MSU Benefits and IUBC Reports
(for years prior to FY05, please see Staff
Senate meeting Minutes)
October 3 & 4, 2013 Inter Units Benefit Committee met:
- Focus on Keeping members well and healthy vs. attention to illness; Attention to Wellness, exercise and being active (Sitting is the New smoking—prolonged sitting is unhealthy)
- Studies showed that a sedentary, low activity lifestyle contribute to higher cardiovascular, etc. illnesses. A high level of activity for short periods of time doesn’t affect that risk
- Don’t just participate in 30 minutes of (moderate or high) activity but be active every day during the day each hour
- A 1953 study—seated bus drivers had twice the risk of illness/health problems as standing bus conductors
- Sitting results in absence of skeletal muscle contraction and reduce movement of joints
- Replace some sedentary minutes with light activity and standing
- Become more aware of the minutes during the day when you can stand instead of sit, walk instead of ride
- 2 minutes of walking (stretching) every 20 minutes
- Stand during phone calls
- Stand up and stretch
- Park further away
- Use stairs rather than elevators
- If you work in a multi-level building then use the restroom on a different floor
- Proposed 2-tier program—
- Complete certain criteria (WellCheck, etc.) to qualify for Premier (lower rates) vs. the Standard plan
- The proposal is to begin this 2-tier program in July 2015 instead of July 2014
- WellCheck—November 5th to 8th
September 18, 2013 Questions about the proposed 2-tier Benefit plan:
- To qualify for the Premier/lower premium will there be certain criteria/qualifications?...Yes
- The first year (July 1, 2013 and June 30, 2014) MUS employees will have to attend one free WellCheck/blood screen to qualify for the Premier premium during the Benefit plan year of (July 1, 2014 to June 30, 2015).
- See additional answers to question #2 and #3
- Will spouses and/or children be included? Proposed plan includes:
- In the second (or third) year (July 1, 2014 to June 30, 2015) both the MUS employee and spouse will have to attend one free Wellcheck to qualify for the Premier premium (in benefit year July 1, 2015 to June 30, 2016)
- In the second (or third) year any children over 18 covered by the plan will need to attend a WellCheck.
- Would it be possible to choose, for example, 3 out of 5 criteria?In future years there is a proposal to have a point system with incentive levels such as dental visits, physician visit, Workshops, vision exam, participate in disease management and/or various activities. Each item (WellCheck, dental visit, etc.) will earn a certain number of points.
- Would an annual doctor visit (with a health screen) meet the WellCheck criteria?....No
- The doctor visit would cost more. It could qualify as one of the criteria but it would not replace the WellCheck.
- The data (from the doctor visit) would not be available for review and possible follow-up suggestions and assistance.
- How would the collected information from the WellChecks be utilized? Could that member’s or all our premiums be increased if the results are outside of the acceptable ranges?
- No, that member’s or our group premiums would not be increased just because of the data collected from WellCheck.
- If some of the data collected is outside of the normal ranges then, depending on the specific results, that individual:
- May decide to show the data to his/her doctor for further analysis; and/or
- May receive a letter from the MUS Benefits team suggesting enrollment in our disease management programs—High Blood Pressure, High Cholesterol, Weight Loss, Diabetes, and Tobacco Cessation.
- The data in aggregate may be utilized to determine if we need additional programs or determine if changes need to be made to existing programs.
July 17 2013 IUBC Meeting
- Financial Update
Apr 12 – Mar 13
Apr 11 – Mar 12
Apr 10 – Mar 11
Mar 13 vs. Mar 12
Mar 12 vs. Mar 11
- Rx increasing due to:
- Specialty medication prices increasing
- Infusion medication
- Encouraging members to use Walgreens (when ordering medication) instead of doctors so the expense is now charged to Rx instead of medical
- Generic market has been increasing so some prices increased but a pharmaceutical manufacturing company in India was closed due to unacceptable quality so prices of generic drugs have increased more.
- ACA (Affordable Care Act)-Exchange rates are less than expected but benefits may also be less and the members may be allowed to only attend certain selected hospitals
- Large claims of MUS benefits Plan—YTD between July 1 to March 31 of each benefit year
# of Claims
Possible solutions: 1) Build up our reserves 2) Buy reinsurance with a $1MM deductible. This situation will affect our reserves and premiums.
- Per Employee per year expenditure
There are lower expenditures due to the efficiency of our MUS plan and educated members.
- Proposed Incentive and Tier design-Prospective plan offerings
- Premier Tier
- Best benefit level for deductible, copayments, coinsurance and maximum out-of-pocket
- Lowest premium
- Requires certain activities under the Wellness Program
- Year 1: Participatory Program—mandatory for an employee to attend one WellCheck (and complete an online HRA-Health Risk Assessment form per year); specific outcomes not required only participation.
- Year 2-5: Incorporate Health Contingent Program. In addition to an annual WellCheck other activities, which will earn points to qualify for Premier, will include:
- Prevention and education of our members to the associated risk linked to our 6 health categories-cancer, diabetes, cardiac, renal failure, orthopedic and neo-natal
- Nutrition education assessment
- Stress management assessment and education
- Physical activity and education
- Some specific examples include: Physician visit, dental visit, eye exam, flu shot, individual case management, Take Control programs (high blood pressure, weight loss, diabetes, tobacco cessation), workshops/webinars (track who watches), Exercise (fitness activity tracker-Fitbit can be purchased at a WellCheck), Nutrition plus other programs and activities offered by the wellness Program
- Wellness Program website: www.wellness.mus.edu
- Standard Tier
- Does not require members to participate in any Participatory or Health-Contingent Programs
- Default election if fail to meet minimum Wellness Program requirements
- Higher deductibles, copayments, coinsurance and maximum out-of-pocket totals
- Higher premiums
- Other comments & considerations
- Participate in WellCheck: 1st year-employee, 2nd year- spouse , 3rd year-dependent (on the plan) over 18
- Tobacco usage—not focused on the first year except to offer a tobacco cessation program.
- Communication (email ,meetings) to the members about the need to attend a free WellCheck between now and April 2014 in order to qualify for the Premier Tier premium for the benefit year of July 1, 2014 to June 30 2015.
- The MUS benefit plan is not just an insurance plan but is offering prevention, wellness and a healthy lifestyle programs which becomes the responsibility of each MUS employee to make a decision:
- If I actively participate in the listed programs then a lower premium will be available to me (and my family).
- If I choose not to participate then a higher premium will be incurred.
- Vision Benefit—we became self-insured in FY2013. A couple options being considered
- Issue an RFP
- Restructure our vision services benefit
- Move the vision exam into the medical benefit
- Have a hard-ware only benefit schedule
May 6, 2013, Benefits Committee met.
- Pension and Retiree Task Force had their initial meeting on May 2. Several options and issues will be considered to include:
- Maintain current arrangement—TIAA-CREF for ORP and four approved vendors for 403(b)
- Consolidate 403 (b) under one provider
- Consolidate ORP and 403(b) under single provider
- All active MUS employees are covered by Montana Teachers Retirement System (TRS) or Montana Public employees Retirement system (PERS) or Optional Retirement Plan (ORP) through TIAA-CREF. These are 401a retirement plans
- ORP will now be referred to as MUS Retirement Program (MUSRP)
- 403(b) is an optional/supplemental retirement plan which has four approved vendors
- Management/service fees
- It is the opinion of several members on the benefits committee that current management fees are rather expensive for these passively managed funds
- Expense ratio—comparing a management fee of 1% to .2% may not appear to be a noticeable figure but when spread over 20 to 30 years there is a significant difference in the amount available to the employee.
- TIAA-CREF determined that they could decrease their fees by 10 basis points (a 1% decrease is a 100 basis point decrease) because they are moving the shares to a lower cost share class
- Comparing performance results has shown that actively managed funds don’t provide much better gains than the passively managed funds. Items for the task force to a consider
- Provide more (pension, options) education for employees
- An independent advisor who would review and make recommendations after analyzing several financial/brokerage providers.
- Offer more funds but not so many that it becomes too challenging to make a choice
- Employee can choose between a Financial provider who offers counseling services which would be more expensive or a lower priced provider which has no counseling services
- Offer life-cycle plans
- Have the expense ratio more transparent
- Provide historical resul
- Wellchecks are going fine with the ISWM approach
- Several workshops have been given throughout the state during April
- Webinar on May 22 at 12:05…Sitting is the New Smoking
February 21, 2013, IUBC meeting
- Cost Drivers: 95% of our MUS population results in 33% of expenditures. The other 5% of our MUS population results in 67% of our claims/expenditures. The six top Cost Drivers (not in specific order) of these type claims and the management of these include:
- Cardiac—Take Control Program
- Diabetes-Take Control
- Newborns-Well Baby
- Renal (pertaining to the kidneys)
- Other (orthopedic-knees and spines)
- Contributing Factors to the above cost drivers
- Lack of Proper Nutrition
- Lack of physical exercise
- Lack of compliance with DM (disease management) programs physician orders, Rx drugs dosage
- Financial pressures
- Intervention strategies, provided by the Wellness Staff, include:
- Nutrition-provide education, recommendations on how proper nutrition benefits health, dietician services
- Physical Exercise-raise awareness about the need for and benefits of physical exercise, physical activity counseling
- Five year strategic plan for Wellness-One of the goals is to minimize the flow of people from the healthy category into the cardiac, diabetes etc. categories (listed in paragraph 1); individuals keep progressing in steps toward a healthier lifestyle.
- Provide Education- Montana Moves and Meals, Webinars, Live On-campus workshops,
- Raising awareness-WellChecks, Re-launch & recruitment of Wellness Champions on campuses, nutrition & physical activity challenge of the month, Facebook
- Gather data-survey, claims data,
- Implementing activity-Health Club membership with ability to track participation, offer a ‘device’ to monitor activity (walk, run) outside of a gym
- Begin to build incentives-free Wellcheck /health screenings
- Assist with implementing improvement in member’s nutritional & exercise habits/practices
- Actual results of improved quality of life and reduced health care costs
- Marinson study-Adults over 50+ had reductions of $2,220 in average annual medical charges with increased activity from 0-1 days per week to 3 or more days per week.
- Anderson(2005) study -Over a 3-year period there was a difference of $1,543 in costs between physically active and inactive members in the 40+ population
- Larson-Noticeable link between physical activity and lower rates of dementia and depression among seniors.
- Financials, trends and rates
- Financials—are currently in good condition with Assets as a % of ACL (Authorized Control Level) at 361% YTD through Dec. 2012. Projected for FY 2013 is 348%
- Trends are good
Dec 12 Dec 11
Benefit vs Dec 11 vs Dec 10
Medical 0.2% 0.9%
Rx 8.8% (11.3%) Specialty drugs (arthritis) going up
Combined 1.6% (1.4%)
- Premium rates are calculated based on the previous 3 years of expenses/claims
- There are charts which display years of actual and projected expenses compared to revenue. These projected expenses take into consideration just the previous 12 months of claims.
- FY2014 Changes
- Adopt Minimum Essential health benefits per PPACA (Patient Protection and Affordable Care Act)
- Cover all contraceptives at 100% per PPACA
- Increase specialty drug copay to $50/$200
- Allow two free WellChecks per year to non-MAP plan members
- Allow durable Medical Equipment out-of-pocket costs to apply toward coinsurance maximums
- No monthly fee ($2.50) for FLEX accounts
- FY2015 Assumptions
- Retiree subsidy-target FY2014 loss ratios of no more than 150% for Non-Medicare and 100% for Medicare retirees.
- Dependent Subsidy
- Reduce active subsidy from 65.6% to 60.6%
- Reduce retiree subsidy from 48.9% to 43.9%
- Traditional Plan/Managed Care The traditional premiums will be used in measuring whether or not our plan(in 2018) is classified as a Cadillac plan and therefore required to pay a tax
- FY2014 Projected trend rates
Medical & Rx— 8%
- FY2014 Medical, dental and vision premium rates
- Medical for Actives--If the state increase of 10% is approved then that additional $73 will offset the preliminary premium increases for most of the active employees. The average premium increase is currently estimated to be less than 5%. MAP increase to $180PMPM
- Dental-Decreases of 4.8% for actives and 11.5% for retirees
- Vision-5.2% increase, self-funding as of this FY13
- RFP announcements
- Flex administration-will be Allegiance Flex Advantage
- Life/LTD/AD&D-The Standard
- Interim Work Plan
- Joint subcommittee (Admin & Plan) on pension, Wilshire will assist
- Campus benefit reps training on March 27 & 28
- Case Management-MAHCP will terminate the services of Knova on March 31, IUBC will do so also. Knova will notify our members.
- Disease management: Take Control will which now services our diabetes program will add WellWeight and WellHeart
Example of a Wellness Champion email informing employees of Wellness Program activities--WellCheck, workshops, webinar
There is a team of individuals on each of our campuses called “Wellness Champions”. This organization is part of the MUS (Montana University System) Wellness Program of our Benefits Plan. These are individuals in various departments who will periodically inform their fellow employees about resources available within MUS to maintain and/or improve their health. Some items include:
- Reminding employees to attend WellCheck on campus (Bozeman March 26 to 29). This is a benefit to you which includes blood screen, blood pressure check, body weight/BMI
- Offering access to educational and informational resources online:
- Wellness Facebook page (www.facebook.com/MUSwellness)
- Check out our wellness team and the two new programs they are sponsoring called, “Montana Moves” and “Montana Meals”. Each month there is a health challenge in these areas and you can win prizes if you participate. For January the Montana Meals focus was “Try one new healthy recipe each week. Montana Moves and Montana Meals Blog updated weekly (www.montanamovesandmeals.com)
- Attend workshops being offered on general health, nutrition and exercise. I’ll email specific titles at a later date.
You will be getting occasional emails from me throughout this next year regarding the above wellness and health items.
You can also contact the wellness team----Kelsey (Wellness Coordinator), Cristin (diet, nutrition) and Neal (exercise, fitness) at : email@example.com.
January 24, 2013, IUBC Meeting
- Financial redcap -With no funding increase from the legislature for FY14 the projected revenue will equal projected expenses but there will be deficit in FY15.
- With a 10% increase in employer contribution for FY14 & Fy15 the revenue will exceed projected expenses.
- Reserves- MUS (Montana University System) plan target is 300%. Currently the plan has about 400% in reserves. In December 2013 the Legislative Fiscal Analyst determined that the plan likely had insufficient reserves, if there is no increase in premiums or state share contribution. Other health insurance companies (like the “Blues’) target 500%.. A couple PPACA expenses (reinsurance fee) will be funded from the reserves during the next three years.
- Pay Plan;--Proposal is 10% increase to $806 in FY14 and another 10% to $887 in FY15
Looking under the Hood
- 1% of the members account for 38% of the plan costs
- 2-5% of the members account for 28% of the plan costs
- MUS Health Strategies being utilized
- Wellness Strategies (WellCheck, active Wellness Program) for 85% of the plan members who use 16% of plan costs
- Disease Management Programs (Tobacco Cessation, WellBaby, WellHeart, WellWeight Diabetes support Program) for 10% of the plan members who use 18% of the plan dollars.
- Case Management Programs for 5% of the Plan members who use 66% of the plan dollars
- Focus on personal responsibility to maintain and improve health
- MUS High cost claims include: Cardiac, cancer, diabetes, Newborn, renal, orthopedic
Wellness Strategies - There is a team of individuals on each of our campuses called “Wellness Champions”. This organization is part of the MUS Wellness Program of our Benefits Plan. These are individuals in various departments who will periodically inform their fellow employees about resources available within MUS to maintain and/or improve their health. Some items include:
- Reminding employees to attend WellCheck on campus (Bozeman March 26 to 29). This is a benefit to you which includes blood screen, blood pressure check, body weight/BMI
- Offering access to educational and informational resources online
- Wellness Facebook page (www.facebook.com/MUSwellness).
- Check out our wellness team and the two new programs they are sponsoring called, “Montana Moves” (exercise) and “Montana Meals” (nutrition). Each month there is a health challenge in these areas and you can win prizes if you participate. Montana Moves and Montana Meals Blog updated weekly (www.montanamovesandmeals.com).
- Attend workshops being offered on general health, nutrition and exercise. Examples include Move your Body, Eating for your heart.
- You can also contact the wellness team Kelsey (Wellness Coordinator), Cristin (diet, nutrition) and Neal (exercise ,fitness) at : firstname.lastname@example.org.
Some Benefit changes for FY14
- No fee for flex accounts
- Increase in specialty drug copays
- Flu shots administrated by nursing students
- Permit 2 free WellChecks per year
Proposed Health club membership and related activities-- This program is still being developed and will continue to be enhanced during the next 3 to 5 years. The first year cost would be funded from the reserve account. A company (Active & Fit) has a network of gyms who participate in this arrangement. Attendance is recorded.
January 9, 2013, Plan Change Sub-Committee meeting.
- The legislation doesn’t consider our current reserves to be excessive.
- Costs that may be incurred due to implementation of PPACA could have an impact on our reserves.
PPACA required changes
- PPACA Essential Health Benefits-Can leave day and visit limits but can’t state a dollar limit. Day limits can be extended if a special situation exists.
- Eye Exams: MUS vision plan is self-funded and doesn’t require eye exams but PPACA may require eye exams for children. Leave our plan as is until 2013/14 plan year
- Women’s preventative care/contraception: Generic is available at no cost
- Add 30 day residential treatment benefit for Mental Illness and Chemical Dependence: Suggest case by case assessment rather than a specific benefit ,No change
Decided or in-progress changes for FY14 to date
- Flex Admin charge: currently have $1.9M balance so probably won’t need to assess this fee for a few years.
- LTC offering or carrier (UNUM): No change
- Increase specialty copays from $0/$150 to $50/$200
- Flu shots will be administered by ISWM (It starts With Me), with assistance from nursing students: less than current costs
- Permit 2 free WellChecks per year so individuals will be more inclined to attend and a base line is established
- Incentive could include a reduced premium payment. This may result in a 2-tier payment within each category. Or still have 1-tier and those who qualify would have an amount subtracted from the premium.
- Participate in the WellChecks now to possibly receive a gift card this year and also to qualify for the reduced premium during the following health plan year.
- Notification would be conducted by email and letters
Proposed Changes for FY14
- DME (Durable Medical Equipment) to apply to coinsurance maximum
- Health Club membership reimbursement ($40/individual and $90/family maximum)
- Two payment models:
- Reimburse the member
- Pay the health club PMPM (Per member per month)
- Keep track of visits/activities at the health club. How verify and reward those physically active individuals who exercise/run outside?
- A couple reasons for supporting the reimbursement of health club dues:
- A survey indicated that members would join a health club if they had the money.
- Instead of having the premiums pay for ill health or sickness claims, it can also be used to reward people who are currently physically active and healthy by exercising at a gym.
- A couple reasons for supporting the reimbursement of health club dues:
- The total projected cost will increase the premiums by about 1.5%
- Life/LTD-Addition of an Option 3 term life for $5.00, increases to $600,000 and changes to dependent spouse who can only have ½ the coverage of employee.
- MAP renewal from New West
- Letter of agreement
- Members will have a gym membership
- Drug plan is with MedImpact with a 33% increase but a $2,000 max
December 6, 2012,IUBC Meeting
Some of the issues discussed at this meeting were included in the Plan Change Sub-Committee report
Health Insurance Reform (PPACA) and Healthcare Issues (AON Hewitt presentation)
- PPACA (Patient Protection and Affordable Care Act)--Under this system ‘everybody’ has insurance/coverage but who pays for it?
- Family health insurance premiums rose annually between 3% and 13% from 2000- 2011.
- Health risks-There are 8 common risks and behavior (Physically inactive, Poor diet, No health screening) which can cause 15 chronic conditions (diabetes, Coronary Artery disease, Obesity, High cholesterol) which account for about 80% of the cost of chronic illnesses world wide.
- Possible sources of reducing the deficit— not allowing a deduction for mortgage interest, charitable, state/local taxes and ……taxing of health insurance premiums which are contributed from employer.
- Reinsurance fee-for 3 years beginning in 2014, Projected amount would be $63.11 per covered life. Explanation: Reinsurance contributions will be used to make reinsurance payments to health insurance issuers that cover high risk individuals in the individual market (excluding grandfathered health plans) for the three year period beginning January 1, 2014. The transitional reinsurance program is intended to reduce the uncertainty of insurance risk in the individual market during the first three years of operation of the state health insurance exchanges, i.e. 2014 through 2016, by making payments toward high cost cases as a result of adverse selection.
- House money means House Rules: Possible future items that may be considered—Since the employer is paying all or a portion of the insurance premium the employees may have to quit smoking, have a wellcheck, change/improve their lifestyle.
- Several other future issues covering PPACA (Patient Protection and Affordable Care Act) provisions.
- State exchanges-carriers compete, different levels
- Minimum essential coverage
- Full time employee equals over 30 hours
Possibility of paying for a portion of a Health Club membership
- Rewards active individuals who are members of a health club
- Encourages individuals to join a health club. A wellness survey indicated that the price of a membership is a barrier to individuals who would like to join.
- There would/could be an increase in the premium, but there are…….
- Long term benefits—healthier members, reduce the increasing costs of health care
November 20, 2012 Plan Change Sub-Committee Meeting
- Financial Update
Benefit Sep 12 Sep 11
vs Sep 11 vs Sep 10
Medical -2.3% 4.8%
Rx -6.9% -17.8% The trend is still going down, which is desirable.
Combined -3.1% 0.1%
Dental -4.2% 0.3%
There have been no large medical claims yet; which have occurred in previous years. Also, the use of generic prescription drugs is increasing which results in lower Rx expenses.
Our target reserve is 300% ($34,220,000). Due to less large claims, lower Rx expenses the actual reserve is 401% ($41,659,000). However, a portion of these reserves will be needed to pay for PPACA (Patient Protection and Affordable Care Act) costs and other projected expenses.
If we do not get an increase in the state share ($733) for the next two years, then based on projected increases in medical and Rx expenses the plan will have a projected 7% to 15% loss by FY15 and our reserves could significantly decrease.
- Issues with PEAK1
There have been reports of documentation to PEAk1 having been lost
Their address is not on the forms
Responses due date is Dec. 3
RFP committee is meeting Dec. 5
Contract finalized Dec. 31 (which may result in a new vendor)
- MAP New West—rep (Ryan) was present
- MUS had a guaranteed rate ($140) for three years, which will soon expire,
- Included in the bid is a membership to a health club which New West pays
- Rx-Changing to Med Impact with 5 tiers
- Possibly switch to a calendar year vs the current fiscal/benefit year which may be advantageous to our retired members
- There are different MAP programs available which offer lower monthly fees, but they also have higher co-pays and/or less benefits.
- The new monthly premiums (from New West) could go to $220/month
Some Benefit Changes/issues
- FLEX admin fee to $0 for FY14
- Rehabilitative & habilitative services—These services could have a significant impact of increased medical claims
- Eye exam requirements under PPACA—It is possible that individuals could double-dip by submitting expense forms to both EyeMed and Medical.
- Change under consideration
- Incentive Payment s for participation in WellCheck— What would be an acceptable and reasonable amount to reduce a members monthly medical premium by a certain amount each month for participating in WellCheck once a year? $5.00 per month or $10 per month or____?
- For Basic life/AD&D the plan offers two choices of $10,000 ($1.55/month) and $20,000 ($3.10/month). Possibly offer a 3rd option at $5.00/month.
- VALIC presentation
- Propose offering a mutual fund plan to our members vs the current annuity plan
- Admin plan cost: currently 1.25 basis points vs proposed .48 basis points
- Total plan cost: current 1.75 vs proposed .88 basis points
- Can choose from 25 mutual funds
- Three options for our members who are currently with VALIC
- Stay with the annuity
- Keep current money in the annuity and have future contributions placed in the mutual fund program
- Convert all annuity funds and future contributions to mutual fund program
f. Comment from committee members after presentation
1) These proposed basis points are still too excessive
2) An RFP should be prepared for our 403(b) program
3) Wilshire could be utilized as an independent consultant
- Introduce Amy Berry-MUS Pensions
- She will basically be a liaison between the vendors and MUS benefits & campus HR
- A letter will be sent to the campus reps. She won’t be a front-line contact to the employees
New benefit for consideration—Health Club Membership
- PPACA is focusing on preventative health care. Therefore, our benefit plan may consider reimbursing a portion of the participating employee’s club membership fee.
- There would be a requirement that the employee would be required to actively participate at the health club 2 or 3 or 4 times per week. A system would be established to verify this participation.
September 27 & 28 2012, IUBC Fall Retreat
Benefits Jun 12 Jun 11 Vs. Jun 11 Vs. Jun 10 Medical (4.2%) 11.6% Rx (6.8%) (11.5%) Combined (4.6%) 6.9%
- Projected shortfalls vs Actual results
- Projected a shortfall for FY12
- Therefore Implementation of several initiatives for FY11/12 included Plan design changes, Dependent Premium waiver, Dependent subsidy reduction (5%), employee premium increases
- Actual medical expenses for FY11/12 were less than initial projected expenses (which had been based on FY10/11 medical expenses) ; Therefore the plan was able to contribute money into reserves.
- Reserve target
- Keep it between 300% to 350%
- Currently reserves are 378%
- Expected future medical related expenses/issues will/could reduce this reserve to less than 350%
- Calculates forecasted future health care liability for retirees based on the members today
- Calculations every 2 years: $183.2MM for 2009/2010 vs $109.8MM for 2011/2012
- Significant decrease due to:
- Prescription Drug claim experience--$67.7MM decrease
- Medical claims experience--$15.5MM decrease
- Spouse contribution changes--$19.9MM decrease
- But an increase of $19.9MM due to elimination of lifetime max due to PPACA
- Strategic Planning
- Promoting an increase of employer contribution, which is currently $733
- Retiree Planning
- *MAP-Projected rate increase from $145 to $180/$220 in FY2014
* MAP could discontinue in 2 years
* PPACA Cadillac Plan (applicable to medical rates not vision or dental)--Effective 2018
* $10,200 limit per year for single
* $27,500 limit per year for family
* Employer (MUS) pays 40% over the limit as penalty
* .An 8% increase in MUS single rates between now and 2018 will result in those rates exceeding the Cadillac plan limits
* PPACA dictates that by 2018 the family premium rates must be 2.7 times a single rate. Currently MUS family rates are 1.7 times the single rates. Therefore the family rates would have to be increased by an average of 11% each year to reach the 2.7 times per PPACA requirements; unless some changes are implemented.
- RFP (Request for Proposal) Roundup
- RFP in 2 weeks
- Admin fee-Plan had paid this fee ($2.50/month), this fiscal year the employees are paying it, Propose to not have members pay this fee for Fy13/14
- RFP being completed for Life/LTD/ADD
- Future RFP’s—403b (supplemental retirement account)
- Employer Clinics—Report from State of Montana and CareHere
- Results from state health screening indicated health problems in:
- High blood pressure
- High cholesterol
- Payer is employer; Patient is employee; Provider is Medical Doctor
- RFP required that three services be provided by the Work Site Health Center
- *Administrative/Management services
* Medical service…-some same-day services
* Wellness and health coaching (dietician, behavioral, nurse)
1. Four Pillars of Long term cost containment
* Core Health Care Plans
* Employee wellness and engagement—get employees more involved
* Comprehensive care management
* Best purchasing practice
2. Benefits to the state employees (and University system , if implemented)
- More patient focused-Allows more time with provider/doctor to cure/solve medical problems, 20 minutes vs 6 to 7 minutes
- Improves quality of health care to employees
- Reduce claims cost and savings on lab tests
- Recruitment of new employees
- Wellness program
- Medical records
- Kept confidential at Health Center
- Provide some data aggregation to MAHCP (Montana Association of Health Care Purchasers)
- Current status of health center for state
- Waiting list of 3 weeks
- Adding doctors and extra hours
- Future expansion sites being evaluated for Miles City, Billings, Bozeman, Missoul
- Wellness Presentation
- Mission is to help our plan members stay healthy by
- providing and incentivizing preventative health screenings,
- health lifestyle education and support;
- disease preventative/management programs
- Wellness education
- Create opportunities for employees to participate
- Endorse healthy habits
- Help participants to reach their health and fitness goals
- Meet objectives
- Communicate with traditional, Socia, video media
- Incentive strategies
- Wellness Champion program
- Montana Moves/Montana Meals
- Full time dietician and trainer
September 18, 2012, Plan Change Sub-Committee
- FLEX Plan Administration
- MUS had been sending a flat amount of $100,000 per week to cover cost of claims and administration.
- A reconciliation of these advances vs actual claims had not occurred for some time. Therefore, approximately $1.4MM was in the account.
- Proposal--MUS pay the administration fee ($2.50/month) for FY13/FY14
- Certified Professional Midwives
- The letters from Sara Rushing (MSU Faculty Advocate) and Stacey Haugland (CPM) promoting the benefits and advantages of CPMs were presented and discussed
- Other items and issues regarding CPMs were presented which included:
- No degree is required for a CPM
- CNMs have access to hospital services but CPMs do not
- CNMS don’t provide in-home birth services due to liability
- CPMS don’t carry liability insurance
- The MUS benefit plan would be liable if a child dies during CPM home birth
- Neither Montana Medicaid nor BCBS cover CPMS
- PPACA doesn’t cover CPM home birth but does cover CNM
- A chart was presented which compared the education and certification requirements of CNM (graduate degree required) and CPM (no degree required)
- It was decided to not include CPM home birth in the MUS benefit pla
- Day/dollar Limits
- Day/dollar limits are not permitted on essential benefits
- This includes (page 7) Mental Illness services and Chemical Dependency
- The maximum of 30 days/year of 40 visits/per must be removed
- These day/dollar limits do not apply to non-essential benefits (yet), which include (page 8) Rehabilitative, Complementary, Extended Care services
- LTC (Long Term Care)
- Our consultant Aon told us there is no indication that UNUM will not leave their existing LTC business
- Our existing policy with UNUM is with a rate guarantee and can’t be canceled as long as the policies are paid.
- If MUS chose to discontinue the group policy wit UNUM then the current participants could remain with UNUM and keep same rates and coverage.
- The policies don’t have a cash surrender features
- Plan Structure--Consider regional rates?
- Can we administer it?
- Offer different rates to people by region?
- Plan reserves
- Target ratio of General Reserves to Authorized Control RBC (Risk Based Capital)=300%
- Total Adjusted Capital relative to RBC ACL (Authorized Control Level) = 378%
- PPACA (Patient Protection and Affordable Care Act) requires self-insured health plans to pay two assessments
- Comparative Effectiveness Research Fee: $1.00 per covered life per year for 2012/2013, = $18,000. Then $2.00 in following years == Estimated $18,000 + $18,000
- Transitional Reinsurance Program: $80.00/ covered life/year== $1,440,000
- Required reserve to cover PPACA Assessments = $1,500,000
- MUS Benefits is working to redesign the benefits website. The goal is to enhance the website so that any relative and new Benefit- related information will be available for viewing on a regular basis. This will be in addition to presenting the Benefits Plan once a year during the annual CHOICES sign-up.
- If there are any issues with the performance of a vendor (such as Delta Dental, Eye Med, Allegiance, BlueCross BlueShield) then the following reporting procedure is suggested:
- Initially contact the campus Human Resources or a Benefits representative from Staff Senate;
- The Montana University System (MUS) Benefits office in Helena (on the back of the CHOICES handbook)
HIPAA requirements and communications with advocates
- “Covered Entity” –These are groups and individuals who are authorized to talk to members about their specific and personal medical situation. This would include the three areas of treatment, payment and operation. This group includes the campus HR and the Benefits office in Helena
- HIPAA waivers-If the member initiates the conversation, then it is also acceptable to bring these issues to the attention of the Benefits rep (at Staff Senate) and/or Benefits Committee. If the answer is not known at that time then the rep or the member can contact the Benefits office in Helena. In general, the rule of thumb is that if the member wishes to have information about their personal medical situation communicated to any third party, the member must tell us who is authorized to receive it.
Assignment of Benefits
- This is where the patient authorizes insurance benefits to be paid directly to the provider rather than to the patient. This is usually indicated on a form which the patient has signed agreeing to have any payment, which is due from the medical plan, go directly to the provider (doctor, dentist, hospital). This type of arrangement is preferred by both the medical plan administrator and provider. The members sometimes do not realize that they have signed this type of form. Most of us are used to having payment transferred in this manner and do not generally expect the insurance benefits to be paid directly to us.
- A potential problem occurs when the patient pays the provider at the time they receive services (a common example is a dentist) and then submits a form to be reimbursed. The administrator (Delta Dental) sends the check to the provider because most payments do go to the provider. This then requires the doctor to turn around and refund money to the patient, which is generally frustrating for both the doctor and patient. The easiest way to avoid this is to indicate that the claim should be paid to the patient when the claim is filed.
- Another problem could occur when a procedure is miss-coded, which affects the reimbursement amount.
Delta Dental issues—reimbursements not being set in a timely manner or not the correct amount
- A (self-audit) service level report was provided from delta dental for 2011
- Results included--Financial Accuracy = 99%; Average number of days to pay claims = 3.7 days
- Separately, the Legislative Auditor conducts an audit of claims administrators for the MUS plan every two years. This is prepared by an independent firm hired by the Legislative Auditor and reported to the Legislature.
- Based upon the number of complaints received from members (at Staff Senate and the Benefits Committee on the Bozeman campus) there appears to be a discrepancy between the reported annual service levels vs the experience of our Bozeman members. MUS benefits asked that the benefits committee and staff senate assist them in researching the issues by noting specific complaints and the situations they arose in. They will continue to work with Delta to improve service and will also continue to ask other campuses what their experiences are. The specific information will help them to diagnose and correct problems.
Alternate IDs instead of SSNs
- SSNs are required federally (Medicare) and must be collected by MUS benefits for every member on the plan (including dependents). It must also be provided to each plan administrator as part of the eligibility information for Medicare auditing.
- MUS benefit needs to obtain the member’s SSN, but does not permit it to be printed on any medical cards.
- Claim system capabilities/challenges of plan administrators
- Each plan administrator collects the SSN within their claims and eligibility system. (see a.)
- The administrators also typically have a unique identifier for each individual within their eligibility and claims systems. There is no standard for what the identifier should be (i.e. how many characters, alpha or numeric, other characters, etc.) So, each administrator could have a different computer system than another administrator and they use completely different identifiers.
- The plan must have a way to ensure that a member’s eligibility and enrollment data is correctly attributed to the participants, that claims pay correctly, and make sure benefits are paid correctly among multiple administrators and often multiple years.
- It might also be necessary to have a different alternate number for each family member
- The MUS system has a block of numbers set aside for alternate numbers but that block does not have the capacity to handle alternate numbers for all 18,000 members.
403(b) and ORP (Optional Retirement Plan)
- 403(b) current financial retirement management companies—Metlife, Valic, TIAA-CREFF, ING
- There is the option of continuing with the current companies or submitting an RFP (Request for Proposal) to consider and add other companies/vendors. Two of the reasons for this consideration are:
- Offer our members more options. The current vendors don’t offer as many funds to choose from as other vendors (Wilshire, Vanguard).
- The historical rate of return is lower when compared to other funds according to some members, so we need to look at the market periodically
- Currently IUBC is responsible for pension matters also. We may want to look at an Investment Advisory Council, or some other expertise.
ORP and TRS (Teachers Retirement System)
- Most of the current and new faculty/professors are paying into the ORP
- However, there is a financial gap (unfunded liability) in TRS as a result of the university system pulling out of the system and into ORP. To fund the ongoing costs incurred by university employees who are still in TRS and drawing benefits, there is an assessment
- Therefore an amount equal to 4.72% of payroll for the MUS ORP members goes to TRS to fill this gap. This funding is not available as employer match for ORP retirees and they will not receive nor have access to this money when they retire.
- Members expressed concern that this arrangement is detrimental to hiring and retention
- The amount of employer matching money from MSU is low when compared to contributions (matching funds) provided by other universities in our western region.
- Questions: How much is still owed to fill this financial gap? Doesn’t the University owe this money, instead of taking it from the MUS match? (Currently it shows up as a deduction on paychecks when in reality they are university system funds which are just calculated as a percentage of payroll.)
April 11, 2012 MSU Benefits Committee met.
Spring 2012 WellCheck
- Some of the members were asked for their ID and others were not at the sign-in desks.
- Some of the members expressed their interest in having the vendors present
- Providing a SSN as ID is questionable. Dennis Defa indicated that SSNs should only be used for payroll and tax purposes. See item #4
- Frank Kerins talked to the CEO of ItStartsWIthMe about getting more members signing up for these health screening sessions.
- Another Employee WellCheck is scheduled for May 24 at the SUB.
Certified Professional Midwives (CPM) and Certified Nurse Midwives (CNM)
- CPMs are experts in physiologic birth and are trained and primarily practice out-of-hospital (home and birth center settings). CPMs are not currently covered by our medical plans. This is basically due to safety and liability reasons
- CNMs are trained for hospital and birth center deliveries. They are not specifically trained for homebirths. CNMs are covered by our plans but are most likely out-of-network.
- These issues (CPM, CNM) will be presented to the IUBC Plan Change sub-committee. Any changes, which might be implemented, would not occur until the next plan year.
Delta Dental issues
- Complaints (reimbursements not being sent in a timely manner and/or being sent to the dentist instead of the patient) mentioned at the Staff Senate were discussed. An email has been sent to the Benefits office in Helena. See paragraph c
- A member mentioned that 2 of the 3 reimbursements he had received were not the correct amounts, but he did eventually receive the proper payment.
- Updated information—An email has been received from the Delta Dental rep:
- Indicating that he has been made aware of these complaints and has requested a service level report to be provided.
- Suggesting that the enrollees contact the Employee Benefits office (Benefit tech in HR on the Bozeman campus) with an explanation of the issue, date of service and claim information. If the Benefit tech is unable to provide an answer or obtain a resolution then the issue will be referred to the MUS Benefits Office in Helena.
Alternate ID vs SSNs for MSU Benefits - Our medical cards use either a SSN or the last 4 digits. An alternate number can be obtained from Human Resources. It has been suggested that banner numbers could also be used for all members in the Montana University System.
Retirement providers-- Discussion of modified 403(b) and/or ORP
- New RFP (Request for Proposal) will be sent next fiscal year regarding investment providers.
- The issue was raised about the difficulty of getting funds from one of the managed 403(b)s.
March 21, 2012 update from Staff Senate meeting:
- The CHOICES handbook should be mailed the first week of April.
- Enrollment for CHOICES benefits is April 16 to May 16.
February 22, 2012 Inter-Units Benefit Committee meeting
- Based on current projected revenue and claims it is calculated that contribution to reserves should be $7.MM
- However, there is always the possibility that the plan could incur some unexpected large claims in the future. For example, there are a couple recent large claims of $1,000,000 plus which haven’t been processed and paid yet.
- URx-The URx plan began in July 1, 2010
The monthly Per-Capita (annualized) claims cost when comparing December 2010 vs December 2011 is -11.3%.
- Funding vs Expenses
- Projected FY13 claims and revenue is currently looking good….small increase in premiums.
- Projected FY14 claims and revenue (based on current $733/month) is not looking so good….3% to 10% increase in premiums.
- Miscellaneous Financial Data
- Large claims over $100,000—last year had 22 at this time of FY11 vs 16 YTD for FY12.
- Admissions in hospital per 1000 members/Year dropped from 55 to 50
- Elective surgery—It is possible that this type surgery is not being performed due to the recession; but it may surge in a few years.
- Scripts-some drugs which had been expensed thru the medical plan are now being listed thru the URx plan. This could be the reason for the increase in scripts. Also, more script utilization now may help reduce future medical expenses.
- FitKik System is being reviewed and considered.
- It was designed to provide employees with a simple, engaging and motivating way to a healthier and more active lifestyle.
- A small device called an ActiPed that can be clipped onto any shoe and it tracks a user’s activity.
- Remote access points (at different locations on campus) can upload the user’s activity information (miles) as he/she walks by an access point.
- ActiPed knows the difference between general movement, walking and running and is able to accurately measure number of steps taken, calories burned, active minutes and miles burned.
- This information is then sent (wirelessly and securely) to the user’s personal FitKik web account.
- Long Term Care (LTC)–UNUM
- UNUM recently announced that it was ‘exiting’ the group long-term care business for coverage of new groups.
- UNUM will still continue to offer LTC to new employees of the Montana University System (MUS) and service our group as normal.
- It is making this change due to lower investment returns and higher than anticipated pay-outs due to longevity and rising costs.
- This program functions as an annuity---if a person or group walks away then all money previously put into it and any benefits will be forfeited.
- All long term offers are risky because costs can’t be controlled. MUS will continue to monitor the status and health of UNUM and the LTC product.
- Plan Change Update
- Hearing aid and Cochlear Implant—Not offer it
- 19 states have some hearing benefits—17 for children and 2 for adults,
- MUS hasn’t had much interest or request from members
- Generally it is not offered by other medical plans
- Annual Dependent Subsidy Adjustment-This is projected to be less than 5%
- Flex Admin Fee—Charge $2.50/month
- Several years ago members were charged a Flex Admin Fee.
- During the past few years that fee has been paid by forfeitures. However, members are using their money in Flex instead of leaving it in that account, so the monthly charge needs to be reinstated.
- Flex adoption benefit—Members can put up to $12,650 into this program for adoption expenses during the 12 months of the medical plan. But this money will be forfeited if it is not spent for adoption related costs.
- Communication Plan-An introduction letter from our Traditional and Managed Care administrators will be included in the FY13 Benefits packet
- FY2013 Changes
- Managed Care Plans
- Add acupuncture/naturopathic benefit
- Change “Alternative Care” to “Complementary Care”
- Add bariatric surgery benefit
- Add travel benefit
- All Plans
- Provide breast pump to new moms
- Cover generic oral contraceptives at 100%
- Discontinue offering colon cancer screening kits
- Dental Plan
- No change in dental rates
- Update fee schedule for diagnostic and preventative codes
- Premium-Add diagnostic and preventative (cleanings) code waiver from applying to annual ($1,500) maximum
- Program changes
- Terminate QCC Oncology program
- Replace Peak with First Choice and New West with Pacific Source. (Updated status as of early March—The timing of First Choice’s acquisition and merger relative to the MUS rating period did not permit sufficient time to have their provider negotiations finalized so that we could reflect the total picture in our rating process. Therefore, it was recommended to not offer First Choice during FY12-13. We will talk to them later in the year when they have completed their provider contracting and analyze how their network would serve the MUS in the future. It was also recommended that the 57 existing Peak plan participants be defaulted into the (lowest cost) BCBS managed care plan).
- Wellness Budget—Set at $796,349
- Dependent Premium Waiver—Earmark $100,000 for Hardship Fund
- Vision Plan—
- Becomes a self-insured program with benefits staying the same
- Rates decrease by 11.5%
- Projected trends for FY2013
- Medical and Rx == 9%
- Dental == 2%
- Vision == 3%
- Administration == 5%
January 26, 2012 Inter-Units Benefit Committee meeting
- Based on current projected revenue and claims for FY12 it is calculated that contribution to reserves should be $2.9MM.
- For FY13, if there are no changes to benefits, rates, dependent subsidies, etc., projected net income/loss is a negative $1.3MM to $4.9MM; depending on claims.
- $10MM from reserves has been invested in longer term (6 months to 1 Year) investments thru the State Board of Investments
- Health Care Reform (HCR) Excise Tax—
- This excise tax on “Cadillac Plans” is based on the medical rates which are charged to the employee (and dependents).
- The employer/MUS benefits plan is responsible for paying this 40% excise tax (in 2018) on excess amounts over the thresholds for a year of:
- $10,200 for a single employee
- $27,500 for an employee plus dependents
- The single rate/premium will exceed the $10,200 limit in 2018 based on an 8% annual increase in Traditional medical rates/premiums for employee only
- The Family (traditional) projected rates won’t exceed the limit until 2025
- One of the reasons for this possibility occurring is because the Employee Only is being ‘overcharged’ while subsidizing the member and family.
- URx- The URx plan began in July 1, 2010
- It is a pleasant surprise that the plan is still experiencing reduced costs
- Members are calling Ask-a-Pharmacist to determine the ‘best’ drug after they have received their doctor’s recommendation
- Pharmacy companies have been told to reduce their drug cost to Medicare patients by 50%. Therefore, it is forecasted that other plans (MUS Benefit Plan) will have their drug costs increased.
- Members are continuing to migrate to lower cost tiers. Tiers A & B now account for 79.6% of scripts vs 68.7% in 2009
- Managed Care Plan Offerings-
- Pacific Source in lieu of New West as our third party administrator, until at least June 30, 2012. They are very interested and can work with our current providers and maintain the discounts. Connie will visit them
- First Choice is a third party administrator located in the Seattle/Spokane areas. MUST (Montana Unified School Trust) utilizes them. MUS may utilize them at some time in the future.
- Plan offerings:
- Could be reduced by eliminating one of the administrators or
- Continue with four administrators to allow for more competition
- Consider Self Funded Vision plan
- 60% of the members are enrolled
- Low risk since there are no million dollar claims; only $100 to $200 claims
- Network remains the same-benefits, vendor, network
- Estimated annual savings of about $100,000
- IUBC could add more optometrists
- Wellness Program—
- Health Screening: Comprehensive biometric tests could cost $350 from a doctor and about $100 when conducted at our Health Screening during WellCheck
- Proposal to offer one free health screening at WellCheck per member (and spouse)
- Proposal is to have the members receive a health screen in FY13. Then when they receive a health screen in FY14 the will receive a $5.00 (plus $5.00 for spouse) discount per month from their medical premiums.
- A risk analysis can be conducted on this data and has the potential to assist in reducing future health care expenses.
- Plan Change Recommendations --
- Recommend terminating the QCC (Quality Care Choices) Oncology Program with Billings Clinics as of July 1, 2012. No new members will be enrolled into the program after March 1, 2012.
- Complexity of managing the program-MUS and the Billings clinic were not able to manage the program as effectively as originally planned,
- The pricing of this program was higher than expected
- Waive of deductibles and co-pays was more than expected
- It was not possible to accurately quantify results
- The infusion program with Walgreens will continue
- Recommend discontinuing offering the colon cancer screening kits.
- Vendors responding to the Wellness RFP (Request for Proposal) indicate that it is not recommended.
- No longer industry standard; not very effective
- Costly since individuals aren’t returning the kits
- PPACA is including colonoscopy as a preventative requirement
- Preventative screening is best
- Recommend changing the funding mechanism for the vision program from fully-insured to self-insured.
- Number of members-Yes, MUS has high enough quantity of members
- Risk—there is some financial risk but history has shown that it would be negligible,
- Potential for savings-yes; Data from July 2010 to June 2011 indicated about $100,000 savings
- Recommend not re-bidding the auto/home insurance coverage contract.
- There is some enrollment at Kalispell but if this benefit were not provided it is still offered from alumni associations
- This type of coverage is not a group product - there is no single premium because each individual has different considerations which affect the premium
- Members which are currently enrolled can continue their coverage which will be deducted from their paycheck
- The Benefits committee won’t have to do anything since each campus will handle this ongoing deduction
- Add acupuncture and naturopathic benefit to the managed care plan offerings. It will be limited to $25 per visit and 15 visits per year.
- It will be in addition to the chiropractic benefits currently in place.
- Can provide long term health benefits
- Change ‘Alternative Care’ category name to ‘Complementary Care’.
- Add bariatric surgery benefit to managed care plans.
- Covered procedure limited to lapband and Roux-n-Y bypass.
- Potential candidates must qualify
- Psychology testing in Missoula, Billings or Great Falls
- 3 month strict program-must lose 10% of weight to be eligible for surgery, and visit one of the three medical centers
- There is after-surgery care
- Total cost is about $20,000 per person
- Individuals have a better quality life and lower health care costs due to reduced possibility of becoming diabetic and other medical problems associated with obesity
- Add Travel benefit (other than for transplants) to managed care plans
- Cochlear implants—For FY13 initiate a pilot program to determine price and utilization ($75,000 maximum benefit)
- Actual cost is about $50,000
- Other developments of child can be impaired
- Cover generic oral contraceptives at 100% of allowed cost.
- Enhance Well Baby Program by providing a breast pump for new moms.
- Continue Dependent Premium Hardship Waiver Pool for FY13 and set aside up to $100,000
- Dental Benefit changes
- Waive the diagnostic and preventative benefit costs (two cleanings per year) from applying to the $750 and $1,500 yearly maximums
- The idea supporting this proposal is that when the maximum is reached then the family may forgo the cleanings. Less than 5% of members reached the maximum in 2010/2011.
January 13, 2012 TIAA-CREFF visit to Benefits meeting, John Holte, individual retirement consultant will be living in Bozeman and serving the MUS system. He can provide active individuals and groups and retiree education. He uses tools/programs to calculate how much money (60% to 80% of current expenses) a member will need upon retirement bases upon different scenarios (inflation, etc.) and a person’s personality. Groups such as the Benefits Committee, Staff Senate, etc. can inform members about the availability of theses group and one-on-one sessions.
The remaining portion of the meeting reviewed and discussed the items which were presented at the Plan Change Committee meeting on Dec. 8th. These notes were distributed near the completion of our Staff Senate meeting on Dec. 21st but were not discussed due to lack of adequate time.
December 8, 2011 IUBC Plan Change Committee Meeting
- Current maximum benefits -
- $1,500 per covered individual
- Basic Plan--$750 per covered individual
- Proposal to consider—Have two cleanings per plan year not subject to the maximums listed in A1.
- The idea supporting this proposal is that when the maximum is reached then the family may forgo the cleanings. Less than 5% of members reached the maximum in 2010/2011
- .If the preventative care were not included in the maximum dollar amounts then the premiums would increase by 1%.
- Indemnify Fee Schedule/Table plan on (pages 18 to 21).
- This is the maximum amount which the plan will pay for these listed procedures.
- These dollar amounts have not been updated since 2007. If these amounts were increased based on more accurate and current procedure costs then the monthly premiums would increase by 14.75%.
- Net Work Driven schedule—This is a co-insurance plan which was reviewed and discussed but then rejected.
- Plan pays 100% of preventative proceduresPlan pays 80% for general procedures
- Plan pays 50% for major procedures of the allowable contracted fee
- The monthly premiums would increase 18.75%.
- Observations of the dental plan
- 60% of the members are using out-of-network due to loyalty to their current dentist and the possibility that they may not be able to find an in-network dentist.
- Some members are enrolling in the premium plan to have certain dental procedures performed and then enrolling in the basic plan the following year.
- The Fee Schedule empowers our members to negotiate fees with the dentist and is a simpler set of costs to understand when compared to the Net Work Driven schedule.
- Recommendations of Plan Change Sub-Committee
- Waive the Diagnostic and Preventative (DNP) from the maximums ($1,500 and $750).
- 1% increase in premiumsIncrease the costs of the procedures on the Fee Schedule on a more regular basis…once a year. 14.75% increase in premiums
Update on New West/Pacific Source—New West is owned by seven hospitals. It currently has 15% of our members.
- Four arrangements being reviewed
- Have hospital employees being insured by New West
- Handle self-insured groups, Like MUS
- Handle Commercial market
- Handle MAPP
- New West wants to get out of the health insurance business so they could sell 1a (above) to BC/BS
- Due to Federal regulations New West can’t sell 1b and 1c to BC/BS, but Pacific Source could buy those
- MUS would be serviced by New West or Pacific Source until June 2012
- New West will maintain MAPP
- Considerations for MUS:
- Do we offer the Managed Care (MC) plan from Pacific Source? The network and discounts stay in place. Or
- Do we consider other MC companies who are in or planning to move into Montana?
- Considerations for adding certain benefits to Managed Care (MC) Plans, which are currently in the Traditional Plan,
- Alternative Care—Includes a request to change the name to Complementary Care
- Acupuncture and naturopathic--Page 11 of CHOICES
- Combine with the 20 visits per year maximum to a chiropractic or
- Separate with 15 visits between the two and members pay over $25 per visit
- Kelly will price these considerations
- Bariatric surgery-Page 11 of CHOICES
- Must have 10% weight loss (Obesity management) to qualify for the surgery
- Kelly will price this option
- Travel Benefits for conditions other than transplants
- Traditional Plan has $1,500 for travel benefits. MC has $5,000 for transplants only
- Kelly will price $1,500 for travel benefits in Mc
- Considerations for benefit changes to all Plans
- Hearing aids and cochlear implants are currently not covered
- Per Kelly-plans which have these benefits are keeping them, while plans which don’t have them are not including them
- Kelly will price these and include a limit on the expenditure
- Preventative Benefits
- These must be offered after any plan which begins after August 1, 2012. It is recommended we include these benefits beginning July 1,2012 instead of July 1, 2013.
- Contaceptives—100% covered for all types, with one caveat…generic contraceptives to be included in tier I while others will be included n Tier II
- Breast Pump—every new mom is provided with one thru Well Baby. These can cost from $40 to $300 depending on quality. It is recommended that a large quantity be ordered at one time.
- Update of Dependent Premium/Hardship Waiver
- $200,000 had been set aside for those families who didn’t qualify for Healthy Montana Kids (HMK)
- If the family had been denied from HMK then they could submit a Waiver with the MUS medical plan. To qualify for the waiver their household income had to be less than 15% above the HMK household income requirement.
- 45 applied—40 were approved and 5 denied
- $70,000 will be used by the end of the plan year compared with almost $500,000 in prior plan year
- It is being considered to offer this waiver next year but it will be less than $200,000 since we implemented closed enrollment for adding children unless certain criteria are met.
- VALIC/TIAA-CREFF—Items to consider
- We should be more active with over-seeing & managing 403b plans and have a structure to implement this involvement.
- OCHE (Office of Commissioner of Higher education) is attempting to add one position to cover retirement issues
- Two sources of advice and involvement would be active employees and the Retiree CommitteeConnie recommended that Tom Toth (consultant from Wilshire) and Frank Kerins could help with these issues
- Regarding VALIC, Connie was concerned about moving away from annuities when considering risk assessment vs safety
- Financial education and material can be made available such as Lunch and Learn
- Additional Items
- Remove clause which includes “pre-existing condition” from our contracts effective July 1,2012
- We won’t have to consider deductibles, co-insurance, co-pays for this coming (FY13) year
- Reserve funds could be approaching 400%. However, it is always possible that several major claims could be presented. The comfort zone for this fund is between 250% to 350%.
- Doug suggested that we consider adjusting/increasing premiums based on children covered in the family instead of having the same premium for Employee & Child(ren) and Employee & Family. Connie indicated that having more than one child covered does not significantly increase the costs.
- Working years at MUS
- There is some frustration and concern with regards to older employees who work for only five years at the university system and then retire as opposed to those who work 20 plus years and retire.
- It is possible for an individual to work for the state, retiree at 55, work for five years, then retire from MUS and receive two pensions---a double-dip pension.
- Could we consider adjusting the retiree health insurance premium based on years of service?
- The Plan Change Sub-Committee is scheduled for January 18 from 10AM to 2PM.
December 1, 2011 Benefits Committee meeting, in attendance: Frank Kerins, Doug Young, Ken Hapner, Susan Alt, Barbara Wheeler, Bob McKenzie; Don Mathre; Jerry Coffey; Jo Packham; Robert Johnston, Carol Shannon, Shari Curtis, Kelsey Hartzheim, Ron Brekke
- Alternative IDs vs SSN for MSU Benefits: Jo has been talking to Mary Lachenbruch at the Benefits office
- TIAA-CREF visit to Benefits meeting: John Holte will try to attend the January meeting.
- Discussion of modified 403(b) and/or ORP (Optional Retirement Plan) providers. Per Connie an RFP will be sent out in 2012 regarding new investment providers. Items to consider:
- A family of more index funds and lower fees-Vanguard
- Don’t require on campus or state presence
- A one-page Comparison of VALIC vs Vanguard vs TIAA-Creff with regards to fees, on-site and/or phone assistance, number and types of funds offered
- RFP could list a cap on management fees
- Educate individuals about fund costs
- There are classes being offered on Money Management, Investments, Retirement and Estate Planning. There are also available online.
- Marketing research/analysis by College of Business marketing classes to better understand MSU Benefit Community’s (employee’s) understanding of MUS (Montana University System) benefits. A marketing class will have this as a project for next semester.
A. Bozeman Campus Wellness Task Force
- Transition year for Wellness- Some services (Wellcheck) provided by an outside vendor
- What is the Bozeman Campus interested in preserving which will not be handled by the revised MUS Wellness program.
B. MUS Wellness Design Proposal
- On January 20 a vendor will be chosen. The services they will provide could include Health Risk Assessment (HRA), Blood Draw, Biometric screening (height, weight, blood pressure), Flu vaccination,
- Positions within MUS will include:
* Marketing/communications coordinator-filled
* Nutrition and Health Education Specialist-to be chosen
* Exercise and Fitness Specialist—to be chosen
- Discussion of portion of MUS ORP (Optional Retirement Plan) match going to TRS (Teachers Retirement System):
- Presently 1% of MUS match to ORP retirement funds goes to TRS system. ORP retirees have no access to these funds.
- Terry Leist indicated that OCHE (Office of the Commissioner of Higher Education) is aware of the issue and the last review was done in 2004.
- Knova solutions
- Montana University System is implementing a new health information service, Knova Solutions, to help participating plan members and families with their needs.
- Knova Solutions is a voluntary, confidential and individualized health service. Having access to useful and accurate health information and support through this service will help you understand your diagnosis, treatments, tests and medications, and allow you to better manage your health. Knova Solutions is fully funded by MUS and is provided at no cost to the member or family.
November 16, 2011, as reported at the Staff Senate meeting. Shari and Carol noted the group continues to pursue alternate ID numbering for the Rx card. A retirement planner is available for counseling. Senators requested a retirement link on the Senates web page. Senators also request Shari and Carol following on information regarding the BCBS lawsuit and changes to New West and that may effects MSU.
November 3, 2011, Benefits Committee met. In attendance: Susan Alt, Barbara Wheeler, Bob McKenzie; Carol Shannon, Don Mathre; Doug Young; Jerry Coffey; Jo Packham; John Jutila; Ken Hapner; Frank Kerins, Lisa Buss; Robert Johnston, Shari Curtis, Kelsey Hartzheim, Marty Hamilton, Bob Swensen, Ron Brekke
- Mary L at the Benefits office has been called to obtain their comments and suggestions. Currently about 100 out of 8,000 MUS (Montana University System) employees have chosen an alternate number.
- 403 (b) and ORP (Optional retirement Plan) providers
- TIAA-CREF (403(b) and ORP)
(1) John Holte, TIAA-CREF Individual Consultant will be living in Bozeman and serving MUS. It was suggested that John be invited to speak at one of our Benefits Committee meetings.
(2) If an employee has an account with TIAA-CREF then John would be willing to discuss their complete investment strategy even though the employee’s other investment funds are not with TIAA-CREF
- VALIC (403(b) only)
(1) VALIC is moving from providing variable annuities as a primary product to providing mutual funds
(2) The difference between TIAA-CREF and VALIC is that VALIC offers a more active higher touch management of an investor’s account, and therefore the fees are higher.
(3) For example: If VALIC were to recommend a Dryfus fund there would be a yearly management fee of 50 basis points (.005)…$10,000 in an individual’s account X .005= $50. Whereas, if a brokerage company such as Vanguard (which is self-directed with the investor making that choice without any advise) the fee would be 11 basis points (.0011)…$10,000 X .0011 = $11.00 (for a passive index of the same securities). A basis point is 1% of 1%, so a 1% management fee is 100 basis points.
- Discussion of 403(b) and/or ORP Providers from the attending members:
- Our members/employees should be educated about basis points and the fact that active management of a retirement account doesn’t necessarily provide higher returns.
- It was suggested that the IUBC (Inter Units Benefit Committee) consider offering other 403 (b) and ORP vendors such as Vanguard to our employees. We currently offer four choices: TIAA-CRE, VALIC, MetLife and ING. Connie Welsh (Director of Benefits) has indicated that this can be accomplished when an RFP (Request For Proposal) is submitted in 2012 to potential vendors. Ken Hapner will include this on the agenda for the next Retiree Sub-Committee meeting.
- The trend for retirement plans is to have employees become more involved and responsible for making their own investment decisions.
- Potential for marketing research/analysis by College of Business marketing classes to better understand MSU Benefit Community’s (employee’s) understanding of the MUS Benefit Plan. Prof. Omar Shehryar teaches the marketing research class in the College of Business.
- Some reasons that employees/members may not be interested in learning more about the options and choices of our (self-insured) Medical plan:
- The belief that they can’t do anything or have any control over decisions regarding the medical plan or by attending the presentations.
- The learning and decision making process may be considered to be complex.
- A couple suggestions to help our employees/members increase their awareness and knowledge of our Medical plan:
- Have an open forum for suggestions
- Conduct a survey
- Professor Shehryar, Frank and Kelsey will initiate a sub-committee meeting
- Bozeman Campus Wellness Task Force
- Our medical plan will not be funding certain areas of the Wellness program beginning July 1, 2012. Programs, such as WellCheck, will be supported by our medical plan but conducted by an outside vendor.
- A Wellness Task Force will be established to determine those services that can be provided which will not duplicate any to be offered by our Medical Plan and then determine how funding will be provided from the Bozeman campus.
- Discussion of present policy regarding retiree post employment for those retiring under ORP (Optional Retirement Plan) within MSU. The policy or lack thereof would mainly affect faculty retirees who desire to continue working (likely research) after retirement.
- Ken Hapner: A MSU faculty retiree can earn up to 33% of their previous salary.
- Marty Hamilton and Bob Swenson: Many retirees would like to maintain contact with MSU. The faculty retirement association is studying financial retirement options.
- Phase into retirement incentives
- Post retirement options
- Retirees who volunteer must report their hours to TRS
- There should be more generous and flexible regulations to allow retired faculty to volunteer and/or receive compensation.
- Incentive for early retirement
- Other universities are much more supportive of their faculty retirees in preparation prior to and during retirement.
- The retiree association can work as an advocacy group since they are not influenced by politics or campus influence
- Jo Packham distributed a spreadsheet displaying
- Eligibility for enrollment in MUS retiree health plan
- Working retiree eligibility for active employee coverage….50 FTE, 6 or more months. Most retirees will not qualify due to retiree system limits.
Future meetings, December 1 from 8:30 to 10:00. Ken Hapner will contact Connie Welsh (director of MUS Benefits) and give her an open invitation to attend any of our Benefit Committee meetings
September 29 & 30, 2011 - IUBC (Inter Units Benefit Committee) meeting notes.
June 10 vs June 11 vs
June 09 June 10
Medical 7.9% 11.6%
Rx 3.9% -13.5%
Combined 7.1% 6.5%
Dental 0.4% -1.3%
- Enrollment for actives in the Traditional medical plan decreased from 2,197 to 1,017. 50.5% decrease. This was due to the increase in deductibles.
- Enrollment in the Managed Care plans (except Blue Cross/Blue Shield) decreased from about 2,900 to 2,600
- Enrollment in Blue Cross/Blue Shield increased from 1,750 to 3,196. This was due to the lower premium prices, members moving from the Traditional to BC/BS and the number of providers in BC/BS
- Enrollment in all Combined Managed Care increased 22.8%.
- Recommended/required reserves dropped because ACL (Authorized Control Level) was less. ACL is based on previous 12 months claims. Claims for April, May and June of 2011 (which was added to the equation in the amount of $17,372,284) was significantly less than the claims for April, May and June of 2010 (which was deleted from the equation in the amount of $19,740,255). These recommended reserves will increase again as future claims are expected to increase.
- The equation includes several factors. One of these is 300% of ACL. The standard required by the agency which oversees the insurance industry is 200%. Other medical insurance companies keep 500% to 600% in their reserves.
- Another method of comparing and understanding our required reserves is that the reserve amount for MUS (Montana University System) is usually equivalent to about 6 months of our yearly claims.
Report Date Fund Balance Reserves Difference
9/30/2010 $32,392,000 $35,660,000 ($3,268,000)
12/31/2010 $35,145,000 $37,060,000 ($1,915,000)
6/30/2011 $37,483,036 $32,960,000 $4,563,921
Explanation: This is the projected cost of the health plan for retirees to the University system. There are several factors in this calculation which include years of service, expected years of retirement, premiums paid by retirees
- It is currently calculated at $183,000,000; which needs to be reported but doesn’t need to be funded……yet.
- This liability can be reduced by increasing premiums for retirees and encouraging them to enroll in MAP (Medicare Advantaged Plan)
PPACA (Patient Protection and Affordable Care Act)
- Changes which were initiated for Plan Years beginning after Sept. 23, 2010. For the MUS medical plan this was July 1, 2011.
- Coverage of children to age 26
- Elimination for Pre-existing condition exclusions for children greater than 19 years
- Mandated Preventative Care Coverage
- Elimination of lifetime dollar limits on essential benefits
- Emergency services covered at network benefit and cost
- Changes initiated on January 2011
- OTC (Over the Counter) medications no longer reimbursable under Flexible Savings Account without prescription
- Requirements for reporting value of benefits on Form W-2
On-Site (Near-Site) Employer Clinics
- On the East Coast many employers, with 1000 plus employees at one location have on-site clinics. Montana doesn’t have many employers with that many employees at one location.
- With regards to employers in Montana it may be possible to consider a Multi-Employer clinic. Several employers would combine to support a clinic.
- Clinic could be available to family members
- On-site Clinic Components
- Primary Care Physician
- Care coordinator
- Disease Management (MUS medical plan provides this service)
- Pharmacy (MUS has URx)
- Wellness Programming (Provided by MUS medical plan)
- Disability and Workers Comp (Available thru the state)
- On-site clinics results in:
- The Primary Care doctor spending more time with the member during their visits
- Paying more for Primary Care so that major medical expenses (surgery, unhealthy lifestyle, chronic conditions) are reduced.
- These chronic conditions include:
- Asthma * Coronary Artery Disease * Congestive Heart Failure * Diabetes * Hypertension
Health Care Costs
- Emphasizing Primary Care
- In the US about 25% of the doctors are in Primary Care
- In Europe about 40% to 50% of the doctors are in Primary Care
- Only about 10% of the current medical students want to enter Primary Care
- In 1980 the health care costs were 9% of GDP (Gross Domestic Product). In 2010 the health care costs were 17.6% of GDP
- Other developed countries have health care costs of 10% to 12% of GDP
- Patient Centered medical home: Case managers over-see high-cost patients by having them visit doctors, take their medication and implement a healthy lifestyle.
TIAA-CREF A 403(b) and ORP (Optional Retirement Plan) provider:
- John Holte, TIAA-CREF Individual Consultant will be living in Bozeman and serving the Montana University System. He will be available for one-on-one financial advice and group presentations.
- Visit www.tiaa-cref.org/montana for FAQ, investment options, planning tools & education, investment choice explanations and managing your portfolio.
VALIC 403(b) provider
- VALIC is currently providing variable annuities as a primary product to some of our members. They are proposing to provide mutual funds (Retirement Services Value Plan-RSVP) to those members. This proposal will be reviewed by IUBC members. Options available for participation include:
* New enrollees will only be able to invest in mutual funds
* Current VALIC participants may continue to contribute to their annuity account or freeze contributions to their annuity fund and enroll in RSVP or enroll in RSVP and convert their annuity to RSVP
- Potential mutual funds appear to have high costs, but these may be offset by increased service. Currently the average fee for the annuity funds is 1.75% compared to the proposed average of .88% for the mutual funds
- Disease/Wellness Management – Take Control Eat Well…..Stay Active…..Reduce Your Risks
- The Diabetes Program consists of education and an active support group to improve the health of our members on an individual basis.
- WellWeight: Participants reported Positive changes—more active, less tired, eating better, less health risks
- WellBaby: Program: FY2010 had 113 (63%) participation, FY2011 had 174 (93%) participation
- Out of pocket costs increased $200,000 from FY10 to FY11, while plan costs fell $2.6 million. Member-plan costs are now split about 25%-75%, which is the target.
- If URx had not been established, estimated out of pocket costs would have been $300,000 more and plan costs would have been $3.8 million more. Thus URx saved more than $4 million in costs members and reduced premiums, or about $500 per member.
Future IUBC meetings: December 16, January 26, February 22
September 28, 2011 - Responses to the Questions from Staff Senate (Sept. 28) Related to the September Benefit Committee Report
- Total Revenue for FY11 exceeded Total Medical Expenses for FY11 by 4.7%.
Answer: a. The expenses (and revenue) for each fiscal year are based on the previous year’s medical expenses/claims and projected future expenses/claims.
b. FY11 was the first year for the URx program, which contributed to reduced expenses.
c. Previous years (FY10 and FY09) have had medical expenses exceed revenue.
FY2011 FY2010 FY2009
July 1, 2010- July 1, 2009- July 1, 2008-
June 30, 2011 June 30, 2010 June 30, 2009
Total Revenue $72,163,243 $62,422,547 $59,201,368
Total Expenses $68,771,382 $67,159,498 $62,691,420
Addition/(Deficit) $3,391,860 ($4,736,951) ($3,490,051)
4.7% of Revenue (7.6%) of Revenue (5.9%) of Revenue
Consider the following……If the trend of increase in expenses from FY09 ($62,691,420) to FY10 ($67,159,498) (which is about 7%) would have continued into FY11 then the Total Expenses for FY11 could have been $71,860,662 instead of $68,771,382.
- Revenue exceeded expenses by 4.7% for FY11. What is this dollar figure?
- Obtaining an alternate number instead of utilizing an individual’s Social Security Number on the medical card.
- It was mentioned at this Staff Senate meeting that the member’s medical number could default to an alternate number. This suggestion was also mentioned at our Benefits Committee meeting (October 6) by our new chairman (Frank Kerins). This proposal will continue to be pursued to determine the steps necessary to get it implemented. It might be possible to use the member’s banner number with a B or M in front so there is no duplication.
- There is a form which can be submitted to HR requesting an alternate number. Jo Packham will review the possibility of submitting this request online. Therefore the memo suggesting that members requesting an alternate number (via hard copy) from HR will be delayed.
- It was suggested that when out members sign up for CHOICES each year then they could mark a box requesting an alternate number.
- The Reserve Fund for the MUS Benefits Program is earning about 1% interest. Who is managing and investing this Reserve Fund?
Answer: Board of Investments -- A State of Montana agency in Helena which manages and invests state assets.
- Is it still possible to submit the URx Plan Exception form?
- Does the Great Falls campus have a student clinic?
September 1, 2011, Benefits Committee met. Those in attendance included Doug Young (chairman), Ken Hapner, Susan Alt, Jo Packham, Bob McKenzie, Barb Wheeler, Ahsan Mian, Kathryn Tanner, Carol Shannon, and Ron Brekke
- Reviewed each of the Sub Committees of the IUBC (Inter-Units Benefits Committee)—Admin, Appeals, Retiree, Plan Change, Wellness. How is each member chosen? Is there a stated mission for each subcommittee? Who directs the meeting?
- Some of the members (from other campuses) are no longer involved in IUBC and therefore will not be sub-committee members
- The membership was reviewed to insure that there was at least one member representing the Bozeman campus on each sub committee
- The position of Ad hoc members was discussed and clarified. These individuals are not members of IUBC but they are involved with these sub-committees due to their expertise, interest and commitment. Most of them have been employed fulltime in the Health Benefits field.
- Jo Packham will talk to Connie about being an Ad hoc member in the Admin and Retiree sub committees. Jo wants to be more involved with pre-retiree/retiree programs related to the area of financial management.
- Ken would like the sub-committee chairperson or members to take the initiative on issues to be discussed and establishing meetings.
Social Security Number issue
- SSN should not be printed on the cards---URx card has the SSN whereas the medical card can have an alternative number.
- Why are there two cards?....URx and medical. There should be a single card for our members and if the SSN is used then the card could be blank.
- The HR website allows a member to request an alternative number. This would be a random number provided by HR
- The FTC recommends that the SSN is not used on the medical cards.
- Doug will write an email which will request an alternative number from HR. This will be provided to our members from the various member groups on campus (Faculty Senate, Staff Senate).
Financial report July 2010 to June 2011
- For all medical plans the combined revenues exceeded expenses by 4.7% FY11, compared to expenses exceeding revenues by 7.6% for the same period a year ago.
- Annualized medical expenses increased 11.6% when comparing FY10 to FY11.
- Annualized Rx expenses decreased by 13.5% when comparing FY10 to FY11. However, this significant decrease won’t continue because it is due to more generic drugs being utilized than in previous years. 78% of the drugs now being consumed are generic.
Interest on money in Reserve
- The plan is required to have a certain amount of money in reserve. This amount is earning only about 1% interest per year.
- Are there other safe, secure and reliable investments which would pay more than 1%?
- The fall IUBC meeting will be September 29 and 30.
- The next Campus monthly Benefits meeting will be October 6
August 11, 2011, Benefits Committee meeting. Those in attendance included Doug Young (chairman), Ken Hapner, Susan Alt, Jo Packham, Bob McKenzie, Barb Wheeler, Ahsan Mian, Kathryn Tanner, Lisa Buss, Shari Curtis, Ron Brekke, Amanda Gergenbacher, Laura Underkofler, Ahsan Mian, Jim Mitchell
- Membership of the Benefits Committee
- Carol Shannon and Ken Hapner have been appointed to a second three term representing classified and retired faculty, respectively.
- Ahsan Mian and Frank Kerins have been appointed to first three-year terms representing faculty. A chairman has not yet been picked – University Governance has been asked to forward a name to the president for approval.
Membership of IUBC
- The membership structure of IUBC is composed 24 reps == 12 management and 12 labor reps
- There have been some changes during the past year so this 12/12 arrangement is not currently in effect and will be discussed at IUBC
- Criteria for Hardship Application for Dependent Premium Waiver
- If MUS employees apply for HMK and are not accepted then they can apply for Dependent Premium Waivers from the MUS benefit Plan
- A list of Six criteria was provided
- There was a discussion as to the meaning and purpose of #6 criteria…”Provide a description of medical or financial hardship incurred”. Do people have to get into financial trouble before applying for DPW?
- It would be worthwhile to know how many people/families were rejected when they applied for HMK
- It would be interesting to know how many people/families have submitted the Hardship Application
Closed Enrollment for Dependents
- This is the last scheduled enrollment period to add dependents, unless there is qualifying change during the year
- Was there a significant increase in dependents being added to the medical benefit plan due to this change? An answer may be provided at the IUBC meeting on August 17th.
- A new vendor (Knova Solutions) will be discussed at the IUBC meeting on August 17th
- Knova will be assisting the MUS (Montana University System) with controlling the high medical trend costs. It is an integrated system to identify and proactively target the management of health care costs for the most risky individuals we cover.
- Over half of the medical plan resources are spent on a handful of people, so to the extent that we can ensure the highest quality and efficiency in care for these folks, it is critical to control the overall spending.
- This will be a volunteer program on behalf of the patient to help him/her in reviewing and deciding among the options available. It will complement our current case management program.
Identity Theft—An Important issue for our members/employees
- Members have been given the option of using their SSN or an alternative number on their medical benefits card.
- However due to the possibility of ID theft for all individuals nationwide our members should be not be using their SSN. It is believed that the members should not be given a choice but instructed to use an alternative number. In addition, the URx cards state that an employee’s ID is the SSN.
- The Student Health Services has achieved this policy by using alternative numbers for the medical ID of all students.
- Our employees could use their banner number with an additional one or two characters, because a UM employee could have the same banner number.
- This issue will be raised at a IUBC meeting
HR reported on several issues
- TIAA-CREF will have a greater presence in the area with a rep living in Montana, probably Bozeman.
- Retirement under the Optional Retirement Plan is not clearly defined. Many members believe that the rules for how much one may work while “retired” are not clearly spelled out. Jo will report at the next meeting.
- 47% of MSU employees are eligible for retirement under the traditional plans: (25 years of service or age 55 plus 5 years of service).
- The”Solid Finances in Shaky Economic Times” educational series has been awarded a grant to extend to other campuses and some rural areas of Montana.
- It is hard to get new employees to Benefits Orientation. As a result some new employees are signed up for choices they later regret. It would help if departments would encourage new employees to attend orientation.
March 11, 2011 MSU Benefits Committee Meeting. Attendance-Doug Young (chairman), Jerry Coffey, Ken Hapner, Barb Wheeler, Deborah Haynes, Bob Johnston, Shari Curtis, Ron Brekke
Doug started the meeting by listing methods which could be implemented to reduce the projected shortfall of money in our medical benefits plan: Increase premiums, reduce benefits, change behavior, reduce health care costs or utilize more cost effective methods.
The Purpose of this meeting was to present ideas on reducing/cutting health care costs.
- Prevention First
- $15.00 physical for all benefit plans
- Require a physical within one year of employment
- Encourage exercising—with benefits positively affecting attitude, mood, brain, energy, body
- On-site health clinic for employees (Bozeman, Missoula)
- Contracting with an urgent care facility—persuade employees to visit the urgent care facility instead of emergency care for certain medical cases. Provide an incentive for visiting urgent care. Suggest urgent care stay open 24 hours.
- Discourage use of emergency care with an extra fee
- Look at administrative expenses of our plans
- Is it possible to earn more interest income?
- Provide a card for our members which consists of certain questions to ask their doctor
- Reward doctors for keeping our members healthy—doctor is the gatekeeper
- Keep single employee whole?
- Have Dependent Premium waiver based on total household income instead of just the employee’s Montana University System income
- Lobby our legislature to change the law so that our employees can qualify their children for CHIP
- Have contribution ($733 for FY10-11) from legislature based on FTE percentage….an employee working a .6 FTE would receive .6 X $733 contribution from the legislature towards their premium payment. The difference (.4 X $733) could be added to the contribution ($733) from the state.
- Premiums paid by retirees would be based on longevity. A retiree with 30 years employment would pay a lower premium than a retiree of 5 years employment.
- Encourage and/or Move ‘all’ employees to MC plan and eliminate the traditional plans. Default to the MC plans instead of the traditional plans.
- Reward healthy behavior with a premium kickback to the participating members based on satisfying selected standards or criteria which must be achieved in certain areas such as--tobacco usage, healthy weight, blood pressure, cholesterol levels. This is similar to the automobile insurance model which has different premiums based on driver behavior. Safeway has implemented this type health-care plan which rewards healthy behavior.
- Raise deductibles to COHP level ($1,200)
- Consider Integrated medicine (IM), Complementary Medicine Alternative (CMA) and have these included in our Alternative Health Care Services (Chiropractic)
- A chart from 2007 displayed that 56% of the medical costs are incurred by 5% of the population. This could include areas such as cancer. Therefore focus on high cost services, conditions and diseases.
- Lower the reserve level
- Spouse revenue ($1.00) is not covering those expenses ($3.50) related to the spouse. If a working spouse has access to a medical benefit plan from their employer then he/she needs to be covered by that employer’s plan instead of the MUS plan.
- Encourage eligible retirees to migrate to MAPP
- The playing field should be leveled concerning the retiree/dependent subsidy. That is, subsidize everyone to the same extent and see what this does to the premiums and the bottom line. Adjustments can then be made to counteract unintended results.
Reviewed by Doug Young
As reported at the 3/16/11 Staff Senate meeting,
Benefit Changes and Considerations for FY2011/2012
DPW (Dependent Premium Waiver) will be discontinued because the Center for Medicare and Medicaid Services has approved the State of Montana’s request to permit MUS employee’s to apply for the HMK (Healthy Montana Kids) program.
Letters will be sent to the current DPW members by the end of March.
Members can review the qualifications and apply online at http://hmk.mt.gov or submit a paper application
Annual scheduled Open Enrollment for spouses and children will be discontinued after this year’s enrollment. Members will be required to maintain their spouses and children on the plan from year to year. If children and spouses are not enrolled this year then there must be a qualifying event to add them onto the plan. Qualifying events would include: Spouses lose their job or health insurance, Birth of a child, Marriage, Divorcee, A ‘significant’ increase in the cost of the spouse’s insurance
There will be one Traditional Plan instead of two Traditional Plans
Increase deductibles and Out-of-Pocket (OOP) maximums
Montana University System (MUS) Benefit Design Changes
FY 2010 to 2011 (Current)
Out of Pocket
Maximum (Single/Family) Includes Deductible
FY 2011 to 2012 (July 1, 2011)
Out of Pocket
Increase in medical premiums
There will be an average of about a 7% increase. The range will vary from approximately 3% to 13%.
There are several major changes in the benefits plan this year. Members will be encouraged to attend the pre-enrollment sessions in April/May. After considering your individual and family situation, you will then be requested to thoroughly review and analyze the options before choosing a benefit package.
Healthy Montana Kids (HMK) Questions and Answers
Are letters being sent to current DPW (Dependent Premium Waiver) members? Yes, letters will be sent from MUS (Montana University System) Benefits office to current DPW members – by the end of March.
- Do individuals visit the website http://hmk.mt.gov and submit their application? Yes, individuals can apply online which is the easiest and quickest method – or they can send in a paper application?
- Can the HMK Application forms be sent to the folks losing DPW when the letters are sent out at the end of March? Yes, a hard copy of the HMK application form will be included in the letters that are mailed out to employees who are losing the (DPW) Dependent Premium Waiver.
- Will the pre-enrollment sessions provide information and assistance? Yes, information will be provided during the spring tour.
Do folks from HMK make themselves available to come on campus to explain the program and sign up qualified applicants No, HMK staff cannot “sign up” applicants – it is necessary to go through the application process.
- If there is a substantial number will that cause a problem with HMK’s ability to screen and process the applications in a timely manner? HMK is prepared to process applications in volume. However, if there is a huge influx of applications there is the potential that it could take a couple months for the applications to be processed (as opposed to a few weeks). For that reason we will encourage employees to apply as soon as possible so that hopefully approvals will be done by July 1.
- If an employee does NOT enroll their children in the MUS plan and applies for HMK, but HMK doesn’t accept them then would that employee be permitted to enroll their children in the MUS benefit plan after the open enrollment period? No – members should enroll their children in our plan until they are accepted in HMK at which time they would drop ours and pick up HMK on the same date. If they do not have their children enrolled on our plan and they are not accepted in HMK then they would not be eligible to enroll them in our plan. There is one small caveat here in that we are going to do a one-time special enrollment period in July for dependents who aged off the plan – it’s a PPACA requirement to have a special enrollment period to allow 25 year olds to return to the plan – so during July that will happen and it will be a special enrollment period for anyone who was applying for HMK also. If they don’t enroll at that time though, then “no” they could not come onto our plan just because they were not accepted into HMK.
- Sometime after open enrollment, a low income employee decides HMK would be a better deal for them. If they successfully enroll their children in HMK, can they drop the children coverage with MUS in the middle of the year? Yes – if they decide at any time to apply for HMK and they are accepted, they would then drop off our plan.
Possible Enrollment Questions to Consider
Here are some questions which each employee could consider when reviewing which Montana University System (MUS) medical plan would best match the individual and family situation to the available benefits.
- Compare premium prices
- Enroll spouse or if spouse is working then review that medical plan and compare.
- Take into consideration that this is the last scheduled year for Open Enrollment for spouses and children, unless there is a qualifying event.
- Enroll children or consider working spouse’s medical plan for children
- If children are less than 19 years of age then consider enrolling them in HMK (Healthy Montana Kids) if the criteria (such as the household income level) is satisfied or enroll them in the MUS benefit plan
- Review the Provider network of each plan--Traditional and Managed Care (MC)
- For retirees look at MAPP if both spouses are Medicare qualified
IUBC (Inter Units Benefits Committee) Meeting-Oct. 30, Dec. 2, 2010 and Jan. 25, 2011
Plan Change Sub-Committee Meeting Jan. 13 and 21, 2011
- Pharmacy and medical expenses (hospital & doctor fees) are increasing significantly.
- Annualized change—Oct. 09 –Sep. 10 vs Oct. 08 – Sep. 09
*Medical == +11.2%
*Rx == +14.5%
- Q1 (July 1, 2010-Sept. 30, 2010) costs this year vs Q1 (July 1, 2009-Sept. 30, 2009) costs last year.
* Medical == 22%
* Rx == 33% If the new URx prescription drug program had not been implemented then expenses would have been even higher.
- The increases in expenditures are almost entirely due to provider cost increases. Member utilization remains relatively steady. A portion of these increases is due to the response to national health care reform changes to be implemented.
- Projected deficit/funding shortfall for FY2011/2012 is about $11,000,000.
- IUBC is anticipating that there will be no increase to the employer contribution of $733/month.
- Situation—A certain percentage of our members are adding or removing their spouse/dependents on a regular basis. Effectively what is happening is that in the prior year to dis-enrollment, our spouses of active employees (pre-65 retirees and retirees) maximize their utilization of the plan and receive a significant number of services. Then they skip a year of premium payment and then come back on the plan. Members are also adding and removing their children as they anticipate increasing or decreasing usage of medical services.
- Recommendation—Discontinue (spouse/dependent) Open Enrollment
- It will be permitted to add any spouses/dependents this year (FY11-12) during the open enrollment period.
- However, actives and retirees will then be required to maintain their spouses and dependents on coverage from year to year. Dependents/spouses may be dropped during the spring enrollment periods. But once the coverage has been dropped for a spouse/dependent then (beginning in FY12-13) there must be a qualifying event to add them back on the plan….also available anytime during the year.
- Examples of qualifying events:
- Spouses loses their job or health insurance
- Birth of a child
- A ‘significant’ increase in the cost of the spouse’s insurance
- The plan may choose to periodically offer an open enrollment period to assist employees, but do not count on that availability.
- The only choice the employees and retirees can’t do every year is to add dependents/spouses. All the other options including making benefit offering choices, switching in and out of benefits (like adding or dropping vision coverage) continue to operate exactly the same way they have.
- The State of Montana implemented this approach in 2005.
MUS (Montana University System) Medical Plans
- The MUS Traditional (Plan A & Plan B) and Managed Care (MC) Plans were compared to 32 other university, state, chamber and municipality medical plans.. The following items were compared: deductibles, coinsurance, out-of pocket maximum, hospital/ ER copay and Prescription Drug (deductible, generic, formulary) programs. The MUS managed care plan was given a 1.00. Only 8 had richer plans (greater than 1.00) and of these only two were in Montana.
- The MUS medical plan has become the ‘payer of choice’ among plan members who have a spouse insured by another employer. Because our out-of pocket costs (deductibles, coinsurance, Out-of-pocket (OOP) maximums) for services are relatively low compared to other employers in places like Bozeman, Billings and Missoula there is a built in incentive for the spouse to use the MUS plan as their primary insurer.
- Recommendation-Increase deductibles and Out-of-Pocket (OOP) Maximums
- Create a single Traditional Plan which has a significantly higher deductible for the individual/family,
- Revise the In-Network MC plan to implement a higher deductible for the individual/family
- Modify the Out-of-Network MC plan to have a. higher deductible for the individual/family
- Annual Out of Pocket (OOP) maximums will be increased. This is starting to become standard in other medical plans
- The default plan for our members has been one of the Traditional plans. It has been recommended that the most cost effective MC plan become the default plan.
- There were comments from the union representatives:
- It is common practice to include benefits and wages together in the collectible bargaining process between labor and management. Whereas in Montana University System (MUS) the benefits are not included in this process and therefore not given the importance, influence and impact which should be attributed to them.
- We are not expecting an increase in employer contribution (from the current $733). Therefore any increase in deductibles, OOP maximums and premiums will have a more noticeable and adverse impact on the income of the lower paid employees, with regards to less take-home pay and their initial out-of-pocket expenses.
- This recommendation (with some to-be-decided modifications) was voted on by the IUBC reps, with several ‘No’ votes from the union representatives.
- These will increase but the percentages have not been calculated.
- The spouse/dependent premiums will incur percentage increases (similar to last year from 1.18% to 1.24%) so there won’t be as much subsidy.
- Recommendation to replace Dependent Premium Waiver (DPW) with Healthy Montana Kids ( HMK)
- The Center for Medicare and Medicaid Services has approved the State of Montana’s request to permit MUS and State employee’s children on the HMK program.
- Some committee members said that DPW is no longer needed – it was started because MUS employees were not eligible for SCHIP (HMK), which they are now.
- HMK has a maximum amount that the family must contribute (total out of pocket) of $215 per year for all children enrolled in HMK. This is a big savings over our MUS deductibles and copays/coinsurance.
- Medicaid (supporter of HMK) has a pretty big network in Montana. They are required by federal law to maintain a broad network of providers.
- If a provider for the children of a MUS employee is not currently an HMK provider then there are two choices:
- The MUS employee can stay on the MUS plan, pay the premium and continue to use that provider or
- Negotiate with that provider to participate in HMK.
- There has been some concern regarding the impact this change may have on certain families. Therefore it has been recommended to set aside a maximum of $200,000 in reserves for hardship:
- The member must first apply to HMK and be denied.
- The criteria has not yet been developed.
- This change will be communicated via letter and articles in our newsletter.
- Consider whether a group Medicare Supplement product may provide an opportunity for Medicare retirees to save on their premiums. This would be offered in addition to the MAPP Plan and replace other offerings for Medicare Retirees. The retirees would still be included in the MUS benefit plan. This program would be handled and managed by another company…similar to our dental plan. Our URx prescription drug program could be retained after considering other pharmacy programs which may be presented.
- Another alternative— If the above plan is not viable then reduce the loss ratio to no more that 100% for the next two years.
- The Wellness Program was receiving funding from the reserve fund but it will, for this coming year, be supported from the premium payments.
- The Wellness team submitted a list of services which they believe are priorities for MUS employees/members on the plan
* Well Check and Health screenings * Fitness and Exercise * Nutrition and Health Education
3. The Well Awards program will be discontinued
H. FLEX--The new federal health care plan has changed the rules for purchasing over the counter (OTC) products beginning Jan. 1, 2011. Flex funds can no longer be used to purchase several OTC medicines, unless they are prescribed
I. Pre-enrollment session
There are several major changes in the benefits plan this year. Members will be encouraged to attend the pre-enrollment sessions in April/May. The members will be requested to thoroughly consider, review, analyze and choose the plan offerings which have the best discounts across the board for their individual or family situation.
January 6, 2011, MSU Benefits Committee Meeting -present: Young, McKenzie, Hapner, Curtis, Wheeler, Alt, Mathre, Brekke, Shannon, Underkofler, Packham, Coffey, William, Buss
- The schedule of upcoming plan change, IUBC, MSU Benefits and pre-enrollment meetings was discussed.
- Young reviewed his presentation Jan 5 to University Council.
- The Dec 20 Plan change meeting was reviewed, including preliminary rates, drug costs, comparisons with other plans and proposed plan changes.
- Committee members made several points in connection with proposed plan changes.
- Other changes should be considered instead of or in addition to those listed on the excel spreadsheet “Medical Benefit Pricing.” In particular,
- premium based on number of dependents
- separate premiums for spouses versus child dependents based on costs associated with each.
- a high deductible plan
- increase family deductible to 3x (or more) individual deductible
- premium based on income
- employer contribution based on fte
- Doing with medical procedures what we did with Rx: Seeking cost-effective alternatives and encouraging members to use them. Quality Care Choices are a step in that direction.
- “keeping the employee whole” may not be possible in future years, but this depends on spouse/dependent subsidies
- Concern was expressed that reducing retiree benefits and/or increasing premiums would result in more people remaining active past the age of 64, so that MUS would still be primary and Medicare secondary. We don’t know:
- How many such people there are currently
- How much additional expense to MUS
- MHK/DPW. Some committee members said that DPW is no longer needed – it was started because MUS employees were not eligible for SCHIP (HMK), which they are now. A member expressed concern that some providers say they will not accept HMK reimbursement rates. Members are encouraged to negotiate with providers when possible.
- Members were reminded that one of the most basic goals of health insurance is to prevent bankruptcy.
- Members are looking forward to seeing the comparison of benefits with other universities
- MSU Benefits will meet again Feb 3 in 232 SUB. Communicating plan changes will be a major task during the spring. Members are encouraged to attend pre-enrollments meetings in April-May.
December 2, 2101, IUBC (Inter Units Benefits Committee)
1. Pharmacy and medical expenses (hospital & doctor fees) are increasing significantly.
a. Q1 (July 1, 2010-Sept. 30, 2010) costs this year vs Q1 (July 1, 2009-Sept. 30, 2010) costs last year. Total medical costs have risen 22%,
b. There have been notable increases in prescription drug prices….+33%. If the new URx prescription drug program had not been implemented then expenses would have been even higher.
c. The increases in expenditures are almost entirely due to provider cost increases. Member utilization remains relatively steady. A portion of these increases is due to the response to national health care reform changes to be implemented. Estimating--Adding over 5% to expenses.
d. Annualized change—Oct. 09 –Sep. 10 vs Oct. 08 – Sep. 09
*Medical == +11.2%
*Rx == +14.5%
2. Plan year 2010 to 2011 and future years
a. When the premiums were set at the beginning of 2010 we had projected a surplus of approximately $4M which would keep our reserve at the authorized level of 300%. However, if the current trend of higher expenses continues then the plan could experience a loss.
b. Without significant changes in the benefits structure the coming biennium (Plan years 2011-12 and 2012-13) will experience projected losses of 6% and 15%.
c. IUBC is anticipating that there will be no increase to the employer contribution of $733/month.
3. IUBC (Plan Change sub-committee) is evaluating a number of possible plan changes:
a. Increases in employee paid premium
b. Increases in deductibles, co-pays and coinsurance
c. Increases in spouse/dependent and retiree premiums
d. Migrating to a “bi-annual” plan vs the current “annual” enrollment
e. Combining Plan A and Plan B
f. Exploring other Wellness and disease management programs
g. Out-sourcing the retiree medical plan, but still manage it. Also, working spouses of pre-65 retirees are staying on the MUS plan (since it is less expensive) instead of using their own employer health plan.
B. Healthy Montana Kids (HMK)
1. Center for Medicare and Medicaid Services has approved the State of Montana’s request to permit MUS (Montana State University) and State employee’s children on the HMK program.
a. Employees who are currently on DPW (Dependent Premium Waiver) may have kids eligible for HMK
b. Employees who did not qualify for DPW but their overall household income will permit them to qualify for HMK
c. Employees (currently on DPW) who apply & qualify for HMK will be removed from the DPW program.
d. This will be communicated via letter and articles in our newsletters
C. Premium Incentive Plan proposal---will be delayed a couple years
D. TLC (The Life Connection)—Certain areas (counseling) are underutilized and could be eliminated, to reduce costs
E. Planned Future meetings
1. Plan Change meeting December 20th and in January
2. Full IUBC meetings in January and February
November 1, 2010, 3-year projections of the increases in medical expenses was share with the senate.
Total Expenses ($M)
State Share ($M)
Excess Reserve ($M)
EE/Ret Contribution ($M)
% Change in EE/Ret Cont.
September 30 through October 1, 2010, the Inter-Units Benefit
- Financials- URx update
7/1-9/15 7/1-9/15 Difference % Difference
2010 2009 URx – CMx
Total Cost $1,919,492 $2,677,118 ($757,626) -28.0%
Members $ 691,595 $ 899,432 ($207,836) -23.11%
Tot pd/clm $ 59 $ 75
Plan pd/clm $
Mbr pd/clm $ 21 $ 25
This is the amount of money which the employer should currently have in their medical plan to cover all current and future retiree (forecasted) medical liability. This calculation is completed every two years. It is currently not a requirement for government/public agencies to have this total amount of money available. However, it is advisable to start placing funds into this account because it does affect the rating of bonds. Additional information from Connie Welsh: Laura Humberger, Assistant VP for Financial Svcs from MSU has been communicating with Frieda Houser in OCHE. Laura shared the Standard and Poor’s – Global Credit Portal – Ratings Direct from July 23, 2010 with us. In it, Montana State University is singled out and a discussion of the 2009 operating performance for the campus is noted as follows:
· Montana State University's (MSU) operations had what we consider to be substantial OPEB accruals. For the fiscal year ended June 30, 2009, MSU's UNA decreased nearly $9 million. The university had an operating deficit of $8.7 million for fiscal 2009 due primarily to, according to management, the amortization of OPEB liabilities, which it began to record in fiscal 2008. Without this expense, operations would, in our view, have been positive. The university recorded $25.7 million of depreciation expense and its budget is consistently balanced on a cash basis. (For more information, see the analysis published Dec. 18, 2009.)
Laura followed up with Frieda following publication of that article and shared the following – “We just had our bond ratings affirmed (hooray!), but both agencies (S&P and Moody's) talked a lot about the OPEB liability, and Moody's went so far as to subtract the OPEB liability from our calculation of "unrestricted resources." When that amount is $18 million it's one thing, but when it grows to exceed our cash on hand we're going to be in real trouble.”
This may be good to share with your committee. We will be working with campus controllers and financial staff on this issue, but it is here and we are faced with financial consequences that we must manage.]
Before Adjustments $142.4MM
FY2010 Adjustments 40.8MM
There are two approaches being utilized to reduce this liability:
- Those retirees in MAPP are not a medical liability to their previous employer (ie. MUS) and therefore not included in this figure.
- The Medicare Supplement plan will cover a portion of these liabilities, but we will still have obligations for the early retirees as long as we subsidize their premiums. The reason MAPP and Medicare Supplement reduce the liability is that they are fully insured products and the MUS plan is not self-insured for folks in these plans.]
Also, mentioned…..Consider several pros and cons of the feasibility of moving Medicare retirees to a private insurance plan.
- Health Care Reform Bill (Patient Protection and Affordable Care Act--PPACA) —Comments from a (AON) health consultant
- Only in the US does the employer offer health insurance for the employees.
- Nothing in this bill will reduce medical costs
- 20 million additional people will be have insurance coverage……..resulting in premiums being increased.
- There is expanded coverage to the individuals—increase costs
- It is complex and lacks clarity
- Big employees have some of this required coverage but small businesses will be affected the most
- The initial intent of medical insurance (many years ago) was to cover only catastrophically medical related expenses.
- In 2018 there will be a 40% tax on ‘Cadillac’ insurance plans. Those which exceed $10,200 single and $27,500 family.
- Starting in 2011 the value of an employee’s health plan will be included in their yearly income statement from the employer. This value is not necessarily the yearly premium amount nor will it (currently) be included in taxable income.
- On January 1, 2011 there will be certain OTC drugs which will not be eligible for FLEX. A list will be distributed by FLEX Connect to our members.
- In 2014 there will be a yearly $2,000 fee assessed against an employer who does not have an employee health plan.
- Elimination of $2MM lifetime maximum.
- Several actuaries in other insurance plans have calculated that this health care reform bill (PPACA) will add 2% to 5% to the medical premiums.
- Our illnesses (heart disease, diabetes II, anti-depressant) are based on each individual’s lifestyle…..which includes exercise and healthy eating habits.
- Employees who are actively involved in our Wellness programs can help to reduce medical expenses.
- URx Panel
- Pharmacy & Therapeutic Committee (PTAC) works with MedMetrics (which provides independent evaluation of prescription drugs) to place the drugs in the various tiers.
- Ask-A-Pharmacist works with the members to provide----primarily a clinical effective drug and then secondarily a cost effective drug.
- Some patients weren’t sure as to why they were taking certain drugs
- The interaction between drugs is evaluated.
- Members are provided with alternative, clinically effective, drugs which can be presented to their doctor.
- Review of Plan A and Plan B (Traditional Plans). There are not a lot of people in these plans. Therefore, the following possibilities may be considered:
- Plan B members will transfer to Plan A.
- The two traditional plans combine into one.
- Cost of Health Care on national basis looking at 11,000 employers with 6.5 million employees.
- Out of pocket for: individual $113; family $443
- Medium RX deductible: individual $150: family $200
- Proposal: Preliminary Wellness Incentive Structure
- The Health Care Reform Bill makes it legal to charge individuals a higher premium if they are unhealthy; such as high cholesterol.
- MUS is taking into consideration the possibility of rewarding employees & spouses for staying healthy with cash and/or a reduction in their premium. This program would be designed to change behavior and then continue to live a healthy lifestyle. The proposal being considered could consist of:
- In FY12-- A cash reward for submitting a HRA (Health Risk Appraisal) and a chemical screen. This would provide some bench mark (bio-chem) data such as HDL, LDL, Glucose, BMI (or waist size), and blood pressure.
- In Fy13 and future years it would be possible to qualify for a premium reduction when certain individual medical data is compared to the established bench mark, by scoring an acceptable range in 4 of 6 categories.
- Children of university and state employees were not eligible to participate in SCHIP
- Due to some changes in the regulations those employees with children will be eligible to apply for SCHIP….probably by July 1, 2011. Not all will qualify or apply.
- Continuum of Care
- 5% to 10% of the members account for 85% to 90% of medical expenditures. We have case managers which focus on guiding and helping these members.
- 5% to10% of the members account for 5% to 10% of the expenditures. In order to insure that these members don’t move into the ‘high maintenance’ category there are special programs which are available.
- 80% to 90% of the members account for 5% to10% of the expenditures. Our Wellness Program is focused on keeping these individuals healthy.
- Proposal: Open enrollment
- A study was conducted which reviewed the number of claims during the year. It became apparent that there was a significant number of (elective) surgeries in August, which was immediately after our members had enrolled their spouses/children during the annual enrollment period prior to July 1 of each year. Then these family members would be removed during the following months or during the next enrollment year.
- The State of Montana allows dependents to be added every three years. However, dependents can still be added due to qualifying events—marriage, births.
- The IUBC is considering the possibility of having open enrollment every two years at which time dependents can be added, unless there is a qualifying event during those two years. Proposal—members can add dependents during the next enrollment period (April/May 2011) but won’t be able to add any dependents for two years.
- Establishing Reserve Levels is 300%
- Should we maintain that level? There is evidence that it may be too low.
- How do we handle known high cost cases? Hemophilia Rx costs are up to $8 million/year/individual. The MUS plan has more than 6-times the number of cases that would normally be expected for a plan of our size.
- Medicare Supplement Strategy
- Comparing the premiums paid and expenses incurred by pre-65 retirees indicates that the medical expenses of these individuals are being subsidized by the active members. However, the premiums paid by the members-only are also subsidizing the members plus family.
- The GASB liability for the university system is increased due to these pre-65 retirees.
- There is consideration being given to the possibility of “out-sourcing” the medical coverage for pre-65 retirees.
- WellAwards Program
- More members have signed up for this year’s program.
- Comments from the participants---they were very pleased with the program and their achieved results.
- Quality Care Choices—Well Weight
- In order to participate the member must be in a Managed Care program and have a BMI of 30 or higher.
- This is an 18-month active program which provides assistance from a Exercise Specialist, Registered Dietician, Counseling, Incentives and a health care provider.
- Traditional plan offers surgical treatment.
- Case Studies
- URx Plan Exception Process
- 600 plan exception forms out of 18,000 members were submitted.
- A significant number of the forms did not have adequate medical documents or provider’s name or the member’s name.
- Letters were sent the member and doctor requesting the clinical documentation
- In certain situations the doctor would approve a change but the patient didn’t want to make that change.
- During this process (and prior to the URx program being initiated) it was discovered that Caremark/CVS was approving all (more expensive) prescription drugs to be distributed without considering clinical effective but lower priced drugs. They were also not enforcing the Quantity Limits which was prescribed by the doctor.
- Members need to:
- Submit the proper medical records
- Have the patient/doctor write the (medical) reasons as to why an A, B or C tier drug is not acceptable as an alternative to a D or F.
- The Plan Exception forms have been reviewed and processed by the MUS Benefits personnel in Helena. In the future these forms will be handled by Ask-A-Pharmacist.
- Other considerations
- With proper review and approval on an individual basis…D & F drugs can be moved to A, B or C.
- C drugs can’t be moved to an A or B category.
- Well Baby
- 63 mothers were classified as potentially high risk and qualified for case management
- 4 were identified as diabetic and were referred to the Take Control Program
- More mothers need to be informed of this program during the first trimester
- WellHeart: Purpose—Achieve sustainable healthy and nutritious lifestyle; Prevent or reduce cardiovascular disease, hypertension, obesity, diabetes.
- Future IUBC meetings: December 2, January 25, February 24
September 2, 2010, Attendance-Doug Young (chairman), Jerry Coffey, Ken Hapner, Bob McKenzie, Jo Oudshoorn, Barb Wheeler, Susan Alt, Don Mathre, Robert Johnston, Jim Mitchell, Kathryn Tanner, Carol Shannon, Shari Curtis, Kelsey Rozell, Ron Brekke
- Director of Health Benefits
- As of July 1 Paul Bogumill has resigned as director but he will be working one day a week
- Connie Welsh is the new Director of Benefits for the Montana University System (MUS). She was Administrator for the State Employee Benefit Plan.
- Out-of-Pocket costs in URX
The initial data since July 1, 2010 compared to the previous year indicates that the reduced cost is $20.00/member/month. This includes the savings from the elimination of the deductible in our new URx prescription program. More results will be available at the IUBC retreat Sep 30 – Oct 1.
- URx memo sent by Staff Senate to its members. (distributed at this meeting)
During one of the early Staff Senate summer meetings there had been a few comments and questions regarding the new URx program. Therefore a memo was written and emailed to the members which consisted of:
- A reminder of the 4-step process which should be followed for those individuals who are taking prescriptions drugs.
- A phone number and email for those individuals who had additional questions, comments or concerns.
- URx Prescription drug program (Ken Hapner)
- The MUS (Montana University System) has received a special recognition award from the Pharmacy Industry for their new URx program.
- There are several other businesses (Bankers Association) who have shown an interest in joining our URx program.
- There have been some comments from members that their prescription drugs are more expensive with the URx program.
- It is possible to provide a summary (as more data is collected) of the amount being paid for separately by the plan and also by the members. For example: 80% being paid for by the plan while 20% is being paid for by the members.
- Future items to consider
- It appears that there are some members who may be taking advantage of the system when adding dependents to their plan…….adding a child just prior to a planned surgery.
- Having enrollment every two years instead of each year. What items need to be taken into consideration? Signing up for the FLEX account would still have to be annually.
- Federal Health Care Reform—Patient Protection and Affordable Care Act (PPACA)
Some of the earliest provisions (those beginning in 2010 and 2011) of this PPACA were introduced and discussed as to the impact these would have on the MUS benefit program. A more detailed explanation of these provisions will be provided in the upcoming Wellness newsletter.
- Early Retiree Reinsurance Program (2010)--Provides financial assistance to employers with the cost of early retiree coverage.
- Dependent coverage up to age 26 (MUS plan will be July 1, 2011) --Provide coverage for dependents to remain on the parent’s policy up to age 26 regardless of martial or student status, provided they are not eligible for coverage elsewhere.
- Elimination of lifetime plan benefit maximums (2011)—Eliminate financial caps on policy limits
- Allows restricted annual limits for essential benefits--as determined by HHS (2011) —Remove or alter benefit limits on certain ‘essential benefits’. This provision needs further clarification.
- Waiver of pre-existing conditions exclusions —for children under 19 in 2011, for all plan members in 2014
- Over-the-counter (OTC) drugs are not reimbursed under healthcare FSA (FLEX) without a prescription. (2011)
- W-2s must disclose the value of health benefits (—In 2011 employers will disclose the value of health benefits on the employee’s W-2 form but it is still tax exempt.
“Some of these provisions are likely to increase plan costs and member premiums, on top of the existing trend of higher costs.
- Higher Annual Deductible
One of the members at the Staff Senate meeting during the summer had inquired about the possibility of offering a benefit plan which had a high annual deductible which would then decrease the monthly premium. The following considerations were discussed:
- Disadvantage--The healthier individuals/families would gravitate to this plan. Therefore the premiums of the other plans would increase for those who chose to stay with those current plans.
- Advantage—Individuals/families with the higher deductible would be more cost conscious. It may be possible for these individuals to set up a Health Savings Account (HSA). This type of account allows funds to be carried forward to future years.
- An eligible employee can apply for Dependent Premium Waiver (DPW) if their annualized salary is no more than $30,000. This would reduce the premium for the employee.
- There is the possibility that CHIP may be available for MUS employees starting July 2011 and would therefore reduce the premiums for those who have the Employee & children or family plan.
- It has been noticed that, as medical expenses continue to increase, the trend is for companies to increase the annual deductible to their employees.
- Retiree update provided by Ken Hapner
- MAPP offers a good medical plan for our retirees with about 284 currently enrolled. Both husband and wife must be over 65.
- Over the next three years the subsidization of MAPP by the federal government will be reduced.
- Reserve Capital—Should the reserves be increased?
- The current goal for the MUS is to keep reserves at 300% or a little higher.
- The private sector insurance companies have reserves of 500% to 1000%
- Items to consider:
- Private insurance companies can increase their premiums any time during the year, whereas the MUS only does it once a year.
- Private insurance companies can obtain loans. The MUS can not receive loans for their benefit plan.
- The Health Care Reform Bill—reserves need to be higher (than the 300%)
- Benefits Committee
- Members of the Benefits Committee will be attending the IUBC meeting during Sept. 30 to Oct. 1
- The next local campus meeting is October 7th at 8:30AM in the SUB. Reviewed and Edited by Doug Young
May 6, 2010, Attendance-Doug Young (chairman), Jerry Coffey, Ken Hapner, Jo Oudshoorn, Barb Wheeler, Susan Alt, Don Mathre, Robert Johnston, Kathryn Tanner, Carol Shannon, Shari Curtis, Rachel Rockafellow, Ron Brekke
- Doug Young will be retiring but will still be teaching one class per semester and will continue to be the chairperson for one more year.
- This position has been filled by a faculty member. It has been suggested that we consider and select a person to fill that position so she/he can be involved with the benefit committee meetings and activities as soon as possible.
- Director of Benefits
- Paul Bogumill will be resigning as Director of Benefits on July 1, 2010.
- He will still be a consultant one day per week
- Ken Hapner attended a Strategic Planning Committee meeting in Helena in which the following items were discussed:
- Health Care Reform Act—It is very complicated. We will be discovering how it will affect our benefit plan and members as we receive more information. As we obtain more information we will be planning ahead.
- There is a one-year program which consists of a $5 Billion subsidy to off-set the initial high cost of early retirees (under 65).
- Employer Group Waiver Plan-This is a Retiree Drug Subsidy (RDS) plan to help the employer help escape the unfunded retiree liability under GASP.
- There is a proposed 21% cut in Medicare which is delayed a month at a time. A 21% cut is unlikely to occur, but Congress has put off reaching a longer term solution.
- MAPP (Medicare Advantage Program)-The subsidy for this program may gradually discontinue or the premiums may increase in 2012/2013.
- Re-enrollment in CHOICES-per Jo Oudshoorn
- The re-enrollment process and lab sessions went well
- It was possible to track those individuals who didn’t click ‘complete’, or didn’t include any remaining FLEX funds or hadn’t submitted (online) their CHOICES form for 2010/2011.
- Plan Change and Administrative sub-committees
These IUBC sub-committees will be meeting before the next IUBC meeting. One of the areas to be reviewed is…..managing increased medical expenses. Reviewed and Edited by Doug Young
April 1, 2010, MSU Benefits Committee Meeting, in attendance-Doug Young (chairman), Jerry Coffey, Ken Hapner, Jo Oudshoorn, Barb Wheeler, Deborah Haynes, Don Mathre, Robert Johnston, Kathryn Tanner, Carol Shannon, Shari Curtis, Ron Brekke
- New West will be offering 6 meetings for retirees who may be interested in signing up for MAPP (Medical Advantage Pilot Program).
- Those individuals who have reviewed the Benefit CHOICES podcast have indicated that it is worthwhile, informative and recommend that all members review it before attending the information sessions.
- A list of the Benefit committee members was reviewed and updated.
- Establishing premiums and explanation of shortfall for FY2008-2009
- Premiums are established in February of each year based on claims received from the recent previous months
- After these premiums had been established there was a significant (unexpected) increase in medical expenses during the following months from March to June 2009.
- These expenses resulted in the shortfall of $2MM for FY08-09
- Premiums during the past three years have gone only about 2% but based on our most recent claims and projected expenses there will be some significant increases in premiums during the next several years.
- The CHOICES booklet is being delivered April 1st. It will include the re-enrollment schedule from April 12th to May 7th which will list: Information sessions, Computer lab and Vendor sessions.
- Some changes to the re-enrollment process:
- More emphasis will be placed on informing members about the FLEX accounts
- Members will have be given the opportunity to check and review their decisions for any errors before clicking ‘Submit’
- It will be possible for our members to sign up for the WellAwards Program while they are re-enrolling in CHOICES
- Doug Young will not be able to give the Benefits Committee presentations on April 9th. Jo Oudshoorn has volunteered to give that presentation.
- URx- Prescription Drug Program
- The presentations are going well
- On April 1st MedVantx Pharmacy Services will be handling prescription drug mail orders. Members who have been receiving prescriptions drugs from CVS/Caremark will be receiving information by both phone and mail directly from MedVantx.
- Handling increased medical expenses and projected shortfalls in future years
- The Benefits committee has submitted a list of 22 items/suggestions for consideration to fill these shortfalls to the Director of Benefits in Helena.
- These will be reviewed and discussed by the Plan Change and Admin sub-committees during the summer.
- A comparison between our benefits plan and the benefits plan of private companies reveals that our plan is very cost effective. This is especially significant when comparing the premiums of adding a spouse.
- Our plan currently adds only 18% to a member only premium for covering a spouse. For FY10-11 the additional premium for a spouse will be 24%. Other plans add about 100%.
- Our plan currently adds 36% to a member only premium to cover spouse and (any number) of kids. The average national plan adds 175%. For FY 10-11 the additional premium for spouse and kids will be 49%.
- Out-of-state/country medical networks and coverage
- Question—What type of coverage (in-network and/or out-of-network) is available to our members if they need medical attention when they are out of the state or country? What type of costs would they incur?
- Most managed care providers have networks limited to providers in Montana. People in managed care who incur expenses outside of Montana are subject to a separate deductible amount, which is $550 per person ($1100 per family) for FY10-11. Traditional Plans A and B do not have the separate deductible.
- Emergency services are an exception: All plans cover emergency treatment in case of accident, etc.
- The following members have volunteered to obtain the answers from our providers:
- Carol Shannon--BCBS and New West
- Robert Johnston--Allegiance
- Ken Hapner—MAPP
- The next Benefits Committee will be May 6th. Reviewed and Edited by Doug Young
March 4, 2010, MSU Benefits Committee Meeting, Attendance-Doug Young (chairman), Jerry Coffey, Ken Hapner, Jo Oudshoorn, Barb Wheeler, Deborah Haynes, Don Mathre, Bob McKenzie, Bob Johnston, Jim Mitchell, Lisa Crow, Maggie Spinelli, Laura Underkofler, Shari Curtis, Ron Brekke
- URx information sessions-Two have been presented
- Benefits committee (Doug Young)-Power points presentation, there is a projected savings of 20% for the plan and an average projected savings of 20% for the members. An example provided was Lipitor which is about $326 for a three month supply. Whereas the equivalent generic was $26 for a three month supply. There were a few members who indicated that their new prescription drug cost (in tier C) was going to be more expensive. It was emphasized that there is no deductibles and if the listed price is lower than the copay then that lower price will be the amount which will be paid.
- Human Resources (Jo Oudshoorn)—similar presentation as mentioned above but a selected slide emphasized that without this new prescription drug program all the prices would be higher.
- IUBC report from the February 25th meeting in Helena
- The members received, reviewed and discussed the items (Financials, Medical rate increases, Wellness programs, Tobacco Cessation, URx, Disease management programs, Dependent Premium Waiver) in this report with some additional comments.
- Wellness--The colon kit will still be free for the spring WellCheck (March 30th & 31st in at the Bozeman campus) but there will be $10.00 envelope charge for members at future WellChecks.
- Wellness—Flu shots will be less since we are working directly with the manufacturer and student nurses will be initiating the shots.
- Medical Rates-- More retirees (depending on eligibility) may move into the Managed Care programs or MAPP ($140.00 per Medicare eligible) due to significant rate increases in Traditional medical plans. There could be more information provided to Retirees about MAPP so they become more aware of this program and can save some money because there is the possibility that the subsidy for this program may be discontinued. It was suggested that New West should send more information to eligible to retirees about MAPP.
- VEBA- There had been some discussion that 30 days notice of different options/categories was not adequate so it should be increased to 60 days.
- Next Meeting—April 1st Reviewed by Doug Young
February 25, 2010 in Helena, IUBC (Inter Units Benefits Committee) Meeting
- Projected loss for FY09-10 is $4.8MM
- A bar chart was presented which displayed projected losses for FY11 and FY12
- The premium prices for our health plan consist of: Claim costs + admin fees + adding money into reserves as needed. The high rise in claims costs will reduce our reserves below the established 300% level. Therefore some of the premium from each member will now be added to our reserve fund.
- The amount of money in the reserve fund is determined by our yearly medical expenses. As the yearly medical expenses increase then the reserve fund needs to increase.
- Comparison of medical and prescription drug claim costs between 2008 vs 2009 increased 10.1%
- Medical Rate increases---Actives
- Description 300% 293%
Administrative .8 .8
Contribution to reserve 6.8 5.8
Retiree Subsidy reduction .3 .3
Dependent Subsidy “ 3.4 3.4
Total 20.7% 19.7%
300% is the recommended reserve level but for FY10-11 we may only be able to achieve a 293% level.
- The employee is still kept ‘whole’ in each medical plan. The medical premiums in each plan for the employee are less than the contribution from the state which will be about $733 for FY10-11.
- Basic price will remain flat
- Premium will increase 3.2%
- The colon cancer kits were costing $20.00 each to the wellness program. An arrangement was made with the vendor to pay $10.00 for each kit and the other $10.00 after a kit has been submitted. It has been determined that only 5% of the kits were being returned. Therefore members will be charged $10.00 for the kits.
- Flu shots—lower price has been negotiated…from $17.50 to $10.75.
- There are several programs which will be available
- Metabolic syndrome
- Healthy Thinking
- Health/Wellness coach
- Well Awards Program for Fy10-11—Predicating 42% signing up with 80% completion
- Tobacco Cessation Program
- Will be offered beginning July 1, 2010 to those who are seriously interested in quitting
- In partnership with Montana Tobacco Quitline (QL) for one year—once a month discussion with a QL coach
- There are some expenses which will be waived
- MedImpact (new administrator and claims processor) will have a prescription drug website available for our members to utilize sometime after April 1. It will offer the following information:
- Designed for the individual with a history of the member’s prescription drug usage
- Drug search-name of drug, dosage, how dispersed (retail, mail order)
- Drug prices-member will pay the copay amount or listed price, whichever is less
- View lower cost equivalent drugs
- Starting April 1 Caremark is discontinuing its’ mailorder program with the MUS. Fortunately the new mailorder vendor within URx (MedVantx) is willing to help us and take over these prescriptions and services . All Caremark mail orders will be shipped from our new vendor—Medvantex located in S. D. Members using Ridgeway as there mail order sevice provider will see no change at all – will have no impact.
- Plan Exceptions (PE) form—Our members should obtain these forms from the URx website now, have them completed by their provider/doctor and submit them.
- URx Disease Management Programs (DM) offered by the Montana University System (MUS)
- Diabetes-take control…1-800-746-2970
- Tobacco Cessation….1-877-501-1722 (MUS Benefits staff)
- Biological Infertility….1-877-501-1722
- Weight Management….1-877-501-1722
- Dependant Premium Waiver
The new qualifying annualized salary of $30,000 is now in effect
- IUBC formal meeting
- Financials—A projected $4.8MM shortfall for this Fy10 will result in a reduction in our reserve fund. Therefore some of the member’s premium payment ($22.00) will be used to bring our reserve fund up to the required 300% recommended level.
- Director of Benefits (Paul Bogumill) requested that due to projected increased medical expenses in future years we start to consider items to fulfill those shortfalls, such items may/could be:
- Charge higher copays
- Continue to decrease the spouse/dependent subsidy
- Reinstate the annual fee for members in the FLEX program, which had been discontinued a few years ago
- Prior to the next IUBC meeting in the fall there will be two sub-committees (Plan Change and Administrative) whose members will review and discuss the 300% recommended reserve level.
Next IUBC meeting will be from September 30th to October 1st ( Thursday and Friday) in Butte. Reviewed and edited by Paul Bogumill
January 28, 2010 - IUBC (Inter Units Benefits Committee) Meeting, in Helena
- There was a cost explosion in second quarter 2009 after the medical premium rates had already been established and published. Significantly higher claims arrived near the end of our fiscal quarter compared to the first quarter: July-Sept 2008 average medical expenses were $508 per member vs April-June 2009 was $696. July-Sept 2009 was $543 which is about 7% higher than the previous year’s comparable quarter.
- The projected increase in expenses this fiscal year (FY09-10) compared to last fiscal year (FY08-09) will be at least 7% to 8%. FY11-12 is projected to have another 8% to 12% increase in medical expenses.
- For FY08-09 the plan purposely was driving towards a $2MM spend down on reserves (loss) but the actual loss was $3.93MM. For this FY09-10 there is a projected loss of $4MM.
- Approximately two months ago there was a projected loss of $6MM for FY10-11. Approximately $2.9MM of that loss would be covered due to our savings which would be achieved when our new prescription drug program is implemented in July 2010. The Plan Change Committee reviewed and initially approved changes in coinsurance maximums, deductibles, copays, Maximum out of pocket (MOOP), subsidy of spouse/dependents, retirees’ subsidy, and Wellness budget. See paragraph 2
- At this IUBC meeting the committee members were informed that the projected loss for FY10-11 has been increased another $2MM to $8MM. If current premium payments (coinsurance maximums, copays etc) stay the same then the projected loss for FY11-12 will be another $8MM and for FY12-13 will be an additional $9MM.
- The Montana legislature had approved an 8 ½% increase (to $679) for FY09-10 and 8% increase for FY10-11 in the contribution from the state towards the premium payment of the employee. The IUBC is not expecting any increase to contributions from the legislature for the next couple years after FY10-11.
- Plan Change-A spreadsheet listing all the proposed benefit changes was presented
- Items which were reviewed and considered but did not get out of the Plan Change
- Life Insurance: Consider additional options for spouse/dependent. It Is currently too complex to implement per the insurance companies.
- Spouse/dependent surcharge: There are other employers who are adding a surcharge for spouses. Due to the fact that our medical plan is significantly less costly to add spouses our employees are adding their spouses as opposed to having the spouse covered by his/her employer.
- Items which were approved to fill the initial projected $6MM shortfall
- Traditional Plan A & B: Increase coinsurance maximums--The out-of-pocket maximums have not been increased in 3 years. These amounts are being exceeded sooner and need to be raised. Currently about 8% of our members are exceeding these maximums. With these new increases there will be about 4% who will exceed these maximums.
- Increase the Maximum Out-of-Pocket (MOOP) for Out-of Network (ON) in Managed Care (MC)
- Increase Ambulance copay from $100 to $200
- Increase Emergency Room copay from $75 to $125 and Urgent copay from $25 to $50: Some employees are going to the emergency rooms for their primary care due to the low copay.
- Wellness Budget: Decrease budget by $250,000. This will not affect the continuation of the WellAwards program.
- Switch to URx Pharmacy Plan-Projected savings to the plan of $2.9MM and also savings for those employees, who identify, choose and utilize an equivalent clinical based alternative prescription drug.
- Increase deductibles by $25.00
- Decrease Spouse/dependent subsidy: The increase in premiums from member only to member plus spouse or dependent is only 18%. For every dollar in revenue received for spouse/dependent the medical plan is paying $3.50 towards the spouse/dependent medical expenses. Therefore the member only is subsidizing these spouses/dependents who are on the medical plan. The member plus spouse/dependent medical premiums were increased by approximately 4.5% for a total of 22.5%. It has been estimated that every 1% increase in the cost of the spouse/dependent premium is equivalent to a $6.00 per month increase in that premium. Every 1% increase in the family premium is equivalent to a $10.00 per month increase in that premium. Due to continued increases in future medical expenses it is expected that the spouse/dependent premium will continue to increase during the next several years.
- Decrease the retiree subsidy
- At the IUBC meeting the members were informed that the initial projected $6MM
shortfall has increased to an $8MM shortfall. Therefore additional benefit changes
- Increase deductibles by $50.00 instead of the initial proposed $25.00
- Increase MOOP for in-network and out-of-network in MC
- Increase the member plus spouse/dependent medical premium by 6% (instead of the original 4.5%), which will result in those premiums being about 24% more than the member only premium.
- Prescription drugs account for about 31% of our total medical expenses. If our new prescription drug program was not being implemented in July then our members would start to pay more for their drugs
- Phase I Communication plan
- Some University/college executives plan a brief introduction via email to all employees
- The Wellness newsletter (being mailed in mid February) will provide background information and specific steps for the member to begin implementing in July
- A podcast has been developed for viewing
- HR personnel will have training sessions on Feb. 10-11 so they may assist members
- A website is available
- URx presentations or video conference at various campuses and locations beginning
- Phone access—Ask-a-Pharmacist
- A letter will be sent to members who are taking those drugs which will be classified as D & F drugs. They will be informed of alternative drugs.
- Phase II communication plan—Look at the pills our members are taking to determine if these are the proper ones for our members conditions
- Phase III communication plan
- Obtain direct rebates from the manufacturers,
- Obtain bigger discounts for specialty drugs from the manufacturers
- Keep current with availability of new generic drugs
- The state of Montana has implemented the URx plan as of January 1, 2010. Results (so far……) were provided
- IUBC formal meeting
- Subcommittee reports-Appeals, retiree, Wellness, Administrative, Compliance, Plan Change
- The benefit changes as presented in paragraph #2 above were discussed and approved.
- Next IUBC meeting will be February 25 in Helena
Reviewed and edited by Paul BogumillJanuary 14, 2010, MSU Benefits Committee Meeting. Attendance-Doug Young (chairman), Jerry Coffey, Ken Hapner, Jo Oudshoorn, Susan Alt, Jim Mitchell, Lisa Crow, Barb Wheeler, Carol Shannon, Deborah Haynes, Shari Curtis, Kelsey Rozell, Ron Brekke
CHOICES: presented by Jo Oudshoorn
- The online re-enrollment schedule for 2010/2011 was presented. This will occur between April 12th and May 7th , which is the last day for re-enrollment.
- URx information session-Feb 26th-April 8th. Since we will be implementing some significant changes to our Prescription Drug Program these sessions will be very important, worthwhile and beneficial for involved individuals to attend. Our Human Resources department will be presenting the information at these sessions. There is also a podcast which will be made available. These presentations will present information on how to start purchasing lower priced but clinical equivalent prescription drugs. Meeting schedule is not yet fixed.
- Computer lab assistance-April 12th to May 7th.
- Other dates include-Vendor information sessions, Benefits Committee presentations, Office of the Commissioner of Higher Education presentations and Human Resources help sessions
- Some employees were not aware of these information & assistance sessions during last year’s re-enrollment days. Therefore these re-enrollment sessions will be disbursed through the following methods:
- Email—President Cruzado’s Monday Memo and emails from other groups.
- Wellness newsletter in mid February- A copy (with URx presentation dates) was disbursed and some comments were provided with suggested changes.
- Wellness Fair in March
- Possibly included within the CHOICES handbook
Economical/Financial learning sessions
- Most to the people attending these sessions have been classified. Staff Senate has been sending emails to the classified employees.
- There will be more effort made to notify Faculty and Professional Council employees
Plan Change: presented by Doug Young and Ron Brekke
- A spreadsheet, with many Savings Opportunities/Benefit Changes, was handed out for the committee members to review and discuss.
- These changes have been reviewed and discussed by the Plan Change Sub-Committee on two previous occasions. Some of the areas which were reviewed include: Coinsurance maximums, Maximum-out-of-pocket for managed care plans, Ambulance and Emergency copay, Switch to URx Pharmacy plan, increase deductible, spouse and dependent subsidy, Wellness budget, retiree subsidy.
- These proposed changes will be introduce, reviewed and discussed at the IUBC (Inter Units Benefits Committee) meeting in Helena on January 28th.
- There were three changes which were discussed at our local Benefits Committee meeting in early December. These were then presented and discussed during the Plan Change phone conference in mid December.
- Decrease spouse and dependent subsidy.
- Question; Should we decrease the dependent subsidy?
- Answer: The Dependent Premium Waiver helps to insure that children are covered with health insurance.
- Increase the deductible by $25 or $50.: The $25.00 deductible increase was approved by the Plan Change Sub-Committee
- Decrease Wellness budget
- Question: Would this decrease in budget eliminate the WellAwards Program? Should we decrease the Wellness Budget since the purpose of the Wellness Program is to help prevent future health problems and therefore help to lower medical expenses?
- Answer: The WellAwards Program will not be eliminated due to this budget decrease.
MAPP (Medicare Advantage Program)
Would it be possible for MSU retirees who are members of MAPP to participate in our Wellness Program benefits, such Wellness fairs? This request will be discussed between New West (who manages MAPP for our retirees) and our Montana University System (MUS) Benefits Committee.
- When employees sign up for CHOICES this year they will also be provided the opportunity to sign up for the WellAwards Program.
- Premiums: Approximately 80% of the medical premiums are provided by the Montana University System/Montana Legislature. The other 20% is paid by the employee.
- Medical costs of hospitals and doctors are starting to increase more than they have in previous years.
- As costs increase then the amount in our reserve account will probably need to increase which could then result in our premiums increasing.
- Delta Dental—There have been complaints that our members have not been able to get through to customer service.
- Several of our committee members will be attending the IUBC meeting in Helena on January 28th.
Reviewed by Doug Young
November 17, 2009, MUS Benefits Plan Change Committee Meeting
Attendance: Paul Bogumill, Kathy Crego, Mary Lachenbruch, Cindy Millard, Kevin McRae, Quint Nyman, Maggie Peterson, Janet Simon, Doug Young, Ron Brekke
- Background information
- Increase in contributions toward our medical plan provided by our employer (MUS-Montana University System) was 8.5% to $679 for 2009-2010) and will be 8% for 2010-2011.
- Our goal in managing the finances of our medical plan is to maintain a RBC (Risk Based Capital) reserve level of 300%. Due to better than expected plan performance with the implementation of various plan changes over the last couple years we have been able to build excessive money in the reserve fund, and thus we have purposely reduced these reserves by $2M for the past three years. Therefore:
- The overall medical premiums (paid by the employee) are only 1% higher than they were 3 years ago and
- We were able to do this without shifting costs to the employees such as deductibles, coinsurances etc which have not been raised over the past 3 years.
- However during the fourth quarter of our 2008-2009 fiscal year we incurred additional (unexpected) expenses of $1.9M, for a total loss of $3.93M – we had rated for a loss of $2M
- This cost explosion hit after we set rates for this year so it is expected that this year’s revenue will be $2.1 M short.
- And as this cost trend cariies out, it is projected that the next plan year will nedd an additional $1M above the state share increase to maintain the 300% RBC level.
- Due to recent cost explosion that started in the 4th quarter of last year we are projected to exceed revenue by approximately $ 5M.
- Also we must implement an inhance autism benefit manadated by the last Montana legislative session, this will cost the plan $775,000.
- We are also implementing a tobacco cessation program to coordinate with campuses tobacco free status, this will cost the plan $200,000.
- So in total we have a $6M hole to fill with plan reductions for next plan year
- The good news is the new prescription drug program will be rady to roll out 7/1/10 and it is calculated to save $3M. So that fills half the hole leaving us with a fairly doable exercise of saving the plan an additional $3M.
- Also, our medical plan has paid about $400,000 in medical bills for an individual’s accident which should have been classified as work-related and therefore covered by worker’s comp. Documents have been submitted so our medical plan can be reimbursed from worker’s comp. This has not yet been approved.
- Several suggestions and areas were considered to satisfy the remaining shortfall (approximately 3M) that is projected to occur.
- Rates for spouse/dependents
- Increase rates for dependents/spouse: The current rates for member & spouse (dependents) is only about 18% of what their true rates should be.. Subsidization-The member only is subsidizing the member and spouse (dependents).Therefore the member and spouse rates could be increased by an additional 2% to 5% without much harm.
- Or we could look to apply a surcharge for spouse/dependants who may have medical coverage elsewhere. This was not approved for further review/discussion.
- Raise premiums in Traditional plan
- Increase coinsurance maximums in Traditional Plans:
- Plan A—from $1,250/$2,500 to $2,250/$4,500
- Plan B—from $2,500/$5,000 to $3,500/$7,000
- Increase MOOP (Money out of pocket) for (MC) managed care plans IN & OON (in
network and out of network). A couple examples from several that were
- Managed Care Plan—Increase MOOP (IN & OON) $2,000/$4,000 to $2,500/$5,000
- Managed Care Plan—Increase MOOP (OON only) $2,000/$4,000 to $3,000/$6,000
- Increase ambulance copay from $100 to $200
- Increase Emergency Room copay from $75 to $150 and Urgent Care copay from $25 to $35
- Preliminary summary of proposed changes to satisfy the projected shortfall of $3M. These changes will be presented to the IUBC for review, discussion, any modifications and approval
- Plan A—increase coinsurance from $1,250/$2,500 to $2,250/$4,500 $833,018
- Plan B—increase coinsurance from $2,500/$5,000 to $3,500/$7,000 $117,055
- Managed Care Plan—Increase MOOP (OON only) $2,000/$4,000 to $3,000/$6,000 $46,079
- Subsidization of spouse/dependents—Increase 3% (from current 18% to 21%) $850,000
- Increase Emergency Room copay from $75 to $125 and Urgent Care copay from $25 to $50 $438,000
- Increase ambulance copay from $100 to $200 $69,000
- Retiree increase premiums--$2.00 per month $176,600
- Wellness program—reduce budget $250,000
- We are also getting further information regarding an increase to deductables that may be added to this package. The additional cost savings from thisdesign change is being put together by our actuary for final review.
Total Approximately $2,800,000
- Dental Plan—Several changes were submitted for the Premium Plan
- Orthodontic benefit is for adult/child with a $1,500 lifetime max covered at 50%. Consider increasing to a $2,000 lifetime max. This would increase the monthly premium by 1%.
- Annual Maximum is $1,500. Consider allowing D & P (Diagnostic & Preventative) waiver if the $1,500 annual max has been reached due to other procedures such as implants. Increase monthly premium by 1.7%. Less than 10% of the members exceed this $1,500 max each year.
- Due to other increase in premiums which will occur this year these proposed dental changes will not be implemented this year but will be reviewed for the following year.
- Life Insurance—Additional coverage for Spouse above the current max of $25,000
In order to provide more amounts to spouses it would be necessary to switch to an incremental plan allowing for employees to elect increments of $5,000 to a maximum of $150,000. This will require a major platform change within the present carries claims system and then an update to all our payroll systems to accomidate this change. This proposal will be considered again next year.
- URx—New Prescription Drug Program
- Our current prescription drug expenses are about 31% of our total medical costs. The plan is paying about $69,500 per day for prescription drugs.
- The URx presentations to the state employees have been well received. Some of the feedback from these presentations will be helpful when presented to MUS employees.
- The URx presentations and education for the employees of the MUS (Montana University System) will begin in February and/or March. There will be several opportunities to learn about the URx program—presentations, website, Wellness newsletter in January, Quick List (list of brand name drugs and their equivalent clinical based drugs).
Reviewed and edited by Paul BogumillOctober 8-9, 2009 IUBC Meeting notes as submited by Ron Brekke
- The overall premiums are only 1% higher than they were 3 years ago. We also were able to do this without shifting costs to the employees, as deductibles, coinsurances, etc have not been raised over the past 3 years.
- The legislature audits the Plans financial records and processess which include: money received (premiums)/ money spent (expenditures), check and balance procedures. There were no adverse findings discovered..
- The benefits plan had made a forecast to lose $1.9M this last benefit year. Once again our goal in managing this plan is to maintain a RBC level of 300%.Our plan had an excessive amount of money in reserves and needed to reduce that amount. The excess came from successful plan management programs that outperformed expectations.This has been the situation during the past three years—to reduce reserves by $2M each year. However the last quarter of this fiscal year experienced an unusual and unexpected increase in expenses, which resulted in a loss of $3.93M.
- An analysis was conducted to determine the reason for these extra unexpected expenditures. There could be two major reasons:
- Additional usage of benefits by our members (utilization cost—more visits by members) and/or
- A significant increase in the price of medical services. (An increase in cost per unit).
It was determined that the usage of benefits was not the reason but the medical expenses (cost per unit—cost per doctor visit, cost per procedure) were increasing. This increase was across the board and not specific to any one part of our plan.
- Our medical benefit plan is set up to have a ratio of 75%/25% (The plan pays 75% of medical expenses and the member pays 25%). The current ratio is 82%/18%.
- During the past few years these medical expenses have not increased significantly compared to many years ago, However, we are now starting to experience higher medical costs which are expected to continue for several more years. For example:
- From July 1, 2008 to September 30, 2008 the average cost per eligible member per month was $508.53.
- From April 1, 2009 to June 30, 2009 the average cost per eligible member per month was $696.37.
- Assets vs required reserves
- For fiscal year 2009 the reserves are projected to be 295%.Our goal is 300%.
- For fiscal year 2010 the reserves are projected to be 225%if we make no plan changes.
- For fiscal years 2011 and 2012 there is a possibility that the state legislature may not increase the p employer contribution dollars due to the recession. Therefore, agreesive plan changes (like URx) and/or increases to the member’s contribution will start to increase next year so we don’t have to implement a huge increase in fiscal 2012.
- Risk Migration analysis
- Average age dropped by .52 years which was due to retirees moving to MAPP
- Continuously enrolled members changed plans—13%
- Enrollment Risk Migration—Members moving from traditional plans to Managed Care (MC) plans.
- MAPP Medical Advantage Plan
- National health care reform will affect MAPP
- Approximately 30% of our MUS retirees are enrolled in MAPP. However, most of these people are healthy, with the less healthy members staying with our MUS plan. .
- The government subsidy for MAPP may be eliminated which will result in increased premiums for the retirees.
- A survey of retirees who attended MAPP seminars and the enrollment process indicated that a few items needed additional explanation—Rx and Dental plans and WellCheck fairs.
- Take Control--Diabetes Program
- There are some groups which incur a significant expense within our plan. On a volunteer basis members within these groups (Diabetes) can participate in:
- Education tailored to each participant’s needs—dietician assistance, exercise
- Group education
- Receive monthly newsletters
- The results of these focused groups;
- Increased wellness for the individuals
- Significant cost savings in medical and prescription drugs
- Less hospital visits
- Emergency room visits are less when comparing enrolled to no-enrolled members
- Defined Contribution Plan—the member is in control and decides which offered investments that he/she will choose
- There are currently 22 funds offered in the MUS TIAA-CREF program
- Our plan provider suggested seven other which could be considered for greater diversification. Four of these were chosen and approved.
- These included: High Yield Fund, Lifecycle 2045, Lifecycle 2050 and Retirement Fund
- The Lifecycle Funds have a fund manager who changes the investments in the fund as the group matures. For example: Lifecycle 2050 would be for younger members and therefore the investments would be 70% stocks/equities and 30% bonds. As the members mature and get closer to the year 2050 the investments would have 30% stocks/equities and 70% bonds.
- The new Retirement Fund is established for retirees and consists of Equities 40%/Bonds 60%
- Participant Services—Telephone and internet (www.tiaa-cref.org), web seminars
- Quality Care Choices
- In collaboration and partnership with local providers, the MUS employee benefit plan had been working to establish Quality Care Choices programs to help employees and their enrolled dependents living with certain serious diseases.
- Two of such programs are Infusion Therapy and Cancer Services
- Explanation of the Cancer Services program-comprehensive cancer care with multi-disciplinary teams of physicians, specially trained nurses, patient care navigators, social workers, dietitians and naturopathic physician to personalize the treatment.
- Prescription Drug Program (URx)
- The MUS benefit plan spends about $65,000 per day for prescription drugs
- The cost of Prescriptions drugs is about 28% of our total plan expenses.
- Problems with current system of PBM’s (Pharmacy Benefit Manager):
- For-profit companies that collect a fee for each drug claim processed
- PBM’s receives rebates from the pharmaceutical companies for purchasing certain drugs and then steering our members to those more expensive drugs
- The formulary (list of preferred drugs) created by the PBM consists of drugs promoted by the pharmaceutical companies
- URx will address these problems with our MUS and State of Montana Pharmacy and Therapeutics Committee (P&T) which will put us in control.
- Promote evidence-based formulary---the use of medications with the best clinical results…not necessarily those drugs most promoted by the drug companies.
- Improved plan management
- Achieve significant savings—Estimated annual savings would be about $3.5MM
- There will be a concentrated effort and focus on member education prior to and during implementation of this program—seminars, booklets, internet access and telephone assistance.
- URx will begin January 1, 2010 for State employees and July 1, 2010 for MUS employees.
- Wellness Power Point Presentation-- Overview of the WellAwards Program
- Program participation-9,657 were eligible, 3,040 participated = 32%; 2,143 earned $100.00
- Gender: 67% female and 33% male
- Several slides showed which activities participants selected and therefore were able to earn credits
- Many slides showed participants evaluations of the program by answering 11 questions
- What new activities did you to participate in?—Regular stretch, strength training and others. These charts showed number of participants.
- Which health improvements did you notice?—lower blood pressure, feel healthier, lost weight
- 73% of FY09 participants have re-enrolled in FY10. Enrollment for FY10 is 3,460
- Plan Changes--There were several proposed plan changes which will be discussed at the Plan Change Sub-Committee meeting. This meeting will be held in November. These include:
- Out-of-Pocket maximums for Traditional and Managed Care
- Copayment increase for three services—ambulance, emergency room, urgent care
- Life Insurance options
- Maximums on Dental
- Retiree subsidization
- Dependent/spouse subsidization
- IUBC Formal Meeting
- Financials: As explained at the beginning of our meeting….Due to the significant increase in the unit cost per service during the last quarter (April 1 to June 30 2009) of our fiscal year there will probably be a higher loss for 2009/2010 than originally budgeted. This increase in medical expenses will result in higher premiums for 2010/2011.
- Each of the sub committees provided a brief summary of their activities and meetings if they had met.
- Next IUBC meeting will be January 28th
Reviewed and edited by Paul BogumillSeptember 3, 2009 MSU Benefits Committee Meeting; Present: Mathre, Johnston, Haynes, Brekke, Curtis, Wheeler, Shannon, Hapner, Mitchell, Oudshoorn, Alt, Young
- Membership: Brekke has been reappointed. Doug will check if Tanner was reappointed, and then inform Office of Planning and Analysis: http://www.montana.edu/opa/coms/benefits.html
- The upcoming IUBC meeting Oct 8-9 and invitation for Bozeman people to attend was noted. Agenda will be forwarded when received.
- MSU Meeting schedule (revised):
- Oct 1: Room TBD
- Oct 29: SUB 232
- (Fall Wellcheck Nov 4-5)
- Dec 3: SUB 232
- Digital Mammography: Carol and Barb trying to document whether BZN charges are higher than other cities in Montana, via data review by Bernard at MAHCP. A related issue is call back rates (frequency) which fall under diagnostics – do these differ significantly among cities and are the fees similar? Perhaps the Plan change committee should reconsider commitment to pay for “max allowable” when no max is specified, or to specify a max.
- Shannon encountered significant delays in last six months in resolving issues which New West attributed to delays in MUS approving payments to providers. Other committee members did not know what was going on.
- Coupons to pay about half the cost of Nexium are available at purplepill.com, the Nexium website. Apparently, the active ingredient is different from prilosec otc, and some members continue to have problems with digestion or effectiveness of the cheaper products.
- Hapner reported on progress of URx. The program increases the onus on consumers to be smart shoppers, and education will be more important than ever. The MSU committee is awaiting the educational plans of IUBC and HR/PP. A quick check indicated that Nexium is Class F: pay the whole thing yourself and does not count toward max out of pocket.
- A recent conference in Bozeman sponsored by Baucus’ office focused on Promoting Wellness and Prevention in Rural Communities with a national perspective. Obesity due to a less active lifestyle was addressed, esp. among youth. Various companies, groups and government agencies presented their programs which were actively promoting wellness and improving health for their employees, members and residents.
- Hapner reviewed the August meeting of the Retiree task force. There are several issues with both the ORP and the 403(b) plans, including widening or narrowing the vendor lists as well as the funds offered by specific vendors. Defaults on loans from retirement accounts are in some cases alarming. A clear statement of MUS’s fiduciary responsibility is lacking. The MSU committee wonders if this is on the agenda for IUBC meeting and/or there are plans to move ahead on these issues during the coming year.
August 9-10, 2009 Submitted by Ron Brekke, Make Health Happen Promoting Wellness and Prevention In Rural Communities, Montana State University Campus
- Max Baucus, Senator
- Obesity is culture related,
- Montana residents are about in the middle of the ratings which is not good
- Lead by example-kids see parents/adults lack of exercise vs more active
- Larry Krystkowiak—Former professional basketball player, NBA head coach
- In the past the kids were more active with bicycling, basketball. Now they are involved with computer games, watching TV
- Getting kids off the couch is a challenge
- Start with yourself since the kids are looking at you as the example. Push yourself and your family to more physical activities--walking
- Kids gravitate to video games
- Use some creativity with your activities
- Reach out to the others and the community
- Take time for a community rally
- Instead of being in the middle of the pack Montana residents should be in the front with less obesity
- Sally Jewell—President and CEO of
- YMCA is wellness focused
- Data has been collected from 5 states-Montana, Washington, Alaska, Idaho, Wyoming. Child obesity has grown from 13% to 33%.
- Kids used to just play on their own with several activities but now it is organized teams which focus on just a few exercises
- Only 2% of the children continue with sports after leaving school while others become spectators
- Kids are being restricted from playing outside due to kidnappings, fear. ie Amber Alert
- We think of medications first instead of going outside or exercising
- Technology is the competing for children’s attention vs outdoor active
- REI has local programs/classes to get people outdoors and active. A video-Kids Passport to Adventure
- Wellness/Employer creates an environment of health from high school to senior citizens
- Obtain a general health profile which displays which areas which are most expensive for the company insurance plan
- Create culture of wellness-at home from parents to kids, employer to employee
- Dr. Lisa Lavizzo-Mourey, President and CEO of Robert Wood Johnson Foundation
- Halt child obesity by 2015—less soda at school, remove candy machines, consume 100 calories less per day, put PE back into class
- Physically fit students learn better and are less disruptive
- BMI- Body Mass Index, nurses at schools inform parents if a student’s BMI is too high
- A commission was started 18 months ago which asked…What can be
accomplished to help individuals become healthier
- Begin health awareness early in life
- Ban junk foods from school
- 30 minutes per day of activities
- Families and therefore children eat healthy foods
- Health professionals educate families
- Educators become involved
- Senator Tester
- Provide healthy food
- Obesity increasing due to decline in child activities
- Healthy body = Healthy mind
- YMCA-Neil Nicoll, President and CEO of YMCA of the USA
- Helping to create healthy communities with activities and classes outside their building into the community. Support healthy lifestyle on an individual basis
- Healthier Community Initiative-focuses on healthy eating and activities focusing on child obesity, a 12 week course
- Goal--reduce chronic disease such as diabetes
- Children in rural areas are more likely to be obese
- Health Seekers—people wanting to be healthy but don’t become active
- Getting families outdoors—trails
- Collaboration—partner with schools, hospitals, county agencies
- Greater focus on prevention
- Panel on Rural Health Initiative RHI
- Obesity most serious health problem in children
- Success stories-5th grade gave power point presentation to 4th graders, More kids in the woods on snowshoes,
- Physical center was available 24/7—members had key to enter, there were cameras. Restaurants offered a free one-day pass for children to the physical center if they would choose a salad. Trails were built.
- Shape Up Montana: Team based program with activities being converted to miles. Focus on participation and being active.
- Workshop: Investing in Wellness—There were several panelists
- City of Boise
- Downtown market on Saturdays-locally grown food sold
- Active transportation-walking, bicycle
- Branch libraries in strip malls- people would bicycle, health centers would set up near the libraries,
- A Family Foundation based in Washington serving a 5-state region
- Focuses on science, arts, needs of vulnerable population, well being of community
- Applicants must meet selected criteria and have measurable impact
- Lanesboro Root River Trail MN
- Promotes bicycling, boating, trails for visitors
- The city has theatres, art center
- 67% of US adults are overweight
- 60% don’t exercise
- 67% have at least one chronic disease
- Viable health plans offered by employer because there is a captive audience at the workplace
- Corporations may not believe that wellness programs will change the behavior of employees but the programs benefit with Physical, Emotional and Social health.
- Some employees believe that if they get ill then their benefit plan will just ‘repair’ them so they can return to normal health.
- Prevention is achievable when utilizing attention-getting promotions. Remember the following: Don’t litter—teary-eyed Native American and fire control-Smokey the Bear
- Works with partners to build healthy communities
- Obesity Prevention Program, Fresh Food Financing, trails
- City of Boise
- Workshop: Lowering Health Care Costs—There were several panelists
- Paychex Inc.—provides payroll services
- Promotes blood drives with a local ‘champion’, results are sent to wellness coordinator or doctor
- Wellness coaches
- Catch potential illness early which reduces expenses
- Educate employees on resources which are available
- Earn points by completing certain activities
- Reynolds Charitable Trust
- Health Care Division-assistance for low-income people
- Used to focus on treatment but now giving attention to prevention
- Able to measure the outcome of the prevention programs
- Focus on the big three—Physical activity, Nutrition, Tobacco usage
- Positive lessons learned from these Programs
- Competition between/within schools
- Use of non-traditional providers—churches, parks
- Target children and older adults
- Leadership—get a local leader involved
- Negative lessons learned from these programs
- Doctors don’t have time to educate their patients
- Hard to measure results
- Sustainability of programs
- Leadership lacking if leader leaves
- Items to consider and implement
- Local leadership
- Education must be continuous
- Integrate community-doctors, churches, schools, public
- Take Care Health Systems—Walgreens
- On-site clinics at their stores
- Early intervention is important
- Managing risk through wellness coaching—blood pressure, hypertension
- Small business-several co-op together
- Convenient Care Clinics—vaccinations, ear ache, back-to-school physicals, minor injuries
- Worksite-based medical centers
- Target Corporation
- Have young employees so maternity cost is the highest expense in their plan
- Develop culture of health—health coaches
- Alliances with other companies
- Has a website with health evaluation
- Live Well Challenge—watch 3 videos per week (health, nutrition, fitness), 12 week program, earn challenge points with competition between stores
- Microsoft Corp
- Average age is 38.6 with maternity cost consisting of the largest percentage in their plan
- On-site health screen, flu, 24-hour health line
- Mobile medicine visit---house calls, co-op with other organizations
- Education Program-Live Life Well
- Focus on: Be Aware Be Active Eat Well Stay Tobacco Free Take Care
- Has a website
- Paychex Inc.—provides payroll services
- Indian Health Board
- Obesity--$1.00 spent == $5.00 saved
- Behavioral modification
- Prevention—responsibility of individual
- Diabetes-Not present 60 years ago
- Value of partnership
May 14, 2009 Attendance-Don Mathre (presiding chairman), Jerry Coffey, Ken Hapner, Lisa Crow, Bob Johnston, Barb Wheeler, Carol Shannon, Deborah Haynes, Shari Curtis, Ron Brekke
- CHOICES Re-enrollment: Lisa reported that there has been significant increase with retirees enrolling in the MAPP insurance plan. They feel comfortable that it is possible to switch back to the MUS retiree plan if they are not satisfied with MAPP.
- URx-Ken Hapner (member of the P & T committee) provided a status report on
the progress of the Prescription Drug Program which will be implemented by the State
of Montana in January and MUS on July 1, 2010.
- There is currently about $4,000,000 per month being spent on prescription drugs.
- The P & T (Pharmacy and Therapeutic ) Committee is composed of 3 doctors, 3 pharmacists and
- individuals from the State of Montana and MUS system. This committee has been reviewing the formulary list which is a detailed report, clinical efficiency and explanation of benefits of each prescription drug. There has been a significant amount of information presented to and reviewed by the P & T committee.
- Each prescription drug is placed in 1 of 5 tiers after reviewing the formulary:
- A--Zero co-pay (member pays no cost)
- B--$15.00 co-pay
- C--$50.00 co-pay
- Dâ€”50% co-insurance
- Fâ€”100% co-insurance (member pays 100% for the cost of these drugs placed in this tier)
- Mail order will still be available.
- There will be no deductible requirement to fulfill for the co-pay tiers.
- Ken indicated that it is important to inform and educate the MUS employees regarding this new prescription drug program. The State of Montana will be establishing several educational seminars explaining this new prescription drug program to the state employees before their implementation date of January 1, 2010. It was suggested that the MUS could start informing and educating their employees at this fall's Well-Check health fairs.
- There will be several more meetings by the P & T committee during the summer. They will continue to place the drugs in the five tiers and discuss other issues such as: * splitting pills, * drug stores in rural areas * cost of over-the-counter (OTC) drugs vs drugs in Tier A which are $0 co-pay.
- Ken will decide when it will be appropriate to have another benefits committee meeting during the summer to keep us informed.
- Wellness Award results Approximately 3,000 MUS employees signed up for the Wellness Award Program. 2,200 earned 15 credits or more and will receive $100.00. These checks will be mailed within next few days.
- Loss of Dependent Premium Waiver---An individual lost their Dependent Premium
Waiver for health insurance due to a raise he/she received. This fact surfaced
because the CHOICES re-enrollment software did not allow this person to apply the
- It was noted that when an employee receives a pay-raise ( in October) which results in their annualized wages exceeding the established threshold (currently $28,314) they will still remain eligible to receive the dependent premium waiver for the remainder of the benefit year....another 7 months.
- It was suggested that individuals who will receive a raise which will disqualify them from the Dependent Premium Waiver benefit be notified in advance at the time they receive the raise, so they won't be surprised and have the 7 months to prepare.
- Items to review at future meetings
- The progress of our URx program
- The progress of MAPP
- Reviewed by Don Mathre and Ken Hapner
April 16, 2009 Attendance-Don Mathre (presiding chairman), Susan Alt, Jerry Coffey, Lisa Crow, Bob Johnston, Jo Oudshoorn, Barb Wheeler, Carol Shannon, Kathryn Tanner, Carol Shannon, Shari Curtis, Ron Brekke
- Re-enrollment for the 2009/2010 CHOICES
- The MSU Benefits Committee (Don Mathre) will give presentations on April 17th at 10:00 and 11:30AM at the SUB in Ballroom D. HR personnel will also be present to answer any questions.
- When choosing a Managed Care Plan each employee should review the list of providers, to insure that their preferred physicians are listed in that network.
- It was recommended that interested employees review Paul Bogumill's Podcast explaining the MUS Employee Benefits Plan. www.montana.edu/CHOICES.
- Blue Cross Blue Shield (BCBS): It was noted that even though a provider may have a BCBS sign in their office they may not be a provider in the MUS Benefits Plan. It is necessary to check that a specific provider is included in BCBS for our MUS Benefit Plan at www.montana.edu/CHOICES Group Plans-BCBS Providers.
- IUBC-Benefit Reps Benefit Reps from various campuses met in Helena to receive training related to re-enrollment for 2009/2010 CHOICES.
- MAPP (Medicare Advantage Pilot Program) This program is being reviewed by the Federal Government. There is a possibility that the subsidized portion of this program may be eliminated or reduced.
- Dependent Life Insurance There was a question from an employee regarding the $25,000 limit on Dependent Life Insurance vs the $300,000 Supplemental Life Insurance available to employees. Is it possible for our benefits plan to offer the same levels of insurance ($25,000 to $300,000) for a dependent (spouse) as is offered for the employee?
- Discussion included: The current Supplemental Life Insurance for employees
depends on their age as of July 1 and the amount of coverage selected. The optional
dependent life insurance is not age-based.
- If the proposed increase in coverage is not age-based then what could be the increase in coverage and premium? This might be possible.
- If the proposed increase in coverage is age-based then this could be more challenging to implement. After the some discussion it was decided that our benefits committee will recommend that the IUBC plan change committee review the possibility of adding this option to our benefits package.
- Reviewed and edited by Don Mathre
March 5, 2009 Attendance-Don Mathre (presiding chairman), Susan Alt, Jerry Coffey, Lisa Crow, Jim Mitchell, Deborah Haynes, Bob Johnston, Jo Oudshoorn, Barb Wheeler, Carol Shannon, Kathryn Tanner, Ron Brekke
The following items which were presented at the IUBC (Inter-Unit Benefits Committee) in Helena on February 26th were discussed at the campus Benefits Committee meeting on March 5th, 2009.
- ProtoCall Specialty Drug Program
- The Director of Benefits (Paul Bogumill) will be reviewing several high cost drugs. He will be analyzing and comparing the effectiveness of these specialty drugs vs. other similar (just as beneficial), but lower priced drugs.
- He is currently reviewing all claims which exceed $5,000 per month.
- MAPP (Medicare Advantage Pilot Program)
- The initial program was initiated on two campuses for benefit year 2008-2009. For the 2009-2010 benefit year MAPP will be expanded to include all campuses and will be offered to all MUS Medicare qualified retirees. A letter of introduction and Medical Plan Highlights from Susan Schmitt has been mailed to those retirees.
- The cost will be $140.00 per covered member per month for qualified Medicare members of the MUS benefits plan.
- There will be several meetings beginning in April which will explain MAPP in more detail to those retirees.
- Barb Wheeler (Bozeman Wellness Director) mentioned that those retirees who choose the MAPP insurance program will not be eligible to participate in the MUS Wellness Program or attend the Wellness Checks. However, they are eligible to participate in the Medicare Prevention Program.
- Wellness Budget
- The Wellness Committee had budgeted a 70% participation in the WellAwards Program but had only 30% participation. Therefore, these (one-time) extra funds will be distributed to the Wellness departments on each campus. Utilization of these funds for wellness and preventative measures will be determined by the Wellness Committee.
- A question from Staff Senate regarding the possibility of allocating some money to help pay for gym membership or related classes was presented. This was answered by Barb Wheeler: When members of our benefits plan sign up for the WellAwards Program and earn 15 credits they will receive $100. This money can pay for about half a year's campus gym membership.
- Benefit Plan premium and rates
- The employer contribution will increase 8.5% ($53.00), from $626 to $679 per month.
- The average rate increase for medical premiums will increase 6.2% for actives and 6% for retirees.
- One of the purposes of the MUS benefit plan is to guide and educate the members towards the most cost effective and best coverage for them and their families. This is the reason several plan options are offered. When reviewing each plan a member should not just consider the (lower) cost, but also the providers which are in the plan.
- Optional Supplemental Life Insurance
- Available life insurance increases from a maximum of $200,000 to a max of $300,000.
- For this year only--employees may choose to increase by $100,000 (instead of $25,000) without medical underwriting, but only employees who have not been previously denied are eligible,
- Dental-Premium Plan
- Several additional benefits were added to the Premium option:
- Coverage for occlusal guards (night guards). Subject to $1500 benefit annual max
- Coverage for nonsurgical treatment of TMJ. Subject to $1500 benefit year max
- Coverage for implants will now be subject to the $1,500 benefit year maximum and no longer be a separate lifetime maximum.
- Members with periodontal disease may request authorization for up to 4 cleanings per year, instead of 2.
- The premium rate increased due to these additional benefits and other dental related expenses.
- Several additional benefits were added to the Premium option:
- WellBaby (Previously StarBaby)
- Wellness will now be responsible for this program. A part-time individual has been hired to be actively involved with providing information, overseeing and managing the WellBaby program.
- This program has had only about 25% participation but will now have more attention to promoting and monitoring it.
- LTC (Long Term Care)
- This is coverage that should be considered by all members of all ages----not just the more senior and retirees.
- A unique one-time opportunity is available for MUS employees to enroll in LTC, if those employees have not previously been denied. More information is available at the campus meetings or at http://mus.edu/choices.
- Miscellaneous Items
- Campus presentations for the 2009-2010 Choices/Medical Plan will be on April 17th and April 22nd. Online Re-enrollment computer Lab Assistance will begin April 20th. A flyer will be distributed with specific days and times.
- It was strongly suggested that if members have their SSN on their medical ID cards then they should get it changed to a different number. Forms are available at HR.
- Next meeting will be April 16th.
- Reviewed and edited by Don Mathre.
February 12, 2009 Attendance-Don Mathre, Susan Alt, Jerry Coffey, Lisa Crow, Sharon Curtis, Ken Hapner, Deborah Haynes, Bob Johnston, Bob McKenzie, Jo Oudshoorn, Barb Wheeler, Ron Brekke
- Prescription Drug Program-EBF (Evidence Based Formulary)
- An interview of the two EBF (Evidence Based Formulary) finalists was conducted in Helena on January 29th. Four individuals from MSU attended-Jo Oudshoorn, Susan Alt, Barb Wheeler, Ron Brekke
- Notes from the meeting were presented and discussed
- Introduction-The members will have the opportunity to move from brand name drugs to generic. This flexibility will drive the utilization of drugs that are more effective (Evidence Based) and if drugs of the same class are equally effective, then to the more cost effective medication.
- Interview of first EBF company: They have been providing EBF services for about one year and have one client. They have one clinical pharmacist who would be responsible for formulary management and developing the monographs. Several handouts were presented.
- Interview of second EBF company: They have been providing EBF services for about six years and have at least 6 clients. They have 60 clinical consultant pharmacists with 25 of them fulltime. Several people prepare and review the documents (monographs) before they are disseminated to the client. A thick notebook was presented to each attendee.
- Montana University System (MUS) Benefit changes for July 1, 2009. These
changes will be reviewed and discussed at the IUBC meeting on February 26th in
Helena. They were listed on the notes of the Benefits Committee meeting for
December 12, 2008. More details on the MUS Benefit changes for 2009-10 Plan Year
will be forthcoming at the Campus Benefits Representatives meetings. Lisa Crow
has emailed the re-enrollment presentation and computer lab assistance dates to
Benefit Committee members.
- Optional supplemental Life Insurance
- Dental Plan changes
- WellBaby (currently it's StarBaby)
- Long Term Care (LTC)
- MAPP (Medicare Advantage Pilot Program)
- Ken Hapner attended the Retiree Subcommittee meeting on Feb. 6th in Helena.
He presented the following information.
- MAPP will be offered to all Medicare qualified MUS retirees on a voluntary basis for 2009-10 year. Approximately 1,500 qualify for MAPP and will receive mailings.
- MAPP does not address retirees under 65.
- The MAPP premium is $140 per covered member per month plus Medicare Part B premium of $96.40, equaling $236.40 pmpm.
- MUS retirees will have the option of adding the "Choices" Premium Dental and/or Vision coverage.
- An in-network out-of-pocket max of $2,500 per covered member, inclusive of co-pays and coinsurance has been added to the (New West) MAPP product ( at some increase In premium).
- Some providers are not taking Medicare patients, but this has not become a major problem, according to New West.
- Goals: The goals of the MAPP project have not changed. They include---reduction in premium, reduction in GASB liability and reduction in degree of active member subsidy of retired member.
- Update on the retiree survey letter
- The letter, with 10 questions, has been mailed to 30 retirees who were in the MUS plan but have opted out.
- 19 survey letters have been returned. We now have 22 returns and they are being examined.
- Notes prepared by Ken & Ron and reviewed by Don.
January 15, 2009 Present: Young, Coffey, Curtis, Tanner, Wheeler, Brekke, Hapner, Shannon, Oudshoorn, and McKenzie
- The proposed survey of retirees who drop MUS insurance was discussed.
- The committee thinks the information to be gathered would be useful, especially with regard to whether affordability is an issue.
- There should be two survey letters/forms, since the Medicare questions are not relevant for those < 65 years of age.
- There is concern that the survey would be viewed as "alarming" by anyone who has not in fact dropped MUS coverage. They may believe that they are being dropped.
- A telephone survey has advantages: a knowledgeable interviewer could reassure people, and better response rate than mail.
- A telephone survey would be more expensive partly because trained interviewers would be required.
- Are the people who drop those who utilize MUS insurance less? MAHCP could calculate costs (to MUS) for those who drop in comparison with other retirees.
- Doug will rewrite the draft survey
- The committee looks forward to seeing Bernard's count of retirees who left MUS insurance in the last 18 months.
- Ken Hapner, together with Don Mathre, will follow up on this issue.
- Other aspects of retiree insurance were discussed.
- Retiree premiums are less than the costs of the services provided.
- GASB pressure is to raise those premiums.
- How MUS treats its retirees is part of the package of benefits that affect an employer's reputation as a good (or bad) place to work.
- The Medicare Advantage Plan pilot will be offered next year to all Medicare-eligible MUS retirees. The MAP reduces GASB pressure on MUS and provides lower cost coverage to retirees.
- There is great uncertainty about the long run viability of MAP plans because of the potential for changes in Federal policy.
- Ken discussed a spreadsheet under construction to systematically (and, hopefully, intelligibly) compare the different options for retirees. Considerable education will be necessary in the next few years. The committee supports the idea of a separate retiree enrollment meeting, off campus.
- Barb discussed the MAHCP tabulation of costs for digital v. standard mammograms
in various locations in Montana. The results are dramatic.
- Perhaps MUS can use the results to negotiate with Bozeman providers.
- Perhaps similar comparisons can be done for other procedure codes.
- Digital mamos find more "suspicious" results, which further increases costs for both patient and MUS as additional diagnostic views are commonly called for.
- What are committees of the medical profession recommending? Bob McKenzie will look at the current literature.
- Ron Brekke and others provided an update on URx.
- Contract negotiations are underway with two PBAs.
- Drug pricing does not appear to be lower. How rebates fit in was not completely clear.
- Several members of the committee will attend the Jan 29 meeting re: formulary.
- The committee continues to be concerned about how our drug pricing schemes affect
incentives for use of cheaper or more expensive drugs, particularly with regard to
over the counter alternatives.
- The PPI saga was reviewed. It would be interesting to know what has in fact happened to PPI costs to the plan since the changes 7/09.
- Some members have responded with reduced dosage.
- The next meeting of MSU Benefits is not yet scheduled.
Inter Units Benefit Committee (IUBC) December 04, 2008 IUBC Workshop meeting with discussion. questions, explanations
- Financials for Quarter ending September 30, 2008
- Based on data through September 2008 the plan is expected to lose approximately $1.87 million over the plan year. Our goal, with rate setting this last year is to lose $2 million. This planned loss of $2 million reflects the reduction in reserves necessary to reach our desired Risk-Based Capital (RBC) goal of 300%. Presently our RBC is closer to 400%.
- A brief comparison of Medical, Rx and Dental monthly Per-capita claims cost
shows the annualized changes--- either increases or decreases
Sep 08 Sep 07 vs Sep 07 vs Sep 06 Medical +3.0% +5.1% Rx +4.1% +10.0% Dental -9.9% +13.4%Dental--The most recent (3-month) claims costs compared to rates have a 10% to 15% deficit. Therefore, if this continues then it will be necessary to raise rates in the dental plan. There are some changes which will require an increase in dental rates for the premium plan.
- There were several more detailed charts available which presented total annual
and average monthly income & expenses per eligible going back to October 2005.
The following categories were included in these charts:
- Separate and Combined Medical and Dental plans
- Traditional Plans
- Managed Care plans
- Actives and Retirees
- Audits: The state legislature requires an audit of the University Employees
Benefit Plan administrators every two years. These audits review claims (35 to 200)
from each of our plan providers and include such areas as coding, eligibility,
underpayment and overpayment errors.
- Some of the providers had errors of 1% to 2%, which is acceptable.
- Two of the providers had no errors, while another provider had a high of 6% errors.
- Plan Changes: There were several medical and dental changes introduced and
- Life insurance/Accidental Death and dismemberment (Life/AD&D)
- Long Term Care
- Dental-implants, TMJ, guards
- Med-ex Travel These were then approved during our formal business meeting. See Item 'II G' for more details
- Monitor and aggressively review the expenses: The Director of Benefits (Paul
Bogumill) will continue to review and focus on certain medical expenses which appear
to be excessive. These reviews will begin on January 1, 2009 and include the
- In the prescription drug programâ€”any 30-day claim over $5,000
- In the Traditional Planâ€”any line item over $5,000
- Proposed Change in the Prescription Drug Program: This will be presented in
another report since there will be two separate meetings on December 8th and 12th.
These meetings will discuss in detail the proposed changes in our Prescription Drug
Program. There has been an extensive amount of research, review, data-gathering and
analysis devoted to implementing these proposed changes. A brief explanation of our
- Having more control of pharmacy benefits and incentives,
- Implementing Evidence Based Formularyâ€”Choosing prescription drugs based on their benefits,
- Reducing expensesâ€”ie. Administration fees,
- Retiree Optional 403(b) plan
- New federal regulations required some changes in the MUS 403(b) plan by January 1, 2009.
- Four of the five vendors to the MUS 403(b) plan agreed to the changes. This enabled MUS to be in compliance with these new regulations. The employees who were making contributions to that vendor who did not respond had to establish their 403(b) account with one of the four approved vendors. Letters were sent to these retirees in November.
- Communication strategies
- The annual Benefits 'road show' which traveled to campuses explaining the health benefits for the upcoming year will be active again this year. Due to some personnel changes this live presentation was canceled last year. However, a power point presentation and a pod cast presentation by Paul was available on the Wellness website.
- Newsletter: The Wellness and the Benefit newsletters will be combined into one newsletter. An added feature will list answers to frequently asked questionsâ€”FAQ.
- Formal IUBC Meeting---Sub-Committee reports, Motions, Voting
- Director's Report-Based upon the guidelines set by the Legislature we are spending down our excessive reserves so there will be 300% of our annual expenses in that fund. Therefore we anticipate approximately a $2,000,000 loss for the 2008-2009 benefit program.
- Administration committee-
- It is proposed that updates of RFP's, financial and committee reports will be provided on a more regular basis
- DPW (Dependent Premium Waiver)â€”Eligibility and data from 2 years will be brought forward to the Board of Regents
- Retiree Committee-
- MAP (Medical Advantage Program) will continue for an additional year and we will try to include more retirees in this benefit program. It was expected that the riskier retirees would enroll in MAP. However, the current enrollment results have indicated that the healthier retirees have moved into MAP.
- A significant number of our retirees are opting out of our retiree benefits program. There is some data being gathered as to why this may be occurring.
- Compliance Committee-Federal rules and regulations were reviewed and found to be in compliance.
- Appeals Committee-No meeting/report
- Plan Change Committee-Several motions were brought before the IUBC for
discussion. Then a vote of approval or disapproval was offered. All motions were
approved and are listed below.
- Dental-The changes listed below were approved for the benefit year beginning
July 1, 2009
- Non-surgical TMJ (temperomandibular joint disease) will be included in the Premium Plan
- Occlusal Guards will be included in the Premium Plan
- The current dental plan has a $1,500 maximum lifetime benefit for implant expenses. Those implant expenses will be included in the $1,500 maximum annual benefit.
- Due to the above additional benefits there will be an increase in the Premium rates from $36.00 to an estimated $43.00 per month.
- Life Insurance/Accidental Death & Dismemberment (Life/AD&D)
- These rates will remain constant for two years
- The insurance company (Standard Insurance Company) has offered to increase the supplemental life insurance benefits from $200,000 to $300,000. This has been approved by IUBC. Those individuals presently covered have the option of increasing their benefits by an additional $100,000. Those individuals who are not covered but want to be included have the option of purchasing up to $100,000 coverage, unless they have been previously denied.
- Long Term Care (LTC)
- After reviewing information from several insurance companies it has been decided to stay with our current provider---UNUM.
- It has been approved to accept their offer of keeping the rates constant for the next five years.
- We will have a Guaranteed Issue period for this upcoming open enrollment period.
- The MUS benefit program will pay the $1.25 monthly charge for any employee who stays overseas for more than 90 days. This benefit will begin January 1, 2009.
- A form (Extended Coverage for Foreign Travel) needs to be submitted to the Benefits Department in Helena.
- Future IUBC meeting
- The next meeting for IUBC will be on February 26th (Thursday) starting at 9AM in Helena.
- Some of the items to be discussed include: FLEX RFP, Progress of Urx, MAP, Wellness Budget, Actual rates for the 2009-2010 plan year.
- Dental-The changes listed below were approved for the benefit year beginning July 1, 2009
November 13, 2008 (notes from Doug Young, Chair) - Attending: Young, Coffey, Johnston, Brekke, Haynes, Wheeler, Alt, Mathre, Crow, Curtis
- Notes from October were reviewed and revised.
- Shannon's email on pharmacy costs was reviewed. Pharmacare and Ridgeway both report that they charge individuals the retail price when it is less than the MSU maximum. For example, 90 days of Levoxyl costs $17.61, which is less than the MSU max charge of $20, so individuals will be charged $17.61. Question: Is the MUS plan charged $20 by Pharmacare or Ridgeway, or $17.61? Probably the amounts of money are small.
- Brekke reviewed the agenda for the plan change committee meeting Nov 17 in
- Committee suggested that Plan A is becoming more like a Managed Care Plan, ie with an increasingly restrictive network. Is this desirable? We already have several managed care plans, and Plan A is supposed to be a "traditional" alternative. If it is to be "managed care," then it should be priced accordingly.
- Committee members also had some specific comments/questions. Apparently, doctors affiliated with Billings Clinic are no longer in network this year, and the change was not well communicated to our members. People are complaining, as doctor bills are going toward the out of network deductible. (Gee, it does sound like managed care ...) Also, what is the status of the Livingston hospital, which is owned by Billings Clinic?
- Wheeler discussed last week's Wellcheck. >1,000 flu shots and did not run out, 800 blood draws up from 700, lots of bone density, BMI. People appear to be responding to incentives in Well Awards. Also, scheduling of blood draws is very attractive for those who think their time is valuable.
- The committee discussed URx.
- Several members expressed concern about the competence of U Montana in determining the formulary, because academics often have specialized rather than wide-ranging knowledge and sometimes lack a business perspective. Could we buy the formulary from U Michigan, or some other source?
- Can our new formulary incorporate information about generic equivalents, and their prices at WalMart and other low cost outlets, so members are automatically directed to these sources? This would reduce costs for both individuals and the plan.
- Barb Wheeler, Ron Brekke, and Don Mathre are planning to participate in the initial review of RFP(s) in early December. Note: Email received after meeting shifts RFP review dates to Dec 8 and 12.
- MSU Benefits will meet again Th Dec 11 in 232 SUB (old 272).
From Staff Senate Minutes, 10/22/08 Carol Shannon reported that MSU's is the most active benefits committee within the MUS, and how involved it is in benefits administration. Some issues under discussion at the last meeting include
- Situations have arisen where recipients of donated sick leave have left MSU before using all their hours, rendering the balance "lost". A suggestion is being made that donors "pledge" initially, not relinquishing hours until the recipient is ready to use them;
- some drugs cost less than the mail-in pharmacy flat rates. Employees have the option of filling prescriptions without going through insurance so as not to pay more than is necessary;
- financial report - drug costs have increased; medical costs decreased; expenditure is 5% less than revenue. Enrollment in managed care is up. Steerage in the traditional plan has been effective and discounts applied;
- various retiree issues;
- Wellcheck is November 6 and 7; Well Awards enrollment is now closed. Ron Brekke followed up on a question from last month's Staff Senate meeting: the Well Awards program would prefer that employees have blood drawn (for Well Awards credit) through Wellness rather than counting tests they've had for other purposes. This is because blood tests, e.g. prior to surgery, may focus on specific problems rather than general health.
From Staff Senate Minutes, 9/24/08 - Ron Brekke reported that the Well Award sign up (for the possibility of receiving $100 for wellness activity) closes September 30th. Ron will follow up on Staff Senate's concerns, today, that health-oriented activities as described by Well Award but not conducted through the Wellness Program, don't qualify for credit towards the $100. Deb Harrison was asked about Wellness participation for remote staff, and she confirmed that the program provides Well Check events etc at remote locations.
Ron reported on the $1500 dental maximum, which some staff members had raised as being adequate. Ron had consulted the chair of MSU's benefits committee as well as the director of benefits for the Office of the Commissioner of Higher Education. No plans currently exist to alter the benefit for reasons including: any increase in coverage must be funded by increased premiums. Only 4% of people covered by the MUS dental plan exceeded or hit the $1500 maximum last year. There is currently no deductible applied to the MUS dental insurance policy. Ron said that the Benefits Department would be happy to present further information to Staff Senate/MSU (it was mentioned at today's Senate meeting, that Faculty Senate are looking into arranging something like this).
Ron also mentioned that IUBC meets October 2-3.
September 4, 2008
Attending: Young, Johnston, Brekke, Crow, Shannon, Coffey, Haynes, Wheeler, Hapner, Alt, Spinelli, McKenzie, Mathre
- Sherry Todd is leaving MSU and a replacement is needed. Doug will contact Sara France. Fall schedule was reviewed (see last item below).
- Ken Hapner reviewed WalMart's drug program, which offers certain drugs for $4 for 30 days and $10 for 90 days. A doctor's prescription is required, even for non-prescription drugs. Prescription dosages may differ from WalMart offer, eg doctor says 20 mg and WalMart offers 10 mg. Avenues for informing our members (on this and other drug pricing issues) were discussed. Jerry Coffey will bring in a Consumer Reports article on buying drugs.
- Barb Wheeler discussed the Well Awards program for active employees and their spouses. The most important thing for people to do at this time is to register at www.montana.edu/wellness. with a deadline of Sept. 30th. WellAwards allows participants to receive $100 by earning 15 credits for participating in health-related activities between May 1, 2008 and April 30, 2009.
- The first, new combined Wellness/Choices newsletter is at the printer and will be mailed home. It will be printed 4 times per year. Topics will be determined by questions from the members. Members expressed continuing concern at the loss of Choices.
- Several additional (>65) retirees have dropped MUS insurance, either at reenrollment or later. There seem to be several reasons, including migration to a spouse's plan. The committee would like to know to what extent cost is the issue. Also, do retirees consider more than the premium cost, eg the deductibles and the richness of the benefits? Is the plan simply too expensive for some, leaving them exposed to all expenses not covered by Medicare? Could a follow-up questionnaire for those dropping shed light on these issues?
- The committee reviewed the information with regard to replacing the Pharmacy Benefit Manager (PBM) with a self administrated programâ€”Pharmacy Benefit Administrator (PBA). This would be a huge undertaking which would includeâ€”employing some in-house staff, contracting for products and services, incorporating a culture of education/health/prevention, building consumerism into all components, involving the pharmacy school at UM , purchasing a formulary.
- Several members will be attending the IUBC (Inter-Units Benefit Committee) meeting in Helena from October 2-3.
- The committee will meet again in 272 SUB at 8 AM: Oct. 9, Nov. 13, Dec. 4
(At Staff Senate, August 20th) Ron Brekke reported that enrollment details and full information about the Well Award program have been mailed - sign up during September. Ron also invited input to take to the MSU Benefits Committee meeting, September 4, and to Inter Units Benefits Committee on October 2. Ron was reminded of outreach feedback that the $1500 annual maximum benefit on the premium dental plan was found to be insufficient by some employees.
July 23, 2008 (at Staff Senate meeting) Ron Brekke spoke about the WellAward program in which participants (faculty, staff, and spouses) can earn $100 for participating in health-related activities. Details will be circulated in September.
Also HR/Personnel & Payroll's recent announcement of the Benefits Calculator was discussed, and the feature applauded. The concept originated with Staff Senate at a Board of Regents meeting in 2006 and Staff Senate is delighted to see it come to fruition.
May 21, 2008 the Montana Chamber of Commerce sponsored a 2-hour Wellness Program presentation for Montana businesses. The presentation was provided by David Hunnicutt, PhD, the President of WELCOA (Wellness Council of America). WELCOA's membership includes over 2,500 companies and over 700 Well Workplaces. Dr. Hunnicutt is widely recognized as a national wellness advocate, consulting with hundreds of organizations each year
- Wellness is: Process of being aware of and actively working towards better health.
- Wellness Programs are something we do for people, not to them.
- Unhealthy lifestylesâ€”People value their health more when they start to loose it. Pharmaceutical solutions offer assistance but sometimes have side effects.
- Healthy Lifestyle---
- Walking 30 to 35 minutes every day can insure a longer and healthier lifestyle by 10 to 12 years
- Eat 100 fewer calories per day than you are currently eating
- Four Major Points
- Health Care is Expensiveâ€”We spend more on health care than any other industrialized nation.
- The situation will get worse unless something is done
- Many current health problems can be preventedâ€”80% of citizens are sedentary. More physical activity increases heath but you should start slowly if haven't been active.
- Well-Designed Worksite Wellness Programs Save Moneyâ€”Cost/benefit analysis from 10 studies showed that there was $3.93 savings for each $1.00 invested.
May 1, 2008
Attending: Young, Johnston, Brekke, Marx, Crow, Todd, Shannon, Coffey, Haynes, Wheeler (brought the Bagels!),
- The 3-year terms of Debbie Haynes and Doug Young as faculty representatives on the MSU Benefits Committee are expiring. Both are interested in continuing. In addition, Rachel Rockafellow is interested. Doug forwarded all three names to Faculty Senate, which is responsible for sending a slate of candidates to the President for selection. Update: Faculty Senate forwarded all three names to the President.
- Carol Shannon has been reappointed to a new 3-year term. Welcome back, Carol.
- Reenrollment for FY09 health and other benefits is proceeding. Some members find
the on-line process cumbersome. Ideally: Should be as easy as buying a camcorder on
- Difficulty finding initially.
- Difficulty navigating - sometimes circular.
- Some links are very small at the bottom of the page.
- After choosing a new plan (eg switch from New West to Allegiance A), user must still separately go through and remove each dependent from the old plan.
- Dates on flex plan are incorrect. Some of these issues seem to be dictated by Banner (eg dates). But it isn't apparent why the user has to be exposed to Banner's anomalies. Amazon has very complex software operations occurring in the background, but the customer isn't exposed to them. HR/PP personnel have conducted numerous help sessions to deal with these problems. Some members of the benefits committee suggested that the Chair contact the relevant folk in ITC.
- Paul Bogumill has suggested a review of the structure of our pharmacy offerings, with the aim of encouraging people to use the least cost drugs and sources. The issue arose this year with Proton Pump Inhibitors such as Nexium and Prevacid, and will arise as other drugs go off patent or generic "equivalents" come on the market (ala Prilosec OTC). Deb Haynes reminded the committee that financially strapped people may fail to take appropriate drugs and/or dosages, with cost consequences for the plan at a later date. A "carrot" approach may be more effective than "sticks" in getting people to get their meds in a cost-effective manner. The following people agreed to meet over the summer to look at this issue: Young, Haynes, Wheeler, Brekke, Coffey. They may begin with a conference call with Paul Bogumill.
- The committee suggested that several issues will be important next year, many of
which involve Communication with Members:
- The Choices Newsletter has been an effective way to communicate complex information. The committee remains concerned that the Newsletter has been interrupted.
- Wellness will begin its Well Awards program in September. Members (and spouses) can earn up to $100 by certifying various behaviors, including exercise, blood draw, etc.
- A survey of members regarding problems/complaints/satisfaction may provide useful information. A blog could be established and/or a Frequently Asked Questions site. Existing members could be encouraged to attend New Employee orientations (even if long-standing employees), because health and other benefit options are extensively discussed.
- Will SPDs on the web be accurate July 1? For what period? Will managed care SPDs change Jan 1? Can the web site clearly indicate the applicable period for the SPDs that are posted? Also, SPDs are sometimes unreadable if they span across two pages (as the workbook does), but only one page will fit on the screen.
- There is little or no information on the web regarding retirement plans. RFPs are overdue, and MUS could provide comparative info on expense ratios, as well as discussions of investment issues, eg diversification.
- The committee tentatively scheduled its first meeting of the fall for Sep 4.
April 11, 2008 The pod cast for CHOICES 2008/09 is up and running at http://www.mus.edu/choices/
April 3, 2008
Attending: Young, Johnston, Brekke, Alt, Marx, Tanner, Shannon, Hapner, Mathre, Coffey, Haynes, Wheeler
- Ken Hapner introduced the Medicare Advantage plan to be tried on a pilot basis in
Missoula and Billings this fall. (Bozeman retirees are not eligible this year.)
- The new plan offers premium savings estimated to be $116-135 per month to retirees on Medicare, because of a subsidy from the federal government.
- The new plan shifts GASB liability away from MUS.
- Caution: The drug formulary is somewhat different (required by Medicare), so it's important for retirees to check whether it suits their needs.
- The pilot is optional and participants may switch back to normal MUS health plans the following year.
- The new plan has the potential to save MUS money as well, because retiree costs > premiums (no state contribution).
- However, MUS must watch for "adverse selection" - if relatively healthy members leave for Medicare Advantage, while relatively unhealthy (and thus expensive) members stay with MUS.
- The MUS letter to current users of Proton Pump Inhibitors was distributed.
Prilosec OTC and Omeprazole will be available over the counter. Other PPIs (Nexium,
Aciphex, etc.) will be available from retail pharmacy, but not from mail order. These
other PPIs are "chemically equivalent," but some users report differences in
effectiveness or side effects.
- Costs will increase substantially for people who use retail pharmacy.
- Costs will increase even for people who use the over the counter drugs, but these costs can be mitigated through the use of the flex plan.
- Costs are expected to decrease substantially for the plan.
- Alternate IDs: Several committee members urged everyone to use alternate ID numbers (rather than social security numbers) for their medical plans. Alternate ID numbers can be requested on a HR/PP form available at: http://www.montana.edu/wwwpn/HealthBenefits/Alternate%20ID%20Form.pdf
- On Friday, Apr 4 at 3PM in 276 EPS, Paul Bogumill will record his Choices talk for podcast. Committee members are encouraged to attend.
- Points for Doug to cover in his Choices talks Monday April 7 at 10 and 11:30 in
- Reserves => Rates
- Blood lab via Wellness
- Flex advantage with example
- Reenrollment: Active-Online only; Retiree-Paper only
- Alternate ID procedure
- Contacts for Complaints, Clarification and Cuss words: MSU Benefits Committee members (list), HR/PP, COHE
- The Choices newsletter has been abruptly suspended. The MSU committee expressed strong support for Choices, saying that it is widely read by faculty, staff and especially retirees. It plays an important role in providing information to our members on benefits issues, including the health plans and retirement. The committee would like to see the problems resolved so that Choices can be continued.
- The MSU Benefits committee will meet May 1 in 274 SUB.
February 28 & 29, 2008 IUBC met in Helena. Please see additional handout from MSU Benefits Committee meeting.
- The InterUnits Benefits Committee (IUBC) made final decisions on plan changes and
premium rates for the upcoming plan year (FY 09). The hard decisions and major
decisions we made last year to our indemnity plans and the adoption of our new vision
and dental plans have had their desired effects. Claims costs so far this year have
been reduced due to the plan changes and a significant number of our members
switching to our more cost efficient managed care plans.
There was some extensive analysis conducted which indicate that our reserve funds are becoming more than was needed to pay claims already incurred and to provide a adequate cushion for inevitable claims fluctuations that always occur. As a result the IUBC made the decision to spend-down these excess reserves by lowering premiums for this coming plan year (FY 09). The rates for Actives will be reduced an average of 7% with a range of +2% to a -11% in the various categories (Employee only, Employee + spouse, etc). Retiree rates will remain the same overall for the next year with adjustments of +1% to a -2% in these various categories. The premiums for the vision and the dental plans will remain basically the same for all members for FY 09. It must be noted and remembered that these reductions are likely a one-time only occurrence due to the extra work, diligence and continuous monitoring by our benefits team in Helena. Medical inflation will continue and members should anticipate at least modest increases in future years.
- Unlike last year, the plan changes for next year consist of minor changes rather than major restructurings. More complete details will be offered in the next Choices Newsletter which should be available before the enrollment begins on April 21st. Both Actives and Retirees will also be receiving an Enrollment Workbook that will outline the complete rates for next year and the various plan choices.
- Our pharmacy provider (CVS/Caremark) will be making available to our members an ExtraCare Health card which will provide an opportunity to reduce health care costs and improve employee health. Card holders will receive a 20 percent discount on regular, non-sale priced CVS/pharmacy brand health-related items at CVS pharmacies nationwide. There are currently 8 CVS stores in Montana, with plans to nearly double that amount over the next couple years. Specifically important to our MUS plan, the ExtraCare Card provides an opportunity to assist in reducing drug expenses by increasing access to over-the-counter (OTC) products. Card-holders can utilize the card for more than 1,300 eligible health-related CVS/pharmacy and exclusive brand products. More information will be made available when this ExtraCare Health card becomes available.
- A pilot WellAwards Program was initiated for three months (September to November 2007) at Flathead Valley Community College. It provided cash incentives to encourage healthy activities and life styles. A participant earned credits by completing various activities. These activities included---Chemistry screen, blood pressure check, teeth cleaning, eye exam, bone density exam, weight management, strength training, aerobic exercise, flexibility exercise and many others. A participant earned one credit for each activity. At the completion of the program each participant who had earned 5 credits received $50.00. This WellAwards Program will be introduced and implemented on other campuses this fall. It will be for 8 months and more credits will be required to complete the program but the cash incentive will be $100.00.
- Schedule for 2008 CHOICES Meetings in Bozeman on April 14th
- Retirees---8:30 at Wingate Inn, 2305 Cantron St
- Actives---11:30 in Reid 101
- Actives--- 1:30 in Reid 105
- Items of interest
- Blood chemistry screenings which are provided at WellCheck or the Wellness program are submitted to a lab which provides results that are as acceptable and as good quality as any lab your physician may recommend. Your doctor should be able to review and utilize these lab tests without requiring similar screenings from his/her recommended lab.
- In 1977 the Montana University System (MUS) received $30.00 per month for each employee from the state, which was equivalent to an average of 2% of an employee's wages. For 2007-2008 the monthly employer contribution is $590.00 for each employee which is equivalent to about 20% of an employee's wages.
February 14, 2008
- Retirement: Ken Hapner introduced us to three educational references at various
websites which would be helpful for all employees to read and, as appropriate,
initiate action to benefit their retirement years.
- Shopping for a Long-Term Care Policy, Tom Lauricella, Feb 3, 2008, Wall Street Journal, http://online.wsj.com/article/SB120200860508738543.html
- Long Term Care Insurance, AARP: http://www.aarp.org/money/financial_planning/sessionfive/longterm_care_insurance.html
- How Will You Pay for Old Age? Consumer Reports, pages 35-50, October, 1997.
- EAP (Employee Assistance Program) The university will be contracting with a new EAP Provider
- We reviewed the IUBC (Inter Units Benefit Committee) agenda which will be
presented and discussed February 28th to 29th in Helena. About 5 to 6 members from
MSU will be attending. A more detailed report will be provided after the meeting.
Some of the items to be discussed include:
- MUS Risk Management
- Rx plan changes
- Dental plan changes
- Medical plan changes and prevention coverage
- Vision plan update
- WellAwards pilot outcome
- Rates and Reserves
- Year in review
Plan Change Sub Committee meeting February 7, 2008 This report is a brief explanation of the items discussed at the meeting
- Delta Dental
- The plan is breaking even (for claims under the new plan design) as of now, so the plan will continue as is and see how it develops. The "run in" dental claims expense (claims with dates of service prior to July 1 but paid this benefit year) are large - which was expected.
- Utilization of our dental plan is as expected and normal. There have been very few complaints. Delta Dental has been working with us very well.
- It is possible to look at different categories (preventative, restoration, diagnostic etc) and review planned vs actual expenses.
- Pharmacy expenses have been increasing and the trend in the industry is for
members to pay more of the cost. The MUS goal is to have 75%/25% (benefit plan
pays 75%/member pays 25%). The most recent 12-month period has about 78%/22%.
- Various scenarios being considered: are increasing the copays (example $10/$20/$30 to $10/$25/$40) and/or increasing the retail Pharmacy deductible (from $200 per family/year to $300 per family/year) and /or increasing the benefit year out-of-pocket maximum (from $800/$1,600 to $1,200/$2,400). These changes would have members paying 23% to 27%.
- There are also plans being developed to inform, promote and encourage members to purchase OTC (Over the Counter) medications whenever possible. Zyrtec is one example of medication now being offered OTC.
- There will also be a program to review certain medications which may be over-utilizedâ€”sleep aids, heartburn
- A lot of effort and time has been put forth over the past year reviewing the pharmacy plan design and negotiating with PBMs (Pharmacy Benefit Manager). It was discovered that some significant rebates from the pharmacy companies had not been paid to the MUS benefits program per contract agreements.
- Pharmacy expenses have been increasing and the trend in the industry is for members to pay more of the cost. The MUS goal is to have 75%/25% (benefit plan pays 75%/member pays 25%). The most recent 12-month period has about 78%/22%.
- EAP (Employee Assistance Program) /Wellness
- We are in the process of choosing a new EAP Provider.
- The EAP program is currently underutilized by employees
- The new EAP program will offer more online tools and training in addition to legal and financial advice.
- A spring tour by members of the Benefits team will be promoting and informing employees of EAP services.
- WellAward Program
- This is a healthy lifestyle and disease prevention program for insured faculty, staff and their insured spouses. Flathead valley Community College was selected to participate in the WellAwards Pilot Program.
- This is an incentive-based wellness program linked to a $50 cash reward through achievement of wellness criteria, which is based upon earning credits. Various program categories and Wellness activities earn 1 or more credits. A minimum of 5 credits must be earned. More information will be provided as this WellAward Program is expanded.
- Federal GASB regulations This was presented and discussed at the MSU January 17th benefits meeting and was included in that monthly report.
- Final Preventative Benefit Language
- A summary of the preventative benefits available (for MUS 2008-2009) in Traditional, Managed Care In Network and Out of Network were listed. This summary is similar to the list which was in a previous report from the Plan Change committee meeting on December 3, 2007. There was a request that the 'Preventative Medical Exam" paragraph provide a more detailed explanation of the procedures and tests which are included in this exam. A list of suggested procedures and tests for the "Preventative Medical Exam" was included in the original Preventative Services recommendations.
- The template for helping to develop the Preventative Benefits was provided by the benefits team from the MSU campus.
- FLEX Plan Beginning July 1, 2008 the administration fee will be zero cost to the participant.
January 17, 2008
As an introduction to the Benefits committee meeting here are some comments of an email from Paul Bogumill (Director of Benefits):
- We are looking at eliminating the employee's admin fee for flex accounts - to better promote the use of this benefit. We will focus some upcoming newsletters and presentation on how best to use these accounts.
- The Pharmacy (Prescription Drugs Program) benefit needs a lot of attention - a very high trend. To fix it we are trying to get better unit costs from the PBM (Pharmacy Benefits Manager) and we need to evaluate the member share on RX . The member share component is very important for you folks to understand - presently we have fallen into an 80 / 20, meaning at the end of the day the plan is paying 80% of the total rx spend and the members 20%. Our "goal" is to maintain at least a 75% / 25% split - so we will be making rx plan design changes to support this shift - thus copays and deductibles will be going up.
- Also - with in the RX plan changes we are looking to introduce
a program on PPI meds that will read as
As many of you may already know, once a drug becomes available to purchase over-the-counter, it can no longer be claimed under the prescription drug plan. Recently the medication Prilosec (and it's generic Omeprazole), which is a Proton Pump Inhibitor, became available without a doctor's prescription.
There are other Proton Pump Inhibitor medications that are prescribed by doctors such as Aciphex, Nexium, Prevacid, and Protonix. These prescription drugs are still a benefit under the State's prescription drug program as long as they are filled at a retail pharmacy. Because of the availability of an over-the-counter alternative and other cost considerations, these drugs will not be available through the mail order facilities.
- If the admin fee for the flex accounts is eliminated then where will the money come from to pay the admin fee?-----From the forfeited money
- Has an RFP (for Prescription Drug Program) been issued? Yes-responses have been evaluated and currently the final contract negotiations on the new contract are in progress. This is being done through the purchasing association of the large employers as one group, which allows for better pricing.
- When will the new Prescription Drug Program be implemented? July 1, 2008 and it will be seamless to the members for the most part.
- Benefits Committee membership: Ken Hapner brought it to our attention that there were two (slightly different) lists of members--Benefits Committee list and OPA (Office Planning and Analysis) list of members. He will develop one correct list. There is one vacancy for a classified rep. Previous Chair of the Benefits Committee will be added as an ex-officio member.
- Plan Change Committee: Ron Brekke reported.....As mentioned above
the Prescription Drug Program has a goal of 75%/25% pay plan. Since this is not being
met there is a proposal to increase the co-pays and deductibles for retail and mail
order, to be similar to the state's plan. This includes the following brief example:
Type of Drug Local Pharmacy Costs Mail Order Pharmacy Costs You Pay / Current / Proposed You Pay / Current / Proposed Generic The greater of $10 or 20% / 20% with $10 minimum $20 / $20 Brand formulary Thegreater of $20 or 30% / 30% with $25 minimum $40 / $50 Brand non-formulary The greater of $30 or 40% / 40% with $40 minimum $60 / $80
3. Eyemed has increased the out-of-network benefits for members living more than 50 miles from a network provider.
4. Wellness Subcommittee: Barb Wheeler reported
- A RFP has been issued for our EAP (Employee Assistance Program) and Wellness services.
- EAP includes issues related to life and work, legal and financial counseling, short term mental health counseling. Employees are encouraged to utilize this assistance program as the services can be very helpful and beneficial. Favorable comments have been made regarding these services.
- Federal GASB (Government Accounting Standards Board) may require accountability for all unfunded liabilities within our Health Plan. This could result in large increases in premiums for the retirees and Medicare eligible active employees in order to cover unfunded liabilities). An insured product such as an MA (Medical Advantage) plan for these members would remove the unfunded liability...hence the request to New West to propose a MA plan to address this issue.
- 403b Plan Modifications Federal guidelines require upgraded regulations and oversight of 403b tax-deferred savings plan by January 1, 2009. The various 403b plans within the MUS system need to be refined and standardized within a single "umbrella" plan document.
Plan Change Committee meeting Dec 3, 2007
This report is a brief explanation of the items discussed at the meeting.
- A. The IUBC (Inter University Benefits Committee) is reviewing vendors for our
MUS (Montana University System) RX (Prescription Drugs) program. The present contract
has been in place for 7 years, and in accordance with Montana law a new bid process
must be completed. This bid process "forces" us to research the present market to be
sure we are getting the best deal available. Our present PBM has been absorbed by
CareMark - and CareMark is one of the companies being considered.
As the incumbent, we are looking at RX plan changes as we would do any year. They
gave a presentation which included the following information and services they could
- A confidential personal health record that can be accessed by designated advisors.
- Specific advice from their pharmacist about their medications and health plan
- Access to lifestyle and biometric screening and the tools (blood pressure monitors, pedometers, diabetic testing equipment , etc.) to monitor and maintain health.
- Company Profile: 6,200 retail and specialty stores, 170,000 employees including 20,000 pharmacists, 16% share of U.S. retail prescriptions, 8 pharmacies in Montana
- A team contact list for the MUS account
- A Plan Design Summary which basically listed the current MUS program One item which was briefly discussedâ€”Out of Pocket max (retail only): $800 individual $1,600 family. It appears that when this max is reached then the member may not be as cost conscious when purchasing the prescription drugs since he/she will not be incurring any expenses on future purchases. The state has a max of $1,400 individual $2,800 family.
- Programs to inform and encourage members to buy generic and order by mail
- An analysis of MUS prescription expenses included the following data from
January 1, 2007 to September 30, 2007
- Total net cost paid by plan--$11, 527,719 up about 14% (taking into account an increase in membership) This is a SIGNIFICANT increase and steps need to be taken to reduce these expenses.
- Total member cost--$3,341645 which is 22.5% of total net cost
- Generic substitution rateâ€”93.5%
- SPD Review
There were various paragraphs within the benefits booklet which were reviewed as to whether words should be deleted or remain the same. These subjects included: Pre-existing conditions, Continuation of Coverage, Retiree coverage eligibility, Open enrollment
- Preventative Schedule of Benefits
A spreadsheet displaying preventative benefits for Traditional and Managed Care plans was presented. A brief summary is listed below.
- Traditional Plan
Preventative services, Adult Exams and Tests Mammogram, gynecologic exam, Pap test, clinical breast exam, preventative medical visit (includes physical exam, personal and family history, urinalysis, screening for high risk behaviors and obesity), bone density, sigmoidoscopy, colonoscopy, blood analysis.
- Immunizations and pneumonia and flu shots EXCLUDES immunizations recommended due to types of employment or travel (ie. Malaria, yellow fever etc)
- Child checkups through age 7
- Physical exam visits are covered at the following approximate ages:
- *Newborn who did not receive exam in hospital or birthing facility or was discharged in less than 36 hours
- *1, 2, 4, 6, 9, 12, 15, 18, 24 months
- *One per year thereafter through the 7th year
- MC (Managed Care) in Network
- Mammogram-age 40+ one/year (no deductible, no coinsurance), Ages 35-39 one baseline mammogram (no deductible no coinsurance)
- Gynecolocic exam and pap test one/year (included in office co-pay)
- Preventative Medical Visit age 8-39 one every two years $15 co-pay, age 40+ one/yr $15 co-pay
- PSA test for males (included in office visit co-pay)
- Bone density screen once every 5 years for females age 60+ an males age 70+ subject to deductible and 25% coinsurance)
- Blood analysis (included in office visit co-pay)
- Stool occult blood colorectal screening ages 40+ (include in office visit co-pay)
- Flexible sigmoidoscopy and double contrast barium enema every five years for members age 50+ (subject to deductible and 25% coinsurance)
- Colonoscopy once every ten years age 50+ (subject to deductible and 25% coinsurance)
- Immunizations and pneumonia and flu shots $15/visit without office visit 25% coinsurance (no deductible)
- Child checkups through age 7 (same schedule as proposed for traditional) $15 co-pay per visit
- Proposed Plan (Developed by MSU Benefits Committee)
- Mammogram one/year for female members age 40+ (no deductible, no coinsurance)
- Gynecologic exam, pap test, clinical breast exam one/yr for female members age 19+ ( no deductible, no coinsurance)
- #Preventative Medical visit-one visit every 2 years for age 19+ (no deductible: $15 copay) #See note below
- Bone density (DEXA) screen once every 5 years for females age 60+ and males 65+ (deductible and coinsurance apply)
- Ultrasound heel scan for bone density every 5 years for members+ (Obtain from MUS Wellness at Wellcheck, $10 copay)
- Blood analysis (Obtain from MUS Wellness-chemistry screen with lipid analysis $20 copay; complete blood count $16 copay; for male members PSA screening
- Stool occult blood screening-once per year age 50+ ( obtain free from MUS Wellness)
- Flexible sigmoidoscopy every 5 years OR
- Colonoscopy every 10 years for members age 50+ (deductible and coinsurance apply)
- Children 0-7: Included in office visit copayment. If no office visit,
subject to coinsurance up to a $10 max (no deductible).
- 8-18: No deductible up to max. Max=$250/yr
- 19+: $75/yr
An item under further consideration and to be discussed at next plan change committee meeting is a baseline medical visit within 1 year of employment by MUS for persons 19+ including adult dependents. Visit will include physical exam, personal and family history, urinalysis and screening for high risk behaviors and obesity. No deductible; $15 copay Obtain blood analysis from MUS Wellness in advance.
- Vision Plan updateâ€”Enhanced Out of Network benefits
Since the Eyemed vision network has not been able to sign-up providers in all areas then it has enhanced some out-of-network allowances if there are no in-network providers within 50 miles. This includes:
- a. Exam with dilation as necessary-up to $85 instead of $45
- Frames: $100 instead of $47
An additional benefit--Providers out of the network are being more flexible and offering lower prices to our members to compete against Eyemed.
November 9, 2007 Present: Barb Wheeler, Sherry Garner, Lisa Crow, Ron Brekke, Jim Mitchell, Susan Alt, Kathy Tanner, Jerry Coffey, Bob Johnston, Don Mathre, Doug Young
Doug passed on Paul Bogumill's comments on SPD issues:
The law specifies that major changes have to be up within 30 days and minor changes within 90 days. Most of our changes are regarded as minor - hence the 90 day window.
The managed care plans are a group purchase with the other members of MAHCP - something that I didn't know - and they have various starting dates. The State begins Jan 1 I believe.
General policy has been: If a change is an improvement for employee, implement Jan 1 and advertise July 1. If a change is not better, implement (and advertise) July 1.
The issue of New West not having the up to date spd's has arisen before and "they are working on it." (My quotes - not Paul's) Other managed care providers have specialty teams for MUS, but New West doesn't. MUS continues to address this issue with New West.
Committee members noted an additional problem: The plan documents are extremely hard to read, because they read across two pages on the paper copies, but the pdf's on the web don't line up that way.
Ron Brekke stated that he will attend a meeting of the Plan Change Subcommittee of IUBC in a few weeks. The Preventive proposal developed at MSU last summer and presented at IUBC this fall is not on the agenda of the email he received.
Committee members have heard numerous complaints about Delta Dental's claims processing, including denying claims. Approximately 20 complaints have been forwarded to the Commissioner's office.
One committee member expressed concern about the continued use of social security numbers for insurance identification. MSU was able to make an alternative numbering system work for students across diverse computing environments.
Jerry Coffey will present pre-retirement workshops November 9 at 12 and 4 in Ballroom D.
Anyone considering rolling over a 403(b) should be extremely cautious as the tax situation is unclear.
Don Mathre offered an article from Business Week describing employer policies to adjust insurance premiums based on risk factors such as cholesterol, BMI, and/or Blood Pressure. http://www.businessweek.com/magazine/content/07_45/b4057083.htm Discussion suggested that positive incentives (lower premiums for low risk) meet less employee resistance than negative incentives (higher premiums for high risk). Positive incentives may be more likely to be legal. Incentives must be targeted at risk factors that people can control - or at least influence - through their behavior, in order to have a positive incentive effect. Other considerations are the costs and benefits to the plan, as opposed to costs and benefits to Medicare. Also, human costs and benefits as opposed to strictly financial costs to insurance plans, and costs to employers and employees of ill health through lost productivity.
October 3-5, 2007 IUBC Retreat:
MSU attendees: Ron Brekke, Ken Hapner, Jerry Coffey, Barb Wheeler, and Doug Young
This is a summary of the IUBC topics which were presented and discussed at the annual 3-day retreat.
- Financial Report
- For all medical and dental plans combined, revenues exceeded expenses by 1.2% for FY 2007. IN FY 2006, the excess of revenue over expenses was 8.6%.
- The dental plan experienced a deficit while the medical plan experienced a positive cash flow.
- Actives have a current Funding Loss Ratio of 93.0% while the retirees are running at 137.4%.
- Pharmacy expenses have increased significantly......8.2% when 06/07 Medicare Part 2 subsides are taken into account. Without these subsides the trend would be 16.5%
- MUS (Montana University System) Account Report
- There were charts which showed the number of members (percentage) by age group in each plan for two years. It was noted that members were moving into the managed care plans.
- The claims (policies) which have been filed were separated into the
following categories: Medical: 70%
- Balance Sheet
This report is 'snapshot' once a week comparing total assets to liabilities. An industry standard is 3-6 months of assets greater than liabilities. The MUS group insurance figure is about 5.4 months, down from 5.7 months a year ago.
- CDHP Consumer Driven Health Plan
These type plans consist of:
- HSA (Health Saving Account) which have tax advantages and can be used to help pay health expenses.
- High deductibles with the insurer paying expenses up to an amount of the deductibles and then the health insurer starts to contribute.
- Preventative Benefits
This report has been previously presented.
- Diabetes Management Program
This presentation included the following information:
- In 2004 diabetes was the 6th leading cause of death
- People with diabetes are at increased risk for Hypertension, heart disease, heart attack, congestive heart failure, amputation of lower limbs.
- Type II diabetes is an acquired life -long disease marked by high levels of sugar in the blood.
- Obesity is the most powerful predictor of who will have Type II
- Treatment includes: dietary modification, drug therapy, Increased physical, weigh loss
- Vision Plan
This presentation was from our EyeMed provider
- Benefits of an eye exam can help identify: diabetes, hypertension, multiple sclerosis
- An explanation of the MUS vision was provided
- EyeMed has been finding it challenging to develop their network, so there have been some changes due to Montana's rural environment. This includes a higher out-of-network allowance for some services and material in rural areas. Out of network benefits may be increased in urban areas next plan year - under discussion.
The pharmacy expenses of the MUS insurance plan have been increasing significantly. The pricing of the prescriptions drugs is sometimes rather complicated. An audit was conducted which revealed that the MUS insurance plan had not received $500,,000 in rebates per our contract. Another audit discovered that we were receiving a 55% discount vs 62% per the contract. The Benefits department will continue to conduct their own audits to discover any discrepancies regarding pricing and how rebate checks are calculated. Consultants have been retained to assist in writing a new pharmacy RFP that will include third party audits and other improvements.
- Allegiance has a pilot program utilizing Comprehensive Enrollment Wizard (CEW) which allows members to access their benefits online.
- Allegiance also showed several charts relating to the level of service they were providing our members and how they had met or exceeding those targets. Standards for service provision are a new feature of the current contract.
This presentation was given by Delta Dental representatives
- Features and highlights of the Premium and Basic Plan
- Online service with www.WeKeeepYouSmiling.com/MUS This website allows an enrollee to view benefits, eligibility, claim status and dental health information. It also includes a dental fee finder which shows the customary cost for a procedure by zip code and a directory of providers.
- Working Families Tax Relief Act (WFTRA)
Employees of the Montana University system who are enrolled in our health insurance will receive an explanation (and form) of the new tax regulations regarding payroll health insurance deductions. Some people who are eligible dependents from the perspective of our plan are not dependents from the perspective of the IRS. Therefore, premiums for those dependents must be taken out on an after tax basis.
- Next Steps
Various task forces and subcommittees of the IUBC will meet this fall and winter to work on a number of issues:
The full IUBC will meet again in late February to decide plan changes and premiums for FY 2008-09. Tentative meeting date is Feb 28-29.
September 6, 2007 - The first meeting for this school year of the MSU Benefits Committee was held September 6, 2007. Present: Kerri Marx, Lisa Crow, Jerry Coffey, Ron Brekke, Deb Haynes, Don Mathre, Ken Hapner, Barb Wheeler, Carol Shannon, Jim Mitchell, Susan Alt and Doug Young. The items discussed included:
- Preventative services
- During the summer several members of the benefits Committee held meetings to develop a Proposed Preventative Services Program. Some of the changes were mandated by the last legislature (ages 0-7). It recommended doctor's visits depending on age (0 to over 50) to include: physical examination, immunization, urinalysis, lab tests, blood analysis, screening for high risk & obesity, mammogram, gynecological exam, Pap test, Ultrasound heel scan for bone density, colorectal cancer screening, PSA screening, personal & family history.
- A more detailed explanation by age group is attached.
- A very thorough cost analysis spreadsheet was also presented and attached
These are proposed preventative services. If any of the CEPAC members have any additional recommendations then feel free to contact me.
- IUBC Meeting
- The IUBC annual meeting will be October 3-5
- Topics will include: Financial condition of the plan(s), Preventative Benefits, Diabetes Management, Depression Management, Metabolic Syndrome Program, Vision Update, Pharmacy Industry, Traditional Plan Update, Dental Update, Subcommittee Reports (Admin, Plan Change, Appeals), Task Force Committee Reports (Compliance, Wellness, Retiree), Old business, New business.
- If any of the CEPAC members has a specific question regarding one of the above topics or would like a topic not listed to be presented then feel free to contact me before October 3, 2007.
- Other items presented which will be discussed in future meetings
- A booklet or notebook for families to keep their own records and history of doctor's visits
- A concern about codes used by doctors and insurance companies which may be too general and not as detailed or specific enough to describe the various reasons for a doctor visit.
- An awareness that the IRS and the MSU medical plan have slightly different qualifications for individuals being classified as dependents. For example, our health plans allow children to be covered up to the age of 25 (if they are not married and not covered in another job). The premiums for these dependents are taken out of employees' paychecks on a pre-tax basis, but the IRS only allows them to be pre-tax if the children are claimed as dependents on the income tax returns.
- Concerns about the complexity of the health plans, and what can be done to more effectively communicate with members .
Fall, 2007 - Ron Brekke appointed to the committee. His first meeting will be during Fall semester. November 9, 2006 - Present: Barb Wheeler, Heather Barnaby, Lisa Crow, Kerri Marx, Dori Fuentes-Sanchez, Jerry Coffey, Robert McKenzie, Don Mathre, Deborah Haynes, Doug Young, Jodie DeLay
- Barb Wheeler reported that numbers were down for the fall wellcheck, probably
because flu shots were not offered at the same time. Wellness performs about 1400
blood screens annually, reaching about 25% of participants.
Flu shots will be available Monday, Nov 13, Thursday, Nov 16, and Monday, Nov 27. Shots are free to participants. There are currently no plans to seek reimbursement from Medicare: Discuss with Paul.
- We discussed the EyeMed plan that will be an option July 1, 2007. Their network is still very weak here: For zip code 59715, EyeMed lists two national retailers (one in bozeman and one in helena) and 6 private practitioners (2 in bozeman, 2 in butte and 2 in helena). Hopefully the state contract will pave the way for us.Coffey recommended a recent article in Consumer Reports and will seek permission to post it to the Choices web site.
- We continue to be concerned about participants making poor choices, and what this costs them and the plans. What about a "pocket guide" that people could consult when an issue arises? the guide could list questions to ask in various situations: Prescriptions drugs: Is a generic available? Is this maintenance/Could I get this from mail order? When should I consult a case manager? Whom do I call? For surgeries and other non-emergency events: What will the be the charges, including facilities, labs, physicians, anesthesiologists, assistant surgeons, etc? Are each of the providers in my network or out of network? If not, could something be done differently? Is an assistant surgeon really necessary?
There was also discussion of additional ways that participants could be better informed about choosing which plan to participate in. The Choices booklet is already available, the plan reps come to campus, and HR puts on Reenrollment help sessions, but these are lightly attended.
Doug was directed to contact Paul with regard to these issues.
September 7, 2006 - Attended by: Susan Alt, Barbara Wheeler, Deborah Haynes, Don Mathre, Doug Young, Gail Weidenaar, Jodie Delay, Heather Barnaby, Kerri Marx, Norma Tatarka, and Robert Johnston.
- We greatly appreciate all the contributions from Montana Hall.
- Susan Alt discussed Admin Subcomm of IUBC
- No enlargement of IUBC to accommodate additional union rep
- Sue Schmitt in OCHE has been hired as a Quality Assurance person. She will focus on Medicare Part D and Outreach/Case Management for retirees. Don Mathre volunteered to meet with her if she came to MSU.
- Allocations of funds to Wellness will become more transparent.
- New Vision cntract is coming. Also, dental will be separated from medical.
- The RFP for Third Party Administrator is expected to go out late this month and be awarded, hopefully, in January, 2007.
- Wellness Fair will be Oct 24-5. Flu shots will be offered in early November if sufficient vaccine is available.
- Jodie reported on the Plan Change subcomm: Discounts from some hospitals disappeared with the contract that began July 2005. These substantially increase costs. The new RFP will ask the TPA to seek discounts from one hospital in two hospital cities (Missoula, Billings, and Great Falls?).
- Barb discussed the possibility of a consumer driven health plan at Miles City CC. The community colleges only get about 1/3 of the money per employee from the state for health insurance that the universities get. MCC was considering dropping health insurance entirely because of cost. Will not begin before July 1, 2007, if then. MCC has about 75 FTE employees.
- Jodie discussed the work of the pharmacy ad hoc committee:
- Letters to people using high cost drugs who are not using mail order.
- Diabetes disease management.
- Specialty pharmacy: New organization/contract.
- Doug, Susan, Norma and Jodie will attend IUBC fall retreat Sep 19-21.
Carol was then asked various health benefit questions:
- Are social security numbers still being used for benefit claims? Yes but you may specify the use of an alternate ID through HR/Personnel and Payroll (http://www.montana.edu/wwwpn/Health%20Benefits/Alternate%20ID%20Form.pdf).
- Allegiance had announced that its traditional plan providers were also its managed care providers but staff had experienced some providers to be unaware of their provider status under managed care. Carol said that the list of providers on the Allegiance web site should be accurate.
- Shouldn't the income ceilings used to determine eligibility for, for
instance, the health insurance premium waiver for dependent children, be
re-examined every year? (It was suggested that salary increases might
unreasonably render employees ineligible for the program). Carol will raise the
question with the MSU Benefits Committee. Since Carol's term on the committee
ends this month, Sara France undertook to alert Jodie DeLay and Gil Weidenaar to
April 6, 2006 - Carol Shannon submits this report:
- The new Director of Benefits for MUS is Paul Bogumill
- There are new lower premiums for retirees who are 65+. These will appear in the Choices packets that will be distributed in mid-April.
- The next Choices newsletter will explain the change in premiums in detail. The newsletter will also explain the new Managed Care option for retirees.
- Allegiance will now offer a Managed Care option (in addition to the Traditional Indemnity Plan).
- A letter will be sent to all active employees and retirees describing the changes for FY 07 and listing the help sessions that will be available.
- The survey results will be posted on MSU Today in the near future. The results will include data from both active employees and retirees. Disclaimers will be included to help people better interpret the results.
- The Dependent Waiver report for this first year was consistent with expectations for costs and intentions.
- Allegiance and New West now have local anesthesiologists in their networks and BCBS now has a local allergist in its network.
- Under the indemnity plans, there are no deductibles on annual mammograms, gynecological and prostrate exams and they are covered up to the maximum allowable amounts.
- Under both the indemnity and managed care plans, it is usually a good idea to get a prescription for the mammogram at the same time as the gynecological exam, in order to avoid a possible charge for another office visit.
- The next MSU Benefits meeting will be 5/2/2006.
March 8, 2006 (from CEPAC Minutes) - Carol Shannon reported on the last meeting of the MSU Bozeman Benefits Committee (notes to follow). Three issues will be voted upon at IUBC tomorrow:
- next year's proposed premium structure
- managed care options for retirees
- debit cards for flex accounts
Carol also reported on the progress of the recent CHOICES survey. Results will be offered to CEPAC for publication on the web, but preliminary findings have been sent to IUBC. Carol intimated there are no startling outcomes from the survey.
Jodie DeLay reported that, barring any last minute events, she will vote in favor of the three issues, as Carol just described, at IUBC tomorrow. In other IUBC business, Jodie reproted that Glen Leavitt is retiring at the end of the month and IUBC has requested to be involved in hiring his replacement. Further, the RFP process to receive bids on the third party administration of the MUS health care plan is due to begin again (the current contract with Allegiance expires summer, 2007. Finally, Jodie mentioned wanting input into how to promote under-utilized mail-in prescription opportunities, and she will ask for CEPAC's feedback in due course.
IUBC Meeting February 2, 2006
Submitted by: Jodie DeLay, MPEA Representative from Bozeman.
Note: This is my first meeting so I've done my best to capture the highlights. There is a huge volume of information and a major learning curve, so understand that these notes are from a rooky perspective!
Glenn Leavitt announced that he will be retiring at the end of March.
PHARMACY REPORT: Tammy Tarzynski (Pharmacare) reported to the committee. Written report was also submitted. Highlights include: MUS is doing a good job of using mail-order pharmacy and generic prescriptions (better than average). This keeps costs down for the plan. The Specialty Pharmacy option is underutilized at this point. Discussion followed as to how to increase participation. Three of the top 25 Rx's used by MUS employees will become generic in 2006 - this will reduce costs for our plan. There was a spike in expenses to the plan in July (likely due to consumer response to changing from Blue Cross to Allegiance as administrator) and in October (no absolute explanation, but will continue to track). Pharmacare recommends that we consider opportunities to continue to encourage people to use the mail order pharmacy and specialty pharmacy, that we add coverage for Prilosec OTC at zero copay (much cheaper than the RX form of the drug) and that we consider tablet splitting for appropriate drugs.
AFLAC sent a request letter defining their service and looking for MUS participation. The committee, by voice vote, elected not to follow-up.
Dependent Fee Waiver Summary for UM campuses was presented. Based on initial data the program seems to be a success - more children are being insured. Indications are that MSU data is similar.
New colonoscopy benefit: Between July and January, 52 screening colonoscopies were completed. Through seven months the cost to the plan is around $14,000. Expect that this is more than what will be typical because of the newness of the benefit, should taper off somewhat. Cost is within what was projected.
PLAN CHANGE DISCUSSION - Items to be discussed at campus meetings and then voted on at the next meeting:
FLEX Spending account: Ellen Feaver (EBR) reported to the
In the past year the IRS modified its rules allowing employers to extend the period in which qualifying expenses may be incurred and reimbursed. The plan change committee was not in favor of making any changes: no clear benefit and could be a struggle administratively. EBR now offers debit cards for medical spending. If the IUBC elects to take this option, each employee would be able to choose whether or not to use the card. The amount of election would be loaded on the card and it could be used just like a credit/debit card to cover medical expenses. The administrator would follow up with the employee to request documentation for expenses which were not obviously medical (for instance if something is purchased at a grocery store, a receipt would likely need to be mailed or faxed to show that the expense was for a qualifying medical need.) Employees who choose the debit card would be charged a one time set-up fee of $10.00, as well as $1.00/month processing fee. The costs would automatically be deducted from the medical spending election.
Finally, EBR would like to change from sending four statements through the mail annually, to sending two statements through the mail. This would save considerable expense and many employees now use the online service which makes the statements available at any time.
A new adult dependent declaration form was presented which the subcommittee recommended the IUBC approve. The employee must certify that they are eligible to receive adult-dependent benefits. Personnel and Payroll staff can request specific documentation be turned in with the form, but the documentation would be returned.
Premium changes: Indemnity plan - $400 deductible: No increase is
suggested for employees. Suggest increase of $7.00/mo for spouse, $6.00/mo
for children or $14.00/mo for family
Indemnity plan - $575 deductible: No increase is suggested for employees. Suggest increase of $6.00/mo for spouse, $5.00/mo for children and $10.00/mo
No increase is suggested for any of the HMO plans or for dental.
Suggest increase of 6% for retirees. Retirees under 65 would be $24.00, retiree +one would be $32.00, Retiree +2 would be $34.00, Retiree + spouse would be $27.00, survivor would be $24.00 and survivor and children would be $32.00.
Retirees over 65: Retiree only - $17.00, Retiree +1 - $27.00, Retiree +2 - $32.00, Retiree + spouse $22.00, Retiree + spouse + children - $26.00, survivor - $17.00, survivor + children - $25.00.
Suggest increase to make these premiums 85% of lower deductible plan:
$1500 deductible for Retirees under 65: Retiree only - $12.00, Retiree +1 - $17.00, Retiree +2 - $1.00, Retiree + spouse $13.00, Retiree + spouse + children - ($12.00), survivor - $12.00, survivor + children - $15.00.
$1500 deductible for Retirees over 65: Retiree only - $12.00, Retiree +1 - $13.00, Retiree +2 - $15.00, Retiree + spouse $15.00, Retiree + spouse + children - $16.00, survivor - $12.00, survivor + children - $15.00.
Also suggest that HMO's be made available to retirees at premium that is 93% of indemnity plan rates above.
Administrative/fiduciary items to be voted on at the March
Plan change subcommittee recommended that a number of caps be placed on services in our plan in order to limit liability to the plan and allow the case manager to better negotiate with providers for lower costs. Suggestions made are based on norms in the industry and mimic the state plan.
Refine language describing our gastric bypass coverage
Skilled nursing benefit - 70 days/year
Hospice - Max of 180 days
Outpatient Therapies (occupational therapy, physical therapy, speech therapy) will be limited to $2,000 per year, or up to $10,000 per year if prior authorized through case management.
Transplant Maximums: Liver $200,000, Heart $120,000, Lung $160,000, Pancreas $68,000, Cornea/Kidney -no max, Multiple transplants $500,000.
Lifetime limit: $4,000,000 per family
Increase in chemical dependency limits from $4,000/year and $8,000/lifetime to $6,000/year and $12,000/lifetime
Durable medical equipment - allow rent up to the purchase price (rent to own)
Mental Health benefits were discussed rather extensively. Proposal to change outpatient coverage to 25% copay and max of 40 visits with Employee Assistance Program referral and 50% copay and max 20 visits without EAP referral.
Preventative Benefit - discussion to cap adult preventative services at $300.00 per person per year was discussed.
Retiree Part D Subsidy: Not sure yet whether we'll qualify, will have a plan ready by March 1st. Would likely cost plan around $150,000 - $200,000. Would receive around $1million from federal government. Premiums for medicare/retirees would be reduced by approximately $64/month.
Dental plan for retirees and increased benefit for children - committee looked at potential costs for a number of combinations and coverages. Decided the information was too broad and that the committee should limit potential options before putting before campuses.
The IUBC will meet again in March.
January 12, 2006 - Carol Shannon reports, at CEPAC meeting February 8, on the January 12 Benefits meeting
MPEA Representative: Susan notified Quint Nyman that there is a vacancy on the committee and will follow-up with him to make sure there is someone on board to attend the Inter-units Benefits Committee (IUBC) meeting in February.
VEBA: There has been some question as to whether employees who are on PERS can count sick leave in their High Average Salary (HAS) and VEBA or if they have to choose one or the other. Both MSU classified VEBA groups (one is union and one is not) were under the impression that they could count the sick leave in both places. The state of Montana has determined that employees must choose one or the other, and though the commissioner's office is still reviewing, it appears that our groups will likely have to reevaluate based on having to choose. If this turns out to be the case, personnel staff will go to both groups and let them know of the change. The state has tools which help people decide whether to count the sick leave in HAS or VEBA, and has promised to send these tools to Dawn. In addition, any of the VEBA groups can collectively, by vote, decide NOT to participate in the VEBA program. (The program is not voluntary for individuals, however, the group they are included in does vote on whether or not to participate. Individuals within the group must then go along with the vote.) Employees who are on TRS have been excluded from participating in VEBA. Employees who are on TIAA CREF may count sick leave in both HAS and VEBA.
MSU currently has five VEBA groups:
- Union/classified - The teamsters union recently voted to opt out so they are excluded, but all other union employees who are over 55 are included.
- Non-union classified group - 55 years and older
- Extension employees - per their request, all are included regardless of age
- Faculty - 59 years and older (members of TRS excluded)
- Professional employees - 55 and older
- Traditional Plan
The following web page has some FAQ's about VEBA: http://www.montana.edu/staffsenate/veba%20faqs.html
SURVEY REGARDING HEALTH PLAN TRANSITION: Chris Fastnow attended to answer questions. She explained that the data is better if we have a high percentage of surveys returned from a stratified sample, than if we send the survey to every employee and get a low percentage returned. It is also more cost effective to do a stratified sample. The committee agreed using samples stratified by employee group (classified/prof/faculty/extension) as well as by the plan (Allegiance/Blue Cross Blue Shield HMO/New West HMO) would be fine. The question then came up whether we should include the other MSU campuses in the survey. Some of the personnel folks were meeting with representatives of the other campuses and agreed to discuss with them. The committee is fine with including the other campuses or not based on that meeting. This survey will be done now and we will do a larger survey late in the summer prior to the RFP being awarded for the new contract.
There was a question as to who would be on the RFP writing committee. No one knows but we will try to find out so that we can hopefully avoid some of the concerns that developed with the last RFP.
ALLEGIANCE EXPLANATION OF BENEFITS FORM: Some retirees have complained that the EOB is not as clear or easy to read as it was with Blue Cross/Blue Shield. Non-retirees don't seem to have the same concerns. The issue might relate to Medicare. We have a couple of committee members who will compare an old BCBS EOB with the new Allegiance EOB so that we can identify the specific problem and develop a solution.
Personnel and Payroll staff has worked hard to get Allegiance and BCBS together to work out issues with Medicare claims which have occurred since the transition. Last month there was a meeting with all parties which hopefully will resolve some of the problems and get the processing of Medicare claims back on track. KUDOS to Susan, Dawn, Kerri, Heather, Lisa and any others who assisted with this effort!
MAMMOGRAM UPDATE: The Hospital Board of Directors and the doctors of Advanced Imaging met on December 21st to discuss potential solutions which would allow our employees to continue the same type of mammogram program which was available prior to Advanced Imaging changing their name and getting their own facility outside of the hospital. More questions came from that meeting and no decisions were made. The group was getting together again January 11th. We have not been updated regarding any outcomes from that meeting. Beginning in February, Bozeman Deaconess will be able to do MRI mammograms (advanced diagnostic) rather than sending people to Billings.
WELLNESS UPDATE: Wellness subcommittee of IUBC has met twice -lots of response and discussion. They would like to begin doing some targeted messaging in the next fiscal year and will be asking for $12,000 to cover the costs of compiling data, mailing, etc. Targeted messaging is being used in many states and large companies to help improve overall health by changing lifestyles and offering direct options. Accomplishing this goal would require employees to sign a HYPPA agreement with re-enrollment to allow MAHCP and case managers access to personal information. At this time only the OCHE Director of Benefits and his staff have this information. We send data without personal info to MAHCP to compile statistics, but nothing can be linked to an individual. The Bozeman Benefits Committee had some very strong concerns about rushing something like this to try and get HYPPA language into the next enrollment period. We would like to take more time and do it correctly - have some research on how the state process is working and how this type of targeting has been met by others. Some companies offer lower premiums to people who participate - could we? Who would the letters come from? Would employees have the ability to "opt out"? Barb will try to get more information and share our concerns with the IUBC.
OTHER: Pharmacare - the online history only goes back six months rather than to the beginning of the year. Is there a reason? In the past this has been a great way to get information for tax purposes. Doug will look into this.
Retirement Subcommittee of IUBC: Mike Boysza (Chair), Norma Tatarka and Doug Young had a conference call with Glen Leavitt. They discussed: Medicare Part D: May have plan in place by July 1 or perhaps join with state of Montana and start Jan 1, 2007. Glen to bring options to retiree committee. Rebid 403(b) and ORP: Admin subcommittee to handle. Dental Plan for Retirees: Glen will approach consultants/providers and ask for quote. Voluntary plan more costly than mandatory. Adjusting premiums between large deductible and other plans for retirees: Glen to analyze/discuss with consultants and bring options to committee. Premiums originally set by estimating that large deductible plan was "worth" 85% of normal plan. Managed care options for retirees: State offers all types of plan to its retirees. Glen will bring options to retiree committee. Retiree appointee to IUBC: Glen notified UM who says "they will" have someone.
The next meeting will be February 9th at 8:00 a.m. in SUB 272.
December 5, 2005 - Jodie Delay reports
MAMO UPDATE - Barb: Barb, Doug and Bob McKenzie met with Don Majerus (Deaconess), and Tamar Bartz, Rich Wallace and ? of Advanced Medical Imaging. The MSU group expressed concerns about the changes that resulted in the loss of "one-stop" mamo + clinical. Advanced Medical Imaging are radiologists and won't be responsible for clinical exams. AMI and Deaconess are meeting later this month and will consider if they can better accommodate MSU.
Committee recommended that IUBC carefully consider and review the potential for adding an annual preventative screening for men and women under our plan. The screening could be age and gender specific but should include the preventative screens which are generally suggested by the medical establishment for basic wellness. Also, once it is clear which tests and office visits are acceptable with our plan (either as is or as amended), we would like to have Allegiance send a letter to all preferred providers that clarifies how screenings should be coded.
DOMESTIC PARTNER DECLARATION: Committee decided to ask the IUBC Administrative Sub-committee to review potential legal and procedural concerns.
SURVEY: Craig Roloff recommended that a survey be done to collect data on the satisfaction that people have with Allegiance, New West and the Blue Cross HMO. The Benefits Committee was asked to be included in the introduction of the survey. We agreed that we should be part of the survey, but thought since we have had very little time transitioning to the new administrator and PPO plans, it might be better to use the initial survey to identify any problems that there are or have been with the transition. A second survey could be done again later, before the RFP, to gauge the response to these problems and general satisfaction. Susan Alt will work with group to make changes to survey and circulate back to Benefits committee before it is completed. RETIREE DENTAL BENEFITS: Ken inquired about when/why dental benefits for retirees were dropped. No one could recall a time when retirees had dental benefits, so if there was ever such a thing it would have been more than twenty years ago. Discussed the possibility of adding the benefit. Concerns were raised about the potential cost of the program. It would likely have to be optional as even a marginal premium would be difficult for many retirees to handle. With fewer people enrolled the cost might be prohibitive. The question then came up about the possibility that we could "subsidize" dental insurance for retirees at roughly the same rate as the subsidy for health insurance ($.12/dollar). It was brought up that people do have the option to purchase COBRA for dental and health insurance for 18 months after they retire or leave MSU. This is new since Allegiance came on as our administrator.
There was discussion regarding the need to collect some data about why we are losing retirees from our plan. We assume that it is because of the cost of the premium, but don't have any data. The committee asked the representatives of the IUBC Retiree Subcommittee to take this to the next meeting for discussion.
CEPAC INITIATIVES: The Benefits Committee appreciated hearing about CEPACs thoughts on the Benefits Smorgasbord, etc. They will wait for CEPAC to define their plan and evaluate as more details are available. Please continue to keep the Benefits Committee in mind as work continues.
MPEA UNION REP.: Janae Heap has resigned from the committee so we need to find a new representative. Susan will ask Quint Nyman to put out a request to MPEA members to see if anyone is interested. The committee will think about colleagues who might be suitable. This person will also serve as a representative on the IUBC.
VEBA: Susan will ask someone to attend the next meeting to provide and update.
NEXT MEETING: The next meeting is tentatively scheduled for January 12th at 8:00a.m. in the SUB.
October 6, 2005 - Carol Shannon reports
IUBC report - Revenues exceeded expenditures this past FY and the same is expected for this FY. In FY 07 the state will pay an additional $50/month per employee. There will probably be no increase to out-of-pocket costs for employees for next FY 07. The premium for retirees will likely increase similar to the increased state contribution for employees.
The MUS has a registered nurse to assist employees in cases where there is a "serious diagnosis" (e.g. terminal diagnosis, problem pregnancy, etc.). She will help with negotiations for wheelchairs, air evacuation and general case management. There is no deductible and no co-pay. Call Personnel and Payroll Services for more information.
There is still no retiree representative on the MUS Benefits Committee.
Other items - There has been no response from the letters sent to the dermatologists and allergists in Bozeman, with the exception Dr. Brian Rogers. Dr. Rogers does not want to become a preferred provider with Allegiance because of the time and expense in handling claims. He currently does not balance bill and does accept BCBS allowables.
There have been some complaints about the slowness in turn around time for claims with Allegiance.
New West will be the carrier for Bozeman Deaconess Hospital as of July 1, 2006. At this time New West will not sign with the Surgery Center. As a result, the Bridger Orthopedic doctors who use the Surgery Center are currently unable to sign on with New West as preferred providers.
Currently, the MSU Benefits plan is a qualified substitute for the new Medicare prescription plan and creditable coverage letters will be mailed in November. The MUS plan does not, however, qualify for the federal subsidy that can be given to some plans that cover retirees on their prescription coverage. However, retiree coverage options will be researched for the next plan year (7/1/06) with the hope of being able to qualify for the subsidy. Right now, MUS individuals who qualify for Medicare are being encouraged to wait to sign up for a prescription drug plan until the MUS Benefits plan has been reorganized.
Advanced Imaging is the only place in Bozeman who performs mammograms. At the time of this meeting, they were not preferred providers with Allegiance and this was a concern since employees would be balanced billed for diagnostic mammograms (screening mammograms would be covered 100% but would cost our plan more). They did sign with Allegiance on October 11, 2006. Employees still need to see a physician for a breast exam and to get a prescription for a mammogram.
There is some confusion as to what benefits are considered "Wellness" benefits. The MSU Wellness director was not able to attend the meeting due to off-site Well Checks.
September 22, 2005 - information supplied by Personnel and Payroll
Services, circulated by CEPAC via the classified listserv:
Faculty Council, Professional Council, and the Classified Employee Personnel Advisory Committee (CEPAC) have received some inquiries from their constituents about dealing with issues from the switch from Blue Cross Blue Shield to Allegiance and/or the new managed care plans (New West and Blue Cross Blue Shield). Here is a list of where you should go with questions.
Medical Claims Questions: Contact your plan administrator directly
Blue Cross Blue Shield 1-800-820-1674
New West 1-888-500-3355
Dental Claims Questions: Contact Allegiance directly 1-877-778-8600
Insurance Card Replacement: Contact your plan provider directly
Blue Cross Blue Shield 1-800-820-1674
New West 1-888-500-3355
If you have contacted your Medical plan administrator about an expense that has
been covered in the past and now is not covered or some other unusual circumstance then
Kerri Marx (Beneifts Manager) email@example.com or Heather Barnaby(Insurance Specialist) firstname.lastname@example.org
Personnel and Payroll Services, 994-3651
Faculty and staff who have comments about the switch from BCBS to Allegiance and/or the new managed care plans (New West and BCBS) can contact members of the MSU Benefits Committee, including Douglas J. Young, Debbie Haynes, Robert Johnston, Carol Shannon and Jodie Delay. http://www.montana.edu/pps/NewEmployee/NEBO/MSUBenefitsCommitteeMembers.pdf
Claims decisions can be appealed to Commissioner's Office: Shelly Murphy Benefits Representative 444-0330 email@example.com
Upcoming health care sessions on campus:
-New West Health Services Representatives will be on campus to answer your questions: September 22, 2005 11am - noon Noon - 1pm 1 - 2pm SUB Ballroom D Can't attend a session? Contact New West at 1-888-500-3355
-Allegiance, BCBS, and New West will be on campus for the Wellness Fair which is scheduled for November 8th and 9th from 7am -11am in the SUB Ballrooms.
September 12, 2005 - Jodie DeLay reports:
ALLEGIANCE: Overall positive reports on transition. Staff has been responsive and easy to work with. Turnover time has been a little slow, but at this point, not a big issue as staff is working to address the situation. The benefits committee is sending a letter to five local physicians, mostly dermatologists, to ask them to either join the Allegiance network or to sign an agreement to not balance bill MSU employees.
BLUE CROSS HMO: There have been some significant problems to date including the very late mailing of benefits cards and, in some cases, doctors being listed as providers who were not. About 100 employees signed up for this option. Personnel is considering each complaint and working to find solutions.
NewWest HMO: No problems.
Immunization Benefit: MUS plan includes only $250 for immunizations from age 0-2 and providers charge significantly more than that. The County Health Department does these shots for $10.00 each - we need to better advertise/promote that option for people.
Change in mammogram benefit: Advanced Imagery will now be doing mammograms at their facility, located in the hospital complex, but not at the hospital itself. Because they do not have nursing liability, women will now need to see their physician for the clinical breast exam, get a prescription for their mammogram and then schedule the mammogram separately. Wellness is looking into this situation to see if there is a remedy. MSU is the only institution that previously had the one-stop mammogram benefit (women received a prescription from wellness and then reported to radiology at the hospital for a clinical breast exam and mammogram).
Medicare Reform Act: Glen Leavitt is hoping to set up a meeting to discuss the ramifications of this on our retirees/employees. For now we are recommending that people stay on our plan, and don't worry about making a hasty decision to meet the November 1st deadline. Because we are a qualifying plan, retirees will not suffer any penalty if they decide later to switch. However, once someone leaves our plan, they can not come back. We need to figure out how to get this info in front of people. We will look at including in the next Choices later and possibly a mailing to our retirees.
IUBC: We are continuing to work to get a retiree appointed to the IUBC. Cathy Conover has talked to Sheila Stearns and we will pursue.
TIAA CREF/PERS/TRS: Retirement benefits are also part of the Benefit Committee's charge. Currently TRS has an unfunded liability. The legislature, perhaps during the special session this winter, will need to find a solution to this situation. Employer contributions to TIAA CREF are less than to TRS/PERS already, in fact they are the lowest in the nation. Employer contributions to all the plans are low compared to other states. Is it time to lobby for more funding? How do we protect our employees from having the unfunded liability paid for by employees? We will ask Glen Leavitt to put this issue on the IUBC agenda and will continue to follow issue and hopefully be able to be proactive.
Well Check: Set for November 8 and 9. Anticipate having plenty of flu shots.
June 20, 2005 - Campus announcement:
2005-2006 CHOICES Re-Enrollment is wrapping up!
A letter from Personnel and Payroll Services confirming your CHOICES selections for the upcoming year will be arriving in campus mail next week. Read this confirmation letter - if you find an error contact Personnel and Payroll Services immediately at 994-3651 or email firstname.lastname@example.org.
A "Welcome Packet" from Allegiance will be arriving at your home address next week in a Montana University System Envelope. If you turned your enrollment form in late you may receive your card later this month or after July 1st. In order to insure timely claims processing provide your doctors/dentists/pharmacists your new insurance card for any services rendered on or after July 1, 2005. Following is the Allegiance group number for our campus: 9500025. The Allegiance Customer Service toll-free number will be available for your use beginning July 1, 2005. (1-877-778-8600)
*Please note that if you have chosen medical coverage through New West Managed Care or Blue Cross Blue Shield Managed Care you will use your Allegiance card for dental appointments and prescription drug coverage and will be receiving a separate card from New West or Blue Cross Blue Shield for your medical Insurance coverage.
June 2, 2005 - Carol Shannon reports: the Benefits committee will have a special meeting in July since so many changes are taking place July 1. We haven't had a meeting since the last report.
May 3, 2005 BCBS Managed Care will be on campus to present two additional information sessions on Thursday, May 5 from 10am-11am and from noon - 1pm in the President's Conference Room.
April 28, 2005 - Carol Shannon reports: the MSU Benefits committee had its meeting on April 28. (Carol and Jody in attendance)
If anyone at the meeting sees anything that needs to be corrected and/or added, please let me know.
SSNs will be sent to Allegiance for everyone at MSU except those individuals who already had generated IDs with BCBS (80+ individuals). These numbers are necessary for transferring data from BCBS to Allegiance. MSU employees will have the opportunity later to request a generated ID from Allegiance. ID numbers will not be printed on the ID cards since for the majority of the people it would mean their SSN.
There may be some tax implications for insuring domestic partner and /or children over 19 who are not attending school. More information about this to come later.
There are some issues with electronic submission of claims from Allegiance to Medicare. Allegiance did buy software to handle this but do not have it working yet.
There is some confusion with the BCBS HMO. Some people are thinking they have a choice of staying with BCBS for the traditional plan which is incorrect. BCBS is in the process of establishing a local network in Bozeman for their HMO. It was not in the Choices booklet since it was not available at the time the booklet was printed.
"Marriage Penalty" - Currently, when both spouses work at MSU there is not a "family" deductible. This will be presented to IUBC at their fall meeting.
"Marriage Benefit" - Currently, when both spouses work at MSU and there are 2 children attending college in the MUS, both children will get the dependent tuition waiver.
There are currently 3 VEBA groups designated at MSU: Faculty (60 years +), Extension (all individuals), and Classified Professional Union Exempt (55 years +). The committee received letter from an employee asking if the University System could follow the lead of the State and institute a "pre-retirement option" in addition to the sick leave for the VEBA. This will be presented to the IUBC at their fall meeting.
There is some confusion as to whether sick leave monies designated to go into a VEBA are eligible for retirement. This issue is being explored by Personnel and Payroll folks.
Barb Wheeler has been hired as the new Wellness Director. She will begin around June 1. Barb worked with the MSU Well Program for many years.
The MSU Benefits Committee does not usually meet in the summer but with so many changes taking place they are planning on meeting in July.
April 27, 2005 - click here to review frequently asked questions about VEBA
April 25, 2005 - announcement from Personnel and Payroll Services:
Attend an information session to find out more about which Bozeman doctors are members of New West Health Service, & details about the plan!
Wednesday, May 4th at 7 am, 8.30 am, 10.30 am, and noon. All sessions will be presented in SUB Ballroom B.
April 21, 2005 - CEPAC announcement:
CEPAC has received calls from staff with questions about the inclusion of managed care options (in the Bozeman area) as part of the CHOICES package. This is an important new option to consider and Personnel and Payroll Services is working hard to bring us information in this regard.
The two organizations offering managed care here are Blue Cross Blue Shield and New West. Both are coming to campus (BCBS on Thursday, April 28th 8 am and 10 am, President's Conference Room) and New West (time/date TBA) to give information and answer questions. Dates/times/venues of presentations will be announced via the President's Office listservs.
April 11, 2005 - President's Listserv announcement:
The Allegiance Website is live!
To check whether your provider is a member, check their website at www.abpmtpa.com/mus. Click on "Find A Doctor". For In-State providers, click on "Allegiance Multi-Provider Search". For Out-of-state providers click on "National Network.". If you discover that your provider is not a member, you can fill in or download a provider nomination form at http://www.abpmtpa.com/mus/providernominationform.pdf and Allegiance will attempt to obtain a contract with your doctor.
To learn more about the transition of third party administrator from Blue Cross Blue Shield to Allegiance Benefit Plan Management, please attend the CHOICES Insurance Update on Monday, April 18th, 9am-10am, in Roberts Hall Room 101. Other topics to be discussed are: Retiree Premium Changes, Colonoscopy Coverage and Dependent Premium Waiver. The update will be presented by Glen Leavitt, Director of Benefits, Commissioner of Higher Education's office, MUSBenefits@oche.montana.edu.
April 1, 2005 - Carol Shannon reports:
My understanding is that Allegiance isn't prepared to handle generated id's for the entire university system at this time. If employees at MSU wish to have a generated id used with Allegiance they need to contact Dawn Watkins in Personnel and Payroll. Personnel and Payroll will manually edit the file sent to Allegiance to change the ID number that is sent. Currently there are about 20 people at MSU who do not wish to have their SSN used for their id. SSN's will not be printed on the id cards. Employees will receive their cards around 6/17.
Dawn Watkins (PPS) adds: we are working very hard on not using soc sec numbers for ID numbers concerning the medical insurance. For the time being there is a strong chance we will be using our generated ID numbers.
Announcement via the President's Listserv:
Allegiance Transition Task Force Update
The network of doctors in the Bozeman area is currently available at the following
website: http://www.montana.edu/pps .
[Carol adds: The state and national networks will be provided later. The list of local doctors was available now. Our insurance plan will provide coverage for doctors outside of Bozeman, both statewide and nationwide]. If you live in the Bozeman area and do not see your doctor listed, please complete the nomination form also found at the above listed website. This nomination form should be returned to Allegiance so that they can contact your doctor and begin contract negotiations. The network listing of doctors outside of the Bozeman area is currently unavailable; you will be notified when it is available.
InterUnits Benefits Committee UpdateThe Spring Meeting was held on March 10, 2005. Following are changes to the plan effective July 1, 2005.
*Preventive Colonoscopies will be covered once every 10 years beginning July 1st for people age 50 and older
*The Dependent Premium Waiver was approved as a 2 year pilot program. Employees who make $25,000 or less and cover dependent children may apply during CHOICES re-enrollment to have their insurance premium for their children's medical coverage waived.
*There will be no increase in employee premiums for the 2005-2006 plan year. Employees who elect to be covered on a Managed Care Plan will see a decrease in their premium. Retirees will see a 4% increase in their premiums.
*There will be a lifetime maximum of $2,000,000.
*Mammograms will no longer be on an age schedule - they will be available at any age as a preventive coverage
*Dependent Children will be eligible to remain on the plan until age 25 as long as they are an IRS definable dependent
*1 pair of glasses or contact lenses will be covered on the medical plan after cataract surgery
Upcoming CHOICES re-enrollment meetings
CHOICES Insurance Update: Monday, April 18th , Roberts Hall Room 101
?Transition of 3rd Party
Administrator from BCBS to Allegiance
?Retiree Premium Changes
?Dependent Premium Waiver
Presented by Glen Leavitt, Director of Benefits, OCHE, MUSBenefits@oche.montana.edu
CHOICES Help Sessions: SUB room 106E, Monday, April 25th - noon to 1pm;
Tuesday, April 26th- 3:30pm - 4:30pm;
Friday, April 29th noon-1pm
March 10, 2005 - Don Mathre reports on the IUBC meeting:
It was a most interesting meeting. The vote to cover colonoscopies passed on a 10 to 9 vote. The folks voting against it were mainly interested in getting more economic information, but I voted for covering them since I felt we had enough info to go ahead for a trial period. The affordability measure passed easily but we reduced the maximum salary to $25,000 instead of $30,000 just to see how many folks would sign up and how much it would cost the system in the first year of operation. The other main thing that was passed was to institute a $2,000,000 life-time maximum on health insurance coverage. This was to make it comparable to the max allowed by the HMO's. I voted against it, but I also don't think it is that big a deal at the current time. Perhaps sometime in the future. Other than that we did approve the premium changes that Glen [Leavitt] suggested which were basically those that we received a month ago.
March 9, 2005 - updates discussed at CEPAC monthly meeting:
Third Party Administrator Task Force. Janae Heap, member of the Third Party Administrator Task Force, had sent an update, and Dawn Watkins spoke of continued meetings with Allegiance every other week. Hold ups in the selection of hospital network members has delayed the publication of the provider list on the OCHE web site. However, Personnel and Payroll Services will shortly publish the Bozeman provider list via its web site. A discussion took place regarding Allegiance's proposed continued use of SSN rather than GID. The SSN will not appear on the membership card, but will play a role in the claims process. Dawn has repeatedly questioned this practice and will follow up again, asking for a description of the security processes Allegiance has in place, and establishment of the reasons why a GID cannot be substituted.
Dependent Health Insurance Premium Fee Waiver. Janae Heap, member of IUBC, had sent an update and Dawn Watkins reported that IUBC will vote tomorrow on recommending the proposed two year pilot program to the Commissioner. If approved by IUBC and the Commissioner, the issue will progress to the Regents this month. The pilot provides for employees making less than $30,000 annually (MSU income only, and without reference to spousal earnings) to apply for a waiver of the premium to cover dependent children ($60-100 per head). Funding for this pilot comes from the benefits pool.
Health Insurance Premiums. Dawn Watkins reported no premium increase, other than 4% for retirees.
Colonoscopy. Janae Heal, member of IUBC, had sent an update and Dawn Watkins reported that discussion of a plan to cover colonoscopy is under way. Preliminary ideas include the first free colonoscopy at aged 50; the regularity of screening thereafter is still under review.
Common Law Health Coverage. Montana recognises common law partners, and yet the current MUS health insurance policy does not provide coverage to unmarried couples. Dawn Watkins spoke of a proposal, on which IUBC will vote tomorrow, under which employees could cover unrelated adults via their health insurance eligibility. It is possible, if passed, that this plan will be presented to the Regents as soon as this month.
February 9, 2005 - Jodie DeLay reports:
- Report on IUBC meeting on Feb. 1: Our plan is in good financial shape with about a $6million reserve this year alone. IUBC supports no major changes in premium's etc. but would like input from campuses.
- Report on Transition Task Force: Group is meeting bi-weekly (please see Janae's report). The OCHE web page is running a little behind schedule, largely due to the untimely death of Linda Ryckman who worked in Glen Leavitt's office and the legislative session ~ not Allegiance. They have made great strides in signing providers in Montana. The Benefits committee continues to have concerns about the nationwide provider network and is anxious to see the list. The committee also continues to feel that the design of the card will be critical to the service provided outside of Montana and looks forward to being briefed as the design is developed.
- Consider final affordability proposal: This is the proposal to use funds from our plan to help supplement the cost of insurance for the children of low income employees. The IUBC will vote on adding this benefit at their March 9th meeting. The details are as follows: the program will be an expense to the plan (similar to the Wellness Program and annual admin costs), the IUBC will approve the expense annually as it does the other expenses, the program will be evaluated as a two-year pilot to determine the impact on eligible plan members and the cost to the plan, eligibility criteria include an annualized wage of $30,000 or less and an IRS definable/verifiable dependent enrolled in the plan. (coverage of spouse is not included), premium waiver granted to employees who actively select the waiver. The benefit would cover the additional expense of insuring dependents only. The benefits committee was supportive of the plan for several reasons. First, our plan has sufficient reserves at this time that this will not have a negative fiscal impact. Second, this would be a significant benefit to our lower-paid employees. We would wish to make sure that people are aware that this is a two-year pilot program and that depending on the actual cost to the plan, etc. it could change or be eliminated. As with other programs, even after the pilot-program it would be reviewed annually.
- Consider premium changes for next year: There is no plan to make any change to the premiums of currently employed folks, assuming that the legislature passes the current bill which adds $46.00 contribution from the state. This will be voted on at the March 9th meeting. Those who switched to the HMO would actually see a decrease of $34 -$45. There is a proposal to increase the out-of-pocket premium for retirees by $11 - $23. This is smaller than was projected and is necessary because the state doesn't contribute to the retiree premium. Another caveat is that we do NOT go to the Medicaid pharmacy program. This will be discussed at the March 9th IUBC meeting. The committee felt that the Medicaid pharmacy program was not a good idea, based on various background knowledge, and hoped that it wouldn't be considered strongly. This is another area where solid and extensive data would be needed before recommending.
- Consider a lifetime maximum benefit policy: Currently our plan has no cap on the amount of benefit that can be paid. There are some who think we should consider placing a cap. The rational is that hospitals etc. consider this cap when billing expenses and may charge less if there is a cap. The committee discussed the need to have significant data in hand before this was considered. There would need to be strong evidence that NOT having a cap is hurting the plan for it to be a positive change. Setting limits for no real purpose would not be a benefit for our plan or the individuals that use the plan. Data, data, data.
- Consider a proposal to pay for colonoscopies as a screening program: Our plan already covers colonoscopies that are done for specific concerns or by doctor's suggestion. This proposal would have the plan pay for a colonoscopy for people 50 and older, for the purpose of screening. The proposal would be to pay for one every 5 - 10 years up to the age of 65, when Medicare covers the cost. The committee was strongly supportive of this as it could well save the plan costs, and lives. Again, the committee would like to see data - number of employees with colon cancer, cost of claims, etc.
- Domestic partner policy: This is a Board of Regents issue. Glen Leavitt is drafting a policy to define who qualifies as domestic partners. We will wait to see what is developed.
- Terms of office for committee members: Don Mathre will investigate the rules and bylaws of the committee to see who should be reappointed, whose terms are complete and who is eligible to be the chair person.
- Spring Campus Meetings: We will have meetings on March 1st to discuss the affordability plan, proposal to not change premiums and proposal to offer colonoscopies. We will advertise via staff bulletin, listserv, and the personnel and payroll web site.
Update: The Ask an Expert trial has had great call volume. The experts are overloaded with emails and requests. We have no results, at this time, regarding customer satisfaction. There have been some complaints. Laci would recommend that we try to have experts from our own campus for this effort.
January 13, 2005 Jodie Delay reports: Lacy Hintzpeter gave an update on a number of activities within the wellness program.
Ranger Website - Security is very strong on our network. We use banner numbers rather than social security numbers and everyone signs a HYPPA agreement.
CHOICES - next edition will feature wellness
ASK an EXPERT - Four-month trial program will begin early in February on a first come, first serve basis. Benefit provides one-on-one consultation with a registered dietician (Food4you2@msn.com) or exercise specialist (email@example.com). For full detail, please visit http://www.montana.edu/wellness/event_asktheexpert.html.
Spring Wellness Fair - March 22, 2005
Fall Wellness Fair - November 8 and 9, 2005
In process of linking the Ranger database (wellness efforts) with the state claims database so that we can identify trends and be proactive with our wellness program.
Flu shot is covered 100% by our insurance (up to $75.00). It is part of our immunization benefit. The County Health Department has flu shots available, by appointment only, for $17.00. Call 406-582-3100 to make an appointment.
Affordability Task Force: Our committee's recommendations to the IBC after our last meeting were to annualize the salary when determining if a person is eligible and to require people to apply to receive the benefit. The IBC adopted both these suggestions and the proposal currently being discussed is to cover the additional insurance premium for children (not spouses) of low-income employees (currently being defined as having an annualized salary of less than $30,000) if they apply for the benefit. IUBC was told that $500,000 is the most it will cost the plan. The inter-units benefits committee will vote on whether to adopt this benefit at their meeting on February 1st.
New West Health Services HMO: About 25 people signed up during the enrollment session.
Liberty Mutual -we will not do payroll deductions
Senate Bill 72: a retirement incentive that would pay one year of health insurance for every five years worked for employees who retire within a small window. As drafted, the person must be eligible for retirement. Also, as drafted, the bill is unfunded and calls for vacancy savings to be used to cover the cost. The committee suggests that the university oppose this bill.
December 16, 2004 Carol Shannon reports:
- New West Health Services (aka Managed Care Health Option, CHO Health, HMO)
Employees are currently able to sign up for this plan which will start January 1, 2005. I explained to Kerri Marx that there was quite a bit of confusion as to the email posting on the President's list serve because of the wording of the name. The suggestion was made to put all of the literature/information, that PPS is currently giving to employees who request more information, on the PPS website. Once that is done, another email should be sent out that clears up the name confusion and that provides a link to the information on the web.
- VEBA (Voluntary Employee Benefit Account)
This is a new program that allows employees to put unused sick leave in a tax free VEBA when they retire or leave the university. This money can then be used for medical purposes. PPS is in the process of defining groups that will then vote on whether or not they wish to participate. Once the group is defined and votes, every member in that group has to follow the group's decision. You don't have the option as an individual to decide whether or not to participate. At this time there are no groups defined for classified employees. If you have questions, please contact Kerri Marx or Susan Alt.
A letter from Glen Leavitt, Director of Benefits (OCHE), will be sent to all Metropolitan Life 403(b) participants stating that Randy Knowles has lost licensing for both insurance and securities in Montana and should not be meeting with employees on any MUS campus to service any 403(b) supplemental retirement programs. The names of the individuals who will be handling the Metlife accounts will be sent to MSU employees in the near future.
- Transition Task Force
The Transition Task Force, which is handling the transition from BCBS to Allegiance, will now start meeting bi-weekly. As of yesterday the Allegiance contract had still not been signed but it should be signed very soon. At this point, 93% of the doctors in Bozeman have signed with Allegiance and all medical centers. Allegiance is now working on contacting and signing non-MD professionals. Allegiance has been successful in landing contracts with other large companies - D.A. Davidson, Northwestern Energy, Washington Mutual and Town Pump. As soon as the contract is signed, information will be available on the OCHE website. I requested that an email be sent to all employees providing a link to the website. I also requested that the website include a list of local doctors as well as the other networks that have been contracted so that employees can find out if their personal doctors (both in-state and out-of-state) have contracted with the Allegiance network.
- Affordability Task Force
This task force is working on a plan to help lower income employees, with children as dependents, in getting monetary assistance with their health insurance costs. This money is budgeted out of the medical account (the same account that funds Wellness). The two recommendations from our committee today were 1) to adjust the salary by the FTE when determining whether an employee qualifies (e.g. if an employee makes $25,000 and works halftime - .5 FTE - then the salary used to determine qualification would be $50,000 for that employee) and 2) every employee who wishes to receive the benefit must fill out an application.
- Search for new Wellness Director
The search committee has been selected and will start meeting in January.
November 10, 2004 Neither CEPAC representative could be present at the November 10th meeting. However Carol Shannon relayed a message from Benefits Committee Chair, Don Mathre in which he reported "most of the discussion [at the meeting] was what issues would need to be covered by the transition task force. That will also be our main topic of discussion at our next meeting". Jodie DeLay reported that the Benefits Committee is awaiting confirmation of the contract with Allegiance having been signed and, subsequently, the informational web site going live (possibly next week). Meanwhile, many employees' questions were addressed when Allegiance and the Director of Benefits, Office of the Commissioner of Higher Education, came to Bozeman on October 19 - a summary of which was circulated from the VP for Administration and Finance's office on October 22. Next Benefits Committee meeting will be December 16.
October, 13, 2004 Jodie DeLay reported that on September 29th at the Inter-Units Benefits Committee meeting, a list of MD's from the Bozeman Area was presented to Bozeman representatives. According to the list, which was compiled by the Commissioners Office, one provider shy of 90% had signed with Allegiance. 90% was required in order for a contract to ultimately be awarded. Other questions that the Bozeman Benefits Committee had raised were not addressed in writing. In addition, there was some concern regarding the meaning of "signed". Some area providers told representatives from the Bozeman Campus that they were not providers, when Allegiance indicated that they had signed contracts.
Three staff members from Allegiance, as well as Glen Leavitt and Cathy Swift from the Commissioners Office, met with the Bozeman Benefits Committee on Tuesday, October 12th. They responded to questions and provided information.
Glen indicated that the Commissioners Office was aware of the concern about whether contracts were in place and had asked for an audit of the list of MD's Allegiance had indicated had signed. The audit showed that a "memorandum of agreement" had been signed by all of the physicians that were listed as "signed". Allegiance stated that it would have detailed contracts in place with each provider listed as signed once they are awarded the Third Party Administrator Contract. Some of the providers have formally signed extensive contracts directly with Allegiance to serve other contracts they have with other employers.
Allegiance representatives indicated that they would do everything possible to sign as many ancillary service and specialty care providers as possible if they were awarded the contract. They offered to supply us with a list of these that are currently on board.
Allegiance representatives indicated that if they receive the contract, when an employee needs service out of state, the service provider can access the Allegiance website 24 hours a day for verification of benefits. Also, if the contract is signed with Allegiance, their web page will be updated for the MUS to show MUS providers in all areas and customer service representative would be well trained to answer any questions. Out of state employees will be provided with information regarding providers that are members of the network of third party administrators with whom Allegiance has contracts.
Allegiance representatives stated that they were testing their software which should provide a smooth claims process for Medicare patients and were comfortable that they would be in position to offer a smooth, simple process by the time the plan year started in July.
The question was asked, "what do we stand to gain from making this change?" and the response was that we would have improved service through a better web interface, have better flow of data from an administrator perspective and would have customer service representatives dedicated to the MUS contract.
Allegiance representatives indicated that providers within the network would continue to file patient claims, would enjoy claim processing times of around two weeks and would not balance bill. They indicated that they had a strong support network and generally had very positive responses from providers that they currently work with. In addition, they have taken over other plans from Blue Cross and Blue Shield and those transitions have been smooth. They agreed to work with us, if they receive the contract, to put together a FAQ and other information to help fully inform our employees of changes, enhancements, etc. They also agreed to have a regular presence in Bozeman, similar or better than that which Blue Cross Blue Shield currently has.
Allegiance representatives agreed to come back to Bozeman next week to meet with CEPAC and I agreed to compile a list of questions to send them in advance of that meeting.
To fully address the questions and concerns of classified employees, I look to CEPAC to take the pulse of our constituents to make sure that we have the opportunity to at least ask for information necessary to determining whether we, as the Bozeman Benefits Committee, should recommend that the contract with Allegiance be signed or not. Ultimately, however, the decision to sign the contract with Allegiance or to enter into a new RFP process belongs to Commissioner of Higher Education, Sheila Stearns and NOT the Benefits Committee.
If CEPAC can provide a list of questions, I will see to it that the questions are presented to Allegiance so they can respond at the meeting next week.
September 15, 2004 - Jodie DeLay reported that the MSU-Bozeman Benefits Committee met with President Gamble for an update on the status of the possible change from Blue Cross Blue Shield to Allegiance, 7/1/05. Since then the Commissioner's office has requested a written response and supporting documentation from Allegiance to address the concerns that the MSU-Bozeman Benefits Committee has over preserving the level and standard of coverage in such a switch. These responses are due to the Commissioners Office by the end of September, in time to give the Bozeman Benefits committee and the I.U.B.C. a chance to review before passing a recommendation to the Commissioner's Office by October 29. Jodie reported President Gamble to have expressed confidence that Allegiance is endeavoring to meet MSU-Bozeman's needs.
August 11, 2004 - Jodie DeLay and Carol Shannon gave an update to the May 12, 2004 report. Brief history: the administration of the university system's health insurance program was put out to bid for a new contract commencing July 1, 2004, as the previous contract was expiring. Allegiance received the most points in the RFP process and was recommended as the successful bid. Blue Cross Blue Shield submitted a counter bid and matched the costs offered by Allegiance. Due to concerns about Allegiance's coverage, including an insufficient network of providers in Bozeman, MSU requested confirmation of the contract be delayed. Blue Cross Blue Shield was given a one year contract extension at the lower bid price until June of 2005. The inter-units benefit committee has been asked to give a recommendation to Commissioner Stearns at the end of October as to whether Allegiance has built a satisfactory network in the Bozeman area and responded to other issues, or whether the contract should be re-bid. Jodie and Carol reported that meetings are scheduled to pursue complete and accurate communication around this issue, and to ensure MSU has opportunity to review the network documentation. Jodie and Carol will contact CEPAC officers when there are further updates and work with CEPAC to inform staff of any changes in the program's administration.
July 7, 2004 - no report.
October 14, 2003, Note from Carol Shannon: Here is the report that Don Mathre presented to the MSU Benefits committee on 10/14. As you have probably seen in the paper recently, medical and pharmacy costs everywhere are continuing to rise and there is a concern as to what shape our plan will be in in two years. The MSU Benefits committee hopes to meet with President Gamble in November. Benefits Overview: Blue-Cross/Blue Shield of Montana which administers the medical insurance program for MSU employees has reported that because of inflation and increased utilization of the health system that costs are up 9.5% in Montana and 13.2% in the USA. Pharmacy costs are going up about 20%/year in both Montana and the rest of the United States. Drugs as a proportion of claims is at 16% in Montana but 19% in the USA. For the last fiscal year, the benefits program for the University system had an ending balance of about $200,000, which is very good. For the current fiscal year, we are predicting a balance in the black of about $1.5 million. This will allow us to maintain our reserves at a level to cover 2 months of costs and equals about $7.5 million. Therefore, because of the increased state contribution of $44/month last year, and $50/month this year plus a small additional premium increase from the employee (about $10/month), we are in very good shape at the current time. One reason for the good balance sheet is that more and more people are using the HMO program. But an HMO program is not yet available in Bozeman. Looking to the future, is problematic since we don't know whether the state will increase it's contribution. This will be determined by the next Legislature. We are looking at the Wellness Program to see if there are things that it could do more things to help people reduce their risks from various health conditions. Getting more people to participate in the WELLCHECK fair in November would certainly be a good starting point. Currently, only about 50% of our employees take advantage of this service.