Reso 2015-2377 - Laserfiche WebLink

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441(7..-".. CITY OF SUNNY ISLES BEACH • Health Plans cannot include an Annual Maximum • New Wellness Plan Requirements • Distribution of Summary of Benefits and Coverage (SBC) 60 days prior to Plan Effective Date • Distribution of DOL Insurance Marketplace Notice by October 1, 2013 • W-2 Reporting of Health Care Costs for all employers issuing 250 or more W-2s Health Care Reform Fees The Patient Protection and Affordable Care Act(PPACA) introduces new fees for health insurance companies and plan sponsors,which began in 2012. The four fees include the Health Insurance Industry Fee, Reinsurance Assessment Fee, Patient-Centered Outcomes Research Institute Fee (PCORI) and the Federally Facilitated Exchange User Fee. Under a CIGNA's Level Funded Arrangement,the City of Sunny Isles Beach would only be responsible for 2 of the new fees introduced under PPACA,the PCORI and Reinsurance Assessment Fee. • The PCORI Fee for the 2014 Plan Year would be reported on IRS Form 720 and due on July 31,2015. The PCORI Fee is a$2 fee for each member based on the average number of members for a single month over a 12 month period. For the period of March—November, 2014,the membership averaged 321 or a total due of$642. The PCORI Fee in subsequent years will be tied to increases in the per capita amount of the national Health Expenditures which has not yet been released. • The Reinsurance Assessment Fee will be due to the Department of Health and Human Services, reporting to be determined. The Reinsurance Assessment Fee for 2015 is a$63 fee due for each member per year($5.25 per member per month)to fund a 3 year reinsurance program to reimburse insurance companies that insure high-cost members covered through the Insurance Marketplace (Exchange). For the period of March—November, 2013,the membership averaged 318 or a total due of $20,034. The Reinsurance Assessment Fee in subsequent years will be adjusted, however, proposed regulations will discontinue this fee under your Level Funded Arrangement in 2015 moving forward. Recommendations Medical Plan We are recommending renewing with Cigna Health Care. Due to the high utilization of the Emergency Room,we are recommending that the copays are increased to try to incentivize the employees to seek care in the Urgent Care setting in lieu of the ER.We have also recommended a mandatory generic take effect.This will affect three of the highest cost drugs currently being taken.We do feel that this will cause minimal disruption to your employees, but will greatly help with cost containment. In addition,we are recommending that the max out of pocket for medical services double from what it currently is under the 2013-2014 plans and add a RX max out of pocket to each plan,which the plans did not contain one this year as the copays were continuous. In addition,we are recommending to change the Major Diagnostic copay from$100 to$150 on the high option and from$0 to$150 on the low option. Less than 5%of the population used these services and we feel it will have little or no impact on the employees.Cigna has removed the copay for Outpatient Surgery of$200.These services are now only subject to your deductible and 3IPage NI,FIT rn::n uxu.0>rr