Active Medical and Dental Benchmarking
Retirement Related Benefits
(Excludes Federal Government)
November, 2016
Prepared by Aon Hewitt
Health & Benefits Consulting
About the Study
Current State
Medical Benchmarking
2017 Medical/ Rx Recommendations
Dental Benchmarking
Retirement Related Benefits
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Current Medical/ Dental State - Offerings
 Two medical/prescription vendors (prescription is carved in)
– CIGNA
– Kaiser
 Three medical plans offered to Actives
Enrollees
Plans Offered
Actives
CIGNA High Plan
1,016
CIGNA Low Plan
734
Kaiser HMO
1,695
 One dental plan offered to Actives – Delta Dental
Enrollees
Plans Offered
Actives
Delta Dental PPO Premier
3,176
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2
Active Medical Benchmarking
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Active Healthcare Plan – Current Medical Plan Offerings
Benchmarked Arlington Public School’s medical and Rx plans against 14 local employers:
Medical Vendors
Low Option
High Option
HMO Option
Arlington Public
Schools
CIGNA
Kaiser
√
√
√
Alexandria City
Public Schools
United Healthcare
Kaiser
√
Anne Arundel
County Public
Schools
CareFirst
√
Arlington
County
Government
CIGNA
Kaiser
Baltimore City
Public Schools
CareFirst
United Healthcare
Kaiser
√-
Baltimore
County Public
Schools
Anthem
√
D.C. Public
Schools
Aetna
Kaiser
United Healthcare
Fairfax County
Public Schools
Aetna
Kaiser
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√
√-2
√
√
CDHP
√-3
√- 3
√-3
√-2
√
√-3
√
√
√
4
Active Healthcare Plan – Current Medical Plan Offerings
Benchmarked Arlington Public School’s medical and Rx plans against 14 local employers:
Medical Vendors
Low Option
High Option
HMO Option
Arlington Public
Schools
CIGNA
Kaiser
√
√
√
Falls Church
Public Schools
Anthem
Frederick
County Public
Schools
UHC
Howard County
Public Schools
Aetna
CareFirst
Loudoun County
Public Schools
CIGNA
√
Montgomery
County Public
Schools
CIGNA
CareFirst
Kaiser
√-2
Prince George’s
County Public
Schools
CareFirst
√
√
Prince William
County Public
Schools
Anthem
√
√-2
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√-2
√
√
√
CDHP
√-2
√
√-3
√
5
Assessment of APS’ In-Network Active Medical Health Program Design –
Cigna High Option
 APS’ primary benefit features compared to local employers
– Richness of benefits from employees’ standpoint relative to the benchmark employers with same
type of plan
Arlington Public Schools
Cigna High Option
VA Schools
MD /DC Schools
(In-Network)
Deductible
Individual / Family
$300/
$600
$0-$500/
$0-$1,000
$0- $750/
$0-$1,500
Out of Pocket Maximum
Individual/Family
$3,000/
$6,000
$1,500-$4,000/
$3,000-$8,000
$500-$6,350/
$1,500-$12,700
PCP
$20
$20-$25
$5- $20
Specialists
$40
$35-$50
$10-$30
Coinsurance
10%
0%-20%
0%-15%
$0-$400
$0
$0-$200
$0
Inpatient Hospital
Outpatient Facility
$250 copay +
coinsurance
$100 copay+
coinsurance
Emergency
$200
$0-$200
$25-$100
Urgent Care
$50
$0-$50
$10-$30
Note: VA Schools range includes Arlington County Government
APS is not as rich
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APS is within range
APS is richer
6
Assessment of APS’ Out-of-Network Medical Active Health Program
Design – Cigna High Option
 APS’ primary benefit features compared to local employers
– Richness of benefits from employees’ standpoint relative to the benchmark employers with same
type of plan
Arlington Public Schools
Cigna High Option
VA Schools
MD/DC Schools
(Out-of-Network)
Deductible
Individual / Family
$750/
$1,500
$300-$1,000/
$600-$2,000
$100-$1,500/
$300-$3,000
Out of Pocket Maximum
Individual/Family
$3,750/
$7,500
$2,500-$7,000/
$5,000-$14,000
$500-$3,000/
$1,000-$6,000
PCP
30%
30%-40%
20%-25%
Specialists
30%
30%-40%
20%-25%
Coinsurance
30%
30%-40%
10%-25%
$0-$400
$0
$0-$200
$0
Inpatient Hospital
Outpatient Facility
$250 copay +
coinsurance
$100 copay+
coinsurance
Emergency
$200
$0-$200
$25-$100
Urgent Care
$50
$0-$50
$10-$30
Note: VA Schools range includes Arlington County Government
APS is not as rich
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APS is within range
APS is richer
7
Assessment of APS’ In-Network Active Medical Health Program Design –
Cigna Low Option
 APS’ primary benefit features compared to local employers
– Richness of benefits from employees’ standpoint relative to the benchmark employers with same
type of plan
Arlington Public Schools
Cigna Low Option
VA Schools
MD Schools
(In-Network)
Deductible
Individual / Family
$400/
$800
$0-$250/
$0-$500
$0
Out of Pocket Maximum
Individual/Family
$3,000/
$6,000
$1,000- $3,000/
$2,000- $6,000
$1,000- Unlimited/
$2,000- Unlimited
PCP
$40
$20
$5-$20
Specialists
$80
$20-$40
$10-$30
Coinsurance
20%
0%-10%
0%
$0-$250 copay
$0-$100
$0-$200 copay
$0-$20 copay
Inpatient Hospital
Outpatient Facility
$250 copay +
coinsurance
$100 copay+
coinsurance
Emergency
$250
$125-$200 copay
$50-$100 copay
Urgent Care
$50
$20-$50 copay
$0-$20 copay
Note: DC Public Schools does not have this plan option
APS is not as rich
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APS is within range
APS is richer
8
Assessment of APS’ Out-of-Network Active Medical Health Program
Design- Cigna Low Option
 APS’ primary benefit features compared to local employers
– Richness of benefits from employees’ standpoint relative to the benchmark employers with same
type of plan
Arlington Public Schools
Cigna Low Option
VA Schools
MD Schools
(Out-of-Network)
Deductible
Individual / Family
$800/
$1,600
$500-$750/
$1,000-$1,800
$100-$300/
$100-$600
Out of Pocket Maximum
Individual/Family
$5,000/
$10,000
$2,000-$4,000/
$4,000-$9,000
$1,000-$1,250/
$2,000- $2,500
PCP
40%
20%-40%
20%-30%
Specialists
40%
20%-40%
20%-30%
Coinsurance
40%
20%-40%
20%-50%
$0-$150 copay
$0 copay
$0 copay
$0 copay
Inpatient Hospital
Outpatient Facility
$250 copay +
coinsurance
$100 copay+
coinsurance
Emergency
$250
$0-$150 copay
$0-$100
Urgent Care
$50
$0-$25 copay
$0-$20
Note: DC Public Schools does not have this plan option
APS is not as rich
Aon Hewitt | Health & Benefits Consulting
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APS is within range
APS is richer
9
Assessment of APS’ Active Medical Health Program Design – Kaiser
HMO Option
 APS’ primary benefit features compared to local employers
– Richness of benefits from employees’ standpoint relative to the benchmark employers with same
type of plan
Arlington Public Schools
VA Schools
MD/ DC Schools
Out of Pocket Maximum
Individual/Family
$3,500/
$9,400
$2,250-$6,600/
$4,500- $13,200
$1,000- $6,350/
$2,000- $12,700
PCP
$10
$15-$20
$5-$30
Specialists
$10
$15-$60
$5-$40
Coinsurance
0%
0%-10%
0%-30%
Inpatient Hospital copay
$0 copay
$150-$500
$0-$10
Outpatient Surgery
copay
$10 copay
$50-$250
$0-$25
Emergency copay
$50 copay
$100-$200
$35-$300
Urgent Care copay
$10 copay
$15-$75
$5-$100
Note: VA Schools range includes Arlington County Government
APS is not as rich
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APS is within range
APS is richer
10
Assessment of APS’ Active Medical Health Cost Share
 APS’ cost share (as a % of total premium) compared to those of benchmark group
– Richness of benefits from employees’ standpoint relative to the benchmark employers with same
type of plan
Arlington Public Schools
VA Schools
MD / DC Schools
Cigna High Option
Individual
68%
55%-98%
70%-90%
Individual + Child(ren)
64%
50%-91%
70%-90%
Individual + Spouse
64%
52%-85%
70%-90%
Family
57%
52%- 82%
70%-90%
Individual
72%
77%-95%
75%-97%
Individual + Child(ren)
67%
70% -79%
90%-96%
Individual + Spouse
67%
70%-77%
75%-96%
Family
62%
70%-77%
75%-96%
Individual
77%
77%-85%
75%-97%
Individual + Child(ren)
73%
75%-77%
75%-96%
Individual + Spouse
73%
75%-80%
75%-96%
Family
68%
75%-80%
75%-96%
Cigna Low Option
Kaiser HMO Option
DC Public Schools does not have a low option plan.
Premiums for Falls Church not provided
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Hewitt
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Arlington
County
Government
included
in VA Schools
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Some Public& Schools
does not have a EE+ Child tier
APS is not as rich
APS is within range
APS is richer
11
Recommendations
 Continue to increase plan differential between Cigna High and Low Plans.
Changes may include:
– Change network co-pays
– Change out-of-pocket maximum amounts
– Move to coinsurance on certain prescription drug
 Change the cost-sharing formula:
– Larger School Board subsidy on the Cigna Low plan
– Reduce School Board subsidy on Cigna High Plan. These changes better
align with industry benchmarks.
 For 2017, APS reduced the co-pays on the Cigna Low Plan to better align with
benchmarks, and moved to the Standard Rx Formulary on both Cigna plans.
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Active Dental Benchmarking
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Assessment of APS’ In-Network Active Dental Design – Delta Dental
PPO
 APS’ primary dental benefit features compared to local employers
– Richness of benefits from employees’ standpoint relative to the benchmark employers with same
type of plan
Arlington Public Schools
Delta Dental PPO Premier
VA Schools
MD/DC Schools
Deductible
Individual
$50
$0-$55
$0-$50
Family
$50
$0-$150
$0-$150
Annual Benefit Max
$1,500
$1,200-$2,000
$1,000-$4,000
Orthodontics Lifetime
Max
$1,500
$1,000-$1,500
$1,000- unlimited
Basic
20%
20%
0%-20%
Major
35%
40%-50%
20%-50%
Orthodontics
50%
20%-50%
50%
Periodontics and
Endodontics Covered
under Basic or Major
Services?
Basic
Basic
75% Basic
50% Major
Diagnostic/ Preventative
APS is not as rich
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APS is within range
APS is richer
14
Assessment of APS’ Active Dental Cost Share
 APS’ cost share (as a % of total premium) compared to those of benchmark group
– Richness of benefits from employees’ standpoint relative to the benchmark employers with same
type of plan
Arlington Public Schools
Delta Dental PPO
VA Schools
MD Schools1
Individual
35%
57%-98%
48%-77%
Individual + Child(ren)
35%
70%-97%
48%-65%
Individual + Spouse
35%
27%-85%
48%-83%
Family
35%
24%-82%
48%-83%
1Howard
county public school dental program is 100% Employee paid
APS is not as rich
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APS is within range
APS is richer
15
Retirement Related Benefits
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Retirement Related Benefits
Sick Leave Pay Out
 APS Sick Leave Payout features compared to local employers
APS Sick Leave
Payout Policy
Employed before 7/1/11: Paid
50%(accrued without limit) at daily
rate upon retirement.
Employed Post 7/11: Paid 25% of
all sick days
Competitor Summary
3 out of 9 employers do not pay out for unused sick days
Of the employers who payout (6),
the majority pay 20%-40%
Of the employers who payout,
Some include caps i.e., $10,000 lifetime maximum or the
maximum dollar value changes annually and is equivalent to
25% of the previous year’s average salary.
Defined Contribution
 APS Defined Contribution features compared to local employers
APS Policy
Competitor Summary
4 out of 9 employers do not offer a company match
Greater of .4% of salary or $240
per year
Of the employers who match (5), the percent is
based on gross or base pay
Two employers offer $20 per pay period ($520 annually)
APS is not as rich
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APS is within range
APS is richer
17