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Health Insurance Update November 2010. Goals of Franciscan University’s Health Insurance Program. Protect University employees and their families from the financial consequences of catastrophic health care claims Provide reasonable access for routine family health care

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goals of franciscan university s health insurance program
Goals of Franciscan University’s Health Insurance Program
  • Protect University employees and their families from the financial consequences of catastrophic health care claims
  • Provide reasonable access for routine family health care
  • Provide health care services that are compatible with Catholic moral teaching
  • Encourage employees to participate as good stewards of their own health care
slide3
Franciscan University’s health insurance program should balance the following objectives with the overall goals:
  • Manage health care costs and cost increases
  • Provide employees with a quality health care provider network
  • Encourage employees to participate in the control of health care costs
  • Recognize and support the health care needs of large families
  • Recognize and support the health care needs of individuals on the lower end of the pay scale
benchmarking
Benchmarking
  • Milliman (MMMS)
    • 2010 plan designs
    • 4,054 companies
    • 2.2 million employees
  • Milliman Western PA
    • 2010 plan designs
    • 140 organizations
self funded health insurance
Self-funded Health Insurance
  • Fully insured vs. self-insured
    • University responsible for claims
  • Pay Third Party Administrator (TPA) to pay claims and use network
  • Pay for stop-loss insurance (high deductible)
  • Assumes risk for claims
  • Admin fees + stop loss insurance + claims =TOTAL COST
pcuc consortium
PCUC Consortium
  • Private College and University Consortium
  • 7 private schools in western PA
  • Highmark BC/BS
  • Greater leverage in negotiating admin fees and stop loss insurance (1700 members)
  • Level out self-insured risks by sharing in claims risk with other members
  • Maintain control over plan design
  • Additional administrative fee
health care reform act changes for 2011
Health Care Reform Act: Changes for 2011
  • Adult children up to age 26 are allowed to be enrolled in the plan as long as the child is not eligible for insurance through his/her employer.  Affidavit required.
  • No lifetime maximum on individual claims costs
  • Flexible spending accounts, health reimbursement accounts, and health savings accounts cannot be used to pay for over the counter drugs, purchased without a prescription, except for insulin.
  • Additional mandates will roll out over next several years.
  • Overall impact is still not clear, even on 2011 changes.
slide14
2010
  • 272 Employees on health insurance coverage
  • Over 900 lives
  • Project to spend about $1.9 million on doctors and facilities
  • Project to spend about $450,000 on drugs
  • No large claims
  • Consortium members also had a good year
slide15
2011
  • NO INCREASE in BC/BS deductibles, copays, out-of-pocket maximums, and co-insurance levels for medical on either plan
  • PPO access to BC/BS network (Pittsburgh & nationwide) continues for both plans
  • HRA maintained at same funding schedule for both plans
  • Maintain vision benefit for employees on both plans; option for dependent vision coverage requires additional contribution of $18
2011 total cost
2011 Total Cost
  • Increases due to HCRA
  • Zero net increase in projected total cost
  • Single Coverage: $5,220 annually
    • employees contribute $516 or 9.8%
  • Family Coverage: $13,944 annually
    • employees contribute $936 or 6.7%
2011 monthly employee contributions
2011 Monthly Employee Contributions
  • PPO Core Single: $43/month: no increase
  • PPO Core Family: $78/month: no increase
  • PPO Buyup Single: $115/month: no increase
  • PPO Buyup Family: $281/month: no increase
  • Dependent vision coverage may be added for a contribution of $18/month
  • Employee contributions will be pre-tax payroll deductions
7 year comparisons
7 Year Comparisons
  • Core Monthly Contributions2005: $24 sgl / $46 family 2006: $18 sgl / $34 family2007: $28 sgl /$63 family 2008: $15 sgl/ $45 family2009: $37 sgl/ $74 family 2010: $43 sgl/ $78 family2011: $43 sgl/ $78 family
  • Deductibles2005: $0 2006: $250/$5002007: $350/$700 2008: $500/$1,0002009: $500/$1,000 2010: $500/$1,0002011: $500/$1,000
voluntary dental
Voluntary Dental
  • Completely Voluntary (University acts as a conduit)
  • Claims costs since implementation have exceeded insurers expectation (pent up demand & larger families)
  • 19% increase for 2011 (negotiated down from 30%)
  • In 2010 we negotiated down to 12% increase (United Concordia wanted a 15% increase)
  • Monthly rates:
    • Core $16.67/$43.06
    • Buyup $34.93/$90.06
committee membership
Committee Membership

David Schmiesing Chair

Janine Stasiulewicz Secretary

Sue Dukich Robert Filby

Catherine Heck John Herrmann

Patrick Lee Mary Lynn Lewis

Don Materniak Adam Mitchell

Brenan Pergi Adam Scurti

Mary Salter Patti Scheel

Dave Skiviat

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