HomeMy WebLinkAboutAgenda - 10-09-2007-6eORANGE COUNTY
BOARD OF COMMISSIONERS
ACTION AGENDA ITEM ABSTRACT
Meeting Date: October 9, 2007
Action Age da
Item No. c~ - ~„
SUBJECT: 2008 Employee Health, Dental and Life Benefits Recommendation
DEPARTMENT: Personnel PUBLIC HEARING: (Y/N) No
ATTACHMENT(S):
1) Participants in Health Plan
2) Health Care Claims Experience
3) Top 20 Drugs by Patients Use
4} Total Monthly Cost by Options
5) Total County Cost by Options
6) Total Employee Cost by Options
7) Rate Increase for Option I
8) Rate Increase for Option II
9) Rate Increase for Option III
10)Rate Increase~for Option IV
INFORMATION CONTACT:
Michael McGinnis, Personnel Director
Extension 2552
Diane Shepherd, Benefits Manager
Extension 2558
PURPOSE: To approve the 2008 Employee Health, Dental and Life Benefits Recommendation.
BACKGROUND: The County annually reviews and revises the employee benefit plans and
makes a recommendation to the Board. This recommendation includes health care, dental
care, and term life insurance. The County has requested and received renewal premium rate
options for the employee health care plan, dental care plan and life insurance for the plan year
effective January 1, 2008. Staff has requested a renewal option for the health care plan- that
represented making no changes in the coverage level and 3 additional options that make
minimal changes in the coverage while reducing the increases in total premiums. These 4
options have increases in the total premium of 10.7% for no changes in coverage levels to a
4.9% increase in premium for copay increases in doctor and pharmacy copays.
The dental plan and premium rates will remain the same for 2008: The term life insurance
premium rate quoted by MetLife is a 22% decrease over 2007. All Benefit plan rates and the
increase in the health care expenditures are within the approved budget. The Manager
recommends that the Board approve the renewal of the health care option that increases the
health care premium by 8.7% with the increase of doctor copays: The Manager further
recommends the approval of dental and life insurance plans. Additional information is provided
below.
Staff reviewed changes with the Employee Relations Consortium (ERC) and requested
feedback from members on preferences relating to changes the members would support for
2008. Responses received were fairly split between accepting increases in pharmacy copays
and accepting an increase in physician copays.
Health Plans
Currently the County offers two fully insured health insurance .plans. Both health plans are
contracted through the NCACC Health Insurance Trust and administered by CIGNA. One plan
is a Health Maintenance Organization (HMO). This plan has only in-network benefits that
require participants to use the CIGNA network of physicians and facilities: The second plan is a
Preferred Provider Organization (PPO) that allows both in and out of network services. Both
plans offer a wellness benefit at no cost when employees have a doctor visit for physicals and
immunizations. Attachment 1 shows the number of employees enrolled in each plan and the
rate changes in the annual health insurance since 2001.
The County health care plan is a benefit valued by employees and making large or drastic
changes would not be appropriate for this year. Based on claims generated by the plan, it will
be necessary to increase the monthly premiums paid by the County or to reduce the coverage
level of the health care plan. This rate increase is largely due to a 23.0% increase in net claims
from July 2006-July 2007 over claims July 2005-July 2006. See Attachment # 2 Claim
Experience. NCACC statistics further show that the County group pharmacy claims amount to
43% of overall claims. This is slightly above the total NCACC pool for pharmacy. See
Attachment 3 Top 20 Drugs. The County is also above the pool in outpatient doctor and
specialist costs and slightly below in inpatient hospital costs. The County emergency room
admissions have dropped slightly and remain below the pool average.
Staff requested a change in coverage options that adds a fifth tier for coverage. The
Employee/Child tier is a more economical option for those covering only one dependent child
compared to the Employee/Child(ren) option. This additional tier will affect approximately 80
employees currently in the Employee/Child(ren) tier and will reduce both County and employee
premiums. This addition is incorporated in all options.
Staff has considered four options for health care coverage to reduce the costs for both the
County and employees. With each of the options that reduce the increase of the total premium
there is a small increase in the copays of either the Physician Copay (Option II), the Pharmacy
Copays (Option III) or both the Physician and Pharmacy Copays (Option IV). Currently, the co-
pays for doctors and specialist are lower than the NCACC group overall and lower for pharmacy
drugs. The impact of the four options on the premiums by Total Cost, County Cost and
Employee Premium are indicated in Attachments 4, 5 and 6.
The County and employee premium rates indicated in Attachments 5 and 6 continue the current
52.0% dependent subsidy, based on the HMO Plan. Continuation of the subsidy at this level
maintains a key "family friendly" policy offered by the County that is highly valued by a large
number of County employees. This policy makes health insurance coverage for dependents,
whether spouse, domestic partner, children, or entire family more affordable, and thus,
accessible. It particularly benefits lower salaried employees for whom dependent health
insurance coverage is a significant cost.
Option 1 No Change to Current Plan with addition of Employee/Child tier
Description: The current plan with no changes in the plan design copays for doctor or specialist
visits, pharmacy drugs, or any changes in annual deductibles.
Primary Care Physician visit = $10 and Specialist = $20
Pharmacy Drug Copay $5 for Generic, $15 for Brand and $30 for non-formulary
Mail Order Drug Benefit: 3 mo. supply for $13 Generic, $26 Brand and $60 non-formulary
Annual Deductible is $250 per member with maximum for Family of $750.
Wellness benefit of "no copay" for physicals, immunizations, diagnostic tests
With HMO there is 100% payment of claims after annual deductible
With PPO there is a 90% payment of claims after annual deductible
Total Premium Increase of 10.7% (Attachment 7)
Effect of Option I Rate increase on County and Employee costs in Attachments 5 and 6
Option II Only Increase in Physician Copays (Recommended)
Description: The current plan with change in only the copays for Physician Copays from $10 for
Primary Care Physicians and $20 Specialist to $15 for Physician and $30 for Specialist.
Total Premium Increase 'of 9.7% (Attachment 8)
Effect of Option II Rate increase on County and Employee costs in Attachments 5 and 6
Option III Only Increase in Pharmacy Copays
Description: The current plan with change in only the pharmacy drug copays from $5 for
generic, $15 for Brand and $30 for Non Formulary to $10 for Generic, $25 for Brand and $40 for
non-formulary. Mail Order Drug Benefit changes from $13 Generic, $26 Brand and $60 non-
formulary to $25 Generic, $49 Brand and $87 non-formulary.
Total Premium increase of 5.8% (Attachment 9)
Effect of Option II.I Rate increase on County and Employee costs in Attachments 5 and 6
Option IV Increase in Prescription Copays and Physician Copays
Description: The current plan with changes in the pharmacy drug copays from $5 for generic,
$15 for Brand and $25 for Non Formulary to $10 for Generic, $25 for Brand and $40 for non-
formulary . Mail Order Drug Benefit changes from $13 Generic, $26 Brand and $60 non-
formulary to $25 Generic, $49 Brand and $87 non-formulary and the copays and for Physician
Copays from $10 for Primary Care Physicians and $20 Specialist to $15 for Physician and $30
for Specialist
Total Premium increase of 4.9% (Attachment 10)
Effect of Option IV Rate increase on County and Employee costs in Attachments 5 and 6
Dental Insurance
The County's employee dental insurance program is aself-insured plan administered by Delta
Dental of North Carolina. The County pays the full cost for individual employee dental coverage
Employees pay the full cost of dependent dental coverage. ,The Personnel Department has
evaluated the dental plan costs and projected plan revenue needed for 2008. Based on this
evaluation, staff recommends no changes to the dental plan design and no increase in dental
premium rates for the 2008 calendar year effective January 1, 2008.
Employee Monthly Rates:
Life Insurance
Employee $0 .
Employee/Children $41.93
Employee/Spouse $35.17
Employee/Family $60.07
The County's Term Life Insurance Plan has been provided by Ft. Dearborn Life Insurance
affiliated with Blue Cross Blue Shield of NC. The cost will increase in November 2007 from
4
$0.25 to $0.29 per $1000 of coverage. Earlier in 2007, staff retained benefits consultant Mark III
to identify alternatives to our current vendor. After analyzing the alternatives provided, staff
selected MetLife for coverage that will become effective January 1, 2008. MetLife will provide
identical term life coverage at a cost of $0.225 per $1,000 of coverage. MetLife will also provide
a supplemental benefit for employees wishing to purchase additional insurance. Staff
recommends a change in vendor with reduced premiums and the offering of employee paid
supplemental coverage.
Next Steps
• Develop and distribute open enrollment packets early October
• Benefits and Wellness Fair Thursday, October 18
• Hold open enrollment period from October 19 through November 2
• Payroll deductions begin December 3
• Coverage effective January 1, 2008
FINANCIAL IMPACT: The 2008 Benefit Recommendations are all within the County budget for
2007-08. The actual health care plan financial impact will depend on the option approved. The
County expenditures of the 2007 fully insured health care plan is $6,943,933. The projected
rate increase of for health care in the FY 07-08 Budget was14%. The Manager's
recommendation will increase the expenditures by 9.7%. Assuming the same employee
participation, the County expenditures for 2008 will be $7,618,740 for an increase of $674,807.
There are no other financial impacts relating to this recommendation.
RECOMMENDATION(S): The Manager recommends that the Board:
® Approve Option I I for the 2008 Employee health care plan that adds the Employee/Child tier,
increases the total health care premium by 9.7% and increases the Physician/Specialist
copays from $10/20 to $15/$30.
® Approve renewal of employee dental insurance plans with Delta Dental with an effective date
of January 1, 2008.
• Approve the change of Term Life Insurance vendor from Ft. Dearborn Life to MetLife and the
term life insurance rates.
Attachment 1
~~
Participants in Health Plans
Health Plan # Enrolled
Open Access Plus In-Network
Co-Pay (HMO) 850
Open Access Plus Co-Pay 57
Past Years Health Insurance Rate Changes
The chart below lists past increases implemented by the NCACC Health Insurance Trust:
Plan Year Percentage Increase
2007 1.9%
2006 16.5%
2005 -3.6%
2004 13.8%
2003 25.0%
2002 8.0%
2001 18.9%
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Attachment 7
North Carolina Association of County Commissioners ~~
Group Benefits Pool
Rates Effective January 1, 2008 to January 1, 2009
for Orange County
Alternate #1: Add Employee /Child Rate
Standard Funding Kates
PPO PPO Rates
Renewal HMO
cts
Co HMO Rates
Monthly Rates Contracts Current
84
$475
$526.83 473 $405 64 $44910
Employee 47
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003.94
$1 $1,111.52 114 $855.52 $947.19
Employee /Spouse , $737:55 0 na $628.72
Emp /Child
p
3
na
30
$918
$1,016.69
145
$7216 2
$
Employee /Children
0 .
427.46
$1
$1,580.41
118
$1, 1 347.32
'
Family
Total /Annual Amount 57 ,
$385,764 $427,101 850 $6,558,169 $7,1 60o26i
10.7%
Rate Change _._.
Health Benefits Current PPO Renewal PPO 1 Current HMO
$10 Renewal HMO
$10
PCP Copay $10
$20 $10
$20 $20 $20
Specialist Copay $150 $150 $150 $150
Emergency Room Copay $250 $250 $250 $250
In-Network Deductible 000
$1 $1,000 $0 $0
~In-Network Out-of-Pocket ,
3 times 3 times 3 times s
Family Limit 90% 90% 100% 100%
In-Network Coinsurance
In-Network OP Laboratory Services
100% 100% 100% 100%
100%
Preventive Care Program 100%
$5-15-30 100%
$5-15-30 100%
$5-15-30
$5-15-30
Rx Copay -Retail $13-26-60 $13-26-60 $13-26-60 $13-26-60
Rx Copay -Mail Order $10 $10 $10 $10
Vision Exam Deductible na na
Vision Hardware
na
na
1. No change from Current Benefits
Please Note:
1. Annual cost projections are based upon "Number Enrolled" as shown above. Actual cost will vary
based upon actual enrollment.
2. At least 75% of eligible employees must participate in this plan.
3. Standard Funding covers eligible claims which are incurred during the contract period.
4. Please indicate your acceptance of this renewal offer by signing below. Please submit to NCACC at least 30 days
prior to the effective date of the contract period.
Accepted by the County or Group
Name:
Title:
n~+o•
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act.
Financial Officer Date:
Attachment 8
North Carolina Association of County Commissioners
Group Benefits Pool ~a
Rates Effective January 1, 2008 to January 1, 2009
for Orange County
Alternate #9: Add Employee /Child Rate and Change Dr Copays
Standard Funding Rates
PPO PPO Rates HMO HMO Rates
Monthly Rates Contracts Current Renewal Contracts Current Renewal
Employee 47 $475.84 $522.08 473 $405.64 $445.06
Employee/Spouse 7 $1,003.94 $1,101.52 114 $855.52 $938.66
Emp /Child 0 na $730.90 0 na $623.06
Employee /Children 3 $918.30 $1,007.54 145 $782.90 $858.98
Family 0 $1,427.46 $1,566.18 118 $1,216.92 $1,335.18
Total /Annual Amount 57 $385,764 $423,252 850 $6,558,169 $7,195,488
Rate Chan a 9.7% 9:7%
Health Benefits Current PPO Renewal PPO ~ Current HMO Renewal HMO ~
PCP Copay $10 $75 $10 $75
Specialist Copay $20 $30 $20 $30
Emergency Room Copay $150 $150 $150 $150
In-Network Deductible $250 $250 $250 $250
In-Network Out-of-Pocket $1,000 $1,000 $0 $0
Family Limit 3 times 3 times 3 times 3 times
In-Network Coinsurance 90% 90% 100% 100%
In-Network OP Laboratory Services 100% 100% 100% 100%
Preventive Care Program 100% 100% 100% 100%
Rx Copay -Retail $5-15-30 $5-15-30 $5-15-30 $5-15-30
Rx Copay -Mail Order $13-26-60 $13-26-60 $13-26-60 $13-26-60
Vision Exam Deductible $10 $15 $10 $?5
Vision Hardware na na na na
1. Chan°e the PCP / S°ecialist Conavs to $15 / $3D
Please Note:
1. Annual cost projections are based upon "Number Enrolled" as shown above. Actual cost will vary
based upon actual enrollment.
2. At least 75% of eligible employees must participate in this plan.
3. Standard Funding covers eligible claims which are incurred during the contract period.
4. Please indicate your acceptance of this renewal offer by signing below. Please submit to NCACC at least 30 days
prior to the effective date of the contract period.
Accepted by the County or Group
Name:
Title:
Date:
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act.
Financial Officer Date:
Attachment 9
North Carolina Association of County Commissioners ~~.--~
Group Benefits Pool
Rates Effective January 1, 2008 to January 1, 2009
for Orange County .
Alternate #4: Add Employee /Child Rate and Change Rx Copays
Standard Funding Rates
PPO Rates HMO HMO Rates
PPO
'Monthly Rates Contracts Current Renewal Contracts Current
64
$405 Renewal
34
$429
Employee 47
7 $475.84
94
003
$1 $503.64
062.60
$1 473
114 .
$855.52 .
$905.52
Employee /Spouse .
, ,
08
$705 0 na $601.06
Emp /Child
Employee /Children 0
3 na
$918.30 .
$971.96 145
8 $782.90
92
216
$1 $828.64
288.04
$1
Family 0
57 $1,427.46
764
$385 $1,510.86
302
$408 11
850 .
,
$6,558,169 ,
$6,941,383
Total !Annual Amount , , 5
8%
5.8% .
Rate Chan a
Health Benefits Current PPO Renewal PPO Current HMO Renewal HMO
PCP Copay $10
$20 $10
$20 $10
$20 $10
$20
Specialist Copay
Emergency Room Copay $150 $150 $150 $150
In-Network Deductible $250 $250 $250., $250
$0
In-Network Out-of-Pocket $1,000
3 times $1,000
3 times $0
3 times 3 times
Family Limit 90% 90% 100% 100%
In-Network Coinsurance
!n-Network OP Laboratory Services 100% 100% .100% 100%
Preventive Care Program 100% 100% 100% 100%
Rx Copay -Retail $5-15-30 $90-25-40 $5-15-30 $90-25-4Q
Rx Copay -Mail Order $13-26-60 $25-49-87 $13-26-60 $2~_4g_g7
$10
Vision Exam Deductible $10 $10 $10
Vision Hardware na na na na
Please Note:
1. Annual cost projections are based upon "Number Enrolled" as shown above. Actual cost will vary
based upon actual enrollment.
2. At least 75% of eligible employees must participate in this plan.
3. Standard Funding covers eligible claims which are incurred during.the contract period.
4. Please indicate your acceptance of this renewal offer by signing below. Please submit to NCACC at least 30 days
prior to the effective date of the contract period.
Accepted by the County or Group
Name:
Title:
Date:
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act.
Financial Officer Date:
North Carolina Association of County Commissioners
Group Benefits Pool
Rates Effective January 1, 2008 to January 1, 2009
for Orange County
Alternate #10: Add Employee /Child Rate, Change Dr Copays and RX Copays
Attachment 10
~~
Standard Funding Rates
PPO PPO Rates HMO HMO Rates
Monthly Rates Contracts Current Renewal Contracts Current Renewal
Employee 47 $475.84 $499.10 473 $405.64 $425.46
Employee /Spouse 7 $1,003.94 $1,053.04 114 $855.52 $897.36
Emp /Child 0 na $698.74 0 na $595.64
Employee /Children 3 $918.30 $963.20 145 $782.90 $821.18
Family 0 $1,427.46 $1,497.26 118 $1,216.92 $1,276.44
Total /Annual Amount 57 $385,764 $404,623 850 $6,558,169 $6,878,792
Rate Chan a 4.9% 4.9%
Health Benefits Current PPO Renewal PPO 1 Current HMO Renewal HMO 1
PCP Copay $10 $15 $10 $15
Specialist Copay $20 $30 $20 $30
Emergency Room Copay $150 $150 $150 $150
In-Network Deductible $250 $250 $250 $250
In-Network Out-of-Pocket $1,000 $1,000 $0 $0
Family Limit 3 times 3 times 3 times 3 times
In-Network Coinsurance 90% 90% 100% 100%
In-Network OP Laboratory Services 100% 100% 100% 100%
Preventive Care Program 100% 100% 100% 100%
Rx Copay -Retail $5-15-30 $10-25-40 $5-15-30 $10-25-40
Rx Copay -Mail Order $13-26-60 $25-49-$7 $13-26-60 $25-49-87
Vision Exam Deductible $10 $15 $10 $15
Vision Hardware na na na na
1.Chanoe the PCP / Specialist CopaVS to $15 / $30 and the Rx Copays to $10-25-40 (mail order at $25-49-87) _ _
Please Note:
1. Annual cost projections are based upon "Number Enrolled" as shown above. Actual cost will vary
based upon actual enrollment.
2. At least 75% of eligible employees must participate in this plan.
3. Standard Funding covers eligible claims which are incurred during the contract period.
4. Please indicate your acceptance of this renewal offer by signing below. Please submit to NCACC at least 30 days
prior to the effective date of the contract period.
Accepted by the County or Group
Name:
Title:
Date:
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act.
Financial Officer Date: