GIC Public Hearing

1. GIC Public Hearing February 1, 2012

2. We Are Not Yet Out of the Woods

3. The Good News • State tax collections expected to increase 4.5% for Fiscal Year 2013 • But not good enough…

4. The Bad News • Debt Service; • Pensions; • Medicaid; and • HR Costs • Expected to consume new revenues • Unknown – federal budget axe to close national debt???

5. 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

6. 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

7. New for Fiscal Year 2013 • City of Lowell • Town of Monson • Possibly more municipalities and other groups – not yet known

8. 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

9. 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

10. 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

11. Limited Network Plan IncreasesBefore and After Re-enrollment

12. 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)

13. The GIC will Continue Focus on Limited Network Plans Same great benefits with limited provider networks

14. Limited network plan premium 20% less than wider network counterpart

15. Last Year was a Year of Big Change Our Hope - This Year Should be Relatively Calm

16. 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

17. 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?

18. 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.

19. 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

20. 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

21. 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

22. State Employee and Retiree Health Insurance Buyout • Now offered twice per year • For July 1 • For January 1

23. 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

24. Weigh Your Options • April 9 – May 7, 2012 • Changes Effective July 1, 2012 • Guides distributed in April

25. 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

26. Websites – Great Resource • GIC website updated by end March (www.mass.gov/gic): • 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