firefighter healthcare proposal - fort worth,...
TRANSCRIPT
Firefighter Healthcare ProposalPresented to the City Council
by
David Cooke, City Manager
and
Michael Glynn, President of the Local 440
October 24, 2017
1
Guiding Principles (“Our Agreement”)
• 440 will assume responsibility of healthcare for all recruits, active fire fighters and pre-65 retirees
• Separation of firefighter plan will not have a negative financial impact on the City; 440 will cover all transition costs
• City’s exposure to liability will be minimized to every extent possible
• 440 assumes all accountability for the success of their plan
2
Medical Plan Components
Local 440
Medical Plan
Stop Loss/
Reinsurance
Medical & Trust
Administrator
Pharmacy Benefit
Manager
Reference Based
Provider
Consultant
Maestro Health:Medical & Trust
Administration
LBG Advisors:Assists trust with plan set
up and monitoring
AMPS:Works with providers, facilities,
and coordinates fair paymentsKroger Prescription
Plans:Coordinates with pharmacies for
pricing, access, data
Montgomery
Management:Handles Re-insurance for large
claims or too many claims
Claims Support: Chain of Command
Customer Service @ Maestro Health / AMPS /
Kroger
•800 number access
•Service reps can look up plan benefits, claim details, etc.
•Care coordinators @ Maestro for claims issues
•Care coordinators @ AMPS for coordinating care connex/ billing issues
•Kroger customer service assists with pharmacy related questions
•Day to day issues with providers, cards, benefits questions, etc.
Dedicated Account Management @ Maestro Health / AMPS / Kroger
Dedicated account manager with escalated claims issues at each vendor
Those with ongoing issues tend to utilize these key vendor reps ongoing
Special issues addressed at this level that cannot be handled by regular customer service at vendors
LBG Advisors’ Claims Advocacy / Client Support
/ Consultant Support
LBG Advisors internal claims support staff handles issues escalated beyond dedicated account management at vendors
LBG Advisors staff performs monthly calls to client locations to check on needs of population
LBG Advisors’ consultants handle more complex issues that LBG Advisors internal claims support staff cannot handle
Trust Board Management
Trust board representatives (typically 3) that can field screened questions/issues from LBG Advisors and make final decisions
Voluntary Procedure• PreCertification Request
• Member Contacts AdvocateMember Contact
• Tier 1 – Direct Contract Option
• Tier 2 – High Quality, Fair Price
• Tier 3 – Physician ReferralMember Options
• Member goes for care at chosen facility
• Member PreCertified or presents Voucher
• Facility collects CoPay, submits claim to Maestro
Member Treatment
• Tier 1 - Maestro pays claim according to the voucher
• Tier 2/3 - Maestro pays claim according to the Plan Document
Claim Payment
Member has some control over time and
place
Potential Balance Bill
See Balance
Bill Workflow
Emergent Procedure • Member goes for care
• Member presents ID card
• Provider contacts Maestro for authorization
Member Visit
• Provider may be Care Connex
• Provider may be member of extended network
• Otherwise, provider is informed of member responsibility
Member Authorization
• Facility collects CoPay, submits claim to Maestro
Member Treatment
• Maestro pays claim according to the Plan Document
• If not a contracted facility, member is contacted and provided instructions in case there is a Balance Bill.
Claim Payment
Member has no control over time and
place
or member goes for care without
contacting
Maestro for Navigation Assistance.
Potential Balance Bill
See Balance
Bill Workflow
Next Steps
Enroll Group Medical, Dental, Vision, Ancillary
Set Set enrollment calendar and process
Engage Engage medical TPA, dental carrier, vision carrier, ancillary benefit options to create Plan Documents
Create Finalize trust document
Finalize Finalize budget, agreement between the city and L 440
Transition Steps: October 2017
• Council Meeting(s)
• Determine budget/agreement between the City and L440 for January 1st, 2018 start date
• Notify selected service vendors of approval to move forward
• Begin Trust establishment (including trustees selection) & filings
• Begin coordination of data to / from cityOctober
Transition Steps: November 2017
• Set up agreements/contracts between carriers, Trust Consultant
• Secure updated data from current carrier/update stop loss pricing
• Coordinate data between city and The Trust carriers/set up appropriate EDI files
• Trust membership education: establish open enrollment dates, initial enrollment document creation
• Plan doc, SPD creation Set actuarial rates/COBRA
• Set up Trust benefits web site
• Finalize budget/agreement between the City and L440 for January 1st, 2018 start date
November
Transition Steps: December 2017
• Enrollment meetings/Trust Membership education cont.
• Confirm eligibility accuracy
• Monitor State and Federal filing and submissions (as required)
• First payment from city to Trust
• Strategic plan development
• Set quarterly trust meetings for upcoming plan year
December
2018: Ongoing
• Quarterly meetings with trust
• Ongoing education- participant
• Ongoing education- trust board
• Additional participant meetings/town hall with membership
• Support moves from operational set up to claims control
• Strategic planning
• Consider enacting recommended strategies of strategic plan
• Operational quarterly reviews: monitor operations, address needs, compliance needs
Ongoing
Discussion Items
• Collective Bargaining
• Retirees: Waivers required
• Association Management
• Plan Design – Financial Projections
• Plan Design – Reference-Based Pricing
12
Collective Bargaining
• Current contract expires September 30, 2018 and includes: Article 14 Group Health Benefits
− Requires same plan and subsidy as that offered to other employee groups
− Disallows diminishment of City’s contribution below 2015 level
Article 15 Retiree Health Benefits− For firefighters hired prior to 1/1/2009, City required to comply with Chapter 175 of the LGC
with same plan and subsidy as those offered to other employees
• Change during 2018 requires an amendment approved by members
• New negotiations commenced on October 3, 2017 for a contract commencing October 1, 2018
13
Retirees: Waiver Required• Texas Law clearly excludes retirees from representation by the
Association
• City will require a waiver from every retiree− Waiver cannot guarantee the right of a retiree to return to the City plan if the
Association ceases plan operation in the future
− City may offer opportunity to return if plan ceases for firefighters and retirees if City still providing benefit to other similarly situated retirees
• Separate contract with the Association is necessary to outline the conditions of the City’s premium remittance
• 440 is declining to include language that would prevent retirees from suing over introduction of new premium tiers
14
Association Management• Intended to maintain control of benefits offered
• Proposed structure to transfer responsibility:• Recruits – condition of employment• Active firefighters – CBA • Retirees – diversion of subsidy to the association resulting in full cost if they
stay on City plan
• Association to establish a Trust to receive premiums from City, Retirement Fund and members
− Administered by a board of 5 firefighter trustees− Contractual requirement to allow City attendance at all Board meetings
• Plan to be administered by consultant with oversight by 440 Board15
Plan Design – Financial Projections
• Mimic City’s 2017 plan design with lower deductibles, co-pays and maximum out of pockets
• 440 will charge same member premiums as the City’s 2018 rates
• City’s subsidy to be reduced by:− Life insurance and EAP costs
− Increased admin fee for City for UHC administration
• Manages cash flow with a monthly aggregate stop-loss attachment of an amount similar to monthly premiums
16
Fire Proposal
17
Revenue Expenditures
City $11.8M Claims $13.56M
Retiree $ 1.2 M Admin $ 1.0M
Member $ 4.5 M Stop Loss $ .8M
Trust Expenses $ .1M
Reserve Target $ 1.4M
$17.5M $16.86M
Contract Considerations• City subsidy would be paid based on a composite rate applied to
actual enrollment on a per pay period basis
• Methodology for future subsidy levels must be determined
• Experience with Workers Comp presumption for certain cancers need to be accounted for in future subsidy rates
• Terms of re-entry if plan fails must be identified
18
Responsibilities in MOU1. City contribution and transition costs finalized2. CBA amendment language approved by City and 4403. Employee vote to amend CBA 4. Waiver language approved by City and 4405. Retiree waivers received (100%) 6. City Council approval of CBA and healthcare contract7. 440 create Trust8. 440 plan contracts (TPA, PBM, RBP); premiums finalized 9. Data interfaces with City and FWERF
10. Transition and enrollment plan19
Guiding Principles (“Our Agreement”)
• 440 will assume responsibility of healthcare for all recruits, active fire fighters and pre-65 retirees
• Separation of firefighter plan will not have a negative financial impact on the City; 440 will cover all transition costs
• City’s exposure to liability will be minimized to every extent possible
• 440 assumes all accountability for the success of their plan
20
Questions