OFFICE OF GROUP INSURANCE CEC COMMITTEE ~ JANUARY 3, 2020 - PowerPoint PPT Presentation

DEPARTMENT OF ADMINISTRATION OFFICE OF GROUP INSURANCE CEC COMMITTEE ~ JANUARY 3, 2020

 Jennifer Pike, Group Insurance Administrator  Bryan Mooney, Dept of Administration Director  Keith Reynolds, Deputy Director 2

OFFICE OF GROUP INSURANCE  5 full-time employees  Administrator  Benefit Manager  Group Insurance Specialist  Employee Benefits Specialist  Employee Benefits Technician  Annual personnel and operating budget for FY2020 $852,000 3

ENABLING STATUTES AND RULES  I.C. 67-5760 – 67-5772  Powers and duties  Objectives and considerations  Retiree medical eligibility and subsidy  Perpetual appropriation  Group Insurance Advisory Committee (GIAC) • Website: https://ogi.idaho.gov/group-insurance-advisory-committee/ 4

BENEFITS PACKAGE  Active employee medical & dental  Vision benefit  Telemedicine (MDLive)  Prescription drug coverage  Case Management  Employee assistance program (EAP)  Cost Advisor/Transparency Tools  Disease management programs  Wellness/well-being resources  Retiree medical  Basic life insurance  Short and long-term disability  Accidental death and dismemberment  Voluntary term life (VTL)  Flexible spending accounts (FSA) 5

FY2020 SIGNIFICANT PLAN/ADMINISTRATION CHANGES  Relinquished “Grandfathered” status  Implemented 4-tier pharmacy and $2,000 out-of-pocket maximum for Rx  Increased individual and family deductibles  Musculoskeletal (MSK) Management Program  Improved Physical Therapy (Increase 20 covered visits up to 40 covered visits)  Incentivized telehealth with a lower PPO copay  Introduced elements of value-based payment arrangements with providers  Made the High Deductible Plan HSA compatible  Increased the Dental maximum allowance to $1,500 6

MILLIMAN MEDICAL CLAIMS ACTUALS & PROJECTIONS 320 300 Nov-18 280 Millions May-19 260 Nov-19 240 220 FY2018 FY2019 FY2020 FY2021 7 FY2018 & FY2019 show actual claims. FY2020 & FY2021 show projected claims.

MEDICAL PLAN MEMBERSHIP OVERVIEW ACTIVE EMPLOYEES 46,808 Members as of June 2019 RETIREES 855 Members as of June 2019 8

FUTURE PLAN DESIGNS INITIATIVES  FY2020  New PBM – IngenioRx  Working with SCO on the LUMA project  FY2021  Enhance the Vision benefit with a traditional in-network VSP plan and continue the same out- of-network reimbursement model  Implement a wellbeing platform that provides engagement and ability to communicate with employees  Implement an E.R. copay of $100  Increase the specialist PPO copay to $40  Incentivize use of ChoiceDocs program with lower PPO copays for PCP and specialists 9  Continue working with SCO on the LUMA project

PROJECTION METHODOLOGY  Actual claims experience  Industry trend (Milliman Health Cost Guidelines™ blended with state of Idaho trend experience)  Reserve requirements  Reserve balance (funds held by OGI)  Enrollment  Benefit changes  Health Care Reform related fees – H.R. 1865, Further Consolidation Appropriations Act, 2020 10 Projections conducted in May and November 

PROJECTED MEDICAL PLAN COSTS 5% 1.5% 3% Other* 350 $322 $318 $303 $294 300 Employee 250 Contributions Millions ACA Fees 200 150 State Contributions 100 50 Total Plan Costs 0 11

PROJECTED DENTAL PLAN COSTS 7.5% 0.5% Other* 16 $13.8M $13.9M 14 $12.9M Employee 12 Contributions 10 ACA Fees Millions 8 State Contributions 6 4 Total Plan Costs 2 0 12 FY 2019 2020 Projected 2021 Projected

MEDICAL & DENTAL RESERVES 100 $94.2M 90 80 $75.3M 70 60 $64.5M Millions 50 40 $30.1M $27.1M $29.1M 30 20 10 0 13

MILLIMAN NOVEMBER PROJECTIONS – APPROPRIATION OPTIONS FY2020 Medical & Dental Appropriation = $11,650 FY2021 Options  10% Drawdown Appropriation $10,690 ($32 million medical & dental reserve balance)  90 th Percentile Appropriation $11,630 ($52 million medical & dental reserve balance) $11,760  Not to exceed the Federally Allowed Reserve ($54.5 million medical & dental reserve maximum) 14

Office of Group Insurance 650 W. State Street, Ste 145 Boise, ID 83720-0035 (208) 332-1860 (800) 531-0597 ogi@adm.Idaho.gov https://ogi.Idaho.gov 15