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Employee Health and Accident Fund FY 2015-16 Plan Modifications

Employee Health and Accident Fund FY 2015-16 Plan Modifications. Underlying Market and Demographic Issues. Affordable Care Act does increase upward rate pressure Recent data suggest a 9.9% increase in costs Rx Costs are increasing at higher rate than medical services

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Employee Health and Accident Fund FY 2015-16 Plan Modifications

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  1. Employee Health and Accident Fund FY 2015-16 Plan Modifications

  2. Underlying Market and Demographic Issues Affordable Care Act does increase upward rate pressure Recent data suggest a 9.9% increase in costs Rx Costs are increasing at higher rate than medical services Demographics of the Health Plan will increase upward rate pressure Current average age of member is 51 Retiree membership continues to make up a larger share of total membership

  3. Employee Cost Impacts

  4. Possible Plan Provisions to Modify Deductible Max Out of Pocket Include an Rx Deductible Increase ER Co-pay to $250 ER visits increased 25.4% ER costs increased 37.2% Need to modify behavior

  5. Modification Impact on Premium

  6. Proposed Modifications in RED

  7. Employee Cost ImpactsWith Changes

  8. Employee Cost Impacts

  9. Impact Demographics

  10. Claims Payment Facts Average Claims Cost per Member - $4,200 Maximum Impact of All Changes - $1000 Minimum Claims Payments to Max Impact – $16,250 Number of Members >$15,000 in Claims 276 Percentage of Total Membership - 5.5%

  11. Discussion Items Premiums are increasing because costs are increasing How does the Plan pay for the increased costs? Revenue Solution -Increase Premiums to reflect cost increase Cost Solution – Reduce benefits to reflect current revenues Balanced Solution – Looks at both sides of the equation Modify Benefits for some upward premium pressure relief More moderate premium increases to address cost increases

  12. What is this Really all about?

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