Kentucky Health Insurance Online Web Enrollment

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1 2006 NASCIO Recognition Awards Nomination Category: Digital Government - Government to Government (G to G) Kentucky Health Insurance Online Web Enrollment Kentucky Personnel Cabinet KentuckyUnbridledSpirit.com An Equal Opportunity Employer M/F/D

2 Executive Summary The Kentucky Health Insurance Online Web Enrollment system is a Web enrollment application for Kentucky's employee health insurance program. The system replaces a cumbersome paper process that was in use for many years. With the implementation of the 2006 Online Web Enrollment Application, 115,000 employees were eligible to make their health insurance benefit elections online and receive an confirmation. The Online Web Enrollment Application has saved money and proven to be a vital benefit for participants of the Commonwealth Health Insurance Program. Manual enrollment of more than 185,000 state employees, small local government employees, and retirees is no small task. It requires months of preplanning every year. Annually the Health Insurance Program encounters numerous benefit plan and rate changes yearly that require staff and contractors to work long hours to implement. A large staff is a necessity to handle the distribution of open enrollment handbooks and paper applications, numerous phone calls, open and scan all the incoming paper applications into the Personnel Cabinet's FileNet system, and manually process every paper enrollment into the General Health Insurance (GHI) Application. In years past, 40 to 60 temporary employees were hired during the enrollment period. Two years ago, state employees from other state agencies participated in a training course so they could assist with processing applications. With the implementation of the 2006 Online Web Enrollment Application, 115,000 employees were able to make their health insurance benefit elections online and receive an confirmation; of these 115,000 employees, approximately 40,000 employees actually enrolled online. The remaining 75,000 either did not make a change (68,000), or submitted a paper application (7,000). This reduced budget expenses for staffing, postage, and printing. It also reduced the error ratio and the number of grievances that normally follow an open enrollment. The system automatically rolled over benefits elections for employees who made no changes, and were assigned a new carrier. The Online Web Enrollment Application has proven to be a significant cost saving initiative and is now considered to be a vital benefit for participants of the Commonwealth Health Insurance Program. 2

3 Project Description Each year months of pre-planning are required to handle the manual enrollment of health insurance for more than 185,000 state employees, local government employees and retirees. The Health Insurance Program has annually changed carriers, plan and rates. Those changes required an approximate staff of 30 full-time employees, 5 contractors, and 40 to 60 temporary staff for a period of 49 to 59 days, and an estimated 60 state employees for 30 days, who worked half days, evenings, weekends, and a few holidays. A large staff was necessary for handling program changes, Insurance Coordinator training, training for fulltime and temporary processors, distribution of open enrollment handbooks, paper applications, numerous phone calls, incoming faxes, opening and scanning incoming paper applications into our FileNet system, quality assurance, and reporting. With the implementation of the 2006 Online Web Enrollment Application, 40,000 employees were able to make their health insurance benefit elections online and receive an confirmation of their enrollment. This reduced expenses for staffing, postage and printing. It also reduced the number of errors and the number of grievances that normally follow an open enrollment. Staffing expenses were drastically reduced because we did not use temporary employees, or part-time state employees from other agencies. Three contractors worked on the project, DEI Staff totaled 21, and fewer over time hours were needed to accomplish our goal. Significance to the improvement of the operation of government The Executive Management Team demonstrated excellence with its vision and support. The team provided the direction and oversight needed to ensure that the appropriate authorities, at all levels, bought into the project and provided the necessary funding for its completion. Their involvement and support throughout the process was integral to the overall success of this project. The management team and staff also played a major role in the success of our Online Web Enrollment system by marketing our product and identifying the benefits of the system for various groups. The management team held meetings to promote the Web Enrollment with the state agencies, retirement groups, the health insurance board and the employee advisory committees, which includes the State Budget Director, the Secretary of the Finance and Administration Cabinet, the Commissioner of Education, the State Auditor, members of the Kentucky Education Association and the Kentucky Office of Insurance, and many others. 3

4 In an effort to promote the efficiency of the system, inter-governmental relationships were built. For example, the Cabinet for Health and Family Services provided access to TrainKY, which hosts online education and tutorials. The use of this service was provided at no cost to the Department for Employee Insurance. TrainKY assisted with development of a tutorial for the web application, which walked employees through the process of enrolling on-line. The Commonwealth Office of Technology (COT) provided a help desk service to assist members who experienced difficulty or had questions related to web enrollment. The Online Enrollment system increased efficiency to the extent that it allowed us to reduce the number of full-time staff, totally eliminate temporary staff, and significantly reduced the number of over-time hours worked. The online system reduced processing time and the clean-up work that follows every open enrollment period from months to a few weeks. Enrollment data was forwarded to the carriers within a time frame of four weeks shorter than in years past. By placing control of the Health Insurance and FSA elections in the hands of the members, it drastically reduced the work load for DEI staff and the agencies insurance coordinators. It also reduced the number of payroll problems experienced due to processing errors and missing enrollment applications. Overall, government operations ran more efficiently with the elimination of the extra time required by the general work force during and after open enrollment. It also lowered the budget expenses for those agencies that paid their state employees who assisted with the open enrollment processing for the 2005 plan year out of their own budget. Benefits realized by service recipients, taxpayers, agency or state The Online Web Enrollment system enabled the completion of open enrollment and transfer of information to the health care third party administrator in four weeks less than had been done in the past with passive enrollments. As an example, for 2004 open enrollment (our last passive open enrolment), the open enrollment period was the first two weeks of October, and information was communicated to the Insurance Carriers on November 24, For 2006 open enrollment, the open enrollment period was from October 17 through October 28, 2005 and files were transmitted to the TPA on November 14, Our customer base consists of active employees from state agencies, boards of education, health departments, quasi governmental agencies and retirees from the retirement systems. The web enrollment allowed the customers to have greater control and it gave them the ability to view and make real-time changes to their own, or in the case of Insurance Coordinators, to their employees enrollment elections. 4

5 Once enrollment was completed, employees were able to immediately print a confirmation of their elections. This resulted in employees ability to take ownership of their health care elections and their peace of mind in knowing that they were receiving exactly the benefits they wanted. The timely benefit feeds to our health insurance carrier and the (FSA) Flexible Spending Account carrier enabled benefits cards to be sent out in mass and in time for benefits to be set up. Our payroll systems, UPPS and MUNIS, received benefit feeds in time to allow timely payroll deductions to be taken for 2006 coverage on schedule. The member groups benefited from replacing printed confirmation information (often a box of paper for some groups) with on-line, real-time tracking of their employees elections to determine the status of open enrollment and individual employee s elections. Our taxpayers benefit from the efficiency of the new system because of the reduction in our operational costs each open enrollment. Realized return on investment, short-term/long-term payback Historically, the Department for Employee Insurance has used temporaries, employees from other agencies who volunteered for overtime, and interim employees during the annual enrollment period. Additionally, significant amounts of overtime were required by DEI employees, and the annual enrollment workload of the agencies Insurance Coordinators. For the 2005 plan year open enrollment (performed in the Fall of 2004), the costs for temporaries and interim employees alone was approximately $182,000. In addition, the cost of production and distribution of printed Enrollment Application forms was approximately $75,000. For the 2006 plan year open enrollment, none of this additional cost was incurred. In addition, while we have been unable to measure the cost savings in the agencies, anecdotal reports indicate that Insurance Coordinators annual enrollment work effort was reduced by half. The Web Open Enrollment system was developed using Microsoft s.net framework and works with Microsoft Internet Explorer 6.0 and above, Netscape Navigator 6.0 and above on Windows 2000 and Windows XP Home or Professional operating systems. The total cost of development and implementation for the Web Open Enrollment system was approximately $198,000. The annual enrollment costs for servers and support staff was approximately $13,900, for a cost for 2005 annual enrollment of $211,900. The $198,000 development cost is not recurring. 5

6 Therefore, the payback for the cost of developing and implementing this system, using a 3.5% cost of capital, is.86 years, and the return on in investment in the second year is 106%, ranging up to 279% in the fourth year. The 3.5% cost of capital reflects the interest rate of the most recent Commonwealth bond activity. As noted above, both the breakeven point and the return on investment does not include the unknown cost avoidance of Insurance Coordinators time. Summary Calculations are presented in the table on the next page, Web Annual Enrollment Return on Investment. 6

7 Department for Employee Insurance Web Annual Enrollment Return on Investment 06/08/2006 Cash flow and ROI statement BENEFITS YEAR Cost of temporary staff, agency overtime, interims (1, 2) $182,000 $185,640 $189,353 $193,140 Cost of application form printing and distribution $75,000 $75,000 $75,000 $75,000 Total annual benefits $257,000 $260,640 $264,353 $268,140 Implementation filter 95% 95% 95% 95% Total benefits realized $244,150 $247,608 $251,135 $254,733 Costs Total $211,900 $14,178 $14,462 $14,751 Benefits Annual benefit flow $32,250 $233,430 $236,673 $239,982 Cumulative benefit flow 32, , , ,335 Discounted benefit flow (Present Value) Discounted costs $204,734 $13,235 $13,044 $12,855 Discounted benefits 244, , , ,985 Total discounted benefit flow 39, , , ,130 Total cumulative discounted benefit flow 39, , , ,921 Initial investment Development, Implementation and Training Costs (3) $198,000 $0 $0 $0 Ongoing Server and Support Costs (2) 13,900 14,178 14,462 14,751 Total costs $211,900 $14,178 $14,462 $14,751 ROI measures Cost of capital (4) 3.5% Net present value $695,173 Return on investment 106% 198% 279% Payback (in years) 0.86 : (1) Does not include realized benefits in member groups from reduced Insurance Coordinator effort (2) Staff and support costs increase at 2% per year (3) Annual enrollment application only. Does not include the cost of planned 7 enhancements to expand functionality of the system (4) Interest rate on recent bond issue used as cost of capital

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