MAY 6, 2016 California Independent Schools Benefit Trust
MAY 6, 2016 California Independent Schools Benefit Trust UPDATES AND INFORMATION Agenda Welcome and Introductions CISBT Goals and Structure Who is Bolton? What is their role in the Trust? Trust update and reason for being ACA updates Anthem medical option Lines of Coverage Options Carrier and Vendor Options Plan Designs and Rates Carrier Requirements Workterra online enrollment & administration Next Steps 2 About Bolton In business for over 85 years, Bolton & Company is one of Californias largest privately owned insurance and employee benefits consulting firms Worked with the task committee and the trustees to create the CISBT program Proud to have more than 100 Independent Schools as clients. Committed to the long term success and health of the Trust. Offices in Pasadena, Santa Clara and Orange County 3 Bolton Team Ronald Wanglin, CIC, CSRM Chairman of the Board Jamie Gershon, CSRM, AAI
Senior Vice President Education Practice Group Tom Polenzani Director of Employee Benefits EMPLOYEE BENEFITS John Garner, CEBS, CLU, CFCI, CMC, GBA, RPA Chief Compliance Officer Lina Sanchez Senior Account Executive Scott Tamura Assistant Vice President Technical Consulting Unit Brent Graham Account Executive Megan Lee Senior Account Manager Kristy Ureta Account Manager Javier Guillen Account Manager Kimberly Marrone Employee Benefits Assistant 4 Jacqueline Roth Executive Vice President Education Practice Group Goals and Objectives A sustainable statewide trust, accessible to all CalISBOA member schools Leverage large-scale volume into: Administrative efficiencies Premium savings (reduce trends) Multiple lines of coverage
Additional services: Voluntary Plans, Wellness, Work Perks, Compliance and more 5 Update Four schools enrolled, 175 members 70 plus schools requested initial quotes 75 percent of member schools renew in October January 1st Goal of 15 schools enrolled by January 1, 2017 Still working to get Kaiser to join the Trust Renewal with Anthem due September 1, 2016 6 This is your Trust Requested by member schools Three years in the making CISBT will have a Board of Directors comprised of member schools. The success of this trust is up to you: you are the decision makers and you will shape the future direction of the trust, make plan decisions and other decide on other benefits. Stake holder meeting each July to review and improve the trust. 7 For the Trust to survive and become a viable option, schools must commit to the Trust as a long term Long-term strategy Built to be sustainable Bend the trend Attractive so that schools join Choice - multiple plan offerings Enhanced contracts and benefits In compliance with ACA regulations Combined risk (need a good mix of good and bad risk) Increase membership year after year
Wellness and disease management (near future) Must be viewed as a long term solution, not a year to year rate chasing option 8 Trust Structure Established under a Multiple Employer Welfare Arrangement (MEWA) Trust plan year begins January 1st. Renewal will always be January 1st of each year. Designed to give small employers access to health coverage on terms similar to those available to large employers This allows us to combine all the schools (small and large) to leverage our combined size and offer large group plans 9 We are creating our own pool of like-demographics based on our industry that will run better than the insurance carriers existing pools which combine industry groups based on size ACA Changes in 2016 Small group is being redefined Employers with 50 to 100 employees: Must move to small group at renewal Only small group-specific plans are available Metallic plans with reduced benefit options Member level rating, every member rated based on age No more composite rates Narrow networks are often the only way to reduce cost Individual Mandate 2016 penalty: $695 per adult or 2.5 percent of household income 10 Medical Insurance Rating Structure: The way the rating structure was established is on a 4-tier basis: 1. Employee only 2. Employee + Spouse
3. Employee + Child(ren) 4. Employee + Family In addition, each schools demographics and risk will be reviewed by underwriting in order to determine which rating band your school will be assigned. The trust has Seven rating bands (rating band number 1 represents lowest risk, number 7 is maximum risk) Since CISBT is structured as a large group program, pediatric dental and vision are not embedded in the medical plans offered. However, dental and vision are benefits offered within the trust and your school is free to choose to offer these benefits to your faculty and staff. You can offer them a la carte, or on a packaged basis. 11 Medical Insurance What information is needed in order to determine what rating band Anthem would apply to our school? The following information is required in order for Anthem to provide a medical quote for your school: Complete census information, including date of hire, number of hours worked, date of birth, home zip code, dependent tiers of coverage Current and renewal information (if available): summary of current plans, rates, contributions, any claims and/ or large claims information Names of the medical insurance carriers your school has had in place for the past 5 years A broker authorization letter, if you are not currently a Bolton employee benefits client. 12 Trust Structure Medical: Anthem Blue Cross Ancillary Dental: Guardian Vision: VSP/Davis Group Life/AD&D: Guardian Voluntary Life/AD&D: Guardian Disability: Guardian Employee Assistance Program (EAP) 13
Trust Structure Do we have to purchase all of the lines of coverage offered in the trust? No, you have the following purchasing options available: Just medical Medical and ancillary products Medical, dental and vision only Medical, life and disability only In addition, the Workterra COBRA administration services and FSA Administration services are optional Please keep in mind: while participation in all of the lines of coverage offered is not required, one of the advantages of electing all of the coverages and services available in the CISBT is billing consolidation In addition, you will be able to have Workterra customize your online program offering to include your current school program options outside the trust. There is a $0.50 PEPM (per employee per month) charge to cover the amount of system work required to provide this customization 14 Medical Insurance What about Kaiser? We are actively engaged with Kaiser to join the Trust, and we are hopeful Kaiser will Join in January 2017 You will be able to continue to offer your Kaiser policy outside of the trust and include the Anthem products from the trust as part of your program Under this offering, please note the following: Anthem requires that at least 50 percent of the total participants enroll in their plans You will need to switch brokers for both the Kaiser plan as well as the trust plans, if your school is currently not a Bolton employee benefits client this will allow you the opportunity to review potential changes to the existing Kaiser policy Depending on when your current Kaiser policy renews, you may have two separate open enrollment periods Depending on your group size, Kaiser may agree to change your renewal date; as a result, there may be a rate change for this existing policy Bolton can help you explore these options and help your school with any compliance requirements associated with this change (i.e. short plan year 5500 filing, etc.) 15 Ancillary Lines of Coverage 2 DHMO Plans 4 DPPO Plans
4 Group Life/AD&D Plans 1 LTD Plan Additional Voluntary Life/AD&D Plan The CISBT program offers several ancillary products. 16 3 Vision Plans Additional Services Member advocacy Workterra Designated Bolton customer service line HR consulting services Employee handbook HR-focused webinars and seminars ThinkHR Absence management support* Compliance consulting services Updates Webinars and seminars Summary plan descriptions (SPDs) and 5500s *optional additional fees apply 17 Administrative Efficiencies One online enrollment system - WorkTerra Helps guide the member through the trust options Can be customized to each schools needs Branded with schools logo Own Program Special Announcements
Feeds data to insurance carriers Feeds data to your payroll company* (depending on payroll firm, there may be fees involved) COBRA administration services* FSA administration services* *optional additional fees apply 18 Trust Fees You can join CISBT on the first of any month during the plan year The program will renew for all school participants on January 1st of each year, no matter when your school joined 19 Trust Fees There will be trust fees associated with the CISBT program In order for the trust to make these benefits available, expenses have been incurred and collectively we pay for these services The trust does not charge fees to make a profit and none of the trustees are paid for their work. Like you, they are all employed at an Independent School, which is a member of Cal-ISBOA and they volunteer their time There are two types of technology fees: The first is a $1,000 enrollment fee per school, which covers all the technology implementation costs The second monthly fee is $6.50 per employee, per month. This fee may decrease in the future as the trust grows in number of enrolled employees 20 Trust Termination Rules If we participate in the CISBT program and a year or two into it we decide to leave it, what do we have to do? Also, if we decide to come back to the CISBT program are there any restrictions? As long as you complete one full year of coverage with the trust, if your school decides to leave the CISBT program, you may do so
You will need to provide Cal-ISBOA with a 60-day written notice You will not be able to come back into the program for two years 21 Upon your return, you may be required to complete an Next Steps Interested in looking further into the trust? Look for census template, broker authorization sample letter, and other information on the Cal-ISBOA website Submit the required information to Bolton business cards are being passed out now 22 Online System Requirements For each participating school: School information: address, list of contacts and type of access requirement Workterra agreements: Remote Access Secure Site Business Associate Agreement Carrier Letters advising them that Workterra will be implemented Customized to each schools needs: Schools logo 23 Certain Lines of Coverage offered, outside of the trust offerings Online System Requirements For each participating school Feeds data to ancillary insurance carriers Will need carrier information for those outside the trust offerings Feeds data to payroll company Will need payroll vendor and contact information COBRA administration services
Will need detailed report on current COBRA participants and anyone in their election period (name, address, plans participating in, dependents covered, etc.) FSA administration services Will need detailed report on current FSA participants (election amount by FSA account, what has been used so far, etc.) 24 Absence Management Requirements For each participating school that would like a quote on implementing this service School information (address, main contact) Current paid time off policy Accrual definitions Absence types Period term Eligibility Carry over rules Administrative rules Current disability policy, if outside of the trust Contract Eligibility 25 Trust Requirements For each participating school School information (address, main contact, etc.) Membership agreement Banking information and school contact Authorization to automatically draw from their bank account 26 Medical Insurance The CISBT program offers 9 medical plans. HMO Plans PPO Plans
Premier HMO 10 100 Classic PPO 250 20 10 Classic HMO 20 250 125 Value HMO 30 40 500 3 day Value HMO 20 30 20% Traditional HMO Network 27 Classic PPO 500 30 20 Classic PPO 1000 30 20 HSA HDHP PPO Plans Lumenos LHSA497 Lumenos LHSA499 No HSA School Funding Required! Medical Insurance Benefit Attribute Value 20 30 20% PCP Office Visit Specialist Office Visit $10 copay $10 copay $20 copay $20 copay $30 copay
$40 copay $20 copay $30 copay Preventive Care No Charge No Charge No Charge No Charge Lab and X-Ray Advanced Imaging No Charge $100 per test No Charge $100 per test No Charge $100 per test 20% coinsurance $100 per test Out-of Pocket Max Ind. Out-of Pocket Max Fam. $1,500 $3,000 $2,000 $4,000 $3,000 $6,000 $3,500 $7,000
$155.08 $156.15 $153.43 $168.34 $234.68 $236.58 Employee + Family 34 DPPO Opt. 1 Participation Requirement 75% of schools eligible employees 75% of schools eligible employees 75% of schools eligible employees 75% of schools eligible employees Minimum Employer Contribution Requirement 75% for employee only 75% for employee only 75% for employee only
75% for employee only Vision Insurance Vision Options - Benefits Benefit Attribute Davis Vision Opt. 1 PPO Frequency Exam Lenses Frames 35 Non-PPO 12 Months 12 Months 24 Months VSP Opt. 2 PPO Non-PPO Every calendar year Every calendar year Every other calendar year VSP Opt. 3 PPO Non-PPO Every calendar year Every calendar year Every calendar year Eye Exam $10 copay Up to $50
$10 copay Up to $39 $10 copay Up to $39 Lenses Single Bifocal Trifocal $25 copay $25 copay $25 copay Up to $48 Up to $67 Up to $86 $25 copay $25 copay $25 copay Up to $23 Up to $37 Up to $49 $10 copay $10 copay $10 copay Up to $23 Up to $37 Up to $49 Contact Lenses $130 allowance Up to $105 $130 allowance
Up to $100 $130 allowance Up to $100 Frames $130 allowance Up to $48 $130 allowance Up to $46 $130 allowance Up to $46 Vision Insurance Vision Options Rates Rate Tier Employee Only 36 Davis Opt. 1 VSP Opt. 2 VSP Opt. 3 $8.00 $8.98 $13.98 Employee + Spouse $13.46 $15.12
$23.53 Employee + Child(ren) $13.73 $15.42 $24.00 Employee + Family $21.73 $24.40 $37.97 Participation Requirement 75% of schools eligible employees 75% of schools eligible employees 75% of schools eligible employees Minimum Employer Contribution Requirement 75% for employee only 75% for employee only 75% for employee only Group Life/AD&D Insurance Group Life and AD&D Plan Options BenefitsPlan
and Rates Benefit Attribute Opt. 1 Plan Opt. 2 Plan Opt. 3 Plan Opt. 4 37 Life and AD&D Amount $25,000 $50,000 $75,000 1 x annual salary to $300,000 Guaranteed Issue Limit $25,000 $50,000 $75,000 $300,000 Reduction Schedule To 65% at age 65, to 40% at age 70, to 25% at age 75, to 15% at age 80 To 65% at age 65, to 40% at age 70, to 25% at age 75, to 15% at age 80 To 65% at age 65, to 40% at age 70, to
25% at age 75, to 15% at age 80 To 65% at age 65, to 40% at age 70, to 25% at age 75, to 15% at age 80 Exclusions Suicide, war, riots, felony and substance abuse Suicide, war, riots, felony and substance abuse Suicide, war, riots, felony and substance abuse Suicide, war, riots, felony and substance abuse Waiver of Premium Included Included Included Included Accelerated Benefit Included Included Included Included
Conversion Included Included Included Included Rates Life Rate (per $1,000) AD&D Rate (per $1,000) $0.140 $0.020 $0.130 $0.020 $0.120 $0.020 $0.120 $0.020 Voluntary Life/AD&D Insurance Voluntary Life and AD&D Plan Options Benefits Benefit Attribute Life and AD&D Amount Employee Spouse Child 38 Plan Opt. 1 $10,000 increments to $500,000 (OE increase $50,000, not to exceed GI) $5,000 increments to $250,000 (not to exceed 50% of employee amount) $1,000 increments to $10,000 (not to exceed 10% of employee amount)
$500 infants (birth to 14 days) Guaranteed Issue Limit Employee Spouse Child $150,000 under age 65; $50,000 age 65-69; $10,000 for age 70+ $20,000 under age 65; $10,000 age 65-69 $10,000 or $500 Reduction Schedule To 65% at age 65, to 40% at age 70, to 25% at age 75, to 15% at age 80 Exclusions Suicide, war, riots, felony and substance abuse Waiver of Premium Included Accelerated Benefit Included Conversion Included Voluntary Life/AD&D Insurance Voluntary Life and AD&D Plan Options Rates Rate Age Bracket 39 Life Rate per $1,000 Under 20 $0.044 20-24
$2.458 Employee and Spouse Child AD&D Rate per $1,000 $0.030 Life Rate per $1,000 $0.156 Child AD&D Rate per $1,000 $0.030 Employee coverage must be elected before purchasing life/AD&D coverage for your spouse or child. Group LTD Insurance Benefit Attribute 40 Long Term Disability Plan Option Benefits and Rates Plan Opt. 1 Monthly Benefit Amount 66.23% Earnings Definition Gross monthly income before taxes, including any pre-tax contributions to a deferred compensation plan, excluding commissions, bonuses, overtime pay or other extra compensation Monthly Benefit Maximum $7,000
Elimination Period 90-Day Definition of Disability Unable to perform the material duties of your own occupation during the own occupation period. After two years, you must be unable to perform the material duties of any occupation for which you are reasonably fit by education, training, and experience. Benefit Duration To SSNRA Pre-Existing Limitations 3/12 LTD Rate (per $100 of covered payroll) $0.180
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