On the occasion of CCAP's 125th Anniversary we are pleased to report that, with apologies to Pete Townshend, the kids are alright. As with families, anniversaries are often a time for reflection. CCAP can be proud of its "kids" and "grandkids", member service programs, ranging in age from 31 years to just about ready to be born. And they are doing alright, in fact, they are doing very well. Every CCAP member participates in at least one of our programs, and several participate in nine or ten (it is not possible to participate in all of them, as a couple are mutually exclusive, for example PCoRP and COBALT).
Our thanks to the more than 90 representatives from the membership who participate on the insurance and member service program governing boards. Without their active interest and advice, the success of the programs would not be possible.
Here is a report on our family of programs, listed in order from oldest to youngest:
CCAP UC TRUST 
Chairman: Joe Giles, Erie County Council Member
CCAP's oldest program, its first "kid", turned 31 in 2011. Membership is at an all time high of 44. The impact of the economic downswing is still lingering, but the first quarter 2011 reports show some signs of improvement in the world of unemployment compensation...for Pennsylvania's counties at least. In spite of several difficult years that included high claim volumes, increased claim charges, and few wins at the appeal level, the CCAP UC Trust has remained in good financial standing. The Trust was able to continue its Loss Control Incentive Program into 2011 which allows members to earn credits, up to 5%, towards their next year's contributions to the Trust. The Loss Control Incentive Program began in 2009 to recognize the annual loss control activities conducted within each member entity. Properly implemented loss control activities, such as education, development of policies and procedures and timely reporting, can help reduce the costs of unemployment charges before a separation even occurs.
At its May meeting, the CCAP UC Trust Board of Trustees unanimously agreed to renew its agreement with the Mazzitti & Sullivan Employee Assistance Program (EAP). Mazzitti & Sullivan has provided EAP services for Trust members for 12 years and the service continues to be well received year after year. Through the agreement with Mazzitti & Sullivan, all employees from a member entity and anyone residing in the employee's household may see a counselor for up to three sessions per problem situation at no cost. Additionally, the Trust purchases Critical Incident Stress Management (CISM) Response Services for its members through Mazzitti & Sullivan.
PCoRP 
Board Chairman: Frank Staudenmeier, Schuylkill County Commissioner
The Pennsylvania Counties Risk Pool (PCoRP ) provides liability, auto, property, crime and other insurance to forty-four counties and four county related entities. Begun in 1987 with twelve initial members, the pool has experienced consistent growth. In our 24th year of operations, the pool has a strong financial condition and the highest number of members ever.
PCoRP was pleased this year to present the members with a June 1 renewal that on average kept costs the same as last year, in spite of a general increase in the members' exposures. PCoRP has a strong surplus position, and this funding allowed the program to increase its self insured retention for liability claims from $350,000 per claim to $450,000. This saved a considerable amount on our reinsurance premiums, and if the members' claims experience is good, means more money stays with the pool instead of being paid to the reinsurers.
CCAP also assists Berks and York Counties with their individual property/casualty insurance through a program called COBALT (County Balanced All Lines Transfer). In the past year Chester County also elected to utilize COBALT. This program helps larger counties set up their own all-lines aggregate program, with a structure similar to PCoRP. CCAP staff provides administrative, claims and loss control services to the counties.
PComp 
Board Chairman: Bill Soberick, Columbia County Commissioner
PComp is the Pennsylvania Counties Workers' Compensation Trust, a self insured group fund regulated by the Department of Labor and Industry (L&I). PComp was started in 1993 when counties asked for another option for workers' compensation insurance in a tight market. Thirty-four counties and 13 county related entities belong to the pool, for a total of 47 members.
PComp members renewed coverage on January 1, 2011 with rates rising on average one percent compared to the prior year. PComp members with low experience modifications can earn up to 20 percent off their premium through PComp's Risk Management Credits, and members who employ a full time risk manager can save two percent off their premium.
PIMCC 
Board Chairman: Dale Shelley, Juniata County Commissioner
PIMCC, the Prison Inmate Medical Cost Containment/Public Institution Medical Cost Containment program, is a money saving consulting service for CCAP members. PIMCC has saved its member counties over $22 million since its inception in 1995. PIMCC works with county prisons, providing case management, medical bill auditing and contract negotiation on behalf of member counties. As the program administrator, Cost Management Plus, Inc., a certified WBE, provides these managed care services to PIMCC.
Education is a PIMCC priority, and Cost Management Plus, Inc. works with prison doctors and nurses to standardize documentation and procedures. This assists counties to meet their Department of Correction health care requirements. PIMCC annually sponsors correctional care nurses' seminars that provide continuing education and strengthen county training options.
Originally, PIMCC was formed to help small to medium size counties control rising prison inmate health related costs. Cost Management Plus, Inc. arranged for statewide pharmacy, medical supplies, lab service and medical waste contracts for PIMCC members. Economies of scale allowed greater discounts for member counties. There are also regional PIMCC contracts with hospital systems. In 2002 the PIMCC Board authorized the expansion of PIMCC contracted services to county nursing homes who wanted to take advantage of purchasing program economies. The PIMCC name was amended to include "Public Institution Medical Cost Containment" making the program available to other interested county departments.
Given its success as a full service program, PIMCC branched out in 2008 to larger counties that use privatized medical providers. By providing unbiased auditing of those privatized programs on an individual or annual basis, providing request for proposal expertise, and working with counties who face catastrophic situations, PIMCC is able to help larger counties meet their fiduciary responsibilities.
COMCARE 
Board Chair: Donna Gority, Blair County Commissioner
COMCARE (County Managed Care Resource) assists counties participating in HealthChoices, Pennsylvania's Medicaid managed care program. COMCARE provides counties with assistance in the administration of managed behavioral healthcare. Service offerings include training opportunities, technical consulting, a website providing a wealth of online resources and COMCARE PRO (see more about COMCARE PRO later in this report).
Sixty-four counties are members of COMCARE, more counties than any other member service offered by CCAP.
PELICAN 
President: Mike Wilt, Executive Director, PACAH
PELICAN Insurance is a CCAP insurance program sponsored by PACAH (the Pennsylvania Association of County Affiliated Homes). Begun in 2003, PELICAN was created specifically for PACAH full voting and associate member county owned and non-profit nursing homes. With the March 1, 2011 renewal, PELICAN added a third category of membership. Category "C" welcomes former subscribers of PELICAN that are now for-profit programs.
In February 2011, for the second year in a row, PELICAN was pleased to return a dividend of $1 million to its subscribers (members). Currently PELICAN has 27 subscribers. The PELICAN premium as of March 1, 2011 is approximately $3.2 million, excluding the Mcare assessment, which is $290,000.
The PELICAN liability insurance program provides primary and excess nursing home professional liability (malpractice) and general liability insurance on a claims-made basis. PELICAN Insurance is a Vermont domiciled Reciprocal Risk Retention Group (RRG) formed under federal law and is owned by the participating nursing facilities.
COMCARE PRO 
President: Donna Gority, Blair County Commissioner
COMCARE PRO Insurance, a Reciprocal Risk Retention Group (RRG), provides stop-loss liability insurance to Pennsylvania counties providing managed behavioral healthcare through HealthChoices, Pennsylvania's Medicaid managed care program. COMCARE PRO is a Vermont licensed insurance company approved to provide coverage by the Pennsylvania Department of Insurance. PRO is owned by its members and is governed by an advisory committee, all in compliance with Vermont laws.
Currently 14 counties or county joinders are subscribers of PRO, covering a total of 33 counties. Membership in PRO is open to members of COMCARE, the County Managed Care Resource.
CCAP DEFERRED COMP ADVISORY COMMITTEE
Chairman: Joe Giles, Erie County Council Member
Taking its lead from the National Association of Counties (NACo), CCAP developed a Deferred Compensation Advisory Committee in 2006 to actively monitor the program's services throughout the commonwealth. The committee meets on an annual basis and reviews the marketing and service initiatives of CCAP, NACo, and Nationwide Retirement Solutions (NRS). The committee also receives a detailed economic outlook and review of the NACo/NRS fund selections and their performance. This committee provides no input on the fund selection. The presentation is for education and information only.
In recent years, there has been significant turnover on this committee, and it is currently seeking volunteers to fill several vacancies. If you are interested in serving, please contact Lauren Kenes at lkenes@pacounties.org or Julia Jackson at jjackson@pacounties.org. Your county must participate in the NACo/NRS 457 Deferred Comp program in order to participate on this committee.
CCAP Health Alliance 
Board Chairman: June Sorg, Elk County Commissioner
Our newest insurance program, the CCAP Health Alliance, is still in its infancy but will begin full operations in January 2012. The goal of this program is to create a pooled risk group, similar to PComp and PCoRP, for the purpose of purchasing group health insurance. The Alliance is in the process of partnering with three health insurance carriers (UPMC, Capital Blue Cross and Aetna) in order to offer coverage to all Pennsylvania counties regardless of size or geographic location. Small to mid-size counties will benefit from group purchasing power, unique funding mechanisms and increased cost control, and counties large enough to self-insure will be able to remain self-insured while accessing the group discounts afforded to the pool. Effective January 1, 2011, Berks and Franklin counties joined as "pilots" for the program in order to begin the process of working with the health insurance partners and help determine the fundamentals necessary for the program's infrastructure.
The CCAP Health Alliance replaces the CCAP BEST Flex program which dissolved effective December 31, 2010. The former BEST Flex board of directors has transitioned into an interim board of directors for the CCAP Health Alliance. The Alliance has contracted with Jones Management Consulting, Inc. to design and build the new program, and the law firm of Eckert Seamans serves as its legal counsel.
ANCILLIARY INSURANCE PROGRAMS
CCAP has established several insurance programs to assist counties with some "niche" risk exposures not covered elsewhere:
Tax Collectors 
The CCAP Tax Collector Bond Program provides the required bond coverage for all tax collectors in each participating county. Forty-eight counties participate in the program, which covers approximately 1,700 individual tax collectors with over $4 billion in bond limits. The Bond Program is written on a four year term. The current program runs for the January 1, 2010 to January 1, 2014 coverage term.
Volunteers 
This program provides $25,000 medical reimbursement and $2,500 Accidental Death & Dismemberment insurance for community volunteers (including nursing home and conservation district volunteers), court referred alternative sentencing (probation), work release inmates, and juvenile tobacco enforcement program youth volunteers. This coverage is in excess over any other collectible insurance. There are currently 38 counties and seven county related entities purchasing this coverage. Members of this program renew their coverage at various times throughout the year.
PACAH Bonds 
This program offers PACAH member nursing homes the ability to purchase patient trust fund bonds to meet federal law requirements. The bond program, run in conjunction with CCAP, was instituted April 1, 1997 and currently covers 28 homes through the Traveler's Casualty and Surety Company. The program provides a total of more than $10 million in surety bond limits. Membership is open to current PACAH members.
ENDORSED PROGRAMS
CCAP endorses these programs which were developed by the National Association of Counties (NACo) or other sponsoring entities:
NACo 457 Deferred Compensation and PEHP Programs
The 457 Deferred Compensation program and Post Employment Health Plans (PEHP) are sponsored by the National Association of Counties (NACo) and administered through Nationwide Retirement Solutions. The deferred compensation program provides county employees with multiple investment options for their voluntary deferred compensation savings. A total of 47 counties and 14 county related entities participate in this program.
The Post Employment Health Plan (PEHP) is a way for counties to provide employees with funds for medical expenses incurred after they retire or leave the county's employ. This program is 100 percent employer funded, and as a result, many Pennsylvania counties have been unable to find a place for this unique benefit in their budgets.
U.S. Communities Government Purchasing Alliance
U.S. Communities is a nonprofit instrumentality of government that helps counties and other public agencies (including states, cities, towns and villages, special districts, public and private K-12 schools, community colleges, public and private colleges and universities, and nonprofits) reduce the cost of purchased goods by combining the potential purchasing power of up to 90,000 public agencies nationwide. This objective is accomplished by competitively soliciting quality products by a single lead public agency and making the resulting contract available to other public agencies nationwide. Counties and other public agencies pay no costs and are charged no fees to participate. The suppliers, who pay a minimum one percent administrative fee to participate, fund U.S. Communities. All contracts are non-exclusive, competitively solicited government contracts that meet government agency "piggybacking" requirements.
U.S. Communities has successfully implemented an initiative to "go green". U.S. Communities/Green is the one-stop source for public agency access to a broad line of environmentally certified products and services. From Energy Star to EcoLogo to Green Seal, U.S. Communities/Green has identified those items in its contracts that meet third-party environmental certification standards to help public agencies meet their responsible procurement needs.
Energy and Telecom Consulting Services
This program, administered by Cost Control Associates, provides assistance to counties and other local government agencies to help reduce energy and telecom costs by performing complete reviews of bills for possible errors that can be refunded to the county or local government. Reviews in rate changes or services are also made to help reduce ongoing energy and telecom costs. The program is contingency fee based with no up-front costs to the county. Like other NACo programs, counties enjoy the ease of participating through nationally bid contracts.
Pennsylvania Local Government Investment Trust (PLGIT)
When PLGIT was created in 1981, a handful of local governments pooled their resources in an effort to gain better control of their assets, get a good return, and seek a safe haven for their money. Those same principles guide PLGIT today. Unlike other Pennsylvania institutions which counties can use to invest their money, PLGIT is owned and operated by its members. Members sit on the board, set investment goals, and spur the development of new services. CCAP is confident in PLGIT's ability to manage and succeed in times of both economic certainty and ambiguity. We encourage you to revisit this unique investment vehicle that is tailored to meet the specific needs of Pennsylvania's counties.
OTHER SERVICES
CCAP provides other services to counties as part of the insurance programs mentioned in this report:
Loss Control
CCAP is trusted by PComp, PCoRP and PELICAN insurance programs' member counties and county related entities across the state to providing them the highest level of loss control services and loss control solutions. Each of our members is provided individual attention, and receives specialized loss control services. By utilizing our wealth of technical knowledge and depth of expertise we provide loss control services that are designed to reduce members' risk. We consider our ability to provide ongoing safety support and solutions our most valuable asset.
A large part of reducing risk is avoiding accidents in the first place. A well-constructed loss control program can assist members create a safer work environment. Loss control services provide members with a comprehensive array of services especially designed to address challenges in county government.
Last year we introduced the Risk Management Assistance Program (RMAP) to PComp members with an experience modification factor of 1.1 or greater to help those members develop and implement a program that will work to reduce their experience modification factor. Through that experience we have learned that the members appreciated and valued the customized service.
For 2011, CCAP's insurance programs announced another service, Hazard Identification surveys. Hazard identification is an integral part of every loss control program. Frequently we address specific hazards after an incident has occurred, and then we investigate and find the cause or the hazard that contributed to the incident or injury. This frequently is not the best use of time or human resources resulting in loss of productive time and energy. Identifying potential hazards prior to an incident is a more effective way of controlling losses and costs. We recommend periodic hazard identification surveys also known as a self-inspection program. Members should be conducting these surveys to detect potential hazards.
A loss control specialist is available to assist insurance program members and their safety committees to develop a program that will meet their needs. The specialist is pleased to assist conducting a hazard identification survey, and provide training as necessary in the development of a hazard identification program. After initial demonstration, education and training, the member's staff will be capable of maintaining the hazard identification program indefinitely. This integral part of your safety program will benefit members for years to come by controlling or eliminating potential incidents, injuries and related costs.
Also for 2011, we have introduced a loss control incentive program for the PELICAN insurance program. Subscriber facilities are encouraged to conduct and participate in various loss control activities in order to lessen the chances of loss, and also to reduce the costs of losses when they do occur. The PELICAN Loss Control Credit Program rewards subscriber facilities who conduct certain activities with a reduction of their premium costs, up to three percent annually. The first time this credit can be earned will be for the March 1, 2012 renewal, based on activities conducted from March 2011 through February 2012.
These are examples of value-added loss control services that are available to members of PComp, PCoRP and PELICAN at no additional charge. For loss control assistance for members of CCAP's insurance programs, please call 800-895-9039 and ask for Gary Nicholson, Loss Control Programs Manager.
Loss Control Training Programs
Over 1,000 officials and employees of Pennsylvania's counties and county related entities attended trainings provided by CCAP's loss control programs in 2010. Trainings on a variety of topics were offered in multiple locations around the state throughout the year.
During 2010, topics included customer service, effective communication, time management, leadership, risk management and much more! All workshops were planned based on the feedback received from workshop evaluations and other information provided by members. We also examine claims trends and develop training designed to help counties reduce both the number and cost of claims.
PCoRP, PComp, COBALT, PELICAN, and the UC Trust insurance programs continue to sponsor the loss control training programs. The members of the sponsoring programs continue to be able to attend the workshops for free, except the Defensive Driving course where PCoRP, PComp and COBALT members receive a discounted rate.
