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5 Attachment: PPT Presentation from TIS Employee Compensation and Benefits Minutes April 9, 2015 A meeting of the Washington County Employee Compensation and Benefits Committee was held on Thursday, April 9, 2015, at 5:30 pm in Courtroom 7 of the George Jaynes Justice Center in Jonesborough. Committee members attending: Commissioners McAllister being the Chair, Baker, Krieger, Light, and Storey. Others in Attendance: Ms. Michelle Stewart, Commissioner Ford, Mr. Ben Kelly and Ms. Beth Stiles representing TIS Insurance services, members of the Employee Advisory Panel including Ms. Leighta Laitinen, Ms. Sheila Hayes, and Ms. Cheri Jamerson, and many Washington County employees. Committee members absent: None Chairperson McAllister called the meeting to order at 5:30 pm and requested that all comments and questions directed to the Committee and to the representatives from TIS be related to the recommendations presented for renewing Washington County s health insurance plan. 1. Mr. Ben Kelly presented the TIS proposal for renewing Washington County s health insurance plan with Blue Cross Blue Shield of Tennessee (BCBST) see attached PPT presentation. Mr. Kelly explained that his company s recommendations are based on the goal of keeping costs as low as possible now and in the future. Mr. Kelly explained that after communicating with other insurance companies, TIS did not receive any competitive bids, but BCBST presented the best opportunity for savings. His recommendation is a modified BCBST plan in which premiums and maximum out-of-pocket costs remain the same as in the current plan. Recommendations are as follows and are explained in more detail in the PPT: a. Renew with BCBS modified plan b. Expand Health Reimbursement Arrangement (HRA) c. Renew existing dental and vision plans d. Add (optional) Telemedicine services e. Add (optional) Flexible Spending Account (FSA) f. Implement Tobacco Surcharge g. Implement spousal surcharge for spouses with access to equal or better than coverage from their own employers h. Continue to develop wellness program Commissioner Storey inquired as to what will happen next year if the Committee votes to accept these recommendations and does not address health risks/concerns of employees. Mr. Kelly Page 55 of 375

6 explained that this plan only covers claims over $6500 (as the rest of the claims are essentially self-insured through the HRA) and that lower claims may result in lower premiums next year. Mr. Kelly explained that this proposal was designed to keep as much money as possible in employees paychecks. Mr. Kelly explained that Telemedicine saves $700/claim on average. All employees family members can use telemedicine services whether they are covered by the plan or not for no copay. An employee asked how patients could get a doctor s excuse when using the Telemedicine services. An employee from the Sherriff s Department inquired about the $20 copay vs. 20% visit cost. An employee asked about whether the Telemedicine providers would have access to employees medical records/medications lists, etc., and Mr. Kelly explained that yes, the employee would have the opportunity to complete a profile with relevant information for the Telemedicine providers. The employee wanted to ensure that the provider has access to medical history before recommending any treatment. Another employee asked about prescriptions that are closely regulated (e.g., controlled substances), and Mr. Kelly explained that Telemedicine providers cannot prescribe controlled substances over the phone, especially for prescriptions that require the patient to hand deliver the prescription to the pharmacy. An employee asked about the specialist example provided in the PPT presentation, and Mr. Kelly explained that the charges are based on the cost of the visit. Another employee asked about providers that require payment at the time of the visit. Mr. Kelly explained that it varies by office, but typically, the office files the claim, and the patient receives the Explanation of Benefits (EOB) and the bill at a later date. Another employee asked if they would be able to continue seeing their same doctor(s), and Mr. Kelly explained that since TIS is recommending we stay with BCBST, the doctors will be the same. Another employee asked for justification for the co-insurance (as opposed to copay) recommendation. Mr. Kelly explained that, in some cases, the payment for a visit would be more than the current $20 copay, in some cases it would be less, but no matter what, the maximum out-of-pocket will be the same under the proposed plan as under the current plan. Discussion continued re: FSA concerns, rollover amounts, qualified expenses, etc. Chairman McAllister confirmed with Mr. Kelly that the Affordable Care Act (ACA) mandates a minimal level of coverage in the discussion re: the spousal surcharge. Tobacco use is defined by the ACA as using tobacco of any form in the past 6 months 4 or more times per week. Discussion continued re: concerns over the tobacco surcharge and participation in the cessation program (specific concerns re: employees that work night shift and may have a difficult time reaching the health coach, how the potential of ACA repeal could impact tobacco surcharges, etc.). Employees expressed concerns that some are being penalized to keep their spouse on their plans, in the event that the spouse s coverage is optimal than that provided by BCBST. In discussing the wellness program, an employee asked about the former visiting nurse program costs. Michelle explained that that cost $50,000 for employee visits/month, so the expense could not be justified, and the program was terminated Page 56 of 375

7 Commissioner Light inquired as to how leaving the $20 copay (as opposed to the recommended 80/20 co-insurance) and eliminating the recommended surcharges would affect premiums. An employee expressed concerns over the Commission s spending on other initiatives and how that spending is impacting employees. Commissioner Storey explained that spending is a balancing act. Another employee asked about the advantages of dropping the surcharges, and discussion continued re: employee concerns. A motion was made by Commissioner Storey to move the TIS proposal forward to the full Commission for discussion during the April meeting. The motion was seconded by Commissioner Baker. The Committee approved the motion on a 4-1 vote (Commissioner Light opposed). An employee encouraged the Committee to consider compensation increases. Ms. Stewart explained that the Committee needed to make several additional decisions in preparation for the insurance renewal. The first discussion addressed whether or not to continue with the current wellness program (biometric screenings, etc.). Discussion continued. Commissioner Light made a motion to continue with the BCBST wellness program as it is currently designed. The motion was seconded by Commissioner Krieger. The Committee approved the motion unanimously. The second discussion addressed renewing the current gym membership program. After discussion, Commissioner Light made a motion to continue with the gym membership program as it is currently designed. The motion was seconded by Commissioner Krieger. Discussion continued re: who is eligible for the program. The motion was amended such that Commissioners will no longer be eligible for this benefit. The Committee approved the amended motion unanimously. 2. Next meeting on Tuesday, May 12, 2015 on 5:30 pm in the 1 st floor conference room of the Historic Courthouse in Jonesborough. The meeting was adjourned at 7:10 pm Page 57 of 375

8 Washington County Employees Renewal Recommendations July 1, 2015 Prepared for Committee Discussion April 9, 2015 Renewal Recommendations 1. Renew with BCBS Modified Plan 2. Expand Health Reimbursement Arrangement (HRA) 3. Renew existing Dental and Vision Plans 4. Add Telemedicine 5. Add Flexible Spending Account (FSA) 6. Implement Tobacco Surcharge 7. Implement Spousal Surcharge 8. Continue to develop Wellness Program Page 58 of 375 1

9 Current Renewal Option 4 Annual Premium $4,164,911 $5,325,864 $3,399,678 Est. HRA Payments $360,000 $360,000 $1,499,000 Estimated HRA Admin ($3 PEPM) BCBS Option 4 $15,480 $15,480 $15,480 Est. Total $4,540,391 $5,701,344 $4,914,158 Est. Dollar Change $1,160,953 $373,767 Est. Percent Change +28% +8% BCBS Plan Ded / OOP $4,000 / $4,000 $4,000/ $4,000 $6,500 / $6,500 BCBS Plan Office Visits $20 $20 100% after Ded HRA Allocation $1,500 $1,500 $4,000 Employee Ded / OOP $750 / $2,500 $750 / $2,500 See HRA Plan Design Employee Office Visit $20 $20 See HRA Plan Design 3 How the HRA works Claim Expenses Employee Out-of-pocket BCBST pays 100% You pay $0 $6,500 $5,000 You pay 100% You pay $1,500 $0 HRA pays 80% (up to $4,000) You Pay 20% You pay $1,000 Office Visits and ER Visits covered at coinsurance instead of copay Preventative Care 100% RX: $15 Generic, $30 Preferred Brand, $50 Non-Preferred Band Not eligible for HRA Reimbursement Page 59 of 375 2

10 HRA Examples Office Visit Current Plan Physician Charge $75 Lab $125 Total $200 Less BCBS Discount $75 Total Allowed $125 Proposed Plan Physician Charge $75 Lab $125 Total $200 Less BCBS Discount $75 Total Allowed $125 Employee Pays Office Visit Copay $20 HRA Pays (80%) $100 Employee Pays (20%) $25 5 HRA Examples Specialist Office Visit Current Plan Physician Charge $225 Lab $486 Total $511 Less BCBS Discount $210 Total Allowed $301 Proposed Plan Physician Charge $225 Lab $486 Total $511 Less BCBS Discount $210 Total Allowed $301 Employee Pays Office Visit Copay $20 HRA Pays (80%) $ Employee Pays (20%) $ Page 60 of 375 3

11 HRA Examples Out Patient Service Current Plan Facility Charge $643 Physician Charge $263 Total $906 Less BCBS Discount $545 Total Allowed $361 Employee Pays $361 Proposed Plan Facility Charge $643 Physician Charge $263 Total $906 Less BCBS Discount $545 Total Allowed $361 HRA Pays (80%) $ Employee Pays (20%) $ Teladoc Teladoc does not replace primary care or emergency care. All employees and their families will have unlimited access to a physician 24/7 for minor illness and injuries. Members pay $0 for each Teladoc consult! Top Diagnosis -Sinus Problems -Urinary tract infection -Pink eye -Bronchitis -Upper respiratory infection -Nasal congestion -Allergies -Flu -Cough -Ear infection WCG Cost: $3.15 per employee per month Approximately $17,000 per year Page 61 of 375 4

12 Teladoc Teladoc is the first and largest provider of telemedicine in the US 97% Member Satisfaction 0 Malpractice Claims 100,000 + Consultations Annually 1hour Guaranteed Response Time 5 Million Members 91% Patient Issues Resolved 9 Flexible Spending Account TASC Allows employees to pay for qualified medical expenses pre-tax. $2,000 Implementation Fee $4.75 per participant ($332 per month minimum) Includes 2 free debit cards $350 Renewal Fee includes non-discrimination testing. The county saves 7.65% (FICA match) on every dollar contributed by employees to offset the administration cost Page 62 of 375 5

13 Flexible Spending Account Saves Money $$$ Without FSA With FSA Gross Income $30,000 $30,000 FSA Contributions $0 $2,000 Gross Income $30,000 $28,000 Estimated Taxes Federal/FICA 22% $6,600 $6,160 After Tax Earnings $23,400 $21,840 Eligible Medical Expenses $2,000 $0 Spendable Income Increase $ Flexible Spending Account TASC Examples of Eligible Expenses Medical Dental Vision Deductibles Fillings Exam Copays Coinsurance Crowns Prescription Glasses Rx Copays Root Canals Contacts Implants Special Testing Orthodontics Lasik Surgery Page 63 of 375 6

14 Surcharges Spousal - $50 per month for employees who cover a spouse who has access to coverage through an employer program. Excludes spouses who also work for the county. Tobacco - $25 per month for employees or covered dependents who use tobacco. Only one charge per covered employee regardless of the number of tobacco users on the plan. Employees will have access to a free tobacco cessation program through BCBS. They will not incur the surcharge if they successfully complete the program. 13 Wellness Schedule Biometric Screenings with BCBS prior to July implementation Work with Wellness Committee and BCBS to move toward a results based incentive program Page 64 of 375 7

15 Dental / Vision BCBS reduced the renewal 3%. Total increase estimated to be $35,000. Vision rates did not change. 15 Summary Office Visits / ER Visits will be at coinsurance instead of a fixed copay No first dollar deductible for eligible expenses Employee Out-of-Pocket remains at $2500 per employee / $5000 per family No premium increase to employees if surcharge(s) do not apply. Pharmacy Copays remain the same Teladoc service for minor injuries and illness at no cost to the employee Tax savings available for qualified expenses through the FSA Page 65 of 375 8

16 Questions? Ben Kelly President, Employee Benefits TIS Insurance Services, Inc Beth Stiles Account Executive TIS Insurance Services, Inc Page 66 of 375 9

17 HEALTH, EDUCATION AND WELFARE COMMITTEE Minutes April 8, 2015 Attachment: 1. Report from Environmental Court Administrator and General Welfare Officer 2. Family Justice Center overview A meeting of the Washington County Health, Education and Welfare Committee was held on Wednesday, April 8, 2015, at 5:30 pm in the conference room on the 1 st floor of the Washington County Courthouse in Jonesborough. Committee members attending: Commissioners Baker being the Chair, McAllister, Oldham and Hensley. Others in Attendance: Ms. Betty Ziesel, County Mayor Eldridge, Commissioners Meredith, Hodge and Tester, District AG Tony Clark, Circuit Court Clerk Karen Guinn, JCPD Chief Mark Sirois and Becky Haas, Coordinator JC/WC Family Justice Center Heather Brack, BOE Chair Todd Ganger, Director of Schools Ronald Dykes, Attorney Erick Herrin, Attorney Josh Hardin, Interim County Attorney Tom Seeley, Karen Sells Herald & Tribune, Jeff Keeling News and Neighbor and Roberta Chubb. Committee members absent: Commissioners Grandy Chairperson Baker called the meeting to order at 5:30pm. 1. Environmental Court monthly report Mr. Seeley submitted a monthly report from the Environmental Court Administrator and General Welfare Officer for Washington County, which included pictures. There are five zoning violation cases on April 10, 2015, docket and 12 scheduled for later in April (see attached). Discussion continued. 2. Johnson City/Washington County Family Justice Center grant Chief Sirois gave an overview of current intergovernmental partnerships relating to criminal justice: Northeast Tennessee Criminal Information Partnership a grant through the Office of Criminal Justice Partnerships in Nashville with participating agencies of JCPD, WCSO, Sullivan County Sheriff s Office, Bristol, Tennessee and ETSU Department of Public Safety assisted with excellent results in local and regional criminal investigations; the Day Reporting Center a part of the city s target crime reduction project which is a high intensity three-phase program in which felony offenders are court ordered to attend for 9 months to 1 year depending on the rate of individual program progression. Each offender must meet requirements of one phase before moving on to the next and then on to graduation. Partners in the Day Reporting Center are Frontier Health, Tennessee Department of Corrections, Alternative Community Corrections Program, Washington County Criminal Court, ETSU and UT Extension Program. Ms. Heather Brack, Coordinator of the Johnson City/Washington County Family Justice Center grant gave a PowerPoint presentation (attached) regarding domestic violence statistical information; a history of Family Justice Centers (FJC) which are comprised of agencies and service providers in one location to assist victims and families of domestic and sexual assault; a Page 67 of 375

18 Steering Committee comprised of community partners which began meeting monthly in December 2014; completion of a community needs assessment survey that was launched in December 2014 to get input from the general public, training received on the proper governance model for the local FJC, Memorandums of Understanding executed with some community partners; and discussion of Tenn. Code Ann Services to victims of certain types of crimes as a possible funding source for the FJC. Discussion continued with comments from Mayor Eldridge, District AG Clark and Circuit Court Clerk Guinn regarding collection and use of fee. Commissioner Oldham made a motion to recommend to the full commission to establish the $45.00 fee in addition to other costs pursuant to T.C.A with $3.00 going to the courts and $42 assigned to the FJC, which was properly seconded by Commissioner McAllister. Discussion continued. Following discussion, Commissioner Oldham withdrew his motion. Commissioner Baker then asked Ms. Guinn to follow up with other counties regarding the collection and use of the additional $45 fee and bring back to the May 13, 2015 meeting. 3. Continued discussion from March 23, 2015 Full Commission meeting re. Washington County Board of Education v. The City of Johnson City Attorney Hardin requested the committee to go into Executive Session to provide counsel regarding the matter. EXECUTIVE SESSION Upon reconvening, Commissioner McAllister made a motion to return the question regarding an intervening petition in the matter of Washington Count BOE vs. City of Johnson City and for Mr. Hardin to be at the full commission meeting on April 27 th, which was properly seconded by Commissioner Oldham. Upon a voice vote the motion was approved unanimously. 4. Chairperson Baker then stated Mr. Seeley, Ms. Stewart and Ms. Hagaman have met and have another meeting scheduled later this month regarding Washington County s Local Prescription for Success and drug-free workplace program. Discussion will continue at the May 2015 meeting. 5. Applications regarding appropriations to non-profit agencies have been submitted. The committee will review applications and prepare a recommendation to the full commission regarding funding amounts. 6. Being no further business, the meeting adjourned at 7:03pm. Respectfully submitted, Roberta Chubb, CP Page 68 of 375

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