Allegheny County Schools

Health Insurance Consortium

(ACSHIC)

Health Care Renewal 7/1/2017 – 6/30/2018

Michael Garofalo, Vice PresidentEQT plaza, 10th Floor

625 Liberty AvenuePittsburgh, PA 15222

T: 412.263.6353 C: 412-874-8104

February 14, 2017

Michael Garofalo 412-263-6353 michael.garofalo@aon.comKathy Glynn 412-263-6374 kathy.glynn@aon.comDiana Gregorakis 412-263-6365 diana.gregorakis@aon.com

2017-2018 Monthly Rates For Health Benefits July 1, 2017 – June 30, 2018

• The percentage an employee contributes is based on their Collective Bargaining Agreement or Contract for Community Blue Flex PPO and Community Blue Flex EPO

• Individuals selecting PPO coverage will be responsible for their premium plus the difference between the EPO and PPO rates.

• Part-Time employees pay full amount as shown

CBF PPO United Concordia Dental $ 585.99 Individual $26.70 Individual $1,313.81 Parent/Child $87.81 Family $1,445.18 Parent/Children $1,591.89 Husband/Wife $1,655.13 Family Davis Vision $ 4.88 Individual $11.92 Family CBF EPO $ 547.41 Individual $1,227.87 Parent/Child $1,350.64 Parent/Children $1,487.12 Husband/Wife $1,546.29 Family

Confidential, unpublished property of Aon. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © Aon

Table of Contents

Page / Pages

Trustee List

Management Contacts

Network Chart

Executive Report

Trend

Benefit Changes

1

2

3

4 – 5

6

7

Benefit Grids / Additional Benefits Information

CommunityBlue Flex EPO

CommunityBlue Flex PPO

PPO / EPO Side by Side Schedule of Benefits

Pharmacy Network

Giant Eagle Specialty Pharmacy

Grand Rounds

Lytle EAP Partners

Dental

Vision

8 – 9

10 – 13

14 – 15

16

17 – 18

19

20

21

22 – 25

Rates / Financial Ratings

CommunityBlue PPO / EPO

Dental Rates

Vision Rates

Financial Ratings

26

27

28

29

Retiree Only – Voluntary Dental & Vision

Voluntary Dental & Vision Rates

Program Information

Voluntary Dental Benefit Summary

Voluntary Vision Benefit Summary

30

31

32

33 – 34

ACSHIC Health Care Renewal 7/1/2017 to 6/30/2018 1

ACSHIC Trustees

Allegheny Intermediate Unit Linda Hippert Superintendents Bart Rocco, Elizabeth Forward Patrick O’Toole, Upper St. Clair William Short, Gateway Gene Freeman, Fox Chapel Area Business Managers Jan Klein, Mt. Lebanon Open Higher Education Michael Swartzendruber AFT Pennsylvania Walt Michalski Christina Armbruster Donald Alexander Jo Ann Hunter

PSEA Marylou Stefanko David Wyatt Barbara Bell Robert Tuite, Jr. Alisa Murray SEIU Joseph Wysocki Helen Spade Peter Schmidt School Board Members Salvatore J. Colella, Eastern Region Thomas L. Kelly, Northern Region Judith Andzelik, Southeastern Region Open, Western Region

ACSHIC Health Care Renewal 7/1/2017 to 6/30/2018 2

Management Contacts

www.ACSHIC.com

Michael Garofalo 412.263.6353 michael.garofalo@aon.com Kathy Glynn 412.263.6374 kathy.glynn@aon.com Diana Gregorakis 412.263.6365 diana.gregorakis@aon.com

ACSHIC Health Care Renewal 7/1/2017 to 6/30/2018 3

ACSHIC Health Care Renewal 7/1/2017 to 6/30/2018 4

EXECUTIVE REPORT

ACSHIC Rate Renewals

2017/2018 Health Insurance Renewals

The Allegheny County Schools Health Insurance Consortium (ACSHIC) Trustees present the following rate changes effective July 1, 2017 through June 30, 2018:

Community Blue Flex 1.9%

Community Blue Flex EPO 1.9%

Standard Dental 1.9%

Davis Vision 1.9%

Vision Benefits of America (VBA) 1.9%

The July 1, 2017 renewal rates were set by the ACSHIC Trustees at the February 14, 2017 Board Meeting. The increases were due to the following 3 items.

1. For July 1, 2017 Benefit Changes will be made to the PPO, EPO and the Prescription Drug Program. These changes are outlined in this document as well as new benefit grids.

2. The July 1, 2017 rates have been developed and approved by the Trustees using a 12-month trend of 5% for annual cost, which reflects the ACSHIC past experience.

3. The continuing saga between Highmark and UPMC has caused local trends (11.0%) to climb over the national trends of 5.0%.

ACSHIC Health Care Renewal 7/1/2017 to 6/30/2018 5

ACSHIC Rate Renewals

2017/2018 Health Insurance Renewals (continued)

It has been the Trustee Boards’ goal to continue the Consortium’s Vision as stated below:

It is with this Vision that the Trustee Board made its decision on the July 1, 2017 rates.

The following is a narrative of our health care situation. This report should be shared with your School Boards and your local Labor Officers.

Health plan cost increases continue to slow down, according to national consulting firm annual surveys of insurers, managed care organizations, pharmacy benefit managers and third party administrators. Prescription drug benefit cost trends, while slowing, continue to have the highest trend rates. Specialty prescription drug benefit costs are expected to increase at an annual rate of nearly 14%, while the medical benefit cost trend is running between 5.0% to 9.0% for 2017.

But, for the last three years, our local Health care trend (11.0%) is more than the national healthcare trend (6%). The major reason for this high trend in Western PA is the lack of a long term agreement between Highmark and UPMC. Without an agreement, Highmark continues to pay UPMC facilities at the established rate set by the Governor’s compromise. Effective January 1, 2017, Highmark will now pay UPMC at Highmark’s agreed 2016 rate plus a single digit increase.

Western Pennsylvania also has the second oldest population in the US. This includes our Consortium as schools offer early retirement to our members. These members stay in the ACSHIC until 65 or PSERS eligibility.

The Trustees continue to monitor, meet, and discuss the Provider market in Western PA through the attendance at Pittsburgh Business Group on Health, Three Rivers Labor-Management, PASBO, and PAGE. The Trustees also monitor the provider segment as Highmark completes their negotiations with the West Penn AGH providers.

With the final split or divorce in the provider networks for July 1, 2019, the Trustees have reacted with new plans, providing the best quality healthcare plans for the ACSHIC employees at a responsible cost for July 1, 2017.

Vision The Allegheny County Schools Health Insurance Consortium is a recognized model for and is providing the best quality health care plans, emphasizing preventative care, at a responsibly established cost for Allegheny County school entities.

ACSHIC Health Care Renewal 7/1/2017 to 6/30/2018 6

Aon’s Health Care Trend Forecast

Medical Actives Under Age 65 Medical Rx

Medical – National 5.0% 9.3%

Highmark Tiered Network Plans 9.24% 14.0%

Highmark All Other Medical Plans 11.0% 14.0%

Medical Retirees Age 65 & Over With Rx

Medicare Supplement 4.3%

Medicare Advantage PPO 3.0%

Dental

PPO 4.1%

Pharmacy

General 11.7%

Specialty 18.7%

Vision 2.6%

Trend Trend is the average forecasted change in a health plan’s per capita “Claim cost” determined by insurance carriers, managed care organizations and third party administrators. Many factors are taken into account when determining trend. Simply, Trends are the cost of services and the quantity of those services.

These factors include:

Medical price inflation

Utilization of care

Demographics of group

Government mandated benefits

Technology changes

In Western Pennsylvania, we are experiencing a higher medical trend than the average national medical trend. This local higher trend is due primarily to mandated Federal and State benefits, the uncertain provider contracts signed by the carriers with the local hospital providers, and the local economy, including the Highmark – UPMC disputes.

ACSHIC Health Care Renewal 7/1/2017 to 6/30/2018 7

Benefit Changes January 1, 2017

The Advantage Pharmacy Network had changes within the network – some providers joined while others are no longer participating, see page 16.

Benefit Changes July 1, 2017

The Standard and Out-of-Network schedules have been changed for both the EPO and the PPO Benefit Plans. Please see the new benefit grids that follow.

Select DME (Durable Medical Equipment): Highmark has high quality, more efficient network for DME. Please verify your provider is in the Network through either your Doctor, the DME Supplier or the Highmark website.

Giant Eagle: You can obtain “some” of your specialty drugs at your local Giant Eagle Store. Always contact your local Giant Eagle to verify availability of the drug.

ACSHIC Health Care Renewal 7/1/2017 to 6/30/2018 8

ACSHIC Health Care Renewal 7/1/2017 to 6/30/2018 9

ACSHIC Health Care Renewal 7/1/2017 to 6/30/2018 10

“PPO”

What Is Community Blue Flex? A PPO health insurance product with a tiered benefit design – built on the Community Blue network – that helps groups and their employees control costs and keep care within the community.

Helps groups control their health care costs and gives their employees the ultimate in care and cost choice.

Engages employees and their dependents with their health. Every time they get care, including certain specialty services, they make a decision regarding which provider from which to receive care. Depending on the tier in which that provider’s services are covered, the employee will have different levels of cost-sharing.

Preserves health care choice because members have in-network access to high quality providers allowing the member to choose healthcare providers where they live – while at the same time offering them lower cost options.

ACSHIC Health Care Renewal 7/1/2017 to 6/30/2018 11

ACSHIC Health Care Renewal 7/1/2017 to 6/30/2018 12

ACSHIC Health Care Renewal 7/1/2017 to 6/30/2018 13

Community Blue Flex Hospitals in Your Region

ACSHIC Health Care Renewal 7/1/2017 to 6/30/2018 14

ACSHIC Health Care Renewal 7/1/2017 to 6/30/2018 15

ACSHIC Health Care Renewal 7/1/2017 to 6/30/2018 16

ACSHIC Health Care Renewal 7/1/2017 to 6/30/2018 17

ACSHIC Health Care Renewal 7/1/2017 to 6/30/2018 18

ACSHIC Health Care Renewal 7/1/2017 to 6/30/2018 19

ACSHIC Health Care Renewal 7/1/2017 to 6/30/2018 20

ACSHIC Health Care Renewal 7/1/2017 to 6/30/2018 21

A school must use this chart as the “Standard” Dental plan

A “sunset” provision will apply that does not use this chart

A school will use the “Building Block” approach of providing:

i. Basic Services only ii. Basic and Specific Riders iii. Basic and All Riders

But “Standard” Benefits Must be:

For the entire school or the entire CBA segment

There is no voluntary dental option, nor is there any optional cafeteria plan picking of the riders

Level of Coverage

BASIC SERVICES

Diagnostic & Preventive

Routine Exam 100%

Prophylaxis 100%

Fluoride Treatments 100%

Sealants 100%

Bitewing X-Rays 100%

Full Mouth X-Rays 100%

Endodontic Services

Root Canal Treatment 100%

Restorative Services (Under Local Anesthesia)

Fillings 100%

Anesthesia 100%

Consultation 100%

Oral Surgery Services

Simple Extractions 100%

Removable Prosthetics

Repairs 100%

Fixed Prosthetics

Repairs 100%

RIDER A SERVICES

Endodontic Services

Apicoectomy 80%

Restorative Services (Under Local Anesthesia)

Single Unconnected Inlays, Onlays and Crowns 80%

Oral Surgery Services

Most Oral Surgery – excluding simple Extractions 80%

RIDER B SERVICES

Removable Prosthetics

Full or Partial Dentures 50%

Replacement 50%

Relining and rebasing 50%

Fixed Prosthetics

Dental Implants $500 per implant

(limited to 3 - $1,500)

Dental Implants – Related Services (crown over implant)

50%

Fixed Bridgework 50%

Replacement 50%

RIDER C SERVICES

Periodontics

Non-Surgical 80%

Surgical 80%

RIDER D SERVICES

Orthodontics – Dependents to age 19

Diagnostic, Active and Retention Treatment 50%

Lifetime Orthodontic Maximum – Per Child $1,200

POLICY DEDUCTIBLES AND MAXIMUMS

Annual Program Maximum-Per Covered Individual Unlimited

Annual Program Deductible None

Rider Percentage Individual Family

Basic 100% $11.73 $42.09

A 80%* 5.90 15.72 B 50%* 8.36 17.65 C 80%* .72 2.17 D 50%** N/A 10.18

$26.71 $87.81

Rate Increase: 1.9%

* Unlimited yearly maximum ** $1,200 maximum

Dental Implants - $500 per implant

ACSHIC Standard Dental Option

ACSHIC Health Care Renewal 7/1/2017 to 6/30/2018 22

ACSHIC Health Care Renewal 7/1/2017 to 6/30/2018 23

ACSHIC Health Care Renewal 7/1/2017 to 6/30/2018 24

ACSHIC Vision Benefits of America

FREQUENCY OF SERVICE:

Employee Spouse

Student Age: 25 Children (to age

19)

Vision Exam 24 Months 24 Months 12 Months

Lenses 24 Months 24 Months 12 Months

Frames 24 Months 24 Months 24 Months

EMPLOYEE CAN SELECT EITHER:

VBA Participating Doctor (13,000 Nationwide)

Non-Participating Doctor

BENEFITS Amount Covered Amount Reimbursed

Vision Exam 100% $35.00

Clear Standard Lenses (Pair)+: Single Vision 100% $30.00 Bifocal 100% $40.00 Trifocal 100% $60.00 Lenticular 100% $80.00 Polycarbonate Lens Material++

100% N/A

Frame OR Contacts (includes the vision exam allowance)

Selected in lieu of Glasses $125.00 $125.00 Medically Required UCR** $250.00

Low Vision Aids UCR** $500.00

Laser Vision Correction: Discount off prevailing fees at TLC Laser Eye Centers

Individual $4.88

1.9% Family $11.92

No Benefits Changes

* Within the program’s 50 wholesale allowance (approximately $100 to $135 retail). ** Usual, Customary and Reasonable as determined by VBA. + All spectacle lenses dispensed through a VBA Participating Provider are warranted for 1 yr.

against scratching. ++ Available In-Network at no charge for children under age 19. All

ACSHIC Health Care Renewal 7/1/2017 to 6/30/2018 25

26

ACSHIC Health Care Renewal 7/1/2017 to 6/30/2018

Rate History – ACSHIC Standard Programs

Select Blue POS & PPO

(2007-2008) (2008-2009) (2009-2010) (2010-2011) (2011-2012) (2012-2013) (2013-2014) (2014-2015) (2015-2016) (2016-2017) (2017-2018)

Individual 398.95$ 422.89$ 439.81$ 461.80$ 461.80$ 483.74$ 517.60$ 547.36$ 562.41$ 575.06$ 585.99$

Parent/Child 929.99$ 948.14$ 986.07$ 1,035.37$ 1,035.37$ 1,084.55$ 1,160.47$ 1,227.20$ 1,260.95$ 1,289.32$ 1,313.81$

Parent/Children 929.99$ 1,042.95$ 1,084.67$ 1,138.90$ 1,138.90$ 1,193.00$ 1,276.51$ 1,349.91$ 1,387.03$ 1,418.24$ 1,445.19$

Employee & Spouse 1,083.79$ 1,148.82$ 1,194.77$ 1,254.51$ 1,254.51$ 1,314.10$ 1,406.09$ 1,486.94$ 1,527.83$ 1,562.21$ 1,591.89$

Family 1,126.85$ 1,194.46$ 1,242.24$ 1,304.35$ 1,304.35$ 1,366.31$ 1,461.90$ 1,546.01$ 1,588.53$ 1,624.27$ 1,655.13$

Percentage Change 2.5% 6.0% 4.0% 5.0% 0.0% 4.75% 7.00% 5.75% 2.75% 2.25% 1.9%

Keystone HMO

(2007-2008) (2008-2009) (2009-2010) (2010-2011) (2011-2012) (2012-2013) (2013-2014) (2014-2015) (2015-2016) (2016-2017) (2017-2018)

Individual 379.80$ 402.59$ 418.69$ 439.62$ 439.62$ 460.50$ 486.53$ 511.33$ 525.39$ 537.21$ 547.42$

Parent/Child 851.88$ 902.99$ 939.11$ 986.07$ 986.07$ 1,032.91$ 1,084.56$ 1,146.92$ 1,178.46$ 1,204.98$ 1,227.88$

Parent/Children 937.07$ 993.29$ 1,033.02$ 1,084.67$ 1,084.67$ 1,136.19$ 1,193.00$ 1,261.60$ 1,296.29$ 1,325.46$ 1,350.64$

Employee & Spouse 1,031.74$ 1,093.65$ 1,137.40$ 1,194.27$ 1,194.27$ 1,251.00$ 1,313.55$ 1,389.08$ 1,427.28$ 1,459.39$ 1,487.12$

Family 1,072.81$ 1,137.17$ 1,182.66$ 1,241.79$ 1,241.79$ 1,300.78$ 1,365.82$ 1,444.35$ 1,484.07$ 1,517.46$ 1,546.29$

Percentage Change 2.5% 6.0% 4.0% 5.0% 0.0% 4.8% 5.0% 5.75% 2.75% 2.25% 1.9%

Community Blue Flex EPO

Community Blue Flex PPO

27

ACSHIC Health Care Renewal 7/1/2017 to 6/30/2018

Allegheny County Schools Health Insurance Consortium

Dental Rates

Standard Dental Plan

( 10 Years of Rate Holds for Individual and Family )

Individual

Family

2017 -2018 2017 -2018

Basic $11.73 Basic 42.09

Rider A $5.90 Rider A 15.72

Rider B $8.36 Rider B 17.65

Rider C $0.72 Rider C 2.17

Rider D N/A Rider D 10.18

Total $26.71 Total 87.81

Percent Change 1.9% Percent Change 1.9%

28

ACSHIC Health Care Renewal 7/1/2017 to 6/30/2018

Allegheny County Schools Health Insurance Consortium

Vision Rates

Davis Vision

INDIVIDUAL

FAMILY

2017 - 2018 2017 - 2018

$4.88 $11.92

1.9% 1.9%

Vision Benefits of America (VBA)

INDIVIDUAL

FAMILY

2017 - 2018 2017 - 2018

$4.30 $10.15

1.9% 1.9%

29

ACSHIC Health Care Renewal 7/1/2017 to 6/30/2018

Overview of Financial Rating of Current Carriers

Coverage Carrier/ Vendor

A.M. Best Rating

Standard & Poor Rating

Renewal

Date

Medical/RX Highmark

BC/BS A- A- 7/1/2017

Vision Davis Vision A-g Not Rated 7/1/2017

Vision VBA Not Rated Not Rated 7/1/2017

Dental UCCI A- Not Rated 7/1/2017

30

ACSHIC Health Care Renewal 7/1/2017 to 6/30/2018

Allegheny County Schools Health Insurance Consortium

Voluntary Dental and Vision Rates Retirees Only

July 1, 2017

Concordia Choice C – Plan V6 (United Concordia Dental)

Coverage Level Rate/Month ** Cost/Quarter

Individual Retiree $33.83 $101.49

Retiree + Spouse or Child * $86.06 $258.18

Retiree + Family $86.06 $258.18

Davis Vision Plan

Coverage Level Rate/Month ** Cost/Quarter

Individual Retiree $9.03 $27.09

Retiree + Spouse or Child * $16.25 $48.75

Retiree + Family $25.27 $75.81

* Child included qualified dependents to age 26 and certified disabled dependents ** Member will be billed rate ÷ $3.00 administrative fee per month ($9 maximum admin fee per quarter)

Member will be billed for coverage on a quarterly basis. The billing will come from AMCA Systems, LLC and payments will be remitted to AMCA Systems, LLC / Retiree Billing. Payments will be due by the 20th of the month before the quarter begins. A 30-day grace period will be given for receipt of payments. If payment is not received within 30 days of the due date, the coverage will be cancelled.

31

ACSHIC Health Care Renewal 7/1/2017 to 6/30/2018

Optional Dental and Vision Programs for Retirees

IMPORTANT: Applications should be returned to the following address for handling: AMCA Systems, Inc. 101 Bradford Road, Suite 340 Wexford, PA 15090 724-934-2270 (605) Karen Altman ATTN: Retiree Dental and Vision

32

ACSHIC Health Care Renewal 7/1/2017 to 6/30/2018

33

ACSHIC Health Care Renewal 7/1/2017 to 6/30/2018

34

ACSHIC Health Care Renewal 7/1/2017 to 6/30/2018