HomeMy WebLinkAbout2002 Annual ReportANNUAL CLAIMS REPORT - CITY OF JEFFERSONVILLE
Total claims paid (including drug card programs) by Stewart C: Miller & Co., Inc.
for the City of Jeffersonville Employee Health Care Plan for the 12-month period
ending December 31, 2002, was $2,284,522~90. The Plan's average monthly claim cost
was $758.47 per participant based on an average of 251 employees per month.
Through the Specific Stop-Loss Reinsurance policy purchased from Union Labor Life
Insurance (ULLICO), jeffersonville received $77,244.40 in reimbursements. Subtracting
these reimbursements from the gross claims paid results in a net claims expense of
$2,207,278.50 or $732.83 per employee per month. Other expenses such as claims
administration expense, ICM's fees, Rx Drug Card Participation Fees, PPO Access Fees,
etc. should be added to the pure claims costs to determine total costs per participant.
A total of 5,605 claims representing over $3.1 million in charges was received by the
Administrator's Office for adjudication for the year. The average paid per claim
submitted was $407.59. The average turn around time was 10 days. Turn-around-time
is the time it takes from the first day a claim is received until the day it is processed for
payment.
We have broken down the City's claims experience by benefit area in the chart below.
Cost per Employee by Benefit Area
$260
$241.75
$97,84
$240
$220
$2OO
$16o ~
$160 -
$140
$120
$1oo
$80'
$80
$40
$20
$0
Inpatient Surgery Diag/Lab Physician Other All RX Psych/Sub Oulpatient Phys/Occ
Hospital Abuse Hospital Therapy
Prepared by Stewart C. Miller & Co., Inc.
CLAIMS PAID BY BENEFIT AREA - 12 MONTHS ENDING 12/31/2002
The City's greatest claim expense category for the year was Inpatient Hospitalization. A
resulting 31.87%, or $728,150162 was spent on this one benefit area in 2002. The next
largest benefit expense was in the Outpatient Hospitalization category with a total of
$445,322.38 representing 19.49% of Jeffersonville's total expenses.
Prescription Drugs accounted for 12.90% of all claims paid during the year, or
$294,682.03 which is less than the 18% predicted by industry experts. *'In 2002,
prescription drugs are expected to represent 18% of the total medical costs nationwide,
up from 10% in 1995. Direct to consumer promotion of drug therapy not only increases
prescription drug use but increases the frequency of office visits to health care
professionals.' *Source: Sega/Health Plan Cost Trend Survey 2002
The Other category includes such benefit areas as Home Health Care Services,
Chiropractic Care, Medical Equipment, and Ambulance Services.
Claim Experience by Benefit Area
Outpatient
Hospital
19%
Phys/Occ
Therapy
1%
Inpatient Hospital
32%
Psych/Sub Abuse
1%
All RX~
13%
Other
12%
Physician
7%
Surgery
8%
Diag/Lab
7%
Prepared by Stewart C. Miller & Co.. Inc.
2
f
LARGE CLAIMS FOR POLICY YEAR 4/01/2002 - 3/31/2003
To lessen the impact of catastrophic claims, the City of Jeffersonville purchased Stop-
loss insurance from ULLICO with a Specific Stop-loss deductible of $75,000. The claims
listed below have reached at least 50% of the deductible, meaning the City has paid at
least $37,500 in claims for each individual. These six claims totaled $393,917.05. All
participants continue to be covered by the Plan.
Status
Employee
Dependent
Employee
Employee
Employee
Employee
Diaqnosis
Auto Accident Injuries including Brain injury
Acute Pancreatitis, Gastritis
Coronary Atherosclerosis
Mechanical Complications of Internal Orthopedic Device
Coronary Atherosclerosis
Lung Cancer
$159,570.77
$61,960.04
$47,472.58
$42,541.04
$42,009.90
$40,362.72
CLAIM ANALYSIS BY PARTICIPANT
Of the 5,605 total claims submitted, 2,187 were submitted for employees, 1,800 were for
spouses, and 1,618 were submitted for dependents.
The next graph illustrates the total claims paid for the plan year by employee, by spouse
and by dependent.
Claims Paid by Participant
$1,350,000 '
$1,250,000 '--
$1,150,000 '--
$1,050,000 --
$950,000
$850,000 --
$750,000 --
$450 000 ---
$350,000
Employees
Prepared by Stewart C. Miller & Co., Inc.
$R0~1;773
Spouses
Dependents
HOSPITALIZATION
The average length of stay for all Jeffersonville admissions was 4.09 days. Of the 55
total admissions for the year, pregnancy-related conditions were the most frequent cause
of hospitalization with 6 admissions among the City's participants. The next table shows
the frequency of admissions by common diagnoses:
2002 Admission Diagnosis In-Network Out-of-Network Total Admits
Heart/Heart Complications 3 0 3
Pregnancy/Birth and/or Related 6 0 6
Complications
Cancer Related 1 0 1
Mental Nervous and/or 0 0 0
Substance Abuse
Inpatient Admissions
St. Anthony Medical
Center
66%
All Others
16%
Floyd Memorial
Hospital
9%
Inpatient Provider
Clark Memorial Hospital
Norton Suburb Hospital
Jewish Hospital
Floyd Memorial Hospital
All Others
Total Inpatient for all Hospitals
Total Claims Paid to all Providers
~_ Jewish Hospital
9%
Norton Suburb
Hospital
14%
# of Admits
27
9
5
5
55
Amt. Paid
$256,939
$107,633
$132,458
$32,571
$23O,557
$727,587
$2,282,128
Prepared by SteWart C. Miller & Co., Inc.
4
SAGAMORE HEALTH NETWORK IMPACT
The City of Jeffersonville has participated in the Sagamore Health Network, a preferred
provider orgamzabon (PPO) sinCe APril 2001. There was 1 Out-of-Network admission for
the year. The 55 total admissions resulted in a total of 229 days paid for hospitalization.
The average Inpatient Hospitalization charge per day for the year was $2,978; the
average paid per day was$ 2,334. Total charges for the year were $934,717; the total
paid was $727,587.
Average Hospital Charges
JDAverage Cha~ge Per Day BAverage Paid Per Day 1
$2,978
$3,500
$3,000
$2,500
$2,000
$1,500
$1,000
$500
$0
PROVIDER REPORT
The Provider Y, ear End Journal indicates that the Plan paid $2,282,127.90 in benefits to
various providers in 2002. The largest provider payments were as follows:
Clark Memorial Hospital
Express Scripts
Norton Hospitals
Jewish Hospital
University Medical Center
Floyd Memorial Hospital
All Others
Total Paid to All Providers
$606,100.17
$294,682.03
$196,678.03
$172,894.44
$100,443.69
$96,280.04
$815,049.50
$2,282,127.90
Payments to these six providers totaled $1,467,078 and represented 64% of the Plan's
overall payments to providers for the year.
Prepared by Stewart C. Miller & Co.,/nc.
F
Cate_clorv
Inpatient Hospital
Surgery
Diag/Lab
Physician
Other
All RX
Psych/Sub Abuse
Outpatient Hospital
Phys/Occ Therapy
Total
2002 # Claims
Employees 2187
Spouses 1800
Dependents' 1618
Total 5605
Average Cost per Claim
Paid by Benefit Area
2002 % of Total Cost per Participant
728,150.62 31.87% 241.75
186,453.43 8.16% 61.90
166,527.61 7.29% 55.29
153,326.72 6.71% 50.91
272,153.19 11.91% 90.36
294,682.03 12.90% 97.84
19,910.21 0.87% 6.61
445,322.38 19.49% 147.85
17,996.71 0.79% 5.98
2,284,522.90
100.00%
Paid Claims Analysis
$758.47
Charges MMDeduct MMOOP Paid
1,771,231.08 3,089.95 13,083.69 1,291,237.41
862,302.76 1,500.00 8,168.61 609,772.63
518,893.68 1,317.12 5,350.88 383,512.86
3,152,427.52 5,907.07 26,603.18 2,284,522.90
$406.09