1 / 25

Whitman College

Whitman College. Fringe Benefits Committees May 14, 2014. Agenda. Healthcare Reform Update Plan Performance Routine and Preventive Care Employee Assistance Plan Transgendered Surgery Update Healthcare/Insurance Market Changes. Healthcare Reform – Update - 2014.

marinel
Download Presentation

Whitman College

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Whitman College Fringe Benefits Committees May 14, 2014

  2. Agenda • Healthcare Reform Update • Plan Performance • Routine and Preventive Care • Employee Assistance Plan • Transgendered Surgery Update • Healthcare/Insurance Market Changes

  3. Healthcare Reform – Update - 2014 • Individual Exchanges Online • PSF did a Seminar at Whitman in November • Open enrollment period • Oregon is a mess, WA is not • Individual Mandate • All Americans must have coverage or pay a penalty (assessed on tax return) • 2014 penalty is $95 or 1% of earnings, increasing to $695 or 2.5% of earnings in 2016

  4. Healthcare Reform – Update - 2014 • Individual Exchanges • Individual Plans • Subsidies for those who don’t have access to coverage through their employer • Families won’t be eligible for subsidies if the employee has access to adequate and affordable coverage through their employer • Subsidies for those at 400% of FPL and below • Four Benefit Levels – different by state • Deductible cannot be higher than $2,000 (except for young invincible – under age 32)

  5. Healthcare Reform – Update - 2014 • What Changed in 2014? • Annual Limits Prohibited On “Essential Benefits” • No Pre-Existing Limitations for Adults • Maximum out of pocket for medical plans limited to HSA Maximum • 2014: $6,350 single, $12,700 family • Copays apply to out of pocket maximum • Medical in 2014, Rx in 2015

  6. Healthcare Reform – Update - 2015 • 2015 – Employer Mandate (delayed from 2014 to 2015 • Pay or Play? What does that mean? • Employers with more than 50 employees are required to provide adequate and affordable medical benefits to their employees (play) OR pay penalties ($2,000/employee if no benefits provided, $3,000/employee if standards not met) • Adequacy standard – the plan has to cover 60% of the cost of eligible expenses • Affordability standard – payroll deductions for employee only medical coverage cannot exceed 9.5% of income • Whitman College meets both standards

  7. Healthcare Reform – Update - 2015 • 2015 – Impact on the College • Who is the College required to provide benefits to (to avoid penalties)? • Employees who are regularly scheduled to work 30 or more hours per week, or 130 hours per month • For those with variable work hours, seasonal, etc. the government provides a “safe harbor” that allows employers to look back up to 12 months to determine if the 130 hours per month threshold is met

  8. Healthcare Reform – Update – 2016 and Beyond • 2016 • Employer reporting requirements (IRS) • 2018 • Excise tax for high cost plans that (in theory) offer generous benefits that insolate plan participants from the cost of care (due to low cost share – deductibles, copays, out of pocket maximums) • For plans whose total annual cost exceeds $10,200 individual, $27,500 family • 40% tax on amounts over limits

  9. Plan Performance - Self Insurance • A tool for managing cash flow, avoiding some taxes, more control of the plan • Components • Plan Administration (Work of Premera) • Insurance (Purchased from Lifewise) • Individual Claimants over $100,000 per year • Aggregate of all claims paid during the year (120% of the expected claims) • Paid Claims • Incurred But Not Reported (IBNR) Reserves (to be used to pay claims in the event of plan termination)

  10. Plan Performance2012 & 2013 *In 2012, there were 5 claimants with total claims in excess of $100,000 and in 2013 there were 3.

  11. Plan Performance2013 & 2014 YTD *The 2014 first quarter expenses are 7.2% higher than the first quarter of 2013.

  12. Plan Performance • How does that compare with what we were expecting for 2013? • Total costs were lower than we expected • Claimants with expenses over $25,000 were above norm with 40.4% of total paid claims (norm is between 35% & 38%) by 22 individuals • There were 3 claimants each with total costs over $100,000 • Dental costs leveled out

  13. Plan Performance • How did 2013 compare with Whitman’s Budget? • Goal was to under-fund expected costs to use about $368,036 of current reserve • What happened? Budget of $5,341,698 and actual expenses of $5,257,194 for a gain of $84,504 (98.4% of budget) • How about so far 2014? • Goal is to under-fund expected costs to use about $410,000 of current reserve for the year • What’s happening? Budget of $1,352,026 and actual expenses of $1,316,747 for a gain of $35,279 for the first quarter (97.4% of budget)

  14. Plan Performance • History of EE Cost Share for Claims

  15. Plan Performance • What is driving your medical and prescription costs? • We do an annual deep dive into your claim data • De-identified claims information is added to a data warehouse called MedStat • Whitman College utilization is compared with norms (based on size, industry, company location) • We can drill down to see what is driving costs, where the plan may or may not be working, if people are having their preventive care, etc.

  16. Plan Performance • Preferred Providers • 96.3% of claims • 99.4% of costs • Discount of 36.5% or $2,884,423 ($509 PEPM) • Cost Drivers – outside norms • Outpatient Surgery • Office Visits • Outpatient Behavioral Health • Musculoskeletal, circulatory problems

  17. Plan Performance • Top 10 Major Diagnostic Categories

  18. Plan Performance • What was the breakout of paid medical claims?

  19. Plan Performance • Top 10 Claimants • 2013 • Accounted for 31.8% of total paid medical claims • 3 were over $100,000 • Variety of Diagnosis • 2012 • accounted for 33% of total paid medical claims • 5 were over $100,000 paid • 4 were cancer diagnosis • 2011 • Accounted for 34% of total paid medical claims • 4 were over $100,000 paid • Variety of diagnosis

  20. Plan Performance • Use of few drive cost of plan (“80/20 Rule”) • 87.7% of claimants had total paid less than $5,000 (11.3% of total paid claims) • 12.3% of claimants had 88.7% of total paid claims • 75.5% had total paid less than $2,500 (9.7% of total) • 53.7% had total paid less than $1,000

  21. Plan Performance • Prescription Drugs • 83% of scripts were generic, compared with 81.9% in 2012, 71.2% in 2011 • Average Paid - Generic $33.56, Brand $287.64 • Top 4 were specialty medications • 2 MS drugs at $4,289 and $4,154 per script • 2 for rheumatoid arthritis at $2,464 and $2,210 per script • New Therapies (Specialty)

  22. Routine and Preventive Care • Are Whitman employees and families having their routine care? • 890 total covered individuals • Preventive care visits: 389, 130 were kids • Cervical cancer screenings: 139, 328 females between 20 and 60 • Breast cancer screenings: 141, 246 females over 40 • Prostate cancer screenings: 67, 220 males over 40

  23. Routine and Preventive Care • Reminders? • From the providers? • Premera in 2013 • Two year birthday cards with reminders about immunizations (ongoing) • Colorectal Screenings: calls to members age 50 to 75 who had not been screened (according to claim data) • Hypertension – calls to those diagnosed to get their blood pressure monitored • Diabetes phone calls (2) to encourage tests associated with diabetes (eye, H1C, etc)

  24. Healthcare/Insurance Marketplace Updates • Many changes, some resulting from the implementation of the ACA • Information only (you may hear or read about these) • Restriction of coverage for Spouses • High Deductible Plans • Cost and Quality, Transparency Tools • Employer Defined Contribution/Private Healthcare Exchanges (Marketplace)

  25. Questions? • Thank you!

More Related