The State Group Insurance Program for Plan Year 2007

1. The State Group Insurance Program for Plan Year 2007

2. Presenter Verla Lawson Division of State Group Insurance DMS People FirstTeam

3. The Changes • DSGI’s – Role and Responsibilities • People First – Benefits Administration • New Benefit Plans and New Vendors

4. The Challenges • Coordination and cooperation between DSGI and People First to effectively manage complex processes that serve employees and retirees within a complex regulatory environment • Enrollment in and implementation of new types of benefit plans and new vendors

5. DMS People First Benefits Team • Contact the team at 850-921-4500 • The People First Benefits Team consists of the following members: • Tom Lockridge – Team Lead • Verla Lawson • Janice Lowe • Jackie Ward • Lenora Williams • Mike Waller

6. DSGI Reductions • Downsizing and staff reductions • Client Services outsourced • Administrative Services outsourced

7. DSGI Today • Agency Liaison • Policy Analysis • Product Management • Procurement • Policy and Rule Determinations • Financial Management and Residual Accounting Functions

8. People First • System of Record (data) • Customer Service • Correspondence • Transaction Processing • Open Enrollment • Fiscal Administration • Eligibility Files to Vendors

9. Customer Interfaces • Bureau of State Payrolls • State Agencies • Universities • Devolved • Not yet devolved • Division of Retirement • “Benefits Only” Entities

10. People First as System of Record • COPES Insurance phased out • COPES data out of date • Transfer of COPES data to People First (PF) • New enrollment in PF SAP system • Historical data to Data Warehouse • Transfer of DSGI historical data • SAP data and DSGI data in the People First Data Warehouse

11. DMS People First Benefits Team • Facilitates the implementation of system and operational processes in People First • Assists employees and agencies with People First Issues • Receives direction regarding laws, rules and policies from DSGI

12. Changes in roles and processes Changes in roles and processes, coordination and cooperation. Two Examples are: • Underwriting approval process • Exceptions and appeals

13. Underwriting Approval • Underwriting approval process • Old procedure • Deductions began prior to approval • Cancellations and refunds required when underwriting was denied • New procedure • New enrollment records “locked” until approved • Deductions begin after approval is received

14. Escalations and Appeals • Escalated Issues • Pertain to People First Processes • Submitted to PF Client Services Team • Submitted by Agencies or DMS Project Team • Employee Appeals and Agency Errors

15. Appeals and “Exceptions” • “Agency error” letters to People First (coordinates with DSGI in complex cases) • Employee appeals • “Level 1 appeals by employee (not agency) sent to People First” • If denied, employee has right to Level 2 appeal • People First sends Level 2 appeals to DSGI • If denied, employee is notified by registered mail of his right to an Administrative Hearing

16. 2007 Benefit Plans • HMO Service Area Expansions • Open Access HMO Plans • Prescription Drug Program and Medicare Part D

17. Retiree Life Insurance • Effective January 1, 2007 Retirees will have two benefit levels to choose from: $2,500 & $10,000 • Cost to Retiree: $ 4.20 & $ 35.79

18. Retiree Life Insurance • Actual Premium paid to Prudential $4.20 + $6.36 = $10.56 for $2,500 and $35.79 + $6.36 = $42.15 for $10,000

19. Retiree Health Insurance Retirees who are not eligible for Medicare pay the same premium for both the PPO and HMO plans.

20. Effective April 1, 2007 • Effective April 1, 2007 for May coverage monthly premiums will increase. • Retirees who are not eligible for Medicare and members of the Standard PPO/HMO plans the premiums will increase as follows: • Individual Coverage - $427.86 • Family Coverage - $967.60

21. Medicare I • A Retiree/Surviving spouse who is eligible for Medicare. • For the Standard PPO Plan, coverage will increase to $227.18.

22. Medicare II • Retirees/spouse or surviving spouse who are eligible for Medicare and one or more dependents are not eligible. • In this case the premium will increase to $655.04.

23. Medicare III • Two Medicare eligible participants and no other dependents. • The premium will increase to $454.36

24. Health Investor PPO PlanMedicare I • Premiums for those retirees enrolled in the Health Investor PPO Plan and not Medicare eligible, will increase to: Individual Coverage - $351.20 Family Coverage - $768.56

25. Health Investor PPO Plan Medicare I • Premium for a Retiree enrolled in the Health Investor Health Plan who is eligible for Medicare. Individual Coverage - $169.46

26. Health Investor PPO PlanMedicare II Retiree/spouse or surviving spouse eligible for Medicare with other dependents. Premium amount $562.34

27. Health Investor PPO PlanMedicare III A Retiree and spouse eligible for Medicare with no other dependents or a retiree or a surviving spouse with a disabled dependent. Premium amount $338.92

28. Retiree HMO’s • Retirees who are eligible for Medicare and enrolled in one of the HMO Plans pay monthly premiums which vary by HMO and county.

29. Retiree HMO’s • For Plan Year 2007, some premiums have increased while others have decreased or remained the same. (There is a chart showing all retiree premiums, by county on the People First web site at https://peoplefirst.myflorida.com)

30. Health Investor Health Plans • Health Investor Health Plans • PPO • HMO • Health Savings Accounts • Limited Purpose Medical Reimbursement Accounts

31. Health Investor Plans • Lower premiums • Higher deductibles • Coinsurance rates • Medical • Prescriptions • Eligibility for Health Savings Account • Election decision based upon utilization

32. Health Savings Accounts • Tax exempt employee contributions • Employer contributions • Ineligible for “regular” Medical Reimbursement Account • Eligible for Limited Purpose Medical Reimbursement Account • Employee managed account

33. HMO Changes • HMO Service area expanded • Mail order Rx drug plans • Statewide contract rates • no more “service area codes” • “Open Access” HMOs • no “gatekeeper”

34. Medicare Part D • Federal requirement to coordinate enrollment with Medicare • Notification to participants • Retirees who choose Medicare D subject to Coordination of Benefits • Data interfaces to monitor enrollment in State Plan and Medicare D

35. The Future of Benefits Administration and the State Group Insurance Program • DSGI will continue to work with People First cooperatively to provide the State’s employees and retirees with a comprehensive package of quality benefits, meeting their needs in the most cost effective manner and using the latest technology to provide ready access to information and election opportunities.