HomeMy WebLinkAbout12-151RESOLUTION NO. 12-151
A RESOLUTION AUTHORIZING A CHANGE OF THE EMPLOYEE HEALTH BENEFIT PLAN OPTIONS,
ADJUSTMENT OF CURRENT EMPLOYEE HEALTH INSURANCE PREMIUMS/CONTRIBUTIONS
AND USE OF INSURANCE FUND RESERVES TO DISCOUNT TOTAL FUNDING OF THE PLAN.
WHEREAS, the Board of County Commissioners of St. Lucie County, Florida, based on information provided
by the Insurance Advisory Committee and County staff, has made the following determinations:
1. County staff, in conjunction with the County Benefits Consultant and the County Health Plan Third-Party
Administrator, developed alternative benefit plan options and premiums calculated to fully fund the health
plan as shown in Column Four of Attachment C and employee contributions that would be based on a
percentage of premiums as shown in Column Six of Attachment C.
2. That there are sufficient Insurance Fund reserves and therefore the Insurance Advisory Committee's
recommendation that $2,660,000 of the Insurance Reserves be used for aone-time discount of the Health
Plan Full Funding rates is reasonable.
3. That the Insurance Advisory Committee's recommendations to drop current benefit Plan-3562 and replace it
with Plan-3566 is appropriate. That it is desirable to offer both Low and High Benefit plans and that Plan-
3566 and Plan-3766, as shown in Attachment D, should be the Low and High Health Benefit plan options
offered to all Constitutional Officer and Agency employee's desiring to enroll for CY-2013.
4. That the discounted premium rates and the employee contribution rates as listed in Attachment A should be
the Premium and the contribution rates applied to all Constitutional Officer and Agency participants in the
County Health Plan for CY-2013.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of St. Lucie County, Florida:
That Health Plan-3562 is dropped and replaced with Plan-3566 which shall be offered with Plan-3766 to all
Constitutional Officer and Agency employee's desiring to enroll in a health plan for CY-2013 and that the use of
$2,660,000 of Health Fund reserve to discount the full premiums is approved and t hat the premium/contributions
to the County Health Plan shall be those shown in Attachment A and C and shall be in effect for CY-2013.
After motion and second, the vote on this Resolution was as follows:
Chairman Chris Dzadovsky AYE
Vice Chairman Tod Mowery AYE
Commissioner Chris Craft AYE
Commissioner Frannie Hutchinson AYE
Commissioner Paula A. Lewis AYE
PASSED AND DULY ADOPTED this 4th day of September 2012.
BOARD OF COUNTY COMMISSIONERS
ST. L Y, D
BY:
airma
APPROVED AS~TO FORM AND
BY:
Cou
Attachment A
MEMORANDUM
TO: Tod Mowery, Chairman BOCC
Chris Craft, BOCC
Frannie Hutchinson, BOCC
Paula Lewis, BOCC
Faye Outlaw, County Administrator
Dan McIntyre, County Attorney
Tara Raymore, Director Human Resources
Dan Lutzke, Risk Manager
FROM: Insurance Committee ~'~~.
DATE: July 11, 2012.
RE: Insurance Committee Recommendations for Fy 2013
Following an Insurance Committee Meeting on July 10, 2012 at 2:00 p.m., the committee voted to
approve the recommendations of the Tax Collector, Mr. Bob Davis, CPA, CGFO, CFC which state the
following:.
1. Plan 3566 will be offered to the employees of St. Lucie County at the following costs:
Total Employer
Contribution Employee
Contribution
Emplo ee Onl 420.00 420.00 0
Em loyee + 1 840.00 807.00 33.00
Family 1,050.00 1,008.00 43.00
2. The second recommendation is that $2,660,000 in reserves is used to partially fund health
insurance costs for the upcoming year. Participants in plan 3766 would not experience any price
increase. Employeesthat have coverage for Employee plus one will. actually have a $7.00
decrease in contribution amount. The rate schedule for plan 3766. is as follows:
Total Employer
Contribution Employee
Contribution
Emplo ee Only 474.36 449.36 25.00
Em to ee + 1 983.43 910.43 73.00
Family 1,206.46 1,121..46 85.00
Attachment: Projected revenue and expenses
Attachment A
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Attachment B
ST. LUCIE COUNTY, FLORIDA
STATEMENT OF NET ASSETS
HEALTH INSURANCE FUND -UNAUDITED
Assets
Current assets:
Cash and investments
Accounts receivable, net
Interest receivable
Due from other governments
Inventory
Prepaid items
Total current assets
Nan-current assets:
Buildings and improvements
Machinery and equipment
Accumulated depreciation
Total non-current assets
Total assets
Liabilities
Current liabilities:
Accounts payable
Claims payable
Accrued liabilities
Interest payable
Capital Lease
Accrued compensated absences
Total current liabilities
Non-current liabilities:
Capital Lease
OPEB Liability
Total non-current liabilities
Total liabilities
Fiscal Year Ending Fiscal Period Ending
September 30, 2011 March 31, 2012
$ 23,244,451 $ 23,182,966
177,422 8,008
125,105 -
27,666 -
17,810 17,810
30,000 30,000
23,622,454 23,238,781
216,388
133,847
(29,237)
320,998
23,943,452
216,388
133,847
(29,237}
320,998
23,559,779
935,483
1,460,000
38,624
3
393
80,779
1,460,000
175
103
2,28a 2,280
2,436,783 1,543,337
216
29,589
29,805
2,466,588
216
29,589
29,805
1,573,142
Net assets
Invested in capital assets, net of related debt 320,389 320,679
Unrestricted 21,156,475 21,665,958
Total net assets $ ~ 21,476,864 $ ~ .21,986,637
ATTACHMENT C
St. Lucie County BOCC Health Plan Funding
Health Plan Funding Comparison - CY-2012 v. CY-2013
For FY-2012
~,
Plan Options
# Enrolled by Plan
Plan 3562 / PPO
Employee Only:
Employee + 1:
Family:
Total for Plan
Plan 3766 / PPO
Employee Only:
Employee + 1:
Family:
Total for Plan:
Rates by Tier
Plan 3562 / PPO
Employee Only:
Employee + is
Family:
Plan 3766 / PPO
Employee Only:
Employee + 1:
Family:
Total Monthly Funding By Tier
Plan 3562 / PPO
Employee Only:
Employee + 1: '
Family:
Plan 3766 / PPO
Employee Only:
Employee + 1:
Family:
Total Monthly Funding:
Mnual Premiums 1 Contributions:
$ - $ -
Other Funding Sources Included: $467,000 $467,000 $ 305,000 $ 305,000
Health Fund Reserves Utilized: $0 $2,000,000 $ - $ 2,660,000
Total Budgeted Funding: $12,228,347 $12,239,237 $12,363,074 $ 12,363,073
Required Annual Funding: $12,239,237 $12,239,237 $12,363,074 $ 12,363,073
INCLUDED EXPENSE INCLUDED EXPENSE
FY-2011 Final Claims: $ 8,789,679 Fv-2012 Final claims: $ 9,321,096
Stop-Loss Insurance: $ 1,138,135 Stop-Mross Insurance: $ 1,200,000
Miscellaneous Expenses: $ 842,011 Mental Health : $ 124,323
Clinic Operations: $ 982,192 Clinic Operations: $ 1,011,887
CountyAdministrotiveExpenses: $ 487,220 TPA Expenses: $ 705,768
2012 Required Funding: $ 12,239,237 2013 -Funding: $ 12,363,074
Summary of Benefits
St. Lucie BOCC 1/1/13 thru 12/31/13
Attachment D
Option 1 Option 2
• -•. ••. .
- -
Deductible (DED) (Per Person/Family Agg)
In-Network $500 / $1500
~ $0 / $0
Out-of-Network
' $1,000 / $3000 $500 / $1,500
Coinsurance (Member Responsibility) ~~ ,
In-Network 20%
Out-of-Network .
10% -°~~ "~
% '~
"
50% 50
,,
:
Out of Pocket Maximum (Per Person/Family Agg) Includes DED, Coins: Includes DED, Coins:
Excludes Copays 8t Rx Excludes Copays 8t Rx
In-Network i $3,000 $2,500
Out-of-Network i $6,000 Combined w/In-Ntwk
Lifetime Maximum .No Maximum No Maximum
-o • -• ~
Allergy Injections
In-Network Family Physician ~ $30 $25
In-Network Specialist j $50 $45
Out-of-Network DED + 50% DED + 50%
E-Office Visit Services j
In-Network Family Physician $10 j $10
In-Network Specialist
Out-of-Network $10 ~
DED + 50% ' $10
.DED + 50%
Office Services
In-Network Family Physician $30 $25
In-Network Specialist
~ $50 $45
Out-of-Network DED + 50% DED + 50%
Provider Services at Hospital and ER
In-Network Family Physician I DED + 20% ~ 10% (No DED)
In-Network Specialist
Out-of-Network DED + 20%
In-Ntwk DED + 20% 10% (No DED)
Varies by Provider Type
Provider Services at Other Locations
In-Network Family Physician ~ DED + 20% 10% (No DED)
In-Network Specialist i DED + 20% 10% (No DED)
Out-of-Network i DED + 50% DED + 10%
Radiology, Pathology and Anesthesiology Provider Services
at Ambulatory Surgical Center or Hospital
In-Network Specialist DED + 20% ~ 10% (No DED)
Out-of-Network In-Ntwk DED + 20% 10% (No DED)
Adult Wellness Office Services
In-Network Family Physician $0 $0
In-Network Specialist $0 $0
Out-of-Network 50% (No DED) 50% (No DED)
Colonoscopies (Routine) Age 50+ then Frequency i Age 50+ then Frequency
Schedule Applies Schedule Applies.
In-Network $0 $0
Out-of-Network $0 $0 ,
,
Mammograms (Routine and Dx) i
In-Network I $0 $0
Out-of-Network !, $0 $0
Well Child Office Visits (No BPM)
I
N
k F
i
Ph
i
i
0 i
n-
etwor
am
ly
ys
c
an $ $0
In-Network Specialist $0 $0
Out-of-Network 50% (No DED) 50% {No DED)
•
Ambulance Maximum (per Day) No Maximum No Maximum
In-Network DED + 20% 10%
Out-of-Network
Convenient Care Centers (CCC) In-Ntwk DED + 20% 10% (No DED)
Jn-Network $35 $25
Out-of-Network DED + 50% DED + 50%
*~~ : V-
FLORIDA
61ue Cross and Lilue Shield of Florida. its subsidiary Health options and its aitillate Florida Combined Life, are all Independent Licensees of the Blue Cross and 61ue Shield Association to the purwhaF6whh
Attachment ll
1 Option 2
Emergency Room Facility Services
(also see Professional Provider Services)
In-Network
DED + 20% $50
DED + 2p% $50
$50 I ' ` $95
j In-Network ~ DED + 2p% $250
Out-of-Network
Independent Clinical Lab.
In-Network I DED + 50%
i DED + 50%
I
I $0 10%
Out-of-Network DED + 50% DED + 50%
Independent Diagnostic Testing Facility -
Xrays and AIS (Includes Physician Services)
In-Network -Advanced Imaging Services (AIS) i DED + 20% 10%
In-Network -Other Diagnostic Services DED + 20% 1 p%
Out-of-Network
Inpatient Hospital (per admit).
In-Netwo
k , DED + 50% DED + 50%
r Option 1 -DED + 20% Option'1 - $300
Out-of-Network
- I Option 2 -DED + 20%
DED + 50%
j Option 2 - $300
D
D
+
0%
Inpatient Rehab Maximum
Outpatient Hospital (per visit)
I
N 21 Days
i i ~
D
~
n-
etwork Option 1 -DED + 20% I Option 1 - $250
Out-of-Network Option 2 -DED + 20% ~
DED + 50% I Option 2 - $250
DED + 50%
Therapy at Outpatient Hospital
In-Network O lion 1 $45 °
P - Optlon 1 -10 /o
I Option 2 - $60 Option 2 - 10%
DED + 50% DED + 50%
~ In-Network Family Physician DED + 20% 10% (No DED)
In-Network Specialist
I
DED + 20%
10% (No DED)
Out-of-Network I DED + 50% DED + 50%
~ .Birthing Center
~ ~ In-Network ~
Out-of-Network
DED + 20%
`
10% (No DED)
~ DED + 50% DED.+ 50%
~ Durable Medical Equipment, Prosthetics, Orthotics BPM i, Enteral Formulas:$2,500Rll Enteral Formulas:$2,500 All
Other: No Maximum Othe
: No Maximum
In-Network DED + 20 /0 r
10 /o (No DED)
Out-of-Network
Home Health Care BPM DED + 50%
40 Visits DED + 50%
40 Visits
1n-Network +
' Out-of-Network
I DED
20%
DED + 50% 1010
DED + 50%
I
Hospice LTM ~ No Maximum i No Maximum
In-Network DED + 20% 10%
j Out-of-Network DED + 50% DED + 50%
Outpatient Therapy and Spinal Manipulations BPM i 70 Visits (Includes up to 26 ~ 70 Visits (Includes up to 26
Spinal Manipulations) Spinal Manipulations)
, Skilled Nursing Facility BPM I 120 days 120 days '
In-Network i DED + 20% 1p%
Out-of-Network DED + 50% DED + 50%
• ~-
In-Network ,
Retail (30 days) ~ ~
GeneriGPreferred Brand/Non-Preferred $10 / $35 / $45 $6 / $25 / $25
Mail Order (90 days)
' Generic/Preferred Brand/Non-Preferred ,' $20 / $70 / $90 $12 / $50 / $50
I Out-of-Network
Retail (30 days)
Generic/Preferred Brand/Non-Preferred 50% / 50% / 50% 50% / 50% / 50%
Mail Order (90 days)
GeneriGPreferred Brand/Non-Preferred. ~_ _ _ _ 50% / 50% / 50% 50% l 50% / 50%
r~~ .:
. ~,; ,.e Shir-ld of Florida, its r~ibsidiary Health Options and its artiliate Florida Combined Life, are all Inde~~ndent Licensees of the Blue Goss and Dlue Shield Association FLORIDA
h d,e purwlt of healrh
Attachment D
Diabetic Supplies (lancets, strips, etc.) are covered under the Rx benefit. Diabetic Equipment (insulin pumps, tubing) are always
covered under the medical benefit.
This is not an insurance contract or Benefit Booklet. The above Benefit Summary is only a partial description of the many
benefits and services covered by Blue Cross and Blue Shield of Florida, Inc., an independent licensee of the Blue Cross and
Blue Shield Association. For a complete description of benefits and exclusions, please see Blue Cross and Blue Shield of
Florida's Benefit Booklet and Schedule of Benefits; their terms prevail.
The information contained in this proposal includes benefit changes required as a result of the Patient Protection
And Affordable Care Act (PPACA), otherwise known as Health Care Reform (HCR). Please note that plan
benefits are subject to change and may be revised based on guidance and regulations issued by the Secretary of
Health and Human Services (HHS) or other applicable federal agency. In addition, the rates quoted within this
proposal are based on the plan benefits at the time the proposal is issued and may change before the plan
effective date if additional plan changes become necessary.
Additionally, Interim rules released by the Federal Government February 2, 2010 require BCBSF to test all benefit
plans to ensure compliance with the Mental Health Parity and Addiction Equity Act (MHPAE). Benefits reflected in
the proposal are subject to change based on the outcomes of the test.
Total Premium & Employee Contributions
Option-la Plan 3562
Total Emp
Premium Pays
Emp Only: $ 420.00 $ .00
Emp+1: $ 840.00 $ 33.00
Family: $1,050.00 $ 42.00
Option-2, Plan 3766
Total Emp
Premium Pays
$ 474.36 $ 25.00
$ 990.43 $ 73.00
$ 1,206.46 $ 85.00
Dlue Cross and Blue Shield of Florida, its subsidiary liealth Options and Rs affiliate Florida Combined Llfe, are all Independent licensees of the Dlue Cross and Dlue Shield Association
'~G~
FLORIDA
In the purwlt ui haahh