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Health Insurance:

 

How the Health Reform Package Will Help Americans in Connecticut!


The New Health Care Law and You:

The AARP Bulletin website can be a great resource for you! Specifically, the AARP Bulletin has a chart titled, A Quick Guide to Health Care Reform, and this provides helpful insights into the health care reform legislation. Please click on this link,


http://bulletin.aarp.org/yourhealth/policy/articles/reform_splash.html
 


New Pharmacy Benefits Manager - Questions & Answers

http://www.ct.gov/trb/cwp/view.asp?Q=451834&A=1598


 

A note from Darlene Perez, Administrator - Connecticut Teachers’ Retirement Board

re: New Pharmacy Benefits Manager

 

Teachers’ Retirement Board (TRB) Approves  New Pharmacy Benefits Manager For TRB Sponsored Health Insurance Plan

 

I am pleased to announce that on Monday, November 23, 2009, the Teachers’

Retirement Board (the Board) approved CVS/Caremark to serve as our new

Pharmacy Benefits Manager (PBM) effective February 1, 2010.

 

While there is sure to be some disruption with this change, I assure you

that we made every effort to select a PBM that has comparable prices,

pharmacy access and formulary list similar to our current plan for a smooth

transition with as little disruption as possible.

 

Participating members will receive a new member package directly from

CVS/Caremark in January including a new membership identification card for

retail prescriptions, a list of participating pharmacies and information on

how to use their mail-in prescription program.

 

As a reminder - there are 100,000 of you (including active and inactive

members, as well as retired teachers, beneficiaries, dependents and

survivors who are receiving benefits from this system) and 24 of us. We are

unable to provide personal responses to all the questions that we receive;

therefore, we encourage you to e-mail your questions to Marie Dempsey,

Administrative Assistant at marie.dempsey@ct.gov. Questions and answers

(Q&A’s) will be posted to our web-site (www.CT.gov/trb) periodically.

 

 

Darlene Perez, Administrator

 

Connecticut Teachers’ Retirement Board

www.ct.gov/trb 

 

 “A Pending Disaster”

We are all aware of the looming $8.6 billion dollar deficit facing our biennial budget for 2010-2011. We also are aware that the state has a statutory responsibility under Connecticut General Statutes, Chapter 167a, to provide retirement, disability, survivorship, and health insurance benefits for Connecticut public school teachers and their beneficiaries. The benefits of the program are funded by employee contributions, state appropriation, and investment income.
 

State employee contributions and state investment income are there. (These two aspects will be discussed later in this article.) It’s the state appropriations portion which is the “pending disaster” to the Connecticut Teachers Insurance Fund referred to in the title of this article. If the state withholds contributions for one or two years it will have a disastrous impact on our funds viability. You say, “How can this happen if the general fund requires state appropriations to the CTRB Insurance Fund?” In effect, if the Legislature passes the budget and “cuts” are in the budget for our Insurance Fund they can list the areas being amended at the end of the budget. This will, in effect, reduce the funding legally to our Insurance Fund.
 

At the meeting on August 19, 2009, Dr. Joe Field (consultant to the CTRB on health insurance) offered the following model for our understanding. The key elements that contribute to the viability of the CTRB Insurance Fund:

  • Active Teacher contributions (1.25 % of cost)

  • State Contributions (1/3 of cost)

  • Interest

  • Federal Drug Subsidy

At the end of June 2008 the model that was produced by Dr. Field showed the CTRB Insurance Fund would be extremely healthy through 2018 at $274 million dollars.

As of August 19, 2009, all the key elements of the model have been compromised, because of the stated deficit and its implications on state and local school districts.
 

  • Active teacher contributions are down due to an estimated 1200-1500 less teachers in 2009-2010. Salaries are flat and have not increased by the estimated 4%.

  • State contributions, if eliminated for one year, will have an impact on our Insurance Fund in the amount of $26 million dollars… if eliminated for two years the impact on our Insurance Fund will be $52 million dollars. In effect, this is 1/3 of the Insurance Fund’s solvency.
     

The loss of active teacher contributions places the new model for our Insurance Fund viability at $150-175 million dollars through 2017. This is a considerable downward trend and it will have a major impact on the fund. Dr. Field clearly stated if the state contribution is belated for one year, it will have a major impact on the fund but it could survive until 2015. If the state contributions are eliminated for two years, losing $52 million dollars, the Insurance Fund could be bankrupt in 2 ˝ years! There are many facets to this model that are extremely complex, above and beyond the major factors that were presented to us, and now to you in this article. Some of these factors are: cash flow, cost of medical necessities, increases, usage, etc. All have an impact on the Insurance Fund viability.


Many interested parties, from different agencies and teacher groups, were present at this work session as well. The latest information from the Capitol seems to suggest a one year loss of state funding to the CTRB Insurance Fund. The ARTC will keep our members updated on any new development in this vital area through our website and member mailings.


This meeting then turned to another major problem facing our Insurance Fund. The Pharmacy Benefits Manager (PBM), Medco, due to a “Held Harmless Clause,” that is required by the state of Connecticut in all contracts, was advised by its legal department, not to sign a three year contract. Negotiations have gone on for many months to no avail and this is a $95 million dollar contract! The three year contract with Medco would have saved the fund approximately $5.7 million dollars. As we go to press, Dr. Field is pursuing other PBM companies to take over our drug program. This change will occur in late February or March, 2010. It is very important for all our members to stay up to date on this topic. Each member using the drug plan will be informed by the CTRB on how to get ready for this change. Please watch for CTRB mailings and website directions.

Authors Note: Why is the state taking funding off the backs of Retired Teachers when state employees have NOT been involved in an insurance give back at all?! Their subsidy from the state is 7 times that of teachers!

As always, any new information on these topics will be forwarded to ARTC members by mail or via our website.


  


 

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