HomeMy WebLinkAboutEBAC Recmd Chgs - Health BenefitsDeschutes County Board of Commissioners
1300 NW Wall St., Suite 200, Bend, OR 97701-1960
(541) 388-6570 - Fax (541) 385-3202 - www.deschutes.org
AGENDA REQUEST & STAFF REPORT
For Board Business Meeting of 06/30/2010
Please see directions for completing this document on the next page.
DATE: 06/25/2010
FROM: Ronda Connor Personnel 385-3215
TITLE OF AGENDA ITEM:
Consideration Board Approval of EBAC recommended changes to the health benefits.
PUBLIC HEARING ON THIS DATE? No
BACKGROUND AND POLICY IMPLICATIONS:
Each year, in advance of the plan renewal the health benefits Renewal Committee and EBAC meet to
analyze our current benefit structure, state and federal requirements, benefits trends, and requests from
employees.
Our health plan insures approximately 2,500 people. We provide a comprehensive benefit package of
Medical, Dental, Vision, Prescription and Alternative Care coverage.
Below is a listing of the items that are recommended by EBAC.
Adding coverage for Dependents age 23-26 within the detailed criteria of the Federal Legislation.
The Patient Protection and Affordable Care Act of 2010 requires that our health plan enroll/ re-enrc 11
these people effective 08/01/2011. The major carriers in Oregon and nationwide are opening up their
eligibility in advance of their required dates as encouraged by federal regulators. Allowing these
dependents to come on one year earlier than required has the potential to increase our enrollment by as
much as 140 dependents.
Estimated Cost: Historic data of enrollees that are either employees or dependents in this age group
shows that if all of those effected elect to enroll and have similar experience, claims expense could be
increased as much as $250,000 in a 12 -month period.
Change of Preferred Provider Network.
Change from Providence Preferred Provider Organization to First Choice Health Network.
Since the beginning of self -funding, Deschutes County has accessed Providence's PPO and has been.
experiencing some difficulty in the transition of re -priced claims data to EBMS. This resulted in an
analysis of other feasible networks. First Choice was identified as the network with the greatest
savings, the most inclusive network of providers, and the most competitive fees.
Estimated Cost: An increase to the network access fee of $.55 per employee per month or
approximately $6,500 annually and a savings of approximately $300,000 in network contracted rat( s.
Add a Flu Shot benefit to the Prescription benefit with a $10 co -pay.
Currently flu shots are covered only in the medical benefit as an immunization. With the great increase
in interest of the flu shot, there are many pharmacies now providing this service. Pharmacies do not
typically join medical preferred provider organizations and our plan is reimbursing 80% of the flu shot.
Adding this in the prescription benefit will allow for another option for those seeking their flu shot from
their pharmacy provider. Employees are still able to receive their flu shot at the employee clinic with
coverage at 100%
Estimated Cost: The cost is expected to be budget neutral, as the $10 co -pay will offset those that were
being paid at the out of network rate.
FISCAL IMPLICATIONS:
Given the sum of these benefit changes, and estimates of the frequency of enrollees accessing these
benefits, it is estimated that a savings of $435,000 in could potentially be incurred.
RECOMMENDATION & ACTION REQUESTED:
Consideration of approval of EBAC recommendations
ATTENDANCE: Ronda Connor
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