Primary Department: Management and Budget
Primary Department Head/Elected Official: Daniel Ramos
Secondary Department: Human Resources and Talent
Secondary Department Head/Elected Official: Sakita Douglas
Regular or Supplemental RCA: Regular RCA
Type of Request: Financial Authorization
Project ID (if applicable): N/A
Vendor/Entity Legal Name (if applicable): N/A
MWBE Contracted Goal (if applicable): N/A
MWBE Current Participation (if applicable): N/A
Justification for 0% MWBE Participation Goal: N/A - Goal not applicable to request
Grant Indirect Costs Rate (if applicable): N/A
Justification for 0% Grant Indirect Costs Rate (if applicable): N/A - Not a grant item
Request Summary (Agenda Caption):
title
Request for approval to implement an Employer Group Waiver Plan for prescription drug coverage for Medicare retiree members covered under the group health plan.
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Background and Discussion:
Harris County currently offers prescription drug coverage to Medicare retiree members through its self-funded health plan administered by Aetna and a Part D plan for those enrolled in the fully insured Medicare Advantage Prescription Drug (MAPD) plan through Humana. Prescription benefits are identical to employee coverage for members not enrolled in the MAPD plan. For these members, the Centers for Medicare & Medicaid Services (CMS) allows employer sponsored plans to offer Part D coverage that closely aligns with what is offered to their employees through what is called an Employer Group Waiver Plan (EGWP).
An EGWP would provide savings to the county's health plan through additional subsidies provided by CMS and manufacturer discounts. Disruption to members would be minimal since an EGWP enables plan sponsors to closely replicate their current plan design. Therefore, it is recommended the county implement Aetna's fully insured EGWP called SilverScript for Medicare members not enrolled in Humana's MAPD plan. If approved, Human Resources and Talent (HRT) will coor...
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