HomeMy WebLinkAboutCity of Tamarac Resolution R-2006-1781
Temp. Reso. #11058
September 11, 2006
Page 1
CITY OF TAMARAC, FLORIDA
RESOLUTION NO. R-2006-I:)
A RESOLUTION OF THE CITY COMMISSION OF THE
CITY OF TAMARAC, FLORIDA, AUTHORIZING THE
APPROPRIATE CITY OFFICIALS TO RENEW THE
COVERAGE FOR THE CITY'S HEALTH INSURANCE
PROGRAM WITH AETNA, INC. FOR THE PLAN YEAR
EFFECTIVE JANUARY 1, 2007; PROVIDING FOR
PREMIUM RATES CHANGES; PROVIDING FOR THE
CONTINUATION OF THE CURRENT COST
ALLOCATION OF THE HEALTH INSURANCE PREMIUM
BETWEEN THE CITY AND EMPLOYEES; PROVIDING
FOR A WAIVER REIMBURSEMENT MAXIMUM;
PROVIDING FOR CONFLICTS; PROVIDING FOR
SEVERABILITY; AND PROVIDING FOR AN EFFECTIVE
DATE.
WHEREAS, the City's contract with Aetna, Inc. for health insurance coverage for
employees expires on December 31, 2006; and
WHEREAS, Aetna, Inc. provided premium rates for the renewal of the City's
health insurance plan for 2007; and
WHEREAS, the City has reviewed our experience with Aetna, and determined
that employees were satisfied with Aetna as its insurance provider; and
WHEREAS, the City reviewed the City's plan design and determined that the
current plan design is appropriate and no plan design changes should be made for
2007; and
WHEREAS, City staff has worked with representatives of Aetna, Inc. to negotiate
the most comprehensive and cost effective health plan for the City's employees and
their dependents; and
Temp. Reso. #11058
September 11, 2006
Page 2
WHEREAS, as a result of these negotiations, our overall premium increase is 5%
for the HMO, QPOS and PPO plans. (See Exhibit A)
WHEREAS, health insurance rate increases were anticipated and were budgeted
accordingly in the FY 2007 Budget; and
WHEREAS, the City will continue to pay the premium for HMO single coverage in
total, and maintain the current cost allocation on an 80/20 ratio between the City and the
employee for all other coverages so that both the City and the employee bear a portion
of the premium; and
WHEREAS, a waiver reimbursement maximum will allow employees who elect to
purchase insurance through their spouse's employer or otherwise independently from
the City to be reimbursed up to a maximum amount equal to 100% of the single HMO
rate and 80% of the family HMO rate for the plan year beginning January 1, 2007; and
WHEREAS, it is the recommendation of the Director of Human Resources and
the City Manager that the City of Tamarac renew the coverage with Aetna, Inc. for
health insurance for City of Tamarac employees as described in Exhibit A subject to any
revisions consistent with the benefit plan as negotiated by and between City staff and
Aetna, Inc. and approved by the City Manager and the City Attorney effective January 1,
2007; and
WHEREAS, the City Commission of the City of Tamarac, Florida deems it to be
in the best interest of the citizens and residents of the City of Tamarac to renew the
coverage with Aetna, Inc. for health insurance for City of Tamarac employees as
outlined in Exhibit A subject to any revisions consistent with the benefit plan as
1
I
1
Temp. Reso. #11058
September 11, 2006
Page 3
negotiated by and between City staff and Aetna, Inc. and approved by the City Manager
and the City Attorney effective January 1, 2007.
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COMMISSION OF THE CITY
OF TAMARAC, FLORIDA:
SECTION 1: That the foregoing "WHEREAS" clauses are hereby ratified
and confirmed as being true and correct and are hereby made a specific part of this
Resolution.
SECTION 2: That the appropriate City officials are hereby authorized to
renew the coverage with Aetna, Inc. for health insurance for City of Tamarac employees
as outlined in Exhibit A subject to any revisions consistent with the benefit plan as
negotiated by and between City staff and Aetna, Inc. and approved by the City Manager
and the City Attorney effective January 1, 2007.
SECTION 3: That the appropriate City officials hereby authorize
continued payment of the total cost of the premium for HMO single coverage and
maintain the current cost allocation of the health insurance premium on an 80/20 ratio
between the City and the employee for all other coverage.
SECTION 4: That the appropriate City officials hereby authorize a waiver
reimbursement maximum, to allow employees who elect to purchase insurance
through their spouse's employer or otherwise independently from the City to be
reimbursed up to a maximum amount equal to 100% of the single HMO rate and 80%
of the family HMO rate for the plan year beginning January 1, 2007.
Temp. Reso. #11058
September 11, 2006
Page 4
SECTION 5: That all resolutions or parts of resolutions in conflict
herewith are hereby repealed to the extent of such conflict.
SECTION 6: That if any clause, section, or other part or application of
this Resolution is held by any court of competent jurisdiction to be unconstitutional or
invalid, in part or application, it shall not affect the validity of the remaining portions or
applications of this Resolution.
SECTION 7: This Resolution shall become effective immediately upon
adoption.
PASSED, ADOPTED AND APPROVED this .21 day of September , 2006.
ATTEST:
r
MARION SW SON, CMC
CITY CLERK
I HEREBY CERTIFY that
I have approved this
RESOLUTION as to form.
4 ://J�� /�i/_,i �% �✓ ,
BETH •
MAYOR
RECORD OF COMMISSION VOTE:
MAYOR FLANSBAUM-TALABISCO
DIST 1: V/M PORTNER
DIST 2: COMM ATKINS-GRAD
DIST 3: COMM. SULTANOF
DIST 4: COMM. DRESSLER
1
EXHIBIT A
Summary Of Renewal/Proposed Rates
City of Tamarac
Effective January 1, 2007
Policyholder Number - U8264234
This exhibit outlines your renewal/proposed rates effective January 1, 2007.
Please refer to the Financial Conditions and Plan Design Exhibits for an outline of the level of benefits
quoted, as well as the terms and conditions of this proposal.
HMO
Coverage Categories
Assumed
Employees
Current Rates
Proposed Rates
Change
Emp Onl
143
$317.81
$333.70
5.0%
Emp + Family
176
$824,32
$865.54
5.0%
TOTAL
319
$190,527.15
$200 053.51
5.0%
OPOS
Coverage Categories
Assumed
Employees
Current Rates
Proposed Rates
%
Change
Emp Only
7
$397.63
$417.51
5.0%
Emp + Family
15
$927.67�
$974.05
5.0%
TOTAL
22
$16,698.46
$17 533.38
5.0%
PPO
Coverage Categories
Assumed
Employees
Current Rates
Proposed Rates
%
Change
Emp Only
11
$501.40
$526.47
5.0%
Emp + Family
24
$1,220.88
$1 281.92
5.0%
TOTAL
35
$34,816.52
$36557.35
5.0%
Current Proposed
Employees Premium Premium % Change
Mdnthly Totals 376 $242.042.13 $254,144.24 5.6%
09/08/2006
Medical Renewal Assumptions - Administrative
The City of Tamarac
Policyholder Number - #809520
Group Number - US264234
Renewal Rate Period: 01/01/2007 through 12/31/2007
The financial quotation presented is based on the administrative assumptions outlined in this document. It is important to note that
deviations from these assumptions may result in additional charges and/or adjustments to the renewal rates and/or site terminations.
Compliance - The City of Tamarac will be required to supply Aetna with confirmation of compliance with these Renewal Assumptions.
For example, enrollment materials to verify employer contribution, enrollment to verify minimum participation and plan designs.
Plan Design - The renewal is based on the current plan design. Aetna's standard provisions, contract wording and claim settlement
practices will apply for items not specifically outlined.
Plan offering - We assume that the HMO plan will be offered as an option to the Open Choice for employees residing in an Aetna HMO
network service area,
Changes in Plan - Our guidelines allow for a change in plan on the renewal date only, unless initiated by legislative actions. If a
material change in the plan is initiated by The City of Tamarac and approved by Aetna, an adjustment to the rates may apply.
Legislative Action - If a material change in the plan is required by legislative action, an adjustment to the rates may apply.
Billing and Payment of Premium - Amount due is payable on the 1 st day of the monthly coverage period covered by the invoice. If the
amount due is not paid in full within 30 days, Aetna reserves the right to terminate the contract and/or assess late premium payment
charges.
Open Enrollment - The rates assume that there will be a predetermined annual enrollment period when all eligible employees have a
choice of enrolling in any of the available plans.
Health Insurance Portability and Accountability Act (HIPAA) - Our rates assume that Aetna will be providing HIPAA certification of
coverage for terminated employees or employees who move from product to product.
Plan eligibility - Our rates assume that permanent full-time employees work a minimum of 25 hours per week on a regularly scheduled
basis and that eligible dependents include an employee's spouse and unmarried children up to the limiting age of the plan. Our rates
assume that temporary employees are not eligible for coverage.
Retirees - The quoted plan is only for active employees, It is assumed that all retirees over and under age 65 are not eligible for
coverage.
Our responses are statements of fact as they exist today. We have made every effort to include information in a manner that reflects
existing and expected business practices for the next policy period. However, nearly all of the matters addressed in this renewal are
dynamic and subject to change before or after the effective date. This renewal is not intended to serve as a substitute for your Group
Agreement and the statements in the renewal are not intended as legal representation or warranties. Our obligation to one another will
be limited to the terms of the Group Agreement.
07/05/2006 www.aetna.com Medical Admin Assumptions
Medical Renewal Assumptions Financial
The City of Tamarac
Policyholder Number - #809520
Group Number - US264234
Renewal Rate Period: 01/01/2007 through 12/31/2007
The financial quotation presented is based on the financial assumptions outlined in this document. It is important to note that
deviations from these assumptions may result in additional charges and/or adjustments to the renewal rates and/or site terminations.
Employer Contributions - Our rates assume compliance with our standard guidelines on employer contribution strategy. We standardly
require that the employer contribute 75% of the employee cost, or 50% of the total employee and dependent cost. Employer
contributions may not favor other medical plans over that of the Aetna plans.
Participation - 75% of total eligibles must participate in the employer's plan. In the event of waivers due to spousal coverage,
participation should be 50% or higher. Failure to meet one or both of these percentages will have an impact on the next renewal and
could lead to possible withdrawal of medical products. Our offering assumes that Aetna is the sole medical carrier. In the event
alternative carriers are to be offered, we reserve the right to reassess our rates immediately.
Demographic Change - The medical rates will continue to apply assuming that a change in The City of Tamarac's demographic and/or
geographic mix from that assumed at the time the rates were established does not change the enrollment by more than 10% for any
individual site or product.
We reserve the right to reallocate the premium ratios and/or the premium rates due to changes in composition of the census.
Eligible population includes active employees only. Retirees, regardless of age, are not eligible for coverage.
Our rating also assumes that COBRA enrollment continues to represent less than 10% of the covered population.
Contract Period- Our policies provide for automatic renewal upon the completion of each contract period unless either party invokes the
termination provision requiring 31 days advance written notice of termination to the other party. This provision may be invoked at any
time during the continuance of the contract (i.e., is not just limited to termination occurring on the renewal date).
Commissions - Commissions have been excluded from our quoted rates.
Producer Compensation - Aetna has various programs for compensating agents, brokers and consultants, If you would like information
regarding compensation programs for which your producer is eligible, payments (if any) which Aetna has made to your producer, or
other material relationships your producer may have with Aetna, you may contact your producer or your Aetna account representative.
Information regarding Aetna's programs for compensating producers is also available at www.aetna.com.
Enrollment Assumptions - We have assumed that the plan of benefits will be extended to all groups included in our current eligibility
files. Our renewal assumes that coverage will not be extended to any additional groups of employees without additional census and
rate determination. A summary of assumed enrollment by plan option has been provided in the rate exhibit.
Rate Guarantee - Our rates apply for the contract period and are valid as of the effective date, 01/01/2007. The rates apply only to the
benefit levels and conditions specified and any variations in benefit level or assumed conditions may require a rate change.
Our responses are statements of fact as they exist today. We have made every effort to include information in a manner that reflects
existing and expected business practices for the next policy period. However, nearly all of the matters addressed in this renewal are
dynamic and subject to change before or after the effective date. This renewal is not intended to serve as a substitute for your Group
Agreement and the statements in this renewal are not intended as legal representation or warranties. Our obligations to one another
will be limited to the terms of the Group Agreement.
07/05/2006 www.aetna.com Medical Financial Assumptions
Customer Notifications version 2.9
The City of Tamarac
Policyholder Number - #809620
Renewal Rate Period: 01/01/2007 through 12/31l2007 Group Number - US264234
Aetna is committed to providing quality health benefit plans at reasonable rates. We continually review the terms of our programs and
make changes as needed to help us meet our goals. This notice is to inform you about changes to your program that will become
effective upon renewal. Should you decide not to incorporate any of the below benefit plan offerings, which will create a change in
your current selection of benefits, you will need to coordinate with your Account Manager. The rates quoted will be adjusted
accordingly.
Bariatric Surgery (Morbid Obesity):
Effective January 1, 2005, Aetna excluded coverage for bariatric surgery as treatment for morbid obesity from our base medical plans,
except for HMO based plans in California, Illinois, Indiana, Maine, Maryland, Michigan, Nevada ($7,000 Lifetime maximum), New York,
and Virginia. This renewal has been processed to exclude coverage for bariatric surgery in all HMO plans, except for those in New
Jersey and the states listed previously. In addition, bariatric coverage is not excluded for the Traditional based medical products when
the contract situs is New York or Maryland. Aetna is offering several buy -up coverage options. Please contact your Account Manager
if you would like more details.
Comprehensive Infertility:
Infertility is broken into 3 categories: Basic, Comprehensive Rider and ART Rider.
r Basic is offered as the standard benefit and includes: initial evaluations, tests, lab studies, semen analysis, ovulatory
function, post -coital test, surgery, hysteroscopy, ultrasounds and biopsy.
r Comprehensive Infertility rider (For groups with 500 or more employees a rider that can be purchased separately, unless
mandated) includes: infertility surgery,
artificial insemination (6 cycles) and ovulation induction (6 cycles).
■ Advanced Reproductive Technology (ART) Rider— ( For groups with 500 or more employees a rider that can be purchased
separately, unless mandated)
includes: in -vitro, intra fallopian transfer, transfers of embryo, gamete intrafallopian transfer (GIFT) and zygote
intrafallopian transfer (ZIFT).
The Comprehensive Infertility rider is not a standard benefit included in the base plan. Should you choose not to purchase the
Comprehensive Infertility benefit, you will still have Basic Infertility care. While Connecticut, Illinois, Massachusetts, Maryland, New
York and New Jersey mandate comprehensive benefits, the other locations must now purchase this rider in addition to their base plan.
The rates attached exclude the Comprehensive Rider for those locations that do not mandate the Comprehensive Infertility benefit.
Individual Conversion Plans:
Additionally, we would like to take this opportunity to assure that you have been informed of Aetna's decision to discontinue offering
individual medical conversion policies.
As you may or may not already know, Aetna has for the past few years received approval from several state. Departments of Insurance
to cease offering individual medical conversion plans in states where it is permissible by law to do so. During this time, Aetna has also
received approval of the amendments to our benefit coverage documentation and has also been notifying all of our affected customers
of these changes.
Individual conversion policies have been discontinued for newly eligible individuals who reside in and/or have a group policy issued in
the following states:
Traditional medical products (non -HMO) - Alabama, Alaska, Delaware, District of Columbia, Hawaii, Indiana, Mississippi, Nebraska,
New Jersey, North Dakota, Rhode Island and Texas.
Aetna will continue offering coverage to those already enrolled in an individual medical conversion plan in the states mentioned above.
07/05/2006 www.aetna.com Customer Notifications FI
Customer Notifications - version 2.9
The City of Tamarac
Policyholder Number - #809520
Group Number - US264234
Renewal Rate Period: 01/01/2007 through 12/31/2007
Self Injectable Medications:
Certain self -injectable medications will be moved under your prescription drug benefit for members enrolled in HMO -based plans
effective with the upcoming renewal date. Formerly, these medications were covered under medical benefits for HMO -based
members. Please see your account manager for a listing of the "Pharmacy -managed Self Injectable" (PMSI) medications. This benefit
is currently in effect for members with PPO and indemnity plans that have Aetna prescription benefits. There is no change in the
coverage of self -injectable medications for Aetna HealthFund® or Medicare members, or for HMO -based members in California and
New Jersey.
07/05/2006 www.aetna.com Customer Notifications FI