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Item B1County of Monroe BOARD OF COUNTY COMMISSIONERS l�l Mayor Heather Carruthers, District 3 The Florida Keys Mayor Pro Tem George Neugent, District 2 y Danny L. Kolhage, District 1 David Rice, District 4 Sylvia J. Murphy, District 5 County Commission Meeting September 6, 2016 Agenda Item Number: B.1 Agenda Item Summary #1898 BULK ITEM: No DEPARTMENT: Employee Services TIME APPROXIMATE: STAFF CONTACT: Teresa Aguiar (305) 292-4458 2:00 P.M. SPECIAL MEETING AGENDA ITEM WORDING: Presentation by Gallagher Benefit Services of Health Insurance Fund status and discussion and direction to staff on recommended Health Insurance Plan changes beginning January 1, 2017. ITEM BACKGROUND: The County's Health Insurance Consultant, Gallagher Benefit Services (GBS), provides annual projected estimates on the health of the Insurance Fund each year. The Fund balance forecast demonstrates an estimated deficit of $2,364,789 for Fiscal Year 2016, using data through June 30, 2016. The projected deficit (with no plan changes) for Fiscal Year 2017 is $3,473,087. The BOCC established a Fund Balance policy of 6 months of claims surplus, since the County doesn't purchase stop -loss insurance. The target surplus for FY 16 is $8,086,049. The FY 17 target surplus is $8,729,342. Based on the projected loss for FY 17, Plan changes will be required to stay within policy. Given the magnitude of projected loss this year and next, the staff recommended changes were developed to ensure all stakeholders share in impact of actions taken. $3,770,559 savings in plan changes are needed to address the projected fund balance deficiency. Staff has worked with GBS and prepared a list of 18 optional changes to help with the deficit. These are outlined in an attachment entitled "Impact of Proposed Plan Changes." The remaining recommended plan changes include: ProjedkA Swrplus S>Vartlnll Willi No Befit or FudhM (S3,776, chmgvs Shortfall lase Department Rabe Impact of Inng D Rate from $885 to $985 $1,405,770 ($2,364,759) Banc& Changes (1 7) $932,29e4 ($1,432,495) Add Teledac M $19,575 1,412NO Resd Dependent Conbrilmtioos to 50% ofActumial at Cuncot $373,230 ($1,039,690) HWxw Costs (10) No Refuse D mndent Subsidy for Medicarc Eligible RetQees $254,448 ($785,242) (11) Adive Employees Pay S50n5 far Employee Coverage (16) $263,025 ($522,217) Set Prcmxa for Retiree Only Coverage for Rule of 70 Retirees to $272,025 ($250,192) Flat S200 (18) Spouses of Active Employees pay 1 OD% of Actuarial Rate if fey $234,077 ($16,116) have access to their oven employer sponsored covcmge but elect to stay an ComLy pLan (modified 13) Other plan changes have been included as possible options the BOCC may choose. PREVIOUS RELEVANT BOCC ACTION: N/A CONTRACT/AGREEMENT CHANGES: N/A STAFF RECOMMENDATION: Direct staff to implement Health Insurance Plan Changes including: -Increase Department Rate from $885 per month to $985 per month -Benefit Changes (1-7) -Teledoc (8) -Reset Dependent Contributions to 50% of Actuarial at Current Higher Costs (10) -No Retiree Dependent Subsidy for Medicare Eligible Retirees (11) -Active Employees Pay $50/$75 for Employee Coverage (16) -Set Premium for Retiree Only Coverage for Rule of 70 Retirees to Flat $200 (18) -Spouses of Active Employees pay 100% of Actuarial Rate if they have access to their own employer sponsored coverage but elect to stay on County plan (modified 13) DOCUMENTATION: MCBOCC Health Plan Renewal Analysis 16.17 MCBOCC REPORT MCBCC Placemat for 2017 plan mods Envision Benefit Review by Rolling Period HISTORICAL CHANGES FINANCIAL IMPACT: Effective Date: Expiration Date: Total Dollar Value of Contract: Total Cost to County: Current Year Portion: Budgeted: Source of Funds: CPI: Indirect Costs: Estimated Ongoing Costs Not Included in above dollar amounts: Revenue Producing: Grant: County Match: Insurance Required: Additional Details: If yes, amount: REVIEWED BY: Assistant County Administrator Christine Hurley 08/31/2016 2:14 PM Cynthia Hall Completed Budget and Finance Completed Kathy Peters Completed Board of County Commissioners Pending Completed 08/31/2016 5:52 PM 09/01/2016 8:05 AM 09/01/2016 8:36 AM 09/06/2016 2:00 PM w Q c Q m L Q s C7 c 0 0 c Q U) Q L a 00 0) 00 ti CD U) .N c Q 3 Q c Q c 0 a s Q m U U O m U c a� s v 0 zo B.1.a Packet Pg. 7 B.1.a w Q c Q m L Q s C7 c 0 0 c Q U) Q L a. 00 0) 00 ti CD U) .N c Q 3 Q c Q c 0 a. s Q m U U O m U c a� s v 0 zo Packet Pg. 8 $1,000.00 $900.00 $800.00 $700.00 $600.00 $500.00 $400.00 $300.00 $200.00 $1.00.00 $0.00 PEPM Claims Gzam Packet Pg. 9 a. co an co n $20,000,000 $18,000,000 OF- $16,000,000uvvxx� -OFFF... FO- ..... ... ... . . . . ......... - $1.4,000,000 $12,000,000 2009/10 201.0/11 2011/12 2012/13 2013/14 201.4/15 2015/1.6 2016/17 urnpun-urnpurm R e Ve 11 U e ------- Expense Projected Projected C (D C 0 C a. 00 0) 00 I Packet' Pg. 10 1 .................................................. .................................................. ................................................ WVFPA BCBSFL Month Enrollees Rx Medical Medical Total Oct-14 ....................................................... ... .................... ...................................................... .......... .. $1,377,697 .......................................... Nov-14 ....................................................... .... .................. 77 .................................................................. 77 .. $1,071,021 .......................................... Dec-14 .......................................................................................................................................................................................................................................... $1,182,746 .............................................. Jan-15 .................................................................. $1,138,982 Feb-15 $939,930 Mar-15 $1 241 439 A r 15 ----- - -P - - --- - ----- ------------------------------------- ---- 1,125,937 --- - May-15 - - - $1,143,410 --- -- --- --- Jun-15 .......................................................................................................................................................................................................................................... $1,313,532 .............................................. Jul-15 $1,1 14,677 15 ....................... ............................. ........ ........................... ..............::................................................. ........ .... .............................................. Sep- 15 $1,426,003 Oct-15 ................................................. $1,3 86,947 Nov-15 ................................................. ........... ............. :............... ................................. :............ .......... ............ ............ ........ ........ ... ............. ............... .................. ................................................. $1,344,880 Dec-15 ......................................................................................................................................................................................................................................................................................... $1,414,734 .................................. Jan-1677� .... ................... ............................................... $1,005,689 Feb-16 ..........Mar-....�........... .. ........... ............................................ .......... $1,065,584 .......477 ........................................................................................................................................................................................................................................ 477... .............................z............... - Apr-16 - - `'`- - - - - $-1,067,649 -- --- May-16 - - $1 523,114 Jun-16 $1,586,170 2010/11 .................................................. 19,122 ..................................................................................... $2,502,150 $12,241,475 .............................................. $0 ............................................................................................... $14,743,626 2011/12 .................................................. 19,227 ..................................................................................... $2,285,804 $3,896,996 .............................................. $7,303,927 ............................................................................................... $13,486,728 2012/13 .................................................. 19,151 ..................................................................................................................................... $2,599,582 $13,901 $10,030,926 ............................................................................................... $12,644,409 2013/14 ....................................................................................................................................................................................... 19,223 $2,888,594 $0 $9,686,074 ............................................................................................... $12,574,668 2014/15 ......................................... 19,108 ..................................................................................................................................... $3,614,264 $0 $10,920,069 ............................................................................................... $14,534,332 2015/16 ....................................................... 14,237 ............................................................................................................................................................................................................. $2,783,115 $0 $9,089,129 $11,872,244 Last 12 Mos 18,992 $3,730,068 $0 $12,141,815 $15,871,883 B.1.a PacketPg. 11' $10,594,436 $8,431,870 $8,729,342 ............ S8,086,049 2009/1.0 201.0/11 2011/12 2 Ol 2/1.3 201.3/1.4 2 01.4/15 201.5/1.6 201.6117 Projected Projected Fund Balance . ! 6 Month Targ(x?t 2016/17 Projected Assumes No Change in Benefits or Funding Q C Q Q 0 Q U) Q a. 00 0) 00 Z, I Packet' Pg. 12 1 2016/17 With Department Rate 2015/16 Baseline Forecasts No Changes) Increased to 2016/17 2017/18 2018/19 Forecast $985 Eff 10/1/16 Revenue $15,592,823 $15,542,467 $19,313,026 $21,179,204 $16,945,267 Claims $16,172,098 $17,458,683 $18,879,363 $20,415,648 $17,458,683 Fixed Costs $1,583,291 $1,556,871 $1,589,502 $1,592,307 $1,556,871 Total Expense $17, 755, 389 $19, 015, 554 $20, 468, 865 $22, 007, 955 $19, 015, 554 Gain/(Loss) Terminate Subsidy $0 $0 $0 $0 $0 for Medicare Eligible Revised Gain/(Loss) Starting Surplus $10,594,436 $8,431,870 $8,729,342 $9,439,681 $8,431,870 Closing Surplus $8,431,870 $4, 958, 783 $7, 573, 503 $8, 610, 930 $6, 361, 583 Target Surplus ' $8, 086, 049 $8,729,342 $9,439,681 $10, 207, 824 $8,729,342 Surplus Variance $345,821 Assumed Employees 1,169 1,169 1,169 Department Rate Increase Needed to Reach Surplus Target $269 $133 $114 Current Department Rate $885 $1,154 $1_,287 $885 Resulting Department Rate $1,154 $1,287 $1,401 $985 Adjusted Revenue $19, 313, 026 $21,179,204 $22, 776, 098 Adjusted Gain/(Loss) $297, 472 $710, 340 $768,143 Adjusted Closing Surplus $8,729,342 $9,439,681 $10,207,824 1. BOCC adopted policy to keep surplus equal to at least 6 months of claims B.1.a PacketPg. 13' B.1.a PacketPg. 14' B.1.a PacketPg. 15' Option # Description Projected Impact 1 Increase Deductible from $400/$800 to $600/$1200 $282,831 2 Increase ER deductible from $100 to $300 $97,769 3 Increase Specialist and Urgent Care copay from $25 to $50 $94,277 4 Increase out of Pocket Maximum From $6350 to $7150 $139,669 5 Add $100 pharmacy deductible $162,366 Increase retail brand copay from $35/$70 (preferred / non preferred) to 6 $50/$90 and Increase retail 90 brand from $87.50/$175 to $125/$225 $143,161 7 Increase specialty pharmacy cost share to 20% to a maximum of $250 $13,661 1 8 lAdd Teledoc $19,575 ISubtotal Plan Design Changes $953,308 * Total Projected savings does not equal sum of individual components because changes are not independent w -W. W 01,11 frotft 0.9011-Offl: 1026 9"IT11 I Packet' Pg. 16 1 Items in blue are recommended by staff. Item in red is recommendelo' only for instances where the covered spouse has access to health insurance offered by his/her own employer. C 4) 0 Q U) Q a. 00 0) 00 Z, I Packet' Pg. 17 1 /;Urre t PrerniLAM 1i- /2 C111 7 Active Employees Single Hired prior 5/1/2012 $25 $50 Single Hired after 5/1/2012 $50 $75 Employee Dependents Only Spouse Only $332 $419/$838 Spouse + 1 child * $480 $606/$986 Spouse + 2 or more children $701 $885/$1133 One child only $148 $186 Two children only $295 $373 Three children only $443 $558 Four children only $591 $745 Five+ children only $738 $931___ Retirees Retiree (10+ YOS) Pre Medicare FRS _ $200 Retiree (10+ YOS) Medicare FRS $200 Spouse >65 $166 $559 Spouse <65 $332 $419 Retiree >65 Without Subsidy $531 $591 Retiree <65 Without Subsidy $885 $985 9-Month Impact $1,399,775 * Higher rates apply to employees whose spouse has available coverage through his/her own employer B.1.a PacketPg. 18' Projected Surplus Shortfall With No Benefit or Funding Changes Remaining Impact Shortfall Increase Department Rate Impact of Increasing Department Rate from $885 to $985 $1,405,770 Plan Design Changes Benefit Changes 1-7 $932,294 Add Teledoc (8) $19,575 Employee/Retiree Contribution Changes Reset Dependent Contributions to 50% of Actuarial at Current Higher Costs (10) $373,230 No Retiree Dependent Subsidy for Medicare Eligible Retirees (11) $254,448 Active Employees Pay $50175 for Employee Coverage (16) $263,025 Set Premium for Retiree Only Coverage for Rule of 70 Retirees to Flat $200 (18) $272,025 Spouses of Active Employees pay 100% of Actuarial Rate if they have access to their own $234,077 employer sponsored coverage but elect to stay on County plan (modified 13) B.1.a PacketPg. 19' MONROE COUNTY BOARD OF COUNTY COMMISSIONERS Total Net Paid Prescription Drug and Medical Claim Summary October 1, 2012 through June 30, 2016 Claims Paid WFTPA BCBSFL Month Enrollees Rx Medical Medical Total Oct-14 1,605 $229,487 $1,148,209 $1,377,697 Nov-14 1,604 $237,026 $833,995 $1,071,021 Dec-14 1,597 $300,612 $882,134 $1,182,746 Jan-15 1,591 $306,699 $832,283 $1,138,982 Feb-15 1,583 $269,368 $670,562 $939,930 Mar-15 1,593 $339,055 $902,384 $1,241,439 Apr-15 1,590 $325,345 $800,592 $1,125,937 May-15 1,598 $329,886 $813,524 $1,143,410 Jun-15 1,592 $329,832 $983,700 $1,313,532 Jul-15 1,592 $348,993 $765,684 $1,114,677 Aug-15 1,581 $283,561 $1,175,399 $1,458,960 Sep-15 1,582 $314,399 $1,111,604 $1,426,003 Oct-15 1,588 $316,611 $1,070,336 $1,386,947 Nov-15 1,588 $289,929 $1,054,951 $1,344,880 Dec-15 1,580 $285,826 $1,128,908 $1,414,734 Jan-16 1,578 $276,866 $728,823 $1,005,689 Feb-16 1,581 $307,561 $758,023 $1,065,584 Mar-16 1,587 $337,615 $1,139,862 1,477,477 Apr-16 1,584 $288,758 $778,891 $1,067,649 May-16 1,576 $349,196 $1,173,918 $1,523,114 Jun-16 1,575 $330,753 $1,255,417 $1,586,170 2010/11 19,122 $2,502,150 $12,241,475 $0 $14,743,626 2011/12 19,227 $2,285,804 $3,896,996 $7,303,927 $13,486,728 2012/13 19,151 $2,599,582 $13,901 $10,030,926 $12,644,409 2013/14 19,223 $2,888,594 $0 $9,686,074 $12,574,668 2014/15 19,108 $3,614,264 $0 $10,920,069 $14,534,332 2015/16 14,237 $2,783,115 $0 $9,089,129 $11,872,244 Last 12 Mos 18,992 $3,730,068 $0 $12,141,815 $15,871,883 PEPM 2009/10 $119.63 $628.40 $0.00 $748.02 2010/11 $130.85 $640.18 $0.00 $771.03 2011/12 $118.89 $202.68 $379.88 $701.45 2012/13 $135.74 $0.73 $523.78 $660.25 2013/14 $150.27 $0.00 $503.88 $654.15 2014/15 $189.15 $0.00 $571.49 $760.64 2015/16 $195.48 $0.00 $638.42 $833.90 Last 12 Mos $196.40 $0.00 $639.31 $835.71 MCBCC Budget Meeting Report 8 31 2016 MONROE COUNTY BOARD OF COUNTY COMMISSIONERS Status Report for 2015/16 Plan Year as of June 30, 2016 Employees or Dependents Actual YTD Projected Retirees Per GBS Year End I. Total Gross Paid Claims (1) a. BCBSFL Active 1,153 694 $ 7,224,441 $ 9,818,996 b. BCBSFL Retiree 422 117 $ 1,864,688 $ 2,534,364 c. Envision Active 1,153 694 $ 1,716,548 $ 2,326,542 d. Envision Retiree 422 117 $ 1,066,567 $ 1,445,583 Benefit Changes $ - $ - Total Paid Claims $ 11,872,244 $ 16,125,485 II. Fixed Costs (2) a. BCBSFL 663,328 879,497 b Envision 53,389 71,108 c. Internal Expenses 189,453 252,604 d. PPACA (5) - PCOR Fee (6) 3,104 5,352 e. PPACA (5) - Transitional Reinsurance Fee (7) 47,878 74,731 f. Other (GBS, Life, AD&D, EAP) 225,000 300,000 Total Fixed Costs $ 1,182,151 $ 1,583,291 III. Total Paid Plan Costs $ 13,054,395 $ 17,708,777 IV. Funding a. Contributions (4) 11,550,581 15,400,774 b. Interest (3) $ 27,037 $ 36,049 c. Other (3) $ 117,000 $ 156,000 Total Funding $ 11,694,617 $ 15,592,823 V. Cash Surplus/(Deficit) $ (1,359,778) $ (2,115,954) VI. Change in Claim Reserve a. Starting Reserve $ 927,198 $ 927,198 b. Estimated Closing Reserve $ 973,811 $ 973,811 c. Change in Reserve $ 46,613 $ 46,613 VII. Incurred Surplus/(Deficit) $ (1,406,390) $ (2,162,566) Vill. Incurred % Surplus/(Deficit) -12.2% -14.0% (1) Based on paid claims through June 30, 2016. (2) Based on fixed rates (3) Based on September 2015 Financial Statements. (4) Based on enrollees multiplied by current funding rates. (5) PPACA - Patient Protection Affordable Care Act (6) Assessed through fiscal year 2018/19 MCBCC Budget Meeting Report 8 31 2016 MONROE COUNTY BOARD OF COUNTY COMMISSIONERS Renewal Projections October 1, 2016 through September 30, 2017 Assuming Current Enrollment Projected Assumed Projecte 2015/16 % Change 2016/1 I. Total Net Incurred Claims (1) $ 16,172,098 8.1% $ 17,458,68, II. Fixed Costs (2) a. BCBSFL 879,497 0.0% 864,67`. b. Envision 71,108 0.0% 70,87`. c. Internal Expenses 252,604 10.3% 278,66, d. PPACA - PCOR Fee 5,352 4.0% 5,55, e. PPACA - Transitional Reinsurance Fee 74,731 16,10( f. Other (GBS, Life, AD&D, EAP) 300,000 7.0% 321,00( Total Fixed Costs 1,583,291 0.0% 1,556,87, III. Total Incurred Plan Costs 2 $ 17,755,389 $ 19,015,55, IV. Revenue at Current Level a. Contributions (4) $ 15,400,774 $ 15,350,41£ b. Interest (3) $ 36,049 $ 36,04� c. Other (3) $ 156,000 $ 156,00( Total Revenue at Current Level 15,592,823 0.0% $ 15,542,46, V. Surplus/(Deficit) With No Change in Funding $ 2,162,566 $ 3,473,08; VI. Increase Required to Break Even in 2016/17 N/A 22.6% $ 3,473,08;1 Notes: (1) 2015/16 Net Claims $ 16,125,485 - 46,613 $ 16,172, 098 (2) 2015/16 Total Plan Costs from Prior Page $ 17,708,777 - 46,613 $ 17, 755, 389 (3) Projected 2016/17 Funding $ 15,542,467 $ 192,049 $ 15,350,418 x 1.2263 $ 18, 823, 505 $ 192,049 $ 19,015,554 $ 12, 744, 00( Projected Paid CIS $ 5,271,55, Reserve Change $ 2,396.1( Total Paid Plan Costs Reserve Change Annualized Funding at 2015/16 Rates Less Interest and Other Income Annual Contributions Required 10/1/16 Increase Resulting 2016/17 Contributions Plus Interest and Other Income Total Projected 2016/17 Revenue $ 3,473,087'' Difference to projected revenue MCBCC Budget Meeting Report 8 31 2016 6.9.b Cash Balance at Beginning of Year Cash Surplus/(Deficit) for Year Transfer In/(Out) Cash Balance at End of Year Claim Reserve at Year End (IBNR) (a) Other Amounts Payable at Year End 60-day Safe Harbor Claim Margin for OIR (b) Total Liability and Surplus Required at Year End Year End Fund Equity Before OIR Margin Year End Equity Net of OIR Margin County Adopted Minimum Fund Balance (6 Months) Actual Surplus Less County Minimum Target Notes MONROE COUNTY BOARD OF COUNTY COMMISSIONERS Projected Fund Balance and Reserve Adequacy As of June 30, 2016 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 $ 17,946,663 $ 16,192,402 $ 14,559,350 $ 12,883,164 $ 12,867,407 $ 13,208,152 $ 11,546,869 $ 9,430,915 $ (1,754,261) $ (1,633,052) $ (1,676,186) $ (15,757) $ 340,745 $ (1,661,283) $ (2,115,954) $ (3,473,087) $ 16,192,402 $ 14,559,350 $ 12,883,164 $ 12,867,407 $ 13,208,152 $ 11,546,869 $ 9,430,915 $ 5,957,828 $ 1,948,746 $ 2,024,412 $ 1,016,833 $ 965,564 $ 1,043,765 $ 927,198 $ 973,811 $ 973,811 $ (141,986) $ 288,696 $ 77,753 $ 61,425 $ 92,592 $ 25,235 $ 25,235 $ 25,235 $ 2,352,291 $ 2,502,161 $ 2,695,350 $ 2,297,656 $ 2,101,832 $ 2,695,350 $ 2,909,781 $ 3,146,560 $ 4,159,051 $ 4,815,269 $ 3,789,936 $ 3,324,645 $ 3,238,189 $ 3,647,783 $ 3,908,826 $ 4,145,606 $ 14,385,642 $ 12,246,242 $ 11,788,578 $ 11,840,418 $ 12,071,795 $ 10,594,436 $ 8,431,870 $ 4,958,783 $ 12,033,351 $ 9,744,081 $ 9,093,228 $ 9,542,762 $ 9,969,963 $ 7,899,086 $ 5,522,089 $ 1,812,222 $ 7,153,736 $ 7,056,873 $ 7,506,483 $ 6,374,575 $ 6,305,495 $ 7,267,166 $ 8,086,049 $ 8,729,342 (a) Actual figures through 2014/15. 2015/16 and future equal February 2016 estimate (b) Estimated at 1/6 of Annual Incurred Claims $ 3,327,270 $ 345,821 $ (3,770,559) (1) (2) (3) _ (1) + (2) (4) (5) (6) _ (4) + (5) (7) _ (3) - (4) (8) _ (3) - (6) Q MCBCC Budget Meeting Report 8 31 2016 Packet Pg. 24 B.1b MONROE COUNTY BOARD OF COUNTY COMMISSIONERS Florida Blue Large Claim Summary as of Claimant Number 6/30/2016 9/30/2015 9/30/2014 9/30/2013 9/30/2012 9/30/2010 9/30/2009 1 $650,445 $560,607 $503,159 $310,603 $323,462 $338,544 $402,792 2 $422,795 $326,270 $239,090 $291,049 $320,118 $224,043 $290,146 3 $400,458 $321,107 $197,829 $282,573 $268,729 $220,450 $134,646 4 $174,484 $298,995 $177,903 $207,021 $201,912 $148,066 $109,928 5 $165,197 $270,238 $175,983 $178,797 $196,659 $146,906 $85,944 6 $144,378 $235,346 $167,378 $163,122 $117,674 $101,914 $85,706 7 $141,501 $203,001 $146,363 $153,269 $116,592 $91,317 $84,623 8 $124,511 $192,172 $136,212 $118,555 $114,750 $76,118 $76,682 9 $119,649 $170,219 $125,463 $117,803 $94,178 $71,028 $65,374 10 $100,797 $166,412 $124,102 $114,376 $92,001 $68,704 $64,492 11 $99,792 $150,535 $119,792 $111,122 $90,148 $66,763 $61,525 12 $94,667 $143,011 $114,009 $110,962 $86,922 $66,392 $61,158 13 $93,513 $126,615 $109,154 $104,392 $83,772 $63,776 $60,197 14 $87,718 $117,146 $107,906 $101,381 $71,659 $61,416 $58,112 15 $81,068 $115,968 $103,619 $95,807 $70,268 $60,003 $57,051 16 $80,529 $109,866 $102,158 $94,435 $69,931 $57,619 $54,270 17 $72,758 $104,317 $101,228 $94,433 $66,602 $55,504 $54,218 18 $71,027 $94,146 $88,520 $82,169 $66,061 $55,416 $51,334 19 $70,632 $92,932 $85,181 $80,193 $65,531 $52,899 20 $70,368 $91,791 $79,737 $77,282 $64,327 $50,110 21 $69,933 $86,663 $77,940 $75,227 $62,859 22 $67,116 $82,177 $71,837 $72,821 $60,670 23 $64,533 $78,271 $69,605 $71,309 $59,190 24 $59,999 $77,173 $63,734 $71,194 $57,240 25 $57,225 $75,186 $59,738 $70,814 $55,264 26 $56,118 $74,547 $58,581 $66,559 $54,455 27 $53,961 $71,116 $58,087 $65,798 $50,968 28 $52,926 $68,479 $57,977 $65,739 29 $51,792 $66,258 $56,507 $65,399 30 $51,646 $64,204 $54,508 $62,494 31 $50,714 $63,616 $52,800 $57,753 32 $62,540 $51,421 $54,300 33 $58,688 $51,245 $53,410 34 $57,313 $51,170 $52,167 35 $56,915 $51,662 36 $56,179 37 $52, 804 38 $51,871 39 $51,334 40 $51,050 41 $51,040 42 $51,004 43 $50 285 Total $3,902,247 $5,349,407 $3,839,936 $3,845,990 $2,981,942 $2,076,986 $1,858,196 Total YTD Claims (Medical & Pharmacy) $ 11,872,244 Large Claims as 32.9% % of Total "Includes claims paid by BCBSFL only I MCBCC Budget Meeting Report 8 31 2016 Subscribe--rs r 1,j r �—,emiurn EE Annual Con'r`bution Total An n —0st County Su0sid,1 o u nty Dqpde-nent SUb-GI(D' 50% With Benefit Changes furam rc k., rt Benefits 2016/17 2017/18 2018/19 FY 16/17 Employees Paying $25 Premium 872 $25 $261,600 $6,864,213 96% $25 $25 $25 $25 Recent Hires Pay $50 mo prem 297 $50 $178,200 $2,337,926 92% $50 $50 $50 $50 Subtotal: $439,800 $9,202,139 95% $439,800 $439,800 $439,800 $439,800 Change From Current Waived coverage (Dept Rate $320 mo) 51 Employee Dependents Only: Spouse Only 112 $332 $446,208 $1,190,217 63% $443 $419 $451 $485 Spouse + 1 child 43 $480 $247,680 $660,051 62% $640 $606 $652 $701 Spouse + 2 or more children 47 $701 $395,364 $1,054,428 63% $935 $885 $953 $1,025 One child only 97 $148 $172,272 $458,139 62% $197 $186 $200 $215 Two children only 60 $295 $212,400 $566,770 63% $394 $373 $402 $432 Three children only 14 $443 $74,424 $198,369 62%1 $590 $558 $601 $646 Four children only 1 $591 $7,092 $18,892 62% $787 $745 $802 $862 Five+ children only 0 $738 $0 $0 0% $984 $931 $1,002 $1,077 Subtotal $1,555,440, $4,146,866 62% $1,944,753, $1,860,900, $1,973,535, $2,092 731 Change From Current 1 $389,313 1 $305,460 1 $112,635 1 $119,196 MCBCC Budget Meeting Report 8 31 2016 Summary of Impact of Benefit and Funding Changes 2015/16 Baseline Forecasts (No Changes) Forecast 2016/17 2017/18 2018/19 2016/17 With Department Rate Increased to $985 Eff 10/1/16 Revenue $15,592,823 $15,542,467 $19,313,026 $21,179,204 $16,948,237 Claims $16,172,098 $17,458,683 $18,879,363 $20,415,648 $17,458,683 Fixed Costs $1,583,291 $1,556,871 $1,589,502 $1,592,307 $1,556,871 Total Expense $17,755,389 $19,015,554 $20,468,865 $22,007,955 $19,015,554 Gain/(Loss) Terminate Subsidy $0 $0 $0 $0 $0 for Medicare Eligible Revised Gain/(Loss) Starting Surplus $10,594,436 $8,431,870 $8,729,342 $9,439,681 $8,431,870 Closing Surplus $8,431,870 $4,958,783 $7,573,503 $8,610,930 $6,364,553 Target Surplus' $8,086,049 $8,729,342 $9,439,681 $10,207,824 $8,729,342 Surplus Variance 1 $345,821 Assumed Employees 1,169 1,169 1,169 Department Rate Increase Needed to Reach Surplus Target $269 $133 $114 Current Department Rate $885 $1,154 $1,287 $885 Resulting Department Rate $1,154 $1,287 $1,401 1 $985 Adjusted Revenue $19,313,026 $21,179,204 $22,776,098 Adjusted Gain/(Loss) $297,472 $710,340 $768,143 Adjusted Closing Surplus $8,729,342 $9,439,681 $10,207,824 1. BOCC adopted policy to keep surplus equal to at least 6 months of claims 2. Contribution change includes resetting dependent premiums to 50% of current actuarial cost and charging Medicare retirees 60% of the current Dependent rate ($531) MCBCC Budget Meeting Report 8 31 2016 Packet Pg. 27 B.1.b Summary of Projected Impact of Benefit and Contribution Changes Option # Description Projected Impact 1 1. Increase Deductible from $400/$800 to $600/$1200 $282,831 2 2. Increase ER deductible from $100 to $300 $97,769 3 3. Increase Specialist and Urgent Care copay from $25 to $50 $94,277 4 4. Increase out of Pocket Maximum From $6350 to $7150 $139,669 5 5. Add $100 pharmacy deductible $162,366 6. Increase retail brand copay from $35/$70 (preferred / non preferred) to $50/$90 and 6 Increase retail 90 brand from $87.50/$175 to $125/$225 $143,161 7 17. Increase specialty pharmacy cost share to 20% to a maximum of $250 1 $13,967 Subtotal Plan Design Changes * I $932,294 * Total Projected savings does not equal sum of individual components because changes are not independent 8 Add Teledoc $19,575 9 Charge Full Annual Amount of Health Insurance to Medicare Eligible Retirees $1,312,500 10 Reset Dependent Contributions to 50% of Actuarial at Current Higher Costs $373,230 11 No Retiree Dependent Subsidy for Medicare Eligible Retirees $254,448 12 No Subsidy for Dependents of Any Retirees $459,378 13 Spouses of Active Employee Pay 100% of Actuarial Rate $936,306 14 No subsidy for Pre-65 Retirees $1,311,728 15 Pre 65 Retirees Pay 50% of Actuarial Rate $621,033 16 Active Employees Pay $50/75 for Employee Coverage $263,025 17 Reset Dependent Contributions to 60% of Actuarial Rates $599,868 18 Set Premium for Retiree Only Coverage to a Flat $200 $272,025 All Changes assumed to take place on January 1, 2017 Staff Recommendations Projected Surplus Shortfall With No Benefit or Funding Changes ($3,770,559) Remaining Impact I Shortfall Increase Department Rate Impact of Increasing Department Rate from $885 to $985 1 $1,405,770 ($2,364,789) Plan Design Changes Benefit Changes 1-7 $932,294 ($1,432,495) Add Teledoc (8) 1 $19,575 1($1,412,920)1 tmpioyeeiKetiree contrinution cnanges Reset Dependent Contributions to 50% of Actuarial at Current Higher Costs (10) $373,230 ($1,039,690) No Retiree Dependent Subsidy for Medicare Eligible Retirees (11) $254,448 ($785,242) Active Employees Pay $50/75 for Employee Coverage (16) $263,025 ($522,217) Set Premium for Retiree Only Coverage for Rule of 70 Retirees to Flat $200 (18) $272,025 ($250,192) Spouses of Active Employees pay 100% of Actuarial Rate if they have access to their own $234,077 ($16,116) employer sponsored coverage but elect to stay on County plan (modified 13) MCBCC Budget Meeting Report 8 31 2016 Packet Pg. 28 F—B.I.b Premiums Under Illustrative Options Cuirem Pier n i uIrr'. ncrea sed Deparmiem Rate 9 10 11 12 13 14 is 16 17 18 R-�commended ff —2 L '1 M � 017 Active Employees Single Hired prior 5/1/2012 $25 $25 $25 $25 $25 $25 $25 $25 $25 $25 $25 $50 Single Hired after 5/1/2012 $50 $50 $50 $50 $50 $50 $50 $50 $50 $50 $50 $75 Employee Dependents Only: Spouse Only $332 $332 $332 $332 $332 $332 $332 $332 $332 $419/$838 Spouse + 1 child $480 $480 $480 $480 $480 $480 $480 $480 $480 $606/$986 Spouse + 2 or more children $701 $701 $701 $701 $701 1 $701 $701 $701 $701 $885/$1133 One child only $148 $148 $148 $148 $148 $148 $148 $148 $148 $148 $186 Two children only $295 $295 $295 $295 $295 $295 $295 $295 $295 $295 $373 Three children only $443 $443 $443 $443 $443 $443 $443 $443 $443 $443 $558 Four children only $591 $591 $591 $591 $591 $591 $591 $591 $591 $591 $745 Five+ children only $738 $738 $738 $738 $738 $738 $738 $738 $738 $738 $931 Retirees Retiree (10+ YOS) Pre Medicare FRS FRS FRS FRS FRS FRS FRS FRS FRS $200 Retiree (10+ YOS) Medicare FRS FRS FRS FRS FRS FRS FRS FRS FRS FRS $200 Spouse >65 $166 $166 $166 $166 $166 $166 $166 $166 $559 Spouse <65 $332 $332 $332 $332 $332 $332 $332 $332 $332 $332 $419 Retiree >65 Without Subsidy $531 $591 $591 $591 $591 $591 $591 $591 $591 $591 $591 $591 $591 Retiree <65 Without Subsidy $885 $985 $995 $995 $985 $985 $985 $985 $985 $985 $985 $985 $985 9-Month Impact $2,970 $1,312,500 $373,230 $254,448 $459,378 $936,306 $1,311,728 $621,033 $263,025 $599,868 $272,025 $1,399,775 Higher rates apply to employees whose spouse has available coverage through his/her own employer Description of Options 9 Charge Full Annual Amount of Health Insurance to Medicare Eligible Retirees 10 National Range: 20% to 55% / Median: 30% / Mode: 100% 11 No Retiree Dependent Subsidy for Medicare Eligible Retirees 12 No Subsidy for Dependents of Any Retirees 1 13 Spouses of Active Employee Pay 100% of Actuarial Rate 14 No subsidy for Pre-65 retirees 15 Pre 65 Retirees Pay 50% of Actuarial Rate 16 Active Employees Pay $50 (Pre 5/1/2012) or $75 (Post 5/1/2012) for Employee Coverage 17 Reset Dependent Contributions to 60% of Actuarial Rates T7 18 Set Premium for Retiree Only Coverage to a Flat $200 1 1 MCBCC Budget Meeting Report 8 31 2016 Current and Proposed MCBCC Retiree Contribution Schedules Hired before 10/1/2001 (Rule of 70) Resolution #-388-2013 TODAY PROPOSED Current Retirees (and future retirees) Current Retirees>' (and future retirees ........................... Non Medicare and Medicare Eligible Non Medicare Eligible $50 to $150 Per Month $50 to $150 Per Month 430 Retirees 1122 Retirees 280Eligible to receive in future 280 280 Alternatives I RANGE Medicare Supplement MCBCC Budget Meeting Report 8 31 2016 Hired on or after 10/1/2001 Resolution # 388 - 2013 TODAY TODAY PROPOSED PROPOSED Current Retirees (and future '' '.retirees) Current Retirees r (and future retirees) Proposed Retirees (and future retirees Proposed Retirees (and future retirees Non Medicare' Eligible Medicare Eligible` Non Medicare Eligible Medicare Eligible Dept Rate (currently $885 per month)month $531 per month (60% of Dept rate) Dept Rate (currently'$885 per $531 per month (60% of Dept rate); 8 retirees 2 retirees 8 retirees r 295 Retirees 8.'I'.b r 6 r.6 Imp act of Proposed Plan Changes Estimated Benchmark ng Thisisa completeoutlne.foil hangerr.qu,.d to reach the$M0,000 savings. Plan Savings Galloghe,:Ntional Benchmark ng Survey Medical 1. Increase Detluctible fi..$400 to$600 Employee($fa.$800 to$1200 family) $282831 Payme.ts;.PerEmployee Pedyea,(PEPV'ioctlie CumenY peViotl 4.tle[[eview are$G,932. op M%fiord The.,t--, for both the Annual PEPY payments of 14%antl the PMPMI--, of 12.8%forth, C... Ty, —tlal only National Deductible: the prior pgri.d. . clams o higher than the trend that we ree for metical claims. The PMPM C-s lsoexceetls Me Flontla R I., benchmark by 39% M,ci- $1500 -T-Ip,Vme.tr PMPM ha,ai...... yd by 123%,fmm$341,87 A,$385. 72 Benchmark PMPM k I--mgthe ...Mc—,tblewill helpt..ff.....e of the expense a ntl s a. eff,,t,,.eth.tlm.... —.,t share Mod,, SSW $277." 3rtl 4dar:tile $2,500 Average post is.p in all afeg Res of servi.etvlth exception to Urgent Care. Wellness- pin mugs are below the Honda Blue benchmarks.3.ut.fthe 4scre—ng P.. -Screenmg, ,ill —i. at no charge a ntl DoctorsoffceV st,,llre.anwth C.pay.e.ts. No cost Well.... Vi s Over1,O00EmployeesDednRble- alegones.: :allow for early tletect.. antl my leatl t. a sight mn gat on of c--.phi, cairns. Early d,tecton a ntl treatment has been shown Metlan'.5750 ASP r.xI. tely l7%.f male, and8%off-1,, did not utl ze the healthcare benefits d.d.g the t. save money. Motle.$500 ,epo,ti.gpen.tl antl did .dth ve any allowable tl lkro showingas payable to a p-Ic,,. 3rd quartile 51500 2. Increase ERtic-iblefi..$100to$300 $97769 335 di,th—...be.114%dtotal p.pulat.n)v,Retl the Emerge.,, R...(ER)whu subsequent -The$300p i,t--tble for ERvsts,..re.l., ,th the marketplace a ntl h..Id ci-.age. embers tam us.g the Natlo..I ER Cost Share admkd..d r.gthereport ngprrod-dabmuntetl for 482 total ER,sts. :: ER for M-,i lServ... eatl.tthe Pnmary Care Phys nan Oran Urgent Care Faclty Wh Ie ER,isitsh-1c11l.1cthe C...ry M,di- $150 10%dit-IERvst,(7% t.ues to utlze the ER at ahgh,, ateth- Flortla Blue Benchmarks. M.tle:$1Q0 nfec400i; bad pi. -ugh)- 3rd 4tlartile $250 33 unique: embers have 3.rm.re ERAlit, 12 -hp..d u.d..... ew, 1,OM. Employees ER Cost Share: ERutrl2at has d,,,eased: tl I, c -thy at 203v,Rs per1000 Flortla Bluebe..h—k1, 193/1000.: M,di-$100 M.tle..$100 31d Quartile $200 3.1.... —Spe.alst-c1 Urgent Care-payfa.$25t.$50 $94277 ex.epd11t1UW,,tCare. Thsism.reI.l.ewththe marketplace--ll help k-pth, .,t share.li—h benchmarks. National Sp calstCortShate- - Urgent Carevsts have nc asetl antlwh(, this ispost,, ttheservcesare be.gpav tletl as- aft e.Mi-to the ERw it ,ill Mecfi ,$40 c— up costs f partc pants use the Urgent Care Center I. place of the Primary Care Physida.. Motle': $40 - The higher Copy will help d,termembersf.. utlz.g the Urgent Care Center a ntl/.. Specalrt a the. tha n the Pnmary Care 3rtl Quar:4e$50 <Physioa.. 1,000+Employees spec alist Cost: Media. $35 Motle $40 3rtl Quartile $45 41.... outof Pocket Max...Fam$6350t.$7150 Employee a ntl fro.$12,700t.$14,300 Family $139,669 - The Maximum out of Pocket permssble untlerthe PPACA Iegidhti..has.... asetl every years... the law was. ple. e.t,d. National Max OOP• The County a dually retlu.ed the —i—Out of P.det ft..$7,500 to$6,350 when the r.Ie, equretl the change I--img Metl- $5,350 tothe$7,150wll offset s..e.fthe plans chi.—pe.se hle remanngbel—the.rg-I 2—maximum. M.de:$10000— 3rtl Quartile $10000`*. "Outnf Network Amounts Employees 1,0M. Max OOP Medan: $5 875 -de %,— 3rtl Quarttile $8000 Total ProleRed Savings for 2016/17 $fi14,54fi Pharmacy S. Add$100 pha,.ary ded-table $162366 Plan Costs{ h Pres[nptin. tlr.g p,ogam:n s,d by 3252% f, the reporting p d devaluated. ::-Addi.ga ph— ded-tble for pres..pt... ,ill help t.mtigate -idly --mg pharmary-rts N/A NO Bench. a,kimg for R. Ded-tibles Part npaw.tsll ..t..e t. be.ef t ft.. the neg.t —d pr c.g that the PBM has.bta ned for. etl cat.....til the $100 ded-tible has been met. fi Increase r—lb--!..pay fa.$35 to$50 $143161 Membe-CostShared,.pped from 1463%t.1215%(e ch—ge bf 1693%)whle the ne total drug :-Pha,.a .-are rs.gfaster than metl-Icosts--il antl the use.faC.pay.e.t for the R. be.eft-.p... c, the pact Nati0n alrR —Shard Prahrred Increase Pit, P,eferretl Copay fro. $70 t. $90 antl ..Is ...eased by 28 78% :.f Whti.. be -use partcpants c...t sh, e . the .,,-,e . -rn This —ease .-paymentsv,ll help t. m t g—the Metl an'.$35/ M.de $30/3,cQ—JI, $40. Increase etai190 b—c! fro. $ST-t. $125 : ap dly --mg-sts.f pharma cent ak. 1,OO .Employee Range Preferred: Increase retail 90 N on P,efe,retl fi..$175 to$225 : The generic.pay—tI, .tbe.gch-ged tallow part.pants t...t..e.btanng the most-st effectve pres..pt..s M,di-$30/M.d, S./3rtl Q—tile$40 possible. National Rx Cost Share Non Preferred M-m $55/Motle $5./3d Quartile $70 1,000+Employee Range N.. Preferred: an Metl : $5F/M.de $10 / 3 td Q-11, $60 7. Increase spe,alY-rtsh— t. 20% t.a max mum .f$250 $13967 Sp-itfty:Cd ,forth, pl,,1 asetl by SO— and to embe..pay less that 1%ofth -stfo, these :: :-Spe,iAty Drugsare among the m..- expe.s,e d,ugs..the .a rket— ..pr,e 36.10%.f the. —Al d,ug-st. N/A N. Be-h.ark.g for Spedelty Drugs Sp_bda y Drags Implementing.. -...ante -rt share v,th a per Pres.r ipti.. max mu. will help t. dirn bute the expenses for these metl-tons-.ree utabl between the C... t antl ph. a Total ProleRed Savings for 2016/17: $319,490 Combined Projected Pha,m. and M.di cal S. $931,294 ' Total Projected savings does not equal sum of individual components because changes are not independent Additi... l Cost Savings Suggestions Teledoc a.dC ibuti.. Changes 8. ImpaR of Addine Teledoc Option Estimated Firs[ Vear Savings PCP Office Vsts(A... A Sped f$250,000 exclutlng testng a ntl pa.ec—d $12,500 Teled.c cane ,idea c.R: effeRve aIt....t veil :Partidp-1. bt,inmrea Imes svh., the:: Spedo li. Vsts(A... A Sped f$475,000 exclutlng testing a ntl p,..ed.,es) $118751,i—, Care Physcan s valable Wth Teledoc, M/7—il blty, part cipa [ eek med cal nhe ER Visks (Annual spentl.f $1,000,000) ERVi AnualSpentl.f$,00,000) $10000 thus h ly h n: uldbeth ER TI d-f... ape,call b nd a: hIy PEP. :h g f h b pl d d ed Tlre$40: is $10000 h g peril(( h na y th It at f p p d II fc t ngs fortibth: Totalsavings $443T5 the Counry: dplan F-kipa is Teledoc has th. dd.d ad —tog fJ...... ing h alablllty of :. ra r.fo,:non emergency mndRons. Est mated Fist vea, Cost Annual Ad. n rtat ve Fee Based .n $1.00 PEPM $18 900 Fee per Call $40 Member Copay per Call $20 Net Plan C.. Per Call $20 Erti.ated first year Call, I. PCP visRs, 2% Spec al stvimt, 1% ER Visits) $295 Annual C.rt for Utili,ati.n Fee $5900 Total Estimated F ,st year Fee $24 800 Net First Vear Gain/(Loss) $19,575 Grand Total Savings $951,1169 ji.p.tt of P d C..t,ib.ti.. Changes 9. 1.— of Chareine F.11 Annual A....t of Health Insurance ..dim... Climbl. Retirees C.,,,.t -ch—, Eligible R,ti .... (295) p, FRS —Ith I.... —, Supplement f., EE coverage — the "g.1h, d,p,.d,.t ,, to ....r a p ....... th,, d,p,.d,.t, H.d,, this proposal, ' they —.1d pay— y f the full Department Rate( thy $531) f., EE coverage -c! continue to pay the .Ih, D,p,.d,.t ,, to ....s spouse..other d,p,.d,.t, Expected l-S-th`' in 2016/17 Plan yearl-'t _.cic Elimble Retiree, L Plan Wd be County g. and useMedicare) 30. Reset De.e.ce.t Contributions t. 50% fAd.oriol of Current Hwher C.- Rates were not I.... —d f., 2015/16 -pit, high,, costs Impact of Hwher De.e.ce.t Contributions $373,230 C-t,iffidtill 311,hki,g: 11t St do' C,,tlb,t, f,, rally N.t l..oIRo3./M.d , 1 0. 1,O.E.d.,e: -3/M,di .%/ ..d, 20. 11 - Retiree De.e.ce.t S.b,iclvf.r Medicare Eliwiffile Retiree, M,di,�eligible have th ........ .f coverage =,ti,e, M'dI ''IgIb'Pp".i.. is only 50%f what an -we employee pays t. mvera spouse Due t. high mst.f prescription d,.g,, total dh I. — f., Mediae eligible spouse is — parable t. _'t of a spouse f an -we employee I.. oct f Eli. moti. e S. b,i clv and Cho r0 — f Ad. oral Rote for Medicore Spouse $254,.9 Very few manic pa I employers I , Flrld, ,b,idl,, tl pen d co g. for r1ti—, 12. N . Subs iclv for De.en cle- f A- Retiree, Mediae eligible spouse pre. I.. is only 50%f what an -we employee pays t. mvera spouse P,e M edi—e eligible spouse pre. I.. is 100% f whatan -we employee pays,de,pite much higher 't't , f., the Pre Medi—e eti,ee subset 0�i", Mecfice Ol i==Lo nial Rot e for Medto re Spouse and Cho r,i g Pre- $459,37B =_t—'fCh Medicare Ebible Spouse_'. I_ Sp. se V f. ...icip.1 employers. Fl.rid. b,iclfic.p-de.t c-er for retir.- B. SIP ... e, fActime E.pl.vee, Pov% fAct-riol Rote Sp .. e, " e, "tExchange.Hy ,e ed be,, , nd I. rases coverage e, h, t. ge f their through - e p'.ye , . the I.p oct f Cho rgi.g — f the Ad. o rio I Rote for SIP ... e Coverage for Active E.pI Vee, $936,30fi Might also... ide, ding thi, ..Iy f., wheree, �hethe Sp ... e — �, ibble ... —ge through hi,/he, employerExp el resulting impact—.1d be 25% t. 30% f the total shown. Spd—I sdreh., r ... 1-i— or. lb —mg —r. .. N.S.b,iclvf.rPre-6511eti— P,e 65 retirees -id be e,.i,ed t. pay the Department 11— (Ifil,e retiree—h. d. not m e. the .Ie f )0 d . ,). Pre 65 retiree group is the most expensive d.e t. Ide, , — .. .... di-tim. with Mediae Impact f Chor,i", Pre -Medicare Retiree, — f the Department Rote $1,311,7213 Most 1-dipli g holl eIra iloted, Ir Irl r1tim .Ibsidfi,, i. r.,p,.,e t, G!SB 45 - P-65 Retiree, P.Y 5E. of Ad..ri.1 Rate Same a, Option 14 but retirees 50% insteatl of 100% of Department Rate moat[ of Ch—ine Pre -Medicare Retiree, 50% f the Department Rate $,033 A mbn tip 1 t, 22dee elm Al" ri, etir,, b,icie, I Inre,p," e t,GA1 5 A , P.Y 5o"75Active EIe for -.1—ee C-er-e —we employees hired prior to 5/1/2012 pay $25 per month f., single coverage, — employees hired on or after 5/1/2012 pay $5 0 per ...th-r J.de, this proposal, both —.1d increaseby $25 I.,_ f 1. cre.,i Actime —Wee Prem.. t. 550/575 $263,025 C.rre.tr.te,.re4 t.B .f.ct..ri.1c.,t. With dje.t,thi..Id mcre—t—t.12%. - Reset Deo en dent C.nt rib.ti.n, t. 60% . Actuarial Rate Bard established a target f 50% (— Option 10) Current target I, .re in line with survey data but employers are generally passing an in,rea,ing hare .f the premium cost t. employees who cover dependent,. I.o.ct f Incre.,i- Premiums for Deoencent Cover -et. — dthe Actuarial Rate$, ,dntrib,tidn B—h—king: Percent E,pty... C-0— for: F.,ily —i ... I 20% t. 55% / M,di 30% / M.de 100% 1,000E.pfi,,e.r.ng.: 17V1%jM,di 24%/ M 20% 1B. Set Premium for Retiree Only Cover -et. . Flat 5200per M.nth Retiree, currently pay their HIS benefit antler FRS $5 per ..nth per year f service p t. 30 years. pi.yee, with longer FRS service get a larger HIS benefit and therefore contribute ..re t. the plan for retiree myerage Impact f Chore in, All Retiree, $WO per M.nth for Single Coverage $272, 101, 150--th l.� e,th�n�.,t�..icip.lepiyersch.rg.. [--d T-1 Increased C-trib.ti—, (Recommended. Changes. Highlighted in Yell.) $1,396,1305 Grand 1 Plan Changes PI., C.ntribut i.n Changes $2,3413,673 PEPY Trend Population By Coverage Tier .......+.. .........:', ......... .........:', .........,', ........ Contracts 1,588 1,601 ---- ---- ---- --- ---- Members 2,379 2,377 0.1% $ 6,932 $ 6,089 $6,024 MembersPe-Ccntact 1.5 1.5 0.9% 13 85% - Increase 1.08% - Increase 0.00% - Baseline Poplulation Average Age By Relation and Gender ... ... .., ........:. ... Employee ... .:. 51.7 .......:...... 51.6. ...: 0.0PA Payment and Utilization Indicators Males 50.0 : 50.0 0 0% ...•, ........ .........,', ........ ........',. ....... Females 536: 53.5 02%:. Claims 44,180 45,436 Dependents 29.7 -. 30.2 Spend Per Claim : : $249 : $215 161%.. Males 288> 28.9 Spend $ 11,009,510 : $ 9,750,458 12.9%. Females 30.4 > 31.2 PMPM : $277.51: $385.72 $341.87. 12.8%: All Members 44.2 :. 44.5 - PEPM : $47Z.60 $ 577.69 . $ 507.41 . 13.8% ..... i:'.. ............. Admits--- ............. ............. 234 ............. ........ 236 Members By Payment Range ■Current Spend Per Admit $ 14,829 $ 13,021 $ 13,362 500 ■Prior 1,000 1,500 ALOS 4.01: 3.91. 4.75 ' ' ' ' . 965 . Total Spend : : $3,047,014: $3,153,432 Sri Utll/1000 68 98 99' 33 PMPM . ; $ 83 93 $ 106.75 $ 110.57 $500 $999 V sits2,301 2 1% $1,000 $2,494 0 Spend Per Visit $ 1,029 $ 1,640 $ 1,191 37 6%. 229 Total Spend : : $ 3,851,839 $ 2,741,619 40 5%: $2,500 $4999 Util/1000 771 988 968 Z 0%. 53 PMPM $ 66.13 : $ 134.95 : $ 96.13 404% $5,000 $6,Z49 150 Visas 482 552 Spend Per Visit $ 1,362 $ 2,021 $ 1,761 14. Total Spend :. :. $974,135 $972,155 0. Utl/1000 193 203 232 PMPM $2194 $3473 $3409 0 ....... ......... Services ............ ........... 1,088 .........,,, ......... 877 , 24 Spend Per Service : $ 67 : $ 173 $ 177 Total Spend : :. $ 188,170 : $ 155,445 21. Util/1000 198 : 457 : 369 24. PMPM $ 1.10 $ 6.59 : $ 5.45 21. S rvi 9,241 8,680 6. Spend Per Service : $ 58 : $ 50 $ 49 : 2. Total Spend : : $466,248 : $425,759 9. Util/1000 3,592 : 3,885 : 3,652 6: PMPM $1751 $1633 $1493 9 ., .. Services .........:. ...... 30,786 ......:. ........ 32,790 : Spend Per Service $ 89 $ 80 $ 70 14 Total Spend $2,448,466 $2,284,532 7 Util/1000 11,850 12,943 : 13,796. PMPM : $ 86.90 : $ 85.78 $ 80.10 ; 7. Scripts Spend Pe -Script Total Spend Util/1000 - PMPM PMPM $ 1.18 $ 0.61 PMPM by. Age Range...._ ■Group Male ■Group Female N Book Male N Book Female $700 $600 $500 $400 $300 $200 $too $o 0-18 19-24 25-35 3645 46-55 56-64 65+ M $ 167 $ 186 $ 101 $ 145 $ 299 $ 589 $ 325 F $195 $266 $420 $517. $674 $ 597 $ 513 Member Share as a Percentage of Total Spend and Claim Type High Cost Member Impacts $50,000 Theovemgemembershorefm groupsin your S/Cof91 is 12% ■Current Error..,, ...........'.. ...........'., ...........'., ..........,'., ...........'., ::1.''... High Cost Members 42. 40. 5.0% $2.UM 0I$A% Percent of Population 177%. 168%. 4.9% All -m 016.5% High Cost Member Spend $ 5,105,630 $ 4,491,344 13.7% :. Average Spend Per Case $ 121,563 : $ 112,284 : 8.3% Prof High Cost PMPM Impact $ 17888 : $ 15747 : 13.6% U PMPM Less High Cost Mbrs $ 206.84 : $ 184.39 : 12.2% C OP '! : Percent of TotaIPMPM 46.4%. 46.1%. N 3 0.7%ER c IP $8K $6,932 $7K : 2 N uc $6K $5K s4.629 : U_ 4) RX 0� $4K 3,215 in _ N 0®0% . --. -. -. $OK $500K $,-$1.5M $2.OM $25M $3K $2K ... $2,141 : N rn N Top Five Diagnosis Categories With PMPM `-° $301M $2- ECnrrenT ■Pr Or PEPYIAII) PEPYL-C 1y) PMPV(All) PMPV (H-cly) : (D ®$91.19 C $Z OM $1.3M ®$472g 1.OM 991K $965K Current Prior O r ® $35.27 ®$34.72 ®$33.80 C $1 OM 633K High Cost Spend as Percentage by Claim Type $OK NIP MOP = P-SP OP -PC Q. ER N pl C y M ,I Sy III D f d sy c d ry/ Poi -ma current m ao 13%1 � Key Facility Utilization I .. .......... .......... .......... .......... ......... ......... .................-. (1) L K y M d cal Center $ 1,526853 $ 1,706710 : Prior 12% �6%; : E (2) MarcHospital $ 1,152,571 $ 504:183 : C (3) Baptist Hospital Of Miami Inc $ 1,111,396 $ 665,198 (4) U. Of M. Hospitals & Clinics- Ncch $ 374,693 : $ 439,706 . 0% 20% 40% 60% 80% 100% : to (5) South Miami Hospital $ 336,272 $ 158,668 N (6) Homestead Hospital Inc $ 317,412 $ 220,334 Network Savings and Utilization i (7) Lower Fla Keys Health Systems $ 287,115 (8) FshermenS Hospital, Inc.nc $ Z75,9Z0 $ 181,6Z7 Savings% N E (9) West Kendall Baptist Hospital $ 193,116 $ 13,043 80 0% - - - - - (10) Jackson Memorial Hospital $ 191,249 $ 336,568 60 0% .: t% a 8 U Plan Risk Vs Book by Age Bracket 40 0% % ro ZO% OY 20% 40Y . ...,..,. ... ... 60% 80Y 1009s : .. -Y. . f� 0 22% 00% Males 0 18 -13.4% 1914 99.31,1924 49.1 y9�� Inpatient Outpatient Professional Total 25-35 15.0% 3645 4.6% 5% v zs 55 38,E ■ In Network Spend % ■ In Network Utilization % O x L. Q 105.0% 100.0% 95.0% 90.0% 85.0% 80.0% Inpatient Outpatient Professional Total BM = Benchmark Book of Business benchmarks are based on claims incurred 01/01/2015-12/31/2015 and through 02/29/2016 Packet Pg. 33 ■Current ■Prior ■Benchmark Colorectal Cerwal Breast Cancer Adult Wellness 0% 10% 20% 30% Non Users by Age Bracket e N 4E I 19-24 11 17.5 36 45 12 8 # 4E Compliance Criteria Breast Cancer Screening: Ages: W omen 52- 74 years. Continuous Enrollment 24 Months • Allowable Gap:Nomorethanonegapinenrollment ofupto45daysduringeachyearofmntnuous enrollment. Compliant Criteria One or more mammogrzms any time during the two year measurement period. Colorectal Cancer Screen ing: Ages:51-75 years. Continuous Enrollment 24 Months • Allowable Gap: No more than one gap in enrollment of u p to 45 days during each year ofmntnuous enrollment. Compliant Criteria: F,,,,,f g;r ;2ca:?k:0ne coring the hst 12 months. -OR- Ftesthte Sirmo'd;+rcanF: One du ring the hst 60 months. -OR- CJaoosca One during the last 120 months. 40% 50% 60% 70% 80% Cervical Screen ing: Ages: women 21- 64 years. Continuous Enrollment 36 Months • Allowable Gap: No more than one gap in enrollment of u pro 45 days during each year of continuous en m11—m.. 40% 34% Compliant Criteria Women age 21--64 who had cerviczl cytology performed every3 years. -OR- 20% 1 11% 12% Women a go 3064 who had cervcaI cytology/human papllomavi—(HPV) wresting performed every 5 years. 10%'■',.■■=: Exclusions: Memberswith evdence ofa Hysterectomy. o% Adult Wellness: c Ages:Adults 18+ Continuous Enrollment: 12 Months 20% 1J% 17% Allowable Gap: No more than one gap in enrollment of u pro 45 days during each year of contn.ous enrollment. ts% Compliant Criteria: One or more well vkit, aduk checkmp or other wellness visit that falls into the standard set of wellness codes. 10% _. 6 � rry 5�. 0% "Compliance data excludes Retiree and COBRA members q M, i Value Based Provider Attribution (Accountable{a eOrganzanon Regional Primary Care Program ■P tk,nt Centered Medical Home EC mprehe is Prmary Carg Progam a3 to ,MMM43 .......... .......... ......... ............. 0 10 20 30 40 50 60 70 80 90 B'lc Key Findings Page 1 • Payments Per Employee PerYear (PEP f) for the current period under review are $6,932, up 14%from the prior pormd. • Total payments PMPM have hiMeased by 12 89, from $341,87 to $395 72, Benchmark PMPM is $277,51 • Average cost Is up in all categories of service with exception to Urgent Care, • Overall milbation decreased in allcategodes with exception to Urgent Care:. Outpatient utilization remained relatively stable. • Top Inpatient DRGs by spend include cardiovascular pedures, kidney transplant, NICU(neonate born at 31 weeks), hip/knee replacement. • Top Outpatient Diagnoses include Cancer ( lung, breast, tongue, colorectal), cancer preventive screenings, ankle fracture, ESRD, knee/foot disorders, and ER related services. • 335:distinct members (14% of total population) visited the Emergency Room (ER)without subsequent admission during the reporting period and accounted for 482 total ER visits. • ER utilization has decreased and is currently at 203. visits per 1000 Florida Blue: benchmark is 193/1000.: Employees account for 66%oftotal visits, Children are 189v, and Spouses are 16%. • 10% of total ER visits (7%of total. ER spend) are potentially d vertible (UTI, acute upper respiratory infections, back pain, cough). 33 unique members have 3 or more ER visits during the 12 month period under review.: • Total membership remained stable at 2,379 members. • Total population is 50% male and 50%female. Average age of Employees is 51.7. • The majority of members have total paid claims in the $0-$499 range. • The largest variance in PMPM by age and gender in comparison to the Florida Blue book of business is in the Females ages 46-55 category. PMPMs for this demographic for Monroe County BOCC is$674 compared to the benchmark of$475. The higher PMPM is attributable to 8 high cost claimants totaling SLAM. • Member cost shares currently at 154% Industry comparison is 12%for total member cost share • Top medical diagnostic categories include Cancer (lung, cervical, ovarian, colorectal, breast, cancer preventive screenings), Circulatory (heart disease/attack, aortic aneurysm, hypertension), Musculoskeletal (osteoarthross, back and bone d isorders, ), III - Defined Conditions (symptoms related to chest/abdominal pain, general symptoms) and Injury/Poisoning (ankle and radius fractures, complications related to digestive procedure and ventricular drainage device). • The female population for Monroe County BOCC has 48%more risk than the Florida Blue book of business and the male population has 45%more risk. Males ages 19-24 are nearly 99% riskier than our book of business. Top conditions for this demographic include various injuries, musculoskeletal disorders, and regional enteritis. • High cost claimant activity has increased in the current period under review. Spend related to high cost cases at the$50K threshold increased by 149v, from$4.5M to $5.1M. • 42 cases were identified versus 40 high cost cases in the prior period. 1.8%of the total population is identified as high cost and is dnving46%of spend Benchmark s1% ofthe population driving 33%of total spend (including Rx). With outlier HCC removed, PM PMs would be $207 versus the actual $386. • Cancer is the number one condition by spend and prevalence with 11 high cost cases totaling $2.410, followed by Circulatory conditions with 7 cases totaling$750K. • Top cases are Cancer (lung, ovarian, cervical, colorectal, breast, tongue, liver), Circulatory (heart attack, hypertensive kidney d isease, aortic aneurysm), M usculoskeletal (osteoarthros s, spinal stenosis), Digestive (Crohn s disease, appendicitis, gastmenter t s, dive rtculit s), and Pregnancy/Child birth (complications d ur ng pregnancy, neonate born at 31 weeks). • 6 high cost members are no longer actively enrolled on the health plan ($923K) 10 members appear on the high cost report for both the current and prior period. Subscribers account for 52% of total high cost case spend. • Network Savings is currently performing at 58 9% Page 2 Welfiness compliancescr gs arebel the Florida Blue benchmarks 3 outofthe 4 screening categories. • Approximately 17%of males and 8%df females did not utilize their healthcare benefits dunngthereporting period and did not have any allowable dollars showing as. payable to a provider. • 215 distinct members (9% oftotal membership) are attributed to a Florida Blue value based provider. BM = Benchmark Book of Business benchmarks are based on claims incurred 01/01/2015-12/31/2015 and through 02/29/2016 Packet Pg. 34 Benefit Review By Boiling Period Flag Cost Tread' % Specialty Plan Cost Plan Cast B.1.d B.I. END OF YEAR FUND BEGINNING OF BALANCE'On l511114 PROJECTED YEAR FUND' BOCC set policy of GAIN/(LOSS) FOR ACTUAL GAIN/(LOSS) BALANCE minimum 6 months MINIMUM RESERVE Fiscal Year YEAR claim reserve (6 Mos'Claims) BENEFIT FROM TO ' DIFFERENCE TPA - WELLS FARGO PBM - WALGREENS 75% of allowed amount 100% of allowed Physician Office Visit after deductible amount, no deductible after a 20 co- a Fiscal Year $14385642 $7153736 Accumulated Total Lifetime $1,000,000 Unlimited 10/01/09 - 09/30/10 ,, ,, Maximum No Deductible Deductible no longer applicable to applicable to Preventive Items and Preventive Items and No longer a "grandfathered Services; added Services health plan" - amended the Preventive Child Health plan to include provisions for Services, revised plan a "grandfathered health plan" document language regarding coverage of dependents to age 26, TPA - WELLS FARGO PBM - WALGREENS Fiscal Year $14,385,642 $12,246,242 $7,056,873 10/01/10 . 9/30/11 Effective 11 /1 /11 ASO - BLUE CROSS/BLUE SHIELD OF FLORIDA Effective 10/01/11 PBM - ENVISION Individual Deductible $300 yr Fiscal Year 10/01/11-9/30/12 $12,246,242 $11,788,578 $7,506,483 Family Deductible $600yr Emergency Room Deductible 75 per visit Inpatient Deductible (per admit) $150 Out of Pocket Maximum $7500/$7500 Office Visit CoPay $20 per visit Pharmacy tiers: Generic 10 Preferred Brand 25 Non -Preferred 70 s O Q 2 N Q V Q w Q C Q m L Q s O) O :7 C O C G1 N G1 L a co 0 co W Z Q 2 U J Q U_ 0 H N 2 J C 4) E s V M 21 health/pharmacy/life s coverage)for those Hired on= or after 5/1/12 $0 per month $50 per month $50 per month y = Allow opting out of health insurance only. Those opting N G1 Fiscal Year out, department rate charged $51,840 v 10/1/12 - 9/30/13 $11,788,578 $11,840,418 $6,374,575 is $320 vs $790 for full $790 per month $320 per month � benefits department rate department rate N/A fn w Allow Retirees to drop Health Insurance and keep C Life Insurance at a rate of 41 $11.00 minimum 10 years of m service N/A N/A N/A 4) s Effective 1/1/14: c3 Individual Deductible $300 yr $400 yr $100 C7 Family Deductible $600 yr $800 yr $200 Emergency Room C Deductible $75 yr $100 yr $25 O C Office Visit CoPay $20 per visit $25 per visit $5 Fiscal Year $11,840,418 $12,071,795 $6,305,495 C 41 Pharmacy preferred tier $25 $35 $10 per year o service 10/1/13 - 9/30/14 Retiree premium for those hired prior to dep on yrs of $231,377 L contributions $50 per month 10/1/01 service d Annual out of Pocket (PPACA Mandate) $7,500/$7500 $6350/$12,700 $1,150 00 Incentive 4 hours of leave for 0000 Wellness participants 0 4 hours 4 hours Fiscal Year $12,071,795 $10,594,436 $7,267,166 a 10/1/14-9/30/15 Effective 1/1/15: Q No hire tobacco users N/A N/A N/A = Newly enrolled employees, V retirees, dependents on or J after 1/1/15 penalized if Q tobacco user. $0 $50 per month $50 per month U la� Newly enrolled employees, retirees, dependents on or 0 after 1/1/15 penalized $100 per month iffailing to certify or certifying ($50 user and $50 2 incorrectly tobacco user. $0 $0 penalty) Dependent Health Insurance C Premium subsidized 50% varied 50% N/A 4) Annual out of Pocket no change $6350/$12,700 N/A s (PPACA Mandate) include C1 pharmacy cc pays in total for 2015 year Q B.I. END OF YEAR FUND BEGINNING OF 13ALANCE 'On 511114 PROJECTED YEAR FUND' BOCC set policy of GAIN/{LOSS) FOR ACTUAL GAIN/(LOSS) BALANCE minimum 6 months MINIMUM RESERVE Fiscal Year YEAR claim reserve (6 Mos Claims) BENEFIT FROM TO DIFFERENCE Health Insurance Premium (includes health/pharmacy/life coverage)for those Hired prior to 5/1/12 $0 $25 per month $25 per month Health Insurance Premium (includes health/pharmacy/life coverage)for those Hired on or after 5/1/12 $50 $50 no change Continue Incentive 4 hours of leave for Wellness participants 4 hours 4 hours no change Fiscal year 10/1/15 - 9/30/16 $10,594,436 $8,431,870 $8,086,049 Department Rate change $790 per month $885 permonth $95 Incentive health insurance $50 per month (if hired $25 per month (if hired premium reduction for on or after 5/1/12) or on or after 5/1/12) or $0 Wellness participants during $25 per month (if hired per month (if hired prior Fiscal Year $8,431,870 $4,958,783 $8,729,342 10/1/15 - 10/31/16 prior 5/1/12) 5/1/12) $25 per month 10/1/16 - 9/30/17 Continue incentive 4 nours of leave for Wellness participants 4 hours 4 hours no change e M Q Q Q Q r- Q Q O aI O a. 21