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2014 Insurance and Wellness Benefits Committee
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Purpose of the Committee 2 Review Current Insurance and Wellness Benefits Provide Recommendations on Insurance Benefits Assist with Development of new Benefits/Programs Assist with Selection of Insurance Broker Represent the Employee Associations
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3 Role of Broker Negotiate Renewals Assist with Claim Resolution Conduct Open Enrollment Meetings Provide Employee Resources Broker Representatives for ECC Scott Schroepfer, Broker Nancy Brown, Account Manager Jodie Miller, Claims Representative
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Benefit Package 4 Medical Insurance Health Savings Account Dental Insurance Vision Insurance Basic Life/Accidental Death & Dismemberment (AD&D) Insurance Long Term Disability (LTD) PSRS/PEERS Retirement Paid Holidays Vacation Leave Personal Leave Sick Leave
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Benefit Package - Continued 5 Voluntary Life/Accidental Death & Dismemberment (AD&D) Insurance Employee Spouse & Children Flexible Spending Accounts (FSA) Health Care Dependent Care Employee Assistance Program (EAP) Wellness Programs 403b/457b Retirement Plans Tuition Reimbursement Tuition Waiver Employee Spouse & Children
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Glossary of Terms Premium The amount of money charged by an insurance company for coverage. Employer determines how much of the premium employees must pay for coverage. East Central College currently contributes 100% of premium. Employee’s Deductions are Pre-taxed which provides an additional savings for the employee. 6
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Glossary of Terms Provider The clinic, hospital, doctor, dentist, laboratory, health care practitioner or pharmacy that provides services. 7 Providers In-Network The facilities, providers and suppliers your insurance carrier has contracted with to provide health care services and discounts. Out-of-Network The facilities, providers and suppliers your insurance carrier has not contracted with to provide health care services.
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Glossary of Terms Deductible The amount you pay before your plan begins to pay. 8 $1000 Deductible Examples Example 1Example 2 Cost of Service$250$5000 YTD Deductible$250$1000 Plan Pays$0$4000
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Glossary of Terms Copayment or Copay A fixed amount you pay. The amount can vary by the type of covered service. Copayments do not apply to the deductible. 9 Example Cost of Office Visit$200 Copayment$25 Plan Pays$175
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Glossary of Terms Coinsurance Your share of the cost after the deductible is met. The covered health care service is calculated as a percent. 10 80/20% Coinsurance Example Cost of Covered Service$100 80% - Insurance pays$80 20% - Member pays$20
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Glossary Terms Out-of-Pocket Maximum (OOPM) OOPM protects you from very high medical expenses. After you reach the annual OOPM, your health insurance begins to pay 100% of covered health care services or items for the Plan year. The OOPM includes deductibles, coinsurance and copayments. It does not include your monthly premium. 11
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Glossary Terms Health Savings Account (HSA) Cost Savings Funded with tax-exempt dollars Medical plan contribution reduction Used to help pay for health expenses including deductible, coinsurance and certain services not covered by your health plans. Choices This is your account! You control and manage your health care expenses. You decide when to use your HSA dollars. You may use the money in your account for family member’s health expenses (even if they are not on your health plan). Long-Term Advantages Save for future medical expenses Funds roll over year-to-year Interest-bearing savings account Account is portable, which means you take it with you Retirement dollars are tax deferred 12
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Medical Loss Ratio 2012 (Jan – Dec) 13 Coventry ProductPremiumClaims MLR Average Medical$1,349,438$ 687,659 69.5% Rx$0$ 250,541 Total$1,349,438$ 938,200
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Medical Loss Ratio 2013 (Jan – Dec) 14 Coventry ProductPremiumClaims MLR Average Medical$1,359,983$1,014,504 96% Rx$0$ 290,720 Total$1,359,983$1,305,224
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Medical Loss Ratio 2014 (Jan – Jul) 15 Anthem ProductPremiumClaims MLR Average Medical$760,383$751,727 120% Rx$0$162,066 Total$760,383$913,793
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Renewal Factors 16 Trend Prediction of how much health care cost will rise over the next policy year The Market’s current health care inflation rate Group Experience – Medical, Pharmacy & Ancillary Claims Medical Loss Ratio (MLR) Claims compared to premiums Claims Analysis Carrier Discounts Network Usage Plan Design Wellness Program Funding
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Renewal Factors - Continued 17 Health Care Reform Taxes and Fees Patient-Centered Outcomes Research Institute ( PCORI ) fee. Effective 2013 - $1 fee multiplied by the average number of covered lives under the plan. Effective 2014 the fee increases to $2 and then beginning 2015 the fee is indexed for future years. Component represents approximately a 4% - 5% increase to renewal each year. College Budget for Renewal 2015 Budget has 4% increase for all insurance benefits combined (medical, dental, vision and life)
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Renewal Timeline 18 Currently Seeking Renewal numbers from Anthem and other providers Upcoming Committee Meetings October 3 – Review Renewals/Recommend Suggestions October 10 – Review Plans with the Suggested Changes October 17 – Finalize Recommendations November 3 – Board Approval November 10 – Open Enrollment Begins
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