Welcome Employee Benefits

Committee

November 17, 2015

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EBC Members

113 Members -Representing every site, department, & retirees

Non-Voting Support Team: Candace BoswellDori CirrincioneMichael ClearShareen CrosbyBarry JagerMichael Johnston Steve WardAlan Thaxter - Gallagher Benefit ServicesBecky Troncoso – Gallagher Benefit Services

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All EBC meetings at BHS Lecture Hall 3:30 to 5:30

EBC Nov 17EBC Dec 8SBC Jan 7EBC Jan 14SBC Jan 21EBC Jan 28EBC Feb 9? or 16?EBC Feb 25

All dates subject to changeTBD Additional EBC & SBC meetings in March and April

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Attendance is critical.You are the

representative for your site/department

SBC ECCSep 10 Sep 3Oct 15 Oct 8Oct 27 Oct 29Nov 9

EBC Topics for Today

EBC Mission, Structure, and Role w/other Employee Committees

Review of Health Plan Policies and Historical Data

Self-Insurance Fund (SIF) – Revenues and Expenditures

Major Tasks and Voting for 2015/16:Modify and implement cost sharing strategy for 2016/17Study and potentially implement employee health clinic Summer ‘16Review and potentially change Pharmaceutical Benefit Manager

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District Employee Committees & Responsibilities

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Employee CompensationAdvisory/Recommendations regarding Total Compensation(36 members)

StandingBenefits Study group and recommendations(18 members)

Employee BenefitsFinal decisionsregarding Benefit Plan(113 members)

3,282 Health Benefitted1,800 Non-Health Benefitted

Mission of the Employee Benefits Committee Mission

Employees and retirees working to provideall of our employees and retirees with:

The Best Possible Benefits

The Best Possible Service

The Lowest Possible Cost

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Authority of the EBC

For over 20 years, the Governing Board has granted the EBC the authority to make “final” decisions impacting the health of our employees and the fiscal solvency of our District.

The EBC reports its decisions to the Board, however the Board does not take action regarding the plan, nor do they choose the providers.

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What is the role of each EBC member?

Members understand that his/her role on the EBC is not to represent herself/himself. Instead:Members are on the committee to

represent the employees in his/her department/school/staff.

BEYOND THAT, each member considers globally, what is best decision for the majority of CUSD employees.

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Norms and Expectations

• Closed Meetings – Only EBC members, support staff, and invited presenters may attend

• Confidentiality – Allows open and honest interaction Respect for the opinions and

viewpoints of every member

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Norms and Expectations

Attendance at all meetings is expected Share information and gather input and

questions from co-workers All factual information and decisions

may be shared with co-workers or retirees

All handouts will be available to the public on the CUSD website

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Self-Insurance Plan and Self-Insurance Fund (SIF)• Clovis operates its own Health Insurance

program under the leadership of the EBC/SBC

• All Medical, Prescription, Dental, and Vision expenses are paid for by the Self-Insurance Fund

• Insurance companies are NOT involved, other than our stop-loss insurance

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CUSD Website – All Documents Posted

CUSD.comEmployees

BenefitsHealth Plan

See Links for: Employee Benefits CommitteeSummary of Benefits & CoverageBoard Policy #6503History of Health Plan

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History of the Clovis Health Plan (see handout)

History of CUSD Health Plan Changes (from page one)9/01/1989 - 8/30/1992 – Change from Blue Cross SIF to Independent SIF

Changes Include:o Agreements with Saint Agnes Medical Center & Community Medical Centers with employees required to make a choice of providers each yearo Exclusive Agreement with Priority Health provider networko Interplan provider network utilized for services in CA outside of Fresno area Californiao Plan benefits paid at 100% for in network services; 70% for out of network serviceso 100% of Usual and Customary paid for emergency services and services rendered outside CAo Plan previously processed by Blue Cross; now processed by Associated Third Party Administrator

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Summary of Benefits and CoverageACA Requirement for All Health Plans (see handout)

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Flu Shot Clinics – Staffed by Pharmacists

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Expanded number of clinics and locations

Clovis North 271 Clovis High 355 Clovis East 203 Buchanan 371 Clovis West 397 Alta Sierra 201 District Office/Online 1,099 Total of 2,897

31 ?Ask your EBC rep today

EBC meetings: 2/16/12; 11/1/12; 2/21/13; 10/14/14; 12/9/14; 11/17/15

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After the birth of your new daughter or son, how many days do you have to enroll her/him in CUSD’s health plan in order for him/her to receive benefits?

31 daysEBC meeting: 2/16/12; 11/1/12; 2/21/13; 10/14/14; 12/9/14; 11/17/16

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Rx Formulary Changes – Individuals Impacted Notified by Letters from Clovis & Caremark (see handout)

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Savings reflect brand to generic shiftingo Every effort is made by CVS/caremark and its advisors to maintain the highest level of accuracy in its projections; however, because of the variability of numerous factors, which are not under the control of CVS/caremark, we cannot guarantee the estimated results.o Savings are based on current enrollment and utilization, thus any changes in these will impact the estimated savings.Nearly 50% of savings are in one drug group

ZUBSOLV OPIOID PARTIAL AGONISTS 1 1 12.50% 6.25%

VIAGRA IMPOTENCE AGENTS 89 148 47.09% 43.66%

QSYMIA ANOREXIANTS NON-AMPHETAMINE 14 25 23.33% 23.81%

NORITATE ROSACEA AGENTS 2 2 3.51% 2.70%

INVOKANA SODIUM-GLUCOSE CO-TRANSPORTER 2 (SGLT2) INHIBITORS 26 34 96.30% 94.44%

INVOKAMET SODIUM-GLUCOSE CO-TRANSPORTER 2 (SGLT2) INHIBITORS 2 4 3.70% 5.48%

INTUNIV ATTENTION-DEFICIT/HYPERACTIVITY DISORDER (ADHD) AGENTS 2 3 12.50% 12.50%

FOSRENOL PHOSPHATE BINDER AGENTS 1 1 14.29% 9.09%

FORTESTA ANDROGENS 3 4 4.55% 3.42%

FLUOROURACIL ANTINEOPLASTIC OR PREMALIGNANT LESION AGENTS - TOPICAL 0 0 0.00% 0.00%

EXFORGE HCT ANTIHYPERTENSIVE COMBINATIONS 1 1 0.22% 0.16%

EXFORGE ANTIHYPERTENSIVE COMBINATIONS 1 2 0.22% 0.32%

DIOVAN ANGIOTENSIN II RECEPTOR ANTAGONISTS 1 1 0.24% 0.18%

CYMBALTA SEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITORS (SNRIS) 2 2 1.09% 0.68%

CLOBEX CORTICOSTEROIDS - TOPICAL 5 5 1.56% 1.17%

CARDIZEM CALCIUM CHANNEL BLOCKERS 1 2 0.30% 0.44%

CARAC ANTINEOPLASTIC OR PREMALIGNANT LESION AGENTS - TOPICAL 2 2 6.90% 6.06%

BYDUREON INCRETIN MIMETIC AGENTS (GLP-1 RECEPTOR AGONISTS) 9 11 20.93% 21.15%

AMITIZA GASTROINTESTINAL CHLORIDE CHANNEL ACTIVATORS 9 13 100.00% 100.00%

ABILIFY QUINOLINONE DERIVATIVES 13 15 43.33% 34.88%

Drug Name Drug Group Affected Members

Affected Scripts

Percent Affected Members in therapeutic class

Percent Scripts in therapeutic class

$58,798.01 $55,617.31 $3,180.70 0.33% 0.34% 0.20%

Annual Gross Savings Annual Net Savings Annual Member Savings

Annual Gross Savings as % Gross Cost

Annual Net Savings as %

Annual Member

Employee Primary Health Care

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Exploring Options for Employee Primary Health Care

Handles non-emergency medical needs.

Not intended to replace your primary doctor.

Utilize a Third-Party Vendor to operate the clinic ( a TPA alleviates medical liability; ensures regulatory compliance)

Staffing is based upon volume of people expected to use the clinic and can range from nurse practitioners and physician assistants to a full blown health care staff.

Services can range from just immunizations and limited acute care to physicals, lab work, and behavioral health services.

Convenience; employees do not need to schedule an appointment weeks in advance.

Savings to district plan and employees through incentives20

Clovis Unified Employee Primary Health Care

Standing Benefits Committee work to date:• Interviewed three potential providers in May after reviewing

Request for Information (RFI) submitted by six providers• Invited all three to submit a formal Request for Proposal (RFP)• SBC sub-committee selected two for interviews on Nov. 19

• Interviews will be two hours in length• One or two will be chosen to continue the vetting process• Next steps include: Discussions with current clients and/or

visits to clinics; additional conversations with provider(s)• SBC will select one finalist to present to EBC in late January• EBC will consider implementing clinic and choosing a provider

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Self-Insurance Fund (SIF)

Revenue and Expenses

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Total Employee Compensation

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Total Employee Compensation

Dollars for Salary

Health Benefits

ECC

Retirement STRS / PERS

mandated increases for employer contribution over 7 yearsPERS 11% to 20%STRS 8% to 19%

2014: STRS + PERS = $18 million2021: STRS + PERS = $44 million (est.)

Total Increase in Annual Cost = $26 million

Originating Source of Funds for Employee Compensation

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District General Fund(Direct pay to SIF or Salary)

Employee

State or Federal Entitlements

State and Federal Income, Sales, Fuel, Property, Corporate Taxes

2013/14 Total Funding per Student

California’s 30 Largest

Unified Districts

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San Francisco Unified (San Fr 57,620 $12,242Oakland Unified (Alameda) 47,194 $11,767Los Angeles Unified (Los Ange 653,826 $11,110San Bernardino City Unified (S 53,785 $10,204Stockton Unified (San Joaquin 39,486 $10,198Sacramento City Unified (Sacr 47,031 $10,183Twin Rivers Unified (Sacrame 31,122 $10,174San Diego Unified (San Diego 130,303 $10,086West Contra Costa Unified (Co 30,720 $9,954Fresno Unified (Fresno) 73,353 $9,771Mt. Diablo Unified (Contra Cos 31,955 $9,506San Jose Unified (Santa Clara 33,152 $9,500Santa Ana Unified (Orange) 57,499 $9,259San Juan Unified (Sacramento 49,035 $8,903Long Beach Unified (Los Ange 81,155 $8,875Garden Grove Unified (Orange 46,936 $8,830Lodi Unified (San Joaquin) 30,256 $8,762Fontana Unified (San Bernard 39,982 $8,677Moreno Valley Unified (Riversi 34,468 $8,666Riverside Unified (Riverside) 42,587 $8,494Elk Grove Unified (Sacramento 62,499 $8,384San Ramon Valley Unified (Co 31,398 $8,314Irvine Unified (Orange) 30,123 $8,280Fremont Unified (Alameda) 33,887 $8,266Clovis Unified (Fresno) 40,783 $8,204Poway Unified (San Diego) 35,498 $8,028Chino Valley Unified (San Bern 30,206 $7,980Capistrano Unified (Orange) 53,833 $7,941Corona-Norco Unified (Riversi 53,782 $7,867Temecula Valley Unified (Rive 30,065 $7,825

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2013/14 Self Insurance FundManaged by the Employee Benefits Committee

Retiree Paid

Premiums

District Paid for Retirees

Cobra

SIF Pays Expenses

$1.1m $43.3m $3.2m $5.2m

$2.1m

$145k $140k

$53m

$55.1m

Revenue Distribution:88.3% District11.6% Employee/Retiree

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2014/15 Self Insurance FundManaged by the Employee Benefits Committee

Retiree Paid

Premiums

District Paid for Retirees

Cobra

SIF Pays Expenses

$1.2m $45.8m $3.6m $6.9m

$2.7m

$120k $100k

$57.8m

Total $60.5m

Revenue Distribution:87.6% District12.4% Employee/Retiree

Originating Source of Funds for Health Benefit Revenues

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District General Fund(Direct pay to SIF or Salary)

STRS/PERS Pension Plan

EmployeeState or Federal Entitlements

State and Federal Income, Sales, Fuel, Property, Corporate Taxes

Increasing Costs for Health Benefits1971/72$8,013 Teacher BA+30

$250 Health Benefits 3% of Total Compensation

1990/91$24,828 Teacher BA+30

$4,000 Health Benefits 14% of Total Compensation

2015/16$43,305 Teacher BA + 30

$13,310 Health Benefits24% of Total Compensation29

Total Health Plan Expenditures

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History of Total Health Plan

Expenditures

All Claims

Expenses

All Administrative Expenses

Total Health Plan Expenses

Total Expenses % Increase

from Prior Year

# of Members as of June 30

Total Expenses

per Member Per Year

2008/09 $35,678,232 $2,882,667 $38,560,900 10,003 $3,855

2009/10 $37,977,666 $2,819,883 $40,797,549 5.8% 10,269 $3,973

2010/11 $41,589,731 $2,953,346 $44,543,077 9.2% 10,919 $4,079

2011/12 $43,569,278 $3,996,066 $47,565,344 6.8% 11,135 $4,272

2012/13 $43,311,780 $3,574,354 $46,886,134 -1.4% 11,316 $4,143

2013/14 $48,916,857 $3,922,063 $52,838,920 12.7% 11,240 $4,701

2014/15 $53,028,869 $4,816,517 $57,845,385 9.5% 11,707 $4,941

7.0% 2.7% 4.2%Historical Annual Trend over 6 years

History of Total Health Plan

Expenditures

All Claims

Expenses

All Administrative Expenses

Total Health Plan Expenses

T

2008/09 $35,678,232 $2,882,667 $38,560,900

2009/10 $37,977,666 $2,819,883 $40,797,549

2010/11 $41,589,731 $2,953,346 $44,543,077

2011/12 $43,569,278 $3,996,066 $47,565,344

2012/13 $43,311,780 $3,574,354 $46,886,134

2013/14 $48,916,857 $3,922,063 $52,838,920

2014/15 $53,028,869 $4,816,517 $57,845,385

Historical Annual Trend over 6 years

History of Total Health Plan

Expenditures

All Claims

Expenses

All Administrative Expenses

2008/09 $35,678,232 $2,882,667

2009/10 $37,977,666 $2,819,883

2010/11 $41,589,731 $2,953,346

2011/12 $43,569,278 $3,996,066

2012/13 $43,311,780 $3,574,354

2013/14 $48,916,857 $3,922,063

2014/15 $53,028,869 $4,816,517

Historical Ann over 6 y

Historical Number of Members Covered by CUSD Health Plan

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# As of November 1 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015Active Employees 1,836 1,974 2,134 2,300 2,498 2,655 2,737 2,845 2,961 2,969 3,059 3,187 3,284

Dependents 4,068 4,429 4,842 5,246 5,755 6,172 6,376 6,638 6,864 6,879 6,745 6,946 6,933Total 5,904 6,403 6,976 7,546 8,253 8,827 9,113 9,483 9,825 9,848 9,804 10,133 10,127

Dependents as % of Total 68.9% 69.2% 69.4% 69.5% 69.7% 69.9% 70.0% 70.0% 69.9% 69.9% 68.8% 68.5% 68.5%

Retirees 387 424 446 470 509 623 650 779 798 848 908 948 1,015Dependents 216 239 250 264 291 377 398 497 483 525 567 599 649

Total 603 663 696 734 800 1,000 1,048 1,276 1,281 1,373 1,475 1,547 1,664Dependents as % of Total 35.8% 36.0% 35.9% 36.0% 36.4% 37.7% 38.0% 38.9% 37.7% 38.2% 38.4% 38.7% 39.0%

Combined 2,223 2,398 2,580 2,770 3,007 3,278 3,387 3,624 3,759 3,817 3,967 4,135 4,299Dependents 4,284 4,668 5,092 5,510 6,046 6,549 6,774 7,135 7,347 7,404 7,312 7,545 7,582

Total 6,507 7,066 7,672 8,280 9,053 9,827 10,161 10,759 11,106 11,221 11,279 11,680 11,881Dependents as % of Total 65.8% 66.1% 66.4% 66.5% 66.8% 66.6% 66.7% 66.3% 66.2% 66.0% 64.8% 64.6% 63.8%

Retirees as % of Active Employees + Retirees

17.4% 17.7% 17.3% 17.0% 16.9% 19.0% 19.2% 21.5% 21.2% 22.2% 22.9% 22.9% 23.6%

Retiree Program

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Retiree Historical Medical & Rx Claims and Percentage of Total Health Plan Claims

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Retiree % of Total Claims 2014/15 2013/14 2012/13

% of Rx 32.8% 32.4% 33.0%% of Medical 13.9% 13.1% 14.8%

% of Total 19.8% 18.6% 20.1%

Retiree Only

2014-15 Actuals

2013-14 2012-13

RX 4,847,065$ 4,116,904 3,657,828

MEDICAL 4,563,504$ 4,103,179 4,025,972

TOTAL 9,410,570$ 8,220,083 7,683,799957 911 871

Historical Retiree Premiums

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Classification of Retiree

2001/02 2002/03 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09* 2009/10** 2010/11*** 2011/12 2012/13 2013/14 2014/15 2015/16

Retiree Only 0 on Medicare 99 121 106 110 201 219 119 132 174 175 263 272 256 240 267

Retiree Only 1 on Medicare 49 60 52 54 99 108 59 36 78 78 167 172 151 135 162

Retiree +1 0 on Medicare

198 243 213 220 401 439 239 265 349 350 526 545 513 480 533

Retiree +1 1 on Medicare

98 120 105 108 198 217 118 168 252 253 429 445 408 375 428

Retiree +1 2 on Medicare

72 156 157 333 345 303 270 323

Retiree +2 or more 0 on Medicare

296 364 319 329 602 658 358 397 523 524 789 817 769 720 800

Retiree +2 or more 1 on Medicare

146 180 158 163 298 326 177 300 427 428 692 717 664 615 695

Retiree +2 or more 2 on Medicare

204 330 332 596 617 559 510 590

Retiree +2 or more 3 on Medicare 108 234 235 500 517 454 405 485

History of Retiree 12 month Premiums as of June 30

Active Employee Program

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Average Cost of Medical Claims per Active Employee

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Average Cost of Rx Claims per Active Employee

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Changes over Four Years in Rx Expenditures

DemographicsAvg Eligible Members per Month 10,350 11,640 1,290 3%

Avg Monthly Utilizers as % of Members 30% 31%Avg Member Age 36.5 38 2

CostEmployee CoPays $1,608,882 $1,546,971 -$61,911 -0.01Total Net Cost $10,130,000 $15,244,000 $5,114,000 11%

Net Cost Per Member Per Year $980 $1,310 $330 8%Drug Mix

% Single Source Brand 32% 18%Generic Dispensing Rate 67% 81%

UtilizationTotal Prescriptions 77,965 93,095 15,130

Avg Prescriptions per Member 7.5 8.0 0.5 2%Speciality

Specialty Total Net Cost $1,435,000 $3,778,000 $2,343,000 27%Specialty Utilizers as % / # of Members 1.0% / 105 1.4% / 165 0.4% / 60

Speciallty Net Cost per Member $140 $330 $190Specialty as % of Total Net Cost 12% 25%

Specialty as % of Total Prescriptions 0.6% 0.7%

Annual Prescription Expenditures2011 to 2015

June 2011

June 2015

4 Year Change

Annual % Increase

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Top 25 Drugs by Total Net Cost

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Top 25 Specialty Class by Total Net Cost

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Historical Actual Costs and Average Cost Sharing per Active Employee (see handout)

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Historical Actual Costs and Average Cost Sharing per Active Employee

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$5.7m Solve for 2016/17

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$3m Employees

ECC Recommends Action Item for the Employee Benefits Committee at its October 29th Meeting

2016/17 –Employee Benefits Committee to develop a plan for generating an additional $3,000,000 in revenue through employee cost sharing.

Cost sharing can also be mitigated through the implementation of benefit plan modifications which would reduce expenditures.

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Current Employee Cost Sharing Plan

Medical Copayments $25 for Office Visits/Laboratory/Chiro/PT$100 for Emergency Room unless admittedCurrent Maximum Out-of-Pocket $1,250 per person

Prescription CopaymentsGeneric $9 / $18Preferred $24 / $48Brand or Non-Preferred $34 / $68

PremiumsRetiree Program Active Employee Program

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Share of all expenses for office visits, Rx, surgical procedures, mental health, ongoing treatments, emergency services, and other health related services is paid by all members.

Premiums

Premium Changes

2015/16Current

Premiums

$4.1m total

3281 Active Employees Annual

560 EE Only $550736 EE +1 $1,0501,985 EE + 2+ $1,540

Note: All values rounded

Premium Changes

2015/16Current

Premiums

$4.1m total

2016/17Premiums with$3.0m Increase

$7.1m total

3281 Active Employees Annual Annual

560 EE Only $550 $950736 EE +1 $1,050 $1,8001,985 EE + 2+ $1,540 $2,660

Note: All values rounded

Premium Changes

2015/16Current

Premiums

$4.1m total

2016/17Premiums with$3.0m Increase

$7.1m total

Annual Increase

3281 Active Employees Annual Annual

560 EE Only $550 $950 $400736 EE +1 $1,050 $1,800 $7501,985 EE + 2+ $1,540 $2,660 $1,120

Note: All values rounded

CopaymentsFixed amount paid by the employee for a covered service at the

time the service is received. Under the ACA, copayments are now included in the annual “Maximum Out Of Pocket” expense.

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Current CUSD CoPay

Office Visit, Labs, Other Medical Services

$25

Emergency Room $100

Rx 30 day $9 / $24 / $34100 day $18 / $48 / $68

CoPay Modification OptionsEmergency Room

Urgent CareOffice Visit

Rx

2014/15 Total CopaysActive & Retirees

$2.9 million

Example below ACA Silver Plan

Primary Care Visit Copay 45Specialty Care Visit Copay 65

Lab Testing Copay 45X-Ray Copay 65

Urgent Care Visit Copay 90Emergency Room Copay 250

Generic medication Copay 15

Brand medications Copay after drug deductible 50

Deductibles

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Employee pays the total cost of claims until reaching the deductible.

After paying copay or deductible, the remaining claim cost is shared between employer and employee on a % basis. Upon reaching the annual Maximum Out Of Pocket, the employer pays 100% of claims.

Co-Insurance

Next Steps continued

Over the next two months, the EBC and SBC will meet several times to discuss and eventually vote to implement a strategy for 2016/17 to resolve the revenue deficits of $3 million.

At least two meetings will include small group discussions to ensure all members have a chance to share ideas, feedback from colleagues, and ask questions.

Work with your supervisor to develop a strategy to share information and gather feedback from your colleagues as the EBC develops a cost sharing plan for 2016/17.

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EBC Action Items

Provide updates to your colleagues Work with your supervisor to determine a

plan for dispensing information to your site/department

Kelly Avants will provide talking points

Next EBC Meeting: Tuesday, December 8, BHS Lecture Hall

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