Post on 26-Jun-2020
transcript
Office of Group Insurance Administers group plans including:
Basic Life and Voluntary Term-Life (Principal)
Short-Term and Long-Term Disability (Principal)
Active employee medical & dental (Blue Cross of Idaho)
• Traditional
• Preferred Provider- PPO
• High Deductible
Flexible Spending Account (Stanley, Hunt, Dupree & Rhine)
Retiree medical
Six full-time employees
Annual operating budget of $849,800
Agenda
• Plan Structure
• Grandfathered Status
• OGI Funding / ACA Impacts
• Reserves
• Talking Points
Medical Plan Snapshot
Traditional Deductible Out-of-
Pocket Limit
Plan
Payment
Wellness/Prev.
Care Payment
Individual $350 $4,300 80% 100%
Family $1,050 $8,600
PPO Deductible
Out-of-Pocket
Limit
Plan
Payment
Wellness/Prev
Care Payment
IN OUT IN OUT IN OUT IN OUT
Individual $250 $500 $3,250 $6,500 $20
copay/
85%
70%
No copay
for listed
services
70% Family $750 $1,500 $6,750 $13,500
High
Deductible Deductible
Out-of-
Pocket Limit
Plan
Payment
Wellness/Prev.
Care Payment
Individual $2,000 $5,000 70% 100%
Family $6,000 $10,000
Enrollment by Plan Type Active
Employees Traditional PPO
High
Deductible Total
Employees 17.6% 82.2% .2% 18,270
Dependents 13.9% 86.0% .1% 26,851
Total 45,121
Retirees Traditional PPO High
Deductible Total
Employees 33.4% 52.7% 13.9% 837
Dependents 30.5% 57.5% 12% 200
Total 1,037
Demographics Active Employee Age Female Male Average
Employee 49 52 51
Spouse 48 55 52
Children 14 12 13
Retiree Age Average
Retiree 62
Spouse 60
Children 21
FY2016 – Eligibility
IDAPA 38-03-01 – Rules Governing Group Insurance
http://ogi.idaho.gov/employees/benefits_summary_and_co
ntracts.html
Tiered premium structure based on average hours worked per week:
Tier 1: 30 – 40 hours per week
Tier 2: 20 – 29.9 hours per week
FY2016 – Tier 1 Monthly Premiums Full-Time Tier (30 – 40 hours/ week)
State Contribution Per Eligible Employee Per Month = $911.90
Employee
Only
Employee &
Spouse
Employee, Spouse
& Children
PPO Plan $47.00 $119.00 $171.00
Traditional $58.00 $144.00 $202.00
High Deductible $38.00 $101.00 $141.00
Dental $8.24 $38.24 $63.24
Premium details for all plan types posted on the OGI website:
http://ogi.idaho.gov/employees/premium_rates.html
FY2016 – Tier 2 Monthly Premiums
Part-Time Tier (20 – 29.9 hours/week) State Contribution Per Eligible Employee Per Month = $748.50
Employee
Only
Employee &
Spouse
Employee, Spouse
& Children
PPO Plan $210.40 $282.40 $334.40
Traditional $221.40 $307.40 $365.40
High Deductible $201.40 $264.40 $304.40
Dental $12.08 $42.08 $67.08
163 employees enrolled as of June 30, 2015
Agenda
• Plan Structure
• Grandfathered Status
• OGI Funding / ACA Impacts
• Reserves
• Talking Points
“Grandfathered” Status Plans that existed before March 23, 2010 Mandatory changes included:
Removal of lifetime and annual maximums Coverage for dependents to age 26 Removal of pre-existing condition exclusions
Little to no flexibility
PPO Plan Design Current Increase Possible to Employee
Co-Payments $20 $6.32 per visit
Deductible $250 employee only
$750 family
$78.98 employee only
$236.93 per family
Co-Insurance 15% $0
Benefits Package No adverse changes allowed
“Grandfathered” Status, Cont.
Loss of grandfathered status would result in:
Coverage of all preventive health services with no co-pay
Coverage for certain clinical trials cannot be denied
Modifying out-of-pocket limits to include deductibles,
coinsurance, and co-payments for covered services
Providing same level of cost sharing for out-of-network
emergency services
Loss of discretion to cover certain procedures and
prescriptions
Agenda
• Plan Structure
• Grandfathered Status
• OGI Funding / ACA Impacts
• Reserves
• Talking Points
OGI Funding
Fully insured plan that functions much like a self-insured plan
Maintain contractual (contingency) reserves
Costs are projected 12 months in advance and refined prior to each budget setting.
Actuarial projections (June and December)
Total Plan Costs vs. Contributions
239,990,000 262,600,000
288,160,000 305,410,000
-
100,000,000
200,000,000
300,000,000
400,000,000
Other
EmployeeContributions
ACA Fees
StateContributions
Total PlanCosts
9.73% 6%
9.42%
* Total Plan Costs include premiums, co-pays and deductibles
* Other includes retiree and cobra contributions
Affordable Care Act Fees
0
2,000,000
4,000,000
6,000,000
8,000,000
10,000,000
ReinsuranceAssessmentFee
PCORI Fee
HealthInsurer Fee
4,850,000 4,940,000
9,220,000 8,874,776
3,652,776
Agenda
• Plan Structure
• Grandfathered Status
• OGI Funding / ACA Impacts
• Reserves
• Talking Points
Contractual Reserves
A contingency reserve
Reserve set at 10% of annualized premiums
State’s total liability is 110% of annualized premiums
Reserves could be depleted
Decreasing Reserves Balances
53,130,000
27,970,000
27,020,000
28,020,000
21,100,000
26,940,000 28,950,000
0
10,000,000
20,000,000
30,000,000
40,000,000
50,000,000
60,000,000
Transfer
Fiscal YearEndReserveBalance
Governor’s Recommended Appropriation
FY2016 Appropriation = $11,200
Active Medical Appropriation $12,012
Active Dental Appropriation $ 228
Final FY2017 Appropriation $12,240
9.3%
Agenda
• Plan Structure
• Grandfathered Status
• OGI Funding / ACA Impacts
• Reserves
• Talking Points
Options –
Get a 3rd FY2017 actuarial projection due to increased plan cost unpredictability
Return to a 90th percentile actuarial reserve Actuarial recommended reserve for FY2017
= $36 million
Options –
Increase minimum number of hours requirements for healthcare benefits (Eliminate Tier 2)
Would not result in loss of grandfathered status
Some cost savings due to reduced administration
Drop “Grandfathered” Status
Greater flexibility in cost sharing and premiums
$2 million Total Plan Cost increase
Alternatives – Self Funding Self-Insured Plans
Potential on-going cost savings
Avoids ACA fees
Could maintain “grandfathered” status
Complex administration
Requires a trust, re-insurance and HIPAA compliance
Start-up and operational costs
Premium tax savings; Department of Insurance budget considerations
Alternatives – HD/HSA, VEBA High Deductible/Health Savings Account (HSA)
Contributions can be made by the employee and employer,
with limits
Accounts are employee-owned & transferable to other
qualifying HSA’s
Plan must meet federal definition of high deductible plan and
would not be grandfather-able for the State
Voluntary Employee Benefit Associations (VEBA)
Require an independent trust
Require third-party plan administrator, creation of trustee group
and funds for the program
No limits to yearly contributions
Group Insurance Advisory Committee
Members:
Senator Fred Martin
Representative Phylis King
Director Robert L. Geddes
Dick Humiston, Retired Employee
Roxanne Lopez, Tax Commission, Active Employee
Andrea Patterson, Judiciary Representative
Website: http://ogi.idaho.gov/giac
Questions?
Office of Group Insurance
Phone Numbers (208) 332-1860 (in the Treasure Valley) (800) 531-0597 (outside the Treasure Valley) (208) 332-1888 (fax) Street Address 304 North 8th Street, Room 434 Boise, ID 83702 Email Address ogi@adm.idaho.gov