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HomeMy WebLinkAbout1997 11 10 Consent Item A COMMISSION AGENDA ITEM A Regular Consent X Informational November 10. 1997 Meeting MGR DEPT~ Authorization -" REQUEST: City Manager requesting City Commission to authorize the City Manager to extend the current health insurance policy for a period of one year with the plan changes listed in Alternative "2". PURPOSE: The purpose of this item is for the City Commission to review alternative health plan designs for City employees to determine if it desires to change the current plan design or not, and to authorize the City Manager to either extend the current health insurance policy for one year with the desired level of changes, or bid the health insurance alternative selected by the Commission. CONSIDERATIONS: The current health insurance policy is due for renewal January 1, 1998. The current plan has been in place for the past two years. The City received a guaranteed rate when it awarded the health insurance coverage to United Health Care for two years with an option to renew for one year. The City asked the City Attorney for an opinion on whether the City could extend the current policy with United Health Care, or does the City need to seek competitive bids. The City Attorney stated in his memo that the City has the option to either extend or not. Department heads were asked if they favored keeping the same health provider, and if so, would they prefer to pay more for the same coverage or pay more in co-pays in order to keep their dependent cost at or near their current rate. The consensus of the department heads was that they, and their employees; would prefer retaining the current carrier, increase the co-pay, and maintain the dependent cost near current levels. Page 1 The City asked United Health Care for plan design alternatives, with costs. Below are these alternatives: Office Visit Hospital RX Ambulance Physical Co-Pay Co-Pay Co-pay Co-pay Co-pay Current: City $147.62/mo $5 -0- $5 -0- $5 Family 383.81/mo Alternative 1: City $157.95/mo $5 -0- $5 -0- $5 Family 410.68/mo 7% increase Alternative 2: City $1 51.09/mo $10 $100 $8 -0- $10 Family 392.85/mo 2.4% increase Alternative 3: City $147.62/mo $10 $250 $10 $50 $20 Family 383.81/mo 0% increase ISSUE: Two issues arise from the information: 1) Does the City Commission desire to retain the current health care provider with or without a change to the plan design? Items to consider: · You can retain the same rates by changing the plan design. . Employees like the current plan. · The City has received good claim service. · The City has received good support service. . The plan is very comprehensive. 2) Does the Commission desire to re-bid the health insurance? Items to Consider: · Companies could low ball the rates 111 order to obtain the City's business. . Extra cost to bid the health insurance. . A change in provider could result in a change in health networks and plans that are less comprehensive. . Implementation of a new plan by a different provider usually brings confusion and anxiety for a short period of time. . Employees morale could be affected. Page 2 FUNDING: A 10% increase was provided for in the FY98 budget. Alternative" 1" represents a 7% increase. Alternative "2" represents a 2.4% increase. Alternative "}" represents a 0% increase. RECOMMENDA TIONS: It is recommended that the Commission authorize the City Manager to extend the current health insurance policy with United Health Care for one year, with the plan benefits in Alternative "2". If the Commission opts to bid the health insurance, authorize the City Manager to bid the health insurance alternative chosen by the Commission. ATTACHMENTS: Memo of October 21, 1997, from City Attorney Current plan design COMMISSION ACTION: Page 3 OCT 21 ''37 03: 34Pi1 KRUPPEl'mACHER & ASSC P.2/2 LAW OFFICES FRANK KRUPPENBACHER A Professional Association Frnnk Kruppenbacher. Robert D. Guthrie P.O. Box 3471 Orlando, Florida 32802-3471 10S E, Robinson Street, Suite 201 Orlando, Florida 32801-1622 Telephone (407) 246-0200 Facsimile (407) 426-7767 · Ahio Admitted in Colorado MEMORANDUM i TO: Ron McLemore Robert Guthri~) City Attorney ~ October 21 ) 1997 FROM: DATE: RE: Employee Group Health Insurance You asked me to review a package of materials on the subject of Employee Group Health/LifelDisability Insurance as the city approaches an end of a policy year. I reviewed state law, city code, the original request for proposals (RFP), and the insurance contract. It is my opinion that it is the city's option to either extend this coverage through the next policy year, or to not do so. This is based on the original RFP (item #7, page 3 of 61) and the contract signed by the city (fonner city manager). Call if you have questions. = :: -., '--_1 "':_--.:.,- ".. - -. - . . ..., .,. -... . ~ -. ~ : '; : -i- :- p '}.: I UNiTEd1ealthcare 1\. UNITED PLUS d. _.... .. .... .......... .. .. ..... . ...... ..... ... .... ':';-:}:.:;::';';;:::::.;.:.::;:::::};,;.:::;:::.".::.'::::,:,:::::;:;:,:;:;::;'" ;.;.;.;;:t';:;:;:::;:;:;:::;:;::: 'i:':;:i';';'!it.':-:!Ji.8~~Ii.Qi'~:~Si~rn.:..:'i::;i..i:i::;i:'i:;.::!:t.-,.;:ii;,:::,":::lN:.~ij1;~:QJ~f<!::::::.:<':'::::.!!:i::::.;::!!(~fQmQgi~~!;:W:Q~:::i'i!' Pre-Existin Conditions Covered in Full See Pre-Ex Deductible IndividuaJfFamil None $500/$1,000 Lifetime Maximum None $2,000,000 per covered erson I I I I Out-of-Pocket Maximum Individual/Famil Coinsurance I Preventive Care · Physical Exam · Immunizations · Well-Baby Care · Well Woman Exam · Mammogram/Prostate Screening I J I Maternity Care - Pre and Post Natal Exams co a a lies for initial visit Emergency Care Emergency Room (waived if admitted) I Urgent Care Situations requiring prompt medical attention although they are not emer encies. Ambulance Hospital . Inpatient Services o Semi-Private room and board o Physician Services o Surgical Services o Diagnostic X-ray and lab services o Otildbirth Physician Office . Office Visit . Sur 'cal Procedures Outpatient Services . Surgical Care . X-Ra sand dia os tics Prescription Drugs J POINT OF SERVICE PLAN 210 (5/0/5) $1,500 Individual $3,000 Family None $3,000/$6,000 30 % after calendar year deductible is met No Charge No Charge No Charge No Charge No Charge Coverage is for state mandated benefits only No Charge 30% after calendar year deductible is met $50 Copay 30% after calendar year dedcutible is met $25 Copay 30% after calendar year deductible is met .~ $0 Copay Covered up to $100 per hip No Additional Charge No Additional Charge No Additional Charge No Additional Charge No Additional Charge 30% after calendar year deductible is met No Additional Charge $5 Copay No Additional Charge 30 % after calendar year deductible is met No Charge No Charge $5 copay (up to 31-day supply per drug formulary) 30 % after calendar year deductible is met 30% after calendar year deductible is met .- uNiTEmealthcan ..:.... ...; . ...;;<:;(;';:..:.' YOUR <BasT;:; .. ::'. ..::;;:::::.,:::i;.;;;; ; , .:::;:'€6VEiu30 BENEFIT...,. .. \\i::\:::.::/::i;'}::i':'1NI'1EI WORK .,.~iiiii.:ii@:m.;~~iiii~i~i~iii:iiii .... $5 Copay . . Family Planning . Tests, counseling . Surgical Sterilization procedures (vasectomy, tubal ligation) o Inpatient Facility Charge o Outpatient Facility Charge o . Surgery in Physician's Office . . Infertility Services (applicable to policy exclusions) . Office Visit . Treatment/Surgery Vision Care Routine Eye Exam Allergy Testing and Treatment . . . Durable Medical Equipment . Prosthetics . Physical Therapy . Home Health Care . Skilled Nursing - III Mental Health . Inpatient * -- . Outpatient * * Requires authorization with U13S Substance Abuse . Inpatient * -- . Outpatient * * Requires authorization with U13S $0 Copay No Charge No Charge For Diagnoses only $5 Copay Not covered $10 Copay (Every 12 months) $5 Copay for testing Office visit copay for treatment $50 Copay per item - Authorization required for items over $500 - No maximum limit $50 Copay per item - Initial purchase only - No maximum limit $5 Copay (60 days) No Charge Requires prior authorization No Charge - Limited to 90 days per calendar year Requires prior authorization $100 per admission (30 day limit) $10 Group $20 Individual (30 visit limit) $100 per admission (30 day limit) $10 Group $20 Individual (30 visit limit) Not Covered Not Covered Not Covered Not Covered 30% after calendar year deductible is met 30% after calendar year deductible is met 30% after calendar year deductible is met, subject to a $3,000 maximum 30% after calendar year deductible is met. 30 % after calendar year deductible is met. Up to $1,000 per calendar year 30% after calendar year deductible is met ,t i 30 % after calendar year . deductible is met Same limits apply .... 30% after calendar year deductible is met Same limits apply ... Pre-Existing Medical Condition Llmlation. No coverage 15 proVIded (or charges which result from I P~Iisting Medical Condition until the earher 0(: 1. The end of 6 consecutive montlu with no treatment; or 2. The end of 12 montlu of continuous coverage under the Policy. -- . Exceptions: The Pre-existing Medical Condition limitation does not apply to Covered Persons covered under a prior plan of the Enrolling Unit on the date that ploUt was replaced by the Policy, unless such charges would have been excluded under that pl~ ---. . No Loss No Gain - Any current deductible satisfied since January 1997 will be applied to Out-of.Network deductible. It is the responsibility of the member to send a previous explanation of benefits. ---. . Calendar Year Carryover. Deductibles satisfied in the last J month.! or the calendar year are ""rried over to aid in satisfying deductible requiremenl:l ror the next ""lendar yar. All bC1lLfits, prorrided ITy participating prooiders, are subject to tile copayments as described abooe. nle United POS plan is an open access prooider network where referrals are not required for participating specialty care. Please remember tluzt this is jw;t a summary of your benefits. Certain limitations may apply for bC1lLfits. For further details, please read the Certificate ofCooerage. --..