Health Pool Comparison Matrix NLC-RISC Trustees Conference, Newport, Rhode Island

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1 Pool Size - Member groups - Covered lives - Annual premium - Current surplus 590 covered entities 56,655 covered lives $404.5 million annual contributions $88.7 million current surplus 265 member groups 24,182 Covered lives $135.7 million annual premium $61.3 million current surplus 35 covered entities (See Demographics section on next page for breakdown by type of participating entity) 17,200± covered lives 7,300± covered employees $105M Premium Health $5M Premium Dental 70 local government members, primarily municipalities 7,719 covered lives $39.4 million premium $8.9 million surplus 193 member municipalities 4,107 covered lives 1,875 covered employees $28 million premium $2 million surplus $5.4M Surplus Health $115K Surplus Dental Risk Model (i.e. self-insured, purchasing vehicle, servicesonly) Self-insured since inception (1984), except for life and long-term disability plans Self-insured (since 2009) for largest medical and dental PPO plans Insured medical/dental HMOs, life, disability Overall Pool is Self-insured since inception (2005), except for certain Medicare supplement plans Individual Members provided Guaranteed Rates Self-insured (since 1981) Purchasing Vehicle with CIGNA as insurer Separate pools for Health and Dental Pool since 2009 Page 1 of 6

2 Demographics - Member size - Regionalization - Other Coverage is statewide Community rate groups with under 100 employees Offer two renewal options January and July Coverage provided to municipal, county and school entities Provide coverage and services statewide. 89% of employers have fewer than 100 employees, but groups > 100 account for 40% of the pool s population By law, only groups with more than 50 employees may be experience-rated and therefore eligible for the program Coverage for: 18 Municipalities 12 Schools 5 Special Purpose Districts linked to municipality as sponsoring parent Common rating among entities (school, municipality, special purpose district) within a municipal border <50 employees 47 members with 22% of employees/retirees >50 employees 23 members with 78% of employees/retirees All local government entities-no schools <50 employees 184 members employees 9 members No schools No regionalization Page 2 of 6

3 Market Drivers - Competition - Provider models - Unions Virtually all local governmental employees covered by union agreements, which require collective bargaining for health benefits. Until recently, virtually all union contracts specify Blue Cross Blue Shield or equivalent for health coverage and Delta Dental or equivalent for dental coverage. Public competition from two other NH based public sector risk pools. One announced recently that it will exit the health market on June 30, A number of private insurers, particularly regional ones, provide competition. Biggest threats have been from the state legislature, members of which have expressed a great interest in bringing all public employees into one plan to drive the market (and were successful in doing so with school districts but with lessthan-stellar results). Unions have not been an issue per se, except to the extent that collective bargaining limits changes in plan design. Virtually all local governmental employees covered by union agreements which require collective bargaining for health benefits Until most recently, virtually all union contracts specify Blue Cross Blue Shield or equivalent for health coverage and Delta Dental or equivalent for dental coverage, though new State law allows local governments to change that unilaterally. BCBS still much preferred by unions. Private competition only from United Healthcare, and very limited though growing. Public competition from two other RI based intergovernmental pools/programs similar to RI Trust Health Pool, though with some key differences. Commercial competition State Health Plan availability Increased medical costs & utilization Economy-reduction in revenues State Legislaturerestrictions on local governments ability to generate needed revenue Federal Healthcare law unknowns No unions Competition Collective bargaining State regulation State level reform Limited number of insurers Secondary competition indirectly from BCBS and Delta Dental, though local governments securing identical coverage through RI Trust Health or Dental Pools enjoy lower rates due to much lower administrative charges from BCBS and Delta Dental through The RI Trust Pools. Page 3 of 6

4 State Regulation (i.e. state oversight, rate filings, special public sector benefit requirements) Limited state oversight; self-insured pools are exempt from state insurance laws, but do have to file an annual report of financial and coverage information with the Secretary of State. Local governments must permit retirees to participate in the same medical coverage as actives and shall be deemed part of the same group as active employees for purposes of determining medical premiums. Limited State oversight; municipal self-insured pools are exempted from the state insurance code, but do have to file an annual report of financial and coverage information. Local governments must offer pre- Medicare retirees same plan as actives as same rate, but don t have to pay anything toward the cost. No State regulation of any kind However, new (and contested) State law requires school districts to offer one of only six plans, the top plan being equal actuarially to the State plan for its employees. Must be implemented as union contracts expire. Similar law now being proposed for municipalities. (Currently, local governmental units negotiate with their unions over all benefit terms and conditions. As a result, Health Pool offers probably about 125 to 150 different plans.) No State regulation Heavy state regulation for small group market (<50) Community rating for small group market Page 4 of 6

5 Benefit Design (i.e. number of plans, level of customization, types of plans HMO, PPO, high deductible) Guide to Acronyms: HDHP = High Deductible Health Plan HSA = Health Savings Account HRA = Health Reimbursement Account Offer five core medical plans: POS (38%) Indemnity (8%) HMO (35%) HDHP/HSA (0%) Medicare Supplement (19%) Many, many variations exist as a result of changes in deductible levels, prescription drug coverage, co-pays, etc. Medicare Supplemental plans are offered with and without prescription drug coverage. Medical Plan Options: Plan V PPO (90/10, choice of deductibles, Rx) Plan I PPO (80/20, choice of deductibles and drug cards) Copay Plan PPO ($20 copay, 80% coinsurance, Rx) HDHP w/hsa ($1,500 and $2,500 deductible options) Kaiser Permanente HMO As noted above, Health Pool offers probably about 125 to 150 different plans. There are, however, four core plans: PPO (94%) Indemnity (2%) HMO (2%) HDHP/HSA (2%) Variations are then extensive in terms of deductible levels, prescription drug coverage, copays, etc. Medicare Supplemental and limited Medicare Advantage enrollment for Medicare eligible retirees. 9 different plan options 4 standard PPO plans 1 HDHP 2 HRA Plans 1 HSA Plan 1 Medicare Supplement Plan The above include two PPO network options 16 different plans Indemnity 2 plans PPO 9 plans HDHP 5 plans Includes 2 Rx plan choices Retiree plans Six plans currently closed to new members POS = Point of Service PPO = Preferred Provider Organization Rx = Prescription Drug Page 5 of 6

6 Value-Added Services (i.e. wellness programs, Employee Assistance Program EAP, Health Savings Account HSA, or Health Reimbursement Account HRA, etc.) Other coverage options: Short-Term Disability Long-Term Disability Flexible Spending Account administration Extensive health management programs including a personal health analysis with incentive payment, reimbursement for health management and physical fitness classes, incentives for selfreported physical activity, and telephonic health coaching WellDollar grants for employer level wellness activities Other coverage options: Vision Long-Term Disability Long-Term Care Flexible Spending Account administration Worksite wellness screenings & grants Weight management, tobacco cessation, health coaching EAP services COBRA/Retiree administration Other coverage options: Pool Group Life (underwritten by private carrier with RI Trust assuming no risk) Medicare Part D Drug Processing Wellness Programs offered through BCBS Other coverage options: Vision $300 wellness benefit no copay/no deductible Extensive case management/ disease management programs, including prenatal Tobacco cessation program COBRA/Retiree administration On-site health risk appraisals and biometric screenings Other coverage options: Vision Disability Long-Term Care Extensive wellness programs EAP Health Advocate COBRA admin HRA admin EAP program which includes on-site trainings Grant program COBRA/Retiree administration Page 6 of 6