Benefits Committee Meeting
March 30,, 2012
Table of Contents/Agenda:
Section 1:
October 2011 Renewal Overview
-Current Rates & Benefits
Section 2:
October 2012 Renewal Planning
- Renewal
R
l Schedule
S h d l
- Goals & Objectives
Section 3:
Options to Consider
- Recap
R
off 2011 Plan
Pl Options
O ti
Section 4:
SISC Updates
S ti 5:
Section
5
N t Steps
Next
St
Exhibits:
Health Care Reform
- Changes on the Horizon
2
Cabrillo College – March 30, 2012
Copyright © 2012 Alliant Insurance Services, Inc. Confidential; not for distribution
Section 1: October 2011 Renewal Overview
Medical HMO (SISC)

Cabrillo College renewed with Blue Shield (SISC)

High Option HMO $10-0: 5.6%

Low Option HMO $25-500 Admit; changed Rx from $5/$20 copay to $9/$35: 4.0%

Rate guaranteed for 1 year (10/1/2011 – 10/1/2012)
Medical PPO (SISC)

Cabrillo College renewed with Blue Shield (SISC)

High Plan 90-E $10: 4.9%

Medium Plan 80-G $10: 4.8%

Low Plan HDHP-B: 7.0%

Rate guaranteed for 1 year (10/1/2011 – 10/1/2012)
Dental PPO (ACSIG)

Cabrillo College renewed with Delta Dental

Dental PPO: 0.0%

Rate guaranteed for 1 year (10/1/2011 – 10/1/2012)
CompanionCare (Individual Retiree Plan)

Cabrillo College renewed with CompanionCare

C
CompanionCare:
i C
-2.3%
2 3%

Rate guaranteed for 1 year (10/1/2011 – 10/1/2012)
Kaiser Permanente (Individual Retiree Plan)

Cabrillo College renewed with Kaiser Permanente

Kaiser Permanente : 0
0.0%
0%

Rate guaranteed for 1 year (10/1/2011 – 10/1/2012)
3
Cabrillo College – March 30, 2012
Copyright © 2012 Alliant Insurance Services, Inc. Confidential; not for distribution
Section 1: October 2011 Renewal Overview
Trend Surveys
Medical (Actives & Retirees < 65)
Fee-for-Service (FFS)/Indemnity Plans
High-Deductible Health Plans (HDHPs)**
Open-Access Preferred Provide Organizations
(PPOs/Point-of-Service (POS) Plans ***
PPOs/POS Plans (with PCP GateKeepers)
Health Maintenance Organizations (HMO's)
Segal
Aon Hewitt (Summer 2011)
(w/o Rx)
w/Rx
10.5%
10.1%
9.8%
9.7%
(w/o Rx)
11.7%
10.4%
w/Rx
10.9%
9.8%
10.0%
9.5%
9.9%
10.0%
10.4%
9.6%
9.8%
9.2%
10.3%
10.1%
10.0%
9.8%
* Trend projections w ere derived by proportionally blending medical trends and freestanding prescription drug trends.
** HDHPs are defined as those plans w here the deductible is at least the minumum health savings account (HSA) level required
by the Internal Revenue Service ($1,200 single, $2.400 family in 2012)
*** Open-access PPO/POS plans are those that do not require a primary care physician (PCP) gatekeeper referral for specialty services.
Year
2006
2007
2008
2009
2010
2011
2012
PPO Renewal / Trend Summary
SISC PPO
CalPERS PERS
Statewide
Choice PPO
Renewals
Renewal *
6.80%
9.43%
7.50%
12.50%
4.80%
9.00%
0.00%
0.00%
11.60%
2.00%
6.7%,
9.89%
TBD
1.91%
CA PPO Trend
10.00%
11.00%
10.00%
10.00%
11.00%
12.00%
9.80%
AVERAGE
6.1%
6.39%
10.54%
* CalPERS PERSChoice renewal figures represent overall statewide figure as published by CalPERS
4
Cabrillo College – March 30, 2012
Copyright © 2012 Alliant Insurance Services, Inc. Confidential; not for distribution
Section 1: October 2011 Renewal Overview
Financial Summary
Li off Coverage
Line
C
E ll
Enrollees
BLUE SHIELD ACTIVE EMPLOYEES
HMO High ($10 copay)
78
HMO Low ($25 copay)
293
PPO High ($300 ded)
76
PPO Med ($500 ded)
33
PPO Low ($2,500 ded)
31
BLUE SHIELD RETIREE INCLUDING EARLY RETIREE
HMO High ($10 copay)
13
HMO Low ($25 copay)
11
PPO High ($300 ded)
94
PPO Med ($500 ded)
4
PPO Low ($2,500 ded)
2
COMPANIONCARE (INDIVIDUAL RETIREE PLAN)
CompanionCare (Individual Retiree Plan)
8
KAISER PERMANENTE (INDIVIDUAL RETIREE
PLAN)
KP ((Individual Retiree Plan))
1
DELTA DENTAL
Active
521
Retirees
126
MONTHLY TOTAL
ANNUAL TOTAL
644
10/1/2010
10/1/2011
$∆
%∆
$215,530
$230,785
$114 563
$114,563
$37,871
$18,200
$227,588
$240,107
$120 128
$120,128
$39,690
$19,467
$12,058
$9,322
$5 565
$5,565
$1,819
$1,267
5.6%
4.0%
4 9%
4.9%
4.8%
7.0%
$15,368
$8,902
$69,511
$2,452
$962
$16,196
$9,184
$73,104
$2,580
$1,030
$828
$282
$3,593
$128
$68
5.4%
3.2%
5.2%
5.2%
7.1%
$4,807
$4,697
-$110
-2.3%
$324
$324
$0
0.0%
$64,641
$10,422
$64,641
$10,422
$0
$0
0.0%
0.0%
$794,338
$829,158
$34,820
4.4%
$9,532,059
$9,949,899
$417,840
4.4%
5
Cabrillo College – March 30, 2012
Copyright © 2012 Alliant Insurance Services, Inc. Confidential; not for distribution
Section 1: October 2011 Renewal Overview
Current Benefits
None
High PPO
(90-E $10, Rx 5-20 w $100 brand
deductible)
$300 p/ind; $600 p/fam
Medium PPO
(80-G $10, Rx 5-20 w $100 brand
deductible)
$500 p/ind; $1,000 p/fam
$1,000 / $2,000
$2,000 / $4,000
$600 / $1,800
$1,000 p/ind; $3,000 per fam
MAJOR MEDICAL
Physician Office Visit
Specialist Visit
Preventive Care
Inpatient Hospital
Lab & X-Ray
$10
$10/$30
No charge
No charge
No charge
Outpatient Surgery
No charge
$25
$25/$30
$0
$500 / Admit
No charge
$150 at an Ambulatory Surgery
Center; $300 at a Hospital
$100 (waived if admitted)
$500 / Admit
$500 / Admit
$25 per visit
Medco
Generic/Brand**
$ $
$9/$35
$18/$90
N/A
Benefits
Calendar Year Deductible
Calendar Year Copayment Maximum
Individual / Family
Emergency Room
Mental Health Care/Substance Abuse
Inpatient hospital facility
Outpatient Physician Visit
Outpatient Prescription Drugs
(At participating Pharmacies only)
Retail - 30 day supply
Mail order - 90 day supply
Annual Deductible
High HMO
$10-0 w/Chiro
Low HMO
$25-500 w/Chiro
None
$100 (waived if admitted)
No charge
No charge
$10
Medco
Generic/Brand**
$ $
$5/$10
$10/$20
N/A
Low PPO
(HDHP -B w/HSA Compatibility)
$2,500 p/ind; $5,000 p/fam
$5,000 p/ind or $10,000 per fam
In Network
$10
$10
Ded waived; 100%
90%
90%
Out of Network
50%
50%
50%
$600 p/day
50%
In Network
$10
$10
Ded waived; 100%
80%
80%
Out of Network
50%
50%
50%
$600 p/day
50%
In Network
90%
90%
Ded waived; 100%
90%
90%
Out of Network
50%
50%
50%
$600 p/day
50%
90%
$350 p/day
80%
$350 p/day
90%
$350 p/day
$100 copay
$100 copay
$100 copay
90%
50%
80%
50%
90%
50%
90%
50%
80%
50%
90%
50%
90%
50%
80%
50%
90%
50%
Medco Rx plan $5-20 w/$100 brand ded Medco Rx plan $5-20 w/$100 brand ded Rx w/ Blue Shield Contracted Provider
Generic/Brand**
Generic/Brand**
Generic/Brand**
$
$5
$
$10
$$5
$
$10
$
$7
$
$14
$20
$50
$20
$50
$25
$14
$100 per individual up to $300 per family $100 per individual up to $300 per family
$2,500 medical deductible must be met
6
Cabrillo College – March 30, 2012
Copyright © 2012 Alliant Insurance Services, Inc. Confidential; not for distribution
Section 1: October 2011 Renewal Overview
Current Rates (Active Employee Rates and Contributions)
HIGH HMO
($10-0 w/Chiro)
Actives
Employee Only
Employee +1
Family
MONTHLY PREMIUM
ANNUAL PREMIUM
TOTAL MONTHLY PREMIUM
TOTAL ANNUAL PREMIUM
Employee Contributions
Employee Only
Employee +1
Family
y
MONTHLY CONTRIBUTION
ANNUAL CONTRIBUTION
TOTAL MONTHLY CONTRIBUTION
TOTAL ANNUAL CONTRIBUTION
30
17
31
78
10/1/2011
$780
$1,559
$2,149
$116,522
$
,
$1,398,264
HIGH PPO
(90-E $10, Rx 5-20 w
$100 brand)
LOW HMO ($25
($25-$500
$500
w/Chiro)
138
59
96
293
10/1/2011
$644
$1,288
$1,777
$335,456
$
,
$4,025,472
42
23
11
76
10/1/2011
$853
$1,514
$2,320
$96,168
$
,
$1,154,016
MEDIUM PPO
(80-G $10, Rx 5-20 w
$100 brand)
14
11
8
33
10/1/2011
$774
$1,373
$2,100
$42,739
$
,
$512,868
LOW PPO
(HDHP-B w/H.S.A.
Compatibility)
25
2
4
31
10/1/2011
$577
$1,030
$1,611
$22,929
$
,
$275,148
$613,814
$7,365,768
HIGH HMO
($10-0 w/Chiro)
LOW HMO ($25-$500
w/Chiro)
HIGH PPO
(90-E $10, Rx 5-20 w
$100 brand)
MEDIUM PPO
(80-G $10, Rx 5-20 w
$100 brand)
LOW PPO
(HDHP-B w/H.S.A.
Compatibility)
10/1/2011
$136
$271
$372
$
$20,219
$242,628
10/1/2011
$0
$0
$0
$
$0
$0
10/1/2011
$209
$226
$543
$
$19,949
$239,388
10/1/2011
$130
$85
$323
$
$5,339
$64,068
10/1/2011
$0
$0
$0
$
$0
$0
$45,507
$546,084
7
Cabrillo College – March 30, 2012
Copyright © 2012 Alliant Insurance Services, Inc. Confidential; not for distribution
Section 1: October 2011 Renewal Overview
Current Rates & Benefits (CompanionCare Retiree Plan)
S
SERVICES
C S
MEDICARE
CompanionCare
2011 Benefits
Based on 2011 Medicare Benefits
Pays all but first $1132 for 1st
60 days
Pays all but first $283 a day for
the 61st to 90th day
Inpatient Hospital (Part A)
Pays $1132
Pays $283 a day
Pays all but $566 a day Lifetime
y
Reserve for 91st to 150th day
Pays $566 a day
Pays nothing after Lifetime
Reserve is used
Pays 100% for 1st 20 days
Pays all but $141.50 a day for
21st to 100th day
Pays nothing after 100th day
Pays 100% for 151st day to 515th
day
Pays nothing
Pays $141.50 a day for 21st to 100th
day
Pays nothing after 100th day
Deductible (Part B)
$162 Part B deductible per year
Pays $162
Basis of Payment (Part B)
80% Medicare Approved (MA)
charges after Part B deductible
80% MA charges
20% MA charges including 100% of
Medicare Part B deductible
20% MA charges
100% of MA charges
Pays nothing
Skilled Nursing Facilites
(Must be approved by Medicare)
Medical Services (Part B)
Doctor, x-ray, appliances, &
ambulance Lab
20% MA charges up to the Medicare
80% MA Charges up to the
annual benefit amount. (Physical &
Medicare annual benefit amount
p
Therapy
py Combined))
Speech
Pays 1st 3 pints unreplaced blood
80% MA charges after 3 pints
and 20% MA charges
Pays 80% inpatient hospital, surgery,
Not covered
anestetist and in hospital visits for
medically necessary services for 90
Physical/Speech Therapy (Part B)
Blood (Part B)
Travel Coverage
(when outside the US for less than 6
consecutive months)
Rx drug plan enhanced through Medco Health effective 1/1/2012
Outpatient Presrciption Drugs
CompanionCare EMPLOYEES
Retiree
Retiree plus 1 dependent
TOTAL MONTHLY PREMIUM
TOTAL ANNUAL PREMIUM
EE
6
2
8
co pay for a 30-day
30 day
* Generic: $9 co-pay
SISC will automatically enroll supply at a retail pharmacy or $18 copay for a 90-day supply through
CompanionCare members into
home delivery service
Medicare Part D. No additional
* Brand: $35 co-pay for a 30-day
premium required. SISC plans
supply at a retail pharmacy or $90 coare not subject to the
pay for a 90-day supply through
'doughnout hole'.
home delivery service
Renewal
$427
$854
$4,270
$51,240
8
Cabrillo College – March 30, 2012
Copyright © 2012 Alliant Insurance Services, Inc. Confidential; not for distribution
Section 1: October 2011 Renewal Overview
Current Rates & Benefits (Kaiser Retiree Plan)
KAISER PERMANENTE
INDIVIDUAL RETIREE PLAN
SERVICES
Hospitalization
* Inpatient
* Emergency Room
$200/Admit
$50 co-pay/waived if admitted
Skilled Nursing Facility
Covered in full for 100 days per
benefit period
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
$10 co-pay per visit
No charge
No charge
$10 co-pay
co pay per visit
$10 co-pay per visit; $5 co-pay per
group visit
Outpatient Mental Health/20visits
Vision Care
* Examination for eyeglasses
* Glaucoma testing
* Standard frame/lenses every 24 months
$10 per visit
$10 co-pay per visit
$150 frame and lens allowance every
24 months
Not covered
$10 co-pay per visit
Dental Care (DeltaCare)
Hearing Examination
Immunizations
* Includes flu injections and all Medicare
approved immunizations
Ambulance
No charge
$50/Trip
$10 co-pay per visit
( bj t tto medical
(subject
di l necessity)
it )
Manual Manipulation of the Spine
Prescription Drugs
$10 co-pay per generic/$20 co-pay
per brand name up to $100 day
supply at Kaiser pharmacies
* Prescription drugs related to sexual dysfunction
50% co-insurance;
limited to 27 doses in any 100-day
period
RETIREE UNDER AGE 65
Retiree
TOTAL MONTHLY PREMIUM
TOTAL ANNUAL PREMIUM
1
Renewal
$324
$324
$3,888
9
Cabrillo College – March 30, 2012
Copyright © 2012 Alliant Insurance Services, Inc. Confidential; not for distribution
Section 1: October 2011 Renewal Overview
Current Rates & Benefits (Dental PPO Plan)
ACTIVES
RETIREES
Dental Benefits
In-Network
$2,000/Member
Calendar Year Maximum
Calendar Year Deductible
Individual / Family
Diagnostic
g
and Preventive
Oral Exam & X-Rays
Teeth Cleaning
Fluoride Treatment
Space Maintainers
Bitewings
Basic Services & Crowns
A l
Amalgam/Composite
/C
it Filli
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
RATE GUARANTEE
ACTIVES RATES
Employee Only
Employee + 1 Dependent
E l
Employee
+ 2 or M
More D
Dependents
d t
EE
229
126
166
Out-of-Network
$2,000/Member
Out-of-Network
$2,000/Member
None
None
None
None
70-100%
70-100%
70-100%
70-100%
70-100%
70-100%
70-100%
70-100%
60%
50%
60%
50%
50%
Child(ren) Only
$1,000
100%
$1,000/Member
100%
$1,000/Member
1 Year
1 Year
10/1/2011
$65.92
$130.03
$192 72
$192.72
521
MONTHLY PREMIUM
ANNUAL PREMIUM
In-Network
$2,000/Member
Not Covered
EE
63
61
2
10/1/2011
$63.76
$115.48
$166 07
$166.07
126
$63,471
$761,652
$11,393
$136,720
10
Cabrillo College – March 30, 2012
Copyright © 2012 Alliant Insurance Services, Inc. Confidential; not for distribution
Section 2: October 2012 Renewal Planning
Renewal Schedule
Coverages
Effective Date
Release Date
10/1/2012
May 18, 2012
10/1/2012
Mid July 2012
Medical
Blue Shield HMO, PPO, H.S.A.
Dental
Delta Dental PPO
11
Cabrillo College – March 30, 2012
Copyright © 2012 Alliant Insurance Services, Inc. Confidential; not for distribution
Section 3: Options to Consider
Recap of October 2011 Plan Options – HMO High
Renewal
Alternative 1
Alternative 2
None
HMO 10
10-0
0 w/Chiro
/Chi
$5/$20 Rx
None
HMO 20
20-250
250 w/Chiro
/Chi
$5/$10
None
$1,000 / $2,000
$1,000 / $2,000
$1,500/$3,000
$10
$10/$30**
No charge
No charge
$10
$10/$30**
No charge
No charge
No charge
No charge
$20
$
$20/$30**
No charge
No charge
$100 performed in an ASC;
$150 in a hospital
No charge
g
No charge
g
$250 / admission
$
$100
$100 (waived if admitted)
20%**
$10 in your service area;
$50 outside your service area
$100
$100 (waived if admitted)
20%**
$10 in your service area;
$50 outside your service area
Chiropractic Services (see separate
rider)
$10
(up to 30 visits per cal year)**
$10
(up to 30 visits per cal year)**
$100
$100 (waived if admitted)
20%**
$20 in your service area;
$50 outside your service area
$10
(up to 30 visits per cal year)**
Skilled Nursing (up to 100/days/cal year
Home Health Care
No charge
$10 (up to 100 visits p/cal yr)
No charge
$10 (up to 100 visits p/cal yr)
$100/day
$25 (up to 100 visits p/cal yr)
No charge
No charge
$250 / admission
$
$10
$
$10
$20
No charge
No charge
$250 / admission
$10
Medco
Generic/Brand**
Generic/Brand
$5/$10
$10/$20
$10
Medco
Generic/Brand**
Generic/Brand
$5/$20
$10/$50
$20
Medco
Generic/Brand**
Generic/Brand
$5/$10
$10/$20
5.6%
4.3%
-2.7%
Pl
Plans
Calendar Year Deductible
Calendar Year Copayment Maximum
Individual / Family
MAJOR MEDICAL
y
Office Visit
Physician
Specialist Visit
Preventive Care
Lab & X-Ray
Outpatient Surgery
Hospitalization
I
Inpatient
ti t
Ambulance
Emergency Room
Durable Medical Equipment
Urgent Care
Mental Health Care
Inpatient hospital facility
Outpatient Physician Visit
Substance Abuse - (see separate rider)
Inpatient Detox
Inpatient hospital facility
Outpatient Physician Visit
Outpatient Prescription Drugs
(At participating Pharmacies only)
Retail - 30 day supply
Mail order - 90 day supply
% ∆ to Current
Cabrillo College – March 30, 2012
High HMO $10-0 w/Chiro
Copyright © 2012 Alliant Insurance Services, Inc. Confidential; not for distribution
12
Section 3: Options to Consider
Recap of October 2011 Plan Options – HMO Low
None
Alternative 1
HMO $25-500 w/Chiro
$7/$25 Rx
None
New Low HMO Plan effective 10/1/2011
HMO $25-500 w/Chiro
$9/$35 Rx
None
Alternative 3
HMO 30-20% Zero Facility
$5/$10 Rx
None
$2,000 / $4,000
$2,000 / $4,000
$2,000 / $4,000
$1,500 p/member
$25
$25/$30
$25/$30**
$0
No charge
$150 at an Ambulatory Surgery
Center; $300 at a Hospital
$25
$25/$30
$25/$30**
$0
No charge
$150 at an Ambulatory Surgery
Center; $300 at a Hospital
$25
$25/$30
$25/$30**
$0
No charge
$150 at an Ambulatory Surgery
Center; $300 at a Hospital
$30
$30/$45
$30/$45**
$0
No charge
$500 / Admit
$500 / Admit
$500 / Admit
20%
$100
$100 ((waived
i d if admitted)
d itt d)
$100
$100 (waived
( i d if admitted)
d itt d)
$100
$100 ((waived
i d if admitted)
d itt d)
$100
$150 ((waived
i d if admitted)
d itt d)
20%**
20%**
20%**
50%**
Urgent Care
$25 in your service area;
$50 outside your service area
$25 in your service area;
$50 outside your service area
$25 in your service area;
$50 outside your service area
$30 in your service area;
$50 outside your service area
Chiropractic Services (see separate
rider)
$10
(up to 30 visits per cal year)**
$10
(up to $30 visits per cal year)**
$10
(up to 30 visits per cal year)**
$10
(up to 30 visits per cal year)**
Skilled Nursing (up to 100/days/cal year
Home Health Care
$100 per day
$25 (up to 100 visits p/cal yr)
$100 per day
$25 (up to 100 visits p/cal yr)
$100 per day
$25 (up to 100 visits p/cal yr)
20%
$20 (up to 100 visits p/cal yr)
$500 / Admit
$500 / Admit
$500 / Admit
20%
$25 per visit
$25 per visit**
$25 per visit
$30 per visit
$500 / Admit
$500 / Admit
$500 / Admit
20%
$25
Medco
Generic/Brand**
$5/$20
$10/$50
Self Injectables;
Covered at generic or brand
$25**
Medco
Generic/Brand**
$7/$25
$14/$60
Self Injectables;
Covered at generic or brand
$25
Medco
Generic/Brand**
$9/$35
$18/$90
Self Injectables;
Covered at generic or brand
FINAL
$30
Medco
Generic/Brand**
$5/$10
$10/$20
Self Injectables;
Covered at generic or brand
5.5%
4.9%
4.0%
-1.2%
2011 Renewal
Plans
Calendar Year Deductible
Calendar Year Copayment Maximum
Individual / Family
MAJOR MEDICAL
Physician Office Visit
Specialist Visit
Preventive Care
Lab & X-Ray
Outpatient Surgery
Hospitalization
Inpatient
Ambulance
E
Emergency
Room
R
Low HMO $25-500 w/Chiro
Durable Medical Equipment
Mental Health Care
Inpatient hospital facility
Outpatient Physician Visit
Substance Abuse - (see separate rider)
Inpatient Detox
I
Inpatient
ti t hospital
h
it l facility
f ilit
Outpatient Physician Visit
Outpatient Prescription Drugs
(At participating Pharmacies only)
Retail - 30 day supply
Mail order - 90 day supply
No annual deductible
% ∆ to 2011
No charge
Cabrillo changed to this plan
for 10.01.2011
Cabrillo College – March 30, 2012
Copyright © 2012 Alliant Insurance Services, Inc. Confidential; not for distribution
13
Section 3: Options to Consider
Recap of October 2011 Plan Options - PPO High
Plans
Calendar Year Deductible(s)
Maximum *Co-Insurance
Services
Office Visits
Inpatient Hospital
Room, Board & Support Services
(prior authorization required)
Emergency Room (non-emergency)
Preventive Care
Routine Exam
Diagnostic X-Ray & Lab
Chiropractic
Physical Medicine PT, OT
Ambulance
Home Health Care
100 visits/yr (prior authorization required)
Psychiatric
Inpatient
Outpatient Visits For Severe Conditions
Outpatient Visits For Non-Severe Conditions
Substance Abuse
Inpatient For Acute Detox
Outpatient Visits
Outpatient Prescription Drugs
Supply
Generic Drugs
Single Source Brand Name Drugs
Multi Source Brand Name Drugs
Brand Name Calendar Year Deductible
% ∆ from 2011
Renewal
Alternative 1
Alternative 2
Alternative 3
Alternative 4
PPO High
(90-E $10, Rx 5-20 w $100 brand deductible)
90-C $30
Rx $7/$25
80%-C $20
Rx $5/$20
80%-D $20
Rx $5/$20
80%-D $30
Rx $5/$20
$300 p/ind; $600 p/fam
$600 p/ind; $1,800 per fam
In Network
Out of Network
$10; (does not apply to
deductible or coinsurance
50%
max.)
90%
$600 p/day
$100 copay
Ded waived; 100%
50%
Ded waived; 100%
Not Covered
90%
50%
20 Visits per year
90%
50%
90%
50%
90%
90%
90%
Not covered unless pre auth
$200 p/ind; $500 p/fam
$300 p/ind; $900 per fam
In Network
Out of Network
$30; (does not apply to
deductible or coinsurance
50%
max.)
90%
$600 p/day
$100 copay
Ded waived; 100%
50%
Ded waived; 100%
Not Covered
90%
50%
20 Visits per year
90%
50%
90%
50%
90%
90%
90%
Not covered unless pre auth
$200 p/ind; $500 p/fam
$500 p/ind; $1,500 per fam
In Network
Out of Network
$20; (does not apply to
deductible or coinsurance
50%
max)
80%
$600 p/day
$100 copay
Ded waived; 100%
50%
Ded waived; 100%
Not Covered
80%
50%
20 Visits per year
80%
50%
80%
50%
80%
80%
80%
Not covered unless pre auth
$200 p/ind; $500 p/fam
$1,000 p/ind; $3,000 per fam
In Network
Out of Network
$20; (does not apply to
deductible or coinsurance
50%
max)
80%
$600 p/day
$100 copay
Ded waived; 100%
50%
Ded waived; 100%
Not Covered
80%
50%
20 Visits per year
80%
50%
50%
80%
80%
80%
80%
Not covered unless pre auth
$200 p/ind; $500 p/fam
$1,000 p/ind; $3,000 per fam
In Network
Out of Network
$30; (does not apply to
deductible or coinsurance
50%
max)
80%
$600 p/day
$100 copay
Ded waived; 100%
50%
Ded waived; 100%
Not Covered
80%
50%
20 Visits per year
80%
50%
80%
50%
80%
80%
80%
Not covered unless pre auth
90%
$600 p/day
90%
$600 p/day
80%
$600 p/day
80%
$600 p/day
80%
$600 p/day
$10 copay
50%
$30 copay
50%
$20 copay
50%
$20 copay
50%
$30 copay
50%
90%
$600 p/day
90%
$600 p/day
80%
$600 p/day
80%
$600 p/day
80%
$600 p/day
$10 copay
50%
Medco Rx plan $5-20 w/$100 brand ded
Retail
Mail
30 days
90 days
$5
$10
$20
$50
$5 + cost diff
$10 + cost diff
$100 per individual up to $300 per family
$30 copay
50%
Medco Rx plan $7/$25
Retail
Mail
30 days
90 days
$7
$14
$25
$60
$7 + cost diff
$14 + cost diff
None
4.9%
3.4%
$10 copay
50%
Medco Rx plan $5/$20
Retail
Mail
30 days
90 days
$5
$10
$20
$50
None
$10 copay
50%
Medco Rx plan $5/$20
Retail
Mail
30 days
90 days
$5
$10
$20
$50
$5 + cost diff
$10 + cost diff
None
$10 copay
50%
Medco Rx plan $5/$20
Retail
Mail
30 days
90 days
$5
$10
$20
$50
$5 + cost diff
$10 + cost diff
None
3.6%
1.80%
-0.2%
14
Cabrillo College - March 30, 2012
Copyright © 2012 Alliant Insurance Services, Inc. Confidential; not for distribution
Section 3: Options to Consider
Recap of October 2011 Plan Options - PPO Medium
Plans
Calendar Year Deductible(s)
Maximum *Co-Insurance
Services
Office Visits
Inpatient Hospital
Room, Board & Support Services
(prior authorization required)
Emergency Room (non-emergency)
Facility Expenses:
Professional Expenses:
Preventative Care
Routine Exam
Chiropractic
Physical Medicine PT, OT
Ambulance
Home Health Care
100 visits/yr (prior authorization required)
Psychiatric
Inpatient
Outpatient Visits For Severe Conditions
Outpatient Visits For Non-Severe Conditions
Substance Abuse
Inpatient For Acute Detox
Outpatient Visits
Outpatient Prescription Drugs
Supply
Generic Drugs
Single Source Brand Name Drugs
Multi Source Brand Name Drugs
Brand Name Calendar Year Deductible
% ∆ from 2011
Renewal
Alternative 1
Alternative 2
Alternative 3
Alternative 4
PPO Medium (80-G $10, Rx 5-20
w $100 brand deductible)
80%-E $30
Rx $9/$35
80%-G $30
Rx $5/$20
80%-G $20
Rx $5/$20
80%-D $30
Rx $5/$20
$500 p/ind; $1,000 p/fam
$1,000 p/ind; $3,000 per fam
In Network
Out of Network
$10;
does not apply to ded or max
50%
80%
$600 p/day
$100 copay
80%
90% of eligible expenses
80%
50%
Ded waived; 100%
50%
Ded waived; 100%
Not Covered
20 Visits per year
80%
50%
80%
50%
80%
80%
$300 p/ind; $600 p/fam
$1,000 p/ind; $3,000 per fam
In Network
Out of Network
$30; (does not apply to
deductible or
50%
coinsurance max)
80%
$600 p/day
$100 copay
80%
90% of eligible expenses
80%
50%
Ded waived; 100%
50%
Ded waived; 100%
Not Covered
20 Visits per year
80%
50%
80%
50%
80%
80%
Not covered unless pre
80%
auth
80%
Not covered unless pre auth
80%
$600 p/day
80%
$10 copay
50%
80%
$600 p/day
$500 p/ind; $1,000 p/fam
$1,000 p/ind; $3,000 per fam
In Network
Out of Network
$30; (does not apply to
deductible or
50%
coinsurance max)
80%
$600 p/day
$100 copay
80%
90% of eligible expenses
80%
50%
Ded waived; 100%
50%
Ded waived; 100%
Not Covered
20 Visits per year
80%
50%
80%
50%
80%
80%
Not covered unless pre
80%
auth
$600 p/day
80%
$30 copay
50%
80%
$600 p/day
$500 p/ind; $1,000 p/fam
$1,000 p/ind; $3,000 per fam
In Network
Out of Network
$20; (does not apply to
deductible or
50%
coinsurance max)
80%
$600 p/day
$100 copay
80%
90% of eligible expenses
80%
50%
Ded waived; 100%
50%
Ded waived; 100%
Not Covered
20 Visits per year
80%
50%
80%
50%
80%
80%
Not covered unless pre
80%
auth
$600 p/day
80%
$30 copay
50%
80%
$600 p/day
$200 p/ind; $500 p/fam
$1,000 p/ind; $3,000 per fam
In Network
Out of Network
$20; (does not apply to
deductible or
50%
coinsurance max)
80%
$600 p/day
$100 copay
80%
90% of eligible expenses
80%
50%
Ded waived; 100%
50%
Ded waived; 100%
Not Covered
20 Visits per year
80%
50%
80%
50%
80%
80%
Not covered unless pre
80%
auth
$600 p/day
80%
$600 p/day
$20 copay
50%
$20 copay
50%
80%
$600 p/day
80%
$600 p/day
$10 copay
50%
Medco Rx plan $5-20 w/$100 brand ded
Retail
Mail
30 days
90 days
$5
$10
$20
$50
$5 + cost diff
$10 + cost diff
$100 per individual up to $300 per family
$30 copay
50%
Medco Rx plan $9/$35
Retail
Mail
30 days
90 days
$9
$18
$35
$90
$9 + cost diff
$18 + cost diff
None
$30 copay
50%
Medco Rx plan $5/$20
Retail
Mail
30 days
90 days
$5
$10
$20
$50
$5 + cost diff
$10 + cost diff
None
$20 copay
50%
Medco Rx plan $5/$20
Retail
Mail
30 days
90 days
$5
$10
$20
$50
$5 + cost diff
$10 + cost diff
None
$20 copay
50%
Medco Rx plan $5/$20
Retail
Mail
30 days
90 days
$5
$10
$20
$50
$5 + cost diff
$10 + cost diff
None
4.8%
4.3%
2.1%
4.1%
-0.3%
15
Cabrillo Collge - March 30, 2012
Copyright © 2012 Alliant Insurance Services, Inc. Confidential; not for distribution
Section 3: Options to Consider
Recap of October 2011 Plan Options – PPO Low
Plans
Calendar Year Deductible(s)
Maximum *Co-Insurance
Services
Office Visits
Inpatient Hospital
Room, Board & Support Services
(prior authorization required)
Emergency Room (non-emergency)
Facility Expenses:
Professional Expenses:
Preventative Care
Routine Exam
Diagnostic X-Ray & Lab
Chiropractic
Ambulance
Home Health Care
100 visits/yr (prior authorization required)
Psychiatric
Inpatient
Outpatient Visits For Severe Conditions
Outpatient Visits For Non-Severe Conditions
Substance Abuse
Inpatient For Acute Detox
Outpatient Visits
Outpatient Prescription Drugs
Supply
Generic Drugs
Single Source Brand Name Drugs
Multi Source Brand Name Drugs
Brand Name Calendar Year Deductible
% ∆ from 2011
Renewal
Alternative 1
PPO Low
(HDHP -B w/HSA Compatibility)
HDHP A w HSA Compatibility
$2,500 p/ind; $5,000 p/fam
$5,000 p/ind or $10,000 per fam
In Network
Out of Network
90%
50%
90%
$600 p/day
$100 copay
90%
90% of eligible expenses
90%
50%
50%
Ded waived; 100%
Ded waived; 100%
Not Covered
90%
50%
12 Visits per year
90% up to $25 p/visit
50% up to $25 p/visit
90%
90%
Not covered unless pre
90%
auth
$1,200 p/ind; $2,400 p/fam
$5,000 p/ind or $10,000 per fam
In Network
Out of Network
90%
50%
90%
$600 p/day
$100 copay
90%
90% of eligible expenses
90%
50%
50%
Ded waived; 100%
Ded waived; 100%
Not Covered
90%
50%
12 Visits per year
90% up to $25 p/visit
50% up to $25 p/visit
90%
90%
Not covered unless pre
90%
auth
90%
$600 p/day
90%
$600 p/day
90%
50%
90%
50%
90%
$600 p/day
90%
$600 p/day
90%
50%
90%
50%
Rx w/ Blue Shield Contracted Provider
Rx w/ Blue Shield Contracted Provider
Retail
Mail
Retail
Mail
30 days
90 days
30 days
90 days
$7
$14
$7
$14
$25
$14
$25
$14
$25
$60
$25
$60
$2,500 medical deductible must be met before $1,200 medical deductible must be met before
co-pays apply
co-pays apply
7.0%
20.4%
16
Cabrillo College – March 30, 2012
Copyright © 2012 Alliant Insurance Services, Inc. Confidential; not for distribution
Section 4: SISC Updates
 No major changes for 10/01/2012
 Legislative Changes
 Women’s Preventive Services
 Changes to the CompanionCare Prescription plan
 Details to follow
 Rate Grid will be available May 18, 2012
 SISC needs final plan changes by August 1, 2012 for October 1, 2012 effective date
17
Cabrillo College – March 30, 2012
Copyright © 2012 Alliant Insurance Services, Inc. Confidential; not for distribution
Section 5: Next Steps
 Schedule meetings to discuss renewal and benefit options
 Set open enrollment dates
18
Cabrillo College – March 30, 2012
Copyright © 2012 Alliant Insurance Services, Inc. Confidential; not for distribution