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R2005-0131 08-22-05 RESOLUTION NO. R2005-131 A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF PEARLAND, TEXAS, APPROVING HEALTH INSURANCE RENEWAL RATES FOR CIGNA HEAL THCARE. BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF PEARLAND, TEXAS: Section 1. That the City received renewal rates, attached hereto as Exhibit "A", for health insurance benefits from Cigna HealthCare and such rates have been evaluated. Section 2. That the City Council hereby adopts the renewal rates for health insurance benefits in the amount described in exhibit "A", attached hereto and incorporated for all purposes. PASSED, APPROVED and ADOPTED this the 22nd day of AUCjust A.D., 2005. ~~-~ TOM REID MAYOR ATTEST: ~~ APPROVED AS TO FORM: (J4-' 1(. ()!- DARRIN M. COKER CITY ATTORNEY II CIGNA HealthCare Proposed Benefits Product: CIGNA HealthCare POS Open Access Situs State: TX Effective Date: 1 % 1/2005 Benefits Summary Category Description Medical Benefits Modular Medical Management Program Benefit Option Coinsurance PCP Office Visit Copay Specialist Office Visit Copay HospitallP - Per Admit Copay HospitallP Deductible - Per Admit Hospital IP Copay Per Day Hospital IP Deductible - Per Day Hospital IP - Number of Co pays 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 l-IRG23UII-SIF-l Revisionl City of Pearland 2 of 12 In Network PHS+ $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 20 NA NA 07/15/05 Out of Network 50% NA NA NA $600 $1,200 $6,000 $12,000 $1,000,000 NA $0 60 40 NA NA NA .. CIGNA HealthCare Proposed Benefits Product: CIGNA HealthCare POS Open Access Situs State: TX Effective Date: 1 % 1/2005 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 l-IRG23Ull-SIF-l Revisionl City of Pearland 3 of 12 In Network NA $75 Excluded Option I Excluded NA Excluded Included Included Included Included Included Included Included Included Included Included Included Included Excluded Out of Network $0 Excluded 07/15/05 .. CIGNA HealthCare Proposed Benefits Product: CIGNA HealthCare POS Open Access Situs State: TX Effective Date: 1 % 1/2005 Benefits Summary (Cont.) Category Description Pharmacy Benefits $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 MH/SA Benefits Option 2 - Low (POS) Inpatient Per Day Copay Inpatient Max Number of Days MH/SA Combined MH Outpatient Copay I 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 Vision Benefits None l-lRG23UII-SIF-l Revisionl City of Pearl and 4 of 12 In Network $10 $20 $40 $20 $40 $80 $0 $0 NA NA Covered Covered Not Covered Covered Covered Covered Not Covered Covered Included Incentive Open In Network $100 8 $40 20 $15 $40 20 $20 40 Out of Network Excluded 07/15/05 II CIGNA HealthCare Proposed Medical Rates HMO Code: - Site In : Grouo DescriotIon : PO A Tier Inforce Current Renewal Monthly Change% Subscribers Members Rate Rate Premium Employee 209 209 $324.39 $324.39 $67,798 0.00 Emp + Spouse 26 52 $681.19 $681.19 $17,711 0.00 Emp+ 75 224 $583.88 $583.88 $43,791 0.00 Child(ren) Emp + Family 33 133 $908.26 $908.26 $29,973 0.00 Total 343 618 $159,272 SO l-IRG23UII-SIF-l Revisionl City of Pearland 5 of 12 07/15/05 II CIGNA HealthCare Proposed Benefits Product: CIGNA HealthCare PPO Situs State: TX Effective Date: 1 % 1/2005 Benefits Summary Category Description In Network Medical Benefits Inpatient Coinsurance Outpatient Coinsurance PCP Copay HospitallP Deductible - Per Day HospitallP 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 24HIL Extended Preventive Care Transition of Care 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 l-IRG23Ull-SIF-l Revisionl City of Pearl and 6 of 12 07/15/05 Out of Network 60% 60% $100 NA $6,000 $12,000 $25 $0 $600 $1,200 II CIGNA HealthCare Proposed Benefits Product: CIGNA HealthCare PPO Situs State: TX Effective Date: 1 % 1/2005 Benefits Summary (Cont.) Category Description In Network Pharmacy 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 Generic Mandatory Generic MD Dispense as Written Generic Push Formulary $10 $20 $40 $20 $40 $80 NA 95% Covered Covered Covered Covered Covered Not Covered Not Covered Not Covered Not Covered Covered Excluded Excluded Excluded Excluded Open MWSA Benefits {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 90% NA $25 NA NA 30 NA 60 NA Vision Benefits None l-IRG23UII-SIF-l Revisionl City of Pearland 7 of 12 07/15/05 Out of Network 40% NA NA NA $100 NA Open 70% 50% NA NA 30 NA 60 NA II CIGNA HealthCare Proposed Medical and RX rates Site: Group Description: PPO Outlier Inforce Total Total Monthly Tier Current Renewal Change % Subs Mem Rate Rate Premium Employee 1 1 $439.02 $439.02 $439 0.00 Emp + Spouse 0 0 $921.95 $921.95 $0 0.00 Emp + Child(ren) 0 0 $790.24 $790.24 $0 0.00 Emp + Family 0 0 $1,229.27 $1,229.27 $0 0.00 Total 1 1 $439 l-lRG23Ull-SIF-l Revisionl City of Pearland 8 of 12 07/15/05 II CIGNA HealthCare Medical History Information For City of Pearland Houston 1. Have there been any claims over $10,000 in the last 12 months? 2. Has any employee missed more than 10 consecutive days in the last 12 months due to illness or injury? 3. Are there an em 10 ees with on oin disabilities? 4. Have any individuals been diagnosed, received treatment, or are currently receiving treatment for any of the following conditions in the past three years: Alcohol/Drug abuse, Cancer, Diabetes, Heart Conditions, Immune System Disorders, Kidney Ailments, Liver Diseases, Lung Conditions, Obesity, Organ Transplants? No known medical conditions exist l-lRG23Ull-SIF-l Revisionl City of Pearl and 9 of 12 07/15/05 II 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 30 days. *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. l-IRG23Ull-SIF-l Revisionl City of Pearl and 10 of 12 07/15/05 II 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. 1-lRG23U11-SIF-1 Revision1 City of Pearl and 11 of12 07/15/05 II CIGNA HealthCare Underwriting Contingencies For City of Pear/and (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 Date Client Name Title l-IRG23UII-SIF-l Revisionl City of Pearl and 12 of 12 07/15/05 July 21, 2005 ~..,/ ...~tt:J.. "~ "'("(.7ttDAN~T /""\ .);. ..... V ! '-. ,,-,\ I ': I' City of Pearl and Attn: Yesenia Garza 3519 Liberty Drive Pearland, TX 77581 GROUP In: 1744 Dear Benefits Administrator: Thank you for making Fortis Benefits Insurance Company an integral part of your overall benefits program, We hope that you have been pleased with your dental benefit plan, October 1, 2005 is the renewal date for your dental benefits with Fortis Benefits Insurance Company, As you may be aware, inflation experienced in the dental industry and other factors 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. The renewal rating for your group has been completed and your new rates effective October 1, 2005 are: Premier Tier Structure Employee Only Employee & Spouse Employee & Child(ren) Employee & Family Current Rates Tier Structure Employee Only Employee & Spouse Employee & Child(ren) Employee & Family Renewal Rates $27.81 $49.83 $64.55 $86.57 $27.81 $49.83 $64.55 $86.57 Fortis Benefits appreciates your business and is committed to providing you with the highest quality, affordable dental coverage available. We are The Benefits Solutions PeoplesM! Please contact me if you need to request enrollment materials or for questions regarding the renewal process at 713-830-3609. Sincer~ly, Indel1lnityGeneric--no VSP-Group.doc Prudential i$ Financial Suzanne L. Potter Account Manager Group Insurance The Prudential IMuraoce Company of America 8117 Preston Road Suite 600 Dallas. Texas 75225 Phone: (214) 750-5067 Fax: (214) 750-5080 Email: suzanne.poner@prudential.com July 29, 2005 James Cole 23 L 9 Frances Pearland, TX 77581 Houston Hamilton 9707 Spring vieW T.N Houston, TX 77080 RE: Renewal Group Life Control Number: 40754 Policyholder Name: City of Pearl and Dear James/llouston: On behalf of Prudential, I would like to thank you for the opportunity to provide coverage over the recent policy period_ As is customary this time of year, we have reviewed the rating and plan design for City of Pcarland's program with Prudential. The review was done witb a focu.<l on any changes becoming effccti VI; October 1, 2005. The renewal evaluation has been completed and effective October 1, 2005, the following current contract renewal rates will apply. COV~~ Life AD&D Current Rate $0.147 per $1000 $O.033/per $1000 Renewal Rate $0.147 per $1000 SO.033 per $1000 Action Continue Continue The basic life rate will continue at 0.147 per $1000, as of the effective renewal date. AD&D, Optional Life and Dependent Life rates will be continued. A two year rate guarantee will also apply to all inforce life coverages thru October 1, 2007. We appreciate the opportunity to provide Life coverage to City of Pearl and and we look forward to continuing to work with you to meet our client's benefit needs. Please feel free to contact me with any questions you may have regarding the renewal. For any service related questions, please contact your Account Consultant at 1-888-598-5671. Sincerely, SUZ4ftftB L. a>otur Suzanne 1. Potter Account Manager CC: Client Operations Service Center I e6lld 00000-000-000 f~:LO VOOZ'61 d~S