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Home My WebLink AboutPR 21137: AMENDMENT TO BC/BS RENEWAL EFFECTIVE 11/1/2019 City of • or rthuc Texas INTEROFFICE MEMORANDUM Human Resources Department Date: October 23, 2019 To: Ron Burton, Interim City Manager From: Trameka Williams, Director of Human Resources Elizabeth Diaz, Assistant Director of Human Resources Re: Amendment to BC/BS Renewal Effective 11/1/2019 P.R.No.21137-A Resolution Authorizing the City Manager to Execute Amendments to the Contract Between Its Third Party Administrator (Administrative Services Only) For The City 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. Nature of the request: The City of Port Arthur is self-insured and contracts with a third party administrator to administer its Health Insurance Plan for major medical health and dental insurance, basic life insurance, and basic accidental death and dismemberment insurance are also provided for employees and City Council appointees. Additionally,the City provides access to its major medical health insurance coverage, including prescription drug coverage, for its retirees under age 65. Resolution 19-424 was approved by Council on 09/24/2019 with the following modifications to the current plan level of benefits as delineated below: • Add MDLive/TELEDOC services • Increase ISL - $125 • Decrease ASL- 125% • Increase ER Copay from $150 to $200 • Increase RX Brand Copay from $35 to $40 • Add RX PA w/Fast Path • Exclude from pharmacy the following: o PPI o NSA o All OTC However, while the underwriters of Blue Cross Blue Shield were processing the renewal paperwork it was noticed that the HSA Plan will not be ACA compliant as the current individual deductible and family out-of-pocket maximum are below the limit. The 2019 ACA regulated minimum deductible for HSA plans are $2700 and the maximum OOP is $6750. The following amendments will need to be adjusted in order to offer the HSA plan to participating members effective 11/1/2019. Staff Analysis, Considerations: The City of Port Arthur has a Preferred Provider Organization (PPO) insurance format which provides participants great latitude in selection of health care providers. This format has been deemed most beneficial for plan participants and most compatible with our organizational culture. The City also offers a lower cost Health Savings Account (HSA) option, which approximately 70 employees are enrolled. The amendments to the HSA Plan will allow for the City to continue offering the HSA plan and be in compliance with Affordable Care Act(ACA) guidelines. Recommendation: It is recommended that the City Council approve P.R.21137 which authorizes the City Manager to amend the contract between its third party administrator (administrative services only) for the City 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., and Dearborn National Life Insurance Company for its 11/1/2019- 10/31/2020 plan year; to allow benefits to be offered to Employees and Dependents that elect to participate in the HSA plan in the plan year 2019-2020. Budget Considerations: Approval of P. R.No.21042 will not have a budgetary impact for which funds are available in Fund No. 614-1701-583.53.00 (Health Insurance Fund). P. R. No. 21137 10.24.19--ed RESOLUTION NO. A RESOLUTION AUTHORIZING THE CITY MANAGER TO EXECUTE AMENDMENTS TO THE CONTRACT BETWEEN ITS THIRD PARTY ADMINISTRATOR (ADMINISTRATIVE SERVICES ONLY) FOR THE CITY OF PORT ARTHUR GROUP MEDICAL, DENTAL INSURANCE, BASIC LIFE, BASIC ACCIDENTAL DEATH AND DISMEMBERMENT, AND EXCESS LOSS INDEMNITY WITH BLUE CROSS AND BLUE SHIELD OF TEXAS,INC. FUND NO. (S): 614-1701-583.53-00 (HEALTH INSURANCE FUND) WHEREAS, pursuant to Resolution 19-424, the City of Port Arthur entered into contract with Blue Cross and Blue Shield of Texas, Inc. as a third party administrator, as the City of Port Arthur is self-funded, to provide major medical health care benefits for its City's employees, City Council appointees, and its retirees under the age of 65 effective on 11/01/2019; and, WHEREAS, the City of Port Arthur has a Preferred Provider Organization (PPO) insurance format which provides participants great latitude in selection of health care providers. The City also offers a lower cost Health Savings Account (HSA) option. WHEREAS, the City's group health plan coverage encompasses the enactment of the Patient Protection and Affordable Care Act (PPACA) effectuated on March 23, 2010, with continuing provisions enacted annually, and do hereby affirm to continue to make changes to its existing health plan policies or products as required to comply with the law; and, current language ties the City of Port Arthur to specific disaster declaration by the President in which the City wishes to modify to a more standard term; and, P. R. No. 21137 10.24.19--ed WHEREAS, the Affordable Care Act (ACA) set new limits for HSA Plans for the 2019 calendar year, the minimum embedded deductible for Health Savings Account (HSA) are $2,700 individual and$2,700 family;and the out-of-pocket max are$6,750 individual and$13,500 family. NOW,THEREFORE,IT BE RESOLVED BY THE CITY COUNCIL OF THE CITY OF PORT ARTHUR,TEXAS: Section 1. That, the City Council of the City of Port Arthur hereby accept the following amendments to Blue Cross and Blue Shield of Texas, Inc., attached hereto and made a part hereof, as is fully delineated herein: HSA DEDUCTIBLE & OOP CURRENT IN NETWORK 2019ACACHANGES HSA minimum deductible $2,600/Individual $2,700/Individual $5,200/Family $5,200/Family HSA OOP maximum $5,000/Individual $6,750/Individual $10,000/Family $10,000/Family Section 2. That, that the Summary of Benefits (SOB) for HSA Plan, Exhibit"A"is replaced in its entirety. Section 3. That, the City Manager is hereby further authorized to execute the necessary amendments to be in compliant with Affordable Care Act (ACA) as set by the IRS for group plans and HDHP/HSA plans on behalf of the City of Port Arthur subject to the approval of the Council. Section 4. That, a copy of the caption of this Resolution be spread upon the minutes of the City Council. READ,ADOPTED AND APPROVED this day of A.D. 2019 at a Regular Meeting of the City Council of the City of Port Arthur, Texas by the following votes: P. R. No. 21137 10.24.19--ed AYES: Mayor Councilmembers Noes Thurman Bill Bartie, Mayor ATTEST: Sherri Bellard, TRMC, City Secretary APPROVED AS TO FORM: T Z/ eG4 -1-•- Val Tizeno, City torney APPROVE1I,FOR ADMINISTRATION: CY (WU LLCUMc Trameka Williams, Director of Human of Resources Ron Burton, Interim City Manger P. R. No. 21137 10.24.19--ed APPROVED AS TO THE AVAIABILITY OF FUNDS: Kandy Daniel, Interim Director of Finance P. R. No. 21137 10.24.19--ed EXHIBIT "A" BlueEdge ASO HSA with Embedded BlueCrossBtueShield Deductible Ga° of Thcas BENEFIT HIGHLIGHTS Prepared for City of Port Arthur BlueChoice Network Effective Date : 11 /01 /2019 BA# 003 **This is a general summary of your benefits. Please refer to your Summary of Benefits and Coverage(SBC),or you may request a copy of the policy or plan document for additional details and a description of the plan requirements and benefit design. This plan does not cover all health care expenses. Please carefully review the plan's limitations and exclusions. Overall Payment Provisions In-Network Out-of-Network Benefits Benefits Embedded Deductible Calendar Year Deductible $2,700 Individual/ $5,200 individual/ Applies to all Eligible Expenses(unless otherwise indicated) $5,200 Family $10,400 Family Applies to Out-of-Pocket Maximum Family coverage: When one family member meets the individual Deductible, benefits become available under the plan for that individual. NOTE: The individual Deductible amount must be equal to or greater than the minimum family Deductible amount. This qualification is established by the U. S. Treasury for a plan to be considered a qualified HSA plan. Deductible credit from prior carrier(Applied on initial group enrollment only) Out-of-Pocket Maximum $6,750 Individual/ $10,000 Individual/ $10,000 Family $20,000 Family Deductible applies to Out-of-Pocket Yes—no option Yes** Copayment applies to Out-of-Pocket Yes—no option Yes** Network Deductible&Out-of-Pocket Out-of-Network Deductible&Out- will only apply toward Network of Network Out-of-Pocket will only Deductible&Out-of-Pocket Maximum apply toward Out-of-Network Deductible&Out-of-Network Out- of-Pocket Maximum Maximum Lifetime Benefits Per Participant i Unlimited BlueEdge CDHP Health Savings Account Stack#1:HSA Inpatient Hospital Expenses Inpatient Hospital Expenses All services must be preauthorized Inpatient Hospital Expenses 80%of Allowable Amount after 60%of Allowable Amount after Each admission must be preauthorized Deductible Deductible All usual Hospital services and supplies,including semiprivate room, intensive care,and coronary care units. Penalty for failure to preauthorize services None $250 For Inpatient Facility Services,Blue Cross Blue Shield of TX or the Host Blue's Participating Provider is required to obtain preauthorization.If preauthorization is not obtained,the Participating Provider will be sanctioned based on Blue Cross Blue Shield of TX or the Host Blue's contractual agreement with the Provider,therefore the member will be held harmless for the Provider sanction. A Division of Health Care Service Corporation,a Mutual Legal Reserve Company,an Independent Licensee of the Blue Cross and Blue Shield Association NGF 151+Business BlueEdge ASO H S A Embedded Ded Rev.3/2019 for eff.dates 07/01/19&after i 4%20 i9 Release; Page 1 of 5 BlueEdge ASO HSA with EmbeddedBlueCrossBlueShield Deductible �U� V ofTiexas BENEFIT HIGHLIGHTS Prepared for City of Port Arthur BlueChoice Network Effective Date : 11 /01 /2019 BA# 003 Medical/Surgical Expenses Medical/Surgical Expenses Services performed during the Physician's office visit/consultation,including lab 80%of Allowable Amount after 60%of Allowable Amount after &x-ray Deductible Deductible -Lab&x-ray in other outpatient facilities 80%of Allowable Amount after 60%of Allowable Amount after Deductible Deductible -Physician surgical services performed in any setting 80%of Allowable Amount after 60%of Allowable Amount after Deductible Deductible -Physician inpatient hospital visits 80%of Allowable Amount after 60%of Allowable Amount after Deductible Deductible -Certain Diagnostic Procedures;such as Bone Scan,Cardiac Stress Test,CT 80%of Allowable Amount after 60%of Allowable Amount after Scan(with or without contrast),MRI,Myelogram,PET Scan. Deductible Deductible -Home Infusion Therapy(Services must be preauthorized) 80%of Allowable Amount after 60%of Allowable Amount after Deductible Deductible -All other outpatient services and supplies 80%of Allowable Amount after 60%of Allowable Amount after Deductible Deductible Virtual Visit MDLIVE(Standard) -Virtual Visit 100%of Allowable Amount after NA Medical Deductible -Virtual Visit Behavioral Health No NA NA Note: Behavioral Health Virtual Visit Applies to MHP Not Covered In Vitro Fertilization Services Extended Care Expenses In-Network Out-of-Network Benefits Benefits Extended Care Expenses (must be preauthorized) 80%of Allowable Amount after 60%of Allowable Amount after Deductible Deductible Skilled Nursing Facility Limited to 25 day maximum each Year* Home Health Care Limited to 60 visit maximum each Year' Hospice Care Unlimited Special Provisions Expenses Mental Health(Serious Mental Illness (SMI)included) and Chemical Dependency(Substance Use Disorder) Inpatient Services inpatient Chemical Dependency treatment must be provided in a Chemical Dependency/Residential Treatment Center(RTC) 80%of Allowable Amount after 60%of Allowable Amount after -Hospital services(facility) Deductible Deductible -Physician services 80%of Allowable Amount after 60%of Allowable Amount after Deductible Deductible Penalty for failure to preauthorize services None $250 Preauthorization required for inpatient,residential treatment centers (RTC),partial hospital program admissions,and certain outpatient professional services Outpatient Services -Services performed during Physician office visit/consultation (does not include psychological testing) 80%of Allowable Amount after 60%of Allowable Amount after Deductible Deductible A Division of Health Care Service Corporation,a Mutual Legal Reserve Company,an Independent Licensee of the Blue Cross and Blue Shield Association NGF 151+Business BlueEdge ASO H S A Embedded Ded Rev.3/2019 for efi dates 07/01/19&after(4/2019 Release) Page 2 of 5 BlueEdge ASO HSA with Embedded BlueCrossBlueShield Deductible CKJ of Texas BENEFIT HIGHLIGHTS Prepared for City of Port Arthur BlueChoice Network Effective Date : 11 /01 /2019 BA# 003 -All outpatient services and psychological testing 80%of Allowable Amount after 60%of Allowable Amount after Deductible Deductible Emergency Room/Emergency Treatment Room Accidental Injury&Emergency Care -Facility charges 80%of Allowable Amount after Deductible -Physician charges 80%of Allowable Amount after Deductible Non-Emergency Care -Facility charges 80%of Allowable Amount after 60%of Allowable Amount after Deductible Deductible -Physician charges 80%of Allowable Amount after 60%of Allowable Amount after Deductible Deductible Urgent Care Services Urgent Care center visit,including lab&x-ray services 80%of Allowable Amount after 60%of Allowable Amount after Deductible Deductible Certain Diagnostic Procedures;such as Bone Scan,Cardiac Stress Test, CT Scan(with or without contrast),MRI,Myelogram,PET Scan,surgical 80%of Allowable Amount after 60%of Allowable Amount after procedures and all other services and supplies. Deductible Deductible Ground and Air Ambulance Services 80%of Allowable Amount after Deductible Preventive Care Routine annual physical examinations,well-baby care exams, 100%of Allowable Amount 60%of Allowable immunizations 6 years of age&over,and any other preventive health services as determined by USPSTF 100%of Allowable Immunizations for Dependent children through the date of the child's 6th 100%of Allowable Amount birthday *Benefits used In-Network and Out-of-Network will apply toward satisfying any Annual Maximum benefits indicated. Special Provisions Expenses, cont. In-Network Out-of-Network Benefits Benefits Speech and Hearing Services Services to restore loss of or correct an impaired speech or hearing Covered same as any other sickness Covered same as any other sickness function Hearing Aids 80%of Allowable Amount after 60%of Allowable Amount after Deductible Deductible Hearing Aid Maximum Hearing aids are subject to 1 per ear per 36 month period Physical Medicine Services Chiropractic Care-Office Services 80%of Allowable Amount after 60%of Allowable Amount after Deductible Deductible Maximum Limited to 35 visit maximum each Year* All other Physical Medicine Services rendered by any other Provider will be allowed on the same basis as any other sickness. *Benefits used In-Network and Out-of-Network will apply toward satisfying any Annual Maximum benefits indicated. A Division of Health Care Service Corporation,a Mutual Legal Reserve Company,an Independent Licensee of the Blue Cross and Blue Shield Association NGF 151+Business BlueEdge ASO H S A Embedded Ded Rev.3/2019 for eff.dates 07/01/19&after j 4x2019 Release) Page 3 of 5 BlueEdge ASO HSA with Embedded BlueCrossBlueSbield Deductible coof Texas • Pharmacy Benefits Participating Non-Participating Pharmacy* Pharmacy (member files claim) Prime Therapeutics Drug List** Basic Compound Drugs Not Covered Non-sedating antihistamine(NSA)drugs and combination medications Not Covered containing a non-sedating antihistamine and decongestant Proton Pump Inhibitors Not covered Cover prescribed over-the-counter(OTC)medications Not Covered. Cover prescription medications with OTC equivalents(same strength, No same active ingredients) Deductible and Out of Pocket Accums-Integrated is the Standard option for HSA. Integrated RX Accum The drug deductible and Out-of-Pocket is the same as the medical Deductible and/Out-of-Pocket.All benefits,including prescription drug benefits(retail and mail order)must apply to the plan's overall Deductible and Out-of-Pocket Maximum. Vaccinations obtained through Pharmacies*** Yes Covered under medical policy,if All ACA vaccines,including flu applicable Covered at pharmacies participating in Prime's Vaccination Network only. Zero Copayment Deductible does not apply Retail Pharmacy (Benefit payments are based on a 30-day supply. With appropriate prescription order,up to a 90-day supply is available.) $50 Copayment Amount after the Deductible*** Specialty Drugst Specialty Lock-Out through specialty pharmacy network provider applies: No coverage available for specialty drugs when purchased through any other provider. Mail Order Program (Benefit payments are based on a 30-day supply. With appropriate $50 Copayment Amount after the Deductible*** prescription order,up to a 90-day supply is available.) DELETE THE LANGUAGE THAT DOES NOT APPLY: MAC 1•No Penalty—Member pays no more than the applicable Generic,Preferred Drug,or Non-Preferred Drug Copayment. Product selection is permitted,even when generic equivalents are available. (standard for HSA) *To locate a preferred/participating pharmacy in your area,go to myprime.corn or contact customer service at the phone number on the back of your identification card. —The drug lists are available at:bcbstx.com/member/rx_drugs.html ***Select Participating Pharmacies have been contracted to provide vaccination services. Each pharmacy may have age,scheduling,or other requirements that will apply. Members are encouraged to contact the store in advance. Benefit does not include childhood immunizations,subject to state regulations. tFor more information on the specialty drug program,call(877)627-6337. Diabetes Supplies are available under the Prescription Drug benefits of your plan. Diabetic Supplies include insulin and insulin analog preparations,insulin syringes necessary for self-administration,prescriptive and non-prescriptive oral agents,all required test strips and tablets which test for glucose,ketones,and protein,lancets and lancet devices,biohazard disposable containers,glucagon emergency kits,and other injection aids.All provisions of this portion of the plan will apply including Copayment Amounts and any pricing differences that may apply to the items dispensed. **Effective 11/1/2015,added Specialty Lock-Out through Prime Specialty Pharmacy applies. No coverage available for specialty drugs when purchased through any other provider. One grace fill allowed. **Effective 11/1/2015,Prior Authorization is required for the drug class PCSK-9 Inhibitors(Specialty injectable drugs)for Homozygous Familial Hypercholesterolemia Agents. tFor more information on the specialty drug program,call Prime Specialty Pharmacy at(877)627-6337. ± Please be reminded that Health Savings Accounts(HSA's)have tax and legal ramifications. Blue Cross and Blue Shield of Texas does not provide legal or tax advice,and nothing herein should be construed as legal or tax advice. These materials,and any tax-related statements in them,are not intended or written to be used,and cannot be used or relied on,for the purpose of avoiding tax penalties. Tax-related statements,if any,may have been written in connection with the promotion or marketing of the transaction(s)or matter(s)addressed by these materials. You should seek advice based on your particular circumstances from an independent tax advisor regarding the tax consequences of specific health insurance plans or products. A Division of Health Care Service Corporation,a Mutual Legal Reserve Company,an Independent Licensee of the Blue Cross and Blue Shield Association NGF 151+Business BlueEdge ASO H S A Embedded Ded Rev.3/2019 for eff dates 07/01/19&after 4/2019 Release) Page 4 of 5 BlueEdge ASO HSA with Embedded BlueCrossBtueShield Deductible e 92 of Thcas Non-Standard Covered Benefits Effective 11-1-2011: • Radial Keratotomy covered • Lasik surgery covered • Medicare Assumption/Estimation • Services,supplies and prescription drugs for the reduction of morbid obesity,including surgical procedures,when medically necessary,covered same as any other illness(note:prescription drugs for morbid obesity are not subject to medical necessity) • Age limit increased to age 26 for the following benefit: Reconstructive surgery performed on a covered dependent child under the age of 26 due to craniofacial abnormalities to improve the function of,or attempt to create a normal appearance of an abnormal structure caused by congenital defects, developmental deformities,trauma,tumors,infections or disease. Non-Standard Covered Benefits Effective 11-1-2014: Effective 11-1-14—Services,supplies and Prescription Drugs for Sexual Dysfunction are covered. Prescription Drugs for Sexual Dysfunction are limited to 8 pills per month "Effective 11/1/2019,PPI,NSA and All OTC drugs are excluded. Added MDLive and RX PA w/Fast Path ± Please be reminded that Health Savings Accounts(HSA's)have tax and legal ramifications. Blue Cross and Blue Shield of Texas does not provide legal or tax advice,and nothing herein should be construed as legal or tax advice. These materials,and any tax-related statements in them,are not intended or written to be used,and cannot be used or relied on,for the purpose of avoiding tax penalties. Tax-related statements,if any,may have been written in connection with the promotion or marketing of the transaction(s)or matter(s)addressed by these materials. You should seek advice based on your particular circumstances from an independent tax advisor regarding the tax consequences of specific health insurance plans or products. Group Executive Name and Title Signature Date (Please type or print) Agent of Record Name Signature Date (Please print or type) BCBSTX Representative Name Signature Date (Please print or type) A Division of Health Care Service Corporation,a Mutual Legal Reserve Company,an Independent Licensee of the Blue Cross and Blue Shield Association NGF 151+Business BlueEdge ASO H S A Embedded Ded Rev.3/2019 for eft.dates 07/01/19&after(4/2019 Release) Page 5 of 5