Self-Funded Insurance Committee

CITY OF HENDERSON SELF-FUNDED INSURANCE COMMITTEE MEETING MINUTES Wednesday, November 16, 2022 I. CALL TO ORDER Chair Jim McIntosh called the City of Henderson Self-Funded Insurance Committee meeting to order at 1:10 p.m., in the Green Valley Training Room, City Hall 2nd Floor, 240 Water Street, Henderson, Nevada 89015. II. CONFIRMATION OF POSTING AND ROLL CALL Courtney Redsull, Employee Benefits Manager, confirmed the Self-Funded Insurance Committee meeting had been noticed in compliance with the Nevada Open Meeting Law. PRESENT: Chair Jim McIntosh Christopher Aguiar Bret Hyde Nick McLemore JJ Moyes Brooke Stream ABSENT: Gary Hargis (Excused) Daniel Pentkowski (Excused) ALTERNATES: Carol Banks Joann Carter Maria Gamboa Charles Hedrick Carlos McDade Michael Page Shawn Thibeault ABSENT: Michael Charlton (Excused) STAFF: Amy Adamson, Employee Benefits Specialist Bre Beaumier, Employee Benefits Coordinator Kristina Gilmore, Assistant City Attorney III (via videoconference; left at 2:46 p.m.) Courtney Redsull, Employee Benefits Manager Janet Sandifer, Deputy City Clerk Self-Funded Insurance Committee Meeting Page 2 of 10 Wednesday, November 16, 2022 – Minutes III. PUBLIC COMMENT There were no public comments presented. IV. ACCEPTANCE OF AGENDA (Motion) Member Christopher Aguiar introduced a motion to accept the agenda, as presented. The vote favoring approval was unanimous. Chair Jim McIntosh declared the motion carried. V. NEW BUSINESS 1 MINUTES SELF-FUNDED HEALTH INSURANCE COMMITTEE SEPTEMBER 21, 2022 FINANCE DEPARTMENT Self-Funded Health Insurance Committee minutes of September 21, 2022. (Motion) Member Christopher Aguiar introduced a motion to adopt the Self-Funded Health Insurance Committee minutes of September 21, 2022, as presented. The vote favoring approval was unanimous. Chair Jim McIntosh declared the motion carried. 2 MONTHLY FINANCIAL REPORT FINANCE DEPARTMENT City of Henderson Self-Funded Health Plan monthly financial report for September 2022. Maria Gamboa, Director of Finance, reviewed and summarized the following financial reports: Self-Funded Health Insurance Fund (Fund 6051) as of September 2022 Cash Basis - Unaudited, Retiree Insurance Subsidy, and Stop Loss Restricted Cash, as of September 30, 2022. For the benefit of the new Committee members, Courtney Redsull, Employee Benefits Manager, stated Stop Loss is insurance coverage for self-funded insurance plans. She stated because the renewal is due, Stop Loss will be discussed later in the meeting. Self-Funded Insurance Committee Meeting Page 3 of 10 Wednesday, November 16, 2022 – Minutes Ms. Redsull said the Stop Loss deductible was $225,000.00; however, in 2017, the Committee voted to increase the deductible to $525,000.00, which generates premium savings that goes into the Stop Loss Restricted Cash Account. She said those funds are used to pay claims that are over $225,000.00 and up to the current Stop Loss deductible of $525,000.00. She said once a claimant reaches $525,000.00, the Stop Loss carrier will start to issue reimbursements for those claims at that point. 3 HEALTHSCOPE QUARTERLY REPORT - 3RD QUARTER PLAN YEAR 2022 FINANCE DEPARTMENT HealthSCOPE quarterly report for 2nd Quarter Plan Year 2022. Courtney Redsull, Employee Benefits Manager, stated this agenda states HealthSCOPE; however, the plan is transitioning to UMR, Inc., as a third-party administrator, effective January 1, 2023. Russell Garrett, UMR, Inc., presented a summary of this item and highlighted the following information:  Financial Summary  Utilization Summary  Cost Distribution by Claim Type  High-Cost Claimants (HCCs)  In Network Discounts  Diagnosis Grouper Summary  Top 3 Diagnoses Grouper Top Diagnoses  Inpatient Summary  Emergency Room / Urgent Care Summary  Emergency Room / Urgent Care by Provided  Dental Claims Summary  Quality Metrics Responding to an inquiry from Ms. Redsull regarding whether Nevada-based members are utilizing United Healthcare Choice Plus providers for inpatient care, Mr. Garrett stated he could provide a report containing that information. Kelly Hall, Sierra Healthcare Options, continued to present a summary of this item and highlighted the following information:  Utilization Management Dashboard Self-Funded Insurance Committee Meeting Page 4 of 10 Wednesday, November 16, 2022 – Minutes A discussion ensued regarding the case management for inpatient care related to behavioral health and the inpatient bed days cost savings. 4 GALLAGHER BENEFIT SERVICES QUARTERLY CLAIMS REPORT 3RD QUARTER PLAN YEAR 2022 FINANCE DEPARTMENT Gallagher Benefit Services Quarterly Claims Report for 3rd Quarter Plan Year 2022. Shawn Adkins, Gallagher Benefit Services, presented a summary of this item and highlighted the following slides:  GBS Estimated Accrual Plan Status Report – All Benefits  GBS Estimated Accrual Medical Plan Status Report (Active vs. Retiree)  Monthly Claims Summary – Medical and Rx  Large Claim Summary  Large Claim Analysis  Self-Funded Medical and Rx  Medical & Rx Paid Claims  Medical Claim Report – Dental (SHO Network)  Dental Claims paid (SHO Network) At the request of Courtney Redsull, Employee Benefits Manager, Mr. Adkins explained prescription benefits to the newer Committee members that may not be familiar with the various plan discount options that are available. Mr. Adkins did not review the Delta Dental reports, which he said have remained consistent. Self-Funded Insurance Committee Meeting Page 5 of 10 Wednesday, November 16, 2022 – Minutes 5 STOP LOSS COVERAGE FOR PLAN YEAR 2023 FINANCE DEPARTMENT Review the Stop Loss Insurance renewal options for Plan Year 2023 from Berkshire Hathaway Specialty Insurance (BHSI). Renewal options also detailed in the attached renewal proposal and renewal analysis. Select one option for recommendation to City Council for approval. Current Deductible – $525,000.00 Estimated current annual premium: $547,509.00 Option #1 – Insure at Current Individual Deductible of $525,000.00 Single Rate: $11.77 per employee per month Family Rate: $46.07 per employee per month Estimated total annual premium: $650,311.00 Increase of 18.78% over current year premium Option #2 – Insure at Individual Deductible of $550,000.00 Single Rate: $10.84 per employee per month Family Rate: $42.93 Estimated total annual premium: $605,062.00 Increase of 10.51% over current year premium Option #3 – Insure at Individual Deductible of $575,000.00 Single Rate: $10.23 Family Rate: $41.01 Estimated total annual premium: $577,094.00 Increase of 5.40% over current year premium Option #4 – Insure at Individual Deductible of $600,000.00 Single Rate: $9.50 Family Rate: $38.59 Estimated total annual premium: $542,124.00 Decrease of 0.98% over current year premium Shawn Adkins, Gallagher Benefit Services, presented a summary of this item by reviewing the Plan Year 2023 Stop Loss Renewal Analysis. Mr. Adkins stated Gallagher Benefits Services recommends continuing with Berkshire Hathaway Specialty Insurance (BHSI) and reviewed Options 1 through 4. A lengthy discussion ensued regarding the benefits and drawbacks of the various options. Self-Funded Insurance Committee Meeting Page 6 of 10 Wednesday, November 16, 2022 – Minutes (Motion) Member Nick McLemore introduced a motion to renew the Stop Loss Insurance renewal option for Plan Year 2023 from Berkshire Hathaway Specialty Insurance (BHSI) with the following option: Option #1 – Insure at Current Individual Deductible of $525,000.00 Single Rate: $11.77 per employee per month Family Rate: $46.07 per employee per month Estimated total annual premium: $650,311.00 Increase of 18.78% over current year premium The vote favoring approval was unanimous. Chair Jim McIntosh declared the motion carried. 6 CONSIDERATION OF PLAN DESIGN CHANGE TO REMOVE THE ANNUAL BENEFIT LIMIT ON TREATMENT FOR AUTISM FINANCE DEPARTMENT Currently, the self-funded health plan complies with NRS 689A.0435, which includes a $72,000.00 annual benefit limit for applied behavior analysis treatment, which is inconsistent with the spirit of the Affordable Care Act. Consider plan design change by removing the $72,000.00 annual benefit limit for treatment of Autism to allow for consistency with the spirit of the Affordable Care Act. Courtney Redsull, Employee Benefits Manager, presented a summary of this item. She said the self-funded health plan complies with NRS 689A.0435; however, staff would like to consider a different direction to align with the spirit of the Affordable Care Act, which precludes health plans from setting annual or lifetime limits on essential health benefits. She said the $72,000.00 annual benefit is tied to applied behavioral analysis therapy, which she said is the primary therapy for the treatment of Autism. She said staff recommends the removal of the $72,000.00 annual limit and imposing no limit for the treatment of Autism. Ms. Redsull also said the estimated cost is currently between $50,000.00 and $75,000.00 annually and stated that figure is based on the number of members that are receiving treatment for Autism at this time; however, that cost could potentially increase if more children receive a frequent level of treatment on the plan. Following the inquiry from Member Shawn Thibeault regarding whether there is a need for an increase at this time, Ms. Redsull said there is at least one current plan member that will hit the $72,000.00 annual limit this plan year and two members reached the cap last plan year. Self-Funded Insurance Committee Meeting Page 7 of 10 Wednesday, November 16, 2022 – Minutes (Motion) Member Christopher Aguiar introduced a motion to approve a plan design change to remove the annual benefit limit for the treatment of Autism to make the treatment of Autism more consistent with the Affordable Care Act, effective retroactively, on January 1, 2022. The vote favoring approval was unanimous. Chair Jim McIntosh declared the motion carried. 7 CONSIDERATION OF CITY REQUEST FOR PLAN DESIGN CHANGE TO ENHANCE NON-NETWORK OUT-PATIENT MENTAL HEALTH AND SUBSTANCE ABUSE TREATMENT BENEFIT FINANCE DEPARTMENT Committee discussion and consideration of a City request for self-funded health plan design change to waive non-network deductible and standard 50 percent co-insurance level on any professional mental health and substance abuse office visits. This plan design changes would include implementing a non- network benefit for these services not to exceed $150.00 per office visit, and carries an estimated cost to the self-funded health plan of $130,000.00 annually. Members may be subject to balance billing by their provider for billed charges that exceed the $150.00 limitation paid by the plan. Up to $150,000.00 in funding for this plan design change would be provided by the City from its budget each year. The committee may consider and elect any of the following options related to the plan design change request.  Approve plan design change request to waive non-network deductible and standard 50 percent co-insurance level on professional mental health and substance abuse office visits and implement a non-network benefit for these services not to exceed $150.00 per office visit paid by the plan, and direct staff to implement this plan design change effective 01/01/2023 and facilitate applicable changes to the Summary Plan Description.  Approve a modified version of this plan design change request as determined by the Committee, and direct staff to implement this plan design change effective 01/01/2023, or an effective date determined by the Committee, and facilitate applicable changes to the Summary Plan Description.  Deny this plan design change request. Courtney Redsull, Employee Benefits Manager, presented a detailed summary of this item. She said this item is before the Committee because City leadership has requested a way to create greater access to care for the plan members that have expressed difficulties when attempting to obtain access to in-network mental health providers. Self-Funded Insurance Committee Meeting Page 8 of 10 Wednesday, November 16, 2022 – Minutes She said the most viable option that would help the members would be to approve a plan design change request for the non-network mental health and substance abuse office visit benefit and to make the benefit more robust to create greater ability for individuals to seek treatment with non-network providers. Ms. Redsull said if the Committee were to vote to implement the design change request, staff recommends implementing it on a pilot basis for one year and communicating it as such since the true costs are currently unknown. She said by doing so, unrealistic expectations should not be created and the option to revert to the original plan design, make adjustments, or make the change permanent, would be available after one year from the implementation of the benefit once the true costs have been analyzed. A lengthy discussion ensued regarding the types of services and office visits this plan design change would apply to and how the change would affect any plan members that are on the high deductible health plan. Ms. Redsull stated, if approved, details related to this design change will be communicated to the members immediately to help them understand how to utilize this plan benefit. (Motion) Member Bret Hyde introduced a motion to approve a plan design change request to waive the non-network deductible and standard 50 percent co-insurance level on non-network professional mental health and substance abuse office visits, implement a non-network benefit for these services not to exceed $150.00 per office visit paid by the plan, and directed staff to implement this plan design change effective 01/01/2023 and facilitate applicable changes to the Summary Plan Description on a pilot basis to be reevaluated in one year. The vote favoring approval was unanimous. Chair Jim McIntosh declared the motion carried. 8 SELF-FUNDED HEALTH INSURANCE COMMITTEE CHAIRMAN FINANCE DEPARTMENT Take nominations and elect the Committee chairman for calendar year 2023. Courtney Redsull, Employee Benefits Manager, presented a summary of this item, stated each year the Committee’s Chair and Vice Chair roles alternate between management and union members, and opened the floor for union Chair nominations. Because Member Pentkowski was excused from the meeting, Ms. Redsull stated she spoke to him prior to the meeting, and he advised he would accept the Office of Chair, if nominated. Self-Funded Insurance Committee Meeting Page 9 of 10 Wednesday, November 16, 2022 – Minutes (Motion) Member Christopher Aguiar introduced a motion to elect Member Daniel Pentkowski for the Office of Chair of the Self-Funded Insurance Committee for calendar year 2023. The vote favoring approval was unanimous. Chair Jim McIntosh declared the motion carried. 9 SELF-FUNDED HEALTH INSURANCE COMMITTEE VICE CHAIRMAN FINANCE DEPARTMENT Take nominations and elect the Committee vice chairman for calendar year 2023. Courtney Redsull, Employee Benefits Manager, opened the floor for management Vice Chair nominations. (Motion) Member JJ Moyes introduced a motion to elect Member Brooke Stream for the Office of Vice Chair of the Self-Funded Insurance Committee for calendar year 2023. The vote favoring approval was unanimous. Chair Jim McIntosh declared the motion carried. 10 CONSUMER DRIVEN HEALTH PLAN COMPLIANCE REQUIREMENTS FINANCE DEPARTMENT Discuss IRS guidelines for Calendar Year 2023 that require the self-funded health plan to increase the individual out-of-pocket maximum and the family deductible from $2,875.00 to $3,000.00. Courtney Redsull, Employee Benefits Manager, presented a summary of this item. VI. CHAIRMAN\MEMBER COMMENTS Courtney Redsull, Employee Benefits Manager, stated today is, most likely, Chair Jim McIntosh’s last meeting due to his new role as the Assistant City Manager. She said Member Maria Gamboa will take his role as the management representative and Rebecca Gillis, Accounting Manager, will become Member Gamboa’s alternate. Ms. Redsull thanked Chair McIntosh for his time and service on the Committee. Self-Funded Insurance Committee Meeting Page 10 of 10 Wednesday, November 16, 2022 – Minutes VII. SET NEXT MEETING Courtney Redsull, Employee Benefits Manager, stated the meeting for December will be canceled; therefore, the next meeting date was set for January 18, 2023, at 1:00 p.m. She also stated the meeting in February is tentatively scheduled as the annual strategic meeting, which will last a full day and said lunch will be provided. VIII. PUBLIC COMMENT There were no public comments presented. IX. ADJOURNMENT There being no further business to discuss, Chair McIntosh adjourned the meeting at 2:51 p.m. Respectfully Submitted, /s/ Janet Sandifer Janet Sandifer, Deputy City Clerk