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R2004-134 08-23-04 RESOLUTION NO. R2004-134 A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF PEARLAND, TEXAS, APPROVING HEALTH AND DENTAL INSURANCE RENEWAL RATES. BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF PEARLAND, TEXAS: Section 1. That the City received renewal rates, attached hereto as Exhibits "A" and "B", for health and dental insurance benefits and such rates have been evaluated. Section 2. That the City Council hereby adopts the renewal rate for health and dental insurance benefits in the amount described in exhibits "A" and "B", attached hereto and incorporated for all purposes. PASSED, APPROVED and ADOPTED this the 23rd~day of Au~just , A.D., 2004. ATTEST: Y~)~ G LO~ (~,~' SECR'ETARY APPROVED AS TO FORM: DARRIN M. COKER CITY ATTORNEY TOM REID MAYOR Exhibit "A" Resolution No. R2004 134 CIGNA HealthCare CIGNA HealthCare Group Benefits Proposal City of Pearland 3519 Liberty Drive Pearland, TX 77581 SIC Code : 9131 Group Contact : Mary Hickling Account Number : 3196548 Total Eligible Employees: Employer Contributions : Waiting Period : Eligibility Definition : 324 Participating Subscribers : 324 Employee Contribution : 100% Dependent Contribution: 0% DOH Active Employees working 30 hrs Note: The Quoted rates are subject to final Underwriting approval and, as noted below, are subject to change in the event of changes in benefits selected or changes in the risk factors upon which the Quoted Rates are based. In addition, state law may require regulatory approval of rates. If required regulatory approval has not been obtained on the proposed effective date, the healthplan shall use rates that are consistent with its then currently approved rating methodology and the quoted rates shall be effective immediately on the date for which they are approved for use. The Quoted Rates are guaranteed while the Group Service Agreement remains in effect until the next anniversary date, unless enrollment changes by 15% in which case the CIGNA Companies may change the Quoted Rate. • 1-102ITX31-SIF-1 Revisionl 1 of 13 08/12/04 City of Pearland CIGNA HealthCare Proposed Benefits Product: CIGNA HealthCare POS Open Access Situs State: TX Effective Date: 10/01/2004 Benefits Summary Category Description Medical Benefits Modular Medical Management Program Benefit Option Coinsurance PCP Office Visit Copay Specialist Office Visit Copay Hospital IP - Per Admit Copay Hospital IP Deductible - Per Admit Hospital IP Copay Per Day Hospital IP Deductible - Per Day Hospital IP - Number of Copays Per Admission Hospital IP - Number of Deductibles Per Admission Hospital IP Coinsurance Plan Deductible — Individual Plan Deductible — Family Out of Pocket Maximum — Individual Out of Pocket Maximum — Family Lifetime Maximum Annual Maximum Outpatient Facility Copay Outpatient Facility Deductible Outpatient Coinsurance Emergency Room Copay Urgent Care Copay Skilled Nursing Facility Copay Skilled Nursing Facility Maximum Days Home Health Care Copay Home Health Care Maximum Days DME Durable Medical Equipment Maximum EPA External Prosthetic Appliances Deductible External Prosthetic Appliances Maximum Chiro Short Term Rehab Copay Chiro Copay Short Term Rehab and Chiro Combined Maximum Visits Short Term Rehab Maximum Visits Self -Referred Chiro Maximum Amount • In Network $20 $40 NA NA NA 80% $0 $0 $3,000 $6,000 Unlimited NA 80% $100 $50 $0 60 $0 60 Included $3,500 Included $200 $1,000 Included $40 $40 60 NA NA Out of Network 50% NA NA NA $600 $1,200 $6,000 $12,000 $1,000,000 NA $0 60 40 NA • NA 60 1-1 02ITX3 1-SIF- 1 Revisionl City of Pearland 2of13 08/12/04 CIGNA HealthCare Proposed Benefits Product: CIGNA. HealthCare POS Open Access Situs State: TX Effective Date: 10/01/2004 Benefits Summary (Cont.) Category Description Medical Benefits (Cont.) Self -Referred Chiro Maximum Visits MRI CT PET Scans Copay PCL Infertility Non -Surgical TMJ Medicare COB: Retirees >=65 Admin Option Robust Reporting Package 24 Hour Health Info Line Well Aware Program (Diabetes, Asthma, Low Back) Well Aware Program (Cardiac) Well Aware Program (COPD) Well Being Newsletter Healthy Babies Healthy Rewards Life Source Organ Transplant Network Guest Privileges Language Line Drugstore.Com Transition of Care CIGNA Health Advisor Benefit Option In Network NA $75 Excluded Option 1 Excluded NA Excluded Included Included Included Excluded Included Included Included Included Included Included Included Included Excluded Out of Network Excluded 1-102ITX31-SIF-1 Revisionl City of Pearland 3of13 08/12/04 CIGNA HealthCare Proposed Benefits Product: CIGNA HealthCare POS Open Access Situs State: TX Effective Date: 10/01/2004 Benefits Summary (Cont.) Category Pharmacy Benefits MH/SA Benefits Vision Benefits Description $10/$20/$40 Copay - Generic Copay - Brand Non -Preferred Copay Mail Order Copay - Generic Mail Order Copay - Brand Mail Order Copay - Non -preferred Retail - Individual Deductible Retail - Family Deductible OOP - Individual Maximum OOP.- Family Maximum Oral Contraceptives Contraceptive Devices Lifestyle Drugs Insulin Needles & Syringes Glucose Test Strips/Lancets Prenatal Vitamins Oral Fertility Drugs Insulin Generic Push Formulary Prescriber Panel Description Option 2 - Low (POS) Inpatient Per Day Copay Inpatient Max Number of Days MH/SA Combined MH Outpatient Copay 1 to 20 Visits MH Outpatient Max Number of Visits Outpatient SA visits 1-2 Copay Outpatient SA visits 3-20 Copay SA Outpatient Max Number of Visits Group Therapy Outpatient Copay Group Therapy MH/SA Combined Maximum Visits MH/SA OON Buy -up Option None In Network S10 S20 S40 S20 S40 S80 SO SO NA NA Covered Covered Not Covered Covered Covered Covered Not Covered Covered Included Incentive Open In Network S100 8 S40 20 S15 S40 20 $20 40 Out of Network Excluded 1-102ITX31-SIF-1 Revisionl City of Pearland 4of13 08/12/04 CIGNA HealthCare Proposed Medical Rates HMO Code : - • OSOA VTier Inforce Current Renewal Monthly Change% Subscribers Members Rate Rate Premium $324.39 $64,554 0.00 Employee 199 199 $324.39 Emp + Spouse 16 32 $681.19 $681.19 $10,899 0.00 + 70 204 $583.88 $583.88 $40,872 0.00 Emp Child(ren) 26 $908.26 $34,514 0.00 Emp + Family 38 154 $908 Total 323 589 $150,838 1-102ITX31-SIF-1 Revisionl City of Pearland 5 of 13 08/12/04 CIGNA HealthCare Proposed Benefits Product: CIGNA HealthCare PPO Situs State: TX Effective Date: Benefits Summary Category Description Medical Benefits Inpatient Coinsurance Outpatient Coinsurance PCP Copay Hospital IP Deductible - Per Day Hospital IP Deductible - Per Admit Out of Pocket Maximum - Individual Out of Pocket Maximum - Family Emergency Room Deductible MRI, CT PET Scans Copay Plan Deductible - Individual Plan Deductible - Family Lifetime Maximum DME Chiro Non -Surgical TMJ EPA PCL Infertility 24 HIL Extended Preventive Care Transition of Care 10/0 1/2004 In Network 80% 80% $20 NA NA $3,000 $6,000 $100 $0 $300 $600 $1,000,000 Included Excluded Included Excluded Included Excluded Included Included Excluded Out of Network 60% 60% NA NA $6,000 $12,000 $100 $0 $600 $1,200 1-102ITX3 1-SIF- 1 Revisionl City of Pearland 6of13 08/12/04 CIGNA HealthCare Proposed Benefits Product: CIGNA HealthCare PPO - Situs State: TX Effective Date: 10/01/2004 Benefits Summary (Cont.) Category Description Pharmacy Benefits MH/SA Benefits RxPRIME Three -Tier Copay (PPO) Pharmacy Coinsurance Copay - Generic Copay - Brand Non -Preferred Copay Mail Order - Generic Copay Mail Order - Brand Copay Mail Order Copay - Non -preferred Drug Deductible Network Match % Oral Contraceptives Contraceptive Devices Insulin Needles & Syringes Glucose Test Strips/Lancets Prenatal Vitamins Vitamins Smoking Cessation Injectable Drugs Oral Fertility Drugs Insulin No Mandatory Genene Mandatory Generic MD Dispense as Written Generic Push Formulary {Mental Health - Alcohol & Drug Abuse} Inpatient Coinsurance Outpatient Coinsurance Outpatient Copay Inpatient Deductible - Per Admit Inpatient Deductible - Per Day Inpatient Cal Year Max Days Inpatient Lifetime Max Days Outpatient Cal Year Max Days Outpatient Lifetime Max Days Vision Benefits None In Network $10 $20 $40 $20 $40 $80 NA 95% Covered Covered Covered Covered Covered Not Covered Not Covered Not Covered Covered Covered Included Excluded Excluded Excluded Open 80% NA $25 NA NA 30 NA 60 NA Out of Network 50% NA NA NA NA NA Open 60% 50% NA NA 30 NA 60 NA 1-102ITX31-SIF-1 Revisionl City of Pearland 7of13 08/12/04 CIGNA H ealthCare Proposed Medical and RX rates Group Description : PPO Outlier (EE's out of the OA POS network) Inforce Renewal Monthly Premium Change g Total Rate Current Total Rate Tier Subs Mem Employee 0 0 $450.46 $450.46 $0.00 0.00 Emp + Spouse 0 0 $945.98 $945.98 $0.00 0.00 Emp + Child(ren) 0 0 $810.84 $810.84 $0.00 0.00 Emp + Family 0 0 $1,261.31 $1,261.31 $0.00 0.00 Total 0 0 $0.00 Group Description : Medicare COB Inforce Renewal Monthly Premium Change o g /o Total Rate Current Total Rate Tier Subs Mem Employee 1 1 $439.02 $439.02 $439 0.00 Emp + Spouse 0 0 $921.95 $921.95 $0.00 0.00 Emp + Child(ren) 0 0 $790 24 $790.24 $0.00 0.00 Emp + Family 0 0 $1,229.27 $1,229 27 $0.00 0.00 Total 1 1 $439 1-102ITX31-SIF-1 Revisionl City of Pearland 8 of 13 08/12/04 CIG-N-AI-HealthCare Medical History Information For City of Pearland Houston 1. Have there been any claims over $10,000 in the last 12 months? last 2. Has any 12 months employee due to illness missed mjury? than 10 consecutive days in the more or 3. Are there any employees with ongoing disabilities? 4. currently the Conditions, Diseases, Have past three any receivmg Lung individuals Immune years: Conditions, treatment Alcohol/Drug System been diagnosed for abuse of Organ the received Cancer, Kidney following Transplants? Ailments, treatment, Diabetes, conditions Liver Heart or are in Obesity, any Disorders, No known medical conditions exist • 1-102ITX31-SIF-1 Revision 1 City of Pearland 9 of 13 08/12/04 CIGNA Hea1thCare 1-1O2ITX31-SIF-1 Revisionl City of Pearland 10 of 13 08/12/04 CIGNA HealthCare Underwriting Contingencies For City of Pearland *The rates are guaranteed for a period of 12 months while the contract remains in force. *The employer contributes at least 50% toward the total cost of the plan. *No seasonal employees are covered under this plan. *The current waiting period is Date of Hire. *This quote assumes all employees are located in the network area, and that all employees are only eligible for the product offerings specified. *The CIGNA HealthCare Companies retain the right to modify the rates and benefits set forth in this quotation, or to decline to offer coverage if any of the information upon which these rates or benefits was based changes or is not accurate. *If any information set forth in this form changes at any time while coverage is provided to you by CIGNA HealthCare Companies, you must notify us within 30 days of these changes. *There is a minimum participation of 50% required. This will be based on the total eligible employees, identified as employees. *If a decision is not reached within 60 days from the date the rates and/or fees set forth herein are received, then Connecticut General Life Insurance Company and its affiliated companies and entities (collectively, "CIGNA") reserves the right to revise said rates and/or fees. *If enrollment increases or decreases by 15% or more from the enrollment assumptions used in establishing the rates and/or fees set forth herein, CIGNA reserves the right to revise said rates and/or fees. *Connecticut General may cancel the policy as of any Premium Due Date if the number of insured Employees fails to meet the minimum required per group participation rules or for failure to comply with any other material plan provision relating to Employer contributions or group participation rules. *No Medicare eligible retirees are covered under this plan. *Medical History Information is accurate to the best of your knowledge *State law may require regulatory approval of rates. If, as of their proposed effective date, regulatory approval is not obtained, the healthplan shall use rates consistent with its then currently approved rates and the foregoing rates shall be effective automatically upon approval. 1-102ITX31-SIF-1 Revisionl City of Pearland 11 of 13 08/12/04 CIGNA HealthCare Underwriting Contingencies For City of Pearland (cont.) *Out of Network benefit maximums are reduced by In -Network utilization. *Urgent Care is subject to plan deductible and coinsurance if member is out of area. *Emergencies are always covered In -Network provided that the situation meets CIGNA HealthCare's standard definition of an Emergency. *All covered Out -of -Network services are subject to plan deductible and coinsurance. *Blended rates apply to current sites only. New members added to the existing sites during the year are covered under the existing blended rate *Any new sites added during the year, regardless of membership size, must be priced and quoted by Underwriting according to the site specific demographics *CIGNA HealthCare reserves the right to re -blend the quoted rates, if one or more of the quoted sites A) Withdraws prior to the effective date of the account or B) Cancels during the policy year. *CIGNA HealthCare Companies reserve the right to adjust the quoted rate(s) including blended rate(s) if: A) One or more of the quoted sites withdraws prior to the effective date or terminates during the contract term, or B) At any time following enrollment the distribution of covered participants by site would cause the blended rate(s) to vary by 5% or more. *CIGNA HealthCare is the exclusive provider of healthcare coverage to your employees. 1-102ITX31-SIF-1 Revisionl City of Pearland 12 of 13 08/12/04 CIGNA H ea1t Care Underwriting Contingencies For City of Pearland (cont.) The CIGNA HealthCare Companies reserve the right to change the Quoted Rates and/or Quoted Benefits or to decline to offer coverage if any of the foregoing information is inaccurate or changes prior to the proposed Effective Date indicated above, or if the quoted rates and/or fees are not agreed to within 60 days of receipt of this summary information form. If any of the information identified above changes either prior to the proposed Effective Date or while coverage is in effect, you agree to notify us promptly of such change. The "Underwriting Contingencies" set forth above shall survive execution of any insurance policy, application, etc., issued by Connecticut General Life Insurance Company or any other CIGNA HealthCare company, and shall further survive the effective date of any such policies. The benefits displayed in this summary are, for the most part, modular benefit packages used to develop the rates. Please review the Benefit Summary and its attachments for information about the benefits available in your sites. "CIGNA Healthcare ' refers to various operating subsidiaries of CIGNA Corporation. Products and services are provided by these subsidiaries and not by CIGNA Corporation. These subsidiaries include Connecticut General Life Insurance Company, Tel -Drug, Inc. and its affiliates CIGNA Behavioral Health, Inc. Intracorp, and HMO or service company subsidiaries of CIGNA Health Corporation and CIGNA Dental Health, Inc. Client Signature Bill Eisen 8/23/04 Date City Manager Client Name Title 1-1O2ITX31-SIF-1 Revisionl City of Pearland 13 of 13 08/12/04 Exhibit "B" Resolution No R2004 134 ASSURANT Employee Benefits Ms. Yesenia Garza City of Pearland 3519 Liberty Dr. Pearland, TX 77581 Group ID #: I744 Dear Mr. Garza: July 13, 2004 Thank you for making Assurant Employee Benefits, formerly Fortis Beneftis Insurance Company, an integral part of your overall benefits program. We hope that you have been pleased with your dental plan. October 1, 2004 is the renewal date for your dental beneftis with Fortis Benefits Insurance Company. As you may be aware, inflation experienced in the dental industry and other facotrs necessitate periodic reviews of rates. Our goal is to hold these rates at levels that are reasonable and adequate to fund your level of benefits .while providing the best possible service. We are pleased to announce that the renewal rating for your group will be unchanged effective October 1, 2004: INDEMNITY PLAN (Premier F4): Employee Employee/Spouse Employee/Children Employee/Family Current $27.81 $49.83 $64.55 $86.57 Renewal $27.81 $49.83 $64.55 $86.57 We appreciate the confidence you have placed in Assurant Employee Benefits and we remain committed to providing the highest quality dental coverage and the best customer service available. We art The Benefits Solutions People! Please contact me if you need to request enrollment materials or for questions regarding the renewal process at - 713-780-1111 ext. 7114 tan ' a DePrato Renewal Manager 10375 Richmond Avenue Ste 1675 Houston, TX 77042 713-780-1111/713-780-2121