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#5186 Approving an Insurance Renewal Between the City of Canton and Blue Cross Blue Shield
RESOLUTION NO. 5186 A RESOLUTION APPROVING AN INSURANCE RENEWAL BETWEEN THE CITY OF CANTON AND BLUE CROSS BLUE SHIELD OF ILLINOIS FOR THE POLICY YEARS MAY 1,2019 TO APRIL 30,2020 WHEREAS, the City of Canton, Illinois provides health insurance to not only its various Union employees,but also its non-Union employees and elected officials; WHEREAS, the City and the Insurance Committee investigated and determined what options would be available for health insurance purposes to continue said coverage for the City employees; WHEREAS, the City, upon discussion and recommendation of the Insurance Committee, has determined that it is necessary and in the best interest to renew the health insurance policy and coverage through Blue Cross Blue Shield of Illinois for the policy term period May 1, 2019 through April 30, 2010. NOW, THEREFORE, BE IT RESOLVED BY THE MAYOR AND THE CITY COUNCIL OF THE CITY OF CANTON, FULTON COUNTY, ILLINOIS AS FOLLOWS: 1. That the renewal attached hereto and incorporated herein as Exhibit A is hereby approved by the Canton City Council. 2. That the Mayor and the City Clerk of Canton, Illinois, are hereby authorized and directed to execute and deliver said agreement on behalf of the City of Canton. 3. That this Resolution shall be in full force and effective immediately upon its passage by the City Council of the City of Canton, Fulton County, Illinois, and approval by the Mayor thereof. PASSED by the City Council of the City of Canton. Illinois, at a regular meeting this 16' day of April, 2019, upon a roll call vote as follows: AYES: Aldermen Ryan Mayhew, Justin Nelson, John Lovell, Craig West, Angela Hale, Tad Putrieh, Angela Lingenfelter, Quin Mayhew NAYS: None ABSENT: None APPROVED: Mayor ATTEST: City Clerk 09 BlueCross BlueShield of Illinois Account Name: CITY OF CANTON Account Number: 389388 Renewal nate: 05/01119 Grandfathered Health Plan Form The Affordable Care Act(ACA)provides that certain group health insurance coverage in which an individual was emptied on March 23,2010,(ACA's date of enactment)may be a"grandfathered health plan."Grandfathered health plans are not subject to certain ACA provisions.Among other requirements,in order to maintain grandfathered health plan status,an employees or employee organization's contribution rale toward the cost of any tier of coverage cannot decrease by more than five(5)percentage points since March 23,2010. By default,our group renewal offers)reflect a non-grandfathered health plan design.This Grandfathered Health Plan Form must be S'aned by the croup representative and returned to our offices at least 10 days prior to your renewals)effective data In order to change your renewalls)to a grandfathered health plan design. If a plan is modified to a non-grandfathered health plan design on its effective date,it cannot later revert back to a grandfathered health plan design. For more information on grandfathered health plans and what changes or events may cause a plan to lose grandfathered health plan status,go online to:bcbsil.com/affordable care act. If you have questions regarding this worksheet,contact your insurance broker(if applicable) or your BCBSIL account representative.The rules related to grandfathered health plans are complex.We recommend that you seek the advice and guidance of your legal counsel regarding ACA and grandfathered health plans. If you believe a plan or policy has lost or will lose grandfathered status,contact your insurance broker(if applicable)or BCBSIL representative immediately for available benefit plans options. Check the"Grandfatherill box for only the benefit plan(s)in effect that quality for and that you wish to renew with a grandfathered health plan design. Plan/Beeefit Premium: Premium: Premium: Premium: Premium: Group Agreement GmndFathered? Employee Employee Employee Premium: Medicare Medicare Number Name/Number Only *Spouse +Child(ren) Family Primary Primary Employee Family P89388 BPP72322 ® Yes ❑ No $797.66 $1588.10 $1453.82 $2244.25 $458.07 $916.14 P95069 MPS91605 ❑ Yes © No $689.13 $1372.03 $1256.01 $1938.91 $395.75 $791.50 ❑ Yes ❑ No A Division WNeslt',Gra Service Corporation,a Mutual Loyal Reserve Company,an Independent boensee of Me Blue CrossanCBlus ShieidAssdtla6dn. Grandfathered Health Plan F -SGFI-2012 69 BlueCross BlueShield of Illinois Account Name: CITY OF CANTON Account Number: 389388 Renewal Date: 05/01/19 TO BE SIGNED BY THE GROUP REPRESENTATIVE: I, the undersigned, a duly authorized representative of the policyholder named above("Policyholder"), hereby: (i) represent that I am knowledgeable as to standards associated with a"grandfathered health plan'as set forth in the Affordable Care Act and applicable regulations, and that the information contained in this Grandfathered Health Plan Form,and any subsequent updates to such Form,are true, complete and accurate; (ii)agree that the Policyholder will immediately provide BCBSIL with written notice prior to renewal(and during the plan year, with at least 60 days advance written notice)of any changes to the employer's or employee organization's contribution rete toward the cost of any tier of coverage;and (iii)agree that BCBSIL retains the authority to determine, at its sole discretion, whether any health insurance coverage constitutes a grandfathered health plan under the Affordable Care Act, applicable regulations and interpretations thereof. ,{ NaJACYlG '`7j -, 14( 0, Gv ame — P algnzture Date A Oiv000n ofHeatth Care Se one Corporation,a Mutual Legal Reserve Company,an Independent Licensee ofthe Blue boss and Blue ShieldA poadon. Grandfath[ed Health Plan Fomr-SGR-2012 0 BlueCross BlueShield of Illinois Account Name: CITY OF CANTON Account Number: 389388 Renewal Date: 05/01/19 Grandfathered Health Plan Form Contribution Information Complete the following information to report on employer or employee organization contribution rates only for benefit plans)where YES was checked in the 'Grandfathers column on page 1 of this form. Should the contributions differ by any employee class or tier within the employer group or employee organization,each of them must be stated. Benefit Employee Class Tier Renewal Date Plan (e.g.,All, Hourly Only, (e.g., Employee, Employer's or Employee Name Salaried Only or Other(as Employee Organization's Contribution e.g.,PPO, defined by Employer or +Child(ren), Rate HMO) Employee Organization)) Employee-Spouse, 50% 75% 100% Other% Family) (Indicate Yo amount if Other) PPO All - All Tiers ❑ ❑ ❑ 80% Add additional details as needed by copying this page.Make sure you return the signature and fable page(s)together. A Division or Health Gra Ser vine Corporation,a Mutual Legal Resarre Company,an Independent Lirensee of the Nue Cross amf Nue 5hieOAssociadon. GrandfathenN Health Plan Form-SGFI-2012 aes. eroop c=om -sa19 4 30 20 mmm City s-a3rvzoCity of Canton For prep Plan refer meaner proposal for fulldetails Report 15A April 2019 page Abtl4onsbeaosroolipe xi Cirpent Medical Plan Group I Blue Gross Medical Plan Dosign Single Family Single Family Single Family Sul Family Deductible 5 Soo $ 1,500 $ 500 8 1,500 $ 1,500 $ 3,000 S 500 $ 1,500 Employee Comeurance 10 % 10 °re 10 % 10 % 20 % 20 % 10 % 10 % Out of Por lMax S FOOD $ 3,000 $ freed $ 3,000 $ 3,000 Is 6.000 $ law S 3,000 Enipioyer Funding $ - o $ - 0 $ - 0 $ - o $ - o $ - 0 $ 0 $ 0 Net Out-of-Pocket Ma[ $ 1,000 $ 3,000 $ 1 N $ $000 $ $000 $ 61000 $ 1,000 $ 3 N Employee A,mnal Prem S 0 $ 1 0 S o S 0 $ 0 $ 0 $ . o $ + 0 Employee Mas Ann.Cost $ 1,000 $ 3,000 $ 1,000 $ 3,000 $ 3,000 $ 6,000 $ I'ow $ 3,000 1 io .l COPaya Cop" Copay Copay Copay Pmnury Care $ 20 $ 20 $ — is 20 specialty Cam $ 40 $ 40 S — $ 40 urgenlCore $ - $ — $ — $ — Emargenoy S 150 $ 150 $ — 10%comouance $ 150 Outpu", rtmepnal $ — $ -. $ — $ — IoPatnmHueptal 6 — S — $ — $ — Rx No Deructible No Deductible Intel wilfl Minicel No Debroubie Tiers $10,$20,$35,- $10,$20.$35.— — $10,$20,$35.— Enrollment 104 Prem Ea BE 1 Prem ER BE 20 P. ER EE 104 Prem ER EE EnrolCyee Only, 29 $ 743- 100% $ 0. 1 $ 429'° IN%$ 0. 12 $ 642" 100% $ mr, 29 $ 797- 100% $ 0°a EmpiCyeo.Spouse 25 $1,492- 100% S 0. 0 S 856'" 100% S 0. 3 $1,2891° 100%$ 0. 25 $1.GeV 100% $ O6n Employee i CM1lltlren 14 $1,3531' 100% $ 0°° 0 $ 850''6 ON or $ 0°° 3 $1,168r 100% $ Om 14 $1,453°= 1 W°/ $ 0°n Family 36 $2,101- 100% 5 0°1 0 S 8M. 100% $ 0. 2 S 1,816- 100-, If 0°° 36 $2,244m 100% $ 0. Am.marooned Premium $1,84208316 S5,150'6 $224,651- $1,967,773"" Employer Prem courciflon S 1.842.08316 $ 5,150'6 $ 224,651- $ 1,961 Budgeted HRA.HSA S .0'.0. $ a0'+0' $ +a-,O's $ a0-+0- EmployerAnn.Cost $ 1,842,08316 $ 5,15016 $ 224,65100 $ "1,967,773°6 City of Canton clan creep Comparison propo Ili for full For IIIUStrelrve purposas rater to carne,parch alIm full tletele Report as of 15 April 2019.page 2 of 2 �-Add ilienal details available Renewal Courid Proposed Medical Plan Group Blue Gross Health Alliance(Plot)Match) Medical Plan Design All Family Single Family ample Family Sirple Family Deductible $ Sib $ t'NO $ 1,500 S 3,000 S 500 $ 1,500 $ 11600 $ 3,000 Employed coinsurance 10 % 10 pie 20 % 20 1 10 Y 10 1 20 % 20 % Our or center Max $ 1,00 $ 3,00 $ 3,000 5 AOOD $ 1,000 $ 3,000 $ 3,000 $ 6,000 Employer Ponding $ 0 $ 0 $ 0 $ 0 $ 0 S 0 $ - 0 $ - 0 Net Out-of-Pocket Max $ host; $ 3,000 $ 3,000 $ 6,000 $ 1,000 $ 3,000 $ 3,000 $ 6,000 Fmpmyee Annual worn $ r 0 $ r 0 $ . 0 $ r 0 $ r 0 $ r 0 $ . 0 $ r 0 Employee Max Ann.Cost $ 1,000 $ 3,000 $ 3,000 3 6,000 S 1,000 5 3,000 $ A3,000 $ 16,000 Medical Coal COPay Copay COPay Copay "r,..Hard $ 20 $ - $ 20 $ - Seocmlly are $ 40 $ - $ 40 $ HechtCare S - $ - S 25 $ - Emar9ency $ 150 $ 10%oolnsoience $ 150 $ - Out-Patient Hospital $ - $ - S - $ m.PaeantHpep'1al $ - Is - 5 - $ - Nx No Deductible Integraled with Most No Oatluclible hampered!with Madmal Lars $10,$20,$35.- - $10,$20.$40.20% Mi 20%,20% Enrollment 4 Prem EF EE 20 Prem EF EE 105 Prem EP EE 20 prem ER BE Ernployeo Or If 1 $ Fees 100% $ he 12 $ 669° IN% $ 0- 30 $ 679- 100% $ 0. 12 $ 712fe 100% $ 0- F"Idn"o-Spouse 0 $ 9161, 100% $ 0- 3 $1,372" 100% $ 0- 25 $1,763- 100% $ 0- 3 a 1,426- 100 a to W° Employee r Children 0 $ 816" 100% $ 0" 3 $1,256°' 100% $ Om 14 $1.599- 100%$ 0°5 3 $1,295" t W°b $ 0°° Fan d, 0 $ 916" 100% $ 0" 2 $1,938x' 100% $ Oes 36 $2481 100%$ 0°n 2 $2,012" 1D0% $ 0. Ann.Insurance Premium $5,496°-♦ $240,yore♦ $2.187,050°u♦ $246,644" Employer From Oontnbutien $ Evile ' $ 240,370° $ 2,107,000°° $ 240,844- BuddenedHRA rHSA $ r0-r 0- $ r0-r0- $ r0-.Ore $ .0-.0- Employer Ann.Cost $ A5,49680 $ A240,37888 $ A2,187,08000 $ A248,84488 Embedded Deductible