HEALTH WEALTH CAREER 2017 RENEWALS SAN DIEGO COUNTY EMPLOYEES RETIREMENT ASSOCIATION JUNE 14, 2016

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1 HEALTH WEALTH CAREER 2017 RENEWALS SAN DIEGO COUNTY EMPLOYEES RETIREMENT ASSOCIATION JUNE 14, 2016

2 TODAY S AGENDA Section Page 1. SDCERA Plans Demographic Overview Premium Increases 8 - Committee discussion and recommendation to Board 3. Health Care Reform Update 12 MERCER

3 SECTION 1 SDCERA PLANS DEMOGRAPHIC OVERVIEW MERCER MERCER

4 SDCERA RETIREE MEDICAL ENROLLMENT AS OF APRIL 2016 The numbers represented are for member-only enrollments and do not include dependent enrollments. Dependent enrollment is an additional 16%. 69% of SDCERA retirees are not enrolled in SDCERA-sponsored medical plans In 2016 the total retiree population increased 3%, while the number of retirees enrolled in an SDCERA plan decreased by 4% Over the last 5 years, the total number of retirees has increased 15% Retirees not enrolled in an SDCERA plan has increased 29% MERCER

5 SDCERA RETIREE MEDICAL PLAN POPULATION Medical Plan Retiree Enrollment Yr Change Non-Medicare 1, % Medicare 4,804 4,862 4,943 4,980 4,807 0% Total 5,896 5,851 5,753 5,710 5,497-7% The numbers represented are for member-only enrollments and do not include dependent enrollments Non-Medicare enrollment continues to decline Medicare enrollment declined 3.5% for 2016 Dependent enrollment also declined by 2% MERCER

6 SDCERA RETIREE MEDICAL PLAN ENROLLMENT Majority of enrollment is in Kaiser 62% of all enrollees All plans experienced a decline in enrollment for 2016 Health Net plans continue to experience greater declines MERCER

7 SDCERA MEDICAL PLAN PREMIUM RATES MERCER

8 SDCERA RETIREE DENTAL PLAN ENROLLMENT The numbers represented are for member-only enrollments and do not include dependent enrollments Dental plan enrollment is lower than medical, but has been fairly steady MERCER

9 SECTION PREMIUM INCREASES MERCER MERCER

10 HEALTHCARE TRENDS Increase in medical plan trends with insurance company trends averaging 7% to 10% Significant increases in prescription drug trends to 9% - 15%, due to: Utilization of high cost prescriptions Price increases for all drugs, primarily generics Reduction in Medicare reimbursement to group Medicare Part D prescription drug plans 2.5% reduction over the next two years is expected MERCER

11 RENEWAL SUMMARY RETIREE PREMIUM Single-Tier Medical Rates Kaiser 2016 Current Monthly Premium 2017 Initial Renewal 2017 Negotiated Renewal $ Change % Change Traditional HMO (Non-Medicare) $ $ $ $ % Senior Advantage $ $ $ $ % Senior Advantage B Only $ $ $ $ % Senior Advantage Unassigned $1, $1, $1, $ % UHC Choice Plus PPO $3, $3, $3, $ % Signature HMO $1, $1, $1, $ % Medicare Advantage HMO $ $ $ $ % Senior Supplement $ $ $ $ % Health Net Early Retirees & Retirees w/out Medicare $1, $1, $1, $ % Health Net HMO $ $ $ $ % Medicare Advantage HMO $ $ $ $ % Average Premium Increase: 5.82% Medical 8.79% Non-Medicare 4.48% Medicare Renewal option for Senior Supplement Renewal option for Medicare HMO Dental Plans 2016 Current Monthly Premium 2017 Initial Renewal 2017 Negotiated Renewal $ Change % Change Delta Dental PPO $44.23 $44.23 $43.35 ($0.88) -1.99% Cigna Prepaid HMO $16.73 $17.24 $17.24 $ % Renewal option for Delta Dental PPO MERCER

12 KAISER Kaiser 2017 renewal is an overall 4.26% premium increase Non-Medicare 9.01% premium increase is driven by: - Change in rating methodology - 36% increase in outpatient and emergency room cost per visit - 13% increase in pharmacy costs, primarily brand name drugs - 10% drop in enrollment Medicare 0.99% premium increase is estimated and will be finalized in June There are no plan changes for 2017 to the Non-Medicare plans, the Medicare premium rates and plan designs will be finalized in June MERCER

13 UNITED HEALTH CARE United Health Care (UHC) overall 2017 premium increase is 8.59% Non-Medicare HMO premium increase is 10.25% - Renewal is not based on SDCERA-specific claims experience - initial premium increase was 11.25%, negotiations resulted in savings of $6,000 annually Non-Medicare PPO premium increase is 11.25% - Only 1 retiree remains on this plan - Last year, the Board agreed to cease offering the plan at the end of 2016 Medicare HMO premium increase is 5.00% Senior Supplement premium increase is 9.73% - Renewal is driven by prescription drug utilization, primarily high cost drugs - Initial premium increase was 10.42%, negotiations resulted in savings of $36,000 annually There are no plan changes for any UHC plan for 2017 MERCER

14 UNITED HEALTH CARE RENEWAL OPTIONS MEDICARE SUPPLEMENT PLAN UHC provided an alternate renewal to change the Medicare Supplement to a Medicare Advantage PPO plan Revised premiums would be: 3.07% premium increase for the Medicare Advantage plan - Savings of $28 per month for retirees on the plan Key features of the Medicare Advantage PPO are: - Retirees can use any physician that accepts Medicare - Benefits are the same in- and out-of-network - Enhanced benefits to retiree - Members would be required to assign their Medicare benefits, similar to the HMO - UHC will not provide the Medicare Advantage PPO alongside the Medicare supplement plan MERCER

15 HEALTH NET Health Net initial 2016 premium increase is 6.84% overall Non-Medicare HMO premium increase is 6.83% - Due to enrollment size, non-medicare renewals are based on demographics (not SDCERA experience) The Medicare HMO premium increase is 10.00% - Initial increase was 10.97%, negotiations resulted in savings of $7,000 annually - The Medicare Advantage HMO premium increase is 5.00% - Initial premium increase is 7.00%, negotiations resulted in savings of $26,000 annually Health Net has not yet released plan changes for 2017 Non-Medicare plan changes are expected in June Medicare plan changes are expected later in the year MERCER

16 HEALTH NET RENEWAL OPTIONS-MEDICARE HMO Health Net offered renewal alternates to the Rx plan to lower the Medicare HMO premium Status Quo Renewal Option #1 Option #2 Option #3 Option #4 Rx - Willow Rx - Oak Rx Pine In 2015, 27 of the 123 members on the Health Net HMO utilized high cost drugs None of the other SDCERA plans have a higher copay for high cost drugs If this option were implemented, Kaiser may add a 1% load to their rates Rx Maple 2017 Premium Increase 10.00% 6.27% 4.70% 2.94% 0.58% $ Increase Per Retiree Per Mo. $ $ Savings from Renewal Per Retiree Per Mo. - ($19.00) ($27.00) ($36.00) ($48.00) Retail Generic Copay $10 $5 $10 $10 $10 Retail Brand Copay $30 $15 $30 $20 $35 Retail Non-Formulary Copay $45 $35 $50 $40 $50 High Cost Drugs ($500+) None 25% 10%, with $100 maximum 25% 25% MERCER

17 DENTAL PLANS Delta Dental Negotiated premium increase is a 2.00% decrease with a two-year rate guarantee If SDCERA would prefer a one-year rate guarantee, the renewal is a 4.50% premium increase Renewal decrease is driven by a 6.00% decrease in claims during the last year Initial premium increase was 0.00%, negotiations resulted in a savings of $36,000 to $82,000, depending on the option selected There are no changes to benefits Cigna Negotiated premium increase is 3.00% Initial renewal was 4.00%, negotiations resulted in a savings of $2,000 annually There are no changes to benefits MERCER

18 BENEFITS COMMITTEE ACTION ITEMS Review renewals Decide whether to recommend approval of renewal options UHC Medicare Supplement - Maintain existing Medicare Supplement plan - Change the Medicare Supplement plan to a Medicare Advantage PPO plan Health Net Medicare HMO - Maintain existing Medicare HMO prescription drug plan - Implement new prescription drug plan - Option 1 - Option 2 - Option 3 - Option 4 Finalize renewals and develop recommendation to the Board MERCER

19 SECTION 3 HEALTH CARE REFORM UPDATE MERCER MERCER

20 HEALTH CARE REFORM UPDATE Two-year Cadillac tax delay Congress postponed the tax until 2020 Delay may signal bipartisan support and momentum toward further amendment or repeal of the tax Fees Fees built into renewal rates Health insurance provider fee moratorium for fees due in 2017 Transitional reinsurance fee included sunsets in 2016 PCORI fees continue through 2019 Fees administered by SDCERA for HIR participants only PCORI fees continue through Estimated fee for 2016 (paid in 2017) is $2.26 per member per year fee (paid in 2018) will be finalized later this year MERCER

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