City of Rocky Mount

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City of Rocky Mount 2009 2010 - Medical Plan
April 15, 2009
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2009 2010 Medical Plan Performance

• Without plan design changes there will be an
  increase in funding of 17 for 2009 2010
  Medical Plan by the City and the employees.
• Because of the economic realities, a 17 increase
  is not an option for the City or employees.
• For 2009 2010 the City offer two plans
• An HSA Plan.
• Traditional Copay Plan.
• Mark III has clients who are experiencing
  positive plan performance by implementing this
  strategy.

 
 
3
There have been a significant change in the
claims activity?
Rolling Incurred - Claimants Top 25 High Cost Claimants Rolling Incurred - Claimants Top 25 High Cost Claimants Rolling Incurred - Claimants Top 25 High Cost Claimants Rolling Incurred - Claimants Top 25 High Cost Claimants Rolling Incurred - Claimants Top 25 High Cost Claimants
Rolling 12 Months Incurred View of Claims Paid from Apr 2004 through May 2007 Rolling 12 Months Incurred View of Claims Paid from Apr 2004 through May 2007 Rolling 12 Months Incurred View of Claims Paid from Apr 2004 through May 2007 Rolling 12 Months Incurred View of Claims Paid from Apr 2004 through May 2007 Rolling 12 Months Incurred View of Claims Paid from Apr 2004 through May 2007
Encrypted Member ID Leading Diagnosis MCC Billed Allowed Paid
MFSU-BFYL-BHS Endocrine (other), immune and metabolic (non sex gland) 438,880 201,669 196,158
ZXGN-MDOV-GHZ Neoplasms, malignant non-hematologic excluding breast and GYN 424,832 202,311 194,319
ZLZW-MLGN-QHS Neoplasms, malignant non-hematologic excluding breast and GYN 151,134 103,221 95,570
ZLAV-QHPF-SHS Renal/urinary tract kidney failure 137,727 92,279 85,487
ZLAV-QDGU-BHS Neoplasms, malignant hematologic 178,714 90,496 82,900
ODML-AXQH-OHS Cardiovascular coronary heart disease 127,730 67,052 64,040
ZLPT-YNZX-SUS Ill-defined signs and symptoms except seizures 155,890 62,311 55,105
ZXGV-ALZL-GHS Neoplasms, malignant hematologic 94,629 53,034 48,741
ZXGD-SDYH-SHZ Musculoskeletal spinal conditions (including nonbony neck and back) 107,723 48,560 43,914
ZLSW-AFQX-AHS Hematology benign conditions 72,741 41,407 40,972
MWZX-BWZV-PHS Neoplasms, malignant non-hematologic excluding breast and GYN 70,542 42,723 39,644
ZLAN-QLQD-QHS Gastrointestinal other 61,798 43,604 37,075
ZXYD-GFBX-AHS Gastrointestinal other 42,068 39,575 34,303
ZLON-BTAU-YHS Neoplasms, malignant non-hematologic excluding breast and GYN 57,545 39,910 33,747
ZLPW-ZHAN-PHO Musculoskeletal other 61,995 38,594 31,589
ZLAV-ZLMX-GHS Maternity/perinatal perinatal period - other causes 40,087 34,063 30,675
ZLAV-AXOL-ZHS Musculoskeletal osteoarthritis (non-spine) 114,431 36,462 30,376
Summary   2,338,466 1,237,269 1,144,614
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It is a result of a significant increase in the
number of High Cost Members.
Top 25 Paid Top 25 Paid Top 25 Paid Top 25 Paid Top 25 Paid
Rolling Incurred View of Claims Paid from Nov 2005 through Dec 2008 Rolling Incurred View of Claims Paid from Nov 2005 through Dec 2008 Rolling Incurred View of Claims Paid from Nov 2005 through Dec 2008 Rolling Incurred View of Claims Paid from Nov 2005 through Dec 2008 Rolling Incurred View of Claims Paid from Nov 2005 through Dec 2008
Encrypted Member ID Leading Diagnosis MCC Billed Allowed Paid
ZLGF-ZLPH-MHS Cardiovascular coronary heart disease 456,905 172,324 164,864
ZDBL-AVBU-GHS Cardiovascular coronary heart disease 254,563 136,059 126,958
ZXBF-AFMV-GHS Cardiovascular coronary heart disease 212,867 102,011 96,806
ZXYH-QUBN-QHS Neoplasms, malignant non-hematologic excluding breast and GYN 174,982 102,473 94,348
ZXBF-ANMD-MHS Gastrointestinal inflammatory bowel disease 180,599 102,204 90,638
ZXYX-PXBV-AHS Neoplasms, malignant breast (M or F) and GYN 129,389 88,038 81,795
ZLOU-YDSV-MHS Cardiovascular peripheral vascular disease/ atherosclerotic or thrombotic 194,245 85,723 79,476
ZLQH-ZTOH-PHS Neoplasms, malignant non-hematologic excluding breast and GYN 172,133 85,550 78,964
ZXBX-SUST-YHS Cardiovascular coronary heart disease 165,503 72,620 67,610
ZLPW-AHBN-YHS Cardiovascular coronary heart disease 127,794 72,578 66,194
STOL-QNSU-MHS Neoplasms, malignant non-hematologic excluding breast and GYN 80,075 64,525 63,177
ZLQT-PVZF-BHS Neoplasms, benign, uncertain behavior, unspecified nature, and carcinoma in situ 119,543 68,697 55,483
ZLPN-BNAD-PHZ Complications of care not elsewhere classified 174,856 60,132 53,366
ZLAW-MLPL-SHS Ophthalmology glaucoma and cataract 60,748 60,567 50,183
ZLAN-QLOX-PHQ Cardiovascular peripheral vascular disease/ atherosclerotic or thrombotic 127,457 51,912 45,621
ZLAW-ZFBW-OHS Neoplasms, malignant non-hematologic excluding breast and GYN 79,489 45,777 43,508
ZLYU-PXBF-PHQ Gastrointestinal other 65,982 47,283 42,591
ZLAN-QLYV-ZHZ Neoplasms, malignant non-hematologic excluding breast and GYN 72,315 45,723 42,160
MVGL-MTSV-YHS Gastrointestinal other 84,950 47,229 41,909
ZLZF-QVMH-GHS Cardiovascular coronary heart disease 75,038 46,618 41,396
ZLSD-GTPU-SHZ Cardiovascular coronary heart disease 72,488 48,413 39,418
ZXBH-BTMT-MHS Neoplasms, benign, uncertain behavior, unspecified nature, and carcinoma in situ 107,875 48,283 39,125
ZLAV-ZLMX-GHS Maternity/perinatal perinatal period - other causes 50,233 41,131 37,277
ZLMW-ZVOX-AHZ Musculoskeletal osteoarthritis (non-spine) 56,414 36,767 30,023
Summary   3,296,442 1,732,637 1,572,888
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2009 2010 Renewal Calculation
City of Rocky Mount Subscribers Medical Pharmacy CombinedMedical Claims Claims PerActive/RetireePer Month ManagementFees Stop-lossCredits Net Claims Net Claims/Sub/Mth
January-08 1,058 239,705.09 63,555.45 303,260.54 286.64 1,270.55 3,301.91 301,229.18 284.72
February-08 1,057 205,685.85 127,347.89 333,033.74 315.07 1,345.15 3,925.08 330,453.81 312.63
March-08 1,067 309,120.61 73,586.12 382,706.73 358.68 1,354.80 4,260.48 379,801.05 355.95
April-08 1,067 306,390.93 86,540.56 392,931.49 368.26 1,340.20 3,518.79 390,752.90 366.22
May-08 1,034 400,105.35 87,488.84 487,594.19 471.56 1,327.25 63,347.50 425,573.94 411.58
June-08 1,033 320,549.14 84,103.15 404,652.29 391.73 1,106.20 7,058.72 398,699.77 385.96
July-08 1,029 334,040.51 81,134.18 415,174.69 403.47 1,040.85 0.00 416,215.54 404.49
August-08 1,028 213,997.73 130,597.77 344,595.50 335.21 1,475.50 0.00 346,071.00 336.64
September-08 1,036 179,645.35 89,825.99 269,471.34 260.11 1,322.75 0.00 270,794.09 261.38
October-08 1,042 396,259.15 92,131.24 488,390.39 468.70 1,267.95 0.00 489,658.34 469.92
November-08 1,049 368,780.61 89,193.71 457,974.32 436.58 1,264.05 0.00 459,238.37 437.79
December-08 1,047 188,427.85 95,581.09 284,008.94 271.26 1,425.76 13,024.73 272,409.97 260.18
Total 12,547 3,462,708.17 1,101,085.99 4,563,794.16 363.74 15,541.01 98,437.21 4,480,897.96 357.13
                   
Medical Projections - 2009 - 2010 Medical Projections - 2009 - 2010 Medical Projections - 2009 - 2010
  Per Annum Per Month
1/2008-12/2008 Experience 4,480,897.96 357.13
Trended Claims 9 - 18 Months of trend - (13.5) 113.50 113.50
Estimated Claims Based on Experience - 2009-2010 (Annualized) 5,085,819.18 405.34
Estimated Administration Charges (Annualized) 972,517.97 77.51
Expected Total Costs 2009 - 2010 6,058,337.15 482.85
City Budgeted Total Costs 2008-2009 5,206,126.71 414.93
Rate Action 2009 - 2010 Renewal - City 116.37 116.37
The medical plan was marketed and there is not a
compelling reason to change payors.
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2009 2010 Renewal
City of Rocky Mount City of Rocky Mount City of Rocky Mount City of Rocky Mount
  7/08 - 6/09 7/09 - 6/10 7/09 - 6/10
  In-Network Duel Option Duel Option
PCP/SCP Visits 35/70 40/75 Deductible/80
Preventive Care 35 40 100
Deductible 1,000 1,250 1,500
Deductible - Family Maximum 3,000 3,750 3,000
Out of Pocket Limit 4,000 4,000 2,000
Out of Pocket Limit - Family Max 12,000 12,000 2,000
Hospital Services 80 80 Deductible/80
Emergency Room 150 150 Deductible/80
Pharmacy 10/35/50 10/35/50/75 Deductible/80
    HSA 500
Lifetime Maximum 5,000,000 5,000,000 5,000,000
Increase   12 0
Active EmployeeCost EmployeeCost EmployeeCost
Employee Only 0.00 40.27 0.00
Employee and Spouse 401.96 490.47 401.96
Employee and Children 300.54 376.88 300.54
Employee and Family 636.14 752.75 636.14
Retirees      
Employee Only 0.00 43.90 0.00
Employee and Spouse 438.24 534.73 438.24
Employee and Children 327.66 410.88 327.66
Employee and Family 693.98 821.16 693.98
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Health Savings Accounts

• On July 1, 2009, the City will deposit 500
  into Health Savings
• Account participants account.
• The State Employees Credit Union will be the
  recipient of the Citys
• and employees deposits.
• You can use the HSA for unreimbursed medical
  expenses.
• Low utilizers build up positive HSA balances
  and receive recognition
• that doesnt exist in traditional plan designs.
• The HSA plan design promotes efficient
  utilization of health plan
• resources.
• And yet, the protection is still there for
  those who have health care
• needs.

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Health Savings Accounts How do I know it is for
me??
Rolling Incurred View of Claims Paid from March 2008 through February 2009 Rolling Incurred View of Claims Paid from March 2008 through February 2009 Rolling Incurred View of Claims Paid from March 2008 through February 2009 Rolling Incurred View of Claims Paid from March 2008 through February 2009 Rolling Incurred View of Claims Paid from March 2008 through February 2009
         
Allowed Subscribers Subscribers Allowed/Subscriber Allowed
0 - 1,000 491 43.10 298.41 146,518
1,000 - 2,000 148 13.00 1,477.77 218,710
2,000 - 3,000 101 8.90 2,502.54 252,756
3,000 - 4,000 77 6.80 3,465.92 266,876
4,000 - 5,000 47 4.10 4,508.68 211,908
5,000 - 6,000 34 3.00 5,432.92 184,719
6,000 - 7,000 29 2.50 6,442.55 186,834
7,000 - 8,000 28 2.50 7,534.57 210,968
8,000 - 9,000 18 1.60 8,471.04 152,479
9,000 - 10,000 19 1.70 9,384.15 178,299
10,000 - 11,000 17 1.50 10,488.54 178,305
11,000 - 12,000 11 1.00 11,457.20 126,029
12,000 - 13,000 13 1.10 12,471.13 162,125
13,000 - 49,000 90 7.92 25,189.11 2,267,020
Greater Than 50,000 13 1.10 99,025.97 1,287,338
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Health Savings Accounts
  Flexible Spending Accounts (FSA) Health Savings Accounts (HSA)
Account Ownership Employer Employee
Is Account Funded? (Held outside of employer assets) Rarely Yes
Who can contribute to the account? Employee and Employer Employee and Employer
Basis of Contribution Pre-tax Pre-tax
Tax on Account Disbursements Disbursements for qualified expenses are not taxable Disbursements for qualifiedexpenses are not taxable
Eligible Expenses Section 213(d) Expenses Section 213(d) Expenses Premiums for Qualified LTC Insurance Medical premiums forcontinuation of coverageprovisions or duringunemployment. Insurance during Medicareeligibility (except Med Supp).
"Use It or Lose It" Rules? Yes No
Roll Overs Allowed? No Yes
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Health Savings Accounts
Flexible Spending Accounts (FSA) Health Savings Accounts (HSA)
Plan Design Requirements None HSA can only be offered with"High Deductible Plan" defined as Minimum Deductible (for 2009)Single - 1,150Family - 2,300 Deductibles on preventive care not required. Insured cannot be covered by other health plan, and cannot be claimed as a dependent. Out-of-network coverage allowed with higher cost sharing provisions. Entire Family deductible must be met before coinsurance applies. Known as embedded deductible.
Can plan have copays? Yes No
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Health Savings Accounts
Flexible Spending Accounts (FSA) Health Savings Accounts (HSA)
Maximum Account Contribution No Maximum on Medical FSA Maximum Contribution Under the new provision, eligible individuals will be able to contribute up to 3,000 (self-only) and 5,950 (family coverage) for 2009, regardless of the annual deductible amount. Single - 3,000Family - 5,950Extra contributions for age 55 1,000 6 excise tax for excess contributions
Medicare Eligibles No restrictions No contributions allowed once individualis Medicare eligible
Fund for retirees Yes Not after Medicare Eligibility
Penalty for Nonqualified Expense Withdrawals N/A - withdrawal for nonqualifiedexpenses not allowed Income 10 (except after death,disability or Medicare eligibility)