April 21, 2020 Presentation
North Dakota Public Health Insurance Trust April 21, 2020 Presentation
NDIRF-SEEC Partnership -Brennan Quintus SEEC and Hays Trust Program Overview Evaluation Process Resources and Next Steps
Brennan Quintus, CEO North Dakota Insurance Reserve Fund (NDIRF) In surveys, members are asking about: Property Insurance Health Insurance NDIRF works with virtually all political subdivisions in North Dakota: The “umbrella” to help local governments get the buying power of a large group. Partnering with consulting firms that specialize in health insurance in North Dakota.
Who are the REA’s and SEEC Kyle Davison Executive Director
Who We Are Hays Companies was founded in 1994 Became part of the Brown & Brown Team in 2018 Full-service insurance brokerage consultancy specializing in: Employee Benefits Property & Casualty Risk Management Retirement Planning All-inclusive resources and national leverage with the speed and agility of a smaller broker Transform benefits and risk through modern technology and industry expertise Creative. Data-Driven. Strategic. Consultants. The past 10 years, the Hays’ Risk Pool Management client groups have experienced a 4% market rate renewal trend for their health plan premiums as compared to the market in the same period at 8.2% The Hays Difference 5
The Hays NDPHIT Service Team NATIONAL RESOURCES Heather Kopnicky Louise J. Short, MD, MSc Health Strategist National Clinical Leader Strategic Benefit Advisors Frank Bacon Greg Rucinski RPh Pharmacy Consultant Executive VP PillarRx Consulting, LLC Dave Ross Josh Rydberg Executive VP of Underwriting Senior Underwriting Consultant Ben Graves Nicholas Karls Executive Director Associate Director Steve Piccolino, MBA Catherine Hobbs Vice President National Benefits Technology Director of Software Implementation Wellness Stephanie Mace Randy Johnson Lead Consultant Strategic Consultant Pharmacy Financial Strategies Jon Heath Elizabeth McArthur Benefits Consultant Financial Consultant Compliance & Legislation Olena Zhuravlova Megan Karis Benefit Analyst Marketing Director Technology Rich Scherer International Benefits The Hays Difference 6 Vice President International Benefits Amy Peterson Senior Analyst
North Dakota Employer Clients The Hays Difference 2 Proprietary and Confidential Work Product
Strategic Approach to Health Plan Management One solution will not mitigate rising health plan costs. In addition to our proven Risk Pool Management (RPM) strategy, Hays analyzes your data, evaluates multiple strategies and develops custom solutions. Population Health Strategies Well-Being Management Pharmacy Saving Solutions Audit Surgery & Physician Networks Analyze your data Catastrophic Claim Management Diagnose On-Site & Near Site Clinics Understand the results Direct Provider Contracting Execute Implement strategies Accountable Care Organizations Stop-Loss Cooperatives Assess Measure impact The Hays Difference 2 Proprietary and Confidential Work Product Medicare Transition Solutions RPM
History of Success The Hays Client Management Process: Our focus is using Tools, Resources and Strategies to manage risk In-depth of Professional Expertise and Competencies Consulting and Advising vs. traditional Broker transactional product pricing Consistency of Planning and Analysis Forward Thinking and Strategic Initiatives A broad and expert level of HR, Legal Compliance, Actuarial/Underwriting, Clinical and Risk Management Resources Dedicated Service Team Detailed Execution The Hays Difference 9
ND Public Health Insurance Trust Objectives The primary function of the NDPHIT is to provide benefit programs and services within the scope of a (“VEBA”) Trust which could include but not limited to: 1. Health Insurance Premium Stability and predictability target medical trend 3% to 6% annually 2. Public Schools and Political subdivisions control with local, regional and state-wide representation 3. A benefit to Political subdivisions fully-insured and potentially self-insured groups. 4. Access to both additional and better HR Administration Services, Employee Benefit Communications and Transparent Cost Reporting 5. More Health Plan Choices 6. In addition to Medical Insurance -Dental and Vision Insurance -Life Insurance -Disability Insurance -Voluntary benefits -or other programs permissible and determined by the board of Trustees
FAQ: Public Health Insurance Trust Opportunities
FAQ: How will this affect my plan current health insurance benefits?
FAQ: How is the program structured?
Trust Board of Trustees Structure Following the initial establishment of the Trust, a nine-member Board of Trustees of participating schools, which will be comprised of the following: Four (4) Superintendent Trustees, which shall be the superintendent or the superintendent's designee for intervals of 1, 2 and 3 year terms, and will be entitled to appoint a Trustee to serve on the Trust based upon its relative size to the other Participating Employers. One (1) Trustee shall be the representative of a teacher bargaining unit for a 2 year term; One (1) Trustee shall be a member of the North Dakota Insurance Reserve Fund; Three (3) Trustees shall be a member Non-School Political Subdivisions or Designee for 2 and 3 year terms. All Trustees shall be afforded one (1) vote ND Public Health Insurance Trust Board of Trustees School District A School District-B School School District C District D School Teacher Bargaining Rep Fiscal Agent NDIRF Representative Non-School Non-School Political Subdivision Political Subdivision Non-School Political Subdivision
Other Trust Participation Agreement Terms
Other Trust Participation Agreement Terms
ACA Covered Preventative Care-No Member Cost Share Adult Preventative Care Alcohol misuse screening and counseling Blood pressure screening Cholesterol screening for adults of certain ages or at higher risk Colorectal cancer screening for adults 50 to 75 Depression screening Diabetes (Type 2) screening for adults 40 to 70 years who are overweight or obese Diet and obesity counseling for adults at higher risk for chronic disease Hepatitis B screening Hepatitis C screening for adults at increased risk HIV screening for everyone ages 15 to 65 Immunization vaccines for adults Urinary tract or other infection screening Breast cancer mammography screenings Osteoporosis screening Well-woman visits Children Preventative Care Autism screening for children at 18 and 24 months Behavioral assessments for children ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years Bilirubin concentration screening for newborns Blood screening for newborns Depression screening for adolescents beginning at age 12 Developmental screening for children under age 3 Fluoride varnish for all infants and children as soon as teeth are present Gonorrhea preventive medication for the eyes of all newborns Hearing screening for all newborns; and for children once between 11 and 14 years, once between 15 and 17 years Hematocrit or hemoglobin screening for all children Hemoglobinopathies or sickle cell screening for newborns Hepatitis B screening HIV screening for adolescents at higher risk Hypothyroidism screening for newborns Immunization vaccines for children from birth to age 18Iron supplements for children ages 6 to 12 months at risk for anemia Lead screening Obesity screening and counseling
NDPHIT Trust Timeline Political Subdivisions for a July snd January 2021 Renewal We need a letter of authorization for your groups claims data and plan benefits now through May 15 Individual Employer Determination and Underwriting. May 15 to June 15 Groups Renewal Health Plan Strategies. June 15 to July 1 Renewal Decisions by August 15 Open Enrollment Preparation and Communications September 15 Open Enrollment October through November 30 Schools October 2020-21Renewals We have 34 schools letters of authorization, claims data and are interested to participate in the medical plan in 2021 Additional schools we need authorization letters now for the medical (NDPERS, Sanford or BCBSND) for 2021. April through May 2020 Review information for the Trust Dental, Vision and Voluntary programs for October 2020 Dental, Vision and Voluntary Individual Employer Determination and Underwriting. June 1 through July 15 Open Enrollment Preparation and Communications July 15 through August 1 Open Enrollment August 1 through August 31st, 2020
Initial Schools and NDPHIT for proposed Underwriting Model
34 Schools used for Final Underwriting Barnes County North Cavalier School District Central Regional Education Assoc. (CREA) Ellendale Public School ENL Public School (Elgin/New Leipzig) Grafton Public School Hankinson Public School Hillsboro Public School Kenmare School District Kidder County Public School District Kindred School District LaMoure Public School Litchville / Marion Mapleton Public School McKenzie County-Watford City Medina Midway Milnor School Montpelier Public School New Rockford-Sheyenne North Border School Dist. North Sargent Oakes Public School Oliver Mercer Special Ed Rugby School District Rural Cass Special Education Unit Scranton Public Schools South East Ed Coop Thompson Public School Underwood Public School Wyndmere
Initial School Underwriting Model Underwriting Parameters: The current school health plan benefits with expanded preventative care services with no cost sharing Current enrollment and 2019-2020 premium Up to 24 months of historical enrollment and claims though1-31-2020 Adjusted for claims over 175K Removed individuals not covered as of January 31, 2020 Funding claims through September 30, 2021 with a 6.85% trend (26 months) Annual Trust Premium Assumes No premium increase for participating Trust Members for October 2020 through September 2021 The annual expected premium is 13,203,105 for 34 schools The model accumulates a monthly surplus over expected claims of 74,765 or 898,589 in year one BCBSND requires 2 months of claims and first October premium by September 30 Assumes each school contributes 7.5% of their annual premium as an initial deposit Final underwriting will be determined by participating schools – could be less than 34 schools.
NDPHIT How is the Health Plan Managed? 16
What Drives Health Insurance Premium Increases? These factors can cause employer health plan increases 3% to 10% annually Unaligned Employer Contributions by Tiers can understate required budget revenue Rates Tier Factors are generally not set correctly according to enrolled Age/Sex demographics Offering unaligned Multiple Plans can Create Adverse Selection-Healthy members select lower cost plans Plan Design does not drive Health Care Cost increases -High Cost Claimants Drive Cost Behavior economics and plan member choices are most often misaligned and almost never considered by employers (Cost vs. Value)
Risk Pool Management – Think Differently The Hays Difference Proprietary and Confidential Work Product
How to control health insurance premium increases? Population Health Strategies Well-Being Management Pharmacy Saving Solutions Surgery & Physician Networks Catastrophic Claim Management On-Site & Near Site Clinics Direct Provider Contracting Accountable Care Organizations Stop-Loss Cooperatives Medicare Transition Solutions The Hays Difference 2 Proprietary and Confidential Work Product
Self-Funded vs. Fully Insured Cost Components of Self-Funding and Fully Insured Plans Range and varies by State Savings Pooling/Commission 4% Terminal Lag 3% Risk Margin (Profit) 3% State Tax 1.75%-3% 5-12% Claims Partially Self-Funded Plan The Hays Difference 2 Proprietary and Confidential Work Product Fully Insured Plan Stop Loss or Pooling Charge 3% to 5% Admin 2% to 4%
Reinsurance-Stop Loss Aggregate Reinsurance – Pool Level 20% Corridor- BCBSND Health Care Expenditures for High Cost Cases using data from the Society of Actuaries The Hays Difference 2 Proprietary and Confidential Work Product
175K Stop Loss Example NDPHIT Reinsurer's Target Loss Ratio – 175,000 Deductible Analysis Period – 1/1/2018 through 12/31/2018 2018 High Case Analysis Tool Specific Deductible Maximum Specific Reimbursement Membership Network and/or Demographic Adjustment Specific Stop Loss Premium Expected Liability between 175,000 and 2 Million Reinsurer's Overhead (Admin, Reserves, Taxes, Profit, etc.) Reinsurer's Estimated Target-Loss-Ratio Specific Deductible Projected Members/1000 in Excess of Deductible for a Normal Population Expected Members in Excess of Deductible 25,000 30,000 35,000 40,000 45,000 50,000 55,000 60,000 65,000 70,000 75,000 80,000 85,000 90,000 95,000 100,000 105,000 110,000 115,000 120,000 125,000 130,000 135,000 140,000 145,000 150,000 155,000 160,000 165,000 170,000 175,000 180,000 32.350869 25.844008 21.211804 17.819469 15.263028 13.261636 11.550102 10.337759 9.275426 8.258862 7.619765 6.956512 6.408184 5.911275 5.450743 4.984950 4.716573 4.352603 4.105559 3.886811 3.556121 3.353479 3.109720 2.945366 2.759702 2.581582 2.409403 2.269105 2.173431 2.060783 1.954770 1.840617 77.499742 61.911906 50.814997 42.688319 36.564110 31.769575 27.669425 24.765136 22.220210 19.784931 18.253909 16.665021 15.351447 14.161051 13.057801 11.941947 11.299023 10.427095 9.835276 9.311245 8.519044 8.033595 7.449646 7.055919 6.611141 6.184438 5.771965 5.435867 5.206672 4.936811 4.682846 4.409382 The Hays Difference 2 Proprietary and Confidential Work Product 175,000 2,000,000 2,260 1.0600 1,367,233 751,542 615,691 55.0% Expected Members between the Deductible and the Incrementally Lower Deductible Midpoint between the Deductible and the Incrementally Lower Deductible Additional Liability between the Deductible and the Incrementally Lower Deductible Expected Additional Liability between the Deductible and the Incrementally Lower Deductible for Members that Exceeded the Deductible Expected Additional Liability from Members between the Deductible and the Incrementally Lower Deductible Total Expected Liability 0.2735 177,452 2,452 22,047 671 22,717
Comparisons Self-funded Schools Program Cost Details Health Insurance Program Plan Year Trust Trend Calculation(IBNR Medical Trend) Per Employee Per Year Cost Number of Covered Employees Number of Covered Lives(EE's/Dependents) Premium Budget Per Employee Per Year Annual Premium Increase Administration, Stop Loss and Medical Costs BCBSND Administration Costs Trust Management Costs Stop Loss Total Administration Stop Loss Cost Medical/Rx Cost Per Employee Per Month Total Acutal Medical Trend Actual Annual Cost Loss Ratio The Hays Difference 2 Proprietary and Confidential Work Product Grand Forks Public Schools* 1,000 Deductible 6 Year Average Jamestown Public Schools* 250 Deductible 6 Year Average Dickinson Public Schools* 500 Deductible 6 Year Average Wahpeton Wahpeton 2,700 Deductible 2019 2,800 Deductible 2020-21 854 1960 255 663 359 955 133 303 134 305 11,825 5.3% PEPM 37 126 163 761 924 11,092 1.2% 94% 13,415 4.0% PEPM 78 13,474 5.1% PEPM 209 287 756 1,043 1.9% 12,516 93% -2.5% PEPM -8.6% 60 60 166 233 873 1,106 426 486 545 1,031 426 486 615 1,101 13,270 98% 13,394 67 4.9% 14,653 -36.8% 13,394 91% -8.6%
Claims Trend – 3 Public Self-funded Schools Grand Forks Medical/Rx Claims Totals Monthly Claims with Trend Line 1,400 1,200 1,000 800 -2.7% 600 400 200 0 Claims PEPM Budget PEPM Linear (Claims PEPM) Linear (Budget PEPM) 4.9% Jamestown Public Schools Medical/Rx Claims Monthly Claims with Trend Line 1,600 1,400 1,200 1,000 800 1.9% 600 400 200 0 Claims PEPM Budget PEPM The Hays Difference 2 Proprietary and Confidential Work Product Linear (Claims PEPM) Linear (Budget PEPM)
Example 2020-21 Renewal- Grand Forks Public Schools Medica ACO Grand Forks Public Schools Preliminary Underwriting for 2020/2021 Plan year Claims Enrollment Enrollment Method 1 Method 2 Method 3 Rolling 12 - 60 day lives setback Paid 3/1/19 - 2/29/20 1/1/19 -12/31/19 10,326 Rolling 12 Paid 3/1/19 - 2/29/20 3/1/19 - 2/29/20 10,337 Current Year Paid 9/1/19-2/29/20 9/1/19-02/29/20 5,241 Medical Claims Medical Claims (ACO) 6,796,162 Rx Claims Claims over stoploss deductible Total Claims 1,600,636 (556,754) 7,840,044 1,600,636 (556,754) 7,840,044 443,819 (37,925) 3,661,493 Medical PEPM Medical Trend Months trend Effective Trend 604.24 6.80% 18 1.1071 603.60 6.80% 18 1.1071 613.94 6.80% 18 1.1071 Rx PEPM Rx Trend Months trend Effective Trend 155.01 7.10% 18 1.1120 154.85 7.10% 18 1.1120 84.68 7.10% 18 1.1120 841.31 840.42 773.84 33.65 150.45 0.46 184.56 33.65 150.45 0.46 184.56 33.65 150.45 0.46 184.56 Claims plus Trend Medical/Rx Admin Fees Admin Fee (Medical/RX) 2 Stop Loss PPACA fees Total Admin 1 2020/2021 Accrual Rate Medical/Rx 2019/2020 Accrual Rate Medical/Rx % Increase from 2019 to 2020 The Hays Difference 2 Proprietary and Confidential Work Product 1,025.87 1,093.59 -6.2% 6,796,162 1,024.97 1,093.59 -6.3% 3,255,599 958.40 1,093.59 -12.4% Reduction of 12.4% 1.472 Million Savings
Monthly Financial Reports Examples 16
Meaningful Reporting and Analytics
Health Plan Intelligence (HPI)
Monthly Reporting The Hays Difference 35
Monthly Reporting The Hays Difference 36
Monthly Reporting The Hays Difference 37
Financials The Hays Difference 38
Employee Communication Resources
Communications Strategy 40
Mobile App Hays Companies offers Mobile Benefits Solutions to provide your employees with 24/7 access to employee benefit information from any mobile device. The app is designed to help employees easily use and better understand their benefits, saving both the member and company valuable time and money. Access your employee benefits anytime, anywhere! KEY APP FEATURES o o o o o o o o o Benefits & Coverage Information General Medical ID Cards Benefit Forms & Documents Educational Videos Provider Directories Service Contact Information Wellness Plans Accessible on Mobile, Tablet, & Desktop Customized, Branded Design dickinson.mybenefitsapp.com Do I have to download an app to use it? No, when you access the website address for the app with your mobile device, you will be automatically directed to the mobile app. The app is a web app, which means there is nothing to download, no need to access an app store, etc.it’s ready for use when you access the site address from your device! But, what if I want an “app-like” icon on my home screen? You can add an icon to your Home Screen by clicking the Add to Home Screen icon when you are on the app’s home page. Now it will work just like any other app! Mobile Compatibility iOS (iPhone/iPad), Android, and Windows
Breaking Through to Employees With Text Company Perks more likely to respond to a text than an email People are Student debt & loan repayment Tuition reimbursement 401k plan they do so more than an average email Making Better Choices 1 Set up your telemedicine account Where to go for care SMS texts have a ER vs Urgent Care open rate Pharmacy, mail order Notifications of people read a text within 15 minutes of receiving it Sources: Trumpia, Dynmark, TextMarks, MarketingCharts, Pure360 Deadlines Open Enrollment Announcements And MORE!
Custom Communications 43
bswift – Benefits Administration Our EBTech team evaluates and matches a qualified benefits administration solution that best meets the needs of your organization and employees. Our teams are made up of experienced professionals who will both implement the technology platform and provide ongoing support. SERVICES TECHNOLOGY SUPPORT TOOLS Other Benefits: Dental Vision Life Disability Voluntary Benefits OUTCOMES Conduct Needs Analysis Enhance Employee Experience Prepare Vendor Comparison Ease Administrative Hassle Negotiate Prices Online Benefits Enrollment HRIS HR, Benefits, Payroll (stand alone or integrated) Improve ACA Compliance Manage Demos Simplify Open Enrollment Support Vendor Selection Accurate Eligibility and Carrier Feeds Oversee Implementation Decision Support Technology Time and Attendance Employee Self-Service (mobile and web)
Empowering HR and Organizations 45
Next Steps Group Level-Letter of Access - Advisor Appointment by each political subdivision – Gather your claims data from the carriers – Obtain all benefit programs (medical, dental, voluntary, etc) currently in place – Provide a summary analysis of findings and options – Develop a renewal time-line for each group Trust Level– Form Trust Board May 2020 – File Trust to State to cover scope of Medical, Dental and Vision services – Trust Program Benefits October 2020 and January 2021 – Confirmation of Groups to finalize Trust participation agreements we will contact groups individually – Launch Schools in October – NDIRF Groups in 2021
Jon Heath Benefit Consultant (801) 505-6506 Hays Companies of Utah jheath@hayscompanies.com Randall Johnson Senior Vice President Email: rjohnson@hayscompanies.com Direct: (801) 505-6481 Mobile: (801) 5058974 Fax: (801) 505-6501 Hays of Utah Insurance Services 201 South Main Street Suite 2100 Salt Lake City UT 84111 A Brown and Brown Company
Montpelier Public School New Rockford-Sheyenne North Border School Dist. North Sargent Oakes Public School Oliver Mercer Special Ed Rugby School District Rural Cass Special Education Unit Scranton Public Schools South East Ed Coop Thompson Public School Underwood Public School Wyndmere.
EU Tracker Questions (GB) Total Well Total Badly DK NET Start of Fieldwork End of Fieldwork 2020 15/12/2020 16/12/2020 40 51 9-11 08/12/2020 09/12/2020 41 47 12-6 02/12/2020 03/12/2020 27 57 15-30 26/11/2020 27/11/2020 28 59 13-31 17/11/2020 18/11/2020 28 60 12-32 11/11/2020 12/11/2020 28 59 12-31 4/11/2020 05/11/2020 30 56 13-26 28/10/2020 29/10/2020 29 60 11-31
April 3rd Raise the Flag for Autism SOM Assemblies April 6th and 20th Sundaes for Kids April 10th Carousel Players (1-4) April 13th Spirit Day – Patterns! April 14th Good Friday April 17th – Easter Monday April 18th HepB/HPV shots – Gr. 8 April 25-28th Scholastic Book Fair April 25th Gr. 3-6 to Wizard o
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1C Select appropriate presentation aids, materials and techniques 23 1D. Brief others involved in the presentation on their roles and responsibilities within the presentation 33 1E Select techniques to evaluate the effectiveness of the presentation 40 Summary47 Learning checkpoint 1: Prepare a presentation 48. Topic 2: Deliver a presentation 55
Adding a Digital Signature After completing this module, students will be able to: Share your presentation with a remote audience. Embed fonts in a presentation. Inspect the presentation. Package your presentation for a CD. Use PowerPoint Viewer. Save your presentation for web viewing. Encrypt your presentation.
Creating a new presentation AutoPilot Empty presentation creates a presentation from scratch. From template uses a template design already created as the base of a new presentation. Open existing presentation continues work on a previusly created presentation. OpenOffice.org After launching OpenOffice.org an AutoPilot Presentation window appears.
MUS Annual Enrollment - April 22, 2020 - May 15, 2020 Please Read Retiree Annual Enrollment Benefits Presentation Live, interactive webcast: Friday, April 17, 2020, 2:00 p.m. Access from the MUS Choices website Home page at www.choices.mus.edu On-Demand Benefits Presentation Available on April 22, 2020 at www.choices.mus.edu
Course Calendar. This is a tentative outline, and the instructor reserves the right to make changes as she deems necessary. Week Date (Mon – Sun) Activity 1 April 5 – April 11 April 11, Sunday: Lecture. 2 April 12 – April 18 3 April 19 – April 25 4 April 26 –
