HomeMy WebLinkAbout2010-06-02 PACKET 12.B.REQUEST OF CITY COUNCIL ACTION COUNCIL AGENDA
MEETING ITEM #
DATE 06/02/201
PREPARED BY Administration Ryan Schroeder
ORIGINATING DEPARTMENT DEPARTMENT HEAD
COUNCIL ACTION REQUEST
Consider approving changes to the health insurance plan.
STAFF RECOMMENDATION
Approve the changes.
BUDGET IMPLICATION
BUDGETED AMOUNT
ADVISORY COMMISSION ACTION
DATE REVIEWED
❑ PLANNING ❑
❑ PUBLIC SAFETY ❑
❑ PUBLIC WORKS ❑
❑ PARKS AND RECREATION ❑
❑ HUMAN SERVICES /RIGHTS ❑
❑ ECONOMIC DEV. AUTHORITY ❑
❑ ❑
SUPPORTING DOCUMENTS
ACTUAL AMOUNT
APPROVED
DENIED
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El
El
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® MEMO /LETTER: Memo and attachments from Joe Fischbach dated 5/25/10.
❑ RESOLUTION:
❑ ORDINANCE:
❑ ENGINEERING RECOMMENDATION:
❑ LEGAL RECOMMENDATION:
❑OTHER:
ADMINISTRATORS COMMENTS
n
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City Administrator Date
COUNCIL ACTION TAKEN: ❑ APPROVED ❑ DENIED OTHER
HAMemos & Resolutions \060210- CC Action Form- Health Insurance.doc
• • is •
Honorable Mayor and City Council
Joe Fischbach, Human Resources Coordinator
ZZISM
Health Insurance
Below is the commentary that was provided in preparation for the January 23r strategic
planning session regarding health insurance. After that is an update of the work that has taken
place since then by both staff and the Insurance Committee.
2
3
TOTAL ANNUAL COST
Single
ER
EE
Total
MIC Choice 1000
8,260
1,918
10,178
%of total
81%
19%
HDHP (HSA)
7,832
1,800
9,632
% of total
81%
19%
HDHP (HSA) Elect Plan
7,261
1,800
9,061
% of total
80%
20%
Family
MIC Choice 1000 11,301 10,124 21,426
% of total 53% 47%
HDHP (HSA) 12,701 7,367 20,069
% of total 63% 37%
HDHP (HSA) Elect Plan 11,797 7,066 18,863
%oftotal 63% 37%
ER = Employer
EE = Employee
.0
The Insurance Committee, which is made up of employees from each department and labor
union, has met twice a month since January. Initially, the Committee put together a health
insurance survey, distributed it to all benefit - earning employees and tabulated the results. 71%
of employees completed and returned the survey. The resounding theme of the survey is that
employees desired enrollment options other than just single and family coverage. In addition to
more enrollment options, employees wanted a plan design that decreased or limited the
annual premium increases they experienced.
From there, the Committee took to looking at general plan designs and formulating goals for
the City health insurance program. The 11 general goals are below. The goals with
commentary and examples are attached. There were many different plan designs that were
presented and discussed over the course of several different Committee meetings.
1. Limit annual premiums increases to trend with the goal of keeping increases as close to zero percent as
possible
2. Attempt to get employer and employee costs below our comparison group average
3. Attempt to get more employees to enroll in the high deductible health plan, HDHP /HSA
4. Provide employees with enrollment options other than just single and family
S. Reduce the number and dollar amount of preventable claims
6. Provide health and wellness coaching to employees, through our insurance company
7. Provide access to programs that may reduce future costs to both the employee and employer, programs
such as smoking cessation
8. Increase employee understanding of drivers of health care costs
9. Improve employee health care purchasing decisions
10. Identify ways to reward employees who limit use of the health care plan
11. Decrease the timeframe in which the City deposits its full HSA contribution in to employees' account
Through the work of the Committee we believe that we have come up with a plan design that
achieves a majority of the goals that we, as a Committee, came up with. It is our belief that this
design will be sustainable long -term and will reduce costs for a majority of employees, either
through premium savings or out -of- pocket costs. This design will reduce the amount of claims
In
experienced by the health insurance carrier, theoretically, reducing our annual premium
increases.
Over the past weeks we have been meeting with all employee groups to explain the new plan
design to ensure that it is understood. If Council approves the health plan changes, we would
look for the labor unions to vote on the proposal in the next few weeks. Included is the
proposed labor contract language. We would then have our benefits consultant, FCI, prepare
for the renewal in July /August.
Currently we have 3 plans; MIC Choice co -pay plan, HDHP and HDHP Elect. The HDHP Elect
is the same coverage as the other HDHP Plan but members must choose a primary care clinic.
The Elect Plan provides an opportunity for lower premium costs. Employees who choose the
Elect Plan are required to get referrals from their Primary Care Clinic before seeing a doctor
and /or specialist outside their clinic.
Both HDHP plans have a $2,500- single and $5,000- family deductible with 100% coverage
once the deductible is met. There is also an imbedded deductible where no one family member
on family coverage can pay more than $2,500. Currently the City contributes $700- single and
$1,400- family, on a 2 to 1 matching basis, to each employee's HSA. There are not any
employees that do not contribute enough in to their HSA to not receive the City's full
contribution. The City's contribution is put into each employee's HSA in 24 equal amounts (the
first 2 pay periods of each month).
Under the proposal we would move from having 3 plans to having 2 plans. We propose
eliminating the MIC Choice co -pay plan. Those on the MIC Choice family are guaranteed to
come out money ahead. A majority of those on the MIC Choice single plan would also come
out money ahead but there is a chance that some could lose moving to the HDHP plan. The
amount is dependent on individual circumstances but it is in the few hundred dollar range.
Also under the proposal the enrollment options would increase. Currently employees have 2
options; single or family. That would expand to include; employee plus one (spouse or one
child) or employee plus children. This has been an option that many employees have
requested for many years. Before now it was not feasible because it drove the family
premiums too high.
Under the proposal the deductible would go from $2,500 to $4,500. Once the deductible is met
there would then be an 80/20 arrangement where the City /employee would be responsible for
20% of the costs, up to an out of pocket max of $5,800. The medical plan would then cover
100% after that, up to claims of $50,000. At that point the claim would be pooled out among a
larger population of clients. We have a similar arrangement now. The gap between $2,500 and
$4,500 would be paid by the City through an HRA. The City would also cover the first $850 of
the $1,300, the difference between $5,800 and $4,500. That would leave the employee
responsible for the last $450. The employee would not have to pay any of the $450 amount
until their claim costs exceeded $8,750. The employee would be able to pay this amount out of
their HSA on a tax favored basis. Under the HRA arrangement the employee would submit
bills to a third party administrator that would process them and reimburse the employee.
M
The City would also increase its contribution to the HSA. Currently it is $700- single and
$1,400- family. We propose to increase that to $1,000- single and $2,000- all others. We would
also put the City's contribution to each employee's HSA quicker. Instead of 24 equal payments
we would accelerate that to 4 equal payments, the first pay period of each quarter. This
addresses another concern of employees who have costs at the beginning of the year.
We believe this plan design is sustainable for many reasons. First, it reduces premiums
dramatically whereby we can increase enrollment option from 2 to 4. Second, it allows us to
give employees a larger contribution to their HSA. Third, it reduces the amount of claim dollars
that the insurance company sees. This is by far the biggest factor in determining annual
increases year to year. This plan design also increasing consumerism because now all
employees on are the consumer driven health plan. Any money an employee saves by
shopping around is money they get to keep in their HSA, which is a property right.
Requested Action
Considering approving the healthcare plan design changes as presented.
Attachments
Costs spreadsheet
Health Insurance Goals with commentary and examples
Proposed contract language
External Comparisons
0
1. Limit annual premium increases to trend or below:
The Committee determined that in order to achieve this goal the Co -pay plan,
which is the high utilization and expense plan, needs to be dropped in favor of
offering only a High Deductible Health Plan. That adjustment provides increased
incentive for the consumer to consider available options in purchasing services
due to cost sharing by the consumer in health care expenses. It is believed that
elimination of the Co -pay option in concert with the increase in deductible
covered by the City HRA along with the 80/20 plan will result in moderation of
premiums if utilization does not spike.
2. Attempt to get ER and EE costs below comparison group average:
Proposed on top of the HDHP is an HRA component designed to remove some
of the first dollar risk beyond the HDHP from the health care provider, thus
lowering the claims that would be experienced by the provider. Effectively, within
the proposal does not experience any costs until individual claims exceed $4,500
and the provider does not take on 100% exposure until claims exceed $11,000.
Further, adding EE + One, EE + Children plan options provide cost savings
options for the employees.
It is proposed that the employee share in the claims exposure within the HRA
component of the plan (between $4500 and 11,000 in claim size) in order to
continue the consumer incentive within the HRA segment. With a deductible cost
share as proposed the employer would need to budget for $150,000 in claims
exposure. Employee exposure is limited to $450 single or embedded/ $900
family, which can be covered by fully funding the HDHP within the HSA (note,
some employees are already funding their HDHP's to this level). Maximum
employee exposure for all premiums and claims is at or below 2010 exposure for
all employees previously on the HDHP or Co -pay family plans. Maximum
exposure for those previously on the Co -Pay single plan is reduced to $0 for
premiums but is increased to the extent of fully funding the HDHP deductible
minus the employer contribution. The minimum exposure for those on the Health
plan not incurring claims is reduced significantly.
The Employer maximum exposure increases due to the HRA component and
due to the free choice of employees choosing either to re- enroll in the employer
plan or to choose a plan more expensive than currently projected. The minimum
(best case) for the Employer is similar to that of the employees, which is a
reduction in premium expense.
It should be noted that in charts providing maximum exposure comparisons co-
pays and the $1,000 hospitalization deductible are not included. Further, the
deductible expense for the HSA plans assume maxing out the deductible and
does not account for expected savings resulting from the embedded deductible
components on the family plans or that the HSA's have a savings component
that for many will result in interest earnings. The comparisons also assume that
in each year of membership in the HSA that the employee will contribute the
maximum allowed under law to the HDHP and for many enrollees that will not be
necessary after accumulating a level of savings into the HDHP that is sufficient to
cover the deductible exposure. Finally, all contributions to premium and /or
HDHP savings are not taxable so that the actual impact to paychecks of
contributions is significantly less due to deductibility than shown in the charts.
3. Increase enrollment in the HDHP:
Removal of the Co -pay plan automatically accomplishes this goal. Additionally,
however, plan options of EE + One and EE + Children provide options to the
employee below the cost of standard family coverage. Further, those persons
previously on Co -pay family coverage will save significant premium and total out
of pocket expense by movement to the HDHP and those previously on Co -pay
single coverage will see their premium expense reduced from $917 /year to $0
with out of pocket expense reduced in the best case scenario to the minimum
dollar necessary to gain the employer HDHP match.
4. Provide Employees with enrollment options beyond single and family:
Proposed is EE + One, and EE + Children, both of which have premium
expenses below the current family coverage. The Elect plan is also proposed for
each of the plan options.
5. Reduce the number and dollar amount of preventable claims:
This goal has been referred to the Wellness Committee.
6. Provide health and wellness coaching to employees through the
insurance company:
This goal has been referred to the Wellness Committee.
7. Provide access to programming such as smoking cessation:
This goal has been referred to the Wellness Committee.
8. Increase employee understanding of drivers of health care costs:
The HR Department, with assistance from Insurance Committee representatives,
will provide educational opportunities for employees.
9. Improve employee health care purchasing decisions:
See # 8.
10. Identify a reward system to limit use of the health care plan:
For future discussion.
11. Decrease the timeframe of Employer contributions to Deductible:
Proposed is that employer would contribute at first payrolls of January, April, July
and October. This increases employer costs due to annual turnover of
employees although maximum exposure at current contribution levels is about
$6,000 /year within the HSA at a 15% turnover rate. The HRA component would
be fully funded on January 1 of each year with expected budgeted exposure of
$150,000 per plan year.
Other Issues:
A. Impact to persons waiving coverage:
No change. ER contribution to grandfathered employees is assumed to
continue at $225 /month with those persons waiving coverage through the two
$0 contribution enrollment openers also not changing. Future deductibility of
this entire contribution is in doubt which we create a need for further review.
B. Plan enhancements such as vision care:
No enhancements are proposed in order to positively address the primary
goal of premium cost reduction.
C. Employer contribution to premium and deductible:
ER contribution to premium is reduced due to the expected reduction of
premiums within the proposed plan. In 2010 the ER pays for 90% of the Co-
Pay single, 100% HDHP single premium, and 75% HDHP family and 58% of
Co -pay family. The proposed plan shows ER contribution at 100% single and
70% family and EE + plans. ER contribution to premiums is a negotiable
item. The proposed plan shows an employer contribution of $700/1400 to the
HDHP deductibles. ER contribution to deductibles is a negotiable item.
However, with the above contributions to premium and deductibles it is
projected that employee costs will be at or below 2010 costs for all persons
on family coverage, all persons previously on HDHP single and for at least
many persons previously on the Co -Pay single coverage (cost savings would
vary dependent upon employee choice of contribution levels to the HDHP
savings component. In other words those previously on the Co -pay single
can choose to lower their contributions and thus save funds on their paycheck
or they can choose to fully fund their deductible or anywhere in between).
D. Employee contributions to HDHP savings /deductible component:
Currently there are 26 persons on HDHP family. EE contributions are:
$4,750 @ 4
$4,000 @ 2
$3,600 @ 5
$3,000 to $3,500 @ 5
$2,000 to $2,999 @ 4
$1,000 to $1,999 @ 4
$ 700 to $ 999 @ 2
$700 is required to gain the maximum Employer contribution and $4,750 is
the maximum IRS contribution limit (including the $1400 ER contribution).
An employee contribution of $3,600 fully funds the deductible. There are no
employees not receiving the maximum $1400 ER contribution. About half of
enrollees currently fund, or are close to completely funding the deductible.
Currently there are 39 persons on the HDHP single. EE contributions are:
$2,350 @ 7
$2,000 (and $2,010) @ 2
$1,500 to 1,999 @ 6
$1,000 to $1,499 @ 11
$ 500 to $ 999 @ 7
$ 350 to $ 499 @ 6
$350 is required to gain the maximum Employer contribution and $2,350 is
the maximum IRS contribution. An employee contribution of $1800 fully
funds the deductible (plus ER contribution. Currently about 40% of enrollees
fully fund or come close to fully funding the deductible. There are no
employees not receiving the maximum contribution.
It should be recalled that a number of employees have been on the HDHP
plan for a number of years. Many of those employees will have accumulated
funds within their HDHP savings account to allow them to reduce future
contributions to the account should they wish and still provide sufficient funds
to cover maximum HDHP exposure.
E. Embedded deductible continuation:
The Employer considers the embedded deductible component of the plan as
an important and valuable component of the plan and therefore would
anticipate continuation of that plan component.
F. Future of Employer contributions to HDHP deductible /savings component:
In a review of 2010 HSA /HRA employer contributions within the market
Cottage Grove is reasonably placed on average. In the market there are 10
cities that we have identified with an average contribution to the Family HDHP
of $973 (ranging from $0 to $3250) and six cities contributing to HRH's up to
an average of $2,047 (ranging from $1140 to $3460). For single coverage
there are 11 cities with an average contribution of $1406 (ranging from $0 to
$2685) towards an HSA and 6 cities with an average contribution up to $1334
to the HRA (ranging from $600 to $2210.
As shown in our projections Cottage Grove currently contributes $1400 to
family and $700 to single HDHP HSA coverage. Proposed is that on top of
that Cottage Grove would contribute up to $2,850 to an HRA. Maximum
Employer exposure at current enrollment levels is $333,450 but the most
likely exposure is in the $150,000 range. Future contributions to the HDHP
savings /deductible are negotiable but the Employer would desire to continue
to be reasonably placed within the market.
Finally, just what is the plan proposal, what does the employee pay and
what does the employer pay:
The deductible for HDHP single enrolled employees and embedded family
enrollees is increasing from $2500 to $4500. On top of that is an 80/20 plan
up to a maximum exposure limit for the employee and employer of $5800.
However:
1. The employee continues to be 100% responsible for the first $2500 of
claims (although the employer contributes $700 toward the employee
HDHP account toward this expense)
2. The employer picks up 100% of the next $2,000 of employee claims
through an HRA mechanism (this mechanism, while potentially expensive
to the Employer is projected to have a significant positive impact upon
future premiums).
3. For the next $6,500 in claims the EE /ER is responsible for $1,300 (20% of
$6,500; this is the 80/20 plan component). The ER will cover the first
$850 of that liability and the employee will cover the last $450 of that
liability from his /her HSA account.
4. The insurance company provides 100% coverage for any remaining
claims (which is beyond $11,000).
Examples:
A. $1,000 claim: Employee covers out of HDHP account
B. $3,000 claim: Employee covers the first $2500 out of HDHP account and
Employer pays $500 from HRA
C. $4,000 claim: Employee covers the first $2500 out of HDHP account and
Employer pays $1500 from HRA
D. $5,000 claim: Employee covers the first $2500 out of HDHP account and
Employer pays $2100 from HRA and the insurance company pays $400 (in
that the claim is beyond the deductible level).
E. $6,500 claim: Employee covers the first $2500 out of the HDHP account and
Employer pays $2,400 from the HRA and the insurance company pays
$2000. (note: employee does not have any additional exposure until the claim
exceeds $8,750 which is the claim level at which the Employer participation
max's out).
F. $9,500 claim: Employee covers the first $2500 out of the HDHP account and
the Employer pays $2850 from the HRA with the employee covering $150
and the insurance company pays $4,000.
G. $10,000 claim: Employee covers the first $2500 out of the HDHP account and
the Employer pays $2850 from the HRA with the employee covering $250
and the insurance company pays $4,400.
H. $11,000 claim: Employee covers the first $2500 out of the HDHP account and
the Employer pays $2850 from the HRA with the employee covering $450
and the insurance company pays $5,200.
I. Larger claims: The insurance company covers 100% of claims expense
larger than $11,000. For instance in a $50,000 claim the Employee still pays
only the $2500 plus $450 and the Employer pays only the $2,850 while the
Insurance Company picks up the remainder, which is $44,200. For claims
larger than $50,000 the Insurance Company will carry re- insurance coverage.
For family coverage with claims beyond the embedded deductible (multiple family
claimants) the total deductible exposure is $5,000 plus $900 for large claims.
INSURANCE
The EMPLOYER shall pay a maximum contribution per month per employee. The contribution may be
used toward the premium for group medical coverage.
Employer Contribution
HSA Plan
Single- 100% of premium
Single + One- 70% of premium
Single + Children- 70% of premium
Family- 70% of premium
HSA Elect Plan
Single- 100% of premium
Single + One- 70% of premium
Single + Children- 70% of premium
Family- 70% of premium
Both plans have a, $4,500- single and $9,000- all others, deductible. However, the employee will be
responsible for, $2,500- single and $5,000- all others, of the deductible amount. The remainder will be
covered by the employer through a HRA. Of the $2,500/$5,000 amount the employer will contribute
$1,000/$2,000 in to the employee's HSA, on a matching basis. The employer contribution amount is
provided on a matching basis of 2 (two) employer dollars for every 1 (one) dollar contributed by the
employee, up to the annual employer maximum. The employer HSA contributions will be made in four
equal payments, the first pay dates in January, April, July and October. Both plans will have an imbedded
deductible. There is an 80/20 payment arrangement once the deductible is met, whereby the insurance
company pays 80 percent and the employee /employer pay the other 20 percent, up to an out of pocket
maximum. The out of pocket maximums are, $5,800- single and $11,600- all others. If the
employee /employer experience out of pocket costs, the employer will cover the first $850- single and
$1,700- all others. The employee is then be responsible,for $450- single and $900- all others.
Employees currently receiving waiver compensation will continue to receive waiver compensation. It will
be $225 /month for full -time employees and $112.50 /month for part -time employees. Employees who
waive but do not receive waiver compensation may still waive but will not receive any waiver
compensation. All new employees must enroll in a minimum of single medical coverage. If an employee
receiving waiver compensation elects City insurance and then waives again in the future, they will not be
eligible for the waiver compensation.
For the City of Cottage Grove For the Bargaining Unit
Ryan Schroeder, City Administrator
Union Steward
Business Agent (if applicable)
2 Tiers. Current Costs
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MIC Choice Single
688.37
76.48
764.85
8,260.44
148,687.92
917.76
16,519.68
0.00
8,260.44
917.76
917.76
18
16,519.68
H S A Single
594.31
0.00
594.31
7,131.72
263,873.64
0.00
0.00
700.00
25,900.00
350.00
1,450.00
550.00
86,950.00
3,050.00
0.00
7,831.72
350.00
2,350.00
37
12,950.00
H S A Single Elect
546.77
0.00
546.77
6,561.24
13,122.48
0.00
0.00
700.00
1,400.00
350.00
1,450.00
550.00
4,700.00
3,050.00
0.00
7,261.24
350.00
2,350.00
2
700.00
MIC Choice Family
941.78
677.04
1,618.82
11,301.36
45,205.44
8,124.48
32,497.92
0.00
11,301.36
8,124.48
8,124.48
4
32,497.92
H S A Family
941.78
313.93
1,255.71
11,301.36
214,725.84
3,767.16
71,576.04
1,400.00
26,600.00
700.00
2,900.00
1,150.00
90,250.00
6,150.00
0.00
12,701.36
4,467.16
8,517.16
19
84,876.04
H S A Elect Family
866.43
288.81
1,155.24
10,397.16
72,780.12
3,465.72
24,260.04
1,400.00
9,800.00
700.00
2,900.00
1,150.00
33,250.00
6,150.00
0.00
11,797.16
4,165.72
8,215.72
7
29,160.04
758,395.44
144,853.68
63,700.00
215,150.00
176,703.68
ER Total
876,095.44
EE Total
360,003.68
Total
1,236,099.12
$2500 EE Pays 10% After Deductible ($4501$900)
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H S A Single
369.49
0.00
369.49
4,433.88
243,863.40
0.00
0.00
1,000.00
55,000.00
500.00
1,000.00
550.00
112,750.00
3,050.00
2,850.00
156,750.00
5,900.00
8,283.88
500.00
2,050.00
55
27,500.00
H S A Single Elect
339.93
0.00
339.49
4,079.16
8,158.32
0.00
0.00
1,000.00
2,000.00
500.00
1,000.00
550.00
4,100.00
3,050.00
2,850.00
5,700.00
5,900.00
7,929.16
500.00
2,050.00
2
1,000.00
H S A EE + 1
543.16
232.78
775.94
6,517.92
45,625.44
2,793.36
19,553.52
2,000.00
14,000.00
1,000.00
2,000.00
1,150.00
29,050.00
6,150.00
5,700.00
39,900.00
11,850.00
14,217.92
3,793.36
6,943.36
7
26,553.52
H S A Elect EE+ 1
499.70
214.16
713.86
5,996.40
0.00
2,569.92
0.00
2,000.00
0.00
1,000.00
2,000.00
1,150.00
0.00
6,150.00
5,700.00
0.00
11,850.00
13,696.40
3,569.92
6,719.92
0
0.00
H S A EE + Children
491.43
210.61
702.04
5,897.16
23,588.64
2,527.32
10,109.28
2,000.00
8,000.00
1,000.00
2,000.00
1,150.00
16,600.00
6,150.00
5,700.00
22,800.00
11,850.00
13,597.16
3,527.32
6,677.32
4
14,109.28
HSA Elect EE +Children
452.12
193.76
645.88
5,425.44
5,425.44
2,325.12
2,325.12
2,000.00
2,000.00
1,000.00
2,000.00
1,150.00
4,150.00
6,150.00
5,700.00
5,700.00
11,850.00
13,125.44
3,325.12
6,475.12
1
3,325.12
H S A Family
720.66
313.93
1,034.59
8,647.92
103,775.04
3,767.16
45,205.92
2,000.00
24,000.00
1,000.00
2,000.00
1,150.00
49,800.00
6,150.00
5,700.00
68,400.00
11,850.00
16,347.92
4,767.16
7,917.16
12
57,205.92
H S A Elect Family
663.01
288.81
951.82
7,956.12
47,736.72
3,465.72
20,794.32
2,000.00
12,000.00
1,000.00
2,000.00
1,150.00
24,900.00
6,150.00
5,700.00
34,200.00
11,850.00
15,656.12
4,465.72
7,615.72
6
26,794.32
478,173.00
97,988.16
117,000.00
241,350.00
333,450.00
156,488.16
ER Total
982,623.00
EE Total
339,338.16
Total
1,321,961.16
full -time waivers
waiver w/o ER contribution
Employer Costs
Premium
HSA
HRA
Waiver
HRA 3rd Party Admin Fee
225.00 20 54,000.00
8
total 54,000.00
478,173.00
117,000.00
150,000.00
54,000.00
10,000.00
876,095.44 Now
809,173.00 809,173.00 Proposed
66,922.44 Difference