Agenda - 10-09-2007-6e - Laserfiche WebLink

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Health Plans Currently the County offers two fully insured health insurance .plans. Both health plans are contracted through the NCACC Health Insurance Trust and administered by CIGNA. One plan is a Health Maintenance Organization (HMO). This plan has only in-network benefits that require participants to use the CIGNA network of physicians and facilities: The second plan is a Preferred Provider Organization (PPO) that allows both in and out of network services. Both plans offer a wellness benefit at no cost when employees have a doctor visit for physicals and immunizations. Attachment 1 shows the number of employees enrolled in each plan and the rate changes in the annual health insurance since 2001. The County health care plan is a benefit valued by employees and making large or drastic changes would not be appropriate for this year. Based on claims generated by the plan, it will be necessary to increase the monthly premiums paid by the County or to reduce the coverage level of the health care plan. This rate increase is largely due to a 23.0% increase in net claims from July 2006-July 2007 over claims July 2005-July 2006. See Attachment # 2 Claim Experience. NCACC statistics further show that the County group pharmacy claims amount to 43% of overall claims. This is slightly above the total NCACC pool for pharmacy. See Attachment 3 Top 20 Drugs. The County is also above the pool in outpatient doctor and specialist costs and slightly below in inpatient hospital costs. The County emergency room admissions have dropped slightly and remain below the pool average. Staff requested a change in coverage options that adds a fifth tier for coverage. The Employee/Child tier is a more economical option for those covering only one dependent child compared to the Employee/Child(ren) option. This additional tier will affect approximately 80 employees currently in the Employee/Child(ren) tier and will reduce both County and employee premiums. This addition is incorporated in all options. Staff has considered four options for health care coverage to reduce the costs for both the County and employees. With each of the options that reduce the increase of the total premium there is a small increase in the copays of either the Physician Copay (Option II), the Pharmacy Copays (Option III) or both the Physician and Pharmacy Copays (Option IV). Currently, the co- pays for doctors and specialist are lower than the NCACC group overall and lower for pharmacy drugs. The impact of the four options on the premiums by Total Cost, County Cost and Employee Premium are indicated in Attachments 4, 5 and 6. The County and employee premium rates indicated in Attachments 5 and 6 continue the current 52.0% dependent subsidy, based on the HMO Plan. Continuation of the subsidy at this level maintains a key "family friendly" policy offered by the County that is highly valued by a large number of County employees. This policy makes health insurance coverage for dependents, whether spouse, domestic partner, children, or entire family more affordable, and thus, accessible. It particularly benefits lower salaried employees for whom dependent health insurance coverage is a significant cost. Option 1 No Change to Current Plan with addition of Employee/Child tier Description: The current plan with no changes in the plan design copays for doctor or specialist visits, pharmacy drugs, or any changes in annual deductibles. Primary Care Physician visit = $10 and Specialist = $20 Pharmacy Drug Copay $5 for Generic, $15 for Brand and $30 for non-formulary Mail Order Drug Benefit: 3 mo. supply for $13 Generic, $26 Brand and $60 non-formulary