1 / 11

AGENDA

AGENDA. Further Work on the three Plan Design Models Two-Year Plan Design Changes Rx Plan Design Model Next Steps. Scenario 3.

konala
Download Presentation

AGENDA

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. AGENDA • Further Work on the three Plan Design Models • Two-Year Plan Design Changes • Rx Plan Design Model • Next Steps

  2. Scenario 3 • PY 2012 and PY 2013 funding PEPM is based on 5% increases over 2011 re-projected costs of $1,229.61 PEPM with the April 1, 2011 changes. Requires additional resources through the bargaining process to bridge the gap between the State’s proposal of $1,149.04 PEPM and the current cost of $1,229.61 PEPM. • Add more procedures to the Additional-Cost Tier $ 5,000,000 • Increase Out-of-Pocket Max: $1,500 6,200,000 • $35/month Spouse or Domestic Partner Surcharge 9,000,000 • TOTAL: $22,200,000

  3. The Scenarios • Scenario 3 • PY 2012 and PY 2013 funding PEPM is based on 5% increases over 2011 re-projected costs of $1,229.61 PEPM with the April 1, 2011 changes • $20.2 million in plan design changes for 2012 • Scenario 5 • PY 2012 and PY 2013 funding PEPM is based on 0% increases over 2011 re-projected costs of $1,229.61 PEPM with the April 1, 2011 changes • $59.8 million in plan design changes for 2012 • Scenario 2 • 2012 to 2013 funding PEPM is based on 0% increase from proposed Governor’s Budget of $1,149.04 PEPM • $100.3 million in plan design changes for 2012

  4. Scenario 5 • PY 2012 and PY 2013 funding PEPM is based on 0% increases over 2011 re-projected costs of $1,229.61 PEPM with the April 1, 2011 changes; requires $59.8 million in plan design changes for 2012. Requires additional resources through the bargaining process to bridge the gap between the State’s proposal of $1,149.04 PEPM and the current cost of $1,229.61 PEPM. Add more procedures to the Additional-Cost Tier $10,000,000 Out-of-Pocket Max: $1,500 6,200,000 $35/month Spouse or Domestic Partner Surcharge 9,000,000 Reduce Chronic Care Coinsurance (Asthma, Hypertension, Diabetes, COPD, CHF, Cholesterol ($2,800,000) Add Deductible - $250 In-Network; $500 Out-of-Network (4 office visits not subject) 12,900,000 4TH Rx Tier for Specialty Drugs - $100 copay 600,000 Tobacco Surcharge for Employees and Spouses $25/mo 2,400,000 $1,000 out-of-pocket max for Rx (1,000,000) Office Visit Coinsurance: 20% PCP, 35% Specialist 5,600,000 Rx Tiers: $10 Generic, $30 Brand, Higher of 50% or $60 Brand non-formulary, Mail Order: 2.5 x Retail 11,500,000 Discontinue Prescription Drug Exceptions 1,500,000 Rx Deductible: $50 3,900,000 TOTAL $59,800,000

  5. Scenario 2 • PY 2012 and PY 2013 funding PEPM is based on 0% increase from the State’s proposal of $1,149.04 PEPM; requires $103,500,000 in plan design changes. Add more procedures to the Additional-Cost Tier $10,000,000 Out-of-Pocket Max: $1,500 6,200,000 $50/month Spouse or Domestic Partner Surcharge 12,000,000 Reduce Chronic Care Coinsurance (Asthma, Hypertension, Diabetes, COPD, CHF, Cholesterol ($2,800,000) Add Deductible - $500 In-Network; $500, $1,000 Out-of-Network 27,600,000 4TH Rx Tier for Specialty Drugs - $100 copay 600,000 Tobacco Surcharge for Employees and Spouses $25/mo 2,400,000 Rate Retirees Separately going forward 1,900,000 $1,000 out-of-pocket max for Rx (1,000,000) Office Visit Coinsurance: 20% PCP, 35% Specialist 5,600,000 Discontinue Prescription Drug Exceptions 1,500,000 Rx Deductible: $50 3,900,000 Additional funding through bargaining or premium contribution 31,000,000 TOTAL $103,500,000

  6. Employee Contributions • PEBB IS NOT PROPOSING EMPLOYEE CONTRIBUTUIONS • The $31,000,000 number on the previous slide used the following employee contributions. However, the same $31,000,000 could come from the bargaining process. • Employee only - $25/mo • Employee and Spouse/Domestic Partner - $50/mo • Employee and Child(ren) - $50/mo • Employee and Family - $75/mo

  7. Two-Year Plan Design Changes • Previous Scenarios were 2012 changes only, meaning that additional, unknown changes would need to be made for the 2013 plan year • The Board asked the staff and consultants to determine what changes we would need to make in 2012 to resolve the existing funding gaps for the entire biennium • This does not guarantee that we won’t need to make some changes in 2013, but it greatly reduces that possibility

  8. Two-Year Plan Design Models

  9. Two-Year Plan Design Models

  10. Current Plan Design

  11. Next Steps • Next PEBB Mtg on April 19 • Goal is to finalize Models for each of the three Scenarios for final pricing and confirm the Pharmacy Plan Design • We will also continue to discuss other possible changes that could save us money and/or improve purchasing value in 2012 and the future

More Related