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Item E1County off Monroe ELj »moo � i G�, � BOARD OF COUNTY COMMISSIONERS /� ri � �� Mayor George Neugent, District 2 The Florida. Ke Sew', y i Mayor Pro Tern David Rice, District 4 ; -== :'„ j y Danny L. Kolhage, District I Heather Carruthers, District 3 Sylvia J. Murphy, District 5 County Commission Meeting May 10, 2017 Agenda Item Number: E.1 Agenda Item Summary #2895 BULK ITEM: No DEPARTMENT: Employee Services TIME APPROXIMATE: STAFF CONTACT: Maria Fernandez -Gonzalez (305) 292-4448 3 pm AGENDA ITEM WORDING: Discussion and direction regarding consideration of benefit, contribution, plan management and administrative changes being proposed for the Health Insurance Plan for FYI 8. ITEM BACKGROUND: The Health Plan has experienced large claims and heavier than normal expenses over the past 3 years. It is estimated that $3.3 Million needs to be cut from the expense side or raised by contributions or plan changes so the plan will maintain the required 6-month reserve, established by the Board several years ago, in light of the fact that the plan does not carry stop loss insurance. In December 2016, the Board established a Health Plan Advisory Committee (HPAC) made up of a representative of: • Each geographic area in the Keys (Key Largo, Marathon, and Key West); • Each Union in which BOCC or constitutional officer employees were members; • Each Constitutional Office; and • Retirees from the Upper and Lower Keys. The HPAC met over the past 4 months to review options to address the projected shortfall. Gallagher, Health Plan Consultants, have worked with staff and the HPAC to develop changes to benefits, contributions by employees, dependents, and retirees, plan and administrative processes to address the $3.3 Million shortfall. The HPAC developed over time and then reviewed 35 options culminating in their vote on April 28, 2017 for a final recommendation to the Board. HPAC RECOMMENDATION: The HPAC voted to recommend Options 2, 2A, 29, 30, 31, 18, 28, 9, 11, 32, 13, 15, 19, and 35. The recommendations they made equated to $2,375,558 of the requested $3,300,000 needed to balance the fund. The HPAC then voted to request the Board to fund the remaining amount of $958,558 from Ad Valorem, Non -Ad Valorem, Enterprise, or Internal Funds. The attached table titled "Benefit and Contribution Changes Recommended for FY 2018" is included. It demonstrates the HPAC recommendations and the amount of funding needed to support the $3.3 Million for the Health fund. Correspondingly, there is a table titled "Monroe County Board of County Commissioners, Illustrative 2018 Plan Design and Contributions Based on Committee Recommendations" that shows the costs to the various types of covered lives in the Plan if these options are adopted by the Board. It also shows a new plan option that would be offered to our employees, retirees, and dependents. This is the new HIGH DEDUCTIBLE PLAN (LOW) OPTION. This is a new concept that would be more of a long-term solution to the Plan and the increased medical expenses that have plagued healthcare costs nationwide. HPAC RECOMMENDATION PLUS VOTES OF 4 OR MORE: After the meeting, staff analyzed the Committee votes to include not only the Options (2, 2A, 29, 30, 31, 18, 28, 9, 11, 32, 13, 15, 19, and 35) that received 7 or more votes (there are 13 committee members); but, also included the Options that included 4 or more votes (to get to the total $3.3 Million needed). The additional Options now included that garnered 4 or more votes are: 3, 6A, 5, 20, and 34). Further, Senior Staff of the County have been evaluating the Plan and the options for change and have recommended Option 36 be added, which eliminates Over the Counter drugs from the pharmacy formulary. Option 37 was added which would make the amount of money each employee pays equal to $75/month (the retiree Option would bring retiree payment to a flat $200/month [of which $50-$150 comes from an FRS subsidy given to FRS retirees, dependent upon their years of service]). Option 38 was added because the HPAC recommended increasing generic drug charge from $10 to $15 and staff recommends the Board increase brand drug charges Option 22 if generic will be increased. Given the County's wellness policies, raising generic may not be a good way to incentivize cost cuts, since short term savings to employees could cause long term illness that is very costly. It is possible, generics could be increased; but preventative generics could be changed (even to no charge) to encourage their use as part of the wellness plan. The attached table titled "Benefit and Contribution Changes Recommended for FY 2018 with 4+ votes from the Committee" is included to demonstrate the options needed to reach the $3.3 Million in cuts or revenue increases. That would mean approving Options: 2, 2A, 29, 30, 31, 18, 28, 9, 11, 32, 13, 15, 19, and 35 recommended by the HPAC, then also approving: Options 3, 6A, 5, 20, and 34 reach the $3.3 Million. This would represent $3,472,183 in savings to the plan. Correspondingly, there is a table titled "Monroe County Board of* County Commissioners, Illustrative 2018 Plan Design and Contributions Based on Modified Committee Recommendations to get to the $3.4 Million Target" that shows the costs to the various covered lives in the Plan, if these options are adopted by the Board. Finally, Senior Staff were also surveyed on the options presented and they have recommended: Options: 30, 31, 6, 18, 28, 5, 7A, 15, 19, 20, 21, 34, 35. The attachment labeled "Final Senior Staff FY2018 Recommended Changes.pdf" demonstrate that their recommendations were short in reaching the $3.3 Million goal by $659,406. See last column. We took the votes added: Options 2, 2A, 29, 4, 32, 15, 19, 20, 21, 34, 35, which is $807,364 more than the $3.3 Million. See file titled: "Final Senior Staff FY2018 Recommended Changes — MODIFIED to get to $3.3M.pdf' PREVIOUS RELEVANT BOCC ACTION: CONTRACT/AGREEMENT CHANGES: Discussion and direction regarding consideration of benefit, contribution, plan management and administrative changes being proposed for the Health Insurance Plan for FYI 8. STAFF RECOMMENDATION: No staff recommendation is being given at this time. There are options from the Health Plan Advisory Committee, as well as Senior Management to review and to choose from, all of which would be beneficial to the plan and would address funding deficiencies. DOCUMENTATION: MCBCC Commission meeting 05-10-2017 FY 2018 Recommended Changes Final voted with modifications for Board Large Employers Comparison Ad Valorem Spreadsheet Rate sheet for HPAC with revenue History of Raises with Health Insurance Expenses MCBCC FB Placemat for 2017 plan mods High Claims Summary by Dx Catagories 2015 to 2016 Summary of Retiree Resolutions Retirees Years of Service 3 6 17 Potential Rule of 70 No PHI Enrollment Changes Envision Select Formulary Res 049-2017 Wellness Committee Members Suggestions Final Senior Staff FY 2018 Recommended Changes Final Senior Staff FY 2018 Recommended Changes - MODIFIED to get to $3.3M FINANCIAL IMPACT: Effective Date: Expiration Date: Total Dollar Value of Contract: Total Cost to County: Current Year Portion: Budgeted: Source of Funds: CPI: Indirect Costs: Estimated Ongoing Costs Not Included in above dollar amounts: Revenue Producing: Grant: County Match: Insurance Required: Additional Details: N/A If yes, amount: REVIEWED BY: Christine Hurley Completed 05/03/2017 3:30 PM Cynthia Hall Completed 05/03/2017 5:58 PM Budget and Finance Completed 05/04/2017 8:10 AM Maria Slavik Completed 05/04/2017 10:01 AM Kathy Peters Completed 05/04/2017 10:20 AM Board of County Commissioners Pending 05/10/2017 10:00 AM Monroe County Board of FY 2018 Health Plan Options Ml--.Iy 10� 2017 ColIIIS -, ' � ,jr O-.1 ISIrl Meetff 9 Monroe County Health and Prescription Insurance Overview: • The Board of County Commissioners (BOCC) administers a self -insured health and prescription drug insurance program for.2409 lives, that covers BOCC employees and the 5 Constitutional Office employees: • Sheriff • Elections Office • Tax Collector • County Clerk • Property Appraiser Retiree Benefits Provided 0 c 0 • Employees hired prior to 10/1/2001 who have at least 10 years of full time service with the County, and meet the retirement criteria of the Florida Retirement System (FRS) may continue to participate in the Plan at a cost equal to the FRS Health Insurance Subsidy for term years of service (currently $5 per month for each year of service credit at retirement [$50-$150 per month]). There are 422 current retirees and 300 +/- current active employees that are eligible for this benefit if they work for the County until retirement E.1.aClaims per Member - 2,409 Average Covered Lives r- a The Plan provides medical coverage and prescription drug benefits to 1162 active employees and an additional 708 spouses and dependents of active employees In accordance with FL. Stat. 112.0801 the County also has available medical coverage and prescription drug benefits to retirees and their eligible dependents. There are currently 422 retirees and 117 retiree spouses and dependents. Data as of 12/31/16 Historical Paid Clairris Data as of 12/31/16 Historical Active and Retiree Claim Split FY 09/10 1 FY 10/111 FYII/121 FY 12/131 FY 13/141 FY 14/151 FY 15/16 Annual Claims Active Active Medical Pharmacy $9,348,087 $1,361,081 $10,307,935 $1,449,067 $8,639,657 $1,323,481 $7,047,670 $1,461,181 $7,908,415 $1,756,333 $8,990,024 $2,215,091 $10,053,260 $2,263,630 .Active Tota 1 $10,709,167 $11,757,002 $9,963,138 'r$8,508,851I $9,664,748I $11,205,115 $12,316,890 Retiree Retiree Medical Pharmacy $2,671,227 $927,078 $1,933,540 $1,053,083 $2,572,858 $962,323 $2,983,256 $1,138,401 $1,777,659 $1,151,543 $1,930,045 $1,419,247 $2,560,144 $1,472,955 Retiree Total $3,598,305 $2,986,623 $3,535,182 $4,121,656 $2,929,202 $3,349,292 $4,033,099 Average Employees Active Retiree 1,263 354 1,248 365 1,255 367 1,211 384 1,210 394 1,181 411 1,161 421 Average Members Active Retiree 1,777 438 1,767 451 1,777 454 1o814 479 1,876 493 1,856 519 1,859 535 Annual Claims Per Employee Active Active Medical Pharmacy $7,401 $1,078 $8,260 $1,161 $6,885 $1,055 $5,820 ss $1,207 $6,536 $1,452 $7,612 $1,876 $8,659 $1,950 Active Total $8,479 $9,421 $7,940 $7,026 $7,987 $9,488 $10,609 Retiree Retiree Medical l Pharmacy $7,546 $2,619 $5,297 $2,885 $7,010 $2,622 $7,769II I $2,965 I $4,512II $2,923 I $4,696 $3,453 $6,081 $3,499 Retiree Total $10,165 $8,183 $9,632 $10,733 $7,435 $8,149 $ 9::5 8=0 Annual Claims Per Member Active Active Medical Pharmacy $5,260 $766 $5,833 $820 $4,862 $745 $3,885 $806 $4,216 $936 $4,844 $1,193 $5,408 $1,218 Active Total $6,026 $6,653 $5,607 $4,691 $5,152 $6,037 $6,626 Retiree Retiree Medical Pharmacy $6,103 $2,118 $4,285 $2,334 $5,671 $2,121 $6,228 $2,377 $3,606 $2,336 $3,719 $2,735 $4,785 $2,753 Retiree Total $8,222 $6,619 $7,792 $8,605 $5,942 $6,453 $7,539 LO a) 00 PIL Historical RevenUe and Expense $22,000,000 Based on State Filings $20,000,000 ........... $18,000,000 AF LO Co $16,000,000 ................ ... MEN=.. ........................ WMM-FRFM <1 zL nnn nnn -UMMM "'Ift ................. LO 0 tM $12,000,000 - Expense includes claims plus a// administrative expenses Data as of 12/31/16 I f", Florida Blue Provider Discount *:)ummary Network Savings 62.0% 61.0% 60.0% 59-01YO SS,4% 58-01YO 57.0% 56.3% 5G.0% 55-01YO CP' As reported by Florida Blue. 61.2% M Savi rip,--j Ln rn 00 N 552d,572 Tota 1 $17,685,480 1 Packet Pg. 165 GROUP INSURANCE RATES EFFECTIVE'JANUARY 1, 2017 PER PAYDAY PER MONTH c 0 EMPLOYEE ONLY COVERAGE: (Hired 05/0I1/12) $23.00 $50.00 r_ EMPLOYEE ONLY COVERAGE: (Hired prior to 5/1/2012) $11.50 $25.00 0 .2 m DEPENDENT COVERAGE TIERS: R NOW c SUBSIDIZED NON -SUBSIDIZED SUBSIDIZED SUBSIDIZED* � SPOUSE ONLY $153.00 $387.00 $332.00 $838.00 y SPOUSE + ONE CHILD $222.00 $455.00 $480.00 $986.00 0 SPOUSE + TWO OR MORE CHILDREN $324.00' $557.00 $701.00 $1,207.00 uO am 0 N ONE CHILD ONLY $68.00 $148.00 TWO CHILDREN ONLY $136.00: $295.00 n c THREE CHILDREN ONLY $204.00 $443.00 N 0 FOUR CHILDREN ONLY $273.00' $591.00 FIVE OR MORE CHILDREN $341.00 $738.00 0 m m E RETIREES (MONTHLY RATES): c 4 $5.00 for each yr,of FRS' service at time of retirement .y E HIRED' PRIOR TO 10/01/01, MUST MEET "RULE OF 70" (SEE RESOLUTION) ALL AGES with Monroe County E U HIRED AFTER 10/01101 OR UPON RETIREMENT,'IMONROE COUNTY 'I UNDER AGE 65: $1,035.00 U U WAS YOUR LAST FRS EMPLOYER OVER AGE 65: $621.00 M U RETIREE DEPENDENT COVERAGE TIERS: c SPOUSE ONLY UNDERAGE 65: $332.00 E SPOUSE ONLY OVER AGE 65: $559.00 R a FOR DEPENDENT CHILDREN RATES SEE TIERS ABOVE *NOTE: Packet Pg. 16ti NON -SUBSIDIZED PREMIUM APPLIES TO SPOUSES/DOMESTIC PARTNERS WHO ARE ELIGIBLE FOR COVERAGE THROUGH THEIR EMPLOYER BUT ELECT TO ENROLL IN THE MONROE COUNTY HEALTH PLAN Q I Historical Fund Balance $16,000,000 $14,385,642 $14,000,000 $12,246,242 $11,840,418 $11,788,578 $12,071,795 $8,271,901 $8,582,60 8 $1.2,000,000 $10,594,436 $10,000,000 $7,595,391 $9,132,140 $8,175,284 ME $8,000,000 67,166 ............ a i a a agar MINE a MINE a am, MINE NEW MINE $6,000,000 ........... MINE i Immi ............ ........ ..... ........... 4 a IN 'm ............ a RE MM� a 1 a a am i am a a III ..... a MINE a a MM� a a Im a $5,79805 am a am a SION $4,000,000 . ... ... . ... ... . ... ............ am am am am ........... am IN INE INE INE INE am Imm RE a a a a a ........... a a a mmm am a a a a Sam a a a a Sam a a a Sam a a Sam a xxxxBINE am RE am RE am RE am RE a a Sam a ffi�— a a a a am a a a a ffi�— am a a a a ffi�— am a ffi�— am a a a $2,000,000 am M.M.M. 'm IIIm am RE am IIIIE RE am RE am a a a a am NEW a a a a a am a am a a a $0 ........... ......... ... ............ am ... ... ... . ... ... ... ... ... ... ... ... ... ... ... ... am RE am RE am a am a a a a a a a am am 2009/1.0 201-0/1.1 201.1/1.2 2012/13 2013/14 2014/15 201.5/16 201.6/17 201.7/18 Projected Projected 6 Month Target Fund Balance 2017/18 Projected Assumes No Change in Benefits or Funding Data as of 12/31/16 - --mmomm— r- 0 r- .2 0 LO a) CO O O LO 0 E r- .2 0 2 E E 0 L) L) L) E M Large Claims Increase FY Ending # of Claimants Over $5 K Total Claim for Lame Claimants Largest Claim # Over $250K # Over $40 K 2009 18 $1, 858,196 $4027792 2 1 2010 20 $21076, 986 $3381544 1 0 2011 22 $21388, 534 $3361742 1 0 2012 27 $2, 81, 942 $3231462 3 0 2013 35 $3, 845, 990 $310,603 3 0 2014 34 $31839, 936 $5031159 1 1 2015 43 $51349, 407 $5601607 5 1 2016 50 $612871104 $8161745 4 3 2017 YTD 11 $1,1481758 $2671761 1 0 2017 Ann'd 44 $415957030 LO CD co N What does this mean for the Health Fund for 2018 FY 2018 Forecasts Baseline FY 18 Forecast Projected Starting Fund Balance $7)5951391 Projected Revenue at Current Funding $18)0527606 Projected Claims $18,264,281 Projected Fixed Costs $1)585)691 Projected Expenses $19)8497972 P ro►' e cte d Ga i n/(Loss) ($1,797,366) Projected Closing Fund Balance $5)798)025 Projected Target Fund Balance $9)132)140 Projected Excesst(Shortfall) ($3,3343,116) a Health Plan Changes Implemented for 2017 Prajected FY Impact Benefit Changes (Effective January 1, 2017) Increase E R ded ucti ble from $100 to $300 $97,769 Increase out of Pocket Maximum From $6350 to $7150 $139,669 Increase retail brand copay from $35/$70 (preferred/ non preferred) to $50/$90 and Increase retail 90 brand from $87.50/$175 to $125/$225 $143,161 Increase specialty pharmacy cost share to 20% to a maximum of $250 $13,967 Add Teledoc $19,575 lSubtotal Plan Design Changes $414,141 Funding Changes (Effective Oc--tc)ber 1, 2016 fbr County and January 1, 2017 far Employees No Subsidy for Medicare Eligible Dependents of Retirees $254,448 Spouses of Active Employee Pay 100% of Actuarial Rate if Spouse has Access to Coverage Through His/Her C>,vn Employer $234,077 Increase County Contribution $2,261,970 Subtotal Funding Increases $2,750,495 I Total Estimated Impact of 2017 Changes $3,164,636 LO a) 00 PIL 2017 Plan Changes Considered - Not Implemented Projected FY Impact Benefit Changes Increase Deductible from $4001$800 to $600/$1200 $282,831 Increase Specialist and Urgent Care copay from $25 to $50 $94,277 Add $100 pharmacy deductible $162,366 Contribution Changes Charge Full Annual Amount of Health Insurance to Medicare Eligible Retirees $1,312,500 Reset Dependent Contributions to 50% of Actuarial Rate at Current Higher Costs $373,230 No Subsidy for Dependents of Any Retirees $459,378 No subsidy for Pre-65 Retirees $1,311,728 Pre 65 Retirees Pay 50% of Actuarial Rate $621,033 Active Employees Pay $50/75 for Employee Coverage $263,025 Reset Dependent Contributions to 60% of Actuarial Rates $599,868 Set Premium for Retiree Only Coverage to a Flat $200 $272,025 LO a) w PIL Top 10 Prescription Diagnoses Management Sinus Problems Urinary Tract Infection Pink Eye Bronchitis Upper Respiratory Infection Nasal Congestion Allergies Flu Cough Ear Infection .y N 7 U N LO 00 N n 0 N O 11 Electronic prescribing (SureScripts) or by phone. if needed d E Frequency of prescribing lower than same `o diagnoses when comparing best provider y practices (about 80% vs. 83%) E Patient education and physician reminders for ci appropriate use L) No prescribing of DEA-controlled substances, m 2 medication for psychiatric illness. or lifestyle drugs (i.e. erectile dysfunction, diet). E Generic drugs are automatically t y recommended What staff is doing and what may be on the horizon for the 2017/2018 budget considerations., • Initiating an education and outreach program to train users of health insurance to "shop around" for the treatment that is the least costly to the plan and to the employees with a private company who will travel to all County offices and educate staff on how to save money — For example: rLK - �ostiy Si SSS Did you know that you can shop around to save money on your medical care? Shopping for non-amerponvy cam can save you BIG dollars. W Florida Blue pro VldeS a cost rom parison feature. Q Log Dnto hTCp:ffWWW3�bcbSfl.CorVwpslportaI CgSfl LO Choose the'Tools'tab and 'Compare Medical Cost' a) 00 N Far cnnmplc, If I hod deco I — mg acvcrc Ircoclac hca for o long tllnc. my doctor in my n CT aeon at my to be ears that 1 have ono. My doctor wool ld write a praa:cription far a CT Scan withc ut contreaa. Procedure coda n runhu. O N CHECK GUT THE ESTIMATED GIFFERENC ES FOR THESE IN -NETWORK PROVIDERS: O' PROVIDER AUVANCEU I 11WFR KFYS FISHERMEN'S MAKINER5 HUSPI IAL HC1IVFSTFAr1 MFrllr.AI NAME: VRCiENI l4RRE CENTER HU5 NIIRL —EIIP 1151 HEhL IH DIAr5Nnq TIC' CENTER LO O a7 � 1M0 N. 5900 C Gllege R 1. 3301 Clv4rSka5 Roosevelt ❑Ivd. 91500 Over— I Iwy. 2975 I lomeateud y ADDRESS: Kcy West, FL KEY WEST, FL Hwy T-or MI, r, FL 33070 13Ivd Rl7 37040 Mara lllulr, 33040 FL. Home stea (l. FL E 1i050 33030 C CONTACT C (305] 294 0011 f305} 294-5531 (305) 743-5533 (305) 434-3000 (305)24C 5600 IN FV I fp E TYPICAL 191 %3,243.07 st 469 44szz stzao COST. S25 Co-Pny , All fl N'c61C Alliiwnl:lr gSAO.RA All�rw,i l:Ir S�Tl1.'i All—:,l,le. %inn Allowably $.26❑ 91764.13 V Example: '� ei already pall m my $400 L) L . r dcducti blc � rL and h— not reached my 161,350 011i Of SaTf-o $446.03 $135.21 5675.75 $47.50 E I—, kvl ,Il.lc fro the ye:u. tl The bottom line is that it pays tD shop far medical cost! aR-r My out of pocket cost The difference is iimie Plalr 5300 UUL of Iriy puukel. Q ccIu Id pay as much as S67%:.7❑ or as little as S47, 01 is 251 o-t the Can yuu guyswllere I and yoiuy lu yc, if I ,Iced a CT allowable. What staff 'i's doing and what may be on the horizon for the 2017/2018 budget considerations: • RFP Pharmacy Benefit Manager in 2017 • RFP Fully Insured Medical without Pharmacy in 2017 • RFP self insured if fully insured doesn't produce good results • RFP Stop Loss insurance for large claims a Request for Proposals Draft Timelined Health Insurance and Prescription Benefit Request for Proposals (RFPs) Recommended Timelines Selection Termination Notice BOCC Approvalof Ana lys is to Committee Finalist Presentations Recommendation- BOCCAward to Vendor nraftq from rRq RFP P,,hliqh nat. RFP Ononino mrRrr M..tino (nnlw K noodoril A—daItem noadlino RnrrAward Rid r—ftat flat—t dat.1 Implementation Da LO Pharmacy BM - Standalone 1/19/2017 4/12/2017 4/17/2017 6/6/2017 7/10/2017 7/20/17-7/21/17 7/25/17-7/26/17 8/1/2017 9/16/2017 10/20/2017 11/1/2017 9/1/17 - 1/1/18 Stop Loss 4/19/2017 5/17/2017 5/22/2017 7/5/2017 8/25/2017 9/13/2017 9/15/2017 10/3/2017 10/18/2017 12/1412017 N/A 10/1/17 - 1/1/1E Termination Notice and Contract The PBM RFP is critical for 2017 due to the expiration of the current contract with EnvisionRx. Expiration to Envision (RX provider) Termination Noticeto FI3 The County must make a determination as towhether to terminate Florida Blue and notify FB by7/1/2018 if it wishes toterminate the Administrative Services Agreementfor the medical plan beginning 1/1/19. Fully Insured Medical without Rx, With HMO & PPO Options. 10/1/2017 11115/2017 11/20/2017 1/9/2018 2/12/2018 2/22/18-2/23/18 2/27/18-2/28/18 3/7/2018 3/2112018 5/16/2018 7/1/2018 4/1/2018 - 1/1/20 Medical TPA RFP -with 180 day Itermination notice 1 10/1/2017 12112/2017 1/1/2018 2/13/2018 3/12/2018 3/21/18-3/23/18 3/27/18-3/29/18 4/2/2018 4/1612018 6/20/2018 7/1/2018 6/1/18 - 1/1/19 L) L) L) X11 Current Contract Expiration Dates: L) 2 Pharmacy Benefit Manager 4j (Envision RX) 12/31/2017 47 E O Medical TPA (Florida Blue) 12/31/2020 $150,000 Early Termination Fee per the Amendment LUN11 PA R ISUN -UF M[}NEUE. C-ULJN I LA KUEH (xUVk R rYMENI EMIIr LUYEP5 Cii.Hly r'.•. P. i i.. Oc rc�idcir� PS, Fcli icc Pi ciui-i & EMpLOVER EMr-LOYEn EMPLOYER Mo-nrec Cauney EOCC mlti dfr: �332 EOti F}1-IF rcd aM1.cr .c 1". 1�'OL r n 10 yr: s'ac-icc. r.n ane liLl�n. ,.rn u,. a e n ne Sp—e f One Child S450 n.-Tnuu c❑iild "d1 Pi u 12 ° Y Pc h'U i..� 8i . C i i 8i '1=3 Ti+e[Lhlldmi, 5Y5 F.—:a Ca I. r.-a: SEJI r rr CI IJ.— . "]3 FK" lOC'i 5C 0O m Onc Oc c,&— r3C0.1C ET Hlo�c P. Full{ort Ci4 ;C ram II }'. SIL5.21 L...[F.n ISa ardi[Fcrcd Lppc-W-5.T cr. x,.[a-. --.1 id 100 N rle.v a LI p,rl,'aac.w-r.ereaa bri+: ba w dcn le.• lead e- Ci �r v'Ffsr Wra. Yrc-[o lo,r 1. 10: IOO°: pnc-b IO:O S: 10: $ 0.00 0'd - $ECS.iE ON A"r 10.'01.`LO: 9]'4 .She' L0:'C 1: 10: i 311E Chlldmn S49�3n C rder 65 rLII C-1 i nl0.92 F.m il}: CI. 1.3.:1 0—di: C E0: 0: H.y. 1—." 10V �C Ca O'U rSE9.iE LOOQ: E lig ble Pe[Irees M l FI, IF, I. e.- 9. 1939. iJ.. �.. Lc .I -111c •v �..Ilr.[ LI . rr.— r a .I} childmin S426.51! r— ill, S931 .�2 Ci[y ur Mai cLI.... rcn108ti ^ ^ e. �.r.a.,er- —rap, .r aux, pl.r :: ra}, ,[LOON L5SC9 ON R. i.c.. srli;,iL lr i.. CODE P., 100ti p 04 I7 F^ F.ril CI.T^. dy3i „91'aa r 1' P n J1.9- • 9137.91, F^ •WBAS F. T it n talon orado, Y'illc6c o= Islands 96`d =7O Ore ipa=• . CI.BJ s ,: $'ce.1C $-SW i4 ON •.C�.-iJ �C7 "70.00 F.— it GU} U3 PIar: I!,i Lp P an LL'r Up P an MUST re%e 10'ie ar c [ .ICI[ °-n •:1a TOC=1025.15 MvinucCwinr '+t Luul n �.rn Ganci Tp[r,v -ri. I,pr..:. n-I:F.— Para : aiJv la..— ru-}cc rr v I•I Trk; r13 R., -c ES $, 2 Miami pedc C—ty HMO HMO 3 HMO HMO r =--ar.. b,'I. .. `.` L=. HMO U,drr oS: �i90 IOLP. 5OM Lp. 151.'3 p!ti Lr c.r 6S: C11 GS child.— • ] 30.5' a.r.[ FPR� $ee3.su .. nr.a .a�.. -ppl—re:r rrr r - 1.'.Ji�.ir �.✓✓.-i. sY n_PI. =230 P05 I li,, 1. Oyliuii Phil. 2311, POi CI.i1J.c j-=.00 Fa T'1, CI isc-16 M7 00 N To maintain a 6 month reserve an-)OUnt in the Health Insurance Fund C 0 LO CF) 00 Lh 0 E C 0 E E 0 L) L) L) C a) E 2018 Options to be StUd,led byCOMMIttee and discuss-,.,.,. . .. ... ... ....... o n 3 2 4 17 t o m e e t Droiected shortfall 0 0 Recommended by Decrease Expense Committee by Benefit and Contribution Changes Recommended for FY 2018 by: $3.3 Million Majority Vote Projected FY Impact Y or N Benefit Changes 1. Increase Deductible from $400/$800 to $600/$1200 $282,831 2. Increase Specialist and Urgent Care copay from $25;,to $50 $94,277 3. Add $100'pharmacy deductible $162,366 Contribution Changes 4. Charge Full Annual Amount of Health Insurance to Medicare Eligible Retirees $1,312,500 5. Reset Dependent Contributions to 50% of Actuarial Rate at Current Higher Costs $373,230 6. No Subsidy for Dependents of Any Retirees $459,378 7. No subsidy for Pre-65Retirees $1,311,728 8. Pre 65 Retirees > Pay 50% of Actuarial Rate $621,033 9. Active Employees Pay $50/75 for Employee Coverage $263,025 10. Reset Dependent Contributions to'60% of Actuarial Rates $599,868 11. Set Premium for Retiree Only Coverage to a Flat $200 $272,025 Benefit and Contributions Changes Recommended by Staff for 2018 Benefit Changes 12. Dual Option HSA $729,734 >.13. Dual Option HSA with retirees getting high deductible plan at no cost' $711616 14. Dual Option like MCSB $573,964 15. RDS vs EGWP $250,000 Contribution Changes 16. Discontinue Dependent Subsidy for employees hired after 10/1/17 $139,209 LO a) w N FY 2018 Option 1 LO w N Expected to reduce claims costs by 1.6%. FY 2018 Option 2 LO w N Expected to reduce claims costs by 0.45%. FY 2018 Option 2A LO w N Expected to reduce claims costs by 0.05%. FY 2018 Option 3 R C O .y N 7 U N a Would apply to each individual covered, so all family members would be subject to this deductible. Expected to reduce claim costs by 0.9% FY 2018 Option 4 R C O .y N 7 U N This would increase retiree rate for Medicare retirees to approximately $700 per month. Virtually all of these retirees would then leave the plan in favor of Medicare Supplement or Medicare Advantage plans. FY 2018 Option 4A R C O .y N 7 U W This would increase the retiree rate for Medicare retirees to approximately $447 per month ($697 actuarial rate - $250 subsidy). We expect a majority would leave the plan in favor of Medicare Supplement or Medicare Advantage plans. FY 2018 Option 5 R C O .y N 7 U Option 10 has a different dependent contribution illustration. Only 1 of these 2 can be selected. FY 2018 Option 6 LO w N Subsidy for Medicare eligible spouses has already been discontinued. FY 2018 Option 6A LO w N Tier Covered Current Rate Revised Rate Spouse <65 37 $332 $628' 1 Child 5 $148 $279' 2 Children > 4> $295 > $558 3 Children > 2' $443 $837' Spouse <65 & 1 Child 2' $480 $907 Spouse < 65 + 2 Childre 1 1 $701 $1 ,325 Total Annual 51 $201 ,012 $380,1 12 Annual Swings $179,100 9 Month Savings $134, 325► Subsidy for Medicare eligible spouses has already been discontinued. FY 2018 Option 7 R C O .y N 7 U N Pre-65 Retirees currently pay $50 to $150 depending on years of service. Under this option they would pay $1035. Option 8 has a different pre-65 retiree contribution illustration. Only 1 of these 2 can be selected. FY 2018 Option 7A Years of Service Retiree Contribution 25+ FRS HIS ($125 to $150 - same as current) 20-24 25% of Actuarial Rate 10-20 50/0 of Actuarial Rate LO CD N FY 2018 Option 7A LO w N FY 2018 Option 8 R C O .y N 7 U N Pre-65 Retirees currently pay $50 to $150 depending on years of service. Under this option they would pay $518. Option 7 has a different pre-65 retiree contribution illustration. Only 1 of these 2 can be selected. FY 2018 Option 9 R C O .y N 7 U N Option 24 has a different employee contribution illustration. Only 1 of these 2 can be selected. FY 2018 Option 10 R C O W N 7 U N a Option 5 has a different dependent contribution illustration. Only 1 of these 2 can be selected. FY 2018 Option 11 R C O .y N 7 U N Applies only for retirees who have met the Rule of 70. Retirees not eligible for Rule of 70 continue to pay full Department rate Option 17 has a different retiree contribution illustration. Only 1 of these 2 can be selected. FY 2018 Options 12 - 14 Current Plan Options 12& 13: Illustrative HDHP with HSA Option 14: Nbnroe Schools HDHP Feature Network Non Network Network Non Network Network' Non Network Deductible - Individual' Deductible - Family $400 $800 $400 $800 $2,000 $4,000 $4,000 $8,000 ;$1,750 $3,500 $1,750' $3,500' Coinsurance >' 75% 45% 80% 50% 75%' 60% Out of Pocket Max - Individual Out of Pocket Max - Family $7,150 $14,300 $7,150 $14,300 $7,150 $14,300 $14,300 $28,600 >$6,850 $13,700 $6,850> $13,700>' Physician Office Visit Copay $25 Ded/Coinsurance Ded/Coinsurance Ded/Coinsurance >$50 (PCP Only)' $60 (PCP Only)' ER Copay $300> Ded/Coinsurance Ded/Coinsurance Ded/Coinsurance' Ded/Coinsurance Prescription Drug Deductible Per Member N/A > N/A $100 Retail Pharmacy Copays (After' Deductible for HSA) Generic Preferred Brand Non Preferred Brand' $10' $50' $90 $10 $50 $90 $15 $50 $75 Mail Order Pharmacy Copays (After` Deductible for HSA) Generic Preferred Brand Non Preferred Brand' $25' $125' $225' $25 $125 $225 $30 $100 $1,50 HSA Contribution From County;' EE Only 1EE + Dependents N/A > N/A' $500 $1,000 N/A N/A Estimated Cost of Illustrative' HSA Plan Relative to 2017 PPO * 1.000 0.818 0.889 LO o) 00 FY 2018 Option 12 Hi h Option Current Plan Low Option (HSA Plan Enrollees Monthly Rate; Enrollees Monthly Rate Monthly Rate % Enrollees Monthly Rate Monthly Rate % Employees Paying $25,'Premium 616 $25 493 $50 64% 123 $0 0% Recent Hires Pay $50 mo prem 556 $50 445 $75 57% 111 $0 0% EMPLOYEE DEPENDENTS ONLY: Spouse Only 110 $332 88 >$394 38%>' 22 $299 35% Spouse + 1 child 37 $480 30 ;,$570 38% 7 $432 35% Spouse + 2 or more children 33 $701 26 ;,$832 38% 7 $631 35% One child only 120 $148 96 $175 38% 24 $133 35% Two children only 80 $295 64 ;,$351 38% 16 $266 35% Three children only 15 $443 12 ;,$526 38% 3 $399 35% Four children only 3 $591 2 ;,$702 38% 1 $532 35% RETIREES ONLY: 10+ YRS <65 117 $125 94 $146 11%' 23 $75 12% 10+ YRS >65 296 $1',25 237 $146 21 %' 59 $75 12% Surviving Spouse < 65' 3 $332 2 $394 29%' $299 27% Surviving Spouse 65+ ? ;6 $559 5 ;$598 86%' 1 $503 88% RETIREE DEPENDENTS ONLY: Spouse Only <65 34 $332 27 $394 29%' 7 $299 27% Spouse only <65 + 1 child 2 $480 2 $570 31 %' 0 $432 29% Spouse only <65 + 2 or more children 1 $701 1 $832 33%' 0 $631 31% Spouse Only >65 18 $559 14 $598 86%' 4 $503 88% Two children only 4 $295 »3 »$351 38% 1 $266 ' 35% Monthly Rate % is the % of the Actuarial Rate (true expected cost) paid by the employee LO a) co PIL FY 2018 Option 12 R C O .y N 7 U N Options 13, 14, and 33 have different high deductible dual option illustrations. Only 1 of these 4 can be selected. FY 2018 Option 13 Current Dual' ' Option Hi h Option Current Plan Low Option (HSA Plan Enrollees' Monthly Rate Enrollees Month Rate Monthly mate % Enrollees Monthly Date Month Rate °la' Employees Paying $25 Premium 616 $25 493 $50 63% 123 $0 0% Recent Hires Pay $50 mo prem 556 >.$50 >.445 $75 57% 111 $0 0%Q EMPLOYEE DEPENDENTS ONLY: Spouse Only 110 $332 88 $396 37% >22 $299> 35% Spouse + 1 child 37 $480 30 $571 37% 7 $432 35% Spouse + 2 or more children' 33 $701 26 $835 37% 7 $631 35% One child only 120 $148 96 $176 37% >.24 $133> 35% Two children only 80 $295 64 $352 37% 16 $266' 35% Three children only ; 15 $443 12 $528 37% 3 $399 35% Four children only 3 $591 2 $704 37% 1 $532 35% RETIREES ONLY: 10+'YRS <65 117 $125 0 $146 11% 117 $0 0% 10+'YRS>65 296 $125 0 $146 21% 296 $0 0% Surviving Spouse < 65 3 $332 0 $395 29% $299' 27% Surviving Spouse 65+ 6 $559 0 $600 85% 6 $503 87% RETIREE DEPENDENTS ONLY: Spouse Only <65 34 $332 0 $396 29% >.34 $299>' 27% Spouse only <65 + 1' child 2 $480 0 $571 31% 2 $432' 29% Spouse only <65 + 2 or more children 1 $701 0 $835 33% 1 $631 30% Spouse Only >65 18 $559 0 $600 85% 18 $503 87% Two children only 4 $295 0 $352 37% 4 $266' 35% Monthly Rate % is the % of the Actuarial Rate (true expected cost) paid by the employee a FY 2018 Option 13 R C O .y N 7 U N Options 12, 14, and 33 have different high deductible dual option illustrations. Only 1 of these 4 can be selected. FY 2018 Option 14 Current Dual ' Option High Option Current Plan Low Option (HSA Plan Enrollees Monthly Rate Enrollees Monthly Rate Monthly Rate % Enrollees Month Mate Monthly Rate Ufa Employees Paying' $25 Premium 616 $25 493 $50 64% » 123 $25 4% Recent Hires Pay $50 mo prem 556 $50 445 $75 58% >.111 $25 4% EMPLOYEE DEPENDENTS ONLY: Spouse Only 110 $332 88 $385 37% 22 $299> 32% Spouse +'1 child 37 $480 30 $557' 37% 7 $432' 32% Spouse +'2 or more children 33 $701 26 $813' 37% 7 $631' 32% One child only 120 $148 96 $171 >' 37% 24 $133>' 32% Two children only 80 $295 64 $343> 37% 16 $266> 32% Three children only 15 $443 12 $514' 37% 3 $399' 32% Four children only; 3 $591 2 $685 37% 1 $532' 32% RETIREES ONLY: 10+ YRS <65 117 $125 94 $139 10% 23 $75 11 % 10+ YRS >65 296 $125 237 $139 20% 59 $75 11 % Surviving Spouse < 65 3 $332 2 $385' 29% $299' 25% Surviving Spouse 65+ 6 $559 5 $589' 85% 1 $503' 82% RETIREE DEPENDENTS ONLY: Spouse Only <65 34 $332 27 $385' 29% 7 $299' 25% Spouse only <65 + 1 child' 2 $480 2 $557' 31% 0 $432' 27% Spouse only <65 + 2 or more children 1 $701 1 $813> 33% 0 $631> 28% Spouse Only >65 18 $559 14 $589' 85% 4 $503' 82% Two children only ;, 4 $295 3 $343 37% 1 $266' 32% Monthly Rate % is the % of the Actuarial Rate (true expected cost) paid by the employee LO o) co N FY 2018 Option 14 R C O .y N 7 U N Options 12, 13, and 33 have different high deductible dual option illustrations. Only 1 of these 4 can be selected. FY 2018 Option 15 LO w N FY 2018 Option 16 a Options 32 has different dependent subsidy illustrations. Only 1 of these 2 can be selected. FY 2018 Option 17 R C O .y N 7 U N Applies only for retirees who have met the Rule of 70. Retirees not eligible for Rule of 70 continue to pay full Department rate Options 11, 25 and 26 have different retiree subsidy illustrations. Only 1 of these 4 can be selected. FY 2018 Option 18 .2 C M C O .y N 7 U N a LO T Co N Premium for a spouse of a retiree with access to other coverage would increase from $332 to $1046. Committee Suggestions - FY 2018 Option 19 LO w N Projected FY 2018 Claims $18, 264, 281 Projected FY 2018 Dependent Claims $6, 528, 257 Estimated DEA Savings % 3.0% 5.0% 4.0% Estimated DEA Savings $ $195, 848 $326, 413 $2611130 9 Month Savings $146, 886 $244, 810 $195, 848 Committee Suggestions - FY 2018 Option 20 R C O .y N 7 tl a Current Generic Dispensing Rate (GDR) 83.0% Attainable GDR Under Mandatory Generic 83.5% Attainable Increase in GDR 0.5% Estimated Resulting Pharmacy Savings 0.8% Projected FY 2018 Pharmacy Claims $4,392,682 Estimated Annual Savings $32,945 Estimated 9-Month Savings $24,709 Per Envision, current generic use is close to maximum attainable due to mix of County drug therapies. Committee Suggestions - FY 2018 Option 21 R C O .y N 7 tl a Plan already has this for some therapies Expect limited impact of additional requirements 0.5% Expected Annual $ Impact $213963 Estimated 9 Month Impact $163473 Option 34 is based on a revised drug formulary that would eliminate any additional step therapy savings. Only one of Options 21 and 34 can be selected. -mmomm- Committee Suggestions - FY 2018 Option 22 R C O .y N 7 tl a Baseline claim projection for FY 2018 $1812641281 Projected % Savings 0.51% Projected Annual Impact $93,148 Projected 9 Month Impact $69,861 Committee Suggestions - FY 2018 Option 23 LO w N Baseline claim projection for FY 2018 $1872647281 Projected % Savings 0.12% Projected Annual Impact $211,9117 Projected 9 Month Impact $%438 Committee Suggestions - FY 2018 Option 24 R C O .y N 7 tl W a Projected Actuarial Rate for FY 2018 $775 Enrollees Current Revised Monthly Impact 725 448 $25 $50 $65 $95 1,173 $40, 525 $89, 685 $49,160 Average $35 $76 Average % 4.50/o 9.90/0 9 Month Impact 1 $ 442,440 Option 9 has a different employee contribution illustration. Only 1 of these 2 can be selected. Committee Suggestions - FY 2018 Option 25 R C O .y N 7 tl N a Enrollees Current Average Contrib FY 2018 Actuarial Rate Current % Illustrative Contribution Illustrative % <65 65+ 117 296 $125 $125 $1, 035 $697 12.1 % 17.9% $207 $139 20.0% 20.0% Total/Average 413 $125 $793 15.8% $159 20.0% Total Monthly Premium $51,625 1 $65,510 Monthly Impact 9 Month Impact $13,885 $124,963 Option 17 and 26 have different retiree contribution illustrations. Only 1 of these 3 can be selected. Committee Suggestions - FY 2018 Option 26 R C O .y N 7 tl W a Current Proposed Years of Service Enrollees Premium Premium 10-20 242 $17,465 $36,300 20+ 171 $21,955 $8,550 Tota 1 41-31 $39,420 $44,850 Monthly Change $5,430 9 Month Change $48,870 Option 17 and 25 have different retiree contribution illustrations. Only 1 of these 3 can be selected. Committee Suggestions - FY 2018 Option 27 LO W N 2018 2019 2020 New Hires 176 149 127 Avg New Hires 87.9 250.5 388.7 Adj New Hires 65.9 231.8 372.9 Monthly Impact $25 $25 $25 $ Impact $19,778 $69,551 $111,858 Committee Suggestions - FY 2018 Option 28 LO w N Enrollment Date Prior to 1/1/2015 1/1/15 or Later Total' Total Covered Employees 1,415' 176' 1,591 Total Covered Dependents 702 124 826 Total Covered Members 2,117 300 2,417 Current Smoker Surcharge $0 $50 Illustrative Smoker Surcharge $100 $100 Estimated Smoking % - Employee 10% 10% Estimated Smoking % - Dependents 5%' 5%' Estimated Smokers 174' 23 197' Current Total Monthly Surcharge $0 $1,168 $1,168 Illustrative Total Monthly Surcharge $17,407 $2,335 $19,743 Annual Increase in Surcharge $222,900 9-Month Increase in Surcharge $167,175 Current surcharge is $50 per month for members enrolled on 11112015 or later Committee Suggestions - FY 2018 Option 29 R C O .y N 7 tl Baseline claim projection for FY 2018 $1812641281 Projected % Savings 0.17% Projected Annual Impact $31,049 Projected 9 Month Impact $23,287 Committee Suggestions - FY 2018 Option 30 LO w N Estimated Utilization Total Lab/Path Utilization per 1000 1 ,1 16 Estimated % Quest (Exclude IP, ER, pathology) 85% Estimated Quest utilization per 1000 949 Average members 2,400 Annual Quest services 2,277 Adjustment for multiple services in one claim 50% Total applicable copays 1,138 Increase in copay $10 Annual Copay $11,383 9 month copay $8,537 Committee Suggestions - FY 2018 Option 31 LO w N Baseline claim projection for FY 2018 $1872647281 Projected % Savings 0.63% Projected Annual Impact $115,065 Projected 9 Month Impact $86,299 Committee Suggestions - FY 2018 Option 32 R C O .y N 7 tl a FY 18 FY 19 FY 20 Impact of Eliminating Current Subsidy $139,209 $590,866 $997,202 Impact of Reducing Subsidy to 50% (18% reduction $36J06 $155J95 $262,934 Option 16 also involves a change to the dependent subsidy for future hires. Only 1 of these 2 options could be selected. Committee Suggestions - FY 2018 Option 33 R C O .y N 7 tl a HRA Plan Value 0.8039 HSA Plan Value 0.8177 9 Month 12 Month Original Claim Savings $404, 248 $537, 650 Revised Claim Savings $434, 849 $578, 349 Contribution Increase $325,486 $432,896 Total Impact $760,335 $1,011,246 Options 12, 13, and 14 also involves adding a high deductible plan. Only 1 of these 4 options could be selected. Envision Suggestion - FY 2018 Option 34 m R C O .y N 7 tl a Current formulary is very broad. Current year savings estimate provided by Envision. Envision indicates that this would have affected 163 members over the most recent 12 months. Option 21 involves a change to step therapy requirements that would be unnecessary if Option 34 is implemented. Only 1 of these 2 options could be selected. Committee Suggestions - FY 2018 Option 35 .2 R C O .y N 7 U W a Clc_UJt=L t=U .7 IIIIPCILA ?-L 7GlJ 7177,J0 y7L1J,JJ7 rn 00 N Current +Capays 0-[Day 90-©ay Generic $10 $25' Preferred 'Brand $50 $925 NonPreferred Brand $90 $225 n 0 N O LO O d E r- O y N E E O Current use of 90-day retail is high and we do not see any real savings potential for just requiring mandatory mail order or 90-day retail. This Option assumes a mandatory 90-day requirement (the member can choose between mail order and 90-day retail) is coupled with a narrower 90-day retail network that will have better discounts. The savings are driven by the improved discounts. This would effectively require members to use Walgreen's for retail maintenance E medications and would require members to pay the 90-day copay up front rather than the 3 monthly copays. The nei y effect is a lower copay but the higher up front cost may be a hardship for some members. a Envision Suggestion - FY 2018 Option 36 m R C O .y N 7 tl a Includes the following classes of drugs • Antihistamines (Claritin, Zyrtec) • PPIs (Nexium) • NSAIDs (Ibuprofen, Naproxen) • Nasal Corticosteroids (Flonase) Additional Suggestion- FY 2018 Option 37 R C O .y N 7 tl a Additional Suggestions - FY 2018 Option 38 a Baseline claim projection for FY 2018 $1812641281 Projected % Savings 0.51% Projected Annual Impact $93,148 Projected 9 Month Impact $69,861 Committee Suggestions Not Valued - FY 2018 'a R C O .y N 7 tl W a Mix of Enrollees by Salary Band (Based on 2014 Life RFP Census) <$50, 000 726 57.9% $50, 000 - $74, 999 404 32.2% $75, 000 - $99, 999 83 6.6% $100,000+ 40 3.2% 1,253 Conclusion is that there are not enough employees in the higher salary bands to make this an effective strategy Committee Suggestions Not Valued - FY 2018 e U R O Penalty under ACA 2017 Active employees 1,224 y Employees exempted 30 Employees subject to penalty LO 1,194 2017 Penalty per Employee $2,260 N Estimated 2018 Penalty/EE $2,350 r Estimated 2018 Penalty $2,805,900 N 0 FY 2017 County Cost $15,808,136 Ln rn c Available for Stipend if County Cost is Frozen $13,002,236 Current Active Employees 1,224 c Current Retirees Currently Receiving Subsidy 413 E Total Eligible_ 1,637 0 L) Potential Monthly Subsidies L) m Illustrative Subsidies L) Eligible A B C D u Active _ 1,224 $662 $750 $800 $850 c E Retiree 413 $662 $401 $253 $104 R Conclusion is that this would create extreme hardship on older employees and those with dependents a covered. Parlcn+ Prr 77R-== Menu of Benefit and Contribution Changes Benefit ad Contribution Ch..9.. R...Mm..d.d f., FY 2018 IBM Decrease E.p .... by: $3.3 R....d.d by Committee by Majority Vote Rank Order F 2019 Projected Savings F 2020 Projected SavingsTOTAU F 2018 Running r_ 0Million Pj N tr 0 jq This is zippli.abl. t.: . F Rot' r .. ;2!�n -r4A.rll.rl7.r25ar26vrnvtoalifive . For Retirees: n,6 t or no t,a lb�th OPT F P65 Retirees: Opt 1— . In. oe -8 El, -.nr_t E�pt!Z� �E5 10 toboth Foror r ;�le ee: letsng - r n.o to bath For future hlhiredepend!Etui;si,;�!16 ar 32 or nv t. bath F Dual 12 13 or 14 car 33 W all four ,n • Far Pharmacy 21 r 34 r n. t. bath fn $3,334,116 Benefit ch..Q- 1 1,,r .... D.d,,t,bi. from $400/$800 t. $600/$1200 $282,831 $376,165 $3.1,.0). $3,334,1 2 2 1,,r .... Sp.,,.I,.t copay fr.m $25 t. $50 $84,849 $112,849 $113,978 $3,334,116 Increase Urgent Car. copay fr.m $25 t. $50 $9,428 $12,539 $12,664 $3,334,116 3 Add $100 pharmacy deductible per,,di d,.I $162,366 $215,947 $218,106 $3,334, 116 LO 22 Increase brand drug copay. t. $60/$100 (30 day) and $150/$250 (90 day) $69,861 $92,915 $92,915 $3,334,116 CF) 23 1,,r .... . p .... Ity dr,g ,pay t, 25% t, maximumf $300 $16,438 $22,955 $24,562 $3,334,116 00 29 Change PCP, B.h-.r.1 H..[th and Pre/Post Natal Car. C.Iesy t. $30 $23,287 $31,281 $31,594 $3,334,1 113 00 30 Add $10 mIesy for Independent Cl,,,,.l Lab (Quest) $8,537 $11,355 $11,355 $3,334,116 31 1,,r.... Generic Drug C.p.y t. $15 $86,299 $117,073 $119,414 $3,334,116 cnntributiun hang, �'y f., Dependents6 No Subs of Any RHres $459 ' 37 $041,521 S686, 428 $3,334,116 6A 40% S,bidy for Dependents of fRebrea, (E-I.dmg M.di Eligible Sp..s.$) $134, 325 $187,585 $200 716 $3,334,116 18 f Retirees Pay 100% of Actuarial Rate if Spouse has A,,e.. t. Coverage Through His/Her � Empl.yer. $13,662 $18,216 $18,216 $3,334,116 LO 27 New hires pay $75for EECoverage $19778 $69551 $111 858 $3334116 0 28 Add $100 per month smoker surcharge $167,175 $219,418 $215,937 $3,334,116 5 Reset Dependent C.ntnb,fi.ns t. 50% f Actuarial:Rate at Current H,gher Costs(currently 40%) $373,230 $521,216 $557,701 $3,334,116 10, Reset Dependent Cont,bubons to CO% ef /\ctuanat Rates (currently 40%) $59 '8 $837,716 $896,356 $3,334,226 7, NO subs,dy f., Pr Ret, rees 95$3,334,116 $1,311 , 728 S1,831,827 $1,9(50,055 1 1 $3,334, 6 7A S,.Ied Subsidy far �bre $42, i 19 $�2 1 19 $1,123,572 $1,221,540 $3,334,116 8, Pre (�5 Retirees Pay 50% of ^ctuarlal Rate $621,033 $8(57,272 $927,981 $3,334,116 0 Aeb- E-play.es Pay $50/75 fe, E-play.. Core rage 2 $_3' ') $349,823 $349, A23 $3,334,116 24. 1 nc mass act1w E E conVI be b ors, fro M $251$50 to $05t$95 (10% of astu ., 1.1 -1..) $442,440 $017,867 $m 1,11 a $3,334,116 4. Change Full ^nnual ^assunt of Health Insurance to Medicare EIIAlble Retirees ($697) 4^. Pmmde a Flat $250 Subsidy to Medicare Eligible Retirees ($697 - $250 - $447r) JJIS272,025 $1,312,500 1_1 t�.Jj 1,750,000 $1,178,130 $1,750,000 $1,237,030 $3,33• $3,334�212126 E 11. Set Premium far Rebse. Only C.-nag. W . Flat $200 for Rule of 70 Rehr,— $301,793 $361,793 $3,334,116 E 17 1—— Retire. -Dantlbb ... to . flat $150 for R.I. sf 70 Rsfi,... $204,750 _I $273,000 $273,000 $3,334,116 0 25 1—— Retire. 1-Dantibb ... t. 2MA of AcW.H.l V.I.. f., R.I. f 70 R.U ($207 -65, $139 65-) $124,963 $174,510 $186,726 $3,334,226 L) 26 Change Rati,se, C..b ibb ... te $150 fs, 10 - 20 YOS and $50 far 2(�- YOS far R.I. of 70 Flb 16 Dib... D.pa.d..t Subsidy f., enpl.y... hired after 10/1/17 $48,870 $139,2W $64,997 $5007866 $64,007 $097,202 1 1 $3,334,116 $3,334,116 L) L) :32 Dependent Subsidy for Pftn- Hires to SM. 12 D..I CJpti an HSA $36,706 $729,734 $155,795 $1,019073 $262,034 $1,090,408 $3,334,116 $3,334,116 m L) 13, Dual Option HSAwth retirees getting high deducbble plan at no cost $732,955 $1,023,572 $1,095,222 $3334116 11 )Ull Op", "I'- mcs" 4 $573,964 $801,541 $857,049 $3,334,116 33 D..I Cth 1pti.n WHRA (A-- - .aplan design as HSA option 12) PI.. Wa....lAan' $1�8 ,061 08 $1,136,135 $3,334,116 E 15 Change Medicare EbTe Drug Coverage from RDS t. ECWP $250,000 $250,000 250,0 0 $3,374116 19C.nd "t Dependent Eligibility Audit (estimated 4% of Dependent $195,848 $273,501 $292,646 $3,334,116 20 Mandatory Generic Pharmacy Benefit 0' 34,506 $36,921 $3,334,116 21 Expanded Mandatory Step Therapy Nl475 $23, OD $24,614 $3,334,116 34, Adopt Emission Select Formulary $1643 0 $229,529 $245,596 $3,334,116 35 Mandatory 9O-d.yS,,,p�for Maintenance -th�,,-�- Narrower $ 42t620 $199,587 $213,559 $3,334,116 36 EA,,de D,,c. available Oyer -the -Counter (OTC) $66,524 $92,901 $99,404 Summary of 2018 Illustrative Contributions Current Q ion 4 0 tion 4A 0 tion 57$332$332 Q ion 7 Option 7A Option 8 Option 9 Option 10 0 t on 11 O t on 16 Option17 Option 24 Option 25 Option26 Option 27 Option 32 Employees Paying $25 Premium $25 $25 $25 $25 $25 $25 $25 $50 $25 $25 $25 $25 $65 $25 $25 $75 $25' Recent Hires Pay $50 mo'prem $50 $50 $50 $50 $50 $50 $50 $75 $50 $50 $50 $50 $95 $50 $50 $75 $50> EMPLOYEE DEPENDENTS ONLY: Spouse Only $332 $332 $332 $523 $332 $332 $332 $332 $628 $332 $1,046 $332 $332 $332 $332 $332 $523' Spouse + 1 child $480 $480 $480 $756 $480 $480 $480 $480 $480 $480 $907 $480 $1,511 $480 $480 $480 $480 $480 $756' Spouse+ 2 or more children $701 $701 $701 $1104 $701 $701 $701 $701 $701 >$701 $1325 >$701 $2,209 $701 >$701 $701 $701 $701 $1104' One chid only $148 $148 $148 $232 $148 $148 $148 $148 $148 $148 $278 $148 $465 $148 $148 $148 $148 $148 $232' Two children only $295 $295 $295 $465 $295 $295 $295 $295 $295 $295 $558 $295 $930 $295 $295 $295 $295 $295 $465' Three children only $443 $443 $443 $697 $443 $443 $443 $443 $443 >$443 $836 $443 $1,395 $443 >$443 $443 $443 $443 $697' Four children only $591 $591 $591 $930 $591 $591 $591 $591 $591 >$591 $1116 >$591 $1,860 $591 >$591 $591 $591 $591 $930' RETI REES ONLY: 10+YRS <65; $125 $125 $125 $125 $125 $125 $1035 $298 $518 >$125 >.$125 $200 >$125 $150 >$125 $207 $109 $125 >.$125> 10+YRS>65> $125 $697 $447 $125 $125 $125 $125 $298 $125 >$125 >$125 $200 >$125 $150 >$125 $139 $109 $125 >$125> Surviving Spouse < 65 $332 $332 $332 $332 $332 $332 $332 $332 $332 $332 $332 $332 $332 $332 $332 $332 $332 $332 $332' Surviving Spouse 65+ $559 $559 $559 $559 $559 $559 $559 $559 $559 $559 $559 $559 $559 $559 $559 $559 $559 $559 $559; RETI PEE DEPENDENTS ONLY: Spouse Only <65 $332 $332 $332 $332 $1046 $628 $332 $332 $332 $332 $332 $332 $332 $332 $332 $332 $332 $332 $332' Spouse only <65 + 1 child' $480 $480 $480 $480 $1512 $907 $480 $480 $480 $480 $480 $480 $480 $480 $480 $480 $480 $480 $480,' Spouse only <65 +2 or more children; $701 $701 $701 $701 $2 208 $1325 $701 $701 $701 ;$701 $701 ;.$701 ;$701 $701 ;$701 $701 $701 $701 ;.$701 > Spouse Only >65 $559 $559 $559 $559 $697 $697 $559 $559 $559 >$559 >$559 >$559 >$559 $559 >$559 $559 $559 $559 >$559> Tx children only 1 $295 $295 $295 $295 $930 $558 $295 $295 $295 $295 $295 $295 $295 $295 $295 $295 $295 $295 $295' For Option 7A, contributions vary by years of service. Estimated averages are $141 for employees A 25+ years $199 for 20-24 years and $399 for 10.19 years of service For Option 26, contributions are $50 for retirees with 20+ years of service and $150 for retirees Wth 10-20 years of service> The folloWng Options apply only to new hires: Options 16, 27, and 32 LO o) 00 N Summary of 2018 Illustrative Dual Option Contributions Current Option 12 Option 13 Option 14 PPO HDHP PPO HDHP PPO HDHP' Employees Paying $25 Premium $25 $50 $0 $50 $0 $50 $25 Recent Hires;, Pay $50 mo prem $50 $75;, $0 $75 $0 $75 $25 EMPLOYEE DEPENDENTS ONLY: Spouse Only $332 $394>' $299 $394 $299 $385 $299 Spouse + 1 child $480 $570;, $432 $570 $432 ` $557 $432 Spouse + 2 or more children $701 $832;, $631 $832 $631 ' $813 $631 One child only $148 $175; $133 $175 $133' $1>71 $133' Two children only $295 $351 $266 $351 $266 $343 $266 Three' children only $443 $526; $399 $526 $399' $514 $399 Four children only $591 $702; $532 $702 $532' $685 $532' RETIREES ONLY: 10+ YRS <65 $125 $146> >.$75 $146 $0``, $139 $75,' 10+ YRS >65 $125 $146> >.$75 $146 $0' $139 $75,' Surviving Spouse < 65 $332 $394; $299 $394 $299 > $385 $299 Surviving Spouse 65+ $559 $598> $503 $598 $503 $589 $503 RETIREE DEPENDENTS ONLY: Spouse Only <65 $332 $394> $299 $394 $299' $385 $299' Spouse only <65 + 1' child $480 $570> $432 $570 $432 $557 $432 Spouse only <65 + 2 or more children $701 $832> $631 $832 $631 $813 $631 Spouse Only>>65 $559 $598> $503 $598 $503 $589 $503 Two children only $295 $351 $266 $351 $266 $343 $266 Annual County Contribution to HSA EE NIA NIA $500 NIA $500> NIA NIA EE +'Dependents NIA NIA 1 $1,000 1 NIA 1 $1,000'1 NIAI NIA Ln a) 00 -fit antl Contribution Cbanges Recommentletl for FY 2018 Decrease Expense by: $3.3 Million Recommentletlby Committee by Major'Ty Vote FY 2019 Projeled Savings FY 2020 Projectetl Savings FY 2018 Running TOTAL items shown as the same color are mutually exclusive. Therefore, you cannot say yes to each one of them. FY lr„pazr YurN This is applicable to: ForReHress: Option 4 or4A or 11 or 17 or25 or26 or no to all flue e For Qe enclen[s of Retirees: Option Gof6A ornoto both :Fr�jazrea ForPre-65 Re6rees: O ton 7or8 or na:[o both For Deendent Subsid. `.IO tion Sot 10 or no to both FarAc[tve Employ-! Option 9 W 24 orno to both e Forfuture hire dependent 'subsid : Option 16 or 32 or no to both ForDual Q'tion laps! Option 12 ar 13 o'r t4 or33 or noto all four F-PhamSsc Chan es Option 21 o04ornotoboth $3,334,116 Benefit mange. 1. ase Deductible fi-$400/$800 to$600/$1200 $282,831 N $376165 $381,808 $3 334116 2. Increase Specialist copey fi-$25 to$50 $84, 849 Y $112,849 $113,978 $3,249,267 2A. Increase Urgent Carecopey fi-$25 to$50 $9,428 Y $12539 $12,664 $3,239,839 3.Add $100 pharmacy ded-ble per ndiyidual $162366 N $215,947 $218106 $3,239,839 22. Increase brand drug copeys to$60/$100 (30 day) and $150/$250 (90 day) $69,861 N $92915 $92915 $3,239,839 23. Increase specialty drug copey to 25% to maamum of$300 $16,438 N $22955 $24562 $3,239,839 29. Change PCP, Beh-,ell HeaOh and Pre/Pest Nffial Care Copey to $30 $23 287 Y $31 281 $31 594 $3,216,552 30. Add$10 copey forind.p.,d-Cri ILee(Q-Q $8537 V 1 $11355 $11355 $3,208,015 31. Increase Generic Drug Cop %to$15 $86299 Y $117,073 $119,414 $3121,716 confd"- mange. Ne Suksdy for: Depeodeltts of Any Per-$459,378 N $641521 :::$686428 : $3121,716 6A 40%SrbIdy ror:D.epe.dence of Kerr-(Erlud.g Me Tare Eligible Spouses) $134325 N $187585 :$290716 $3121,716 18. SpouSasofRetreeSPay 100%of Actuarial Rac.rSpousehes Access to C-ege Through His/Her Own Em $13662 Y $18216 $18216 $3108054 27. New hires pay $75 for EE Coverage $19778 N $69551 $111,858 $3108054 28. Add$150 per month smoker surcharge $256,017 Y $219,418 $215,937 $2,852,037 :5:.:Reset Deperideri[Contrbufo.s:to50%dACWanal PI,at Current Huh., Costs (...... fly :40/) :$373230 :::N :::$521216 :::$557701 :: $2,852,037 :10::Reset DegehdehcCo.trbut-td60/ of ACWatial Rates(currerly 40%):: ::$599,368 :::N :::$337716 :::$896356 :: $2,852,037 7 ::No subs dy forFraeS Re[reas $1311728 N $138t 827 $1860055 : $2352037 7A : Sceled Sabsdy forRet2a� $772119 N $7123572 $1.:221540 $2,852,037 8.:Pre 65 REtlx6es P.ar 50%of Ac[uenel:Rae $621033 N $867272 $927981 $2,852037 9 Active EmplPoreespa$85075 for Employee Coaeeage ;. $2�t12Sa y $9A9,823 $3t19,823 $2,589,012 24 E creare aIXt2 EE:cwtritw[ ors fmq$25f$50 to $6S$55 (i9%ef acW anal value) $A42p-0u N $6 kl,8fi£ $6611 18 $2,589,012 4 Uerge Full Annua..AmouMIt Hsadr In...me6 tg Medl Core Bustle Per-t$697j 4A'.. Preece a Flat$250 Subs Cy t4 Med-Eligible Pert ($697 $211 1147) 11 Set Peernium Fa Retree Coly Cmaageto a Fla[ $260 Fa Rule of 76 Retirees 17 I tease R.i C-loctiors to afl a[ $150 far Rule of 76 Revrees 25 1 rcrease Raltee Carr Gutien5 b 20%4 Actuarial Par e fat Rtlla a 70 Ren-($297<65 $13965,) $1312500 $841,521'.. $272025 $204,75g'.. $124,go N'.. $1,759,068 N,,. $1,178,136 YI $36t1,m N'.. $2730 `1 $174,510 $1,759,066 $1,237,036 $361,751 $273.06g $186,726 $2589012 $2589012 $2316,987 $2 316 987 $2316,987 26 Qnsnge RBCIr GtTltnbuCUtsto $150..CY 14 20 YQS slid $56fori20+ YOS CY R016 r 76 R4lfee5 16 ICkscantlnue Ckperjdent Subsidy far sprplogees n eed after 1Ni717 $48,$70'.. $136�209 N'.. $64 997 N�. $ew a" $64 997 $90 202 $2 316 987 $2316,987 32 Reduce Perendert[ Srbsdy fr,Futnre Hies to 56% $36,7t16< Y< $155795 $262834 $2,280,281 12 iDc sl Qpt/on HSA i $729 734 N $1,C199,073 $t E190408 $2,280,281 13:Dusl Qpilen HSAfM[B ref YBeS gaanpfl(gq dedU&[bl8 pten of ne LeSC f7.,P', Y $1,023572 $1,895,222 $1,547326 M iDual Dpnan Yke MCSB $5It . N $861 541 $857,649 $1,547326 33 ;Dual Qpbbr with HreA (Asvme -.plan des gn as HSA opt on 12) veu 33^a. N $1091 808 $i, F36,135 $1,547326 The Committee voted to recommend that the BOCC fund $958,558 from County increase to Department Rate (from $12,420/per employee per year to $13,228/per employee per year). IIAd VA Fund# Group Insurance $12,420/Emp$13,228/Emp Group Insurance $808/1 nc Emp 001-General 4,175,212 4,446,836 271,624 101-F&F 5,386,679 5,737,117 350,438 141-Fire 1,197,784 1,275,707 77,923 147-Parks 159,101 169,452 10,351 148-Planning 0 0 0 149-Police 881,820 939,188 57,368 TOTAL::: 11,800,596 12,569,300 767,704 Non AdV 1 1,910,076 1 2,034,338.59 1 124,262.59 Enterprise 827,545 1 991,392 153,837 Internal Funds r 339,435 1 360,452 122,017 :Total All Funds: 14,976,652 15,944,473 967,921 # of Yes Voted yes butrolls Inm 9 This is applicable to: o o ME N= MENNE im osmommmummmEm MONSOON o � a � � a � The HPHC recommended ell options shown with a Y except those shaded RED. Their recommendations didn't come up m the full $3.3 Million m savings needed. I ertead, the Committee made a motion to ask the BOCC to fund approximately $988, BBB+using tax payer funding. Staff wpW-dl how the BOCC used over $3 Million m tax payfoedieg lest year m balance the fund. However, the Committee did not went to readdress the items that had the most votes m try to reach the $3.3 Milli— S., m thi—d- ofthe spreadsheet,staff has highlighted inred the options that receivedbetween9 fivotesm reach the $3.3 Million in savings needed. While that doesn't demononstrete a full mejoriry vote, it does demonstrate the options that had the most votes. VotedYrsb,tro11=,,to9 as cu 0 (a 0 CL 0 LO 00 04 0 0 Ua C 0 m 0 E aa�ad. M U- CD a m L) E E 0 CD co LL E Monroe County Board of County Commissioners Illustrative 2018 Plan Design and Contributions Based on Committee Recommendations Assumes Current Plan remains in place at increased employee/retiree contribution rates Option 1 Assumes HDHP with HSA option that is expected to cost 18 % less than current plan added at employee/retiree contribution rates 20 % below current PCP Office Visit Copay $25 1 Ded/Coinsurance '' $30 1 Ded/Coinsurancel Ded/Coinsurance Ded/Coinsurance Specialist Office Visit Copay $25 1 Ded/Coinsurance '' $50 1 Ded/Coinsurance Urgent Care Copay $25 1 Ded/Coinsurance '' $50 1 Ded/Coinsurance ERICo a $300 1 $300 1 Ded/Coinsurance Ded/Coinsurance Independent Clinical Lab'Copay i $0 1 Ded/Coinsurance!'' $10 1 Ded/Coinsurance ;.I Prescription Drug Deductible Per Member N/A N/A N/A Retail PharmacyCopays'' Generic $10 $15 $15 (After Deductible for HSA) j Preferred Brand $50 $50 '1l ;', $50 Non Preferred Brand '1l $90 $90 '1l $90 2018 High Option Low Option Pre 2018 Hires New Hires Current Employees Paying $25 Premium $25 $50 $50 $0 Recent Hires Pay $50 mo(prem $50 $75 $75 $0 EMPLOYEE DEPENDENTS ONLY: Spouse Only `, $332 $394'' $523 $299 Spouse + 1 child $480 $570'1l $756 ;', $432 Spouse +2orlmore children $701 $832'1l $1,104 '1l $631 One child only $148 $175'1l $232 $133 Two children only $295 $351'1l $465 $266 Three children only $443 $526I' ss $697 $399 Four children only $591 $702', $930 $532 RETIREES ONLY: 10+ YRS <65 Rule of 70 FRS HIS $200' ss $200 $0 10+ YRS <65 Rule of 70 FRSHIS $200' $200 $0 10+ YRS <65NOT Rule of 70 $1,035 $1 102 $1 102 $882 10+ YRS <65 NOT Rule of 70 $621 $661;; $661 $529 Surviving Spouse < 65 $332 $394' $523 $299 Surviving Spouse 65+ $559 $598', $598 $503 RETIREE DEPENDENTS ONLY: Spouse Only <65 $332 $394'' $523 $299 Spouse only <65 + 1 child' $480 $570'' $756 $432 Spouse only <65 + 2 or more children $701 $832'1l $1,104 $631 Spouse Only>65 $559 $598'1l $598 $503 Two children only $295 $351'>s $465 $266 Smokers would pay a $150 monthly surcharge '1l annot receive HSA* Lf> DO N L O m L O O r O E t N r O C M to N a1 C c>s t U N C N E E O U CD DO V- CD N LUL r C N E t C) Q Copy of FY 2018 Recommended Changes Final voted with modifications for Board (00000002) Monroe County Board of County Commissioners Illustrative 2018 Plan Design and Contributions Based on MODIFIED Committee Recommendations to Get to $3.4 Million Target Assumes Current Plan remains in place at increased employee/retiree contribution rates Option 1 Assumes HDHP with HSA option that is expected to cost 18 % less than current plan added at employee/retiree contribution rates 20 % below current PCP Office Visit Copay i $25'4s Ded/Coinsurance '' $30 1 Ded/Coinsurance Ded/Coinsurance Ded/Coinsurance S ecialist Office isit Copay $25`` Ded/Coinsurance $50 Ded/Comsurance Ur`ent Care Cc a $25ss1 Ded/Coinsurance '.'. $50 Ded/Coinsurance ER'Co a .$300 '.' $300 Ded/Coinsurance Ded/Coinsurance Independent Clinical Lab '.Co a $o.'.1 Ded/Coinsurance $10 1 Ded/Comsurance ;r,I Pi'escri tion Drug Deductible Per Member S'. N/A $1.............................................. NIA Retail Pharmacy Copays ;. Generic '. $10 $15 $15 (After Deductible for HSA)j'. Preferred Brand '. $50 i ................ ....... ......... Non Preferred Brand $90 $ Imo........: t Also implement Select formulary and mandatory generic programs Smokers would pay a $150 monthly surcharge `. Lf> 00 N L O m L O O a+ C) O E t N r O C M to N a1 C t U CD c CD E E O U CD W 00 V- CD N LL r C N E t t) r r Q Copy of FY 2018 Recommended Changes Final voted with modifications for Board (00000002) COMPARISON OF MONROE COUNTY LARGER GOVERNMENT EMPLOYERS E.I.c Employee Premium Subsidy Employee Premium Rate (Dependent Premium subsidy Dependent Premium Rates Retiree Premium Subsidy' Retiree Premium Rate EMPLOYER EMPLOYERS % EMPLOYER CONTRIBUTION EMPLOYEE CONTRIBUTION % EMPLOYER CONTRIBUTION EMPLOYEE CONTRIBUTION CONTRIBUTION RETIREE CONTRIBUTION Spouse: $332 LL Spouse +One Child: $480 Spouse +Two or more Children: $701 Monroe County BOCC 95% Prior to 5/1/12 $ 25 Per Month 60% C $ 50-150 Month Depending on years of service w One Child Only: $148 90% Two Children: $295 On or After 5/1/12 $ 50 Per Month FRS. a y Three Children: $443 0 C Four Children: $591 Five Children: $738 7 N One Dependent: $380.10 0% Regular Employees C Pay Full Cost: $ 824.98 .L.. Family: $545.21 10 Less than 15 grandfathered Upper Management that are currently paid I= _ d FKAA 100% $0.00 39% L Now pay Upper Management a subsidy based on level and years of service +0„ N d Prior to 10/01110: 100% Prior to 10/01/10: $ 0.00 Spouse: $688.26 City of Key West I0% After.. 10/01/10: 95% After 10/01/10: $ 54.16 Children: $494.95 0% Under 65 Full Cost: $ 958.92 aJ Family: $1,183.21 Over65: $602.02 0 d Spouse: $565.16 p Keys Energy 100% $0.00 0% Children: $426.36 100% Eligible Retirees $ 0.00 Eligible Retirees 0' a Family: $991.52 a C 0 Base Plan: Base Plan: Base Plan: Base Plan: c .2 '.. 100% $0.00 Spouse: $885.78 0 d Children: $728.52 City of Marathon 0% Retirees are eligible to enroll in COBRA. Pay 100 Family $1,796.32 0% High Option Plan: High Option Plan: High Option Plan: High Option Plan: C 91% $81.97 Spouse: $987.98 N O Children: $812.55 Family $2,003.63 .N 7 Spouse: $786.10 y Islamorada, Village of Islands 90% $70 0% <65 and >65: $ 750.00 O Children: $586.14 0% Family: $1,372.24 m $280 67% Employee+ One (Spouse or Child(: $508.38 numberof years of service 10-19 YOS: $758.89 N MUST have 10 year of 0 Buy Up Plan: Buy Up Plan: Buy Up Plan: service with MCSB. <10 YOS: $ 1028.15 N Pays subsidy based on M a. C Monroe County School Board numberof years of service U $280.00 67% Employee +One (Spouse or Child(: $508.38 with MCSB. 10-19 YOS: $ 758.89 d *MCSB offers three plans. Buy Up Plan 19 YOS -50%20+YOS- a. '.. illustrated as it is most comparable to BOCC. : : Family Plan: $642.20 100% 20+YOS: $ 489.63 E W 79% d Retirees over age 65 pay full premium: $ 102! a1 10 J HMO HMO HMO HMO HMO Under 65: $490 y 100% $0.00 43% Spouse: $451A3 POS Under 65: $1165 t County provides a flat Children: $390.37 0 10 Family $623.50 fixed dollar subsidy that Medicare Supplement with Pharmacy.,$645 Q Miami -Dade County varies by plan and tier but POS High Option Plan: POS POS Medicare Supplement without Pharmacy: $280 9791 $32.28 43% does not change each year Spouse: $714.22 Children: $587.08 Family $1,258.16 Packet Pa. 236 E.1.c 'r PPO A - 0317 PPO A $159.86 '0% PPO A Family PPO A Columbia County pays a defined contribution of $6,786 '.. 76.2% $747.92 Columbia County PPO C - 03359 78.7% PPO C $120.54 0% PPO C Family PPO C ($565.50/month) for medical on an annual basis.l- fully subsidizes the cost of Plan D for employees. $676.20 68,348 D or E(HSA) 03160/61 100% D or E (HSA) $0.00 D% D or E (HSA) Family D or E (HSA) amounts over the premium go toward the HSA, Participants pay up to the premium amount if th $458.52 F or G (HSA) - 05192/93 F or G (HSA) $0.00 0% F or G (HSA) Family F or G (HSA) contribution does not cover the expense. LL w 100% $217.86 C State of Florida Standard Plans HMO and PPO 92.8% $50.00 '.. 98.8% $8.34 '.. 95.7% $30.00 '.. 0,0% $692.84 '.. 0.0% $692.84 High Deductible Plans HMO and PPO 97,6% $15.00 98.6% $8.34 95.1% $30.00 0.0% $616.18 0.0% $616.18 I88% 198% '0% 95% 98% 0% Standard Plans Family Family Family High Deductible Plans Family Family Family HMO and PPO $180.00 $30.00 $1,559.60 HMO and PPO $64.30 $30.00 $1,360.57 Annual Cost of Individual Coverage Standard a Career Service Select Exempt & Sr. Mgmt. Spouse Program Overage Deps Retiree <65 $8,31 y C 7 N C t Career Service Select Exempt & Sr. Mgmt. Spouse Program Overage Deps Annual Cost of Individual Coverage HDHP 0 $7,39_ y .L. Retiree <65 N 4f i 01 Charlotte County '.. 97% $26.00 86% Employee + spouse Employee + Child(ren) Employee + Family 10 L $286.00 V 'a $249.00 0% $921.83 $315.00 O a 0 a c O c Clay County Blue Option PPO 727 79% Blue Option PPO 3766 92% HSA (Blue Options Network) Higher Cost PPO (Blue Options 1552) $99, Blue Option PPO 727 $165.41 Blue Option PPO 3766 $60.43 HSA (Blue Options Network) Higher Cost PPO (Blue Options 1552) $64.42 Blue Option PPO 727 62% Blue Option PPO 3766 78% HSA (Blue Options Network) Higher Cost PPO (Blue Options 1552) 81% I79% I79% Blue Option PPO 727 Employee + Family Blue Option PPO 3766 Employee + Family HSA (Blue Options Network) Higher Cost PPO (Blue Options 1552) Employee + Spouse Employee + Children Employee + Family U65: Blue Choice PPO 716 32% „O-„ $740.51 $523.80 U65: Blue Option PPOp $422.28 34% HSA (Blue Options Network) $494.65 '13 C N U65: 0 O_ Medicare PPO N N 065: 47% $170.72 V U65: 78% $70.72 N 065: Blue Choice PPO 716 19% $623.80 065: Blue Options PPO o 20% $594.65 C 0 Higher Cost PPO (Blue Options 1552) N $267.78 0% $578.39 m a $260.92 E $378.44 0 U j N Escambia County Lower Cost PPO (Blue Options 1352) 95% HSA (Blue Options 1168) 100% Lower Cost PPO (Blue Options 1352) $27.62 HSA (Blue Options 1168) $0 *Charges an extra $20 for tobacco use Lower Cost PPO (Blue Options 1352) 86% 86% 86% HSA (Blue Options 1168) 192% 92% 92% Lower Cost PPO (Blue Options 1352) Employee + Spouse Employee + Children Employee+ Family HSA (Blue Options 1168) Employee + Spouse Employee + Children Employee + Family Lower Cost PPO (Blue Options 1352) p $183.38 $535.24 $164.02 W $226.82 Blue Medicare PPO & Rx Plan $268.61 & $89A2 J $87.38 $79.20 4t E $111.92 V 5 Q Packet Pg. 237 Ad Val Fund # Group Insurance $12,420/Emp % by Fund Source of FY 2017 Increase 001 $4,145,497 28% $631,419 101 $5,461,199 37% $831,819 141 $1,197, 784 8% $182,440 147 $159,101 1% $24,233 148 $0 0% $0 149 $881,820 6% $134,314 TOTAL $11,845,401 1 80% $1,804,225 Non Ad V 1 $1,816,926 1 12% 1 $276,744 Enterprise 1 $839,965 1 6% 1 $127,939 Internal Funds 1 $348,371 1 2% 1 $53,062 TOTAL 1 $14,850,663 $2,261,970 LL 0 a. �a as 0 0 0 �a c� �a e� 0 CL 0 CL LO CO c� as as �a as U) E T C 4) E c� GROUP INSURANCE RATES FY 2016-2017 REVEN E.1,1 EFFECTIVE DAT COUNTY PAYS PER EMPLOYEE/PER MONTH: OPT -IN PER PAYDAY PER MONTH SPOUSES LEAVING PLANFOR 2017 ANNUAL 10/1 /2016 $1,035.00 •$558 toward employee health insurance coverage •$170 toward dependent subsidies •$284 toward retirement subsidies $14,764,500 •$23 toward life insurance/AD&D/EAP COUNTY PAYS PER EMPLOYEE/PER MONTH: OPT -OUT •$320 for employees who opt out of County insurance of 5/1/2012 $320.00 EMPLOYEES: I I EFFECTIVE DAT PER PAYDAY PER MONTH ANNUAL EMPLOYEE ONLY COVERAGE: (Hired 05/01/12 or later) 5/1/2012 $23.00 $50.00 EMPLOYEE ONLY COVERAGE: (Hired priorto 5/1/2012) 5/1/2012 $11.50 1 $25.00 DEPENDENT TITERS: EFFECTIVE DAT PER PAYDAY PER MONTH SUBSIDIZED NON -SUBSIDIZED' SUBSIDIZED NON -SUBSIDIZED' SPOUSE ONLY 1/1/2017 $153.00 $387.00 $332.00 $838.00 16 Spouses left the plan SPOUSE + ONE CHILD 1/1/2017 $222.00 $455.00 $480.00 $986.00 6 more stayed on but are $2,400,408 SPOUSE + TWO OR MORE CHIL 1/1/2017 $324.00 $557.00 $701.00 $1,207.00 aying the higher premiury ONE CHILD ONLY 1/1/2017 $68.00 $148.00 TWO CHILDREN ONLY 1/1/2017 $136.00 $295.00 Total annual impact is THREE CHILDREN ONLY 1/1/2017 $204.00 $443.00 estimated to be $160,000 FOUR CHILDREN ONLY 1/1/2017 1 $273.00 $591.00 vs. projected savings FIVE OR MORE CHILDREN 1/1/2017 1 $341.00 $738.00 1 of $234,000 LEAVE WITHOUT PAY: EFFECTIVE DATE PER MONTH EMPLOYEE ONLY: 1/1/2017 $1,035.00 DEPENDENT RATES 1/1/2017 SEE TIERS ABOVE COBRA: EFFECTIVE DATE PER MONTH SINGLE COVERAGE: 1 1/1/2017 $1,044.00 FOR DEPENDENT RATES SEE TI 1/1/2017 RETIREES: PER MONTH ANNUAL HIRED PRIOR TO 10/01/01, MUST MEET "RULE UM 1/1/2014 1 $50-$150 $5. 00 for each yr of FRS service at time of retirement with Monroe Count HIRED AFTER 10/01/01 OR UPON RETIREMENT MC WAS YOUR LAST FRS EMPLOYER UNDER AGE 65: 1/1/2017 $1,035.00 OVER AGE 65 1/1/2017 $621.00 $520,572 RETIREES: Life Insurance Coverage Only NO EDICAL) 1 $11.00 G ONLY ELIGIBLE TO KEEP IF YOU HAD 10 OR MORE YEARS OF FULL-TIME SERVICE WITH MONROE COUNTY RETIREE DEPENDENT COVERAGE TIERS: SPOUSE ONLY UNDER 65: $332.00 SPOUSE ONLY OVER 65 $559.00 FOR DEPENDENT CHILDREN RATES SEE TIERS ABOVE 'NOTE: NON -SUBSIDIZED PREMIUM APPLIES TO SPOUSES/DOMESTIC PARTNERS WHO ARE ELIGIBLE FOR COVERAGE THROUGH THEIR EMPLOYER BUT ELECT TO ENROLL IN THE MONROE COUNTY HEALTH PLAN $17,685,480 0 00 N Additional Health Insurance', Expenses', borne by employees 2010 1 2011 1 Diff Employee 2C I $2821 $282 3C1 C.�51 I C:k51 2010-FY11 Budget No Change No Change 3%COLA & 3-5%Step 5C $529 $529 Retirees <10-1-01 $50 $50 Retirees > 10-1-01 -underage 65 $790 $790 -over age 65 $474 $474 Retiree Spouse <65 $353 $353 Retiree Spouse >65 $176.50 $176.50 Rate 1 C $238 $238 2C $282 $282 3C $351 $351 4C $468 $468 5C $529 $529 Retirees <10-1-01 S50 S50 -over age 6b Retiree Spouse <65 Retiree Spouse >65 Accumulated Total Lifetime $1,000,000 Unlimited Maximum No Deductible applicable to Preventive Deductible no longer No longer a "grandfathered Items and Services; added Preventive applicable to Preventive health plan" - amended the plan Child Health Services, revised plan Items and Services to include provisions for a document language regarding coverage "grandfathered health plan" of dependents to age 26, 'hysician Office Visit 75% of allowed amount after deductible -not subject to $20 copde deductible e :ffective 11/1/11 chg to FB :ffective 10/1/11 chg to Envision ndividual Deductible $300annual :amity Deductible $600 annual :R Deductible $75 per visit n-Patient deductible S150peradmission E.1'„f Out of Pocket Maximum $7500/$7500 Office Visit $20 copay Pharmacytiers: Generic 10 25 Preferred Brand 70 d Non -Preferred L) c Hired on or after 5/1/12 $0 per month $50 per month (health/rx/life ins) U) Active Employees - OptingOutof $790 monthly departmental rate $320 monthly departmental L health insurance BOCC approved rate March 2012 = Retirees - Opt Out of health N/A N/A t insurance and keep life insurance p at a rate of $11 with minimum 10 ears of service. Im c m t v d O 0 a 2 3%to make 3%to make a c 2012-FY13 Budget employees whole FRS employees whole No Change C c law change FRS law change 2012 2013 Diff B 2%COLA 2%COLA Departmental Rate $790 $790 d Employee $50 $50 h Spouse $353 $353 c Spouse +1 C $470 $470 Spouse 2+ C $529 $529 2 .N 1 C $238 $238 N 2C $282 $282 N 3C $351 $351 4C $468 $468 5C $529 $529 a0 N Retirees <10-1-01 $50 $50 N Retirees > 10-1-01 0 N -underage 65 $790 $790 d -overage 65 $474 $474 w Retiree Spouse <65 $353 $353 d Retiree Spouse >65 1$176.50 $176.50 2013-FY14 Budget No Change No Change No Change NO CHANGE IN PREMIUMS Effective 1/1/14 � Individual Deductible $300 annual $400 annual L Family Deductible $600 annual $800 annual Emergency Room Deductible $75 per visit $100 per visit = Office Visit Copay $20 per visit $25 per visit $_ Pharmacy Preferred Brand Tier $25 copay $35 copay 3 $5 per year of service for U) 0) 0) Retiree Premium Contributions $50 monthly those hired prior to 10/01/01� O Annual Out of Pocket $7500/$7500 $6350/$12,700 (PPACA Mandate) N Incentive 4 hours of leave for 0 4 hours 'x Wellness Participation d E 0%-5% 0%-5% t � Performance— Performance— a 2014-FY15 Budget based/Merit based/Merit No Change (no C.O.L.A. average (no C.O.L.A. 3%) average 3%) Packet Pg. 241 > 2014 2015* Diff Departmental Rate $790 $790 Employee (Hired afer 5/1/12) $50 $50 Employee (Hired before 5/1/12) $0 $25 $25. Spouse $353 $332 Spouse +1C $470 $480 $10' Spouse 2+C $529 $701 I'. IIII$172'. 1C $238 $148 2C $282 $295 $13'. 3C $351 $443 $92' 4C $468 $591 "'lllll$123 5C $529 $738IIIIIII$209'. Retirees <10-1-01 $50 $50 Retirees > 10-1-01 -underage 65 $790 $790 -overage 65 $474 $474 Retiree Spouse <65 $353 $332 Retiree Spouse >65 $176.50 $166 Effective 1/1/15 No hiring of tobacco users Newly enrolled employees, retirees, dependents on or after 1/1/15 pay a penalty if tobacco user $0 $50 monthly Newly enrolled employees, retirees, dependents on or after 1/1/15 penalized iffail to certify or certify incorrectly about their tobacco usage $0 monthly r and nd $50 penalty) ($50 user Annual out of pocket (PPACA Mandate) include pharmacy copay in total for 2015 no change $6350/$12,700 * Dependent coverage subsidies varied throughtout the tiers. A Adjusted all premiums to reflect 50% subsidy varied 50% subsidy for all tiers Hired prior to 5/1/12 (health/rx/life ins) $0 $25 monthly 2% 2% 2% 2015-FY16Budget Performance— based/Merit Performance —based/Merit Performance— based/Merit 2015 2016 Diff NO BENEFIT CHANGES -1.20% -1.20% -1.20% Departmental Rate $790 $885 $95 Retirees > 10-1-01 -under age 65 $790 $885 $95 -overage 65 $474 $531 $57 I' NO OTHER PREMIUM CHANGES 2016-FY17 Budget 4% 4% 4% Performance— based/Merit -3.30% Performance— based/Merit -3.30% Performance— based/Merit -3.30% 2016 2017 Diff Departmental Rate $790 $1,035 $245I Spouse *NON -SUBSIDIZED RATE $332 $838* Spouse +1 C "NON -SUBSIDIZED RATE $480 $986* Spouse 2+C *NON -SUBSIDIZED RATE 1 $701 $1207* E.1'„ f "EFFECTIVE 1/1/17 SPOUSES OF ACTIVE Participation in the Wellnesss EMPLOYEES WHO ARE ELIGIBLE FOR A Program and completing of the GROUP HEALTH PLAN THROUGH THEIR required age appropriate EMPLOYER BUT DECIDE TO REMAIN screenings with required ENROLLED IN THE COUNTY PLAN PREMIUMS WOULD NO LONGER BE documents during the period of SUBSIDIZED. 10/1/15-10/31/16 active participants will save $300 annually on their Employee Only rate effective 1/1/17 Retirees > 10-1-01 -under age 65 $885 $1,035 $95 -over age 65 $531 $621 $57 Retiree Spouse >65 * $166 $559 $393 "EFFECTIVE 1/1/17 RETIREE SPOUSES OVER 65 WHO REMAINED ON THE COUNTY PLAN HAD AN INCREASE OF 1393 PER MONTH NO OTHER PREMIUM CHANGES E.1'„f PEPY Trend .:.:.:,.......:................................:, Population By Coverage Tier .......:,,.......:.,.......:.,.......:.,....::, Member Share as a Percentage of Total Spend and Claim Type High Cost Member Impacts $50,000 m ........................................ ,,.......:,,.......:,,..................................... : > ' .......;......... ......... ......... ......... ......... .. Contracts ..... '' 1,588 1,601,,. ....:; , The overage member sharefor groups in your SIC of91 is 12% ...... ...... ...... ...... uCurrent .. Wrier+ _ High Cost Members ....... ......... 42 ........ .40 .... ......5 0% Members 2,379 2,377 0 1% @2.aM 015d% Percent f Population 177% 168% 4.9% C :... $ 6,932 :... $ 6,089 :... $6,0^I /I :. Members Per Contract 1.5 1.5 09% All 15'1.gM0-M High Cost Member Spend $5,101.77 $4,491,38 74.9% Y) V 7JL Y) V 07 Y)V L'-F I Average Spend Per Case $ 121,563 $ 112,284 8.3% a 1385% Increase 1.08% Increase 000%-Basel Baseline POplU lation Average Age By Relation and Gender $853K ®23% Prof $sssK®z4% 8 High Cos[ PMPM Impact $ 17888 : $ 15747 13.6% O .... .... ..... .. .......', .. .. ....', ........'. ... PMPM Less High Cos[Mbrs $20684: $18439: 122% i Employee 5 1. 7 51.6 0.0% pp : $561K013% : Percent of TotaIPMPM 464%: 461%: 0.7% ti Payment and Utilization Indicators Males 500: 50.0 00%. f $518KO16% c ...•, ........ ......... ........ ........',. .......... Females 53 6 53.5 0 2% I �J $331K ® 25% L Claims 44,180 45,436 : Dependents 29.7 30.2 Fa $331K®25% $8K m o Spend Per Claim $249 $215 161% Males 288 28.9 _ $227K ® 7% $6,932 = $7K Spend : $11,009,510 $9,750,458 129%: Females 304 31.2 .. Ip $220K07% .. PMPM $277.51 : $385.72 $341.87 128%: All Members. 44.2 >. 44.5. II $6K r PEPM $47260 $57769 $50741 1389'. UC 1 $20K 010% $13K08% $5K $4,629 :. N rn .... i:........................... Ad colts ............. ............. ........ ..............3.6.......... Members By Payment Range uCurlerrt 0 c 0% ax $4K $3,215 : m Spend Per Admit $ 14,829 021 $ 13,021 : 362 $ 13,362 500 ,Poor 1,000 1,500 0®a% $3K 1 $2,147 : U ALOS 4.01 3.91 475 ..... ......... 1 ...I...... ... �1 965 $OK $500K $l OM $15M $20M $25M $2K d Total Spend $3,047,014 $3,153,432 953 T I Util/1000 68. 98 99 a 336 $1K : O PMPM $ 83 93 $ 10675 $ 110.57 $500 $999 351 Top Five Diagnosis Categories With PMPM ---- ---- - $0K $6,089 ,... $2,805 $4,102 ,:::��... $1,890 ... a 2 ..; ......:...............:....... .....2,349' .... $1,000 $2,499 { 3 90 3 $ OM YCurrent Prior PEPV (All) PEPV IHCLOnIV) PMPV (All) PMPV IHC�Onlyl V sits Spend Per Visit $ 1,029 $ 1,640 2,301 $ 1,191 21%.,. 37 6% 373 { 229 $Z,500 $4,999 : .. $20M ®$91M9 $1.3M C ACurrent IPnorp Totals end I/1000 PMPM 771 6613 $3851839 988 $ 13495 $2741619 968 $ 9613 40 5% 2 OY' 40 4vHigh - 249 I $5000 $6249 )53$10M : ®$47.28 $35. $$34. $$33.Ut ®$35.n ®$34J2 ®$33.80 !$1.7M $1.3M $933K $912K I ®$46.141 I $32.70I $31.991 I 633K$ ® $22.20 Cost Spend as Percentage by Claim Typ5059.83I .Its ...... ........,,, .... .......',,.. .......... $6,250 $12,499 ? 119 $OK II�� 11--JJ-- IJ 41P iOP PSP OP PC ER :.. C V slts JB 482 552 -0] N pl C y M kl Sy III D f d t ry/ O .y Spend P V st Total Spend $ 1,362 $ 2,021 $ 974,135 $ 1,761 $ 972,155 14 8% 0 2% i 67 $12,500 $24,999 59 sY C d Key Facility Utilization P g Current 3rA 13% 0 3 1 Ut I/1000 193 203 232 $25,000 $49,999 41 31 :'. ........:...........:...........:.... ... ... :.: - - m ._ ❑ PMPM $2194 $3413 $3409 01% (1)L K M dc,l Center y $1,5 $1,526853 $1,706710 Prior I I 25% �6% 12% :., .. ,,,,,,,,,i ....... $50,000 $99,999 26 (2) Mar nets Hospital $ 1,152,571 $ 504,183 S vI 1,088 877 241% 24 (3) Baptist Hospital Of M am Inc $ 1,111,396 $ 665,898 _ Spend Per Service $ 67 $ 173 $ 177 $100000+16 (4) U OF M Hos it Clinics-Ncch $374,693 $439,706 0% 20% 40% 60% 80% 100% .� Total Spend $188,170 : $155,445 211%.. 16. : (5) South Miami Hospital $336,272 $158,668 O Util/1000 198 : 457 369 24.0%: (6) Homestead Hospital Inc $ 317,412 $ 220,334 : Network Savings and Utilization E PMPM $110 $659 $545 210% PMPM by Age Range (7) Lower Fla Keys Health Systems $287,115 N ' (8) Fshermen S Hospital, Inc $ 275,920 : $ 181,627 Savings % : a Services 9,241 8,680 6 5% Group Male 5 Group Female ❑ Book Male N Book Female (9) West Kendall Baptist Hospital $ 193,116 { $ 13,043 '80 0% Spend Per Service : $ 58 : $ 50 $ 49 2.9%: : (10) Jackson Memorial Hospital $ 791,249 $ 336,568 60 0% �_ N Total Spend $ 466,248 $ 425,759 9 5% Utl/1000 3592 3885 3652 64% -' Plan Risk Vs Book by Age Bracket L I PMPM $1751 $1633 $1493 9 % 20g 4 ZO% 0 0 OY 60% 80W l00 iZ0% 200% o . o 3h Q .. . .., .. Services ......... ......... 30,786 ........,', 32,790 .... ......: ..........' ....... M Ies :018 -73.4% e i� 22% u - 009` Spend Per Service $ 89 $ 80 $ 70 14 2% $500 1914 99.3% 14 14 9"A Inpatient Outpatient ProfessionalTotal m iy Total Spend : : $2,448,466 $2,284,532 72%. $400 - 25-35 15.0% 1 49% U Ut l/1000 11850 12,943 36115 4.6% 15% 38°� U RI In Network Spend% In Network Utilization% PMPM '0 $8690 85.78 $8578 80.10 $8010 719': $300- I46-55 2319'2535 56-64 -2.79' 5% 105 0% 0 ..., ........, Scripts Spend PerScript ......... ........ - ........:. - .......o:, 0 09': 0 0%. $200 - A� $l00 - ° 36 4s :65+ 7.7% 46% Females 0-18 21.9% 96 55 23% 100 0% : .. 95 0% N I`{ `F Total Sp d 0 09' 19-24 49.4% 1�'6 90 0% t L Ut /1000 0 09' $0 -:. : : m 5 ..39 566654+ SS 0% I ar PMPM , 0.0 0-18 19 24 25-35 3615 46 55 56 64 65+ 3645 45.8% 46-55 17.1% 'Aales 98% 97% 90% u u S9% 11 11 SO 0%. 1. . . . ..... i.. Total ..'....'....M . $17,517 920% $167 $186 $ 101 $ 145 $ 299 $ 589 $325 q 566799% 16% Inpatient Outpatient Professional Total PMPM $1.18 $0.61 91 9%. F $195 $266 $ 420 1 $517 $674 $ 59733,639 513 �II r•%�R7s,6k +/2�.Ru%F. 65+ 15.6% is+l Females BM = Benchmark Book of Business benchmarks are based on claims incurred 01/01/2015-12/31/2015 and through 02/29/2016 Packet Pg.. 244 o Cu went ,Prior ABenchmark Colorectal Cerwal Breast Cancer Adult Wellness Non Users by Age Bracket 0% 10% 20% 30% 40% 50% 60% 70% 80% dp N36-45 n Value Based Provider Attribution uA tbrC Og to '•` uR g IPrimary C P g m �Pt tC i dMd IH me . 4, uC rnprehe is Prmary Care program 83 78 43 11 0 10 20 30 40 50 60 70. 80 90 Compliance Criteria Breast Cancer Screening: Ages: W omen 52- 74 years. Continuous Enro11—t: 24 Months • Allowable Gap: No more than one gap in enrollment of u pro 45 days during each year ofmntnuous enrollment. Compliant Criteria Oneormoremammogrzmsanytimeduringthetwoyearmeasurementperiod. Colorectal Cancer Screen ing: Ages:51-75 years. Continuous Enrolinn.- 24 Months • Allowable Gap: No more than one gap in enrollment of u p to 45 days during each year of ontn.—enrollment. Compliant Criteria: • Fe,a`?1vodOca:?z: 0 no coring the hst 12 months. -OR- ResifiteSir�4na'rta4caryF One during the1 st 60 months. -OR- Ono during the last 120 months. Cervical Screening: Ages: women 21- 64 years. Con tinuous Enro11 end: 36 Months • Allowable Gap: No morethan one gap in enrollment ofupto 45 days during each yearofmntinuo—mrollme Compliant Criteria: Women age 21-64 who had cerviczl cytology performed every3 years. OR Women age 30 64 who had eery czl cytology/human pap llorn-ims (HPV) co testing performed every 5 years • Exclusions:Memb—wth evdence ofa Hysterectomy. J O Adult Wellness: Ages:Adults 18+ Continuous Enrolinn.- 12 Months • Allowable Gap: No morethan one gap in enrollment ofupto 45 days during each yearofmntnuous enrollment. • Com lient Criteria One or more well vst aduk check-u or otherwellness vsitthatfalk into the standard set of P P wellness codes "Compliance data excludes Retiree and COBRA members BM = Benchmark Book of Business benchmarks are based on claims incurred 01/01/2015-12/31/2015 and through 02/29/2016 'IFE1,9 ! Key Findings Page 1 • Payments Per Employee PerYear (PEPY) for the current period under review are $6,932, up 14%from the prior period.; •Total payments PMPM have increased by 12,8%from $34187 to $395 72, Benchmark PMPM is$277,51 • Average cost is up in all categories of service with exception to Urgent Care. • Overall utilization decreased in all catagodeswith exception to Urgent Care. i Outpatient utilization remained relatively stable. • Top Inpatient DRGs by spend includecardiovascular procedures, kidney transplant, NICU(neonate born at 31 weeks), hip/knee replacement. • Top Outpatient Diagnoses include Cancer ( lung, breast, tongue, colorectal), cancer preventive screenings, ankle fracture, ESRD, knee/foot disorders, and ER related services. • 335 distinct members (14% of total population). visited the Emergency Room (ER) without subsequent admission during the reporting period and accounted for 482 total ER visits. • ER utilization has decreased and is currently at 203 visits per 1000 Florida Blue: benchmark is 193/1000.: Employees account for 66%oftotal visits, Children are 1891., and Spouses are 16%. • 10%:of total ER visits l7%of total ER spend) are potentially d ivertible (UTI, acute upper respiratory infections, back pain, cough). 33 unique members have or more ER visits during the 12 month period under review.: • Total membership remained stable at 2,379 members. • Total population is 50% male and 50% female. Average age of Employees is 51.7. • The majority of members have total paid claims in the $0-$499 range. • The largest variance in PMPM by age and gender in comparison to the Florida Blue book of business is in the Females ages 46-55 category. PMPMs for this demographic for Monroe County BOCC is$674 compared to the benchmark of$475. The higher PMPM is attributable to 8 high cost claimants totaling SLAM. • Member cost shares currently at 15.4%. Industry comparison is 12%for total member cost share. • Top medical diagnostic categories include Cancer (lung, cervical, ovarian, colorectal, breast, cancer preventive screenings), Circulatory (heart disease/attack, aortic aneurysm, hypertension), Musculoskeletal (osteoarthross, back and bone d isorders, ), III - Defined Conditions (symptoms related to chest/abdominal pain, general symptoms) and Injury/Poisoning (ankle and radius fractures, complications related to digestive procedure and ventricular drainage device). • The female population for Monroe County BOCC has 48%more risk than the Florida Blue book of business and the male population has 45%more risk. Males ages 19-24 are nearly 99% riskier than our book of business. Top conditions for this demographic include various injuries, musculoskeletal disorders, and regional enteritis. • High cost claimant activity has increased in the current period under review. Spend related to high cost cases at the$50K threshold increased by 1491., from $4 5M to $51M -42 cases were identified versus 40hgh cost cases inthe prior period. 18% of the total population is identified as high cost and is drvng46%of spend Benchmark s1% ofthe population driving 33% of total spend (including Rx) With outlier HCC removed, PM PMs would be $207 versus the actual $386. • Cancer is the number one condition by spend and prevalence with 11 high cost cases totaling $2.4M, followed by Circulatory conditions with 7 cases totaling$750C • Top cases are Cancer (lung, ovarian, cervical, colorectal, breast, tongue, liver), Circulatory (heart attack, hypertensive kidney d isease, aortic aneurysm), M usculoskeletal (osteoarthros s, spinal stenosis), Digestive (Crohn s disease, appendicitis, gastroenteritis, diverticulitis), and Pregnancy/Child birth (complications d ur ng pregnancy, neonate born at 31 weeks). • 6 high cost members are no longer actively enrolled on the health plan ($923K) 10 members appear on the high cost report for both the current and prior period. Subscribers account for 52% of total high cost case spend • Network Savings is currently performing at 58.9%. Page 2 Wellness pl ce screenings arebel the Florida Blue benchmarks in 3 outof the 4 screening categories. • Approximately 17%of males and 8%of females did not utilize their healthcare benefits dunngthe reporting period and did note have any allowable dollars showing as payable to a provider. • 215 distinct members (9% oftotal membership) are attributed to a Florida Blue value based provider. '. Packet Pg. 245 ; NEOPLASMS Inpatient $194,453.67 10.5% $282,414.39 15.1%', -4.5% ($87,960.72) 329.6% -31.1% Outpatient $1,412,597.76 76.4% $1,281,168.88 68.3% 8.1% $131,428.88 -492.5% 10.3% Professional $241,257.54 13.1% $311,409.42 16.6% -3.6% ($70,151.88) 262.9% -22.5% Sub -Total $1,848,308.97 100.0% $1,874,992.69 100.0% 0.0% ($26,683.72) 100.0% -1.4% INJURY/POISONING Inpatient $586,521.03 77.0% $506,860.80 79.1%, -2.1% $79,660.23 65.7% 15.7% Outpatient $142,837.89 18.7% $99,201.81 15.5% 3.3% $43,636.08 36.0% 44.0% Professional $32,618.41 4.3% $34,714.43 5.4% -1.1% ($2,096.02) -1.7% -6.0% Sub -Total $761,977.33 100.0% $640,777.04' 100.0% 0.0% $121,200.29 100.0% 18.9% CIRCULATORY SYSTEM Inpatient $412,312.46 64.4% $733,327.08 79.3% -14.9% ($321,014.62) 112.7% -43.8% Outpatient $135,985.14 21.2% $114,621.67 12.4% 8.8% $21,363.47 -7.5% 18.6% Professional $91,871.13 14.4% $76,968.23 8.3% 6.0% $14,902.90 -5.2% 19.4% Sub -Total $640,168.73 100.0% $924,916.98' 100.0% 0.0% ($284,748.25) 100.0% -30.8% PERINATAL PERIOD Inpatient $476,898.50 90.4% $28,029.44 81.2%, 9.2% $448,869.06 91.0% 1601.4% Outpatient $0.00 0.0% $1,103.80 3.2% -3.2% ($1,103.80) -0.2% 100.0% Professional $50,704.37 9.6% $5,374.66 15.6% -6.0% $45,329.71 9.2% 843.4% Sub -Total $527,602.87 100.0% $34,507.90 100.0% 0.0% $493,094.97 100.0% 1428.9% MUSCULOSKELETAL SYSTEM Inpatient $310,641.67 64.8% $240,179.62 51.2% 13.6% $70,462.05 705.2% 29.3% Outpatient $93,162.33 19.4% $187,724.03 40.0% -20.6% ($94,561.70) -946.4% -50.4% Professional $75,562.47 15.8% $41,471.25 8.8% 6.9% $34,091.22 341.2% 82.2% Sub -Total $479,366.47 100.0% $469,374.90' 100.0% 0.0% $9,991.57 100.0% 2.1% ILL-DEFINED CONDITIONS Inpatient $25,120.45 6.4% $22,085.13 13.5%, -7.2% $3,035.32 1.3% 13.7% Outpatient $266,688.94 67.5% $102,809.41 63.0% 4.5% $163,879.53 70.7% 159.4% Professional $103,352.61 26.2% $38,333.09 23.5% 2.7% $65,019.52 28.0% 169.6% Sub -Total $395,162.00 100.0% $163,227.63' 100.0% 0.0% $231,934.37 100.0% 142.1% DIGESTIVE SYSTEM Inpatient $181,737.69 54.4% $300,650.70 83.1% -28.8% ($118,913.01) 435.4% -39.6% Outpatient $102,118.82 30.5% $30,204.42 8.4% 22.2% $71,914.40 -263.3% 238.1% Professional $50,414.11 15.1 % $30,723.80 8.5% 6.6% $19,690.31 -72.1 % 64.1 % Sub -Total $334,270.62 100.0% $361,578.92' 100.0% 0.0% ($27,308.30) 100.0% -7.6% GENITOURINARY SYSTEM Inpatient $97,965.10 36.0% $133,051.36 47.3%, -11.3% ($35,086.26) 376.0% -26.4% Outpatient $142,393.11 52.4% $107,359.98 38.2% 14.2% $35,033.13 -375.4% 32.6% Professional $31,591.48 11.6% $40,870.64 14.5% -2.9% ($9,279.16) 99.4% -22.7% Sub -Total $271,949.69 100.00- $281,2111.98' 100.0% 0.00 ($9,332.29) 100.0% -3.3% PREGNANCY/CHILDBIRTH Inpatient $238,897.24 95.6% $228,380.34 90.1% 5.5% $10,516.90 -300.1% 4.6% tG 0 N O r 0 N This Florida Blue report is proprietary and confidential. Report Run: 03/14/2017 4:27 PM Page 1 of 1 Outpatient $663.30 0.3% $2,113.63 0.8% -0.6% ($1,450.33) 41.4% -68� Professional $10,325.07 4.1 % $22,895.63 9.0% -4.9% ($12,570.56) 358.7% 54. Sub -Total $249,885.61 100.0% $253,389.60 100.0% 0.0% ($3,503.99) 100.0% -1.4 ENDOCRINE/METABOLIC Inpatient $103,097.92 51.8% $38,520.07 28.6%, 23.2% $64,577.85 100.4% 167.6 Outpatient $72,987.08 36.7% $73,221.38 54.3% -17.7% ($234.30) -0.4% -0.3 Professional $23,060.14 11.6% $23,062.38 17.1 % -5.5% ($2.24) 0.0% 0.0 Sub -Total $199,145.14 100.0% $134,803.83 100.0% 0.0% $64,341.31 100.0% 47.7 INFECTIOUS/PARASITIC Inpatient $145,466.51 83.8% $0.00 0.0% 83.8% $145,466.51 98.3% 0.0 Outpatient $18,923.55 10.9% $17,050.16 66.8% -55.9% $1,873.39 1.3% 11.0 Professional $9,149.71 5.3% $8,480.86 33.2% -27.9% $668.85 0.5% 7.9 Sub -Total $173,539.77 100_0% $25,531.02 100.0% 0_0% $148,008.75 100.0% 579.7 CONGENITAL ANOMALIES Inpatient $97,962.41 74.3% $0.00 0.0% 74.3% $97,962.41 80.6% 0.0 Outpatient $2,994.32 2.3% $5,486.90 53.6% -51.3% ($2,492.58) -2.1 % -45.4 Professional $30,853.87 23.4% $4,754.41 46.4% -23.0% $26,099.46 21.5% 549.0 Sub -Total $131,810.60 100.0% $10,241.31 100.0% 0.0% $121,569.29 100.0% 1187.0' NERVOUS SYSTEM/SENSE ORGAN Inpatient $0.00 0.0% $18,954.34 38.7% -38.7% ($18,954.34) -31.6% -100.0 Outpatient $77,200.70 70.9% $16,204.74 33.1 % 37.8% $60,995.96 101.7% 376.4 Professional $31,757.92 29.1% $13,841.14 28.2% 0.9% $17,916.78 29.9% 129.4 Sub -Total $108,958.62 100.0% $49,000.22 100.0% 0.0% $59,958.40 100.0% 122.4 RESPIRATORY SYSTEM Inpatient $70,813.52 68.7% $48,814.50 89.8%, -21.1% $21,999.02 45.2% 45.1 Outpatient $20,625.17 20.0% $250.04 0.5% 19.6% $20,375.13 41.9% 8148.7 Professional $11,572.04 11.2% $5,298.17 9.7% 1.5% $6,273.87 12.9% 118.4 Sub -Total $103,010.73 100.0% $54,362.71 100.0% 0.0% $48,648.02 100.0% 89.5 MENTAL DISORDERS Inpatient $77,875.60 84.4% $0.00 0.0% 84.4% $77,875.60 86.6% 0.0 Outpatient $9,402.40 10.2% $0.00 0.0% 10.2% $9,402.40 10.5% 0.0 Professional $4,945.95 5.4% $2,322.71 100.0% -94.6% $2,623.24 2.9% 112.9 Sub -Total $92,223.95 100_0% $2,322.71 100.0% 0_0% $89,901.24 100.0% 3870.5 BLOOD/BLOOD ORGANS Inpatient $60,411.00 83.1 % $4,603.94 6.3% 76.7% $55,807.06 -72712.8% 1212.2 Outpatient $3,170.88 4.4% $49,232.05 67.6% -63.3% ($46,061.17) 60014.6% -93.6 Professional $9,149.03 12.6% $18,971.67 26.1% -13.5% ($9,822.64) 12798.2% -51.8 Sub -Total $72,730.91 100.0% $72,807.66 100.0% 0.0% ($76.75) 100.0% -0.1' OTHER CONDITIONS Outpatient $30,048.19 68.0% $25,353.30 66.4% 1.6% $4,694.89 78.0% 18.5 Professional $14,157.69 32.0% $12,830.42 33.6% -1.6% $1,327.27 22.0% 10.3 Sub -Total $44,205.88 100.0% $38,183.72' 100.0% 0.0% $6,022.16 100.0% 15.8 SKIN & SUBCUTANEOUS TISSUE Inpatient $10,048.22 53.6% $0.00 0.0%, 53.6% $10,048.22 -148.3% 0.0 Outpatient $457.00 2.4% $16,224.96 63.6% -61.2% ($15,767.96) 232.8% -97.2 Professional $8,235.33 43.9 o $9,290.03 36.4% 7.5% ($1,054.70) 15.6% -11.4 Sub -Total $18,740.55 100.0% $25,514.99 100.0% 0.00Y6 ($6,774.44) 100.0% 26.6 Total $6,453,058.44, 100.0%'', $5,416,815.81' 100.0% 0.0%'', $1,036,242.63 100.0%'' 19.1 This Florida Blue report is proprietary and confidential. Report Run: 03/14/2017 4:27 PM Page 1 of 1 Monroe County Board of County Commissioners History of Board Resolutions Relating to Retiree Health Insurance Eligibility and Premiums Resolution Effective Employee/Retiree Number Date Category Criteria Retiree Premium 104-1999 10/1/1999 Existing Retiree N/A $0 Future Retiree 10 YOS with County AND $0 Either Age 60 or Rule of 70 Future Retiree 10 YOS with County AND Department Rate Until Age 60 OR < 60 AND Not Rule of 70 Rule of 70 and then $0 Future Retiree < 10 YOS Department Rate 119-2001 10/1/2001 Hired Prior to 10/1/2001 10 YOS with County AND $0 FRS Normal Retirement Hired Prior to 10/1/2001 10 YOS with County AND Department Rate Until Age 60 OR FRS Early Retirement Rule of 70 and then $0 Hired 10/1/2001 and Later OR 10 YOS with County AND Department Rate Retiree with <10 YOS FRS Normal or Early Retirement 154-2003 1/1/2004 Hired Prior to 10/1/2001 10 YOS with County AND 20 years HIS supplement = $100 FRS Normal Retirement OR Current Retiree Paying $0 Hired Prior to 10/1/2001 10 YOS with County AND Department Rate Until Age 60 OR FRS Early Retirement Rule of 70 and then $100 Hired 10/1/2001 and Later 10 YOS with County AND Department Rate FRS Normal or Early Retirement 354-2003 1/1/2004 Hired Prior to 10/1/2001 10 YOS with County AND 10 years HIS = $50 FRS Normal Retirement OR Current Retiree Paying $0 Hired Prior to 10/1/2001 10 YOS with County AND Department Rate Until Age 60 OR FRS Early Retirement Rule of 70 and then $50 Hired 10/1/2001 and Later 10 YOS with County AND Department Rate FRS Normal or Early Retirement 388-2013 1/1/2014 Hired Prior to 10/1/2001 10 YOS with County AND HIS ($50 to $150) FRS Normal Retirement OR Current Retiree Paying $0 Hired Prior to 10/1/2001 10 YOS with County AND Department Rate Until Age 60 OR FRS Early Retirement Rule of 70 and then HIS ($50 - $150) Hired 10/1/2001 and Later 10 YOS with County AND Department Rate FRS Normal or Early Retirement Section 5 of Resolution 388-2013 states: "The Monroe County Board of County Commissioners formally reserves the right to any and all future changes and modifications of this resolution, the group insurance contract providing health insurance benefits described herein andfor the require contribution premiums." This same language was also included in all prior resolutions. E.1.i 0 LO rn 00 YEARS OF SERVICE Years of Service # of Retirees 39 1 38 2 37 3 36 1 35 5 34 4 33 7 32 4 31 6 30 13 29 7 28 7 27 7 26 11 25 18 24 19 23 14 22 20 21 17 20 18 19 22 18 12 17 22 16 19 15 24 14 16 13 17 12 28 11 29 10 47 Total 167 Option 7 & Option 4 Option 6 8 48 SPOUSES 10> 65 38< 65 19 CHILDREN Option 7A Option 11, 17 & 25 Option 18 Option 25 0 N Years of Service # of Retirees Years of Service # of Retirees m 39 1 39 1 r 38 2 38 2 10 SPOUSES >65 d 125 RETIREES c 37 3 37 3 ARE PRE-65 o L 36 1 36 1 38 SPOUSES <65 a 35 5 35 5 0 34 4 34 4 c 33 7 33 7 32 4 32 4 v 31 6 31 6 m 30 13 30 13 0 29 7 29 7 •N 28 7 28 7 N 27 7 27 7 26 11 26 11 N 0) 25 18 25 18 24 19 24 19 r 23 14 23 14 M 22 20 22 20 d it 21 17 21 17 Cn 20 18 20 18 c 19 22 19 22 m 18 12 18 12 17 22 17 22 N d d 16 19 16 19 L 15 24 15 24 14 16 14 16 u0i 13 17 13 17 r 12 28 12 28 11 29 11 29 a 10 47 10 47 Total 421 Total 421 F Packet Pg. 249 (S �A-A J01 Mid eouneinsul 1-1111ENSI-11 044 04 siSBUR21-113 pesochaid thor urreipejify Due thoissn3sU3 : 968Z) IHd ON OL 10 9UTN 1e1LL1940d 4LIBUJ1,13IR44V COULD RETIRE AT —kw NAME FIRST NAME I DIVISION I I 00" Current YOS 7TFLE I DOS I MEDICALEFF I CURRENTSTATUS I YOS+AGE AGE I AGE: Shirk heriell Clerk of the Court 17-Sep-01 15 Clerk 11 18-Oct-82 16-Nov- 01 Active 49 34 44 Torres Jennifer MCSO, 26-Jul-99 17 Sgt. Deputy Sheriff 12-Mar-80 24-Sep-99 Active 53 36 44 malgrat Tims Property Appraiser 30-Aug-99 17 Receptionist 12-Feb-80 27-Aug-97 Active 53 36 44 Sprinkle Charlene IVICSO 10-Aug-94 22 Lt. Deputy 04-Jun-75 08-Oct-94 Active 63 41 44 Sheriff Cane Cassaundus BOCC - Emergency 19-Dec-99 17 Fire Rescue 04-Oct-78 17-Feb -00 Active Services Lieutenant 55 38 as Captain Crane Jonathan DICED 01-Apr-98 18 Detention 09-Feb-78 01-jun-98 Active Deputy 56 all AS Todd Marsha WICSO 02-Nov-98 is Communication 06-Oct-78 01-Jan-913 Active 45 s Officer 56 38 Thompson Mark BOCC - Emergency 22-Jan-96 20 Fire Rescue 11-Jul-75 21-Mar-96 Active Services Battalion Chief 61 41 45 Sanchez Nelson WICSID 11-May-95 21 Deputy Sheriff 28-Sep-75 09-1u1-95 Active 62 41 45 Knowles Violate Clerk of the Court 14-Mar-94 22 Clerk III D4-Apr-74 02-May-94 Active 64 42 45 Carey David WICSO 04-Oct-91 25 Lieutenant 13-Jul-71 02-Dec-91 Active 70 45 45 Deputy Sheriff Detention O'Connell Tiffany mcso 08-May-90 26 Records 26-Aug-71 19-Nov-87 Active Manager 71 45 45 Gil Jessica Tax Collector 11-Jun-90 26 Deputy Clerk 15-Mar-71 09-Aug-90 Active 71 45 45 Supervisor of Ruble Staid Elections 13-Nov-90 26 Deputy 31-Dec-71 11-Jan -91 Active 71 45 45 Thompson Andrea BOCC - Emergency 30-Jul-01 15 Fire Rescue 20-May-79 25-Sep-01 Active Services Lieutenant 52 37 46 Matthews Chandra Clerk of the Court 01-Jun-99 17 Re Supervisor 19-Oct-77 31-ju1-99 Active 56 39 46 Paskiewicz Andrew MCSO 12-Jan-96 20 Sgt Detention 01-Jun-73 11-mar-96 Active 63 43 46 Deputy Human Albury Kendra MOSO 25-Jul-94 22 Resources 12-Aug-72 22-Sep-94 Active Specialist 66 44 4r, Lieutenant Linares Joseph MCS0 20-Apr-92 24 Detention 08-Nov-71 18-Jun-92 Active Deputy 69 45 46 Supervisor of Brown Belinda Elections 04-Oct-92 24 Deputy 29-May-70 02-Dec-92 Active 70 46 46 Cdeman Amanda MC50 22-Aar-91 25 0enuty5heriff 19-Feb-70 19-Mar-90 Active 71 46 46 {0 �A-A -11 Lie1d aotaecansul 411IND 1 044 04 ISO ca12y3 joessedraid tau upSip alp pule uois n3 i(3 e 6 Z) IHd ON OL 10 eirrN 1121IL1911d 4LURUJy3ellyy LIJ sto Dawn MCSO 15-Jul-91 25 Deputy Sheriff 27-Aug-70 12-Sep-91 Active 71 46 46 Johnson Ryan BOCC - Emergency 10-Aug-01 15 Fire Rescue 20-Mar-77 09 rt-01 Active Services Captain 54 39 47 Mornpoint Desilles MCSO 28-5ep-01 15 Deputy Sheriff 1 ct-77 27-Nov-01 Active 54 39 47 slough Joel MCSO 05- ep 16 Sgt. Deputy 27-Nov-75 04-Nov Active Sheriff 57 41 47 Active - No LeIrd Andrew MCSC3 11-May-98 18 Deputy Sheriff II-Sep-74 10-Jul-98 Medical 60 42 47 Lieutenant Major Patrick MC 0 15-Dec-97 19 Detention 02-Aug-73 1 -Feb-98 Active Deputy 62 43 47 Brown William MCSO 12-Jan-95 21 Detention 25-Mar-73 12-Mar-95 Active 64 43 47 Deputy Mixon Eric MCSD 08-May-95 21 SGT Deputy Sheriff 08-Sep-72 06-Jul-95 Active 65 44 47 6riguglio Michelle Clem of the Court 29-Sep-97 19 Clem 11 07-Feb-71 28-Nov-97 Active 64 45 4 tecoumpte AngeliRue Tax Collector 03-5ep-96 20 Clem 16-Feb-71 01-Nov-96 Active 65 4S 47 Assistant Airport Fleita Sonja BOCC - Airport 02-Dec-96 20 Security Jul-71 Jan-97 Active Services Manager 65 45 47 Sergeant Katz Steven MC50 06-Dec-96 20 Detention 08-Sep-71 03-Feb-97 Active Deputy 65 45 47 Sergeant Morales Juan MC50 11-May-95 21 Detention 07-Dec-70 09-Jul-95 Active Deputy 67 46 47 Detention Carey leggy MCSO 25-Jan-93 23 Records 27-Jan-70 25-Mar•93 Active Assistant 69 46 47 Bartley Munn Linda MCSO 05-Apr-93 23 Sergeant Deputy Sheriff 16-Dec-70 03-Jun-93 Active 69 46 47 Keen John DICED 17-May93 23 Detention 11-Mar-69 15 Jul-93 Active 70 47 47 Deputy Human Battle Deshawn DICED 18-5ep-91 25 Resources 02-Jan-69 1 Nov-91 Active Supervisor 72 47 47 Supervisor DeSands William BOCC - Public 05-oct-88 28 Facifites 15-Oct-69 03-Dec-88 Active Works Maintenance 75 47 47 Pre Trial Barnett Lnakay Court 16-Oct-01 15 Assessment 18-May-75 15-Dec 1 Active Administration Officer 56 41 48 (8 1,A-A -101 Reid euSueinsul 111111129H 044 04 s9BUIEn-13 pesteclarid Do knSipajils pue uoissn3si(3 : 969Z) Mid ON OL 10 elrfN IeNuWIP0d WOUJILIMPff Jey Programs - Larry RICO) 09-Jun-00 16 Classification 16-Sep-74 08-Aug-00 Active Supervisor 58 42 48 Guerra Wilfredo MCS0 06-Nov-00 16 Deputy Sheriff 12-May-74 05-jan-01 Active 58 42 48 Sr. Coordinator, BOCC - Growth Petrick Nicole 01-May-00 16 Code 08-Jan-73 30-Jun-00 Active Management Enforcement 59 43 48 Huff Jon NICSO 08-May-00 16 Deputy Sheriff 24-jul-73 07-Jul-OO Active 59 43 48 Financial parsley Karen MC50 22-May -W 16 Analyst 31-Jan-73 21-Jul-00 Active 59 43 48 Lt. Deputy Active - No Paul Derek MCS0 30-Jun-99 17 Sheriff 04-Jun-73 29-Aug-99 Medical 60 43 48 Alvarez Julia MCS0 16-Jun-97 19 Deputy Sheriff 22-Jan-71 15-Aug-97 Active 64 45 48 LT Detention Sheagren James MCS0 11-Jul-96 20 01-Feb-70 tab-Sep-96 Active Deputy 66 46 48 Rodriguez Freddy MCS0 16-Sep-96 20 Deputy Sheriff 08-Aug-69 14-Nov-96 Active 67 47 48 Diaz Carmen Tax Collector 14-Feb-94 22 Clerk 26-Aug-69 14-Apr-94 Active 69 47 48 Sgt. Deputy Fisher Gerald MCS0 09-Aug-94 22 Sheriff 05-Aug-69 07-Oct-94 Active 69 47 48 Silva Ricardo MCS0 01-Oct-94 22 Team leader 05-Apr-69 30-Nov-94 Active 69 47 48 Assistant Orlin Pamela Clerk of the Court 03-May-93 23 Supervisor 28-Oct-68 01-Jul-93 Active 71 48 48 Galwas Aileen Tax Collector 18-Oct-93 23 Clerk 16-0ec-68 16-Dec-93 Active 71 48 48 White Patrick Clerk of the Court 10-Aug-92 24 Clerk I 08-Apr-68 08-Oct-92 Active 72 48 48 Winegarden Brenda MCS0 25-Nov-91 25 Secretary 20-Sep-68 23-Jan-92 Active 73 48 49 BOCC - Library Business Moore Valerie Services 21-May-90 26 Manager 22-Aug-68 19-Jul-93 Active 74 48 48 Wyatt Christopher MCS0 28-Nov-89 27 Deputy Sheriff 24-Jan-68 26-Jan-90 Active 75 48 48 Administrator BOCC -Library Nowanitz Nancy 26-Sep-88 28 Library 27-Jun-68 24-Nov-88 Active Services Headquarters 76 49 48 Cohen Michelle Clerk of the Court 23-Jun-86 30 Clerk 11 17-Jan-68 2D-Aug-86 Active 78 48 48 Assistant Knowles Has MCS0 28-Jul-86 30 19-Mar-68 25-Sep-86 Active Finance Director 78 48 48 Perez Iscondel MC50 30-MAY-01 15 Deputy Sheriff 27-Oct-72 29-Jul-01 Active 59 44 49 I ME Sr, Bartlett Sandra MC50 22-May -00 16 Technical 20-Sep-71 21-Jul-00 Active Advisor 61 45 49 Denton Jamie MCS0 14-Aug-00 16 Director - 03-Sep-71 13-Cor-00 Active Central Records 61 45 49 Vidal Jason WCO) 20-5ep-00 16 Detention 25-Oct-71 19-Nov-00 Active norultv 61 45 49 (8 I,A-A -101 Uleld eouainsul 1411189H 044 04 SN)BLIMIL13 pashedoid DO upSipajild pue uoqsSHT3s;i(3 : 968Z) MAI ON OL 10 elrrN le'll-1940d 4LIBULILIM11V r4nard Tommy SOCC - Emergency 06-Nov-00 I& Office Assistant 19-Sep-71 05-jan-01 Active Services 61 45 49 Report Patrick BOCC - Emergency 14-Dec-99 17 Fire Rescue 28-Jan-71 12-Feb-OO Active Services Lieutenant 62 45 49 Chief of Rice Michael NICS0 16-Dec-98 18 Administration 24-Nov-70 14-Feb-99 Active 64 46 49 Woods Von SOCC - Public 21-Jan-97 aintenance 19 M 20-Apr -68 22-der -97 Active Works Worker 1 67 48 49 Silvers Todd MCS O 11-May-95 21 LL Detention 03-Aug-67 09-jul-95 Active 70 49 49 Deputy Kiffney Thomas IVICS0 06-AM-92 24 Sgt. Deputy 18-Mar-67 EN-Jun-92 Active Sheriff 73 49 49 Stubblefield David NICS0 17-Sep-01 is Detention 20-Apr-71 16-Nov-01 Active 60 45 50 Deputy Rahming Roxanne MCS0 07-Aug-00 16 Civil Clerk 13-Jui-70 06-Oct-00 Active 62 46 so BOCC - Social Special Needs Haskins Anna 21-Aug-00 16 27-Dec-70 20-Occ-00 Active 62 46 50 Services Coord. Bentley Alvin ISOCC - Emergency 24-Oct-00 16 Fire Rescue 16-Sep-70 23-Dec-00 Active Services Battalion Chief 62 46 so Hustad Sever MCAD 16-Apr-99 17 Victim Advocate 16-Sep-70 15-jun-99 Active 63 46 so McAnaIRr Steven BOCC - Emergency 24-Sep-99 Fire Rescue 17 I"OV-70 23-Nov-99 Active Services Ueutenant 63 46 so O'Keefe Patricia MCSO II-Oct-99 17 Deputy Sheriff 11-Jan-70 20-Dec-99 Active 63 46 50 Thompson Margo Clerk of the Court 01-Jun-99 17 Clerk It 31-Jul-69 31-Jul-99 Active 64 47 so Cabot Daniel Tax Collector 20-Sep-99 17 Clerk 11-May-68 19-Nov-99 Active 65 48 50 Sergeant Gonzalez Luis MCSO 09-Jun-98 18 Detention 05-May-67 08-Aug-98 Active Deputy 67 49 so Adams Kirsten NICSO 24-OCt-94 22 Senior Analyst 04-Feb-66 22-Dec-94 Active 72 so so Supervisor of Gallagher Leslie Elections 29-Nov-93 23 Deputy 10-Aug-66 27-Jan-94 Active 73 so so Hitchcock Angela Tax Collecow 18-Feb-86 30 Asst, Tag Dept, 27-Dec-66 16-Apr-86 Active 80 so 50 Supervisor Alvarez Nancy MCSO 21-Apr-86 30 lieutenant 31-May-66 29-Jun-86 Active so 50 50 Deputy Sheriff Dixon Yvonne MCS0 28-Sep-01 is Detention 23-Jul-70 27-Nov-01 Active 61 46 51 Deputy Leon Manuel BOCC - Emergency 30-Jul-01 15 Firefighter EMT 24-May-69 28-Sep-01 Active Services 62 47 51 (8 LA -A J01 ueld ensupiinsul 411129H 044 04 WS61-let,13 persodoid uo upSipaiiie pue uRSissn3si(3 : 968Z) 1Hd ON OL 10 elnN lelluel0d WRILLH-13MV11V nty BOCC - Cogan Executive _Joe Auto Attorney 06-Auk -01 is Assistant 23-Feb-69 05-Oct-01 Active 62 47 51 Detention DeLaRma Marco MCSO 12-Mar-01 is Deputy 28-Feb-68 11-May-01 Active 63 48 si Lieutenant INGravarml Michael MOSS) 14-Sep-01 is Deputy Sheriff 26-Nov-63 13-NOV-tit Active 63 48 51 Tynes Carla Property Appraiser 09.Oct-01 is Deputy Property 22-Feb-66 08-Dec-01 Active Appraiser 63 48 51 Ortiz Rattle MCS0, 14-Feb-00 16 Accountant 30-Sep-68 24-Apr-00 Active 64 48 51 Gooey John MCS0 14-Aug-00 16 Deputy Sheriff 25-Jun-68 13-oct-00 Active 64 48 51 Programs Sender Mark MCSO 29-Oct-99 17 Assistant - Main 20-Feb-67 28-Dec-99 Active Control 66 49 51 Sr Intelligence Naz Use MCSO, 08-Nov-99 17 Analyst 28-Oct-67 07-1an-00 Active 66 49 51 Financial Unit Perez Patricia MCS0 II-Jan-99 17 16-Feb-66 12-Mar-99 Active 51 Manager 67 so Stankiewics Ififfia by BOCC - Growth 09-Jun-98 Technician is 20-Jan-66 08-Aug-98 Active Management Planning 68 so 51 Dowling Matthew MCS0 23-Nov-98 IS Deputy Sheriff 08-Apr-66 08-Feb-98 Active 69 50 51 Certified BOOC Mathis Mathis Martha 19 Nursing 22-Feb-66 16-Nov-97 Active Services ices Assistant 69 so 51 Executive Whom Hancock Pamela Clerk of the Court 03-Mar-97 19 Aide 04-Nov-65 02-May-97 Active 70 51 51 BOCC - Public Sr, Project Briggs Clark Works 02-Jun-99 17 Administrator IS-Feb-64 01-Aug-99 Active 69 52 51 Coleman Mark M(GO 01-Nov-95 21 Sergeant 02-Jul-65 30-Dec-95 Active 51 Deputy Sheriff 72 51 Rivas Eugenia MCSO 29-Aug-94 22 Civil Clerk 21-Feb-65 27-Oct-94 Active 73 51 52 Thompson Eugene mcso W-Dec-93 23 Captain Deputy 12-May-65 13-Feb-94 Active Sheriff 74 51 51 Haney Norman BOCC - Public 16-Feb-92 24 Mobile 06-Apr-65 17-Apr-92 Active Works Mechanic 75 51 51 Begin Mark MCSO 28-Aug-69 27 Detention 09-Feb-65 26-Oct-89 Active Deputy 78 51 51 Catala Donald MCSO 14-Nov-88 28 Sergeant 21-May-65 12-Jan-89 Active 51 Deputy Sheriff 79 51 Ramsay Richard MCSO 09-Nov-87 29 Sheriff 16-Nov-65 07-Jan-88 Active so 51 51 ganse Christine Tax Collector 27-Jan-86 30 Supervisor 06-Feb-65 27-Mar-86 Active 81 51 51 Hiller Donald MCSO 21-Jan-85 31 Captain Deputy 28-Aug-65 21-Mar-85 Active Sheriff 82 51 51 Scibilia Chad PICSO 05-Nov-85 31 Major Deputy D7-Apr-65 05-Jan-86 Active Sheriff 82 51 51 (8 LA -A J01 DOW eoueinsul 411189H 044 04 159BLIEH43 pescidoid to upoiji3wip pue uclissnrcusi(3 : 968Z) Me! ON OL 10 91nN 1e111,11940d 41-191MI-131244V staff es Rachelle DICED 06-Jul-82 34 Accreditation 09-Sep-65 06-Sep-82 Active Inspector as 51 51 BOCC - social Transportation N Nelson ed Clifford 07-May-01 15 18-Aug-67 06-Jut-01 Active Services Driver 64 49 52 BOCC - Public Maintenance M M ollineda Julio 21-May-01 15 21-May-66 20-Jul-01 Active Works Worker 11 65 so 52 Robe rtson Cheryl Clerk of the Court 03-Dec-01 15 Clerk III 06-May-66 01-Feb-02 Active 65 50 52 Escobar Rita MC50 14-Aug-00 16 Accountant 09-Jun-66 13-Oct-00 Active 66 so 52 Deputy Sheriff, Coleman Dennis MC50 24-Jan-00 16 30-Sep-65 24-mar-00 Active Lt, 67 51 52 Office Specialist Atwell Patti Tax Collector 24-Jan-00 16 09-Feb-65 09-May-08 Active 1 67 51 52 BOCC - Public Jernigan Rickle 28-Feb-00 16 StaffAssistant 131an-65 28-Apr-00 Active Works 67 51 52 BOCC - Social Compliance Wean Kimberly 06-Nov-00 16 01-Jun-65 05-Jan-01 Active Services Manager 67 51 52 ShillingerJr Robert BOCC - County 18-Dec-00 16 County Attorney 16-May-65 16-Feb-01 Active Attorney 67 51 52 Fire Rescue BOCC - Emergency Zavalney Steven 24-May-99 17 Paramedic 29-Mar-65 23-Jul-99 Active Services Captain 68 51 52 Major Detention Age Timothy MC50 16-Jan-98 18 01-Jan-64 17-Mar-98 Active Deputy 70 52 52 War, Director, BOCC-Library Rice Anne 29-May-98 19 Library 13-12&�64 28-Jul-98 Active Services Administrator 70 52 52 Human Slebodnick Charles MCS0 05-Oct-98 18 Resources 13-Aug-64 04-Dec-98 Active Specialist 70 52 52 Hong Daniel MCS0 30-Jun-97 19 Computer 25-May-64 29-Aug-97 Active Animator 71 52 52 SOCC - Emergency Fire Rescue Sebben David 01-May-95 21 13-Jul-64 29-Jun-95 Active Services Battalion Chief 73 52 52 Program / Allen Keene MCSO 19-Aug-94 22 Inmate Services 11-Aug-64 17-Oct-94 Active Director 74 52 52 Henriques Danise Tax Collector 11-Feb-91 25 Tax Collector 14-Mar-64 11-Apr-91 Active 77 52 52 Firefighter Webb, III Stanley BOCC - Emergency 20-Aug-90 26 Charge 09-Aug-64 18-Oct-90 Active Services Paramedic 78 52 52 (8 1,A-A J01 ueld enSueinsul LillesH 044 04 159BUML113 pescidoid Do upSipajilp pue upgissn3si(3 : 9686 1Hd ON OL 10 ainN le'll-1940d WRLULPEC14V Alberto MCSO 21-Aug-89 27 Lt. Deputy 25-Sep-64 19-oct-89 Active --Inirez Sheriff 79 52 52 Executive Snider Tamara MCS0 03-Jun -85 31 Assistant Assistant 01-Aug-85 Active 83 52 52 Price Miriam Tax Collector tit -Jan- 84 32 Clerk 25-0ct-64 27-Feb-84 Active 84 52 52 Detention Heaviland Michael MCSO 05-Mar-01 15 Deputy Sgt 26-Auff-65 04-May-01 Active 66 S1 53 Morales Alex Tax Collector 24-Sep-01 15 Window Clerk 10-Feb-65 23-Nov-01 Active 66 51 53 Executive Serra Jacqueline MCSO 03-Apr-00 16 Assistant 15-Oct-66 02-Jun-00 Active 68 52 53 Sergeant Lawson Lisa MCS0 10-Apr-OD 16 Detention 08-Jul-66 09-Jun-00 Active Deputy 68 52 53 Morgan Sonya MCA0 10-Aug-00 16 Deputy Sheriff 01-May-64 09-0Ct-00 Active 68 52 53 Senior Martinez Maria Clerk of the Court 14-Aug-00 16 Marathon 23-Dec-64 13-00-00 Active Criminal Clerk 68 52 53 SOCC - Public Desquotte Montilla Works 11-Aug-99 17 Foreman 10-Jun-64 I0-Oct-99 Active 69 52 53 Seago, Sheila RACED, 19-Feb-98 18 SgL Deputy 09-May-63 18-Apr-98 Active Sheriff 71 53 53 Shaw Robbie Property Appraiser 06-Oct-97 19 Deputy 26-Apr-63 05-Dec-97 Active 72 53 53 Supervisor of Robinson Donna Elections 22-Feb-96 20 Deputy 29-Aug-63 11-Apr-96 Active 73 53 53 DOCC - Growth Sr, Coordinator Wingate Mary Management 08-Mar-95 21 Flood Planning 06-May-63 06-May-95 Active 74 53 53 Cohen Mary MCSO 2G-Jui-94 22 Training 24-Nov-63 17-Sep- 94 Active Specialist 75 53 53 Accounts McIntosh Salome Clerk of the Court 08-Jun-92 24 Payable 24-Aug-63 06-Aug-92 Active Supervisor 77 53 53 Holrowl Lee Ann MCSO 21-1an-83 33 Captain Deputy 03-Sep-63 21-Mar-93 Active Sheriff 86 53 53 BOCC - Airport Airport Business Leto Beth 01-Jun-83 33 24-Jun-63 01-Aug-83 Active Services Manager 96 53 53 SOCC - Social Administrative Monty Dorothy Services 04-Jan-DO 16 Assistant 11-Nov-63 04-Mar-00 Active 69 53 54 Zamora Anita Tax Collector 01-May-00 16 Bookkeeper 07-Dec-62 30-lun-00 Active 70 54 54 Reyes Carload SOCC - Library 14-Aug-00 16 Library Assistant 05-Sep-62 13-Oct-00 Active Services 70 54 54 Cletta Richard BOCC - Emergency 29-Nov-99 Fire Rescue 17 11-Mar-62 28-Jan-00 Active Services Captain (ARFFj 71 54 54 (8 1,A-A -101 Uleld enSueinsul 411189H 044 04 ss)Buet-13 pescadoid NO urniperip pue uoissmsi(3 : 968Z) lHcI ON OL 10 9lnN lelluGslu)d WOUJILIM11V lzini-Marengo Maclean MCSO, 03-Oct-94 22 Sr. intelligence 01-Dec-94 Active Analyst analyst 76 54 Leto Michael BOCC - Public 01-Nov-94 22 Sr. A/C 10-Aug-62 26-Jul-88 Active Works Technician 76 54 Jensen Tamale MCSO, 31-Mar-91 25 Deputy Sheriff 24-Aug-62 29-May-91 Active 79 54 Firefighter Novak Milan BOCC - Emergency 09-Jul-89 27 Charge 30-mar-62 06-Sep-89 Active Services Paramedic 81 54 Herrin Rebecca MCSO 11-Apr-88 28 Director- Media 28-Nov-62 30-May-88 Active Relations 82 54 Bryan Peggy MCAD 19-Aug-88 28 Records 22-Aug-62 17-Oct-89 Active Supervisor 82 54 O'Neill Lawrence MCSO 27-Jul-87 29 Deputy Sheriff 27-Dec-62 24-Sep-87 Active 93 54 Fanelli Donald MCSO 22-Apr-86 30 Captain Deputy 25-Jan-62 20-Jun-86 Active Sheriff 84 54 "an Corey IVICSO 08-Dec -86 30 Capt. Deputy 16-Oct-62 05-Feb-87 Active Sheriff 94 54 Director - O'Dell Diana NICSO fly-Nov-85 31 Property/Eviden 02-Apr-62 03-dan-86 Active ce 85 54 DI(pavared Rosa MCSO 05-Mar-01 15 Deputy Sheriff 30-Nov-61 20-Aug-00 Active 70 55 Martinez Denise KICSO 21-Aug-00 16 Detention 18-Oct-61 20-Oct-00 Active 71 55 Deputy Records Hinerman Rita MCSO 12-Jan-98 is 16-May-61 13-Mar-98 Active 73 55 Assistant Librarian Stafford Eva BOCC - Ubrary 14-Sep-98 18 Technical 20-Jan-61 13-NOV-98 Active Services Services 73 55 Burgess Gary BOCC - Emergency 13-Oct-98 18 Drefighter EMT 13-May-61 12-Dee-98 Ac(iye Services 73 5S Sr, Mytnik Ann BOCC - Public 01-MW94 22 Budget/Contract 27-May-61 25-jun-94 Active Works Administrator 77 55 Valdes Lazans MCSO 23-Mar-92 24 Deputy Sheriff 17-Dec-61 21-May-92 Active 79 55 Dewcoght Terri MCS0 03-Jul-91 25 Communication 06-Apr-61 31-Aug-91 Active a officer 80 55 Sheriff William MCSO 09-Sep-92 25 Detention 08-Oct-61 07-NOV-91 Active Deputy 80 55 Sr. Property Reach Mark Land Authority 02-Aug-88 28 Acquisition 24-Feb-61 30-Sep-88 Active srsarinfi't 93 S5 54 54 54 54 54 54 54 54 54 54 55 55 55 55 55 55 55 55 55 55 (8 1,A-A JOI kleld eoueinsul 4111SOH 044 04 1596HR143 piescycloid DO hiclipajilis pue uoissn3si(3 : 968Z) 1Hd ON OL 10 9lrLN 11SE11-1940d 41,19LUILIM11V SOCC-Technical Administrative _Jrra Maria Services 16-Sep-81 35 Assistant 10-Feb-61 14-Nov-81 Active 90 55 55 Howard Carlton SOCC - Public 14-May-98 IS Maint. Worker 5 14-Jun-60 23-jul-55 Active Works 74 56 56 Sr. Intelligence Mullin -Meagher Margaret NICS O 01-Oct-94 22 Ana hat 26-Jan-60 01-Oct-94 Active 78 56 56 O'Connor Lynn Property Appraiser 11-Jun-84 32 Deputy Clerk II-Nov-60 09-Aug-84 Active as 56 56 Data Processing Thurston Tangelo Clerk of the Court 28-Aug-78 38 27-Nov-60 28-Oct-78 Active Supervisor 94 56 56 BOCC - Growth inspector Code Link Diane Management 01-Feb-00 16 Compliance 26-Dec-59 01-Apr-00 Active 73 57 57 Sr, inspector, Dowling Nancy ROOD - Growth 15-May-00 16 Code 12-Apr-59 08-Feb-98 Active Mana gement Compliance 73 57 57 Entry Bobbies, Maria NICSO, 05-Sep-00 16 Intelligence 19-Nov-S9 04-clov-00 Active Analyst 73 57 57 Lamarche Tamara BOCC 25-Oct-00 is Executive 01-Sep-59 24-Dec-00 Active Assistant 73 57 57 Pedraza Plerfina IVICSO 0I-Nov-99 17 Intelligence 06-Jul-59 31-Dec-99 Active 74 57 57 Analyst Lowe Edward FLOCC - Public 01-Apr-98 is Operations 11-Mar-59 31-May-98 Active Works Manager 75 57 57 Fire Rescue Boswell Gary BOCC- Emergency 23-Jul-95 20 Deputy Chief - 13-Jul-59 20-Sep-96 Active Services Operations 77 57 57 Sr, Intelligence Davis Havel MC50 17-Sep-96 20 Analyst IS-Mar-59 15-Nov-96 Active 77 57 57 Records Center Colleen MC50 18-May-94 22 Assistant 06-Sep-59 16-Jul-94 Active 79 57 57 Moore Donna MC50 03-Dec-90 26 Executive 15-jul-59 31-Jan-91 Active Director - HR 83 57 57 Koval Matthew IVICSO 30-Now-87 29 Deputy Sheriff 15-May-59 28-Jan-88 Active 86 57 57 Sanchez Roy BOCC - Public 16-jun-86 30 Director, Fleet 08-Feb-59 14-Aug-86 Active Works Management 87 57 57 Receptionist/ Diaz Margarita Property Appraiser 23-Jon-94 32 27-Aug-59 22-Mar-84 Active 89 57 57 Deputy Clerk Sergeant Harper Beverly MCSO 24-Aug-98 18 Detention 08-Aug-58 23-Oct-98 Active Deputy 76 58 58 Shine Derek INICSO 12-jan-96 20 Detention 04-Dec-58 11-Mar-96 Active Dimotv 73 56 56 (8 1,A-A -101 ueld eroulainsull 1-111GOH 044 04 SJOBUR243 pesoolorid DO usSipaiija pue upaissrhorsi(3 : 968Z) 1Hd ON OL 10 elrrN le'll-19110d eau 9UJI-13MVIV Digital James Property Appraiser 03-Am-95 21 Cartographic 11-Aug-58 03-Mar-95 Active Tech 79 58 58 Project Mellon Phdlipp MCSO 01-00-94 22 Supervisor 15-Sep-58 01-Oct-94 Active Analyst so 58 58 Grattan Michael MCSO 25-Jan-93 23 HAS Supervisor 2"un-58 25-Mar-93 Active 81 58 58 Fire Rescue Lt, Bock Donald BOCC - Emergency 09-0ct-92 24 Infections 10-Mar-58 07-Dec-92 Active Services Control Officer 82 58 58 Sgt Detention Lopez Fernando DICED 01-Mar-91 25 29-Dec-58 01-Jun-91 Active 83 58 58 Deputy Diaz Christine BOCC - Employee 19-Feb-80 36 Executive 06-g1ov-58 18-Apr-80 Active 94 58 58 Services Assistant Myers Eric DICED 28-May-01 is Sr. Intelligence Analyst 28-Jul-57 27-Jul-01 Active 74 59 59 Thomas Dawn BOCC - Extension 17-Jul-01 15 Staff War 11 21-Sep-57 15-Sep-01 Active 74 59 59 Services Supervisor Wundedich Paul BOCC - Public 03-Dec-01 15 Construction 22-Oct-57 01-Feb-02 Active Works Inspector 74 59 59 Pierce Roxana Clerk of the Court 27-Sep-99 17 Finance Clerk IV 12-Jun-57 05-Oct-93 Active 76 59 59 Sr. Jones Richard BOCC - Growth 05-Nov-97 19 Administrator, 15-Cct-57 D4-Jan-98 Active Management Marine Resources 78 59 59 Gonzalez Divinely Clerk of the Court 31-jul-95 21 Clerk 11 29-Mar-57 28-Sep-95 Active 80 59 59 Tynes Louis BOCC - Public 28-Feb-94 22 Maintenance 19-Dec-57 28-Apr-94 Active 81 59 59 Works Worker 3 Zalanka David BOCC - Emergency 25-Apr-94 22 Fire Rescue 05-Oct-57 21,mn-94 Active Services Lieutenant 81 59 59 Goodwin Julie NICSO 01-Oct-94 22 Sr. Intelligence 22-May-57 01-Oct-94 Active 81 59 59 Analyst Administrator, Rumor Pamela BOCC - Employee 03-Oct-94 22 Human 15-Oct-57 01-Dec-94 Active Services Resources 81 59 59 Murray Kenneth BOCC - Public 03-Feb-92 24 Toll Collector 28-Sep-57 02-Apr-92 Active 83 59 59 Works Reid Taylor DOCC - Public 06-Apr-92 24 Equipment 18-Dec-57 04-Jun-92 Active 93 59 59 Works Operator Slawk Mary BOCC-County 28-Oct-91 25 Risk Mgmt. 22-Amy-57 26-Dec-91 Active 84 59 59 Attorney Specialist Chavka David AIDED 22-Aua-88 28 Detruty Sheriff 12-Sep-57 20-Oct-88 Active 87 59 59 (8 1,A-A JOI Lfield eyoueinsul LlIlIyGH 044 04 IN)BLIM43 pescidoid DO wipajilp pue uoissn3si(3 : 968Z) IHd ON OL 10 yflnN 112111-1940d WBUIL13ettlif Senior Forensic Cha 1 CS0 27-Aug-01 15 11-Jan-56 26-Oct-o2 Active 60 _jwn Accountant 75 60 Sands Richard BOCC - Public 24-Jan-00 16 Maintenance 11-Mar-56 24-Mar-00 Active Works Worker 1 76 60 60 BOCC - Public Sign Technician Crane James Works 17-Aug-98 18 / fatal 08-Aug-56 16-oct-98 Active 78 60 60 Training Unit Wells Victoria MC50 24-Nov-97 19 10-Jul -56 23-jan-98 Active 79 60 60 Manager BOCC - Social Attendant Barker Patricia 16-Jan-96 20 22-Oct-56 IS - Mar -96 Active Services Supervisor so 60 60 Wilcox Denise Tax Collector 01-Nov-93 23 Clerk 25-Mar-56 30-Dec-93 Active 83 60 60 Tuite-Mongelli Ann Clerk of the Court 04-May-87 29 Night Operator 16-Jan-56 02-Jul-87 Active 89 so 60 BOCC - Employee Allen Calvin 01-Nov-84 32 EEO Coordinator 19-Dec-56 30Dec94 Active 92 60 60 Services SOCC - Airport Sr Maintenance Lordelo Kenneth 04-Nov-81 35 17-Sep-56 04-Jan-82 Active Services Technician 95 60 60 Detention Greene -Mingo Beverly MCS0 14-Aug-01 15 Records 08-Dec-55 13-Oct-01 Active Supervisor 76 61 61 Sgt. Deputy Burkett Bobby MCS0 05-Sep-01 is Sheriff 21-Jul-55 04-Nov-01 Active 76 61 61 BOCC - Public Maintenance Thompson Terry Works 24-Apr-00 16 Worker ill 04-NOV-55 23-Jun -00 Active 77 61 61 identification Ritchason Debra MCS0 OS-Jun-98 is 15-Feb-55 31-Jul-98 Active 61 Technician 79 61 BOCC - Public Sr. Tech. Poll Luna Richard 15-Dec-97 19 07-May-55 13-Feb-98 Active 61 Works Control 80 62 Sr. intelligence Gonzalez Pedro MCS0 01-Oct-94 22 02-Aug-55 30-Nov-94 Active 61 61 Analyst 83 Detention Tobin Debra MCS0 15-Dec-93 23 Records- 31-Mar-55 12-Feb-94 Active Transport 84 61 61 Fernandez- BOCC - Employee Administrator, Maria 2D-Apr-92 24 02-Oct-55 18-Jun-92 Active 62 61 Gonzalez Services Benefits 85 Maintenance Gonzalez Nestor MCSO 30-Oct-00 16 145ep-54 29-Dec-00 Active 62 62 Specialist 78 Roberts Debra Clerk of the Court 07-May-99 17 Clerk t 16-Oct-54 06-Jul-99 Active 79 62 62 BOCC- Library Sr. Uproot Scott Pamela 16-NOV-98 is 22-Feb-54 15-Jan-99 Active Services Assistant so 62 62 Auten Nancy Clerk of the Court 16-Sep-96 20 Clerk 11 19-Mar-54 01-Feb-90 Active 82 62 62 Supervisor of Griffin Roslyn 16-Apr-84 32 Deputy 02-Dec-54 16-Jun-84 Active 62 62 Elections 94 Executive Active - No Peterson Carol NICSO 28-Nov-01 15 Assistant 24-May-53 27-Jan-02 Medical 78 63 63 (IR 1,A-A J01 Held aouainsul 111lesH 044 04 15961-11243 pershodoid NO uclipajilp pue upoissrronsi(3 : 969Z) 1Hd ON OL 10 elrrN IIS111-1940d WOUJILIM11V SOCC - Social 40 Bienvenklo Services BOCC - library Chambers Stephen Services Winkler Jane MCSO Norman James MCSO Painter James MCSO BOCC - Public Celia Claude Works Cross Susan Property Appraiser Walter Phyllis mcso Sweeney Anne MCSO Yongue Johnnie MCSO - Public Suarez Bruno Works Works Raginski Gary MCSO King Karen MCSO Verifies Laura Clerk of the Court Price Karen Tax Collector BOCC - Dore ry Moriarty Claudia Services Columns Teresa ROCC Lake Ovilda IVICS0 Caputo Louis MCSO BOCC- Public Herith Gary Works Harbin Martin MCSO Gaubert Curtis MCSO 18-May-98 18 Client Transport 07-Oct-53 17-Jul-98 Active Specialist 81 63 63 05-May-97 19 Branch Manager 01-Oct-53 04-Jul-97 Active 82 63 63 Entry 02-9un-97 19 Intelligence 23-Feb-53 01-Aug-97 Active Analyst 82 63 62 03-Nov-93 23 Lieutenant 03-Jul-53 01-Jan-94 Active Deputy Sheriff 86 63 E3 Director - 18-Mar-91 25 Information 12-Mar-53 16-May-91 Active Management as 63 63 26-Dec-89 27 Equipment 29-Mar-53 23-Feb-90 Active 90 63 63 Operator 10-Oct-01 15 Deputy Clerk 08-Nov-52 09-Cec-01 Active 79 64 64 21-Nov-96 20 Training 14-Jul-52 19-Jan-97 Active 84 64 64 Coordinator Captain 06-Der-96 20 Detention 23-Aug752 03-Feb-97 Active Deputy 84 64 64 30-Dec-91 25 Fleet Manager ......... ........................................................ 15-Nov-52 28-Feb-92 Active 89 64 64 08-Feb-00 ... ... ... ... ... ... ... . 16 Maintenance 06-Oct-51 08-Apr-00 Active 65 65 Worker 1 81 22-Mar-99 17 Pilot 01-Jan-51 21-May-99 Active 82 65 65 12-Apr-99 17 Communication 19-Mar-51 11-Jun-99 Active 65 65 a Assistant 82 06-may-99 17 Clerk 11 30-Sep-51 05-jul-99 Active 82 65 65 Deputy'nde 25-Oct-99 17 Clerk 26-Jan-51 24-Dec-99 Active 82 65 65 06-Jan-97 19 Senior Library 07-Jun-51 06-Mar-97 Active 84 65 65 Assistant 05-Jun-97 19 Executive 07-Aug-51 04-Aug-97 Active 84 65 65 Assistant 03-Jan-91 25 Airport Security 16-Nov-51 03-Mar-91 Active Technician 90 65 65 30-Sep-91 25 Under Sheriff 04-Aug-50 28-Nov-91 Active 90 65 65 07-May-01 is Sr, Tech,/Installer 07-Apr-50 06-Jul-01 Active 81 66 66 26-Nov-01 15 Deputy Sheriff 03-Jul-50 25-Jan-02 Active 81 66 66 29-May-00 16 Multimedia Mannoor 14-May-50 28-Jul-00 Active 82 66 66 (8 �A-A JOI cleld eocucinsul 1-11IMEH 044 04 SuaBIJISIA3 presiodoid to usSipwip pue uclissrnorsi(3 : 968Z) Me! ON OL 10 ElInN lelIch940d 41JOUJI-IM11V ROCC, - Emergency Executive ,Jachek Darice 27-Dec-00 16 12-Dec-50 25-Feb-01 Active Services Assistant 82 66 66 Pena Anna LOCOS 24-Nov-97 19 Translator 24-Dec-50 23-Jan-98 Active 85 66 66 BOCC - library Valdez Teresa 13-May-97 19 Sr. Ubrary Asst 22-FeD49 12-Jul-97 Active 67 67 Services 86 BOCC - Public Gartenmayer Tony 17-Jan-95 21 Maint. Worker 5 10-Oct49 17-Mar-95 Active Works as 67 67 County Neuegnt George BOCC 11-Jan-99 17 Commissioner Commissioner 11-jan-99 Active as 68 68 Training Sees Gladys MCS0 14-Au8-00 16 Coordinator 02-Dec-46 13-Oct-00 Active 86 70 70 Forensic Planb Est vacso 12-Apr-99 17 27-Oct-43 11-Jun-99 Active 73 Accountant 90 73 BOCC- library Sullivan Paulette 29-May-96 20 Branch Manager 13-Jun-43 27-Jul-96 Active Services 93 73 73 Property/ Glover Angela MCCID 01-Dec-97 19 Evidence 11-Oct-60 18-Sep-86 Active Assistant 75 56 75 Kula Nonua BOCC - Umury 16-May-84 32 Director, 29-May-40 16-Jul- 84 Active Services Libraries 108 76 76 BOCC - library Senior Librarian, Hambright Thomas 03-0ec-85 31 23-Feb-38 03-Feb-86 Active Services Florida History 109 79 78 Enrollment Change at 2017 Open Enrollment 5ingie Hirea prior biiilui1 142 /1b (11) Single Hired after 5/1/2012 426 448 22 Spouse 112 110 (2) Spouse + 1 Child 43 37 (6) Spouse + 2+ Children 47 33 (14) 1 Child 97 120 23 2 Children 60 80 20 3 Children 14 15 1 4 Children 1 3 2 5+ Children 0 1 1 Spouse with Other Coveraqe 0 6 6 MMEMEMEMEMEM Retiree (10+ YOS) 402 413 11 Retiree >65 No Subsidy 1 2 1 Retiree <65 No Subsidy 1 3 2 Spouse >65 56 18 (38) Spouse <65 43 34 (9) 1 Child 0 5 5 2 Children 2 4 2 3 Children 0 2 2 Spouse <65 & 1 Child 3 2 (1) Spouse < 65 + 2 Children 0 1 1 Sury Spouse only >65 14 6 (8) Sury Spouse only <65 3 3 0 ay; o; sa6ueyo pasodoid uo uopowip pue uolssnosla : 568Z) Ajelnwjo=l pejeg uolslnu3 :;uauayoe;;V Select Formulary Exclusion & Step Therapy List Effective: January 1, 2017 no � . 800 3614542 I envisionrx.com ay; o; sa6ueyo pasodoad uo uoi;oaaip pue uoissnosia : 568Z) Ajelnuaao=l;oeleS u01slAu3 :;uauayoe;;V Formulary Exclusions Nonsteroidal Anti-inflammatory Agents (NSAIDs) Opioid Agonists - Extended Release Opioid Agonists - Immediate Release Opioid Abuse Tetracyclines Hepatitis C Antidementia Agents Attention Deficit Hyperactivity Disorder (ADHD) Transmucosal Fentanyl Analgesics Oral Contraceptives I,I^jtid.til?ilf Zipsor Butrans, Nucynta ER, Hysingla ER, Oxycontin Nucynta Bunavail, buprenorphinelnaloxone, Zubsolv Acticlate, Doryx diclofenac potassium, Zorvolex [NP] Belbuca, Opana ER, Zohydro ER [NP] generic immediate release opioids Suboxone Fiim generic tetracycline Olysio, Technivie, Viekrra, Zepatier I Daklinza, Harvoni, Sovaldi Namenda XR, Namzaric Concerta, Daytrana, Focalin XR, QuilliChew, Quillivant, Ritalin LA Abstral, Fentora, Lazanda, Subsys generic Beyaz, generic Safyral, generic Yasmin', generic Yaz', Minastrin 24 Fe, Lo Loestrin donepezil, memantlne (immediate release) Vyvanse, generic ADHD medications fentany! lozenge Beyaz, Natazia, Safyral, Yasmin, Yaz 'generic Yasmin and Yaz are commonly marketed as Gianvi, Loryna, Ocella, Syeda, Vestura, or Zarah 800.361.4542 1 envisionrx.com 2 ay; o; sa6ueulo pasodoad uo uoi;oaaip pue uoissnosia : 568Z) Ajelnuaao=l;oeleS uolslAu3 :;uGwt43e;;V Formulary Exclusions (continued) Therapeutic Category Formulary Alternative DERMATOLOGY Acne (Oral Agents) Absorica Amnesteen, Claravis, Myorisan, Zenatane Acanya, clindamycin phosphate, Acne (Topical Agents) Aczone, Clindagel, Epiduo Onexton, Retin-A Micro Gel 0.08%, Ziana Picato [NP], Zyclara [NP], Actinic Keratosis Carac, fluorouracil 0.5% cream fiuorouracil 5% cream, imi uimod 5% cream Antifungals Kerydin Jublia Anti -Inflammatory Agents - Pennsaid Flector Topical DIABETES Biguanides Fortamet, Glumetza, metfarmin generic Glumetza Abbott (Freestyle, Precision), Blood Glucose Meters &Test Ascencia (Breeze, Contour), Roche (Accu-Chek), LifeScan (CneTouch) Strips All other test strips that are not UfeScan (OneTouch) brand Dipeptidyl Peptidase-4 Inhibitors Jentadueto, Kazano, Kombiglyze, Janumet, Januvia (DPP-4) & Combinations Nesina, Oseni, Onglyza, Tradjenta Glucagon-Like Peptide-1 TanZeUm, Trukoity Bydureon, Byetta, Victoza Agonists (GLP-1) Rapid Acting Insulin Afrezza, Apidra, Humalog, Humulin Novolog, Novofm Sodium -Glucose Co -transporter 2 Invokana, Invokamet, Jardiance, (SGLT-2) Inhibitor & Farxiga, Xigduo Synjardy Combinations ENDOCRINE Growth Hormone Humatrope, Norditropin, Nutropin Genotropin AQ, Omnitrope, Saizen, Zomacton Hormones Estrace Vaginal Cream Premarin Vaginal Cream Topical Testosterone Products Androderm, Axlron, Fortesta, Androgel 1.62%, generic Testim testosterones 800.361.4542 1 uvisionrx.com ay; o; sa6ueyo pasodoad uo uol;oaalp pue uolssnosla : 568Z) Ajelnuaao=l peleS u01slAu3 :;uGwt43e;;V Formulary Exclusions (continued) Category Formulary Alternative GASTROINTESTINALTherapeutic Anti-Inflammatory/Anti-Ulcer famotidine PLUS ibuprofen Agents Duexis, Vimovo or omeprazole PLUS naproxen Inflammatory Bowel Agents Asaccl HD, Canasa, Delzicol, Apriso, Lialda Dipentium, Giazo, Pentasa MUSCULOSKELETAL Hyaluronics Gel -One, Orthovisc, Mcnovisc, Euflexxa, Hyalgan (Osteoarthritis Agents) Supartz, Synvisc, Synvisc One HEMATOLOGICAL Aranesp, Epogen, Mircera Procrit Erythropoiesis-Stimulating Agents RESPIRATORY Chronic Obstructive Pulmonary Incruse Ellipta, Seebri Spiriva Disease Nechaler,Tudorza Selective beta-2-Adrenergic Proair, Proventil, Xopenex Ventolin Agonlsts Long -Acting Muscarinic Anoro Eliipta, Utibron Neohaler Sticlto Containing Agents Pulmonary Anti -Inflammatory Pulmicort, QVAR Arnuity Ellipta, Asmarex, Rovent Inhalers HFA, Flovent Diskus Pulmonary Anti -Inflammatory ! Long -Acting Beta Agonist Dulera, Symbicort Advair, Breo Ellipta Inhalers UROLOGICAL Erectile Dysfunction Cialis2, Levitra, Staxyn, Stendra Viagra Urinary Antispasmodic Enablex, Toviaz, Vesicare oxybutynin, tolterodine, trospium WEIGHT LOSS Weight Loss Agents Saxonda, Qsymia Belviq, Contrave 2Managed by prior authorization to assess indication 800.361.4542 I envisbnrx.com ay; o; sa6ueulo pasodoad uo uol;oaaip pue uoissnosia : 568Z) Ajelnuaao=l;oeleS u01slAu3 :;uauayoe;;V Hv IC m Step Therapies Therapeutic Category Primary Tre; ANTINEOPLASTICS Oral Oncology Multiple Sclerosis Aubagio3, Betaseron, Extavia, Avonex, Copaxone, Gilenya, Lemtrada, Rebif, Tysabri, Zinbryta Plegridy, Tecfidera Anticoagulants I Pradaxa, Savaysa I Eliquis, Xarelto Irritable Bowel Syndrome & Opioid Induced Constipation Linzess, Movantik, Relistor Amitiza Agents Actemra4, Cimzia4, Cosentyx, Inflammatory Conditions Kineret4, Orencia4, Otezla, Enbrel, Humira Simponi4, Stelara, Taltz, Xeljanz 3Requires trial and failure of only one primary treatment 4Xeljan7 required to be tried and failed prior to use of other Secondary Treatment options for Rheumatoid Arthritis 800 361 442 1 envisionrx.com 5 RESOLUTION NO. 049 - 2017 A RESOLUTION OF THE BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA APPROVING AND ESTABLISHING THE 2017 WELLNESS PROGRAM; REPEALING PRIOR RESOLUTION NOS. 369-2011 AND 147-2013; AND PROVIDING FOR AN EFFECTIVE DATE. WHEREAS, beginning in 2015, the contract between Blue Cross Blue Shield of Florida ("Florida Blue") and the County, whereby Florida Blue serves as the third party administrator for the County's self -insured health insurance plan ("Plan") has provided that Florida Blue will contribute an annual amount toward the County's wellness -related initiatives and activities, consisting of $100,000 at execution of the agreement, $75,000 on each of January 1, 2016 and January 1, 2017, with additional contributions of $50,000 on each of January 1, 2018 and January 1, 2019 (subject to a rebate of $150,000 if the County terminates the agreement prior to January 1, 2020); and WHEREAS, currently, the balance of funds contributed by Florida Blue toward wellness programs stands at approximately $273,770 ("Wellness Fund"); and WHEREAS, the County has received the results from the personal health assessments completed by the fall 2015 health fair participants, and the results indicate that the top four at -risk areas for participants are diabetes, hypertension, cancer and obesity; and WHEREAS, it is in the best interests of Plan participants and the plan that Monroe County adopt a coordinated program designed to improve and promote the health of its Plan participants through early assessments, intervention, education, information, and incentives, particularly targeted against the top four at -risk areas for health fair participants; and WHEREAS, the County desires to use the Wellness Fund on the activities described below. NOW THEREFORE, BE IT RESOLVED BY THE BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA that: 1. In calendar year 2017, the Monroe County Wellness Program shall consist of the following items, which shall be paid for from the Wellness Funds contributed by Florida Blue pursuant to its contract with Monroe County. All such purchases must be finalized within calendar year 2017. If the Wellness Funds are being used to reimburse the employee or health plan participant, the request for reimbursement must be submitted no later than January 10, 2018. Page 1 of 4 Recurring Events: a. Community Organized Event Reimbursement: All employees covered under the County's health insurance plan are eligible to be reimbursed their registration fees in an amount not to exceed one hundred dollars ($100.00) annually upon presentation of proof that the individual has registered for and has completed community organized foot, bicycle, and swimming races that take place in the Florida Keys, including but not limited to triathlons, run/walkathons, and bikeathons. Said requests for reimbursement shall be handled on a "first come first served" basis, up to a maximum cumulative expenditure of five thousand dollars ($5,000.00). All request for reimbursements must be submitted to the Employee Benefits Department no later than January 10, 2018. b. "Lunch and Learn": The County's Benefits office will schedule education "lunch and learn" activities throughout the Florida Keys. Staff will purchase healthy food items for consumption by covered health plan participants who attend and complete scheduled activities. The maximum cumulative expenditure of Wellness Funds under this resolution shall not exceed thirteen dollars ($13.00) per individual per meeting, up to a maximum cumulative expenditure for all Lunch and Learn events of five thousand dollars ($5,000.00). c. Exercise Classes: Wellness Funds will be used to provide free exercise classes for individuals covered under the County's health insurance plan. The classes will consist of different types of exercise, including but not limited to Yoga, Zumba and Pilates. These classes will be held at various County buildings with outside instructors. Wellness Funds will be used to compensate the instructors and purchase supplies. The maximum cumulative expenditure for Wellness Funds used on all Exercise Classes during CY 2017 shall be twenty thousand dollars ($20,000.00). d. Annual Health & Wellness Fair: Each year, Monroe County Benefits office coordinates the Monroe County Health & Wellness Fair. The fair is presented in three (3) locations (Upper, Middle and Lower Keys/Key West). Any active employees and their covered dependents over age 18, retirees and their covered dependents over age 18 may attend. In 2015, 335 employees attended the Annual Health Fair; an additional 32 employees filled out the on-line preventive health assessment. The Annual Health & Wellness Fair is a wonderful opportunity to obtain basic diagnostic tests at no cost, as well as to obtain a flu vaccine and information about the County's health plan vendors. Wellness Funds will be used to purchase prizes that promote healthy living (i.e., bicycles, Fit Bits, Smoothie Makers) for participants who attend one of the Health & Wellness Fairs and complete their Passport to Wellness. There will also be a cost for the use of the facilities where the Health & Wellness Fairs will be held in the lower, middle and upper keys and Wellness Funds will be used for that purpose. The maximum cumulative expenditure for Wellness Funds used on the Annual Health & Wellness Fair shall be fifteen thousand dollars ($15,000.00). Page 2 of 4 e. Health Designs, Inc./ Wellness Consultant: Wellness Funds will also be used to pay for a consultant with expertise in health benefits, to serve as a Wellness Champion. The consultant shall serve as an extension of Monroe County Benefits staff and shall be an advocate to explain features of the Monroe County Wellness program, provide Wellness topic presentations, and provide health and benefit information to employees of the BOCC and the constitutional officers who are members of the Monroe County health plan. The consultant will be visiting at least 42 locations at which the employees are employed, in Upper, Middle and Lower Keys, on at least a quarterly basis. In calendar year 2017, approximately $20,693 in Wellness Funds will be spent on Health Designs. Purchases of Goods: f. Gym Equipment: The Monroe County Sheriffs Office has proposed that the County pay thirty-five thousand, two hundred sixty-nine dollars and fifty-four cents ($35,269.54) to purchase additional gym equipment for the Plantation Key gym. In return, all employees and retirees of Monroe County Board of County Commissioners ("BOCC"), Monroe County Land Authority, and the constitutional officers (Property Appraiser, Supervisor of Elections, Clerk of Court, Tax Collector, and Sheriff) who are participants in the Monroe County health plan ("Employees and Retirees") will have access to the Sheriffs gyms in all three locations (Key West, Marathon, and Plantation Key). The Sheriff will purchase and have ownership of the equipment. The agreement with the Sheriff will be finalized in a separate agreement. g. Sit -Stand Desktop Workstations: Over 80 BOCC employees have expressed an interest in a Sit -Stand Desktop Workstation. Studies have shown that spending more of your day standing could reduce the risk of obesity, diabetes, cardiovascular disease and cancer. These are top health risks among our plan participants. Wellness Funds shall be used to make a purchase of up to one hundred (100) Workfit-TL sit -stand desktop workstations and up to one hundred (100) active mats. The maximum cumulative expenditure of Wellness Fund to be used on this equipment shall be fifty thousand dollars ($50,000.00). 2. Resolution Nos. 269-2011 and 147-2013 are inconsistent with this resolution and are hereby repealed. 3. This resolution shall take effect upon adoption. Page 3 of 4 PASSED AND ADOPTED by the Board of County Commissioners of Monroe County, Florida, at a regular meeting of said Board held on the 15th day of March, 2017. Mayor George Neugent Yes Mayor Pro Tern David Rice Yes Commissioner Danny Kolhage Yes Commissioner Heather Carruthers Yes Commissioner Sylvia Murphy Yes ,OK, Clerk By: Deputy Clerk BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA By: 4"qwe. Mayor Page 4 of 4 -71 rV .3 MONROE (;C)UNITY ATTORNEY AP RO'J A TO O c C YNTH!A L. HALL ASSiSTANT�UNTY AT (3RNE«Y Date Health Plan Advisory Committee Committee Member Suggestions and Gallagher Responses 1. Complete audit of all insureds — audits average a result of 10% of people who are ineligible and should no longer be carrying coverage. This will only apply to dependents. Audits we have done for other clients show an average of 3% to 5% of dependents on the plan are not eligible. Dependents currently make up approximately 1/3 of plan claims. See Option 19. 2. Stop -loss insurance. This is currently being discussed and we have requested and received proposals in the past. Another RFP in 2017 will be conducted. Prior proposals did not generate any savings. 3. Retirees kick in more since older demographics are typically the ones with the higher expenses a. Right now, retirees are provided a stipend by the State of Florida, which really means there is no out-of-pocket contribution on the retirees' part. We are all adults and for someone to maintain that a "promise" needs to be kept, that person needs to be realistic. In addition, no one has "given" Monroe County 30+ years as during that entire time, they were provided a paycheck — and with it, a larger retirement package the longer the term of employment. Only 20 percent of employers continue to offer a retiree health plan. We are looking at scenarios under which retirees would contribute more. See options 6, 7, 8, 11, 17, 25 and 26. We can model other illustrative rates if there are specific suggestions. 4. Develop tiered premiums: a. Income i. Gross employee only. We have looked at this in the past. Unless there is a large spread of salaries, it is hard to generate any material additional revenue without imposing very large increases on the higher paid employees. 55% of plan enrollees earn less than $50,000 and only 10% earn more than $75,000. If we want to give a break to those in the lower band we have to hit those in the higher band very hard to pay for it. For example, if we wanted to have those in the >$75K band pay more and those in the <$50K band pay less, then for each dollar we reduce the <$50K premium we would need to increase the >$75K premium by $5 dollar just to break even. It is hard to make that work. ii. Gross total household income. This is not practical as there is no way to verify current household income. b. Age (just like they do for life insurance). We have concerns that this may trigger discrimination issues. Also note that basic life insurance is not age rated. c. Scale back or eliminate certain benefits. Again there are laws that limit our ability to exclude coveraizes fbr soiree einpl N ce , but in [lie end # doesn't re.nJIN matter. °or cm niplev inen don't € et mammograms so excluding coverage for them has no impact. i. All in one policy not always effective ii. Single men don't require mammogram coverage 5. Increase out of network costs to: Out of network coinsurance is currently 55% to the member after deductible, with a few exceptions. a. Offset higher costs. b. Drive insureds to use in -network providers According to Florida Blue Placemat, over 92% of services are at network providers, and those claims represent 99% of claims paid. There is very little opportunity to increase network utilization. 6. Pharmacy Benefit Manager. Currently being discussed — some of these ideas would not be handled by the PBM, but should still be considered. We can estimate the impact of these programs. All would require extensive communication. a. Generics required — if not utilized, and then pay higher co -pays (see b.). Currently not in place. Can be added easily. See Option 20. b. Increase co -pays on Preferred and Non -preferred drugs. The County made changes in this direction for 2017 and continues to look at this. See Option 22. Health Plan Advisory Committee Committee Member Suggestions and Gallagher Responses c. Step -therapy (If generic is not effective THEN Preferred or Non -preferred). There is step therapy in place currently for some medications. There are additional drugs that could be added to the list. See Option 21. d. Have the employee pay the difference between generic and brand prices, in addition to the co -pay. This is generally what happens under a mandatory generic program. See item 6a above. e. Mandatory mail-order for maintenance medications. The County has fairly significant utilization under the `Retail 90" tier. This is gradually replacing much of the mail order use on many employer plans. f. No co -pay for select generic medications. This is generally done as part of a disease management program. Any savings will emerge gradually and will depend on the scope of the program. We are working on expanding the disease management program and this is an area we are considering. g. Utilize pharmacies that provide free medications (Publix is one). This can certainly be promoted as a member benefit but will not save the plan much, if anything, because the free drugs are generally priced below the County generic copay today so the employee pays the full cost. h. Require specialty medication to be obtained through a specialty pharmacy. This is in place — except that the I't Rx can be filled at retail then must be Specialty Pharmacy. i. Pharmacy plan designed with a specialty tier with greater cost sharing. The County made changes in this direction for 2017 and continues to look at this. See Option 23. 7. Utilize HSA's or FSA's These help soften the blow of increased deductibles and out-of-pocket expenses. a. HSA — carry over pre-tax deposits. We modeled options that includes anHSA. See Options 12 and 13. b. FSA — use it or lose it. An FSA might save the County on payroll taxes but beyond that has no impact on benefit costs. 8. Decrease the employer subsidy (95%) for current employees, and increase employee contributions to cover the decrease (wash -out). This was one of the options we looked at for 2017 but did not implement. We modeled the 2018 impact — see Options 9 and 24. 9. Employer subsidy remains at 95%, and increase employee contributions to build reserves. We would need to know the amount by which employee contributions would be increased. See Options 9 and 24. 10. Decrease the employer subsidy (801/o) for retirees, and increase retiree contribution to cover the decrease (wash -out). We have modeled several variations of this. See Options 7, 8, 11, 17, 25, and 26. 11. Employer subsidy remains at 80%, and increase retiree contributions to build reserves. See comments for 9 above. 12. Decrease the employer subsidy (601/o) for dependents, and increase dependent contribution to cover the decrease (wash -out). We looked at this for 2017 and it was not implemented. We have modeled options for 2018 — see Options 5, 10 and 32. 13. Employer subsidy remains at 60%, and increase dependent contribution to build reserves See comments on 9 and 11 above. 14. Requirement for an employee's working spouse to pay a premium surcharge for coverage through the employee's (Monroe County) enrollment if the spouse's employer offers health insurance and the spouse has declined it. The County implemented this for 2017. 15. Requirement for an employee's working spouse purchase health insurance through the spouse's employer's plan before also purchasing it through the employee's (Monroe County) enrollment. The action the County took for 2017 essentially does this. 16. Increase "Out -of -Pocket "across the board or tier it based on salary. We are already at the highest out of pocket maximum allowed by the Affordable Care Act. Until the law changes, any increases will be limited by changes in the amount allowed by law. 17. Mandatory "Healtli/Wellness" seminars to inform and update employees on health plans and how to reduce their own expenses, i.e.: utilizing Urgent Care Centers and not ER's. The County contracted for a Wellness Champion on March 15. The sole purpose of this contract is to meet with employees, educate 2 Health Plan Advisory Committee Committee Member Suggestions and Gallagher Responses them on how to save money by effectively using the health plan and taking advantage of the wellness program. 18. Eliminate Group Insurance and the BOCC provides a flat amount for employees/retirees to purchase their own plan. Under the Affordable Care Act, the County would be subject to the "Free Rider" which -,ve estimate would be a tax of $2.8 million if they terminate the Group Health Plan. If the County were to freeze its cost at projected FY 2017 levels, that would leave $13 million to fund subsidies. That works out to $662 a month per active and participating retiree. The County could use a higher stipend for actives than retirees — for example, $750 per month for actives and $400 per month for retirees. However, older employees (and pre -Medicare retirees) would have to pay far more for coverage than younger employees so this would be very difficult to do without affecting some employees far more than others. This would also eliminate the dependent subsidy. 19. Negotiate with local providers for an employee to pay upfront to garner a cheaper fee, and then the employee is reimbursed. Doctor/facility gets payment upfront and not forced to wait on reimbursement. Florida Blue is a very fast payer and has discounts that average over 50%. We don't believe individuals would be able to negotiate rates as favorable as Florida Blue. Also, we would need a process for adjudicating the claims under this agreement since Florida Blue would not be part of it. 20. Ensure/Require that all Medicare eligible are enrolled, as this is NOT a requirement by the US Government. The County addresses this by having Florida Blue adjudicate claims for Medicare eligible retirees as though theN have Medicare. even if they don't. 21. Ensure that eligible Veterans are registered with the VA. In my experience, older Vets do not register because they think they need to have a disability or condition that occurred while a member of the military. As long as they are honorably discharged (any type of discharge, except "Dishonorable"), they can register for health care and pharmacy. Again, we certainly agree with the intent. We are not aware of how we could but a value on this without knowing more about the eligible vets who are not participating in the VA program. 22. Savings can also be generated across the budget if one looks hard enough to offset any increases. BOCC has an "Employee Suggestion Program," but how many people know about it? I have asked five current employees, with no knowledge of the program. Not only that, the Personnel Policy explains it and refers you to Administrative Instruction 4010, which is not readily available? This program should be advertised and supported with implemented ideas displayed on the Intranet, showing cost savings and the employee who submitted the idea -just like the Quarterly "Employee Service Award" winners. 23. I think we touched on this in regards to offering a higher deductible plan for those who healthy and only use their insurance for basic things like physicals, annual exams, flu shots, etc. I was reading about Health Savings plans that could be implemented to go along with the high deductible plan. To keep the coverage level and employee exposure the same, we offer an Integrated HRA to cover the additional out-of-pocket deductible costs. The employer reimburses employees through the HRA for their additional deductible costs. The company achieves savings because on average, employee utilization of the HRA is only 30-50%. It is true that using an HRA instead of an HSA would reduce the County cost since not all of the County could have copays under an HRA program. The downside is that employees cannot contribute their own money to an HRA and there is no hard dollar savings account for employees to own. We could revise the HSA options 12 and 13 using an HRA platform if the Committee would like to see that (see Option 33). We would need guidance on the plan design. 24. I know last year it came up that Retirees dependents with Medicare could go to the marketplace and find a cheaper plan. Can we find a better plan overall for them if Blue Cross is more expensive? Is it worth exploring having the Retirees in their own group plan so to speak? But only if helps them and our helps our deficit. Medicare eligible dependents (and retirees) are not eligible for the Exchange (a.k.a. Marketplace) plans under the ACA. They do have Medicare Advantage options as well as Medicare Supplement options that can be combined with Medicare. The action taken for 2017 makes those options more attractive financially for most dependents of Medicare eligible retirees. Under Florida Statue 112.08, Health Plan Advisory Committee Committee Member Suggestions and Gallagher Responses state and local governments in Florida who offer health insurance to active employees are required to make the same coverage available to retirees. The County can encourage alternative plans but can't cane retirees out of the active plan. 25. The health fee should be a %, not a flat rate, to more equitably "share the pain". I propose 2% with incentives to drop it to 1% if staff meets certain healthy guidelines such as attending the health fair, attending a weight loss group, yoga classes, bike races, dance classes, swimming etc. Voluntary weight/height numbers, blood pressure contests, BMI, etc. Just as one receives a good driver discount, one should receive the health fee reduction for adopting and/or maintaining healthy lifestyle choices. The County does give premium discounts for participating in a wellness program. The current monthly contributions of $25 or $50 represent 3.2% and 6.4% of the projected 2018 cost. Employee premiums are reduced by $25 per month for qualifying employees. This is a bigger wellness credit (3.2%) than we would get by giving a 1% credit. Setting employee contributions at levels as low as 2% of the cost would constitute a reduction for employees and therefore a cost increase for the County. 26. Why are we not addressing obesity? It seems to me it is the single biggest source of health problems. I asked a co-worker how he felt about his health (quite overweight). He replied "I don't have to worry about it. I have insurance, so my doctor will take care of it." This staff member sleeps with an oxygen tank and carries a boatload of medicines. Do we have no personal responsibility for our own well-being? Can we please have some exercise programs with incentives? For example, the current yoga classes offered in Marathon. Attendance should be rewarded for such endeavors. We could make this fun. Instead of bragging how much junk we eat, we will brag about our latest personal health success, whether exercise or weight loss, etc. Caring for one's health would become the norm. On March 15, the Board approved that all exercise programs offered at County buildings will be paid for by the wellness program. 27. This ties in with #26. Nutrition information is scarce. Perhaps we can implement some kind of workshops, more lunch and learns, cooking demos, health cook -offs? We should be emphasizing what all the research shows: that actual whole food is far better than eating overly processed meals at fast food chains and the like. How often do you see a commercial for broccoli or cucumbers? How about melon, or carrots? When did we stop eating vegetables and fruits? Why are we all eating so much salt, sugar, and fat? We are eating ourselves sick. Then we take medications to treat the symptoms and not the cause. How much longer can we as a people expect to live like this? And how on earth are we going to pay for all this self- induced illness? The county continues to promote being healthy and healthy lifestyles. In addition to 4 lunch and learns, an annual employee assistance program workshop, a health and wellness fair, weekly benefit/health living email, monthly distribution of newsletters from Florida Blue, Quantum Health Solutions and Delta Dental, on March 15, 2017, the BOCC approved the addition of a wellness champion who will visit employees throughout the county. The wellness champion will visit quarterly with employees showcasing a three-part presentation: 1) Wellness Topic, 2) Health Plan Education, and 3) Passport to Wellness Promotion. At this same time the BOCC approved an agreement with MCSO so that employees could utilize gyms at no cost. 28. What happened to our wellness committee? We should have all stakeholders at the table working on this all year. This tsunami will get far worse as our aging staff inevitably become ill. County to address. 29. New employee contribution = $75 per month. See Option 27. 30. Current employees that smoke: $100.00 per month See Option 28. 31. Primary care visit - $30.00 copay per visit. See Option 29. 32. Mental/Behavior health outpatient - $30.00 copay per visit. See Option 29. 33. Substance use disorder outpatient - $30.00 copay per visit. See Option 29. 34. Prenatal and postnatal care - $30.00 copay per visit. See Option 29. 35. Independent Clinical Lab (Quest) - $10 copay. See Option 30. 36. Generic drugs - $15.00 copay. See Option 31. 37. New employees' dependent coverage - 50%. See Option 32. 4 Health Plan Advisory Committee Committee Member Suggestions and Gallagher Responses 38. I believe it was said at the last meeting that we would be presented with a tier system for retirees. I would support increasing retiree copays for those with 10-15 years of service. See Option 26. 39. Could we get a list of the monies paid for the high end payouts for claims, cancer treatments etc. We won't get names of course, but I would like to see the breakdowns for the high paid claims, what was paid for in these claims. We have run a report from the Florida Blue System that will be shared with the Committee. 40. Gallagher Placemat First page - Payment and Utilization Indicators. The ups and downs in amounts don't appear to be different than one might expect EXCEPT for outpatient expenses. 40.5 % increase. That's seems really out of what one would expect. What is driving this massive increase? We are trying to hold cost down by utilizing outpatient services. Many of the cancer claims will be provider through outpatient services and that is driving much of the jump. 41. Large Claim Increase - (Slide 12) 2017 Annualized of $4.6 million decrease of $1.7 million from 2016 and also a decrease from 2015. What seems to be driving these decreases? 2017 includes only one quarter of large claims. The large claim start for FY 2017 is not any more favorable than FY 2016. . 42. 'Overview - (slide 2) What is the split by active employees/dependents; by constitutional office? What is the split by retirees/ dependents (currently 422/117) for BOCC & 5 other constitutional offices? Also would like to see this by constitutional office. Did we lose dependents & how many with the changes that went into effect Jan 1, 2017? Did we lose people where spouses with available insurance from another employee were forced off our plan? We did lose a small number of spouses due to the change implemented for 2017. There are 16 fewer spouses covered now than there were previously, and 6 employees elected to leave the spouse on the plan and pay the higher premium. See the table in item 44 below. Further research needed on enrollment splits by constitutional office. 43. Revenue (Slide 9) What is the split between ad valorem and non -ad valorem revenue? Ad Val Fund # Group Insurance $12,420/Emp % by Fund Source of FY 2017 Increase 001 $4,145,497 28% $631,419 101 $5,461,199 37% $831,819 141 $1,197,784 8% $182,440 147 $159,101 1% $24,233 148 0 0% $0 149 $881,820 6% $134,314 TOTAL $11,845,401 80% $1,804,225 Non Ad V 1 $1,816,926 1 12% 1 $276,744 Enterprise 1 $839,965 1 6% 1 $127,939 Internal Funds 1 $348,371 1 2% 1 $53,062 TOTAL 1 $14,850,663 1 1 $2,261,970 Health Plan Advisory Committee Committee Member Suggestions and Gallagher Responses 45. January 1, 2017 rates (slide 10) What was the county by category of participants before change in fees and rules and after implementation? We created an exhibit showing the change in enrollment by tier for actives and retirees. Single Hired prior 5/1/2012 742 725 (17) Single Hired after 5/1/2012 426 448 22 Spouse 112 110 (2) Spouse + 1 Child 43 37 (6) Spouse + 2+ Children 47 33 (14) 1 Child 97 120 23 2 Children 60 80 20 3 Children 14 15 1 4 Children 1 3 2 5+ Children 0 1 1 Spouse with Other Coveraae 0 6 6 Retiree (10+ YOS) 402 413 11 Retiree >65 No Subsidy 1 2 1 Retiree <65 No Subsidy 1 3 2 Spouse >65 56 18 (38) Spouse <65 43 34 (9) 1 Child 0 5 5 2 Children 2 4 2 3 Children 0 2 2 Spouse <65 & 1 Child 3 2 (1) Spouse < 65 + 2 Children 0 1 1 Sury Spouse only >65 14 6 (8) Sury Spouse only <65 3 3 0 46. Historical Fund balance (slide 11) As a self -funded plan, I don't know that there is a guide line on how much fund balance you need. The fund balance has been relatively stable until about 2015-16. That is a big drop. The BOCC apparently doesn't want to make drastic changes as seen in their action at the last budget hearing. The fund balance started to drop steadily beginning with the 2014/15 year. This was expected because health claims will grow over time while revenue remained flat. There is no hard and fast rule of thumb for appropriate fund balance. The state insists on a minimum of 60 days of claims, but for a plan the size of the County and with no stop loss protection, the County should maintain a significant higher fund balance. Gallagher has recommended and the Board has adopted a target of 6 months of claims. 47. Projecting fund balance (slide 13) Projected fund balance should be a 5 year rolling average to prevent large swings in what is required. Claims don't always go up and you don't want to over collect and chase people off the plan. The more employees/dependents covered the better you can absorb changes in fees/claims. We disagree with the notion of a 5-year rolling average. It is not actuarially sound and would not be accepted by the Office of Insurance Regulation. 11 Health Plan Advisory Committee Committee Member Suggestions and Gallagher Responses 48. Board wants a 6-month of claims reserve. This is not a legal mandate to my knowledge. They did not adjust in 2016-17 year with changes effective Jan 2017 so trending that way will probably get them to where they want to be over a period of years. The 6-month target is not a legal mandate — it was recommended by Gallagher and adopted by the Board. If changes are not made to expenses and/or revenue, the plan will not only fall well short of the 6-month target, it will become insolvent in a relatively short period. 49. Prescriptions (slide 14). At one time we had prescriptions by mail - is that still available? What other ways do you suggest people can save on prescriptions? Mail order is still available. Retail 90 is also available and if much more frequently used by County employees than mail order. This allows members to get a 90 day supply of drugs at a retail outlet. This saves the plan more money than the mail order. Utilize Publix, Winn Dixie, Walmart for their free or low copay drugs. They will supply a list of the free drugs to your members. 50. Not implemented Plan Changes - (slide 15) - I don't like any plan that breaks promises to retirees and hurts current employees. One of your aims should be to have the best benefit plan available for your employees. Our objective with your help is to keep an affordable quality health plan for the employees and retirees. We have to find fair and equitable savings to your plan or it will not be sustainable in the future. Losing the plan will hurt everyone. 51. Teladoc (slide 16) - Sounds like a good plan. Are you giving lots of instructions to your employees so it is fully utilized? Have many employees/dependents have signed up for it? Reasonably easy to sign up. Are you assisting the employees to sign up? Employees will be receiving welcome packages from Teladoc. This is an excellent benefit to the members. Signing up is easy and it is easy to use the plan. We don't know yet how many employees have signed up. Education program will be developed by the Wellness Champion. 52. (slide 17) Knowing the differences in costs is a vital ingredient to save money on costs. Education of these differences are the key. What is being done to educate participants? This is an area where we are looking to the committee members to help in suggesting and them supporting member education programs. Florida Blue has programs under which participants can get information about costs of services prior to receiving them. It takes a consistent communication campaign to get employees to use the programs on an ongoing basis. 53. Request for proposals (slide 19) Why can't we request proposals for multiple type plans? Some plans fit younger people better than they fit older people. Maybe a catastrophic coverage for retiree dependents as their secondary coverage? We are looking at offering additional plans in the future. See Options 12, 13, and 14. One of the strategies is to offer a lower cost HSA plan that might be attractive to pre -Medicare retirees. 54. Comparison (slide 20) - Do you only want to control costs OR do you want to attract the best employees and KEEP THEM in the county? There is a tremendous cost for attracting and training good employees in all constitutional offices and running them off because of costs only raises your cost for getting good employees. What is your overall mission? Our objective is to manage the Coulm 's expense with as little impact on County recruiting and retention. This is a difficult objective. That is why we have established this committee. We need your input to help define our strategies. We agree it is important to offer a quality healthcare program to attract good employees, but plan design and contributions are indispensable tools in managing cost. 55. If you make drastic changes, do it going forward - ex. Retirees after 1/l/2018 will not be able to purchase dependent coverage upon retirement. Don't go back and harm employees who made plans based on a promise that was made to them. This will decrease your ability to attract the best employees but at least employees will know what they can plan on. The County has already eliminated retiree subsidies for all new hires. By law, it must still allow retirees the option of participating and sets a limit on how much they can be charged. 7 Health Plan Advisory Committee Committee Member Suggestions and Gallagher Responses 56. Shortfall - (slide 21) - Again you are having a rock solid shortfall. Your claims go up and down and without using a rolling average you are sticking it to your employees and the payees of the claims whether they are ad valorem or non -ad valorem. Since it is a self -funded plan, some of the shortfall can be billed to departments like you bill the monthly fee amounts. There is nothing that states you cannot you can't bill individual funds for at least part of this shortfall. Claims in general do not go down. The only time the County saw a drop in claims was when they moved to Florida Blue and got the benefit of much better discounts than they were previously receiving. Since that reduction, we have seen a steady increase in claims. We do not believe there is any reason to expect claims to ever go down. Some years will see smaller increases and we may occasionally see a small drop but in the long run claims will continue to go Up. 57. Options (slide 22) All of these ideas are ways to shortchange your employees. Hitting their dependents is much like a sucker punch to the employee. It is reasonable to expect employees to share in some portion of health plan cost increases. 58. Employees with 15 - 20 years of service to be entitled for retirement benefits - beginning with new hires. This will increase County costs. 59. Doing away with dependent benefits would be a tremendous burden on the employee, or the retiree (single parent home, etc.). Yes it would and that is likely the main reason that staff and Committee members have looked at phasing this in for new hires only. 60. Benefits offered at the time of hire should not be changed. Retirees factored in their medical benefits when they retired. To change them now should not occur - retirees do not have many options. Changing benefits or contribution requirements over time is a very standard approach used by employers to control benefit expense. Certainly the County needs to consider the impact on employees and retirees, but some level of change is reasonable. Medicare eligible retirees do have other options that are affordable. 61. The proposed increase deductible from 400/800 to 600/1200 is quite high - it is going to put many in a difficult position - especially the retirees where their incomes are less than half of what it was during their employment with the County. Any change will cause some level of hardship, but based on a review of other government employers in the area, a $600 deductible is still very competitive. 62. The county employees and retirees have accepted increased deductibles and do understand the need to save money, but it is time for the BOCC to understand that continuous major changes that are going to put a financial burden on people, those that were promised the benefits that were on the books at a time of their hire is going to greatly impact their lives (especially the retirees). The County has never promised that current benefit levels will remain in place forever. The County faces the same issue that all local governments are dealing with As healthcare costs increase at rates well above average inflation rates, how do you share the cost between plan participants and taxpayers? 63. Increase taxes to cover the shortfall. Items 62 to 65 are beyond the scope of what the Committee was asked to do. They are considerations for County Commissioners to debate and will be forwarded to the Commission. 64. Sell some of the properties the county purchased that are just sitting there - not being utilized or developed for county benefit - those monies could be allocated toward the 3.3 mil shortfall See note to item 62. 65. Start charging or increase fees for the use of county properties (i.e. Nelson Government Center; Rowells Marina, etc). See note to item 62. 66. Postpone spending money on projects, such as Bernstein Park, Staten Island, etc. - those projects should not take precedence over employees and retirees - if the county is financially strapped. Revenue used for capital projects is restricted in use and cannot be used for employee benefits. 67. Do not purchase any new properties until the budget is balanced. Revenue used for capital projects is restricted in use and cannot be used for employee benefits. 68. And this one is not going to be popular but: do not hire employees (for certain positions) at exorbitant salaries. Example: some are on their second, and at times on their third, retirement, but want to continue to work. Hiring them at 85K - 100K and over (in many cases) is a tremendous waste of money. Such offered salaries, to such applicants, need to be evaluated, See note to item 62. E3 Health Plan Advisory Committee Committee Member Suggestions and Gallagher Responses 69. Compare our benefits with counties that are similar to ours in population and county staff. Comparing us to Miami -Dade, or any such relatively large county, would not be very beneficial. See revised large employer comparison. 70. Change the plan for new hires - Employees with 15-20 years (I'm on the fence about the number of years) of service to be entitled for retirement benefits. Any reinstatement of a subsidy for new hires when they reach retirement would increase the County cost significantly over time. See Option 26. E] SENIOR MANAGEMENT - Benefit and Contribution Changes Recommended for FY 2018 IFY 2018 Projected Savings- Decrease Expense by: $3.3 Million Yes or No Votes IFY 2019 Projected Savings IFY 2020 Projected Savings IFY 2018 Running TOTAL .......... This is applicable to: . For Retirees: Option 4 or 4A or 11 or 17 or 25 or 26 or no to all five . For Dependents of Retirees: Option 6 or 6A or no to both . For Pre-65 Retirees: Option 7 or 8 or no to both . For Dependent Subsidy: Option l5 or 10 or no to both . For Active Employee: Option 9 or 24 or no to both . For future hire dependent subsidy: Option 16 or 32 or no to both . For Dual Option plans: Option 12 or 13 or 14 or 33 or no to all four . For Pharmacy Changes: Option 21 or 34 or no to both $3,334,116 Benefit Changes 1. Increase Deductible from $400/$800 to $600/$1200 $282,831 NO=15 YES=3 $376,165 $381,808 $3,334,116 2. Increase Specialist copay from $25 to $50 $84,849 NO=9 YES=9 $112,849 $113,978 $3,334,116 2A. Increase Urgent Care copay from $25 to $50 $9,428 NO=10 YES=8 $12,539 $12,664 $3,334,116 3. Add $100 pharmacy deductible per individual $162,366 NO=13 YES 5 $215,947 $218,106 $3,334,116 22. Increase brand drug copays to $60/$100 (30 day) and $150/$250 (90 day) $69,861 NO=13 YES 5 $92,915 $92,915 $3,334,116 23. Increase specialty drug copay to 25% to maximum of $300 $16,438 NO=14 YES=4 $22,955 $24,562 $3,334,116 29. Change PCP, Behavioral Health and Pre/Post Natal Care Copayto$30 $23,287 NO=10 YES=8 $31,281 $31,594 $3,334,116 30. Add $10 copay for Independent Clinical Lab (Quest) $8,537 Y YES--10 N4--8 $11,355 $11,355 $3,325,579 31. Increase Generic Drug Copayto $15 $86,299 Y YES=11 NO=7 $117,073 $119,414 $3,239,280_ Contribution Changes 6. No Subsidy for Dependents of Any Retirees $459,378 Y YES=15 NO=3 $641,521 $686,428 $2,779,902 6A. 40% Subsidy for Dependents of Retirees (Excluding Medicare Eligible Spouses) $134,325 $187,585 $200,716 $2,779,902 18. Spouses of Retirees Pay 100% of Actuarial Rate if Spouse has Access to Coverage Through His/Her Own Employer. $13,662 Y YES=11 NO=7 $18,216 $18,216 $2,766,240 27. New hires pay $75 for EE Coverage $19,778 NO=11 YES=7 $69,551 $111,858 $2,766,240 28. Add $100 per month smoker surcharge $167,175 Y YES=12 NO=6 $219,418 $215,937 $2,599,065 5. Reset Dependent Contributions to 50% of Actuarial Rate at Current Higher Costs (currently 40%) $373,230 Y YES=9 NO=9 $521,216 $557,701 $2,225,835 10. Reset Dependent Contributions to 60% of Actuarial Rates (currently 40%) $599,868 NO=16 YES=2 $837,716 $896,356 $2,225,835 7. No subsidy, for Pre-65 Retirees $1,311,728 NO=15 YES $1,831,827 $1,960,055 $2,225,835 7A. Scaled Subsidy for Retirees $772,119 Y YES=10 NO=8 $1,123,572 $1,221,540 $1,453,716 8, Pre 65 Retirees Pay 50% of Actuarial Rate $621,033 NO=15 YES $867,272 $927,981 $1,453,716 9, Active Employees Pay $50175 for Employee Coverage $263,025 NO=12 YES $349,823 $349,823 $1,453,716 24, Increase active EE contributions from $251$50 to $651$95 (10% of actuarial value) $442,440 NO=15 YES $617,867 $661,118 $1,453,716 4. Charge Full Annual Amount of Health Insurance to Medicare Eligible Retirees ($697) 4A. Provide a Flat $250 Subsidy to Medicare Eligible....Retirees ($697 - $250 = $447) 11. Set Premium for Retiree Only Coverage to a Flat $200 for Rule of 70 Retirees 17. Increase Retiree Contributions to a flat $150 for Rule of 70 Retirees $1,312,500 $841,521 $272,025 $204,750 NO=10 YES NO=1 4 YES=4 NO=16 YES $1,750,000 $1,178,130 $361,793 $273,000 $1,750,000 $1,237,036 $361,793 $273,000 $1,453,716 $1,453,716 $1,453,716 $1,453,716 2& Increase Retiree Contributions to 20% of Actuarial Value for Rule of 70 Retirees ($207 G65, V 39 65-) 2& Change Retiree Contributions to $150 for 10 - 20 YOS and $50 for 20+ Y38 for Rule of 70 Retirees 16, Discontinue Dependent Subsidy for employees hied after 1011/17 $124,963 $48,870 $139,209 NO=17 YES NO=17 YES NO=15 YES $174,510 $64,997 $590,866 $1813,7213 $64,997 $997,202 $1,453,716_ $1,453,716 $1,453,716 32, Reduce Dependent Subsidy for Future Hires to 50% $36,706 NO=10 YES $155,795 $262,934 $1,453,716 12, Dual Option HSA $729,734 NO=12 YES=5 JD=1 $1,019,073 $1,090,408 $1,453,716 13, Dual Option HSA with retirees getting high deductible plan at no cost $732,955 NO=13 YES=4 JD=1 $1,023,572 $1,095,222 $1,453,716 14, Dual Option like MCSB $573,964 NO=16 YES=1 JD=1 $801,541 $857,649 $1,453,716 33a Dual Option With HRA (Assume same plan design as HSA option 12) $760,335 NO=17 JD=1 $1,061,808 $1,136,135 $1,453,716 Plan Management/Administration Changes 15. Change Medicare Retiree Drug Coverage from RIDS to EGWP $250,000 Y YES=12 NO=6 $250,000 $250,000 $1,203,716 19. Conduct Dependent Eligibility Audit (estimated 4% of Dependent claims) $195,848 Y YES=15 NO=3 $273,501 $292,646 $1,007,868 20. Mandatory Generic Pharmacy Benefit $24,709 Y YES=10 NO=8 $34,506 $36,921 $983,159 21. Expanded Mandatory Step Therapy $16,473 Y YES =5 NO=13 $23,004 $24,614 $966,686 34. Adopt Envision Select Formulary $164,360 Y YES=10 NO=8 $229,529 $245,596 $802,326 35. Mandatory 90-day Scripts for Maintenance with Narrower 90-day Retail Network $142,920 Y YES--12 NO=6 $199,587 $213,559 $659,406 SENIOR MANAGEMENT - Benefit and Contribution Changes Recommended for FY 2018 IFY 2018 Projected Savings- Decrease Expense by: $3.3 Million Yes or No Votes IFY 2019 Projected Savings IFY 2020 Projected Savings IFY 2018 Running TOTAL .......... This is applicable to: . For Retirees: Option 4 or 4A or 11 or 17 or 25 or 26 or no to all five . For Dependents of Retirees: Option 6 or 6A or no to both . For Pre-65 Retirees: Option 7 or 8 or no to both . For Dependent Subsidy: Option l5 or 10 or no to both . For Active Employee: Option 9 or 24 or no to both . For future hire dependent subsidy: Option 16 or 32 or no to both . For Dual Option plans: Option 12 or 13 or 14 or 33 or no to all four . For Pharmacy Changes: Option 21 or 34 or no to both $3,334,116 Benefit Changes 1. Increase Deductible from $400/$800 to $600/$1200 $282,831 NO=15 YES=3 $376,165 $381,808 $3,334,116 2. Increase Specialist copay from $25 to $50 $84,849 Y NO=9 YES=9 $112,849 $113,978 $3,249,267 2A. Increase Urgent Care copay from $25 to $50 $9,428 Y NO=10 YES=8 $12,539 $12,664 $3,239,839 3. Add $100 pharmacy deductible per individual $162,366 NO=13 YES 5 $215,947 $218,106 $3,239,839 22. Increase brand drug copays to $60/$100 (30 day) and $150/$250 (90 day) $69,861 NO=13 YES 5 $92,915 $92,915 $3,239,839 23. Increase specialty drug copay to 25% to maximum of $300 $16,438 NO=14 YES=4 $22,955 $24,562 $3,239,839 29. Change PCP, Behavioral Health and Pre/Post Natal Care Copayto$30 $23,287 Y NO=10 YES=8 $31,281 $31,594 $3,216,552 30. Add $10 copay for Independent Clinical Lab (Quest) $8,537 Y YES--10 N4--8 $11,355 $11,355 $3,208,015 31. Increase Generic Drug Copayto $15 $86,299 Y YES=11 NO=7 $117,073 $119,414 $3,121,716_ Contribution Changes 6. No Subsidy for Dependents of Any Retirees $459,378 Y YES=15 NO=3 $641,521 $686,428 $2,662,338 6A. 40% Subsidy for Dependents of Retirees (Excluding Medicare Eligible Spouses) $134,325 $187,585 $200,716 $2,662,338 18. Spouses of Retirees Pay 100% of Actuarial Rate if Spouse has Access to Coverage Through His/Her Own Employer. $13,662 Y YES=11 NO=7 $18,216 $18,216 $2,648,676 27. New hires pay $75 for EE Coverage $19,778 NO=11 YES=7 $69,551 $111,858 $2,648,676 28. Add $100 per month smoker surcharge $167,175 Y YES=12 NO=6 $219,418 $215,937 $2,481,501 5. Reset Dependent Contributions to 50% of Actuarial Rate at Current Higher Costs (currently 40%) $373,230 Y YES=9 NO=9 $521,216 $557,701 $2,108,271 10. Reset Dependent Contributions to 60% of Actuarial Rates (currently 40%) $599,868 NO=16 YES=2 $837,716 $896,356 $2,108,271 7. No subsidy, for Pre-65 Retirees $1,311,728 NO=15 YES $1,831,827 $1,960,055 $2,108,271 7A. Scaled Subsidy for Retirees $772,119 Y YES=10 NO=8 $1,123,572 $1,221,540 $1,336,152 8, Pre 65 Retirees Pay 50% of Actuarial Rate $621,033 NO=15 YES $867,272 $927,981 $1,336,152 9, Active Employees Pay $50175 for Employee Coverage $263,025 NO=12 YES $349,823 $349,823 $1,336,152 24, Increase active EE contributions from $251$50 to $651$95 (10% of actuarial value) $442,440 NO=15 YES=3 $617,867 $661,118 $1,336,152 4. Charge Full Annual Amount of Health Insurance to Medicare Eligible Retirees ($697) 4A. Provide a Flat $250 Subsidy to Medicare Eligible....Retirees ($697 - $250 = $447) 11. Set Premium for Retiree Only Coverage to a Flat $200 for Rule of 70 Retirees 17. Increase Retiree Contributions to a flat $150 for Rule of 70 Retirees $1,312,500 $841,521 $272,025 $204,750 Y NO=10 YES=8 NO=14 YES=4 NO=16 YES $1,750,000 $1,178,130 $361,793 $273,000 $1,750,000 $1,237,036 $361,793 $273,000 $23,652 $23,652 $23,652 $23,652 25� Increase Retiree Contributions to 20% of Actuarial Value for Rule of 70 Retirees ($207 G65, V 39 65-) $124,963 NO=17 YES $174,510 $1813,7213 $23,652 26� Change Retiree Contributions to $150 for 10 - 20 YOS and $50 for 20+ Y38 for Rule of 70 Retirees 16, Discontinue Dependent Subsidy for employees hired after 1011/17 $48,870 $139,209 NO=17 YES NO=15 YES $64,997 $590,866 $64,997 $997,202 $23,652 $23,652 32, Reduce Dependent Subsidy for Future Hires to 50% $36,706 Y NO=10 YES $155,795 $262,934 12, Dual Option HSA $729,734 NO=12 YES=5 JD=1 $1,019,073 $1,090,408 13, Dual Option HSA with retirees getting high deductible plan at no cost $732,955 NO=13 YES=4 JD=1 $1,023,572 $1,095,222 14, Dual Option like MCSB $573,964 NO=16 YES=1 JD=1 $801,541 $857,649 33a Dual Option With H RA (Assume same plan design as HSA opti on 12) $760,335 NO=17 JD=1 $1,061,808 $1,136,135 Plan Management/Administration Changes 15. Change Medicare Retiree Drug Coverage from RIDS to EGWP $250,000 Y YES=12 NO=6 $250,000 $250,000 19. Conduct Dependent Eligibility Audit (estimated 4% of Dependent claims) $195,848 Y YES=15 NO=3 $273,501 $292,646 20. Mandatory Generic Pharmacy Benefit $24,709 Y YES=10 NO=8 $34,506 $36,921 21. Expanded Mandatory Step Therapy $16,473 Y YES =5 NO=13 $23,004 $24,614 34. Adopt Envision Select Formulary $164,360 Y YES=10 NO=8 $229,529 $245,596 35. Mandatory 90-day Scripts for Maintenance with Narrower 90-day Retail Network $142,920 Y YES=12 NO=6 $199,587 $213,559 t r - FSA Sec. 112.0801, Group insurance; participation by retired employees Page 1 *27477 West's F.S.A. § 112.0801 WEST'S FLORIDA STATUTES ANNOTATED TITLE X. PUBLIC OFFICERS, EMPLOYEES, AND RECORDS (CHAPTERS 110-123) CHAPTER 112. PUBLIC OFFICERS AND EMPLOYEES: GENERAL PROVISIONS PART I. CONDITIONS OF EMPLOYMENT; RETIREMENT; TRAVEL EXPENSES Current with chapters in effect from the 2013 1st Reg. Sess. of the 23rd Legislature through April 2, 2013 112.0801. Group insurance; participation by retired employees (1) Any state agency, county, municipality, special district, community college, or district school board that provides life, health, accident, hospitalization, or annuity insurance, or all of any kinds of such insurance, for its officers and employees and their dependents upon a group insurance plan or self-insurance plan shall allow all former personnel who retired before October 1, 1987, as well as those who retire on or after such date, and their eligible dependents, the option of continuing to participate in the group insurance plan or self-insurance plan. Retirees and their eligible dependents shall be offered the same health and hospitalization insurance coverage as is offered to active employees at a premium cost of no more than the premium cost applicable to active employees. For retired employees and their eligible dependents, the cost of continued participation may be paid by the employer or by the retired employees. To determine health and hospitalization plan costs, the employer shall commingle the claims experience of the retiree group with the claims experience of the active employees; and, for other types of coverage, the employer may commingle the claims experience of the retiree group with the claims experience of active employees. Retirees covered under Medicare may be experience -rated separately from the retirees not covered by Medicare and from active employees if the total premium does not exceed that of the active group and coverage is basically the same as for the active group. *27478 (2) For purposes of this section, "retiree" means any officer or employee who retires under a state retirement system or a state optional annuity or retirement program or is placed on disability retirement and who begins receiving retirement benefits immediately after retirement from employment. In addition to these requirements, any officer or employee who retires under the Florida Retirement System Investment Plan established under part II of chapter 121 is considered a "retired officer or employee" or "retiree" as used in this section if he or she: (a) Meets the age and service requirements to qualify for normal retirement as set forth in s. 121.021(29); or (b) Has attained the age specified by s. 72(t)(2)(A)(i) of the Internal Revenue Code [FN1] and has the years of service required for vesting as set forth in s. 121.021(45). CREDIT(S) Laws 1976, c. 76-151, § 2; Laws 1979, c. 79-88, § 1; Laws 1980, c. 80-304, § 1; Laws 1981, c. 81-103, § 5; Laws 1983, c. 83-294, § 1; Laws 1987, c. 87-373, § 1. Amended by Laws 2007, c. 2007-92, § 1, off. July 1, 2007; Laws 2007, c. 2007-100, § 1, off. July 1, 2007; Laws 2011, c. 2011-68, § 2, eff. July 1, 2011. [FN1] 26 U.S.C.A. § 72(t)(2)(A)(i). HISTORICAL NOTES HISTORICAL AND STATUTORY NOTES Amendment Notes: Laws 1979, c. 79-88, § 1, provided for insurance to employees of community colleges. © 2013 Thomson Reuters. No claim to original U.S. Govt. works. ri FSA Sec. 112.0801, Group insurance; participation by retired employees Page 2 Laws 1980, c. 80-304, § 1 substituted "paid" for "entirely paid for" preceding "by the retired employee" at the end of the first sentence, and added the second and third sentences. Laws 1981, c. 81-103, provided for self insurance and dependent coverage in the first sentence and provided for payment of the coverage and interpolated the second to fourth sentences. Laws 1983, c. 83-294, § 1, substituted "shall" for "is authorized to" preceding "allow retired former personnel" in the first sentence. Section 17 of Laws 1984, c. 84-266, provides: "Notwithstanding any previous rejection or cancellation of participation in any group insurance plan or self- insurance plan provided under s. 110.123 or s. 112.0801, Florida Statutes, participation in such insurance plan shall be offered to all former employees who retired prior to the effective date of this act [July 1, 1984], as well as those employees who retire on or after such date, and the eligible dependents of such employees and former employees. Accordingly, all employers who provide insurance coverage under s. 110.123 or s. 112.0801, Florida Statutes, shall, not later than January 1, 1985, notify all previously retired former personnel or their eligible dependents in writing of their eligibility to participate in the same group insurance plan or self-insurance plan, as provided in s. 110.123 or s. 112.0801. Such previously retired personnel or their eligible dependents shall have until April 1, 1985, to, in writing, accept or reject participation in their former employer's group insurance plan or self-insurance plan." 0 2013 Thomson Reuters. No claim to original U.S. Govt. works. FSA Sec. 112.043, Age discrimination Page 1 *27323 West's F.S.A. § 112.043 WEST'S FLORIDA STATUTES ANNOTATED TITLE X. PUBLIC OFFICERS, EMPLOYEES, AND RECORDS (CHAPTERS 110-123) CHAPTER 112. PUBLIC OFFICERS AND EMPLOYEES: GENERAL PROVISIONS PART I. CONDITIONS OF EMPLOYMENT; RETIREMENT; TRAVEL EXPENSES Current with chapters in effect from the 2013 I st Reg. Sess. of the 23rd Legislature through April 2, 2013 112.043. Age discrimination It shall be the public policy of the state that no officer or board, whether state or county, shall discriminate in the employment of any person solely on the basis of age. Persons who apply for employment with the state or any county of the state shall be selected on the basis of training, experience, mental and physical abilities, and other selection criteria established for the position. Unless age restrictions have been specifically established through published specifications for a position, available to the public, the employing authority shall give equal consideration to all applicants, regardless of age. CREDIT(S) Laws 1969, c. 69-141, § 1. REFERENCES LIBRARY REFERENCES Civil Rights (9= 1207. Westlaw Topic No. 78. REFERENCES RESEARCH REFERENCES ALR Library 51 ALR 5th 1, Application of State Law to Age Discrimination in Employment. Encyclopedias Unlawful Employment Practices; Remedies --Age Discrimination, FL Jur. 2d Civil Rights § 34. Qualification Requirements; Disqualifications, FL Jur. 2d Counties & Municipal Corporations § 130. Age, FL Jur. 2d Cvl. Servts. & Pub. Officers & Employees § 115. Treatises and Practice Aids Emp. Discrim. Coord. Analysis of State Law § 13:2, Survey of Statutory Prohibited Bases. Emp. Discrim. Coord. Analysis of State Law § 13:51, Hiring Practices. Emp. Discrim. Coord. Analysis of State Law § 13:56, Discrimination Prohibitions Applicable to All Terms and Conditions of Employment. *27324 UNITED STATES SUPREME COURT Age discrimination, enforceability of collective bargaining agreement requiring members to arbitrate, see 14 Penn Plaza LLC v. Pyett, 2009, 129 S.Ct. 1456, 173 L.Ed.2d 398. Age discrimination in employment, mixed motives jury instruction, see Gross v. FBL Financial Services, Inc., 2009, 129 S.Ct. 2343, 174 L.Ed.2d 119. ANNOTATIONS NOTES OF DECISIONS Police officers 2 Validity 1 1. Validity Age discrimination statute, .(this section), which permits age discrimination in employment to positions within state government where age restrictions have been established through published specifications, was constitutional as applied to petitioner, whose application for reemployment by highway patrol was denied under rule requiring highway patrol applicants to be less than 35 years old, on ground 0 2013 Thomson Reuters. No claim to original U.S. Govt. works. FSA Sec. 112.043, Age discrimination Page 2 that he was seven months over 35-year-age limit. Ridaught v. Division of Florida Highway Patrol, 314 So.2d 140 (1975). States G=53 2. Police officers The maximum age limit for hiring police officers cannot be established solely on the basis of age but on factors of training, experience, mental and physical abilities, pursuant to this section; and, the minimum age for hiring police officer is 21, pursuant to § 943.13. Op.Atty.Gen., 071-181, July 1, 1971. © 2013 Thomson Reuters. No claim to original U.S. Govt. works. FSA Sec. 112.044, Public employers, employment agencies, labor organizations; discrimination based Page 1 on age prohibited; exceptions; remedy *27325 West's F.S.A. § 112.044 WEST'S FLORIDA STATUTES ANNOTATED TITLE X. PUBLIC OFFICERS, EMPLOYEES, AND RECORDS (CHAPTERS 110-123) CHAPTER 112. PUBLIC OFFICERS AND EMPLOYEES: GENERAL PROVISIONS PART I. CONDITIONS OF EMPLOYMENT; RETIREMENT; TRAVEL EXPENSES Current with chapters in effect from the 2013 1st Reg. Sess. of the 23rd Legislature through April 2, 2013 112.044. Public employers, employment agencies, labor organizations; discrimination based on age prohibited; exceptions; remedy (1) Legislative intent; purpose. --The Legislature finds and declares that in the face of rising productivity and affluence, older workers find themselves disadvantaged, both in their efforts to retain employment and in their efforts to regain employment when displaced from jobs. The setting of arbitrary age limits, irrespective of capability for job performance, has become a common practice, and certain otherwise desirable practices may work to the disadvantage of older persons. In comparison to the incidence of unemployment among younger workers, the incidence of unemployment, especially long-term unemployment with resultant deterioration of skill, morale, and employer acceptability, is high among older workers, whose numbers are great and growing and whose employment problems are grave. In industries affecting commerce, the existence of arbitrary discrimination in employment because of age burdens commerce and the free flow of goods. It is the purpose of this act to promote employment of older persons based on ability rather than age and to prohibit arbitrary age discrimination in employment. *27326 (2) Definitions. --For the purpose of this act: (a) "Employer" means the state or any county, municipality, or special district or any subdivision or agency thereof. This definition shall not apply to any law enforcement agency or firefighting agency in this state. (b) "Employment agency" means any person, including any agent thereof, regularly undertaking, with or without compensation, to procure employees for an employer, including state and local employment services receiving federal assistance. (c) "Employee" means an individual employed by any employer. (3) Prohibited activities; exceptions. -- (a) Except as provided in paragraph (f), it is unlawful for an employer to: 1. Fail or refuse to hire, discharge or mandatorily retire, or otherwise discriminate against any individual with respect to the compensation, terms, conditions, or privileges of employment because of age. 2. Limit, segregate, or classify employees in any way which would deprive, or tend to deprive, any individual of employment opportunities, or otherwise adversely affect an individual's status as an employee, because of age. 3. Reduce the wage rate of any employee or otherwise alter the terms or conditions of employment in order to comply with this act, unless such a reduction is with the employee's express or implied consent. (b) Except as provided in paragraph (f), it is unlawful for an employment agency to fail or 0 2013 Thomson Reuters. No claim to original U.S. Govt. works. FSA Sec. 112.044, Public employers, employment agencies, labor organizations; discrimination based Page 2 on age prohibited; exceptions; remedy refuse to refer for employment, or otherwise to discriminate against, any individual because of age or to classify or refer for employment any individual on the basis of age. (c) Except as provided in paragraph (f), it is unlawful for a labor organization to: 1. Exclude or expel from its membership, or otherwise discriminate against, any individual because of age. 2. Limit, segregate, or classify its membership, or fail or refuse to refer for employment any individual, in any way which would limit, deprive, or tend to deprive the individual of employment opportunities or which would otherwise adversely affect the individual's status as an employee or as an applicant for employment solely because of age. 3. Cause or attempt to cause an employer to discriminate against an individual in violation of this section. *27327 (d) It is unlawful: 1. For an employer to discriminate against any employee or applicant for employment; 2. For an employment agency to discriminate against any individual; or 3. For a labor organization to discriminate against any member or applicant for membership, because such employee, applicant for employment, individual, member, or applicant for membership has opposed any practice made unlawful by this section or because the employee, applicant for employment, individual, member, or applicant for membership has made a charge, testified, assisted, or participated in any manner in an investigation, a proceeding, or litigation under this act. (e) Except as provided in paragraph (f), it is unlawful for an employer, labor organization, or employment agency to print or publish, or cause to be printed or published, any notice or advertisement relating to: 1. Employment by such employer; 2. Membership in such labor organization or any classification or referral for employment by such labor organization; or 3. Any classification or referral for employment by such employment agency, which notice or advertisement indicates any preference, limitation, specification, or discrimination based on age. (f) It is not unlawful for an employer, employment agency, or labor organization to: 1. Take any action otherwise prohibited under paragraph (a), paragraph (b), paragraph (c), or paragraph (e), based on a bona fide occupational qualification reasonably necessary to the normal operation of the particular business. 2. Observe the terms of a bona fide seniority system or any bona fide employee benefit plan, such as a retirement, pension, or insurance plan, which is not a subterfuge to evade the purposes of this act. 3. Discharge or otherwise discipline an individual for good cause. (4) Appeal; civil suit authorized. --Any employee of the state who is within the Career Service System established by chapter 110 and who is aggrieved by a violation of this act may appeal to the Public Employees Relations Commission under the conditions and following the procedures prescribed in part H of chapter 447. Any person other than an employee who is within the Career Service System established by chapter 110, or any person employed by the Public Employees Relations Commission, who is aggrieved by a violation of this act may bring a civil action in any court of competent jurisdiction for such legal or equitable relief as will effectuate 0 2013 Thomson Reuters. No claim to original U.S. Govt. works. e FSA Sec. 112.044, Public employers, employment agencies, labor organizations; discrimination based Page 3 on age prohibited; exceptions; remedy the purposes of this act. *27328 (5) Notice to be posted. --Each employer, employment agency, and labor organization shall post and keep posted in conspicuous places upon its premises notices required by the United States Department of Labor and the Equal Employment Opportunity Commission. CREDIT(S) Laws 1976, c. 76-208, §§ 6 to 8, 10, 11; Laws 1977, c. 77-174, § 1; Laws 1979, c. 79-7, § 7; Laws 1979, c. 79-190, § 31; Laws 1981, c. 81-169, § 4; Laws 1986, c. 86-163, § 75. Amended by Laws 1995, c. 95-147, § 679, eff. July 10, 1995; Laws 2011, c. 2011-213, § 5, eff. July 1, 2011. HISTORICAL NOTES HISTORICAL AND STATUTORY NOTES Amendment Notes: Laws 1977, c. 77-174, a reviser's bill, amended this section to reflect language editorially inserted or substituted in the interest of clarity by the division of statutory revision and indexing. Laws 1979, c. 79-7, a reviser's bill, modified this section to conform language with Laws 1978, c. 78-201, which created the department of labor and employment security and which incorporated implied amendments resulting from the creation of the board of review by Laws 1977, c. 77-399. Laws 1979, c. 79-190, created the executive office of the governor and amended statutes so as to transfer powers, duties and functions in conformance therewith. Laws 1981, c. 81-169, a reviser's bill, conformed language of the statutes to the reorganization of state planning and budgetary functions among the executive office of the governor, the department of administration and the department of veteran and community affairs resulting from Laws 1979, c. 79-190. See Reviser's Note--1981. Laws 1986, c. 86-163, § 75, eff. July 1, 1986, amending subsec. (4) substituted "public employees relations" for "career service" preceding "commission", substituted "part two of chapter 447" for "chapter 110" in the second sentence, and inserted in the third sentence "or any person employed by the public relations commission". Laws 1995, c. 95-147, a reviser's bill, eliminated gender - specific references without making substantive changes in legal effect. REFERENCES LAW REVIEW AND JOURNAL COMMENTARIES Compensatory and punitive damages in age discrimination in employment. 32 U.Fla.L.Rev. 701 (1980). Florida age discrimination in Employment Act --a cautions first step. Wayne J. Birschbach, 51 F1a.B.J. 445 (1977). Gender -based discrimination and equal protection. 29 U.F1a.L.Rev. 582 (1977). 0 2013 Thomson Reuters. No claim to original U.S. Govt. works. - _:Z z: v