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GIC Public Hearing. February 1, 2012. We Are Not Yet Out of the Woods. The Good News. State tax collections expected to increase 4.5\% for Fiscal Year 2013 But not good enough…. The Bad News. Debt Service; Pensions; Medicaid; and HR Costs Expected to consume new revenues

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gic public hearing

GIC Public Hearing

February 1, 2012

the good news
The Good News
  • State tax collections expected to increase 4.5% for Fiscal Year 2013
          • But not good enough…
the bad news
The Bad News
  • Debt Service;
  • Pensions;
  • Medicaid; and
  • HR Costs
        • Expected to consume new revenues
    • Unknown – federal budget axe to close national debt???
pressures on the gic s budget
Pressures on the GIC’s Budget
  • Added Costs from Federal Health Care Reform:
    • Dependent benefits expansion to age 26: 5,000 added
    • Eliminated copays and deductibles for preventive services
    • New external appeals process
  • New groups add costs to the GIC’s budget, but help keep local taxes affordable
chapter 69 of acts of 2011 new ways for municipalities to join gic
Chapter 69 of Acts of 2011 – New Ways for Municipalities to Join GIC
  • New This Fiscal Year – 7,700 members
    • Town of Arlington
    • Town of Lynnfield
    • Town of Wakefield
    • City of Medford
    • City of Somerville
new for fiscal year 2013
New for Fiscal Year 2013
  • City of Lowell
  • Town of Monson
  • Possibly more municipalities and other groups – not yet known
house 2 budget released january 25 2012
House 2 Budget Released January 25, 2012
  • $35 million over FY12 appropriation
  • GIC estimated costs of new municipalities that joined in FY12: $60 million
  • Health care costs continue to go up
  • Plus additional groups joining in FY13 - unknown
appropriation is an 8 act play
Appropriation is an 8-Act Play
  • House 2
  • House Ways & Means
  • House Final
  • Senate Ways & Means
  • Senate Final
  • Conference Committee
  • Governor Signs/Vetos
  • Legislature Overrides Vetos or Sustains
big success last year s re enrollment and limited network premium incentive
Big Success – Last Year’s Re-enrollment and Limited Network Premium Incentive
  • Over 99% of state employees re-enrolled in health insurance
  • Over 30% of state employees selected a limited network plan
  • Almost 12,000 employees chose to change plans, a 275% increase
  • State employees who enrolled in a limited network plan saved on average: $600/individual and $1,400/family coverage
  • Projected $20+ million savings for Commonwealth
the gic s cpi initiative rewards enrollees for visiting higher quality cost efficient providers
The GIC’s CPI Initiative Rewards Enrollees for visiting higher quality, cost efficient providers

Tier 1 (excellent) – lowest copay

Tier 2 (good)

Tier 3 (standard)

the gic will continue focus on limited network plans
The GIC will Continue Focus on Limited Network Plans

Same great benefits with limited provider networks

last year was a year of big change
Last Year was a Year of Big Change

Our Hope - This Year Should be Relatively Calm

proposals to build in more measures to help very sick
Proposals to Build in More Measures to Help Very Sick
  • Inpatient hospital member copay (non-Medicare plans) – one per calendar quarter: Fallon Direct and Select, Harvard Independence and Primary Choice, Health New England, NHP Care, and Tufts Navigator and Spirit; UniCare already does
provider networks change every july 1
Provider Networks Change Every July 1
  • Is your (and your dependents’) doctor in the plan network?
  • Is your hospital in the plan network?
  • If doctor is in network, what is his/her copay tier?
  • Were you specific about the plan name when you checked with the plan or at the doctor’s office–Harvard Primary Choice vs. Independence?
remember doctors and hospitals can leave a plan during the year
Remember – Doctors and Hospitals Can Leave a Plan During The Year
  • Often as part of health plan/provider contract issues, practice mergers, retirement, or relocation
  • If this happens, the health plan will help you pick a new provider
  • You cannot change health plans during the year, unless you move out of the plan’s service area – or become Medicare eligible, at which point you must change plans.
other potential health plan changes
Other Potential Health Plan Changes
  • Promoting use of lower cost doctors and high-tech imaging facilities
  • Already Approved: PCP Referrals reinstated for NHP Care as of July 1, 2012
  • Keep in mind: state enrollee premium contributions can change when the budget is finalized
other benefit news for state enrollees effective 7 1 12
Other Benefit News for State Enrollees Effective 7/1/12
  • MetLife awarded new contract for GIC Dental/Vision and Retiree Dental Plan
  • Retiree Dental: elimination of 6-month waiting period for major restorative services (e.g., crowns or dentures)
  • Long Term Disability carrier contract to be awarded at February 10 Commission meeting
state enrollee wellness pilot program to be introduced
State Enrollee Wellness Pilot Program to Be Introduced

Funded in part from Early Retiree Reinsurance Program: retirees ages 55-64 and their spouses, and active employees of Executive Branch, Constitutional Officers, and Legislature:

    • Health assessments
    • Online resources
    • Health coaching
  • Wellness seminars offered to all – to be held at certain state offices
state employee and retiree health insurance buyout
State Employee and Retiree Health Insurance Buyout
  • Now offered twice per year
    • For July 1
    • For January 1
next year
Next Year

GIC to go out to bid for all health plan benefits and mental health/substance abuse benefits for UniCare and Tufts Navigator/Spirit members

To Take Effect in FY14

weigh your options
Weigh Your Options
  • April 9 – May 7, 2012
  • Changes Effective July 1, 2012
  • Guides distributed in April
gic health fairs
GIC Health Fairs
  • Schedule in works – not final until March
  • Distributed geographically across state
  • Open to all members – especially those who are enrolling for first time and those wishing to make a change
  • Wellness exhibits will return
websites great resource
Websites – Great Resource
  • GIC website updated by end March (
    • Annual enrollment news and changes
    • Rates
    • Answers to FAQs
    • Forms to expedite your decisions
    • Links to plans
  • Plan Websites
    • Provider networks updated by April 9