• Insurance Committee Meeting Minutes 4/23/2019

    Posted by Kristin Baum on 4/26/2019

     

    INSURANCE COMMITTEE Meeting Minutes

    Meeting Date: April 23, 2019

    Meeting Location: Administration Meeting Room

    Recorded By: Kristin Baum

      

    20 of the 35 Campus/Departments were represented at the meeting.

     

    1. Enrollment System Update – we have contracted with TBX (TheBenefitseXpert) for our online benefits enrollment system. The system will go live in the summer and we plan to have the new hires be the first to enroll online. During open enrollment all employee will enroll online. More information will be provided as well as a demonstration of the site at a future meeting.

     

    1. Supplemental Plans Renewal – We will provide analysis of the bids at the May meeting.

     

    Davis Vision – we have not received a rate increase for the last 4 years.  If there is no rate increase, we do still plan to go out to bid. This is at the request of some of our highly utilize providers as well as employees. Davis Vision requires providers to use their lab when ordering glasses, which creates a delay. They also have contact lens restrictions. Do to these limitations we will go out to bid and look at other providers.

     

    Delta Dental – back in 2018, we were given a 2-year rate guarantee with year 3 not to exceed 7.5%. January 1, 2020 will be our third year.  We are bidding out the dental to see if we can get some competitive quotes.

     

    Texas Life (whole life) – we have had steady rates with Texas Life for several years, however there are some newer life insurance plans that include some extra benefits that we want to take a look out. 

     

    Hospital Indemnity Plan – this is a new option. This plan that would pay you benefits when confined to a hospital. Once we receive the bids back and have more information we will discuss at the next committee meeting.

     

    1. United Health Care Presentation – Laurie Macina from UHC presented on the Telemental Health and Nurse Line programs as well as how to use the Health4Me app and myuhc.com site. UHC Programs and Tools Presentation

     

    1. Opioid Program – proposed opioid management program to implement for January 1, 2020. This program would put restrictions on new prescriptions to limit over prescribing as well as help prevent overuse and addiction. The cost of the program is $.32 per employee per month. Opioid Impact and Program Information.

     

    1. Spousal Surcharge – this was the final discussion to add a spousal surcharge for the next plan year. Spouse costs are 80% higher than the average member costs. Three out of the five individual high cost claims are spouses. A spousal surcharge would be implemented if the spouse has access to their employer’s group health plan but is choosing to be covered under PfISD’s plan. The cost to the employee would be $200 additional a month if their spouse chooses to remain on the PfISD plan. Committee vote was 15 to add spousal surcharge and 5 against. We will recommend to District leaders to implement this surcharge effective January 1, 2020. Spousal Surcharge

     

    1. Surgery Plus –discussed the value of adding this program for 2020. This program allows employees on the PPO plans to have certain surgeries by highly qualified surgeons at no cost. There would be a cost for employees on the HDHP, as the rules under this plan do not allow for zero cost. Provided sample list of the most common surgeries and will discuss more at the May insurance committee meeting. Surgery Plus - Common Procedures * this is a sample as the procedure would still have to be covered under our group health plan.

     

    • Next Meeting: Wednesday, May 22, 2019, 4:30 – 6:00 pm discuss all renewal-related items and reach consensus on committee’s recommendations

     

    Comments (-1)
  • Insurance Committee Meeting Minutes 2/20/2019

    Posted by Kristin Baum on 3/9/2019

     

     

    Meeting Date: February 20, 2019

    Meeting Location: Administration Meeting Room

    Recorded By: Kristin Baum

     

     22 of the 35 Campus/Departments were represented at the meeting.

     

    1. Medical Consultant Update – updated committee on the change of consultants. In June 2018 we changed consultants to Gallagher, however this relationship did not work out and we have changed back to our previous consultants with Marsh & McLennan Agency (MMA).

     

    1. Open Enrollment and Enrollment System – requested comments and feedback about the open enrollment process. Implemented online option as well as continued to have enrollment representatives’ onsite. Received positive responses.

     

    Discussed that we are looking at a new enrollment system. This will allow for 100% online enrollment next year. We have discussed this change over the past two years and we will be moving this direction for the 2020 open enrollment. The enrollment system will also allow new hires to self-enroll as well. We are working with two vendors to make the selection. The criteria is to make sure the system is user friendly, a dedicated call center for employee questions as well as better reporting capabilities on the administrative side. 

     

    1. Supplemental Plans Renewal - several of our supplemental plans are up for renewal as well as we have plans that we want to bid out to look at other providers and compare rates.

     

    Davis Vision – we have not received a rate increase for the last 4 years.  If there is no rate increase, we do still plan to go out to bid. This is at the request of some of our highly utilize providers as well as employees. Davis Vision requires providers to use their lab when ordering glasses, which creates a delay. They also have contact lens restrictions. Do to these limitations we will go out to bid and look at other providers.

     

    Delta Dental – back in 2018, we were given a 2-year rate guarantee with year 3 not to exceed 7.5%. January 1, 2020 will be our third year.  We are bidding out the dental to see if we can get some competitive quotes.

     

    Lincoln Financial (term life) – we will look at the renewal and if there is a rate increase we will bid this out as well.

     

    Texas Life (whole life) – we have had steady rates with Texas Life for several years, however there are some newer life insurance plans that include some extra benefits that we want to take a look out. 

     

    Allstate Cancer – we have had this plan in place for a long while and have never received a rate increase. We want to make sure we are providing the best option to our employees so we do plan to bid this out as well.

     

    Hospital Indemnity Plan – this is a new option. This plan that would pay you benefits when confined to a hospital. Once we receive the bids back and have more information we will discuss at the next committee meeting.

     

    1. Employee Assistance Program (EAP) –we have changed to Optum Health for our EAP. Flyers were provided to place in the work room, bathroom or any high traffic area. The EAP provides short term counseling up to 3 face to face visits and 24/7 telephonic support. They also provide financial and legal advice, family support, relationship help and much more. This is for every employee in the District, not just employees on the medical plan. More information can also be found on the benefits webpage. http://www.pfisd.net/Page/5707

     

    1. Medical Pharmacy Update – presented by Jared Moss and Adam Sadler of MMA. Click the link to the power point presentation Medical and Pharmacy Update

     

    1. Spousal Surcharge – discussed adding a spousal surcharge for 2020. Spouse costs are 80% higher than the average member costs. Three out of the five individual high cost claims are spouses. A spousal surcharge would be implemented if the spouse has access to their employer’s group health plan but is choosing to be covered under PfISD’s plan. We will continue discussions at the next insurance committee meeting.

     

    1. Surgery Plus –discussed the value of adding this program for 2020. This program allows employees on the PPO plans to have certain surgeries by highly qualified surgeons at no cost. There would be a cost for employees on the HDHP, as the rules under this plan do not allow for zero cost. More information will be discussed at the next insurance committee meeting.

     

    • Next Meetings Dates

     

    Tuesday, April 23, 2019, 4:30 – 6:00 pm discuss potential changes to coverage and employer/employee premium contributions, UHC presentation, discuss supplemental bids

     

    Wednesday, May 22, 2019, 4:30 – 6:00 pm discuss all renewal-related items and reach consensus on committee’s recommendations

     

     

    Comments (-1)
  • Insurance Committee Meeting Minutes 4/19/17

    Posted by Kyndall Jirasek on 4/19/2017

    Meeting Date: April 19, 2017

    Meeting Location: Administration Meeting Room

    Recorded by: Kristin Baum

     

    16   of the 33 Campus/Departments were represented at the meeting.

     

    1.     Dental Renewal – Received the renewal for 2018 with a 9% premium increase and a two year rate guarantee.  This is making no changes to the current benefit structure. The original increase was 14% but we were able to negotiate it down to 9%.

     

    Delta Dental provided an alternate option to control the rate increase.  With this option the benefits remain the same for both the low and high plans and the change is to the out-of-network percentile.  

    ·      Currently members who go to an in-net-work Delta Dental dentist, fees are paid at a set contracted rate.

    ·      With this change, if a member goes to a non-Delta Dental Dentist (out of the network) the fees are paid at the 51st percentile instead of the 80th percentile, which is what we currently have.

    ·      Members could pay more out of pocket to continue to go to a non-Delta Dental Dentist.

    ·      With this plan we will keep our current rates for two years and at year 3 the rates are guaranteed not to exceed 7.5%.

    ·      Between January 1, and December 31, 2016 20% of the procedures were billed by a non-Delta Dental Dentist

     

    The group discussed the options and voted 2 to 14 in favor of the alternate plan with the out-of-network percentile at 51% and locking in our current rates for from January 1, 2018 through December 31, 2020.

     

    2.     2018 Medical Plan Update -  Several changes are being made to the medical plan for 2018. In 2016 we lost $3 million and are at the point the District cannot continue to fund this account. The money will need to come from employees by making plan changes and increasing the premiums. The District will not be increasing their contribution. It will remain at $400 in 2018.   The following changes are being proposed:

     

    ·      Eliminate the iNGAGED program.

    ·      Offer an incentive for employees who are seen by a physician on our medical plan. Claims will be pulled from January 1 – September 30 and employees who have seen a physician will receive $100 in December.

    ·      Addition of the high deductible plan. Under this plan the premiums are the same as our low option rates this year.

    ·      Increase premiums by 10% on the low, mid and high plans.

     

    ·      Additional changes to the low, mid and high plans include:

    o   Primary Care visit co-pay going from $30 to $35

    o   Specialist Visit co-pay going from $30 to $50

    o   Urgent Care visit co-pay going from $40 to $50

    o   Emergency Room co-pay going from $300 to $400

    o   Low Plan prescription co-pays going from $10/$40/$60 to $15/$50/$75 the 4th tier will remain the same at 10% co-pay capped at $2,500

    o   Mid Plan in-network deductible is going from $1,500 to $1,750 for individual and $3,000 to $3,250 for family. Out of network is going from $3,100 to $3,350 for individual and $6,200 to $6,450 for family.   Prescription co-pays going from $10/$40/$60 to $15/$50/$75 the 4th tier will remain the same at 10% co-pay capped at $2,500

    o   High Plan in-network deductible is going from $1,000 to $1,250 for individual and $2,000 to $2,250 for family. Out of network is going from $2,350 to $2,600 for individual and $4,700 to $4,950 for family.   Prescription co-pays going from $10/$30/$50 to $15/$40/$65 the 4th tier will remain the same at 10% co-pay capped at $2,500

     

     

    3.     Next Meeting – the proposed medical changes will be presented to the board in August. Unless there becomes a need the May 24, 2017 meeting has been cancelled.

    Comments (-1)
  • Insurance Committee Meeting Minutes 2/15/17

    Posted by Kyndall Jirasek on 2/15/2017

    Meeting Date: February 15, 2017

    Meeting Location: Administration Meeting Room

    Recorded By: Kristin Baum

     

    23   of the 33 Campus/Departments were represented at the meeting.

     

    1.     Open Enrollment – requested comments and feedback about the open enrollment process. Responses were positive in regards to the process as well as the flow with the screenings and enrollment. There were a large amount of employees who came on the last day Saturday, November 12, 2016. These employees expressed that they were not aware they needed to go through the screening process. Discussed how campuses could communicate more during open enrollment so that all employees are aware of the requirements (more emails, announcements and during staff meetings).

     

    2.     Employee Assistance Program (EAP) –We have completed the first full year with the EAP. There were 85 members who accessed the EAP/Work Life Services.  Provided flyers to be in the work room, bathroom or wherever high traffic areas for employees. More information can also be found on the benefits webpage. http://www.pfisd.net/Page/5707

     

    3.  Pharmacy/RxBenefits - with the change to our pharmacy program effective January 1, 2017 to Express Scripts administered by RxBenefits there have been a lot of questions. RxBenefits representatives, Tressa Chretien, Account Manager, Polly Pardo, Account Executive and Cynthia Johnson, Chief Operating Officer attended the meeting to give an overview of the pharmacy program and answer questions.  Employees with questions about their pharmacy benefits can contact RxBenefits at 1-800-334-8134 or the Benefits Department at 594-0019.

     

    4.     Next Meetings

     

    • Wednesday, April 19, 2017 – 4:30 – 6:00 pm 
    • Discuss potential changes and renewal-related items

     

    • Wednesday, May 24, 2017 – 4:30 – 6:00 pm
    • Finalize renewal-related items
    Comments (-1)
  • Insurance Committee Meeting Minutes 9/21/16

    Posted by Kyndall Jirasek on 10/17/2016

    Meeting Date: September 21, 2016
    Meeting Location: Administration Meeting Room
    Recorded By: Kristin Baum
     

     

    20   of the 32 Campus/Departments were represented at the meeting.

     

    1.     Compass – Catherine Donaldson is no longer our Health Pro.  Catherine’s emails are being re-routed to our new Health Pro, Laurens Doelman. Please communicate this change to your staff.  (flyer attached – please put up in work/break room).

     

    2.       Airrosti Update - We will no longer be waiving the co-pay to go to Airrosti beginning January 1, 2017. Please communicate this important update to your staff. 

     

    3.     Davis Vision - Davis Vision provides an added benefit if employees buy their glasses from a Visionworks provider. The frame allowance is $200 instead of $150 for all other providers. (benefit summary attached)

     

    4.     Delta Dental Renewal - We changed to Delta Dental on January 1, 2014 with a two-year rate guarantee. In 2016 we received an initial 40% rate increase due to utilization running at 118%. What this means is that Delta Dental is not collecting enough premium to cover the cost of the claims. January through July 2015 they collected roughly $608,000 in premium but paid out over $717,000 in claims. What is driving the high utilization are employees utilizing a non-network dentist instead of going to a Delta Dental provider where we receive the best discounts. We were able to make some plan changes and received a 9.9% increase in 2016.  We still have not improved as much as we need to and received a 13.62% increase for 2017. 

     

    We did discuss making some plan changes which would have given a 9.9% increase on the high plan and no increase on the low plan for 2017.  Committee members polled their campuses and with a vote of 13 to 9 it was voted to keep the plans as they are for 2017 with the 13.62% increase. 10 campuses did not respond. Keep encouraging employees to utilize an in-network dentist.

     

    5.     Employee Assistance Program (EAP) – The first 9 months of the Employee Assistance Program (EAP) have been slow. From January through May 31, 2016 a total of 49 employees have received assistance. Please remind employees that this program is available with many services to help with work and life issues (flyer attached – please put up in work/break room).


     

    6.     Medical Plan Changes for 2017

    There are several changes being made to the medical plan effective January 1 (refer to medical plan option attachment)

    1.     The District monthly contribution is increasing from $375 to $400

    2.     Employees with single coverage on the iNGAGED plan will not see a rate increase

    3.     iNGAGED and Non-Engaged participants will be eligible to enroll in any of the plan options. There are new rules that now limit the way we can structure the Non-Engaged plan. We currently have 3 iNGAGED plans and one Non-Engaged plan (low option). With this change we can no longer alter the benefits, only the rates. We will continue to have 3 plans (low, mid and high) and six sets of rates (3 iNGAGED and 3 Non-Engaged).

    4.     Premiums are increasing for most employees covering dependents.

    5.     The deductible and out of pocket maximums have increased across all 3 plans for both in network and out of network.

    6.     The emergency room facility co-pay increased from $150 to $300. The physician fee remained the same with deductible and co-insurance.

    7.     The fourth quarter deductible carryover has been eliminated.

    8.     The total out of pocket maximums (medical and prescription) increased.

     

    7.       Pharmacy Update – we currently have a 3 tier pharmacy structure and will be moving to a 4 tier. Generic drugs will be in the 1st tier, brand in the 2nd, formulary in the 3rd and specialty in the 4th.  Members whose drugs fall into the 4th tier will pay a 10% co-pay up to a $2500 maximum. We have gone out to bid for new pharmacy benefit manager. More information on the pharmacy program will be communicate once a decision has been made.

     

    8.     Open Enrollment – An email will be send the Principals announcing the upcoming open enrollment to provide to all staff. It will include the schedule along with the instructions for completing the health assessment and scheduling the biometric screening.

     

    We will hold 5 question and answer sessions. Four will be here at Admin and one at Support Services. These sessions are for employees who want to talk about specific situations, or have personal questions they want answered prior to making their decision on enrollment day. If employees can’t make it to one of these sessions, they can call or email the benefits department at any time.

     

    All employees will receive an Open Enrollment flyer. The flyer will include all of the information we have discussed regarding the changes for 2017. Extra flyers will be sent to be placed in your work room/break room and it will also be available on the PfISD website on the benefits page available for download.

     

    Important items to remember and communicate to your staff regarding the iNGAGED plans:

    1.     Employees and Spouses enrolling in the iNGAGED plan must complete the Health Assessment

    2.     The Health Assessment site will open on September 27

    3.     If the spouse is not in the HA site email the benefits department at benefits@pfisd.net with their full name and date of birth – we can update immediately

    4.     We are resetting all of the passwords so employees are not expected to remember from last year. Employee will login with social and date of birth as password and then will be prompted to change it at that point.

    5.     The directions to completing the HA is included in the flyer and I will provide it in the email to the Principals and Supervisors.

    6.     Employees need to schedule their bio-metric screening appointment.

    7.     Employees without appointments will only be seen as time permits.

    8.     The last day to enroll will be Saturday, November 12th. Employees should make appointments for their bio-metric screening on this day as well. They can show up without an appointment but again appointment will be honored first.

     

    When enrolling:

    1.     There will be a gatekeeper at the door of the enrollment location. This gatekeeper will verify that you and your spouse (if enrolling) have completed the requirements.

    2.     If you are enrolling in the iNGAGED plan and you have not met all of the requirements you will not be able to meet with the enrollment rep

    3.     The gatekeeper is going to give you a confirmation page to provide to the enroller –

    -           you (and your spouse) have met the requirements

    -           you are electing the Non-Engaged plan

    -           you are waiving medical coverage

     

    9.     Next Meetings

     

    Wednesday, February 15, 2017 – 4:30 – 6:00 p.m.

    Review results from the previous year (enrollment, premiums received, claims paid, reserve amounts, etc.), begin discussion for possible changes for the next plan year

     

    Wednesday, April 19, 2017 – 4:30 – 6:00 p.m.

    Discuss potential changes to coverage and employer/employee premium contributions

     

    Wednesday, May 24, 2017 – 4:30 – 6:00 p.m.

    Discuss all renewal-related items and reach consensus on committee’s recommendations

     

    Comments (-1)
  • Insurance Committee Meeting Minutes 2/24/16

    Posted by Kyndall Jirasek on 3/10/2016

    Meeting Date: February 24, 2016
    Meeting Location: Administration Meeting Room
    Recorded By: Kristin Baum
     

    21 of the 34 Campus/Departments were represented at the meeting.

     

    1.     Delta Dental Update – Ida Kelly and Chris Hinds with Delta Dental presented 2014 & 2015 utilization review. Discussed the importance of utilizing a contracted Delta Dental dentist vs. a non-contracted dentist to receive the best pricing/discounts. We have been educating employees and did see a small amount of movement. In 2014 35% of employees went to a non-contracted dentist and in 2015 this went down to 32.6%.  However, best practice would be at 23%. Utilizing a Delta Dental Dentist provides a bigger discount for the employee as well as the plan. Will have a good idea of renewal rates by next committee meeting. 

     

    2.     Compass – Madelon Parker presented a review of 2015 utilization. Very positive results. Employees called in for the following:

    46.7% - Doctor Recommendation

    19.2% - Insurance Benefit Question

    13.2% - Cost Estimate

    11.5% - Bill Review

    3.7% - Prescription Review

    2.7% - Coordination of Care

    1.8% - Schedule Appointment

    1.2% - Other 

    The highest savings opportunity is for employees seeking cost estimates and prescription reviews.

    The standout claims from 2015 came from employees utilizing emergency rooms instead of urgent care facilities. The free-standing ERs have caused confusion as to what are true urgent care facilities. Email addresses have been provided to Compass and an education flyer will be emailed to all employees and an English/Spanish postcard will be mailed to all auxiliary employees with helpful information about local ERs vs. Urgent Cares. They will specifically state “this” is an urgent care and “this” is not.  

     

    3.     Humana Update – Jared Moss with MHBT present a review of 2015. PfISD averaged 3418 members with the average age being 42. 67% are female and 33% are male. In 2014 the cost per member per month was $310.75 and increased to $311.08 in 2015. There were 6 claims that were more than $100,000 which was down from 12 claims in 2014. The top diagnosis in 2015 was the musculoskeletal system. Emergency room visit costs increased from $737,802 in 2014 to $1,335,139 in 2015. For more information email benefits@pfisd.net for the summary to be sent to you.

     

    4.     Open Enrollment – requested comments and feedback about the open enrollment process. Four campuses responded that there were sensitivity issues as well as a differential in blood pressure readings. Response from four campuses that they were pleased with their enrollment and had no issues. The addition of the “gatekeeper” to direct the flow to the enrollers worked very well and received a positive response. 

     

    5.     Employee Assistance Program – we continue to receive inquiries about this program.  Information is available about the EAP on the PfISD website under the Employee Benefits page. Employees are able to access this program and have 3 face to face counseling sessions and unlimited 24/7 phone support.

     

    6.     Airrosti - we have extended the Airrosti program through December 31, 2016. If you or your dependents are covered under the Districts medical plan you can treat with Airrosti at no cost to you. We are also conducting on-campus injury assessments at 15 locations for the spring semester.  An assessment is a brief complimentary evaluation to determine if further treatment options are necessary and then employees are scheduled a follow up appointment.  We are definitely interested in any feedback you have to this program. One concern that was brought to our attention was the clinic hours.  The last appointment for the day was at 4:00 pm. The Pflugerville location on 685 has adjusted their appointment times and added a 5:30 appointment on Monday and Tuesdays. In the future they hope to extend to 6:00 pm. 

     

    7.     Colonoscopy and BRCA Testing –

    a.     Colonoscopy – employees that go in for a preventative colonoscopy that is covered at 100% will no longer be charged their deductible/co-insurance if a polyp is found during this visit. Insurance companies cannot change the coding from preventative to diagnostic and charge the employee. If the employee goes in originally for a diagnostic test then it is subject to their deductible/co-insurance

    b.     BRCA Genetic Testing - For some women a genetically inherited trait puts them at very high risk for developing breast cancer (BRCA Mutation).  This testing is now covered under preventative services. Group discussed 3D and MRI mammogram coverage. Currently both are not covered. We will look into considering the cost to add for next year. 

     

    8.     403b and 457 TPA Change - There have been questions about the change PfISD made to The OMNI Group as out third party administrator for 403b and 457 plans as well as how to handle financial advisors requesting to solicit business on campus. Effective January 1, 2016 PfISD moved from National Plan Administrators for the 403b plans and VOYA for 457 plans to The OMNI Group as our third party administrator. Nothing has changed except that the employee’s financial advisor will send their salary reduction agreements to The OMNI Group. This information can be found under the employee benefits link on the PfISD webpage under employee benefits.

    Additionally, there are specific guidelines set by TRS regarding what an educational institution MAY NOT do in regards to 403(b) plans. Educational institutions cannot give exclusive access to any company offering investment products. What this means is that if you allow one company onsite (such as AXA Advisors, Capital Advisors, Edward Jones) then you must allow any other company offering financial/retirement planning products onsite as well.  PfISD does not endorse any financial advisor and will not recommend one company over another. It is the employee’s responsibility to contact a financial advisor of their choice, and meet with them outside of work hours. If the employee enrolls in a 403b or 457 plans then their financial advisor will contact The OMNI Group for processing.

     

    Questions should be directed to their advisors or The OMNI Group.

     

    Mailing Address:

    The OMNI® Group

    Water Tower Park

    1099 Jay Street, Building F

    Rochester, NY 14611-1153

    ATTN: Service Provider Team

     

    Website/Phone/Fax:

    www.omni403b.com

    Phone: 877.544.6664

    Fax: 585.672.6194

     

    9.     IRS Form 1095c - Form 1095c is an annual reporting form used in connection with the Affordable Care Act. Form 1095c includes information about the health insurance coverage offered to you and, if applicable, your family. The IRS extended the deadline from February 1 until March 31. The forms have been mailed to all employees employed with PfISD from January 1 – December 31, 2015. Employees do not need to wait on this form to file their 2015 taxes. Every employee will receive this form whether they were enrolled in the district medical plan or not. More information about this required reporting can be found on the PfISD website under Employee Benefits.

     

    10.  Employee Question/Coordination of Benefits – It is an industry practice for insurance companies to ask if you or your dependents have other medical coverage. They typically do so by sending a letter that you must respond to. Failure to respond to the letter will result in the denial of claims payment until you respond. PfISD is working with Humana to coordinate this during our open enrollment process so that employees are not faced with this throughout the year. This will go into effect next year (2016) so please respond to the letters if you should receive them through the end of this year. 

     

    Next Meetings:

    April 13, 2016 at 4:30 p.m.

    May 17, 2016 at 4:30 pm

     

     

    Comments (-1)
  • Insurance Committee Meeting Minutes 9/22/15

    Posted by Kyndall Jirasek on 9/23/2015

    Meeting Date: September 22, 2015
    Meeting Location: Administration Meeting Room
    Recorded By: Kristin Baum



    22 of the 33 Campus/Departments were represented at the meeting.

    1. Delta Dental Update – utilization from January 1 – July 31, 2015 is running at 118% (claims payout is higher than the premium being collected). Delta Dental collected roughly $608,000 in premium but paid out over $717,000 in claims. We are up 2% from the same time period in 2014. Discussed the importance of educating employees to treat with a contracted Delta Dental dentist vs. a non-contracted dentist to receive the best pricing/discounts.

    Handout – Employees are able to download the Delta Dental app or logon to the Delta Dental website to get the most up to date information. Employees can:
    - check benefits
    - eligibility and claim status
    - view and print id card
    - find a dentist

    This handout can be found on the benefits page on the PfISD website under Delta Dental.

    2. As you heard from Dr. Torrez during convocation we are going to offer an Employee Assistance Program (EAP) through Humana. This was discussed and approved during the June 23, 2015 insurance committee meeting. For those of you not familiar with an EAP, this program will help employees with a variety of issue. EAP services include:
    - counseling and referral services
    - substance abuse programs
    - legal and financial advice
    - unlimited access 24 hours a day, 7 days a week to a master or doctor level EAP professional for telephonic counseling
    - 3 face to face in-person counseling sessions

    We have received a lot of calls from employees wanting to access this service. However, this program is not effective until January 1, 2016. More information can be found on the benefits page on the PfISD website.

    3. Emergency Rooms vs. Urgent Cares – There has been an increase in Emergency Room (ER) utilization. We are up from 517 ER visits in 2014 to 664 visits in 2015 for the same time period. A misconception might be that employees are going to an ER that they think is an Urgent Care. The current list of true Urgent Care facilities are listed on the PfISD website under Medical Plans.

    4. Pharmacy 2016 Changes - As there are every year, there will pharmacy changes for 2016.

    109 members have drugs moving tiers (member could be the employee, child or spouse)
    - 26 members will be negatively impacted (moving from tier 2 to tier 3)
    - 83 members will be positively impacted (moving from a higher tier to a lower tier or having their non-formulary drug moved to formulary)

    323 members will see a coverage change
    - 301 members on a formulary covered drug will move to non-formulary
    - 29 members will be positively impacted as their drugs will now be covered under tier 3 or tier 1 for drugs that were previously not covered

    6 members will have prior authorization changes
    - 5 members will be positively impacted as they will no longer need prior authorization for their drugs
    - only 1 member will be negatively affected as they will need to provide a prior authorization attached to their drug request

    35 members will have step therapy changes
    - 34 members will be positively impacted as they will no longer need to show step therapy in order to receive their drug
    - only 1 member will be negatively impacted as they will be required to continue with step therapy attached to their drug request for approval.

    Humana will send postcards out in mid-November to every member being affected by a formulary change. They will be notified 30 days prior to the change becoming effective on January 1, 2016.

    5. Open Enrollment – employees will be notified about open enrollment through an email that will be sent to Principals announcing the upcoming open enrollment and the open enrolment flyer that has been mailed.

    We will hold 3 question and answer sessions. They will be at the 3 high schools and will be held early in the morning and after school. There was a misconception as to what these sessions were about last year. These are not meetings. They are for employees who want to talk about specific situations, or have personal questions they want answered prior to making their decision on enrollment day.

    Open Enrollment Flyer
    - the open enrollment flyer was mailed out today to every employee
    - it will also be on the website under the benefits page available for download

    Important to remember and communicate to your staff:

    Employees enrolling in the iNGAGED plan must complete the Health Assessment
    1. The Health Assessment site opened yesterday (September 21)
    2. If the employee will be enrolling their spouse they will be required to also complete the HA
    3. If the spouse is not in the HA site email the benefits department at benefits@pfisd.net with their full name and date of birth – we can update immediately
    4. We are resetting all of the passwords so employees are not expected to remember from last year. Employee will login with social and date of birth as password and then will be prompted to change it at that point.
    5. When employee’s login and click on “Take the Health Assessment” it will take them to the Acknowledgement Form. (if you remember this was a paper form last year)
    6. Employees will be asked to check that they consent to the requirements for the iNGAGED program and then fill in some information and electronically sign the form.
    7. Once this is done it bounces you back out to the Health Assessment section again and you will need to click on “Take the Health Assessment” again to then start the assessment.
    8. The system is requiring you to sign the Acknowledgement form first before it will let you take the HA. Employees and spouses must agree to the Acknowledgement.

    Make sure you schedule your bio-metric screening appointment.
    1. This can be done by typing in the website address or clicking on the link from the Asset Health site.
    2. It is HIGHLY recommended to schedule an appointment.

    When enrolling:
    1. There will be a gatekeeper at the door of the enrollment location. This gatekeeper will verify that you and your spouse (if enrolling) have completed the requirements.
    2. If you are enrolling in the iNGAGED plan and you have not met all of the requirements you will not be able to meet with the enrollment rep
    3. The gatekeeper is going to give you a confirmation page to provide to the enroller –
    - you (and your spouse) have met the requirements
    - you are electing the non-Engaged plan
    - you are waiving medical coverage

    Next Meeting - February 24, 2016 at 4:30 pm


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  • Insurance Committee Meeting Minutes 6/23/15

    Posted by Kyndall Jirasek on 6/23/2015
    Meeting Date: June 23, 2015
    Meeting Location: Administration Meeting Room
    Recorded By: Kristin Baum



    8 of the 33 Campus/Departments were represented at the meeting.

    1. Medical Renewal – Medical bids were received on May 20, 2015. We received 4 bids plus the renewal from Humana. After review and receiving the best and final offer, the recommendation to the Board in July will be to continue with Humana. Humana has offered a 2 year rate guarantee. In addition, Humana has also offered a $36,000 performance guarantee in 3 buckets of $12,000. On December 1st PfISD will rate Humana with a pass/fail under the following 3 categories. 1. Electronic Data Integration & Reporting, 2. Scott & White Administration, 3. Customer Service. We will continue to offer the 3 iNGAGED plans (low, mid & high) and one non-Engaged plan (low option only).

    2. Employee Assistance Program (EAP) - Discussed adding an Employee Assistance Program (EAP) to help employees with a variety of issue. EAP services include counseling and referral services, substance abuse programs, legal and financial advice.

    Employees will have unlimited access 24 hours a day, 7 days a week to a master or doctor level EAP professional for telephonic counseling. In addition, 3 face to face in-person counseling sessions will also be available.

    Examples of services offered:

    Life Coach (which helps with):
    • Managing stress
    • Becoming better organized
    • Managing goals related to parenting, caregiving and family
    • Dealing with financial issues
    • Communicating better at work

    Legal/Financial Services:
    • Free 30 minute consultation with attorneys, CPAs, mediators and financial advisors
    • Do it yourself document preparation
    • 60 minute consult with expert fraud resolution specialist
    • ID theft emergency response kit included


    Substance Abuse:
    • Specialized network of trained substance abuse professionals
    • Timely appointments with certified substance abuse professionals
    • Referral to treatment facilities

    Family Issues:
    • Family and relationship counseling
    • Budgeting, debt management
    • Caregiver resources
    • Adoption, child and eldercare issues

    Humana is offering this EAP program at a cost of $0.98 per member/per month.

    After a vote of 8 for/0 against we will be adding this program effective January 1, 2016.

    3. Scott & White Issue – Humana has identified 142 members that were affected by their claims paying incorrectly. All 142 members will be reimbursed for any incorrect amounts they paid do to the facility fee being charged or the claim not processing correctly. We are working with Humana to determine the best way to reimburse members their out of pocket costs.


    Please reserve the following dates for the 2015-216 Insurance Committee Meetings. They will be located in the Administration Board Room from 4:30 – 6:00 pm. If you are unable to attend these meetings, please find an alternate to attend in your place.


    September 22, 2015 – prepare for open enrollment and review medical utilization.

    February 24, 2016 – discuss take away from open enrollment, review results from previous years (enrollment, premiums received, claims paid, reserve amounts, etc.), begin discussion for possible changes for next plan year.

    April 13, 2016 – discuss potential changes to coverage and employer/employee premium contributions

    May 17, 2016 – discuss all renewal-related items and reach consensus on committee’s recommendations

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  • Insurance Committee Meeting Minutes 5/14/15

    Posted by Kyndall Jirasek on 5/14/2015
    Meeting Date: May 14, 2015
    Meeting Location: Administration Board Room
    Recorded By: Kristin Baum



    21 of the 33 Campus/Departments were represented at the meeting.

    1. Delta Dental Renewal - Over the last few weeks we have been working with Delta Dental on our renewal. Initially PfISD was presented with a 32% renewal increase. This increase is due to very high utilization and significant usage of non-participating dentists. Delta Dental has been able to secure a 9.9% rate increase for one year and the only plan change is that reimbursement to non-Delta Dental Dentists will go from the 90th percentile to the 80th percentile. In order to prevent receiving a double digit renewal next year education needs to be made to employees who see out of network Dentists.

    We have two networks of Dentist that Delta Dental contracts with under our plan. They are the Delta Dental PPO Network (which we receive a 37% savings if employees use a Dentist in this network) and the Premier Network (which we receive a 21% savings if an employee uses a Dentist in this network). There is no savings to the plan or to the employee if they see a non-participating Dentist.

    To put this in perspective, the Dentists that do not contract (a non-Delta Dental Dentist) submitted claims in 2014 that totaled $459,664. They received $459,664 (the plan paid $259,127 and employees paid out $162,468). Under the Delta Dental PPO plan claims were submitted that totaled $843,315 but with the discounts they received $486,418. A savings of $356,897. The Premier Network of Dentists submitted claims that totaled $387,581 but with the discounts they received $295,164. A savings of $92,417.

    Additionally, this is important for the employee. If there are no fee agreements in place then the employee is not receiving a discount and pays significantly higher out of pocket costs (see Claims Example).

    We have run a report of the top 50 Dentists that PfISD employees see and Delta Dental is reaching out to attempt to contract with the ones who are not on one of their plans. Education to employee about the use of in-network Dentists will be ongoing.


    2. Vision Renewal - We received bids from five carriers plus the renewal from Block Vision. We presented the top three along with the renewal. The top three are Superior Vision Southwest, Superior Vision National and Davis Vision. Davis Vision matched the current benefits as well as offered enhanced benefits to the frame allowance, progressive lenses, polycarbonate and UV coating. Additionally they matched the current rates with a four year rate guarantee. A vote of 19 for and 3 against to change to Davis Vision effective January 1, 2016 was approved.



    3. $20 Employer Contribution – Effective January 1, 2016 employees who do not elect medical but have elected dental and/or vision will no longer receive the $20 contribution towards these plans. This contribution is being eliminated as there is no other District that provides this benefit and the money will be used in other areas (Airrosti, medical employer contribution, etc.).


    4. Medical Renewal – Medical bids are due on May 20, 2015. We will be moving to 4 plans (3 iNGAGED and 1 Non-Engaged – low option only). If we receive a narrow network plan that we decide to add then we would move up to 5 plans (4 iNGAGED and 1 Non-Engaged).

    Another change we will be making is to the plans we offer to part-time employees. Currently part-time employees can enroll under our medical plan but they must pay the full premium. We will still allow employees to elect coverage, however it will be limited to the low option, iNGAGED plan, employee only.


    5. Scott & White Issue - We have talked with Humana and feel that we have determined the cause of the issue. When an employee goes to a Scott & White facility they bill two claims to Humana. Once is for the office visit and the other is a facility fee. The problem occurs when the claim for the facility fee comes in before the office visit claim. These claims are typically rejected and then Scott & White bills the employee. We are working with Humana to determine which employees have paid these fees and what is still outstanding. We are also working with Humana to talk to Scott & White to discuss removing this separate facility fee.


    6. Compass Update - We will be continuing the incentive program through July 31st. When we return back in next school year we are looking to continue the incentive program but potentially have campus/department competitions. More will be discussed at the September meeting.

    Compass has offered to provide a webinar on their services. Presentation is about 15 – 18 minutes (30 minutes max with questions). More information will go out via email to employees when these are scheduled.


    7. Airrosti Update - We will be continuing the Airrosti promotion with the co-pay being waived through December 31, 2015.




    The next committee meeting is scheduled for Tuesday, June 23, 2015 at 2:00 pm to discuss the medical renewal. Attendance is not required.




    Comments (-1)
  • Insurance Committee Meeting Minutes 4/15/15

    Posted by Tamra Spence on 5/11/2015

    Insurance Committe

     
     
    21 of the 33 Campus/Departments were represented at the meeting.

    1. Follow up from last meeting
      • Ambulance Charges (clarify how paid)
        Ambulance charges are eligible expenses and paid at the in-network level. What members are seeing with the high out of pocket costs is the balance billing and ineligible expenses. They should contact Humana by calling the phone number on their ID card to ask questions about their specific bills.

        Ambulance Services

      • Pharmacy – drugs not covered as of 1/1/2015
        It was brought up that there was a concern that members did not receive letters that these changes were being made. After checking with Humana, letters were mailed on November 21, 2014 to 383 members. These letters told the members that their medications would no longer be covered and it listed lower cost alternative. So possibly members just thought it was junk mail and tossed.

    2. Compass Update - We began the incentive program February 1, 2015. For the month of February 76 employees contacted Compass and 44 in the month of March. Everyone that was contacted in February received their $10 Target gift card and the cards for March went out last week. The incentive program will end on May 31st. We will have the first quarter report at the May meeting and can decide if we want to extend a couple more months or end the incentive program.

    3. Airrosti Update - Reminder that the Airrosti promotion will run through May 31, 2015. The co-pay will be waived until this date. I did hear from Airrosti that they are not seeing employees from all campuses so please make sure you have communicated the promotion to your staff. In January there were 93 visits, 179 visits in February and 239 visits in March.

    4. Scott & White Issue - several employees have seen an extra facility fee or charge from Scott & White. We are working with Humana to determine the cause of this issue. In the meantime, if an employee has received a bill with this fee from Scott & White have them email it to Kristin Baum. Humana is looking at each of these on an individual basis.

    5. 2014 Financials – Last year we lost $500k. However, there were 7 high dollar claims (over $150k) that totaled $1.6 million. Two of these claims were over $300K. To put this in perspective, in 2013 there was only 1 claim over $150k ($227K). The good news is that for the first two months in 2015 we are trending well. We have collected more premiums in January and February than paid claims

    6. Employer Contribution Proposed for 2016 - next year the proposed will be to increase the employer contribution to keep the same out of pocket cost for the employee only coverage. This amounts to $750k to cover this increase.
    7. Proposed changes for next year
      • Our vision plan with Block Vision (Superior) is up for renewal. Our vision plan had a 3 year rate guarantee. We will be going out to bid. We will discuss the proposals at the May 14th meeting.

      • The medical contract with Humana is also up for renewal this year. We must go out to bid every five years. We will continue to offer the iNGAGED plans regardless of who we go with.

        With this said, we will most likely be receiving multiple bids from different carriers. The request for proposals will go out at the end of May, bids will be due back in June and the recommendation will go to the board in July.

        Currently we offer 6 plans. 3 iNGAGED plans (low, mid, high) and 3 Non-Engaged plans (low, mid, high). If we should continue with Humana, or any carrier for that matter, we will consider offering 3 iNGAGED plans (low, mid, high) and only one Non-Engaged plan (low option).

        The reason to consider making this change is that there are 28 employees on the mid Non-Engaged plan and a total of 41 members (employee plus their spouse or dependents). On the high plan there are 14 employees (no spouses or dependents are being covered). By law we have to generate a Summary of Benefits and Coverage (8 pages) and a Summary Plan Description (131 pages) for every plan we offer. With this minimal participation this will help administratively.

        Also, a potential option that we may receive is a narrow network concept. A narrow network is a group of physicians and hospitals that employees are only able to go to. There is no out of network benefits. Carriers can get larger discounts if they narrow the network and limit the amount of providers and facilities. An example would be that a carrier contracts with ARC doctors and Seton hospitals. If an employee enrolls in the narrow network they would only be able to utilize doctors and facilities in these groups. If you have a primary doctor or specialist that does not practice in this network and you do not want to change providers then this would probably not be for you.

        If this is an option we decide to go with we would offer all 3 iNGAGED plans, the low non-Engaged plan and the narrow network concept.

    The next committee meeting is scheduled for Thursday, May 14, 2015 at 4:30 pm in the Administration Board Room. If you are unable to attend this meeting, please find an alternate to attend in your place.
     
    At the April 15 committee meeting a request was made to hold a meeting in June to present the proposals received for our medical plan. This meeting is scheduled for June 23, 215 at 2:00 pm in the Board Room.
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