NEW MEXICO PUBLIC SCHOOLS INSURANCE AUTHORITY

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NEW MEXICO PUBLIC SCHOOLS INSURANCE AUTHORITY

• Benefits Program
• April 2009

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NMPSIA Today

• Benefits and Risk Programs covering
• Mandatory 88 Public School Districts
• Mandatory 74 Charter Schools
• Optional 24 Other Educational Entities
• 11 Staff Members

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COVERED EMPLOYEES
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Unrestricted cash balance(in millions)
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Past Medical Cost Containment

• PPO plans with negotiated fees administered by
  BCBS and Presbyterian
• Modifying behaviors through health management
  programs
• Encouraging appropriate care through plan design
  (i.e., 0 copay for preventive care and diabetes
  medications)
• Diabetes Pilot Program

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Past Plan Improvements

• PCP Copay 15
• Physical Therapy Copay 20
• Orthodontia maximum to 1,500
• Improved dental plan periodontal benefit
• 2/5 Generic drug Copay
• 0 Copay for formulary diabetic supplies,
  insulin, and oral medications

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Medical Premiums, Expenditures(in millions)
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Projected Trend vs. NMPSIA
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Use of Fund Balance in 2008(in millions)
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Observations on our expenses

• Preventive care utilization is fabulous
• Many large claims
• Long term investment losses
• Flat revenues for 2010

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Premiums October 2009

• Blue Cross Medical No Change
• Presbyterian Medical No Change
• UCCI Dental No Change
• Davis Vision No Change
• The Standard Life No Change
• The Standard LTD No Change

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No Choice But To Downsize

• JULY 1ST PLAN

• CURRENT PLAN

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Whats Everyone Else Like?

• Los Alamos Labs
• 250 deductible
• 90 coinsurance Preventive 80 In-Network
• 3,000 out of pocket plus deductible

• Colorado Public EEs
• Three PPO Plans
• 750 deductible
• 1500 deductible
• 3000 deductible
• 150 Rx deductible

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Whats Everyone Else Like?

• (CURRENT GSD)
• In-Network 100 Deductible
• 2,000 Out of Pocket
• PCP 15 No Deductible
• Specialist 25 No Deductible
• Diagnostic Testing 10 coinsurance
• Outpatient Hospital 150 plus 10

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Whats Everyone Else Like?

• (CURRENT APS)
• In-Network No Deductible
• 2,000 Out of Pocket
• PCP 20 copay
• Specialist 25 Copay
• Diagnostic testing 50copay for PET, MRI, CT
• Outpatient Hospital 100 copay

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Medicare Plan Design

• Part A (Hospital) deductibles
• 1,068 for a hospital stay of 1-60 days.
• 267 per day for days 61-90
• 534 per day for days 91-150 of a hospital stay
• All costs for each day beyond 150 days
• Part B (physician services, outpatient hospital
  services, certain home health services, durable
  medical equipment)
• 135 per year then 20

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What Will We Look Like?

• 300 In-Network Deductible
• Deductible waived for Preventive (still free) and
  office visits
• 80-20 coinsurance plus copays
• 2,800 Out of Pocket Limit per Calendar Year
  then plan pays 100

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What Will We Look Like?

• Rx Change
• Non-formulary (third tier) brand name drugs
  limited coverage since alternatives available
• Member charged 70 of discounted price
• Lunesta, approximately 54.00 for a quantity of
  15
• Ambien (zolpidem) would be a 2.00 copay

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Communication Campaign

• Newsletter
• Mailings with explanation of plan change
• New Program Guide
• PowerPoint for employee presentations
• Cost Estimator on Carrier websites

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Things to Stress

• Rich level of benefits not affordable in these
  economic times
• New plan very similar to plans we had in the
  1980s (the last time we had a recession)
• Plan still provides protection against
  catastrophic medical expenses

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TPA Updates from ERISA

• COBRA Subsidy
• Medicare Data Match requiring SSNs
• Online enrollment
• New NMPSIA website

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COBRA Subsidy

• Only Involuntary Termination Qualifies
• Position eliminated, Contract not renewed,
  Employee on medical leave not released to work
  after 1 year, Employer reduced hours of position
• 102 Premium Paid 35 by employee, 65 by
  employer effective 03/01/2009
• Employer takes credit on quarterly 941 report

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Medicare Data Match SSNs

• All members enrolled must have an SSN
• Non-U.S. Citizens over age 16 should have an SSN
  or ITIN number
• Non-U.S. Citizens under age 16 provide a copy of
  their government issued VISA to enter the U.S.
  until an SSN or ITIN is acquired
• Enrollments received without dependent SSN will
  delay that members effective date. (Do NOT hold
  forms for this information)

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Online Enrollment

• Encouraged for Employer Transactions
• Basic Life Enrollment
• Update EE and Dependent Information (like
  employee address or dependent SSN)
• Cancel All Enrollment
• Log on to districts.nmpsia.com and click on
  Online Enrollment
• Encouraged for Employee
• View and confirm enrollment
• Update address, phone or add email address
• Go to nmpsia.com Members tab and click on
  Employee Online Enrollment System

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Updated NMPSIA Website
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In Closing . . .

• Thanks!
• Questions?
• Comments?