SPECIAL INSURANCE EDITION

This special edition of the County Line is focused entirely on the county employee health insurance program – the Health Partnership Plan (HPP) – and related benefits. Health insurance is an important part of your compensation and a significant benefit provided by the county. The articles in this newsletter are focused on how the HPP is struc-tured, how you and your family can save money by using the program effectively, and how you can help keep county health care costs in check. For the purposes of employee health insurance, the county is the insurance company. The county self-insures employee and dependent medical and prescription drug costs and coverage, and contracts with private companies to provide claims administration. The county negotiates rates and charges with large network providers, such as Florida Memorial Health Network and Volusia Health Network, to get the best health care at the lowest cost. Health care costs nationally have risen dramatically in recent years. The county is affected by these trends, as are employees. Because the county’s cost for medical claims is rising faster than the national average, we have engaged an insurance expert to analyze coverages and costs over the next several months. The expert will suggest ways of saving the county’s health plan money while still providing a quality plan. Employees can help the county keep health insurance costs in check by managing their health care costs. In fiscal year 2014, the county contributed $33.4 million to the health plan, while employees contributed $4.8 mil-lion through bi-weekly paycheck deductions and paid $5.9 million in out-of-pocket costs for co-pays and deductibles.

Understanding county health insurance

(See UNDERSTANDING page 3)

Manager’s columnPage 2

How the plan worksPage 5

Cost of health care while on vacation Page 7

Want a free annual physical? Page 11

What is a self-funded health plan?Page 3

One of the most important things management will do this year is to conduct a comprehensive review of our health insurance program. We have engaged a private firm with expertise in this area to give us an independent, objective view of what’s right with our plan and what steps we need to make to shore up any deficiencies. As noted in this County Line, the county self insures for employee health care. This means we fund claims; we don’t buy commercial insurance. We estimate claims and we set aside money every year to pay those claims. When the number and type of claims increase, we incur more expense. In essence, we’ve been dipping into our reserves to meet expenses. Just with your budgets, when you exhaust your savings you have big bud-get trouble. So I ask you to pay close attention to the helpful informa-tion in this County Line with the goal to reduce your health care costs by using the Health Partnership Program effi-ciently and effectively. Don’t go to the hospital emergency room when you could go to an urgent care center. Don’t use brand name drugs when generics are available. Etc. etc. etc. And do yourself and your families a favor by living healthy lifestyles… if you smoke, please try to quit. If you’re over-weight, please try to lose a few pounds. Try to eat healthy foods and exercise regularly. Now with all of this having been said, let me close by assuring you I am keenly aware of the importance of our group health insurance program. It’s an essential component of your compensation package and is a major influence on why people want to work for county government and why employees stay with the county. Although we are conducting a major analysis of our health insurance program, I commit to you my goal is to maintain a quality employee health insurance program. I am not interested in saving money by gutting the quality. But I think we all should have the mind-set that both the county and employees are going to have to absorb some additional costs. I welcome your suggestions and feedback. Sincerely, Jim Dinneen, County Manager

COUNTY COUNCIL

The County Line, published by Volusia County Government, an EEO/AA employer, is ded-icated to county employees and things that affect county employees. News items or cor-respondence should be addressed to: The County Line, Community Information, Volusia County Government, 123 W. Indiana Ave., DeLand, FL 32720-4612. Printed on recycled paper

Jason P. Davis — County ChairPat Patterson — Vice Chair, District 1

Joyce M. Cusack — At-largeJoshua J. Wagner — District 2Deborah Denys — District 3

Doug Daniels — District 4Dr. Fred Lowry — District 5

James T. Dinneen, County ManagerDavid F. Byron, EditorKendra Lee, Co-editor

Paul Radetsky, Graphic De sign erJeff M. Crumbley, Photographer

Straight talkWith costs rising, health insurance under study

Jim Dinneen

2

We’ve decided to focus this edition of the County Line entirely on employee health insurance because it’s such an important part of our compensation package. It probably comes as no surprise to you that health care costs are rising – not just here but across America. Companies, both private and public, are struggling with how to provide a decent health insurance benefit for the workforce at a cost the employer and covered employee can withstand. Volusia County Government is facing sig-nificant year-over-year cost increases for employee health care, to the point prudent management dictates we analyze our health care program with the goal to contain costs. It is important we all work together to achieve that goal. As this County Line shows, the overall cost of our health insurance program is rapidly approaching $50 million annu-ally. Over the past five years, the cost grew by 9 percent annually. Due to the recession we chose to spend reserves in the fund rather than increase your out-of-pocket costs or the county’s subsidy. We now must begin to cover the costs with sustainable revenues and do all we can to reduce costs and minimize increases. As an interim measure, your paycheck deduction for health insurance will increase June 5. I honestly wish we didn’t have to take this step, but we have no choice. Even with this increase out of your pockets, we only partially offset the problem.

3

For your benefit

Health plan cost breakdown (FY 2014) premium, out-of-pocket costs

Medical plan trend claims impact county compared to national

Retirees who remain covered by the county contributed $2.6 million. The total cost for health insurance in fiscal year 2014 was $46.7 million. This is illustrated by the pie chart below.

UNDERSTANDING from page 1

For your benefit

4

The Health Partnership Plan is a self-insured health plan. This means the county is responsible for the cost of all medical claims and prescription drugs for its employees, their spouses and dependents, and plan participant retirees. In fiscal year 2014 the county contributed 87 percent of the total cost, while employees contributed 13 percent. An increasing number of private employers are not offering employee health insurance. Many companies offer a fully-insured plan where the company buys health insurance from a private company and pays a pre-mium based on the number of employees enrolled in the plan. With a fully insured plan, employees usually pay a monthly or bimonthly premium along with deductibles, co-pays and services not covered. Many company-pro-vided employee health insurance plans cost employees well over $300 a month for employee-only coverage; frequently those plans offer benefits inferior to those provided by Volusia County Government through the HPP. Even though the costs of health care continue to rise, the county has tried hard to avoid raising employee premiums and co-pays. Last July it became necessary to raise employee premiums and health plan co-pays. The bi-weekly employee, parent, couple and family premium increased $15; generic prescription drug co-pays increased $5; and other health plan co-pays increased $5, $10 and $15. Before the 2014 increase, premiums had not increased since 2007 and co-pays had not increased since 2008. Another increase is necessary to help with the rising plan costs. Beginning with the June 5, 2015, paycheck, the health/dental biweekly premium will increase by $10. Health/dental co-pays and deductibles are not increasing at this time.

Components of HPP HealthSmart – The county’s contracted insurance administrator, which processes medical, prescription drug, dental, and vision claimsCatamaran – The pharmacy company that oversees prescriptionsProvider networks • Tier 1 in-network – Florida Memorial Health Network and Volusia Health Network • Tier 2 expanded-network – Multi-plan • Tier 3 – Out-of-network • Chiropractic network – Doctors Professional ServicesKePro – The company that precertifies and authorizes medical proceduresHealth Advocate – The company that provides the Employee Assistance Program (EAP) for counseling on a wide range of personal issues

What is a self-funded health plan?

5

For your benefit

The HPP has three tiers of provider networks of doctors, hospitals and other facilities. Each tier has a different level of co-payments, co-insurance, and/or deductibles depending on the provider. • Tier 1 in-network providers: These providers in Volusia, Flagler, Lake, Seminole, Osceola and Orange counties have negotiated lower rates with the county based on the expectation of higher use. • Tier 2 expanded-network providers: These providers are nationwide or outside the providers in the tier 1 in-network. They are more costly for employees and their dependents than the tier 1 in-network providers. • Tier 3 out-of-network providers: These providers are not in the tier 1 or 2 networks. They are the most costly for employees and their dependents.

Comparison of the employee cost based on a $3,000 charge

Finding a doctor, hospital or other in-network provider Way too many times, providers assure HPP members they are in-network when, in fact, they are not. Since networks change periodically, members always should check with the networks to find out if the provider is still in the network or not. Use the directories below to find an in-network provider.Tier 1 in-network in Volusia and Flagler counties: Florida Memorial Health Network http://fmhn.org/search.phpCustomer service: 386-231-4398 or 888-839-7430

Volusia Health Network http://www.myvhn.com/provider-search-pdf Customer service: 386-425-4846, option 3

Lake, Orange, Osceola and Seminole counties Florida Memorial Health Network Expanded Network (FHHS) http://fmhn.org/search.php Customer service: 386-231-4398 or 888-839-7430 Make sure you check that your doctors, hospitals and other facilities are in-network before your appointment. Employees are responsible for all out-of-pocket costs.

How the plan works

RESEARCHING DOCTORS – Claudia Pizarro, Community Information,navigating the Volusia Health Network website.

6

For your benefit

If you are vacationing outside the United States or its terri-tories, only medical claims for accidental injuries and medical emergencies are covered. For example, if you seek medical attention for a common cold, you will pay the full cost of the treatment. If you seek medical attention for an accidental injury or medical emer-gency, you will be responsible for paying the expanded-net-work benefit of 20 percent of the bill. If possible, obtain a detailed written description (in English) of the treatment received and the costs. It’s a good idea to consider purchasing travel health insurance for your trip. Here are some tips about prescription drugs when traveling: • Pack and label your prescriptions. • Check with airlines to see if certain liquids or quantities of your prescriptions are prohibited. • Take medications in original containers, bearing the name of pharmacy and prescribing physician. • Make a list of your prescriptions including generic names in case of emergency. • Before you leave determine if the country you are visiting has restrictions on the medications you are taking.

Cost of health care while on vacation

The county provides a wellness program with a full-time wellness coordinator. The wellness program is available for eligible employees, retirees and their spouses. The program offers training programs, healthy lifestyle challenges, and fitness centers on the east and west sides of the county.

The wellness program

WORKING OUT – April Miller, Budget Analyst with Budget office, on the leg press machine in the TCK Wellness Center.

WORLD TRAVELER – Marcia Naber, Public Works, comtemplates her next journey.

Emergency room or urgent care? Using urgent care centers rather than hospital emergency rooms can save you and the county money. • The co-pay for emergency room use is $65, while the average cost to the county is $2,261. • The co-pay for an urgent care center is $50, while the average cost to the county is $196.Which facility should I use when seeking medical treatment? If you have an urgent medical health condition that cannot wait for a visit to a primary care doctor, ask yourself if the condition should be treated in a hospital emergency room or an urgent care center. In general, a medical health emergen-cy is something that can cause permanent impairment or is life-threatening. Examples of conditions that require emergency medical care include: • Severe chest pain or pressure • Uncontrolled bleeding • Coughing or vomiting blood • Difficulty breathing or shortness of breath • Sudden dizziness, weakness, or change of vision • Severe or persistent vomiting or diarrhea • Changes in mental status, such as confusion

Urgent medical conditions are not considered emergencies, but still require care within 24 hours. Examples include: • Sprains and strains • Moderate back problems • Mild to moderate asthma attacks • Bleeding/cuts that are not bleeding profusely but require stitches • Eye irritation and redness • Mild to moderate vomiting • Fever or flu • Severe sore throat or cough • Skin rashes and infections • Urinary tract infections HAVING A PRIMARY CARE PHYSICIAN IS IMPORTANT! Hospital emergency room and urgent care centers are not alternatives to having regular medical care from a primary care physician. DIAL 911 IMMEDIATELY FOR ANY MEDICAL PROBLEM THAT APPEARS TO BE LIFE-THREATENING!

For questions about urgent care centers, please contact or search for a tier 1 in-network provider using the information provided on the previous page.

7

For your benefit

For your benefit

8

Prescription drugs are an increasing expense for you and the county. Antidiabetic drugs, which stabilize and control blood glucose levels, are some of the most commonly used and most expen-sive medications. People with type 1 diabetes require daily insu-lin injections; they also must eat properly, keep blood glucose levels from going too low or too high, and monitor blood sugar levels. Diet and exercise may be enough to control blood glucose levels for people with type 2 diabetes. Many cases of diabetes can be prevented by maintaining a healthy weight, eating well, being active and attending regular doctor visits. You can save money by using generic drugs ($20 co-pay)

rather than preferred drug brands ($35 co-pay). Generic brands also cost the county less. You also can save money by ordering pharmaceuticals in a 90-day quantity; using this method; you pay only two co-pays instead of three. This can be done at a pharmacy or by mail. Ask your doctor to write your prescription for a 90-day supply. It’s important to cost-shop for pharmacies that do not charge co-pays or reduced co-pays for certain prescriptions. Publix pharmacies offer these drugs free: Amoxicillin, Ampicillin, Sulfamethoxazole/trimethoprim (SMZ-TMP), Ciprofloxacin (excluding ciprofloxacin XR) and Penicillin VK. Talk to your doctor about other options to reduce the cost of prescriptions.

Prescription drugs

Most expensive drugs used by county employees (FY 2013)

Catamaran Rx As a plan member you can have instant, secure access to your personal prescription information and trusted pharmacy resources through Catamaran Rx. Compare prescription prices, check your prescription history, set medication refill reminders, locate pharma-cies and more. Visit mycatamaranrx.com/PortalCentral. Look for the new registra-tion option at the bottom of the web page. Catamaran also offers apps for smartphones.

9

For your benefit

Flexible Spending Accounts (FSAs) offer a great way to save money on medical and/or child care. If you do not have an FSA, you can open one during the annual open enrollment period. You can contribute a maximum of $2,500 to a health care FSA and $5,000 to a child care FSA. The county’s FSA vendor is WageWorks.How do I save money with an FSA? An FSA allows you to pay for your health, prescription drugs, dental, vision co-pays, deductibles, dependent care for children and elders, and more. The money to pay these expenses comes out of your paycheck before taxes.

Once you elect to place money into a health care FSA, the annual amount you elect is deducted from your paycheck pre-taxed over 26 pay periods. The total amount you elected is available on Jan. 1. You can pay for your medical, prescrip-tion drug, dental, and vision expenses by using the provided VISA card or by paying the provider up front and then obtain-ing a reimbursement. Below is a health care FSA annual savings example. Let’s say you earned $40,000 in 2014 and elected to put $2,000 into a health care FSA. At the end of 2014, you would have an increased spendable income of $500.

Save money with a Flexible Spending Account

• Pay eligible heath care expenses directly from your take care by WageWorks benefit account– just swipe and go• Avoid the hassle of submitting receipts – most card transactions are automatically verified at checkout• Enjoy the convenience of smart card functionality – use your card with multiple take care by WageWorks benefit accounts

Why you need it

For questions about FSAs, contact WageWorks at 800-950-0105. If your card is lost or stolen call 866-679-7649.

For your benefit

10

Magnetic Resonance Imaging (MRI) and Computerized Axial Tomography (CAT) scans can cost you a lot more if you do not follow health plan procedures. An MRI machine uses a magnetic field and radio waves to create detailed images of the body. CAT uses a computer that takes data from several X-ray images of structures inside the body and converts them into pictures on a monitor. If your physician requires you to have one of these scans, the costs are: • In-network facility – $250 deductable and 10 percent of allowable cost • Expanded-network facility – $500 deductable and 20 percent of allowable cost • Out-of-network facility – $2,000 deductable and 40 percent of allowable cost

Cost comparison for MRIs

To reduce your out-of-pocket costs, always check to make sure the facility is in-network before you schedule the appointment.For questions contact HealthSmart at healthsmart@volusia.org or 386-736-5951, ext. 13249.

Costs of MRI and CAT scans

The county’s Employee Assistance Program (EAP) provider, HealthAdvocate, offers licensed professional counselors and online services that include videos, articles, health assess-ments, monthly food recipes, training courses, news alerts and more. These services are available to employees, their spouses, dependent children, parents and parents-in-law. Employees and their eligible family members have access to licensed professional counselors, who can provide con-fidential short-term support for a wide range of personal issues such as: • Marital or family/parenting• Work stress or conflicts• Anger, grief, loss or substance abuse• Depression or anxiety• Legal or financial problems• Child care, elder care or adoption

• Time management issues • And more Employees and their eligible family members can schedule up to 10 free confidential, in-person counseling sessions per year. For 24/7 support, call 877-240-6863. You also can go to the website or download the new app. For information about HealthAdvocate’s online services, visit HealthAdvocate.com/members, enter “Volusia County Government,” and click the submit button.

Employee Assistance Program (EAP)

11

For your benefit

It is very important to see your physician annually, even if you feel fine. An annual physical is a good way to catch prob-lems early. Annual physicals are based on your age, gender and family history. Diagnostic testing and cancer screenings such as colonoscopies and mammograms can detect early signs of disease, which can increase the chances greatly of successful treatment. The county’s health plan covers annual physical examina-tions and well woman and child care services for you and your family. These preventive services are not subject to calendar year deductibles. One annual physical examination is covered each calendar year if you use a preferred provider physician whose practice is family or general medicine, internal medicine or gynecology. The annual routine physical benefit includes, and is limited to, any combination of these services: EKG; blood test; chest X-rays; digital prostate exam; hearing screening; PSA blood test; pap smear; and inoculations and immunizations for flu, tetanus and pneumonia. The annual well woman services also include mammogram screenings. The annual child care services include vision, hearing, oral health assessment, laboratory, immunizations, boosters and other covered services. Please consult page 7 of the health plan Summary Plan Description for annual physical details. The SPD is on the Personnel web page or you can call Personnel at 386-736-5951 or ext.15951.

Want a free annual physical?

1) Obtain a 90-day prescription. Doctors often write monthly maintenance prescriptions for a 30-day supply. By asking your physician to write a 90-day supply, you will pay two co-pays instead of three. For example, if the monthly main-tenance drug costs $20 for a 30-day supply, switching to a 90-day supply of the same prescription will would cost only $40. The cost savings of using this method is $80 per year. 2) Open a Flexible Spending Account (FSA). During the annual open enrollment period, open an FSA to pay for medical, pre-scription drug, vision and dental expenses while lowering your annual taxable income. For example, if in an average year

expenditures for approved FSA items equal $2,000, putting that $2,000 into an FSA instead of paying out of pocket could total up to $500 in spendable income.3) Use urgent care facilities. By using an urgent care facility for a nonemergency instead of going to the emergency room, the co-pay savings is $15. This also saves the county money. If you visit an urgent care facility instead of the emergency room, the county saves on average $2,065 per visit, allowing us to keep costs in check.

Top three ways to save with the health care plan

For your benefit

The following information can be found on Personnel’s web-page, http://ennprod.covdnssrv.co.volusia.fl.us/personnel

• 2015 Supplemental Benefits Guide – Information on all benefits (health, dental, vision, and other types of insurance and plans).• 2015 HPP Summary of Benefits Coverage (SBC) – This document explains your health insurance in easy-to-under- stand language. • 2015 HPP Summary Plan Description (SPD) – The SPD provides specific information on health, prescription drug and dental coverages (co-pays, deductibles, eligibility, claims denials, etc.).

• 2015 Provider Network Contact Information – Information on the network providers (doctors, hospitals, and other facilities). If you have questions please call Personnel at 386-736-5951 or ext. 15951.

HPP documents

The county’s HealthSmart representative can answer questions about your health, prescription drugs, dental and vision benefit claims, bills, and plan document information.The representative is available from 8 a.m. - 5 p.m. Monday through Friday in the Personnel office at 230 N. Woodland Blvd., DeLand (second floor, suite 262, Bank of America building).

The representative also can be reached at healthsmart@volusia.org or 386-736-5951, ext. 13249.

Contact the HealthSmart representative

GETTING INFO – Art Graham, Legal, making important insurance decisions with HealthSmart.