Travis County Commissioners Court
May 12, 2009,
Item 8
>> item no.
8.
consider and take appropriate action on the following recommendations regarding group benefits plan, health plan, fiscal year 2010 rates and issues.
a, no rate increase to active employees health care premiums for fiscal year 2010; all in gave?
that passes by unanimous vote.
b, life and disability.
b 1 continuing supplemental life, accidental death and dismemberment and short term disability coverages with no rate increase for fiscal year 2010; b 2.
basic life rate increase from .106 to .135 -- well, we probably ought to discuss that.
b, b 1 move approval.
>> second.
>> discussion?
discussion?
all in favor?
that passes by unanimous vote.
because no change on that one.
b 2, though, is basic hraoeufr rate increase from .106 to .135 for fiscal year 2010; what does that mean in american dollars?
>> why, we're still working on that, we're expecting word back from the carrier, if we could roll that over to next week.
>> really that over means postpone is basically.
>> for the work session?
>> I don't know that it's posted.
is it posted for the work session discussion?
>> I'm not sure.
>>
>> [indiscernible]
>> what does this mean in american dollars, by the way?
>> the rate increase would be -- we're calculating that now because the rate that you are seeing there, 1.135 is not correct.
>> we will have it back on next week.
>> what about b 3 long term disability rate increase from -- is that next week, too?
>> yes, sir.
>> what about b 4, next week, too?
>> no,.
>> we're ready on that one judge, b 2 and 3 back on next week.
that is may 19th, right, ms.
porter?
>> uh-huh.
b 4, release of long term care request for proposals.
>> judge,
>> [indiscernible], hrmd, the benefits committee has been meeting, in response to employee input, we would like to advise the court that we would like to release an r.f.p.
for long-term care.
this would be available to the Travis County employees and most likely their family members as well.
allow them to have long-term care policy.
at this point we just are -- are wanting direction from the court that it's okay to release an r.f.p.
on long-term care, then of course when we got all of that back, we would report to the court.
>> at employee's option.
>> it would be an optional product.
>> the employee would pay for it.
>> employee would pay for it.
probably payroll deducted depending on what we got back on the quote.
but the thought is to have it payroll deducted for the employees.
questions?
move approval.
second.
>> discussion?
all in favor?
that passes by unanimous vote.
c is option to renew all three dental plans with no increase for fiscal year 2010; still at the employees' option, the employee pays for it.
that's why I move approval.
>> second.
>> I vote --
>> discussion?
>> yes, I have a question.
the cap that sits at $1,500, has that been -- there there been any input from our employees maybe to raise that cap whereby they will be able to -- to maybe even pay more in premium if they can get more out of the service because right now the way I'm understanding it for $1,500, it wants us exhausted, out of pocket expense.
so my question is have there been any employees that have come to you, talked to you one way or the other, committee or anything else, maybe look at premiums increase if in change for an increase of -- of moneys outside of the capped $1,500 range now?
>>
>> [indiscernible]
>> any employees approach me --
>> they are aware, employees are basically aware of a lot of things to have a public hearing, stuff like that.
but I would like to maybe sit on this one to see what kind of input we get from our employees.
because I think that has been brought to my attention.
maybe not to you, but I have heard.
>> Commissioner, cindy perrington again.
i have talked to a few employees requiring on how the cap worked, why the cap was there.
our dental insurance is a fully insured product.
they come to us with a plan in place.
if we did decide to ask them to change the plan it would involve premium increases, but that may be something we can look at for next year.
>> maybe something employees would like to consider.
in exchange for more services beyond that cap --
>> one thing --
>> go ahead.
>>
>> [multiple voices]
>> the calendar year cap, so you have it from January to December, it's a $1,500 cap.
but it starts over again the next calendar year.
>> yeah.
>> so -- so if -- if someone would need to talk about how that would work for their particular instance they could call me.
>> okay.
i will just refer them to you then when I get inquiries, thank you.
>> Commissioner, did you want to delay action on this?
>> no.
i think we can maybe move forward, but I would like to reserve I think the right to make sure that -- that since the time is already elapsed, that's what you are saying cindy as far as are you suggesting that -- that the time has elapsed for any consideration consideration would be, two thousand within a calendar year for example, $2,500 for a calendar year, is there any way that that can be adjusted if -- if enough folks are interested in raising the ceiling for the cap amount.
>> probably not for this plan year since we're getting ready to start up very soon, but we can certainly look at that for next year.
>> Commissioner goes there's --
>> can you give me an answer from the provider.
>> certainly.
>> let me just hold up one week on that judge, see what the provider may say.
if they can't deal with it this year, this complaint deal with it.
-- they can't deal with it.
>> chances are changes in benefit on a plan like this would require approval through the state department of insurance.
>> oh, really?
>> that's a process that takes several months.
>> oh, okay.
>> we can --
>> still a lot of road blocks being thrown up, I'm trying to maneuver.
>> we can confirm that.
>> that would be a next week item, judge, if you don't mind.
>> we will have cbac on next week.
c back on next week.
>> d, release of employee/retiree communication prior to employee hearing and open enrollment;
>> judge, alicia perez, executive manager for administrative operations.
on an annual basis, we send information out on rates plans and all of the choices and information on death benefits and on supplemental insurance for dependents, all that information goes out to employees prior to the employee hearing scheduled for June 17th and we would like the -- the court's approval.
the thing that will be different this year is that -- is that we would like to -- to hold the information until we are able to get some determination on retiree rates because retiree rates are not included in here right now.
so we usually do release that information once we deal and discuss and address the retiree rate information.
i think the deadline that we provided the court was may the 26th.
this information is ready to go, though, so we can get approval on this.
you don't have to hold the whole item.
>> we can send it out once it's approved.
then wait for approval and the retiree issue.
>> so you mean the information that we're acting on today?
>> yes.
what we don't act on, another communication later on, but before the June 17th hearing.
>> yes.
>> any more discussion of d?
>> move approval.
>> second.
>> any discussion of the motion?
all in favor?
that passes by unanimous vote.
with Commissioner Eckhardt temporarily away from the dais.
she had to run to another commitment and will rejoin us as soon as possible.
e open enrollment for fiscal year 2010 from July 20, 2009 through August 12, 2009 as the dates; and
>> is that the same period of time that we have allowed in the past?
yes.
>> cindy again.
this year we want open enrollment to be July 20th through August 21st, 2009, which is almost identical to the last couple of years.
we want to remind the employees that we have a 10 step process and we want them to be sure and complete all 10 steps.
employees that could not complete all 10 steps have defaulted in the past to basic lives and employee only co-insured ppo.
>> what are the percentage of the employees that have fallen into the -- into the role of default?
not able to act within the open period.
>> how many?
>> yes.
do we have a percentage basically that we -- that we have been able to track or capture?
>> we do.
go ahead, I'm sorry.
>> we defaulted about 12 people last year after trying to contact them and worked with them.
we have about a week after open enrollment where we scrub our data, try to get everybody in if we just can't reach them and -- and handle their benefits then they get defaulted.
>> do you only specify let's say defaulted, but specify the reasons why they were not able to -- yes, sir, we send them a little letter to let them know we have changed their benefits and what their coverage is at that point.
>> I guess my question, though, is to why they didn't do it.
>> no, sir.
>> there are reasons for people not to do certain things, though.
>> if we have someone that comes in with a valid reason like a death if their family or something that -- that has required them maybe they are sick for that entire month, it's hard to have a reason for a whole 30 days.
but we do have employees that have mitigating circumstances, we work with those employees.
it's just people that don't handle their business that get defaulted.
>> procrastination is the main reason.
>> those of you that have been through this a couple of times.
you know that we make every effort to hundred you down like a dog to get your open enrollment done.
reports sent to the departments, manager, liaisons, all hands on deck, everybody tries to get this accomplished.
>> is that a misprint then on the agenda, it says 12, but you said 21.
>> our -- on the item that's August 21st.
>> on my agenda it says 12.
>> yeah.
on the 21st is the date for the second August?
>> yeah.
>> okay.
>> that would be the take it, August 21st would be the date of open enrollment ends.
>> with that correction, I guess we can move on.
>> move --
>> second.
>> they did not hunt me down like a dog, but it was a constant reminder that finally got to me.
the stress of being repeatedly reminded finally got to me.
>> and it's -- it's really very, very important because some of these have the -- their insurance is -- the employee does not -- does not participate in open enrollment during July, between July 20th of 2009 and August the 21st.
they will be -- the default and then only they will have -- will have insurance coverage?
one thing that's a little different this year, that all dependents need social security numbers.
we have been working on that for a couple of months now.
>> all dependents need a social security number.
>> yes, sir.
>> regardless of age?
>> yes.
in order to be covered on the plan, we have to capture a social security number now because there's a law that are requiring the carriers to capture that from us.
>> okay.
any more discussion?
all in favor?
that passes by unanimous vote.
f, encourage employees to complete united healthcare online health assessment.
>> the health assessment means by which you can identify potential serious illness and take action prevention means to -- to eliminate or to manage a disease.
and it goes -- once the assessment is done, it doesn't come to the county, it goes back to in this case united health care.
they reach out to the individual with -- with items that they should do dietary exercise and regular visits to the doctor.
it's protected by hipaa, health insurance accountability act.
it's confidential information.
we encourage all employees to take the assessment because it's a first step in the direction and prevention.
>> there will be a link on the open enrollment site that will make it easy for them to go to that.
it's helpful if you have your basic bio metric numbers like blood pressure, cholesterol amounts and weight, that sort of thing before you go in to take the health assessment.
you get more out of it that way.
you can take it without that.
but you can get more value in feedback if you have your numbers when you go in to take it.
we will be spending out communication to the employees as well to alert them to that and to express to them how important it is for them to do this.
>> okay.
if Commissioner Eckhardt were here, she would ask as she did in the e-mail yesterday, what protocols are in place to guarantee the confidentiality of the online health assessment?
as I mentioned it's personal health information, protected by hipaa, managed by united health care.
>> what protocols?
>> there's -- secure --
>> [multiple voices]
>> there's --
>> [multiple voices]
>> one at a time.
>> > the hipaa regulations require a business need to know particular personal health information.
in this case we would only have aggregated information to look at.
personal health information, individualized would be -- would be protected by united health care.
they have security issues, they have security that -- within their electronic data that -- that require them to have certain encryptions and that's -- that's how that information is handled and protected.
>> the information is not available to Travis County at all.
>> I think she's worried about the world rather than just us.
>> certain regulations that are outlined, we have to follow them.
if you will recall, there have been several budget requests that provide the technology that not only monitor anyone that not only restrict access to anyone wishing to be heard that wants the information, also monitor any intrusion into the information into the data, all that is required under hipaa.
so there is a whole act, literally a federal act that has step by step what is required.
everything from secure idf and mdf closet all the way to monitoring equipment on the technology.
so we will be happy to provide the act and that has very strict guideline --
>> uhc is the holder of the information, they are responsible for keeping it secure which they do.
we have a written agreement with them that they keep our data secure.
>> ms.
wilson, anything else?
>> what I would say is that whatever they are going to say it would go across the internet as scrambled eggs, they will unscramble it at the other end.
i'm saying not anybody would be able to pick it up.
>> when did hipaa come into effect.
>> about five or six years ago.
>> we made an investment in terms of software, we tried to be sure that we were very secure.
>> encrypted on both ends.
>> right, okay.
>> so after I tell Commissioner Eckhardt we followed the law and she asked well who can give me more details, refer her to y'all.
>> she can talk to me.
>> > what is the purpose?
>> what happens when like if you filled it out, Commissioner Huber, they are capturing -- it's a 52 question survey of your particular lifestyle, health issues, concerns, what are you interested in as far as doing better on like, you know, say you wanted to walk more or eat healthier.
they capture that.
what they are doing is looking for high risk individuals that maybe vice-president been diagnosed.
and as we know, we have a lot of diabetics in the county.
they are looking for people that maybe don't realize that they might be prediabetic or prehigh cholesterol.
and if they -- if they come out as a high risk individual, then there's a reach out effort from a nurse to contact them to say perhaps you should go to your doctor.
you look like you may be at risk for this or that condition.
it's an awareness thing.
then they also give you a program of three main things that you can work on that -- as a result of your particular health assessment to again in the wellness area, maybe you are a diabetic, maybe you have high cholesterol.
things like that to help educate you and we found that education is the key.
the more you know about whatever your particular conditions are, the better you do in managing that condition.
so if we can identify a diabetic or identify someone with high cholesterol just through the results of this screening, then we're all better off.
>> are you the new county employee that everybody has been talking about?
>> I don't think so.
>> [laughter]
>> we couldn't afford him, judge.
>> you are a consultant.
>> I am john
>> [indiscernible] a consulting actuary with melantha did the rate re-- melman that did the rate review assessment and helped the committee, the group review rates for recommendations.
>> john is here, judge, to talk about trends.
one of the ropes that we are able to hold the line on health care insurance now for three years in a row we -- we are recommending no increases in rates and part of that has been the great participation that we have had from Travis County employees and participating in wellness programs, taking those health assessments, having their annual physical, so we were able to detect any illness before it got critical.
so we have been fortunate in that.
john will talk a little bit more about that.
but the national trend is 8% and that's what they have projected as our trend for fy '10 and instead we came in at 3%, lower than the national average.
i wanted john to take a minutes and talk about that and -- and what that means to Travis County.
>> sure, sure.
you have got about 4,000 employees enrolled in the plan and about 500 retirees, so you have a -- you are a large group, self insured so we look at your claims history and your fixed costs to project the rate requirements for the next plan year.
one of the key assumptions is how much claims are going up.
we all hear about health care trends being high.
when we factor in the 8% cost increase in historical claims, it shows the current rates in place are sufficient to cover projected claims in administrative costs for the next year.
this is the third year we were able to pass through no rate increase.
we are not quite sure, the reasons why your experience is running so well, but your costs essentially are increasing only a slight amount per year, so current rates are adequate.
we can speculate a little bit about why your cost experience is good.
when I think about what's different about this group versus most other employer groups, they don't have a clinic, on site clinic and -- utilization of that clinic is increased, that could be a significant driver of why your costs have not increase.
i'm also aware that united health care, who is the network that employees use and they are using contracts that united health care has with the hospital it is and physicians, they have multi--year agreements.
it appears united has done a good job of controlling how much they are paying providers out there for services that you are -- that your members are accessing.
the plan he is very sound financially.
that's your favorable experience.
but self insured so you are taking that risk.
but -- but again you have built up a reserve, you are fully covering your unpaid liability out there.
the plans are not very sound financial footing, they don't think there's any work to --
>> I think it was a very positive message to deliver to moody's and standard and poors.
they seemed to rapidly take note of the fact that this is the third year that we have not increased premiums.
then the fact that we came in at 3%, it's an impressive record to have and it also would lend support to the fact that Travis County has very strong management practices in place.
so I was real proud to represent Travis County.
>> is this health assessment
>> [indiscernible]
>> yes.
>> and what kind of numbers do we have as far as preventive measures that came out of the assessment?
>> we did a push on the health assessment about two years ago and we -- we trying on remember exactly how we completed.
we don't -- united health care handles the data that is -- that is put into the health assessment and they react to that data.
they tell us maybe how many people take the health assessment, more feedback now because their program is more sophisticated than it was three or four years ago when we put the link on our website.
i would have to look back at my records, so I don't misspeak.
let me look and I'll report to you about what we found.
>> okay.
what percentage of employers participated in this assessment.
>> I think the year that we put the link on the open enrollment, we had about 237 I think.
but again I don't want to misspeak the number.
we have several hundred, take it.
union united health care took note because as I said that was a high response at that period of time.
i think we can do better than that.
i think we can get a higher response to that.
it's a level of awareness for the employees, this year a little bit better.
>> did I understand correctly this is also used to help set rates?
>> no.
>>
>> [indiscernible]
>> no.
>>
>> [indiscernible] 3% versus the
>> [indiscernible] bill the national average as far as increasing premium versus our low Travis County's 3% according on what I'm hearing.
has there been a comparison of maybe this region or within the county itself or within governmental entities, have that been -- in anything done on those to let folks know that we are doing some things.
>> oh, absolutely.
if you recall last year our clinic was recognized by the Texas association of counties for services.
also we share information with the city of Austin, aisd, lcra, and state of Texas on a regular basis, not only on rates but also on plan design.
for example the city of Austin last year raised their rates by around 7%.
i believe they are looking at perhaps another rate increase again this year.
again, if we look at the plans they are also self insured but we have a clinic, we have really pushed wellness and those wellness classes are attended very well.
i mean, you have -- you have a noon exercise class that is done by an ex-n.f.l.
player comes in and runs our noon exercise class.
we fill that up.
we have increased enrollment in the fitness center.
the sheriff has a program for all of his officers, he is really running them through the treadmill requiring them annual physicals and requiring them to -- to meet the certain weight loss goals.
so it's been a county-wide effort and it's -- as part of that we have not done it alone.
people at this table are -- very few, I would like for the benefits committee, we have been together for seven years, we are still happily marry and -- and do well.
so I would like for them to stand up and get recognized in travis and susan was here, too, she's part of it.
but we have a -- we have a -- so -- so charles it back there.
we've had a real good committee.
everyone participates.
we have a couple of retirees on the committee, too.
>> thank you.
my final question on this assessment, this whole line and stuff.
have that been enough -- well, I'm just wondering for those that -- that do not have the computer skills, who may need to say well I would like to be a part of this, what do we do for those folks that -- that of course they have personal information or they have information they would like to put on line.
even though it may be scrambled up as eggs as she said.
how do we address those persons --
>> [multiple voices]
>> it can be handled in a couple of ways.
we take our computers out to the precincts and to various locations where we can make a computer available to all of the employees.
if they are uncomfortable using the computer, we sit down and key for them, they tell us what they want with their benefits.
we will be able to do that with the health assessment or if they want to keep their stuff totally private, we will have a written form sent into uhc, results entered into the system.
it should be available to everyone, even if they are not comfortable doing it on the computer.
we will have it available on hard copy.
>> that would be the other option that I was looking for.
>> we do that with all of the survey that's we send out to the employees.
we make the surveys available and the hard copy for those that don't have access or aren't comfortable on a computer.
>> we will make whatever accommodation is needed to -- to help the individual complete the assessment.
we feel it's that important.
>> thank you.
>> john, did we let you finish?
>> I have no other comments.
>> okay.
>> we did have a motion and a second.
any more discussion?
we did not?
move approval.
>> second.
>> discussion?
this is f.
all in favor?
show Commissioners Davis, Gomez, yours truly voting in favor.
Commissioner Huber voting against it.
that passes by a vote of 3-1.
anything else on 8?
we do have parts that we will bring back next week.
okay.
thank you all very much.
>> thank you.
>> thanks.
>> now, let me indicate my intention to call up the medical examiner's item next, number 10.
after that we will call up golfsmith, which is item no.
20, we do need our medical examiner to -- to -- to finish and I guessing back to the clinic -- guess go back to the clinic and forensic center.
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Last Modified:
Tuesday, May 12, 2009 2:30 PM