Minutes
Committee Name: Benefits Committee Minutes
Date: 4/17/2015
Time: 10:00 am – 11:00am
Facilitators/Location/Chair: Conference room 2030
Attendees:
X
X
X
X
X
Doug Deaver
Diane Goody
Leah Hlavaty
Jennifer Lee
Victoria Lewis
X
X
X
X
Anne Lucero
Loree McCawley
Graciano Mendoza
Alta Northcutt
Michael Robins
X
X
X
X
Cheryl Romer
Conrad Scott-Curtis
Sue Torres
Kathie Welch
Alliant Staff
Guests:
Item
Topic and Discussion
Topic
Lead
Time on
topic
1.
New Introductions
Victoria
2 Mins
2.
Adopt Agenda
Victoria
3 Mins
3.
Approve Meeting Minutes: 3/19/15 Benefits Committee Mtg.
Victoria
3 Mins
Alliant
30 Mins
Victoria
5 Mins
4.
Alliant staff reviewed the renewal info in the booklet:
 Overall 2015-16 medical rate increase is 1.9%
 2015-16 Plan designs and cost changes
 Contribution analysis (10thly and 12thly)
 Blue Shield 65+ HMO Medicare Advantage Plan
 Anthem Companion Care
 Kaiser
 Dental Plan – 3% renewal anticipated in June
Action
By
Whom/
When
Primary
Effectiveness
Link
Approved:
Robins/Torres
SISC will review ACA at the 5/14/15 Benefits Committee meeting
 Actual Dental rates anticipated by 5/28/15
5.
Summary/Agenda Building
6.
Next meeting dates:
 May 14, 2015: Alliant will present on ACA implementation
O:\Administrative Services\Benefits Committee\Benefits Committee 2014-15\041715BenefitsMins.docx
Page 1 of 2
Minutes
Item
Topic
Lead
Topic and Discussion
Time on
topic
Action
By
Whom/
When
Primary
Effectiveness
Link
Information Requested
1.
Rates for Bronze plan? To be emailed out before 5/14/15.
2.
Meeting Summary/Take Aways:
1.
To be added during the meeting
2.
Effectiveness Links
1.
5.
Facilities Plan
6.
Technology Plan
3.
Mission Statement and Core 4 Competencies
(Communication, Critical Thinking, Global Awareness, Personal and
Professional Responsibility)
Strategic Plan
1. Professional Development and Transformational Learning
2. Sustainable Programs and Services
3. Community Partnerships and Economic Vitality
4. Institutional Stewardship
5. Institutional Responsibilities
Board Goals
7.
Program Plans
4.
Education Master Plan
8.
Student Equity Plan
2.
O:\Administrative Services\Benefits Committee\Benefits Committee 2014-15\041715BenefitsMins.docx
Page 2 of 2
Cabrillo College
2015/16 Renewal Meeting
April 17, 2015
Christine Kerns, Senior Vice President
Eryn Elola, Account Executive
Sommer Griffin, Account Manager
AGENDA

2015/16 Financial Overview

SISC Updates

2015/16 Renewal


Current Rates and Benefits (Handout)

Contribution & Plan Analysis (Handout)
Next Steps
© 2015 Alliant Insurance Services, Inc. All rights reserved. Alliant Employee Benefits, a division of Alliant Insurance Services, Inc. CA License No. 0C36861
2
FINANCIAL OVERVIEW
Cabrillo College
FINANCIAL SUMMARY
Line of Coverage
BLUE SHIELD ACTIVE & EARLY RETIREE
HMO $10-0
HMO $25-500
HMO $30-20%
PPO 80-E
PPO 80-J
PPO HDHP B
BLUE SHIELD RETIREE +65
HMO $10-0
HMO $25-500
HMO $30-20%
PPO 80-E
PPO 80-J
PPO HDHP B
COMPANIONCARE (Individual Ret Plan)
CompanionCare
KAISER PERMANENTE (Individual Ret Plan)
Kaiser Permanente
DELTA DENTAL (ACSIG)
Active
Retirees
Enrollees
10/1/2014
10/1/2015
$∆
%∆
61
252
68
91
41
34
$1,264,152
$4,288,284
$1,069,116
$1,561,740
$737,856
$344,880
$1,270,416
$4,403,448
$1,095,252
$1,584,156
$749,712
$355,092
$6,264
$115,164
$26,136
$22,416
$11,856
$10,212
0.5%
2.7%
2.4%
1.4%
1.6%
3.0%
5
7
0
41
4
0
$40,260
$38,556
$0
$268,320
$22,752
$0
$40,440
$38,808
$0
$273,996
$23,280
$0
$180
$252
$0
$5,676
$528
$0
0.4%
0.7%
0.0%
2.1%
2.3%
0.0%
8
$35,520
$36,960
$1,440
4.1%
2
$11,844
$11,880
$36
0.3%
465
162
$713,577
$181,579
$734,984
$187,026
$21,407
$5,447
3.0%
3.0%
$10,578,435
$10,805,450
$227,015
2.1%
Estimated
Total Annual Premium
© 2015 Alliant Insurance Services, Inc. All rights reserved. Alliant Employee Benefits, a division of Alliant Insurance Services, Inc. CA License No. 0C36861
3
SISC OVERVIEW
RENEWAL RATE HISTORY
SISC STATE-WIDE RATE HISTORY
YEAR
PPO
HMO
2005 - 2006
2006 - 2007
2007 - 2008
2008 - 2009
2009 - 2010
2010 - 2011
2011 - 2012
2012 - 2013
2013 - 2014
2014 - 2015
2015 - 2016
AVERAGE
7.4%
6.8%
7.5%
4.8%
0.0%
12.1%
6.4%
8.3%
8.2%
6.0%
2.8%
6.4%
7.1%
17.8%
5.3%
5.7%
14.7%
12.4%
6.4%
8.3%
8.2%
6.0%
2.8%
8.6%
Santa Cruz County:
2011-12 – 3.7%
2012-13 – 3.7%
2013-14 – 6-10%
2014-15 – 6-10%
2015-16- 0-4%
* HMO/PPO combined
Note: PPO/HMO renewal increases represent average Anthem Blue Cross and Blue Shield rate increases.
© 2015 Alliant Insurance Services, Inc. All rights reserved. Alliant Employee Benefits, a division of Alliant Insurance Services, Inc. CA License No. 0C36861
4
SISC PLAN UPDATES/PROGRAMS
EFFECTIVE 10/1/2015
SISC 2015-2016 Plan Year Medical Changes/Updates – PPO Plans
 Out-of-Pocket (OOP) Maximum Changes
 As SISC continues to comply with the ACA, there will be some changes to medical outof-pocket maximums on some PPO plans. The OOP maximum changes for the
Cabrillo College plans are identified in the benefit summary handouts.
 Rx Plans – The OOP Max has been added per ACA compliance.
 X-Ray & Lab, Durable Medical Equipment, and Physical Medicine – Out-of-Network
Benefit Change
 X-Ray, Lab, Durable Medical Equipment and Physical Medicine provided by nonparticipating providers will no longer be covered. Physical Medicine includes
chiropractic, physical and occupational therapy. This change does not apply to
emergencies.
© 2015 Alliant Insurance Services, Inc. All rights reserved. Alliant Employee Benefits, a division of Alliant Insurance Services, Inc. CA License No. 0C36861
5
SISC PLAN UPDATES/PROGRAMS
EFFECTIVE 10/1/2015
Diabetic Test Strips
•
As of October 1, 2015, SISC will have preferred test strips from Abbott (Freestyle) and
Lifescan (One Touch) available at the generic co-pay. All other test strips will be covered at
the brand co- pay. Members affected by this change will be notified by Navitus 90-days and
again 30-days prior to October 1. If a physician prescribes a preferred test strip, a new
meter will be provided at no cost.
•
The SISC Health Benefits Manual indicates that all diabetic supplies are available only in
brand form but SISC charges a generic co-pay. So right now everyone is paying a generic
copay for test strips but as of October 1, 2015, only the preferred test strips will have a
generic copay and all others will have a brand copay.
© 2015 Alliant Insurance Services, Inc. All rights reserved. Alliant Employee Benefits, a division of Alliant Insurance Services, Inc. CA License No. 0C36861
6
SISC PLAN UPDATES/PROGRAMS
EFFECTIVE 10/1/2015
MDLive 24/7 Physician Access
•
MDLive provides SISC PPO members with on-demand access to board-certified
physicians by online video, phone, or secure e-mail.
•
These “doctor visits” are available to PPO Members for a $5 co-pay regardless of the
plan’s regular office visit co-pay.
•
Great alternative if members are considering the ER or urgent care for a nonemergency medical issue or when a Primary Care Physician is not available.
•
Also when traveling and in need of medical care
•
Available weekends and even holidays
•
The service is secure, confidential and compliant with all medical privacy regulations
© 2015 Alliant Insurance Services, Inc. All rights reserved. Alliant Employee Benefits, a division of Alliant Insurance Services, Inc. CA License No. 0C36861
7
SISC PLAN UPDATES/PROGRAMS
EFFECTIVE 10/1/2015
Employee Assistance Program (EAP)
Districts continue to find value in the Employee Assistance Program
•
Voluntary program offered to employees & their families
•
No cost to use EAP, Available 24 hrs/7 days per week
•
Confidential service by Licensed Professionals
•
6 brief counseling sessions per incident
•
Comprehensive website
•
Resources for Managers and Supervisors
800-999-7222
www.anthemeap.com
Program name: SISC
© 2015 Alliant Insurance Services, Inc. All rights reserved. Alliant Employee Benefits, a division of Alliant Insurance Services, Inc. CA License No. 0C36861
8
SISC PLAN UPDATES/PROGRAMS
ADDITIONAL PLAN - CONSIDERATION FOR CABRILLO COLLEGE
Two-Tiered Anchor Bronze PPO Plan

Same plan design as the Minimum Value PPO Plan

Will be added to current plan options – will NOT count towards max number of plans
allowed

Two-tier rate structure: Employee OR Employee + Child(ren)

No dental, vision or life option

No participation or contribution rules apply

Only plan option available to variable hour, temporary and seasonal employees
© 2015 Alliant Insurance Services, Inc. All rights reserved. Alliant Employee Benefits, a division of Alliant Insurance Services, Inc. CA License No. 0C36861
9
2015/16 FINAL RATES, BENEFITS & CONTRIBUTIONS
See Handouts
© 2015 Alliant Insurance Services, Inc. All rights reserved. Alliant Employee Benefits, a division of Alliant Insurance Services, Inc. CA License No. 0C36861
10
2015/2016 FINAL RATES & BENEFITS
BLUE SHIELD HMO (SISC)
Benefits
Calendar Year Deductible (Individual / Family)
Out-of-Pocket Maximum
Individual / Family
MAJOR MEDICAL
HMO $10-0 w/Chiro
HMO $25-500 w/Chiro
HMO $30-20%
Zero Facility w/Chiro
None
$1,000 / $2,000
Calendar Year Copayment Maximum
None
$2,000 / $4,000
Calendar Year Copayment Maximum
None
$1,500 / $3,000
Calendar Year Copayment Maximum
Physician Office Visit
Specialist Visit
$10
$25
$30
$10 referral / $30 Access+ self-referral
$25 referral / $30 Access+ self-referral
$30 referral / $45 Access+ self-referral
Preventive Care
No charge
$0
$0
$10
$25
$30
Inpatient Hospital
No charge
$500 / Admit
20% up to $1,500 p/member
Lab & X-Ray
No charge
No charge
No charge
$10 / 30 visits (combined)
$10 / 30 visits (combined)
Urgent Care
Chiropractic / Acupuncture
Outpatient Surgery
No charge
Emergency Room
$100
$10 / 30 visits (combined)
$150 at an Ambulatory Surgery Center;
$300 at a Hospital
$100
Mental Health Care/Substance Abuse
No charge
$500 / Admit
20% up to $1,500 p/member
Inpatient Hospital Facility
No charge
$500 / Admit
20% up to $1,500 p/member
$10
$25 per visit
Outpatient Physician Visit
Outpatient Prescription Drugs
Showing In-Network Benefits Only
Navitus (Retail)
Costco
Costco
$1,500 / $2,500
$2,500 / $3,500
(At participating Pharmacies only)
Generic/Brand
Generic/Brand
$5/$10
Mail order - 90 day supply
$9/$35
Navitus (Retail)
Costco
$2,500 / $3,500
Generic/Brand
$0/$35
$9/$35
Generic/Brand
$0/$35
$0/$20 (Costco Mail Order)
$0/$90 (Costco Mail Order)
$0/$90 (Costco Mail Order)
N/A
N/A
N/A
Annual Deductible
Actives
$0/$10
$150
$30 per visit
Navitus (Retail)
Rx Out of Pocket Maximum (Ind / Fam)
Retail - 30 day supply
No charge
2014 - 2015
2015 - 2016
2014 - 2015
2015 - 2016
Employee Only
14
$975
$980
98
$771
$792
33
$724
$742
Employee + 1
15
$1,890
$1,900
48
$1,512
$1,554
7
$1,417
$1,453
Family
15
$2,641
$2,653
90
$2,130
$2,186
27
Total Monthly Premium
44
$81,615
$82,015
236
$339,834
$348,948
67
$1,995
$87,676
$89,818
$979,380
$984,180
$4,078,008
$4,187,376
$1,052,112
$1,077,816
Total Annual Premium
2014 - 2015
2015 - 2016
$2,043
$ ∆ to Current
$4,800
$109,368
$25,704
% ∆ to Current
0.5%
2.7%
2.4%
Early Retiree
Employee Only
Employee + 1
Family
Total Monthly Premium
Total Annual Premium
$ ∆ to Current
% ∆ to Current
Retirees Over Age 65
Retiree
Retiree plus 1 dependent
Total Monthly Premium
Total Annual Premium
$ ∆ to Current
% ∆ to Current
10
6
1
17
5
0
5
2014 - 2015
$975
$1,890
$2,641
$23,731
$284,772
2015 - 2016
$980
$1,900
$2,653
$23,853
$286,236
$1,464
0.5%
2014 - 2015
$671
$1,342
$3,355
$40,260
2015 - 2016
$674
$1,348
$3,370
$40,440
$180
0.4%
9
7
0
16
7
0
7
2014 - 2015
$771
$1,512
$2,130
$17,523
$210,276
2015 - 2016
$792
$1,554
$2,186
$18,006
$216,072
$5,796
2.8%
2014 - 2015
$459
$918
$3,213
$38,556
2015 - 2016
$462
$924
$3,234
$38,808
$252
0.7%
0
1
0
1
0
0
0
$0/$60 (Costco Mail Orde
2014 - 2015
$724
$1,417
$1,995
$1,417
$17,004
2015 - 2016
$742
$1,453
$2,043
$1,453
$17,436
$432
2.5%
2014 - 2015
$457
$914
$0
$0
2015 - 2016
$460
$920
$0
$0
$0
0.0%
© 2015 Alliant Insurance Services, Inc. All rights reserved. Alliant Employee Benefits, a division of Alliant Insurance Services, Inc. CA License No. 0C36861
11
2015/16 FINAL RATES & BENEFITS
BLUE SHIELD PPO (SISC)
PPO 80-E
Benefits
PPO 80-J
$300 / $600
$1,000 / $3,000
Calendar Year Out-of-Pocket Max
In Network
Out of Network
Calendar Year Deductible (Individual / Family)
Out-of-Pocket Maximum
Individual / Family
MAJOR MEDICAL
PPO HDHP -B w/HSA Compatibility
$750 / $1,500
$3,000 p/ind; $6,000 per fam
Calendar Year Out-of-Pocket Max
In Network
Out of Network
$3,000 / $5,000
$5,000 p/ind or $10,000 per fam
Calendar Year Out-of-Pocket Max
In Network
Out of Network
Physician Office Visit
Ded waived; $20
50%
Ded waived; $30
50%
90%
Specialist Visit
Ded waived; $20
50%
Ded waived; $30
50%
90%
50%
Preventive Care
Ded waived; 100%
Not Covered
Ded waived; 100%
Not Covered
Ded waived; 100%
Not Covered
Ded waived; $20
50%
Ded waived; $30
50%
90%
50%
80%
$600 p/day
80%
$600 p/day
90%
$600 p/day
80%
Not Covered
80%
Not Covered
90%
Not Covered
80% 1
Not Covered
80% 1
Not Covered
90% 1
80%
$350 p/day
Urgent Care
Inpatient Hospital
Lab & X-Ray
Chiropractic / Acupuncture
Outpatient Surgery
80%
$350 p/day
2
$100 per visit + 20% (waived if admitted)
Emergency Room
Mental Health Care/Substance Abuse
Inpatient Hospital Facility
Outpatient Physician Visit
Outpatient Prescription Drugs
Showing In-Network Benefits Only
Rx Out of Pocket Maximum (Ind / Fam)
Ded waived; $20
50%
Annual Deductible
Actives
$100 per visit + 20% (waived if admitted)
Not Covered
$350 p/day
Ded waived; $30
50%
90%
50%
$600 p/day
80%
$600 p/day
90%
$600 p/day
50%
Ded waived; $30
50%
90%
50%
Navitus (Retail)
Costco
Navitus (Retail)
Costco
$1,500 / $2,500 (In-network Only)
$2,500 / $3,500 (In-network Only)
Generic/Brand
Generic/Brand
$0/$25
$9/$35
Rx w/ Blue Shield Contracted Provider
Combined with Medical OOP Maximum
Generic/Brand
$7/$25 after the deductible
$0/$35
$0/$60 (Costco Mail Order)
$0/$90 (Costco Mail Order)
$300 p/ind; $600 p/fam
$750 p/ind; $1,500 p/fam
$14/$60 (Blue Shield Mail Order)after the deductible
$3,000 medical deductible must be met
before co-pays apply
2014 - 2015
2015 - 2016
2014 - 2015
2015 - 2016
Employee Only
29
$956
$968
15
$848
$861
27
$681
$701
Employee + 1
17
$1,778
$1,807
13
$1,578
$1,607
3
$1,281
$1,323
Family
Total Monthly Premium
9
55
Total Annual Premium
$2,679
11
$81,755
$82,902
39
$981,060
$2,645
$994,824
$2,348
2014 - 2015
$2,382
3
$59,062
$60,008
33
$708,744
$720,096
$1,943
2015 - 2016
$1,998
$28,059
$28,890
$336,708
$346,680
$ ∆ to Current
$13,764
$11,352
$9,972
% ∆ to Current
1.4%
1.6%
3.0%
Early Retiree
Employee Only
Employee + 1
Family
Total Monthly Premium
Total Annual Premium
$ ∆ to Current
% ∆ to Current
Retirees Over Age 65
Retiree
Retiree plus 1 dependent
Total Monthly Premium
Total Annual Premium
$ ∆ to Current
% ∆ to Current
1
2
19
17
0
36
39
2
41
2
$100 per visit + 10% (waived if admitted)
80%
$7/$25
Mail order - 90 day supply
90%
Ded waived; $20
(At participating Pharmacies only)
Retail - 30 day supply
2
50%
2014 - 2015
$956
$1,778
$2,645
$48,390
$580,680
2015 - 2016
$968
$1,807
$2,679
$49,111
$589,332
$8,652
1.5%
2014 - 2015
$520
$1,040
$22,360
$268,320
2015 - 2016
$531
$1,062
$22,833
$273,996
$5,676
2.1%
1
1
0
2
4
0
4
2014 - 2015
$848
$1,578
$2,348
$2,426
$29,112
2015 - 2016
$861
$1,607
$2,382
$2,468
$29,616
$504
1.7%
2014 - 2015
$474
$948
$1,896
$22,752
2015 - 2016
$485
$970
$1,940
$23,280
$528
2.3%
1
0
0
1
0
0
0
2014 - 2015
$681
$1,281
$1,943
$681
$8,172
2015 - 2016
$701
$1,323
$1,998
$701
$8,412
$240
2.9%
2014 - 2015
$483
$966
$0
$0
2015 - 2016
$485
$970.00
$0
$0
$0
0.0%
Chiropractic limited to 20 visits per calendar year, Acupuncture limited to 12 visits per calendar year
Performed at an ambulatory surgery center
© 2015 Alliant Insurance Services, Inc. All rights reserved. Alliant Employee Benefits, a division of Alliant Insurance Services, Inc. CA License No. 0C36861
12
2015/16 FINAL RATES & BENEFITS
BLUE SHIELD MEDICARE ADVANTAGE 65+
BLUE SHIELD 65+ HMO MEDICARE ADVANTAGE PLAN
Effective October 1, 2015
SERVICES
Current
Renewal
$0 co-pay per trip
$0 co-pay per trip
Annual Physical Examination
• Office visit co-pay may apply
$0 co-pay*
$0 co-pay*
Durable Medical Equipment (DME)
Medicare covered services
$0 co-pay
$0 co-pay
$0 co-pay per admission
$0 co-pay per admission
Ambulance
Hospitalization
• Inpatient
• Outpatient hospital services
• Emergency Room
Immunizations
• Includes flu injections and all Medicare approved immunizations
Laboratory Services
$20 co-pay
$20 co-pay
$50 co-pay/waived if admitted within 24 hrs for the same
condition
$50 co-pay/waived if admitted within 24 hrs for the same
condition
$0 co-pay*
$0 co-pay*
No charge
No charge
$10 co-pay per visit (subject to medical necessity)
$20 co-pay per visit (subject to medical necessity)
No charge for day 1-150
Member pays 100% from day 151 and over
No charge for day 1-150
Member pays 100% from day 151 and over
$20 co-pay
$20 co-pay
• Office visits
$20 co-pay
$20 co-pay
• Consultation, diagnosis & treatment by a specialist
$20 co-pay
$20 co-pay
Prescription Drugs
30 day supply at Retail and 90 day supply through Mail Order
10/30/50 Three Tiered Plan
10/30/50 Three Tiered Plan
Generic
$10 Retail, $20 Mail order
$10 Retail, $20 Mail order
Preferred Brand
$30 Retail, $60 Mail order
$30 Retail, $60 Mail order
Non-Preferred Brand
$50 Retail, $100 Mail order
$50 Retail, $100 Mail order
Injectables
20% up to $100 per prescription Retail, $300 Mail order
20% up to $100 per prescription Retail, $300 Mail order
Specialty
20% up to $100 per prescription Retail, $300 Mail order
20% up to $100 per prescription Retail, $300 Mail order
Covered in full for 100 days per benefit period
Covered in full for 100 days per benefit period
$0 co-pay*
$0 co-pay*
2014 - 2015
$406
2015 - 2016
$428
$0
$0
$0
$0
Manual Manipulation of the Spine
Mental Health - Inpatient
Mental Health - Outpatient unlimited visits
Physician Services/Basic Health Services
Skilled Nursing Facility
X-Ray Services
• Includes routine annual mammography
Rates
Retiree
Total Monthly Premium
Total Annual Premium
0
© 2015 Alliant Insurance Services, Inc. All rights reserved. Alliant Employee Benefits, a division of Alliant Insurance Services, Inc. CA License No. 0C36861
13
2015/16 FINAL RATES & BENEFITS
COMPANIONCARE – RETIREE PLAN
Anthem CompanionCare - RETIREE PLAN
Effective October 1, 2015
CompanionCare
Current / Renewal
Pays $1260 (1-60 days)
Pays $315 a day (61-90 days)
Pays $630 a day (91-150 days)
Pays 100% after Medicare and Lifetime reserve are exhausted up to 365
days per lifetime
Pays nothing
Pays $157.50 a day for 21st to 100th day
Pays nothing after 100th day
Pays $147
Pays 20% MA charges including 100% of Medicare Part B deductible
Pays 20% MA charges
SERVICES
Inpatient Hospital (Part A)
Skilled Nursing Facilites
(Must be approved by Medicare)
Deductible (Part B)
Basis of Payment (Part B)
Medical Services (Part B)
Doctor, x-ray, appliances, &
ambulance Lab
Pays nothing
Pays 20% MA charges up to the Medicare annual benefit amount.
(Physical & Speech Therapy Combined)
Pays 1st 3 pints unreplaced blood and 20% MA charges
Physical/Speech Therapy (Part B)
Blood (Part B)
Travel Coverage
(when outside the US for less than 6
consecutive months)
Pays 80% inpatient hospital, surgery, anesthetist and in hospital visits for
medically necessary services for 90 days of treatment per lifetime
* Generic: $9 co-pay for a 30-day supply at a retail pharmacy or $18 copay for a 90-day supply through home delivery service
* Brand: $35 co-pay for a 30-day supply at a retail pharmacy or $90 copay for a 90-day supply through home delivery service
Outpatient Prescription Drugs
(Navitus)
CompanionCare EMPLOYEES
Retiree
Total Monthly Premium
Total Annual Premium
EE
2014 - 2015
2015 - 2016
8
$370
$2,960
$35,520
$385
$3,080
$36,960
8
$ ∆ to Current
$1,440
% ∆ to Current
4.1%
© 2015 Alliant Insurance Services, Inc. All rights reserved. Alliant Employee Benefits, a division of Alliant Insurance Services, Inc. CA License No. 0C36861
14
2015/16 FINAL RATES & BENEFITS
KAISER PERMANENTE INDIVIDUAL RETIREE PLAN
KAISER PERMANENTE INDIVIDUAL RETIREE PLAN
Effective October 1, 2015
SERVICES
Hospitalization
* Inpatient
* Emergency Room
Skilled Nursing Facility
Physician Services/Basic Health Services
* Office visits
* Consultation, diagnosis, and treatment by a
specialist
X-Ray Services
* Includes routine annual mammography
Laboratory Services
Annual Physical Examination
* Includes pap smears
Current
Renewal
$200/Admit
$50 co-pay/waived if admitted
$0/Admit
$50 co-pay/waived if admitted
Covered in full for 100 days per
benefit period
Covered in full for 100 days per benefit
period
$10 co-pay per visit
$10 co-pay per visit
No charge
No charge
No charge
No charge
$10 co-pay per visit
$10 co-pay per visit
Chiropractic/Acupuncture
* ASH Network
$10 co-pay per visit/ 30 visits combined
Outpatient Mental Health / Unlimited Visits
Vision Care
* Examination for eyeglasses
* Glaucoma testing
* Standard frame/lenses every 24 months
Dental Care (DeltaCare)
Hearing Examination
Immunizations
* Includes flu injections and all Medicare approved
immunizations
Ambulance
$10 co-pay per visit; $5 co-pay per
group visit
$10 co-pay per visit; $5 co-pay per
group visit
$10 per visit
$10 co-pay per visit
$150 frame and lens allowance every
24 months
Not covered
$10 co-pay per visit
$10 per visit
$10 co-pay per visit
$150 frame and lens allowance every
24 months
Not covered
$10 co-pay per visit
No charge
Manual Manipulation of the Spine
Prescription Drugs
Retiree Over Age 65
Subscriber w/Medicare
Subscriber w/Medicare + Spouse w/Medicare
1
Total Monthly Premium
Total Annual Premium
$ ∆ to Current
% ∆ to Current
2
1
1
No charge
1
$50/Trip
$50/Trip
$10 co-pay per visit
$10 co-pay per visit
(subject to medical necessity)
(subject to medical necessity)
$10 co-pay per generic/$20 co-pay $10 co-pay per generic/$20 co-pay per
per brand name up to 100-day supply
brand name up to $100 day supply at
at Kaiser pharmacies
Kaiser pharmacies
2014 - 2015
2015 - 2016
$329
$330
$658
$660
$987
$990
$11,844
$11,880
$36
0.30%
© 2015 Alliant Insurance Services, Inc. All rights reserved. Alliant Employee Benefits, a division of Alliant Insurance Services, Inc. CA License No. 0C36861
15
2014/15 FINAL RATES & BENEFITS
DELTA DENTAL PPO + PREMIER (ACSIG) - 3% ESTIMATED
DELTA DENTAL PPO PLAN OVERVIEW ACSIG
Effective October 1, 2015
2015 / 2016 Illustrative Rates with a 3% Increase
ACTIVES
Delta Dental PPO
Dental Benefits
Calendar Year Maximum
Calendar Year Deductible
Individual / Family
Diagnostic and Preventive
Oral Exam & X-Rays
Teeth Cleaning
Fluoride Treatment
Space Maintainers
Bitewings
Basic Services & Crowns
Amalgam/Composite Fillings
Periodontics (Gum disease)
Endodontics (Root Canal)
Extractions & Oral Surgrey
Sealants
Crown Repair
Restorative - Inlays and Crowns
Prosthodontics
Orthodontics
Eligible for Benefit
Lifetime Maximum
Dental Accident
Lifetime Maximum
PPO Premier
PPO Premier
Out-of-Network
PPO Premier
PPO Premier
Out-of-Network
$2,000/Member
$2,000/Member
$2,000/Member
$2,000/Member
None
None
None
None
70-100%
70-100%
70-100%
70-100%
70-100%
70-100%
70-100%
70-100%
50%
60%
50%
60%
50%
Child(ren) Only
$1,000
100%
$1,000/Member
100%
$1,000/Member
1 Year
1 Year
Rate Guarantee
Active
Employee Only
Employee + 1 Dependent
Employee + 2 or More Dependents
Total Monthly Premium
Total Annual Premium
$ ∆ to Current
% ∆ to Current
EE
188
120
157
465
RETIREES
2014 - 2015
$67.29
$132.73
$196.73
2015 - 2016
$69.31
$136.71
$202.63
$59,465
$713,577
$61,249
$734,984
$21,407
3%
Not Covered
EE
80
77
5
162
2014 - 2015
$65.09
$117.88
$169.52
2015 - 2016
$67.04
$121.42
$174.61
$15,132
$181,579
$15,586
$187,026
$5,447
3%
© 2015 Alliant Insurance Services, Inc. All rights reserved. Alliant Employee Benefits, a division of Alliant Insurance Services, Inc. CA License No. 0C36861
16
NEXT STEPS
 Future Committee Meeting Date
 May 14
 SISC
 District must submit any desired benefit changes to SISC by August 1
 ACSIG – Delta Dental Renewal
 ACSIG Board meeting on May 22
 Expect to have Cabrillo College’s specific Dental renewal no later than May 28
 Open Enrollment Dates?
© 2015 Alliant Insurance Services, Inc. All rights reserved. Alliant Employee Benefits, a division of Alliant Insurance Services, Inc. CA License No. 0C36861
17
NOTES
© 2015 Alliant Insurance Services, Inc. All rights reserved. Alliant Employee Benefits, a division of Alliant Insurance Services, Inc. CA License No. 0C36861
18
Public Entity Benefits Group
100 Pine Street, 11th Floor
San Francisco, CA 94111