Embed Size (px)
Citation preview
Office of Group BenefitsTommy D. Teague
Chief Executive Officer
TODAY’S SMART CHOICES...
TOMORROW’S HEALTHY SAVINGS
EligibilityEligibility
Full-time employees and retirees of… state agencies state colleges and universities participating school boards
…and legal dependents: Legal spouse Never-married child from birth to age 21 Never-married child age 21-24 (if full time student)
Effective date of coverage is first day of month after enrollment plus 30 days
OGB Plan Member PremiumsOGB Plan Member Premiums
Plan member pays 25% of premium for self
Plan member pays 50% of premium for any dependents
Aggregate contribution level is 29% by plan member
4
Retiree Health CoverageRetiree Health Coverage
OGB Health PlansOGB Health Plans
4 plans -- for all plan members
PPO (self-insured & administered by OGB)
HMO (self-insured; administered by Humana)
EPO (self-insured; administered by UnitedHealthcare)
Medical Home HMO (fully-insured & administered by Vantage)
6
OGB Medicare Advantage OGB Medicare Advantage Health PlansHealth Plans
5 plans – only for retired plan members with Medicare Part A & Part B
3 Medicare Advantage HMO plans Humana HMO (only in certain areas of LA) Peoples Health (only in certain areas of LA) Vantage/POS Option (statewide)
2 Private Fee-for-Service (PFFS) plans Humana PFFS (nationwide) SecureHorizons Medicare Direct (nationwide)
Total Enrollment 132,305***
Active employees 86,253 65%
Retired employees 46,052 35%
*** figures don’t include LSU plans
OGB Health Plan EnrollmentOGB Health Plan EnrollmentOGB Health Plan EnrollmentOGB Health Plan Enrollment
8
OGB Budget
FY 2010
$1.264 billion
9
Fiscal Year 2009-10Fiscal Year 2009-10
Fund Balance as of August 14, 2009
$484,176,551
10
OGB Administrative CostsOGB Administrative Costs
MEDICAL BENEFITS
DRUGS
ADMINISTRATIVE
MENTAL HEALTH
Administrative costs are 3% of total costs
MEDICAL BENEFITSMEDICAL BENEFITS
11
OGB Organization
332 employees
5 divisionsBenefit Services
Customer Services
Information Services
Quality Assurance & Administration
Legal & HIPAA
12
OGB Organization
Chief Executive OfficerTommy Teague
Benefit ServicesHubert Lincecum
Customer ServicesMalcolm Veazie
Administration &Quality Assurance
Brenda St. Romain
Information ServicesCharles Jumonville
Legal & HIPAA ComplianceTommy Benoit
13
CHIEF EXECUTIVE OFFICERTommy Teague
(3 positions)
BENEFITS SERVICESHubert Lincecum(152 positions)
INFORMATION SERVICESCharles Jumonville
(53 positions)
ADMINISTRATIONBrenda St. Romain
(36 positions)
CUSTOMER SERVICESMalcolm Veazie(76 positions)
LEGAL/HIPAATommy Benoit(10 positions)
ELIGIBILITY
CLAIMS PROCESSING
FISCAL
FLEXIBLE BENEFITS & IMAGING SERVICES
SYSTEMS
APPLICATIONS
PLAN ADMINISTRATION
QUALITY ASSURANCE
HUMAN RESOURCES
COMMUNICATIONS
PROCUREMENT
DEVELOPMENT
SUPPORT SERVICES
PROVIDER SERVICES
AGENCY SERVICES
PLAN MEMBER SERVICES
LEGAL
HIPAA
FRAUD & ABUSE
INTERNAL AUDIT(4 positions)
OGB Organization
Retired Employees 46,573
With Medicare 27,854
(Medicare is primary) 59%
Without Medicare 18,719
(OGB is primary) 41%
EnrollmentEnrollmentEnrollmentEnrollment
Life InsuranceLife Insurance
Group term life plan
Prudential
State pays 50% of premium for employees and retirees
Employee pays premium for dependent life
Reduced coverage and premiums, on July 1 after reaching age 65 and age 70
Basic Plan
Option I Option II
Employee $5,000 $5,000
Spouse $1,000 $2,000
Each Child $ 500 $1,000
Life InsuranceLife Insurance
Basic Plus Supplemental Plan
Option I Option II
Employee:
Based on schedule to
maximum of $50,000
Based on employee’s
annual salary
Based on employee’s
annual salary
Spouse $2,000 $4,000
Each child $1,000 $2,000
Life InsuranceLife Insurance
GASB 45 / OPEB LiabilityGASB 45 / OPEB Liability
Historically, governments accounted for retiree health care benefits on pay-as-you-go (PAYGO) basis.
– Cost of covering active employees was only a function of current year costs
– Did not reflect total cost of employee health coverage …only included current year
– Without projected future costs, governmental entities’ financial statements did not fully disclose all costs
– GASB requires disclosure of future costs associated with current services
– Those future costs are classified as OPEB
GASB 45 / OPEB LiabilityGASB 45 / OPEB Liability
OPEB (other post-employment benefits) – a compilation of all non-pension benefits an employee receives after retirement
Examples include:Health benefitsDental, vision and hearing coveragePrescription drug coverageLife insuranceLong-term care commitmentsLong-term disability
GASB 45 / OPEB LiabilityGASB 45 / OPEB LiabilityLiability calculation assumptions:
Benefit composition
Medical inflation
Turnover rate
Mortality assumption
– Will employee live to reach retirement?
– How long will retiree live in retirement?
Discount rate
Other factors that affect number of dependents
GASB 45 / OPEB LiabilityGASB 45 / OPEB Liability GASB 45 does not require funding of the calculated liability
Decision to fund or not is significant:– Funded plans have lower liabilities– Unfunded plans have larger liabilities– Rating agencies may consider funding
Funding requirements are strict; funds must be held in irrevocable trust
Depending on funding or not:
State’s liability now stands at
$13.7 billion over 30 years….and growing
