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INFORMAL REPORT TO CITY COUNCIL MEMBERS No. 8493
To the Mayor and Members of the City Council may 13, 2003
Page 1 of 5
SUBJECT: GROUP HEALTH AND LIFE INSURANCE FUND
fins UPDATE—SECOND QUARTER REPORT— FY2002-2003
PURPOSE:
Reports on health benefits and on the Group Health and Life Insurance Fund (FE85) have been
provided to the City Council on a quarterly basis, since the City 's health benefit program became
self-insured on October 1, 2001.
This Quarterly Report for the second quarter of fiscal year FY2002-03 provides an update on
claims costs, the status of the Group Health and Life Insurance Fund (Fund FE85), and a brief
summary of issues/concerns with the health benefit plans.
UPDATE ON CLAIMS/EXPENSE COSTS TO DATE:
The City's health benefit plans were restructured effective August 1, 2002, in order to be more
comparable to other employers and to reduce costs through "risk sharing." At the same time,
contribution rates were increased. The first six months of FY2002*03 reflect the effects of those
changes.
October 2002 — March 2003
orr/ 1111
Total Claims Paid Total Paid Funding
Revenue Reported Claims from Claims Plus Surplus
received in From UHC Fund FE 85 Admin. Fees (Deficit)
Fund FE 85 from Fund Fund FE 85
FE 85
OCT '02 3,664,141 3,597,289 2,316,783 2,626,658 1,037,483
NOV '02 3,788,882 2,645,989 3,093,095 3,403,696 385,186
DEC '02 3,357,507 3,024,928 2,461,126 2,772,597 584,910
JAN '03 4,099,582 2,711,258 3,050,827 3,359,494 740,088
FEB '03 3,698,912 3,062,465 2,9537,755 3,265,689 433,223
MAR'03 3,986,691 3,024,533 3,0961471 1 3,518,211 1 468,480
Total 22,595,715 18,066,462 16,976,057 1 18,946,345 1 3,649,370
During the first quarter the cumulative funding surplus was $2,007,579 or 18.5% of all revenue.
In the second quarter, the cumulative funding surplus resulting in $1,641,791 or 14% of all
revenue. It is expected that the quarterly cumulative surplus will continue to decline, based upon
the Medical cost inflationary trend of 15% this fiscal year.
ISSUED BY THE CITY MANAGER FORT WORTH, TEXAS
INFORMAL REPORT TO CITY COUNCIL MEMBERS No. 8493
To the Mayor and Members of the City Council May 13, 2003
Page 2 of 5
SUBJECT: GROUP HEALTH AND LIFE INSURANCE FUND
UPDATE —SECOND QUARTER REPORT— FY2002-2003
STATUS OF THE GROUP HEALTH AND LIFE INSURANCE FUND:
The current status of the Group Health and Life Insurance Fund through the 2nd quarter of
FY2002-03 is provided below:
Beginning Fund Balance as of September 30, 2002* $ 6,789,084
Actual Revenue (10/1/02 — 3/31/03) 22,595,715
Actual Expenses (1011,102- 3/31/03) (19,248,355)
Fund Balance as of 3131/03 10,136,443
Claims reported but not paid by City (1011/02 — 12/31/02) ($1,090,405)
Adjusted Fund Balance as of 3/31/03* $ 9,046,038
The projected status of the Group Health and Life Insurance Fund for FY02-03 is as follows:
Beginning Fund Balance as of September 30, 2002* $ 6,789,084
Projected Revenue (10/1/02 — 9/30/03) 44,608,732
Projected Expenses (10/1/02- 9/30/03) (41,085,198)
Projected Fund Balance as of 9/30/03 $10,312,618
Preliminary fund balance, pending any final audit adjustments
SUMMARY OF CONCERNS WITH THE HEALTH BENEFIT PLANS:
The Health Benefit Advisory Committee is evaluating several issues and concerns:
(1) Medicare-eligible retirees and/or retirees with Medicare-eligible dependents continue to
raise issues about the fairness of the contribution rates. Medicare-eligible retirees have
the same contribution rate as non-Medicare-eligible retirees and, in addition, pay the
monthly premium for Medicare Part B. Furthermore, because Medicare is the "first payer'
of health care claims for these retires, their cost to the City's health plan is significantly less
than that of non-Medicare-eligible retirees.
ISSUED BY THE CITY MANAGER FORT WORTH, TEXAS
INFORMAL REPORT TO CITY COUNCIL MEMBERS No. 8,493
To the Mayor and Members of the City Council May 13, 2003
Page 3 of 5
SUBJECT: GROUP HEALTH AND LIFE INSURANCE FUND
.UPDATE —SECOND QUARTER REPORT— FY2002-2003
fell
The Health Benefit Advisory Committee established an ad hoc committee several months ago
to examine this issue and to determine whether the City should consider defraying any portion
of the cost of Medicare Part B and/or establish a different cost-sharing with such retirees.
Because of the complexity of the issue, the Ad Hoc Committee has not reached a final
conclusion yet. The issue involves the following components:
• The City's current policy provides for one plan of health coverage at no cost to the
retiree for those retirees hired before October 5, 1988. The policy recognizes only
costs associated with the plans sponsored by the City and does not consider costs
charged by the federal government to Medicare participants for Part B insurance..
• Beginning in January 2003, the City required United HealthCare to coordinate benefits
with Medicare for Medicare-eligible retirees whether or not -those retirees had
Medicare Part B. The City does not require such retirees to purchase Medicare Part
B.
• Based on preliminary data, claims costs per retiree under the City's health care plans
for Medicare-eligible retirees are significantly less than the claims cost per retiree for
non-Medicare-eligible retirees. Prior to August 2002, the City provided the "high-
/` option" plan at no cost to the Medicare-eligible retirees in recognition of the fact that
their claims costs were lower. However, since August 2002 the City's "low-option"
plan is the plan that is offered at no cost to all retirees regardless of their Medicare
status.
• Although the plans sponsored by the City on behalf of its active and retired employees
do benefit from the risk assumed by Medicare (as it does when the City plans are
secondary to any other coverage), the Medicare-eligible retiree also benefits by
having a large portion of the deductible and co-insurance satisfied by Medicare
payments in the event of any serious health problem resulting in hospitalization. Both
the City and the Medicare-eligible retiree benefit from the Medicare status of that
retiree.
• Prior to May 16, 1986, the City did not contribute into Medicare for its employees.
Most retirees who are Medicare-eligible at this time established that eligibility through
a different employer.
In order to resolve this issue, staff and the committee are continuing to analyze data from United
HealthCare that compare the average out-of-pocket expenses for Medicare-eligible retirees to
non-Medicare-eligible retirees to ascertain whether or not any significant difference exists. In
addition, they are analyzing the claims costs of Medicare-eligible retirees and non-Medicare-
eligible retirees to determine if this analysis will be helpful in determining the proposed
contribution rates for the 2004 plan year.
2) Some members have requested that the City either: (1) allow the $1,000 or $500 deductible
required for the Classic and the Performance Plans respectively, which was satisfied in the
ISSUED BY THE CITY MANAGER FORT WORTH, TEXAS
INFORMAL REPORT TO CITY COUNCIL MEMBERS No. 8493
To the Mayor and Members of the City Council May 13, 2003
CAP PAT IF
Page 4 of 5
SUBJECT: GROUP HEALTH AND LIFE INSURANCE FUND
UPDATE -SECOND QUARTER REPORT- FY2002-2003
2002 plan year, to apply to an entire year (from August 2002 through July 2003); or (2) allow
any expenses which applied to the deductible and which were established in the 4th quarter of
the last calendar year to be carried over to the 2003 plan year.
A 4th quarter carryover generally means that if a person has failed to meet the deductible
during the calendar year, the amount of eligible expenses incurred between October 1st and
December 31st would be carried forward to the next calendar year's eligible expenses. If a
person had met the deductible prior to the 4th quarter, nothing would be carried forward for
consideration with eligible expenses incurred in calendar year 2003.
Based upon United HealthCare's estimate, the inclusion of a 4th quarter benefit would result
in $500,000 to $1 million in additional, unfunded costs to the plan. Moreover, United
HealthCare has informed staff that the retroactive adjustment required to include the benefit
would be extremely difficult, if not impossible to administer and would result in additional
administrative fees. Based upon the estimated additional, unfunded cost to the plan and the
difficulty in administering such a retroactive benefit, the Health Benefit Advisory Committee
does not support nor recommend the implementation of a Carryover Provision.
(3) The contract with United HealthCare allows for two audits during the first contract period
(10/01-12/02). The City's Internal Audit Department has conducted the first audit of United
HealthCare's claims paying process and its performance on the contract guarantees.
The focus of the audit was on the period 10/1/01 through 6/30/02. The audit identified
$51,316 in overpayments by United HealthCare (less than .2% of claims). The Internal Audit
Department also identified an additional $29,245 of overpayments that was outside the scope
of the initial audit but will be pursued in the second audit that will be performed by a
contracted auditor. The Internal Audit Department indicated that United HealthCare needed
improvement in its subrogation efforts, fraud and abuse management, and alternate benefit
program management.
Staff will continue to work with United HealthCare to ensure contractual compliance and to
correct the deficiencies identified by the Internal Audit Department. Human Resources staff,
Internal Audit staff and the Health Benefit Advisory Committee are in the process of selecting
a contracted auditor that specializes health plan audits. It is anticipated that the second audit
will begin in September 2003.
(4) The Healthy Challenge Wellness Program is in its second year. Staff has recently
completed the 2nd Health Risk Assessment (HRA) health screening. This assessment
includes a written survey about healthy lifestyle behaviors. This year a total of 1,338
employees participated. Of the 1,338 employees, 939 participated in the program last year.
ISSUED BY THE CITY MANAGER FORT WORTH, TEXAS
e
INFORMAL REPORT TO CITY COUNCIL MEMBERS No. 8493
To the Mayor and Members of the City Council May 13, 2003,
Page 5 of 5
V
SUBJECT: GROUP HEALTH AND LIFE INSURANCE FUND
UPDATE —SECOND QUARTER REPORT— FY2002-2003
Results from the screening show a definite improvement in various risk factors related to
cholesterol levels and blood pressure. In addition to the improvement in individual risk factors,
there was a significant decrease in the number of participants who had five or more risk
factors. Due to individuals moving from the high risk factor status into a lower risk factor
status, there was an increase in those lower risk status groups.
5+ Risk Factors (High) 56% 36%
2-4 Risk Factors (Med) 40% 53%
0-1 Risk Factors (Low) 4% 11%
The Wellness Program offered incentives (monetary or time off work) to the 939 participants who
also participated the year before and who demonstrated healthy lifestyle behaviors: $97,900 will
be paid out to those who selected the monetary incentive and 4,485 hours of wellness leave time
will be credited to those employees who selected leave time as their incentive.
Since the City has limited claim information on the current program participants, it is too early to
r,"ietermine the direct impact on health claims costs and benefit plan utilization. It is anticipated
that the staff will be able to conduct a preliminary analysis and gather baseline claims information
on Wellness Program participants around December 2003.
(5) Effective Plan Management (EPM), the current health plan consultant, informed staff that it will
not renew its contract with the City of Fort Worth after the current contract expires in
December 2003. Staff is in the process of soliciting proposals for a new health plan
consultant. Staff and the Health Benefit Advisory Committee will evaluate all proposals and a
consultant will be selected before the end of the calendar year.
In summary, the changes in the health, plans and in the contribution rates in August 2002 appear
to be having the desired result. Staff continues to recommend that few, if any, plan changes or
administrative changes be made that could increase the cost of the plans unless additional
funding is authorized.
Should you have any questions regarding this report, please contact Linda Cobb, Human
Resources Director, or Richard Zavala, Acting Assistant City Manager.
Garry W. Jackson
1tv M� aer
ity Manager
ISSUED BY THE CITY MANAGER FORT WORTH, TEXAS