SAU 16 Medical Benefits Presentation October, 2010. SAU 16 Joint Board Committee. Formed in April 2010 to review all aspects of compensation. Focused on Health Care due to rapidly rising costs. Members: P. Lovejoy, CoopC. Gargaly, Brentwood C. Ellis, StrathamP. O’Day, Exeter
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P. Lovejoy, CoopC. Gargaly, Brentwood
C. Ellis, StrathamP. O’Day, Exeter
A. Mower, KensingtonC. Bellisio, Newfields
P. Flynn, SAU 16M. Morgan, SAU16
B. Nigrello, E. Kingston, Chair
In NH there are three entities that offer health insurance to local governments and school districts.
Source: LGC: M. Briggs email 9/22/10 and 9/24/10 SchoolCare: L. Duquette email 9-28-10. Primex: K. VanBuskirk email 9/9/10.
Overall Net operating loss for 2009: (- $14.2 Million)
Medical Book of Business loss for 2009: (- $14.8 Million)
SchoolCare: Net operating gain for 2009: + $4.12 Million
Primex: Net operating Loss for 2009 (-$2.9 Million)
for Primex Health Programs
LGC and Primex report financials as a calendar year, above 1/1/09-12/31/09.
SchoolCare reports as a fiscal year, above 7/1/09-6/30/10.
Source: LGC 12/31/09 Financial Statement and 9-24-10 email from M. Briggs for Medical Loss. NH SchoolCare Coalition Financial Statement ending 6/30/10. K. VanBuskirk email from Primex 9/9/10 breaking out financials for health portion of the business.
Source: LGC 2/16/10 Memo from M. Briggs comparing CSD to LGC Overall. 2010-2011 LGC rate from 9-24-10 email from M. Briggs. SchoolCare 2/17/10 Overview Slide Presentation to CSD. Primex: K. VanBuskirk email 9/9/10. Paul Flynn Memo to SAU Joint Chairs, undated. SAU 16 Stewardship report for 17.1% rate, 6/7/2010.
Source: LGC Financial Statements ending 12/31/09, page 24. SchoolCare email from L. Duquette 9/3/10. Primex email from K. VanBuskirk 9/9/10.
One Of NH’s Largest SAUs
This SAU has very low premiums, low claims, and has done an excellent job of educating employees as to the value of the HMO plan. 79% of employees are on the HMO compared to only 42% in the LGC Trust book of business and 16% for SAU 16.
Source: SAU 16 census from LGC Health Trust 6/8/10. Anthem Cost & Utilization for another NH SAU, reported 10-2010.
100 $5 Office Visit Copays =
COMP 100 or JW Plan Designs with $500 Max Out of Pocket
Lower Overall Claims Costs Result in Lower Premium Increases and Employee Contribution Levels for SAU 16.
POS 3 Tier $436.89 pmpm, 1149 members
HMO $262.88 pmpm, 193 members
Source: Anthem SAU 16 Cost & Utilization report 9/292010 page 2.A.4. Claims Costs Per Member Per Month 7/2009-6/2010.
A $4,200 Difference!
Effective 12/31/10, Anthem will terminate its contract with Exeter Hospital and Exeter physician medical staff. Unless a new agreement is reached, Exeter Hospital will no longer be participating in the Anthem network as of 1/1/2011.
47% of All SAU 16 inpatient and outpatient claims are through Exeter Hospital.
Source: Glenn Klink, VP Exeter Health Resources 9/8/10 Memo from Exeter Hospital.
SAU 16 Anthem Claims & Utilization Report 9/29/10.
Side Bar Language to Allow Shopping of Coverage
It is the recommendation of IPG that SAU 16 seek side bar language, where necessary, with each of the Labor Units. The side bar language would give SAU 16 the right to look at competitive pricing from SchoolCare and Primex. If it is determined that a given Labor Unit wishes to switch carriers or plan designs within the LGC HealthTrust, then such a change would be pursued in accordance with the terms or sidebar of the applicable Collective Bargaining Agreement.
"For the plan year beginning 7/1/11 (Fill in name of district) may seek bids from alternative health insurance providers, or alternative plans within the LGC HealthTrust may be adopted in accordance with the terms of the Collective Bargaining Agreement of (Fill in the name of district). Sufficient time and resources shall be provided by (Fill in name of district) Labor and School Board to fully research and review the alternative plans with its members before implementing any identified changes. Should a decision be made to elect an alternative health insurance provider and plans, or alternative plans within the LGC HealthTrust, this decision will render the current contractual obligation to Anthem Blue Cross Blue Shield null and void for the period July 1, 2011 – June 30, 2013.”
October 2010: IPG to meet with Representatives from Labor, Administration & School Board.
November 10, 2010: Goal is to secure contract language sidebar approval.
November 16, 2010: IPG to issue full RFP to shop Medical coverage.
January 2011: Carrier quotes back. IPG to analyze/spreadsheet.
Before February Vacation 2011: IPG to meet with School Board, Labor, & interested parties regarding proposed plan design or carrier changes.
By March 11, 2011: Approve plan design or carrier changes, if any.
April/May 2011: Open Enrollment. IPG to present to employees either to maximize current LGC HealthTrust offerings – including Flex and Wellness -
or to explain new plan/carrier offerings.