THE FINANCE AND ADMINISTRATIVE SERVICES DEPARTMENT AND THE HUMAN RESOURCES DIVISION RECOMMEND APPROVAL OF THE ABOVE MOTION.
To prepare for open enrollment for calendar year 2019, currently scheduled to begin on October 15, 2018, this item seeks the Board’s approval of the funding for health and pharmacy benefits with the following plan design changes:
All health plans:
- No increase to 2019 Employee Contributions.
- Continue funding the Health Savings Accounts for the HDHP Base and Out-of-Network (OON) plans at the HDHP Base Plan level for an additional year.
- Reduce new hire/newly benefit-eligible waiting period to the 1st of the month following 30 days in a benefit-eligible position. Waiting period is currently the 1st of month following 60 days in a benefit-eligible position.
UnitedHealthcare Plans:
Implement Diabetes Health Plan for pre-diabetic and diabetic members. Incentivize members with diabetes or pre-diabetes who routinely follow independent, medically proven steps to help manage their condition (such as regular blood tests, routine exams, and preventative screenings and use wellness coaching). Enrollment will be automatic with an opt-out-provision.
• Incentives
Office visits:
CDH High - no copay when visit is related to diabetes, pre-diabetes and/or high blood pressure and high cholesterol.
HDHP Base and Out of Network - no coinsurance (after annual deductible is met).
Pharmacy:
CDH High - reduced or waived copays for generic and preferred tier medications and supplies related to diabetes.
HDHP Base and Out of Network plans - after annual deductible is met, reduced or waived coinsurance for generic and preferred tier medications and supplies related to diabetes not currently covered under the HDHP Preventive Drug list.
Community Care Plan - Narrow Network Plan:
Implement Qualified Care Coordination Program for diabetes, hypertension and asthma/COPD. Incentivize members who routinely follow independent, medically proven steps to help manage their condition (such as regular blood tests, routine exams, and preventative screenings and use wellness coaching).
• Incentives:
Office Visits:
Lower out of pocket maximum
Primary care visit copay reduced from $25 to no cost
Specialist visit copay reduced from $50 to $25
Virtual visit copay reduced from $40 to $20
MDNow Urgent Care Clinic copay reduced from $25 to no cost
Pharmacy:
Reduced or waived copays for generic and preferred tier medications and diabetic supplies
This recommendation also includes the continuation of the following health program initiatives:
- The annual waiver credit of $3,100 for employees who opt-out of the County’s health insurance program with proof of other group coverage;
- The $20 bi-weekly surcharge for working spouses/domestic partners who have health coverage available from their employers, but chose to enroll in the County health plan;
- The Engagement Incentive with the requirement that employees (and spouses/domestic partners enrolled in a County health plan) must complete a designated preventive screening within the prior 12 months to receive County-funding in their 2019 Health Savings Account (HSA) or Health Reimbursement Account (HRA), if not eligible to participate in a Health Savings Account.
Exhibit 1 reflects the actuarial health and pharmacy insurance premiums, County contribution amounts, net employee cost, and Health Savings Account amounts for each plan and tier of coverage for plan year 2019.
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