HomeMy WebLinkAboutAgenda - 09-11-2012 - 2 1
ORANGE COUNTY
BOARD OF COMMISSIONERS
ACTION AGENDA ITEM ABSTRACT
Meeting Date: September 11, 2012
Action Agenda
Item No. 2
SUBJECT: Employee Benefits Updates and Preliminary Recommendations Regarding
Calendar Year 2013 Health Insurance Modifications
DEPARTMENT: Human Resources PUBLIC HEARING: (Y/N) No
ATTACHMENT(S): INFORMATION CONTACT:
A. Benefits Report Nicole Clark, Human Resources
B. Health Insurance History Director, 245-2552
C. 2013 Renewal Option Costs Detail for Diane Shepherd, Benefits Manager, 245-
Active Employees and Pre-65 Retirees 2558
D. Employee Health Insurance Survey
Responses
E. Retiree Health Eligibility by Jurisdiction
PURPOSE: To receive information and provide feedback to staff on employee pay and
benefits for calendar year 2013.
BACKGROUND: The County provides employees with a comprehensive benefits plan
including County-paid health, dental and life insurance, an employee assistance program,
flexible compensation plan and paid leave for permanent employees. Additionally, the County
contributes to the Local Governmental Employees' Retirement System and a supplemental
retirement plan.
Staff provided information relating to FY 2012-13 employee benefits at the June 7, 2012 work
session and in the County Manager's recommended budget for FY 2012-13. Retiree health
insurance was discussed at the June 19, 2012 regular meeting. The FY 2012-13 Approved
Budget includes funds for up to a 23.0% ($171,609) health insurance premium increase
effective with the January 1, 2013 renewal. An overview of current benefits and proposed
changes to health benefits are discussed in the attached report (Attachment A).
Effective January 1, 2012, health insurance benefits for Orange County employees and retirees
changed significantly due to the termination of the North Carolina Association of County
Commissioners' health insurance pool. Orange County conducted a competitive process and
selected UnitedHealthcare as the provider for a fully insured group health insurance plan.
Attachment B shows a brief history of health insurance changes and premiums.
Attachment C provides details of current and alternate plan designs. A recommendation to
consider and approve final plan design and premium structure will be presented at the Board's
October 2, 2012 regular meeting based on input received during the September 11, 2012 work
session.
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Employees provided their opinions related to health care insurance in a survey conducted in
August 2012. Over 400 employees responded, representing nearly 50% of employees. The
results, including comments, were taken into consideration in developing the 2013 plan designs.
A summary of results is contained in Attachment D.
At the June 19, 2012 BOCC meeting, the Board approved an amendment to the Personnel
Ordinance Article IV, Section 28-36 changing eligibility for retiree health coverage for
employees hired on or after July 1, 2012 from ten years total service to twenty years continuous
service. At that time, the BOCC requested additional information about requirements in other
jurisdictions, which is provided in Attachment E.
Healthcare Reform
The Supreme Court's decision on the Affordable Care Act upheld most elements of health care
reform legislation. In 2013, a modification to the Flexible Medical Spending Account is needed
to comply with federal legislation because contribution amounts have been limited to $2,500 per
plan year, which is less than the current maximum of$3,000.
A broader discussion of the impact of the Affordable Care Act will be presented at a later work
session.
FINANCIAL IMPACT: Attachments A, B and C include information about the estimated costs
of various pay and benefits options.
RECOMMENDATION(S): The Manager recommends that the Board:
1) discuss employee insurance benefits for calendar year 2013; and
2) provide direction to staff regarding consideration, at an upcoming regular Board meeting,
of the renewal of the current policy coverage and benefits (with Board authorized
modifications) as presented by staff and the County's insurance consultant (Mark III).
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Attachment A
BENEFITS REPORT
The County benefits package helps attract and retain employees as evidenced by comments
from employees at orientations, exit interviews and surveys. Benefits are a key component of
total compensation, providing on average 40% of a permanent employee's compensation
package.
Open Enrollment dates are tentatively scheduled for October 22 — November 2, 2012 with an
effective date of January 1, 2013. Prior to these dates, numerous opportunities to learn about
2013 benefits will be available. Communications will be sent to employees describing the 2013
plan designs and encouraging them to attend an enrollment meeting. Human Resources staff
will attend departmental meetings and hold "lunch & learns" prior to Open Enrollment.
The following pages describe recent activities and considerations for 2012.
Topic Page
Health Insurance A-2
Wellness Activities 2011/2012 A-6
Supplemental Retirement Benefits A-8
Flexible Compensation Plan and Health Savings A-9
Accounts
Dental Insurance A-11
Vision Benefits A-12
Other Insurance Benefits A-13
Employee Assistance Program (EAP) A-14
Decision Points/Actions Needed A-15
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HEALTH INSURANCE
Currently the County offers two fully insured health insurance plans contracted through
UnitedHealthcare. Over 75% of employees participate in the Point of Service (POS) Choice
Plus plan, which is frequently referred to as a traditional plan. The second plan is a High
Deductible Health Plan paired with a Health Savings Account. Both plans allow services in and
out of network. A history of employees enrolled in each plan, rate changes and plan changes to
the health insurance are on the following pages.
Both health insurance plans provide coverage for health care services but have the most value
in the event of catastrophic illness or injury. Changing health insurance companies and plan
designs provided the County an opportunity to encourage healthy behaviors that can lead to
lower long-term health insurance costs. UnitedHealthcare incentive programs to improve
employee health are discussed in the Wellness Section below.
The 2012 plan options available are a) Point of Service Plan, which is similar to the current
traditional plans and b) a High Deductible Plan/Health Savings Account (HDP). Health Savings
Accounts (HSA) provide coverage for current expenses and allow the option to save for future
expenses with portable, tax-advantaged funds. Although the premium for the POS is more
expensive than the HDP, the County contributed the difference to a Health Savings Account for
employees in the HDP. This equalized the amount the County paid and allowed employees to
choose a plan that meets their needs without regard for premium cost.
The two charts below provide additional information regarding the two plans. Each plan offers
advantages and disadvantages to employees, depending on the individual or family health care
needs.
Comparison of 2012 Orange County Health Plans
Traditional Plan: Point High Deductible Plan/
of Service Plan Health Savings Account
Choice Plus POS Definity HSA
100% covered Yes Yes
preventive care
Co-Pays for Office Yes, $20 primary care No; 100% co-insurance
Visits and and $40 specialist until the deductible is met
Prescriptions
Deductible $500/individual, $1,500/ $1,500/individual,
family, exclusive of $3,000/family
prescriptions and office
visit co-pays
County contribution to None Yes, in 2012 $1,237.20
deductible and co- contributed to Health
insurance Savings Account
Co-Insurance (after $1,000 individual, Yes, $2000 for individual
the deductible is met) $3,000 family, exclusive and family
of prescriptions and
office visit co-pays
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Traditional Plan: Point High Deductible Plan/
of Service Plan Health Savings Account
Choice Plus POS Definity HSA
Maximum Out of $1,500 individual $3,500 individual
Pocket $4,500 family $4,500 family
Out of network Yes Yes
providers available
Flexible Spending Medical FSA ($2,500 Child/dependent care FSA
Account maximum) and ($5,000 maximum)
child/dependent care
FSA ($5,00 maximum)
Health Savings Not available $3,250 maximum/individual
Account $6,250 maximum/family
The plan funding provides the same County contribution regardless of the plan an employee
selects, within each option. In 2012, the County contributed $1,237.20 to a health savings
account on behalf of each employee who enrolled in the High Deductible Plan. This was a
significant factor in the success of the High Deductible Plan, with over 20% of employees
enrolling during the first year.
Dependent Coverage
The County currently pays the cost of coverage for employees and retirees for both the HDP
and POS plans. The County also subsidizes the premium cost for the employee's and retiree's
dependent coverage at 52%, based on the lower priced plan (currently the HDP plan).
Continuation of the subsidy at this level maintains a "family friendly" feature of employment with
Orange County.
In a survey of employees completed in May 2011, only 16% of respondents felt the subsidy
should be changed.
Because UnitedHealthcare did not offer more than four tiers (individual, individual & spouse,
individual & children, family), employees with one child who elected the POS had an increase in
their premiums. Employees who covered their spouse, multiple children or family and elected
the HDP had lower premiums than in 2011. As of August 2012, approximately 42% of
employees and 26% of pre-65 retirees have dependent coverage.
2013 Options
The UnitedHealthcare quote for renewal of the current Point of Service (POS) and High
Deductible Plan with Health Savings Account (HDP) was 107.1% of current premiums.
Proposed enhancements to these plans resulted in increases ranging from 108.8% to 113.4% of
current premiums. The Board approved a funding level of 123% of 2012 premiums for the
health insurance renewal for FY 2012-13 (six months of benefits).
In determining enhancements that would be most appropriate for County employees, staff
considered how each enhancement would:
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1. Meet the FY 2012-13 budget;
2. Minimize impact on employees with and without dependents;
3. Positively impact employees;
4. Take into account employee concerns, including responses to a survey in August 2012.
Staff presents three options for health insurance with UnitedHealthcare on the following pages.
When the costs increase, employees with dependent coverage bear a greater cost compared to
employees and retirees with individual coverage.
• The renewal of the current two plans, a traditional plan (POS) and a Health Savings
Account/High Deductible Health Plan, is lower than the FY 2012-13 health insurance
budget.
• Option 1 offers the same two plans with enhancements that will reduce POS members'
costs for prescriptions, minor office surgery, and simple office lab work.
• Option 2 includes the enhancements of Option 1 and adds obesity services, including
gastric bypass surgery, to the existing POS plan.
Summary of 2013 Plan Designs
Renewal of 2012 Plan
In-Network Service High Deductible
(Out of Network Services available, but POS Plan
not shown) with Health
Savings Account
$20, includes
minor surgery 80% after
Primary Care Physician Visits and lab work Deductible
Specialist Physician Visits $40 80% after Ded.
Preventive Care 100% 100%
Deductible $500 $1,500
Deductible - Family Maximum $2,250 $3,000
Coinsurance Limit $1,000 $2,000
Coinsurance Limit - Family Max $3,000 $2,000
In-patient Hospital Services 80% after Ded. 80% after Ded.
Out-patient Hospital Services 80% after Ded. 80% after Ded.
Emergency Room $150 80% after Ded.
Pharmacy $8/$25/$45 80% after Ded
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Option 1
Same plan as the renewal, with the addition of:
• In Network simple labs (e.g., throat cultures) included in office co-pay (covered at 100%)
instead of additional charges subject to deductible or coinsurance
• Pharmacy benefits with co-pays of$4/$25/$45, and all generics in Tier 1
• Office surgery included in office co-pay instead of additional charges subject to
deductible or coinsurance (e.g., mole removals)
• Contribution of$1,237.20 to Health Savings Account for members of High Deductible
Plan
Option 2
Same plan as Option 1, with the addition of obesity services, including obesity surgery
Costs
Attachment 3 provides cost details for the renewal and options.
Self-Funding
The renewal information presented by UnitedHealthcare and Mark III is based on less than six
months of claims. As a fully-insured plan, the County would continue to pay a premium for
health insurance, and would bear no additional risk. If claims exceed the amount of premiums
paid, UnitedHealthcare pays the cost of those claims. If the County is self-insured, the County
pays all claims as well as additional stop-loss insurance.
Self-funding allows greater flexibility in addressing the health care needs of employees and
retirees. An insurance carrier providing fully insured coverage is limited by standardized plans
approved by the North Carolina Department of Insurance.
Staff will review the feasibility of self-insuring in 2014 when the County has twelve months of
claims information, in the spring of 2013. A third-party administrator would be determined
through a competitive process and employee input would be requested in designing the plan
components.
Should self-funding be implemented, a County-operated employee clinic would potentially offer
increased cost reductions and productivity. An employee clinic would offer a no-cost option to
employees for minor illnesses and preventive care, save employees' time, and reduce health
care expenses for both the County and employees.
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WELLNESS ACTIVITIES 2011/2012
Research has shown that every dollar spent on wellness activities generates at least $3 in
return. Fewer sick days, increased productivity, and greater ability to deal with stress are all
common results of wellness programs. A healthier workforce results in greater productivity and
employee satisfaction as well as lower health insurance costs.
Investing in preventive screenings for high blood pressure and cholesterol can reduce health
care costs. Employees have shown their willingness to engage in healthy, or healthier, activities
to keep health insurance benefits at current levels and minimize both their costs and County
costs. UnitedHealthcare funds onsite biometric screenings, employee newsletters, payroll
stuffers and promotional posters. The UnitedHealthcare SimplyEngaged® programs offer
employees incentives in the form of gift cards for completing an online health assessment, and
for participating in both online and telephone health counseling.
Highly discounted membership rates for the Orange County SportsPlex continue to be a popular
wellness benefit for employees. Currently 208 employees are members, a 5% drop over 2011's
membership of 218.
Below is a list of wellness activities and programs between October 2011 and August 2012.
1. Flu Clinics
The Health Department partners with the Human Resources Department to provide two
flu clinics each year, at no cost. Over 150 employees were immunized at the Flu Clinics
held in late 2011. Flu Clinics will be held on October 19 and November 2, 2012 at two
County locations.
2. Biometrics Screenings, Health Assessment and Health Coaching
UnitedHealthcare sponsored biometric screenings in February 2012, and 266
employees learned their numbers related to blood pressure, blood glucose, and
cholesterol. Nearly 400 employees and retirees completed the online health
assessment between January 1 and July 31, 2012.
After completing the health assessment, employees are able to enroll in one or more
online health coaching programs related to exercise, stress, weight loss, tobacco
cessation and others. More than 250 programs were started, and over 124 were
completed. Additionally, 37 employees either completed or are still involved with
telephone counseling on topics of weight and stress management.
3. SportsPlex Membership
Notices were sent to employees in January 2012 reminding them of the Orange County
SportsPlex discount. New employees are informed about the discount at employee
orientation, and the SportsPlex rates and schedules are on the County's Wellness Web
page. The SportsPlex participates in the Annual Employee Wellness & Appreciation
Lunch each spring.
4. Employee Appreciation and Wellness Lunch — June 2012
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Over 200 employees attended and about 125 participated in activities such as tai chi
and yoga, bean bag toss, bocce ball, disc golf, recipe sharing and others. Orange
County SportsPlex representatives attended and taught two Zumba mini-classes and
UnitedHealthcare representatives showed employees strength building exercises with
stretch bands, among other activities. Take-out lunches were provided for staff not
attending.
5. Mini-Grants
$2,500 of the North Carolina Association of County Commissioners (NCACC) grant
funds were designated for employee "mini-grants" not to exceed $250 each. Seven
grant applications totaling $1,543 have been approved. Each encourages weight
management and exercise for different County departments.
6. Orange SLICE Superstars Recognition Program
Incentives were awarded to employees nominated and selected as Orange SLICE
Superstars, who Successfully Live and Inspire County Employees (SLICE), as selected
by a subcommittee of the Wellness Committee.
7. Walking Days
Employees led walks throughout the year at various locations in Hillsborough and
Chapel Hill, including Ayr Mount, Occoneechee Historic Speedway, and the landfill.
Additional walks are planned for Fall 2012.
8. Nutritional Counseling
The County Health Department continues to publicize its nutritional counseling and
diabetes self-management program to employees. Because the Health Department is a
network provider, these services are available at a low co-payment. Employees can use
funds from either their Health Savings Account or Medical Spending Account for these
services.
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SUPPLEMENTAL RETIREMENT CONTRIBUTIONS
Orange County contributes $715 per year ($27.50 per pay period) to either a 401(k) or a 457(b)
Supplemental Retirement Account for each permanent employee. Employees can designate
one of three Plans — Prudential 401(k), ICMA-RC 457, or Nationwide 457 for the County's
contribution and may elect to make a payroll deduction up to legal limits. The $715 per
employee is approximately $543,000 over twelve months. The County does not pay any Social
Security/Medicare taxes on these contributions, for a payroll savings of $41,000 over twelve
months.
The County contribution was suspended between July 1, 2009 and January 1, 2011. The chart
below shows employee contributions to all supplemental retirement plans from September 2010
(during the suspension of the contribution) and August 2012.
Total Annual Employee
Contribution to All Plans
2010 $772,872
2011 $903,310
2012 $920,640
Because the County does not pay tax on $840,900 of these contributions, there is a savings of
approximately $64,300 over twelve months. Employee contributions to the Roth 401(k) are
taxed at the time of the payroll deduction, and do not provide any tax savings.
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FLEXIBLE COMPENSATION PLAN AND HEALTH SAVINGS ACCOUNTS
The County provides a Section 125 Flexible Compensation Plan administered by Tucker
Administrators, with a plan year from January 1 to December 31. This Plan consists of a) tax
sheltering of health and dental premiums and b) two Flexible Spending Accounts (a medical
spending account and dependent/child care spending account).
The Spending Accounts enable employees to contribute money on a pre-tax basis to a separate
account. Employees and the County save money because no income or Social Security taxes
are deducted from contributions made to the Flexible Spending Account(s). Employees may
contribute a maximum of $2,500 to the Medical Spending Account and up to $5,000 to the
Dependent/Child Care Spending Account each plan year in 2012.
As part of the High Deductible Plan, employees may contribute to a Health Savings Account at
either the Local Government Federal Credit Union or the State Employees Credit Union. The
maximum amount allowed for 2012 is $3,100 (individual) or $6,250 (family).
Every $100 employees contribute to a Flexible Spending Account or Health Savings Account
saves the County $7.65 in Social Security taxes. In 2012, employees' contributions of $463,000
to these accounts will result in approximately $35,000 tax savings for Orange County and
$26,000 tax savings for employees.
Number of Employees Contributing to their Accounts
Type of Account 2008 2009 2010 2011 2012
Child Care
Spending 12 12 12 10 13
Account
Medical Spending 95 138 178 214 170
Account
Health Savings 83
Account
Health Care Reform
Effective January 1, 2011, the Patient Protection and Affordable Care Act impacted all medical
spending accounts by requiring prescriptions for over-the-counter medications. Effective
January 1, 2013, the maximum annual allowable contribution to medical spending accounts will
be capped at $2,500. In 2012, the County aligned the plan year for the Flexible Spending
Accounts with other benefits plan years to January 1-December 31, 2012.
No Social Security or Medicare taxes are paid on the amounts employees contribute to either
Medical or Dependent Care Spending Accounts. In 2012, the County is expected to save
approximately $14,000 in taxes because of employee contributions.
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An additional plan design change recommended for 2012 is the elimination of the grace period
for use of the funds in the Medical Spending Account. Employees still have a 90 day grace
period for submitting claims for services received during the plan year.
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DENTAL INSURANCE
The County provides a self-insured dental plan through Delta Dental of North Carolina. The
County pays all costs for employee coverage (claims and an administrative fee to Delta Dental).
Dental claims are now all paid according Delta Dental's standard reimbursement rates.
Previously, the County paid claims according to a unique Orange County Table of Allowances
that was often confusing to employees and their providers. Beginning in 2009 until 2012, the
County gradually increased its reimbursement levels for services with the goal of matching the
Delta Dental maximum payable rates. Accomplishing this has led to significantly less confusion
and greater satisfaction with the dental coverage.
These changes have reduced employees' out of pocket dental expenses. Employees can also
manage their dental costs by using providers within the Delta Dental Premier network and can
achieve greater savings with the PPO Plus Premier networks.
Employee Dental Insurance is budgeted as part of departmental personnel costs. The $24.30
charge includes a monthly administrative fee of $2.80/month per employee and a projected
premium to cover claims. Employees pay the full cost of any dependent coverage.
At the end of FY 2011-12, the dental plan's fund balance was approximately $199,000.
Although the increased reimbursements effective January 2012 were expected to increase
claims by $40,000-$45,000 over a 12 month period, the claims actually decreased by $10,000 in
the first seven months of 2012. There were fewer charges for oral surgery and exams/cleanings
in 2012 and membership in the dental plan decreased by 124 participants compared to the first
seven months of 2011.
No changes to the Dental Plan are being considered for calendar year 2013.
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VISION BENEFITS
Routine eye exams with UnitedHealthcare Choice Plus (POS) are subject to a co-pay and are
covered every other year. With a Health Savings Account/High Deductible plan, all vision
exams are subject to the deductible and co-insurance.
Effective January 2012, employees became eligible to enroll in a vision plan with Community
Eye Care. Employees who enroll pay a premium on a pre-tax basis. The plan includes a
routine eye exam for a $20 co-pay and an $150 allowance for eyeglasses or lenses.
375 employees are currently enrolled in the vision plan. There are no changes anticipated for
2013.
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OTHER INSURANCE BENEFITS
The County continues to provide term life insurance for all permanent employees at no cost to
the individual employee. MetLife has provided this coverage with no increase in price since
2007. The monthly rate of $.225 per $1,000 of coverage (up to $50,000) was renewed last year
for a three year term ending December 31, 2014. Employees may purchase group discounted
term life insurance for themselves, spouse/domestic partner and/or children.
Employees may elect additional income protection paid through payroll deductions. Employees
benefit from group purchasing if they wish to purchase whole life insurance, Accident Insurance,
Critical Illness (including cancer), and/or Short Term Disability. In 2011, the County changed its
provider from Colonial Insurance for all products to Mark III recommended providers.
Participants in each of the supplemental benefits is shown below.
Number of Supplemental Benefits Policies
Product Current Carrier 2009 2010 2011 2012
Short Term Disability AUL (American 62 91 136 199
United Life)
Critical Illness/Cancer Continental 17 21 92 150
Insurance American
Life Insurance (Whole Boston Mutual 4 2 53 95
Life)
Accident Insurance Continental 9 16 45 142
American
Total Policies 110 141 326 486
A minor change to Short Term Disability is planned for 2013 that will allow employees to enroll
for the first time with a benefit of $1,000/month (increased from $500 for 2012) of coverage
without an extensive review process.
There are no other changes to these benefits effective January 1, 2013.
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EMPLOYEE ASSISTANCE PROGRAM (EAP)
Magellan Behavioral Health provides the County's EAP for County employees and their
dependents. The EAP provides confidential assessment and counseling services, 24/7
emergency services, and legal consultation. It also serves as a complement to services
provided through the County Health Plan at no cost to employees or their dependents.
The current contract ends December 31, 2013. The County has budgeted $15,500 for the
Employee Assistance Program in Fiscal Year 2012-13.
As part of its health insurance plans, UnitedHealthcare provides an employee assistance
program at no additional cost. Services consist of three counseling sessions, legal and
financial telephone consultations, and six hours of employee training programs.
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DECISION POINTS/ACTIONS NEEDED
Staff is seeking guidance related to
1) Employee insurance benefits for calendar year 2013; and
2) Direction regarding the renewal of the current coverage and benefits for consideration at
an upcoming regular Board meeting.
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2013 Renewal Option Costs Detail for Active Employees and Pre-65 Retirees Attachment C
Type of Total County Employee
Plan Coverage Premium Pays Pays
2012
Individual $ 578.59 $ 578.59 $ -
Point of Service Ind/Children $ 937.32 $ 731.89 $ 205.43
Ind/Spouse $ 1,220.83 $ 853.04 $ 367.79
Family $ 1,735.77 $ 1,073.10 $ 662.67
High Deductible Individual $ 578.59 $ 578.59 $ -
Plan/Health Ind/Children $ 873.39 $ 731.89 $ 141.50
Savings Acct. Ind/Spouse $ 1,106.38 $ 853.04 $ 253.34
$103.10 Family $ 1,529.57 $ 1,073.10 $ 456.47
2013 Renewal
Individual $ 620.77 620.77 $ -
Point of Service Ind/Children $ 1,005.65 $ 777.72 $ 227.93
Ind/Spouse $ 1,309.83 $ 907.71 $ 402.12
Family $ 1,862.31 $ 1,143.81 $ 718.50
High Deductible Individual $ 613.25 $ 613.25 $ -
Plan/Health Ind/Children $ 929.54 $ 777.72 $ 151.82
Savings Acct. Ind/Spouse $ 1,179.51 $ 907.71 $ 271.80
$103.10 Family $ 1,633.55 $ 1,143.81 $ 489.74
Option 1 2013 w/Enhancements
Individual $ 631.18 $ 631.18 $ -
Point of Service Ind/Children $ 1,022.52 $ 777.72 $ 244.80
Ind/Spouse $ 1,331.80 $ 907.71 $ 424.09
Family $ 1,893.54 $ 1,143.81 $ 749.73
High Deductible Individual $613.25 $ 613.25 $ -
Plan/Health Ind/Children $929.54 $ 777.72 $ 151.82
Savings Acct. Ind/Spouse $1,179.51 $ 907.71 $ 271.80
$103.10 Family $1,633.55 $ 1,143.81 $ 489.74
Option 2 2013 w/Enhancements and Obesity Surgery
Individual $ 658.81 $ 658.81 $ -
Point of Service Ind/Children $ 1,067.28 $ 807.41 $ 259.87
Ind/Spouse $ 1,390.81 $ 943.12 $ 447.69
Family $ 1,976.43 $ 1,189.60 $ 786.83
High Deductible Individual $635.70 $ 635.70 $ -
Plan/Health Ind/Children $965.92 $ 807.41 $ 158.51
Savings Acct. Ind/Spouse $1,226.89 $ 943.12 $ 283.77
$103.10 Family $1,700.90 $ 1,189.60 $ 511.30
Each High Deductible Plan premium includes a contribution to
a Health Savings Account of$103.10 ($1,237.10/year).
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Attachment D
Health Insurance Survey Results
In January 2012, United HealthCare became Orange County's health insurance
provider offering eligible employees and family members a point of service (POS) and
high deductible plan (HDP). The increases in premiums and changes in plan design
have resulted in employee dissatisfaction with the plan. Points of dissatisfaction
include:
Prescriptions:
• Brand names for certain acid reflux medications were not covered
• Supplies were limited for migraine and asthma medication
• Members had to change prescriptions to get a lower co-pay
• All generic prescriptions were not categorized in Tier 1
• Tier 1 co-pays increased from $0 to $8
Services:
• Office visit co-pays did not include diagnostic tests, lab work or minor surgery
• Preventive versus non-preventive services were unclear
The Human Resources Department conducted a survey to gather feedback to assist
with the upcoming 2013 renewal process. Approximately 400 employees responded to
the survey, with 73% of the respondents participating in the POS plan and 26% of the
respondents participating in the high-deductible plan. The survey validated the informal
feedback received regarding prescription benefits and delivery of services referenced
above. Overall, employees indicated that Cigna provided better service than UHC in
the areas of receiving explanation of benefits, on-time payment of claims and website
ease of use. However, the comments to support the responses did not provide specific
information to support the comments. The demographic breakdown is detailed below.
Respondent Demographics
Point of Service Plan High Deductible Plan
Employee Only 151 43
Employee/Spouse 34 11
Employee/Children 76 27
Employee/Family 30 23
Totals 291 104
Key points from the survey include:
• 96.6% of the POS participants indicated they are very familiar or somewhat
familiar with their benefit plan
• 94.2% of the HDP participants indicated they are very familiar or somewhat
familiar with their benefit plan
• 76% of respondents indicated they participated in the health assessment and
received coaching as appropriate
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• 95% of respondents indicated they would like to have $0 generics included in the
plan
• 29% of respondents indicated they would like to reduce prescription costs
• 22.8% of respondents indicated they would like to see plan improvements, only if
premiums remained the same or were reduced
• 34.3% of respondents indicated they support requiring employees to take health
assessments if it would lower premiums
• 31% of respondents indicated they support requiring employees to improve or
maintain their good health through smoking cessation and setting weight loss
goals.
Employee feedback throughout the year and survey results were considered during
negotiations for the 2013 renewal and resulted in plan design changes that address
prescription coverage and categories and eliminate some of the added costs for office
visits due to simple labs and minor office surgery.
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Attachment E
Retiree Health Eligibility by Jurisdiction
At the June 19, 2012 BOCC meeting, the Board approved an amendment to the
Personnel Ordinance Article IV, Section 28-36 regarding retiree health coverage for
employees hired on or after July 1, 2012. The amendment changed the requirements
for health coverage for service retirees from ten total years to twenty continuous years
of service. The BOCC requested additional information about service requirements in
other jurisdictions.
Staff conducted a survey of comparable jurisdictions. The results are shown below.
Ten jurisdictions require continuous service (one requires the last 10 years of 30 be
continuous and another allows an exception for a break of less than one year) and eight
jurisdictions require total service, with one that starts the count over if there is a break of
more than three years.
Jurisdiction Minimum Years of Service for Full Total or Continuous Service?
Benefit(Hired on or after 7/1/12)
Orange CountY 2°Years Continuous
Iredell County 30 years as of 7/2006 Continuous
Cary 25 years Continuous
30 years if hired after July 1, 2006 or
Durham County age 60 or more with 25 years meeting
service hour requirements
Continuous
Hillsborough (Town 30 years and age 60, or age 57 if sworn
of) law enforcement officer Continuous Service
Person County 30 years Continuous
Rowan County None Continuous
Union County 20 years Continuous
Continuous,with an exception made
Carrboro 20 years for those who return after one year
or less
Randolph County 30 years Continuous for the last 10 years of
service
Alamance County 25 years if hired after 7/1/08 Total
Buncombe County 20 years if hired after 7/1/2008. Total
Catawba County 30 years Total
Chatham County 30 years Total
Forsyth County 20 years Total
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Jurisdiction Minimum Years of Service for Full Total or Continuous Service?
Benefit(Hired on or after 7/1/12)
Granville County 20 years and age 65 (more years Total
required if a younger age)
Raleigh 20 years
Total
30 years at any age or 20 years at age Total years (exception: a break in
OWASA 60 service of more than 3 years starts
the count over)
No retiree health insurance provided if
Durham, City hired after 7/1/08; participation in a
Retirement Health Savings Account is
mandatory. Not applicable
If hired after 6/30/10, participation in a
Chapel Hill Retirement Health Savings Account is
mandatory.
Not applicable
If hired after 7/1/09, participation in a
Guilford County Retirement Savings Account is
mandatory.
Not applicable
Wake County No coverage provided if hired or
reinstated after 6/30/11
Not applicable
Davidson County No retiree insurance after 7/1/09
Not applicable