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. 2
NMPSIA Staff 11 FTE NMPSIA Board of Directors 11 Board Members NMPSIA Today NEA-NM Mary-Parr Sanchez, President New Mexico Association of 88 School Districts – Mandatory School Business Officials Participation (Excludes ABQ Public Schools) Chris Parrino, Vice President Governor Appointees 96 Charter Schools – Mandatory Alfred Park, Secretary Vacant Position Participation 3 Vacant Position AFT-NM 27 Other Educational Entities – Tim Crone Voluntarily Joined NMPSIA Educational Entities at Large David Willden NEA-NM David Martinez Jr. Covered Members Public Education Commission Trish Ruiz on Medical/Rx School Boards Association ◦ 21,497 Pauline Jaramillo employees Superintendents Association Ricky Williams ◦ 46,917 lives 3
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. 4
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 1 st 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 1 st 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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Employee Benefits Fund Rate Increases 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% 7
FY20 PREMIUM CHANGES EFFECTIVE 10.1.19 Medical Plan Rate Increase Dental Plan Rate Increase High Option 5.0% High Option 5.9% Dental Plan Increase Medical Plans Increase Low Option 5.0% Low Option 3.1% Dental Pan Increase Medical Plans Increase EPO Medical 5.9% Plan Increase 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 options 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. 8
Cost Containment Efforts New contract with pharmaceutical benefits manager with improved • pricing Saveon Program for high cost specialty drugs • Medical carrier/provider arrangements to implement bund l ed 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 9
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 of 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 10
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 11
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 12
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