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Personnel Director Jack Price presented a brief overview of the major changes in the health care plan from last year to this year and stated that there were 2 guidelines used in choosing the plan; one being the desire to keep the fringe benefits package, particularly the health care plan, as competitive as possible, and secondly, to get the very most coverage from each dollar possible. It was assumed that it would be necessary to ask the employees to participate to a greater extent in the cost of the plan. The objective was to do the most good for the typical claimant. Commissioner Bird asked for an explanation of the headings in the backup provided and Director Price explained that the "County PPO" represents the Class A discount, covered by direct contracts between the County and 2 major providers, Indian River Memorial Hospital and Doctors' Clinic; the second tier discount was "FHN", Florida Health Network; and the third was "out of network" which was the most costly because there were no discounts involved. The modified plan included a change in incorporating the direct contracts the County had into the Florida Health Network contract so that there would be a 2 -tier system, rather than a 3 -tier system. One of the contracts the Board is being asked to approve includes the guarantee that the discounts we had directly with the Hospital and Doctors' Clinic would be sustained or improved by combining them with the Florida Health Network discount program. Therefore, there is now no "County PPO" column. There are now over 70 local providers for employees to select from. Commissioner Eggert inquired about the current situation at Sebastian Hospital, and Director Price advised that Sebastian Hospital is a participant in the Florida Health Network although the County did not previously have a direct contract with that hospital. Director Price went on to explain the changes in the out-of- pocket expenses and stated that encouraging participants to stay within the network is really the heart of the health care program. In calendar 1994, gross claims paid under the plan were almost $6,000,000, while the actual claims paid under the program were $4,200,000, with the difference being entirely attributable to the discount. The whole plan is designed to encourage participants, in a financial way, to seek treatment within the network. Acordia has projected that only 40 participants would be affected by the out- of-pocket limits because most participants will not spend that much on medical expenses. This is one of the categories which had limited impact as far as the whole work force is concerned as j Bw 94 FEBRUARY 14, 1995 17