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County Administrator's Report 13. 16.
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| BCC Regular Meeting |
Budget & Finance Consent |
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| RECOMMENDATION: |
Recommendation Concerning Group Medical Insurance - Eric Kleinert, Human Resources Department Director
That the Board take the following action concerning the County’s Group Medical Insurance:
A. Approve the employee and retiree health insurance premiums; Attachment 1 shows premiums reflecting a $50 discount for employees who do not use tobacco; Attachment 2 shows the health insurance premiums for the County’s retirees; Medicare Advantage, Pharmacy and Medicare Plan F premiums will be determined later. Retirees will be responsible for paying their full premium, whether they are Medicare-eligible or not;
B. Authorize staff to deposit $600 into the Health Saving Account (HSA) account of each employee who elects the HSA Plan. This will assist the employee in paying the higher deductible ($2,100 or $4,200). The deposit will be reviewed each year at renewal time, along with monthly administrative fees of $2.50 per member and a one-time start-up fee of $22 for each new employee who enrolls. The cost is included in the total cost estimate;
C. Authorize the Health Care Opt-out Program at the same amount as 2018 plan year; and
D. Authorize the following plan design changes to assist in aligning our plans to our costs (net claims per employee per month) and Affordable Care Act requirements upon losing our Grandfather status:
- No changes to the HSA (Health Saving Plans)
- Blue Option 1352
- Change the deductible from - $750 (single)/$2,250 (family) to $1,000 (single) /$3,000 (family)
- Change the Out-of-Pocket maximum from - $3,000 (single)/$9,000 (family) to $3,250 (single)/$9,750 (family)
- Wellness Preventive Care - $20 copay/20% coinsurance to 100% (deductible waived) (Affordable Care Act)
- Walk-In Urgent Care Visit – Deductible + 20% to a $50 co-pay
- Emergency Room - $100 + 20% to $200 +20% (waived if admitted into the hospital)
- Blue Option 1552
- Change the deductible from - $500 (single)/$1,500 (family) to $750 (single)/$2,250 (family)
- Change the Out-of-Pocket maximum from - $2,000 (single)/$6,000 (family) to $2,250 (single)/$6,750 (family)
- Wellness Preventive Care - $15 copay/$30 copay to 100% (deductible waived) (Affordable Care Act)
- Emergency Room - $100 + 20% to $200 +20% (waived if admitted into the hospital)
- Increase the premiums for both the employer and employee contribution by 8.8%
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| BACKGROUND: |
In 2018, the County added an additional 120 eligible employees to its plan through Mass Transit. Also, in 2017, we had 17 claims over $125,000, in 2016 we had 10 claims over $125,000, and 9 claims over $125,000 in 2015. We saw a 30% increase in our stop/loss premiums due to our claims history in 2017. Our claims are trending this year at $21,070,247. Stop Loss is trending at $2,069,153. This does not include the staffing cost, the cost of the clinic or any retirees that we have on Medicare Plan F, Pharmacy, or Medicare Advantage plan.
The County has been able to maintain the Grandfather Clause under the Affordable Care Act (ACA) since it was put in place (2010). The Affordable Care Act has strict rules on how an organization can maintain this status and there are very few plans that are still Grandfathered under the ACA.
With the help of USI, it was recommended that in 2019, we move away from the Grandfathering to look at ways to mitigate our cost by making slight plan changes.
Presently, the HSA plan does not have to be changed.
Wellness Preventative Care – Will be covered waiving any co-pays or deductibles for both 1352 and 1552. This is required by the ACA once we remove our Grandfather status.
Emergency Room - Both 1352 and 1552 plans - Increased our co-pay for employees going to the emergency room from $100+20% co-insurance to $200+20% co-insurance.
We want to encourage our members to use our County Health Clinic and Urgent Care facilities in the area. Cost for emergency room care is three times more than going to an urgent care facility. Our number of visits are high for the emergency room. When we were briefed in past years by Florida Blue, some of our members were using the ER as their primary care. Emergency Rooms are extremely important in the health care environment. If a member is admitted into the hospital the co-pay for the ER is waived.
Per the ACA, all emergency visits will be considered in network.
Urgent Care – 1352 Plan (Only) – Change the urgent care visit from deductible + 20% co-insurance to a $50 co-pay. This provides employees an incentive to utilize the urgent care versus the ER if they are unable to see their primary care or the County clinic. We have a number of urgent care facilities in both Escambia and Santa Rosa County with extended work hours.
Deductible - for both 1352 and 1552 plans:
1552 plan deductible will change from $500 for single/$1,500 for family to $750 for single/$2,250 for family
1352 plan deductible will change from $750 for single/$2,250 for family to $1,000 for single/$3,000 for family
The national average for health care deductibles is $1,000. On average, 15-18% of our members meet their deductibles.
Out-of-Pocket-Maximum
1552 - Out-of- Pocket maximum change from $2,000 single/$6,000 family to $2,250 single/$6,750 family
1352 - Out-of-Pocket maximum change from $3,000 single/$9,000 family to $3,250 single/$9,750 family
This change coincides with the changes to the deductible.
Increase Premiums on the 1552 Plan Only
One of the key indicators when evaluating our plans was “the net claims per employee per month” since 2015. The 1352 and HSA plans are within $100 of each other (i.e. between $525 to $625). While the 1552 plan spread has been increasing every year. In 2015, it was $300 more than the other plans and in 2018, the spread is over $500. We recommend adjusting the premium to support the value of the plan.
We are continually looking at ways to reduce costs through plan design, stop loss measures, and any other available measures. In the next year, the County will be actively looking at ways to reduce costs and still have a health plan that will be attractive to our employees.
With our Plans becoming ACA compliant, our plan names will be changing. Florida Blue will notify the County once this has been completed. The name change will become effective January 1, 2019.
The County will offer the existing plans and will provide individual supplement options during open enrollment for retirees that are Medicare-eligible.
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| BUDGETARY IMPACT: |
| Funds are available in Fund 501, Internal Service Fund, Cost Center 150108, Object Codes 53401 and 54501.
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| LEGAL CONSIDERATIONS/SIGN-OFF: |
| This is in accordance with Florida Statutes 112.09 and 112.0801. |
| PERSONNEL: |
| The Human Resources Department and all appointing authorities (payrolls) will have to make the appropriate adjustments to their payroll systems, Human Resources Information System, and work with Florida Blue to ensure changes are made in the respected systems.
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| POLICY/REQUIREMENT FOR BOARD ACTION: |
| N/A |
| IMPLEMENTATION/COORDINATION: |
| A purchase order will be the instrument utilized for making payment against the Contract. The Human Resources Department will coordinate with Legal, the Office of Purchasing, FRS, and the other appointing authorities to ensure all changes are made in the respected systems.
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