NEW MEXICO PUBLIC SCHOOLS INSURANCE AUTHORITY

1. NEW MEXICO PUBLIC SCHOOLS INSURANCE AUTHORITY Regional Training - Benefits Program July 2010

2. Your Presenters • Christy Edwards, NMPSIA • 800-548-3724 christy.edwards@state.nm.us • Martha Quintana, ERISA • 800-233-3164 mquintana@santafe.cserisa.com • Managed Health Care Bureau • 800-947-4722 mchb.grievance@state.nm.us • Julie Garcia, Poms & Associates • 800-898-6236 JGarcia@pomsassoc.com

3. Spring Benefits Fund Balance

4. Now, how is the NMPSIA fund doing? • Self – Insured Coverage • Began FY 09 with an $8 million deficit • No Premium Increases allowed in FY10 legislative budget process • Current fund balance is a positive$7 million

5. Premiums October 2010 Blue Cross Medical: +6.4% Presbyterian Medical: +6.4% UCCI Dental: +6.4% Davis Vision: No Change The Standard Life: No Change The Standard LTD: No Change

6. July 1, 2010 Program Guide • Carrier Contact Information now on inside covers • References to Healthy Vistas deleted • New Employer Plan Matrix & Rates • Medco Pages 33 and 34 • Correction of maximum on Non-Network High Option Dental

7. July 1, 2009 Medical Plan “Fixes” • Infusion Therapy • In-office Sterilization • Maternity Benefits (see handout)

8. Two Recent NMPSIA Notices • CHIPRA • Mental Health Parity Opt Out

9. Medco • ID cards and welcome kits mailed June 22 • Temporary ID card can be printed from “medco.com” • Alternate ID number same as it was with Catalyst • Mail order prescription number same as it was with Catalyst

10. Medco • Catalyst Formulary Status grandfathered until January 1, 2011 • NMPSIA and ERISA have access to Client Website allows view of claims and changes to eligibility real-time • Important for members to register on “medco.com”

11. Medco • Specialty drug are filled by Accredo (separate division of Medco). Retail fills limited to 2x. • Immunization program to continue. • Diabetes Pilot Program will probably expand this fall or early 2011.

12. Some new acronyms & headaches • PPACA – Patient Protection and Affordable Care Act • HCERA = Health Care and Reconciliation Act (aka “budget reconciliation bill” • Combined form, they form Federal Health Care Reform

13. Reform from 50,000 feet • By 2014 everyone must have minimum essential healthcare or pay a tax. • Employer obligations dovetail with programs for low paid persons who cannot afford coverage • Low paid means employee household income of 100% to 400% of Federal Poverty Level

14. Federal Poverty Level

15. Minimum Essential Coverage • Specific plan design – yet to be determined • Bronze (60%), Silver (70%) Gold (80%) and Platinum (90%) • Must cover ambulatory patient service, emergency services, hospitalization, maternity & newborn care, mental health & substance abuse, prescription drugs, Rehab services, lab services, wellness & preventive services, chronic disease management, pediatric services

16. Vouchers Begin January 1, 2014 • Avoid $2,000 penalty per employee by offering plan to all full-time employees • Avoid $3,000 penalty by offering a voucher to anyone who is low income and would pay between 8 – 9.8 % of income for group plan • Tax deductible voucher: a contribution to plan to which employer pays greatest proportion of costs (not highest dollar amount of contribution).

17. Voucher Example for Low Income • Household income $15,000 (single EE < $15,000) • Current BCBS premium: $458.40 • EE contribution 25% or $114.60 per month, $1375 annually, or 9.1% of $15,000 income • If EE declines NMPSIA coverage, employer issues voucher to EE for employer share of $343.80 month

18. Impact to NMPSIA • Plan year after October 1, 2010: no annual and lifetime caps except on “non-essential benefits” • Children covered until age 26 (including married children) effective 7/1/11 (first plan year after October 2010) • 2011 must include cost of employer sponsored benefits on employee’s W-2 • July 1, 2014, pre-ex exclusion eliminated, automatic enrollment required

19. MEDEX Travel Assistance • The Standard Life Insurance coverage also includes MEDEX assistance • Pre-trip Assistance (visa, inoculation requirements, health hazards, etc. ) • Emergency evacuation and repatriation when 100 or more miles away from home or out of country • Coordinates with any medical coverage • Benefits for companion or children transportation

20. ARRA COBRA Subsidy • ARRA is an acronym for? • (a) Accounts Receivable’s Receivable Accounts • (b) Aggravating Rules and Regulations Activities • (c) American Recovery and Reinvestment Act

21. ARRA COBRA Subsidy Update • July 2, 2010 News from the Hill • “Prospects for congressional approval of another extension of the COBRA subsidy are dim. The subsidy was first authorized in last year’s stimulus bill and has already been extended twice. However, the 15-month subsidy was not available after June 1. • An extension of the subsidy was included in House jobs bill but conservative Democrats and Republicans forced Democratic leaders to jettison it over cost concerns. The provision was never in the Senate bill.  Sens. Sherrod Brown, D-Ohio, and Bob Casey, D-Penn., want to reinstate the subsidy as an amendment to the bill if it again reaches the Senate floor. But since reconsideration of the bill seems unlikely, a spokeswoman for Brown said the senators are pushing for the COBRA subsidy as a separate piece of legislation, and pay for it by eliminating a tax break. • The Senate proposal would, be retroactive, giving people laid off since June 1 six months (through 11/30/2010) of the federal subsidy instead of the 15 months that earlier law had provided. “

22. Online Enrollment • Encouraged for Employer Transactions: • Basic Life Enrollment • Update EE and Dependent Information (like employee address or dependent SSN) • Cancel All Enrollment • Log on to districts.nmpsia.com and click on Online Enrollment • Encouraged for Employee • View and confirm enrollment • Update address, phone or add email address • Switch Enrollment • Go to nmpsia.com “Members” tab and click on Employee Online Enrollment System

23. Warning on Possible Rule Change • August Board discussion of no longer allowing 1 penalty waiver per rolling 12 months • Staff recommendation because of additional work involved in penalty waiver research and accounting

24. Changes to Website

25. In Closing the Benefits Training . . . • Any More Questions? • Comments? • Thanks! Let’s Break for Lunch