bob: welcome. i’m bob burton, and i’mhere today with chris owen, marketing manager for the calpers health benefits program forpublic agencies and schools. we want to welcome everyone to the 2016 calpers health plan rateand benefit changes webinar. chris and i are here today to have a conversation about nextyear’s health plan rates and benefit changes. so chris, what can you tell us about the ratesand benefits for next year? chris: well thank you bob. let’s take alook at the overview we’ve got for the 2016 where we look at the overall health premiumchanges which will be a percentage of change for all the hmo, ppo, and association plans.next, we’re going to take a look at individual premium changes which will cover thestate of california as well as our five regional
rates as well as association plans and ourout of state health plans. next, we are going to talk about 2016 health program changeswhich we will go over the plans that will be expanding their areas and offer differentservices for next year. next, we’re going to take a look at the health program benefitchanges which will cover a new benefit such as the new single payer supplement to medicareplan. then, we’re going to do a recap on the dev project. and lastly, we’ll coversome information and resources for open enrollment. bob: sounds similar to what we went over lastyear. before we dive into this, is there anything employers need to know about this webinarspecifically? like how they can ask questions or access supplemental information?
chris: yes, based on feedback from last yearwe want to be clear that this is a pre-recorded webinar as it does save time and help to targetthe subjects for next year and it also gives us the time to research all the answers weare going to get from questions that have been submitted on the webinar, from variousprogram areas. that being said, we encourage questions and comments during this webinarusing the submission box on your screen and we also would direct you to some feedbackvia a short survey at the end of this webinar to help us improve future webinars. there’salso a dialogue box that’s located on your screen for a download of all supplementalinformation such as this script and slides as well as information about the health planchooser.
bob: alright, beginning with the first topicof our overview, explain what you mean by “overall health premium changes for 2016� chris: well, depending on upon what kind ofagency you are working for will determine the kinds of plans you’re going to takea look at and we are going to briefly go through each plan type and show average increasesfor next year. bob: so you mean all of the hmos, ppos, associationplans, medicare plans etc…? chris: that is correct. bob: so here we begin with the basic hmo’snow chris at 7.21%. this means that if i am currently in an hmo the average increase forall of the hmos went up 7.21%.
chris: that is correct. it’s the same kindof idea when we are taking a look at the ppos, the basic association, then the medicare hmosupplement, medicare supplement ppo, as well as the medicare supplement association. bob: just so i understand you chris, for thosehealth benefit officers out there that are with the csu campuses or judges and legislators,you’ll probably pay more attention to the hmo and ppo percentage increases, while correctionalfacilities for example would interested in the basic association changes? chris: that’s correct. basically becauseyou know your california correctional peace officers have access to the basic associationplan, the ccpoa association plan, while the
csu, and jlrs would look at hmo and ppo changessince those are the kinds of plans their employees would be more interested in. bob: so what plans your employees are moreconcerned with will depend on what kind of agency they work for. chris: that’s very accurate. just kind ofkeeping in mind it’s a picture of average premium changes for 2016 and is meant to givea general idea of those changes for next year based on plan type. as it is with every newcontract year some plans went down and others went up and calpers is always striving tokeep overall keep healthcare premiums in check. bob: alright, it seems most members and retireesare likely more interested in what their current
health plan premium will be for 2016. what’sthe point of giving average increases? chris: well, the rates when they first comeout are kind of the first rung on the ladder that all members and employers take a lookat. because calpers is one of the largest purchasers of health insurance in the unitedstates, many sees us as an indicator of industry trends and lots of health benefit officerswould like to compare other regional prices to their own. that being said, we’re goingto take a look at individual plan changes by region once we first go over the statepremiums for all state and csu active employees. bob: is there really a reason for the statepremiums as a key to understanding regional premium rates?
chris: well not exactly, it’s just simplythat the state premiums are first created for all of our state active employees andthen the regional rating is done to reflect the cost of health care for each of thoseareas. bob: so these premiums are for all of thestate of california and csu employees? chris: correct. now when we look at the bayarea, you can see how they differ from the state premiums. here is the sacramento region.health net added smartcare to several counties for northern california so you will note thatthere won’t be a percentage change for that health plan for next year. bob: do regions ever change?
chris: not this year. last year, the regionalchange we had was the yolo county being grouped with the sacramento region instead of thebay area region. bob: why does calpers have regional ratingfor public agencies and schools, but not for the state of california? chris: regional rating was created in 2005to reflect the cost of all the five different regions in california. basically, becausesouthern california was disproportionately lower in cost than the more rural northerncalifornia areas. as you can see the los angeles region from that slide you can see it’sstill true today and it’s also the same with the other southern region.
bob: so regional rating was created to chargepremiums that reflect the cost of care in that geographic area. can members choose theregion they would like to use? chris: members must select a region basedon their residential or work zip code. we have included the eligibility zip code linkon our materials in the download. as you can see the percentage changes for each plan canvary significantly between. again, this difference in pricing between regions reflects the marketcost of services in those areas. bob: just to clarify once again chris, regionalrates only apply to public agency and school members while state employees are not regionallyrated? chris: that is correct. the only exceptionis when we are talking about out of state
or supplement to medicare plans. bob: from a quick glance at the rates it seemsthat there were pretty significant increases in the premiums. can you give us some insightto why that happened? chris: well, pharmacy costs accounted fornearly 45 percent of overall rate increases for both the hmo and ppo plans in 2016. additionallycalifornia is one of the more expensive states for health care costs. it’s just part ofthe case where every contract year some plans will go up and some plans will go down andcalpers is trying to mitigate the increases as much as we can. bob: now what about our retirees and membersthat may live out of state? what happens for
those folks? chris: kaiser/out-of-state is available tomembers based on the eligibility zip code which is part of the download and we willalso cover a little bit later here, whereas pers choice and perscare are available nationwideand worldwide. all of these plans are not regionally rated. bob: how does medicare work with regionalpricing? chris: again, medicare is also not regionallyrated. given that most of our audience today is comprised of health benefit officers foractive employees, and contracting agencies and schools, there may not be as many inquiriesabout medicare plans. however we have included
our understanding medicare publication inthe download in case there’s inquires on medicare. bob: there are a lot of plans chris, it’sa bit overwhelming. have we covered all of them? chris: well almost. we do have our associationplans and these are offered exclusively to our dues paying members of three associations:the california association of highway patrol, the california correctional peace officersassociation, and the peace officers research association of california. and for more informationon these benefit changes for next year, we encourage our members to contact the associationsdirectly for more information and at this
point we have covered all of our calpers sponsoredhealth plans. bob: a ton of information, how would i findout if my doctor contracts with a plan? chris: included in the download are all ofthe calpers micro-sites for all of our plans and from there once you go to those micro-sitesyou can find all of the doctors that would be available if you select that plan as wellas the various medical groups that participate. bob: okay chris, that seems pretty straightforward.what’s going to be new or different for 2016? chris: well, now we’re taking a look atsome of the health program changes and the big change that we have is the unitedhealthcare'smedicare advantage preferred provider organization
plan will be the prevailing medicare supplementfor anthem blue cross, blue shield of california, health net, and sharp. the kaiser permanente'smedicare advantage and the ppo medicare plans will remain the same for their supplementto medicare. public agency and schools will also be able, if you’re retired and havemedicare, have the option of a dental and vision plan as part of the unitedhealthcaresupplement to medicare bob: so now to get back to our active members,what should our actives be aware of regarding individual plan changes? chris: well the good news is we won’t haveany drastic changes such as office co-pays or deductibles for 2016. what we do have,let’s just run through a little bit of each
plan, say for anthem blue cross for example,they’re going to expand their pers select into san diego county and they’ll be alsoextending their castlight pilot project which is basically the calpers compare functionwhich allows you to look at different kinds of, maybe hip replacement surgery or so forththrough different medical providers to see what costs would be more cost effective. there’salso going to be a standardization of acupuncture and chiropractic benefits for medicare witha $15.00 co-pay and 20 combined visits per year. bob: i remember when ann boynton and i dida calpers insight interview on the castlight or calpers compare function.
chris: oh yes, it’s a great way for membersto do their own cost comparing between different medical groups and it’s hopefully goingto cause the industry to pay a little bit more attention to what the cost would be forvarious procedures. let’s see, let’s move on to blue shield is next. blue shield designchange will be enhancing their prescription benefit to include a 90-day supply option. bob: and what does that mean exactly? chris: well, it’s just that if the 90 daysupply is not available through the blue shield’s primemail service, the customer can go toa retail pharmacy and get the same amount for the same cost instead.
bob: okay, sounds very convenient, good toknow. what else will be new for 2016? chris: well as mentioned in the basic premiumchanges earlier, health net will be expanding into alameda, contra costa, fresno, kern,essentially expanding into northern california for 21 counties completely serviced. bob: okay, health net smartcare doesn’thave a percent change since it will be new for 2016? chris: right, that’s what we kind of mentioneda little earlier because it is brand new and the premiums are just beginning for thosenew areas that they’re servicing. we don’t actually have a change to report yet.
bob: more choices for next year is a goodthing, what else can we share with the folks out there for next year? chris: again this is more for retirees thanit is for actives but the kaiser is going to standardize their acupuncture and chiropracticbenefit providing the 20 combined visits with a $15 copay. bob: that’s good to know for our retireesthat have kaiser; who is the next carrier with changes for next year? chris: now we come to united healthcare, expandingtheir united alliance hmo into kings, marin and san diego. they’ll also standardizetheir 90-day supply of mail order similar
where if you can’t get it through the mailservice you can go to a retail location as well as the option for the public agency andschools that have a medicare supplement plan the option of a dental and vision plan. bob: another expansion and easier access for90-day prescriptions, and now the public agencies and schools have dental and vision care thatoption that they enjoy using united healthcare as a supplement to medicare. chris: well that’s correct and with thepublic agency and school united healthcare medicare enrollees having this option as astraight supplement to medicare or a supplement to medicare that includes dental and visionis something that has been discussed for a
long time and we’re very happy that we canhave this option for those public agency and school retirees. bob: really is great news. i know questionsabout dental and vision have come up in the past, so it is huge. do current medicare enrolleesneed to be aware of anything else? chris: there will be more information sentout to those that are going to be affected by anything but if someone is enrolled ina combination basic and medicare plan and it’s not kaiser, our ppos, or united healthcarefolks will be notified to decide to select a different plan. and folks that are affectedwill receive correspondence if they fall into a category with directions on what to do.
bob: any other changes to go over for anyof the other carriers? chris: well, blue shield and anthem blue crossare going to be introducing welvie product to members which is an online tool to helpeducate folks about minimizing unnecessary surgeries. bob: okay, i believe that pretty well wrapsup the health plan changes for next year. our next item is the dependent eligibilityverification or dev project. i know we were into this last year. chris: right, we talked a little bit aboutthe dev project last year and the big news obviously is that the dev project is over.the reason why we’re bringing this up is
to indicate to those that are listening thathaving proper documentation is still really important to minimize the cost as well asto protect your agency if you’re audited by calpers so to make sure you got those birthcertificates and marriage certificates and so forth all on file. bob: i know dev project was a huge undertakingand all the employers, i bet, are certainly glad it’s over with. now, we are gettingdown to our last bit about open enrollment information. chris: yes, this year, open enrollment willtake place from september 14th through october 9th. open enrollment packets will be mailedout to all enrolled members in two waves.
the first wave is going to go out august 17thand the second will be mailed on august 24th. also important, these packets go to enrolledactive and retired members so if you know of active employees or if there’s retireesout there that are eligible but not enrolled, they’re not going to get a packet and itis up to these individuals to kind of seek out either through the health benefit officersor to contact calpers to ask how to get enrollment information if they’re interested. again,that number for calpers is 1-888-225-7377. another important point to mention about theopen enrollment circular letter which is scheduled to be sent out at the end of july so employersshould receive open enrollment information at that time and it’s also very importantto make sure that their contact information
is up to date. bob: okay well, how does the employer keeptheir contact information current? chris: this, through the system access administratorfor the agency, they update contact information in the my|calpers systems under the businesspartner contacts and that’s essentially how calpers communicates with all of our agencies. bob: so if the contact information is missingor incorrect no communication? chris: that’s right. that is why it’sso important to update contacts periodically. if folks are listening out there and do notknow how to update the contact information or don’t know who their system access administratoris, again, contact calpers. our contact number
888-225-7377.bob: well, we’ve covered a lot of information, as you mentioned, there more details providedin the download for this webinar. i know i’ve learned a few things and enjoyed our timetoday. chris: well, thank you bob, it’s alwaysa pleasure to talk with you, and share information with our employers and members. i know i mentionedthe survey at the end of this webinar so i am going to mention it again so please tellus what was useful to you or what you would like to find more useful in future webinars. bob: chris, you’re certainly welcome andthank you everybody out there for your participation. this concludes that 2016 calpers health planrate and changes webinar. we appreciate your
time and attention. like us on facebook orfollow us on twitter and check out the calpers videos on youtube. have a great day.
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