N Network rk Zero Premium Compreh ehens ensive ve Andrews ews Institu tute te Yes Yes Imaging Center er of Pensac sacola Yes Yes Baptist st Hospita tal No No Sacred d Heart t Hospita tal Yes Yes West t Florida Hospita tal Yes Yes 14

 ECSD Has the Option to Consider Offering the Non- Medical Benefits as Well  Options Available Through the Consortium, and Administered by FBMC, for 2015 ◦ Group Dental Insurance Plans  PPO  DHMO ◦ Group Vision Insurance Plan ◦ Identity Theft Protection Plan ◦ IT Tech Support Program  Non-Medical Plan Options Will be Expanded to Meet the Unique Needs of Retirees in the Future 15

Benef nefit its Low PPO O Pla lan High gh PPO O Plan In Network twork Out of Network twork In Network twork Out of Network twork Annual al Maximum um $800 per person per year $1,500 per person per year $100/ person to $50/ person to Annual max $300 for $50 per person to max $150 for max $150 for Basic Deduc uctib ible Basic or Major Basic or Major Services or Major Services Services Diagno nost stic c & 100% 100% 100% 100% Preve ventive ve Basic ic 70% 70% 80% 80% 50% 50% 50% 50% Major 2 Preventive 2 Preventive 2 Preventive 2 Preventive Plan Inclusio sions Cleanings and 2 Services Cleanings and 2 Cleanings and 2 Perio. Basic Cleanings per Perio. Basic Perio. Basic Cleanings/Year Year Cleanings/Year Cleanings/Year OON Allowa wance ce PPO Schedule 80 th percentile Monthly y Rates $28.25 8.25 $38.69 8.69 Retiree Only Retiree + 1 $56.24 6.24 $77.04 7.04 $73.29 3.29 $100. 0.04 04 Retiree + Family 16

Serv rvic ices es Low DHMO MO Plan High gh DHMO MO Plan Network Network Only Network Only Annual Maximum NA NA Deductible $0 $0 Office Visit Copay $0 $0 Panoramic X-ray & Bitewings $0 $0 Prophylaxis $0 $0 Amalgam – One Surface – Permanent $5 $0 Resin – Based Composite – One surface, $30 $0 Anterior Endodontic Therapy, Molar $250 $210 Periodontal Scaling & Root Planning- 4 or $55 $50 More Teeth Complete Denture – Maxillary $375* $325* Crown – Porcelain Fused to Nobel Metal $270* $245* Extraction, Erupted Tooth or Exposed $0 $5 Root Month thly ly Rates tes Retiree Only $9.95 .95 $16.15 6.15 Retiree + 1 $19.70 9.70 $31.98 1.98 Retiree + Family $35.02 5.02 $56.85 6.85 17

Pla lan In Network twork Benefi nefits ts Frequenc ency (Exam /Lenses/ Frames) 12/12/24 Exam/Sp Spec ecta tacle e Lenses ses $10/$15 Eyeglass ss Benefi efit t – Frame Up to $130 OR Non-Collecti ection on Frame Allowance e (Retail): Up to $180 at Vision Works Davis vis Vision Frame Collection ection (in lieu ieu of of All llowance): Fashion Level and Designer Level Included Premier Level $25 Eyeglass ss Benefi efit t – Specta ctacle e Lenses ses Member er Charges es Clear Plastic Lenses & Scratch-Resistant Coating Included Polycarbonate Lenses Adults $30 Progressive Lenses (Standard / Premium / Ultra) $50/$90/$140 Contact Lens Benefi efit (in lieu of Eyeglasses) Up to $130 Month thly Rates: s: Retiree $6.17 $6.17 Retiree + 1 $11.11 $11.11 Retiree + Family $17.28 $17.28 18