NY44 Health Benefits Plan
Trust
Information Session
For
Elmira City SD
Presenters:
Dr. Darleen Michalak, Plan Administrator, NY44 Health Trust
Laura Wander and Amber Wallace, MVP
Regis Bernardi and Melissa Svarczkopf, Pharmacy Benefit
Dimensions
3/5/2015
Background Information:
• The Trust Plan (originally formed in 2003 at Erie 1
BOCES) is an Article 44 governed by the NYS Insurance
Department
• Collaborative approach with Trustees representing both
management and labor jointly making decisions
• Partnership through a third party administrator with
MVP for payment of medical claims and Pharmacy
Benefit Dimension (PBD) for payment of pharmacy
claims
• Plan Year runs from July 1- June 30
• Four Year commitment
2
Trust Objectives:
• Contain costs for health coverage
• Work collaboratively with labor and management and
TPAs
• Enhance benefits for enrollees, when possible
• Focus on health and wellness
• Comply with various mandates
(Patient Protection and Affordable Care Act Legislation)
3
Erie 1 BOCES Cost Containment
Plan Year
Single Contribution
(Monthly)
Family Contribution
(Monthly)
Percent
Increase
Total Annual Cost
Avoidance
2003-2004
$
253.45
$
702.04
8.0%
$
355,424.64
2004-2005
$
264.18
$
731.97
4.8%
$
627,709.44
2005-2006
$
278.81
$
767.82
5.3%
$
1,191,137.64
2006-2007
$
305.30
$
829.25
8.5%
$
1,729,859.64
2007-2008
$
332.50
$
903.00
8.9%
$
2,345,672.52
2008-2009
$
369.10
$
975.25
9.5%
$
2,897,929.92
2009-2010
$
407.32
$
1,068.03
9.5%
$
2,461,879.44
2010-2011
$
439.50
$
1,185.00
9.5%
$
2,418,795.84
2011-2012
$
479.50
$
1,266.00
7.9%
$
2,790,529.92
2012-2013
$
497.00
$
1,322.00
4.9%
$
3,412,936.20
2013-2014
$
526.50
$
1,400.00
5.9%
$
3,113,423.52
2014-2015
$
541.75
$
1,482.50
5.9%
$
3,425,400.00
Total Cost Avoidance 2003-2014
$26,726,854.80
4
Estimated Enrollment from
Fiscal Year 2003 - 2014
13700
14000
11700
12000
10000
9300
8000
8000
6600
6000
5500
4000
3100
1900
2000
1400
700
750
800
0
7/1/2003
7/1/2004
7/1/2005
7/1/2006
7/1/2007
7/1/2008
7/1/2009
7/1/2010
7/1/2011
7/1/2012
7/1/2013
7/1/2014
5
Western New York Schools
District/ School Name
Akron
Alden
Cheektowaga
Cheektowaga-Maryvale
Cheektowaga-Sloan
Cleveland Hill
Depew UFSD
Ellicottville
Elmwood Franklin School
Erie 1 BOCES
Gowanda
Grand Island
Hamburg
Iroquois
Kadimah
Lackawanna
Lewiston-Porter
Niagara Falls City
Niagara Wheatfield CSD
North Collins
Pioneer
South Buffalo Charter School
Springville Griffith Institute
St. Francis High School
St. Mary's School for the Deaf
Sweet Home
The Park School
West Seneca
28 IH/ Nova Schools
Represents Districts/ Schools with 100% participation
Administrative
Instructional
X
X
X
X
XX
X
X
X
X
X
X
X
XX
X
X
X
XX
X
XX
X
X
X
X
X
X
X
X
X
X
X
X
XX
XX
X
X
X
X
X
X
X
X
X
X
X
X
X
XX
X
X
X
X
X
Total IH/ Nova Units
Support
X
X
X
X
XX
XX
X
X
X
XX
X
X
XXX
X
X
X
XX
XX
X
XX
X
XXX
X
X
XX
X
96
6
Schools East of Buffalo
District/ School Name
Alfred-Almond
Bainbridge-Guilford
Canajoharie CSD
Candor CSD
Canisteo-Greenwood
DCMO BOCES
Elmira City SD
Elmira Heights
Franklin CSD
Fulton Montgomery Community College
Gilbertsville-Mt. Upton CSD
Greater Southern Tier BOCES
Madrid Waddington
Mechanicville CSD
North Rockland CSD
Norwich City SD
Odessa-Montour CSD
Oneida-Herkimer-Madison BOCES
Oppenheim-Ephratah-St. Johnsville
Oxford Academy
Spencer Van-Etten CSD
Watkins Glen CSD
Waverly CSD
23 MVP Schools
51 Schools in Total
Administrative
X
XX
X
X
X
Instructional
X
X
X
X
X
Support
X
X
X
X
X
XX
X
X
X
X
X
X
X
XX
X
X
X
XX
X
X
XX
X
X
X
XX
X
X
X
X
X
X
X
X
X
XXX
X
X
XX
X
XX
X
X
X
XX
X
X
X
X
X
X
X
X
X
XXX
XXXX
82
178
Total MVP Units
Total Participating Units
As of March 1, 2015, 51 Schools/ Districts and 178 separate units participate with the NY44 Health Trust
X
7
Contribution Rates
East Central New York State
Option A
Contribution Rates
2015-16
Monthly
Single
Enrollee + Spouse/
Domestic Partner
Enrollee + Child(ren)
Family
*+$7 PM/PM Administrative
Fee
$531.25
Annually
2014-15
Monthly
Annually
Percent
Increase
$6,375.00
$492.25
$5,907.00
7.9%
$1,401.00 $16,812.00
$1,298.50
$15,582.00
7.9%
$1,260.75 $15,129.00
$1,168.50
$14,022.00
7.9%
$1,483.00 $17,796.00
$1,374.50
$16,494.00
7.9%
8
Benefits in 2003-04:
• $0 Co-pay for Office Visits
• Dependent Coverage for College
Students – Age 25
• Health and Wellness Workshops
• $3/$15/$30 – 3 tier drug plan
Benefits as of July 1, 2014:
• $0 co-pay Office Visits
• $0 co-pay for Annual Eye Exam
• Dependent Coverage to Age 26
• Health and Wellness Workshops
• $0 co-pay for Tier 1 drugs;
$0/$15/$30 – 3 Tier drug plan
• $0 co-pay for diabetic supplies
and services for Tiers 1 and 2
• $0 co-pay for Tier 2 Inhaled
Corticosteroids
• Smoking Cessation – prescription
drugs added to the formulary
• Annual Healthy Living: Wellness
Reimbursement of $100 (S) /$150
(F)
$25 /$50 Reward for Annual
Physical with Primary Care
Physician
• Annual District Reimbursement
(up to $1,000)
9
Deductibles for In-Network:
(refer to the Benefit Grid in your folder)
• Emergency Services:
– Ambulance Transportation $25 co-pay
– Emergency Room Service $50 co-pay
(waived if admitted to hospital)
• Durable Medical Equipment (wheelchairs,
etc.) covered at 50%
• Prosthetics & Appliances covered at 50%
co-payment
• Prescription Plan $0/$15/$30
10
Out-of-Network (O-O-N):
• If it’s an emergency, it’s treated like innetwork for claims
• If the medical provider/hospital is not part
of the network, it’s considered out-ofnetwork (O-O-N)
• Routine care outside the area of residence
is considered out-of-network
• All O-O-N must be pre-certified by the
enrollee requesting pre-certification from
MVP (phone number on back of card)
11
Benefits Summary Grid:
• Note: Rehabilitation Therapies (Physical,
Occupational and/or Speech) are covered in full up
to 30 visits per therapy, per calendar year;
additional medically necessary visits may be
covered only if preauthorized
• Benefits do not include a dental plan
• Effective 1/1/2014, no preauthorization for
chiropractic visits
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Wellness Initiatives:
• Wellness Fitness Activity
Reimbursements: (gym memberships;
exercise/yoga classes; purchase of gym
equipment; league participation; etc.)
– Annually $100/single and $150/family
– New: Reimbursement for massage therapy;
must be administered by a licensed massage
therapist
• Wellness Annual Physical Exam Reward:
– $25/single and $50/family to have a
preventive exam from your primary care
physician
31
Staffing in 2003-04:
• Plan
Administrator
• Secretary
Staffing Today:
• Plan Administrator/
Ex-Officio Trustee
• Administrative
Assistant/ Wellness
Representative
• Fiscal Agent
• Fiscal Agent/
Software Trainer
• Health/ Claims
Consultant
• Claims Risk
Coordinator
32
Consultants to the Trust 2015
• Legal Consultant
(Carolyn R. Friedman, Esq.)
• Actuarial Consultants
(Harbridge Consulting Group)
• Communications Consultant
(Lori Sosenko)
• Auditors (Bahgat & Laurito-Bahgat)
• Claims Auditor Consultant
• Specific Claims Audits
(Global Excel)
• Appeals Audits (Coordinated by
Nova/ MVP/ PBD)
• Medical Consultant
(Dr. Len Katz)
• Stop Loss Provider (Self-Funded)
• Financial Consultant (Morgan Stanley)
•Third Party Administrators for Claims:
Medical (Nova/ Independent Health
and MVP); Pharmacy (Pharmacy Benefit
Dimensions)
•Manning & Napier Information Service
(BSwift)
• Disease Management Consultants
(Marsh & McLennan/ Verisk)
33
For Assistance:
• MVP Customer Service—number on the back
of the enrollee’s insurance card(800-229-5851)
• Pharmacy Benefit Dimensions (800-665-3089)
• Website lists lots of VERY important
information www.ny44.e1b.org
• Wellness Questions/Reimbursement
– Jeni Kapalczynski 716-821-7161
• Final Option
– Dr. Darleen Michalak, Plan Administrator
716-821-7161
34
www.ny44.e1b.org
• Summary Plan Description (SPDs)
• Summary of Benefits and Coverage (SBCs)
• Newsletter
• Wellness Videos
• NY44 Health Trust Board of Trustees
Meeting Minutes
• Upcoming Information for All Plan Options
35
www.ny44.e1b.org
36