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HomeMy WebLinkAboutJanuary 2005 • CITY OF OAK PARK HEIGHTS CI157 January 1 , 2005 South Central Region of the City, County, and Other Governmental Agency Service Cooperative January 1, 2005 Renewal TABLE O F C ONTENTS 1) Renewal Rates 2) Projected Renewal Year Claims and Renewal Development Summaries 3) Combined Experience Reports for Periods 1, 2, and 3 4) High Case Report 5) Component Summary Report 6) Utilization Graph 7) Population Distribution Graph • 8) Age Distribution Graph 9) Claims Distribution Report 10) VEBA Alternates 11) Miscellaneous • • January 1, 2005 Increase for CITY OF OAK PARK HEIGHTS 01157 Increase: 2004 Rate 0.0% 2005 Rate DOUBLE GOLD- PLAN#1 S $454.50 $454.50 F $1,250.00 $1,250.00 • • South Central City, County and Other Governmental Agency Service Cooperative 0 '0 CD 0 O N N N- N O N O O O O tf) .L O CD O of O O N 69 N ° C*) O C*) .;,,,,.=, C) O) O N O N C'7 CO CO LO r' If) CX) CO 0. 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CC Oo00000w oa0000000Ly) 000000000w CL 3 _o-tt) OOtritnttioL')> CL o-'t?46Ttri tri otri> 0)-`t?ooTtr) u)oui> O d N N co to r O J L m r N In N Ch to n J i W r N Ln N Ch t) r` J Q a f9 t7, f9 E9 69 CA EA f9 69 69 Q m or fA.9 69 69 69 64 69 69 69 O Q W CS 49 69(A 64 69 69 69 69 O Q O Q' O Mi O r r r O C . ■ , a7 0 i Ks F- CY �cc0oo00cc 0 0 CC f9oo o o 000000 CM 69000000000 F- LL• o 0 L o 000ao otn0000 000 otno000000 O r N lt) O Lt)to tfi C7 tf) N Lti O tt) lt) t[)C7 tti N tt) O tti to tti O t!) ›- cv fPi C9 b9 a-- r N co co N- 69 69 69 r r N C) to n- 69 69 EA r r N co to r-- )- ._ 69 64 64 Efl E9 69 69 69 E9 64 64 69 69 69 69 69 69 69 U n • a M N C O O N n in • o LC) CD r 'Cr CV CO • O 7 ;t 64 69 to 64 O O Q O o co O on O co co N- O� 6464 O O O o tfi O m O Ni 4 LJ O co CV CO > b9 • It 64 64 O O O to Q p ul c0 co co O O LC) O Q m b-s O O co co N sO> 64�O7 O O Q O o f') to O CO L N tf> c+7 LL1 N9 a a) N 64 64 N o O m N V O C) CN CO Q > co 't 64 O U CD 2 0 � � E Qo tno • i U N w co 0 co O co CV Lo N N. C/) O Q > t9 N CO N > O O OC U m T c N LC CO CO > Eq O 64 64 O U O a m LL C.) � U) Z 0 W S a 0 LL • a (0 0 C� Z U 2 N- N 2• 4t LC) La U U as BlueCross BlueShield t76) V BluePius of Minnesota Small Employer Survey • Independent licensees of the Blue Cross and Blue Shield Association Date Group Number Group Name The purpose of this survey is to determine if your business is currently in compliance with the Minnesota Small Employer Health Benefit Act. This law requires that we check an employer's status each year at their renewal. Please answer the questions listed below and follow the instructions at the bottom. If you have any questions,please call your agent or Blue Cross market representative. Yes No ❑ ❑ 1. Is the headquarters of your business located in Minnesota? ❑ ❑ 2. Are all employees paid wages under your company's Federal Tax ID number? ❑ ❑ 3. Is Blue Cross Blue Shield of Minnesota or Blue Plus your company's only health care plan? ❑ ❑ 4. Our records indicate that your company is not a member of a controlled group. Is this correct? (If you are unsure, consult your accountant.) ❑ ❑ 5. Did you employ an average of no less than 2 (including owners and partners)nor 41) more than 50 employees (excluding owners and partners) during the previous calendar year? Please note, an employee is defined as an individual working at least 20 hours or more per week, and excludes COBRA, seasonal, leased, temporary, and independent contract employees. Cl ❑ 6. Do at least 75%of the employees that your company has defined as eligible for coverage participate in this plan? Please note, to determine your participation level, do not include employees that have waived coverage due to coverage under another group health plan, MCHA, medical assistance (MA), General Assistance Medical Care, or Medicare Plans A and B. ❑ ❑ 7. Do you contribute at least 50% of each employee's (single coverage only) monthly health insurance cost? If you answered YES to all the questions,you need to take no further action. The payment of your premium constitutes no change in your employer status. If you answered NO to any of the questions, please fax the completed survey to (651) 662-1068 or mail it to: Blue Cross Blue Shield of Minnesota Small Group Underwriting, Route 3-40 PO Box 64560 St. Paul,Minnesota 55164-0560 All other questions about this renewal should be referred to your agent or Blue Cross market , 0representative. compliance A 10/07/02 Blue Cross and Blue Shield of Minnesota • 2005 Group Renewal Bulletin Small Group Service Cooperative Blue Cross • Effective with January 2005 renewals, Small Group Service Cooperative groups will be required to select a standard Small Group product offered by Blue Cross or a Common Benefit plan as designated by your regional Service Cooperative. Upon each renewal thereafter, you will be required to change your benefits as designated by Blue Cross, Service Cooperative and/or State and Federal legislation. Please contact your agent or sales representative if you have any questions regarding these changes. Thank you for renewing your Plan. We appreciate your business. Legislative Changes and Annual Reminders The following describes the benefit changes as a result of State legislation. • Cleft Lip and Palate Mandate Changed—This mandate increases the age limit for a dependent child to receive services for cleft lip and palate that are scheduled or initiated prior to the child turning age 19. The statute previously required treatment up to age 18. • Scalp Hair Prostheses Changed-This mandate was effective August 1, 1987 mandating coverage for scalp hair prostheses worn for hair loss due to Alopecia Areata. The benefit was up to $350 per calendar year and expenses were not subject to a deductible. With the change the expenses are now subject to deductible. • Routine Cancer Screening Changed -This mandate has been expanded to include coverage for CA125 tests for women at risk for ovarian cancer. • Annual Notification to Employees and Dependents who are Minnesota Comprehensive Health Association (MCHA)Enrollees-Minnesota law requires employers to notify their employees who are covered by MCHA of their right to enroll in the group plan on the renewal date. The employee can choose to join the group plan or stay with MCHA. Please notify your employees and dependents with MCHA coverage about this option. If they want to apply, ask them to complete a health history application and mail the completed application to your agent or sales representative immediately. Blue Cross will review the applications and reserve the right to adjust your group rates. The applicant's coverage will be effective on your renewal date. Benefit Changes The following describes the benefit changes made by Blue Cross. These changes represent our commitment to remaining competitive in both cost and plan design. • Change to Comprehensive Major Medical with Deductible Plans—The benefit level for office visits is changing from 80%coverage to 100%coverage after a $25 office visit copay. Lab and x-ray services occurring during the visit will be paid at 100%. • Closing of Basic Blue Plans—As a result of low enrollment in Basic Blue plans 124, 126, 128, 130 and the increased interest in our consumer directed products(Health Reimbursement Accounts(HRAs) and Health Savings Accounts(HSAs) we have decided to close Basic Blue. S Renaming the Options Blue for Small Groups product- We are now using Options Blue as the name for all consumer directed products. With this change,we are renaming the Options Blue for Small Groups product to as Blue Cross and Blue Shield of Minnesota is an independent licensee of the Blue Cross and Blue Shield Association qQQ L253P 1(4'OG1 Options Blue-High Deductible Health Plan(HDHP) compatible with HRAs. Plan numbers are 161, 163 and 165. • Closing of MSA Blue Plans and introduction of Options Blue 1I -High Deductible Health Plan (HDHP) compatible with HSAs-We are closing the MSA Blue Plans to make way for our new HSA products, Options Blue- High Deductible Health Plan (HDHP) compatible with HSAs. The new product is very similar to MSA Blue but takes advantage of recent changes in the law that allow for lower deductible options and first-dollar preventive care coverage. The plan numbers are 140- 151. • Prescription drug copay changing—The current drug copay of$14 is changing to a 20%coinsurance with a minimum of$10 and a maximum of$30 per prescription. If the cost of the prescription is less than $10,the member pays the cost of the drug. Drugs purchased through mail order will require a copay of$40 per prescription. This change does not apply to Plans 1, 23, 24, 161, 163, 165, 170, 172, 174, 176, 178 or 180. • Limitations now applying to PT/OT/ST services-Physical, occupational and speech therapy services will be limited to a combined maximum benefit of$500 per person per calendar year when services are received from a nonparticipating provider. • Plan Name Savings Single Family Plan #1 (Aware Gold No Copay) 0.0% $454.50 $1,250.00 Plan#4 (Aware Gold With Copay) 10.7% $406.00 $1,117.00 Plan #6 (Preferred Gold Full w/Copay) 8.9% $414.00 $1,138.50 Plan#8 (Preferred Gold Limited 90/10) 17.3% $376.00 $1,034.00 Plan #27 (Preferred Gold Limited 80/20) 19.9% $364.00 $1,001.00 Plan #30 (Preferred Gold $300 Ded.) 24.0% $345.50 $949.50 Plan#31 (Preferred Gold $500 Ded.) 25.8% $337.50 $928.00 Plan #32 (Preferred Gold $1000 Ded.) 29.4% $320.50 $882.00 Plan #33 (Preferred Gold $2000 Ded.) 32.7% $306.00 $841.50 Plan#113 (CMM $15 Copay) 15.9% $382.00 $1,051.50 Plan #114 (CMM $25 Copay) 17.5% $375.00 $1,031.50 Plan #118 (CMM $300 Ded.) 20.7% $360.50 $991.00 Plan#120 (CMM $500 Ded.) 22.6% $351.50 $967.00 Plan#122 (CMM $1000 Ded.) 26.5% $334.00 $919.00 Plan #123 (CMM $2000 Ded.) 29.9% $318.50 $876.50 Plan #161 ($1000 Ded. HRA) 31.9% $309.50 $851.50 Plan#163 ($1500 Ded. HRA) 36.3% $289.50 $797.00 Plan #165 ($2500 Ded. HRA) 43.0% $259.00 $712.50 Plan#170 ($1100 Ded. 80% HSA) 32.8% $305.00 $839.50 Plan #172 ($1800 Ded. 80% HSA) 40.4% $270.50 $744.50 Plan #174 ($2600 Ded. 80% HSA) 46.8% $241.50 $664.50 Plan#176 ($1100 Ded. 100% HSA) 25.3% $339.50 $933.50 Plan #178 ($1800 Ded. 100% HSA) 33.0% $304.50 $837.00 Plan #180 ($2600 Ded. 100% HSA) 40.0% $272.50 $750.00 Please contact me with any questions that you may have. Thanks! David D. Smith Underwriting (651) 662-4147 • ® BlueCross BlueShield Group Leader ooa BluePlus• of Minnesota Inkmdent Names o•e Um Om and IIw. Assoelailaa od Bulletin, Bulletin G5A-04 April 2004 Blue Cross and Blue Shield of Minnesota and Blue Plus Pharmacy Solutions Introduces New Mail Order Pharmacy Your health plan includes a mail-order prescription drug program administered by Caremark called Gold Net by Mail. With this benefit, your members can receive their long-term or maintenance medications (typically 90 days) through the mail. Starting June 1, 2004, Gold Net by Mail will be replaced by PrimeMail Pharmacy, a program administered by Prime Therapeutics.At that time,we will discontinue our relationship with Caremark for mail order prescriptions. Why the change? Prime Therapeutics, our pharmacy benefits manager recently completed construction of a world-class mail order pharmacy in Dallas,Texas.We believe PrimeMail will offer members safe and quality medications, timely home delivery, improved customer service and cost savings. We are communicating with members. To ensure a smooth transition for your employees to PrimeMail Pharmacy, members will receive a PrimeMail introductory packet.The packet will be mailed the week of April 19,2004 and will include: • Member Guide to learn about this benefit •Pharmacy Form to order long-term medications •Prescription Checklist to review order before sending • Return envelope to mail orders to PrimeMail Pharmacy Savings s for employers and your employees. Currently, only a small percentage of your employees are utilizing their mail-order benefit. This is unfortunate because a mail-order pharmacy offers significant cost-savings opportunities for members. PrimeMail offers competitive discounts on brand-name prescription drugs and considerable savings on generics. In addition, many patients will be able to receive a three-month supply of their medication for the cost of just two copayments. Plus, PrimeMail is a service your employees will appreciate because it affords quality medication, convenience,privacy and safety. Help us get the word out. To help build awareness and encourage use of PrimeMail, we've prepared a series of employer announcements, newsletter articles and posters that you can share with your employees. Contact your sales representative for PrimeMail promotional reminders and additional PrimeMail packets to distribute to new employees. Blue Cross and Blue Shield of Minnesota and Blue Plus strive to provide you with the best possible benefits and services. We're confident you and your employees will find PrimeMail to be a safe, convenient and cost-effective way to order your long-term prescriptions. Thank you for your attention to this important change. Blue Cross and Blue Shield of Minnesota and Blue Plus•P.O. Box 64560•St. Paul, MN 55164-0560 ® BlueCross Blueshieki Group Leader ,769 BluePlus of Minnesota Wgwdrt keme.1 W Mr 4w w Mw fMM/MW Wr • Bulletin G1A-04 February 2004 New Policy for Blue Cross and Blue Shield of Minnesota Conversion/Transfer from Group Coverage to Individual Medicare Supplement/Select Coverage Effective March I,2004,if Medicare-eligible members covered under employer group contracts want to change their coverage to an individual Medicare Supplement/Select product with prescription drug coverage (Senior GoldsM drug rider or the Extended Basic contract),a health history application must first be completed and approved. If prescription drug coverage is not included in the Medicare Supplement/Select product,those members may simply complete an Open Enrollment application in order to transfer from group coverage to an individual Medicare Supplement/Select product. Members wishing to transfer from a group product to an individual Medicare Supplement/ Select plan must apply within 63 days of the loss of group coverage. Please Note: State and Federal law allows members applying l ' within six months of their Medicare Part B effective open-enrollment date to enroll in any Medicare Supplement/Select product with no health questions asked.