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Item N2 BOARD OF COUNTY COMMISSIONERS AGENDA ITEM SUMMARY Meeting Date: August 15 & 16.2001 Division: Management Services Bulk Item: Yes Services No XX Department: Administrative AGENDA ITEM WORDING: Discussion and approval of proposed changes to the Group Insurance Program in order to reduce ad valorem costs. ITEM BACKGROUND: During the budget workshop of July 20, 2001, the Board of County Commissioners suggested we readdress the group insurance proposals recommended on March 13, 2001 as a means to reduce the impact on taxpayers. PREVIOUS REVELANT BOCC ACTION: The last major presentation on Group Insurance was on March 13, 2001. CONTRACT/AGREEMENT CHANGES: Not applicable STAFF RECOMMENDATIONS: TOT AL COST: BUDGETED: Yes No COST TO COUNTY: REVENUE PRODUCING: Yes No AMOUNTPERMONTH_ Year APPROVED BY: County Atty_ DIVISION DIRECTOR APPROVAL: o~~ LskManagement_ ~..;5,. (-e ~ James L. Roberts DOCUMENTATION: Included To Follow_ Not Required_ DISPOSITION: AGENDA ITEM # /--~~ Revised 2/27/01 O~~y ~o~~~E (305) 294-4641 Administrative Services Department 5100 College Road Key West, FL 33040 (305) 292-4537 Date: August 6,2001 (~.,- MEMORANDUM To: All Active and Retired Employees Constitutional Officers From: James L. Roberts County Administrator Subject: Group Insurance Discussions BOARD OF COUNTY COMMISSIONERS MAYOR George Neugent, District 2 Dixie M, Spehar, District I Charles "Sonny" McCoy, District 3 Mayor Pro Tern, Nora Williams, District 4 Murray E. Nelson" District 5 At the July 20th budget workshop, the Board of County Commissioners asked that we readdress our March 13,2001, recommendations for savings in the Group Insurance Program. We will address the Group Insurance costs with the Board on August 15,2001. 1 O,Y.,~rY ~O~~~E (305) 294-4641 Administrative Services Department 5100 College Road Key West, FL 33040 (305) 292-4537 Date: March 16, 2001 (-.' ,...........-. BOARD OF COUNTY COMMISSIONERS MAYOR George Neugent, District 2 Dixie M. Spehar, District I Charles "Sonny" McCoy, District 3 Mayor Pro Tern, Nora Williams, District 4 Murray E. Nelson" District 5 MEMORANDUM All Active and Retired Employees Constitutional Officers Mosquito Control To: From: James L. Roberts County Administrator Subject: Group Benefits Program On Tuesday, March 13,2001, the Board of County Commissioners undertook a very lengthy and involved discussion to improve the overall health of the County Benefits Program. They were presented with 15 proposals and adopted the following: Proposal Number 1 - Employees hired on or after October 1, 2001, would not be eligible for free or reduced coverage upon satisfying Florida Retirement System requirements. Employees hired on or after October 1, 200 I would have to pay full premium rate upon retirement (whatever that , rate is at the time). Proposal Number 2 - Implementation of Emergency Room Visit deductible of$75 per visit. Implementation date is October 1, 200 I. Proposal Number 3 - Not adopted Proposal Number 4 - Change Pharmacy Co-Pays from $6 for generic and $12 for preferred brands to: Retail: $10 for generic, $20 brand, $35 for non-preferred brands Via mail: $25 for generic, $50 brand, and $87.50 for non-preferred brands. Implementation date is October 1, 2001. 1 Proposal Number 5 - Examine other options for health coverage including self-funded; fully- funded, and cafeteria plans. This will be done as soon as possible. Proposal Number 6 - Secure wrap around network and eliminate out-of-network exclusion. This will be implemented when we secure contract with Network. Proposal Number 7 - Increase out of Network disincentive from 10% to 30%. This will be implemented when proposal Number 6 is implemented. Proposal Number 8 - Limit Chiropractic visits per calendar year from 60 to 30. Implement January 1, 2002. Proposal Number 9 - Limit Massage Therapy visits per calendar year to 15. Implement January 1,2002. Proposal Number 10 - Limit Acupuncture Treatments per calendar year to 15. Implement January 1,2002. Proposal 11 - Vision Benefits - return to "no more than one complete visual examination, including refraction, during any two calendar years. Implement January 1, 2002. Proposa112 - Increase yearly deductible from $200 to $300 per individual and from $400 to $600 per family. Implement January 1,2002. Proposal 13 - At present, covered individuals are responsible for 20% of health care costs on a total cost of$10,000. Raise 10% per year until base cost moves from $10,000 to $20,000. Effective January 1,2002, the base amount will be $11,000. Proposal 14 - Acordia to process claims under Medicare guidelines regarding unburidling of costs. Implement October 1, 200 I. , Proposal 15 - Rates for dependant health care will increase $10 per pay period. Currently it is $100 for one dependant, $120 for two or more. Effective January 1,2002, it will be $110 for one dependant, $130 for two or more. Open enrollment will be held during October 2001, with changes implemented January 2002. You will be receiviIli more information as we secure a wrap-around network and an official plan change prior to implementation date. 2 Group Benefits Program " March 13, 2001 . .' Group Insurance Message Contents Board of County Commissioners' Actions & Approvals Programs Under Group Insurance Program Medical Dental Vision Prescription Benefits Life Insurance Employee Assistance Program Specific & Aggregate Excess Insurance Contractual Administrators History of Claims Expense How Rate is Developed Group Insurance FY 2001 Budget Coverage Comparison FY 1999-FY2001 Relationship to ad Valorem Tax Actions Taken Task Force Recommendation Section Exhibits: The Key West Citizen Resolution approved March 1999 Retiree Group Health Insurance Survey WHP Presentation KPHA Presentation Arthur J. Gallagher (Long-Term Liability Issues) 1 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 A B C D E F GROUP BENEFITS MESSAGE Over the last few years, the issue of Group Benefits and specifically, Retiree Health Coverage has been to the Board on a rather frequent basis. It has caused great concern among both retirees and active employees. To explore fully the problems facing Monroe County in a fund that is approximately $13 million and expenses for claims alone reach nearly $9 million, it is necessary to review the history of the program. Board of County Commissioners' Actions & Approvals Year Coverage Company 1984 Major Medical-Self- Insurance Gallagher Bassett Third-Party Administrator (TP A) Program Acordia National- TPA -1996-current 1987 Dental Benefits - Self-Insurance SunLife of Canada - TP A- 1987-1989 Program Gallagher Bassett - TPA -1989-1996 Acordia National- TPA -1996-current 1987 Vision Benefits- Self- Insurance Gallagher Bassett -TPA - 1987-1996 Program 1988 Free Retiree Insurance 1987 Precertification 1984 Prescriptions 1990 Surviving Spouse 1996 1997 1999 Prescription Card Employee Assistance program Rule of 70 Eligibility Acordia National- TP A - 1996-current Prior to 1988: Retirees underage 65 paid 60% of Department Rate Retirees 65 & over paid 40% of Department Rate Medical Foundation Services -1987-1994 Advanced Focus - 1994-1996 Keys Physician Hosptial Alliance - 1996-current Gallagher Bassett - TPA -1989-1996 Covered under Indemnity Self-Insurance Program Surviving Spouse of Retired Employees can keep ins. Premium Rate must be paid. WHP Health Initiatives - Administrator - Self Insured Care Center of Mental Health Requirement of Rule of 70 (age & years of service) or minimum age of 60 The Group Insurance Program is a self-insured program with Insurance purchased for excess claims and specific coverage, i.e., life insurance. The self-insurance program was begun in 1983 after the rates quoted by Metropolitan Insurance Company were deemed to be too high. (Copy of The Kev West Citizen article attached, Exhibit A). In 1989, claims were $2,500,000 with an increase to $8,600,000 in 2000. Board Action of 1988. In July, 1988, the Board was asked if insurance could be provided to retirees free under the County's policy. The answer was yes. There was no impact study of future costs associated with this decision. At the time this action was taken, the retirees paid a percentage of the premium rate of $170; if under age 65, 60% of the premium rate ($170), resultlng in a charge of $105 to the retiree; and if over the age of 65, 40% of the premium rate, resulting in a charge of $70 to the retiree. If that same percentage were charged to the retirees at this time with the current premium rate of $470 the rates would be $282 for under age 65 and $188 for retirees over age 65. 2 Programs under the Group Insurance Program: MEDICAL INSURANCE:, Maximums: Major Medical Benefits $1,000,000 Lifetime Benefit for all Outpatient Treatment by a Physician of a Mental! Nervous Disorder 50% of charges Benefit for Treatment of Chemical Dependency (alcoholism or drug abuse) $25,000 lifetime (one confinement per lifetime) Benefit for Inpatient or Partial Hospitalization Treatment of a Mental!nervous Disorder 30 days per year Deductibles: Calendar year Deductible Family Maximum Hospital- per period of confinement $200 per individual $400 $150 Co-payment Percentages Covered Expenses 80% of first $10,000 100% thereafter per individual per calendar year Claims Paid in FY 2000 $ 6,967,753 3 DENTAL INSURANCE: Benefit: Dental $2,000 per calendar year Benefit: Treatment of Tempomandibular Joint Disjuntion Syndrome (subject to Deductible) $1,000 per calendar year Benefit: Orthodontia (subject to Deductible) $1,500 lifetime Deductible: Per Calendar Year $50 per individual $150 per family Copayment percentages: (County pays after deductible) Preventative Services 100% Basic Services 80% Major Services 50% Orthodontia 50% Claims Paid in FY 2000 $ 482,242 4 VISION: Benefits: Complete visual examination including refraction $50 per year Lens, other than Contact Lens, per pair and Frames $150 per single purchase; limited to one purchase during anyone twenty-four month period. Contact Lens, per single purchase $150 Claims Paid in FY 2000 $ 80~654 Claims Paid in Medical, Dental, Vision Total Eligible Claims Submitted $7,530,649 $13,144,986 Total Claims Paid to Total Eligible Claims Submitted 570/0 5 PRESCRIPTION BENEFITS: You can obtain your prescriptions either at a participating retail pharmacy by presenting an Identification Card and paying a co-pay at the time of service or by using the mail service program. Co-payments: Retail (30 Day Supply) $12.00 $ 6.00 Mail Service Brand Generic (90 day Supply) $30.00 $12.00 Prescriptions have increased dramatically since the implementation of this program. Attached find a listing of the top 25 pharmaceuticals used during the 3rd quarter of 1999 compared to the top 25 pharmaceuticals used during the 3rd quarter of2000; a 27% increase. Much of what has fueled this increase is the advertising of "designer drugs." Patients are influenced by the advertisements and ask for prescriptions by name when less costly prescriptions will treat the same ailments. Prior to having the Pharmaceutical program, prescriptions were reimbursed under medical coverage at 80% County/20% employee. The County's expenses prior to 1996 were approximately $250,000. The estimate to go to the prescription card program was an annual expense of $500,000. Amount in FY 2000 $ 1,109126 6 9900 COMPARISON ..;......r ".:~;f.R~~.,~~;.~,;;::;;;~-3Q 1999 . ,,~:i:r,;~;'~\~:.';:":'W;3.fJ,'~,~::';3Q 1999,;'~)~1c~!;~~i:o:~ .1999,;;":n.'dd,iE'~ .1999 :~~r'f,:i;}(tij~;i",~i! i30 1 ~ ..,~i'!';l~~\,.$'i It MEDICA nON I TOTAL SALES I .. of RXs I COST PER RX I USE 1 PRlLOSEC , $20,378,001 171 i $119.17 GASTRO INTESTINAL/ULCER I 2 LIPITOR , $9,66,l.00 : 153 ; $63.16; CHOLESTEROL 3 PROZAC $8,720,001 78 $111.79: DEPRFSSION 40XYCONTIN $5,079.00: 35 . $145.11 i PAIN ! 5iPREV ACID $5,026.00: 46 $109.26 GASTRO INTESTINAL/ULCER 61Z0LOFT $4,963.00: 72' $68.93, DEPRFSSION 7iNORV ASC $4,779.00. 94 $50.84 : BLOOD PRFSSURE 8~CELEBREX $4,639,00: 61 $76.05 f ARlHRlTIS 91NEURONTIN $4.451.00: 29 : $153A81 SEIZURES 10 AUGMENTIN 53,727.00 r 66 : $56.47i ANTIBIOTIC lllCLARI1lN 53.477.00i 62 $56.081 ALLERGIES 12iNEORAL $3,388.00 I 14' $242.00 : ARlHRlTIS/ORGAN RJC1l0N 131pAXIL : 53,372.00 I 51 i $66.121 DEPRFSSION 14jGLUCOPHAGE 53,290.001 73 i $45.071 DIABE1F.S 15 :CIPRO 53,118.00i 44 i $70.86 f ANTIBIOTIC 16,:LEV AQUIN $3,071.00 i 37, $83.00 I ANTIBIOTIC 17jAMBIEN 53,030.00' 58 $52.24 : INSOMNIA/SLEEP 181REZULIN 52,914.001 25 ; $116.561 DIABETE5 19 NEUPOGEN $2,911.001 1 , $2,911.001 BLOOD PROTEIN/CANCER 20 FAMVlR $2.586.00 : 91 $287.33 i HERPES 21 ZIlHROMAX $2,353.001 64; , $36.77i ANTIBIOTIC 22~SPORANOX $2,317.00 I 11 $210.641 ANTIFUNGAL 23"PREMARlN $2,301.001 121 I $19,02 HORtvIONE REPLACEMENT 24 ZYPREXA $2.221.001 31 $740.331 ANTIPSYCHOTIC 25 ZOCOR $2,173.00/ 32 , $67.911 CHOLESTEROL TOTAL : 5113,948,00 I i I fi.,~ ;;' "~< ':\'~",,~.a.Q7090 :{:- .. MEDICA nON 1 PRlLOSEC 2 LIPITOR 3 VlOXX 4 OXYCONTIN 5 ZOLOFT 6 PREV ACID 7 GLUCOPHAGE 8 NORV ASC 9 PROZAC 10 PAXIL 11 CLARlTIN 12 NEURONTIN 13 ZOMIG 14 CELEBREX 15 ZYPREXA 16 COMBIVlR 17 REBETRON 1000 18 EFFEXOR XR 19 AMBIEN 20 NEUPOGEN 21 PRA V ACHOL 22 A V ANDIA 23 CIPRO 24 ACiOS 25 ZOCOR TOTAL .~ ~!'...-:: .. of RXs COST PER RX I 200 I $137.70 192 $66.93 132 $79.70, 43 $158.09 86 $75.91 54 $111.801 103 $58.061 109 $50.21 ! 41 $124.76/ 74 $67.97' 70 I $62.20 i 27 ! $158.74: 18 I $219.94: 46 ! $85.701 14 i $278.791 7 ' $521A31 3 I $1,205.00! 41 : $85.981 64 i $50.69! 2 I $1,589,001 38 : $80.34, 25 : $121.521 38 i $79.391 26 : $115.77: 35 i $83.-t6 i .2000 USE GASTRO INTESTIN AL/ ULCER CHOLESTEROL ANTIINFLAMMATORY PAIN DEPRESSION GASTRO INTESTINAL/ULCER DIABE1F.S BLOOD PRESSURE DEPRESSION DEPRESSION ALLERGIES SEIZURES MIGRAINE ARlHRlTIS ANTIPSYCHOTIC HIV / AIDS HEPC DEPRESSION INSOMNIA/SLEEP BLOOD PROTEIN/CANCER CHOLESTEROL DIABETES ANTIBIOTIC DIABETES CHOLESTEROL TOTAL SALES I $27,539.001 $12.851. 00 $10,521.00 I $6,798.00 $6,528.00 $6,037.00 $5,980.00 $5,473.00 $5,115.001 $5,030.00 $4.354.00 , $4,286.00 $3,959.001 $3,942.001 $3,903.001 53,650.001 $3,615.001 $3,525.00 I $3,244.001 $3.178,00 I $3,053.001 $3,038.00 I $3.017.001 53,010.001 :52.921.001 $144,567.00 I project 01.7501 - 9900 3Q cOJllparison.xls Page 6A LIFE INSURANCE Active Emolovees: Coveraee Under 70 years of age $20,000 Age 70-74 13,400 75 and over 10,000 Active Employees covered under Accidental Death and Dismemberment. The above coverage is paid at double the stated amount. Dismemberment paid per policy schedule. Retirees: Under 70 years of age Age 70 and over Coveraee $20,000 10,000 Premium paid to Hartford Life $146,000 7 EMPLOYEE ASSISTANCE PROGRAM The EAP provides confidential, no cost professional assistance to help employees and their families resolve problems that adversely affect their personal lives and job performance. The EAP also assists the County with problems when issues arise that decrease productivity. Contract Price 8 $ 66,288 SPECIFIC & AGGREGATE EXCESS INSURANCE Specific Excess - All claims over $100,000 per individual per year are covered 1000/0 by excess policy. Aggregate Excess - When total claims exceed $10,000,000 per year, excess pays 1000/0 of all remaining claims. Premium Paid FY 2000 $ 635,000 9 CONTRACTUAL ADMINISTRATORS Medical, Dental, Vision Acordia National Third-Party Administrator - Claims processing is currently handled on a direct submission basis. Claims are sent directly to Acordia National which reviews them for eligibility and processes them for payment along with the Explanation of Benefits (EOBs). Acordia prints claim checks for the County on its local checking account and forwards the checks directly to the employee. The claim registers are then forwarded to the County for monitoring. Periodic claim audits are performed by the County and separately by the TP A. Acordia maintains a thirty (30) day claim turn around,. Keys Physician-Hospital Alliance Utilization Review and Large Case Management. Provide network of hospitals and physicans in the Keys to obtain discounted rates. Dimension Health, Inc. Provide network of hospitals and physicians in Miami- Dade and Broward County to obtain discounted rates. Excess (Specific & Aggregate) Insurance Lincoln Re/Arms (Alden Risk Management Services Life Insurance Hartford Life Pharmaceuticals WHP Health Initiatives Employee Assistance Plan Care Center for Mental Health 10 History of Claims Expense: The following details hOlY the actual dollars for claims have increased since 1989, along with the number of enrollees split benveen active employees and retirees. It also shows the premium rate that is charged the department for each active employee. It also gives the rate charged for dependant coverage. More about how this rate is developed in a later section. Year Enrollees Active Retirees % of (Oct) Employees Retirees to Total Enrollees $ Claims Increase from Prior Year Premium Rate per Month Dependant Single per pay period Dependant Rate Family per pay period 1988 24 $190.50 $57.90 1989 1,040 990 50 4.81% $2,514,461 $237,00 $63,69 1990 1,217 1,147 70 5.75% $3,213,994 28.00% $285.00 $76.43 1991 1,226 1,140 86 7.01 % $3,495,272 9.00% $300.00 $80.25 1992 1,319 1,222 97 7.35% $3,809,723 9.00% $300.00 $80.25 1993 1,306 1,197 109 8.35% $4,170,660 9.000(0 $250.00 $80.25 1994 1,424 1,306 118 8.29% $4,824,782 16,00% $410.00 $80.25 1995 1 ,481 1,355 126 8.51% $6,769,588 40.00% $410.00 $90.00 1996 1,492 1,340 152 10.19% $6,396,551 -6.00% $380.00 $90.00 $110,00 1997 1,529 1,360 169 11.05% $6,831,941 7.00% $451.00 $100.00 $120.00 1998 1,575 1,394 191 12.10% $7,039,738 3.00% $470.00 $100,00 $120.00 1999 1,585 1,354 227 14.36% $7,248,064 3.00% $470.00 $100.00 $120.00 2000 1,596 1,360 236 14,80% $8,639,775 18.00% $470.00 $100.00 $120.00 Actives covered under group insurance program unavailable for 1988. In October 1994, the Group Insurance Premium Rate was set at $310 per month. During the year, there was a mid-year special billing raising the rate to $410. This amount was needed to cover the claims experience of the period 1994-95 and to rebuild the fund that was severely harmed by the reduction of the premium rate. 11 How Rate is developed: Since the County is a self-insured fund, it must raise from the departments sufficient money to cover all anticipated claims, expenses and reserves. Expenses and revenue sources are reviewed and an amount that needs to be funded through departmental charges is established by the Board of County Commissioners. Budget for Fiscal Year 2001 Expenses to Cover: Administration Operations/Insurance Claims Asserted Claims & Reserves Outside Revenue to Off-set above Dependent Contributions Excess Interest COBRA Payments Fund Balance Forward adjusted 5% FI. Statute Remainder Needed to Fund Program Number of Active Employees -10-1-2000 1352 $7,906,429 shared by 1352 Amount being Billed $186,819 $1,153,788 $8,376,465 $3,197,284 $12,914,356 -$1,331,000 -$400,000 -$100,000 -$18,330 -$3,158,597 -$5,007,927 $7,906,429 $5,848 annually $487 monthly $470 monthly The County pays 100% of the premium for the employees through departmental billings and subsidizes the dependant rates approximately 30%. 12 tn CI) UCl).... .~ g & (1)C\S~ (/) ~ :J c:~CD (1)c"t"" -0 E a.o (1):JN 00_ C\S~- COu.. C\S ::E l/l C o ;:; lU 'C 0. e 0. 0. <( O)IX)LC'J ..... IX) (() IX)r---q- cO M- cO IX)LC'Jr-- ..... ....._ M_ ..... IX) IX)0-q-r--0-q-LC'J 0) CO LC'JCO.....IX) CO M-q-IX)OIX).....M tri N tri ci ...: N. -q-- O.....(()COr--Mr-- LC'J N N .......... 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E ~ c>~ c .Q 0 .Q .2 'SUlU .0-> E 8>E ~"O ~l!!c"O<( .QO)oc- lU>U8.,g >'~cO)- "O""'O)Oc J!! lU<('O 0)5 cce::::~O)E l!! 0 co 0.:S <( C)ZOO)O) uoe:::: -q-oco ~-q-U) Mo)M 0)-"":"'; o IX) '"" M IX) en NN .- ..... o o ~ ~ M MLC'J 0) (() .....-q- aicO ..... r-- 0_ M_ ..... IX) l/l E -..: 'm ~- coU ..c::'O CI) 0) ~1: ~~ ~~ 1::- \l) l/l 010) I:: ~ ~O) I:: l/l o 0) ua:::: - l/l - C 0) E 1: lU 0. 0) "0 <( - "0 0) l/l lU .0 C ~ o .c l/l .!!! c ~ "0 ~ lU 0) ~ .0 0) I/) C 0) 0. X 0) 0) .s::. - 0) Cl lU a.. l/l 0) ~ ;:; 0) a:::: M ..... ...: 0) U IE o iV' ~oocn(()coc-g ~gg~~~~t:: ______:J:J NOONO"ll'=:g cooocnLC'J'""iiio ~ ...- ~ ,. <0. G!.. c M MNOe '"" U ._ >>lU .00 l/l 0) .5 ~ lU.s::. 0-;; 0) ~ m~ g ~ =- lU 0 ~~ lU 0 :Jiii 'E 0'- lU.c ~~ -iV .aa g.a lUlL. OU l/l Ci5 0) '0 ~ 5..JU-O)lU o)LLC.:!~~ c lUO -- _lU~~t-~g ~a;LC'J "O:J"::; Q)~lZ-gC,glU _-c;;;: 0) :J .? ~ c .o:::..Ju.-<(o l/l 0) U '~ 0) CJ) 0) > :;::; lU .... - l/l '2 'E '0 <( Coverage comparison FY 1999 vs. FY 2001 Enrollment by Constitutional Officer Comparison I i . I , , : Oct-98 Oct-OO 1 i iOffice: en en , , en - en c: ! III C III i III III -c III III -c >- -c III >- -c III 0 C .... 0 c .... c.. III III c.. III III E c.. > en E c.. > en i III o III III o III W (:) u> W (:) u> \ :;t :;t :;t:.:::::i :;t :;t :;t:.:::::i , ~ Clerks Office 104 74 178 1061 65' 171 i I i Property Appraiser 41 23 64 43 24 671 Tax Collector 46 31 77 47 34 81 I Supervisor of 13 8 21 12 10 22 I Elections , Sheriffs Oept 542 351 893 563 397 960 I I Court Administration 29 24 53 26 28 54 Subtotal 775 511 1286 797 558 1355 BOCC' 32 13 45 32 10 42 Mgmt Services 36 35 71 32 38 70 Community Services 146 40 186 145 45 190 Public Safety 69 41 110 65 43 108 Growth Management 51 29 80 40 25 65 Public Works 162 99 261 167 108 275 Solid Waste 26 9 35 17 6 23 I Subtotal 522 266 788 498 275 773 I Mosquito Control 47 32 79 52 34 86 Retirees 233 56 289 236 61 297 Other: 11 4 15 19 8 27 Subtotal 291 92 383 307 103 410 I I Total 1588 869 2457 1602 936 2538 I I I BOCC includes The Board, County Attorney's Office, County Administrator's office, Veteran's Affairs Office; and Healthcare Taxing Oistrict 14 A look at the contribution to the Group Health Insurance Program in relationship to the ad Valorem tax levied in FY 2001. General Fund F&F F&A District 1 F&A District 6 Parks & Beaches Planning/Building/Code Municipal Policing Subtotal Health Dept. Billed for Group Ins. 2,419,831 2,464,860 253,800 5,640 94,244 451,200 383,520 6,073,095 o ad Valorem Per Fund 13,607,015 28,223,639 4,057,015 740,924 1,168,355 1,515,852 ' 3,656,499 52,969,299 281,000 53,250,299 Group as % of ad Valorem 17.78% 8.73% 6.26% 0.76% 8.07% 29.77% 10.49% 11.47% Total Amount of Fund 42,104,928.0 40,514,893.0 5,518,225.0 1,018,458.0 1,651,848.0 8,316,570.0 5,591,535.0 104,716,457.0 The $6,073,095 budgeted for group insurance in ad Valorem funds is approximately 66% of the amount billed out in Departmental charges. 15 ACTIONS TAKEN BY THE BOARD OF COUNTY COMMISSIONERS REGARDING RETIREE HEAL TH INSURANCE AND GROUP INSURANCE ISSUES: Date Agenda Item Wording . August 1998 Approval to change the eligibility for group health program benefits for retirees, to lower the number of years of exposure for the County. NO ACTION TAKEN . September 1998 Approval to change the eligibility for group health program benefits for retirees, to lower the number of years of exposure for the County. Presentation by Lawton Swan, President ofInterisk, Inc. the County's insurance consultant, and Jeff Angelo, Area President of Arthur J. Gallagher & Company. NO ACTION TAKEN. · October 1998 Approval to change the eligibility for group health program benefits for retirees, to lower the number of years of exposure for the County. Directed to explain this issue to employees. Eight Sessions held by Employee Benefits in four locations in September 1998 (Harvey Government Center, Chapel, Marathon EOC and Key Largo Library). . . q January 199j! Approval to change the eligibility for group health program benefits for retirees, to lower the number of years of exposure for the County. TASK FORCE APPOINTED Three Sessions held by County Administrator and Human Resources Director on January 8, 1999 Task Force comprised of Monroe County Personnel Policies & Procedures Review Board and Appointment of employee or retiree from each of the Constitutional Officers, Commissioners and Mosquito Control. Task Force met February I and 22, 1999. Submitted proposal to BOCC in March 1999. · March 1999 Approval to change the eligibility for group health insurance for group health benefits for retirees, to lower the number of years of exposure and lower outstanding liability for the County. Approval of resolution recommended by Task Force on Retiree Insurance. Potential liability lowered from $65 million to $25 million. MOTION PASSED. · May 24, 1999 Not an agenda item: Commissioner Williams asked what we were going to do regarding the $25 million liability for retiree health insurance. · December 8, 1999 Discussion of Retiree Health Insurance Program and discussion of possible options for reduction of liability. DISCUSSION ITEM ONLY, NO ACTION REQUESTED. Motion made to notify retirees and employees of any agenda item discussing group insurance. · June 14,2000 Not an agenda item: Mr. Roberts notified employees that the Task Force was being reactivated to discuss Insurance Liability. . July 2000 recommendations. Not an agenda item: Task force met twice and arrived at five 16 Issues leading to Presentations to BOCC and Task Force Review: As early as February 1997 the County's Insurance Consultant, Interisk, pointed out that our retiree base was receiving benefits in the amount of $500,000 (excluding prescriptions) without an offsetting revenue source. In the summer of 1998, we had an alert from our excess carrier that our claims were running very high, especially our retiree claims. They had an actuarial study completed to see what our current and potential liability would be. The actuarial study, provided in July 1998 pointed out that there was a potential $65 million liability. The Administration proposed a plan to increase the age of free health care in conjunction with retirement from anytime after the age of 42 with 10 years of service to a minimum of age 55 with 10 years of service. Together with this, it was proposed that the retiree return to the county the amount received in health insurance subsidy from the state to cover a portion of their insurance expense. This was not accepted by the BOCC and after several board presentations, the task force was appointed and reviewed many options. Task Force Participants: Representing First Task Force ppp% Review Board Member PPP Review Board Member PPP Review Board Member PPP Review Board Member PPP Review Board Member PPP Review Board Member PPP Review Board Member PPP Review Board Member District One Commissioner District Two Commissioner District Three Commissioner District Four Commissioner District Five Commissioner Clerk of the Court Property Appraiser Sheriff Supervisor of Elections Tax Collector Mosquito Control Dave Owens Sheila Barker James Paros Anne Rioseco Patty Frazier (Alternate) Beth Leto Bill Kelly Paul Patterson Tom Brown Lisa Druckemiller Nancy Cohen Sylvia Murphy Kay Gissendaner Jackie Clynes Leonard Knowles Beth Barnes Joyce Griffin Phyllis Pita Billy Southcott 2 Personnel Policies and Procedures Review Board Members 17 Second Task Force Jackie McLain Sheila Barker James Paros Sally Smith Sandy Molina Beth Leto Ken Perryman Pat Reeder Gib Peters Lisa Druckemiller Nancy Cohen Sylvia Murphy Tom Brazil Jackie Clynes Leonard Knowles Mike Rice Joyce Griffin Don Gates Ed Fussell Recommendations of First Task Force: The Task Force made a recommendation that was passed at the March 10, 1999, Board Meeting. That resolution implementing the Rule of 70 is attached, along with a grid showing its effect. Exhibit B. What other entities are doing: During both Task Force processes, the County surveyed what other entities were doing in reference to retiree coverage. The latest survey is attached. Exhibit C. 18 RECOMMENDA TIONS As the Board of County Commissioners is certainly aware, public and private entities for many years have been adjusting their group benefits programs. This has been very much in response to the growth in health care and pharmaceutical costs. Our experience in the Keys has been that health insurance providers find it very difficult to sustain an ongoing program. There have been many entities that have withdrawn from serving the citizens in the Keys over the years. The following recommendations are the result of deliberations by the Monroe County Employees Task Force, the Keys Physician Hospital Alliance, Walgreen Health Initiatives, Inc. and Arthur 1. Gallagher and Company as well as the County Administration. All of these have worked on the growing problem for quite some time. The recommendations cover wide-ranging issues involved in the group benefits program. EVEN IF ALL OF THE RECOMMENDATIONS BELOW WERE IMPLEMENTED, THE COUNTY MUST HAVE A CONTINUOUS PROGRAM OF REVIEWING THE STATUS OF THE GROUP BENEFITS PROGRAM AND THE OPTIONS AVAILABLE. IN FEBRUARY, 2001, THE BOARD OF COUNTY COMMISSIONERS SUPPORTED THE PASSAGE OF LEGISLATION BY THE STATE TO MAKE SMALL COUNTIES (UNDER 100,000) ELIGIBLE FOR THE ST ATE HEALTH BENEFITS AND PHARMACEUTICAL PROGRAMS. IF THAT PASSES, THE COUNTY SHOULD UNDERTAKE A MAJOR ANALYSIS AS TO ITS BENEFIT FOR THE FUTURE. IN ADDITION, THERE SHOULD BE CONTINUAL MONITORING OF THE COMMERCIAL MARKET AND OTHER OPTIONS. . The Recommendations from the Task Force are: 1. Employees hired on or after October 1, 2001 would not be eligible for free or reduced coverage upon satisfying Florida Retirement System requirements. Employees hired on or after October 1, 2001 would have to pay full premium rate upon retirement (whatever that rate is at the time). At present, retirees do not contribute toward the cost of health insurance. The Administration concurs. 2. Implementation of Emergency Room Visit deductible of $75 per visit. Implementation date is October 1, 2001. At present, there is a tendency for employees and dependents to utilize the emergency room for non-emergency situations rather than going to a personal physician or a clinic. The Administration concurs. 3. Implement a charge for all current r~tirees and all employees employed by the county prior to October 1, 2001, upon their satisfying all retirement requirements. The charge should be $100 per month for their insurance. Group Insurance will assist all retirees who do not claim their Retiree Health Insurance Subsidy from the FRS with the process to obtain it. Implementation date of October 1, 200 I. (The amount of the subsidy is based on service credit at retirement, $5 for each year of service, with a minimum monthly subsidy of $50 and a maximum of $150. The County pays FRS for Insurance Subsidy.) The Administration concurs but is willing to consider a different amount commensurate with the amount received by retirees to assist with the provision of health insurance. 4. The task force recommendation was to change Pharmacy co-pays from $6 for generic and $12 for preferred brands to $6 for generic, 20% for preferred brands ($12 minimum and $50 maximum), and 20% for non-preferred brands ($35 minimum and $50 maximum). An updated recommendation from Walgreen Health Initiatives - Retail: $10 for generic, $20 brand, $35 non-preferred brands. Via mail: $25 for generic, $50 brand, $87.50 non-preferred brands for 90 day supply. Implementation date of October 1, 2001. The Administration concurs with Walgreen Health Initiatives recommendation with room left to consider adjusting rates and percentages as experience dictates. 5. Begin two-stage approach on examining other options for health coverage. Phase one: Work with consultant on what plans are available and what would be the range of options we would have from self-insurance to fully funded plan and/or a mixed plan. Phase Two: Refine our range of options and RFP for providers. The recommended time for implementation would be ASAP. The 2 Administration concurs and feels that the state health benefits program should be considered if eligibility for Monroe County is passed by the state legislature. The Recommendations from Keys Physician Hospital Alliance and County Administration are: 6. Secure National wrap around network and eliminate out-of-network exclusion. This means that retirees and dependents who live around the country will have the benefit of in-network expenses rather than out-of-network expenses. The Administration concurs. 7. Increase out of Network disincentive from 10% to 50%. Since a reduced cost of network services will be available in most areas of the country and since almost all plan participants will be able to take advantage of it, there is little need to go outside of network. Plan members who go outside the network for' personal reasons, thereby costing the County more money, should pay a higher percentage. The Administration concurs. 8. Limit Chiropractic visits per calendar year from 60 to 30. The Administration concurs. 9. Limit Massage Therapy visits per calendar year to 15. The Administration concurs. 10. Limit Acupuncture Treatments per year to 15. The Administration concurs. 11. Vision Benefits - return to "no more than one complete visual examination, including refraction, during any two calendar years. At present, the benefit is available for each calendar year. The Administration concurs. 12. Increase yearly deductible from $200 to $300 per individual and from $400 to $1000 per family. The Administration concurs. 13. At present, covered individuals are responsible for 20% of health care costs on a total cost of $10,000. Thereafter, the plan pays 100%. Recommendation is to change the base limit to $20,000. The Administration concurs. 14. Acordia to process claims under Medicare guidelines regarding unbundling of charges. The Administration concurs. This will 3 reduce the possibility for providers to charge full fees for two services when both rely upon the same basic procedures. Additional Administration Recommendation: 15. The rates for dependent health premiums should be increased $10 per pay period to help cover the deficit between health care costs and dependent premium contributions. This will change the deduction per pay period from $100 for one dependant to $110 and from $120 for two or more to $130. Some of the recommendations above will produce some short-term financial savings. Others will create longer-term savings year over years. The County should continually review its program status as it has been doing and should consider the possibilities of commercial insurance or the state health benefits program, should they prove to be more advantageous in the future. 4 Exhibits . ( \ ,. . ~: .\ ~~~ '.;:." ',~: :... .;:",-~' :'~~ ..'.{ ..']"',.' . ' ~~::.-' .O:t'. i t~ ~ t: :.~: 1'1: f J ',f,. l- f r j,' '" .,;, '::' . . .~' ~. ~:,"::... . . .......,' . , . raz:-. .. ) '.- .~;;.,_... .of -." -.... -- ".. . ... _..I..~.... ~.- .-'~~.';'.~~..L:_"~JU..::': -:.i'. y ~rX2 --- ._.J,;~.__ . ........ ~ lit - .' i......::.:<,:: - '" 't\) n' 0" .~ ~ '~'. 'U\ ' ..n_.... 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U "5.-:::-::: ...e, c.....::I- QC, Q.- = = ~ = ll) !I ~ - 0 ls.= - '0 'C ~ C': :: - .!!!... cu CII OOC~~..~ _C::IC>O"'>O~CO=S~O"O~O~ IlI::CII:: "c:I~"::~" -";>oOC::;~ ;~::~O~ ~~=c-~_~o,g=",_-:::~=..IlI"~c-~=Euc t~.c=~=_~_'Cco~-t6e"=e"C ~~3~~~~~~E~e~~~~~e~~~e~~~~~i~~~~S~8~~e~~~~;~~~~~~~]=E8E~ '.' -~. -.,.. ~'~'-', ':; " " " "-' ,.....-, - - - . -' -' . . "'C-~~p Board of County Commissioners RF..liQ1JJTION NQ. 104 -1999 A RESOLUTION AMENDING RETIREMENT ELIGIBILITY REQUIREMENTS FOR GROUP HEALTH INSURANCE COVERAGE FOR MONROE COUNTY EMPLOYEES. WHEREAS, group health insurance expenses have been steadily increasing; and WHEREAS, the number of retired County employee continues to increase dramatically each year; and , ~ " :t :::l ~ - \VHEREAS, it is the intent of the Monroe County Board of County Commi~on~i.s t~llo~ :;:0 (""') -.- -.-. CJ o r -~ ~ County employees, including employees of the Constitutional Officers and the M~~~o ~tng; .0(""')' ::::0 Board, who meet the criteria established in this resolution to retire through the Flo$E5getir;ilR1eI15o :::i' r :x r:1 System and maintain their group heaith insurance benefits \vith Monroe County as p~~j n:; ....ing ~ C'> c.n ;:0 now, therefore, J:> rT1 \.0 0 - . BE IT RESOLVED BY THE BOARD OF COUNTY C01v1.1vfISSIONERS OF MONROE COU1\TTY, FLORIDA: Section 1. Retiree eligibility for group health insurance benefits. A.) Employees in FRS Regular Class with a minimum of 10 years of service with Monroe County who retire on, or after, their normal retirement date as described in Sec. 121.021 (29), F.S., or Employees in other FRS Classes who complete years of creditable service as required by Florida Statute who retire on, or after, their normal retirement date as described in Sec. 121.021 (29), F.S. including all group insurance participants who have retired or will retire prior to October 1, 1999, will maintain their group health insurance benefits with r.,'fonroe County. B.) Effective October 1,,1999, employees who retire at an early retirement date, as described in Sec. 121.021 (30), F.S., must, in order to maintain their group health insurance benefits with Monroe County, pay to Monroe County a monthly premium in an amount established annually by the Board of County Commissioners. The premium will equal, but not exceed, the County's premium cost for active employees. Retirees who must pay the monthly premiums described in this subsection (IB) will have their premiums canceled when they reach (i) 60 years of age; or (ii) qualify under the Rule of 70 wherein the combined years of service with Monroe County and the retiree's age equal a total of70. C.) Employees who have less than 10 years of service with Monroe County and are fully vested with the Florida Retirement System, must, in order to maintain their group health insurance benefits with Monroe County, pay to Monroe County a monthly premiur:l i:l an ..mount establish~d annually by the Board of County Commissioners. The premium will equ:lI, but not exceed, the County's premium cost for active employees. Section 2. This resolution does not affect any re,quirement of eligibility with the Florida Retirement System; i.t affects only eligibility to receive health insurance benefits under the Monroe County Group Employee Benefit Plan; Section 3 The Monroe County Board of County COrnn'lissioners formally reserves the right to any and all future changes and modifications of this resolution. PASSED AND ADOPTED by the Board of County Commissioners of Monroe County, Florida, at a regular meeting of said Board held on the 10th day of Narch 1999. Mayor Wilhelmina Harvey Mayor Pro Tern Shirley Freeman Commissioner George Nuegent Commissioner Mary Key Reich Commissioner Nora Williams yes yes yes ~e5 YP~ (SEAL) ATTEST: DANNY L. KOLHAGE, CLERK BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA By ..Do a.l...Q.. c... ~)&~ , Deputy Clerk . - ~- By ~... ':t.H fI 'V'. . ..' "'--", '.- r'. \,,,.. Mayor/Chairman I -4 -0> ::0 I I 0 -c.c _cc.- 1m rn .. 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CDm3 :00 CD C ::T ~ -mS" CD CO - g.CD:o .....enm 00;- -0 m '< Z o .. ::T -. ~ cc :0 CD !:!: .., CD ~ o 3 ." :0 en C" CD 0- .., CD ...L o - o ...L - co co go ...L o '< CD m .., U) :E ;:;: ::T s: o ~ .., o CD (') o C ::s ~ -0 m '< Z o .. ::T -. ~ co (') C .., .., CD ~ .. :0 CD !:!: .., CD CD -0 m '< Z o .. ::T - ~ cc = ~ - - ::1 n ~ "' - o = en 0' tot = > rn t:I:J '=' o 2: ~ ~ o ~ o rn t:I:J '=' ~ rn o S ~ .... o ~ n o = "' - = = tD Q. ~ tot o = .... = rn = tot ~ = n tD n o <= tD tot ~ tD ~ "' IP; ~ tD "' - tot tD a tD = "' o ~ = o n n is: ~ 2: ~ o ~ o (,) ....... .... o ....... \0 \0 MEMORANDUM RE: CC: February 23, 1999 All employees David P. Owens, Grants Coordinator, Social Services; Chairma~rsonn~1 ~J~ app Procedures Review Board ~~~~ Retiree Health Insurance Task Force recommendation DATE: TO: FROM: The Retiree Health Insurance Task Force held its second meeting on February 22, 1999 and agreed upon an alternative to present to the'Board of County Commissioners concerning the proposed changes in retiree health insurance. The Task Force consisted of the Personnel Policies and Procedures Review Board and appointees from each of the constitutional offices, Mosquito Control Board, and County Commissioners. The makeup and mission of the Task Force were agreed upon by the County Commission at its January 1999 meeting. Current employees and retirees were included. Below is a summary of the issues discussed and the alternative proposal. Prior to October 1, 1988, retirees were offered health insurance, and those under age 65 paid 60% of the department rate ($175.00), or $105.00 per month. Retirees 65 and over paid 40% of the department rate, or $70.00 per month. The difference was due to the fact that those 65 and over would have Medicare coverage, which would be the primary coverage. The department rate is the amount charged to your department per employee for our health insurance package. This rate is currently $470.00 per month per employee and covers the costs of claims, administration, excess coverage (over the self-insurance limit), life insurance, and retiree health coverage. At its meeting held on July 21, 1988, the County Commission unanimously voted to Yauthorize the payment of Group Insurance Premiums to all County Retirees with the requirement of a minimum of ten years' service- (quoted from the minutes of that meeting). This would provide free health insurance to anyone approximately 42 years of age and up with ten years of county employment. Recently. consultants hired by the county have estimated that the potential liability for providing free retiree health insurance under the October 1988 policy amounts to approximately 65 million dollars as of July 1, 1998. In arriving at this estimate. they considered the number of current employees, the number of current retirees, the number of ecnployees eligible to retire, life expectancies, and so on. This estimates the cost of providing free health insurance to retirees for the rest of their lives. Currently, there is no money set aside for funding this potential expense. The consultant has advised us that regulations are expected in the future which would require the County to fully fund a retiree's estimated cost of health insurance for their lifetime at the time of their retirement. This would mean that, for a current employee eligible for retirement, on his or her day of retirement, the County would have to have set aside approximately $92,398.00 under the October 1988 policy. In August 1998, a proposal was sent to the Commission, to be effective October 1, 1999, which would require that an employee must have ten years of service with Monroe County and be at least age 55, or have ten years of service with Monroe County and their years of service and age add together to equal at least 70 (rule of 70). In addition, the proposal required that retirees contribute to the cost of their coverage in an amount equal to the subsidy paid to them for health insurance from the state retirement system. Currently, retirees receive $5.00 per year of service per month as a subsidy to help them pay for health insurance. Someone with 20 years in the Florida Retirement System would receive a $100.00 per month subsidy, for example, and would contribute that amount under the August 1998 proposal. This proposal reduces the potential liability to approximately 36 million dollars and the amount to fund an employee on their retirement date to approximately $54,476.00. The alternative agreed upon by the Task Force is similar to the August 1998 proposal, but would require a retiree to be at least 60 years old (instead of 55) or meet the rule of 70, and would not require payment of an amount equal to his or her subsidy. This proposal reduces the potential liability to approximately 25 million dollars. This alternative will be considered by the County Commission at its meeting on March 10, 1999. Several alternatives were discussed by the Task Force. These included: Charging existing employees and retirees a flat monthly fee for insurance. Various changes to years of service and age requirements. Self-insurance versus purchased coverage. Benefits and drawbacks of cafeteria plan features. How to preserve current benefit package features. Ways to reduce claims. ' Approval of August 1998 proposal. Charging retirees a flat monthly rate regardless of subsidy amount. Charging retirees different percentages of department rate, depending on age. Discussion and comparison of our plan benefits and costs compared to other entities. .. '-J III . . Ul . ?' :+:- ~ !'J 3: o ::l ... ~ ("') o c: ::l -< t'I'1 3 ~ 0" '< III III c::l III ::l III ~ fJ> S' C1 ~ 0 .J~,,<_ ~ ; 4"" '-< .. < 0 ~ ~ .... ^ >- >- O~ ,-<";' " g, :E~ ":"l r C1l S" .... i'1) n":"l o T- o o t':'l "0 ~ r'l .... :r: o c CJl 5' Qq ":"l ^ n n :>o-Ul ~ 0 Ul z .......... :> z .......... :> .,. N >-0- ~ N o-:>Ul o~ Ul UJ N .... 000 -t;"r;" [ ~ ~ -<-<-< < .. .. ~ ~ ~ ~ "0 "'J ~ ~ ~ ~ ~ ~~ .,. N 0- 0- Ul NOUl NUl.... o 0 .... o UJN.... 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Q. ~ iW -< ~ ;:. = = ;: ~ ... .... =~~=~=:1= :~= ~ .., ~ =- o=~. = (J'Q aQ q- r= ~ ~ N ~ ~ .. ~~~~-1 =:t~= =i ~ " ~ a := =. 5- ;- ~ .~111=~ ==~-t = . ~ ~ = ~ = fIIIto. '{ fI - · !!!II f') -=(1QaQ~~. ~: ; ~ ~ g .. ~ .., rIl ~ .. = ~ ~~ ~ ~ Q ... ~ ~ ~ ~ == ~ ~ ~ < ~ = ... .,. Q = ~- z ... - -f ....l..e -~& ;~l < .1"" ~ m Con ~ = ~ ., ~ II ~ i = Q. g. ~. ~ -. = a ~= ~ e = .. " .. ~ ~ ~ = ,= ~ 0' t~ = ~ e ~ = i =- ~e: C1 .= = ~ .... ~~[~ g'~i> ~ ~~ ~ ~ = C"/) ::1 = {IJ ..... .. .....~~ ~ = ~ ;J CoC"/) = = = fM+. -t g ~ Q.. tD rIJ ~ ~ ... ... ... ~~~~ ""-" .. ~tH=N ~==~ ~~~~ = ~ ~ .~. ~ ~ 00 = ~. = ~ rIj - z . -T <. m CA l1.s/iJ~...'r.;l 1',': ul WHI-'Hl c.H~: ~HLc.~/L ~VL~ ~ 13[J5292~~52 NO. 72"': t-"iJ14/t)16 H. Pylori Pro~rarn for 1\1onroe County/KPHA WHllllons with KPHA will provide a scre::ning for H. Pylori for Lh: m:mbl:f:i of Ihe Montee County Govemment. Thi~ screening willloke place in conjunction with the 2001 annual health fairs provided by KPHA. Tho purpose of this program is a reduction in cost ofltle class of druE:s known as proton pump inhibitois, This cli1sS iepil;~ent~ approximately 9-10% of Ihe tOlal dollars spent on prescription drugs for the county, Identifying cnd treating Ihose patients that test PCSiliv:: for the l1'_pylori bact::-::, we would e:cpccl n redtlction in these cc~ts os well t'.5 a possible reduction in future costs rchllcd to the lfeatment of peptic ulcer disease in the county's members. The program will . cost SJS per member screened with il minimum charge of $2500.00. This will be included in the counr;'s rC!;Uhlr invoice after complC:Iion OrIne progr:Jm. 111e primary KPHA conlnct will be Winnie Radosti and the WHI clinical 'onl<1ct will be JLlck Diamond. Winnie will piavide us with the contact name as well ::\5 Lhe da!e~ and time! ortlle health fairs within 30 days ofth;5 corre5pondence. Pro~r:m componen!~: 1_ Idenlificaliun of potential patients by \\.'HI. Those palients will be long lerm. high dose utiiizers of tile PPI'~, 2- Leners and patienl sUl"\'eys will be mailed directly to the patients identified. Members will be asked 10 complete the survey and bring them with them to the health fair for review by a WHI pha."inacist. All mailings will be done by WHI. Additionol surveys will be available at Ihe health fair for Ihose patients who eithcr foriet to hring their: or did not receive one via mail. 3- After review of the survey, the WHI phftnnacist will determine if the palien! meets Ihe crilc:rill for funher testing and direct the patient to the appropriate station at the health fair, providing appropriato educational materials to the patients pertaining to the cause and treatment of Peplic acid disease. 4- The lest c:onsists of 4 fin~er ~tick. blood dlllw pro~ided by WHI and will be pcrfonncd by a phlebotomist/nurso provided by KPHA staff. KPHA will be responsible for all-proper licensing nnd cenificates necessil}' to perform the above which will include disp03aJ ofBll sha.-ps materials related to the blood draw. 5- Thc Icst results will be Rvailable within 5-7 minutes. 6. If the patienttcsts positive they will be educated and referred to their physician for funher treatment. ,. WHI will also provide a copy of the lest results directly to the physician along with matcrial~ showing the mOSt recently approved FDA treatment protocols, The c09t of trelllmenl for ft pntienl on PPI's ftnnuall)' is approximately $650.00. After treatment, the H.pylori p!Stienl will provide SAvings of lIppro~imat\)ly SI26,QO in the tirsl year and grellter sflvings in the subsequent years ofter di3Continuotion of PPI Iherapy. A preliminary count o(lhe number of pOi sible candidates for screenings is approximalely 90 plllien15. Experience hu shown we should get between 50-75 p~tients screened. Approximlltely SS% of these plltienls will hay:: additional therapy recommended due to a posili"e leSI result. 03/02/01 17: 01 WHPHI EAST SALES/C SUCS ~ 13052924452 NO. 724 PCl15/015 WHT will provide reporting as to the number ofpfltienr identified, screened and test results within one month ol'thc last set of screenings. Al 6 olld 12 montlu post trealment, WHI will review ancJ report on the: uuh:omcs and savings accnlcd. Anached are the SAMPLE leners we have used in previou5 .~creenings. There will be no charge for customi:,cing the letters to meet the needs of the client. WHI will provide a!! educolional materiAls for both pnticnts omd physicians. WHI's objective is to promote tho most appropriate use of these and other drug Iherapies Wilh Q resultont cost reduction for lhe county, We loole. for.vard \0 working with both Monroe County Government and KPHA in providing this exciting and .effective oppornmity to b=tter m:l:l4&= cr.J1: expenditures. Ple~se feel free to contact Shawna Turner, Elizabeth Linl~ Or mYiclf at o\lr office for any questions, Yours truly, Jack Diamond R.Ph. Regional Clinic:!l Director Wolgreens Health Initialives. Inc. V!i~~ .. ~ rI} erIJ.:-. =aa ~-= = =,...;- S. =- == rI.) ~ ~ ~. CM= ~CJQ ~~ = ~ a = tD ~ a.= =-= ~ = ., = ~ct ~~ ~i ... .. //IIi. .... = fIj = ~ !~ .....~ g er ~~ ~ .., fD ft) ~ 51 a ~ == -=~ :!=.. = ~ ~ ~. :.; .... (J'Q =- ~ ..... II f CTf"') ,_.._ . ~ ~ ~ fT> ~ ., ~ = = = ~ e = = = ,... ~ -= n> = .... = = ~ ~ ~ ... ~ II ~ 'I-' N th ~ = ~ . cc = - ~ a ~ ;; :1 == ~ ~ ~. ,-_. f) I, = = -. ~ = ~ ~ = fiiiP. ~ ., ~ ~ a -. = == rIj ~ ~ ~ e -Co ;&iiiiif rP - z . -:1: -tm~ ->~ ;~l <:I: m en )> o o -, a. -- Q) z Q) ~ -- o :J Q) - '.\;"""'" , ~;. .'./ - /' ~ ',~~',' ~~ :,.-,.' ,""."1.. , ~::.,... .......... "t ~-~.l.~"."':"'. "~%.....' . ....... , n:,., }'" (f~, "- ,.; ,~~.'- " . / .' l,A; '; ~;:.." "'~,:. ;.,:.,...-~' __ ...... _,C~ ~'. ij/' ,. ". 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CD en - C') 5a o -. c:: < :J CD .-+ .-+ en 0 -0 - 0) :J - .-+ ::T m a. c:: C') Q) .-+ -. o :J -0 ..., o co ..., Q) 3 en ~ ~ r:no ~ I I-t > a 0 CD ~. 03. < (0 CD rJJ. n no o rJJ. ~ ~ ~. Id ~ (0 ~ g- ~o . ~ . ~. o ~ 'MAR-C5-ZCOl lZ;31 FROM- T-79i P,OOZ/OO~ F-413 Monroe (;Qunty Board of County CommuliiuncTS Summary of Post Retiree Medi~a.l1ssue ~/JdF DRAFT 1. Dacklround In December 1990. the Finam;i~l Accounting Standard:i Board (FASB) issued a sta<;ement changing the way employers subject to its reponing rutes had to reporr liability and expense associated health benefit plans tor retirees. financial Accounting Standard 106 (F AS lOG) was pha.~ed in be~innini in 1993 and requires employers to accrue the costs of postretirement he31th benefit plans over the working years of the emplo}'ees. This trea.tment is very similar to the Vt.'aY cxpe1l3es for defined benefit pensioo. pl~ns ~re rer-orted under F AS 87. Prior to F AS 106, the expense for retirees was reported the same was as the expense for actives - employers simply reporred the claim::; llu':W'led during a reportil1g period. . As a public employer. the Monroe County Board of County Commis::;iom:r:.; (lhe COUllty) is not subject to F ASB statements. Historically, however, the Government Accounting Sta.'1dards Board (GASB) has often issued statements that mirror earlier FASB statements. liAS]; has not yet issued a statement comJ'larahle to F AS 106. but iiven the possibility that this may occur at !lome point over the next several years, the County asked Galla.gher Benefit Services (aBS) to pI'l:pare a valuation of its ret1rce medical plan lU1d~r F AS 106. Although t.AS 106 was the motivating faCIOr in the study, iL ~huuld be aoted that fAS 106 dOC3 not create liability or expense - it just changes the way they are measured. The benefits are ultimately going to be paid, whether you accrue today as required by F AS 106 or expense them when they are paid several years from now, Even if no F AS 106 counterpart is ever adopted by GASB, the costs identified in a F AS 106 valuation provide a very good warning oft.lte retiree medical exp~1: WI;: COWlty \-,ill one day have to recognize, ~ Initial County Results The County's initial FAS 106 valuation was completed in August 1998. It identitled an accrued liability ofS65 million And an annual expense of$1S million usin~ FAS 106 rules, In rc~ponse to thc:se number3, the County adopted a sisnificant change in the eligihitity requirement, introducing what is referred to as the "Ru1~ of 70". It requires that an employee's age plus his years of service must equal at leasl iO fur 11lul to be eligible for the retiree benefit. Pre\iouslYI any employee age 42 Or over with at least 10 years of service was eligible for the retiree benetit. The Rule of 70 significantly reduc~d the nwnber of eliiible employees. and this c.aused the ar:r.1'11ed FAS 1061iability to fall from $65 million to $36 million. The annual expense under F AS 106 fell from S15 million to $8.5 1l'.illion, 3. Sub~cqueDt Review and Recommendations In JUIle 2000, the FAS 106 valuJtion was run again, using updated claim. and census data. It showed the liability was back up to $53 million and the annual expense had increased to $11 million. Ther~ are 2 main reasons t.ie numbers had increased so sharply. First, FAS 106 figures will almost always increase over time given a relatively stable active population. Much like a pension plan, you have Q liCLbility that srow~ ov~r unle as int~rest is ;u~~Tued and employees earn additional service credits. This natural growth accounted for $6 million of the $17 million increase in liability. An addiliuuw $8 uwllon \W:S due to the f:lpid increase in medic31 costS that the County experienced during 1999. The expected annual per capita increase under the F AS MAR-OS-ZOOI IZ;ZZ FROM- T-791 F,003/005 F-41Z Monroe County Buard of County Cummh~iunt:n Summary of Post Retiree Medical Issue work w:lS 11.25%, but costs were up well over 30%. The proiet.1ed cost of retiree health benefits increased sharply as a result, and this caused a further jwnp in the liability and expense figures under FAS 106. The remaininy $3 million increas~ was due 1:0 other minor changes in assumptions and plan experience. During the summer of2000. the County's Task Force on retiree health met several times to review further changes to the pian. In late July. the Task Force members voted to recommend that additional changes be made. The changes recommended were: . Employees hired by the County after October t, 2000 would be required to pay the full department rate ($470 at the time) for retiree coverage. This would largely eliminate any liability fur n~w hires. . All current retirees and any future retirees hired prior to October I, 2000 would be required to pay $100 per month for their medical coverage. . An emergency room r.npaymt>nr of$75 would he introduced effective October 1. 2000. . The pharmacy copays would be changed to $6 for generic chugs, 20% for preferred bn1.uu dJ'ugs, and $35 for nOll-preferred brand drugs effective Januaxy 1,2001. The combined impact of these changes would have reduced the liability to $28.5 million and the annual expense to $5.6 million under FAS 106. It is our 1.1nderstandins that the rounfy (Ho nor, ~dopllhe~ change~. 4. Additional Plan Chao!!cs We have been asked by the County [Q estimate the impact of ac1dltlonal plan changes. Because the Task Force focused much more on the liability than the expense, we used the FAS 106 liability as baseline for comparing different plan options. The attached table shows the plan r.hl\nep.!Il ann n111' e~timate of the impact of each on the FAS 106 liability. If the County were to implement all the plan dc~ign chtu1gcs (Itema 10, 2. 3, c:uld 4 from the table). the accrued liability for 2000 would fall by $7.3 million (14%), to $45.6 million. These changes would. also result in reduced costs for the County"S active employees, although the % change 'would not be quite as great since the pharmacy changes have a larger affect on retiree costs. In addition to the plan design changes, the COWlty asked us to value the impact of increasing the atnOlJ11t cmploycc~ and retiree, pay to cover dependents. We e:;umllte that each $50 per month increase in the dependent contribution requirement will reduce the liability by another 52 million. or 4%. An increase of$200 per mon[h would eliminate vinual1y all oftht: $9 million liability associated with dependents. 5. Other Consideratj9-'s One of the reaions so many employers have smuggled with their retiree plans i'i th:.t the liahility and expense numbers present such a moving target. Assuming all the actuarial assumptions l1lllde 111 setting the: 2000 COWlty liability otSS3 million turn out to be eXACtly correct, thc MAR-os-zeal 1~;~3 FROM- T-791 P 004/005 F-413 Monroe County Board or County Cummb~iu..cn Summary of Post Retiree Medical Issue liability L'1. 2001 will have increased to $6] million, with a number ot' close to $70 million by 2002. If we continue to see high medical trends, which is certainly possible, the change in liability will be even sreatcr. Even without the FAS 106 impa~ the County's retiree hc!!alth expense is going to increase sharply over the next several years as the number of retirees increases steadily. The failure to plan for this expense, whether or nul OASe adapts t1 retiree healthcare standard. ",ill cause far worse headaches for the County in the not-so-distant fum:e. Since FAS 106 was hnple!nented in 1 ()()':\, there has been a steady drop in the I1umber of employers offering health benefits to retirees, and many of those employers that have continued to offc:r bcudits have changed their plans to reduce their liability and expense. Accordins to the 1999 MercerlFoste:' Higgins Benefit Survey. 40% of large employers provided health benefits to retirees age 6S ar...d over in J 993, but o[lly 28% did so by 19~9. The: ~m:: pl:lllc:m holds true for rt:tirees under 65, with. a drop from 46% of employers to 35%. The survey also notes that among employers continuing to offer retiree coverage, about 25% have increased the % of the cost passed on to the p.mployees, These chan~es have taken place despite a very tight labor market in recent years. Any slowdown in the economy is likely to speed up the rate at which employers arc: modifying their retiree hetllth plans. Two things that employers really need lO kc:~p ill miud i!U'C the need to preserve their right to make changes to the plan and the need to communicate this right to employees and retirees. This extends to both active and retiree plans, but is especially impOrtant for retiree plans because ot the lon~-term nature of the employer's obligation. Employers should establish a routine practice for considering and adopting changes to their plans, and the practice should be communicat~ to employees and retirees in writinS. Th= most common complaint from retirep.l'1 whn~e ~Ian!> have been modified by their former employers is that they were never told this could happen. An established, cOlT'..municated process \\;11 prol~cL Ihe cmpluye1' but will also be received by rctiree3 as a much fairer approach, even if they don't like the changes that are made. Another adv~mHlce of a documented periodic review of plan design and costs is that it makes it much easier to make necessary c1um.gcs. Once a process becomes familiar, it can generally proceed with fAr less effort mCUl i~ required under an ad.hoc approach to plan m'ln"eement. In the event that CASB ever adopts a F AS 106-type standard, a documented procedure for make changes \\>ill make auditors more comfonablc: ll~l;c:pliug assumptions that ~ticipeltc future changes. For example. an employer might assume that retirees will have to pay a flXed % of the retiree cost, but if the employer has no history otincreasmg retiree contributions to ensure mat this happens. an auditor will question the appropriateness of the assumption. The same logic applies to using plan design changes that keep medical trend assumptions down, or any other key Q33umption used in the valuation. Whether or not QASB auupws u n:t.iLee medical rule, the County ill going to ha.ve to dooJ. with sharply increased retire health cOStS over the next dt:cade as the nwnbcr of retirees receiving benefits increases, The longer the delay in taking steps to manage the expense, ~ mUrl: w~tlc the steps needed will become. We urge the County to take the necessary steps to begin to address this issue. 'MAi\-05-ZC01 12;$3 FROM- T-7'91 F,005/ao~ F-413 ... - ~ ~ :(0- Ch 141~ to-; <C o II) C") Q;) , .... c N .... .... .... 0 c:i c:i ~(f.l~ V) In In ID ID It) It) ;<= a:~:i ue 8~ N' n IU :J ~ '1;1(1)~ -- - - - - ui I) < .- "":~ C"I .... <0 .... i -~= ci ci. d III ..:a .... .... .... Ecl! -- - :;Q;-' LU eft 8 1i c_ :s ! "Q U tit' ~ .E: JQJ~ ~ ~'iJ? ~ 'if. 'iJ? ff. ! CD 2' c3 :z: \CW') M 0 0 0 c)i<1 C)I ~ u; ~ '0 illSe I Oca Ii w~a:: II) .ii CD e= ,... - ..a .!!! j~ 8 ~ 0 i )5 ~ ~ In := ~ U} CD ~I ,. CD ~ 8 :0 .8 Ii 8 ;;;I ~ tt U. c=. c=. 9 r. .... b,~ :6 88 ~ oS - - 8 "l:I :I S gi ig~~ CDO , .&J ~ '"Og 'C o c::: Sg ~ 2 ~ ~ 0 E~ @ - << CJ 0 ~ 0 - :@R I o III ~;.,.~ :,." "I 1!~ .!!fIIt u i ca 't::1 8 l! f; i ~.s F c:: r- C CD a:a..c c: CJ e 'UJ 0 { Q..s:: i ~ CDo CD at: rc; - 1- lei; ..c .e c:: ~ 0- :~ en =.!! ~ ~l ~g - t ~ 'E .- ~ Be: ;2 ~8. (J .5o!! eN U ~ (J (!) 2~ _ 0 () i ~ g ClI C (,) :if 1A CD.Q i1 _..... N CO) oq- 10 Z Board of County Commissioners RESOLUTION NO. -2001 A RESOLUTION CANCELLING RESOLUTION NO. 104-1999 AND AMENDING RETIREMENT ELIGIBILITY REQUIREMENTS FOR GROUP HEALTH INSURANCE COVERAGE FOR MONROE COUNTY EMPLOYEES. WHEREAS, group health insurance expenses have been steadily increasing; and WHEREAS, the number of retired County employees continues to increase dramatically each year; and WHEREAS, it is the intent of the Monroe County Board of County Commissioners to allow County employees, including employees of the Constitutional Officers and the Mosquito Control Board, who meet the criteria established in this resolution to retire through the Florida Retirement System and maintain their group health insurance benefits with Monroe County as provided herein; now, therefore, BE IT RESOLVED BY THE BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA: Section 1. A. Employees in FRS Regular and Special Risk Classes with a minimum of ten (10) years of full-time service with Monroe County, who retire on, or after, their normal retirement date as described in Sec. 121.021(29), F.S., and who are covered under the group health insurance coverage provided by Monroe County upon retirement, employees in other FRS Classes who complete the number of years of creditable service required by the Florida Statutes to be eligible for a benefit under FRS, who retire on, or after, their normal retirement date under Sec. 121.021(29) F.S., and who are covered under the group health insurance coverage provided by Monroe County upon retirement, including those who have retired or will retire in accordance with these provisions, and all other retirees who as of October 1, 2001 are participating in the County's group insurance program at no cost, may maintain their group health insurance benefits with Monroe County following their retirement, provided such retirees pay to Monroe County the following monthly premium: (i) One hundred dollars ($100.00), or such other amount as determined by the Board of County Commissioners. Page 1 (ii) The payment of the initial premium under this subsection I.A. for those employees who retired prior to October 1, 200 I, is due on October 1, 2001 and the first day of each month thereafter. For employees who retire on or after October 1, 2001, their initial premium will be due on the first day of the month following the month in which they retire and the first day of every month thereafter. B.) Employees with ten (10) years of full-time service with Monroe County who are coyered under the group health insurance coverage provided by Monroe County upon retirement and retire on their early retirement date, as described in Sec. 121.021(30) F.S., may maintain their group health insurance benefits with Monroe County following their early retirement, provided such early retirees pay to Monroe County a monthly premium in an amount established annually by the Board of County Commissioners. The premium will equal, but not exceed, Monroe County's monthly departmental cost for active employees. Such premium will be payable on the first day of every month commencing with the month following the month in which the employee retires. Notwithstanding the foregoing, early retirees required to pay the premiums described in this subsection I.B. will become subject to the premium set forth in subsection I.A. above upon meeting one of the following requirements: (i) Sixty (60) years of age for Regular Class employees or fifty-five (55) years of age for Special Risk Class; or (ii) Qualification under the Rule of 70 wherein the combined years of service with Monroe County and the retiree's age equal a total of seventy (70). c.) Employees with at least ten (10) years of full-time service with Monroe County who are covered under the group health insurance coverage provided by Monroe County upon termination of employment and are fully vested under FRS who elect not to retire under FRS upon termination of employment with Monroe County, may elect to re-enroll under the group health insurance coverage provided by Monroe County upon retirement under FRS, provided that Monroe County was their last FRS employer. Former employees electing this option, may maintain their group health insurance benefits with Monroe County following such election, provided such former employees pay to Page 2 Monroe County a monthly premium in an amount established annually by the Board of County Commissioners. The premium will equal, but not exceed, Monroe County's monthly departmental cost for active employees. Such premium will be payable on the first day of every month beginning with the first of the month following the month in which the employee elects to re-enroll under the group health insurance coverage provided by Monroe County upon retirement from FRS. Employees electing this option must, notify Monroe County of their intent to re-enroll in the County's group health insurance program. Employees who elect to re-enroll under this option are not eligible for premium adjustments under subsection LA. or LB. of this resolution. D.) Employees with less than ten (10) years of full-time service with Monroe County who are covered under the group health insurance coverage provided by Monroe County upon termination of employment and are fully vested under FRS, upon retirement under FRS, including those employees retired prior to October 1, 2001 in accordance with 'these provisions, may maintain their group health insurance benefits with Monroe County following their termination of employment, provided such terminated employees pay to Monroe County a monthly premium in an amount established annually by the Board of County Commissioners. The premium will equal, but not exceed, Monroe County's monthly departmental cost for active employees. Such premium will be payable on the first day of every month beginning with the first of the month following the month in which the employee terminates employment with Monroe County. Employees with less than ten (10) years of full-time service with the County are not eligible for premium adjustments under subsection 1.A. or 1.B. of this resolution. E.) Notwithstanding the foregoing, employees with a hire date on or after October 1,2001 may, upon their retirement under FRS, maintain their group health insurance benefits with Monroe County following such retirement, provided such former employees pay to Monroe County a monthly premium in an amount established annually by the Board of County Commissioners. The premium will equal, but not exceed, Monroe County's monthly departmental cost for active employees and will be payable on the first day of every month beginning with the first of the month following the month in which the employee retires under FRS. Employees with a hire date on or after October 1, 2001 are not eligible for premium adjustments under subsection LA. or LB. of this resolution. Section 2. This resolution shall be effective as of October 1,2001. Page 3 Section 3. This resolution does not affect any requirement of eligibility with the Florida Retirement System; it affects only eligibility to receive health insurance benefits under the Monroe County Group Employee Benefit Plan. Section 4. For purposes of this resolution, full-time service shall have the meaning provided in the County's policies and procedures governing determination of service. For purposes of this resolution, the definition of date of hire is the date an employee first begins work for Monroe County determined in accordance with the County's procedures governing fringe benefits. Any break in employment of forty-eight (48) hours or more will result in a new date of hire if the employee returns to County service. Section 5. The Monroe County Board of County Commissioners formally reserves the right to any and all future changes and modifications of this resolution, the group insurance contract providing health benefits described herein and/or the required premium contributions. Section 6. The Monroe County Board of County Commissioners cancels Resolution No. 104- 1999. PASSED AND ADOPTED by the Board of County Commissioners of Monroe County, Florida, at a regular meeting of said Board held on the day of , 2001. Mayor George Neugent Mayor Pro Tern Nora Williams Commissioner Dixie Spehar Commissioner Charles "Sonny" McCoy Commissioner Murray Nelson (SEAL) ATTEST: DANNY L. KOLHAGE, CLERK BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA By By Deputy Clerk Mayor/Chairman Page 4 August 15,2001 Agenda Item I-N2 At the July 20, 2001, budget workshop, the Board of County Commissioners asked that we readdress our March 13,2001, proposals. As of June 2001, we have a total of2,603 individuals covered under our group insurance program. Recommendations - Note 70% of cost savings will impact ad valorem funds and 30% will impact other revenue sources. (Item 3 from March 13,2001 Proposals) Implement a charge for all current retirees and all employees employed by the county prior to October 1,2001, upon their satisfying all retirement requirements. The charge should be $100 per month for their insurance. Group Insurance will assist all retirees who do not claim their Retiree Health Insurance Subsidy form the FRS with the process to obtain it. Implementation date of January 1,2002 (originaIly recommended 10/1/01). The amount of the subsidy is based on service credit at retirement, $5 for each year of service, with a minimum monthly subsidy of $50 and a maximum of $150, The County pays FRS for Insurance Subsidy. This item was recommended by the Task Force during 2000. The administration concurs but is willing to consider a different amount commensurate with the amount received by retirees to assist with the provision of health insurance. Savings 191 retirees (255 retirees x 75%) x 100/mo x 9 months $171,900 Medical savings not projected because we should be secondary for those individuals who drop coverage. 2 (Item 13 from March 13,2001 Proposals) At present, covered individuals are responsible for 20% of health care costs on a total cost of $10,000. Thereafter the plan pays 100%. Recommendation is to change the base limit to $20,000. On March 13,2001, the amount was raised from $10,000 to $11,000 with direction to raise amount by 10% a year until it reaches $20,000. Recommend we go immediately to $20,000. Claims between $10,000 and $20,000: Year Employees Savins~:s Sept 1999 130 $165,150 Sept. 2000 137 $190,900 June 2001 (9 months) 125 $160,000 Projected Savings (Effective January 1, 2002) $120,000 /-NL We have heen purchasing Excess and Aggregate coverage for many years, It is designed to reimburse us for claims over specified amounts. We have raised the specific deductible over the years in an attempt to keep this coverage at a reasonable level. We have received word that our premium is increasing by $88,899 for FY 2002, When reviewing this coverage and reimbursement from October 1989, we believe we can manage this expense by increasing our reserves to cover very large claims, This would allow us to decrease expenses. As you can see by the chart below. since October 1989, the total reimbursements have equaled about 60% of the premium, JOlIN ALDEN JOHN ALDEN REIMBURSEMENTS IICLAIMANTS Specific (Exces-~) (AlIllrellate) O1:ductible FY 89190 415,437 19,242 476,665 7 $50,000,00 90J9\ 462,864 31,806 201,291 7 $50,00000 91/92 540,631 33,102 293,039 9 $60,00000 92/93 648,823 34,992 173,681 4 $65,000.00 93/94 824,130 34,695 82,946 5 $75,00000 94/95 647,312 27,047 1,223,799 17 $85,00000 95/96 848,672 32,923 741,958 14 $85,000.00 96/97 815,107 33,100 441,498 II $85,000.00 97/98 680,304 35,962 204,686 7 $85,00000 98/99 695,138 37,020 344,388 5 $85,00000 99/00 622,897 37,303 520,976 13 $85,000 00 00/01 638,108 46,282 104,691 3 $100,00000 TOTAL 7,839,423 403,474 4,809,619 01102 721,029 52,260 Proposed Premium "NOTE: FY 00/01 BASED ON SEVEN MONTHS OF PREMIUMS AND REIMBURSEMENTS We would propose that we budget $400,000 as a special reserve line item and decrease appropriations by $284,390. Implement October 1, 2001 $284,390 4, Monroe County has one ofthe most economical pricing structures for dependant care in the County, We have looked at alternative pricing struclures to shift more of the cost of dependant. 5, Both ofthese options are detailed on the attached sheet: Dependant Coverage: Option A: Spouse Children Family $290 $218 $508 $491,634 $238 $281 $346 $202,500 Savings Option B: One Child Spouse Only Children Family Savings (Effective January 1,2002, after open enrollment) E"d tlrtlrStlr-GSG-SOE u~wp~ o~ s~~aqo~ l sawer eGtlr=ll 10 El ~n~ CO' l/l..- ~N f)' 0.. ~ I 1_____ ,N, 'to' (1) 'ER- e> c co .r:; U 0, 0); N: <(ER- e: .Qi OJ o III U I: (1)[ ra ... lJ) :::I ::I, CIl 0 ~ a., 0.. U) :::J e C) CO ,(") ~ N ;::., fh c: ::J . 0, U; "'C eli; 0 0 .r:; (,) U) i r- ~~ ~ ER-; ~ (3 ..- 0) ,NI ,~ U) W U N (") (") ~fh l1- ..- 0, 01 N -- ..- 0' -- (1) 0 lJ) ..- ::I 0 a. 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II '~[ (")00 IC:I=~ , '~I; I~ ~I 1 1m as ill 1 I : I~~ I ' I~I~I 1~'B'I;g: ~ -- I CIlI IU 1:2 I 1-- CiO>..c co'(\"), i r '--r i~ ~r- '--I8J~~-ll ,- IN1 ~ CO~~I'I, -I -1'~I~'I-,~I,8:~- v(") , C:'C: I 'oml I (") vie." c:e: fh' ~i~: I~I II i I~~!, i ~!; ~I I li''5~'('')i Nl<Or' I~ I 'I' '1'~i~l; !I~!~I,~I, I ;w, , I ~Io I .c 0, ' ;2, I ,Q), 00 U,Q.!a.l ~dill~il1",ril-\"~I.: -Ii fn-; !~iN: :tlW c: I , I, ~ ' I ! ~ " I I' c( I I, ~ I I c: i I I~, I ' I ~ i -g , m ~ ~ I~, I I c:i 5, i i !~' lR, ~I~' ~I i s;; i:g: e:, "0 '-, Q) I I ~"-I i ::I I '1:J, E I w ~ a. ! ~ = E' >1 1....1 ,.... , 10 = ,>: .... '0 0.. .c m I, 0 I I =' i Q. i 0-1 .c' co I '0 ! =' . .... I, 0 ! Ul1- U, () 0 U) Ul1-' U Uj a.. ""9"-2S2-901:: u~wp~ OJ s~~aqo~ 1 sawer e2..:11 10 1::1 ~n~ - c as ''C 1:1 18- CDQ "O;Q ... Ill) ,.E,N IQ (1)1"1 I g:' (II) , :>., II 0: _"I o..,Q EO III "I >-,)- .Q'LL. I: o ~ :::J, ,.Q, !'c:g , j'E1Q ,00 u.... wiN CIl,fh I'll w- ... CD u.... 'I: I'll ..'- E '1:1,'- ._1 >< !51e I :!:,Q, , (i as CIl' o.c 0.., CD 2' o..f! (I) III .- > .c' 0 ~ u ...- o o N -- o ...- <Xi o FKAA Current monthly dependent coverage rates (FKAA SUBSIDIZES 1/3 DEPENDENT COVERAGE RATE PER UNION CONTRACT): PREMIUM: $179.46 - spouse only $133.83 - child only $366.55 - family coverage - ~ Recent RFP done by FKAA (July 2001) only ~ fully-funded proposals were received, all others were self-funded proposals. FKAA union employees had their union find an insurance carrier just for union employees and their dependents. FKAA does not anticipate going self-funded due to funding cost. Their recommendation at this time is to split their employees coverage (union and non-union). Union employees would be insured by the union plan and their non-union employees (80) would remain insured with League of Cities. Union Plan - $100. Deductible/90% reimbursement UCR/no PPO or network/Medical/Dental/Vislon/RX coverage. PREMIUMS 10/01/01: $365.00 - employee $183.35 - 1 dependent $267.63 - 2 or more dependents League of Cities - Plan changes - increase co-pay from $20 to $30/out of network reimbursement only 50%. PREMIUMS 10/01/01: $522.20 - employee (paid by FKAA) $247.51 - children only (employee paid) $331.90 - spouse only (employee paid) $632.67 - family coverage (spouse and children) (employee paid) *NOTE: ABOVE DEPENDENT COVERAGE PREMIUMS SUBSIDIZED 1/3 BY FKAA. *NOTE: on~y. Above premiums are for Medical and Prescription coverage Dental and Vision additional premiums. 9'd t-t-9v-~S~-90E u~wp~ o~ s~~aqo~ I sawer eEt-=11 10 E1 ~n~ CITY ELECTRIC SYSTEM 51% increase last year with League of Cities. Current monthly dependent coverage rates: $240.66 - spouse only $185.14 - children only $425.80 - family coverage *NOTE: CES does not subsidize any of the dependent coverage prendums . Currently CES has 154 active employees and 120 retirees. Recent RFP done by CES (July 2001) - will recommend to continue with League of Cities with an increase of 21%. CES does not anticipate going self-funded at this time due to funding cost. PREMIUMS 10/01/01: $465.93 - employee (eES pays) $291.20 - spouse only (employee paid) $224.01 - children only (employee paid) $515.33 - family (spouse and children) (employee paid) *NOTE: CES does not subsidize any of the dependent coverage premiums . *Note: Above premiums are for Medical and ~rescription coverage only. Dental and vision additional premiums. S.d vvSv-~S~-SOE u~wp~ o~ s~~aqo~ I sawer eEv : 11 IDE 1 ~n~ CITY OF KEY WEST Ci ty expects go have RFP's out by the first or second week of August. They are currently insured with League of Cities, Silver Plan. Current Premiums: $313.58 - employee (eES pays) $277.03 - spouse only (emp1oyee paid) $205.59 - children only (emp1oyee paid) $482.62 - family coverage (spouse and children) (employee paid) *Note: Above premiums are for Medical and Prescription coverage only. Dental and vision additional premiums. *Total coverage including (medical/dental/vision/prescription) for family would be $545.09 ($482.62 med/RX, $43.30 dental, $19.17 vision) l..cI VvSV-G6G-SOE u~wp~ o~ s~~aqo~ I sawer eEv: 11 10 E 1 ~n~ MONROE COUNTY SCHOOL BOARD Actual percentage increases not available. Current monthly rates (based on 10 months) : *NOTE: Increased February 2001 - first increase in nine years $93.55 to $111.31 - employee pays (board subsidizes 78%) $250.67 to $314.79 - family (one or more) employee pays (board subsidizes 22%) Other plan changes made February: Deductible $300 to $400 (two per family); Beechstreet network 85% to 80%; out-of-network 80% to 70%; added 3rd tier to RX plan *NOTE: only. Above premiums are for Medical and Prescription coverage Dental and Vision additional premiums. At this time the Monroe County School Board is unsure of whether they will be going out for RFP this year. They do not anticipate a rate increase in october as their rates were just adjusted February 2001. S.d vvSv-2S2-S0E u~wp~ o~ s+~aqo~ I saw~r ~vv : 11 10 E 1 ~n~ Aug 13 01 11: 44a ...... Q o o >- lL (/) '- Q) c: o '00 (/) 'E E o <.) Z. c: :;J o <..) ..- o "E 11l o CD Z. c: :;J o <..) Q) ~ c: o :::2: ~ w g <..) '(ii ~ ~ Ix: - ::>en~ (/,)~ffi z-o -:5:::::. a...<..)~ ::> "- OD-g Ix:<(~ C)o.._ ~ '" :. ~:I: ~ ... ~ "C1Z CI - 0 ~ ~::!: ~ ;i ~ .. ... .... c "" f to- C)I , , ,.., 1~!Qlx I. 10(':(1'_ I 'olA.S o I::(I~ ~ ...c.u i C,S- 1 t;!u ~ ja!< X I ! ' I 01- ' IO:::! i I~ 'wI .. '~I I en ~ i I!I ' oo~ ' lo! 10 : <C! '" a. 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III III c-i' CIO qo 0. o .- o .- i ' M ~ N -<l qo "!. ~ ~ ~ ~ 305-292-4544 p. 15 1Il ~ Cf) ~ 3 () o 4: 0.. ~ o o c-.I I o o o N >- U. ~ c: ::l o () ~ ..... c: o :2: Dop8ndentCov~g8 April 2001 by family composition one child children only spouse only spouse + child s~use + children TOTAL 35 44 218 83 123 503 by # of dependents 1 2 3 4 5 6 TOTAL 253 109 98 35 4 4 503 91 . d vvSv-2S2-S0E u~wp~ OJ s~~aqo~ I sawer el..v:11 10 E1 ~nl;:l By Family Composition One Child Children Only Dependent Coverage April 2000 Spouse Only Spouse + Child Spouse + Children 46 38 206 77 116 By Number of Dependents 1 2 3 4 5 6 252 100 96 30 2 3 '- ',-- t-', Monroe County >'.r~::~:'~~h,:..- 1.1.d VVSV-GSG-SOE: TOTAL: 483 483 Employee Benefits :.':<'~.' .:..... 1:'":<<(''' ~ '>::f.,~~'.,~\ ,,' . u~wp~ o~ s~~aqo~ I sawer el.v:ll 10 81 ~nld ..: Gl l!! Ul - .a 0 .!J 0 ... () III >- Gl C C 0 >- 0 II) E C, c, Gi It'l E CO > > Q. eo u u E .... 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W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W .- C >- >- >- >- >- >- >- >- >- >- >- >- >- >- >- >- >- >- >- >- >- >- >- >- >- >- >- >- >- >- >- >- 1::._ ra Co W <{ z .a- w w :c 0 <{ a3 ~ en <{ w c 0 en 0 w W l- e Z w <{ en ~ en w I- :5 C> ~ ~ w W ::l 0 :c w w ~ :E z U a:: 0 -I c::: Z <: z 0 0 !;( Z Z C 0 () ~ 0 a3 J: 0 Z a:: (i.j -I 0 Z U en 0 i= I c::: <{ 0 0 <{ 0 ::> ~ en z w ~ 0 Z Z c::: ~ en -I w Z w ::E () -I ~ Z <{ I- ::> ::l I- J: S C c::: z W -I -I Q 0 w z c::: en ~ w ~ () en -I I- -, Z c::: ::E ::E -I ~ ...J en <{ -I >- W W a3 <{ <: <{ <{ ::E 0 <{ ~ en <: <{ z 0 ::> ~ ~ <{ <{ w ::> ::l ~ Z 0 ~ <{ <{ -I -I ~ ::E :E ::E ::E ::E z 0 0 0 0 a.. a.. a:: a.. a.. en en en en en en en ::> > ~ ~ 8/15/01 '1'0 the Board of County Commissioners: T attended the discussion in Marc,h of this year about raising the cost of insurance to the County Employees. A compromise was met that was at least reasonable. The increase of premium deducted from my paycheck is going from $120 to $130 every two weeks, I had to take 5 hours of vacation time to attend that meeting but apparently that was for naught. Now the same discussion is happening again, I can't afford to take more vacation time to drive to Key Largo to protest what T have already protested. Now the proposal is to raise the contribution for family insurance to $160, I believe that I will be getting about a $30-$40 raise in October. So, if my insurance is $160 a pay period, I will probably be netting less per paycheck than I am now. Great incentive. I would like to protest that increase. The $10 a paycheck is enough. Don't hurt the employees that can lease afford that increase. The Commission has already voted on this issue. Please don't make it even worse. Sincerely, ~~nga~~6of-r Growth Management A./.:L