1. Financials
2. 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.
3. 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..
4. 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.
5. An analysis was conducted to determine the reason for these extra unexpected expenditures. There could be two major reasons:
6. Additional usage of benefits by our members (utilization cost—more visits by members) and/or
7. 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.

1. 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%.
2. 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:
3. From July 1, 2008 to September 30, 2008 the average cost per eligible member per month was  $508.53.
4. From April  1,  2009 to June  30,  2009   the average cost per eligible member per month was     $696.37.

1. Assets vs required reserves
2. For fiscal year 2009 the reserves are projected to be 295%.Our goal is 300%.
3. For fiscal year 2010 the reserves are projected to be 225%if we make no plan changes.
4. 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.

1. Risk Migration analysis
2. Average age dropped by .52 years which was due to retirees moving to MAPP
3. Continuously enrolled members changed plans—13%
4. Enrollment Risk Migration—Members moving from traditional plans to Managed Care (MC) plans.

1. MAPP Medical Advantage Plan
2. National health care reform will affect MAPP

1. 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. .
2. The government subsidy for MAPP may be eliminated which will result in increased premiums for the retirees.
3. 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.

1.  Take Control--Diabetes Program
2. There are some groups which incur a significant expense within our plan. On a volunteer basis members within these groups (Diabetes) can participate in:
3. Education tailored to each participant’s needs—dietician assistance, exercise
4. Group education
5. Receive monthly newsletters
6. The results of these focused groups;
7. Increased wellness for the individuals
8. Significant cost savings in medical and prescription drugs
9. Less hospital visits
10. Emergency room visits are less when comparing enrolled to no-enrolled members   

1. Pension
2. Defined Contribution Plan—the member is in control and decides which offered investments that he/she will choose
3. There are currently 22 funds offered in the MUS TIAA-CREF program
4. Our plan provider suggested seven other which could be considered for greater diversification. Four of these were chosen and approved.
5. These included: High Yield Fund, Lifecycle 2045, Lifecycle 2050 and Retirement Fund
6. 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.
7. The new Retirement Fund is established for retirees and consists of Equities 40%/Bonds 60%
8. Participant Services—Telephone and internet (www.tiaa-cref.org), web seminars

1. Quality Care Choices
2. 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.
3. Two of such programs are Infusion Therapy and Cancer Services
4. 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.  

1. Prescription Drug Program (URx)
2. The MUS benefit plan spends about $65,000 per day for prescription drugs
3. The cost of Prescriptions drugs is about 28% of our total plan expenses.
4. Problems with current system of PBM’s (Pharmacy Benefit Manager):
5. For-profit companies that collect a fee for each drug claim processed
6. PBM’s receives rebates from the pharmaceutical companies for purchasing certain drugs and then steering our members to those more expensive drugs
7. The formulary (list of preferred drugs) created by the PBM consists of drugs promoted by the pharmaceutical companies
8. URx will address these problems with our MUS and State of Montana Pharmacy and Therapeutics Committee (P&T) which will put us in control.
9. Promote evidence-based formulary---the use of medications with the best clinical results…not necessarily those drugs most promoted by the drug companies.
10. Improved plan management
11. Achieve significant savings—Estimated annual savings would be about $3.5MM    
12. 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.
13. URx will begin January 1, 2010 for State employees and July 1, 2010 for MUS employees.

1. Wellness Power Point Presentation-- Overview of the WellAwards Program
2. Program participation-9,657 were eligible, 3,040 participated = 32%; 2,143 earned $100.00
3. Gender: 67% female and 33% male
4. Several slides showed which activities participants selected and therefore were able to earn credits
5. Many slides showed participants evaluations of the program by answering 11 questions
6. What new activities did you to participate in?—Regular stretch, strength training and others. These charts showed number of participants.
7. Which health improvements did you notice?—lower blood pressure, feel healthier, lost weight
8. 73% of FY09 participants have re-enrolled in FY10. Enrollment for FY10 is 3,460

1. 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:
2. Out-of-Pocket maximums for Traditional and Managed Care
3. Copayment increase  for three services—ambulance, emergency room, urgent care
4. Life Insurance options
5. Maximums on Dental
6. Retiree subsidization
7.     Dependent/spouse subsidization

1. IUBC Formal Meeting
2. 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.
3. Each of the sub committees provided a brief summary of their activities and meetings if they had met.
4. Next IUBC meeting will be January 28th

Reviewed and edited by Paul Bogumill

1. 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
2. The upcoming IUBC meeting Oct 8-9 and invitation for Bozeman people to attend was noted. Agenda will be forwarded when received.
3. MSU Meeting schedule (revised):
1. Oct 1: Room TBD
2. Oct 29: SUB 232
3. (Fall Wellcheck Nov 4-5)
4. Dec 3: SUB 232
4. 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.
5. 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.
6. 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.
7. 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.
8. 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.
9. 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
  1. Obesity is culture related,
  2. Montana residents are about in the middle of the ratings which is not good
  3. Lead by example-kids see parents/adults lack of exercise vs more active
• Larry Krystkowiak—Former professional basketball player, NBA head coach
  1. In the past the kids were more active with bicycling, basketball. Now they are involved with computer games, watching TV
  2. Getting kids off the couch is a challenge
  3. Start with yourself since the kids are looking at you as the example. Push yourself and your family to more physical activities--walking
  4. Observations:
     1. Kids gravitate to video games
     2. Use some creativity with your activities
     3. Reach out to the others and the community
     4. Take time for a community rally
     5. 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 REI                          REI.com
  1. YMCA is wellness focused
  2. Data has been collected from 5 states-Montana, Washington, Alaska, Idaho, Wyoming. Child obesity has grown from 13% to 33%.
  3. Why—
     1. Kids used to just play on their own with several activities but now it is organized teams which focus on just a few exercises
     2. Only 2% of the children continue with sports after leaving school while others become spectators
     3. Kids are being restricted from playing outside due to kidnappings, fear.  ie Amber Alert
     4. We think of medications first instead of going outside or exercising
     5. Technology is the competing for children’s attention vs outdoor active
  4. REI has local programs/classes to get people outdoors and active. A video-Kids Passport to Adventure
  5. Wellness/Employer creates an environment of health from high school to senior citizens
  6. Obtain a general health profile which displays which areas which are most expensive for the company insurance plan
  7. 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
  1. Halt child obesity by 2015—less soda at school, remove candy machines, consume 100 calories less per day, put PE back into class
  2. Physically fit students learn better and are less disruptive
  3. BMI- Body Mass Index, nurses at schools inform parents if a student’s BMI is too high
  4. A commission was started 18 months ago which asked…What can be accomplished to help individuals become healthier
     1. Begin health awareness early in life
     2. Ban junk foods from school
     3. 30 minutes per day of activities
     4. Families and therefore children eat healthy foods
     5. Health professionals educate families
     6. Educators become involved
• Senator Tester
  1. Provide healthy food
  2. Obesity increasing due to decline in child activities
  3. Healthy body = Healthy mind
• YMCA-Neil Nicoll, President and CEO of YMCA of the USA
  1. Helping to create healthy communities with activities and classes outside their building into the community. Support healthy lifestyle on an individual basis
  2. Healthier Community Initiative-focuses on healthy eating and activities focusing on child obesity, a 12 week course
  3. Goal--reduce chronic disease such as diabetes
  4. Children in rural areas are more likely to be obese
  5. Health Seekers—people wanting to be healthy but don’t become active
  6. Getting families outdoors—trails
  7. Collaboration—partner with schools, hospitals, county agencies
  8. Greater focus on prevention
• Panel on Rural Health Initiative RHI
  1. Obesity most serious health problem in children
  2. Success stories-5th grade gave power point presentation to 4th graders, More kids in the woods on snowshoes,
  3. 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.
  4. 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
  1. City of Boise
     1. Downtown market on Saturdays-locally grown food sold
     2. Active transportation-walking, bicycle
     3. Branch libraries in strip malls- people would bicycle, health centers would set up near the libraries,
  2. A Family Foundation based in Washington serving a 5-state region
     1. Focuses on science, arts, needs of vulnerable population, well being of community
     2. Applicants must meet selected criteria and have measurable impact
  3. Lanesboro Root River Trail MN
  • Promotes bicycling, boating, trails for visitors
  1. The city has theatres, art center
  2. Healthways
  3. 67% of US adults are overweight
  4. 60% don’t exercise
  5. 67% have at least one chronic disease
  6. Viable health plans offered by employer because there is a captive audience at the workplace
  7. Corporations may not believe that wellness programs will change the behavior of employees but the programs benefit with Physical, Emotional and Social health.
  8. Some employees believe that if they get ill then their benefit plan will just ‘repair’ them so they can return to normal health.
  9. Prevention is achievable when utilizing attention-getting promotions. Remember the following: Don’t litter—teary-eyed Native American and fire control-Smokey the Bear
  • PolicyLink
  1. Works with partners to build healthy communities
  2. Obesity Prevention Program, Fresh Food Financing, trails
• Workshop: Lowering Health Care Costs—There were several panelists
  1. Paychex Inc.—provides payroll services
     1. Promotes blood drives with a local ‘champion’, results are sent to wellness coordinator or doctor
     2. Wellness coaches
     3. Catch potential illness early which reduces expenses
     4. Educate employees on resources which are available
     5. Earn points by completing certain activities
  2. Reynolds Charitable Trust
     1. Health Care Division-assistance for low-income people
     2. Used to focus on treatment but now giving attention to prevention
     3. Able to measure the outcome of the prevention programs
     4. Focus on the big three—Physical activity, Nutrition, Tobacco usage
     5. Positive lessons learned from these Programs
        1. Competition between/within schools
        2. Use of non-traditional providers—churches, parks
        3. Target children and older adults
        4. Incentives
        5. Leadership—get a local leader involved
     6. Negative lessons learned from these programs
        1. Doctors don’t have time to educate their patients
        2. Hard to measure results
        3. Sustainability of programs
        4. Leadership lacking if leader leaves
     7. Items to consider and implement
        1. Local leadership
        2. Education must be continuous
        3. Integrate community-doctors, churches, schools, public
  3. Take Care Health Systems—Walgreens
     1. On-site clinics at their stores
     2. Early intervention is important
     3. Managing risk through wellness coaching—blood pressure, hypertension
     4. Small business-several co-op together
     5. Convenient Care Clinics—vaccinations, ear ache, back-to-school physicals, minor injuries
     6. Worksite-based medical centers
  4. Target Corporation
     1. Have young employees so maternity cost is the highest expense in their plan
     2. Develop culture of health—health coaches
     3. Alliances with other companies
     4. Has a website with health evaluation
     5. Live Well Challenge—watch 3 videos per week (health, nutrition, fitness), 12 week program, earn challenge points with competition between stores
  5. Microsoft Corp
     1. Average age is 38.6 with maternity cost consisting of the largest percentage in their plan
     2. On-site health screen, flu, 24-hour health line
     3. Mobile medicine visit---house calls, co-op with other organizations
     4. Education Program-Live Life Well
     5. Focus on: Be Aware     Be Active     Eat Well     Stay Tobacco Free     Take Care
     6. Has a website
• Indian Health Board
  1. Obesity--$1.00 spent == $5.00 saved
  2. Behavioral modification
  3. Prevention—responsibility of individual
  4. Diabetes-Not present 60 years ago
  5. 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

1. 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.
2. 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.
   1. There is currently about $4,000,000 per month being spent on prescription drugs.
   2. The P & T (Pharmacy and Therapeutic ) Committee is composed of 3 doctors, 3 pharmacists and
   3. 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.
3. Each prescription drug is placed in 1 of 5 tiers after reviewing the formulary:
   1. A--Zero co-pay (member pays no cost)
   2. B--$15.00 co-pay
   3. C--$50.00 co-pay
   4. D—50% co-insurance
   5. F—100% co-insurance (member pays 100% for the cost of these drugs placed in this tier)
4. Mail order will still be available.
5. There will be no deductible requirement to fulfill for the co-pay tiers.
6. 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.
7. 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.
8. Ken will decide when it will be appropriate to have another benefits committee meeting during the summer to keep us informed.
9. 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.
10. 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 waiver.
    1. 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.
    2. 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.
11. Items to review at future meetings
    1. The progress of our URx program
    2. The progress of MAPP
12. 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

1. Re-enrollment for the 2009/2010 CHOICES
   1. 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.
   2. 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.
   3. It was recommended that interested employees review Paul Bogumill’s Podcast explaining the MUS Employee Benefits Plan. www.montana.edu/CHOICES.
   4. 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.
2. IUBC-Benefit Reps Benefit Reps from various campuses met in Helena to receive training related to re-enrollment for 2009/2010 CHOICES.
3. 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.
4. 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?
5. 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.
   1. If the proposed increase in coverage is not age-based then what could be the increase in coverage and premium? This might be possible.
   2. 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.
6. 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.

1. ProtoCall Specialty Drug Program
   1. 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.
   2. He is currently reviewing all claims which exceed $5,000 per month.
2. MAPP (Medicare Advantage Pilot Program)
   1. 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.
   2. The cost will be $140.00 per covered member per month for qualified Medicare members of the MUS benefits plan.
   3. There will be several meetings beginning in April which will explain MAPP in more detail to those retirees.
   4. 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.
3. Wellness Budget
   1. 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.
   2. 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.
4. Benefit Plan premium and rates
   1. The employer contribution will increase 8.5% ($53.00), from $626 to $679 per month.
   2. The average rate increase for medical premiums will increase 6.2% for actives and 6% for retirees.
   3. 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.
5. Optional Supplemental Life Insurance
   1. Available life insurance increases from a maximum of $200,000 to a max of $300,000.
   2. 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,
6. Dental-Premium Plan
   1. Several additional benefits were added to the Premium option:
      1. Coverage for occlusal guards (night guards). Subject to $1500 benefit annual max
      2. Coverage for nonsurgical treatment of TMJ. Subject to $1500 benefit year max
      3. Coverage for implants will now be subject to the $1,500 benefit year maximum and no longer be a separate lifetime maximum.
      4. Members with periodontal disease may request authorization for up to 4 cleanings per year, instead of 2.
   2. The premium rate increased due to these additional benefits and other dental related expenses.
7. WellBaby (Previously StarBaby)
   1. 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.
   2. This program has had only about 25% participation but will now have more attention to promoting and monitoring it.
8. LTC (Long Term Care)
   1. This is coverage that should be considered by all members of all ages----not just the more senior and retirees.
   2. 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.
9. Miscellaneous Items
   1. 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.
   2. 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.
   3. Next meeting will be April 16th.
10. 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

1. Prescription Drug Program-EBF (Evidence Based Formulary)
   1. 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
   2. Notes from the meeting were presented and discussed
      1. 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.
      2. 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.
      3. 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.
   3. 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.
      1. Optional supplemental Life Insurance
      2. Dental Plan changes
      3. WellBaby (currently it’s StarBaby)
      4. Long Term Care (LTC)
      5. MAPP (Medicare Advantage Pilot Program)
   4. Ken Hapner attended the Retiree Subcommittee meeting on Feb. 6th in Helena. He presented the following information.
      1. 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.
      2. MAPP does not address retirees under 65.
      3. The MAPP premium is $140 per covered member per month plus Medicare Part B premium of $96.40, equaling $236.40 pmpm.
      4. MUS retirees will have the option of adding the “Choices” Premium Dental and/or Vision coverage.
      5. 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).
      6. Some providers are not taking Medicare patients, but this has not become a major problem, according to New West.
      7. 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.
   5. Update on the retiree survey letter
      1. The letter, with 10 questions, has been mailed to 30 retirees who were in the MUS plan but have opted out.
      2. 19 survey letters have been returned. We now have 22 returns and they are being examined.
   6. Notes prepared by Ken & Ron and reviewed by Don.

January 15, 2009 Present: Young, Coffey, Curtis, Tanner, Wheeler, Brekke, Hapner, Shannon, Oudshoorn, and McKenzie

1. The proposed survey of retirees who drop MUS insurance was discussed.
   1. The committee thinks the information to be gathered would be useful, especially with regard to whether affordability is an issue.
   2. There should be two survey letters/forms, since the Medicare questions are not relevant for those < 65 years of age.
   3. 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.
   4. A telephone survey has advantages: a knowledgeable interviewer could reassure people, and better response rate than mail.
   5. A telephone survey would be more expensive partly because trained interviewers would be required.
   6. 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.
   7. Doug will rewrite the draft survey
   8. The committee looks forward to seeing Bernard’s count of retirees who left MUS insurance in the last 18 months.
   9. Ken Hapner, together with Don Mathre, will follow up on this issue.
2. Other aspects of retiree insurance were discussed.
   1. Retiree premiums are less than the costs of the services provided.
   2. GASB pressure is to raise those premiums.
   3. 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. >li> 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.
   4. There is great uncertainty about the long run viability of MAP plans because of the potential for changes in Federal policy.
   5. 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.
3. Barb discussed the MAHCP tabulation of costs for digital v. standard mammograms in various locations in Montana. The results are dramatic.
   1. Perhaps MUS can use the results to negotiate with Bozeman providers.
   2. Perhaps similar comparisons can be done for other procedure codes.
   3. Digital mamos find more “suspicious” results, which further increases costs for both patient and MUS as additional diagnostic views are commonly called for.
   4. What are committees of the medical profession recommending? Bob McKenzie will look at the current literature.
4. Ron Brekke and others provided an update on URx.
   1. Contract negotiations are underway with two PBAs.
   2. Drug pricing does not appear to be lower. How rebates fit in was not completely clear.
   3. Several members of the committee will attend the Jan 29 meeting re: formulary.
5. 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.
   1. 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.
   2. Some members have responded with reduced dosage.
6. 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

1. Financials for Quarter ending September 30, 2008
   1. 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%.
   2. 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.

2. 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:
   1. Separate and Combined Medical and Dental plans
   2. Traditional Plans
   3. Managed Care plans
   4. Actives and Retirees
3. 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.
   1. Some of the providers had errors of 1% to 2%, which is acceptable.
   2. Two of the providers had no errors, while another provider had a high of 6% errors.
4. Plan Changes: There were several medical and dental changes introduced and discussed.
   1. Life insurance/Accidental Death and dismemberment (Life/AD&D)
   2. Long Term Care
   3. Dental-implants, TMJ, guards
   4. Med-ex Travel These were then approved during our formal business meeting. See Item ‘II G’ for more details
5. 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 following:
   1. In the prescription drug program—any 30-day claim over $5,000
   2. In the Traditional Plan—any line item over $5,000
6. 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 goals:
   1. Having more control of pharmacy benefits and incentives,
   2. Implementing Evidence Based Formulary—Choosing prescription drugs based on their benefits,
   3. Reducing expenses—ie. Administration fees,
7. Retiree Optional 403(b) plan
   1. New federal regulations required some changes in the MUS 403(b) plan by January 1, 2009.
   2. 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.
8. Communication strategies
   1. 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.
   2. Newsletter: The Wellness and the Benefit newsletters will be combined into one newsletter. An added feature will list answers to frequently asked questions—FAQ.
9. Formal IUBC Meeting---Sub-Committee reports, Motions, Voting
10. 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.
11. Administration committee-
    1. It is proposed that updates of RFP’s, financial and committee reports will be provided on a more regular basis
    2. DPW (Dependent Premium Waiver)—Eligibility and data from 2 years will be brought forward to the Board of Regents
12. Wellness
13. Retiree Committee-
    1. 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.
    2. 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.
14. Compliance Committee-Federal rules and regulations were reviewed and found to be in compliance.
15. Appeals Committee-No meeting/report
16. 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.
    1. Dental-The changes listed below were approved for the benefit year beginning July 1, 2009
       1. Non-surgical TMJ (temperomandibular joint disease) will be included in the Premium Plan
       2. Occlusal Guards will be included in the Premium Plan
       3. 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.
       4. 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.
    2. Life Insurance/Accidental Death & Dismemberment (Life/AD&D)
       1. These rates will remain constant for two years
       2. 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.
    3. Long Term Care (LTC)
       1. After reviewing information from several insurance companies it has been decided to stay with our current provider---UNUM.
       2. It has been approved to accept their offer of keeping the rates constant for the next five years.
       3. We will have a Guaranteed Issue period for this upcoming open enrollment period.
    4. Med-Ex
       1. 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.
       2. A form (Extended Coverage for Foreign Travel) needs to be submitted to the Benefits Department in Helena.
    5. Future IUBC meeting
       1. The next meeting for IUBC will be on February 26th (Thursday) starting at 9AM in Helena.
       2. Some of the items to be discussed include: FLEX RFP, Progress of Urx, MAP, Wellness Budget, Actual rates for the 2009-2010 plan year.

November 13, 2008 (notes from Doug Young, Chair) - Attending: Young, Coffey, Johnston, Brekke, Haynes, Wheeler, Alt, Mathre, Crow, Curtis

1. Notes from October were reviewed and revised.
2. 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.
3. Brekke reviewed the agenda for the plan change committee meeting Nov 17 in Helena.
   1. 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.
   2. 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?
4. 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.
5. The committee discussed URx.
   1. 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?
   2. 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.
   3. 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.
6. 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

1. Sherry Todd is leaving MSU and a replacement is needed. Doug will contact Sara France. Fall schedule was reviewed (see last item below).
2. 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.
3. 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.
4. 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.
5. 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?
6. The committee reviewed the information with regard to replacing the Pharmacy Benefit Manager (PBM) with a self administrated program—Pharmacy Benefit Administrator (PBA). This would be a huge undertaking which would include—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.
7. Several members will be attending the IUBC (Inter-Units Benefit Committee) meeting in Helena from October 2-3.
8. 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

1. Wellness is: Process of being aware of and actively working towards better health.
2. Wellness Programs are something we do for people, not to them.
3. Unhealthy lifestyles—People value their health more when they start to loose it. Pharmaceutical solutions offer assistance but sometimes have side effects.
4. 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 Expensive—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 prevented—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 Money—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!),

1. 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.
2. Carol Shannon has been reappointed to a new 3-year term. Welcome back, Carol.
3. 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 Amazon.com. Reality:
   1. Difficulty finding initially.
   2. Difficulty navigating – sometimes circular.
   3. Some links are very small at the bottom of the page.
   4. 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.
   5. 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.
4. 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.
5. The committee suggested that several issues will be important next year, many of which involve Communication with Members:
   1. The Choices Newsletter has been an effective way to communicate complex information. The committee remains concerned that the Newsletter has been interrupted.
   2. 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.
   3. 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.
   4. 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.
   5. 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.
6. 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

1. 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.)
   1. 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.
   2. The new plan shifts GASB liability away from MUS.
   3. Caution: The drug formulary is somewhat different (required by Medicare), so it’s important for retirees to check whether it suits their needs.
   4. The pilot is optional and participants may switch back to normal MUS health plans the following year.
   5. The new plan has the potential to save MUS money as well, because retiree costs > premiums (no state contribution).
   6. 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.
2. 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.
   1. Costs will increase substantially for people who use retail pharmacy.
   2. 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.
   3. Costs are expected to decrease substantially for the plan.
3. 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
4. On Friday, Apr 4 at 3PM in 276 EPS, Paul Bogumill will record his Choices talk for podcast. Committee members are encouraged to attend.
5. Points for Doug to cover in his Choices talks Monday April 7 at 10 and 11:30 in 276 SUB.
   1. Self-insured
   2. Reserves => Rates
   3. PPIs
   4. Blood lab via Wellness
   5. Flex advantage with example
   6. Reenrollment: Active-Online only; Retiree-Paper only
   7. Alternate ID procedure
   8. Contacts for Complaints, Clarification and Cuss words: MSU Benefits Committee members (list), HR/PP, COHE
6. 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.
7. 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.

1. 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.

2. 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.
3. 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.
4. 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.
5. 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
   The Chairman of our campus benefits committee (Douglas Young Phd Professor of Economics) will also be providing information for the CHOICES benefits (2008 to 2009) on April 7th at 10-11 and 11:30-12:30 in SUB 276
6. Items of interest
   1. 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.
   2. 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

1. 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.
   1. Shopping for a Long-Term Care Policy, Tom Lauricella, Feb 3, 2008, Wall Street Journal, http://online.wsj.com/article/SB120200860508738543.html
   2. Long Term Care Insurance, AARP: http://www.aarp.org/money/financial_planning/sessionfive/longterm_care_insurance.html
   3. How Will You Pay for Old Age? Consumer Reports, pages 35-50, October, 1997.
2. EAP (Employee Assistance Program) The university will be contracting with a new EAP Provider
3. 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:
   1. Financials
   2. MUS Risk Management
   3. Rx plan changes
   4. Dental plan changes
   5. Medical plan changes and prevention coverage
   6. Vision plan update
   7. WellAwards pilot outcome
   8. Rates and Reserves
   9. Year in review

Plan Change Sub Committee meeting February 7, 2008 This report is a brief explanation of the items discussed at the meeting

1. Delta Dental
   1. 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.
   2. 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.
   3. It is possible to look at different categories (preventative, restoration, diagnostic etc) and review planned vs actual expenses.
2. Pharmacy
   1. 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%.
      1. 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%.
      2. 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.
      3. There will also be a program to review certain medications which may be over-utilized—sleep aids, heartburn
   2. 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.
3. EAP (Employee Assistance Program) /Wellness
   1. We are in the process of choosing a new EAP Provider.
   2. The EAP program is currently underutilized by employees
   3. The new EAP program will offer more online tools and training in addition to legal and financial advice.
   4. A spring tour by members of the Benefits team will be promoting and informing employees of EAP services.
4. WellAward Program
   1. 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.
   2. 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.
5. Federal GASB regulations This was presented and discussed at the MSU January 17th benefits meeting and was included in that monthly report.
6. Final Preventative Benefit Language
   1. 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.
   2. The template for helping to develop the Preventative Benefits was provided by the benefits team from the MSU campus.
7. 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):

1. 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.
2. 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.
3. Also – with in the RX plan changes we are looking to introduce a program on PPI meds that will read as follows…….
   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.
   

1. 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
2. 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.
3. When will the new Prescription Drug Program be implemented? July 1, 2008 and it will be seamless to the members for the most part.

1. 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.
2. 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.
   5. Retiree Task Force: Ken Hapner reported….
   • 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.

1. 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 provide:
   1. A confidential personal health record that can be accessed by designated advisors.
   2. Specific advice from their pharmacist about their medications and health plan
   3. Access to lifestyle and biometric screening and the tools (blood pressure monitors, pedometers, diabetic testing equipment , etc.) to monitor and maintain health.
   4. 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
   5. A team contact list for the MUS account
   6. A Plan Design Summary which basically listed the current MUS program One item which was briefly discussed—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.
   7. Programs to inform and encourage members to buy generic and order by mail
   8. An analysis of MUS prescription expenses included the following data from January 1, 2007 to September 30, 2007
      1. 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.
      2. Total member cost--$3,341645 which is 22.5% of total net cost
      3. Generic substitution rate—93.5%
2. 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
3. Preventative Schedule of Benefits
   A spreadsheet displaying preventative benefits for Traditional and Managed Care plans was presented. A brief summary is listed below.
   1. 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
   2. MC (Managed Care) in Network
      1. Mammogram-age 40+ one/year (no deductible, no coinsurance), Ages 35-39 one baseline mammogram (no deductible no coinsurance)
      2. Gynecolocic exam and pap test one/year (included in office co-pay)
      3. Preventative Medical Visit age 8-39 one every two years $15 co-pay, age 40+ one/yr $15 co-pay
      4. PSA test for males (included in office visit co-pay)
      5. Bone density screen once every 5 years for females age 60+ an males age 70+ subject to deductible and 25% coinsurance)
      6. Blood analysis (included in office visit co-pay)
      7. Stool occult blood colorectal screening ages 40+ (include in office visit co-pay)
      8. Flexible sigmoidoscopy and double contrast barium enema every five years for members age 50+ (subject to deductible and 25% coinsurance)
      9. Colonoscopy once every ten years age 50+ (subject to deductible and 25% coinsurance)
      10. Immunizations and pneumonia and flu shots $15/visit without office visit 25% coinsurance (no deductible)
      11. Child checkups through age 7 (same schedule as proposed for traditional) $15 co-pay per visit
   3. Proposed Plan (Developed by MSU Benefits Committee)
      1. Mammogram one/year for female members age 40+ (no deductible, no coinsurance)
      2. Gynecologic exam, pap test, clinical breast exam one/yr for female members age 19+ ( no deductible, no coinsurance)
      3. #Preventative Medical visit-one visit every 2 years for age 19+ (no deductible: $15 copay) #See note below
      4. Bone density (DEXA) screen once every 5 years for females age 60+ and males 65+ (deductible and coinsurance apply)
      5. Ultrasound heel scan for bone density every 5 years for members+ (Obtain from MUS Wellness at Wellcheck, $10 copay)
      6. Blood analysis (Obtain from MUS Wellness-chemistry screen with lipid analysis $20 copay; complete blood count $16 copay; for male members PSA screening
      7. Stool occult blood screening-once per year age 50+ ( obtain free from MUS Wellness)
      8. Flexible sigmoidoscopy every 5 years OR
      9. Colonoscopy every 10 years for members age 50+ (deductible and coinsurance apply)
      10. 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
          
          
      Comments: Most of the Proposed Plan items are being offered in the MC and Traditional or offered at Wellness Check (items e, f, g, h). Some of the preventative services in Traditional and MC could have a more thorough explanation. The bone density (DEXA) is not included in Traditional or MC as presented in the Proposed Plan but it may be covered under Medicare?

      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.

   4. Vision Plan update—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:
      1. a. Exam with dilation as necessary-up to $85 instead of $45
      2. 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.

   1. Financial Report
      1. 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%.
      2. The dental plan experienced a deficit while the medical plan experienced a positive cash flow.
      3. Actives have a current Funding Loss Ratio of 93.0% while the retirees are running at 137.4%.
      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%
      If current expense growth continues, then an adverse financial situation will result. With projected funding increases of 6% and projected expense increases of 10% medical & 13% Rx, then expenses will exceed revenue. There were several detailed and historical charts showing and comparing medical categories and plans.
   2. MUS (Montana University System) Account Report
      1. 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.
      2. The claims (policies) which have been filed were separated into the following categories: Medical: 70%
         Pharmacy: 20%
         Dental: 10%
   3. 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.
   4. CDHP Consumer Driven Health Plan
      These type plans consist of:
      1. HSA (Health Saving Account) which have tax advantages and can be used to help pay health expenses.
      2. High deductibles with the insurer paying expenses up to an amount of the deductibles and then the health insurer starts to contribute.
      A survey letter was sent to 3,500 MUS employees with 20% responding. The survey asked several questions regarding CDHP and an individual’s involvement in his/her financial decisions. The initial results indicated that there was some interest in these types of health plans.
   5. Preventative Benefits
      This report has been previously presented.
   6. Diabetes Management Program
      This presentation included the following information:
      1. In 2004 diabetes was the 6th leading cause of death
      2. People with diabetes are at increased risk for Hypertension, heart disease, heart attack, congestive heart failure, amputation of lower limbs.
      3. Type II diabetes is an acquired life –long disease marked by high levels of sugar in the blood.
      4. Obesity is the most powerful predictor of who will have Type II
      5. Treatment includes: dietary modification, drug therapy, Increased physical, weigh loss
      A pilot program of 69 participants showed improvements, relating to diabetic complications, moving from extreme risk level to high or moderate levels. In addition to living a healthier life these reduced risk levels also decrease medical costs.
   7. Vision Plan
      This presentation was from our EyeMed provider
      1. Benefits of an eye exam can help identify: diabetes, hypertension, multiple sclerosis
      2. An explanation of the MUS vision was provided
      3. 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.
   8. Pharmacy
      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.
   9. Allegiance
      1. Allegiance has a pilot program utilizing Comprehensive Enrollment Wizard (CEW) which allows members to access their benefits online.
      2. 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.
   10. Dental
       This presentation was given by Delta Dental representatives
       1. Features and highlights of the Premium and Basic Plan
       2. 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.
   11. 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.
   12. Next Steps
       Various task forces and subcommittees of the IUBC will meet this fall and winter to work on a number of issues:
       WFTRA
       Pension Admin
       Wellness
       403(b) RFP
       Pharmacy RFP
       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:

   1. 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.

   2. 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.
   3. 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

   1. 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.

   2. 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.
   3. 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.

   1. We greatly appreciate all the contributions from Montana Hall.
   2. 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.
   3. Wellness Fair will be Oct 24-5. Flu shots will be offered in early November if sufficient vaccine is available.
   4. 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?).
   5. 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.
   6. 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.
   7. Doug, Susan, Norma and Jodie will attend IUBC fall retreat Sep 19-21.
   From CEPAC 5/10/06 unapproved Minutes - Carol Shannon reported on some errors in the overview section of the CHOICES workbook. Carol recommended that staff check service details with their plan administrator.

   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 the question.

     ---

     April 6, 2006 - Carol Shannon submits this report:
     

     1. The new Director of Benefits for MUS is Paul Bogumill
     2. There are new lower premiums for retirees who are 65+. These will appear in the Choices packets that will be distributed in mid-April.
     3. The next Choices newsletter will explain the change in premiums in detail. The newsletter will also explain the new Managed Care option for retirees.
     4. Allegiance will now offer a Managed Care option (in addition to the Traditional Indemnity Plan).
     5. 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.
     6. 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.
     7. The Dependent Waiver report for this first year was consistent with expectations for costs and intentions.
     8. Allegiance and New West now have local anesthesiologists in their networks and BCBS now has a local allergist in its network.
     9. 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.
     10. 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.
     11. 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
     Recent public forums indicate the staff are in agreement with adoption of these items (some logistical issues were discussed).

     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 committee.
       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 Meeting:
       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)

     Items sent back to committee for further discussion:
     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