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HomeMy WebLinkAboutRES 07-422P.R. No. 14361 o9/o4/o7 - ULR/pd RESOLUTION NO. ~ 7-- ~6~..~ A RESOLUTION AUTHORIZING THE CITY MANAGER TO EXECUTE RENEWAL CONTRACTS BETWEEN ITS THIRD PARTY ADMINISTRATOR (ADMINISTRATIVE SERVICES ONLY) FOR THE ~ OF PORT ARTHUR GROUP MEDICAL, DENTAL INSURANCE; FOR BASIC LIFE, FOR BASIC ACCIDENTAL DEATH AND DISMEMBERMENT, AND EXCESS LOSS INDEMNITY WITH BLUE CROSS AND BLUE SHIELD OF TEXAS, INC, FUND NO. (S): 614 - HEALTH INSURANCE FUND WHEREAS, the City Council of the City of Port Arthur deems it necessary and appropriate to continue major medical health cam benefits for the City's employees and its retirees, and; WHEREAS, the City Council deems it in the best interest of the citizens of Port Arthur to be self-funded and to contract with Blue Cross and Blue Shield of Texas, Inc. as a third party administrator at an estimated cost of $342,525 per year (administrative charge based on the present number of employees and retirees) as well as at a cost of $428,566 per year for stop loss premium (excess indemnity), and; WHEREAS, such contracting with Blue Cross and Blue Shield of Texas, [nc. complies with Sections 252.021(b), Comoetitive Reeuirements for Certain Purchases. 252.024, Section of [nsurance Broker. and 252.048, Chanqe Orders. respectively of the Local Government Code; and, P.R. No. :1436! 09/04/07- HLR/pd Page 2 of 5 WHm:I~:A~, the nature of the premiums to be charged by the Ob/and the benefits are as delineated in Exhibits "A-I", and "A-2" which reflect the costs for administraUon by Blue Cross and Blue Shield of Texas, the stop loss premium, the expected reserve, and, WHEREA~, the Basic Ufe Insurance will also be conUnued, with no increase, as per the Blue Cross and Blue Shield of Texas communicaUon dated 05/29/07 attached hereto as Exhibit "B~, which w~ml cost the ob/$1.62 per employee per month {for a $6,000 death benefit policy), and, WHERE,, as part of the renewal, the City is also obtaining Accidental Death and Dismemberment insurance on behalf of its employees which will cost the City $.30 per employee per unit ([for a $5,000 accidental death and dismemberment policy) per month, at a total expected to be less than $3,000 per year. BE Z'I' RESOLVED BY THE CZl'Y COUNC3L OF THE CZTY OF PORT ARTHUR: THAT, the City Council of the City of Port Arthur hereby awards the following contracts to Blue Cross and Blue Shield of Texas, Thc.; attached hereto and made a part hereof, as is fully delineated herein: TNSURANCE COVERAGE Administrative Services Only for the City of Port Arthur's Group Medical, ADMINISTRATIVE SERVICES Blue Cross & Blue Shield EFFI~(~IVE DATE November 1, 2007 P,R. No. 1436). 09/04./07 - HL~pd Page 3 of 5 Basic Life & AD&D Excess Loss Indemnity Blue Cross & Blue Shield Blue Cross & Blue Shield November 1, 2007 November 1, 2007 THAT, the renewal proposal submitted by Blue Cross and Blue Shield of Texas, Inc. dated 05/29/07 as delineated in Exhibit "B' (attached), is hereby approved. TRAT, the Summary of Benefits which includes plan modifications changing the calendar year deductible from $1,0~ Zndividua~/$$,~7 Family Networl0 to $$00 [~dividual/$1,$O0 Family (In-Network) and from $1,5~0 Indlv/duay$$,~ Fam#y (Out. of-Network) to I~dividual/$ExO00 Family (Out, f-Network) as delineated in Exhibit (attached) with all other existing health plan benefits unchanged along with current funding levels for all impacted employees, retirees, and/or dependents as delineated in Exhibit "D" (attached); and, THAT, the City Manager is hereby further authorized to execute the necessary contracts and other documents on behalf of the City of Port Arthur subject to the approval of the City Attorney, and to make payment of necessary premium and adminlstraUve charge to bind coverage pending receipt of the Conbact for Third Party Admini~krdtor Admini~bafive Services and the Contracts for Insurance; and, P.R. No. 14361 09/04/07 - HLR/izI Page 4 of 5 THAT, the Oty Manager is hereby directed to take all actions necessary to ensure proper funding of the City of Port Arthur's employee health insurance Fund (pending budget approval) in accordance with Exhibits "A(1,2,)'; "B'; "C'; ~D", attached hereto and made part hereof; and, THAT, a copy of the caption of this resoluUon be spread upon the minutes of the City Council. AD, 2007, at a Regular Neefing of the City Council of the Qb/of Port Arthur, by . NOES: ~~.? ' /~el~ris ~Bobbie" Prince, Mayor A~-FES'I': ~, APPROVED AS TO FORIVI: ity ~cney (ON b¢l~Lg P.R. No. 1,~361 09/04/07 - HLR, Jpd Page 5 of 5 APPROVED FC~ ADMINISTRATION: Step-~e~"B. Fitzgi6bons APPROVED AS TO AVAILABILITY OF FUNDS: Director Finance 'ID EXHIBIT "B" May 29, 2007 BlueCross BlueShield of Texas Mr. Ha~ey Robinson City of Port Arthur P. O. Box1089 PortAAhur, Texas 77641-1089 Re: AnniversaW Date: November1,2007 Group#:31118 Dear Mr. Robinson: Thank you for allowing Blue Cross and Blue Shield of Texas (BCBSTX) the oppodunity to provide group benefit coverage to you and your employees this past year. We are proud of the partnership we have developed with you and will continue to strive to meet your needs for quality health care coverage while managing health care costs. SB 51 Reminders: The recent passage of Senate Bill 51, Group Premium Payment after Employee Termination by the 79~h Texas Legislature Regular Session amends Chapters 843 and 1301, of the Texas Insurance Code (TIC). This legislative change applies to all fully insured PPO and HMO benefit plans issued, delivered or renewed, on or after, January 1, 2006. This legislation change does not impact self-funded (ASO) accounts. Please note, this change is due to Texas Legislative requirements and is not a business decision of Blue Cross and Blue Shield of Texas (BCBSTX). The information provided below is to supply you with the high- level legislative requirements and operational impacts to employer groups for Senate Bill 51. Premium Payment and Coveraqe after Enrollee's / Insured's Termination: Group policyholders are liable for an enrollee's or insured's premiums payments from the time the enrollee or insured ceases to be eligible for coverage until the end of the month, in which the group policyholder notifies the HMO or insurer, that the enrollee or insured is no longer part of the group and eligible for coverage; and · Group policyholders are required to provide coverage for the enroliee or insured, under the policy, until the end of the month in which notification is received by the benefit plan, carrier or insurer. Example: An employee terms with the employer on August 20, 2005. The employer notifies the carrier on September 6, 2005. Under the new Senate Bill 51 requirements, the employer is responsible for premium payment for the entire month of September 2005, in which the employer notified the carrier. Important Note: Due to this legislation, BCBSTX will require written notification to cancel coverage for an enrollee or insured. Notification will be accepted by receipt through the U.S. Postal Service, email, tape submission, or by real time entry into Blue Access for Employers (BAE). If you are not currently using Blue Access for Employers, please contact your BCBSTX representative for your account's eligibility. You may visit the Employer section of our public website at www.bcbstx.com and click on the link to "Take a Tour" of Blue Access for Employers. 26 [5 Cahlcr, Suilc 700, I:k:aumont, 'l'ttxas 77702 · (409) 8.96 0100. ["ax (409) 89(i-011 I · Important Note: Due to this legislation, retroactive group adjustments will no longer be allowed by BCBSTX for the termination of an enrollee, not posted to the monthly billing, in which the enrollee or insured is no longer part of the group and eligible for coverage. Dental and Vision Sinqle Service HMO's Verification: Senate Bill 51 requires appropriate staffing personnel must be available for verification and preauthorization of health care services for dental and vision $inClle service HMO's between the hours of 8 a.m. and 5 p.m.C.S.T., Monday through Friday, fo~ e~ch day that is not a holiday; and Single service HMO's must have a telephone system capable of accepting or recording incoming phone calls for verification after 5 p.m. Monday through Friday and ail day Saturday, Sunday and legal holidays. Responses are required to all incoming calls accepted or recorded, not later than the next business day, after the date the call is received. Compliance BCBSTX and HMO Blue will fully comply with Senate Bill 51 legislation requirements. As policy and procedure changes are approved, BCBSTX will notify you of the required implementation changes in support of the statute. Sub-workgroups have been diligently identifying operational and administrative impacts. Required operational changes and educational materials will be communicated in the immediate future. Additional Information If you require additional information regarding this legislature, please refer to the following Texas Department of insurance (TDI) website at http://www.capitol state tx us/cqi- bin/tlo/textframe cmd?LEG=79&SESS=R&CHAMBE R=S&BILLTYPE=B&BILLSUFFIX=00051 &VERSiON=5&TYPE=R Access: Unparalleled Provider Networks BCBSTX offers managed care and traditional provider networks that are among the largest in the health care industry, with superior savings. The Texas PPO network, BlueChoice®, is one of the largest PPO networks in the state, including more than 42,000 physicians and 470 hospitals that is available in all 254 Texas counties. Our network features strong relationships with local providers, fostered by our Office of Physician Advocacy When consulting a Physician or Professional Other Provider who does not participate in the Network, your employees may also benefit from discounts if the provider participates in ParPlan -- a simple, direct- payment cost protection feature that is not available with other carriers. If the Physician or Professional Other Provider participates in ParPlan, he agrees to: · File member claims directly with BCBSTX, · Accept the allowable amount determination as payment for Medically Necessary services, and · Not bill for services over the Allowable Amount determination Service: Excellent Customer Service, Online Capabilities BCBSTX traces its or[gin to the non-profit Baylor Plan founded in 1929. We have continued to serve Texans and Texas-based employers ever since, and have become one of the most widely recognized and widely respected health care companies in the state. As your carrier, BCBSTX has demonstrated a commitment to outstanding account management and customer service. The account management team will continue to interact with you as necessary to ensure the ongoing maintenance of your benefits program. Your employees have benefited from the one-stop shopping of the Full Service Unit. Online resources allow members to take control of their health care and afford them the necessary information to make wise decisions. 2 BCBSTX,com ~Blue Access for Employers- secure portion of the Web site, for group-specific product, membership, billing, and other account information. Services also include online enrollment for existing groups, as well as, real time maintenance entry to add or cancel a member's coverage. To view the employer features available please visit the Employer section of our public website at www.bcbstx.com, and click on the link to "Take a Tour" of Blue Access for Employers. Comprehensive Data Reporting Employers also have access to the Blue Outlook management reporting function which includes: · easy-to-read reports and graphs · integration of HMO and non-HMO data, as applicable · immediate access to data at any time · electronic storage · statistical monitoring advanced technological capabilities, by delivering data directly to the desktop Based on group size and funding arrangement, data reporting services may include standard monthly, quarterly, and annual reports that provide in-depth utilization analysis, enrollment reports, and related savings, such as Coordination of Benefits and subrogation. Ad hoc reports may be available for an additional charge. Employer groups may access their reports online. Blue Access for Members - secured access to view claims and Explanations of Benefits, request replacement ID cards, print temporary ID cards, and e-mail questions to Customer Service. Provider Finder® and Pharmacy Finder- downloadable network provider directories that can be formatted by product/network type, region, and city area, A link to the Blue Cross and Blue Shield Association Web site provides a listin9 of national and international providers. A link to the Prime Therapeutics LLC site is available for national pharmacy listings, Pharmacy-related services - including online mail order capabilities for members currently enrolled in Prime Therapeutics' mail order prescription program; an alphabetical listing of the most commonly prescribed medications available in the preferred brand name category with noted generic equivalents; and information about the BCBSTX three-tier copayment structure. Downloadable forms - for claims submission, student dependent certification, prescription drug claim reimbursement, and prescription mail orders. ~ Customer service - for replacement ID card requests and other e-mail inquiries, Health Care Decision Tools In addition to offering eligibility and claim status information online, BCBSTX provides members with access to exclusive online health and wellness content and decision-making tools, > Health Risk Assessment .- Members will benefit from the Health Risk Assessment and other self- management Web-based tools relating to common health care problems such as asthma, Iow back pain, and headaches. These programs will be integrated with BCBSTX care management programs, as applicable. Members may also access information about specific diseases and treatments, including alternative medicine and interactive health/lifestyle decision-making tools. > Hospital Comparison Tool-- BCBSTX also offers members access to a hospital comparison tool that allows members to make informed hospital selections using interactive software. Members can generate a list of hospitals meeting criteria they've specified, such as patient volume, location, mortality rates, and unfavorable outcomes. Members can perform their own side-by-side comparisons of network hospitals, to ensure their comfort and satisfaction with their hospital experience. Value: Competitive Administrative Costs, Innovative Medical Management, Health Care Cost Solutions Keeping health care affordable is important to us because it's important to you. BCBSTX takes a preactive approach to lowering the cost of health care for employers and employees. Blue Resource in conjunction with the Blue Cross and BIue Shield Association, BCBSTX has launched the Blue Resource communication campaign to increase awareness of how health care choices impact the rising cost of health care. BCBSTX provides applicable messages and artwork online at www.bcbstx.com, at no cost to employers. Campaign materials are grouped by health care topic such as Health and Wellness, Weight Loss and Fitness for Work (maximizing productivity through ergonomics, stress management and more). Rates The rates provided in this renewal are effective for the 12-month period beginning November 1, 2007~ These rates are subject to the terms and conditions of the applicable group agreement, contract, schedule of coverage, schedule of specifications, or schedule of benefits. ~' Please advise your agent and/or BCBSTX of your renewal decision at least 15 days prior to your anniversary date. >' Please see attached ASO Exhibit for the Health Renewal Rates. Dental Rates Present Effective on Renewal Employee Only $16.81 $18.71 Employee & One $40.09 $44.62 Employee & Family $49.16 $54.72 ' Life Rates Present Effective on Renewal Basic Life $.27 $.27 AD & D ) $.06 $.06 Additional Information and Reminders Texas legislation mandates an annual open enrollment period. This means your annual open enrollment for all eligible employees and their dependents must be at least 31 days long and prior to your anniversary date. It is imperative that you submit all enrollment applications and change forms during this open enrollment period. Enrollment updates received after your anniversary date will be considered late. The next eligibility window will occur at your group's open enrollment the next year. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) became effective 07/01/97 and was modified 07/01/05. HIPAA continues to affect all individuals eligible to enroll for coverage under your plan. A requirement of this bill is to provide a General Notice of Enrollment Rights and Pre-existing Condition Exclusions. This notice is directly related to Employer Groups and is required by HIPAA and does not necessarily reflect the rules mandated by House Bill 1212 (Texas Legislation). A copy of the HIPAA Notice has been included with your renewal for use in distribution. Please copy and distribute this General Notice of Enrollment Rights directly to all of your employees as soon as possible. This new notice must also be given to each new employee prior to enrollment in or declination of health coverage. The Employee Retirement Income Security Act of 1974 (ERISA) is a federal law that sets minimum standards for employee benefit plans in the private industry. ERISA status is important in determining whether state laws apply to a benefit plan, and is also important for tax and reporting purposes. BCBSTX requires written documentation including signature of your group representative concerning your ERISA exemption status. Please contact your broker or BCBSTX account executive to report changes in your ERISA status or to confirm you have previously reported your ERISA status. If you have any questions regarding the information provided in this letter, any of the enclosed documents, or would like alternate plans quoted, please do not hesitate to contact your agent. We 4 appreciate the opportunity to provide your benefits program and we value the partnership we have built with the City of Port Arthur and look forward to continuing our relationship. Sincerely, Terry Villiva, MHP Account Executive TV:mj Enclosures cc: Mickey Moshier