Five Colleges, Incorporated Amherst College Hampshire College Mount Holyoke College Smith College University of Massachusetts Amherst Memorandum To: All Benefited s From: Barbara Lucey Date: November, 2015 Re: Health Insurance We have decided to make a change of health insurance carrier this year due to pricing and offerings of the competing plans. For the last 3 years, we have kept the employee contributions steady as Tufts Health offered good renewal prices. But this year Tufts went up more than 7%. We looked at competitive plans and asked several employees to offer feedback on the various options. The carrier we chose is Harvard Pilgrim Health Plan which will allow us again to reduce employee contributions, with a few changes to the plan offerings. The reduced premiums you pay will help to offset the new plan s copays (some of which have increased). OPEN ENROLLMENT The open enrollment period is November 9-20. We will need everyone wishing to be covered by health insurance to fill out a new enrollment form. Representatives from Harvard Pilgrim will be here to facilitate and answer questions (see next page). If we do not hear from you by November 20, you will be NOT be enrolled in Five College health insurance. ALL HMO EMPLOYEE CONTRIBUTIONS WILL DECREASE The Harvard Pilgrim plan is very similar to our current Tuft s plan, but with changes as highlighted below. The PPO continues to be more expensive for employees, with the employer contribution amount the same as for the HMO plan. Highlights of the HMO plan changes: The biggest change (across the state) is that there will now be 4 tiers. The 2- person tier has been split into + Spouse and + Child. The premiums for the +Spouse tier are higher in total and therefore the employee contribution for this tier will be slightly higher than the contribution for the +Child tier. The next most significant change is in the office visit co-pay. Under Tufts, the amount was $25 for all visits. With Harvard, the primary care physician (PCP) 97 Spring Street Amherst, Massachusetts 01002-2324 Tel 413/542-4000 Fax 413/ 542-4028
visits remain $25, but all specialists (that is, anyone NOT your PCP) require a $40 co-pay. (We hope that the lower employee premium will help to offset this increase.) The employee co-pay for high-tech imaging increases from $100 to $150, which is $50 more than last year; emergency room visit co-pay increases from $125 to $150, $25 more than last year. Harvard s prescription (RX) rates are the same as current Tufts plan. Five Colleges will continue to pay $250 towards hospital and out-patient surgery co-pays, up to a plan limit, via Health Reimbursement account (HRA). This is half of the $500 total. The employee portion of $250 remains the same. Pediatric dental care up to age 19 is included for no additional charge. This benefit continues under Harvard Pilgrim (some changes). Please see separate attachment for the details. You may want to check the offering in detail before making a decision about your Delta Dental coverage which renews January 1. (Open enrollment for Delta Dental will be in December.) There are new lower maximum limits to the total amount paid out of pocket by the employees for pharmacy and separately for all other medical expenses. See the Plan Design for details. Provider network (doctors, behavioral health, hospitals) is almost identical to Tufts network. The FCI website has the list of the most current. You can also check on the HPHC website to search for your providers. Please select HMO or PPO (If you have PPO) from the Standard Plan menu; https://www.providerlookuponline.com/harvardpilgrim/po7/search.aspx You can also call your provider and ask. Please review the attached documents. Harvard Pilgrim Health Plan representative will be here on Monday, November 9, 10:00 11:30 am to discuss the plan and answer any questions. ). If you cannot make this date, please contact the business office to make arrangements to complete your form November 9 or 10 if at all possible! Yvette and I can help answer your questions as well. Page 2 of 8
HEALTH INSURANCE PLAN SUMMARY NOVEMBER, 2015 POLICY Five Colleges, Incorporated is amending its personnel policy on Health Insurance. 4-TIER PLAN Beginning in December 2015, Five Colleges offered a 4-tier medical plan, covering not only individual and families, but two rates for two party families (one for + Spouse and one for + Child), for both the HMO and PPO plans. RATES Five Colleges continues to keep its employee contribution rates adjusted to near the median of the four private colleges. This year we are BELOW that average for the HMO plan. Monthly Costs Monthly Premium Rates and Contributions for 2015 (starting December 1, 2015) HMO Premium Total Premium % Annual Change- Individual $537.00 $80.00 15% -$60.00 + Spouse $1,073.99 $260.00 24% -$240.00 + Child $993.44 $240.00 24% -$480.00 Family $1,503.44 $370.00 24% -$660.00 PPO Premium Total Premium % Annual Change- Individual $709.85 $252.85 36% $273.60 + Spouse $1,419.71 $605.72 43% $427.44 + Child $1,313.23 $559.79 43% -$123.72 Family $2,023.08 $862.64 43% $29.88 The amount deducted from 24 paychecks will be half the amount shown in the Premium column above. (*Please speak to Yvette for part-time costs if you are a regular employee working less than 30 hours/week.) Page 3 of 8
Five Colleges, Inc. 12/1/2015 Contribution Summary (with savings) and Contribution Percentage % Medical Contribution Summary Current Contributions - Tufts Contributions effective: 12/1/15-11/30/16 - Harvard Pilgrim % Savings Savings/month to Savings/year to Savings per pay period (24) HMO Individual $85.00 $80.00-5.9% -$5.00 -$60.00 -$2.50 EE + Spouse $280.00 $260.00-7.1% -$20.00 -$240.00 -$10.00 EE + Child $280.00 $240.00-14.3% -$40.00 -$480.00 -$20.00 Family $425.00 $370.00-12.9% -$55.00 -$660.00 -$27.50 Tufts PPO Individual $230.05 $252.85 9.9% $22.80 $273.60 $11.40 EE + Spouse $570.10 $605.72 6.2% $35.62 $427.44 $17.81 EE + Child $570.10 $559.79-1.8% -$10.31 -$123.72 -$5.16 Family $860.15 $862.64 0.3% $2.49 $29.88 $1.24 Contribution Percentage % Current Total Premium - Tufts Total Premium effective: 12/1/15-11/30/16 Harvard Pilgrim Contributions Effective: 12/1/15-11/30/16 % cost to Tufts HMO Individual $584.64 $537.00 $80.00 15% EE + Spouse $1,169.28 $1,073.99 $260.00 24% EE + Child $1,169.28 $993.44 $240.00 24% Family $1,753.92 $1,530.44 $370.00 24% Tufts PPO Individual $729.69 $709.85 $252.85 36% EE + Spouse $1,459.38 $1,419.71 $605.72 43% EE + Child $1,459.38 $1,313.23 $559.79 43% Family $2,189.07 $2,023.08 $862.64 43% Page 4 of 8
Five Colleges, Incorporated Effective 12/1/2015-11/30/2016 HMO Plan Current (Tufts) HPHC (Tiered Copayment HMO 25) Individual $584.64 $537.00 + Spouse $1,169.28 $1,073.99 + Child(ren) $1,169.28 $993.44 Family $1,753.92 $1,530.44 Current Effective 12/1/2015 Deductible N/A N/A Office Visit Copay $25 $25 PCP $40 SP Inpatient Hospital $500 ($250 Cost*) $500 ($250 Cost*) Outpatient Hospital** $500 ($250 Cost*) $500 ($250 Cost*) ER Copay $125 $150 High Tech Imaging $100 $150 RX - retail $15/$30/$50 $15/$30/$50 RX - mail $30/$60/$150 $30/$60/$150 Annual Medical Out-of-Pocket maximum $2,500 / $5,000 Annual RX Out-of-Pocket maximum $2,400 / $4,800 PPO Plan Individual + Spouse + Child(ren) Family Annual Deductible N/A $750/$1,500 N/A $400/$800 Office Visit Copay $25 $20 PCP $35 SP Inpatient Hospital* $500 ($250 Cost*) $500 ($250 Cost*) 20% Co-insurance after deductible Outpatient Hospital* $500 ($250 Cost*) $500 ($250 Cost*) 20% Co-insurance after deductible ER Copay $125 $100 High Tech Imaging $100 $150 RX - retail $15/$30/$50 N/A $5/$15/$30/$50/20% N/A RX - mail $30/$60/$150 N/A $12.50/$37.50/$75/$125/20% N/A Annual Out-of-Pocket Maximums $2,500/$5,000 (Med) $2,000 / $4,000 (medical) $3,750/$7,500 (medical) $2,400/$4,800 (Rx) $1,000 / $2,000 (Rx) $3,000/$6,000 (medical) * Five Colleges currently reimburses employees $250 Rate Summary Plan Summary $2,000 / $4,000 (combined medical/rx) Current (Tufts) HPHC (Affordable PPO 20) In Network Out of Network In Network Out of Network Rate Summary $729.69 $709.85 $1,459.38 $1,419.71 $1,459.38 $1,313.23 $2,189.07 $2,023.08 Plan Summary Current Effective 12/1/2015 Page 5 of 8
Five Colleges Benchmarking HMO Updated: 11/3/2015 500 450 $448 $437 400 350 $370 300 250 200 150 100 $80 $99 $159 50 0 Individual Family Proposed Five Colleges 5 College Average* SBA Higher Ed Survey** Contribution Effective Date 12/1/2015 2015 2015 Proposed Five Colleges 5 College Average* SBA Higher Ed Survey** Individual $80 $99 $159 Family $370 $448 $437 *Includes Five Colleges, Inc. **Includes 12 Higher Education institutions located in MA and RI. Page 6 of 8
Five Colleges Hospital Inpatient and Day Surgery Copay Explanation Five Colleges HMO and PPO medical plans have $500 copay for Hospital Inpatient and Outpatient Day Surgery (per occurrence). We realize that this copay increase may create a financial burden to some employees. To assist our employees and their family members, Five Colleges will implement a Health Reimbursement Account (HRA) to cover some of the additional copay burden. An HRA plan is similar to the Healthcare FSA that we currently offer. However, an HRA uses employer-funded dollars while the FSA uses employee-funded dollars. s should still consider utilizing their FSA program to offset some of these costs. Here is how it works: For employees with individual coverage, Five Colleges will cover the difference between the new $500 copay and the existing $250 copay ($250 covered by HRA). Five Colleges will cover the copay difference for the first two copays for the renewal period (12/1 11/30). For employees with two-party or family coverage, Five Colleges will cover the different between the new $500 copay and the existing $250 copay ($250 covered by HRA). Five Colleges will cover the copay difference for the first three copays for the renewal period (12/1 11/30). In addition, the Harvard Pilgrim HMO plan includes a medical out of pocket maximum of $2,000 per individual and $4,000 for two-party or family coverage. These maximums include all copay dollars including those paid by employees/dependents and the Five Colleges HRA. The Harvard Pilgrim PPO plan includes an in-network medical out of pocket maximum of $2,000 per individual and $4,000 for two-party or family coverage. These in-network maximums include all copay dollars including those paid by employees/dependents and the Five Colleges HRA. Page 7 of 8
Five Colleges Inpatient and Outpatient Copay Examples with HRA Funding Inpatient and Day Surgery Summary HMO & PPO (In-Network) Individual 2 person Family HARVARD PILGRIM Annual Medical Out-of-Pocket Maximum* $2,000 $2,000 $4,000 Maximum Number of Inpatient & Outpatient Copays** Before OOP Maximum is Hit 4 4 8 Out of Pocket Costs for s HMO Individual 2 person Family Maximum Number of Inpatient & Outpatient Copays** Before OOP Maximum is Hit 4 4 8 (A) # of Copays partially reimbursed by HRA*** 2 3 3 (B) # of Copays remaining until OOP maximum is met 2 1 5 Maximum HRA funding of copays (A x $250) $500 $750 $750 Funded Balance on HRA Assisted Visits (A x $250) $500 $750 $750 Remaining Copays assuming maximum (B x $500) $1,000 $500 $2,500 Maximum Liability $1,500 $1,250 $3,250 Maximum Liability explained - HRA portion 2 x $250 3 x $250 3 x $250 -non-hra portion 3 x $500 7 x $500 7 x $500 * Note: ALL medical copays accumulate towards the annual out-of-pocket maximums. This includes copays for office visits, emergency room and high tech imaging in addition to the inpatient and outpatient surgery copays. The maximum number above assumes no other copays have been paid toward your out-of-pocket maximum. ** Effective December 1, 2015, the inpatient and outpatient copay will be $500 per occurrence. ***Five Colleges will reimburse $250 of the $500 inpatient and outpatient copay. This is capped at a maximum of 2 occurrences for Individual coverage and 3 occurrences for 2-person and Family coverage. Page 8 of 8