UFCW LOCAL 1000 & KROGER DALLAS HEALTH AND WELFARE PLAN December 15, 2015 Presentation to UFCW Local...

UFCW LOCAL 1000 & KROGER DALLAS HEALTH AND WELFARE PLAN

December 15, 2015Presentation to UFCW Local 1000 Shop Stewards

AGENDA

I. IntroductionII. Administrative Manager’s Presentation III. Consultant’s PresentationIV. Cigna PresentationV. MedExpert Presentation

ADMINISTRATIVE MANAGER’S PRESENTATION

WHO IS NEBA?

NEBA stands for “National Employee Benefits Administrators, Inc.”.

NEBA is a Third Party Administrator (TPA) that specializes in administering benefit plans that cover employees working under Collective Bargaining Agreements (CBAs) with various Unions across the United States.

NEBA has been in business for over twenty (20) years and employs approximately eighty (80) union members covered under a Collective Bargaining Agreement with the United Food and Commercial Workers Local Union 1625.

WHAT DOES NEBA DO FOR THE MED-1000 PLAN?

NEBA… Collects contributions from Kroger & Participants Determines who is eligible for benefits and which plan they may

qualify for Sends eligibility information to other parties that provide benefits,

such as: Dental Insurance Provider Vision Insurance Provider Life Insurance Provider Provider Network and Medical Management Program Provider Kroger - Pharmacy Program Provider MedExpert – Employee Assistance with Individual Medical Decisions Program Provider

Administers COBRA when Participants lose coverage

WHAT DOES NEBA DO FOR THE MED-1000 PLAN? (continued)

NEBA…Processes self insured claims

Medical claims Life insurance claims Short Term Disability / “Loss of Time” claims

Provides Member Services to ParticipantsProvides general Administration Services to the Trustees

Accounting Compliance Etc.

ELIGIBILITY: HOW IS IT DETERMINED?

Employees may qualify for the Med-1000 plans based on:• length of

employment;• number of hours

worked; and• status as either Full

Time or Variable Hour employees.

Hire Date

Hours Worked

Employee Status

ELIGIBILITY: HOW IS IT DETERMINED?

• Kroger submits a monthly report of hours worked by each employee in the bargaining unit

• The report includes hire dates and other information that is used to determine eligibility

• NEBA credits each employee with their hours worked

• NEBA applies the Med-1000 Plan’s eligibility rules to determine who is eligible

WHEN DOES ELIGIBILITY BEGIN?WORK, ADMINISTRATIVE LAG AND COVERAGE PERIODS

Work, Administrative Lag and Coverage PeriodsFixed “Standard” Measurement Periods for earning initial or continuing coverage for all Plans other than Plan C

Standard Measurement Period in Which Minimum Hours are Accumulated Administrative Lag Period Coverage Period

May - October November - December January - June

November – April May - June July - December

Work, Administrative Lag and Coverage PeriodsEach Calendar Month is a Measurement Period for earning initial or continuing coverage for Plan C

Measurement Period in Which Minimum Hours are Accumulated Administrative Lag Period Coverage Period

January February-March April

February March-April May

Etc…

WHAT PLANS ARE AVAILABLE TO VARIABLE HOUR EMPLOYEES?

• 60 Hours per MonthPlan C – Employee Only4th Month

• 780 Hours in 6 MonthsPlan E – Employee/Child9th Month

• 720 Hours in 6 Months or• 1,200 Hours in 12 Months

Plan D-Family13th Month

• 192 Hours in 6 MonthsPlan B-Employee Only25th Month

• 720 Hours in 6 MonthsPlan A - Family25th Month

WHAT PLANS ARE AVAILABLE TO FULL TIME EMPLOYEES?

• No Minimum Hours Required

Plan E – Employee/Child1st Month After 60 Days

• 720 Hours in 6 Months or• 1,200 Hours in 12 months

Plan D - Family13th Month

• 720 Hours in 6 MonthsPlan A - Family25th Month

WHAT BENEFITS ARE AVAILABLE UNDER EACH PLAN?

Major Benefit Provisions as of 1/1/2016

Plan Deductible Out of Pocket Max Coinsurance

PCP & Specialist

Copay

Vision & Dental

Benefits

Dependent CoverageSpouse Child

C $400 $4,000 70% $25 Vision13th Month N N

E $400 Individual $1,200 Family

$4,000 Individual

$8,000 Family70% $25 Vision

13th Month N Y

D $400 Individual $1,200 Family

$4,000 Individual

$8,000 Family75% $25 Dental &

Vision Y Y

B $400 Individual $4,000 Individual 75% $15 Dental &

Vision N N

A $400 Individual $1,200 Family

$2,500 Individual

$5,000 Family80% $15 Dental &

Vision Y Y

HOW DO PARTICIPANTS ENROLL?

• New Hires are sent enrollment instructions upon hire and again when they first qualify for coverage

• Open Enrollment is held annually during the last quarter of the year

• Special Enrollment is available if Participants have a life event

• The enrollment website is www.mybenefitplaninfo.com

HOW DO CLAIMS GET PAID? Healthcare Provider Visit

Healthcare Provider Submits Claim to

Cigna

Cigna Reprices Claim and Submits to

NEBA

NEBA Processes the Claim

NEBA Issues Payment or Denial

to Provider

NEBA Issues Explanation of

Benefits to Participant

Cycle of a

Claim

CYCLE OF A CLAIM: HEALTHCARE PROVIDER VISIT

• Patient Visits Healthcare Provider

• Patient Presents their Cigna ID Card

• Healthcare Provider Calls NEBA to Verify Eligibility and Benefits

• NEBA Provides Eligibility Verification

• NEBA Provides a Summary of Benefits Available

• Patient Receives Healthcare Services

CYCLE OF A CLAIM: HEALTHCARE CLAIM SUBMISSION & REPRICING

• Healthcare Provider Submits a Claim to Cigna Which Includes Details Regarding the Healthcare Services Provided

• Cigna Reviews the Claim and Applies a Discount Based on the Agreement They Have with the Healthcare Provider

• Cigna Discounts in 2015 Have Been in Excess of 50%

CYCLE OF A CLAIM: HEALTHCARE CLAIM ADJUDICATION

• Cigna Submits “Repriced” Claim Reflecting Discounts to NEBA for Adjudication

• NEBA Reviews the Claim and Determines if the Claim is Payable• Is the Patient Eligible?• Are the Services Covered?

• NEBA Applies the Med-1000 Benefits, such as Copays, Deductibles, etc.

• NEBA Calculates the Amount Due to the Provider or Participant

EXPLANATION OF BENEFITS: WHAT DOES IT MEAN?

• The Explanation of Benefits (EOB) Provides Details Regarding how a Claim was Adjudicated

• The EOB shows if the claim was approved or denied. • If the claim was denied, the EOB shows the reason and refers the

Participant to the correct pages in the Summary Plan Description to learn more about the reason for the denial

• The EOB shows the amount applied towards the Patient’s Deductible

• The EOB shows the amount of copay the healthcare provider should have collected during the patient’s visit

• The EOB tells the patient and the healthcare provider how much the patient owes

• The EOB tells the healthcare provider how much the Patient’s bill should be discounted

• The Patient should always confirm that the healthcare provider is billing them correctly by comparing the bill to their EOB

FUND CONSULTANT’S PRESENTATION

Jim Crump

UFCW LOCAL 1000

The new Patient Protection and Affordable Care Act (ACA) contains provisions that impact health plans such as MED 1000 and UFCW Local 1000 Oklahoma Health and Welfare Plan.

24

ACA PLAN PROVISIONS• No Lifetime or Annual Limits

2010 Annual Maximum 2014 Annual Maximum Plan A $100,000 UnlimitedPlan B $ 30,000 UnlimitedPlan C $ 20,000 UnlimitedPlan D $ 50,000 Unlimited

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ACA PLAN PROVISIONS (continued)• Minimum Essential Coverage

• Ambulatory patient services,• Emergency Services,• Hospitalization,• Maternity and newborn care,• Mental health and substance use, • Prescription drugs – Kroger Plan• Rehabilitative services,• Laboratory services,• Preventive and wellness service and chronic disease management,• Pediatric services, including oral and vision care.

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ACA PLAN PROVISIONS (continued)• Coverage of Adult Children Up to Age 26.• Emergency services without prior authorization and covered at In-

Network rates. (non-grandfathered plans). • Plans may not impose a waiting period of more than 90 days.• Plans may not impose pre-existing condition exclusions on any

participants.• Plans do not have to offer coverage for Spouses.

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INCREASED BENEFIT COSTMED 1000 Medical Claims Per Employee Per Year (All Plans) – Does not include Dental, Vision, Disability, Administration, PPO fees, or Stop Loss Insurance. 2010 2011 2012 2013 2014 2015$3,059 $3,577 $4,489 $4,906 $5,480 $6,664 Medical Claim Cost has more than doubled since ACA was enacted!

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MED 1000 FINANCIAL SUMMARY12 Months Ending September 30, 2015Additions Kroger Contributions $31.8 million Employee Contributions$ 2.3 million Investment Income $ .9 million

$35.0 million Deductions Benefits Paid $38.7 million Other Benefit Expenses $ 2.7 million Administrative Expenses $ 2.0 million

$43.4 million Change in Fund Equity ($8.4 million)

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NEW TAXES, FEES and STOP LOSS PREMIUMSACA has imposed fees, taxes and premiums that did not previously exist.

Reinsurance FeePayable by Self-Insured Plans to subsidize the Individual Health Insurance market.

2014 2015 2016$63 per covered life $44 per covered life $27 per covered life

Patient-Centered Outcomes Research Institute Fee (PCORI Fee)

2014 2015 2016$2 per covered life $2.08 per covered life $TBD

MED 1000 paid or will pay more than $466,000 in 2014 and $365,000 in 2015 for the Reinsurance and PCORI Fees.

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NEW TAXES, FEES and STOP LOSS PREMIUMS(continued)Health Insurer FeePayable by Health Insurance Companies, based on market share and intended to generate substantial revenue to help pay for ACA. This fee is passed on to consumers in the form of higher premiums.

Cadillac Plan Tax• Effective 2018• 40% of the value above $10,200

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NEW TAXES, FEES and STOP LOSS PREMIUMS(continued)Stop Loss Premiums

Self-insured plans like MED 1000 and CARE 1000 purchase Stop Loss Insurance to cover large claims. Because Annual Limits are not permitted, the cost of Stop Loss Insurance has increased significantly. Claims in excess of $1 million are now occurring regularly.

MED 1000 will pay more than $700,000 in 2016 for Stop Loss Insurance.

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MANDATES AND PENALTIES

Individual Mandate and Penalty

Penalties to Employees for Not Maintaining ‘Minimum Essential Coverage’ with either Medicare, Medicaid, Individual Insurance Policies, Employer or Taft-Hartley Sponsored Plans.

2014 $95 per adult and $47.50 per child



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MANDATES AND PENALTIES(continued)Employer Mandate

Employers with 50+ full-time employees must offer medical coverage that is “affordable” and provides “minimum value” or else be subject to Employer Penalties (below).

Coverage is “affordable” if employee contributions are less than 9.5% of Employees W-2 wages.

A plan must pay 60% of the cost of covered health services to be considered “minimum value.”

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MANDATES AND PENALTIES(continued)Employer Penalties

If employer does not provide “affordable” “minimum value” coverage the penalty will be the lesser of:• $2,000 for each employee, minus the first 30; or• $3,000 for each employee who receives a subsidy for coverage on an exchange.

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CIGNA WELLBEING PARTNERSHIP

UFCW “Med 1000” Kroger Dallas StewardsDecember 15th, 2015 Jodi Berry

Dawn Godard

Drive Member Engagement• Provide the packet today, with copies of the key member

communications . Custom one page member flyer.

• Educate on Emergency Room alternatives. Provide a member letter or e-mail sample and UC/CC In-Network directories for the Dallas, TX area.

• Provide helpful focus topics quarterly, in PDF’s to post to local websites and provide newsletter content.

• Provide step by step instructional on online provider look-up guide. Promote PCP and Cigna Designated Specialty provider selection.

Thank You! – We appreciate the opportunity to work together with everyone here today, to support providing educational communications

to the members!

37Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2015 Cigna

Objectives

Goal 1Increase health awareness

• We want to ask for your partnership to Drive member awareness in Cigna toll free support lines, online website wellness tools and programs and to help members and their dependents be empowered to make better health decisions.

• Partner today, with the Trustees, Stewards and NEBA, to coordinate quarterly periodic member communications, on key topics and provide healthy recipes and nutritional and fitness tips. Please help us promote this member engagement!

Goal 2Increase health and wellness events onsite

• Promote the members to get their Preventive Care screenings with biometrics and knowing personal health numbers to address any identified risk.

• Increase group.MyCareallies.com personal website user awareness, utilization and taking the Health Assessment.

• Educate membership to call the Cigna 24 hour health information nurse line for decision support on health decisions and steerage in choosing a Participating Provider

• MedExpert vendor also available, for additional medical inquiry information

Goal 3Implement a robust communication campaign to create awareness of…

• Partner to help educate the members on alternatives to the ER. Encourage members to choose participating UC/CC when appropriate, for cost savings and a better quality of care.

• Key focus on Maternity Health. Provide support and education on having a healthy pregnancy, to support healthy babies

• Increase member awareness in Cigna Care Allies Case Managers. Encourage members to Take the call and Make the call, to utilize the Case Management.

Goal 4Improve plan utilization

• Educate and create awareness on the Healthy Rewards member discounts and cost savings program on health care items for fitness, weight management and quitting tobacco. Support healthy pregnancies and help address chronic conditions.

Goals and Objectives

38Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2015 Cigna

December 15, 2015

Introduction to MedExpert

(c) 2015 MedExpert International, Inc. | Confidential

(c) 2015 MedExpert International, Inc. | Confidential 40

Independent Experienced Vetted

CA-based

No Compromising Affiliations

On-staff physicians and nurses

30+ years to build

10+ years with UFCW Funds

Over 125,000 UFCW lives covered

CMS Health Care Innovations Award

5 year longitudinal study with Harvard, Stanford, and MIT


Mission Statement MedExpert’s mission is to improve lives of UFCW members

through the timely exchange, understanding, and implementation of current, unbiased, and accurate medical and health information. MedExpert believes that every UFCW member, regardless of language, education, or station in life, deserves today’s finest medical knowledge delivered in a prompt, honest, clear, and respectful manner.

This mission is possible through a robust knowledge system that identifies EBM quality information within 4 to 8 minutes and exchanges that knowledge through MedExpert’s knowledge transfer platform.


MICOMM™Advanced Telecomm System

UFCW Members will always be automatically routed to their MedExpert case manager.

MICOMM™ Features:

Fully integrated with knowledge (FAME ™) and EHR system (MILS™) Phone number identified in <0.025 seconds Call routed to Member’s Personal Case Manager in < 1.00 seconds EHR loads with member information in <2.00 seconds No phone trees No voice mail Current engineered capacity 3,000,000 calls every 4 hours

<0.025Seconds

<1.00Second

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MedExpert QMMS™ Products & Services

(Quality Medical Management System)

IMDS™ (Individual Medical Decision Systems) is based on artificial intelligence that required over a decade to develop.

IMDS™ covers all 22,000+ conditions; 16,000+ pharmaceuticals; all wellness issues and 300,000+ co-morbidities.

MedExpert QMMSTM Products & Services Medical Decision Support

MISP1 IMDS ™ (Individual Medical Decision Systems) Biometric

MISP2 Body Composition | BMI | Waist | BPFMISP3 Glucose | Fasting Glucose | A1cMISP4 Lipid | Cholesterol | HDL/LDL | TriglycerideMISP5 Blood Pressure

Assessment Execution MISP6 Health Risk | HRQ | LLLMISP7 Health Plan | CAHPSMISP8 Provider | VSQ9MISP9 Disease Risk | Asthma + >75 assessments

Screening & ToxicologyMISP10 Nicotine | CotinineMISP11 FITMISP12 Schedule C Drugs

Utilization | Case Management MISP13 Informed ™ (Prospective Utilization/Case Management)MISP14 Independent Utilization Review

Medical ManagementMISP15 Health Coaching MISP16 Chronic Disease ManagementMISP17 Directly Observed Therapy (DOT)

WellnessMISP18 Smoking Cessation MISP19 Nutrition Fundamentals™MISP20 Exercise On!MISP21 Sleep SoundlyMISP22 Stress Less

Data ManagementMISP23 MICore™ MISP24 MI Data AnalyticsMISP25 QMMS™ Incentive ManagementMISP26 Member Program Agreement Fulfillment


Co-Branding to Provide Numerous Modes of Engagement

UFCW LOCAL 1000 & KROGER DALLAS HEALTH AND WELFARE PLAN December 15, 2015 Presentation to UFCW Local...

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