HomeMy WebLinkAboutAgenda - 10-02-1995 - IX-C a
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Orange County
Board of Commissioners
Action Agenda Item Abstract
Meeting Date: October 2, 1995
Action Agenda
Item No:
Subject: Employee Health Insurance for 1996
Department: Personnel Public Hearing Yes No x
Attachment(s): Information Contact:
1-Health Insurance Options Elaine Holmes, Personnel Director
2-Preferred Care Plan Benefits Extension 2550
3- Differences Between Traditional and
Preferred Care Plans Telephone Number:
4- Differences Between HealthSource and Hillsborough 732-8181
BC/BS Personal Care Plan Chapel Hill 968-4501
5-Health Insurance Dependent Care Subsidies Mebane 227-2031
6- Supplemental Retirement Area Employer Durham 688-7331
Contributions
7- Draft Health Insurance Rates for
Options A, B and C
Purpose: To consider employee health insurance options effective January 1, 1996 for
calendar year 1996.
Background: During the 1995-96 budget work sessions,the Board of Commissioners focused a
portion of the employee compensation discussion on health insurance. Areas of
discussion included:
Participation in the newly formed North Carolina Association of County
Commissioners(NCACC) Health Insurance Trust.
Whether limiting employee choices in health plans would result in
significant cost savings.
The current health insurance waiver option and whether this should
continue to be offered.
Currently Orange County offers three health plans:
Blue Cross/Blue Shield(BC/BS) Traditional Plan(a comprehensive major
medical plan)
- Blue Cross/Blue Shield Personal Care Plan(a health maintenance
organization)
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HealthSource of North Carolina, Inc. (a health maintenance organization).
In reviewing health insurance for 1996, Personnel has explored these and other
plan options. Personnel has obtained health insurance rate quotes and related
benefit and plan operation information on a variety of plan options including:
Renewal through the NCACC Health Insurance Trust.
Changing the BC/BS Traditional Plan to a Preferred Provider Plan (which
is similar to a traditional plan but provides managed care incentives)
Entering into a contract for health insurance with a single provider(an
exclusive or so-called "sole provider" contract).
In obtaining rate quotes and identifying plan options, Personnel has focused on
the County's current health insurance providers, Blue Cross and HealthSource.
The reason for narrowing this focus is because of the County's experience with
these plans, the well established, existing local network of physicians
participating in these plans and the existing relationship between County
employees and these participating physicians.
Cost Saving Options Identified
The approved budget for fiscal year 1995-96 included funding for up to a five
percent increase in health insurance effective January 1, 1996. Blue Cross and
Blue Shield's 1996 rate quote for renewal of the current plans (Traditional and
Personal Care Plan)provides for an approximate six percent reduction from the
current rates. HealthSource's rate quote provides for an approximate 2.5 percent
increase.
Taking account of the budgeted increase and the rate quotes from both plans,
renewal of the current plans with no other change would result in cost savings
over the amount budgeted of approximately $80.080 for 1995-96 (from January 1
through June 30)and$121.394 on a full year basis.
Beyond this,three options are presented for consideration. The options that are
presented consider the following alternatives(individually or in combination):
Participation in the NCACC Health Insurance Trust
Changing the Blue Cross/Blue Shield Traditional Plan to a"Preferred
Provider Plan" and
Entering into a sole provider(exclusive) contract for health insurance.
The options identified provide the opportunity for significant additional cost
savings. Attachment 1 shows these options and estimated cost savings.
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In summary:
- Option A provides for the most cost savings identified with the least
change from an employee standpoint.
Option B provides for the most cost savings identified while still retaining
HealthSource as a health plan option, and
Option C provides for the greatest cost savings of all the options
identified, but also results in the most employee change in terms of
physician relationships.
NCACC Health Insurance Trust
Options A, B and C all provide for renewal of the Blue Cross plans through the
NCACC Health Insurance Trust, contingent on negotiation of a satisfactory
Interlocal Agreement with the Trust. The Trust's quoted rates for the various
BC/BS plan options average about 2.5 percent lower than those quoted directly by
BC/BS. Depending on the option,this cost savings ranges from about$36,000 to
$39,000 on a full year basis.
The Trust offers only Blue Cross plans, although at least currently, we have been
advised the County may enroll in the Trust and also offer a health insurance plan
through another health insurance provider as well.
The Trust is a health insurance purchasing cooperative established by the NCACC
effective July 1, 1995. As of August 1995, about 46 counties and other
governmental units have decided to join the Trust.
Many details related to how the Trust will be structured and operate remain to be
worked out. For example,the rate quotes the Trust provided for Orange County's
1996 renewal are based on a different calculation method than would be used for
1997 and beyond. For 1997 and beyond, rates will be based on a planned
actuarial study of the Trust participants and involve some form of experience
rating based on all Trust participants and the County's individual experience.
If the County participated in the Trust,the Trust advises Blue Cross would
continue to provide the same services it now provides. The Trust representatives
advise that employees would not see any change in services from Blue Cross.
A key question considered in evaluating Trust participation has been what risk, if
any,the County incurs by Trust participation. The County's current Blue Cross
plans operate on a fully insured basis. There is no financial liability to the County
beyond the monthly premiums for the contracted period. The County would join
the Trust on a"fully insured"basis but in the context of the Trust as a legal entity
this has some different ramifications.
Through the negotiation of the Interlocal Agreement the County would seek to
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clearly define and limit any potential financial liability beyond the monthly
premium for Trust participation. As of this date, it appears any liability beyond
the monthly premium for the contract period would arise only in the circumstance
in which the Trust as a whole exceeded its loss expectations, experienced a deficit
and the Trust Board of Trustees levied a special assessment on the Trust members.
If the Board elects to pursue the Trust option, participation in the Trust is only
recommended contingent on negotiation of a satisfactory Interlocal Agreement
within the necessary time frames. Absent this, the County may pursue Option A,
B, or C by contracting directly with Blue Cross.
If the County enrolled in the Trust and then decided to discontinue participation in
the future, it could do so only on the renewal effective date. This would require
Board of Commissioners' action and at least 90 days advance notice to the Trust.
Preferred Provider Plans
Options B and C provide for changing the current BC/BS Traditional Plan to a
BC/BS Preferred Provider Plan. A Preferred Provider Plan is like a Traditional
Plan in that it has deductibles, out-of-pocket limits and co-insurance amounts.
The difference is that the Preferred Provider Plan provides for two tiers of
benefits: One tier applies to services received from"preferred care" providers and
the other tier applies to "non-preferred care" services. The reason for cost
savings under the preferred care benefits is that BC/BS has negotiated lower rates
with the preferred providers.
A Preferred Provider Plan may cover hospitals only or both hospitals and
physicians. The plan quoted in Options B and C is called "PPO Select" and it
covers both hospitals and physicians. Attachment 2 outlines the plan benefits.
Attachment 3 compares the benefits of the PPO Select preferred provider plan to
those of the current Traditional Plan.
In terms of the preferred care benefits,the deductibles and out of pocket
limits are the same as the current Traditional Plan and the co-insurance
amount is 90 percent rather than the current 80 percent.
For the non-preferred care benefits the deductibles and out of pocket limits
are higher than the current Traditional Plan and the co-insurance amount is
80 percent, the same as the current plan.
Under a Preferred Provider Plan, the employee may still choose the hospital or
physician from whom he or she receives care. The plan provides financial
incentives for choosing the preferred providers.
A key question evaluated has been whether to pursue the option of a hospital and
physician or hospital only preferred provider plan. In this regard,the following is
noted:
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If the employee uses the preferred provider physician network, the
employee benefits are better than those under the current plan in that the
employee co-insurance amount for general services is 10 percent rather
than 20 percent.
- If the employee does not use the preferred care physicians then the
employee pays higher deductible and out of pocket amounts than
currently.
The preferred care physician network includes the following:
County Preferred Care Physicians
Alamance 81
Durham 796
Orange 631
Wake 462
The preferred care hospitals currently include UNC Hospitals, Duke,
Durham Regional and Wake Medical Center, among others.
During the period from June 1, 1994 through May 31, 1995,participants in
the current BC/BS Traditional plan made 1,793 physician visits. Of these
1,287 or 72 percent were to physicians who currently are preferred
providers and 506 or 28 percent were to physicians who are not.
Effective October 1, 1995, Duke private diagnostic clinic physicians will
no longer be covered as preferred care physicians, unless the physician
contracts individually with BC/BS. Current Traditional plan participants
made 163 visits to these physicians in the covered period. If these are
counted as non-preferred physicians,the number of non-preferred
physician visits is 669 or 37 percent.
In summary for those approximately 37 percent of physician visits which involve
non-preferred care physicians,the employee may still choose to see that
physician. However, for such visits the employee will pay higher deductibles
($300 vs $200 for an individual) and out of pocket amounts ($2,000 vs $1,000 for
an individual). If the employee elects to see a preferred care physician instead, he
or she will pay the same deductible and out of pocket amount as presently, but a
lesser co-insurance amount(10 instead of 20 percent).
The County may change the BC/BS Traditional Plan to a BC/BS Preferred
Provider Plan and still offer the additional plan option of the BC/BS Personal
Care Plan(a health maintenance organization) as it does now. Options A, B and
C all provide for continuing the BC/BS Personal Care Plan.
Sole Provider Contract
Option C provides for a sole provider or exclusive contract with BC/BS through
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the NCACC Health Insurance Trust. If the County entered into a sole provider
contract with BC/BS, this would mean discontinuing the current HealthSource
plan effective January 1, 1996. Under a sole provider contract, the County could
continue to offer more than one plan type through Blue Cross, as is provided in
Option C.
Approximately 200 or 40 percent of employees are currently enrolled in the
HealthSource plan. If the County changed to a sole provider contract with
BC/BS, these employees would have to change to either the BC/BS Preferred
Provider Plan or BC/BS Personal Care Plan during open enrollment for 1996.
As to benefits, Attachment 4 compares the benefits offered through the Personal
Care Plan to those offered through HealthSource. In general the benefits are
relatively similar. In terms of required co-payments,the Personal Care Plan
requires fewer co-payments.
As to physicians in the network, HealthSource offers a broader physician network.
County PCP Physicians HealthSource Physicians
Alamance 20 22
Durham 39 90
Orange 74 77
Wake 120 272
HealthSource provided the names of its physicians designated as primary care
physicians by Orange County members of the plan. Personnel compared these
physicians to the list of PCP (BC/BS Personal Care Plan)physicians. Of the
approximately 453 Orange County members (employees and dependents) of
HealthSource, about 104 or 23 percent have primary care physicians who
currently are not PCP physicians. Under a sole provider contract with BC/BS,
these members would have to change physicians if they joined PCP. If they
joined the BC/BS Preferred Provider Plan, they could retain the current physician.
However,they would be subject to deductibles and co-insurance to which they are
not currently subject and the amount of these would depend on whether the
physician was a preferred provider.
Dependent Subsidy
Orange County provides a partial subsidy to offset the employee cost of
dependent coverage. This subsidy currently is calculated as a flat dollar amount.
If calculated as a percentage of the cost,this current subsidy amount is:
Coverage Category Percentage
Employee and Child(ren) 30.7%
Employee and Spouse 41.7%
Employee and Family 40.9%
Options B and C provide for calculating the dependent subsidy on a percentage
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basis. Calculating the subsidy in this way provides for more equitable handling
and is easier to explain and communicate. In Options B and C, the percentage
used is 42 percent. The amount is calculated using the BC/BS Traditional Plan as
the base plan, determining 42 percent of each dependent coverage category and
then applying that same dollar amount to dependent coverage under the other
plans. Attachment 5 shows the dependent care subsidies provided by area local
government employers.
Health Insurance Waiver Option
The County currently provides an option where an employee may waive health
insurance coverage, if he or she has health insurance coverage through another
provider, and receive a payment of$67.50 per month in lieu of coverage. The
Board had asked that Personnel revisit this option as part of the 1996 health
insurance review.
Both HealthSource and Blue Cross have advised that this option has no adverse
impact on the County's rates so long as the County requires evidence of health
insurance coverage through another provider, as is done presently.
Among seven area local government employers surveyed, five (Carrboro, Cary,
Chapel Hill, Durham County and Wake County)permit the employee to decline
health insurance coverage and two (Durham City and Raleigh) do not. Of the five
who permit it,two (Cary and Durham County)require the employee have health
insurance elsewhere and these same two provide for the employee to receive a
payment in lieu of insurance (Cary - $62.50 per month and Durham County - up
to $12 per month).
If the County eliminated the waiver option and the 46 employees currently
participating elected health insurance, additional funds ranging from$69,000 to
$156,000 (using current rates) would be required depending on coverage elected.
The effect of the waiver option is to reduce the County cost in the instance where
an employee has coverage elsewhere and declines coverage instead of enrolling
because there is no other alternative. If the Board elects to discontinue the waiver,
it is recommended that current employees participating in the waiver be allowed
to continue to do so under a "grandfather" provision so that additional funds are
not required.
401(k) Plan Option
The health insurance options presented and, in particular, Option C provide the
opportunity for significant cost savings. An alternative for the Board's
consideration is to use a portion of that cost savings to enhance the current
employee benefits package.
Many area local government employers provide for an employer contribution to a
401(k)plan for general government employees in addition to the five percent
A
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401(k)plan contribution State law requires for law enforcement officers. •
Attachment 6 shows area local government employers and the supplemental
retirement contribution amount.
If the County initiated a one percent 401(k)plan contribution for general
government permanent employees, the estimated cost is approximately:
$75,000 effective January 1, 1996 for the period through June 30
$151,000 effective July 1, 1996 for fiscal year 1996-97
Summary
Personnel has shared the information in this report with department heads and
members of the County's Employee Relations Consortium. Personnel and the
Manager also have met with these groups to get their feedback on the options.
Based on these discussions and evaluation of the options, it is recommended that
the Board pursue Option B. Under Option B,the estimated cost savings to the
County on a full year basis is approximately $225,000.
This recommendation results from the strong feeling expressed by employees that
it is important to continue to offer HealthSource as a health plan option and the
fact that approximately 200 employees currently are enrolled in this plan. The
reasons expressed for this relate to established relationships with physicians and
strong customer satisfaction with HealthSource.
Option C is presented in response to the Board's question as to whether significant
cost savings could be realized by limiting employee choice in health plans. If the
Board elected to pursue Option C, it is recommended that the Board accompany it
with implementation of a one percent County paid 401(k)plan contribution for
each general government permanent employee effective either January 1 or
July 1, 1996. Under this scenario, the net total savings to the County is
approximately $180,000 on a full year basis.
The reasons for combining Option C with a 401(k) contribution is that the County
realizes very significant savings in health insurance compared to other options, yet
at the same time it recognizes that employees may face some higher expenses
depending on the employee's need or desire to maintain a relationship with a
particular physician. Absent the 401(k)benefit,this option may be perceived by
employees as too much of a change without an accompanying employee benefit.
At the same time,the 401(k)plan is a key benefit lacking in the current benefits
package. Thus this option permits the County to redistribute and enhance the
impact of its benefits dollars.
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Recommendation: The Manager recommends the Board:
1. Adopt Attachment 1, Option B which provides for:
a. Changing the Blue Cross Traditional Plan to a Blue Cross
Preferred Provider Plan covering hospitals and physicians
b. Renewing the two Blue Cross Plans (Preferred Provider and
Personal Care Plan)through the NCACC Health Insurance Trust,
contingent on negotiation of a satisfactory Interlocal Agreement
with the Trust.
C. Continuing the HealthSource plan.
d. Establishing the health insurance dependent subsidy at 42 percent.
e. Continuing the health insurance waiver option.
2. Authorize staff and the County Attorney to work with the NCACC Trust
to negotiate the provisions of the Interlocal Agreement with the Trust,
with the resulting Agreement to be presented to the Board of
Commissioners for consideration at the Board Worksession scheduled for
October 12.
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• BENEFITS PLAN S3 ATTACHMENT 2
SERVICES PREFERRED BENEFITS NONPREFERRED BENEFITS
Deductible
$200 per calendar year $300 per calendar year
(maximum of$600 per family) (maximum of$900 per family)
Out-of-Pocket Limit
- ---------------- . -
$1,000 per member 52,000 per member
$2,000 per family $4,000 per family
Lifetime Maximum
$1,000,000 per member
Chemical Dependency Maximums'
Calendar year $8,000 per member
Lifetime $16,000 per member
Physician Services
Office visits 90% covered 80% PRC'
Inpatient care 90% covered 80% PRC
Surgery 90% covered 80% PRC
Outpatient diagnostic 90% covered 80% PRC
Maternity care 90% covered 80% PRC
Chemical dependency' 90% covered 80% PRC
Ambulatory Surgical Facility Services
90% covered 80% PRC'
Hospital Services
Per confinement deductible None None
Inpatient 90% covered 80% PRC
Outpatient 90% covered 80% PRC
Chemical dependency' 90% covered 80% PRC
Facility Provider Services
Durable medical equipment 90% covered 80% PRC
Private duty nursing care' 90% covered 80% PRC
Home health care 90% covered 80% PRC
Hospice care 90% covered 80% PRC
Chemical dependency treatment facility' 90% covered 80% PRC
Psychiatric Services
Per confinement deductible None None
Inpatient 90% covered 80% PRC
Outpatient 70% covered 50% PRC
Calendar year maximum $6,000 per member
Lifetime psychiatric maximum $25,000 per member
Emergency Care'
Hospital services 90% covered 90% PRC(initial visit)*
Physician services 90% covered 90% PRC(initial visit)'
The following services are subject to the preferred benefits deductible of$200.
Special Services/Providers'
Ambulance services 80% PRC 80% PRC
Prescription drugs 80% PRC 80% PRC
Prosthetic appliances 80% PRC 80% PRC
Orthotic devices 80% PRC 80% PRC
Dental services related to injury 80% PRC 80% PRC
Skilled nursing facility 80% PRC 80% PRC
'See reverse for explanation.
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ADDITIONAL INFORMATION ABOUT PREFERRED CARE SELECT
FROM BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA
Provider's Reasonable Charge (PRC).
The charge that Blue Cross and Blue Shield of North Carolina determines is reasonable for covered services
provided to a member.
Special Services/Providers Deductible.
Special services and services of special providers are amount each calendar year All covered services under
subject to the$200 preferred benefits calendar year this option apply toward meeting the calendar year
deductible. You will pay only one maximum deductible deductible.
Admission Certification.
Many medical and surgical procedures that were hospital admissions must be certified prior to the
previously performed on an inpatient basis can now be hospitalization.Approval for emergency and maternity
done safely in a less costly outpatient setting.Admission admissions should be requested within two days or on
certification is a program designed to make sure that the first business day after the admission.
your care is given in a cost effective setting and an If the admission is not certified,charges for room and
efficient manner board will not be covered by Blue Cross and Blue Shield
If you need to be hospitalized, you must obtain of North Carolina.
admission certification.'Nonemergency and nonmaternity
Length of Stay Assignment.
When Preferred Care Select subscribers are admitted help avoid unnecessary and costly hospital days to keep
to a nonpreferred hospital, the doctor must obtain a costs to a minimum. If a longer stay is needed, the
length of stay assignment as well as admission certification. doctor should contact Blue Cross and Blue Shield of
With a length of stay assignment,a certain number of North Carolina.
days will be approved for the hospital stay.The length of If a Preferred Care Select subscriber is admitted to a
stay assignment reflects the number of inpatient days that nonpreferred hospital and does not obtain a length of
are normally necessary to treat the patient's condition. stay assignment, room and board charges will not be
The length of stay assignment program is designed to covered by Blue Cross and Blue Shield of North Carolina.
Emergency Care.
During an emergency, the initial visit or admission will preferred hospital.The preferred level of benefits includes
be paid at the preferred level of benefits even when the$200 preferred deductible(with a maximum of$600
services are not provided by a preferred doctor or in a per family)and the preferred copayment of 10 percent.
Chemical Dependency.
All chemical dependency benefits are subject to the lifetime and calendar year chemical dependency maximums.
Preferred Care Providers.
A directory of doctors who participate in our Preferred Care Select program, the preferred hospitals and the
preferred ambulatory surgical facilities will be included in your employee information.
Facility Providers.
Private duty nursing is covered for agencies only; it is not covered for individual facilities.
Carry Over Credit.
Expenses incurred for covered services in the last that calendar year deductible will be applied to the
three months of a calendar year which were applied to deductible of the next calendar year.
This fact sheet is a summary of Preferred Care Select limitations and exclusions of Preferred Care Select are
benefits Plan S3.This is meant only to be a summary. found in and governed by the group contract.
Final interpretation and a complete listing of benefits,
L901 5,95 0�
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' LIMITATIONS AND EXCLUSIONS
This is only a partial list of limitations and exclusions. A complete list is available
upon request.
Preferred Care Select does not provide benefits for services, supplies or charges:
- For individuals who are eligible for Workers' Compensation or Medicare (including those
under age 65 who are eligible for Medicare disability coverage).
-That are not medically necessary as determined by Blue Cross and Blue Shield of
North Carolina.
-That are investigational in nature.
- For injury or illness resulting from an act of war.
- For cosmetic services or cosmetic surgery.
- For personal hygiene and convenience items.
- For custodial care, domiciliary care or rest cures.
- For inpatient admissions that are primarily for diagnostic studies.
- For palliative or cosmetic foot care.
- For dentistry or dental processes except for treatment of accidental injury.
- For eyeglasses, contact lenses, vision examinations and surgery to correct nearsightedness.
- For hearing aids, tinnitus maskers or hearing examinations.
- For any treatment in connection with transsexualism, sex changes or modifications.
-For conception by artificial means.
- For treatment of obesity, except for surgical treatment of morbid obesity.
-For treatment of sexual dysfunction not related to organic disease.
This policy is renewable at your option except under conditions such as nonpayment of fees.
This coverage may be subject to a waiting period for preexisting conditions in accordance
with the North Carolina Small Employer Group Health Coverage Reform Act.
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or North Carolinla
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Attachment 3
September 5, 1995
Differences Between Traditional and
Preferred Provider (Covering Hospitals and Physicians) Health Plans
Section A: General Services
Category Traditional Plan PPO PP
Preferred Non-Preferred
Deductible $200 $200 $300
$600 p/family $600 p/family $900 p/family
Coinsurance 20% 10% 20%
Maximum Out of $1,000 p/member $1,000 p/member $2,000 p/member
Pocket Annually $2,000 p/family $4,000 p/family
Lifetime Maximum $1,000,000 $1,000,000 $1,000,000
Physician Services
Office Visits 80%covered 90% covered 80%PRC*
Inpatient Care 80%covered 90% covered 80%PRC
Surgery 80%covered 90%covered 80%PRC
Outpatient Diagnostic 80%covered 90%covered 80%PRC
Maternity Care 80%covered 90%covered 80%PRC
Chemical Dependency 80%covered 90%covered 80%PRC
Routine Physicals not covered not covered not covered
Immunizations not covered not covered not covered
* Provider's Reasonable Charge
r
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Category Traditional Plan PPQ P_PO
Preferred Non-Preferred
Hospital Services
Selection of any hospital Preferred Hospital Non-preferred
Hospitals from list provided Hospitals
by BC/BS
Inpatient Care 80% covered 90% covered 80%PRC
Outpatient 80%co-,ered 90%covered 80%PRC
Room& Board 80% covered 90%covered 80% PRC
semi-private semi-private semi-private
room rate room rate room rate
Emergency Services
And Out of Area
Hospital Services 80%covered 90%covered 90%PRC
initial visit*
Physician Services 80% covered 90% covered 90% PRC
initial visit*
Urgent Care Centers 80%covered 90%covered 80% PRC
Surgery
Operating & 80%covered 90%covered 80%PRC
Recovery
Outpatient 100%PRC 100%PRC 100% PRC
Second Surgical 100%PRC 100%PRC 100%PRC
Opinion
Ambulatory 80%covered 90%covered 80%PRC
Surgical Facility
Services
*In an emergency, services will be paid at the preferred level of benefits at a non preferred hospital
which includes a$200 deductible ($600 for family)an a 10 percent copayment.
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Category Traditional Plan PPO PP.
Preferred Non-Preferred
Ambulance Services see section B: Special Services
Accidental Injua
Outpatient 100% PRC 90% PRC 80% PRC
When treated within
3 days of accident
When treated within 100% PRC 90%PRC 90%PRC
24 hours of accident
Inpatient 80%covered 90% covered 80% PRC
Short Term
Rehabilitation 80%covered 90% covered 80%PRC
Up to 70 days in a semi-
private facility (After
70 days, additional days
allowed if hospitalized)
Physical Therapy 80%covered 90% covered 80%PRC
Medically necessary
and given by eligible
provider
Mental Health
Outpatient 50%covered 70%covered 50% PRC
up to $2,000
Inpatient 80%covered 90%covered 80% PRC
Mental Health n/a $6,000 p/member $6,000 p/member
Calendar year
Maximum
Mental Health
Lifetime Maximum $10,000 p/member $25,000 p/member $25,000 p/member
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Category Traditional Plan PPO PP
Preferred Non-Preferred
Substance Abuse
Chemical Dependency
Outpatient 50%covered 70%covered 50% PRC
Detoxification 80%covered 90% covered 80% PRC
Inpatient 80% covered 90%covered 80%PRC
Chemical Dependency $8,000 $8,000 $8,000
Calendar year
Maximum
Chemical Dependency $16,000 $16,000 $16,000
Calendar year
Maximum
Eye Care
Routine Eye Exams Not covered Not Covered Not Covered
Eyeglasses
Contact Lenses
Cataracts 80%covered 90%covered 80%PRC
Surgery and one
set of lenses as
needed as a result
Cardiac
Rehabilitation 80%covered 90%covered 80%PRC
Private Duty Nursing 80%covered 90%covered 80%PRC
Covered for agencies
only; not covered for
individual facilities
Home Health Care 80%covered 90%covered 80%PRC
Hospice Care 80%covered 90%covered 80%PRC
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Category Traditional Plan PPO PPO
Preferred Non-Preferred
Chiropractic
When medically 80% covered 90% covered 80%PRC
necessary
Durable Medical
Equipment
Prosthetic/Orthopedic
Devices and
Medical Supplies 80%covered 90%covered 80%PRC
When medically
necessary
Hearing Aids Not covered Not covered Not covered
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Section B: Special Services/Providers
Services listed below requires only a$200 deductible for an individual and $600 for family for the
plans listed. A separate deductible is not required. Additionally, the coinsurance is 20 percent.
Category Traditional Plan PPO PPO
Preferred Non-Preferred
Ambulance Services 80% PRC 80%PRC 80% PRC
Prescription
Services
Participating pharmacies
as designated by the plan
(Result: less out-of-
pocket cost and
simpler claim filing)
or
Non-participating pharmacies
(Result: greater out-of-
pocket cost and more
complex claim filing)
Prescription charges 80% PRC 80%PRC 80%PRC
Oral Contraceptives/ Not Covered Not Covered Not Covered
Fertility Drugs
Prosthetic/Orthopedic
Devices
When 80%PRC 80%PRC 80%PRC
medically necessary
Dental
Accidental injury 80%PRC 80%PRC 80%PRC
Skilled Nursing
Facility 80% PRC 80%PRC 80% PRC
Up to 70 days in a semi-
private facility (After
70 days, additional days
allowed if hospitalized)
Attachment 4 20
September 5, 1995
Differences Between Healthsource and
the Blue Cross/ Blue Shield Personal Care Plan
Category Personal Care Plan Healthsource Plan
Lifetime Maximum Unlimited proposed 1/1/96 Unlimited
(currently $1,000,000)
Physician Services
Specialist Referrals Written referrals good for 6 months Paperless referrals
(proposed 1/1/96)
Specialist Visits Fully covered $20 copayment
OB-GYN Visits Unlimited self referrals Unlimited self referrals
(proposed 1/1/96)
After Hours
Physician Visits $15 copayment $20 copayment
Allergy Injections Fully covered Up to $10 per injection
separate cost from
office copayment
Mammograms Fully covered No cost except for office
copayment
Emergency Services
And Out of Area
ER Visit $25 copayment $50 copayment
(waived if admitted)
Urgent Care Centers Not covered $25 copayment
Out of Area
Non-emergency Toll-free out of area network Not available
r
21
Category Personal Care Plan Healthsource Plan
Surgery
Second Surgical Fully covered if authorized $20 copayment
Opinion
Medically necessary
Transplants with Fully covered Fully covered
prior authorization (proposed 1/1/96)
Heart, Kidney, Liver
Cornea, Bone Marrow
Prescription
Services
Prescription charges $5 generic, $10 brand name $3 generic, $10 brand name
(proposed 1/1/96)
34 day supply or 100 unit doses 34 day supply
whichever is greater
Fertility Drugs Covered drug if authorized Not covered
by physician
Short Term
Rehabilitation&
Physical Therapy Fully covered for 30 visits per year $20 copayment
for each type of therapy 20 visits per year
Mental Health
Outpatient 1 -20 visits $20 copayment 1 -20 visit$20 copayment
21- 30 visits $30 copayment
1-20 group visits $10 copayment
21- 30 group visits $15 copayment
(proposed 1/1/96)
Inpatient $100 copayment per day 20%copayment
30 day limit
(proposed 1/1/96)
Mental Health No maximum $7,500 per year
Lifetime Maximum $15,000 lifetime
22
Category Personal Care Plan Healthsource Plan
Substance Abuse
Outpatient Fully covered for 20 visits $20 copayment
Detoxification No limit on days $20 copayment
Inpatient Fully covered for up to 20%copayment if
30 days per year fully confined
Day Treatment
Facility 15%copayment
Eye Care
Routine Eye Exams $10 copayment $20 copayment
Providers Optometrist Optometrist
Ophthalmologist
Eyeglasses Not covered Not covered
20%discount on complete
pair if purchased from a
participating doctor
Cardiac
Rehabilitation Fully covered for 30 visits per year Copayment based on place
per type of therapy based on place of service
of service Up to 6 months per year
Private Duty Nursing Fully covered Fully covered to 60 days
per year
Skilled Nursing Fully covered for 100 days per year Fully covered
Facility 100 days per year
200 days lifetime
Chiropractic Covered if authorized by primary Not covered
care physician and approved by
the plan(see short term therapy)
23
Category Personal Care Plan Healthsource Plan
Dental Accidental injury only except: Repair of fractures and
under age 19 congenital defects removal of tumors and
or abnormalities covered cysts.
Accidental injury:
Services to repair sound,
natural teeth rendered within
48 hours of injury.
Copayment based on place
of service
Medical Supplies
Medical Equipment Fully covered when medically 25%copayment per item
Prosthetic/Orthopedic necessary up to $2,500 per year
Devices
Wellness 24 Hour Nursing Telephone Line In-house and worksite
Self-Care Book Health Education Programs
Health Risk Appraisals
Topic-Specific Materials
(all proposed 9/1/95)
Conversion After COBRA expires, After COBRA expires,
conversion to non-group plan conversion to another
with Blue Cross& Blue Shield health insurance company
with HMO benefits continued occurs and HMO benefits
are no longer an option
Medicare Supplement Provides Medicare Supplement Plan No Medicare Supplement Plan
24
1
Attachment 5
Health Insurance Dependent Care Subsidies
Employer Percentage of Coverage Paid
Carrboro 25
Cary 25
Chapel Hill 50
Durham City 55
Durham County 43 to 57 (depending on plan)
Raleigh 19
Wake None
25
Attachment 6
Supplemental Retirement
rea Employer Contributions
5% 401(k) Plan 3% 401(k) Plan Other
Cary Carrboro Raleigh
Chapel Hill (Up to 1.75%
Durham (City) of salary to
Durham County 457 Plan)
Wake County
$30,000 Salary
Additional Supplemental Retirement Dollars
$1,600
$1,400
$1,200 -
$1,000 -
$800 - -----
$600 ------------
$400 ------
$200 ------
$0
a0 �`'� �Z`�\ .'�, G°. CP* `fir c'c1
G C;& sp
G•c� OJ�aF O�� o�a� Q' ��m
26
Attachment 7
Health Insurance Option A
Total Cost Paid By County Paid By Employees
Personal Care Plan Monthly Rates Monthly Rates Monthly Rates
Old New Old New Old New
Employee Only $192.70 $175.35 $192.70 $175.35 $0.00 $0.00
Employee and Child(ren) $371.90 $338.43 $247.78 $225.48 $124.12 $112.95
Employee and Spouse $406.58 $369.99 $281.94 $256.57 $124.64 $113.42
Employee and Family $578.04 $526.05 $350.36 $318.85 $227.68 $207.20
Total Cost Paid By County Paid By Employees
Traditional Plan Monthly Rates Monthly Rates Monthly Rates
Old New Old New Old New
Employee Only $192.70 $175.35 $192.70 $175.35 $0.00 $0.00
Employee and Child(ren) $371.90 $338.43 $247.78 $225.48 $124.12 $112.95
Employee and Spouse $406.58 $369.99 $281.94 $256.57 $124.64 $113.42
Employee and Family $578.04 $526.05 $350.36 $318.85 $227.68 $207.20
Total Cost Paid By County Paid By Employees
HealthSource Monthly Rates Monthly Rates Monthly Rates
Old New Old New Old New
Employee Only $164.00 $168.00 $164.00 $168.00 $0.00 $0.00
Employee and Child(ren) $342.00 $351.00 $247.78 $225.48 $94.22 $125.52
Employee and Spouse $366.00 $376.00 $281.94 $256.57 $84.06 $119.43
Employee and Family $521.00 $535.00 $350.36 $318.85 $170.64 $216.15
M:\A11\0pfions.WK4
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Health Insurance Option B
Total Cost Paid By County Paid By Employees
BC/BS Personal Care
Plan Monthly Rates Monthly Rates Monthly Rates
Old New Old New Old New
Employee Only $192.70 $162.85 $192.70 1 $162.85 $0.00 $0.00
Employee and Child(ren) $371.90 $314.29 $247.78' $226.45 $124.12 $87.84
Employee and Spouse $406.58 $343.61 $281.94 $238.77 $124.64 $104.84
Employee and Family $578.04 $488.54 $350.36 $299.64 $227.68 $188.90
Total Cost Paid By County Paid By Employees
BC/BS Preferred
Provider Plan Monthly Rates Monthly Rates Monthly Rates
Old New Old New Old New
Employee Only $192.70 $162.85 $192.70 $162.85 $0.00 $0.00
Employee and Child(ren) $371.90 $314.29 $247.78 $226.45 $124.12 $87.84
Employee and Spouse $406.58 $343.61 $281.94 $238.77 $124.64 $104.84
Employee and Family $578.04 $488.54 $350.36 $299.64 $227.68 $188.90
Total Cost Paid By County Paid By Employees
HealthSource Monthly Rates Monthly Rates Monthly Rates
Old New Old New Old New
Employee Only $164.00 $168.00 $164.00 $168.00 $0.001 $0.00
Employee and Child(ren) $342.00 $351.00 $247.78 $226.45 $94.22 $124.55
Employee and Spouse $366.00 $376.00 $281.94 $238.77 $84.06 $137.23
Employee and Family $521.00 $535.00 $350.36 $299.64 $170.64 $235.36
M:\A11\0ptions.WK4
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2s
r
Health Insurance Option C
Total Cost Paid By County Paid By Employees
BC/BS Personal Care
Plan Monthly Rates Monthly Rates Monthly Rates
Old New Old New Old New
Employee Only $192.70 $150.83 $192.70 $150.83 $0.001 $0.00
Employee and Child(ren) $371.90 $291.11 $247.78 $209.75 $124.12 $81.36
Employee and Spouse $406.58 $318.26 $281.94 $221.15 $124.64 $97.11
Employee and Family $578.04 $452.50 $350.36 $277.53 $227.68 $174.97
Total Cost Paid By County Paid By Employees
BC/BS Preferred
Provider Plan Monthly Rates Monthly Rates Monthly Rates
Old New Old New Old New
Employee Only $192.70 $150.83 $192.701 $150.83 $0.001 $0.00
Employee and Child(ren) $371.90 $291.11 $247.78 $209.75 $124.12 $81.36
Employee and Spouse $406.58 $318.26 $281.94 $221.15 $124.64 $97.11
Employee and Family $578.04 $452.50 $350.36 $277.53 $227.68 $174.97
M:\All\Options.WK4
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