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2.4 2.4 INSURANCE\Empire MediBlue Freedom Medicare Advantage Renewal for 2021 - 10-5-2020 RESOLUTION AUTHORIZING 2021 RENEWAL CONTRACT FOR EMPIRE MEDIBLUE FREEDOM (PPO) MEDICARE ADVANTAGE INSURANCE RESOLUTION NO. ,2020 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 Upstate Agency LLC, has negotiated a renewal contract for the year 2021 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 2021 with Empire MediBlue Freedom (PPO) Medicare Advantage with the 2021 monthly premium to be $395.80 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 5th day of October, 2020, by the following vote: AYES : NOES : ABSENT: 2 Empfre © BLUECROSS An Anthem Company Group Retiree Solutions _ 1.„ t:> Town of Queensbury TABLE OF CONTENTS 'I August 26, 2020 Barbara Tierney Town of Queensbury 742 Bay Road Queensbury, NY 12804 Re: 2021 Empire MediBlue Freedom PPO and Part D Renewal for Town of Queensbury Ms. Tierney, We value your business and thank you for offering the Empire BlueCross Medicare Advantage plan to your retirees. We are committed to providing Town of Queensbury with solutions and services that provide meaningful value, while also helping your retirees stay active and healthy. Empire BlueCross continues to offer a suite of solutions to keep health care costs down, and comprehensive care management programs to improve health outcomes for your retirees. We take a holistic approach to health, offering support to retirees no matter where they fall on the health spectrum.We encourage your retirees to utilize our wellness programs such as LiveHealth Online, Silver Sneakers, 24/7 NurseLine and more—available at no additional cost. In 2014, the Affordable Care Act(ACA) imposed an annual fee on health insurance providers. As of 2021, this fee has been repealed and is no longer included in the premium development. Enclosed are your 2021 Renewal Development and Featured Plans and Rates exhibits, which reflect your Empire MediBlue Freedom PPO and Part D renewal for the January 1, 2021 contract year. The premium rate will remain unchanged at$395.80 per member per month (PMPM). Please review the rate stipulations in the attached 2021 Featured Plans and Rates exhibit. Also included below is the Benefit Change Summary, which outlines 2021 benefit changes. Formulary Changes: We want to remind you that your plan's Formulary is reviewed annually and changes to drug tiering, utilization management and coverage are effective January 1st. Your retirees will receive notice the formulary has been updated and how to view it online. They can call our Pharmacy Member Services department with questions. Medicare Part D plan drug coverage and members' accumulations are managed on a calendar year basis. Group Structure Changes: Due to administrative changes, Empire BlueCross will need to make an update to the group structure and issue ID Cards for the 2021 plan. Your Account Management team will keep you informed as we implement these changes. Open Enrollment/Annual Notice of Change (ANOC) Mailings: Let us know as soon as possible if and when you are holding an open enrollment period for your retirees eligible for this retirement benefit plan. To be compliant with CMS ANOC requirements, we will need 2021 RENEWAL LETTER confirmation of your renewal at least 45 days prior to your open enrollment period or renewal date (if you are not offering an open enrollment). Online Evidence of Coverage (EOC) and Formulary: Your retirees will continue to view the EOC and Formulary online. It's easy and convenient—they simply follow the steps listed in the flyer included in the ANOC mailing. At any time, retirees can call Member Services should they have questions or would like a printed copy of their plan documents. Retiree Communications: Please provide us with communications you distribute to your retirees. We will provide these documents to our Member Service department so Customer Service Representatives can continue to fully support your retirees. We are pleased to continue to provide you and your retirees with the personalized focus and dedicated service you have come to expect from us. We look forward to the opportunity to continue our partnership with you. Please do not hesitate to contact me if you have any questions. Sincerely, Barry Grimmell Account Management Executive Empire BlueCross Cc: Shelly Marcantonio, Upstate Agency Kyle Cordsen, Empire BlueCross Attachment: 2021 Featured Plans and Rates exhibit 2021 RENEWAL LETTER PPO 2021 Benefit Change Summary This summary tells you about Empire Blue Cross changes. Please note this is only a summary of changes. Summary of Important Medical Benefit Changes for 2021 Healthy Nutrition Benefit provides members with tools to change eating habits to help address a chronic condition. As part of the benefit,there are 12 telephonic nutritional counseling sessions plus a monthly shipment of non-perishable pantry staples to help a member try products that should be part of a healthy diet for their condition. Routine Vision Care Administration Routine vision care will now be administered by Blue View Vision Routine vision care with Blue View Vision $0 copay for an annual routine vision exam with a$100 eyewear allowance every 2 calendar years Blood glucose monitors Frequency limitation will change from once every 6 month to once every year. Medicare-covered acupuncture Covered for patients with chronic low back pain. Summary of Important Prescription Drug Benefit Changes for 2021 Description 2020 2021 Select Drugs We are increasing the day supply limit allowed for drugs covered Allowed up to a Allowed up to a under the Select Drugs benefit in order to promote medication 90-day supply 100-day supply adherence of low cost drugs,which treat several conditions common among seniors.We are not changing the ability to request fills for a lower day supply. Preferred Pharmacy Network • Bartell Drugs • Albertsons/Safeway • CVS Pharmacy • Bartell Drugs 2021 BENEFIT SUMMARY There are some changes to the list of preferred network • Food Lion • Costco pharmacies for 2021. Changes include adding and removing • Giant Eagle • CVS Pharmacy pharmacies. Members who have used a network pharmacy that is Pharmacy • Giant Eagle no longer preferred can still fill their prescriptions at that pharmacy • Hannaford Pharmacy or transfer their script to a 2021 preferred pharmacy. If a member • Harris Teeter • Harris Teeter continues to use a network pharmacy that is no longer preferred, Pharmacy Pharmacy they will pay the standard pharmacy copay. • H-E-B • H-E-B PHARMACY Please let us know if you would like to receive a network disruption PHARMACY • Kroger report. • Kroger • Publix • Roundy's • Roundy's Walmart(including •Walmart(not Sam's Club) including Sam's Club) Medicare Part D Limits Each year Medicare evaluates the limits used to define the Part D coverage phases. True Out-of-Pocket(TrOOP)Limit:Defines the end of the Part D $6,350 $6,550 Gap phase Medicare Catastrophic Minimum Copays Each year Medicare evaluates the minimum copays charged during the Catastrophic phase. Generic drugs $3.60 $3.70 Brand drugs $8.95 $9.20 Empire BlueCross is an HMO and an LPPO plan with a Medicare contract.Empire BlueCross Retiree Solutions is an LPPO plan with a Medicare contract.Empire BlueCross Retiree Solutions is the trade name of Anthem Insurance Companies,Inc.Enrollment in Empire BlueCross and Empire BlueCross Retiree Solutions depends on contract renewal.Services provided by Empire HealthChoice HMO,Inc.and/or Empire HealthChoice Assurance,Inc.,dba Empire BlueCross.Empire BlueCross Retiree Solutions is the trade name of Anthem Insurance Companies,Inc.Independent licensees of the Blue Cross and Blue Shield Association,an association of independent Blue Cross and Blue Shield plans. 2021 BENEFIT SUMMARY Featured Plans and Rates - MAPD Empire >'=`•> &u(CAoss Town of Queensbury to Eaxitc:yr�.;;rnpsm, Effective:January 01,2021 through December 31,2021 Medical Plan LPPO$5 with$100 deductible Pharmacy Plan $151$251$45(F-10R)ECDHLP Preferred Network Standard Members Monthly billed PMPM rates., Medical 90 $144.12 Pharmacy $251.68 Total PMPM Rate $395.80 Total monthly premium $35,622 Total annual premium $427,467 Plan(s)Selected: Authorized Signature: Title: Date: C.C. 1. Town of.Queensbury Assumptions&Conditions Effective 01/01/2021 through 12/31/202.1 Rates and benefits may need to be revised based on legislative,regulatory or other changes including,but not limited to,CMS guidance which becomes effective during the quoted product years.Plan limits and formularies are approved by CMS on an annual basis and can change in January each year.Also,all Part D plan changes,such as deductibles,copays, Part D and non-Part D drug coverage,may only be implemented in January of each year. o This quote assumes co-branding(plan sponsor name and/or logo is allowed on member materials including Medicare Advantage plan quality and health programs). o Participants have Medicare Parts A and B. o Eligibility for coverage for subscribers or their dependents is based on the subscriber meeting their employer's requirements for coverage of retiree medical benefits. o 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. o The employer will contribute 50%towards the premium. If the contribution strategy does change,Empire must be notified and reserves the right to re-evaluate its underwriting position.If more than one plan is offered to members,then Town of Queensbury shall offer Empire plan coverage to all eligible Members at terms and contribution levels that are no less favorable than those applicable to any other health coverage available through Town of Queensbury. o 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. o The pricing census included a total of 90 retired members,including 7 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. o Broker Commissions are included at$11.00 PMPM o 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. o 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. o 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. o Medical and prescription drug plans must be sold as a package. o 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. C.C. 2.