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HomeMy WebLinkAboutPR 21117: BLUE CROSS MEDICARE ADVANTAGE RENEWAL EFFECTIVE 1/01/2020 A City of n r! r!h rr tas INTEROFFICE MEMORANDUM Human Resources Department • Date: October 14, 2019 To: Ronald Burton, Interim City Manager From: Trameka Williams, Human Resources Director S Elizabeth Diaz, Assistant Director of Human Resources r Patricia Davis,Human Resources Training Manager RE: Blud Cross Medicare Advantage Renewal Effective 1/01/2020 P. j R. No. 21117 - A Resolution Authorizing The City Manager To Execute Contracts Between Its Third Party Administrator(Blue Cross and Blue Shield of Texas, Inc.) For The City of Port Arthur Blpe Cross Medicare Advantage PPO and Prescription Drug Plan for its Existing Medicare Eligible Retirees and/or Their Medicare Eligible Dependent(s) Nature of the request: The City of Port Arthur provides access to their Medicare eligible retirees and/or their Medicare eligible dependent(s) to the Blue Cross Medicare Advantage PPO and Prescription Drug Plan for major medical health insurance coverage, including prescription drug coverage. Medicare eligible retirees and their Medicare eligible dependent(s) transitioned to the Blue Cross Medicare Advantage PPO and Prescription Drug Plan effective on 11/1/2016. Staff Analysis, Considerations: The City of Port Arthur has a Preferred Provider Organization (PPO) insurance format which provides participants in the selection of health care providers. This format has been deemed most beneficial for plan participants and most compatible with our organizational culture. The upcoming 1/1/2020 renewal has presented an increase of 4.44%over last year's renewal of 15%. Per the attached, it has been determined that this year's 4.44% increase was principally due to high utilization of claims experience incurred during the current plan year to date. There are approximately 115 Medicare eligible retirees and/or Medicare dependents on the plan. The writers, Mr. Ron Burton, Interim City Manager, and Mr. Mickey Moshier, the City's Insurance Consultant, met to consider the BC/BS proposal as presented along with discussing other plans from other major carriers. Ron Burton, Interim City Manager Page 2 of 2 P.R. #21117 Staff views the health insurance benefit as an earned as well as deserved benefit for its City retirees, and will continue to strive to provide the best health plan available at the best price to all of its plan participants. The City's Insurance Consultant, Mickey Moshier, received Request for Proposals (RFP's) from other major carriers as weIl;as supplemental plans costs to determine that the City is offering the best plan to Medicare retirees and Medicare Dependents. During last year's renewal period, Staff was committed to assure the Medicare Retirees and Medicare Dependents are being offered the b,est option, and we are'confident that the City is receiving the best benefits for the cost. Staff is recommending, the following proposed renewal for 1/1/2020 for your review and consideration: 1. To accept the 01/01/2020 propo"sal.as presented by Blue Cross and Blue Shield of Texas, Inc. which includes a 4.44%increase over last year's 15%. 2. No change in the current benefit levels as follows: • $0 Annual Deductible • Maximum Out-of-Pocket$1,500 • Level Copays • Silver)Sneakers Program(i.e.YMCA, Curves,World Gym, etc.) • Hearing Aid Benefits '. Incentives totaling$100/per year for Wellness Benefits 3. Last year's renewal involved a change in premium cost sharing; whereby, Medicare eligible retirees were required to pay 50% of the monthly premium and Medicare dependents were required to pay 100% of the monthly cost. Effective 01/01/2020, it is recommended the plan continue with last year's premium cost sharing wherein Medicare retirees pay 50% of the monthly premium and Medicare dependents pay 100%of the monthly premium. It shall be noted that the City's Retirees Benefit Renewals for Active Employees and Under 65 Retirees(Resolution 19-424)renewal rate for FY 19-20 was 4.9%increase; which is in line with the proposed FY 19-20 Blue Cross Blue Shield Medicare Advantage Renewal Plan. Recommendation: It is recommended that the City Council adopt P. R. No. 21117 authorizing the renewal of the Blue Cross Medicare Advantage PPO and Prescription Drug Plan for its Medicare eligible retirees and/or their Medicare eligible dependent(s), and authorizing the City Manager to execute all documents necessary for its 1/01/20-12/31/20 plan year. Budget Considerations: Approval of P.R.No.21117 will have a budgetary impact of$89,000 which is available in the FY 2019-20 Health Insurance Fund(614-1701-583.18-03). "Remember we are here to serve the Citizens of Port Arthur P.R. No. 21117 10/14/2019—evd RESOLUTION NO. A RESOLUTION AUTHORIZING THE CITY MANAGER TO EXECUTE CONTRACTS BETWEEN ITS THIRD PARTY ADMINISTRATOR (BLUE CROSS AND BLUE SHIELD OF TEXAS, INC.) FOR THE CITY OF PORT ARTHUR'S BLUE CROSS MEDICARE ADVANTAGE PPO AND PRESCRIPTION DRUG PLAN FOR ITS MEDICARE ELIGIBLE RETIREES AND/OR MEDICARE ELIGIBLE DEPENDENT(S),AND AUTHORIZING THE CITY MANAGER TO EXECUTE ALL DOCUMENTS FUND NO: ¢14-1701-583.18-03 (HEALTH INSURANCE FUND) WHEREAS, the City, Council of the City of Port Arthur deems it necessary and appropriate to provide major i'ne4ical health care benefits along with a prescription drug benefit to its Medicare,eligible retirees and/or Medicare eligible dependent(s) effective 01/01/2020; and, WHEREAS, inasmuch as the upcoming year's renewal reflects a 4.44% increase over last year's renewal, the City recommends acceptance of the BC/BS Medicare Advantage PPO Prescription and Drug Plan renewal as presented with no change in its current benefits levels as fully delineated in Exhibit"A"; and, WHEREAS, Blue Cross and Blue Shield of Texas will take the necessary actions to comply with the Centers for Medicare and Medicaid Services' (CMS) requirements to continue the provisions enacted annually,and do hereby affirm to continue to make changes to its existing health plan policies or products required to comply with the law; and, NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY PORT ARTHUR, TEXAS: Section 1. That, the City Council of the City of Port Arthur hereby accepts the contract proposal from Blue Cross and Blue Shield of Texas, Inc., to renew the Blue Cross Medicare Advantage PPO and Prescription Drug Plan for its Medicare eligible retirees and/ P.R. No. 21117 10/14/2019 evd Page 2 of 3 or their Medicare eligible dependent(s) for the 01/01/20 plan year which includes a renewal rate of 4.44%over last year's renewal. Section 2. That, the City will be billed 50% of the proposed premium cost of $206.58/month for all impacted Medicare eligible retirees (approximately 70 Medicare retiree participants). The City's monthly premium cost which equates to $103.29/per member/month, for all impacted Medicare eligible retirees for the 01/01/2020 — 12/31/2020 plan year as is fully delineated in Exhibit"B". Section 3. That, the City Manager is hereby further authorized to execute the necessary contracts and other ddcuments on behalf of the City of Port Arthur subject to the approval of the City Attorney,t and to make payment of necessary premium and administrative charges to bind coverage subject to the terms and conditions of the contract for Third Party Administrator(Blue Cross and Blue Shield of Texas,Inc.)and the Contracts for Insurance attached hereto as required to effectuate said services. 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 AD, 2019, at a Regular Meeting of the City Council of the City of Port Arthur, by the following vote: AYES: Mayor Councilmembers: NOES: Thurman Bartie, Mayor P.R. No. 20563 10/14/19 evd Page 3 of 3 ATTEST: Sherri Bellard, City Secretary APPROVED AS TO FORM: 4r_V f Valecia Tizeno, Ci Attorney APPROVED FOR ADMINISTRATION: Trameka Williams, Director of Human Resources Ron Burton, Interim City Manager APPROVED AS TO AVAILABILITY OF FUNDS: Kandy Daniel, Interim Director of Finance Exhibit " A" 2020 Blue Cross Medicare Advantage - PPO City of Port Arthur Fs' PSP Category RENEWAL F.� A (Benefit Description) CUSTOM PLAN IN-NETWORK OUT-OF-NETWORK G• Deductible SO 5250 Premium MOOP(Maximum out of Pocket) 51,500 $2,250 Combined OOP Max 52,250 -z Inpatient Hospital -Acute S 100/day 40%coinsurance (days 1-6) Inpatient Mental Health Care S 100/day 40%coinsurance (days 1-6) SO/day(1.20) Skilled Nursing Facility S 100/day (21-100) 40^e coinsurance Cardiac and Pulmonary Rehabilitation Services $20 copay 40%coinsurance Emergency Care $50 copay S50 copay Urgently Needed Services S40 copay 40%coinsurance Partial Hospitalization $30 copay 40%coinsurance • Home Health Service SO copay 40%coinsurance (60 visits limit per yr) (60 visits limit per yr) 72 Primary Care Physician Services S30 copay 40%coinsurance 7- Chiropractic Services SIO copay 40%coinsurance 7c Occupational Therapy Services 520 copay 40%coinsurance Physician Specialist Services Excluding Psychiatric Services $50 copay 40°e coinsurance (exclude Radiology) 7 Outpatient Mental Healthcare Visit S20 copay 40%coinsurance -P Podiatry Services S30 copay 40%coinsurance • Other Health Care Professional Services S50 copay 40%coinsurance 7t Outpatient Mental Healthcare Psychiatric Visit S20 copay 40%coinsurance Physical Therapy and Speech Language Pathology Services S20 copay 40%coinsurance �.3 Lab Services S20 copay 40%coinsurance sa Diagnostic Procedures S60 copay 40%coinsurance Si) Therapeutic Radiology S60 copay 40%coinsurance St Diagnostic Radiology services/X-Ray S60 copay 40%coinsurance Sb Advanced Imaging(MRI,MRA,CT Scan, PET) S50 copay 40%coinsurance Outpatient Hospital Services 5100 copay 40%coinsurance Ambulatory Surgical Center(ASC)Services S100 copay 40%coinsurance Outpatient Substance Abuse: Individual Therapy S40 copay 40%coinsurance Outpatient Substance Abuse: Group Therapy 540 copay 40%coinsurance i OP Blood Services SO copay SO copay so:, Ambulance Services 20%coinsurance 20%coinsurance Mu Transportation Services Not Covered Not Covered 113 Durable Medical Equipment (DME) 10%coinsurance 40%coinsurance 11- Prosthetics/Medical Supplies 10%coinsurance 40%coinsurance 0%-20%coinsurance Diabetes Supplies and Services (0%for preferred test strips:20% 40%coinsurance for all other supplies) :2 End-Stage Renal Disease 10%coinsurance 40%coinsurance 13a Acupuncture Not Covered Not Covered 13b Over-the-counter RX Not Covered Not Covered Lac Meal Benefit Not Covered Not Covered 14a Medicare-covered Preventive Services SO Copay SO Copay i' Annual Physical Exam SO Copay SO Copay 14- Supplemental Education/Wellness Programs SilverSneakers 14J Kidney Disease Education Services SO Copay SO Copay 14r Diabetes Self-Management Training SO Copay SO Copay 1S Medicare Part B Rx Drugs 20%coinsurance 40%coinsurance :6a Preventive Dental Not Covered Not Covered irb Comprehensive Dental 20%Medicare covered 40% Medicare covered SO copay 40% Medicare covered eye 17e Eye Exams Medicare Covered eye exam exam SO copay Medicare covered eye 40% Medicare covered 17b Eye Wear wear 25%Medicare Covered; 1sa Hearing Exams S10 copay for 1 routine hearing 40%Medicare Covered exam each year sat HearingAids S1.000 combined in-network and out-of-network allowance on hearing aids every 3 years MAPD-PD See PD Tab For members that are outside of service Travel Benefit 4C area for up to 6 months Worldwide Emergency Urgent/Emergent Care• S50 copay:No annual limit incentives 525 offered at 4 times per year Deductible is applicable to all cells with a coinsurance. 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