August 9, 2021

Portico Continues to Deliver Rate Stability in 2022

Each year in August, Portico’s Board of Trustees convenes to consider and approve Portico’s rate and benefit recommendations for the coming year for the ELCA Traditional Benefits Program. For 2022, they gave ELCA organizations, sponsored members, and enrolled retirees many reasons to smile:

  • The lowest ELCA-Primary health contribution baseline rate increase in eight years
  • No change to current ELCA-Primary health deductibles, out-of-pocket limits, prescription drug cost-share, and coinsurance
  • A double-digit contribution decrease for retired and non-sponsored ELCA Medicare-Primary health benefit members
  • A new hearing aid benefit for adults and voluntary vision care services coverage delivered in response to member feedback

While these changes will impact individuals and congregations differently, Portico’s responsibility as the ELCA’s benefit ministry is to support the long-term interests of the community.

“Our ability to deliver quality, cost-effective benefits year over year is stronger because we stand together and buy benefits as one community,” emphasized Rev. Jeff Thiemann, Portico’s president and CEO. “It’s the power of the pool. Our combined and growing numbers strengthen our negotiating position to secure lower administrative fees, and enable us to offer benefits and services not normally available to small groups.”

ELCA-Primary Health Benefits: Low 3% Baseline Rate Increase

Stacy Kruse, Portico’s chief operating and financial officer, explained that the low 3% baseline rate increase* for 2022 — the lowest increase that still maintains an appropriate hedge against inflation — reflects both Portico’s intelligent plan design and member use of benefits.

As a self-insured plan, Portico bills sponsoring organizations during the year based on a predetermined rate. It then uses that money to pay claims incurred by its members. According to Kruse, this year’s particularly low increase stems from:

  • Intelligent plan design — offering the right combination of benefits and pricing to match the needs of the membership, including increasingly popular virtual options
  • Member use of benefits — striving for good health, using benefits like preventive care and condition management programs wisely, and, during the pandemic, the unfortunate reality that many avoided in-person care

“This low rate increase is great news for ELCA-Primary health benefit members and their sponsoring organizations who, like all of us, are still adapting to this evolving pandemic,” Kruse said. “But stable pricing is not new for Portico; this is the lowest ELCA-Primary health baseline rate increase in eight years but the sixth consecutive year we’ve delivered an increase of 5% or less. We take a long-term approach, working to balance cost-containment strategies with steady increases that keep pace with inflation and avoid disrupting employer budgets. We do the same thing on behalf of members, working to make only small, periodic changes to avoid significant out-of-pocket cost increases for them in any one year.”

ELCA Medicare-Primary Health Benefits: Cost Decrease for Retirees & Sponsoring Organizations

For 2022, Portico opted to bundle Humana’s Medicare Advantage and prescription drug coverage — and created dramatic savings in the process.

Currently, Portico contracts with Humana to provide the Medicare Advantage benefit and Express Scripts, Inc. to provide the prescription drug benefit. For 2022, Humana will take over delivery of the prescription drug benefit from Express Scripts. The efficiency of bundling the two benefits with Humana will simplify the experience for members and create significant cost savings.

For retirees and non-sponsored members:

  • Those choosing the Standard and Premium options will see a 25% decrease in their monthly contribution rate.
  • Those choosing the Economy option will see a 39% decrease in their monthly contribution rate.

Organizations sponsoring members with ELCA Medicare-Primary benefits will, in nearly all cases, also see cost savings.

“We’ve been carefully monitoring prescription drug costs,” said Lindsey Holman, Portico’s senior director of products, “and asked Humana to price out the cost of bundling the Medicare Advantage and prescription drug benefits while maintaining deductibles, out-of-pocket limits, and prescription drug cost-share and coinsurance. Their proposal created $12 million in collective savings for our members for 2022 with guaranteed limits on 2023 and 2024 price increases — a huge win for our retirees living on a fixed income.”

Portico felt comfortable consolidating benefits given its now-established track record with Humana. The company has proven itself a reliable partner and earns strong member satisfaction scores.

Before approving this change, Portico worked with Humana to assess potential disruption of cost and service for members. The impact is estimated to be minor. The assessment did discover that some drugs previously covered are not covered by Humana because they’re available over the counter. To offset this impact, Portico will provide members with a $25 over-the-counter allowance per quarter for 2022.

Other Benefit Changes

Trustees approved the addition of new voluntary vision care services coverage for all sponsored members, regardless of their health benefit enrollment. While ELCA-Primary health benefits already cover an annual eye exam — unusual in many health plans — Portico had received requests from members for help managing the cost of prescription frames and contact lenses. The new 100% member-paid vision care services coverage gives members an affordable way to prepare for additional vision care needs, including prescription eyewear.

Also in response to member feedback, Portico is introducing a hearing aid benefit for adult ELCA-Primary health benefit members subject to one’s deductible and coinsurance — up to $3,000 in a 36-month period. This type of coverage was added in recent years for children enrolled in ELCA-Primary health benefits and ELCA Medicare-Primary benefit members through Medicare Advantage benefits. Adding it for adult ELCA-Primary members creates greater benefit consistency and will support the hearing needs of adults not yet eligible for Medicare.

Holman underscored the importance of ongoing analysis. “To best support this community and contain cost increases, we keep a careful eye on evolving member needs and market options. As in past years, this rigorous approach is delivering real value for our community in 2022 — serious cost savings on ELCA Medicare-Primary coverage, consistent hearing aid coverage, and the timely addition of voluntary vision care services to help members offset their out-of-pocket costs.”

Other Pricing Changes

  • Like last year, the 2022 rate for ELCA-Primary health benefit members enrolling children will be increased to offset rate reductions for those not enrolling children. This step helps to ensure that rates more equitably reflect actual claim costs.
  • Rates for survivor and disability benefits are both changing; however, sponsoring employers will see no net increase in the combined contribution rates for these benefits. Survivor coverage is increasing by 0.2% of defined compensation. Disability coverage is decreasing by 0.2% of defined compensation.

Sponsoring employers can estimate their 2022 costs using their Custom Comparison Report on EmployerLink starting in late August.

Members can find 2022 benefit information on myPortico during Annual Enrollment this fall. Those enrolled in ELCA Medicare-Primary benefits will receive details from Portico and Humana in September about their Medicare Advantage Group PPO plan with prescription drug coverage.

*The 2022 ELCA-Primary health contribution baseline 3% increase doesn’t reflect adjustments related to changes in compensation, age, and health coverage level (that is, whether members enroll their spouse and/or children).

Benefit plans are governed and administered individually through separate plan documents. Eligibility for any benefit will be governed by the terms of the applicable plan, program, or policy. Portico (and its designee or the insurer or claims administrator, as applicable) will have the power, including, without limitation, discretionary power to make all determinations that the plan(s) require for its administration, and to construe and interpret the plan(s) for purposes of determining eligibility and benefits. Each plan’s assets are held in separate trusts; accordingly, one plan cannot fund a shortfall of another plan. Portico reserves the right to change any of the terms of the plans at any time through the amendment or termination process described in each plan document. Plan documents are available by contacting Portico.

The health and disability benefit plans are self-insured and are not provided through an insurance company, with the exception of the Medicare Advantage benefit and ELCA Part D drug benefit under the health plan and the insurance benefit under the disability benefits plan. Portico’s ability to pay claims is dependent upon continued contributions, claims experience, and market performance. Portico has contracted with an insurance company to administer the Medicare Advantage benefit and the ELCA Part D drug benefit.

While every effort has been made to ensure the information contained within this communication is correct, the applicable legal plan document(s), policy(ies) or program(s) will control in the event of any omission or misstatement.