What's New/Changing for Staff & Non-Bargaining Unit Faculty?

Cost Drivers and Key Considerations:

  1. Benefits continue to represent approximately 18% of our total unrestricted budget of which medical is the primary controllable cost.
  2. A $2 million inflation cost increase is expected for 2019 which cannot be fully absorbed by the university.
  3. Premiums will continue to be targeted at 20% average employee cost share.
  4. Emergency room utilization for non-emergency visits continues to increase.
  5. A significant increase in pharmacy expected to continue and is influenced by expansion of specialty drugs.
  6. Medical expenditures for spouses continue to exceed the medical costs for employees.

Plan Design Changes

To address the annual medical and pharmacy inflation noted above, the various medical plan design components were discussed. Since the deductibles and out-of-pocket-maximums were significantly increased in 2018, they will remain unchanged in 2019. In addition, the employer contribution to the Health Savings Account had been lowered the last few years, and will remain unchanged in 2019.

The medical plan design changes are limited to copay amounts in the PPO 80/20 plan and to address pharmacy, we are moving to a new formulary which impacts both the PPO 80/20 and HDHP plans.

Medical Plans Design:  PPO 80/20

Benchmark comparisons indicated we had some room to move selected copays. The Primary Care Physician was left unchanged while the Specialty and Urgent Care copays were increased $5 and $10 respectively.  The most significant change is the Emergency Room copay.

Our experience for the emergency room (ER) has seen an increase in visits for non-emergency care.  For example, 10% of the visits in 2017 were related to the common cold, nose and throat infections, outpacing every other reason for ER visits.  Thus raising the copay will incent utilization of the ER for only emergency care.  Lower cost alternatives for non-emergency visits will save both employee and employer dollars, e.g. urgent care, primary care physicians, Livehealth Online, and 24/7 Nurseline.

This table presents the copay changes for 2019:

PPO (80/20)

2019

Change

Specialty Copay

$40

$5

Urgent Care Copay

$50

$10

Emergency Room Copay        (waived if admitted)

$300

$100


Pharmacy Formulary (PPO 80/20 and HDHP)

With increased pharmacy costs impacting employers across the United States, everyone is seeking alternative costs initiatives. Specialty drugs is one area of pharmacy that is drastically expanding and difficult to control, therefore, employers have been focusing on what they can control, the non-specialty drug market, asking what can be done? Anthem, has addressed this need with the offering of an alternative formulary that provides cost savings while maintaining a high-quality and affordable list of both generic and brand name drugs. They have been providing this formulary to both their fully-insured and self-insured customers.

We will be moving to this formulary, titled Essential Drug List, effective January 1, 2019.

This formulary is a list of brand-name and generic prescription medications that have been selected and are periodically reviewed by Anthem’s physicians.  It includes FDA approved drugs that are proven effective and ensures no gaps in care.    

Changes you might encounter:

  • Drugs with an over-the counter equivalent will no longer be offered
  • Drugs shift tiers
  • If there are alternatives, Drugs may no longer be available
  • Select drugs might now require precertification
  • Drugs with no over-the counter or a lower-cost alternative will remain on the plan

90% of current utilized prescriptions will remain unchanged.  Anthem will be mailing letters to impacted members the week of October 22. 

Spousal Added Fee

A continued trend on our medical expenditures the last several years is that spouses on our plans are driving higher costs than our employees. To address this concern, various employers have implemented a spouse strategy, including several IUC universities and local institutions, Sinclair Community College and University of Dayton. The benchmark for a spouse fee is $75 to $140 per month. 

Wright State will be implementing a spousal added fee for anyone covering a spouse on our medical plan effective January 1, 2019. It will be applicable to Employee + Spouse and Employee + Family coverages. This spousal added fee will be tiered by the three salary levels, ranging from $32 in Tier 1 to $68 for Tier 3. It will be presented separate from the medical plan premiums but will be added to the monthly or biweekly premiums costs within the online enrollment. 

The spousal added fee was intentionally listed as a separate component.  If the trend reverses and our costs for spouses become more aligned with employees, the added fee would be re-evaluated.   

Salary Tier

< $47,000

$47,000 - $75,000

> $75,000

Medical Spousal Added Fee*

$32

$50

$68

                * Does not apply to dental and vision premiums.
 

IRS increased Health Savings Account (HSA) Contribution Limits

The IRS issued the 2019 annual contribution limits listed below, increasing the Single coverage by $50 and Family coverage by $100.

  • $3,500 for Single coverage
  • $7,000 for Family coverage
  • $1,000 additional for HSA catch-up contributions (age 55 or older)

According to the IRS, it is your personal responsibility to ensure that you do not exceed these HSA contribution limits.  You can determine your total HSA contributions by adding the following:

  • Wright State University contributions, and
  • Your personal paycheck contributions

The Wright State University contribution to the Health Savings Account for 2019 remains unchanged.  There will be two semi-annual deposits as follows:

 Wright State University’s HSA Contribution

     Staff & Non-Bargaining Unit Faculty

Coverage

January 4

July 5

Total

     Employee

$250

$250

$500

     Employee + child(ren)

$500

$500

$1,000

     Employee + spouse

$500

$500

$1,000

     Employee + family

$500

$500

$1,000


Flexible Spending Accounts

The IRS has not released the 2019 limits for FSA Healthcare or FSA Dependent Care.

Employee Premium Cost-Share

For 2018, we moved to a 20% employee cost-share for premiums.  For 2019, to maintain the 20% cost-share, the premiums would have had to increase an average of 8%.  To reduce this increase, the decision was made to implement a temporary slight reduction in the employee cost-share to 19.5%, which lowered the average premium increase to 5.2%.  

Our goal for the future remains to be as close as possible to the 20% employee cost-share.

Medical Premiums

As established in 2018, the premium structure continues to be a 4-step process:

  1. Horan Associates, our benefit consultant, provided the following total cost projections: 

Coverage

Ratio

PPO 80/20

 HDHP

  Employee

1.0x

    $606

   $534

  Employee + child(ren)

1.8x

 $1,098

   $962

  Employee + spouse

2.2x

 $1,342

$1,170

  Employee + family

3.0x

 $1,828

$1,598

  1. These total costs were multiplied by 19.5% to obtain the employee cost share: 

Coverage

Ratio

PPO 80/20

 HDHP

  Employee

1.0x

 $118

  $104

  Employee + child(ren)

1.8x

 $214

 $188

  Employee + spouse

2.2x

 $262

 $228

  Employee + family

3.0x

 $356

 $312

  1. The three tier structure remains unchanged with the current salary levels providing an equal distribution of employees over the three tiers. 

Tier 1

Tier 2

Tier 3

< $47,000

$47,000 - $75,000

> $75,000

1/3 employees

1/3 employees

1/3 employees

  1. The premiums for Tier 2 represents the 19.5% cost share noted in Step 2 above.  The discount value for Tier 1 equals the additional percentage assigned to Tier 3. Consistent with the 1/3 guidance in Step 3, we established Tier 1 to represents 67% of Tier 2 premiums (a 33% decrease) and Tier 3 to represent 133% of Tier 2 (33% increase).

Tier 1

Tier 2

Tier 3

< $47,000

$47,000 - $75,000

>$75,000

67%

100%

133%

The resulting monthly medical premiums for 2019 are as follows:

Plan

Coverage

< $47,000

$47,000 - $75,000

> $75,000

PPO 80/20

 Employee

  $80

$118

$158

 Employee + child(ren)

$144

$214

$286

 Employee + spouse

$176

$262

$348

 Employee + family

$240

$356

$472

 

 

 

 

 

HDHP

 Employee

  $70

  $104

$138

 Employee + child(ren)

$126

$188

$250

 Employee + spouse

$154

$228

$302

 Employee + family

$210

$312

$416

The spousal added fee mentioned above will be in addition to the premiums listed in this chart.


Dental and Vision Premiums

The dental and vision premiums were developed similar to the medical premiums with the total cost spread over the four coverage levels utilizing the same relationship ratio as medical.  The 20% employee cost share was applied to the total costs.  These premiums will remain one tier.

Coverage

Ratio

Delta Dental of Ohio

 Vision Service Plan (VSP)

  Employee

1.0x

   $7.40

  $1.60

  Employee + child(ren)

1.8x

 $13.32

 $2.88

  Employee + spouse

2.2x

 $16.28

 $3.52

  Employee + family

3.0x

 $22.20

 $4.80


Castlight (transitioning to Anthem Engage on January 1)

Anthem is launching a new comprehensive digital health platform for members nationwide. The platform, called Anthem Engage, comes out of the company's partnership with Castlight Health. The digital tool creates a personalized member experience by connecting health plan and benefits data with individual clinical and claims data. Engage will also help members make better cost and quality decisions when accessing care. Wright State will transition to Anthem Engage beginning January 1, 2019. 

Current Castlight enrollees will be automatically added to Anthem Engage on January 1, 2019. Those with phone apps will need to reestablish after January 1. 

Not enrolled in Castlight?  Enroll by December 1, 2018, and automatically be added to Anthem Engage. 

As a reminder, you can use Castlight to:

  • Save on the care you need. Find doctors, hospitals, medical services, and prescriptions. Compare them by cost and quality.
  • Understand your plan. See simple descriptions of your medical plan and what’s covered.
  • Review past expenses. Learn where you are in your deductible phase and how much you paid and why, so you can plan for the year ahead.
  • Make smart choices. Receive personalized recommendations based on your past care and in-network options.

To start using Castlight CLICK HERE or to download the mobile app CLICK HERE.

Castlight is provided free of charge for adults enrolled in a Wright State medical plan.

Watch your email for more information on Anthem Engage!


Reminder: $50 Late Enrollment Fee

Wright State University believes it’s important for each employee to take the time to understand their healthcare options so they can select the coverage that best suits their needs and their budget. Regardless of current coverage, you must take action online to continue, change, enroll or waive your 2019 healthcare coverage.

A $50 late enrollment fee has been established to encourage our workforce to take action and submit their benefit elections during the November 1st through November 14th open enrollment.  Those who do not take action, will have the $50 late fee deducted from their January 2019 paycheck.

Enroll by the deadline to avoid a one-time $50 late enrollment fee!


New Anthem Medical Cards

New Anthem Medical Cards will be sent to the following employees:

  • All participants enrolled in the PPO 80/20 plan
  • New participants in the HDHP plan
  • Addition of a spouse or dependent(s)

NOTE:  If you are in the HDHP plan today, and continue in 2019, your current Anthem cards will continue to be applicable in 2019. 

Your new Anthem insurance cards will be mailed to your home address. 

  • In addition, you can access a copy of your new card at www.anthem.com or on Anthem’s or Castlight’s mobile app late in December.
  • Remember to provide your new card to your medical and pharmacy providers.