SELF-FUNDED PPO HEALTH PLAN RATE REQUIREMENTS RETIREES JANUARY 1, 2017 DECEMBER 31, 2017 COUNTY OF ORANGE JUNE 2016

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1 SELF-FUNDED PPO HEALTH PLAN RATE REQUIREMENTS RETIREES JANUARY 1, 2017 DECEMBER 31, 2017 COUNTY OF ORANGE JUNE 2016 Page 1 of 12

2 CONTENTS 1. Introduction Rate Adjustment Reserve Fund Exhibits...6 Page 2 of 12

3 1 Introduction Based on the past twelve months of claims data for retirees and annual trends of 7.0% for medical and 10.0% for prescription drug, Mercer recommends the current rate levels for the Wellwise Retiree and Sharewell Retiree plans be increased by 12.4% on average (with rate adjustments varying by enrollment tier and plan) for the plan year effective January 1, Mercer is recommending application of separate rate adjustments by plan and coverage tier to improve consistency and reasonability, better align plan values (including Medicare offsets) and better accommodate Medicare Part D subsidy credits. To allocate the increase across retiree rates by enrollment tier and plan Mercer considers the following factors: The value of the plan design differential between Wellwise Retiree and Sharewell Retiree The value of Medicare for Medicare eligible retirees Claim utilization experience for Wellwise Retiree and Sharewell Retiree participants (Medicare and non-medicare) Number of retirees in the Wellwise and Sharewell plans to determine if claims experience is credible Appropriateness of rates compared to other plans offered to retirees Appropriately apply Medicare Part D subsidy credits This proposed rate action of 12.4% (in addition to the rate adjustment made for active employees) should result in a projected fund balance of $22,000,000 to $24,000,000 as of December 31, This projected fund balance is for both active and retired employees and is above the fund balance necessary to cover all incurred but not reported claims (the IBNR should the County terminate the self-funded arrangement of these plans) and the cost of administering these claims. We recommend the County continue the self-funded arrangement of these plans. The low administrative expense, cash flow available to the County, and flexibility of this funding arrangement make self-funding the most advantageous funding vehicle available for these plans. In addition, self-funded plans are not subject to the health insurer fee under the Affordable Care Act (insurer fee not applicable in 2017 due to moratorium). Page 3 of 12

4 2 Rate Adjustment The most recent twelve months of experience are totaled using paid claims of retired employees from May 1, 2015 through April 30, 2016 as the beginning claims cost. These paid claims are adjusted to incurred claims by lagging enrollment by 2 months for medical claims and 1 month for pharmacy claims. This adjusts for the change in the IBNR claim reserve liability from the beginning of the experience period to the end reflecting changes in paid claim patterns and enrollment. The result is an estimate of retiree claims that were actually incurred from May 1, 2015 through April 30, These incurred claims are then projected to 2017 levels using annual cost trend assumptions of 7.0% for medical and 10.0% for pharmacy. These trend levels are based on a combination of historic County medical and prescription drug claim experience of the self-funded plans and general industry trend factors used by similar plan sponsors. The medical and pharmacy trends are consistent with the trends used in the 2016 self-funded projections. National health trends provided by the major insurance carriers for 2016 are at 4.5% - 9% for PPO plans and 9% - 14% for prescription drug card programs. The County s own trend outlook may be viewed more favorably than survey data based on better PPO network discounts and historic claims experience that has outperformed insurance carrier trend rates. Self-funded employers similar to the County have generally been using trend factors in the range of 4% - 10% for projection purposes. There were no adjustments to incurred claims as there were no plan changes during the experience period. A claim credit was applied in the amount of $1,058,000 for the estimated Medicare Retiree Drug Subsidy for We recommend the County continue to apply for the Medicare Retiree Drug subsidy. Additionally, the pharmacy rebate expected in 2017 was applied proportionately to active employees and retirees. The Patient Protection and Affordable Care Act (PPACA) transitional reinsurance fees sunset in 2016, so these fees are not included in the 2017 budget projection. An administration adjustment was applied to the projected claims for claims administration; utilization review, case management, disease management, and PPO network access fees. Administration also reflects the claims administration fees associated with the pharmacy contract with OptumRx. Page 4 of 12

5 The overall 2017 premium needed is compared to the 2016 premium to determine the rate increase of 15.2%. However, Mercer recommends a 12.4% increase on average, with rate adjustments varying by enrollment tier and plan. The recommended renewal increase of 12.4% assumes no buy-down on the fund balance; however, the typical 2.5% claim fluctuation margin which covers the variability high cost claims was removed Renewal Adjustments* Pre-65 Post-65 Wellwise 12.0% 10.0% Sharewell 12.0% 22.0% Overall 12.4% *Actual change may vary based on number of dependents and their Medicare status There are a few elements that contributed to this recommended adjustment, but the main driver is unfavorable claims experience over the past 12 months. The exhibits at the end of the report provide the details to the rate calculation: Exhibit I Exhibit II Exhibit III Provides the details of the rate calculation Presents the premium and paid claims by month Details the enrollment by plan Page 5 of 12

6 3 Reserve Fund The County maintains a surplus of revenue over expenses called the Fund Balance. Based on Mercer and County staff recommendations, and as determined by the Board of Supervisors, the Fund Balance: 1. Acts as a Premium Stabilization Reserve (PSR), to serve as a hedge against unfavorable claim fluctuations and to absorb unusually high individual claims that may emerge from time to time 2. Funds Incurred But Not Reported (IBNR) claim reserves, claims incurred prior to a potential termination of the plan or portion of the plan. Mercer recommends the Self-Funded PPO reserve target be set to cover 100% of the IBNR reserve and an additional amount as a Premium Stabilization Reserve (PSR). The IBNR reserve is estimated to be 15% of the annual projected claims and the basis for the PSR component is 15% of projected annual claims. Therefore, Mercer continues to target reserve level of 30% of annual claims, with a margin of +/- 3% to accommodate fluctuations in experience consistent with the target policy established by the Board of Supervisors in 2011 for the Self-Funded PPO reserve. The recommended target reserve level for 2017 is $20,000,000. The reserve has grown this year due to enrollment migration into the Sharewell PPO plan which results in lower monthly claim costs. The current fund balance is approximately $25,000,000, $5,000,000 above the 2017 target fund level. The proposed active rates include a reduction in the fund balance, equivalent to about $1,500,000, with the strategy to gradually reduce the fund balance to the target level over the next three years. The reduction is anticipated to leave an estimated balance of $22,000,000 to $24,000,000 as of December 31, While the Fund Balance is expected to drop, the estimated balance is still above the target reserve level providing some margin for unexpected claim fluctuation volatility and unforeseen catastrophic claims. These are estimates based on the current benefit plans remaining in place and assume a continuation of current enrollment levels and emerging claims experience consistent with projections. Page 6 of 12

7 While the IBNR reserve covers the claims runout for claims incurred but not yet paid, the PSR is used to smooth out premium increases from year to year caused by unfavorable claims fluctuations. A reasonable PSR level for an ongoing self-funded program should represent about 15% of expected annual claim cost, which translates to approximately $10,000,000 for the County s programs (actives and retirees combined) as of December 31, Any projection of the expected fund balance as of December 31, 2016 or 2017 is subject to considerable fluctuation due to changing claim trends and utilization patterns as well as the timing of payments from the fund. All estimates are based upon the information available at a point in time, and are subject to unforeseen and random events. Therefore, any projection must be interpreted as having a likely range of variability from the estimate. Any estimate or projection may not be used or relied upon by any other party or for any other purpose than for which it was issued by Mercer. Mercer is not responsible for the consequences of any unauthorized use Page 7 of 12

8 4 Exhibits Page 8 of 12

9 Exhibit I County of Orange Most Recent 12 s Experience 2017 PPO Budget Projection Experience Period: May 1, April 30, 2016 Projection period: January 1, December 31, 2017 Wellwise Pre-65 Wellwise Post-65 Sharewell Pre-65 Sharewell Post-65 Overall Medical Paid Claims $1,537,956 $5,224,508 $5,697,410 $3,036,632 $15,496,507 Pharmacy Paid Claims $174,236 $5,468,912 $717,356 $468,184 $6,828,688 Total Claims $1,712,192 $10,693,420 $6,414,766 $3,504,816 $22,325,195 Average Enrollment 66 1, ,704 Claims Per Capita $2,169 $629 $751 $573 $688 Current Enrollment 60 1, ,701 Adjusted Claims $1,561,682 $10,682,265 $6,458,761 $3,497,944 $22,200,653 Combined Trend Margin Adjusted Projected Incurred Claims $1,821,245 $12,680,879 $7,535,568 $4,085,003 $26,122,696 Health Care Reform / Reinsurer Fee $0 $0 $0 $0 $0 Less: Rx Rebates ($13,514) ($424,179) $0 $0 ($437,693) Less: Part D Subsidy $0 ($1,058,011) $0 $0 ($1,058,011) Administration $30,078 $709,347 $335,040 $237,846 $1,312, Premium $1,837,809 $11,908,037 $7,870,608 $4,322,848 $25,939, Premium $1,418,053 $10,972,146 $6,973,115 $3,143,717 $22,507, Increase 29.6% 8.5% 12.9% 37.5% 15.2% Without 2.5% Margin 2017 Premium $1,793,389 $11,598,747 $7,686,814 $4,223,214 $25,302, Increase 26.5% 5.7% 10.2% 34.3% 12.4% Recommended Increase 2017 Premium $1,588,220 $12,069,361 $7,809,889 $3,835,335 $25,302, Increase 12.0% 10.0% 12.0% 22.0% 12.4% All estimates are based upon the information available at a point in time, and are subject to unforeseen and random events. Therefore, any projection must be interpreted as having a likely range of variability from the estimate. Any estimate or projection may not be used or relied upon by any other party or for any other purpose than for which it was issued by Mercer. Mercer is not responsible for the consequences of any unauthorized use Page 9 of 12

10 Exhibit II WellWise Loss Enrollment Premium Medical Rx Claims Ratio May-15 1,485 $1,007,890 $419,914 $438,984 $858,898 85% Jun-15 1,486 $994,743 $910,849 $460,752 $1,371, % Jul-15 1,483 $994,377 $488,240 $463,210 $951,450 96% Aug-15 1,486 $995,890 $1,084,050 $465,097 $1,549, % Sep-15 1,485 $996,638 $662,897 $520,974 $1,183, % Oct-15 1,479 $984,971 $368,718 $478,586 $847,304 86% Nov-15 1,475 $988,651 $678,885 $457,637 $1,136, % Dec-15 1,472 $984,344 $614,732 $500,310 $1,115, % Jan-16 1,472 $1,032,532 $397,414 $456,512 $853,926 83% Feb-16 1,472 $1,033,540 $315,691 $437,034 $752,725 73% Mar-16 1,468 $1,029,686 $425,918 $507,644 $933,562 91% Apr-16 1,475 $1,032,517 $395,158 $456,408 $851,566 82% May-15 to Apr-16 17,738 $12,075,780 $6,762,464 $5,643,148 $12,405, % Sharewell Loss Enrollment Premium Medical Rx Claims Ratio May-15 1,234 $750,332 $728,471 $75,965 $804, % Jun-15 1,228 $747,316 $745,690 $84,475 $830, % Jul-15 1,226 $744,180 $818,766 $100,734 $919, % Aug-15 1,227 $743,023 $397,961 $104,015 $501,976 68% Sep-15 1,233 $744,652 $837,811 $123,304 $961, % Oct-15 1,234 $744,929 $574,929 $146,200 $721,129 97% Nov-15 1,233 $742,574 $559,534 $145,202 $704,735 95% Dec-15 1,225 $737,775 $820,864 $169,430 $990, % Jan-16 1,200 $827,121 $890,048 $100,572 $990, % Feb-16 1,204 $826,168 $961,287 $11,027 $972, % Mar-16 1,205 $829,345 $652,913 $42,832 $695,745 84% Apr-16 1,226 $843,069 $745,769 $81,784 $827,553 98% May-15 to Apr-16 14,675 $9,280,485 $8,734,043 $1,185,540 $9,919, % WellWise & Sharewell Combined Loss Enrollment Premium Medical Rx Total Ratio May-15 2,719 $1,758,222 $1,148,384 $514,949 $1,663,333 95% Jun-15 2,714 $1,742,060 $1,656,540 $545,227 $2,201, % Jul-15 2,709 $1,738,557 $1,307,006 $563,944 $1,870, % Aug-15 2,713 $1,738,913 $1,482,011 $569,112 $2,051, % Sep-15 2,718 $1,741,291 $1,500,708 $644,279 $2,144, % Oct-15 2,713 $1,729,901 $943,646 $624,786 $1,568,433 91% Nov-15 2,708 $1,731,225 $1,238,418 $602,838 $1,841, % Dec-15 2,697 $1,722,119 $1,435,596 $669,740 $2,105, % Jan-16 2,672 $1,859,654 $1,287,462 $557,084 $1,844,546 99% Feb-16 2,676 $1,859,708 $1,276,977 $448,061 $1,725,039 93% Mar-16 2,673 $1,859,031 $1,078,831 $550,476 $1,629,307 88% Apr-16 2,701 $1,875,586 $1,140,927 $538,193 $1,679,120 90% May-15 to Apr-16 32,413 $21,356,264 $15,496,507 $6,828,688 $22,325, % Page 10 of 12

11 Exhibit III Wellwise Retiree Enrollment 2015 Sharewell Retiree Enrollment Jan-15 1,497 Feb-15 1,491 Mar-15 1,492 Apr-15 1,507 May-15 1,485 Jun-15 1,486 Jul-15 1,483 Aug-15 1,486 Sep-15 1,485 Oct-15 1,479 Nov-15 1,475 Dec-15 1,472 Jan-15 1,192 Feb-15 1,196 Mar-15 1,193 Apr-15 1,226 May-15 1,234 Jun-15 1,228 Jul-15 1,226 Aug-15 1,227 Sep-15 1,233 Oct-15 1,234 Nov-15 1,233 Dec-15 1,225 Wellwise Retiree Enrollment 2016 Sharewell Retiree Enrollment Jan-16 1,472 Feb-16 1,472 Mar-16 1,468 Apr-16 1,475 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-16 1,200 Feb-16 1,204 Mar-16 1,205 Apr-16 1,226 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Page 11 of 12

12 Mercer Health & Benefits LLC Von Karman Avenue, Suite 1100 Irvine CA Page 12 of 12

SELF-FUNDED PPO HEALTH PLAN RATE REQUIREMENTS RETIREES JANUARY 1, 2018 DECEMBER 31, 2018 COUNTY OF ORANGE JUNE 2017

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