Health Insurance Update
Setting the Stage
SUU is self-insured
Share in providing coverage/protection for all
Spreading risk over all employees (healthy and sick)
Risk pools in general
Cost ups and downs
Claims are covered as they are submitted
Calculations and projections attempt to smooth
More individuals in pool, greater spreading, mitigates
volatility
Benefits Committee
Peers who are asked to review plan design
and changes annually
Concerned about health and wellbeing of
employees and dependents
Benefits provided to address unique health
needs of individuals which often drives
them to one plan or the other
SUU is the only USHE school without a
Options
Open both Traditional and HDHP to all at
open enrollment and for new hires
Leave Traditional premiums at current
levels
Lower Traditional premiums by plan
modifications
Abandon self-insurance and seek to join
PEHP
SUU Healthcare Costs
Cost containment
•
$8,016,000 as of June 30, 2011
•
$8,941,000 as of June 30, 2012
•
$9,816,000 as of June 30, 2013
•
$8,935,000 as of June 30, 2014
Question of the day
Plan design and costs moving forward
What about Traditional coverage?
Current Plans
Two medical plans
Traditional
•
Was the only plan offered by SUU until July 1, 2012
•
Closed to new employees: October 15, 2013
•
2014 open enrollment period was the last time employees
could switch
High Deductible
•
Introduced to encourage more self-awareness of health costs
•
Allow employees to save money for current/future expenses
through Health Savings Account (HSA)
Plan Comparison
Plan Option
Traditional
High Deductible
Deductible (individual in-network)* $1,000 $1,500 Deductible (family in-network)* $2,000 $3,000 Preventive services 100% covered 100% covered Co-Pays (primary care) $40 (not subjected to Deduct.) $40 (after plan Deduct.) Co-Pays (secondary) $50 (not subjected to Deduct.) $50 (after plan Deduct.) Other medical services 20% (after medical Deduct.) 20% (after plan Deduct.) Out-of-pocket Max (individual in-network)* $3,000 $3,000
Out-of-pocket Max (family in-network)* $6,000 $6,000
Prescription deductible $50 single/$150 family Fall under overall plan Deduct. Generic prescription co-pays (after Rx deductible) $10 $10
Brand prescription co-pays (after Rx deductible)^ 30% 30% Non-Brand prescription co-pays (after Rx deductible)^ 50% 50% Specialty drug tiers (after Rx deductible)^ 15%/25%/40% 15%/25%/40%
*Out-of-network levels are double the in-network levels.
Plan Costs
Equal pay plan for personal budgeting vs.
pay as you go plan based on use
Premium
Employee Employer
Total
Employee* Employer
Total
Single Coverage - annual $1,739 $4,660 $6,399 $521 $4,689 $5,210 Two-Party Coverage - annual $3,914 $10,487 $14,401 N/A N/A N/A Family Coverage - annual $5,623 $15,066 $20,689 $1,512 $13,607 $15,119 Single Coverage - monthly $145 $388 $533 $43 $391 $434 Two-Party Coverage - monthly $326 $874 $1,200 N/A N/A N/A Family Coverage - monthly $469 $1,256 $1,724 $126 $1,134 $1,260*Employee premiums on the HDHP are redistributed into the employee’s individual Health Savings Account and not used for plan claims/administration.
Traditional Plan
High Deductible Plan
Costs
43% of Employees
57% of Employees
PEHP Option
Public Employees Health Plan (PEHP) is the
state’s self-insurance
the State of Utah, its counties, cities, school districts,
and other public agencies.
Several USHE schools use – including Weber,
Snow, Dixie, and USU/Eastern
Loss of “local control” because Legislature
determines plan design and premiums
PEHP Option continued
Have Traditional and High Deductible
plans
All or nothing provider – can’t split plans
between PEHP and self-insured options
PEHP Plan Comparison
Plan Option
SUU Current
PEHP Option
SUU Current
PEHP Option
Deductible (individual in-network)* $1,000 $250 $1,500 $1,500 Deductible (family in-network)* $2,000 $500 $3,000 $3,000 Preventive services (in-network) 100% 100% 100% 100% Co-Pays (primary care) $40 (not subjected to Deduct.) $25 $40 (after plan Deduct.) 20% (after deduct) Co-Pays (secondary) $50 (not subjected to Deduct.) $35 $50 (after plan Deduct.) 20% (after deduct) Other medical services 20% (after medical Deduct.) 20% (after medical Deduct.) 20% (after plan Deduct.) 20% (after deduct) Out-of-pocket Max (individual in-network)* $3,000 $2,500 $3,000 $2,500 (not including deduct.) Out-of-pocket Max (family in-network)* $6,000 $7,500 $6,000 $7,500 (not including deduct.) Prescription deductible $50 single/$150 family $100 single/$200 family Included in overall plan deduct. Included in overall plan deduct. Generic prescription co-pays (after Rx deductible) $10 $10 $10 $10
Brand prescription co-pays (after Rx deductible)^ 30% ($250 max) 25% ($25 min no max) 30% ($250 max) 25% ($25 min no max) Non-Brand prescription co-pays (after Rx deductible)^ 50% ($350 max) 50% ($50 min no max) 50% ($350 max) 50% ($50 min no max) Specialty drug tiers (after Rx deductible)^ 15%/25%/40% (w/ max.) 20%-30% (No max.) 15%/25%/40% (w/ max.) 20%-30% (No max.)
*Out-of-network levels are double the in-network levels for SUU coverage. PEHP has no out-of-pocket max for out of network providers. ^SUU monthly prescription maximum costs are assigned so even a very expensive drug has a per-month co-pay cap for the employee.
Monthly Total Premiums
Monthly Total Premium
TRADITIONAL COVERAGE
Single
Two-Party
Family
SUU current
$533
$1,200
$1,724
PEHP option*
$454
$936
$1,249
Savings
$79
$264
$475
HIGH DEDUCTIBLE COVERAGE
Single
Two-Party
Family
SUU current
$391
$1,134
$1,134
PEHP option*
$408
$842
$1,124
Savings
($17)
$292
$10
Employee Share
Monthly Employee Share of Premiums
TRADITIONAL COVERAGE
Single
Two-Party
Family
SUU current
$145
$326
$469
PEHP option (10% of Prem)
$45
$94
$125
Savings
$100
$233
$344
HIGH DEDUCTIBLE COVERAGE
Single
Two-Party
Family
SUU current*
$43
N/A
$126
PEHP option*
$66
$132
$132
Savings
($23)
-
($6)
Proposed Modifications
SUU Traditional Plan Modifications
Traditional Plan Options
PEHP
SUU Current
SUU Proposed
Deductible (individual in-network)* $250 $1,000 $500 Deductible (family in-network)* $500 $2,000 $1,000
Preventive services 100% 100% 100% -Co-Pays (primary care - not subjected to Ded.) $25 $40 $35
Co-Pays (secondary - not subjected to Ded.) $35 $50 $45
Other medical services (after deductible) 20% 20% 20% -Out-of-pocket Max (individual in-network)* $2,500 $3,000 $3,500
Out-of-pocket Max (family in-network)* $7,500 $6,000 $7,000
Prescription deductible (single/family) $100 / $200 $50 / $150 $50 / $150 -Generic prescription co-pays (after Rx deductible) $10 $10 $10 -Brand prescription co-pays (after Rx deductible)^ 25% ($25min No Max) 30% 30% -Non-Brand presc. co-pays (after Rx deductible)^ 50% ($50min No Max) 50% 50% -Specialty drug tiers (after Rx deductible)^ 20%-30% (No Max) 15%/25%/40% 15%/25%/40%
-*Out-of-network levels are double the in-network levels.
