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INSURANCE\Empire Blue Cross Renewal Contracts 2022-2023-5-16-2022
RESOLUTION AUTHORIZING CONTRACTS WITH EMPIRE BLUE
CROSS BLUE SHIELD FOR EMPLOYEE GROUP HEALTH AND DENTAL
INSURANCE PLANS EFFECTIVE JULY IST, 2022—JUNE 30TH, 2023
RESOLUTION NO. ,2022
INTRODUCED BY:
WHO MOVED FOR ITS ADOPTION
SECONDED BY:
WHEREAS, the Town of Queensbury previously entered into agreements for employee
group health and dental insurance plans with Empire Blue Cross Blue Shield,and
WHEREAS, the Town Board, in conjunction with Upstate Agency, LLC, has negotiated
renewal contracts for the employee group health and dental insurance plans with Empire Blue
Cross Blue Shield,
NOW,THEREFORE,BE IT
RESOLVED, that the Queensbury Town Board hereby approves and authorizes renewal
contracts for employee group health and dental insurance plans with Empire Blue Cross Blue Shield
with the-monthly premiums and contract expiration dates as follows:
INDIVIDUAL FAMILY EXPIRATION DATE
PPO 985.72 2879.61 06/30/2023
EPO 909.48 2656.86 06/30/2023
DENTAL 34.74 83.76 06/30/2023
and
V
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 16'h day of May,2022,by the following vote:
AYES
NOES
ABSENT:
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RENEWAL
EXHIBITS
EmpjSO
iln An!bein Company
Services prodded by Empue HealthChoice Assurance,Inc,licensee of the Blue Cross and Blue Shield Association,an as3sociaationn ooffIInddeeppee�ndde�ntt Blluyey�crress�end
—Blue Sheld plans.
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Group Name: Town of Queensbury
Group Number: 990880
Contract Period: July 01,2022-June 30,2023
Funding Arrangement: Prospective
Broker Name: SHELLY MARCANTONIO
Brokerage Name: UPSTATE AGENCY,LLC
Sales Representative Name: BARRY GRIMMELL
1 Non Grandfathered Underwriting Approved
Prospect ID: 860768 Scenario ID: 973593 Rating ID: 7721959 QD041322
Includes the addition of Empire Health Guide.
� dti --
Enrollment 50 33 64 0 1 1
Current Rates $887.30 $2,592.06 $2,592.06 $614.89 $1,449.37 $2,283.87
Renewal Rates $909.48 $2,656.86 $2,656.86 $630.26 $1,485.60 $2,340.97
Rate Action 2.50%
Broker Commission Rate:$25.86 PCPM
This renewal is contingent upon the group I plan sponsor being current with all premium or fees as of the effective date of the renewal,unless specifically agreed to
to writing in advance by Anthem.
Disclaimers See attached disclaimer page(s).
Print Name: _ W
Title:
Signature:
Date:
Page 2 CD012022AD041322
Town_of Queensbury__860768_990880_combo0l_NY201 Customer Exhibits_04-13.22_R
EmpjTO5
Ail A.nthein Company
Services provided by Empire HeallhChoke Assurance,Inc.,licensee of the Blue Cross and Blue Shield Association,an association of independent Blue Cross and Blue Shield plans.
Group Name: Town of Queensbury
Group Number: 990880
Contract Period: July 01,2022-June 30,2023
Funding Arrangement: Prospective
Broker Name: SHELLY MARCANTONIO
Brokerage Name: UPSTATE AGENCY,LLC
Sales Representative Name: BARRY GRIMMELL
1 Non Grandfathered Underwriting Approved
Prospect ID: 860768 Scenario ID: 973593 Rating ID: 7721958 QD041322
Includes the addition of Empire Health Guide.
Enrollment 0 I 1 0 0 0 0
Current Rates $961.68 $2,809. 88 $2,809.38 $666.75 $1,571.62 $2,476.51
Renewal Rates $985.72 $2,879.61 $2,879.61 $683.42 $1,610.91 $2,538.42
Rate Action 2.50%
Broker Commission Rate:$17.45 PCPM
This renewal is contingent upon the group/plan sponsor being current with all premium or fees as of the effective date of the renewal,unless specifically agreed to
In writing in advance by Anthem.
Disclaimers See attached disclaimer page(s).
Print Name:
Title:
Signature:
Date:
Page 1
EmppiresGz
An iinthem Company
Town of Queensbury
Group Number: 990880
Fully Insured Ceh-I-ci�
Rate Sheet
July 01, 2022 through June 30, 2023
ENROLLMENT
Average Enrollment for the Experience Period 121
Employee Only 33
Family 91
Total Current Enrollment 124
CURRENT RATES
Employee Only $32.77
Family $79.02
Total Monthly Premium $8,272.23
Total Annual Premium $99,266.76
FINAL RATE ACTION 6.00%
RENEWAL RATES
Employee Only $34.74 -'
Family $83.76
Total Monthly Premium $8,768.58
Total Annual Premium $105,222.96
Broker Commission 5.00%
There is a 6% rate cap on this renervaL
Empire BlueCross reserves the right to revise the premiums or charges should the group request changes in their
benefits,networks,or service level, or should the total enrollment or enrollment distribution by product,membership
type,or location differ by 10%or more from the ending of the enrollment noted above. Minimum participation and
contribution requirements must be maintained at all times to continue coverage.
This renewal is contingent upon the group/plan sponsor being current with all premium or fees as of the effective
date of the renewal,unless specifically agreed to in writing in advance by Anthem.
Name Signature
Title Date
jmf 1/31/2022
• • . .
Total Rate
Individual $4.06
2-Party $7.71
Family $11.83
•
Total Rate
Individual $4.17
2-Party $7.92
Family $12.15
Commission Rate 1.30%
In addition to the applicable commissions paid to the broker(including a general agent or consultant)on the business sold,the brokermay
receive payments from Empire or may participate in non-cash award programs,underone ormore 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.
-The above rates are guaranteed for 24 months provided that commissions and/or the tier structure do not change.
•If the above rates are not elected within 30 days of the date shown below,this proposal will be withdrawn.
•A change in the contract period may require a recalculation of rates.
•The above rates are contingent upon full replacement.
•Above rates reflect 95%total vision employer contribution.
•The rates provided assume this is a renewal for a group that qualified as large group prior to 1/112016.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 this is not a renewal,please notify us as soon as possible.
•The above rates are based on 230 eligible employees. If the actual number of eligible contracts differs by 10%or more,Empire reserves the
right to revise the rates.
•If the actual enrollment is less than 75%of the total number of eligible,this proposal may be withdrawn.
•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.
•This is a primary vision care benefit intended to cover only routine eye examinations and corrective eyewear.Benefits are payable only for
expenses incurred while the group and insured person's coverage is in force.This information is intended to be a brief outline of coverage.All
terms and conditions of coverage,including benefits and exclusions,are contained in the group policy and member certificate,which shall
control in the event of a conflict with this overview.Laws in some states may prohibit network providers from discounting products and services
that are not covered benefits under the plan.Frame discounts may not apply to some frames where the manufacturer has imposed a no
discount policy on sales at retail and independent provider locations.Discounts are subject to change without notice.This benefit overview is
only one piece of your entire enrollment package.
•
Reviewed and Accepted on behalf of the Group by:
Print Name: h
Si nature:
G
Date: 'Z
Empire BlueCross
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Town of Queensbury-Renewal Quote Summary.xlsx 3/11/2021
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