1 VOLUSIA COUNTY SCHOOL BOARD HEALTH INSURANCE RENEWAL/UPDATE February 26, 2014
Highlights 2 Acronyms and definitions Historical rate review and enrollment Federal and Local Marketplace Preliminary Projection
Acronyms 3 ACA – Affordable Care Act CAT Plan – Catastrophic Plan EAP – Employee Assistance Program HMO – Health Maintenance Organization HCR – Health Care Reform HRA – Health Reimbursement Account OPEB – Other Post Employee Benefits Liability OPPAGA – Office of Program Policy Analysis and Government Accountability POS – Point of Service (Triple Option) PPACA – Patient Protection and Affordable Care Act PPO – Preferred Provider Organization RFP – Request for Proposal WAT – Wellness Action Team
Definitions 4 Medical Trend The projected cost of medical inflation Retention The projected cost to administer the plan – including network access, claims processing and administration Target Loss Ratio The projected amount of total claims divided by total premiums Claims The amount paid by the carrier for the cost of services for an insured member of the plan
Insurance Committee & Meetings 5 Volusia County School Board Insurance Committee (union representation and voting members as required by contracts) Rita Ware (AFSCME) Joe Zaffuto (AFSCME) Laura Cloer (VESA) Carol Sawyer (replacing Mr. Zaffuto 3/6) Diane Vaissiere (VESA) John Darby (VTO) Dr. Maryann Bull (Non-barg) Jacqueline Sadler (VTO) Russ Tysinger (Non-barg) Denise Dietrich (Non-barg) Insurance Committee meetings for 2013-2014 (monthly during school year, * indicates Wellness Action Team meeting as well) • September 5, 2013 January 9, 2014 • October 3, 2013* February 6, 2014 • November 7, 2013 • December 5, 2013* Next meeting March 6, 2014
Revisiting April 23, 2013 6 Significant increases to the Florida Health Care Plans – Increased deductibles Copays Maximum Out of Pocket In / Out Patient Emergency Room Lab No changes to the Florida Blue Plans Renewal rates were 9.5% for Florida Blue and 4% for Florida Health Care for a blended rate increase of 5.4% Projected financial impact - $3.5M
Revisiting April 10, 2012 7 Plan Design Changes to the Florida Blue Plans – Increased deductibles Maximum Out of Pocket No changes to the Florida Health Care Plans Plan design changes kept rate renewal down to 0%
Review of Rates and Renewals 8 VCSB Renewals National Trend (blended) (blended) 2004-2005 3.91% 14.83% 2005-2006 12.80% 14.24% 2006-2007 3.05%* 12.97% 2007-2008 10.40% 11.18% 2008-2009 9.30% 10.94% 2009-2010 8.54% 10.50% 2010-2011 6.36%** 8.00% 2011-2012 6.10% 10.50% 2012-2013 0% 9.06% 2013-2014 5.40% 6.00% 2014-2015 U p to 7.6%*** 7.00% Prior RFP was done in March, 2002 *RFP was done in November, 2005 (remained with BCBS/FHC) **Vote against RFP in November, 2009 and March, 2010 ***Subject to potential plan design adjustments
Enrollment 9 Health Enrollment Totals As of 10/1/2007 8,286* As of 10/1/2008 7,867* As of 10/1/2009 7,512* As of 10/1/2010 7,585* As of 10/1/2011 7,402* As of 10/1/2012 7,079* As of 10/1/2013 6,739* Health Enrollment by Plan 10/ 1/ 07 10/ 1/ 08 10/ 1/ 09 10/ 1/ 10 10/ 1/ 11 10/ 1/ 2012 10/ 1/ 2013 Pre fe rre d Pro vide r Organizatio n (PPO) 2,809 1,484 1,436 1,525 1,434 1,283 1,215 He alth Re imburse me nt Ac c o unt (HRA) 126 1,231 943 646 489 410 355 T riple Optio n (Po int o f Se rvic e ) 2,869 2,946 3,117 3,550 3,723 3,706 3,581 He alth Mainte nanc e Organizatio n (HMO) 2,482 2,206 2,016 1,848 1,737 1,659 1,554 Catastro phic Plan 16 19 21 34 (*Numbers do not include dependents or retirees) (These numbers include both husband & wife that are enrolled under split family – approx. 230 couples)
Marketplace/Volusia Comparison 10 Higher FEDERAL MARKETPLACE Premiums / Platinum Lower Out of Gold Silver Pocket Costs Bronze Catastrophic VOLUSIA COUNTY SCHOOLS PLANS: Lower Premiums Florida Health Care HMO – Platinum Florida Health Care Triple Option – Platinum / Higher Out Florida Health Care POS (Catastrophic) – Gold of Pocket Florida Blue PPO – Gold Florida Health Care HRA - Gold
Local Marketplace School District Comparisons 11 Brevard County Schools (Self-Insured) Lake County Schools (Fully-Insured) Lee County Schools (Self-Insured) Manatee County Schools (Fully-Insured) Pasco County Schools (Self-Insured) Seminole County Schools (Self-Insured)
Local Marketplace Florida Health Care Plans BCBSFL Plans HMO Triple Option POS Plan PPO HRA Classic VP-1, L-43 Classic L03 Balance LQ16 - MOD 3 Plan 117 Plan 0317 In BC PPO Network In Network Out of Network In Network Out of Network In-Network only In Ntwk Opt 1 Opt 2 Opt 3 In HMO Network & OOA Deductible HRA Single $600 $600 Family Annual Deductible Single $0 $0 $250 $500 $1,500 $4,500 $600 $1,650 ($1,050 Gap) Family $0 $0 $500 $1,000 Per Person Per Person $1,200 $2,400 ($1,800 Gap) Coinsurance (Plan Pays) 100% 100% 70% 50% 90% 50% 85% 70% 85% 70% Out of Pocket Max Single $2,000 $2,000 $3,000 $6,000 $5,000 $10,000 $2,250 AD $2,850 (Incl. Gap and HRA) Family $4,000 $4,000 $6,000 $12,000 $10,000 $20,000 $4,500 AD $5,700 (Incl. Gap and HRA) Physician Services PCP Copay $20 $20 $30 50% AD $35 50% AD 15% AD 30% AD 15% AD 30% AD Specialist Copay $35 $35 30% AD 50% AD $50 50% AD 15% AD 30% AD 15% AD 30% AD Preventive Care 30%, Ded 30%, Ded Routine Physical Exam, Well Child, $0 $0 $0 50% AD $0 50% AD $0 $0 Immunization Waived Waived Hospital Services $250/Day $250/Day $300 + 30% $300 + 30% Inpatient N/A 50% AD 10% AD 50% AD 15% AD 15% AD (Days 1-5) (Days 1-5) AD AD Outpatient $100 $100 N/A 50% AD 10% AD 50% AD 15% AD 30% AD 15% AD 30% AD Emergency Services Emergency Visit $100 $100 $100 $100 10% AD 10% AD 15% AD 15% AD 15% AD 15% AD Urgent Care $60 $60 $60 $60 10% AD 10% AD 15% AD 30% AD 15% AD 30% AD Lab, Xray, & Diagnostics Lab and Radiology $0 $0 N/A 50% AD $0 lab, $50 X-ray 50% AD 15% AD 30% AD 15% AD 30% AD Advanced Imaging $0 $0 N/A 50% AD 10% AD 50% AD 15% AD 30% AD 15% AD 30% AD Prescription Drugs FHCP pharmacies; FHCP pharmacies, Walgreens (nationwide), and FHCP pharmacies and Walgreens Retail 30-day supply Retail 30-day supply Retail (31 Day Supply) Select Walgreens / Publix (Volusia and Flagler Co. only) (nationwide) Select Hours Preferred Generic $3 $3 (FHCP pharmacies only) $3 (FHCP pharmacies only) NA NA $10 FHCP Pharmacy $10 FHCP Pharmacy Non-Pref Generic $10 / $15 $10 50% $10 50% $15 Walgreens or Publix Pharmacy $15 Walgreens Pharmacy $30 FHCP Pharmacy $30 FHCP Pharmacy Preferred Brand $30 / $35 $25 50% $25 50% $35 Walgreens or Publix Pharmacy $35 Walgreens Pharmacy $55 FHCP Pharmacy $55 FHCP Pharmacy Non-preferred Brand $55 / $60 $40 50% $40 50% $60 Walgreens or Publix Pharmacy $60 Walgreens Pharmacy 12
Local Marketplace - Brevard (In-network benefits only) 13 Benefit Feature VCSB Triple Option L03 Cigna PPO Annual Deductible $0 $150/$300 Coinsurance 0% 20% Out of Pocket $2,000 / $4,000 $3,000 / $6,000 Maximum $20 PCP $25 PCP Office visit copay $45 Spec $35 Spec $250 / day Inpatient $500 +20% AD (Days 1-5) Outpatient $100 20% AD Emergency Room $150 + 20% AD $100 Prescription $3/10/30/55 $15/40/70 (30-day, Retail) Employee cost is $72 per month for single coverage
Lake County Schools (In-network benefits only) 14 Florida Blue VCSB Triple Option Florida Blue Benefit Feature Blue Choice L03 Blue Choice 3359 PPO HSA Annual Deductible $0 $500 / $1,500 $1,500 / $3,000 Coinsurance 0% 20% 20% Out of Pocket Maximum $2,000 / $4,000 $3,000 / $6,000 $4,000 / $8,000 $20 PCP $25 PCP $35 PCP Office visit copay $35 Spec $60 Spec $85 Spec $250/day Inpatient $100 +20% AD $300 +20% AD (Days 1-5) Outpatient $100 $100 + 20% AD 20% AD Emergency Room $100 $300 $350 Prescription $0/25/40 $0/25/40 $3/10/30/55 (Mandatory Generic / Mandatory Mail Order) (Mandatory Generic / Mandatory Mail Order) (30-day, Retail) Employee cost is $25 per month for single coverage
Lee County Schools (In-network benefits only) 15 Florida Blue Florida Blue Benefit Feature VCSB Triple Option L03 BlueOptions 3769 BlueOptions 5773 Annual Deductible $0 $500/$1,500 $1,000/$3,000 Coinsurance 0% 20% 20% Out of Pocket Maximum $2,000 / $4,000 $3,000/$6,000 $4,000 / $8,000 $20 PCP $25 PCP $35 PCP Office visit copay $35 Spec $60 Spec $85 Spec $250/day Inpatient $100 +20% AD $300 + 20% AD (Days 1-5) Outpatient $100 $100 + 20% AD 20% AD Emergency Room $100 $300 $350 $0/$25/$40 $0/$25/$40 Prescription $3/10/30/55 (Mandatory Generic / Mandatory Mail (Mandatory Generic / Mandatory Mail (30-day, Retail) Order) Order) Employee cost is $0 per month for single coverage
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