City of Fort Worth Health Plan Update. Council Presentation September 12, 2017 Brian R. Dickerson Director of Human Resources

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1 City of Fort Worth Health Plan Update Council Presentation September 12, 2017 Brian R. Dickerson Director of Human Resources

2 2018 Proposed Plans Health Center Plan Free primary physician care Provides copays for specialists and prescription drugs Maintains lower deductibles and out of pocket costs Pediatrics, obstetrics and mental health services continue with network physicians outside of health centers Consumer Choice Plan High-deductible Health Savings Account (HSA) available to allow people to save for health costs on a pre-tax basis Members will be able to use the health centers at a discounted rate All preventive care, including mammograms and colonoscopies, are free to members on both the Health Center Plan and the Consumer Choice Plan 2

3 Health Center Plan Introduction of EMPLOYEE HEALTH CENTERS established through Texas Health Resources (THR) All services at the health centers and satellite locations are FREE Fixed cost to the health plan Tiered network with specialists co-pays Control quality of care No upfront costs to build Convert Basic Plan to Health Center Plan: Propose three health centers supported by five satellite locations in the North Texas area All members seen same or next day for sick appointments Staffed with quality doctors, physician assistants and nurse practitioners No mandatory referrals required Physician choice maintained with tiered copays within UHC network 3

4 Satellite Locations 3 Dedicated Health Center locations targeting Alliance, Burleson and Fort Worth areas Physicians at each location All Health Centers will not be ready by January Completion date targeted for no later than April 5 Satellite Locations Convenient locations all around North Texas All locations available in January Not held to same metrics as dedicated health centers 1. Texas Health Family Care Lake Worth 6100 Lake Worth Blvd, Fort Worth 2. Medical Family Center of South West 7001 Granbury Rd, Fort Worth 3. Hoffman Family Practice Associates PA 2730 SW Wilshire Blvd, Burleson 4. Texas Health Family Care Grand Prairie 2950 W. Camp Wisdom Rd, Grand Prairie 5. Texas Health Family Care Weatherford 2005 Fort Worth Highway, Weatherford 4

5 Physicians Network Full access to UHC network, but receive benefit for Premium Designated Doctors No referrals needed for specialists Can still use the clinic at a reduced cost Co-pay/Co-insurance Consumer Choice Plan Deductible increased to $2,700 individual/$5,400 family Out of pocket maximums increase to $6,550 individual/$13,100 family Pharmacy deductible, then 20% co-insurance up to Out-of-Pocket maximum Contributions City contributes $540/$1,000 Premiums lower than Health Center Plan 5

6 Choosing a Premium Provider means a lower copay and out of pocket costs Urgent Care: Health Center Plan = $75 Consumer Choice Plan = 20% after deductible Non-emergency use of emergency rooms will be: Health Center Plan = $500 then 50% after deductible Consumer Choice Plan = 50% after deductible Virtual Visits are free on the Health Center Plan and low cost on the Consumer Choice Plan PROPOSED 2018 Summary of Medical Plan Benefits Plan Features Health Center Plan Consumer Choice Plan Annual Deductible Individual $1,500 $2,700 Family $3,000 $5,400 Total Out of Pocket Max including deductibles, copays, coinsurance, prescription deductible, prescription copays Individual $6,000 $6,550 Family $12,000 $13,000 Physician Office Visit PCP (At Health Center) $0 copay $60 per visit OBGYN/Peds (Premium Provider) $60 copay 20% after deductible Specialist (Premium Provider) $75 copay 20% after deductible PCP (Premium Provider) $60 copay 20% after deductible PCP (Not Premium Provider) $60 copay then 20% after deductible 20% after deductible OBGYN/Peds (Not Premium $60 copay then 20% after Provider) deductible 20% after deductible Specialist (Not Premium $100 copay then 20% after Provider) deductible 20% after deductible Emergency Room visits for true emergencies only $500 copay (waived if admitted) 20% after deductible 6

7 Health Center Pharmacy Plan Retail Mail Order/Select 90 Generic 20% coinsurance, $10 min/$20 max 20% coinsurance, $25 min/$50 max Brand Formulary 20% coinsurance, $30 min/$50 max 20% coinsurance, $75 min/$125 max Brand Non-Formulary 20% coinsurance, $50 min/$70 max 20% coinsurance, $125 min/$175 max Specialty 20% coinsurance, $200 max 20% coinsurance, $200 max No change to Consumer Choice Pharmacy Plan Maintenance medications still obtained through mail order or Walgreens 10

8 Staying on the plan Leaving the plan Keeping working employee spouses Reality - reduces revenue Theory - reduces costs Keeping retiree dependents Premium more than covers costs until it doesn t Eliminating working retirees If the retiree is eligible for health care coverage through their current employer 89% of retirees pay nothing for health coverage No loss of revenue, loss of claims The retiree s family must also leave the plan Eliminating working retiree spouses If the retiree spouse is eligible for health care coverage through their current employer Loss of revenue and possible loss of claims *If the retiree loses their job provided health care insurance then the retiree can return to the city s plan within 30 days of loss of coverage 11

9 Upcoming Council Decision M & C Presented to Council September 19 Contract with Southwestern Health Resources for Health Center Services effective January 1 Open Enrollment begins October 1 and ends October 20 12

10 Go online to the Open Enrollment page FORTWORTHTEXAS.GOV/OPENENROLLMENT On the city s webpage you can learn more about: Plan Comparisons Plan Design Open Enrollment Meeting Dates ALEX Your Online Benefits Counselor Healthcare Vendors Frequently Asked Questions (FAQs) 13

11 QUESTIONS 14