“The CIGNA plans continue to offer better benefits with greater freedom of choice and fewer restrictions than TRS at competitive deductions along with its annual contribution to the Health Savings Account.”
The El Paso Independent School District was the second Texas public school district to challenge TRS ActiveCare mandates in 2019 (Second Texas School District Challenges TRS ActiveCare Mandate.
Below are excerpts from a plan update given recently to the Board of Trustees:
Based on claims and trends evaluated, the initial recommendation was to increase the Self-Funded Health Plan from $435 pepm to $493 pepm. (11.7% funding increase – see Presentation)
Given the update from TRS-AC, Administration is recommending that the current district contribution towards employee health coverage remain the same at a maximum of $435 per employee per month for both the CIGNA Self-funded plan and TRS-AC plans.
With the objective to make sure that the health plan revenues will cover increased medical expenses due to inflationary trends and accomplish growth in reserve funding, HUB International recommends that the Health Care Fund be supported with a maintenance of fund allocation in the amount of $4,200,000. (Reserves)
Health Care & TRS Active Care Update
The Raymondville Independent School District (RISD) was the first district to challenge TRS ActiveCare (Texas School District Challenges TRS ActiveCare Plan Mandates).
The new RISD program is a Reference Based Pricing – PCP Centric plan administered by Centivo (www.centivo.com), an independent TPA, while the EPISD’s is a traditional PPO plan administered by Cigna. Benefit levels between the two plans vary as do funding levels.
RISD enjoys better benefits at lower unit costs. How can that be? RISD is a small group of +300 employees while EPISD is a 5,000 pound gorilla. In addition health care costs in the Lower Rio Grande Valley where RISD is located is considered one of the highest health care cost centers in the World:
“McAllen, Texas, the most expensive town in the most expensive country for health care in the world, seemed a good place to look for some answers.” The Cost Conundrum | The New Yorker
RELATED BLOG POSTS: South Texas Health System Defends 920% Price Markup The Case of The $153,887 Kidney Stone
It is important for the reader to bear in mind neither EPISD or RISD had the benefit of experience rating (TRS AC does not provide member districts with their own claim experience history). Without the benefit of experience rating risk, underwriting both cases was necessarily challenging and problematic.
How will Raymondville’s first year renewal compare to El Paso’s? TRS ActiveCare, legislators and district officials around the state are watching with interest……..
RiskManagers.us is a specialty company in the benefits market that, while not an insurance company, works directly with health entities, medical providers, and businesses to identify and develop cost effective benefits packages, emphasizing transparency and fairness in direct reimbursement compensation methods.
The shared vision of RiskManagers.us and clients who retain our services is to establish and maintain a comprehensive employee health and welfare plan, identify cost areas that may be improved without cost shifting to any significant degree, and ensure a superior and sustained partnership with a claim administrator responsive to members needs on a level consistent with prudent business practices.
Plan costs, in all areas including fixed expenses and claims are open for review on a continuing basis. Cost effective plan administration and equitable benefit payment to providers are paramount to fulfilling our mutual fiduciary duties. As we proactively monitor and manage an entire benefit program we are open to any suggestions members may make or the dynamic health benefit market may warrant in order to accomplish these goals.
Duty of loyalty to our clients, transparency and accountability are essential to the foundation of our services. To that end, we expect our clients to realize a substantial savings based upon the services that we will deliver.
2020 RiskManagers.us All Rights Reserve
