Pasadena Area Community College District Future Plan Design Changes/New Plans

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1 Pasadena Area Community College District Future Plan Design Changes/New Plans September 17, 2015

2 Healthcare Renewal Process Keenan saved the District money by applying strong negotiations, which netted reductions in the initial rate renewals for the District s healthcare plans Anthem HMO: initial renewal was a +9.0% increase Keenan negotiated; resulting in a +7.0% increase Anthem PPO: initial renewal was a % increase Keenan negotiated; resulting in a reduction to +12.0% increase Kaiser HMO: initial renewal was a <5.0%> decrease Keenan s reviewed the renewal and agreed with 5% reduction Delta Dental CSDC: initial renewal was a 4.55% increase Keenan s reviewed the renewal and agreed with 4.55% increase to build reserves Delta Dental AB528: No change to rates; 2 nd year of rate guarantee 2

3 Healthcare Renewal Process Continued Medical Eye Services Full Service and MES Eye Wear Only: No change to rates; 2 nd year of rate guarantee Hartford Long Term Disability (LTD): No change to rates; 2 nd year of rate guarantee Keenan Saver Rx Discount Rx Program: No Cost to District or Employee and Dependents 3

4 Plan Design Discussions Recap 27 Different PPO Plan Designs Reviewed Anthem Home Delivery Choice Program Allows members to fill maintenance medications at retail twice, after which they have to either switch to mail order, or they have to call our pharmacy department and proactively notify them that they are making an informed decision/choice to continue filling their maintenance medication at retail. As long as they call, there is no penalty for continuing to use retail. However, if they don t call to notify Anthem of their choice, the member is 100% responsible for the full cost of the retail Rx. Industry standard; member pays for postage if they elect to complete the Rx form and send a copy of their prescription into the Rx Mail Order vendor. However, this postage cost can be avoided if they just have the doctor send the prescription into the Rx Mail Order vendor directly. Receiving the prescription through the mail this postage is absorbed by the Rx Mail Order vendor and not passed onto the employee/recipient. Adding $100 ER Copay IF this had been the ONLY change PACCD made, then the net result would be an increase in the rates; because this change in ER copay would pierce the Grandfathered status, and the required plan changes would outweigh the decrement for the ER copay change. 4

5 Plan Design Discussions Recap Continued Additional Benefits by piercing Grandfather Status i.e. move to non- Grandfather Status under the Affordable Care Act (ACA): All In-Network Preventive Care Services (for children and adults, including female contraceptives, breast pumps/supplies, etc.) will be covered at 100% with zero employee/member cost share. Anthem s standard benefit summaries: Preventive Care Services including*, physical exams, Preventive Screenings (including screenings for cancer, HPV, diabetes, cholesterol, blood pressure, hearing and vision, immunizations, health education, intervention services, HIV testing), and additional preventive care for women provided for in the guidelines supported by the Health No copay (deductible waived) 5

6 Healthcare Plan Design Changes Anthem PPO Plan Design Changes are: Mandatory Mail Order Home Delivery Choice Program $100 Emergency Room copay All In-Network Preventive Care Services (for children and adults, including female contraceptives, breast pumps/supplies, etc.) will be covered at 100% with zero employee/member cost share. All Cost Shares (deductibles, copays, coinsurance including Rx cost shares) will now apply toward the satisfaction of the overall Out-of-Pocket Maximum. Once the Out-of-Pocket Maximum is met, members will no longer be responsible for any cost share, including Rx copays. The only thing members would be responsible for would be any amounts in excess of the maximum allowed amount for services provided by a nonparticipating provider or pharmacy (this is already in place today). Previously the Out-of-Pocket Maximum was $200 In-Network and $400 Out-of-Network for each individual and was unlimited (i.e., 10 individuals = $2,000/$4,000). Effective October 1, 2015 it will be $200 per individual for In- Network providers and $400 per individual for Out-of-Network providers, capped at $600/$1,200 (or three individuals). There were no District plan design changes made to the following plans: Anthem Premier HMO Plan Kaiser Permanente HMO Plan Delta Dental PPO Plan MES Vision Plans Hartford LTD 6

7 Dental DHMO & Vision Plan Marketing Future Plan Design Changes Dental Plan Evaluation Criteria: Most Cost Effective (premium savings?) Rate Guarantee Minimum Enrollment Requirement Highest Orthodontia Benefit Implants included Crown Benefit Vision Plan Evaluation Criteria: Most Cost Effective (premium savings?) Rate Guarantee Basic Progressive Benefit Revisit one or both for Plan Year ? 7