HomeMy WebLinkAbout05-08-06 Admin Com. MinutesDublin City Council
ADMINISTRATIVE COMMITTEE MEETING
Mav R, 2006
Council members present: Vice Mayor Lecklider, Chair, Mrs. Boring, Ms. Salay, Mayor Chinnici-
Zuercher, Mr. Keenan, Mr. Reiner (joiied the meeting near the end)
Staff Members present: Ms. Brautigam, Mr. Harding, Ms. Ruwette, Ms. Hamilton, Ms. Rummer
CALL TO ORDER
Mrs. Boring called the meeting to order at 6:00 p.m. in the Council Conference Room. She noted
that the topic of tonight's discussion is Employee Dental Benefits. Review of the issue was
assigned to this committee earlier in the spring. Mr. Harding has indicated that some changes have
occurred since then, so there is no need to address those. She asked staffto elaborate.
Ms. Ruwette responded that there has no change in the City's plan for dental health benefits.
However, at the beginning ofthe year, the City's new health insurance provider, United Health
Care, was applying in and out-of-network charges. Dublin health plan is not structured with in and
out-of-network dental providers. When Human Resources became aware of the error, they
requested UHC to re-process all dental claims from the beginning of the year. UHC did so and
corrected those that had not been paid appropriately
Mrs. Boring indicated that the in/out of network charge has therefore been addressed. Two other
issues are: maximum UCR fee reimbursement and the maximum life-time cap. She has had a
personal experience with the first. Her dentist informed her that the UCR is not really the "usual
and customary rate." It is actually the amount the provider has decided they will cover. For
example, if a crown costs $800 or $900, and the City's plan is 50/50 (50% of the cost is covered),
the amount is subject first to the L1CR. In her case, UHC determined that the crown her dentist
placed was not the type of cro«~n they would cover. If the only crown UHC will cover ~0/50 costs
$600, then UHC would pay 50% of $600, not 50% of $S00 or $900. The end result is that the plan
is covering only 30% of the cost; the employee is responsible for the remainder. She asked her
dentist for his input. He informed her that UHC will cover 50% of the cost of a metal crown, not a
porcelain crown. He further stated that there is no dentist in Dublin that would place a metal cro«~n
in thei• patients' mouths. Most dentists seat only porcelain crowns for both cosmetic and health
reasons. Therefore, she requests that staff examine the UCR the City's insurance permits for
cro~rns, perhaps for other dental procedures, also.
Ms. Ruwette responded that the UCR was another issue addressed earlier this year. Staff
determined that the portion saved by the City versus the difficulty resulting for the employees did
not justify including the UCR. Therefore, the City asked L1HC to re-process the 2006 dental claims
at 100%, eliminating the UCR in the consideration.
Mrs. Boring responded that the information in her packet includes the UCR consideration.
I~~Ir. Harding responded that he inadvertently provided earlier information. Revised copies were
provided tonight.
Vice Mayor Lecklider inquired if Mr. Harding has been able to assess the financial impact of the
new plan versus the former plan.
Administrative Committee
May 8, 200&
Page 2
I~~Ir. Harding responded that they have not observed a significant change. The dental program is a
very small portion of the overall employee health program.
Vice Mayor Lecklider noted that the City has generous changes in the plan's benefits.
lU1rs. Boring responded that one change was not to be that the employees would be financially
impacted if they agreed to the preferred material being used.
Vice Mayor Lecklider concurred -most dentists place only porcelain crowns.
Mrs. Boring noted that she also has information detailing the health risks caused by metal dental
materials, including proposed legislation prohibiting the same. Consistent with the City's employee
wellness focus should be the intent that employees do not have metal dental materials.
I~~Irs. Boring stated that the third issue is the annual maxirnum dental benefit. From the time the
dental benefit was originally instituted, the annual maxirnum has never been adjusted in accordance
l~~ith the increased costs. The City will pay a maximum of $1,500 today, the same it would pay
several years ago, and today, that cap is reached very quickly. Her concern is that there are cities in
the area that do not have nearly the financial prosperity of Dublin who provide their employees a
greater annual maximum -Upper Arlington - $2,500 and Grandview Heights - $2,000. The City of
Dublin requires a high level of productivity and quality from its employees, and the benefits are
important to the employees. She would like the committee to consider raising the annual maximum
for City of Dublin employees to $2,000.
Mayor Chimiici-Zuercher inquu•ed if staff would know approximately how many employees use the
maximum of $1,500 and «•ould benefit from the increase.
Mr. Harding responded that he did not have the data with him, but he is a«-•are that several
employees had to have significant dental work done and they eclipsed the $1,500 very easily. It is
not a high level of coverage. However, if the entire benefits package is considered, there are trade-
offs. The City's prescription drug program is very rich - he believes employees are probably
paying only about 10% of their prescription drug costs. The City also has a fairly rich medical
program. Dublin's dental benefit program is not nearly as rich as those two programs, but
consideration should be given to the trade-offs
Mrs. Boruig responded that the dental program is a component of the overall wellness program. It
is important that employees maintain oral health in the interest of maintaining overall health.
I~~Is. Salay noted that all ofthe preventive dental care is paid at 100%. But if the employee has
anti~thing other than basic work done, the $1,500 is reached very quickly.
Mrs. Boring stated most insurance companies cover preventive care and cleaning at 100%. But
there are other procedures that should not be considered optional, such as replacement teeth for
pulled lost teeth to protect the bite.
Ms. Salay inquu•ed if staff could assess the number of employees who eclipse the present $1,500
max and the number of employees who might not lie having work done because they cannot afford
it. How are the employees who are not in the upper echelons of the City's pay scale impacted? The
employees who make more money have more disposable money and are less impacted. If
Administrative Committee
May 8, 200&
Page 3
employees are deferring dental work, it can ultimately cost the employee more and cost the plan
more.
lU1rs. Boring inqui•ed how that type of information could be obtained.
Ms. Salay responded that staff could look historically at numbers of employees who have maxed
out their dental benefit.
Mr. Harding responded that it is possible to determine the number of employees who maxed out
thew cot%erage each year.
Mr. Keenan stated that there are 400 full-time employees, so, theoretically, the risk of increasing the
maximum by $500 is $150,000-$200,000 - if every employee were to max out their dental
coverage.
Mr. Harding noted that including employees' family members, there are actually 1,000 covered
under the City's plan.
I~~Irs. Boring stated that the message that would be sent by increasing the maximum to that
equivalent with Grandvie«T or Upper Arlington is the value we put on our employees. If
Grandview, which is less economically prosperous than Dublin, provides a higher maximum for
their employees, why can't Dublin?
Ivlr. Keenan noted that it is important to look at Dublin's entire health benefits package -the
medical, dental, vision, employee assistance and wellness. In contract negotiations with union
members, one element is not considered separate from the other issues -the health benefits package
is similar.
Vice Mayor Lecklider stated that he would prefer to improve the plan by improviig the percentage
of coverage in major services. At least half of the cities surveyed provide a benefit equal to
Dublin's.
I~~Irs. Boring stated that even if the plan were increased to 80%, employees still would not be able to
have two crowns unless the maximum is increased. The only city on this chart where that makes
sense is Upper Arlington. Thei• plan provides a max of 80% for major services and a maximum
combined cap of $2,500.
Ms. Salay inqui•ed if the benefits package is looked at as part of the compensation study.
I~~Ir. Harding responded that it is not.
Ms. Salay stated that she would like to review the maximum in context with the whole plan; she
t~~~ould also like staff's estimate of the cost of increasing the maximum. She ~~~ould also like to know
if this would be an area where the investment would be highly valued by the employees. Would it
help in attracting and retainiig employees? Is this where the City prefers to spend $500/employee
or would another area be more beneficial to the employees?
lU1r. Harding responded that the dental program is such a minor component in the overall benefits
package. He does not l~elieve any employment decision would be made based on the City's dental
program.
Mrs. Borilg agreed that this alone would not affect all employment decision, but in conjunction
with some other things, it could assist in a decision.
Administrative Committee
May 8, 200&
Page 4
Mayor Chimiici-Zuercher stated that it is a benefit that often goes uiuioticed in employment, except
by those who have children or dental problems. It is a relatively low cost benefit to provide.
Mr. Harding noted that increasing the maximum in medical benefits would have a far greater impact
on the employee.
Vice Mayor Lecklider referred to a potential impact in major services, and inquired what a crown
typically costs.
1VIrs. Boring responded that a crown costs $900 - $1,000.
Vice Mayor Lecklider stated that increasing the annual maximum of major services to 75% would
enable the employee to purchase two crowns/per year.
Mrs. Boring responded that she does not believe that many employees t~~ould use the maximum
benefit. It would be a great benefit, however, for those few employees who might have major
dental health issues arise -who suddenly need a couple of crowns, a bridge, and replacement teeth.
This r~~ould impact them significantly, and the real risk to the City isn't substantial -not many
employees will rush out to buy dental services.
Mr. Harding stated that most benefit programs are not designed to protect a small group of
employees.
Mrs. Boring stated it is, however, unusual not to increase the annual maximum after a number of
years to reflect the significant changes that have occurred in costs. The cost of living has increased
greatly in recent years. If the City's annual maximum for the last few years has been $1,500, it
t~~ould be appropriate to increase it.
Mr. Harding responded that the annual maximum was increased 4 years ago from $750 to $1,500.
Vice Mayor Lecklider stated that there are probably employees who do need two crowns in a year,
but at 50% coverage, it would be only $1,000 out of pocket for the employee.
Nlrs. Boring inquired if the other Committee members would be interested in increasing the annual
maximum from $1,500 to $2,000.
Ms. Salay stated that before she could make a decision, she would like to know how many
employees nnaxed out at the $1,500 limit.
Mr. Harding stated that staff would obtain that information.
Vice Mayor Lecklider stated that he would also like to know the expected impact of increasing the
percent of major services. He does not want to suggest increasing it from 50% to 80%, as he does
not know what the financial impact «-ould. Perhaps it should be a 70-75%.
I~flr. Harding responded that staffwould review last year's claims and prepare a financial impact
statement.
Vice Mayor Lecklider stated that while employees l~~ould appreciate having the annual maximum
raised, he believes the City's overall health benefit package compares favorably with the other
communities.
I~~Ir. Harding responded that Dublin is a little low in two areas -the percentage covered for major
services and the lifetime maximum for orthodontia services.
Vice Mayor Lecklider suggested increasing the orthodontia services maximum to $1,250.
Mrs. Boring stated that her basis is that in most areas, Dublin leads the other communities. She is
not pleased that Dublin does not. "stack up" as a leader in the provision of health benefits -other,
smaller, less economically affluent communities do better. However, that is her view.
Administrative Committee
May 8, 200&
Page 5
She inquired if Vice Mayor Lecklider would like to recommend to Council raising the lifetime
maximum for orthodontia services from $1,000 to $1,250 or would he requi•e additional
information?
Vice Mayor Lecklider responded that he t~~ould like staff to prepare a financial impact assessment
on an increase in orthodontia services coverage as well.
Mrs. Boring summarized that staff should prepare a financial impact assessment on: (1) increasing
the annual maximum from $1,500 to $2,000; (2) increasing the major services maximum from 50%
to an unspecified percentage - staff to calculate at various percentages; and (3) increasing the
lifetime maximum for orthodontia services to $1,250 and to $1,500.
Vice Mayor Lecklider responded that he agrees with Mr. Keenan -the dental benefits are a minor
component in the overall employee health benefits package.
lU1rs. Boring responded that the City of Dublin is a government entity and should not be compared
with the private industry marketplace. It should be compared with other municipalities. On a
number of occasions, Council has acknowledged that City of Dublin employees typically are
«~orking harder and longer to perform the jobs for this city than is necessary in other area cities.
Council has also said they want employees to kno~;~ that Council is aware and appreciative ofthat
fact. Increasing the annual maximum from $1,500 would be an easy, yet inexpensive ~~~ay to
express that. It would be less expensive than increasing the salaries to 100% of the marketplace.
Ivls. Salay inqurded if removal of impacted wisdom teeth falls under dental services or medical
services.
lU1r. Harding responded that oral surgery is a medical service, and oral surgeons are included in the
list of providers for the plan.
Ivlrs. Boring requested that Mr. Harding provide the f°mancial impact assessments as requested for
the next Council meeting. In that report, staff should also clarify the issues that have recently been
resolved - (1) that no dentists are considered out of network and (2) charges for dental services are
not subject to a L1CR. Employees were concerned about those issues and may not be a~~~are that
they have been addressed.
Mr. Harding responded that any employees who were charged incorrectly for dental services were
reimbursed the difference by UHC. He believes the employees are aware that the City has corrected
the issue. He indicated that the information requested will be compiled and forwarded to Council.
• ~~~ellness/Health 117anagement Implementation Approach
Mr. Harding stated that last year when the t74~ellness Initiative «Tas introduced, staff met with the
Administrative Committee to review details of the new program. At that time, staff suggested that
it might be necessary to retain a thid party administrator to assist Human Resources with employee
health management and wellness coaching. Staff has identified a consortium through Cuyahoga
Community College, in conjunction with the University of Michigan, «~ho are known for thei• data
analysis prowess, and the Os«~ald Company of Cleveland, a benefits consulting firm. That
consortium «~ill be able to design a fiill range of wellness initiativ°es and health management tools.
They will be able to advise the City on the addition of a variety of preventive health screenings to
the City's plan. Representatives from Health Wise are present tonight. The company provides a
Variety of EBT scans -cardiovascular scans, one of several preventive screenings that HR would
like to add to the ~velhiess initiatives.
Administrative Committee
May 8, 2QQ&
Page 6
Nis. Hamilton stated that Tri-C has implemented this strategic wellness program at Cuyahoga
Community College and has seen an improvement in cost containment. Tri-C will be able to
provide connections to vendors to provide screenings and to help with some of the wellness
programs. They will also evaluate the City's medical claims and prescription costs against the
individual employee health risk assessments. They will identify employees with high risk behaviors
that would contribute to the high costs. They will separate the high risk employees cost-wise fi•orn
the low risk employees cost-wise. They will also assess how often employees are absent and how
often the employees are in a state called "presenteeism" -- the employees are at work but not fully
engaged.
Mrs. Boring inquired if that is believed to be health-related?
Ms. Hamilton responded that they will evaluate the City's environment and help the City embrace
and promote a healthy culture. It will do more than helping an employee set up a walking program.
It will identify which people are contributing to the high costs and identify programs to help them,
perhaps through disease management programs. They will get that aspect under control in addition
to helping the healthy people stay healthy.
Mrs. Boring responded that she is very concerned about what she is hearing. It sounds very
discriminatory -essentially identifying people who are costing the City more money.
Ms. Hamilton responded that she will correct that aspect. The City will not look at individual
employees but. at the work force as a whole. Staff will see the aggregate results of Tri-C's studies,
not. individual studies.
Ivirs. Boring stated that she recognizes that cities are beginning to be involved with these types of
programs, but the manner in which that is done must be handled very sensitively.
Ms. Hamilton responded that Tri-C will also help in crafting that message for employees. It is not a
"finger pointing" opportunity. It will focus on how to achieve a healthier «~orkforce to contain
health costs. Tri-C and Community Relations will help with the marketing piece.
Vice Mayor Lecklider inquired if the medical claims would be evaluated, not individual employees.
Mr. Harding responded that they ~~~ill be providing aggregate data to the City.
Vice Mayor Lecklider inquired if the choice of whether the employee wants to avail thernselves of
the recommended sohrtions remains their choice.
Ms. Hamilton responded that is correct.
1VIrs. Boring stated that employees could potentially be offended by those messages.
Ms. Salay noted that it will be important to convey that information in a manner that does not make
employees feel they are being singled out in any way.
Mrs. Boring inquired what types of screenings are being considered.
Ms. Hamilton responded that they have not yet been determined. Blood pressure, diabetes, and
cholesterol screenings are curl•ently provided to employees.
Mrs. Boring inquu•ed where those are provided.
Nis. Hamilton responded that the screenings are provided at the annual health fau• and through other
oppoi-tunitie s.
Administrative Committee
May 8, 20Q&
Page 7
I~~Ir. Harding noted that Health Wise can also provide major types of screenings, such as
cardiovascular and cancer, that can identify health issues before they become major claims. The
screenings can contribute significantly to disease prevention.
lUlrs. Boring inquied if staff intends to provide Council a recommended strategy including
estimated costs and how the various components would be made available.
Mr. Harding stated that once a contract is signed with Tri-C to be the thud party administrator, they
will combine all the elements into a total program. They will also identify the best vendors for
specific screenings and their recommendations for bringing them online. This year's budget covers
only Tri-C's third party administration (TPA) fees for selection of the vendors. The funding for
Health Wise screenings would be included in a future budget proposal.
Vice Mayor Lecklider inquired the cost of the TPA fees.
Mr. Harding responded that they do not have that information on hand, but it is included in the 2Q06
budget. He will obtain the information and provide it to Council.
I~~Is. Salay stated that if her father had such screenings available to him several years ago, he could
have avoided recent heart bypass surgery.
Vice Mayor Lecklider stated that the screenings could help the City avoid many major claims.
Mrs. Boring added that it would help employees avoid the hospital experience.
Ivlr. Harding stated that studies indicate that every $1 invested in wellness and prevention provides a
$4 - $~ return.
Ms. Salay inquired how the new wellness program is being received. Are the employees embracing
these ideas? Have there been changes in attitudes?
N1s. Ruwette stated that 80% of the employees signed up for the free DCRC membership. Some
employees are using the free employee fitness center at the Service Complex.
Ms. Hamilton responded that facility is nice because it is used by employees only. In regard to
attitudes -there is some caution and concern from employees regarding their privacy. However,
employees know there will be some changes, and they are beginning to ask questions about those.
Mr. Harding noted that there is much more to come, the program has only begun to "scratch the
surface."
Mrs. Boring inqui•ed if employee usage of their free DCRC memberships is being tracked.
Ms. Hamilton responded that has not yet occurred due to the hesitancy of employees concerning
being tracked. A tracking mechanism might be implemented with Tri-C, so that the City can see a
return on that investment.
Ms. Salay stated that she would not like being tracked as to the number of times she used the Rec
Center. However, it would be interesting to know what percent of the 80% employee memberships
were showing usage once or twice a week.
I~~Irs. Boring noted that would be preferable because it is anonymous.
Ms. Salay responded that obviously employees should not be "singled out."
lUlr. Reiner inquired if there is still opportunity for employees to acquire the free DCRC
membership.
Ms. Ruwette responded that it provided in the open enrollment ofthe City's health insurance
program last fall. If employees wanted to have the free membership, they were required to
complete the online health risk assessment.
Administrative Committee
Nlay 8, ZQQ&
Page 8
I~~Ir. Reiner and Mrs. Boring responded that they did not receive free memberships.
NIs. Ruwette responded that if they completed the health survey, they received the tree membership.
However, it is necessary to go to the Rec Center to obtain their membership cards.
Vice Mayor Lecklider thanked staff for the information.
The meeting was adjourned at 7:UU p.m.
Deputy Clerk of Council