Brothers and Sisters;

Attached you will find a letter from the Division of Pension and Benefits, Health Benefits Policy and Planning that outlines the details of a special open enrollment period for members who are now enrolled in the Horizon HMO plans.

As we informed you several months ago, Horizon was awarded the bid for all members in the SHBP who are not medicare enrollees in 2019 for the current period. This eliminated the ability of any member in the SHBP to remain in the Aetna plans. As a reminder, this was done through a bidding process in which the PBA had no role.  One of the most noticeable differences between the Aetna and Horizon HMO plans are the accessibility to providers based on geography. The Horizon plans have a smaller access area.

In a break from past practices, the Division has undertaken an initiative to allow anyone currently enrolled in a Horizon HMO to change to a PPO plan to better serve our members.

This special enrollment will run from February 17th, 2020 Through February 28, 2020 and the new plans will have an effective date of April 1, 2020. This open enrollment does not apply to prescription plans.

The letter is self-explanatory, please contact the office with any questions.


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As we have for the past several years, we are providing you with an update that may help you with anticipating rates for the next plan year. Please note that these rates have yet to be adopted by the Commission.

Over the past two years, we have worked to keep the rates at an effective 0% increase which has been unheard of in the health insurance realm. Unfortunately, this year there would be plan design changes that would compromise the quality of the plans thus leaving us with increases that frankly are in line with national averages.

Below you will find the proposed increases for the different plans for state employees and local government (county and municipal) employees. These are two different risk pools and rates are computed independently due to the funding sources. You will see that State employees have a substantially lower rate increase this year.

In, order to apply these rates you must take the 2018 rates and apply the appropriate increase to the current plan rate, for instance if you are a local government employee in a family plan with direct 15 you must apply an increase of 7.3% to $2,104.28 (monthly) for medical and 14.3% to $547.94 (monthly) for prescription (if you are in the state prescription plan).

If you notice, the Employee (Ee) and child and family have substantially higher increases then employee (single) this is due to a shift in the ratio that Aon uses to assign risk to the different tiers of coverage. All of the rates are based off of the single rate which has a value of 1. Aon has proposed that Employee plus children be adjusted from 1.79 to 1.825 and families from 2.79 to 2.825.

Early retirees have an 8.2% increase and medicare retirees have a 14.8% decrease.

If you would like to review the complete renewal reports they are available at:

Finally, as many locals enter into negotiations, the yearly misinformation is being spewed by unscrupulous municipal representatives. Please note the following:

  1. No unit that relinquishes health benefits in retirement is eligible for Chapter 330 health benefits.
  2. There have been no discussions on the design committee to eliminate the PPO 10 or 15 plans.

As always, please contact your attorney or the State office before making any major decisions regarding health benefits.

On Friday, March 20th, the State Health Benefits Design Committee unanimously voted for a solution that finalized the Superior Court decision that unilaterally indexed retiree prescription copays in the years 2013, 2014 and 2015.

The committee was presented with three possible solutions to rectify the overpayment of copays in the aforementioned years. Unfortunately, the monumental task of calculating payments to members would have resulted in another year of delay in payments to our retirees and due to medicare regulations some members would have actually owed money to the federal government. This solution allows for compensation in that copays will be reduced or eliminated depending on the classification of the drug and the type of in which the member is enrolled for the period from July 1, 2015 through December 31, 2015 and will return to 2012 rates as a baseline for negotiating new plans for 2016.

The decision in superior court was a landmark decision, in that it gives the committee the authority on all levels to negotiate plans going forward which is especially important in this era of escalating costs in the health care realm. The committee, both labor and management have made a commitment to work together to create plans that provide better health care for both our retirees and active enrollees.

The terms of the retirees are as follows for the rest of 2015 are as follows:

For the period from now to June 30, 2015, copays will remain as they are currently.

For the period from July 1, 2015 through December 31, 2105 copays for $10 and $15 copay plans will be, see graphic.

The maximum out of pocket will be $1,351 per person which is the 2012 rate will apply for 2015.

Please notify your retired members of these pending changes.

Kevin C. Lyons Sr.