CalPERS Health Benefits Program

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					CalPERS Health Benefits Program
         2007 Rates
Public Employees’ Medical and
Hospital Care Act (PEMHCA)

CalPERS Objective
• To provide you, our employers, with a
  comprehensive, cost-effective health benefits

• To help agencies attract and retain qualified
• To foster a healthier and happier workforce

What’s Happening in the
Public Employer Insurance Market?

• Local governments are under pressure to
  reduce costs due to budget constraints

• Public agencies are looking for cost saving

• Commercial rates may change significantly
  after the first year

CalPERS Understands

Health Care Cost Drivers

• Aging population            • Escalating hospital costs

• Provider reimbursements     • Member health decisions

• Escalating pharmacy costs   • Medical technology

• Chronic diseases            • Uninsured population

• Provider disruptions        • Federal and state mandates

CalPERS Basic HMO Increase
Lower than the California and national averages for 10 years

CA Legislative Analyst’s Office

In 2006, LAO said CalPERS saved more than $168
million since 2002 by implementing the following initiatives:
• Did not renew contract with Health Net and Pacific Care -
• Narrowed Blue Shield’s hospital provider network - $45M
• Moved Medicare eligible members from basic to Medicare
  plans - $19M
• Provided member incentives to use over the counter and
  mail order prescriptions - $27M

Other Contracting Agency-specific initiatives:
• Adopted Regional Pricing - $40M
Approved Regions for Contracting

2007 CalPERS Regions
• Bay Area/Sacramento
• Los Angeles Area
• Other Southern
• Other Northern
• Out-of-State

CalPERS 2007 Health Premiums
Medicare Rates

                                  2006                           2007
    Medicare                                                                            Percent
                                                                                      Change (+/-)
                        Single    2-Party   Family     Single    2-Party   Family

                        Medicare Premium Rates - All Regions

  Blue Shield CA        $286.49   $572.98   $859.47    $318.95   $637.90   $956.85        11.33%

  Kaiser CA              218.59    437.18    655.77     289.68    579.36    869.04        32.52%

  Kaiser/Out of State    209.99    419.98    629.97     271.78    543.56    815.34        29.43%

  PERS Choice            322.03    644.06    966.09     341.75    683.50   1025.25         6.12%

  PERSCare               347.20    694.40   1,041.60    371.68    743.36   1,115.04        7.05%

  WHA                    277.44    554.88    832.32     296.86    593.72    890.58         7.00%

CalPERS “More Than The Premium”

• Experienced

• Proven Leaders

• Committed

• Innovative

• Educators

CalPERS Quality Care and Coverage
Disease Management Programs

Programs to improve outcomes and cost-effectiveness
• Identify and educate high risk individuals
• Case management
• Five chronic disease care programs
         Asthma
         Diabetes
         Cardiovascular risk reduction
         Chronic Obtrusive Pulmonary
         Heart Failure

 CalPERS health plans provide these programs
       at no additional premium cost.
CalPERS Quality Care and Coverage
Strategic Initiatives

Member Engagement
• CalPERS Web-based Health Plan Chooser Tool
• CalPERS Health Wallet

Member Incentives
• Pilot programs such as Blue Shield’s Healthy Lifestyle
  Rewards program

• Blue Cross telemedicine pilot program implemented for
  select PERSCare and PERS Choice Basic plan members
  in 2006
CalPERS Quality Care and Coverage
Strategic Initiatives (cont’d)

High-Intensity Case Management (HICM)
• Blue Shield pilot program indicates preliminary estimated
  savings of over $7,000 per case
• Staff continues to review results of existing HICM

Centers of Expertise (COE)
• CalPERS works with health plan partners to identify
  certain procedures and facilities as Centers of Expertise
• Planning to implement bariatric COEs in 2006
• Reviewing joint replacement surgery COEs for 2007

Addressing Public Agency Needs
Ease of Program Administration

Administrative Support
• Established negotiating power with health plans and

• Online enrollment system (ACES)

• Continuous educational and program support

• Timely grievance resolution of both provider and plan issues

• CalPERS Health Benefits Officer for retirees

CalPERS Administrative Costs
Lowest in the State

Our low administrative costs cover all of the following:
• Online enrollment costs
• Dedicated member services
• Open Enrollment support
• Annual Open Enrollment notification process
• Health Benefits Officer for retirees

Also, participating agencies pay no commissions
 and there are no commission fees built into the
             health plan partner rates.
CalPERS Board of Administration

Priya Mathur – Elected Member for Public Agency Membership
Tony Oliveira – Governor Appointee for Local Government Representative

Board Member                        Constituency
Rob Feckner, President              School Members - Elected
Marjorie Berte                      Insurance Industry Representative
George Diehr                        State Employees - Elected
Charles P. Valdes                   Total Membership - Elected
Steve Westly                        State Controller
Philip Angelides                    State Treasurer
David Gilb                          Department of Personnel Administration
Mike Quevedo Jr.                    Public Representative
Maeley Tom                          State Personnel Board
Kurato Shimada                      Total Membership - Elected
Robert F. Carlson, Vice President   Retired Members - Elected

Employer Engagement
Your Voice

Health Benefits Constituent Workgroup
• Stay informed and provide input
• Meets monthly (second Thursday) from 10:00 -11:30 a.m.
• Attend in person or via teleconference
       Contact: Jennifer Rae at (916) 795-2807 or via email at:

                         Meetings held at:
      CalPERS, Lincoln Plaza North at 400 Q Street, Room 1140
                      Sacramento, California

  Dial-in number for teleconference is (877) 771-5833, Code 784356#
Employer Engagement
Your Voice (cont’d)

Health Benefits Committee and Board Meetings

• Generally held the third Tuesday and Wednesday
  of each month

• Agendas available at

Contact CalPERS

The highest level of customer service

• Contact us through CalPERS On-Line or our toll-free
  Employer Contact Center:

      888 CalPERS (or 888-225-7377)

CalPERS Health Plan Partners

The following contacts are available to you when you need
additional assistance with a specific health plan question:
  Ann DeRose, Account Manager for Blue Shield HMO N. CA

    Call 916-329-4567 or email @

  Terri Raymond, Account Manager for Blue Shield S. CA

     Call 310-568-2813 or email @
  Mark Johnson, Account Manager for Blue Cross PPO PERS Choice or PERSCare
     Call 916-636-2181 or email @
  Gladys Stone, Account Manager for Western Health Advantage
     Call 916-563-2283 or email @
  Josh Costa, Account Manager for Kaiser Permanente
     Call 916-614-4557 or email @
CalPERS Health Care for Today
and Tomorrow


• Fully committed to our partnership with you

• Delivering quality and affordable health