Employee Benefits renewal update.

1. Clermont County
2018 Renewal Update
August 9, 2017
Steve Ashe, CEBS, Director,
Employee Benefits

2. Employee Benefits Consulting
Wealth Management
Life & Disability Insurance
1. 2015 vs 2016 Financials Recap from 4-24-17 Presentation
2. 2017 Financials YTD
3. 2018 Projected Medical Renewal
4. 2018 Medical Request for Proposal
– Humana vs UHC
5. UHC and Alternative Strategies
6. 2018 Projected Dental Renewal
7. 2018 Dental Request for Proposal
8. Other Benefit Renewals
9. Next Steps
Agenda
2

3. Employee Benefits Consulting
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Life & Disability Insurance
2015 vs 2016 comparison:
2016 Claims Update
3
*Pepm = per employee per month
2015 2016 Change 2015 PEPM* 2016 PEPM* Change
Total Claims $9,031,041 $10,486,211 16.1% $737 $849 15.2%
Medical Claims $7,290,940 $8,415,020 15.4% $595 $681 14.5%
Rx Claims $1,740,102 $2,071,191 19.0% $142 $168 18.1%
2015 vs 2016 comparison netting out stop loss reimbursement ($0 in 2015 vs, $277,905 in
2016):
2015 2016 Change 2015 PEPM* 2016 PEPM* Change
Total Claims $9,031,041 $10,208,306 13.0% $737 $826 12.1%
Financials:

4. Employee Benefits Consulting
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The following chart is the monthly dashboard HORAN provides Clermont County in order to
track how the plan is performing compared to total expected costs:
4
2017 YTD Claims Update
Employees Members
HCR Fees
(PCORI
&
Reinsurance)
*
Fixed Cost
(Admin, ISL,
& ASL)**
HORAN
Expected
Claims
Sun Life Max
Claims
Liability
Medical
Paid Claims
Rx
Paid Claims
Total
Paid Claims
Total
Plan Cost
Expected
Total
Plan Cost
Actual vs
Expected
Monthly Total
Plan Cost (%)
Jan-17 1,049 2,337 $5,731 $154,696 $810,795 $1,210,525 $588,728 $130,506 $719,234 $879,661 $971,223 91%
Feb-17 1,041 2,319 $5,687 $153,826 $805,015 $1,201,293 $633,296 $114,796 $748,091 $907,604 $964,529 94%
Mar-17 1,044 2,319 $5,687 $153,812 $806,636 $1,204,755 $740,056 $169,863 $909,919 $1,069,418 $966,136 111%
Apr-17 1,045 2,325 $5,702 $153,886 $806,573 $1,205,909 $393,300 $188,667 $581,967 $741,556 $966,161 77%
May-17 1,051 2,329 $5,712 $154,673 $806,519 $1,212,833 $596,422 $178,838 $775,260 $935,645 $966,904 97%
Jun-17
Jul-17
Aug-17
Sep-17
Oct-17
Nov-17
Dec-17
Total 5,230 11,629 $28,520 $770,894 $4,035,538 $6,035,315 $2,951,802 $782,669 $3,734,471 $4,533,885 $4,834,952 94%
Avg. / PEPM 1,046 2,326 $5 $147 $772 $1,154 $564 $150 $714 $867 $924 94%
ISL Loss Ratio (ISL reimbursements
/ ISL Premium): 0%
Less Estimated Stop Loss
Reimbursements:
$0
Net Total Plan
Cost: $3,734,471 $4,533,885 $4,834,952 94%
*HCR Fees included in the report are as follows:
$2.43 PMPY for PCORI and $27 PMPY for Transitional Reinsurance
**The County Fee, estimated HSA Contributions, and the Stop Loss Carve Out Fee are included in the Fixed Cost column
above.
Over/Under
Claims
Budget: $301,067

5. Employee Benefits Consulting
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Life & Disability Insurance
2018 Medical Renewal / Projection
5
• Humana Administration: HORAN negotiated a -10.9% reduction, $63k, as well as $255k in
prescription drug rebates paid out over the course of three years that were not previously
offered.
– Administration reduction guaranteed for two years
• Sun Life Stop Loss: HORAN negotiated a 16.0% increase, $130k, and is still working with
Sun Life to further reduce the renewal. Aggregate stop loss increased 3.0%, $938.
– Please note: Clermont County qualified for stop loss premiums back and will received a check
for $169k.
• Medical / Rx Claims projection: HORAN’s projection shows a 15.8% increase, $1,540,258.
• 2018 Total Cost Projection: Clermont County’s renewal is projected at 12.6%, $1,465,596.
– Does not take into consideration the stop loss premium refund or plan changes

6. Employee Benefits Consulting
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Life & Disability Insurance
2018 Medical Renewal / Projection
6
A full breakout of the renewals and other medical costs outlined below:
2017 Annual 2018 Annual % Change $ Change
Administration $580,656 $517,596 -10.9% ($63,060)
County Fees $120,000 $120,000 0.0% $0
Specific Stop Loss $813,343 $943,529 16.0% $130,185
Aggregate Stop
Loss
$31,278 $32,216 3.0% $938
PCORI $5,677 $6,131 7.9% $454
Claims Projection $9,732,446 $11,272,704 15.8% $1,540,258
HSA Contributions $301,800 $301,800 0.0% $0
Rx Rebate Credit - ($80,000) - ($80,000)
TOTAL $11,657,381 $13,122,977 12.6% $1,465,596

7. Employee Benefits Consulting
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Life & Disability Insurance
2018 Medical Request for Proposal
7
HORAN conducted a full market bid receiving quotes from the following carriers:
• Aetna
• CEBCO
• Custom Design Benefits (Traditional self-funding quote and TruCost)
• Humana (incumbent)
• Medical Mutual of Ohio (MMO)
• Unitedhealthcare (UHC)
HORAN has had several meetings with the HR Team and the Healthcare Advisory Committee.
After evaluating final quotes, network access, network discounts, pharmacy rebates and other
carrier nuances we have narrowed our focus to Humana and UHC.

8. Employee Benefits Consulting
Wealth Management
Life & Disability Insurance
2018 Humana vs UHC Costs
8
Below compares the financial between Humana and UHC:
Current Renewal UHC
Total Annual $11,657,381 $13,122,977 $12,879,746
$ Change - $1,465,596 $1,222,365
% Change - 12.6% 10.5%
Notes
-Administration
Guaranteed 2 Years
-Approx. $80k in
rebates (included for
3 years)
-Quoted through Health
Action Council
-Approx. $478k Rx Rebates
(included for 3 years)
Total increases do not take into consideration the $169k stop loss premium refund that will offset any final increase
Above costs shown with UHC/BP Stop Loss
UHC is offering $70k in miscellaneous credits not deducted from above

9. Employee Benefits Consulting
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Pharmacy Rebates
9
Both UHC and Humana have committed to offering prescription rebates, but UHC’s three year
total is approximately $1,321,310 more than Humana’s:
Year UHC Humana
2018 $478,354 $80,000
2019 $525,437 $85,000
2020 $572,520 $90,000
3 Year Total $1,576,310 $255,000

10. Employee Benefits Consulting
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UHC Strategies and Further Evaluation
10
Several items we are further evaluating with UHC:
PBM Carve Out Pharmacy
• UHC has the ability to carve out specific pharmacies that are typically higher cost. Designating CVS as
out-of-network pharmacy can actually save approximately 3-4% to Rx claims (~$99k).
UHC Plan Changes – Tiering Benefits
• UHC can offer tiered benefits to drive members to their preferred providers. HORAN worked with
UHC on the benefits structure and savings to claims which are expected to be approximately 2%
depending on the final plan structure (~$225k).
– Typically 35% of physicians are designated Tier 1
UHC Wellness Opportunities
• UHC offers a program called Real Appeal which focuses on weight loss. The programs typically gets
good traction within groups and any cost associated with the program is paid as a preventive claim so
may work within Clermont County guidelines.

11. Employee Benefits Consulting
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Plan Design & Other Strategies
11
Plan Design
• HORAN is evaluating several other plan design changes with The HR Team and HCAC to drive better
utilization and further reduce the renewal.
• Health Savings Account employer contributions
• A few modest plan changes we can possibly reduce the renewal to single digits.
Musculoskeletal Spend
• 2016 utilization showed a 46% increase in musculoskeletal spend accounting for a total of $1,660,000.
• Possibly looking to bring awareness to a local physician practice called Airrosti who has had third
parties conduct analysis showing less costs per episode of care than the norm.

12. Employee Benefits Consulting
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Dental Renewal and RFP
12
Dental Care Plus (DCP) Administration: HORAN negotiated a $1.00 pepm reduction, ($9,900).
HORAN developed a renewal projection using 24 months of Clermont County data. Overall
costs are expected to remain flat:
2017 Annual 2018 Annual % Change $ Change
Total Costs $498,433 $488,580 -0.2% ($9,853)

13. Employee Benefits Consulting
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Life & Disability Insurance
2018 Dental Request for Proposal
13
HORAN conducted a full market bid receiving quotes from the following carriers:
• Anthem
• Dental Care Plus (incumbent)
• Delta Dental
• Lincoln Financial Group
• MetLife
HORAN has met on several occasions with the HR Team and the Healthcare Advisory
Committee. After evaluating final quotes and network access we decided to narrow our focus
to DCP and MetLife.

14. Employee Benefits Consulting
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Life & Disability Insurance
2018 DCP vs MetLife Cost / Network
14
MetLife quoted a fully insured quote (currently self-funded). While MetLife can offer a
savings to the dental plans there will be large disruption to the dentists currently utilized.
DCP and MetLife both confirmed the two providers cannot both be offered.
Carrier $ Change % Change % Provider Match
MetLife (-$42,033) -8.5% 42%

15. Employee Benefits Consulting
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Other Benefit Renewals
15
Symetra / Basic Life, Voluntary Life and LTD: Under rate guarantee until 2019
EyeMed / Voluntary Vision: Under rate guarantee until 2020
Chard Snyder / Flexible Spending Account (FSA): Under rate guarantee until 2019
TriHealth / EAP: Renewal expected September
P&A Group / COBRA: Renewal expected September
Park National / Health Savings Account (HSA): No charge for the accounts
• Evaluating moving to a full service provider allowing employees access to more investment
opportunities, HSA subject matter experts, ‘Smart Cards’ that do not allow for non qualified
purchases to name a few of the differences.

16. Employee Benefits Consulting
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Next Steps
16
• Finalist Meetings with Humana and UHC (Aug 17)
• Finalize Stop Loss Renewal from Sun Life
– Continue carving out stop loss or carve-in with UHC?
• Decision on medical, dental and Health Savings Account carriers
• Finalize Plan Design
• Finalize 2018 projection based on stop loss refund, plan designs and credits
• Finalize Employee Contributions (medical / dental)
• Implementation Meetings (if necessary)
• Open Enrollment / Communications to Employees
• Non-tobacco discount for 2018
• Health District currently offers tobacco cessation classes at no charge to County employees

17. Questions