Redlands Unified Insurance CommitteeHealth and Welfare Benefits Plan
April 2012
Insurance Committee Members
Maria ClarkChuck MendozaDeborah Severo
Mike Kress
Jolene TrippMiguel Ruiz
Celiza Hernandez
Ed Sibby
Sabine Robertson-
Phillips
Brad MasonBrian
GuggisbergFelicia Robinson
Kate PearneCurtis Marcell
Janet Jungnickel
Insurance Committee Timeline
September-OctoberCommittee reviewedloss ratio reports of current providers, health care reform updates, IRC 125, and health fair.
November-DecemberCommittee provided Keenan a list of providers for requests for proposals.
JanuaryCommittee listened to presentation from Rx and reviewed loss ratio reports.
FebruaryCommittee received results of proposals from selected carriers and provided direction to Keenan.
March- 1st MeetingCommittee listened to presentations from selected providers.
March- 2nd MeetingCommittee continued to listen to presentations from selected providers.
Insurance Committee Timeline
March- 3rd MeetingCommittee participated in a prioritization activity and reviewed rates submitted from selected providers. Committee discussed rates and gave direction to Keenan to negotiate lower rates based on decrement adjustments.
April- 1st MeetingCommittee reviewed new rates and gave Keenan further direction to request different decrements within the presented plans. Committee also reviewed final rates of Rx and Mental Health plans.
Insurance Committee Timeline
April- 2nd MeetingCommittee met to finalize recommendations for Benefits plan for the 2012-13 school year.
FINAL PLAN PRESENTATIONS TO RUSD EMPLOYEES
Request for Proposals (RFP)
Selected Carriers from RFP Process
Aetna
Kaiser
Mental Health Network
Express Scripts (Rx)
Plan Rates – Aetna
Aetna
Tier 1
Aetna
Tier 2
Aetna
PPO
$20 Copay $30 Copay$20 Copay,
80/60Medical $7,990.20 $12,258.00 $12,476.52 KPPC Pharmacy $1,925.64 $1,925.64 $1,925.64 Behavioral Health (MHN) $591.84 $591.84 $591.84 Delta Dental $1,522.08 $1,522.08 $1,522.08 Medical Eye Services $150.00 $150.00 $150.00 Prudential $156.00 $156.00 $156.00
Total Health &Welfare Premium Cost $12,335.76 $16,603.56 $16,822.08
Maximum District Contribution $10,640.64 $10,640.64 $10,640.64
Employee Pay Annually $1,695.12 $5,962.92 $6,181.44
Employee Pay - 10thly $169.51 $596.29 $618.14
Aetna Tier 1 Information
• Providers included are Beaver Medical Group, Redlands Yucaipa Medical Group, Pinnacle Medical Group
• Epic Management still offering $20.00 co-pay for office visits and Urgent Care
• Aetna plan design comparable to current health plan through Anthem Blue Cross
Aetna Tier 2 Information
• Changes to Tier 2 are:– Redlands Yucaipa Medical Group and
Pinnacle Medical Group are now in the Tier 1 network
– Loma Linda University Medical Center is no longer in Tier 2. Those wishing to continue with Loma Linda will need to move to Aetna PPO
– All other providers in Tier 2 remain the same
Plan Design - Aetna
Redlands Unified School District
Summary of HMO Plans Current ProposedEffective Date 7/1/2011 7/1/2012Renewal Date 7/1/2012 7/1/2013Carrier Name Anthem Blue Cross AetnaPlan Name HMO HMOEligible Class Eligible Employees Eligible EmployeesGeneral Plan Information Outpatient Specialist Visit Tier #1 ( Beaver MG) $20 copay $20 copay Tier # 2 $30 copay $30 copay Annual Out-of-Pocket Limit/Individual $500 $500 Annual Out-of-Pocket Limit/Family $1,000 Two-Party; $1,500 Family $1,000 Family Lifetime Plan Maximum Unlimited Unlimited Primary Care Physician Election Required Yes YesOutpatient Services Preventive Services Well-Child Care 100% 100% Immunizations 100% 100% Adult Periodic Exams with Preventive Tests 100% 100% Diagnostic X-Ray and Lab Tests 100% (CT scan, CAT scan, MRI,
Nuclear Cardiac scan, PET scan $100 copay when not performed in a hospital-
based facility)
100% (CT scan, CAT scan, MRI, Nuclear Cardiac scan, PET scan $100
copay when performed at an outpatient facility)
Maternity Care Pregnancy and Maternity Care (Pre-Natal Care)
Tier #1 ( Beaver MG) $20 copay $20 copay Tier # 2 $30 copay $30 copayInpatient Hospital Services Inpatient Hospitalization 100% 100% Pre-Authorization of Services Required Yes Yes Semi-Private Room & Board; Including Services and Supplies
100% 100%
Surgical Services Outpatient Facility Charge 100% 100%
Plan Design - Aetna
Redlands Unified School District
Summary of HMO Plans Current ProposedEffective Date 7/1/2011 7/1/2012Renewal Date 7/1/2012 7/1/2013Carrier Name Anthem Blue Cross AetnaPlan Name HMO HMOEligible Class Eligible Employees Eligible EmployeesEmergency Services Emergency Room $100 copay waived if admitted $100 copay waived if admitted Air/Ground 100% 100% Air/Ground 100%Urgent Care Urgent Care Facility $30 copay Tier #1 ( Beaver MG) $20 copay Tier # 2 $30 copayPrescription Drug Benefits Generic $10 copay
(administered by Express Scripts)$10 copay
(administered by Express Scripts)
Brand (Formulary/Preferred) $20 copay (administered by Express Scripts)
$25 copay (administered by Express Scripts)
Brand (Non-formulary) $40 copay (administered by Express Scripts)
Number of Days Supply 30 days 30 days Mail Order Generic $20 copay
(administered by Express Scripts)$20 copay
(administered by Express Scripts) Brand (Formulary/Preferred) $40 copay
(administered by Express Scripts)$50 copay
(administered by Express Scripts) Brand (Non-formulary) $80 copay
(administered by Express Scripts) Number of Days Supply for Mail Order 90 days 90 days
Plan Design - Aetna
Redlands Unified School District
Summary of HMO Plans Current ProposedEffective Date 7/1/2011 7/1/2012Renewal Date 7/1/2012 7/1/2013Carrier Name Anthem Blue Cross AetnaPlan Name HMO HMOEligible Class Eligible Employees Eligible EmployeesOther Services and Supplies Durable Medical Equipment & Prosthetic Devices 100% 100%
Home Health Care 100% Limited to 100 days per calendar year
100% Limited to 100 days per calendar year
Skilled Nursing or Extended Care Facility 100% Limited to 100 days per calendar year
100% limited to 100 visits per calendar year
Hospice Care 100% 100% Chiropractic Services $10 copay; 30 visits per calendar year $15 copay; 30 visits per calendar year
Acupuncture $30 copay per visit $30 copay per visit
Vision Examination 100% Evaluation only 100% Evaluation only Materials 100% limited to 100 visits per calendar Hearing Screening 100% 100% Aid(s) 100% Hearing Aids benefit limited to
one hearing aid per ear, every three 100% Hearing Aids benefit limited to one hearing aid per ear, every three
Infertility Diagnosis/Treatment See Plan Certificate See Plan Certificate
Outpatient Rehabilitative Therapy Services Physical, Occupational and Speech $30 copay Limited to a 60-day period of
care after an illness or injury; additional visits must be authorized by the
medical group
$30 copay treatment over a 60-day consecutive period per incident or
illness or injury beginning with the first day of treatment
CONFIDENTIAL: The information contained in this chart is intended for the exclusive use of the recipient with the recipient's review of this proposal. It is not intended for any other purpose. The information described on this page is only intended to be
Aetna – Open Enrollment
All Aetna Enrollees Must Participate in the
Open Enrollment Process
Plan Rates- Kaiser
Kaiser Permanente $30 CopayMedical $9,446.64 Kaiser Pharmacy Included Behavioral Health (Kaiser) Included Delta Dental $1,522.08 Medical Eye Services $150.00 Prudential $156.00 Total Health &Welfare Premium Cost $11,274.72 Maximum District Contribution $10,640.64 Employee Pay Annually $634.08 Employee Pay - 10thly $63.41
Plan Design- Kaiser
Kaiser – Plan Design
Kaiser – Open Enrollment
If you are currently with Kaiser
and are remaining with Kaiser,
and you are not making any
changes to your dependents, you do not have to participate
in the Open Enrollment Process
Express Scripts (Rx) Information
• Cost Saving Changes to Rx are:– Co- pay $10/$25/$40– Step Therapy– Select Home Delivery
Changes to Rx saved each member approximately $13.00 per month
Mental Health Plan Information
• Mental Health Plan Changes are:– Carrier changing from Holman to Mental
Health Network (MHN)– Similar Provider Network with Ability to
include current provider– Enhancements with Employee Assistance
Program (EAP)– No co-pay change– Holman’s renewal rate was 100% increase
Watch for more details shortly regarding Transition of Care formembers who are receiving outpatient or inpatient mental healthor substance abuse services on 7/1/2012.
Plan Design – Mental Health Network
Redlands Unified School DistrictBenefits & Premium AnalysisEffective Date
Renewal Date
Carrier Name
Employee Assistance Program 5 Face to face sessions with telephonic & web option
Enhanced member website
Basic Work & Life
Client Services including CISD
8 Training Hours
Mental Health Benefits In-Network Out-of-Network In-Network Out-of-Network Inpatient Care 100% Emergency Only 100% Emergency Only
Outpatient Care 100% Not Covered 100% Not CoveredSubstance Abuse In-Network Out-of-Network In-Network Out-of-Network
Inpatient Care
Inpatient Hospitalization 100% Unlimited Acute Care
Emergency Only100%
Unlimited Acute CareEmergency Only
Residential, Partial Hospitalization and Day Treatments 100% 100 days per/ cal yr
Not Covered 100%
100 days per/ cal yrNot Covered
Outpatient Care
Outpatient Services $0 Copay Not Covered $0 Copay Not CoveredRate Subscribers Rate Subscribers
Composite $31.71 1027 $49.32 1027
$ Total Monthly Premium
$ Total Annual Premium
$ Change Over Current Monthly Premium
% Change Over Current Annual Premium
CONFIDENTIAL: The information contained in this chart is intended for the exclusive use of the recipient with the recipient's review of this proposal. It is not intended for any other purpose. The information described on this page is only intended to be
Not Covered
Not Covered
Not Covered
Not Covered
100%
100%
100%
100%
100%
$390,794.04
55.53%
$18,085.47
Not Covered
$607,819.68
7/1/2012
Holman HMO
$32,566.17 $50,651.64
Proposed
7/1/2012
7/1/2013
Current
MHN HMO
7/1/2011
Dental/Vision/Life Information
NO CHANGES
Rates for Part-time Employees
FTE CLASSIFIED BARGAINING UNIT
CONTRACT PER MONTH (10 MONTHS) COST OF BENEFITS FOR THE 2012-2013 SCHOOL YEAR
MEDICAL DENTAL VISION LIFE
KAISER
AETNA HMOTIER 1
(BEAVER ONLY)
AETNA HMOTIER 2(FULL
NETWORK)AETNA PPO
DELTA DENTAL
MEDICAL EYE
SERVS.PRUDENTIAL
LIFE INS.
100%
6.25 OR MORE EMPLOYEE 63.41 169.51 596.29 618.14 0.00 0.00 0.00 HRS PER DAY
20/80%
4 HRS BUT EMPLOYEE 239.66 345.76 772.54 794.39 30.44 3.00 3.12 LESS THAN 6.25 HRS PER DAY
40/60%
2.25 HRS BUT EMPLOYEE 415.91 522.01 948.79 970.64 60.88 6.00 6.24 LESS THAN 4.00HRS PER DAY
60/40%
EMPLOYEE 592.17 698.27 1,125.05 1,146.90 91.33 9.00 9.36 LESS THAN 2.25HRS PER DAY
Rates effective 07/01/2012
Rates for Part-time EmployeesFTE CERTIFICATED BARGAINING UNIT, ADULT EDUCATION, RISE, AND HOME TEACHERSCONTRACT **HOURLY PER MONTH (10 MONTHS) COST OF BENEFITS FOR THE 2012 - 2013 SCHOOL YEAR
MEDICAL (MED+PHAR+BH+CHIRO) DENTAL VISION LIFE
KAISER
AETNA HMOTIER 1
(BEAVER ONLY)
AETNA HMOTIER 2(FULL
NETWORK)AETNA PPO
DELTA DENTAL
MEDICAL EYE
SERVS.PRUDENTIAL
LIFE INS. 100%
EMPLOYEE 63.41 169.51 596.29 618.14 0.00 0.00 0.00
76-100%36 HRS OR
MORE/WEEK 25/75%
EMPLOYEE 283.72 389.82 816.60 838.45 38.05 3.75 3.90
51-75%27 TO 36
HRS/ WEEK 50/50%
EMPLOYEE 504.04 610.14 1,036.92 1,058.77 76.10 7.50 7.80
26-50%18 TO 27
HRS/ WEEK 75/25%
EMPLOYEE 724.35 830.45 1,257.24 1,279.09 114.16 11.25 11.70
0-25%12.5 TO 18
HRS/ WEEK
**ADULT ED, R.I.S.E., and HOME TEACHERS ONLYRates effective 7/1/2012
Information Meeting Timeline
• April 17, 2012 @ 10:00 a.m. General Information Meeting • April 17, 2012 @ 5:00 p.m. General Information Meeting• April 18, 2012 @ 3:00 p.m. General Information Meeting• April 19, 2012 @ 4:30 p.m. General Information Meeting• April 26, 2012 @ 2:00 p.m. Retiree Information Meeting
RETIREES ONLY
• April 25-27, 2012 RTA/RESPA/RAPA Voting
All information meetings will be held in the Board Room• May 14, 2012 Open Enrollment Begins• May 25, 2012 Open Enrollment Closes• July 1, 2012 New Benefit Cards received by
staff
Computer Lab open daily 8:00 a.m. – 5:00 p.m.
during the Open Enrollment Period.