National Governor s Association Center for Best Practices

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1 National Governor s Association Center for Best Practices Data, Technology and Benefit Design to Manage State Employee and Retiree Health Programs Sustaining Retiree Health Care in Nevada June 25, 2013 James R. Wells, CPA Executive Officer State of Nevada Public Employees Benefits Program June 25,

2 Who we are What we did prior to 2011 Why the changes Solutions Agenda Medicare Exchange (Implementation, Outreach, Subsidization and Enrollment) Retiree experience (Issues, Surveys and Claims Audit) Other Post Employment Benefit Liability Key Takeaways What s next? June 25,

3 Who We Are PEBP Board s Mission Statement: Recognizing the fiduciary responsibility of the Board, promote wellness, transparency, ease of use, communications and integration of PEBP programs centered around the people we serve. June 25,

4 As of May 1, 2013: 23,636 Active Employees Who We Are 23,612 State; 24 Local Government 8,843 State Retirees 3,822 on State Plans; 5,021 on Medicare Exchange 7,976 Local Government Retirees 3,373 on State Plans; 4,603 on Medicare Exchange Separate rating pools for State and Local Government About 1,000 who will never have Medicare Part A June 25,

5 What We Did Prior to 2011 Commingling retirees and active employees implicit subsidy Medicare retirees for Rx and Dental only Cash Subsidy explicit subsidy Both primary participants and dependents subsidized No collective bargaining for State employees Only State has a formal retiree healthcare subsidy benefit Legislative Changes to Cash Subsidy 2009 increased minimum years of service from 5 to 15 for those hired after 1/1/ eliminated for those hired after 1/1/12 can still participate in plan June 25,

6 Why the Changes? $3 Billion Shortfall on $7 Billion biennial State budget Flat State subsidies for healthcare - $111.2M gap between what the State would provide and the amount actuaries projected would be required to maintain the current benefits at the same contribution ratio Participants would be responsible for covering all of the costs of medical inflation and utilization increases for the biennium. Political climate: Spending and Government Efficiency Commission Nevada Taxpayers Association Local Chambers of Commerce June 25,

7 The PEBP Board considered: The Solutions Reducing benefits (e.g., increasing deductibles, copayments, coinsurance and out-of-pocket maximum) Increasing participant premium cost sharing Converting the self-funded Preferred Provider Option (PPO) plan to a Consumer Driven PPO High Deductible Health Plan (CD PPO HDHP) Eliminating benefits (e.g., life insurance, vision and dental) Moving Medicare retirees to the individual market through an Exchange June 25,

8 The Solutions The Board approved a multi-pronged approach: Reduced dental coverage and life insurance; Converted the PPO plan to a CDHP Reduced coinsurance rates Added contributions to HSA and HRA Accounts Increased participant cost sharing for monthly HMO premiums; Transition Medicare retirees to the individual market through an Exchange o Provide monthly Health Reimbursement Arrangement contribution June 25,

9 Medicare Exchange Move retirees eligible for Medicare Part A to an Individual Market Medicare Exchange Eliminate premium subsidy and Fund an HRA for retirees in the Medicare Exchange $10 per month per Year of Service (YOS) o o o minimum 5 YOS ($50/month; $600/year) maximum 20 YOS ($200/month; $2,400/year) $150/month for pre-94 retirees, regardless of YOS Can be used for premiums or other out of pocket cost for both the primary retiree and the spouse June 25,

10 Medicare Exchange Offers Medicare Advantage and Medigap plans provided by recognizable insurance companies (e.g., Anthem, Cigna, Aetna, Humana, United Healthcare, etc.) Guaranteed issue and pricing regardless of health status Multiple plans available in every zip code in which PEBP Medicare retirees reside Larger risk pool (40+ million) over which to spread risk Provides for more competitive rates due to the size of the risk pool and the competition in each geographic location Allows for similar benefits at lower cost for PEBP and retiree June 25,

11 Medicare Exchange Allows for participant and spouse to enroll in different plans depending on their individual circumstances Healthy individual may select a low premium plan Member with medical conditions can select a plan covering more out-of-pocket costs Spouse may select different plan from retiree Based on RX usage, geographic location, provider preferences Provides licensed benefit advisors to guide retirees through the plan evaluation and selection process Provides advocacy to retirees in dealing with insurers Can add Rx, dental and vision coverage through Exchange June 25,

12 Medicare Exchange Retirees not eligible for Medicare Part A or those with non- Medicare eligible Dependents Option to remain on non-medicare HDHP or HMO Plan Pay non-medicare retiree rates and receive premium subsidy and HRA contributions as a non-medicare retiree Receive a credit for primary insured Medicare Part B premium Option for retiree to go on Exchange and pay full premiums for dependents remaining on the HDHP or HMO Eligible to participate in PEBP Dental coverage (voluntary) Eligible for Basic Life (except reinstated retirees) June 25,

13 A win-win proposition Medicare Exchange Reduce State and participant out-of-pocket costs Provide more participant choice Provide better benefits for a majority of the retirees Evaluating the marketplace, Extend Health (EH): Offered these services longer than their competitors Had transitioned very large corporate employers with significant Medicare retiree populations Had worked with public sector clients Offered integrated HRA administration June 25,

14 Medicare Exchange We re in it together Implementation Preparation Concurrent with contract negotiations, a team of EH and PEBP staff: Developed a Population Summary Document, including: o o o o Eligibility requirements for participating in the Exchange Exceptions to remain part of the group health insurance program Documenting the design and rules for HRA contributions Other components of the implementation and transition strategy Formulated a communications campaign and timeline Created a data sharing agreement as well as rules and associated timelines for those who would age in after the initial transition June 25,

15 Medicare Exchange Retiree Outreach Retirees were skeptical of the Exchange; education and communications would be critical More than 80 informational sessions throughout the State between 10/2010 and 02/2011 5,200 retirees attended Open Enrollment information (04/ /2011) - 2,200 retirees attended Official announcement of the transition mailed by PEBP in December 2010 We re in it together June 25,

16 EH provided: Medicare Exchange Retiree Outreach A dedicated customer service team for the transition A unique toll-free telephone number and website for PEBP o secure on-line profile for contact, RX & provider information We re in it together A co-branded suite of printed communications to educate and guide retirees through the process First EH mailing in late January 2011 Focus on helping retirees gather RX & provider information Set up enrollment appointment June 25,

17 Medicare Exchange Subsidization and HRA Cash subsidy provided by statute Pre-1994 retirees receive a flat base amount Post-1994 retirees based on years of service Expanded to local government retirees in 2003 Medicare HRA based on the subsidy structure above Base HRA contribution set at $150 per month We re in it together Post 1994 retirees receive $10 per month per year of service up to a maximum of $200 per month Must have at least five years of service (15 if hired after 1/1/10) Dependents and survivors do not receive contribution Unused balances revert upon death or termination June 25,

18 Medicare Exchange We re in it together Special Enrollment Period (SEP) 4/1/2011 through 9/2/2011 (90 days before and 63 days after the date on which the retirees lost group health insurance coverage) Each retiree engaged in a telephonic conversation with an EH benefit advisor who helped the retiree : Review and evaluate available plans Choose plan(s) best suited to RX usage, geographic location, lifestyle and provider preferences Complete the insurance carrier application(s) June 25,

19 Medicare Exchange No Retiree Left Behind 11,953 members eligible to enroll during SEP 10,316 enrolled in EH (86%) 1,067 enrolled in PEBP w/ non-medicare dependents (9%) 338 enrolled outside PEBP or EH (3%) 181 determined to be deceased (1.5%) Only 51 were not located or contacted (0.5%) We re in it together 446 Different plans from 81 different carriers (as of 6/30/12) 73% Medigap 27% Medicare Advantage Over 4,800 have enrolled in the PEBP self-funded dental plan June 25,

20 Retiree Experience Participant Issues 403 transition complaints/issues thru 9/1 (SEP) Concerns relating to the transition in general (23%) Erroneously receiving request from specific carrier (19%) HRA/Auto-Reimbursement process (4%) Plan availability/pressured (3%) Incorrect effective dates (3%) RX Costs (2%) 250 post implementation complaints/issues (thru 1/31/12) HRA/Auto-Reimbursement process (58%) Problems with enrolling (18%) Concerns relating to the transition in general (7%) Plan availability/pressured (5%) We re in it together June 25,

21 Retiree Experience Participant Issues HRA and Auto-Reimbursement Issues Communications and expectations issue Reimbursement delay based on carrier notification timing Inconsistent documentation requirements Partial claim reimbursements We re in it together Electronic data transfers relative to age-in and new retirees subsequent to the SEP and a return transfer to PEBP to close the information loop June 25,

22 Retiree Experience Extend Health Survey 4,222 of the 10,316 enrolled were surveyed We re in it together 1,688 responses (40.0% response rate to the number of surveys sent; 16.4% of total enrolled population) On a scale from 1-10, how satisfied are you with Extend Health s service? Average score from PEBP retirees was 8.6 More than 65% giving the service a 9 or 10 Less than 5% giving the service a 4 or less June 25,

23 9,065 surveys sent Retiree Experience PEBP Survey We re in it together 3,582 responses received (39.5% response rate) Overall satisfaction with the value of the health care benefits, the premium cost of the plan(s), the contribution amount of the HRA? 79.1% satisfied or greater (average score 3.18 on scale of 5) Received enough information to make informed decision? 76.5% satisfied or greater (average score 3.21 on scale of 5) 80.8% believe Extend Health is committed to providing longterm support and advocacy 60.6% believe concerns will decrease over time June 25,

24 Retiree Experience We re in it together PEBP Survey The satisfaction scores decreased when participants attempted to change their plan during the first general open enrollment period after the transition: 74.8% satisfied or greater (average score 3.08 on scale of 5) 31.1% experienced difficulty with HRA reimbursement Once a participant had a problem with their HRA reimbursement, they were not as pleased with the HRA customer service 66.8% satisfied or greater (average score of 2.89 on scale of 5) Age-in participants more likely to have enrollment issues than those during the initial transition June 25,

25 Retiree Experience We re in it together PEBP Audit PEBP routinely audits the claims payment processes of our vendors to insure claims are being adjudicated correctly. First year s audit found: Lower than expected payment accuracy percentage Inconsistencies in documentation requirements Inconsistent/incorrect service dates entered, especially premium reimbursements Issues with format/documentation requirements for certain claim types Issues with tracking incoming claims Issues with Explanation of Benefits containing insufficient information Issues with the timing of processing electronic claims files Issues with reprocessing claims for retroactive eligibility changes June 25,

26 Retiree Experience We re in it together PEBP Audit Extend Health and PayFlex have been very proactive in correcting problems identified during the audit Many issues had been or were in the process of being corrected at the time of the audit or shortly thereafter Extend Health and PayFlex submitted a formal corrective action plan and timeline to address all outstanding issues PayFlex implemented specific changes for PEBP claims to process in accordance with our plan rules as well as global changes for how premium claims are processed Performance Standard Guarantees added to the contract as a result of the audit Penalties associated with not meeting the performance standards Follow up audit reported significant improvement June 25,

27 OPEB Liability Pre-conversion (7/1/09 Valuation) Present Value of Benefits - $3.26B Actuarial Accrued Liability - $1.87B Annual Required Contribution - $222.1M Post Conversion (7/1/10 Valuation)* Present Value of Benefits - $1.77B (decrease of $1.49B) Actuarial Accrued Liability - $977.0M (decrease of $897M) Annual Required Contribution - $120.0M (decrease of $100.8M) *Assumes no increase in future HRA contribution amounts; any future inflation in HRA contributions (which are likely) will increase OPEB liability. June 25,

28 Key Takeaways Stay involved in the transition Being off-cycle was a big advantage (except high RX users) Follow up on issues Data exchange is critical Staffing capacity Communications Early and often Changes it s the little things Capacity of retirees to understand what is going on Managing perceptions - Help retirees understand this is not a takeaway, but an opportunity to get a plan right for their needs and budget June 25,

29 What s Next? Continued reporting to and oversight by the PEBP Board and the Legislature Monitoring the HRA to address decreases in buying power due to premium increases Monitoring the impact of the Federal Health Care Reform Exchanges on the marketplace Identifying potential opportunities for non-medicare retiree population PEBP required to go to bid in 2014 Use experiences to generate an RFP June 25,

30 James R. Wells, Executive Officer Public Employees Benefits Program 901 South Stewart Street, Suite 1001 Carson City, NV (775) Website: June 25,

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