health insurance program. health insurance team members favorite city manager human resources ...
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HEALTH INSURANCEHEALTH INSURANCE
PROGRAMPROGRAM
Health Insurance Team MembersHealth Insurance Team Members
Favorite City ManagerFavorite City Manager Human ResourcesHuman Resources
FinanceFinance ContractsContracts PurchasingPurchasing
UtilityUtility FireFire
Medical DirectorMedical Director Insurance BrokerInsurance Broker
With support from the Employee CommitteeWith support from the Employee Committee
GROUP HEALTH INSURANCE GROUP HEALTH INSURANCE PROGRAM OVERHAULPROGRAM OVERHAUL
Contract with Insurance Broker on Flat Fee Contract with Insurance Broker on Flat Fee BasisBasis
Evaluate employee clinic conceptEvaluate employee clinic concept Evaluate fully-insured vs. self-insured Evaluate fully-insured vs. self-insured
optionsoptions Analyze Plan DesignAnalyze Plan Design Promote healthy workforce through Promote healthy workforce through
enhanced wellness programsenhanced wellness programs
Fully-Insured vs. Self-InsuredFully-Insured vs. Self-Insured
Fully InsuredFully Insured– Underwriters set premiums Underwriters set premiums
anticipating profit (premiums anticipating profit (premiums received exceed claims received exceed claims paid)paid)
– Lack of control over pricingLack of control over pricing– Utilization of five (5) years Utilization of five (5) years
claims experienceclaims experience– Anticipated annual increases Anticipated annual increases
based on current trends based on current trends would continue to be in would continue to be in double digitsdouble digits
Self-InsuredSelf-Insured– City pays fixed City pays fixed
administrative costsadministrative costs– City pays actual claims City pays actual claims
incurred (based upon incurred (based upon network negotiated rates)network negotiated rates)
– Dollars spent are Dollars spent are representative of care representative of care received, without insurance received, without insurance company added profitscompany added profits
– Better opportunities to Better opportunities to mitigate costsmitigate costs
– Stop Loss Insurance limits Stop Loss Insurance limits liability to $125,000 per liability to $125,000 per insuredinsured
Carrier Comparison – Fixed CostsCarrier Comparison – Fixed CostsAdministrative & Stop Loss InsuranceAdministrative & Stop Loss Insurance
CARRIERCARRIER TOTAL TOTAL ANNUAL FIXED ANNUAL FIXED
COSTSCOSTS
DIFFERENCEDIFFERENCE
AetnaAetna $368,912.00$368,912.00
Blue Cross/Blue Cross/
Blue ShieldBlue Shield
$470,554.00$470,554.00 $102,642.00$102,642.00
United United HealthcareHealthcare
$437,619.00$437,619.00 $68,707.00$68,707.00
NEXT STEPS…NEXT STEPS…
Implement Self-Insured Group Health Implement Self-Insured Group Health Insurance ProgramInsurance Program
Begin negotiations with clinic providersBegin negotiations with clinic providers Evaluate plan designsEvaluate plan designs
– Analyze adding high deductible plan optionsAnalyze adding high deductible plan options
Healthcare Empowerment Training for Healthcare Empowerment Training for Employees and FamiliesEmployees and Families
Develop Wellness Programs Develop Wellness Programs
Approve Aetna Healthcare as the Plan Approve Aetna Healthcare as the Plan Administrator for the City’s Self-Insured Administrator for the City’s Self-Insured
Group Health Insurance ProgramGroup Health Insurance Program
RECOMMENDATIONRECOMMENDATION
HEALTH INSURANCE TEAMHEALTH INSURANCE TEAM
QUESTIONS???QUESTIONS???