GNY Employer News - Winter 2011

1199SEIU Funds 330 West 42nd Street New York, NY 10036-6977 www.1199SEIUFunds.org

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Winter 2011

FROM THE EXECUTIVE DIRECTORS The past year has been a challenging one for all of our Greater New York Funds. The relentless growth in the cost of healthcare continued to keep the Greater New York Benefit Fund underfunded and, unable to reach an agreement, the trustees and collective bargainers sent the matter to arbitration. After months of careful analysis, the Arbitrator for the Fund and Industry issued a new Award that stabilizes the Fund for the time being by requiring shared sacrifices on the part of both members and employers. In this issue of Greater New York Employer News, we have outlined the key provisions and changes to the plan that both the Benefit Fund and our employers must implement. Meanwhile, our Training and Employment and our Child Care Funds have been working to make a difference in the industry and our communities. Our Greater New York Education Fund has brought workers and managers together to improve case mix scores – and reimbursement – in our facilities.To support working families both on and off the job, our Child Care Corporation raised critical funds at our Fourth Annual Gala to expand the reach of our successful programs. The year may have just begun, but we are already looking for ways we can better carry on our mission in the coming months, such as the unveiling of our updated website with interactive capacity for members and providers to safely and securely access claims and eligibility information online. We know that this year will be another challenging one, but we remain committed to providing the best service possible, and to working with you to make the transitions ahead as smooth as possible for your employees, our Greater New York facilities and our industry.

IN THIS ISSUE . . . 2010 Arbitrator’s Award Stabilizes Greater New York Health Benefits, Mandates Shared Sacrifices . . . . . . . . . . . . . 2 Provisions of the Greater New York Arbitration Award . . . . . . . 2 Award-Mandated Changes Began March 1 . . . . . . . . . . . . . 2 Premium Contributions for Spouse Coverage Began March 1 . . . . . . 3 Make Sure Your Employees’ Spouses Are Covered . . . . . . . . . 3 January Brings Health Reform Changes to the Greater New York Benefit Fund . . . . . . . . . . . . . . . 4 Website Improvements Put Benefit Details at Employers’ and Members’ Fingertips . . . . . . 5 2010 Team Approach to Care and Reimbursement Management: Case Mix Improvement Project . . . . . . . . . 6

Sincerely,

Child Care Corporation Gala Raises Awareness and Funds to Support Healthy Children . . . . . 7 Mitra Behroozi Executive Director Benefit and Pension Funds

Deborah King Executive Director Training and Employment Funds

Vivian Fox Executive Director Child Care Funds

2010 Arbitrator’s Award Stabilizes Greater New York Health Benefits, Mandates Shared Sacrifices The Ongoing Challenge to Maintain Benefits Funding benefits for your 1199SEIU employees – our members – has historically been a great challenge. Promised state funding and other measures to help cover the difference between your contributions and the cost of your employees’ comprehensive benefit package never fully closed the gap. Consequently, the collective bargainers and Industry Arbitrator were forced to find creative ways, year after year, to pay for the benefits through a series of temporary measures. But, as healthcare costs continued to climb and one-shot solutions were exhausted, finding longer-term, structural solutions to our funding challenges became critical. In 2009, the collective bargainers were unable to come to a resolution in the face of a severe funding shortfall, and the Arbitrator issued an Award directing a series of measures to plug the gap. Members diverted their expected 3% wage increase to the Fund, employer contributions increased and the Benefit Fund was mandated to achieve a $12 million annual reduction in healthcare costs in order to sustain benefits.

factors translated to a projected deficit of $174 million by the end of the contract in 2014.

New Arbitrator’s Award Closes the Gap Arbitrator Martin Scheinman was asked again to decide on a resolution for both the Fund and the Industry. He issued an Award in December 2010 that amends the health plan and the collective bargaining agreements, calling for shared sacrifices from both members and the employers. Employers must increase their Benefit Fund contributions and members will take on new costs, including co-payments for certain services and a premium contribution for covered spouses.

Provisions of the Greater New York Arbitration Award • •

However, even these dramatic steps did not yield enough dollars to sustain the benefit package. Applying the National Benefit Fund’s aggressive cost-containment programs to the Greater New York Benefit Fund generated far less than the required $12 million in annual savings, and despite the Fund’s strict cost controls, the cost of healthcare continued to climb faster than the Fund’s auditors projected. In addition, the Benefit Fund faces new health reform costs. All of these

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Employer contribution rates increase by 4.15%, effective with the contribution based on the February 2011 payroll. Employers’ $295 lump sum payment per FTE ($177 for PTEs) set forth in the 2007-2011 collective bargaining agreement, originally due on March 1, 2011, is postponed until March 1, 2012. Members will have co-pays for certain medical services. Members must pay a premium for spouse coverage through payroll deduction. Members and their children will continue to be covered with no premium contribution.

Award-Mandated Changes Began March 1 On March 1, 2011, members began paying co-payments and making premium payments for their spouses, and employer contributions increased based on February 2011 payroll. Greater New York members have also received new 1199SEIU Health Benefits ID cards in the mail that list their new copayments and their covered family members.

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$10 for a three-month supply of generic drugs and $20 for a three-month supply of brand-name drugs when members use The 90-Day Rx Solution for long-term medication (mail order or at Rite Aid) $15 for high-end imaging:CT and PET scans,MRAs and MRIs $75 for emergency room visits (if the member is not admitted to the hospital)

New Co-Payments for Greater New York Members As of March 1, your 1199SEIU employees are responsible for the following co-payments: • $10 for primary care visits (with an internist, OB/GYN or a general or family practitioner; or a pediatrician for children) • $15 for specialist visits • $4 for generic drugs and $12 for brand-name drugs at participating retail pharmacies

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There will be no co-payments for preventive services. All of the current plan rules continue. These include, for example, mandatory generics and the Preferred Drug List, participating lab and radiology networks, and prior authorization where required. And of course, to save unnecessary out-of-pocket costs, your 1199SEIU employees should continue to use the Fund’s participating providers.

Child Care Corporation Gala Raises Awareness and Funds to Support Healthy Children “We have worked hard to develop a broad-based portfolio of educational programs and services designed to enrich the growth and development of our children and to keep them healthy and fit,” CCC President Vivian Fox told the event’s attendees. “Part of keeping them fit means we must recognize the serious nature of childhood obesity.” Supporting children’s healthy development is a cornerstone of our Greater New York Child Care Fund’s mission. Providing children and their families with the tools that they need to live well, like nutritious diets and plenty of exercise, has always been an integral part of the Child Care Fund’s regular child care and youth programs. First Lady Michelle Obama’s Let’s Move! campaign inspired us to place greater emphasis on raising awareness about the childhood obesity epidemic. In that spirit, the Child Care Corporation’s Fourth Annual Care for Kids Awards Gala honored those recognized leaders whose efforts have helped improve the health of children and families, including Danny Glover, actor and UNICEF Ambassador, who received the Lifetime Achievement Award for his humanitarian and philanthropic efforts focused on HIV/AIDS in children. The gala also honored Dr. Philip Ozuah, Physician-in-Chief of the Children’s Hospital at Montefiore Medical Center, and Professor and University Chairman of the Departments of

Actor Danny Glover, CCC President Vivian Fox and Montefiore Medical Center's Dr. Philip Ozuah

Pediatrics at the Albert Einstein College of Medicine and Montefiore Medical Center, with the Care for Kids Distinguished Service Award for his work as a staunch advocate for children’s health. Nancy Kolben, Executive Director of the Center for Children’s Initiatives, was presented with the Care for Kids Crusader Award for her leadership in early child care policy and education. The gala, held on December 6, 2010, at the Tribeca Rooftop in New York City, was attended by approximately 300 people and raised critical funds to support the CCC’s ongoing advocacy, education and professional development programs for the children and families we serve. “We have worked hard to develop a broad-based portfolio of educational programs and services designed to enrich the growth and development of our children and to keep them healthy and fit,” CCC President Vivian Fox told the event’s attendees. “Part of keeping them fit means we must recognize the serious nature of childhood obesity.” Winter 2011 EMPLOYER NEWS 7

2010 Team Approach to Care and Reimbursement Management: Case Mix Improvement Project After the 2009 New Direction and Innovation Committee (NDIC) conference, a number of GNY facilities decided to continue working to improve documentation by implementing onsite labor management projects. The NDIC committee, with funding from the 1199SEIU Worker Participation Fund, initiated a six-month project after a February 2010 kickoff meeting. Eleven GNY facilities joined the project and established local joint labormanagement committees that reviewed the internal documentation process leading to improvement of the case mix scores and, ultimately, reimbursement. The work groups in each facility followed a similar process developed by a team of four Fund consultants assigned to the project. The first step of the process was to provide full information about the scope of the project to the staff, making sure that workers from all classifications, shifts and departments were involved. Working closely with the nursing department and MDS coordinator, the working groups provided tools to help the staff understand the documentation process by examining the MDS form and the full range of data collection documents developed in each facility. A key element was to

link the MDS with the care that staff members provide to residents, and to increase awareness of the importance of recording the full extent of care rendered to residents. Each of the 11 participating facilities implemented the case mix project differently.The projects worked better in facilities where the local committees were able to engage the staff in particular units by identifying peer mentors who, in turn, generated protocols to record and improve discrete aspects of care, such as behaviors, pain reduction, toileting and night shift care. In some instances, over a four-month period, case mix scores improved significantly in the facilities and netted a 2% to 10% increase in revenue. A few facilities maintained or increased their case mix scores modestly. Whether facilities improved or maintained case mix scores, the project in the 11 facilities elevated the quality of joint labor-management work and resulted in improved relationships and trust between employers, the union and staff. After the October 2010 NDIC conference, several facilities requested the continuation of the case mix documentation project, possibly including new facilities during 2011.

Premium Contributions for Spouse Coverage Began March 1 Over the past months, our Greater New York Benefit Fund staff reached out to your 1199SEIU employees to help them sign their eligible spouses up for coverage and authorize payroll deductions for premium contributions. In order for spouses to be eligible as of March 1, 1199SEIU Greater New York members must have returned a completed, signed payroll deduction authorization form to their employers, and employers in turn must have submitted an initial list of the members’ and spouses’ names to the Fund. If any of your 1199SEIU employees did not sign their spouses up during this initial period, the next open enrollment period will begin in July for a September 1 effective date. The exception is newly eligible employees or those recently married will be able to sign their spouses up at the time of their own enrollment. Please refer to the more detailed information in the recently mailed guidelines, “Incorporating Spousal Premium Deductions Into Your Monthly Reporting and Payment Processes.”

Make Sure Your Employees’ Spouses Are Covered Deducting Premium Contributions Your facility should have submitted a list of employees who wish to continue their spouses’ coverage to the Benefit Fund, based on the authorization forms you received. Beginning with the first payroll check issued in March 2011, you should have started deducting $30 per week from the paycheck of each employee hired prior to January 1, 2011, who requested payroll deduction to continue their spouse’s coverage.

1199SEIU employees hired on or after January 1, 2011, are subject to a higher rate. For these employees, the contribution will be $60 per week for the first five years of their employment. After that, the amount will drop to $30 per week.

Remitting Premium Contributions to the Benefit Fund Once these premiums are deducted, you must send them to the Benefit Fund no later than the 10th of each month following the month in which they were collected. For example, the March spousal premium payments should be submitted by April 10th. Arbitrator Scheinman has been very clear that employers should not hold employee premium contributions. While it is not always the practice, your contract does require you to submit your contribution payments by this date as well. Although the Award originally called for premium contributions to be paid on the first Friday of the month, Arbitrator Scheinman has allowed a grace period until the 10th to help streamline the process for both payments. We hope that you will make every effort to submit your contribution and premium payments by the required date. If you have difficulties meeting this schedule, please contact Anthony Petrella in our Contracts and Collections unit at (646) 473-6460 or at Anthony.Petrella@1199funds.org. Both your regular contributions and premium payments should now be sent electronically to the bank on the 10th of each month. Payments must be submitted to: 1199SEIU Greater New York Benefit Fund; Account # 01114038; Amalgamated Bank; Routing # 026003379

Reporting to the Fund Is the Key to Ensuring Spouses Are Covered Your monthly payroll reports are also due on the 10th of each month and should now include additional fields with the members’ and their spouses’ names, the amount of the weekly premium and a total remitted. The reports should be sent electronically to: EmployerReports@1199funds.org. For a template of the revised report, please contact Anthony Petrella, Manager, Contracts and Collections, at (646) 473-6460 or at Anthony.Petrella@1199funds.org. Open Enrollment for Spouse Coverage Employees who have not signed their spouses up will have the opportunity to do so twice each year. The next open enrollment period will begin in July for coverage effective September 1, 2011. But, newly eligible employees will be able to enroll themselves and their dependents, including spouses, when they first become eligible for benefits, regardless of when the open enrollment periods occur.

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January Brings Health Reform Changes to the Greater New York Benefit Fund As required by the Patient Protection and Affordable Care Act (PPACA), coverage for dependent children has been extended up to age 26 and lifetime benefit maximums were eliminated as of January 1, 2011.

1,912 Young Adults Enroll in Greater New York Benefit Fund The Fund spent the fall months actively reaching out to eligible members and enrolled a total of 1,912 young adult dependents, including 947 who had aged out and re-enrolled, 264 who are new to Fund coverage, and 701 who would have aged out but instead rolled over with no break.

Members Can Still Enroll Young Adult Dependents

Website Improvements Put Benefit Details at Employers’ and Members’ Fingertips

The new www.1199SEIUFunds.org has been designed so that fewer clicks are required to get users where they want to go, and drop-down menus from the navigation bar will help users pinpoint the precise location of key information rather than forcing page-to-page searches.

1199SEIU employees, there is a useful new Personal Information Account feature, which allows them to create a secure account through which to view their personal health and benefit information, such as eligibility, medical claims and details on co-payments. The improved selfservice capability offered through the Personal Information Account feature can save your employees time on the phone or a trip to our Member Services Office at 330 West 42nd Street, Manhattan.

As an employer, your Human Resources staff will be able to better find and access benefit information. And for your

We hope you and your employees will take advantage of accessing Funds information through the new site in 2011.

The 1199SEIU Funds began 2011 with a redesigned website that includes many improvements, including a simplified navigation menu and a user-friendly Tool Center.

If there are employees at your facility who have not enrolled newly eligible dependents, they can still take advantage of this extended coverage by filling out a special Young Adult Enrollment Form. Enrollment will be continuous, but coverage will not begin until the first day of the month that follows 30 days after we receive their form. These forms are available on our website (www.1199SEIUFunds.org), from your Outreach Coordinator or by calling our Member Services Representatives at (646) 473-9200 to request one.

Maximums on Benefit Costs End Effective January 1, 2011, PPACA required that all plans eliminate any lifetime or annual maximums. For the Greater New York Benefit Fund, that meant an end to the $500,000 lifetime maximum and cost limits on biotech medications and newborn medical care. Our Care Management staff is working to coordinate and manage the care of the few members affected by this change, and is helping them to transition back into the Fund if they still need the coverage. And if any of your 1199SEIU employees are among the few who have reached the lifetime or any of the other maximums, they can still contact the Fund’s Care Management Department at (646) 473-7446 to discuss transitioning back into their Fund coverage, subject to eligibility. 4 EMPLOYER NEWS Winter 2011

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