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
EBAC Meeting – October 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
EBAC Meeting – October 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
EBAC Meeting – October 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
EBAC Meeting – October 2015
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
EBAC Meeting – October 2015
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
EBAC Meeting – October 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
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
EBAC Meeting – October 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
EBAC Meeting – October 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
27
Maximizing your health care investment starts here …
27
Heidi Duncan
Senior Consultant, Large Group Sales
(916-935-0100) work
(916-765-3848) cell
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
EBAC Meeting – October 2015
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
EBAC Meeting – October 2015
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 + Child(ren) $191.94 $204.03 $176.58 $192.68 $214.94 $214.94
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 + Child(ren) $135.00 $148.00 $157.95 $157.95 $191.43 $191.43
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%
EBAC Meeting – October 2015
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%
percent change from prior year 1.5%
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%
EBAC Meeting – October 2015
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
percent change from prior year 6.5%
College Share % of Total Cost 76.6% 77.7% 76.8% 76.9% 77.9%
percent change from prior year 1.5%
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
EBAC Meeting – October 2015
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