FY17 Risk Management Report on Health Care

1. FY17 Risk Management Report on Health Care

2. Summary • Total Claims Paid decreased by $525,858 • RX Claims increased by $639,632 • Emergency Room Claims increased by $115,904 • Urgent Care Claim Paid decreased by $2,970 • Primary Care Claims decreased by $163,018 • Specialty Care decreased by $65,620 • Inpatient claims decreased by$480,344 • Outpatient claims decreased $569,813

3. RX Factors • 35% of the membership used their RX benefit. • Brand Drugs were responsible for 78% ($3,684,206) of the plan spend for this period while accounting for 15% of the utilization. • Specialty Drugs accounted for 23.3% ($1,097,743) of plan spend but only accounted for .04% utilization. • The trend for specialty drug cost increased 39% and utilization was up 20.4%. • Generic Drugs were responsible for 22% ($1,018,392) of the plan spend and 85% of the utilization.

4. Emergency Room Factors • Utilization of emergency room increased by 50 visits. • 14.8% of the member population visited the Emergency Room without admission to the hospital. • 35.8% of the ER visits were divertible – could have been handled by Urgent Care or Primary Care (dizziness, nausea, vomiting or headache)

5. Urgent Care Factors • Urgent Care claims cost were down by $2,970 and utilization was down by 105 visits. • The average spend per visit for a Urgent Care Claim was up from $129 to $146. • Compared to the cost is significantly lower than the average spend per visit for a Emergency Room Claim of $1,838

6. High Cost Claims >100K • High Cost Claims expenditures were down by $465,956 and utilization was down by 13%. • These claims accounted for 0.50% of the member population and 18% of the total cost. • Retirees accounted for 16% of the High Cost Spend. • The average age of the High Cost Members was 52.2 years of age.

7. A Look Back FY 16/17 Employee Health & Wellness Center

8. Status of the Center • Demographics of Visits • Total Visits in FY16/17 8922 Visits 1945 Unique Patients

9. Prevalent Conditions Found

10. Impact on FL Blue Utilization Based on # of visits- • Primary Care-  15.0% (FY16 -12.2% ) • Emergency Room-  6.7% (FY16 -10.8%) • Urgent Care Centers-  14.4% (FY16 -32.6%) • Specialty Care-  4% (FY16 -37%) • Pharmacy-  9.5% (FY16 -12.5%)

12. Cost Avoidance vs Clinic Expenses

14. High Deductible Plan Health Insurance

15. High Deductible Plan • Offer as an Option – Not Mandatory. • Premiums for Employee will be lower. • Higher Deductible equates to more risk for employee. • Will be coupled with a Health Reimbursement Account. • Expect a 5% migration to this plan. • Premiums are set to be revenue neutral.

16. Premiums - All Rates Are Monthly

17. Plan Design – Deductibles and Co-Insurance • Deductibles are as follows: • Single Coverage - $1,500 Annually in Network $3,000 Annually Out-of-Network • Employee + 1/Family - $3,000 Annually $6,000 Annually Out-of-Network

18. Plan Design – Deductibles and Co-Insurance • After the Deductible is met the coverage is 80/20 in Network and 50/50 Out of network co-insurance with one exception – Prescription Drugs • The same co –pay structure as in the current plan applies once deductible is met. • Generic - $10 per 30 day supply • Preferred Brand - $50 per 30 day supply • Non-Preferred Brand - $80 per 30 day supply

19. Plan Design - Health Reimbursement Accounts and Maximum Out of Pocket Limits • The County will fund a Health Reimbursement Account (HRA) as follows: • Single Coverage - $750 Annually • Employee +1/Family Coverage - $1,500 Annually • The Maximum Out of Pockets Limits are as follows: • Single Coverage - $4,000 network/$8,000 out of network • Employee + 1/ Family Coverage - $8,000 in network/$16,000 out of network

20. Here Is How It Works - Single Coverage

21. Here is how it Works - Employee +1/Family Coverage

22. Fourth QTR and HRA Rollover Feature • The County will do a one time fourth quarter Rollover for October, November, and December of 2018. • The deductible for the last three months of 2018 will be the full $1,500/$3,000. Any money you spend against your deductible during this period will be credited against the new calendar year. • The County will fund the HRA for the last three months of 2018 at $500/$1,000. • Any unused HRA, up to an amount equal to the annual contribution, can be rolled over to the next calendar year.

23. New Supplemental Insurance Offerings • Short Term Disability • Long Term Disability • Critical Illness • Accident • Employee Identity Theft and Legal Protection Plans

24. New Supplemental Insurance Offerings • The four insurance policies will be offered by Standard Insurance and the Legal Services will be through Legal Shield. • Participation is voluntary. • All premiums are 100% paid by the employee.

25. Short Term Disability • Will cover up to 60% of their weekly salary (tax free). • Maximum benefit is $1,000 weekly. • There is a 7 day waiting period before benefits begin. (illness or accident). • Only good for off-duty injuries or illnesses. • Maximum coverage period is 13 weeks. • No pre-existing condition exclusions. • 20% participation is required for coverage to be effective.

26. Long Term Disability • Will cover up to 60% of their monthly salary (tax free). • Maximum benefit is $5,000 per month. • There is a 90 day qualifying period before benefits begin. • The maximum benefit period is up to Normal Social Security Retirement age. • There is a 3/12 pre-existing condition limitation. • 20% participation is required for coverage to be effective.

27. Critical Illness • Covers a wide variety of illnesses including heart attack, stroke and cancer. • Premiums are based non-tobacco versus tobacco user, amount of coverage desired and age • Spouse can be covered for an additional premium (based on factors listed above) • Children are covered at no additional charge • Coverage is portable.

28. Critical Illness • Coverage amounts are: • Employee - $5,000 to $50,000 in $5,000 increments • Spouse - $5,000 to $30,000 in $5,000 increments • Child – 25% of the employee amount • Guarantee issue up to $20,000 for employees and $10,000 for spouses. • Guarantee issue up to $20,000 for employees and $10,000 for spouses. • Plan includes a $50 wellness benefit. • Coverage is portable. • There is a pre existing condition clause of 6/12.

29. Accident Policy • Only covers on/off duty accidents. • 4 levels of premiums (All premiums listed are monthly) • Employee - $18.24 • Employee and Spouse - $27.28 • Employee and Children - $31.70 • Employee and Family - $48.84

30. Accident Policy • Covers numerous injuries at varying benefit levels. • Has an Accidental Death Benefit. • Employee - $50,000 • Spouse - $25,000 • Children - $12,500 • Plan includes a $50 wellness benefit. • Policy is portable.

31. Identity Theft Protection • Includes • Privacy Monitoring • Security Monitoring • Social Media Monitoring • Credit Monitoring • Monthly Credit Score Tracker • Consultation • Full Service Restoration

32. Employee Legal Protection Plans • Provided by LegalShield Closed Panel Network of Attorneys • Legal Protection Covers: • Legal Advice and Consultation – Including Attorney Letters and Phone Calls • 24/7 Emergency Assistance • Family Law Matters • Contract and Document Review • Attorney Prepared Estate Planning (Will, Living Will, Health Care POA, Durable POA) • Traffic Violations and Accident Protection • IRS Audit Assistance • 25% member discount with network attorneys

33. Premiums • Legal Shield Plan (All premiums monthly) • Employee Only – $23.95 • Family - $23.95 • ID Shield Plan • Employee Only - $8.95 • Family - $18.95 • Combined Plans • Employee Only - $32.90 • Family $38.90