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Item B1M C ounty of f Monroe ELj » °o � BOARD OF COUNTY COMMISSIONERS /� r i � �� Mayor George Neugent, District 2 The Florida. Ke Se y I Mayor Pro Tern David Rice, District 4 Danny L. Kolhage, District I Heather Carruthers, District 3 Sylvia J. Murphy, District 5 County Commission Meeting June 20, 2017 Agenda Item Number: B.1 Agenda Item Summary #3048 BULK ITEM: No DEPARTMENT: Employee Services TIME APPROXIMATE: STAFF CONTACT: Maria Fernandez - Gonzalez (305) 292 -4448 1:30 p.m. AGENDA ITEM WORDING: Discussion and direction on recommended changes, from the May 10th meeting, to the County's Group Health & Prescription Plan for 2018. ITEM BACKGROUND: The Board of County Commisioners met on May 10, 2017 to discuss recommended changes to implement for calendar year 2018 to address Health and Prescription Plan costs. The Board instructed staff to develop alternative options. Attached are revised options, along with a couple of new options discussed during the meeting. Staff is seeking direction. PREVIOUS RELEVANT BOCC ACTION: CONTRACT /AGREEMENT CHANGES: N/A STAFF RECOMMENDATION: DOCUMENTATION: MCBCC Projected Retiree Health Costs and Enrollment, based on Other Post - Employment Benefits (OPEB) Forecast summary Large Employers Comparison Ad Valorem Funding Rate Sheet for HPAC with Revenue History of Raises with Health Insurance Expenses MCBCC FB Placemat for 2017 Plan Modification 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 Resolution #049 -2017 Wellness Committee Member's Suggestions MCBCC Commission meeting 06 -20 -2017, Power Point Presentation Benefit and Contribution Changes Recommended for FY 2018 Health Plan After 5 -1 -2017 Meeting FINANCIAL IMPACT: Effective Date: N/A Expiration Date: N/A Total Dollar Value of Contract: N/A 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: If yes, amount: N/A REVIEWED BY: Christine Hurley Completed 06/08/2017 12:55 PM Budget and Finance Completed 06/12/2017 12:10 PM Cynthia Hall Completed 06/12/2017 9:01 PM Maria Slavik Completed 06/13/2017 7:22 AM Kathy Peters Completed 06/13/2017 10:08 AM Board of County Commissioners Pending 06/20/2017 1:30 PM Benefit and Contribution Changes Recommended for FY 2018 after 5 -10 -17 BOCC Meeting m r �- N co o Q it X N CD a 00 NN LL ua a 0 N L N ` a N N LPL U W U L,J W Q o } a C G I- w W Z o CO o U o m 00 } LL $3,334,116 Items shown as the same color are mutually exclusive. Therefore ou cannot say es to each one of them. 13. Dual Option HSA with LOW option (employees and retirees paying $0); (dependents pay less) HIGH option (employees and retirees pay MORE monthly to stay on rich plan) $732,955 $1,023,572 $1 ,095,222 $3,334,116 13A. Dual Option HISA with LOW option (employees and retirees paying SO); (dependents pay l ess) HIGH option ( employees, retirees, an $464,120 $648,144 $693,514 $3,334,116 BENEFIT CHANGES - ALL COVERED LIVES IMPACTED 29. Change PCP, Behavioral Health and Pre /Post Natal Care Copay FROM $25 to $30 $23,287 $31 ,281 $31,594 Y $3,334,116 2A. Increase Urgent Care copay from $25 to $50 $9 ,428 $12,539 $12,664 Y '" $3,334,116 30. Add $10 copay for Independent Clinical Lab (Quest) $8,537 $11,355 $11,355 $3,334,116 3. Add $100 pharmacy deductible per individual $162,366 $215,947 $218,106 $3,334,116 3A. Add $100 pharmacy deductible limited to $200 per family $129,893 $172,757 $174,485 N I Y $3,334,116 31. Increase Generic Drug Copay to $15 $86 ,299 $117,073 $119,414 y $3,334,116 28. Add $150 per month smoker surcharge $256,017 $337,874 $334,392 $3,334,116 22. Increase brand drug co a s FROM $50/$90 to $60/$100 30 day) and $150/$250 (90 day) $69,861 $92,915 $92,915 $3 ,334,116 CONTRIBUTION CHANGES 37. All employees pay the same ($75 /month) $402,300 $536,400 $536,400 $3,334,116 38. Char a $200 monthly premium for each employ retiree, and dep endent $1,850,787 $2,467,716 $2,467,716 $3,334,116 38A. Charge greater of current premium and $200 monthly premium for each employee, retiree, and dependent $2 ,149,695 $2,866,260 $2,866,260 $3,334,116 6. No Subsidy for Dependents of Any Retirees $459,378 $641,521 $686,428 °( $3,334,116 6B. No subsidy for Dependents of Any Retirees (rule of 70 retiree dependents and non -rule of 70 retiree dependents) - (with the exception of Rule of 70 retirees who retired prior to 1 1 18 whose spouses will remain subsidized at the overall dependent subsidy rate $55, $1 09,152 $154,620 $3,334 6A. 40% Subsidy for Dependents of Retirees (Excluding Medicare Eligible Spouses) $134,325 $187,585 $200,716 $3,334,116 6C 40% subsidy for Dependents of Any Retirees (rule of 70 retiree dependents and non -rule of 70 retiree dependents) (with the exception of Rule of 70 retirees who retired prior to 1 1 18 whose spouses will remain subsidized at 60% dependent subsidy rate) $39,366 $75,708 $107,988 $3,334,116 18. Spouses of Retirees Pay 100% of Actuarial Rate if Spouse has Access to Coverage Through His /Her Own Employer. $13,662 $18,216 $18,216 $3,334 18A. All spouses of employees or retirees who have access to coverage through his /her own employer are ineligible for County Insurance $54,578 $76,409 $80,230 $3,334,116 7. No subsidy for Pre -65 Retirees $1 ,311,728 $1,831,827 $1,960,055 r4 $3,334,116 7A. Scaled Subsidy for Rule of 70 Retirees ($141- w 25 yos; $200 - w 20 -24 yos; $400 w -10 -19 yos) $772,119 $1 ,123,572 $1,221,540 $3,334,116 8. Pre 65 Retirees Pay 50% of Actuarial Rate $621,033 $867,272 $927,981 $3,334,116 4A. Provide a flat $250 Subsidy to Medicare Eligible Retirees ($697 - $250 = $447) $841,521 $1,178,130 $1,237,036 $3,334,116 �%B. Provide a $200 Subsidy to Medicare Eligible Retirees ($697 - $200 = $497) $979,743 $1,371,640 $1,440,222 $3,334,116 PLAN MANAGEMENT /ADMINISTRATIVE CHANGES 15. Change Medicare Retiree Drug Coverage from RDS to EGWP $250,000 $250,000 $250,000 $3,334,116 19. Conduct Dependent Eligibility Audit (estimated 4% of Dependent claims) $195,848 $273,501 $292,646 $3,334,116 34. Adopt Envision Select Formulary $164,360 $229,529 $245,596 Y Y Y $3,334,116 36. Exlcude Drugs available Over -the- Counter (OTC) $66 ,524 $92,901 $99,404 $3,334,116 39. Request Clerk audit claims processing (Kolhage requested Madok do this) ?? I Y y $3,334 40. Exclude CVS from network for all prescriptions $108,750 $152,250 $159,863 Ew OPTIONS $3,334,116 '- 7 7 ... a W U) Benefit and Contribution Changes Ruled Out at mo Q _ (9 = � z Z W W U 'F o m .2 o Z) CL w (7 Q c m the 5 -10 -17 BOCC Meeting Q o 00 0 o °� 0 W co Y Z ( V rC C14 N N U O N } e, ■ RULE OUT ON 5-10-1,L7 1. Increase Deductible from $400/$800 to $600/51200 2. Increase Specialist co pay from $25 to $50 584,849 $112,849 $113,978 23. Increase specialtV drug copay to 25% to maximum of $300 $16,438 $22,955 $24,562 5. Reset Dependent Contributions from 40% to 50% of Actuarial Rate at Current Higher Costs $373.230 $521.216 $557,701 10. Reset Dependent Contributions from 40% to 60% of Actuarial Rates $599,868 $x37.716 $896,356 9. Active Employees Pay $50/75 for Employee Coverage $263.025 $349,823 $3002 24 Increase active EE contributions from $25/$50 to $65/$95 (10% of actuarial value) $442.44u $617,867 $661,118 4 Charge Full Annual Amount of Health Insurance to Medicare Eligible Retirees $697) $1,312 $1,750.700 $1,750,000 11. Set Premium for Retiree only Coverage to a Flat $200 for Rule of 70 Retirees $272,025 $361,793 $361,793 17 Increase Retiree Contributions to a flat $150 for Rule of 70 Retirees $204,750 $273,OOD $273,000 25 Increase Retiree Contributions to 20% of Actuarial Value for Rule of 70 Retirees ($207 <65, $139 65 +) $124,963 $174 ,510 $186.726 26. Change Retiree Contributions to $150 for 10 - 20 YOS and $50 for 20 +YOS for Rule of 70 Retirees 548.870 $64,997 $64,997 16 Discontinue Dependent Subsidy for employees hired after 10/1/17 $139,209 $590.866 $997202 32 Reduce Dependent Subsidy for Future Hires to 50% $36.706 $155795 $262,934 12 Dual Option HSA $729.734 $1 $1,090,406 14 Dual Option like MCSB $573 ,964 $801.541 $857 ,649 33 Dual Option with HRA (Assume same plan design as HSA option 12 ) $760,335 $1,061 808 $1136,135 20. Mandatory Generic Pharmacy Benefit $24,709 $34,506 $36,921 21 Expanded Mandatory Step Therapy $16,473 $23.004 $24,614 35. Mandato 90 -day Scripts for Maintenance with Narrower 90-day Retail fretwork (Wal reens only) $142 ,920 $199 ,587 $213,559 E E M �a �a as 0 LL LU CL 0 �a as as 0 E w �a 0 CL �s �a �s E 0 LU �a �a 0 �a �a �s c� �a CL U U KJ �a c� A I B C D E F G H 1 Monroe County BCC 2 Projected Retiree Health Costs and Enrollment 3 4 Based on FY 2016 OPEB Valuation 5 6 7 Fiscal Year Projected Claims Projected Fixed Costs Retiree Contributions Net County Cost Projected Retirees Projected Spouses Total Projected Members 8 2017 $5,073,781 $259,231 ($1,297,213) $4,035,799 407 92 499 9 2018 $5,414,169 $272,339 ($1,517,931) $4,168,577 398 91 489 10 2019 $5,722,278 $285,764 ($1,743,139) $4,264,903 389 89 478 11 2020 $6,028,493 $300,003 ($1,954,347) $4,374,148 379 87 466 12 2021 $6,347,631 $314,601 ($2,141,519) $4,520,714 369 86 454 13 2022 $6,683,611 $328,986 ($2,306,269) $4,706,328 358 84 442 14 2023 $6,890,993 $343,596 ($2,449,776) $4,784,813 348 82 429 15 2024 $7,208,551 $358,180 ($2,596,238) $4,970,493 336 80 416 16 2025 $7,451,641 $373,157 ($2,726,069) $5,098,728 325 78 403 17 2026 $7,832,767 $388,919 ($2,860,879) $5,360,807 313 76 389 18 2027 $8,048,355 $404,147 ($2,999,096) $5,453,405 301 74 375 19 2028 $8,259,029 $419,087 ($3,118,278) $5,559,837 289 71 360 20 2029 $8,551,777 $432,746 ($3,243,204) $5,741,319 277 69 346 21 2030 $8,724,099 $445,210 ($3,338,302) $5,831,007 264 67 331 22 2031 $8,855,103 $457,342 ($3,414,481) $5,897,964 251 64 315 23 2032 $9,048,252 $468,365 ($3,494,114) $6,022,502 239 61 300 24 2033 $9,260,274 $478,087 ($3,569,360) $6,169,001 226 59 284 25 2034 $9,394,716 $486,589 ($3,627,149) $6,254,156 213 56 269 26 2035 $9,502,565 $493,936 ($3,680,902) $6,315,599 200 54 253 27 2036 $9,621,055 $499,374 ($3,710,881) $6,409,547 187 51 237 28 2037 $9,595,337 $503,643 ($3,719,884) $6,379,095 174 48 222 29 2038 $9,647,701 $506,586 ($3,727,342) $6,426,945 161 45 206 30 2039 $9,657,482 $507,878 ($3,713,526) $6,451,833 149 43 191 31 2040 $9,664,758 $507,684 ($3,680,475) $6,491,967 137 40 177 32 2041 $9,650,582 $505,821 ($3,630,217) $6,526,186 125 37 162 33 2042 $9,624,289 $502,612 ($3,580,227) $6,546,675 114 34 148 34 2043 $9,585,630 $498,752 ($3,525,567) $6,558,815 103 32 135 35 2044 $9,498,163 $493,757 ($3,465,069) $6,526,851 93 29 122 36 2045 $9,392,030 $487,288 ($3,384,105) $6,495,212 83 27 110 37 2046 $9,277,300 $480,702 ($3,311,543) $6,446,458 74 25 99 38 2047 $9,139,494 $473,136 ($3,223,378) $6,389,252 66 22 88 39 2048 $8,970,058 $463,333 ($3,120,466) $6,312,924 58 20 78 40 2049 $8,751,929 $452,484 ($3,004,306) $6,200,107 51 18 69 41 2050 $8,500,774 $440,652 ($2,882,546) $6,058,881 44 16 60 42 2051 $8,248,353 $427,667 ($2,756,275) $5,919,745 38 14 53 43 2052 $7,979,149 $414,062 ($2,630,800) $5,762,411 33 13 46 44 2053 $7,695,039 $399,757 ($2,505,043) $5,589,752 28 11 40 45 2054 $7,386,940 $384,684 ($2,380,285) $5,391,339 24 10 34 46 2055 $7,062,851 $369,080 ($2,253,410) $5,178,521 20 9 29 47 2056 $6,705,398 $352,997 ($2,112,493) $4,945,902 17 7 24 48 2057 $6,368,972 $336,498 ($1,991,781) $4,713,689 14 6 20 49 2058 $5,987,982 $319,696 ($1,848,198) $4,459,480 12 4 16 50 2059 $5,660,033 $302,764 ($1,743,685) $4,219,112 10 4 13 51 2060 $5,322,456 $285,754 ($1,637,617) $3,970,593 8 3 11 52 2061 $4,999,135 $268,771 ($1,544,376) $3,723,530 6 2 9 53 2062 $4,685,207 $251,906 ($1,459,678) $3,477,435 5 2 7 541 2063 $4,378,530 $235,224 ($1,381,219) $3,232,535 4 2 5 551 2064 $4,078,050 $218,902 ($1,306,294) $2,990,659 3 1 4 561 2065 1$3,786,980 1 $203,052 ($1,236,100) $2,753,932 1 21 11 3 E E M �a �a as 0 LL LU CL 0 �a as as 0 E w �a 0 CL �s �a �s E 0 LU �a �a 0 �a �a �s c� �a CL U U KJ �a c� COMPARISON OF MONROE COUNTY LARGER GOVERNMENT EMPLOYERS I tl.b Employee Premium Sol Employee Premium Rate Depend- Premmm subsdy Dependent Prem um Rates ReCITee Premum S.b.dy Retiree Premium Rate EMPLOYERS % EMPLOYER CONTRIBUTION EMPLOYEE CONTRIBUTION %. EMPLOYER CONTRIBUTION EMPLOYEE CONTRIBUTION EMPLOYER> CONTRIBUTION RETIREE CONTRIBUTION Monroe COUntyBOCC 60% Spouse: $332 $50 -150 Month Depending on years of rer -- FRS W 42 Spouse +One Child: $480 Spore Two or m ore Ch $701 45% PH- to 5 11112 $25 Per Month One Child Only: $148 80% On or After S /1/12 $50 Per Month Two Children: $295 Three Chil dren: $443 Four Children: $591 r- Child-: $738 FKAA SDI}% $0.00 39% One Dependent: $380.10 0% Regular Employees Pay Full Cost $824.98 Family: $545.21 4. Less than 15gtindfathered Upper Managementthatare wrrently paid 1005 Now pay Up per Managemen to su bsi dy bared on level an d years of service City of Key Wert F'ar Eo SOj01f10: 10©% PHortolo /ol /10: $0.00 0% Spot- $688.26 Aftb".jc1j10: 95 After l0 /01/10:$54.16 Children: $494.95 0% Under65 FUII COS[: $958.92 E Family: $1,183.21 Over 65: $602.02 E Keys Energy 100% $0.00 0% Spot- $565.16 100% Eligible Redrew $0.00 Eligible Redrew !C Children: $426.36 Family: $991.52 Cityof Marathon Base Plan: Base Plan: 0% Base Plan: Base Plan: _ N Retirees eligible to e in are nroll COBRA. Pay 100 100% $0.00 Spot- $885.78 Children: $728.52 Family $1,J96.32 0% High Option Plan: High Option Plan: High Option Plan: Spot- High Option Plan $987.98 93% $81.97 Children: $812.55 Family $2 Islamorada, Village of Islands 90#0 $JO 0% Spot- $786.10 <65 and >65: $750.00 '~ Children: $586.14 0% Family: $1,372.24 O $280 67% Employee + One (Spouse or Child): $50838 a berofyears of e,i,e 10 -19 YOS: $758.89 _ Buy Up Plan: Buy Up Plan: Buy Up Plan: MUST have 10 year of with MCSB. O. <10 YOS: $1028.15 E Monroe County Sshool Board $280.00 67% Employee+ One (Sp ouse or Chil dl: $508.38 Pays subsdy bared on um berof years of e,i,e with MCSB. U O 10 -19 YOS: $758.89 C *MCSB offers threeplan5. Buy Up Plan ated as t S most compatible to BOIL Family Plan: $642.20 <10 YOS =0% 10- 19 YOS- 50 %20 +YOS- 100% LU 20 +YOS: $ 489.63 79% J Retirees over age 65 pay ful l premium: $102 E Miami -Dade County HMO HMO 43Y HMO HMO County p- desa flat Axed dollarsubsdy that es by plan and ter but does not change each year HMO Under 65: $490 SD9% $0.00 Spou- $451.43 POS Under 65: $1165 Children: $39037 Family $623.50 Med-e Supplement wth Pharm -y$645 POs High Option Plan: 43Y POs POS Med-e Supplement wthout Pharmary:$2.0 Y. $32.28 Spou- $714.22 Children: $587.08 Family $1,25..16 Packet Pa 5 B.l.b PPO A - 0317 76.E PPO A $159.86 0% PPO A Family PPO A $747.92 Columbia County paysa def ned contr but on of $6,786 Columbia County P PO C - 03359 78.7% PPO C $120.54 0% PPO C Family PPO C ($ 565. 50 1month( for medi -1 on an annual bass. - fully subsd- the c,,tof Plan D for employe,,. $676.20 68,998 Dor E (HSA) - 03160/61 SDO% Dor E(HSA) $0.00 0% Dor E(HSA) Family Dor E(HSA) ,over the prem um go toward the HSA. Part dp-t, pay up to the em - amount if t[ $458.52 ForG(HSA) 05192/93 S00% For G(HSA) $0.00 0% For G(HSA) Family For G(HSA) contrb, on do„notcover the expense. $217.86 Y State of Florida Standard Plans HMO and PPO 92.8% $50.00 98.8% $8.34 9 &.7% $30.00 0,0% $69284 0,0% $69284 High Deductble Plans HMO and PPO 97.6% $15.00 98.630 $8.34 95.330 $30.00 '},D% $616.18 '},D% $616.18 88% 98% 0% 95% 98% 0% Standard Plans Family Family Family High Deductible Plans Family Family Family HMO and PPO Annual C,,t of In d v'd al Coverage Standard LL Career3ervice $180.00 Sel - Exempt &Sr. Mgmt $30.00 Spousz Pr - 0-, Deps Rehree 165 $1,559.60 HMO and PPO Annual Cost of In d id-I Co-, HDHP Career Service $64.30 $7,39 0 ' Select Exempt &Sr. V-7 $30.00 _ Spo", Pr - 0-, Deps Rehree 165 $1,360.57 Charlotte County 97% $26.00 86% Employee +spoure Employee +O ild(ren( Employee +Family E $286.00 O $249.00 0% $921.83 $315.00 O O Clay County Blue Op[- PPO 727 79% Blue Op[on PPO 3766 32% HSA(BI a Op[ons Network) HigherC- PPO(Blue Options1552) 89% Blue Option PPO 727 $165.41 Blue Option PPO 3766 $60.43 HSA(Blue Options Network) HigherC- PPO(Blue Options 1552) $64.42 Blue Option PPO 727 62% Blue Op[on PPO 3766 78% HSA(Blue Op[ons Network) HigherC- PPO(Blue Options1552) 81% 79% 79% Blue Option PPOJ27 Employee +Family Blue Op[on PPO 3766 Employee +Family HSA(Blue Options Network) HigherC- PPO(Blue Options1552) Employee +Spo - Employee +O ildren Employee +Family U65 Blue Chose PPO 716 $740.51 32% $523.80 U65 Blue Op[on PPO $422.28 34% $494.65 U65: HSA(Blue Options Network) Medicare PPO 065: 47% $170.72 U65: 78% $70.72 065: Blue Choice PPO 716 V 19% $623.80 065. Blue Options PPO N 20% $594.65 HigherC- PPO(Blue Options1552) $267.78 $578.39 U $260.92 0% $378.44 0 Essambia County Lower COSt PPO(Blue Options 1352) 95% HSA(Blue Op[ons 1168) 100% Lower COSt PPO(Blue Options 1352) $ 27.62 HSA(Blue Options1168) $0 *Charges an eras $20 for tobacco use Lower COSt PPO(Blue Options 1352) 86% 86% 85% HSA(Blue Options1168) 92% 92% 92% Lower COSt PPO(Blue Options 1352) Employee +Spo - Employee +O ildren Employee +Family HSA(Blue Options1168) Employee +Spo - Employee +O ildren Employee +Family E Lower COSt PPO(Blue Options 1352) LU $183.38 $535.24 $164.02 $226.82 Blue Medicare PP0 &Px Plan $268.61 & $89.42 E $87.38 $79.20 ^' $111.92 Packet Pg. 6 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 $2,261,970 LL L . �a �a �a �a E E 0 c� �a �a �a c� �a CO U— E �a E c� CU GROUP INSURANCE RATES FY 2016-2017 REVEN B.L4 EFFECTIVE DAT COUNTY PAYS PER EMPLOYEE/PER MONTH OPT-1 N PER PAYDAY PER MONTH SPOUSES LEAVING PLAN FOR 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 EFFECTIVE DAT PER PAYDAY PER MONTH ANNUAL EMPLOYEE ONLY COVERAGE: Hired 05/01/12 or later 5/1/2012 $23.00 $50.00 EMPLOYEE ONLYCOVERAGE: Hired riorto5 /1/2012 5/1/2012 $11.50 $25.00 DEPENDENT TIERS - -. 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 CHILE 1/1/2017 $324.00 $557.00 $701.00 $1,207.00 aying the higher premiu 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 1/1/2017 $204.00 $443.00 estimated to be $160,000 FOUR CHILDREN ONLY 1/1/2017 $273.00 1 1 §521 .00 vs. projected savings FIVE OR MORE CHILDREN 1/1/2017 $341.00 $738.00 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: 1/1/2017 $1,044.00 FOR DEPENDENT RATES SEE TI 1/1/2017 RETIREES.' PER MONTH ANNUAL 1/1/2014 $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 1 U DER DER AGE 65: 1/1/2017 $1, 035.00 OVER AGE 65 1/1/2017 $621.00 $520,572 RETIREES:'. Life Insurance Coverage Only (NO MEDICAL) I I I i $11_00 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 M1 IN -under age do 2010 -Fy 1l Budget No Change No Change 31 COtA &3 -SYO Step -over age 65 Retiree Spouse <65 Retiree Spouse >65 ental Rate 3C 4C 5C Retiree Spouse >65 NO Deductible applicable to Preventive Ueductible no longer No longer a "grandfathered Items and Services; added Preventive applicable to Preventive alth 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; ysician Office Visit 75-1. of allowed amount after deductible $20 copay- not subject to a W. PP PP P MEN Active EM - Opting Out of March 1011 $790 monthly departmental rate letinees - Opt Out of health 2012-FY13 Budget Departmental Rate MEMIMEMEMM : - - s P F .. 1/1/15 pay a penalty if tobacco retir d epen d en t s on or 11 monthly MMM 'in�totaIMfo!2015 $6350/$ 12,700 �MMM * Dependent co,era,e subsidies iecl throughtout the tiers. 50% subsidy -under age 65 F .. PackefPg. 12 '. *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 EMPLOYER BUT DECIDE TO REMAIN required age appropriate ENROLLED IN THE COUNTY PLAN screenings with required PREMIUMS WOULD NO LONGER BE documents during the period of SUBSIDIZED. 10/1/15 - 10/31/16 active participants will save $300 wally on their Employee Only rate effective 1/1/17 Retirees >10-1-01 -under age 65 $885 $1,035 $95. -ov erage 65 $531 $621 $57 Retiree Spouse >65 $166 $559 '.$393 *EFFECTIVE 1/1/17 RETIREE SPOUSES OVER 55 WHO REMAINED ON THE COUNTY PLAN HAD AN INCREASE OF $393 PER MONTH NO OTHER PREMIUM CHANGES PackefPg. 12 '. 3If FL& E e KD V p-d P., A $ 14,829 $ $ O Pend $ 3 $ 2 "111000 9 PM $8393 $106.]5 $1105] S pend SP VSt $ $ $ d Utl//1000 771 9 e PM $6613 5134.95 $9613 S pend S V $ $2,0 $ 13 Pend $ 974 ' 1 55 utl//1000 2 32 PM $2194 $34.13 $3409 Spend Pe, Se.�ee $62 $ 1 $ [ 41). o Pend $18, $15, . utl /ioSo 1 457 PMPM $ 110 $6.9 $5.45 PMPM by Age Range Group Male Group Female❑ Book Male IN Book Female pend Per service $58 9 $50 8 $49 Spen $ 425,759 9.5-A 1,592 3 I INS $ $ . ....... $$$ 00 - Spen Spen 0 11,S50 1 /1000 ) 0 ... ..... .... Spen d s I t. 0 utf 24 25 35 3645 46 55 56 64 65. al Spend $33,6 $ 1] b M $ $ 6 $ $ $ $ $ 325 PMPM $1.18 $061 1 $195 $255 5420 5511 $624 $ 5 ] 5 5 BM = Benchmark Book of B- m—benchmarksare based on dams i nwrred 01/01/2015- 12/31/2015 and through 02/29/2016 Member Share as a Percentage of me a.e.o memee. :� h.e.=un: Total Spend and Claim Type �n Leo /s1 �: u^c rent �Pr or High Cost M b pat $50,000 m +i'... . •i ...... -',. .. H Est Memee,s .. 42 ...... 40 ...... so,s> A 1 S @ a< 9 sm @16 Mb o-to 1 as 491 H g ' ast Me' de.spend $ 05, $4,491,344 l 1 5asax @zx< pendMe. $12 1, $11 ai t I $ass. @24< PSe Cost P m e $12888' $15242 P Hah OP 0 1 Ss61K @13°< 1 @1 @b eK 5331K @u< 5331K @zs< 52nK@ w< Cost Md,s $206 ail $1'39 or ant ofTOrsI PMPM 46. 46 $8g. .. .. .. .. 5 $ssaz n $6K i @ a< a A @o< p.@ 5nK $SOOK $1 OM $1 SM Top F ve D agnos s Categor es With PMPM $20th $25M $5K '. $4,629 ' $4K $a2 s $3K $2,141 i $2K M O OK O : J$6,089 $2,eoe 5a,10 L OK $3 .OM $2.6m uNrrent .Prot P,p, Aq . I'll ( "I Mat Pmav�—ony $2.OM $13th uCurrent �P. or $ 1 @ .0 5 83 ` IIJI @$35n @534 T2 @ I @�6M4I' ��c @ @$ e0 19911 b5yml :. :. •. •. •. H C.. Spendas Percentage by Clam Type - $OK ms III Ms m II@ ury/ �P OP -P mp PC ER O y went 3 4 KyF It U t 1' [] rK d r . 5 .. 1 5 P rot I I 2- 11. IS ne.sHOsp ml 51, 52,n1 5504,is3 3 2 [] nstHOST, mI OfM am no 51 5 ,a98 -- (4)u OfM Hose, t.lsaana -IP., $374,693 $439,706 0°6 20°6 40°6 60°6 eo°6 00,6 o () uth Mam HOSp rsl 5 5 e (6) Homestead Hosp t. n� $3 7 12 $220,334 Network Sav ngs and UI z c t at on () er Fla Keys Health Systems (] he men SHOSp t.1, In.. $ $111 o. saving, Y n o (9)west Kendall 9aptst H osptal 5193 $13 (SO]ladcsonMe- 1.1 Hosptsl Plan R I, V1. B kby Age Blacket reu aP< are< $ 191,249 ; $33,568 arc asc im 400% c `f 0 Malez ': ofbl .. 1 .. _ 9- 0 0 2% . OOYo m P tfent. O P P f I Total. U 46 55 1 %% 23 1-A t ¢] u In Netwodk Spend Yo i In Netwodk Ut li-on Yo 2 4 h S 105.0% ' 4 { � 96 G S � 26% 1 A6 1000% u 95 9000% 35 s O,A b 5� �� p% a 850% 98% 9J% 89% 90% L I m \ e 1 55 64 h 9 °h U ktF Ma es sk + /fema es 80.0% _ L In Pati ent Outpatient Professonal Tobl PeCk2t Pg. 13 B— F14 &IF - Compliance Criteria: Brea�zt za w0 one r - 1 . me 4 AllG ^ N [ n 5 d a pli — e an on.gap .nmllmenr HIT. durng.ach-- htnrnuousenrollmenr : Cmpliarrc criteria: o more mammograms anyr ime during the rwo year measurement period. colorectal canrer Preening: Agez: a : nrolar l 24 Months Allorable Gap: N. more than on. gap In enrollment of up m 45 days dudng each year of - nrinuousenrollmenr. • mPliarrc Criteria: Fecal Blacd Owelt: One during the last 12 months. • flexMleggmaidozwpy : One d wring the l asr 60 months. • Wwwzwpy One -mg the l asr 120 months. Non Users by Aee Bracket till II ��II b IJIJuJuuu I o Preening: vl �ez: years • nrollmart th- s h. All Gap: No more than one gap In enrollment of up m 45 days during each year of - nrinuousenrollmenr. • mpliarrc criteria: • l�i4 who had cervl -I rytology performed every3years. w whohada.al tole /humanpapuema.ru,wP mto g p— ,.d 5 Eaeluz on M.mbersw M- dens ofa Hysterectomy Adult V✓ellnezz: Agez:ul • Adrs 18♦ nrol n, th- s h. All U— ne ehan one 11 nroll - of upto th., dur ng ntth.t la rof -nr nuousenrollmenr Ilh . O or more well vsq adult dreckup orother wellness vs [that ps nto the standard setof w.1Mes -de= Key Findings ge Per Etnpleu.ey$er year ip —)Porgy rod �€ a are$6,9 14 %1—th T.P. p •Pa pe ew gyp nr e TOialA p M M M a i dby 3$8 %fi �It, I-t. 2 $ —x3 Bench l—k PMPM i55�3 TJ 1; •AVgag cos[fs R, Ih A bb, rfe5 of servi.:ewith except On tp T,g t9'- T. p I hp H.ht DR G, byspehit lndud.and I.... -lar procedure,, kldney tr—P lan S N I N h e nat. bo m at 31 weeks), h 1p /knee ER'. a HI H h'11 d11.1ed. d[11,1 —dya 203 :.,it, P.r:1000 1 HIP Blue ben cbmaik:1, 193 /1000; Em ploy... a-ount for - ,c of mto1 V,I , a,ddr- are la c, and Sp.—, are 16°M. 10 %cf -.1 ER vsfs(Td f-.1 ER -- spend]a eritally dr— (Tl,awte;upp prafdty nfec ,back R.Ii,: -gh). embers ha4e:3 n Esd grh. 12 month od —.r t — - embership remalned slab le at 2,171 members. o[a m ulatlon Is 50 %male and 50- Ab —ll..A .o f Emp loyees 1,51.7. The TP.Hty of members have torn) pald dalms In the $0g$499 I._ Ms for th s d.mogaph c for Monroe County B— 1, $674 - -pared I. the benchmark of $475. The h gh.r PMPM Is attr i I, —bl. e high -s[ dalmant, totaling $1.1M. ember - stsh.re, - T-tyat , 154% ndus[ry- tops --,12 %for -tai - ember- .[shar Cancer lu r cal —I mlorecral ca e Crop ry (h m.d ..1d "' deeese//e eo nd rt.a — y— ,nypet- li,h), Nlu breast loskele[al(ost...rM —1,I, d�end bone d soNe III Oefn.d COndrons(rympmmsrelared mches[/abdom nal P.1 n, geneal rympmms]and nlury /PO SOn ng [ankle and ad us factures, -mpl.. ons relat ell I. d procedure and..ntr -Iar dr. nag. d.. .) • The female population for Monroe County BOCCh -4BM more risk than the Flodd. Blue book of bushes and the male on has 45 % -ore rsk Malesages 1924 a re nearly 99 %rsk.r Man our book of bush T.p -nd tons for th, dmogrepH.In d ud. —1— InJurles, mus- Iosk.l.ra1 dl—d hit regl —ll eht.dg,. • High m.t da manta.[ v ty has ncreased n the -rent perod under —1 3p.nd r.lat.d m high -s[ asesat the $50K th —held ncaa,,d by 14 %, from $4 5M to $51M -42 a edei,H ell versos 40 h gh -,t asesn the pror perod —Ofthetotalp.pulaton, dentfed a,hgh- stand1, drrN ng 46°,6 of spend Benchmarks 1 %of the popular on % dr v hg 33 of total spend (ndud ng R.) w M -tier HCC removed, s Quid be 5207 versus the :-al $386. y IS Me number one -n dltion by spend and prevalence with 11 high -,t a,e, totaling $2.4M, followed by Clr -latory .o dltio- with 7 a se, totnling$750K. TOP se, are ncer(lun o al, breast, tongue ll. er), Or- Iatory(heart attack, hyperte -Ne kldney III sea,e, aortcaneury,m), M— Rloskeletal(osr arthross, spnal stei,,$),Oge,tve(Crohn,dsease, append ct,, ga,tmenterd,, dNertl -I r,), and Pregnanq /Ch Idblrth ( -mpl at it, durng pregnanq, neonate bom at 31 week,) .6hlgh- .[members are no longeracr vely enrolled on the health plan ($923K) 10 me The rsappear on thehgh - ,t report for 60th M. - rrentand prior period. -- ther, a.. —nt for 52% of total high -,t a,e spend . twork 3a.ng „- rrendy perform at -9 -A. Wel e re bel the Florida Bue l bend,mark, n 3 out of the 4 screen ng ategorle,. •Appro atdy l Ab of mal sand 8,6 f i emdl sdd nor utl ze rh h alrh,— bdndf s durng Me report ng perod and d hoe have. any allowable dollai, ayable to a pro. ber, : 215 dl,tnct member, (9 %of total - mbershp) are attrbuted to a Flor Blue value based pro der Value Based Prov der Attr but on Acm abl on Pam ome INN -�; Y` 'IV >a s' 0 � as 0 BM = Benchmark Book ofl w— benchmarksare based on dams mc .... d 01/01/201512/31 /2015 and through 02/29/2016 Pie Ca[Pg. 14 High Cost Claims Summary by Diagnostic Categories e.1ls Company: MONROE COUNTY BOCC Group: B0611 High Cost Claims Threshold: 50000 Current Paid Period: From 01/2016 to 12/2016 Prior Paid Period: From 01/2015 to 12/2015 ..... ... NEOPLASMS ... Inpatient p - $194,45367 .. 105/ .. $282,41439 151/0 ........ -45/0 ...... ($87,960.72) .. ..... 329.6% ... .... -31.1 Outpatient $1,412,597.76 76.4% $1,281,168.88 683% 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% ISub-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% $506,860.80 791% -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 54% -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% $733,327.08 793%, -14.9% ($321,014.62) 112.7% -43.8% Outpatient $135,985.14 21.2% $114,621.67 124% 8.8% $21,363.47 -7.5% 18.6% Professional $91,871.13 14.4% $76,968.23 83% 6.0% $14,902.90 -5.2% 19.4% Sub -Total $640,168.73 100.0% $924,91,6.98 100.0% 0.0% ($284,748.25) 100.0% -30.81 PERINATAL PERIOD Inpatient $476,898.50 90.4% $28,029.44 812%, 9.2% $448,869.06 91.0% 1601.4% Outpatient $0.00 0.0% $1,103.80 32% 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% $240,179.62 512%, 13.6% $70,462.05 705.2% 29.3% Outpatient $93,162.33 19.4% $187,724.03 400% -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% $22,085.13 135%.. -7.2% $3,035.32 1.3% 13.7% Outpatient $266,688.94 67.5% $102,809.41 630% 4.5% $163,879.53 70.7% 159.4% Professional $103,352.61 26.2% $38,333.09 235% 2.7% $65,019.52 28.0% 169.6% ISub-Total $395,1162.00 :100.0% $163,227.63 1.00.0% I'. 0.0% $231,934.37 100.0% 1142.11% DIGESTIVE SYSTEM Inpatient $181,737.69 54.4% $300,650.70 831% -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 ISub-Total $334,270.62 :100.0% $361,578.92 100.0% I'. 0.0% ($27,308.30) 100.0% I'. -7.6% GENITOURINARY SYSTEM Inpatient $97,965.10 36.0% $133,051.36 473% -11.3% ($35,086.26) 376.0% -26.4% Outpatient $142,393.11 52.4% $107,359.98 382% 14.2% $35,033.13 - 375.4% 32.6% Professional $31,591.48 11.6% $40,870.64 145% 2.9% ($9,279.16) 99.4% -22.7% Sub -Total $271,949.69 100.0% $281,281.98 100,0% 0.0% ($9,332.29) 100.0 % -3.3% PREGNANCY /CHILDBIRTH .Inpatient $238,897.24 95.6% $228,380.34 901%. 5.5% $10,516.90 - 300.1% 4.6% This Florida Blue report is proprietary and confidential. Report Run: 03/14/2017 4:27 PM Page 1 of 1 r Packet 9 Outpatient $663.3C 0.3% $2 1 13 63 0.8% -0 6 % ($1,450.33) 41.4% -68I Professional $10,325.07 4.1% $22,895.63 90% -4.9% ($12,570.56) 358.7% -54. ISub-Total $249,885.61 :100.0% $253,389.60 100.0% I'. 0.0% ($3,503.99) 100.0! I'. -1. JOCRINE /METABOLIC Inpatient $103,097.92 51.8% $38,520.07 286% 23.2% $64,577.85 100.4% 167. Outpatient $72,987.08 36.7% $73,221.38 54.3% -17.7% ($234.30) -0.4% -0. Professional $23,060.14 11.6% $23,062.38 17.1% -5.5% ($2.24) 0.0% 0. ISub-Total I'. $199,145.14 :1000% $134,803.83 100,0% ". 0.0% $64,341.31 100.0% 147. ECTIOUS /PARASITIC Inpatient $145,466.51 83.8% $0.00 00% 83.8% $145,466.51 98.3% 0. Outpatient $18,923.55 10.9% $17,050.16 66.8% -55.9% $1,873.39 1.3% 11. Professional $9,149.71 5.3% $8,480.86 332% -27.9 % $668.85 0.5% ,...... 7. Sub -Total $173,539.77 100.0% $25,531.02 100.0% 0.0% $148,008.75 100.0% 579. NGENITAL ANOMALIES . Inpatient $97,962.41 74.3% $0.00 00% 74.3% $97,962.41 80.6% 0. Outpatient $2,994.32 2.3% $5,486.90 53.6% -51.3% ($2,492.58) -2.1% -45. Professional $30,853.87 23.4% $4,754.41 46.4% -23.0% $26,099.46 21.5% 549. Sub -Total $131,810.60 100.0% $10,241.31 100.0 % 0.0% $121,569.29 100.0% 1187.. RVOUS SYSTEM/SENSE ORGAN Inpatient $0.00 0.0% $18,954.34 38.7% -38.7% ($18,954.34) -31.6% -100. Outpatient $77,200.70 70.9% $16,204.74 33.1% 37.8% $60,995.96 101.7% 376. Professional $31,757.92 29.1% $13,841.14 282% 0.9% $17,916.78 29.9% 129. Sub -Total $108,958.62 100.0% $49,000.22 100.0 % 0.0% $59,958.40 100.0% 122.. 3PIRATORY SYSTEM Inpatient $70,813.52 68.7% $48,814.50 89.8% -21.1% $21,999.02 45.2% 45. Outpatient $20,625.17 20.0% $250.04 0.5% 19.6 % $20,375.13 41.9% 8148. Professional $11,572.04 11.2% $5,298.17 97% 1.5% $6,273.87 12.9% 118. ISub-Total $103,010.73 .100.0% $54,362.71 1.00.0% I'. 0.0% $48,648.02 100.01 II89. NTAL DISORDERS Inpatient $77,875.60 84.4% $0.00 0.0% 84.4% $77,875.60 86.6% 0. Outpatient $9,402.40 10.2% $0.00 00% 10.2% $9,402.40 10.5% ,...... 0. Professional $4,945.95 5.4% $2,322.71 1000% -94.6 % $2,623.24 2.9% 112. ISub-Total $92,223.95 100.0% $2,322.71 100.0% I'. 0.0% $89,901.24 100.0% 3870. )OD /BLOOD ORGANS Inpatient $60,411.00 83.1% $4,603.94 6.3% 76.7 % $55,807.06 - 72712.8% 1212. Outpatient $3,170.88 4.4% $49,232.05 67.6% -63.3% ($46,061.17) 60014.6% -93. Professional $9,149.03 12.6% $18,971.67 261% -13.5% ($9,822.64) 12798.2% -51. ISub-Total I'. $72,730.91 :1000% $72,807.66 100,0% I'. 0.0% ($76.75) 100.0% :: -0. 1ER CONDITIONS Outpatient $30,048.19 68.0% $25,353.30 664% 1.6% $4,694.89 78.0% 18. Professional $14,157.69 32.0% $12,830.42 336% 1.6% $1,327.27 22.0% 10. .Sub- Total '.'. $44,205.88 .100.0% $38,183.72 100.0% '' 0.0% $6,022.16 100.0 % II15. N& SUBCUTANEOUS TISSUE ,Inpatient $10,048.22 53.6% $0.00 00% 53.6% $10,048.22 - 148.3% 0. Outpatient $457.00 2.4% $16,224.96 636% -61.2 % ($15,767.96) 232.8 % -97. Professional $8,235.33 43.9% $9,290.03 364% 7.5% ($1,054.70) 15.6% -11. ISub-Total $18,740.55 100.0% $25,514.99 100.0% 0.0% ($6,774.44) 100.0% -26. al $6.453.058 .44 100.0% $5.416.815.81 100.0% 0.0% r $1.036.242.63 100.0% 19. C 0 C 0 to 0 tJ U7 M! 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 600R < 60 AND Not Rule of 70 Rule of 70 and then $0 Future Retiree I< 10 YOS I 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 and /or the require contribution premiums." This same language was also included in all prior resolutions. 6.1.h Packet Pg. 17 Option 7 & I YEARS OF SERVICE Option 4 Option 6 8 Option 7A Option 11, 17 & 25 Option 18 Option 25 rs of Service # of Retirees Years of Service # of Retirees Years of Service # of Retirees 39 1 39 1 39 1 38 2 48 SPOUSES 125 RETIREES 38 2 38 2 10 SPOUSES >65 125 RETIREES E E 37 3 10> 65 ARE PRE -65 37 3 37 3 ARE PRE -65 36 1 38< 65 36 1 36 1 38 SPOUSES <65 35 5 35 -- 5 35 5 ° 34 4 19 CHILDREN 34 4 34 4 33 7 33 ' 7 33 7 U 32 4 32' 4 32 4 31 6 31 6 31 6 30 13 30' 13 30 13 2 N 29 7 29 7 29 7 28 7 28 7 28 7 N 27 7 27 ' 7 27 7 a oa 26 11 26' 11 26 11 25 18 25' 18 25 18 V 24 19 24' 19 24 19 r 23 14 23': 14 23 14 22 20 22 20 22 20 2 21 17 21s 17 21 17 20 18 20'- 18 20 18 0 19 22 19 22 19 22 18 12 18' 12 18 12 > 17 22 17 22 17 22 N 16 19 16' 19 16 19 15 24 15 24 15 24 14 16 14' 16 14 16 a 13 17 13'' 17 13 17 = 12 28 12' 28 12 28 11 29 11 29 11 29 10 47 10 47 10 47 Total 167 Total 421 Total 421 PackatPq.18 rn rn 't A A cm -4 c Ul � # Im = W Ln m w � {o 0 7*�Y B� � ro 0 M to � 13 p 0 " Z, Ui a t 10 YET L"L VI L q VI 4P Lll m Ln U 0 di � � �" �" ;F V r go lu CL m w r ri m a OL O z A En LM ca N 0 Lq 03 € n tRX n' 4p " fq 0 0 � pr r y 0 rn 4? n O %d m �ry P4 n +y � �{ "4 P^t tj 9 i ppa�yy -{ am = = 4d lb to 0 0 Q w L ^r G ro qtr NJ � ssr sari NJ 0 C N 14 -4 m m M M M C M M iC P dX� 0 m m � m as 0• � m q 0 m °� M rv4 F� ; ro im M r z ro m rs � = r, c to cc w 00 m c W 0 c ro 3 a LA OP ha Ln M to ct cr. ex c m m m m 40 ro a ro ro m m m m m m ID m eD ri CD rn rn 't A A -4 -do- Ul � # m m w � {o 7*�Y B� � +6`++ � " Z, Ui a t 10 YET L"L VI L q VI 4P Lll m CL 0 z 0 as g CL E CA 0 � ca � m n a ea w m w cu I. %P cc a% Ln Ln 4,P9 n. 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Lo to m at m w ko Ul co > > > > > > > Y2 t9 r% m m m m m m fD m m M m m m li to 00 to co to co co ¢fro %A w Ln Ln hi CC S en 00 at 14 li Let -4 -4 -4 m cn m M co m al w w O w 1 Ci 4 �j Im cn CL 0 z 4— 0 2 M 0 CL E CC cn i.R w w 0 1 M 1 0 3 It Enrollment Change at 2017 Open Enrollment 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 Coverage 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 Go LL 0 0 as cu c� CL M as �a as E E 0 0 as 0 0 �a 0 0 fa co �a �a U E 0 LU as E d ueld y ;leay pepuewwooej uo uopowip pue uolssnosla : gb0£) Aaelnwjo = l pejeg uolslnu3 : ;uGwt43e ; ;V Select Formulary Exclusion & Step Therapy List Effective: January 1, 2017 no � . 800 3614542 I envisionrx.com ueld y ;leay pepuawwooaa uo uoi ;oaaip pue uoissnosia : gbo£) Aaelnuaao ;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 Zipsor Butrans, Nucynta ER, Hysingla ER, Oxycontin Nucynta f-- A c" K) R, diclofenac potassium, Zorvolex [NP] Belbuca, Opana ER, Zohydro ER [NP] generic immediate release opioids Bunavail, buprenorphinelnaloxone, Zubsolv Acticlate, Doryx 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 donepezil, memantlne (immediate release) Vyvanse, generic ADHD medications fentany! lozenge generic Beyaz, generic Safyral, Beyaz, Natazia, Safyral, Yasmin, Oral Contraceptives generic Yasmin', generic Yaz , Yaz Minastrin 24 Fe, Lo Loestrin 1 generic Yasmin and Yaz are commonly marketed as Gianvi, Loryna, Ocella, Syeda, Vestura, or Zarah 800.361.4542 1 envisionrx.com 2 ueld y ;leey pepuewwooea uo uoi ;oaaip pue uoissnosia : gbo£) Aaelnuaao ;oeleg uolslAU3 : ; uGwt43e ; ;V Formulary Exclusions (continued) Therapeutic Categor 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 EN 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 ueld y ;leay pepuiewwooei uo uoi ;oaaip pue uoissnosia : gbo£) Aaelnuaao = l peleS uolslAU3 : ; uGwt43e ; ;V Formulary Exclusions (continued) Therapeutic Category l 1',IWM" j'H)'JWJI 1i, GASTROINTESTINAL Anti - Inflammatory/Anti -Ulcer Duexis, Vimovo Agents Inflammatory Bowel Agents Asacol HD, Canasa, Delzicol, Dipentium, Giazo, Pentasa Hyaluronics Gel -One, Orthovisc, Monovisc, (Osteoarthritis Agents) Supartz, Synvisc, Synvisc One Erythropoiesis - Stimulating Aranesp, Epogen, Mircera Agents famotidine PLUS ibuprofen or omeprazole PLUS naproxen Apriso, Lialda Euflexxa, Hyalgan Procrit Chronic Obstructive Pulmonary Incruse Ellipta, Seebri Spiriva Disease Neahaler,Tudorza Selective beta- 2- Adrenergic Proair, Proventil, Xopenex Ventolin Agonlsts Long - Acting Muscarinic Anoro Eliipta, Utibron Neohaler Stialto Containing Agents Pulmonary Anti - Inflammatory Pulmicort, QVAR Arnuity Ellipta, Asmanex, Rovent Inhalers HFA, Flovent Diskus Pulmonary Anti - Inflammatory ! Long-Acting Beta Agonist Dulera, Symbicort Advair, Breo Ellipta Inhalers Erectile Dysfunction Cialis Levitra, Staxyn, Stendra Urinary Antispasmodic Enablex, Toviaz, Vesicare Weight Loss Agents I Saxonda, 2 Managed by prior authorization to assess indication Viagra oxybutynin, tolterodine, trospium , Contrave 800.361.4542 I envisbnrx.com 4 ueld y ;leoy pepueww000a uo uol ;ooalp pue uolssnosla : St Aaelnwjo ;oeles u01slAu3 : ;uGwt43e ; ;V H v I ((-) m Step Therapies 4 Xeljan7 required to be tried and failed prior to use of other Secondary Treatment options for Rheumatoid Arthritis 800 361 442 1 envisbux.com 3 Requires trial and failure of only one primary treatment 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 describeda below. NOW THEREFORE, BE IT RESOLVED BY THE BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA that: cis 8 1. In calendar year 2017, the Monroe County Wellness Program shall consist of the following It 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. �a �a C4 It 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 B Deputy Clerk BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA By: 4"qwe. Mayor -71 N .3 ;• N ca MONROE (,C)UNITY ATTORNEY A'J - � AS TO O P RO c YNTHIA L. HALL ASSISTANT LINTY AT ORNE«Y Date �a �a �a cis It Page 4 of 4 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. For 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' 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 an HSA. 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 (80 1 /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 (60 1 /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 Coverage 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 County'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 1/1/2018 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] Monroe County Board of County Commissioners FY 2018 Health Plan Options June 20, 2017 Commission Meeting Packet Pg. 51 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 Packet Pg. 52 Retiree Benefits Provided • Employees hired on or after 10/1/2001 who retire as an active participant in the Plan may continue coverage by paying the monthly premium established annually. • 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 Packet Pg. 53 Expense includes claims plus all administrative expenses Data as of 12/31/16 Packet Pg. 54 Florida Blue Provider Discount Summary 62.0% 61.01 60.01 59.01 58.0% 57.01 56.01 55.01 54.0% 53.01 58.4 vc 56.30 Li L Network Savings 58.8% 61.2% 58.0% A Savi rigs 1 As reported by Florida Blue. 'Packet Pg. 55 Where does Revenue Come From? TOta1 g $17,685,48 PacketPg.56 Historical Fund Balance $16,000,000 $14,385,642 $1.4,000,000 $12,246,242 $11,840,418 8 $12,071,795 $8,271,901 $8,582,608 $11,788,57 $12,000,000 $1.C!"000,o0o $8 $6,000,000 $4 $2,000,000 0 0 .. ... .. ... ... . .... .... . .... ..... S ... 2009 2010111 2011/12 2012 2013114 2014/15 2015116 2016/17 2017/18 Projected Projected Fund Balance 916 Month Target 2017/18 Projected Assumes No Change in Benefits or Funding Data as of 12/31/16 Large Claims Increase FY Ending # of Claimants Over $50K Total Claims for Large Claimants Largest Claim #(firer $250K # Over $480K 2009 18 $1,858,196 $402,792 2 1 2010 20 $2,076,986 $338,544 1 0 2011 22 $2,388,534 $336,742 1 0 2012 27 $2,981,942 $323,462 3 0 2013 35 $3,845,990 $310,603 3 0 2014 34 $3,839,936 $503,159 1 1 2015 43 $5,349,407 $560,607 5 1 2016 50 $6,287,104 $816,745 4 3 2017 YTQ 11 $1 $267 1 0 2017 Ann "d 44 $4,595,030 Packet Pg. 58 O What does this mean for the Health Fund for 2018 FY 2018 Forecasts Baseline FY 18 Forecast Projected Starting Fund Balance $7,595,391 Projected Revenue at Current Funding $18,052,606 Projected Claims $18,264,281 Projected Fixed Costs $1,585,691 Projected Expenses $19,849,972 JProjected Gain/(Loss) ($1,797,366) Projected Closing Fund Balance $5,798,025 Projected Target Fund Balance $9,132,140 Projected Excesst(Shortfall) ($3,334,116) Mn U Mi 0 I Packet Pg. 59 1 We need to recommend changes in premiums or benefits to meet a shortfall of: $3,334,116 To maintain a 6 month reserve amount in the Health Insurance Fund Packet Pg. 60 FY 2018 Options 13 — 13A Dual Options with New High Deductible Health Plan (HDHP) Option I Packet Pg. 61 1 Current Plan Options 13113A: Illustrative HDHP with HSA IFeature N.twrk No. Network Network N o n Network Deductibe - Indim ual Deductib Fardly $400 $800 $400 $800 $21 $4: $4"000 $8000 lCoinsurance 75%1 45% 80 50% Out of Pocket Max Individual Ou t of Pocke t ily Max - Fam $7; $14, $7,150 $14,300 $6,650 $13,300 1 $13,300 $26,600 Phvsician Office Visit Copay $251 Ded/Coinsurance Ded/Goinsurance Ded/Coinsurance ER Co pay $300 bed/Coinsurance Ded/Coinsurance Prescription Drug Deductible Per Member N/A N/A Retail Pharmacy. Copays (After. Deductible for HSA) Genenc Preferred Brand iNon Preferred Brand $10 $50 $90 $10 $50 $90 Mail Order Pharmacy Copays (After. Deductible for HSA) Genenc Preferred Brand iNon Preferred Brand $25 $125 $225 $25 $125 $225 HSA Contribution From County JE E O E � E N/A N/A $500 S$1,000 EatimatGd Cost of Illustrative HSA Plan Relative to i 2017 PPO * 1.000 i i 0.818 I I ' This means the HDHP /HSA is expected to cost 18.2% less in claims than the current PPO I Packet Pg. 61 1 BG"1.4 FY 2018 Option 13 Add HSA Option with Increased Rates for Current Plan Monthly Rate % is the % of the Actuarial Rate (true expected cost) paid by the employee I Packet Pg.62 Current; Dua1Option Hi h Option Current Plan Low Option: HSA Plan Enrollees Monthly Rate; Enrollees Monthly Rate Monthly Rate % Enrollees Monthly Rate > Monthly Rat Employees Paying $25 Premium 616 $25 493 $50 6% 123 $0 0 %d Recent Hires Pay $50 mo prem 556 $50 445 $75 10°% 111 $$0 0 %` 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 ``, 800 $295 64 $352 `` 37% 16 $266 35% Three children only 15' $443 12 $528 37% 3 $399 35% Four children only ! 3 `ss $591 2 ! $704 ! 37% 1 $532 35% RETIREES ONLY: 10+ YRS <65 117 $125 0'' $146 '' 11% 117 $0 0 ° 10' 10+ YRS >65 296 $125 0'' $146 '' 21% 296 $0 0 %! Sur\Qng Spouse < 65 3 $332 0 $395 29% $299 27 % Sur\��ng 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 +I1 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 1 4 1 $295 0 1 $352 1 37% 1 4 1 $266 1 35 % Monthly Rate % is the % of the Actuarial Rate (true expected cost) paid by the employee I Packet Pg.62 FY 2018 Option 13 Add HSA Option with Employees and Retirees Getting Single HSA Coverage for $0 With Increased Premium Rates for Current Plan Packet Pg. 63 BG"1.4 FY 2018 Option 13A Add HSA Option with No Change in Rates for Current Plan Other Than Employee Only at Flat $75 Monthly Rate % is the % of the Actuarial Rate (true expected cost) paid by the employee. Employee Only rate set to $75 for all employees regardless of hire date. Packet Pg. 64 Current: Dual Option Hi h tT tion Current Plan Low Option HSA Plan Enrollees Monthly Rate; Enrollees Monthly Rate Monthly Rate % Enrollees Monthly Rate Monthly Rate a r l o' Employees Paying $25 Premium 617 $25 555 $75 10% 62 $0 0% Recent Hires Pay $50 mo prem 557 $50 501 $75 10% 56 $0 0% EMPLOYEE DEPENDENTS ONLY: Spouse Only 110 $332 99 $332 '' 32% 11 $299 35°% Spouse+ 1 child 37' $480 33 $480 32% 4 $432 35 %' Spouse + 2 or more children 33' ss $701 30' $701 `` 32% 3 $631 35 %`` One child only ', 120 ; $148 108 $148 32% 12 $133 35% Two children only 80 $295 72 $295 32% 8 $266 35% Three '! children only 15 $443 14 $443 '' 32% 1 $399 35°fo'' Four children only 3'' $591 3; $591 32% 0 $532 35 %'' RETIREES ONLY 10+ YRS <65 117 $125 105 $125 !' 9% 12 $0 0% !' 10+ YRS >65 296 $125 266 $125 '' 18% 30 $0 0% Surviving Spouse < 65 3'! $332 3'! $332 '! 25% $299 27% Surviving Spouse 65+ 6'! $559 5'! $559 '! 81% 1 $503 89°fo'' RETIREE DEPENDENTS ONLY: Spouse Only <65' 34' ss $332 31" $332 ss ss 25% ss 3 $299 27°!0 >' Spouse only <65!+ 1 child 2' ; $480 2' $480 27% 0 $432 29 %' Spouse only <65+ 2 or more children 1' $, $701 1' $701 28% 0 $631 31 %'' Spouse Only >65 18 $559 16 $559 '! 81% 2 $503 89% Two children only 1 4 1 $295 4 1 $295 '' 32% 1 0 1 $266 1 35°% Monthly Rate % is the % of the Actuarial Rate (true expected cost) paid by the employee. Employee Only rate set to $75 for all employees regardless of hire date. Packet Pg. 64 FY 2018 Option 13A Add HSA Option with Employees and Retirees Getting Single HSA Coverage for $0 and No Increase for Current Plan Packet Pg. 65 FY 2018 Option 29 Increase PCP, Behavioral Health, and Pre /Post Natal Copay to $30 (from $25) Baseline claim projection for FY 2018 $18,264,281 Projected % Savings 0.17% Projected Annual Impact $31 Projected 9 Month Impact $23 Packet Pg. 66 FY 2018 Option 2A Increase Urgent Care Copay from $25 to $50 Expected to reduce claims costs by 0.05 %. Packet Pg. 67 FY 2018 Option 30 Add $10 Copay for Independent Clinical Lab (Quest) Estimated Utilization Total Lab /Path Utilization per 1000 1,116 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 Packet Pg. 68 FY 2018 Option 3 Add $100 Annual Pharmacy Deductible Would apply to each individual covered, so all family members would be subject to this deductible. Expected to reduce claim costs by 0.9% Packet Pg. 69 FY 2018 Option 3A Add $100 Annual Pharmacy Deductible Limited to 2 Per Family $172,757 Family maximum of $200. Packet Pg. 70 FY 2018 Option 31 Increase Generic Drug Copay to $15 (from $10) Baseline claim projection for FY 2018 $18,264,281 Projected % Savings 0.63 % Projected Annual Impact $115 Projected 9 Month Impact $86 Packet Pg. 71 FY 2018 Option 28 Add $150 Per Month Smoker Surcharge Enrollment Date Prior to 1/1/2015 1/1/15 or Later Total' Total Cored Employees 1,415 176 1,591 Total Co \ered Dependents 702' 124' 826' Total Co \ered Members 2,117 300 2,417' Current Smoker Surcharge $0 $50 Illustratke Smoker Surcharge $150 $150 Estimated Smoking % - Employee 10% 10% Estimated Smoking % - Dependents 5 %`' 5 %' Estimated Smokers 174 23 197' Current Total Monthly Surcharge $0 $1,168 $1,168 Illustratke Total Monthly Surcharge $26,111 $3,503 $29,614 Annual Increase in Surcharge $341,355 9 -Month Increase in Surcharge $256,017 Current surcharge is $50 per month for members enrolled on 11112015 or later I Packet Pg.72 FY 2018 Option 22 Increase Brand Drug Copays to $60/$100 (30 day) and $150/$250 (90 day) Baseline claim projection for FY 2018 $18,264,281 Projected % Savings 0.51% Projected Annual Impact $93,148 Projected 9 Month Impact $69,861 Packet Pg. 73 FY 2018 Option 37 All Employees Pay $75 for Employee Coverage Packet Pg. 74 FY 2018 Option 38 Monthly Premium for Each Covered Employee, Retiree, and Dependent is $200 F Pe,,k,t Pg. 75 Enrollees Monthly Rate Enrollees Monthly Rate Employees Paying $25 Premium S 616 j.$25 616 Recent Hires Pay $50 mo prem <I 556 $50 556 EMPLOYEE DEPENDENTS ONLY: Spouse Only 110 $332 110 Spouse 1 child S 37 $480 37 Spouse 2 or more children 33 $701 33 One child only S 120 $148 120 Two children only 80 $295 80 Three children only 15 $443 15 'Our children only 3 $591 3 RETIREES ONLY 10- YRS 165 117 $125 117 10 YRS >65 296 $125 296 Surviving Spouse l< 65 3 $332 3 Surviving Spouse 65 6 $559 6 RETIREE DEPENDENTS ONLY Spouse Only <65 34 $332 34 Spouse only <65a+ 1 child 2 $480 2 Spouse only <65`+ 2 or more children 1 $701 1 Spouse >65 'y ' 1 4 ' 59 1 8 TTwo children n', $295 4 F Pe,,k,t Pg. 75 FY 2018 Option 38A Monthly Premium for Each Covered Employee, Retiree, and Dependent is Greater of $200 and Current Rate 'Packet Pg. 76 Current 3 Illustrative Flat $204 Premium i En rollees t Mnthlv Rate t Enrollees MnthIV Rate i Employees Paying $25 Premium .616 $25 616'. ....... ,: Recent Hires Pay $50 mo prem 7:556 $50 556'. EMPLOYEE DEPENDENTS ONLY Spouse Only <: 110 $332 110'. $332'. Spouse .+ 1 child ? ? 37 $480 37 ? $480: Spouse .'+ 2 or more children '. 33 $701 33 '. $701';. One child only 'Jl 120 $148 120',, T— children only ? 80 $295 80 -' ... ... .:'.. Three children only :: 15 $443 15 :. Four children only 3 $591 3 RETIREES ONLY 10+ YRS <65 :I' 117 $125 1171' 10+ YRS >65 >;. 296 $125 296''. Surviving Spouse < 65 ': 3 $332 3 ': $332'. Survive ng Spouse. 65+ ? 6 $559 6 ? $3321: RETIREE DEPENDENTS ONLY Spouse Only <65(: '< 34 $332 34'< $3321. Spouse only <65 '+ 1 child '. '. 2 $480 2 '. $480'. Spouse only <65 f+ 2 or more children 1 $701 1 7 $701''. Spouse'Ony >65' ? 18 $559 18 ' $559' T— children on :: 4 $295 4 '. 'Packet Pg. 76 FY 2018 Option 6 No Subsidy for Dependents of Any Retirees Subsidy for Medicare eligible spouses has already been discontinued. Packet Pg. 77 FY 2018 Option 6A 40% Subsidy for Dependents of Retirees Other Than Medicare Eligible Spouses Tier Covered Current Rate Revised Rate Spouse -65 37 $332 $628 1 Child 5 $148 $279 * Children 4 $295 $558 * Children 2 $443 $837 Spouse -65 & 1 Child 2 $480 $907 Spouse - >. 65 + >. Childre 1 1 $701 $1,325 Total Annual 51 $201,012 $380,112 Annual SaxAngs $179,100 9 Month Savings $134,325 Subsidy for Medicare eligible spouses has already been discontinued. I Packet Pg. 78 1 FY 2018 Options 6B & 6C Current and Future Actives Satisfying Rule of 70 Packet Pg. 79 Assumed N u mber Retiring Actives Satisfying Rule Current No Dependent 40 Dependent Year Tier of 70 Subsidy Subsidy (613) subsidy (6C) 1 Employee 47 19 19 19 Spouse 14 6 1 3 Children 31 6 3' 3 2 Employee 57 29 29 29 Spouse 15 8 2' 4 Children 33 8 3' 5 3 Employee 62 37 37 37 Spouse 16 10 2' 5 Children 35 11 4 7 Packet Pg. 79 FY 2018 Option 6B No Subsidy for Dependents of Any Future Retirees No subsidy for dependents of any retirees - (Rule of 70 retiree dependents and non -rule of 70 retiree dependents) — (with the exception of Rule of 70 retirees who retired prior to 1/1/18 whose spouse will remain subsidized at the overall dependent subsidy rate). Subsidy for Medicare eligible spouses has already been discontinued. Packet Pg. 80 FY 2018 Option 6C 40% Subsidy for Dependents of Future Retirees Other Than Medicare Eligible Spouses Tier Covered Current Rate Revised Rate Spouse -65 37 $332 $628 1 Child 5 $148 $279 * Children 4 $295 $558 * Children 2 $443 $837 Spouse -65 & 1 Child 2 $480 $907 Spouse - >. 65 + >. Childre 1 1 $701 $1,325 - 1 - 6tal Annual 51 $201,012 $380,112 Annual SaxAngs $179,100 9 Month Savings $134,325 40% subsidy for dependents of any retirees - (Rule of 70 retiree dependents and non-rule of 70 retiree dependents) — (with the exception of Rule of 70 retirees who retired prior to 1/1/18 whose spouse will remain subsidized at 60% dependent subsidy rate). Subsidy for Medicare eligible spouses has already been discontinued. I Packet Pg. 81 1 FY 2018 Option 18 Spouse of Retirees Pay 100% of Actuarial Rate if Spouse has Access to Coverage Through His /Her Own Employer Premium for a spouse of a retiree with access to other coverage would increase from $332 to $1046. Packet Pg. 82 FY 2018 Option 18A Spouse of Employees or Retirees with Access to Coverage Through His /Her Own Employer Are Ineligible for County Dependent Subsidy Packet Pg. 83 FY 2018 Option 7 No Subsidy for Pre -65 Retirees Hired Prior to 2001 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. Packet Pg. 84 FY 2018 Option 7A Rule of 70 Retiree Subsidy Based on Years of Service Years of Service Retiree Contribution 25+ FRS HIS ($125 to $150 - same as current) 20 -24 25% of Actuarial Rate 10 -20 50% of Actuarial Rate Packet Pg. 85 FY 2018 Option 7A Rule of 70 Retiree Subsidy Based on Years of Service Packet Pg. 86 FY 2018 Option 8 Pre -65 Retirees Hired Prior to 2001 Pay 50% of Actuarial Rate 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. Packet Pg. 87 FY 2018 Option 4A Provide $250 Subsidy to Medicare Eligible Retirees But Require Them to Pay the Full Actuarial Rate of $697 This would increase the retiree rate for Medicare retirees to approximately $447 per month ($697 actuarial rate - $250 subsidy). HIS supplement would serve to reduce the out of pocket cost. We expect a majority would leave the plan in favor of Medicare Supplement or Medicare Advantage plans. Packet Pg. 88 FY 2018 Options 4A/4B Summary of 2017 Medicare Supplement Plans WM1at R— Medicare Supplement Insurance policies pay: MEDICARE —ES—T PAY_ Band C— Bantl Mantl A s— select 51- F G K L 1e1- N Medicare Para A: Hospital Sernces & Cr B� Mi S1,— n1-1 hospital deductible (Part AdeduttI —) —h benefit period r r r r v v r r r S— p- day cci nsura nce fo r d a 61 l -9C In' hospital r r r v r r r r v r $649 per Ca y coinsurance for days 91 - 1501n a hospital r r r v r v r r 1CC %of M—, are - allowable expenses fo r addition. 1365 days Medicare hospital benefit' step icmpletely $161 per day Coinsurance fo r days 2l -1 CCIn a Sk111ed Nursing Fatilrtylrr Calendar year bl— deductlble((Irst three plots of bcod) iftha detluctlble r r ,� v r r r r v r 1s nc met by you replacing the blcod (also in Chides any Part B ch —g—) I_ coverage of Hospice Care (also in Cl ud es any Part B charges) $166 ca lender year Part B deductible Generally, 20% cf the Medlcaraapp— pro thecase of hospital outpatient de specti— payment system, the "" ""-charge' of excess Charge Part 9 cha ")e 'n —ti anal Benefits — Covered by —fit, for modic a11, C "s care n country (after a $250 CeduCtlble i' met? Z" f- pockethmF respoi red szrvices until the annual cut -c On e reached, plue Mzdicare Supplem copays antl colnsuran Ce fcr the rest of Packet Pg. 89 FY 2018 Options 4A/4B Summary of Plan F Benefits Part A Services Medicare Pays Plan Pays You Pay HOSPITALIZATION' First 60 days All but $1,316 $1,316 (Part A Deductible) $0 61n thru 10t' day All but $329 a day $329 a day $0 91n day and after: All but $658 a day $658 a day $0 —While using 60 lifetime reserve days — Once lifetime reserve days are used: • Additional 365 days • Beyond the additional 365 days $0 1 % of Medicare eligible expenses $0.. $0 $0 All costs SKILLED NURSING FACILITY CARE' First 20 days All approved amounts $0 $0 21n thru 100th day All but $164.50 aday Up to $164.50 a day $0 101n day and after $0 $0 All costs BLOOD First 3 pints $0 3 pints $0 Additional amounts 100% $0 $0 HOSPICE CARE You must meet Medicare's requirements, including a All but very limited copayment/ Medicare copayment/ $0 doctor's certification of terminal illness. coinsurance for outpatient drugs and coinsurance inpatient respite care. Packet Pg. 90 BG1.4 FY 2018 Options 4A/4B Summary of Plan F Benefits Part B Services Medicare Pays Plan Pays You Pay MEDICAL EXPENSES — IN OR OUT OF THE HOSPITALAND OUTPATIENT HOSPITAL TREATMENT First $183 of Medicare Approved amounts' $0 $183 (Part B Deductible) Generally $0 Remainder of Medicare Approved amounts Generally 80% 20% $0 PART B EXCESS CHARGES (Above Medicare - approved amounts) $0 100% $0 BLOOD First 3 pints $0 All costs $0 Next $183 of Medicare Approved amounts' $0 $183 (Part B Deductible) $0 Remainder of Medicare Approved amounts 80% 20% $0 CLINICAL LABORATORY SERVICES — Tests For Diagnostic Services 100% $0 $0 Packet Pg. 91 FY 2018 Options 4A/4B Summary of Plan F Benefits Other HOME HEALTH CARE MED— Medically necessary skilled care services and medical supplies 100% $0 $0 ICARE APPROVED SERVICES — Durable medical equipment: • First $183 of Medicare Approved $0 $183 (Part B $0 amounts' $0 Deductible) 20% and amounts • Remainder of Medicare Approved 80% 20 % $0 amounts of $50,000 lifetime maximum FOREIGN TRAVEL— NOT COVERED BY MEDICARE Medically necessary emergency care services beginning during the first 60 days of each trip outside the USA First $250 each calendar year $0 $0 $250 Remainder of Charges $0 80% to a lifetime 20% and amounts maximum benefit over the $50,000 of $50,000 lifetime maximum Packet Pg. 92 FY 2018 Options 4A/4B Summary of Florida Blue Prescription Drug Plans Plan Cost. option I Option 2 $79.40 (You must continue to pay your $172.00 (You must continue to pay your Monthly plan premium Medicare Pan B premium.) Medicare Pan B premium.) Thisplan does not have a you have to pay before o' uary l toDecem December Calendar Year (January our share o prescription pay f your istion drug claims. to 31) Deductible plies all drug tiers $335 -A copay is fi-d — ($20, f.,pk) y..p.yf.,d ripfi.. drug Copays and coinsurance —varies by tier Coi.__isthc Pcrccourev Y_Pryfmr.rvicc, such r"', for the coat ofa • specialty prescription drug. What You Pay al , What You Pay at a What You Pay at a What You Pay at Preferred P P'harmacy Standard Pharmacy Preferred Pharmacy Standard Pharmacy Initial Coverage Stag. (Total Drug Cost paid by beneficiary and plan is from $0 to $3700) Tier I - preferred generic $2 copay $9 copay $3 copay $10 copay Tier2 - generic $13 copay $20 copay $10 copay $17 copay Tier3 - preferred brand $40 copay $47 copay $40 copay $47 copay Tier4 - non-preferred brand $93 copay $100 copay $93 copay $100 copay 26% coinsurance (you pay 26% of the cost of the drug) 33% coinsurance (you pay 33% of the cost of the drug) Tier 5 - specialty I Mail order (have your drugs delivered to you at home) lame c Preferred Pharmacy listed above for lame copaysa Preferred Pharmacy listed above for one-m o h s up y one- m onth s up y I Packet Pg. 93 1 BG1.4 FY 2018 Options 4A/4B Summary of Florida Blue Prescription Drug Plans 'Packet Pg. 94 What You Pay at What You Pay at What You Pay at What You Pay at Coverage Gap stage (Begins when total drug a Preferred a Standard a Preferred a Standard cost paid by beneficiary and plan reaches $3700 Pharmacy Pharmacy Pharmacy Pharmacy and continues until total beneficiary out of p ocket expense reaches $4,950) Greater of $3.30 copay or 5% Greater of $3.30 copay or 5% Tiers 1, 2 and 5 - generic (preferred and coinsurance (you pay no more than 5% of 51 % coinsurance (you pay 51 % of the no more than 5% of specialty) Tier 1 - preferred generic cost of the drug) $3 copay $10 copay 51 % coinsurance (you pay 51 % of the Greater of $8.25 copay or 5% Tiers 3, 4 and 5 -brand (preferred, non- Tier2 - generic cost of the drug) $10 copay $17 copay Tiers 3, 4 and 5 - generic (preferred, non- 51 % coinsurance (you pay 51 % of the 51 % coinsurance (you pay 51 % of the preferred, specialty) cost of the drug) cost of the drug) Tiers 3, 4 and 5 - brand (preferred, non- 40% coinsurance (you pay 40% of the 40% coinsurance (you pay 40% of the preferred, specialty) cost of the drug) cost of the drug) 'Packet Pg. 94 What You Pay at What You Pay at What You Pay at What You Pay at Catastrophic Coverage Stage (Begins when a Preferred a Standard a Preferred a Standard beneficiary reaches out of pocket cost of Pharmacy Pharmacy Pharmacy Pharmacy $4,950) Greater of $3.30 copay or 5% Greater of $3.30 copay or 5% Tiers 1, 2 and 5 - generic (preferred and coinsurance (you pay no more than 5% of coinsurance (you pay no more than 5% of specialty) the cost of the drug) the cost of the drug) Greater of $8.25 copay or 5% Greater of $8.25 copay or 5% Tiers 3, 4 and 5 -brand (preferred, non- coinsurance (you pay o no more than 5% of coinsurance (you pay o no more than 5% of preferred, specialty) the cost of the drug) the cost of the drug) 'Packet Pg. 94 FY 2018 Option 4A Provide $250 Subsidy to Medicare Eligible Retirees But Require Them to Pay the Full Actuarial Rate of $697 Note that Medigap premiums are higher for smokers Packet pg. 95 Medicaria Supplement Plan F t Prescri Lion Plan 2 Plan F Plan 2 i Total MontMly A cl� Mnnthl PUP M ©nthl Premium 65 '.$196 70 $17200 $36870 66 '. $20&50 $17200 'I '. $372 '. 67 $205.60 $172.00 'I $377-60 68 $210 70 $172.00 'I $382-70 'I 69 $215.70 $172.00 'I $387-70 70 - 71 $223.00 $172.00 'i $395.00 72-74 $236.20 $172.00 $408.20 75-79 $253.60 $172.00 $425.60 80+ $284.40 $172.00 $456.40 LL�surnI9CI Count. Subsid II$250 E)istribution of Medicare Eligible Retirees by YOS YOS 4 AvEerage YOS 17.5 10 38 AvEera e HIS 1 $87.72 11-15 97 16 -20 70 21-25 55 26 -29 10 30+ 26 Note that Medigap premiums are higher for smokers Packet pg. 95 FY 2018 Option 4A Provide $250 Subsidy to Medicare Eligible Retirees But Require Them to Pay the Full Actuarial Rate of $697 Medigap Plan Plan > F YOS 10 17.5 30' A'' e 65 $68.70 ! $30.98 66 $72.50 $34.78 67 $77.60 > $39.88 68 $82.70 $44.98 69 $87.70 ! $49.98 70-71 $95.00 $57.28 72-74 $108.20 $70.48 $8.20 75-79 $125.60 $87.88 $25.60 80+ 1 $156.40 $118.68 $56.40 Premium to Stay F on County Plan $397.00 ? $359.28 $297:!00 Note that Medigap Premiums are higher for smokers Packet Pg. 96 FY 2018 Option 4B Provide $200 Subsidy to Medicare Eligible Retirees But Require Them to Pay the Full Actuarial Rate of $697 This would increase the retiree rate for Medicare retirees to approximately $497 per month ($697 actuarial rate - $200 subsidy). HIS supplement would serve to offset this. We expect a majority would leave the plan in favor of Medicare Supplement or Medicare Advantage plans. Packet Pg. 97 FY 2018 Option 4B Provide $200 Subsidy to Medicare Eligible Retirees But Require Them to Pay the Full Actuarial Rate of $697 Note that Medigap premiums are higher for smokers Packet pg. 98 FY 2018 Option 4B Provide $200 Subsidy to Medicare Eligible Retirees But Require Them to Pay the Full Actuarial Rate of $697 Medigap Plan Plan F YQS 10 17.5 30' Age 65 $118.70 $80.98 $18.70 66 $1!22.50 $84.78 $22_50 67 $1!27.60 $89.88 $27!.60 68 $132.70' $94.98 $32.70 69 $1137.70' $99.98 $37.70 70-71 $145.00s $107.28 $45.00 72-74 $158.20 $120.48 $58.20 75-79 $175.60: $137.88 $75`.60 80+ $206.40; $168.68 $106.40 Premium to stay on County Plan $447.00' $409.28 $347_00 Note that Medigap premiums are higher for smokers 'Packet Pg. 99 FY 2018 Option 15 Change to EGWP from RDS for Medicare Retiree Pharmacy Delivery If Medicare eligible retirees are steered to Medicare Supplement or Medicare Advantage plans that provide prescription drug coverage, these savings will be reduced or eliminated Packet Pg''.1 ©D BG7.4 FY 2018 Option 19 Conduct Dependent Eligibility Audit 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 $261,130 9 Month Savings $146,886 $244,810 $195,848 Packet Pg'.101 FY 2018 Option 34 Replace Current Drug Formulary with Select Formulary 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 a Option 34 is implemented. Only 1 of these 2 options could be selected. Packet Pg',162 FY 2018 Option 36 Exclude Coverage for Drugs Available Over - the - Counter (OTC) Includes the following classes of drugs • Antihistamines (Claritin, Zyrtec) • PPIs (Nexium) • NSAIDs (Ibuprofen, Naproxen) • Nasal Corticosteroids (Flonase) Packet Pg'.103 FY 2018 Option 39 Ask Clerk to Conduct Claim Audit Packet Pg'.104 FY 2018 Option 40 Exclude CVS from Pharmacy Network for All Prescriptions Packet Pg'.105 Menu of Benefit and Contribution Changes Benefit Recommended BOCC Meeting BENEFIT CHANGES -ALL COVERED LIVES IMPACTED CONTRIBUTION CHANGES PLAN MANAGEMENT/ADMINISTRATIVE CHANGES Packet Pg'.166 Summary of 2018 Illustrative Contributions For Option 7A, contributions vary by years of service Estimated averages are $141 for employees with 25+ years $199 for 20 -24 years, and $399 for 10 -19 years of servi Packet Pg'.107 Current Option 4A Option 48 Option 6' Option 6A Option 71 Option 7A Option 8 Option 37 Option 38 Option 38A Employees Paying ''$25 Premium $25 $25 $25I $25I $25 $25 $25 $25 $75 $200 $200 Recent Hires Pay $50 mo prem $50 `` $50 `` $50ss $50ss $50 $50 $50 $50 $75 $200 $200' EMPLOYEE DEPENDENTS ONLY: Spouse Only $332 $332 '' $332'' $332'' $332 $332 $332 $332 $332 $200 $, $332` Spouse '+ 1 child $480 $480 $480' $480' $480 $480 $480 $480 $480 $400 $480,' Spouse + 2 or more children ! $701 $701 '! $701'! $701'! $701 $701 $701 $701 $701 $600 $701' One child only $148 $148 '' $148'' $148'' $148 $148 $148 $148 $148 $200 $200' Two children only $295 $295 $295 $295 $295 $295 $295 $295 $295 $400 $400 Three children only ss $443 `` $443 `` $443`` $443`` $443 $443 $443 $443 $443 $600 $600' Four children only ``, $591 $591 `` $591; $591 `` $591 $591' $591 $591 $591 $800 $800' RETIREES ONLY: 10+ YRS <65 $125 '' $125 $125' $125' $125 $1,035 $298 $518 $1,25 $200 $200' 10+ YRS >65 $125 $447 $497' $125'' $125 $125 $298 $125 $125 $200 $200' Sur\nvring Spouse < 65 $332 $332 '' $332'' $332'' $332 $332 $332 $332 $332 $200 $332' Sur\nving Spouse 85+ $559 $559 $559` $559` $559 $559 $559 $559 $559 $200 $332, RETIREE DEPENDENTS ONLY: Spouse Only <65 ss ss $332 ss $332 ss $332ss $1,046 $628 $332 $332 $332 $332 $200 ss $332' Spouse only <65 +! 1 child $480 $480 $480 $1 512 $907 $480 $480 $480 $480 $400 $480 Spouse only <65 +!2 or more children $701 $701 $701' $2,208 $1,325 $701 $701 $701 $701 $600 $, $701 Spouse Only >65 '! $559 ! $559 '! $559'! $697' $697 $559 $559 $559 $559 $200 $559ra Two children only 1 $295 '' $295 '' $295'' $930' $558 $295 $295 $295 $295 $400 $400' For Option 7A, contributions vary by years of service Estimated averages are $141 for employees with 25+ years $199 for 20 -24 years, and $399 for 10 -19 years of servi Packet Pg'.107 Summary of 2018 Illustrative Dual Option W Contributions V Packet Pg'.108 Current 4 tion PPO 13 ; "D"P Opti o PPO 13A HDHP' Employees Paying $25 Premium $25 $50 $0 $75 $0 Recent Hires Pay $50 mo,',prem $50 $75 $O $75 $',0 EMPLOYEE DEPENDENTS ONLY: Spouse Only $332 $396 $299 $332 $299 Spouse + 1 child $480 $571 $432 $480 $432 Spouse + 2 or more children $701 $835 '' $631 $701 '' $631 One child only $148 $176 $133 $148 `` $133'' Two children only $295 $352 $266 $295 $266 Three children only $443 $528 '' $399 $443 '' $399' Four children only`, $591 $704 $532 $591 `` $532'' RETIREES ONLY: 10+ YRS <65 $125 $146 $0 $125 $0I' 10+ YRS -65 $125 $146 '' $O $125 $0'' Surviving Spouse < 65 $332 $395 $299 $332 $299 Surviving Spouse 65+ > $559 $600 $503 $559 $503' RETIREE DEPENDENTS ONLY: Spouse Only <65 '' $332 $396 $299 $332 '' $299 Spouse only <65 + 1 child $480 $571 $432 $480 `` $432 Spouse only <65 + 2 or more children $701 $835 $631 $701 $631 Spouse Only X65 $559 $600 $503 $559 $503 Two children only', $295 ss $352 $266 $295 $266'' Annual County Contribution to HSA EE N/A N/A $500 N/A $500 EE + Dependents < N/A N /A $1,000 N/A ss $1,000'' Packet Pg'.108 Options Initially Voted Down by Board Packet Pg'.109 FY 2018 Option 1 Increase Calendar Year Deductible from $400/$800 to $600/$1200 Expected to reduce claims costs by 1.6 %. Packet Pg'.11D BG7.4 FY 2018 Option 2 Increase Specialist Copay from $25 to $50 Expected to reduce claims costs by 0.45 %. Packet Pg'.111 FY 2018 Option 23 Increase Specialty Drug Copay to 25% to Maximum of $300 Baseline claim projection for FY 2018 $18 Projected % Savings 0.12% Projected Annual Impact $21,917 Projected 9 Month Impact $16,438 Packet Pg'.112 FY 2018 Option 5 Reset Dependent Contributions to 50% of Actuarial Rate at Current Costs Option 10 has a different dependent contribution illustration. Only 1 of these 2 can be selected. Packet Pg'.113 FY 2018 Option 10 Set Dependent Contributions to 60% of Actuarial Rate at Current Costs Option 5 has a different dependent contribution illustration. Only 1 of these 2 can be selected. Packet Pg'.114 FY 2018 Option 9 Active Employees Pay $50/$75 for Employee Coverage (Currently $25/$50) Option 24 has a different employee contribution illustration. Only 1 of these 2 can be selected. Packet Pg'.115 FY 2018 Option 24 Increase Active EE Contributions from $25/$55 to $65/$95 (10% actuarial value) Projected Actuarial Pate 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 % 4.5 0 /6 9.9 0 /0 9 Month Impact $ 442,440 Option 9 has a different employee contribution illustration. Only 1 of these 2 can be selected. Packet Pg'.116 FY 2018 Option 4 Charge Full Annual Amount of Health Insurance to Medicare Eligible Retirees 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. Packet Pg'.117 FY 2018 Option 11 Set Premium for Rule of 70 Retiree Only Coverage to a Flat $200 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. Packet Pg'.118 FY 2018 Option 17 Increase Rule of 70 Retiree Contributions to a Flat $150 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. Packet Pg'.119 FY 2018 Option 25 Increase Retiree Contributions to 20% of Actuarial Value Option 17 and 26 have different retiree contribution illustrations. Only 1 of these 3 can be selected. Packet Pg!.120 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 $65,510 Monthly Impact 9 Month Impact $13,885 $124 Option 17 and 26 have different retiree contribution illustrations. Only 1 of these 3 can be selected. Packet Pg!.120 BG7.4 FY 2018 Option 16 Discontinue Dependent Subsidy for Employees Hired After 10/1/17 Options 32 has different dependent subsidy illustrations. Only 1 of these 2 can be selected. Packet Pg!.121 FY 2018 Option 32 Reduce Dependent Subsidy for New Hires to 50% (currently projected to be 68 %) FY 18 FY 19 FY 20 Impact of Eliminating Current Subsidy $139 $590 $997 Impact of Reducing Subsidy to 50% (18% reductioi $36,706 $155,795 $262,934 Option 16 also involves a change to the dependent subsidy for future hires. Only 1 of these 2 options could be selected. Packet Pg!.122 FY 2018 Option 12 Add HSA Option with Employees Getting Single HSA Coverage for $0 Monthly Rate % is the % of the Actuarial Rate (true expected cost) paid by the employee I Packet Pg'.123 High Option (Current Plan) Low Option (HSA Plan) Enrollees) Monthly Rate _` Enrollees Monthly Rate; Month Rate % Enrollees Monthly ' Rate Monthly Rate % Employees;, Paying $25 Premium 616 $25 493 ? $50 64% 123 $0 0% ? Recent Hires Pay $50I 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 'I $146 11% 23 $75 12% 10+ YRS >65 296 $125 237 '' $146 21% 59 $76 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 I Packet Pg'.123 FY 2018 Option 12 Add HSA Option with Employees Getting Single HSA Coverage for $0 Options 13, 14, and 33 have different high deductible dual option illustrations. Only 1 of these 4 can be selected. Packet Pg!.124 BG"1.4 FY 2018 Option 14 Add High Deductible Option Based on Monroe County Schools Plan Monthly Rate % is the % of the Actuarial Rate (true expected cost) paid by the employee I Packet Pg'.125 Current; Dual Option Hi h Option Current P[an) Low Option HSA Plan Enrollees Monthly Rate Enrollees Monthly Rate Monthly Rate A la Enrollees Monthly Rate Monthly Rate A la' Employees Paying $25 Premium 616 $25 493 $50 ! 64% 123 $25 4% Recent Hires Pay $50 mo prem 556 $50 446 $75 58% ill $25 4% EMPLOYEE DEPENDENTS ONLY: Spouse Only 110 $332 88 $385 '! 37% 22 $299 32°10'' 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°10 >' RETIREES ONLY 10+ YRS <65 117 $125 94 $139 '! 10% 23 $75 11 %'' 10+ YRS >65 296 $125 237 $139 !' 20% 59 $75 11% SuN ing Spouse < 65 3> $332 2> $385 29% $299 25°lo`ss SuNving Spouse 65+ 6 ! < $559 5 ! $589 ! < 85% 1 $503 82 %` RETIREE DEPENDENTS ONLY: Spouse Only <65 34 $332 27' $385 ! 29% 7 $299 25 %'i Spouse only <65 »+ 1 chid 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 1 $343 >. 37% >. 1 1 $266 1 32°10 >' Monthly Rate % is the % of the Actuarial Rate (true expected cost) paid by the employee I Packet Pg'.125 FY 2018 Option 14 Add High Deductible Option Based on Monroe County Schools Plan Options 12, 13, and 33 have different high deductible dual option illustrations. Only 1 of these 4 can be selected. Packet Pg!.126 FY 2018 Option 33 Add High Deductible Plan with HRA (Same Plan Design as Option 12) 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. Packet Pg. 127 FY 2018 Option 20 Implement Mandatory Generic Pharmacy Benefit 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. Packet Pg!. 128 FY 2018 Option 21 Implement Expanded Step Therapy Plan already has this for some therapies Expect limited impact of additional requirements 0.5% Expected Annual $ Impact $21,963 Estimated 9 Month Impact $16,473 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. P�4ketp --NAL-- �-�� ~� �� Option �� [- � �- � ^^ K � U �� K � �� U�� ~� -� � Look at Mandatory Use of 90-Day Supply for Maintenance Drugs N � � � Projected $ Impact $142,920 $199,587 $213,559 a; � PZ � � Mn � 8 Current use of 90-day retail is high and we do not see any real savings potential forjust requiring mandatory mail order or9U'dayretail. 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 drivenbuthe improved discounts. This would effectively require members to use Walgreen's for retail maintenance medications and would require members to pay the 90-day copay up front rather than the 3 monthly copayo' Then«l� effect is a |onvercopay but the higher upfront coot may be a hardship for some rnernbero' Packet Pg. 130 Nc)n Pr4afEwr4ad Brand $90 $225 � � Mn � 8 Current use of 90-day retail is high and we do not see any real savings potential forjust requiring mandatory mail order or9U'dayretail. 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 drivenbuthe improved discounts. This would effectively require members to use Walgreen's for retail maintenance medications and would require members to pay the 90-day copay up front rather than the 3 monthly copayo' Then«l� effect is a |onvercopay but the higher upfront coot may be a hardship for some rnernbero' Packet Pg. 130 Original Premium Illustrations Packet Pg!.131 Summary of 2018 Illustrative Contributions I Packet Pg. 132 1 Current Option 4 pp!tn , 5 ion j 6A ion 7 2edon 7A Option 8 Option 9 Option 10 Option fl Option 16 Option V Option 24 Option 25 Option 26 Option 27 Option 32 Employees Paying $25 Prernurn $25 $25 $25 _2RqE $25 . 2g $25 . 2�ion $25 . 2 $25 $25 $25 $50 $25 $25 $25 $25 $65 $25 $25 $75 $25 Recent Hires Pay W rno preen $50 $50 $50 1 $50 ss $50 ss $50 $50 $50 ss $50 $75 $50 $50 ss $50 $50 $95 $50 ss $50 $75 $50 EMPLOYEE DEPENDENTS ONLY: Spouse Only $332 $332 $332 $523 $332 $332 $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 $1,104 $701 $701 $701 $701 $701 $701 $1,325 $701 $2,209 $701 $701 $701 $701 $701 $1,104 One child 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 $43 $697 Four children only $591 $591 $591 $930 $591 $591 $591 $591 ss $591 $591 $1,116 $591 $1,860 $591 $591 $591 $591 $591 $930 RETIREES ONLY: 10+ YR$ <65 $125 $125 $125 $125 $125 $125 $1,035 $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 RETIREE DEPENDENTS ONLY: Spouse Only <65 $332 $332 $332 $332 $1,046 $628 $332 $332 $332 $332 $3K $332 $332 $332 $332 $332 $332 $332 $332 Spouse only <65 + I child $480 WO $480 $0 $1,512 $907 WO $480 W $480 $480 $480 $480 $480 $4 0 4 $480 Spouse only <65 + 2 or more children $701 $701 $701 $701 II $2,208 $1,325 $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 Two children only 1 $295 $295 $295 $295 $930 $558 $295 $295 $295 $295 $295 $295 $295 $295 $295 $295 $295 For Coon 7A, contributons vary by years of'service. Estimated averages are $141 for emooyees Wt h 25+ years, $199 for 2024 years, and $399 for 1019years of service For 00on 26, con(tributions are $50 for retrees A 20+ years of service and $150 for rebrees A 10.20 years of service The following Opbons apply only to new hires: Oodons 16, 27, and 32 I Packet Pg. 132 1 Summary of 2018 Illustrative Dual Option W Contributions V Packet Pg!.133 Current Option 12 O tion 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 preen $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 o more children `` ss $701 ss $832' $631 ss$832 ss $631 !' $813' $631 One child only $148 $175 $133 $175 $133 $171 $133 Two children only $295 $351'J $266 $351 $266 $343' $266 Three children only ``, $443 `` $526 $399 ss$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 ss $332 ss $394 $299 ss$394 $299 !' $385' $299 Surviving Spouse 65+ $559 $598 $503 $598 $503 $589' $503 >' RETIREE DEPENDENTS ONLY: Spouse Only <65 ss $332 $394 $299 ss$394 ss $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 N/A N/A $500 N/A $500 N/A NIA EE + Dependents N/A N/A $1,000 N/A $1,000 N/A N/A Packet Pg!.133 Bene • Contributio Rec ommended • i B OCC Meeting PLAN MANAGEMENT/ADMINISTRATIVE CHANGES BEIM �� F . - IT ] Packet.Pg. 134 '. � .A J • FSA Sec. 112.0801, Group insurance; participation by retired employees *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 I st 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 Page 1 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, eff. July 1, 2007; Laws 2007, c. 2007 -100, § 1, eff. 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. r • FSA Sec. 112.0801, Group insurance; participation by retired employees 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 Page 2 of participation in any group insurance plan or self - insurance plan provided under s. 110.123 or s. 112.080 1, 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. 112.080 1, 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.