Board Meeting on 2005 Medical Plan East Baton Rouge Parish School System October 28, 2004 © 2004, Mercer Human Resource Consulting All rights reserved

Board Meeting on 2005 Medical Plan East Baton Rouge Parish School System

October 28, 2004

© 2004, Mercer Human Resource Consulting

All rights reserved. This presentation and the materials presented herein contain confidential and proprietary information of Mercer Human Resource Consulting, Inc. The presentation and such materials have been prepared and are intended for the exclusive use of East Baton Rouge Parish School System. The presentation and such materials (including the format and the presentation thereof) may not be reproduced, modified, sold or otherwise transferred or provided, in whole or in part, to any other person or entity without the prior written permission of Mercer Human Resource Consulting.

© 2004, Mercer Human Resource Consulting 2

Executive Summary

At Board workshop on October 20, the Board asked for:

– More data on plan benchmarking, particularly for retirees

– Less dramatic contribution changes for those retirees who may never be eligible for Medicare

– Preventive care coverage details

Proposed 2005 plan design changes are modest

The 2006 plan year will require more robust changes to improve plan viability

Requested Board actions:

– Approve proposed 2005 plan designs

– Approve proposed 2005 employee/retiree contributions

– Authorize RFPs for disease management programs, outpatient mental health precertification


Benchmarking

Mercer used one of its actuarial tools, MedPrice, to value the State and area plans that were benchmarked

– MedPrice values the key features of plan design—including copays, coinsurance, deductibles and out of pocket maximums

MedPrice analysis provides a relative value of assessed plans versus the plan identified as the benchmark.

– The EBRPSS core plan is used as the benchmark

MedPrice analysis does not consider employee contributions


BenchmarkingRelative Value

Core

Plan

Buy Up

Plan

1.00 1.08

Enhanced

PPOPPO HMO EPO

0.98 0.94 1.27 1.02

PPOEPO

United

HMO

(OHP B.R.)

Vantage

HMO MCO

1.05 1.07 0.96 1.22 1.18

PPO

0.93

State Insurance

East Baton Rouge Parish

School Board

Iberville Parish

School Board

Orleans Parish

School Board

Terrebonne Parish

School Board


BenchmarkingEmployee Contributions

Tier Enhanced PPO PPO HMO EPO PPO Non-Network

EE Only $120.48 $86.68 $43.53 $0.00 $0.00 $0.00EE + Spouse $170.46EE + Child(ren) $151.07EE + Family $277.87EE + One $216.71 $161.73 $188.41 $188.41 $188.41EE + Two $264.76 $198.27 $294.92 $294.92 $294.92

Orleans Parish

School Board

Terrebonne Parish

School Board

Iberville Parish

School Board

Tier PPO EPO - United EPO - BCBS** HMO (OHP B.R.) HMO (OHP Hammond) MCO - FARA

EE Only $111.78 $147.58 $115.46 $88.72 $107.00 $76.00EE + Spouse $316.74 $385.30 $298.78 $238.08 $278.10 $215.38EE + Child(ren) $169.34 $214.30 $199.90 $129.62 $156.68 $115.14EE + Family $347.08 $420.48 $313.40 $265.52 $321.76 $236.00EE + OneEE + Two

*Does not include St. Tammany - they pay a portion of the shown state retiree contribution

**As of July 1, 2002

State Insurance*

Effective J uly 1, 2004

Tier Core Plan Buy Up Plan Out-of-Area

EE Only $52.00 $101.00 $52.00EE + Spouse $211.00 $298.00 $211.00EE + Child(ren) $168.00 $245.00 $168.00EE + Family $327.00 $441.00 $327.00EE + OneEE + Two

East Baton Rouge Parish School Board

2005 Rates


Retiree Plan Structure

The districts Mercer used for benchmarking the EBRPSS plans have the same plan design for retirees and actives, just as EBRPSS does

There is a wide variation in what surrounding districts require their retirees to pay

– Terrebonne Parish (Houma) uses a tiered approach, based on service

– The contributions required for OGB state coverage is about 20% more, on average, than the proposed 2005 rates for EBRPSS


2005 Retiree Contributions

Mercer analyzed two options for 2005 retiree contributions

– Revising contributions for retirees without Medicare access

– Determining if retirees can “buy into” Medicare, and at what cost

The approximate cost for revising the costs for the “never Medicare” group (creating a fourth rate structure) is about $400,000 for 2005

Funding the payment required for this group to “buy in” to Medicare is a long-term commitment and much more costly

– Would cost close to $1 million for 2005, with likely increasing costs each year going forward

– In addition, EBRPSS would still be subsidizing this group through the “with Medicare” rate structure


Retiree StructureContributions

Tier Enhanced PPO PPO HMO EPO PPO Non-Network

EE Only Yet to hear from $233.69 Depends on years of service and time at retirementEE + Spouse $597.54EE + Child(ren) $488.11EE + Family $841.55EE + OneEE + Two

Iberville Parish School Board

(retired w/ no Medicare)

Orleans Parish School Board


Terrebonne Parish School Board


Tier Core Plan Buy Up Plan Out-of-Area

EE Only $76.00 $148.00 $76.00EE + Spouse $201.00 $329.00 $201.00EE + Child(ren) $192.00 $291.00 $192.00EE + Family $316.00 $471.00 $316.00EE + OneEE + Two

East Baton Rouge Parish School Board

(retired w/ no Medicare) - 2005 Rates


Retiree StructureContributions (cont’d)

Tier PPO EPO - United EPO - BCBS HMO (OHP B.R.) HMO (OHP Hammond) MCO - FARA

EE Only $111.80 $175.44 $115.46 $88.74 $156.72 $76.00EE + Spouse $316.74 $436.66 $265.06 $248.34 $552.62 $215.38EE + Child(ren) $169.34 $241.30 $199.44 $129.62 $213.18 $115.14EE + Family $347.08 $465.48 $313.40 $300.00 $604.80 $236.00EE + OneEE + Two

State Insurance

(retired w/ no Medicare) - Effective J uly 1, 2004

Tier PPO EPO - United EPO - BCBS HMO (OHP B.R.) HMO (OHP Hammond) MCO

EE Only $35.12 $37.95 $27.88 $33.61 $23.88EE + Spouse $189.87 $205.06 $144.80 $170.63 $129.12EE + Child(ren) $125.56 $134.52 $96.76 $116.84 $84.70EE + Family $198.88 $214.78 $153.53 $185.82 $135.22EE + OneEE + Two

*St. Tammany pays a portion of the state retiree contribution

St. Tammany Parish School Board *

Effective J uly 1, 2004


Preventive Care Benefits

The Board expressed concern that the proposed 2005 structure for preventive care coverage might disincent participants from using this benefit

Upon further investigation Mercer determined that the preventive benefit is currently adjudicated at 100% coverage after copayment

It is recommended that this structure remain for 2005


Plan Design ChangeBuy-up Plan

Plan Features In-Network Out-of-Network In-Network Out-of-Network

Lifetime Maximum Benefit

Annual Deductible$100 per person

waived for physician office services$750 per person


waived for physician office services$1,000 per person

waived for physician office services

Annual Out-of-PocketMaximum

$1,700 / ind.$3,400 / fam.

$5,750 / ind.$11,500 / fam.

$1,700 / ind.$3,400 / fam.

$5,750 / ind.$11,500 / fam.

Office Visit $20 copay 70% after deductible $20 Primary/$40 Specialty 70% after deductiblePreventive CareRoutine physicals, well child/baby care, immunizations for dependents up to age 7, etc.

100% after copay 70% after deductible 100% after copay 70% after deductible

Hospital Service - Inpatient90% after

$300 copayment70% after deductible

90% after$300 copayment

70% after deductible

Hospital Service - Outpatient 90% after deductible 70% after deductible 90% after deductible 70% after deductible

Emergency Care100% coinsurance after $200

copay70% after deductible 90% after deductible 70% after deductible

Prescription Drugs - RetailGenericBrandNon-formulary

Deductible:$50 / ind.

$100 / fam.$10$25$40



$100 / fam.$10$25$40


Prescription Drugs - MailGenericBrandNon-formulary


$100 / fam.$20$50$80

N/A


$100 / fam.$20$50$80

N/A

2004 2005

$2 million


Plan Design ChangeCore Plan



Annual Deductible$300 per person



waived for physician office services$1,500 per person

waived for physician office services


$2,500 / ind.$5,000 / fam.

$5,750 / ind.$11,500 / fam.

$2,500 / ind.$5,000 / fam.

$5,750 / ind.$11,500 / fam.

Office Visit $25 copay 60% after deductible $25 Primary/$50 Specialty 60% after deductiblePreventive CareRoutine physicals, well child/baby care, immunizations for dependents up to age 7, etc.

100% after copay 60% after deductible 100% after copay 60% after deductible

Hospital Service - Inpatient80% after

$200 copayment60% after deductible

80% after$200 admission copayment


Hospital Service - Outpatient 80% after deductible 60% after deductible 80% after deductible 60% after deductibleEmergency Care 80% after deductible 60% after deductible 80% after deductible 60% after deductible



$100 / fam.$10$25$40



$100 / fam.$20$35$50




$100 / fam.$20$50$80

N/A


$100 / fam.$20$50$80

N/A

2004 2005

$2 million


2005 Medical Plan Contributions(Includes Deficit Reduction)

1 Medicare eligible Retiree and Non-Medicare eligible spouse

2 Non-Medicare eligible Retiree and Medicare eligible spouse

Employee Contribution Rates

2004 2005 2005

Coverage Tier Buy-Up Core OOA Buy-Up Core OOA Buy-Up Core OOA

Active Employees

Employee $ 84.71 $ 35.94 $ 35.94 $ 101.00 $ 52.00 $ 52.00 $ 16.29 $ 16.06 $ 16.06 Employee + Spouse 255.31 173.27 173.27 298.00 211.00 211.00 42.69 37.73 37.73 Employee + Child(ren) 208.65 141.34 141.34 245.00 168.00 168.00 36.35 26.66 26.66 Employee + Family 381.05 285.92 285.92 441.00 327.00 327.00 59.95 41.08 41.08

Retirees

Non-Medicare Retiree Only $ 94.14 $ 39.33 $ 39.57 $ 148.00 $ 76.00 $ 76.00 $ 53.86 $ 36.67 $ 36.43 Retiree + Spouse 283.70 201.13 190.77 329.00 201.00 201.00 45.30 -0.13 10.23 Retiree + Child(ren) 231.85 157.51 149.40 291.00 192.00 192.00 59.15 34.49 42.60 Retiree + Family 423.43 318.63 302.22 471.00 316.00 316.00 47.57 -2.63 13.78 Split Medicare Retiree + Spouse 1 $ 245.23 $ 159.41 $ 151.20 $ 229.00 $ 134.00 $ 134.00 -$ 16.23 -$ 25.41 -$ 17.20 Retiree + Spouse 2 264.47 180.26 170.98 246.00 143.00 143.00 -18.47 -37.26 -27.98 Retiree + Family 1 384.95 276.91 262.65 372.00 250.00 250.00 -12.95 -26.91 -12.65 Retiree + Family 2 408.57 297.78 282.44 389.00 259.00 259.00 -19.57 -38.78 -23.44 Medicare Retiree Only $ 55.67 $ 0.00 $ 0.00 $ 49.00 $ 10.00 $ 10.00 -$ 6.67 $ 10.00 $ 10.00 Retiree + Spouse 225.99 138.56 131.42 147.00 77.00 77.00 -78.99 -61.56 -54.42 Retiree + Child(ren) 193.37 115.79 109.83 191.00 125.00 125.00 -2.37 9.21 15.17 Retiree + Family 365.71 256.06 242.88 290.00 193.00 193.00 -75.71 -63.06 -49.88

Total Active Employees $9,979,000 $10,746,000

Total Retirees $6,360,000 $6,871,000

Total All Employees $16,338,000 $17,617,000

Employee Contribution Rates Change


Contracts

Benefits Management

Services Starmount Southern National Standard SunLife*

Louisiana DentalPlan

United Behavioral Health** Medco

Medical Plan Administration Dental / Vision

Flexible Spending

Long-term Disability Life EAP Pharmacy

Approved

Rejected

Approve withrevisions

* Based on plan administration revision

**Revise termination language

Appendix


2005 Employee Rates



Employee Rates Deficit Recoup Ee Contributions

Coverage Tier Buy-up Core OOA Buy-up Core OOA Buy-up Core OOA

Active Employees

Employee $ 89.00 $ 40.00 $ 40.00 $ 12.00 $ 12.00 $ 12.00 $ 101.00 $ 52.00 $ 52.00 Employee + Spouse $ 277.00 $ 190.00 $ 190.00 $ 21.00 $ 21.00 $ 21.00 $ 298.00 $ 211.00 $ 211.00 Employee + Child(ren) $ 226.00 $ 149.00 $ 149.00 $ 19.00 $ 19.00 $ 19.00 $ 245.00 $ 168.00 $ 168.00 Employee + Family $ 413.00 $ 299.00 $ 299.00 $ 28.00 $ 28.00 $ 28.00 $ 441.00 $ 327.00 $ 327.00

Retirees

Non-Medicare Retiree Only $ 130.00 $ 58.00 $ 58.00 $ 18.00 $ 18.00 $ 18.00 $ 148.00 $ 76.00 $ 76.00 Retiree + Spouse $ 297.00 $ 169.00 $ 169.00 $ 32.00 $ 32.00 $ 32.00 $ 329.00 $ 201.00 $ 201.00 Retiree + Child(ren) $ 266.00 $ 167.00 $ 167.00 $ 25.00 $ 25.00 $ 25.00 $ 291.00 $ 192.00 $ 192.00 Retiree + Family $ 433.00 $ 278.00 $ 278.00 $ 38.00 $ 38.00 $ 38.00 $ 471.00 $ 316.00 $ 316.00 Split Medicare Retiree + Spouse 1 $ 206.00 $ 111.00 $ 111.00 $ 23.00 $ 23.00 $ 23.00 $ 229.00 $ 134.00 $ 134.00 Retiree + Spouse 2 $ 221.00 $ 118.00 $ 118.00 $ 25.00 $ 25.00 $ 25.00 $ 246.00 $ 143.00 $ 143.00 Retiree + Family 1 $ 342.00 $ 220.00 $ 220.00 $ 30.00 $ 30.00 $ 30.00 $ 372.00 $ 250.00 $ 250.00 Retiree + Family 2 $ 357.00 $ 227.00 $ 227.00 $ 32.00 $ 32.00 $ 32.00 $ 389.00 $ 259.00 $ 259.00 Medicare Retiree Only $ 39.00 $ 0.00 $ 0.00 $ 10.00 $ 10.00 $ 10.00 $ 49.00 $ 10.00 $ 10.00 Retiree + Spouse $ 130.00 $ 60.00 $ 60.00 $ 17.00 $ 17.00 $ 17.00 $ 147.00 $ 77.00 $ 77.00 Retiree + Child(ren) $ 175.00 $ 109.00 $ 109.00 $ 16.00 $ 16.00 $ 16.00 $ 191.00 $ 125.00 $ 125.00 Retiree + Family $ 266.00 $ 169.00 $ 169.00 $ 24.00 $ 24.00 $ 24.00 $ 290.00 $ 193.00 $ 193.00

Total Active Employees $9,753,000 $994,000 $10,746,000

Total Retirees $5,811,000 $1,060,000 $6,871,000

Total All Employees $15,564,000 $2,053,000 $17,617,000


2005 Medical Plan Funding Rates (Includes Deficit Reduction)



Total Funding Rates Employer Funding Rates

2004 2005 2004 2005

Coverage Tier Buy-up Core OOA Buy-up Core OOA Buy-up Core OOA Buy-up Core OOA

Active Employees

Employee $ 415.65 $ 289.78 $ 289.78 $ 469.00 $ 420.00 $ 420.00 $ 330.94 $ 253.84 $ 253.84 $ 368.00 $ 368.00 $ 368.00 Employee + Spouse 731.82 510.38 510.38 826.00 739.00 739.00 476.51 337.11 337.11 528.00 528.00 528.00 Employee + Child(ren) 645.28 450.01 450.01 730.00 653.00 653.00 436.63 308.67 308.67 485.00 485.00 485.00 Employee + Family 964.86 672.99 672.99 1,086.00 972.00 972.00 583.81 387.07 387.07 645.00 645.00 645.00

Retirees

Non-Medicare Retiree Only $ 539.99 $ 371.16 $ 373.24 $ 691.00 $ 619.00 $ 619.00 $ 445.85 $ 331.83 $ 333.67 $ 543.00 $ 543.00 $ 543.00 Retiree + Spouse 951.24 653.75 657.50 1,218.00 1,090.00 1,090.00 667.54 452.62 466.73 889.00 889.00 889.00 Retiree + Child(ren) 838.67 576.41 579.70 951.00 852.00 852.00 606.82 418.90 430.30 660.00 660.00 660.00 Retiree + Family 1,254.34 862.04 867.03 1,476.00 1,321.00 1,321.00 830.91 543.41 564.81 1,005.00 1,005.00 1,005.00 Split Medicare Retiree + Spouse 1 $ 951.24 $ 653.75 $ 657.50 $ 899.00 $ 804.00 $ 804.00 $ 706.01 $ 494.34 $ 506.30 $ 670.00 $ 670.00 $ 670.00 Retiree + Spouse 2 951.24 653.75 657.50 975.00 872.00 872.00 686.77 473.49 486.52 729.00 729.00 729.00 Retiree + Family 1 1,254.34 862.04 867.03 1,159.00 1,037.00 1,037.00 869.39 585.13 604.38 787.00 787.00 787.00 Retiree + Family 2 1,254.34 862.04 867.03 1,235.00 1,105.00 1,105.00 845.77 564.26 584.59 846.00 846.00 846.00 Medicare Retiree Only $ 539.99 $ 371.16 $ 373.24 $ 374.00 $ 335.00 $ 335.00 $ 484.32 $ 371.16 $ 373.24 $ 325.00 $ 325.00 $ 325.00 Retiree + Spouse 951.24 653.75 657.50 658.00 588.00 588.00 725.25 515.19 526.08 511.00 511.00 511.00 Retiree + Child(ren) 838.67 576.41 579.70 632.00 566.00 566.00 645.30 460.62 469.87 441.00 441.00 441.00 Retiree + Family 1,254.34 862.04 867.03 918.00 821.00 821.00 888.63 605.98 624.15 628.00 628.00 628.00

Total Active Employees $33,657,000 $37,366,000 $23,678,000 $26,620,000

Total Retirees $33,330,000 $38,134,000 $26,970,000 $31,263,000

Total All Employees $66,986,000 $75,499,000 $50,648,000 $57,882,000


Medical Plan Enrollment



Plan Enrollment

Actual 2004 Projected 2005

Coverage Tier Buy-Up Core OOA Total Buy-Up Core OOA Total

Active Employees

Employee 1,967 752 4 2,723 1,649 981 4 2,634 Employee + Spouse 545 137 1 683 457 179 1 637 Employee + Child(ren) 749 192 1 942 628 250 1 879 Employee + Family 638 168 0 806 535 219 0 754

Retirees

Non-Medicare Retiree Only 1,110 479 59 1,648 809 831 60 1,700 Retiree + Spouse 444 130 21 595 324 226 21 571 Retiree + Child(ren) 114 44 3 161 83 76 3 163 Retiree + Family 126 49 6 181 92 85 6 183 Split Medicare Retiree + Spouse 1 31 14 6 51 18 24 6 48 Retiree + Spouse 2 103 72 9 184 60 122 9 191 Retiree + Family 1 4 2 1 7 2 3 1 7 Retiree + Family 2 7 3 0 10 4 5 0 9 Medicare Retiree Only 324 1,151 46 1,521 328 1,165 47 1,540 Retiree + Spouse 138 213 8 359 140 216 8 363 Retiree + Child(ren) 13 7 0 20 13 7 0 20 Retiree + Family 3 3 0 6 3 3 0 6

Total Active Employees 3,899 1,249 6 5,154 3,269 1,629 6 4,904

Total Retirees 2,417 2,167 159 4,743 1,877 2,763 161 4,801

Total All Employees 6,316 3,416 165 9,897 5,147 4,392 167 9,705


Medical Plan Financial Projections(1000s)

Actual Projected Projected

2003 2004 2005

Enrollment

Active Employees 6,305 5,264 4,904

Retired Employees 4,356 4,689 4,801

Total Enrollment 10,661 9,953 9,705

Paid Claim Expense

Medical $47,735 $48,137 $50,019

Prescription Drug 15,242 15,452 16,724

Total Paid Claims $62,977 $63,590 $66,743

Other Expense

Administrative Expense $3,530 $3,026 $2,951

Change in Unpaid Claim Liability 839 (70) 600

Total Plan Cost $67,347 $66,546 $70,294

Employer Funding

Current Year Plan Cost ($50,113) ($50,351) ($55,016)

Margin 0 0 (808)

Deficit Recoup 0 0 (2,057)

Transfers 0 (5,000) 0

Total Employer Funding ($50,113) ($55,351) ($57,882)


Medical Plan Financial Projections(1000s)

Actual Projected Projected

2003 2004 2005

Employee Contributions

Current Year ($12,677) ($13,899) ($15,314)

Margin 0 0 (246)

Deficit Recoup 0 (2,104) (2,057)

Total Employee Contributions ($12,677) ($16,002) ($17,617)

Total Funding ($62,790) ($71,354) ($75,499)

Medical Acct Deficit/(Surplus) (EOY) $13,037 $8,229 $4,115

EE Cost Share (Excl. Deficit Recoup) 20.2% 21.6% 21.8%

Incurred Claim Cost PEPY $5,986 $6,382 $6,939


Medical Insurance Fund Projected Deficit in 2005

Projected deficit at 12/31/2004 $8.2 million

Projected 2005 plan expense $71.3 million

Total Funding ($75.5 million)

– From EBRPSS

($57.9) million

– From employees/retirees

($17.6) million

Projected deficit at 12/31/2005 $4.1 million


BenchmarkingState Benefits

* Family Unit Maximum: 3 individual deductibles


Lifetime Maximum Benefit $1,000,000 $1,000,000 $2,000,000 $2,000,000

Annual Deductible$500/active

$300/retired*$500/active

$300/retired*$300* $300 separate deductible


$1000 per person $1000 per person N/A N/A

Office Visit 90%70% / State Resident

90% / Non-State Resident$15 / PCP

$25 / Specialist70% after deductible

Preventive CareRoutine physicals, well child/baby care, immunizations for dependents up to age 7, etc.

90% / Child100% / Adult

70% / State Resident90% / Non-State Resident

$15 / Child100% / AdultUp to $200


Hospital Service - Inpatient 90% after deductible70% / State Resident

90% / Non-State Resident$100 per dayMax of $300


Hospital Service - Outpatient 90% after deductible70% / State Resident

90% / Non-State Resident100% 70% after deductible

Emergency Care 90% after deductible70% / State Resident

90% / Non-State Resident$100 copay

Hospital Copays apply70% after deductible

Urgent Care Facility


50% maximum $50 for 34 day fillLifetime Max : $250,000

After $1200 per person per plan year

Copay Brand $15, Generic $0









same same same 70% after deductible

EPOPPO


BenchmarkingState Benefits (cont’d)

Vantage HMO MCO

Plan Features In-Network Out-of-Network In-Network In-Network

Lifetime Maximum Benefit Unlimited Unlimited $2,000,000 / person Unlimited

Annual Deductible$1000 / ind.$3000 / fam.

$1,000 None None


None None N/A None

Office Visit$15 / PCP

$25 / Specialist70% after deductible

$15 / PCP$25 / Specialist

$15 / PCP$25 / Specialist

Preventive CareRoutine physicals, well child/baby care, immunizations for dependents up to age 7, etc.

$15 copay 70% after deductible $15 copay $15 copay

Hospital Service - Inpatient$100 per day$300 / admit.

70% after deductible$100 per day$300 / admit.

$100 per day$300 / admit.

Hospital Service - Outpatient 100% 70% after deductible 100% 100%

Emergency Care$100 copay

Hospital Copays apply70% after deductible

$100 copayHospital Copays apply

$100 copayHospital Copays apply





Copay Brand $15, Generic $0Forumlary Applies


$10$25$40

Formulary AppliesMandatory Generic Required



Copay Brand $15, Generic $0Formulary applies

Mandatory Generic RequiredPrescription Drugs - MailGenericBrandNon-formulary

same 70% after deductibleUp to 90 day supply

2 copayssame

Ochsner HMO


BenchmarkingIndependent Districts

EPO PPO Non-NetworkPlan Features In-Network Out-of-Network In-Network In-Network Out-of-Network


Annual Deductible None$150 / ind.$450 / fam.

$600 / ind.$1,000 / fam.

$600 / ind.$1,000 / fam.

$1,000 / ind.$2,000 / fam.

Annual Out-of-Pocket

Maximum$1,000 / ind.$3,000 / fam.

$1,500 / ind. $2,000 $3,000 $4,000

Office Visit $15 copay 70% after deductible 85% after deductible 70% after deductible 50% after deductiblePreventive Care

Routine physicals, well child/baby care, immunizations for dependents up to age 7, etc.

$15 copay 70% after deductible $20 copay $30 copay $30 copay

Hospital Service – Inpatient 100%$150 separate

deductible70% after deductible

85% after deductible 70% after deductible 50% after deductible

Hospital Service – Outpatient 100% 70% after deductible 85% after deductible 70% after deductible 50% after deductible

Emergency Care $25 copay $25 copay $100 copay $100 copay $100 copay


Prescription Drugs – Retail

GenericBrandNon-formulary

$5$20$45

Prescription Drugs are covered Nationwide

when filled at a participating pharmacy

$100 deductible / ind.$200 deductible / fam.

$10$20$40


$10$20$40


$10$20$40

Prescription Drugs – Mail


$10$40N/A

N/A


$10$20$40


$10$20$40


$10$20$40

Coventry HMO

Orleans Parish School Board Terrebonne Parish School Board


BenchmarkingIndependent Districts (cont’d)


Lifetime Maximum Benefit Unlimited $1,000,000 Unlimited N/A

Annual Deductible $500 / ind.$1,000 / fam.

$500 / ind.$1,000 / fam.

$500 / ind.$1,000 / fam.

N/A

Annual Out-of-Pocket

Maximum$1,000 / ind.$2,000 / fam.

$4,000 / ind.$8,000 / fam.

$1,750 / ind.$3,500 / fam.

N/A

Office Visit $25 copay 70% after deductible $25 copay N/APreventive Care

Routine physicals, well child/baby care, immunizations for dependents up to age 7, etc.

$25 copay$300 maximum

N/A$25 copay

$300 maximumN/A

Hospital Service – Inpatient$100 copay

90% after copayand deductible

70% after deductible 75% after deductible N/A

Hospital Service – Outpatient$100 copay


70% after deductible 75% after deductible N/A

Emergency Care$50 copay


$50 copay90% after copayand deductible

N/A


Prescription Drugs – Retail


$50 deductible per ind.$17$35$50 N/A


Prescription Drugs – Mail


$50 deductible per ind.$24$75

$100 N/A


Iberville Parish School Board

Enhanced PPO PPO

Documents

Board Meeting on 2005 Medical Plan East Baton Rouge Parish School System October 28, 2004 © 2004, Mercer Human Resource Consulting All rights reserved