1. NEW MEXICO PUBLIC SCHOOLS INSURANCE AUTHORITY

2. NMPSIA is born Created by New Mexico legislators in 1985 Response to unfavorable conditions in the insurance industry Many schools could not find risk insurance Medical insurance increases in the twenties School administrators lacked the expertise to bid and evaluate responses or manage programs

3. NMPSIA Structure Mandatory participation by 88 of 89 school districts and all charter schools Original proposed law was modified to exclude school districts with 60,000 or more students Colleges and universities not mandatory, but may opt to participate Other non-profit educational entities may also participate

4. Initial Resistance Obstacle Solution School administrators resisted because of loss of local autonomy Added an opt-out provision every four years Notification of opt-out provision given to school superintendents during the contract bid time period To opt-out, school district must prove same coverage obtained at equal or better price

5. Initial Resistance Obstacle Solution Union resistance due to lack of local autonomy and right to negotiate benefit package Local insurance agents loss of commission Gave unions seats on the Board Allowed schools to elect to pay commission to local agent

6. Board representation 2 classroom teachers from NEA 1 classroom teacher from AFT-NM 3 Governor appointees 1 Superintendents’ Association 1 School Business Officials 1 Educational Entities at Large 1 School Boards Association 1 Public Education Commission

7. Key Components to Success Build constituent support Mandatory participation to prevent adverse selection Balanced board representation Deficit payback provision for voluntary members who leave the pool

8. Self-insurance Initially, all programs were fully insured Over the years, both Risk and Benefits changed to self-insured The Risk coverages are protected with a self- insured retention limit of $750,000 The Medical, Rx, and Dental coverages are totally self-insured without reinsurance

9. NMPSIA Today Benefits and Risk Programs covering ▫Mandatory: 88 Public School Districts ▫Mandatory: 67 Charter Schools ▫Optional: 24 Other Educational Entities 11 Staff Members

10. Risk Program Exposure 270,000 students (activities covered at no cost to student) 41,000 employees Property values in excess of $7 billion 5,000 buses and other school vehicles Thousands of field trips 42,000 sports participants 6,500 volunteer workers

11. Risk Program Loss Control Civil rights training to discourage discriminatory employment practices Ergonomics Program to reduce repetitive motion injuries Premises safety inspections OSHA trainings Customized coverage documents

12. Medical/Rx Claims

13. Past Medical Trend vs. NMPSIA

14. Recent Medical Trend FY 08 our medical trend exceeds national average 15.5% NMPSIA versus 11% nationally Catastrophic claims  10 between $330K & $550K  4 over $550K Overall increase in utilization and cost of service

15. Medical Cost Containment PPO plans with negotiated discounts administered by BCBS and Presbyterian Modifying behaviors through health management programs Encouraging appropriate care through plan design (i.e., $0 copay for preventive and diabetic supplies)