Redlands Unified Insurance CommitteeHealth and Welfare Benefits Plan

April 2012

Insurance Committee Members

Maria ClarkChuck MendozaDeborah Severo

Mike Kress

Jolene TrippMiguel Ruiz

Celiza Hernandez

Ed Sibby

Sabine Robertson-

Phillips

Brad MasonBrian

GuggisbergFelicia Robinson

Kate PearneCurtis Marcell

Janet Jungnickel

Insurance Committee Timeline

September-OctoberCommittee reviewedloss ratio reports of current providers, health care reform updates, IRC 125, and health fair.

November-DecemberCommittee provided Keenan a list of providers for requests for proposals.

JanuaryCommittee listened to presentation from Rx and reviewed loss ratio reports.

FebruaryCommittee received results of proposals from selected carriers and provided direction to Keenan.

March- 1st MeetingCommittee listened to presentations from selected providers.

March- 2nd MeetingCommittee continued to listen to presentations from selected providers.

Insurance Committee Timeline

March- 3rd MeetingCommittee participated in a prioritization activity and reviewed rates submitted from selected providers. Committee discussed rates and gave direction to Keenan to negotiate lower rates based on decrement adjustments.

April- 1st MeetingCommittee reviewed new rates and gave Keenan further direction to request different decrements within the presented plans. Committee also reviewed final rates of Rx and Mental Health plans.

Insurance Committee Timeline

April- 2nd MeetingCommittee met to finalize recommendations for Benefits plan for the 2012-13 school year.

FINAL PLAN PRESENTATIONS TO RUSD EMPLOYEES

Request for Proposals (RFP)

Selected Carriers from RFP Process

Aetna

Kaiser

Mental Health Network

Express Scripts (Rx)

Plan Rates – Aetna

   

Aetna

Tier 1  

Aetna

Tier 2  

Aetna

PPO  

  $20 Copay $30 Copay$20 Copay,

80/60Medical $7,990.20 $12,258.00 $12,476.52 KPPC Pharmacy $1,925.64 $1,925.64 $1,925.64 Behavioral Health (MHN)   $591.84   $591.84 $591.84 Delta Dental $1,522.08 $1,522.08 $1,522.08 Medical Eye Services   $150.00 $150.00 $150.00 Prudential $156.00 $156.00 $156.00                       

Total Health &Welfare Premium Cost   $12,335.76   $16,603.56   $16,822.08  

               

Maximum District Contribution   $10,640.64   $10,640.64   $10,640.64  

               

Employee Pay Annually   $1,695.12   $5,962.92   $6,181.44  

           

Employee Pay - 10thly   $169.51   $596.29   $618.14  

Aetna Tier 1 Information

• Providers included are Beaver Medical Group, Redlands Yucaipa Medical Group, Pinnacle Medical Group

• Epic Management still offering $20.00 co-pay for office visits and Urgent Care

• Aetna plan design comparable to current health plan through Anthem Blue Cross

Aetna Tier 2 Information

• Changes to Tier 2 are:– Redlands Yucaipa Medical Group and

Pinnacle Medical Group are now in the Tier 1 network

– Loma Linda University Medical Center is no longer in Tier 2. Those wishing to continue with Loma Linda will need to move to Aetna PPO

– All other providers in Tier 2 remain the same

Plan Design - Aetna

Redlands Unified School District

Summary of HMO Plans Current ProposedEffective Date 7/1/2011 7/1/2012Renewal Date 7/1/2012 7/1/2013Carrier Name Anthem Blue Cross AetnaPlan Name HMO HMOEligible Class Eligible Employees Eligible EmployeesGeneral Plan Information Outpatient Specialist Visit Tier #1 ( Beaver MG) $20 copay $20 copay Tier # 2 $30 copay $30 copay Annual Out-of-Pocket Limit/Individual $500 $500 Annual Out-of-Pocket Limit/Family $1,000 Two-Party; $1,500 Family $1,000 Family Lifetime Plan Maximum Unlimited Unlimited Primary Care Physician Election Required Yes YesOutpatient Services Preventive Services Well-Child Care 100% 100% Immunizations 100% 100% Adult Periodic Exams with Preventive Tests 100% 100% Diagnostic X-Ray and Lab Tests 100% (CT scan, CAT scan, MRI,

Nuclear Cardiac scan, PET scan $100 copay when not performed in a hospital-

based facility)

100% (CT scan, CAT scan, MRI, Nuclear Cardiac scan, PET scan $100

copay when performed at an outpatient facility)

Maternity Care Pregnancy and Maternity Care (Pre-Natal Care)

Tier #1 ( Beaver MG) $20 copay $20 copay Tier # 2 $30 copay $30 copayInpatient Hospital Services Inpatient Hospitalization 100% 100% Pre-Authorization of Services Required Yes Yes Semi-Private Room & Board; Including Services and Supplies

100% 100%

Surgical Services Outpatient Facility Charge 100% 100%

Plan Design - Aetna

Redlands Unified School District

Summary of HMO Plans Current ProposedEffective Date 7/1/2011 7/1/2012Renewal Date 7/1/2012 7/1/2013Carrier Name Anthem Blue Cross AetnaPlan Name HMO HMOEligible Class Eligible Employees Eligible EmployeesEmergency Services Emergency Room $100 copay waived if admitted $100 copay waived if admitted Air/Ground 100% 100% Air/Ground 100%Urgent Care Urgent Care Facility $30 copay Tier #1 ( Beaver MG) $20 copay Tier # 2 $30 copayPrescription Drug Benefits Generic $10 copay

(administered by Express Scripts)$10 copay

(administered by Express Scripts)

Brand (Formulary/Preferred) $20 copay (administered by Express Scripts)

$25 copay (administered by Express Scripts)

Brand (Non-formulary) $40 copay (administered by Express Scripts)

Number of Days Supply 30 days 30 days Mail Order Generic $20 copay

(administered by Express Scripts)$20 copay

(administered by Express Scripts) Brand (Formulary/Preferred) $40 copay

(administered by Express Scripts)$50 copay

(administered by Express Scripts) Brand (Non-formulary) $80 copay

(administered by Express Scripts) Number of Days Supply for Mail Order 90 days 90 days

Plan Design - Aetna

Redlands Unified School District

Summary of HMO Plans Current ProposedEffective Date 7/1/2011 7/1/2012Renewal Date 7/1/2012 7/1/2013Carrier Name Anthem Blue Cross AetnaPlan Name HMO HMOEligible Class Eligible Employees Eligible EmployeesOther Services and Supplies Durable Medical Equipment & Prosthetic Devices 100% 100%

Home Health Care 100% Limited to 100 days per calendar year

100% Limited to 100 days per calendar year

Skilled Nursing or Extended Care Facility 100% Limited to 100 days per calendar year

100% limited to 100 visits per calendar year

Hospice Care 100% 100% Chiropractic Services $10 copay; 30 visits per calendar year $15 copay; 30 visits per calendar year

Acupuncture $30 copay per visit $30 copay per visit

Vision Examination 100% Evaluation only 100% Evaluation only Materials 100% limited to 100 visits per calendar Hearing Screening 100% 100% Aid(s) 100% Hearing Aids benefit limited to

one hearing aid per ear, every three 100% Hearing Aids benefit limited to one hearing aid per ear, every three

Infertility Diagnosis/Treatment See Plan Certificate See Plan Certificate

Outpatient Rehabilitative Therapy Services Physical, Occupational and Speech $30 copay Limited to a 60-day period of

care after an illness or injury; additional visits must be authorized by the

medical group

$30 copay treatment over a 60-day consecutive period per incident or

illness or injury beginning with the first day of treatment

CONFIDENTIAL: The information contained in this chart is intended for the exclusive use of the recipient with the recipient's review of this proposal. It is not intended for any other purpose. The information described on this page is only intended to be

Aetna – Open Enrollment

All Aetna Enrollees Must Participate in the

Open Enrollment Process

Plan Rates- Kaiser

  Kaiser Permanente  $30 CopayMedical $9,446.64 Kaiser Pharmacy Included Behavioral Health (Kaiser) Included Delta Dental $1,522.08 Medical Eye Services $150.00 Prudential $156.00       Total Health &Welfare Premium Cost $11,274.72    Maximum District Contribution $10,640.64    Employee Pay Annually $634.08    Employee Pay - 10thly $63.41

Plan Design- Kaiser

Kaiser – Plan Design

Kaiser – Open Enrollment

If you are currently with Kaiser

and are remaining with Kaiser,

and you are not making any

changes to your dependents, you do not have to participate

in the Open Enrollment Process

Express Scripts (Rx) Information

• Cost Saving Changes to Rx are:– Co- pay $10/$25/$40– Step Therapy– Select Home Delivery

Changes to Rx saved each member approximately $13.00 per month

Mental Health Plan Information

• Mental Health Plan Changes are:– Carrier changing from Holman to Mental

Health Network (MHN)– Similar Provider Network with Ability to

include current provider– Enhancements with Employee Assistance

Program (EAP)– No co-pay change– Holman’s renewal rate was 100% increase

Watch for more details shortly regarding Transition of Care formembers who are receiving outpatient or inpatient mental healthor substance abuse services on 7/1/2012.

Plan Design – Mental Health Network

Redlands Unified School DistrictBenefits & Premium AnalysisEffective Date

Renewal Date

Carrier Name

Employee Assistance Program 5 Face to face sessions with telephonic & web option

Enhanced member website

Basic Work & Life

Client Services including CISD

8 Training Hours

Mental Health Benefits In-Network Out-of-Network In-Network Out-of-Network Inpatient Care 100% Emergency Only 100% Emergency Only

Outpatient Care 100% Not Covered 100% Not CoveredSubstance Abuse In-Network Out-of-Network In-Network Out-of-Network

Inpatient Care

Inpatient Hospitalization 100% Unlimited Acute Care

Emergency Only100%

Unlimited Acute CareEmergency Only

Residential, Partial Hospitalization and Day Treatments 100% 100 days per/ cal yr

Not Covered 100%

100 days per/ cal yrNot Covered

Outpatient Care

Outpatient Services $0 Copay Not Covered $0 Copay Not CoveredRate Subscribers Rate Subscribers

Composite $31.71 1027 $49.32 1027

$ Total Monthly Premium

$ Total Annual Premium

$ Change Over Current Monthly Premium

% Change Over Current Annual Premium

CONFIDENTIAL: The information contained in this chart is intended for the exclusive use of the recipient with the recipient's review of this proposal. It is not intended for any other purpose. The information described on this page is only intended to be

Not Covered

Not Covered

Not Covered

Not Covered

100%

100%

100%

100%

100%

$390,794.04

55.53%

$18,085.47

Not Covered

$607,819.68

7/1/2012

Holman HMO

$32,566.17 $50,651.64

Proposed

7/1/2012

7/1/2013

Current

MHN HMO

7/1/2011

Dental/Vision/Life Information

NO CHANGES

Rates for Part-time Employees

FTE CLASSIFIED BARGAINING UNIT

CONTRACT   PER MONTH (10 MONTHS) COST OF BENEFITS FOR THE 2012-2013 SCHOOL YEAR

      MEDICAL DENTAL VISION LIFE

  KAISER

AETNA HMOTIER 1

(BEAVER ONLY)

AETNA HMOTIER 2(FULL

NETWORK)AETNA PPO

DELTA DENTAL

MEDICAL EYE

SERVS.PRUDENTIAL

LIFE INS.

    100%              

6.25 OR MORE EMPLOYEE 63.41 169.51 596.29 618.14  0.00  0.00 0.00 HRS PER DAY

   

    20/80%              

4 HRS BUT EMPLOYEE 239.66 345.76 772.54 794.39 30.44 3.00 3.12 LESS THAN 6.25 HRS PER DAY

    40/60%              

2.25 HRS BUT EMPLOYEE 415.91 522.01 948.79 970.64 60.88 6.00 6.24 LESS THAN 4.00HRS PER DAY

    60/40%              

  EMPLOYEE 592.17 698.27 1,125.05 1,146.90 91.33 9.00 9.36 LESS THAN 2.25HRS PER DAY

Rates effective 07/01/2012

Rates for Part-time EmployeesFTE CERTIFICATED BARGAINING UNIT, ADULT EDUCATION, RISE, AND HOME TEACHERSCONTRACT **HOURLY PER MONTH (10 MONTHS) COST OF BENEFITS FOR THE 2012 - 2013 SCHOOL YEAR

     

MEDICAL (MED+PHAR+BH+CHIRO) DENTAL VISION LIFE

      KAISER

AETNA HMOTIER 1

(BEAVER ONLY)

AETNA HMOTIER 2(FULL

NETWORK)AETNA PPO

DELTA DENTAL

MEDICAL EYE

SERVS.PRUDENTIAL

LIFE INS.    100%              

    EMPLOYEE 63.41 169.51 596.29 618.14 0.00   0.00  0.00

76-100%36 HRS OR

MORE/WEEK          25/75%              

    EMPLOYEE 283.72 389.82 816.60 838.45 38.05 3.75 3.90

51-75%27 TO 36

HRS/ WEEK          50/50%              

    EMPLOYEE 504.04 610.14 1,036.92 1,058.77 76.10 7.50 7.80

26-50%18 TO 27

HRS/ WEEK                          75/25%              

    EMPLOYEE 724.35 830.45 1,257.24 1,279.09 114.16 11.25 11.70

0-25%12.5 TO 18

HRS/ WEEK                      

**ADULT ED, R.I.S.E., and HOME TEACHERS ONLYRates effective 7/1/2012

Information Meeting Timeline

• April 17, 2012 @ 10:00 a.m. General Information Meeting • April 17, 2012 @ 5:00 p.m. General Information Meeting• April 18, 2012 @ 3:00 p.m. General Information Meeting• April 19, 2012 @ 4:30 p.m. General Information Meeting• April 26, 2012 @ 2:00 p.m. Retiree Information Meeting

RETIREES ONLY

• April 25-27, 2012 RTA/RESPA/RAPA Voting

All information meetings will be held in the Board Room• May 14, 2012 Open Enrollment Begins• May 25, 2012 Open Enrollment Closes• July 1, 2012 New Benefit Cards received by

staff

Computer Lab open daily 8:00 a.m. – 5:00 p.m.

during the Open Enrollment Period.