HR Conference 2006Tallahassee, Florida November

14 &15

Programs ~ Processes ~ Partnerships ~ Programs ~ Processes ~ Partnerships

The State Group Insurance

Program for Plan Year 2007

Presenter

Verla Lawson Division of State Group

Insurance DMS People First Team

The Changes

•DSGI’s – Role and Responsibilities

•People First – Benefits Administration

•New Benefit Plans and New Vendors

The Challenges

• Coordination and cooperation between DSGI and People First to effectively manage complex processes that serve employees and retirees within a complex regulatory environment

• Enrollment in and implementation of new types of benefit plans and new vendors

DMS People First Benefits Team

• Contact the team at 850-921-4500• The People First Benefits Team

consists of the following members:• Tom Lockridge – Team Lead• Verla Lawson• Janice Lowe • Jackie Ward• Lenora Williams• Mike Waller

DSGI Reductions

•Downsizing and staff reductions

•Client Services outsourced

•Administrative Services outsourced

DSGI Today

•Agency Liaison•Policy Analysis•Product Management•Procurement•Policy and Rule

Determinations•Financial Management and

Residual Accounting Functions

People First

• System of Record (data)• Customer Service• Correspondence• Transaction Processing• Open Enrollment• Fiscal Administration• Eligibility Files to Vendors

Customer Interfaces

•Bureau of State Payrolls•State Agencies•Universities

–Devolved –Not yet devolved

•Division of Retirement•“Benefits Only” Entities

People First as System of Record

• COPES Insurance phased out• COPES data out of date • Transfer of COPES data to People

First (PF)• New enrollment in PF SAP system• Historical data to Data Warehouse• Transfer of DSGI historical data• SAP data and DSGI data in the

People First Data Warehouse

DMS People First Benefits Team

• Facilitates the implementation of system and operational processes in People First

• Assists employees and agencies with People First Issues

• Receives direction regarding laws, rules and policies from DSGI

Changes in roles and processes

Changes in roles and processes, coordination and cooperation.

Two Examples are:

• Underwriting approval process

• Exceptions and appeals

Underwriting Approval

• Underwriting approval process• Old procedure

– Deductions began prior to approval

– Cancellations and refunds required when underwriting was denied

• New procedure– New enrollment records “locked”

until approved– Deductions begin after approval is

received

Escalations and Appeals

• Escalated Issues – Pertain to People First

Processes– Submitted to PF Client

Services Team– Submitted by Agencies or

DMS Project Team• Employee Appeals and Agency

Errors

Appeals and “Exceptions”

• “Agency error” letters to People First (coordinates with DSGI in complex cases)

• Employee appeals – “Level 1 appeals by employee (not

agency) sent to People First”– If denied, employee has right to Level 2

appeal– People First sends Level 2 appeals to

DSGI– If denied, employee is notified by

registered mail of his right to an Administrative Hearing

2007 Benefit Plans

•HMO Service Area Expansions

•Open Access HMO Plans•Prescription Drug Program and Medicare Part D

Retiree Life Insurance

•Effective January 1, 2007 Retirees will have two benefit levels to choose from:

$2,500 & $10,000•Cost to Retiree: $ 4.20 & $ 35.79

Retiree Life Insurance

•Actual Premium paid to Prudential$4.20 + $6.36 = $10.56

for $2,500 and

$35.79 + $6.36 = $42.15 for $10,000

Retiree Health Insurance

Retirees who are not eligible for Medicare

pay the same premium for both the PPO and HMO plans.

Effective April 1, 2007

• Effective April 1, 2007 for May coverage monthly premiums will increase.

• Retirees who are not eligible for Medicare and members of the Standard PPO/HMO plans the premiums will increase as follows:

• Individual Coverage - $427.86• Family Coverage - $967.60

Medicare I

•A Retiree/Surviving spouse who is eligible for Medicare.

•For the Standard PPO Plan, coverage will increase to $227.18.

Medicare II

•Retirees/spouse or surviving spouse who are eligible for Medicare and one or more dependents are not eligible.

•In this case the premium will increase to $655.04.

Medicare III

•Two Medicare eligible participants and no other dependents.

•The premium will increase to $454.36

Health Investor PPO Plan

Medicare I•Premiums for those retirees enrolled in the Health Investor PPO Plan and not Medicare eligible, will increase to:

Individual Coverage - $351.20

Family Coverage - $768.56

Health Investor PPO Plan Medicare I

•Premium for a Retiree enrolled in the Health Investor Health Plan who is eligible for Medicare.

Individual Coverage - $169.46

Health Investor PPO Plan

Medicare IIRetiree/spouse or surviving spouse

eligible for Medicare with other

dependents.Premium amount

$562.34

Health Investor PPO Plan

Medicare IIIA Retiree and spouse eligible for Medicare

with no other dependents or a retiree or a surviving spouse

with a disabled dependent.

Premium amount $338.92

Retiree HMO’s

•Retirees who are eligible for Medicare and enrolled in one of the HMO Plans pay monthly premiums which vary by HMO and county.

Retiree HMO’s• For Plan Year 2007, some

premiums have increased while others have decreased or remained the same. (There is a chart showing all retiree premiums, by county on the People First web site at

https://peoplefirst.myflorida.com)

Health Investor Health Plans

•Health Investor Health Plans–PPO–HMO

•Health Savings Accounts•Limited Purpose Medical

Reimbursement Accounts

Health Investor Plans

• Lower premiums• Higher deductibles • Coinsurance rates

– Medical– Prescriptions

• Eligibility for Health Savings Account

• Election decision based upon utilization

Health Savings Accounts

• Tax exempt employee contributions

• Employer contributions • Ineligible for “regular” Medical

Reimbursement Account• Eligible for Limited Purpose

Medical Reimbursement Account• Employee managed account

HMO Changes

• HMO Service area expanded• Mail order Rx drug plans• Statewide contract rates

–no more “service area codes”

• “Open Access” HMOs –no “gatekeeper”

Medicare Part D

• Federal requirement to coordinate enrollment with Medicare

• Notification to participants• Retirees who choose Medicare D

subject to Coordination of Benefits• Data interfaces to monitor

enrollment in State Plan and Medicare D

The Future of Benefits Administration and the State Group Insurance

Program• DSGI will continue to work with

People First cooperatively to provide the State’s employees and retirees with a comprehensive package of quality benefits, meeting their needs in the most cost effective manner and using the latest technology to provide ready access to information and election opportunities.