TML Intergovernmental Employee Benefits Pool

About TML IEBP

TML Intergovernmental Employee Benefits Pool Mission Statement

To provide excellent service offering competitive health benefits and administrative services to eligible municipalities and other governmental entities in Texas by utilizing innovative, viable and affordable alternatives while maintaining financial integrity.

TML IEBP Milestones


May 1, 1979	Health Benefits Trust, under Texas Municipal League Insurance Trust Fund ("the 1979 Trust"), was created and accepted by the Board of Trustees $0 in Assets Staff Count: 2

1984 - 1986	$3.1 Million in Assets Staff Count: 6 Service Improvements: Hired Billing & Eligibility personnel Purchased computer Developed Board Vision Marketing Plans were in initial phases of development Operational Guidelines: Separated Risk Pool Boards between TML, IEBP, and IRP

1989 - 1991	$1.2 Million in Assets Staff Count: 37 In-House Services: Marketing Underwriting Claims Adjudication Utilization Management Large Case Management Service Improvements: Pool becomes self-funded Opened field offices throughout the state All Indemnity plans Added 2 Vision plans Operational Guidelines: Pool ("TMLGBRP") became a partially self-funded pool under the Texas Political Subdivision Employees Uniform Group Benefits Act, Texas Local Government Code Chapter 172. The Pool purchases both Individual and Aggregate Stop loss. The Act calls for the Pool to be governed by a Board of Trustees (§172.006) and gives them investment authority under the Public Funds Investment Act and the Texas Trust Code (§172.009).

1993 - 1995	By 1995: $22.5 Million in Assets Staff Count: 117 Service Improvements: Purchased building Improved technology with imaging/OCR and electronic claims URN/TML Transplant Centers Leased Preferred Provider Network, transitioned to TML IEBP Statewide Preferred Provider Network Operational Guidelines: Trust terms were incorporated into the Interlocal Agreement, April 22, 1993

1998	$30.3 Million in Assets Staff Count: 133 New Benefit: Nurse On-Call Service Improvements: Administrative Manual Design infrastructure of workflow processes Expansion of Preferred Provider Network Out-of-State Network Expanded administrative services to self funded Independent School Districts

1999 - 2000	$33.0 Million in Assets Staff Count: 141 Service Improvements: In-House Right of Recovery Web site enhancement Continued relationship development with reinsurance carriers

Plan Year 2000 - 2001	$33.5 Million in Assets Staff Count: 161 Service Improvements: Full-time Collection Specialist Part-time Medical Director Increased electronic claim adjudication process Enrollment online services Web site update with benefits online Operational Guidelines: TML Group Benefits Risk Pool transferred all of its assets and obligations to TML Intergovernmental Employee Benefits Pool (TML IEBP), a successor Trust with identical purposes to the original Trust, April 1, 2000

Plan Year 2001 - 2002	$37.4 Million in Assets Staff Count: 153 Service Improvements: Claims Cost Management Disease Management New organizational goals and objectives Auto-Audit, contract compliance, nurse claims liaison personnel FastStart mail service reminder program Three-tiered prescription copay plan Access PHCS out of state network

Plan Year 2002 - 2003	$42.5 Million in Assets Staff Count: 153 Service Improvements: In-House professional negotiations Automated Pre/Post-duplicate Identifier Wellness program implementation HIPAA Title II Compliance Loss prevention analysis expansion Out of Network Hospital usual and customary fee schedules Provision of Chapter 172 Trustee training for self-funded members External professional negotiations

Plan Year 2003 - 2004	$45.7 Million in Assets Staff Count: 156 Service Improvements: In-House professional negotiations Onsite wellness with local providers Specialty claims adjudication procedure Health Reimbursement Account plan designs Health Saving Account plan design Contribution/Non Contribution Medicare Supplement Option

Plan Year 2004 - 2005	$51.6 Million in Assets Staff Count: 153 Service Improvements: On-Line claim status look-up January 2005: TML IEBP and Texas Association of Counties assumed administrative services for Public Employee Benefits Alliance (PEBA) PEBA Administrative Services: PEBA@tmliebp.org Onsite wellness with external vendor Disease Management external vendor -- Asthma Supplemental Secondary Repricing Network at Out of Network Benefit Percentage Patient Advocacy Program

Plan Year 2005 - 2006	$58.0 Million in Assets Staff Count: 154 Service Improvements: NHBC Claim Audit Alliance

Plan Year 2006 - 2007	$62.0 Million in Assets Staff Count: 140 Service Improvements: Be Well at TML IEBP Underwriting Consultant Ernst & Young Section 125 Debit Flex Card/MBI HealthX Section 125 Exante Relationship Storage Area Network Expansion D2 Claim Stratification Healthy Acute Chronic Catastrophic October 2006: United Medical Resource Alliance Partnership Options PPO Network Claim Adjudication System Transition PEBA Administrative Services: Disease Management 10/06 Pharmacy Benefit Manager 10/06 Retiree Advantage Program 1/1/07 EAP Services-Deer Oaks 10/1/07 Cancer Supplemental Benefits-Colonial 10/1/07 Critical Care Supplemental Benefits-AFLAC 10/1/07 Accidental Supplemental Benefits-Colonial 10/1/07 Life/LTD/STD Benefits-The Standard 10/1/07 Wellness Benefits-Circle of Health 10/1/07

Plan Year 2007 - 2008	$62.5 Million in Assets Staff Count as of February 27, 2008: 145 Service Improvements: Claim Adjudication System Upgrade to 3.3 Healthy Initiative Program D2 Hawkeye Prochaska: Healthy Lifestyle Stages of Change Claim Integration Clinical Stratification/Adjusted Risk Index Healthy Initiative HealthPlan: Community Based Biometric Screenings/Health Risk Appraisals/Incentive Plan Multidisciplinary Medical Management Team Intake Specialist Behavior Specialist Nutritionist Nurse Medical Consultant Nutritional/Diabetic Specialist Be Well at TML IEBP/Healthy Lifestyle Management Program Web Wellness Portal Return on Investment Incentive Plan with compliance of Biometric Screenings and Health Risk Appraisal Navigating GASB Liability Risk Transition Retiree Reimbursement Account and Access for Life Program Defined Benefit vs. Defined Contribution OON RBRVS Reasonable and Customary 100% participation requirement was updated to exclude: The requirement for employees who are on their spouses plan, TRICARE, or have retired from a previous employer Employees who access a Documented Spouse Plan Employees who access a Retirement Plan due from prior employer Data Warehouse: Milliman Creditable Coverage Recognized to offset pre-existing limitation