WASHINGTON COUNTY ADMINISTRATIVE SERVICES COMMITTEE. Courthouse - Government Center August 28, 2014

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1 WASHINGTON COUNTY ADMINISTRATIVE SERVICES COMMITTEE Courthouse - Government Center August 28, 2014 West Bend, WI 10:00 a.m. Present: Kristine Deiss, Jeffrey Geib, Marilyn Merten, Michael Miller, and Peter Sorce. Also Present: Human Resources Director Todd Scott, Human Resources Employee Relations Manager Sandy Weiland, County Administrator Joshua Schoemann, County Board Chairperson Herbert Tennies, County Clerk Brenda Jaszewski, County Attorney Kim Nass, Chief Deputy County Clerk Linda Doro, and Supervisor Dennis Myers. Chairperson Sorce called the meeting to order at 10:00 a.m. and read the Affidavit of Posting. MINUTES Moved by Ms. Deiss, seconded by Mr. Miller to approve the minutes of August 14, 2014, as presented. Motion carried. DEPUTY SHERIFF'S ASSOCIATION GRIEVANCE Appearance: Sheriff's Detective Jim Wolf, representing the Deputy Sheriff s Association Detective Wolf presented the Deputy Sheriff s Association grievance against Washington County's Attendance Policy and is requesting that the Deputy Sheriff s Association be excluded from the attendance policy until contract negotiations for the CLOSED SESSION Moved by Mr. Miller, seconded by Ms. Merten to convene into Closed Session at 10:08 a.m. pursuant to 19.85(1)(e) Wis. Stats., deliberating or negotiating the purchasing of public properties, the investing of public funds, or conducting other specified public business, whenever competitive or bargaining reasons require a closed session, specifically "to discuss the Deputy Sheriff's Association Grievance," and "to discuss status of the Facilities Management contract." Motion carried unanimously by roll call vote. OPEN SESSION Moved by Mr. Miller, seconded Mr. Geib by to return to Open Session at 11:54 a.m. Motion carried unanimously by roll call vote. ACTION ON ITEMS DISCUSSED IN CLOSED SESSION Moved by Ms. Merten, seconded by Mr. Miller to deny the Sheriff s Deputy Association grievance, due to implementation of the attendance policy being an exercise of management rights for Washington County. Motion carried. The meeting recessed at 11:55 a.m. and reconvened at 12:03 p.m.

2 Administrative Services Committee August 28, 2014 Page 2 of ORDINANCE: WASHINGTON COUNTY STAFFING PLAN - ADMINISTRATION DEPARTMENT - FACILITIES MANAGER POSITION Moved by Ms. Deiss, seconded by Mr. Geib to approve an ordinance amendment to 7.02 & 7.03 of the County Code relating to the Washington County Staffing Plan for the Administration Department - Maintenance, to add one full-time Facilities Manager position, at Pay Grade 13, and forward to the County Board. Motion carried HUMAN RESOURCES BUDGET Human Resources Director Todd Scott presented the 2015 Human Resources budget. The 2015 Human Resources base level budget is $773,788 and the requested level budget is $770,710. There are no user fee changes, outlay, or out-of-state travel requests for Moved by Ms. Deiss, seconded by Mr. Miller to approve the 2015 Human Resources budget with a net levy, in the amount of $770,710, and forward to Administration. Motion carried with Ms. Merten voting no. BACKGROUND CHECK POLICY Moved by Mr. Miller, seconded by Ms. Merten to implement a Background Check policy, as presented. Motion carried. STUDENT INTERNSHIP POLICY Mr. Schoemann requested that this agenda item be postponed to a future meeting. HUMAN RESOURCES DIRECTOR'S UPDATE Employee Relations Activities Mr. Scott presented an update on the new hires, open positions within the County, and the ongoing training being provided by the Human Resources Department. Mr. Scott reported that Geralyn M. Kaehny, who has 14 years of service, is retiring from her position of Corrections Officer at the Sheriff's Department. REPORT ON POSSIBLE SPECIAL ELECTION - STATE SENATE DISTRICT 20 Ms Jaszewski reported there may be special elections that are not funded in the 2015 County Clerk budget for the 20 th Senate District, if Senator Glenn Grothman is elected to the 6 th Congressional District FACILITIES MANAGEMENT BUDGET Facilities Manager Dave Loomans presented the 2015 Facilities Management budget. The 2015 Facilities Management base level budget is $2,445,549, and the requested level budget is $2,711,109. There are no user fee changes or out-of-state travel for Proposed Staffing Changes Increase two (2) custodial staff from three-quarter time to full time $22,415

3 Administrative Services Committee August 28, 2014 Page 3 of Outlay UPS Batteries Replacement at Public Agency Center & Sheriff s Department $30,000 Emergency Evacuation Chair for the stairwell in the Government Ctr. $2,800 Water Softener Replacement - Jail $8,000 Nobels Speedgleam 5 Self Propelled Burnisher - Courthouse $6,700 Carriage House Roof Replacement - Old Courthouse $8,000 Grounds Signage Additions and Modifications - Old Courthouse $9,000 Fence Installation - AC Units - Ziegler Expo Center - Fair Park $10,000 Decision Items 1. Water Softener Replacement - Jail $8, Nobels Speedgleam 5 Self Propelled Burnisher - Courthouse $6, Carriage House Roof Replacement - Old Courthouse $8, Grounds Signage Additions and Modifications $9, Fence Installation - AC Units - Ziegler Expo Center $10,000 Total $41,700 Moved by Ms. Merten, seconded by Ms. Deiss to approve the 2015 Facilities Management budget with a net levy in the amount of $2,711,109, including outlay, and forward to the Finance Committee. Motion carried. NEXT TENTATIVE MEETING DATE The Administrative Services Committee is tentatively scheduled to meet on Thursday, September 18, 2014, at 9:00 a.m. ADJOURNMENT Moved by Mr. Geib, seconded by Mr. Miller to adjourn the meeting at 12:58 p.m. Motion carried. Brenda J. Jaszewski, County Clerk

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14 COMMITTEE REPORT To: Administrative Services Committee From: Todd Scott, Human Resources Director Date: September 18, 2014 Re: Medical/Prescription RFP POLICY QUESTION: Should Washington County make a change to the current provider of the County s Medical and Prescription plans? DISCUSSION: Washington County has been in the process of RFP s for both the medical and prescription plans. This has included both paper and onsite visits from providers. As this process concludes, we are receiving final proposals with modified plan options and rates. Due to the fact that this process is not yet complete and will be finalized in the next few days, we will need to provide to you our specific findings and recommendations prior to the meeting and will look for your support. FISCAL EFFECT: To be included with forthcoming information. ATTACHMENTS: To be delivered to your home prior to the 9/18/2014 Administrative Services Meeting. RECOMMENDATION: Motion to approve the appropriate provider of the County's Medical and Prescription plans based on the details in the attachments.

15 COMMITTEE REPORT To: Administrative Services Committee From: Todd Scott, Human Resources Director Date: September 18, 2014 Re: Short Term Disability RFP POLICY QUESTION: Which vendor should Washington County choose to be providing the Short Term Disability benefits for eligible county employees? DISCUSSION: Upon the implementation of the PTO (paid time off) plan it was decided that the County should provide a Short Term Disability plan for its eligible staff. As a result, Washington County has been in the process of RFP s for Short Term Disability coverage. This has included both paper and onsite visits from providers. As this process concludes, we are receiving final proposals with modified plan options and rates. Due to the fact that this process is not yet complete and will be finalized in the next few days, we will need to provide to you our specific findings and recommendations prior to the meeting and will look for your support. FISCAL EFFECT: To be included with forthcoming information. ATTACHMENTS: To be delivered to your home prior to the 9/18/2014 Administrative Services Meeting. RECOMMENDATION: Motion to approve the appropriate provider of the County's Short Term Disability Benefits Plan based on the details in the attachments.

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18 Executive Summary and Recommendation Prepared for: Washington County September 12, 2014 Presented by: Rae Anne Beaudry / Executive Vice President HBS Division Raeanne.beaudry@thehortongroup.com Phone:

19 Request for Proposal Washington County engaged The Horton Group to release a Request for Proposal (RFP) to the marketplace on behalf of the County in order to review all available vendor options. The request for proposal (RFP) released was for the medical administration, prescription drug administration and stop loss. We have provided an overview for each type of coverage quoted. Medical Marketing Overview The following carriers were sent an invitation to quote, or responded to a public advertisement with respect to Medical Administrative services. The carriers that issued a quotation are highlighted below. Those that did not respond to the invitation to quote or who did not issue a quotation are also summarized below. Note the results: Carrier Aetna Allied Anthem Aurora Health Care Auxiant CIGNA Cypress Benefit Administrators Humana Meritain Prairie States Professional Benefit Administrators Security Health Plan WCA Group Health Trust/UMR WEA Trust WPS Status Declined to quote Received an invitation, but did not ask to be sent the Request for Proposal Provided a quotation for medical administration and pharmacy benefit administration Received an invitation, but did not ask to be sent the Request for Proposal Incumbent Provided a quotation for medical administration Received an invitation, but did not ask to be sent the Request for Proposal Received an invitation, but did not ask to be sent the Request for Proposal Provided a quotation for medical administration and pharmacy benefit administration Received an invitation, but did not ask to be sent the Request for Proposal Declined to quote Received an invitation, but did not ask to be sent the Request for Proposal Did not provide a quotation Provided a quotation for medical administration and pharmacy benefit administration Provided a fully insured quotation Provided a quotation for medical administration and pharmacy benefit administration The request for proposal asked for quotes to match the current underlying plan. Any plan discrepancies were to be identified in the proposal response. 2

20 In addition to the quotes and questionnaires provided, the criteria used for evaluating medical providers is outlined below. Ability to match existing plan design and eligibility requirements Competitive Pricing Network Providers/Available Discounts Performance Guarantees Completeness of proposal References Capacity Quality Provider Disruption Medical Administration Services The analysis was performed on the questionnaire responses, criteria outlined in the Request for Proposal documents as well as the cost information provided by each vendor that issued a proposal. Below are the Pros and Cons for each of the Respondents: Auxiant/HPS PROS: Competitive administration fees and strong partners for networks, Utilization and Disease Management programs. Can maintain existing provider relationships and there would be no member disruption. Excellent reporting capabilities available to clients and brokers. Standard monthly reports with the availability of ad hoc reporting at no additional cost. Interface feeds are currently available for most Pharmacy Benefit Manager s utilized in the Wisconsin marketplace. Great deal of flexibility with respect to selection of networks, stop loss carriers, etc. due to component purchasing. Low administrative fees. Claims office located in Madison, WI. The claims processor for the group has 20 plus years of claims processing experience. Will conduct meetings on a monthly basis to address member claim concerns. Can market the stop loss to a select group of stand alone stop loss vendors and will work with stop loss vendors that the client and/or broker selects. Interface fees for these services are 5% of stop loss fees. CONS: Auxiant does not offer a comprehensive wellness program that is integrated into the claims management system. Auxiant does not offer EAP services. While Auxiant has an interface with most PBM s, because this would be an outside vendor, it would not be real time benefit integration. 3

21 Anthem PROS: They are a well known national full service carrier that offers an extensive network of providers and their quote would include the Blue Card National Network at no additional cost. Very little manual intervention for claim payments once plan is built and good customer service. They have an extensive reporting package that is available to their clients and brokers. Their administrative expense is all inclusive; there are no additional costs for networks or management programs. Minimal disruption from a provider perspective. They allow stand alone pharmacy benefit managers and will cover such claims under stop loss. CONS: While Anthem offers an extensive provider network, there would be disruption over the existing provider network. Anthem fixed fees are significantly greater than existing fixed fees. Anthem would not allow the County to maintain its relationship with HPS/Trilogy. Not willing to administer oral surgery benefits as a part of the medical plan. Benefit changes will likely be required in order for claims to be electronically adjudicated. The claims office will be located in either Indiana or Ohio. The claims management team has not yet been assigned. No public sector references were provided. While they are part of a national association of Blue Plans, each plan is responsible for their own administrative rules. Cannot work with an outside Provider network. External stop loss carrier or Pharmacy Benefit Manager would likely require additional interface fees, which could be substantial. Customer service is handled out of state. Lengthy implementation and product build process. Will not provide references of terminated clients; will give references only if selected as a finalist. Anthem will not provide a Master Plan Document or a Summary Plan Description on behalf of the County. Humana PROS: The overall network discounts, without regard to fixed fees are comparable to the existing network. Humana has the ability to work with an outside stop loss carrier. Humana, although a national carrier, has their sales and customer service located in Wisconsin. Long time industry leader in providing healthcare services to individual client groups. Works with a number of Public sector groups. Comprehensive wellness program available for purchase. 4

22 CONS: They have an extremely lengthy implementation and plan build process. Fixed fees would be higher than with existing vendors. If contracted with an external stop loss carrier there may be additional interface fees. They have experienced some challenges in customer service recently due to downsizing and movement of positions within Humana. Benefit changes will likely be required in order for claims to be electronically adjudicated. Unwilling to work with outside managed care organizations or PPO networks. While Humana offers an extensive provider network, there would be disruption over the existing provider network. The claims office is located in Louisville, KY. May not be willing to hold rates quoted if an outside Pharmacy Benefit Manager is selected (Interface fees will also apply) Humana would not allow the County to maintain its relationship with HPS/Trilogy. Change in personnel from the Sales and Implementation Team to the Renewal Team can result in a loss of understanding of the plan administration. WCA PROS: The WCA/GHT has an Administrative Services relationship with UMR. The UMR link allows for the Trust to have a national presence. The WCA/GHT uses the United Health Care Choice Plus Network, which has discounts and providers that are widely utilized by the County members. WCA/GHT would allow the County to continue its current stop loss and Pharmacy Benefit Manager relationship without regard to additional interface fees. WCA/GHT has an additional level of oversight via the Aegis Corporation to maintain prompt customer service and grant medication exceptions and quick claims determination when payment is in question. WCA/GHT already has a relationship with the County via the Workers Compensation program. Costs as originally provided showed additional savings over the current Auxiant Discount arrangement. WCA did agree to accept the fiduciary liability for the County for an additional $1.00 per employee per month in fixed costs. Essentially what this means is that UMR would administer the plan as though they paid for it. Tighter administration would mean savings for the County. CONS: The WCA/GHT has fixed costs that are higher than those of the current incumbent vendors. The WCA/GHT had originally indicated an inability to administer the County s current plan design for Plan F, and if Plan G was changed they originally would not have been able to administer it. UMR has stated that they can now administer these plans, but to date there is no indication as to whether that administration would be standard throughout UMR or a manual or one-off process for Washington County. 5

23 The Trust would require their portion (as the Third Party Administrator) of the stop loss fees to be 5%. Currently the fees paid to the Third Party Administrator are limited to no more than $50,000 per calendar year. WCA/GHT was unable to provide references precisely as they were required by the County. References that were contacted did indicate issues with timeliness, particularly at renewal time as well as for certain customer service issues. Additionally, it does not always appear that UMR and Aegis agree with the plan provisions and how they should be administered. Wellness is not available unless the County agrees to pay for any wellness provisions (other than newsletters) in their entirety. UMR has no in-network relationship with UW Madison, which is a top 10 provider for the County. 6 WPS PROS: The WPS quote can match the County s current plan design and can administer all plans and programs without deviation. The WPS administration fees, although higher than the incumbent fees, were the lowest of the carriers providing Administrative Services Only proposals. WPS has a broad network and would have little provider disruption. WPS has been a past administrator for Washington County and to date has many municipal clients. They are a flexible and creative administrator. CONS: The WPS Network provided no additional savings to the County over the current HPS/Trilogy arrangement. WPS would require a change in Pharmacy Benefit Managers to Express Scripts. Express Scripts is particularly rigid in its benefit administration and adheres only to its own formulary. WPS has a new Specialty Pharmacy Vendor and they are not user friendly. WPS does not allow utilization of outside stop loss vendors and their own paper is not always the most cost effective. WEA Trust PROS: WEA provides an extensive network match. WEA is very familiar with public sector benefit plans and their administration. CONS: The WEA Proposal was only provided on a fully insured basis. WEA could not administer the County s programs specifically as requested. WEA did not provide references of other public entities the size and scope of Washington County. The WEA could not utilize any outside vendors, including pharmacy, stop loss or network. Disruption to employees would be an issue. Network pricing was not disclosed. This would not be unusual for a fully insured quote.

24 Medical Recommendation for Finalist Interviews The Horton Group scored each medical administrative services proposal based on the questionnaires and information provided. Based on the results of the scoring, Horton recommended that finalist interviews be conducted with the incumbent Auxiant, in combination with HPS and Serve You, Anthem, Humana and WCA Group Health Trust (UMR). The other vendors were not considered due to their overall score. WEA Trust did not offer a self funded proposal. When the fixed fees were added for run-out administration, and the run-out claims were added to the fully insured premiums, the costs were not competitive. The proposal issued by WPS reflected higher fixed costs and similar discounts to current, which was not competitive as compared to the current or other proposed plans. Prescription Drug Marketing Overview The following carriers were sent an invitation to quote, or responded to a public advertisement with respect to Pharmacy Benefit Management Administrative services. The carriers that issued a quotation as well as those that did not issue a quotation are outlined below: Carrier Aetna Anthem Express Scripts Humana/Right Source Navitus Prairie States RESTAT (Catamaran) Security Health Plan Serve You WCA Group Health Trust (UMR) Optum/Express Scripts Wisconsin Rx/Caremark WEA Trust WPS/Caremark Status Declined to quote Provided a quotation for medical administration and pharmacy benefit administration Did not provide a quotation Provided a quotation for medical administration and pharmacy benefit administration Did not provide a quotation Declined to quote Received an invitation, but did not ask to be sent the Request for Proposal Did not provide a quotation Incumbent Provided a quotation for pharmacy benefit administration Provided a quotation for medical administration and pharmacy benefit administration Provided a quotation for pharmacy benefit administration Provided a fully insured quote only Provided a quotation for medical administration and pharmacy benefit administration 7

25 The request for proposal asked for quotes to match the current underlying plan. Any plan or formulary discrepancies were to be identified in the proposal response. In addition to the quotes and questionnaires provided, the criteria used for evaluating medical providers is outlined below. Ability to match existing plan design and formulary Ability to work with selected Administrator Competitive Pricing Network/Available Discounts Cost Completeness of proposal References Capacity Quality Overall Disruption Pharmacy Benefit Management Administration Services Anthem (Express Scripts) Because Anthem was selected as a finalist for the medical claims administration, their Rx proposal was not considered separately. Refer to the further comments below with respect to Express Scripts and Walgreens. Humana Because Humana was selected as a finalist for the medical claims administration, their Rx proposal was not considered on a separate basis. 8 Serve You Serve You was founded in 1987 by independent pharmacists. These original founders serve as the Board of Directors. The estimated claim costs presented by Serve You are the lowest received. Their dispensing fee is a little higher, but they charge no additional administrative fees. They responded to all of the pricing questions in the RFP. PROS: They are an independent company not tied to any large pharmaceutical company. Their program can be customized based on client and member needs. Serve You offers a wide variety of Utilization Management (UM) Programs that can have significant savings for Washington County. They can administer the existing formulary, as they are the incumbent. Health plans and UM vendors have access to claim history on line. Rebates are guaranteed on a per claim basis. 24 hour access to a local pharmacist. They currently administer programs for other clients who utilize Auxiant as their Third Party Administrator (TPA).

26 Local mail order provider. Comprehensive reporting package is available on-line. Easy to use member website. Offer a $20 incentive to encourage mail order utilization (cost covered by Serve You) Mailings to members and overall member education are conducted at no additional cost to the County. They are flexible as to contract terms. CONS Their national network is slightly smaller with approximately 59,000 participating pharmacies. Wisconsin Rx/CVS Caremark CVS Caremark an independent PBM does business in Wisconsin through their partner, Wisconsin Rx. Wisconsin Rx is a not for profit cooperative with a Board of Directors comprised of their client groups. They are the primary administrator of prescription drug programs for individuals and clients such as the Wisconsin Education Association Trust (WEAC Trust). The net earnings are returned to member groups in the form of dividends. PROS: Their approach to prescription drugs is unique and the dividends returned to the members over the last four years have been substantial. Rebates are on a per claim basis equal to approximately 95% of the rebates and are not contingent on benefit design. Pharmacists are on call 24 hours per day, seven days a week. Wisconsin Rx offers a wide variety of Utilization Management Programs that can generate savings for Washington County. They are able to integrate pharmacy, HRA, wellness programs with the County s health management vendors. WI Rx/Caremark can grandfather existing participants for a period of up to 6 months (although not reflected in the pricing). They have an extensive reporting package available through the web. They currently administer programs for other clients who utilize Auxiant as their TPA. CONS: They are not the incumbent therefore there may be transition issues if they are chosen. There are implementation fees and ongoing fees per member per month that would be charged to the County. Their Account Management Team is located in Northbrook, Illinois. Customer Service is located in Texas. Mail order will be processed in Pennsylvania. The pricing provided assumed continuation of the existing formulary, rather than a match or grandfathering of existing participants. They retain a portion of the rebates (5%). 9

27 Horton recommended that the County conduct a finalist interview with Serve You as it is the incumbent vendor as well as a preferred vendor for UMR, another chosen Medical Administration vendor. Serve You works with a large number of Wisconsin public sector groups and offers competitive pricing. They have strong reporting and web capabilities for the County as well as its members. There is a strong focus on member communications. Serve You has the ability to match the existing formulary as well as the ability to manage a phase in of new programs as the County desires. Stop Loss Marketing Overview Due to timing of the initial Request for Proposal process, the stop loss proposals were not yet final. In addition, depending on the carrier selected, the County may be limited in the stop loss carriers that can be selected. A final stop loss recommendation will be made once the carrier has been selected, and once the carrier proposals are firm. Final Report & Recommendation Interviews The Horton Group and Washington County reviewed the request for proposal responses and selected finalists. Finalist interviews were conducted on September 3 rd and 4 th. In attendance at the finalist interviews were The County, the Horton Group, and the carriers as below: 1. Auxiant/HPS/Serve You 2. Anthem 3. WCA/UMR 4. Humana The finalists were chosen for their ability to administer current benefit designs, the provider networks proposed, the savings associated with these networks and the overall responses to the RFP. Finalists were each given a 1½ hour time period. During this period each vendor was allowed to provide introductions and a brief overview, with the bulk of the time devoted to questions and answers. Each vendor was allowed to make closing remarks. We have highlighted some additional key points from the interviews below: Auxiant/HPS/Trilogy Ability to maintain existing provider network, at a greater savings than current, due to a new pricing contract with Froedtert and affiliates (which includes St. Joseph s in West Bend). The new pricing provides approximately an 8% differential to both the County and the plan participants on an immediate and ongoing basis, should the County announce its intent to renew. Implementation of new pricing can begin immediately. Existing interface with various Pharmacy Benefit Managers, including the incumbent Serve You. Existing interface with more than 11 stop loss carriers, including the incumbent QBE. 10

28 Auxiant/HPS/Trilogy has agreed to waive the network access fees for both their programs. This provides additional savings for the terms of this contract. Customer Service is provided via a dedicated team. Additionally, there is access to all levels of management in all offices and areas of need, including legal. There are no run-out costs to consider. Auxiant has agreed to a $50,000 cap on their compensation via the stop loss contract. Serve You Ability to match existing formulary, and provide additional savings due to new pricing. Serve You can be utilized by WCA/GHT, Anthem and the incumbent Auxiant and will provide their new pricing methodology to any Administrator the County would select. Serve You has offered programs that would reduce cost, without significant member disruption and these programs will be communicated well in advance of the change and can be phased in as the County desires. Anthem 90% of all Anthem ASO products are written on proprietary stop loss paper. They would want to integrate Pharmacy, Stop Loss and Disease Management under one entity for bundled claims savings and tracking. They will have their internal Corporation Counsel review the Summary Plan Document of the current carrier and recommend updates, but will not give the County a legally, compliant SPD or Master Plan Document. They have a telemedicine provider for easy and quick physician access that would also save the County money. They committed to an early lock on stop loss and they have provided that quote. The County would not be able to keep (or need to keep) the transplant rider in place as their stop loss quotes assume transplants to be in and only covered under their network. Dean isn t covered in Dane County, but they do have access to UW Madison hospital and physicians as in-network. Anthem provided a one year implementation credit of $50,000 that the County can use how it wishes. Without that being taken into consideration they would be among the highest with regard to administrative fees. Humana Humana has provided and committed to a firm stop loss proposal, at the current $75,000 level. However, they reserve the right to adjust if lasers are necessary upon final disclosure. They have agreed to the current commission to Horton, and do not take an additional fee themselves from the stop loss proposals. They revised their administrative fees downward. 11

29 They revised their quote to provide a better deal with the Broad Based Network (NPOS) allowing for minimal employee/plan participant disruption and removing the need to pay additional fees to the BHCG. Vitality administration is included in the stop loss fees, but rewards would still be paid by the County. We cannot and will not need the transplant rider. Similar to Anthem they require that transplants be included and paid through their specialty networks only. They require their own stop loss paper and Pharmacy Benefit Management; however they would allow current plan design (using Humana s formulary management) to remain in place for pharmacy benefits. They provided a claims cost performance guarantee. They provided an aggregate stop loss quote that is at 115% of expected (10% less than standard). WCA/GHT They have provided notice that the County can continue with both QBE and Serve You. Additionally, the County can continue to utilize their transplant rider. QBE has indicated that they will discount their quote based on the United HealthCare Network. At this time it is difficult to tell if this will be more than the new discount with the incumbent under the new deals with providers. WCA has indicated, after much follow up that they will be able to administer the County s current Plan F and Plan G with the changes that are currently being contemplated. However, this was not the stance taken in the RFP response, the interview or the follow up after the interview. This decision came in on Monday, September 8, after being told that this would impact their scores negatively. Plan F out of network plan design must be updated to meet the Choice Plus discount requirements. They do not have UW Madison Hospitals or Physicians in network and only have Dean in their Options Network (not the network currently proposed for the County). UMR/Aegis administrative fees are the highest among the finalists quoted. UMR agreed to waive the fees for an interface between the incumbent stop loss vendor and the current Pharmacy Benefit Manager. UMR indicated that Aegis needs the full 5% stop loss commission to take over the account. 12

30 Final Recommendation Third Party Administration Auxiant is the incumbent provider for administrative services, offers a great deal of flexibility and no provider or benefit disruption. The Auxiant fixed fees are reasonable. By selecting a Third Party Administrator, this gives the County the additional flexibility in the future of adjusting provider networks, benefit levels or pharmacy benefit managers, without a significant disruption to the overall plan. HPS also renegotiated with its providers and was able to negotiate a significant improvement in network contracting, without any provider disruption. They also eliminated the fixed fees for the Trilogy network. Further, this would avoid any duplication of administrative or run-out claims during the first quarter of If the County renews with Auxiant/HPS for a 3 year period, they are willing to implement the new PPO pricing schedule on 10/1/2014, which provides further savings to the County. Based on the overall scoring, the finalist interviews and the overall outcome of the RFP process, Horton is recommending that the County renew with Auxiant for a 3-year contract beginning January 1, Pharmacy Benefit Manager Serve You has a number of Wisconsin public sector groups and improved their pricing for 2015, without requiring significant changes to members. They have strong reporting and web capabilities and a very strong focus on member communications. They are able to continue the existing formulary, have local customer service, account management, and mail order operations. Horton is recommending renewal with Serve You with the new contract terms with a January 1, 2015 effective date. 13

31 Washington County Administrative Services Comparison Effective January 1, 2015 Draft Dated 9/8/2014 Enrollment Auxiant Single 175 Anthem UMR / WCA Group Health Trust* Humana NPOS-Open Access Family 351 Current Proposed Includes Vitality Access 527 fees in stop loss Medical Claims Fee $14.05 $14.35 $39.82 $41.37 $28.75 UR Fees $2.00 $2.00 Included $2.98 Included Network Access Fees $4.00 $0.00 Included Included Included Network HPS/Trilogy (527 lives) HPS/Trilogy (527 lives) Anthem POS Choice Plus NPOS (527 lives) Alternate Network Access Fee $4.70 N/A N/A N/A Network PHCS (0 lives) (PHCS) N/A N/A N/A HIPAA $0.25 $0.00 N/A Included N/A Interface Fees -Rx N/A N/A N/A N/A N/A Lifesynch (Humana Achieve) N/A N/A N/A N/A Included Nurseline $0.55 $0.55 Included $0.50 Included PBM Data exchange fee N/A N/A N/A $1.00 N/A Annual Admin Fee $1,000 year $1,000 year N/A N/A N/A Other N/A N/A N/A N/A N/A Total PEPM Fixed Fees $20.85 $16.90 $39.82 $45.85 $28.75 Implementation/Wellness Credit N/A N/A -$50,000 N/A N/A Monthly Costs (Less Credit) $10,990 $8,908 $16,818 $24,163 $15,151 Annual Admin Costs (Less Credit) $131,878 $106,898 $201,822 $289,955 $181,815 Additional Fees (Annual) Transplant Rider $104,868 $110,109 N/A $110,109 N/A Stop Loss agg $23,670 $23,670 $42,371 $23,670 $38,956 Stop Loss spec $1,198,404 $1,415,830 $1,283,709 $1,435,830 $1,416,260 PCORI $2,568 $2,568 $2,568 $2,568 $2,568 Reinsurance Fee $80,952 $80,952 $80,952 $80,952 $80,952 Annual Costs with Stop Loss & ACA $1,542,340 $1,740,027 $1,611,421 $1,943,085 $1,720,551 Projected Medical & Rx Claims less stop loss reimbursements $8,210,417 $7,470,423 $7,537,980 $7,568,492 $7,562,111 Run-Out Admin Fees N/A N/A $56,230 $56,230 $56,230 There would be no run-in adjustment needed for Auxiant. For each of the other proposed vendors, a run-in adjustment would be needed to reflect run-in claims paid by Auxiant during the 2015 calendar year. If a 3 month run-out is estimated at 20%, this figure would range from $1,507,596 to $1,513,698. This will be offset somewhat by the reduction in claims in the initial months of Adjustment for run-in claims N/A calendar year Gross Costs (including Admin + claims + run-out) $9,884,635 $9,317,349 $9,407,453 $9,857,762 $9,520,707 Estimated Yr 1 Savings over Current Proposal Evaluation Scores N/A -$567,286 -$477,182 -$26,873 -$363, Note: This comparison is intended as a general overview and summary of the quotations provided. Final figures will be based on the contracts provided by the vendors and stop loss carriers. If there is a conflict, the final contracts will govern. * UMR did not issue a specific stop loss quotation, so the figures provided for the projected medical and Rx are an estimate. Anthem and Humana provided a stop loss proposal so the expected medical and Rx claim costs were taken from the stop loss proposal.

32 Disability Summary and Recommendation Prepared for: Washington County September 12, 2014 Presented by: Rae Anne Beaudry / Executive Vice President HBS Division Raeanne.beaudry@thehortongroup.com Phone:

33 Request for Proposal Washington County engaged The Horton Group to release a Request for Proposal (RFP) to the marketplace on behalf of the County in order to review all available vendor options. The request for proposal released was for Long-Term Disability (LTD) and Short-Term Disability (STD). We have provided an overview for each type of coverage quoted. LTD/STD Marketing Overview The following carriers were sent an invitation to quote, or responded to a public advertisement with respect to Disability. The carriers that issued a quotation are highlighted below. Those that did not respond to the invitation to quote or who did not issue a quotation are also summarized below. Note the results as summarized below: Carrier Aetna Anthem Assurant Benefits Inc Cigna Colonial Life EPIC Life Guardian Life Hartford Lincoln Financial Group Metlife National Insurance Services Principal Financial Group Prudential Reliance Standard Standard Life Sunlife United HealthCare Unum WPS Status Provided Full LTD/STD Proposal Provided Full LTD/STD Proposal Received an invitation, but did not ask to be sent the Request for Proposal Requested RFP Did not send Proposal Requested RFP Did not send Proposal Declined to Quote Requested RFP Did not send Proposal Requested RFP Did not send Proposal Requested RFP Did not send Proposal Declined to Quote Declined to Quote Provided Full LTD/STD Proposal Declined to Quote Not Competitive Declined to Quote Not Competitive Requested RFP Did not send Proposal Received an invitation, but did not ask to be sent the Request for Proposal Requested RFP Did not send Proposal Received an invitation, but did not ask to be sent the Request for Proposal Declined to Quote Cannot offer Advise to Pay Received an invitation, but did not ask to be sent the Request for Proposal 2

34 Because there is not an in-force Short Term Disability plan, Horton worked with the County to develop a requested plan design and asked carriers to match, or provide enhancements to the requested plan design. We asked for fully insured options as well as advice-to pay for the short term disability plan. The County is in the process of eliminating its Extended Leave Bank (ELB) system, which prompted the need for a short term disability program. We also asked for Long Term Disability quotes based on the existing plan design, as well as some benefit enhancements and an Employer paid option. Any plan discrepancies over the requested plan design were to be identified in the proposal response. In addition to the quotes and questionnaires provided, the criteria used for evaluating disability providers is outlined below. 3 Ability to match existing plan design and eligibility requirements Competitive Pricing Quality of Service Team Questionnaire Response Completeness of proposal References Capacity Quality Value Added Services Minimum Participation Requirements LONG TERM DISABILITY The analysis was performed on the questionnaire responses, criteria outlined in the Request for Proposal documents as well as the cost information provided by each vendor that issued a proposal. Below are the Pros and Cons for each of the Respondents: Aetna PROS: A.M. Best Rating of A. Evidence of Insurability is not required when due to a salary increase. Quotation did not include a limitation for self-reported claims. Employee assistance program included. CONS: The buy-up premiums were more expensive than incumbent and the core premiums were comparable to the renewal provided by NIS. They offered a two year rate guarantee, as compared to a 3 year rate guarantee with the incumbent. Did not offer an option whereby the employee could buy-up based on an incremental benefit, rather than their full salary, as requested. The minimum level for buy-up participation was 40%. The other carriers indicated a minimum with respect to guarantee issue limitations, but did not have an overall minimum. Self-Bill is the only billing option offered. Claims administered from Portland, Oregon and the service office is in Chicago, IL. No references were provided for terminated public sector groups. There was no survivor benefit.

35 Anthem PROS: A.M. Best Rating of A. Benefit includes indexing. Quotation included minimum benefit of the greater of 10% or $100. Salary increases are not subject to evidence of insurability. CONS: More expensive than incumbent both to the employer and to the employees. Minimum participation of 50% in order to maintain guarantee issue. National Insurance Services PROS: A.M. Best Rating of A-. Incumbent less disruption. Provided a reduction in rates over current resulting in a savings of approximately 15%. Provided a 3 year rate guarantee. Minimum participation of 25% in order to maintain guarantee issue. Provided quotes for incremental buy-up options for participants with an annual enrollment. Initial salary increase above guarantee issue requires evidence of good health, but is not required for subsequent salary increases. Employee assistance program included. Service team locally in Brookfield, WI. Claims processed in Madison, WI. CONS: Initial proposal required total disability, and did not include zero day residual. Initial benefit quoted had minimum benefit of $50. Initial benefit quoted had no benefit for survivors. Initial benefit quoted did not include a work incentive benefit. SHORT TERM DISABILITY 4 Aetna PROS: A.M. Best Rating of A. There is no pre-existing condition limitation. Employee assistance program included. CONS: The premium rates quoted for STD were significantly higher than those quoted by the incumbent or Anthem. Provided only a 1 year rate guarantee. Self-Bill is the only billing option offered. Claims administered from Portland, Oregon and the service office is in Chicago, IL. No references were provided for terminated public sector groups.

36 Anthem PROS: A.M. Best Rating of A. Premium rates quoted included the same premium regardless of ELB balance for ease of administration. Overall STD premium cost is lower for Anthem. Benefit level is slightly higher at 67% versus 66 2/3%. Stronger definition of Disability with initial proposal. Provided a 2 year rate guarantee. No pre-existing condition limitation. Includes a partial disability benefit. The service office is in Waukesha, WI. CONS: The claims office location is in Atlanta, GA. The STD quotation did not include a FICA match. National Insurance Services PROS: A.M. Best Rating of A-. Incumbent provider for LTD benefits which should reduce implementation time. Employee assistance program included. Provided a 2 year rate guarantee. Service team locally in Brookfield, WI. Claims processed in Madison, WI. Initial proposal included a pre-existing condition limitation. Benefits quoted as proposed. CONS: Initial proposal required total disability, and did not include zero day residual or partial disability benefit. Premium is higher than proposed by Anthem. Recommendation for Finalist Interviews The Horton Group scored each carrier based on the questionnaires and information provided. Based on the results of the scoring, Horton recommended that finalist interviews be conducted with the incumbent National Insurance Services (Madison National) and Anthem. Aetna was not selected as a finalist due to their overall score. The proposal issued by Aetna reflected higher fixed costs and similar discounts to current, which was not competitive based on completeness of the proposal as well as overall costs. 5

37 Interviews The Horton Group and Washington County reviewed the request for proposal responses and selected finalists. Finalist interviews were conducted on August 5, In attendance at the finalist interviews were the County, the Horton Group, and the carriers as below: 1. National Insurance Services (Madison National) 2. Anthem The finalists were chosen for their ability to administer current benefit designs, pricing, quality of service team, questionnaire responses, completeness of proposal, references, capacity, quality, value added services and minimum participation requirements. Finalists were each given a 1½ hour time period. During this period each vendor was allowed to provide introductions and a brief overview with the bulk of the time devoted to questions and answers. Each vendor was allowed to make closing remarks. We have highlighted some additional key points from the interviews below: National Insurance Services All proposals for STD and LTD were revised to include zero day residual and a work incentive benefit for no additional cost. NIS provided additional employer paid options and benefit alternatives at 60% along with quotes that removed the 70% all source integration. They also quoted alternatives to enhance the own occupation definition for managers class 13 and above. The minimum monthly benefit for LTD was enhanced to the greater of 10% or $100. A 3 month lump sum survivor benefit was included in the LTD plan. The pre-existing condition limitation was removed from the STD benefit. Anthem Anthem included the removal of the 2-year special condition limitation at no additional cost. Anthem provided additional employer paid options and benefit alternatives at 60%, along with quotes that removed the 70% all source integration. They also quoted alternatives to enhance the own occupation definition for managers class 13 and above. 6

38 Final Report & Recommendation Long Term Disability (Core Benefit with Option for Employee to Buy-up) Although Anthem is a strong vendor and offered a quality benefit plan, their premiums were more costly to the County as well as to the employees. Further, since Anthem required 50% participation in order to maintain the guarantee issue limits, and offered increased costs to participants, it is likely that we would lose some of the current participation which could result in newly eligible participants being required to offer evidence of good health in order to qualify for the buy-up benefit. This could also result in declining participation over time, which would result in higher than average increases in future years in order to maintain the same level of benefits. National Insurance Services provided a reduction in rate over current, along with a number of benefit enhancements over the current plan and a 3 year rate guarantee. Further, the participation can drop as low as 25% and still maintain the guarantee issue on the buy-up amounts. The reduction in premium may result in increased participation over time, which could bring down the rates. The carriers quoted a number of different options. We have illustrated the options that we believe would be most relevant to the County. The medical benefits now consider full time to be 30 hours per week. For consistency, the County may wish to consider offering Long Term Disability coverage to the 11 employees who work 30 or more hours per week. The current requirement for the LTD plan is 40 hours per week. This would still result in a reduction in overall premium to the County, since National Insurance Services offered a reduced rate. Based on the quotes provided, we are recommending that the County purchase the NIS with Core and Buy up based on 30 hours per week (designated as Recommended Option on the LTD summary). This option results in an increase of $914 on an annual basis to the County with no cost increase to the employees. We believe this is the best option due to the lower overall premium as compared to Anthem, improvement in the definition of disability, increased minimum monthly benefit, the addition of a 3 month survivor benefit, and the addition of a work incentive benefit. The County receives the benefit of many of the enhancements offered by Anthem, but with a lower overall premium for the County and for employees. We have also included an option with an expanded definition of disability for the Management grade 13 or above. This option would expand the disability definition from a two year period based on the ability to perform the duties of the individual s own occupation to a period ending at Social Security Normal Retirement Age. This greatly expands the benefit to the Management team, with an annual cost increase of only $391 to the County and no increase to the employees. Although we did not list this as our recommended plan, we believe that strong consideration should be given to this option. 7

39 Long Term Disability (Employer Paid Plan) One of the challenges with an employee buy-up option for Disability benefits is that the employees that need a disability plan the most are often the ones that do not purchase the benefit. Although the County currently offers a core benefit, it translates to a maximum monthly benefit of only $833 on a monthly basis. While it is better than offering a fullycontributory LTD plan, it will not provide enough income for most individuals who become totally disabled. The County has only 56% participation in the current LTD program, which means that 44% of the eligible employees have not purchased LTD coverage. According to the Social Security Administration, a year old has about a 30 percent chance of becoming disabled by the time he retires. Often times the younger workers are the ones that are least able to afford disability insurance. The County currently pays approximately $20,000 per year to fund the core LTD program. The cost to increase to a 100% employer paid program with a 60% benefit would range from approximately $80,000 to $100,000 per year. While this is a significant increase over the amount currently being paid by the County, this would be a significant benefit to plan participants, and provide additional security to those that have not elected the buy-up and a cost reduction to those that are currently electing a benefit. Short Term Disability (Employer Paid Plan) Although National Insurance Services and Anthem quoted a fully funded employer paid STD plan, as well as an advice to pay plan for those with a significant balance of hours in their Extended Leave bank, at this time we would recommend a fully-insured STD program. National Insurance Services provided alternate rates, based on the balance in an employee s ELB account at a set time each year. As such, we believe that the County would be able to more easily budget for the program having an estimate of the cost of the program on an annual basis. Further, the premium differential is minimal. While an advice to pay program does not require a significant premium on the part of the County, it is very difficult to budget for on an annual basis due to fluctuations in claims activity. Horton is recommending a fully insured short term disability program with National Insurance Services as of January 1, NIS is the incumbent carrier for our disability programs and as such, it should be a simplified implementation process. NIS improved its benefits to reflect a zero day residual and removal of the pre-existing condition limitation. While the premium is slightly higher for Anthem, because the rates quoted from both carriers are based on the carrier writing both the LTD and STD coverages, the pitfalls associated with the participation requirements and overall rates for the LTD; we do not believe the potential STD savings is enough to overcome the challenges on the LTD. The plan we are recommending with NIS would add zero day residual and remove the pre-existing condition limitations as we feel the additional costs for these options is warranted to have a quality STD plan. 8

40 Washington County Long Term Disability January 1, 2015 Recommended Option NIS Current 40 hours per week NIS Renewal 40 Hours per week NIS Renewal Option 30 hours per Week NIS - Core / Buy Up Plan - HMR 30 NIS Core / Buy Up Plan - HMR 30 (expanded own occ) Anthem AM BEST Rating A- A- A- A- A- A LTD RATES Estimated Core Volume (Monthly) $637,213 $637,213 $650,957 $650,957 $650,957 $650,957 Rate (per $100) $0.27 $0.23 $0.23 $0.276 $0.281 $0.30 Estimated Monthly Premium (County) $1, $1, $1, $1, $1, $1, Estimated Annual Premium (County) $20,646 $17,587 $17,966 $21,560 $21,950 $23,434 Percentage Change N/A % % 4.43% 6.32% 13.51% Dollar Change N/A -$3,059 -$2,679 $914 $1,305 $2,789 Estimated Buy-Up Volume (monthly) $833,187 $833,187 $833,187 $833,187 $833,187 $833,187 Rate (per $100) $0.660 $0.435 $0.435 $0.600 $0.600 $0.750 Estimated Monthly Premium (Employees) $5, $3, $3, $4, $4, $6, Estimated Annual Premium (Employees) $65,988 $43,492 $43,492 $59,989 $59,989 $74,987 Percentage Change N/A % % -9.09% -9.09% 13.64% Dollar Change N/A -$22,496 -$22,496 -$5,999 -$5,999 $8,998 Rate Guarantee N/A 36 months 36 months 36 months 36 months 24 months Minimum Participation No minimum No minimum No minimum No minimum No minimum No minimum Billing Options Self or List Bill Self or List Bill Self or List Bill Self or List Bill Self or List Bill Self or List Bill Summary of LTD Benefits Benefit Percentage 66.67% 66.67% 66.67% 66.67% 66.67% 67.00% Guarantee Issue (But-Up) $0 if participation is less than 25%; $5,611 if participation is 25% or higher $0 if participation is less than 25%; $5,611 if participation is 25% or higher $0 if participation is less than 25%; $5,611 if participation is 25% or higher $0 if participation is less than 25%; $5,611 if participation is 25% or higher $0 if participation is less than 25%; $5,611 if participation is 25% or higher $5,000 if participation is less than 50% Annual Maximum Covered Salary Core $15,000 $15,000 $15,000 $15,000 $15,000 $15,000 Buy-Up $100,992 $100,992 $100,992 $100,992 $100,992 $102,000 Total $115,992 $115,992 $115,992 $115,992 $115,992 $117,000 Monthly Benefit Maximum Core $833 $833 $833 $833 $833 $838 Buy-Up $5,611 $5,611 $5,611 $5,611 $5,611 $5,695 Total $6,444 $6,444 $6,444 $6,444 $6,444 $6,533 Minimum Monthly Benefit $50 $50 $50 greater of 10% greater of 10% greater of 10% or or $100 or $100 $100 Elimination Period 90 days 90 days 90 days 90 days 90 days 90 days Own Occupation 24 months 24 months 24 months 24 months Management (grade 13 and above) own occupation to SSNRA; All 24 months others own occupation for 2 years Pre-Existing Condition 3/12 3/12 3/12 3/12 3/12 3/12 Survivor Benefit 3 month gross 3 month gross benefit benefit 3 month gross benefit Waiver of Premium Included Included Included Included Included Included Salary Increases Subject to Evidence Yes for initial increase above Guarantee issue; not for subsequent salary increases Yes for initial increase above Guarantee issue; not for subsequent salary increases Yes for initial increase above Guarantee issue; not for subsequent salary increases Yes for initial increase above Guarantee issue; not for subsequent salary increases Yes for initial increase above Guarantee issue; not for subsequent salary increases Salary increases are not subject to evidence of insurability Cost of Living Adjustment Not included Not included Not included Not included Not included Not included Indexing Not included Not included Not included Not included Not included Yes, Partial Disability and Gainful Occupation Social Security Integration Full Family Full Family Full Family Full Family Full Family Full Family

41 Washington County Summary of Employee Health Insurance Plan Changes for 1/1/15: 1. A 10% increase in premiums for both the County Departments and the Employees enrolled in the medical plans. 2. Plan Changes: a. Elimination of Plan F low deductible plan option; impacts 69 employees b. Plan G (HRA) Increase deductibles to $1,500/$4,000 in-network & $3,000/$8,000 out-ofnetwork from the current $1,350/$3,300 in-network & $2,800/$6,600 outof-network. This is to become compliant with the minimum levels set by the Affordable Care Act that will go into effect in the near future. Add coinsurance of 90%/10% in-network & 70%30% for out-of-network after the deductible is met. The current levels are 100% in-network & 80%/20% out-of-network. Increase the out-of-pocket maximum (OOPM) to $3,000/$6,000 in-network and $6,000/$14,000 out-of-network from the current $1,350/$3,300 innetwork & $4,800/$10,600 out-of-network. The OOPM is a combination of deductible and coinsurance. Make changes to the office visit copay the amount will remain at $25 for the visit only. The additional diagnostic/labs will not be applied towards the $300 level, nor will they be included in the copay itself; they will be applied towards the deductible. Add additional copays for both in-network and out-of-network. The deductible and coinsurance will still apply for the ER, Inpatient and Outpatient care received. o $50 for Specialty Office Visit o $250 for Emergency Room (ER) o $150 for Inpatient Visit o $25 for Urgent Care Visit o $50 for Outpatient Surgery Summary of Plan Changes for 2015 rev. 9/11/14 MJH Page 1

42 Prescription changes that include raising the copays for each level by $5 at Retail and $10 at Mail Order. o $10 for Generic at Retail (from $5) / $20 at Mail Order (from $10). o $25 for Preferred Brand at Retail (from $20) / $50 at Mail Order (from $40). o $40 for Non-Preferred Brand at Retail (from $35) / $80 at Mail Order (from $70). c. Plan H (HSA) Increase deductibles to $1,500/$4,000 in-network & $3,000/$8,000 out-ofnetwork from the current $1,350/$3,300 in-network & $2,800/$6,600 outof-network. This is to become compliant with the minimum levels set by the Affordable Care Act that will go into effect in the near future. Increase the out-of-pocket maximum (OOPM) to $1,500/$4,000 in-network and $5,000/$12,000 out-of-network from the current $1,350/$3,300 innetwork & $4,800/$10,600 out-of-network. The OOPM is a combination of deductible and coinsurance. Prescription changes that include raising the copays for each level by $5 at Retail and $10 at Mail Order. o $10 for Generic at Retail (from $5) / $20 at Mail Order (from $10). o $25 for Preferred Brand at Retail (from $20) / $50 at Mail Order (from $40). o $40 for Non-Preferred Brand at Retail (from $35) / $80 at Mail Order (from $70). Summary of Plan Changes for 2015 rev. 9/11/14 MJH Page 2

43 NIS Current 40 hours per week NIS Renewal 40 Hours per week NIS Renewal Option 30 hours per Week NIS - Core / Buy Up Plan - HMR 30 NIS Core / Buy Up Plan - HMR 30 (expanded own occ) Anthem Social Security Freeze Included Included Included Included Included Included Benefit Offset 70% all source 70% all source 70% all source 70% all source 70% all source 70% all source FICA Match Included Included Included Included Included Included if benefits are taxable Work Incentive Benefit Not included Included Included Included Included 100% for 12 months Accumulation of Elimination Period IF you return to work following a disability for more than ten days then go out due to a similar disability, the elimination period begins again. IF you return to work following a disability for more than ten days then go out due to a similar disability, the elimination period begins again. IF you return to work following a disability for more than ten days then go out due to a similar disability, the elimination period begins again. IF you return to work following a disability for more than ten days then go out due to a similar disability, the elimination period begins again. IF you return to work following a disability for more than ten days then go out due to a similar disability, the elimination period begins again. IF you return to work following a disability for more than 30 days then go out due to a similar disability, the elimination period begins again. Recurrent Disability 6 months 6 months 6 months 6 months 6 months 6 months Definition of Disability Must be totally disabled during the elimination period - unable to perform the majority of material duties of your own occupation for the 1st 24 months; thereafter any occupation for which you are qualified based on education and experience. Must be totally Must be totally disabled during the disabled during the elimination period - elimination period - unable to perform unable to perform the majority of the majority of material duties of material duties of your own your own occupation for the occupation for the 1st 24 months; 1st 24 months; thereafter any thereafter any occupation for occupation for which you are which you are qualified based on qualified based on education and education and experience. experience. May be totally or partially disabled and during the elimination period - unable to perform the material duties of your own occupation for the 1st 24 months; thereafter any occupation for which you are qualified based on education and experience. May be totally or partially disabled and during the elimination period - unable to perform the material duties of your own occupation for the 1st 24 months; thereafter any occupation for which you are qualified based on education and experience. May be totally or partially disabled and unable to perform the material duties of your own occupation for the 1st 24 months (20% earnings loss required); thereafter any occupation for which you are qualified based on education and experience. (40% earnings loss required) Zero Day Residual Not included Not included Not included Included Included Included Mental Illness/ Substance Abuse Limitation Special Condition Limitation Benefit Duration Combined LTD/STD Proposal Evaluation Scores 24 months unless hospitalized 24 months unless hospitalized 24 months unless hospitalized 24 months unless hospitalized 24 months unless hospitalized 24 months unless hospitalized No separate limit No separate limit No separate limit No separate limit No separate limit No separate limit ADEA 1 61 or under To 65 Age months Age months Age months Age months Age months Age months Age months Age months ADEA 1 61 or under To 65 Age months Age months Age months Age months Age months Age months Age months Age months ADEA 1 61 or under To 65 Age months Age months Age months Age months Age months Age months Age months Age months 84 ADEA 1 61 or under To 65 Age months Age months Age months Age months Age months Age months Age months Age months ADEA 1/SSNRA 61 or under To 65 Age months Age months Age months Age months Age months Age months Age months Age months RBD/SSNRA <60 To SSNRA Age mo/ssnra Age mo/ssnra Age mo/ssnra Age mo/ssnra Age mo/ssnra Age months Age months Age months Age months Age months 83 This proposal is based off the information provided by you and is intended to be illustrative of the proposal provided by the carrier. Final rates are determined by the carrier after the carrier completes the underwriting and final enrollment process. Rates quoted are not guaranteed and may change subject to updated claim information, changes to the census &/or enrollment elections. If there is a discrepancy between the rates provided in this proposal and the rates provided by the carrier, the carrier s final rates will govern. Additional coverage may be available. All efforts have been made to ensure the information in this proposal is accurate; however no warranty of complete accuracy is guaranteed.

44 COMMITTEE REPORT To: Administrative Services Committee From: Sandy Weiland Date: September 18, 2014 Re: Funeral Leave Policy POLICY QUESTION: Should Washington County change the funeral leave policy? DISCUSSION: Under the current Washington County policy, employees are entitled to funeral leave with pay consisting of not more than three (3) consecutive work days, including the day of the funeral, and work days immediately prior or subsequent to the day of the funeral, for any of the following relatives: spouse, child, step-child, parent, step-parent, grandparent, grandchild, brother, sister, mother-in-law or father-in-law of the employee. This policy has been very challenging to administer over the past several years because many times an employee needs the time off to make funeral arrangements, but the service may not be held within consecutive days. Often times it may be later in the week, month or even year so that relatives can attend. This causes additional stress and frustration on the employee during the time of loss. Human Resources is recommending a change to the policy to remove "consecutive" days so that an employee may take three days for funeral leave to plan arrangements or to attend services and that those days must be used within six months of the funeral COST: None ATTACHMENTS: Current funeral leave policy and proposed policy RECOMMENDATION: Motion to authorize Human Resources to work with the County Attorney to change the Funeral Leave Ordinance to allow more flexibility for employees to make arrangements or attend funeral services.

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