Item B1
&
CM
ounty of onroe
BOARD OF COUNTY COMMISSIONERS
Mayor Heather Carruthers, District 3
Mayor Pro Tem George Neugent, District 2
TheFloridaKeys
Danny L. Kolhage, District 1
David Rice, District 4
Sylvia J. Murphy, District 5
County Commission Meeting
September 19, 2016
Agenda Item Number: B.1
Agenda Item Summary #2103
BULK ITEM: DEPARTMENT:
No Employee Services
TIME APPROXIMATE:STAFF CONTACT:
Teresa Aguiar (305) 292-4458
10:00 a.m.
AGENDA ITEM WORDING:
Discussion and direction to staff on recommended Health
Insurance Plan changes beginning January 1, 2017.
ITEM BACKGROUND:
Consultant,
Gallagher Benefit Services, provided a presentation to the BOCC on the health insurance fund and
forecast for the upcoming fiscal year. A list of 18 options were presented to the BOCC which
ensured that all stakeholders share in impact of actions taken. The BOCC directed staff to change
the projected amount of necessary cuts from $3,770,559 to $3,400,000. Further, they requested staff
revise their recommendation to accomplish meeting the projected shortfall.
Staff has now provided a list of 8 options for the BOCC to consider. A brief discussion on those
items was conducted on September 12, 2016, with commissioners as part of the budget public
hearing. The new staff recommendations are:
Increasing the Department Rate to $1035
Increasing Emergency Room deductible from $100 to $300
Increasing the out of pocket maximum from $6,350 to $7,150 (consistent with Federal
Affordable Care Act)
Increasing the amount for retail brand copay for pharmaceuticals from $35 (preferred)/ $70
(non-preferred) to $50 (preferred)/$90 (non-preferred and Increasing the 90 day supply of retail
brand from copay from $87.50 (preferred) / $175 (non-preferred) to $125 (preferred)/$225
(non-preferred)
Increasing specialty pharmacy cost share to 20% with a maximum of $250
Adding Teledoc
Ending Subsidy for Medicare Eligible Dependents of Retirees
Charging 100% actuarial rate to spouses who have health insurance but choose to stay on the
Monroe County Health Plan
These proposed changes are recommended to be approved at the September 19, 2016 Special BOCC
meeting.
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Attached are updated documents provided by Gallagher Benefit Services.
PREVIOUS RELEVANT BOCC ACTION:
September 6, 2016 BOCC special meeting with direction to staff on health insurance fund changes
for 2017.
CONTRACT/AGREEMENT CHANGES:
None
STAFF RECOMMENDATION:
Direct staff to implement Health Insurance Plan changes which
include:
Increasing the Department Rate to $1035
Increasing Emergency Room deductible from $100 to $300
Increasing the out of pocket maximum from $6,350 to $7,150 (consistent with Federal
Affordable Care Act)
Increasing the amount for retail brand copay for pharmaceuticals from $35 (preferred)/ $70
(non-preferred) to $50 (preferred)/$90 (non-preferred and Increasing the 90 day supply of retail
brand from copay from $87.50 (preferred) / $175 (non-preferred) to $125 (preferred)/$225 (non-
preferred)
Increasing specialty pharmacy cost share to 20% with a maximum of $250
Adding Teledoc
Ending Subsidy for Medicare Eligible Dependents of Retirees
Charging 100% actuarial rate to spouses who have health insurance but choose to stay on the
Monroe County Health Plan
In addition, staff plans to work on the following items during 2017:
Re-evaluate purchasing stop-loss insurance for high cost claims
Issue a Request for Proposal for a fully insured plan
Issue a Request for Proposal for a new Third Party Administrator (TPA)
Issue a Request for Proposal for our Health Insurance Consultant
DOCUMENTATION:
MCBCC Report 06_2016 2016_09_13
Benefits Survey 9 12 16
FINANCIAL IMPACT:
Effective Date:
January 1, 2017
Expiration Date:
Total Dollar Value of Contract:
Total Cost to County:
Current Year Portion:
Budgeted:
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Source of Funds:
CPI:
Indirect Costs:
Estimated Ongoing Costs Not Included in above dollar amounts:
Revenue Producing: If yes, amount:
Grant:
County Match
:
Insurance Required:
Additional Details:
REVIEWED BY:
Teresa Aguiar Completed 09/13/2016 5:11 PM
Assistant County Administrator Christine Hurley Completed
09/13/2016 5:13 PM
Cynthia Hall Completed 09/13/2016 6:31 PM
Budget and Finance Completed 09/14/2016 8:08 AM
Maria Slavik Completed 09/14/2016 8:11 AM
Kathy Peters Pending
Board of County Commissioners Pending 09/19/2016 10:00 AM
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MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
Total Net Paid Prescription Drug and Medical Claim Summary
October 1, 2012 through June 30, 2016
Claims Paid
WFTPABCBSFL
MonthEnrolleesRxMedicalMedicalTotal
Oct-14 1,605$229,487$1,148,209$1,377,697
Nov-14 1,604$237,026$833,995$1,071,021
Dec-14 1,597$300,612$882,134$1,182,746
Jan-15 1,591$306,699$832,283$1,138,982
Feb-15 1,583$269,368$670,562$939,930
Mar-15 1,593$339,055$902,384$1,241,439
Apr-15 1,590$325,345$800,592$1,125,937
May-15 1,598$329,886$813,524$1,143,410
Jun-15 1,592$329,832$983,700$1,313,532
Jul-15 1,592$348,993$765,684$1,114,677
Aug-15 1,581$283,561$1,175,399$1,458,960
Sep-15 1,582$314,399$1,111,604$1,426,003
Oct-15 1,588$316,611$1,070,336$1,386,947
Nov-15 1,588$289,929$1,054,951$1,344,880
Dec-15 1,580$285,826$1,128,908$1,414,734
Jan-16 1,578$276,866$728,823$1,005,689
Feb-16 1,581$307,561$758,023$1,065,584
Mar-16 1,587$337,615$1,139,8621,477,477
Apr-16 1,584$288,758$778,891$1,067,649
May-16 1,576$349,196$1,173,918$1,523,114
Jun-16 1,575$330,753$1,255,417$1,586,170
2010/11 19,122$2,502,150$12,241,475$0$14,743,626
2011/12 19,227$2,285,804$3,896,996$7,303,927$13,486,728
2012/13 19,151$2,599,582$13,901$10,030,926$12,644,409
2013/14 19,223$2,888,594$0$9,686,074$12,574,668
2014/15 19,108$3,614,264$0$10,920,069$14,534,332
2015/16 14,237$2,783,115$0$9,089,129$11,872,244
Last 12 Mos 18,992$3,730,068$0$12,141,815$15,871,883
PEPM
2009/10$119.63$628.40$0.00$748.02
2010/11$130.85$640.18$0.00$771.03
2011/12$118.89$202.68$379.88$701.45
2012/13$135.74$0.73$523.78$660.25
2013/14$150.27$0.00$503.88$654.15
2014/15 $189.15$0.00$571.49$760.64
2015/16$195.48$0.00$638.42$833.90
Last 12 Mos$196.40$0.00$639.31$835.71
MCBCC Report 06_2016 2016_09_1319/13/2016
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7XEXYW6ITSVXJSV4PER=IEVEWSJ.YRI
Employees orDependentsActual YTDProjected
RetireesPer GBSYear End
I.Total Gross Paid Claims (1)
a. BCBSFL Active1,153694$ 7,224,441$ 9,818,996
b. BCBSFL Retiree422117$ 1,864,688$ 2,534,364
c. Envision Active1,153694$ 1,716,548$ 2,326,542
d. Envision Retiree422117$ 1,066,567$ 1,445,583
Benefit Changes$ -$ -
Total Paid Claims$ 11,872,244$ 16,125,485
II.Fixed Costs (2)
a. BCBSFL 663,328 879,497
b Envision 53,389 71,108
c. Internal Expenses 189,453 252,604
d. PPACA (5) - PCOR Fee (6) 3,104 5,352
e. PPACA (5) - Transitional Reinsurance Fee (7) 47,878 74,731
f. Other (GBS, Life, AD&D, EAP) 225,000 300,000
Total Fixed Costs$ 1,182,151$ 1,583,291
III.Total Paid Plan Costs$ 13,054,395$ 17,708,777
IV.Funding
a. Contributions (4) 11,550,581 15,400,774
b. Interest (3)$ 27,037$ 36,049
c. Other (3)$ 117,000$ 156,000
Total Funding$ 11,694,617$ 15,592,823
V.Cash Surplus/(Deficit)$ (1,359,778)$ (2,115,954)
VI.Change in Claim Reserve
a. Starting Reserve$ 927,198$ 927,198
b. Estimated Closing Reserve$ 973,811$ 973,811
c. Change in Reserve$ 46,613$ 46,613
VII.Incurred Surplus/(Deficit)$ (1,406,390)$ (2,162,566)
VIII.Incurred % Surplus/(Deficit)-12.2%-14.0%
(1) Based on paid claims through June 30, 2016.
(2) Based on fixed rates
(3) Based on September 2015 Financial Statements.
(4) Based on enrollees multiplied by current funding rates.
(5) PPACA - Patient Protection Affordable Care Act
(6) Assessed through fiscal year 2018/19
MCBCC Report 06_2016 2016_09_1329/13/2016
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Renewal Projections
3GXSFIVXLVSYKL7ITXIQFIV%WWYQMRK'YVVIRX)RVSPPQIRX
ProjectedAssumedProjected
2015/16% Change2016/17
I.Total Net Incurred Claims (1)$ 16,172,098 8.1%$ 17,458,683
II.Fixed Costs (2)
a. BCBSFL 879,497 0.0% 864,675
b. Envision 71,108 0.0% 70,875
c. Internal Expenses 252,604 10.3% 278,662
d. PPACA - PCOR Fee 5,3524.0% 5,553
e. PPACA - Transitional Reinsurance Fee 74,731 16,106
f. Other (GBS, Life, AD&D, EAP) 300,000 7.0% 321,000
Total Fixed Costs 1,583,291 0.0% 1,556,871
III.Total Incurred Plan Costs (2)$ 17,755,389 $ 19,015,554
IV.Revenue at Current Level
a. Contributions (4)$ 15,400,774 $ 15,350,418
b. Interest (3)$ 36,049 $ 36,049
c. Other (3)$ 156,000 $ 156,000
Total Revenue at Current Level 15,592,823 0.0%$ 15,542,467
V.Surplus/(Deficit) With No Change in Funding$ (2,162,566)$ (3,473,087)
VI.Increase Required to Break Even in 2016/17N/A22.6%$ 3,473,087
$ 12,744,000
Notes:(1) 2015/16 Net Claims$ 16,125,485 Projected Paid Claims$ 5,271,554
- 46,613 Reserve Change$ 2,396.16
$ 16,172,098
(2) 2015/16 Total Plan Costs from Prior Page$ 17,708,777 Total Paid Plan Costs
- 46,613 Reserve Change
$ 17,755,389
(3) Projected 2016/17 Funding$ 15,542,467 Annualized Funding at 2015/16 Rates
$ 192,049 Less Interest and Other Income
$ 15,350,418 Annual Contributions
x 1.2263 Required 10/1/16 Increase
$ 18,823,505 Resulting 2016/17 Contributions
$ 192,049 Plus Interest and Other Income
$ 19,015,554 Total Projected 2016/17 Revenue
$ 3,473,087 Difference to projected revenue
MCBCC Report 06_2016 2016_09_1339/13/2016
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Projected Fund Balance and Reserve Adequacy
As of June 30, 2016
2009/102010/112011/122012/13 2013/14 2014/15 2015/16 2016/17
Cash Balance at Beginning of Year$ 17,946,663$ 16,192,402$ 14,559,350$ 12,883,164$ 12,867,407 $ 13,208,152 $ 11,546,869 $ 9,430,915 (1)
Cash Surplus/(Deficit) for Year$ (1,754,261)$ (1,633,052)$ (1,676,186)$ (15,757)$ 340,745 $ (1,661,283)$ (2,115,954)$ (3,473,087) (2)
Transfer In/(Out)$ -$ -$ -$ -$ -$ -$ -$ -
Cash Balance at End of Year$ 16,192,402$ 14,559,350$ 12,883,164$ 12,867,407$ 13,208,152 $ 11,546,869 $ 9,430,915 $ 5,957,828 (3) = (1) + (2)
Claim Reserve at Year End (IBNR) (a)$ 1,948,746$ 2,024,412$ 1,016,833$ 965,564$ 1,043,765 $ 927,198 $ 973,811 $ 973,811 (4)
Other Amounts Payable at Year End$ (141,986)$ 288,696$ 77,753$ 61,425$ 92,592 $ 25,235 $ 25,235 $ 25,235
60-day Safe Harbor Claim Margin for OIR (b)$ 2,352,291$ 2,502,161$ 2,695,350$ 2,297,656$ 2,101,832 $ 2,695,350 $ 2,909,781 $ 3,146,560 (5)
Total Liability and Surplus Required at Year End$ 4,159,051$ 4,815,269$ 3,789,936$ 3,324,645$ 3,238,189 $ 3,647,783 $ 3,908,826 $ 4,145,606 (6) = (4)
+ (5)
Year End Fund Equity Before OIR Margin$ 14,385,642$ 12,246,242$ 11,788,578$ 11,840,418$ 12,071,795 $ 10,594,436 $ 8,431,870 $ 4,958,783 (7) = (3) - (4)
Year End Equity Net of OIR Margin$ 12,033,351$ 9,744,081$ 9,093,228$ 9,542,762$ 9,969,963 $ 7,899,086 $ 5,522,089 $ 1,812,222 (8) = (3) - (6)
County Adopted Minimum Fund Balance (6 Months)$ 7,153,736$ 7,056,873$ 7,506,483$ 6,374,575$ 6,305,495 $ 7,267,166 $ 8,086,049 $ 8,729,342
Actual Surplus Less County Minimum Target$ 3,327,270 $ 345,821 $ (3,770,559)
Notes
(a)Actual figures through 2014/15. 2015/16 and future equal February 2016 estimate
(b)Estimated at 1/6 of Annual Incurred Claims
MCBCC Report 06_2016 2016_09_1349/13/2016
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*PSVMHE&PYI0EVKI'PEMQ7YQQEV]EWSJ
'PEMQERX
2YQFIV6/30/20169/30/20159/30/20149/30/20139/30/20129/30/20109/30/2009
1
$650,445 $560,607 $503,159 $310,603 $323,462 $338,544 $402,792
2
$422,795 $326,270 $239,090 $291,049 $320,118 $224,043 $290,146
3
$400,458 $321,107 $197,829 $282,573 $268,729 $220,450 $134,646
4
$174,484 $298,995 $177,903 $207,021 $201,912 $148,066 $109,928
5$165,197 $270,238 $175,983 $178,797 $196,659 $146,906 $85,944
6
$144,378 $235,346 $167,378 $163,122 $117,674 $101,914 $85,706
7$141,501 $203,001 $146,363 $153,269 $116,592 $91,317 $84,623
8
$124,511 $192,172 $136,212 $118,555 $114,750 $76,118 $76,682
9$119,649 $170,219 $125,463 $117,803 $94,178 $71,028 $65,374
10
$100,797 $166,412 $124,102 $114,376 $92,001 $68,704 $64,492
11$99,792 $150,535 $119,792 $111,122 $90,148 $66,763 $61,525
12
$94,667 $143,011 $114,009 $110,962 $86,922 $66,392 $61,158
13$93,513 $126,615 $109,154 $104,392 $83,772 $63,776 $60,197
14
$87,718 $117,146 $107,906 $101,381 $71,659 $61,416 $58,112
15$81,068 $115,968 $103,619 $95,807 $70,268 $60,003 $57,051
16
$80,529 $109,866 $102,158 $94,435 $69,931 $57,619 $54,270
17$72,758 $104,317 $101,228 $94,433 $66,602 $55,504 $54,218
18
$71,027 $94,146 $88,520 $82,169 $66,061 $55,416 $51,334
19$70,632 $92,932 $85,181 $80,193 $65,531 $52,899
20
$70,368 $91,791 $79,737 $77,282 $64,327 $50,110
21$69,933 $86,663 $77,940 $75,227 $62,859
22
$67,116 $82,177 $71,837 $72,821 $60,670
23$64,533 $78,271 $69,605 $71,309 $59,190
24
$59,999 $77,173 $63,734 $71,194 $57,240
25$57,225 $75,186 $59,738 $70,814 $55,264
26
$56,118 $74,547 $58,581 $66,559 $54,455
27$53,961 $71,116 $58,087 $65,798 $50,968
28
$52,926 $68,479 $57,977 $65,739
29$51,792 $66,258 $56,507 $65,399
30
$51,646 $64,204 $54,508 $62,494
31$50,714 $63,616 $52,800 $57,753
32
$62,540 $51,421 $54,300
33$58,688 $51,245 $53,410
34
$57,313 $51,170 $52,167
35$56,915 $51,662
36
$56,179
37$52,804
38
$51,871
39$51,334
40
$51,050
41$51,040
42
$51,004
43$50,285
8SXEP
Total YTD Claims (Medical & Pharmacy)$ 11,872,244
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* Includes claims paid by BCBSFL only
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MCBCC Report 06_2016 2016_09_1359/13/2016
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County
FY Total
Dependent
Annual Current
Subsidy
Current EE Annual Projected County
50%With Benefit Changes
SubscribersPremiumContributionCostSubsidy
Current Benefits2016/172017/182018/19
FY 16/17
Employees Paying $25 Premium 872$25$261,600$6,864,21396%$25$25$25$25
Recent Hires Pay $50 mo prem297$50$178,200$2,337,92692%$50$50$50$50
Subtotal:$439,800$9,202,139$439,800$439,800$439,800$439,800
95%
Change From Current
Waived coverage (Dept Rate $320 mo)51
Employee Dependents Only:
Spouse Only112$332$446,208$1,190,21763%$443$419$451$485
Spouse + 1 child43$480$247,680$660,05162%$640$606$652$701
Spouse + 2 or more children47$701$395,364$1,054,42863%$935$885$953$1,025
One child only97$148$172,272$458,13962%$197$186$200$215
Two children only60$295$212,400$566,77063%$394$373$402$432
Three children only14$443$74,424$198,36962%$590$558$601$646
Four children only1$591$7,092$18,89262%$787$745$802$862
Five+ children only0$738$0$00%$984$931$1,002$1,077
Subtotal$1,555,440$4,146,86662%$1,944,753$1,860,900$1,973,535$2,092,731
Change From Current$389,313$305,460$112,635$119,196
6
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Revenue$15,592,823$15,542,467$19,313,026$21,179,204$17,804,437
Claims$16,172,098$17,458,683$18,879,363$20,415,648$17,458,683
Fixed Costs$1,583,291$1,556,871$1,589,502$1,592,307$1,556,871
Total Expense$17,755,389$19,015,554$20,468,865$22,007,955$19,015,554
+EMR
0SWW
Terminate Subsidy$0$0$0$0$0
for Medicare Eligible
Revised Gain/(Loss)($3,473,087)($1,155,839)($828,751)
Starting Surplus$10,594,436$8,431,870$8,729,342$9,439,681$8,431,870
Closing Surplus$8,431,870$4,958,783$7,573,503$8,610,930$7,220,753
1
Target Surplus
$8,086,049$8,729,342$9,439,681$10,207,824$8,729,342
Surplus Variance$345,821($3,770,559)($1,866,178)($1,596,894)($1,508,589)
Assumed Employees1,1691,1691,169
Department Rate Increase Needed to
Reach Surplus Target
$269$133$114
Current Department Rate$885$1,154$1,287$885
Resulting Department Rate$1,154$1,287$1,401$1,035
Adjusted Revenue$19,313,026$21,179,204$22,776,098
Adjusted Gain/(Loss)$297,472$710,340$768,143
Adjusted Closing Surplus$8,729,342$9,439,681$10,207,824
1. BOCC adopted policy to keep surplus equal to at least 6 months of claims
2. Contribution change includes resetting dependent premiums to 50% of current actuarial cost and charging Medicare retirees 60% of the current
Dependent rate ($531)
7
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3TXMSR3VMKMREP6IGSQQIRHEXMSR7ITXIQFIV-QTEGX6IZMWIH6IGSQQIRHEXMSR7ITXIQFIV-QTEGX
1Increase Deductible from $400/$800 to $600/$1200$282,831
2Increase ER deductible from $100 to $300$97,769Increase ER deductible from $100 to $300$97,769
3Increase Specialist and Urgent Care copay from $25 to $50$94,277
4Increase out of Pocket Maximum From $6350 to $7150$139,669Increase out of Pocket Maximum From $6350 to $7150$139,669
5Add $100 pharmacy deductible$162,366
Increase retail brand copay from $35/$70 (preferred /
Increase retail brand copay from $35/$70 (preferred / non preferred) to $50/$90 non preferred) to $50/$90 and Increase retail 90 brand
and Increase retail 90 brand from $87.50/$175 to $125/$225from $87.50/$175 to $125/$225
6$143,161$143,161
Increase specialty pharmacy cost share to 20% to a
Increase specialty pharmacy cost share to 20% to a maximum of $250maximum of $250
7$13,967$13,967
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%HH8IPIHSG Add Teledoc
9Charge Full Annual Amount of Health Insurance to Medicare Eligible Retirees$1,312,500
6IWIX(ITIRHIRX'SRXVMFYXMSRWXS SJ%GXYEVMEPEX'YVVIRX,MKLIV'SWXW
2S7YFWMH]JSV1IHMGEVI)PMKMFPI(ITIRHIRXWSJ6IXMVIIW No Subsidy for Medicare Eligible Dependents of Retirees
12No Subsidy for Dependents of Any Retirees$459,378
Spouses of Active Employee Pay 100% of Actuarial
7TSYWIWSJ%GXMZI)QTPS]II4E] SJ%GXYEVMEP6EXIMJ7TSYWILEW
Rate if Spouse has Access to Coverage Through
%GGIWWXS'SZIVEKI8LVSYKL,MW,IV3[R)QTPS]IVHis/Her Own Employer
13
14No subsidy for Pre-65 Retirees$1,311,728
15Pre 65 Retirees Pay 50% of Actuarial Rate$621,033
%GXMZI)QTPS]IIW4E]JSV)QTPS]II'SZIVEKI
17Reset Dependent Contributions to 60% of Actuarial Rates$599,868
7IX4VIQMYQJSV6IXMVII3RP]'SZIVEKIXSE*PEX
All Changes assumed to take place on January 1, 2017
7XEJJ6IGSQQIRHEXMSRW7ITXIQFIV7XEJJ6IGSQQIRHEXSMRW7ITXIQFIV
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Impact of Increasing Department Rate from $885 to $985$1,405,770($2,364,789)$1,405,770($1,994,230)
Impact of Increasing Department Rate from $985 to $1035$856,200($1,138,030)
4PER(IWMKR'LERKIW
Benefit Changes 1-7$932,294($1,432,495)$394,566($743,464)
Add Teledoc (8)$19,575($1,412,920)$19,575($723,889)
)QTPS]II6IXMVII'SRXVMFYXMSR'LERKIW
Reset Dependent Contributions to 50% of Actuarial at Current Higher Costs (10)$373,230($1,039,690)$0($723,889)
No Retiree Dependent Subsidy for Medicare Eligible Retirees (11)$254,448($785,242)$254,448($469,441)
Spouses of Active Employees pay 100% of Actuarial Rate if they have access to their own$234,077($551,166)$234,077($235,364)
employer sponsored coverage but elect to stay on County plan (13)
Active Employees Pay $50/75 for Employee Coverage (16)$263,025($288,141)
Set Premium for Retiree Only Coverage for Rule of 70 Retirees to Flat $200 (18)$272,025($16,116)
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2017 Premium Recommendation as of September 12, 2016
Assumption
Option #13
Recommended Effective (spouses who
Current Premium1/1/2017Subcribershave insurance)Monthly Increase% Increase
Active Employees
Single Hired prior 5/1/2012$25$25872$00%
Single Hired after 5/1/2012$50$50297$00%
Employee Dependents Only:
Spouse Only *$332$332/$838112$0/$5060%/152%
25% (50
Spouse + 1 child *$480$480/$98643$0/$50626%/105%
(incl 2 Retirees)
individuals)
Spouse + 2 or more children *$701$701/$120747 $0/$50626%/72%
(incl 2 Retirees)
One child only$148$14897$00%
Two children only$295$29560 $00%
(incl 2 Retirees)
Three children only$443$44314 $00%
(incl 2 Retirees)
Four children only$591$5911$00%
Five+ children only$738$7380$00%
Retirees
Retiree (10+ YOS) Pre Medicare** FRS** FRS110$00%
Retiree (10+ YOS) Medicare** FRS** FRS281$00%
Spouse >65$166$55957/13 $393237%
Surviving Spouse
Spouse <65$332$33233/1 $00%
Surviving Spouse
$531$5315$00%
Retiree >65 Without Subsidy
Retiree <65 Without Subsidy$885$1,0354$15017%
1SRXL-QTEGX$491,495
* Higher rates apply to employees whose spouse has available coverage through his/her own employer
COBRA Employees 4: From $895 to $1,044 per month** Premium $50-$150 pm
(back out $11 for Life x 2% admin costs on dept rate)30 years and over 21
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Impact of Proposed Plan ChangesEstimatedBenchmarking
This is a complete outline of all changes required to reach the $900,000 savings.Plan SavingsGallagher National Benchmarking Survey
Medical
2. Increase ER deductible from $100 to $300$97,769- 335 distinct members (14% of total population) visited the Emergency Room (ER) without - The $300 per visit deductible for ER visits
is more in line with the marketplace and should discourage National ER Cost Share:
subsequent admission during the reporting period and accounted for 482 total ER visits.members from using the ER for Medical Services instead of the Primary Care Physician or an Urgent
Care Median: $150
- 10% of total ER visits (7% of total ER spend) are potentially divertible (UTI, acute upper Facility. While ER visits have declined the County continues to utilize the ER at a higher
rate than Florida Mode: $100
respiratory infections, back pain, cough). Blue Benchmarks.3rd Quartile: $250
- 33 unique members have 3 or more ER visits during the 12-month period under review.1,000 + Employees ER Cost Share:
- ER utilization has decreased and is currently at 203 visits per 1000. Florida Blue benchmark is Median: $100
193/1000.Mode: $100
3rd Quartile: $200
4. Increase out of Pocket Maximum From $6350 to $7150 Employee and from $12,700 to $14,300 Family$139,669- The Maximum out of Pocket permissible under the PPACA legislation has increased
every year since the law National Max OOP :
was implemented. The County actually reduced the Maximum Out of Pocket from $7,500 to $6,350 when Median: $6,350
the rules required the change. Increasing to the $7,150 will offset some of the plan's claims expense while Mode: $10,000**
remaining below the original 2010 maximum.3rd Quartile: $10,000**
**Out of Network Amounts
1,000 + Employees Max OOP :
Median: $5,875
Mode: $6,000
3rd Quartile: $8,000
Total Projected Savings for 2016/17$237,438
Pharmacy
6. Increase retail brand copay from $35 to $50$143,161- Member Cost Share dropped from 14.63% to 12.15% (a change of 16.93%) while the net total - Pharmacy costs are rising faster than
medical costs overall and the use of a Copayment for the Rx benefit 'National Rx Cost Share Preferred:
Increase Non Preferred Copay from $70 to $90 anddrug costs increased by 28.78%compounds the impact of inflation because participants do not share in the increase in costs. This increase
Median: $35/ Mode: $30 / 3 rd Quartile: $40
Increase retail 90 brand from $87.50 to $125in copayments will help to mitigate the rapidly increasing costs of pharmaceuticals.1,000 + Employee Range Preferred:
Increase retail 90 Non Preferred from $175 to $225- The generic copayment is not being changed to allow participants to continue obtaining the most cost Median: $30 /Mode: $30 / 3 rd
Quartile: $40
effective prescriptions possible.
National Rx Cost Share Non Preferred:
Median: $55/ Mode: $50 / 3 rd Quartile: $70
1,000 + Employee Range Non Preferred:
Median: $50 /Mode: $50 / 3 rd Quartile: $60
7. Increase specialty cost share to 20% to a maximum of $250$13,967Specialty Costs for the plan increased by 90.66% and members pay less that 1% of the cost for - Specialty Drugs are
among the most expensive drugs on the market and comprise 36.10% of the overall N/A No Benchmarking for Specialty Drugs
these Specialty Drugs.drug cost. Implementing a coinsurance cost share with a per Prescription maximum will help to distribute
the expenses for these medications more equitably between the County and plan participants.
Total Projected Savings for 2016/17:$157,128
Combined Projected Pharmacy and Medical Savings *$394,566
ΎdŽƚĂůWƌŽũĞĐƚĞĚƐĂǀŝŶŐƐĚŽĞƐŶŽƚĞƋƵĂůƐƵŵŽĨŝŶĚŝǀŝĚƵĂůĐŽŵƉŽŶĞŶƚƐďĞĐĂƵƐĞĐŚĂŶŐĞƐĂƌĞŶŽƚŝŶĚĞƉĞŶĚĞŶƚ
Additional Cost Savings Suggestions
Teledoc and Contribution Changes
8. Impact of Adding Teledoc Option
Estimated First Year Savings
PCP Office Visits (Annual Spend of $250,000 excluding testing and procedures)$12,500Teledoc can provide a cost effective alternative for participants to obtain care at times when
the Primary Care Physician is not available. With Teledoc's 24/7 availability, participants can
Specialist Visits (Annual Spend of $475,000 excluding testing and procedures)$11,875
seek medical care at those times when the only other alternative would be the ER. Teledoc
ER Visits (Annual Spend of $1,000,000)$10,000
fees are on a per call basis and a monthly PEPM charge for the service to be implemented and
UC Visits (Annual Spend of $200,000)$10,000
access maintained. The $40 charge per call is lower than any other alternative for participants
Total Savings$44,375
and allows for cost savings for both the County and plan participants. Teledoc has the added
advantage of increasing the availability of care for non-emergency conditions.
Estimated First Year Cost
Annual Administrative Fee Based on $1.00 PEPM$18,900
Fee per Call$40
Member Copay per Call$20
Net Plan Cost Per Call$20
Estimated First Year Calls (4% PCP visits, 2% Specialist visits, 1% ER Visits)$295
Annual Cost for Utilization Fee$5,900
Total Estimated First year Fee$24,800
Net First Year Gain/(Loss)$19,575
Grand Total Savings$414,141
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Impact of Proposed Contribution Changes
Board established a target of 50% (see Option 10)
11. No Retiree Dependent Subsidy for Medicare Eligible RetireesCurrent target is more in line with survey data but employers are generally passing an increasing share
of the premium cost to employees who cover dependents.
Medicare eligible access retirees have other sources of coverage
Medicare eligible spouse premium is only 50% of what an active employee pays to cover a spouseImpact of Increasing Premiums for Dependent Coverage to 60% of the Actuarial Rate$599,868
Due to high cost of prescription drugs, total claim cost for Medicare eligible spouse is comparable to
cost of a spouse of an active employeeContribution Benchmarking: Percent Employees Contribute for Family
National Range: 20% to 55% / Median: 30% / Mode: 100%
Impact of Eliminating Subsidy and Charging 100% of Actuarial Rate for Medicare Spouse$254,448 1,000 Employee range: 17% - 31% / Median: 24% / Mode: 20%
Very few municipal employers in Florida subsidize dependent coverage for retirees18. Set Premium for Retiree Only Coverage to a Flat $200 per Month
'13. Spouses of Active Employees Pay 100% of Actuarial Rate if They Have Access to Coverage
Through Their Own Employer
Spouses are most costly covered members and in many cases have access to coverage of their own
an employer or the Exchange.
Impact of Charging 100% of the Actuarial Rate for Spouse Coverage for Active Employees if the $234,077
Spouse has Access to Coverage Through His/Her Own Employer
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COMPARISON OF MONROE COUNTY LARGER GOVERNMENT EMPLOYERS
Employee Premium Dependent Retiree Preium
SubsidyEmployee Premium RatePremium subsidySubsidyRetiree Premium Rate
Dependent Premium Rates
% EMPLOYER % EMPLOYER EMPLOYER
CONTRIBUTION EMPLOYEE CONTRIBUTION CONTRIBUTIONCONTRIBUTIONRETIREE CONTRIBUTION
EMPLOYERS EMPLOYEE CONTRIBUTION
Spouse:$332
Spouse + One Child:$480
Spouse + Two or more Children:$701
$ 50-150 Month Depending on years of service with
Prior to 5/1/12 $ 25 Per MonthOne Child Only:$148
Monroe County BOCC95%60%80%FRS. *Hhired prior to 10/1/01 min 10 yrs of service.
On or After 5/1/12 $ 50 Per MonthTwo Children:$295
*Hired after 10/1/01 pay full dept rate.
Three Children:$443
Four Children: $591
Five Children:$738
0% Regular
One Dependent:$380.10 EmployeesPay Full Cost: $ 824.98
Less than 15 grandfathered Upper Management that are currently paid
FKAA100%$0.0039%
Family: $545.21 100%.
Now pay Upper Management a subsidy based on level and years of service.
Prior to 10/01/10: 100%Prior to 10/01/10: $ 0.00Spouse: $688.26
City of Key West0%0%
After 10/01/10: 95%After 10/01/10: $ 54.16Children:$494.95 Under 65 Full Cost: $ 958.92
Family: $1,183.21 Over 65: $ 602.02
Spouse:$565.16
Children: $426.36
$ 0.00 Eligible Retirees *Hired prior to June
100% Eligible
Keys Energy100%$0.000%9, 1999 and must be eligible to collect their
Retirees
retirement immediately upon retirement.
Family: $991.52
Base Plan: Base Plan: Base Plan: Base Plan:
100%$0.00 Spouse: $885.78
Dependent coverage Children:$728.52
on both plans: Family $1,796.32
City of Marathon0%Retirees are eligible to enroll in COBRA. Pay 100%
Employee pays
High Option Plan:High Option Plan:High Option Plan:High Option Plan:
100%
91%$81.97 Spouse: $987.98
Children: $812.55
Family$2,003.63
Spouse: $786.10
Islamorada, Village of
90%$700%Children: $586.14 0%<65 and >65: $ 750.00
Islands
Family: $1,372.24
MUST have 10 year
of service with
MCSB.<10 YOS: $ 1028.15
Buy Up Plan:Buy Up Plan:Buy Up Plan:
Pays subsidy based
on numberof years
Monroe County School
of service with
Board
$280 67%Employee + One (Spouse or Child):$508.38 MCSB.10-19 YOS: $ 758.89
<10 YOS = 0%
*MCSB offers three plans. Buy Up Plan 10-19 YOS = 50%
illustrated as it is most comparable to 20+ YOS = 100% ŽĨ
BOCC.Family Plan:$642.20 ĂĐƚƵĂůƌĞƚŝƌĞĞĐŽƐƚƐ20+ YOS: $ 489.63 ŽĨƚŽƚĂůƉůĂŶĐŽƐƚ
Retirees over age 65 pay full premium: $ 1028.15
79%
HMOHMOHMOHMOHMO Under 65: $490
County provides a
$0.00 Spouse: $451.43 POS Under 65: $1165
100%
43%
flat fixed dollar
Children:$390.37
subsidy that varies
Family $623.50 Medicare Supplement with Pharmacy: $645
Miami-Dade County
by plan and tier but
POSHigh Option Plan:POSPOSMedicare Supplement without Pharmacy: $280
does not change
$32.28 Spouse: $714.22
97%
43%
each year
Children: $587.08
Family$1,258.16
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