Transcript Slide 1

2014 Insurance and Wellness
Benefits Committee
Purpose of the Committee
 Review Current Insurance and Wellness Benefits
 Provide Recommendations on Insurance Benefits
 Assist with Development of new Benefits/Programs
 Assist with Selection of Insurance Broker
 Represent the Employee Associations
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 Role of Broker
 Negotiate Renewals
 Assist with Claim Resolution
 Conduct Open Enrollment Meetings
 Provide Employee Resources
 Broker Representatives for ECC
 Scott Schroepfer, Broker
 Nancy Brown, Account Manager
 Jodie Miller, Claims Representative
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Benefit Package
 Medical Insurance
 Health Savings Account
 Dental Insurance
 Vision Insurance
 Basic Life/Accidental Death & Dismemberment (AD&D)
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Insurance
Long Term Disability (LTD)
PSRS/PEERS Retirement
Paid Holidays
Vacation Leave
Personal Leave
Sick Leave
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Benefit Package - Continued
 Voluntary Life/Accidental Death & Dismemberment
(AD&D) Insurance
 Employee
 Spouse & Children
 Flexible Spending Accounts (FSA)
 Health Care
 Dependent Care
 Employee Assistance Program (EAP)
 Wellness Programs
 403b/457b Retirement Plans
 Tuition Reimbursement
 Tuition Waiver
 Employee
 Spouse & Children
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Glossary of Terms
 Premium
 The amount of money charged by an insurance company for
coverage.
 Employer determines how much of the premium employees
must pay for coverage.
 East Central College currently contributes 100% of premium.
 Employee’s Deductions are Pre-taxed which provides an additional
savings for the employee.
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Glossary of Terms
 Provider
 The clinic, hospital, doctor, dentist, laboratory, health
care practitioner or pharmacy that provides services.
Providers
In-Network
The facilities, providers and suppliers your
insurance carrier has contracted with to
provide health care services and discounts.
Out-of-Network
The facilities, providers and suppliers your
insurance carrier has not contracted with to
provide health care services.
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Glossary of Terms
 Deductible
 The amount you pay before your plan begins to pay.
$1000 Deductible Examples
Example 1
Example 2
Cost of Service
$250
$5000
YTD Deductible
$250
$1000
$0
$4000
Plan Pays
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Glossary of Terms
 Copayment or Copay
 A fixed amount you pay. The amount can vary by the type of
covered service. Copayments do not apply to the deductible.
Example
Cost of Office Visit
Copayment
Plan Pays
$200
$25
$175
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Glossary of Terms
 Coinsurance
 Your share of the cost after the deductible is met. The
covered health care service is calculated as a percent.
80/20% Coinsurance Example
Cost of Covered Service
$100
80% - Insurance pays
$80
20% - Member pays
$20
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Glossary Terms
 Out-of-Pocket Maximum (OOPM)
 OOPM protects you from very high medical
expenses. After you reach the annual OOPM, your
health insurance begins to pay 100% of covered
health care services or items for the Plan year.
 The OOPM includes deductibles, coinsurance and
copayments. It does not include your monthly
premium.
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Glossary Terms
 Health Savings Account (HSA)
 Cost Savings
 Funded with tax-exempt dollars
 Medical plan contribution reduction
 Used to help pay for health expenses including deductible, coinsurance
and certain services not covered by your health plans.
 Choices
 This is your account! You control and manage your health care expenses.
You decide when to use your HSA dollars.
 You may use the money in your account for family member’s health
expenses (even if they are not on your health plan).
 Long-Term Advantages
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Save for future medical expenses
Funds roll over year-to-year
Interest-bearing savings account
Account is portable, which means you take it with you
Retirement dollars are tax deferred
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Medical Loss Ratio
2012 (Jan – Dec)
 Coventry
Product
Premium
Claims
Medical
$1,349,438 $ 687,659
Rx
$0
Total
$1,349,438 $ 938,200
$ 250,541
MLR
Average
69.5%
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Medical Loss Ratio
2013 (Jan – Dec)
 Coventry
Product
Premium
Claims
Medical
$1,359,983 $1,014,504
Rx
$0
Total
$1,359,983 $1,305,224
$ 290,720
MLR
Average
96%
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Medical Loss Ratio
2014 (Jan – Jul)
 Anthem
Product
Premium
Claims
Medical
$760,383
$751,727
Rx
$0
$162,066
Total
$760,383
$913,793
MLR
Average
120%
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Renewal Factors
 Trend
 Prediction of how much health care cost will rise over the next
policy year
 The Market’s current health care inflation rate
 Group Experience – Medical, Pharmacy & Ancillary Claims
 Medical Loss Ratio (MLR)
 Claims compared to premiums
 Claims Analysis
 Carrier Discounts
 Network Usage
 Plan Design
 Wellness Program
 Funding
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Renewal Factors - Continued
 Health Care Reform Taxes and Fees
 Patient-Centered Outcomes Research Institute (PCORI) fee.
 Effective 2013 - $1 fee multiplied by the average number of
covered lives under the plan. Effective 2014 the fee
increases to $2 and then beginning 2015 the fee is indexed
for future years.
 Component represents approximately a 4% - 5% increase to
renewal each year.
 College Budget for Renewal
 2015 Budget has 4% increase for all insurance benefits
combined (medical, dental, vision and life)
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Renewal Timeline
 Currently Seeking Renewal numbers from Anthem
and other providers
 Upcoming Committee Meetings
 October 3 – Review Renewals/Recommend Suggestions
 October 10 – Review Plans with the Suggested Changes
 October 17 – Finalize Recommendations
 November 3 – Board Approval
 November 10 – Open Enrollment Begins
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