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HomeMy WebLinkAboutPR 23351: THIRD-PARTY ADMIN, BLUE DCROSS AND BLUE SHIELD OF TEXAS, INC. City of nrt rthu�� Texu INTEROFFICE MEMORANDUM Human Resources Department Date: September 19, 2023 To: Ron Burton, City Manager Trameka Williams, Director of Human Resources From: Elizabeth Diaz, Assistant Director of Human Resource Re: BC/BS Renewal Effective 11/1/2023 P.R. No. 23351 - A Resolution Authorizing the City Manager to Execute Contracts Between Its Third-Party Administrator (Administrative Services Only) For the City of Port Arthur Group Medical, Dental Insurance, For Basic Life, For Basic Accidental Death and Dismemberment, And Excess Loss Indemnity with Blue Cross and Blue Shield of Texas,Inc. Nature of the request: The City of Port Arthur is self-insured and contracts with a third party administrator to administer its Health Insurance Plan for major medical health and dental insurance, basic life insurance, and basic accidental death and dismemberment insurance are also provided for employees and City Council appointees. Additionally,the City provides access to its major medical health insurance coverage, including prescription drug coverage, for its retirees under age 65. Medicare retirees as well as their Medicare dependent(s) transitioned to the Blue Cross Medicare Advantage PPO and Prescription Drug Plan 11/1/2016. The upcoming renewal initially offered a +18% funding adjustment over last year's funding level; however,with continuous negotiations it reduced health renewal rate to+4.7%as an overall suggested funding adjustment. The City's claim experience summary reflects an approximate 14% increase from the most recent experience period health claims. The increase in claims relates to the eight (8) high- dollar claims that exceeded the 140K individual stop loss level and two (2) more claims that will very likely exceed that prior 11/01/2023. Although for the last couple of years, the city has experienced eight (8) high-dollar claims, it's anticipated that next year, of the eight (8) high-dollar claims, will be reduced to four(4)high-dollar claims. Other favorable news is that the prescription rebate credit increased significantly this year and as a result, overall costs (administration, individual stop loss, and aggregate stop loss) decreased slightly. BCBSTX is including a $100,000 credit for the city to use as deemed appropriate towards funding of monthly cost. The dental coverage renewal reflected a 9.8% increase but continuous negotiations, it was lowered to+4.9% funding adjustment. Basic Life insurance and AD&D rates remained constant with no increase through 11/1/24. Staff Analysis. Considerations: The City of Port Arthur has a Preferred Provider Organization (PPO) insurance format which provides participants great latitude in selection of health care providers. This format has been deemed most beneficial for plan participants and most compatible with our organizational culture. The City also offers a lower cost Health Savings Account (HSA) option. The City is self-insured for major medical health insurance coverage. This year's renewal reflects a 4.9%increase in recommended premium funding, Attachment "A", is an analysis of this year's renewal proposal from Blue Cross Blue Shield of Texas as presented by the City's insurance consultant,Mr. Mickey Moshier. In order to continue to offer this benefit to employees and dependents in the most cost-effective manner, the following changes are being recommended: 1. Performance Select Drug List • The most robust drug list that drives optimal savings by selectively excluding high-cost drugs with minimal value,driving utilization to generics, and drugs with the over the counter (OTC)alternatives. Utilization Management Programs applies. • Approximately 33 members impacted of 700+ 2. Advantage Network(removing CVS) • Narrow pharmacy network that excludes CVS and other pharmacies to offer competitive rates to drive savings. Includes Walgreens and many regional, local, and independent pharmacies. • Members impacted: 84 or 5.9%of membership. 3. Weight Loss Drug Prior Authorization • Clinical program to encourage safe and appropriate medication use and provide safe and effective ways to minimize risk and reduce the cost of treatment. Additional efforts regarding wellness and education (e.g., emphasizing use of Employee Health Clinic, telehealth, exercise/gym programs) regarding plan usage and alternatives will be a significant initiative in the upcoming renewal year. The 2023-2024 Open Enrollment period will be from October 1 to October 31,2023. Recommendation: It is recommended that the City Council adopt P. R. No. 23351 which authorizes the City Manager to execute contracts between its third party administrator (administrative services only) for the City of Port Arthur group medical, dental insurance; for basic life, for basic accidental death and dismemberment, and excess loss indemnity with Blue Cross and Blue Shield of Texas, Inc., and Dearborn National Life Insurance Company for its 11/1/2023- 10/31/2024 plan year. Budget Considerations: Approval of P. R. No. 23351 which authorizes the City Manager to execute contracts with the following budgetary impact for which funds are available: Fund No. 614-11-025-5411-00-00-00 (Health Insurance Fund) Expected claims $10,812,001 Administration/Stop Loss $1,345,713 Dental $393,620 Basic Life/AD8cD $ 30,000 Total $12,581,334 P. R. No. 23351 09/19/2023--evd RESOLUTION NO. A RESOLUTION AUTHORIZING THE CITY MANAGER TO EXECUTE CONTRACTS BETWEEN ITS THIRD- PARTY ADMINISTRATOR (ADMINISTRATIVE SERVICES ONLY) FOR THE CITY OF PORT ARTHUR GROUP MEDICAL, DENTAL INSURANCE,BASIC LIFE, BASIC ACCIDENTAL DEATH AND DISMEMBERMENT, AND EXCESS LOSS INDEMNITY WITH BLUE CROSS AND BLUE SHIELD OF TEXAS,INC. FUND NO: 614-11-025-5411-00-00-00 (HEALTH INSURANCE) WHEREAS, the City Council of the City of Port Arthur deems it necessary and appropriate to provide major medical health care benefits for its City's employees, City Council appointees, and its retirees under the age of 65 effective on 11/01/2023; and, WHEREAS, the City Council deems it in the best interest of the citizens of Port Arthur to be self-funded and to accept the renewal from Blue Cross and Blue Shield of Texas, Inc. as a third party administrator at an estimated cost of $498,590 and a prescription drug and medical rebate of $817,278 leaving a net administrative fee credit of $318,688 (administrative charge based on the present number of employees) as well as at a cost of $1,641,301 per year for stop loss premium (excess indemnity) per recommendation of the City's insurance consultant, Mickey Moshier, listed hereto as Attachment "A"; and, WHEREAS, the City's group health plan coverage encompasses the enactment of the Patient Protection and Affordable Care Act (PPACA) effectuated on March 23, 2010, with continuing provisions enacted annually, and do hereby affirm to continue to make changes to its existing health plan policies or products as required to comply with the law; and, current language P.R.No. 23351 09/19/2023--evd ties the City of Port Arthur to specific disaster declaration by the President in which the City wishes to modify to a more standard term; and, WHEREAS, such contracting with Blue Cross and Blue Shield of Texas, Inc. complies with Sections 252.021(b), Competitive Requirements for Certain Purchases. 252.024, Section of Insurance Broker,and 252.048,Change Orders,respectively,of the Local Government Code;and, WHEREAS, the nature of the premiums to be charged by the City and the summary of benefits are as delineated in Exhibit"A",which reflects the costs for administration by Blue Cross and Blue Shield of Texas, Inc.,the stop loss premium, and the expected reserve; and, WHEREAS, the Basic Life Insurance will also be continued per Dearborn National Life which includes provisions to provide basic life insurance coverage to Fire Civil Service personnel at a rate of one times his/her base annual salary in accordance with the IAFF Collective Bargaining Agreement between the City $.22/per thousand dollar unit, and all other eligible employees' coverage will remain a $6,000 death policy, which will cost the City $.19/per thousand dollar unit/per employee/per month and attached as Exhibit"B"; and, WHEREAS, as part of the Dearborn National Life proposal, the City is also obtaining Accidental Death and Dismemberment Insurance on behalf of its employees which will remain at a cost of $.04/per thousand-dollar unit/per Employee (for a $5,000 accidental death and dismemberment policy for all eligible Employees) per month as attached Exhibit"B"; and, WHEREAS,the current year's renewal provides a 4.9% increase in premium to the City, to employees, City Council appointees,and to retirees under the age 65. It is being recommended that effective 11/01/2023 all impacted plan participants will incur a 2%premium increase. P. R.No. 23351 09/19/2023--evd NOW,THEREFORE,IT BE RESOLVED BY THE CITY COUNCIL OF THE CITY OF PORT ARTHUR,TEXAS: Section 1. That, the City Council of the City of Port Arthur hereby accept the following contracts to Blue Cross and Blue Shield of Texas,Inc., attached hereto and made a part hereof, as is fully delineated herein: INSURANCE COVERAGE ADMINISTRATIVE SERVICES EFFECTIVE DATE Administrative Services Blue Cross and Blue Shield November 1, 2023 City of Port Arthur's Group Medical and Stop Loss Dental Blue Cross and Blue Shield November 1, 2023 Basic Life &AD&D Dearborn National Life November 1, 2023 Section 2. That, the City Manager is hereby further authorized to execute the necessary contracts and other documents on behalf of the City of Port Arthur subject to the approval of the City Attorney, and to make payment of necessary premium and administrative charges to bind coverage subject to the terms and conditions of the contract for Third Party Administrator (Administrative Services Only) and the Contracts for Insurance attached hereto as required effectuate said services; and, Section 3. That,the City Manager is hereby directed to take all actions necessary to ensure proper funding of the City of Port Arthur's Employee Health Insurance Fund; and, Section 4. That, a copy of the caption of this Resolution be spread upon the minutes of the City Council. P. R. No. 23351 09/19/2023--evd READ,ADOPTED AND APPROVED this day of A.D. 2023 at a Regular Meeting of the City Council of the City of Port Arthur, Texas by the following votes: AYES: Mayor Councilmembers Noes • Thurman Bill Bartie, Mayor ATTEST: Sherri Bellard, TRMC, City Secretary APPROVED AS TO FORM: Val Tizeno, City Attorney APPROVED FOR ADMINISTRATION: Trameka Williams, Director of Human Resources Ron Burton, City Manager P. R. No. 23351 09/19/2023--evd APPROVED AS TO THE AVAIABILITY OF FUNDS: Kandy Daniel, terim Director of Finance P.R. No. 23351 09/19/2023--evd ATTACHMENT "A" J.S. Edwards & -- Sherlock INSURANCE AGENCY City of Port Arthur Benefit Renewals Active Employees and Under Age 65 Retirees 11/1/23 LIFE INSURANCE: The City's renewal with Dearborn National/BCBSTX reflects NO CHANGE to current rates for either life coverage classification. In addition, life coverage amounts may be increased with no change to the current per $1000 of coverage cost if requested. DENTAL INSURANCE: After 2 years in a row of no change to the City's fully insured dental plan, the original renewal offer foril/1/23 reflected a 9.8% adjustment. Negotiations lowered the adjustment to a modest 4.9%. Open enrollment provisions 4155 Phelan Boulevard • Beaumont,TX 7 7 707 ' 1).0. Box 22237, 77720-2237 Beaumont(409)832-7736 • Fax(409)833-1721 • Houston(713) 224-8723 allow employees to add/delete eligible dependents with no questions on your 11/1/23 renewal date. Please remember that only ACTIVE employees and their dependents are eligible for dental coverage. HEALTH PLANS: The City offers 2 health plans for active employees and retirees to choose from . Both plans are funded via the City's ASO (Administrative Services Only) arrangement, a partially self-insured financial design, via BCBSTX. Annual costs are comprised of administrative fees and stop loss premiums and actual claim costs. Current stop loss coverage offers a maximum liability of $140K for each covered individual as well as a total liability maximum for the City as a whole. For the most recent claim experience period, there have been 8 claims exceeding the $140K individual stop loss level and 2 more that will exceed that level prior to the City's 11/1/23 renewal date. Individual stop loss cost for the most recent period was approximately $1,640,000 while claims over the stop loss (which are funded by BCBSTX) have totaled approximately $2, 100,000. Overall paid claims for the most recent experience period totaled $10,700,000 while the previous period total was approximately $9,350,000. That said, the recommended funding level suggests an increase of 4.7% over current. Remember, if claims are less than what are anticipated, the City retains those dollars. BCBSTX is including a $100,000 credit for the City to use as deemed appropriate. Employee contributions can be reduced or the City can use it to fund a portion of the fixed monthly costs. All said, the renewal is both fair and appropriate. Claims have increased and the City needs to fund to the suggested level in order maintain proper financial viability. I am at your service 24/7 for additional discussion. Mickey Moshier, MHP it(Apt, J .S. Edwards and Sherlock Agency P.R.No. 23351 09/19/2023--evd EXHIBIT "A" % 5 N 0-5 | ` ] | ] 1 \, lx ) | P. a . \ � � ` � L. (N = \k 2 \ f { £) z . 2- )! % 2 § \ { f« i 114 $ o § y q ) 2 \ \ !� vt � .- o % f E . : o O Q ƒ 7 ! % _ , // \ 7 : _ / \{ 0 - ' CD q ¥ / U lID CL / \ k / . E - ( \ k r 17) } 0 0 � � Z ] 7 j � 'I \ I ] | ] \ ; ] — D | eti \ 1 1 E 1 1 1 1 1 7m CP r V O N CO CO to M CO CD C V N N. C) 1.- a CO CO t` a 1.- CD G Q V O V) V co co co r CO 0) ".0 N N N N N N CO CO CO V' 1-r r t` t` Cn CO C-1- 1.- I-- 1- 1- 1- N e- W, N.- N n r N N N n N N N N � m .� rO d O al Q C C a . 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F 2 0-u- n 3 \ _ � 'a a a 6FF o = _ O a OR/ E \3 k / o>— ƒ §>- EE I k �= / > Q_I- �ƒ 0 �j-30 � / 3 n • C) o m - 0 CO „ o $ % E ] 2 S & n e o ± / 2 2 U a)—0 # a n -0e 0 - C 0 =••7 = o D a) I _ CO E / m o Ca 7C3 a, a) c /_ \ o _c a) » E 2 = %Jk 1 ƒ £ 7p § \ =_ = = = CL 0 = %_3 3 U E•5 k ® © 5 =<_C) ] 0m c - C� 2 - SS~ _ 3U \ 0 k =� 2 = �1a ® C @ % 7p . oC p2 Cb/ o 7/ ea3c 0EC ] 2 cam = / j o ® 0 a) 50-c0 > qE , 1 E a = ! ; | ; BlueCross BlueShield of Texas Al „ --7.,,- --- ,,,-.. it i.,4000400 „ _ ...... . _. .,...,... . rr _ " , „„ i . --,- .„. , ,4, ....,,. .000,100P ., , , . , . . ., ,. 1 ‘,., . -,:, i,-, .,,,i, ,. -., , .. , , , ,..,. ., .::, , ... , , 1+ , it , k . , ,,, \ ..., . . r r 4 *' ..>.. ,.. , b ' '::,.' ; :, .., i..,,' _ h , G !AP, BF r ,t -,:i. MedsYourWay' Connects Members to Discounts MedsYourWay is a drug discount card savings program for Blue Cross and Blue Shield of Texas(BCBSTX) members.' It simplifies members'drugstore experience by automatically searching for and finding lower costs for eligible medicines.All your employees need is their BCBSTX member ID. How it Works • Members visit select, in-network retail pharmacies • The comparisons are done behind the scenes and show their BCBSTX Member ID when picking at the pharmacy.The member pays the lower up prescriptions. available price. • MedsYourWay automatically compares the prices from • All MedsYourWay purchases apply to yearly plan participating drug discount cards against the member's deductibles and/or out-of-pocket maximums. cost share under their pharmacy benefit plan for eligible prescriptions. Blue Cross and Blue Shield of Texas,a Division of Health Care Service Corporation, a Mutual Legal Reserve Company,an Independent Licensee of the Blue Cross and Blue Shield Association _,. .. ''' ' s l 7. 'z' . sr I1/4, 11‘ f w - rl- Why its Important It's All Part of the Plan About 79%of U.S. prescriptions are filled using drug There's nothing you or your employees need to do to discount cards to save money on the out-of-pocket start using the MedsYourWay program. It's part of your cost2—even if it means purchasing prescriptions benefit plan,and there's no sign-up or additional cost. outside of the benefit plan.This can erode member We're making it easy to help keep costs low and improve perception of their plan value. It also limits our ability members'health. to identify gaps in care and medication adherence. Their Benefit Is Your Benefit This seamless experience motivates cost-effective When your employees use their BCBSTX Member ID,they decisions,fosters medication adherence and can access the MedsYourWay savings opportunities under strengthens your employees'perception and use their benefit plan.This also gives us a line of sight into of their plan benefits. their overall care and increases opportunities for holistic care coordination and improved whole person health. • 0 Contact your account representative to learn more. 1. MedsVourWay is not insurance.It is a drug discount card program that compares the drug discount card price for an eligible medication(up to a 90-day retail supply based on plan benefits) at select in-network retail pharmacies to the member's benefit plan cost share amount and then applies the lower available price.Eligible medications are subject to change and prescription prices may vary by location.Not all retail pharmacies may participate with MedsYourWay.MedsYourWay is administered by Prime Therapeutics,LLC,a separate pharmacy benefit management company contracted by BCBSTX to provide pharmacy benefit management and related other services.In addition,contacting pharmacies are contracted through Prime Therapeutics.The relationship between BCBSTX and contracting pharmacies is that of independent contractors.BCBSTX,as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics. 2. Drug discount cards in an era of higher prescription drug prices:A retrospective population-based study.(2019).PubMed.https://pubmed.ncbi.nlm.nih.gov/31422026/ 762339.0523 no a BlueCross BlueShield of Texas •!i r.r: L} t11 1,IA1.,:te'. v Current Medication ei.,yw,��a'un Ptorvastatln Calcium t0mg Your Y i rt u a I gr:d P•--- Feb18,2023 fa 2 _ nrchae Artlo:�in tablet Medicine Cabinet roxas Metlorminhd1000mg Ne.Pe1,,A,ah Rxl:�lc8eme+`^8 laar 20,2073 Is Here - 2 �e, „„„ ` tralin mg . Xt Ser e S0 ReNK Pemang NIA NIP e i• C Save On Prescriptions With Just A few Clicks MyBlueRxTX Is a personalized pharmacy app for Blue Cr oss and Blue Shield of Texas (BCBSTX) members, We're making it easy to understand and manage prescription drugs and out-of-pocket costs for yourself and your family. How it works This app puts your prescription drug information in your Scan a QR code to download the free app. hands with features that allow you to: Use your Blue Access for MemberssM login, or create • Compare drug costs at different pharmacies a new account to get started. • Find available lower-cost drug options • Manage prescription drug care for your family* [■ . . ' -p!' Q �:;,ti•ri r' • Access information about your prescription drugs, . ..r .;j • ry including medication details, claims history, coverage, !:41,..1 t•*1!e V . •. pre-approvals and refills ■ ;C • „EriE 1- � -1•.• �"; ::4 • Get reminders when it's time to refill your prescription r�. • . ■ 'l' • Search for and contact in-network pharmacies MyBIoeReTX(OS) MyBiueRxrX(Android) Doweatl an GET IT ON $ApnIp Storthee ® Google Play *Who are listed as dependents on your BCBSTX plan.Adult children(age 18-26)and other dependents can download the app and create their own account. Not all features are available for all plans Blue Cross and Blue Shield of Texas,a Division of Health Care Service Corporation, a Mutual Legal Reserve Company,an Independent Licensee of the Blue Cross and Blue Shield Association 761087.1222 BlueCross BlueShield of'Texas tw • v, a • -0 I,t ! • • Digital . •4. .•• ••• * Pharmacy • so ,• . n 4 , ' Benefits , - ,, . , -, 1:. .... .. - . ,,, 4 Puts Savings Power # d'' x t. .-, �tl �, '"#•�... In Members' Hands ' ,+ a Ir s • * * s . R .0* ; 44 s y i * * I. ' . • ♦ • '* ' M t :' a, v, a '` , * I •a 0 a • * • • • • e - * * i • ua wad >x R `'n MyBlueRxTX Opens Digital Doors to Rx Savings MyBlueRxTX is a new, personalized One App That Makes a Big Impact pharmacy app from Blue Cross and MyBlueRxTX is a powerful digital tool that puts members in control of their Blue Shield of Texas(BCBSTX)that Rx spending.After downloading and signing up to use the app, members can: makes it easy for your employees to access, understand and manage • Compare drug costs at different pharmacies their prescription drug care and • Find available lower-cost options out-of-pocket costs. • Receive reminders when it's time to refill a prescription MyBlueRxTX delivers on our • Access information about their prescription drugs, including medication commitment to an intuitive digital details,claims, coverage, pre-approvals and refills pharmacy experience.The app gives • Search for and contact in-network pharmacies members easy, 24/7 access to personalized pharmacy benefits The MyBlueRxTX app allows employees to take charge of their prescription information and also to drug drug care. It puts the most useful and current information into members' cost savings opportunities. hands. It fully engages them in their health care and is the best way to lower costs and improve overall health. It also provides new cost-savings opportunities that help members reduce their out-of-pocket costs,while reducing your total health care spend. Blue Cross and Blue Shield of Texas,a Division of Health Care Service Corporation, a Mutual Legal Reserve Company,an Independent Licensee of the Blue Cross and Blue Shield Association 761405.0223 • MyBlueRxTX Frequently Asked Questions Q: What is the MyBlueRxTX app? A. It's the BCBSTX pharmacy app that gives members 24/7 access to their pharmacy benefits. Q: Is there a cost to members for MyBlueRxTX? A: Members can download MyBlueRxTX for free from the App Store or Google Play. Q: How is MyBlueRxTX different from the BCBSTX App? A. MyBlueRxTX irrrpw owes pharmacy benerit access. The BCBSTX app provides access to members'medical health insurance. Q: Will the BCBSTX App account work with MyBlueRxTX, or will it require a separate login? A: Members can use their existing BCBSTX App login to access their MyBlueRxTX account. Or, they can create an account after downloading the MyBlueRxTX app. Q: Can members renew prior authorization (PA) through MyBlueRxTX? A: MyBlueRxTX notifies members when their current approval (PA, coverage exception, etc.)will expire. They cannot complete the renewal in the app but are alerted to complete the renewal process in time for their next prescription. It's easy for your employees to get started, following these simple steps: gC 1. Download MyBlueRxTX from the App Store or Google Play. It's free. 2. If they already use the BCBSTX mobile app or have a Blue Access for MemberssM account,they Texas } can use the same login for MyBlueRxTX. 3. 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No. 23351 09/19/2023--evd EXHIBIT "B" Te1 lexas BlueCross BlueShield of Texas 1 701 E.22ntl Street,Suite 300—Lombard,IL 60148 1 CITY OF PORT ARTHUR ATTN: ELIZABETH VILLARREAL PO BOX 1089 1 PORT ARTHUR TX 776411089 1 June 17,2021 1 Subject: Renewal Analysis Group Policy Number: G31118 Anniversary Date: November 1,2021 1 Dear Policyholder: We would like to thank you for allowing us the opportunity to provide you and your employees with Group insurance products. We have reviewed the current demographics of your group insurance programs. We are pleased to I inform you that there will be no change in the existing rates for the upcoming renewal period. Rates will be guaranteed until November 1,2024. Products Current Rates Renewal Rates Basic Life(Class 1) $0.19 per $1,000 $0.19 per $1,000 Basic Life(Class 2) $0.22 per $1,000 $0.22 per $1,000 Basic AD&D $0.04 per$1,000 $0.04 per$1,000 IIf you have any questions pertaining to your renewal, or would like more information including the availability of other products as well as a quote for additional benefit programs, please contact your local IBlue Cross and Blue Shield of Texas Ancillary sales office or insurance broker. We value our relationship with you and look forward to providing quality service to you in the future. I Sincerely, Ancillary Underwriting Department I Cc Mickey Moshier I I Insurance products issued by Dearborn Life Insurance Company,701 E.22nd St.Suite 300,Lombard,IL 60148.Blue Cross and Blue Shield of Texas is the trade name of Dearborn Life Insurance Company,an independent licensee of the Blue Cross and Blue Shield Association.BLUE CROSS',BLUE SHIELD'and the Cross and Shield ISymbols are registered service marks of the Blue Cross and Blue Shield Association,an association of independent Blue Cross and Blue Shield Plans. I 1