How to Use Your CVUSD Health Benefits Effectively

1. How to Use YourCVUSD Health Benefits Effectively

2. Why the presentation? • Education • A better understanding of our system • A better understanding of the funding • Empower you to be a better health care consumer • We are in NO WAY are telling to avoid the doctor • Trying to be smarter about usage of benefits

3. Funding • CVUSD collects contributions from members and pays out of the general fund into the health benefits fund • This year it is $14,273 per employee in PPO. 963 employees enrolled in PPO. • Anthem Blue Cross HMO for singles $5,871; $12,045 for double; $17,908 for families. 231 HMO employees enrolled. • CVUSD pays Kaiser an amount per employee for their coverage. • We negotiate each year with Kaiser for the amount charged. • Singles- $5,346; $10,692 double; $15,129 for families • 315 employees enrolled • CVUSD pays Blue Cross to “rent” their insurance pool. • The money in the CVUSD health benefits fund pays for PPO claims that are processed through Anthem Blue Cross. • EACH time you go to the doc or have something done, CVUSD gets a bill from Blue Cross for the agreed-upon amount. • It is paid out of CVUSD’s Health Fund • If any claims go above $260,000 we have an insurance plan called “Stop/Loss” that covers all medical costs in excess of that amount. • Approximately $78K per month

8. In short • Total costs dropped, but on the rise • Employee contributions helped flatten the trend out • Fewer employees • As the budget decreases health care becomes a larger share. • Costs per employee up and costs TO employee up • Premium increases • More usage • Doc fee increases • Plan modifications

11. Preventative Care • Affordable Care Act (aka “Health Care Reform” or “Obamacare”) • Should not cost you anything out-of-pocket (IN-NETWORK ONLY) • No more co-pays for preventive check ups • Cost of appointment to plan not applied to deductible • The key is to set the appointment the correct way. • When you set the appointment make sure you ask for a “preventive care” screening.  • Once in the appointment, do not ask for a diagnosis of another issue or ask for a prescription, or Rx renewal. • Adding a diagnosis and/or prescription makes it a diagnostic appointment and then no longer qualifies as preventive screening.  • The doctor may make a diagnosis or give a prescription as a result of the screening, but that should be his/her decision, not your request.  • Remind your doc that lab coding must be for preventative care – not with a diagnosis code.

12. Who pays for preventative care? • You don’t pay anything, intent is to encourage you to go to the doc for the check-up • Intent to save money over the long-term because issues will be caught early • District (health plan) DOES pay the full amount.

13. Prescriptions- same for in and out-of-network • Going to the pharmacy • 30 Day Supply • $15 for generic • $30 for brand name • Mail Order • 90 Day Supply • $30 generic • $60 brand

14. Monthly Premium Payments - CVUSD

15. District Website- Under Departments/Employee Benefits

16. Emergency Room Visits • 213 total last year • $429,714 in total claims • $1,471 per visit average • Of the 213 visits, only 2 were admitted to the hospital

17. What’s the difference?! • Approximate emergency room costs (national avg. ER visit $1,349): • To YOU: • $100 Co-Pay • 20%- $249.80 • To the PLAN (the district) • 80% of remaining- $997 • Approximate cost of urgent care visit ($100 national avg.) • To YOU: • Co-pay- $20 • 20%- $16 • To the PLAN: • 80% of remaining- $64

18. Emergency Room Visits

20. If you are having an emergency- go to the ER • Urgent care is for ear infections, sometimes stitches, tummy aches, sore throats, etc. If you’re having chest pain GO TO THE ER!

21. If you do have an emergency • If you get checked into a non-network hospital • Anthem will pay as if you are in-network UNTIL YOU ARE STABILIZED • Once you are stabilized, you begin to pay out-of-network rates • Get to an in-network hospital ASAP

22. Kaiser Changes last year to this year • Inpatient Costs- UP 250% • Outpatient Costs- DOWN 29% • Pharmacy- DOWN 15% • “Other”- UP 62%

23. Kaiser Inpatient Analysis • Medical- UP 625% • Surgical- DOWN 50% • Maternity- UP 132% • Mental Health- UP 801% • PPO is up 21% total • HMO is up 32% total

24. Top Kaiser Prescriptions Paid Claims

25. Nationwide trend of usage

26. Parting thoughts • Eat right • Exercise • REST • Do preventive appointments • Better to catch things early • “I save the plan money because I never go to the doctor”- DOESN’T SAVE MONEY • Go to the dentist • Get an annual eye exam • Encourage each other for better health • Participate in the programs that have been created like Conejo Cares Wellness Plan. • ASK QUESTIONS