becker county health benefits

BECKER COUNTY HEALTH BENEFITS

P R O P O S E D I N S U R A N C E C H A N G E S F O R 2 01 8

1

BACK GROUND INFORMATION:

Plan # of Contracts as of 3/1/2017 % of Total Contracts

$750 Deductible 37: 34 single, 3 Family 16%

VEBA 37: 19 Single, 18 Family 16%

5,000 Deductible 157: 130 single, 27 Family 68%

Total 231 2

Becker County’s renewal from the LCSC was 19%. In addition benefits will be removed effective

1/1/2019 and to maintain certain benefit there would be an up-charge. BCBS brought these changes at

renewal effective1/1/2018. LCSC did agree to continue and cover any up charge for these benefits in

2018

*Accident Benefit under 750 Deductible to maintain benefit in 2019 there will be a 2% upcharge

*Pharmacy dispensing Benefit for 750 and VEBA there will be a 2% upcharge in 2019.

*OTC coverage will be eliminated in 2019

*Life Style medication will be eliminated in 2019.

RECOMMENDATION:

Move to PEIP (Public Employee Insurance Program) and implement all three plans offered by PEIP. Notification to PEIP and Lakes Country Service

Cooperative must be by 12/1/2017.

3

WHY IMPLEMENT PEIP

• PEIPs offers various options for employees such as the Network, the cost range and

plan design.

• The plans offered by PEIP are similar in the respect they have low, medium and

high deductibles.

• PEIP offers three plans:

HSA Plan:

Value Added Plan

Advantage Plan

4

PEIP RENEWAL HISTORY

July Group Average January Group Average

July, 2010 +8.0% January, 2013 +5.0%

July, 2011 -6.6% January, 2014 +.5%

July, 2012 -3.3% January, 2015 +2.4%

July, 2013 +6.0% January, 2016 +5.5%

July, 2014 +1.9% January, 2017 +3.5%

July, 2015 +2.0% January, 2018 +.2%

July, 2016 +5.9%

July, 2017 +1.3%

Combined Pool Average rate increase = 2.3%

Average increase including plan design changes = 3%

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Over the last eight years renewals the PEIP pool has averaged a 2.3% increase!! The pool is up to over 115 schools, 200 total groups/30,000 members.

Single

Plan

Monthly

Premium

%

Chang

e from

2017

rate

#

emp

$750 $1,029 19% 34

Advant $858.94 (1%)

Total

Savings $170.06 20%

Single

Plan

Monthly

Premium

% change

from 2017

plan

#

emp

VEBA $758 19% 19

Value $771.32 21%

Total

Savings ($13.32) (2%)

Single

Plan

Monthly

Premium

% change

from 2017

plan

#

emp

5,000 $680.50 19% 130

HSA $586.84 3%

Total

Savings $93.66 16%

Family

Plan

Monthly

Premiu

m

%

chang

e from

2017

rate

# emp

$750 $2,470.

50 19% 3

Advant $2,293.

58 10%

Total

Savings $176.92 9%

Family

Plan

Monthl

y

Premiu

m

%

change

from

2017

rate

#

emp

VEBA $1,819.

50 19% 18

Value $2,059.

70 35%

Total

Savings ($240.2) (16%)

Family

Plan

Monthly

Premium

% change

from 2017

plan

#

em

pl

5000 $1,636.50 19% 27

HSA 1567.10 14%

Total

Savings $69.40 5%

6

Based on the premiums from our current plan versus PEIP plans 194 (84%) employees will see a saving if they

move to the like plan at PEIP

PEIP SUMMARY OF BENEFITS

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Review handout of summary of benefits

PEIP PLANS:

• You will need to select a Network: BCBS, Health Partners or Preferred One:

You can change your network with annual enrollment

• You will need to select a cost plan which is determined by the primary care clinic

you select

• You will need to select a primary care clinic within your network

You can change your primary care clinic monthly.

Your primary clinic will need to refer you to other providers in order for the

services to be covered under the plan, .

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PEIP’S PLANS:

• Sanford and Essentia are both listed in cost level two for 2018

• Clinic list will be posted on the intranet

• All plans consist of deductibles, copays and max out of pockets.

• Our current 750 plan is comparable to the advantage plan

• Our current 2,600 deductible plan is comparable to the Value Added plan

• Our current 5,000 deductible plan is comparable to the PEIP HSA plan

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COMPARISONS: 5,000 DEDUCTIBLE TO PEIP HSA COST LEVEL 2:

Current plan deductible 5,000 single and 10,000 family

PEIP: 2,000 for single plan; family – 3,200 per family member; 4,000 for family

3,000 saving for single and 1,800 to 6,000 for family

Copays for services begin after the deductible is met, if you enter the hospital you pay your deductible and then you would pay the copays for

services until your MOP is met.

Coverage will begin sooner under PEIP then with the current 5,000 deductible

MOP (Max out of Pocket) current plan 5,000

PEIP: 3,000 single plan; 5,000 per family member 6,000 per family

2,000 savings for single and 4,000 for family

:Drug coverage: Copays begin after the deductible, therefore the coverage begins sooner on drugs than with the current 5,000 plan.

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PLAN COMPARISON: 750 DEDUCTIBLE TO PEIP ADVANTAGE PLAN:

Current Deductible: 750 single and 2,500 family

PEIP; 250 single and 500 family

Deductible savings: 500 single and 2,000 family

Copays for services begin after the deductible is met so if you enter the hospital you pay your deductible and then you would pay the copays for


Coverage will begin sooner under PEIP than with the current 750 deductible

Current MOP: 2,500 single and 5,000 family

PEIP: 1,200 single and 2,400 family

MOP savings: 1,300 single and 2,600 family

Current Drug Coverage: $25 copay for formulary and $40 copay for non formulary

PEIP: $14 copay Tier 1; $25 copay Tier 2; $50 copay Tier 3

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PLAN COMPARISON: VEBA 2600 TO PEIP VALUE ADDED

Current Deductible: 2,600 single and 5,200 Family PEIP: 700 single 1,400 family

Deductible saving 1,900 single and 3,800 family

Copays for services begin after the deductible is met so if you enter the hospital you pay your deductible and then you would pay the copays for


Coverage will begin sooner under PEIP than with the current 2,600 deductible

Current MOP: 3,400 single and 6,400 family PEIP: 2,200 and 4,400 family

MOP Saving 1,200 single and 2,000 family

Current Drug coverage: $14 or 25% which ever is greater MOP 750 single 1,000 family

PEIP: $20, $40, and $65 - Drug MOP 1,000 single 2,000 family

Greater possibility in savings for co-pays but a loss in Drug MOP 250 single and 1,000 family

12

PEIP DRUG PLAN:

Drugs are covered based on a Tier System:

Drug lists and tier cost will be posted on the intranet under benefit section, this is a

148 page document.

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COUNTY CONTRIBUTION

For the next several slides cost comparison will include the County Contribution.

For these comparisons the County Contribution will be the 2017contribution when

utilizing PEIP plans but will show the change in contribution based on current

contract language for our current plan.

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SCENARIOS:

15

Scenario 1 Single

$0 Medical Costs in Plan Year

$0 Prescription Costs in Plan Year

Plan Monthly

Premium

*Annual

County

Contribution

Annual

Premium

Cost Max Out

Of Pocket

Separate

Drug Plan

Cost Net

Gain

PEIP HAS $586.84 $15,057.00 ($7,042.08) $0.00 $0.00 $8,014.92

$5000 Ded $680.50 $16,041.60 ($8,166.00) $0.00 $0.00 $7,875.60

Advantage $858.94 $15,057.00 ($10,307.28) $0.00 $0.00 $4,749.72

$750 Ded $1,029.00 $16,041.60 ($12,348.00) $0.00 $0.00 $3,693.60

Value Add $771.32 $15,057.00 ($9,255.84) $0.00 $0.00 $5,801.16

VEBA $758.00 $16,041.60 ($9,096.00) $0.00 $0.00 $6,945.60

Based on 2018 Premium & Contribution Numbers

* Annual Contribution is less the Basic Life ($1.20) and LTD ($13.20) premiums; cost level 2

SCENARIOS

16

Scenario 2 Single

$5,000 Medical Costs in Plan Year

$1,000 Prescription Costs in Plan Year

Plan Monthly

Premium

*Annual

County

Contribution

Annual

Premium

Cost Max Out

Of Pocket

Separate

Drug Plan

Cost Net

Gain

PEIP HAS $586.84 $15,057.00 ($7,042.08) ($2,000.00) ($480.00) $5,534.92

$5000 Ded $680.50 $16,041.60 ($8,166.00) ($5,000.00) Incl in plan $2,875.60

Advantage $858.94 $15,057.00 ($10,307.28) ($1,200.00) ($300.00) $3,249.72

$750 Ded $1,029.00 $15,886.00 ($12,348.00) ($1,600.00) ($300.00) $1,638.00

Value Add $771.32 $15,057.00 ($9,255.84) ($2,200.00) ($480.00) $3,121.16

VEBA $758.00 $16,041.60 ($9,096.00) ($3,080.00) ($249.00) $3,616.60


* Annual Contribution is less the Basic Life ($1.20) and LTD ($13.20) premiums

** Assumptions: PEIP Cost level 2, tier 2 and 1 monthly formulary prescription at $83.00 each

SCENARIOS

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Scenario 3 Single



Plan Monthly

Premium

*Annual

County

Contribution

Annual

Premium

Cost Max Out

Of Pocket

Separate

Drug Plan

Cost Net

Gain

PEIP HAS $586.84 $15,057.00 ($7,042.08) ($3,000.00) incl in plan $5,014.92

$5000 Ded $680.50 $16,041.60 ($8,166.00) ($5,000.00) Incl in plan $2,875.60

Advantage $858.94 $15,057.00 ($10,307.28) ($1,200.00) ($800.00) $2,749.72

$750 Ded $1,029.00 $16,041.60 ($12,348.00) ($2,500.00) ($900.00) $293.60

Value Add $771.32 $15,057.00 ($9,255.84) ($2,200.00) ($1,000.00) $2,601.16

VEBA $758.00 $16,041.60 ($9,096.00) ($3,500.00) ($750.00) $2,695.60



** Assumptions: PEIP Cost level 2, Tier 2 and 3 monthly formulary prescription at $112.00 each.

SCENARIOS

18

Scenario 4 Family

$0 Medical Costs in Plan Year


Plan Monthly

Premium

*Annual

County

Contribution

Annual

Premium

Cost Max Out

Of Pocket

Separate

Drug Plan

Cost Net

Cost

PEIP HSA $1,567.10 $15,057.00 ($18,805.20) $0.00 Incl in plan ($3,748.20)

$5000 Ded $1,636.50 $16,041.60 ($19,638.00) $0.00 Incl in plan ($3,596.40)

Advantage $2,293.58 $15,057.00 ($27,522.96) $0.00 $0.00 ($12,465.96)

$750 Ded $2,470.50 $16,041.60 ($29,646.00) $0.00 $0.00 ($13,604.40)

Value $2,059.70 $15,057.00 ($24,716.40) $0.00 $0.00 ($9,659.40)

VEBA $1,819.50 $16,041.60 ($21,834.00) $0.00 $0.00 ($5,792.40)



SCENARIOS

19

Scenario 5 Family



Plan Monthly

Premium

*Annual

County

Contribution

Annual

Premium

Cost Max Out

Of Pocket

Separate

Drug Plan

Cost Net

Cost

PEIP HAS $1,567.10 $15,057.00 ($18,805.20) ($6,000.00) Incl in plan ($9,748.20)

$5000 Ded $1,636.50 $16,041.60 ($19,638.00) ($9,000.00) Incl in plan ($12,596.40)

Advantage $2,293.58 $15,057.00 ($27,522.96) ($2,400.00) ($300.00) ($15,165.96)

$750 Ded $2,470.50 $16,041.60 ($29,646.00) ($3,400.00) ($300.00) ($17,304.40)

Value $2,059.70 $15,057.00 ($24,716.40) ($4,400.00) ($480.00) ($14,539.40)

VEBA $1,819.50 $16,041.60 ($21,834.00) ($5,760.00) ($249.00) ($11,801.40)



** Assumptions: PEIP Cost level 2, Tier 2 and 1 monthly formulary prescription at $83.00 each.

SCENARIOS

20

Scenario 6 Family



Plan Monthly

Premium

*Annual

County

Contribution

Annual

Premium

Cost Max Out

Of Pocket

Separate

Drug Plan

Cost Net

Cost

PEIP HAS $1,567.10 $15,057.00 ($18,805.20) ($6,000.00) Incl in plan ($9,748.20)

$5000 Ded $1,636.50 $16,041.60 ($19,638.00) ($10,000.00) Incl in plan ($13,596.40)

Advantage $2,293.58 $15,057.00 ($27,522.96) ($2,400.00) ($900.00) ($15,765.96)

$750 Ded $2,470.50 $16,041.60 ($29,646.00) ($5,000.00) ($900.00) ($19,504.40)

Value $2,059.70 $15,057.00 ($24,716.40) ($4,400.00) ($1,440.00) ($15,499.40)

VEBA $1,819.50 $16,041.60 ($21,834.00) ($6,500.00) ($1,000.00) ($13,292.40)



** Assumptions PEIP cost level 2, Tier 2 and 3 monthly formulary prescription at $112.00 each.

PEIP SCENARIO

21

Advantage Single (cost level 2)-Ded=$250, OOP =$800 RX, $1,200 Med.

Date Activity Cost Member pays Notes

1/1/2017 Annual wellness physical $450 0 Preventive covered at 100%

2/1/2017 Office visit $250 $250 Deductible satisfied for 2017

3/1/2017 Prescription Tier 1 $25 $14 $14 copay

4/1/2017 Office visit $150 $30 $30 OV copay

5/1/2017 Referral to specialist office visit $375 $30 $30 OV copay

6/1/2017 Knee Surgery out patient $4,000 $120 $120 copay

7/1/2017 5 tier 2 prescriptions 5@ $75=$375 $125 5 times $25 copay

8/1/2017 8 Rehab visits 8@100=$800 $240 8 times $30 copay

9/1/2017 Prescription Tier3 $150 $50 $50 copay




Total $6,950 $944

Deductible met ($250)

$214 of $800 Rx Out of pocket satisfied

$730 of $1,200 Medical Out of pocket satisfied

This sample assumes a cost level 2 and all care provided by the member's primary care clinic or, required referrals are made.

Actual benefit determinations can only be made by the network claims administrators based on the Advantage High plan documents.

PEIP SCENARIO

22

Advantage Value Single (cost level 2)-Ded=$700, OOP =$1,000 RX, $2,200 Med.



2/1/2017 Office visit $250 $250 $250 towards Deductible satisfaction



5/1/2017 Referral to specialist office visit $375 $335 $300 towards deductible (satisfied) + $35 copay

6/1/2017 Knee Surgery out patient $4,000 $175 $175 copay


8/1/2017 8 Rehab visits 8@100=$800 $280 8 times $35 copay





Total $6,950 $1,585

Deductible met ($700)

$325 of $1,000 Rx Out of pocket satisfied

$1,260 of $2,200 Medical Out of pocket satisfied


Actual benefit determinations can only be made by the network claims administrators based on the Advantage Value plan documents.

PEIP SCENARIO

23

Advantage HSA Single (cost level 2)-Ded=$2,000, OOP =$3,000 Med. (Medical ,Rx combined)






5/1/2017 Referral to specialist office visit $375 $375 $375 towards deductible satisfaction

6/1/2017 Knee Surgery out patient $4,000 $1,600 $1200 towards Deductible (satisfied)+$400 copay


8/1/2017 8 Rehab visits 8@100=$800 $400 8 times $50 copay Out of pocket max reached





Total $6,950 $3,000

Deductible met ($2,000)

Combined out of pocket reached ($3,000)


Actual benefit determinations can only be made by the network claims administrators based on the Advantage HSA plan documents.

PEIP SCENARIO

24

Advantage Family (cost level 2)-Ded=$250/500, OOP =$800/1,600 RX, $1,200/2,400 Med.


1/1/2017 Annual wellness physical (EE) $450 0 Preventive covered at 100%

2/1/2017 Office visit (Spouse) $250 $250 Deductible satisfied for 2017 Spouse

2/1/2017 Office visit (Son) $250 $250 Deductible satisfied for 2017 whole family


4/1/2017 Office visit (Son) $150 $30 $30 OV copay

5/1/2017 Referral to specialist office visit (EE) $375 $30 $30 OV copay

6/1/2017 Knee Surgery out patient (EE) $4,000 $120 $120 copay

7/1/2017 5 tier 2 prescriptions (EE) 5@ $75=$375 $125 5 times $25 copay

8/1/2017 8 Rehab visits (EE) 8@100=$800 $240 8 times $30 copay





12/15/2017 Hospitalization (Spouse) 3 days $5,500 $200 $200 copay

Total $12,700 $1,394

Family Deductible met ($500)

$214 of $1,600 family RX out of pocket satisfied

$1,180 of $2,400 Med. Out of pocket satisfied


Actual benefit determinations can only be made by the network claims administrators based on the Advantage High plan documents.

PEIP SCENARIO

25

Advantage Value Family (cost level 2)-Ded=$700/1,400, OOP =$1,000/2,000 RX, $2,200/$4,400 Med. Date Activity Cost Member pays Notes


2/1/2017 Office visit (Spouse) $250 $250 $250 towards Deductible satisfaction

2/1/2017 Office visit (Son) $250 $250 $250 towards Deductible satisfaction



5/1/2017 Referral to specialist office visit (EE) $375 $375 $375 towards Deductible satisfaction

6/1/2017 Knee Surgery out patient (EE) $4,000 $500 $325 towards family Deductible (satisfied)+ $175 copay

7/1/2017 5 tier 2 prescriptions (EE) 5@ $75=$375 $200 5 times $40 copay

8/1/2017 8 Rehab visits (EE) 8@100=$800 $280 8 times $35 copay


10/1/2017 Office visit (Spouse) $150 $35 $35 OV copay

11/1/2017 Office visit (EE) $150 $35 $35 OV copay


12/15/2017 Hospitalization spouse 3 days $5,500 $325 $325 copay

Total $12,750 $2,575

Family Deductible met ($700)

$325 of family RX out of pocket satisfied


Actual benefit determinations can only be made by the network claims administrators based on the Advantage Value plan documents.

PEIP SCENARIO

26

Advantage HSA Family (cost level 2)-Ded=$3,200/4,000, OOP = $5,000/6,000 Med. (Medical ,Rx combined) Date Activity Cost Member pays Notes


2/1/2017 Office visit (Spouse) $250 $250 $250 towards Deductible satisfaction


3/1/2017 Prescription Tier 1 (son) $25 $25 $25 copay


5/1/2017 Referral to specialist office visit (EE) $375 $375 $375 towards Deductible satisfaction

6/1/2017 Knee Surgery out patient (EE) $4,000 $3,225 $2,825 towards EE Deductible (satisfied)+ $400 copay

7/1/2017 5 tier 2 prescriptions (EE) 5@ $75=$375 $200 $40 copay X 5

8/1/2017 8 Rehab visits (EE) 8@100=$800 $200 $200 towards Individual OOP

9/1/2017 Prescription Tier 3(son) $150 $150 $75 towards Family Deductible (satisfied) +$65 copay

10/1/2017 Office visit (Spouse) $150 $150 $50 Copay

11/1/2017 Office visit (EE) $150 $0 Covered at 100%

12/1/2017 Prescription Tier 2 (EE) $75 $0 Covered at 100%

12/15/2017 Hospitalization spouse 3 days $5,500 $650 $650 copay

Total $12,750 $5,675

$4, 000 family Deductible satisfied

EE OOP of $5,000 satisfied

$5,675 of $6,000 Family Med. Out of pocket satisfied


Actual benefit determinations can only be made by the network claims administrators based on the Advantage HAS plan documents.

ADDITIONAL INFORMATION ABOUT PEIP:

• Urgent Care versus emergency: Urgent care definition: if condition or symptoms is delayed results will create dire

situation. Urgent care include injuries or Illnesses such as sprains, high fever or severe vomiting which are painful

and severe enough to require urgent Treatment, but are not life-threatening. You may seek assistance at any urgent

care without contacting Your own PCC. Example: Traveling and child has score throat day one, not urgent. The next

day child has high temperature this now could be urgent. PEIP always stated a member can always call your primary

clinic and get a referral.

• Convenient Clinic: In the metro these are in stores like Target where they have very limited services, they are called

minute clinics. 7 day clinics are not considered convenient.

• A benefit of all plans is online clinic visit, paid at the convenience clinic level.

• Referrals: PEIP has found that Sanford and Essentia have been good at working with their patients and referring

them to another doctor such as Mayo. If you are referred to Mayo charges stay under the cost level that your primary

is under. In addition a member could change primary clinics if a situation arose such as a member wanted to be

treated at Mayo but could not get referred.

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• Primary Clinic: If your doctor at your primary clinic admits you to a hospital that is not owned by your primary care

provider it is still covered because your primary clinic doctor admitted you. Example: Your primary clinic is Sanford

clinic in DL but the hospital in DL is Essentia. If your Sanford clinic admits you to the hospital in DL there would be

coverage.

• Self- Referring: Each network has steps and providers that are considered self -referring so you can just go and in

some cases it may be a different provider entity versus your primary. Some self -referring could be essential but you

can still go even if you are with Sanford. This would be something a member would need to check before going.

• Wellness program: work the same as our current program

• Traveling out of state: Primary is Sanford, PEIP said Sanford usually allows a member could go to another Sanford

clinic in another state but to be safe an employee should always call to confirm or get primary to refer.

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• Changes to plan design and notification of changes: PEIP usually reviews the plan designs every couple of years and

changes may occur such as needed to keep up with the market. PEIP stated that the changes in the last few years has

been minimal (there have been more benefit increases than decreases in the last 3 years). **remember, if PEIP makes

changes it is automatic we cannot design our own plans.

• Two year commitment: each renewal is for a two year period. PEIP requires this to help create a more stable pool.

• Notice to leave PEIP: 30 days prior to the end of the two year commitment

• Renewals: Renewals are based on the whole PEIP group utilization not individual group’s utilization. The Co-op looks at

each group’s utilization, at PEIP it is the entire membership’s utilization. PEIP has 30,000 members so they can spread

the risk better and that PEIP is a “true Pool” because they do it this way and not look at individual group’s

utilization. Each plan through PEIP could get a different increase at the time of renewal. (Changes differ by plan

occasionally but by less than 1%). PEIP's average renewal increase for the pool is 2.3% over the last eight years.

WHAT HAPPENS TO MY VEBA FUND

• Employees with VEBA funds maintain those funds and can use them as long as they are not

funding an HSA at anytime during a plan year.

• If an employee with a VEBA fund (HRA) wants to fund an HSA then the VEBA fund must be

“limited”, “suspended”, “post-retirement” or a “post-deductible” for the participant to be HSA

eligible:

Limited: Dental/Vision expenses only

Suspended or Post-Retirement: all medical expenses will be reimbursed from the HSA as the

VEBA (HRA) funds are not available until a future specified event

Post Deductible: Limited to dental/vision expenses during the deductible phase. Once the

deductible has been met, all eligible 213(d) medical expenses may be reimbursed through

the FSA

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becker county health benefits

Documents