Humongous Insurance 2011-2012 Benefit Plan Recommendations Kitty Poehler Executive Director of Personnel Services
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Humongous Insurance
2011-2012 Benefit Plan
Recommendations
Kitty PoehlerExecutive Director of
Personnel Services
Plan Performance• Two stop loss claims equal $300,000
• Core plan performing 13% above projections
• Basic plan performing 22% below projections
• Dental plan performing 16% below projections
• No recommended premium increases for 2011-2012
• Reduction in District contribution from $260 to $225
Required Changes for 2011-2012 as a result of Health Care
Reform Act• Remove dollar limits for Hospice Care, Sleep Studies, Diabetic
Supplies, and TMJ Treatment
• For Chiropractic Services remove $1,000 annual Limit and limit these services to 20 visits per year
• Remove $250 lifetime dollar limit for a wig after Chemotherapy and instead limit to one per lifetime
• Remove $1500 annual limit for prosthetics and make them subject to prior authorization for any amount over $1500
Increase in Employee Cost
• All participants will have a $35.00 per month increase as a result of the reduction in the District Contribution as part of Tier I budget cuts
• No other premium increases are recommended at this time for medical
• No premium increase for dental
• No premium increase for vision
Plan design change recommendations
• Core and Basic Plan retail drug premiums for brand name drugs increased from $25 to $35
• Core and Basic Plans mail order co-pays increase generic from $20 to $25
• Core and Basic Plans mail order co-pays increase brand from $70 to $75
• Core Plan In-Patient Hospital co-insurance decreased from 90% to 80%
• Core Plan Out-Patient Hospital co-insurance decreased from 80% to 70%
• Reduce the Alternate Plan Daily reimbursement from $500 to $50 per day.
• Core Plan add a $200 Emergency Room Co-pay along with 30% coinsurance before all other benefits are paid.
• Basic Plan add a $200 Emergency Room Co-pay along with 20% coinsurance before all other benefits are paid.
• Basic Plan Change the In Network Co-Insurance from 80% to 70% and Out Of Network from 60% to 50%.
How do we compare to TRS Active Care
Employee Cost
ActiveCare2 Northwest Core PlanIn Network In Network
DeductibleIndividual $ 750 N/AFamily $2,250 N/A
CoinsuranceIndividual $750 + 20% 30%Family $2,250 + 20% 30%
Out of Pocket MaxIndividual $2,000 $4,000
Family $6,000 $8,000
How do we compare to TRS Active Care
Employee Cost ActiveCare2 Northwest Core Plan
In Network In Network
Office Visit$25/35 30%
Emergency RoomIndividual $150 + $750 + 20% $200+ 30%Family $150+ $2,250 + 20% $200 + 30%
Hospital AdmissionIndividual $150+$750 + 20% 20%
Family $150+$2,250 +20% 20%
How do we compare to TRS ActiveCare 2 Prescription Costs?
Employee Prescription Drug CostActiveCare2 Northwest Core Plan In Network In Network
Deductible $100 $100
Retail 30-Day Generic $15 Greater of $5 or 30% Preferred Brand $35 Greater of $35 or
30%Non-Preferred $60 $125 (Specialty Drug)
Mail Order – 90 Day Generic $45 $25 Preferred Brand $105 $75Non-Preferred $180 N/ASpecialty Drug
Premium Costs
Active Care2 2011-2012 Plan
Employee Only $176.00 $153.00
Employee Child(ren) $432.00 $509.00
Employee/Spouse $729.00 $621.00
Employee/Family $827.00 $817.00
Where do we come in District Contribution to surrounding
Districts?District Plan Year Contribution Premium Increase
Garland ISD 2010-2011 $350.00 6% + Plan Changes
Lewisville ISD 2010-2011 $347.50 6% + Plan Changes
Carroll ISD 2010-2011 $290.00 6% + Plan Changes
Grapevine-Colleyville ISD
2011-2012 $285.00 20% + Plan Changes
Keller ISD 2011-2012 $275.00 5% + Plan Changes
Denton ISD 2010-2011 $259.00 5% + Plan Changes
Irving ISD 2010-2011 $265.00 6% + Plan Changes
Carrollton-Farmers Branch ISD
2010-2011 $262.00 6% + Plan Changes
Plano ISD 2010-2011 $259.00 6% + Plan Changes
Mesquite 2010-2011 $242.00 6% + Plan Changes
Northwest ISD 2011-2012 $225.00 $35.00 + Plan Changes
Birdville ISD 2010-2011 $225.00 6% + Plan Changes
HEB ISD 2010-2011 $225.00 6% + Plan Changes
Eagle Mountain Saginaw ISD
2010-2011 $225.00 6% + Plan Changes
District Rate Comparison
District Plan Plan Year
Employee Only Rate
Employee / Family Rate
NISD – Core Plan 30% Coinsurance 2011-2012 $153.00 $817.00
Birdville ISD$500 Deductible
ActiveCare 2 2011 - 2012 $209.00 $860.00
Carroll ISD$500 Deductible
ActiveCare 2 2011 - 2012 $144.00 $795.00
Carrollton-Farmers Branch ISD$500 Deductible
ActiveCare 2 2011 - 2012 $172.00 $823.00
Denton ISD $500 Deductible 2011 $158.40 $754.50
Eagle Mountain-Saginaw ISD$500 Deductible
ActiveCare 2 2011 - 2012 $209.00 $860.00
Irving ISD$500 Deductible
ActiveCare 2 2011 - 2012 $137.00 $788.00
HEB ISD$500 Deductible
ActiveCare 2 2011 - 2012 $209.00 $860.00
Keller ISD $625 Deductible 2011 $51.50 $674.65
Lewisville ISD$500 Deductible
ActiveCare 2 2011 - 2012 $86.50 $737.50
Plano ISD$500 Deductible
ActiveCare 2 2011 - 2012 $175.00 $826.00
District Rate ComparisonsOther Plans Offered by Other Districts: In Ascending Deductible Order
District Plan Plan YearEmployee Only
Rate
Employee / Family Rate
Denton ISD $1,000 Deductible 2011 $108.50 $629.50
Grapevine-Colleyville ISD $1,000 Deductible 2011 $155.00 $925.00
Northwest ISD $1,100 Deductible 2011 - 2012 $75.00 $580.00
Lewisville ISD$1,200 Deductible
ActiveCare 1 2011 - 2012 $0.00 $469.50
Carroll ISD$1,200 Deductible
ActiveCare 1 2011 - 2012 $35.00 $527.00
Carrollton-Farmers Branch ISD$1,200 Deductible
ActiveCare 1 2011 - 2012 $63.00 $555.00
Plano ISD$1,200 Deductible
ActiveCare 1 2011 - 2012 $66.00 $487.00
Birdville ISD$1,200 Deductible
ActiveCare 1 2011 - 2012 $100.00 $592.00
Eagle Mountain-Saginaw ISD$1,200 Deductible
ActiveCare 1 2011 - 2012 $100.00 $592.00
HEB ISD$1,200 Deductible
ActiveCare 1 2011 - 2012 $100.00 $592.00
Irving ISD$1,200 Deductible
ActiveCare 1 2011 - 2012 $28.00 $520.00
Grapevine-Colleyville ISD $1,750 Deductible 2011 $57.00 $555.00
Grapevine-Colleyville ISD $2,500 Deductible 2011 $0.00 $415.00
NISD Wellness Center
• Employees are currently scheduled for Personal Health Plan Assessments
• Working on developing hours of operation schedule
• Analyzing and determining prescription drugs for Center
• Construction is underway on the Wellness Center
NISD Wellness Center
Strategic Goals II: Northwest ISD will recruit, develop, retain, and recognize an exceptional, highly motivated staff to optimize student engagement and learning
Strategic Goal IV: Northwest ISD will provide premier facilities and support systems that enhance a positive learning environment and foster student and community pride.
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