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College Benefits Council Meeting

January 24 2013
HR Training Room

Dana Williams called the meeting to order at 2.10pm

Robert Shumsky made a motion to approve the Minutes of the last meeting, 26 October 2012. Patricia Pioli seconded the motion. The motion was passed with a show of hands.

2012-2013 Benefit Initiatives

Data Review
Open Enrollment Results Compared to 2012
The distribution was very similar to last year. 84 per cent of employees enrolled in the Dartmouth health plan; 679 waived coverage (16%). Some of these may be insured through Dartmouth spouses.;

The distribution of employees by plan has remained the same: 76% OAP1/POS, 19% OAP2/PPO and 5% HDHP.

The average HSA contribution has grown by 2% while the average FSA contribution has declined by 21%. The decline is not surprising because the FSA limit went down. Most employers are seeing the same trend.

The number of employees receiving the $250 contribution to the FSA is down by 1%, although the average contribution per person is up8%.

Members in health plans
The number of active members grew in 2012 after declining in 2010 and 2011.

The average number of active members per employee (subscriber) is 2.09 and has remained constant at 2.10 or 2.09 over this period. The average age of subscribers is mid-40s.

The number of 65+ retiree members continue to grow each year.

Per Member Per Month Costs
For active members, per-member costs grew in 2010 and declined in 2011 because of the increase in out-of-pocket costs (deductibles, coinsurance and copayments).
Claims Expense for Active Members
From 2011 to 2012 there was a shift to doing more on an outpatient basis. The largest areas of expenses growth were pharmacy and outpatient. Pharmacy costs do not include drug rebates, which increased under the CVS Caremark contract.
65+ Retirees – DCMS Plan
65+ retiree spending grew in 2010 and 2011 and declined in 2012. The majority of the spending in this population is in pharmacy, since Medicare covers other services. The DCMS plan covers supplemental Medicare coverage.
The Silverscript implementation in 2013 should reduce the pharmacy spending trend.

There followed a discussion on the need for further data and analysis on out-of-pocket costs.
In 2010 out-of-pockets costs for active members grew; an increase is not expected for 2012-2013. Members expressed a desire for analysis of these costs, and how they affect employees according to pay level.

2012-2013 Benefit Initiatives

Review of Cigna transition:
Transition process: Communications; education sessions; pre-implementation audit; identification of disruption issues; new ID cards mailed in December; weekly implementation calls with Cigna staff ongoing

Plan Design Issues:
There are three primary plan design issues we are currently addressing re Cigna:

i)Physical Therapy – With Cigna there is a pre-authorization requirement, unlike with Anthem. The plan has been modified to allow eight visits before a medical necessity review needs to be completed.

ii)Mental Health Coverage Exception Benefit – This benefit allows for out-of-network claims to be paid at the in-network level for a maximum of 12 mental health visits. Cigna will pay 90% of the provider’s fee. The benefit will begin on 4/1/13 after the mental health 90 day transition of care has been exhausted.

iii)Vision Benefit – The implementation team is currently reviewing this benefit with Cigna.

SilverScript
There have been some frustrating implementation issues with SilverScript. ID cards and Welcome Kits were not mailed when expected. Dartmouth is currently receiving daily updates from SilverScript to ensure that all issues have been resolved.

CVS Caremark
There has also been some confusion with CVS Caremark cards. We are working with CVS Caremark to correct these issues. It was also noted that communications with Caremark take 21 days to resolve. Alice Tanguay will address this with Caremark.

Wellness Update

Fall 2012Wellness review:
Biometric screenings:
Launched Fall 2012 with 23 events in fall; 1,119 employees
Goal of 60% engagement ofbenefits eligible active employees
Hope to screen 1,000 more in Jan/Feb
Online scheduling tool working well

Health assessments:
Launched January 21
60% engagement goal
Participants receive a report
Available via Cigna website

Field Health Coaching:
Three coaches (2 FTE)
Signed up 650 employees in fall
50 % engagement goal

  • You! Harvesting Health Event: October 17 2012 attended by 400+ employees
  • Incentives: First payouts in February payroll to qualifying employees; employees can earn a total of $200
  • Wellness website:Wellness is getting very good feedback on this and have had 3,917 unique visitors
    2013 Initiatives
  • Data Analysis & Reporting:Wellness is working to identify opportunities for programming beyond 2013
  • Evaluation planning:
    Wellness is identifying opportunities for getting a PI involved to support credible evaluation design; Melissa asked for faculty input into the PI
  • Dartmouth Health Connect:1020 patients enrolled as of December 30, 2012. Wellness is working with Iora to make sure the practice is reachingthe patients who can benefit the most
  • Advisory Committee: The committee structure has been defined; Wellness is looking for a demographic mix on the committee
  • Wellness Roadshow: presentations to One Dartmouth, Staff Meetings, etc. to promote current activity

Benefits Initiatives 2013-2014

Short and Long Term Disability Programs
Benefits would like to review the STD and LTD benefit offered by Dartmouth and review the current vendor and plan design in order to align us more closely with our peers. We will be working with AON Hewitt on this. A working group will look at faculty/staff differences in STD/LTDs.

Supplemental Benefits: Benefits is looking at supplemental benefitswhich employees could voluntarily purchase on their own, for example giving them a better rate on disability.

Plan Benefit Design/HR Policy
This spring CBC working groups will examine:
i)Domestic Partner Benefit
ii) Preventive Care Coverage
iii)Life Insurance Vendor (currently Metlife). We want to make sure we are getting the best rate – not looking at a plan design change.

There followed further discussion on whether there should also be a working group to review data utilization and the issue of how the recent changes have affected different income levels. Several members mentioned that they want to study the impact on employees of the increase in health costs. Alice Tanguay mentioned that the Healthcare Hardship fund has had minimal utilization,we may need to publicize this fund more. There was a discussion about the effectiveness of the Healthcare Hardship fund. Some feel that the fund is too restrictive and only for extreme cases. There was a suggestion that the benefits team use claims data to see who might be eligible for the fund and reach out to those employees. Some were concerned about the confidentiality issues involved in reviewing person level claims data.The consensus of the discussion was that further communication about the Healthcare Hardship Fund is required.

Affordable Care Act (ACA) overview

2013 Impact

  • Expanded coverage of women’s preventative health services (birth control)
  • Medicare withholding tax increased from 1.45% to 2.35% for individuals earning over $200K/joint filers over $250K (effective 1/1/3)
  • Health FSAs are limited to $2,500 (effective 1/1/13)
  • Health and Human Services will evaluate each state’s progress in establishing a health insurance exchange (from 1/1/13)
  • Employers issuing more than 250 W-2s are required to report the aggregate costs of employer-sponsored health care coverage on employees W-2s (January 2013 for 2012 tax year)
  • Employers need to provide their employees notice about future availability of health insurance exchange in their state
  • Insured and self-insured plans will be required to pay a $1 per member fee to fund comparative effectiveness research of medical treatment. This is in Dartmouth’s budget – it will be raised to $2 after 2014
  • Group health plans must certify they are in compliance with the HHS rules on electronic transactions between health provider and health plans (by 12/31/12)

2014 Impact

  • Individuals who work more than 30 hours a week must buy health care or pay a tax. This impacts our temp employment policy and reviewing the 200+ employees who do not buy insurance
  • There will be annual dollar limits on EHB (essential health benefits) and preexisting condition exclusion prohibited. There will be EHBS that every plan has covered – this list is not available yet
  • State insurance exchanges begin
  • Employer reporting on health insurance information to government or participants
  • Increased cap on rewards for participating in health-contingent wellness programs (Dartmouth does not have one – ours is participation-based)
  • Transitional reinsurance fees: the fee the government is charging to employers to help fund the exchanges. Establishing a high-risk pool to stabilize the exchanges – legislation calls for a $25 billion reinsurance pool to get a wide spread of risk. Declining funding for $63 per participant in 2014 to 201/20156. Cost to Dartmouth –approximately $500,000 for 2014.

There will be more information on the ACA at the next meeting.

The meeting was adjourned by Chairman Dana Williams at 3.50pm.