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INSURANCE\Blue View Vision Renewal Contract 2016- 10-19-15
RESOLUTION AUTHORIZING RENEWAL CONTRACT
FOR BLUE VIEW VISION INSURANCE PLAN-
JANUARY 1, 2016 -JUNE 30, 2017
RESOLUTION NO. ,2015
INTRODUCED BY:
WHO MOVED FOR ITS ADOPTION
SECONDED BY:
WHEREAS, the Town of Queensbury previously entered into an employee group health
insurance agreement with Blue View Vision, and
WHEREAS, the Town Board, in conjunction with Capital Financial Group, has
negotiated a renewal contract for January 1, 2016 — June 30, 2017 with Blue View Vision and a
copy is presented at this meeting,
NOW, THEREFORE, BE IT
RESOLVED, that the Queensbury Town Board hereby approves and authorizes the renewal
contract for January 1, 2016 — June 30, 2017 with Blue View Vision substantially in the form
presented at this meeting, with the monthly premiums to be as follows:
INDIVIDUAL TWO PERSON FAMILY
BLUE VIEW 4.27 8.33 12.38
VISION
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 the contract substantially in the form presented at this meeting and any other necessary
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 19th day of October, 2015, by the following vote:
AYES
NOES
ABSENT:
2
• EHC Benefits Agency,Inc.
11 Corporate Woods Blvd
Albany, NY 12211
AUTHORIZED REPRESENTATIVE
Empire 0.ecuEceoss
September 24,2015
Ms.Barbara Tierney
Town of Queensbury
742 Bay Road
Queensbury,New York 12804
Dear Ms. Tierney:
Empire BlueCross is pleased to present the enclosed renewal for your Vision insurance
coverage effective January 1,2016 through June 30,2017. We hope this coverage has
fulfilled your expectations as we place a high value on continuing our relationship with
you.
It is important to note that the renewal is for 18 months not our standard 24 month vision
renewal. This will move your coverage to a July PI renewal to coincide with your health
plan renewal date. The Frequency of Service for exam was changed from 24 months to
12 months as requested. The others will remain at 24 months.These changes generate an
increase of 10.3%to your current rates.
Attached you will find an exhibit which illustrates your renewal rates. Also affecting
your renewal are the new taxes associated with the Affordable Care Act.
In order to ensure a smooth transition into the new contract period, once you have
reviewed the new options and renewal,we request that you sign the appropriate
documents and have returned to my attention thirty(30)days prior to the renewal date.
Thank you for choosing Empire to serve your vision benefits needs. We are committed
to providing you with the best products, networks and service.
Sincerely,
gtz c)LcEt¢-t e - rrl1ti�
Judith Moore-Kelman
Account Manager
Enclosure
cc: John Weber,Capital Financial
Kristy Laney, Capital Financial
Jason O'Malley, Empire BlueCross
Empire BlueCross is an independent licensee of the Blue Cross and Blue Shield Association
EHC Benefits Agency,Inc.is an affiliate of Empire BlueCross
BLUE VIEW VISION"RENEWAL QUOTE SUMMARY
Group Name Town of Queensbury
Group Number 990880
Effective Date 1/1/2016
End Date 6/30/2017
BENEFIT SUMMARY
Benefits In-Network Out-of-Network
��9x it _ ,'v$a°3>.:.�a` a,
amination $10 Not Applicable
-•lass Lens $0 Not Applicable
Exam 12 months 12 months
Lenses 24 months 24 months
Frames 24 months 24 months
Contact Lenses 24 months 24 months
Comprehensive vision examination Covered in full after copayment up to$40 allowance
Single Vision Covered in full after copayment up to$25 allowance
Bifocal Covered in full after copayment up to$40 allowance
Trifocal Covered in full after copayment up to$55 allowance
Eye•lasses frame allowance 1 I .1 1,,t:n«• I, r°„ •,i r-m- • •.- ..... . • . .,
Elective Conventional $130 allowance,then 15%off remaining balance up to$105 allowance
Elective Disposable $130 allowance(no additional discount) up to$105 allowance
Non-Elective Contact Lenses Covered in full up to$210 allowance
Factory scratch coating included. Covered in full Not Applicable
Polycarbonate Lenses for children under 19 years old. Covered in full Not Applicable
Transitions Lenses for children under 19 ears old. Covered in full Not A.•icable
Discounts In-Network Out-of-Network
UV Coating $15.00 Not Applicable
Tint(Solid Gradient) $15.00 Not Applicable
Standard Polycarbonate $40.00 Not Applicable
Transition Lenses for Adults $75.00 Not Applicable
¢yea•, % :s(:.,,'°( Bt .::... A,., - �& i' R {� S '
Standard Progressive $65.00 Not Applicable
Premium Tier 1 $85.00 Not Applicable
Premium Tier 2 85,00
$ Not Applicable
Premium Tier 3 $110.00 Not Applicable
Standard Anti-Reflective Coating $45.00 Not Applicable
Premium Tier 1 Anti-Reflective Coating $57.00 Not Applicable
Premium Tier 2 Anti-Reflective Coating $68.00 Not Applicable
Other 20%Discount off retail.rici • Not A..icable
Dependent Eligibility
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QUOTED MONTHLY RATES
Portion of Total Rate Portion of Total Rate
Total Rate Attributed to ACA Fee Not Attributed to ACA Fee
Individual $4.27 $0.15 $4.12
2-Party $8.33 $0.29 $8.04
Family $12.38 $0.43 $11.95
COMMISSIONS
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 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.
DISCLAIMERS
*The above rates are guaranteed for 18 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 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.
•The above rates are based on 186 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.
•The above rates are pending Underwriting approval.
•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.
SIGNATURE SECTION
Reviewed and Accepted on behalf of the Group by:
Print Name:
Tide:
Signature:
Date:
Empire BlueCross
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