; District_Proposal_HEALTH_10-12-10_MLCCCBU_MSC_3.342151342
Learning Center
Plans & pricing Sign in
Sign Out



  • pg 1
									                           DISTRICT PROPOSAL – MCFT, MLCCCBU, MSC
                                                                                         Estimated <Savings>/Cost
Restore the 4% salary reduction effective 1/1/11.                                                          $184,000

       Regarding MLCCCBU and MSC employees who did not take the specified time off
       (July 2, 9, 16, 23 and 30) for the 4% salary reduction from 7/1/10-12/31/10:
        If you worked one or more of the specified 5 days off and arranged with your supervisor
           to take a different day off, you would continue with that plan (even if the day off is after

          If your work year, work week, or daily work hours were changed to allow for time off
           equivalent to July 2, 9, 16, 23 and 30, Human Resources would work with you to
           determine any adjustment that might be needed to make sure equivalent time off is
           received for the six month salary reduction.

                                               Effective 10/1/10

Change health screening benefit for spouse from 50% District paid to 100% District paid.                   <$5,000>
It’s less expensive to provide a blood test at the health screening rather than through the health plan.

                                               Effective 1/1/11

Increase the medical deductible                                                                            <$26,000>
$200 $400 (single)/$400 $800 (family)

Increase the medical co-payments                                                                           <$60,000>
Single: In-network, 10% of the first $3,000 $4,000 in covered benefits (up to $300 $400 out of pocket)
Out-of-network, 30% on the first $4,000 $5,000 in covered benefits (up to $1200 $1,500 out of pocket)

Family: In-network, 10% of the first $6,000 $8,000 in covered benefits (up to $600 $800 out-of-pocket)
Out-of-network, 30% on the first $8,000 $10,000 in covered benefits (up to $2,400 $3,000 out-of-pocket)

Maximum out-of-pocket for copayments, in-network and out-of-network:
$1,200 $1,500 (single) and $2,400 $3,000 (family); plan pays 100% of UCR thereafter

Note: This change could increase the cost for a single by $500 and a family by $1,000.

Change dental benefits:                                                                                      $4,400
From: BASIC SERVICES - 70% of covered fees 1st year, 80% 2nd year, 90% 3rd year, 100% thereafter
      and PROSTHODONTIC SERVICES - 50% of covered fees (subject to $1,500 per year)

To:     BASIC AND PROSTHODONTIC SERVICES, 100% of covered fees (subject to $1500 per year)

Move from exclusions list:
Sealant to Basic Services, every 4 years to age 16; dental implants to Prosthodontic Services

Expand case management by SHPS in the medical plan. Currently, before a plan member has
an inpatient or outpatient procedure, the hospital or provider must inform SHPS, as noted on the
benefit ID card. A case management nurse with a related clinical specialty is assigned to the case
to verify medical necessity with the physician and certify the anticipated number of days stay.
For tertiary procedures (complex, requiring super-specialty physicians/hospitals), the case nurse
can also recommend appropriate facilities and surgeons and negotiate out-of-network rates for
physicians and facilities.

It is proposed that: (1) these services be expanded to other large-cost claims, including high risk
pregnancies; (2) the covered person/family member can contact SHPS for such assistance; and
(3) the SHPS case nurse can contact the plan member to provide alternative care settings when
needed and patient counseling/educational materials (voluntary). These changes will provide
better support to plan members and there could be a savings because SHPS can inform plan
members of in-network providers and negotiate savings with out-of-network providers.              <unknown>

                                           Effective 7/1/11

Change how an employee qualifies for District benefits from 20 hours per week to .50 FTE.
This change only affects the vacant .39 FTE Ad Asst I-CDV position; the savings would reduce
the District’s supplement to the CDV budget.                                                     <$18,708>

Change the base of the contribution rate for part-time regular employees. Employees
working less than .79 FTE (9.5 mo/yr, 40 hrs/wk) pay to participate in the health benefit plan
based on the total of the maximum deductible and copayment amounts (currently $2,800),
prorated by the employee’s FTE. However, such rates are typically based on the annual
amount an employer pays for a 1.0 FTE employee, currently $17,952 for actives.
A spreadsheet summarizing the proposal details is attached.                                      <$24,952>

Change the eligibility requirement for retiree health benefits. To qualify for retiree health
benefits to age 65, an employee must have 15 years of service as a permanent employee
of the District and be retirement eligible PERS (50 years old) or STRS (55 years old). If an
employee who is PERS or STRS retirement eligible dies with 15 or more years of service as a
permanent District employee, retiree health benefits are extended to the spouse/registered
domestic partner and dependents according to the retiree health benefit provisions.

Proposed change: Employees hired on or after 7/1/11 must be 58 and have 20 years of
service as a permanent employee of the District to be eligible for retiree coverage. The savings
could be 3-10 years of health benefit costs per future retiree, potentially <$63,360-$211,200+>
per retiree.                                                                                   <unknown>

                                                TOTAL ESTIMATED HEALTH BENEFIT SAVINGS <$130,260>
                       (plus potential savings from reduced retiree costs and expansion of SHPS services)

Part-time Employee Contribution Rates for Health Benefits

                   % less     employee                    District   Employee
          # on                             Employee                               Increase to
  FTE               than        health                    Would      Currently
          plan                             Would Pay                               Employee
                   .79FTE      benefit                     Pay         Pays

 0.79      0                   $17,952        $0.00      $17,952          $0          $0

 0.75      0       4.0%        $17,952      $718.08      $17,234         $700        $18

 0.667     4       12.3%       $17,952     $2,208.10     $15,744         $933      $1,275

 0.625     2       16.5%       $17,952     $2,962.08     $14,990         $1,050    $1,912

 0.51      1       28.0%       $17,952     $5,026.56     $12,925         $1,340    $3,687

 0.52      1       27.0%       $17,952     $4,847.04     $13,105         $1,344    $3,503

  0.5      1       29.0%       $17,952     $5,206.08     $12,746         $1,400    $3,806

 Total:     9                  $161,568    $29,836.24    $131,732    $9,916.00     $19,910

*Annual health benefit budgeted cost $21,120 (85% $17,952 active cost)


Effective 7/1/10 (already implemented)

      Coverage for a dependent child attending a postsecondary educational institution
       extended for up to one year if the child takes a medically necessary leave of
       absence as certified by the treating physician.

      Treatment for mental health or substance use disorders must be treated the same
       as an illness (i.e., cannot have separate deductibles/copayments or restrictions on
       number of visits).

Effective 1/1/11

      Over-the-counter drugs and medicines will no longer be qualified medical expenses for
       the IRS 125 flexible spending plan.

Effective 7/1/11

These changes were effective 10/1/10 (or the first of the plan year after that date which is 7/1/11
for MC):

      Increase age limit for unmarried dependent coverage to 26 (unless dependent
       is eligible for other employer-sponsored coverage).

      Eliminate pre-existing condition exclusions for dependent children under age 19.

      Eliminate lifetime benefit limits (Mendocino College $2 million).

      Include both internal and external appeal processes in the benefit plan.

      Eliminate restricted annual limits for all essential benefits. (Currently, there is only one
       annual limit in the MC plan that needs to be removed - $50/year for well baby care.)


To top