2021 Best and Final Renewal Review - Oregon Public Employees' Benefit Board April 21, 2020 - Oregon.gov
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Attachment 7
2021 Best and Final
Renewal Review
Oregon Public Employees’ Benefit Board
April 21, 2020
Trisha Tyler
Nick Albert
Emery Chen
Photo by Cristofer Jeschke on Unsplash
welcome to brighterAgenda
• COVID-19 Financial Considerations
• Financial Overview
• Composite Rate
• Considerations for 2021
• Administrative Fee Benchmarking
• Medical Renewal Considerations
• Non-medical Renewal Considerations
• The Standard Life/Disability Renewal
• Next Steps
• Appendix
Copyright © 2020 Mercer (US) Inc. All rights reserved. 2Guiding Principles
Triple Aim Improve the quality of care Improve the patient experience Deliver care more efficiently
Improving Behavioral Health systems & Address social determinants of health and
Maintain a sustainable cost growth
increase value and pay for performance equity
OHA Guiding Principles Innovation with Collaborative Social determinants
Access accountability Patient-centered Health equity partnerships of health
PEBB Vision An innovative Accessible and
delivery system in Promotion of health understandable Appropriate
communities A focus on improving and wellness information about provider, health plan Benefits that are
statewide that quality and through consumer costs, outcomes, and and consumer affordable to
uses evidence- outcomes, not just education, healthy other health data incentives that employers
based medicine to providing health behaviors, and that is available for encourage the right and employees
maximize health care informed choices informed decision- care at the right
and use dollars making time and place
wisely
Health Plan Patients Delivery System Plan Sponsor and Administrator
Success
Measure
Areas
Copyright © 2020 Mercer (US) Inc. All rights reserved. 3COVID-19 Financial Considerations
Latest update
COVID-19 in Oregon
Through April 16*:
• 1,736 confirmed cases
and 64 deaths
• Institute for Disease
Modeling (IDM) and
Oregon Health
Authority (OHA) project
18,000 cases and 200
deaths in Oregon
through May
• From April 10 report
Sources:
* OHA April 16, 2020
report
Map based on NY Times
data as of 9 am
April 17, 2020
No Cases 1 to 9 Cases 10 to 99 Cases 100 to 199 Cases 200+ Cases
Copyright © 2020 Mercer (US) Inc. All rights reserved. 5COVID-19 confirmed cases
Incidence rates adjusted for population
Based on NY Times cases by County as of 4/13/2020
Copyright © 2020 Mercer (US) Inc. All rights reserved. 6Impact of COVID-19 on health care claims
Difficult to gauge full impact due to multitude of
uncertainties
Uncertainties
1. Prevalence and severity 3. Government actions 5. Approval for treatment
2. Outbreak duration 4. Testing availability & 6. Development of a vaccine
treatment protocols
COVID-19 COVID-19
Updated 2020 Current Elective
Testing Treatment
Claims Estimate 2020 Claims Services
Related Related
Estimate Adjustment
Claims Claims
Will there be a second wave of COVID-19 and impact 2021?
Copyright © 2020 Mercer (US) Inc. All rights reserved. 7Oregon PEBB impact
What we know
COVID-19 Delays in
COVID-19
Treatment Elective
Claims
Claims Services
• 11 confirmed cases for Oregon PEBB • Statewide hospitalized patients were • Non-critical elective services are cancelled
• Six in Moda and five for Providence released in less than seven days • Most recent two weeks of Providence
(Statewide and Choice) • Current projected costs for COVID-19 medical invoices are 30% to 40% below
• Data is not available from Kaiser treatment is under $1 million for PEBB typical weekly invoice
• Five total PEBB members were admitted to barring increased incidence and severity • Moda invoices are about 10%
the hospital • Based on initial wave and IDM below average
• Three for Moda (unknown severity) projections • In March there was a 20% increase in
• The two in Statewide have been • Using Institute for Health Metrics and prescription drug claims
released Evaluation projections as of April 13 • April dental claims for Delta Dental of
would double the cost Oregon are 80% below typical
• At least seven cases for staff in the Oregon
State Penitentiary (Salem) and Santiam • Cost for covering treatment at 100% (no • Duration of outbreak is a key factor in
Correctional Institution member cost sharing) is projected to be terms of when we’ll see a ‘rebound’ in
under 0.1% at current incidence and non-elective appointments and procedures
• 244 additional pended testing claims in
severity • Long-term COVID-19 pandemic could
Providence
• Costs are based on initial wave of shift services from 2020
• PEBB incidence rate is approximately 1/5th
COVID-19 cases into 2021
that of Oregon
• Second wave or ongoing pandemic
could result in a multiple of the
projected costs
Copyright © 2020 Mercer (US) Inc. All rights reserved. 8Illustrative impact of COVID-19 on budget
One wave Illustrative; not based on
PEBB specific modeling
50
45
40
35
30
25
20
15
10
5
0
Cases Hospitalizations
$650.00
$600.00
$550.00
$500.00
$450.00
$400.00
$350.00
$300.00
$250.00
$200.00
Claims COVID Costs Returning Elective Care Budget
Copyright © 2020 Mercer (US) Inc. All rights reserved. 9Illustrative impact of COVID-19 on budget
Second wave and long-term pandemic Illustrative; not based on
PEBB specific modeling
120
100
80
60
40
20
0
Cases Hospitalizations
$650
$600
$550
$500
$450
$400
$350
$300
$250
$200
Claims COVID Costs Returning Elective Care Budget
Copyright © 2020 Mercer (US) Inc. All rights reserved. 10Caveats
• Given the lack of robust data and existing uncertainty regarding COVID-19, Mercer presents this
information with the caveat that it should be considered an informed estimate based on limited and
changing anecdotal and actual information
• The range of these financial impact estimates reflects our best thinking as of April 14, 2020. Our
estimates will change (up or down), and perhaps rapidly, and to a significant degree, as more experience
and information emerges.
• Client experience should be monitored as appropriate and feasible, with adjustments made to
projections as needed
• The range of these financial impact estimates was developed on a ‘national average’ basis; we expect
significant variations between employers, geographic locations, demographics, etc.
• The experience of similarly situated employers may deviate very significantly from one another
• There are many unknowns at this time, all of which could impact our cost estimates. As these variables
change and we learn more, we will update our estimates.
1. Prevalence and severity
2. Outbreak duration
3. Government actions
4. Treatment protocol development, including delivery channel
5. Approval for treatment
6. Development of a vaccine
Copyright © 2020 Mercer (US) Inc. All rights reserved. 11Decision Required
Waiving member cost share
for COVID treatment
Decision: Whether to waive member cost • Waive all member cost share for COVID related treatment at all
Mercer’s facilities (in-network and out-of-network) until 12/31/2020
sharing for COVID related treatment, and
specify time period for waiving cost sharing Recommendation • Low risk from a mental health parity (MHP) perspective; Mercer
would recommend MHP testing in the future
Background and Considerations Member Impact and Cost Alignment with PEBB Vision
• PEBB has the option to waive member • Aligns with Governor Brown’s and OHA’s
• Allows members to focus all energy on
cost sharing related to COVID-19 principle of improving health equity for
getting well, rather than worrying about
treatment members who may be affected by COVID
paying for the treatment
• Each of PEBB’s carriers has waived cost
share for their fully-insured book of • PEBB incidence rate is 1/5th the rate in • Patient-centered
business: Oregon
• Ensures treatment is affordable for all
• Kaiser: 4/1 through 5/31 • Mercer expects minimal claims impact members
• Providence: 4/1 through 5/31 from waiving cost share
• Moda: 4/1 through 5/31 •Financial Overview
Composite rates
Historical & projected
Composite Rate Composite Rate % Change
Year Using Prior Year’s Using Plan Year’s From Prior
March Census % Change March Census Composite
2014 $1,333.58 $1,327.47
2015 $1,321.53 -0.9% $1,313.06 -1.5%
2016 $1,356.47 2.6% $1,347.31 2.0%
2017 $1,416.93 4.5% $1,405.13 3.6%
2018 $1,464.20 3.3% $1,452.68 2.5%
2019 $1,513.98 3.4% $1,495.83 2.2%
2020 (w/Premium Tax and 2.676%
$1,594.86 5.3% $1,588.17 4.9%
funding assessment)
2021 (Prior to potential funding
$1,611.97 1.1%
assessment)
2021 with PEBB Admin increase (Prior to
$1,618.71 1.5%
potential funding assessment)
• Projected composite rate is below the 3.4% limitation
• PEBB has approximately $24.4M buffer projected for 2021 without an increase to the PEBB admin fees
• $20.0M after increase
Copyright © 2020 Mercer (US) Inc. All rights reserved. 14Renewal overview
Summary of coverages
Admin Fee Premium /Accrual Total Projected 2021 Plan’s Share of
Carrier Line of Coverage
Increase Rate Increase Active Premiums Composite Increase
Providence - Statewide Medical / Rx 2.7% 4.5% $371,600,000 0.5%
Providence - Choice Medical / Rx 2.8% 3.8% $314,600,000 0.3%
Kaiser Medical / Rx n/a 3.2% $181,500,000 0.2%
Moda Medical / Rx 1.9% 5.0% $103,500,000 0.1%
Moda / DDOR Dental 1.0% 2.1% $47,400,000 0.0%
Willamette Dental Group Dental n/a 0.0% $8,700,000 0.0%
Kaiser Dental n/a 0.0% $15,700,000 0.0%
VSP Vision 0.0% 1.3% $11,000,000 0.0%
The Standard Basic Life n/a 0.0% $600,000 0.0%
Total $1,054,600,000
Carrier Line of Coverage Fee Increase
ASI Flex 0.0%
Coverage is not included in
BHS COBRA / Retiree Admin 0.0%
the composite rate
Cascade Centers EAP 0.0%
Copyright © 2020 Mercer (US) Inc. All rights reserved. 15Considerations for 2021
Medical + non-medical
Composite Mercer
Coverage Category Current Plan Design Proposed Plan Design Premium Impact
Impact Recommendation
Medical / Rx – all carriers Alternative Care $1,000 annual maximum $1,500 annual maximum $2,150,000 0.2% Reject
Medical / Rx – all carriers Alternative Care $1,000 annual maximum $2,000 annual maximum $2,800,000 0.3% Reject
Coverage limited to diagnosis Coverage for Assisted Reproductive Techniques,
Medical / Rx – all carriers Fertility Services $3,560,000 0.3% Reject
and basic treatment including IVF
Coverage for all specialty drugs Certain specialty drugs would be allowed to refill
Medical / Rx - Moda Specialty Lite n/a n/a Accept
limited to 30-day supply with 90-day supply
RTBC is built into provider EMR systems and can
Real time benefit check
Medical / Rx - Moda n/a help providers and patients find the most n/a n/a Accept
(RTBC)
appropriate and lowest cost drug
Moda360 is an enhanced member concierge and
Medical / Rx – Moda Moda360 n/a advocacy program with built-in connections to $200,000 0.02% Accept
digital health point solutions
Optum ED Analyzer is a tool designed to identify
Medical / Rx – Providence Optum ED Analyzer n/a ($800,000) -0.1% Accept
and mitigate emergency department upcoding
Medical / Rx – Kaiser Vision Hardware $200 allowance every 2 years $200 allowance every year $700,000 0.07% Accept
Medical / Rx – Kaiser Vision Hardware $200 allowance every 2 years $250 allowance every year $1,300,000 0.12% Reject
Medical / Rx – Kaiser Vision Hardware $200 allowance every 2 years $300 allowance every year $1,400,000 0.13% Reject
Basic / Major Services
Dental – Moda 12 months No waiting period $500,000 0.05% Accept
Waiting Period
Dental – Moda Orthodontia Waiting Period 24 months 12 months $100,000 0.01% Reject
Dental – Moda Orthodontia Waiting Period 24 months No waiting period $200,000 0.02% Accept
• After PEBB admin fee increase, PEBB is $20.0M under the 3.4% composite for 2021
Copyright © 2020 Mercer (US) Inc. All rights reserved. 16Administrative Fee Benchmarking
Self-insured administrative fee comparison
Goals and background
Goal:
• Provide the Board with a complete representation of the fees charged to PEBB for the self-
funded medical plans and compare those fees against Mercer survey benchmarks
• Due to the COVID-19 pandemic and direction from the State of Oregon to devote resources
to fighting the pandemic, accepting the final proposed admin fees from the carriers is
advisable at this time
Background:
Administrative
Total fees paid by Variable
Service Fees
PEBB (PEPM) Fees
Typically charged as a %
of the savings achieved
through a negotiation
Copyright © 2020 Mercer (US) Inc. All rights reserved. 18Variable fees
What are they?
• Variable fee programs are becoming more prevalent and visible as associated dollars grow
• Programs charged as a percentage of claims/savings and not a fixed amount (PEPM)
• Not included in base medical ASO fee and vary from year to year, based on activity
• Harder to track and quantify based on variability and in some cases, complexity of the
calculation
• Examples: out-of-network provider and/or facility negotiations, fraud and abuse
monitoring/prevention, transplant negotiations
• Programs can, but don’t always, generate true savings and carrier keeps a portion of the savings
• A complete and thorough review of these programs is critical to accurately capture carrier
revenue
• Especially important in RFP situations, where carriers may use these programs to offset very
low admin fees
Mercer sees the value in some of these types of programs,
however, transparency is crucial
Copyright © 2020 Mercer (US) Inc. All rights reserved. 19Historical PEBB administrative fees
Providence and Moda
$100.00 • Since 2015 Providence has
increased their ASO fees
$90.00 $93.21 approximately 2.0% and 2.4%
annually for Statewide and Choice,
$76.85 $78.32
$80.00 $75.97 respectively
$75.44
• Medical RFP for the 2015 plan
$70.00
$71.64 $71.64
$73.42 year resulted in significant
$69.64
$68.05
$57.29
decreases in admin fees: 29.7%
$60.00 $65.50 $55.76
$53.03 $54.55 $54.55 for Choice and 2.2% for
$52.00 $50.85 $51.93
Statewide
$50.00
• Moda’s fees have increased 1.5%
$40.00 per year since 2019 – the first year
the plan was self-funded
$30.00
$20.00
$10.00
$0.00
2014 2015 2016 2017 2018 2019 2020 2021
Statewide Choice Moda
ASO = Administrative Services Only (Fixed PEPM)
Copyright © 2020 Mercer (US) Inc. All rights reserved. 20Historical PEBB administrative fees
Providence Triple Aim incentive
$90.00 • The total Providence admin
fee includes incentives for
$80.00 the Triple Aim
$75.44
$73.42
$71.64 $71.64
$68.05
$69.64 • The Triple Aim incentive for
$70.00
$65.50 Providence has been
decreasing as a percent of
$60.00 $57.29 the total admin fee since
$54.55 $54.55 $55.76
$51.93 $53.03 the 2015 RFP
$50.85
$50.00
• PHP refunded $468,000 ($1
PEPM) for the 2017 plan
$40.00
year for missing one of the
service level measures
$30.00
$20.00
$15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00
$13.63 $13.20 $13.63 $13.20 $13.63 $13.20
$10.00
$0.00
2015 2016 2017 2018 2019 2020 2021
Statewide - Total Choice - Total Statewide - Triple Aim Choice - Triple Aim
21
Copyright © 2020 Mercer (US) Inc. All rights reserved.Administrative fee benchmarking Legend
Drivers of medical ASO fees
75 th Percentile
Median
25 th Percentile
Enrollment Vendor
The higher the enrollment with carrier, ASO fee ranges vary by vendor
the lower the ASO fees
$55 $55
$50
ASO $50
$45
Fees
$45
$40 $40
$35 $35
$30 $30
$25 $25Administrative fee benchmarking
Providence and Moda vs. benchmarks
$80
$70
$60
$50
PEPM
$40
$30
$20
$10
$0
Comparison 1 - Large Group; High Comparison 2 - All Groups; Normal Comparison 3 - All Groups; Comparison 4 - All Groups; High
Member Ratio Renewal Competitive Marketing Member Ratio
25th Percentile Median 75th Percentile Statewide Choice Moda
Comparison 2/3 Comparison 4
Comparison 1: Competitive marketing tends to Increases in member counts
Most similar to PEBB profile result in lower fees (10-15% on will increase admin fees
average) (1-5% on average)
Mercer Conclusions and Point of View
• Choice and Moda admin fee surpasses high-end of Mercer benchmarks
• Statewide is in line with benchmarks, but still higher than median
Copyright © 2020 Mercer (US) Inc. All rights reserved. 23Variable fees
PEBB carriers
Providence Moda
• CPC+ Care Management and PCPCH • Provider Integrity Program ― Fraud
and Abuse Prevention
• Senate Bill 204
• AccessPlus Supplemental PPO
• External Network Fees (FCHN, FH,
Network Program (claims repricing)
Multiplan)
• Professional Negotiation Services
• Transplant network
(claims repricing)
• Joint Bundle Program
• TruClaim ― Sourced & Documented
• Optum High Dollar Review Code Edits
• Transplant network
• Overpayment identification &
recovery services
Copyright © 2020 Mercer (US) Inc. All rights reserved. 24Variable fee comparison
$12.00
$10.30
$10.00
$8.00
$6.89
$6.23
PEPM
$6.00 $1.74
$1.01
$4.00 $2.96
$1.22
$2.00 $4.14 $4.07
$1.74
$0.00
Providence Moda Mercer Benchmark (trended to 2021)
Network Fees Claims management Provider Payments
Mercer Conclusions and Point of View
• Moda variable fees do not include CPC+ and PCPCH payments
• Moda retains approximately 25% of shared savings, which is at the lower end of benchmarks
• Both carrier’s variable fees are at the lower end of Mercer’s benchmarks
Copyright © 2020 Mercer (US) Inc. All rights reserved. 25Administrative fee benchmarking
Next steps
Benchmark Comparison to Comparison to
Fixed Fees 2021 Fee Variable Fees 2021 Fee Benchmark Range
Range Benchmark Benchmark
Providence – Statewide $57.29 $40 - $63 In Range Providence – Statewide $6.89 $10 - $20 Below
Providence – Choice $75.44 $40 - $63 Above Providence – Choice Included Above
Moda $78.32 $40 - $63 Above Moda $2.96 $10 - $20 Below
Comparison to
Total Fees 2021 Fee Benchmark Range
Benchmark
Providence – Statewide $64.18 $50 - $83 In Range
Providence – Choice $75.44 $50 - $83 In Range
Moda $81.28 $50 - $83 In Range
Next steps and Board action items:
• Administrative fees for Providence and Moda represent their best and final offers for the 2021 plan year
• Mercer has begun inquires with each carrier in order to obtain information on:
• Network contracting & management, including staffing, provider quality management, services each plan is doing to
support PCPCH, and financial metrics
• Clinical programs such as staffing levels, clinical cases for PEBB, impact of interventions, and member experience
• Finally, while administrative fees for Choice and Moda are on the higher end of Mercer benchmarks, the normalized cost
(adjusted for member risk score) for each of those plans is lower than the Statewide PPO
Copyright © 2020 Mercer (US) Inc. All rights reserved. 26Medical Renewal Considerations
Decision Required
Fertility Benefits
• Postpone addition of IVF and ART coverage given ASRM’s
Decision: Whether to add some level guidelines regarding fertility coverage
Mercer’s
of advanced reproductive techniques
as a covered benefit Recommendation • Conduct full inclusive benefits review in 2020 to prep for
2022 renewal
Background and Considerations Member Impact and Cost Alignment with PEBB Vision
• During the March Board meeting, Mercer made the
recommendation to add fertility coverage in two • Adding IVF and other Assisted • Well designed inclusive benefits offering
stages: Reproductive Techniques: aligns with Governor Brown’s tenant of
• 2021 Plan Year – Add IVF and other Assisted
addressing equity
Reproductive Techniques (ARTs) • $3,560,000 Total Cost
• Adding coverage improves affordability of
• 2022 + - Conduct inclusive benefits review to
start after renewals are finalized, with benefits
• +0.3% Composite Impact benefits
to be implemented for 2022 plan year
(adoption, surrogacy, and other fertility • Allows PEBB to guide members to seek
support) appropriate treatment at the right setting
• As of March 17th, 2020, the American Society for
Reproductive Medicine (ASRM) issued new
guidelines for patients undergoing fertility
treatments, in relation to COVID-19
• Postponing new cycles of IVF or other ARTs
• Postponing all IVF transfers
Copyright © 2020 Mercer (US) Inc. All rights reserved. 28Decision Required
Massage Therapy
Decision: Whether to increase alternative Mercer’s • Do not increase the alternative care annual maximum at this time
• Cost considerations and not a strong alignment with PEBB vision
care maximum to either $1,500 or $2,000 Recommendation • A small percentage of members reached the current benefit limit
Background and Considerations Member Impact and Cost Alignment with PEBB Vision
• Providence reported 6,464 unique Choice
• Massage therapy was added as a enrollees used the alternative care benefits,
• Besides being a benefit enhancement for
covered benefit effective with 374 members meeting the maximum members, there is not a clear alignment
January 1, 2020 under the alternative (5.8%) with PEBB vision
care benefit, subject to a $1,000 • Moda reported 0.39% of their enrollees
benefit maximum reached the $1,000 maximum
• $1,500 Maximum
• Carrier-reported book of business
statistics: • $2,150,000 Total Cost
• +0.2% Composite Impact
• PHP / Moda - $1,500 maximum • $2,000 Maximum
• Kaiser - $1,000 maximum • $2,800,000 Total Cost
• +0.3% Composite Impact
Copyright © 2020 Mercer (US) Inc. All rights reserved. 29Decision Required
Moda ― Specialty Lite
Add Specialty Lite
Decision: Whether to add Moda’s Specialty Mercer’s •
• Alignment with PEBB Vision
Lite program Recommendation • No cost impact
Background and Considerations Member Impact and Cost Alignment with PEBB Vision
• Current PEBB benefits limit Specialty medications • Positively affects members taking • Innovative delivery system which uses
to a maximum of a 30-day supply evidence-based medicine to maximum
the specialty medications within the
• Promotes frequent interaction between program health and use dollars wisely
pharmacists and members
• Focus on improving quality and outcomes
• Minimizes waste associated with treatment • No cost impact
regimen changes
• Promotion of health & wellness through
• However, some specialty meds, such as PCSK9 and healthy behaviors and informed choices
CGRP inhibitors, don’t require the same level of
intensive monitoring and support
• Specialty Lite would allow certain specialty
medications to be filled for a 9-day supply
• Moda recommends adding this program and
applying the 2.5 month copay for each 90-day
supply
Copyright © 2020 Mercer (US) Inc. All rights reserved. 30Decision Required
Moda – Real-Time-Benefits-Check (RTBC)
• Add RTBC
Decision: Whether to add Moda’s Mercer’s
• Alignment with PEBB Vision
RTBC program Recommendation • No cost impact
Background and Considerations Member Impact and Cost Alignment with PEBB Vision
• RTBC is a prescriber decision support service • Positively impacts members receiving • Innovative delivery system which uses
built directly into EMR systems evidence-based medicine to
prescriptions in their doctor’s office
• RTBC shows member-specific cost and coverage setting maximum health and use dollars
details, including low-cost therapeutic wisely
alternative drugs and preferred alterative • No cost impact
pharmacies • Focus on improving quality and
outcomes
• System uses actual point-of-sale cost amounts
inclusive of accumulators, deductibles, and
benefit information • Promotion of health & wellness
through healthy behaviors and
• Also informs the provider of coverage limits,
prior authorization, and/or quantity informed choices
restrictions
• Moda recommends expanding the pilot and
adding to all EMR systems
Copyright © 2020 Mercer (US) Inc. All rights reserved. 31Decision Required
Moda ― Moda360
• Add Moda360
Decision: Whether to add Moda’s Moda360 Mercer’s
• Alignment with PEBB Vision and strategic priorities
program Recommendation • Minor cost impact
Background and Considerations Member Impact and Cost Alignment with PEBB Vision
• Moda360 offers enhancements to the • Positively impacts members by adding enhanced • Alignment with PEBB long-term strategic
current coordinated care model: clinical management and care coordination vision of member concierge and advocacy
between providers and digital health point
• Collaborative IT platform across solutions
• Patient-centered approach
providers, members, and Moda care
• Administration of the program is $5.73 PEPM, and
management additional variable fee per actively engaged • Care coordination delivering the right
• Adds additional support for chronic member care in the right setting
condition management • Moda estimates the variable fee to be $2.94
PEPM for PEBB • Promotion of health and wellness
• Clinical point solutions (Virta, Livongo, through consumer education and
Meru, Cirrus) • Estimated savings equate to $5.96 informed choices
• Member navigation and advocacy • Net admin fee is estimated to be $2.71
• $200,000 Total Cost
• +0.02% Composite Impact
Copyright © 2020 Mercer (US) Inc. All rights reserved. 32Decision Required
PHP ― Optum Emergency
Department (ED) Analyzer
• Add Optum ED Analyzer
Decision: Whether to add Optum ED Mercer’s
• Alignment with PEBB Vision
Analyzer to both Statewide and Choice Recommendation • Savings
Background and Considerations Member Impact and Cost Alignment with PEBB Vision
• As part of PHP’s efforts to improve coding • No member impact, but possibility of • Alignment with OHA guiding principle of
quality, they are proposing PEBB provider abrasion innovation and accountability
implement the Optum Emergency
Department Analyzer Tool • Optum charges variable fees equal to • Maximizes effective use of healthcare
20% of the savings generated by the dollars
• Potential downside: program
• Maintains affordable benefits for
• Increased provider appeals members
• $800,000 Net Savings
• Increased administrative fees related
to the appeals • -0.1% Composite Impact
Copyright © 2020 Mercer (US) Inc. All rights reserved. 33Decision Required
Kaiser Vision Benefits
Decision: Whether to increase vision • Change benefit to $200 / year
Mercer’s
allowance for Kaiser participants to one of • Better alignment with VSP offering
the options outlined below Recommendation • Enhancement for Kaiser members who cannot elect VSP
Background and Considerations Member Impact and Cost Alignment with PEBB Vision
• Kaiser medical enrollees do not have the
ability to enroll in VSP for their vision • 30% of Kaiser adult members reached the • Besides being a benefit enhancement for
hardware benefits (vision exams are current allowance members, there is not a clear alignment
covered under the medical benefit) with PEBB vision
• PEBB and Kaiser have received member • Cost estimates vary by offering:
feedback stating the $200 allowance • $200 / year: $700,000; +0.07%
(every two years) is inadequate
• $250 / year: $1,300,000; +0.12%
• VSP offers the following frame
allowances: • $300 / year: $1,400,000; +0.13%
• Basic: $150 allowance every calendar
year
• Plus: $225 allowance every calendar
year
Copyright © 2020 Mercer (US) Inc. All rights reserved. 34Non-Medical Renewal Considerations
Decision Required
Moda / Delta Dental
Decision, whether to: • Recommend eliminating waiting periods for both
Mercer’s
• Remove Orthodontia waiting period • Better alignment with VSP offering
• Remove Basic & Major waiting period Recommendation • Enhancement for Kaiser members who cannot elect VSP
Background and Considerations Member Impact and Cost Alignment with PEBB Vision
• Moda applies waiting periods to dependents • 2,047 members were impacted by the • Alignment with Governor Brown and OHA
who are added to coverage at Open waiting periods in 2019 initiative for health equity by eliminating
Enrollment waiting periods for dependents who need
• Basic & Major: 12-month • 2,026 members are currently subject to a these services
waiting period
• Orthodontia: 24-month
• OHA Guiding Principle of improving
• Basic & Major: access to care
• The waiting period is never applied to the
subscriber • Eliminate: $500,000; +0.05%
• Creates more affordability for members
• Moda allows PEBB to request waiting period • Orthodontia: who need these services
changes without documentation and they
allow members to send documentation of • 12-month: $100,000; +0.01%
prior coverage • Eliminate: $200,000; +0.02%
• Kaiser and Willamette Dental do not have
waiting periods
Copyright © 2020 Mercer (US) Inc. All rights reserved. 36The Standard Life & Disability Renewal
The Standard
2021 Renewal ― background considerations
• PEBB pays for a $5,000 Basic Life benefit for all employees
• All other lines of coverage are voluntary, meaning employees can sign up for additional
coverage if they choose but must pay the full cost of coverage
• Current status of renewal and negotiations:
• The Standard proposed an increase of 4%, with a two-year rate guarantee
- Increases would be applied to the optional life/disability premiums; basic life would
see no increase
- If The Standard is able to renew with an aggregate increase close to 4%, they are
willing to extend the rate guarantee an additional year, to make it a
three-year guarantee
• Mercer reviewing underlying claims experience, reserves, and actuarial factors
Copyright © 2020 Mercer (US) Inc. All rights reserved. 38The Standard
Voluntary STD and LTD
Voluntary STD Experience STD/LTD
$13,000,000 100% • STD rate increase was originally proposed for the
$12,500,000 99%
98% 2019 renewal but Mercer negotiated a rate hold
$12,000,000 96%
$11,500,000
94% 94%
• Plan running consistently, with loss ratios in the
$11,000,000 93%
92%
90% range
$10,500,000
$10,000,000 90% • LTD rate increases were proposed renewal but
$9,500,000 88% negotiated rate holds for the 60% plans and lower
2017 2018 2019 increases to the 66.67% plans
Earned Premium Incurred Claims Loss Ratio • LTD plans have run poorly with loss ratios greater
than 100%
Voluntary LTD Experience
$15,000,000 150%
133% 133% 137%
$10,000,000 101% 100%
88% Given loss ratios, the proposed renewal increase is
$5,000,000 50% consistent, if not slightly lower than what Mercer would
expect from the market on a renewal
$0 0%
2015 2016 2017 2018 2019
Earned Premium Incurred Claims Loss Ratio
• Life/AD&D rates have been subsidizing the disability rates over the past three to four years
• During the 2019 renewal, the decision was made to spread the premium increase between the Life/AD&D and the disability plans
• For 2021, The Standard is focusing on “right-sizing” the disability premiums and is not proposing increasing the Life/AD&D premiums
Copyright © 2020 Mercer (US) Inc. All rights reserved. 39The Standard
Voluntary Life and AD&D
Voluntary Life Experience Life/AD&D
$15,000,000 100% • Basic Life running very well with loss ratio of 55%
78% 79% 80% over the experience period
$10,000,000 70%
60%
55% • Optional Life (Actives and Retirees) remains stable
40% 40%
$5,000,000 with consistently low loss ratios
20%
$0 0% • Voluntary AD&D running very well with a 31% loss
2015 2016 2017 2018 2019 ratio over the experience period
Constant Premium Incurred Claims Loss Ratio
Voluntary AD&D Experience
$2,000,000 40%
37%
32% 33%
$1,500,000 30%
24%
27% Basic Life rates were reduced to their current level at
$1,000,000 20% the 2019 renewal
$500,000 10% Life products offsetting the losses incurred on the
$0 0% Disability plans
2015 2016 2017 2018 2019
Earned Premium Incurred Claims Loss Ratio
• Life/AD&D rates have been subsidizing the disability rates over the past three to four years
• During the 2019 renewal, the decision was made to spread the premium increase between the Life/AD&D and the disability plans
• For 2021, The Standard is focusing on “right-sizing” the disability premiums and is not proposing increasing the Life/AD&D premiums
Copyright © 2020 Mercer (US) Inc. All rights reserved. 40The Standard
Next steps
• Mercer will present final analysis during the May Board meeting
• Mercer in the process of conducting final peer review on a full LTD reserve audit
• The LTD reserve audit examines The Standard’s proposed reserve levels on the LTD
claims versus where Mercer would expect the reserve levels to be set
• Preliminary results show The Standard’s reserve levels are lower than Mercer’s
expectation
• PEBB Board will make decision based on analysis and possible alternative options Mercer
and The Standard complete
Copyright © 2020 Mercer (US) Inc. All rights reserved. 41Next Steps
Next steps
Mercer to
Board to decide develop final
on final plan accrual rates and Board to approve
design changes composite based final rates
for 2021 on Board
decisions
Copyright © 2020 Mercer (US) Inc. All rights reserved. 43Appendix
Mercer’s Administrative fee benchmarking survey Database • Self-insured ASO Fee benchmarks included for medical, dental, and vision plans as well as clinical management programs such as utilization management, disease management, and nurse line • Survey of 1,796 medical plans, 613 dental plans, 169 vision plans • Represents 694 employers (medical), 491 (dental), 199 (vision) • All fees are displayed on a Per Employee Per Month (PEPM) basis Employer Demographics • Results represent various size employers from across the US • Reported by employee size categories: •
How to save money in health care
Pay Less for Services
• Favorable contracted rates via health plans or vendor contract terms
• Site neutral payment
• Prospective payment system (PPS), like diagnosis related groups (DRGs) for hospitalizations
• Implement formulary with generics
• Steerage, such as COEs and narrow networks
• Implement reference based pricing, usually based on Medicare fee schedule
Pay for Fewer Services
• Avoid non-value add services, e.g., the Waste Calculator and Choosing Wisely
• Avoid service duplication
• Implement efficient bundles
• Increase scrutiny for fraud, waste, and abuse detection and avoidance
• Increase focus with prior authorization and medical management
Need Fewer Services
• Effective programs to support healthy behaviors and resiliency
• Decreasing risk factors for disease and injury
• Early identification of health conditions
• Maximize chronic condition management
• Proactive population health management
• Systematic implementation of evidence-based clinical guidelines
• Meaningfully address the impact of adverse childhood experiences (ACEs)
Copyright © 2020 Mercer (US) Inc. All rights reserved. 46Renewal planning ― 2020 through 2022 and beyond
2020 2021 2022 and Beyond
• Funding remains above costs so • Projected costs are slightly above • Projected costs are significantly
large changes are not required PEBB funding requiring small above PEBB funding requiring large
• Considerable Staff and Board changes to remain at the 3.4% changes to the plans unless steps
resources will be devoted to limitation are taken to bend the cost curve
Consultant RFP to be released later • Ongoing planning for medical RFP to • Release of RFP for new medical plan
this year be released in early 2022: • Selection and implementation of
– Initial medical RFP planning starts – Continual development of medical plan(s) starting in 2023
after selection of consultant requirements for the new health
• Initial renewal questions focused on plan
Bridge Strategies for care delivery: – Updated quality metrics and
– Site of care for oncology performance guarantees
– COEs • Major changes to the medical plans
– EMO for 2022 plan year are unlikely
– Digital Health Solutions
– Emergency Department coding
– Benefit tweaks
– Performance guarantees
– Status of Value Based Payments
Copyright © 2020 Mercer (US) Inc. All rights reserved. 47Long-term strategy
Long-term strategy
Oncology site of care steerage
.05 Providence (PHP) Moda Kaiser (KP)
Oncology Site of Care • PHP recommends specific • Recommends a phased approach • Not asked of Kaiser as care is
Steerage supportive oncology meds for site for oncology site of care steerage, already directed to appropriate
of care program; dependent on starting with “supportive” site due to integrated system
which hospitals are approved for oncology medications
the program
• Data shown to the IWG indicates potential savings
from redirecting care to lower cost settings
• Mercer supports steerage when drugs can be safely
Mercer’s Point of View
administered to a lower-cost site of care
and Recommendation
• Mercer recommends following carrier
recommendations on the oncology drugs that can be
safely transferred to a lower-cost site of care
Copyright © 2020 Mercer (US) Inc. All rights reserved. 48Long-term strategy
Long-term strategy
Center of Excellence (COE)
Providence (PHP) Moda Kaiser (KP)
COE • Does not recommend a formal • Does not have an existing COE or • KP offers internal and external
COE program at this time EMO relationships COEs regionally and nationally,
• Many Providence Hospitals • Moda is willing to partner/build which aligns to the
perform as COE-”like” functions with PEBB specifications best-practices Mercer would
expect from COEs
• Implement COE for total joint replacement
• Adopt The Bree Collaborative report and
recommendations for specifications of the COE:
Screening for medical appropriateness
Mercer’s Point of View
Shared decision-making
and Recommendation
High quality facilities and professionals
Payment adjustments based on member experience
and quality metrics
Warranty
Copyright © 2020 Mercer (US) Inc. All rights reserved. 49Long-term strategy
Long-term strategy
Expert Medical Opinion (EMO)
Providence (PHP) Moda Kaiser (KP)
EMO • PHP does not have a formal EMO • Moda does not have a formal EMO • EMOs are not utilized by KP; The
program at this time, but would program at this time, but is looking Permanente Group physicians
be willing to partner with an into a vendor partner with clinical work closely with members and
outside vendor should PEBB nurses as case managers and other providers on treatment
pursue that route physician led teams plans
• Carriers can partner with EMO vendors of their choice, but the EMO’s should
incorporate the following:
Use of the Health Evidence Review Commission Coverage Guidelines and
Reports
Systematic incorporation of shared decision making with members
Reviewers are board-certified physicians licensed in Oregon
Mercer’s Point of View
and Recommendation Routine offering of peer-to-peer consultation by the EMO reviewers with
the treating physicians
Reporting on the reviewed cases with the plan, including the decision by
the member regarding medical care that will be sought after the EMO
review
Coordination and integration with the utilization management process by
the health plans to reduce member and physician abrasion and confusion
Copyright © 2020 Mercer (US) Inc. All rights reserved. 50Long-term strategy
Long-term strategy
Digital health point solutions
A digital health solution is the convergence of digital technologies with health,
healthcare, living, and society to enhance the efficiency of healthcare delivery
while making medicine more personalized and precise
• Digital health solutions have the potential for:
• Increasing access to treatment and support with 24/7/365 availability
• Allowing for real time support when the member needs it
• Integrating between benefit programs and providers
• Increasing customized education using artificial intelligence for a member’s specific needs
• Each of PEBB’s carriers has varying level of expertise/relationships with these solutions
• If PEBB were interested in exploring further, Mercer would recommend:
• Identify the specifications for the priorities and success metrics for these digital health
solutions
• Create arrangements with digital health solutions that will optimize meaningful and sustained
engagement
Copyright © 2020 Mercer (US) Inc. All rights reserved. 51Appendix
The Standard
Benchmarking
Copyright © 2020 Mercer (US) Inc. All rights reserved. 52Basic Term Life and AD&D
• The recommendations on this page are to evaluate PEBB’s plan designs against benchmarks from The
Standard’s industry data (public administration)
Plan Design Feature Oregon Public Benchmark Comparison Mercer Notes
Judicial Management Service:
The flat $5,000 benefit for all
Benefit 1x Salary, no maximum
All others: $5,000 flat
Only 29% of employers have less
than $10,000 flat coverage – others is below market
Age Reduction None
99% of plans have an age
reduction schedule of some kind +
Copyright © 2020 Mercer (US) Inc. All rights reserved. 53Voluntary Term Life and AD&D
• The recommendations on this page are to evaluate PEBB’s plan designs against benchmarks from The
Standard’s industry data (public administration)
Plan Design Feature Oregon Public Benchmark Comparison Mercer Notes
Benefit
$20,000 increments up to
$600,000
Just 37% of plans offer plans of
$500,000 or more +
Age Reduction None
99% of plans have an age
reduction schedule of some kind +
Benchmarking not available but
Guaranteed Issue $100,000 N/A N/A Mercer speculates that this is a bit
below average
Spouse and Child life benchmarking
$20,000 increments up to
not available but ER paid benefits
Spouse Benefit $400,000, $20,000 GI N/A N/A
for spouse and child are becoming
Flat $5,000 ER Paid
rare in the marketplace
Child Benefit Flat $5,000, ER Paid N/A N/A See above
AD&D benchmarking not available
Multiples of $50,000 to but Mercer most typically sees the
N/A N/A
VAD&D $500,000 Voluntary AD&D benefit matches to
the Voluntary Life benefit
Copyright © 2020 Mercer (US) Inc. All rights reserved. 54Short Term Disability
• The recommendations on this page are to evaluate PEBB’s plan designs against benchmarks from The
Standard’s industry data (public administration)
Plan Design Feature Oregon Public Benchmark Comparison Mercer Notes
Benefit 60%
60% is the most common
offering at 52% of employers =
Funding Employee Paid
Just 28% of employers have fully
employee paid plans –
Maximum $1,662
65% of employers have a
maximum lower than $1,000 +
Minimum $25 N/A N/A
+
Most employers have a longer
Accident: 0 days accident elimination period,
Elimination Period
Sickness: 7 days while 7 days is most common for
sickness
Four weeks if disability is
=
The four-week limit for conditions
due to a pre-existing Duration varies by plan but 13
Benefit Duration with a pre-existing condition is a
condition weeks is common
rare policy stipulation
13 weeks if not
Copyright © 2020 Mercer (US) Inc. All rights reserved. 55Long Term Disability
• The recommendations on this page are to evaluate PEBB’s plan designs against benchmarks from The
Standard’s industry data (public administration)
Plan Design Feature Oregon Public Benchmark Comparison Mercer Notes
+
65% of employers offer the 60%
Plan 1 & 2: 60%
Benefit plan
Plan 3 & 4: 66.67%
23% offer the 66.67% plan
Just 21% of plans are fully
Funding Employee Paid employee paid whereas
72% are fully employer paid –
Maximum
Plan 1 & 2: $7,200
Plan 3 & 4: $8,000
Most plans have a maximum
between $5,000 and $9,999 =
Minimum $50 N/A N/A
Elimination Period
Plan 1 & 3: 90 days
Plan 2 & 4: 180 days
90 day and 180 days are most
common =
=
Age 65 is the most common
To age 65 with ADEA
Benefit Duration while paying to SSNRA has nearly
grading
the same prevalence
Copyright © 2020 Mercer (US) Inc. All rights reserved. 56Appendix
2021 BAFO Proposals
Medical
Copyright © 2020 Mercer (US) Inc. All rights reserved. 57Kaiser
Medical BAFO – Round 3
Full-time HMO Rates 2020 2021
Employees $791.38 $816.51
Employee & Spouse/Partner $1,582.77 $1,633.03
Employee & Children $1,345.35 $1,388.07
Employee & Family $2,136.74 $2,204.59
Child Only $636.30 $656.51
Full-time HMO Non-HEM Rates 2020 2021
Employees $784.89 $809.82
Employee & Spouse/Partner $1,569.80 $1,619.65
Employee & Children $1,334.30 $1,376.67
Employee & Family $2,119.21 $2,186.51
Child Only $631.09 $651.13
• Prior to PEBB admin, consultant commission, and funding assessment
• Includes 2% premium tax
Copyright © 2020 Mercer (US) Inc. All rights reserved. 58Kaiser part-time
Medical BAFO – Round 3
Part-time HMO Rates 2020 2021
Employees $669.95 $691.22
Employee & Spouse/Partner $1,339.90 $1,382.45
Employee & Children $1,138.89 $1,175.05
Employee & Family $1,808.85 $1,866.29
Child Only $538.67 $555.78
Part-time HMO Non-HEM Rates 2020 2021
Employees $659.77 $680.72
Employee & Spouse/Partner $1,319.56 $1,361.47
Employee & Children $1,121.60 $1,157.22
Employee & Family $1,781.40 $1,837.97
Child Only $530.49 $547.34
• Prior to PEBB admin, consultant commission, and funding assessment
• Includes 2% premium tax
Copyright © 2020 Mercer (US) Inc. All rights reserved. 59Kaiser deductible
Medical BAFO – Round 3
Full-time Deductible Rates 2020 2021
Employees $726.39 $749.46
Employee & Spouse/Partner $1,452.80 $1,498.93
Employee & Children $1,234.88 $1,274.10
Employee & Family $1,961.29 $2,023.57
Child Only $587.86 $606.53
Full-time Deductible Non-HEM Rates 2020 2021
Employees $717.38 $740.16
Employee & Spouse/Partner $1,434.80 $1,480.37
Employee & Children $1,219.55 $1,258.28
Employee & Family $1,936.98 $1,998.49
Child Only $577.09 $595.41
• Prior to PEBB admin, consultant commission, and funding assessment
• Includes 2% premium tax
Copyright © 2020 Mercer (US) Inc. All rights reserved. 60Kaiser deductible part-time
Medical BAFO – Round 3
PART-TIM E DEDUCTIB L E RATES 2020 2021
Employees $599.03 $618.06
Employee & Spouse/Partner $1,198.08 $1,236.12
Employee & Children $1,018.36 $1,050.70
Employee & Family $1,617.40 $1,668.76
Child Only $518.01 $534.46
PART-TIM E DEDUCTIB L E N ON -HEM RATES 2020 2021
Employees $589.41 $608.13
Employee & Spouse/Partner $1,178.80 $1,216.23
Employee & Children $1,001.97 $1,033.79
Employee & Family $1,591.38 $1,641.92
Child Only $509.58 $525.76
• Prior to PEBB admin, consultant commission, and funding assessment
• Includes 2% premium tax
Copyright © 2020 Mercer (US) Inc. All rights reserved. 61Moda
Medical BAFO – Round 3
Full-time (HEM/non-HEM) 2020 2021
Employees $722.05 $758.32
Employee & Spouse/Partner $1,444.10 $1,516.63
Employee & Children $1,227.49 $1,289.14
Employee & Family $1,949.54 $2,047.46
Child Only $613.74 $644.57
Part-time (HEM/non-HEM) 2020 2021
Employees $587.85 $617.38
Employee & Spouse/Partner $1,175.70 $1,234.76
Employee & Children $999.35 $1,049.54
Employee & Family $1,587.19 $1,666.92
Child Only $499.67 $524.77
• Prior to PEBB admin, consultant commission, and funding assessment
• Includes 2% premium tax
Copyright © 2020 Mercer (US) Inc. All rights reserved. 62Statewide
Medical BAFO – Round 3
Statewide Full-time (HEM/non-HEM) 2020 2021
Employees $829.36 $866.72
Employee & Spouse/Partner $1,658.71 $1,733.45
Employee & Children $1,409.91 $1,473.43
Employee & Family $2,239.27 $2,340.15
Child Only $704.95 $736.71
Statewide Part-time (HEM/non-HEM) 2020 2021
Employees $673.73 $704.08
Employee & Spouse/Partner $1,347.47 $1,408.16
Employee & Children $1,145.36 $1,196.94
Employee & Family $1,819.09 $1,901.02
Child Only $572.67 $598.47
• Prior to PEBB admin, consultant commission, and funding assessment
• Includes 2% premium tax
Copyright © 2020 Mercer (US) Inc. All rights reserved. 63Providence Choice
Medical BAFO – Round 3
Choice Full-time (HEM/non-HEM) 2020 2021
Employees $694.72 $721.32
Employee & Spouse/Partner $1,389.45 $1,442.63
Employee & Children $1,181.03 $1,226.23
Employee & Family $1,875.76 $1,947.55
Child Only $590.52 $613.12
Choice Part-time (HEM/non-HEM) 2020 2021
Employees $562.99 $584.54
Employee & Spouse/Partner $1,125.98 $1,169.08
Employee & Children $957.08 $993.72
Employee & Family $1,520.07 $1,578.27
Child Only $478.54 $496.86
• Prior to PEBB admin, consultant commission, and funding assessment
• Includes 2% premium tax
Copyright © 2020 Mercer (US) Inc. All rights reserved. 64Appendix
2021 BAFO Proposals
Non-Medical
Copyright © 2020 Mercer (US) Inc. All rights reserved. 65Delta Dental of Oregon
Dental BAFO – Round 3
Premier 2020 2021
Employees $58.03 $59.25
Employee & Spouse/Partner $116.06 $118.50
Employee & Children $98.65 $100.73
Employee & Family $156.68 $159.98
Child Only $49.33 $50.36
PPO 2020 2021
Employees $53.62 $54.75
Employee & Spouse/Partner $107.24 $109.49
Employee & Children $91.15 $93.07
Employee & Family $144.77 $147.82
Child Only $45.58 $46.54
Part-time 2020 2021
Employees $41.76 $42.64
Employee & Spouse/Partner $83.53 $85.28
Employee & Children $71.00 $72.48
Employee & Family $112.76 $115.12
Child Only $35.50 $36.24
• Prior to PEBB admin and consultant commission
Copyright © 2020 Mercer (US) Inc. All rights reserved. 66Kaiser
Dental BAFO – Round 3
Full-time 2020 2021
Employees $64.43 $64.43
Employee & Spouse/Partner $128.86 $128.86
Employee & Children $109.54 $109.54
Employee & Family $173.97 $173.97
Child Only $51.93 $51.93
Part-time 2020 2021
Employees $48.05 $48.05
Employee & Spouse/Partner $96.10 $96.10
Employee & Children $81.69 $81.69
Employee & Family $129.74 $129.74
Child Only $38.68 $38.68
• Prior to PEBB admin and consultant commission
Copyright © 2020 Mercer (US) Inc. All rights reserved. 67Willamette Dental Group (WDG)
Dental BAFO – Round 3
Full-time/Part-time 2020 2021
Employees $55.85 $55.85
Employee & Spouse/Partner $111.70 $111.70
Employee & Children $95.00 $95.00
Employee & Family $150.85 $150.85
Child Only $47.45 $47.45
• Prior to PEBB admin and consultant commission
Copyright © 2020 Mercer (US) Inc. All rights reserved. 68Vision Service Plan
Vision BAFO – Round 3
Base Plan 2020 2021
Employees $8.50 $8.61
Employee & Spouse/Partner $17.00 $17.22
Employee & Children $14.45 $14.64
Employee & Family $22.95 $23.25
Child Only $7.23 $7.32
Plus Plan 2020 2021
Employees $14.88 $15.07
Employee & Spouse/Partner $29.75 $30.14
Employee & Children $25.29 $25.61
Employee & Family $40.16 $40.68
Child Only $12.64 $12.81
• Prior to PEBB admin and consultant commission
• Includes revision to plan relativities
Copyright © 2020 Mercer (US) Inc. All rights reserved. 69Cascade Centers
Employee Assistance Program BAFO – Round 3
Model 2020 2021 (through 6/30/21)
Three-Visit $1.04 $1.04
Five-Visit $1.33 $1.33
WholeLife Directions $0.18 (effective 7/1/2019) $0.18 (effective 7/1/2019)
• WholeLife Directions was added effective July 1, 2019
• The Board decided the additional charge for WholeLife Directions will be paid through
the PEBB stabilization reserve for the first year
• Effective July 1, 2020, the PEPM cost for WholeLife Directions will be passed to the
agencies
Copyright © 2020 Mercer (US) Inc. All rights reserved. 70ASIFlex
Flexible Spending Account administration BAFO – Round 3
Item 2020 2021
Set Up Fee Waived Waived
• Initial Plan Year
• Renewal Plan Year
Monthly Administration Per Participant Per Month $2.95 $2.95
(PPPM)
Optional ASIFlex Card PPPM Included Included
• Replacement or additional card sets • $5.00 billed to participant FSA • Included
Employee Communication
• PDF documents • No Charge • No Charge
• WebEx group meetings • No Charge • No Charge
• Onsite Enrollment Meetings • $250 per day, plus travel expenses • $250 per day, plus travel expenses
• No plan design changes for 2021
Copyright © 2020 Mercer (US) Inc. All rights reserved. 71BenefitHelp Solutions
COBRA, Retiree, Semi-Independent and BAFO – Round 3
Self-Pay administration
Item 2020 2020
Per Service Option • Service Representative • Service Representative
− $1,000 per month ($750 COBRA; $250 − $1,000 per month ($750 COBRA; $250
Retiree) Retiree)
• Qualifying Event Letter • Qualifying Event Letter
− $4.00 per letter − $4.00 per letter
• Per COBRA Continuant • Per COBRA Continuant
− $7.25 per month − $7.25 per month
• Per Retiree • Per Retiree
− $7.25 per month − $7.25 per month
• Open Enrollment Questionnaire • Open Enrollment Questionnaire
− $3.15 per letter − $3.15 per letter
• Self-Pay (Foster Parents, etc.) enrollees are charged $10.30 per family for eligibility and
premium administration
• No plan design changes for 2021
Copyright © 2020 Mercer (US) Inc. All rights reserved. 72The Standard
Life & Disability
2021 Rate guarantee through December 31, 2023
Covered Lives 2020 Rates 2021 Rates % increase
Basic Life
• Active 52,464 $0.180 / 1,000 $0.180 / 1,000 0.0%
• Judicial 512 $0.280 / 1,000 $0.280 / 1,000 0.0%
• Dependent 29,894 $1.290 per member $1.290 per member 0.0%
Optional Life
• Employee 32,444 Step Rates Step Rates 0.0%
• Spouse/Partner 15,143 Step Rates Step Rates 0.0%
• Child 23,418 $0.75 per member $0.75 per member 0.0%
Voluntary AD&D
• Employee 11,880 $0.02 per member $0.02 per member 0.0%
• Family 14,958 $0.034 per member $0.034 per member 0.0%
Disability
Short Term Disability 29,500 0.69% 0.75% +8.7%
LTD 1 (60% 90 EP) 13,534 0.54% 0.54% 0.0%
LTD 2 (60% 180 EP) 5,536 0.19% 0.19% 0.0%
LTD 3 (66 2/3% 90 EP) 4,989 1.12% 1.23% +9.8%
LTD 4 (66 2/3% 180 EP) 4,363 0.28% 0.31% +10.7%
Copyright © 2020 Mercer (US) Inc. All rights reserved. 73You can also read
