3.01 3.1
INSURANCE\Empire Blue Cross Medicare Advantage Renewal Contract 2018- 11-20-17
RESOLUTION AUTHORIZING 2018 RENEWAL CONTRACT FOR
EMPIRE BLUE CROSS MEDICARE ADVANTAGE INSURANCE PLAN
RESOLUTION NO. ,2017
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 2018 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 2018 with Empire MediBlue Freeom (PPO) Medicare Advantage with the
2018 monthly premium to be $439.69 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 20th day of November, 2017, by the following vote:
AYES
NOES
ABSENT:
2
Empire ESN
ss
Summary of Rates
Town of Queensbury
Effective 01/01/2018
Premium
PMPM
Medical: LPPO$5P
Medical Rate without ACA $132.05
Medical ACA Insurer Fee $29.56
Total Medical Rate $161.61
Prescription Drug:
15/25/45(10R)Preferred Network ECDHLP
Part D Waiver Plan Rate without ACA $155.81
Part D ACA Insurer Fee $6.01
Senior Rx Plus Rate without ACA $112.33
Senior RX Plus ACA Insurer Fee $3.93
Total Part D with Senior RX Plus Rate $278.08
Total Rate Medical with Senior RX Plus Rate $439.69
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 2018 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 01101/2018.
-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 2017 within the rating period.
-This quote is based on a 01/01/2018 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 74 retired members,including 5 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.
11/02/2017 V.P.
Town of Queensbury
Medicare Advantage Plans
Present plan Rates Effective 01/1/17
Present Plans Rates
Carrier Dr. Copay Hosp. Copay Rx Individual
Empire Blue Cross $5/$20 $100 $10/$20/$40 $445.93
Freedom PPO
Present Plan Renewal Rates effective 1/1/18
Present Plans Rates
Carrier Dr. Copay Hosp. Copay Rx % Inc. Ind.
Empire Blue Cross $5/$20 $100 $10/$20/$40 2.6%
$457.32
Freedom PPO
Empire Blue Cross $10/$20/$40 Preferred/
Freedom PPO $5/$20 $100 Standard $15/$25/$45 -1.4% $439.69
These Rates are subject to change due to differences in underwriting criteria and enrollment vs. proposed selection of benefits.
Created:October 2017