Loading...
4.13 REVISED 4.13 INSURANCE\Anthem Blue Cross Renewal Contracts 2024-2025-5-6-2024 RESOLUTION AUTHORIZING AGREEMENTS WITH ANTHEM BLUE CROSS FOR EMPLOYEE GROUP HEALTH,DENTAL AND BLUE VIEW VISION INSURANCE PLANS EFFECTIVE JULY 1ST,2024-JUNE 30TH, 2025 RESOLUTION NO. ,2024 INTRODUCED BY: WHO MOVED FOR ITS ADOPTION SECONDED BY: WHEREAS, the Town of Queensbury previously entered into- agreements for employee group health, dental and Blue View Vision insurance plans with Empire Blue Cross Blue Shield, now known as Anthem Blue Cross,and WHEREAS, the Town Board, in conjunction with Upstate Agency, LLC, has negotiated renewal agreements for employee group health, dental and Blue View vision insurance plans with Anthem Blue Cross, NOW,THEREFORE,BE IT RESOLVED, that the Queensbury Town Board hereby approves and authorizes renewal contracts for employee group health; dental and Blue View vision insurance plans with Anthem Blue Cross effective July 1st,2024 through June 30th,2025,with the-monthly premiums as follows: INDIVIDUAL 2 PERSON FAMILY PPO 1,188.18 2,316.95 3,445.72 EPO 1,096.27 2,137.73 3,179.19 DENTAL 36.48 87.95 87.95 VISION 4.06 7.71 11.83 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 and/or Town Budget Officer to execute any agreements, forms and/or documentation and take any other actions necessary to effectuate this Resolution. Duly adopted this 6th day of May,2024,by the following vote: AYES : NOES : ABSENT: • Anthem, Anthem Blue Cross Is the trade name of Anthem Heathchoice Assaance,Inc Independent Swam of the Sue Cross and Blue SluedAssociaron.Anthem Is a registered trademark of Anthem Insaance Compenles,Inc. • RENEWAL QUOTE SUMMARY Group Name: TOWN OF QUEENSBURY Group Number. 990880 Contract Period: July 01,2024-June 30,2025 Funding Arrangement: Prospective Broker Name: Chad Mallow Brokerage Name: UPSTATE AGENCY,LLC Sales Re•resentative Name: ALYSSA JACQUES I✓ombl.natton�Numerl o a F ra "PACl1 2[ teStatus� ' .I?p rt hr, D�,..� � �•m � �!�a Non Grandfathered Underwriting Approved Prospect ID: 889376 Scenario ID: 991575 Rating ID: 7804362 QD050224 Anthem PPO-'Copay-Legacy-with Blue Access-High Plan Includes the addition of Empire Health Guide. Rate Summary Non-Medicare Medicare 1 dlviNi t ai: a s itla Pert r ,FafnilY I �,,,„�al , . 2rP.a r.r � Fami�, Indiv:tduat � �, 0 2 0 0 0 0 Current Rates $1,148.00 $2,238.60 $3,329.20 $1,148.00 $2,238.60 $3,329.20 Renewal Rates $1,188.18 $2,316.95 $3,445.72 $1,188.18 $2,316.95 $3,445.72 Rate Action 3.50% Broker Commission Rate:$18.51 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). Signature,Section: Reviewed and Accepted on behalf of the Group by: Print Name: Title: Signature: Date: • Page 1 • Anthem® Anthem Blue Crass is the trade name of Anthem Heal hChalce Assmranw,Ina.Independent licensee of the Blue Cross and Blue ShiaAssoclatlon.Anthem Is a registered trademark or Anthem Insurance Companies,Inc. ' ,.-RENEWAL QUOTE SUMMARY•' - Group Name: TOWN OF QUEENSBURY Group Number. 990880 Contract Period: July 01,2024-June 30,2025 Funding Arrangement: Prospective Broker Name: Chad Mallow Brokerage Name: UPSTATE AGENCY,LLC Sales Re•resentative Name: ALYSSA JACQUES tmtaionNume t 'naafi Ve l ?ArAVIel. 1 Non Grandfathered Underwriting Approved Prospect ID: 889376 Scenario ID: 991575 Rating ID: 7804363 QD050224 'Anthem EPO-Co pay . p y ;Legacy with Blue Access-Low Plan Includes the addition of Empire Health Guide. • Rate Summary - • • -Non=Medicare . Medicare 14Wat n M. .r t � . .�-a s> ! �x Y� . , k• • msm,f'tY al Indivfdui § 2 a ;�'� Famit •^��. ':Individuals �� � •:�2-�'� Enrollment 50 37 111111EMMI0 1 0 Current Rates $1,059.20 $2,065.44 $3,071.68 $1,059.20 $2,065.44 $3,071.68 Renewal Rates $1,096.27 $2,137.73 $3,179.19 $1,096.27 $2,137.73 $3,179.19 Rate Action 3.50% Broker Commission Rate:$27.44 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). • Signature Section::Reviewed and Accepted on behalf of the Group by: ' ; • Print Name: Title: Signature: Date: • Page 2 CD011724AD050224 TOWN_OF_QUEENSBURY_889376_990880 combo0l_NY201_Customer Exhibits_05-02-24_R Non-HMO Disclaimers • TOWN OF QUEENSBURY Group Number:990880 Contract Period:July 01,2024-June 30,2025 Funding Arrangement:Prospective Combination Number: 1 Prospect ID: 889376 Scenario ID: 991575 •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 Anthem 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 Anthem's general administrative charges, such broker compensation programs are not charged specifically to an individual customer's account. You can obtain additional information regarding Anthem's large group commission rate schedules and its broker compensation programs by visiting www.anthembluecross.com or by contacting your Anthem representative. ▪Anthem 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 and benefits, including wellness programs, being quoted for this contract are subject to regulatory approval. We expect that these rates and benefits will be approved by the NYS Department of Financial Services 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 and/or benefits as quoted unless and until approval is obtained. Once the rates.and benefits are ultimately approved, they will include any adjustments required by the regulators during the review process. Any differences between the filed and approved rates and benefits, including wellness programs, and what was quoted while approval was pending will be settled between the parties. ▪This quotation includes amounts for the ACA Insurer Fee. Since the fee changes 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 143 contracts. If the actual number of contracts differs by 10% or more, Anthem reserves the right to revise-the rates. Anthem 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. •Anthem 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, Anthem reserves the right to revise the rates. •The rates assume that COBRA enrollment represents less than 15%of the enrolled population. •Anthem will automatically renew the group with the current benefits and attached renewal rates unless notified otherwise. Page 3 • • Non-HMO Disclaimers TOWN OF QUEENSBURY Group Number:990880 Contract Period:July 01,2024-June 30,2025 Funding Arrangement:Prospective Combination Number: 1 Prospect ID: 889376 Scenario ID: 991575 '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, Anthem shall have the right, upon 30 days notice, to adjust the rates and enforce four tier rating. 'The rates provided assume you qualify for large group coverage. A group is considered a large group 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. ▪Since Anthem is neither a Hawaii authorized insurer nor a Hawaii Health Care Contractor, we are unable to insure members located in Hawaii. We recommend that you obtain direct quotes for either an individual policy for employees who live and work in Hawaii or if there are several employees within an employer group to obtain group coverage from a Hawaii authorized insurer. 'This quote includes nonstandard benefits that are subject to approval by the New York Department of Financial Services. If the group accepts the proposal,Anthem will file the proposed benefit riders with the Insurance Department. '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 Anthem, 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. 'Under final rules issued by EEOC under the Americans with Disabilities Act and the Genetic Information Nondiscrimination Act, wellness incentives are subject to certain limits in some situations. Incentive limits may also apply under the Affordable Care Act. Employers are responsible for taking steps to comply with all legally-required incentive limits. Please consult your attorneys or advisors for additional information as needed. Page 4 CD011724AD050224 TOWN_OF_QUEENSBURY 889376_990880 comboOl NY201 Customer Exhibits 05-02-24_R Antherna 9 � t .L -,i= I t Renewal dental. rate'sjheet F,�,� t , 1 �, > lt° i s. tt c d 1 i1 J 1� ��� 1� . t 3�n��s�. �, t,� - ��$ k� 1 7 i "t€ �, q � 3�n Tow of Queensbury `G F J ar € ..• e%F t• P 4 S ' F # C ''-t'-! 1 1 Y r,4'S < i� Group Number 990880x M G ▪ rtf r,• � v Fullyalnsured� g } E } c T h • �� rf a • 6 4 Y: ✓~} -.k r• � ;� r 8 : .aT - � t a �fi t YLfh`kl�.c1f.<y4 S.• {if , 3 *4p4 Y''�7•ck,��,� i1"� 1y - - # f ffectiveJuly)1 •2024 hroughJine 30 2025 _..........<.«-a..r.:.....�.�� ,e xx,.�,fi;• .,_�, er- _�....._._.:.�„•:..,a'�.::.:.�:...z.......u�:.s--�..,� _ �.. ��....c.w..�..,'-.yam.:.. .. .x...���..�.�.�..z°.��.L;....:,._-`.....� r i ..s�x.�.- Commission level: 5.00% Monthly rates Employee+ `Plan Name • Employee Only Total Family Renewal Plan Designs � t • o �E3!. a s 7,�,5 Yn• '-? y,J�}$z»;}, ;�"S .? ;,. ;5^. 6avx y`ti "z n �o� a° - '�' 'Ys � T�,E " '-Y.x-i,?�£. '• ,t1 4 V.a'}^i a r aRl : V 0 r 'C a r` e Yt g V fc.�,.,y,'�r T Renr.ew w.irIa`l�.�;�:4�..��1 F t.�.1°*-$$3 6r' 3,�.,�.:��i..e:.'s•f..._.k«.',$S 83}=s.�Tc.}�"c 7rod 6at Ch"".c.}.'.?"�45' 5�1 Q". P � 4 410 rg nDental PPO j a4 C $34 74� 4 itr r�. Ift �+ r.± � ;r & �� �� d � r# fr�- I A� Z x4.8 �a 4 $.87 9Ar5.e ,� . .8r1,9 36.9`;1..".4a. .s4 fS 5: Required Rate Action }' 4 = #14.43%0 P opo end RateA.cton § Renewal of your contract is predicated upon the assumption that your group continues to meet Anthem's underwriting guidelines. Payment of the renewal rates listed constitutes acceptance of this renewal offer.If you wish to cancel your contract with Anthem for any reason,we must have notification 15 days prior to the renewal date.It is not necessary to complete any paperwork or forms to continue your plan. Anthem Blue Cross 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. Authorized Signature: By typing my name I intend for it to serve as my signature,and that I am authorized to sign on behalf of this group. Title: Date: jmf 4/17/2024 UPSTATE LAI,AGENCY Town of Queensbury Health Reimbursement Account(HRA) INSURANCE EPO Reimbursement Request Form • EMPLOYEE BENEFITS DIVISION Participant Name: Mailing Address: Phone Number: Email Address: Last 4 Social Security#: Mail to: Upstate Agency PLLC 103 Main Street So. Glens Falls, NY 12803 Fax to: (855) 220-9669 `:® toO ' G .E , � � � � ff5mJjTh Co aertig0 . s e;�t ^. r e ndr moA o Oki k ❑ Hospital Copay;$1000 Reimbursement ❑ EPO$20 Copay;$10 Reimbursement ❑ ER$200 Copay;$165 Reimbursement ❑ Acupuncture;up to$80 Reimbursement ❑ Brand/Non-Formulary Rx Deductible;$100 per calendar year El Brand Rx$25 Copay;$5 Reimbursement ❑ Non-Formulary Rx$50 Copay;$25 Reimbursement ❑ Mail Order Brand Rx$50 Copay;$10 Reimbursement ❑ Mail Order Non-Formulary Rx$100 Copay,$50 Reim. U Hospital Copay;$1000 Reimbursement ❑ EPO$20 Copay;$10 Reimbursement ❑ ER$200 Copay;$165 Reimbursement ❑ Acupuncture;up to$80 Reimbursement ❑ Brand/Non-Formulary Rx Deductible;$100 per calendar year ❑ Brand Rx$25 Copay;$5 Reimbursement ❑ Non-Formulary Rx$50 Copay;$25 Reimbursement ❑ Mail Order Brand Rx$50 Copay;$10 Reimbursement ❑ Mail Order Non-Formulary Rx$100 Copay,$50 Reim. U Hospital Copay;$1000 Reimbursement ❑ EPO$20 Copay;$10 Reimbursement ❑ ER$200 Copay;$165 Reimbursement El Acupuncture;up to$80 Reimbursement ❑ Brand Rx$25 Copay;$5 Reimbursement ❑ Non-Formulary Rx$50 Copay;$25 Reimbursement El Mail Order Brand Rx$50 Copay;$10 Reimbursement ❑ Mail Order Non-Formulary Rx$100 Copay,$50 Reim. ❑ Hospital Copay;$1000 Reimbursement ❑ EPO$20 Copay;$10 Reimbursement ❑ ER$200 Copay;$165 Reimbursement ❑ Acupuncture;up to$80 Reimbursement ❑ Brand Rx$25 Copay;$5 Reimbursement ❑ Non-Formulary Rx$50 Copay;$25 Reimbursement ❑ Mail Order Brand Rx$50 Copay;$10 Reimbursement ❑ Mail Order Non-Formulary Rx$100 Copay,$50 Reim. Total Reimbursement Amount Requested: • Participant Signature: Date: Submit one expense per row,even if items are contained on the same receipt.Each For each claim,attach an Explanation of Benefits(EOB)and/or an itemized bill showing: item must be Itemized and must have a corresponding receipt.Please DO NOT provider name,patient name,date of service,amount charged and description of services. group items together or write"See Attached".Upstate Agency can only process DO NOT SEND CREDIT CARD RECEIPTS,ORIGINAL RECEIPTS or CANCELLED claims that are properly submitted and will deny claims that are submitted Incorrectly. CHECKS.If covered by Insurance,submit EOB or bill showing insurance payment. Please be sure to provide the last four digits of your SSN All claims are subject to deadlines and a$10.00 check minimum as defined in you Summary Plan Description. By submitting this form to Upstate Agency,I certify that the Information herein Is true and correct,that the expenses incurred were for myself,spouse or qualified dependents and that these expenses are not reimbursable under any other plan coverage(i.e.,spouse's insurance)