Loading...
HomeMy WebLinkAbout12/19/2007• B A K E R S F I E L D Staff: City Council members: John W. Stinson, Assistant City Manager Harold Hanson, Chair Steven Teglia, Administrative Analyst III David Couch Ken Weir SPECIAL MEETING NOTICE PERSONNEL COMMITTEE of the City Council -City of Bakersfield Wednesday, December 19, 2007 3:00 p.m. City Manager's Conference Room, Suite 201 Second Floor, City Hall, 1501 Truxtun Avenue, Bakersfield, CA AGENDA 1. ROLL CALL 2. ADOPT NOVEMBER 27, 2007 AGENDA SUMMARY REPORT 3. PUBLIC STATEMENTS 4. DEFERRED BUSINESS A. Discussion regarding Medical Insurance Renewals -Lozano, Stinson 5. COMMITTEE COMMENTS 6. ADJOURNMENT -- DR~~T B A K E R S F I E L D ~. Harold Hanson, Chair Staff: John W. Stinson David Couch Assistant City Manager Ken Weir AGENDA SUMMARY REPORT SPECIAL MEETING of the PERSONNEL COMMITTEE Tuesday, November 27, 2007 3:00 p.m. City Manager's Conference Room 1501 Truxtun Avenue; Bakersfield, California 93301 Called to Order at 3:16:52 PM 1. ROLL CALL Committee members present: Councilmember Harold Hanson, Chair Councilmember David Couch Councilmember Ken Weir Staff present: Alan Tandy, City Manager John W. Stinson, Assistant City Manager Rick Kirkwood, Management Assistant -City Manager's Office Steven Teglia, Administrative Analyst -City Manager's Office Virginia Gennaro, City Attorney Javier Lozano, Human Resources Manager Ginger Rubin, Benefits Clerk Pamela McCarthy, City Clerk Nelson Smith, Finance Director Allan Abney, Sergeant -Bakersfield Police Department Bob Bivens, Captain -Bakersfield Police Department Brian West, Detective -Bakersfield Police Department Brad Underwood, Operations Manager -Public Works Department Sam Russell, Communications Technician -Public Works Department Retired employees: Margaret Ursin and Sandee Morris Others: Chuck Waide, SEIU Local 521 Miscellaneous members of the media 2. ADOPT OCTOBER 31, 2007 AGENDA SUMMARY REPORT Adopted as submitted 3. PUBLIC STATEMENTS None DRAFT 4. DEFERRED BUSINESS A. Discussion re4arding Medical Insurance Renewals -Lozano, Stinson City Manager Tandy stated that this item is on the November 28, 2007 City Council meeting agenda. The Blue Cross and Kaiser policies have a 30-day term, with the 2007 rates remaining in effect. These terms were agreed to by both companies. The intent is to return to the City Council on January 16, 2008 with 11-month extensions of the contracts. The Insurance Committee and staff have not reached an agreement on insurance rates and terms. This will allow additional time for discussions to take place. The Unions have asked for more time to return to their memberships for further discussions. Once Council approves the final contracts in January, the City is required by law to mail the information to all employees, and then hold an open enrollment period and counseling sessions. There is insufficient time remaining in this calendar year to fulfill these requirements. Assistant City Manager Stinson reported that two meetings of the Insurance Committee have been held since the last meeting of the Personnel Committee. Staff provided a proposal as to the potential changes. Option A focuses primarily on establishing or increasing the office visit co-payments for the Blue Cross PPO and HMO, and the Kaiser HMO plans. Option B focuses on restructuring the prescription drug payments that would be spread out amongst these same three plans. The savings in both options is fairly equivalent. The Unions have been provided with this information and plan to meet soon to discuss it. Chuck Waide said that the hope is for Blue Cross to return with additional information and ideas. He projected that employees would not be happy with a $25 office visit co-payment, and suggested that this increase be applied to visits to specialists only. He also suggested an option where the rate increases would be a combination of office visit co-payments and prescription drug co- payments, rather than one or the other. In response to a question from Committee member Weir, the adjustments made for 2006 were discussed. There were no adjustments made for 2007. The Committee unanimously agreed to staff s recommendation that will be presented to the full City Council on November 28, 2007 to approve all of the contracts, with 3 of them to be on a 30-day basis and projected extensions for 11 months. City Manager Tandy recommended that the Personnel Committee meet again in December. The contract extensions must be on the agenda for the January 16, 2008 City Council meeting. 5. COMMITTEE COMMENTS Committee Chair Hanson strongly recommended that the 2008 process begin by September 1, 2008. Human Resources Manager Lozano indicated that the schedule is already in place. 6. ADJOURNMENT The meeting was adjourned at 3:46:56 PM S:\Council Committees\2007\07 Personnel\November 27\November 27 ASR.doc Page 2 O O a~ U N i~. ~ ¢ O ooU ,-+ M .-~ I ~ ~ ~ ~ Q ~ y O W ~ O Q°a +~~-+ .~ O U U o .~ ~ ~ U ~(~E~~ i V -tiN ~ ~ ~ ~ ti ~ i ~ O c~ 6' bA Q 'b s ., «3 OA s., C O . ~ ~ ~ ~ ~ N ~; ~ ~ a o ~ o ~ S o ~ ~ b ' M Q . U + ~ ~ ~' '" I ~ ~ O . ~ bU ~~~ .~ > b~ o. a~ o w o b ~ ~ ~ O a v~ ~ a~ w O o x ~ ~ o •`~ ~ ~ 0 a~i U ~ ~ ~, °on c ~ o ~Q ~a zb A N • • • • • • • • • • • 0 a ' ~ ~ ~ •~ ~ ~ Y ~ ~, ~w i • E-i a oo U + ~ ~~ °~ U p4 V ~ ' + ~ ~ ~ y ~ - ~~ ~ ~ ~~ cd ~~ ~ o ,~ x U ~ o ~ a ~~Y o ~~ ~. ~ ~ ~ o 3 ~ Sx xz ~~ ' z W QI b "~ C . `~i e~ ~. w+ O O I ~°o Ci O w .~ C 3 a • • Item # 1 The termination provisions on the current Kaiser contract states: Group may terminate this Agreement effective December 24 by giving at least 15 days prior written notice to Health Plan and remitting all amounts payable to this Agreement, including Premiums, for the period prior fo the termination date. Item # 2 Blue Cross response regarding if KMC is approved provider for trauma emergency. Kern Medical Center is absolutely not a provider and there is no current indication that we are in talks with them. If an employee goes to the trauma center and it is a true emergency- it will be treated as an emergency as defined by The City's benefit plan. If an employee goes fo fhat facility and it is NOT a true emergency- it will be treated as non-PAR based on their benefit plan Item #3 What would be the % Savings if the OOP Max was recommended to: $1,500 Individual / $4,500 Family? I will certainly have Blue Cross provide us with a quote for this plan design option. However, please note that the underwriter for the City is currently on vacation this week and you will not get a quick turnaround on this request as another underwriter needs fo fill-in. 1 will certainly push to get this turned around ASAP. Item #4 This is related to the '08 Blue Cross Standard Contract change which was accepted by the City. Rx plans will require that compound medications be dispensed by a participating pharmacy and specialty pharmacy drugs must be obtained using the specialty pharmacy program. (Applies fo both HMO and PPO plans) These drugs can change at any time and not all drugs are on the list For a list of additional specialty medication offered through PrecisionRx please visit www.precisionRx.com. CITY OF BAKERSFIELD INSURANCE COMMITTEE REQUESTED ITEMS FOR DECEMBER 11, 2007 MTG. 1. City is strongly considering the PPO plan design option of $25 OV copay (not subject to deductible) for 3.43% savings. I need to confirm that flat copay only applies to office visits but 90/60 coinsurance still applies for all other services. What about specialist visits $25 OV copay or 90/60 coinsurance? What about therapy visits? The $25 Office Visit Copay applies to in-network physician (including specialist) visits only. Out-of- network office visits are subject to the OON coinsurance level and the deductible. 2. If there's no formulary on their current plans, then why can't they get the drugs they want? For example, they are forced to take generics for the following drugs: Protonix Previcid Prilosec We have PA step therapy edits on the drugs that were mentioned in the e- mail. The preferred PPI drugs are Prevacid and Protonix, which are both brand drugs, and Omeprazole, which is the generic for Prilosec. If a member tries to get anon-preferred PPI drug, then it will reject for prior authorization. If the patient meets the PA criteria then the approval will be loaded. 3. What is the estimated % savings if the Blue Cross PPO plan OOP Max was $1,500 individual/$4,500 family? The estimated % savings is 0.86% to the total rate. The overall dollar savings is $95,060 and is included in the revised plan design options spreadsheet. Please see attachment titled "Plan Change Savings Summary Update". 4. Javier requested actual premium rates for Option A as presented to Insurance Committee which included the following recommended plan design changes: Blue Cross PPO -increase ov copay from coins to $25 Blue Cross HMO -increase ov copay from $20 to $25 Kaiser -increase ov copay from $20 to $25 Revised Blue Cross and Kaiser Premium rates for Option A are included in the spreadsheet titled "Rates 2008 for Option A Plan Design Changes". 5. Have Blue Cross quote a voluntary dental PPO plan for the retirees only effective 1 /1 /08. Blue Cross is only willing to quote a voluntary dental plan design on a full takeover basis. In other words, the City would have to terminate all other voluntary dental plans including Pacific Union Dental. The rates provided in the "Retiree Voluntary Dental Rates" are net of commission. Three different plan design options are provided. Both the rates and the corresponding plan design summaries are attached. Blue Cross has a minimum participation requirement of the greater of 40 lives or 25% participation. 6. What is savings if Blue Cross takes over the entire Kaiser population effective 1 /1 /08? Blue Cross is willing to provide a 1.0% discount to HMO active and early retiree rates only. Jim provided an analysis of the additional cost to the overall City's plan (due to higher Blue Cross rates) see attachment titled "Blue Cross Costs Without Kaiser". 7. Have Kaiser quote keeping only the early retirees and Medicare eligible retiree coverage and losing actives effective 1/1/08. Kaiser declined to provide a quote for the retiree only population due to the population health risk. 8. The City is considering the 3-tier rx plan design option which includes a formulary. Please provide me with the formulary or link to the formulary that would apply to the plan design rx options quoted for the City. Please see attached `BCC_Generic Formulary" file. 9. Need explanation on how the Blue Cross reserves work. Details previously provided under separate email cover. Blue Cross Generic Prescription Drug Formulary .~ The Blue Cross of California Generic Prescription Drug Formulary is a list of generic drugs covered under your benefit These are commonly prescribed Food and Drug Administration (FDA)-approved drugs chosen by Blue Cross of California for their value and effectiveness. The Blue Cross Generic Prescription Drug Formulary is updated quarterly and is subject to change without prior notification. To check for regular updates to the formulary, please visit us on the web at www.bluecrossca.com. Alternatively, you can contact the Customer Service Center at the number listed on your Blue Cross ID card. We encourage you to share this drug list with your doctor. This program is designed to encourage appropriate and cost-effective use of medications. Drugs included in this program are generally those that have a high side effect potential, those that should be reserved for a specific FDA indication. or those tnat nave a nign misuse or aouse potential. If your doctor prescribes a medication that requires prior authorization for benefit coverage, please ask your doctor to complete a Prior Authorization of Benefit Form and submit it to Blue Cross. To obtain a list of drugs which require Prior Authorization for Benefit Coverage, please contact the Customer Service Center at the number listed on your Blue Cross ID card. tl1~~I~C~(~IC1~.~~S~e\~u~ A brand name drug is one that is developed, patented, and marketed by the original drug manufacturer. Until the patent expires, no other companies can produce that same particular brand name drug which keeps the price relatively high. A generic drug contains the same active ingredient as its brand name counterpart. A generic drug may be manufactured by various drug companies after the original patent expires. A generic drug is identical to the brand name drug in dosage form, strength, route of administration, quality, and intended uses. Generics may differ from their brand name equivalent in color and or shape. But both brands and generics have to meet the same strict safety, purity, and performance standards governed by the FDA. In order to minimize the potential for adverse drug reactions due to over utilization, Blue Cross has implemented an upper dispensing limit on select medications. These quantities were determined based on the FDA (Food and Drug Administration) dosing recommendations. The quantity limits adopted by Blue Cross should allow for a medically appropriate quantity for most conditions. However, if your doctor has determined that it is medically necessary for you to take a larger amount, please ask your doctor to submit a prior authorization of benefits request to have the additional amount reviewed for coverage. Certain medications require that your physician carefully monitor the dosage that you are on to achieve optimal effect while preventing adverse side effects. For these select few drugs, it is recommended that you NOT switch between the brand and generic version of the drug. If you are already on a generic version, it is recommended that you continue taking the generic version. If you are already on the brand name version, it is recommended that you continue taking the brand name drug. The following is a list of narrow therapeutic index drugs: Cordarone, Paceron, Tegretol, Lanoxin, Synthroid, Levoxyl, Dilantin, Phenytek, Coumadin, Sandimmune, Neoral, Gengraf, Eskalith, Lithobid, Uniphyl, Elixophyllin, Depakote, Depakote ER, and Depakene. Your pharmacy benefit will provide coverage for these brand name medications if you are currently on a brand name version. The first column lists the brand name or common name of a given drug, and is for reference purposes only. With the exception of a few narrow therapeutic index drugs and some insulins, brand name medications are NOT covered under your pharmacy benefit plan. The second column lists the generic name or the name of the active ingredient(s) of the drug. Your benefit plan provides coverage for these generic medications. If your physician prescribed a medication that does not appear on this list, the medication may not be covered under your pharmacy benefit. Please share this list with your doctor and ask him/her to prescribe a generic alternative drug that is medically appropriate for your condition and is listed on this Formulary. Certain drugs may be plan specific and are not listed on this Blue Cross Generic Prescription Drug Formulary. Please call the Customer Service Accu-Chek Test Strips Accupril Accuretic Accutane Aclovate Actifed w/ Codeine Actigal I Actiq Adalat CC Adderall Agrylin Vospair Aldactazide Aldactone Aldomet Aldoril Alesse Allegra Alphagan alprazolam extended release Amaryl Amicar Ambien Amoxil Anafranil Anaprox Ansaid Antabuse Anusol HC Apresoline Apresazide Aralen AriStocort Armour Thyroid Artane Atarax Arava Ativan Atrovent Augmentin Auralgan AVC Cream Axid Aygestin Azo-Gantrisin Azulfidine Bacitracin Opth Bacticin Bactrim/DS B-Complex Vit Plus Belladonna & Opium Bellergal Bellergal-S Benemid number listed on your Blue Cross ID card if you have questions regarding your benefit or questions regarding a specific drug coverage. The hearing and speech impaired may contact us using the TTD number at 1-877-247-1657 for additional information. Hours of operation are Monday through Thursday 8AM- 6PM and Friday 8AM- 3PM. You may also visit us on the web at www.bluecrossca.com. Regular updates to the Formulary as well as other pharmacy program information are available here. Accu-Chek BS Test Strips Quinapril Quinapril/HCTZ Isotretinoin Aclometasone P-Ephed/Cod/Triprol Ursodiol Fentanyl Lolli-pops Nifedipine SR Amphetamine Salt Combo Anagrelide Albuterol HCTZ/Spironolactone Spironolactone Methyldopa Methyldopa/HCTZ Lessina, Aviane, Lutera Fexofenadine Brimonidine Xanax XR Glimepiride Aminocaproic Acid Zolpidem Amoxicillin Clomipramine Naproxen Sodium Flurbiprofen Disulfiram Hydrocortisone Hydralazine Hydralazine/HCTZ Chloroquine Triamcinolone Thyroid Trihexyphenidyl Hydroxyzine Leflunomide Lorazepam Ipratropium Inhal Soln Amoxicillin/Clavulanate Antipyrine/Benzocaine/Glycerin Sulfanilamide Nizatidine Norethindrone Su If isoxazol e/Phe nazopy Sulfasalazine Bacitracin Bacitracin Su Ifamethoxazole~TM P Multivits, Therap w-Fe, Hematin Opium/Belladonna Alkaloids Ergot/Bellad Alk/PB Ergot/Belladonna/PB Probenecid • - • - Bentyl Dicyclomine Desyrel Trazodone Benzac AC Benzoyl Peroxide Dexedrine D-Amphetamine Sulfate Benzamycin Erythromycin/Benzoyl Peroxide Diabeta Glyburide Betagan Levobunolol Diabinese Chlorpropamide Betapace Sotalol Diamox Acetazolamide Betoptic Betaxolol Dicloxacilin Dicloxacilin Biaxin/XL Clarithromycin Diflucan Fluconazole Bicitra Citric Acid/Sodium Citrate Dilacor/XR Diltiazem Blephamide Na Sulfacetm/Prednisol Ac Dilantin Phenytoin Blocadren Timolol Maleate Dilaudid Hydromorphone Brevicon Noreth-Eth Estrad Diprolene Betameth Dipro/Prop Gly Bromfed P-Ephed/BR-Phenir Diprosone Betamethasone Dipro Buspar Buspirone Disalcid Salsalate Cafergot Ergotamine Tartrate/Gaff Ditropan Oxybutynin Galan/SR Verapamil Dolobid Diflunisal Capoten Captopril Dolophine Methadone Capozide Captopril/HCTZ Domeboro Otic Acetic Acid/Aluminum Acet Carafate Sucraltate Donnatal Belladonna Alks/P-Barb Cardene Nicardipine Dostinex Cabergoline Cardizem Diltiazem Duragesic Fentanyl Patch Cardura Doxazosin Duricef Cefadroxil Carmol RE Urea 40 gel Dyazide HCTZ/Triamterene Catapres Clonidine Dymelor Acetohexamide Ceclor/CD Cefaclor Dynacin Minocycline Ceftin Cefuroxime Dynacin Isradipine Cefzil Cefprozil Dynapen Dicloxacillin Celexa Citalopram E.E.S. Erythromycin Ethylsuc Chronulac Lactulose Effexor Venlafaxine Ciloxan Ciprofloxacin Efudex fluorouracil Cipro Ciprofloxacin Elavil Amitriptyline Cleocin Clindamycin HCL Eldepryl Selegiline Cleocin-T Clindamycin Phosphate Elixophyllin Theophylline Climara Estradiol Patch Elocon Mometasone Clinoril Sulindac Empirin w/ Codeine Codeine/Aspirin Clozaril Clozapine Enpresse Levonorges/Eth Estra Codimal DH Phenyleph/Hydrocod/Pyr Entex LA Guaifenesin/Phenylephrine Cogentin Benztropine E-Pilo-6 Polocarpine/Epi Bit Colchicine Colchicine Equanil Meprobamate Colestid Colestipol Eryc Erythromycin Base Colestid Ganules Colestipol Erygel Erythromycin Base/Ethanol Colyte Sod Sulf/Sod/NAHCO3/KCUPEG's Erythrocin Erythromycin Stearate Combipres Clonidine/Chlorthalidone Esclim Estradiol Patch Compazine Prochlorperazine Eskalith/CR Lithium Copegus Ribivirin Estrace Estradiol Cordarone Amiodarone Eulexin Flutamide Corgard Nadolol Extendryl Phenyleph/Chlor/Scop Cortef Hydrocortisone Feldene Piroxicam Cortisporin Otic Sol/Susp Neomy/Polymyx B Sulf/HC Fenofibrate Lofibra Cortisporin Opth Oint Neomy/Bacitrac ZN/Poly/HC Fioricet Acetaminophen/Gaff/Butalb Cortisporin Otic Susp Neomy Sulf/Polymyx B/HC Fioricet w/codeine Cod/apap/caffein/butalb Cortone Cortisone Flagyl Metronidazole Coumadin Warfarin Flarex Fluorometholone Cutivate Fluticasone Flexeril Cyclobenzaprine Cyclocort Amcinonide Flonase Fluticasone Cyclogyl Cyclopentolate Florinef Fludrocortisone Cylert Pemoline Floxin Ofloxacin Cytotec Misoprostol Flumadine Rimantadine Dalmane Flurazepam FML Fluorometholone Darvocet-N Propoxyphene/APAP Folic Acid Folic Acid Darvon Propoxyphene Gantrisin Sulfisoxazole Daypro Oxaprozin Garamycin Gentamicin DDAVP Desmopressin Glucagon Kit Glucagon Decadron Dexamethasone Glucophage/XR Metformin/ER Deconamine SR P-eph/Chlor Glucotrol/XL Glipizide/ER Deltasone Prednisone Glucovance Glyburide/Metformin Demerol Meperidine Glynase Glyburide, Micronized Demulen Kelnor, Zovia Halcion Triazolam Depakene Valproic Acid Haldol Haloperidol Depakote/ER Divalproex/ER Histinex HC Phenyleph/Hydrocodone/CP Dermatop Prednicarbate Histinex PV P-Ephed/Hydrocod/CP Desogen Apri, Reclipsen, Solia Histussin D P-Ephed/Hydrocod Desowen Desonide Humalog Insulin Lispro Desquam-X Benzoyl Peroxide Humalog Mix 75/25 Insulin NPL/Insulin Lispro Humatin Humulin 50/50 Humulin 70/30 Humulin L Humulin N Humulin R Hycotuss Hydergine Hydrea Hycodan hydrochlorothiazide/moexipril Hydro-Diuril Hygroton Hytone Hytrin Ilotycin Imdur Inderal Inderide Indocin/SR Inflamase Forte Intal I smo Isoniazid Isoptin/SR Isordil Kayexalate K-Dur Keflex Kenalog Kerlone Klonopin Klor-Con K-Lyle Lanoxin Lantus Lasix Levlen Levoxyl Levsin/SL Librax Librium Lidex/E Lioresal Lithium Citrate Lithobid Lodine/XL Loestrin/Fe Lofibra Lofibra Lomotil Loniten Lo/Ovral Lopid Lopressor Lotensin/HCT Lotrisone Loxitane Lozol Luvox Macrobid Macrodantin Mandelamine Mavik Maxiflor Maxitrol Maxzide Mebaral Medrol Megace Mellaril Mepergan Fortis Rowasa Paromomycin Sulfate HU Insul NPH S-S/INS RG HU Rec Insul NPH/INS RG Insulin Zinc Human REC Insulin NPH Human Recom Insulin Regular Human REC Guaifenesin/Hydrocod Bit Ergoloid Mesylates Hydroxyurea Hydrocod/Homatropine Uniretic Hydrochlorothiazide Chlorthalidone Hydrocortisone Terazosin Erythromycin Base Isosorbide Dinitrate Propranolol HCTZ/Propranolol Indomethacin Prednisolone Cromolyn Sodium Isosorbide mononitrate Isoniazid Verapamil Isosorbide Dinitrate Sodium Polystyrene Sulfonate Potassium Chloride Cephalexin Triamcinolone betaxolol Clonzepam Pot Chloride Pot Bicarbonate/Cit AC Digoxin Insulin Glargine Furosemide Portia, Levora Levothyroxine Sodium Hyoscyamine Clidinium/Chlordiazeperoxide Chloradiazepoxide Fluocinonide/Emollient Baclofen Lithium Citrate Lithium Carbonate Etodolac Junel/FE, Microgestin/FE Fenofibrate Fenobibrate, Micronized Diphenoxylate/Atrop Minoxidil Cryselle, Low-ogestrel Gemfibrozil Metoprolol Benazepril/HCTZ Clotrimazole/betamet Loxapine Indapamide Fluvoxamine Nitrofurantoin/nitrofuran mac Nirtofurantoin Macrocrystal Methenamine Mandelate Trandolapril Diflorasone Diacetate Neo/Polymyx B Sulf/Dexameth HCTZ/Triamterene Mephobarbital Methylprednisolone Megestrol Thioridazine Meperidine/Prometh Mesalamine 4gm/60m1 enema Metaglip Methimazole Methotrexate Metoprolol extended release Metrocream Mevacor Mexitil Miacalcin Micronase Midrin Minipres Minocin Mircette Mobic Modicon Monodox Monoket Monopril/HCT Morphine Motrin MS Conlin MSIR Myambutol Myclex Troche Mycolog II Mycostatin Mydriacil Mysoline Naprelan Naprosyn Nasarel Navane Neo-Calglucon Neosporin Ophthalmic Neomycin Neoral Nephro-Fer RX Neptazane Neurontin Nicobid Nimotop Nitrobid Nitro-Dur Nitrostat Nizoral Noctec Nolvadex Norco Nordette Norflex Norgesic Forte Norinyl Normodyne Norpace Norpramin Nor-O-D Norvasc Novolin 70/30 Novolin L Novolin N Novolin R Novolog Novolog 70/30 Nucofed Nystatin Ocufen Ocuflox Ocupress Ogen Omnicef One Touch Test Strips Ophthaine Opticrom Glipizide/Metformin Methimazole Methotrexate Toprol XL Metronidazole Lovastati n Mexiletine Fortical Glyburide Isometheptene/APAP/Dichlphen Prazosin Minocycline Desoges-ethinyl estradiol, Kariva Meloxicam Notrel, N.E.E. 0.5/35, Necon Doxycycline monohydrate Isosorbide Mononitrate Fosinopril/HCTZ Morphine Ibuprofen Morphine sulfate Morphine sulfate Ethambutol Clotrimazole Nystatin/Triamcin Nystatin Tropicamide Primidone Naproxen sodium Naproxen Flunisolide Thiothixene Calcium Glubionate Neomycin sulf/Gramicidin/Polymyxin B Neomycin Sulfate Cyclosporine Ferrous Fumarate/Folic Acid Methazolamide Gabapentin Niacin Nimodipine Nitroglycerin Nitroglycerin Patch Nitroglycerin Ketoconazole Chloral Hydrate Tamoxifen Hydrocodone bit/apap Portia, Levora, Levlen Orphenadrine Orphenadrine/Aspirin/Gaff Nortrel, Necon Labetalol Disopyramide Desipramine Camila, Errin, Jolivette, Nora-BE Amlodipine Human Insulin NPH/Reg Human Insulin Zinc Human Insulin NPH Human Insulin Reg Insulin Aspart Insulin ASP PRT/Insulin Aspart Guaifenesin/P-Ephen/Cod Nystatin Flurbiprofen Ofloxacin Carteolol Estropipate Cefdinir One Touch BS Test Strips Proparacaine Cromolyn • - • - , O ti ranolol P P Metipranolol Quinidex Quinidine Sulfate Orapred Prednisolone Rebetol Ribavirin Orinase Tolbutamide Reglan Metoclopramide Ortho Micronor Camila, Errin, Jolivetie, Nora-BE Relafen Nabumetone Ortho Novum 1/35 Necon 1/35 Remeron Mirtazapine Ortho Novum 1/50 Necon 1/50 Restoril Temazepam Ortho Tri-Cyclen Trinessa, Tri-Previfem, Tri-Sprintec Retin-A Tretinoin Ortho-Cept Apri, Reclipsen, Solia Retrovir Zidovudine Ortho-Cyclen Mononessa, Previfem, Sprintec Revia Naltrexone Ortho-Est Estropipate Rifadin Rifampin Ortho-Novum 777 Necon 777, Nortrel 777 Rifamate Rifampin/Isoniazid Orudis Ketoprofen Ritalin/SR Methylphenidate ER Ovral Norgestrel-Ethinyl Estradiol, Ogestrel RMS Supp Morphone Oxandrin Oxandrolone Robaxin Methocarbamol Oxycontin Oxycodone SR Robaxisol Methocarbamol/ASA OxyIR Oxycodone IR Robitussin AC Guaifenesin/Codeine Roxicodone Oxycodone Rondec Phenylephrine-chlorpheniramine Pacerone Amiodarone Rondec DM D-Methorphan/PE/Chlorphenir Pamelor Nortriptyline Rowasa Mesalamine 4gm/60m1 enema Pancrease Amylase/Lipase/Protease Ryna-12 Phenyleph Tan/Pyril/CP Parafon Forte DSC Chlorzoxazone Rynatan Phenyleph/Chlor Parlodel Bromocriptine Mesylate Rynatuss Car-B-Pen/Ephed/PE/CP Paxil Paroxetine Salagen Pilocarpine Paxil Paroxetine suspension Sandimmune Cyclosporine Pediazole Ery E-Succ/Sulfisoxazole Seasonale Jolessa, Quasense Pen Vee K Penicillin V Potassium SelsunRx Selenium Sulfide Pepcid Famotidine Serax Oxazepam Percocet Oxycodone/APAP Septra/DS Sulfamethoxazole/TMP Percodan Oxycodone/Aspirin Serzone Nefazodone Periactin Cyproheptadine Silver Sulfadiazine Silver Sulfadiazine Peridex Chlorhexidine Gluconate Sinemet Carbidopa/Levodopa Permax Pergolide Sinequan Doxepin Persantine Dipyridamole Slo-Phyllin Aminophylline Phenergan Promethazine Slow-K Potassium Chloride Phenergan DM D-Methorphan/Prometh Sodium Sulamyd Sulfacetamide Sodium Phenergan VC Phenylephrine/Prometh Soma/Compound Carisoprodol/ASA Phenergan VC w/ Codeine Phenylephrine/Cod/Prometh Soma Compound w/ Codeine Carisoprodol/ASA/Codeine Phenergan w/ Codeine Codeine/Promethazine Spectazole Econazole Phenobarbital Phenobarbital Sporanox Itraconazole Pilostat Pilocarpine SSKI Potassium Iodide Plaquenil Hydroxychloroquine Stelazine Trifluoperazine Plendil Felodipine Sulfacet-R Sulfacetamide Na/Sulfur Pletal Cilostazol Sultrin Triple Sulfa Sulfathiaz/Sulfacet/S-Benz Polycitra SodlPotass/K CiUSodium Cit/CA Sumycin Tetracycline Polycitra - K Citric Acid/Potassium Citrate Symmetrel Amantadine Polysporin Bacitracin/Polymyxin B Synalar Fluocinolone Acetonide Polytrim Polymyxin B/TMP Synthroid Levothyroxine Prelone Prednisolone Tagamet Cimetidine Pravachol Pravastatin Tambocor Flecanide Prilosec Omeprazole Tapazole Methimazole Principen Ampicillin Tebamide Supp Trimethobenzamide/B-caine Prinivil Lisinopril Tegretol Carbamezapine Prinzide Lisinopril/HCTZ Temovate/E Clobetasol/Enroll ProAir HFA Albuterol HFA Tenoretic Chlorthalidone/Atenolol Probanthine Propantheline Tenormin Atenolol Procan Procainamide Tessalon Benzonatate Procardia XL Nifedipine XL Theo-Dur Theophylline Anhydrous Proctocort Hydrocortisone Thorazine Chlorpromazine Proctocream HC Hydrocortisone Tiazac Diltiazem Proctofoam HC HC Acetate/Pramoxine Ticlid Ticlopidine Prolixin Fluphenazine Tigan Trimethobenzamide Proloprim Trimethoprim Timoptic/XE Timolol Propine Dipivefrin Tobrex Tobramycin Propylthiouracil Propylthiouracil Tofranil Imipramine Proscar Finasteride Tolinase Tolazamide Provers Medroxyprogesterone Tolectin/DS Tolmetin Prozac Fluoxetine Topicort Desoximetasone Psorcon Diflorasone Diacetate Toradol Ketorolac Pyrazinamide Pyrazinamide Trandate Labetalol Pyridium Phenazopyridine Mavik Trandolapril Questran/Light Cholestyramine Tranxene Clorazepate Quinaglute Quinidine Gluconate Trental Pentoxifylline Quinamm Quinine Sulfate Triavil Amitriptyline/Perphenazine • - • Trilafon Tri-Levlen Trilisate Trimpex Tri-Norinyl Triphasil Tylenol w/ Codeine Tylox Ultracet Ultravate Univasc Urocit K Ultram Uniretic Urecholine Valisone Valium Vantin Ventolin HFA Vaseretic Vasocidin Vasotec Ventolin HFA Verelan Vibramycin Vicodin/ES/HP Vicoprofen Viokase Viroptic Visken Vistaril Vitamin D Vivelle Voltaren Vosol/HC Vospair Wellbutrin/SR Wellbutrin XL Westcort Xanax/XR Xanax/XR Xylocaine Viscous Yodoxin Zanaflex Zantac Zarontin Zestoretic Zestril Ziac Zithromax Zocor Zofran Zofran Zoloft Zonegran Zorprin Zovia 1/35E Zovirax Zyloprim Generic Nar Grua Covered ~ Perphenazine Enpresse, Trivora Chol Sal/Mag Salicylate Trimethoprim Arenelle, Leena Enpresse, Trivora Codeine/APAP Oxycodone/Acetaminophen Tramadol hcl/apap Halobetasol Moexipril Potassium Citrate Tramadol hydrochlorothiazide/moexipril Bethanechol Betamethasone Diazepam Cefpodoxime Ventolin HFA Enalapril/HCTZ NA Sulfacetm/Prednis SP Enalapril Albuterol HFA Verapamil Doxycycline Hydrocodone/APAP IBU/Hydrocodone Amylase/Lipase/Protease Trifluridine Pindolol Hydroxyzine Pamoate Ergocalciferol Estradiol Diclofenac Sodium Acetic Acid/HC Albuterol Bupropion/SA Budeprion XL 300mg Hydrocortisone Valerate Alprazolam alprazolam extended release Lidocaine lodoquinol Tizanidine Ranitidine Ethosuximide Lisinopril/HCTZ Lisinopril HCTZ/Bisoprolol Azithromycin Simvastatin Ondansetron Ondansetron rapid dissolve Sertraline Zonisamide Aspirin Ethynodiol D-Eth Estra Acyclovir Allopurinol FBCG0320 - 6/2007 Blue Cross of California is an Independent Licensee of the Blue Cross Association. WeIlPoint NextRx is a service mark of WeIlPoint, Inc. Services are provided by a WeIlPoint PBM (either Professional Claim Services Inc., doing business as WeIlPoint Pharmacy Management, or Anthem Prescription Management, LLC, as appropriate). WeIlPoint NextRx is a division of WeIlPoint, Inc. Voluntary Prudent Buyer b Dental incentive Plan DV01 ~. We're Committed To Providing You With Great Dental Care Options ~ tp Dental care is an essential part of your comprehensive health care coverage and well-being. BC Life & Health Insurance Company knows being protected by dental insurance is an important safeguard for you and your family. Diagnostic and preventive services are the key to maintaining good dental health. Dental coverage is designed to guarantee that you receive regular preventive care. With routine examinations, minor dental problems can be diagnosed and treated before major, more costly problems set in. Voluntary Prudent Buyer Dental Incentive Plan can be instrumental in your long-term dental health. Voluntary Prudent Buyer Dental Incentive Plan Advantages - You and your covered family members can take advantage of one of the largest dental networks in California with nearly 13,000 dentists - You can enjoy negotiated rates and no payment due at time of service (excluding any applicable copayments) from network dentists - No claim forms How The Plan Works Your Voluntary Prudent Buyer Dental Incentive Plan is a preferred provider organization (PPO) plan from BC Life & Health Insurance Company (BC Life & Health), an affiliate of Blue Cross of California. The Voluntary Prudent Buyer Dental Incentive Plan provides you with the freedom to select virtually any licensed dentist. You are responsible for the calendar year deductible and for your portion of the covered services. Participating Dentist If you choose a PPO participating dentist, you take advantage of negotiated rates. The negotiated rate is the amount a participating dentist agrees to accept as payment in full for covered services. The negotiated rate is usually lower than the participating dentist's normal charge. By choosing a participating dentist, you will not be responsible for any amount in excess of the negotiated rate for covered services. Please note that you must verify that the dentist you use is a member of the Prudent Buyer PPO network. Non-Participating Dentist If you choose a licensed dentist who does not participate in the Prudent Buyer PPO network, you are not eligible for negotiated rates and your out-of-pocket expenses may be greater. You are responsible for the calendar year deductible and for any ~ amount over the maximum payment amount that is shown in the Reimbursement ~, Schedule. You may also be asked to pay your ~ portion of the bill at the time of service and submit claim forms for reimbursement. The maximum payments BC Life & Health will pay for covered services from non-participating dentists are shown in the Reimbursement Schedule. For example: If you have a complete series of intraoral X-rays taken, the maximum payment by BC Life & Health will be $48. If the dentist charges you more than $48, you are responsible for the balance of the cost. Network After enrolling in the Voluntary Prudent Buyer Dental Incentive Plan, you will receive a Directory of Participating Dentists. If you have a particular dentist in mind and he or she is not in the directory, you may call the customer service telephone number on your ID card to see if the dentist has recently joined the network. Late Entrant Waiting Period If you do not enroll in your dental plan within 31 days of your eligibility date, you will be subject to a Late Entrant Waiting Period. This means that you will not be covered immediately for certain dental services. Details of the Late Entrant Waiting Period can be found in the Exclusions and Limitations section of this document. Filing A Claim When you use a participating dentist, you do not need to submit a claim form for covered dental expenses. Your participating dentist will complete and submit the claim form to BC Life & Health. BC Life & Health will pay the benefits of the plan directly to your dentist. If your dentist is not in the network, you must complete and submit your own claim forms. Dental Deductible A deductible is the amount of money you pay for a covered dental expense prior to benefits being paid under the plan. Only charges that are considered a covered dental expense will apply toward satisfaction of the deductible. Please refer to the deductible amount in the chart. SC10885 Effective 3/2005 Printed 12/11/2007 Pre-Authorization When the anticipated expense for any course of treatment exceeds $350, you should submit a request for pre-authorization. If you use a participating dentist, your dentist will submit the authorization form for you. If your dentist is not part of the network, you will have to submit apre-authorization form to your dentist for completion and then send it to BC Life & Health for approval. Conditions of Service Services must be provided by a licensed dentist and must be for treatment of dental disease, defect or injury, and are subject to any Exclusions and Limitations or Annual Maximum specified under the plan. Customer Service A Customer Service Representative is available to answer your questions and inquiries at (800) 627-0004. Annual Maximum Dental benefits are limited to a maximum payment for expenses incurred by each insured person during a calendar year. Please refer to the amount on the chart. Continuing Coverage As required by federal law, certain restrictions and conditions apply to continue coverage and are described in your Certificate. Summary of Benefits Calendar Year Deductible $50/insured person; maximum of three separate deductibles/family Annual Maximum $1,000 Benefit Waiting Periods* The following benefit waiting periods will apply to services for: - Preventive and Diagnostic None - Restorative Three months - Oral Surgery 6 months - Periodontics, Endodontics, or Prosthodontics 12 months * Benefit waiting periods may be waived with proof of at least 12 continuous months of prior dental coverage. See Certifrcate for details. Predetermination of Benefits Charges in excess of $350 Covered Expense Plan payments will be applied to the lesser of the charges billed by the provider or the following: PPO Dentists The Prudent Buyer Dental Plan negotiated rate or fee. When using a participating dentist, insured persons are not responsible for the d~erence between the provider's usual charges and the negotiated amount. Non-PPO Dentists Amounts in the Reimbursement Schedule under Maximum Payment When using a non participating dentist, insured persons are responsible for any amount over the maximum payment amount. Covered Services Please see the Reimbursement Schedule. Any procedures not listed in this reimbursement schedule are not covered. Reimbursement Schedule Covered Services PPO Dental Program Maximum Payment PPO Dentists Non-PPO Dentists Diagn ostic 0120 -Periodic oral evaluation 100% $21 0140 -Limited oral evaluation -problem focused 100% $33 0150 -Comprehensive oral examinations 100% $33 0160 -Detailed & extensive oral evaluation -problem focused, by report 100% $59 0170 - Re-evaluation -Limited problem focused (not post-operative visit) 100% $33 0180 -Comprehensive periodontal evaluation -new or established patient 100% $36 0210 - X-rays -intraoral -complete series (including bitewings) 100% $48 0220 - X-rays -intraoral -periapical -first film 100% $12 0230 - X-rays -intraoral -periapical -each additional film 100% $ 9 0240 - X-rays -intraoral -occlusal fzlm 100% $16 0250 - X-rays -extraoral -first film 100% $24 0260 - X-rays -extraoral -each additional film 100% $15 0270 - X-rays -bitewing -single film 100% $ I 1 0272 - X-rays -bitewings -two films 100% $18 0274 - X-rays -bitewing -four films 100% $27 Covered Services PPO Dental Program Maximum Payment PPO Dentists Non-PPO Dentists Diagnostic (continued) 0277 - X-rays -vertical bitewings 100% $39 0290 - X-rays -posterior-anterior or lateral skull facial bone survey firm 100% $40 0330 - X-rays -panoramic film 100% $38 0340 - X-rays - cephalometric film 100% $41 0415 -Bacteriologic studies for determination of pathologic agents 100% $16 0460 -Pulp vitality tests 100% $22 0470 -Diagnostic casts 100% $50 0472 -Accession of tissue, gross exam 100% $39 0473 -Accession of tissue, gross exam & micro exam 100% $90 0474 -Accession of tissue, gross exam & micro exam (including assess surgery) 100% $75 0480 -Processing & interpretation of cytologic smears 100% $39 9310 -Consultation (diagnostic service other than practitioner providing treatment) 100% $54 Preventive 1110 -Prophylaxis -adult 100% $42 1120 -Prophylaxis -child 100% $29 1201 -Topical Fluoride -child (including prophylaxis) 100% $43 1203 -Topical Fluoride -child (excluding prophylaxis) 100% $16 1204 -Topical Fluoride -adult (excluding prophylaxis) 100% $15 1205 -Topical Fluoride -adult (including prophylaxis) 100% $50 1330 -Oral hygiene instructions 100% $23 1351 -Sealants -per tooth 100% $23 1510 -Space maintainers -fixed -unilateral 100% $150 1515 -Space maintainers -fixed -bilateral 100% $234 1520 -Space maintainers -removable -unilateral 100% $186 1525 -Space maintainers -removable -bilateral 100% $270 1550 - Recementation of space maintainer 100% $30 Restorative 2140 -Fillings, amalgams -one surface, primary or permanent 50% $46 2150 -Fillings, amalgams -two surfaces, primary or permanent 50% $58 2160 -Fillings, amalgams -three surfaces, primary or permanent 50% $70 2161 -Fillings, amalgams -four or more surfaces, primary or permanent 50% $84 2330 -Resin -one, surface, anterior 50% $53 2331 -Resin -two surfaces, anterior 50% $65 2332 -Resin -three surfaces, anterior 50% $82 2335 -Resin -four or more surfaces, anterior, or involving incisal angle 50% $96 2390 -Resin -based composite crown, anterior 50% $107 2391 -Resin -based composite, one surface, posterior 50% $61 2392 -Resin -based composite, two surfaces, posterior 50% $80 2393 -Resin -based composite, three surfaces, posterior 50% $99 2394 -Resin -based composite, four or more surfaces, posterior 50% $121 2930 -Prefabricated stainless steel crown -primary tooth 50% $57 2931- Prefabricated stainless steel crown -permanent tooth 50% $65 2932 -Prefabricated resin crown 50% $75 2933 -Prefabricated stainless steel crown with resin window 50% $75 2940 -Sedative filling 50% $24 2951 -Pin retention -per tooth, in addition to restoration 50% $12 Endodontics 3110 -Pulp cap -Direct (excluding final restoration) 50% $17 3120 -Pulp cap -Indirect (excluding final restoration) 50% $14 3220 -Therapeutic pulpotomy (excluding final restoration) 50% $38 3221 -Gross pulp debridement primary & permanent teeth 50% $44 3230 -Pulp therapy (resorbable filling) -anterior, primary tooth 50% $53 (excluding final rest.) 3240 -Pulp therapy (resorbable filling) -posterior, primary tooth 50% $54 (excluding final rest.) 3310-Anterior root canal therapy (excluding final restoration) 50% $171 3320 -Bicuspid root canal therapy (excluding final restoration) 50% $203 3330 -Molar root canal therapy (excluding final restoration) 50% $255 3332 -Incomplete endodontic therapy (inoperable or fractured tooth) 50% $90 3333 -Internal root repair of perforation defects 50% $63 3346 -Retreatment of previous root canal therapy -anterior 50% $227 3347 -Retreatment of previous root canal therapy -bicuspid 50% $257 3348 -Retreatment of previous root canal therapy -molar 50% $300 3351 - Apexification/recalification -initial visit (apical closure/calcific repair) 50% $83 3352 - Apexification/recalification -interim medication replacement 50% $45 Covered Services PPO Dental Program Maximum Payment PPO Dentists Non-PPO Dentists 3353 - Apexification/recalification -final visit (includes completed root) 50% $143 3410 -Apicoectomy/periradicular surgery -anterior 50% $195 3421 -Apicoectomy/periradicular surgery -bicuspid first root) 50% $212 3425 -Apicoectomy/periradicular surgery -molar ~rsr root) 50% $233 3426 -Apicoectomy/periradicular surgery -each additional tooth 50% $81 3430 -Retrograde filling -per root 50% $56 3450 -Root amputation -per root 50% $128 3920 - Hemisection (including any root removal), not including 50% $98 root canal therapy 3950 -Canal preparation and fitting of preformed dowel or post 50% $35 Periodontics 4210 -Gingivectomy/Gingivoplasty -per quadrant 50% $144 4211 -Gingivectomy/Gingivoplasty -per tooth 50% $45 4240 -Gingival flap procedure, including root planing -per quadrant 50% $183 4241 -Gingival flap procedure, including root planing -one to three 50% $90 teeth per quadrant 4245 - Apically positioned flap 50% $176 4249 -Clinical crown lengthening -Hard tissue 50% $224 4260 -Osseous surgery (including flap entry & closure) -per quadrant 50% $270 4261 -Osseous surgery (including flap entry & closure) -one to three 50% $146 teeth per quadrant 4263 -Bone replacement graft -first site in quadrant 50% $105 4264 -Bone replacement graft -each additional site in quadrant 50% $60 4266 -Guided tissue regeneration -resorbable barrier, per sire 50% $128 4267 -Guided tissue regeneration -non-resorbable barrier, per site 50% $150 (includes membrane removal) 4268 -Surgical revision procedure, per tooth 50% $150 4270 - Pedicle soft tissue graft procedure 50% $218 4271 -Free soft tissue graft procedure (including donor site surgery) 50% $239 4273 - Subepithelial connective tissue graft procedure (including donor site surgery) 50% $263 4274 -Distal or proximal wedge procedure (when not performed in 50% $102 conjunction with surgery 4275 -Soft tissue allograft 50% $128 4276 -Combined connective tissue & double pedicle graft 50% $246 4320 -Provisional splinting - intracoronal 50% $90 4321 -Provisional splinting - extracoronal 50% $75 4341 -Periodontal scaling/root planing -per quadrant 50% $59 4342 -Periodontal scaling/root planing -one to three teeth, per quadrant 50% $32 4355 -Full mouth debridement to enable 50% $37 comprehensive periodontal evaluation/diagnosis 4381 -Localized delivery of chemo agents 50% $21 4910 -Periodontal maintenance procedures (following active therapy) 50% $33 Oral Surgery 7111 - Coronal remnants -deciduous tooth 50% $40 7140 -Extraction, erupted tooth or exposed root (elevation and/or 50% $53 forceps removal) 7210 -Surgical removal of erupted tooth requiring elevation 50% $60 of mucoperiosteal flap 7220 -Removal of impacted tooth -soft tissue 50% $72 7230 -Removal of impacted tooth -partial bony 50% $90 7240 -Removal of impacted tooth -completely bony 50% $105 7241 -Removal of impacted tooth -completely bony, 50% $123 with unusual surgical complications 7250 -Surgical removal of residual tooth roots (cutting procedure) 50% $65 7260 - Oroantral fistula closure 50% $360 7270 -Tooth reimplantation and/or stabilization of 50% $105 accidentally evulsed or displaced 7280 -Surgical exposure of impacted or unerupted tooth for orthodontic reasons 50% $143 7281 -Surgical exposure of impacted or unerupted tooth to aid eruption 50% $120 7282 -Mobilization of erupted or malpositioned tooth to aid eruption 50% $45 7285 -Biopsy of oral tissue -hard (bone, tooth) 50% $135 7286 -Biopsy of oral tissue -soft (all others) 50% $78 7310 - Alveoloplasty in conjunction with extractions -per quadrant 50% $57 7320 - Alveoloplasty not in conjunction with extractions -per quadrant 50% $120 7340 - Vestibuloplasty -ridge extension (secondary epithelialization) 50% $384 7410 -Radical excision -lesion diameter up to 1.25 cm 50% $146 7411 -Excision of benign lesion Qreater than 1.25 cm 50% $371 Covered Services PPO Dental Program Maximum Payment PPO Dentists Non-PPO Dentists 7412 -Excision of benign lesion, complicated 50% $413 7413 -Excision of malignant lesion up to 1.25 cm 50% $280 7414 -Excision of malignant lesion greater than 1.25 cm 50% $416 7415 -Excision of malignant lesion, complicated 50% $447 7440 -Excision of malignant tumor-lesion diameter up to 1.25 cm 50% $269 7441 -Excision of malignant tumor-lesion diameter greater than 1.25 cm 50% $270 7450 -Removal of odontogenic cyst or tumor- lesion diameter up to 1.25 cm 50% $13 I 7451 -Removal of odontogenic cyst or tumor 50% $210 -lesion diameter greater than 1.25 cm 7460 -Removal of nonodontogenic cyst or tumor- lesion diameter up to 1.25 cm 50% $119 7461 -Removal of nonodontogenic cyst or tumor 50% $226 - lesion diameter greater than 1.25 cm 7465 -Destruction of lesion(s) by physical or chemical method, by report 50% $75 7471 -Removal of exostosis -per site 50% $150 7472 -Removal of torus palatinus 50% $268 7473 -Removal of torus mandibularis 50% $252 7485 -Surgical reduction of osseous tuberosity 50% $225 7510 -Incision & drainage of abscess - Intraoral soft tissue 50% $53 7520 -Incision & drainage of abscess - Extraoral soft tissue 50% $200 7530 -Removal of Foreign boy, skin or subcutaneous areolar tissue 50% $68 7880 -Occlusal orthotic device, by report 50% $180 7910 -Suture of recent small wounds to 5 cm 50% $63 7911 -Complicated suture - up to 5 cm 50% $150 7912 -Complicated suture -greater than 5 cm 50% $321 7960 - Frenulectomy (frenectomy or frenotomy) -separate procedure 50% $113 7970 -Excision of hyperplastic tissue -per arch 50% $105 7971 -Excision of pericoronal gingiva 50% $51 7972 -Surgical reduction of fibrous 50% $174 Prosthodontics 2510 -Inlay -metallic -one surface 50% $195 2520 -Inlay -metallic -two surfaces 50% $225 2530 -Inlay -metallic -three or more surfaces 50% $243 2542 - Onlay -metallic -two surfaces 50% $252 2543 - Onlay -metallic -three surfaces 50% $255 2544 - Onlay -metallic -four or more surfaces 50% $269 2610 -Inlay -porcelain/ceramic -one surface 50% $219 2620 -Inlay -porcelain/ceramic -two surfaces 50% $237 2630 -Inlay -porcelain/ceramic -three or more surfaces 50% $255 2642 - Onlay - porcelain/ceramic -two surfaces 50% $255 2643 - Onlay -porcelain/ceramic -three surfaces 50% $261 2644 - Onlay - porcelain/ceramic -four or more surfaces 50% $270 2662 - Onlay -resin-based composites (composite/resin) -two surfaces 50% $228 2663 - Onlay -resin-based composites (composite/resin) -three surfaces 50% $240 2664 - Onlay -resin-based composites (composite/resin) - four or more surfaces 50% $252 2710 -Crown -resin (indirect) 50% $106 2720 -Crown -resin with high noble metal 50% $243 2721 -Crown -resin with predominantly base metal 50% $210 2722 -Crown -resin with noble metal 50% $225 2740 -Crown -porcelain/ceramic substrate 50% $270 2750 -Crown -porcelain fused to high noble metal 50% $255 2751 - Crown -porcelain fused to predominantly base metal 50% $221 2752 -Crown -porcelain fused to noble metal 50% $235 2780 -Crown -cast high noble metal 50% $259 2781 -Crown -cast high predominantly base metal 50% $263 2782 -Crown -cast noble metal 50% $263 2783 -Crown -cast porcelain/ceramic 50% $270 2790 -Crown -Full cast high noble metal 50% $240 2791 -Crown -Full cast predominantly base metal 50% $225 2792 -Crown -Full cast noble metal 50% $225 2910 -Recement inlay 50% $23 2920 -Recement crown 50% $23 2950 -Core buildup, including any pins 50% $59 2952 -Cast post and core in addition to crown 50% $95 2953 -Each additional cast post (same tooth) 50% $59 2954 -Prefabricated post and core in addition to crown 50% $75 2955 -Post removal (not in conjunction with endodontic therapy) 50% $62 2957 -Each additional prefab post (same tooth) 50% $38 Covered Services PPO Dental Program Maximum Payment PPO Dentists Non-PPO Dentists Prosthodontics (continued) 2960 -Labial veneer (laminate) - chairside 50% $132 2961 -Labial veneer (resin laminate) -laboratory 50% $239 2962 -Labial veneer (porcelain laminate) -laboratory 50% $263 2970 -Temporary crown (fractured tooth) 50% $60 6210 -Pontic -Cast high noble metal 50% $240 6211 -Pontic -Cast predominantly base metal 50% $225 6212 -Pontic -Cast noble metal 50% $225 6240 -Pontic -Porcelain fused to high noble metal 50% $252 6241 -Pontic -Porcelain fused to predominantly base metal 50% $218 6242 -Pontic -Porcelain fused to noble metal 50% $233 6245 -Pontic -Porcelain/ceramic 50% $260 6250 -Pontic -Resin with high noble metal 50% $255 6251 -Pontic -Resin with predominantly base metal 50% $225 6252 -Pontic -Resin with noble metal 50% $239 6545 -Retainer -Cast metal for resin fixed prosthesis 50% $119 6548 -Retainer - Porcelain ceramic (resin bonded faxed prosthesis) 50% $135 6600 -Inlay - porcelain/ceramic -two surfaces 50% $193 6601 -Inlay - porcelain ceramic -three or more surfaces 50% $202 6602 -Inlay -cast high noble metal -two surfaces 50% $206 6603 -Inlay -cast high noble metal -three or more surfaces 50% $227 6604 -Inlay -cast predominantly base metal -two surfaces 50% $202 6605 -Inlay -cast predominantly base metal -three or more surfaces 50% $214 6606 -Inlay -cast noble metal -two surfaces 50% $199 6607 -Inlay -cast noble metal -three or more surfaces 50% $220 6609 - Onlay -porcelain/ceramic -three or more surfaces 50% $218 6611 - Onlay -cast high noble metal -three or more surfaces 50% $243 6613 - Onlay -cast predominantly base metal -three or more surfaces 50% $231 6615 - Onlay -cast noble metal -three or more surfaces 50% $225 6720 -Crown -resin with high noble metal 50% $251 6721 -Crown -resin with predominantly base metal 50% $210 6722 -Crown -resin with noble metal 50% $239 6740 -Crown -Porcelain/ceramic 50% $269 6750 -Crown -porcelain fused to high noble metal 50% $255 6751 -Crown -porcelain fused to predominantly base metal 50% $224 6752 -Crown -porcelain fused to noble metal 50% $236 6780 -Crown -cast high noble metal 50% $239 6781 -Crown -cast predominantly base metal 50% $269 6782 -Crown -cast noble metal 50% $240 6783 -Crown -porcelain/ceramic 50% $240 6790 -Crown -Full cast high noble metal 50% $240 6791 -Crown -Full cast predominantly base metal 50% $225 6792 -Crown -Full cast noble metal 50% $227 6793 -Crown -Provisional retainer 50% $104 6930 - Recement fixed partial denture 50% $32 6950 -Precision attachment 50% $128 6970 -Cast post and core in addition to fixed partial denture retainer 50% $90 6971 -Cast post as part of fixed partial denture retainer 50% $87 6972 -Prefabricated post and core in addition to fried partial denture retainer 50% $75 6973 -Core buildup for retainer, including any pins 50% $58 6975 -Coping -metal 50% $150 6976 -Each additional cast post (same tooth) 50% $37 6977 -Each additional prefab post (same tooth) 50% $39 6985 -Pediatric partial denture, fried 50% $118 5110 -Complete denture (maxillary) 50% $300 5120 -Complete denture (mandibular) 50% $299 5130 -Immediate denture (maxillary) 50% $330 5140 -Immediate denture (mandibular) 50% $323 5211 -Partial denture (maxillary) 50% $245 - resin base (including any conventional clasps, rests & teeth) 5212 -Partial denture (mandibular) 50% $270 - resin base (including any conventional clasps, rests & teeth) 5213 -Partial denture (maxillary) 50% $351 -cast metal framework with resin denture bases 5214 -Partial denture (mandibular) 50% $347 -cast metal framework with resin denture bases Covered Services PPO Dental Program Maximum Payment PPO Dentists Non-PPO Dentists Prosthodontics (continued) 5281 -Removable unilateral partial denture 50% $188 -one piece cast metal (including clasps & teeth) 5410 -Adjust complete denture (maxillary) 50% $l 8 5411 -Adjust complete denture (mandibular) 50% $17 5421- Adjust partial denture (maxillary) 50% $20 5422 -Adjust partial denture (mandibular) 50% $18 5510 -Repair broken complete denture base 50% $39 5520 -Replace missing or broken teeth -complete denture (each tooth) 50% $32 5610 -Repair resin denture base 50% $38 5620 -Repair cast framework 50% $45 5630 -Repair or replace broken clasp 50% $48 5640 -Replace broken teeth - (per tooth) 50% $35 5650 -Add tooth to existing partial denture 50% $44 5660 -Add clasp to existing partial denture 50% $51 5670/5671 -Replace all teeth and acrylic 50% $127 on cast metal framework (maxillary/mandibular) 5710 -Rebase complete denture (maxillary) 50% $116 5711 - Rebase complete denture (mandibular) 50% $120 5720 -Rebase partial denture (maxillary) 50% $111 5721 -Rebase partial denture (mandibular) 50% $120 5730 -Complete denture reline -chairside (maxillary) 50% $72 5731 -Complete denture reline -chairside (mandibular) 50% $68 5740/5741- Partial denture reline -chairside (maxillary/mandibular) 50% $68 5750 -Complete denture reline -laboratory (maxillary) 50% $93 5751 -Complete denture reline -laboratory (mandibular) 50% $94 5760/5761 -Partial denture reline -laboratory (maxillary/mandibular) 50% $98 5810 -Interim complete denture (maxillary) 50% $150 5811 -Interim complete denture (mandibular) 50% $153 5820 -Interim partial denture (maxil/ary) 50% $128 5821 -Interim partial denture (mandibular) 50% $135 5850 -Tissue conditioning (maxillary) 50% $33 5851 -Tissue conditioning (mandibular) 50% $36 Other Services 9110 -Palliative (emergency) treatment of dental pain 100% $41 -minor procedure 9220 -General anesthesia -first 30 minutes 50% $86 9221 -General anesthesia -each additiona115 minutes 50% $31 9241 - IV sedation/analgesia -first 30 minutes 50% $80 9242 - IV sedation/analgesia -each additional I S minutes 50% $27 9248 -Non-IV conscious sedation 50% $20 9420 -Hospital call 100% $150 9430 -Office visits for observation 100% $33 (during regularly scheduled hours) 9440 -Office visits -after hours 100% $60 9450 -Case presentation, detailed & extensive treatment planning 100% $23 9910 -Application of desensitizing medicament 50% $11 9911 -Application of desensitizing resin, per tooth (cervical and/or root surface) 100% $12 9940 -Occlusal guard, by report 50% $135 9941 -Fabrication of athletic mouthguard 50% $38 9950 -Occlusion analysis -mounted case 50% $61 9951 - Occlusal adjustment -limited 50% $26 9952 - Occlusal adjustment -complete 50% $149 9971 - Odontoplasty 1 -two teeth (includes 50% $15 removal of enamel projections) This Summary of Benefits is a brief review of benefits. Once enrolled, insured persons will receive the Certificate of Insurance, which explains the exclusions and limitations, as well as the full range of covered services of the plan, in detail. Voluntary Prudent Buyer Dental Incentive Plan Exclusions 8~ Limitations Services Provided Before or ARer the Term of This Coverage. Services received before the insured person's effective date. Services received after the insured person's coverage ends, as specified as covered in the Certificate. Experimental or Investigative Procedures. Any procedures which are considered experimental or investigative or which are not widely accepted as proven and effective procedures within the organized dental community. Medically Necessary. Any services or supplies which are not medically necessary. Workers' Compensation. Any work-related conditions if benefits are recovered or can be recovered either by adjudication, settlement or otherwise under any workers' compensation, employer's liability law or occupational disease law, even if the insured person does not claim those benefits. Govemment Programs. Services provided by or payment made by any local, state, county or federal government agency, including Medicare and any foreign government agency. No Charge Services. Services received for which no charge is made to the insured person or for which no charge would be made to the insured person in the absence of insurance coverage. Results of War. Disease contracted or injuries sustained as a result of war, declared or undeclared, or from exposure to nuclear energy, whether or not the result of war. Provider Related to Insured Person. Professional services received from a person who lives in the insured person's home or who is related to the insured person by blood or marriage. Excess Expense. Any amounts in excess of covered dental expense or the Dental Benefit Maximums. Professionally Acceptable Treatment. If more than one treatment plan would be considered acceptable services for a dental condition, any amount exceeding the cost of the least expensive professionally acceptable treatment plan is not covered. Transfer of Care. Ii the insured person transfers from the care of one dentist to another dentist during the course of treatment, or if more than one dentist renders services for one dental procedure, we shall be liable only for the amount we would have been liable for had one dentist rendered the services. Hospital Charges. Hospital costs and any additional charges by the dentist for hospital treatment. Services Not Included as a Covered Procedure. Services not specifically provided for by the plan unless they are similar in nature to an included procedure. In such event, the benefit payable will be based on the most nearly comparable services included. Treatment By An Unlicensed Dentist. Charges for treatment by other than a licensed dentist or physician except charges for dental prophylaxis performed by a licensed dental hygienist, under the supervision and direction of a dentist. Treatment of the Joint of the Jaw and/or Occlusion Services. Diagnosis, services, supplies or appliances provided in connection with any of the following: Y Any treatment to alter, correct, frx, improve, remove, replace, reposition, restore or otherwise treat the joint of the jaw (temporomandibularfoint) or associated musculature, nerves and other tissues for any reason or by any means; or 1 Any treatment, including crowns, caps and/or bridges to change the way the upper and lower teeth meet (occlusion); or Treatment to change vertical dimension (the space between the upper and lower jaw) for any reason or by any means including the restoration of vertical dimension because teeth have worn down. Vertical Dimension and Attrition. Procedures requiring appliances or restorations (other than those for replacement of structure lost due to dental decay) that are necessary to alter, restore or maintain occlusion. These include, but are not limited to: changing the vertical dimension ~ replacing or stabilizing tooth structure lost by attrition, abrasion, or erosion S realignment of teeth 1• gnathological recording r occlusal equilibration L periodontal splinting Prosthetic Replacements. Replacement of an existing fixed or removable prosthesis, is not a benefit if the replacement occurs within five years of the original placement, unless the prosthesis is a stayplate used during the healing period for recently extracted anterior teeth. Replacement of a removable partial will be allowed if the partial is no longer useable, cannot be made serviceable and meets the five year requirement. Crown Replacements. Crowns, inlays, onlays or cast restorations on the same tooth in excess of once every five years of the original replacement. Prosthetic Repairs. Repairs, adjustments or relines offull or partial dentures, or other prostheses are not covered for a period of six months from the initial placement if they were paid for under this plan. Adjustments or repairs are limited to once in a 12-month period. Rebase and reline are limited to once in a 24month period. Mandibular tissue conditioning is limited to once per quadrant in a 12-month period. Recement of an existing crown is not a benefit if done within 6 months of initial placement. Lost or Stolen Dentures or Appliances. Replacement of existing full or partial dentures or prosthetic appliances which have been lost or stolen if replacement occurs within five years of the original placement. Space Maintainers. Limited to children under age 16. Use of space maintainers in excess of one treatment per lifetime, which includes one adjustment within six months of placement. Prosthetics (patients under 16 years old). Fixed bridges, removable cast partials, cast crowns, with or without veneers, and inlays for patients under sixteen years old. Prefabricated stainless steel crowns for primary teeth of children under age 16 are limited to one per tooth in a 5-year period. Implants. Implants (materials implanted into or on bone or soft tissue) or the removal of implants. However, if implants are provided in connection with a covered prosthetic appliance, we will allow the cost of a standard complete or partial denture, or a bridge, toward the cost of the implants and the prosthetic appliances. Malignancies and Neoplasms. Services for treatment of malignancies and neoplasms. Cosmetic Dentistry. Any services performed for cosmetic purposes, unless they are for correction of functional disorders or as a result of an accidental injury occurring while the insured person was covered for dental benefits under this plan. Congenital or Developmental Malformation. Services to correct a congenital or developmental malformation including, but not limited to, cleft palate, maxillary and mandibular (upper and lower jaw) malformations, enamel hypoplasia (lack of development), fluorosis (discoloration of the teeth) and anodontia (congenitally missing teeth). X•rays. Mare than one set offull-mouth x-rays or its equivalent in a 36-month period. Periapical and bitewing x-rays submitted individually will be combined and paid up to the amount of a full mouth series. Bitewing X-rays. Bitewing x-rays in excess of two series for standard in a calendar year. Vertical bitewings limited to 8 films in a 60-month period. Oral Exams. Oral exams are limited to two, in any combination, per calendar year. Prophylaxis or Periodontal Prophylaxis. Prophylaxis or periodontal prophylaxis treatments, singly or in combination, exceeding two treatments in a calendar year. Periodontics. Osseous surgery, including flap entry and closure, exceeding one time per quadrant in 36-month period. Gingivectomy or gingivoplasty exceeding one time per quadrant in a 24month period. Full mouth debridement limited to one time at the beginning of a periodontal treatment plan, prior to pocket depth charting. Periodontal scaling. Periodontal scaling exceeding one time per quadrant in a 24month period. Sealants. Sealants are limited to children between 6 and 18 years of age for permanent unrestored first and second molars. Treatment is limited to once every 36 months per tooth. Prescription Drugs and Medications. Any prescribed drugs, pre-medication or analgesia. Root Canal Therapy. Root canal therapy in excess of one treatment per tooth for initial treatment and one retreatment per tooth. Oral Hygiene. Oral hygiene instruction. Oral Surgery. Extraction of third molars (wisdom teeth) if the patient is under the age of 16. Alveoloplasty or frenulectomy are limited to once per quadrant or arch in an insured person's lifetime. Teeth Lost Prior to this Coverage. Teeth lost prior to coverage under this plan are not eligible for prosthetic replacement unless the prosthetic replacement replaces one or more eligible natural teeth lost during the term of this coverage. Precision Attachments. Precision attachments and the replacement of part of a precision attachment, magnetic retention or overdenture attachments. Overdentures. Overdentures and related services, including root canal therapy on teeth supporting an overdenture. Third Molars. The replacement of extracted or missing third molarslwisdom teeth. Restorations. Restorations exceeding one per tooth in a 24month period. Replacement of existing restoration if replacement occurs within 24 months of the original placement. Harmful HabR Appliances. Fixed and removable appliances to inhibit thumb sucking. Fluoride. Topical application of sodium fluoride or stannous fluoride to the teeth is limited to once in a 12-month period. Palliative Treatment Emergency treatment of dental pain is limited to once in a 12-month period. Orthodontics. Orthodontic braces, appliances and all related services. Late Entrant Waiting Periods If the insured person does not enroll within 3t days of eligibility date, the following late entrant waiting periods will apply to services for: - Preventive and Diagnostic None - Restorative 6 months Oral Surgery 12 months Periodontics, Endodontics, or Prosthodontics 12 months Third Party Liability BC Life & Health Insurance Company is entitled to reimbursement of benefits paid 'rf the insured person recovers damages from a legally liable third party. Coordination of Benefits The benefits of this plan may be reduced if the insured person has any other group dental coverage so that the services received from all group coverages do not exceed 100°k of the covered expense. The Power of B/ue.~'" BC Life & Health Insurance Company is an Independent Licensee of the Blue Cross Association. The Blue Cross name and symbol are registered service marks of the Blue Cross Association. www.bluecrossca.com BC Life Voluntary Prudent Buyer Dental Plus Plan DV03 We're Committed To Providing You With Great Dental Care Options Dental care is an important part of your comprehensive health care coverage and well-being. BC Life & Health Insurance Company knows being protected by dental insurance is an important safeguard for you and your family. Diagnostic and preventive services are the key to maintaining good dental health. Dental. coverage is designed to guarantee that you receive regular preventive care. With routine examinations, minor dental problems can be diagnosed and treated before major, more costly problems set in. Your Voluntary Prudent Buyer Dental Plan can be instrumental in your long-term dental health. Voluntary Prudent Buyer Dental Plus Plan Advantages - You and your covered family members can take advantage of one of the largest dental networks in California with nearly 13,000 dentists - You can enjoy negotiated rates and no payment due at time of service (excluding any applicable copayments) from network dentists - No claim forms How the Plan Works Your Voluntary Prudent Buyer Dental Plus Plan is a preferred provider organization (PPO) plan from BC Life & Health Insurance Company (BC Life & Health), an affiliate of Blue Cross of California. The Voluntary Prudent Buyer Dental Plus Plan provides you with the freedom to select virtually any licensed dentist. You are responsible for the calendar year deductible and for your portion of the covered services. b ~. cp Participating Dentist If you choose a PPO participating dentist, you take advantage of negotiated rates. The negotiated rate is the amount a participating dentist agrees to accept as payment in full for covered services. The negotiated rate is usually lower than the participating dentist's normal charge. By choosing a participating dentist, you will not be responsible for any amount in excess of the negotiated rate for covered services. Please note that you must verify that the dentist you use is a member of the Prudent Buyer PPO network. Non-Participating Dentist If you choose a licensed dentist who does not participate in the PPO Dental network, you are not eligible for negotiated rates and your out-of- pocket expenses will be greater. You will be responsible for your annual deductible and for your portion of the Covered Expenses plus charges in excess of Covered Expenses. Please see your Certificate of Insurance (Certificate) for details. You will also be asked to pay your portion of the bill at the time of service and submit claim forms for reimbursement. Network After enrolling in the Voluntary Prudent Buyer Dental Plus Plan, you will receive a Directory of Participating Dentists. If you have a particular dentist in mind and he or she is not in the directory, you may call the customer service telephone number on your ID card to see if the dentist has recently joined the network. SC10887 Effective 3/2005 Printed 12/11/2007 Late Entrant Waiting Period If you do not enroll in your dental plan within 31 days of your eligibility date, you will be subject to a Late Entrant Waiting Period. This means that you will not be covered immediately for certain dental services. Details of the Late Entrant Waiting Period can be found in the Exclusions and Limitations section of this document. Filing A Claim When you use a participating dentist, you do not need to submit a claim form for covered dental expenses. Your participating dentist will complete and submit the claim form to BC Life & Health. BC Life & Health will pay the benefits of the plan directly to your dentist. If your dentist is not in the network, you must complete and submit your own claim forms. Dental Deductible A deductible is the amount of money you pay for a covered dental expense prior to benefits being paid under the plan. Only charges that are considered a covered dental expense will apply toward satisfaction of the deductible. Please refer to the deductible amount in the chart. Pre-Authorization When the anticipated expense for any course of treatment exceeds $350, you should submit a request for pre-authorization. If you use a participating dentist, your dentist will submit the authorization form for you. If your dentist is not part of the network, you will have to submit a pre-authorization form to your dentist for completion and then send it to BC Life & Health for approval. Conditions of Service Services must be provided by a licensed dentist and must be for treatment of dental disease, defect or injury, and are subject to any Exclusions and Limitations or Annual Maximum specified under the plan. Customer Service A Customer Service Representative is available to answer your questions and inquiries at (800) 627-0004. Annual Maximum Dental benefits are limited to a maximum payment for expenses incurred by each insured person during a calendar year. Please refer to the amount on the chart. Continuing Coverage As required by federal law, certain restrictions and conditions apply to continue coverage and are described in your Certificate. Calendar Year Deductible $50/insured person; maximum of (waived for Diagnostic & Preventive services three separate deductibles/family listed in Covered Services) Annual Maximum $1,000 Benefit Waiting Periods* The following benefit waiting periods will apply to services for: - Preventive and Diagnostic - Restorative - Oral Surgery - Periodontics, Endodontics, or Prosthodontics - Orthodontics None Three months 6 months 12 months 18 months Benefit waiting periods may be waived with proof of at least 12 continuous months of prior dental coverage. See Certificate for details. Predetermination of Benefits Charges in excess of $350 Covered Expense PPO Dentists Non-PPO Dentists Plan payments will be applied to the lesser of the charges billed by the provider or the following: The Prudent Buyer Dental Plan negotiated rate or fee. When using a participating dentist, insured persons are not responsible for the difference between the provider's usual charges and the negotiated amount. The amount calculated by us, as specified in the Certificate, for professional services in the dentist's geographical location. When using a non participating dentist, insured persons are responsible for the d fference between the covered amount and actual charges, in addition to any deductible, and copayment amounts. Covered Services Per Insured Person Copay PPO Dentists Non-PPO Dentists Diagnostics (deductible waived) (exams) No Copay No Copay Preventive (deductible waived) (teeth cleanings) No Copay No Copay Restorative fillings, sealants, and space maintainers) 20% 20% Endodontics (root canal therapy) 50% 50% Periodontics (gum surgery) 50% 50% Oral Surgery (extractions) 50% 50% Prosthodontics (dentures, crowns, bridges) 50% 50% Orthodontics (teeth straighteninp,J $1,000 lifetime maximum up to age 19 50% 50% This Summary of Benefits is a brief review of benefits. Once enrolled, insured persons wilt receive the Certificate of Insurance, which explains the exclusions and limitations, as well as the full range of covered services of the plan, in detail. Voluntary Prudent Buyer Dental Exclusions ~ Limitations Services Provided Before or After the Term of This Coverage. Services received before the insured person's effective date. Services received after the insured person's coverage ends, as specified as covered in the Certificate. Experimental or Investigative Procedures. Any procedures which are considered experimental or investigative or which are not widely accepted as proven and effective procedures within the organized dental community. Medically Necessary. Any services or supplies which are not medically necessary. Workers' Compensation. Any work-related conditions if benefits are recovered or can be recovered either by adjudication, settlement or otherwise under any workers' compensation, employer's liability law or occupational disease law, even if the insured person does not claim those benefits. Government Programs. Services provided by or payment made by any local, state, county or federal government agency, including Medicare and any foreign government agency. No Charge Services. Services received for which no charge is made to the insured person or for which no charge would be made to the insured person in the absence of insurance coverage. Results of War. Disease contracted or injuries sustained as a result of war, declared or undeclared, or from exposure to nuclear energy, whether or not the result of war. Provider Related to Insured Person. Professional services received from a person who lives in the insured person's home or who is related to the insured person by blood or marriage. Excess Expense. Any amounts in excess of covered dental expense or the Annual Maximum. Professionally Acceptable Treatment If more than one treatment plan would be considered acceptable services for a dental condition, any amount exceeding the cost of the least expensive professionally acceptable treatment plan is not covered. Transfer of Care. If the insured person transfers from the care of one dentist to another dentist during the course of treatment, or if more than one dentist renders services for one dental procedure, we shall be liable only for the amount we would have been liable for had one dentist rendered the services. Hospital Charges. Hospital costs and any additional charges by the dentist for hospital treatment. Services Not Included as a Covered Procedure. Services not specifically provided for by the plan unless they are similar in nature to an included procedure. In such event, the benefit payable will be based on the most nearly comparable services included. Treatment By An Unlicensed Dentist Charges for treatment by other than a licensed dentist or physician except charges for dental prophylaxis performed by a licensed dental hygienist, under the supervision and direction of a dentist. Treatment of the Joint of the Jaw andlor Occlusion Services. Diagnosis, services, supplies or appliances provided in connection with any of the following: - Any treatment to alter, correct, fix, improve, remove, replace, reposition, restore or otherwise treat the joint of the jaw (temporomandibularfoint) or associated musculature, nerves and other tissues for any reason or by any means; or - Any treatment, including crowns, caps andlor bridges to change the way the upper and lower teeth meet (occlusion); or - Treatment to change vertical dimension (the space between the upper and lower jaw) for any reason or by any means including the restoration of vertical dimension because teeth have worn down. Vertical Dimension and Attrition. Procedures requiring appliances or restorations (other than those for replacement of structure lost due to dental decay) that are necessary to alter, restore or maintain occlusion. These include, but are not limited to: - changing the vertical dimension - replacing or stabilizing tooth structure lost by attrition, abrasion, or erosion - realignment of teeth - gnathological recording - occlusal equilibration - periodontal splinting Prosthetic Replacements. Replacement of an existing fixed or removable prosthesis, is not a benefit'rf the replacement occurs within five years of the original placement, unless the prosthesis is a stayplate used during the healing period for recently extracted anterior teeth. Replacement of a removable partial will be allowed if the partial is no longer useable, cannot be made serviceable and meets the five year requirement. Crown Replacements. Crowns, inlays, onlays or cast restorations on the same tooth in excess of once every five years of the original replacement. Prosthetic Repairs. Repairs, adjustments or relines of full or partial dentures, or other prostheses are not covered for a period of six months from the initial placement if they were paid for under this plan. Adjustments or repairs are limited to once in a 12-month period. Rebase and reline are limited to once in a 24month period. Mandibular tissue conditioning is limited to once per quadrant in a 12-month period. Recement of an existing crown is not a benefit if done within 6 months of initial placement. Lost or Stolen Dentures or Appliances. Replacement of existing full or partial dentures or prosthetic appliances which have been lost or stolen if replacement occurs within five years of the original placement. Space Maintainers. Limited to children underage 16. Use of space maintainers in excess of one treatment per lifetime, which includes one adjustment within six months of placement. Prosthetics (patients under 76 years old). Fixed bridges, removable cast partials, cast crowns, with or without veneers, and inlays for patients under sixteen years old. Prefabricated stainless steel crowns for primary teeth of children under age 16 aze limited to one per tooth in a 5-year period. Implants. Implants (materials implanted into or on bone or soft tissue) or the removal of implants, However, if implants are provided in connection with a covered prosthetic appliance, we will allow the cost of a standard complete or partial denture, or a bridge, toward the cost of the implants and the prosthetic appliances. Malignancies and Neoplasms. Services for treatment of malignancies and neoplasms. Cosmetic Dentistry. Any services performed for cosmetic purposes, unless they are for correction of functional disorders or as a result of an accidental injury occurring while the insured person was covered for dental benefits under this plan. Congenital or Developmental Malformation. Services to correct a congenital or developmental malformation including, but not limited to, cleft palate, maxillary and mandibular (upper and lower jaw) malformations, enamel hypoplasia (lack of development), fluorosis (discoloration of the teeth) and anodontia (congenitally missing teeth). X-rays. More than one set of full-mouth x-rays or its equivalent in a 36-month period. Periapical and bitewing x-rays submitted individually will be combined and paid up to the amount of a full mouth series. Bitewing X-rays. Bitewing x-rays in excess of two series for standard in a calendar year. Vertical bitewings limited to 8 films in a 60.month period. Oral Exams. Oral exams are limited to two, in any combination, per calendar year. Prophylaxis or Periodontal Prophylaxis. Prophylaxis or periodontal prophylaxis treatments, singly or in combination, exceeding two treatments in a calendar year. Periodontics. Osseous surgery, including flap entry and closure, exceeding one time per quadrant in 36-month period. Gingivectomy or gingivoplasty exceeding one time per quadrant in a 24month period. Full mouth debridement limited to one time at the beginning of a periodontal treatment plan, prior to pocket depth charting. Periodontal scaling. Periodontal scaling exceeding one time per quadrant in a 24month period. Sealants. Sealants are limited to children between 6 and 18 years of age for permanent unrestored first and second molars. Treatment is limited to once every 36 months per tooth. Prescription Drugs and Medications. Any prescribed drugs, pre-medication or analgesia. Root Canal Therapy. Root canal therapy in excess of one treatment per tooth for initial treatment and one retreatment per tooth. Onl Hygiene. Oral hygiene instruction. Oral Surgery. Extraction of third molars (wisdom teeth) if the patient is under the age of 16. Alveoloplasty or frenulectomy are limited to once per quadrant or arch in an insured person's lifetime. Teeth Lost Prior to this Coverage. Teeth lost prior to coverage under this plan are not eligible for prosthetic replacement unless the prosthetic replacement replaces one or more eligible natural teeth lost during the term of this coverage. Precision Attachments. Precision attachments and the replacement of part of a precision attachment, magnetic retention or overdenture attachments. Overdentures. Overdentures and related services, including root canal therapy on teeth supporting an overdenture. Third Molars. The replacement of extracted or missing third molars/wisdom teeth. Restorations. Restorations exceeding one per tooth in a 24month period. Replacement of existing restoration if replacement occurs within 24 months of the original placement. Harmful Habit Appliances. Fixed and removable appliances to inhibit thumb sucking. Fluoride. Topical application of sodium fluoride or stannous fluoride to the teeth is limited to once in a 12-month period. Palliative Treatment Emergency treatment of dental pain is limited to once in a 12-month period. ORTHODONTIC EXCLUSIONS AND LIMRATIONS Myofunctional Therapy. Myofunctional therapy (the use of muscle exercises as an adjunct to orthodontic mechanical correction of malocclusion) and related services. ORhodontia•Related Surgical Procedures. Surgical procedures incidental to orthodontic treatment, including, but not limited to, extraction of teeth solely for orthodontic reasons, exposure of impacted teeth, correction of micrognathia or macrognathia, or repair of cleft palate. Services Provided Before or Alter the Term of This Coverage. Orthodontic treatment begun prior to the insured person's effective date or after the termination of coverage. Temporomandibular (Jaw) Joint Orthodontic treatment related to temporomandibular joint disturbances or hormonal imbalance. Orthodontic Records. Orthodontic records, including, but not limited to, cephalometric tracing, photographs, study models and diagnostic radiographs. Late Entrant Waiting Periods If the insured person does not enroll within 31 days of eligibility date, the following late entrant waiting periods will apply to services for: - Preventive and Diagnostic None - Restorative 6 months - Oral Surgery 12 months - Periodontics, Endodontics, or Prosthodontics 12 months - Orthodontics 24 months Third Pally Liability BC Life 8 Health Insurance Company is entitled to reimbursement of benefits paid if the insured person recovers damages from a legally liable third party. Coordination of Benefits The benefits of this plan may be reduced if the insured person has any other group dental coverage so that the services received from all group coverages do not exceed 100°h of the covered expense. The Power of B/ue.s"' BC Life & Health Insurance Company is an Independent Licensee of the Blue Cross Association. The Blue Cross name and symbol aze registered service marks of the Blue Cross Association. vvvvw.bluecrossca.com BC Life Voluntary Prudent Buyer Dental Plus Plan DV04 We're Committed To Providing You With Great Dental Care Options Dental care is an important part of your comprehensive health care coverage and well-being. BC Life & Health Insurance Company knows being protected by dental insurance is an important safeguard for you and your family. Diagnostic and preventive services are the key to maintaining good dental health. Dental coverage is designed to guarantee that you receive regular preventive care. With routine examinations, minor dental problems can be diagnosed and treated before major, more costly problems set in. Your Voluntary Prudent Buyer Dental Plan can be instrumental in your long-term dental health. Voluntary Prudent Buyer Dental Plus Plan Advantages - You and your covered family members can take advantage of one of the largest dental networks in California with nearly 13,000 dentists - You can enjoy negotiated rates and no payment due at time of service (excluding any applicable copayments) from network dentists - No claim forms How the Plan Works Your Voluntary Prudent Buyer Dental Plus Plan is a preferred provider organization (PPO) plan from BC Life & Health Insurance Company (BC Life & Health), an affiliate of Blue Cross of California. The Voluntary Prudent Buyer Dental Plus Plan provides you with the freedom to select virtually any licensed dentist. You are responsible for the calendar year deductible and for your portion of the covered services. Participating Dentist b cp If you choose a PPO participating dentist, you take advantage of negotiated rates. The negotiated rate is the amount a participating dentist agrees to accept as payment in full for covered services. The negotiated rate is usually lower than the participating dentist's normal charge. By choosing a participating dentist, you will not be responsible for any amount in excess of the negotiated rate for covered services. Please note that you must verify that the dentist you use is a member of the Prudent Buyer PPO network. Non-Participating Dentist If you choose a licensed dentist who does not participate in the PPO Dental network, you are not eligible for negotiated rates and your out-of-pocket expenses will be greater. You will be responsible for your annual deductible and for your portion of the Covered Expenses plus charges in excess of Covered Expenses. Please see your Certificate of Insurance (Certificate) for details. You will also be asked to pay your portion of the bill at the time of service and submit claim forms for reimbursement. Network After enrolling in the Voluntary Prudent Buyer Dental Plus Plan, you will receive a Directory of Participating Dentists. If you have a particular dentist in mind and he or she is not in the directory, you may call the customer service telephone number on your ID card to see if the dentist has recently joined the network. SC10888 Effective 3/2005 Printed 12/11/2007 Late Entrant Waiting Period If you do not enroll in your dental plan within 31 days of your eligibility date, you will be subject to a Late Entrant Waiting Period. This means that you will not be covered immediately for certain dental services. Details of the Late Entrant Waiting Period can be found in the Exclusions and Limitations section of this document. Filing A Claim When you use a participating dentist, you do not need to submit a claim form for covered dental expenses. Your participating dentist will complete and submit the claim form to BC Life & Health. BC Life & Health will pay the benefits of the plan directly to your dentist. If your dentist is not in the network, you must complete and submit your own claim forms. Dental Deductible A deductible is the amount of money you pay for a covered dental expense prior to benefits being paid under the plan. Only charges that are considered a covered dental expense will apply toward satisfaction of the deductible. Please refer to the deductible amount in the chart. Pre-Authorization When the anticipated expense for any course of treatment exceeds $350, you should submit a request for pre-authorization. If you use a participating dentist, your dentist will submit the authorization form for you. If your dentist is not part of the network, you will have to submit apre- authorization form to your dentist for completion and then send it to BC Life & Health Conditions of Service Services must be provided by a licensed dentist and must be for treatment of dental disease, defect or injury, and are subject to any Exclusions and Limitations or Annual Maximum specified under the plan. Customer Service A Customer Service Representative is available to answer your questions and inquiries at (800) 62'7-0004. Annual Maximum Dental benefits are limited to a maximum payment for expenses incurred by each insured person during a calendar year. Please refer to the amount on the chart. Continuing Coverage As required by federal law, certain restrictions and conditions apply to continue coverage and are described in your Certificate. for approval. Calendar Year Deductible $50/insured person; maximum of (waived for Diagnostic & Preventive services three separate deductibles/family listed in Covered Services) Annual Maximum $1,500 Benefit Waiting Periods* The following benefit waiting periods will apply to se rvices for: - Preventive and Diagnostic None - Restorative Three months - Oral Surgery 6 months - Periodontics, Endodontics, or Prosthodontics 12 months - Orthodontics 18 months * Benefit waiting periods may be waived with proof of at least 12 continuous months of prior dental coverage. See Certificate for details. Predetermination of Benefits Charges in excess of $350 Covered Expense Plan payments will be applied to the lesser of the charges billed by the provider or the following: PPO Dentists The Prudent Buyer Dental Plan negotiated rate or fee. When using a participating dentist, insured persons are not responsible for the difference between the provider's usual charges and the negotiated amount. Non-PPO Dentists The amount calculated by us, as specified in the Certificate, for professional services in the dentist's geographical location. When using anon-participating dentist, insured persons are responsible for the difference between the covered amount and actual charges, in addition to any deductible, and copayment amounts. Covered Services Per Insured Person Copay PPO Dentists Non-PPO Dentists Diagnostics (deductible waived) (exams) No Copay No Copay Preventive (deductible waived) (teeth cleanings) No Copay No Copay Restorative fillings, sealants, and space maintainers) 20% 20% Endodontics (root canal therapy) 50% 50% Periodontics (gum surgery) 50% 50% Oral Surgery (extractions) 20% 20% Prosthodontics (dentures, crowns, bridges) 50% 50% Orthodontics (teeth straightening) $1,000 lifetime maximum up to age 19 50% 50% This Summary of Benefits is a brief review of benefits. Once enrolled, insured persons will receive the Certificate of Insurance, which explains the exclusions and limitations, as well as the full range of covered services of the plan, in detail. Voluntary Prudent Buyer Dental Exclusions 8~ Limitations Services Provided Before or After the Term of This Coverage. Services received before the insured person's effective date. Services received after the insured person's coverage ends, as specified as covered in the Certificate. Experimental or Investigative Procedures. Any procedures which are considered experimental or investigative or which are not widely accepted as proven and effective procedures within the organized dental community. Medically Necessary. Any services or supplies which are not medically necessary. Workers' Compensation. Any work-related conditions if benefits are recovered or can be recovered either by adjudication, settlement or otherwise under any workers' compensation, employer's liability law or occupational disease law, even if the insured person does not claim those benefits. Govemment Programs. Services provided by or payment made by any local, state, county or federal government agency, including Medicare and any foreign government agency. No Charge Services. Services received for which no charge is made to the insured person or for which no charge would be made to the insured person in the absence of insurance coverage. Results of War. Disease contracted or injuries sustained as a result of war, declared or undeclared, or from exposure to nuclear energy, whether or not the result of war. Provider Related to Insured Person. Professional services received from a person who lives in the insured person's home or who is related to the insured person by blood or marriage. Excess Expense. Any amounts in excess of covered dental expense or the Annual Maximum. Professionally Acceptable Treatment. If more than one treatment plan would be considered acceptable services for a dental condition, any amount exceeding the cost of the least expensive professionally acceptable treatment plan is not covered. Transfer of Care. If the insured person transfers from the care of one dentist to another dentist during the course of treatment, or if more than one dentist renders services for one dental procedure, we shall be liable only for the amount we would have been liable for had one dentist rendered the services. Hospital Charges. Hospital costs and any additional charges by the dentist for hospital treatment. Services Not Included as a Covered Procedure. Services not specifically provided for by the plan unless they are similar in nature to an included procedure. In such event, the benefit payable will be based on the most nearly comparable services included. Treatment By An Unlicensed Dentist. Charges for treatment by other than a licensed dentist or physician except charges for dental prophylaxis performed by a licensed dental hygienist, under the supervision and direction of a dentist. Treatment of the Joint of the Jaw andlor Occlusion Services. Diagnosis, services, supplies or appliances provided in connection with any of the following: i Any treatment to alter, correct, fx, improve, remove, replace, reposition, restore or otherwise treat the joint of the jaw (temporomandibular joint) or associated musculature, nerves and other tissues for any reason or by any means; or r Any treatment, including crowns, caps andlor bridges to change the way the upper and lower teeth meet (occlusion); or i Treatment to change vertical dimension (the space between the upper and lower jaw) for any reason or by any means including the restoration of vertical dimension because teeth have worn down. Vertical Dimension and Attrition. Procedures requiring appliances or restorations (other than those for replacement of structure lost due to dental decay) that are necessary to alter, restore or maintain occlusion. These include, but are not limited to: r changing the vertical dimension r replacing or stabilizing tooth structure lost by attrition, abrasion, or erosion r realignment of teeth i gnathologica recording i occlusal equilibration - periodontal splinting Prosthetic Replacements. Replacement of an existing fixed or removable prosthesis, is not a beneft if the replacement occurs within fve years of the original placement, unless the prosthesis is a stayplate used during the healing period for recently extracted anterior teeth. Replacement of a removable partial will be allowed if the partial is no longer useable, cannot be made serviceable and meets the five year requirement. Crown Replacements. Crowns, inlays, onlays or cast restorations on the same tooth in excess of once every five years of the original replacement. Prosthetic Repairs. Repairs, adjustments or relines of full or partial dentures, or other prostheses are not covered for a period of six months from the initial placement if they were paid for under this plan. Adjustments or repairs are limited to once in a 12-month period. Rebase and reline are limited to once in a 24-month period. Mandibular tissue conditioning is limited to once per quadrant in a 12-month period. Recement of an existing crown is not a beneft if done within 6 months of initial placement. Lost or Stolen Dentures or Appliances. Replacement of existing full or partial dentures or prosthetic appliances which have been lost or stolen if replacement occurs within fve years of the original placement. Space Maintainers. Limited to children under age 16. Use of space maintainers in excess of one treatment per lifetime, which includes one adjustment within six months of placement. Prosthetics (patients under 16 years old). Fixed bridges, removable cast partials, cast crowns, with or without veneers, and inlays for patients under sixteen years old. Prefabricated stainless steel crowns for primary teeth of children under age 16 are limited to one per tooth in a 5-year period. Implants. Implants (materials implanted into or on bone or soft tissue) or the removal of implants. However, if implants are provided in connection with a covered prosthetic appliance, we will allow the cost of a standard complete or partial denture, or a bridge, toward the cost of the implants and the prosthetic appliances. Malignancies and Neoplasms. Services for treatment of malignancies and neoplasms. Cosmetic Dentistry. Any services performed for cosmetic purposes, unless they are for correction of functional disorders or as a result of an accidental injury occurring while the insured person was covered for dental benefits under this plan. Congenital or Developmental Malformation. Services to correct a congenital or developmental malformation including, but not limited to, cleft palate, maxillary and mandibular (upper and lower jaw) malformations, enamel hypoplasia (lack of development), fluorosis (discoloration of the teeth) and anodontia (congenitally missing teeth). X-rays. More than one set offull-mouth x-rays or its equivalent in a 36-month period. Periapical and Bitewing x-rays submitted individually will be combined and paid up to the amount of a full mouth series. Bitewing X-rays. Bitewing x-rays in excess of two series for standard in a calendar year. Vertical bitewings limited to 8 films in a 60-month period. Oral Exams. Oral exams are limited to two, in any combination, per calendar year. Prophylaxis or Periodontal Prophylaxis. Prophylaxis or periodontal prophylaxis treatments, singly or in combination, exceeding two treatments in a calendar year. Periodontics. Osseous surgery, including flap entry and closure, exceeding one time per quadrant in 36-month period. Gingivectomy or gingivoplasty exceeding one time per quadrant in a 24-month period. Full mouth debridement limited to one time at the beginning of a periodontal treatment plan, prior to pocket depth charting. Periodontal scaling. Periodontal scaling exceeding one time per quadrant in a 24-month period. Sealants. Sealants are limited to children between 6 and 18 years of age for permanent unrestored f rst and second molars. Treatment is limited to once every 36 months per tooth. Prescription Drugs and Medications. Any prescribed drugs, pre-medication or analgesia. Root Canal Therapy. Root canal therapy in excess of one treatment per tooth for initial treatment and one retreatment per tooth. Oral Hygiene. Oral hygiene instruction. Oral Surgery. Extraction of third molars (wisdom teeth) if the patient is under the age of 16. Alveoloplasty or frenulectomy are limited to once per quadrant or arch in an insured person's lifetime. Teeth Lost Prior to this Coverage. Teeth lost prior to coverage under this plan are not eligible for prosthetic replacement unless the prosthetic replacement replaces one or more eligible natural teeth lost during the term of this coverage. Precision Attachments. Precision attachments and the replacement of part of a precision attachment, magnetic retention or overdenture attachments. Overdentures. Overdentures and related services, including root canal therapy on teeth supporting an overdenture. Third Molars. The replacement of extracted or missing third molars/wisdom teeth. Restorations. Restorations exceeding one per tooth in a 24-month period. Replacement of existing restoration if replacement occurs within 24 months of the original placement. Harmful Habit Appliances. Fixed and removable appliances to inhibit thumb sucking. Fluoride. Topical application of sodium fluoride or stannous fluoride to the teeth is limited to once in a 12-month period. Palliative Treatment. Emergency treatment of dental pain is limited to once in a 12-month period. ORTHODONTIC EXCLUSIONS AND LIMITATIONS Myofunctional Therapy. Myofunctional therapy (the use of muscle exercises as an adjunct to orthodontic mechanical correction of malocclusion) and related services. Orthodontia-Related Surgical Procedures. Surgical procedures incidental to orthodontic treatment, including, but not limited to, extraction of teeth solely for orthodontic reasons, exposure of impacted teeth, correction of micrognathia or macrognathia, or repair of cleft palate. Services Provided Before or After the Term of This Coverage. Orthodontic treatment begun prior to the insured person's effective date or after the termination of coverage. Temporomandibular (Jaw) Joint. Orthodontic treatment related to temporomandibularjoint disturbances or hormonal imbalance. Orthodontic Records. Orthodontic records, including, but not limited to, cephalometric tracing, photographs, study models and diagnostic radiographs. Late Entrant Waiting Periods If the insured person does not enroll within 31 days of eligibility date, the following late entrant waiting periods will apply to services for: r Preventive and Diagnostic None r Restorative 6 months Oral Surgery 12 months r Periodontics, Endodontics, or Prosthodontics 12 months Y Orthodontics 24 months Third Party Liability BC Life & Health Insurance Company is entitled to reimbursement of benefits paid if the insured person recovers damages from a legally liable third party. Coordination of Benefits The benefits of this plan may be reduced if the insured person has any other group dental coverage so that the services received from all group coverages do not exceed 100% of the covered expense. The Power of B/ue,s"' BC Life & Health Insurance Company is an Independent Licensee of the Blue Cross Association. The Blue Cross name and symbol are registered service marks of the Blue Cross Association. vvvvw. bl uecrossca. com BC Life City of Bakersfield -Retiree Voluntary Dental Effective 1/1/08 Rates Are Net of Commission BCC only agrees to a full takeover of the retiree voluntary dental population. Rates are valid for Retiree Population Only In-State Lives Single 2-Party Family Enrollment 274 125 9 DV01 $26.61 $50.56 $81.61 DV03 $48.72 $92.57 $149.43 DV04 $55.27 $105.02 $169.52 Out-Of-State Lives Single 2-Party Family Enrollment 11 13 0 NDV01 $25.99 $49.38 $79.70 NDV03 $52.94 $100.58 $162.36 NDV04 $60.05 $114.10 $184.18 City of Bakersfield -- Medical Rates Without Kaiser Proposed Renewal Increase Enrollment 2008 % Blue Cross Active Monthly Rates Prudent Buyer PPO EE 755 $ 42b.21 EE+1 189 $ 853.84 Family 393 $+ 1,282.99 Monthly Total 737 $ 731,653 Annual Total $ 8,779,839 20.2% pepm $ 992.75 Retiree Monthly Rates EE 712 $ 867.81 EE+1 52 $ 1,735.55 Family 1 9i 2,603.33 Monthly Total 165 $ 190,047 Annual Total $ 2,280,566 0.0% pepm $ 1,151.80 Blue Cross Active Monthly Rates CaliforniaCare HMO EE 213 - $ 347.19 EE+1 163 $ 697.79 Family 358 $ 1,020.10 Monthly Total 734 $ 552,886 Annual Total $ 6,634,634 -0.1 % pepm $ 753.25 Retiree Monthly Rates 1 < 65 79 $ 626.20 2 < 65 35 $ 1,298.0,0 Family < 65 6 $ 1,830.49 1 > 65 51 $ 3$5.21 Family>65 2 $ 1,35U.23 EE < 65/SP > 65 5 $ 1,U21.2SU EE > 65/SP < 65 2 $ 1,064.40 Monthly Total 208 $ 157,174 Annual Total $ 1,886,083 18.2% pepm $ 755.64 Blue Cross Senior Secure Monthly Rates Senior Secure EE 78 S ~$f).+99 Monthly Total 78 $ 21,917 Annual Total $ 263,007 8.0% pepm $ 280.99 pepm 2008 Active pepm 873.24 Actives $ 15,414,473 0.6% Retiree pepm 818.49 Retirees $ 4,429,656 6.7% Total pepm 860.39 Total $ 19,844,129 1.9% Active pepm increase 0.6% check $ 19,844,129 1.9% Retiree pepm increase 6.7% $ 366,381 Total pepm increase 1.9% if all go HMO dollar cost $ 2,873.93 annual additional cost per each former Kaiser going PPO FUNDING PROVISIONS EXPERIENCE RATED REFUNDING between BC LIFE & HEALTH INSURANCE COMPANY (BC Life) and CITY OF BAKERSFIELD (the Group) SECTION I: BASIC FACTS Group Policy WF00403-W (R-104) (the Policy) currently in effect between the Group and BC Life is subject to the Funding Provisions of this endorsement. Effective January 1, 2005, these Funding Provisions are made a part of the Policy. All other provisions of the Policy which are not inconsistent with this endorsement remain in effect. With respect to these Funding Provisions, the Policy Year will begin on the effective date of this endorsement and will end on December 31, 2005. Each subsequent Policy Year will be a period of twelve (12) consecutive calendar months, beginning on the first day of January. Any Policy Year will end, however, upon termination of the Policy. SECTION II: PRINCIPAL RESOLUTION After the close of the Policy Year, BC Life will perform an accounting in which total Income will be compared to total Expense with respect to such Policy Year. Such accounting shall be referred to herein as the "Annual Accounting". The following provisions shall apply in connection with such Annual Accounting: A. If Expense exceeds Income, BC Life will deduct the amount of the Deficit from the Stabilization Fund. B. If Income received exceeds Expense, BC Life will add the amount of the Surplus to the Stabilization Fund. C. If the amount in the Stabilization Fund exceeds the Required Minimum Fund Level, the Group may request a refund as described in the Stabilization Fund provisions of this endorsement. The operation of the Stabilization Fund is explained in Section IV. The Required Minimum Fund Level is shown in the Schedule. 00403.F47.ERR4-W 405 PAGE 1 VCH #F050331-02 FUNDING PROVISIONS SECTION III: DEFINITIONS The following terms, when capitalized throughout these Funding Provisions, shall have the meanings set forth below. Annual Accounting refers to the annual settlement of accounts performed by BC Life within 120 days after the end of each Policy Year, in which total Income is compared to total Expense with regard to the respective Policy Year. Benefit Expense includes paid claims, the adjustment to reserve for incurred but not reported claims, and a charge for excluding portions of large claims from the Group's experience. In determining paid claims, BC Life will subtract the amount by which medical claims (excluding dental and prescription drug claims) paid on behalf of any Insured Person during the Policy Year exceed the large claim pooling point. This adjustment will not be made to claims paid after termination of the Policy. (The Large Claim Pooling Point for the Policy Year is shown in the Schedule.) Deficit refers to an underwriting loss attributable to the Group with respect to the Policy. The amount of the Deficit, if any, for the Policy Year is equal to the amount by which Expense exceeds Income. Expense refers to Benefit Expense and Retention Expense, plus the amount of any Prior Deficit. All Expense, as well as any Deficit or Surplus and the value of medical provider discounts, will be determined by BC Life in accordance with corporate policies in effect at the time of the calculation. Income refers to Premiums received by BC Life under the Policy. Prior Deficit refers to any Deficit carried forward from a prior Policy Year or attributable to a prior arrangement between BC Life and the Group. Retention Expense includes the cost BC Life incurs in administering the Policy, including the direct and indirect cost of doing business, and a charge for the conversion option available to Insured Persons in accordance with the conversion privilege. Surplus refers to an underwriting gain attributable to the Group with respect to the Policy. The amount of the Surplus, if any, for the Policy Year is equal to the amount by which Income exceeds Expense. SECTION IV: STABILIZATION FUND A. Deficit. If, for any Policy Year, it is determined that a Deficit exists, the following provisions will apply: 1. BC Life will deduct the amount of the Deficit from the Stabilization Fund. 2. If the amount in the Stabilization Fund is less than the Deficit for the Policy Year, the Deficit will be carried forward to the next Policy Year and, if applicable, to subsequent Policy Years. B. Prior Deficit. If any Prior Deficit exists between BC Life and the Group, the amount of that Prior Deficit will be recorded as a Deficit to the Stabilization Fund as of the effective date of these Funding Provisions. C. Surplus. If, for any Policy Year, it is determined that a Surplus exists, BC Life will credit the amount of the Surplus to the Stabilization Fund. D. Prior Surplus. If any Surplus is from a prior Policy Year or attributable to a prior arrangement between BC Life and the Group, the amount of that Surplus will be credited to the Stabilization Fund as of the effective date of these Funding Provisions. 00403.F47.ERR4-W 405 PAGE 2 FUNDING PROVISIONS E. Refund of Surplus to the Group. The Group may claim a refund of the Surplus, if any, .subject to the following provisions: If, after all credits are added to and all deductions subtracted from the Stabilization Fund, the amount in the Stabilization Fund exceeds the Required Minimum Fund Level (as provided in paragraph F below), the Group may request a refund of such excess by making a written request within thirty (30) days following the day it receives the annual settlement statement from BC Life. 2. If the Group is in arrears in the payment of Premiums, no refund will be made until the Premiums have been paid. BC Life may, at its sole option, apply any refund due against delinquent Premiums. 3. BC Life will not be responsible for the Group's use of any refund payment. F. Required Minimum Fund Level. The Required Minimum Fund Level is the minimum level of funds which must be maintained in the Stabilization Fund in the event that the Group is eligible to claim a refund of Surplus, as described in paragraph E above. The Required Minimum Fund Level for the Policy Year is shown in the Schedule. BC Life reserves the right to amend the Required Minimum Fund Level, as a condition of renewal, upon mutual agreement between BC Life and the Group. G. Interest. Any amount retained by BC Life in the Stabilization Fund after completion of the Annual Accounting (excluding any Surplus refunded to the Group) will earn interest. The interest rate will be determined from an analysis of Federal T-Bill yields, BC Life Treasury short-term yields, and BC Life fixed-income yields. Interest will be calculated based on the interest rate in effect at the close of the applicable Policy Year. In situations where funds are maintained for less than one year, short-term interest rates at the Federal T-Bill yield will be used to calculate interest. Interest earned during a Policy Year will be credited to the Stabilization Fund as of the last day of that Policy Year. In the event that these Funding Provisions are not executed by an authorized officer of the Group prior to the end of the Policy Year, BC Life shall not be liable for the payment of such interest to the Group. SECTION V: MODIFICATION OF FUNDING PROVISIONS BC Life may amend the terms of these Funding Provisions as follows: A. At the beginning of any month or upon annual renewal of the Policy, provided BC Life gives the Group thirty (30) days written notice; B. Any time the provisions of the Policy are changed; or C. Any time there is a ten (10) percent or greater change in the number of Employees enrolled under the Policy during the preceding three months, from the number of Employees enrolled at the start of the Policy Year. SECTION VI: AUDIT A. Authorization of Audits. BC Life may authorize audits, subject to certain limitations, to be performed by auditors employed by the Group. The Group shall have the right to select an auditor of its choice, except that the auditor shall not be involved in, or be subsidiary to, a business engaged in activities competitive to BC Life or to subsidiaries or affiliates of BC Life. Such audits will be conducted in accordance with, and subject to, the auditing standards of the American Institute of Certified Public Accountants and the written audit policy of BC Life, a copy of which shall be provided to the auditor. 00403.F17.ERR1-W 105 PAGE 3 FUNDING PROVISIONS B. Confidential and Proprietary Information. BC Life shall make available such records as may be reasonably necessary for a valid audit. Access by the Group, or any third party acting on behalf of the Group, to BC Life's confidential and proprietary information shall be restricted to only such information as deemed necessary by BC Life to accomplish the audit. The Group and the Group's auditor shall agree in writing (by a separate "Audit Agreement") regarding the auditor's conduct, and to maintain the confidentiality of any trade secret or proprietary information of which it may become aware during the course of the audit. C. Reimbursement of BC Life for Expense. The Group agrees to reimburse BC Life for all expense incurred by BC Life in support of the audit. Any such expense will be billed to the Group and the Group will remit the amount billed to BC Life within 15 days from the date of the bill. Failure of the Group to pay such bill by the end of that 15 day period shall be deemed reason for cancellation of the Policy by BC Life. SECTION VII: MINIMUM ENROLLMENT REQUIREMENT BC Life may terminate these Funding Provisions, upon thirty-one (31) days advance written notice to the Group, if enrollment under the Policy falls below 100 Insured Employees for a period of three consecutive months. In the event of such termination, the account will be converted to anon-refunding arrangement. Beginning with the effective date of such termination, the Group shall pay to BC Life the monthly Non- Refunding Premiums specified in the Policy for the remainder of the Policy Year. SECTION VIII: RECOVERY PROVISIONS A. Recovery of Overpayments. If it is determined that any payment has been made under this Policy to an ineligible person, or if it is determined that more or less than a correct amount has been paid by BC Life, BC Life shall make a reasonable effort to recover any such overpayment made or to adjust the payment, subject to the following: BC Life, at its discretion, may use the services of subcontractors (collection agencies and bill audit firms) to identify and recover overpayments. Any expenses which BC Life incurs for such services are included in the retention. BC Life will not be required to initiate court proceeding for any such recovery. B. Recovery of Liens. Subject to the following, BC Life agrees to use reasonable diligence to identify and seek to recover third-party liability liens or workers' compensation liens: In pursuing these recoveries, BC Life reserves the right to use its discretion in negotiating and compromising recoveries from third parties. 2. BC Life may engage the services of subcontractors to assist in the recovery process. Expenses which BC Life incurs for such services are included in the retention. 3. The Group will fully cooperate with BC Life in such recoveries and advise BC Life of any potential recoveries of which it becomes aware. 4. BC Life will not be required to initiate court proceeding for any such recovery. 5. BC Life will submit monthly reports to the Group listing all cases identified as subject to third parry liens or workers' compensation liens, the amount of claims paid, the current status of collection efforts and a report of all amounts collected and waived. The Group will advise BC Life of those cases which, in the Group's determination, shall warrant recovery. 00403.Ft7.ERRt-W 105 PAGE 4 FUNDING PROVISIONS SECTION IX: POST-TERMINATION PROVISIONS The following provisions will apply after the "Termination Date". "Termination Date", as used in this section, shall refer to the earlier of: the date the Policy terminates; or the date these Funding Provisions are otherwise not renewed at the end of the Policy Year. A. BC Life will perform a final settlement of all accounts. The final settlement will take place on a date determined by BC Life; however, in no event will such final settlement occur later than 24 months after the Termination Date. B. Following the completion of the final settlement, BC Life will remit to the Group any amount remaining in the Stabilization Fund, subject to the Group's endorsement of the "Acknowledgment of Receipt and Release of Claim". C. In the event that any claims incurred under the Policy prior to the Termination Date are paid by BC Life after the final settlement, the Group will reimburse BC Life for the amount of such claims. The Group's liability for such reimbursement will be limited, however, to the amount of money, if any, returned to the Group by BC Life at the final settlement. D. BC Life will not be responsible for the Group's use of any payment made by BC Life under these Funding Provisions. SECTION X: FINANCIAL ARRANGEMENTS WITH PROVIDERS BC Life or an affiliate has contracts with certain health care providers and suppliers (hereafter referred to together as "Providers") for the provision of and payment for health care services rendered to its Insured Persons and Members entitled to health care benefits under individual certificates and group policies or contracts to which BC Life or an affiliate is a party, including all persons covered under the Policy. Under the above-referenced contracts between Providers and BC Life or an affiliate, the negotiated rates paid for certain medical services provided to persons covered under the Policy may differ from the rates paid for persons covered by other types of products or programs offered by BC Life or an affiliate for the same medical services. In negotiating the terms of the Policy, the Group was aware that BC Life or its affiliates offer several types of products and programs. The Insured Employees, Family Members and the Group are entitled to receive the benefits of only those discounts, payments, settlements, incentives, adjustments and/or allowances specifically set forth in the Policy. Also, under arrangements with some Providers certain discounts, payments, rebates, settlements, incentives, adjustments and/or allowances, including, but not limited to, pharmacy rebates, may be based on aggregate payments made by BC Life or an affiliate in respect to all health care services rendered to all persons who have coverage through a program provided or administered by BC Life or an affiliate. They are not attributed to specific claims or plans and do not inure to the benefit of any covered individual or group, but may be considered by BC Life or an affiliate in determining its fees or subscription charges or premiums. 00403.F97.ERR9-W 905 PAGE 5 FUNDING PROVISIONS AUTHORIZATION Authorized officers of BC Life and of the Group have approved this endorsement as of its effective date. FOR BC LIFE by: David S. Helwig by: Thomas C. Geiser Title: President Title: Secretary, BC Life FOR THE GROUP by: by: Title: Title: D0403.F~7.ERR9-W 105 PAGE 6 SCHEDULE EFFECTIVE DATE This Schedule reflects the Funding Provisions which become effective on January 1, 2005. LARGE CLAIM ADJUSTMENT The Large Claim Pooling Point for the Policy Year is $75,000. REQUIRED MINIMUM FUND LEVEL The Required Minimum Fund Level will be determined by BC Life in accordance with the following table: Employees Covered Required Minimum Fund Level 100 - 249 Two (2) months of Income 250 - 499 One (1) month of Income 500 - 999 One-half (0.5) month of Income 1,000 or more Nil (0) months of Income Employees Covered means the average number of Employees enrolled during the last three months of the Policy Year. The Group will not be entitled to a refund if Employees Covered is less than 100, except as provided in Section IX: Post-Termination Provisions. The Required Minimum Fund Level is expressed as months of Income based upon the average monthly Premiums payable under the terms of the Policy during the last three months of the Policy Year. 00403.F17.ERR1-W 105 PAGE 7 F x 0 0 -~ o' D ~_ (TO n S (10 ti zn~e z'?~ 'fin m _ ~ y ^ o a~ p ~ -s o o ° ~ -c . O - . 'Y^ H ~ w .+. r N y ~~ y.~~ W t ~ A < . ~ ~ A ~ ~ ~ ~ "J O n rn o: ~ ~, ~ z a c. 71J-TIJ~:°. ~mr~ -cmm~ ~mm~ nt7~' t ~ '~.rn~'~.rnrnm ~ ~ + ~ ~ ~ + ~ O~ ~.< <n v, ~ v. v, .~ ~ . ~ V /~ ti ~• vci vii D7 rr J t ~ IY ti .~ y lJ IJ V~ W IJ ~ ~ IJ A IJ ~' -~ G '~ Ut W A O ~ `D J IJ ~D ~D A V. W O IJ Z C ~ A VJ ~ ~ 69 65 b9 65 EH 69 69 if3 69 t ~ o o ~ 7' ~ ~ ~ ~ w stn VO vi ~ A w ~.~y W A lJ A ~D tJ ,..' J IJ O~ y O Oo IJ Oo Go ~ fD -- IJ O ~ 00 Q~ Q1 01 01 V ~ IJ W W (I. 0o Q~ W O ~ V to u, ~ 69 69 FH 69 69 (A ~ 7 o z e ~ N 'TJ ~ ~ C =. `~ J y IJ -~ ' ' ? - 7 T ~ x O w O~ A w - y ~D N Q~ y W U, J~ N J W~ W U, oo U ~O O~ ~n w O~ - O~ -' o0 Ef3 Ef3 ffi 69 E~9 69 4f3 69 62 a o z S ~ ~ ~ W ~] W OC N O~ yx' S- W - 'A N O~ V IJ ~ IJ O~ IJ Ut y ~O N ~D O - N R Oc O ~D ~ A~ IJ .~ to J u IJ W W v, vi V~ Oo -- IJ U t- O ~] J J ~] J J J O O C O~ O~ O~ ~ O~ T O~ O~ O~ 0 0 0 0 o a c ~~'1 a a a C y Va' 69 LA ff 49 69 i-i9 G7 7 o = N ~! v ~ IJ ~- ~ - ~ v, a oo y v, w - ~ ~ w A rn oo y ~ oo co o> ~- o ,.o ~ C O O A w F- oo Vi ~O m A O~ ~ W W W O~ T O\ A A A 0 0 0 0 0 0 ~ ~.. v ~0 ~ \ .Z] Z] V. 2 N ` ~ y a ~ ~_ ~ y a ~ ~ a s ~ a s ~ ~ ~ b ~ a ~ o a ~ o ~ t ~ a. ~ ~ ~ r ~ ~ , T ^• ~ ~ ~ o o a ~ N ~ y a ~ C N 5 S y e A O O O J n C7 0 c v r r n (D n (D CD N 0 0 v N V J N A V CP O O W U1 N N CTi O Ui ~ A W N -~ W O O o ~ Z7 ,~i. .ZI ,TJ ~7 ~ W ~ N X X X X X ~;. ~ ~ m vi ~ ~ ~ v ~ O ~ T11 ~ 0 v ~ ~ ~ ~' ~ w C7 < z =~ Z-v ~ ~, c~ O ~ m - m ro m 3 ~ N = O 7 C ~ 4 m '~ Q ~ ~ m a " a: O ~. N ~ ~ ~ ~ fl_ 'j ~ Q ~ - O ~ 7 ~ ~ O ~ ~ Q ~ ~ fl_ ~ ~ ~ ~ O j O O N :~' '~ a m ~ ~ ~ ~ m ° m ~ 5 - m o_ s ~ 6 (D nj ~ fD Q ~ ~ Q j N N Q ~ O N O t Efl fA ~ 69 fA O O ~ O O ~ ~ 4A ~ N N O N N O O ~' O O m n H3 69 fA N Ui O O ffl N A N N (~ O O U~ Efl ~ ~ O O CWti -~ O W ~ v, CO N A 0 0 0 w v rn v, A w N D -~ D~ .z l7 .J ~XIJ ~. ~~~ ~ O o 00 00 x x x ~~7 O~~c c ~ c ~ ~ ~~ ~~ °_' m Ov.~D .~~.~~ ~ ~ c ~~ ~~ -0' o= Z-ff'-aaacs r.o=~ ~ ~ ~ N ~' x x x K ~ ~ ~ ~ i ~ ~ - ~ ~ T 7 ~ ~ T~~ 7 O p7 ~ N Q ~ ~. d Q .-. fD ~ (D iN. ¢, ~% Q co _.y~ w O c < __ <_ 7~ ~ 7 n 7-~ II Q i ~ Q Q . K ~ _ N N ~ O v v ~• N O ~ ~ O ~~ v ~~ 47 ~ 7 (~7 _~ _ ( 3 ~ ~ ^,Q v~ . C~ ~ 7 fl7 ~ C ~~ ~ j O O O O N ~ ~ ~ 7 fl- O ~ O ~ fl- 0 O '~ ~ 7 ~ 8 ~ O ~ ~ 7 ~ ~ O O CD O O (D D O O O O Z O Z ~ O ~ ~ d ~ O ~ ~ I -O a { ~ Z . Z~ ` m °- ~ m °' a- ~ s ' e O O_ ~ Q O Q O" O_ ' ~ O_ v N '3..+x ;~; 7 7 , C O' (D .O-. O fA fA b9 ffl 0 W .~ W ~~ ~~~ ~ O fA ffl J N - c o O O 0 0 O O 0 0 0 0 O O O ~ ~ N N EA fA EA ~ ~ N N N rt = ~ O ~ ~ GO W ~ ~~ (9 W O O O O O p ~p o p 0 0 O ~ O O 0 0 O O 0 0 0 0 ~' c m ~ ~ O N o ~ O ~ O O fA fH fA ffl ffl fn .~ A ~ O W O O O O O O" ~ ~ ~ p 0 Efl Efl ffl ffl ffl ~ W 00 ~ O O O ~ O 0 0 0 0 0 °O °O . -. ~ O CEO A ~ N ml ffl ffl O A ffl fA ffl 0 0 ~ ~ O tTi ' O i U Q X 0 0 ~ O ~ O < n O O CD ~ N N O O W N O ~_; CO CO ~I A W 00 W W W J W 0 0 0 0 0 0 N W N O ~ J CO _ W V (O ~I A cn N 07 (O A ~ CO O~ O N N 67 O O O O 00 J W N N (1~ W (J~ W N 67 N O W CO A O A Oi O i W (O CA J CO ~1 W O N W N ~-. ' W ~ O + O J N C) W Cn ~~~E'i,'. , W J W ~ ~ W ~I ~ CIi .--. .A. J ~ W ; A O A W N ~ O CT W W N (3i V J N W N ~ W N .--. _ W W ~1 W O V A CO N Ut O O W ~ O j U~ J U1 07 N CO N A O ~ k C C7 0 N O Documents related to the Special Meeting of the Personnel Committee December 19, 2007 ~^... B A K E R S F I E L D OFFICE OF THE CITY MANAGER MEMORANDUM December 19, 2007 TO: Personnel Committee FROM: Alan Tandy, City Manager SUBJECT: Health Insurance Renewal In the last 10 years, benefits have gone from 21% of salary to 32% of salary. In that same time period, retiree and active payments for medical insurance have gone from 6% of the General Fund to 9%. Insurance costs are up $2.2 million this year, and it has become routine to have increases in the area of 20%. In an effort to achieve at least some cost containment on these rising costs, the City offered two alternatives to the Insurance Committee. One is an office co-pay and the second is an increase in the co-payments on prescription drugs. Both have a value of about $500,000 of the $2.2 million premium increase. The balance of the increase.. would. simply be paid 80% by the City and 20% by the employees. Of the employee groups, only Management and Supervisory has acquiesced to any plan changes; and of the two options, they prefer the office visit co-pay. All other units appear unwilling to compromise in any form. Additionally, we are facing a bad budget year and employee groups seem not to recognize that fact. Our largest General Fund. revenue, the Sales Tax, has been in decline, compared to the previous year, for three consecutive quarters. Several special revenues are down by millions of dollars each due to the slow growth in the housing industry. The State. is facing what may be a $14 billion deficit, and one of the few options open to them is for them to "borrow" from cities and counties. It will be months before we know whether that will happen or in what amount may be "borrowed." In light of the sequence of events that has taken place, it appears we are at an impasse on the issue of insurance policy renewals. We need to make a decision by the January 16, 2008 Council meeting in order to meet legal mandates for open enrollment. Primary health care policies expire at the end of January. We note that while we started this process late, we added a full month to it to offset the late start. Therefore, the insurance contracts will be placed. on the January 16, 2008 Council agenda for consideration, with the office visit co-pay being the basis of the proposed contracts. To that end, it is, regrettably, necessary to follow impasse procedures. City of Bakersfield Revenue Trends /Projected Shortfalls /General Fund Salaries & Benefits Sales Taxes: Average Sales tax growth rate for the past 10 years is about 7.5% Sales tax growth / (loss) for the past 4 quarters Sept. 2006 2.69% Dec. 2006 -3.68% March 2007 -1.51 June 2007 -1.48% 4 quarter average -1.00% Five Month Review of Other Selected Revenue Estimates: Projected Budget Shortfall Development Permits and other charges $ 2,000,000 Park Improvement Funds $ 350,000 Transportation Development Funds $ 1,800,000 Sewer Connection Fees $ 1,200,000 General Fund -Salaries /Benefits /Operating costs Pie Charts Attached for Review and Discussion General Fund Expense Analysis 1997 Operatir $18,494,256 Benefits $16,975,143 - 2' 2007 Operatir $36,132,278 Benefi $50,791,43b - ~~ io Salary $43,488,167 - 56% Salary $70,968,953 - 45% S:\Richard\General Fund -Salary Benefit Analysis 12(17!2007 General Fund Expense Analysis 1997 uperaunc $18,494,25E Other Benefits $6,126,924 - 8% Retiree Med $726,577 - 1 Active Med $3,604,619 - 5' PE $6,517, 2007 Operating ~~~- $36,132,278 Other Benefits $15,602,788 - 10% Retiree Med $5,289,463 - 3°i Active M $9,356,377 Regular Salary $40,754,420 - 52% Regular Salary $65,375,895 - 41 e - 4% S:\Richard\General Fund -Salary Benefit Analysis 12/17/2007 022 - 8% Overtime _ $2,733,747 - 3% $20,542,811 - 13% 12/18/2007 City of Bakersfield Joint Insurance Committee The Joint Insurance Committee has met and provides to the Council Personnel Committee the following response to the City's two proposals: Whereas, the Ciry failed to meet and confer with the Insurance Committee prior to October 31, 2007, in accordance with the MOU, despite numerous written and verbal requests; Whereas, the first City-scheduled Insurance Committee meeting was held on November 14, 2007; Whereas, the City requested an extension of the October 31, 2007 meet and confer deadline which was unanimously rejected by the Committee at the November 14, 2007 committee meeting. However at the request of the City, the Insurance Committee continued to meet for informational purposes only; Whereas, the City was provided with timely information by their insurance consultant and failed to share this information with the Insurance Committee prior to November 14, 2007; Whereas, the City has unilaterally implemented a number of contract plan changes without participation or knowledge of the Insurance Committee; these items include but are not limited to: • Prior authorization on prescription drugs • Co-pays for wellness exams • Retiree medical contribution based upon active rates rather than retiree rates. Therefore based on the above facts, it is the recommendation of the Insurance Committee: • ALL medical insurance plans remain unchanged for the calendar year of 2008. • The City recognizes the Insurance Committee structure as proposed by the Committee. • All future insurance plan changes shall be presented to the Committee- for meet and confer. • Prior Plan changes unilaterally implemented by the City shall be brought to the Committee for action. • The City to utilize the lowest "applicable retiree rate" when computing the retiree years of service contribution. The following are in response to the proposal by the Insurance Committee dated 12/18/07. • The City met with the Insurance Committee to meet and confer to discuss the upcoming renewals on the following dates and meetings: May 9 -Insurance Committee October 31 -Personnel Committee November 14 -Insurance Committee November 21 -Insurance Committee November 27 -Personnel Committee December 11 - Insurance Committee December 18 - Insurance Committee December 19 - Personnel Committee Due to the late start in meeting with the Insurance Committee, the City extended the time available to meet and confer by 30 days by extending the implementation of the medical insurance plans to January 31, 2008. • During the above mentioned meet and confer meetings the members of the Insurance Committee requested information, solicited proposals from the City regarding the proposed plan design changes and submitted proposals to the City for consideration. • The City's consultant provided information verbally and in writing to the Personnel Committee and members of the Insurance Committee jointly at the October 31, 2007 Personnel Committee Meeting. • The "contract plan changes" noted by the Insurance Committee are explained as follows: o We have confirmed the co-pays for the wellness exams have been in place since 1994. The prior authorization on prescription drugs has been in place since 1999 if not earlier. These are not changes that have recently occurred. o Retiree medical contribution based upon active rates rather than retiree rates -This is not a contract plan change and has been implemented in accordance with the current language in the MOU's which base the year's service retiree medical subsidy on the lowest HMO or fee for service single rate. • The City desires to modify the benefit structure to achieve some cost savings for both the City and the employees to mitigate the significant increase in medical premium costs. • The Insurance Committee structure is outlined in the MOU's with each bargaining unit. Any changes to that would have to be negotiated between each bargaining unit and the City through the meet and confer process. • Insurance plan changes have been presented to the insurance committee for meet and confer pursuant to the current MOU's. Future plan changes would also follow the process indicated by the MOU's with the bargaining units. • As noted above the "prior plan changes" are explained above and have been in place for some time. • For the City to utilize the "applicable retiree rate" for computing the retiree years of service contribution would require a change from the current language in the MOU's which base the year's service retiree medical subsidy on the lowest HMO or fee for service single rate. This would have to be negotiated between with each bargaining unit and the City through the meet and confer process. SPECIAL MEETING OF THE PERSONNEL COMMITTEE Wednesday, December 19, 2007 ATTENDANCE LIST Name ~ Organization Gl~l a Contact: Phone/ E-mail .~; ~! er' 02e /~d ~d ~~ / L ~ 9- G~~ ~- ~~.~ a ~~ ~~ ~ (/l C ' ~~~ r .G- ~ ~ ~le ~ Coo ~ .3 r-t SS-~~ ~ '~.Z L-t LL `' -!-~-~'~..un3~1 ~2Sv{G2s ~~~~i~ VU' S~' 131~i~fasr~~"tD r'vC j c~ . b •~! ~jw„ ~ 1 /r~ ~ ~ v~; c l~~ C ~ O ~,. PUBLIC STATEMENTS SPEAKER'S CARD Personnel Committee Committee of the Bakersfield City Council Committee Meeting Date ~2~/'~1~07 You are invited to address the Committee under'Public Statements on any subject that is listed on the Committee Agenda. Public statements are limited to three (3) minutes per speaker with a maximum of fifteen (15) minutes, per side, for any one subject. The Committee may, by simple majority vote, waive the time limit. No action will be taken; this Committee gathers information and reports back to the City Council. Please fill out a Speaker's Card and present it to the Committee Chair: Harold Hanson Name: ~/ Company/ c y / / ~ / Organization: l G / ~/( ~l ~ I .~~ Address: __ ~_~~ ~ 7 ~ ~ ~~~ c Phone: ~~~ •r ~ Fax/e-mail C'~~~•~~fir~PC~S'~/~ - ~~~ Subject: ~s~ %' u dT/