SCHOOLS HEALTH INSURANCE FUND OPEN MINUTES May 23, 2018 MOORESTOWN COMMUNITY HOUSE 12:00 PM

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1 SCHOOLS HEALTH INSURANCE FUND OPEN MINUTES May 23, 2018 MOORESTOWN COMMUNITY HOUSE 12:00 PM Meeting of Board of Trustees called to order by Chair Collins Open Public Meetings notice read into record. PLEDGE OF ALLEGIANCE ROLL CALL OF BOARD OF TRUSTEES: Trustee BOE Joseph Collins Delsea Regional BOE Chairman Present Beth Ann Coleman Collingswood BOE Secretary Present Lisa Giovanelli Rancocas Valley BOE Present Michael Colling Medford Lakes BOE Present Christopher Lessard Frankford Township BOE Present Christopher Destratis Swedesboro-Woolwich BOE Absent Evon Digangi Mount Holly BOE Absent Jim Sekelsky Hardyston Township BOE Present Nicholas Bice Burlington Township BOE Present Marie Goodwin Medford Township BOE Present Christina Moskal Ewing Township BOE Present PRESENT FUND PROFESSIONALS: FUND ADMINISTRATOR: PROGRAM MANAGER: FUND ATTORNEY: FUND TREASURER: FUND ACTUARY: PRESCRIPTION ADMIN: MEDICAL TPA AMERIHEALTH: PERMA Risk Management Paul Laracy Emily Koval Karen Kamprath Conner Strong & Buckelew Brandon Lodics Jozsef Pfeiffer Ken Harris Lorraine Verrill Absent Absent Mike Murphy

2 MEDICAL TPA AETNA: MEDICAL TPA HORIZON: Joe Rodrigues Michelle Witherspoon ALSO PRESENT Scott Davenport, Conner Strong & Buckelew Carrie Specht, Assure Partners John Recchinti, Evesham BOE Rob Wachter, Mount Laurel Frank DeBerardinis, Voorhees Township Joanne D Angelo, Moorestown John Cobb, JCobb Insurance Greg Grimaldi, Conner Strong & Buckelew Chuck Grande, Integrity Consulting Group Anthony Tonzini, Integrity Consulting Group Dina Murray, Allen Associates Susan Jarnigan, AJG Joe Madera, Hardenbergh Insurance Susan Morris, Conner Strong & Buckelew Ms. Koval said 31 ballots were received and the results of the election are as follows: Joseph Collins, Chair Beth Ann Coleman, Secretary Trustees Lisa Giovanelli Michael Colling Christopher Lessard Christopher Destratis Evon Digangi Jim Sekelsky Nicholas Bice Marie Goodwin Christina Moskal Jason Schimpf Frank Deberardinis Chair Collins thanked everyone for their continue participation and everyone will be sworn in at the July meeting. APPROVAL OF MINUTES: March 28, 2018 Open MOTION TO APPROVE OPEN MINUTES OF MARCH 28, 2018 Moved: Second: Vote: Trustee Coleman

3 CORRESPONDENCE None PUBLIC COMMENT None EXECUTIVE DIRECTORS REPORT FINANCIAL FAST TRACK as of March 31, 2018 Executive Director said the surplus for all years combined is slightly less than $53 million. He said the IBNR went from $15.4 million to over $20 million due to Fund growth as well as a lag in AHA claims. ORGANIZATIONAL RESOLUTIONS Executive Director said the current contracts expire on December 31, Our original RFP process was for 3 years starting on 1/1/2016. The new RFP process will be for a 2.5 year term so the contracts will be conterminous with the fiscal year that the Fund operates under. Executive Director said because the Aetna appointment will exceed $2 million, we have provided a separate resolution and a certification that the contract is an extraordinary unspecifiable service. This is being done to allow for the filing of these documents with the Office of the State Comptroller Executive Director said the Risk Management Plan contains updated factors for claims ceded to the Municipal Reinsurance Health Insurance Fund as well as a new section which allows for small claims committee review of certain enrollment adjustments. Executive Director said there was one additional change to Resolution He said Brown & Brown worked to standardize their fees to $48.53 pepm. In response to Trustee Colling, Executive Director said the Kingsway fee is correct. In response to the non-solicitation clause should be removed from the BRM agreement and an updated version will be distributed. In response to Trustee Sekelsky, Executive Director said Conner Strong & Buckelew represents the Fund as the Program Manager and subcontracts with outside Brokers for field services at the discretion of the individual entity. In response to Trustee Sekelsky, Executive Director said he does not recall there being a conflict with voting. Ms. Koval noted there was a typo on resolution 9-18 and the Attorney fees should read $17, and the resolution will be amended accordingly. EXPRESS SCRIPTS OPIOID PROGRAM Executive Director said it is being recommended that all HIFs implement ESI s opioid program in addition to the fraud waste and abuse program. This program seeks to reduce opioid abuse and addiction by limiting dosages, identifying and correcting drug seeking behavior, using prior authorizations, and encouraging safe disposal of unused opioids. The annual cost of the program is $22,606. However, from a budgeting standpoint, the net cost is $7,193 because of overall reductions in the cost of ESI s utilization management program as a result of improved contract terms. This is

4 recommended as a safety and disease management program and does not come with a guaranteed return on investment. However, we also expect reduced spending on opioids and the costs attendant to the overuse of these drugs. MOTION TO APPROVE THE IMPLEMENTATION OF THE EXPRESS SCRIPTS OPIOID PROGRAM: Moved: Second: Vote: Trustee Sekelsky WELLNESS AND CLAIMS COMMITTEE Ms. Koval said the Wellness Committee met last week to review the grant application. The recommended application was included in the agenda. The application will be distributed to all member brokers by May 30. The Wellness Committee will be asked to review the request responses for approval at the July meeting. Ms. Koval said the current amount budgeted will only be available to the current membership. MOTION TO APPROVE THE WELLNESS GRANT APPLICATION: Moved: Second: Vote: Trustee Sekelsky PROGRAM MANAGER S REPORT KENNEDY: CAMDEN GLOUCESTER COUNTIES Program Manager said Aetna is in active negotiations with Kennedy Hospital. The term date of this contract has been extended to 6/30/18 from 4/30/18. Aetna is confident that an agreement will be made. LOURDES-VIRTUA MERGER Program manager said there are no further update at this time. NEGOTIATIONS WITH ADVOCARE Program Manager said Advocare has sent a letters to its members advising they will not accept any new patients who are insured with Aetna. There is a provision in the providers PCP contract that allows freezing of their panel of patients. As of now, Advocare is still an Aetna participating provider. To date, we have had only one call from membership experiencing an issue with obtaining a new Advocare PCP. He said this will not impact current Advocare patients who are joining Aetna for the first time. NATIONAL PREFERRED FORUMLARY UPDATES Program Manager said ESI has informed us that the National Preferred Formulary Guide (NPF) is being updated effective the following 33 medications will be added to the list of excluded medications. An updated list of all excluded medications is included in the agenda.

5 MEMBER IMPACT % of members will not see any changes to their drug coverage. - Approximately 84 SHIF members will be impacted by the formulary update. o These individuals will be receiving a notification letter that has been included in your packet roughly 30 days prior to implementation - Of the 33 products being added to the exclusion list, 30 are multi-source brands, products with generic equivalents. The remaining 3 drugs are high-cost combination drugs with lower-cost generic or over-the-counter options. - Impacted members will receive a customized letter (sample included with the agenda) - Members who cannot tolerate the suggested alternative (or generic version) have the option of having their provider request a clinical exception with ESI. SAVEON SAVINGS UPDATE Program Manager said Effective January 1, 2018 the SHIF implemented the SaveOn Copay Assistance program. SaveOn works directly with members to enroll them in manufacturer based rebate programs allowing the member to receive a $0 copay on their medication and the fund to receive the balance of the manufacturer rebate. Most drugs impacted are high cost specialty medication. The most current data available through the end of March indicates the SHIF has a net savings of $105,699. RITE AID WALGREENS MERGER Program Manager said the majority of the SHIF is not impacted by the merger, however certain groups have larger member disruption than others. Though the SHIF as a whole does not need to take action, we are currently working with groups on an individual basis. We feel it is reasonable to allow groups with larger than 15% member disruption to move to the larger pharmacy network at no additional cost. To date, Califon BOE has moved off the Prime Network given its rural location and highest disruption (greater than 25% of membership impacted).

6 PLAN DESIGN CHANGES Program Manager said several groups made plan changes for open enrollment. Group Current Census Plan Request Financial Impact Effective Black Horse Pike Regional 387 Remove Gate Keeper, increase vision hardware reimbursement Mt Holly BOE 117 Add new QPOS $15 as part of negotiations Rancocas Valley High School 175 Add new Virtua ACO Tiered Network Product Lower Alloways Creek 24 Increase copays on HMO and PPO plan, add three new low cost options as part of contract negotiations Woodstown Pilesgrove 160 Add new optional PPO plan East Greenwich BOE 121 Add three new custom plans as part of contract negotiations Chatham BOE 406 Adjust fee schedule from SHIF standard to 80% of Fair Health 3% Rate Increase Watchung Hills Regional High 216 Adjust fee schedule from SHIF standard to 80% of Fair Health School 3% Rate Increase MOTION TO APPROVE ADMINISTRATIVE PLAN DESIGN ADDITIONS AND OR CHANGES AS DESCRIBED: Moved: Second: Vote: Trustee Lessard Trustee Sekelsky DOMESTIC PARTNERSHIP Program Manager said New Jersey had a domestic partnership act that became effective on July 10, 2004 and was amended by the Civil Union Act implemented on February 19, Under the original Domestic Partnership Act, same-sex couples age 18 or older and opposite-sex couples age 62 or older had to meet the requirements of the Act to register a Domestic Partnership. The implementation of the Civil Union Act amended this requirement so that effective February 19, 2007, same-sex or opposite-sex couples must be age 62 or older and meet the remaining eligibility requirements of the Domestic Partnership Act to register as Domestic Partners. Domestic Partnerships registered prior to February 19, 2007 are still valid and are afforded the rights and benefits of Domestic Partners. He said the Fund does not cover domestic partnerships unless a separate resolution is passed. Fund Attorney said an affidavit of domestic partnership would have to be filed with the municipality. ADMINSTRATIVE AUTHORIZATIONS Type Reason/Description Outcome Prescription Medical Necessity Denial Overturned Prescription Medical Necessity Denial Overturned Medical Medical Necessity Denial Upheld Medical Medical Necessity Denial Overturned

7 Prescription Medical Necessity Denial Upheld OPEN ENROLLMENT SHIF conducted its 2018 Spring Open Enrollment from Friday April 27 th Friday May 18 th. As a reminder, all enrollments must be entered into Benefit Express online enrollment system by Friday May 25 th. Open Enrollment changes not entered by the deadline can result in the delay in ID cards. This was the first year we conducted an electronic open enrollment and received positive feedback from a majority of groups, moving forward we will continue to distribute open enrollment materials electronically. ONLINE ENROLLMENT SYSTEM TRAINING The Executive Committee voted and approved mandatory use of the online enrollment system by each member group. If you need training or would like a refresher course on the online enrollment system, please reach out to Karen Kidd at kkidd@permainc.com of PERMA. CONTACT INFORMATION Please direct any eligibility, enrollment, billing or system related questions to our dedicated SHIF Team. The team can be reached by at cs.mb.shifenrollments@permainc.com or by fax at MONTHLY BILLING As a reminder, please be sure to check your monthly invoice for accuracy. If you find a discrepancy, please report it to the SHIF enrollment team. The Fund s policy is to limit retro corrections, including terminations, to 60 days. We have noticed an increase in requests for enrollment changes, billing changes, terminations and additions well past the 60 day time frame. Moving forward, it is of the utmost importance to review bills for rate and enrollment accuracy on a monthly basis. If there is an error, please bring it to the enrollment team s attention. BROKER CONTACT INFORMATION Please direct any escalated claims, benefit coverages, prescription coverage, or appeal related questions to our dedicated SHIF Client Servicing Team. The team can be reached by at brokerservices@permainc.com. ID CARDS As a reminder, PERMA no longer has direct carrier system access to order ID cards for members. We wanted you to be aware of the following carrier contact numbers members can call to request additional ID cards if needed. o Aetna ID cards: o Express Scripts ID cards: o Delta Dental: o AmeriHealth Admin (non referrals):

8 MEMBER COMPLAINT Program Manager said a formal complaint was filed against AmeriHealth because of an Out of Network reimbursement lag. He said they have resolved this issue with the individual and continue to work with AmeriHealth to monitor the situation. IRS NEW 2018 HSA CONTRIBUTION LIMIT REVERSED Program Manager said the IRS recently reversed the reduction in the 2018 annual maximum family HSA contribution from $6,850 back to $6,900. TREASURER The bills list and Treasurer s report was included in the Agenda. Confirmation of Payment April 2018 FUND YEAR AMOUNT FUND YEAR 2017/2018 $4,599, TOTAL ALL FUND YEARS $4,599, Confirmation of Voided Payment April 2018 FUND YEAR AMOUNT FUND YEAR CLOSED -$15, TOTAL ALL FUND YEARS -$15, RESOLUTION # MAY 2018 BILLS LIST FUND YEAR AMOUNT FUND YEAR 2017/2018 $1,700, TOTAL ALL FUND YEARS $1,700, MOTION TO APPROVE RESOLUTION THE APRIL AND MAY 2018 BILLS LIST AND TREASURERS REPORT AS PRESENTED: MOTION: SECOND: VOTE: Trustee Colling FUND ATTORNEY Fund Attorney said CMS has issued guidance that states in 2020 individual states will be allowed to change the essential health benefits in the aca type insurance policies. AETNA Ms. Dennison said the average pepm for February was $1, 198 and $997 in March. She said there were 11 high claims in February and only 6 in March. She said the dashboard report has been updated to include teledoc statistics. She said 125 members used teledoc in Q1 which equates to a net savings of about $19,000. She said all of the performance metrics were met for Q1. AMERIHEALTH Mr. Murphy reviewed the claims through April He said the pepm is $740 but they expect that to increase as the come out of the claims lag. He said they are currently tracking 3 large claimants for April. He reviewed the dashboard report and noted an average speed of answer of 11 minutes and abandonment rate of 32%. He said they were initially satisfied with the claims migration, however a few issues arose. He said the claims backlog increased, and has been addressed

9 with system adjustments and additional staffing. He said as of May 1 they have seen a decrease in call times and backlog. He said they also initiated a benefit audit through June 2017 to make sure claims are being processed correctly. He said as of May 31 they intend to have the OON issues resolved. HORIZON- None EXPRESS SCRIPTS None DELTA None CONSENT AGENDA- MOTION TO APPROVE THE CONSENT AGENDA AS DISCUSSED WITH AMENDMENTS TO RESOLTUIONS 9-18 AND 18-18: MOTION: SECOND: VOTE: Trustee Colling OLD BUSINESS: None NEW BUSINESS: None PUBLIC COMMENT: Mr. Finn said there was no discussion about plan design changes at the SHBP meeting. He said they are also dealing with the court decision which agreed with ESI that the Optum contract was awarded incorrectly. MOTION TO ADJOURN: MOTION: SECOND: VOTE: Trustee Coleman Trustee Di Gangi MEETING ADJOURNED: 1:00 pm NEXT MEETING: July 25, 2018 Moorestown Community House 12:00pm Karen Kamprath, Assisting Secretary Date Prepared: June 6, 2018