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Employee and Retiree Healthand Welfare Benefits Program2015 Plan Year

Agency Benefits Coordinator TrainingAugust 2014

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Agenda

Medical Plans Wellness Program

Dental Plans

SLEOLA Carve-Out Open Enrollment

Subsidized health benefits for certain

contractual employees

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The Times They Are A-Changing

New medical and dental contracts beginJanuary 1st

POS plans eliminated

Aetna EPO eliminated

UCCI DHMO eliminated

APS eliminated

Kaiser added

Delta Dental DHMO added

SLEOLA plans - one carrier for all three plans

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Medical Plans

Five medical plansCareFirst EPO, CareFirst PPO

Kaiser

United Healthcare EPO, United Healthcare PPO

Behavioral health added back in

All medical plans will use their own BH network

Possible disruption

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Medical Plans Benefit Updates

RFP

GID coverage added

Acute inpatient rehab for stroke and brain injury added

Mental Health Parity

Residential treatment centers covered Services/Supplies provided as a result of failure or refusal to

obtain treatment or follow prescribed treatment no longer

excluded

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State of the States Population

Treatment non-complianceincreases costs Increased usage of ER

Increase in large claimants

Increase in ESRD

Majority of population notobtaining age appropriatescreenings for breast cancer,colorectal cancer, etc.

Aging population Actives average age = 37.1

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Chronic Diseases Per Person Annual CostBreakdown

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Chronic Diseases Annual Costs

State Program continues to pay higheramounts for costly members with chronic

conditions totals below include all

medical/Rx costs associated with a member

that has been identified as having a chronic

condition.- $722.6 million in FY 2012

- $683.7 million in FY 2011- $660.5 million in FY 2010

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Chronic Diseases Annual Costs

Underlying factors driving cost increases:- Few members complete preventive screenings- Many members are not currently treatment compliant

- Low out-of-pocket health care costs

- No incentive to change

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Wellness Program - Goals

Improve overall population health Flatten trend line without cost shifting to

participants

Promote employee/retireewellness and personalresponsibility

Incentivize plans to focus on quality of care

provided and patient outcomes

Enhance participant awareness of differences incost/quality

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Wellness Program Plan Features

Affordable Access to Care All lab and x-ray covered with no copay or

coinsurance for all participants (in-network)

Copays for primary care visits waived if healthrisk assessment completed and discussed with

physician

Continue waiving drug copays for genericdrugs targeting certain chronic conditions

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Wellness Program Plan Features

Education and Resources Weight management, nutrition education, tobacco

cessation provided at no cost to participant

Offer online resources allowing members to compare

providers based on quality and efficiency

Provide reports on provider outcomes

Offer online tools for members for pricing basic

services, tests and procedures

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Wellness Requirements Phased-in 2015 2020

2015:

Communicate the coming health initiatives under the value basedbenefit design that will go into effect in 2016

Health plans will collect data for administering the value based benefitdesign

Employees/retirees and covered spouses will need to designate aprimary care physician (PCP) through their health plan and reviewhealth risk assessment with PCP

2016: Participants complete recommended healthy activities and participate

in disease management program if appropriate

PCP copays waived if employee & covered spouse completed healthrisk assessment in 2015; surcharge if no PCP selection and/or healthrisk assessment not completed in 2015

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Healthy Activity Requirements

Participants with a Chronic Condition & Eligible for

the Disease Management Program

Participants not Eligible fo r the Disease Management

Program

Year 2015: Health Activity Requirements No

Surcharge

Year 2015: Healthy Acti vity Requirements No

Surcharge

Employees and covered spouses required to designate a PCP

Complete carrier health risk assessment; review with PCP.

PCP sign-off confirming review

Employees and covered spouses required to designate a PCP

Complete carrier health risk assessment; review with PCP. PCP

sign-off confirming review

Year 2016: Healthy Acti vity Requirements Surcharge

Appl ies

Year 2016: Healthy Activity Requirements Surcharge

Appl ies

Actively participate in the disease management (D/M) program

& follow disease management call-in & treatment guidelines of

the care manager, or complete/graduate from the D/M program

Complete a Nutrition Education or Weight Management program

sponsored by your health plan (i.e. online or class setting)

Complete carrier health risk assessment; review with PCP.PCP sign-off confirming review

Complete carrier health risk assessment; review with PCP. PCPsign-off confirming review

Complete all recommended age/gender specific biometric

screenings & discuss the results with your PCP

Complete all recommended age/gender specific biometric

screenings & discuss the results with your PCP

Year 2017: Healthy Acti vity Requirements

Surcharge Applies

Year 2017: Healthy Activity Requirements Surcharge

Appl ies

Actively participate in the disease management (D/M) program

& follow disease management call-in & treatment guidelines ofthe care manager, or complete/graduate from the D/M program

Complete all recommended age/gender specific biometric

screenings and discuss results with your physician

Complete all recommended age/gender specific biometric

screening & discuss with your PCP

Complete carrier health risk assessment; review with PCP. PCP

sign-off confirming review

Complete carrier health risk assessment; review with PCP.

PCP sign-off confirming review

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Healthy Activity Requirements

Participants with a Chronic Condition & Eligible for

the Disease Management Program

Participants not Eligible for the Disease Management

Program

Year 2020: Healthy Activi ty Requirements Surcharge Applies

Year 2020: Healthy Activity Requirements SurchargeAppl ies

Actively participate in the disease management (D/M)

program & follow disease management call-in &

treatment guidelines of the care manager, or

complete/graduate from the D/M program

Complete carrier health risk assessment; review with

PCP. PCP sign-off confirming review

Complete all recommended age/gender specific

biometric screening, maintain blood pressure and

cholesterol in the normal ranges, & discuss with yourPCP

Complete all recommended age/gender specific

biometric screening & complete a physical exam

showing blood pressure, and cholesterol in the normalrange, & discuss with your PCP

Complete the online Personal Health Assessment

(PHA), including your current blood pressure, BMI,

cholesterol levels and take a copy of the PHA to

your physician & discuss results with your PCP

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You have time to get your activities done!

2015: Complete your healthy activities between Jan 1 and Sep 30 to avoid surcharge

in 2016.

2016: Complete your healthy activities between Oct 1 2015and Sep 30 2016

After 2016: Oct 1 through Sep 30

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Non-Compliance Surcharges

Participant penalties

$50 per year premium surcharge for healthy individuals who fail to

complete healthy activity requirements

Begins in 2016, increases to $75 in 2017

Applies individually to employee/retiree and spouse

$250 per year premium surcharge for individuals identified for diseasemanagement who fail/refuse to engage in treatment

recommendations and healthy activity requirements

Begins in 2017; increases to $375 in 2018

Alternative activities available to individuals unable to complete

required activities due to medical reasons Appeals process

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Wellness Program Beyond Employees andRetirees

Delivery System ReformsIntegrate community health workers into the

overall health management of members

In consultation with the State, identify high value

medical services and offer recommendations foradministering incentives that reward these high

value services

Provide reporting and data to the State and itsvendors to support plan management and the

development of additional strategic initiatives

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Carrier Performance Measures

Increasing the percentage of eligible members who receive

preventive care, including cancer screenings

Increase treatment compliance by participants with diabetes,

hypertension, and hyperlipidemia

Increase number of participants with diabetes, hypertension,

and hyperlipidemia with key numbers in the normal range

(e.g. blood pressure, HbA1c, etc.)

Reducing hospital readmission rates within 30 days of

discharge

Reducing emergency room visits by participants with asthma,

COPD, and diabetes

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Dental Plans

DPPO UCCI Annual maximum increased to $2,500 from

$1,500

DHMO Delta Dental National network

Enrollees in UCCI DHMO MUSTselect a new

dental plan Must also select primary dental office (PDO)

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SLEOLA Bargaining Unit I

Separate RFP for Medical Plans Still have PPO, POS, and EPO

Only one carrier: CareFirst

Separate contract from Program medical plans

No wellness

Subgroup on enrollment forms

Carve-Out Prescription Still under Express Scripts

Sub-group to Program

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Open Enrollment

October 15 November 14

NO IVR paper only

Be sure to print summary statements every day!

Many participants must make new elections

All POS participants (except SLEOLA)

All DHMO participants

All Aetna EPO participants

Everyone will get new cards

Domestic partner coverage ends 12/31/14

Rates not available yet Stay Tuned!

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Open Enrollment New Packet DistributionPolicy

Lost or misplaced OE packets are considered aHIPAA improper disclosure

To avoid HIPAA jail ABCs MUST:

Send a confirmation of receipt of all expected

boxes and the condition of the boxes to

EBD.mail@maryland.gov on the date of receipt

Distribute packets within 5 business days and

email EBD.mail@maryland.govconfirmingdistribution date

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HIPAA Reminders

DO NOT put employee names in email subject line

ALWAYSproperly secure printed material containing

PHI

ALWAYSencrypt email containing PHI or

attachments containing PHI NEVERdiscuss individual cases using a speaker

phone

NEVERdiscuss/disclose PHI without executed HIPAArelease

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