Spokane Public Schools EBCC Meeting. April 21, 2016

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1 Spokane Public Schools EBCC Meeting April 21, 2016

2 WEA Select Program Structure

3 WEA Select Plans - Program Structure WEA is the Plan Sponsor Accountability Benefits Services Advisory Board (BSAB) Primary work group for the WEA Select Plans Consists of ~15 members representing education employee groups from across the state Acts like a group of trustees, meets throughout the year to evaluate plans and renewal options Plans are monitored closely by WEA s BSAB and Board of Directors 3

4 WEA Select Plans - Program Structure All final rates, benefits and plan offerings must be approved each year by the BSAB and Board of Directors Board meets in early June to finalize renewals (79 voting members) Board Executive Committee Rate Stabilization Fund (RSF) Trustees RSF - favorable financial provisions Separate & unique claim appeal process Input Welcome!! Many benefits have been enhanced or added based on input from locals, districts and enrollees 4

5 WEA Select Plans - Program Structure Large statewide purchasing pool covers over 110,000 school employees and their families = low administrative expenses (~5%) Claims experience is maintained on a statewide basis Not tracked by employee group or school district Blended into a much larger pool of school employees Rates are based on WEA plan participant s claims experience only Due to the size of the medical plan, WEA closely monitors only large claims once they exceed $100,000 5

6 WEA Select Plans General Utilization Several hundred claims exceeded $100,000 First medical claim to exceed 3 million Starting to see prescription claims over $100,000 Healthcare market was hit by large increases in 2014 pharmacy trend Preceding years had seen very low drug trend Last year WEA implemented 2 Prescription Drug Management Programs Focused on patient safety to drug efficacy Helps manage future costs 6

7 Top 20 Drugs* Grouped by Class Rheumatological Agents (Arthritis/Osteoarthritis) - Humira, Enbrel, Celebrex Neurological/Interferons (Multiple Sclerosis) - Copaxone, Tecfidera, Gilenya, Avonex Insulin/Non-Insulin Hypoglycemic Agents (Diabetes) - Lantus Solostar, Humalog, Lantus, Victoza 3-Pak Lipid/Cholesterol Lowering Agents - Crestor, Atorvastatin Calcium Proton Pump Inhibitors (Gastrointestinal/Ulcer) - Nexium, Omeprazole Antidepressant Agents/Antipsychotics - Abilify, Venlafaxine HCL ER Psychotherapeutics and Anticonvulsants - Dextroamphetamine- AMPH, Vyvanse *Based on last year s renewal data 7

8 WEA Select Medical Plans

9 WEA Select Medical Plan - Highlights Medical Plan is underwritten by Premera Blue Cross 10% rate discount available for groups that only offer the WEA Select Medical and one licensed HMO option SPS currently on full rates Seven medical plans options available Broad range of benefits and rates Various cost shares (i.e., copays, deductible, coinsurance) Dollar, day and/or visit limits may vary SPS currently offers WEA Select Plan 5, EasyChoice and the Qualified High Deductible Health Plan Not offered today Plans 2, 3 and the Basic Plan 9

10 WEA Select Medical Plan - Highlights Three provider networks - Over 24,000 contracted providers statewide Heritage (Plans 2, 3 and EasyChoice A & B) Foundation (Plans 5 and QHDHP) Heritage Prime (Basic Plan) Value of provider discounts - more dollars go to pay claims Note: The Heritage Prime network does not include Kadlec Medical Center or Lourdes Medical Center and their associated physicians The Heritage and Foundation networks do include these groups. All plans include out-of-area care Access to over 1 million in-network providers across the country through the BlueCard program All covered benefits are available worldwide 1 0WEA Select Health Plans Open Enrollment Premera Blue 10

11 WEA Select Medical Plan - Highlights No referrals or primary care physicians required Plans include in- and out-of-network coverage Pharmacy - Open Drug Formulary All FDA medications are covered if prescribed for a covered condition as approved by FDA No classes of drugs are excluded due to cost Deductible carryover (except QHDHP) Dual WEA coverage (except QHDHP) $12,500 Employee Only Life and AD&D Benefit Surviving Dependent Benefit COBRA for dependent children child rate not employee rate 11

12 Medical Plan Options 12

13 WEA Select Plan 5 (In-network) Currently Offered Plan 5 Provider Network Office Visit (Not subject to deductible) Preventive Care Exams/Immunizations/screenings Deductible Per Calendar Year Foundation $15 Unlimited/Paid in full $200/person or $600/family Coinsurance 10% Medical Out of Pocket Maximum (Includes copays, deductible and coinsurance) $700/individual or $2,100 /family PCY Hospital Care 10% Inpatient Copay (per person) $150/day; $450 max per calendar year Emergency Room Copay (Waived if admitted) $50 Prescription Drugs Rx Out of Pocket Maximum Generic / Preferred / Non Preferred $2,000/individual $4,000 /family Retail 30 day supply $10 / $15 / $30 Mail 90 day supply $15 / $30 / $60 Specialty drugs 30 day supply $50 copay 1 3 This summary is not a contract. Please refer to benefit booklets for complete plan details. 13

14 WEA Select Plans 2, 3 (In-network) Not Currently Offered Plan 2 Plan 3 Provider Network Heritage Heritage Office Visit $25 $30 (Not subject to deductible) Preventive Care Exams/Immunizations/screenings Paid in full Paid in full Deductible Per Calendar Year $200/person or $600/family $300/person or $900/family Coinsurance 20% 20% Medical Out of Pocket Maximum (Includes copays, deductible and coinsurance) Hospital Care Inpatient Copay In network: $1,700/individual or $5,100 /family Out of network: $3,400/Individual or $10,200/family 20% $150/day; $450 max per calendar year in network: $2,950/individual or $8,850 /family Out of network: $5,900/Individual or $17,700/family 20% $300/day; $900 max per calendar year Emergency Room Copay (Waived if admitted) $75 $100 Prescription Drugs Generic / Preferred / Non Preferred Generic / Preferred / Non Preferred Rx Out of Pocket Maximum $2,000/individual or $4,000 /family $2,000/individual or $4,000 /family Retail 34 day supply $10 / $20 / $35 $15 / $25 / $40 Mail 100 day supply Specialty drugs 30 day supply $15 / $30 / $45 $50 copay $20 / $35 / $50 $60 copay This summary is not a contract. Please refer to benefit booklets for complete plan details. 1 4WEA Select Medical Plans Open Enrollment Premera 14

15 WEA Select EasyChoice Plans (In-network) Currently Offered EasyChoice A EasyChoice B Provider Network Heritage Heritage Office Visit (Not subject to deductible) $15 $30 Preventive Care Exams/Immunizations/screenings Medical Deductible Per Calendar Year Paid in full $1,000/person or $3,000/family Paid in full $750/person or $2,250/family Coinsurance 20% 25% Medical Out-of-Pocket Maximum (Includes copays, deductible and coinsurance) Hospital Care Inpatient Copay $4,000/individual $8,000/family $3,500/individual $7,000/family Emergency Room Copay (Waived if admitted) $100 $150 20% $0 25% $0 Diagnostic lab/x-ray 1st $1,000 paid in full; deductible waived Prescription Drugs Rx Deductible (Waived for generics) $500 per person $250 per person Rx Out of Pocket Maximum $2,500/ind $5,000 /family $2,500/ind $5,000 /family Retail 30 day supply $5 / 30% / 30% $5 / $30 / $45 Mail 90 day supply $10 / 25% / 25% $10 / $75 / $112 Specialty drugs 30 day supply 30% 30% 1 5WEA Select Medical Plans Open Enrollment Premera This summary is not a contract. Please refer to benefit booklets for complete plan details. 25% 15

16 WEA Select Basic Plan Not Currently Offered Premera s newest plan helps keep monthly premium costs down while providing full coverage for in-network preventive care. Medical care Uses NEW Heritage Prime provider network Higher medical out-of-pocket maximum and deductible compared to other WEA Select Medical Plans Prescription drugs Deductible applies to all drugs including generics Same pharmacy network and pharmacy programs as other WEA Select Medical Plans Note: Heritage and Foundation networks include Kadlec Regional Medical Center and Lourdes Medical Center, and their associated physicians. Heritage Prime network does not include these groups. 16

17 WEA Select Basic Plan (In-network) Not Currently Offered Basic Plan Provider Network Heritage Prime Office Visit (Not subject to deductible) $30 Preventive Care Exams/immunizations/screenings Medical Deductible Per Calendar Year Paid in full $1,250/person or $2,500/family Coinsurance 30% Medical Out of Pocket Maximum (Includes copays, deductible and coinsurance) Hospital Care Inpatient Copay $4,500/individual or $9,000 /family PCY 30% $0 Emergency Room Copay (Waived if admitted) $200 Prescription Drugs Rx Deductible (all drug tiers) Rx Out of Pocket Maximum Generic / Preferred / Non Preferred $500/individual or $1,000/family $2,100/individual or $4,200 /family Retail 30 day supply $15 / $30 / $45 Mail 90 day supply $15 / $60 / $90 Specialty drugs 30 day supply 30% This summary is not a contract. Please refer to benefit booklets for complete plan details. 1 7WEA Select Medical Plans Open Enrollment Premera 17

18 WEA Select Qualified High Deductible Health Plan (QHDHP) (In-network) Currently Offered Different from other WEA Plans: No deductible carryover No dual WEA coverage Office visits subject to medical deductible Prescriptions subject to medical deductible If you cover dependent(s) You must meet family deductible before benefits begin for any family members You must meet family out-of-pocket maximum before services are covered in full for any family member 1 8WEA Select Health Plans Open Enrollment Premera Blue 18

19 WEA Select Qualified High Deductible Health Plan (QHDHP) (In-network) Currently Offered QHDHP Preventive Care Exams/Immunizations/screenings Provider Network Foundation Paid in full Deductible Per Calendar Year $1,500/person or $3,000/family Coinsurance 20% Out of Pocket Maximum (Includes coinsurance and deductible) $4,000/individual or $8,000/ family PCY Prescription Drugs Retail 30 day supply Mail 90 day supply Specialty drugs 30 day supply 20% This summary is not a contract. Please refer to benefit booklets for complete plan details. 1 9WEA Select Medical Plans Open Enrollment Premera 19

20 Questions??? Aon Hewitt Contact Information: Kathy Delano, Meg Paul, Jennifer Weddle,