Item C30 C30
BOARD OF COUNTY COMMISSIONERS
COUNTY of MONROE �� i Mayor Holly Merrill Raschein,District 5
The Florida Keys Mayor Pro Tern James K.Scholl,District 3
Craig Cates,District 1
Michelle Lincoln,District 2
' David Rice,District 4
Board of County Commissioners Meeting
July 17, 2024
Agenda Item Number: C30
2023-2258
BULK ITEM: Yes DEPARTMENT: Employee Services
TIME APPROXIMATE: STAFF CONTACT: Natalie Maddox
N/A
AGENDA ITEM WORDING: Approval of a Resolution Revising Health Plan Design for Active and
Retired participants; lowering maximum out-of-pocket threshold; lowering the cost share (co-insurance)
percentages; setting maximum specialist office visit co-pays for physical, occupational, chiropractic
therapies, and obstetric services; and establishing an effective date. Also, authorization for the
Employee Services Director and/or the County Administrator to sign/execute any necessary
document(s)with service providers to effect these changes.
ITEM BACKGROUND:
The Monroe County Group Health Plans, Monroe County's medical insurance, are self-insured.
Employees are eligible to participate if they are full-time employees working a minimum of 25 or more
hours per week. Retirees and dependents are also eligible to participate.
The County recognizes the need to provide an array of competitive benefits to attract and retain
employees. Staff directed the County's benefits consultant, Gallagher, to assist in comparing the
County's current plans and rates against the plans of local entities to evaluate plan design and
competitiveness. It was found that the County's plan is non-competitive in a few key areas. Plan
changes recommended include: lowering the maximum out-of-pocket thresholds; lowering the
employee cost share (co-insurance)percentages; setting the specialist office visit co-pay equal to the
primary care physician co-pay for physical therapy, occupational therapy, chiropractic therapy, and
obstetric services; and establishing an effective date.
PREVIOUS RELEVANT BOCC ACTION:
October 2011: BOCC approved a three-year agreement with Blue Cross & Blue Shield of Florida.
October 2015: Board granted approval of the Amendment to Administrative Services Agreement with
Blue Cross and Blue Shield of Florida (BCBSF) effective November 1, 2015.
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December 2017: Board granted approval to advertise a Request for Proposals for Fully Insured
Medical Plans (without Pharmacy Benefits), including Claims Administration, Case Management and
Utilization Review Services, Disease Management(DM),Network Management, Wellness Programs,
and other Related Services.
February 2018: Board adopted the following Resolution of the Board of County Commissioners of
Monroe County, Florida approving and establishing the 2018 Wellness Program which includes health
and wellness events (lunch and learns, health and wellness fairs, exercise and nutrition classes), Health
Designs, Inc./Wellness Consultant, wellness exam and age-appropriate screenings with a participation
incentive that now includes a tobacco cessation plan, community organized event reimbursement
(walks, runs, bikes, swims), and purchases of related goods (gym equipment and sit-stand
workstations); and approval of the 2018 Wellness expenditures which are consistent with the items
described in the 2018 Wellness Program.
June 2018: Board granted approval to renew and authorized execution of the Administrative Services
Agreement for five years with Florida Blue to continue providing Claims Administration, Case
Management and Utilization Review Services, Disease Management,Network Management, Wellness
Programs and other Related Services to Monroe County.
September 2018: Board granted approval and authorized execution of an Amendment extending the
Administrative Services Agreement with Florida Blue in the amount of approximately $4.5 million for
five years (beginning January 1, 2019 through December 31, 2023), with approximately $830,625.00 in
2019, to continue providing Claims Administration, Case Management and Utilization Review
Services, Disease Management,Network Management, Wellness Programs and other Related Services
to Monroe County.
July 2023: Board granted approval and authorized execution of a 4th Amendment to the
Administrative Services Agreement with Florida Blue, in the amount of approximately $4.1 million
dollars, and extending the term of the Agreement by five years, to cover January 1, 2024 through
December 31, 2028, to continue providing Claims Administration, Case Management and Utilization
Review Services, Disease Management,Network Management, Wellness Programs and other Related
Services to Monroe County.
INSURANCE REQUIRED:
No
CONTRACT/AGREEMENT CHANGES:
N/A
STAFF RECOMMENDATION: Approval.
DOCUMENTATION:
07.17.2024_Resolution_plan_design_Final.pdf
FINANCIAL IMPACT:
Fund: 502 - Group Insurance; Cost Center: 08002 - Group Insurance Operations
Effective Date: 01/01/2025
Expiration Date:12/31/2028
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Total Dollar Value of Contract: N/A
Total Additional Cost to County: Approximately $ 901,749.00 Annually
Current Year Portion: N/A
Budgeted: Yes
Source of Funds: Primarily Ad Valorem
CPI: N/A
Indirect Costs: N/A
Estimated Ongoing Costs Not Included in the dollar amounts: N/A
Revenue Producing: N/A
Grant: N/A
County Match: N/A
Insurance Required: Yes
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I 4Y
l
I
RESOLUTION NO. 2024
A RESOLUTION OF THE MONROE COUNTY BOARD OF
COUNTY COMMISSIONERS REVISING MONROE COUNTY
HEALTH PLAN DESIGN; LOWERING MAXIMUM OUT-OF-
POCKET THRESHOLDS; LOWERING THE COST SHARE
(COINSURANCE) PERCENTAGES; SETTING MAXIMUM
SPECIALIST OFFICE VISIT CO-PAYS FOR PHYSICAL AND
OCCUPATIONAL THERAPY, CHIROPRACTIC THERAPY,
AND OBSTETRIC SERVICES; AND ESTABLISHING AN
EFFECTIVE DATE.
WHEREAS, Monroe County Board of County Commissioners ("BOCC") is the plan
administrator for the health plan providing medical benefits for active and retired employees of
Monroe County, the Monroe County Land Authority, and the constitutional officers; and
WHEREAS, Monroe County desires to make certain changes to its health plan design, in
order to deliver the most cost-effective medical and prescription coverage; and
WHEREAS, the County desires to lower the maximum out-of-pocket thresholds for
the Traditional Plans and High Deductible Health Plans ("HDHP"); and
WHEREAS, the County desires to lower the member cost share (coinsurance) in the
Traditional Plans to match the member share in the HDHPs; and
WHEREAS, the County desires to lower specialist office visit co-pays for physical
and occupational therapy, chiropractic and obstetric services office visits in the Traditional
Plans, creating a specialist office visit carve-out for these three categories; and
WHEREAS, the County wishes for these changes to take effect for the plan year
beginning January 1, 2025.
NOW THEREFORE, BE IT RESOLVED BY THE BOARD OF COUNTY
COMMISSIONERS OF MONROE COUNTY, FLORIDA,
Section 1. The recitals above are hereby adopted and incorporated in this Resolution.
Section 2. Plans 03559 and 03769 (Traditional Plans)will be amended to lower the maximum
out-of-pocket thresholds for each plan year. from $7,150 per person/$14,300 family aggregate, to
$5,000 single coverage/$10,000 family coverage.
1
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Section 3. Plans 05182 and 05183 (High Deductible Plans) will be amended to lower the
maximum out-of-pocket thresholds from $6,650 per person/$13,300 family aggregate, to $4,000
single coverage/$8,000 family coverage.
Section 4. In Plans 03559 and 03769 (Traditional Plans), the cost share (coinsurance) will be
amended, to lower the member responsibility from 25% to 20% for in-network services, and from
55%to 50% for out-of-network services.
Section 5. In Plans 03559 and 03769 (Traditional Plans), specialist office visit co-pay for
Physical & Occupational Therapy, Chiropractic Therapy, and Obstetric Services will be reduced to
$30.00 per visit.
Section 6. The above changes to plan design for the Monroe County health plan shall take
effect on January 1, 2025.
PASSED AND ADOPTED by the Board of County Commissioners of Monroe County,
Florida, at a regular meeting held on the 17th day of July, 2024.
Mayor Holly Merrill Raschein
Mayor Pro Tem James K. Scholl
Commissioner Craig Cates
Commissioner Michelle Lincoln
Commissioner David Rice
(SEAL)
BOARD OF COUNTY COMMISSIONERS
Attest: KEVIN MADOK, CLERK OF MONROE COUNTY, FLORIDA
BY: BY:
As Deputy Clerk Holly Merrill Raschein, Mayor
Approved as to form and legal sufficiency:
Monroe County Attorney's Office
Date: 7-1-2024
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1523
Liz Yongue
From: Shillinger-Bob <Shillinger-Bob@ Mon roeCounty-FL.Gov>
Sent: Friday, July 12, 2024 2:18 PM
To: Shillinger-Bob
Cc: Wilson-Kevin; Gastesi-Roman; Cook-Bryan; Gomez-Krystal; Ballard-Lindsey; Kevin
Madok; Liz Yongue
Subject: Request to Postpone Items C30 and C49
Attachments: Request to Postpone Agenda Items C30 and C49 on 17 July 2024 agenda.pdf
Follow Up Flag: Follow up
Flag Status: Flagged
Mayor&Commissioners (via blind copy):
Attached please find a request to postpone items C30 and C49 on next Wednesday's (7/17) agenda form Commissioner
Cates.
1 10RI4)
� Bob Shillinger
n County Attorney
,may Monroe County Attorney's Office
1111 12th Street, Suite 408
_
SM cEBT���w4 Key West, FL 33040
(305)292-3470
CITY,COUNTY (305)292-3516 (facsimile)
&LOCAL
GOVERNMENT LAW
Note, Florida has a broad public records law. Any information you send to this address, including your
contact information, may be subject to public disclosure.
i
W. BOARD OF COUNTY COMMISSIONERS
County of Monroe �� � !����YY����JJII °� Mayor Holly Merrill Raschein,District 5
The Florida Keys Mayor Pro Tem James K.Scholl,District 3
�ya' Craig Cates,District 1
Michelle Lincoln,District 2
_ ,.
David Rice,District 4
July 12, 2024
To whom it may concern:
I am writing this letter to ask that the Monroe County Board of County Commissioners postpone
July's agenda items C30 and C49 until after the 2025 budget has been discussed and analyzed by the
board and employees. In doing so, I believe this will help us to make a more informed decision for both
County employees and the tax paying citizens of Monroe County. I appreciate your consideration.
Sincerely,
411
Craig Cates
Monroe County Commissioner
District 1
305-587-0587
BoccdlsI(c onroecount - oy
Employee Benefits:
2025 Proposed Benefit Changes (C30)
& Rate Adjustments (C49)
* History
* Current Issues
* Proposed Plan & Rate Adjustments
p
A collaborative presentation by Monroe County Employee Benefits ;
and Gallagher Benefits Services, Monroe County's Benefits Consultants. Gallagher
'r,. r':J N (.Fc Y+ricn Vi w4 N1nn,mtiJLL v@ Cc�r.^,�rl1i[rq
Current Issues
• Some plan coverages and costs are not competitive in the local public sector
employment market (C30):
1. Post-deductible Cost Share: 75% County/25% Employee
2. Obstetrics, Chiropractic, Physical and Occupation Therapy: $ 50 Copay
3. Maximum Out of Pocket Costs Set High:
* Traditional Plan: $ 7,150 Single and $ 14,300 Family
* High Deductible w/Health Savings Acct: $ 6,650 and $ 13,300 Family
• Three Tiers of Employee and Dependent rates (C49):
1. Employees Hired Prior to 5/1/2012
2. Employees Hired between 5/1/2012 and 1/1/2018
3. Employees Hired Since 1/1/2018
• For post-2018 hires, dependent rates are variable from year to year
• Many tiers of rates exist for many dependent coverage scenarios
Some plan coverages and costs are not competitive (C30)
Proposed Plan Adjustment:
1. Post-deductible Cost Share (Traditional Plan): 75% County/25% Employee
Proposal: Change % Co my/ % Employee
2. Traditional Plan OBGYN, Chiropractic, Physical & Occupational Therapy:
$50 Co-pay
Proposal: Change Co-pay to (same as primary care visit co-pay)
3. Maximum Out of Pocket costs set high:
Traditional Plan: $7,150 Single/$14,300 Family
Proposal: $5,000 Single/$10,000Family
High Deductible/Health Savings Acct: $6,650 Single/$13,300 Family
Proposal: $4,000 Sin e/$ , Family
*Applicablet active/retired employees, and dependents
Estimated 2025 Plan Enhancement Costs
(00)
Cast
Description of Plan Change Impact
Once the Traditional PPO deductible is met, employees pay 20% of balance vs. 25% $303,682
The maximum out-of-pocket cost for the Traditional PPO reduces to $5,000 for single
coverage and $10,OOO for family coverage from $7,150/ $14,300 $335,354
The maximum out-of-pocket cost for the HDHP/ HSA reduces to $4,000 for single
coverage and $B4OOOfor family coverage from $6,650/ $13,300 $197,505
Traditional PPO: Change the office copay on specialist office visits for specific specialities:
Chiropractic: change from $50 to $30 (matching the PCP office copay) $29,809
Physical & Occupational Therapy: Change from $ 50 to $30 $33,535
OBGYN: Change from $50 to $ 30 $1,863
Projected Impact of All Changes $901,749
Issue:
Three tiers of employee and dependent rates (C49)
Current rate tiers:
1. Employees hired prior to 5/1/2012
2. Employees hired between 5/1/2012 and 1/1/2018
3. Employees hired since 1/1/2018
Proposal : Remove rate system based on hire date and
change to one rate structure for all employees and
dependents. This is also applicable to retiree dependent
coverage cost.
s
Many tiers of rates exist for various dependent coverage scenarios (C49)
Current dependent rate structure issue:
Overly complex tier rates exist for dependent coverage scenarios:
1. Employee
2. Employee, + Spouse/Domestic Partner
3. Employee, Spouse/Domestic Partner, + Child
4. Employee, Spouse/Domestic Partner, + 2 or more Children
5. Employee, + 1 Child
6. Employee, + 2 Children
7. Employee, + 3 Children
8. Employee, + 4 Children
9. Employee, + 5 Children
*Rates for these options, times two (2), due to varied rates based on hire date
Proposal: Reduce the rate scenarios from 9 to 4:
1. Employee
2. Employee, + Spouse/ o estic Partner
3. Employee, + Cil (ren)
4. Employee, + Spouse, and Children)
�a
Example: Employee A-hired prior to 2012
Employee 6-hired after 2018 *Salary of $43,000
. w
a
2017 2018 2019 2020 2021 2022 2023 2024 2025'
Employee A hired prior to 2012-Salary$43,000 $ 1,653.85 $ 1,720.00 $ 1,756.12 $ 1,826.36 $ 1,826.36 $ 1,917.68 $ 2,090.27 $ 2,236.59 $ 2,348.42
EmployeeA Health Care Premium $ 278.00 $ 278.00 $ 278.00 $ 278.00 $ 278.00 $ 278.00 $ 278.00 $ 350.00
2017 2018 2019 2020 2021 2022 2023 2024 2025'
Employee B hired after 2018-Salary$43,000 $ 1,720.00 $ 1,756.12 $ 1,826.36 $ 1,826.36 $ 1,917.68 $ 2,090.27 $ 2,236.59 $ 2,348.42
Employee B Health Care Premium $ 373.00 $ 373.00 $ 428.00 $ 428.00 $ 448.00 $ 500.00 $ 500.00 $ 350.00
*Amounts in example are per pay period
7
Proposed 2025 Active Employee Rates (C49)
Proposed 2025 Active Employee & Dependent Rates
High Deductible/Health
Traditional Plan Savings Account
(HDHP/HSA)
Monroe County Board of County Commissioners
BiWeekly Rate BiWeekly Rate
EMPLOYEE AND DEPENDENT MEDICAL/RX PREMIUMS EFFECTIVE 1/1/25
Employee Only
$35 $0
Employee,+ Child(ren) Only $150 $100
Employee,+ Spouse Only $200 $135
Employee, Spouse, + Child(ren) (Family) $350 $235
Proposed 2025 Active Employee Rates and Impact
(C49)
Current 26-Pay Rate Change in 26-Pay Rate
Current Longer Shorter Longer Shorter
Plan Tier Proposed Tier, Service Service Proposed Service Service'
Traditional PPO EE Employee Only $23 $35 $35 $12 $0
ES Employee +Spouse $199 $357 $200 $1 ($157)
E1C Employee +Child(ren) $101 $178 $150 $49 ($28)
E2C Employee +Child(ren) $180 $321 $150 ($30) ($171)
EK Employee +Child(ren) $258 $465 $150 ($108) ($315)
E4C Employee +Child(ren) $337 $608 $150 ($187) ( 458)
E5C Employee +Child(ren) $415 $751 $150 ($265) ($601)
ES1C Employee +Family $278 $500 $350 $72 ($150)
ES2C lEmployee +Family $395 $715 $350 ( 45) ($365)
High Deductible Health EE Employee Only $0 $0 $0 $0 $0
Plan (HDHP)/HSA ES Employee +Spouse $138 $270 $135 ($3) ($135)
E1C Employee +Child(ren) $61 $120 $100 $39 ($20)
E2C Employee +Child(ren) $122 $240 $100 ($22) ($140)
EX Employee +Child(ren) $184 $360 $100 ($84) ($260)
E4C Employee +Child(ren) $246 $479 $100 ($146) ($379)
E5C Employee +Child(ren) $307 $599 $100 ($207) ($499)
ES1C Employee +Family $199 $389 $235 $36 ($154)
ES2C Employee +Family $291 $569 $235 ($56) ($334)
2025 Proposed Rule of 70 Retiree Rate Adjustments
(C49)
Rule of 70 Retirees:
1. Rule of 70 Retirees with 10 — 24 years of service, not Medicare Eligible, have variable rates and
increase each year.
Proposal: Remove variable determination of rates and adopt current rates which have been in
place for 2 years (lock in rates).
2. Rule of 70 Retirees Medicare Eligible but remain on the County Plan have a variable rate and
increase each year.
Proposal: Adopt current rate, which have been in place for 2 years, and remove
variable determination of rates from the process.
Adopt Rule of 70 Retiree Traditional Plan — Medicare Eligible: $6 0
(Net After County Retiree Subsidy of$250 is applied.)
3. The BOCC adopted that rates for Rule of 70 Retirees with 25 — 30 Years of Service would be based
on the Florida Retirement System (FRS) allowance for health insurance subsidy. The FRS has
changed the allowance from $5.00 for each year of creditable service to $7.50.
Proposal: Adopt the FRS $7.50 per year of service as the rate for Rule of
70 Retirees with 25 — 30 Years of Service.
1..0
Estimated 2025 Rate Adjustments (C49 )
Active Employee Contribution Changes $1,715,510
Retiree Contribution Changes )
Total Cost to Board $1,665,181
*Retiree changes are the result of adopting the Florida
Retirement System Health Insurance subsidy change from
$5 to $7.50, per year of creditable service
Estimated 2025 Total Projected Impact
(C30 & C49)
Active Employee Contribution Changes $1,715,510
Benefit Plan Changes $901,749
Retiree Contribution Changes )
Total Cost to Board $2,566,930
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Questions ?
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