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AWANE 2016

This text provides an overview of the AWANE 2016 Board of Directors & Trustees Meeting, including updates on legal and fiduciary matters, membership statistics, stop loss history, and rewards program results.

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AWANE 2016

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  1. AWANE2016 Board of Directors & Trustees Meeting Stage Neck Inn York Harbor, MAINE September 16-18, 2016 Begin

  2. Agenda FRIDAY MEETING • SATURDAY MEETINGAWANE Overview, Phillip Healy • 2017, Stuart Piltch • Legal Update, Tess Ferrera • Fiduciary Update, Bill Kropkoff • 3:00 to 5:00 PM CPA Update – Ken Kron • Investment Overview – Ray Piacentini • AICC/USI – Joe Blanche

  3. AWANE Overview

  4. Membership

  5. Subscriber Counts by Plan

  6. Non-VEBA-Life, Short & Long Term Disability

  7. Short Term Disability

  8. Long Term Disability

  9. Life Insurance

  10. Liberty Mutual Review STD, LTD, and LIFE • 3 Year Renewal – 2015-2017 • Fixed at Current Rate for 2017

  11. Dental Plan

  12. 2015 VEBA – Self Funded

  13. 2015 VEBA – SF & Fully Insured

  14. 2015 Contingent Settlement – Fully InsuredFull Premium Amount $8,171,233Contingent Premium Amount 90% $7,354,109Risk Margin: 105% $8,579,794Incurred Claims $5,985,130Less Pooled Claims $ 282,848Plus Pooling Charge $ 377,342Plus Retention $1,511,479Total Expense $7,591,103Gain/(Loss) ($ 236,994)

  15. Jan – July 2016 VEBA – Self Funded

  16. Jan – July 2016 VEBA – Fully Insured • Anthem Loss Ratio as of 7/16 – 94.59% • Anthem Loss Ratio as of 7/15 –70.40% • Reserve for potential premium for 2016 at $729,148 • (Potential expected to go to $1,250,00)

  17. Anthem UnderwritingRetention for 2016 – 18.71%Retention for 2017 – 13.2%2016 received $175,000 credit for network issues

  18. 2016 YTD RX Utilization on Self Funded Business • January – July 2016 • 21 Claims over $10,000 • 40 Claims over $10,000 including fully insured business • Largest claims to date are: • $224,265 – GaucherDisease – Genetic enzyme disease causing problems with liver and spleen • $118,693 – Hepatitis C • $ 92,959 – Hepatitis C • $ 95,350 - Pulmonary Hypertension • $ 71,782 – Pulmonary Hypertension

  19. Express Scripts RX Rebates • 2014 - $1,079,477 • 2015 - $1,590,882 • 2016 estimated - $1,750,000 • 2016 we also received a $75,000 rebate related • to our drug program for Hepatitis C

  20. Stop Loss History

  21. STOP LOSS RENEWAL OPTIONS 2017

  22. 2017 Stop Loss Renewal • For 2017 we opted for the 12/15 stop loss contract with a $300,000 specific • with an aggregating $200,000. This will result in a 52% decrease in stop loss premium • paid. These numbers include RX

  23. Jan – July 2016 Rewards Program Results • Eligible to Participate in the Reward Program - 2500 • Health Risk Assessment - 203 • Physical Exams – 102 • Future Moms – 1 • Condition Care – 1 • Cholesterol Testing - 43 • Colonoscopy – 8 • Diabetes Testing – 7 • Mammograms - 39 • Weight Watchers -2 • REWARDS DOLLARS PAID FOR JAN – JUNE 2016 - $16,075 • REWARDS DOLLARS PAID FOR 2015 - $125,550 • New Reward for 2017 – Enroll your personal email into wellness/EAP campaign and receive $25

  24. McDEVITT, Paul F. Age 74 years. Of Housatonic and South Boston, formerly of Charlestown, Dorchester, and Braintree, September 12th. Son of the late James P. and Agnes (Dunn) McDevitt. Graduate of St. Gregory Grammar School, B.C. High, Boston College, and UMass Boston. Former Second Lieutenant in the Mass. National Guard. President of Modern Assistance Programs, Inc. Sober one day at a time for 38 years. Beloved husband of State Auditor Suzanne Bump. Paul is also survived by son Neil of Housatonic, son Andrew and his wife Jennifer, and their sons Kole and Liam of Attleboro, sister Catherine Lent and her husband William of Mt. Kisco, NY, sister Marie Biggs and her husband John of Lake Forest, IL, brother Attorney Daniel McDevitt and his wife Marie Downey of Quincy, sister-in-law Joanne McDevitt of South Boston, as well as numerous nieces and nephews. He was pre-deceased by his brother James. He loved his family, his home in the Berkshires, politics, college sports, the fellowship of AA, and stories, especially his own. Paul's life was defined by service to others, with a special devotion to those burdened by addiction, mental illness, poverty, and incarceration. A Boston high school teacher in his early years, in 1967 he became the youngest person ever elected to the Boston School Committee. In the 1970's, Paul became engaged in the social activism at the Paulist Center in Boston. Cooking at the Wednesday night Supper Club for the poor and homeless led to chairing the board of Project Bread. Through the ensuing decades he helped lead Bridge Over Troubled Waters, Friends of the Shattuck Shelter, Gavin Foundation, Maria Droste Counseling Services, and Edwina Martin House, even as he continued ministering to individuals and organizations in need, whenever and wherever he found them. Julie's Family Learning Center and Haley House were other favorite organizations. This year he was honored when the Paraclete Center in South Boston, whose board he chaired, named its building McDevitt Hall.

  25. The combination of Jesuit instruction and the reawakening of his own spirituality through Alcoholics Anonymous compelled Paul to live this life of service, which also became his profession. Modern Assistance Programs, which he founded 30 years ago, has helped thousands of area individuals and families recover from the effects of substance abuse and mental health afflictions. Paul particularly appreciated that the long-term relationships between management and worker found in unionized setting enabled him to create services which provided not just treatment but healing. His professional achievements included a Cushing-Gavin award in 1995 from the Boston Archdiocesan Labor Guild and recognition from the National Addiction Counselor's Association. Paul was extraordinarily gifted as a leader, mentor, speaker, counselor, and friend. Throughout his life, even during his recent illness, Paul dispensed wisdom, compassion, and humor in equal measure. He never was motivated by acclaim in his charitable or professional work. It was simply how he put his faith in action. A Funeral Mass will be celebrated in St. Margaret Church of St. Teresa of Calcutta Parish, 800 Columbia Rd., Dorchester, on Friday morning, September 16, at 10 A.M. Friends may visit with Paul's family at the IBEW Local 103 Hall, 256 Freeport St., Dorchester, on Thursday, from 3-8 P.M. In lieu of flowers, memorial donations may be made to Paraclete Center, 207 E Street, South Boston, MA 02127, Edwina Martin House, 678 North Main St., Brockton, MA 02301, and Maria Droste Counseling Services, 1354 Hancock St., Quincy, MA 02169.

  26. Modern Assistance Programs, Inc. • EAP contacts in 2016 • 52 individual contacts • Informational site visits to AWANE clients • Team Nissan • One location/four presentations • Portsmouth Ford • Four locations/six presentations in Portsmouth • One location/two presentations in Wiscasset Maine • Sanel Auto Parts • Presentation to 50-60 managers • Visits to several outlets in New Hampshire, Vermont, and Maine ongoing • Medically Assisted Treatments • Working on recommendations toward a policy for improved therapeutic treatment with opiate replacement therapies including cost containment strategies

  27. 2017 Rate Increases by Area • New Hampshire 5-8% varies by plan • Southern Maine 15.8% • Northern Maine 6% • Massachusetts 2-8% varies by plan

  28. Fees Associated with Health Care Reform Reinsurance Fees - $43,821 Patient Centered Research Outcomes Fee $3,934 Premium Tax on Fully Insured Plans $284,359 Total ACA Tax = $332,114

  29. New for 2016 – Live Health Online • Doctor visits from your own computer or mobile device • Lower co-pay for online visit • Doctors available 24 hrs a day, 7 days a week – U.S board certified physicians with an average of 15 years practicing medicine • Live Health – commonly used for cold and flu symptoms, allergies, sinus infections, family health questions • Sign on to livehealthonline.com, select the state you are in and answer some basic questions to create your account. Once your account is created, you can easily connect with doctors. Most sessions last about 10 minutes. • Copays are paid via credit card • Depending on state law, some prescriptions can be given with a “live health” visit • We had no participation for 2017 • AWANE did 2 mailings and open enrollment materials to promote this program.

  30. Health Care Reform – 1094/1095 Reporting Requirements - Regulations • Over 50 Self Funded – Employer completes 1094/1095C forms for all employees • Over 50 Fully Insured – Anthem completes 1094/1095B forms for all employees on the plan. Employer completes 1094/1095C forms for all employees • Under 50 Self Funded – 1094/1095B forms to be completed and distributed to member companies • Under 50 Fully Insured – Anthem completes 1094/1095B forms and distributes to covered individuals • Electronic Filing requirement drops to companies with 100 employees from 250

  31. Data Security Breach of Data = $150 per person Data due to coalition is estimated at 120,000 lives Liability = $18,000,000.00 Completed complete backup server with all data not connected to network • Reduced to 12,000 • Currently at 30,000

  32. 7 Reasons Obamacare Failed Health Standards, Obamacare in Gartner’s ‘trough of disillusionment by Dan Munro, September 13, 2016 https://healthstandards.com/blog/2016/09/13/obamacare-trough-of-disillusionment/

  33. 1. Many of the people who enrolled through Obamacare were “sicker” than first anticipated – so the premiums charged didn’t cover their healthcare expenses. This shouldn’t have been as much of a surprise as it turned out to be – because many of the uninsured arrived at that position when they were denied coverage for a pre-existing condition. Health Standards, Obamacare in Gartner’s ‘trough of disillusionment by Dan Munro, September 13, 2016 https://healthstandards.com/blog/2016/09/13/obamacare-trough-of-disillusionment/

  34. 2.Healthcare is really expensive, so the losses weren’t trivial (literally hundreds of millions of dollars) and public companies don’t answer to the government – they answer to their Board of Directors, shareholders, and existing customers. As a “new” line of business, Obamacare policies have their own accounting for companies that sell the policies and there’s no way to legitimately push losses in one line of business into another (without incurring the sizable wrath of existing customers, shareholders, boards). Health Standards, Obamacare in Gartner’s ‘trough of disillusionment by Dan Munro, September 13, 2016 https://healthstandards.com/blog/2016/09/13/obamacare-trough-of-disillusionment/

  35. 3.Insurers had very limited data on the people that were signing up and their best “guestimates” at initial pricing were wrong. No surprise here because actuarial math for N=1 is really more like a roulette wheel. Health Standards, Obamacare in Gartner’s ‘trough of disillusionment by Dan Munro, September 13, 2016 https://healthstandards.com/blog/2016/09/13/obamacare-trough-of-disillusionment/

  36. 4.It takes a couple of years of data to see how any new market (certainly one of this size and scope) will play out. Now we have the actual data – not just rosy forecasts, hopes and dreams. Health Standards, Obamacare in Gartner’s ‘trough of disillusionment by Dan Munro, September 13, 2016 https://healthstandards.com/blog/2016/09/13/obamacare-trough-of-disillusionment/

  37. 5.In a truly surprising and entirely unanticipated move, the Government removed a key variable in the pricing equation – the risk corridors (specifically designed to protect insurers against unpredictable losses). Health Standards, Obamacare in Gartner’s ‘trough of disillusionment by Dan Munro, September 13, 2016 https://healthstandards.com/blog/2016/09/13/obamacare-trough-of-disillusionment/

  38. 6.Insurers aren’t charities and they have no obligation to fix design flaws in government policy (either initially, or after a significant change). Health Standards, Obamacare in Gartner’s ‘trough of disillusionment by Dan Munro, September 13, 2016 https://healthstandards.com/blog/2016/09/13/obamacare-trough-of-disillusionment/

  39. 7.Our current government is largely dysfunctional, illustrated by the lack of a Supreme Court Justice (simply because Congress refuses to vote on viable candidates) and funding for infectious diseases like the Zika virus. Health Standards, Obamacare in Gartner’s ‘trough of disillusionment by Dan Munro, September 13, 2016 https://healthstandards.com/blog/2016/09/13/obamacare-trough-of-disillusionment/

  40. What Changed About the Initial Design for Obamacare? Health Standards, Obamacare in Gartner’s ‘trough of disillusionment by Dan Munro, September 13, 2016 https://healthstandards.com/blog/2016/09/13/obamacare-trough-of-disillusionment/

  41. The national expansion of Medicaid. This didn’t happen and, not surprisingly, states that did expand Medicaid are seeing lower healthcare costs generally. Health Standards, Obamacare in Gartner’s ‘trough of disillusionment by Dan Munro, September 13, 2016 https://healthstandards.com/blog/2016/09/13/obamacare-trough-of-disillusionment/

  42. The “public option” – government-priced insurance with no profit – was removed as a condition of getting the needed Congressional votes to pass the ACA. Health Standards, Obamacare in Gartner’s ‘trough of disillusionment by Dan Munro, September 13, 2016 https://healthstandards.com/blog/2016/09/13/obamacare-trough-of-disillusionment/

  43. The “risk corridors” – a mechanism to protect for-profit payers against outsized initial losses – was also removed as part of partisan politics. Health Standards, Obamacare in Gartner’s ‘trough of disillusionment by Dan Munro, September 13, 2016 https://healthstandards.com/blog/2016/09/13/obamacare-trough-of-disillusionment/

  44. 4 Main Changes to Pay or Play Rules

  45. 1. Transition Relief Expired: The transition relief which delayed compliance with the pay or play requirements for ALEs with 50 to 99 full-time employees (including FTEs) in 2015 is now expired for employers with calendar year health plans. For ALEs with non-calendar year health plans, this transition relief, along with the transition relief for dependent coverage, continues to apply for any calendar month during the 2015 plan year that falls in 2016.

  46. 2. New Affordability Threshold: If an employee's share of the premium for employer-provided coverage in 2016 would cost the employee more than 9.66% (formerly 9.56%) of his or her annual household income, the coverage is considered unaffordable to that employee. Employers offering unaffordable coverage may be subject to a pay or play penalty.

  47. 3. Coverage Thresholds Increased: For 2016, ALEs will now be liable for a penalty if they:  Do not offer health coverage or offer coverage to fewer than 95% (formerly 70%) of their full-time employees (and their dependents), and at least one full-time employee receives a premium tax credit; or  Offer health coverage to at least 95% (formerly 70%) of their full-time employees (and their dependents), but at least one full-time employee receives a premium tax credit.

  48. 4. Increased Noncompliance Penalties: For 2016, the general annual penalty for ALEs that do not offer coverage or offer coverage to fewer than 95% of their full-time employees (and their dependents) is $2,160 (formerly $2,080) per full-time employee, minus up to 30 full-time employees. For ALEs offering coverage to at least 95% of their full-time employees (and their dependents), the general annual penalty is $3,240 (formerly $3,120) per full-time employee that receives a premium tax credit.

  49. What is Affordable Care Act (ACA) Compliance? The Affordable Care Act requires employers with more than 50 full time employees to offer affordable health care coverage to its full time employees, which is defined as employees who were paid for more than 30 hours per week on average over a defined measurement period. Typically this measurement period is 12 months. The IRS is authorized to track compliance of employers and individuals and has issued regulations for reporting and filing. Following these regulations ensures ACA Compliance and avoids significant IRS penalties. BenefitScape provides a technology and services that ensures compliance in a timely and accurate basis. Do you have to comply? Anyemployerwithmorethan50fulltimeorfulltimeeligibleemployeesmustcomply.Wecanhelpyoudetermineifyour parttimeemployeesareeligible. If you have more than 250 FT employees, you must file with the IRS electronically. Any employer with fewer than 250FT employees but greater than 50 FT employees can choose to file on paper or electronically. We advise every client to file electronically,asitmakestheprocesssimplerfortheclient. What needs to be reported? Eligibleemployersmustreportthattheyofferedtheiremployeeseitheradequatehealthcoverageoraffordablemarketplace options.Eachfulltimeemployeemustbeissuedcompleted1095form(s)withdetailedmonthlycoverageinformation,and the1094isissuedastheemployertransmittalform.Whatweuseforthisreportingistakenfromyourbenefitsdataand employeeHR/Payrollinformation.ThisisthenfiledtotheIRSusingForms1094and1095. When does this need to be done? 1094/1095FormsneedtobeprovidedtoemployeesbyJanuary31st,2017andfiledwiththeIRSbyMarch31st,2017.This isacomplexprocessmadesimplebystartingearlywithBenefitScape.TheBenefitScapetechnologyandservicesarevery flexible.So,nowisthetimetobeginplanningfortheprocess.Agoodtargetdatetohaveinmindistoprovideyourdatato usbyNovember15th,2016,soBenefitScapecanmanagetheprocess. How will you ensure 100% ACA Compliance and avoid penalties? BenefitScapeguarantees100%ACAComplianceusingoursimpleandaffordablesoftware.Wewillcommunicatewhatwe needtoensuredeadlinesaremet. We recognize that this is a complex process, and we guarantee that BenefitScape can make this a simple one for you. You can find more information at www.benefitscape.com

  50. Digital Marketing Overview Completed projects for AWANE: Social Strategy Site Design • GOAL: Increase social audience and lead new potential customers to the site • Connected with AWANE members on social platforms • Targeted advertising on Facebook and Twitter • Updated strategies for LinkedIn connections and messaging • Ongoing analysis of social engagement and traffic • GOAL: Improve conversions • Completed design analysis that suggested better user interface and understanding of what AWANE offers • Implemented new design with updated colors and attention to conversion points on the website • Consistent site maintenance and content updates Lead Generation SEO • GOAL: Increase traffic and attract potential leads • Completed keyphrase strategy • New architecture plan • Additional pages • Sitemap and coding improvements • Monthly reports • GOAL: Bring new leads into AWANE • PPC (pay per click) campaign on Google • Created an E-Book to offer people online in exchange for information • Added a referral program • Monthly/bi-monthly Email Newsletter campaigns

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