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HomeMy WebLinkAbout2001 August 27, 2001 -' ,- Human Re'sourCes Manager " ~ '"' ": 1501 Truxtun Ave. Re:. Insurance Committee makeTup .- Dear Ms. ' · :-' ,,The city Ma Vnion ~' ,TArticle 18 Of our Memorandum of Understandtng states: . have agreed that all future, meeting &nd conferring and decisions regarding the ~stmcture - of medical/dental insurance coverage's shall take phlee through the Joliet citY~mpl~y~e Mediciil Insurance Committee. The Committee Shall Consist.ofrepresentati~6sfrom each When the Committee was established, there was an agreemem that we sh0'uld :- ha;,,e'aretiree representative sit in as an advisor to the 'committee On retiree issue~i The retiree advisor'did not have voting rights, nor have they' ever had.v0ting'-rightsi under~ the i ~rongiy object t° voting fights for retirees:being ~ven diScMs~il before a council committee without first meeting with all effected Uni°ns.~ .~, :: . ~'. :, ~' .,, ';." :" - -tint, her'0bje~ .to allowing uni ited est to sit t confer Sessions~ Which is exactly What the Committee m~eting are, Margaret Ursin Claims ~o an alternate representative'for the'retirees. Th ere'ale ne.Provisions for alterrdtes On the 'fiommittee eSp~ially for sory ositi°n,'. , · , ? _:~ .... "~ ~ {Both these issues need immediate TABLE OF CONTENTS · INTRODUCTION City of Bakersfield Introduction We have completed our evaluation of the City of Bakersfield's (City) 2002 benefit plan renewals. These coverages include: >> Blue Cross PPO, HMO, Medicare Risk and dental indemnity >> Kaiser HMO & Medicare Risk >> PacifiCare Secure Horizons Medicare Risk >> Dedicated Dental DHMO >> PacificDental DHMO >> Medical Eye Services vision >> PacifiCare Behavioral Health mental health and EAP >> HealthComp FSA program This report will summarize the renewal results, evaluate claim patterns and trends, illustrate projected 2002 premiums and total plan costs, and identify all renewal rates based on the current benefit designs. I SULTANTS S1 - RENEWAL COMMENTARY m m m m m .m mm m m m m mm m mm City of Bakersfield Renewal Commentary Renewal Summary · 2002 premiums for the City's medical, dental, Vision and mental health coverages are projected to increase 8.5%, or $806,843, to $10,342,297. Overall, medical premiums are increasing 10.4%, dental premiums are decreasing 5.3%, while the mental health, EAP, vision premiums and FSA program fees are not changing. This increase compares favorably to the increases that Buck is seeing for other clients in the central valley of California. · The medical plan increases are largely driven by health care trend. A renewal summary of each plan follows: I[ Renewal-Adiustment I% ~;I I 2°°2 ual IPremium Blue Cross PPO 6.8% $317,837 $4,981,616 Blue Cross HMO 14.3% $406,135 $3,310,666 Senior Secure - Medicare Risk 34.4% $16,913 $66,082 Kaiser HMO 9.5% $55,778 $640,309 Kaiser Medicare Risk 13.2% $1,188 $10,162 S~cure Horizons HMO 286.6% $54,788 $73,904 Blue Cross Dental Indemnity -9.4% ($51,586) $496,096 Dedicated Dental 0.0% $0 $105,207 PacificDental 2.8 % $5 ~790 $211,968 Medical Eye Services 0.0% $0 $164,057 PacifiCare Behavioral Health 0.0% $0 $277,730 HealthComp FSA 0.0% $0 $4,500 Total 8.5% $806,843 $10,342,297 2 %LTANTS City of Bakersfield Renewal Commentary Blue Cross' overall medical PPO/Rx renewal adjustment is 6.8%. The active's premiums are increasing 4.8%, while the retiree's premiums are increasing 11.6%. Blue Cross' renewal premiums include a 5% margin, which is Used to offset claim fluctuation. The active and retiree increases are very favorable in comparison to the increases in the recent past. Blue Cross' overall HMO renewal adjustment is 14.03%. The Senior Secure Medicare Risk premiums have increased 34.4%. Blue Cross' renewal premiums for the medical PPO/Rx and HMO coverages is $8,358,364. Kaiser's HMO premiums are increasing by 9.5%, and this is largely due to the increase in the base medical cost increase for 2002. The base medical cost increase stems from the rising costs in almost all sectors of the health care industry (e.g. labor shortages, medical technology, seismic safety laws and baby boomers increasing utilization of medical services). Kaiser's base medical cost increased 8.59% for 2002 in comparison to only 3.87% for 2001. Kaiser's Medicare Risk premiums are increasing by 13.24%, which is significantly lower than last year's increase. PacifiCare's Secure Horizons premiums are increasing by 286.6%, the result of the HCFA filed rates for Medicare Risk HMO plans. The early retiree premiums are increasing by 147.8%. This is due to the fact that there is no current membership in the early retiree plan, therefore PacifiCare provided manual rates for the City of Bakersfield. If there were membership, the demographic factors would have played a role in determining the 2002 premiums. 3 - ULTANTS City of Bakersfield Renewal Commentary The overall dental premium is decreasing by 5.3%. The Blue Cross dental plan is decreasing -9.4%. The recommendation to the City is to implement a rate pass for the Blue Cross dental premium since this portion of the plan is refunding. The Dedicated Dental premiums are renewing at current rates. Pacific Union Dental proposed a 5.5% increase for the 2002 premium rates, but after reviewing the renewal and negotiating with Pacific Union Dental, the 2002 premium rates are increasing by only 2.8%. PacifiCare Behavioral Health's MH/SA and EAP premium rates are renewing at the current rates. · Medical Eye Services (MES) Vision and Eyewear Only plans will be renewing at the current rates. MES has terminated its agreement with Security Life Insurance Company and would like to convert the City to MES Vision, the specialized health care service plan licensed by the CA Department of Managed Care. Due to the conversion, MES has also proposed a two-year rate guarantee for the Vision and Eyewear Only plans effective January 1, 2002. MES Vision is a fully-insured plan, and the City will have to sign a new agreement and receive updated contracts. All benefits and plan administration will remain the same under MES Vision. · HealthComp's Flexible Spending Account administration fees will be renewing at the current fees of $5.00 pepm. Projected 2001 Year-End Results (Blue Cross PPO & Dental Indemnity) · We are projecting a 2001 year-end surplus of $380,484. The active medical PPO plan is projected to have a $317,289 Surplus; the retiree medical PPO plan is projected to have a $12,661 surplus; the dental plan is projected to have a $50,534 surplus. The estimated accrued surplus as of 12/31/01 is projected to be $92,524 (i.e., 12/31/00 accumulated deficit of $287,960 less estimated 2001 year-end surplus of $380,484). This is a reflection of the improved experience in both 2000 and 2001. 4 SULTANTS City of Bakersfield Renewal Commentary · Projected 2001 medical PPO premium for the actives and retirees is $4,618,171, compared to total plan costs of $4,288,221. The total plan costs include paid claims, administration, reserve adjustment, retention and stop loss fees. This generates a loss ratio of 92.9%. The projected 2001 active medical PPO premium is $3,338,876, compared to $3,021,588 in plan costs. The projected 2001 retiree medical PPO premium is $1,279,295, compared to $1,266,633 in plan costs. · Projected 2001 dental premium is $551,300, compared to total plan costs of $500,766. This generates a 90.8% loss ratio. · Projected 2001 premium for all Blue Cross dividend eligible coverages (i.e., medical PPO and dental indemnity) is $5,169,471, compared to total plan costs of $4,788,987. The total loss ratio is projected to be 92.6%, which generates a projected $380,484 surplus. · The projected 2001 medical plan cost per employee per year (PEPY) is $6,188 (actives - $5,444; retirees - $9,179), compared to $6,664 (actives - $6,016; retirees - $9,270) in paid premium. The projected dental plan cost PEPY is $806, compared to $888 in paid premium. Claim Res,its & Trends · This City's medical PPO paid claims have remained fairly stable throughout the period from 6/1/00 - 6/1/01. The retiree plan has remained steady within the same experience period, although the month of March 2001 was significantly higher - driven by a large claim - but has normalized over the past months. 5 SULTANTS City of Bakersfield Renewal Commentary The dental claims have remained steady throughout the 6/1/00 - 6/1/01 experience period. The dental paid loss ratio is still above the 81.5% target loss ratio, with the projected 2001 paid loss ratio being 90.8%. The City's active medical PPO paid loss ratio dropped in 1999 to 80.8% from 102.5% in 1998, and increased slightly in 2000 to 83.1%. In 2001, the PPO paid loss ratio is projected to slightly decrease to 70.9%, while in 2002 the PPO paid loss ratio is projected to increase to 78.8%. The retiree paid loss ratio is expected to decrease in 2002. The following table provides medical PEPY comparative results: Premium Paid Claims Loss Ratio Premium Paid Claims Loss Ralio CY 1998 $3,518 $3,606 102.50°,4 CY 1998 $5,734 $5,715 99.68% CY 1999 $5,025 $4,059 80.77% CY 1999 $7,260 $8,429 116.09% CY 2000 $5,424 $4,507 83.08% CY 2000 $8,903 $6,818 76.57°/0 Proj CY200! $6,016 $4,266 70.90°/0 Proj CY2001 $9,270 $7,676 82.80% Proj CY 2002 $6,072 $4,783 78.77% Proj CY 2002 $10,742 $8,739 81.35% 6 ~LTANTS City of Bakersfield Renewal Commentary · The City's 2001 active PEPY paid claims are projected to decrease by 12% from 2000 experience levels, while the retiree PEPY paid claims are projected to increase 10.2%. · Prescription drug increases have continued to be a significant factor in the cost increase for the medical plans. Projected 2001 prescription drug claims are expected to increase by more than 18% per year for both the active and retired employees. Annual prescription drug trend has been averaging between 18% - 25% for the last few years. · A comparative summary of PEPY paid claims for the active and retiree plans follows: Medi~ I mDm~s Medical P,x Da~ PEPY % Ct~ange PEPY % Ctm~ PEPY % Change PEPY % Chan~ CY 1998 $2,948 -13.5% $658 8.9% CY 1998 $4,352 6.3% $1,364 30.8% CY 1999 $3,256 10.4% $803 22.0% CY 1999 $6,637 52.5% $1,791 31.3% CY 2000 $3,555 9.2% $951 18.5% CY2000 $4,811 -27.5% $2,007 12.0% Proj CY2001 $3,128 -12.0% $1,138 19.6% Proj CY2001 $5,304 10.2% $2,371 18.2% Proj CY 2002 $3,440 10.0% $1,343 18.0% Proj CY2002 $5,941 12.0% $2,798 18.0% Averalle 0.8% 17.4% 10.7% 22.1% 7 City of Bakersfield Renewal Commentary Large Claim Results For the 7/1/00-6/30/01 reporting period, the City had 22 active claimants with paid claims exceeding $10,000. No claimants exceeded $75,000. All claim amounts were below $47,436. Total claims above $10,000 were $439,636, or 25.3 % of total paid claims for that same reporting period. In that same period, the City had 17 retiree claimants with paid claims exceeding $10,000. One claimant exceeded $75,000 with $107,878 in paid claims. All other claim amounts were below $69,176. Total claims above $10,000 were $498,348, or 68.1% of total paid claims for that same reporting period. A comparative summary for 1999, 2000 and 7/1/00-6/30/01 follows: 1999 2000 7/00 - 6/01 1999 2000 7/00 - 6/01 Total Paid Claims $1,683,143 $1,923,299 $1,735,818 $982,330 $663,939 $731,967 Claims > $10,000 $623,213 $607,131 $439,626 $624,231 $424,982 $498,348 % Claims > $10,000 37.0% 31.6% 25.3% 63.5% 64.0% 68.1% 8 ~CO~I~L~TS City of Bakersfield Renewal Commentary Per Employee Per Year Costs · Projected 2002 PEPY premium for the City's PPO and HMO plans (active and retiree combined) is $5,755, which represents a 10.4% increase over 2001's $5,212 PEPY. The projected PPO and HMO 2002 PEPY for active employees is $5,770, which represents a 8.9% increase over 2001's $5,297 PEPY. The projected PPO and HMO 2002 PEPY for retired employees is $5,710, which represents an 15.2% increase over 2001 's $4,958 PEPY. · Projected 2002 PPO PEPY premium for all employees is $7,236, which represents a 6.9% increase over 2001's $6,769 PEPY. The projected PPO 2002 PEPY for active employees is $6,304, which represents a 4.9% increase over 2001's $6,009 PEPY. The projected PPO 2002 PEPY for retired employees is $10,796, which represents a 11.7% increase over 2001's $9,669 PEPY: · Projected 2002 HMO PEPY premium for all employees is $4,608, which represents a 15.0% increase over 2001's $4,007 PEPY. The projected 2002 active HMO PEPY is $5,312, which represents a 13.3% increase over 2001's $4,687 PEPY. The projected 2002 retired HMO PEPY is $2,836, which represents a 23.6% increase over 2001's $2,295 PEPY. · 'Projected 2002 dental PEPY premium is $673, which represents a 5.3% decrease under 2001's $711 PEPY. The 2002 dental indemnity PEPY is $805; the Dedicated Dental PEPY is $506; the PacificDental PEPY is $552. 9 LTANTS ILLUSTRATIONS City of Bakersfield 2000 Results Paid Premium $2,934,441 $1,228,681 $4,163,122 $480~134 $4,643,256 Plan Costs Paid Claims $2,438,024 $940,839 $3,378,863 $407,634 ' $3,786,497 Reserve Adjustment $71,451 ($77,831) ($6,380) $6,579 $199 Plan Administration/Retention $240,204 $61,272 $301,476 $29,180 $330,656 Stop Loss net of Recoveries $227,220 ($22,715) $204,505 $0 $204,505 Total Expenses/Fees $2,976,899 $901,565 $3,878,464 $443,393 $4,321,857 Net Balance ($42,458) $327,116 $284,657 $36,741 $321,399 2000 Enrollment 541 138 679 596 PEPY Results Paid Premium $5,424 $8,903 $6,131 $806 $6,937 Total Plan Cost $5,503 $6,533 $5,712 $744 $6,456 Loss Ratio 101.4% 73.4% 93.2% 92.3% 93.1% Notes: PEPY - Per Employee Per Year 10 CO ISULTANTS City of Bakersfield Projected 2001 Results Medical PPO/Rx I ^ct,ve Retiree *o,a, [ I Den's' I I *o's' I Paid Premium $3,338,876 $1,279,295 $4,618,171 $551,300 $5,169,471 Plan Costs Paid Claims $2,367,398 $1,059,228 $3,426,626 $434,654 $3,861,280 Reserve Adjustment $17,528 $24,561 $42,089 $4,864 $46,953 Margin $119,246 $54,189 $173,436 $21,976 $195,412 Plan Administration/Retention $274,059 $68,144 $342,203 $39,272 $381,475 Stop Loss $243,356 $60,510 $303,867 $0 $303,867 Total Expenses/Fees $3,021,588 $1,266,633 $4,288,221 $500,766 $4,788,987 Net Balance $317,289 $12,661 $329,950 $50,534 $380,484 Projected 2001 Enrollment 555 138 693 621 Projected PEPY Results Paid Premium $6,016 $9,270 $6,664 $888 $7,552 Total Plan Cost $5,444 $9,179 $6,188 $806 $6,994 Loss Ratio 90.5% 99.0% 92.9% 90.8% 92.6% Notes: PEPY - Per Employee Per Year ~ ~ ~CO~LTANTS City of BakerSfield Projected 2002 Renewal Analysis Plan Costs Paid Claims $2,611,615 $1,249,666 $3,861 281 $474,270 $4,335,551 Reserve Adjustment $61,054 $47,609 $108 664 $9,904 $118,568 Margin $133,633 $64,864 $198 497 $24,209 $227,706 Plan Administration/Retention $269,615 $70,613 $340 228 $38,956 $379,184 Stop Loss $239,410 $103,355 $342 765 $0 $342,765 Total Expenses/Fees $3,315,328 $1,536,107 $4,851 435 $547,339 $5,398,774 Projected 2002 Enrollment 546 143 689 616 Projected PEPY Renewal Adjustment 2002 Projected An'nual Premium $6,072 $10,742 $7,041 $889 $7,930 2001 Projected Annual Premium $6,016 $9,270 $6,664 $688 $7,552 Buck Renewal Adjustment 0.9% 15.9% 5.7% 0.1% 5.0% Blue Cross Renewal Adjustment 4.9% 11.7% 6.8% -9.4% 5.1% 12 ~LTANTS © o~ City of Bakersfield Actives PEPY Claims - Dental $90O $800 $70O $600 $5OO $400 $300 $200 $100 $0 CY 1998 CY 1999 CY 2000 Proj CY 2001 Proj CY 2002 23 ~LTANTS 8 ~ 8 8 8 8 8 8 8 8 8 8 ° City of Bakersfield Claims Exceeding $1 OK - Actives Claimaq~ Relationship Paid Claims Relationshin Paid Claims I Employee $156,638 Employee $157,838 Dependent $47,436 2 Dependent $94,959 Dependent $84,478 Employee $39,000 3 Dependent $75,934 Dependent $52,479 Dependent $38,009 4 Employee $35,079 Employee $47,260 Dependent $33,176 5 Employee $33,362 Employee $34,413 Dependent $27,584 6 Dependent $27,667 Dependent $32,922 Dependent $20,300 7 Employee $21,956 Dependent $25,641 Dependent $20,144 8 Employee $20,717 Employee $25,048 Dependent $19,169 9 Employee $17,411 Dependent $22,671 D~pendent $18,886 10 Employee $16,264 Dependent $21,049 Employee $18,321 11 Dependent $15,221 Employee $19,161 Dependent $16,683 12 Dependent $14,665 Dependent $16,973 Dependent $15,067 13 Dependent $14,658 Employee $16,131 Dependent $14,595 14 Dependent $14,160 Employee $16,111 Dependent $14,349 15 Dependent $14,041 Dependent $15,326 Employee $14,211 16 Employee $13,600 Dependent $14,853 Dependent $13,038 17 Dependent $13,584 Employee $14,114 Employee $13,028 18 Dependent $12,635 Employee $13,770 Dependent $12,909 19 Employee $10,662 Employee $13,640 Dependent $12,063 20 Employee $13,426 Dependent $10,979 21 Dependent $11,594 Employee $10,596 22 Employee $10,351 Employee $10,083 23 Employee $10,143 24 Employee $10,055 Claims Exceeding $10,000 $623,213 $699,447 $439,626 Pooling Level (during plan year) $0 $92,316 $0 Claims Exceeding $10,000 $623,213 $607,131 $439,626 Total Claims 37.0% 31.6% 25.3% Paid Claims $1,683,143 $1,923,299 $1,735,818 33 %LTANTS City of Bakersfield Claims Exceeding $1 OK - Retirees (~laimant Paid Claims Relationshio Paid Claims Relationshio Paid Claims 1 Dependent $279,680 Dependent $189,673 Employee $107,878 2 Dependent $129,225 Dependent $94,662 Employee $69,176 3 Employee $60,307 Employee $45,932 Employee $66,612 4 Employee $44,742 Employee $42,371 Dependent $29,953 5 Dependent $39,885 Dependent $35,262 Dependent $24,666 6 Dependent $21,496 Dependent $21,397 Employee $22,949 7 Employee $20,442 Dependent $20,540 Dependent $22,732 8 Dependent $20,080 Employee $16,903 Employee $21,484 9 Dependent $19,274 Dependent $16,296 Employee $20,895 10 Employee $15,115 Dependent $14,514 Employee $19,592 11 Employee $14,563 Dependent $13,950 Employee $15,708 12 Dependent $13,779 Employee $13,680 Employee $15,300 13 Employee $13,054 Employee $12,133 Employee $14,644 14 Dependent $12,269 Employee $11,053 Dependent $13,023 15 Dependent $10,951 Employee $11,988 16 Dependent $11,357 17 Dependent $10,391 Claims Exceeding $10,000 $703,911 $559,317 $498,348 Pooling Level (during plan year) $79,680 $134,335 $32,878 Claims Exceeding $10,000 $624,231 $424,982 $465,470 Total Claims 63.5% 64.0% 63.6% Paid Claims $982,330 $663,939 $731,967 34 %LTANTS A1 - RENEWAL SUMMARY City of Bakersfield App. 1 - Renewal Summary by Coverage 2001 2002 Medical $8,230,100 $9,082,739 10.4% $852,639 Dental $859,067 $813,271 -5.3% ($45,796) Vision $164,057 $164,057 0.0% $0 Mental Health $277,730 $277,730 0.0% $0 FSA ram 500 0.0% 35 ~LTANTS City of Bakersfield App. 1 - Renewal Summary by Employee Stares 2001 2002 Medical $6,266,674 $6,821,393 8.9% $554,719 Dental $859,067 $813,271 -5.3% ($45,796) Vision $1 54,598 $1 54,598 0.0% $0 Mental Health $245,648 $245,648 0.0% $0 FSA pro,qram $4~500 $4~500 0.0% $0 ITotals ~;7,530,487 ~8,039,410 6.8"/0 ~;508,923I Medical $1,963,426 $2,261,346 15.2% $297,920 Dental $0 $0 0.0% $0 Vision $9,459 $9,459 0.0% $0 Mental Health $32,082 $32,082 0.0% $0 JTotals ~i2,004,967 ~2,302,887 ' 14.9% ~297,920I 36 %SULTANTS City of Bakersfield App. 1 - Medical Renewal Summary Blue Cross of CA PPO - Active 546 $3,281,067 $3,437,823 4.8% $156,756 PPO - Retiree 143 $1,382,712 $1,543,793 11.6% $161,081 HMO - Active 535 $2,549,754 $2,906,118 14.0% $356,364 HMO - Retiree 133 $354,777 $404,548 14.0% $49,771 Senior Secure 60 $49,169 $66,082 34.4% $16, 913 Total 1,417 $7,617,479 $8,358,364 9.7% $740,885 Kaiser Permanente HMO - Active 102 $435,853 $477,452 9.5% $41,599 HMO - Retiree 19 $148,678 $162,857 9.5% $14,179 H MO - Medicare Risk 14 $8,974 $10,162 13.2% $1,188 Total 135 $593,505 $650,471 9.6% $56,966 PacifiCare HMO - Retiree 0 $0 $0 0.0% $0 HMO - Medicare Risk 27 $19,116 $73,904 ' 286.6% $54,788 Total 27 $19,116 $73,904 286.6% $54,788 37 BU~isULTANTS A2 - RATE SUMMARY City of Bakersfield App. 2 - Blue Cross PPO Premium Rates ~'1 PPO - Active Employee 101 $96.60 $101.22 $219.31 Employee + 1 131 $193.20 $202.44 $438.62 Family 314. ~290.22 ~304.08 $658.84 546 $3,281,067 $3,437,823 4.8% $156,756 PPO Retiree (monthly) Employee 84 $562.09 $627.57 Employee + I 56 $1,124.14 $1,255.10 Family 3 ~ 1 ~686.19 ' ~1 ~882.64 143 $1,382,712 $1,543,793 11.6% $161,081 ITotal PPO 689 ~4;663,779 ~4,981,616 6.8% ~317,837 I (1) Does not include 2% COBRA load. 38 %SULTANTS City of Bakersfield App. 2 - Blue Cross HMO Premium Rates HMO - Active Employee 109 $78.12 $89.04 $192.92 Employee + 1 112 $156.66 $178.92 $387.66 Family 314 ~229.32 ~;261.24 $566.02 535 $2,549,754 $2,906,118 14.0% $356,364 HMO - Retiree (monthly) 1 < 65 42 $171.94 $196.06 2 < 65 25 $355.82 $405.74 Family < 65 11 $501.93 $572.35 1 > 65 36 $104.82 $119.52 2 > 65 18 $210.37 $239.89 Family > 65 1 $366.36 $417.76 EE < 65/SP > 65 0 $183.85 $209.64 EE > 65/SP < 65 0 ~105.56 ~120.37 133 $354,777 $404,548 14.0 % $49,771 Senior Secure - Retiree 60 ~68.29 ~91.78 $49,169 $66,082 34.4% $16,913 ITotal HMO 728 $219531700 $3.3761748 14.3% ~,231048 II (1) Does not include 2% COBRA load. 39 ~CD~ISULTANTS City of Bakersfield App. 2 - Kaiser HMO Premium Rates Actives Employee 30 $76.90 $84.24 $182.51 Employee + I 19 $153.80 $168.48 $365.02 Family 53 9217.63 9238.40 $516.50 102 $435,853 $477,452 9.5% $41,599 Early Retirees (monthly) Employee 7 $166.62 $182.51 Employee + 1 8 $333.24 $365.02 Family 4 9471.53 ~516.50 19 $148,678 $162,857 9.5% $14,179 Senior Advantage (monthly) Medicare Retiree 8 $37.39 $42.34 2 Medicare 6 $74.78 $84.68 1 Medicare/1 < 65 0 $204.01 $224.85 2 Medicare/Dep < 65 0 $241.40 $267.19 I Medicare/2 Dep < 65 0 9370.63 ~407.36 14 $8,974 $10,162 13.2% $1,188 {1) Does not include 2% COBRA load. 40 ~OO~SULTANTS City of Bakersfield App. 2 - PacifiCare Secure Horizons Premium Rates Early Retirees (monthly) Employee 0 $301.10 $418.80 Employee + 1 0 $602.20 $909.00 Family 0 $734.07 $1~093.02 0 $0 $0 147.8% $0 Secure Horizons (monthly) Medicare Retiree 27 $59.00 $228.10 2 Medicare 0 $118.00 $456.20 1 Medicare/1 < 65 0 $360.10 $646.90 2 Medicare/Dep < 65 0 $249.87 $640.22 1 Medicare/2 Dep < 65 0 $491.97 $902.32 27 $19,116 $73,904 286.6% $54,788 41 ~NSULTANTS City of Bakersfield App. 2 - Dental Premium Rates B/ue Cross Employee 128 $13.44 $12.18 $26.39 Employee + 1 135 $26.88 $24.36 $52.78 Family 353 $44.52 $40.32 $87.36 616 $547,682 $496,096 -9.4% ($51,586) Dedicated Dental Employee 44 $8.08 $8.08 $17.51 Employee + 1 35 $16.15 $16.15 $34.99 Family 129 $24.23 $24.23 $52.50 208 $105,207 $105,207 0.0% SC) PacificDental Employee 77 $8.92 $9.17 ' $19.87 Employee + 1 99 $17.78 $18.28 $39.60 Family 208 $26.36 $27.10 $58.71 384 $206,178 $211,968 2.8% $5,790 (1) Does not include 2% COBRA load. 42 ~LTANTS City of Bakersfield App. 2 - Medical Eye Services Premium Rates Fee For Service Employee 116 $2.42 $2.42 $5.25 Employee + 1 157 $4.87 $4.87 $10.55 Family 346 ~6.35 ~;6.35 $13.75 619 $84,303 $84,303 0.0% $0 Eyeware Only- Actives Employee 228 $1.73 $1.73 $3.75 Employee + I 220 $3.46 $3.46 $7.50 Family 344 ~.50 ~;4.50 $9.75 792 $70,295 $70,295 0.0% $0 Eyeware Only - Retirees (monthly) Employee 68 $3.75 $3.75 Employee + 1 62 $7.50 $7.50 Family 7 ~;9.75 ~9.75 137 $9,459 $9,459 0.0% $0 (1) Does not include 2% COBRA load. 43 %LTANTS City of Bakersfield App. 2 - PBH Premium Rates Actives Employee 274 $3.48 $3.48 $7.54 Employee + 1 326 $5.72 $5.72 $12.37 Family 637 $8.96 $8.96 $19.41 1,237 $221,670 $221,670 0.0% $0 Retirees (monthly) Employee 155 $7.32 $7.32 Employee + 1 141 $9.34 $9.34 Family 22 $10.09 $10.09 318 $32,082 $32,082 0.0% $0 EAP (2) Employee 1~155 $1.73 $1.73 1,155 $23,978 $23,978 0.0% $0 (1) Does not include 2% COBRA load. 44 ~SULTANTS A3- MONTHLY ExP. RESULTS City of Bakersfield App. 3 - Monthly Blue Cross Experience Results Active Retiree Jan-01 $153,523 $40,444 $33,208 $227,176 $327,290 69.4% $63,982 $26,094 $90,076 $106,733 84.8% Feb-01 $85,299 $41,377 $31,751 $158,427 $326,575 48.5% $35,448 $21,170 $56,618 $109,606 51.7% Mar-01 $127,731 $71,648 $45,008 $244,388 $327,131 74.7% $103,592 $35,886 $139,478 $109,044 127.9% Apr-01 $99,773 $46,376 $27,609 $173,758 $323,577 53.7% $26,630 $20,103 $46,733 $105,109 44.5% May-01 $1 33,511 $48,175 $41,151 $222,838 $321,248 69.4% $89,531 $25,566 $115,097 $99,488 115.7% Jun-01 $159,589 $46,101 $38,746 $244,436 $319,267 76.6% $54,440 $25,897 $80,338 $110,158 72.9% Jul-01 $0 $0 $0 $0 $0 0.0% $0 $0 $0 $0 0.0% Aug-01 $0 $0 $0 $0. $0 0.0% $0 $0 $0 $0 0.0% Sep-01 $0 $0 $0 $0 $0 0.0% $0 $0 $0 $0 0.0% Oct-01 $o $o $o $o $o 0.0% $o $o $o $o 0.0% Nov-01 $0 $0 $0 $0 $0 0.0% $0 $0 $0 $0 0.0% De~-01 $o $o $o $o $o 0.0% $o 9o $o $o 0.0% YTDII 9759,427 9294,122 $217,474 91,271,023 $1,945,088 65.3%11 II $373,624 9154,716 $528,339 $639,647 82.6°/~ 45 ~CO~LTANTS City of Bakersfield App. 3 - Monthly Blue Cross Experience Results Jan-00 $180,191 $36,975 $39,881 $257,047 $283,338 90.7% $97,934 $22,317 $120,252 $101,008 119.1% Feb-00 $105,710 $38,014 $36,074 $179,798 $283,695 63.4% $107,941 $23,060 $131,001 $105,028 124.7% Mar(X) $249,789 $59,612 $41,189 $350,590 $263,150 123.8% ($53,644) $29,813 ($23,631) $101,511 -23.5°/0 Apr4)O $160,506 $36,697 $38,453 $235,656 $281,592 63.7% $44,182 $19,076 $63,257 $105,506 62.9°/0 May (X) $138,220 $44,283 $45,517 $228,020 $286,818 79.5% $71,244 $21,755 $92,999 $105,003 93.0°/0 Jun-00 $245,770 $36,842 $'20,128 $302,740 $282,297 107.2°/0 $53,361 $20,400 $73,760 $102,516 72.0% Jul-00 $157,734 $38,738 $30,871 $227,343 $280,223 81.1% $60,779 $20,823 $81,602 $100,003 81.6°/0 Aug-00 $168,259 $37,039 $45,048 $250,346 $283,816 88.2% $66,380 $23,798 $90,179 $105,531 85.5% Sep-00 $96,553 $60,988 $21,296 $178,837 $287,063 62.3% $54,315 $29,632 $83,947 $103,018 81.5% Oct-00 $187,000 $40,692 $29,145 $256,836 $287,541 89.3% $64,102 $20,056 $84,157 $104,023 80.9°/0 Nov-00 $98,215 $42,172 $25,205 $165,592 $287,183 57.7% $49,540 $25,232 $74,772 $103,521 72.2°/0 Dec-00 $135,352 ~42,673 ~41828 $2121853 $287,860 73.9°/0 ~t7,806 $201938 ~[~o81744 $1021013 67.4% YTd. I $1.923.299 ~14,725 ~)7,634 $2,845,658 O,414,575 63.3%1111 $663,939 $276,900 $940,839 $1,228,681 76.6°/,I 46 %LTANTS City of Bakersfield App. 3 - Monthly Blue Cross Experience Results ~VG Jan-99 $155,773 $25,180 $28,224 $209,177 $252,253 82.9% $58,125 $18,385 $76,510 $100,140 76.4% Feb-99 $242,698 $30,108 $33,296 $306,102 $253,983 120.5% $84,984 $18,656 $103,640 $86,231 120.2% Mar-99 $156,230 $30,328 $28,517 $215,074 $252,907 85.0% $57,274 $18,299 $75,573 $86,231 87.6% Apr-99 $136,339 $52,802 $27,939 $217,080 $253,262 85.7% $96,996 $32,239 $129,235 $83,847 154.1% May-99 $106,187 $32,827 $28,186 $167,200 $251,915 66.4% $105,815 $18,109 $123,924 $85,039 145.7% Jun-99 $188,224 $33,049 $34,374 $255,647 $250,229 102.20/0 $138,297 $20,074 $156,371 $87,821 180.3% Jul-99 $89,658 $30,353 $31,896 $151,906 $250,410 60.7% $46,131 $20,348 $66,478 $88,616 75.0% Aug-99 $119,538 $30,643 $22,183 $172,365 $252,687 68.20/0 $73,168 $20,819 $93,987 $88,616 106.1% Sep-99 $122,030 $31,124 $24,183 $177,336 $251,111 70.6% $57,876 $20,396 $78,272 $94,974 82.4% 0ct-99 $156,245 $45,933 $39,376 $241,554 $253,501 95.3% $57,222 $31,873 $89,096 $90,603 98.3% Nov-99 $132,015 $34,122 $27,491 $193,628 $251,908 76.9% $101,715 $23,897 $125,611 $90,603 138.6% Dec-99 $78,207 .~38,671 $28,914 $145,791 $9.~?,899 57.6% $104,728 $22,024 $126,752 $91,795 138.1% Y-rd.I $1.~,143 ~15,140 ~54,578 $2,452,861 0,027,063 81.0%1!!1 $982.330 $265,119 $1,247,449 $1,074,515 116.1°/J,! 47 ~SULTANTS A4- 2001 CONT. CHANGES City of Bakersfield App. 4 - Year 2002 Proposed Contract Changes The following enclosures detail the Year 2002 mandated contract changes for Blue Cross and Kaiser Permanente. 48 ~CO~I~~TS Blue Cross COMPANY STANDARD CONTRACT CHANGES Account Name City of Bakersfield VOUCHER # Case # C00403 Group # All Effective Date of Change(s): 1/1/2002 If not already included, the following changes will be added to the contract documents: Blue Cross HMO Plans · For groups with outpatient prescription drugs, exclude prescription drugs with over-the-counter equivalent. · For groups with outpatient prescription drugs, exclude prescription drags with over-the-counter equivalent. · For groups with outpatient prescription drugs, exclude prescription drags with over-the-counter equivalent. · If outpatient prescription drag benefits are provided, exclude drugs used to induce abortions. Mifeprestone is covered under medical when administered in the physician's office. · For outpatient prescription drugs, if the physician prescribes a 60-day supply for drags classified as Schedule II for the treatment of attention deficit disorders, the member has to pay double the amount of copayment for retail pharmacies. If the drags are obtained through the mail order, the copayment will remain the same as for any other prescription drag. · All groups. The process for "Getting Care When You Are Outside of California" has changed. The member will now call the BlueCard Access 800 phone number and be given the names and phone numbers of providers to contact for care. Prudent Buyer Plans · For groups with outpatient prescription drugs, exclude prescription drugs with over-the-counter equivalent. · The Preventive Care Center benefit is being replaced by a new preventive care benefit. There is a $25 copayment for participating providers and the deductible is waived. The benefit maximum is $250 per calendar year. Preventive care services provided by a non-participating provider are NOT covered. · If outpatient prescription drag benefits are provided, exclude drags used to induce abortions. Mifeprestone is covered under medical when administered in the physician's office. · For outpatient prescription drags, if the physician prescribes a 60-day supply for drags classified as Schedule II for the treatment of attention deficit disorders, the member has to pay double the amount of copayment for retail pharmacies. If the drags are obtained through the mail order, the copayment will remain the same as for any other prescription drug. BIII¢ Cross Plus Plans · For groups with outpatient prescription drags, exclude prescription drags with over-the-counter equivalent. · If outpatient prescription drag benefits are provided, exclude drugs used to induce abortions. Mifeprestone is covered under medical when administered in the physician's office. · For outpatient prescription drags, if the physician prescribes a 60-day supply for drags classified as Schedule II for the treatment of attention deficit disorders, the member has to pay double the amount of copayment for retail pharmacies. If the drags are obtained through the mail order, the copayment will remain the same as for any other prescription drug. · All groups. The process for "Away From Home Care" has changed. The member will now call the BlueCard Access 800 phone number and be given the names and phone nUmbers of providers to contact for care. · All groups. The process for "Getting Care When You Are Outside of California" has changed. The member will now call the BlueCard Access 800 phone nUmber and be given the names and phone numbers of providers to contact for care. Fee-For-Service Medical Plans · For with outpatient prescription drags, exclude prescription drugs with over-the-counter equivalent. groups · If outpatient prescription drag benefits are provided, exclude drags used to induce abortions. Mifeprestone is covered under medical when administered in the physician's office. · For outpatient prescription drugs, if the physician prescribes a 60-day supply for drags classified as Schedule H for the treatment of attention deficit disorders, the member has to pay double the amount of copayment for retail pharmacies. If the chugs are obtained through the mail order, the copayment will remain the same as for any other prescription drag. Contracts ~ddministration 1 n:~td formsh'enewal\chang¢.doc 6/27/2001 MBS 50-250 (for 125+), 251-2000, 2,000+, ED/PUBLIC I COMPANY STANDARD CONTRACT CHANGES BlueCard Plans For groups with outpatient prescription drags, exclude prescription drags with over-the-counter equivalent. · On Exclusive plans the applicable payment rate for non-participating providers will be 50% for Connetticut insureds. · If outpatient prescription drug benefits are provided, exclude drags used to induce abortions. Mifeprestone ~s covered under medical when administered in the physician's office. · For outpatient prescription drugs, if the physician prescribes a 60-day supply for drags classified as Schedule II for the treatment of attention deficit disorders, the member has to double the amount of for pay copayment retail pharmacies. If the drugs are obtained through the mail order, the copayment will remain the same as for any other prescription drug. Dental Plans Fee-For-Service Dental: None PPO Dental: · None Dental Net: · None Choice Dental: · None Employee Life and Accidental Death and Dismember Plans Employee Life Insurance: · Retroactive Credits/Retroactive Premiums - BC Life policies will give a maximum retroactive credit on premium paid of 12 months. Under BC Life policies, we will collect retroactive premium to the date a person first became insured. (These procedures differ from what Blue Cross/BC Life does for health coverage agreements/policies which only go backward 90 days.) Employee Accidental Death and Dismemberment Insurance: · Retroactive Credits/Retroactive premiums - BC Life policies will give a maximum retroactive credit on premium paid of 12 months. Under BC Life policies, we will collect retroactive premium to the date a person first became insured. (These procedures differ from what Blue Cross/BC Life does for health coverage agreements/policies which only go backward 90 days.) The exclusion for "medical or surgical treatment of illness" now reads "Medical or surgical treatment of · illness whether the loss results directly or indirectly from the treatment." · An exclusion for "infection" has been added. It reads "Any infection, unless it is pyogenic and occurs through and at the time of an accidental cut or wound." · The exclusion for "suicide" now reads "Suicide or attempted suicide, while sane or insane." · The exclusion for "commission of a felony" now reads "Commission of, or attempt to commit, an assault or felony." · The exclusion for "war" now reads "'War' means declared or undeclared war and includes resistance to armed aggression." · An exclusion for "riot" has been added. It reads "Participation in a riot. 'Riot' means all forms of public violence, disorder, or disturbance of the public by three assembled It does not peace or more persons together. matter whether there was common intent or not and it does not matter whether or not damage to person or property or unlawful act was the intent or the consequence of such disorder." · An exclusion for "being under the influence" has been added. It reads "Being under the influence of any drug or substance. Conviction is not necessary for determination of being under the influence. This does not apply if you are using a drag or substance prescribed for you by a physician. "Drag or substance' means any drug, narcotic, hallucinogen, barbiturate, amphetamine, gas or fumes, poison or any other controlled substance as defined in Title II of the Comprehensive Drag Abuse Prevention and Control Act of 1970, as such act now exists, or is amended from time to time." Contracts Administration 2 n :kqtd formsh'enewal~change.doc 6/27/2001 MBS 50-250 (for 125+), 25 i-2000, 2,000+, ED/PUBLIC I COMPANY STANDARD CONTRACT CHANGES I · An exclusion for "being intoxicated" has been added. It reads "Being intoxicated. Conviction is not necessary for determination of being intoxicated. "Intoxicated" means being legally intoxicated as determined by the laws of the jurisdiction where the accident occurred.." I · An Additional Benefit for Repatriation of Remains has been added. It provides an additional benefit for reimbursement of expenses in connection with the return of a persons remains for burial if the person was accidentally killed more than 75 miles from their principle residence. · Additional Benefit for Using a Seat Belt was added. It provides a benefit of 10% of the person's amount of insurance, up to $25,000, if they die in a car accidental while covered and wearing a seat belt. · An Additional Benefit for Your Children's Education has been added. I provides an amount equal to a I person's AD&D insurance, but, not more than $12,000 for post-highs school education. The benefit is paid our in 4 installments over a 4 year period. It is paid only to a child who is in a college or technical school. I I 1 1 ! ! I I Contracts Administration 3 n:kstd forms'wenewal\change.doc 6/27/2001 MBS 50-250 (for 125+), 251-2000, 2,000+, ED/PUBLIC I MANDATORY LEGISLATIVE CONTRACT CHANGES I If not already included, the following changes will be added to contract documents: Blue Cross HMO Plans · General anesthesia and facility charges for dental procedures rendered in a hospital or ASC are covered for I specified persons, based on clinical status, age, and health. (AB 2003, EOC disclosure made ) · Second medical opinions will be provided if requested by the member or their physician, subject to authorization. (AB 12, EOC disclosure'made ) I · FDA-approved contraceptive methods are covered if the plan includes coverage for prescription drags. Religious employers may choose to be exempt. (AB 39, EOC disclosure made ) · Coverage for the screening, diagnosis, and trealment of breast cancer, including prosthetics and reconstructive surgery, is explicitly stated. (SB 5, EOC disclosure made ) · is provided for the and treatment of diabetes, including supplies, equipment, education, Coverage management and nutrition therapy. (SB 64, EOC disclosure made ) · Benefits for emergency services are provided in connection with psychiatric emergency medical conditions. I (SB 349, EOC disclosure made ) · Severe mental & nervous disorders and serious emotional disturbances of children are not subject to benefit limits for mental and nervous disorders or substance abuse. (AB 88, EOC disclosure made) i · FDA-approved formulas and food products prescribed by a physician for the treatment of PKU are covered. (SB 148, EOC disclosure made) · The state regulator has changed from the Department of Corporations to the Department of Managed Health Care (AB78, EOC disclosure made ) I · Add provision for independent medical review for services denied as not medically necessary. (AB55, change made ) · Add disclosure of availability of guaranteed issue individual coverage for certain former group members. I (SB265, change made ) · Add reproductive health care disclosure. (AB525, change made ) I Prudent Buyer Plans · General anesthesia and facility charges for dental procedures rendered in a hospital or ASC are covered for specified persons, based on clinical status, age, and health. (AB 2003, EOC disclosure made ) i · FDA-approved contraceptive methods are covered if the plan includes coverage for prescription chugs. Religious employers may choose to be exempt. (AB 39, EOC disclosure made ) · Coverage for the screening, diagnosis, and treatment of breast cancer, including prosthetics and reconstructive surgery, is explicitly stated. (SB 5, EOC disclosure made ) I · Coverage is provided for the management and treatment of diabetes, including supplies, equipment, education, and nutrition therapy. (SB 64, EOC disclosure made ) · Benefits for emergency services are provided in connection with psychialric emergency medical conditions. I (SB 349, EOC disclosure made ) · Severe mental & nervous disorders and serious emotional disturbances of children are not subject to benefit limits for mental and nervous disorders or substance abuse. (AB 88, EOC disclosure made ) i · FDA-approved formulas and food products prescribed by a physician for the treatment of PKU are covered. (SB 148, EOC disclosure made ) · The state regulator has changed from the Department of Corporations to the Department of Managed Health Care (AB78, EOC disclosure made ) I · Add provision for independent medical review for services denied as not medically necessary. (AB55, change made ) · Add disclosure of availability of guaranteed issue individual coverage for certain former group members; I (SB265, change made ) · Add reproductive health care disclosure. (AB525, change made ) · Non-parity mental health benefits will no longer have a visit or day limit, e.g., inpatient and outpatient will have a dollar limit only. Substance abuse benefits will be separate from the non-parity mental health benefits I and will same including (DOL Parity ). remain the limits. and Federal Mental Health I i Contracts Administration 1 n :~std formsXrenewal\legis.doc 6/27/2001 MBS 50-250, 125+ cases, 251-2000, 2000+, ED/PUBLIC MANDATORY LEGISLATIVE CONTRACT CHANGES Blue Cross Plus Plans · General anesthesia and facility charges for dental procedures rendered in a hospital or ASC are covered for specified persons, based on clinical status, age, and health. (AB 2003, EOC disclosure made ) I · Second medical opinions will be provided if requested by the member or their physician, subject to · authorization. (AB 12, EOC disclosure made ) · FDA-approved contraceptive methods are covered if the plan includes coverage for prescription drags. I Religious employers may choose to be exempt. (AB 39, EOC disclosure made ) · Coverage for the screening, diagnosis, and treatment of breast cancer, including prosthetics and reconstructive surgery, is explicitly stated. (SB 5, EOC disclosure made ) · Coverage is provided for the management and treatment of diabetes, including supplies, equipment, education, I nutrition EOC disclosure made ) and therapy. (sl~ 64, · Benefits for emergency services are provided in connection with psychiatric emergency medical conditions. (SB 349, EOC disclosure made ) I · Severe mental & nervous disorders and serious emotional disturbances of children are not subject to benefit limits for mental and nervous disorders or substance abuse. (AB 88, EOC disclosure made ) · FDA-approved formulas and food products prescribed by a physician for the treatment of PKU are covered. I (SB 148, EOC disclosure made ) · · The state regulator has changed from the Department of Corporations to the Department of Managed Health Care (AB78, EOC disclosure made ) · Add provision for independent medical review for services denied as not medically necessary. (AB55, change I made ) · Add disclosure of availability of guaranteed issue individual coverage for certain former group members. (SB265, change made ) I · Add reproductive health care disclosure. (AB525, change made ) · Non-parity mental health benefits will remain the same except for the third tier (Out-of-Network). The third tier will no longer have a dollar limit. Substance abuse benefits will be separate from the non-parity mental i health benefits and will remain the same including limits. (DOL and Federal Mental Health Parity ). Fee-For-Service Medical Plans I · General anesthesia and facility charges for dental procedures rendered in a hospital or ASC are covered for specified persons, based on clinical status, age, and health. (AB 2003, certificate disclosure made ) · Coverage for the screening, diagnosis, and treatment of breast cancer, including prosthetics and reconstructive i surgery, is explicitly stated. (SB 5, certificate disclosure made ) · FDA-approved contraceptive methods are covered if the plan includes coverage for prescription drags. Religious employers may choose to be exempt. (SB 41, certificate disclosure made ) · Coverage is provided for the management and treatment of diabetes, including supplies, equipment, education, I and nutrition therapy. (SB 64, certificate disclosure made ) · Severe mental & nervous disorders not subject to mental & nervous benefit limits expanded to include major depression, panic disorder, obsessive-compulsive disorder, anorexia nervosa, bulimia, and serious emotional I disturbances of children. (AB 88, certificate disclosure made ) · FDA-approved formulas and food products prescribed by a physician for the treatment of PKU are covered. (SB 148, certificate disclosure made ) · Add provision for independent medical review for services denied as not medically necessary. (AB55, change I made ) · Add disclosure of availability of guaranteed issue individual coverage for certain former group members. (SB265, change made ) · Preventive care benefit for children changed to provide yearly exams. · Non-parity mental health benefits will no longer have a visit or day limit, e.g., inpatient and outpatient will have a dollar limit only. Substance abuse benefits will be separate from the non-parity mental health benefits i and will remain the same including limits. (DOL and Federal Mental Health Parity ). I Contracts ~4dministration 2 n:~std formsXrenewal\legi$.doc I 6/27/2001 MBS 50-250, 125+ cases, 251-2000, 2000+, ED/PUBLIC I MANDATORY LEGISLATIVE CONTRACT CHANGES I BlueCard Plans · General anesthesia and facility charges for dental procedures rendered in a hospital or ASC are covered for specified persons, based on clinical status, age, and health. (AB 2003, certificate disclosure made ) · Coverage for the screening, diagnosis, and treatment of breast including prosthetics and reconstructive cancer, surgery, is explicitly stated. (SB 5, certificate disclosure made ) · FDA-approved contraceptive methods are covered if the plan includes coverage for prescription drugs. I Religious employers may choose to be exempt. (SB 41, certificate disclosure made ) · Coverage is provided for the management and treatment of diabetes, including supplies, equipment, education, and nutrition therapy. (SB 64, certificate disclosure made ) · FDA-approved formulas and food products prescribed by a physician for the treatment of PKU are covered. (SB 148, certificate disclosure made) · Add provision for independent medical review for services denied as not medically necessary. (AB55, change made ) I · Add disclosure of availability of guaranteed issue individual coverage for certain former members. group (SB265, change made ) · Add reproductive health care disclosure. (AB525, change made ) I · For plans that have the combination of dollar per day maximum and visit per year maximum: Non-parity mental health benefits will no longer have a visit or day limit, e.g., inpatient and outpatient will have a dollar limit only. Substance abuse benefits will be separate from the non-parity mental health benefits i and will remain the same including limits. (DOL and Federal Mental Health Parity ). Arkansas · If Exclusive plan, the non-participating provider copayment is changed from 50% to 25%. (Aarkausas I Insurance Code 23-98-109. ) Connecticut · The law requiring certain benefits for mental or nervous disorders and substance abuse was changed and is no I longer extraterritorial. Residents of Connecticut will receive the benefits provided in the certificate. (Revised Connecticut Insurance Code 38a-514 by SB7032. ) Florida i · Extension of Benefits change. If pregnancy began while policy was in effect, provide extension of benefits for maternity expense. The extension must be for the period of that pregnancy and may not be based on total disability. (Revised interpretation of Florida Insurance Code 627.667.) · General anesthesia and facility charges for dental procedures rendered in a hospital or ASC are covered as I required under California AB2003, but extended to child under age 8. (Florida Insurance Code 627.6515 (8).) Georgia · General anesthesia and facility charges for dental procedures rendered in a hospital or ASC are covered as required under California AB2003, but extended to cover extensive facial or dental trauma. (SB66.) I Kentucky · Recognize registered nurse first assistant for covered services. (HB281. ) Louisiana i · Coverage for certain severe mental disorders expanded tO include: anorexiagoulimia, intermittent explosive disorder, posttraumatic stress disorder, psychosis (NOS) diagnosed in a child under 17 years, Rett's Disorder and Tourette's Disorder. (HB1300.) Maryland I Coverage for outpatient in vitro fertilization procedures deleted. Law requiring coverage amended and no longer extraterritorial. (Revised Maryland Insurance Code 15-810 by SBS16/HB350. ) Massachusetts · Inpatient services in a psychiatric hospital for mental or nervous disorders limited to 60 days per 12-month I period. Outpatient visits limited to 24 visits 12-month period. Treatment of biologically-based mental per disorders, including, but not limited to schizophrenia, schizoaffective disorder, major depressive disorder, bipolar disorder, paranoia and other psychotic disorders, obsessive-compulsive disorder, panic disorder, I delirium and dementia, affective disorders, and pervasive developmental disorder not subject to maximums and limitations applicable to mental or nervous disorders. Also, treatment of rape-related mental or emotional disorders and treatment of nonbiologically-based mental, behavioral or emotional disorders for a child under i age 19 which substantially interferes with functioning are not subject to the maximums and limitations applicable to mental or nervous disorders. If such child is stilling in treatment on 19th birthday, benefits will continue as long as the policy remains in effect and until a mental health professional determines that the · Contracts'~idministration 3 n :~std forms~-'enewal\legis.doc i 6/27/2001 MBS 50-250, ! 25+ cases, 251-2000, 2000+, ED/PUBLIC MANDATORY LEGISLATIVE CONTRACT CHANGES disorder no longer interferes with the child's functioning. (Massachusetts Insurance Code 175:47B, amended by SB2036. ) Montana · Coverage for treatment of inborn errors of metabolism, including diagnosis, monitoring, corrective lenses for conditions related to the inborn error of metabolism, medical foods formulated to be consumed or administered enterally under a physician's supervision. (HB266.) · Severe mental disorders includes: schizophrenia, schizoaffective disorder, bipolar disorders, major depression, panic disorder, obsessive-compulsive disorder and pervasive developmental disorder. (SB219.) New Hampshire · State Continuation of Coverage for divorced or surviving spouse age 55 or older will not terminate at remarriage of insured employee or former spouse. Coverage will terminate the earlier of the date the divorced or surviving spouse becomes eligible for participation in another employer plan or eligible for group Medicare. (SB105.) ·The $1,800 per calendar year maximum for food products modified to be low protein under the Enteral Formulas benefit is deleted. (Calif. SB 148, certificate disclosure made.) · State Continuation for Qualifying Insured Persons of 39 weeks is provided if the policy terminates for any reason. This applies to employees, surviving spouses and dependents covered under the plan. It does not apply to persons covered under another group health plan. (New Hampshire Insurance Code 415:18, VII (g)(4).) North Carolina · If Exclusive plan, the non-participating provider copayment is changed from 50% to 30%. (North Carolina Administrative Code 12.1803.) Oklahoma · If Exclusive plan, the non-participating provider copayment is changed from 50% to 30%. (HB1318.) · Definition of"emergency" for PPO plans changed to: Emergency is the sudden onset of a medical condition manifesting itself by acute symptoms of sufficient severity, including severe pain, such that the absence of immediate medical attention could reasonably be expected to result in: (1) placing the patient's health in serious jeopardy; (2) serious impairment to bodily fimctions; or (3) serious dysfunction of any bodily organ or part. We will have sole and fmal determination as to whether services were rendered in connection with an emergency. (Oklahoma HB2072. ) Dental Plans Dental Net · Second dental opinions will be provided if requested by the member or their dentist, subject to authorization. (AB 12, EOC disclosure made ) · The state regulator has changed from the of to the of Health Department Corporations Department Managed Care (AB78, EOC disclosure made ) ·Add provision for independent medical review for services denied as not medically necessary. (AB55, change made ) Choice Dental: · Second dental opinions will be provided if requested by' the member or their dentist, subject to authorization. Applies to the Dental Net portion only. (AB 12, EOC disclosure made ) ·The state regulator has changed from the Department of Corporations to the Depmhnent of Managed Health Care (AB78, EOC disclosure made ) · Add provision for independent medical review for services denied as not medically (AB55, change necessary. made ) PPO and FFS Dental Plans: · Add provision for independent medical review for services denied as not medically necessary. (AB55, change made ) Note: Additional legislative changes mandated prior to issuance of contract documents will be included. I I Contracts Administration 4 n :~std formsX~'enewal\legis.doc 6/27/2001 MBS 50-250, 125+ cases, 251-2000, 2000+, ED/PUBLIC Kaiser Permanente ~ KAISER PERMANENTE® Summary of benefit changes for the year 2002 Kaiser Permanente Traditional HMO and · B Kaiser Permanente Senior Advantage* All benefit changes will take effect January 1,2002. I Contraception I Certain contraceptives will be covered under the base benefit at no charge in the medical office. As contracts renew, contraception (the after" emergency "morning pill), injectable and implantable contraceptives, and intrauterine devices (IUDs) will be covered under the base benefit at no charge at the medical offices. Oral contraceptives and contraceptive I devices other than IUDs (e.g., cervical will continue caps, diaphragms) to be covered under the supplemental drug plan benefit at the drug plan copayment per days supply. This benefit is new for our California members; contraceptives are currently covered I supplemental drug at drug plan copayment and days supply. This under the benefit the change is a benefit enhancement for Senior Advantage and Medicare Cost direct-pay (DPA)/group members, effective January 1, 2002.* I [Optional] An exception will be made for religious groups as defined by Knox-Keene. I Optical Medically necessary therapeutic contact lenses will be covered for patients I with aniridia. (Aniridia is the congenital absence of an iris.) As contracts renew, medically necessary therapeutic contact lenses with or without refractive value will be covered under the base vision benefit for patients with aniridia. Coverage will be limited to up to two lenses per eye, per year. Extra lenses will be I provided at the Member Rate. This is a new benefit for our California members. This change is a benefit enhancement for Senior Advantage and Medicare Cost direct-paY (DPA)/group members, effective January 1, 2002.* I Up to five medically necessary replacement pediatric aphakic contact lenses Will be covered under the supplemental optical benefit. i (Aphakia is the absence of the crystalline lens of the eye.) As contracts renew, the supplemental optical benefit will cover up to five medically necessary replacement pediatric aphakic contact lenses per eye for children up to the age of 10. Additional lens replacements will be provided only when there is a change of at least 0.5 diopter. This change aligns benefits in the California Division. I *Medicare + Choice Plan changes are subject to Federal Health Care Financing 1 I Administration (HCFA) approval. KAISER 'PERMANENTE Supplemental optical exclusions As contracts renew, the exclusions that apply to the supplemental optical benefit will include (but are not limited to): · Lens adornment, such as engraving, faceting, and jeweling. · Progressive multifocal lenses and high-index lenses. · Ultraviolet-inhibiting lenses. · Tinted or other special-use lenses, such as polarized, polycarbonate, photochromic, or antireflective lenses, unless the lenses are medically required for the treatment of retinitis pigmentosa or macular degeneration. This change aligns benefits in the California Division. In Southern California: Adding coverage for tinted lenses only when medically required for retinitis pigmentosa or macular degeneration will be an enhancement for Senior Advantage direct-pay members.* Prosthesis Three postmastectomy brassieres every 12 months will be covered under the base prosthetics and orthotics (P&O) benefit. As contracts renew, three brassieres every 12 months will be covered under the base P&O benefit for members who require .an external breast prosthesis after mastectomy. Every 12 months, up to three replacement postmastectomy bras will be provided due to wear. No more than three bras will be provided within a 12-month period. This change aligns benefits in the California Division. This benefit is currently covered under Medicare, per Medicare guidelines. I I *Medicare + Choice Plan changes are subject to Federal Health Care Financing 2 I Administration (HCFA) approval. KAISER PERMANENTE, The changes below are being' made to the standard benefit plan. However, purchasers have the option to maintain their existing level of coverage for these items at an increased cost. Please refer to your specific rates and plan of benefits to determine the level of benefits quoted for your group. Ambulance transportation A $50 copayment will apply to medically necessary emergency ambulance transportation.- As contracts renew, a $50 copayment will apply to medically necessary emergency ambulance transportation. Medically necessary non-emergency ambulance transportation will remain covered at no charge. Not covered: · Non-medically necessary ambulance transportation. · Transportation by any means other than a licensed ambulance, including wheelchair and gumey van. This change takes effect at contract renewal for all Medicare group members.* Durable medical equipment, prosthetics, and orthotics A 20 percent copayment will apply to base and supplemental outpatient durable medical equipment (DME) and prosthetics and orthotics (P&O) products dispensed in the medical office, in the pharmacy,, or by a vendor. As contracts renew, a 20 percent copayment will apply to outpatient base and supplemental DME and P&O items dispensed in the medical office, in the pharmacy, or by a vendor. DME and P&O provided during a covered inpatient or skilled nursing facility (SNF) stay will continue to be provided at no charge under the base benefit. Internally implanted devices covered under the base P&O benefit will also continue to be provided at no charge. This change takes effect at contract renewal for all Medicare group members.* Emergency Department visits. A $50 copayment will apply to covered Emergency Department (ED) visits. As contracts renew, a $50 copayment will apply to covered ED visits. This copayment is still waived if the patient is admitted to the hospital within 24 hours for the same condition. This change takes effect at contract renewal for all Medicare group members.* I *Medicare + Choice Plan changes are subject to Federal Health Care Financing 3 I Administration (HCFA) approval. BAKERSFIELD MEMORANDUM August 8, 2001 TO: PERSONNEL COMMI'rrEE Councilmember Harold Hanson, Chair Councilmember Irma Carson ~,~' Councilmember Mark Salvaggio FROM: Carroll Hayden, Human Resources Manager~,~' t, SUBJECT: Date and time for Personnel Committee meeting A Personnel Committee meeting has been confirmed with the chair and members of the Committee for: Monday, August 27~ 4:00 p.m. City Manager's conference room CH:jp cc: Honorable Mayor and City Councilmembers Alan Tandy, City Manager ?:~m~o CarcollPe~so~mclwlxl.wpd