Loading...
HomeMy WebLinkAboutMinutes 6.18.14BOARD OF COUNTY COMMISSIONERS Minutes INSURANCE COMMITTEE The Insurance Committee Meeting was called to order by vice -chair Christine Weekes at 9:30 a.m, on June 18, 2014. Roll call was taken and the following members were present: Christine Weekes, Medical Examiner, Frannie Hutchinson, Commissioner District #3, Dori Ditoro, Children's Services Council, Shai Francis, Clerk of Court, Michelle Franklin, Property Appraiser, Gertrude Walker, Supervisor of Elections, Dan Field, Supervisor of Elections, Chris Craft, Tax Collector, Georgia Rich, Tax Collector, Ken Pruitt, Property Appraiser. Other members present: Robert Bentkofsky, Deputy County Administrator, Heather Young, County Attorney, Pennie Burke, Human Resources, Amanda Torresson, Human Resources, Marie Gouin, Office of Management & Budget, Michaeleen Johnson, Tax Collector, Kathleen Meola, Ascensions, Linda Lisk, CareHere, George Landry, Human Resources, Lorna Smart, Clerk of Court. The items reviewed and discussed were: ➢ Christine Weekes made a motion to approve minutes from February 20, 2014 meeting — approved unanimously. ➢ Kathleen discussed the actual claims experience from 12/13 year reflecting $9.7 million which equates to $804.23 PEPM cost. There is an increase this year from last year. Rolling 12 -month gross claims is $8.6 million, estimated stop loss recoveries is $110,000 and rolling 12 -month net claims is $9.6 million which equates to $869.83 claims cost PEPM. Florida Blue book of business trend is currently running at 10.8% annually. Projecting claims forward to the 14/15 plan year utilizing this trend equates to $11.1 million or $1,002.91 claims cost PEPM. Mr. Craft requests to see types of claims and why such a significant increase during specific months. Kathleen stated that any claim over $125,000 will result in a stop loss which means claims here are those claims under $125,000. Mr. Craft requests to compare claims from this year to last year recovery. Pennie will email it. ➢ Kathleen then discusses expected funding for this plan year in which the committee added 5% for overage to claims, thus funding at 105% of expected claims. October - April utilizes actual enrollment by tier by month, May - September's enrollment was estimated (projected number of enrolled based on average of October -April) with a total of $12.1 million of projected funding for the 13/14 plan year. The renewal for 14/15 year projection with a breakdown of Medical/RX Claims $11.1 million, Florida Blue Admin. Fees (reduced) $653,484, MHNet Carve -out $134,652 (includes +10%) Spec. & Aggregate Stpp Loss $1.2 million (includes + 15%), PCORI Fee (Healthcare Reform Fee) $4,282, Transitional Reinsurance Fee (Healthcare Reform Fee) $94,204 and The Employee Health & Wellness $1.3 million. This is a $2.6 million difference ($14.5 million) from the estimate for 13/14 year. If the County continues to fund at 105% of expected claims ($15.1 million), this is a 24.52% increase from current. Mr. Craft questioned why we are increasing from the estimated funding for 13/14 as well as why the cost of the Health and Wellness Center went up 10%. Mr. Bentkofsky explains that the 10% increase for the Health & Wellness Center is due to high utilization rates, we added an extra exam room as well as a Nurse Practioner to allow more availability. Mr. Craft questioned why our rates are going up opposed to decreasing when the Health & Wellness Center is at 98% usage. George Landry stated that 9,733 appointments went through CareHere and only 3,900 went through Florida Blue in the past 12 -months. Mr. Bentkofsky stated that over time we will see a reduction as the claims should be less in the future. He also clarified that $1.3 million funding for the Health & Wellness Center will actually be around $1.2 million or less. Mr. Pruitt questioned the "estimated" enrollment numbers between May -September. Kathleen stated that it will be fine-tuned month -by -month and that the hope is that the plan performs better than projected before our actual renewal rates are set. Mr. Craft brings up the increase of cost due to trend and our additional funding. Kathleen stated that the same fundamentals were used as last year. It is not just the County experiencing these increases in trend, it is industry wide. Mr. Craft mentioned the expansion of the Health and Wellness Center to veer away from utilizing insurance and therefore keeping claims down. Kathleen mentioned that there are some treatments the Health & Wellness Center would not be able to provide such as those for cancer patients. ➢ Shai brought up the Health & Wellness Center requiring to see the employee for every refill which causes the County to be charged for every visit. George informed Shai that the County pays per employee per month, that the County is not charged for each employee visit and that the Center is now doing a mail order which only requires the employee to been seen once every 6 months. ➢ Kathleen then discussed the preliminary true fund rates. The projection for 14/15 year is a 25% increase than that of 13/14. Christine, Shai and Dori then bring the concern that budget has already been done and submitted only to reflect a 6% increase. Mr. Bentkofsky states this is at the heart of what we are trying to accomplish. We are subsidizing rates with the reserve fund and CHIS IS DZADO VSKY Dins ct %o I i TOD , M' RY, Dkinci Nu. _ 1 [ ALA A ; i E l I. , f3 , cl `2o, : : 'L VIAU III :( H!v, .O -, I KIV + i ^eAdT I,mrint rami j! �f',.njact.0 �o.t llftma, 0 a r BOARD COUNTY LklAftul 611=1 INSURANCE COMMITTEE our numbers are less than what the actual are and therefore we need to make significant changes in the plan but can't do it all at once. He discusses premium onset over time for the future. Mr. Bentkofsky discusses the Health Insurance Reserve Fund. He would like to use the reserves over time and maintain the safe harbor. We started this year expecting that we would have 11 million available to write down premiums even with a 6% increase in premiums. There is a use of 3.5 million of reserve fund for 2015. The evaluation of the reserve fund is dependent on the medical claims trend and what occurs medically. Mr. Bentkofsky stated that we aren't using 11.7 million and that we are using 5% above that. Premium discounting does not address the "Cadillac Plan" and its implications or the effect on medical claims costs in the future years. Mr. Craft requests that we share claims costs/trends from last year to a few years ago. Pennie will send. Mr. Pruitt then asks for clarification if the 10.8% trend is just the County. Kathleen states it is Florida Blues book of business trend (Florida wide). The National Trend Statistics will be lower but because we are Florida and have different demographics, Florida's trend rate will always be higher than national trend. Also, keep in mind that about 85% of our costs are our claims and unfortunately the last 12-14 months have had a real impact on the renewal projection. Kathleen suggested that there are things we can do to decrease claims costs such as Wellness Programs, Changing Benefits — shifting costs to the employees and address the adverse selection issues (currently we ask employees to pay far below the market for their share of the premiums) which cause more dependents to join our plan even if they have another plan available to them. Commissioner Hutchinson states that our changes are not enough and we need to make changes but over the next 4 years. Mr. Craft believes it is important to know what type of claims we have had so that we know who type of wellness programs to put on. Kathleen stated that we don't want to look back as we really need to prevent future claims and a way to do so is have employees complete the CareHere health assessment so that CareHere can provide us with data to put the correct Wellness programs on. Excise tax: Mr. Bentkofsky believes the shift in the structure of the plan where more costs from employees will drive them to utilize CareHere more and eventually we will need to expand CareHere and this is something we need to start thinking about today. Kathleen stated that a 25% increase is not palatable. A new plan design will need to be implemented such as no co -pays (expect for RX) and/or employees pay the discounted rate for services until the deductible is met. Mr. Bentkofsky stated that we are having Kathleen provide a phased solution to avoid the excise tax and we will meet with the committee in July to focus on that issue only. Kathleen discussed voluntary benefits/worksite benefits as there is a need to monitor and offer voluntary benefits that work with the core benefits and that the employees actually receive what they need. Kathleen passed out a booklet with detailed information on 5 voluntary benefits: Critical Illness, Permanent Life Insurance, Accident Policy, Hospital Indemnity and Cancer Insurance. If it is decided that all Constitutionals utilize these then all payroll deductions for other voluntary benefits would need to end and employees would need to be placed on direct bill. Mr. Field asked about Legal Shield and Kathleen clarified that they are OK to continue to payroll deduct. There would need to be a month enrollment (suggested August for September effective_ date). Kathleen would have flyers, brochures and enrollment counselors available to discuss the benefits and answer questions. In order to move forward with this the vote must be unanimous. Commissioner Hutchinson clarified that these benefits would replace the current ones. Kathleen stated that if we move forward we would need at least 60 days to properly implement it and educate the employees. These benefits have a guarantee issue. Christine Weekes asked if we would use Benergy to enroll and y stated no. She also stated that the County would not need to do anything except payroll deduct according to the reports they would send each Constitutional weekly. Mr. Craft, Christine Weekes and Dori Ditoro would like to discuss with their employees before voting. Mr. Pruitt makes a motion to move forward to allow Ascension to communicate with the Constitutionals to determine if they'd like to have these voluntary benefits for their employees subject to a unanimous vote with all of the Constitutionals in favor. Heather Young then stated that if a Constitutional denies the motion for the voluntary benefits then at July's meeting we will formally deny the motion. Deadline to provide Kathleen an answer is July 1St. Constitutionals will email Pennie their final decision and Pennie will inform Kathleen. Michelle Franklin seconds the motion and Mr. Craft thirds it. Christine Weekes finalized the motion as all are in favor and none opposed. George mentions the further utilization of CareHere with Worker's Compensation and Pennie passed out flyers with the 90 day mail order information as well as information on Nurse Practitioner Lucy. Christine Weekes adjourned the meeting at 11:15am. Our next meeting will be scheduled in July. t HRIS D/ -\D0\ 0\ S 1 D,,5: TetNu MD 1,10N t<RY Mgmq No 1 P %= i. a [ ( MV i3 ,f' _ "n , i I FRINNH Edi 7 CHINSON, Grsi icf No P .I KIM IOH\SCY , DiMrlcE y;g. 5 < s [c Adn t -hater [nt r r - Dan Mf i , — �mn a 1 ar w., - €'br me FL.