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  • John DiMartino

SEHBP 2019: Final Rate Renewal

On Monday, September 17, the SEHBP Plan Design Committee met to review potential changes to the 2019 SEHBP Medical and Prescription Drug Program.

There were two plan design changes that took place:

  • Active Population: Addition of the "Horizon Direct 0" and the "Aetna Freedom 0"

  • Competitive In-Network Benefits

  • $0 copay for Primary Care and Specialist Care

  • Mandatory Generic Drugs

  • Less competitive Out-of-Network Benefits

  • Expected to be about 14% less premium than the Direct 10 plans

  • Retiree Population: Movement of Direct/Freedom 10 and Direct/Freedom 15 participants to the Aetna Educators Medicare 10 and Aetna Educators Medicare 15 plans. The NJEA released an FAQ with additional information.

  • Also doubling the NJWELL incentive from $250 to $500

  • Benefit levels will not change

  • No referrals are needed, but some services require pre-authorization

  • No prescription drug changes

  • No change to early retiree benefits

These changes were formally adopted at the Wednesday, September 19th SEHBC meeting. Liberty was live tweeting updates from the meeting.

The next SEHBC meeting took place on Wednesday, September 26th. During this meeting there was no public discussion of the rate renewals or any details regarding the Aon Rate Renewal Report. The commissioners had a hard copy of the Final Aon Rate Renewal Report that was referenced prior to a motion made to adopt the renewals. The resolution was passed unanimously, 7-0.

These rate recommendations varied greatly from the Aon Recommendation released in July of 2018:

The Medical increased from 3.7% to 5.6% and the the Prescription Drug increased from 17% to -24.9%.

The overall renewal for the Actives moved from +6.6% to -1.1% and the overall renewal for retirees moved from -4.9% to -32.6%. It is unclear how the Active renewal was able to achieve an almost 8 point overall swing with no change to the plans, no change in trend, and no change in the adverse selection adjustment.

The change for the Retiree side, however, is warranted based on the change to the Medicare Advantage program.

Look out for more communications regarding the new Direct/Freedom 0 plan, as well as additional updates regarding the SEHBP 2019 renewal.

John DiMartino

President, LBA

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