New District Eligibility and Requirements
Thank you for your interest in the Kansas School Benefits Group Trust (KSBG), administered by Greenbush Health. KSBG is a fully insured Municipal Group Trust. Member groups are offered one plan with four fully insured / four-tier* health coverage options, currently available through Blue Cross Blue Shield of Kansas and life insurance through Advance, plus voluntary life (Sun Life Financial), dental (Delta Dental), and Vision (VSP) benefits. The KSBG Trust utilizes a composite premium rating method for all benefits. The claims experience of all member groups are combined to formulate premium rates, which are identical for all participating groups.
* Four options with different deductible amounts including a QHDP with an optional HSA all with four tiers (Employee/Only, E/Spouse, E/Child(ren) and E/Dependents).
Requirements of those participating in the Trust are:
New members shall commit to participation in the Trust for a full two-year period commencing with the new members initial plan year and extending through the plan year end date no earlier than two years thereafter. All further years will be on an annual basis with notification of cancellation being submitted by February 1 preceding the ending date of the plan year. Improper cancellation will result in a penalty.
Participating employers must enroll at least 75% of KPERS adjusted eligible employees (working 630+ hours annually).
A minimum employer contribution is required of $350 for each eligible / participating employee for all participating months.
Participating employers shall provide at least a $15,000 life insurance policy for all eligible employees through Advance Insurance. ($25,000 or $35,000 buy up policies are available). This insurance is to be provided while employers are covered under the BCBSKS contract.
No cash option may be given to employees, except for Grandfathered employees. (Qualified Grandfathered employees are those continuously receiving cash instead of insurance prior to group joining the Trust). The cash option shall not be extended to additional employees and shall be frozen with no future increases as of your entrance date into the Trust. Once Grandfather status is lost it cannot be reinstated.
Members will pay a $5 per person / per month fee for each employee enrolled in the health insurance to cover the Greenbush Health administrative costs. This fee is not included in the premium rates.
If you decide to pursue the membership process the following will need to be done:
Blue Cross Blue Shield of Kansas will need to review your claims experience to see if your group meets the claims usage allowances to be allowed into the Trust. If you are currently with BCBSKS they will be able to look at the information internally. If you are with another carrier BCBSKS will need copies of your claims and renewal history (not summaries) including a list of your high dollar claims for the last 24 months, a current census and demographics of all eligible employees and a list of any eligible employees that have waived your current plan and the reason they have waived your plan. A copy of your current plan showing benefits and costs will be required along with a brief questionnaire about your plan regarding how you administer your current health benefit plans and if you plan on making changes if accepted into the Trust. (BCBSKS may request health profiles from some employees if adequate date is not available).
Upon approval by BCBSKS an independent actuarial review or an alternative claims review with sufficient covered individuals will be performed at the applying member's expense. Currently we are using either an independent actuary or BCBSKS alternative claims review utilizing the Milliman IntelliScript Curv Census database. The Curv Census database method will look at your current employee's prescription drug usage and will provide us with projected claim risk information.
Our current fees for the actuarial review or the alternative claims review are as follows:
Groups between 51 and 100 eligible employees - $250.00
Groups between 101 and 150 eligible employees - $300.00
Groups between 151 and 250 eligible employees - $350.00
Groups over 250 eligible employees - $425.00
If there is an additional review required due to additional or corrected information there may be an additional charge of up to $100.00 per group, depending on time required.
If both reviews are favorable and the group is still wanting to join the Trust we would then ask our current Trust members for a vote to accept or deny your group as a new Trust member. Upon acceptance the district would sign all appropriate agreements to become a member of the Trust. If denied due to unfavorable review, please keep us in mind for future years if you feel your group's claims usage has improved.
Contact Drennette McCracken. at Greenbush Health (800-595-2955) for more information and to discuss how joining Greenbush Health will be beneficial to your district.