4.03 4.3
INSURANCE\Empire Blue Cross Medicare Advantage Renewal Contract 2016- 11-2-15
RESOLUTION AUTHORIZING 2016 RENEWAL CONTRACT FOR
EMPIRE BLUE CROSS MEDICARE ADVANTAGE INSURANCE PLAN
RESOLUTION NO. ,2015
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 Capital Financial Group, has
negotiated a renewal contract for the year 2016 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 2016 with Empire MediBlue Freeom (PPO) Medicare Advantage with the
2016 monthly premium to be $432.88 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 2"d day of November, 2015, by the following vote:
AYES
NOES
ABSENT:
2
Empire EEO
Summary of Rates
Town of Queensbury
Effective 01/01/2016
LPPO$5P LPPO$10P LPPO$10P
High Low
Medical PMPM $175.25 $169.31 $158.20
Pharmacy Plans
10/20/40(10R)ECDHLP $257.63 $257.63 $257.63
10/25/50(10R)ECDHLP $255.63 $255.63 $255.63
TOTAL RATE
Med w/10/20/40(10R)ECDHLP $432.88 $426.94 $415.83
Med w/10/25/50(10R)ECDHLP $430.88 $424.94 $413.83
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 2016 product year. Plan options,such as the Preferred Retail Pharmacy option,and
formularies are filed and approved with CMS on an annual basis and could change effective 01/01/2016.
-ACA Insurer Fees are included in the quoted premium.The fee included is calculated on a prorated basis across the full
coverage period.
-This quote is based on a 01/01/2016 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 65 retired members,including 4 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.
-The contract holder must qualify as a large group within their state and have at least 51 full-time active employees.
-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.
9/15/2015 V.P.