The URL can be used to link to this page

3.07 3.7 INSURANCE 1 Empire Blue Cross Renewal Contracts 2016-2017- 6-6-16 RESOLUTION AUTHORIZING RENEWAL CONTRACTS FOR EMPLOYEE GROUP HEALTH INSURANCE PLANS WITH EMPIRE BLUE CROSS BLUE SHIELD EFFECTIVE FROM JULY 1ST, 2016-JUNE 30TH, 2017 RESOLUTION NO. ,2016 INTRODUCED BY: WHO MOVED FOR ITS ADOPTION SECONDED BY: WHEREAS, the Town of Queensbury previously entered into agreements for employee group health insurance plans with Empire Blue Cross Blue Shield,and WHEREAS, the Town Board, in conjunction with Capital Financial Group, has negotiated renewal contracts for July I51, 2016 through June 30th, 2017 with Empire Blue Cross Blue Shield, NOW,THEREFORE,BE IT RESOLVED, that the Queensbury Town Board hereby approves and authorizes renewal contracts for July 1st, 2016 through June 30th, 2017 with Empire Blue Cross Blue Shield with the monthly premiums to be as follows: INDIVIDUAL TWO PERSON FAMILY PPO 832.06 2430.73 2430.73 EPO 766.74 2239.89 2239.89 and BE IT FURTHER, RESOLVED, that in the event that surcharges or fees are mandated or imposed on the Town's health insurance policies that are beyond the Town's control, resulting rate changes may be passed on to all employees without further Town Board Resolution, although the Town will provide notice of any such rate changes to all employees and retirees, and BE IT FURTHER, RESOLVED, that the Town Board further authorizes and directs the Town Supervisor to execute any contracts and documentation and the Town Supervisor and/or Town Budget Officer to take such other and further action necessary to effectuate the terms of this Resolution. Duly adopted this 6th day of June,2016,by the following vote: AYES . NOES : ABSENT: EmpiBLre s Sawn prddedbyEnvie Hu Chow Ma,.a by_kenos at eve aaa anti¢1n Shield AtiOtiltal.netud.en el'tweed Ms am anti ebe shied pane ` ' " -:f FRENEWALQUOTESUMMARVta .� r- '�. 4S �'0:41154: 11154:17341.; : 54111 " :'E;.- . wr r r 5 ; Group Name: TOWN OF QUEENSBURY Group Number. 980880 Contract Period: July 01,2016-June 30,2017 Funding Arrangement Prospective Broker Name: JOHN WEBER Brokerage Name: CAPITAL FINANCIAL GROUP,INC. Sales Representative Name: JUDITH MOORE-KELMAN aiotimaSontJ"tiilibe "a' x o:• ortum'f e ;r.`_yo-e z Fa4G". : . .,• gs-,I;Irang .: 1 • 006d000000YFOFk Non Grandfathered pnderwriting Approved Prospect ID: 710691 Scenario ID: 831085 Rating ID: 5899322 QD040716 fp - -RPO Subdlviston 7i�sss` ,+".* - - ' :,ZM a :.1;.), 4 ; �trte t ' Y`tt` r �rM: � %1 *"`a;Ieh ORTY.P. Yc i 13;f7,-.."iY4ik 5'y` Lr9 3 `x r - rWS Iecttotem .r, -an' r '.. In Network Coinsurance 100% Deductible• $0 Medical Out Of Pocket Maximum* $5,080 Out of Network Coinsurance 80% Deductible• $200 Medical Out Of Pocket Maximum' $1,200 'fait)Coverage Is 2.5 mes the te&Mdua=maps amount unless noted(serene/. ,lr� �1� JL �iOvEfi( _�bt Y �`r S.,avy }-: . r Pi-1 d c:�1�FF mi 4anM in� d""�A;yrf y a'?sY r�..,__ :a.. :? .�.+. x`f 4-31 I „�.'` _,-2rT`-;. T o. a'�-5.te r-g w. Benefit Accumulation Calendar Year Calendar Year Prescription Drugs National Drug List In Network Only Deductible$0 In Network Only $10/$25/$50 Tier 1/Tier 2/Tier 3 In Network Only Combined Medical and Drug OOP Max In Network Only Without Preferred Generic In Network Only Mail Order Copay Equals 2.0 times Retail Copay In Network Only Oral Contraceptives 100%for Generic/Single-Source Brand;Multi-Source In Network Only Brand Subj to Rx Cost Share Contraceptive Devices and Female StenTization 100%Covered Deductible&Coinsurance Abortion and Male Sterilization Covered Covered Skilled Nursing Facility 120 Days Not Covered Inpatient Physical Therapy 30 Days Combined with In Network Outpatient Physical Therapy 30 Visits Nat Covered Outpatient Sp/Occ Therapies 30 Visits Not Covered Cardiac Therapy Unlimited Unlimited Out of Network Hospice Not Applicable Not Covered Out of Network Wellness Physical Coverage Not Applicable Not Covered Out of Network Prosthetics Not Applicable Not Covered Out of Network DME Not Applicable Not Covered Out of Network Orthotics Not Applicable Not Covered Out of Network Home Infusion Therapy Not Applicable Not Covered Hearing Aid Not Covered Not Covered Vision Care Priced Separately Priced Separately Precertification Penalty $5,000 In and Out of Network Combined Maximum $5,000 In and Out of Network Combined Maximum Page 1 EmpiBLre s Sagas aeM.dWaro..a Mm a /mr e.Maumee@Me we Ma old Bin 9aaAvodrton,e,=SO=el:kecnamlae.Crass end Ma Shield pin. f. ,4-.,. ..,'; ..'?:', . 1 .,ain uuf'F1c; .:hrt x�ti- r,�e�"-`fi .$,Na:;. 4 :,.;.a«ri.r;=:. Group Name: TOWN OF QUEENSBURY Group Number. 990880 Contract Period: July 01,2016-June 30,2017 Funding Arrangement Prospective Broker Name: JOHN WEBER Brokerage Name: CAPITAL FINANCIAL GROUP,INC. Sales Representative Name: JUDITH MOORE-KELMAN ,q3 7_ o agmei *+K9c',.. .fie","'.. ':u etn..aTi`A"t ` }` • i. . r. l • i ii •= '�> t� 'ilse` o . .O[fll(',11 4. o_.rt°'�n?��"'a',.'%iE1�'.�wsti""„ ,. ::�: :- � 4;*--2,,.:.:.�'.. ��'� - -i:�. :��,� 1 006d000000YFOFk Non Grandfathered Underwriting Approved Prospect ID: 710691 Scenario ID: 831085 Rating ID: 5899322 QD040716 ..; 5 ., ' - . i .i'l '. . ::`;k' , µA' c Subdivision 14'h `.' yr'... ':s'` '4't t•r'012.4...'9,.iCT.1-i,.24Q:sv. -u 'irx-r ` ..,r c 4 ageaait 'att zj e.P rt j-; ,; 'fl rt: ii" 'O64;,nett_3I ... -_ +:�.-' 3 PCP/Specialist Copay/Cost share $20 Deductible and Coinsurance Emergency Room Copay/Cost share $35 $35 Preventive Care Copay $0 Deductible and Coinsurance Inpatient Copay/Cost share $500 Per Admission Deductible and Coinsurance Out Of Network Reimbursement Not Applicable 360%of National Medicare Deductible Carryover/Credit Not Covered Not Covered Domestic Partner Coverage Not Covered Not Covered In VW)Fertilization Not Covered Not Covered Dependent Coverage Age 26 End Of Month Age 26 End Of Month Gym Reimbursement $200/Year-No Minimum Visits Required $200Near-No Minimum Visits Required Healthy Lifestyles Online Online 21, Oixlsr *:iiCi'.Rate$uRlrllanrtgyn'k Tii(WAIU'y:'°5" --} '. "v .�s 155 • '` fir- ) -.. s c r .J x �, 34. t1 . *�? - it- Non-Medicare- `AT + `C ' -"` ) k - _ �'+HMedicafe -r ; z„:"..;-4.41.47,- . ,a t lat z n lndrvigtda!'6>:.. 'C,.1,” ?.P w ..Xa„r elfert t r l dilala.I 1. AWIRS"IS^�.-.sa«' Enrollment 0 1 0 0 0 0 Current Rates $793.19 $2,317.19 $2,317.19 $549.94 $1,296.29 $2,042.63 Renewal Rates Before Fees $816.45 $2,386.18 $2,383.98 $566.85 $1,336.15 $2,105.44 ACA Insurer Fee $14.48 $42.29 $42.29 $10.04 $23.66 $37.28 ACA Reinsurance Fee $1.13 $2.26 $4.46 $0.00 $0.00 $0.00 Renewal Rates $832.06 $2,430.73 $2,430.73 $576.89 $1,359.81 $2,142.72 Rate Action I4.90% Broker Commission Rate:$14.61 PCPM The rates assume that there is not a separate plan in place to fund all or part of the employee cost sharing. The broker and for employer must disclose to Empire, prior to the Implementation, any and all sources of funding for employee cost share. Since our pricing does not incorporate the funding of any of the employee cost sharing,should such a plan be offered the Empire rates will be reviewed and may be revised,or the Empire plan may be withdrawn. Under the Patient Protection and Affordable Care Act (PPACA or health care reform law), fully insured group health plans may not have rules/criteria for member eligibility or benefits that have the effect of discriminating in favor of highly compensated employees, for non-grandfathered insured plans. It is the employers responsibility to ensure compliance with this requirement of the health care reform law. Page 2 • Emi • Sminsperbedgegae HneNOcee *spr k BLUECROSSensee dtsanooa IndDa aueldAad,bon a'mwdaand'MeinndeeteleCrass mdiln eiagmc l - x 1 RENEWAL,QUOTESUMMARY`� €;. ErF .41.- key l'!at t ; Group Name: TOWN OF OUEENSBURY Group Number. 990880 Contract Period: July 01,2016-June 30,2017 Funding Arrangement Prospective Broker Name: JOHN WEBER Brokerage Name: CAPITAL FINANCIAL GROUP,INC. Sales Re•resentative Name: JUDITH MOO.RE-KE.LMAN • � o„nOCi ; 7s.:t "T;p .im • m r . ayrte 1 006d000000YFOFk Nan Grandfathered ndenvriting Approved Prospect ID: 710691 Scenario ID: 831085 Rating ID: 5899322 00040716 The health benefit plan(s) reflected in this quote is not considered to be grandfathered under the provisions of the Patient Protection and Affordable Care Act. Non-grandfathered plans are subject to additional provisions under the Patent Protection and Affordable Care Act that do not apply to grandfathered plans.For further Information,please contact your account representative. The benefits and rates reflected in this quotation have been adjusted to comply with changes required by the Affordable Care Act. If not yet approved by the NY Department of Financial Services,these benefits and rates might need to be adjusted. National Drug List - Open drug list includes brand-name and generic drugs, reviewed and recommended for their quality and for how well they work. For more detailed information please contact your Account Representative(or refer to your Evidence of Coverage for renewing business). Disclaimers See attached disclaimer page(s). 12 ate • Signature Section;Revtewed'and Accepted on-behalf of the;,Group by>r ''? sxy - - bs` >i "A'`'LL`°? Print Name: Title: Signature: Date: Page 3 Empires17469• Sa*nrvMed bycsgexelmueb,3wz tec,t ee dr.Eke Coe sul B/J•ShkkiAssortakin,en ascaoLbndtdepededaue Gpaand®a edeupea r RENEWAL QUOTE SUMMARYt.-- '` 4r x's{�a. y/,ra �" ,�'' r3 sin z.:n;ri-4:. - _ Group Name: TOWN OF QUEENSBURY Group Number. 990880 Contract Period: July 01,2016-June 30,2017 Funding Arrangement Prospective Broker Name: JOHN WEBER Brokerage Name: CAPITAL FINANCIAL GROUP,INC. Sales Representative Name: JUDITH MOORE-KELMAN o 3 ^ s 4K 1•I'Tlrltei i, .;.` :.�- 'k"�'..=` �+'[ .i6U 1 AID_: i'G!_ -,, �.r, 5111,-r `�A' ' ..%, . VFk �£`e 1 006d000000YFOFk Non Grandfathered Underwriting Approved Prospect ID: 710691 Scenario ID: 831065 Rating ID: 5899323 QD040716 _. " a't rb.iet.Y.P. TYP ss ' a�g -�.1J .. SSL � .,c: - PUuSi a'' ��,-P;. electt'S`- In Network Coinsurance 100% Deductible• $0 Medical Out Of Pocket Maximum' $5,060 'Fan Coverage Is 2.5 tars the fr thialacreage mount Men noted(Mandy. Benefit Accumulation Calendar Year Prescription Drugs Deductible$0 $10/$251$50 Generic/Brand/Non-Formulary Combined Medical and Drug OOP Max Without Preferred Generic Oral Contraceptives 100%for Generic/Single-Source Brand;Multi-Source Brand Subj to Rx Cost Share Contraceptive Devices and Female Sterilization 100%Covered Abortion and Male Sterilization Covered Slated Nursing Facility 120 Days Inpatient Physical Therapy 30 Days Outpatient Physical Therapy 30 Visits Outpatient Sp/Occ Therapies 30 Visits Vision Care Priced Separately Precertification Penalty $5,000 PCP/Specialist Copay/Cost share $20 Emergency Room Copay/Cost share $35 Preventive Care Copay $0 Inpatient Copay/Cost share $500 Per Admission Deductible Carryover/Credit Not Covered Domestic Partner Coverage Not Covered In Vitro Fertilization Not Covered Dependent Coverage Age 26 End Of Month Gym Reimbursement $200Near-No Minimum Visits Required Healthy Lifestyles Online Hearing aide coverage every 3 years. Page 4 Empire BLUECROSS Smites eaeeedlyEny:e Kat/Choke Amznc%ll mos Was oovek ebaueaAmd.5e m node=olbeeymantate oanad Wa 4:u pini + i X; x 1'" RENEWAL oUOTE$UMAR�gfre4. r° ' stit: Z r s. r .Thi:. F. , a ; . - ur � . r _ Group Name: TOWN OF QUEENSBURY Group Number. 990880 Contract Period: July 01,2016-June 30,2017 Funding Arrangement Prospective Broker Name: JOHN WEBER Brokerage Name: CAPITAL FINANCIAL GROUP,INC. • Sales Re.resentatrvW�;�ea^^Name: JUDITH MOORE-KELMAN -alefaiM e:;OpfXX�ltll . Okd �ia'.t rca u:J f' e'rl ,.PA.'Ate' n sal? , .!--;.s:','��'1-ta 1 006d000000YFOFk Non Grandfathered Underwriting Approved Prospect ID: 710891 Scenario ID: 831085 Rating ID: 5899323 OD040716 r - + ( s S`t R-T4: PIY , Rate Sumrbary``r tZ.raa ri..eW _ ,S r T t. 'e~e r k . z �- ' , Non-Medicare �� t+i , f -.�3„ 'C iii , 5 `:Medicare "`«Y :sg r - tx, Nd. : � xw-yip. ra,g=t'"'' Wei n t1 a ria 4?ti , --ut "T c. miry' - r. I lfliI�. #><' ., '-- T§..' Inds®ss"�„'. ...q.,, .:!z . Q - `f -;w... _ _ ter: 45 60 1 0 1 Current Rates $730.92 . $2,135.26 $2,135.26 $506.53 $1,193.95 $1,881.38 Renewal Rates Before Fees $752.27 $2,198.66 $2,196.64 $522.10 $1,230.66 $1,939.23 ACA Insurer Fee $13.34 $38.97 $36.97 $9.25 $21.79 $34.34 ACA Reinsurance Fee $1.13 $2.26 $4.28 $0.00 $0.00 $0.00 Renewal Rates $766.74 $2,239.89 $2,239.89 $531.35 $1,252.45 $1,973.57 Rate Action 4.90% Broker Commission Rate:$21.66 PCPM The rates assume that there is not a separate plan In place to fund all or part of the employee cost sharing. The broker and or employer must disclose to Empire, prior to the Implementation, any and all sources of funding for employee cost share. Since our pricing does not incorporate the funding of any of the employee cost sharing,should such a plan be offered the Empire rates will be reviewed and may be revised,or the Empire plan may be withdrawn. Under the Patient Protection and Affordable Care Act (PPACA or health care reform law), fully Insured group health plans may not have rules/criteria for member eligibility or benefits that have the effect of discriminating in favor of highly compensated employees, for non-grandfathered insured plans. It is the employer's responsibility to ensure compliance with this requirement of the health care reform law. The health benefit plan(s) reflected in this quote is not considered to be grandfathered under the provisions of the Patient Protection and Affordable Care Act. Non-grandfathered plans are subject to additional provisions under the Patient Protection and Affordable Care Act that do not apply to grandfathered plans.For further information,please contact your account representative. The benefits and rates reflected In this quotation have been adjusted to comply with changes required by the Affordable Care Act. If not yet approved by the NY Department of Financial Services,these benefits and rates might need to be adjusted. Disclaimers See attached disclaimer page(s). i':;..-...1 Signature Section Reviewed and Acce ted on-behalf of the Group by '.,-+ t. ' ` K ,_ '-+V-'f L t. -:>' ., •-.:. , .. .'.': - u x.r: .. aP ,�� ..�.- ,_i �ir, . .a : .i.-. - ntX`l 414 t..f't.. \F• .. i.r.:.. Print Name: Title: Signature: Date: Page 5 CD020816AD040716 TOWN OF OUEENSBURY_710691 990880_comboOlJlY201_Customer Exhibits 04.07-16_R Non-HMO Disclaimers TOWN OF QUEENSBURY Group Number.990880 Contract Period:July 01,2016-June 30,2017 Funding Arrangement:Prospective Combination Number: 1 Opportunity ID:006d000000YFOFk Prospect ID: 710691 Scenario ID: 831085 •A change in the contract period will require a recalculation of rates. •In addition to the applicable commissions paid to the broker (including a general agent or consultant) on the business sold, the broker may receive payments from Empire or may participate in non-cash award programs, under one or more broker compensation programs (inclusive of overrides, incentive or bonus programs) that may have been based on aggregate sales, business quality, or persistency. Except to the extent that they contributed to Empire's general administrative charges, such broker compensation programs are not charged specifically to an individual customer's account. You can obtain additional information regarding Empire's large group commission rate schedules and its broker compensation programs by visiting www.empireblue.com or by contacting your Empire representative. ▪Your Empire sales associate is a licensed insurance agent and is an employee of the EHC Benefits Agency, Inc. and a representative of Empire HealthChoice Assurance, Inc. and Empire HealthChoice HMO, Inc. ( collectively 'Empire'). In addition to a salary, this sales associate participates in a sales incentive plan (SIP) and may receive additional compensation from Empire based upon considerations such as total number of successful sales, and for servicing policyholders and brokers. If you want additional information regarding the sales associates SIP please contact the associate. .Your Empire sales associate is prohibited by law from altering the amount of compensation that they would receive for the purchase of an Empire insurance policy by providing any rebate or inducement to the purchaser. ▪Empire reserves the right to increase rates due to any taxes, fees and assessments prescribed by any statutory, regulatory, or other legal authority,which may bear directly on the financial consequences of this quote. •Renewal rates include necessary changes to the standard medical plan to comply with the requirements of the federal health care reform legislation. •The rates being quoted for this contract are subject to regulatory approval. We expect that these rates will be approved by the NYDFS prior to the effective date of the group(s) being quoted. If we do not obtain regulatory approval by the effective date, we will not be able to implement the rate as quoted until approval is obtained. Once the rates are ultimately approved, they would include any adjustments required by the regulators during the review process. Any differences between the filed and approved rates and the rates charged while the rates were pending approval will be settled between the parties. ▪Effective January 1, 2014, the Affordable Care Act (ACA or health care reform law) imposes a new annual fee on health insurance providers based on their market share of net premiums written, or the sum of premiums earned from all policies, during the previous year. The total fee amount to be collected across all health insurers is set at $8 billion in 2014, $11.3 billion in 2015 and 2016, $13.9 billion in 2017 and $14.38 billion in 2018. After 2018, it increases annually based on premium growth. The fee is anticipated to raise$101.7 billion and is not tax deductible. •Section 1341 of the Affordable Care Act provides that a transitional reinsurance program be established in each State to help stabilize premiums for coverage in the individual market during the years 2014 through 2016. All health insurance issuers, and third-party administrators (TPAs) on behalf of self-insured group health plans, will submit contributions to support reinsurance payments to issuers that cover high-cost individuals in non-grandfathered individual market plans. ▪This quotation includes amounts for the ACA Insurer Fee and ACA Reinsurance Fee. Since the fees change each year in January for all business regardless of renewal date, we have calculated the amounts on a prorated basis across your full coverage period. •The quote is contingent upon full replacement. ▪The rates assume 139 contracts. If the actual number of contracts differs by 10% or more, Empire reserves the right to revise the rates. Page 6 • Non-HMO Disclaimers TOWN OF OUEENSBURY Group Number.990880 Contract Period:July 01,2016-June 30,2017 Funding Arrangement:Prospective Combination Number: 1 Opportunity lD:006d000000YFOFk Prospect ID: 710691 Scenario ID: 831085 ▪Empire Blue Cross Blue Shield recommends that the employer contribution be at least 50% of the employee rate for the least expensive benefit plan offered for all active and retired employees who are enrolled in the group health plan. ▪The attached renewal assumes that at least 50% of eligible employees and 75% of net eligible employee will participate in this plan. ▪Empire holds the right to reconsider the pricing of this renewal if the above recommendation and assumptions are not accurate. •If the Demographic make up (e.g. age/sex, area and industry) changes by more than 10% from the initial calculation, Empire reserves the right to revise the rates. •The rates assume that COBRA enrollment represents less than 15%of the enrolled population. ▪Empire will automatically renew the group with the current benefits and attached renewal rates unless notified otherwise. ▪If the ratio of the number of Non-Medicare total enrolled members (insureds) to the number of Non-Medicare enrolled subscribers (active enrollees) exceeds 2.8 on the initial effective date or any time thereafter, Empire shall have the right, upon 30 days notice, to adjust the rates and enforce four tier rating. •For effective dates prior to 1/1/16 The rates provided assume that you qualify for large group coverage, which requires that you have at least 51 employees eligible for coverage.For purposes of large group coverage,eligible employees include: > permanent hourly/salary wage employees who are regularly scheduled to work at least 30 hours per week (underwriting approval required for reduced minimum number of hours)throughout the year. > commissioned employees who receive W-2 IRS filing from their employer and who are scheduled to work at least 30 hours per week(underwriting approval required for reduced minimum number of hours)throughout the year. >retirees,provided that underwriting has approved the retiree offering. >union employees who are not eligible for health insurance under a Collective Bargaining Agreement Employees in the waiting period are not included as eligible employees. If you do not have 51 or more eligible employees, please notify us prior to the renewal date so that we can provide you with small group rates. •For effective dates beginning 111/16 The rates provided assume that you qualify for large group coverage in 2016. A group is considered a large grdup if it employed an average of 101 or more full-time employees, including full-time equivalent employees (FTEs), on business days during the preceding calendar year. For purposes of qualifying for large group coverage, eligible employees include every individual who is an employee based on the common law definition, which largely depends on the level of control the employer has over the employee. Employees include full time employees who work an average of 30 hours/week; FTE's calculated using the FTE formula'; foreign nationals,union members,employees in the waiting period and employees covered under other health insurance. Retirees, COBRA enrollees, and partners in partnerships and two percent S corporations are not counted as employees for purposes of determining group size. If you do not qualify for large group coverage,this offer will be withdrawn. *Add together hours of service performed by all employees who work less than 130 hours/month in a given month and divide by 120. The result is the number of FTE's on a monthly basis. •Employees residing in Hawaii may not enroll in EPO. Page 7 Non-HMO Disclaimers TOWN OF QUEENSBURY Group Number:990880 Contract Period:July 01,2016-June 30,2017 Funding Arrangement:Prospective Combination Number: 1 Opportunity ID:006d000000YFOFk Prospect ID: 710691 Scenario ID: 831085 'Please note, if non-voluntary specialty products are purchased in conjunction with the above medical plan, the above medical rates may be eligible for discounts. 'The above medical rates do not include Blue View Vision benefits. Blue View Vision benefits and rates, if requested, will be provided on a separate illustration. ▪Beginning with contract periods effective 1/1/15, the Affordable Care Act requires that health plans have out of pocket maximums which do not exceed a published limit, for all services in total. For groups with no Rx coverage with Empire, this quote assumes that separate out of pocket maximums will be established for pharmacy and for medical, which in total will not exceed the published limit and that Medical and pharmacy costs will not be commingled to accumulate to a combined out of pocket maximum. Page 8 CD020816AD040716 TOWN OF OUEENSBURY 710691 99088D mmbo0l NY201 Customer EAR&04-07-16_R