Goals: Win-Win Federal regulations Budget Manage benefits costs – impact to City cost & Employee cost Address claims drivers – High Risk at the tipping point Partnership between City – Employee – Provide tools for employees facing health challenges – education, information, lifestyle – Nationally recognized health goals – Reward healthy choices User-friendly program Long-term investment
2014 Program to Earn 2015 Credit in HRA Health assessment & biometrics completed 9/1/13 - 8/31/14 by Catapult or PCP (E-Care) Age/gender screening 9/1/13- 8/31/14 Validated thru claims Have 2 or less risk factors; if >2, complete alternative program. Data from Catapult, or form via PCP (E- Care) Non-tobacco confirmed & tracked through Catapult or PCP (E-Care) $100 $200 $100 N/A Naturally Slim, WW@W programs by 8/31/14 Tobacco cessation program by 8/31/14 Activity HRA Deposit Alternatives
What is Metabolic Syndrome? A cluster of conditions occurring together, increasing your risk of heart disease, stroke and diabetes Having one component means you’re more likely to have others Diagnosed based on the results of a physical exam and blood tests Must have at least three of the five metabolic risk factors to be diagnosed with metabolic syndrome: Excess body fast around the waist High Triglycerides Low HDL Cholesterol Increased Blood Pressure High Fasting Blood Sugar
Metabolic Risk Factors 1.A Large Waistline Having a large waistline means that you carry excess weight around your waist (abdominal obesity). This is also called having an "apple-shaped" figure. Your doctor will measure your waist to find out whether you have a large waistline. A waist measurement of 35 inches or more for women or 40 inches or more for men is a metabolic risk factor. A large waistline means you're at increased risk for heart disease and other health problems.
Metabolic Risk Factors 2.A High Triglyceride Level Triglycerides are a type of fat found in the blood. A triglyceride level of 150 mg/dL or higher (or being on medicine to treat high triglycerides) is a metabolic risk factor. (The mg/dL is milligrams per deciliter—the units used to measure triglycerides, cholesterol, and blood sugar.) 3.A Low HDL Cholesterol Level HDL cholesterol sometimes is called "good" cholesterol. This is because it helps remove cholesterol from your arteries. An HDL cholesterol level of less than 50 mg/dL for women and less than 40 mg/dL for men (or being on medicine to treat low HDL cholesterol) is a metabolic risk factor.
Metabolic Risk Factors 4.Increased Blood Pressure A blood pressure of 130/85 mmHg or higher (or being on medicine to treat high blood pressure) is a metabolic risk factor. (The mmHg is millimeters of mercury—the units used to measure blood pressure.) If only one of your two blood pressure numbers is high, you're still at risk for metabolic syndrome.
Metabolic Risk Factors 5.High Fasting Blood Sugar A normal fasting blood sugar level is less than 100 mg/dL. A fasting blood sugar level between 100–125 mg/dL is considered prediabetes. A fasting blood sugar level of 126 mg/dL or higher is considered diabetes. A fasting blood sugar level of 100 mg/dL or higher (or being on medicine to treat high blood sugar) is a metabolic risk factor. About 85 percent of people who have type 2 diabetes—the most common type of diabetes—also have metabolic syndrome. These people have a much higher risk for heart disease than the 15 percent of people who have type 2 diabetes without metabolic syndrome.
City-Approved Alternative Programs City of Frisco pays 100% of employee’s cost “Success” or “Change” is not required – no need to improve cholesterol, lose weight, stop tobacco use, etc. Attendance is required – each program will have established attendance requirements Weight Watchers @ Work – 3 groups have been established; new/additional groups may be formed - contact Becky Cook or Brittany Kagawa if interested Naturally Slim, Alere Tobacco Cessation programs – start dates will be established and communicated in the coming weeks
Wellness Incentives ALL EMPLOYEE DATA IS SHARED DIRECTLY BETWEEN VENDORS AND STRICT CONFIDENTIALITY IS MAINTAINED AS REQUIRED BY LAW – City of Frisco does not receive any health data regarding individual employees Alternative Programs are required by law and are valid only for 1 year as defined by City Biometric data is based on lab or claims data provided to Compass – self-reporting by employee is not a valid method All data must be collected during the period of 9.1.2013 – 8.31.2014 to determine eligibility for the 2015 incentive
Proposed Medical Plan Changes for 2015 Compass will collect and manage all data required Only 2 Plans – eliminate Low Ded ($250) Add Health Reimbursement Account (HRA) Increase Deductibles – offset by HRA Change Out-of-Pocket Maximum Possible Employee premium decrease if claim trend continues (comparing costs of $500 Ded plan to $1000 Ded plan and $1500 Ded plan to $2000 Ded plan)
Proposed Medical Plan Changes for 2015 Increase Employee Incentive Potential by $140/year No Premium Discount - $30 monthly incentive will be replaced by HRA Anticipate proposed plan and incentive designs to be maintained for several years as changes allow City to avoid Cadillac Tax
HRA or HSA? Health Reimbursement AccountHealth Savings Account Allows medical copays, deductibles, coinsurance, etc. Does not allow medical or Rx copays. ALL services subject to the deductible – employee/family paying out of pocket towards the deductible for all costs except preventive care. Funds can roll over year over year Only the Employer funds this account – no tax consequence to employee Employee & Employer can fund this account – employee would be taxed Upon employment termination, funds are forfeited Upon employment termination, funds may be taken by Employee Funds can only be used as stipulated by the Employer – medical, Rx, OTC (w/script), dental, vision Funds can be used for any qualified medical, dental, Rx or vision expense No IRS guidelines around plan design.Strict IRS guidelines around plan design
Proposed 2015 Medical Plan Design BenefitsLow DeductibleHigh Deductible Coinsurance80% Deductible $1,000 ($500) Indiv/ $2,000 ($1,000) Family $2,000 ($1,500) Indiv/ $4,000 ($3,000) Family OOP Maximum $3,000 ($2,750) Indiv/ $6,000 ($5,500) Family $4,000 ($3,000) Indiv/ $8,000 ($6,000) Family PCP Office Visit Copay$20 SPC Office Visit Copay$30 ER Copay$150 Rx Generic Copay$15 Rx Preferred Copay$25 Rx Non-preferred Copay$50 HRA Contribution$500 ($360)