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Item C1
BOARD OF COUNTY COMMISSIONERS AGENDA ITEM SUMMARY Meeting Date: May 1, 2014 Division: Employee Services Bulk Item: Yes No X Department: Employee B nefits ror uscal yezrs 2-4. 1 -1 kwpuun 1 or /-), 2.0 1 W., anu 70 1 7 Tor r7olf-my SITTsimes or employce 7777 urpefluerill health insurance premium amounts and/or department rate changes from $790 per month to various optional rate changes to maintain an adequate fund balance. ITEM BACKGROUND: The County's Health Insurance Consultant, Gallagher Benefit Services, provides annual projected estimates on the health of the Insurance Fund each year. In October, 2013, the BOCC requested an analysis of several components of the Plan. These requested items included: Analysis of whether the County should obtain re -insurance (stop loss), based on large claim payment history Minimum legally acceptable number of months of reserves vs. Gallagher recommended number of months of reserves since the County has no re -insurance (stop loss) to protect against large claims • Analysis of employee subsidies • Analysis of dependent subsidies • Analysis of department rate, based on projected fund balance deficiencies • Analysis of what makes up the County's Department rate of $790 per employee per month ($448 Employee Medical; $25 Employee Life/EAP; $99 Dependent Medical; $218 Retiree Coverage) Note: The department rate of $790 is not adequate and currently assumes a porti of fund balance. • Analysis of Patient Protection and Affordable Care Act (PPACA), commonly referred to as Obamacare compared to the County's Health Insurance Plan and their benefits • Benefit comparison of the County benefits to other communities in Southwest Florida The attached summary table of the Gallagher projections indicates that with no changes being made to the Health Insurance Plan, the following projected revenue deficiencies would occur: • FY14—($ 5123.000) (no changes can be made to this FY) • FYI 5 — ($1,62-3,04-5) • FY16—( $2,752,211') 1P FY17—($3,954,92-21) yrov=es=1r empioyees an eir aepenuen s, as we as Ene amoun ate woum a 1,74 Lv increase to • the amount of reserves currently in the fimd, I III pipill I I # tffib,W�� ffii I, TOTAL COST: MIRECT COST: BUDGETED: Yes Ni Internal Service Fund COST TO COUNTY: SOURCE OF FUNDS Primarily Ad Valorem . .. ... .... ... A Z, APPROVED BY: County Arty_ OMB/Purchasing _ Risk Management. DOCUMENTATION: Included X Not Required DISPOSITION: AGENDAITEM# 0 . c 5r E rL c + a A c S c c -C :C3 Z W ::r n 2: iK to + C16 z V A CL CL eo CL a M IQ Ul :zp Ln ca W, g6 C Da CL m &L u. 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Total Gross Paid Claims (1) a. BCBSFL Active 1,244 662 $ 2,689,084 $ 7,139,652 $ 3,746 b. BCBSFL Retiree 375 131 $ 1,114,902 $ 2,960,121 $ 5,850 c. Envision Active 1,244 662 $ 668,144 $ 1,681,324 $ 882 d. Envision Retiree 375 131 $476,691 $ 1,199,550 $ 2,371 Benefit Changes $ - $ (134,172) Total Paid Claims $ 4,948,821 $ 12,846,474 II. Fixed Costs (2) a. BCBSFL 388,718 934,073 b Envision 30,199 72,566 c. Internal Expenses 90,624 217,498 d. PPACA (5) - PCOR Fee (6) 1,996 4877'' e. PPACA (5) - Transitional Reinsurance Fee (2014) (7) 25,153 113279' f. Other (GBS, Life, AD&D, EAP) 152,500 366,000 Total Fixed Costs $ 689,190 $ 1,708,293 III. Total Paid Plan Costs $ 5,638,011 $ 14,554,768 IV. Funding a. Contributions (4) $ 5,764,544 13,851,941 b. Interest (3) $ 14,583 $ 35,000 c. Other (3) $ 57,917 $ 139,000 d. FRS Health Insurance Subsidy $ - $ 133,346 Total Funding $ 5,837,044 $ 14,159,287 V. Cash Surplus/(Deficit) $ 199,033 $ (395,481) VI. Change in Claim Reserve a. Starting Reserve $ 965,564 $ 965,564 b. Estimated Closing Reserve $ 1,217,874 $ 1,083,731 c. Change in Reserve $ 252,310 $ 118,167 VII. Incurred Surplus/(Deficit) $ (53,277) $ (513,647) Vill. Incurred % Surplus/(Deficit) -0.9% -3.7% (1) Based on paid claims through February 28, 2014. (2) Based on fixed rates and reported and/or projected enrollment and actual WFTPA (3) Based on September 2013 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 (7) Assessment ends December 2016 3 MONROE COUNTY BOARD OF COUNTY COMMISSIONERS Renewal Projections October 1, 2014 through September 30, 2015 Assuminq Current Enrollment Projected Assumed Projected 2013/14 % Change 2014/15 I. Total Net Incurred Claims 1 $ 12,964,641 8.0% $ 14,153,260 II. Fixed Costs (2) a. BCBSFL 934,073 3.0% 962,940 b. Envision 72,566 0.0% 72,630 c. Internal Expenses 217,498 4.0% 226,198 d. PPACA - PCOR Fee 4,877 3.0% 5,051 e. PPACA - Transitional Reinsurance Fee (2014) 113,279 116,903 f. Other GBS, Life, AD&D, EAP 366,000 0.0% 366,000 Total Fixed Costs 1,708,293 0.0% 1,749,722 III. Total Incurred Plan Costs 2 $ 14,672,935 $ 15,902,982 IV. Revenue at Current Level a. Contributions (4) $ 13,851,941 $ 13,928,142 b. Interest (3) $ 35,000 $ 35,000 c. Other (3) $ 139,000 $ 139,000 d. FRS Health Insurance Subsidy $ 133,346 $ 177,795 Total Revenue at Current Level 14,159,287 0.0% $ 14,279,937 V. Surplus/(Deficit) With No Change in Funding $ 513,647 $ 1,623,045 VI. Increase Required to Break Even in 2013/14 N/A 11.7% $ 15,902,982 Notes: (1) 2013/14 Net Claims (2) 2013/14 Total Plan Costs from Prior Page (3) Projected 2014/15 Funding $ 12,846,474 - 118,167 $ 12, 964, 641 $ 14, 554, 768 - 118,167 $ 14,672,935 Projected Paid Claims Reserve Change Total Paid Plan Costs Reserve Change $ 14,279,937 Annualized Funding at 2013/14 Rates $ 351,795 Less Interest and Other Income $ 13,928,142 Annual Contributions 1.1165 Required 10/1/14 Increase $ 15,551,187 Resulting 2014/15 Contributions $ 351,795 Plus Interest and Other Income $ 15,902,982 Total Projected 2014/15 Revenue 4 N G II � � II II II V I- CO Lo I- N - V O 00 (N Cf) (N I- (f) 1- O N (O V V ' O I- V 00 O I� 00 cl I- LD CO - 00 V (O I- N O (p O 00 (D LD O N (O 00 N 00 Cf) V O Cf) LD Cf) O V N — N - N C _ 00 (O 613� 613� Gq Gq Gq Gq Gq Gq Cf) I- V Lo (O Lo 00 N Lo LD L( N - � ' V V (C N V � Lf C6 Lo I- LD - I- V O N V O 00 (O (O (O O N V V I- N 00 00 O (N Cf) 00 LD Cf) N EA EA EA EA EA EA Gq Gq Gq Gq Gq N (n O CO V co co V O 00 V co E LO 00 (O co LO I- (O r- O 00 'O LLI �_ CO - ' - 00 r- r- CO LC) 00 V U Z O O (O C (O I-� O L6 00 I-� ( O N LO I- 00 - I- (O LO 00 N CD V LO (D 00 O - N I- (O LO fn V N C6 O I-� c a �' � a 61) O a _ � U N N O N (O - O N co U v } � � C) O_ O C) � O ' co ('') - O(O V CO - N V 00 N O 00 00 N � Z N O a) LO O- N V V LO _0 N (co 0000 (O LO O N LO 00 N I- O (6 OaN (O- V N NV NOI- LL M m o U i O) c O (6 < f=0 co � N (O CO � � N � (O 0)Q c� LL � O (O (O (ON O V V 00 0') LO I - ONO IT LO CO (O(' r� O 0 O CO m a a (O IT V LO N 0') 00 - N a) V V LO LO LO c LO (o 00 CO LO m O (n } r Q N O r - O 7 cf - cf O () LL I- (O - N z O N O O E U uJ O > O i a z a E � o 75 ate) co (n E v cu (D Cf) U O W (6 N N N CO Z3 O cfj CN (6 m �� -0 (6 LL E O (6 - N Z c6 W c c c .0 z DBE 0 0 (6 mm")0- (6 N N D- 0 0 0 N _ - -0 O �_ E LL1 D O o o .- m (D is c _0 U w ate) >- o� ate) z°' E 0) �' °' Co ism z w E a�i �0 m c >,o (D O aD °D _ in o (D D; � Liw� <LU Q c 0 °'Eco -0-0(D CO (n CO Q >. J W W p) E - UU�U UO(D >->-(D z LO Florida Blue Lar a Claim Su mary for 12 Months Ending: Claimant Number 2/28/2014 9/30/2013 10/31/2012" 9/30/2011 9/30/2010 9/30/2009 1 $496,496 $310,603 '' $323,462 $336,742 $338,544 $402,792 2 $162, 666 $291, 049 $320,118 $299, 312 $224, 043 $290,146 3 $134,784 $282,573 $268,729 $281,670 $220,450 $134,646 4 $103,159 $207, 021 $201, 912 $231, 847 $148, 066 $109, 928 5 $102,098 $178,797 $196,659 $229,022 $146,906 $85,944 6 $86,808 $163,122 $117,674 $183,866 $101,914 $85,706 7 $86,162 $153,269 $116,592 $179,745 $91,317 $84,623 8 $83,234 $118,555 $114,750 $156,736 $76,118 $76,682 9 $70, 929 $117, 803 $94,178 $151, 008 $71, 028 $65, 374 10 $59,440 $114,376 $92,001 $145,166 $68,704 $64,492 11 $56, 761 $111,122 $90,148 $144, 098 $66, 763 $61, 525 12 $54, 029 $110, 962 $86, 922 $142, 657 $66, 392 $61,158 13 $104,392 $83,772 $126,640 $63,776 $60,197 14 $101,381 $71,659 $124,513 $61,416 $58,112 15 $95,807 $70,268 $123,031 $60,003 $57,051 16 $94,435 $69,931 $113,903 $57,619 $54,270 17 $94,433 $66,602 $103,782 $55,504 $54,218 18 $82,169 $66,061 $103,277 $55,416 $51,334 19 $80,193 $65, 531 $100, 757 $52, 899 20 $77,282 $64,327 $98,108 $50,110 21 $75,227 $62,859 $91,498 22 $72,821 $60,670 $90,664 23 $71,309 $59,190 $89,474 24 $71,194 $57,240 $87,217 25 $70,814 $55,264 $84,224 26 $66,559 $54,455 $80,584 27 $65, 798 $50, 968 $78, 731 28 $65, 739 $76, 097 29 $65,399 $73,207 30 $62,494 $69,854 31 $57, 753 $68,167 32 $54, 300 $68,103 33 $53,410 $66,790 34 $52,167 $62, 995 35 $51,662 $61,287 36 $61,142 37 $61, 095 38 $60, 965 39 $59, 791 40 $57, 359 41 $57,269 42 $55, 894 43 $55, 349 44 $54, 950 45 $52, 782 46 $52, 375 47 $50,261 48 1 1 1 $50, 052 Total $ 1,496,566 $ 3,845,990 $ 2,981,942 $ 5,204,004 1$ 2,076,986 $ 1,858,196 Reimbursement with $300K Ded. $196,496 $10,603 $43,579 $36,742 $38,544 $102,792 Reimbursement with $500K Ded. $0 $0 $0 $0 $0 $0 Includes medical claims only. 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We were asked to consider various categories of individuals eligible to participate in the County's medical plan, including active employees, pre -Medicare retirees, and Medicare eligible retirees. There are no plans available on the Exchange for Medicare eligible retirees. The Healthcare Exchange platform offers 4 standard levels of coverage: Platinum, Gold, Silver, and Bronze. A Catastrophic plan is available only on a limited basis and only to individuals of 30 years or younger. A price and benefit comparison was performed of the County's 2014 Medical Benefits versus the standard exchange plans. The plans shown in Exhibit 1 are the closest in value to the County's medical plan. For an Exchange plan to be a viable alternative to the County medical plan, the Exchange plan would have to provide a benefit equal to or better than the County Medical plan at a cost to the individual that is no higher than the cost to enroll in the County plan. It should be noted that Exchange plans generally have more restrictive networks than commercially available plans. BENEFITS: The County's medical plan is most similar in total actuarial value at 81.3% to the Gold Exchange plans which have an actuarial value of 80%. • Florida Blue and CIGNA are the only insurers offering a Gold plan in Monroe County. • While the actuarial benefit value is roughly equal between the offerings, the plans differ in when the patient pays for services. A brief summary of the benefits is attached as Exhibit 1. PRICING: The cost of the County's medical plan is consolidated across all variables such as age, gender, and smoking status. • The average age of the County's active participants is 47 years, based on a plan census from November 2013. The overall average age of participants is 51. • The Exchange plans are rated based on age and smoking status — therefore, to compare pricing we used non-smoking rates and a target age of 45 years for active employees. • The Actuarial Equivalent rate for the County's medical plan for single coverage is $456. © 2014 GALLAGHER BENEFIT SERVICES, INC. ARTHUR J. GALLAGHER & CO. I AJG.COM Page 17 March 2014 • The County currently subsidizes 100% of the premium for single coverage for employees hired before May of 2012. Employees who contribute to their coverage pay no more than $50 per month. Pricing summary: *The premium equivalent represents the cost of the Medical plan only and not the full Departmental rate which incorporates additional expenses. While the County may wish to further evaluate various strategies regarding their benefit plan offering, this review demonstrates that the County's medical plan remains the most viable alternative. For active employees, the cost of the plan approximates breakeven when the employee reaches age 45 (earlier if the employee is a smoker). Given that the average age of Monroe County's participants is 47, the cost difference is negligible between the Exchange plan and the County Plan. For the total plan population, the average age increases to 51 where the average cost favors the County plan. For retirees, the average age is 69 and the mode is 65. Exchange plans are not available for individuals of this age. The only alternative would be a Medicare Supplement or a Medicare Advantage plan (if available). SUMMARY OF OTHER EXCHANGE PLANS: The Bronze plan is the minimum coverage acceptable under the Patient Protection and Affordable Care Act. We did not evaluate the price of Bronze plans, because at a benefit value of 60%, they were not comparable to the County's plan. Silver plans, at a benefit value of 70%, provide a lower level of coverage than the County's plans at 81.3%. Two vendors, CIGNA and Florida Blue, offer Silver plans in Monroe County. Of the five (5) plans evaluated, pricing for the three Florida Blue Silver plans was higher than the $456 cost for the County's plan, starting at age 45. The two CIGNA plans had lower premiums up to the age of 45. The plan designs for these plans have higher in network coinsurance, a more restrictive Prescription formulary with © 2014 GALLAGHER BENEFIT SERVICES, INC. ARTHUR J. GALLAGHER & CO. I AJG.COM Page 18 March 2014 higher copays, and a higher out of pocket maximum for out of network care than the County's plan. All of these design factors push the expense to the participant sooner than with the other plans evaluated. Platinum plans represent the highest level of benefit available on the Exchange platform. The benefit value for a Platinum plan is 90% and only Florida Blue offers a Platinum plan in Monroe County. The pricing for these plans exceeds the cost of the County's plan for even 30 year old, non-smokers. The comparisons of benefits and pricing are provided as backup to this document and are based on research conducted during the Exchange open enrollment for the 2014 plan year. This analysis is an outline of the coverages proposed by the carrier(s) based upon the information provided by your company. It does not include all the terms, coverages, exclusions, limitations, and conditions of the actual contract language. See the policies and contracts for actual language. This analysis is not a contract and offers no contractual obligation on behalf of GBS. Policy forms for your reference will be made available upon request. This analysis is for illustrative purposes only, and is not a proposal for coverage or a guarantee of future expenses, claims costs, managed care savings, etc. There are many variables that can affect future health care costs including utilization patterns, catastrophic claims, changes in plan design, health care trend increases, etc. This analysis does not amend, extend, or alter the coverage provided by the actual insurance policies and contracts. See your policy or contact us for specific information or further details in this regard. © 2014 GALLAGHER BENEFIT SERVICES, INC. Page 19 ARTHUR J. GALLAGHER & CO. I AJG.COM March 2014 EXHIBIT 1-IMONROE COUNTY BOCC COMPARISON I' 2014 GOLD PLANS What You Pay In -Network What You Pay In -Network What You Pay In -Network Covers 80% of Average costs of care What You Pay Out' -of -Network '.'. What You Pay Out -of -Network : What You Pay Out -of -Network Plan Benefits Florida Blue Plan 14 U CIGNfS (Copay fissure Gold MCBCC Plan Annual Deductible In -Network Individual: $2,500 / Family: $5,000 Individual: $0 / Family: $0 Individual: $400 / Family: $800 Out -of -Network)'.'. Individual: $8 000 / Family: $16 000 Individual: $500 / Family: $1,000 Individual: $400 / Family: $800 Coinsurance% In -Network 20% 30% 25% ut-of-Network'.'. 50% 1 50% 55 Annual Out -of -Pocket Maximum (includes Individual: $6,250 / Family: $12,500 Individual: $5,000 / Family: $10, 000 Individual: $6,350 / Family: $12,700 deductible nce copays s and coinsura Individual: $16 000 / Family: $25 000 Individual: $25 000 / Famil : $50 000 Individual: $6 350 / Family: $12 700 Physician Office Visits PrimaryCare Physician $0 for first 3 visits, $20 Copay for all other visits $30 Copay $25 Copay DED +50% DED +50% DED +55% Specialist $50 Copay $60 Copay $25 Copay DED +50% DED +50% DED+55% Preventive Services Preventive and Wellness Care (e.g. physical, $0 $0 $0 mammogram, immunizations) 5 % (No DED) (mammograms & colonosco ies $0 (mammograms &olonosco ies $0)55 Emergency and Urgent Care Emergency Room (waived if admitted to DED + 20% $250 Copay $100 PVD + DED + 25% hospital) DED +20% In -Network DED +30% $100 PVD+ In -Network DED +25% Urgent Care Center DED + 20% $75 $25 Copay DED +50% DED +30% DED +55% Hospital and Surgical Care Ambulatory Surgical Center DED +20% $1,000 Copay DED +25% DED +50% DED +50% DED +55% Outpatient Hospital Facility DED +20% $1,000 Copay DED +25% DED +50% DED +50% DED +55% Inpatient Hospital Facility DED + 20% $1,000 Copay per day $150 PAD + DED + 25% DED +50% DED +50% $150 PAD +DED +55% Physician Services (all locations) $0 DED +30% DED +25% $0 DED +50% DED +55% Outpatient Diagnostic Services Independent Clinical Lab (e.g. blood work) $0 DED +30% $0 DED +50% DED +50% DED +55% Basic Imaging (e.g. x-ray, ultrasound) DED +20% DED +30% DED +25% DED +50% DED +50% DED +55% Advanced Imaging (e.g. CT/CAT Scan, MRI, DED +20% $500 Copay DED +25% MRA) DED +50% DED +50% DED +55% Outpatient Rehabilitation and Habilitation Physical, Speech, Occupational, Cardiac, and DED +20% $60 Copay DED +25% Massage Therapy DED +50% DED +50% DED +55% 50 visit annual max Mental Health and Substance Dependency Specialist Office Visit $50 Copay $60 Copay $25 Copay DED +50% DED +50% DED+25% Inpatient Facility DED + 20% $1,000 Copay $150 PAD + DED + 257 DED +50% DED+50% $150 PAD +DED +55% Maternity Care Prenatal and Postnatal $50 Copay DED +30% $25 Copay DED +50% DED +50% DED +55% Labor and Delivery DED + 20% DED + 30% $150 PAD + DED + 25% DED +50% DED +50% $150 PAD +DED +55% Pediatric Vision and Dental (ages 18 and under) Vision Care Eye Exam -No Charge,Glasses-No Charge Eye Exam -No Charge,Glasses-No Charge Not Covered Dental Care Not Covered Not Covered Not Covered Adult Vision and Dental (ages 19 and over) Vision Care Not Covered Not Covered Not Covered Dental Care Not Covered Not Covered Not Covered Prescription Drug Benefits Generic Dru s Tier 1' Retail Piarmac /Mad Order Preventive (e.g. oral contraceptives) $0 copay (retail) / $0 copay (home delivery) $0 copay (retail) / $0 copay (home delivery) $0/$0 Not Covered 50% co-insurance retail/home deliver Out of network Not Covered Condition Care Rx e. asthma, cholesterol, ( g. $4 copay (retail) / $0 copay (home delivery) Preferred Generic: $10/$25 diabetes, high blood pressure) Not Covered $4 copay (retail) / $10 copay (home delivery) Out of network Not Covered 50% co-insurance retail/home deliver $10 copay (retail) / $25 copay (home delivery) Non -Preferred Generic: $30 Copay / $75 Copay All Other Generic $15 copay (retail) / $37 copay (home delivery) Not Covered 50% co-insurance retail/home deliver Out of network Not Covered Brand Drugs - Tier 2 Retail Pharmac / Mail Order Condition Care Rx (e.g. asthma, cholesterol, $20 copay (retail) / $50 copay (home delivery) Preferred Brand: $30 Copay / $75 Copay diabetes, high blood pressure) Not Covered $45 copay (retail) / $112 copay (home delivery) Out of network Not Covered 50% co-insurance retail/home deliver $40 copay (retail) / $100 copay (home delivery) Preferred Brand: $30 Copay / $75 Copay All Other Preferred Brand $45 copay (retail) / $112 copay (home delivery) Not Covered 50% co-insurance retail/home deliver Out of network Not Covered Non Preferred Brand Drugs Tier 3 (Retail Pharmacy / Mail Order Non -Preferred Brand $70 Copay (retail) / $175 Copay (home delivery) 50% co-insurance (retail/home delivery) $70 Copay / $175 Not Covered 50% co-insurance retail/home deliver Out of network Not Covered Specialty Drugs Tier 4 Retail Pharmacy/ Mad Order Specialty (purchased from specialty pharmacy) $150 Copay (retail) / Not Covered (home delivery) 40% co-insurance (retail) / 30% (home delivery) Covered at Appropriate Copay Not Covered 50%cc_ insurance retail/home deliver Premium Estimates - individual Only Pricing for plans is 30 year old $359.36 M = $4312.32 A MCBCC Active Employees Cost Share: 85 y year old $386.91 M = $4642.92 A $50 M = $600 A (highest) estimated based on MCBCC Average age 47 yrs - active employees 45year old $457 20 M'= $5486 40'A information on the The Actuarially sound rate for a single employee in 50 year old $565.48 M = $6785.76 A Exchange and vendor the MCBCC plan is: 60 year old $859.31 M = $10311.72 A website $456 M = $5,472 A 64. year old $991.00 M = $11,892.00 A Page 20 2013 Comparison of Governmental Plans Medical Products ............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................... Deductible $400.00 $1,500.00 $1,300.00 $500.00' $500.00 Rank. 1 5. 4 2 2 In -Network Coinsurance 72/25 80/20 80/20 80/20 80/20 Rank 5 1. 1 1 1 Out of Network Coinsurance 45/55 50/50 70/30 60/40 60/40 Rank 5 4 1 2 2 Deductible then Physician Copayment $25.00 Coinsurance $25.00 $35.00 $15.00 Rank 2 5. 2 4 1 Deductible then Deductible then Specialist Copayment $25.00 Coinsurance ' ' $50.00 $35.00 ' ' Coinsurance'. Rank. 1 5. 3 2 4 Maximum Out of Pocket $6,350.00 $3,000.00 $2,800.00 $3I,500.00 $3,000.00 Rank 5 2. 1 4 2 Overall Score 19 22 12 15 12 Number Best 2 1 3 1 2 Number Worst 3 3 0 0 0 OVERALL RANK (Based on Overall 4 5' 1 3 2 Score) Employer Subsidy Comparison Attribute ' Monroe County City of Boca Raton Broward County I City, of Miami City of Gainesville' BOCC Government Beach (Target) Employee Subsidy 90% 100% 94% 71% 90% Rank' 3 1' 2 5 3 Dependent Subsidy 52% 66% 62% 51% 45% Rank' 3 1 2 4 5 Overall Score 6 2' 4 9 8 Number Best 0 2. 0 0 0 Number Worst 0 0' 0 1 1 OVERALL RANK (Based on Overall 3 1 2 5 4 Score) 1 = Best in Category 5 = Worst in Category Page 21 MONROE COUNTY MEDICAL BENCHMARKING To assist the County in making determinations about the Medical plan moving into 2015, Gallagher Benefit Services, Inc. consolidated historical information from various Florida governmental entities for comparison purposes. In addition, Gallagher utilized the results of its 2013 National Benchmarking Survey to provide additional information. The sample used in the local benchmarking was based on 2013 benefits and included County Governments, City Governments, and the Broward Sheriff's Office. We provide a brief overview of the key benefit provisions and the premium contribution strategies for employees and the family portion of the rates. Where the plan is self -insured, we utilized published rate equivalents for the comparison. The Entities maintain both Self -Insured and Fully -Insured plans and offer a variety of plans, including HMO, PPO, and Point of Service plans. There are 9 Entities in the comparison including Monroe County, with five offering HMO benefits. The Entities offering HMO benefits are in either Miami - Dade or Broward County, where there is a heavy concentration of health care providers and robust networks. There are 8 Entities offering either a PPO or a Point of Service plan and two offering only a PPO. The two offering only PPO plans are in areas with restricted health care accessibility — Monroe County and the City of Gainesville. 7 of the 9 Entities offer at least a high and a low option benefit for employees to choose during open enrollment. Benefit Design: In comparing the plans most similar to the County, we identified 4 Entities with plans offering Coinsurance both in and out of network. Of these 4 Entities: • Monroe County offered a lower deductible than all four, with the next lowest being $500. Monroe County had a higher in network coinsurance at 75/25 (the employee cost share is 25%) than the others at 80/20 across the board. The out of network coinsurance for Monroe County was also higher at 45/55 with participants paying 55% of allowed amounts. The closest out of network cost share to Monroe County was a 50/50 share in one plan. The most frequent cost share was 60/40 with two plans. The maximum out of pocket amount of $6,350 for Monroe County is a combined in and out of network amount, which was reduced to comply with HealthCare reform. This is the highest in network out of pocket maximum. The other plans are showing separate in network and out of network maximums. The range of in network maximums is $2,800 to $3,500 (two plans have $3,000). The out of network maximum varies from $3,600 to $10,500. • Miami -Dade offers two HMO plans and a Point of Service Plan. © 2014 GALLAGHER BENEFIT SERVICES, INC. Page 22 ARTHUR J. GALLAGHER & CO. I AJG.COM March 2014 Employer Contribution: Rate structures vary widely across the sample of Entities but there was always an individual rate and a family rate. With a lack of specific enrollment data for each Entity it is impossible to obtain a valid consolidation of employer contributions using all tiers. Therefore, to maintain consistency we utilized the individual and the family rates and contribution amounts for this overview. The County contributes 100% of the cost for active employees who were hired before May 2012 and contributes approximately 90% of the cost for employees hired beginning in May 2012. For coverage for the full family add on (spouse and one or more children) the contribution is estimated to be 52%. With the Entities sampled, where there is more than one plan, there is a baseline benefit with a high employer contribution and low employee contributions. The remaining plans offer a higher benefit and consequently, the employee pays a greater share of the cost of coverage. Individual Coverage: For the plans that are most similar to the County's plan, the lowest employer contribution for the individual employee is 70% and the highest is 100%. At 90%(for employees hired beginning May 2012), the County's contribution is competitive for individual coverage. At 100%, the County's contribution is higher than for any of the plans other than the low option plan offered. The low option plan in these cases could be either an HMO or a High Deductible Health Plan. While the Miami -Dade program is not considered to be similar in benefits to Monroe County, Miami -Dade County pays 97% of the individual cost for its only Point of Service plan. This plan provides a higher level of benefits than Monroe County's plan with a $200 deductible and 100% coverage in network, after applicable copayments. The plan costs are also much higher than the County's. Family Add On: For the plans that are most similar to the County's plan, the lowest employer contribution to the family portion of the rate is 45% in the City of Gainesville. The remaining contributions for the family add on range from 51 % to 66%. Looking at the family add on from the employee's perspective, at Monroe the family add on cost is $529 per month. In the remaining groups the range in employee contributions to add family coverage runs from $345 per month to $908. Looking again at Miami -Dade County, the percent of employer contribution to the family add on is only 34%. The employee, however, pays $1,290 per month. © 2014 GALLAGHER BENEFIT SERVICES, INC. Page 23 ARTHUR J. GALLAGHER & CO. I AJG.COM March 2014 In evaluating the County's program against other local governmental entities, we must take into consideration the unique medical and health care profile of the Keys. Because of the relatively limited number of providers and the high costs in the Keys, Monroe County Board of County Commissioners is faced with limited alternatives in the type of medical coverage it can offer employees. The local provider network is not open to HMO products with its rules and reimbursement levels. These factors drive up the cost to deliver a medical plan. 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M V �31 W 31 T O V O T O V O' O — 0 0 O Q U � U� p UO 00 O o UO0 O- o0 0O O- o 0000 o o p o UO 0 LOLO LO Lc) ! (D � 0 L. Q M -(3 'g. E. //--�� V Q 0 m C 0 Co R E O m L C N �. w w N. w c a). N _ �. Co CL N O lfl ll'l O O 4 a) .0U R � y (6. U 0 w , 3. L �. O w O Q w Q w o L � N r r ¢ N' 0 R n _N' p w c ° '- H °: O CiI' z �' cB R w p> w N Lu i a R W •O R lU R_p, U Ci s. U v v- 6 �"f6w3 C f6 u L �, c �, c N. a--' _ co w CL E 15 N @. 1. U C.. a.W •� X Q ti5 0 y �,. 0 (6'. 0 p'. w' CL fU' W 6. 0— CL O'.. U m'.. U Z'.. in rL MONROE COUNTY BOARD OF COUNTY COMMISSIONERS CONSIDERATIONS FOR 20/4/2015 ON THE PATIENT PROTECTION AND AFFORDABLE CARE ACT ("PPACA" A.K.A. "OBAMACARE") FEES AND REPORTING • Transitional Reinsurance Program Fee: This is a 3-year fee (for 2014 — 2016) that Gallagher includes in the plan's forecast. For 2014, it's $5.25 per member per month ($63 per member per year). The per member per year fee for 2015 is $44 and the estimated fee for 2016 is $25. o The 2014 fee is payable in January of 2015. o The 2015 and 2016 fees will be payable in January 2016 and 2017 respectively. • Patient Centered Outcomes Research Institute Fee: This is a 7-year fee (for 2012-2018) that Gallagher includes in the plan's forecast. For 2012, it was $1 per covered member per year; increasing to $2 per member per year for 2013. Years 2014 — 2018 will be indexed accordingly. o It's remitted along with a Form 720 by July 31 of the following year (i.e., July 31, 2014 for the 2013 payment). • Individual and Employer Mandate Reporting: o Minimum Essential Coverage ("MEC") Reporting to the IRS: The County must electronically report on a Form 1095-13, information about the County; each individual covered by the County's plan; and their dates of enrollment in the plan. ■ When: The 2015 MEC Reporting is due by March 31, 2016. o Applicable Large Employer ("ALE") Reporting to the IRS: The County must electronically report on a Form 1095-C the following information: Name, address and EIN of the County; County contact information; calendar year to which the 1095-C relates; Certification as to whether the County offered its full-time employees the opportunity to enroll in MEC; the months during which MEC was available; each full-time employee's share of the lowest cost monthly premium for self -only coverage providing MEC by calendar month; number of full-time employees for each month during the calendar year; and the name, address and taxpayer ID of each full-time employee during the calendar year and the months during which such employee was covered by the plan. ■ When: The 2015 Applicable Large Employer Reporting is due by March 31, 2016. o MEC and ALE Statements to Individuals: Statements must be provided to individuals listed on the IRS Forms 1095-B and 1095-C described above. Those statements must include the information that was reported to the IRS among other things. ■ When: The 2015 Individual Statements must be provided no later than February 1, 2016. © 2014 GALLAGHER BENEFIT SERVICES, INC. Page 1 ARTHUR J. GALLAGHER & CO. I AJG.COM EMPLOYER PENALTIES The County will generally not be subject to the Employer Penalties below because it offers coverage that meets the standards for Minimum Essential Coverage and is Affordable for employees working 30 hours per week or more. Starting in 2015, Applicable Large Employers will be subject to penalties under PPACA as follows: • Penalty for failure to offer "minimum essential coverage" ("MEC") to at least 70% of its full- time employees ("FTE") equal to $2,000 per year for each FTE (minus 80). "Full time" is defined as any employee working on average 30 or more hours per week. (See below) o MEC equates to a 60% actuarial value. The County's group medical plan is approximately 81% actuarial value. o In 2016 the following changes will take place: ■ The minimum percent of full time employees who must be offered MEC increases to 95% in 2016. ■ The penalty if an Applicable Large Employer fails to offer MEC is based on the number of FTS's minus 30. • Penalty for each FTE to whom the County does not offer MEC that's affordable equal to $3,000 per year per FTE. The County offers MEC that's affordable because the plan is offered at zero or nominal cost to employees for the employee -only tier. o From a penalty standpoint, the only concern would be employees who are not currently benefit -eligible who work more than 30 hours per week on average. o The $3,000 penalty is only assessed if the FTE purchases medical insurance through the Marketplace with financial assistance from the Marketplace. FULL-TIME EMPLOYEE DETERMINATION The Employer Penalties described above are assessed against an employer's "full-time" employees. Full-time is anyone who is reasonably expected to work 30 hours per week on average. If the County has any employees that are part time, temporary or seasonal, or who work varying hours, the County can create a lookback measurement period during which they can measure those employees' hours to determine if they work 30 or more hours per week on average. The measurement period can be up to 12 months long. Any employee who works an average of 30 or more hours per week during the measurement period is considered to be a "full time" employee during the immediately following 12-month period (referred to as the "Stability Period.") It's during the stability period that the County would be subject to the Employer Penalties described above with regard to those full-time employees. March 20, 2014 © 2014 GALLAGHER BENEFIT SERVICES, INC. ARTHUR J. GALLAGHER & CO. 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