NMPSIA 2019 Regional Educational Trainings PREVENTION IS THE - - PowerPoint PPT Presentation

NMPSIA

2019 Regional Educational Trainings

PREVENTION IS THE INTENTION

BENEFITS TO SERVE MEMBERS

NMPSIA

• A state agency created in 1986 by the legislature to provide group health

insurance and risk-related coverage for public schools and educational entities (schools were unable to find affordable insurance coverage). Charter schools were added after the Charter Schools Act in 1999.

• NMPSIA’s does not receive a direct appropriation from the State General
• Fund. NMPSIA’s revenues are derived from other state funds (i.e., premiums,

investment funds, etc.)

• NMPSIA follows the state’s procurement process and goes out to bid jointly

with the NM Retiree Health Care Authority, NM Risk Management Division, and Albuquerque Public Schools (Benefits Advisory Committee – IBAC) for health care purchasing (as mandated by Statute). NMPSIA offers self-insured medical, prescription drug, and dental plans, and fully insured vision, life, and disability plans.

• NMPSIA develops and oversees contracts; handles claim and eligibility

appeals; serves as a resource for school benefits specialists and other school administrators; provides training on NMPSIA benefits administration; supports schools with presentations for new hire, switch, and in-service meetings; and coordinates health fairs and wellness/well-being events.

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NMPSIA Today

88 School Districts – Mandatory Participation (Excludes ABQ Public Schools) 96 Charter Schools – Mandatory Participation 27 Other Educational Entities – Voluntarily Joined NMPSIA Covered Members

• n Medical/Rx
• 21,497

employees

• 46,917 lives

NMPSIA Staff 11 FTE NMPSIA Board of Directors 11 Board Members NEA-NM Mary-Parr Sanchez, President New Mexico Association of School Business Officials Chris Parrino, Vice President Governor Appointees Alfred Park, Secretary Vacant Position Vacant Position AFT-NM Tim Crone Educational Entities at Large David Willden NEA-NM David Martinez Jr. Public Education Commission Trish Ruiz School Boards Association Pauline Jaramillo Superintendents Association Ricky Williams

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Erisa Administrative Services, Inc.

(NMPSIA’s Eligibility, Enrollment, and Billing Administrator)

• Erisa is a third-party administrator contracted by NMPSIA to handle benefits

enrollment, eligibility, and billing for the NMPSIA Group Plan.

• Erisa is charged with applying NMPSIA Rules and approved administrative

processes, and Erisa works under performance standards.

• Erisa finalizes all enrollment transactions, prepares monthly benefit billing

statements, collects premium for schools and self-pay participants, sends electronic eligibility to insurance carriers on a weekly basis, works jointly with insurance carriers to reconcile eligibility data, serves as the COBRA Administrator, maintains the NMPSIA website and the online enrollment system, and provides online enrollment system training, and management supports NMPSIA’s special projects.

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School Employee Benefits Staff

Employing School District/Charter School/Educational Entity responsible for the following (as it pertains to NMPSIA Benefits Administration):

• Determine which employees are eligible for employee benefits coverage, offer employee benefits

timely, and determine effective and cancellation dates (no retroactive dates)

• Coverage can begin as early as the 1st day of the month following date of hire (first day actively at

work) provided the employee applies prior to the effective date being requested.

• Enroll all regular employees to basic life coverage if they work 15 hours per week or more

(coverage goes into effect 1st day of the month following date of hire).

• Report enrollments, changes in status, and cancellations timely (no later than the last day of the

month of cancellation), and report and monitor employees on an approved leave of absence

• Pay the NMPSIA employee benefits bill timely, and reconcile the monthly employee benefits bill and

handle discrepancies before the next billing cycle

• Forward enrollment applications and documents upon receipt from employees
• Review and process pending online enrollment transactions on a timely basis
• Prepare and forward all life related and LTD claims to The Standard

Questions? Contact Erisa or NMPSIA – WE ARE HERE TO HELP!

Caution: If your school offers non-NMPSIA (non-competing benefits), be sure to have your employees complete the necessary forms to cancel or enroll for benefits, and for reporting changes in status, such as divorces. 5

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Plan Year Rate Increase 2013-2014 Medical 6.6% Dental 3.0% 2014-2015 Medical 1.5% Dental 0.0% 2015-2016 Medical 4.0% Dental 0.0% 2016-2017 Medical High 8.30% Medical Low 7.15% Dental 0.0% 2017-2018 Medical High 3.98% Medical Low 1.82% Dental 0.0% 2018-2019 Medical High 4.0% Medical EPO 4.0% Medical Low -0.7% Dental 0.0% 2019-2020 Medical High 5.9% Medical EPO 5.9% Medical Low 3.1% Dental 5.0%

Employee Benefits Fund Rate Increases

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FY20 PREMIUM CHANGES EFFECTIVE 10.1.19

When needed, premium changes go into effect on October 1 (affects September payrolls). NMPSIA’s actuarial and benefits consulting firm currently analyzing claims trend experience and will recommend premium

• ptions for FY21 to the NMPSIA Board (in August). Based on outcome of

legislative session, NMPSIA announces any premium changes during Spring Budget Workshop. Plan design changes are announced prior to implementation.

Medical Plan Rate Increase

High Option Medical Plans 5.9% Increase Low Option Medical Plans 3.1% Increase EPO Medical Plan 5.9% Increase

Dental Plan Rate Increase

High Option Dental Plan 5.0% Increase Low Option Dental Pan 5.0% Increase

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• New contract with pharmaceutical benefits manager with improved

pricing

• Saveon Program for high cost specialty drugs
• Medical carrier/provider arrangements to implement bundled payments

for certain services and increase access to care in lower cost settings

• Programs to manage patients with chronic conditions in an effort to

reduce their risk of becoming potential high cost claimants

• Well-being programs with goal to improve the overall health of

membership

• Promote early prevention & detection of chronic diseases to mitigate

higher claims costs in the future

Cost Containment Efforts

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RFP Results for General Counsel

Marty Esquivel and Howington, LLC Contract Effective July 1, 2019

RFP Results for Life and Disability

The Standard Life and Disability Contract Effective July 1, 2019

RFP in Progress

Project Manager for the Developing and Managing

• f Upcoming Medical, Dental, and Vision RFP

Contract Effective Summer 2019

Upcoming RFPs

Medical, Dental, and Vision RFP Contract Effective July 1, 2020 Eligibility, Billing and Enrollment Third-Party Administrator Contract Effective February 2020

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Legislative Changes Impacting Benefits

• Effective July 1, 2019 – Removed age limits on autism benefits
• Effective January 1, 2019 – House Bill 81 Physical Rehab Cost Sharing

Limits - Requires member cost share for physical therapy (PT) be no greater than it is for primary care services

• Current benefits limits 10 specialty copayments per calendar year –

remaining PT for the rest of the calendar year provides PT at no charge for members

• NMPSIA’s Benefits Consultant will make recommendations to the

NMPSIA Board in August

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Benefit Related Questions?? Benefit or Eligibility Clarifications?? Claim Issues?? Request Wellness Support?? Request Training??

Use the contact button at nmpsia.com website to email NMPSIA or email staff directly: melissa.Larranaga@state.nm.us katherine.chavez@state.nm.us ernestine.chavez@state.nm.us

NMPSIA Customer Service

800.548.3724 or 505.988.2736