What is CEBCO and why was it created?
What is the structure of CEBCO?
What programs will be provided by CEBCO and who are the selected vendors?
At this time, CEBCO currently offers medical, dental, prescription drug, vision, an incentive-based wellness program, an Empoyee Assistance Program (EAP), and life insurance coverage. Our vendors are as follows:
- Anthem Blue Cross and Blue Shield – Medical
- Delta Dental – Dental
- Express Scripts – Prescription Drug
- VSP- Vision
- Interactive Health – Wellness Program
- ComPsych – EAP
- Anthem Life – Life Insurance
- Health Advocate – Health Advocacy
How broad is the network of physicians and hospitals?
The Anthem Blue Cross and Blue Shield network is among the broadest provider networks in Ohio. Anthem was selected after an extensive review of the hospital and physician networks in the state.
What is the length of time required for participation in the consortium program?
Participation in the consortium program requires a three-year commitment. The reason for mandating a three-year commitment is to help ensure the stability of the program.
What are the advantages to the counties to participate in the CEBCO consortium program?
By banding together in a consortium, the counties reap the benefits of reduced administrative costs, reduced stop loss fees, the spread of risk over a larger number of participants, and the non-profit nature of the consortium. Counties will be able to participate in a self-funded program on terms that they would not be able to negotiate individually, due to their size and tolerance for risk, but the rates quoted by the consortium will be “guaranteed cost” for each twelve month period of participation.
How will a county’s own claims experience vs. the experience of other counties affect the group rates? Will there be renewal rate guarantees?
Counties will be individually underwritten and will receive rates based on historical claims data. Based on the number of participants in the county’s health plan, a factor (the weighting of a county’s individual claims experience) will be assigned. The larger the county group size, the more their individual rates will be based on a county’s own claims experience and the smaller the county, the more their rates will be based on the experience of the overall consortium.
CEBCO cannot provide guaranteed renewal rate increases. The intention of the program is to help achieve rate stability from year to year. The consortium cannot totally eradicate the effects that medical trend has on the rating process.
What are the benefit plan designs and what level of flexibility exists concerning plan benefits?
CEBCO currently offers 5 medical plan options, 3 dental plan options and 5 prescription drug options. The plans vary primarily by deductibles, coinsurance levels, office visit copays, and out of pocket maximums. Each county will have the ability to offer up to 2 medical options, 2 dental options, and 1 prescription drug option.
The purpose of the standard plan designs is to provide administrative efficiencies resulting in lower costs. The standard plan designs were selected based on the most common plan designs provided by the counties during a survey process. There may be certain instances where a county may need to customize a benefit plan for a particular reason (i.e., to satisfy a collective bargaining agreement) in which case we will work with the county and the vendor to address these non-standard plan features.
What funding approach will be used for the consortium program?
Each year, annual funding costs will be assigned to each member county. The assigned funding costs will consist of the following components: administrative fees, stop loss fees, expected claim costs, and reserves. Reserves are actuarially determined and allocated based on expected claim activity. The rates will be calculated to cover the administrative expenses and expected claims costs of the program. The consortium participation agreement provides additional details on the program funding mechanism.
Can I continue working with my local broker/agent/consultant for the consortium program and how will they be compensated?
Yes. Each county has the ability to maintain existing relationships or create new relationships with a designated broker/agent/consultant. Each county will be able to determine the degree of services required from their agent and what the appropriate compensation should be for those services. The county may either pay the broker/consultant directly on a fee basis or request that the fees be built into the program rates.
Who is the actuary who will be involved in validating the reserve requirements required under ORC Section 9.833? Is he/she a member of the American Academy of Actuaries?
Aon Consulting has been selected as the actuarial firm for the consortium. The actuaries performing the work are active members of the American Academy of Actuaries.
Why is the consortium self-funded rather than fully-insured?
As a self-funded consortium, we are better able to manage the costs of the program. This funding arrangement allows us to avoid paying premium taxes and the higher retention costs of a fully-insured program. Self-funding also allows greater flexibility in designing plan benefits.
Our county has a stand alone Rx program. Who can help us compare our current pricing/rebate structure to that of the consortium to determine if there is savings for us if we participate?
If the appropriate data can be obtained from your current Rx vendor, CEBCO can work with the consortium drug vendor to do a comparison for you.
What is the appeals process if one of the vendors makes a claim decision with which we do not agree?
The appeals process will begin with each vendor administrator’s internal appeals process. If a participant is not satisfied with the outcome of the vendor’s decision, the claimant will be able to present their appeal to the CEBCO Board.
What effort will be made to strengthen the network in my area?
The selected vendors were all chosen based on the size of their statewide networks. All vendors have agreed to continually monitor the sufficiency of their networks across the state. CEBCO will serve as the liaison between the member counties and the contracted vendors to help manage any required network expansion process. There are a few areas of the state where, due to certain network contracting issues, it is unlikely that the networks can expand beyond their current size.
For counties that border other states, what networks can be accessed for those areas?
All contracted networks are national in scope and seamless. This means that where there are border areas, a participant can access networks on both sides of the state line and still receive the same benefits if utilizing participating providers. For network provider information, please see each vendor’s respective website:
What assistance will be provided for enrollment meetings?
CEBCO is committed to providing each participating county with assistance in the enrollment process. We have obtained commitments from the vendors to provide enrollment support.
How does a county enroll in the program?
The Board of County Commissioners is required to complete the Group Application and adopt the Participation Agreement with a remittance of the first month’s premium equivalent. More details will be included in the CEBCO proposal presented to each county requesting rates for the program.