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AGENDA
State and Public School Life and Health Insurance Board Benefits Sub-Committee
March 15th, 2019 10:00 a.m.
EBD Board Room – 501 Building, Suite 500
I. Call to Order .............................................................................. Claudia Moran, Chair
II. Approval of February Minutes .................................................. Claudia Moran, Chair
III. Financials ............................................................... Bonnie Casey, Asst. Comptroller
IV. Naturally Slim Update ............................................... Sandy Schenck, Naturally Slim
V. Catapult Overview ....................................................................... Lee Dukes, Catapult
VI. Trend Analysis ............................................ John Colberg & Gaelle Gravot, Cheiron
VII. Director’s Report .......................................... Chris Howlett, EBD Executive Director
VIII. Adjournment .............................................................................. Claudia Moran, Chair
2019 upcoming meetings:
April 12th, 2019, May 17th, 2019, June 14th, 2019
NOTE: All material for this meeting will be available by electronic means only ASE-PSE
Board@dfa.arkansas.gov
Notice: Silence your cell phones. Keep your personal conversations to a minimum.
BENEFITS MEETING MINUTES The Benefits Sub-Committee of the State and Public School Life and Health Insurance Board (hereinafter called the Committee) met on March 15, 2019, at 10:00 a.m. in the EBD Board Room, 501 Woodlane, Suite 500, Little Rock, Arkansas.
Date | time 3/15/2019 10:00 AM | Meeting called to order by Claudia Moran, Chair
In Attendance
Members Present Members Absent Claudia Moran Susan Gardner Carla Haugen - Teleconference Stephanie Lilly-Palmer Ronnie Kissire Cindy Allen Herb Scott - Proxy - Cayce Rainey Chris Howlett, Executive Director, Employee Benefits Division (EBD)
Others Present Rhoda Classen, Shalada Toles, Eric Gallo, EBD; Takisha Sanders, Health Advantage; Ronda Walthall, ARDOT; Mike Motley, ACHI; Bill Clary, ARSEBA; Treg Long, ACS; Sylvia Landers, Securian; Stephen Carroll, AllCare Specialty; Lee Dukes, Catapult; Sandy Schenck, Naturally Slim; Donna Morey, ARTA; Treg Long, American Cancer Society; Suzanne Woodall, MedImpact
Approval of Minutes by: Claudia Moran, Chair
MOTION by Kissire:
Move to approve the February 15, 2019 minutes.
Lilly-Palmer seconded; all were in favor.
Minutes Approved.
Naturally Slim Update by: Sandy Schenck, Naturally Slim
Schenck provided a brief update on the progress of the Naturally Slim pilot program. A few key points included: 381 individuals lost more than 10 pounds and 32% of individuals lowered their diabetes risk. A few potential initiatives are: pre/post program biometrics analysis with Catapult, one-year follow up survey with May 2018 participants, partnering with EBD to offer Naturally Slim as behavioral alternative to bariatric surgery program, and a celebration video produced in conjunction with onsite event at Arkansas State Capitol for local participants.
Page 2
Catapult Overview by: Lee Dukes, Catapult
Lee Dukes provided an overview of Catapult results from the last year. There were 86,286 eligible participants, 35,315 checkups delivered, 198 ASE locations and 276 PSE locations served. Discussion: Blood Sugar Kissire: Some of the issues we had were related to scheduling. I don’t know if there is a way
to limit who can schedule those early appointments, but we had some with Diabetes
that had to wait and almost passed out. In the future, maybe we can look at those
that we know have an issue and schedule them first.
Dukes: We would like to do something but communicating with people who have a condition
puts you at risk for violating HIPPA. In the future, they can eat something small and
just report it and can still be meaningful.
ASE/PSE Observations
Howlett: Will we be able to correlate with the metabolic syndrome that is associated here as
we move in to next year and then take the data to cross examine with Naturally Slim?
Dukes: Yes, we have done that with other groups that Naturally Slim has been involved with.
Kissire: I think it would be good to show some of the schools that are still not involved in
Catapult the results from these and how well they are benefiting the members and
saving lives.
Howlett: I agree, we are still working on getting more accessibility and exposure. We have set
another goal of around 50,000. We are seeing a lot more participation this year, early
on, than last year.
Trend Analysis by: John Colberg, Gaelle Gravot, Cheiron
Colberg and Gravot provided a trend analysis for ASE and PSE. They also provided 2020 ASE/PSE considerations as listed below:
Medical Trend (5% used for 2019 rate)
• Was higher than 2016-2017 trends
• Will PSE demographic improvement continue?
• Possible market pressures for increasing trends
• Considering 5.5% trend assumption
Page 3
Pharmacy Trend (8% used for 2019 rates)
• National forecasts have come down and the last couple of years of data supports lower trends
• Generic utilization steady at 91.5%
• Specialty drugs will drive the pharmacy trends
• Considering 5.5% trend assumption
Director’s Report: Chris Howlett, EBD Executive Director
EBD Director Chris Howlett provided a short report on legislation and bills that pertain to EBD. SB480, from a plan perspective, is the biggest item of cost to focus on right now.
Comments:
Allen: I was at a retired teacher meeting recently and one of the issues happening right now is teachers that have moved from QualChoice to HealthAdvantage for their supplement are having trouble with their claims going through. Is this a problem that EBD is having?
Howlett: In the fall, notice was given to Medicare that we would be switching from QualChoice to HealthAdvantage. Medicare did have a little latency issue when they posted that on February 8th. All the claims that were caught up in this were reprocessed and adjudicated appropriately. If they are still having issues, we would need to know that.
Allen: If they are still having issues what would you have them do?
Howlett: Have them call into EBD.
Moran: Will we have another round of Naturally Slim?
Howlett: Once we see the combined data between Catapult and Naturally Slim and see how that has joined forces, we can then integrate that within our medical management. Instead of having another pilot program, we will explore looking at that for the whole population and have predetermined kickoff points. Another key item would be integrating Naturally Slim with our bariatric program.
MOTION by Kissire:
Move to adjourn the meeting. Lilly-Palmer seconded. All in favor. Meeting adjourned.
1
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Leading program proven to reverse
metabolic syndrome, prevent diabetes
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M I N D F U L E A T I N G
and skill-building program
Simple, scalable
technology platform
reaches the masses
PREVENTIVE CAREIn-network benefit billed through
claims with BlueAdvantage
Naturally Slim® is the leader in the public sector.
Arkansas’s Metabolic Escalator™
1 Centers for Disease Control and Prevention2 National Institute of Health
living with
pre-diabetes1
of adults
overweight or obese2
70%living with
diabetes1
14% 37%
Foundations® Report
N AT U R A L LY S L I M ®
S t a t e o f A r k a n s a s
A R B e n e f i t s P S E & A S E
P r o g r a m S t a r t D a t e
1 0 / 8 / 2 0 1 8
OURGOAL
Measurably improve the health of ARBenefits plan members.
1. Foundations™ Phase Outcomes
2. Testimonials
3. Next Steps ARBenefits
Objectives:
Purpose of this report:
Achieve measurable weight loss, significant program engagement and
receive positive member feedback to aid in positioning Naturally Slim as a value-add to
benefits for ARBenefits plan members.
PARTICIPATION
Participation
Overview
Number of individuals that applied
and were accepted.
AcceptedNumber of individuals that were
accepted but never started.
Never StartedNumber of individuals that were
accepted and started Week 1 of
program.
Started
2,905 3052,600
90%
Started
Demographic Highlights
The average age of the U.S.
Workforce is 41
Average AgeNormal: BMI 18.5 to < 25.0
Overweight: BMI 25.0 to < 30.0
Obese: BMI > 30.0
Average BMIOn average, male participants lose
more weight than female
participants.
Participants
10%Men
Women
48 34.9
90%
Participation ReportWe e k l y e n g a g e m e n t f o r t h o s e p a r t i c i p a t i n g i n a t l e a s t t w o w e e k s
88%81%
73%68%
62% 61%56%
50%
2128 1870 1718 1555 1455 1319 1288 1193 1062
2 3 4 5 6 7 8 9 10
Week
WEIGHT LOSS
1.5
2.7
3.5
4.35.0
5.5 5.76.4
7.2
9.3
2 3 4 5 6 7 8 9 10
Avg
. W
eig
ht
(in
lb
s.)
Week
Weight Loss by WeekF o r a c t i v e p a r t i c i p a n t s
Total Weight Loss Greater Than 12,600 lbs.
6-m
on
th p
roje
ctio
n
Weight Loss by PoundsP e r c e n t a g e o f t o t a l p o p u l a t i o n r e c o r d i n g w e i g h t m o r e t h a n o n c e
N=2233
8%
48%
27%
15%
2%
Gained (173) Lost 0 to less than 5(1069)
Lost 5 to less than 10(610)
Lost 10 to less than20 (331)
Lost 20 or more (50)
381 ind iv iduals lost
more than 10 pounds
32% of individuals lowered their
diabetes risk.
* Refer to “Federal Treatment Guidelines: How much weight loss is
clinically significant?” slide in the glossary for further explanation
Post
Foundations™
Quality of Life
Survey
Feeling Weight is Out of Control
58%
25%
H o w h a s y o u r f e e l i n g t h a t y o u r w e i g h t i s “ o u t o f c o n t r o l ” c h a n g e d
c o m p a r e d t o b e f o r e s t a r t i n g t h e N a t u r a l l y S l i m p r o g r a m ?
17%
No ChangeVery Much Improved|Improved
83% o f ind iv idua ls fe l t
more in Cont ro l o f
the i r we igh t
Energy LevelH o w h a s y o u r e n e r g y l e v e l c h a n g e d c o m p a r e d t o b e f o r e s t a r t i n g t h e
N a t u r a l l y S l i m p r o g r a m ?
56%
5%
39%
No ChangeVery Much Improved|Improved
61% o f ind iv idua ls
exper ienced a
newfound burs t o f
energy.
Self-ConfidenceH o w h a s y o u r s e l f - c o n f i d e n c e c h a n g e d c o m p a r e d t o b e f o r e s t a r t i n g t h e
N a t u r a l l y S l i m p r o g r a m ?
56%
8%
36%
No ChangeVery Much Improved|Improved
64% o f ind iv idua ls
exper ienced a boos t
in con f idence .
Physical ActivityH o w h a s y o u r l e v e l o f p h y s i c a l a c t i v i t y c h a n g e d c o m p a r e d t o b e f o r e
s t a r t i n g t h e N a t u r a l l y S l i m p r o g r a m ?
56%
7%
37%
Quite a Bit More|Slightly More
No Change
63% o f ind iv idua ls
inc reased the i r leve l
o f phys ica l ac t i v i t y.
IndigestionH o w h a s y o u r i n d i g e s t i o n c h a n g e d c o m p a r e d t o b e f o r e s t a r t i n g t h e
N a t u r a l l y S l i m p r o g r a m ?
42%
16%42%
No ChangeVery Much Improved|Improved
58% o f ind iv idua ls ’
i nd iges t ion has
improved.
TESTIMONIALS
“I have lost 10 pounds. I am not craving sugar as before, I am
eating slower, and I have increased my exercise activity. My
clothes are fitting more loosely and I have lost some of my belly
area. This program has made me see food as a source for energy
and not as a mood enhancer.”
-ARBenefits Participant
“When I first began it was tough, but now that I've completed week 7, I've
noticed a few things: When I get up in the morning I'm normally starving, now
when I get up in the morning, I'm mainly thirsty. As a diabetic, I've took on a job
duty that requires me to walk....a lot including climbing stairs. I don't feel as tired
as I used to be. I only eat when I'm hungry. I monitor my glucose level daily and
notice a HUGE difference. I eat my favorite food first and by the time I do eat my
next item, I'm comfortably full. I think the segment that caught my attention is the
video about the sugar intake. I actually tried mashed cauliflower, similar to
mashed potatoes. I don't think I'll ever eat mashed potatoes again. Thank you
for this program.”
-ARBenefits Participant
“This is my first post, and I'm in Week 4. I've lost 8.4 pounds so far. My goal is to
lose 15 by the end of the 10 weeks. I've lost 3 inches in my waist already and 2
inches in my hips. When I start to think that 15 pounds isn't that much weight, I
look at my cat. He is 16 pounds, and he is a really big boy. When I think about
how much he weighs and my goal, it really puts in perspective how much weight
15 or 16 pounds is. The 10-5-10 skill has been really eye-opening and life-
changing. I can't believe how much food I have left when I do that, and yet I'm
comfortably full and completely satisfied. I'm eating about half of what I was
before I started the program. Really, I'm probably eating less because I'm not
snacking between meals. I feel like I've found the Holy Grail of weight loss
programs!”
-ARBenefits Participant
“This is the first Christmas that I can remember that I have NOT
packed on 5-10 pounds. I actually lost a tenth of a pound, & I’m
very happy about that!”
-ARBenefits Participant
NEXT STEPS
Potential Initiatives
1. Pre/post program biometrics analysis with Catapult to review clinical improvement among May 2018 participants
2. One-year follow up survey with May 2018 participants
3. Partnering with EBD to offer Naturally Slim as behavioral alternative to bariatric surgery program
4. Celebration video produced in conjunction with onsite event at Arkansas State Capitol for local participants
2929
CatapultHealth.com ©2018 Catapult Health • All Rights Reserved. CONFIDENTIAL1
A National Preventive Healthcare Practice
State of Arkansas - 2018
CatapultHealth.com ©2018 Catapult Health • All Rights Reserved. CONFIDENTIAL2
Welcome!
▪ Participation
▪ Satisfaction
▪ Clinical Results
▪ Catapult Enhancements
CatapultHealth.com ©2018 Catapult Health • All Rights Reserved. CONFIDENTIAL3
Participation
CatapultHealth.com ©2018 Catapult Health • All Rights Reserved. CONFIDENTIAL4
Participation Metrics
RESULTS
Eligible Participants 86,286
Checkups delivered 35,315
Participation rate 40.9%
Locations served
ASE = 198
PSE = 276
474
Outstanding/Good rating 94%
Congratulations on a very successful year!
CatapultHealth.com ©2018 Catapult Health • All Rights Reserved. CONFIDENTIAL5
Satisfaction
CatapultHealth.com ©2018 Catapult Health • All Rights Reserved. CONFIDENTIAL6
Patient Satisfaction
94% Rated Catapult
Outstanding/Good
CatapultHealth.com ©2018 Catapult Health • All Rights Reserved. CONFIDENTIAL7
Insightful Comments from Participants
“Excellent program. Very personal treatment. Everyone took even extra time to make sure I understood everything and went above and beyond to ensure I had the best treatment possible. I highly recommend them to all my colleagues that didn't set an appointment.”
“I have never seen a medical program of this caliber that operates in this capacity. I was more than impressed with the overall system (a medical pop-up shop). To setup a medical office in a classroom where they take your vitals and blood, and moments later to video conference with the nurse practitioner who already had all of your information let me know of the level of intentionality that went into this process. It was one of the most efficient and effective things I have seen in a while.”
“As a first timer experiencing this, I was very well pleased. I currently don't have a PCP and this was a great step in that direction! Hope you all return next year.”
“This was absolutely the best for a wellness check up!!! The results were quick and the technician was so nice! The Nurse Practitioner was very nice and helpful! All the tests that are required were run without me having to pay extra at my regular doctor for the cholesterol results as I have had to do in the past. AND....I didn't have to pay a co-pay!!!! It was a win-win in all areas! I hope we have the privilege of having this service every year!!!! Thank you!!!!”
CatapultHealth.com ©2018 Catapult Health • All Rights Reserved. CONFIDENTIAL8
Insightful Comments from Site Coordinators
“I’ve heard nothing but great reviews of how successful the Catapult checkups went. Thank you for making everyone’s experience a great one! We look forward to another one for next year.”~Mayflower School District
“I have praised you all to the highest to anyone that would listen!! Thank you for being efficient and professional!!! There is not a lot about the health assessments that are easy for me since we have a couple hundred people on the insurance, but this was totally painless!!”~White Hall Schools
“I can honestly say that I did not hear one complaint about the Catapult Clinic. I received a ton of kudos. People loved the ease of scheduling an appointment online. There was an overall theme of shock and awe by how fast and efficient the process was. I received multiple comments on how nice and personable the nurses were. That is a point in which I whole-heartedly agree.”~AR Crime Lab
“Everyone was bragging about how much easier it was to do this instead of going to their Doctor and hope we do it again next year. The staff was very pleasant, courteous, and helpful.” ~Harrisburg School District
CatapultHealth.com ©2018 Catapult Health • All Rights Reserved. CONFIDENTIAL9
Clinical Results
CatapultHealth.com ©2018 Catapult Health • All Rights Reserved. CONFIDENTIAL10
Population Health Report Demographics
CatapultHealth.com ©2018 Catapult Health • All Rights Reserved. CONFIDENTIAL11
Metabolic Syndrome
Metabolic Syndrome is the name for a
group of risk factors that occur together
and increase the risk for coronary artery
disease, stroke and type 2 diabetes.
Catapult Average = 24% Metabolic Syndrome
n = 28,480
38.3%
25.1%
36.6%
0-1 2 3+
Non-Fasting Patients
CatapultHealth.com ©2018 Catapult Health • All Rights Reserved. CONFIDENTIAL12
Blood Sugar
Fasting Patients (n = 28,480)
618 newly assessed with Diabetes
3,481 with history of Diabetes
62.1% effectively managing Diabetes
37.9% not effectively managing Diabetes
Non-Fasting Patients (n = 6,835)
0 newly assessed with Diabetes
700 with history of Diabetes
39.3% effectively managing Diabetes
60.7% not effectively managing Diabetes
Catapult Averages = 18.1% Pre-Diabetes5.2% Controlled3.8% Uncontrolled
Fasting Patients
CatapultHealth.com ©2018 Catapult Health • All Rights Reserved. CONFIDENTIAL13
Blood Pressure
Key Findings
11,148* newly assessed with Hypertension
11,316 with history of Hypertension
22.6% not effectively managing Hypertension
77.4% effectively managing Hypertension
3,035 with Elevated Blood Pressure
*Stg 1 - 8,742; Stg 2 - 2,367; Crisis - 39
Catapult Averages = 32.8% Uncontrolled21.6% Controlled10.0% Elevated
CatapultHealth.com ©2018 Catapult Health • All Rights Reserved. CONFIDENTIAL14
Blood Lipids
Key Findings
7,296 newly assessed Dyslipidemia (abnormal lipids)
7,705 with history of High Cholesterol
6,934 not effectively managing lipid condition
771 effectively managing lipid condition
Catapult Average = 12.7% Controlled Dyslipidemia37.9% Uncontrolled
n = 28,480
CatapultHealth.com ©2018 Catapult Health • All Rights Reserved. CONFIDENTIAL15
Body Mass Index & Abdominal Circumference
CatapultHealth.com ©2018 Catapult Health • All Rights Reserved. CONFIDENTIAL16
Depression
Key Findings
105 = Severe Depression
269 = Moderate Depression
406 = Mild Depression
291 = Minimal Depression
CatapultHealth.com ©2018 Catapult Health • All Rights Reserved. CONFIDENTIAL17
Preventive Care
Key Findings
1,603 men reported that they did not have a PCP
1,081 women reported that they did not have a PCP
CatapultHealth.com ©2018 Catapult Health • All Rights Reserved. CONFIDENTIAL18
Preventive Care
Key Findings
3,402 women were overdue for a Mammogram
4,440 women were overdue for a Pap Smear
3,748 women were overdue for Clinical Breast Exam
9,674 ages 50+ were overdue for a Colorectal Exam
CatapultHealth.com ©2018 Catapult Health • All Rights Reserved. CONFIDENTIAL19
High Risk Patients
Emergency Referrals 159High Risk Referrals 2,310
Avg SBP 141.7 High 233Avg DBP 88.9 High 140
Avg GLU 131.8 High 661Avg A1c 9.6 High 14.9
Avg TGS 196.0 High 500
Emergency ReferralsBP ≥ 220/120
Active Heart Attack Symptoms
Active Stroke Symptoms
Active Seizure ≥ 2 min
Elevated Glucose with Emergency Symptoms
High Risk ReferralsBP ≥ 160/100
Triglycerides ≥ 500
HgA1c ≥ 10
Glucose ≥ 400
History of Chest Pain
History of Shortness of Breath
CatapultHealth.com ©2018 Catapult Health • All Rights Reserved. CONFIDENTIAL20
ASE/PSE Observations
ASE PSETotal 12,541 22,774Females 59% 73%Average Age 46.3 46.0
High Risk Referrals 8.4% 5.5%Emergency Referrals 0.6% 0.4%
Metabolic Syndrome 33.6% 27.1%Diabetes 14.6% 10.5%Hypertension 68.9% 60.6%Lipid Disorder 51.2% 45.8%Obesity 58.8% 49.3%Depression 4.1% 2.5%Smoking 13.4% 7.3%Smokeless 6.3% 3.4%
CatapultHealth.com ©2018 Catapult Health • All Rights Reserved. CONFIDENTIAL21
Catapult Enhancements
CatapultHealth.com ©2018 Catapult Health • All Rights Reserved. CONFIDENTIAL22
Addressing Opioids
Filled Prescription Import
Catapult
Enhancements
CatapultHealth.com ©2018 Catapult Health • All Rights Reserved. CONFIDENTIAL23 CatapultHealth.com ©2018 Catapult Health • All Rights Reserved. CONFIDENTIAL
Empowering Individuals to Improve their Health
Trend Experience
& Updated Projections
Gaelle Gravot, FSA, MAAA
John Colberg, FSA, MAAA
Arkansas State Employees
& Public School Employees
Health Benefits Program
March 15, 2019
Benefits Committee Meeting
3/15/2019
Topics
Page
1) Background and Current Assumptions 3
2) Migration Patterns 10
3) Medical Trends 12
4) Pharmacy Trends 16
5) Trend Considerations for 2020 22
6) Updated Projections 23
Appendices
A. 2019 Final Rate Details 26
B. 2019 Plan Design 30
C. Use & Disclosures 32
2
3/15/2019
Background
• Definitions
– Trend: The change in costs (medical or
pharmacy) measured on a per person – or per
member per month (PMPM) – basis
– Plan Paid: The cost of services paid by the
plan
– Allowed: The cost of services after reflecting
provider discounts and plan limits but before
subtracting amounts paid by participants
(deductibles, copays, coinsurance)
3
3/15/2019
Projecting Costs
To project costs we reflect anticipated changes due to
• Plan Design
• Vendors/Network
• Demographics
• Migration (people changing plans)
• Geography
4
Experience period
(e.g., 4/1/2018 –3/31/2019)
Rating Period(e.g., 1/1/2020-
12/31/2020)
• Utilization
• Unit Price Changes
• New Services
• Leveraging
Trend assumptions generally includes
just the items in red, but historical data
usually also includes the other factors
3/15/2019
What is leveraging?
• If copays (or deductibles or out-of-pocket
maximums) remain fixed, plan paid costs
will generally increase more than the
underlying allowed cost trends
– Example: $25 Generic Drug
- $15 Copay (Premium Plan)
$10 Plan pays
$30 Generic Drug
- $15 Copay (Premium Plan)
$15 Plan pays 50% increase
5
If drug price
increases
20%
3/15/2019
Assumptions used for 2019 rates
2019 annual
trend assumptions
• 5% Medical
• 8% Pharmacy
Additional adjustments to reflect:
• Plan Design
• Vendors/Network (e.g., PBM change)
• Demographics
• Migration
(Geography is negligible for ASE/PSE)
6
Utilization
Unit Price Changes
New Services
Leveraging
3/15/2019
How do we set trend assumptions?
• Plan History
– Adjusting for changes in plan design, vendors/network, demographics, migration, etc.
• National Benchmarks
– CPI-Medical (generally unit price only)
– Kaiser Family Foundation (includes plan design and other changes)
– Other publications (e.g., ESI report for pharmacy trends)
• Marketplace Knowledge
• Stress Testing
7
3/15/2019
Historical Trend Data
Factors to remember
• Demographics
– Have lowered PSE non-Medicare (actives &
retirees) medical by 1.0% per year and
pharmacy trends by 1.3% per year for the last
6 years
– Have increased PSE Medicare trends by
approximately 0.9% per year for 2012-2016
then little change for 2017and 2018
– Have not significantly affected ASE trends
8
3/15/2019
Historical Trend Data
Factors to remember
• Plan Design – Changes effective in 2015
– 2019 Changes to PSE not yet reflected in historical trends
• Plans/Vendors– Elimination of silver plan affected PSE in 2015
– PBM change lowered costs 8% effective July 2016(half in 2015-16 trends and half in 2016-17 trends)
– Potential minor impact in 2019 due to change from Qualchoice to Health Advantage for certain retirees
• Migration– Does not significantly affect ASE
– Potentially significant impact on PSE
9
3/15/2019
2018 to 2019 PSE Migration patterns
Migration between plans tends to be offsetting;
Classic most commonly chosen by new hires
10
3/15/2019
2018 to 2019 ASE Migration patterns
Premium continues to dominate enrollment;
Growth in Classic/Basic comes from new hires
11
3/15/2019
Medical Trend: PSE
12
Actives & Non-Medicare Retirees Medicare Retirees
Keep in mind that demographics have lowered PSE non-Medicare (actives & retirees) medical by 1.0% per
year for the last 6 years and have increased PSE Medicare trends by approximately 0.9% per year for
2012-2016 (then little change for 2017and 2018).
3/15/2019
PSE Claims by Diagnosis
13
3/15/2019
Medical Trend: ASE
14
Actives & Non-Medicare Retirees Medicare Retirees
3/15/2019
ASE Claims by Diagnosis
15
3/15/2019
National Pharmacy Trend Forecast
16
Sources: http://lab.express-scripts.com/drug-trend-report
2018
2016
2017
3/15/2019
Pharmacy Costs
17
PSE ASE
3/15/2019
Pharmacy Trends
18
3/15/2019
19
Generic Utilization Growth
3/15/2019
20
Combined ASE/PSE Pharmacy Trends
3/15/2019
21
Adjusted Combined Pharmacy Trends
-2.0%
3/15/2019
Trend Considerations for 2020
• Medical trend (5% used for 2019 rates)– Was higher than 2016-2017 trends
– Will PSE demographic improvement continue?
– Possible market pressures for increasing trends
– Considering 5.5% trend assumption
• Pharmacy trend (8% used for 2019 rates)– National forecasts have come down and the last
couple of years of data is supporting lower trends
– Generic utilization steady at 91.5%
– Specialty drugs will drive the pharmacy trends
– Considering 5.5% trend assumption
22
3/15/2019
PSE Projections
23
ACCOUNTING BASIS 2019 2020 2019 2020
State Contributions for Plan Year 88.1$ 88.1$ 88.1$ 88.1$
Minimum District Contributions 89.3 89.3 89.3 90.2
Participant Contributions 131.7 132.8 132.2 132.9
Other Income 13.8 13.8 13.8 13.8
Reserve Allocated 12.7 25.3 12.7 27.1
TOTAL INCOME 335.6$ 349.3$ 336.1$ 352.1$
TOTAL EXPENDITURES (330.9)$ (349.3)$ (337.4)$ (352.1)$
NET PLAN GAIN / (LOSS) 4.7 -$ (1.3) -$
PLAN ASSETS (END OF YEAR)
Net Assets (Prior to Reserves Allocated) 152.5$ 127.2$ 146.5$ 127.2$
IBNR Reserve (29.0) (29.0) (29.0) (29.0)
Catastrophic Reserve (58.5) (58.5) (58.5) (58.5)
Reserve for Future Premiums (12.5) (22.6) (12.5) (24.4)
NET ASSETS AVAILABLE 52.5$ 17.1$ 46.5$ 15.3$
ENROLLMENT
Active Employees (includes COBRA) 46,750 46,750 46,722 46,722
Retirees 16,397 17,161 16,383 17,083
TOTAL ENROLLED 63,147 63,911 63,105 63,805
TOTAL INCOME PEPM 443$ 455$ 444$ 460$
TOTAL EXPENDITURES PEPM (437)$ (455)$ (446)$ (460)$
Dates for Medical Experience 1/18-12/18 1/18-12/18 1/18-12/18 1/18-12/18
paid through Jan-19 Jan-19 Feb-19 Feb-19
Dates for Pharmacy Experience 1/18-12/18 1/18-12/18 1/18-12/18 1/18-12/18
Census Data through Jan-19 Jan-19 Feb-19 Feb-19
Financial Statement Data through Dec-18 Dec-18 Jan-19 Jan-191 1 The IBNR Change reflects only the June 30 modification shown on the financial statements.
Presented in Feb. Updated
3/15/2019
ASE Projections
24
ACCOUNTING BASIS 2019 2020 2019 2020
Employer Contributions 174.4$ 174.4$ 174.9$ 174.9$
Participant Contributions 96.5 98.2 96.6 98.2
Other Income 19.7 19.7 19.7 19.7
Reserves Allocated 21.7 13.2 21.7 15.7
TOTAL INCOME 312.3$ 305.5$ 312.9$ 308.5$
TOTAL EXPENDITURES (314.8)$ (334.7)$ (310.5)$ (331.5)$
NET PLAN GAIN / (LOSS) (2.5) (29.2)$ 2.4 (23.1)$
PLAN ASSETS (END OF YEAR)
Net Assets (Prior to IBNR) 79.6$ 37.1$ 84.5$ 45.8$
IBNR Reserve (27.1) (27.1) (27.1) (27.1)
Catastrophic Reserve (30.6) (30.6) (30.6) (30.6)
Reserve for Current and Future Premiums (15.3) (8.6) (15.3) (11.2)
NET ASSETS AVAILABLE 6.6$ (29.2)$ 11.5$ (23.1)$
ENROLLMENT
Active Employees (includes COBRA) 26,038 26,038 26,108 26,108
Retirees 12,737 13,196 12,693 13,143
TOTAL ENROLLED 38,774 39,233 38,801 39,251
TOTAL INCOME PEPM 671$ 649$ 672$ 655$
TOTAL EXPENDITURES PEPM (677)$ (711)$ (667)$ (704)$
Dates for Medical Experience 1/18-12/18 1/18-12/18 1/18-12/18 1/18-12/18
paid through Jan-19 Jan-19 Feb-19 Feb-19
Dates for Pharmacy Experience 1/18-12/18 1/18-12/18 1/18-12/18 1/18-12/18
Census Data through Jan-19 Jan-19 Feb-19 Feb-19
Financial Statement Data through Dec-18 Dec-18 Jan-19 Jan-191 1 The IBNR Change reflects only the June 30 modification shown on the financial statements.
Presented in Feb. Updated
3/15/2019
Cheiron (pronounced kī´· ron), the immortal centaur from Greek mythology, broke away from the pack and was educated by the Gods. Cheiron became a mentor to classical Greek heroes, then
sacrificed his immortality and was awarded in eternity as the constellation Sagittarius.
25
3/15/2019
Appendix A – PSE Actives 2019 Final Rate Details
26
Actives
Partially Risk
Adjusted
Total Rate
Direct State
Contrib. & FICA
Reserve Used
/ (Added)
School
District
Contrib.
2019
Employee
Cost
2018 Employee
Cost
Assumed
Enrollment
Premium
Employee Only $555.98 $200.15 $5.88 $159.00 $183.46 $183.46 $0.00 0% 13,987
Employee & Spouse 1,328.58 325.00 5.88 159.00 831.20 831.20 0.00 0% 250
Employee & Child(ren) 967.92 325.00 5.88 159.00 470.54 470.54 0.00 0% 2,149
Family 1,555.82 550.00 5.88 159.00 833.44 833.44 0.00 0% 442
Est. Monthly Total ($mil) $10.9 $3.8 $0.1 $2.7 $4.3 $4.3 $0.0 0% 16,828
Classic
Employee Only $313.40 $95.00 $5.88 $159.00 $46.02 $46.02 $0.00 0% 14,320
Employee & Spouse 717.00 190.00 5.88 159.00 354.62 354.62 0.00 0% 1,604
Employee & Child(ren) 520.80 190.00 5.88 159.00 158.42 158.42 0.00 0% 5,888
Family 900.70 370.00 5.88 159.00 358.32 358.32 0.00 0% 3,563
Est. Monthly Total ($mil) $11.9 $4.1 $0.1 $4.0 $3.6 $3.6 $0.0 0% 25,375
Basic
Employee Only $251.64 $68.00 $5.88 $159.00 $11.26 $11.26 $0.00 0% 3,429
Employee & Spouse 535.16 90.00 5.88 159.00 272.78 272.78 0.00 0% 276
Employee & Child(ren) 384.24 90.00 5.88 159.00 121.86 121.86 0.00 0% 512
Family 603.00 155.00 5.88 159.00 275.62 275.62 0.00 0% 386
Est. Monthly Total ($mil) $1.4 $0.4 $0.0 $0.7 $0.3 $0.3 $0.0 0% 4,604
Total (Monthly) ($ mil) $24.2 $8.3 $0.3 $7.4 $8.2 $8.2 $0.0 0% 46,807
Est Annual Total ($ mil) $290.8 $99.5 $3.3 $89.3 $98.7 $98.7 $0.0 0%
Total Active & Ret ($ mil) $333.3 $99.5 $12.6 $89.3 $132.0 $132.0 $0.0 0% 46,807 Employee Cost assumes wellness participation. Total employee cost reflects 10% assumed not to receive $75 wellness credit.
Change in EE Cost ($/%)
3/15/2019
Appendix A – PSE Retirees 2019 Final Rate Details
27
NME Retirees
Partially Risk
Adjusted Total
Rate
Direct State
Contrib.
Reserve
Used /
(Added)
2019 Retiree
Cost
2018 Retiree
Cost
Assumed
Enrollment
Premium
Retiree Only $555.98 $0.00 ($85.16) $641.14 $641.14 $0.00 0% 484
Retiree & NME SP 1,328.58 0.00 (128.60) 1,457.18 1,457.18 0.00 0% 19
Retiree & Child(ren) 967.92 0.00 (224.68) 1,192.60 1,192.60 0.00 0% 7
Retiree & NME SP&CH 1,555.82 0.00 (452.82) 2,008.64 2,008.64 0.00 0% 4
Retiree & ME SP 747.16 0.00 (47.96) 795.12 795.12 0.00 0% 46
Retiree & ME SP & CH 1,159.10 0.00 (187.48) 1,346.58 1,346.58 0.00 0% 1
Est. Monthly Total ($mil) $0.3 $0.0 ($0.0) $0.4 $0.4 $0.0 0% 561
Classic
Employee Only $313.40 $0.00 $40.10 $273.30 $273.30 $0.00 0% 1,871
Employee & Spouse 717.00 0.00 151.22 565.78 565.78 0.00 0% 257
Employee & Child(ren) 520.80 0.00 50.98 469.82 469.82 0.00 0% 60
Family 900.70 0.00 154.50 746.20 746.20 0.00 0% 38
Est. Monthly Total ($mil) $0.8 $0.0 $0.1 $0.7 $0.7 $0.0 0% 2,227
Basic
Employee Only $251.64 $0.00 $103.14 $148.50 $148.50 $0.00 0% 379
Employee & Spouse 535.16 0.00 265.44 269.72 269.72 0.00 0% 70
Employee & Child(ren) 384.24 0.00 145.72 238.52 238.52 0.00 0% 26
Family 603.00 0.00 267.28 335.72 335.72 0.00 0% 21
Est. Monthly Total ($mil) $0.2 $0.0 $0.1 $0.1 $0.1 $0.0 0% 495
Total (Monthly) ($ mil) $1.3 $0.0 $0.1 $1.2 $1.2 $0.0 0% 3,283
Est Annual Total ($ mil) $16.0 $0.0 $1.7 $14.3 $14.3 $0.0 $0 -$
Medicare Eligible
Partially Risk
Adj Total Rate Subsidy
Reserve
Used /
(Added)
2019 Retiree
Cost
2018 Retiree
Cost
Assumed
Enrollment
Retiree Only $191.18 $39.62 $50.78 $100.78 $100.78 $0.00 0% 12,155
Retiree & NME SP 747.16 0.00 (36.76) 783.92 783.92 0.00 0% 74
Retiree & Child(ren) 603.11 0.00 (153.99) 757.10 757.10 0.00 0% 17
Retiree & NME SP&CH 1,159.10 0.00 (362.38) 1,521.48 1,521.48 0.00 0% 2
Retiree & ME SP 358.00 74.07 20.89 263.04 263.04 0.00 0% 1,072
Retiree & ME SP & CH 769.93 0.00 (118.65) 888.58 888.58 0.00 0% 0
Est. Monthly Total ($mil) $2.8 $0.6 $0.6 $1.6 $1.6 $0.0 0% 13,320
Total (Est. Annual) $33.3 $6.7 $7.6 $19.0 $19.0 $0.0 $0 -$
Change in Retiree Cost ($/%)
Change in Retiree Cost ($/%)
3/15/2019
Appendix A – ASE Actives2019 Final Rate Details
28
ActivesRisk Adjusted
Total Rate
State
Contrib. &
Other
Reserve
Used /
(Added)
2019 Employee
Cost
2018 Employee
Cost
Assumed
Enrollment
Premium
Employee Only $510.48 $355.50 $38.06 $107.92 $107.92 $0.00 0% 13,627 Employee & Spouse 1,138.22 660.35 78.41 390.46 390.46 0.00 0% 2,087 Employee & Child(ren) 851.64 561.03 65.27 216.34 216.34 0.00 0% 4,946 Family 1,479.40 865.90 105.62 498.88 498.88 0.00 0% 1,831 Est. Monthly Total ($mil) $16.3 $10.6 $1.2 $4.5 $4.5 $0.0 0% 22,491
Classic
Employee Only $446.18 $351.74 $37.56 $47.88 $47.88 $0.00 0% 1,360 Employee & Spouse 987.56 651.06 77.18 250.32 250.32 0.00 0% 163 Employee & Child(ren) 740.42 554.30 64.38 112.74 112.74 0.00 0% 348 Family 1,281.80 853.62 104.00 315.18 315.18 0.00 0% 217 Est. Monthly Total ($mil) $1.3 $1.0 $0.1 $0.2 $0.2 $0.0 0% 2,088
Basic
Employee Only $394.52 $348.40 $37.12 $0.00 $0.00 $0.00 n/a 1,175 Employee & Spouse 864.62 643.04 76.12 136.46 136.46 0.00 0% 126 Employee & Child(ren) 650.00 548.40 63.60 29.00 29.00 0.00 0% 229 Family 1,120.10 843.04 102.60 165.46 165.46 0.00 0% 148 Est. Monthly Total ($mil) $0.9 $0.7 $0.1 $0.1 $0.1 $0.0 0% 1,677 Total (Monthly) ($ mil) $18.4 $12.3 $1.4 $4.8 $4.8 $0.0 0% 26,256 Est Annual Total ($ mil) $221.3 $147.4 $16.7 $57.2 $57.2 $0.0 0%
Total Active & Ret ($ mil) $305.0 $185.4 $21.7 $98.0 $98.0 $0.0 0% 39,103
Employee Cost assumes wellness participation. Total employee cost reflects 12% assumed not to receive $75 wellness credit.
Change in EE Cost ($/%)
3/15/2019
Appendix A – ASE Retirees 2019 Final Rate Details
29
NME RetireesRisk Adjusted
Total Rate
State
Contrib.
Reserve
Used /
(Added)
2019 Retiree
Cost
2018 Total
Retiree Cost
Assumed
Enrollment
Premium
Retiree Only $510.48 $215.55 $28.53 $266.40 $266.40 $0.00 0% 1,635 MethodRetiree & NME SP 1,138.22 402.99 53.35 681.88 681.88 0.00 0% 313 Premium ChangeRetiree & Child(ren) 851.64 317.35 42.01 492.28 492.28 0.00 0% 95 Classic ChangeRetiree & NME SP&CH 1,479.40 504.81 66.83 907.76 907.76 0.00 0% 41 Basic ChangeRetiree & ME SP 910.66 349.60 46.28 514.78 514.78 0.00 0% 181 Not UsedRetiree & ME SP & CH 1,251.82 451.40 59.76 740.66 740.66 0.00 0% 9 ME ChangeEst. Monthly Total ($mil) $1.5 $0.6 $0.1 $0.8 $0.8 $0.0 0% 2,272 Not Used
Classic
Employee Only $446.18 $211.78 $28.04 $206.36 $206.36 $0.00 0% 46
Employee & Spouse 987.56 393.70 52.12 541.74 541.74 0.00 0% 15
Employee & Child(ren) 740.42 310.62 41.12 388.68 388.68 0.00 0% 2
Family 1,281.80 492.54 65.20 724.06 724.06 0.00 0% 2
Est. Monthly Total ($mil) $0.0 $0.0 $0.0 $0.0 $0.0 $0.0 0% 65
Basic
Employee Only $394.52 $208.45 $27.59 $158.48 $158.48 $0.00 0% 39
Employee & Spouse 864.62 385.68 51.06 427.88 427.88 0.00 0% 9
Employee & Child(ren) 650.00 304.72 40.34 304.94 304.94 0.00 0% 4
Family 1,120.10 481.96 63.80 574.34 574.34 0.00 0% 2
Est. Monthly Total ($mil) $0.0 $0.0 $0.0 $0.0 $0.0 $0.0 0% 55
Total (Monthly) ($ mil) $1.6 $0.6 $0.1 $0.9 $0.9 $0.0 0% 2,391
Est Annual Total ($ mil) $18.9 $7.5 $1.0 $10.4 $10.4 $0.0
Medicare Eligible
Risk Adjusted
Total Rate
State
Contrib.
Reserve
Used /
(Added)
2019 Retiree
Cost
2018 Total
Retiree Cost
Assumed
Enrollment
Retiree Only $400.18 $206.08 $27.28 $166.82 $166.82 $0.00 0% 7,407
Retiree & NME SP 910.66 289.97 38.39 582.30 582.30 0.00 0% 339
Retiree & Child(ren) 796.34 356.45 47.19 392.70 392.70 0.00 0% 90
Retiree & NME SP&CH 1,369.10 495.35 65.57 808.18 808.18 0.00 0% 23
Retiree & ME SP 776.00 332.35 43.99 399.66 399.66 0.00 0% 2,564
Retiree & ME SP & CH 1,172.16 482.72 63.90 625.54 625.54 0.00 0% 32 Est. Monthly Total ($mil) $5.4 $2.5 $0.3 $2.5 $2.5 $0.0 0% 10,455
Total (Est. Annual) $64.8 $30.4 $4.0 $30.4 $30.4 $0.0
Change in Retiree Cost ($/%)
Retiree CostChange in Retiree Cost ($/%)
3/15/2019
30
Appendix B – 2019 PSE Plan DesignBenefit Option Name: Premium Classic Basic
Last Modified: 1/1/19 1/1/19 1/1/19
Provider Network: Health Advantage Health Advantage Health Advantage
In-Network (INN) Benefits
Deductible (Individual / Family) $750 / $1500 $1750 / $27503
$4000 / $8000
Coinsurance 20% 20% 20%
Coinsurance limit (after Ded.) Individual/Family $2500 / $5000 $4700 / $6925 $2450 / $4900
Copays
Office Visit - Primary Care (PCP) $25 Ded. & Coins. Ded. & Coins.
OV - Specialist Care Provider (SCP) $50 Ded. & Coins. Ded. & Coins.
Urgent Care (UC) $100 Ded. & Coins. Ded. & Coins.
Emergency Room (ER) Non-admitted $250 Ded. & Coins. Ded. & Coins.
Emergency Transportation-Ambulance $50 Ded. & Coins. Ded. & Coins.
Hospital Facility - Inpatient & SNF (Co-pay/Admission)4
$0 Ded. & Coins. Ded. & Coins.
Hospital Facility - Outpatient - Co-Pay4
$0 Ded. & Coins. Ded. & Coins.
Out-of-Pocket Max (Individual / Family)2
$3250 / $6500 $6450 / $96753
$6450 / $129003
Out-of-Network (OON) Benefits 1
Deductible (Individual / Family) $2000 / $4000 $3000 / $60003 Not Covered
Coinsurance 40% 40%
Out-of-Pocket Max (Individual / Family)2 Unlimited / Unlimited Unlimited / Unlimited
Annual Maximum INN / OON Unlimited Unlimited Unlimited
Prescription Drugs
Separate Deductible then the following Copays: None Included with Medical Included with Medical
Retail (31 Days) - Generic/Formulary /Non-Form./ Specialty $15 / $40 / $80 / $100
Mail Order (93 Days) - Generic/Form. /Non-Form./Specialty $45 / $120/ $240/ $300
Non-Formulary Covered Yes No No
Out-of-Pocket Max (Individual / Family)2
$3350 / $6700 n/a / n/a n/a / n/a
Selected Detail Benefits
PsychiatryINN: $25 Copay;
OON: Ded & Coins. Ded & Coins. Ded. & Coins.
Rehabilitation (i.e., speech, occup. physical):INN: $25 Copay;
OON: Ded. & Coins. Ded & Coins. Ded. & Coins.
ChiropractorsINN: $25 Copay;
OON: Ded & Coins. Ded & Coins. Ded. & Coins.
Non- Medicare Benefits Covered: Yes, same as NME
Non- Medicare Providers Covered: Non-Par & Non-Accepting
Pharmacy Covered: Non-Par & Non-Accepting1When an in-network provider is not available within 50 miles for a hospital and 25 miles for all other providers, then in-network benefits apply.
2OOP Max includes the deductible.
3 A $2,700 embedded individual deductible maximum applies for family coverage.
4Deductible and Co-Insurance also applies
3/15/2019
31
Appendix B – 2019 ASE Plan DesignBenefit Option Name: Premium Classic Basic
Last Modified: 1/1/17 1/1/17 1/1/17
Provider Network: Health Advantage Health Advantage Health Advantage
In-Network (INN) Benefits
Deductible (Individual / Family) $500 / $1000 $2500 / $50003
$6450 / $12900
Coinsurance 20% 20% 0%
Coinsurance limit (after Ded.) Individual/Family $2500 / $5000 $3950 / $7900 n/a / n/a
Copays
Office Visit - Primary Care (PCP) $25 Ded. & Coins. Ded. & Coins.
OV - Specialist Care Provider (SCP) $50 Ded. & Coins. Ded. & Coins.
Urgent Care (UC) $100 Ded. & Coins. Ded. & Coins.
Emergency Room (ER) Non-admitted $250 Ded. & Coins. Ded. & Coins.
Emergency Transportation-Ambulance $50 Ded. & Coins. Ded. & Coins.
Hospital Facility - Inpatient & SNF (Co-pay/Admission)4
$250 Ded. & Coins. Ded. & Coins.
Hospital Facility - Outpatient - Co-Pay4
$100 Ded. & Coins. Ded. & Coins.
Out-of-Pocket Max (Individual / Family)2
$3000 / $6000 $6450 / $129003
$6450 / $129003
Out-of-Network (OON) Benefits 1
Deductible (Individual / Family) $2000 / $4000 $4000 / $80003 Not Covered
Coinsurance 40% 40%
Out-of-Pocket Max (Individual / Family)2
Unlimited / Unlimited Unlimited / Unlimited
Annual Maximum INN / OON Unlimited Unlimited Unlimited
Prescription Drugs
Separate Deductible then the following Copays: None Included with Medical Included with Medical
Retail (31 Days) - Generic/Formulary /Non-Form./ Specialty $15 / $40 / $80 / $100
Mail Order (93 Days) - Generic/Form. /Non-Form./Specialty $45 / $120/ $240/ $300
Non-Formulary Covered Yes
Out-of-Pocket Max (Individual / Family)2
$3100 / $6200 n/a / n/a n/a / n/a
Selected Detail Benefits
PsychiatryINN: $25 Copay;
OON: Ded & Coins. Ded & Coins. Ded. & Coins.
Rehabilitation (i.e., speech, occup. physical):INN: $25 Copay;
OON: Ded. & Coins. Ded & Coins. Ded. & Coins.
ChiropractorsINN: $25 Copay;
OON: Ded & Coins. Ded & Coins. Ded. & Coins.
Hearing Aids No Copay; Limit of $1400
per ear every 3 years
Ded. & Coins.; Limit of
$1400 per ear every 3
years
Ded. & Coins.; Limit of
$1400 per ear every 3
years
Durable Medical Equipment (DME) Ded. & Coins. Ded. & Coins. Ded. & Coins.
Monthly HSA Contributions N/A $25 Single/$50 Family $25 Single/$50 Family1When an in-network provider is not available within 50 miles for a hospital and 25 miles for all other providers, then in-network benefits apply.
2OOP Max includes the deductible.
3A $2,700 embedded individual deductible maximum applies for family coverage.
4Deductible and Co-Insurance also applies
3/15/2019
Appendix C – Use & Disclosures
• The assumptions and methods for updated projections are as described on our
monitoring reports dated February 2019 unless otherwise indicated. All projections for
2018 are illustrative and are not intended to convey any projected rate changes.
• In preparing the information in this presentation, we relied on information (some oral and
some written) supplied by the EBD and the Plan’s vendors. This information includes, but
is not limited to, the plan provisions, employee eligibility data, financial information, and
claims data. We performed an informal examination of the obvious characteristics of the
data for reasonableness and consistency in accordance with Actuarial Standard of
Practice No. 23. This presentation does not reflect future changes in benefits, penalties,
taxes, or administrative costs that may be required as a result of the Patient Protection
and Affordable Care Act of 2010, related legislation, or regulations.
• Cheiron's analysis was prepared exclusively for the Employee Benefits Division of the
State of Arkansas for the specific purpose of providing projections and options to the
Arkansas State and Public School Life and Health Insurance Board. Other users of this
document are not intended users as defined in the Actuarial Standards of Practice, and
Cheiron assumes no duty or liability to any other user.
• The figures in this presentation are preliminary and subject to change or modification as
more detailed information is gathered and depending upon decisions made by the
Board.
32
John L. Colberg, FSA, MAAA
Principal Consulting ActuaryGaelle Gravot, FSA, MAAA
Principal Consulting Actuary
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