Metropolitan Healthcare and the GIC .


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Municipal Healthcare and the GIC. Andrew Powell Analyst/Consultant Boston Benefit Partners, LLC Bridgewater-Raynham Education Association October 5, 2010.  177 Milk Street • Suite 310 • Boston, MA 02109 • tel 617.570.9100 • www.bosben.com. Healthcare Costs.
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City Healthcare and the GIC Andrew Powell Analyst/Consultant Boston Benefit Partners, LLC Bridgewater-Raynham Education Association October 5, 2010  177 Milk Street • Suite 310 • Boston, MA 02109 • tel 617.570.9100 • www.bosben.com

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Healthcare Costs Steadily ascending over the previous decade + Massachusetts has a portion of the most elevated expenses in the country Best access to care Aging populace Robust Bio-tech industry that drives innovation Teaching Hospitals National Healthcare Reform Reforms medical coverage with get to and orders Does not address cost issue

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Budgets versus Medicinal services Costs Leaner spending plans are crushing everybody Reduced neighborhood help Less incomes with awful economy No genuine cost-lessening procedures Unions are gotten in the center Pressure to roll out improvements Protracted arrangements over compensation and advantages Has turned into a political combat zone Boston Globe Mass. Citizens Foundation Boston Municipal Research Bureau

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Controlling Costs – Limited Tools Plan Design Tools – prompt impact Coinsurance Deductibles Co-pays Premium commitment rates Non-arrange Design Tools – long haul affect Workforce health Tiered or particular systems

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Plan Design - Copays Traditional office visit copays expanding - $5 copays vanishing and $20 or $25 [or higher] copays are regular Separate, higher copays for pro office visits Higher copays for 3 rd level medications and new fourth level medication copays New in-patient and out-patient administration copays New MRI/CAT check strategy copays

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Insurance Product Innovations Driven by boss cost concerns Leaner spending plans, diminished neighborhood help weight to lessen premium pattern Move to the GIC … or make an arrangement with comparable advantage outline? GIC arrange outline choices Municipal Blue items from Blue Cross High deductible and layered system items from Harvard Pilgrim or Tufts

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Sample BCBS Plan Blue Options Plan = Tiered Networks Tiered Copays for PCP Tier 1 - $15 Tier 2 - $25 Tier 3 - $45 Specialists - $45 $100 Emergency Room Copay High End Imaging/MRI, CAT, PET Scans

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Sample BCBS Plan Blue Options Plan = Tiered Networks Tiered Hospital Copays/Admission Tier 1 "Upgraded" $250 Tier 2 "Standard" $500 Tier 3 "Essential" $1,000 Prescription Drugs Retail - $15/$30/$50 Mail Order - $30/$60/$100

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Sample BCBS Plan Blue Value Plan = Higher Copays $20 PCP and Specialist Copay $75 Emergency Room Copay $50 High End Imaging/MRI, CAT, PET Scans $500 Inpatient Hospital Copay $250 Outpatient Copay Prescription Drugs Retail - $15/$30/$50 Mail Order - $30/$60/$100

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Be Afraid… Be Very Afraid on the off chance that… You are offered an arrangement that uses the accompanying words: Value arrange Rate Saver arrange Best Buy arrange These arrangements are useful for administration; not really useful for workers

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What is the Group Insurance Commission (GIC) Established in 1955 by State Legislature Purchases Health Insurance for more than 350,000 state and civil representatives, retirees, and wards Quasi-Independent State Agency Governed by 15 Commissioners Appointed by the Governor 4 Labor seats, 1 Retiree, 10 Industry, Management July 2007 – MGL 32B, Section 19 Amended to permit Municipalities into the GIC

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Why is GIC so Attractive to Municipal Management? Premium costs have a tendency to be lower More arrangement decisions No haggling over arrangement outline, unions lose capacity to arrange Reduces school locale\'s managerial weight Media and a few lawmakers have called the GIC a "panacea to costs"

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GIC Health Insurance Plans GIC Plan Options Active Employees & Non-Medicare Eligible Retirees Regional HMOs (11.5% in view of 2009 enlistment) Fallon, Health New England, Neighborhood Health Plan Statewide, Limited Network HMOs (New starting 7/1/2010 Tufts Spirit and HPHC Primary Choice PPO Plans (55% in light of 2009 enlistment) Tufts, HPHC, Unicare Plus & Choice Indemnity (21.5% in view of 2009 enlistment) Unicare Basic with CIC * 80% of metropolitan supporters of date have chosen a GIC PPO arrange

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GIC Health Insurance Plans GIC Plan Options Active Employees & Non-Medicare Eligible Retirees Choose from: 4 Statewide PPO Plans 2 Statewide, constrained system HMO Plans (new choice) 4 Regional HMO Plans 1 Indemnity Plan Medicare-Eligible Retirees: Retirees must join Medicare if age 65 and Eligible for Medicare (Self or Spouse) Choose from 6 Medicare Supplemental Plans

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GIC Retiree Health Insurance Plans GIC Plan Options Medicare Supplement Plans HPHC Medicare Enhance Tufts Medicare Complement Tufts Medicare Preferred Fallon Senior (Worcester Area) Health New England MedPlus (Western MA) Unicare Indemnity Medicare Extension OME w/CIC (90% of current enlistment )

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GIC Plan Types INDEMNITY No systems essential National scope without any referrals Best suited for outside of New England retirees and occupants

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GIC Plan Types PPO No PCP referrals vital Regional systems of doctors restricted to New England Provides an out-of-system advantage

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GIC Plan Types HMO Requires utilization of a Primary Care Physician Referrals vital for claim to fame mind Coverage just accessible inside HMO\'s system Tufts Spirit arrange does not require a PCP referral

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Sample Plan - PPO

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Sample Plan – Limited Network HMO

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Sample Plan – Regional HMO

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GIC – Eligibility Rules Municipal Employees May Not Participate in GIC Dental, Vision, Life or LTD programs. Lawrence will keep on offering Altus Dental arrangement Each Member Must Provide Birth and Marriage Certificates for Dependent Coverage New Hires are Eligible First of the Month following 60 Days Retirees over Age 65 on Medicare with Younger Dependents have Special Enrollment Rules

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GIC – Eligibility Rules Medicare Eligible Retirees If 65 and Medicare Eligible Retiree Enrolls in Medicare Supplement Plan If Retiree has Spouse and 1 Dependent under 65, they select in two single GIC arrangements (Example with Tufts/HPHC) If Retiree has Spouse and at least 2 Dependents under 65, they enlist in Family GIC arrange (Example with Tufts/HPHC)

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The GIC Option Advantages Disadvantages Lower premiums Higher out-of-pocket costs Moderate premium increases Lose right to arrange co-pays *Retiree Protection No Blue Cross items No GIC Life, Vision or Dental * Why do retirees obtain insurance under the GIC? . . .

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Section 19, Coalition Bargaining What is Section 19 Coalition Bargaining?

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Section 19 Coalition Bargaining The Law: Mass General Laws Chapter 32B Section 19 Allows a city/town (or local school region) to consult with the majority of the town (or area) unions at one dealing table over the issue of medical coverage. Segment 19 corrected in July, 2007 Allows urban communities and towns to select into the GIC Pool 1 rates through Section 19 coalition dealing. Takes into account impasse determination method.

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Section 19 Coalition Bargaining The Process: How does a region get into the GIC? Neighborhood overseeing body (Selectmen, City Council, Regional School Committee) votes to receive Section 19 of MGL ch.32B. Acknowledgment might be dependent upon inevitable passage into GIC. City delegates meet with the Public Employee Committee to arrange a Section 19/PEC Agreement. Either gathering may constrain other gathering to meet with 30 days take note. Bridgewater-Raynham is as of now Section 19

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Section 19 Coalition Bargaining The Process: (cont.) Negotiations concentrate on: Premium % commitment split Medicare Part B % commitment Impasse determination method Duration – must join for three or six years (GIC just) The Agreement must be concluded before December 1, 2010 keeping in mind the end goal to get into the GIC for July 1, 2011! No assention can occur unless acknowledged by the neighborhood representing body and 70% of the union coalition weighted vote.

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Section 19 Coalition Bargaining The Public Employee Committee (PEC) PEC incorporates reps from every aggregate bartering unit and a retiree assigned by the Retired State, County and Municipal Employee Association (RSCMEA). Retirees have 10% vote. Staying 90% vote is weighted, in view of number of workers qualified for medical coverage.

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Municipal Insurance Legislation Last year we were told - There will be changes. Senator needs change. Senate Leadership needs change. House Leadership needs change. City pioneers need change. Cost of Active and Retiree Insurance are overpowering metropolitan spending plans. The economy is not showing signs of improvement .

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Municipal Insurance Legislation Two ideas in play Senate/Special Commission on Municipal Relief House/Massachusetts Municipal Association

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Municipal Insurance Legislation Senate/Special Commission GIC decides its normal cost per supporter of medical coverage. Civil business figures its normal cost per supporter. In the event that city cost is not exactly or equivalent to GIC –no activity required. Compulsory Medicare (Special Comm.)

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Municipal Insurance Legislation Senate/Special Commission (cont.) If civil cost surpasses GIC by xx%, triggers procedure to deal changes Section 19 assembles All unions (PEC) in one process with metropolitan manager Unions utilize weighted voting – 70% standard Retirees have 10% vote – get security

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Municipal Insurance Legislation Senate/Special Commission Parties can Agree to go into GIC (medical coverage just) Agree to arrange for that meets GIC cost benchmark Go to assertion Some punishments may apply If city boss does not meet GIC cost If concurrence on protection not meet benchmark Penalty – misfortune in neighborhood help

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Municipal Insurance Legislation MMA Municipal business conceded one-sided right to modify arrange plan. Confines on out of pocke

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