Saint Mary’s College€¦ · FINAL Renewal Rates 10/21/2015 Initial 2016 Renewal Rates Revised...

Saint Mary’s CollegeEmployee Benefits Advisory Committee

(EBAC)

October 2015 Meeting

October 21, 2015

EBAC Meeting – October 2015

Agenda –

1. Welcome / Introductions – EBAC Update, Tenets Review

2. Medical Plan Renewal Update – Process Update

1. United HealthCare Adjustments

2. Health Net Alternative presentation

3. Kaiser Full Replacement Discussion

3. Contribution Modeling

4. Next Steps and Future Topics

10/21/2015


Welcome New EBAC Members –

Formed in 2005 as the HIRC to review contribution models. Evolved into the Employee Benefits Advisory Committee (EBAC) in 2013 to provide a forum to address a broader range of employee work-life issues. The EBAC is comprised of members of the Faculty Senate, Staff Council and Administration.

The EBAC has established a set of tenets that guide its actions.

10/21/2015

EBAC Meeting – October 2015Employee Work/Life Program Tenets as developed by the Employee Benefits Advisory Committee (EBAC), Spring 2014.

1. Employee Benefits are part of the college’s total compensation strategy and must be considered as part of a holistic employee engagement.

2. The employee benefits program(s) offered should align with Saint Mary’s College principles. Programs offered will treat all members of the College community with fairness and in a way that supports our families.

3. Where practical the programs offered should be designed to include choices for employees that match their individual needs, beliefs and circumstances.

4. The programs’ financials (budget) should operate within agreed upon (or approved) targets and be easy to project and budget.

10/21/2015

EBAC Meeting – October 2015Employee Work/Life Program Tenets as developed by the Employee Benefits Advisory Committee (EBAC), Spring 2014.

5. Employees should share in the cost of their particular health care plans or coverage options in a way that reflects the relative value of their choices.

6. Wellness initiatives will be supported and promoted.

7. There will be open communication with the campus community about the design, cost and value of the benefit program as well as the decision-making processes involved.

8. All means should be leveraged to contain costs, ease administration and to improve the effectiveness, efficiency and value to all participants.

10/21/2015


Medical Renewal Next Steps:

• Continue discussions with incumbents

• Review alternative Health Net proposal

• Finalize plan design and Carrier proposal

• Model Contributions

10/21/2015


Benefits Plans Renewals

Overall Annual Spend increase, at current enrollment and plan designs, is 5.4%. Medical only is 6.1%.

10/21/2015

Carrier / Plan Initial Renewal Updated Renewal

Kaiser HMO 5% on ‘slice’ rates 5% on ‘slice’ rates

UHC HMO 11.5% on ‘slice’ rates 7.3% on ‘slice’ rates

UHC PPO HSA 13.3% on ‘slice’ rates 8.6% on ‘slice’ rates

Delta Dental PPO 0% 0%

Delta Dental DHMO 5% 5%

VSP Vision 0% 0%

MHN EAP 6% 0%

UNUM (Life/LTD) 0% 2nd year of rate guarantee


FINAL Renewal Rates

10/21/2015

Initial 2016

Renewal Rates

Revised 2016

Renewal Rates

v.2.0

PlanBENU

Census

Updated

Slice Rates

Suite Spot Blended

Renewal Rates

Kaiser & UHC

Rates

Kaiser & UHC

Rates

Kaiser HMO - $20 cpEE 206 $567.44 $646.08 $595.59 $595.59

EE & Spouse 63 $1,191.63 $1,356.77 $1,250.73 $1,250.73

EE & Child(ren) 40 $1,078.14 $1,227.55 $1,131.61 $1,131.61

EE & Family 100 $1,759.07 $2,002.85 $1,846.31 $1,846.31

409 $410,997.93 $467,955.99 $431,382.93 $431,382.93

PEPM $1,004.88 $1,144.15 $1,054.73 $1,054.73

% Change 1.1% 4.0% 5.0% 5.0%

UHC HMO - $20 cpEE 106 $965.44 $812.49 $1,076.09 $1,035.62

EE & Spouse 25 $2,027.51 $1,706.23 $2,259.88 $2,174.89

EE & Child(ren) 13 $1,834.41 $1,543.73 $2,044.65 $1,967.74

EE & Family 42 $2,993.02 $2,518.72 $3,336.05 $3,210.58

186 $302,578.56 $254,634.42 $337,257.09 $324,572.95

$1,626.77 $1,369.00 $1,813.21 $1,745.02

12.0% 7.7% 11.5% 7.3%

UHC PPO-HSA - $250 DedEE 19 $1,016.47 $855.44 $1,151.56 $1,103.63

EE & Spouse 5 $2,134.62 $1,796.42 $2,418.31 $2,317.66

EE & Child(ren) 2 $1,931.33 $1,625.34 $2,188.01 $2,096.94

EE & Family 5 $3,151.11 $2,651.86 $3,569.90 $3,421.31

31 $49,604.24 $41,745.44 $56,196.71 $53,857.70

$1,600.14 $1,346.63 $1,812.80 $1,737.35

626 14.7% 10.4% 13.3% 8.6%

Combined TOTAL Annual $9,158,169 $9,172,030 $9,898,041 $9,717,763

Annual Change % 5.4% 5.6% 8.1% 6.1%

Final 2015 Renewal Rates


Alternative Health Plan Marketing Update:

10/21/2015

Carrier Response

Kaiser & United Healthcare Incumbents who have offered renewals

Kaiser Quoted a full replacement option with stringent requirements

Health NetQuoted, Both Full and “Select” Network,Underwriting requirements on contributions and participation

Sutter HealthQuoted but deemed unacceptable due to lack of John Muir Hospital in network

Aetna Decline, participation

Anthem Blue Cross Decline, participation

Blue Shield Decline, large claims

CIGNA Decline, large claims

Western Health Decline, out of service area


2016 Health Plan Options:

Scenario ONE: Renew with Kaiser and United Healthcare with no change in plans. Possibly add an HSA option to Kaiser

Scenario TWO: Keep Kaiser, replace UHC with Health Net.

Scenario THREE: Kaiser Total Replacement with a PPO option and possibly an HSA.

10/21/2015


2016 Health Plan Options: Scenario ONE

Renew with Kaiser and United Healthcare with no change in plans. Possibly add an HSA option to Kaiser.

Least disruptive – employees are already familiar with plans

Cost is within 6% Budget

No participation issues

Contribution challenges with the re-indexing of rates

10/21/2015


2016 Health Plan Options: Scenario TWO

Keep Kaiser, replace UHC with Health Net.

Require re-enrolling ALL non-Kaiser participants

While Health Net is a known for some, it will be a new carrier (and

process, network, etc.) for many

Specific participation requirements

Contributions modeling requirements

Potential overall savings (renewal of 1.4% to 4%)

10/21/2015

Smart, Sustainable Solutions

Keeping people healthy and your business growing

Presentation for

Saint Mary’s College

Presentation by

Health Net

Oct 21st, 2015

Affordable, tailored solutions

that create the right price point for maximum value and accessibility

Dependable performance

that makes a difference when it counts most

Enduring, productive partnerships

that transcend the traditional buyer-vendor arrangement

Welcome to Health Net

14 14

Agenda

15

Welcome & Introductions

Health Net Facts

Healthcare Providers

Proposal Overview

New Client Experience

Q & A

16

Health Net Facts

What you may not know about us … but should! Strength in Numbers

We are:

• A publicly traded managed care organization that delivers managed health care

services through health plans and government sponsored managed care plans

• We operate in California, Arizona, Oregon and Washington

• Approximately 8,000 associates strong

We provide:

• Health benefits to almost 6 million members across the country: individual,

commercial and government programs including exchanges

• Behavioral health services to over 8 million individuals

We perform:

• $14 billion national company

• One of the lowest debt-to-total capital ratios

• Ranked 254 on the 2014 Fortune 500

Health Net Business Update

Health Net leverages our

longstanding presence in

the Western U.S. to

champion solutions as

unique as our clients. It’s

a 30+ year tradition that

we’ll continue for decades

to come.

16

17

California: Local Expertise, Strong Market Share

• 75,000 PPO physicians

• 58,000 HMO physicians

• 260 HMO and 306 PPO

hospitals

• 46,000 Medicare

Advantage physicians

• More than 6,000 retail

chain and independent

pharmacies

• More tailored network

solutions that any other

California carrier

17

HMO

PPO

Health Net Fast Facts

A complex market …

• 37 million people

• Membership concentrated around high

population density areas

• Highest managed care penetration in U.S

• Dynamic ACA environment

… requires stability and innovation

• $14 billion health plan

• 2nd largest HMO market share (based on

membership) with two million members

• Dominant network HMO and PPO

• Pioneer in tailored networks

• Enhanced Choice portfolio rollout 4/2014!

Healthcare Providers

• John Muir - ACO

• Full Statewide HMO

• Statewide Tailored Network – Smart Care

• Full CA PPO network (for HSA)

• First Choice Network out of state

19

Products Choices

• Starting Line-up

• Full HMO

• Smart Care HMO

• HSA PPO

• Chiropractic

• Behavioral Health, Pharmacy

Products and NetworkBenefits:

• Full Network HMO : $20ov/$250

• Rx 10/30/50/30%

• Chiro $10ov/30 visits

• Smart Care HMO $15ov/$250

• RX 10/30/50/30%/$100

ded brand and non-

formulary

• Chiro/Accu $15ov/10 visits

• HSA PPO : $2000/ 100%/50%

• RX: Combined deductible

with medical then

0/0/0/30%

Proposal Overview for Saint Mary’s CollegeSolutions for your members

20

Why Smart Care?

14 Counties added in NO CA for 2016

Smart Care is the next generation of

health plans that includes:

•Predictable costs – copayments,

and deductibles

•Financial incentives to increase

member involvement by completing

HRQ– $50 gift card

Smart Care also has added benefits

and convenience such as:

•Acupuncture

•Chiropractic

•Access to care via CVS:

MinuteClinic walk-in medical centers

•Ability to offer alongside Kaiser with

less than 50% enrollment

20

Sustainability made possibleHealth Net Smart Care puts together all the pieces employers and

employees value, so you can offer them benefits with sustainable

affordability.

Smart Care - Service Areas

22

Medical Groups:

• Affinity Medical Group

• Hill Physicians Medical Group

• John Muir Physician Network

• Meritage Medical Group

• Chinese Community Heath Care

• Physicians Medical Group – San Jose

• Physicians Medical Group – Santa Cruz

Smart Care HMO Network Bay AreaHospitals:

• Alameda Hospital

• San Leandro Hospital

• San Ramon Medical Center

• St Rose Hospital

• Children’s Hospital - Oakland

• Doctor’s Medical Center – San Pablo

• John Muir Medical Center

• Washington Hospital

• Valley Care Health System

• Queen of the Valley Medical Center

• Santa Rosa Memorial Hospital

• Petaluma Valley Hospital

• Sonoma Valley Hospital

• Chinese Hospital

• Seton Medical Center

• St. Francis Memorial Hospital

• St. Mary Medical Center

• UCSF Medical Center

Health Net Proposal Requirements for Saint Mary’s College

Participation Requirement:

• Total Eligible Employees: 695

• Health Net minimum enrolled employees: 229

• Current UHC enrolled employees (both products): 209

Contribution Requirement:

• Saint Mary’s to adjust contribution to provide lower out of pocket premium cost for an employee to

enroll with one of Health Net’s plans.

24

Health Net Implementation

• Dedicated Implementation Specialist

• Prescription transition of care (COC) process

• Medical transition of care (COC) process

• Health Net Beginnings

• Dedicated new member support line 800-526-6694

• Open Enrollment support available for meetings

• Member Services availability

• HMO 800-522-0088

• PPO 800-676-6976

• OOS PPO 800-861-7214

• Website capabilities and resources

• Account Services Unit (ASU) available for HR – 800-547-2967

• Client Managers provide ongoing employer group service, support

and strategic planning

New Client Experience

Dependable Performance

26

Health Net Mobile, Social Media, and PULSE sites!

Putting People First

Making more and stronger connections

• Enhances communication and collaboration

• Connects with people where they are

• Informs and educates

• Stays fresh with new status posts weekly (or more often)

Where to find us:

• In the App Store and Android Market

• Link to http://on.fb.me/hnfacebook

• We can also be found on Twitter!

• WWW.healthnet.com

http://www.healthnet.com/

27

Maximizing your health care investment starts here …

27

Heidi Duncan

Senior Consultant, Large Group Sales

(916-935-0100) work

(916-765-3848) cell

[email protected]

Questions & AnswersDiscussion

EBAC Meeting – October 2015Scenario TWO Rates -

10/21/2015

Revised 2016

Renewal Rates

Projected

Census

Scenario TWO w/

Health Net

Projected

Census

Scenario TWO w/

Health Net

Kaiser HMO - $20 cpEE 206 $567.44 $646.08 $595.59 193 $595.59 193 $595.59

EE & Spouse 63 $1,191.63 $1,356.77 $1,250.73 61 $1,250.73 61 $1,250.73

EE & Child(ren) 40 $1,078.14 $1,227.55 $1,131.61 39 $1,131.61 39 $1,131.61

EE & Family 100 $1,759.07 $2,002.85 $1,846.31 98 $1,846.31 98 $1,846.31

409 $410,997.93 $467,955.99 $431,382.93 391 $416,314.57 391 $416,314.57

PEPM $1,004.88 $1,144.15 $1,054.73 $1,064.74 $1,064.74

% Change 1.1% 4.0% 5.0% 6.0% 6.0%

UHC HMO - $20 cpAdjusted up

slightly

Health Net HMO 20

- Full Network

Adjusted up

slightly

Health Net HMO 20

- Full Network

EE 106 $965.44 $812.49 $1,035.62 76 $894.47 106 $894.47

EE & Spouse 25 $2,027.51 $1,706.23 $2,174.89 18 $2,146.73 25 $2,146.73

EE & Child(ren) 13 $1,834.41 $1,543.73 $1,967.74 10 $1,565.33 13 $1,565.33

EE & Family 42 $2,993.02 $2,518.72 $3,210.58 35 $2,728.15 40 $2,728.15

186 $302,578.56 $254,634.42 $324,572.95 139 $217,759.41 184 $277,957.36

$1,626.77 $1,369.00 $1,745.02 $1,183.48 $1,510.64

12.0% 7.7% 7.3% -27.2% -7.1%

Assume 32%

of non-Kaiser

Health Net HMO 15

Smart-care Network

Assume 10%

of non-Kaiser

Health Net HMO 15

Smart-care Network

40 $846.10 10 $846.10

10 $2,030.65 3 $2,030.65

5 $1,480.69 2 $1,480.69

10 $2,580.62 5 $2,580.62

65 $87,360.15 20 $30,417.43

$4,368.01 $1,520.87

UHC PPO-HSA - $250 DedMaintain

enrollment PPO HSA 2000Maintain

enrollment PPO HSA 2000

EE 19 $1,016.47 $855.44 $1,103.63 19 $1,060.33 19 $1,060.33

EE & Spouse 5 $2,134.62 $1,796.42 $2,317.66 5 $2,544.80 5 $2,544.80

EE & Child(ren) 2 $1,931.33 $1,625.34 $2,096.94 2 $1,855.58 2 $1,855.58

EE & Family 5 $3,151.11 $2,651.86 $3,421.31 5 $3,234.02 5 $3,234.02

31 $49,604.24 $41,745.44 $53,857.70 31 $52,751.53 31 $52,751.53

$1,600.14 $1,346.63 $1,737.35 $1,701.66 $1,701.66

626 14.7% 10.4% 8.6% 6.3% 6.3%

Combined TOTAL Annual $9,158,169 $9,172,030 $9,717,763 $9,290,228 $9,329,291

Annual Change % 5.4% 5.6% 6.1% 1.4% 1.9%

Final 2015 Renewal Rates


2016 Health Plan Options: Scenario THREE

Kaiser Total Replacement with a PPO option and possibly an HSA.Limits choice, disruptive to 33% of population

Rates adjust based on products offered

Least expensive (range of -9% to +16%) depending on enrollment

Does have a PPO option… BUT the employee contribution for the PPO plan must reflect the FULL buy-up cost (No additional college subsidy)

10/21/2015

Tier Est PPP HMO contrib @ 90%/70% Est PPP PPO Contribution

Employee $31.46 $251.25

EE + Spouse $198.21 $395.47

EE + Children $179.34 $357.81

EE + Family $292.60 $583.79


Contribution History

10/21/2015

2010 2011 2012 2013 2014 -based on formula change

2015 -based on no-change in formula and

Final Rates

Kaiser HMO HMO 15 HMO 15 HMO 20 HMO 20 HMO 20 HMO 20Single Employee $11.07 $11.88 $12.71 $13.60 $31.06 $31.06

Employee + Spouse $116.21 $124.69 $135.16 $144.63 $195.65 $195.65

Employee + Child(ren) $105.15 $112.82 $122.29 $130.86 $177.02 $177.02

Employee + Family $171.55 $184.07 $199.52 $213.50 $288.82 $288.82

change from prior year: NA 7.3% 7.0% 7.0% 28.3% 0.0%

Non - KaiserHMO Anthem HMO 15 UHC HMO 20Single Employee $48.50 $51.56 $34.85 $38.03 $41.48 $41.48

Employee + Spouse $233.85 $248.58 $195.17 $212.97 $237.57 $237.57


Employee + Family $377.43 $401.21 $288.11 $314.38 $350.70 $350.70

change from prior year: NA 6.3% -32.4% 9.1% 9.1% 0.0%

Non-Kaiser HSA Anthem HSA UHC HSASingle Employee $0.00 $0.00 $0.00 $16.10 $31.00 $31.00

Employee + Spouse $165.00 $180.00 $174.58 $174.58 $211.58 $211.58


Employee + Family $270.00 $295.00 $257.72 $257.71 $312.33 $312.33

change from prior year: NA 9.1% -3.0% 0.0% 21.2% 0.0%

College Share PEPM $767.46 $815.85 $860.87 $917.19 $985.33 $1,049.68

6.3% 5.5% 6.5% 7.4% 6.5%


Scenario ONE Contribution Options

10/21/2015

Based on current

(2015) census2014 FINAL 2015 Final

Kaiser HMO HMO 20 HMO 20 HMO 20 HMO 20 HMO 20Single Employee $31.06 $31.06 $29.78 -4.1% $32.92 6.0% $32.61 5.0%

Employee + Spouse $195.65 $195.65 $187.61 -4.1% $207.39 6.0% $205.43 5.0%

Employee + Child(ren) $177.02 $177.02 $169.74 -4.1% $187.64 6.0% $185.87 5.0%

Employee + Family $288.82 $288.82 $276.95 -4.1% $306.15 6.0% $303.26 5.0%

UHC HMOSingle Employee $41.48 $41.48 $51.78 24.8% $43.97 6.0% $44.50 7.3%

Employee + Spouse $237.57 $237.57 $326.23 37.3% $251.82 6.0% $254.84 7.3%

Employee + Child(ren) $214.94 $214.94 $295.16 37.3% $227.84 6.0% $230.56 7.3%

Employee + Family $350.70 $350.70 $481.59 37.3% $371.74 6.0% $376.19 7.3%

UHC PPO HSASingle Employee $31.00 $31.00 $55.18 78.0% $32.86 6.0% $33.66 8.6%

Employee + Spouse $211.58 $211.58 $347.65 64.3% $224.27 6.0% $229.72 8.6%

Employee + Child(ren) $191.43 $191.43 $314.54 64.3% $202.92 6.0% $207.84 8.6%

Employee + Family $312.33 $312.33 $513.20 64.3% $331.07 6.0% $339.11 8.6%

College Share PEPM $985.33 $1,049.68

percent change from prior year 6.5%

College Share % of Total Cost 76.6% 77.7% 77.7% 77.7%


5.3%

0.0%

$1,105.82

Option THREE - Each

plan increase based on

their renewal %

$1,106.14

5.4%

0.0%

Option TWO -Average

Increase of 6% on each

tier

Option ONE - Return to the

90/70 formula

$1,090.44

3.9%

76.6%

-1.4%


Scenario TWO Contribution Options –

10/21/2015

Based on adjusted

census2014 2015

Kaiser HMO HMO 20 HMO 20 HMO 20 HMO 20 HMO 20 HMO 20Single Employee $31.06 $31.06 $29.78 -4.1% $32.92 6.0% $32.61 5.0% $31.06 0.0%

Employee + Spouse $195.65 $195.65 $187.61 -4.1% $207.39 6.0% $205.43 5.0% $195.65 0.0%

Employee + Child(ren) $177.02 $177.02 $169.74 -4.1% $187.64 6.0% $185.87 5.0% $177.02 0.0%

Employee + Family $288.82 $288.82 $276.95 -4.1% $306.15 6.0% $303.26 5.0% $288.82 0.0%

UHC HMO HEALTH NET HMO 20

Single Employee $41.48 $41.48 $44.72 7.8% $43.97 6.0% $43.97 6.0% $41.48 0.0%

Employee + Spouse $237.57 $237.57 $322.01 35.5% $251.82 6.0% $251.82 6.0% $237.57 0.0%

Employee + Child(ren) $214.94 $214.94 $234.80 9.2% $227.84 6.0% $227.84 6.0% $214.94 0.0%

Employee + Family $350.70 $350.70 $409.22 16.7% $371.74 6.0% $371.74 6.0% $350.70 0.0%

UHC HMO HEALTH NET SMARTCARE HMO 15

Single Employee $41.48 $41.48 $29.78 -28.2% $32.92 -21% $32.61 -21% $31.06 -25%

Employee + Spouse $237.57 $237.57 $187.61 -21.0% $207.39 -13% $205.43 -14% $195.65 -18%

Employee + Child(ren) $214.94 $214.94 $169.74 -21.0% $187.64 -13% $185.87 -14% $177.02 -18%

Employee + Family $350.70 $350.70 $276.95 -21.0% $306.15 -13% $303.26 -14% $288.82 -18%

UHC PPO HSA HEALTHNET PPO HSA

Single Employee $31.00 $31.00 $53.02 71.0% $32.86 6.0% $32.95 6.3% $32.95 6.3%

Employee + Spouse $211.58 $211.58 $381.72 80.4% $224.27 6.0% $224.91 6.3% $224.91 6.3%

Employee + Child(ren) $191.43 $191.43 $278.34 45.4% $202.92 6.0% $203.49 6.3% $203.49 6.3%

Employee + Family $312.33 $312.33 $485.10 55.3% $331.07 6.0% $332.01 6.3% $332.01 6.3%

College Share PEPM $985.33 $1,049.68


College Share % of Total Cost 76.6% 77.7% 76.8% 76.9% 77.9%


Option FOUR - No change

in 2016 except for HSA

$1,068.51

1.8%

0.2%

0.3% 0.3% 0.4%

76.8%

-1.2% -1.3% -1.1%

Option ONE - Return to

the 90/70 formula

Option TWO -Average

Increase of 6% on each

tier

Option THREE - Each

plan increase based on

their renewal %

$1,053.05 $1,052.63 $1,054.38


FINAL Observations –

Scenario ONE – Status quo, on budget

Scenario TWO – Change in plan offerings (add limited network option)

Mandated Contribution model

Minimum participation requirement

Scenario THREE – Lose non-Kaiser HMO option

10/21/2015

EBAC Meeting – September 2015

Future EBAC Meeting Schedule:

OCT 21 @ 2:45 to 4:15, FAH 205

NOV 4 @ 2:45 – 4:15; FAH 205

DEC 2 - Benefits Festival @ 10:00 – 2:00; Soda Center

10/21/2015

10/21/2015

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