Delaware Department of Human Resources

This document outlines the strategic framework for the State Employee Benefits Committee (SEBC) concerning the Group Health Insurance Program (GHIP). Its core purpose is to provide State of Delaware employees, retirees, and their dependents with adequate access to high-quality, affordable healthcare that produces good outcomes, promotes healthy lifestyles, and fosters engaged consumers. Key goals include the addition of value-based care delivery models, a reduction in medical and prescription drug cost trends, and increased membership enrollment in consumer-driven or value-based health plans. The framework emphasizes strategies across provider care delivery, health and wellness initiatives, participant care consumption, and engagement.

The committee meeting covered a Director's report concerning several legislative bills, including SB 29 regarding committee governance, and updates on HB 60, HB 54, HB 65, and SB 31. Discussions included the timeline and communication strategy for the benefits modernization survey, a review of the November financial report, and an assessment of Group Health Insurance Plan (GHIP) Strategic Framework goals. Additionally, the committee evaluated the proposed implementation of the PrudentRx program for FY24 to manage specialty medication costs, heard public comments from state retirees, and held an executive session.

The committee reviewed the Director's report regarding administrative form timelines and the consultant request for proposal status. Financial discussions focused on current fund equity and projected claim liability. The agenda included significant deliberation on FY17 planning, addressing premium rate changes, budget allocations, and various legislative initiatives. Additionally, the committee considered and approved several plan design changes aimed at promoting consumerism, including adjustments to copays for high-tech radiology and urgent care, the exclusion of certain prescription drugs covered by over-the-counter equivalents, and coordination of Medicare Part B benefits. Finally, the committee awarded a contract for medical and prescription claims review services.

This document presents revisions to the State of Delaware's Group Health Insurance Plan (GHIP) Strategic Framework, outlining updated goals and guiding principles. The framework aims to ensure adequate access to high-quality, affordable healthcare for employees, retirees, and their dependents, while promoting healthy lifestyles and engaged consumerism. Key strategic areas include increasing medical spend for quality-based care, reducing cost trends for chronic conditions such as diabetes and behavioral health, limiting overall healthcare cost inflation, and enhancing member engagement with benefit utilization tools.

This document provides an analysis of the State Employee Benefits Committee's fund reserves. It outlines the necessity of maintaining reserves to withstand unanticipated financial losses and ensure long-term solvency. The analysis details the use of the Risk-Based Capital (RBC) formula, developed by the National Association of Insurance Commissioners, for measuring solvency and tying it to the State Health Plan's reserve levels. It further specifies the minimum reserve policy adopted by the SEBC, including historical calculations and adjustments to the RBC level.