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Attachment A |
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Plan Design Recommendations - 2016 |
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2016 |
2016 |
2016 |
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Option 1 |
Option 2 |
Option 3 |
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Medical Plan Information |
No Changes |
Recommended
Increase Deductible and Out-of-Pocket |
Balanced Revenues/Expenses |
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Employer HRA Contribution |
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Individual/Family |
$250/$500 |
$250/$500 |
$250/$500 |
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Wellness Incentive (if
earned) |
$300 |
$300 |
$300 |
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Fund Cap |
$1900/$1900 |
$1900/$1900 |
$2,000/$2,000 |
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Deductible
(Individual/Family) |
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In-Network |
$1000/$2000 |
$1200/$2400 |
$3000/$6000 |
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Out-of-Network |
$1000/$2000 |
$1200/$2400 |
$6000/$12000 |
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Out-of-Pocket
(Individual/Family) |
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In-Network |
$2,000/$4,000 |
$2400/$4800 |
$3000/$6000 |
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Out-of-Network |
$4,000/$8,000 |
$4800/$9600 |
$12000/$24000 |
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Coinsurance Level |
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In-Network |
20% |
20% |
20% |
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Out-of-Network |
40% |
40% |
40% |
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Office Visit Copay |
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In-Network - PCP/Specialist |
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Out-of-Network |
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Prescription Drug |
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Generic |
20% |
20% |
deductible then 20% |
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Brand - 30 day supply |
$25 + 20% |
$25 + 20% |
Deductible then $25 + 20% |
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Brand - 90 day supply |
$50 + 20% |
$50 + 20% |
Deductible then $50 + 20% |
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Out of Pocket Maximum,
non-specialty (Individual/Family) |
$1000/$2000 |
$1000/$2000 |
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Specialty - 30 day supply |
$25 + 20% |
$25 + 20% |
Deductible then $25 + 20% |
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Out of Pocket Maximum,
specialty (Individual/Family) |
$1,000/$2,000 |
$1,000/$2,000 |
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Step Therapy |
All available drug classes, GF |
All available drug classes, GF |
All available drug classes, non-GF |
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DAW Override |
No - member pays cost diff. |
No - member pays cost diff. |
No - member pays cost diff. |
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Biweekly Contributions |
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Employee |
$7 |
$7 |
$54 |
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Employee plus Spouse |
$81 |
$84 |
$116 |
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Employee plus Children |
$75 |
$77 |
$105 |
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Family |
$130 |
$136 |
$167 |
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Aggregate Total Yearly
Contributions |
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Employee |
$1,501,000 |
$1,567,000 |
$2,311,000 |
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Retiree |
$439,000 |
$457,000 |
$457,000 |
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City |
$7,845,000 |
$8,159,000 |
$7,845,000 |
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HRA Account Utilization (of
Total Available) |
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Employee Spend Percentage |
80% |
80% |
80% |
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Plan Funding Impact |
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% Change in Projected Plan
Cost |
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-1.93% |
14.00% |
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Projected Fund EOY balance |
$4,870,000 |
$5,598,000 |
$7,479,000 |
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Projected affect to fund--
BOY to EOY |
($2,574,000) |
($1,846,000) |
$35,000 |
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Member Burden Impact |
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City Funds |
74.2% |
71.1% |
55.0% |
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Employee Funds |
25.8% |
28.9% |
45.0% |
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Member
Burden Note: |
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Member burden (employee funds) for 2014 was 26.8%. It is
estimated to change as shown above for the respective plan design
changes. Target range is 25-29% |
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