Loading...
2.2 2.2 INSURANCE\Empire Blue Cross Medicare Advantage Renewal Contract 2019- 10-1-18 RESOLUTION AUTHORIZING 2019 RENEWAL CONTRACT FOR EMPIRE BLUE CROSS MEDICARE ADVANTAGE INSURANCE PLAN RESOLUTION NO. ,2018 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 Blue View Vision, Empire Blue Cross and Empire Blue Cross Medicare Advantage, and WHEREAS, the Town Board, in conjunction with Upstate Agency LLC (formerly Capital Financial Group), has negotiated a renewal contract for the year 2019 with Empire MediBlue Freedom (PPO) Medicare Advantage, NOW, THEREFORE, BE IT RESOLVED, that the Queensbury Town Board hereby approves and authorizes a renewal contract for the year 2019 with Empire MediBlue Freeom (PPO) Medicare Advantage with the 2019 monthly premium to be $416.55 per member, and BE IT FURTHER, RESOLVED, that in the event that surcharges, fees or taxes 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 I"day of October, 2018, by the following vote: AYES NOES ABSENT: 2 f Empire BLUECROSS An Anthem Company September 10, 2018 Barbara Tierney Town of Queensbury 742 Bay Road Queensbury, NY 12804 Re: Empire Medi6lue Freedom PPO and Part D Renewal for Town of Queensbury Dear Ms. Tierney: We value your business and thank you for offering the Empire BlueCross(Empire)Medicare Advantage with Part D plan to your retirees.We are committed to providing you with solutions and services that provide meaningful value,while also helping your retirees stay active and healthy. 2019 Renewal Rates Enclosed is your Summary of Rates exhibit,which reflects your renewal for the January 1, 2019 contract year. The new premiu er member per month (PMPM).This is a$23.14 PMPM decrease equating to a-5.3%decrease the current premium of$439.69 PMPM. �' Also included is the Benefit ange Summary, which outlines 2019 benefit changes. Please review the rate stipulations in the attached 2019 Summary of Rates exhibit. Affordable Care Act On January 1,2014 the Affordable Care Act(ACA) imposed an 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. There will be a moratorium on the assessment and collection of the ACA Insurer Fee in 2019. Important Reminders Formulary Changes:We want to remind you that your plan's Formulary is reviewed annually and changes to drug tiering, utilization management and coverage are effective January 1st. Your retirees will receive a copy of the Formulary and can call our Member Services department with questions. Medicare Part D plan drug coverage and members' accumulations are managed on a calendar year basis. New Group Numbers and ID Cards: Due to mandated changes. Empire will administer new group numbers and ID cards for the 2019 plan. Your Account Management team will seamlessly implement these changes, and your retirees will receive new ID cards before the renewal date. Page 1 Open Enrollment/Annual Notice of Change (ANOC)Mailings: Let us know as soon as possible if and when you are holding an open enrollment period for your retirees eligible for this retirement benefit plan. To be compliant with CMS ANOC requirements,we will need confirmation of your renewal at least 45 days prior to your open enrollment period or renewal date(if you are not offering an open enrollment). Retiree Communications: Please provide us with communications you distribute to your retirees.We will provide these documents to our Member Service department so Customer Service Representatives can continue to fully support your retirees. Quality Medicare Offerings Empire offers a suite of programs to keep health care costs down,while improving quality of life for your retirees.Through these programs,your retirees have easy access to health information,reminders about needed care,and resources to help them stay physically fit.We take a holistic approach to health,offering support to retirees no matter where they fall on the health spectrum. In addition,we understand that managing care and chronic conditions can be difficult.That is why we take a personalized approach to care management with a focus on closing gaps in care and developing individualized goals for at-risk members. To continue strong quality performance,we have made significant investments in our Medicare Advantage and Stars quality programs.In fact,more than 71%of Medicare Advantage members in our parent company's affiliated health plans are now enrolled in plans that achieved four stars or better.The Stars Ratings provide further confirmation that our multi-year focus on improving the quality of our Medicare offerings is delivering real benefits for members. In Closing We are pleased to continue to provide you and your retirees with the personalized focus and dedicated service you've come to expect from us.We look forward to the opportunity to continue our partnership with you. Please do not hesitate to contact me if you have any questions. Regards, Judy Moore-Kelman Account Manager cc: Jason O'Malley, Empire BlueCross Carol Stricos, Empire BlueCross Shelly Marcantonio, Upstate Agency Attachments: 2019 Summary of Rates 2019 Benefit Summaries Page 2 Empire n& Summary of Rates Town of Queensbury Effective 01/01/2019 LPPO$5P Medical PMPM $148.63 Pharmacy Plans 15/25/45(F-10R)ECDHLP Preferred Network $267.92 TOTAL RATE Med w/15/25/45(F-10R)ECDHLP Preferred Network $416.55 Underwriting Stipulations: -Rates and benefits may be revised based on legislative,regulatory or other changes including,but not limited to, CMS guidance effective for the quoted product years. Plan options,such as the Preferred Retail Pharmacy option, and formularies are filed and approved with CMS on an annual basis and could change in January each year. -ACA Insurer Fees are included in the quoted premium.The fee included is calculated on a prorated basis across the full coverage period. The ACA Insurer Fee is excluded for months in 2019 within the rating period. This quote is based on a 01/01/2019 effective date. Participants have Medicare Parts A and B. Eligibility for coverage for subscribers or their dependents is based on the subscriber meeting their employer's requirements for coverage of retiree medical benefits. -Contracted rates are on a Per-Member-Per-Month(PMPM)basis. Each individual will receive the same equal rate;a two member contract would receive twice the rate;a three member contract would receive triple the rate. -The pricing census included a total of 78 retired members,including 6 Medicare eligible,pre-65 retired members. If the enrolled membership differs from the pricing census by more than 10%we reserve the right to review and change the pricing if necessary. -Broker commissions are included at$11.00 PMPM,no portion of this expense can be passed on to the retiree in terms of a contribution. -This quote assumes Empire will be the exclusive post-65 retiree offering. Furthermore,the quote assumes that Empire will offer a single plan design.Any additional plan selections will be subject to underwriting consideration. -The employer will contribute at least 50%towards the premium. Retiree contributions are often negotiated on an annual basis and are subject to change.If the strategy does change,Empire must be notified and reserves the right to re-evaluate its underwriting position. -The employer's eligibility policy does not allow for retirees to enroll in an employer sponsored medical plan if the retiree has previously declined coverage. -This plan may be limited in some states to employers that qualify as a large group within that state. The large group definition varies by state. -Medical and prescription drug plans must be sold as a package. -This quote is contingent upon the majority of the enrolled membership residing in an adequate network service area. The service area and plan design are subject to CMS approval. -Pharmacy benefits are based on a two plan benefit structure:an EGWP plan that covers the standard Part D benefit plan as defined by CMS and the Senior Rx Plus plan that provides the additional drug coverage. Reviewed and Accepted on behalf of the Group by: Print Name: Title: Signature: Date: 8/20/2018 V.P. 2019 Benefit Change Summary Next year,there will be some changes to the prescription drug plan's member cost sharing and benefits.These changes will be communicated to the member in the Annual Notice of Change(ANOC) mailing. This summary tells you about Empire changes as well as CMS changes illustrated in the CY 2019 Cali Letter. Please note this is only a summary of changes. Summary of Important.Changes for 2019 Cost Sharing 2018 2019 Medicare Part D Each year Medicare evaluates the limits used to define the Part D coverage phases. True Out-of-Pocket(TrOOP)Limit: Defines the end of the $5,000 $5,100 Part D Gap phase. Medicare Catastrophic Minimum Copays Each year Medicare evaluates the minimum copays which will be charged during the Catastrophic phase. Generic drugs $3.35 $3.40 Brand drugs $8.35 $8.50 Benefits 2018 2019 EGWP Part D Service Area All 50 states,District of Columbia All 50 states, District of Columbia Expanded service area to include the and U.S.territories,except the and U.S.territories U.S.Virgin Islands U.S.Virgin Islands Page 3 Important Information Regarding Your Drug Coverage To ensure we are able to manage your Formulary generic drugs covered On an exception basis,specific Plan's drug cost increases,a generic on generic tier generic drugs covered on brand drug which is priced by the tiers manufacturer similar to a branded drug may be assigned to a brand tier. If we do so,the members formulary booklet will list the drug as covered at the brand tier. CMS notifies Plans.When a drug's Part Current formulary drug list Non-Part D eligible drugs D status changes due to failure of the removed from formulary drug list manufacturer to meet certain filing requirements.Changes can occur at any time throughout the year so future fills of the affected drugs may no longer be covered. Empire BlueCross is a Medicare Advantage Organization and a Prescription Drug Plan with a Medicare contract Enrollment in Empire BlueCross depends on contract renewal. Services provided by Empire HeatthChoice HMO,Inc.,and/or Empire HealthChoice Assurance,Inc.,licensees of the Blue Cross and Blue Shield Association,an association of independent Blue Cross and Blue Shield plans. Page 4 Your 2019 Prescription Drug Benefits Chart Premier 15/25/45 (with Senior Rx Plus) Your retiree drug coverage Includes Medlcare Part D drug benefits and non Medlcare supplemental drug benefits The cost shown below Is what you pay after all benefits under your retiree drug coverage have been provided. Part D Initial Coverage _ Below is your payment responsibility from the time you meet your deductible, if you have one, until the amount paid by you and the Coverage Gap Discount Program for covered Part D prescriptions reaches your True Out of Pocket limit of$5,100, Retail Pharmacy per 30-day supply (Specialty limited to a 30-day supply) • Generics $10 copay $15 copay • Preferred Brands $20 copay $25 copay • Non-Preferred Brands, including Specialty $40 copay $45 copay Drugs and Non-Formulary Drugs • Select Drugs $0 copay $0 copay Typically retail pharmacies dispense a 30-day supply of medication. Many of our retail pharmacies can dispense more than a 30-day supply of medication. If you purchase more than a 30-day supply at these retail pharmacies,you will only need to pay two copays. Mail-Order Pharmacy per 90-day supply (Specialty limited to a 30-day supply; 30-day Retail copay or coinsurance applies) • Generics $30 copay • Preferred Brands $50 copay • Non-Preferred Brands, including Specialty $90 copay Drugs and Non-Formulary Drugs • Select Drugs $0 copay Y0114_19_35113_104/03/2018 2019 STD GF Premier 15/25/45 Preferred Full Gap P3TO (10R)_SD NY 04/30/2018 Part D Catastrophic-Coverage Your payment responsibility changes after the cost you and the Coverage Gap Discount Program have paid for covered drugs reaches your True Out of Pocket limit of$5,100. 5% coinsurance with a minimum copay of$3.40 • Generic Drugs and a maximum copay of$10.00 (Specialty limited to a 30-day supply) 5% coinsurance with a minimum copay of$8.50 • Brand-Name Drugs and a maximum copay of$20.00 (Specialty limited to a 30-day supply) • Select Drugs $0 copay • Preferred Retail Pharmacies:Your retiree drug plan has a large nationwide retail pharmacy network, plus mail-order pharmacies for convenient home delivery. When you want to use a retail pharmacy,you will save $5 on most fills if you choose to use one of the network's preferred retail pharmacies. Preferred retail pharmacies are identified in your Group Medicare prescription drug plan's pharmacy directory. The list of preferred pharmacies may change each January. • Vaccines: Medicare covers some vaccines under Part B medical coverage and other vaccines under Part D drug coverage.Vaccines for Flu, including H1N1, and Pneumonia are covered under Medicare medical coverage. Vaccines for Chicken Pox,Shingles,Tetanus, Diphtheria, Meningitis, Rabies, Polio,Yellow Fever, and Hepatitis A are covered under Medicare drug coverage. Hepatitis B is covered under medical coverage if you fall into a high risk category and under drug coverage for everyone else.Other common vaccines are also covered under Medicare drug coverage for Medicare-eligible individuals under 65. • Senior Rx Plus:Your supplemental drug benefit is non-Medicare coverage that reduces the amount you pay, after your Group Part D benefits and the Coverage Gap Discount. The copay or coinsurance shown in this benefits chart is the amount you pay for covered drugs filled at network pharmacies.