2015 HEALTH CARE PRESENTATION JOINT CITY COUNCIL/SCHOOL BOARD MEETING March 4, 2014

Transcription

1 2015 HEALTH CARE PRESENTATION JOINT CITY COUNCIL/SCHOOL BOARD MEETING March 4, 2014

2 Agenda Trend Graph Health Care Cost Differential Cost Projections Assumptions Recommendations o Plan Design o Percentage o Defined Strategy o VB WellnessforLife o Health Savings Account Eligibility o Spouses o Retirees Next Steps 1

3 10-Year Status Quo Trend Graph Unsustainable Cost Increases without Plan Change The below chart illustrates the long-term impact of 6%, 7%, and 8% gross cost increases through 2024 Illustrates potential cost of maintaining status quo plan design With 8% annual increases, gross cost would double from 2015 to 2024 to over $300 million Gross plan cost includes projected excise tax per health care reform $350 Impact of 6% - 8% Annual Gross Cost Increase to Status Quo Plan $300 Gross Plan Cost (in millions) $250 $200 $150 $100 $50 6.0% Trend 7.0% Trend 8.0% Trend $

4 Historical Claims Trend for City and Schools January 2010 September 2013 The below chart illustrates monthly incurred claims for medical and pharmacy on a per employee basis Historical Per Employee Trends: 2010/2009: 10.3% 2011/2010: 6.4% 2012/2011: 10.5% YTD 2013/YTD 2012: 6.4% City and Schools Med+Rx Incurred Claims Experience $800 $700 $600 $500 $400 $300 $200 $100 $0 City PEPM School PEPM Combined PEPM 3

5 Health Care Differential $140.0 $120.0 $100.0 $80.0 in Millions $60.0 $40.0 $20.0 $0.0 -$20.0 FY05 FY06 FY07 FY08 FY09 FY10 FY11 FY12 FY13 Employee s $18.8 $19.7 $19.8 $19.6 $20.1 $20.6 $20.6 $21.0 $26.1 s $56.2 $63.6 $74.4 $81.6 $83.8 $86.9 $88.9 $86.0 $93.7 Health Fund Reserves Used $2.6 $0.0 $0.0 $0.0 $0.0 $0.8 $0.6 $12.0 $10.4 Total s $77.6 $83.3 $94.2 $101.2 $103.9 $108.3 $110.1 $119.0 $130.2 Note: The health plan is managed on a calendar year basis, but the figures shown are from fiscal year reporting; therefore total contributions will not be consistent with plan year costs previously provided. 4

6 2015 Status Quo Projection Gross Cost Projection Prior to Strategy Changes 2015 Expense Estimate Total Annual (millions) Projected 2015 Incurred Claims Before Plan Changes $134.2 Required Plan and Eligibility Changes from Healthcare Reform $3.6 Estimated Limited Spousal Coverage Membership Reduction ($0.9) Administrative Services Fees and Stop Loss Premiums $7.6 Health Care Reform Fees $1.1 Additional Administrative Expenses $1.6 GASB 45 Annual Required $4.0 Projected Gross 2015 Status Quo Cost $

7 2015 Plan and Rate Considerations Side-by-Side Cost Comparison Projected 2015 Status Original Quo Projection 1 Recommendation 1 Revised Recommendation 1 Projected Gross Cost $138.6 $151.2 $142.9 $145.4 Estimated Employee s ($27.5) ($30.0) ($37.4) ($33.1) Projected Net Cost $111.1 $121.2 $105.5 $112.3 Projected Cost Share 80% 80% 74% 77% Net Change from 2014 N/A $10.1 ($5.6) $1.2 Net Cost Avoidance from Status Quo N/A N/A ($15.7) ($8.9) 1 Amounts shown in millions 6

8 2015 Plan and Rate Considerations Assumptions Enrollment o Constant enrollment by tier from January 2014 o Approximately 10% of employees elect the PPO, 45% elect the Plus PPO, and 45% elect the POS Plan Design o Health care reform plan change that requires pharmacy copays apply to the medical out-of-pocket maximum o All plans will continue to cover: chiropractic, hearing aid, and routine eye care o All plans will no longer cover: infertility treatment, bariatric surgery, child dependent OB o Plus PPO option modified to a non-qualified HSA plan to allow embedded deductibles and to remove the deductible requirement for pharmacy copays Costs o Status quo 2015 projection based on December 2013 experience update with enrollment through January 2014 o Assumes 5% reduction in spousal membership due to limited spousal coverage o Assumes 200 part-time employees will elect coverage in 2015 due to HCR eligibility requirements o Projections assume 8.0% status quo claims trend for 2015 based on Mercer trend guidelines and historical Virginia Beach experience o Assumes 100% participation in VB WellnessforLife. Non-participants will pay an additional $500 o One-time Health Savings Account contribution of $500 to the PPO plan upon enrollment in Not included in rate setting, but rather paid as a separate cost from health fund. Cost dependent upon migration to PPO plan. Assume 10% enrollment or approximately $0.8M. o Rates will be updated with additional claims and enrollment experience, revised healthcare reform impact, GASB costs, and administrative expenses before final rate setting 7

9 Comparison of Original and Revised Recommendation Plan Design Considerations (In-Network Benefits) Original Recommendation Revised Recommendation POS Plus PPO PPO POS Plus PPO PPO Deductibles $500/$1500 $1,500/$3,000 $3,000/$6,000 $500/$1500 $1,000/$2,000 $1,500/$3,000 (embedded) (non-embedded) HSA Funding N/A N/A $500** N/A N/A $500** Out of Pocket Max $2,500/$5,000 $4,000/$8,000 $5,000/$10,000 $2,500/$5,000 $3,000/$6,000 $3,500/$7,000 PCP Visit $20/100%* 10% Coinsurance 20% Coinsurance $20/100%* 15% Coinsurance 20% Coinsurance Preventive Visit 100%* 100%* 100%* 100%* 100%* 100%* Specialist Visit $40/100%* 10% Coinsurance 20% Coinsurance $40/100%* 15% Coinsurance 20% Coinsurance Diagnostic (X-ray, blood work) 10% Coinsurance 10% Coinsurance 20% Coinsurance 10% Coinsurance 15% Coinsurance 20% Coinsurance Imaging (CT/PET, MRI) 10% Coinsurance 10% Coinsurance 20% Coinsurance 10% Coinsurance 15% Coinsurance 20% Coinsurance Inpatient Hospital 10% Coinsurance 10% Coinsurance 20% Coinsurance 10% Coinsurance 15% Coinsurance 20% Coinsurance Outpatient Surgery 10% Coinsurance 10% Coinsurance 20% Coinsurance 10% Coinsurance 15% Coinsurance 20% Coinsurance Maternity Care $350 Copay* 10% Coinsurance 20% Coinsurance $350 Copay* 15% Coinsurance 20% Coinsurance Pharmacy*** After Deductible: After Deductible: After Deductible: Preferred $15* $15 $15 $15* $15* $15 Standard $30* $30 $30 $30* $30* $30 Premium 25% (min $45, 25% (min $45, 25% (min $45, 25% (min $45, 25% (min $45, 25% (min $45, max $60)* max $60) max $60) max $60)* max $60)* max $60) Premium Plus 50% (min $60, 50% (min $60, 50% (min $60, 50% (min $60, 50% (min $60, 50% (min $60, max $110)* max $110) max $110) max $110)* max $110)* max $110) * Deductible does not apply to this service ** PPO $500 HSA contribution offered first plan year only *** Pharmacy copays do not assume participation in the preferred network 8

10 Comparison of 2014 Plans and Revised Recommendation Plan Design Considerations (In-Network Benefits) 2014 Plans 2015 Revised Plans POS HDHP POS Plus PPO PPO Deductibles $300/$600 $1,250/$2,500 $500/$1500 $1,000/$2,000 $1,500/$3,000 (non-embedded) (non-embedded) HSA Funding N/A $500/$500 N/A N/A $500** Out of Pocket Max $1,500/$3,000 $6,250/$12,500 $2,500/$5,000 $3,000/$6,000 $3,500/$7,000 PCP Visit $20/100%* 30% Coinsurance $20/100%* 15% Coinsurance 20% Coinsurance Preventive Visit 100% 100% 100%* 100%* 100%* Specialist Visit $40/100%* 30% Coinsurance $40/100%* 15% Coinsurance 20% Coinsurance Diagnostic (X-ray, blood work) $40/100% 30% Coinsurance 10% Coinsurance 15% Coinsurance 20% Coinsurance Imaging (CT/PET, MRI) $150/100% 30% Coinsurance 10% Coinsurance 15% Coinsurance 20% Coinsurance Inpatient Hospital $500/100% 30% Coinsurance 10% Coinsurance 15% Coinsurance 20% Coinsurance Outpatient Surgery $250/100% 30% Coinsurance 10% Coinsurance 15% Coinsurance 20% Coinsurance Maternity Care $40 OB Confirm/$200 global then 100% 30% Coinsurance $350 Copay* 15% Coinsurance 20% Coinsurance Pharmacy*** After Deductible: After Deductible: Preferred $15 $15 $15* $15* $15 Standard $30 $30 $30* $30* $30 Premium 25% (min $45, 25% (min $45, 25% (min $45, 25% (min $45, 25% (min $45, Premium Plus max $60) 50% (min $60, max $110) max $60) 50% (min $60, max $110) max $60)* 50% (min $60, max $110)* max $60)* 50% (min $60, max $110)* max $60) 50% (min $60, max $110) * Deductible does not apply to this service ** PPO $500 HSA contribution offered first plan year only *** Pharmacy copays do not assume participation in the preferred network 9

11 2015 Scenario Comparison Active Employee Cost Impact The below chart illustrates the combined monthly employee contribution plus expected out-of-pocket costs based on cost and utilization assumptions Active employees are roughly 40% low, 45% moderate, 15% high utilizers, based on 2012 Optima report Utilization scenarios are illustrative; actual utilization varies greatly among individuals Note: High utilizers illustrate the out-of-pocket maximum for all Original and Revised plans $14,000 Active Employee Annual Cost Employee Only Family Total Employee Cost (Premium + OOP) $12,000 $10,000 $8,000 $6,000 $4,000 $2,000 Status Quo POS Revised POS Revised Plus PPO Revised PPO with one-time HSA $0 Low Moderate High Low Moderate High Utilization Considerations: Low utilizers benefit from reduced monthly contributions of lower cost plans Employee Only high utilizers see large percentage cost increase 10

12 Comparison of Original and Revised Recommendation 2015 Active POS/Plus PPO/PPO Projected Monthly Rates and s Original Projected 2015 Active School and City POS Rates ($500/$1,500 Deductible) Employee Revised Projected 2015 Active School and City POS Rates ($500/$1,500 Deductible) Employee Change from Original Proposal Employee Only $ $ $ Employee Only $ $ $92.33 ($42.57) Employee & Child $ $ $ Employee & Child $ $ $ ($65.13) Employee & Children $1, $ $ Employee & Children $1, $ $ ($95.05) Employee & Spouse $1, $ $ Employee & Spouse $1, $ $ ($81.33) Family $1, $1, $ Family $1, $1, $ ($115.24) Original Projected 2015 Active School and City Plus PPO Rates ($1,500/$3,000 Deductible) Employee Revised Projected 2015 Active School and City Plus PPO Rates ($1,000/$2,000 Deductible) Employee Change from Original Proposal Employee Only $ $ $81.98 Employee Only $ $ $61.74 ($20.24) Employee & Child $ $ $ Employee & Child $ $ $ ($28.94) Employee & Children $1, $ $ Employee & Children $1, $ $ ($40.50) Employee & Spouse $1, $ $ Employee & Spouse $1, $ $ ($29.25) Family $1, $1, $ Family $1, $1, $ ($42.34) Original Projected 2015 Active School and City PPO Rates ($3,000/$6,000 Deductible) Employee Revised Projected 2015 Active School and City PPO Rates ($1,500/$3,000 Deductible) Employee Change from Original Proposal Employee Only $ $ $12.07 Employee Only $ $ $13.16 $1.09 Employee & Child $ $ $61.93 Employee & Child $ $ $67.53 $5.60 Employee & Children $ $ $ Employee & Children $1, $ $ $11.59 Employee & Spouse $ $ $ Employee & Spouse $1, $ $ $20.46 Family $1, $1, $ Family $1, $1, $ $27.25 * Defined employer contribution set at 97% of employee PPO cost, 80% of child dependent PPO cost, and 60% of spouse PPO cost All presented rates are subject to change and were developed with data through September

13 Revised Recommendation 2015 Active POS/Plus PPO/PPO Projected Monthly Rates and s Projected 2015 Active School and City POS Rates ($500/$1,500 Deductible) Employee Change from 2014 POS Rates ($300/$600 Deductible) 2014 POS Employee Employee Change from 2014 POS % $ Employee Only $ $ $92.33 $ % $43.27 Employee & Child $ $ $ $ % $69.96 Employee & Children $1, $ $ $ % ($3.71) Employee & Spouse $1, $ $ $ % $ Family $1, $1, $ $ % $4.91 Projected 2015 Active School and City Plus PPO Rates ($1,000/$2,000 Deductible) Employee Change from 2014 POS Rates ($300/$600 Deductible) 2014 POS Employee Employee Change from 2014 POS % $ Employee Only $ $ $61.74 $ % $12.68 Employee & Child $ $ $ $ % $20.42 Employee & Children $1, $ $ $ % ($78.41) Employee & Spouse $1, $ $ $ % $56.39 Family $1, $1, $ $ % ($94.90) Projected 2015 Active School and City PPO Rates ($1,500/$3,000 Deductible) Employee Change from 2014 POS Rates ($300/$600 Deductible) 2014 POS Employee Employee Change from 2014 POS % $ Employee Only $ $ $13.16 $ % ($35.90) Employee & Child $ $ $67.53 $ % ($58.27) Employee & Children $1, $ $ $ % ($197.05) Employee & Spouse $1, $ $ $ % ($56.87) Family $1, $1, $ $ % ($253.44) 12

14 Comparison of Original and Revised Recommendation 2015 Non-Medicare Eligible Retiree POS/Plus PPO/PPO Projected Monthly Rates and s Original Projected 2015 Retiree School and City POS Rates ($500/$1,500 Deductible) Revised Projected 2015 Retiree School and City POS Rates ($500/$1,500 Deductible) Change from Original Proposal Retiree Retiree Retiree Only $ $ $ Retiree Only $ $ $ ($55.74) Retiree & Child $1, $ $ Retiree & Child $1, $ $ ($78.34) Retiree & Children $1, $ $ Retiree & Children $1, $1, $ ($108.47) Retiree & Spouse $1, $ $ Retiree & Spouse $1, $1, $ ($109.17) Family $2, $1, $ Family $2, $1, $ ($143.32) Original Projected 2015 Retiree School and City Plus PPO Rates ($1,500/$3,000 Deductible) Revised Projected 2015 Retiree School and City Plus PPO Rates ($1,000/$2,000 Deductible) Change from Original Proposal Retiree Retiree Retiree Only $ $ $ Retiree Only $ $ $ ($24.91) Retiree & Child $ $ $ Retiree & Child $ $ $ ($33.64) Retiree & Children $1, $ $ Retiree & Children $1, $1, $ ($45.27) Retiree & Spouse $1, $ $ Retiree & Spouse $1, $1, $ ($37.34) Family $1, $1, $ Family $2, $1, $ ($50.52) Original Projected 2015 Retiree School and City PPO Rates ($3,000/$6,000 Deductible) Revised Projected 2015 Retiree School and City PPO Rates ($1,500/$3,000 Deductible) Change from Original Proposal Retiree Retiree Retiree Only $ $ $49.96 Retiree Only $ $ $54.48 $4.52 Retiree & Child $ $ $99.93 Retiree & Child $ $ $ $9.04 Retiree & Children $1, $ $ Retiree & Children $1, $1, $ $15.06 Retiree & Spouse $1, $ $ Retiree & Spouse $1, $1, $ $31.24 Family $1, $1, $ Family $1, $1, $ $38.07 * Defined employer contribution set at 91% of retiree PPO cost, 80% of child dependent PPO cost, and 60% of spouse PPO cost All presented rates are subject to change and were developed with data through September

15 Revised Recommendation 2015 Non-Medicare Eligible Retiree POS/Plus PPO/PPO Projected Monthly Rates and s Projected 2015 Retiree School and City POS Rates ($500/$1,500 Deductible) Retiree Change from 2014 POS Rates ($300/$600 Deductible) 2014 POS Retiree Retiree Change from 2014 POS % $ Retiree Only $ $ $ $ % $ Retiree & Child $1, $ $ $ % $ Retiree & Children $1, $1, $ $ % $10.25 Retiree & Spouse $1, $1, $ $ % $ Family $2, $1, $ $ % $ Projected 2015 Retiree School and City Plus PPO Rates ($1,000/$2,000 Deductible) Retiree Change from 2014 POS Rates ($300/$600 Deductible) 2014 POS Retiree Retiree Change from 2014 POS % $ Retiree Only $ $ $ $ % $72.47 Retiree & Child $ $ $ $ % $64.38 Retiree & Children $1, $1, $ $ % ($76.27) Retiree & Spouse $1, $1, $ $ % $ Family $2, $1, $ $ % $20.30 Projected 2015 Retiree School and City PPO Rates ($1,500/$3,000 Deductible) Retiree Change from 2014 POS Rates ($300/$600 Deductible) 2014 POS Retiree Retiree Change from 2014 POS % $ Retiree Only $ $ $54.48 $ % $5.42 Retiree & Child $ $ $ $ % ($32.83) Retiree & Children $1, $1, $ $ % ($213.71) Retiree & Spouse $1, $1, $ $ % ($30.18) Family $1, $1, $ $ % ($181.50) 14

16 2015 Plan Design Changes VB WellnessforLife All scenarios assume 100% participation in VB WellnessforLife o Those who elect not to participate will pay an additional $500 for their health coverage as they are not engaging in activities which help reduce their health risks and control the cost of the health plan Services Covered All scenarios assume the following coverage: o All plans will continue to cover: chiropractic, hearing aid, routine eye care o All plans will no longer cover: infertility treatment, bariatric surgery, child dependent OB HSA A $500 one-time employer payment into a Health Savings Account for employees/retirees that elect the PPO plan during open enrollment for the 2015 plan year. Will not be provided for new hires or open enrollment thereafter. 15

17 Changes in Eligibility Spouse Eligibility Effective January 1, 2015, spouses would not be permitted enrollment on city health coverage if have access to other employer coverage. Estimates shown for 5%, 10% and 15% reduction in covered spouses. 2,494 active employee spouses are enrolled as of January Percent of Spouses Leave Plan Number of Spouses Leave Plan Estimated Net Savings 5% 125 $ 530,000 10% 250 $ 1,050,000 15% 375 $ 1,580,000 Retiree Eligibility Effective July 1, 2014, no new employees hired on or after July 1, 2014 would be eligible for an employer contribution towards retiree health care. Employees hired on or after July 1, 2014 who have at least 15 years of service with the City and/or Schools upon retirement may continue to stay on the City and Schools health plan offering, but the retiree would be responsible for 100% of the premium cost. 16

18 Next Steps Decision Points City Council/School Board Direction o Plan Offerings o Percentage o Strategy o VB WellnessforLife o Health Savings Account o Eligibility Spouses Future Retiree Coverage Next Steps March GASB Valuation April Rate Setting (Benefits Executive Committee) o Set rates after obtaining GASB valuation and two months of 2014 claims experience o Employee premiums will be established by determining plan costs and applying contribution scenario selected May-October Health Plan Education/Marketing (Consolidated Benefits Office) 17

19 Important Notice with Respect to Projections Contained in this Document All projections are based on the information and data available at a point in time and the projections are not a guarantee of results which might be achieved. The projections are subject to unforeseen and random events and so must be interpreted as having a potentially wide range of variability from the estimates. The information contained in this document and in any attachments is not intended by Mercer to be used, and it cannot be used, for the purpose of avoiding penalties under the Internal Revenue Code or imposed by any legislative body on the taxpayer or plan sponsor. 18