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SERS Health and Wellness

SERS Health and Wellness. School Employees Health Care Board August 24, 2010. Who We Serve. 189,188 active and retired members 124,370 active, contributing members 64,818 benefit recipients: 55,244 retirees 5,315 disability recipients

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SERS Health and Wellness

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  1. SERS Health and Wellness School Employees Health Care Board August 24, 2010

  2. Who We Serve 189,188 active and retired members • 124,370 active, contributing members • 64,818 benefit recipients: 55,244 retirees 5,315 disability recipients 4,259 survivor benefit recipients

  3. SERS Benefits* • Paid $948.6 million in benefits in FY 2008 • $722.2 million in pension, Medicare B, and death benefits • $226.4 million in Health Care coverage • Our Health Care Fund took in $232.8 million in that same year * Health care is not a guaranteed statutory benefit. SERS provides access to health care and subsidizes the cost to the extent funding is available.

  4. Funding Health Care • Investment income is an important part of how we have paid for health care up to this point, but it is not the largest part • Employer contributions are the single greatest component of funding • The percent of payroll contribution available for Health Care in 2010 is .46% • Beyond 2010, the amount is projected to be zero • The Health Care Fund balance will decline quickly to zero by 2014 based on current spending levels • The decline becomes steep and rapid by 2011

  5. Looking at 2011 Funding $317 million $176 million 2010 2011

  6. Understanding Our Retirees The average SERS retiree: • Makes 8.4 visits to a physician’s office each year • Undergoes 2.2 outpatient procedures each year (these may be multiple procedures in a single visit) • Has a 1 in 3 likelihood of being admitted to a hospital on an inpatient basis in a given year The average SERS retiree: • Has a 1 in 2.5 likelihood of making a visit to the emergency room in a given year • Has 30 prescriptions filled each year • Uses 73.1 percent generic vs. brand

  7. Protecting Health Care for the Future January 2008 • Medicare Advantage introduced • Added 3 years to solvency • MA plans bring Wellness benefits to enrollees • Pharmacy Benefit Manager transition • Medco to Express Scripts • SERS part of RxOhio Collaborative • Estimated savings of $12M per year for 3 years • 2008 performance review showed savings of $23.94M

  8. Protecting Health Care for the Future July 2008 • Moved to single MA vendor resulting in saving $1.8M in 2009 • Wellness benefits for under-65 group approved by Retirement Board • Improved benefits for annual physical, PAP, PSA, mammogram and colorectal screening • New 100% coverage for screenings: osteoporosis, cholesterol, blood sugar, EKG and colonoscopy

  9. Protecting Health Care for the Future June 2009 • Journey to Better Health launched • www.serswellness.org webpage goes live • Letter announcing program sent to all eligible under-65 non-Medicare benefit recipients • Health screening at 6 locations offered in August

  10. Protecting Health Care for the Future July 2009 • Medicare Prescription Drug Plan introduced (Medicare Part D plan) • Immediate savings of $0.5M each month compared to monthly Retiree Drug Subsidy under previous plan

  11. Health Care Going Forward • Eligibility – includes service requirements, spouse and dependent considerations, effect of access to other coverage • Plan Design - deductibles, coinsurance percent, out-of-pocket limits, breadth of networks, coverage for wellness, early detection and prevention • Premiums – subsidy levels, treatment of dependents, service vs. disability retirees • Program Management - funding, Federal action, wellness, disease management, consortium purchasing

  12. 2011 SERS Changes • Higher premiums • Higher deductibles and co-payments • Prescription Plan • High Performance Formulary – generics-based • only the brand drugs on the formulary will be subsidized by SERS • Retiree will pay 100% of SERS discounted price for non-formulary brand drugs • Higher drug co-pays

  13. Current Programs • Vaccine Program • Disease Management • Wellness

  14. Developing Relationships • Patient Centered Medical Homes • Ohio Area Agency on Aging

  15. Future Plans • Work with the School Employee Health Care Board to provide assistance and support to promote healthier lifestyle choices • Goal: to have the retirees come to us in a healthier state so there is less consumption of healthcare resources

  16. Serving the People Who Serve Our Schools

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