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5.3. ERMUSR 10-09-2007~i Elk River -= Municipal Utilities 13069 Orono Parkway • PO. Box 430 Elk River, MN 55330-0430 October 4, 2007 To: Elk River Municipal Utilities commission Jerry Takle Jim Tralle Jerry Gumphrey From: Theresa Slominski Subject: 2008 Health Insurance Phone: 763.441.2020 Fax: 763.441.8099 As reported at the last commission meeting, our renewal for insurance costs was 12.7% this year. The trend in the health insurance world is 12% - 15%, and the renewals ranged from 7% - 22% for other insurance pool participants. Considering these two factors, our renewal is very reasonable. Presented for your review are two tables showing the premiums last year compared to this year, and the cost sharing between the employee and the employer. The top table is the dollar impact of leaving everything the same with the cost sharing at 25%/75%. The bottom table is the dollar impact of changing the cost sharing to a 20%/80% ratio, as requested. (The insurance task group was assembled again and reviewed the renewal 12.7% costs with the 25%/75% split. The group stated that they would like to stay with the same BCBS Aware Gold plan. A copy of the benefit summary is attached.) Also discussed with the insurance task group was an H.S.A. plan under a "dual coverage'' scenario, which would give the employees the opportunity to choose between the Aware Gold or an H.S.A. plan for their insurance coverage. H.S.A.s have been introduced to the employees before and there is some interest but it's hard to say whether anyone would choose to actually participate in such a plan, if offered. In order to have a dual coverage option, at least one individual would need to participate in the other plan. With an H.S.A., the premiums are lower, but the employee has to meet a deductible amount and pay for all costs out of pocket themselves and then reimburse themselves out of funds they have contributed into their account. Whatever dollars they don't actually spend out of the account in a year accumulate and are available at any time in the future. The idea is that the participants would contribute to their accounts the difference of what they save in premiums under the Aware. Gold plan and have those funds available for reimbursement. Since the employer can also contribute to the accounts, there is the potential of having more funds available to cover those out of pocket costs before the deductible is reached. Attached is a table presenting the difference in the premium dollars, and potential funding dollars available if employee and employer contributed at the same dollar value for each plan. The commission would need to decide if they wanted to offer this additional H.S.A. plan to employees, and if so, at what percentage, if any, they would like to contribute towards the H.S.A deductible portion. a~ooo m~~n~ mom, o~~~ri ~ C O ~ ~ - M cs) cfl ~ L d W ~ 'v ~~ o000 ~ ,~ ~n ~n ~n o ~ o. c~i v ca cfl C L ~ i~ O ~ cD C 4f ~ ~ ~ ~ Q Q O ~ ~ ' a <' > w ~ ~ ~ ~ 0 o ~ ~ I~ M ~ n O M I~ N n M M N O ~ .- ~ N ~- ~ O a w'~~~ o ~ M O Q1 an n ao r- ~- ~n~oo~ ~ CD d' r- O .-- M to O a w~~~ y ~ t~ O .~+ I~ N ~ ~ f0 (D N O w ~ ~ O ~ C ~ ~ 0 3 ~ ~, c ~~~~ 0 N ~ ~ N i9 C 'O 00 N Q7 n 00 cD N O ~' f~ O M ip O ~ O ~ n T r ~ U O 'C n n wcfl~bs C a~ ~ nri~rn ~ = ~ v o ~n T r M ~ U ~ o c a L W Efl EA Efl ~ ~ y O O O ~ o o ~n O ~ p ~!) 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N t a~+ ~ ID ~ ~G C ~ C~ ~ N N N _ W I b9 EA EA ~ o ~ ~ ~n ai M f~ N ~ N ~ W ~ ~ ~ H ~ O O ~ ~ 0~0 ~ N w ~ M ti N C ~ r' ° 3 d C ~ 69 b9 Efl ._ • Rr_~in~l?ccrttil is>st.s. C1o777~'r'titil'r' How this plan option works 1~:r1?or rrrn.rlcc~t. C:~rv~~~z,T~Tr~r~,;T~717~; f~.~r 71101'E' t7?7cj f?r'ftt'r 1'1Fti~~~? 1i7fi:ir;?7i7ti0?r l~i7e 17r•L'c`~ fcr j?nTL~t:'tt1Uil1f'iU:t~ r i Cre~rr. Blrrr~ (:roy L7rrr~ ~tlre S17zr`!r O~ .11.7?f'?EjptG7 l~ t 7f' Urit)' .~l"ri?7?c-~S('~7? ~7['r7~tj? ~1Ldi1 t~lt'if C07i7C??17e'.i 71 ][?rr:' t7~lrati 70 y'E~ars Uf r~r:p~'rir~'7Tet' ra;?i~~r c"i~UC1(~ UY7 t%lE ~7Etritjl}' ~r}.ir2 U~ ~777wir?E,'Stir's like yol-crs. Members can see any health care provider of their choice for most covered services -without referrals. For some services, the best benefits are available when members see health care providers in our statewide Blue Cross (Aware') network The Blue Cross network includes primary care clinics, specialists and hospitals. Network providers take care of all claims paperwork Network providers mean savings By using the extensive network of health care providers, members avoid hidden costs. A11 those providers have agreed to accept the "allowed amount" specified in their contracts as full payment for covered services. The BlueCard~ program extends that protection across the United States and even worldwide through the "Traditional" network If a member sees a health care provider who doesn't have a contract with Blue Cross (a nonparticipating provider), the member is responsible for any deductible, the coinsurance amount applied. to the allowed amount, and the difference between the actual bill and the allowed amount Expect more with Blueprint for Health`' Take advantage of programs designed to improve health and productivity: fitness discounts • EAP • 24-hour nurse ad~lce line • prenatal support estop-smoking pro~bram easy-to-use health information at our online wellness center • Blueprint for Health care support, our groundbreaking grogram. far members with chronic conditions. These programs are offered at na additional charge to groups. A - ! ' ` t ~ ', `' " , } + " r ~ ' Please note• Benefits are sub rt to r laic a roaal le- ~ ry Pf~ Ealendar year deductible None ~3001petson - ~9~Glfarrrily. Out-of-pocket maximum ~1,5001person $5,040,rperson A separate out-cif-pocket maximum of X500 per persor, nr g1.00G per famil;~ applies to prescription dnags. lifetime maximum ~5 million far ;erJicesfram aiLpcovlders Office visits or urgent care visits • iline;`~ or injury, 1 GGoiQ after $2G ccpay 8G% after deductible • Behavioral heaBl-~ car? (mental h?atti-~, 1009'o after $20 copay` (seV details below) 80% after deductible sub;rtanc? aGtlse. eating diu~rders and autism) ` • Chiropractic manlp,~ation t OG96 after $~G Copay* (see details below) 8G% after deductible; no benefits for services irorn our-of-network providers ' • In-office surger,<,+allenpy-relat?d serrlces 100% EO% after deductible Preventive care • +N?If-child sen:ices and Irrrmunizatiors 1 GG% ' E04'o afiter deductible • Prenatal care 30046. 80% aftef deductible • Foimne physicals and eye ?xarns 3 0©% ` EO96. after deductible • Cancer sQeenir~gs 1G0%' 804ti after deductible Lab services 3Ot?%: 8646 after deductible X-ray and diagnostic imaging 30tT% $0% after deductible in- and outpati err[ haspitai services • Fadlity services ¢ndudes behavioral health care) .100%* .L,ee derails br-3ew) 80% after dedurtible • Professional services (irdudes behavioral health cjre) 1 G096* fs~ details b°lowi EOgS after deductible. Emergency care • Outpatient fa~lR~f seraices (0046 after. X75 clay t 00ao after $75 copay • Outpatient professional services 300% 8046 after deductible Ambulance services 80% 80°~6 - Medicat supplies EG% 80°,6 _ Therapy services • Chiropractic therapy 100% meter b20cop~ay* ~ e¢de~i~ belani7 8Q% after deductible; no bartefrisforservices ` from aut-of-netvveyrK providers _ • Occupational and playrsral thera~iy 100% after S20 ~_~pay E0~ after deductible** (see det~ifs below) • Speech therapy 1 G0% after S~0 cooay 80% after dedrJCfible** (see dEtails below) Prescription drugs - 31-daY s~PiY _~ • 3-cycle supply of oral cantraceptives far $(} genericR* *f~35 fc~rrnuiary Grand/ ~0 generic***/b35 formulary brand/ 3copays X50 non-fcrtmtiaryGrand 550 norrfarm~iary brar~i; member pays tt"e pharmacy and files a daim. (n addition to capays, member will be ie~,onsible for amounts in excess of aRr)wed amount Maintenance presviptions - 90-day suPPtY • 90dayR:cretail netvuork or ~y mail-order $Q generic"*l57E}focmutaryGrand/ $1~5 norr-famnutaty brand if a generic dr.~g;s atraifable and m>'mberchooses abrand-,name drub merrdiet pays Eire d,Tfercnce between ff,e G,~and .narrre prce and the genr_>rrc price plus any , catnsurance. (n some cases, this can arreunt to the full cost of the brand-nar*le drug.: BluePrintfor Health programs 'Employee asststarxe +stop-smdctng program • 24-hour nur~ advice 6ne • prenatal wpport included with plan ~ onGi-"e wellness cpnte[ rare support for dironic corditirns • mness r~scnunt, How cost Sharing is calculated , Copays aro Flat fees you pay at the time •rou receive aservice: - Coinsurance is th e percentage of diarges you pay for a service. It's based on the a!farred amount. Dxluctibie is the Portion cf the alla.Hed amountyou must pay: Allowed amount is the negotiated amount that network prodders have agreed to acwpt as full payment at the time yon claim is processed: Ifyut sey a prarider who doesn't participa to vrith Blue Cross, the allowed amount is either the 6iI{ed cfrarge or a percentage of the rietvvark allowed amount, +,vbchever is less. * For highest level of cvv~age ore Select network providers for outpatient chiropraQic and behavioral heaftb servit~s For al! other services use the Blue Cross ne~tworfc y;=.~~t `* Physical occupational and speech therapy services limited to a 5500 maximum per ralencfar year ~ ~ *'* SO mpay to member, rnsi of generics ihduded in premium or daims cost rni~ ~ only an outline of p{~n beneFfts lY~e cor~trxt and certiFiiate Irxlude ccm>fete decals of •what s ar~d ~n't «~wred. Ser,ces nc~t coffered include eyeglasses, hear a~g ~~u~~`~~~~~`~=N`~R~^=~?~ aids,ilerresprin~rityu~xdforaran-medkalpuepo~,over-the-ccunterdnagshrutrltionalsupp~ments,serv'r_esttratarecosmelic,experimental,riolmedkallynxessary,a i i373~3a~+'~~ covered t~yvvrr:ors' compensaticm a no-fault auto ir~surarKe. P~e~r<iA~q conditFx~s may not be caPred for a firmed periai of Urtx Ths IFnit is reduced bf prior continuous (Plan numtr_r4) coverane and doesn't applyto pegr"ancy, nev~txxra, ark~p(ed ctddrer, Gr handkapped dependents. We feature a large neNnorkf,( FKalihcare povidets Ezr_h provider s an ind?Fendentconttdtorand is notour agent. t~kinpartkiptkng providers do not havecor"trct,vrtth Blue Crvsand Blue Shield of M1Ainrrsota. Bk,e Crosand Blue ~'iiu!d FS925R23!3lG~ d P.latnesota iron independent licensee cf th=_ Blrw CrcFSarrd Blue Shield ti~~xiar.pn. Benefitsareeffectrs luy t, 2Ga7.