NY44 Health Benefits Plan Trust

Information SessionFor

Elmira City SDPresenters:

Dr. Darleen Michalak, Plan Administrator, NY44 Health Trust

Laura Wander and Amber Wallace, MVPRegis Bernardi and Melissa Svarczkopf, Pharmacy

Benefit Dimensions3/5/2015

Background Information:• The Trust Plan (originally formed in 2003 at Erie

1 BOCES) is an Article 44 governed by the NYS Insurance Department

• Collaborative approach with Trustees representing both management and labor jointly making decisions

• Partnership through a third party administrator with MVP for payment of medical claims and Pharmacy Benefit Dimension (PBD) for payment of pharmacy claims

• Plan Year runs from July 1- June 30• Four Year commitment

2

Trust Objectives:• Contain costs for health coverage

• Work collaboratively with labor and management and TPAs

• Enhance benefits for enrollees, when possible

• Focus on health and wellness

• Comply with various mandates(Patient Protection and Affordable Care Act Legislation)

3

Erie 1 BOCES Cost Containment

4

Plan YearSingle Contribution

(Monthly)Family Contribution

(Monthly)  Percent Increase

Total Annual Cost Avoidance

2003-2004 $ 253.45 $ 702.04   8.0% $

355,424.64

2004-2005 $ 264.18 $ 731.97   4.8% $

627,709.44

2005-2006 $ 278.81 $ 767.82   5.3% $

1,191,137.64

2006-2007 $ 305.30 $ 829.25   8.5% $

1,729,859.64

2007-2008 $ 332.50 $ 903.00   8.9% $

2,345,672.52

2008-2009 $ 369.10 $ 975.25   9.5% $

2,897,929.92

2009-2010 $ 407.32 $ 1,068.03   9.5% $

2,461,879.44

2010-2011 $ 439.50 $ 1,185.00   9.5% $

2,418,795.84

2011-2012 $ 479.50 $ 1,266.00   7.9% $

2,790,529.92

2012-2013 $ 497.00 $ 1,322.00   4.9% $

3,412,936.20

2013-2014 $ 526.50 $ 1,400.00   5.9% $

3,113,423.52

2014-2015 $ 541.75 $ 1,482.50   5.9% $

3,425,400.00   Total Cost Avoidance 2003-2014 $26,726,854.80

5

6

Western New York SchoolsDistrict/ School Name Administrative Instructional Support

Akron X X XAlden X X XCheektowaga XX X XCheektowaga-Maryvale X X XCheektowaga-Sloan X X XXCleveland Hill X X XXDepew UFSD XX   XEllicottville X   XElmwood Franklin School X X XErie 1 BOCES XX X XXGowanda XX X XGrand Island X X XHamburg X X XXXIroquois X X XKadimah X X XLackawanna X X XLewiston-Porter X XX XXNiagara Falls City XX X XXNiagara Wheatfield CSD X    North Collins X X XPioneer X X XXSouth Buffalo Charter School X X XSpringville Griffith Institute X X XXXSt. Francis High School X X XSt. Mary's School for the Deaf X XX XSweet Home X X XXThe Park School X X XWest Seneca X    

28 IH/ Nova Schools Total IH/ Nova Units 96

Represents Districts/ Schools with 100% participation

7

Schools East of BuffaloDistrict/ School Name Administrative Instructional Support

Alfred-Almond X X XBainbridge-Guilford XX X XCanajoharie CSD X X XCandor CSD X X  Canisteo-Greenwood X X X

DCMO BOCES X X XElmira City SD X X XXXElmira Heights XX X X Franklin CSD X XX XFulton Montgomery Community College X X XXGilbertsville-Mt. Upton CSD X X XGreater Southern Tier BOCES X X XXMadrid Waddington X X XMechanicville CSD X X XNorth Rockland CSD X X XNorwich City SD XX X XXOdessa-Montour CSD X X XOneida-Herkimer-Madison BOCES XOppenheim-Ephratah-St. Johnsville X X XOxford Academy XX X XSpencer Van-Etten CSD X X XWatkins Glen CSD X X XXXWaverly CSD XX X XXXX

23 MVP Schools Total MVP Units 8251 Schools in Total Total Participating Units 178

As of March 1, 2015, 51 Schools/ Districts and 178 separate units participate with the NY44 Health Trust

8

Contribution RatesEast Central New York State

  Option A  

Contribution Rates 2015-16 2014-15  

 

Monthly Annually Monthly Annually

Percent

Increase

Single $531.25 $6,375.00 $492.25 $5,907.00 7.9% Enrollee + Spouse/ Domestic Partner

$1,401.00

$16,812.00 $1,298.50 $15,582.00 7.9%

Enrollee + Child(ren)$1,260.7

5 $15,129.0

0 $1,168.50 $14,022.00 7.9%

Family$1,483.0

0 $17,796.0

0 $1,374.50 $16,494.00 7.9%*+$7 PM/PM Administrative Fee

       

9

Benefits as of July 1, 2014:

• $0 co-pay Office Visits• $0 co-pay for Annual Eye

Exam • Dependent Coverage to Age

26• Health and Wellness

Workshops• $0 co-pay for Tier 1 drugs;

$0/$15/$30 – 3 Tier drug plan

• $0 co-pay for diabetic supplies and services for Tiers 1 and 2

• $0 co-pay for Tier 2 Inhaled Corticosteroids

• Smoking Cessation – prescription drugs added to the formulary

• Annual Healthy Living: Wellness Reimbursement of $100 (S) /$150 (F)$25 /$50 Reward for Annual Physical with Primary Care Physician

• Annual District Reimbursement (up to $1,000)

Benefits in 2003-04:

• $0 Co-pay for Office Visits

• Dependent Coverage for College Students – Age 25

• Health and Wellness Workshops

• $3/$15/$30 – 3 tier drug plan

Deductibles for In-Network: (refer to the Benefit Grid in your folder)• Emergency Services:

– Ambulance Transportation $25 co-pay

– Emergency Room Service $50 co-pay (waived if admitted to hospital)

• Durable Medical Equipment (wheelchairs, etc.) covered at 50%

• Prosthetics & Appliances covered at 50% co-payment

• Prescription Plan $0/$15/$3010

Out-of-Network (O-O-N):• If it’s an emergency, it’s treated like in-

network for claims• If the medical provider/hospital is not

part of the network, it’s considered out-of-network (O-O-N)

• Routine care outside the area of residence is considered out-of-network

• All O-O-N must be pre-certified by the enrollee requesting pre-certification from MVP (phone number on back of card)

11

Benefits Summary Grid:• Note: Rehabilitation Therapies (Physical,

Occupational and/or Speech) are covered in full up to 30 visits per therapy, per calendar year; additional medically necessary visits may be covered only if preauthorized

• Benefits do not include a dental plan

• Effective 1/1/2014, no preauthorization for chiropractic visits

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

Wellness Initiatives:• Wellness Fitness Activity

Reimbursements: (gym memberships; exercise/yoga classes; purchase of gym equipment; league participation; etc.)– Annually $100/single and $150/family – New: Reimbursement for massage therapy;

must be administered by a licensed massage therapist

• Wellness Annual Physical Exam Reward:– $25/single and $50/family to have a preventive

exam from your primary care physician

31

Staffing in 2003-04:

• Plan Administrator

• Secretary

• Fiscal Agent

• Health/ Claims Consultant

Staffing Today:

• Plan Administrator/ Ex-Officio Trustee

• Administrative Assistant/ Wellness Representative

• Fiscal Agent/ Software Trainer

• Claims Risk Coordinator

32

Consultants to the Trust 2015

33

• Legal Consultant (Carolyn R. Friedman, Esq.)

• Communications Consultant (Lori Sosenko)

• Claims Auditor Consultant

• Specific Claims Audits (Global Excel)

• Appeals Audits (Coordinated by Nova/ MVP/ PBD)

• Medical Consultant (Dr. Len Katz)

• Actuarial Consultants (Harbridge Consulting Group)

• Auditors (Bahgat & Laurito-Bahgat)

• Stop Loss Provider (Self-Funded)

• Financial Consultant (Morgan Stanley)

• Third Party Administrators for Claims: Medical (Nova/ Independent Health and MVP); Pharmacy (Pharmacy Benefit Dimensions)

• Manning & Napier Information Service (BSwift)

• Disease Management Consultants (Marsh & McLennan/ Verisk)

For Assistance:• MVP Customer Service—number on the back

of the enrollee’s insurance card(800-229-5851)

• Pharmacy Benefit Dimensions (800-665-3089)• Website lists lots of VERY important

information www.ny44.e1b.org• Wellness Questions/Reimbursement

– Jeni Kapalczynski 716-821-7161• Final Option

– Dr. Darleen Michalak, Plan Administrator 716-821-7161

34

www.ny44.e1b.org

• Summary Plan Description (SPDs)• Summary of Benefits and Coverage

(SBCs)• Newsletter• Wellness Videos• NY44 Health Trust Board of Trustees

Meeting Minutes• Upcoming Information for All Plan

Options35

www.ny44.e1b.org

36