LTC 391-2013 2014 Premium Costs for the City of Miami Beach Self-Insured Medical Plan for Active Employees and Retirees MIAMI
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OFFICE OF THE CITY MANAGER
NO. LTC # 311-a013
LETTER TO C0MWWW 11 ' 12
Cli' OFF ICE_
TO: Mayor Matti Herrera. Bower and tubers of th City Commission.
FROM: Jimmy Morales, City Manager
DATE: October 25, 2013
SUBJECT: 2014 Premium Costs for the Ci of Miami Beach Self - Insured Medical Plan
for Active Employees and Retir es
The purpose of this Letter to Commission (LTC) is to provide an update on projected health
insurance premiums effective January 1, 2014, as requested by the Finance and Citywide
Projects Committee (FCWPC).
BACKGROUND
On August 29, 2012, the Committee of the Whole as part of the Mayor and City Commission's
proposed budget for FY 2012/13, discussed the premiums paid by the City and its enrolled
- active employees and retirees for health care insurance. Subsequently, on October 9, 2012, the
Administration provided members of the City Commission supplemental information via LTC
#259 -2012 regarding the City's self- funded healthcare plans' experience from inception in 2009
through August 2012. The information for each individual plan and enrollment group included:
medical plan enrollment by active employees, pre -age 65 and post -age 65 retirees; total
monthly medical plan premiums; total claims paid; medical plans' fixed costs; total medical plan
expenses and the loss ratio (the percentage of claims paid and plan costs for the premium
collected). As part of the discussion, staff was requested to evaluate a premium rebate for
plans where premiums were in excess of actual experience costs.
In LTC #309 -2012, dated November 28, 2012, the Administration reported on the potential
impacts that a premium rebate could have on the City's group health plans. The City's benefits
consultant, Gallagher Benefit Services (Gallagher) advised against such a rebate primarily for
two reasons: (1) enrollment in the City's self- funded plan is too small to be statistically sound,
with few participants and high claims expenses leading to fluctuating loss ratios; and (2) such a
premium rebate could violate Federal laws, such as the Americans with Disabilities Act, as the
City could be perceived as penalizing employees who need medical care and rewarding those
who do not.
fi
The Administration reported in LTC #069 -2013, dated February 28, 2013, on the anticipated
impact of the Patient Protection and Affordable Care Act ( PPACA) on the City's medical
insurance plans. To date, the PPACA has: (1) removed lifetime dollar limits from all plans:; (2)
increased the dependent child coverage age to 26; (3) eliminated pre- existing conditions as a
reason to deny coverage to dependent children to age 19; (4) provided for in- network preventive
care coverage at no cost; (5) required form W -2 reporting of the employer's share of the health
care insurance premium costs; (6) provided for simple language benefit summaries; (7)
decreased medical flexible spending account maximums; (8) imposed the comparative
We are committed to providing excellent public service and safety to all who live, work, and play in our vibrant, tropical, historic community.
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LTC - 2014 Premium Costs for the City of Miami Beach Self- Insured Medical Plan for Active Employees
and Retirees
Page 2
October 25, 2013
effectiveness fee, effective July 31, 2013, which requires employers to pay $1.00 per covered
individual based on the average number of covered individuals in the previous plan year; and
(9) required employers to provide employees with information regarding the insurance
exchanges, which the City provided on September 27, 2013.
The Committee of the Whole referred the matter to the Budget Advisory Committee (BAC) for
their review and recommendations regarding efficiencies and cost savings.
BUDGET ADVISORY COMMITTEE (BAC) RECOMMENDATIONS
The Administration and Gallagher provided the BAC with alternatives to the City's current
medical insurance plan options. The Committee reviewed the cost components of the medical
insurance plans to ascertain where they could be reduced, and identified cost saving options
such as changes in plans' benefits coverage to reallocate cost sharing between the City and
enrollees; compared the City's medical plans to other employers (both in private and public
sectors) to search for plan efficiencies; and reviewed the self- funded plan experience of other
employers based on their individual filings with the State.
In summary, the BAC recommended:
• The City's group health plan should remain self- funded;
• The City's three premium plans, (Premium HMO, Premium PPO and POS) should be
eliminated;
• The Standard HMO and Standard PPO should be replaced with HMO and PPO plans
recommended by Gallagher. These plans would increase the employees' out -of- pocket
expenses and, therefore, result in lower claims costs;
• Prescription coverage should be removed from the Humana plan and provided by a
separate prescription benefit manager;
• Offering a high deductible health care plan and a Medicare advantage plan for post -65
retirees; and
• Change the City's calendar plan year to a fiscal plan year.
FINANCE AND CITYWIDE PROJECTS COMMITTEE ( FCWPC) RECOMMENDATIONS)
This information was presented to the members of the FCWPC during_ the July 8, 2013,
meeting. During the discussion, members expressed concerns over the BAC's
recommendations. Although these recommendations would result in cost savings to the City,
they would also result in reductions in benefits and increased out -of- pocket costs for employees
and retirees, as they added new first dollar deductibles and increased copayments and premium
costs.
As noted in the July 8, 2013, FCWPC memorandum, the City's current plans were projected to
incur at least a 10 percent, or $1.7 million, cost increase in FY 2013/14 assuming the plan
increase was implemented October 1, 2013. If the BAC recommendations were implemented,
the City's medical plan costs would have decreased by 4.3 percent, or $2.4 million, as shown in
the table below:
LTC -. 2014 Premium Costs for the City of Miami Beach Self- Insured Medical Plan for Active Employees
and Retirees
Page 3
October 25, 2013
Fiscal Year 2014 Projections
Current Plan BAC Cost/
Self- funded Design Recommended
(No Changes) Changes
(Savings)
Projected Medical Claims' $12,496,696 $10,777,714 ($1,718;982)
Projected Pharmacy $4,230,904 $3,368,614
Claims ($862,290)
Administration /Disease
Mana ement3 $714,454 $894,885 $180,431
Re- insurance — Specific ($973
and Aggreg ate 4 $1,099,065 $1,098,092 )
Total Estimated Self- $18,541,393 $16,139,305
Funded Expense ($2,402,088)
Current Funding $16,858,099 $16,858,099 0
Funding $ $1,683,294 ($718,794) ($2,402,088)
Increase /Decrease
Funding % 10.0% -4.3% -14.3%
Increase /Decrease
1 Gallagher's claims projections based on proprietary discount tables and adjusted for the proposed plan designs.
2 Prescription Corporation of America identified as the pharmacy benefit administrator under the proposal under a transparent pass through
arrangement of all pharmacy rebates and ingredient cost savings.
3 Humana continues to be the benefit plan administrator but no rebate to offset, producing a slightly higher administrative fee.
4 Symetra continues to provide reinsurance coverage.
In addition to the BAC's recommended plan changes, members of the FCWPC discussed the
disparities in the cost sharing among the City's three premium plans, HMO, PPO and POS, in -
which the City pays 50 percent of the premium cost for both employee only and family
coverage, and the Standard HMO and Standard PPO plans, in which the City pays 75 percent
of the premium for employee only coverage and 60 percent of the premium for family coverage.
There was also concern that the premium plans have higher premiums cost and annual rate
increases than the standard plans, when the loss ratios (the percentage of plan costs to
premiums collected) are lower than the loss ratios for the standard plans. It was noted during
the discussion however, that the claims cost for the premium plans is higher as a consequence
of better plan coverage which results in lower employee out -of- pocket expenses.
At the end of the discussion, there was agreement that the BAC recommendations did provide
cost savings to the City but,that reductions in coverage provided by those changes resulted in
greater out -of- pocket expenses for employees. In summary, employees would spend more for
fewer choices and lower benefits.
The Committee's perspective was that historically public employees are provided better group
health insurance benefits than those in the private sector to offset differences in wages and
other benefits. This discussion resulted in the recommendation to continue with the City's
current group health options.
The Administration was further directed to explore ways to share the plans' premium costs more
equitably among employees. Currently, the City subsidizes the highest dollar value for the
Premium PPO plan. Further, while a lower subsidy, the Standard PPO is also significantly
LTC - 2014 Premium Costs for the City of Miami Beach Self- Insured Medical Plan for Active Employees
and Retirees -
Page 4
October 25, 2013
higher than the Standard HMO, Premium HMO and POS plans.
ANALYSIS
3
A comparison of the current monthly premiums reflecting the employees' monthly premium, the
City subsidy and the total plan premium is provided in the table below:
2013 Monthly Health Plan Premium Cost Share
Employee Only Covera a Family Coverage
Plan Employee City Monthly Employee City Monthly
Cost Subsidy Premium Cost Subsidy Premium
Standard $134.72 $329.84 $464.56 $472.26 $679.60 $1,151.86
HMO
Standard
PPO $261.70 $640.72 $902.42 $908.00 $1,306.64 $2,214.64
Premium $381.74 $381.74 $763.48 $946.40 $946.40 $1,892.80
HMO
Premium $763.90 $763.90 $1,527.80 $1,874.46 $1,874.46 $3,748.92
PPO
POS $425.06 $425.06 $850.12 $1,054.86 $1,054.86 $2,109.72
The standard plans were added to -the City's medical plan offerings in 1991 in an effort to
reduce the City's skyrocketing health care costs. To encourage enrollment in these plans,
which have higher out -of- pocket expenses, the City's premium subsidy was raised.
At the September 11, 2013, City Commission meeting, the City Commission accepted the
recommendations from the FCWPC, with the exception that the change aligning the plan year
with the City's fiscal year would be effective October 1, 2014. As a result, due to the timing
difference and the delay in the premium increase from October 1, 2013 to January 1, 2014, the
premium increase effective January 1, 2014 is 12.5 percent instead of the anticipated 10
percent.
Following direction from the City Commission, the Administration worked with Gallagher to
create two premium scenarios in addition to the base scenario, which reflects the method of
increase previously used by the City. Each scenario is based on an increase of 12.5 percent for
the plan year, which begins January 1, 2014. The scenarios are as follow:
1. Base Scenario is centered on a 12.5 percent across the board increase to the 2013
rates, for both the City and employee contributions. The current City subsidy levels are
maintained for each of the five plans.
2. Scenario 1 provides for a flat dollar equivalent City subsidy for each of the plans for
active employees ($423.70 for employee only and approximately $1,016.88 for family
coverage). Individual plan increases for the combined City and employee premiums are
based on the plan's loss ratio (claim costs versus premiums collected). While this
reflects the approach recommended by the FCWPC, it is in conflict with the City's
collective bargaining agreements. The City's subsidy for retirees decreases from 50
percent to a range of 30 to 40 percent.
r
LTC - 2014 Premium Costs for the City of Miami Beach Self- Insured Medical Plan for Active Employees
-and Retirees
Page 5
October 25, 2013
3. Scenario 2 is based on active employee contributions that are 50 percent or less of the
total premium. Individual plan increases for the combined City and employee premiums
are based on the plan's loss ratio (claim costs versus premiums collected).
Scenarios 1 and 2 reflect changes to the City's premium subsidy for both active employees and
retirees.
Base Scenario
In this scenario, the City's subsidy percentage is maintained at current levels, continuing a
subsidy program that remains disproportionately higher for the PPO plans than the HMO plans.
Therefore, this scenario does not meet the FCWPC and City Commission's direction to rate by
plan experience and provide a City dollar subsidy that is uniform across all plans, as plan loss
ratios are not considered in determining the annual premium increases incurred by each
individual plan.
Under this base scenario, the calendar year 2014 monthly rate charged to active employees
(and the City) for the Standard HMO plan increases by $16.84, the lowest of all the plans. The
most significant increase occurs in the employee cost and City subsidy for the Premium PPO
plan which goes up by $234.31 per month.
Scenario 1
_This scenario is based on the direction received from the FCWPC and the City Commission,
whereby the premiums are experience rated, meaning plan loss ratios were considered. Those
plans with low loss ratios incurred lower premium increases and the inverse was also true.
Premiums for active employees were set to represent a flat dollar City subsidy equivalent, such
that, the dollar value of the City's portion is similar for all plans; approximately $400 for
employee only coverage and $1,000 for family coverage. , Compared to the Base Scenario,
under Scenario 1 the City's cost remains constant for all plans and coverage levels resulting in a
savings to the City while shifting more of the plan premium costs to the employee.
Under Scenario 1 the monthly premiums paid by active employees for the Premium PPO family
coverage decreases by $230.30 when compared to the 2013 rates, and when compared to the
Base Scenario, the employee cost decreases by $464.61. This decrease in cost to the
employee can be attributed to the use of experience rated premiums.
The highest monthly active employee increase in 2014 is for the Premium HMO family coverage
where the monthly premium goes from the current $946.40 to $1,795.30. Compared to the
Base Scenario, under Scenario 1 the employee's cost increases by $730.60. This increase in
cost to the employee is attributed to both the flat City's subsidy and the use of experience rated
premiums.
Under this Scenario, the City's subsidy toward retiree premiums also changes. Currently, the
City provides a subsidy of 50 percent of the total premium costs across all plans and coverage
levels. Scenario 1 decreases the City's subsidy to 40 percent to 30 percent.
Monthly premium rates charged to retirees range from a decrease of $172.56 for the Premium
PPO family coverage from the current monthly cost of $1,164.21 to $991.65. The highest
LTC - 2014 Premium Costs for the City of Miami Beach Self- Insured Medical Plan for Active Employees
and Retirees
Page 6 .
October 25, 2013
increase occurs in the Premium HMO family coverage where the monthly premium increases
$740.91 from the current $946.40 to $1,687.31. When comparing the costs of Scenario 1 to the
Base Scenario, the retiree cost for the Premium PPO family coverage decreases $318.09 and
Premium HMO cost increases $662.61. These changes in costs are directly attributable to the
use of experience rated premiums and the City's change in plan subsidy.
This scenario results in large increases for the Premium HMO and employee contributions that
exceed 50 percent for all plans with the exception of the Standard HMO with employee
contributions at 25 percent. The retiree contributions are also high for all plans with a 70 percent
premium increase in the Premium PPO for pre -65 retirees. Although the employee costs under
the Base Scenario increase across all plans, the increases still occur under Scenario 1 due to
the reduction in the City subsidy.
While apparently more equitable due to each employee receiving the same subsidy level, this
scenario is provided for information purposes only as such a scenario would violate the
collective bargaining agreements among the City, the American Federation of State, County and
Municipal Employees (AFSCME), Government Supervisors Association of Florida (GSAF) and
Communication Workers of America (CWA), all of which require the City to pay at least 50
percent of the premium cost for eligible employees. Should the City elect to pursue the lower
percentage subsidies provided by this scenario, the City would be required to bargain with each
collective bargaining unit.
Scenario 2
This scenario is also based on the direction received from the FCWPC and the City
Commission, whereby the premiums are experience rated and those plans with low loss ratios
incurred lower premium increases and those plans with high loss ratios incurred higher premium
increases.
The City subsidy for active employees ranges from a high of 77 percent for the Standard HMO
employee only coverage to 50 percent for the Premium PPO, Premium HMO and POS plans,
while providing a retiree premium subsidy ranging from 30 percent to 50 percent. Under the
Base Scenario, the City subsidy is set at 50 percent for all plans with the exception of the two
plans that provide lower coverage levels, the Standard HMO and Standard PPO plan, with City
subsidies of 75 percent for employee and 60 percent for family coverage.
It should be noted that the City has already adopted a change to reduce subsidies for future
retirees. Employees hired after 2006, earn a healthcare premium subsidy of $10 or $25 per
month, per year worked, based on whether they are covered by the general or the police and
fire pension plan. - For example, a general employee hired after 2006 who worked for 30 years
prior to retiring, would earn a $300 per month subsidy toward his or her health care insurance
premium. The policy decision made in 2006 will eventually move the City toward a point where
all retirees get a stipend based on their years of service rather than a percentage of the
premium. The subsidy for retirees originally hired before 2006 is significantly more generous.
The retiree subsidies proposed for pre -2006 employees as of January 1, 2014, remain
significantly more generous than for post -2006 employees.
Under this scenario there is a decrease of $543.94 in the monthly rates charged to active
employees for family coverage in the Premium PPO plan. Active employees with family
coverage in the POS plan will incur a monthly premium increase of $376.87. When we review
these costs increases against the Base Scenario, family coverage under the Premium PPO plan
decreases $778.25 with family coverage under the POS plan increasing $245.01. This change
LTC - 2014 Premium Costs for the City of Miami Beach Self- Insured Medical Plan for Active Employees
and Retirees
Page 7
October 25, 2013 i
in cost is directly related to using experience rated premiums as the Premium PPO had a very i
low claims to premium collected cost and the POS had a high claims to premium cost.
Retirees enrolled in the Premium PPO retiree and family coverage will see a reduction in their
monthly premium of $11.73. Retirees enrolled in the Premium HMO retiree and family coverage
will see the most significant change in their monthly premiums with an increase of $740.91, from
the current monthly premium of $946.40 to $1,687.31. When we compare this Scenario to the
Base Scenario, the saving are greater for the Premium PPO $246.04 due to the use of
experience rated premiums even though the City is only providing a 30 percent subsidy for the
plan. While the increase for the Premium HMO when compared to the Base Scenario is a bit
lower at $622.61, the cost impact to the retiree is significant. The least expensive plan, and the
one with the most active employee enrollment, the Standard HMO, is provided a subsidy of 77
percent for employee coverage and 67 percent for family coverage to encourage employees to
participate in a health care plan. With this increased subsidy, the monthly employee premium
cost is reduced from the current $134.72 to $129.64 for employee only coverage and from
$472.26 to $467.09 for family coverage. When compared to the Base Scenario, the employee
sees a savings of $21.92 for employee only coverage and $64.20 for family coverage due to a
greater City subsidy of 75 percent and 60 percent respectively.
This scenario also provides a reduction in monthly premium costs to active employees in the
Premium PPO plan. Active employee with employee only coverage will see a reduction in their
current monthly premium of $763.90 to $542.23, a reduction of $221.67. Similarly, active
employees enrolled in the family coverage will see a reduction of $543.94 from the current
monthly premium of $1,874.46 to $1,330.52. These savings are also seen when comparing the
scenario against the Base Scenario in which there is a savings of $317.16 for employee only
coverage and $778.25 for family coverage, which is directly related to the use of experience
rated premiums.
Additionally, as required by the PPACA, effective January 1, 2014, employees who are provided
group health coverage through their employers, and who do not qualify for health care coverage
through the federal Marketplace, must enroll in a health care plan or incur a tax penalty. Due to
its low employee only cost, participating in the Standard HMO plan will assist employees in
meeting this requirement.
Of the three premium scenarios, this scenario meets all the FCWPC and City Commission
recommendations: providing premiums based on the actual cost of the individual plan, not
based on an average cost of all plans; maintains affordable premiums through the Standard
HMO plan and shares the premium costs of the plan more equitably among all plans.
NEXT STEPS
The Administration is working to provide active employees and all retirees with an annual open
enrollment period beginning November 4, 2013 and ending November 14, 2013. During this
annual open enrollment period, staff provides employees and retirees with information regarding
the City's benefit programs, and the opportunity to make any changes to their coverage.
Changes made by employees and retirees during the open enrollment, period take effect
January 1, 2014.
Prior to the enrollment period, the Administration will begin the annual enrollment process
including drafting communication materials and providing notification to all employees and
retirees regarding any changes to monthly premiums. The anticipated timeline is provided
below.
LTC - 2014 Premium Costs for the City of Miami Beach Self - insured Medical Plan for Active Employees
and Retirees
Page 8
October 25, 2013
Week Task
1 Draft enrollment materials incorporating new premium rates;
October 14 - 18 managerial review.
2 Forward enrollment materials to Central Services for printing and
October 21 st - 25 binding; collate and label enrollment packages.
3
October 28 - Distribute enrollment packages: (1) active employees, through
November 1St department payroll coordinators; (2) retirees, via U.S. mail.
4 and 5 HR Benefits Division staff meets with employees and retirees to
November 4 th - 14 discuss options and gather completed enrollment materials.
Review enrollment requests for accuracy, follow -up with enrollees if
there is information missing; enter enrollment information in Eden
6 and 12 Payroll System to reflect the appropriate payroll premium for the
November 16 - coverage elected; manually enroll employees and .retirees via web
December 27 access to each carrier for plan identification cards to be distributed
prior to January 1, 2014; test payroll to ensure plan contributions
are employee enrollments are correctly loaded.
CONCLUSION
The Administration has worked closely with Gallagher to incorporate direction from both the
FCWPC and City Commission to continue to provide employees and retirees with group health
insurance coverage consistent with current options and to share the different premium costs.
more equitably.
Of the three premium scenarios presented, Scenario 2 best meets the directive of the FCWPC
and the City Commission, by continuing to provide the City's current group health care plan
options; considering each plan's loss ratio by increasing premiums based on the cost of claims
and continuing a City subsidy where employees pay 50 percent or less of the premium for any
plan. As a result, these premium changes will be incorporated in the 2014 open enrollment
period scheduled to begin in a few weeks.
Staff is available to meet with you one -on -one to address any questions or concerns that you
may have regarding any of the premium scenarios and /or the City's group health plan. Please
contact Kathie Brooks, Assistant City Manager, at extension 6249 to arrange a time that is
convenient for you.
JLM/ B /SC -T /CMG
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