Benefits. May 9, 2017 Benefits Partnership Conference

Transcription

1 Benefits John Servais, SVP, Benefits Policy and Design Andrea Still, VP, Benefits Policy and Design Emily Craig, Account Manager, Anthem National Accounts May 9, 2017 Benefits Partnership Conference

2 Agenda Updates across the benefits spectrum Health Medical Trust and Anthem Welfare Life and Disability Pension Defined Benefit and Defined Contribution Q&A / Discussion 2

3 Health: Medical Trust

4 Affordable Care Act 4

5 Plan Array Process Evaluate Analyze Monitor Educate Encourage Assess Strategize 5

6 Plan Array Strategy Our shared goal is an overall smarter healthcare program Meaningful choice, delivered more cost-effectively 2017 to 2018 = transition period Simplification, clarification, and modernization lead the way Allow employers two years to transition to the final plan array Beyond 2018 Focus on healthcare consumerism and program changes Navigator, Concierge, and Decision Support Services 6

7 2018 Plan Array: Simplification Network PPO Plans PPO Plans HSA Option Plan Type Platinum PPO 100 Platinum PPO 90 Gold PPO 80 Silver PPO 70 Gold CDHP 15 Silver CDHP 20 Bronze CDHP 40 Network Coinsurance 0% 10% 20% 30% 15% 20% 40% Individual Deductible* $0 $500 $1,000 $3,500 $1,400 $2,700 $3,500 Family Deductible* $0 $1,000 $2,000 $7,000 $2,800 $5,450 $7,000 Individual Maximum Out of Pocket** $2,000 $2,500 $3,500 $5,000 $2,400 $4,200 $6,000 Family Maximum Out of Pocket** $4,000 $5,000 $7,000 $10,000 $4,800 $8,450 $12,000 Primary Care Physician $30 $30 $30 $30 15% 20% 40% Specialist $45 $45 $45 $45 15% 20% 40% Emergency Room $250 $250 $250 $250 15% 20% 40% Urgent Care $50 $50 $50 $50 15% 20% 40% Outpatient Facility $200 10% 20% 30% 15% 20% 40% Inpatient Facility $250 10% 20% 30% 0% 20% 40% Pharmacy Retail Copay See pharmacy section 15%/25%/50% 15%/25%/50% 15%/25%/50% *CDHP plans combined medical and pharmacy deductible; PPO plans pharmacy will not count towards annual deductible. **Out of Pocket Maximum combines network medical, behavioral, and pharmacy. 7

8 2018 Plan Array: Simplification Non-Network PPO Plans PPO Plans HSA Option Plan Type Platinum PPO 100 Platinum PPO 90 Gold PPO 80 Silver PPO 70 Gold CDHP 15 Silver CDHP 20 Bronze CDHP 40 Non-Network Coinsurance 50% 50% 50% 50% 50% 50% 50% Individual Deductible* $500 $1,000 $2,000 $7,000 $2,800 $3,000 $7,000 Family Deductible* $1,000 $2,000 $4,000 $14,000 $5,600 $6,000 $14,000 Individual Maximum Out of Pocket** $4,000 $5,000 $7,000 $10,000 $4,800 $7,000 $10,000 Family Maximum Out of Pocket** $8,000 $10,000 $14,000 $20,000 $9,600 $13,000 $20,000 *CDHP plans combined medical and pharmacy deductible; PPO plans pharmacy will not count towards annual deductible. **Out of Pocket Maximum combines network medical, behavioral, and pharmacy. 8

9 2018 Plan Array: Focus on PPO Pharmacy 2017 Pharmacy Designs (non-cdhp and non-kaiser plans) Annual Prescription Deductible Annual Out-of-Pocket Maximum Copays/Coinsurance Tier 1: Generic Copays/Coinsurance Tier 2: Formulary Copays/Coinsurance Tier 3: Non-formulary Dispensing Limits per Copayment Standard Plan Premium Plan Retail Mail Order Retail Mail Order $50 per person None $50 per person None $2,500 individual/$5,000 family in-network $2,500 individual/$5,000 family out-of-network (accumulates separately from the medical benefit) Up to $10 Up to $25 Up to $5 Up to $12 Up to $35 Up to $90 Up to $25 Up to $70 Up to $60 Up to $150 Up to $45 Up to $110 Up to a 30-day supply Up to a 90-day supply Up to a 30-day supply Up to a 90-day supply 9

10 2018 Plan Array: Focus on PPO Pharmacy 2018 Pharmacy Designs (non-cdhp and non-kaiser plans) Annual Prescription Deductible Annual Out-of-Pocket Maximum Copays/Coinsurance Tier 1: Generic Copays/Coinsurance Tier 2: Formulary Copays/Coinsurance Tier 3: Non-formulary Dispensing Limits per Copayment Standard Plan Premium Plan Retail Mail Order Retail Mail Order None remove requirement Combined with medical and behavioral out-of-pocket Up to $10 Up to $25 Up to $5 Up to $12 Up to $40 Up to $100 Up to $30 Up to $75 Up to $80 Up to $200 Up to $60 Up to $150 Up to a 30-day supply Up to a 90-day supply Up to a 30-day supply Up to a 90-day supply 10

11 2018 Plan Array: Plan Migration Cigna OAP IN Anthem High Option UHC Choice Plus Cigna OAP Anthem PPO 90/70 Anthem PPO 80/60 Anthem EPO 90 Anthem EPO 80 Anthem PPO 75/50 Anthem PPO 70 SLV PPO 100 PPO 90 PPO 80 PPO 70 11

12 2018 Plan Array: Plan Migration to PPO90 (Member OOP Change Impact Illustrations) Anthem PPO 90/70 and Anthem EPO 90 Low Medium High Maternity Cancer $35 $355 $580 $620 $800 $900 $580 $620 $800 $900 12

13 2018 Plan Array: Plan Migration to PPO90 (Member OOP Change Impact Illustrations) Cigna OAP, Anthem PPO 80/60, and Anthem EPO 80 Low Medium High Maternity Cancer $35 $55 ($20) $20 $150 $250 ($20) $20 $150 $250 13

14 A Smarter Healthcare Program Consistent member experience Enables members to make informed and ideal healthcare decisions so they may: Access the right care at the right place at the right time Ensures quality, effective outcomes Creates better ways to spend and contain costs Streamlines medical necessity review and promotes evidence-based decisions on value and quality

15 Plan Array: Insight into What We re Evaluating What is my course of treatment? How do I know it is the most optimal one? I m not just my knee/back. Is anyone looking at me holistically? Who do I see? Where do I go? How about quality? My back/knee hurts, what do I do next?

16 Plan Array: Dental Dental Overall Network Growth Plan Design Evaluation Dental HMO Wellness Program incentivize behavior 16

17 Plan Array: Dental Network Five year growth 152,000 unique DPPO providers with 380,000 access points Seven in 10 new network dentists come from client requests Plan Design Current offering Design/behavior mismatches Considering a Dental HMO Wellness Dental Wellness Plus Prevention Incentives Earn increased coverage for next year by getting recommended care 17

18 Plan Array: Vision Eye Med Utilization Exams 26% and Materials 37% 78% glasses (9% higher than average) 43% progressive lenses (11% higher than average) Plan Design $130 Frame/Lens allowance annually Network Access 97% in-network (40% retail) 18

19 Plan Array: Vision ACCESS America s largest vision network** Greatest level of access with more independent providers INSIGHT Slightly smaller vision network Cost controls on progressives to reduce out-of-pocket costs PROVIDERS LOCATIONS PROVIDERS LOCATIONS 81,900 26,900 71,400 22,500 Independent 80% Independent 78% Retail 20% Retail 22% Urban access (2 locations within 10 miles) 99.9% Urban access (2 locations within 10 miles) 99.9% Rural access (1 location within 20 miles ) 93.9% Rural access (1 location within 20 miles ) 93% Disruption 9 % *Data based on EyeMed network data, **Based on NetMinder provider comparisons as of September

20 Plan Array: Vision Modernization for 2018 Network Move to the Insight network- expect reduced claims by 3-4% Minimal member disruption Comparable size but offers fixed pricing on premium optionsmember savings up to 35% Plan Design Frame/Lens Allowance $130 per year is outdated 75% of members purchase above allowance Increase to $150 Impact Improved frame allowance enables 20% more to purchase with no out of pocket cost Member savings up to 35% on premium options (ex: progressive lenses, anti-reflective coating) 20

21 Q&A / Discussion

22 Important Disclosures The Church Pension Fund and its affiliates do not provide, and none of the information furnished in this presentation should be viewed as investment, tax, legal, or other advice. Your personal decisions should be based on the recommendations of your own professional advisors. This presentation is provided for your information only. In the event of a conflict between the information contained in this presentation and the official plan documents or policies, the official plan documents or policies will govern. The Church Pension Fund and its affiliates retain the right to amend, terminate, or modify the terms of any benefit plans described in this presentation at any time, without notice, and for any reason. 22