West Palm Beach Firefighters Benefit Fund

Transcription

1 Special Meeting Martin Palermo called the meeting to order at 9:05 AM in the Training room of Fire Station #2, West Palm Beach, Florida. Those persons present included: TRUSTEES Martin Palermo Tom Wesolek Shane Miller Guy Montante Mike Ondo OTHERS Scott Baur, Denise McNeill and Jackie Taylor; Resource Centers CONSULTANT REPORT Scott Baur presented the current status on the renewal process. He advised that he received information as late as yesterday and this process has been very transparent, with a level playing field. He expects Aetna to give additional concessions that may come close to 5% more off their proposed rates and he also expects a substantial change from Cigna; however, with some heartburn. He further explained; if Cigna s revised proposal is dramatically different than the original proposal it could indicate they are buying the business and the end result may be an issue with the relationship not being sustainable at renewal next year. Cigna's revised proposal has multiple options; however, this could increase the rate from 1.5% to 2% due to the expectation of adverse selection. Mr. Baur informed the Board that they could allow dual options with any carrier and if Cigna would offer a two year rate on dental and come back with a new proposal and then it is viable. Blue Cross submitted their best offer to the table at the onset of their proposal. They may be able to adjust an additional 1% if they tweek more on the pharmacy benefit. Blue Cross has deep discounts and he feels the underlying discounts are with facilities at 50%. Mr. Baur explained that Aetna is probably stronger on national discounting and pharmacy; however, it is harder to figure the differences in detail because Aetna had not submitted an update prior to today's meeting. Lengthy discussion followed regarding the proposals. CIGNA PRESENTATION Courtney Rivas, Senior Client Manager, Lynne Swift, New Business Manager, Pamela Serrani, Director of Client Management-Florida and Joyce Lane, Dental Manager. Lynne Swift presented the proposal. She reviewed the highlights and shared returns if the predicted claims cost was left over at year end they will share 50% with the Plan. Ms. Swift explained that Cigna provided a comparable dental quote and if it were bundled with the medical, Cigna would provide a 1% credit to the proposed premiums. Cigna has the capability to provide health management for the following: oral health enhanced benefits, maternity, heart disease, diabetes and allow periodontal for full reimbursement. Cigna will provide a pre-enrollment phone line to answer member s

2 questions prior to benefits becoming effective. Their network nationally is seamless with no state borders 90% geographically. Quest and LabCorp are part of the Cigna network diagnostic facilities. Ms. Swift presented the Board with two plan options; one with a 9.8% increase over current Plan with same benefit structure or a 0% increase with an altered Plan that presented a 4.5% cost shift to the employee on deductible and co-pays. Tom Wesolek asked Cigna representatives if the mental health and substance abuse benefit would change. They confirmed that the mental health benefits were the same and a geographic access would be done for the mental health providers. Ms. Swift reported that Cigna will provide a $15, Wellness Fund effective immediately, July 1, 2014, with a dedicated wellness, billing and claims representative for the group. Mr. Wesolek inquired if the Wellness Fund would assist with the recertification training or continuing education classes for firefighter employees. Pam Serrano assured the Board that this type of training would be eligible for reimbursement on the wellness benefit. She added that Cigna offers a disease management and wellness site at MyCigna.com, for total health and relationship programs. Ms. Swift stated that Cigna encourages the health assessment online and feels that the wellness program is a good complement to the department s personal training. Mr. Wesolek asked for an example of the shared returns. Ms. Swift explained if the Plan is running 30% to 35% better than the typical average Plan the group should expect a dividend. Mr. Baur expressed his concerns to Cigna that if they are seriously underbidding this proposal the group will regret it on the next renewal. Joyce Lane addressed the dental claims for the group. She explained that an oral health program will improve on the groups medical claims. Ms. Swift addressed Mr. Baur s concern on underbidding and explained that Cigna was able to give the group credibility based on prior claims experience. They expect 80% credibility on claims at renewal for this group. Ms. Serrani added that it is in Cigna's best interest to have more than one year with the group. Ms. Swift expects the groups medical to be a 3% increase next year and the two year dental plan to increase 2.5% over the current premium. Ms. Lane added that the DPPO dental network is strong nationally because of deeper discounts and there are over 200 dentists in Palm Beach County alone. Cigna departed the meeting at 9:50 AM. Discussion followed regarding the Cigna presentation. Mr. Baur explained to the Board that the more Cigna narrows down the premium rates the result would end up being no "shared credits" and a high premium at renewal. BLUE CROSS BLUE SHIELD- FLORIDA BLUE PRESENTATION Kelly Sommer, Blue Cross Blue Shield Florida Blue Sales Executive, appeared before the Board. Ms. Sommers explained that she has been with Blue Cross for 14 years and previous to that she was a Dade County Fire representative. She presented the Board with information of the Blue Cross online access to members and that they have representation at their local offices on 45th Street for questions, such as benefits or claims information. Members can view Blue Cross WEBmd for online information to 2

3 research a surgeon s mortality rate when determining what providers to use. The Blue Cross reciprocity is quite seamless; however, for those members living out of the area the group would have to offer a POS plan that would include the local Blue Cross discounting and notification to Blue Cross is necessary when dependent students are residing outside the area. Ms. Sommers explained summary of benefits on the BlueCare Plan 59. This plan included health wellness, various discounts, and three levels of co-pays for in and out of network. Discussion followed regarding the Blue Cross networks with physicians in Florida. Ms. Sommers offered to do comparability through online access. She explained that members would have access to specific Blue Cross urgent care providers over the weekend and some Walgreen Pharmacies also have clinics. Blue Cross requires pre-authorizations for certain tests; such as prelab, CT, MRI, etc. and pre-authorization for surgery is a two day process. Mr. Wesolek asked if the Blue Cross Plans #56 and #59 could be altered. Ms. Sommers explained that there is some latitude on changes, as long as it's within the Plans allowance that is registered with the State. Discussion followed regarding physical therapy benefits on these Plans were only for thirty office visits and the current Plan allows for sixty visits. She explained that this Plan has thirty office visits; however, she will look into adjustments to the amount of office visits. Mr. Baur voiced his concern that Blue Cross on the front end may be buying business and concerned with an increase at renewal. Ms. Sommers assured the Board that she is confident the group was rated appropriately. She explained that the pharmacy plan is three tier, with co-pays at $10.00, $30.00 and $ She explained further that Plan #59 is a very rich plan with nearly all co-pays and all out-of-pocket costs accumulating toward the plan deductible. Mr. Baur suggested that the group could do a "Blue Options" plan as a wrap around and offer a multi plan with the existing rates quoted. Ms. Sommers reported to the Board that Blue Cross has access to Wellness programs and health risk assessment programs. Although this was not quoted, Blue Cross can do a Wellness Fair, to include Body Mass Index testing and massages. Kelly Sommers departed the meeting at 10:45 AM. Discussion followed regarding Blue Cross and the group s share of administration and service issues with this Plan proposal. DELTA DENTAL PRESENTATION Michael Maner, Delta Dental Sales Account Executive, appeared before the Board. Mr. Maner advised the Board that Delta Dental Underwriting had revised the original dental renewal with some rate relief at 16.4% for a one year renewal and 18.73% for a two year renewal. The current Plan design has a rich benefit with no member incentives to use in-network dental providers in the Delta network. The current out of network claim usage is at 29% which has increased claim costs for group. Mr. Maner reviewed the actual cost impact of premiums and out of pocket costs to the group and reported that 3

4 90% of the dental premium collected pays the claims with a low profit margin for Delta Dental. He presented three dental plan options to the Board; the Passive PPO current plan, a PPO plan and the PPO/MPA. Mr. Maner explained to the Board that on the PPO plan it allows members to go out of network; however, they have a shared cost of 10% on out of network and they will most likely be balanced billed by the provider for the payment difference of the claim. He further reported on the PPO/MPA plan and that members have a cost share of 10% for using out of network providers. Mr. Maner explained that with this plan members will be encouraged to stay in the network and it will make a cost difference to the groups over all claims; with better benefits and reduced co-insurance in network. Mr. Maner recommended that the Board change the current Passive PPO plan to the Maximum Plan Allowance (MPA) + PPO plan for a two year renewal. He also confirmed that Delta Dental has added several dentists in Palm Beach County and the Treasure Coast service area. Discussion followed regarding dental networks with Delta Dental and Cigna. Mike Maner departed the meeting at 11:24 PM. AETNA PRESENTATION Jay White, Aetna Sales Vice President for Southeast Labor Division, appeared before the Board along with; Natalie Jones, Aetna Account Manager. Jay White presented a revised proposal to the Board. Mr. White noted that under the Care and Disease Management there were 84 members identified with management needs. He explained that the account was been running well at 10% below trend and that he has been working closely with Scott Baur on the renewal. He expects that Aetna will receive more health care reform ACA taxing and this will be passed on to the group in premiums. Hospital HCA contract renewals have increased costs since the purchase of Coventry Insurance. Mr. White explained that the disease management department is trying to help employees become more aware and manage their health by communicating with providers and local pharmacy. They have reviewed claims through March and could mirror as close as possible to the Blue Cross Plan #59 with the MCOA plan or the group can continue with the current MCOA plan for a renewal rate increase of 8.9%. Tom Wesolek noted that he appreciated Aetna s rate renewal; however, the user satisfaction with membership is very low right now. He explained when the platform changed for July 1, 2013 and service got worse. Ms. Jones explained that until recently she was not aware of any service issues and would like an opportunity to look into the issue. Mr. Wesolek advised that the online was not working sufficiently and he feels that there is more negative than positive with the current administration of the Plan. Mr. White stated he was unaware of any service issues with the Plan. He was willing to offer a six month service performance guarantee to the group for renewal if it would help to repair the relationship. Mr. Wesolek and Jackie Taylor expressed their continual service issues; specifically the ongoing billing issues. Mr. Wesolek stated that 4

5 the members of the Plan would be very unhappy if they were given a premium increase and told they would continue the coverage with Aetna for renewal. Ms. Jones offered to have herself or Sara Venice available to meet individually with members monthly, if that would help the situation? Mr. White suggested that he can pull specific call logs to research the issues because he would like the opportunity to improve the situation. Aetna representative, Jay White and Natalie Gonder-Jones departed the meeting at 12:15 PM The Board discussed Aetna s proposal and the plan comparisons to the Blue Cross Blue #59 plan. Lengthy discussion followed regarding the proposals, plan designs and national networks; with Aetna s network being more seamless than the Blue Cross network. The Board members shared that the member complaints regarding Aetna were coming from heavy users of the Plan and they felt less confident with continuing coverage with Aetna for renewal. The Board expressed that Aetna is out of the proposals with no further discussion. Discussion followed regarding the Blue Cross and Cigna proposals. There were concerns with Cigna s 7.5% adjusted rate proposal, in that they may be trying to buy the business and Blue Cross would require POS Plan for members residing outside of the Plan area. Lengthy discussion followed regarding the additional Plan options presented by Cigna and avoiding dual Plans for the group; as there is the potential for adverse selection. The Board requested that Scott request that Cigna present their Plan with changes to the deductibles, coinsurance and Emergency Room; individual $ and family $1,000.00, 90%/10% and Emergency Room $ There being no further business and with the next meeting scheduled for April 22, 2014, 9 AM. A motion was made to adjourn the meeting at 12:58 AM. The motion received a second and was approved by the Trustees 5-0. Respectfully submitted, Shane Miller 5