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.
August st 14, 2014 Presen sented ted by: John D. R Robinso son, CEBS Robinso sonBush sh
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Formed in 2001 to Assist School Districts with Benefit
Member Organizations and Board Members
Decisions on Initiatives Reached Through Consensus
Transparency of Operations
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Established Under Fl. Statute 163.01 as The Florida
Consortium Responsibilities
Governed by Nine (9) Member Board of Directors
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Retirees Will Have Guarantee Issue, More Benefit
Non-Medical Benefits, Specifically Designed for the
Cost of the Active Employee Health Plan Will be
Additional Retiree Benefits Assistance Will be Provided
Retirees Who Left the District Health Plan Will Have the
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Medicare Supplement (Medigap) Plans on a Statewide
Cigna United Healthcare
Medicare Part D (EGWP) Pharmacy Plans
Medicare Advantage Plans Specifically Selected to Meet
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Plan A Plan F
Part A A Coinsuran rance ce and Hospita tal Costs √ √ √ Medicare re Part B C Coinsu suran rance e or Copayment √ √
Plan N pays 100% of the Part B coinsurance, except for a 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) √ √
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Plan A Plan F Plan N 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
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Rx Benefit fit Enhanced ed
Drug Cover erage Drug List 100% + Bonus 100% + Bonus Initial Coverage rage Period
Deducti ctibl ble $0 $0 Generic $2 to $10 $2 to $7 Brand Prefer ferre red/ d/Non
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
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
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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
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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 Annu nual OOP OOP $6,700 $2,500 Hosp spital tal Admit mit $230/Day to 7 Days $230/Day to 7 Days $175 $175 Offi fice ce Visi sits ts $25/$50 $25/$50 $5/$15 $5/$15 Emergenc rgency Care re $65 $65 $65 $65 Outp tpati tient nt Surge rgery ry 20% 20% $15 $15 Rx Rx Gene neric ric 25% $5 Brand nd 25% $30/$60 Spec ecia ialt lty 25% $80 Covera erage ge Gap Applies No Gap Month thly ly Prem emiu ium $25.00 5.00 $232. 2.00 00
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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
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ECSD Has the Option to Consider Offering the Non-
Options Available Through the Consortium, and
Non-Medical Plan Options Will be Expanded to Meet
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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
Annual Deduc uctib ible
$50/ person to max $150 for Basic
$100/ person to max $300 for Basic or Major Services $50 per person to max $150 for Basic or Major Services
Diagno nost stic c & Preve ventive ve
100% 100% 100% 100%
Basic ic
70% 70% 80% 80%
Major
50% 50% 50% 50%
Plan Inclusio sions
2 Preventive Cleanings and 2
Cleanings/Year 2 Preventive Services Cleanings per Year 2 Preventive Cleanings and 2
Cleanings/Year 2 Preventive Cleanings and 2
Cleanings/Year
OON Allowa wance ce
PPO Schedule 80th percentile
Monthly y Rates Retiree Only
$28.25 8.25 $38.69 8.69
Retiree + 1
$56.24 6.24 $77.04 7.04
Retiree + Family
$73.29 3.29 $100. 0.04 04
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, Anterior $30 $0 Endodontic Therapy, Molar $250 $210 Periodontal Scaling & Root Planning- 4 or More Teeth $55 $50 Complete Denture – Maxillary $375* $325* Crown – Porcelain Fused to Nobel Metal $270* $245* Extraction, Erupted Tooth or Exposed Root $0 $5 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
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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 Non-Collecti ection
e (Retail): Up to $130 OR Up to $180 at Vision Works Davis vis Vision Frame Collection ection (in lieu
ieu of
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
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Pla lan n Featur ures es Prem emiu ium m Ulti timat mate
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Remote Support via Internet, Live Chat, Telephone
Assistance With Various Devices Including:
Computer Protection Software Self Help Database for Assistance With Technology Issues Secure Data Back Up Data Protection Onsite Support Available at $80 per Hour
Unli limit mited ed Support rt Unli limit mited ed Support rt wit ith h Data ta Back ckup up $10.00 per Household $14.00 per Household
Retirees Will Have Guarantee Issue, More Benefit
Retirees Will Have Non-Medical Benefit Options
Retiree Premiums Will be Significantly Lower Than
Savings Will Occur in the Active Employee Health Plan GASB Liability Will be Significantly Reduced Consortium Retiree Benefits Will be Administered by
Retirees Who Left the District Plan May Re-Join the
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Monthly Retiree Premiums Compared to Active Plan $422
Plan N and Comp Rx Age 67
$300.56 $121.44 per Retiree per Month Savings due to removal of monthly subsidy $25 month /retiree $0 $122,000 Annual Savings Administrative Savings of ASO Fees, Stop Loss and Administration 396 retirees $275,000 Annual Savings Active Health Plan Savings With Medicare Retirees on Consortium Plans 396 retirees and their Dependents $326,000 Annual Savings Savings to GASB Liability Over Next 30 Years 30.8 Million 15.4 Million
Core School Districts Are Taking Action on the Plan
Core School Districts Will Pay a One Time Administrative Fee
Retirees Over 65, and Dependents, Will Get Their District
Program Will be Known as the “Florida School Retiree
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The Escambia County School Board approve participation in
The Escambia County School Board authorize the Chairman
Non-Medical Benefits will be reviewed and information will
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Individual District Deliberation and Action on Medicare Plans, and the Participation and Interlocal Agreement June-August District Deadline for Acceptance and School Board Approval of Consortium Plans and Agreements End of August Annual Enrollment at Participating Districts for All Medicare Eligible Retirees and Dependents Oct.-Nov. 2014 Pilot Open Enrollment at a Selected Core District for Medicare Eligible Retirees and Dependents Who Previously Dropped District Coverage
Effective Date of Full Program January 1, 2015
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