HomeMy WebLinkAboutResolution #5009 RESOLUTION NO 5009
A RESOLUTION APPROVING A GROUP ENROLLMENT AGREEMENT BETWEEN
THE CITY OF CANTON AND BLUECROSS BLUESHIELD FOR THE GROUP HEALTH
INSURANCE PLAN,AND DIRECTING THE MAYOR AND CITY CLERK TO EXECUTE AND
DELIVER SAID AGREEMENT ON BEHALF OF THE CITY OF CANTON,ILLINOIS.
WHEREAS, the Insurance Committee of the City of Canton has determined that it is necessary and in the
best interest to enter into an agreement with B1ueCross B1ueShield to administer the City's Group Health
Insurance Plan, as set forth in Exhibit"A" attached hereto and incorporated herein; and
WHEREAS,the City Council of the City of Canton has made similar determination.
NOW, THEREFORE, BE IT RESOLVED BY THE MAYOR AND CITY COUNCIL OF THE
CITY OF CANTON, ILLINOIS,AS FOLLOWS:
1. That the agreement attached hereto and incorporated herein as Exhibit "A" is hereby approved by
the Canton City Council.
2. That the Mayor and City Clerk of the City of Canton, Illinois is 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 effect immediately upon its passage by the City
Council of the City of Canton, Illinois and approval by the Mayor thereof.
PASSED by the City Council of the City of Canton, Illinois at a regular meeting this 21St day of April,
2015 upon a roll call vote as follows:
AYES: Aldermen Gerald Ellis, Justin Nelson, John Lovell, Angela Hale, Craig West, Tad Putrich,
Dave Pickel, Jim Nelson
NAYS None:
ABSENT: None
APPROVED:
Je frey A. ritz, Mayor
ATTEST: 'r
a Pavley-Rock,efTyClirik
Group Health Plan Comparison
e Set YtOni I City of Canton
6-144 6-144 $115 94-15 REVISfIII)i-SOIS IEYMFdi715
CURRENT(incl CURRENT(incl R91EWAL(Ud RE EWAL ood IIIIII31ENI1L,find 51EMERAL(lad
4114 ACAfees) ACA fees)lot ACAAaa) AGft*V& At.Aisat) ALAStatqJilL
cemus 414 Grandfather Grandfather Gmaa'I-- Omaltdlolhttr GswWkalf 6faelkIllaar
$$W cemus SS00 ded. HDHP $580 dad IIOSP riMOtid. iml!
tied. HDHP 6114-515' 6114-SFIV Sf15-SNS• INS-SW GN&Ws' SM6-11111. UHC $1111110 Dad UHCHDHp Humana Mumma
Employee Farr 28 6 641.61 54035 756.47 547.77 683-75 56590 47 57136
+ 32 2 1 93.76 1 7 1 1117 Il 17 1 ,17 11 1327.50 1131211 1 11 .93 11 71
Em +Child men 16 6 1204.96 1015.53 1411,30 1206 1211114.1111111 1 1 38 lism 1 110413 1 /
Family 40 0 I 7,09 1 .15 2170.50 I .73 IJM28 1 1 98,33 1.617.62 7 2113.49 1,82834
Medicare Prime-Fa 0 0 .4 643AO 3 17 _
Total Monthly Medical
Premium 118 14 155.33828 11,516.42 182 .00 1371094 183,13842 12X&12 159,220M 11966.12 IfIctim 1 167,690.36 12.227.06
AnnualExpense 2.902,250.40 1 5.12 4.SS 2.161,409.04
a348Se2ae=173% 3 NOI.i1lOS 5.14% $51A4.72-2-6%
Network BCBS BS BCBS RCBS BICBS BCBS UHC UHC Humana Humana
Coinsurance
90170% 100180% 90170% 100180% 90170% 00 100150% 90170% 100180% 90170% 1 /80% 90/80% 100170%
$20140 copay Ded then 100% $20140 copay Dad then 1DO% $20/40 copay Ded than 100% $20/40 copay Ded then 10D% $25/50
cePaY Ded 61en 100% $20V i copay Ded then 10094
OV in net Ded then BO% OV in net Ded then 60% OV n net Ded Olen 8096 OV n net Ded than 80% OV h no Dad than 80% OV in net Ded then 70%
Deductible !8 i SW-1 1500-XW sw-1 1 500-1 1 _ -two 1 Am--311111111) 500-IMO 1500- $00-1000 11.500-3000
(Single-Family) Out 1.000-3.000 combined 1 000-3 combined 1 -3,000 ooarb'ated 1000-3,000 cOmbkted 1 -2 3-000-B ODO 1500-3.000 4,500-9,000
Single Out of Pocket rh' - 1 0 1,500 1 1 1 1 1
Family(includes t of Pocket Out 3 0 3.000 3 0W 3 000 3 000 3 000 2.000 combined 5.000 W 1.000 1,500
000 7000
Family s d d Packet 4 3,000 4.5W 3,00411 4 3 000 000 eim 5m(includes deductible) SAW 2,0W 3.0Q0 Out 940 6.000 8.000 6,000 9,000 6,000 6.000 combined 10,000 12,000 8.000 14.00D
Dedthan
Drug Card $10/20/35 Ded then 80% $10/20/35 Ded then 50% $10120135 Dad then 80% $10/20/35 Ded then 10135160$3115/30/6W150/3 $3/15/30/601150!! Sto/25/40/ Dad then 100%
m ce co 00 co 00 25%
Rz MOOP Singb/Family
Emergency Room copay 5150 copay 9D%after ded $150 com 90%after ded 5150 copay !i0%after tied 5150 100%after ded 5250 100% er ded 150 100%after tied
Wellness in network S20 co 100% SAI 100% 0 100% id 520/40 100% k7 0 0 0 0o SO
Confidential 4rr=15 Page l
Renewal - FY16
PPO Employer's Share 80%- Employee's Share 20%
PPO Emp E+S E+C Family
Monthly Premium 679.76 1,360.17 1,264.85 1,945.26
Annual Premium 8,157.12 16,322.04 15,178.20 23,343.12
ER Share-80% 543.81 1,088.14 1,011.88 1,556.21
ER Share Annual 6,525.70 13,057.63 12,142.56 18,674.50
EE Share-20% 135.95 272.03 252.97 389.05
EE Share Annual 1,631.42 3,264.41 3,035.64 4,668.62
3
t j fldm i
OR
HDHP Employer Pays 80% of PPO Plan - Employee Pays Remaining
High Deductible/Health Savings Acct Emp E+S E+C Family
Monthly Premium 580.55 1,161.66 1,080.25 1,661.36
Annual Premium 6,966.60 13,939.92 12,963.00 19,936.32
Employer's 80%of PPO Premium 543.81 1,088.14 1,011.88 1,556.21
Difference between HDHP and 80%PPO 36.74 73.52 68.37 105.15
Employee's Monthly Portion 36.74 73.52 68.37 105.15
ER Share Monthly 543.81 1,088.14 1,011.88 1,556.21
ER Share Annual 6,525.70 13,057.63 12,142.56 18,674.50
EE Share Annual 440.90 882.29 820.44 1,261.82
L y'g� tp
Health Savings Contribution
Dental $ 3.35 Per person per month paid by the City
4V
BlueCross BlueShield
of Illinois
Account Name: CITY OF CANTON Account Number: 389388 Renewal Date: 06/01/15
Grandfathered Health Plan Form
The Affordable Care Act(ACA)provides that certain group health insurance coverage in which an individual was enrolled 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 employer's or employee organization's
contribution rate 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 offer(s)reflect a non-grandfathered health plan design.This Grandfathered Health Plan Form must
be signed by the gin reproM . iv.and returned to our offices at least 10 days prior to your renewel(s)effective date
In order to change your renewal(s)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�_cari4_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"Grant fathered?"box for on/ythe benefit plan(s)In effect that qualify for and that you wish to renew with a
grandfathered health plan design.
Plan/Benefit Premium: Premium: Premium: Premium: Premium:
Group Agreement GrandFathered? Employee Employee Employee Premium: Medicare Medicare
Number Name/Number Only +Spouse +Child(ren) Family Primary Primary
Em to ee Ramil
�0-1 00 2322 Yes El No #U1q-1b $i3too.l1 $1210��5 ��r}�2b #3q�.oq �9z.17
❑Yes ❑ No
❑Yes ❑ No
A Division of Health Care Service Corporation,a Mutual Legal Reserve Company,an Independent Licensee of the Blue Cross and Blue Shield Association.
Grandfathered Health Plan Form-SGFI-2012
1b. 9
BlueCross BlueShleld
of Illinois
Account Name: CITY OF CANTON Account Number: 389388 Renewal Date: 06/01/15
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; (I!) 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 rate 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.
Print Name Print Title
Signature Date
A Division of hea/lh Care Service Corporation,a Mutual Legal Reserve Company,an Independent Licensee of Me Blue Cross and Blue ShieldASSadUon.
Grandfathered Health Plan Form-SGFI-2012
Imo'. V
B1ueCross B1ueShield
of Illinois
Account Name: CITY OF CANTON Account Number: 389388 Renewal Date: 06/01/15
Grandfathered Health Plan Form
Contribution Information
Complete the following information to report on employer or employee organization contribution rates only for benefit plan(s)where
YES was checked in the"Grandfathered?"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+Child Organization's Contribution
e.g.,PPO, defined by Employer or (ren), Rate
HMO) Employee Organization)) Employee+Spouse, 50% 75°k 100°%o Other%
Family) (Indicate% amount if Other)
KID R0 e� ❑ ❑ ❑
_ '� -�S ❑ ❑ ❑ t7
01 ❑ ❑ ❑
O ❑ ❑
❑ ❑ O
Add addidonal details as needed by copying this page,Make sure you return the signature and table page(s)
tagether.
A Division of Health Care Service Corporation,a Mutual Legal Reserve Company,an Independent Licensee of the Blue Cross and 8lue Shield Association.
Grandfathered Health Plan Form-SGFI-1012
09
B1ueCross BlueShield
of Illinois
Account Name: CITY OF CANTON Account Number: 389388 Renewal Date: 06/01/13
TO BE SIGNED BY THE GROUP REPRESENTATIVE;
I,the undersigned, a duly authorized representative of the policyholder named above("Policyholder 1, 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; (I!) 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 rate 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 they
PH a Print Tide
Signature Date
A Division of Health Care Service Corporation,a Mutual Legal Reserve Company,an Independent Licensee of the Blue Cross and Blue ShleldAssoclation
Grandfathered Health Plan Form-SGFI-1017