Government of The Virgin Islands of the United States Central - - PowerPoint PPT Presentation

Government of The Virgin Islands of the United States Central Government & GERS Group Health Projected Budget Projected Fiscal Year: October 1, 2019 ‐ September 30, 2020

Plan Coverage Type 2018‐2019 Estimated FY Total Premium 2018‐2019 Estimated FY Employer Share 2018‐2019 Estimated FY Employee Share 2019‐2020 Projected FY Total Premium 2019‐2020 Projected FY Employer Share 2019‐2020 Projected FY Employee Share Employee 26,706,909 $ 17,359,491 $ 9,347,418 $ 30,138,747 $ 19,590,185 $ 10,548,561 $ Family 63,037,712 $ 40,974,513 $ 22,063,199 $ 71,138,058 $ 46,239,738 $ 24,898,320 $ Employee 667,166 $ 433,658 $ 233,508 $ 687,181 $ 446,668 $ 240,513 $ Family 2,276,253 $ 1,479,565 $ 796,689 $ 2,344,541 $ 1,523,951 $ 820,589 $ Basic 156,791 $ 156,791 $ ‐ $ 156,791 $ 156,791 $ ‐ $ Voluntary 1,517,981 $ ‐ $ 1,517,981 $ 1,517,981 $ ‐ $ 1,517,981 $ Spouse 111,084 $ ‐ $ 111,084 $ 111,084 $ ‐ $ 111,084 $ Child(ren) 22,752 $ ‐ $ 22,752 $ 22,752 $ ‐ $ 22,752 $ Employee 117,960 $ ‐ $ 117,960 $ 117,960 $ ‐ $ 117,960 $ Family 301,671 $ ‐ $ 301,671 $ 301,671 $ ‐ $ 301,671 $ 94,916,279 $ 60,404,017 $ 34,512,262 $ 106,536,765 $ 67,957,333 $ 38,579,432 $ 11,620,487 $ 7,553,316 $ 4,067,170 $ 12.2% 12.5% 11.8% Retiree or Family 25,448,793 $ 16,541,716 $ 8,907,078 $ 28,718,963 $ 18,667,326 $ 10,051,637 $ Retiree Dependents 4,140,504 $ 2,691,328 $ 1,449,176 $ 4,672,559 $ 3,037,163 $ 1,635,396 $ Disabled Retirees 26,896 $ 17,483 $ 9,414 $ 30,352 $ 19,729 $ 10,623 $ Plan N 1,704,324 $ 1,107,810 $ 596,513 $ 1,768,236 $ 1,149,353 $ 618,883 $ Plan F+ 7,592,560 $ 3,639,841 $ 3,952,719 $ 7,877,281 $ 3,776,335 $ 4,100,946 $ Rx Plan 7,536,898 $ 4,898,984 $ 2,637,914 $ 7,819,532 $ 5,082,696 $ 2,736,836 $ Standard 841,239 $ 546,805 $ 294,434 $ 904,837 $ 567,311 $ 305,475 $ Premium+ 2,348,681 $ 1,552,640 $ 796,041 $ 2,483,085 $ 1,610,864 $ 825,892 $ Retiree 1,053,113 $ 684,524 $ 368,590 $ 1,084,706 $ 705,059 $ 379,647 $ Family 1,138,302 $ 739,896 $ 398,406 $ 1,172,451 $ 762,093 $ 410,358 $ Basic 527,546 $ 527,546 $ ‐ $ 527,546 $ 527,546 $ ‐ $ Voluntary 5,510,424 $ ‐ $ 5,510,424 $ 5,510,424 $ ‐ $ 5,510,424 $ Spouse 1,573,784 $ ‐ $ 1,573,784 $ 1,573,784 $ ‐ $ 1,573,784 $ Child(ren) 4,104 $ ‐ $ 4,104 $ 4,104 $ ‐ $ 4,104 $ Retiree 41,807 $ ‐ $ 41,807 $ 41,807 $ ‐ $ 41,807 $ Family 37,908 $ ‐ $ 37,908 $ 37,908 $ ‐ $ 37,908 $ 59,526,883 $ 32,948,572 $ 26,578,311 $ 64,227,575 $ 35,905,475 $ 28,243,720 $ 4,700,692 $ 2,956,903 $ 1,665,410 $ 7.9% 9.0% 6.3% 154,443,162 $ 93,352,589 $ 61,090,573 $ 170,764,340 $ 103,862,808 $ 66,823,153 $ 16,321,178 $ 10,510,219 $ 5,732,580 $ 10.6% 11.3% 9.4% Notes:

• A. Projected Budget assumes +15% Active & Under 65 Retiree Medical; +3% Dental; +5/10/8% Over 65 Medical; 0% Life; and 0% Vision
• B. Over 65 Medical (+5%) is 9‐months of the fiscal year (effective January 1, 2020)

+ Plan F & Premium Plans are Buy‐Up Plans; Retirees pay the difference in cost between Plan N & Standard Plans

• 1. Estimated FY Total Premium may vary based upon actual enrollment for the remainder of current Fiscal Year & proposed Fiscal Year
• 2. Costs do not account for any (if any) Senate funded subsidies of member contributions
• 3. Assumes that CIGNA will retain all funds in the PSR through 9/30/2020 & CIGNA Optional Products will be offered

WITH CIGNA Optional Product Offering TOTAL ‐ Active Employees & Retirees $ Amount Increase/(Decrease) % Amount Increase/(Decrease) Dental Life Vision TOTAL ‐ Retirees $ Amount Increase/(Decrease) % Amount Increase/(Decrease) Over 65 Medical (Stateside) Active Employees Medical Dental Life Vision TOTAL ‐ Active Employees $ Amount Increase/(Decrease) % Amount Increase/(Decrease) Retirees Under 65 Medical Over 65 Medical (Territory)

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Government of The United States Virgin Islands Accidental Injury Insurance Policy Proposal Effective Date: October 1, 2019

Accidental Injury Plan 1 Accidental Injury Plan 2 Initial Care & Emergency Care

Plan Pays Fixed Benefit Below Plan Pays Fixed Benefit Below

Emergency Care Treatment $100 (1 per accident) $200 (1 per accident) Physician Office Visit $50 (1 per accident) $100 (1 per accident) Diagnostic Exam (x‐ray or lab) $10 (1 per accident) $50 (1 per accident) Ground/Water Ambulance $300 (nearest hospital) $400 (nearest hospital) Air Ambulance $1,200 (1 per accident) $1,400 (1 per accident) Follow‐Up Physician Office Visit $25 (10 visits per accident) $50 (10 visits per accident) Follow‐Up Physical Therapy Visits $25 (10 visits per accident) $50 (10 visits per accident) Hospitalization

Plan Pays Fixed Benefit Below Plan Pays Fixed Benefit Below

Hospital Admission $500 (1 per accident) $1,000 (1 per accident) Hospital Stays $100 per day (365 days maximum) $200 per day (365 days maximum) Intensive Care Unit Stay $200 per day (365 days maximum) $400 per day (365 days maximum) Physical Therapy $25 $50 Accident Follow Up Treatment Physician Visit $50 Physician Visit $75 Fractures/Dislocations (Sample Listing)

Non‐Surgical / Surgical Non‐Surgical / Surgical

Skull/Hip/Thigh/Pelvis $2,000 / $4,000 $4,000 / $8,000 Upper Arm/Shoulder/Collarbone/Leg $500 / $1,000 $1,000 / $2,000 Ankle/Kneecap/Lower Arm/Foot/Hand $400 / $800 $800 / $1,600 Jaw/Face/Nose/Vertebral Processes $300 / $600 $600 / $1,200 Ribs (2 ribs maximum)/Coccyx $100 / $200 $200 / $400 Finger/Toe (2 digits maximum) $50 / $100 $100 / $200 Multiple Fractures 200% of the single fracture benefit 200% of the single fracture benefit Enhanced Accident Benefits

Plan Pays Fixed Benefit Below Plan Pays Fixed Benefit Below

Burns (2nd/3rd degree) (20% or more) $750 / $7,500 $1,000 / $10,000 Lacerations (based on size) $50 ‐ $400 $100 ‐ $600 General Anesthesia $50 $100 Abdominal or Thoracic Surgery $1,000 $1,250 Ruptured Disc Surgery $500 $750 Eye Injury Surgery $200 $400 Emergency Dental (2 maximum) $100 $150 Coma $5,000 $10,000 Paralysis (Paraplegia / Quadriplegia) $1,000 / $2,000 $5,000 / $10,000 Transportation (100+ miles one‐way) $400 $400 Family Lodging (100+ miles one‐way) $100 per day (30 days maximum) $150 per day (30 days maximum) Accidental Death & Dismemberment

Spouse 50% & Children 25% of Benefit Shown Spouse 50% & Children 25% of Benefit Shown

Loss of Life $25,000 $50,000 Common Carrier Accidental Death $75,000 $100,000 Loss of Eyes/Hands/Arms/Feet/Legs $20,000 $30,000 Speech & Hearing in Both Ears $20,000 $30,000 Speech or Hearing in Both Ears $10,000 $15,000 Loss of One Member (Hand/Arm/Leg/Foot) $10,000 $15,000 Wellness Screening $50 per year $50 per year Premium (Bi‐Weekly) (36‐month Gurantee) Guaranteed Issue Guaranteed Issue Employee Only $5.55 $7.02 Employee + Spouse $8.39 $10.74 Employee + Children $9.55 $12.34 Employee + Family $12.39 $16.05

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Government of The United States Virgin Islands Critical Illness Insurance Policy Proposal Effective Date: October 1, 2019

Benefit Amount Employee Spouse Child (Birth to 26; 26+ if disabled) Initial Critical Illness Benefit Recurrence Critical Illness Benefit Skin Cancer Benefits Maximum Lifetime Benefit Coverage Amounts

Initial Benefit Recurrence Benefit

Cancer Invasive Cancer 100% 100% Carcinoma in Situ 25% 25% Skin Cancer $250 (1 per lifetime) $0 Vascular Heart Attack 100% 100% Stroke 100% 100% Coronary Artery Disease 25% 25% Nervous System Advanced Alzheimer's Disease 25% $0 ALS 25% $0 Parkinson's Disease 25% $0 Multiple Sclerosis 25% $0 Other Conditions Benign Brain Tumor 100% 100% Blindness 100% $0 Coma 25% 25% End‐Stage Renal (Kidney) Disease 100% 100% Major Organ Failure 100% 100% Paralysis 100% 100% Wellness Screening $50 per year $50 per year Premium (Bi‐Weekly) (36‐Month Guarantee) Guaranteed Issue Guaranteed Issue Attained Age as of Policy Year Employee Only Employee & Family 0‐24 $3.55 $5.46 25‐29 $4.05 $6.17 30‐34 $5.40 $8.08 35‐39 $7.58 $11.32 40‐44 $9.76 $14.58 45‐49 $13.66 $20.81 50‐54 $18.46 $29.00 55‐59 $24.70 $36.13 60‐64 $30.69 $49.61 65‐69 $37.31 $59.87 70‐74 $51.87 $82.40 75‐79 $69.81 $108.11 80‐84 $84.87 $132.17 85+ $115.73 $179.55 Benefits will be paid for the diagnosis of a subsequent and same covered condition that has already received a benefit payout under this policy after a 12 month separation period from the previous diagnosis, subject to maximum lifetime limits. Pays a flat dollar amount. See below for Benefit Amount. $100,000 (does not apply to Skin Cancer or Optional Benefits) Summary of Benefits $20,000 $10,000 $10,000 Pays the lump sum benefit direct to the insured. Each covered condition will be payable one time per person, subject to a maximum lifetime limits. A 180 day separation period between the dates of diagnosis is required per condition.

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Government of The United States Virgin Islands Hospital Care Insurance Policy Proposal Effective Date: October 1, 2019

Hospital Care Plan 1 Hospital Care Plan 2 Hospitalization Benefits

Plan Pays Fixed Benefit Below Plan Pays Fixed Benefit Below

Hospital Admission $500 (1 benefit every 365 days) $1,000 (1 benefit every 365 days) Chronic Condition Admission $50 (1 benefit every 90 days) $50 (1 benefit every 90 days) Hospital Stay $100 per day (30 days maximum, 1 benefit every 90 days) $100 per day (30 days maximum, 1 benefit every 90 days) Hospital Intensive Care Unit Stay $200 per day (30 days maximum, 1 benefit every 90 days) $200 per day (30 days maximum, 1 benefit every 90 days) Hospital Observation Stay $100 per day (24 hour elimination period, 72 hours max) $100 per day (24 hour elimination period, 72 hours max) Air Ambulance $1,200 (1 per accident) $1,400 (1 per accident) Follow‐Up Physician Office Visit $25 (10 visits per accident) $50 (10 visits per accident) Follow‐Up Physical Therapy Visits $25 (10 visits per accident) $50 (10 visits per accident) Wellness Screening $50 per year $50 per year Premium (Bi‐Weekly) (36‐month Guarantee) Guaranteed Issue Guaranteed Issue Employee Only $7.12 $9.68 Employee + Spouse $11.29 $18.84 Employee + Children $12.59 $16.57 Employee + Family $19.26 $25.73

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Government of The United States Virgin Islands Short Term Disability Insurance Policy Proposal Effective Date: October 1, 2019

Benefit Criteria Weekly Benefit (Income Replacement) Benefit Waiting Period (Accident/Sickness) Eligibility Waiting Period Maximum Duration from Date of Disability Maximum Weekly Payments Accumulated Sick Leave Minimum Benefit Pre‐Existing Condition Limitation Coverage Type Participation Requirement to Issue Policy Bi‐Weekly Rate per $10 of Weekly Benefit Attained Age as of Policy Year 0‐54 55‐59 60‐64 65+ Sample Bi‐Weekly Premiums Annual Income $25,000 $13.59 $13.59 $13.59 $13.59 $30,000 $16.30 $18.10 $21.08 $23.12 $35,000 $19.02 $21.12 $24.59 $26.98 $40,000 $21.74 $24.14 $28.11 $30.83 $45,000 $24.46 $27.16 $31.62 $34.68 $50,000 $27.17 $30.17 $35.13 $38.54 $55,000 $29.89 $33.19 $38.65 $42.39 $60,000 $32.61 $36.21 $42.16 $46.25 $65,000 $35.33 $39.23 $45.68 $50.10 $70,000 $38.04 $42.24 $49.19 $53.95 $75,000 $40.76 $45.26 $52.70 $57.81 $85,000 $46.19 $51.29 $59.73 $65.52 $86,666+ $47.10 $52.30 $60.90 $66.80 Summary of Benefits 0‐54 years old 55‐59 years old 60‐64 years old 65+ years young 25% of eligible employees (approximately 2,000 lives) Guaranteed Issue Employee Only 60% of your weekly earnings; to a maximum of $1,000 per week 14 days / 14 days No waiting period 13 weeks (includes Benefit Waiting Period) 11 weeks (excludes Benefit Waiting Period) Not included in Benefit Waiting Period $25 per week 3 months prior / 12 months insured Non‐Occupational $0.523 $0.609 $0.668 $0.471

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Government of The United States Virgin Islands Long Term Disability Insurance Policy Proposal Effective Date: October 1, 2019

Benefit Criteria Monthly Benefit (Income Replacement) Benefit Waiting Period (Accident/Sickness) Eligibility Waiting Period Definition of Disability Maximum Duration from Date of Disability Accumulated Sick Leave Return to Work Incentives Rehabilitation Benefits Minimum Benefit Survivors Benefits Pre‐Existing Condition Limitation Coverage Type Participation Requirement to Issue Policy Bi‐Weekly Rate per $100 of Monthly Benefit Attained Age as of Policy Year 0‐24 25‐29 30‐34 35‐39 40‐44 45‐49 50‐54 55‐59 60‐64 65‐69 70+ Sample Bi‐Weekly Premiums Annual Income $25,000 $1.33 $3.98 $8.00 $11.75 $30,000 $1.60 $4.78 $9.60 $14.10 $35,000 $1.87 $5.57 $11.20 $16.45 $40,000 $2.13 $6.37 $12.80 $18.80 $45,000 $2.40 $7.16 $14.40 $21.15 $50,000 $2.67 $7.96 $16.00 $23.50 $55,000 $2.93 $8.75 $17.60 $25.85 $60,000 $3.20 $9.55 $19.20 $28.20 $65,000 $3.47 $10.35 $20.80 $30.55 $70,000 $3.73 $11.14 $22.40 $32.90 $75,000 $4.00 $11.94 $24.00 $35.25 $85,000 $4.53 $13.53 $27.20 $39.95 $90,000 $4.80 $14.33 $28.80 $42.30 $95,000 $5.07 $15.12 $30.40 $44.65 $100,000 $5.33 $15.92 $32.00 $47.00 2 years 24 Months of Your Own Occupation Summary of Benefits 60% of your weekly earnings; to a maximum of $5,000 per month 90 days / 90 days No waiting period Not included in Benefit Waiting Period $100 per month 25% of eligible employees (approximately 2,000 lives) Guaranteed Issue Employee Only 3 months lump sum 3 months prior / 12 months insured Non‐Occupational Included 25 year old 35 year old 45 year old 55 year old $0.595 $0.618 $0.564 $0.050 $0.064 $0.122 $0.634 Included $0.191 $0.285 $0.384 $0.531

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