The WFCA Health Care Program contracts with a third-party administrator, Trusteed Plans Service Corporation (TPSC) for administrative services primarily to support the self-funded health plans but also to support some administrative activities associated with the program’s insured carriers. Premium revenues are sent to TPSC for processing and tracking. A portion of the premium revenue is forwarded to our insured carriers (Kaiser Foundation of WA, Kaiser Foundation of OR, Delta Dental, Standard Life Insurance) to purchase additional benefit choices for our members. The contracts associated with the Program’s insured carriers are negotiated and maintained by our broker, Parker, Smith & Feek. The remainder of the premium revenue is remitted to the Health Care Program. Premium funding from the WFCA is transmitted to TPSC every two weeks to cover medical claims expenses generated by members receiving medical services through our self-funded health plans. Eligibility, enrollment and member support activities are provided by TPSC. Provider networks, medical billings and payments are handled by the Claims Department at TPSC. Exceptions to operating policies and procedures are handled by the WFCA Health Care Manager or the Health Care Committee. Contracts for stop loss insurance and other cost containment management expertise are negotiated by TPSC on behalf of the Health Care Program.
The WFCA Health Care Program contracts with an insurance consultant, Parker, Smith & Feek (PS&F) for consulting services. An integral part of these services is the expertise needed to provide the best plan design possible for our self-funded plan participants and the development of annual premium levels necessary to adequately fund those benefits. The annual renewal process involves the review of benefits, particularly in light of the changing requirements of the Patient Protection and Affordable Care Act (PPACA) and the changes in medical inflation as well as the utilization of medical services by our membership. Making sure the Health Care Program is adequately funded and in balance with the financial capacity of our member employer organizations is an ongoing challenge.
As an alternative to poor interest earnings on bank balances and balances in the Local Government Investment Pool, the Board of Directors initiated a bond investment program during 2014. The WFCA Health Care Program is authorized to purchase federal government agency bonds to restore and improve interest income deposited into the Insurance Rate Stabilization Reserve Account (IRSRA). Bond interest earnings help offset program medical claims expenses and positively influences changes in annual premiums paid by our member organizations.
The number one regulatory requirement of the State Risk Manager is adequacy of reserve funding available to cover any unforeseen or extraordinary medical claims expenses that might accrue to a publicly funded risk pool. The WFCA Health Care Program has always met and exceeded the minimum reserve requirements required by the state. As a result, no re-assessments of our participating member fire service organizations during any Plan Year have ever been necessary to cover extraordinary Program medical expenses. To prudently manage the fund balance, the WFCA Health Care Program has been able hold premium growth in the last few years to a minimum and on occasion has returned premium funding back to fire service organizations in the form of a one month “premium holiday”.
Since the beginning of 2012, utilization of medical services has remained stable resulting in no changes in annual premiums five out of the last six years. The exception was a 6.3 percent increase in 2013. In addition, our member fire service organizations received two one month “premium holidays” during that same six-year time frame. The one month premium rebate equates to an 8.3 percent annual budget savings to our member organizations. The WFCA Health Care Program is a non-profit risk pool established for the dual purposes of providing affordable health care and maintaining the program’s long-term financial viability.
Consistent with state law, this document is required to be read and signed by the involved parties in order to participate in the WFCA Health and Welfare Benefits Insurance Risk Pool. Member fire service organizations and the Washington Fire Commissioners Association agree to purchase employee health and welfare benefits through self-insurance or private insurers to best meet the needs of fire service employees and their families. The inter-local agreement describes the responsibilities of the WFCA Health Care Program and the participating member employer organizations. An inter-local agreement must be signed by the WFCA and the member employer organization before participation in the Health Care Program may begin. The signed inter-local agreement must be on file in the WFCA office and available for review by the State Auditor or the State Risk Manager.
Download Inter-Local Agreement Document
For fire protection districts, regional fire authorities and qualified Public Authorities, a resolution is required to be adopted by the local governing body indicating the member fire service organization chooses to participate in the WFCA Health Care Program and acknowledges the requirement to sign the Inter-Local Agreement and to pay premiums upon enrolling.
Download Model Resolution Document
The purpose of the Local Government Self-Insurance Program is to protect taxpayer resources by ensuring that local government self-insurers are informed about the program’s financial condition, participate in decisions which affect insurance services for entities they represent, and ensure compliance with laws and regulations designed to foster financially sound management practices. This is accomplished through the Office of Risk Management, Department of Enterprise Services, state of Washington. The Office of Risk Management reviews and approves new programs and on-site reviews of approved programs and collects financial, membership and key data annually to allow continuous monitoring of programs between reviews.
The State Auditor's Office is established in the state's Constitution as part of the executive branch of state government. The mission of the Office is to work in cooperation with audit clients and citizens as an advocate for government accountability. As an agency led by an elected official, the State Auditor's Office is independent and is required to objectively perform audits and investigations. Audits conducted by State Auditor staff are designed to comply with professional standards and to satisfy the requirements of federal, state and local laws.
Chapter 48.62 RCW – Local Government Insurance Transactions
Chapter 39.34 RCW – Inter-local Cooperation Act
Chapter 42.30 RCW – Open Public Meetings Act
Chapter 200-110 WAC – Local Government Self-Insurance Health and Welfare Program Requirements