#1State of Arkansas, Executive Subcommittee Employee Health Benefits Actuarial Consulting Services Finalist Presentation July 20, 2022 © 2022 by The Segal Group, Inc. ★ Segal#2Agenda Introductions Segal's State Health Capabilities and Results Scope of Work Closing & Questions Segal 2#3Kickoff and Introductions Kenneth C. Vieira, FSA, FCA, MAAA Account Executive SVP & East Region Public Sector Market Leader Patrick J. Klein, FSA, MAAA Account Manager VP & Consulting Actuary Matthew A. Kersting, FSA, MAAA Lead Actuary VP & Consulting Actuary Kirsten Schatten, ASA, MAAA Strategic Consultant SVP & Public Sector Health Practice Leader “Having the right partner...who is committed to creating something outstanding makes all the difference." ✗Segal 3#4Your Public Sector Focused Team Specialized Expertise Ready to Serve Client Management Team Account Executive Kenneth C. Vieira, FSA, FCA, MAAA Account Management Patrick J. Klein, FSA, MAAA Account Manager Matthew A. Kersting, FSA, MAAA Lead Actuary Strategic Support Health Actuaries & Analysts Peter Wang, ASA, MAAA, EA, PhD Anthony Howard Strategic Healthcare Consultant Kirsten Schatten, ASA, MAAA Subject Matter Experts Wellness & Clinical Joanna Balogh-Reynolds, RN-BC, MSN, DNP Pharmacy Scott McEachern, FSA, MAAA Segal 4#5Agenda Introductions Segal's State Health Capabilities and Results Scope of Work Closing & Questions Segal 5#6Segal - Who We Are ос осос OO Providing Employee Benefit Consulting for over 80 years. Employee-owned and privately-held Deep public sector experience working with counties, cities, school systems and states throughout the country Expertise: Benefit Design, Actuarial, Communication and Compliance We provide trusted advice that improves lives. Segal 6#7Results: Segal's Large Public Sector Clients Health & Retirement Consulting 9 of the Largest Cities New York Philadelphia Los Angeles Chicago ■Houston Phoenix San Antonio Dallas San Jose Health Consulting Retirement Consulting Defined Contribution Consulting AK OR ●VT ME ND NH . WI MA RI WY MI CT IA PA NV NE NJ IL IN MD ● CA CO WV KS KY Washington, DC HI 行 ■NC TN R= AZ NM AR SC MS AL GA TX LA We currently perform health, retirement and/or defined contribution consulting for 37 states, 9 of the largest U.S. cities, 12 California county retirement systems, the District of Columbia, the U.S. Virgin Islands and Puerto Rico. ✗Segal 7#8Our Large State Experience Project Description Financial Projections IBNR Funding Rates/Plan Cost Modeling Actuarial Rate Development Data Analysis/Trends Annual Comprehensive Financial Report Plan Design Review CDHP (HSA/HRA) Kaiser Narrow Networks Benchmarking Medicare Advantage Medicare Supplement/Wrap Medicare Part D Consulting OPEB Valuation Legislative Support ACA Consulting/ Healthcare Reform HIPAA Compliance Other Compliance Support Total Health Management Wellness Plan Designs & Program Analysis Clinics/Wellness Centers Contract Negotiations Direct Provider Contracting Strategic Planning/Migration Strategies Participation in Meetings and Workgroups Pharmacy Collective Bargaining Support Procurement/Marketing Reporting Data Warehousing Services Local Governments/Schools Communications/Virtual Benefits Fair Website Hosting Claims Auditing Technology Consulting/ Implementation SOC Reports Review Cafeteria Plan Support AK AL AR AZ CO CT HI IA IL KS MD MI MS NC NE NH NM NV OR PA RI TX WI WY Segal 8#9AK AL AR AZ CO CT HI ✓ IA IL KS MD MI MS NC NE NH NM NV OR PA RI TX WI WY ✓ Delivering Results Project Description Financial Projections IBNR Funding Rates/Plan Cost Modeling Actuarial Rate Development Data Analysis/Trends Annual Comprehensive Financial Report Plan Design Review CDHP (HSA/HRA) Kaiser Narrow Networks Benchmarking Medicare Advantage Medicare Supplement/Wrap Medicare Part D Consulting OPEB Valuation Legislative Support ACA Consulting/ Healthcare Reform HIPAA Compliance Other Compliance Support Total Health Management Wellness Plan Designs & Program Analysis Clinics/Wellness Centers Contract Negotiations Direct Provider Contracting Strategic Planning/Migration Strategies Participation in Meetings and Workgroups Pharmacy Collective Bargaining Support Procurement/Marketing Reporting Data Warehousing Services Local Governments/Schools Communications/Virtual Benefits Fair Website Hosting Claims Auditing Technology Consulting/ Implementation SOC Reports Review Cafeteria Plan Support Arkansas • Benchmarked plans against surrounding states • Recommended changes to retiree program, prescription drug programs, and budgeting process Analyzed the plan's health conditions and made clinical recommendations. • Advocated for actuarial notes for legislative changes Estimated Savings: $70M+ annually Segal 9#10Agenda Introductions Segal's State Health Capabilities and Results Scope of Work Closing & Questions Segal 10#11Actuarial Statements • Most states require legislative changes to be accompanied by an actuarial note or fiscal impact statement • Incorporating this process allows legislators to fully understand the financial impact of any proposed changes Segal works with most of our state clients to provide these types of changes - Similar proposed legislation across our vast client base allows us to leverage prior analysis - Segal is familiar with the short timeframe in which the actuarial statement needs to be delivered Segal 11#12Fiscal Statement Examples • Kansas HB 2110 – PANS/PANDAS Coverage - • Kansas KB 2103 - Coverage for amino acid-based elemental formula • Kansas Bariatric Coverage - • North Carolina SB 868 - Adaptive Exercise Equipment Coverage • North Carolina HB 93 – Opioid Management Strategy - • North Carolina HB 721 – Increase Access to Teleheath Services • North Carolina HB 184 – Health Plan Design (Referenced Based Pricing) • Wisconsin - Transgender Coverage • Wisconsin - Impact of adding weight loss drugs • Nebraska - LB 337 Step Therapy • Nebraska – LB 370 Member cost sharing limit for Insulin - • Nebraska - LB 604 Right to Shop (Transparency) • Nebraska – LB 1119 Direct Primary Care Pilot - Segal ACTUARIAL STATEMENT The North Carolina State Health Plan for Teachers and State Employees has requested that The Company prepare an Actuarial Note in response to HOUSE BILL 93 to be entitled "AN ACT REQUI EACH HEALTH CARE PRACTITIONER WHO PRESCRIBES AN OPIOID MEDICATION PATIENT TO PRESCRIBE AN OPIOID ANTAGONIST FOR THAT PATIENT UNDER CER CIRCUMSTANCES AND FOR CERTAIN PURPOSES. The Actuarial Note was prepared according to generally accepted actuarial principles and practic compliance with General Statute 120-114. As required by statute, the Note includes an explanatory stat of the proposed change(s) and, to the extent possible, an estimate of the financial and actuarial effect proposed change(s) on the Plan. The Actuarial Note makes no comment or opinion with regard to the of the measure for which the Note is prepared; however, any identified technical or mechanical defect been noted. We have reviewed the input and results of our analysis for reasonableness, and relied upon the dat information provided by the Plan and their Claims Processing Contractor. Cani Viy Pracians ـــل 3/18/2021 Kenneth C. Vieira, FSA, PCA, MAAA Date MEMORANDUM 2727 Paces Ferry Road SE To: Janet Stanek, Director, State Employee Health Plan From: Segal Date: November 22, 2021 Re: Building One, Suite 1400 Alanta, GA 30039-4053 segalco.com House Bill No. 2110-Coverage and prescribed treatment of Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) and Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections (PANDAS) In response to the House Committee on Insurance and Pensions, Segal has researched the potential social and financial impacts of House Bill No. 2110 (HB 2110) on the Kansas State Employee Health Plan ("SEHP) to provide coverage for the diagnosis and prescribed treatment of PANS and PANDAS for the next coverage year. The impact to claims cost and administrative expenses is expected to be minimal. The estimated annual cost range for PANSIPANDAS Segal 12#13Scope of Work • Provide fiscal impact statements as requested for proposed legislation • Provide actuarial and cost analysis regarding proposed funding amounts for the Public School Employee Health Benefits Plan, as set forth in the biennial Education Adequacy Study • Appear at legislative committee meetings, as requested, to present the findings and fiscal impact statements • Attend committee meetings, as requested, to provide routine actuarial consultation on technical, policy, legal, or administrative questions Segal is well positioned to meet the actuarial needs stated in the RFP Segal 13#14Scope of Work • Communicate new developments/trends in public employee health benefits programs and provide improvement recommendations • Assist in preparation of proposed changes to related laws • Provide consultation and advisory services in the policy and administrative problems of new legislation implementation • Develop and provide various tables and factors as needed for legislative committees • Be readily accessible to committee members and staff; and • Be available for periodic educational discussions with committees and staff Segal is well positioned to meet the actuarial needs stated in the RFP Segal 14.#15Core Actuarial Services More than 150 credentialed actuaries in 23 offices • Multi-year budget development - - Expenses, Revenue and Fund Balance • Annual development of actuarially sound rates and funding requirements • Employee and Retiree contribution scenarios • Selection risk modeling associated with changes in benefits, contributions and benefit options • Trend analysis/projection and assumption development יווי יון Segal 15#16Core Actuarial Services More than 150 credentialed actuaries in 23 offices • IBNR calculations for self-insured health benefit programs • Development and valuation of proposed benefit changes Incorporation of vendor contract parameters and guarantees • Reports that are comprehensive and provide a clear understanding of our results/recommendations and the data and methodology utilized • Fiscal notes and valuation of proposed legislation יווי Segal 16#17Agenda Introductions Segal's State Health Capabilities and Results Scope of Work Closing & Questions Segal 17#18What Sets Segal Apart? Independence Segal is not affiliated with any insurance company, brokerage firm or healthcare provider that may create a conflict of interest Experience Approach Credibility Specialization in Public Sector Our only interest is providing objective, independent consulting to our clients Segal is 100% employee-owned We have worked with all of your vendors Your team has deep knowledge in all of the areas requested in the scope of work We have developed and validated proven actuarial methodologies for our health data collection, analysis and review Our approach is highly personal and collaborative, and will always be scaled to fit your needs and budget Segal knows and is respected by all major carriers in today's market Segal is sensitive to multiple constituents of a client, including bargained groups Segal has been successful in optimizing our clients' health programs Segal understands the dynamics of the public sector market We serve as consultants to the full array of governance structures in the public sector Segal optimizes solutions for all stakeholders Based on our expertise, resources, and experience with the State of Arkansas, Segal is best positioned to provide the requested services of the RFP Segal 18#19Thank You What additional questions can we address today? 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