HomeMy WebLinkAboutPR 22114: CONTRACT WITH BLUE CROSS AND BLUE SHIELD OF TEXAS, INC. City of
c
ort rthur
Texas
INTEROFFICE MEMORANDUM
Human Resources Department
Date: August 24, 2021
To: Ronald Burton, City Manager
Trameka Williams, Director of Human Resources
From: Elizabeth Diaz, Assistant Director of Human Resources
RE: Blue Cross Medicare Advantage Renewal Effective 1/01/2022
P. R. No. 22114 - 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 Blue 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 1/1/2022 renewal has presented an increase of 1% over last year's renewal. Per the
attached, it has been determined that this year's 1% increase was principally due to utilization of
claims experience incurred during the current plan year to date. There are approximately 98
Medicare eligible retirees and/or Medicare dependents on the plan.
P.R. No. 22114
08.24.2021--evd
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 two(2)benefit adjustments that go in effect 01/01/2022 are Urgent Care copay will
now be the same for network and non-network providers ($40), and $0 copay for the first three (3)
pints of blood. All other benefits stay the same.
No change in the current benefit levels as follows:
• $0 Annual Deductible
• Maximum Out-of-Pocket$1,500
• Level Copays
• SilverSneakers Program(i.e.YMCA, Curves,World Gym,etc.)
• Hearing Aid Benefits
• Incentives totaling$100/per year for Wellness Benefits
It is recommended that the City continue to share the premium cost with the medicare eligible retiree.
Medicare eligible retirees are required to pay 50% of the proposed monthly premium cost and/or
their Medicare eligible dependent(s) are required to pay 100% of their premium cost. The City
currently has approximately 65 Medicare eligible retiree participants that the City has a shared
premium cost.
Recommendation: It is recommended that the City Council adopt P. R. No. 22114 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 1/01/2022-12/31/2022 plan year.
Budget Considerations: Approval of P. R.No.22114 will have a budgetary impact of$85,000
which is available in the FY 2021-2022 Health Insurance Fund(614-11-025-5127-00-00-00).
"Remember we are here to serve the Citizens of Port Arthur
P.R. No. 22114
08/24/2021—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: 614-11-025-5127-00-00-00 (HEALTH INSURANCE FUND)
WHEREAS, the City Council of the City of Port Arthur deems it necessary and
appropriate to provide major medical health care benefits along with a prescription drug
benefit to its Medicare eligible retirees and/or Medicare eligible dependent(s) effective
01/01/2022; and,
WHEREAS, inasmuch as the upcoming year's renewal reflects a 1% 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 minor positive changes 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. 22114
08/24/2021 evd
Page 2 of 3
or their Medicare eligible dependent(s) for the 01/01/2022 plan year which includes a
renewal rate of 1% over last year's renewal.
Section 2. That, the City will be billed 50% of the proposed premium cost of
$212.20/month for all impacted Medicare eligible retirees (approximately 65 Medicare
retiree participants). The City's monthly premium cost which equates to $106.10/per
member/month, for all impacted Medicare eligible retirees for the 01/01/2022
12/31/2022 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 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
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, 2021, at a Regular Meeting of the City Council of the City of Port Arthur, by the
following vote: AYES: Mayor
Councilmembers:
NOES:
DONALD FRANK, SR.
MAYOR PRO TEM
P.R. No. 22114
08/24/2021 evd
Page 3 of 3
ATTEST:
Sherri Bellard, City Secretary
APPROVED AS TO FORM:
Valecia Tizeno, City Attorney
APPROVED FOR ADMINISTRATION:
Trameka Williams, Director of Human Resources
Ron Burton, City Manager
APPROVED AS TO AVAILABILITY OF FUNDS:
Kandy Danie Interim Director of Finance
P.R. No. 22114
8.24.2021—evd
EXHIBIT "A"
J.S. Ecwards
Sherlock
INSURANCE AGENCY
City of Port Arthur
Medicare Advantage Retiree Health Plan
1/1/22
Extremely good news on the Medicare Advantage plan
offered to eligible City retirees. Unlike the active/under
age 65 retiree health plan, this plan renews January 1st of
each year. Retirees are offered this option if they retire
at age 65 or later or turn 65/become Medicare eligible
after retirement. Rules and regulations effecting
benefits come from the CMS, Centers for Medicare
Services.
The plan in place is extremely competitive both rate and
benefit wise. CMS does require 2 minor benefit
adjustments that will go into effect 1/1/22. The Urgent
Care copy will now be the same for both network and
non-network providers ($40) and 3 units of blood will
now be available at no charge.
4155 Phelan Boulevard • Beaumont,TX 77707 • P.O. Box 22237, 77720-2237
Beaumont(409)832-7736 • Fax(409)833-1721 • Houston(713) 224-8723
Rates are being adjusted 1% effective 1/1/22. The total
employee cost will move from $210.10 to $212.20 (+
$2. 10). If you recall, last year's rates were adjusted
$4.10 for a 2 year total of $6.20.
The Medicare Advantage plan has been in place for
several years now and once past the initial learning curve
required of any new plan, eligible retirees enjoy the
benefits of a very efficient and effective plan. Questions
are few and the provider network, while slowly,
continues to grow.
I have attached the 1/1/22 benefit summary for review
and I am at your service if questions arise.
)1
Mickey Moshier, MHP
0 Ifr Blue Cross Group Medicare Options
Blue Cross Group Medicare Advant092.
Account information
Acccvnt Name CI y of Port Arthur
Substant&Oa TX
Plsn Typa MAPS Traditional PPO
CMS Cwitract-POP H 1Ceir Pi.,
Elhcive Dam T 1,2,22
film Nemo n.r
Pt elltt.
Benefit Dulgn
Corsreotto jf, 5250
Gamboled Deducbtae 0250
OutwnPocket Maximum SI 020 $2 250
Combined OOP Maximum $2 250
Referral Regrarement Not,
SICetlay
Inpatient Hospitad-Acute in%
,56-01,01
inTxtbere Mental Hid&Cara 5 trArday
40%
(days 41
Skilled Nursing Fncility
Benefit Pored 1-20 days
LI."<aaptatiL All,1 e af.ad SO coon 40%
, .
8en00t Period 21400 dare sicaiiii __ 40.%
gospce(Medicate-coveree ii
, Covered by Ongeet Medicare A a Medicare catered&ebbe
Dome Hee& I. $0 caper
.
. 40%
Irnergency Cars INtoriawne) 1 $50 capay STIO.0942
urganey N.4040.eniKin tvvonove.e) .._.-
„
$40 copy $40=pay CMS Aserirenten
---.-
Urgent Care-.4.i,,,V r.41 5,r,:ll,, $25 appay . Not Covered
&Murano°Serwdos;Ground ' .) 20% 20%
,Ambtrarice Services(As) 20% 20%
Primary Caro Physician Servces $3294.1Xte 40%
'Pilo:cum&marl&Services
Et,ft,invn,tin,ma nn,$5,tt inn 4..., VA)caP4Y 40%
SX1CoorrerPCP
Other Haigh Care Professional Services 40%
SSOcooariSPC
.,...raroprocac boraces.014001,are-COveteal
re•ey.i,.4... r.,,-.4,-.,•,.-43 Ar(I`,..1.0.,01,,),Mt'n,2,5n,,t $10 copy 40%
004111111.bervICOS IM800NOKO0G.1110)
row rir ion,.,nati,...•545.110,4 il-i,,c I ler.e I,,rro, $5 ewes 40%
- Aer pund'ure(ineofoire-covers&
.;c err Aim wen,to r'‘1,14,I-Woe,rri,n t2,oo t0 $O cam SO crew,
r ''.i,,,f b whorwiesst Innl,,
20% 40°.
Eye Exam(Medicamcoversd)
SO C VI& 40%
setter(trarrelterire-cOvsnear
$O copay 40e;
gear no err,.Prim care-oe,...)
25% 40%
1.11,,C nananinaten MINI.89
•
620 away 40%
Polowetary Rehabilitation Senecas
el to-1,1 esti&s yin ys ii 520 copay 40%
Sigteriaideiriibliiriiiiiiiii 1Xe PAO
.3.3,1szsurr•al f,71,,,Ch r 529 copay 40%
occupobanal Therapy 544440as
.,al.S2 I 10 vo.”a, S20 copay 40%
enyteelBsre-py WO.peacn Language ParotogY&friezes _
S20 copay 40%
Menial Hearst Speciwty Serve&- 'r . $20 copay 40%
Merl&Heaills Speedily Services- . "0.50.y 40%
Merle Health Specralty Sereces- ,,...i.,,r, 520 copay Not Covered
Fsychratno Services- ....,r,. S"PS.12.2 40%
Ps,chistric Services-T,ye,r w $20&rot& 40%
$20 tonal Not Covered
Pa.-ual Hospital...ion $30 copay 40%
Ortpatterg Substance AbUe. ' ,,,,,,/,I,/ S40 capay 40%
Outpatient Subsiand a Abuse -,...As: $40 copay 40%
Gpod 5WYK65 $O COP& $0 copay
.ao Swircas ' $20 pow& ,1 40%
Diagnosed Procedures $10 corpora 1 40%
T50a0000 Radiology $90...41, 40.
Diagnosed Radickgy Services i vro. "°0.0PIe
1 40%
AManced Snag op(MRI.UP).Cl -s , $50 nosey 40.
JO".ProlY 40%
I siii.., • 40%
- ' $0 r2' '''...-.-''' ISCBSTX alms.=previously member was rasp:mat&for Erst&ma pens(CMS standard)
10% 40%
Durable Modlc4 Equipment(OMB) 10% .
. 40%
Pronherycs tO% 40%
Medical Suppe& 10% 40%
Diabetes Scotties and Sarno&-Profaned rostom Snooless' OSI, 40%
Diabetes Smolt&and Services-Non Referee resit..511.110.5 265$ 40%
1..10011.5 acmes we&roc&
20% 40%
,
Disrepair&Shoes and Inserts
Dayi in r„se V Nibs&V../,..•a,0014....'oat,.:a Lat..di•'co sr 20% 40%
Lana 3 v.,N 4 twers 014 I.f-4 tlf li..Iffi..,,,,
Briny Disease Educallon Seances . SO Cos& $0 Caney
'ereows-covered Prerersve Sermes SO • SO ,...,
,
lOodiuwe Part 8 Rx Drugs
Meditate Pas 8 Re Drugs Chernceneapyrnararaion 20% 40%
Medicare Part 13 Rs Dnigs Other 20% 40%
Home infirsen Therapy Atimmorraecn SO tardy 50 doe&
e7eraer., IS Leraa
Net covered Not covered
,natineiueiru ,
<:(.rC•,A.er to.'w-,,. s nes, nan rtm'•:Hocu
:..q;r[Ya,yr.ara,ann-rA.n s,t:.cr.at'aria"nn inks
s-rnd:l„wan Hal Coned Not Carved
c,enn,tAeoo sit 0eauyr•nor.s,>..w.e.,r• w'•,
, ag :ar.aa
., ro.,xrwm.rnwn.,w-
n.<me rr..n the ruw..aaltaln
yrehen,ive Dona(A9owenca)
Net Co...d
;Hain.Eta Erin _--
.:'.ye'r.a.r y..,wsr Not coveted Not ocher.
(Rfonterte) Not Co..
nonwai 0.1,yd.rTrwx.a...,rn<a'., 1e.r,ew.y:y..rre
-.....a Hearing Ee.rr $10 cep5Y e0 a 20suance
Horng Aim(AMowNn) Si 000 Atw....s,e
Art.Peel Exam W Ccyay SO Cram
Rcsb',e Pottery Serdec Ma cowed Noe Covered
tine(Tteprrbe Servrea Not Covered Not Corned
,4a'.Apep eture Not Covered Not Cowed
Owahe-CormtoiRx A'.larance Na Covered Na(yretir
Post-Discharge Meal Benefit Noi Cowed NU Corer
Hai-Emergency Transportation Sr.. Nana Caweren Not Cow..
SrlrerS,,r*erc•'Heathmine
✓'..-c.. Included
Irclucnd
For rrorbns outside of it.service area tor up too months
He:vy.x I',;gr:ni 525 for up too times per year
'Ooduc0b'a-Only appicabte to coinsurance not copay Oedctibio counts toward out of pocket macmum Decker Ebro dies not apply to Med,cuo
preventive santces
'Skiled Nursing Pacilty,The member cost shahn9 applies to covered benefits incurred during a members Inpatient stay A benefit period begins
the day you 90 Into a hospital or skilled nursing tacky The benefit period errs when you haven't received any inpatient nonce.care(or slur.
care n a SNP)for 00 days In a row.H you 90 Into a hospital a a skilled nursing faciKy alto one benefit prod has ended.a new benefit parsed
tsegins There is no Mr to the number of benefit periods
rHospce-When you ewe Ina MtleartrceNlled hospice pmoans your hospice se-aces and your Port A and Pat B services related to yea
terminal condition are pad for by Original Medbae.not Blue Cross Group Medicare Adverage.Your plan wit pay for a consullatve one before you
scoot how.
ibis footnote see fell blank due to non-appikabisty
'Amatnts In are deiermined by CMS
'Continuous Caucose Mastering(CGM)products obtained through the pbermxy will be subiect to prior authenadon
HMO plan an New Ma ris HMO and HMO-POS plans in III..and PPO plane in Illinois.Montana and New Mexico are provided by Health Care
Service Care-Wort a Mutual Legal Reserve Company(HCSC)NMO Spada Needs Ran in New Mexico provided by HCSC HMO.PPO.and
Dual Coe HMO Special Needs pans In Texas podded by HCSC Insuralce Santee Company(HISC).HMO profs In Texas provided by GHS
Insuance Company(DOS)Al HMO and PPO employer/union group pans prodded by NCSC.Oklahoma PPO plans tor enpkyer and UN.,
groups only HMO pan in Oklahoma provided by OHS Heath Maintenance Organization.Inc.dlda SF elires HMO(Bbuel.ines)HCSC.HISC.
OHS.and BkoeLncs are Independent Licensees a Netlike Cross and Blue Shed Assecieikn.GHS and Bi elkres are Medicare Advantage
agrbabons van a Medicare content HCSC Is a Medicare Advantage organ.aaon with a Mercers contact and a contract with the New Muuco
Medcad program.HISC is a Medicare Advantage organization lath a Modkae correct and a contract with the Texas M Jiear program
Enron..In these plans depends cur contract renewal
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Underwriting Notes-City of Port Arthur Renewal January 1, 2022
1) MAPD renewal rate is$212.20 Per Member Per Month (PMPM)for 1/1/2022
2) Current MAPD rate is$210.10 PMPM
3) Rate adjustment for 2020 is+1.00%
4) BPA must have sign-off to begin Mandated Materials preparation
5) Plan changes highlighted; notation regarding change or mandate
6) Please confirm OE dates; materials request and format- hard copy/PDF
. N
I
P.R. No. 22114
8.24.2021—evd
EXHIBIT "B"
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