Open Enrollment/Benefits Update Session Highlights
Health Plan and Affordable Care Act (ACA) Updates
For those who weren’t able to attend the Open Enrollment/Benefits Update sessions, here are the key highlights of the meetings:
- We did not cover health plan costs in FY 2011 and FY 2012
- Switch to Health America allowed us to cover our costs in FY 2013
- Through 4 months of FY 2014, claims are up 39.5% per employee per month since same time last year, and we have paid out $1.2 million in claims
- In the 12 month timeframe from October 2012 through September 2013, claims over $10,000 are making up 31% of plan expenditures (up from 17% in previous year)
- Prescription drug spend is currently $143.98 PEPM which is up from $132.16 last year at this time, and about 79% of our pharmacy claims have been filled with a generic drug
- Average membership is running around 700 (an increase of about 22 since last year) covered lives and the average age under the plan remains at 37.
- Percentage of Claims Dollars at Participating Providers is 96.2%
- The top utilized facility is J.C. Blair – Health America does have contracts with both Pinnacle Health and UPMC
Affordable Care Act:
- Juniata continues to Maintain Grandfathered status, however, the exclusion for other employer coverage will be removed as of January 2014. All Dependents up to age 26 can be covered without regard to availability of other coverage.
- Employer Mandate Delayed – Large employers (over 50) requirement to provide minimum essential coverage to 95% of full time employees (those working over 30 hours per week). Coverage must meet minimum value and affordability standards which Juniata’s plan does. Basically this delays the paying of a penalty for not providing the coverage until 2015.
- The delay doesn’t eliminate other requirements, however. All employers were required to provide Health Insurance Marketplace Notices by 10/1. Juniata provided these via email and our website during the month of September.
- Juniata is required to provide updated Summary of Benefits and Coverage (SBC) forms which describe key features of the plan at every open enrollment. These forms are available below.
- The Employer Mandate delay also doesn’t apply to the two new taxes employers have to pay if they offer a health plan.
- PCORI Fee – Patient Centered Outcomes Research Institute Fee -$1 Per Member Per Year 2012 ($630) increases to $2 for 2013, and will be indexed each year thereafter
- Transitional Reinsurance Fee - This fee is designed to fund reinsurance payments to health insurance issuers that cover high-risk individuals in the individual market. The transitional reinsurance payments are intended to stabilize insurance premiums in the individual market during 2014, 2015, and 2016 as consumers and insurers become more comfortable with the state health insurance exchanges. Plan sponsors and insurers are required to report their enrollment counts by November 15 of each year (2014, 2015, and 2016). HHS then will provide a notice of fee liability by December 15, and the plan sponsor or insurer will have 30 days to remit the transitional reinsurance fee to HHS. As of November, we were estimating about $46,675 due for 2015 at a headcount of 725.
To summarize, Juniata has not increased health plan premiums since January 2011. Rates will not change in January 2013, but we will be closely watching our claims costs over the next few months. It’s likely that there will be a rate increase in June 2014, due to additional costs mandated by the Affordable Care Act.