To: The Board of Supervisors of Sonoma County, Board of Directors of the Sonoma County Water Agency, Board of Commissioners of the Community Development Commission, Board of Directors of the Sonoma County Agricultural Preservation and Open Space District
Department or Agency Name(s): Human Resources Department
Staff Name and Phone Number: Cheryl Thibault, Employee Benefits Manager - 565-3033
Vote Requirement: Majority
Supervisorial District(s): Countywide
Title:
Title
Employee and Retiree Health and Welfare Plans Agreements and Amendments
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Recommended Action:
Recommended action
A) Authorize the Interim Director of Human Resources to execute an amendment to the Administrative Services Agreement with Anthem Blue Cross for third-party claims administration and provider network access for the County of Sonoma Health Plans, for the term June 1, 2023 through May 31, 2024.
B) Authorize the Interim Director of Human Resources to execute an amendment with CareCounsel to provide third-party healthcare advocacy services for County employees, retirees, and eligible dependents for the term August 1, 2023 to July 31, 2026.
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Executive Summary:
The Human Resources (HR) Benefits Unit is responsible for management and administration of the County’s health and welfare benefit programs provided to employees, retirees, and eligible dependents. The HR Benefits Unit contracts with fully insured providers and third-party administrators (TPA) who provide services, specialized skills and expertise to public and private employers nationally.
Per the County’s purchasing policies, the HR Benefits Unit solicits services from vendors to meet the County’s needs regarding benefits provided through Board approved memorandums of understanding and the Salary Resolution. The HR Benefits Unit’s purpose is to provide high quality benefits at the best market prices.
The recommended actions allow the HR Benefits Unit to continue to provide services through the listed vendors.
Discussion:
The following provides more specific information about each Recommended Action:
Anthem - Anthem Blue Cross (Anthem BC) provides Administrative Services Only for the County Health Plans, which includes third-party claims administration, 24-hour nurse hotline, customer service, excess stop-loss claims filing services, and discounted network access services. Services also include access to the “Blue Card” Program, for CHP members outside California through other Blue Cross/Blue Shield affiliates, nationwide. The amendment extends the agreement term through May 31, 2024 with the monthly administrative fee increasing from $40.12 to $42.53 per subscriber per month. As of March 1, 2023, there are 753 total subscribers in the County Health Plan - 45 active employees and 708 retirees.
CareCounsel - CareCounsel provides healthcare advocacy services, confidential benefits advice, support and assistance, health plan issues resolution, and health claims troubleshooting to County employees, retirees, and their families. Amendment No. 4 extends the agreement term through July 31, 2026 with fees increasing from $1.40 to $1.46 per employee/retiree per month.
Strategic Plan:
N/A
Prior Board Actions:
03/01/2016: Board authorized agreement with Anthem Blue Cross
07/19/2016: Board authorized agreement with CareCounsel
05/25/2021: Board authorized amendment with Anthem Blue Cross and CareCounsel
05/24/2022: Board authorized amendment with Anthem Blue Cross and CareCounsel
Fiscal Summary
|
Expenditures |
FY 22-23 Adopted |
FY23-24 Projected |
FY 24-25 Projected |
|
Budgeted Expenses |
$84,312 |
$532,860 |
$532,860 |
|
Additional Appropriation Requested |
0 |
0 |
0 |
|
Total Expenditures |
$84,312 |
$532,860 |
$532,860 |
|
Funding Sources |
|
|
|
|
General Fund/WA GF |
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|
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State/Federal |
|
|
|
|
Fees/Other |
$84,312 |
$532,860 |
$532,860 |
|
Use of Fund Balance |
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|
|
Contingencies |
|
|
|
|
Total Sources |
$84,312 |
$532,860 |
$532,860 |
Narrative Explanation of Fiscal Impacts:
Costs associated with Anthem Blue Cross are funded through the County Health Plan Internal Service Fund revenues from premiums paid by employer, employee, and retiree contributions.
Costs associated with CareCounsel are funded through the County Health Plan Internal Service Fund revenues as described above, OPEB ISF 8.8% rate charged to County departments, and Benefits Administration ISF rate charged to County departments and agencies, allocated by FTE (full-time equivalent), 47% of which come from General Fund departments and 53% from Non-General Fund departments.
Costs for Anthem Blue Cross and Care Counsel will be absorbed in the Human Resources Department recommended FY 2023/24 budget and the proposed projected FY 2024-25 recommended budget.
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Staffing Impacts: |
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Position Title (Payroll Classification) |
Monthly Salary Range (A-I Step) |
Additions (Number) |
Deletions (Number) |
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Narrative Explanation of Staffing Impacts (If Required):
None.
Attachments:
None.
Related Items “On File” with the Clerk of the Board:
1. Amendment to the Administrative Services Agreement with Anthem Blue Cross
2. Amendment to the Administrative Services Agreement with CareCounsel