2025 Program Information
Local government groups working together to lower health benefit costs through self-funding
It all started with four local government groups in 1991
Recognizing the effectiveness of group purchasing, Benecon pioneered self-funded consortium and cooperative programs. Today, we’re proud to manage fourteen programs across the country and maintain membership retention of more than 98%. With our full suite of services, Benecon is able to provide unlimited expert support through Account Management, Actuarial, Compliance, Finance and the Producer Services Divisions. With the unparalleled Nurse Navigation and Wellness Solutions of our subsidiary, ConnectCare3, Benecon is a powerhouse in the self-insurance marketplace.
A Letter to Our Members
October 1, 2024
Dear PMHIC Members,
Thank you for being a valued member of the Pennsylvania Municipal Health Insurance Cooperative (PMHIC). We strive to provide a cost-effective program with excellent service and stability to our members. Healthcare has not been spared by the rising costs we see elsewhere and generally serves as a lagging indicator of inflation. Some of these costs are driven by provider contract increases, worsening population morbidity, the spreading popularity of GLP-1s and innovative new gene and cell therapies. Despite all of this, our goal is to help you control risk while providing transparency and the tools to utilize cost containment strategies. On behalf of the PMHIC Board of Directors, thank you for your ongoing participation in the program.
For 2025, the average renewal increase for the 291 members of PMHIC is 10%. When developing the rates for individual members, the actuarial staff considered the following:
• Medical trend estimate (projected at 9% for 2025)
• Plan designs and demographics for each member group
• Claims experience for 2023 and the first six months of 2024
• Other relevant factors
PMHIC will continue to stabilize the reinsurance costs of its members through the collective purchasing power of the cooperative.
Your renewal is only one indicator of the total cost of your health insurance program. For the 2023 plan year, 71% of PMHIC members received a surplus. When combining surplus returns with your projected 2025 costs, many members experience level-funding or decreases in their total costs.
This renewal booklet and accompanying packet include other information relating to your 2025 renewal, the PHMIC program, Benecon, your claim fund performance and dental & vision rates. We hope you take a few minutes to review this important information.
We appreciate your participation in PMHIC. It is our pleasure to work with you and we look forward to serving you in 2025.
Sincerely,
Zachary Peirson
Michelle Joy VP Account Management
Meet the PMHIC Team
Kristen Abner Senior Account Manager
Kate Lobley Senior Account Manager
LeeAnn Llewellyn Account Manager
Jo Schweitzer Associate Account Manager
Ashlen Kintner Associate Account Manager
Sandi Mozeliak Associate Account Manager
Deb Haldeman Account Manager
Smith Senior Account Manager Missy Leader Associate Account Manager
Omans Senior Account Manager
Zimmerman Account Manager
Phyllis McComsey Associate Account Manager
Associate Account Manager
McKillips Associate Account Manager
Brian
Danielle
Tiia Huffer
Cindy
Amy
Surplus & Savings
2023-2024 PMHIC Board of Directors
9 Members - 2 Year Term (1/1/23-12/31/24)
Ernie McNeely Chairman
Patrick Caulfield Vice Chairman
Troy Bingaman Secretary
Greg Wilson Treasurer
Tom Vernau
Assistant Secretary/Treasurer
Adam Brumbaugh
Jason Stains
George Zboyovsky
Shannon Berkey
Lower Merion Township, Township Manager 75 East Lancaster Avenue | Ardmore, PA 19003 Office: 610.649.4000 | emcneely@lowermerion.org
Schuylkill County Municipal Authority, Executive Director 221 South Centre Street | Pottsville, PA 17901
Office: 570.622.8240 | pcaulfield@scmawater.com
Amity Township, Township Manager 2004 Weavertown Road | Douglassville, PA 19518
Office: 610.689.6000 | tbingaman@amitytownshippa.com
City of Lock Haven, City Manager 20 East Church Street | Lock Haven, PA 17745
Office: 570.893.5907 | gwilson@lockhavenpa.gov
Lower Allen Township, Township Manager 2233 Gettysburg Road | Camp Hill, PA 17011
Office: 717.975.7575 | tvernau@latwp.org
College Township, Township Manager 1481 E. College Avenue | State College, PA 16801
Office: 814.231.3021 | abrumbaugh@collegetownship.org
Borough of Waynesboro, Borough Manager 55 East Main Street, Box 310 | Waynesboro, PA 17268
Office: 717.762.2101 | jason@waynesboropa.org
Brentwood Borough, Borough Manager 3735 Brownsville Road | Brentwood, PA 15227
Office: 412.884.1500 | gzboyovsky@brentwoodboro.com
Lewisburg Borough, Community Dev. Grant Manager 55 S Fifth Street | Lewisburg, PA 17837
Office: 570.275.3091 x314 | sberkey@lewisburgborough.org
New Groups 2024
Lehigh Valley
Schuylkill
Southeastern
Western
Surplus Distribution
Members of PMHIC have the opportunity to receive surplus money from their claim fund after all non-catastrophic claims have been paid. This does not happen in a typical fullyinsured plan. For the 2023 plan year, we will return in excess of $25.1 million in surplus claim funds to 71% of PMHIC members. When you consider your total cost for health expenses in our program, please include these surplus funds in your calculations.
Most PMHIC members received a 50% distribution of their 2023 surplus in May 2024. The balance will be distributed before the end of the year when all claims have been closed out. If you were eligible for surplus in 2023 and did not receive the initial distribution in May, you will receive the entire amount before the end of the year.
On behalf of the Board of Directors, thank you for your continued participation in the PMHIC program.
Wellness Grant
The PMHIC Board of Directors and our carrier partners have generously offered wellness grants to PMHIC member groups since 2016. The following wellness grant funds are available for 2024.
• Capital Blue Cross groups = $110,000
• Highmark Northeast PA groups = $30,000
• Highmark Western PA groups = $10,000
• Independence Administrator groups = $30,000
• UnitedHealthcare groups = $10,000
Wellness grant funds help PMHIC member groups improve the health and wellness of their employees, which potentially leads to lower claims costs. The funds must be used for wellness activities or equipment that will have a positive impact on overall employee wellness. Examples include:
• Biometric screenings
• AED machines
• Exercise equipment
• Fitness trackers
• Hearing tests
• Gym memberships
• Flu shots
• First aid kits/training
• Lunch & Learn education sessions
• Tobacco cessation classes
• Nutrition education
In early 2025, you will receive information from your PMHIC account management team with details about the amount of the wellness grant available to you, the application process, eligible wellness expenses, how to submit expenses for reimbursement, and deadlines to submit eligible expenses. We encourage you to take advantage of available wellness grants.
Account Services
Enrollments, Changes and Terminations
Unless you are using Benecon’s Simon platform or another electronic enrollment platform, please send completed universal benefit forms (UBF) via secure email to Account Services or fax the form for processing.
ID Card Requests Invoice Questions Enrollment Related Questions
Need a new ID card for an employee? Send Account Services an email to request a new one. Most insurance carriers take 7-10 business days to generate and mail a new card. Don’t forget to include the employee’s address in your request!
Account Services is here to answer all of your billing/invoice questions!
Any other enrollment related questions, we have you covered!
Box.com Invoice Delivery
PMHIC invoices are delivered securely each month using Box.com. Upon receipt of your monthly notification email, you should log in to Box.com to retrieve your most recent invoice as well as review invoices from previous months. To avoid mispayments, please make sure you are accessing the newest invoice each month by following these steps:
• Log in to Box.com and click on “All Files”
• Click the arrow next to recent files to hide this section. The recent files section shows the last files you opened, not the most recent files uploaded.
• Click the “Billing” folder
• Click the most recent month’s folder “yyyy-mm”
Helpful tips: Including the following information in the memo section of your check helps to ensure payments are applied correctly.
• The month of the invoice you are paying
• Your Client Manager Key (this is the 3-digit or 4-digit number located under your Group’s Name in the upper left corner of the Medical Billing Invoice)
Open Enrollment Reminder
Please remember to submit all Open Enrollment changes to AccountServices@benecon.com no later than 12/13/2024; this includes new enrollments, changes, and terminations for an effective date of 1/1/2025. If new ID cards are needed prior to 1/1/2025, we strongly suggest submitting your Open Enrollment changes by 12/6/2024.
For groups who are currently using Benecon’s Simon platform, all Open Enrollment changes for medical, dental and vision must be entered into Simon prior to 12/6/2024 for an effective date of 1/1/2025.
IMPORTANT NOTE: additional enrollment changes can be made in Simon through 12/27/2024 (for an effective date of 1/1/2025), but ID cards will not be received prior to 1/1/2025.
Any Open Enrollment changes submitted after the first of the year cannot be processed.
Anne Walls Senior Enrollment Specialist
Erin Willman Enrollment Specialist
The ConnectCare3 Benefit
Evaluate your organization’s wellness needs
Develop a targeted approach to wellness
Enhance an existing wellness program
Increase employee engagement
Collaborative review of claims data
Identify chronic conditions and gaps in preventive care
Actionable insights and strategies from our Wellness Solutions team
CLINICAL SERVICES
Included as part of the ConnectCare3 benefit
Increase awareness of ConnectCare3's clinical services
Engage employees with incentives & challenges
Improve employee health literacy
ConnectCare3 Platform & App
Empowering a Healthier Workforce
Engage employees with incentives and challenges
Increase awareness of ConnectCare3’s clinical services
Improve employee health literacy
Available online and via Google Play/Apple Store
Included as a part of the ConnectCare3 benefit
HealthyU Learning Modules
Incentive Tracking & Reporting
Wellness Checkpoint Health Risk Assessment
Mayo Clinic Resource Library
Wellbeing Challenges
Push Notifications
Available in English & Spanish
Life & Disability Program
In 2010 the PMHIC Board endorsed Benecon to offer a Life & Disability program for all Members. PMHIC believes there is power and efficiency in group purchasing and encourages all Members to participate.
Program Specifics
1. Provide a significant rate reduction on current Life/STD/LTD Coverage
2. Match each group‘s current plan designs & level of benefits
3. Provide a multi-year rate guarantee
4. Place all Members with one carrier
Information Needed to Provide a Proposal
1. Current employee census (Name, DOB, DOH, Occupation, Salary)
2. Copy of current plan designs (Summary Page of Benefit Booklet)
3. Copy of most recent invoice
Insurance Provider: OneAmerica
1. “A“ financial rating from all rating agencies
2. 141+ years experience
3. $83 billion in assets
Experience: Benecon
Benecon has successfully aggregated the Members of many other Cooperatives to create a significant purchasing power for Life & Disability coverage.
Dental & Vision Coverage Through
PMHIC
Did you know that PMHIC offers dental and vision coverage?
With plans from United Concordia, Davis Vision and National Vision Administrators, we are sure to have a plan that works for you.
For more information, please contact your Benecon Account Manager.
Benecon Administrative Services Product Guide
With Benecon’s Administrative Services, gain access to a full suite of value-added services.
HSA COBRA
A Health Savings Account is an employee owned, taxadvantaged savings account used in conjunction with a High Deductible Health Plan (HDHP).
The Consolidated Omnibus Reconciliation Act gives employees who lose their benefits the right to choose to continue group health benefits provided by their employer for limited periods of time if the employee experiences a qualifying event.
HRA Retiree Billing
A Health Reimbursement Arrangement is an employer funded arrangement that may be used to reimburse employees for qualified medical expenses set by the employer.
Monthly billing services for eligible retirees.
FSA ICHRA
A Flexible Spending Account is an employer offered, tax-advantaged account funded by the employee to pay for qualified medical expenses with pre-taxed dollars.
An Individual Coverage HRA is an employer funded, tax-advantaged arrangement in which employers of any size can reimburse employees for some or all of the premiums that their employees pay for health insurance that they purchase on their own.
DCAP QSEHRA
A Dependent Care Assistance Plan is an employer offered, tax-advantaged plan funded by the employee to pay for care for eligible dependents, such as children or disabled family members.
A Qualified Small Employer HRA is an employer funded, tax-advantaged arrangement in which employers with under 50 Full Time Employees can reimburse their employees for their health insurance premiums that they purchase on their own.
Tuition Reimbursement Programs EBHRA
Employer funded, tax-advantaged plan that can pay an employee up to $5,250 in educational assistance benefits each year.
Commuter Transit / Parking Benefits
Employer established, tax-advantaged account funded by the employee and/or the employer to pay for qualified mass transit and parking expenses on a monthly basis.
An Excepted Benefit HRA is an employer funded, taxadvantaged arrangement, under which employers provide funds towards the cost of vision, dental or short term limited duration insurance premiums that they purchase on their own.
Value Enhancements
In addition to our CDH & COBRA offerings, Benecon’s Administrative Services Team provides best-in-class customer service and access to industry-leading mobile and web-based services.
Administrative Portals/CDH Mobile App
24/7 access to Employer & Participant Portals
Enhanced Reporting Capabilities
Enrollment and Eligibility Management
Account Funding and Contribution Management
IOS/Android App That Makes Account Management Easy
Plan Management and Consumer Engagement
Personalized Customer Service
Representatives Available During Working Hours to Assist our Partners and their Clients
Personalized CDH Open Enrollment Presentations and Marketing Materials
Plan Setup and Renewals with no extra charges (*excluding Mini-COBRA)
No Minimum Requirements on Employee Plan Participation
Compliance Webinars and Instructional Videos
FSA / HSA Store and HealthShopper
Special deals on eligible FSA & HSA products
Industry Leading Web Browsers for FSA/HSA Eligible Items
Customized Communications for Participants
Purchased Products Require Zero Substantiation if paired with a Benecon FSA/ HSA Debit Card
Enhancing the Consumer Experience
Benecon Portal: www.my-healthshopper.com/?id=10624
Bringing together the leader in health spending accounts and the leader in online retail to deliver the easiest way to learn about, shop for, choose and purchase HSA/ FSA eligible retail items online. Under the “Eligible Expense List“ on the Home Page, learn about what expenses can be reimbursed under your program and what documentation may be required.
Search for products on Health Shopper, and when ready to purchase, you will be guided to Amazon to procure the product.The transaction experience will work similar to any other purchase a consumer makes on Amazon, including utilizing Amazon Prime benefits.
Get Started Today!
www.my-healthshopper.com/?id=10624
CDHServices@benecon.com
Amazon is responsible for delivery and customer service for purchases made via Health Shopper.
