HomeMy WebLinkAbout06/16/2009 13 2008 Year-End Medical Insurance Report BUSINESS OF THE CITY COUNCIL
. YAKIMA, WASHINGTON
• AGENDA STATEMENT
Item No. )i 13
For Meeting Of 6/16/09
ITEM TITLE: 2008 Year -End Medical Insurance Report
SUBMITTED BY: David Brush, Chair, Employees' Welfare Benefit Program Board ,
Sheryl M. Smith, Human Resources Manager
CONTACT PERSON /TELEPHONE: Sheryl M. Smith, 575 -6090
SUMMARY EXPLANATION:
Attached is the 2008 Year -End Report for the City of Yakima's Self- Insured Health Care Plan. .
In reviewing this report, it is important to note that Healthcare Management Administrators
utilizes a paid claims system of reporting expenditures. This differs from Generally Accepted
Accounting Principles (GAAP), used by the City of Yakima for its records. The City recognizes
expenditures on a claims incurred basis. Further, the report does not include any revenues or
expenditures for City personnel and administrative costs, which are attributable to the City's
0 Health Benefit Reserve Fund.
•
Resolution Ordinance Contract Other (Specify) Report
Funding Source
APPROVED FOR SUBMITTAL: �— ., I
City Manager ,
STAFF RECOMMENDATION: Accept report. ,
0 BOARD /COMMISSION RECOMMENDATION:
COUNCIL ACTION:
'' . S 1 lc
Northwest
May 15, 2009
City Council Members
CITY OF YAKIMA
129 North 2nd Street
Yakima, WA 98901
Re: Year 2008 Healthcare Plan Report
2009 Renewal and Current Status of Plan
Dear Council Members: -
r a
Enclosed are the Financial Summaries and related rep of the City's Employee
;:.:44':.-:: Health Plan for the calendar year 2008 and first quarter of 2009. These reports are
_ produced by Healthcare Management Administrators, Inc. (HMA) of Bellevue,
` .'' Washington, and record .actual claims and direct plan expenses on a cash basis of
"= accounting. With another favorable annual audit from the Washington State Risk
Manager's Office in 2008, this Plan continues to be well monitored and managed by a
, cooperative relationship between the City Manager's Office, the Human Resource and
0 # !� Finance Divisions and a voluntary Board representing all employees and bargaining
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units. Except for Police, all representatives actively participate. With over 20% of the net
cost of this Plan paid for by employee a roll deductions, employees have a strong
4 P Y' payroll e
,ii, incentive to participate in all efforts to keep the Plan costs under control and the benefits
4 • ,;. competitive.
6,143' Based on these HMA Financial Reports and past experience with your Plan, I offer the
following executive summary.
What is the Plan?
ot, The current City of Yakima Employees' Welfare Benefit Program (the "Plan ") became
3 k effective April 1, 1994 when the seven separate benefit programs covering each
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collectively bargained group of employees consolidated into one Plan Document. At that iilp time, a Board with representatives from all employee groups was formed and became
responsible for defining eligibility and covered benefits, monitoring monthly Plan
4�` financial reports, and making Plan recommendations to the City Manager. This Board
if meets every month and has been chaired by I.A.F.F. representative Dave Brush for
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several years. Employee and employer premium contribution levels are outside of this
Board's responsibilities and remain subject to the collective bargaining process.
3911 Castievale Road #109; Yakima, WA 98902 Phone: 509 - 575 -6497 / 877 -550 -0088 Fax: 509- 457 -3732 www.emsourcenw.com
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2008 Healthcare Plan Report
May 15, 2009
Page 2 •
In addition to meeting many of the statutory requirements for providing LEOFF 1
medical benefits, the purpose of this Plan is to attract and retain a productive workforce
by financing the collective health needs of City employees and their eligible dependents.
In recent years, the Plan has expanded its scope to include wellness services designed
to encourage healthy lifestyles. The Plan has been self - funded with stop -loss insurance
since the early 1980's.
Administration: What is a Self-Funded Health Plan?
The City of Yakima assumes the financial risk for providing covered healthcare and
dental benefits to eligible and participating employees and their dependents. Rather
than paying a monthly premium to an insurance company, a self- funded employer pays
claims out of general assets as they are incurred. The City - of Yakima retains
Healthcare Management Administrators (HMA) to manage the Plan and process
medical claims. Washington Dental Service, though an insurer, acts only as a third party
administrator for the City's dental claims. Both HMA and WDS are paid a flat monthly
fee per employee and assume no financial risk for claims. It is the City's money
combined with employee payroll contributions that pay for all Plan claims and expenses.
To fund very large claims, the City purchases stop -loss insurance. This type of
4
insurance reimburses only for catastrophic claims that exceed a certain amount. That
amount, called a stop -loss deductible, was renewed with Sun Life at $175,000 effective
January 1, 2009. Since this policy reimburses the City and not the plan participant, this
Urf-gt is not considered health insurance.
i
The City self -funds this Plan for several reasons. First, there are no prepayment
. requirements as claims are not paid with a monthly premium. The City also maintains
its own Plan reserves and keeps any investment income. In addition to having more
control over cash flow, the City has ultimate control over the Plan's benefits and can
negotiate more favorable administrative fees. For example, administrative and
consulting expenses for the Plan in 2008 were 5% of Plan costs; a comparable fully -
v insured employer can pay from two to three times as much in their premium for
administration and brokerage.
t
Actuaries commonly analyze three components of healthcare plans to project future
claims: census (who is covered), benefits (what is covered) and administration (how is it
funded). Of the three components, who is covered is by far the biggest factor in
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determining the cost of any healthcare plan.
Census: Who is on the Plan?
In 2008, the Plan covered an average of 908 City employees: 155 are LEOFF 1 active 40
„.*,.„.„ and retirees, 44 are non -LEOFF 1 retirees, and the remaining are active employees,
3911 Castlevale Road #109; Yakima, WA 98902 Phone: 509 - 575 -6497 / 877 - 550 -0088 Fax: 509 - 457 - 3732 www.emsourcenw.com
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2008 Healthcare Plan Report
May 15, 2009
110 Page 3
Council Members and self -pay COBRA participants. Counting all dependents, the Plan
covered a monthly average of 2,579 total participants last year — 59 more people than in
2007. Of the 908 employees, 679 are men and 229 are women.
The Plan has covered more than double the number of employees (active and retired)
over the age of sixty (209) than under the age of thirty (74) for the last decade. Just in
the past 15 months, 22 more employees joined the over age 60 category, while only 4
were added to the under the age 30. Soon we will have triple the number of those over
sixty than under thirty. As of today, the Plan covers 95 employees /retirees over the age
of 65. Unfortunately, advancing age and increasing medical care costs are directly
correlated. It continues to amaze me that this Plan can consistently keep costs at or
below its benchmarks while covering so many LEOFF 1 and over age 60 participants.
Benefits: What is covered under the Plan?
All terms, conditions and . benefits are detailed in the Plan Document (also called a
Summary Plan Description). This Document was rewritten effective January 1, 2008,
and has been copied in its entirety in a Health Care Plan booklet and distributed to all
$�t
0 employees and retirees by your Human Resources Division. The Plan Document was
written to facilitate compliance with the latest Department of Labor (DOL) rules, Health
' }* Insurance Portability and Accountability Act (HIPAA) amendments, and describe benefit
,P` { changes affecting office visit co- payrnents, preventive care, dental and vision coverage.
In general, the Plan pays for eligible expenses after the participant pays a $100 annual
r ' deductible per person, or $200 for their family. After the deductible, the Plan pays 80%
and the participant pays 20% of the bill for most .services: this is called "co- insurance."
After the participant has paid out -of- pocket $600 (or $1 200 for the famil
�- � � x y);' the Plan
pays 100% of eligible expenses up to a lifetime maximum of one million dollars per
€� Si." _ participant. Outpatient prescription drugs are covered after a $10 /g_ eneric,
covered artici ant. Out atient
r $20 /brand name or $40 /non - formulary co- payment for a one month supply. 90 da
��� Pp Y• day
PAPAP
�„ maintenance prescriptions • are available through a mail order program for 2x the
4W4 monthly co- payments. Dental, vision, chiropractic and most other major ma J categories ories of
5 , care are included. There is a free choice of providers, though the City's Plan includes
p� �'' "HMA Preferred / Regence Blue Shield" - a
9 preferred network of physicians and
- 4 A4 : hospitals that offers discounts and direct billing. This Regence preferred
provider
network currently offers the most favorable medical claim pricing available in the State
PAIN of Washington and is one of the primary reasons the City contracts with HMA of
R 4 Bellevue for health claims administration.
14v.`: Changes occurring January 1, 2009 include the adoption of a new wellness program
that incorporates a written health risk assessment and follow up, and the lapse of a
� 3911 Castlevale Road #109; Yakima, WA 98902 Phone: 509- 575 -6497 / 877 - 550 -0088 Fax: 509- 457 -3732 www.emsourcenw.com
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2008 Healthcare Plan Report
May 15, 2009
Page 4
preferred provider agreement for a specific provider of gastric bypass surgeries. No
schedule of benefit changes were made.
How much did the Plan cost in 2008?
City of Yakima
2008 Employee Health Care Plan
Medical Paid Claims
$5,993,563 Stop -Loss Reimbursement
62 % - $146,063
2%
l..4i
Stop -Loss Premium Dental Paid Claims
$400,059 l _- $702,918
0
4/o Administrative Fees Prescription Paid Claims Vision Paid Claims 8%
$425,387 $1,635,616 $133,192
5% 18% 1%
Total 2008 Plan Cost: $9,144,672
5/10/09 12 months experience 1/1/2008 through 12/31/2008
Total 2008 Plan cost, as shown on the pie chart above, was $9,144,672 verses
$8,512,184 in 2007. This 7.4% increase in 2008 is primarily due to the aging of the
covered group and an increase in the number of large catastrophic medical claims. Like
most employer plans, a disproportionate share of the Plan's money is spent on
individuals with the highest claims. $2,160,410 of the total cost above was incurred by
26 individuals. The attached Benefit Analysis Report for 2008 provides detail by
diagnostic category and shows where every dollar went.
The fully integrated disease management and wellness program implemented last year
are addressing this alarming trend. In my opinion, however, reversing this trend will
require much more — like substantial benefit reductions and a wellness program that
includes financial incentives to participate. In the meantime, the Plan includes advanced
case management, utilization review procedures and hospital bill audits — all the
programs you would expect to find in a modern health care plan (see the attached
Health Services Reporting for a summary of the effectiveness of these programs).
3911 Castlevale Road #109; Yakima, WA 98902 Phone: 509 - 575 -6497 / 877 - 550 -0088 Fax: 509 - 457 -3732 www.emsourcenw.com
2008 Healthcare Plan Report
May 15, 2009
Page 5
If we divide total annual plan costs by the number of employee participants (which
include retirees, LEOFF 1, and COBRA participants), and divide again by 12 months,
we get the Total Average Monthly Cost per Employee of $839.50 for 2008.
CITY OF YAKIMA
Health Care Plan
Total Average Monthly Cost Per Employee
2009 - First Quarter $784.00
2008 $839.50
2007 $797.92
2006 $689.45
2005 $728
2004 $670.
2003 $7
2002 $634.16
2001 $591.95
2000 $519.45
1999 $494.88'
1998 $430.00 U
1997 $408.24 [I
1996 $409.07
1995 $366.31 1
1994 $313.48
r —r
$0 $200 $400 $600 $800 $1,000
Through the first quarter of 2009, we have been fortunate to avoid any new catastrophic
claims and the average has dropped. Unfortunately, we have two new very large claims
currently in case management, and the return to an average trend increase in cost by
the end of 2009 is very likely.
Unless the age of the census gets substantially younger (from turnover and hiring), the
schedule of benefits changes dramatically, and /or the new integrated wellness and
disease management programs include near 100% participation, the steady increase in
Plan costs will continue for the foreseeable future.
Benchmarking: how do our costs compare to others?
While the City of Yakima has experienced the same cost pressures that all U.S.
employer- sponsored health plans have incurred since the inception of Medicare, the
3911 Castlevale Road #109; Yakima, WA 98902 Phone: 509 - 575 -6497 / 877 - 550 -0088 Fax: 509 - 457 -3732 www.emsourcenw.com
2008 Healthcare Plan Report
May 15, 2009
Page 6 0
Plan has absorbed an increase of 7% over the last 10 years. Over the same period,
national and regional surveys by Watson Wyatt and Hewitt Associates report average
increases anywhere from 7% to 11%, though all agree that increases have slowed
down into the 6% range as shown in the chart below.
Trey Ids in Medical Pre, N .if, , Increases
15% -
- - Average percentage increase in premiums
1. 12.3%
2% '
m 9.2%
9%
�_�,� 7.9%
art 5.3%
6% 6.0%
s ra
6.4%
ill
3%
. . -it
a
Aga O%
katl
. 2003 -2004 2004 -2005 2005 -2006 2006 -2007 2007 -2008 2008 -2009
WM
(projected)
F Source: ce: Her Associates. 2008
Copyright 2009 by SourceMeoia.
Our most relevant benchmark — the Association of Washington Cities — increased their
. fully- insured premiums 8.2% for their Regence Blue Shield Plan A and Plan B effective
` January 1, 2009. This follows an 11% increase the year before. The Washington
� Counties Insurance Pool (WCIP) has done substantially better than the Association of
Washington Cities in the recent past, with increases more in line with those of our Plan.
Like the City of Yakima plan, the WCIP is self - funded. Both the AWC and the WCIP
include LEOFF 1 and other retiree lans, and both are investing heavily p g in wellness
benefits, incentives and promotions.
g ,,. What changed in the last Plan renewal?
��, The 2009 Renewal was presented to the City Manager and Benefits Board on
November 20, 2008. The City's stop -loss deductible was renewed at $175,000 with Sun � .
3911 Castlevale Road #109; Yakima, WA 98902 Phone: 509 -575 -6497 / 877 -550 -0088 Fax: 509 - 457 -3732 www.emsourcenw.com
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2008 Healthcare Plan Report
May 15, 2009
III Page 7
Life with a 9% increase. Sun Life is one of the largest and highest -rated stop -loss
insurers in North America, and this policy includes a future renewal increase cap and a
"no- laser" agreement (a provision hidden in many contracts that allows the insurer to
exclude, or laser, a high cost individual upon renewal). Under competitive pressure from
other administrators interested in the City's business, HMA handed down a rate pass on
their administration fees.
What are we doing now to control future cost increases to the Plan?
Cost control recently implemented:
® Renegotiated Healthcare Management Administrators (HMA) contract
® Competitively bid and negotiated stop -loss renewal
o Competitively bid and negotiated pharmacy benefit . management contract with
CVS /Caremark
`: ` ® iBenefit report distribution to educate employees about their own prescriptions
Cost control measures approved for January 1, 2009:
Approved contract with American Health Holdings to provide integrated wellness
support, 24 -hour nurse line, online Health -e Outlook web services, health risk
, - , r appraisals , predictive modeling and advanced disease management.
• -
Maternity & Newborn wellness and support program for expectant mothers.
niaift
ti Cost control recommendations receiving on -going attention from the Benefits Board
o
,j ® Consideration for consumer- driven programs (HRAs and HSAs) as options to the
001: current plan.
e Adopting financial incentives to support full participation in the wellness and
14#1, � integrated disease management programs.
, o Increasing out -of- pocket maximums from the current $600 to at least $1,500
Increasing annual deductible from the current $100 to at least $250
{ o Adding a waiting period "of 30 to 60 days for new hire eligibility
".� Adding stronger benefit disincentives for using out -of- network providers
- -
® Negotiate new prescription network contract to include maintenance supply
service from local pharmacies.
A ® Carve -out transplant coverage and fully- insure risk for these potential claims
,.,. Conclusion
�. The business and social impacts of rising health care costs were as alarming in 2008 as
k ever before. Today national healthcare reform is no longer a discussion about "if" but
"when." Even the term "reform" is being replaced with "overhaul" by the Obama
Administration, and rightly so. And on top of it all, current economic conditions have
911 Castlevale Road #109; Yakima, WA 98902 Phone: 509 - 575 -6497 / 877 - 550 -0088 Fax: 509 - 457 -3732 www.emsourcenw.com
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2008 Healthcare Plan Report
May 15, 2009
Page 8
made well- managed, employer - sponsored health plans even more valuable for
employees. As jobs are lost and employers cut back on benefits and pass on more
costs, it's not much of a stretch to consider the City of Yakima's Health Plan a
community asset protecting those who serve the public interest. When healthcare
overhaul occurs, the City is as well positioned as any employer to adjust accordingly.
The Plan is well managed and reserves are adequate.
Compared with many health insurance plans offered by private employers, there is no
question the City of Yakima's Plan offers richer benefits. However, given the
parameters the City has for managing these benefits under collective bargaining, a
substantial LEOFF 1 liability and very low participant turnover, there are few employer -
sponsored programs that share the same risks as this Plan. Yet no matter what our
political and social beliefs are, waiting for healthcare reform to alleviate the financial and
administrative burden is not a viable option.
The mission of my firm and your Board and management team is to balance substantive
changes in the benefits while meeting the long -term needs of the people whose
t ' financial security depend on this Plan. We've squeezed all we can from the
administrative and insurance markets. The next steps have to include building a culture
of wellness and employee engagement with a continuation of performance
` ae t i
p •
E r measurements for all Plan functions.
6VAS As your consulting broker, I always keep in mind why the City has a• health plan and
what it means to those who are covered. My firm is committed to fostering the new
xF culture of wellness, but we need everyone's help. Bargaining units will have to buy into
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the long term benefits of wellness. Management will have to continue to seek ways to
• engage all employees and gauge success with measurable outcomes. We are all in this
together.
1 appreciate very much the opportunity to work for the City of Yakima and to present this
report to the Council. I look forward to any questions or instructions you may have.
1 Sincere)
*1,
an Fisher
} attachments
•
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CITY OF YAK
0 0 Financial Summary 1/1/ 1/08
T cS." '�r sf:".•. ':.:;i:Y ...C.,�. •i`r A'. 5•rw .� �3.: 1 .w: { -.�:w . «. ^.. ^t , 1 . .,. . , - , � . y:.,t. � 5 .�., :;' „ y , F,Ma,. e rr,, _. ., �,. 'd'' -1 r''''' . �: .4u�., :.+: : • a r.,..,p _r ` .,, ..rs, a.r.l ._. '.,.r ..e al Tru - 1 „Excess,', dmin 8 ,D ental . Vision Caremark r ,,. : t , tlrren ,�.: i : .a Tota l , =A r a te ; _ . M , :,; , ,, #Den # ..,- . . V # Tot a l : . Av Co A ,r.,.R" ft.4 KAX - �� ..,.,5n,r,.,. �_ >. �:.� `'��: w',.��s�s .g ,.<,r :�,; {,,,,.,�, . ,.�.y.. r � ,, . I ,..,r + . t . .? :,. � a � . r 4 sy z .. . , , ; h s 0 F • 4 r ,c ee °S - , =a tg aki g�A . d u , � I S -, _ % roily . "W, ? .:. « � 5 `_ ) ' Montccrual;, Premium�FPOiFees ,Pd,Claimsn,Pd;Clams y^ Pd�Claims s� �Pd; Clalmsa�� : ,.Balan c ei�m 5;��; Gostht _,� ;De , :�: , Sin Ie�Femil �� -Sin Ie = , � Tamil �' � �. 'Med.Em '�' Per Em �r !
Derr:', $739,968 $32,793 $33,470 $28,256 $17,566 $135,983 $290,914 $200,987 538,981 $922,788 373 516 263 477 889 $808.28
Feb +'; $744,825 $33,139 $35,777 $75,312 $12,212 $120,670 $311,430 $156,284 588,541 $931,330 374 525 255 478 899 $854.86
Mar $749,247 $33,255 $36,058 $71,467 $9,661 $130,182 $336,387 $132,237 617,010 $943,102 379 529 269 492 908 $679.53
Aprit? $754,633 $33,447 $36,376 $64,114 $12,530 $126,398 $423,131 558,637 695,996 $948,392 385 528 274 492 913 $762.32
Ma $749,303 $33,363 535,827 560,399 510,162 $122,415 5447,962 839,175 710,128 8944,981 380 530 268 493 910 8780.36
mo , , 512,770 5126,206 ,
$742,750 $32,920 $35721 $58813 512770 5126206 5573406
June ($97,087) 839,837 $943,686 382 527 268 490 909 $923.91
lul;i $745,202 $33,141 $35,761 $58,832 $11,930 $192,024 $405,015 $8,499 736,702 $938,981 381 524 263 487 905 $814.04
A u g `;
5753,446 533,457 536,236 $48,663 58,130 5116,078 5666,327 ($155,445) 908,891 8941,333 377 530 262 492 907 81,002.08
Septa $757,883 $33,756 $32,328 $50,655 $12,547 $125,461 $563,589 (560,453) 818,336 $948,036 381 532 265 498 913 $896.32
Oct3` $ 760,065 $33,917 $36,003 $67,568 $8,134 $125,385 $572,021
,,,,, - (582,963) 843,028 8948,857 378 536 266 496 914 8922.35
Nov 5755,744 $33,600 $36,044 $52,452 $8,908 $173,930 $464,802 ($13,992) 769,736 $951,793 385 532 270 493 917 $839.41
Dec;;; $754,627 $33,271 $35,786 $66,389 $8,642 $140,882 $938,580 ($468,923) 1,223,550 $943,449 386 523 268 488 909 $1,346.04
Total $9,007,693 $400,059 $425,387 $702,918 $133,192 $1,635,618 $5,993,563 ($283,043) $9,290,736 $11,306,706 4,561 6,332 3,191 5,876 10,893 $839.50
Avg Claims Per Emp Per Month - 2008 $77.52 $12.23 $150.15 $550.22 Last Year Average Total Cost $811.13
Avg Claims Per Emp Per Month - 2007 $76.79 $8.55 $153.48 $516.44 Percentage Change in Cost 3.50%
Percentage Change 0.96% 43.01% -2.17% 6.54%
Fund Coverage Effective 1/1/2008
Total paid claims all coverages $8,465,290 Balance
Less claims excess of $175,000 individual excess deductible $146,063 Aggregate Claim Factors Aggregate Deductible Analysis
Less Fix reimbursements Factors Include MIDN /Rx
Net total claims $8,319,227 ($136,980) Contract Basis: Paid Expected Claim Cost
Medical Composite $939.31 This plan year $830.38
Dental Composite $118.54 Projected Clm Cost Next Pln Yr
Reserves needed (15% of annual paid claims) $1,247,884 Average Claim Cos $763.72
Aggregate Premlums Claim Lag Adjust 1.00
Beginning claim reserves $768,345 Per Emp Per Month $3.42 Trend 1.15
Plan Change 1.00
Plan reserves and surplus to date $768,345 $176,000 lndiv Ex Loss Rates Exp Paid Claims $878.28
Contract Basis: Paid M/Rx
Single $17.00 25% Margin 1.26
Net total claims $8,319,227 Family $45.10 Aggr Claim Factor $1,097.85
Less claims not covered under aggregate excess loss policy $0
Net claims covered by aggregate excess loss $8,319,227 Accruals Current aggregate factor on a
Med/Den Employee $530.04 composite basis $1,037.98
Net Claims to Aggregate Deductible Loss Ratio 0.736 All Dependents $446.26 % change expecte( 5.8%
Average claims covered by aggregate per employee per month $763.72 Leoff
Average total claim cost per employee per month $763.72 Med. Employee $737.31 Carrler_,V s 3Sur► Life F:
Last year average total claim cost per employee per month $726.15 All Dependents $446.26 GroupB0101 ,-_
Percentage change in average cost per employee 5.17%
""Information on this Financial Summary Is for illustrative purposes only., Actual claims and enrollment figures covered by the Excess Loss contract may be different."'
CITY OF YAKIMA
Financial Summary 1/1/09 to 12/31/09
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Month 'Accrual- � PremwmPPO Fees�Pd,Claims,Pd Claims �P,d,Claims �=s�� ;, - �' ' � 9 � f Y 9 _.6�:... Y <.�.�. -...ate . P _ _
v4 _ _ _ + + •
Jiinl $784,680 $36,347 $39,620 $63,569 $10,862 $125,617 $413,828 594,837 689,843 $944,288 377 529 259 493 906 $761.42
Feb''
5792,319 536,507 $39,810 868,295 57,221 8120,753 $287,837 5231,896 560,423 5948,424 380 529 266 497 909 5618.53
M:.,..'k. s' $794,788 $36,581 $40,108 $56,163 $7,954 $143,544 $607,607 ($97,169) 891,957 $954,912 386 530 270 492 916 $973.75
e;
Mgik
Jun'
ep;
., :
Nov
Dec .
Total $2,371,787 $109,435 $119,538 $188,027 $28,037 $389,914 $1,309,272 $229,584 52,142,223 $2,847,625 1,143 1,588 795 1,482 2,731 $784.41
Avg Claims Per Emp Per Month - 2009 $82.58 $9.53 $142.77 $479.41 Last Year Average Total Cost $839.50
Avg Claims Per Emp Per Month - 2008 $77.52 $12.23 $150.15 $550.22 Percentage Change In Cost -6.56%
Percentage Change 6.52% - 22.05% - 4.91% - 12.87% •
Fund Coverage Effective 11112009 ,
Total paid claims all coverages $1,913,260 Balance
Less claims excess of 5175,000 Individual excess deductible Aggregate Claim Factors . Aggregate Deductible Analysis
Less Rx reimbursements Factors Include MIDNIRx
Net total claims 51,913,250 $229,564 Contract Basis: Paid Expected Claim Cost
Medical Composite $943.87 This plan year $834.16
Dental Composite $118.54 Projected Clm Cost Next Pin Yr
Reserves needed (15% of annual paid claims) $1,147,950 Average Claim Cos $700.57
Aggregate Premiums Claim Lag Adjust 1.00
Beginning claim reserves $768,345 Per Emp Per Month $3.42 Trend 1.15
Plan Change 1.00
Plan reserves and surplus to date . $768,345 $175,000 Indiv Ex Loss Rates Exp Paid Claims $805.65
Contract Basis: Paid MIRx
Single $18.70 25% Margin 1.25
Net total claims $1,913,250 Family 549.61 Aggr Claim Factor $1,007.07
Less daims not covered under aggregate excess loss policy $0
Net claims covered by aggregate excess loss $1,913,250 Accruals Current aggregate factor on a
Med /Den Employee $579.63 composite basis 51,042.70
Net Claims to Aggregate Deductible Loss Ratio 0.672 All Dependents $433.80 % change expectec -3.4%
Average claims covered by aggregate per employee per month $700.57 Leoff
Average total claim cost per employee per month $700.57 Med. Employee $784.47 Cairler:NIWABSiiiatlf0
Last y ge total claim cost per employee per month 5763.72 All Dependents $433.80 Group $' f = B0101.
Pe nge In average cost per employee -8.27% •
"'Information on this Financial Summary is for illustrative purposes only. Actual claims and enrollment figures covered by the Excess Loss contract may be different.""
HEALTHCARE MANAGEMENT ADM
Date: 03/17/2009 B e n e f i t A n a l.y s is Page: 1
Tuesday March 109 rbal
G BO101 CITY OF YAKIMA
Pe 01/2008- 12/2008
Mem, Total copay * - -- Deductibles - - -* C.O.B. Inel Total
Code Description Type Days Charge Amount Co -ins Benefit Savings Amount Paid
AAMB AIR AMBULANCE 200.00 23036.11 0.00 0.00 0.00 7136.14 461.00 14963.97
ACUP ACUPUNCTURE 56.00 3693.54 0.00 0.00 0.00 0.00 3693.54 0.00
ADJM ADJUST PREV MEDICAL CLAIM 1.00 1750.36- 0.00 0.00 0.00 0.00 1750.36- 0.00
ALLI ALLERGY INJECTIONS 1532.00 25477.04 0.00 934.06 0.00 393.81 4866.65 16739.10
ALLT ALLERGY TESTING 1309.00 13734.00 0.00 454.78 0.00 600.87 2838.93 8540.62
AMB AMBULANCE 1272.00 82802.30 0.00 '334.98 0.00 3016.99 32546.83 44593.67
ANES ANESTHESIA SERVICES 14944.00 254411.76 0.00 574.88 0.00 8238.79 94481.88 141688.86
ASST ASSISTANT SURGEON 75.00 124296.14 0.00 0.00 0.00 594.04 . 96047.55 27414.72
AUDR BILL AUDIT REVENUE 0.00 7949.72 0.00 0.00 0.00 0.00 0.00 7949.72
BIOF BIOFEEDBACK SERVICES 3.00 216.00 0.00 0.00 0.00 0.00 216.00 0.00
CHEM CHEMOTHERAPY 32.00 10597.80 0.00 0.00 0.00 1112.83 7061.32 2390.34
CHIR CHIROPRACTIC SERVICES 3387.00 166522.13 0.00 127,62.27 0.00 4463.16 54608.17 79356.86
CNR MEDICAL - INELIGIBLE SERVICES 312.00 84252.65 0.00 0.00 0.00 0.00 84252.65 0.00
COLO COLONOSCOPY 263.00 165717.16 1260.00 0.00 0.00 6651.96 92265.02 65540.18
CONS CONTRACEPTIVE MGMT SURGERY 6.00 978.88 0.00 0.00 0.00 0.00 978.88 0.00
D &A DRUG /ALCOHOL INPT R &B PREAUT 42.00 12814.00 0.00 85.00 0.00 1705.39 5152.41 5352.40
D &AO DRUG & ALCOHOL OUTPT 549.00 25152.03 0.00 100.00 0.00 104.59 11729.41 12064.20
DACC DENTAL SERVICES UNDER MEDICA 2.00 1390.00 0.00 0.00 0.00 0.00 0.00 1194.18
DADJ ADJUST TO A PREV DENTAL CLAI 2.00 1580.00 0.00 0.00 0.00 1230.00 0.00 350.00
DANE LOCAL /BLOCK /I.V. ANESTHESIA 6.00 1234.00 0.00 0.00 0.00 0.00 474.00 608.00
DBW BITEWING XRAYS 33.00 1608.75 0.00 0.00 0.00 274.34 710.36 624.05
DCDU DENTURES UPPER 2.00 2146.00 0.00 0.00 0.00 0.00 441.20 852.40
DCL DENTAL PROPHYLAXIS 43.00 3508.00 0.00 0.00 0.00 547.10 1306.84 1654.06
DCR DENTAL CROWNS 40.00 32188.00 0.00 0.00 0.00 657.00 13237.90 8818.05
DEN2 DENTAL TYPE II SERVICES 93.00 25875.97 0.00 0.00 0.00 1251.45 18953.18 4286.79
DEN3 TYPE III MAJOR SERVICES 21.00 4529.00 0.00 0.00 0.00 179.00 2497.04 836.98
DEP EMERGENCY /PALLIATIVE TREATME 10.00 789.00 0.00 0.00 0.00 107.80 417.19 189.65
DEX DENT EXAMS NO SPEC /NO CONSUL 58.00 2924.00 0.00 0.00 0.00 357.03 1191.38 1375.59
DFL FLUORIDE TREATMENT 32.00 888.00 0.00 0.00 0.00 75.50 353.56 458.94
DFM FULL MOUTH OR PANORAMIC XRAY 10.00 755.00 0.00 0.00 0.00 395.00 459.00 99.00 -
DIAB DIETARY /DIABETIC EDUCATION 204.00 2923.48 0.00 90.40 0.00 56.30 770.34 1775.17
DINL INELIGIBLE DENTAL SERVICES 16.00 342.00 0.00 0.00 0.00 0.00 342.00 0.00
DME DURABLE MEDICAL EQUIPMENT 1173.00 199793.81 0.00 1555.15 0.00 8828.09 92942.40 91636.27
DNG MOUTHGUARDS (NOT TMJ OR ORTH 3.00 350.00 0.00 0.00 0.00 0.00 350.00 0.00
DNO DENTAL NITROUS OXIDE 12.00 156.00 0.00 0.00 0.00 0.00 156.00 0.00
DOMS DOCTORS OFFICE MISCELLANEOUS 163.00 60097.16 0.00 101.12 0.00 1377 38617.93 7278.02
DORT ORTHODONTIA SERVICES 73.00 23256.00 0.00 0.00 0.00 232.40 18970.00 1910.60
DORX DOCTORS OFFICE PRESCRIPTION 605.00 3489.70 0.00 2.93 0.00 8.24.69 2433.46 224.17
DOSG DOCTORS OFFICE SURGERY 985.00 195437.26 0.00 7532.03 0.00 9679.27 74490.47 91045.02
DOSP DOCTORS OFFICE SUPPLY 176.00 13904.01 0.00 33.32 0.00 1826.48 6504.84 5293.21
DOV DOCTORS OFFICE VISIT 6541.00 754398.39 0.00 0.00 0.00 58803.31 163794.63 531800.45
DOV1 DOCTORS OFFICE VISIT 1954.00 218285.29 25575.00 124.51 0.00 7042.46 37301.32 148242.00
DOVP ROUTINE GYNECOLOGICAL EXAM 186.00 33654.10 2370.00 0.00 0.00 2093.31 9885.68 19305.11
DPAT DENTAL PATHOLOGY SERVICES 1.00 159.00 0.00 0.00 0.00 0.00 126.83 25.
DPEP PERIO PROPHY 20.00 2738.00 0.00 0.00 0.00 407.16 1103.00 . 900.84
DPER PERIODONTICS 1.00 79.00 0.00 0.00 . 0.00 0.00 0.00 63.20
DPQ PERIO SCALING /PLANING FM 9.00 1383.00 0.00 0.00 0.00 293.40 0.00 813.00
HEALTHCARE MANAGEMENT ADM
Date: 03/17/2009 B e n e f i t A n a l y s i s Page: 2
Tuesday March 17, 2009 rbal
Group: BO101 CITY OF YAKIMA
Period: 01/2008- 12/2008
Mem Total copay * - -- Deductibles - - -* C.O.B. Inel Total
Code Description Type Days Charge Amount Co -ins Benefit Savings Amount Paid
DPX PERIAPICAL XRAY 28.00 460.00 0.00 0.00 0.00 57.60 278.32 87.74
DRG HOSPITAL PPO DRG AMOUNT 15.00 18157.33 0.00 0.00 0.00 0.00 1755.35 16401.98
DRLU RELINING DENTURE UPPER 1.00 836:00 0.00 0.00 0.00 0.00 335.64 400.29
DRP REPAIR TO DENTURE /BRIDGE /CRO 1.00 . 90.00 0.00 0.00 0.00 0.00 0.00 72.00
DSL SEALANTS *NO AGE LIMIT* 11.00 405.00 0.00 0.00 0.00 0.00 176.44. 182.88
DXT DIAGNOSTIC TESTING 2321.00 427663.46 0.00 11011.14 0.00 23135.45 221132.89 153469.88
EMER EMERGENCY ROOM SERVICES 605.00 664565.77 11475.00 5223.34 0.00 29196.23 369111.73 221585.09
HEAR ROUTINE HEARING SERV INEL 20.00 680.50 0.00 0.00 0.00 0.00 680.50 0.00
HH NURSING VISITS IN HOME 31.00 6777.91 0.00 0.00. 0.00 0.00 3099.02 3678.89
HMAU BILL AUDIT SAVINGS 0.00 26259.76 0.00 0.00, 0.00 0.00 26259.76 0.00
HOME HOME HEALTH MISC SERVICES 14747.00 58542.59 0.00 831.18 0.00 3830.09 22520.69 28959.93
HRB HOSPITAL ROOM & BOARD PREAUT 711.00 533562.80 0.00 921.83 0.00 35208.27 66266.96 420238.50
ICU INTENSIVE CARE UNIT PREAUTH 126.00 211702.84 0.00 19.92 0.00'. 45745.79 21430.06 142377.25
IMX IMMUNIZATION SERVICES 1278.00 29759.89 0.00 0.00 0.00 440.40 4401.93 24997.08
INEL MEDICAL - INELIGIBLE SERVICES 2616.00 261280.81 0.00 0.00 0.00 0.00 261280.81 0.00
INFR INFERTILITY INELIGIBLE 5.00 615.88 0.00 . 0.00 0.00, 0.00 615.88 0.00
INFT INFUSION THERAPY 908.00 28803.94 0.00 0.00 0.00 0.00 15091.68 13340.05
INJT INJECTIONS 10605.00 163368.36 0.00 1170.54 0.00 2780.95 89925.63 66702.69
IPD1 INPATIENT DOCTORS VISIT 85.00 10058.15. 0.00 . 0.00 0.00 0.00 3209.54 6785.12
IPDV INPATIENT DOCTORS VISIT 667.00 107186.17 0.00 0.00 0.00 7762.36 36047.56 63376.25
IPMM MENT /NERV INPT MISC PREAUTH. 81.00 7174.33 0.00 131.00 0.00 2493.92 2755.44 1520.74
IPMN MENT /NERV INPT R &B PREAUTH 1.00 1236.00 0.00 0.00 0.00. 0.00 2.06 987.15
IPMS INPATIENT MISC PREAUTH 153.00 2999019.68 0.00 0.00 0.00 60823.23 1552251.60 1383706.61
IPNP INPATIENT MISC NO PREAUTH 36.00 156652.99 5190.29 0.00 0.00 20673.45 118198.51 12343.32
IPSG INPATIENT SURGERY 254.00 451714.63 0.00 286.32 0.00 9652.29 276996.31 156816.06
LAB LABORATORY 11135.00 450797.32 0.00 29649.47 0.00 14496.70 241424.94 145152.71
LCMS HMA LARGE CASE HOURLY MGMT 2.00 10899.09- 0.00 0.00 0.00 0.00 10899.09- 0.00
MAM ROUTINE MAMMOGRAMS AGE 0 -35 582.00 31963.07 0.00 19.24 0.00 456.28 9701.64 21695.29
MAMM ROUTINE MAMMOGRAM - 2ND CHAR 42.00 2336.03 0.00 3.19 0.00 94.02 818.86 1181.11
MASS MASSAGE THERAPY 174.00 6045.48 0.00 0.00 0.00 0.00 6045.48 0.00
MATD MATERNITY DEPENDENTS 689.00 47332.91 0.00 0.00 0.00 0.00 47332.91 0.00
MRCT MRI OR CT -SCAN 357.00 262240.74 0.00 2731.56 0.00 8293.82 132942.02 104891.72
MRX PRESCRIPTION INVOICES 0.00 1635529.93 0.00 0.00 0.00 0.00 0.00 1635529.93
NEUR NEURODEVELOPMENTAL THERAPY 163.00 . 12521.30 0.00 370.64 0.00 0.00 2892.98 8164.40
NIPM MENT /NERV INPT R &B NO- PREAUT 2.00 1725.16 0.00 0.00 0.00 1410.78 0.00 250.00
NOTC NOT COVERED 41.00 2343.13 0.00 0.00 0.00 0.00 2343.13 0.00
OBES OBESITY 262.00 196019.67 0.00 230.92 0.00 0.00 122660.04 72188.06
OONS OUT OF NETWORK SAVINGS 0.00 8247.62 0.00 0.00 0.00 0.00 31.32 8216.30
OPDV OUTPATIENT DOCTORS VISIT 620.00 175126.02 0.00 4105.96 0.00 7151.20 85959.05 68997.40
OPMN OUTPATIENT MENTAL & NERVOUS 1101.00 130706.04 0.00 4958.14 0.00 2799.99 .37178.84 67540.35
OPMS OUTPATIENT MISCELLANEOUS 8978.00 1566473.03 0.00 2986.19 0.00 83531.94 755920.94 697772.41
OPRH OUTPATIENT REHABILITATION 3852.00 190535.51 0.00 1991.64 0.00 13322.99 93756.76 73272.61
OPRM OUTPATIENT REHAB - MULT SVCS 2440.00 105333.26 0.00 971.20 0.00 8061.12 37005.91 54377.93
OPSG OUTPATIENT SURGERY 590.00 466890.47 0.00 1645.39 0.00 20011.56 278012.43 151546.68
PAP ROUTINE SMEAR LAB TEST 261.00 12957.78 0.00 19.40 0.00 363.95 4367.82 797
PAT PREADMI TESTING 9.00 826.29 0.00 3.95 0.00 45.25 607.04 1
PROS PROSTHE 31.00 13347.38 0.00 0.00 0.00 53.95 1518.31 112
HEALTHCARE MANAGEMENT ADM
Date: 03/17/2009 B e n e f i t A n a l y s i s . Page: 3
Tuesday March 1 09- rbal
G B0101 CITY OF YAKIMA
Pe 01/2008- 12/2008
Mem Total copay * - -- Deductibles - - -* C.O.B. Inel Total
Code Description Type Days Charge Amount Co -ins Benefit Savings Amount Paid
RADT RADIATION THERAPY 140.00 36953.00 0.00 0.00 0.00 0.00' 20394.53 16558.47
SACC SUPPLEMENTAL ACCIDENT 52.00 10011.14 0.00 0:00 0.00 0.00 3861.81 6149.33
SGCT SURGICAL FACILITY FEE PREAUT •322.00 407599.49 0.00 445.34 0.00 10033.07 247777.70 137959.88
SMOC SMOKING DETERRENT CLASSES 4.00 275.96 0.00 0.00 0.00. • 0.00 125.96 150.00
SMOK SMOKING CESSATION 25.00 2621.26 0.00 0.00 0.00 27.38 431.49 1731.26
SNF SKILLED NURSING FACILITY 214.00 88500.35 0.00 0.00 0.00 0.00 23647.45 64852.90
SUP MEDICAL SUPPLY 119.00 3533.99 0.00 239.62 0.00 317.68 1368.68 1460.43
TMJ MEDICAL TMJ SERVICES 12.00 912.98 0.00 0.00 0.00 0.00 912.98 0.00
TRAN TRANSPLANTS 41..00 3203.56 0.00 • 100.00 0.00 248.44 1394.78 1278.47
VEXM ROUTINE VISION EXAM 196.00 17337.89 0.00 . 0.00 0.00 78.46 14691.09 2568.34
VEXS VISION EXAM - 2ND CHARGE 45.00 1685.50 0 0.00 0.00 9.57 1562.37 ,113.56
VHDW VISION HARDWARE. 6.00 32987.96 0.00 0.00 0.00 345.20 22206.36 10436.40
VINL VISION- INELIGIBLE SERVICES 91.00 343.4. 0.00 • 0.00 0.00 0.00 3434.88 0.00
WELC PREVENTIVE WELLNESS - COPAY 560.00 75180.73 7935.00 0.00 0.00 1518.95 15692.29 50034.49
WELL ROUTINE /WELLNESS SERVICES 856.00 56027.70 0.00 0.00 0.00 2941.11 36557.16 16529.43
WELO ROUTINE /WELLNESS OFFICE VISI 35.00 6305.95 0.00 0.00 . 0.00 308.43 1470.15 4527.37
WORK WORKMANS COMPENSATION CLAIMS 24.00 1543.88 0.00 0.00 0.00 0.00 1543.88 0.00 •
XRAY X -RAY SERVICES 2777.00 556547.47 0.00 14439.64 0.00 25974.14 354170.13 145442.27
cobr not on file 0.00 • 0.00 0.00 0.00 0.00 0.00 . 0.00 3579.14
•
*Totals113 Benefit codes 108613.00 53805.29 0.00 6671969.76
15369400.35 109322.19 586654.71 7659606.55
•
•
•
Washington ngt+on Dental Service
Group Summary
Group Name: City of Yakima
Month: Dec 2008
Time Period: Jan, 2008 - Dec, 2008
Group Class: 1
Financial Summary by Relationship to Benefit Breakdown by Service
Subscriber Class
(Paid Time Period) (Net TimePeriod)
Time Period: Jan, 2008 - Dec, 2008 Time Period: Jan, 2008 - Dec, 2008
21.17 % 36.62
42.15 % 11 lk
° !e 35.32 0/0 i 3.18 To
43.51 /o
5.36
12.70
❑ Preventive /Diagnostic
® Basic Services
❑ Subscriber 0 Prosthodontics
❑ Spouse ❑ Orthodontics
O Dependant • Special Rest
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