From
Lisa Norris, Human Resources Director
Title
Insurance Fund Monthly/Quarterly Review
Presenter
Lisa Norris, Human Resources Director
Recommended Action
Review Only
Analysis
This analysis covers the experience in the Employee Insurance Fund through July 2017:
Employee Insurance Fund Summary (Attachment 1):
As we enter the home stretch to end this fiscal year, the insurance fund continues to bleed red, although July was only in the red by -$26.937. With ten months of the year under our belt, and using the highest claims averages, we project to end the year at $15.5 million in active claims (blue column, row 29) and $3.1 million in retiree claims. This moves our year-end operating imbalance projected at -$1,437,632. With only a couple months left in the fiscal year, recovery from our high claims experience over the past 10 months will be limited.
Over the past several months, we continue to work with United HealthCare on strategies in 2018 for out-of-network emergency room claims and are moving closer to plan language that better protects us. Currently they are looking at implementation of a "medicare plus" rate of 110% in 2018 for out-of-network emergency claims. This means that out-of-network emergency room bills will only be reimbursed by the city at 110% of what hospitals can get from Medicare for the treatment code submitted. If finalized, this will severly limit aggregious billing practices that have been gouging employers for the last several years under health care reform.
As submitted in the Budget Workshop, we have completely restructured plans and premiums in 2018 to hopefully improve consumerism of the plan benefits while still remaining market competitive and being able to afford ourselves.
UHC Slides
As of July, we still have 13 claimants that have exceeded $100,000 in claims paid so far this calendar year, and two which have exceeded $400,000-one is at $486K (the prior period high claimant) and the other is at...
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