Health Insurance Update. March 2015

Transcription

1 Health Insurance Update March 2015

2 Setting the Stage SUU is self-insured Share in providing coverage/protection for all Spreading risk over all employees (healthy and sick) Risk pools in general Cost ups and downs Claims are covered as they are submitted Calculations and projections attempt to smooth More individuals in pool, greater spreading, mitigates volatility

3 Benefits Committee Peers who are asked to review plan design and changes annually Concerned about health and wellbeing of employees and dependents Benefits provided to address unique health needs of individuals which often drives them to one plan or the other SUU is the only USHE school without a Traditional Plan choice

4 Options Open both Traditional and HDHP to all at open enrollment and for new hires Leave Traditional premiums at current levels Lower Traditional premiums by plan modifications Abandon self-insurance and seek to join PEHP

5 SUU Healthcare Costs Cost containment $8,016,000 as of June 30, 2011 $8,941,000 as of June 30, 2012 $9,816,000 as of June 30, 2013 $8,935,000 as of June 30, 2014 Question of the day Plan design and costs moving forward What about Traditional coverage?

6 Current Plans Two medical plans Traditional Was the only plan offered by SUU until July 1, 2012 Closed to new employees: October 15, open enrollment period was the last time employees could switch High Deductible Introduced to encourage more self-awareness of health costs Allow employees to save money for current/future expenses through Health Savings Account (HSA) Contributions to HSA with pre-taxed dollars

7 Plan Distribution

8 Plan Comparison Plan Option Traditional High Deductible Deductible (individual in-network)* $1,000 $1,500 Deductible (family in-network)* $2,000 $3,000 Preventive services 100% covered 100% covered Co-Pays (primary care) $40 (not subjected to Deduct.) $40 (after plan Deduct.) Co-Pays (secondary) $50 (not subjected to Deduct.) $50 (after plan Deduct.) Other medical services 20% (after medical Deduct.) 20% (after plan Deduct.) Out-of-pocket Max (individual in-network)* $3,000 $3,000 Out-of-pocket Max (family in-network)* $6,000 $6,000 Prescription deductible $50 single/$150 family Fall under overall plan Deduct. Generic prescription co-pays (after Rx deductible) $10 $10 Brand prescription co-pays (after Rx deductible)^ 30% 30% Non-Brand prescription co-pays (after Rx deductible)^ 50% 50% Specialty drug tiers (after Rx deductible)^ 15%/25%/40% 15%/25%/40% *Out-of-network levels are double the in-network levels. ^Monthly prescription maximum costs are assigned so even a very expensive drug has a per-month co-pay cap for the employee.

9 Plan Costs Traditional Plan High Deductible Plan Premium Employee Employer Total Employee* Employer Total Single Coverage - annual $1,739 $4,660 $6,399 $521 $4,689 $5,210 Two-Party Coverage - annual $3,914 $10,487 $14,401 N/A N/A N/A Family Coverage - annual $5,623 $15,066 $20,689 $1,512 $13,607 $15,119 Single Coverage - monthly $145 $388 $533 $43 $391 $434 Two-Party Coverage - monthly $326 $874 $1,200 N/A N/A N/A Family Coverage - monthly $469 $1,256 $1,724 $126 $1,134 $1,260 *Employee premiums on the HDHP are redistributed into the employee s individual Health Savings Account and not used for plan claims/administration. Equal pay plan for personal budgeting vs. pay as you go plan based on use

10 Costs 43% of Employees 57% of Employees

11 PEHP Option Public Employees Health Plan (PEHP) is the state s self-insurance the State of Utah, its counties, cities, school districts, and other public agencies. Several USHE schools use including Weber, Snow, Dixie, and USU/Eastern Loss of local control because Legislature determines plan design and premiums

12 PEHP Option continued Have Traditional and High Deductible plans All or nothing provider can t split plans between PEHP and self-insured options Would require a 3 year minimum contract

13 PEHP Plan Comparison Traditional High Deductible Plan Option SUU Current PEHP Option SUU Current PEHP Option Deductible (individual in-network)* $1,000 $250 $1,500 $1,500 Deductible (family in-network)* $2,000 $500 $3,000 $3,000 Preventive services (in-network) 100% 100% 100% 100% Co-Pays (primary care) $40 (not subjected to Deduct.) $25 $40 (after plan Deduct.) 20% (after deduct) Co-Pays (secondary) $50 (not subjected to Deduct.) $35 $50 (after plan Deduct.) 20% (after deduct) Other medical services 20% (after medical Deduct.) 20% (after medical Deduct.) 20% (after plan Deduct.) 20% (after deduct) Out-of-pocket Max (individual in-network)* $3,000 $2,500 $3,000 $2,500 (not including deduct.) Out-of-pocket Max (family in-network)* $6,000 $7,500 $6,000 $7,500 (not including deduct.) Prescription deductible $50 single/$150 family $100 single/$200 family Included in overall plan deduct. Included in overall plan deduct. Generic prescription co-pays (after Rx deductible) $10 $10 $10 $10 Brand prescription co-pays (after Rx deductible)^ 30% ($250 max) 25% ($25 min no max) 30% ($250 max) 25% ($25 min no max) Non-Brand prescription co-pays (after Rx deductible)^ 50% ($350 max) 50% ($50 min no max) 50% ($350 max) 50% ($50 min no max) Specialty drug tiers (after Rx deductible)^ 15%/25%/40% (w/ max.) 20%-30% (No max.) 15%/25%/40% (w/ max.) 20%-30% (No max.) *Out-of-network levels are double the in-network levels for SUU coverage. PEHP has no out-of-pocket max for out of network providers. ^SUU monthly prescription maximum costs are assigned so even a very expensive drug has a per-month co-pay cap for the employee.

14 Monthly Total Premiums Monthly Total Premium TRADITIONAL COVERAGE Single Two-Party Family SUU current $533 $1,200 $1,724 PEHP option* $454 $936 $1,249 Savings $79 $264 $475 HIGH DEDUCTIBLE COVERAGE Single Two-Party Family SUU current $391 $1,134 $1,134 PEHP option* $408 $842 $1,124 Savings ($17) $292 $10 *Rates may be artificially low by using reserves to suppress full premium increase.

15 Employee Share Monthly Employee Share of Premiums TRADITIONAL COVERAGE Single Two-Party Family SUU current $145 $326 $469 PEHP option (10% of Prem) $45 $94 $125 Savings $100 $233 $344 HIGH DEDUCTIBLE COVERAGE Single Two-Party Family SUU current* $43 N/A $126 PEHP option* $66 $132 $132 Savings ($23) - ($6) * Employee premium share on HDHP is redistributed to employee HSA.

16 Proposed Modifications SUU Traditional Plan Modifications Traditional Plan Options PEHP SUU Current SUU Proposed Deductible (individual in-network)* $250 $1,000 $500 Deductible (family in-network)* $500 $2,000 $1,000 Preventive services 100% 100% 100% - Co-Pays (primary care - not subjected to Ded.) $25 $40 $35 Co-Pays (secondary - not subjected to Ded.) $35 $50 $45 Other medical services (after deductible) 20% 20% 20% - Out-of-pocket Max (individual in-network)* $2,500 $3,000 $3,500 Out-of-pocket Max (family in-network)* $7,500 $6,000 $7,000 Prescription deductible (single/family) $100 / $200 $50 / $150 $50 / $150 - Generic prescription co-pays (after Rx deductible) $10 $10 $10 - Brand prescription co-pays (after Rx deductible)^ 25% ($25min No Max) 30% 30% - Non-Brand presc. co-pays (after Rx deductible)^ 50% ($50min No Max) 50% 50% - Specialty drug tiers (after Rx deductible)^ 20%-30% (No Max) 15%/25%/40% 15%/25%/40% - *Out-of-network levels are double the in-network levels. ^Monthly prescription maximum costs are assigned so even a very expensive drug has a per-month co-pay cap for the employee.

17 Modified Premiums Traditional Plan Current Proposed Reduction Single Coverage - annual $1,739 $1,315 ($424) Two-Party Coverage - annual $3,914 $2,991 ($923) Family Coverage - annual $5,623 $4,308 ($1,315) Single Coverage - monthly $145 $110 ($35) Two-Party Coverage - monthly $326 $249 ($77) Family Coverage - monthly $469 $359 ($110)

18 Recommendations Modify plan design for Traditional coverage to reduce employee cost Will set as premium for FY 2016 Open both Traditional and HDHP to all at open enrollment and for new hires Allows continuation of entrants into the pool Remain self-insured No premium increase for HDHP in FY16