Your Health Benefits for 2018 Self-Insurance, Regionalization, Medicare, Next Steps

Transcription

1 Your Health Benefits for 2018 Self-Insurance, Regionalization, Medicare, Next Steps Lisa Ellinger, Director Office of Strategic Health Policy Your Health Benefits for 2018 February 24,

2 We want to ensure that you Understand the Group Insurance Board s recent decisions & the process involved Understand how changes will impact you Are aware of next steps and how you can stay informed Know how to get health benefit information & assistance Your Health Benefits for 2018 February 24,

3 Agenda 1. New elearning 2. Understand changes: history, timeline, process 3. Next steps 4. How changes affect you 5. Stay connected 6. Q&A Discussion Your Health Benefits for 2018 February 24,

4 Group Insurance Board Action History, Timeline, Process Your Health Benefits for 2018 February 24,

5 Group Insurance Board Action Feb 8, 2017: Approved self-insured/regional program structure for 2018 Your Health Benefits for 2018 February 24,

6 How did we get here? Group Insurance Board has discussed and considered self-insurance for past five years Your Health Benefits for 2018 February 24,

7 Historical Timeline Oct Deloitte Consulting issued preliminary Oct Board delayed Sept Segal Consulting awarded report action Aug Deloitte presented second report with detailed analysis Jan Board recommended hiring a benefits consultant Your Health Benefits for 2018 February 24,

8 Historical Timeline Mar Segal presented first report to the Board Nov Segal presented second report to the Board Aug Segal issued a Request for Information (RFI) Your Health Benefits for 2018 February 24,

9 How did we get here? Two actuarial studies Deloitte and Segal concluded: A Request for Proposals (RFP) was the only way to determine cost impact Proposals are legally binding Your Health Benefits for 2018 February 24,

10 2016 Timeline Feb Board directed ETF to issue an RFP May 2016 Public Request for Comment issued Jun Public Request for Information issued (draft RFP) Jan RFP developed Jul RFP issued Your Health Benefits for 2018 February 24,

11 2016 Timeline Sept Vendor proposals due Feb Board decision to move to self-insurance/regions Apr. 2017* Contracts sent to Joint Committee on Finance (JCF) for 21-day passive review Nov Board reviews results Feb Vendor contracts negotiated Mar. 2017* May 2017* JCF decision * Estimated timing Your Health Benefits for 2018 February 24,

12 RFP Overview Vendors required to: Bid on any of the four defined regions and/or submit statewide/nationwide bid Complete a technical proposal Submit an administrative cost proposal Complete a claims repricing exercise Submit information about their proposed network for 2018 Your Health Benefits for 2018 February 24,

13 Proposal Scoring 40% Cost / Access Proposal 20% Response to General Questions 40% Response to Technical Questions Your Health Benefits for 2018 February 24,

14 Board Decisions: 2/8/17 Self-insurance 4 regions 1 statewide/nationwide vendor 1-2 additional vendors in each region Effective January 1, 2018 Your Health Benefits for 2018 February 24,

15 Board Decisions: 2/8/17 Medicare 2018 Medicare Supplement through new statewide/nationwide vendor Medicare Advantage through current vendor (Humana) Medicare 2019 Options will be presented at May 2017 GIB meeting Your Health Benefits for 2018 February 24,

16 Self-Insuring / Regions: Next Steps Contract Negotiations Legislative Approval Tiering/Premiums Communication/Outreach Your Health Benefits for 2018 February 24,

17 Legislative Approval February 9 th The board sent a letter to the Joint Committee on Finance chairs to explain decision & rationale Late March or Early April ETF finishes contract negotiations with vendors 21 Day Passive Review Contracts sent to the Joint Committee on Finance Not approved? The Board will reconvene May JFC decision We could maintain the current program structure Your Health Benefits for 2018 February 24,

18 Tiering / Premiums Released at open enrollment No significant changes for 2018 Goal: competitive statewide/nationwide plan Tier 1 Your Health Benefits for 2018 February 24,

19 Looking Forward 2018 & Beyond Your Health Benefits for 2018 February 24,

20 How will this affect retirees? Pre-Medicare retiree program mirrors active employee program Enhancements: Improved Quality & Value Improved Provider Access Improved Customer Service Your Health Benefits for 2018 February 24,

21 North Security Regions & Vendors Statewide/Nationwide Vendor: Anthem West HealthPartners South Dean Quartz East Anthem Network Your Health Benefits for 2018 February 24,

22 Provider Access 98% of Current Providers Expected Available Providers We ll provide info to help you find which plans cover your health care team Your Health Benefits for 2018 February 24,

23 What s changing for Medicare retirees? Same 3 plan options available in 2018: It s Your Choice Health Plan Medicare It s Your Choice Medicare Advantage It s Your Choice Medicare Plus Your Health Benefits for 2018 February 24,

24 What s changing for Medicare retirees? Changes: who will administer & regional structure It s your Choice Health Plan Medicare It s your Choice Medicare Advantage It s your Choice Medicare Plus Now County-specific service areas Administered by 17 plans Administered by: Humana Administered by: WPS Insurance 2018 Region-based Administered by 6 plans Administered by: Humana Administered by: Anthem Blue Cross Blue Shield Your Health Benefits for 2018 February 24,

25 Information about changes will be sent to your home before open enrollment Your Health Benefits for 2018 February 24,

26 Need Medicare Advice? Medigap Helpline ETF Ombudsperson Services or Your Health Benefits for 2018 February 24,

27 2019 & Beyond ETF s goals: Likely focus on expanding Medicare Advantage Expand options with lower monthly premiums Deliver high quality, high value services Provide choice Offer excellent benefit packages Your Health Benefits for 2018 February 24,

28 Stay Connected etf_wi etf.wi.gov ETF Updates ETF will provide information prior to open enrollment. Your Health Benefits for 2018 February 24,

29 Questions? Your Health Benefits for 2018 February 24,

30 Q&A Discussion If you have questions after today s session please send them to: Millard Susman msusman@wisc.edu Your Health Benefits for 2018 February 24,