Transcription
Benefits & Wellness Committee MeetingAugust 11, 2020
Our Focus2
Our Goal for the Benefits and Wellness CommitteeGoals will be to help assure current insurance benefitsare appropriately structured and financed to supportinstitutional needs, including recruiting and retainingfaculty and staff.And to control claims and overall healthcarecosts for 2020-21!!!3
Meeting Goals and Expectations Stress Relief Activity by FBISD Wellness Team Understanding Your Medical Plan 2021 Proposed Benefit Change Employee Impact Your Feedback Counts 2020-2021 Benefit Committee Meeting Dates Q&A
“Stress Relief Activity”5
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2020 Benefit Landscape at a Glance7
Medical Plan Cost Performance Plan Year 2020 funding surplus trends continuing from 2019. 12-month mature incurred claims cycle beginning to show a bend in overall costcurve for the Nexus and Charter plans. Choice Premium plan continues to be the only plan running a (deficit) funding levelwith the highest claim cost PEPM of all plans. Current PY 2020 total plan claims cost is being compromised by Covid pandemic(rationing of healthcare) which may adversely impact Q3 and Q4 claim results. 12017Projected “status quo” 2021 plan year is projected to create a deficit of 1Mnumbers pulled from historical data provided to Gallagher8
2020 Plan PEPM Performance Review1 Premium equivalent represents total district and employee payroll deductions Choice Premium plan (deficit funding) is being subsidized by all other plans (surplusfunding) District is committed to a strategy where each of the five plans are self-sustaining Choice Premium, Nexus, and Kelsey Charter are Gold level ACA plans Choice HRA-Silver level ACA Choice HDHP is Bronze level ACA/HSA Compliant12020Plan Performance through Juneby Plan as of June 20202Enrollment9
2020 Plan PEPM Performance Review1Expenses 318 , 11% 964 , 32% 529 , 17% 469 , 15% 760 , 25%Choice Premium12020Plan Performance through Juneby Plan as of June 20202EnrollmentNexus ACOChoice HRAKelsey CharterCDHP10
2021 Proposed Medical Plan Change11
2021 Benefit Plan Solutions1. Discontinue Choice Premium Tier plan 01/01/2021 due to renegotiated contract with UHC andMethodist.2. Introduce a new plan “Choice PPO” offering a broader network of hospital and providers.3. New plan offering at either a 10% or 15% premium increase from Choice Premium Tier plan.4. The Nexus ACO, Kelsey Charter, Choice HRA, and the Choice HDHP plans will remain with thesame core benefits and payroll contribution deductions, allowing our members to choose thehealthcare system that best meets their needs.5. Provide five (5) unique plans that meet our members healthcare needs and price points.12
WHY the change? Choice Premium plan included a Tier 1 benefit driven by a direct contract agreement betweenthe District and Methodist Hospital systems The District was able to negotiate a new multi-year contract with UnitedHealthcare that willallow us to continue offering affordable healthcare to employees and their dependents UHC and Methodist were able to renegotiate their contract for 2020 and future years providingdeeper discounts; as a result, Methodist terminated the Direct Contract for Plan with theDistrict, ending the “tier” driven benefits pricing Methodist Sugar Land Hospital contractual pricing more in context with Memorial Herman andSt. Luke’s Strategy to balance the Choice Premium financial funding13
A New Benefit LandscapeProposed 2021 Benefit Plan OptionsKelsey UHCCharterKelsey SeyboldNetworkChoiceKelsey-Sebold ProvidersONLY. Exceptions allowed foremergency care, dependent Choice In-Network Benefitsout of area and untreatableconditions. St. Lukes is theAnnual deductibleIndividualFamilyAnnual out-of-pocket max (includesIndividualall medical and pharmacyFamilydeductibles, copays andPreventiveOffice VisitPCPSpecialistsVirtual VisitsInpatient - HospitalSurgery Plus**Emergency Care (True Emergency)Urgent Care FacilityAirrosti Muscle/JointRoutine Lab, X-RayAdvanced Imaging (MRI, MRA, CT Scan, PET)Mental health and substance abuse (inpatient)Prescription drug 31-day retailGenericPreferred brandNon preferred brandSpecialtyGenericPreferred brandPrescription drug 90-day mail****Non preferred brandSpecialty 750 1,500 3,750NexusChoice HRAChoice HighDeductibleNexus ACO Plans Nexus ACO OAChoiceChoiceChoice PPOOut-of-NetworkOut-of-NetworkTier 1 (MemorialHerman ACOProviders andHospital System)When You Get Out-of-Network Care, You Pay More 2,000 4,000 1,500 4,000 8,000 3,000 6,000 12,000 5,000Tier 2 (All UHC ChoiceChoice In-Network BenefitsNetwork Providers and Only (FBISD HRA Contribution:Hospitals) 500 individual/ 1,000 family) 2,000 4,000 6,000 7,500 12,000 24,000 10,000 12,000Costs for Covered Services After Your Deductible Has Been MetCovered at 100%Covered at 100%50% after DeductibleCovered at 100% 25 copay 5050% after Deductible 25 50 35 copay 7550% after Deductible 40 75 0 per visit 0 per Visit50% after Deductible 0 per Visit20% after Deductible 20% after Deductible 50% after Deductible20% after DeductibleCovered at 100%Covered at 100%Covered at 100% 300 copay then 20%after Ded. 300 copay then 20% after Ded. 300 copay then 20% after Ded. 75 copay 75 copay50% after Deductible 75 copay 35 copay 45 copay 40 copay20% after Deductible 20% after Deductible 50% after Deductible20% after Deductible20% after Deductible 20% after Deductible 50% after Deductible20% after Deductible20% after Deductible 20% after Deductible 50% after Deductible20% after DeductiblePRESCRIPTION30%30%Not Covered30%30%40%40%Not Covered40%40%50%50%Not Covered50%50%45%25%35%45%45%45%25%35%45%45%Not CoveredNot CoveredNot CoveredNot CoveredNot Covered**These benefits are separate from UHC and made available in your medical plan at no additional cost to your premium.***Per pay contributions without wellness surcharge****Mail order prescriptions have a maximum per 90-day supply of 15045%25%35%45%45%45%25%35%45%45% 2,500 5,000Choice In-Network BenefitsOnly 6,500 13,000 6,000 6,500 12,000 13,000Covered at 100%30% after Deductible30% after Deductible0% after Deductible30% after DeductibleCovered at 100%Covered at 100%0% after Deductible0% after Deductible0% after Deductible0% after Deductible0% after Deductible30% after Deductible0% after Deductible30% after Deductible30% after Deductible30% after Deductible30% after Deductible30% after Deductible0% after Deductible0% after Deductible0% after Deductible0% after Deductible0% after Deductible30%40%50%0% after Deductible0% after Deductible0% after Deductible0% after Deductible0% after Deductible0% after Deductible0% after Deductible0% after Deductible45%25%35%45%45%14
I am on the Choice Premium Tier Plan What Does this mean for me?15
Proposed New Benefit Plan Option16
New Choice PPO Premium Increase OptionsDisclaimer: Premium increase above is based on employee migrating from Choice Premium Tier Plan to the Choice PPO Plan.17
Your Feedback Counts 18
Four-Key PointsWith these changes, we will still have five plan options and as much hospital choice asbefore: The Choice PPO offers UHC’s broad network with no tiering of In-network hospitals orphysicians, making this a simpler plan for employees. This new plan will be a truePPO plan with out-of-network benefits The Nexus plan remains aligned to Memorial Hermann. Tier 1 is MemorialHermann. Tier 2 is all UHC network hospitals (including Methodist and St. Luke’s) The Kelsey plan is aligned with St. Luke’s as Kelsey’s preferred hospital. However,participants can go to other UHC hospitals as well (including Methodist and MemorialHermann), no referral needed. Choice HRA participants and those on the Choice High Deductible plan can go to anyUHC network hospital (including Methodist, Memorial Hermann and St. Luke’s) Overall, these five plan offerings for 2021 allow us to restructure our strategy andfocus on the long-term success of our health plan.19
Open Dialogue (Please use your “raise the hand button” at the bottom of your zoom screen)20
Survey Voting Options1. Do you understand the rationale provided as to why the Choice Premium Tier plan isbeing discontinued? Yes No2. Do you support the District providing a benefit plan option that offers both innetwork and out-of-network coverage? Yes No3. Please select your preferred premium option for the Choice PPO plan. 10% Premium Increase 15% Premium Increase No increase4. CommentsType your response here .21
2020-2021 Future Committee Meeting Dates(virtual Zoom meetings in the interim)Tuesday, September 15, 2020Tuesday, October 13, 2020Tuesday, November 17, 2020Tuesday, December 8, 2020Tuesday, January 26, 2021Tuesday, February 16, 2021Tuesday, March 9, 2021Tuesday, April 13, 2021Tuesday, May 11, 202122
Your Benefits & Wellness TeamFBISD is proud to offer a comprehensive benefits program that gives employees access to the best healthcareavailable and protection against unforeseen events.Please review the chart below to determine your new FBISD Benefits Coordinator.Alpha Split Benefits CoordinatorEmail AddressPhoneA–CCynthia Muckacynthia.mucka@fortbendisd.com(281) 634-2810D–GAlton Nashalton.nash@fortbendisd.com(281) 327-0357H–LGail Barnes-Maxwell gail.barnesmaxwell@fortbendisd.com(281) 634-1214M–PJanet Singletonjanet.singleton@fortbendisd.com(281) 634-1208Q–SCassandra Whitecassandra.white@fortbendisd.com(281) 634-3958T–ZRachel Robinsonrachel.robinson@fortbendisd.com(281) 327-7511Additional ContactsKimberly Brown Benefit Analyst (for vendor billing andreporting inquiries) kimberly.brown@fortbendisd.com(281) 327-1241LaShonda Walls Director, Benefits & Wellnesslashonda.walls@fortbendisd.com(281) 634-1184FBISD Benefits Departmentbenefits@fortbendisd.com(281) 634-1418FBISD Wellness TeamGary HajdaszCourtney Skileswellness@fortbendisd.com(281) 634-180723
QuestionsFort Bend ISD Benefits DepartmentFort Bend ISD Annex Building3119 Sweetwater Blvd.Sugar Land, Texas 77479(281) 634-1418Benefits@fortbendisd.com24
The Nexus plan remains aligned to Memorial Hermann. Tier 1 is Memorial Hermann. Tier 2 is all UHC network hospitals (including Methodist and St. Luke's) The Kelsey plan is aligned with St. Luke's as Kelsey's preferred hospital.However, participants can go to other UHC hospitals as well (including Methodist and Memorial Hermann .
