Travis County Commissioners Court
May 27, 2008
Item 22
22. Consider and take appropriate action on recommendations from Travis County employee benefits committee regarding fy '09 rates and plan revisions: a. Keeping the epo plan for fy '09 and direct staff to re-evaluate annually; b. Maintaining fy '08 rates and subsidy amounts for the fy '09 plan year for all plans; c. Continuing the life, ad&d and disability coverages at the current rates for fy '09; d. Receive report on dental insurance rfp; -- what kind of. >> dismember.
>> accidental death and dismemberment.
>> really cheery topic. Dental insurance rfp and e in three parts, 1. Increasing the er co-pay from $50 to $100 on all three plans; 2. Covering colonoscopies at 100% on all three plans; 3. Covering diabetic supplies at 100% on all three plans; f is to release -- release of employee/retiree communication prior to the employee hearing and open enrollment; and g -- fy '09 open enrollment dates from July 21, 2008 through August 22, 2008; and second part of f -- second part of g, rather, is default coverage of employee only co-insured epo and basic life for employees that do not complete open enrollment process during the above dates; and 8. Discontinuing the requirement of a notarized paper affidavit for declining insurance and move to an electronic statement of other insurance that would capture any needed information.
>> good morning, judge and Commissioners, alicia perez, executive manager for executive operations. We have good news on the -- on the employee benefits front again this year. If you look at page one of your back up, April the 24th, the benefits committee met and decided to go ahead and met with the act terri, decided to go ahead and set employee premiums for fy twine twine, this is the earliest that we have done that. Therefore the recommendation is here. To you today. The actuary looked at the trend, they take actual trends both for utilization and medical trends, private sector, public sector, they came out with a 12% trend that was what was provided for by milaman, the medical trend was the utilization plus the cost of medical services make up the trend. When we looked at our actual usage in Travis County, that was 5%. We are below what would be the considered the norm on a national scale and are doing really pretty good at 5%. As long as we keep in the single digits I think --
>> did you mention that the norm is 12%.
>> yes.
>> did you? Okay. That is remarkable.
>> that's what they came up with using public, private and national perspective on what that trend should be or would be. Our actual trend was about 5%. So the actuaries looked at that and they looked -- if you look at the bottom chart there, where it has the epo, epo has gone up almost 12%, the ppo and the co-ined epo has decreased about 3.76%. Anyway, all plans combined, you can look at the detail of that on page 6, would have you have an increase of .93%. .93% less than 1%. So f.y. 08 the committee's recommendation is not to increase -- I知 sorry for fy '09 the committee's recommendation is not to increase any of the premiums for health insurance. Either for retirees or for active employees.
>> that's good news.
>> yeah, that's very good news. Second year in a row. That's a first time in Travis County history.
>> glad to hear that news.
>> uh-huh.
>> can you explain just explain the chart on page 1 regarding what is -- what does it mean required increase? Go ahead.
>> page 6 for the details.
>> I知 sorry?
>> page 6 for details.
>> the first page of -- of the memo from the employees benefits committee, has one column required increase for active employees and required increase for retirees. And I知 just trying to understand what -- I知 just unclear what a required increase -- is this -- what's required about it? Are we talking about an increase in utilization, an increase in costs, combination of the two and what's required about it.
>> taking the increase in utilization for the ppo that we're talking about?
>> either one.
>> in the cost, projecting that out, the traditional figure used for premium by both the actuary and the united health care is 12%. And using that figure, calculating what -- what that plan has used in the past 15 months, previous 15 months, indicates that the epo would have a 7.84 rate increase. For actives 43.67, for retirees, combining those, based on the number of enrollees, it would be an 11.8% rate increase for the epo.
>> based on the 12% trend used by miliman.
>> it's strictly for rate setting, doesn't have an experience factor in as alicia said earlier. Ours is closer to 5%.
>> the actuarial term that they use is the final numbers they came up with.
>> got it.
>> comparatively, what -- what are other governmental entities experiencing this year as far as increase or decrease in the premiums? Do we have anything in that --
>> we do. The actuaries told us in their book of business for the public entities that most of them are experiencing double digit increases.
>> double digit increases.
>> yes, sir. In the mid teens to the like 20% depending on what type of plan they have and whatnot, they were very -- very baffle understand one respect that our trend wasn't higher, that our experience wasn't worse. We've had a little bit of an experience increase this year. But we -- they looked back and said the last two years have really been uncharacteristically low for a public entity, we really think that's due to the clinics influence and maybe being able to hold down some of the costs to keep us fairly level or with a very slight incline.
>> we have been fortunate. It doesn't mean the next year that you won't see a higher increase because that's just the way health care goes, you just don't know when you are going to have some -- some catastrophic illnesses show up or --
>> > especially on the self funded plan, but for two years in a row we've been fortunate.
>>
>> [multiple voices]
>> do we give employees an opportunity to respond to recommendations?
>> yes, sir.
>> we do at the employee hearings which is set for June the 18th at 4:30.
>> okay. So basically the request today is for the court to ratify the recommendations for a public hearing.
>> yes, sir. So we can send the information out and then you get retirees and employees showing up on June the 18th at 4:30 p.m. In Commissioners court.
>> what you did last year, judge, since it was the first year we never had a rate increase. You went ahead and approved not having a rate increase, but you kind of reserved the option of coming back after the employee hearing and changing something if the employee hearing changed something. So that's one of the reasons that as we get down to item f, where we're talking about employee communication and item g, open enrollment, that we gave you the opportunity, if you want to go ahead and approve these things today since there are no rate increases you can do so knowing that after the employee hearing, you know, there's still time for you to make a change if you wanted to.
>> uh-huh.
>> talk to me about the -- e. One is a co-pay insurance right for the emergency room.
>> yes.
>> and two and three I guess the plan will pick up 100% of those costs, colons on scopes, diabetic supplies.
>> yes. On e approve -- what we are asking for is approve increasing the e.r. Co-pay from 50 to $100 on all three plans. What we are finding out is that in the last year or so we have had more people going to the emergency rooms when we have availability of -- what they call the doc in a box or emergency primary care facilities that are available. People are showing up in the emergency room. That is just so much costlier for us. So we thought one of the ways to influence that or curb was was one an education program to let people know of the 24 hour clinics set or available and also increasing the e.r. Co-pay from $50 to $100 for all plans. In combination with that, though, we are approving or asking the court to approve the coverage of colonoscopies 100% for all three plans. They are preventive examinations that anyone over 50 is recommended to have on a regular basis. With this there will be no co-pay for that particular procedure. Also, on the preventive side is to approve covering diabetic supplies, this would be strips, syringes, the --
>>
>> [indiscernible] already covered at 100%. But we found that some of the employees are not being as compliant as they would like on their diabetic regime because the cost of the diabetic supplies is -- can be pretty burdensome, especially if you are testing eight or nine times a day. So we are asking for those to be covered also at 100%. Snoog ahead.
>> let me back up a little bit. From $50 to $100 increase as far as the e.r., emergency room is concerned. And the reason for that is I知 hearing is that you are trying to discourage folks from using the emergency room when they may have available critical care under their primary physician; is that correct?
>> right.
>> primary and also clinic. We have the emergency clinics throughout the area.
>> all right. Are they -- are they open 24 hours?
>> not most of them, no, sir.
>> that's why I wanted to bring a point up. Because some -- how many of these hits have been on -- utilizing the emergency services at hospitals -- how many of these have been after hours --
>> [barking] where the person wasn't able to visit --
>> there were some and we may be able to get a little bit more detailed information for you.
>> I would like to get more detail about that.
>> we don't want to discourage people going to the emergency room when they have a life threatening disease or something they feel is a life threatening disease.
>> these are -- when your committee looked at this.
>> uh-huh.
>> what did they take into account, hours after they primary physician was not available.
>> that was not one of the things that were looked at. Right now what you are looking at in this memo is more utilization. The behind the scenes story on each and every visit was not available to us on all of that, but we can do a little digging if you want to and come back and tell you more. We got these numbers from the united health care at the annual meeting that they gave us.
>> so the answer actually rests with them as far as when the person came in.
>> yes, sir.
>> was it after hours --
>> they looked at all e.r. Visits during the day and at night. What we are concerned about is that we had an increase in 36% last year in usage of the e.r. Overall usage. That's a huge jump.
>> 36%?
>> 36%. In one year. And we used it 30% more than our peer groups, other groups that are made up of like public entities made up of the same type of folks as us. We are using it 30% more. That tells us not all of those need to be e.r. Visits. So now what we want to do is do a better job of letting people know what their options are because a lot of times people go to the e.r. When they don't know what else to do.
>> have we been able to direct that concern to the employees just on what you have said as far as giving them proper information to let them know?
>> we have some employee communications almost ready to go out on this very topic because we realize that some employees may not know what their options are. So this was also a suggestion from united health care. They gave us a list of all of the alternatives, the --
>> urgent care clinics.
>> urgent care type of alternatives, we are going to provide, make sure the employees have a list. So they know what they can do.
>> okay.
>> because i, too, have a concern about that. The statistics are really revealing that the 36% more than last year, the 30% more than our peer group, I would ask and although I知 -- I am reluctantly in favor of this increase, I would ask that we drill down to see if we can figure out why that is so. Because they -- I don't think a $50 increase is going to substantially change someone's decision, the education will.
>> sure.
>> but the $50 increase won't because I have utilized the emergency room for my child this year, it costs even with insurance between 3 and $400 to go to the emergency room. So -- that extra 50 bucks isn't really going to change my decision. It's knowing what other options I have at 7:00 at night.
>> we are in agreement with that. Education is the key here. Kind of they also have another option, the nursing --
>> nurse line. We have urgent care clinics, about eight of them throughout the county. We have nurse line, so we will -- when we send out the information on this, we will attach that information to -- to the -- to the information that goes to the employees.
>> I suppose my point is nobody is going to want to spend between 3 and $400 for a trip to the emergency room whether it's 350 or 400 if they didn't need to. So I think the education is really more important than the $50 hike. The $50 hike is -- it's expensive no matter how you slice it. I would prefer us not to hike it $50. And do the education alone.
>> the $50 hike might also have something to do with united health care and what they do with the rate. I mean, it -- you are right, I mean, what you really need in the emergency room, whether it's going to charge you 50 bucks or 100 bucks, if you really got to have the emergency room you are going to go. But I think that what you are dealing with here is you are dealing with -- with united health care saying it's going to make it a lot easier for us to take a good hard look at your plan and the charge because deductible, I mean, that's the reason when you have an automobile deductible, do you have 500, do you have a thousand? You want a lower premium, you get a lower premium when you have a thousand deductible. That's probably, you know, coming or should could into play.
>> that is part of it.
>> this is -- united health care, the actuary and those folks that have the data and have shown demonstrated a 36% increase spike into last year's usage, there's a reason for it. There needs to be drawn out and separated to see why that increase has occurred. In my opinion.
>>
>> [indiscernible]
>> [inaudible - no mic]
>> I have some information that may be helpful as well. Just kind of showing how Travis County employees use the emergency care versus urgent care versus our peers. This is going to be events per 1,000, from the united health recovery report we went to in early spring. For the current period, 206 I guess visits per thousand employees. That compares to 160 per thousand for our peer and about 180 per the norm. The big difference is going to be for urgent care, we have 35.6 events per 1,000. But our peer has 80. So more than double.
>> that's one of the differences.
>> yeah.
>> that's why I speculate education is going to do it for us, not the $50 hike.
>> I also think these other entities have a much higher e.r. Co-pay than we do. Ours was much lower, we may be behind the curve as far as what other entities are doing right now.
>> we are the only one in this intermediate area that still has a $50 co-pay. They all have 75 or $100 co-pay right now.
>> although few people check their co-pay before they rush their loved one to the hospital.
>> exactly.
>> that's true and just as a reminder, if -- if a person is admitted from the emergency room, there is no co-pay.
>> they waive that co-pay, right?
>> that's right.
>> right.
>> so do we know -- are we able to describe what's available at the urgent care facility?
>> the services?
>> yeah.
>> services and I guess whether there's a physician on duty around the clock or -- what the hours are.
>> yeah, sure.
>> this is not a good piece.
>> seems to me more details about -- about that -- that option would be helpful.
>> yeah.
>> also, barbara brought up a good point. The nurse line feature that we have with united health care is a nurse line that you can call into. If you are not sure if you should go to the emergency room or if you can wait until morning or if you should try to find a doctor instead of the emergency room, there's a nurse line that's -- that our employees can call, an 800 number, staffed by registered nurses they can give you a clue as to what you should do if you really don't know. Especially first time mothers, people with children. Is a nosebleed the reason to go to the e.r. Or something that can wait until morning. They will give you some practical things to do in the meantime. If they think it's urgent they will definitely tell you head right to the e.r. Something we have been underutilizing, we need to do a better job again, education is key on that. That would be included in this mailout that we do.
>> I think it's pretty amazing that united health care has told us what they have told us. If keeping us with our weekly or our payments our claims that we are making, I mean, we have got to be 25 or 30% greater, I mean, just like this week, I mean,, you know, we paid out 757,000. Same period last year 571,000.
>> [multiple voices] we are like --
>> we are still within our budget. We are tracking it --
>> we are --
>> we are within the budget that we set out which is amazing because we've had some very large weeks.
>> they don't care about the budget.
>> they don't, we do.
>> all they see is a big increase. I bet you that we are going to witness this next year.
>> through March. These numbers are only through March of this year.
>> through March.
>> those increases --
>> we have gotten our renewal from uhc. And so -- so we know what to expect there for the next queer. The -- for the next year.
>> we have seen bigger sweeps. Highs are higher, lows are lower.
>> judge, do you have questions on any of the other? If not we would like to take advantage to make sure that employees know that open enrollment will be July the 21st. Will begin July the 21st and go through August the 22nd of '08. July the 21st through August the 22nd. It's a full month. O line, we encourage everyone to do online options. If anyone needs help, the h.r. Department is always open and available to provide assistance or you can call h.r. Also.
>> they have computers.
>> yes.
>> and anyone that's not comfortable in using a computer, they can come into h.r., they will provide assistance. But if employees do not register or end roll for benefits, then -- enroll for benefits, then we do have a default where it will be co-insured epo and the basic life. It will only be the employee that will be enrolled, no family members. It's real, real important. Any employees that do require a -- a coverage of their dependents, if they enroll within the time period, between July 21st and August the --
>> how do -- how did we come out on this, you know, because that is a real stinging concern if you -- if you do not end up enrolling between the period that you stated, that you had just stated there. Did we track that to see how many persons have actually by whatever circumstance were not able to stay within the confines of the defined enrollment date.
>> we did.
>> and end up -- pardon me.
>> we do.
>> how many did we have that --
>> like 11 last year.
>> 11 last year.
>> i.t.a. Has a nifty little report for us that we can show who hasn't gone into open enrollment at all, who has done step one, two, three. We can see the actual steps that someone has gone into. If someone has like completed five steps, for some reason didn't complete the rest, we normally e-mail them. Of course you see the e-mails going everywhere to your department and to you personally saying you haven't completed, you haven't completed. Normally we find people are out of the office, those are usually our defaulters. Someone that's declining insurance and thinks they don't have to do anything. Even if you decline you must complete all 10 steps. If you are not sure you can e-mail us, we will go in and look at tell you.
>> 11 out of 4500.
>> right.
>> yeah, that's --
>> usually anywhere from 11 to 15 or 16.
>> we don't want to see anyone fall in that category. I would like for it to be 0.
>> we would like that, too would be a whole lot easier for us, too.
>> I may have misquoted earlier, I said critical care but I meant urgent care. I don't know where I had critical care in my mind, but I actually ended to say urgent care when I was making those comparisons.
>> talk to us about the employee hearing.
>> okay. The employee hearing is scheduled in the p.b.o. June 18th, I went ahead and arbitrarily set the time at 4:30 since that's what we did last year. We wanted to talk to the court about this and make sure this is what the court wanted. Juneteenth is the 19th and on purpose didn't set it on the 19th, so as not to conflict with any Juneteenth activities that were going on and now we are having our Juneteenth on the 18th as well, that's during the day. You know, best laid plans. We wanted to confirm with the court that you do indeed want to have it on June 18th.
>> what day of the week is that?
>> Wednesday.
>> Juneteenth is Thursday.
>> how we had it last year it was on -- what day was it?
>> best day to have it, Wednesday is --
>> taking the compensation hearings from last year is an indication Wednesday would be preferrable.
>>
>> [indiscernible]
>> court needs to approve that.
>> yes.
>> and put it on your calendars.
>> okay.
>> move that we approve all of the items for discussion with employees at the employee hearing. Part of the motion is to set the hearing on June 18th at 4:30 in the afternoon and I do recall some employees prefer to come either before the end of their day or --
>> right after.
>> right after.
>> judge, I second that motion and, you know, if at ought possible within that, I don't know how we get in contact with the retirees.
>> we send a mailing to them Commissioner.
>> of this, also, I want to make sure they are part of this.
>> yeah. As we go through the process.
>> we always notify them before the employee retiree hearing.
>> okay, all right.
>> the discussion at the beginning time on that public hearing previously we have had a lot of employees that have indicated that they cannot make it to a 4:30 hearing and they have to get off work especially, the road crews and get in here. So previous years I think that we've had it at 6:00.
>> how long will the hearing go on?
>> 4:30 to what time.
>> we have 4:30 because some people work 7:00 to 3:00.
>> it was 4:30 last year --
>> the road crews come in usually about 3:00, 3:30 because they start so early in the summertime.
>> 7:00 to 3:00.
>> but child care, some of that stuff was an issue. It always comes up a little bit. People want to know far enough in advance to make arrangements. When we tell them at the last minute we usually get some kick back from the employees if we tell them at the last minute.
>> I thought we scheduled it earlier for employees. Some are saying if they got off -- we used to have them at 6:00. If they got off at 5:00, some have to take care of child care issues. They have to drive, pick up the child, they expressed hardship this getting back downtown to the Commissioners court meeting room. In traffic and all of that. That's why we moved it to 4:30 I thought. Right after work if you come on by.
>> right.
>> that would be -- if you get off at 5:00, you could -- with the supervisors consent maybe get off early and come -- this is county business, come take care of this.
>> okay. That will work.
>> all right.
>> well, part of it may be that we ask how 4:30 is working out. This would be the third year at 4:30 won't it?
>> I think the year before last might have been at 5:00. We tried all different dates trying to accommodate as many people as possible.
>> why don't we ask them and see.
>> okay.
>> but the other thing would be that based on employee input, we would decide what final action to take on this specific recommendation.
>> yes, sir.
>> the goal is to put together a kind of simple english overview, summary of the recommendation here. I think the main issues they seem to be concerned about annually cost to them, coverage, plan amendments, I think that's pretty easy to understand and -- and seems to be more good news than anything else.
>> yes.
>> okay.
>> it is.
>> I have got -- we are not going to take action on any of these.
>> we are approving all of them.
>> discussion of the employees public hearing.
>> we bring them back and have you take your final vote after the employee hearing.
>> so we are going to ask them about covering colonoscopies at 100% and see if we get any complaints?
>>
>> [multiple voices]
>>
>> [inaudible - no mic]
>> 100%.
>> 20% coverage.
>> what you did last year you actually approved them and then with the little caveat that if you needed to come back to change anything that you could. That would be helpful if you wanted to do that. If you want to do it the other way --
>> if I was an employee I think that I would want to know that the Commissioners court has not taken action but has invited notice come come -- invite med to come and give comment and will take that comment into consideration before action is taken.
>> one other comment, dan you should be wearing a zebra tie or something.
>> [laughter]
>> my more discussion? All in favor? That passes by unanimous vote. Thank you all very much.
>> thank you for your hard work, also.
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Last Modified:
Wednesday, May 28, 2008 8:51 PM