HEALTH CARE

1
HEALTH CARE

• Whats in Store for 2009?

2
Agenda

• Then is Now
• Background Renewal
• Capital University Survey
• Deductibles for 2009
• Co-insurance Out-of-pocket maximums
• Prescriptions
• Premium shares
• Spousal/Domestic Partner Waivers

3
Whats in Store for Future?

• Reevaluate employee/employer premium share ratio
  now that we are at 10
• Further reduce premium share levels
• Audit claims and enrollment
• Bid out business for 2009
• Continue Wellness Initiatives
• Look at introducing co-insurance
• Look at spousal coverage

4
Background

• Utilization
• Current Economic picture
• Demographics
• Average age 53.4 years
• 173 members over 65

5
Renewals Active Plan - 2009

• Kaiser 2.1
• MMO - Low 40s
• 23.11 initial renewal
• 21.39 after meeting with MMO
• 10-14 after plan design changes

6
Capital University Survey

• Whether there were any deductibles in the network
  and how much?
• Whether there was any co-insurance in the network
  and how much?
• Were there any out of-pocket maximums and how
  much?
• What is the premium share paid by employer and
  employee?

7
Capital Survey Responses

• Premium shares range from 55 to 95 (B-W pays
  90)
• Average 80-85 of the total premium.
• 26 out of 28 schools had in in-network deductible
  of some sort (first introduced at B-W for Prime
  Plan in 2007)
• In network deductibles ranged from 100 to 1000
  for individuals (200-BW)
• Out-of-pocket maximums were generally
  co-insurance (), although a few used a flat
  dollar amount
• Out-of-pocket maximums ranged from 500/1000 to
  4000/8000

8
MMO Changes for 2007

• Prescription retail co-payments increasing
• 2006 - 5-25-45
• 2007 - 10-30-50
• Network Deductible of 100 single/200 family
  is being introduced to Prime plan
• Network Deductible for MMO Standard increasing
  from 200/400 to 250/500
• MMO Standard premium share going from 50 to 55
  of Prime premium

9
MMO Changes for 2008

• Network Deductible for MMO Prime is increasing
  from 100 single/200 family to 200
  single/400 family
• Network Deductible for MMO Standard increasing
  from 250 - single/500- family to 350 -
  single/700 - family
• 25 emergency room co-pay being added to MMO
  Prime
• MMO Standard premium share going from 55 to 65
  of Prime premium

10
Premium Increases for 2009

• Designed to reduce premium costs
• Posted on HRs web site
• Costs will be manageable

11
Premium Increases 2008 vs. 2009MMO Standard

• Service Worker
• Single-3.29 mo. Family-9.68 mo.
• Office Manager
• Single-4.33 mo. Family-13.73 mo.
• Assistant Professor
• Single-6.71 mo. Family-19.75 mo.
• Manager
• Single-9.17 mo. Family-26.98 mo.

12
Deductibles

• Designed to help reduce utilization
• Currently 200/400 Prime
• 2009 - 300/600
• Currently 350/700 Standard
• 2009 - 500/1000

13
Co-insurance

• What is it?
• Reduces utilization costs
• 90/10 for Prime
• 80/20 for Standard
• Many schools have 80/20 and even 70/30
• We have in out out-of-network benefits

14
Out-of-Pocket Maximum

• What is it?
• We have on out-of-network side
• Prime 500/1000
• Standard 600/1200
• Prevents high costs to employee
• Reduces utilization

15
Co-Insurance Example

• 2000 surgery Prime - 300 deductible
• 10 of 1700 170
• Total 470
• 100,000 surgery Prime -300 deductible
• 10 of 99,700 9,970
• Total 800
• Why not 10,250?
• Because Out of Pocket Max is 500

16
MMO Prescription and Dental Coverage

• One change - brand name off-formulary going from
  50 to 60 for up to 30 day supply
• Mail order going from 100 to 120 for brand-name
  off-formulary for 3 month supply
• Run through flexible spending and save
  approximately 30 - 80
• Pay 180 - 120 or 80 (if you flex)
• No changes to Dental Plan for MMO

17
Spousal/Domestic Partner Waiver

• What is it?
• When will it become effective?
• Purpose is to reduce utilization and premiums
• Spousal/Domestic Partner Waiver Form is required
• Check FAQ on HRs web site

18
Options to Consider

• Kaiser
• no deductibles/no co-insurance
• lower premium than Prime
• covers oral contraceptives
• Prescriptions 15 generic/30 brand 50 mail
  order
• Prime to Standard
• 2008 Family Prime - Office Manager
• 97.91 per month
• 2009 Family Standard Office Manager
• 76.37 per month
• Flexible Spending - Spouses

19
Questions

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