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5.01 5.1 INSURANCE \\ Empire Blue Cross Renewal Contracts 2021-2022 - 4-5-2021 RESOLUTION AUTHORIZING CONTRACTS FOR EMPLOYEE GROUP HEALTH INSURANCE PLANS WITH EMPIRE BLUE CROSS BLUE STTH SHIELD EFFECTIVE JULY 1, 2021 – JUNE 30, 2022 AND STRD BLUE VIEW VISION EFFECTIVE JULY 1, 2021 – JUNE 23, 2023 RESOLUTION NO. ________________________________________________________, 2021 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 Empire Blue Cross Blue Shield and Blue View Vision, and WHEREAS, the Town Board, in conjunction with Upstate Agency, LLC, has negotiated renewal contracts for the employee group health insurance plans with Empire Blue Cross Blue Shield and Blue View Vision, NOW, THEREFORE, BE IT RESOLVED, that the Queensbury Town Board hereby approves and authorizes renewal contracts for employee group health insurance plans with Empire Blue Cross Blue Shield and Blue View Vision with the monthly premiums and contract expiration dates as follows: INDIVIDUAL TWO-PARTY FAMILY EXPIRATION DATE 961.68 2809.38 2809.38 06/30/2022 PPO 887.30 2592.06 2592.06 06/30/2022 EPO 4.06 7.71 11.83 06/30/2023 VISION 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 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. th Duly adopted this 5 day of April, 2021, by the following vote: AYES : NOES : ABSENT: Empirees;000f uECRos An Anthem Company Services provided by Empre HeahhChalce Assurance.Inc.,licensee of the Blue Goss and Blue Shield Assodaton.an association of independent Blue Cross and Blue Shield plans THIRD PARTY ATTESTATION Town of Queensbury Group Number:990880 Funding Arrangement: Prospective Prospect ID:845837 Scenario ID:957479 In order to place clinical calls to members,Anthem receives member phone numbers as enrollment is processed by the Employer Group generally via the employer group's employer portal enrollment process and/or via the employer group's enrollment file.Anthem and its affiliates may contact cell phone numbers included in this file for purposes of administering health care benefits. As a result,the Employer Group must confirm the following: • The employee/member provides his/her phone number to his/her Employer Group as part of the employment process.This number may be periodically updated by the employee/member; • The Employer Group obtains these phone numbers directly from the employee/member. It does not obtain numbers through a lookup service or other third party;AND • The Employer Group will retain member records,including the enrollment application,for a period of four years and will produce such records to Anthem upon request in a timely manner. As part of Anthem's customary practice,Anthem will honor Do Not Call requests for cell phone numbers and landlines. Anthem abides by the Telephone Consumer Protection Act.If you wish to opt out of allowing Anthem to contact your members to discuss items related to their care and coverage,please contact your account representative. ❑ Opt in _., a '^�. �,,. �'x'�"-'sue n•R"� "�`"'e5.r�:x��s y � '�' �kr Sig; ture S ott eyi ed a dd ;:evrg i°-o�n bete. ff df a Gr u re �' n Print Name: Title: Signature: Date: Page 1 CD012621AD031821 Town of Queensbury_845837_990880_combol_NY201_Customer Exhibits_03-18-21_R CCM Empire F BLUECROSS An Anthem Company Bermes prodded by Empbe HeallhChoice Assurance,Inc.,licensee of the Blue Goss and Blue Shield Association,an association of independent Blue Gass and Blue Shield plans. Group Name: Town of Queensbury Group Number: 990880 Contract Period: July 01,2021-June 30,2022 Funding Arrangement Prospective Broker Name: Shelly Marcantonio Brokerage Name: UPSTATE AGENCY,LLC Sales Representative Name: BARRY GRIMMELL i irf r`s at :4f - - 1 Non Grandfathered Underwriting Approved Prospect ID: 845837 Scenario ID: 957479 Rating ID: 7590947 QD031621 ^s: ,•.e, ' t - ar, ' , t � iY e F O Bopay-Lega��f�Benefits €�'. 2Pr' �, 3_ ,. ?"'• �*,k-Y'A#d4d * #:.a'4--P N,,1 Renewal includes Be Active,nutritional counseling and LiveHealthOnline is$0 PCP copay. I 9 ''`er Ke: .'r t7%1a ,, :T iv z °k.,-{+ _ Non edacare 'W ciiicare _..__._.��. i'I h�J C:O _A• _,'I 'I lr. z.:- }i G. i i il+,.i Enrollment 0 1 1 0 0 0 Current Rates $961.68 ` $2,809,38 $2,809.38 $666.75 $1,571.62 $2,476.51 Renewal Rates $961.68 I $2,809.38 $2,809.38 $666.76 $1,571.62 $2,476.51 Rate Action I 0.00% Broker Commission Rate:$16.94 PCPM This renewal is contingent upon the group I 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). Z w tiA s s °nat rejSecion� 'e k e e'°da i ep#ed=dn be fif o i oup:e 4y _ «s<. �- � � •.�a Print Name: Title: Signature: Date: Page 2 Empire s V75' An Anthem Company Servkes provided by Empire HealthOtoze Asstranco.Inc.,licensee of the Blue Doss and Blue Shield Assocsabon,an association of independent Blue Crass and Blue Shield plans. f s - t{ g . , *� �S''a4 -pT & �. � lira �. 'RENEINALQ•-®�TE+SCI MARS.art v.' f 'az^t' '.'�:�� w ` fu s. �.-���•�, '� 's ze`-, ".'-.r... a,i .�ca .< T...,� ,.&11,1jivz,J Group Name: Town of Queensbury Group Number: 990880 Contract Period: July 01,2021-June 30,2022 Funding Arrangement: Prospective Broker Name: Shelly Marcantonio Brokerage Name: UPSTATE AGENCY,LLC Sales Representative Name: BARRY GRIMMELL yy Non Grandfathered Underwriting Approved Prospect ID: 845837 Scenario ID: 957479 Rating ID: 7590948 QD031621 " d t y a T °f Em pire EPO Ca pjy Legacy Benefits ��„ a �` 5 „' t r" y`.a .._ '.,.+ ...,t '4` ok y. `,'. .. ,_ .... `h, _..."6 t i -la ,._ Renewal includes Be Active,nutritional counseling and LiveHealthOnline is$0 PCP copay. x,1n r Nsr Rate Summary 's s s p' 4 Svrz -o F'�'� } �rr � � �� u � �+ �l. � ,�e,�, ra� ;mod Weir ' „ s� a Medicare s # t NQn care v' � ' ` `# ©$� �'' '%h�'A?�'`t� ��s -.�a st �' A a tY! lr r 1"1' 1:Mi h41"r t e I� tp Enrollment 46 34 60 0 1 1 Current Rates $887.30 $2,592.06 $2,592.06 $614.89 $1,449.37 $2,283.87 Renewal Rates $887.30 $2,592.06 $2,592.06 $614.89 $1,449.37 $2,283.87 Rate Action 0.00% Broker Commission Rate:$25.11 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): F § �A� ri Si mature Sect►on evteuvedtandi. e eptetroy-beh of the Grfou =6Y na�,., 'G'�x.' �.�....�u�,i.a*'s�..� Print Name: Title: Signature: Date: Page 3 CD012621AD031821 Town of Queensbury_845837_990880_combot NY201Customer Exhlbils_03.18.21_R • Non-HMO Disclaimers Town of Queensbury Group Number:990880 Contract Period:July 01,2021 -June 30,2022 Funding Arrangement: Prospective Combination Number: 1 Prospect ID: 845837 Scenario ID: 957479 •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 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. 'Empire 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 144 contracts. If the actual number of contracts differs by 10% or more, Empire reserves the right to revise the rates. •Empire 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. •Empire 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, Empire reserves the right to revise the rates. •The rates assume that COBRA enrollment represents less than 15%of the enrolled population. • Empire will automatically renew the group with the current benefits and attached renewal rates unless notified otherwise. Page 4 • Non-HMO Disclaimers Town of Queensbury Group Number: 990880 Contract Period:July 01,2021 -June 30,2022 Funding Arrangement: Prospective Combination Number: 1 Prospect ID: 845837 Scenario ID: 957479 '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 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. 'Employees residing in Hawaii may not enroll in EPO. 'This quote includes nonstandard benefits that are subject to approval by the New York Department of Financial Services. If the group accepts the proposal, Empire 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 Empire, 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 5 CD012621AD031821 Town of Queensbury_845837_990880_combot_NY201_Customer Exhibits_03-18-21_R BLUE VIEW VISIONSM RENEWAL QUOTE SUMMARY Group Name Town of Queensbury Group Number 990880 Effective Date 7/112021 End Date 6/30/2023 •J•••C';'j••••- BENEEfT;ISliMftiAfi.?'-c ; '•••;-'•• •;;,'?••-";-;';'" 'Benefits. •••,',-1Aln-Network - u o f N orke• 601;avmenr - -,„ •, ' • . Examination $10 • Not Applicable Eyeglass Lens $0 Not Applicable Frequency'of,Service; ••••• • ,• • - ' - •• • Exam 12 months 12 months Lenses 24 months 24 months Frames 24 months 24 months - Contact Lenses 24 months 24 months Piofeesiodal Servidee, •. • . • - • , `.• • - ' • ' " •• Comprehensive vision examination Covered in full after copayment up to$40 allowance Basic Lenses(Pair),- ' _ " • _ ! ' 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 • •,„ - ,• , ," :,•••• - • Eyeglasses frame allowance $150 allowance,then 20%off remaining balance up to$45 allowance, Contact Lenses • - • • _ ,• „„ •• ' _ • Elective Conventional $150 allowance,then 15%off remaining balance up to$105 allowance Elective Disposable $150 allowance(no additional discount) up to$105 allowance Non-Elective Contact Lenses Covered in full up to$210 allowance EVealass'Lens Enhancements,, •- - • ' - •-• ,• • • ' • , • 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 Applicable Discchints •••,•••••---"'„':.1 • • 'gr.;•-.;•" ihi-Netwcirk ' • - •' When obtaining eyewear from an In-Network provider,you may upgrade your new eyeglass lenses at theDiscount Lens Options - - discounted costs belokEyeglass lens copayment also applies. 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 Proqressive Lenses Standard Progressive • $65.00 Not Applicable Premium Tier 1 $85.00 Not Applicable Premium Tier 2 $95.00 - Not Applicable Premium Tier 3 $110.00 Not Applicable Anti Reflective Coating - - ' , '• 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 pricing Not Applicable e, , Dependent Age Limits • -Child to iStudent to 26 - _ vpttcx. ?t!, ;561;Z:j:4 1 of 2 Town of Queensbury-Renewal Quote Summary.xlsx 3/11/2021 z, ` NT L• TES3' _:.' ; k ;:, Total Rate Individual $4.06 2-Party $7.71 Family $11.83 4�a ;w. :'•CURRE It ONTiNL:RATE'S' r ;• a f 4,114 Total Rate Individual $4.17 2-Party $7.92 Family $12.15 C MISSIONS' t " 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. o.`:•v i-at]ISLrLA IN RS' :z` 6:`" x,; •The above rates are guaranteed for 24 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 this is a renewal for a group that qualified as large group prior to 1/1/2016.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 this is not a renewal,please notify us as soon as possible. •The above rates are based on 230 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. •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. C ; °.fi_ "7tI' ' .°• ,4.tSIGN TURESE0 ION + `" „ = x' •=sr' .',1 :�� ; 'V ` Reviewed and Accepted on behalf of the Group by: Print Name: Title: Signature: Date: Empire BlueCross 2 of 2 Town of Queensbury-Renewal Quote Summary.xlsx 3/11/2021