HomeMy WebLinkAboutCity of Tamarac Resolution (301)Temp. Reso. # 9932 - October 10, 2002
Page 1
Revision #1 - October 14, 2002
CITY OF TAMARAC, FLORIDA
RESOLUTION NO. R-2002- 30 1
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 US HEALTHCARE FOR THE
PLAN YEAR EFFECTIVE JANUARY 1, 2003; PROVIDING
FOR PREMIUM RATES AND PLAN DESIGN 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; APPROVING THE
APPROPRIATE BUDGETARY TRANSFER OF FUNDS, -
PROVIDING FOR CONFLICTS; PROVIDING FOR
SEVERABILITY; AND PROVIDING FOR AN EFFECTIVE
DATE.
WHEREAS, the City's contract with Aetna US Healthcare for health insurance
coverage for employees expires on December 31, 2002; and
WHEREAS, Aetna US Healthcare provided premium rates for the renewal of the
City's health insurance plan for 2003; and
WHEREAS, the committee appointed by the City Manager to review insurance
proposals in 2001 consisting of the Director of Human Resources, Assistant City
Attorney, Assistant Fire Chief„ Purchasing and Contracts Manager, Benefits
Coordinator, Firefighter Paramedic and the Streets Supervisor was reconvened to
evaluate Aetna's proposed rates and health plans and to consider alternatives; and
WHEREAS, the committee reviewed our experience with Aetna, and determined
that employees were satisfied with Aetna as its insurance provider; and
1
Temp. Reso. # 9932 - October 10, 2002
Page 2
Revision #1 - October 14, 2002
WHEREAS, the committee reviewed the City's plan design and determined that
some plan changes could be made to reduce our overall rate increase, helping to make
the plan more affordable for, the City and its employees (See Exhibits A through F); and
WHEREAS, City staff has worked with representatives of Aetna U.S Healthcare
to negotiate the most comprehensive and cost effective health plan for the City's
employees and their dependents; and
WHEREAS, as a result of these negotiations and our proposed plan design
changes, our overall premium increase is 26%. (See Exhibits B and F.)
WHEREAS, health insurance rate increases were anticipated and were budgeted
accordingly in the FY 2003 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 increase; 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, 2003" 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 US
Healthcare for health insurance for City of Tamarac employees, with modifications to
the plan design and at the rates shown in Exhibits A, B, C, D and E subject to any
0
fJ
Temp. Reso. # 9932 - October 10, 2002
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Revision #1 - October 14, 2002
revisions consistent with the benefit plan as negotiated by and between City staff and
Aetna US Healthcare and approved by the City Manager and the City Attorney effective
January 1, 2003; 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 US Healthcare for health insurance for City of Tamarac
employees, with modifications to the plan design and at the rates shown in Exhibits A,
B, C, D, and E subject to any revisions consistent with the benefit plan as negotiated by
and between City staff and Aetna US Healthcare and approved by the City Manager
and the City Attorney effective January 1, 2003.
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 US Healthcare for health Insurance for City of Tamarac
employees, with modifications to the plan design and at the rates shown in Exhibits A,.
B, C, D and E, subject to any revisions consistent with the benefit plan as negotiated by
and between City staff and Aetna US Healthcare and approved by the City Manager
and the City Attorney effective January 1, 2003.
Temp. Reso. # 9932 - October 10, 2002
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Revision #1 - October 14, 2002
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, 2001
SECTION 5: That the appropriate City officials are authorized to enact
any appropriate budget transfers as needed for this purpose.
SECTION 6: That all resolutions or parts of resolutions in conflict
herewith are hereby repealed to the extent of such conflict.
SECTION is 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.
cPrTenn1 R
adoption.
Temp. Reso. # 9932 - October 10, 2002
Page 5
Revision #1 - October 14, 2002
This Resolution shall become effective immediately upon
PASSED, ADOPTED AND APPROVED this 23rd day of October, 2002.
ATTEST:
MARION SWENSON, CMC
CITY CLERK
u
JOE SCHREIBER
MAYOR
RECORD OF COMMISSION VOTE:
MAYOR SCHREIBER
DIST 1. V/M. PORTNER
DIST 2: COMM. MISHKIN
DIST 3: COMM. SULTANOF
DIST 4: COMM. ROBERTS
I. -AMBIT A
"kActna
Octobcr O. 2002
M;)r i;l .Swarn.srrra
UOV of Tamar�u;
752Nye' Wh idvcnuc
Tamarac, pl. 33321
t c: Mc•dirai 12enew;11
Dear Mat in:
Joy Fenton
Account Manager
_ 8201 Prrters (toad,
. lantation, Florida 33,3214
Tel 954-382-4 292
1-t:{x 954.382 8200 or 9!34-'. i;'-8104
C?ur undcr��1113ntr cle.partrnc•nt lraw 1:c:?trapleted the finanoial analysis of }'our <rroup Medical .[nsurtznce in
ecnmcc;tir,n �ti�ifft Eiac i/1/(l:� rerte��al perit:ul.
l ltc. (rally u'in,.. (actors arc amc)Tgr those taken into consicicration in determining ycrur prertaiunn mites l"r>r the
Conlin- plan vear:
w Yoruhenclit pl;ur dr•t;t.,n
• i'hc' rxlx;rirncc tc:.ulis Cut ynrr plata
• (.:hatlrt;cs its t}u ma, ul maul }rruup ;uui the al!cs o4 the �,Iroup ttaenahers
0 C:hanges in medical tivnd
liatied (m 1h r, araalvsis wt- have dcic.rrnincd Hit, 113i11r4' ct,sl; of ycnn health instnancc co�e.ral tt. .I.Ltt:
rc,ultin,, t It tnt'c; arc displaycd en your c:11c;lo5cd rate shcct s.
Itcnclil plan cic;si,m is an inte(),r]1 part of controlling Costs and utilizatinn. Aetna, Inc. has a gull portfcalio of
products and benefit options de`sr�.lWd to IWI,1> control future health c;tre. Costs. 1 :urr ene lositw, the bell fit.
plan design chant es that you have retltr sted aicnttr• with tiae final rate.~.
Thank you for vour business :and it's boon our, pleasure to provide healthcare benefits to your errtl>loyees
;Ind ilaoir covered depende.tits. N'e look forw,11,d to continue doing business with you-
._:Siticcrcly
ljoy P. Penton
"� flceoautt Mctna�.n:r
' Summary of Monthly Billing Dates
City Of Tamarac
U i NO. 1)6V,34
f'ro(>vsrrci I;rtwi (:BIe(IIV(! J,,rI jry 1. 20U;3 1Y)rouyl) I)wcembrs'003
Rate
Comparison
HMO Medical (Florida-SOuthern FL04)
Annual
?_7.:a4iS, lncr(r.as;rr in f�;�tarr; Annual
Existing Premium at
Proposed
Premium at
Lives Rates Current Rates
Rates
Proposed Rates
Single 13:;Singlef :rnp4oyr r=
740.1:)
IGO `$581.S(1 ;1,11f7,4f.30
t r rnl,y _.. .,._. _
_.
293 $1,414,303
$1,817,399
OPOS Medical (Florida -Souther FL04)
Lives
8 >27Fi.40 $<'(, 726
$:357 20
S34 ?i)1
:;nu lr 1 rnitirtycr;
1:3 $649.50 j 101 37'1..
$H3.3.33
$119,9(�)9
f.;llnily
164,291
$
?� $128,048
Open Choice Medical
12.0 % lncro: ise in Fi,tics;
I ives ` j •`5;32t3.'.�`.� ;y31,!�4
,ingl(, Flnhloye(= ti
1 3r).33ti
Farrrily 13 `!Pio o 00 `.i;1'24 800 5893,19
21 $156,341 $174,552
Combined Medical Premium $1,758,692 $2,216,242
Combined Increase 26.0%
1�1/n',t 111(lln I-rindi+�q F'fnlr--r;ticn
Sa¢pteawa)er 2002 F'agr '<i
1IMO-.1
flan t)rsit;rt Benefits
Aetna U.S. 1lealthcare, Inc. city of T:itmarac•.
l,lcrricla
Phin 1"catures In Network iIreheri,91 ('
Primary C'are 1'hy'. all visits
( )I I lc;c I Iuurs $15 cct}'rry
Allc i l irturti/1 lcaattc• $l c'ctlmy
Specialty ('art:
011'icc Visits `, 15 copay
DI;wnctslic OP 1.ah/x RaY 't'c's(ua (at kicility) $15 cop; y with I I( ft•lral.
8)ia^, nctslic; Ol' I.ah/X Ray l c;tin; (at specaalist) Included in `7peciahsi 011Ice Visit col'a;ty 101' visit
wills I'('I' rcacrr:ak.
( )nlpaticrtt `Therapy (' pJvc(;h, pltystcal. S 15 cctlt.ay: 1'r't.-atrrtent raver' a 60 day c uusecultve pci sod per
occupational) incident of illness or injcu-y be"irtntra",, with tltc lard day of tre,:rtattc°ttt.
outpatient 1.)ialysis/('he,nuithc:r::al'ry $15 copay
Allcr. v'Icstiu•/'her lltrtn.nt yISct)pay fttt'tc'stitt! Its til>eci;alisi:
5I 5 copay fcn- tcnt(inc 1111c;clarrns :tl P(T olilcc•, with ctt without
physician c•rtcuuntcr:.` 0 scrum ccaptty.
111•evenlive ('are
Kocrtirac Physic tl;
Routine Child and Wc1l tiai)v (.'alc,
Immunizations
I\1cart(nw (;YN ('arc
Itcnttine M�rn7ntctpwr.rplty,
Routine I_,Ye. 1.7:'arrl
Pediatric. Dental
Ilchint:, lllxalll
5I -� cctpav
51'> c:ctpay
51 5 c ctli;ty. ( )rte rcxtlInc GYN visit and pap
smc;tr per:ZhS clays. Direct access to pcutiripatin<'.
jwov'ldor5-
51 5 copay, One hasc•hnc hclwcren :rfoes 35 and 0),
one annual txtattlrrutrr,raw.. ,we 40 :.utd aver.
515 copay. Direct access to partic1p;tt1t1g
I rovicicrs; I^rc<lucrtcy and Af.,e Schedules 11'tay
;appiv
Not cctvc:rcd
S 15 copay. Routine 11C;1ritll? screeninp by Prin-tar y Care Physiciatn.
09/Z5/01
IIMI)-2
r�
�i
Man D"In licrwMs
AetN)a) U.S. ticaltlacarc, lnc.
lowida
lniat) FeaturE'ti
Ilearing tl,icls
1?;nuvrl;ency t arc
ilrgel)t (arc. ()ut-ol',A rca
Arnbulame
()(Itpalient Sorgery
J10',pitalizalinu
SkMed NumW9 facilely (Ire On lieu of
Ytospitalization for nvAcAN nc•.cessmy covcmd
bencfks)
Malet•uily
i)13 r/ftiitti
lla,slWal (InchtW WIN" tid; v vs)
Home lleal(I► ('are/ltu,p►icc Q)ntpalicnl
Private+ Duty oI- Sl)c(,ial t)uty Nursing
Hospice - 1111latient
1, a►1)ily t'I.)t)n►ng/Rcproductivc Services,
Stertlizalicna Procedures
Mental Health
Inpatient
0utpadent
Sul)st.ance Abuse Detoxificr►tion
ltlptaiir°a�i t)i•tc,xilu:;alia,at
i)nlp:.tlac•nl 1 )iac,xilla::,iltarta
t►i �ietrM11►i't< 1Re_terml,,,( arm,
N111 c.ovca'r•d
M00 copay
`!; I M) onlmy
No copay
100 copay
US unly
`;;1 _s Colx.ty for initial vigil only
$240 <•m
No i:opay
Not covC•t'ed unless ptc' anihanaiV(I by IIM0, 114)
cxtpay rvlt(at r,rvcrec9.
$ M) w1my
Covered with applicable, sp lCl llist, oulp),rticnt
stn'().cry rat' fatpatiCnl hospital L'npay; TZCvcrs,al of
voluntary steril9 Wkm including related I-011ow-upt
cure and we atrnent oC cornplicatioaas of suc9a
procedill-CS is not covcled.
$240 cNMY 30 dqs pet' calendar you.
$25 cG►pay, 20 visits 1">er calendar year.
$15Copay
0905/01
Plan Design Benefits ,
lctna U.S. Healthcare, Inc.
1'lortda
Plan Features
Substance Abuse Rehabilitation)
hip;iuent Rehabilitation
( )wpaiient Rchabilitation
Diabetic Supplies
Chiropractic ("arc
Dermatologist
Durable Medical E(luiprnct)t
Prescriplion Draag Rider
I I11 0_3
('it.y or''I'll r,:1rac
In Network (Referred Care
` ,,; ,10 copay, 1.inlilc•d to .10 dliv,, pct, c;llcnd«u- year.
15 c:olray. l.unitcci to 3(D visits 1)er calendar' ye;.tt.
RN copay it RX licicr PUT hosed; othcrwisc 1,(T a opay al')phc,s.
$15 copay, Direct acccti5 cublt.txalion 1-cilc'111,.0 visits pc, calendar yce:ar.
S15 copay. Dit'ec't access; 5 vi'sitti pe:r i''-rru,nth I,clincl.
No copay
S10 copay .�c.nc.rte tiirr))trlal. . '} 15 copIly brand lol111111;,ry; $ (D co{lay
Oencric and hrand non-lbi'mulary:up to 30 d;ay supply.
No Mand;.,lory ( iencn<;',
1 90 Day supply Includrd for M;1i{ t)rala, 1)elavc:,ry (Mo l:)) ? tines the 30 day sul)ply col,ay,
( Dpt n (crrnlaaLuy a er; c9a a as and the 1 nrrna l«ary EXCILISIOt1 list.
Additional Pharmacy Options
( wllIlicel)tI\v.s Option
1IL-1ionl a1-ice ( )pllo,a
Dental
vision Corrective Lenses/Contacts
Allowance
included in 1),c,,c•riptiota i)ru,:.t t.)pltana.
Not covered
Not covCred
Not covered
Advanced Rel)rodllctive'l'ccl)nology Not cowicd
(A)vaiiahle In -network only to groups with 500+etrlployees)
Medical Spending Fund
Individual/family Limits Not covered
Norte.: Annual copayment Maximum oi, � I.500 per Individual per calettda, seat / '+, i.000 per 1an)ily pa caletldar year
OT, OI
Man Design Benefits RANIO-4
Aetna U.S. Ilealthe.11'e, Inc. ('ity uiL.aLu.�tac
fI,t,c.{;I
,-\(!Ina f'.S Iic'althr;nc; i";I h?t im)fil INM(.1..
Plus tn:rleriaI is for itlormaiional puritresc; (;Ay and is ndHwr an (Wr M c'ovt r yc nor medical advice:. It contains
oil ;I p:uttai, x nt I,II dc'>CII[)II ofI n( pints or Illoirr;u I hc•rusIiI; ;uul dnr>: rn.,l c oII,Iiftit, a cAll) IIaI( I. f'nns III your pl;trt
dtx•utpcnIs {St ItcrltrlI- of F4:11c•I IIs, Cc oI CovcIagt- nr (it,ruIf A ?Ic•crrIt' nl I it IIt;tcI mine fr,uvt'rrtI t:oil hatanal
pf ovisicuas, nx;lrtdinl.t ptuce,clures, cx(Allsions and iinlaal.ioa5 rclatin}r. to votar pl;in All ill(, Trims and cc:mdition, of
sour plan or prugmin are Subject to al)l>licahlr laves, rcgulatieuts and policies, 1•hc awlibbliky o a Qan or prolrratrt
rtaay v tt by C',tu�;ra .hic scrvitx• arCa. Ail benefits ate subject to coordination pl he nclits.
7 p
Aetna U.S I IC:Illhc;tn;: dnr'_s I4411 prnvtdc health Cate service, ;Ind, Ihciclorr, c;;tnnot rru,tr;utuc any L(,arlts or ouliomCS.
p l-661,alI'I ,, providers ;sod ;" nt y nt000 arr "w pendent CM) Iadoi-s in privalw placket' and arc neither t-Inployecs
:utr &pc'nts of Actno I? S. Ficallha rc or is ailibates. Tk availability rat any p.utic:u m provider cannot be euarentec•d,
and provider network composition is subject to change "!&out notice. Cortatra providers may he affiliated with an
Itulepc.ndcni PraCtice Association (II'.A ), a Pliysician Mc•dic;d Group (NMG), art intcgratt'd dciivcry system or other
Inoviticv I;roups Mcuthc•rs vvhci and t'I Hit>;( Innvicit t ; wtll Ili ni Ially be rc•tcrred to slwciallst and bust>it;d>: within than
0won or guup,
I IMO henClits:ue. provided or achninc;tctcd by. AL -Ina t l .) I lcalth(.aw lilt . Acrna U,S I lcidthatrr Inc:. IUI?), Aunta
U.S. Iicalthcarc• (11,Cal If o I I I la IIIt:,. AuItta t I S, IIt, ait. atr „i du ('arolira;c; Inc.. Ac•uta U,S. IIeahhcarc of (lctngia.
Inc. Acuut t-1.S. licalthcavc of Illinois Inc. and/or At-Illa I!.5. I lcallbc;arc of North l'cxas Inc.
Spccilic plodut is may not l,c ;Iv;ailable oft berth a s11' lundcd and insured bast.
While this material ic, h( tievcd to ht.: act. ut;rte :as ut IIIt, punt daft% it i, :;UlI cl to c'llun t(' wtlhout raiulc:c.
In cas_ of a cttrtllicl f>ctwecrt sour plan ,her unu•IIL; ;Intl file; InitIt nctlum. tln; lai ur do uu(:nl; %Nell Ixovl:In.
OW2 ` 0 I
FIxIMAT 1)
9'I:,,, Design Benetiis
Aetna UI.S. Healthcare. Inc.-._ .....
Florida
Ilan I eatnres
Primary (..are Physician N, isits
Otfic( I-lcntrs
After hours/1l(: "IC
In Netvtork (ltefcrrc�c! (_'arc•
`$ 15 copay
`t;15 copay,
OPOS In-Networh
(',ty oI"i amarac.
Specialty C- 111'e
Office. Visits S25c-opay
I.)iagn(rstic (.)1' I,Jb12\ Kay TLSI.1ng! (tt lacy) S25 copay will, PCP refcrr d
l)ia4a,rtostic OP Lab/X Ray Testing. (at sPccialisl) Included in 51)cclalh"t ()fti(:c, Visit copay for visit
With PCP ref"ct-ral.
(hripatii;rtt'l Therapy (speecai. l)I,ysic al. n'.5 Copay, 'Ilccttrt,ertt ovc-r a 60-clay Cunsccutivc period per
(x:rupa{irniTE tnridc'nl of illness or inlury bc:s%uurin With the Ins, Clay of tre:.rhuent.
( )ulltalrent I Traly,i>;/('I,c n,ulhe?e:,l'ry �'� copay
Allcwy 'l e, liu;?,/ I rratrrtc,rlt `s15 copay (or t(atruW by specialist:
$15 copay tor- routine trrlecl-iorts ',it P(-:P 01TlCc will') or Without
physician ertc;ocntter; $0 serum, copay.
Preventive (:':ire
Routine. Physicals ti15 copay
Routine (`piled aired Well Baby ('art. col,ay
Iuururrti/.atiiTrr^;
Ror ilne GYN ('zinc: ',25 copay- `)tic r'outirle (TYN N-isit and P;.11)
smear per 305 days. Direct access to parlicipalirtg
providers.
Routine Marrttalo!r,raphti $25 copay. One baseline between ages 35 and 39:
cnrc anrnr:rl nrarnn'u,,r,r;un acre 40 and over.
Routine Fyc Ex:.utt ` "). c:o(rry. 1)irc(a :.tcc'css to pal Ilc:ilrrtrng;
lTrovrc,lc:rs, i~recluelwy and Ag;c Sclx:clules rMly
apply.
Prdratr ic, 1 Tc utag Not covelcd
Ilearing Exam } 15 cc,pay. Routine In::rr inp', s( werunl',s by I'riruary Cate Physician.
00/ 12/01
Plan i)cslt;ll l'lenefit�,
Acina U.S. llealllrc•arc, In('.
I-k)]I a
11:ur Ii'caturew
Haan; ,Aids
15"" owy Care
l JI-gent Care Ont-of-Ar•ea
Ambulance.
Outpatient Surgery
Hospitalization
S161lerl Nursing Fat'ilily ('are (in lic:ll 0I
llo�pif,111J;1tic)11 for r'lledIcally necessary Covr,)rctl
herie us)
Maternity
OB Visits
hospital ('lnc:ludes Nc\\,N in
Ilornc Health (':trc/hospice-()rrtpaticnt
I'rirate Duly or Special (Duty Nursing;
I lospicc - Inpatient
1i'aruily 1'Ianninl/Rcprndtrctiwe Services
sIcunlir.;111on hoc:edllrc',
Mental health
lnpa0ent
(hltpatie.nt
Substance Abuse I)cloxification
Illpaticrlt DetoXihwalloll
Owpatiew i7c•t1.lxili(-,Il oil
In Network Keljcrred Lace
Not covered
$100 eopay
$100 c:opay
No (q)ay
$1 50 cc)pay
`t; 00 c ()pay
$500 cop,
,,,,w,ti c•opay for inilial visit ofily
`000 copay
No copay
Not covered unless 1),C ;u111101iz •d by IIMO: nu
c;opay w1wil c()vcl'c°(l.
500 c:cr1);1y
Covcred will) appliwahic' slu'cialisl. outpallelll.
su1',,!ery oI 1111);Itienl ho"pilal c'opay, KCvcrs;ll ut
voluntary sle.rilizalmll inwludinsr re lAcd lollc/w llh
c;.1re and treatment c)f'colllpiicatiorry uf'suc;ll
procc:clures is not covered.
$500 copay: 30 clays per calendar year
$25 coy , 20 visits per ulcndar yam.
$25 colmy
01110S In •Network
Cil) Ill 1:1111.11:1V
DWI XI I
111a1ra t)csivn Benefits QPOS In-Nelwork
Aetna U.S. Healthcare, Ine. � CON i,t'1':im4H—:((
I'lorida
Plan l"Catures
Suhslance Abuse Rehabilitation
Inp:.aticni Itelribjhwtiorl
Outpatient Rehabilitation
Diabetic supplies
Chiropractic Carle
Dermatologist
Durable Medical Equipim-111
Prescription Drug Rider
In Network (Referred Carc
S500 copay. Limited to 30 days per calendar year.
$25 copily. Limited to A visits per caltnld:ai ycar-
RX colmy it RX rider pur(h:ascd: otherwise PUP copay appho.-,
:7 (-ol)ciy. Dire• a((ess suhlnnaition hvnclit, 20 visits pc, calcrldw y ol:
?ti cc,pay, Direct :Iccess, 7 visit,, per 12-month period.
No colmy
10 copaty rcneric kwmul:uy; $15 coptly brand formulary; S30 cop iy
u.c.ncl i(.- :111d 1)r111(1 ,Ion-lnrinui:aIV : i)p to .j0 daY srippIV
No Mandatory (:i-1c1 ics.
� 1 90 Day supply lncludcd 101 ml od Order Delivery (MOD) 2 umc,,,, the 30 cloy supply copay-
c. )IxAn 101111Lllary ('ovc•rti (Irnt's oil 111c 1'01-111LIk ry I'.XCIUSIMI Lill.
;additional Pliarrriacy ()pl.iuras
C.'ontriceptives Option
Perit)rniance. OptiW1
hlchl(crl u1 t'1c"criptinn l)rut Olrl(ur1.
Not covered
Dental Not covercd
Vision Corrective Lenses/('orrtacts Not covered
Allowance
;advainccd Reproductive T'mlznology Not covered
(AValiable In-nctwork only to Lroups with `iO(1+ c.ar1111oyc(',$)
medical spending Fuud
111dlvidual/T"arni1y Limits Not covered
Nc,tc: Annual col)alyment IlMxinittm ol,$1,'i0O per individual l)e1'c..dcndar year/ $-�,000 per family pcI c::alendm vc;11,
111m) De6gli Henetits 0110S III -1'elrvork
Actwi U.ti, 11e,1101(M—C, 111c. a.`iav erf't:arnarcrc
Fj( II ic.i;.I
\t'T II;I Il',. Ilcall hrvc 1,;,i IIII prolll I Mt).
L'hc, in:ilcIT;tl I,: Inr ❑IIoTIIIaIional putposr, oIIly ;Intl ir; IIuithc.I an offer of coverage nor III ccIicaI advice. it conwins
ullly a I>arit;I{, Sit nc•r;Il (it ij)t It III (d I)I:nI or III aiu he ni:IiI tmd doc,>, nnl tlmst rule n contract, Cot) st.Ilt your plan
documcnty l5chccdt.rl
1 In;I I! .ti. I Ic;Illhc;)r[ <lurs rrtu Im,vidc health c;ut, srrvurs ;.Ind, tltcrrl m. cannot g.uaranct; stay rc..titdts or Gtatcome5.
1'atttcll.),Itin! lrrirvidc'Is and :Irt;n, v Irlrrscs art; Intl(lx'mh;nl t oljtrarltas III 1)11vatc• rutlttic'i• ;und left:' ttcither r11)1)loyces
ncm as cats of Attila
I IMIO hcnciits arc pmvitied or adrmT istcrcd by: Actna US. Hcnilhcmc Inc.. Actnn U.S. Healthcnrc Inc;. (DE), Anna
S. I fealthealu of �';Ila(iYI ma Inc., Actlur l;.S. iIcahhcx ltt ()I tile. Carolinas Inc., Aetna 11-S. 11calthearc of Ccor�!ia.
Inc, Aetna t,S. Healthcare
sp, ritic: lln.)tluris nl;;v nrll IIt' ;Iv;tIl;Ihlt: nn IIutII :I :it'll IUFI(II (I ;Int.l Ifl`,Iut:d h;I'a',
1.1'hldt' his molt tEd e; lu'he•vctl to 1W aI. c. Mali• as; "' the Inn'( tl;Iii'' II I:. Ithlt;(-'t to than le cvnhortl notice
In ca>c of a confliet betwexn your plan documents and this information. ihc. I)lat) Ilncurnenls will ,:.ovrltl
tH)/1 IA)I
t'larn Mi};tr BeimMs 0110S Out-ol•-Net),vork
Aetna t1.S. healthcare, luc.
Qtri<lu d.'liy nr'"I:uaaarac
QPOS Plan (Stacked)
t'lan l+'eaturr5 Out of Network Non�Rct'crred (Orr .'.**
Financial
Deductible l.iaxlividual; Iala�nily}
(_•oinsurarnce Bun:°fit ar onnigo Pwd by Plan
('oinsurancc limit: i11dividual/1~am0y
l ifetime. Maximum };cnchl
Primary Care Physici.rn Visits O'or illness
and injury only)
Mice e fours
Affe•t'--1 i(.aitvs/Hcanio
sproaRy (Are
()ittcc Visits
l.Kaagttostic. OP lab/X Ray r'c:stinz.�, (at factlity)
F)tarno,,,tic ()i' I..aab/X lay Tostin,g (at specialist)
C)ao(paticnl l hc•r:?py (spec ch. physics ll, nc:cupahonal)
OullmlloW I)i:alvsi�,Whcnanthcrahy
Allergy l"cstin 1/Tre:ahracnt
PrmeMNP Care
It name, r"hymcals
Routine Child and We'll 13a11hy Care;
lnrtnunizaltoias
Routine (i)'N (.'arc:
Routinc^ Maammograaphy
S500 ljidivt ival/ l J00 1 an iI
80',
$1500 lm tvidual/,A500 family
w1.000,000 i)cr tncrrlhrr
80cl( after deductible
ri0'7f, alter dCcicac:tiblC
so% after deductible.
80`/; alter dL'.ductil)lC
80</, atic t de due Lil?le
80`/ ailc t dcductihlc , h(i datys pci talc rular yeaat.
SOr%r alter deduOlhlc.
80`iG- ahu dccluclk,
NOI/f- deductiblc Waived, claildre n thlrouf1,h a�c )b only
501% . deductible waived, children Ihrou rh age 16 only
No; cc)vcrrd unlc°ss caplional prcvcnlivc calk,.
rider is purchased.
l00 ,4 no deductible.: a.tc 35+ oneper year.
Member precertiiicalion rrcluirrd or he nclils Will he suhslanitally rrcluc:ed. Piec;catii'icatiitn rcxlurremerals
may van} See your plain doc umc•aats fora complete list of mail ail snows that recluirr pre"AHicalion.
0(i/ I JO 1
Plan Design lie:luvlits
Aetna U.S. Healt.ltcarc, Irac-
Flonda
()I'O5 Ilan (Stacked)
flan Features
Routine 1 vc, Exam
Pediatric: I ental
I f(;af MIT Exatti
1le:a[Ing, Aids
Urgent Care Otit-ol•-Arca
A nrhulancc
Ontpatient Srrruer•v
I lospitalization
Skilled Nursing Facility (_'are (it) iicu Of
hospitalization for modic<Illy necc•ss;uy O)v('r('d
ho'n'lits)
iti'lalernily
(M visils
Iiospic'al (.1nc:ludes Newlaurn Sc rvit rs)
Home Ilcalth ('are
Private Duty or Special DWy Nrrrsinl;
hospice - Inpatient
I lospice - Outpatient
Ont of Network (Non -Referred ("arty'
Not covered
Not covered
8014, allcr r,lc-duo.'IIhIc; 1W- illncs": r►r injury
Not covelcd
(Sturte as In -Network coveragc)
(Same as In-Nowoik coveraf?.e)
(Same: as In -Network
80%; after deductible.
O/ ;dtcl do'duc'tii�lc
hU /- aftcr' dedu(.:tIhk'
?.•dU clays poi, c,dclldal vc;tr
SO'/h after deductible
SOrI allcr• deductiblc.
801% after cleductlhlc; 1-10 visit pc•.r ya:Lu'.
(Santo limitations as In Nclwork)
,f after dedm iiblc
'-'MY ;t1tc'r dccluclihl(-
iO day IIICIImc rn;txnnutn
81017c after- deductible
$10,000 lifctirne 17rrximum
(lt OS' Out -i)f-Network
Mettabcr preccrtificatiorl 1'e'il(li1Vd or In: nrlits will be snl)st�uIII:Illy rc'ducc(l. PICt r,rIIIicatioli rcyunc'tncatis
may vary. See y(,nr phis tlue untc„1; fur a c:omplcic list of medical swrvices that te(luire prcccrttf tcatiott.
Plan Features Out oL2!je work Non-lZeferre.d Care t:k
06/ 1:?/O t
Plan Design Benefits,
Aetna U.S. Healthcare, Inc.
Hol id'i
()11()5 Plan (Stacked)
1i':tniily I'lattoin)/Kehrodu(°live Services
Slerilizatit►at I'rocedilres
mental I lellila
lnpalie.nt
OnIpaticnt.
Sal►stance. Abuse Detoxification
Inpatient Detoxification
Owpatient Detoxific:atic►n
Sr►bslauc•e. Abuse Rehabilitation
Inpatient Rc'habilrtaliorl
4 )ulp:Iticrll Rvimblhtallon
Diabetic Sltpplies and Equiptuent.
Durable Medical Equipment.
Chiropractic tare
Oul-ol'-Network All 1'revenlive ('are Ritter
(excluding mandated benefits)
01'05 Oul-ot-Nrrwurl:
801;4 aikcr deductible
C"crrain services are covered. San-rc limitations
as .1ra N twor'k.
80'% a.tftcr dcduc•lil ic, .10 clays pc'r c:derrdar yc'.Ir
50% after deductible.; 20 visits per calendar year
1i0c/( after deductible: 30 clays per cldc.ndar ycm—
combined with Inpatient Rehabilitation
801/c after deductible
8Mi, ;after' deductible _ 0 days per calendar year
c;onlbined Willa Inpatient Dc.luxilic-ation
80'k alter dodlIclihlc.
.14 visits per calendar year
801/> ;al -ter deductible.
80c/ after deductible.
Must pre -certify if over S1.500
i0'ii afICA- decfuc(11dL'; �1MOO anratull III axiIII una
1'ap ,8nte:trs and Routine .Prostate Screeninc,, covered subieo to
dcdttctil)le tuacl cc dnyttrance: Routine.' ( iYN c•ovewd at 100'/( np
to `h.1.50 allowance, then covered snhiecl to (RA"kcubic mid
coir�sur: nc'c'; ('11 Id l lc';alth Supca vision ,scrviccs c-ovcwd
up to `';150 allowance, tlrcra covered suh.Ic'rt to plarl c,ninsttr,incc
(cle.cluetif.>lc waived). 'hhc $150 allowance• is a ccnnhi wd
rnaxirrunra for all Cli�,Iiblc preventive care scrvicr' -
:L Member precertification 1-ecluired or bencfils will be substantially re.'dttc:cd. 1'rccertiticalrtm Icquircrncatls
may vary. See Your plan doctarnents for a complete: list of rnedic,al services that reclttire. hrcce.rtific:ation.
Arleta U.S', f 1c;j11hL:uc' is ca lira IrIOW I IMcl
00/ 12./01
PWn DmQn KctMOts Qll()S (),it -ol'-Network
............... .....--- --.
Actrm IJ.ti. Healthcare, lrrc.
l..len idtl Citynf't'arrt:ar:rr
c POS Man (Stacked)
i'his mmcrial is for only anal r; ncithrr art nlii;i nl I.O;crasr(' lit)' nu;dic;Ii advitt II ct)ttl:liIs' t11V a partial.
prnriai description art pLlil oi- ptotr,rtim hcm.'itti anti does nut L oll"Ii1ilk, :i t t)ill r;4(t (' ,nsnll yunr plall do(,rincnts ISt IteclUIC or Benefits,
att' of (ovc:ras!r, t Troup Apiccimut, ( ifoup Intinr uu,c ('('IIll I(;:Ilc, or t Ir,uilr Poll( yl to dt-willic. gowrijil1g. Conlraciu;tl
Inuvc,urlts, gat IudIIIP! ()I It cclinr", rxdIisu>ns anci Iirinit,ltit-ns ra Ellin. I your i,I;tn All the ions and Conditions Of yunr Irian or prurpaal
:]It, ,t}hjt:ct tt, pplic;tlliv I:twr;• I Yulations an(I pM,cics 11, av;IIlahility of tl plarl or prc,,mm nury vary by grokrmpMe service area. Al
LCnrl III; iii'C subject to CuoldIni utIir ul hcn(,his
\ctna U S. Hrtlthcarc &ws not provide hinth t Tut °services -III, thcrcloic, c:uun,i ;>uatarncc ;ufy it tiulls (rr uutcntateS. Participating
i,rtIVIIlrrs ;wIt t „cnt y nIn m ; ;Ire' uulcpcnwtil t milt tours in I'trival w pr acli(c Intl irt: nt ithcr cmpIoyccs not agcnIs of Aetna U-S-
i Ic;d1ht:a1t• to IN aflili,itc,. I lit• ilv:ulahilily of any parricidal provider ctlnnol he niatanteed. and provider network cornposmon is
suhjcct to 11;Inge without n ticc. Certain providers may be al l iklic-d with an Indcpcndem Practice Asset(,iatioil 1 IPA ). a Physici:u,
"iCciic;ll (.Irnnh (I'MC.i).:.ni into;rated deltvcty syInn a other provider f.trc:n j7s. Meml)crs wh +select obese pauvnirrswill hc•ucr;Illy ht
cfrrrcd to spcCialist anci hospitak withilt that system) or ]Il ulp.
t 110ScsI xid i;SAcccss(,) Telorcd bcnclits may he provuled cx ttdrrunutt red hy: Acnct 1'.S. {li:aliht;arr Inc , Aclna U S I Icallhcarc lot
OPOS anti i ISAeccti (O sell PICIrc,(l hCIlCills tnay he prt)vidccl or adnonnicred hy: Actna U-S. I lcalthCOic Inc., Aelna t l S l lcalihcarc
l tv'Im, s(,JVIQ C ui Supply lh;ll in c,ll)Icct to ;l in)vilnrm limitation, such nulxin arms will be reduced by any scrviceN or stllwhes which
arc t:ovcrcd ,i; rcicrrc(d nr non I(Ifcrrcd ben(fits under the Point oP SCrvic:C t)r liSAccess lrrograto l3cnclit limo~ upset Turd do not
ciUPlic:I1c• c;at 11 olhet'.
I duire�d or heiIt' IiIs will N. tiuh;I;uttlillly rrdut c d ` ,Illr tIl Iht: ht uctils It'tlenllnd[ prct t,liiic;atlnn may Inc'Itath.
>\lcnihcr rrctCtl,ficaticm rc.
httt arc nut iirnticd Io lnpalielti I IoNpilol, Ii,patitml Mrnlal I It'allh. Inpilllcnt 'killed Nnrsuy�, ( htipatl'-w Suli!ul , Sulnt;lm c, Ahusc
I)tiri\itit;lit( m, h,p:alic:nt and Oiltpaticau IZchaP>ilitatiun) PicCerti)it;illuu reeitinetrunis stay vttly. M( n,hc rs ugly rel(•r ir) then plait
i
do( llll rniti loi a t Unpick Ic,t of mudicpl xrviccs that require prr crufit:aticm.
'•;pcc11 iC prt>duc:u; rn:fy nt)t ix :rvail:ihlr on h)lll ;t ticll (under! ,trat.l Insurer
Whllr ihls twilcmil r; hcilrv(ti to he accurate as of the print dale, it is Subject to Chiangr without notice.
In C:lse of a conflict betwec)it your plan documerus and Il,e; ilrl('outrun, IhC I)lart (JO C:urrx IIIN will J',ovrI II
I•;X1.11111'1' F,
Plan I)5ign & lycrrclit (.)(' I
Actna U.S. Healthcare
Florida Dade/Broward/1'a1111 Beach/;Martin/tit. Lucie County
Benefit Al brentlalls lOr (Ven C`lloice to successfully control (:casts, it must create significant benefit
incentives for plan inerniv rs 0) seek care ill -network. To maximize the plan's
impaci ou the cushmnces cast savage. our Ialalls include:
W A reasonable level of ermployee cost sbar•ing, evert for preferred benefits.
.� A nicaningful differential between deductibles and coinsurance for the
preferred benefits for in-nctwclrk sc•r-vicc.s mitt llic non-picicrrcd hcrichis for
uul of nrlwuri: services.
■ 4.'uvera�e for l�reverrlivc sc'rvicc's 1pllysic:ll rxalns :rile! itllmcrrli:r,.riicros) wlle,n
received in -network. or out -of. -network.
a Aetna Navigator"",, ;a powc1-1111. well has(•cl (ool desi.�!,ned to help nlerYlbel"s
acc:css and rlavi,ri;ltc Aetna t IS. I Icalthcal-c "s wide calibre or health informative
;111(1 prograrlls.
1% plan design tellc•ctccl on the fullowilly Imjws is tilt:• basis foe r>in cltlolatioll. 11 is
suhjcct 10 1110(11lic<:ltion in responsc to stale or fcdund legislation, hs intc'1at is to
hi ghh.L7,l1t some of the main features of the plan of benefits. In case of a conflict
istwcen the Group Contract and tilts phi design, the Group Contract will govern.
The avaiiahilily ()rally IMI-11CUlar provider cmi not hc.:assinvd. While Aetna 11S
l Ic:aiihcarc opc'r:ltc's .1 systClIl of rnedieal cfelivcry 1oL111ded in (f1.1a11ty ;and cost
eFfectivelless, it (:;itl not :nly nuwdical r(sulls 01 otrtc0111CS.
Ail benefits of the plan are sc11�j(:,c:.t to c'ourclillatio ll cal benefits and the terms
Oncludiiv,, exclusions) of the (^;ronla Contract, ()pen ChoiCCO PPO. is underwritten
or adni nistewd by Aetna Life insurance Company.
I'hc Information herein is believed to he accurate as of the elate of this document.
and is srlflieci to chanaLe without notice.
Aetna i?.S. UlcaIthcare. 1 0 / 0 9 / 0 2
Ibn 1vsign & lbiw%,
OC'_`
AcIiia U.S. 11ealthcare
Opcn C'lulice(10 PkIll
Florida Dade/llrow.:ard/1'alna Beach/Mal-fill/St.
Lucie County
14k111
Preferred Beiiefits
Non -Preferred Beii 'fits
(in -Network)
(Out -of -Network)
Ilan I)cllrlclihlc (per c;Ilc•r1d;11 yc;11:
$,'3O0 111clividLI;ll
$900 Individual
rIpplics to ;ill covcrcd "(.rvlccs.
$600 Family
$1100 Family
excludes deductihlc c;11°ryover.)
Dedllclible Carryover-
]None
;'done
(Antiurance !.Irbil Wxdiuks
$1.500Individual
$3,000Individiml
deductible; once l"amdy CIAISL1r:lIICC
$ 3,00o Family
$6,()()() f';: nnly
Limit is met- all family nlelllllers will
be considered as havlll`T, met their
COilasut-Gt.racc, for the rem amdci of the
calendar year.)
Lil,efinre Ma\irlallral
Unlimited except where
( lrllin,itc;cl except whery
otherwise lndic<llcd
Nlicrwi""'c• indic.;itc.'(1
Physician Services
(excepl..Mcrltal Health/Alc/Dr tt ?.'
C)f►icc. Visits (non surgical) to Non- 100(Xc, aftcr$15 c)fficc visit 7O`%-;Ihcrdeduclihic•
Specialist (I111crrli'O, ( iencral copay; deductible waived
I'llysiciari, F;,iriiily I'mcliti(>ner cal
Pcdi;ltriciall)
Spcckdist (office visits) loo`%; aller `♦25 specialist "7OY(, nilcr deductihlc
oflice visit c(gmy.
deduchble waivecl
Florida Mid lAcHhh Supervrsicnl
Services
C:hildrera to age It (i cx;irns in first
12 months of fife;. ? rxams m lhe. 1 "-
7 1& nuinths of life, I exam every 12
llu)ntlas (il- tile. thcrcaltcl. InCILICIeS
cover;:+,.=,e for inlmLtriiZati()Ils.
LOOS% rafter applicable
office visit copay;
deductible vvVvec:l
70%; dmMctihle waived
o a L. - S I4 c a! E h c ;i r c 1 0/ O 9 / 0 2
I*
Plan Dc os ,'t c'ti:. B011efit5 O('.
Aetna U.S. IkaltlicaI-v
(::)per) Choice 10, Plan
Florida Dade/Broward/1'aIi in Beach Martin/St. I..ucie (_;unruly
Plan Features
Routine l'hysiCals/IrrnllLrrlisatiorls
('lrildren age 17 f: I cxwn cvemy 1
mouths of life 111) to age IS, I cxarr)
c;vc'ry :2.1 months fOr childrera ,1`,c I
and older. Inc;lu( cs c:i)vc ra+.(: for
immunizations. Adults: I cx urr
every 24 months nths 111) to a:r ,c. O) and 1
cxa m every 12 month~ for- adults age
05 arad Older. Inc dudes covera !c for
immuniz.athms.
KoLrtrne TIC,11'rilL' l;xaM
i 1 exam per 12 months)
Routine Ob/Gyn Exarn ( I ro Hmu
exam per calendar year: incluchng 1.
Pap ','mcar and related fees)
Routinc. Marntnography
Preferred Benefits
(try -Network)
100% at,ter applicable
OfhCC ON Copay;
tQdmAdQ wain ,(l
No coverage
100' o z.rftcr $25 spe.cialist
Office ON Copay
I O Yk Mr amd waNC
(Ance visit way;
deductible waived
1.00'I,; ded.LICtiNC waived
RoutinC Annual l )if,,ilal Rc.c:l:rl F,xam 100`/c after applicable.
:rnd Prosuac /�ntigcn lest office ON c:opay:
(PSA) kw covca'cd nmks age 40 and deduCtiblc waived
over
S Lrr ,rx,et..y.
fovAcitrn In-1 lo, 1pitnl Scrv1Ccs
Allcrl. y 'listing and 11%'a1tT cm (given
by physrctan)
TM aner(Ic(ltacKwu
90% after deductible
1Mq, alter,1421 spccialisl
(Once ;lmt C(lpay:
deductibic waived
........................... .
Non -Preferred Benefits
(Out -of -Network)
7K/; after dedLrCtiNC.
No (_'ovcrr.tge
`70'%, alter ckductihlc
70% aller (:kxl(rctihM
701/0 after dedLICtil_l1C
70% after deductible
7(M after dc.clLLc;ttl)le
70%) aher deductible
70'%, afte.r deductible.
A C I ra a. U. S. I c! a I t h c a r e 1 0/ 0 9/ 0 2
Tian llc`Agn & 13enwht. (i('..<-1
Aetaaa [ .5. 11c�althcaare
.
C}peat Uhmcc6i) Plan
Florida lade/Broward/PalIII Beach/MartLucie Comity
Allegy Jgcctiom (runt 9wen by
i-ahysician)
CHhcr Physician Scrviceti
flan Features
Hospital Services
Inpatient covemge — Inpatient Hospital
c.lecfcictihle will only he alviied once to
A hospital confinements. regaacfless of
c<-ausC:, Which at-c separated by less [hart
M claw
OUIVOicaat crrveragc,
Emei-gency Room
Ncm cl-nei-gency use of the. Emea-gency
Room
goo ,alter cicc.hac:,tihk
90% nailer dccludihic
11'rel,crred licaaelits
(iaa-Network)
901I- after deductible and
$ 00ltca-emilineraaent
deductible]
AN Am deductiblc.
901,7�: after r 100 F1llr, .ency
Room copay (waived it
ccaaafnacd); calendar' yeas
deductible. waived
5M'o attea. de.cluctibic
magimstic. X-ray it Imimraatory (if 90% alter deductible
perfc> mcd as a part of a phymmara's
calCicc visit and hilled by the physician,
expenses aarc. c.ovcr-ed a:at 100`I, sub;ec.t to
the physician's office visit copay.)
('left Lila/('lc:l't. I'alatc. Payable as any other
(iaxjudes services and supplies rc.ela.ria"cd expenses
by State law for dcpc.aadenl children
gander the age of I ti)
!lM alter t6ductib1c
after cluCluctibIC
Nola I'rclerred Benefits
(0iii-ol'-Network)
..............................................
701k after deductible and
$700 pei—confinement
dcxitact N(�
701L, alle.r dc.ducta , c.
saraae as pac'fel-r-eel
cointitaa'llice after $ 100
1?111cl-genc:y Room
deductible (Emer_gency,
Room: deductible waived if
confined); calenclaar year
dcductihlc waived
50clr. a.11'tca- c:IcclnClihle
70'%r, after dedLJCtible
Payable as :any oilier
expenses
~killed Nursing Facility (MIX) ;after cicclnctihic 111t tea 'Mlyu alien, do'duc;til-le up to
(C'onfinerncnt must start within 14 (hays I D) clays per c:aaicndaar 120 clays per caicndar year-'
of hospital discha Tc. hospital shay year,;,
/1el nai U.S. Hcalt11caa-c 1 0/0Q/021
(. G 5
l'hm Def+li.yl 61 Be1lt.IltS
Actim U.S. lleall(.11caarl'
( )f)c'I1 ?. '1loice(D Plan
P'i whh, f)ar,de/Broward/Ya hn llealch/Ma r in/St. hicie ( ""1111y
sllu�( 1)C' ;at least 3 days.)
11mm 11cadth (_'..are 90 J ranter (ic.ductil)Ic up to 70`l) ,after dedllCtil")IC Up to
120 visits per cale'"Au— IT) visits per calendar,
vG,ar:: year'`
l'6vme May Nursing W `y, after dcciu UNIc up m 701� aller dmhctihlc up tc)
70 eight-h(.mr AS IWr 70 cighwhour shifts per
c<.tic:,M tu- yc.M* calcmhr yezlr`''`
P1.111 Features
Preferred Benefits Non-Pre.1'e red Henetits
(try -Network) (Out.-of-Ncfwork)
1halrice. Care 90 `y after cit.duc'Lilalc; up to !1)`%; :11tc•r deduct iHe till to
IItl:lahent (.'overage 30 days* M) days'
011tll:atient Coventge 901y after dedtictihIC up to/tl�% 'tier dc;ductit)ie ttI) to ;.t
a maximum Knefit of maximum I1e11ellt of
Short -Term Rehabilitation 90 cy after deductihlc:, 701yc <111c1 dcduclil)Ie.
AmbulaInce `)() After dCdt1(.A1 C 7()"u :Inter deductihic
Durable. Medical 1°:cl dement 90 `y- aftel deduc;tihlc; 70'%) :liter deductilalc
Maximt.Iuas are, a cmnbined limit for preferred and noel Iarencrre.cl sc'rviccti
Ac; t a1;t I .'s - IIc�11111c::I I e 1 0/09/0'2
i'l;.tiz Ih.si,�ri & .Bellchts
Actua t i.S. I lealthcare
Florida Beach/Martha/St. 1...txcie. County
Ilan Features
R'rescrilrtion Drug
Single rVicred Copay
No Ma id;ilwy ( i("lcl'i(:
(MmuRr is r+~sliotmhlc to pay the
applic.ahic' copay only.)
No cc vei'age fol- c.lrt.tf>,s Oii ilia
Medication i01-111tilary E,\cluyil.til'i IASt.
(Iuc to closcsd f0r-i11u1ary.)
4.)t<al ('uritr;u c^l:�livc' tnc:ludcd
Foodily (burrs Wl l rind irljc;ct<tl)lc)
included
Diaboic; si..1pplics included
Prel*urred lknefils
(In -Network)
..........
Retail
i t?( k after $1 5 copay. t jP
to :30 day stimAy M
lrtrticiliatitl, hharrtiac:ics
Mail Order
1001/c 7 tilm's
retail c oPay fol- a
31-90 day supply fi-otri
liai-tic'ipatiny Mail Ordn
wildol-
Non-l'ref-erc cd Benel its
(Out -of -Network)
Retail
60 ire (1 suhtmlWd cast altc l-
15 cttir.iy ul) IrW clay
supply,
Mail Order
No Coverage
A c• l ii a U . S . H c1 11 1 t. 11 c �1 i c: I () / () c) / () 2
Flan IhsWn & One% 0(>7
Aet►►a U.S. Ile.►lthcare
(7pell (..1mic e(1O Plan
Florida Dade[Browarcl/I alm Beach/Martin/St. I.at►cic (_'ounty
A v 1 na 11 _ S. 11 c a I t h c a r c ! () / () 9/ 0 2
Avilm tl S lle:althcare
Open Clmicc(O Plan
Florida Beach/Martin/St. Lucie County
Maaa Feaattares
-Maternity
(Covc,rage includes Volmilm-V
sterihottion and voluniairy alp Nion.i
Preferred Benefits
Nolt P elerred Renelit.s
(ln-Network)
(OW -of" -Network)
Payahle as ally other
l'ayalilic as gray other
c ove nxi c pense
covered expense
Infertilily Services
w Djat-,,Iwsis mid tl-k-ailliellt ()I Ow.. Payable as any Other Pay%1Wc as any Odwr
underlying cause of inlcrlility cxllcnsc° expense
m Artificial Insemination (himicd to Payahle as any c)(hcr Payable as any Wei-
0 COUFSCs of lrcal17 ent in irl('Illlwrs cxponse expense
111ctlrric'11`)
Ovulaalioil Induction (Innitcd to 6 Payable as ally outer Payable as any other
c'mn-sCN ()I 1w;dIncIll 111 111t;i11I)cI-S expcll5e expense
lifetime-° )
Man F attires
,Mental health Services
Inpatient coverage
Maximum
Mpatient coven,
Alcohol/Drug Abuse
Inpatient c owl-agc.
.........— - Preferred Benefits
(ln-Network}
90`Io after deductiblC 1ancl
$300 I)c;r collfincnlelll
.......
Non -Preferred 1knelits
(Out -of -Network)
70'l<, allcr de.ductihle and
$900 pc'r c onfiracnlcul
deductible
30 clays per caNdar year* 30 clays per calendar year"
90% after deduchWe up to 705; after deductible talc to
30 visits per calendar year" 30 visits per calendar years,
90c7- ;;after dcductihlu land
$300 11cr Conlincillcall
deductible.
701I after deduclihie, :and
$700 laer eonlinellic.ill
dCduct1I)1C
Ac-t n a t.' . S. He.a I t h c a r e 1 0 / 0 9 / 0 2
1c:trr.► V.S. Healthcare.
(_)pen C lloicec) Plan
Florida IBeach/Martir►/tit. l,c►cic, (.'o►ataty
Maxirraum
Outputient coverage
Inpatie►it. I'>t'oceclrrres, rl"realnu-r7lti
am! Services
Inpatient prcccrlification and
concrlrm;nl review
1'emdo to emPloyce for failurc, to
precerti fy
Applies to tnlxrticrll hospital, treatment.
lacilily, ',killed nursing.! facilily, home:
kcal l h tare, hospice care, & Private
duty nursing, care
10 Claim `submission
A days Ivr cak-ndar year" 30 days per c r emkir year*
90%, aller dccltictihlc up to 70I/c> after (lcductible UP to
,M) viols per calendar year O visit~ per calendar year*
Provider. iniliated
None
Provider illitiatcd
` Cotnhincd maximum for preferred gild non prcfcrred services
Pla►] Features
External .Review Program
(Permits merilber.s to request external r-evieev after I•il-;t and second
level internal appeals have hcc.n completed. Cost of service or
trcatnicrlt must exceed $500. C.'iairll denial mu,"l he based on
medical necessity or hecarlsc, proposed service or trc;.ltrrlcrit is
Lmnsidered e.xperunental (a• investigational.)
i al►re-Added Progi-a►ms
Mcnlhcrs have access to the following, special progn"ns:
w Vision ( )nc program for discounts can c yc`,lati5e.s, Contact.
Icnse.s, l.asik -- the laser vision corrcc-tivc procedure and
nonprescription eye.wear.
A Alternative Health (,.' we Progr ins are r7aacic up oi' t.hree distinct
segments.
0 ,Nalural Allernat.ivcs - offers special rates cm a.l(c.r-nalive
thciapic,s, includirl , visits to acupunc;lurists, chiropractors,
Melaahcr initialed
$200 penalty. Applies per
occumneC
Me.rrtber initiated
—lnclu(..-..
ied
lncludal
Vision (.)nc is a xc c.,ititcrcca trademark ol'C'()tr Vision.
A c t n a I.J . S. I l
.l O/O1)/O2
1'lun fh:si<c.n <�;, l�ertc.fits E JC'- ! t t
Aetna U.S. Healtheare
Open C'hc1lC'CP Plan
Florida l)arle/l3roHraZz'd/l'.clrtt Beach/Martin/tit. Lucie County
n� rssa ,c ther,rpist and nutritional counselors.
Vitamin Advantage"" �a savintts pro p-alit for ovor-lllc
c(.)lniters vda nlns as we H as nutrition& sr "Moments
0 Natural Pr(,)dncts a s�lvin��,s prol-7,ra11t for rn<Iliy health.,.
related products.
9 l'itrness program for savings on health Club memberships and
homc cxc vne ecli.lipment.
National Advantage Progi-am Included
flan I cattNrcti
Nalional Medical Em—ellence Program " (N.MV) included
l�rcr�2r;im to licip clis-Jblc menihers access covered trcatment fol
Solid or�!arl ,rnd hone marrow tr.rnsplants and coordinate,
,11ranlye"lrlcnts f()r trcntmunt of mc;ntbers with certain rare; or
complic'atcd conditmns al cc'rt.dn tertiary carefacilities across the
c imlilry when those services arc:, not available locally. May also
inc;lnclr, travel c xpc;riscs for tltc inernber- and a companion.
moms -to -Babies Maternity Management. Program" included
FC etures lnClUde a pregmincv risk survey, case by
registered obstetrical nurses, c,ontprche.rlsive• t.'drlc;alional materials for
lyre 7rrant me l'ntJcas and thcil partners, and a pci-sonalized drug -tree
smoking cessation Imagrarn, Sim.rlcc-1re;c Moms, to-hc "' dc-signed.
Specifically for pregnant women.
AvV iil:lhifily v;iiics by scSivice arEB.
Aetna U -S I1c:,:llt.Itc r1"e; L0/09/0
PI:tat t)c i rt
Actim C i.5. Healthcare
Opelt Chwc'c(10 1'I;tn
Florida l)arle/Broward/PaIIII Beach/Martin/St. Lucie Comity
...... _._
Man Features
l?litz,ihiliiy All employees
I)cpc•tadcnts l lIs!Ihility Spouse, children from hirth to at«.c 19 or to the end of the calendar year
III which age 25 is rcaached ;taut HIC child is (a) cicpcndertt upon the
pal-crtl fOa- supp rt and living within the household or- (fa) attendin0
schocal i1 ]lot Iivin�( within the hc�use.hold.
Private Room a-.it7iit Setni. -Private
1-ITiplovee, Acti vcly-At- Work Do not apply
f)cpcn(lenl Noon Colllirierttcnt
t�tele.s
Pr(- 1?xisI1111, Coltditlon", 161c Applies. On Effective Cate Waived
After Effective I)ate $4,000
The f'rc I?xistint ( "ctn(liliorts IZtalc• is waived tot- tncatviduals who hecortic
c.cavcr-ccf under 11115 Mai), cxclusivc of any prolmlionary perictd_ wt(hirt
90 days following their termination of cc:tvcrage (nacho a Iar-iot- Itlart 01
c rc;elilahle' C-overac:'e. 1)OCS not ::tfaply to pregnancies, ncwhorns
c ovcwd wilhin 60 days Of hirth, :Inca :uaoptcd Ot' l'oster children covered
wilhiat 00 (lays ok placcrlaent foi, adoption- Lookback period for
do".teanaininv a pre-existin-, Condition (conditions for which chagnosis,
care or treatment was reconmicn(led or received) is 90 (lays
prior to the ertroihncnt date.
Ml )Xiraaum cxClusion period is 365 days after enrollment dale.
('c>tivcrsic�at Standard cortvcrsion privilc, c a.cpplies
CmI1irtttatioat Star7dard continuatir>rr appfics (`Of3Rn (ta stair to nu -hated.
(There iti no medic"d Conlinuaatiort fc r sut'vivin« depoll(lr.nls')
Extension of Benefits 12 months extension if totally disabled when coverage ceases - extension
applies to all covered expenses
Act naa 11,S. H e a II hcaI-c 1 0 / 0 9 / 0 2
Plan 1.)c:Agn & Bme%, Oc-12
Aetna U.S. Ncalthca:>tre.
Open choicc(ft) Plan
Flovida Dads./l;r'olvard/PalIII Lucie ('oulity
w._..,-.
11,111 Features
Medicare. ( iovcrrrnrenl I'xclusir,n Medic arcs cligibic herleiits :tre subtracted from
( `ovcred Mcdical 1?xpc:'nses 17c:fr,re secondary Aetna benefits are.
c.arlculatc•d.
C'oordirralio n with, Odic-1- licnc{iIs tJp to 1000V of Allowable p:xpenses per year
'Suhrol,ation Thi d party liability claims with rmovery poic;nlial will be forwarded to
the designated strl>rogaticrn vendor Cor pursuit ` 500 threshold applies.
Actna contractual definitions will apply to treatment received in --as well ;Is out-ol-network.
C%pay
A c:opary is an out 4 luxAct expense applica.hle to "preferred" herrcfits. The c:r,pay is rollc•c lcd al the tirnc
the scr-vice is rendered. (.ul-oPpocket expenses ahlrhi;ahlc to prefe T"I I,t•nchls (exc:cpt those resulting
Iron -I application of a coinsurance percentage, c•!., 901 , MAY(', ctc.), ate, referred to as copnys.
Deduc'lible
A cicdcactible is an-r caul-c_rd pucl.el cxpvrrsc applicable: to NO "preferred" and"11011-l_rreferrcc:d" benefits_
Covmvd exposes are reduced by the auno"rrt c,f the c:.lccluctihde at the time of claim ardjtrdie Oun by the
claim processor. Out oI pockc;l c.xlwnses aappl&ablc to preferred and non-pn dcrrcd hrnelils (cm-ept those
resultiriL, from application of a coinsurance percentage. c.«., 90% SOT en) are rcfcrrc 1 to as &WIM.trl.idcs-
(.'alc radar year dccluctihIcS are individual and family. with family limits cdual Ic, none, :'.x or ?.x Ihc.
IndIVidtraal deductilrlc'.
All covered expenses aaccurnnlatc toward hoth the pI-Cfe.r-r-cd dcdatctlhlC and the nota prefermd dcxluctibic-
Once the non -preferred deductible is nrct, the prelln—ed dedawOlde will have been Considered to be Intl lot,
that calendar year. The total ducimlihlc amount for- the calendar year will not exceed the non pielcrre d
dedtu: tib1C amount.
d herc is no cross application brtwecn the calendar year deductibles and the inpancrrt per confinement.
hospital cleductiNes. Than is ncr deductible carryover provision.
0,ctna I1."';. I1earlt.IrcLt. r-c 1 0 / 0 9 / 0 2
l,lan t)c: si! n l�cnctirs W 1 .)
Aetna U.S. Healthcare
()pcil Ch(lrc;c(.10 Ilan
Yioa-idza lade/Broward/Palm Beaacla/N'l aa•tin/St- Lucie County
Coinsurance Limits
(;oinsurance limits are the max1nium arnomrt Of c) h O poc,kc•1 expenses (other than copays and deductibles)
that an employee/family wilk have to lmy in a calendar yc<:u. Coinsurance limits apply on a calendar year
Imms only. ( Amismaracc. linlits aree mclividt.aal and family, with fancily limits edual to none•, ?x OF 3x Ilia
individual limit..
Expenses a:alrplicable to coinsurance limit -- Only those iadId pocl: i mpenscs res"Inn g frmn the application
of coi munrlce, percentage (except outl►,dknt menhil disorders and akohohmn mid drug expenses and any
1)(•nalty muounts) may he used to satisfy the coinsur;rncc limit- All covered cxpc-nses accumulate towards
hoth the preferred cxaimsuranco limit (ii included) aml the, nora-prcOrrecl coinsurance limit- Once the,
prc.lcrred coinsurance limit is tract, all expenses, except We IN rum-prcicrr-ed care, will be payable al.
l f)(YR ( hwe tllc non llrefcrrc.d coinscmance limit is tact, all expenses will bc, payabic, at I00'% .
6 "oinsuvance - "Otber„ Healtla Care
a Open C hoicc incindes .an "other level of cmnsunm c, N blier-" health caw is dc.firu d as a health care
sc Nwe or s ggdy that is neither prefcl7vS' nor "ncara prelerrcd" care- This, includes care; !.',well by a
pmvidcr who is not in a c mcpm y represented in the• mwork and imn; give n cut OF the scrvwv area. 'i H,
"other" lmd of care QH be reimbursed at am SW clornsnrancc level after the lnelerred calendar year
deductible;. However, any Health care sc°rvic:c or supply Ihal is not available within a network will be
rc•itlabmsed nt thc: preferred coincuranct! level ahvr the preferred calendar year dcductihkc. 'FlIcse expenses
v,J] ac.-c;rrrrlultale h)ward the lareferrc'd Coinsurance limit-
Aetra;a 6,i -S Healthcare 1 U/(.)9/t)2
Plan Design Changes
HMO
Plan'2002
Plan"2003',
Physician Services
..... ... ..... ...... . Services
Primary Phy,,-.,,ivan Copay
$10
$15
Specialist
$10
$15
Routine GYN
$10
$15
Surgical Service,-,
$10
$15
Therapy
$10
$15
Vision I-x�--ini
$10
$15
Lab& R;xJ iology
$10
$15
Hospital Services
. . .. .. ...... . --
Inpatient Acute Care
$0
$240
Mental Health
$0
$240
I.ITIergency Room
$0
$100
Pharmacv.Plan
RX Copay
$5/$110/$2b
$10/$15/$30
QPOS
Plan 2002
Plan 2003
Physician Services
Primary Piysician Copay
$1
Specialist
$20
$25
Routine GYN
$20
$25
Surgical Sowicos
$20
$25
1 herapy
$20
$25
Vision Lx;-Irn
$20
$25
Lab&Radiology
$20
S25
Hospital Services
Inpatient Acute
$2/10
$500
Mental I le,,jith
$2/10
S500
Ernergency Room
$50
$100
Pharmacy Plan
Rx Gopiy
$5/$10/$25
$10/$15/$30
PPOI
Plan 2002''1''
Plan 200315"""':
Phys-ician Services
Pormuy I�Ihysician Copay
$10
$15
Spo(-Ial15-,t
$10
$25
RQLJtlrle (,,YN
$10
$25
Hospital Services
Emergency Roon-i
$50
$100
Phar.macy.._Pjari,
-Rx Cop-,.)%/
$10
$113