Agenda Item   

AGENDA STAFF REPORT

 

                                                                                                                        ASR Control  22-000605

 

MEETING DATE:

07/19/22

legal entity taking action:

Board of Supervisors

board of supervisors district(s):

All Districts

SUBMITTING Agency/Department:

County Executive Office   (Approved)

Department contact person(s):

Kim Derrick (714) 834-2564 

 

 

Diana Banzet (714) 834-2978

 

 

Subject:  Approve Amended Self-Funded PPO Health Plan Documents

 

      ceo CONCUR

County Counsel Review

Clerk of the Board

          Concur

Approved Resolution to Form

Consent Calendar

 

 

3 Votes Board Majority

 

 

 

    Budgeted: N/A

Current Year Cost:   N/A

Annual Cost: N/A

 

 

 

    Staffing Impact:

No

# of Positions:            

Sole Source:   N/A

    Current Fiscal Year Revenue: N/A

  Funding Source:      N/A

County Audit in last 3 years: No

 

 

    Prior Board Action:         9/28/2021 #16, 11/3/2020 #15, 9/10/2019 #9, 6/4/2019 #41

 

RECOMMENDED ACTION(S):

 

 

1.

Authorize the Chief Human Resource Officer or designee to approve the Wellwise Medicare Retiree and Wellwise Non-Medicare Retiree Health Plan Documents effective January 1, 2023.

 

 

2.

Authorize the Chief Human Resource Officer or designee to approve the Sixth Amended and Restated Sharewell Choice Health Plan Document and the Seventh Amended and Restated Sharewell Retiree Health Plan Document effective January 1, 2023.

 

 

3.

Authorize the Chief Human Resource Officer or designee to approve the Seventh Amended and Restated Wellwise Choice Health Plan Document effective January 1, 2023.

 

 

4.

Authorize the Chief Human Resource Officer or designee to transition to the Employer Group Waiver Plan for the Wellwise Retiree Health Plan.

 

 

 

 

SUMMARY:

 

Approval of the Amended and Restated Sharewell Choice and Sharewell Retiree Plan Documents and Amended and Restated Wellwise Choice Plan Document for the 2023 Plan Year will reflect coverage changes. Approval of the Wellwise Medicare Retiree and Wellwise Non-Medicare Retiree Plan Documents will allow the County to differentiate Medicare eligible retirees and incorporate language permitting the County to establish and apply for the Employer Group Waiver Plan.

 

 

BACKGROUND INFORMATION:

 

The County offers self-insured PPO health plans for County employees and retirees and their eligible dependents. The two current self-insured active employee PPO health plans are Wellwise Choice and Sharewell Choice. The two current self-insured retiree PPO health plans are Wellwise Retiree and Sharewell Retiree.

 

The Wellwise Medicare Retiree and Wellwise Non-Medicare Retiree Plan Documents are being established to separate Medicare eligible retirees and incorporate language in the Plan Documents which is required by the Center for Medicare and Medicaid Service (CMS) for the County to qualify for the Employer Group Waiver Plan (EGWP) subsidies.

 

Currently, the County does not differentiate Medicare eligible retirees under the Wellwise Retiree Health Plan and applies for the Medicare Part D federal Retiree Drug Subsidy (RDS) under the Medicare Prescription Drug, Improvement and Modernization Act of 2003. Medicare provides incentives to Plan sponsors, such as the County, to provide prescription drug coverage to retirees that do not enroll in Medicare Part D. RDS is used to reduce rates for Medicare-eligible retirees and spouses enrolled in the Wellwise Retiree PPO Plan.

 

RDS has been declining over the last few years. This has prompted the County’s health and welfare benefits consultant, Mercer Health and Benefits, LLC (Mercer) to look at alternatives to RDS. Currently RDS provides approximately $425,000 in reimbursement. Subsidies under the EGWP are projected to generate $1,500,000 in reimbursement. Based upon this significant increase in reimbursement, Mercer recommends that the County transition to the EGWP. HRS is requesting authorization to implement the EGWP for the Wellwise Retiree Health Plan.

 

In addition, all of the Wellwise Choice and Sharewell Plan Documents are being updated to make clarification to the following benefits:

 

·          

Include prescription strength vitamins in the formulary

·          

Apply 30-day member cost share to any unbreakable package of greater than 30 days.

 

The Plan Documents are on file with Clerk of the Board.

 

PRIOR BOARD OF SUPERVISORS (BOARD) ACTIONS:

 

On September 28, 2021, the Board approved the sixth amended and restated Wellwise plan documents and the fifth amended and restated Sharewell plan documents effective January 1, 2022.

 

On November 3, 2020, the Board approved the fifth amended and restated Wellwise plan documents and the fourth Amended Sharewell plan documents effective January 1, 2021.

 

On September 10, 2019, the Board approved the corrected versions of the fourth amended Wellwise Plan documents and the third amended Sharewell plan documents effective January 1, 2020.

 

On June 4, 2019, the Board approved the fourth amended Wellwise plan documents, effective January 1, 2020.

 

 

 

FINANCIAL IMPACT:

 

There is no financial impact to the County. The EGWP reimbursement will be incorporated into the 2023 Medicare Wellwise rates that will be provided to the Board in July. Retirees are fully responsible for the cost of their health plan premiums.

 

 

 

STAFFING IMPACT:

 

N/A

 

ATTACHMENT(S):

 

Attachment A – Redline Changes Wellwise Choice Health Plan Document
Attachment B – Redline Changes Sharewell Choice Health Plan Document
Attachment C – Redline Changes Sharewell Retiree Health Plan Document
Attachment D – Wellwise Medicare Retiree Health Plan Document
Attachment E – Wellwise Non-Medicare Retiree Health Plan Document