2013 CalPERS Health Plan Rate & Benefit Changes

Uploaded by CalPERSNetwork on 23.08.2012

>>Welcome to the 2013
CalPERS Health Plan Rate
and Benefit Changes webinar.
On our agenda today we will
discuss the following items.
Overall health premium
changes for 2013,
basic and Medicare
premium changes,
overview of the health program
changes for 2013,
and health plan benefit changes,
if any, for our health plan partners,
Blue Shield of California,
Kaiser Permanente,
Anthem Blue Cross
and CVS Caremark.
We will supply you with helpful
resources and useful
information, and at the end of
our presentation we will have a
question and answer session.
We will first go over a couple of
questions that have been
submitted in advance by
employers since our new rates
were announced in June, that
we would like to address in this
public forum.
Please use the question
submission feature on your
screen to ask your questions.
As time permits, we will answer
as many of those questions as
we can, but if we don't get to
your question live today, we will
list the questions submitted
with the answers when this
webinar posts to the CalPERS
video center on August 23rd.
Now let's look at the overall
health premium changes for
the 2013 benefit year.
These percentages reflect the
overall rate changes for the
state agencies and contracting
agencies alike.
We negotiate the rates using
the total risk pool for each plan.
Rates are then modified for
contracting agencies and
schools to reflect the cost of
care in each region.
Next we will look at the
premium changes between the
2012 and 2013 basic
plan premiums.
The next slide shows the rate
change percentages by plan
for the state basic plans, and
gives detail to the overall basic
premium changes we looked at
a moment ago.
These percentage changes
reflect the true change to rates
without modification by region.
These rates are used by the
State of California and California
State University employers.
They are not regionally rated as
these employers have offices
throughout the state, and are
considered one employer for
this purpose.
The next few slides show the
percentage change in
premiums for each region.
The CalPERS board approved
regional rating for contracting
agencies beginning with the
2005 contract year.
The regions are reviewed each
year to maintain correct
placement of counties within
regions, and to reflect the true
cost of providing health benefit
services to members in the
various regions.
For example, in 2010, the
region formerly known as Bay
Area/Sacramento was split into
two regions.
The Los Angeles region
continues to be the lowest
cost region, followed by
Other Southern.
Please note on the Other
Northern region, Blue Shield
added the net value plan to
Humboldt and Stanislaus
Counties for 2013 so there is
no percentage change noted
from 2012.
Members living outside of
California are grouped into one
big region called Out of State.
PERS Choice and PERS Care
are available nationwide and
worldwide as well.
Kaiser Out of State is available
to members in Colorado,
Georgia, Hawaii, Maryland,
Ohio, Oregon, Virginia,
Washington State and
Washington, D.C.
subject to the members'
eligibility zip code.
Our next slide shows
Medicare plan rates.
The Medicare premiums
significantly decreased this
year for the most part,
reflecting the change to the
employer group waiver plan,
also known as EGWP, which
we will talk about in a moment.
Medicare rates are the same
for all state and contracting
agency members within
all regions.
Other plans offered in the
CalPERS health benefits
program are association plans.
We will not be addressing the
association plans in depth but
did want to mention a couple of
points about these plans.
Association plans are offered
exclusively to dues paying
members of these associations:
The California Association
of Highway Patrolmen or CAHP,
The California Correctional Peace
Officers Association or CCPOA,
and the Peace Officers
Research Association
of California, PORAC.
Both police and firefighters can
be members of PORAC.
The basic and Medicare plan
rates for CAHP remain the
same and there were no
benefit changes.
Rates for the CCPOA and
PORAC plans increased by 6.4
percent for basic plans and
decreased 1.8 percent for
Medicare plans.
The CCPOA modified its
behavioral health treatment,
applied behavioral analysis
benefit, and adopted the
employer group waiver plan for
its Medicare coordinated plan.
PORAC had no benefit
changes for 2013.
Association plans are not
regionally rated.
For more information regarding
the association plan benefits,
please contact the association.
Now we will look at upcoming
changes to the CalPERS
health benefits program.
The 2013 health plan design
changes include converting
supplement to Medicare plans,
from the Medicare Part D
retiree drug subsidy or RDS
program, to the employer
group waiver plan or EGWP.
Some people like to call it
CalPERS joined the retiree
drug subsidy program in 2006
and has periodically evaluated
the employer group waiver
plan program.
Until recently, the employer
group waiver plan did not offer
a compelling alternative to the
retiree drug subsidy program.
But this move in 2013 will result
in savings of approximately 39
to 44 million dollars in premium
for the year.
Now let's look at health plans
and the changes in store
for 2013.
Blue Shield is introducing a
new feature call Tel-A-Doc.
Tel-A-Doc is a year round, 24-
hour-a-day physicians network
that offers non emergency
health care consultation
via telephone and secure
online video.
Medical issues such as urinary
tract infections, cold and flu
symptoms, bronchitis, allergies,
migraines and respiratory
infections can be treated by
contacting a Tel-A-Doc
These physicians are able
to write prescriptions for
short-term non controlled
This new service is available to
CalPERS Blue Shield members
for no co-pay or additional fee.
For more information, please
visit the Blue Shield of
California CalPERS member
page, or contact member
Blue Shield is also expanding
its net value plan into Marin,
Sonoma, Humboldt and
Stanislaus counties and will
add its 65 plus managed
Medicare plan to additional zip
codes in Contra Costa County.
Blue Shield also plans to add
providers to net value
programs in Ventura, San
Bernardino, San Diego and
Santa Clara counties.
New for Kaiser Permanente in
2013 is enhanced coverage for
women's services.
In addition to the annual well
woman exams available in all
CalPERS plans at no cost,
Kaiser Permanente has added
contraceptives and
breastfeeding supplies at
no charge for those on
the basic plan.
In addition to this, Kaiser will be
opening new facilities and
expanding currently existing
facilities all around the state.
New facilities include medical
offices in San Mateo,
Bakersfield, Ontario, San
Diego, South Los Angeles,
Anaheim, Carmel Valley,
Escondido, Fontana, Indio,
Lake Forest, Moreno Valley,
Carson and Thousand Oaks.
For more detailed information
on these facilities, please see
the downloadable PDF
This handout will also be
available for download in the
CalPERS video center on
August 23rd.
Also in 2013, Kaiser
Permanente will implement an
alternative access pilot
program for CalPERS
members that will focus on
increasing member awareness
about clinical service options
and encourage members to be
more engaged in managing
their own healthcare.
Anthem Blue Cross, the
administrator of the CalPERS
self funded plans, is pleased to
announce they will be
expanding the PERS Select
service area to include
Alameda, Placer and
Solano counties.
With this expansion, PERS
Select will now cover all 58
counties in California.
PERS Select had a zero
percent increase in premiums
for next year and continues to
be the lowest cost plan overall
in the CalPERS health benefits
Anthem Blue Cross will also be
adding more hip, knee, joint
replacement facilities in 2013.
CVS Caremark has no benefit
changes but is pleased to
announce the addition of
approximately 2,000 more
pharmacies to its network,
bringing the total to over
66,000 in 2013.
This wraps up the changes to
the health plans for 2013.
The next few slides contain
information and resources that
you and your employees may
find useful especially in the
upcoming weeks.
This slide contains information
for the association plans.
Please contact the association
for information about networks,
formulary and benefits specific
to the association plan.
This slide contains contact
information for each of our
health plan partners.
Members can call or access
the website for specific
information regarding benefits
or formulary, as well as
physicians available in network.
If accessing the website,
please make sure that you type
the web addresses exactly as
they appear here to ensure that
you receive CalPERS specific
These links will take you
straight to the section of the
health plan partners micro site
that will allow you to search for
a provider, doctor or clinician.
Again make sure that you type
the web addresses exactly as
they appear here to ensure that
you receive CalPERS specific
Now we will begin our question
and answer session.
During the webinar, you were
provided the option to submit
We have compiled the list of
questions and will now
proceed to answer them for
you as time allows.
If your question is not
answered now, all questions
will be posted with the answers
when the webinar is posted to
the CalPERS video center on
August 23rd.
Similar questions will be
combined so you may not see
your exact phrasing, but all
questions will be answered.
We'll start with a couple that
have come in earlier that we
wanted to address here.
The question, the first question
is kind of long and the answer
is even longer but bear with
me, I think it's very good
Question, we are in a rural area
with only PERS Choice and
PERS Care as options.
We pay up the PERS Choice
plan but it's difficult to negotiate
benefits with bargaining units
when the rates fluctuate so much.
Why do rates change so much
from year to year?
Can't CalPERS stabilize increase?
For instance, the Other
Northern 2011 rate was
approximately an 11 percent
increase, and then in 2012,
only 2 percent.
The answer: There are several
factors that go into rate
changes for each plan.
Our self funded plans, including
PERS Choice, each have a
required minimum reserve
level, but over the last few
years, there have been excess
reserve amounts that CalPERS
has used to artificially buy down
the rate increases that would
have been in effect based on
utilization and cost of care.
In 2010, the bulk of the excess
reserve fund was used to
provide premium holiday for
two months to assist the state
and contracting agencies due
to severe budget problems.
In 2011, the overall premium
change to PERS Choice was
9.9, which reflected more
closely the actual rate increase
necessary in that risk pool.
2012 rates include application
of a portion of the plan's
excess reserves to mitigate
2012 plan rate increases, and
included anticipated early
retirees re-insurance program,
or ERRP funds, for coverage of
early retirees under the Federal
Health Care Reform Law.
Unfortunately, CalPERS did not
receive the projected ERRP
funding but chose to not make
a mid year rate increase to
balance that deficit in 2012.
The 2013 PERS Choice rates
increased by 10.75 based upon
utilization and cost of care.
An additional 1.64 percent
increase was added to adjust
for the loss of ERRP funds in
2012, as well as additional
increase of 3.84 percent to
adjust to the impact of using
reserves in 2012.
That brought the overall
increase in PERS Choice basic
plan rate to 16.22 for 2013.
You can learn more about the
rates at the next health benefits
constituent work group on
Thursday, August 9th at 10:00,
as this session will focus on the
rate composition for our plans.
The next question that we
received early, I am concerned
about the conversion from the
Medicare Part D retiree
subsidy to the employer
group waiver plan.
Our agency receives a large
subsidy each June and
now it looks like we will
lose that benefit.
The answer, with the change
from the retirees drug subsidy
to the employer group waiver
plan, contracting agency
employers will no longer
receive the subsidy check.
The subsidy was based upon
the agency's employer
contribution for annuitants
enrolled in the supplement to
Medicare plans.
With the employer group
waiver plan, while employers
will no longer receive a check,
the overall decrease in
premium will save more than
they gain by the subsidy.
And while some employers do
contribute generously toward
the annuitant coverage, the
evolving trend is toward greater
sharing of premiums costs with
the annuitant.
Many contracting agency
employers pay the minimum
required monthly contribution
of $112.
The employer group waiver
plan provides a lower premium
which benefits equally the
purchaser of the premium
whether that is the employer or
the member.
Employers will receive their last
subsidy check in June of 2014,
for the 2012 contract year.
We also received a couple of
questions about Tel-A-Doc, it
was asked is Tel-A-Doc
available to all CalPERS
And the answer is no.
Tel-A-Doc is only available to
Blue Shield Access Plus or
Net Value members.
Another question concerning
Tel-A-Doc is what is the
co-pay for each consultation
with a physician.
And that answer is zero.
When should I use Tel-A-Doc?
The answer is medical
conditions that Tel-A-Doc can
treat include bronchitis,
allergies, cold and flu
symptoms, urinary tract
infections, to name a few.
You might consider using Tel-
A-Doc as a replacement for the
emergency room for non
emergency medical assistance
or when your primary care
physician is not available or for
non emergency late night
pediatric issues.
There is a question that comes
up pretty often from people
that, why is PERS Care so
much more expensive than
PERS Choice and PERS Select.
And the answer there is PERS
Care is the oldest operating
plan of the three PPO plans
and has realized a significant
enrollment decline
over the years.
Consequently, the existing
PERS Care enrollment is an
older population with a much
higher medical utilization.
PERS Care premiums are
solely based on the medical
experience of the PERS
Care enrollment.
And one last question was
submitted ahead of time is
what's the primary difference
between PERS Care, PERS
Choice and PERS Select.
The answer there, all three are
PPO plans, PERS Care offers
the highest level of coverage
but at a significantly higher
premium cost.
PERS Care and PERS Choice
offer the full Anthem Blue
Cross PPO provider network of
approximately 55,000
physicians, California
physicians, and
over 300 hospitals.
PERS Select offers the same
available benefit coverage as
PERS Choice but through a
narrower physician network of
approximately 30,000 and a
tiered hospital network.
In 2013, PERS Select basic
plan premiums will be 27
percent lower priced than the
PERS Choice premium rates.
Additionally, PERS Select
enrollment will now be available
in all California counties.
These lower premiums are
achieved by having PERS
Select benefit design, direct
members to lower costs,
Anthem Blue Cross contracted
physicians and hospitals.
And now we'll look at your
questions coming in now.
There is a request to repeat
the Blue Shield counties
that are being added to the
Net Value Plan.
And those are,
Net Value is expanding
into Marin, Sonoma,
Humboldt and Stanislaus
counties and will add 65 plus
managed Medicare to
additional zip codes in
Contra Costa.
And another question,
oh repeat PERS Select
county expansion.
And that was expanding into
Alameda, Placer and
Solano counties.
It now will cover all
counties in California.
And one thing that you might
want to remember is that there
may not be a hospital,
contracting hospital for PERS
Select in that particular county,
but the physicians can refer to
hospitals outside of the county.
And there's a question about
when the evidence of coverage
booklets will be available.
We expect them to be
available by the end of August
and members will be receiving
their open enrollment, our open
enrollment period this year is
from September 10th to
October 5th.
And the open enrollment
materials will be mailed out to
members on, I think it's
August 18th.
I'm not sure.
But they will be mailed out
ahead of time and there will be
a postcard attached where
members can ask for different
publications and materials for
open enrollment.
Also, this was going to be a
plug at the end but we're not
getting a lot of questions.
We have produced a video
"Presenting the 2013 CalPERS
Health Plans."
And this will be posted
to the CalPERS video
center on or about
September 1st.
And this would be a great tool
for members who are
considering a health plan
change and serves as an
alternative to an onsite health
fair for employers.
This is also a good tool for
people that just want to find
out about what the other
health plans are like.
Are there any other questions?
Okay, is Tel-A-Doc replacing
urgent care access for
Blue Shield enrollees?
No, not really because you
could still go into your urgent
care center and pay your
15 dollar co-pay.
But for certain issues or when,
maybe when the urgent care
center is closed, you can
access the Tel-A-Doc
24 hours a day.
Oh, okay.
There is a request for the
Kaiser out-of-state to be
And my favorite is Hawaii so
I always remember that.
But the other ones are
Colorado, Georgia, Hawaii,
Maryland, Ohio, Oregon,
Virginia, Washington and
Washington, D.C.
And again that's not throughout
the state, the member still
needs to live in the geographic
service area of Kaiser facilities
in that state.
And you will note that the
health plan premiums are more
expensive in the out-of-state
Kaiser plans than they are in
The question was just asked,
will this webinar be repeated?
No, it will not, this is the only
time we're presenting it but it
will be posted to the CalPERS
video center on August 23rd.
And you'll have access to it then.
Some employers may want to
provide this to employees
but this webinar is actually
directed toward employers,
just specifically.
I think we have time for one
more question, and that
is where do we get the
2013 rates?
The rates are already
posted on CalPERS website.
You go to CalPERS online and
you would go into the health
benefits tab and depending
whether you're a contracting
agency or a state employer,
there's two different links.
And then the health plan rates
will be posted there by region
for the contracting agencies.
So this concludes the 2013
CalPERS health plan rate and
benefits changes webinar.
We appreciate your time
and attention.
And the webinar will be posted,
again, like we've mentioned
several times, to the CalPERS
website on August 23rd.
So please check back then for
anything that you may have
missed, including questions
and answers.
Finally I would like to remind
you about the health benefit
constituent work group which is
for all employers.
The next one is on Thursday,
August 9th at 10:00 a.m.
and will focus on the 2013
rate composition.
You may attend in person
or call in.
You can find the call in number
and instructions to receive the
agenda and materials by, I'm
gonna give you instructions
here so you might want to
write it down.
Log into www.calpers.ca.gov,
select the employer tab, then
select employer education
and events.
And then you'll see the health
benefit constituent workgroup.
You'll see the full schedule for
the calendar year and we
welcome your participation.
Let your voice be heard and
learn what's on the horizon.
Also, I meant to note here that
the, oh yeah, the agenda and
materials are available by
clicking there.
So please join us on Facebook at
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Thank you and
have a great day.