Department of Civil Service

PA96-05

TO: Participating Agency Health Benefits Administrators
FROM: The Employee Benefits Division
SUBJECT: Empire Plan Quarterly Experience Report
DATE: June 19, 1996

Enclosed are the First Quarter Empire Plan Experience Report for 1996 and the cover letter to Chief Executive Officers.

This report provides final 1995 experience, projected 1996 experience and projected 1997 premium rates

June 19, 1996

Dear Chief Executive Officer:

Attached is the Participating Agency First Quarter Report for 1996. This report provides final 1995 Empire Plan Experience, projected 1996 experience based on claims paid through March 1996 and projected 1997 premium rates.

The Plan carriers have declared a surplus for 1995 of $85.5 million, 5.1% of premium. A summary detailing the experience of each of the carriers is included in the report.

Initial projections of 1996 experience, based on claims paid through March 1996, reflect a surplus of approximately $135.2 million or 7.5% of premium. The report includes details for each of the carriers and, as in the past, these projections will be revised in each quarterly report based on actual claims experience for 1996.

The 1997 premium rate projections for each of the options are included in Exhibit III. At this point in time, the gross and net premiums are projected to increase approximately 5.5% and 12.5% respectively; the report explains the basis for these projections and they will continue to be revised in each quarterly report based on the latest claims data available.

The status of Medicare Part B Reimbursement has not changed since the last report. We will notify you as soon as any progress is made on this issue.

Also included with this report is a summary of Participating Agency involvement in NYSHIP. Attachment A provides details on the number of agencies, broken down by type, as well as the percentage of eligible counties, cities, towns, villages and school districts currently participating.

I hope this report is informative and useful to you. Please don't hesitate to contact me if you have any questions, comments or suggestions.

Sincerely,

Robert W. DuBois, CEBS
Director
Employee Benefits Division

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EMPIRE PLAN EXPERIENCE REPORT
JANUARY - MARCH 1996
produced for
PARTICIPATING AGENCIES IN THE
NEW YORK STATE
HEALTH INSURANCE PROGRAM
by
the Employee Benefits Division
New York State Department of Civil Service
George C. Sinnott
President, New York State Civil Service Commission

NYS HEALTH INSURANCE PROGRAM
PARTICIPATING AGENCY GROUP
EMPIRE PLAN EXPERIENCE REPORT
1ST QUARTER REPORT

1995 EMPIRE PLAN EXPERIENCE

The Empire Plan carriers have declared a composite 1995 dividend of $85.5 million or 5.1% of premium. The declared dividend is $41.3 million more than the margin loaded in the 1995 rates. More detailed experience information is provided in Exhibit I. Individual carrier dividend amounts are explained below.

Blue Cross

Blue Cross declared a 1995 dividend of $39.6 million or 6.5% of premium. This represents a $27.6 million increase over the margin loaded in the 1995 rates and is the result of the following factors:

Factor	Amount
Margin in Rates	$12.0 million
Reduction in Claims	24.7
Reduction in Retention	2.9
Total	$39.6 million

Approximately 90% of the dividend, exclusive of margin, is attributable to a reduction in claims from the amount estimated at the time of rate development. This is primarily due to a decrease in the 1994 claim base and a decrease in the 1995 claim trend from 6.2% to 5.6%.

MetraHealth Medical

MetraHealth declared a composite 1995 dividend of $21.7 million or 3.1% of premium representing a $1.7 million increase from the margin loaded in the 1995 rates. The rating of this component of the Empire Plan, on an overall basis, is considered very good given the numerous benefits changes implemented in 1995. These include the introduction of the Managed Physical Medicine Program, the Medicare Crossover process, successful negotiations with Ambulatory Surgical Centers and increased benefits for routine health exams, ambulance services and hearing aids. In general, a slight increase in claims was offset by a reduction in retention.

MetraHealth Mental Health and Substance Abuse Program

MetraHealth declared a composite 1995 dividend of $12.8 million or 11.4% of premium for the Mental Health and Substance Abuse (MHSA) Program. This represents an increase of $7.9 million over the margin loaded in the 1995 rates and is chiefly due to the continued improvement in the claims base. Through aggressive managed care, the overall percentage of care delivered in an outpatient setting has increased from 60% in 1994 to 65% in 1995. This shift in treatment to a more appropriate setting produces savings as the cost of delivering outpatient services is less than the cost of inpatient care.

Cigna

Cigna declared a 1995 surplus of $11.4 million or 4.3% of premium. This reflects a $4.1 million increase in the margin loaded in the 1995 rates and is attributable to the following factors:

Factor	Amount
Margin in Rates	$7.3 million
Reduction in Claims	4.1
Increase in Retention	(.8)
Audit Credits	.8
Total	11.4 million

Though the claim trend for 1995 was higher than what was projected for 1995 (13% vs. 11%) this increase was partially offset by the impact of plan changes which became effective 9/1/95 for certain segments of the enrolled population. These changes include an increase in the copay, the switch to the Select Pharmacy Network which provides larger discounts, and coverage for oral contraceptives and prescription vitamins.

After application of the 1994 carryforward loss of $2.9 million and considering excess formulary rebates of $0.8 million not included as premium, a $9.2 million cash dividend is available to offset future premium liability.

PROJECTED 1996 EMPIRE PLAN EXPERIENCE

Based on claims paid through March 1996, the Empire Plan carriers project a composite surplus of $135.2 million or 7.5% of premium. This is $80.7 million over the margin loaded in the 1997 rates. The 1996 annual experience projected by the insurance carriers is reported in Exhibit II. Individual carrier projections are explained as follows:

Blue Cross projects a 1996 dividend of $81.6 million or 12.7% of premium. This is $62.3 million more than the margin loaded in the 1996 rates and is primarily due to a decrease in the 1995 claim base observed after the issuance of the 1995 experience. This impact is valued at $37.3 million ($20.8 million as a reduction in the projected 1996 claim base and $16.5 as a reduction in the reserves established as of 12/31/95). The excess reserve estimate was caused in large part by Blue Cross's underestimation of the impact of electronic claim submissions. In an electronic processing environment, claims are paid more quickly, thereby reducing the value of incurred but unpaid claim reserve.

The additional $25.0 million of projected dividends is anticipated due to the reduction of trend from 7.6% to 3.0%. This trend reduction assumes the sunset of NYPHRM at 6/30/96 and includes prospective adjustments to the inpatient rates for the first six months of 1996 as ordered by the NYS Department of Health. Should NYPHRM continue for the remainder of 1996 and all other assumptions hold true, the projected dividend would be lower.

MetraHealth Medical

MetraHealth projects a composite 1996 dividend of $22.2 million or 3.0% of premium representing a modest increase over the margin loaded in the 1996 rates. Though, in total, the 1996 claims experience is projected to be the same as what was anticipated during the rate development, the experience of the components is significantly different with the Core generating a large surplus and both enhancements generating large deficits.

This misallocation occurred through the following sequence of events. During 1995 and the early part of 1996, the allocation of paid claims between the Core and the Enhancements was improperly performed, though the actual paid claim amount, in total, was correct. Since the claim allocation error was not discovered until March 1996, the rates established for the components were based on incorrect allocations. The actual paid claim amount for the first quarter has been adjusted and the projected claims for the remainder of the year including the allocation of claims between Core and Enhancements are based on corrected data. Comparing the premium with the adjusted experience produces the large surpluses/(losses). The 1997 plan year rates will include appropriate adjustments to assure proper charges and credits between Core and Enhancement rates. The allocation of the 1995 claims was properly adjusted and reflected in the Annual Experience Statement.

MetraHealth Mental Health and Substance Abuse Program

MetraHealth projects a 1996 surplus of $10.2 million or 9.2% of premium for the Mental Health and Substance Abuse (MHSA) Program. This represents an increase of $5.4 million over the margin loaded in the 1996 rates and is a result of the improvement in reducing unnecessary and inappropriate inpatient utilization in the latter half of 1995. This improvement was not observed and, therefore, not factored into the development of the 1996 rates.

Cigna

A 1996 dividend of $21.2 million or 6.9% of premium is estimated by Cigna. This represents a $12.7 million increase oyer the margin loaded in the 1996 rates. This increase is primarily attributable to higher than anticipated savings generated from the Select Pharmacy Network which became effective 9/1/95 and a reduction in the estimated 1996 trend from 17.6% to 15.3%.

1997 PROJECTED PREMIUM RATES

Exhibit III presents the 1997 projected Empire Plan gross and net rates in comparison to the 1996 rates. The 1997 net rates reflect the application of $129.7 million in dividends to all payors. Empire Plan gross premium is projected to increase approximately 5.5% with a net premium increase projected at 12.5%. The higher net rate increase in relation to the increase in the gross premium reflects the decreased level of dividend application in 1997 as well as a Mediprime premium adjustment to reflect aggregate premiums paid based on the two tier rate structure.

Though the projected net rate increase is considerably higher than the rate increases observed over the previous 5 years, the current projection may be viewed to be conservative due to the following points:

• There is general conservatism by the carriers with only 3 months of actual 1996 paid claim experience.
• The current Prescription Drug contract ends 12/31/96 and the State is currently evaluating proposals for the successor contract. This competitive bid process may result in a 1997 premium lower than the premium which is now projected.

The underlying trend assumptions used by the carriers for the 1997 Participating Agency rates are as follows:

Component	Trend
Blue Cross	5.0%
MetraHealth Medical Core	4.8%
MetraHealth Medical Enhancement	8.0%
MetraHealth MHSA Core	3.0%
MetraHealth MHSA Enhancement	3.0%
Cigna	13.0%
Composite	6.4%

This composite trend factor reflects a more favorable projection than was used in the 1995 Fourth Quarterly Report.

For comparison purposes, Exhibit IV presents the individual and family rate history for the Core plus Medical and Psychiatric Enhancements option based on a Two Tier Empire Plan rate structure. The Five Tier rate structure became effective on January 1, 1996.

KEEPING YOU INFORMED

Medicare Part B Reimbursement

Since our last quarterly report, there has been no change in the status of Medicare Part B Reimbursement. We will keep you informed of any movement on this issue.

Participating Agency Status

A recent review of participating agency enrollment indicates there are currently 737 agencies participating in NYSHIP. These agencies include counties, cities, towns, villages, school districts and other miscellaneous agencies such as fire districts, water districts, housing authorities, public library systems and other special districts. A total of 446, about 19% of the 2,345 eligible counties, cities, towns, villages and school districts now participate in NYSHIP. The number of eligible counties is 57, excluding the 5 boroughs of New York City, and the number of eligible cities is 61, excluding the City of New York. In accordance with Civil Service Law, these areas are not eligible to participate in NYSHIP since their population exceeds one million.

Attachment A provides a summary of Participating Agency status.

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Exhibit I

1995 EMPIRE PLAN EXPERIENCE
In (000's)

	BLUE CROSS	METROPOLITAN MEDICAL Core	METROPOLITAN MEDICAL NY Enhancement	METROPOLITAN MEDICAL PA Enhancement	METROPOLITAN MEDICAL Combined	METROPOLITAN MHSA Core	METROPOLITAN MHSA NY Enhancement	METROPOLITAN MHSA PA Enhancement	METROPOLITAN MHSA Combined	CIGNA	TOTAL
Premium (1)	609,984	533,689	80,925	81,116	695,730	77,550	18,294	16,020	111,864	265,021	1,682,599
Incurred Claims (2)	540,582	466,536	72,295	58,318	597,149	62,737	8,123	7,232	78,092	243,789	1,459,612
Admin. Expenses (3)	29,763	60,310	8,820	7,732	76,862	15,261	3,085	2,666	21,012	9,843	137,480
Gain/ Loss (A-B-C)	39,639	6,843	(190)	15,066	21,719	(448)	7,086	6,122	12,760	11,389	85,507

(1) Earned Premium - Premium which pays for coverage for the period reported (accrual basis).
(2) Incurred Claims - Represents the cost of covered services provided during the period reported by the insurance company (accrual basis).
(3) Administrative Expenses - All charges by the insurance carrier other than for the payment of claims. Includes carrier's cost to administer the program, interest charges, and retention.

Source: 1995 Final Experience Statements

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Exhibit II

1996 PROJECTED EMPIRE PLAN EXPERIENCE
In (000's)

	BLUE CROSS	METROPOLITAN MEDICAL Core	METROPOLITAN MEDICAL NY Enhancement	METROPOLITAN MEDICAL PA Enhancement	METROPOLITAN MEDICAL Combined	METROPOLITAN MHSA Core	METROPOLITAN MHSA NY Enhancement	METROPOLITAN MHSA PA Enhancement	METROPOLITAN MHSA Combined	CIGNA	TOTAL
Premium (1)	641,850	674,100	44,500	16,400	735,000	85,900	14,000	11,200	111,100	308,349	1,796,299
Incurred Claims (2)	530,939	500,800	73,900	64,000	638,700	67,000	8,000	6,400	81,400	272,377	1,523,416
Admin. Expenses (3)	29,331	63,629	6,087	4,408	74,124	15,406	2,280	1,829	19,515	14,749	137,719
Gain/ Loss (A-B-C)	81,580	109,671	(35,487)	(52,008)	22,176	3,494	3,720	2,971	10,185	21,223	135,164

(1) Earned Premium - Premium which pays for coverage for the period reported (accrual basis).
(2) Incurred Claims - Represents the cost of covered services provided during the period reported by the insurance company (accrual basis).
(3) Administrative Expenses - All charges by the insurance carrier other than for the payment of claims. Includes carrier's cost to administer the program, interest charges, and retention.

Source: 1995 Final Experience Statements

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Exhibit III

EMPIRE PLAN
Participating Agency Premium Rates
Comparison of 1996 and Projected 1997 Rates
CORE ONLY

Plan Prime: Individual

	GROSS RATES (1) 1996	GROSS RATES (1) 1997	GROSS RATES (1) % Change	NET RATES (2) 1996	NET RATES (2) 1997	NET RATES (2) % Change
Optimistic	225.10	213.60	-5.1%	203.90	199.86	-2.0%
Best Estimate	225.10	221.05	-1.8%	203.90	207.31	1.7%
Pessimistic	225.10	228.46	1.5%	203.90	214.72	5.3%

Plan Prime: Family

	GROSS RATES (1) 1996	GROSS RATES (1) 1997	GROSS RATES (1) % Change	NET RATES (2) 1996	NET RATES (2) 1997	NET RATES (2) % Change
Optimistic	499.74	473.82	-5.2%	372.35	443.48	-1.5%
Best Estimate	499.74	490.53	-1.8%	372.35	460.19	2.2%
Pessimistic	499.74	507.22	1.5%	372.35	476.88	5.9%

 

MediPrime: Individual

	GROSS RATES (1) 1996	GROSS RATES (1) 1997	GROSS RATES (1) % Change	NET RATES (2) 1996	NET RATES (2) 1997	NET RATES (2) % Change
Optimistic	155.11	152.75	-1.5%	133.91	139.39	4.1%
Best Estimate	155.11	156.86	1.1%	133.91	143.50	7.2%
Pessimistic	155.11	160.95	3.8%	133.91	147.59	10.2%

MediPrime: Family - 1

	GROSS RATES (1) 1996	GROSS RATES (1) 1997	GROSS RATES (1) % Change	NET RATES (2) 1996	NET RATES (2) 1997	NET RATES (2) % Change
Optimistic	429.76	412.98	-3.9%	383.74	383.03	0.7%
Best Estimate	429.76	426.34	-0.8%	383.74	396.39	4.3%
Pessimistic	429.76	439.68	2.3%	383.74	409.73	7.8%

MediPrime: Family - 2

	GROSS RATES (1) 1996	GROSS RATES (1) 1997	GROSS RATES (1) % Change	NET RATES (2) 1996	NET RATES (2) 1997	NET RATES (2) % Change
Optimistic	359.53	351.86	-2.1%	309.98	322.29	4.0%
Best Estimate	359.53	361.88	0.7%	309.98	332.31	7.2%
Pessimistic	359.53	371.89	3.4%	309.98	342.32	10.4%

(1) Represents premiums charged by the carriers.
(2) Represents cost to a participating agency.

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Exhibit III

EMPIRE PLAN
Participating Agency Premium Rates
Comparison of 1996 and Projected 1997 Rates
CORE PLUS MEDICAL ENHANCEMENT

Plan Prime: Individual

	GROSS RATES (1) 1996	GROSS RATES (1) 1997	GROSS RATES (1) % Change	NET RATES (2) 1996	NET RATES (2) 1997	NET RATES (2) % Change
Optimistic	230.91	237.45	2.8%	204.00	221.22	8.4%
Best Estimate	230.91	246.16	6.6%	204.00	229.93	12.7%
Pessimistic	230.91	254.82	10.4%	204.00	238.59	17.0%

Plan Prime: Family

	GROSS RATES (1) 1996	GROSS RATES (1) 1997	GROSS RATES (1) % Change	NET RATES (2) 1996	NET RATES (2) 1997	NET RATES (2) % Change
Optimistic	512.24	525.16	2.5%	449.50	489.25	8.8%
Best Estimate	512.24	544.57	6.3%	449.50	508.66	13.2%
Pessimistic	512.24	563.97	10.1%	449.50	528.06	17.5%

 

MediPrime: Individual

	GROSS RATES (1) 1996	GROSS RATES (1) 1997	GROSS RATES (1) % Change	NET RATES (2) 1996	NET RATES (2) 1997	NET RATES (2) % Change
Optimistic	158.35	166.08	4.9%	131.44	150.25	14.3%
Best Estimate	158.35	170.89	7.9%	131.44	155.06	18.0%
Pessimistic	158.35	175.68	10.9%	131.44	449.28	19.2%

MediPrime: Family - 1

	GROSS RATES (1) 1996	GROSS RATES (1) 1997	GROSS RATES (1) % Change	NET RATES (2) 1996	NET RATES (2) 1997	NET RATES (2) % Change
Optimistic	439.69	453.79	3.2%	376.95	418.27	11.0%
Best Estimate	439.69	469.30	6.7%	376.95	433.78	15.1%
Pessimistic	439.69	484.80	10.3%	376.95	449.28	19.2%

MediPrime: Family - 2

	GROSS RATES (1) 1996	GROSS RATES (1) 1997	GROSS RATES (1) % Change	NET RATES (2) 1996	NET RATES (2) 1997	NET RATES (2) % Change
Optimistic	366.90	382.15	4.2%	309.98	347.04	14.1%
Best Estimate	366.90	393.77	7.3%	309.98	358.66	17.9%
Pessimistic	366.90	405.37	10.5%	309.98	370.26	21.7%

(1) Represents premiums charged by the carriers.
(2) Represents cost to a participating agency.

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Exhibit III

EMPIRE PLAN
Participating Agency Premium Rates
Comparison of 1996 and Projected 1997 Rates
CORE PLUS MEDICAL & PSYCHIATRIC ENHANCEMENTS

Plan Prime: Individual

	GROSS RATES (1) 1996	GROSS RATES (1) 1997	GROSS RATES (1) % Change	NET RATES (2) 1996	NET RATES (2) 1997	NET RATES (2) % Change
Optimistic	234.59	240.33	2.4%	207.66	222.98	7.4%
Best Estimate	234.59	249.19	6.2%	207.66	231.84	11.6%
Pessimistic	234.59	258.00	10.0%	207.66	240.65	15.9%

Plan Prime: Family

	GROSS RATES (1) 1996	GROSS RATES (1) 1997	GROSS RATES (1) % Change	NET RATES (2) 1996	NET RATES (2) 1997	NET RATES (2) % Change
Optimistic	521.96	532.77	2.1%	459.16	493.39	7.5%
Best Estimate	521.96	552.59	5.9%	459.16	513.21	11.8%
Pessimistic	521.96	572.39	9.7%	459.16	533.01	16.1%

 

MediPrime: Individual

	GROSS RATES (1) 1996	GROSS RATES (1) 1997	GROSS RATES (1) % Change	NET RATES (2) 1996	NET RATES (2) 1997	NET RATES (2) % Change
Optimistic	158.65	166.32	4.8%	131.72	149.38	13.4%
Best Estimate	158.65	171.14	7.9%	131.72	154.20	17.1%
Pessimistic	158.65	175.94	10.9%	131.72	159.00	20.7%

MediPrime: Family - 1

	GROSS RATES (1) 1996	GROSS RATES (1) 1997	GROSS RATES (1) % Change	NET RATES (2) 1996	NET RATES (2) 1997	NET RATES (2) % Change
Optimistic	446.03	458.76	2.9%	383.23	419.80	9.5%
Best Estimate	446.03	474.53	6.4%	383.23	435.57	13.7%
Pessimistic	446.03	490.30	9.9%	383.23	451.34	17.8%

MediPrime: Family - 2

	GROSS RATES (1) 1996	GROSS RATES (1) 1997	GROSS RATES (1) % Change	NET RATES (2) 1996	NET RATES (2) 1997	NET RATES (2) % Change
Optimistic	369.87	384.47	3.9%	307.07	345.93	12.7%
Best Estimate	369.87	396.22	7.1%	307.07	357.68	16.5%
Pessimistic	369.87	407.94	10.3%	307.07	369.40	20.3%

(1) Represents premiums charged by the carriers.
(2) Represents cost to a participating agency.

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Exhibit III

EMPIRE PLAN
PA GROUP RATES
1985-1997 Monthly Rates

Individual

Core plus Med. & Psych. Enh.	Gross rate	% Change	Net Rate	% Change
1985*	95.71		92.85
1986	91.97	-3.9%	91.45	-1.5%
1987	103.14	12.1%	101.65	11.1%
1988 (1)	142.01	37.7%	141.52	39.2%
1989	168.72	18.8%	168.05	18.7%
1990 (2)	179.50	6.4%	167.09	-0.6%
1991 (3)	202.09	12.6%	185.09	10.8%
1992	198.85	-1.6%	181.81	-1.8%
1993	214.30	7.8%	194.64	7.1%
1994	213.83	-0.2%	197.39	1.4%
1995	214.70	0.4%	193.54	-2.0%
1996 (4)	219.20	2.1%	192.27	-0.7%
1997 (4) Projected	231.64	5.7%	214.37	11.5%

 

Average Percent Increase	Gross rate	% Change	Net Rate	% Change
From Inception		8.2%		7.8%
Most Recent 10 Years		9.0%		8.4%
Most Recent 5 Years		3.1%		3.5%

 

Family

Core plus Med. & Psych. Enh.	Gross rate	% Change	Net Rate	% Change
1985*	203.97		197.57
1986	195.31	-4.2%	194.30	-1.7%
1987	222.39	13.9%	219.20	12.8%
1988 (1)	324.13	45.7%	323.06	47.4%
1989	383.42	18.3%	381.95	18.2%
1990 (2)	403.75	5.3%	380.15	-0.5%
1991 (3)	464.39	15.0%	417.36	9.8%
1992	445.64	-4.0%	407.76	-2.3%
1993	479.37	7.6%	426.35	4.6%
1994	484.69	1.1%	446.94	4.8%
1995	486.99	0.5%	440.35	-1.5%
1996 (4)	491.07	0.8%	428.27	-2.7%
1997 (4) Projected	518.21	5.5%	479.00	11.8%

 

Average Percent Increase	Gross rate	% Change	Net Rate	% Change
From Inception		8.8%		8.4%
Most Recent 10 Years		9.6%		9.0%
Most Recent 5 Years		3.1%		3.4%

*Statewide Plan Premium Rates

(1) 1988 rates represent the effective amounts of the 1/88 and 8/88 rate changes.
(2) No change in effective net rate over 1989.
(3) Represents rates effective 1/1/91 - 6/30/91.
(4) Represents 2 tier Empire Plan Rates; 5 tier schedule effective 1/1/96.

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NYS DEPARTMENT OF CIVIL SERVICE
EMPLOYEE BENEFITS DIVISION
PARTICIPATING AGENCY STATISTICAL SUMMARY REPORT
PREPARED MAY 1, 1996

AGENCY TYPE	NUMBER PARTICIPATING	% OF TOTAL PA'S
COUNTIES	3
CITIES	13	1.8
TOWNS	131	17.8
VILLAGES	147	19.9
SCHOOL DISTRICTS*	152	20.6
MISCELLANEOUS**	291	39.5
TOTAL PA'S	737	100.0

*Includes BOCES and special types of schools such as schools for the deaf, schools for the blind.
**Includes all types of special districts such as: fire districts, water districts, housing authorities, public library systems, soil and water districts, community development and planning agencies, etc.

AGENCY TYPE	NUMBER ELIGIBLE	NUMBER PARTICIPATING	% PARTICIPATING
COUNTIES	57	3	5.3
CITIES	61	13	21.3
TOWNS	932	131	14.1
VILLAGES	553	147	26.6
SCHOOL DISTRICTS	742	152	20.5
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