5.2 ERMUSR 10-11-2005 Elk River -�-�
I Municipal Utilities
13069 Orono Parkway phone: 763.441.2020
Elk River,MN 55330 Fax 763 441.8099
October 3, 2005
' To: Elk River Municipal Utilities Commission
Jerry Takle
John Dietz
Jim Tralle
From: Bryan Adams
Subject: Health Insurance
' Jodi Berge of David Martin Agency Inc. will be at our meeting to give a presentation
concerning health Insurance. Jodi is our independent health care agent representing our
interest in our insurance pool. Attached is a copy of her power point presentation with
• alternate health plans.
This is the same presentation she gave to our employees on 9-28-05. Our employees are
already discussing options. The bond pool on our behalf bids the insurance coverage on
an annual base. This satisfies our requirement to formally bid health insurance at 5 year
intervals.
1
111 u
14, 1 th copay plan Please note.Benefits are subject to regulatory approval
•M j .4 S `r ' ' Fi -,: x -i- IN-NETWORK �_, .. K
kr ;R „ ,y. T.• . ,,:x.5.1. <' EX7ENDrtD''I.OUT�,O -NE7Vt OR '
inual deductible none $300/person-$900/family
Out-of-pocket maximum
I $1,500/person 45,000/person
A separate out-of-pocket maximum
of$500 per person applies to
prescription drugs
I
Lifetime maximum $5 million for services from all providers
Office visits or Urgent Care visits
• Illness or injury 100%after$15 copay 80% after deductible
I
• Behavioral health care(mental health, 100%after$15 copay* (see details below) 80%after deductible
substance abuse, eating disorders
and autism)
• Chiropractic manipulation '100%after$15 copay* (see details below) 80% after deductible,no benefits for
services from out-of-network providers
• In-office surgery/allergy-related servicesI 100% 80%after deductible
Preventive care
• Well-child services and immunizations 100% 80%after deductible
I • Prenatal care 100% 80%after deductible
• Routine physicals and eye exams 100% 80%after deductible
• Cancer screenings 100% 80%after deductible
I
Lab and X-ray services 100% 80%after deductible
In-and outpatient hospital services
• Facility services(includes behavioral 100%* (see details below) 80% after deductible
health care)
I • Professional services(includes behavioral 100%* (see details below) 80%after deductible
health care)
Emergency care
oOutpatient facility services 100%after$75 copay 100% after$75 copay
utpatient professional services 100% 80%after deductible
Ambulance services 80% 80%
' Medical supplies 80% 80%
Therapy services
• Chiropractic therapy 100%after$15 copay* (see details below) 80%after deductible,no benefits for
services from out-of-network providers
I
• Occupational and physical therapy 100%after$15 copay
100%after$15 copay 80%after deductible** (see details below)
• Speech therapy 80%after deductible**
(see details below)
Prescription drugs
• 31-day supply,3-cycle supply of oralI
$5 generic/$30 formulary brand/ $5 generic/$30 formulary brand/$45 nonformulary
contraceptives for 3 copays $45 nonformulary brand brand, you pay the pharmacy and file a claim
In addition to copays, member will be responsible
for amounts in excess of the allowed amount
I • Mail-order drugs(90 day supply) $10 generic/$60 formulary brand/
$90 nonformulary brand
IBlueprint for Health programs Employee assistance•stop-smoking program•24-hour nurse advice line•prenatal support
included with plan •online wellness center•care support for chronic conditions•fitness discounts
How cost sharing is calculated
Copays are flat fees you pay at the time you receive a service
ICoinsurance is the percentage of charges you pay for a service It's based on the allowed amount
Deductible chaiges are subtracted from the allowed amount
Allowed amount is the negotiated amount that network providers have agreed to accept as full payment at the time your claim is processed If you see a provider who doesn't participate
with Blue Cross,the allowed amount is either the belied charge or a percentage of the network allowed amount,whichever is less
* For highest level of coverage,use Select Network providers for outpatient chiropractic and behavioral health services.
For all other services use the Blue Cross Network.
OU
**Physical,occupational and speech therapy services limited to a$500 maximum per calendar year This is only an outline of plan benefits The contract and certificate include complete details of what is and isn't covered Services not covered include
IMinnesotaoss BlueShield
of eyeglasses,hearing aids,items primarily used foi a non-medical purpose,ovei-the-counter diugsinutiitional supplements,services that vie cosmetic,
of experimental,not medically necessary,or covered by workers compensation of no-fault auto insurance Pre-existing conditions may not be covered for
a limited period of time This limit is reduced by prior continuous coverage and doesn't apply to pregnancy newborns,adopted chiidien or handicapped
dependents We feature a large network of health care providers Each provider is an independent contractor and is not our agent Nonpaiticipating
F5985R2 t(7/05) providers do not have contracts with Blue Cross and Blue Shield of Minnesota Blue Cross and Blue Shield of Minnesota is an independent licensee
'Man number at of the Blue Cross and Blue Shield Association Benefits are effective Jan 1,2006
Ii11iiEierS \/ a k i 'J a r�f i I r._t (-1 l "1
with copay plan Please note:Benefits are subject to regulatory approval
w:�,. , ,r ..„; :•,,,,,,,71q. :- •`x ,: IN-NETWORK EXTENDED/OUT OF-N SIV,
ual deductible none $200/person-$600/family
I Out-of-pocket maximum
A separate out-of-pocket maximum $ $1,100/person-$5,000/family 0 $2,500/person
$1,300/person-$5,000/family 0 42,500/person
of$500 per person or$1,000 per family
applies to prescription drugs
ILifetime maximum $5 million for services from all providers
Office visits or Urgent Care visits
• Illness or injury 100%after 0$15 copay or 0$25 copay * 60%after deductible
I • Behavioral health care(mental health, 100%after 0$15 copay or 0$25 copay* 60%after deductible
substance abuse,eating disorders (see derails below)
and autism)
• Chiropractic manipulation 100%after 0$15 copay or 0$25 copay * 60%after deductible,no benefits for
• (see details below) services from out-of-network providers
In-office surgery/allergy-related services 80% 60%after deductible
Preventive care
I • Well-child services and immunizations 100% 60% after deductible
• Prenatal care 100% 60%after deductible
• Routine physicals and eye exams 100% 60%after deductible
• Cancer screenings 100% 60%after deductible
IILab and X-ray services 100%,80% for inpatient services 60%after deductible
In-and outpatient hospital services
• Facility services(includes behavioral 80%*(sec details below) 60%after deductible
health care)
I
• Professional services(includes behavioral 80%*(see details below) 60%after deductible
health care)
Emergency care
outpatient facility services
utpatient professional services 100%after$75 copay 100% after$75 copay
80% 60%after deductible
Ambulance services 80% 80%
Medical suppliesI
80% 60%after deductible
Therapy services
• Chiropractic therapy 80%*(see details below) 60%after deductible,no benefits for
services from out-of-network providers
• Occupational and physical therapyI
80% 60%after deductible**(see details below)
• Speech therapy 80% 60%after deductible**(see details below)
Prescription drugs
• 31-day supply,3-cycle supply of oral
I
contraceptives for 3 copays $5 genenc/$30 formulary brand/ $5 generic/$30 formulary brand/$45 nonformulary
$45 nonformulary brand brand,you pay the pharmacy and file a claim
In addition to copays,member will be responsible
for amounts in excess of the allowed amount
• Mail-order drugs(90-day supply)I $10 genenc/$60 formulary brand/
$90 nonformulary brand
BluePnnt for Health programs Employee assistance•stop-smoking program•24-hour nurse advice line•prenatal support
included with plan •online wellness center•care support for chronic conditions•fitness discounts
I
How cost sharing is calculated
Copays are flat fees you pay at the time you receive a service
Coinsurance is the percentage of charges you pay for a service It's based on the allowed amount
Deductible charges are subtracted from the allowed amount
IAllowed amount is the negotiated amount that network providers have agreed to accept as full payment at the time your claim is processed If you see a provider who doesn't participate with
Blue Cross,the allowed amount is either the billed charge or a percentage of the network allowed amount,whichever is less
* For highest level of coverage,use Select Network providers for outpatient chiropractic and behavioral health services.
For all other services use the Blue Cross Network.
I
**Physical,occupational and speech therapy services limited to a 5500 maximum per calendar year
This is only an outline of plan benefits The contract and certificate include complete details of what is and isn't covered Services not covered include
I1111° eyeglasses,hearing aids,items primarily used for a non-med cal purpose,over-the-counter drugs/nutntional supplements,services that are cosmetic,
BlueCross BlueShleld experimental,not medically necessary,or covered by workers compensation or no-fault auto insurance Pre-existing conditions may not be covered for
of Minnesota a limited period of time This limit is reduced by prior continuous coverage and doesn t apply to pregnancy newborns,adopted children or handicapped
dependents We feature a large network of health care providers Earls provider is an independent contractor and is not our agent Nonparticipating
F59B6R21 (7/05) providers do not have contracts with Blue Cross and Blue Shield of Minnesota Blue Cross and Blue Shield of Minnesota rs an independent licensee
I
(Plan numbers a 113 b 114) of the Blue Cross and Biue Shield Association Benefits are effective Jan 1,2006
Iti_ 'i ! P i i ln [ ! Ii
w i t I1 d e d u C t 1 b I C plan Please note:Benefits are subject to regulatory approval
+,�S r i v ° c. ri,in.�; ' .. 'fit., x - .--
" rY !1t aYtrisa^te: .x ;;�r-,f.�;;=.,. -4''''-'7z‘,--... 4, IN-NETWORK EXTENDED./OUT-OF�NET IV,ORK'
nual deductible options 0 $ 300/person-$ 900/family
ployers choose one of four options
IOne deductible applies to services from
all providers
Out-of-pocket maximum Q 51,500/person-$5,000/family Q $2,500/person
These options correspond to the deductible
Iselected A separate out-of-pocket maximum
of$500 per person or$1,000 per family for
prescription drugs
ILifetime maximum $5 million for services from all providers
Office visits or Urgent Care visits
• Illness or injury 100%after OQ$25 copay 60% after deductible
• Behavioral health care(mental health, 100% after 00 525 copay 60%after deductible
Isubstance abuse,eating disorders and autism) * (see details below)
• Chiropractic manipulation 100%after 00$25 copay 60%after deductible,no benefits for
*(see details below) services from out-of-network provider
• In-office surgery/allergy-related services 80%after deductible 60%after deductible
IPreventive care
• Well-child services and immunizations 100% 60%after deductible
• Prenatal care 100% 60%after deductible
• Routine physicals and eye exams
I
100% 60%after deductible
• Cancer screenings 100% 60%after deductible
Lab and X-ray services 100%,80%after deductible for inpatient services 60%after deductible
In-and outpatient hospital services
I • Facility services(includes behavioral 80%after deductible*(see details below) 60%after deductible
health care)
• Professional services(includes behavioral 80% after deductible*(see details below) 60% after deductible
lithealth care)
rgency care
• Outpatient facility services 100% after$75 copay 100%after$75 copay
• Outpatient professional services 80%after deductible 60%after deductible
Ambulance services 80% 80%
Medical supplies 80%after deductible 60%after deductible
Therapy services
I
• Chiropractic therapy 80%after deductible* (see details below) 60%after deductible,no benefits for
services from out-of-network providers
• Occupational and physical therapy 80%after deductible 60%after deductible** (see details below)
• Speech therapy 80%after deductible 60% after deductible** (see details below)
IPrescription drugs
• 31-day supply,3-cycle supply of oral $5 generic/$30 formulary brand/ 55 generic/$30 formulary brand/$45 non-
contraceptives for 3 copays $45 nonformulary brand formulary brand,you pay the pharmacy
I
and file a claim In addition to copays,
member will be responsible for amounts in
excess of the allowed amount
• Mail-order drugs(90-day supply) 510 generic/$60 formulary brand/
$90 nonformulary brand
'Blueprint for Health programs Employee assistance•stop-smoking program•24-hour nurse advice line•prenatal support
included with plan •online wellness center•care support for chronic conditions•fitness discounts
How cost sharing is calculated
111 Copays are flat fees you pay at the time you receive a service
Coinsurance is the percentage of charges you pay for a service It's based on the allowed amount
Deductible charges are subtracted from the allowed amount
Allowed amount is the negotiated amount that network providers have agreed to accept as full payment at the time your claim is processed If you see a provider who doesn't participate with
Blue Cross,the allowed amount is either the billed charge or a percentage of the netwoi k allowed amount,whichever is less
* For highest level of coverage,use Select Network providers for outpatient chiropractic and behavioral health services.
For all other services use the Blue Cross Network.
® **Physical,occupational and speech therapy services limited to a 5500 maximum per calendar year
This is only an outline of plan benefits The contract and certificate include complete details of what is and isn't covered Services not covered include
IueCross BlueShleld eyeglasses,hearing aids,items primarily used for a non-medical purpose,over-the-counter drugs/nutritional supplements,services that are cosmetic,
■f Minnesota experimental,not medically necessary,or covered by workers'compensation or no-fault auto insurance Pre-existing conditions may not be coveied for
a limited period of time This limit is reduced by poor continuous coverage and doesn't apply to pregnancy,newborns,adopted children or handicapped
dependents We feature a large network of health care providers Each provider is an independent contractor and is not our agent Nonparticipating
17097P07 17/05) providers do not have contracts with Blue Cross and Blue Shield of Minnesota Blue Cross and Blue Shield of Minnesota is an independent licensee
'Plan numbers a 118 b 120 c 122 d i23) of the Blue Cross and Blue Shield Association Benefits are effective Jan 1,2006
1
(">1. 0
1 Health Plan 2006
Your Opinion Counts
1 September 28, 2005
D ID
\C,
1
Employer(De1eefst
Slee.li.
S
1
1
Healthcare is Expensive!
1 Health Plan Facts
1 • Our BCBS Aware Gold with Copay Plan rates
will increase 20.6% on January 1, 2006.
1 • The 2006 annual premium will be $370,710.
• The Single rate will be $311/month.
1 • The Family rate will be $1,173/month.
1 1
911.
How can we improve
our claim experience?
Although we can not always avoid
becoming ill, we can keep claims lower. 1
•Use your regular or urgent care clinic instead
of the emergency room whenever possible.
•Use generic drugs. Use mail order for your
maintenance medications.
•Use network providers.
•Eat right and exercise regularly. '
-Shop and compare provider cost and quality.
S
What are some options to control
our 2006 health plan costs?
We see three options.
1. Investigate plans from other carriers.
2. Change to a less expensive BCBS plan.
3. Keep our current BCBS plan and ask
you to share more of its cost.
8
4I
' Option 1 : Investigate other plans.
We can explore other health plans.
• Within the Service Co-op
' • Outside of the Co-op
• To receive firm rates, new enrollment
forms will be sent to each carrier.
These rates are age banded.
(Instant App may be used to
facilitate this process.)
4: 9
•
Option 2: Change to a less
expensive BCBS health plan
1 We could use these BCBS options:
' • CMM with $15 Copay
• CMM with $25 Copay
1 • CMM with $300 Deductible
' (CMM means Comprehensive Major Medical)
.o
5
I
1101
BCBS Plans
2006 Benefit Comparison
I
Plan Feature Aware Gold CMM$15/$25 CMM$300
(Current plan) Copay Deductible
I
Deductible None in network None in network $300/calendar
year
Lifetime Max $3 million all providers
Out of Pocket Max $1,500/person $1,100/$5,000 $1,500/$5,000 I
$1,300/$5,000
Office Visits $15 Copay $15 Copay $25 Copay
$25 Copay __ _
Preventive Care 100%covered
Hospitalizations 100%covered 80%covered 80%after I
deductible
Prescription $5 copay genenc/$30 copay formulary
Drugs brand name/$45 copay nonformulary
brand
I
(4,;
All plans use the BCBS Aware network.
ii
•
How does our currentp lan
compare to other groups?
In February 2005, we surveyed the
I
plans of our peer utility groups.
Our current BCBS plan benefits compare 1
favorably with those plans. Our
coverage is equal to or better than most 1
of the other health plan benefits.
1
12
II
6I
Option 3: Employees pay more.
This option means keeping our
1 current Aware Gold plan.
' • Our current contribution strategy is to pay
77% of your total premium.
' • The 2006 strategy would be to pay 77%
of single coverage and 73% of dependent
coverage.
i 13
•
pay Option 3: Employees a more.
p
' 2006 Aware Gold Plan
Monthly Employee Premiums
' Aware Gold
Coverage (Current) CMM$15 CMM $25 CMM $300
' Status Copay Copay Deductible
2005 2006
1 Single $59.34 $71.53 $67.39 $66.13 $63.48
Family $223 79 $316.85 $254.27 $249.44 $239.43
IA 1
4 '; 14
7
I
fl?
Your Opinion Counts!
Tell us which
you optionprefer.
P
1. Investigate plans from other carriers. I
2. Change to a less expensive BCBS plan.
3. Keep our current BCBS plan and ask you I
to share more of its cost.
I
Contact Theresa Slominski by Oct. 7, 2005. I
(763) 441-2020
` tslominski@nsatel.net 15
I
•
I
Health Plan 2006
Thank you!
I
Jodi Berge
David Martin Agency, Inc. I
(952) 285-4503
jberge@davidmartinagency.com I
.-~ 16
8I