HomeMy WebLinkAbout1996-07-31ADJOURNED TENTATIVE
11:45 A.M.
~ULY 29, 1996
ROOM 241, COUNTY OFFICE BUILDING
1)
~)
Call to Order.
Adjourn to July 31, 1996, 5:00 p.m., for Joint Meeting with School Board.
5:00 P.M.
JULY 31, 1996
ROOM 235, COUNTY OFFICE BUILDING
1)
2)
3)
4)
5)
Call to Order.
Executive Session: Legal Matters.
Certify Executive Session.
Joint Meeting with School Board.
A) Discussion: Health Care Proposals.
B) Other Matters not Listed on the Agenda.
Adjourn.
TO:
FROM:
DATE:
RE:
COUNTY OF ALBEMARLE
Office of Board of Supervisors
401 Mclnfire Road
Charlottesville, Virginia 22902-4596
(804~ 296-5843 FAX (804) 296-5800
Robert W. Tucker, Jr., County Executive
Ella W. Carey, Clerk, CMC
August 1, 1996
Board Actions of July 31, 1996
Joint Meeting with the School Board
Charles $. Martin
Walter F. Perkivs
Sally H. Thoma.~
At its joint meeting with the School Board on July 31, 1996, the Board of Supervisors
took the following actions:
Agenda Item No. 1. Call to Order. The meeting was called to order at 5:02 p.m., by the
Chairman of the Board of Supervisors, and by the Chairman of the School Board.
Agendaltem No. 2. Executive Session: Pending Litigation and Legal Matters concerning
Insurance. At 5:03 p.m. motion was offered by Mr. Bowerman that the Board adjourn into
executive session pursuant to Section 2.1-344(A) of the Code of Virginia under subsection (7) to
consult with legal counsel and staff concerning pending litigation and legal matters concerning
insurance. The motion was seconded by Mr. Marshall. The same motion was offered, by the
School Board.
Agenda Item No. 3. CeWffy Executive Session: The Board reconvened into open session
at 6:28 p.m. Motion was made by Mr. Bowerman to certify by a recorded vote that to the best of
each Board member's knowledge only public business matters lawfully exempted from the open
meeting requirements of the Virgin/a Freedom of Information act and identified in the motion
authorizing the executive session were heard, discussed or considered in the executive session.
The motion was seconded by Mrs. Thomas. The same motion was offered by the School Board.
Printed on recpcled paper
Memo To: Robert W. Tucker, Jr.
Date: August 1, 1996
Page: 2
Motion was offered by Mr. Marshall to select QualChoiee of VirginiaJBlue Ridge Health
Alliance, Inc. to provide medical care for the plan year 10/1/96-9/30/96 and Delta Dental as the
dental carder, with rates as shown on the attached. (Appendixes 3 and 4) The motion was
seconded by Mr. Bowerman. The School Board adopted the same motion.
Agenda Item No. 4. Other Matters Not Listed on the Agenda. There were none.
Agenda Item No. 5. Adjottm. At 7:05 p.m., the meet'rog was adjourned.
EWC/abw
Attachments (3)
cc: Melvin Breeden
Kevin Castner
Richard E. Huff, II
Roxarme White
Appendix 3
Page 1 of 2
ALBEMARLE COUNTY 1996-1997 MEDICAL INSURANCE PLANS
RECOMMENDED PLANS AND PREMIUMS
The Executive Committee is recommending.three medical plans be offered for 1996-1997, The recommended
insurance carder is QualChoiee of Virginia/Blue Ridge Health Alliance Inc. The three plans are QualChoice 1I,
QualChoice III and QualChoice Triple Option. Active and Retiree total monthly premiums are the same.
Premiums remalnthe same as 1995-1996. The following table reflects the recommended total monthly premium
for active employees and retirees~ The premium includes the employer, and the employee combined ex)st of
medical care coverage.
KC II QC ii KC III QC Iti POS Triple Opt.
TOTAL PREMIUM Current Projected Current Projected Current Projected
Premium. Prem/um Premium Premium Premium Premium
EMPLOYEE
Employee $196 $196 $161 $161 $145 $145
Employee + minor $260 $260 $197 $197 $160 $160
Employee + spouse $440 $440 $332 $332 $248 $248
Employee + family $495 $495 $374 $374 $280 $280
Page 10
Appendix 3
Page 2 of 2
ALBEMARLE COUNTY 1996-1997 MEDICAL INSURANCE PLANS
RECOMMENDED PLANS AND EMPLOYEE PREMIUMS
The following table reflects the recommended out-of-pecker premium each full-time active employee will pay
based on the Board's contribution of $145.00 per month which is 90% of the QualChoice III and 100% Triple
Option Employee total premium. Retirees pay the full premium.
KC H QC H KC HI QC IH POS Triple Opt.
EMPLOYEE Current Projected Current Projected Current Projected
PREMIUM Premim Premium Premium Premium Premium Premium
ACTIVE EMPLOYEE
Employee $51 $51 $16 $16 0 0
Employee+minor $115 $115 $52 $52 $15 $15
Employee+spouse $295 $295 $187 $187 I $103 $103
Employee+family $350 $350 $229 $229 $135 $135
RETIREES
Employee $196 $196 $161 $161 $145 $150
Employee+minor $260 $260 $197 $197 I $160 $160
Employee + spouse $440 $440 $332 $332 $248 $248
Employee + family $495 $495 $374 $374 $280 $280
Page 11
ALBEMARLE COUNTY 1996-1997 DENTAL INSURANCE PLAN
RECOMMENDED PLAN AND PREMIUMS
Appendix 4
Recommend continue w/th our current Delta Dental Basic Services plan.
Delta Dental's plan is a fully insured program.
The Board contribution for FY 1996-1997 continues at the current level of $60.00 per year.
There is no change in prern~umg as 1996-1997 will be the second year ora two year rate guarantee negotiated
last year.
EMPLOYEE PREMIUM Current Proposed
Employee $5.91 $5.91
Employee + one $1;3.52 $13.52
Employee + 2 or more $28.64 $28.64
Page 12
dULY .31, 1996
EXECUTIVE SESSION MOTION
I MOVE THAT THE BOARD 'GO INTO EXECUTIVE SESSION
PURSUANT TO SECTION 2. I -344(A) Oi: THE CODe OF VIRGINIA
UNDER SUBSECTION (7) TO CONSULT WITH LEGAL COUNSEL AND
STAFF CONCERNING PENDINE~ LITIGATION AND LEGAL MA~FFERS
CONCERNING INSURANCE.
MOTION TO CERTIFY EXECUTIVE SESSION
I MOVE THAT THE BOARD CERTIFY BY A F~ECORDED VOTE
THAT TO THE BEST OF EACH BOARD MEMBER'S KNOWLEDGE ONLY
PUBLIC BUSINESS MAI iERS LAWFULLY EXEMPTED FROM THE
OPEN MEETING rEE)UIREMENTS OF THE VIRGINIA FREEDOM OF
INFORMATION ACT AND IDENTIFIED IN THE MOTION AUTHORIZING
THE EXECUTIVE SESSION WERE HEARD, DISCUSSED OR
CONSIDERED IN THE EXECUTIVE SESSION.
To:
Date:
COUNTY OF ALBEMARLE
Office ot County Executive
401 Mclntire Road
Charlottes_ville, Virginia 22902-4596
(8041 296-5841 FAX (804) 972-4060
MEMORANDUM
Robert W. Tucker, Jr., County Executive
Kevin C. Castner, Superintendent
Medical and Dental Plan Review Committee
1996-1997 Medical and Dental Care Programs
July 26, 1996
The County's Health Care Review Committee has completed a review of our medical and dental plans for 1996-
1997. Part of this review process included seeking negotiated bids for these services from insurance carriers.
Medical insurance is one of the two major benefits funded by the Boards and also is very important to employees
and their families. The focus of our review has been to strive to offer employees medical and dental plans that
provide quality health care, management and administration ina cost effective manner. This memorandum
outlines the current status of our medical and dental plans and also provides a synopsis of the results of our
negotiated RFP process for 1996-1997.
Background: Last year the County requested proposals from carriers for medical and dental plans. The
competitive market resulted in savings kn our fixed costs as well as a change in our benefit design for the medical
plan.
MedicalPlan: Tfigon BC/BS continued as our medical plan provider but there was a major change in our
plan design. We retained a 3-tier medical plan but replaced the Comprehensive 500 plan with a managed
care plan called Point-Of-Service~ The premium structure resulted in a s~gnificant reduction in premiums
for most of the medical options. Approximately 50% of our employees enrolled in the Trigon Point-Of-
Service (POS) plan during the open enrollmant last September. We are now nine (9~ months into our current
plan-year and the 'year-to-date' financial information indicates the KeyCare II&III (PPO -Preferred Provider
Organization plans) claims exceed premiums while claims expenses for the POS are below premium
revenue. Overall, the current plan-year is projected to have a surplus of about $100,000, however, we
usually incur a large number of claims during the summer months and thus the plan may not sustain this
level of projected surplus.
Dental]lan: Delta Dental was retained as oar provider for dental servmes under a fully insured plan with
a two-year rate guarantee.
Negotiated RFP Process For 1996-1997 Plan Year: This spring we solicited Request For Proposals (RFP)
for our 1996-1997 metrical and dental plans. The initial proposals were rejected and a second RFP was initiated
which delayed the process by seven (7 ~ weeks. We received 5 dental proposals and 4 medical proposals. An
analysis of the proposals by the committee was completed with assistance from our consultants. This analysis
Page l
resulted in the comminee recemmmdstion to continue our current dental plan/carrier as the RFP mspouses were
notas competitive. The committee's analysis further resulted in the selection o£two medical plan proposals for
further negotiation.
Financial Status of the Medical Ham The committee strongly recommends continuing with a minimum reserve
of 20°A of projected claims. Based ~xa projected claims cost for 1996-1997 the 20% reserve should be a miniroum
$750,000. During the previous two years the medical plan closed with a surplus. Last November the Boards
approved a refund o£two months pronxium~ to employees l~om the reserves and furlher agreed to fund a wellness
screening from the medical reserves. The medical reserves are currently $1,765,355, of which $260,580 were to
be available for the wellness program. Our current rates were projected to fund this year's plan and create an
additional reserve for wellness initiatives. Nine (9) months into the plan year we are projcoting to end the year
with a $100,000 surplus. Appendix I reflects the current financial status of the medical reserve account.
HealthCare Review Committee Recommendations for the Medical Plan:
1. Reserve: Continue to maintain a minimum reserve of 20% of claims (i.e. $750,000)
2. Number Of Plan(s): Retain a 3-tier medical plan with no major reductions in benefits.
3. Retirees: Continue to set retiree premiums at the same rate as the active employee. Continue to monitor
retire~ claims costs for any adverse impacts.
4. Carrier: Select QualChoice of Virginia/BLne Ridge Health Alliance Inc. as the insurance carrier. ( See
Appendix 2 for a summary of the evaluation of the request for proposals.
5. Rates: QualChoiee's proposal projects claims near current levels and therefore the committee recommends
retaining premiums at current levels as shown in Appandix 3. The Board contribution is based un 90% of the
QuaIChoicel]I single subsctiber rate. The Board contfibution was budgeted at $2,000 £or FY 1996-1997. Based
on the proposed rates the Board contribution would only be $1,860 per full-time subscriber.
6. Fending: Retain a self-insured plan but purchase a 110% Aggregate Cap.
7. 'Specific' Stop Loss: Retain the 'Specific' Stop Loss at $I00,000.
HealthCare Review Committee Recommendations for the Dental Plan:
1. Funding: Retain a fully insured plan
2. Carrier.' Retain Delta Dental as the insurance carrier
3. Rates: Since Delta Dental's two-year rate guaranteed negotiated last year was more competitive than any new
proposal, the recommendation is to exercise that two-year rate guarantee. Fund the plan at the rates shown in
Appendix 4.
4. Plan: Continue the benefits offered under their Basic Services.
In summary, the committee recommends the selection of QualChoice of Virginia/Blue. Ridge Health Alliance Inc.
as the provider of medical insurance and Delta Dental as the provider of dental insurance. The proposed rates
are shown in Appendix 3 and 4.
Attachments
Appendix 1
Appendix 2
Appendix 3
Appendix 4
Financial Status of the Medical Plan
Summmy Of The Evaluation Of The Request For Proposals
Proposed 1996-1997 Medical Plan Premiums
Proposed 1996-1997 Dental Plan Premiums
Page 2
Appendix 1
ALBEMARLE COUNTY 1996-1997 MEDICAL INSURANCE PLANs
FINANCIAL STATUS
BUDGETED BOARD CONTRIBUTION: The Budgeted contribution for FY 1996-1997 was based on
funding 90% of the QualChoico III Employen subscriber rate.
Budgeted Revised
Two Months ~ $145/month $290
Ten Months ~ $171/month $1,710
Twelve Months ~ $155/month* __ $1,860
Total Board Contribution: $2,000 $1,860
*($145 for medical premium and $10 for wellness)
Assuming no change in total enrollment, the projected savings fi'om this reduction in thc Board contribution
for FY 1996-1997 is:
General Government $40,044
School Division $137,034 **
** In the past School Division savings have been a part of the lapse factor.
FINANCIAL STATU$ OF THE MEDICAL RESERVE ACCOUNT:
Balance at end of plan year (September 30, 1994)
Balance at end of plan year (September 30, 1995)
(After rebates for premiums)
Current Balance (As of May 30, 1996)
Projected Surplus from Cmrent Year
Projected Balance September 30, 1996
($260,580 earmarked for wellness)
$915,873
$1,713,086
$1,765,355
$100,000
$1,865,355
Page 3
Appendix 2
Page 1 of 6
ALBEMARLE COUNTY 1996-1997 MEDICAL PLAN
EVALUATION OF PROPOSALS
The following people participated on the Review Committee:
Executive Committee Richard Huff, Deputy County Executive
Melvin Breeden, County Finance Director
Frank Morgan, Assistant Superintendent County Schools
Jackson Zimmermann, School Fiscal Services Director
A1 Tumminia, Superintendent Jo'mt Security Complex
Bernard Snyder, CATEC Asst. Director
William Brent, Service Authority Director
Robert Brandenburger, Deputy Director of Human Resources
Other Participants: Edward Koonce, County Chief of Financial Management
Mark Trank, Deputy County Attorney
Ellen Steele, Human Resources Specialist (County/Schools)
Corporate Benefits Consultants
Proposals: Request For Proposals (RFP) were solicited on March 22, 1996. All replies were rejected and
another RFP was solicited on May 28,1996. We received responses from the following:
Duke Benefits
MAMSI (considered non-responsive)
QualChoice
Trigon Blue Cross Blue Shield
Format: Upon review of all proposals QualChoice and Trigon were selected for further negotiations based
on the RFP criteria. The following benefit structure and design were used by both respondents and were the
basis for comparison of cost:
o Current 3-tier benefit design (like KeyCare II, KeyCare III and Point-Of-Service)
o Current 4revel options (Employee, Employee+minor, Employee+Spouse, Employee+Family)
o A 12/12 Immature-Year plan (claims incurred and paid within 12 months) was used as the initial
basis for cost comparison. QualChoice 15/12 with 110% Aggregate Cap was compared to
Trigon's Paid Plan for cost comparisons since one of these plans would be selected for
implementation.
o Current $100,000 cap on a specific claim, referred to as 'Specific Cap'
o Option for either a 110% or 125% aggregate cap on total claims, referred to as 'Aggregate Cap'
Evaluation Criteria: The RFP established the criteria for the evaluation of all proposals. This criteria is on
page 2 of this appendix.
Evaluation of QuaICholce and Trigon Blue Cross Blue Shield: The evaluation of these proposals by the
committee is on pages 3, 4 and 5 of this appendix.
Page 4
Appendix 2
Page 2 of 6
ALBEMARLE COUNTY 1996-1997 MEDICAL INSURANCE PROPOSALS
EVALUATION CRITERIA
Ref: Page 12 of RFP 95-67
6.2 Evaluation Criteria
6.2.1 Each proposal will be evaluated on the basis of the offerors overall ability to satisfy the terms~
conditions and requirements of th~s RFP, considering the criteria list is section 6.2.2.
6.2.2 Each proposal will be evaluated according to the following criteria, which are not listed in order of
priority or weight to be given:
(1) The qualifications of the offeror to administer a health care plan, with emphasis on the type of
program(s) proposed by the offeror for the County.
(2) The type of program or programs offered for both the administration oftbe general health care
plan and the dental plan, including the responses to the questionnaires and the forms and, in
particular, the depth and quality of the health care provider networks and the offerors performance
standards and guarantees.
(3) The cost of the program or programs offered for both the administration o£the general health
care plan and the dental plan,
(4) The key personnel of the offeror to be assigned to claims administration for the County, and the
availability of those personnel.
(5) The offerors current and projected workloads.
(6) The offeror's,experienen in administering health care plans for local governments
(7) The offerors experience, in its administration of health care plans, in controlling health care
costs, quality assurance, and in meeting deadlines.
(8) References from current and former clients.
(9) The reputation o£the offeror for personal and professional integrity and competency.
(I0) The £mancial condition of the offeror, based upon auditing information and financial ratings,
(11) The offeror's use of specialty consultants in claims administration.
(Note: Procurement process dictates that these evaluation criteria, as listed in the RFP, be
used as the sole basis for the award of the contract.)
Page 5
Appendix 2
Page 6 of 6
ALBEMARLE COUNTY 1996-1997 MEDICAL INSURANCE PROPOSALS
COST BREAKDOWN OF QUALCHOICE AND TRIGON
12/12 CONTRACT (IMMATURE YEAR)
WITH A 110% AGGREGATE CAP:
QualChoico Trig:on
Fixed Costs:
Charge for Specific Cap $97,031
110% Aggregate Cap $30.387
.~ dministration Charge $315,007
Pre-Admission Charge Included
Set-Up Fee: None
Drug Card Fee: Included
Network Access Fee'. Included
Conversion: To be determined
Total Fixed Costs: $442,425
$108,602
$34,133
$353,791
Included
None
Included
Included
Included
$496,526
Expected Claims: $3,004,544 $3,427,735
Total Liability $3,747,423 $4,267,035
15/12 CONTRACT WITH A 110% AGGREGATE CAP vs Existing Plan(Paid Plan):
15/12 w/110% Ag. Paid Plan
QualChoiee Trigon
Fixed Costs:
Charge for Specific Cap $116,919
110% Aggregate Cap $30,101
Administration Charge $309,170
Pre-Admission Charge Included
Set-Up Fee: None
Drug Card Fee: Included
Network Access Fee: Included
Conversion: To be determined
Total Fixed Costs:. $456,190
$126,823
N/A
$354,801
Included
None
Included
Included
Included
$481,624
Expected Claims:
$3,397,093
$4,125,110
Total Liability $4,192,992 $4,606,734
Page 9
Appendix 3
Page 1 of 2
ALBEMARLE COUT~ITY 1996-1997 MEDICAL INSURANCE PLANS
RECOMMENDED PLANS AND PREMIUMS
TheExeeutivo Committee is reeommending three medical plans lso offered for 1996-1997. The recommended
insmanco cartier is QualChoice of Virginia/Blue Ridge Health Alliance Inc. The thren plans are QualChoiee II,
QualChoic~ Ill and QualChoic~ Triple Option. Active and Retiree total monthly premiums am thc samc.
Premiums remain tho same as 1995-1996. Tho folloxving table reflects the recommended total monthly premium
for active employees and retirees. The premium includes the employer and the employee combined cost of
mc~ca] cam coverage.
KC 1I QC II KC III QC IH POS Triple Opt. ,
TOTAL PREMIUM Current Projected Current Projected Current Projected
Premium Premium Premium Premium Premium Premium
EMPLOYEE
Employee $196 $196 $161 $161 $145 $145
Employee+minor $260 $260 $197 $197 $160 $160
Employee + spouse $440 $440 $332 $332 $248 $248
Employee + family $495 $495 . $374 $374 $280 $280
Page 10
Appendix 3
Page 2 of 2
ALBEMARLE COUNTY 1996-1997 MEDICAL INSURANCE PLANS
RECOMMENDED PLANS AND EMPLOYEE PREMIUMS
The following table reflects the recommended out-of-pecket premium each full-time active employee will pay
based on the Board's enntribufion of $145.00 per month which is 90% of the QualChoiee III and 100% Triple
Option Employe~ total premium. Retirees pay the full premium.
KC II QC 1I KC III QC III POS Triple Opt.
EMPLOYEE Current Projected Current Projected Current Projected
PREMIUM Premium Premium Premium Premiura Premium Premium
ACTIVE EMPLOYEE
Employee $51 $51 $16 $16 0 0
Employee+minor $115 $115 $52 $52 $15 $15
Employee+spouse $295 $295 $187 $187 $103 $103
Employee + family $350 $350 $229 $229 $135 $135
RETIREES
Employee $196 $196 $161 $161 $145 $150
Employee+m/nor $260 $260 $197 $197 $160 $160
Employee + spouse $440 $440 $332 $332 ,$248 $248
Employee + family $495 $495 $374 $374 $280 $280
· Page 11
ALBEMARLE COUNTY 1996-1997 DENTAL INSURANCE PLAN
RECOMMENDED PLAN AND PREMIUMS
Appendix 4
Recommend continue with our current Delta Dental Basic Services plan.
Delta Dental's plan is a fully insured program.
The Board contribution for FY 1996-1997 continues at the current level of $60.00 per year.
There is no chango m premiums as 1996-1997 will be the second year of a two year rat~ guarantee negotiated
last year.
EMPLOYEE PREMIUM
Current Proposed
Employee + 2 or moro
Employee $5.91 $5.91
Employee + one $13.52 $13.52
$28.64 $28.64
Page 12
ADDENDUM
The current Trigon Point of Service Plan is enhanced by the QualChoice Point of Service Plan
(QC/POS) proposal in the following ways:
Deductible: No deductible is found in QC/POS. The current plan has $100 and $300
deductibles.
Coinsurance: A member is responsible for no Coinsm:ance when receiving care in QC/POS,
unless purchasing Durable Medical Equipment or Supplies. Currently members are
responsible for 10% of Outpatient diagnostics and 20% Coinsurance of Major Medical
Services.
Self Referral in Network: QualChoice POS Plan offers a self referred benefit option with
80%/20% Coinsurance, This "Option 2" applies when a member self refers to one of the
1700 Network physicians. No provision in the Trigon POS plan provides for this access. A
member under the current Tfigon POS has 70%/30% or 60%/40% Coinsurance when seeking
services without a referral.
PCP Definition - Each Enrollee selects a personal Primary Care Physician (PCP) for general
medical services. Under the plan, female Enrollees age 16 and over may choose two PCPs:
one for general medical services and one for OB/GYN services.
Preventive Services - Preventive Care Services are covered at a 100% after the $10
Copayment. Routine gynecological examinations and pap smears are covered at a $10
Copayment when ordered by the patient's PCP for OB/GYN services. No restriction on the
number of visits per year is placed on any services when ordered or referred by the PCP.
Well Baby Care: Coverage for well child care through age 6, directed by the PCP, is paid
in full after $10 copayment.
Outpatient Hospital and Emergencies: A $50 Copayment is in place for Emergency Room
visits, with the Copayment waived if the patient is admitted. Diagnostics and Surgical
services in the hospital or outpatient settings are paid in full. Physician office visits are
covered at a $10 Copaymem. The current Trigon POS plan covers these services at a $30
Copayment and an additional 10% Coinsurance.
Inpatient Hospital Deductible: No per confinement Copayment is imposed. Inpatient Care
is covered ar 100% per admission deductible and 90%/10% coverage.
Physicals and Immunizations: A patient's PCP may order testing and immunizations as
necessary with no annuaJ limit under Option 2 and a $10 Copay. Currently, the benefit is
90%/10% Coinsurance.
· Skilled Nursing Care: Skilled Nursing Care is covered at 100%. The existing plan holds
members responsible for $50 per day of these servic6 Charges after the first 20 days of care,
Durable Medical Equipment: Durable Medical Equipment and Medical Supplies has
80%/20% Coinsurance but no Major Medical deductible of $100 applies.
Mental Health & Substance Abuse: No inpatient per admission charge is imposed with
QuaiChoice. Inpatient MHSA Services are paid in Full. Inpatient MHSA care is paid at
80°/O/20% Coinsurance following a $100 per admission charge under the current Trigon plan.
For Outpatient services, a $10 Copay applies.
Major Medical Benefits: The QualChoice plan does not have a separate designation for
Major Medical Benefits. Nor does QualChoice impose a $100 Major Medical deductible.
QualChoice covers the Private Duty Nursing, Ambulance Service, Speech and Occupational
Therapy at 100%. The current Trigon plan covers these services at 80%/20%.
Highlights of Medical Care/Dental Insurance Award
Albemarle County/Albemarle County Schools
7/31/96
Medical Insurance
"~Medical Care Contract for 10/1/96-9/30/97 awarded to QualChoice of Virginia/Blue
Ridge Health Alliance, Inc.
~TotalLiability under QualChoice contract $4,192,992 vs. $4,606,734 with Trigon proposal
~Benefits design remains the same as under current Trigon contract, i.e., no change in level
of benefits
~t~0% increase over current rates for employees in first year
U~l~One year contract with option to renew for second and third year
~"~a'Will result in a budget savings for County of approximately $177,000 in FY 96-97
~"~Award based on competitive negotiation process using 11 selection criteria
u~Plan covers approximately 2,000 subscribers in Schools & Local Government
Dental Insurance
"~Dental Insurance contract for 10/1/96-9/30/97 will remain with Delta Dental
"~0% increase over current rates for employees
TO:
FROM:
DATE:
RE:
COUNTY OF ALBEMARLE
Human Resources Department
Albemarle County Office Building
401 Mclntire Road
ChariortesviIl¢. Virginia 22902 4596
Albemarle Count3, Employees
Robert B. Brandeuburger, Deputy Director of Human Resources ~rt ~tla~,''~'
August 9, 1996
1996-97 Benefit Programs and Open Enrollments
BACKGROUND
The purpose of this correspondence is to apprise you of the status of the County's medical insurance and other
benefit programs for plan year 1996-97. The information in this packet is very ~mportam. I urge you to read this
material very carefully. If you intend to add, drop or change your participation in any of these programs, you
must do so by the enrollment deadline specified.
MEDICAL INSURANCE
QualChoice of Virginia will provide our medical insurance commencing October I, 1996. I know many of you
have questions about how this will affect you and also what medical plans will be available through QualChoice.
QualChoice will offer three plans next year that are basically the same as our current plans. These plans are
QualChoice II, QualChoice III and Point-Of-Service Triple Option. The POS Triple Option plan is a managed
care plan that includes enhanced benefits, and more choice on how you obtain medical care, compared to the
Trigon POS plan.
Rates/Types of Coverage: Employee premiums are the same as last year and are shown on the attached rate
sheet. You can still enroll in coverage for yourself, or subscriber plus minor, or subscriber plus spouse, or
subscriber plus family.
Employee Assistance Program (EAP): EAP will continue to be offered through Martha Jefferson Hospital
HealthWorks, and administered by Piedmont Psychiatric Professionals.
The Albemarle County Employee Assistance Program (EAP) continues to be mandatory for any
employee or family member needing mental health or substance abuse services who is enrolled in the
QualChoice II or QualChoice III medical plan. Failure to do so will result in an increased employee co-payment
for any services obtained.
Employees or family members who are enrolled in QualChoice Point-Of-Service Triple Option can seek
mental health or substance abuse services through their primary care physician (PCP), by calling QualChoice for
a referral, or through the EAP.
I-Iow do you enroll? If you intend to enroll in one of the QualChoice programs you must attend an open
enrollment information session. These sessions will be approximately 45 minutes in length. Everyone who
currently is enrolled in the County% Trigon Blue Cross and Blue Shield medical program will have to complete a
new application for the QualChoice program. There will be NO automatic conversion from Trigon to
QualChoice. The enrolhnenl package is not included with this mailing but will be provided to you when you
attend an enrollment session. A new application needs to be completed and returned to the Human Resources
Department no,later than September 15, 1996.
Schedule of Information Sessions:
For School Division Employees located at schools/departments outside the County Office Building:
QualChoiee will be visiting each school. This schedule will be provided in the near furore. They will also be
meeting separately with employees in the Transportation, and Food Service dep_~arrments. Custodians should
attend the session schedul6d for their school building. Buildings Services maintenance personnel should plan on
attending one of the sessions that will be scheduled at Albemarle High School. You are strongly encouraged to
attend the sessmn that will be held at your schooFdepamnent, however, knowing thay you may not be able to
attend that session, there will be subsequent sessions scheduled in regional locations during early September.
Bus Drivers, Special Ed. Car Drivers, Transportation Assistants
(During pre-service day scheduled for August 14th, 15th. or 16th)
Food Service Staff (During training-day scheduled August 21so
Transportation VMF -- To be determined
individual Schools -- To be determined
General Government Employees and School Division Employees Working In The County Office Building:
QualChoice will be conducting information sessions according to the attached schedule. Because each
information session is limited to no more than 50 people you will need to call the Human Resources Office at
296-5827. or call Daweslyn Butler at extension 3348, to sign up for one of these sessions. Once you s~gn-up
please call us if find that you need to reschedule.
General Government and School Division Employees at the County Office Building
Monday, August 19th Tuesday August 20th
Session #1 9:00 a.m Session//8 9:00 a.m.
Session #2 10:00 a.m Session #9 10:00 a.m.
Session #3 11:00 a.m. Session #10 11:00 a.m.
Session #4 1:00 p.m Session # 11 1:00 p.m.
Session #5 2:00 p.m. Session #12 2:00 p.m.
Session #6 3:00 p.m Session//13 3:00 p.m.
Session #7 4:00 p.m. Session #14 4:00 p.m.
If necessary, make-up sessions will be scheduled for early September, Sessions for people working
the 2nd and 3rd shift will be coordinated with their respective department.
Page 2
Prescription Service: The preferred provider network for prescription drugs will again be utilized for the
1996-97 plan year. This network of pharmacies has agreed to aecep~ a lower rate for filling your prescription
needs. The urescriotion drug costs have not changed this year. They remain $5.00 for generic and $15.00 for
brand name drugs.
QualChoice will continue to offer a mail order drug program as part of y0ur prescription drug program. This
program, offered through CFI Pharmacy Service provides you with a convenient and cost effective way to obtain
up to a 90-day supply of those medications you take routinely. The rates for a 90-day supply are $10.00 for
generic and $17.00 for brand name drugs.
WELLNESS
The new Point-of-Service plan offers certain wellness benefits as part of the plan. If you elect a QualChoice II or
QualChoice III you can still receive mammography services under our mammography program and pap smears
Will continue to be covered under both of these plans. A free mammogram is offered to all eligible participants.
To be eligible you must be a County employee enrolled in the County's health insurance program end have a
doctor's referral. Employees who are not enrolled in the County's health insurance program, or spouses of
County employees, may receive a mammogram at a discounted rate. Please call the Human Resources
Department for more information and the forms that must be completed before receiving a mammogram.
Employees do not need to fill out any paperwork before receiving a pap smear.
DENTAL INSURANCE
The County's dental insurance benefits have not changed for the 1996-97 plan year. Three plan options are
offered: employee only, 2-party, or 3-party* coverage. The rates for dental insurance are the same as last year
and are shown on the enclosed rate sheet. If you would like to make any changes to your coverage, a new
application needs to be completed and returned to the Human Resources Department no later than September
15, 1996.
LIFE INSURANCE AND SICK BANK
If you wish to sign up for the SAFECO Supplemental Life Insurance, forms will be available at the
Information Sessions or in the Human Resources Department. SAFECO life insurance requires medical
underwriting if increasing more than $I0,000 or if enrolling for the first time.
If you wish m sign up for the Sick Bank, you must do so no later than October 15. 1996. The forms are
available in the Human Resources Department. A doctor's statement of good health must be attached to the Sick
Bank form. If you are already a member, you do not need to re-enroll.
Supplemental Life Insurance for members of the Virginia Retirement System. The Virginia Retirement
System is offering a supplemental life insurance program that is similar to the SAFECO program for members of
VRS. If you are a current VRS participant and would like to enroll you will be required to complete a
verification of health status along with your application. There is no enrollment deadline for this program. If
you would like an application please contact the Human Resources Office.
Page3
AFLAC
AFLAC is the County-sponsored cancer and accident insurance. Brochures describing the plans AFLAC offers
are available in the Human Resources Department. If you are interested in signing up for one of these plans or
talking with someone, you can contact the AFLAC representative at 804-293-7320.
*** REMINDERS ***
If you wish to enroll in the QualChoice medical plan, you must attend an information session,
complete the appropriate form(s) and return them by September 15, 1996. The effective date
of the change(s) will be October 1. 1996.
If you have a Change In Family Status during the year remember that you must submit a
Family Status Change Form within 30 days of the qualifying event in order to make a change
in your benefits.
HEALTH CARE, DENTAL AND SAFECO FORMS RECEIVED AFTER
SEPTEMBER 15, 1996, CANNOT BE ACCEPTED.
Should you have any questions regarding this information, contact the Human Resources Departmem
at 296-5827.
Page 4
QualChoice of Virginia
,/'CHECK IT OUT!
POS - Triple Option
Effective October 1 st, QualChoice of Virginia will serve as Albemarle County's Health Benefits
Administrator. Please review the Open Enrollment schedule included with this package.
J'Enhanced Benefits
When accessing benefits through your Network PCP, you have the opportunity for 100%
coverage for many services. Despite the fact that many of the benefits available under the
QualChoice program are benefit enhancements, your employee contributions are NOT
increasing this renewal period.
J'Personal Primary Care Physician (PCP)
Each family member may select a personal PCP, and females age t3 and older are invited m
make two selections - a PCP for medical services and a PCP for OB/GYN services. Many
Family Medicine and Internal Medicine PCPs can be chosen for both types o£care. Your PCP
can treat you for a wide variety o£health care services. Your PCP may refer you to a specialist
or authorize hospitalization whenever necessary.
~'Preventive Care Is Covered
QualChoice helps you stay well by offering preventive care. Routine physical exams, well
child care, mammograms, and gynecological exams are covered as determined by your medical
PCP & PCP for OB/GYN services.
~'No Claims To File And No Deductible To Pay
There is no deductible to pay or claims to file under Options 1 and 2. You are responsible for
your copayment and/or coinsurance. The network provider will bill QualChoice for the
remaining balance.
~'Large Service Area and More Primary Care Physicians
QualChoice now serves 42 Virginia counties with more than 2,000 participating physicians
including UVA and Martha Jefferson primary care physicians. This large and growing network
makes it easy for you to continue relationskips with your existing medical care providers.
Network providers are continually being added, Updates are available from QualChoice and
your Human Resources office.
~'Person-to-Person Customer Service
Courteous, caring service designed to help you obta'm the greatest value from your QualChoice
benefits is provided by people--not computers. QualChoice Customer Service is available 9
a.m. to 5 p.m., Monday through Friday. Simply call (804) 975-8900 or (800) 975-0975.
RATE SHEET
Fulltime Employee Contribution
(Effective October 1, 1996)
QUALCHOICE OF VIRGINIA
12-MONTH RATE
(for employees receiving 12 payche¢l~ per year)
Employee Only Employee+Minor Employee+Spouse Employee+Family
QC II 51.00 [ 15.00 295.00 350.00
QC III 16.00 52.00 187.00 229.00
Triple Option 0.00 15.00 103.00 135.00
(Employer contribution: $145/month; $1,740/year)
1 O-MONTH RATE
(for employees receiving 10 payehe¢ '1~ per year)
Employee Only Employee+Minor
QC II 61.20 138.00
QC III 19.20 62.40
Triple Option 0.00 18.00
(Employer con~bution: $174/month; $1,740/year)
Employee+Spouse
354.00
224.40
123.60
Employee+Family
420.00
274.80
162.00
DELTA DENTAL
Single 2-Part~ 3-Party Plus
(Employee Only) (Employee+Spouse or (Employee+Spouse and
one dependent ohild) one or more children)
12-Month Pay 5.91 13.52
(Employer Contkbution: $5.00/month; $60.00/year)
1 O-Month Pay 7.09 16.22
(Employer Conf~rbution: $6.00/month; $60.00/year)
28.64
34.37
(Rev
COUNTY OF ALBEMARLE
Human Resources Department
Albemarle CounTy Office Building
40] Mclntir¢ Road
Chariottesville, Virginia 22902-4596
TO:
FROM:
All Employees Eligible for Benefits
DATE: August 9, 1996
BENEPLUS Reimbursement Accounts Open Enrollment
It's that time of year when you have the opportunity to apply for participation in the Reimburse-
ments Accounts portion of the Flexible Benefit Program (BENEPLUS). If you have previously
participated in this program, you already know this is a very good benefit. Most participants will
realize a tax reduction ranging from $0.28 to $0.42 for each dollar included in the program.
Whether you are a current participant or are joining for the first time, you will need to file an
application. Federal law requires that applications be received prior to the beginning of the Plan
Year. Therefore, your application must be dated and received in the ltuman Resources
Department no later than August 30, 1996. Applications dated and/orreceived after
August 30 cannot be accepted. If you do not wish to participate during the 1996-97 plan year,
you do not need to return an application.
Please refer to the enclosed Fact Sheet for more information. If you would like another copy of
the Beneplus Handbook, please call the Human Resources Department and one will be mailed to
you. Before completing your application, please keep these things in mind:
Do not include health and dental premiums in your Reimbursement Account monies.
Premiums are handled separately and are automatically paid with pre-tax payroll
deductions, unless you indicate otherwise under Section I on the enclosed Beneplus Plan
Application form.
The maximum allowable reduction per year is $4,000 for the Health Care Reimbursement
Account and $5,000 for the Dependent Care Reimbursement Account.
Note that the amount you request under Section II is a Monthly amount not a yearly
amount.
continued on back
Page 2
When filing claims (Reimbursement Request Forms):
Bills or statements must show the date the expense was incurred and be accompanied by
nroof of payment. Checks or receipts showing payment must be accompanied by a bill or
statement showing the date the expense vtas, incurred.
Please double cheek your figures when submitting a claim. Make sure that the amount on
the claim form corresponds to the amount(s) on the receipts submitted. Also make sure
you place the amount(s) on the appropriate line(s) of the Reimbursement Request form
(i.e., medical under Health Care, child care under Dependent Care).
3. Any claims ~[hat are submitted with incomolete documentation will be returned to you.
Closing out your 1995-96 account(s):
If you participated in the BENEPLUS Re'unbursement Accounts program during the
1995-96 Plan Year, your account needs to be closed out. You have until September 20,
1996, to submit claims on your 1995-1996 Plan Year account. If you incur an expense
before August 31 but are not able to pay for it until September, you are still allowed to use
that expense to close out your 1995-1996 account. However, you still must show proof
of payment. This is the only situation where your claims are allowed to "cross over" from
one Phn Year to the next.
Be sure to indicate the appropriate Plan Year at the top of your claim forms. If you are
closin~ out you would write in '95-96'; if you are filing a claim for the new Plan Year you
would write in '96-97'. The date you incurred the expense is the key. Claims incurred
prior to September l, 1996, cannot be filed against your 1996-1997 Plan Year account.
Please feel free to call me or my staff at 296-5827 if you have questions or would like to meet
with us.
REMINDER:
Beneplus application forms must be in our hands (not in the mail)
by 5:00 p.m., August 30, 1996, in order to comply with IRS guidelines.
County of Albemarle
BENEPLUS FACT SHEET
What is it?
A Flem'ble Benefit Program that allows Albemarle County employees to take a voluntary salary
reduction and then use those pre-tax dollars to pay for many medical and dependent care expenses that
are currently being paid for with after-tax dollars. There are two types of pre-tax options:
1)
Medical and/or dental ~remiums
Your monthly premiums will be automatically deducted from your paycheck on a pre-tax basis
unless you indicate otherwise in writing at the time of application or during annual open
enrollment.
Reimbursement Accounts
You may set aside additional money for other out-of-pocket, unreimbursable medical costs and/or
dependent care costs. Unlike the automatic premiums above, you need to apply each year it'you
wish to participate. See below for more details.
What does it do for me?
Reduces your taxable salary.
Most participants will realize a tax reduction ranging fi.om .28 to .42 cents for each dollar
included in the program.
Increases your spendable income.
The tax reduction you receive is money back in your pocket.
Facts about the Program:
·
·
Plan Year: September 1 through August 31
No changes can be made during the Plan Year except for a change in family status.
A family status change is defined as marriage, divorce, death of a spouse or dependent, birth or
adoption ora child, employment or termination of employment of your spouse, or a cl'amge in
your employmem status which effects your benefits.
Eligible Participants: All permanent full-time or part-time employees who are eligible for benefits.
Since your taxable salary is reduced, less Social Security is paid in. However, this very minimal
reduction in Social Security wages does not, in the majority of cases, offset the tax savings benefit
you will receive. However, if you are within a couple of years of retiring, your best option would
be to not participate in this program.
- continued on back -
The Reimbursement Account
What you should know before you participate:
· What are your household medical expenses?
What are your dependent care expenses?
Guidelines for reimbursement accounts:
1)
2)
3)
4)
5)
5)
7)
Prior year elections do not carry over. A new Beneplus application must be filed,
The monthly pre-tax deductions begin with your September 30 paycheck, The application asks
you for the monthly deduction amount. Determine this by dividing the annual amount to be
deducted by the number of paychecks you will receive between September 30 and August 31 (i.e.,
10 pays or 12 pays); or bom the time you join through August Slst.
The health care reimbursement amount you decide on must be based only on unreimbursable out-
of-pocket medical expenses to be incurred and paid for between September 1, or the time you
join, and August 31.
The dependent care reimbursement amount is based on anticipated expenses from September I, or
the time you join, through August 31.
Claims for reimbursement must be made by submitting a Reimbursement Request form with
appropriate receipts attached by the 20th of each month. A reimbursement check will be issued
at the end of that month.
You must show proof that the expense was incurred within the Plan Year, and that payment was
made within the Plan Year.
Any monies remaining in your a~coum(s) at the end of the Plan Year are forfeited.
Note: ffyou are seriously considering or know that you will be dropping your insurance coverage
through Albemarle County at some point during a Plan Year, you may wish to consider rese'mding
your pre-tax insurance premium eiection(s), If you choose to drop coverage for any reason other than a
'change in family status' as mentioned above, the County of Albemarle is still obligated to continue
withholding the pre-tax premium deduction through the end of the Plan Year. These :monies would be
placed in the medical reimbursement account. As mentioned at the beginning of this fact sheet, if you do
not want your premiums pre-taxed, you must put your request in writing at the time of application.
How do I enroll?
Complete and sign a "Beneplus Plan Application".
Mail the application to the Human Resources Departmem, 401 Mclntire Road, Charlottesville,
VA 22902.
The application must be received in the Human Resources Department bv
August 30 or within 30 days of your date of hire (for new employees).
For more information, or to receive a copy of the BENEPLUS Handbook, please call the Human
Resources Department at 296-5827, or stop by the office at the above address.
Revised 8/96
COUNTY OF ALBEMARLE
BENEPLUS PLAN APPLICA ON
PLAN YEAR
NAME
(Please Print)
DIVISION: Local Government
SOCIAL SECURITY NO.
DEPARTMENT/SCHOOL:
School
How many pay periods (circle one): 10 12
L PREMIUM CONVERSION
I understand that my medical and dental insurance premiums are automatically paid on a pre-tax basis unless I decline
participation as follows: [] Do not pre-tax my medical insurance premiums.
] Do not pre-tax my dental insurance premiums.
II. REIMBURSEMENT ACCOUNTS
[] I hereby apply for participation in the Beneplus Reimbursement Account(s) and authorize the County of Albemarle to
reduce my salary by the amount shown below. [ l~rther certify that:
1. [ have been provided an explanation of this Plan and have received a copy of the regulations covering the rules and
administration of the Plan,
2, I understand the amounts reimbursed under this Plan cannot be claimed on my Federal or State Income Tax Return
nor claimed under any other insurance plan.
3. I will submit documentation or evidence to justify all claims for reimbursement,
4, I understand that amounts not used during the Plan Year will be retained by the County.
5. I agree to abide by the Plan regulations as they exist or as they may be amended by the County.
6. [ understand this election cannot be changed during the Plan Year unless there is a change in family status or a change
authorized by IRS or the Plan Regulations.
MONTHLY
HEALTH CARE REIMBURSEMENT ACCOUNT
(MaXimum allowable: $4.000 annually) (Do not include insurance premiums)
DEPENDENT CARE REIMBURSEMENT ACCOUNT
(M~ximum allowable: $5,000 annually)
TOTAL MONTHLY SALARY REDUCTION:
[] I decline participation in the County of Albemarle Beneplus Reimbursement Accounts.
Date
Employee Signature
Verified:
Plan Administrator Date