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Item C30
lrl County�� Mope ; c'�' )' �� r� "16 4 BOARD OF COUNTY COMMISSIONERS The Florida Keys ,- � + m �� u 1 , i Mayor David Rice, District 4 Mayor Pro Tem Sylvia J. Murphy, District 5 Danny L. Kolhage, District 1 . �, zm George Neugenf District 2 Heather Carruthers, District 3 County Commission Meeting October 17, 2018 Agenda Item Number: C.30 Agenda Item Summary #4800 BULK ITEM: Yes DEPARTMENT: Employee Services TIME APPROXIMATE: STAFF CONTACT: Natalie Maddox (305) 292-4450 N/A AGENDA ITEM WORDING: Submittal of Monroe County Group Health Plan fund status through July 31, 2018, given the plan design changes that were implemented on January 1, 2018. ITEM BACKGROUND: An update of Monroe County Group Health Plan experience through July 31, 2018. In July 2017, the BOCC decided on a package of changes to the Monroe County Group Health Plan designed to reduce Health Plan costs. The changes became effective on January 1, 2018. The attachment, MCBOCC Experience Summary July 2018, includes a narrative prepared by Glen Volk, Consulting Actuary with Gallagher Benefit Services, the County's Benefits Consultant. The attachment, MCBOCC Forecast for FYE 2018 and 2019 Thru 2018 07 31, includes claims cost analysis, fund balance forecasts, claims projections, and rate recommendations. PREVIOUS RELEVANT BOCC ACTION: July 2017 — Approved a package of Health Plan changes to become effective 1/1/18 that were designed to reduce costs CONTRACT/AGREEMENT CHANGES: N/A STAFF RECOMMENDATION: N/A - Informational Only DOCUMENTATION: MCBOCC Experience Summary July 2018 - v3 MCBOCC Forecast for FYE 2018 and 2019 Thru 2018-07-31 gv TelaDoc Utilization Report - Estimated Claims Savings FINANCIAL IMPACT: Effective Date: Expiration Date: Total Dollar Value of Contract: Total Cost to County: Current Year Portion: Budgeted: Source of Funds: CPI: Indirect Costs: Estimated Ongoing Costs Not Included in above dollar amounts: Revenue Producing: Grant: County Match: Insurance Required: Additional Details: N/A h]WTA1IH11." If yes, amount: Bryan Cook Completed Natalie Maddox Completed Assistant County Administrator Christine Hurley 10/01/2018 5:32 PM Cynthia Hall Completed Budget and Finance Completed Maria Slavik Completed Kathy Peters Completed Board of County Commissioners Pending 10/01/2018 4:34 PM 10/01/2018 5:07 PM Completed 10/02/2018 9:15 AM 10/02/2018 11:04 AM 10/02/2018 2:20 PM 10/03/2018 11:57 AM 10/17/2018 9:00 AM 2255 Glades Rd 561-998-675EL Boca Raton, FL 33431 WWW.a IR.com USA Insurance I Risk Management I Consulting Monroe County Board of County Commissioners Health Plan Experience Summary through July 31, 2018 Presented October 17, 2018 Insurance I Risk Management I Consulting • 2017/18 Experience and Forecast • The first 7 months of the current fiscal year, following Hurricane Irma, were very favorable, but May through July were poor. The current fiscal year is a blend of 3 months under the original benefit and contribution structure and now 7 months under the revised structure. • The rolling 12-month per employee per month (PEPM) claims have fallen from $902 in July 2017 to $860 in July 2018. That is a 4.6% drop in 12 months. • The plan changes implemented on January 1, 2018 had the desired effect on claims. o Providing a $250 per month subsidy to Medicare eligible retirees - In 2017 there were approximately 310 Medicare eligible retirees on the plan and that fell to 150 in 2018, a drop of just over half. o Pharmacy claims are averaging $185,000 per month in 2018 compared to $261,000 per month in 2017 due to the drop in the number of Medicare eligible retirees on the plan. The reductions in claims projects to an annual drop of over $900,000 in an environment where we would have expected an increase of $300,000. o Medical claims are also performing as expected. The changes in plan design were not as significant as the pharmacy changes, and removing Medicare eligible retirees causes the PEPM medical claims for the remaining lives to increase, so some of the impact of the medical changes is hidden. o Dual Option Health Plan — BOCC created a high deductible/health savings account option. 60 employees migrated to the new option o Changed Medicate Retiree Drug Coverage from RDS to EGWP o Smoker Surcharge o Dependents of employees hired after 1/1/18 will pay 50% of actuarial rate o Established Acturially Sound Retiree Rates for insurance o Reduction of subsidy for Rule of 70 Pre-65 retirees with less than 25 years of experience • One factor that we did not know about at the time the Commission approved the changes was the subsequent change in Board funding policy. Historically, the Board funded the Department Rate for all employees participating in the health plan and funded a lower rate for active employees who waived health coverage but still received other benefits. That was changed for FY 18 to a policy of funding the Department Rate for all budgeted positions. There are approximately 200 more budgeted positions than there are active employees enrolled in the health plan, and the impact of that change is approximately $2.5 million more in annual funding than we had anticipated. • We now expect a gain for FY 18 of right around $4 million. At the time the Board made its decisions for the 2018 health plan, we projected a FY 18 loss of $1.8 million if no changes were made and a gain of $1 million with the changes. The difference between our projected $1 million gain and the updated $4 million gain is due primarily to the increased Board funding noted above. The health plan also benefited from lower utilization in the aftermath of Hurricane Irma and that contributed to the additional positive variance. • The projected $4.0 million gain would leave the yearend surplus at $12.4 million. That is $4.7 million higher than the expected 6-month surplus target of $7.7 million. 2018/19 Forecast • For 2018/19 the plan will get the benefit of the plan design changes and the higher employee and retiree contributions for a full 12 months, so even with no further changes we expect a greater impact on claims and an increase in revenue for 2018/19. Combined with the increased Board funding, we project a further gain of $3.9 million for FY 2019 assuming no benefit or funding changes other than the small increase in premiums for pre -Medicare retirees who satisfy the rule of 70 but have less than 25 years of service (the 5-year phased in increase). In the absence of the Board funding policy change, the projected gain would be closer to $1.4 million. If the funding remains at this level, we expect the plan will be financially sound for several years due to the surplus build up we are projecting. We project that the plan will continue to experience gains at the current funding levels and benefits through the 2012/22 fiscal year, although long term forecasts are subject to some level of error. This gives the County time to continue to educate employees on the new High Deductible plan and to engage employees in the wellness program, both of which will enhance the sustainability of the program. Insurance I Risk Management I Consulting • Large Claims • We have seen increased large claim activity in the last few months, including one very large claim for a hospital confinement that took place in 2017 but was not settled until July 2018. Claimants with an excess of $50,000 in medical claims had a combined $5.5 million in medical claims through July of 2018 and we expect the year will finish at close to the same numbers we saw in FY 17 ($6.7 million). MONROE COUNTY BOARD OF COUNTY COMMISSIONERS Report Date: 3 1 Total Paid Prescription Drug and Medical Claim Summary No. Mo. In Yr. October 1, 2014 through July 31, 2018 Claims Paid Rolling 12 Rolling 12 Rolling 12 Envision BCBSFL Month Members Enrollees Rx Medical Total Total PEPM Total PEPM Medical PEPM Rx PEPM Oct-14 2,375 1,605 $229,487 $1,148,209 $1,377,697 $858.38 $676.03 $526.78 $149.26 Nov-14 2,389 1,604 $237,026 $833,995 $1,071,021 $667.72 $683.21 $533.04 $150.17 Dec-14 2,384 1,597 $300,612 $882,134 $1,182,746 $740.60 $688.89 $535.48 $153.41 Jan-15 2,384 1,591 $306,699 $832,283 $1,138,982 $715.89 $703.84 $546.02 $157.82 Feb-15 2,368 1,583 $269,368 $670,562 $939,930 $593.77 $695.57 $534.57 $161.01 Mar-15 2,378 1,593 $339,055 $902,384 $1,241,439 $779.31 $702.08 $534.92 $167.15 Apr-15 2,375 1,590 $325,345 $800,592 $1,125,937 $708.14 $711.28 $539.44 $171.84 May-15 2,385 1,598 $329,886 $813,524 $1,143,410 $715.53 $718.90 $542.62 $176.28 Jun-15 2,375 1,592 $329,832 $983,700 $1,313,532 $825.08 $737.60 $555.87 $181.73 Jul-15 2,375 1,592 $348,993 $765,684 $1,114,677 $700.17 $731.53 $544.91 $186.62 Aug-15 2,372 1,581 $283,561 $1,175,399 $1,458,960 $922.81 $747.65 $559.77 $187.89 Sep-15 2,378 1,582 $314,399 $1,111,604 $1,426,003 $901.39 $760.64 $571.49 $189.15 Oct-15 2,398 1,588 $316,611 $1,070,336 $1,386,947 $873.39 $761.80 $567.92 $193.88 Nov-15 2,392 1,588 $289,929 $1,054,951 $1,344,880 $846.90 $776.80 $579.98 $196.82 Dec-15 2,376 1,580 $285,826 $1,128,908 $1,414,734 $895.40 $789.66 $593.45 $196.22 Jan-16 2,391 1,577 $276,866 $728,823 $1,005,689 $637.72 $783.25 $588.45 $194.79 Feb-16 2,397 1,580 $307,561 $758,023 $1,065,584 $674.42 $789.97 $593.14 $196.83 Mar-16 2,403 1,587 $337,615 $1,139,862 $1,477,477 $930.99 $802.62 $605.80 $196.82 Apr-16 2,408 1,584 $288,758 $778,891 $1,067,649 $674.02 $799.81 $604.85 $194.96 May-16 2,390 1,575 $349,196 $1,173,918 $1,523,114 $967.06 $820.75 $624.54 $196.21 Jun-16 2,380 1,572 $330,753 $1,255,417 $1,586,170 $1,009.01 $835.98 $639.51 $196.46 Jul-16 2,377 1,572 $281,245 $1,079,457 $1,360,702 $865.59 $849.83 $656.73 $193.10 Aug-16 2,393 1,579 $332,618 $1,388,731 $1,721,349 $1,090.15 $863.76 $668.05 $195.71 Sep-16 2,405 1,588 $340,186 $1,056,087 $1,396,273 $879.27 $861.92 $664.91 $197.00 Oct-16 2,395 1,569 $298,103 $975,187 $1,273,290 $811.53 $856.78 $660.56 $196.22 Nov-16 2,395 1,577 $353,210 $1,068,790 $1,422,000 $901.71 $861.35 $661.67 $199.68 Dec-16 2,400 1,581 $315,082 $1,313,937 $1,629,019 $1,030.37 $872.62 $671.41 $201.21 Jan-17 2,328 1,569 $252,203 $1,272,353 $1,524,556 $971.67 $900.40 $700.40 $200.00 Feb-17 2,324 1,558 $235,740 $337,277 $573,017 $367.79 $875.40 $678.96 $196.43 Mar-17 2,333 1,559 $285,656 $1,660,754 $1,946,410 $1,248.50 $901.53 $707.56 $193.97 Apr-17 2,349 1,574 $241,445 $1,123,628 $1,365,073 $867.26 $917.76 $726.20 $191.57 May-17 2,349 1,577 $287,344 $1,187,466 $1,474,810 $935.20 $915.11 $726.84 $188.27 Jun-17 2,362 1,587 $256,607 $1,205,442 $1,462,049 $921.27 $907.81 $723.62 $184.19 Jul-17 2,364 1,586 $303,886 $962,436 $1,266,322 $798.44 $902.15 $716.89 $185.26 Aug-17 2,360 1,581 $330,586 $1,266,091 $1,596,677 $1,009.92 $895.46 $710.33 $185.13 Sep-17 2,352 1,573 $225,070 $568,963 $794,033 $504.79 $864.29 $685.11 $179.18 Oct-17 2,341 1,564 $264,267 $920,877 $1,185,144 $757.76 $859.85 $682.41 $177.44 Nov-17 2,334 1,561 $235,498 $771,198 $1,006,696 $644.90 $838.57 $667.22 $171.35 Dec-17 2,316 1,553 $222,368 $945,791 $1,168,159 $752.20 $815.36 $648.67 $166.68 Jan-18 2,121 1,390 $188,692 $1,073,155 $1,261,847 $907.80 $809.10 $644.22 $164.88 Feb-18 2,146 1,427 $203,894 $762,007 $965,901 $676.88 $836.02 $671.69 $164.33 Mar-18 2,139 1,421 $216,795 $946,527 $1,163,322 $818.66 $799.72 $637.90 $161.82 Apr-18 2,129 1,410 $137,184 $882,531 $1,019,715 $723.20 $787.97 $630.42 $157.55 May-18 2,138 1,408 $201,261 $1,490,749 $1,692,010 $1,201.71 $807.37 $653.11 $154.26 Jun-18 2,128 1,404 $167,713 $1,359,183 $1,526,896 $1,087.53 $819.26 $668.39 $150.87 Jul-18 2,154 1,418 $184,767 $1,668,614 $1,853,381 $1,307.04 $860.18 $714.61 $145.57 Totals 2014/15 28,538 19,108 $3,614,264 $10,920,069 $14,534,332 2015/16 28,710 18,970 $3,737,164 $12,613,404 $16,350,568 2016/17 28,311 18,891 $3,384,932 $12,942,325 $16,327,257 2016/17 YTD 23,599 15,737 $2,829,276 $11,107,271 $13,936,547 2017/18 YTD 21,946 14,556 $2,022,439 $10,820,634 $12,843,073 Last 12 Mos 26,658 17,710 $2,578,095 $12,655,688 $15,233,783 PEPM 2014/15 $189.15 $571.49 $760.64 2015/16 $197.00 $664.91 $861.92 2016/17 $179.18 $685.11 $864.29 2016/17 YTD $179.78 $705.81 $885.59 2017/18 YTD $138.94 $743.38 $882.32 Last 12 Mos $145.57 $714.61 $860.18 MONROE COUNTY BOARD OF COUNTY COMMISSIONERS Status Report for 2017/18 Plan Year as of July 31, 2018 Avg YTD July 31, 2018 FYE 2018 Projected Claims per Ees/Retirees Dependents Actual YTD FYE 2018 Member I. Total Gross Paid Claims (1) a. BCBSFL Active 1,126 682 $ 8,581,093 $ 10,408,982 $ 5,757 b. BCBSFL Retiree 330 57 $ 2,239,541 $ 2,716,594 $ 7,029 c. Envision Active 1,126 682 $ 1,438,008 $ 1,777,402 $ 983 d. Envision Retiree 330 57 $ 584,431 $ 722,367 $ 1,869 Impact of Benefit Changes (0.006) $ (86,625) Impact of Medicare Retirees $ (138,253) $ 7,017 Total 1,456 739 $ 12,843,073 $ 15,400,468 II. Fixed Costs (2) a. BCBSFL $ 680,754 $ 814,755 b Envision $ 53,129 $ 63,481 c. Internal Expenses $ 238,797 $ 286,556 d. PPACA (3) - PCORI Fee (4) $ 4,490 $ 5,382 e. County HSA Contributions (5) $ 23,042 $ 29,625 f. County Medicare Retiree Stipend $ 283,306 $ 364,250 e. Other (GBS, Life, AD&D, EAP) $ 365,141 $ 438,169 Total Fixed Costs $ 1,648,658 $ 2,002,218 III. Total Paid Plan Costs $ 14,491,731 $ 17,402,686 IV. Funding a. Contributions (6) $ 15,519,452 $ 18,623,342 b. Interest (7) $ 26,827 $ 32,192 c. Other (7) $ 62,500 $ 75,000 d. Recoveries $ 132,924 $ 159,509 Total Funding $ 15,741,702 $ 18,890,043 V. Cash Surplus/(Deficit) $ 1,249,972 $ 1,487,357 VI. Change in Claim Reserve a. Starting Reserve $ 1,155,416 $ 1,155,416 b. Estimated Closing Reserve $ 1,155,416 $ 1,155,416 c. Change in Reserve $ - $ - VII. Incurred Surplus/(Deficit) $ 1,249,972 $ 1,487,357 VIII. Incurred %Surplus/(Deficit) 8.1% 8.0% (1) Based on paid claims through July 31, 2018 (2) Based on CY 2017 and CY 2018 actual fixed rates (3) PPACA - Patient Protection Affordable Care Act (4) Will expire FY 19 (5) Based on January 1 enrollment (6) Based on enrollees multiplied by current funding rates. (7) Based on September 30 2017 County financial report MONROE COUNTY BOARD OF COUNTY COMMISSIONERS Renewal Projections as of July 31, 2018 October 1, 2018 through September 30, 2021 Assuming Current Enrollment and Funding Projected Assumed Projected Assumed Projected Assumed Projected 2017/18 % Change 2018/19 % Change 2019/20 % Change 2020/21 I. Total Net Incurred Claims $ 15,400,468 7 $ 15,824,713 7 g,5% $ 17,005,680 7 g,5% $ 18,274,781 11. Fixed Costs a. BCBSFL $ 814,755 0,0% $ 793,709 13, 0 % $ 817,520 13, 0 % $ 842,046 b. Envision $ 63,481 0,0% $ 61,841 0,0% $ 61,841 0,0% $ 61,841 c. Internal Expenses $ 286,556 4,0% $ 298,018 4,0% $ 309,939 4,0% $ 322,337 d. PPACA - PCORI Fee $ 5,382 $ 1,338 0,0% $ - 0,0% $ - e. County HSA Contributions (5) $ 29,625 $39,500 $ 39,500 $ 39,500 f. County Medicare Retiree Stipend $ 364,250 $485,667 $ 485,667 $ 485,667 e. Other (GBS, Life, AD&D, EAP) $ 438,169 0,0% $ 438,169 0,0% $ 438,169 0,0% $ 438,169 Total Fixed Costs $ 2,002,218 5,8% $ 2,118,242 0,0% $ 2,152,636 0,0% $ 2,189,559 111. Total Incurred Plan Costs $ 17,402,686 $ 17,942,955 $ 19,158,316 $ 20,464,340 IV. Revenue at Current and Adopted Level a. Contributions $ 18,623,342 0,0% $ 18,701,762 0,0% $ 18,701,762 0,0% $ 18,701,762 b. Interest $ 32,192 0,0% $ 35,086 0,0% $ 35,086 0,0% $ 35,086 c. Other $ 234,509 0,0% $ 234,509 0,0% $ 234,509 0,0% $ 234,509 Total Revenue at Current Level $ 18,890,043 0,0% $ 18,971,357 0,0% $ 18,971,357 0,0% $ 18,971,357 V. Surplus/(Deficit) With No Change in Funding $ 1,487,357 $ 1,028,402 $ (186,959)1 $ (1,492,983) 3 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 Incurred Gain/(Loss) for the Year 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 July 31, 2018 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2018/19 $ 16,192,402 $ 14,559,350 $ 12,883,164 $ 12,867,407 $ 13,208,152 $ 11,546,869 $ 9,331,213 $ 9,626,471 $ 11,113,828 (1) $ (1,633,052) $ (1,676,186) $ (15,757) $ 340,745 $ (1,661,283) $ (2,215,656) $ 420,871 $ 1,487,357 $ 1,028,402 (2) $ - $ - $ - $ - $ - $ - $ (125,613) $ - $ - $ 14,559,350 $ 12,883,164 $ 12,867,407 $ 13,208,152 $ 11,546,869 $ 9,331,213 $ 9,626,471 $ 11,113,828 $ 12,142,230 (3) _ (1) + (2) $ 2,024,412 $ 1,016,833 $ 965,564 $ 1,043,765 $ 927,198 $ 1,028,472 $ 1,155,416 $ 1,155,416 $ 1,155,416 (4) $ 288,696 $ 77,753 $ 61,425 $ 92,592 $ 25,235 $ 30,840 $ 73,219 $ 73,219 $ 73,219 $ 2,502,161 $ 2,742,367 $ 2,297,656 $ 2,101,832 $ 2,904,421 $ 2,742,367 $ 2,766,862 $ 2,834,280 $ 3,045,797 (5) $ 4,815,269 $ 3,836,953 $ 3,324,645 $ 3,238,189 $ 3,856,854 $ 3,801,679 $ 3,995,497 $ 4,062,915 $ 4,274,432 (6) _ (4) + (5) $ (2,139,400) $ (457,664) $ 51,840 $ 231,377 $ (1,477,359) $ (2,322,535) $ 251,548 $ 1,487,357 $ 1,028,402 $ 12,246,242 $ 11,788,578 $ 11,840,418 $ 12,071,795 $ 10,594,436 $ 8,271,901 $ 8,397,836 $ 9,885,193 $ 10,913,595 (7) _ (3) - (4) $ 9,744,081 $ 9,046,211 $ 9,542,762 $ 9,969,963 $ 7,690,015 $ 5,529,534 $ 5,630,974 $ 7,050,913 $ 7,867,798 (8) _ (3) - (6) $ 7,267,166 $ 8,175,284 $ 8,163,628 $ 7,912,356 $ 8,502,840 (9) $ 3,327,270 $ 96,617 $ 234,208 $ 1,972,837 $ 2,410,755 (10) =(7) - (9) (a) Actual figures through 2016/17. Future years assumed flat based on emerging claim experience and declining enrollment (b) Estimated at 1/6 of Annual Incurred Claims 4 11 MONROE COUNTY BOARD OF COUNTY COMMISSIONERS Lar a Claims for 12 Months Endin : Claimant Number 7/31/2018 9/30/2017 9/30/2016 9/30/2015 9/30/2014 9/30/2013 9/30/2012 9/30/2010 9/30/2009 1 $715,774 $1,075,287 $816,745 $560,607 $503,159 $310,603 $323,462 $338,544 $402,792 2 $553,933 $469,971 $436,318 $326,270 $239,090 $291,049 $320,118 $224,043 $290,146 3 $435,387 $403,244 $434,671 $321,107 $197,829 $282,573 $268,729 $220,450 $134,646 4 $411,835 $366,622 $305,349 $298,995 $177,903 $207,021 $201,912 $148,066 $109,928 5 $190,071 $314,650 $228,721 $270,238 $175,983 $178,797 $196,659 $146,906 $85,944 6 $185,996 $297,664 $224,272 $235,346 $167,378 $163,122 $117,674 $101,914 $85,706 7 $182,567 $257,695 $188,524 $203,001 $146,363 $153,269 $116,592 $91,317 $84,623 8 $178,244 $214,781 $179,016 $192,172 $136,212 $118,555 $114,750 $76,118 $76,682 9 $142,967 $192,783 $165,197 $170,219 $125,463 $117,803 $94,178 $71,028 $65,374 10 $137,556 $182,266 $154,579 $166,412 $124,102 $114,376 $92,001 $68,704 $64,492 11 $131,269 $181,842 $142,620 $150,535 $119,792 $111,122 $90,148 $66,763 $61,525 12 $119,030 $167,794 $131,735 $143,011 $114,009 $110,962 $86,922 $66,392 $61,158 13 $118,687 $165,338 $116,230 $126,615 $109,154 $104,392 $83,772 $63,776 $60,197 14 $113,595 $136,240 $113,976 $117,146 $107,906 $101,381 $71,659 $61,416 $58,112 15 $112,623 $134,516 $102,571 $115,968 $103,619 $95,807 $70,268 $60,003 $57,051 16 $108,980 $124,393 $100,165 $109,866 $102,158 $94,435 $69,931 $57,619 $54,270 17 $105,916 $114,200 $97,482 $104,317 $101,228 $94,433 $66,602 $55,504 $54,218 18 $102,438 $111,030 $96,507 $94,146 $88,520 $82,169 $66,061 $55,416 $51,334 19 $98,213 $109,698 $94,150 $92,932 $85,181 $80,193 $65,531 $52,899 20 $98,162 $107,802 $93,985 $91,791 $79,737 $77,282 $64,327 $50,110 21 $97,219 $99,446 $89,788 $86,663 $77,940 $75,227 $62,859 22 $94,792 $84,766 $87,846 $82,177 $71,837 $72,821 $60,670 23 $93,748 $77,966 $86,661 $78,271 $69,605 $71,309 $59,190 24 $91,412 $76,457 $83,276 $77,173 $63,734 $71,194 $57,240 25 $90,790 $76,122 $82,327 $75,186 $59,738 $70,814 $55,264 26 $86,315 $75,721 $81,138 $74,547 $58,581 $66,559 $54,455 27 $80,230 $74,463 $80,565 $71,116 $58,087 $65,798 $50,968 28 $59,026 $73,930 $79,781 $68,479 $57,977 $65,739 29 $57,966 $67,548 $79,178 $66,258 $56,507 $65,399 30 $57,242 $67,182 $78,862 $64,204 $54,508 $62,494 31 $57,090 $65,760 $73,652 $63,616 $52,800 $57,753 32 $56,235 $65,219 $71,407 $62,540 $51,421 $54,300 33 $53,907 $62,629 $70,980 $58,688 $51,245 $53,410 34 $53,074 $59,453 $70,632 $57,313 $51,170 $52,167 35 $52,907 $58,236 $70,583 $56,915 $51,662 36 $52,398 $57,588 $70,176 $56,179 37 $50,215 $56,610 $69,584 $52,804 38 $50,153 $56,297 $68,841 $51,871 39 $50,011 $56,101 $64,617 $51,334 40 $55,616 $63,966 $51,050 41 $55,238 $60,605 $51,040 42 $55,181 $59,417 $51,004 43 $53,735 $56,382 $50,285 44 $50,991 $56,241 45 $52,184 46 $51,792 47 $51,646 48 $51,427 49 $50,450 50 $50,289 Total $5,527,972 $6,710,072 $6,287,104 $5,349,407 $3,839,936 $3,845,990 $2,981,942 $2,076,986 $1,858,196 Monroe County BCC Summary of 2017/18 Health Plan Forecasts Forecasts Developed During 2017 * Current Forecast No Changes With Changes Average Employees Average Retirees 1,162 -F 422 1,162 422 1,119 330 Projected Revenue 1 $18,052,606 1 $19,693,167 1 $18,890,043 Projected Claims $18,264,281 $17,129,281 $15,400,468 Projected Fixed Costs $1,585,691 $1,585,691 $1,608,343 HSA Funding N/A Did Not Include $29,625 Medicare Stipend N/A Did Not Include $364,250 Total Projected Expense $19,849,972 $18,714,972 $17,402,686 Projected Gain/(Loss) 1 ($1,797,366) 1 $978,195 1 $1,487,357 Projected Surplus 9/30/17 $7,595,391 $7,595,391 $8,397,836 Projected Surplus 9/30/18 $5,798,025 $8,573,586 $9,885,193 6-Month Surplus Target $9,132,140 $8,564,640 $7,700,234 Projected Surplus Excess/(Shortfall) ($3,334,116) $8,945 $2,184,959 * These forecasts were developed for the HPAC and Board to support plan design analysis that cncluded in July 2017. 0 C.30.b Rolling 12 Month Per Employee Per Month Claims $1,000.00 $900.00 $800.00 — — $700.00 $600.00 Ow $500.00 — $400.00 $300.00 $200.00 $100.00 $0.00 ti� tih ti(0 ti� ti� ti�O ti( ti( tit tiA tit ti� tiA tiA Total Pharmacy Medical $2,500,OOC $2,000,000 $1,500, 000 $1,000, 000 $500,000 $0 Monthly Average of $1.4 Million Monthly Average of $1.3 Million I + > u c -0 > c — ao n — > U c � > c — o v o v o v o v o v z o LL g Q g Q V) O z o LL g Q g Packet Pg. 822 C.30.b Monroe County Board of County Commissioners Recommended Employee and Retiree Contributions Effective January 1, 2019 2018 Employee/Retiree Rates 2019 Employee/Retiree Rates 2019 Actuarial Rates 2019 Employee/Retiree Rates as of Actuarial Rates 2019 COBRA Rates 10/1/2018 Department Rate Traditional Plan Monthly Rate HDHP/HSA Monthly Rate Traditional Plan Monthly Rate HDHP/HSA Monthly Rate Traditional Plan Monthly Rate HDHP/HSA Monthly Rate Traditional Plan Monthly Rate HDHP/HSA Monthly Rate Traditional Plan Monthly Rate HDHP/HSA Monthly Rate Employees Paying $25 Premium (Hired prior to 5/1/2012) $50 $0 $50 $0 $752 $629 7% 0% $767 $642 $1,102.00 Employees Paying $50 Premium (Hired 5/1/12 or later) $75 $0 $75 $0 $752 $629 10% 0% $767 $642 $1,102.00 EMPLOYEE DEPENDENTS ONLY HIRED PRIOR TO 1/1/18 Spouse Only $382 $299 $382 $299 $1,015 $850 38% 35% $1,036 $867 Spouse + 1 child $552 $432 $552 $432 $1,467 $1,227 38% 35% $1,496 $1,252 Spouse+ 2 or more children $806 $631 $806 $631 $2,144 $1,793 38% 35% $2,187 $1,829 One child only $170 $133 $170 $133 $451 $378 38% 35% $460 $385 Two children only $340 $266 $340 $266 $903 $755 38% 35% $921 $770 Three children only $510 $399 $510 $399 $1,354 $1,133 38% 35% $1,381 $1,155 Four children only $680 $532 $680 $532 $1,805 $1,510 38% 35% $1,841 $1,540 Five + Children $849 $665 $849 $665 $2,257 $1,888 38% 35% $2,302 $1,926 EMPLOYEE DEPENDENTS ONLY HIRED ON OR AFTER 1/1/18 Spouse Only $508 $425 $508 $425 $1,015 $850 50% 50% $1,036 $867 Spouse + 1 child $733 $614 $734 $614 $1,467 $1,227 50% 50% $1,496 $1,252 Spouse + 2 or more children $1,072 $897 $1,072 $897 $2,144 $1,793 50% 50% $2,187 $1,829 One child only $226 $189 $226 $189 $451 $378 50% 50% $460 $385 Two children only $451 $378 $452 $378 $903 $755 50% 50% $921 $770 Three children only $677 $566 $677 $567 $1,354 $1,133 50% 50% $1,381 $1,155 Four children only $903 $755 $903 $755 $1,805 $1,510 50% 50% $1,841 $1,540 Five + Children $1,128 $944 $1,129 $944 $2,257 $1,888 50% 50% $2,302 $1,926 RULE OF 70 RETIREES ONLY 25+ YRS - Not Medicare Eligible FRS $56 FRS $56 $752 $629 17% - 21 % 9% N/A N/A 20-24 YRS - Not Medicare Eligible * $127 $66 $142 $80 $752 $629 19% 13% N/A N/A 10-19 YRS - Not Medicate Eligible * $137 $76 $197 $135 $752 $629 26% 21% N/A N/A 10+ YRS Medicare Eligible Staying on County Plan $677 $566 $677 $566 $677 $566 100% 100% N/A N/A 10+ YRS Medicare Eligible Staying on County Plan - County $250 $250 $250 $250 10+ YRS Medicare Eligible Staying on County Plan - Net Retiree $427 $316 $427 $316 10+ YRS Medicare Eligible Leaving County Plan - County Subsidy (Can be used to purchase Medicare Supplement) $250 $250 $250 $250 N/A N/A OTHER RETIREES Non Rule of 70 Retirees - Not Medicate Eligible $752 $629 $752 $629 $752 $629 100% 100% $767 $642 Non Rule of 70 Retirees - Medicare Eligible $677 $566 $677 $566 $677 $566 100% 100% $691 $578 RETIREE DEPENDENTS ONLY: Surviving Spouse - Not Medicare Eligible $382 $299 $382 $299 $1,015 $850 38% 35% $1,036 $867 Surviving Spouse - Medicare Eligible $677 $566 $677 $566 $677 $566 100% 100% $691 $578 Spouse Only- Not Medicare Eligible $382 $299 $382 $299 $1,015 $850 38% 35% $1,036 $867 Spouse only - Not Medicare Eligible + 1 child $552 $432 $552 $432 $1,467K 38% 35% $1,496 $1,252 Spouse only - Not Medicare Eligible + 2 or more children $806 $631 $806 $631 $2,144 38% 35% $2,187 $1,829 Spouse Only - Medicare Eligible (Retiree must remain on County plan for Spouse to be eligible) 7 $566 $691 $578 One child only $170 $133 $170 $133 $451 38% 35% $460 $385 Two children only $340 $266 $340 $266 $903 1 38% 35% $921 $770 * These retirees are transitioning from paying their FRS HIS subsidy to paying 25% of actuarial rate (20-24 years of service) or 50% of actuarial (10-19 years of service) over 5 years. The increase for 2019 represents going from 20% to 40% of the applicable difference. N f6 Q D a1 M I O 00 I O CV 7 L t CA O CV C f6 O O 04 LU ILL L O Cl) t0 V N L O ILL U U O m U C N E t V f0 a+ a+ Q Packet Pg. 823 CLAIMS SAVINGS & UTILIZATION CLAIMS SAVINGS PER EPISODE $475 TOTAL CLAIMS SAVINGS YTD $1451827 Total Claims Savings Calculation: Claim Savings Per Episode x Number of Visits YTD ANNUALIZED UTILIZATION TREND $150,000 $125,000 $100,000 $75,000 $50,000 $25,000 40.00%t -------------- 3 5.00% ----------------------------------------------- $0 �rD s � �. � � '< to � •^� �G n n — O ro r, N C S M w L11 rD r � ro (D 30.00% - - C.30.c September 2018 ANNUALIZED UTILIZATION 27.3% YTD Visits X 12 / # Months Accrued / YTD Average Primary Members 20.00% -------------------------------------------------------------------------------------------------------------------------------------------------- 15.00%----------------------------------------------------------------------------------------------------------------------------------------------------- 10.00%-------- 5.00%-------------------------------------------------------------------------------------------------------------------------------------------------------- 0.00% ' it Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov — 2017 �2018 © 2018 Teladoc, Inc. All rights reserved Monroe County Board of County Commissioners Packet Pg. 825 MEMBER ACTIVITY VISITS THIS PERIOD 17 50 49 44 43 40 39 40 I 30 30 zs I 20 17 17 I 10 0 --- ------------------------ Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec YTD REGISTRATIONS THIS PERIOD C.30.c September 2018 a� c 3 0 0 CU a 45 t 43 E 40 a1°i 35 32 p 301 2 1° 2 5 20 20 19 19 18 D 15 12 10 5 6 5 --- 0---,-------------r-----,-------------r-----,---- ------ Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec a YTD VISITS MEMBERSHIP REGISTRATIONS MEDICAL HISTORY COMPLETIONS Report YTD Report YTD Report YTD Report Since Period Period AVG Period Period Inception Primaries 16 251 1,425 1,499 5 143 7 238 Dependents 1 56 740 2,046 0 31 0 70 Eligible Lives 17 307 2,165 3,545 5 174 7 308 YTD Average: Sum of each month's eligible lives divided by the number of calendar months the account is effective. Eligible Lives: All members with access to the service (primaries & dependents). © 2018 Teladoc, Inc. All rights reserved Monroe County Board of County Commissioners Packet Pg. 826 HOW YOUR MEMBERS RECEIVED CARE YTD VISIT REQUEST METHOD VISIT METHOD C.30.c September 2018 ON DEMAND VS SCHEDULED a r a� x c 0 a� r c� a D VISIT FREQUENCY 100% 90% 80% 70% 64% Total Number of Unique 60% Users: 192 so% ----------------- 40% -------------------------------- --------------------------- 3 0%-------------- o------------- --------------------------- 22 20% --- ----- --- --------------------------- 10% ------ 8% ------------- 6-%----------- 0% ---- ---- 11MERM---- 1 Visit 2 Visits 3 Visits 4 or More © 2018 Teladoc, Inc. All rights reserved Monroe County Board of County Commissioners Packet Pg. 827 WHO RECEIVED CARE AND WHEN YTD GENDER 60% Female • 40% Male 60 -- 57 52 50 40 30 20 10 o----- --- Monday Tuesday UTILIZATION BY AGE 0-17 10.4% 18-26 6.5% 27-30 9.8% 31-45 30.6% 46-55 26.4% 56-65 j4.3% 66+ 2.0% DAY OF WEEK 38 35 Wednesday Thursday 0% 5% 10% 15% 20% 25% 30% 35% 40% © 2018 Teladoc, Inc. All rights reserved Monroe County Board of County Commissioners --------------------------- 54 Friday 37 C.30.c September 2018 a� c 3 0 c CU a x 34 0 a> CU a D Saturday Sunday TIME OF DAY 08am-4pm 04pm-12am 12am-8am Packet Pg. 828 WHERE YOUR MEMBERS RECEIVED CARE YTD State Visits I % Visits FLORIDA 296 •. MICHIGAN 4 1.3% GEORGIA 3 1.0% OHIO 2 0.7% LOUISIANA 1 0.3% NORTH CAROLINA 1 0.3% C.30.c September 2018 a� c 3 0 0 c c CU a a� x c 0 a� CU a D © 2018 Teladoc, Inc. All rights reserved Monroe County Board of County Commissioners Packet Pg. 829 CLINICAL DETAILS YTD TOP PRESCRIPTIONS Frequency Tessalon Perles 100 mg oral capsule 8% Tamiflu 75 mg oral capsule 7% Benzonatate 200 mg oral capsule 6% Amoxicillin 875 mg oral tablet 5% Macrobid macrocrystals-monohyd rate 100 mg oral 5% Flonase 50 mcg/inh nasal spray 5% Augmentin 875 mg-125 mg oral tablet 4% Medrol Dosepak 4 mg oral tablet 3% Bactrim IDS 800 mg-160 mg oral tablet 3% albuterol 90 mcg/inh inhalation aerosol 3% TOP DIAGNOSES Frequency Acute upper respiratory infection, unspecified 11 % Acute sinusitis, unspecified 7% Acute cystitis without hematuria 5% Acute nasopharyngitis [common cold] 5% Urinary tract infection, site not specified 5% Acute bronchitis, unspecified 4% Acute pharyngitis, unspecified 4% Flu due to oth ident influenza virus w oth resp 4% Acute maxillary sinusitis, unspecified 3% Flu due to unidentified influenza virus w oth resp 2% 236 Visits w/Rx 77% % Visits w/Rx 71 Visits w/out Rx 352 Total Rx 1.1 Avg Rx / Visit 76 13% C.30.c September 2018 WHERE MEMBER WOULD HAVE GONE IF TELADOC WERE NOT AVAILABLE MEMBER SATISFACTION Excellent Good 0 Poor Excellent 12 Good 2 Poor 1 Total 15 © 2018 Teladoc, Inc. All rights reserved Monroe County Board of County Commissioners Packet Pg. 830