Pre-Open Enrollment Benefit Information Sessions. October 2015

Transcription

1 Pre-Open Enrollment Benefit Information Sessions October 2015

2 Meeting Purpose Provide education to our employees about their benefits Gain feedback about a possible shift in our healthcare insurance provider Introduce new benefits for

3 Meeting Outcome Provide enough information so our employees feel well-equipped to make decisions about what benefits are right for them Create a baseline of information about the Affordable Care Act and impact on employers and employees 3

4 Today s Agenda Understanding healthcare expenses, the marketplace, and the move to consumer-driven healthcare Explanation of the healthcare request for proposal process to the Benefits Advisory Committee Pros and Cons of health insurance provider Recommendations from our broker and HR Plan design information New 2016 benefit options 4

5 Why we decided to look at the total benefits package We have a responsibility to our employees to ensure they have the knowledge needed to make educated decisions We heard from the community that affordable and quality healthcare is a critical part of their total compensation package We wanted to fill gaps we saw in the benefit package There is urgency in identifying solutions related to the Affordable Healthcare Act Julie is new to Hamline and could provide a competitive market perspective 5

6 Medical Insurance

7 Our Current Challenges Rising Health Care The National average increase is 7.6% Claims Our premiums are based on our claims history Based on our claims, HealthPartners anticipated a 30%+ increase for 2016 Affordable Care Act Cadillac Tax Employers will face significant fines for being overlygenerous beginning in 2018 While this may seem counterintuitive to the ACA, it is a mandate from Congress to reduce preferential treatment 7

8 Consumerism in Healthcare The nation has moved in this direction Choices that promote health and preventative medicine and risk reduction Shopping for better rates Healthcare Savings Accounts Allows consumers to prioritize their choices based on their individual needs Employees have a vested interest in their health care, therefore they are willing to devote more time to proper diagnosis and management of treatment More and more physicians are embracing consumerism, which creates a stronger relationship with patients so they truly understand their healthcare options Physicians have skin in the game Online tools and mobile apps help patients make decisions 8

9 What happens if we don t embrace consumerism? Risks Double-digit health care premium costs Claims outweigh the premiums Employees may not ask questions of costs, resulting in higher premiums Unnecessary tests and procedures Improved financial flexibility for consumer You choose with your physician the right care for you Partner with your physician to hear about all options Control more of what you want from your healthcare vs. anonymous parties Loss of possible change opportunities in the future should we decide (fully funded vs. self-funded) 9

10 We want options that will position us to deliver the best solutions for our community Selecting the right health insurance that fits your need Avoid being at the mercy of the insurance company Self-funded plans We assume the risk for the payments of claims and can help determine our claim renewal rates. Many organizations and universities have moved to this model We received a recommendation from a non-profit third party to consider this in the future Provides a greater flexibility to design a plan that fits the needs of the employees 10

11 Explanation of our Healthcare RFP Process Step 1 - Received initial rates without any plan design changes so we could compare Apples to Apples Blue Cross Blue Shield, Medica, HealthPartners and Preferred One Step 2 - Requested best and final bids Step 3 Selected finalists based on the health insurance company that was willing to offer us the same/consistent level of healthcare, best rates, and position us for options in the future that provide flexibility Step 4 Define plan design changes with the President s Staff that would offer multiple solutions for our employees and manage budget shortfalls Step 5 Gather feedback from the community 11

12 Selection goals and considerations Ensure employees and their families are receiving the best care and options for their healthcare needs Provide the least disruption to our employees Solutions that drive us towards a consumer-driven model Position us to have the option of moving to a selffunded model in the future if we decide this is the right thing for us 12

13 Selection goals and considerations (cont.) 13 Doctor utilization - Avoid disruption of primary health care providers as much as we can A solution that offers creative and motivating wellness program that encourages preventative healthcare Solution that makes our benefits plan a competitive part of our total compensation package Option for a 1 year contract in case we want to change plans in the future Reputation in the marketplace

14 Results HealthPartners initial rate increase was scheduled to be 31%. Their initial quote came in at 20.99% because they knew we were serious about considering other insurance companies. Best and final offers from the 4 providers: HealthPartners (Open Access) 12% Preferred One (PIC) NA Medica (Passport) 8.75% Blue Cross Blue Shield 9.93% 14

15 Cost Renewal Overview Apples to Apples Based on the factors we used to determine our recommendation and the quote, we select HealthPartners and Medica to move forward in the decision-making process. Insurance Company Current Premiums 2016 Projected Expense HealthPartners (Open Access) $4,405, $4,933, Preferred One (PIC) NA Did not quote Medica (Passport) NA $4,790, Blue Cross Blue Shield NA $4,843,

16 16 Pros and Cons Handout

17 Assistance - Benefits Counselors To help our employees, we have hired benefits counselors (through a third party) that will help employees select the right option for themselves. Unbiased Trained on Hamline plans You will either meet with a benefits counselor for a scheduled face to face visit or scheduled call to enroll in your benefits for 2016 If you don t meet with a counselor, you won t be enrolled Various times of days Family is invited to attend Bring your questions! 17

18 Terminology Premium - An amount to be paid for an insurance policy. Deductible - A specified amount of money that the insured pays before an insurance company will pay a claim. Coinsurance - The insured pays a share of the payment made against a claim. Out of pocket - The most you will have to pay for covered medical expenses in a plan year through deductible and coinsurance before your insurance plan begins to pay 100% of covered medical expenses. HSA - Health Savings Account - A savings account used in conjunction with a highdeductible health insurance policy that allows users to save money tax-free against medical expenses. Pharmacy formularies - A list of prescription drugs, both generic and brand name, used by practitioners to identify drugs that offer the greatest overall value. A committee of physicians, nurse practitioners and pharmacists maintain the formulary. Varied by medical insurance provider. Co-payments will vary based on the Tier (I, II, III) Cost sharing - Employees and Hamline share the cost of the medical premiums. Disease Management - A care system that seeks to manage the chronic conditions of highrisk, high-cost patients as a group. Step Therapy - The practice of beginning drug therapy for a medical condition with the most cost-effective and safest drug and progressing to other more costly or risky therapy, only if necessary (i.e., you must try drug "A" before you can get drug "B"). The goal is to control costs and minimize risks. 18

19 Plan Design Provide employees with additional plan options Lower premium and for those who may hit their deductible quickly or have less or a healthcare need Addition of a higher deductible at a dramatically lower premium Addition of network options in which a primary doctor is selected in a vast network at a lower premium Referrals are still available Can switch networks 1 time a month Slightly higher deductibles for those who prefer more up-front coverage We adjusted deductibles, coinsurance, and/or out of pocket maximums to further reduce premium expenses 19

20 Cost Sharing Rightsizing cost sharing models High deductible healthcare plan participants are rewarded for taking on consumerism and potentially higher risk Co-Payment plan will most likely be subject to the Cadillac Tax in 2018, therefore we need to strongly consider a new solution If we continue to receive 10% increases, we will. 20

21 Office Visit Copay Plan A Higher Deductible 2016 Plan Design Plan B High Deductible Plan C Moderate Deductible Plan D Co-pay Plan N/A N/A $35 $35 Deductible $5,000/$10,000 $2,600/$5,200 $1,000/$2,750 $300/$600 Coinsurance 100% 90% 75% 80% Annual Out of Pocket Maximum $5,000/$10,000 $3,100/$6,200 $3,500/$7,000 $2,000/$4,000 Prescription Drugs 100% after deductible 90% after deductible Tier I $11 Tier II $45 Tier II $60 Tier I $11 Tier II $45 Tier II $60 21

22 2016 HealthPartners Plan Design and Rates 22

23 23 Medica Plan Design and Rates

24 Example of best case vs. worst case scenario Why do we point this out? As we move towards consumer-driven healthcare, it is important for us to understand which options are best for your situation. Last year many of our employees on Plan B and Plan C hit their annual out of pocket maximums, these employees would have saved money had they been on a High Deductible Health Plan. Employees would have saved $4,000 per family. 24

25 Benefits Broker Recommendation The benefits broker is responsible for sourcing and negotiating our benefits The broker was put on notice this year that we had high expectations of our relationship and they needed to ensure we were receiving advice that would support our community or we would end our partnership Based on positive dialogue, they worked tirelessly to negotiate and consult with us Our broker advised us to change to Medica based on our needs for 2016 and into the future 25

26 HR Recommendation - Medica Quality healthcare Wellness Program & Incentives My Healthy Rewards (Red Brick) Gift cards for employees and dependants that complete wellness-related activities (up to $100 each) Same physician/provider - 97% match Ability to offer additional lower cost network options National coverage for employees/dependents outside of network though United Health Care Ability to move towards consumerism Reputation and negotiating power in the marketplace Educational opportunities for ALL employees, not just those who elect coverage 26

27 About Medica Non-Profit founded by physicians in 1975 Health coverage services to 1.5 million members Second largest Minnesota health insurer: Primary business in Minnesota, Wisconsin, North Dakota and South Dakota National coverage alliance with United Health Care Nonprofit - 1% target operating margin Link to Medica informational videos: 27

28 Medica s Networks 28 Three network choices Passport - Open access Elect - Care systems in the Twin Cities, Southern Minnesota, and Duluth area Essential - Care systems in the Twin Cities, Northern Minnesota and Duluth area (some of Wisconsin) Medica Choice Passport Network 790,000+ doctors and 5,700 hospitals Primary care physicians: 100% access to a least 2 providers within 10 miles Hospitals: 100% access to a least 1 hospital within 20 miles Medica Elect and Essential Network Accessible to 98% of Hamline Employees 98% access to 2 primary care physicians within 10 miles 98% access to 1 hospital within 20 miles

29 How it works You choose Medica Elect or Essential Network National network coverage Fifteen large care systems Primary care and speciality care Easy to access No referrals required within care system No referrals required for access to in-network: Urgent Care Routine eye exams Chiropractic DME services MH/SA services How it works: 1) Family selects either the Elect or Essential network 2) Each family member chooses a primary care clinic affiliated with a care system 3) Primary care clinic coordinates care 29

30 Network Value Medica Elect and Essential Networks Elect Nine Care Systems Allina Medical Clinic Children s Physician Network Hennepin Health Integrity Health Network Lakeview Health Minnesota Healthcare Network Park Nicollet Health Services Riverway/North Suburban Clinics (Includes HealthPartners-Como) St. Luke s Care System Essential Six Care Systems Altru Health System Essential West (formerly Innovis Health) Fairview Physicians Associates HealthEast Integrity Health Network St. Luke s Care System 30

31 Referrals Referrals are not required for participants in the Passport network. Passport participants can receive care from any in-network provider including specialists. Participants in the Elect and Essential networks may need a referral from their primary care doctor to receive care outside of their care system. There are some exceptions, like chiropractic care, urgent/emergency care and mental health/substance abuse. There are also services that don t require a referral, but need the primary care provider to arrange for the services. Some examples include occupational, physical or speech therapy, home care, skilled nursing facility care. If a participant needs care that their care system can t deliver, the primary care clinic will write a referral and notify Medica. The referral will list the specialist, the type of service, the number of visits and the date range for when they can see the specialist. Note, the specialist cannot refer to another specialist that would need to come from the primary care provider. If a participant sees a specialist outside of their care system without receiving a referral, out-of-network benefit levels will apply and the participant s share of the cost will likely be higher. 31

32 More on Referrals Please make note for those who are on HealthPartners - Como In the Elect network there is one HP Clinic that members can pick as their Primary Care Clinic (PCC), which would be the Coon Rapids Clinic, all the other HP clinics that show up are in-network without a referral as long as the member chooses a clinic within the Riverway-North Suburban Elect Care system (including the Como location) What this means is, if you select the Coon Rapids HP clinic as your primary care clinic, you can utilized the HP Como clinic as well without a referral. 32

33 Medica - Customized Pre-enrollment Site 33 Pre-Enrollment website to familiarize yourself with Medica: Learn about Medica s network options and locate doctors on the Passport Network and/or the Elect/Essential Networks Review and compare Hamline plan options, tips for choosing a plan Review pharmacy network options Explore the wellbeing and wellness options with Medica, Healthy Rewards (Redbrick) and Healthy Savings Access to customer service contact information

34 New Additional Benefits Cancer Insurance Colonial Reimbursement for various circumstances Anti-nausea medication, bone marrow stem cell transplant, experimental treatment, hospital confinement, radiation/chemotherapy, 2 nd medical option (additional insurance), home health care services Available for employee and dependents Bridge Insurance Colonial 34 Preventative appointments - Earn $50 one time per calendar year or two reimbursements / year for family coverage Rehabilitation Unit Benefit - $100 per day up to 15 days per stay as an inpatient in a rehabilitation unit. 30 day maximum per covered persons per calendar year Waiver of Premium Benefit After 30 days on continuous confinement waives premium for the entire policy Available for employee and dependents

35 Dental - Delta Dental Other Benefits 3.99% increase, no plan changes Vision Avesis 1.92 % increase, no plan changes Life Insurance and Long Term Disability Lincoln - rate reduction on basic life insurance and disability Those who have elected voluntary life insurance, can during this open enrollment period, increase their elections to the guarantee issue amounts Short Term Disability - Colonial Additional open enrollment period now Guarantee issue 35

36 Other Benefits - Continued Metlaw - no plan or rate changes Health Savings Account 2016 IRS Maximum Contribution Limit $3,350 employee only coverage $6,750 family coverage Flexible Spending Accounts Dependent Care $5,000 Medical Flexible Spending $2,550 Employee assistance program through Medica Savings of $7,000 per year 36

37 Comments We invite you to provide your comments. Please your comments and questions to or Set up time with Tina Cubas or Julie Kline 37