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City Council Packet 06.19.2018
NEXT RES. NO. R18-29 NEXT ORD. NO.O 18-01 30 aO I CITY COUNCIL AGENDA TUESDAY — JUNE 19, 2018 — 6:45 P.M. WELCOME ... By your presence in the City Council Chambers, you are participating in the process of representative government. To encourage that participation, the City Council has specified times for citizen comments on its agenda -- once following the Consent Agenda, at which time citizens may address the Council concerning any brief community announcement not to exceed one minute in duration for any speaker,- and again following Items Removed from the Consent Agenda, at which time citizens may address the Council on any matter of City business that is not on tonight's agenda. Each speaker will be limited to three minutes, unless the time limit is extended by the Mayor with the consent of the Council. Citizens may also comment on any item removed from the consent agenda prior to council action, with each speaker- limited to three minutes, unless the time limit is extended by the Mayor with the consent of the Council. If a citizen would like to comment on an agenda item, we ask that you wait until the agenda item is presented to the Council by the Mayor and the public is asked to comment by the Mayor. Once again, each speaker is limited to three minutes. Any person who has any question concerning any agenda item may call the City Clerk -Treasurer's office to make an inquiry concerning the nature of the item described on the agenda. Your City government welcomes your interest and hopes you will attend the Laurel City Council meetings often. 1. Pledge of Allegiance. 2. Roll Call of the Council. 3. Approval of Minutes of June 5, 2018. 4. Correspondence. • Laurel Chamber of Commerce minutes of May 10, 2018; Laurel Chamber of Commerce Agenda of June 14, 2018. 5. Council disclosure of ex parte communications. 6. Public Hearing. 7. Consent Items. NOTICE TO THE PUBLIC The Consent Calendar- adopting the printed Recommended Council Action will be enacted with one vote. The Mayor will first ask the Council members if any Council member wishes to remove any item from the Consent Calendar for discussion and consideration. The matters removed from the Consent Calendar will be considered individually at the end of this Agenda under "Items Removed f om the Consent Calendar. " (See Section 12.) The entire Consent Calendar, with the exception of items removed to be discussed under "Items Removed from the Consent Calendar, " is then voted upon by roll call under one motion. a. Claims for the month of June 2018. b. Clerk/Treasurer Financial Statements for the month of May 2018. C. Approval of Payroll Register for PPE 6/3/2018 totaling $188,106.13. d. Receiving the Committee/Board Minutes into the Record. 1) Budget/Finance Committee minutes of June 5, 2018. 2) Council Workshop minutes of June 12, 2018. 3) Laurel Airport Authority minutes of May 22, 2018. 4) Park Board minutes of June 7, 2018. 5) Laurel Urban Renewal Agency minutes of May 21, 2018. 6) Insurance Committee minutes of June 7, 2018. 7) Insurance Committee minutes of June 12, 2018. 8. Ceremonial Calendar. 9. Reports of Boards and Commissions. 10. Audience Participation (Three -Minute Limit). Citizens may address the Council regarding any item of City business that is not on tonight's agenda. Comments regarding tonight's agenda items will be accepted under Scheduled Matters. The duration for an individual speaking under Audience Participation is limited to three minutes. While all comments are welcome, the Council will not take action on any item not on the agenda. 11. Scheduled Matters. a. Confirmation of Appointments. • Re -appointment of Walter Widdis to the Tree Board for a three-year term ending 6/30/2021 • Re -appointment of Arron Christiansen to the Tree Board for a three-year term ending 6/30/2021 • Re -appointment of Council Member Herr to the Cemetery Commission for a two- year term ending 6/30/2020 • Re -appointment of Dixie Feller to the Library Board for a five-year term ending 6/30/2023 • Appointment Ray Ezell, Karen Courtney, and Bethany Langve to their respective positions. b. Resolution No. R18-29: A resolution of the City Council resetting its July 3 regular Council meeting to July 2 in order to avoid conflicts with events and festivities planned for the July 4th Celebration. C. Resolution No. R18-30: Resolution authorizing the Mayor and City Clerk to utilize available revenue in the City's water fund to prepay and retire DNRC loan WRF-10-188. d. Resolution No. RI 8-31: A resolution of the City Council adopting a Management Budget to assist the City's Department Heads with projecting and managing their respective budgets for the Fiscal Year. e. Resolution No. R18-32: A resolution approving agreements between the City of Laurel and Laurel Fire District No. 5, said agreements relating to fire protection. E Resolution No. R18-33: A resolution approving agreements between the City of Laurel and the Laurel Urban Fire Service Area ("LUFSA") said agreements relating to fire protection. g. Resolution No. R18-34: A resolution authorizing the Mayor to execute a contract for the Chief Administrative Officer position between the City of Laurel and Matthew R. Lurker, Sr. 12. Items Removed From the Consent Agenda. 13. Community Announcements (One -Minute Limit) This portion of the meeting is to provide an opportunity for citizens to address the Council regarding community announcements. The duration for an individual speaking under Community Announcements is limited to one minute. While all comments are welcome, the Council will not take action on any item not on the agenda. 14. Council Discussion. Council members may give the City Council a brief report regarding committees or groups in which they are involved. 15. Mayor Updates 16. Unscheduled Matters. 17. Adjournment. Public Works Committee - Monday, June 18"' @ 6:00 p.m. Council Chambers Laurel Urban Renewal Agency - Monday, June 18°i @11:00 a.m. TBD Budget/Finance Committee - Tuesday, June 19'" @ 5:30 p.m. Council Conference Room Laurel City Council - Tuesday, June 19' @ 6:30 p.m. Council Chambers Tree Board - Thursday, June 2151 @ 9:30 a.m. PWD Conference Room Emergency Services Committee - Monday, June 251 @ 5:30 p.m. Council Chambers Council Workshop - Tuesday, June 26`h @ 6:30 p.m. Council Chambers Laurel Airport Authority - Tuesday, June 26" @ 7:00 p.m. Laurel Airport The City makes reasonable accommodations for any known disability that may interfere with a person's ability to participate in this meeting. Persons needing accommodation must notify the City Clerk's Office to make needed arrangements. To make your request known, please call 406-628-7431, Ext. 2, or write to Bethany Langve, PO Box 10, Laurel, MT 59044, or present your request at City Hall, 115 West First Street, Laurel, Montana. JUNE 5, 2018 A regular meeting of the City Council of the City of Laurel, Montana, was held in the Council Chambers and called to order by Mayor Tom Nelson at 6:32 p.m. on June 5, 2018. COUNCIL MEMBERS PRESENT: COUNCIL MEMBERS ABSENT: OTHER STAFF PRESENT: Emelie Eaton Bruce McGee Richard Herr Scot Stokes Iry Wilke Richard Klose Bill Mountsier Heidi Sparks Kurt Markegard, Public Works Directo Tim Reiter, Utility Plant Superintender Forrest Sanderson, Interim Planner Mayor Nelson led the Pledge of Allegiance to the American flag. Mayor Nelson asked the council to observe a moment of silence. MINUTES: Motion by Council Member McGee to approve the minutes of the regular meeting of May 15, 2018, as presented, seconded by Council Member Eaton. There was no public comment or council discussion. A vote was taken on the motion. All seven council members present voted aye. Motion carried 7-0. CORRESPONDENCE: • Executive Order No. E0-01-18 • CHS Letter — June 19t1 and 2011 Road Closure ----0 Governor Bullock & Attorney General Fox in Billings for Yellowstone River Recreation Project Priority Plan COUNCIL DISCLOSURE OF EX PARTE COMMUNICATIONS: None PUBLIC BEARING: • Intent to adopt an official Schedule of Fees and Charges (Resolution No. R18-19 approved on May 15, 2018) Mayor Nelson stated this is the time and place set for the public hearing on the City of Laurel's Intent to adopt an official Schedule of Fees and Charges (Resolution No. R18-19 approved on May 15, 2018). Mayor Nelson opened the public hearing and asked Staff to present the item prior to hearing the public comments. Kurt Markegard, Public Works Director, present the Schedule of Fees and Charges He explained what the Schedule of Fees and Charges is and how it is used. Some examples he gave were for water repairs, fire suppression, ambulance fees, and charges, etc. These are fees the public would need to pay. He spoke to the various changes made to the document. There were changes to the cemetery charges for Saturdays. The Ambulance Department updated a significant portion of their fees. Mayor Nelson opened the floor for public comment and stated that copies of the rules governing the public hearing were posted in the council chambers. Mayor Nelson asked three times if there were any proponents. There were none. Council Minutes of June 5, 2018 Mayor Nelson asked three times if there were any opponents. There were none. Mayor Nelson closed the public hearing. CONSENT ITEMS: • Claims for the month of May 2018 in the amount of $708,838.21. A complete Iisting of the claims and their amounts is on file in the Clerk/Treasurer's Office. • Approval of Payroll Register for PPE 5/20/2018 totaling $174,051.80. • Receiving the Committee/Board/Commission Reports into the Record. --Budget/Finance Committee minutes of May 15, 2018, were presented. --Council Workshop minutes of May 8, 2018, were presented. --Council Workshop minutes of May 29, 2018, were presented. --LURA minutes of April 16, 2018, were presented. --Tree Board minutes of May 10, 2018, were presented. --Laurel Airport Authority minutes of April 24, 2018, were presented. --Transit Authority Committee minutes of March 28, 2018, were presented. --Cemetery Commission minutes of May 22, 2018, were presented. The mayor asked if there was any separation of consent items. There was none. Motion by Council Member Eaton to approve the consent items as presented, seconded by Council Member McGee. There was no public comment or council discussion. A vote was taken on the motion. All seven council members present voted aye. Motion carried 7-0. CEREMONIAL CALENDAR: None. REPORTS OF BOARDS AND COMMISSIONS: None. AUDIENCE PARTICIPATION (THREE-MINUTE LIMIT): None. Karl Dan Koch, 320 Colorado Avenue, spoke regarding the handicap parking located at Thompson Park. He did note that the Public Works Director had placed a large sign, but that people were still parking in the designated area. He requested that this issue be resolved. SCHEDULED MATTERS: • Confirmation of Appointments. o Re -appointment of Wallace Hall to Cemetery Commission for a two-year term ending June 30, 2020. Motion by Council Member Herr to approve the re -appointment of Wallace Hall to Cemetery Commission for a two-year term ending June 30, 2020, seconded by Council Member Eaton. There was no public comment or council discussion. A vote was taken on the motion. All seven council members present voted aye. Motion carried 7-0. • Resolution No. R18-22: A resolution to adopt an official Schedule of Fees and Charges for the City of Laurel, repealing all previous resolutions that set fees or charges that conflict with the schedule attached hereto upon its effective date. Motion by Council Member Stokes to approve Resolution No. R18-22, seconded by Council Member McGee. There was no public comment or council discussion. A vote was taken on the motion. All seven council members present voted aye. Motion carried 7-0. Council Minutes of June 5, 2018 • Resolution No. R18-23: A resolution approving an agreement between the City of Laurel and Yellowstone Boys and Girls Ranch, relating to fire protection. (Fiscal Year 2018-2019) Motion by Council Member Wilke to approve Resolution No. R18-23, seconded by Council Member Mountsier. There was no public comment or council discussion. A vote was taken on the motion. All seven council members present voted aye. Motion carried 7-0. • Resolution No. R18-24: A resolution approving an agreement between the City of Laurel and Fire District No. 8, relating to fire protection. (Fiscal Years 2018-2019; 2019-2020;2020-2021) Motion by Council Member Klose to approve Resolution No. R18-24, seconded by Council j Member Mountsier. There was no public comment or council discussion. A vote was taken on the !— motion. All seven council members present voted aye. Motion carried 7-0. • Resolution No. R18-25: A resolution accepting the Bid from COP Construction, LLC and authorizing the Mayor to sign all related contract documents for the project know as Phase 3 WTP SED Basin Removal and Replacement Project. Motion by Council Member Mountsier to approve Resolution No. R18-25, seconded by Council Member Klose. There was no public comment or council discussion. A vote was taken on the motion. All seven council members present voted aye. Motion carried 7-0. • Resolution No. R18-26: A resolution of the City Council amending the Purchase and Procurement Policy for the City of Laurel Motion by Council Member Eaton to approve Resolution No. R18-26, seconded by Council Member McGee. There was no public comment. The Mayor was thanked for expediting updating this policy. It was requested that discussion continue to clearly define Budget/Finance Committee's roles and responsibilities. A vote was taken on the motion. All seven council members present voted aye. Motion carried 7-0. i • Resolution No. R18-27: A resolution authorizing and approving additional services by KLJ under the task order for planning services approved via Resolution No. R18-12 constituting the preparation of and assistance with the adoption of new floodplain regulations for the City of Laurel, Montana. Mayor Nelson reminded Council that this item was discussed at the previous Council Workshop. It was discussed that the City was in the rears on this policy and with the record flows in the river Council's desire to move expeditiously was made known to the Mayor and placed on this week's Council agenda. Forrest Sanderson, the Interim Planner, recapped the discussion from the previous Council Workshop. The City of Laurel had received a letter from DNRC dated May of 2016. There were identified deficiencies; the most notable is the floodplain regulations. The City of Laurel's floodplain regulations did not meet the minimum requirements imposed by the State of Montana and required by FEMA for the City to participate in the National FIoodplain Insurance Program. The City had been given six months to become compliant with the floodplain regulations. At Workshop, it was stated the benefits of participating in this program, including allowing its residents to be able to purchase flood insurance that is not part of their homeowner's insurance. This insurance is available regardless of the resident's risk zone and is the only insurance that will protect their investment in the event of a flood. He had stated that KLJ could complete all work required to bring the City current for approximately $5,000. This would include the preparation of compliant regulations, navigate the _ adoption process, and submit them to the State and FEMA for final approval. If Council approves this resolution, this item will be scheduled for a public hearing at the City/County Planning Board on July 19, 2018. City/County Planning Board will them give a recommendation to City Council for a public hearing and adoption according to the standard City ordinance adoption procedure. It was questioned what timeline the City is looking at to be able to fully adopt this ordinance and be compliant. Council Minutes of June 5, 2018 It was responded that the City Council could see a recommendation the end of July or beginning of August. The Interim Planner did contact DNRC and informed them that the City is taking corrective action in this matter as quickly as the City is able. At this time the citizens NFIP coverage is not in jeopardy as the City is working towards compliance and is a protected status. Motion by Council Member McGee to approve Resolution No. R18-27, seconded by Council Member Eaton. There was no public comment or council discussion. A vote was taken on the motion. All seven council members present voted aye. Motion carried 7-0. ITEMS REMOVED FROM THE CONSENT AGENDA: None. COMMUNITY ANNOUNCEMENTS (ONE -MINUTE LIMIT): None. COUNCIL DISCUSSION: Council Member Mountsier and Wilke offered to discuss the handicap parking issue with Mr. Koch after tonight's meeting to see what needs to be done to resolve this issue. Cemetery Commission will not be meeting in the month of June. Their next meeting will be held July 10, 2018. Park Board will meet June 7, 2018, at 5:30 p.m. in Council Chambers. It was requested for discussion on Budget/Fiances roles and responsibilities. This item will be placed on the June 26, 2018, Council Workshop Agenda. It was clarified that when Council voted to approve the SED Basin Project that Council approved the base bid and all additive alternative. It was requested that Council receive an update on where in the process the City is on improving West Railroad. City/County Planning Board has been canceled for the month of June as there is no new business. MAYOR UPDATES: (_ The state of emergency declared in May is still in effect. The Mayor is grateful the City did not receive the predicted flooding. The wall donated by CHS will be built during the SED Basin construction. UNSCHEDULED MATTERS: None. ADJOURNMENT: Motion by Council Member Herr to adjourn the council meeting, seconded by Council Member Eaton. There was no public comment or council discussion. A vote was taken on the motion. All seven council members present voted aye. Motion carried 7-0. There being no further business to come before the council at this time, the meeting was adjourned at 7:06 p.m. Brtttneyoo an, Administrative Assistant Approved by the Mayor and passed by the City Council of the City of Laurel, Montana,this 19`h day of June 2018. Thomas C. Nelson, Mayor Attest: Bethany Langve, Clerk/Treasurer Board Meeting Minutes The Meeting was held on May 10, 2018 at Fowl Play. In attendance were: Executive Board Members: Vice President- Chase Anderson, Treasurer- Sandy Reese and executive secretary- Marcia Hafner and Chamber Assistant Camilla Nelson. Directors: Beth Hohener,Patsy Woody,Renee Sbudiner,Bruce Larson, Brent Renier, Katie VVhitrnOyerand 8i||i8 Lehman Members: Ken Gomer, Amanda Powell, and Evan Bruce. Chase called the meeting toorder. The minutes were approved: Katie, Renee 2nd The treasurer's report was accepted. No out of budget bills were presented. w July 4th- Met with community committee yesterday May 9th. Volunteer sheet passed around for members tosign up to help o Food vendors are full o Craft vendors 1Oregistered eofar o Run 4runners signed up. Shirt sponsors are coming into uS o Parade 2 signed up, talked about not throwing/handing out candy this year o Grand Marshall Richard Klouse was nominated and voted to be the Grand Marshal. Billie Renee 2nd- approved = Budget Committee- Done ° By -Laws Committee- Changes were passed around to review. Changes were voted to be approved. Sandy, Beth 2nd New BUSINESS ° Job page/Organization-Job Fair- We have started a]ob Listings page on the website and need help notifying us when you have JD opening and when it is filled. Also we want to Start a ]Ob/Organization fair. It was discussed maybe doing it in Sept and May. Talked about doing it with the schools orthe senior center. ° Truck to move Xmas d6cor` Beth said she will bring a truck and some help from the crossings on Friday Ribbon cuttings � ° Coffee with ����- Evan that �� Eaton will be May 21st 530-6:30pm at Harmony. o @Nay-MaurerChiropnacUc o June- Harmony o July- Kona-IceandtheCrossings o August-Thornae Agenda Laurel = ofCommerce June 14th, 2018 at Sid's Moment of M"11110=17,' Yellowstone Checking - $ 74,555.67 Altana CD $ 8,235.96 Altana Saving $ 748.31 Christmas Repair Fund $ 655.96 TOTAL $ 54,195.90 Bills to be presented for oament: - done to date OLD BUSINESS ® July 4"'- Finalize volunteers. We are still accepting crafter registrations. Run signups are a little low this year. ® Sy -lacers — Did everyone get their copy that was emailed? NEW USINESS — ® . Ribbon Cuttings Culligan — Has not set a date yet. OPEN FORUM Business After Hours — If you would like to host an event, please contact the Chamber. o June- Harmony 0 July - Kona -Ice and the Crossings o August- Thomae Next Meeting Chamber ! y Cabin MINUTES BUDGET/FINANCE COMMITTEE JUNE 05, 2018 5:30 P.M. CONFERENCE ROOM MEMBERS PRESENT: Emelie Eaton Richard Klose Scot Stokes Bruce McGee OTHERS PRESENT: Tom Nelson Bethany Langve Chairwoman Emelie Eaton called the meeting of the Budget/Finance Committee to order at 5:30 p.m. The next regular Budget/Finance meeting will be on Tuesday June 19, 2018 at 5:30 p.m. The minutes of the May 15, 2018 meeting were reviewed. Richard made a motion to approve the minutes, Bruce seconded the motion, all in favor, motion passed. Claims entered through 06/01/2018 which totaled $708,838.21 were presented to the committee. Richard reviewed both the Claims Detail Register and the Check Register to ensure accuracy. Bethany explained the electronic payment to WEX Bank for fuel charges. Richard made a motion to approve the claims, Emelie seconded the motion, all in favor, motion passed. No purchase requisitions were presented. The Comp/OT report for PPE 05/20/2018 was reviewed by the Committee. The Committee questioned why spraying the parks was overtime. Bethany stated she would ask and bring the answer to the next meeting. The Payroll Registers for PPE 05/20/2018 totaling $174,051.80 was reviewed by the Committee. Bruce made a motion to recommend Council approval of the payroll register, seconded by Richard, all in favor, motion passed. Clerk/Treasurer Comments: Bethany stated that she has had no comments. A brief discussion regarding the SED Basin finances did occur. Bethany explained the loan and reserves. Mayor's Comments: The Mayor stated that new tablets for the Council had been purchased and one of them was presented. The Mayor stated that information regarding the MLCT annual conference would be distributed to Council for review. The Mayor stated that the CAO top candidate, Matthew Lurker, would be signing a contract with the City tomorrow and he would be presented to Council at the next workshop. There was a brief discussion regarding CAO pay scale and benefits. The Committee asked if the past CAO received any stipends. Bethany stated that she didn't believe so but would check and get back to the Committee at the next meeting. The Mayor stated that he was trying to gather the numbers associated with Clean-up Day and present them at the next Budget and Finance meeting. Other: Bethany presented the hauling fee numbers as these were requested at the last meeting. The Committee asked what the monthly revenue was required to see a ROI. Bethany said she would get those numbers for the next meeting. For next agenda: o Clean-up Day numbers • Dumping Station figures a Spraying OT • Stipends The meeting adjourned at 6:26 p.m. R spect lly submitted, Beth y Lan , ve, Cle Treasurer P.O. Box 242 Laurel, MT 59044-0242 Laurel Airport Rd. May 22, 2018 Meeting called to order a@ 19:00 hours by Chairman John Smith. Members present John Smith, Shane Linse, Randy Hand Guests present: Nathan Schrott and Craig Canfield of KLJ. Mark Smith (John's son) Minutes approved of last meeting. (4-24-2018) Claims approved: Normal and recurring for utilities, and fuel. Snow removal of $428.50 to Jason Lindell, and $24,533.37 to KLJ as part of the Runway project. Reports: Craig of KLJ 1. Notice to proceed on June 4, 2018 has been issued. 2. Earthwork will commence as soon as weather window allows, anticipate mid-June at this time. 3. With delay in start project should be done in late August or early September, assuming normal weather patterns. 4. Change order #3, approved, with relocation of bldg. #4 and #6 included. Old Business: 1. Web Page ...... in progress for revisions 2. Date for FAA funding discussion ...... pending 3. Will need updated signature card for check register, Randy has contacted bank. Cards are now available at branches.... Pending 4. Prior to next snow season we will need to re -visit snow removal policies to co-ordinate with Northern Skies. New Business: 1. Decided to go with existing building relocation, not new building to stay closer to budgets 2. We will need to locate a new board member, Doug Meyers has relocated to ND for a couple of years. 3. Motion made by Shane to re -use existing building, passed by voice vote. (part of change order) 4. Second letter needed, along with check for buyout of lease to owners effected by RPZ re -location. 5. Motion made by Shane to reach out to city/county for help with Fox road repairs after heavy equipment finished at airport. Meeting adjourned, 20:50 hrs. Randy Hand Secretary City of Laurel Park Board Minutes Thursday, Jade 7, 2018 In attendance were Park Board Members: Scot Stokes, Amy Pollock, Iry Wilke, Richard Herr, Ken Gomer, Phyllis Bromgard; Kurt Markegard, Public Works Director; and Citizens, Curt Lord and Rick Bailey, Laurel Rod & Gun Club; Jamie Krug, 4-H Shooting Program; Jason O'Rear, Laurel Shooting Education 1. Public Comment: Curt Lord expressed frustration that the Mayor and Sam Painter weren't in attendance. Feels like everything has been pushed off for years with nothing getting resolved. Others agreed that the question of the lease and shooting in the park has been going on for far too long and a decision needs to be made. Emails were collected from those in attendance and interested to know if the Mayor and Sam will NOT be attending next month as mentioned. 2. Minutes: Reviewed and approved minutes from May meeting. Iry moved to accept, Phyllis seconded, and they were unanimously approved. 3. Lease Negotiations: Horseshoe Club: Scot has been unable to contact Nick Kisch concerning the need for insurance for the Horseshoe Club. He left a message on the only phone number we have for Mr. Kisch but has not received a return call. He will keep trying. **UPDATE: Scot received a return call from Mr. Kisch on June 8, 2018. He told Mr. Kisch he would need to have insurance by the July Park Board Meeting. Mr. Kisch said he would look for cheaper insurance and let us know. Laurel Rod & Gun Club: Again, frustration was expressed that the lease and shooting has not been addressed/remains unresolved. Mayor Nelson told Scot he and Sam would be at the July 5th Park Board Meeting to address the lease and shooting in the park. 5. Swimming Pool: The Mayor has given the go ahead to purchase the awning/shade for the pool using the INTEREST from the Billie Riddle funds. Kurt asked a contractor to give a bid on installing the awning. The City does not have the necessary equipment or staff to have it installed at this time. We are also looking at purchasing benches @ $30o each from the sign company that has benches around town. We need to see how much the total cost for the shade will be and then we will look at the benches. Kurt said we have already sold four swim passes and the numbers at the pool are up every day. In order to get it ready he had to have a toilet fixed, but all seems to be going well. We are not leaking water like we once did which helps keep the temperature up on the water in the pool and saves money on water. 6. Update on Funds from Dept. of Justices Alicia has contacted Kurt and would like to move forward right away with the vault toilet by the boat access ramp we are coordinating with the FWP on. There was a question as to whether we wanted a single or double vault toilet there. The single vault would be half the price and the Park Board agreed that would be OK believing the saved funds would then be given to other projects in Riverside Park as agreed in the plan. ($50,000 was allocated to Riverside Park if other projects fell through or were cheaper than originally estimated.) Iry motioned we recommend moving forward with a dual gender single vault toilet for the boat access ramp. Amy seconded the motion and it passed unanimously. Kurt expressed the only concern was that the City has no way to take care of the waste with the single vault toilets but DOES have a way to take care of it in the double vaults. Kurt will contact the FWP and find out how/who they use because they have those types of vault toilets around the State. Other: Riverside Park has been closed due to the possibility of ground water going through the septic/drainfield. Kurt says he hopes to have it opened again this weekend. Kurt also looked into the sign at Riverside Park and said it needs to be redone. He felt like it would be a great Eagle Scout Project, suggesting the City could maybe provide the paint. Phyllis provided photos of Arbor Day that was held in May. Looked like a very successful day. She also mentioned Lions has received over $3000 in donations toward the path around the park. They are looking at getting an estimate. Kurt said Matt might know who to contact to get the estimate. Kurt also commended the Tri -County Sports Group for a "job well-done" on their annual banquet. He said the food was great and for him, it brought three generations together. Meeting was adjourned at 6:30 pm. Respectfully submitted by Amy Pollock, Park Board Member Minutes Laurel Urban Renewal Agency (LURA) May 21St, 2018 City Hall Conference Chambers The meeting was called to order by Judy Goldsby. Roll Call/ Attendance: Quorum of voting members present: Judy Goldsby, Don Smarsh, Dean Rankin. Non-voting members: Steve Solberg. City Staff: Kurt Markegard. Big Sky EDA: Dianne Lehm. Laurel Chamber of Commerce: Marcia Hafner. Introductions: None Approval of the minutes from the previous meeting: Dean made the motion to accept the minutes and Don seconded the motion. All were in favor. Old Business: a. Large Grant Application F18 Update- Kurt informed the committee about the grant review process and how the Mayor has asked the City Attorney to review the grants to see if they meet the criteria allowed in State Statute. Don talked about project criteria in order to award grant funds from the submitted applications. Dean also expressed that determining what projects meet the criteria is getting complicated. Dean stated that the projects in the large grant requests are great projects and due to the success of getting the word out there are more applications being submitted. Judy said it would be great to keep giving out the funds for projects that have been submitted. Don stated that many of the projects in the submitted applications are already completed or have started. Don asked about the timeline for finding out about the large grants and Judy stated legal has it and we will not know how long that will take. b. Grants Pending- Steve asked whatever happens to the Technical Assistance Grants funds that have been given out. Don stated that some of the projects will never happen because what is identified in the technical assistance reports that they have funded end up costing too much to complete the proposed projects. Marcia asked about having the applicants present a report about their project once completed. Judy stated that this was added to the grants this year and we should have the project sponsors report back to this committee. Kurt stated that the technical assistance grant for the King Koin Laundry was being used and the new owner of the building has received a building permit to renovate the structure to reopen the laundry business. c. Planner Vacancy Update- Kurt stated that the Mayor will be posting for a department head type position for the Planning Department to garner more interest in the position. The posting for the Planning positon should be out in the next month or so. Discussion that is old business but was not on agenda- Dean asked about the bondable project for Railroad streets. Judy stated that the grain elevators need to be taken down to make the intersection better. Kurt informed the committee that he has been asked to look at the downtown streets for a bondable project. Many of the downtown street need to have major repairs. Den asked what the next process was and Judy said that the Mayor needs to give some direction on what projects he would like to see completed. Dean said a list should be made of what projects need to be done and they make a priority list. The committee discussed a list should be completed so everyone knows what the projects are and what needs to be fixed. New Business: None Reports: a. City Administration: None b. City Planner: None c. City Treasure: Discussion took place about monthly reports not being submitted to the Committee d. Big Sky EDA: Dianne told the committee about the High Plains Business Alliance meeting. They had 60 attendees. Public Comment on Non Agenda Topics: None Next Meeting: June 18th in the City Hall Conference Chambers Adjournment: Don motioned for adjournment and Dean seconded it. All were in favor and the meeting adjourned at 12:00pm. Respectfully submitted Kurt Markegard, Public Works Director MINUTES INSURANCE COMMITTEE JUNE 7, 2018 9:00 A.M. COUNCIL CHAMBERS CONFERENCE ROOM MEMBERS PRESENT: OTHERS PRESENT: Kelly Strecker, Clerk's Office Stan Langve, Union 303 Monica Salo, Union 316 Sheri Phillips, Union 316 Roy Voss, Union 316 Dave Allen, Allen and Associates Eric Allen, Allen and Associates Amanda Burkhart, MMIA Dave Allen introduced himself to the group. The Insurance Committee was presented each of the options to consider for their recommendation. The presentations started with Blue Cross Blue Shield of Montana since they are the current insurance provider. Allen and Associates handed out a spreadsheet to quickly compare each of the policies, see attached. Blue Cross Blue Shield of Montana Renewal Blue Cross Blue Shield of Montana (BCBS) looked at the City's last 18 to 24 months of claims. They used this data to determine if the City would see a rate change. There would be no increase for the Fiscal Year of 2018/2019 insurance premiums. BCBS did provide a claims report that was used to obtain the other bids presented to the Committee. There is a wellness credit of $10,000 fust month's premium credit. While the City would not pay this amount to BCBS, they would need to use these funds to promote wellness. Employees would receive their cards within a month of renewal. MMIA Amanda Burkhart, MMIA, presented what MMIA can offer the City. MMIA is a co-op of cities and towns. Most small cities and towns are lumped into the same pool to share the costs; some are self- funded. MMIA does not process any claims; they manage the reserve the claims are paid from. They contract with third -party companies to administer that process. MMIA requires a five-year commitment from the City; this helps ensure stability across the pool. The City of Laurel's rate was fifteen percent higher than the standard rate. After five years the City of Laurel could drop to the standard rate. If a city or town chooses to leave MMIA, they are required to wait three years before they are able to return. Every hospital in the State of Montana has signed on to accept MMIA coverage. Hospitals have the ability to set their costs for services given. MMIA found that different hospitals charged a wide range for the same procedure. To help reduce the cost they used the Medicare rate plus a percentage as the allowable billable cost, this has helped reduce costs. MMIA only offers four plans. Many Cities have set the rate they are willing to pay and allow the employee to choose the plan that will suit them best. MMIA uses Allegiance to process medical claims in the state. Out of State would be the Cigna network. The State of Montana has worked to offer Montana Health Centers, those on the MMIA plan would be able to receive care at no cost. These centers offer primary care providers, do lab work, CT, and MRI's at no cost to the employee. Council Workshop Minutes of June 7, 2018 The City would have two options for pharmacy. There is a percentage option and a copay option. The percentage option is of less cost to the City, however, may not be well liked by the employee. The copay option, through our current provider, is what the City currently uses for its pharmacy coverage. MMIA does not have pharmacy's that are not covered by their prescription plan. MMIA does participate in a program for mail -in pharmacy. This program is international, there is no copay and may be at no cost to the employee. The medications come from other tier one countries and can save the pool 60-70% on the cost of the medication. MMIA focuses on wellness and risk management. Instead of offering a premium credit like BCBS did they offer $250 to the employee if they meet certain criteria. If the City had 80% or greater participation in the wellness program, all employees would receive an additional $50.00. MMIA focuses heavily on disease and case management. As an example, the most expensive claim is for a premie baby. By having a case manager check in with an expectant mother the insurance company can ensure all possibilities to reduce the possibility of a premie baby have been taken. MMI also offers employee assistance. The offer six visits/per household member/per issue to a mental health provider or counselor for no cost. MMIA uses Delta Dental and VSP to manage their dental and vision benefits. This does require 80% participation for a City in order to participate in the dental benefit. The City would have the option to add an additional orthodontic benefit. For their vision benefits, they offer the 12/12/12 plan. This is one visit to the eye doctor every 12 months, with new glasses or contracts every 12 months. MMIA offers basic life insurance as well. MMIA employees do use the health insurance offered by MMIA. However, the MMIA plans do not directly mirror the current BCBS policy. Pacific Source Initially offered a five percent discount as compared to BCBS. Once the new claims statement came in Pacific Source refigured their quote and reduced their quote to seven percent. The Pacific Source plan mirrors the current BCBS policy. Pacific Source is based out of Oregon and has focused on the Pacific Northwest. They are currently in the process of building a storefront in Billings. They pride themselves on providing excellent customer service. Their goal is to be able to answer a customer's questions within one phone call. There are four plans to choose from including a $500 deductible and $2,500 out of pocket max. All hospitals in the state are in -network, and approximately 89%-90% of all doctors are in -network. BCBS has approximately 94% to 95% of all doctors in their network. These plans do have a $25 copay as opposed to the MMIA that does not use copays. They use tiers for their pharmacy benefits, similar to what BCBS uses. Employees can use CVS Pharmacy for their pharmacy needs. Pacific Source does offer gym memberships for $25.00 per month, however, unlike BCBS employees must choose one gym to use their benefit at. They also have an extensive preventative drug list. Drugs listed on this list are at no cost to the employee. Pacific Source moved into the Montana market approximately 10 years ago, but have been around for many years. 2 Council Workshop Minutes of June 7, 2018 Health Co -Op Like Pacific Source the Health Co -Op did come in at five percent under the BCBS quote. However, Dave Allen cautioned the Committee that while the rate quote was attractive, the plans were not identical to the City's current BCBS plan. They would need to review what was included carefully. Allen and Associates' recommendation is Pacific Source. They offer year to year plans, the City would not be locked into a five-year contract, their rates came in under the current rates for BCBS, and their plans are most similar to what the City currently has. Amanda Burkhart clarified why MMIA requested health questionnaires from all employees. MMIA works on money in money out system. For this reason, they needed an accurate overview of the rate utilization. Dave Allen clarified the City could look into extending their contract with BCBS for one month and pushing the start date with another insurance company to August Is'. Dave clarified that he does work on commission if the City chooses to go with MMIA the City could still retain his services. The Insurance Committee adjourned at 10:33 a.m. Respectfully submitted, JKN_,_� Brittn oo an Administrative Assistant 3 Q N H- (m N cn S0 O E m -0 z O ct 0 f7 V C'f (D 1D fD t N 00 N n . 3 Q rr Vf N NCL z Q a o 4 m 0 3 3 D c o a m o m o c n of it m O - d d ?: `� o v,. -, o ti; u, m o �, d a -+, ,ny, a 00 °.'� m °' 3 p ° "", m a' o p a m z nr, ti `" m rD ro o m O a o m m° m * n m ; � c CD 3 O n '-* n y is m m m O tD rt O m O O' m mm o -+ <? o (D m rt 'd 0) n O (D m Ln A W N H C O ENO 0 n n H o o n CO O N N H p fD o N A \ W O- to Crm LD W A V V O 0 M'�D 11 cOi� O m gyp„ N N -,S n OO O 00 Da N W ,n N to to 'tn � (D m 'v < O O H V7 O e V l71 00 N Ol N Ort -n -h m m (-iU y u J'jV1 0 0 0 mO CL Q. 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H m0 .on-1r N OOInA -- (OH�D O m a;m VN VtA 0WA ^0 d-� G w(DO O 6A1 VV AVl NH nN • H aOm e H Ut O OHl71 ��* z OON<Q O n = ED '•" HO W O Z 'S 'S m m O ON W w�H O l0 mN 000 N0 H � w ry wW H VWp V to UO CO 0 � 0 0 0 K n H O z w w w 0 = 7 Lnw Ul LD S 0Oq O O W 5n O N N N H O w O A Gt H lAn to (Wn 0 PO Box 80826 Billings, Montana 59108 Customer Information Line: 800.447.7828 r www.bcbsmt.com April 26, 2018 Kelly Strecker City of Laurel P.O. Box 10 Laurel, MT 59044-0010 Dear Kelly: Blue Cross and Blue Shield of Montana (BCBSMT) is proud to present a fully insured renewal that underscores the value of our health plans. We appreciate the opportunity to continue serving you, your employees and their families. At BCBSMT, our goal is to build a stronger health care system for tomorrow while giving employers immediate solutions to the issues they are facing today — like rising health care costs and the need to engage employees in making smart decisions about their health. To drive long-term change, BCBSMT launched the most robust Value -Based Care initiatives in Montana. These programs are transforming our health care system — shifting the emphasis of health care from volume to quality, transparency and accountability — while reducing costs. BCBSMT launched the most robust transparent pricing initiative in Montana, giving City of Laurel employees the power to easily shop for health care based on quality and cost. The Cost Estimator is powered by BCBS Axis D, the largest database of health care quality and cost information in the health care industry — and the only data resource that includes health care information from every ZIP code in the United States. We also continue to provide the greatest savings on medical care in the industry. A January 2016 Milliman National Benchmark Comparison found that health care providers offer Blue Cross and Blue Shield (Blue) plan members almost 14 percent better savings than our competitors. In addition, it found that in -network utilization was approximately six percent higher for Blue plan members than for our competitors. As the industry leader and your health benefits partner for the past year, BCBSMT is well equipped to support your goals and objectives with cost-effective programs, exceptional account management, and new tools and resources to improve the quality and reduce the cost of your employees' health care. Your Agent, Dave Allen will contact you soon to set up a personal visit to discuss your renewal and available options. Our goal is to ensure that your annual plan renewal is understandable, that desired benefit options are promptly delivered for your consideration, and that the required documentation to complete the renewal is processed efficiently. We appreciate the continued opportunity to serve you, your employees, and their dependents. If you have questions about your renewal or if I can help in anyway, please contact me at (406) 437-6363. Sincerely, Shellie WherIey Account Executive Enclosures/cc: Dave Allen A DIVISIOta OF HEALM CARE SERVICE CORPORATION. A MUTUAt LEGAL RESERVE COMPANY. AN INDEPENDENr LICENSEE OF THE BLUE CROSS AND BLUE SHIELD ASSOCIAHOH Kelly Strecker City of Laurel Page 2 7fi1R Renewnl Tnfnrmntinm F,ffeetive 7/1/2018 Trinle Option: BIue Dimensions 80/20 PPO Plan Type Blue Dimensions PPO: 80/20 co -ins In -network; - 65/35 Co -Ins Out -of -Network Office Visit Co a . $25 Par Professional Provider services done in office setting. Deductible $1,000 IndividuaU$2,000 Family Out -of -Pocket Maximum $2,500 Individual/$5,000 Family Efficient RX $100 Deductible — waived on Generics Performance Formulary Retail/Value Pharmacy: $10/$40/60% up to max $200 per fill; 90 -day supply at Value Pharmacy Retail only at 3 Copays. Retail/Prime Network: $15/$50/60% up to max of $250 per fill; Mail Order: $20/$80/60% up to max of $400 per fill 90 -day supply Specialty RX: $100/$200 copays after deductible. OON Specialty: 50% co-insurance; *Performance Formulary applies at renewal Accident Process off Standard Medical Benefits Preventive Benefit In -Network: 100% coverage up to allowable fee for routine/preventive services including Well Child and routine Mammograms. Out -of -Network: Ages 19+ - Deductible applies; Well Child under 19 — deductible waived; Routine Mammo ams — first $70 is aid; deductible applies X If group wishes to purchase EAP services — we can provide pricing .EAP thru Magellan Behavioral Health. COBRA HCSC Renewal Rates below do not include the $75 COBRA administered Administration Fee and Activity Fees. Blue` Dimensi€:ns 80/20 PPO Renewal Single $803.52 Two Party $1,782.60 Employee/Child/Children $1,278.42 Family $2,048.18 Single Medicare $450.15 2P/1\4ed $899.17 Kelly Strecker City of Laurel Page 3 2f11R Renewal Tnfnrmatinn: Effective 7/1/2018 Triple Option: Blue Dimensions 70/30 PPO Plan Type Blue Dimensions PPO: 70/30 co -ins In -network; Single 55/45 Co -Ins Out -of -Network Office Visit Cbpay $35 Par Professional Provider services done in office setting. Deductible $1,500 Individual/$3,000 Family Out -of -Pocket Maximum $3,500 Individual/$7,000 Family Efficient RX $100 Deductible — waived on Generics Performance Formulary Retail/Value Pharmacy: $10/$40/60% up to max $200 per fill; 90 -day supply at Value Pharmacy Retail only at 3 Copays. Retail/Prime Network: $15/$50/60% up to max of $250 per fill; Mail Order: $20/$80/60% up to max of $400 per ft1190-day supply Specialty RX: $100/$200 copays after deductible. OON Specialty: 50% co-insurance; *Performance Formulary applies at renewal Accident Process off Standard Medical Benefits Preventive Benef t In -Network: 100% coverage up to allowable fee for routine/preventive services including Well Child and routine Mammograms. Out -of -Network: Ages 19+ - Deductible applies; Well Child under 19 — deductible waived; Routine Mammograms — first $70 is aid; deductible applies EAP*' If group wishes to purchase EAP services — we can provide pricing thru Ma ellan Behavioral Health. COBRA HCSC Renewal Rates below do not include the $75 COBRA administered Administration Fee and Activity Fees. Biue Dimensions 70/30 PPO Reneiyal Single $755.13 Two P $1,675.68 Employee/Child/Children $1,199.65 Family $1,924.39 Single Medicare $423.14 2P/Med $846.28 Kelly Strecker City of Laurel Page 4 Blue Choice HSA PPO 53.500 Deductible Plan— effective 7/1/18 Plan Type Blue Choice PPO/HSA Compatible Plan $627.84 100/0 co-insurance feature after deductible is met Deductible $3,500 Individual/$7,000 Family In -network $998.26 $7,000 Individual/$14,000 Family Out -of -network Out -of -Pocket Maximum $3,500 Individual/$7,000 Family In -network $7,000 Individual/$14,000 Family Out -of -network Performance. Formulary ; Non -Preventive Covered Brand/Generic Drugs apply to Medical Deductible/OOP Out -of -Network Specialty Drugs: 50% co-insurance after deductible. *Performance Formulary applies: Non -Covered drugs; Step Therapy, Prior Authorization and dispensing limits apply. 90 -Day at retail only available thru Extended Supply Value Preferred Pharmacies Accident Process off Standard Medical Benefits Preventive Benefit 100% coverage In -Network up to allowable fee for routine/preventive services including Well Child and Mammograms. Out -of -network routine/preventive Mammograms — First $70 paid; deductible and Co-insurance applies Out-of-Nehvork Routine/Preventive —19+ (Adult) — Deductible and co- insurance applies Out -of -Network Well Child Services — Under 19 — co-insurance a lies deductible waived COBRA — Vendor Our records indicate COBRA. is not administered thru Administered HCSCBCBSMT. Blue Choice HSA $3,500 Renewal Single $627.84 Two P $1,393.17 Em l/Child ren $998.26 Family $1,600.36 Kelly Strecker City of Laurel Page 5 Important Notices and Enclosures: ✓ Renewal Paperwork: I will forward the Merit Group Application once you finalize the review of the renewal and determine if you are electing to make any benefit modifications. ✓ Open Enrollment Notice: Please share a copy of the enclosed open enrollment notice with your employees. ✓ HIPAAJSpecial Enrollment Rights Notice: Please share a copy of the enclosed Special Enrollment notice with your employees. ✓ Summary of Benefits and Coverage (SBC): BCBSMT is required to provide a Summary of Benefits and Coverage (SBC) with your renewal packet. You, as the employer, must distribute a copy of the enclosed SBC to all individuals eligible for your group health insurance policy. The requirements and timelines are detailed in the enclosed attachment. 2018 SBCs for your Blue Dimensions PPO and Blue Edge Plus PPO plans offered at renewal are enclosed for your reference. ✓ 2018 Pharmacy Changes: 2018 Notice of Pharmacy changes is enclosed that highlights the changes incorporated to applicable BCBSMT group plans effective 1/1/18 or at renewal. ✓ Participation Requirement Notice: Please review the requirement with your agent/consultant to ensure your group is meeting participation requirements. ✓ Value Added Services/Resources/Tools: The enclosed brochures provide you an overview of the additional services, resources and tools that are provided to your employees and their families. We encourage you to share this information with them. If you would like to order any of these materials, please contact me. Blue Cross and Blue Shield of Montana 2018 Fully Insured Business et,:..Pharmacy Changes BCBSMT has identified the following opportunities that will help manage costs while still offering our members a high quality and effective prescription drug program. The following is a summary of the changes for our customers. This is effective January 1, 2018 or upon a group's renewal unless specifically noted: ✓ Six -Tier Benefit Design: o Blue Choice/Blue Options - Standard Plans will move to a Six -Tier benefit design upon their 2018 renewal/effective date. Preferred and Non -Preferred Tiers for Generics, Brand Name Drugs and Specialty Drugs. Current Blue Choice/Blue Options Plan Designs will be discontinued and replaced with the following Plan Designs: o $0/$10/$50/$100/$150/$250 — at Value Preferred Pharmacies. Blue Choice Efficient RX and 5 Tier Drug Plan replaced by plan design above. Blue Options 4 Tier Drug Plan replaced by plan design above. Separate RX Out of Pocket on Blue Options Pians removed. o $0/$10/$35/$75/$150/$250 - at Value Preferred Pharmacies Blue Choice 4 Tier Drug Plan $8/$35/$75/$150 replaced by plan design above. o 10%/10%/20%/30%/40%/50% -at Value Preferred Pharmacies Blue Choice HSA Plans with co -ins after deductible replaced by plan design above. ✓ HDHP/HSA Eligible Plans - $0 Copay Preventive Drug List: o Revised Drug List effective 1/1/18 and upon renewal. ✓ Terminology Change: o Formulary & Non -Formulary Drug Changing to Preferred and Non -Preferred Drug. ✓ Drug List and Pharmacy Networks: o MT Standard Insured and Custom Insured Plans will remain on their Current 2017 Drug List and Pharmacy Network for 2018. Performance Drug List Value Network (Pharmacy Network) CVS/Target Pharmacies —Out -of -Network as of 1/1/17. ✓ Want more information? Find a Pharmacy or search the Performance drug list on www.mvprime.com. See www.bcbsmt.com for Drug List, Value Pharmacy and additional Pharmacy Resources. Please work with your Account Executive with any questions. Please note: This is a general overview of changes and not a guarantee of payment. Please reference the specific benefit materials and information on your plan. Account Name CITY OF LAUREL Account Number 138674 Rate Effective Date 07/01/2018 Experience Period: Incurred: 11/01/2015-10/31/2017 Active Contracts as of 02/28/2018 66 Projected Claims PCPM based on Experience with Pooling: $788.14 Credibility 64.59% Adjusted Manual Claims PCPM: $756.34 Credibility 35.41% Total Projected Claims PCPM: $776.88 Desired Loss Ratio* 81.79% Calculated Premium PCPM** $949.85 Premium at Current Rates PCPM $949.85 Calculated Premium Rate Action 0.0% Final Premium Rate Action 0.0% o Change in Demographics -0.2% o Annual Trend 7.5% *Includes provisions for Administrative Costs, State Taxes & Assessments, and Commissions **Reflects the effects of Health Insurer and Reinsurance Fees, plus any federal and state taxes applicable to these fees. A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association. 04105/2018 Registered Marks Blue Cross and Blue Shield Association 6 Preventive check-ups and screenings can help find illnesses and medical problems early and improve the health of you and everyone in your family. Your health plan covers screenings and services with no out-of-pocket costs like copays or coinsurance as long as you visit a doctor in your plan's provider network. This is true even if.you haven't met your deductible. Some examples of preventive care services covered by your plan include general wellness exams each year, recommended vaccines, and screenings for things like diabetes, cancer or depression. Preventive services are provided for women, men and children of all ages. For more details on what preventive services are covered at no cost to you, refer to the back of this flier for a listing of services, or see your benefits materials. Learn more on immunization recommendations and schedules by visiting the Centers for Disease Control and Prevention website at www.cdc.gov/vaccines. These preventive services are covered by your plan at no cost to you' f ] SCREENINGS FOR ❑ Abdominal aortic aneurysm ❑ Alcohol abuse and tobacco use f❑ Cardiovascular disease (CVD) including cholesterol screening and statin use for the prevention of CVD ❑ Colorectal and lung cancer ❑ Depression ❑ Falls prevention and vitamin D use for stronger bones ❑ High blood pressure, obesity, diabetes and depression ❑ Sexually transmitted infections, HN, HPV and hepatitis ❑ Tuberculosis COUNSELING FOR ❑ Alcohol misuse ❑ Domestic violence ❑ Healthy diet and physical activity counseling for adults who are overweight or obese and have additional cardiovascular disease risk factors ❑ Obesity ❑ Sexually transmitted infections ❑ Skin cancer prevention ❑ Tobacco use, including certain medicine to stop ❑ Use of aspirin to prevent heart attacks 50 EwL �A ❑ Aspirin for preeclampsia prevention ❑ Breast cancer screening, genetic testing and counseling ❑ Breastfeeding support, supplies and counseling ❑ Certain contraceptives and medical devices, morning after pill, and sterilization to prevent pregnancy ❑ Cervical cancer screening ❑ Chlamydia, gonorrhea, syphilis, HIV and hepatitis B screenings ❑ Counseling for alcohol and tobacco use during pregnancy ❑ Folic acid supplementation during pregnancy ❑ Human papillomavirus(HPV) DNA test ❑ Osteoporosis screening ❑ Screenings during pregnancy, including screenings for anemia, gestational diabetes, bacteriuria, Rh(D) compatibility, pre- eclampsia mcm. W1., SCREENINGS FOR ❑ Autism ❑ Cervical dysplasia ❑ Critical congenital heart defect screening for newborns ❑ Depression ❑ Developmental delays ❑ Dyslipidemia (for children at higher risk) ❑ Hearing loss, hypothyroidism, sickle cell disease and phenylketonuria (PKU) in newborns ❑ Hematocrit or hemoglobin ❑ Lead poisoning ❑ Obesity ❑ Sexually transmitted infections and HIV ❑ Tuberculosis ❑ Vision screening ASSESSMENTS ANIS COUNSELING ❑ Alcohol and drug use assessment for adolescents ❑ Obesity counseling ❑ Oral health risk assessment, dental caries prevention fluoride varnish and oral fluoride supplements ❑ Skin cancer prevention counseling ❑ Diphtheria, Pertussis, Tetanus ❑ Haemophilus Influenzae Type B (Hib) ❑ Hepatitis A and B ❑ Human Papillomavirus (HPV) ❑ Inactivated Poliovirus (Polio) ❑ Influenza (Flu) ❑ Measles, Mumps, Rubella (MMR) ❑ Meningitis ❑ Pneumococcal ❑ Rotavirus ❑ Varicella (Chicken Pox) ❑ Zoster (Herpes, Shingles) B1ueCross BlueShield of Montana Well l rr c, Make YFitness Program Membership \/\/o r Tor You ! Fitness can be easy, Tun and affordable. Well onTarget makes it possible with the Fitness Program. Since you are a Blue Cross and Blue Shield of Montana member, the Fitness Program is available exclusively to you and your covered dependents (age 18 and older). The program gives you unlimited access to a nationwide network of more than 10,000 fitness locations. If you want, you can choose one gym close to home and one near work. You can visit gyms while you're on vacation or traveling for work. Other program perks include: No long-term contract: Membership is month to month. Monthly fees are $25 per month per member, with a one-time enrollment fee of $25 per member.' Complementary and Alternative Medicine (CAM) discounts: Save money through a nationwide network of 40,000 health and well-being providers, such as acupuncturists, massage therapists and personal trainers. o Blue Pointss'": Get 2,500 points for joining the Fitness Program. Earn additional points for weekly visits. You can redeem points for apparel, books, electronics, health and personal care items, music and sporting goods." a Web resources: You can go online to locate gyms and track your visits. Convenient payment: Monthly fees are paid via automatic credit card or bank account withdrawals. ARE YOU READY FOR FITNESS? It's easy to sign up: 1. Go to bcbsmt.com and log in to Blue Access for MemberssM 2. Under "Quick Links," choose "Fitness Program." On this page, you can enroll, search for nearby fitness locations and learn more about the program. 3.Click "Enroll Now." Then search and select the fitness location that is best for you. Remember, you can visit any participating fitness location after you sign up. 4.Verify your personal information and method of payment. Print or download your Fitness Program membership ID card. You may also request to receive the ID card in the mail. 5.Visit a fitness location today! Prefer to sign up by phone or have questions about the Fitness Program? Just call the toll-free number 888 -762 -BLUE (2583) Monday through Friday, between 7 a.m. and 7 p.m. CT (6 a.m. and 6 p.m. MT). The one-time enrollment fee and monthly membership fee for the Fitness Program are both subject to applicable taxes. Blue Points Program Rules are subject to change without prior notice. See the Program Rules on the Well onTarget Member Wellness Portal for more information. The Fitness Program is provided by Tivity Health", an independent contractor that administers the Prime Network of fitness locations. The Prime Network is made up of independently owned and operated fitness locations. Blue Cross and Blue Shield of Montana, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association 350150.0218 09 BlueCross B1ueS hield of Montana Well OnTargeto A New 'Alay to Experience Wellness Well onTarget offers personalized tools and resources to help you — no matter where you may be on the path to health and wellness. Well onTarget can give you the support you need to make healthy choices — while rewarding you for your hard work. MEMBER WELLNESS PORTAL The heart of Well onTarget is the member portal, available at wellontarget.com. It uses the latest technology to offer you an enhanced online experience. This engaging portal links you to a suite of innovative programs and tools. Self-directed courses: These courses let you work at your own pace to reach your health goals. Learn more about nutrition, fitness, losing weight, quitting smoking and managing stress. Track your progress and reach your milestones as you make your way through each lesson. Reach your milestones and earn Blue PointssM ' e Health and wellness content: The health library teaches and empowers through evidence -based, reader -friendly articles. e Tools and trackers: These resources can help keep you on course while making wellness fun. Use a food and exercise diary, symptom checker and health trackers. *Blue Points Program Rules are subject to change without prior notice. Seethe Program Rules on the Well onTarget Member Wellness Portal at wellontarget.com for further information. HEALTH ASSESSMENT (HA) The HA uses adaptable questions to learn more about you. After you take the HA, you will get a personal wellness report. This confidential report offers you tips for living your healthiest life. Your answers will help tailor the Well onTarget portal with the programs that may help you reach your goals. BLUE POINTS PROGRAM Blue Points can help motivate you to maintain a healthy lifestyle. Earn points for participating in wellness activities. You can redeem points in the online shopping mall. The program gives you points instantly, so you can use them right away. If you want a larger reward, you can purchase additional points when you check out. FITNESS PROGRAM' ' Fitness can be easy, fun and affordable. The Fitness Program is a flexible membership program that gives you unlimited access to a nationwide network of more than 9,000 fitness centers. If you want, you can choose one gym close to home and one near work. And you can visit gyms while you're on vacation or traveling for work. Other program perks include: © No long-term contract: Membership is month to month. Monthly fees are $25 per month per member, with a one-time enrollment fee of $25 per member. • Blue Points: Get 2,500 points for joining the Fitness Program. Earn additional points for weekly visits. • Convenient payment: Monthly fees are paid via automatic credit card or bank account withdrawals. © Web resources: You can go online to locate gyms and track your visits. o Health and wellness discounts: Save money through a nationwide complementary and alternative medicine network of 40,000 health and well-being providers, such as massage therapists, personal trainers and nutrition counselors. It's easy to join the Fitness Program! Just call the toll-free number 888 -762 -BLUE (2583) Monday through Friday, from 8 a.m. to 9 p.m. in any continental U.S. time zone. FITNESS TRACKING Track your fitness activity using popular fitness devices and mobile apps. WELLNESS PROGRAM QUESTIONS? Call Customer Service at 877-806-9380. The Fitness Program is provided by Healthways, Inc., an independent contractor that administers the Prime Network of fitness centers. The Prime Network is made up of independently owned and operated fitness centers. Blue Cross and Blue Shield of Montana, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association 350148.0616 09 B1ueGross BlueShield of Montana Care When and Where You Need 1t Just Got Easier, Getting sick is never convenient, and finding time to get to the doctor can be hard. Blue Cross and Blue Shield of Montana (BCBSMT) provides you and your covered dependents access to care for non- emergency medical issues and behavioral health needs through MDLIVE. Whether you're at home or traveling, access to a board-certified doctor is available 24 hours a day, seven days a week. You can speak to a doctor immediately or schedule an appointment based on your availability. Virtual visits can also be a better alternative than going to the emergency room or urgent care center.' MDLIVE doctors or therapists can help treat the following conditions and more: General Health Pediatric Care Behavioral Health Allergies Cold Anxiety/depression Asthma Flu Child behavior/learning issues Nausea Ear problems Marriage problems Sinus infections Pinkeye s Blue Cross and Blue Shield of Montana, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association Blue Cross". Blue Shield° and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. MDLIVE, an independent company, provides virtual visit services for Blue Cross and Blue Shield of Montana. MOUVE operates and administers ilia virtual visit program and is solely responsible for its operations and that of its contracted providers. Ic1DLIVE and the MOL NE logo are registered trademarks of MDLIVE. Inc. and may not be used without vvitten permission. 352512.0217 Website: Visit the website MDLIVE.com/bebsmt Choose a doctor Video chat with the doctor You can also access through Blue Access for Members"' Mobile App: Download the MDLIVE app from the Apple App Store', Google Play' Store or Windows° Store Open the app and choose an MDLIVE doctor Chat with the doctor from your mobile device L_: x ccm, ]Ete P,:.ed t u d ayI T Temic-!,er, you'll need' to ppyovide youy first and ilai se; hate of birth andOSA,r`i mwniber ID number. Indmeventofair emegency,thisset vice should not take theplace ofanemergencyroomururgentcamcenter. NU WE doctors do not take the place of your primarycareductor.Properdiagnosisshculdcomefromyour doctor. and nrudicaladvice is always beivveen you and your doctor. Inlemet/Wi-ri connection is needed for ccmpu ter access. Data charges may apply when using your tablet or smanphone. Check your phone carrier's plan for details. Video on -demand consultations for behavioral health are available by appointment. Service is limited to interactive -audio consultations (phone only), along with the ability to prescribe, adren clinically appropriate, intexas. Service is f noted to interactive-audio/video (video only), along with the ability to prescribe, vrhen clinically appieptiate, it Idaho, Montana. &1ew Ivlexico and Oklahoma. Virtual visits are cuuuntfy not available in Arkansas. Service availability depends on mentL•er"s location. Virtual visits may not be available on all plans. MDLIVE is not an insurance product nor a prescription fulfillment warehouse. MDLIVE operates subject to state regulations and may not be available in certain states. MDLIVE does not guarantee that a prescription will be vaiter. MDLIVE does not prescribe DEA -controlled substances, non -therapeutic drugs and certain other drugs that maybe harmful because of their potential for abuse. MDLIVE physicians reserve the right to deny care for potantial misuse of services. APP Store is a service mark of Apple Inc. Google Play Store is a trademark of Google Inc. ('Google'). Windows is a registered mark of Microsof ell z � .-informed' CO Cost,. Mann � Optl'oris., Provider Finder®, from Blue Cross and Blue Shield of Montana (BCBSMT), is an innovative tool using the nation's largest claims database that helps Your employees find in -network doctors and hospitals, compare the costs and quality for more than 1500 procedures, and estimate out-of-pocket costs before making treatment decisions. Members can log in to Blue Access for Memberss`^ on mobile or the web to use Provider Finder to: o Find a network primary care physician, specialist or hospital. Filter search results by doctor, location, specialty, ZIP code, language and gender — even get directions from Google Maps7m • Estimate the cost of a provider's procedures, treatments and tests — and estimate their out-of-pocket expenses. o Determine if a Blue Distinction°.Center is an option for treatment. • View patient feedback and add a provider review. • Check the clinical quality data from Blue Cross and Blue Shield as well as independent third parties. o Search in Spanish. o Review providers' certifications, recognitions, awards and publications. Searches on Provider Finder are: Accurate This tool helps members estimate the overall cost of procedures, treatments, and tests, while calculating their out-of-pocket expenses, all based on the search parameters they choose. Members are able to compare estimated costs between different providers, based on typical episodes of care. With information on over 20,000 health care facilities and more than 400,000 professional providers, as well as cost information for more than 1,500 treatment categories, Provider Finder is a robust database. € ersonal This tool provides information and costs that apply to a specific member's health benefit plan to estimate the cost of care. This means members can instantly see how much they will need to pay in deductible, coinsurance or copayments, in addition to seeing how much their plans may pay. Data are presented in a.format that's easy to navigate and helps your employees better understand how their benefits work. Active, Engaged Employees Lower Health Care Costs You want your employees to live healthier, happier lives while lowering your costs for their health care. Provider Finder does just that — giving accurate, transparent and personal information based on the employee's specific benefit plan. This tool is available on mobile as well, helping members where they are and when they need access to this information. Blue Cross and Blue Shield of Montana, a Division of Health Care Servica Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association 350008,0315 lj_�: .tom' >ti � - .`�. n ta �� -� '� � L ,i � `4u7 Z+ry `a �� � y,�H t x? � :{ _-+ `+i y �rav`, � y � = Medication Covered a 0 Cost to You aspirin chew tab 81 mg aspirin tab delayed release 81 mg Your health plan may include certain prescription and over-the-counter (OTC) preventive medicines, as a benefit of membership, at no cost to you when you use a pharmacy or doctor in your health plan's network. There is no co -pay, deductible or coinsurance, even if your deductible or out-of-pocket maximum has not been met. Coverage for these medicines can vary according to the type of plan you are enrolled in. Call the Customer Service number listed on your member ID card to find out what drugs are covered at no cost share under your plan. Below are the preventive care drugs that may be covered under your plan for both adults and children. Please see the Women's Contraceptive Coverage List for a list of contraceptive methods that may be covered at no cost to you. Age limits, restrictions and other requirements may apply.* folic acid caps, 0.8 mg folic acid tabs, 400 mcg, 800 mcg peg 3350-kcl-na bicarb-nacl-na sulfate for soln 236 gm, 240 gm carbonyl iron suspension _ peg 3350-kcl-sod bicarb -gaol for soln 420 gm FERROUS SULFATE LIQUID, 220 MG/5 ML ME t eEN.MM M FERROUS SULFATE SYRUP raloxifene ferrous sulfate elixir, solution tamoxifen IRON UP L M I '` NOVAFEARUM PEDIATRIC DROPS sodium fluoride chew tabs; 0.25 mg f (from 0.55 mg naf), 0.5 mg f (from 1.1 mg Mill, l mg f (from 22 mg Mall sodium fluoride cream 1.1% sodium fluoride gel 1.1%(0.5%f) sodium fluoride paste 1.1% sodium fluoride rinse 02% sodium fluoride sola; 0.125 mg/drop f (0.275 mg/drop naf), 0.5 mg/mL f (from 1.1 mg/mL naf) sodium fluoride/potassium nitrate paste 1.1-5% stannous fluoride cone 0.53% stannous fluoride gel 0.4% lovastatin 20 mg, 40 mg bupropion hcl (smoking deterrent) tab sr 12hr 150 mg CHANTIX nicotine polacrilex gum 2 mg, 4 mg nicotine polacrilex lozenge 2 mg, 4 mg nicotine td patch 24hr 7 mg/24hr,14 mg/24hr, 21 m9/24 hr NICOTINE TRANSDERMAL KIT NICOTROLINHALER _ NICOTROL NS Generic Drugs = bold Brand Drugs = CAPITAL LETTERS 354674,1017 �r• �,. ^.�� h � M " . �vA5a4.. D 0 L`�t t ce �� N a 0 N � D ,"§t -. a�� y � �,�, �WE PNEUMOVAX 23 ACTHIB PREVNAR 13 ( ADACEL AFLURIA/PF/QUADRIVALENT BEXSERO ' BOOSTRIX CERVARIX COMVAX DAPTACEL DIPHTHERIA/TETANUS TOXOID ENGERIX-B PROQUAD QUADRACEL RECOMBIVAX HB ROTARIX ROTATEQ TENIVAC TETANUS/DIPHTHERIA TOXOIDS TRUMENBA t TWINRIX FLUAD VAQTA FLUARIX QUADRIVALENT VARIVAX FLUBLOK ZOSTAVAX FLUCELVAX/QUADRIVALENT FLULAVAL QUADRIVALENT cholecalciferol cap 400 unit, 1000 unit FLUVIRIN cholecalciferol chew tab 400 unit, 1000 unit FLUZONE/HIGH-DOSEANTRADERMAL/QUADRIVALENT/SPLIT cholecalciferol drops 400 unit/O.03 mL (per drop), 5000 unit/mL GARDASIL (1000 unit/O.2 ml) GARDASIL 9 cholecalciferol oral liquid 400 WWI. HAVRIX cholecalciferol tab 400 unit, 1000 unit HIBERIX INFANRIXr a IPOL INACTIVATED IPU KINRIX, M-M-R 11 MENACTRA ,0 - MENHIBRIX MENOMUNE-A/C/Y/W-135 t� ,5= MENVEO PEDIARIX. T. d PEDVAX HIB PENTACEL r Generic Drugs = bold Brand Drugs = CAPITAL LETTERS Some of these products maybe covered under yaw medreal benefit if provided by a doctor in your health plan's notacrk Prescription coverage for these drugs may vary according to the terms and conditions of the plan. A prescription maybe required to curer vvidrout cost-shming under the pharmacy bemdit for non -grandfathered plans. The plan may also require a genetic drug to be tried fist before the bmnd%vision, This infonhtation is lot inf r national purposes only. does not constitute legal or other advice and should not be relied upon to detenrdne coverage. beabrunt decisions ate tet%v:t fm the niendref and his or her health care prmider. Coverage is always subject to duo limitations and exclusions of the benefit plan. for details about your plan, check your benefit materials or call the Pharmacy Program number on }cur mec`cr ID card. i Third -party brand names are to propery, of their respective owners. E 2 •E = 0 0 o � n po 1p ey Z9 ago o vm o y a as oo mm aaaaaK mmm m Nm aaaKa mmmmm ^aa mmm as mm ax mom" as as xaa. 0 a aG n we u n m Q 6 m m u a o 0.p m Mnln �'• - V C o .-¢ 3 6 66 4¢ " 4.4 n n 6 a ¢ Q 6¢¢q C ¢ o r�ff ¢¢Q da 4¢ ¢Q 4¢ 6 a d 6 m 22 N to p m h N of V) o m V! V} .0 •� $ j $ �� ¢Qo:� �G 'L •$ 3S1 u _ u �.O $u 3L3 -�'Lo uE v u u �-pTiu uU'o E p Ei p 0O' 3 0 0 8 0 0 ISO's 0 0 0 D O O O D O D O 0 0 8 S o o a 08 K as ZA as 0o v •vE ea �� aaa mmmm$m a'T' aaaaa mmmmm T'aa mmm mm mm mm ��,>�.¢ go Lb on 9a te��:amE $ �o�� od �EBEad dHo� 9d8 �0 8m �". $ nm e� o$ $g ^~�Ea 3 3a 33¢33¢ 3aao 3 3a3 3a 3a 3a 3a W n? :"'min NT u�`g'�in T x s v� m g �s pp v' $v'�q OOOmO OOO DO DO OO 00'a;,U c 0 0 �E 0 O m o '2S, u`S o ax ao aaaaoa aaaaa 00000 aaa 000 as �0 as 00 as 0 n n co po of v Cc coa $ a^ o rr d Fam ^ooaoo nnn o n$ r a3 nnnnn �w$$ B.>_'�o i$irk nnn r nr 9mm m nn $ n 4�j d0 --• hm ti0 N r2 5 �a O $9 %3 6 Q 39 ¢ O 7jd 3¢33 m 3 33'3 m a3Sa Ba a 2B BnOGO Sa a 'n '' O $ 0All. O O D O O O O 00 O O O O g c p $ p D 0 0 O J Vv N Na o as aaaaaK T'aaa .-o.2m K aKa mmm as mm as mm $ $'ro $ ro' mo m $`' $ ev,o .2_=-z �5 m o�'$�v •2 '�-2 n ¢m $i"� a3.2 o`" .z" ._ u m d mm on 33¢33¢3d33Qo 3a3 3¢ 3¢ 3¢ 30 n5 NtMcq mmvi mm sz za z 3 gg L .22-2 cm`cL .9 Sma a�aO � OiS`� 232 as � �ig na U a� t;� a w'8 000 Fes' 00 oc 0? -y g 00m o0 00000 000 00 E a„ Ol C E aE s�-i, oa O ^ EW`gf mp<a`m a m 5 am Z2 uu� -so Q q4� q4 E> Eo `gym � 3NVE gNm Qc02 o-Toi 1. .1 tl,do-• o "aW w_mOv`g,Ea a vswc CmS V i�o8 y .pYm./,. m =n' wvV v' bOo NN W3 Wdmnt� C c NIN i�mBp aa3«x `n .6 vm" wpV c a Er v®S a €na d v p 0o"oCr mFO` m5vmci 4(_Fj Vum v�jU'j' O°a" fUr�L rc�V ` No6'C U`g'm0 °- c0�E. o` tl OLg O�yGn �9aE- 'N=� OS$ncVz a2bao`"0m ad`m. •Vp>{- -mco yNC"ui Wqu -tlo3o,.i' c'nmm$°W W m�^'ri;aEeZ.E2o'6 FFUcUa ai5 '6 egoR_ -IaL '6o. a{L'tE o4. .4a.l-� m E Eu 1 m �O ("pQ e .1a Kand 2 2 a oo o- W W Qo cZ[ mc Q GC 6 6IOi� 64- VO Db O W SL S^ ZGZ V O aZK 10 8 8 ICD-9 Codes for Disclosure Notification Please list all Plan Participants who have been diagnosed with or treated for any of the codes listed under the following categories during the current Benefit Period: 001-139 Infectious and Parasitic Diseases 038-038.9 Septicemia 042 AIDS / HIV 070-070.9 Viral Hepatitis 140-239 NeoplasntS 140-149.9 Malignant Neoplasm of Lip, Major Salivary Glands, 417.1 Gum, Mouth, Oropharynx, Nasopharynx, and/or 421421.9 Hypopharynx 150-150.9 Malignant Neoplasm of Esophagus 151-151.9 Malignant Neoplasm of Stomach 153-153.9 Malignant Neoplasm of Colon 154-154.8 Malignant Neoplasm of Rectum 155-155.2 Malignant Neoplasm of Liver 157-157.9 Malignant Neoplasm of Pancreas 161-161.9 Malignant Neoplasm of Larynx 162-162.9 Malignant Neoplasm of Lung 170-170.9 Malignant Neoplasm of Bone 174-174.9 Malignant Neoplasm of Female Breast 179-I82.8 Malignant Neoplasm of Uterus or Cervix 183-183.9 Malignant Neoplasm of Ovary 185 Malignant Neoplasm of Prostate 186-186.9 Malignant Neoplasm of Testis 188-189.9 Malignant Neoplasm of Bladder, Kidney, Urinary 191-191.9 Malignant Neoplasm of Brain 192-192.9 Malignant Neoplasm of Nervous System 194-194.9 Malignant Neoplasm of Endocrine Glands 195-195.8 Malignant Neoplasm of Other Ill -Defined Sites 196-196.9 Secondary Malignant Neo. Lymph Nodes 197-197.8 Secondary Malignant Neo. Respty and Digestive Systems 198-198.89 Secondary Malignant Neo. Other Specified Sites 200-208.9 Lymphoma and/or Leukemia 235 Neoplasm Uncertain Behavior 239.2 Neoplasm Unspecified Nature -Bone, Skin 240-279 Endocrine Nutritional, Metabolic, Inrmrrnity 250-250.9 Diabetes 277.0 Cystic Fibrosis 278.0 Obesity/Hyperaliment 280-289 Diseases ofthe Blood mut Blood -Forming Organs 282.6 Sickle -Cell Anemia 284.9 Aplastic Anemia NOS 286-286.9 Coagulation Defects and/or Hemophilia 320-389 Diseases ofthe Nervous Systems and Sense Organs 330 Cerebral degenerations 344.0-344.09 Quadriplegia and Quadriparesis 331.0-331.9 Reye's Syndrome 344.1 Paraplegia 348.0-348.9 Encephalopathy 357,358 Neuropathy / Myasthenia Gravis 390-459 Diseases of the Circ rtlatory Systems 410410.9 Acute Myocardial Infarction 411411.89 Acute and Subacute Ischemic Heart Disease 414-414.05 Coronary Atherosclerosis (ASHD) 4151115.19 Acute Pulmonary Heart Disease 416416.9 Chronic Pulmonary Heart Disease 417.1 Aneurysm of Pulmonary Artery 421421.9 Acute and Subacute Endocarditis 424424.9 Valve Disorders 425425.9 Cardiomyopathy 426426.9 Conduction Disorders 427427.9 Cardiac Dysrhythmias 428428.9 Heart Failure 430,431 Subarachnoid / Intracerebral Hemorrhage 434.9 Occlusion of Cerebral Arteries 436 Acute Cerebrovascular Accident (CVA) 440441.9 Atherosclerosis / Aortic Aneurysm 460-519 Diseases ofthe Respiratory System 480-486 Pneumonia 490496 Chronic Obstructive Pulmonary Disease (COPD), etc. 515 Postinflammatory Pulmonary Fibrosis 518-518.89 Pulmonary Collapse and/or Respiratory Failure 520-579 Diseases ofthe Digestive System 555-555.9 Regional Enteritis (Crohn's Disease) 560.0-560.9 intestinal Obstruction 562.1 Diverticulitis of Colon 567-567.9 Peritonitis 569.0-569.9 Other Disorders ofIntestine 570-571.9 Liver Diseases and Cirrhosis 572.8 Other Sequela ofChronic Liver Disease 573-573.9 Other Liver Disorders 577-577.9 Pancreas Diseases 578-578.9 Gastrointestinal Hemorrhage 580-629 Diseases ofthe Genitourinary System 584-584.9 Acute Renal Failure 585 Chronic Renal Failure 586 Renal Failure, Unspecified 588 Disorders resulting from impaired renal function 592 Calculus of Kidney & Uerter 630-677 Complications ofPreglnallct',Childbirth 641.1 Placenta Previa 642.5-642.7 Eclampsia, pre-eclampsia 644.0-644.2 Premature Labor 648.0 Gestational Diabetes 651 Multiple Gestation 654.5 Cervical Incompetence 710-739 Diseases of the Musculoskeletal Svstem and Connective Tissue 715.0-715.9 Osteoartrhosis 721.3 Lumbosacrel Spondylosis 722.0-722.9 Intervertebral Disc Disorders 730-730.9 Osteomyelitis and/or Periostitis 737.3 Kyphoscoliosis and scoliosis 740-759 Congenital Anomalies 747.2 Aortic Atresia / Stenosis 751.6 Biliary Atresia 759-759.9 Other and Unspecified Congenital Anomalies 760-779 Conditions Originating in the Perinatal Period 765-765.1 Prematurity 769 Respiratory Distress Syndrome 770.0-770.9 Other Respiratory Conditions of Newborn 780-799 Synnptoln7s Signs and Ill-Derned Conuditions 785-785.9 Symptoms Involving Cardiovascular System 786.5-786.59 Chest Pain 800-999 Injury and Poisoning 800-804.9 Fracture of Skull 805-805.9 Fracture of Vertebral Column 806-806.9 Fracture of Vertebral Column with Spinal Cord Injury 828-828.1 Multiple Fractures 853-854.1 Intracranial Injury 869-869.1 Internal Injury 887-887.7 Traumatic Amputation of Arm and Hand 897-897.7 Traumatic Amputation of Leg 949-949.5 Bums 952-952.9 Spinal Cord Injury 996-997.0 Complications peculiar to certain specified conditions V23 Supervision of High Risk Pregnancy V42 - V58.9 Transplants, etc i w VT iA V% • p t N � p � m N a w c 1 MW wpi o E > 15 jjj a m a C j C v°i � w a2f w d{ a i d5 w O W O m W CL OCL l31 O CL lt! MMIA PO Box 6669 - Helena, MT 59604-6669 MONTANA UUNICWALINTERLOCALAUTHORITY Toll Free: (800) 673089 - Tel: (406) 443-0907 - Fax: (406) 449-7440 The MMIA is pleased to offer what we believe are very competitive rates for a group term life insurance product for our membership. UNUM Life Insurance Company has rates specifically for members of the MMIA Employee Benefit program that may generate savings for your city/town. Basic Life & AD&D Plan Description Eligibility: Each active full-time employee working the minimum hours required per your city or town, and no less than 20 hours, is eligible to participate in the MMIA Life Insurance program. Participation: 100% of eligible employees. Employer Contribution: 100% of employee premium cost. Benefit Amount and Cost: The cost per $1,000 basic life and AD&D is $0.28. Listed in the table below are varying levels of insurance coverage and the applicable monthly cost per employee. Life and AD.&D Benefit _.. Monthl' Cost er Em to ee $10,000 $2.80 $15,000 $4.20 $20,000 $5.60 $25,000 $7.00 $50,000 $14.00 $100,000 $28.00 Each employee within the group or bargaining unit must have the same benefit level. Benefit Descriptions: Guarantee Issue: Per schedule AD&D Included Waiver of Premium Included Conversion of Benefits Available Travel Assistance Included Age Reduction: The Principal sum of the life insurance coverage will be reduced by 50% at age 70. MMIAPO Box 6669 • Helena, MT 59604-6669 MONTANA LW NICIGAL INTMOGL AUTHORITY Toll Free: (800) 635-3089 • Tel: (406) 443-0907 • Fax: (406) 449-7440 I Accidental Death and Dismemberment: In the event of death, loss of limbs, loss of eyesight, loss of speech or hearing due to an accidental injury, additional benefits, based on the selected life insurance amount, will be paid based on the selected life insurance amount. Additional benefits include: Seat Belt Benefit Airbag Benefit Common Carrier Benefit Accelerated Benefits Living Care Benefit Pays up to additional $25,000 Pays up to additional $5,000 Included Included Included This benefit is paid in addition to any other benefits provided by the Plan subiect to the terms and conditions contained in the Group Insurance Policy. Dependent Group Life Insurance is also available at $0.35 per $1,000 of benefit. Each employee with dependents (spouse or children) must have the same dependent benefit level The monthly unit cost covers an employee's eligible dependents. Eligible children must be less than 26 years of age. MMLIL PO Box 6669 • Helena, MT 59604-6669 MONTANA MUNICIPAL INTERLOCAL AUTHORITY Toll Free: (800) 635-3089 • Tel: (406) 443-0907 • Fax: (406) 449-7440 NOV VOLUNTARY TERM LIFE AND AD&D The MMIA Employee Benefits Program now offers a very competitively -priced Voluntary Term Life and AD&D program for our membership. The carrier is the same as the Basic Group Life and AD&D - UNUM Life Insurance Company. Voluntary Life can be offered without providing the Basic Life. Each employee can select an amount of life insurance benefits that best fits their circumstances and needs. Rates are based on the age of the covered person. Employer Contribution: None; this program requires the premium be paid 100% by the employee. Coverage Amount: The maximum amount an employee can apply for is 5x their salary up to the maximum of $500,000. Employees may purchase benefits increments of $5,000. Spouses may receive coverage, up to 100% of the employee amount, not to exceed $500,000. Guarantee Issue Amount: Up to $200,000 for Employee; $25,000 for spouse. Amounts in excess of the Guarantee Issue Amount will require a health statement. Voluntary Life and AD&D Monthly Premium Rates per Thousand: Rates are age -banded and are shown below. Age Voluntary !_tfe VoluntaryxLtfe Wath ,Category Rate Per AD&D Rate Per Thousand '..... *Thousand 15-34 $0.08 $0.13 35-39 $0.11 $0.16 40-44 $0.15 $0.20 45-49 $0.26 $0.31 50-54 $0.47 $0.52 55-59 $0.72 $0.77 60-64 $1.37 $1.42 65-69 $2.17 $2.22 70+ $3.82 $3.87 Dependent Child Benefit: Employees can cover their child(ren) in increments of $2,000, up to a maximum of $10,000. The cost is the same for one child or multiple children. The rate is $.16 per $1,000 of coverage. Employee coverage is required. AD&D coverage is not available for children. Eligible children must be less than 26 years of age. Benefit Descriptions: Waiver of Premium: Included Portability Available Accelerated Benefits Included Travel Assistance Included Benefits are paid subject to the terms and conditions contained in the Group Insurance Policy. Please share this information with your employees, whether or not they are covered by our group health benefits. All employees are eligible to participate in this program if minimum participation requirements are met. For additional information or enrollment forms, contact the MMIA Employee Benefits Department at 1-800-635-3089. 1®RI MMIA Employee Benefits Programs - Standard Plan Offerings Effective Date 711118 This Document is a Summary of Coverage Only. The MMIA Employee Benefits Program Plan Documents are available at www.mmia.net and must be referenced for details of all coverages. Medical Benefits - Cost Sharing Provisions Bridger Plan Madison Plan Mission Plan HDHP - HSA Qualified Annual Deductible (January 1 - December 31) $500 (Individual) - S1,000 (Family) $500 (Individual)- $1,000 (Family) $1,000 (individual)- 52,000 (Family) $2,700 (individual)- $5,400 (Family) Benefit Percentage of Allowable - All Montana & Non -Montana Participating' Before satisfaction of Out -of -Pocket Maximum 80% 70% 60% 80% After satisfaction of Out -of -Pocket Maximum 100% 100% 100% 100% -Applies to all benerrts unless otherwise listed in schedule below or SPD Benefit Percentage of Allowable - Non -Montana, Non -Montana Participafing' Before satisfaction of Out -of -Pocket Maximum 60% 50% 40% 60% After satisfaction of Out-of-pocket Maximum 100% 100% 100% 100% Applies to all beneh7s for Non-Mxrrtana Non -Participating p"ders Annual Out -of -Pocket Maximum includes Deductible $1,500 (individual) -53,000 Famil $2,000 (Individuall-54,000(Family)_ S3,000 Individual)- S6.000 (Family) 55,250 Individual) -570:500 (Famil ) Preventive Care All MT & Non -MT Participating All MT & Non -MT Participating All MT & Non -MT Participating I All MT & Non -MT Participating Preventive Benefit (as recommended by US Preventive Services Task Force. CDC, and Health Resources & Services Administration at Deductible waived, 100% Deductible waived, 100% Deductible waived, 100% Deductible waived. 10095 www.healthcare.gov) Medical Services All MT & Non -MT Participating All MT & Non -MT Participating All MT & Non -MT Participating All MT & Non -MT Participating Accidental Injury Benefit 100% to $300; then standard benefits 100% to $300; then standard benefits 100% to $300; then standard benefits Deductible Applies, 80% Alternative Medicine Benefit Deductible Waived, 80% up to S500 Deductible Waived, 70% up to S500 Deductible Waived, 60% up to $500 Deductible Applies. 80% up to S500 Chiropractic Care Deductible Waived, 80% to $400 plus Deductible Waived, 70% to $400 plus Deductible Waived, 60% to $400 plus Deductible Applies, 80% to $400 plus $100 x-ray benefit $100 x-ray benefit 5700 x-ray benefit S100 x-ray benefit Diabetic Education Benefit Deductible Waived, 100% Deductible Waived, 100% Deductible Waived, 100% Deductible Applies, 100% Diagnostic Services Professional Provider Expenses Deductible Waived, 80% Deductible Waived, 70% Deductible Waived, 60% Deductible Applies, 80% Facility Provider Expenses Deductible Applies, 80% Deductible Applies, 70% Deductible Applies, 60% Deductible Applies, 80% Durable Medical Equipment Rental or purchase Deductible Waived, 80% Deductible Waived, 70% Deductible Waived, 60% Deductible Applies, 80% Repair and Replacement Deductible Waived, 80% Deductible Waived, 70% Deductible Waived, 60% Deductible Applies, 80% Emergency Room Care (regardless of Participating Provider status Deductible Applies, 80% Deductible Applies, 70% Deductible Applies, 60% Deductible Applies. 80% Home Health Care Deductible Waived, 80% Deductible Waived, 70% Deductible Waived. 60% Deductible Applies, 80% Hospice Care Deductible Waived. 100% Deductible Waived, 100% Deductible Waived, 100% Deductible Applies, 80% Hospital Facility Services Deductible Applies, 80% Deductible Applies, 70% Deductible Applies. 60% Deductible Applies. 80% Maternity Services Professional Provider Expenses Deductible Waived, 80% Deductible Waived, 70% Deductible Waived, 60% Deductible Applies, 80% Facility Provider Expenses Deductible Applies, 80% Deductible Applies. 70% Deductible Applies, 60% Deductible Applies, 80% Newborn Initial Care Deductible Waived. 80% Deductible Waived, 70% Deductible Waived, 60% Deductible Ap Iles, BO% Nutritional Counseling limit of 10 visits per ear Deductible Waived, 80% Deductible Waived, 70% Deductible Waived. 60% Deductible A plies, 80% Obesity Surgery- One per lifetime Deductible Applies, 80% Deductible Applies, 70% Deductible Applies, 60% Deductible Applies, 80% Benefit Max for Procedure $30,000 $30,000 530,000 $30,000 Organrrissue Transplants - Center of Excellence only Professional Provider Expenses Deductible Waived, 80% Deductible Waived, 70% Deductible Waived, 60% Deductible Applies, 80% Facility Provider Expenses Deductible Applies. 80% Deductible Applies, 70% Deductible Applies, 60% Deductible Applies, 80% Professional Provider Services Deductible Waived. 80% Deductible Waived. 70% Deductible Waived, 60% Deductible Applies. 80% Rehabilitation Therapy Professional Provider Expenses Deductible Waived, 80% Deductible Waived, 70% Deductible Waived, 60% Deductible Applies, 80% Facility Provider Ex enses Deductible Ap lies, 80% Deductible Waived, 70% Deductible Applies, 60% Deductible Applies. 80% Mental Illness Professional Provider Expenses Deductible Waived, 80% Deductible Waived, 70% Deductible Waived, 60% Deductible Applies, 80% Facility Provider Expenses Deductible Applies, 80% Deductible Applies, 70% Deductible Applies, 60% Deductible Applies. 80% Therapies - Physical, Occupational, Speech, Cardiac Professional Provider Expenses Deductible Waived, 80% Deductible Waived, 70% Deductible Waived. 60% Deductible Applies, 80% Facility Provider Expenses I Deductible Applies, 80% Deductible Waived, 70% Deductible Applies, 60% Deductible Applies, 80% Chemical Dependency Treatment Professional Provider Expenses Deductible Waived, 80% Deductible Waived, 70% Deductible Waived, 60% Deductible Applies, 80% Facility Provider Expenses Deductible Applies, 80% Deductible_ Waived, 70% _ _ Deductible Applies, 60% Deductible Applies, 80 Prescri tion Drug Plan - Group Choice of: 1) Prescription Drug Percentage, or Generic Deductible Waived, 80% Deductible Waived, 70% Deductible Waived, 60% Deductible Applies. 80% Brand - Formulary or Non -Formulary Deductible Applies, 80% Deductible Applies, 70% Deductible Applies, 60% Deductible Applies, 80% 2) Prescription Drug Copay Plan Generic S4 Co -pay Ralal/58 C"ay Mal order S4 Co -pay Relaa/S8 C"ayMal Order S4 Co -pay Relay S8 Co-payMad Ordar Deductible Applies, 80% Brand -Formulary S20 Co -pay Retail/ $40 Co -pay Mad Order $20Co-pay Retal/540Co-payMal Order $20Co-pay Relalls40Co-pay Mall Order Deductible Applies, 80% Non -Formulary $50Co-pay Rota l/S100Co-payMalOrder $50 Cc -pay Retail/ 3100 CoTay Mau Order S50Co-payRetal/5100Co-pay Mal Ord er Deductible Applies, 80% 2018 -2019 Monthly Contributions - Rx Percentage EE - Employee Only $683 $661 $610 $515 ES - Employee & Spouse $1,366 $1,322 $1,220 $1,030 EC - Employee & Child $1,195 $1,157 $1,068 $901 EF - Employee & Family $1,878 $1,818 $1,678 $1,416 Med - Retiree Only Medicare $444 $430 $397 $335 2Med - Retiree & Spouse Medicare $888 $860 $794 $670 141+65 - One with Medicare & One without Medicare 1 $1,127 $1,0.91 $1,007 $850 2018 - 2019 Monthly Contributions - Rx Copay EE - Employee Only $792 $768 $706 $515 ES - Employee & Spouse $1,584 $1,536 $1,412 $1,030 EC- Employee & Child $1,386 $1,344 $1,236 $901 EF - Employee & Family $2,178 $2,112 $1,942 $1,416 Med - Retiree Only Medicare $515 $499 $459 $335 2Med - Retiree & Spouse Medicare $1,030 $998 $918 $670 1-/1+65 - One with Medicare & One without Medicare $1,307 $1,267 $1,165 $850 This rate quote expires after 9/30/18. New claims data will be required to provide updated rates after that date. Exclusions: All claims will be excluded from coverage if they were not disclosed prior to the effective date of coverage (7/1/18), and were known to: 1. Be currently disabled, confined to Medical Facility, or have been precerlified within the last three months. 2. Have received medical services during the current plan year the cost of which exceeds $50,000, and for which bills have been received by the Claims Administrator and entered into their Claims System. 3. Have been identified as a candidate for Case Management and has having the potential to exceed during the policy period S50,000. 4. Have been diagnosed, during the current plan year, with a condition represented by any of the ICD-9 codes contained in the attached list and have also received medical services costing S5,000 during the same period. YLMILAL PO Box 6669 • Helena, MT 59604-6669 MONTANA MUNICIPAL INTERLOCAL AUTHORITY (800) 635-3089 i :r. (406) 443-0907 f (406) 449-7440 BASIC GROUP DIFF AND AD&D The MMIA is pleased to offer what we believe are very competitive rates for a group term life insurance product for our membership. UNUM Life Insurance Company has rates specifically for members of the MMIA Employee Benefit program that may generate savings for your city/town. Basic Life & AD&D Plan Description Eligibility: Each active full-time employee working the minimum hours required per your city or town, and no less than 20 hours, is eligible to participate in the MMIA Life Insurance program. Participation: 100% of eligible employees. Employer Contribution: 100% of employee premium cost. Benefit Amount and Cost: The cost per $1,000 basic life and AD&D is $0.28. Listed in the table below are varying levels of insurance coverage and the applicable monthly cost per employee. Life and AD&D Benefit Monthly Cost per Employee $10,000 $2.80 $15,000 $4.20 $20,000 $5.60 $25,000 $7.00 $50,000 $14.00 $100,000 $28.00 Each employee within the group or bargaining unit must have the same benefit level. Benefit Descriptions: Guarantee Issue: Per schedule AD&D Included Waiver of Premium Included Conversion of Benefits Available Travel Assistance Included Age Reduction: The Principal sum of the life insurance coverage will be reduced by 50% at age 70. ivu"nuiL PO Box 6669 • Helena, MT 59604-6669 MONTANA MUNICIPAL INTERLOCAL AUTHORITY (800) 635-3089 G>',: (406) 443-0907 F: (406) 449-7440 VOLUNTARY TERM LIFE AND A®&® The MMIA Employee Benefits Program now offers a very competitively -priced Voluntary Term Life and AD&D program for our membership. The carrier is the same as the Basic Group Life and AD&D - UNUM Life Insurance Company. Voluntary Life can be offered without providing the Basic Life. Each employee can select an amount of life insurance benefits that best fits their circumstances and needs. Rates are based on the age of the covered person. Employer Contribution: None; this program requires the premium be paid 100% by the employee. Coverage Amount: The maximum amount an employee can apply for is 5x their salary up to the maximum of $500,000. Employees may purchase benefits increments of $5,000. Spouses may receive coverage, up to 100% of the employee amount, not to exceed $500,000. Guarantee Issue Amount: Up to $200,000 for Employee; $25,000 for spouse. Amounts in excess of the Guarantee Issue Amount will require a health statement. Voluntary Life and AD&D Monthly Premium Rates per Thousand: Rates are age -banded and are shown below. Age Category Voluntary Life Rate Per Thousand Voluntary Life With AD&D Rate Per Thousand 15-34 $0.08 $0.13 35-39 $0.11 $0.16 40-44 $0.15 $0.20 45-49 $0.26 $0.31 50-54 $0.47 $0.52 55— 59 $0.72 $0.77 60-64 $1.37 $1.42 65-69 $2.17 $2.22 70+ $3.82 $3.87 Dependent Child Benefit: Employees can cover their child(ren) in increments of $2,000, up to a maximum of $10,000. The cost is the same for one child or multiple children. The rate is $.16 per $1,000 of coverage. Employee coverage is required. AD&D coverage is not available for children. Eligible children must be less than 26 years of age. Benefit Descriptions: Waiver of Premium: Included Portability Available Accelerated Benefits Included Travel Assistance Included Benefits are paid subiect to the terms and conditions contained in the Group Insurance Policy. Please share this information with your employees, whether or not they are covered by our group health benefits. All employees are eligible to participate in this program if minimum participation requirements are met. For additional information or enrollment forms, contact the MMIA Employee Benefits Department at 1-800-635-3089. —.do _7 Q LLJ *Ile ` fi U-4 N cc I— _� f �a V ` N Q w TT � w N N 00 0 0 N L6 Ln co LZOL£ NI TOOMIUM OS£ a}inS'AeM eiui611n LKS Q ° 0 — ° ° o Q N ° N �5 O c t ; J t N N ?� (6 .0 a > N m C �Yso z m� N cm:° a � O N ° �-0� N� f' z 41 a) C 41 O " ° ° ° 4' Ln N N m U LU c 0 N tn m O'0 N Q7 f6 T N O u Q d o 3 y WL V N 0 w co Q- y tn3 V *' N m O O_ a Q Wa c _0o O C C Q 0o >> =° LU Q p Oi ° O N N 00 0 0 N L6 Ln co LZOL£ NI TOOMIUM OS£ a}inS'AeM eiui611n LKS r C h 9 ; J O 0 N � N y m� N cm:° NO C ' N L O m T C >� u U O � Ln tn m O'0 C •%O co O d o C L C C *' N m O O_ a Q N N O ra v - c O C-2 c _0o = m t Q p Oi ° O O Q p u Q Ou Q Q O v (D O C O C 469N +' 'C E N i N O N O In O Z Z O .Z 0 W 3 O _ a) c U O N p N 0 cn E ra Q . fu U C -O �' co N N O= -° O U@ 0 H � E O U O r N L- u Ou °� @ p .� o a `O U _ t to L£ u >, Ln a_ C AA.- i.L. U �' N O T '^ - � 0 W c ° L u 3 T in V -O p a'' . O ZL u. 3 N 'z ° > o° s m e O m uj m ° ° � QH = V) ° Z -0 M U) n. - 3 _c � pta'a° 2> u �� Teladot"" Getting started with Teladoc® yLqu MONTANA MUNICIPAL INTERLOCAL AUTHORITY Teladoc's U.S. hoard -certified doctors are available 24/7/365 to resolve many of your medical issues through phone or video consults. Set up your account today so when you need care now, a Teladoc doctor is just a call or click away. SET UP YOUR ACCOUNT It's quick and easy online. Visit the Teladoc website at Teladoc.com, click "Set up account" and provide the required information. You can also call Teladoc for assistance over the phone. REQUEST A CONSULT Once your account is set up, request a consult anytime you need care. PROVIDE MEDICAL HISTORY Your medical history provides Teladoc doctors with the information they need to make an accurate diagnosis. Online: Log into the Teladoc website at Teladoc.com and click "My Medical History". Mobile app: Log into your account and complete the "My Health Record" section. Visit Teladoc.com/mobile to download the app. Call Teladoc. Teladoc can help you con-plete your medical history over the phone. Teladoc.com I* ' 1-800-Teladoc (835-2362) ❑■ r ■0 Facebook.com/Teladoc Teladoc.com/mobile 0, primary care physician. Teladoc docs not yuatantee that a picsciiption hall be c,raten. Ichdoc operates sublcct to state regulation and may not be available in certain states. Teladoc does not prescribe DEA controlled substances, non therapeutic druos and certain other drugs which may be harmful because of their potential for abuse. Teladoc physicians rescrvc the richt to deny care for (A Allegiance�� MATERNITY MANAGEMENT Care Management j PROVIDING SUPPORT AND REDUCING THE RISK OF COMPLICATIONS The Allegiance Care Management maternity management program provides support to expectant parents with pregnancy related education and support offerings. Experienced maternity nurse specialists are connected with the member and their family as early in the pregnancy as possible to ensure the member receives the right care at the right time. Allegiance ensures the best possible outcome is achieved through: Collaboration with their attending physician Prenatal and lifestyle education • Educational material on prenatal care, trimester expectations and newborn care One-on-one support throughout the pregnancy and following the birth of the child Customized incentives offered to members who participate in the program - k�. -OC/ ' PROGRAM HIGHLIGHTS Allegiance works to minimize potential complications through health management and continuous assessment -% The program provides early intervention and management of high-hisk pregnancy and neonatal cases by referring to case management as appropriate Provides support and education while also watching for potential complications throughout the term of the pregnancy j - k�. -OC/ ' PROGRAM HIGHLIGHTS Allegiance works to minimize potential complications through health management and continuous assessment -% The program provides early intervention and management of high-hisk pregnancy and neonatal cases by referring to case management as appropriate Provides support and education while also watching for potential complications throughout the term of the pregnancy Work -Life Tools • j \=/- Legal Services — access a free, half-hour consultation, by phone or in person, for ' 9 any non -work related issue, followed with a 25% discount in legal fees. Free. Fast. Confidential. • • • • - • • . - • • Financial Services — access free phone support for up to 30 days for each new financial issue, such as debt counseling, The EAP (Employee Assistance Program) helps you privately budgeting, and college or retirement solve problems that may interfere with your work, family, and planning. life in general. EAP services are FREE to you, your dependents, all household members. EAP services are always confidential Mediation Services — request free and provided by experts. consultations for personal, family, and Confidential Counseling non -work related issues such as divorce, 24-hour Crisis Help — toll-free access for you or a family member neighbor disputes, or real estate. experiencing a crisis. In-person Counseling — up to 6 face-to-face counseling sessions Online Legal Forms — create, save, print, are available for each new issue. Simply call for access to qualified, and revise online legal forms including local counselors who can help you with a variety of problems wills, contracts, leases, and many more. such as family, parenting, relationship, stress, anxiety, and other challenges. Home Ownership Program — get free Online Consultations — convenient access to online consultations support and information about making with licensed counselors through RBH eAccess at MyRBH.com. smarter choices when shopping for a Online consultations are a great way to get support for brief new home; making financing decisions; issues, even when time is limited. relocating; or selling a home. Worksite Tools All supervisors have fast access to phone consultations, trainings Identity Theft Services — access support about the EAP and management topics, critical incident in planning the recovery process for response, and online supervisor resources for using the EAP and restoring your identity and credit after making employee referrals during workplace challenges. an incident. MyRBH.com At MyRBH.com you can access current health news, tools for parenting, health topic movies, wellness resources, financial To find out more about your EAP services calculators, legal forms, and over 50 online trainings. call, 866.750.1327, or visit us online at Lunch + Learn Webinars MyRBH.com. Free supervisor and employee webinars are presented each month. Visit MyRBH.com for more information or to register. Archived webinars can be accessed on the RBH YouTube Once you're incode ,use channel. the same accesss ccoode for Personal Advantage. RBH Your MyRBH Access Code is: Reliant Behavioral Health A+0"MMIA MyRBH.com 1866.750.1327 Il� For More Information: Call 1-866-488-7874 Ta ABILIFY DISCMELT 10MG CLIMARA PATCH (G) 76MCG GLEEVEC 100MG NESINA 25MG SUTENT 12.5MG ABILIFY DISCMELT 15MG CLIMARA PRO 0.045/0.015MG GLEEVEC 400MG NEUPRO 1MG SUTENT 25MG ACCOLATE (G) 20MG COMBIGAN 0.2-0.5% GLUCAGEN HYPOKIT 1MG NEUPRO 2MG SUTENT 50MG ACIPHEX (G) 20MG COMBIVENT RESPIMAT GLUMETZA ER 1000MG NEUPRO 3MG SYNAREL NASAL ACTONEL 5MG 20MCG/100MCG IMITREX AUTOINJECTOR STATDOSE NEUPRO 4MG SYNJARDY 5MG/50OMG ACTONEL 30MG COMPLERA 200/25/300MG (G) 6MG/O.5ML NEUPRO 6MG SYNJARDY 5MG/1ODOMG ACTONEL 35MG CORGARD (G) 80MG IMITREX NASAL SPRAY (G) NEUPRO 8MG SYNJARDY 12.5MG/500MG ACTONEL 150MG CRESTOR 5MG 5MG-21DOSE NEXAVAR 200MG SYNJARDY 12.5MG/1000MG ACTOPLUS (G) 15MG-850MG CRESTOR 10MG IMITREX NASAL SPRAY (G) NEXIUM 20MG TABLOID 40MG ACULAR LS SOL (G) 0.4% CRESTOR 20MG 20MG-21DOSE NEXIUM 40MG TARKA 2/18OMG ACZONE 5% CRESTOR 40MG INCRUSE ELLIPTA 62.5 MCG NEXIUM DR 10MG TARKA 41240MG ACZONE 7.5% CRINONE GEL 8% INLYTA 1MG NORITATE CREAM 1% TASIGNA 150MG ADCIRCA 20MG CRIXIVAN 200MG INLYTA 5MG NORVIR TABLET 100MG TASIGNA 200MG ADVAIR DISKUS 100MCG CRIXIVAN 400MG INSPRA (G) 25MG ODEFSEY 200MG-25MG-25MG TASMAR 100MG ADVAIR DISKUS 250MCG DALIRESP 500MCG INSPRA (G) 50MG OLYSIO 150MG TAZORAC CREAM 0.05% ADVAIR DISKUS 500MCG DERMOTIC OIL 0.01% INTELENCE 100MG OMNARIS NASAL SPRAY 50MCG TAZORAC CREAM 0.1% ADVAIR HFA 45/21MCG DESCOVY 20OMG/25MG INTELENCE 200MG ONGLYZA 2.5MG TAZORAC GEL 0.05% ADVAIR HFA 115/21 MCG DETROL LA 2MG INVEGA 3MG ONGLYZA 5MG TAZORAC GEL 0.1% ADVAIR HFA 230/21MCG DETROL LA 4MG INVEGA 6MG ORACEA 40MG TECFIDERA 120MG AFINITOR 2.5MG DEXILANT DR 30MG INVEGA 9MG OTEZLA 30MG TECFIDERA 240MG AFINITOR 5MG DEXILANT DR 60MG INVIRASE 500MG PATADAY 0.2% TEGRETOL (G) 200MG AFINITOR 10MG DIFFERIN CREAM (G) 0.1% INVOKAMET 50MG-500MG PATANOL OPHTH SOL 0.1% TEGRETOL XR (G) 200MG AGGRENOX 200/25MG DIFFERIN GEL (G) 0.1% INVOKAMET 50MG-1000MG PENTASA 500MG TEGRETOL XR (G) 400MG ALOCRIL OPHTH 2% DIFFERIN GEL 0.3% INVOKAMET 150MG-500MG PLAQUENIL (G) 200MG TEKTURNA 150MG ALOMIDE 0.1% DIPENTUM 250MG INVOKAMET 150MG-1000MG PRADAXA 75MG TEKTURNA 300MG ALPHAGAN-P OPHTH SOL (G) DIPROLENE LOTION (G) 0.05% INVOKANA 100MG PRADAXA 150MG TEKTURNA HCT 150-12.5MG 0.15% DIPROLENE DINT (G) 0.05% INVOKANA 300MG PRED FORTE (G)1% TEKTURNA HCT 150-25MG ALREX 0.2% DIVIGEL 0.5MG ISENTRESS 400MG PREMARIN 0.3MG TEKTURNA HCT 300-12.5MG ALVESCO 80MCG 100MCG DIVIGEL 1MG ISOPTO CARPINE 1% PREMARIN 0.625MG TEKTURNA HCT 300-25MG ALVESCO 160MCG 200MCG DOVONEX CREAM (G) SOMCG ISOPTO CARPINE 2% PREMARIN 1.25MG TIVICAY 50MG AMITIZA 24MCG DUAVEE 0.45-20MG ISOPTO CARPINE 4% PREMARIN VAG 0.625MG/GM TOBREX DINT 0.3% ANORO ELLIPTA 62.5/25MCG DULERA 100MCG/5MCG JADENU 90MG PREMPRO 0.3MG/1.5MG TOVIAZ 4MG ANZEMET 100MG DULERA 200MCG/5MCG JADENU 180MG PREMPRO 0.625MG/5MG TOVIAZ 8MG ARCAPTA NEOHALER 75MCG DYMISTA NASAL SPRAY JADENU 360MG PREVACID SOLUTAB 15MG TRACLEER 62.5MG ARNUITY ELLIPTA 100MCG 137/50MCG JAKAFI 5MG PREVACID SOLUTAS 30MG TRACLEER 125MG ARNUITY ELLIPTA 200MCG EDARBI 40MG JAKAFI 10MG PREZCOBIX 800MG/15OMG TRADJENTA 5MG ARTHROTEC (G) SOMG EDARBI 80MG JAKAFI 15MG PREZISTA 600MG TRAVATAN Z OPHTH SOL 0.004% ARTHROTEC (G) 75MG EDARBYCLOR 40MG/25MG JAKAFI 20MG PREZISTA 800MG TRIBENZOR 20/5/12.5MG ASACOL HD 800MG EDECRIN 25MG JALYN 0.5MG/O.4MG PRISTIQ 50MG TRIBENZOR 40/5/12.5MG ASMANEX TWISTHALER 110MCG EDURANT 25MG JANUMET 501500MG PRISTIQ 100MG TRIBENZOR 40/5/25MG ASMANEX TWISTHALER 220MCG EFFIENT 5MG JANUMET 50/1000MG PROMETRIUM (G)100MG TRIBENZOR 40/10/12.5MG ASTAGRAF XL 5MG EFFIENT 10MG JANUMET XR 50MG/50OMG PROTOPIC DINT 0.03% TRIBENZOR 40/10/25MG ATACAND (G) 4MG ELIDEL 1% JANUMET XR 50MG/1000MG PROTOPIC OINT 0.1% TRINTELLIX 5MG ATACAND (G) 8MG ELIQUIS 2.5MG JANUMET XR 100MG/1000MG QVAR 40MCG 50MCG TRINTELLIX 10MG ATACAND (G) 16MG ELIQUIS 5MG JANUVIA 25MG OVAR 80MCG 100MCG TRINTELLIX 20MG ATACAND (G) 32MG ELMIRON 100MG JANUVIA 50MG RANEXA 500MG TRIUMEQ TABLET ATACAND HCT (G)16MG/12.6MG EMADINE 0.05% JANUVIA 100MG RAPAFLO 4MG TRUVADA 200-300MG ATACAND HCT (G) 32MG/12.6MG ENABLEX 7.5MG JARDIANCE 10MG RAPAFLO 8MG TUDORZA PRESSAIR 400MCG ATELVIA DR 35MG ENABLEX 15MG JARDIANCE 25MG RAPAMUNE (G) 0.5MG TWYNSTA 40/5MG ATRIPLA 600-200-300MG ENTOCORT (G) 3MG JENTADUETO 2.5MG-500MG RAPAMUNE (G) 1MG TWYNSTA 40110MG ATROVENT HFA 20UG ENTRESTO 24MG-26MG JENTADUETO 2.5MG-850MG RAPAMUNE (G) 2MG TWYNSTA 80/5MG AUBAGIO 14MG ENTRESTO 49MG-51MG JENTADUETO 2.5MG-1000MG RELPAX 20MG TWYNSTA 80/10MG AVANDAMET 4MG/500MG ENTRESTO 97MG-103MG JUBLIA 10% RELPAX 40MG ULORIC 80MG AVANDAMET 4MG/1000MG EPIDUO GEL PUMP 0.1%/2.5% KAZANO 12.5/1000MG RENAGEL 800MG UROCIT-K (G) 1OMEQ AVANDIA 2MG EPIPEN 0.3MG KOMBIGLYZE XR 2.5MG/1000MG RENVELA 800MG URSO (G) 250MG AVANDIA 4MG EPIPEN JR 0.15MG KOMBIGLYZE XR 5MG/50OMG RESTASIS VIALS 0.05% VAGIFEM 10MCG AVANDIA 8MG EPIVIR (G)160MG KOMBIGLYZE XR 5MG/1000MG RETIN A CREAM (G) 0.05% VECTICAL (G) 3MCG/GM AVODART 0.5MG EPIVIR / HBV (G) 100MG LATUDA 20MG RETIN A MICRO GEL PUMP (G) VENTOLIN HFA 90MCG AXERT 6.25MG EPZICOM LATUDA 40MG 0.04% VESICARE 5MG AXERT 12.5MG ESTROGEL 0.06% LATUDA 60MG RETIN-A MICRO GEL PUMP (G) VESICARE 10MG AZILECT 0.5MG EVISTA 60MG LATUDA BOMG 0.1% VIMOV037520MG AZILECT IMG EXELON 3MG LATUDA 120MG REXULTI 0.25MG VIMOVO50020MG AZOPT OPHTH DROPS 1 % EXELON 6MG LESCOL XL 80MG REXULTI 0.5MG VIRAMUNE XR 400MG AZOR 20/5MG EXELON 4.6MG24HR LEX IVA 700MG REXULTI 2MG VIREAD 300MG AZOR 40/5MG EXELON 9.5MG/24HR LIALDA 1.2GM REXULTI 4MG VIVELLE-DOT 25MCG AZOR 40/10MG EXELON 13.3MG24HR LINZESS 145MCG REYATAZ 150MG VIVELLE-DOT 37.5MCG BACTROBAN NASAL OINT 2% EXFORGE HCT 160/12.5/5MG LINZESS 290MCG REYATAZ 200MG VIVELLE-DOT 50MCG BANZEL 200MG EXFORGE HCT 160/12.5/10MG LIPITOR (G) 10MG REYATAZ 300MG VIVELLE-DOT 75MCG BANZEL 400MG EXFORGE HCT 16025/5MG LIPITOR (G) 20MG SAPHRIS 5MG VIVELLE-DOT 100MCG BARACLUDE 0.5MG EXFORGE HCT 160/25/10MG LIPITOR (G) 40MG SAPHRIS 10MG VOLTAREN GEL BARACLUDE 1MG EXFORGE HCT 320/25/1OMG LIPITOR (G) 80MG SEASONIQUE (G) VYTORIN 10/10MG BECONASE AQ 42MCG EXJADE 125MG LOCOID LIPOCREAM 0.1 % 0.15/0.03/0.01MG VYTORIN 10/20MG BENICAR 20MG EXJADE 250MG LOTEMAX GEL 0.5% SENSIPAR 30MG VYTORIN 10/40MG BENICAR 40MG EXJADE 500MG LOTEMAX SUSP 0.5% SENSIPAR 60MG VYTORIN 10/8OMG BENICAR HCT 20MG/12.5MG FARESTON 60MG LOTRISONE CREAM (G) SENSIPAR 90MG WELCHOL 625MG BENICAR HCT 40MG/12.5MG FARXIGA 5MG 1%/0.06% SEREVENT DISKUS 50MCG XALKORI 200MG BENICAR HCT 40MG/25MG FARXIGA 10MG LOVENOX (G) 40MG SEROQUEL XR 50MG XALKORI 250MG BENZACLIN PUMP FELDENE 10MG LOVENOX (G) 60MG SEROQUEL XR 150MG XARELTO 10MG BETIMOL 0.25% FELDENE 20MG LOVENOX (G) 80MG SEROQUEL XR 200MG XARELTO 15MG BETIMOL 0.5% FETZIMA 20MG LOVENOX (G) 100MG SEROQUEL XR 300MG XARELTO 20MG BETOPTIC S OPHTH 0.25% FETZIMA 40MG LUMIGAN OPHTH 0.01% SEROQUEL XR 400MG XELJANZ 5MG BONIVA (G)150MG FETZIMA 80MG MESNEX 400MG SIMBRINZA 1%/0.2% XELODA (G) ISOMG BREO ELLIPTA 100/25MCG FETZIMA 120MG MESTINON TS 180MG SOLARAZE (G) 3% XELODA (G) SOOMG BREO ELLIPTA 200/25MCG FINACEA GEL 15% METRO CREAM (G) 0.75% SOOLANTRA 1% XIGDUOXR 5/1000MG BRILINTA 60MG FLAREX 0.1% METROGEL PUMP 1% SPIRIVA 18MCG XIGDUO XR 10/500MG BRILINTA 90MG FLOVENT 44MCG 50MCG MICARDIS HCT (G) 40/12.5MG SPIRIVA RESPIMAT 2.5MCG XIGDUO XR 10/1000MG SYSTOLIC 2.5MG FLOVENT 11OMCG 125MCG MICARDIS HCT (G) 80/12.6MG SPRYCEL 20MG ZANAFLEX (G) 2MG SYSTOLIC 5MG FLOVENT 220MCG 250MCG MICARDIS HCT (G) 80/25MG SPRYCEL 50MG ZELAPAR 1.25MG SYSTOLIC 10MG FLOVENT DISKUS 100MCG MIGRANAL NASAL SPRAY 4MG/ML SPRYCEL 70MG ZETIA 10MG SYSTOLIC 20MG FLOVENT DISKUS 250MCG MIRAPEX ER 0.375MG SPRYCEL 100MG ZOMIG NASAL SPRAY 5MG CADUET (G) 5/1OMG FORADIL + AEROLIZER 12MCG MIRAPEX ER 0.75MG STIOLTO RESPIMAT 2.52.5MCG ZORTRESS 0.25MG CADUET (G) 6/20MG FOSRENOL CHEW 500MG MIRAPEX ER 1.5MG STIVARGA 40MG ZORTRESS 0.5MG CADUET (G) 5140MG FOSRENOL CHEW 750MG MIRAPEX ER 2.25MG STRATTERA 10MG ZORTRESS 0.75MG CADUET (G) 10/10MG FOSRENOL CHEW 1000MG MIRAPEX ER 3MG STRATTERA 18MG ZOVIRAX CREAM 5% CADUET (G)10120MG FOSRENOL POWDER 750MG MIRAPEX ER 3.75MG STRATTERA 25MG ZYCLARA 3.75% CAMBIA 50MG FOSRENOL POWDER IOOOMG MIRAPEX ER 4.5MG STRATTERA 40MG ZYTIGA 250MG CARDIZEM CD (G) 360MG FROVA 2.5MG MIRVASO 0.33% STRATTERA 60MG CARDIZEM LA (G) 180MG GELNIQUE 10% MULTAQ 400MG STRATTERA 80MG CARDIZEM LA (G) 360MG GENVOYA 150-150-200-10MG MYRBETRIQ 25MG STRATTERA 100MG CARDURA XL 4MG GILENYA 0.5MG MYRBETRIQ 50MG STRIBILD CARDURA XL 8MG GILOTRIF 20MG NASONEX 50MCG SUSTIVA 50MG CLIMARA PATCH (G) 25MCG GILOTRIF 30MG NESINA 6.25MG SUSTIVA 200MG CLIMARA PATCH (G) SOMCG GILOTRIF 40MG NESINA 12.5MG SUSTIVA 600MG NOTE: Medication names appearing with (G) are available in a Generic version from your local or U.S. mail order pharmacy. This list is subject to change. Please call 1-866-488-7874 toll free to verify the availability of your medication through this program. November 2017 GET THY. 11/iMIAI El-oployee Benefits HealthSpective WELLNESS PROGRAM 2018 Engage httpsa//portaLhealthspective, com/mmia The MMIA Employee Benefits Program is continuing to build on its successful Wellness Program. In 2018, we are making some changes to make the program even more effective. Big Changes • Five new incentive categories reward you for taking proactive steps to improve your health and make the most of your benefits. A new way to trackyour well-being. Register on the HealthSpective Engage portal found at https:./,[portal.healthspective.com/mmia. This system shows what incentives you've earned, your screening results, and more. No physical gift cards. You must log into the Engage portal at to access your incentive. You can select from multiple vendor gift cards, direct deposit to your bank account, or a combination of both. Incentive Activities i_ You must register in the Engage portal in order to access your incentive. Seem ore d etails on each activity and how to register for the portal on the next page or by visiting www. m m ia. n et�aetwell thy. &+ $50 —Fill out the Health Risk Assessment and watch a short video on the Engage platform. $50 — Get a biometric screening through It Starts With Me or the Montana Health Center between July 1 and September 30. Mve� $50 — If 80% of eligible employees get health screenings, all eligible employees, spouses and retirees who get health screenings will get an extra $50. O$50 — Engage with a Get Wellthy Health Coach. 0 $50 — Get an immunization or preventive cancer screening. The Fine Print Total Possible Incentive: $250 In order to receive an incentive, you must be enrolled on an MMIA medical plan and registered with the Engage portal. If you are no longer on an MMIA plan, you will not have access to Engage and will not be eligible to receive an incentive. Montana Municipal Interlocal Authority Employee Benefits reserves the right to alter the Wellness Program at any time. This program is developed in compliance with the EEOC wellness rules and does not violate anti -discrimination laws as determined by the Americans with Disabilities Act and Genetic Information Nondiscrimination Act. Participation in this program is voluntary. MMIA maintains the privacy and security ofyour personally identifiable health information. For more information, visit www.nivnia.rnet/eeoc-notice% AL Montana Municipal Interlocal Authority EMPLOYEE BENEFITS PROGRAM ENROLLMENT FORM Please fax to: 406-449-7440 or submit to: PO Box 6669 — Helena, MT 59604-6669 Please use this form for New Enrollments, Changes and Terminations- disregard all previous Enrollment, Change & Termination forms Please mint clearly on entire form. Last Name First Name Initial Work Phone Home Phone Cell Phone Current Address City State Zip SECTION 3 N OTHER INSURANCE: Will you, your spouse or your children have any other coverage while on any of the coverages listed above? If yes, please provide the required information below: Employer Name, Insurance Carrier Name & Address Employee's Email Address: Employer Group Number: SECTION 1 - Please fill out the section below that applies to anew enrollment, enrollment changes or termination of coverage if waiving coverage stop here and proceed to the back side of this form Part - New Enrollment Part 8 - Enrollment Changes Event Date Effective Date of Coverage: First Day of Work: Hours worked per week: Plan Status: ❑ Active Employee ❑ Retiree ❑ Elected Official ❑ Surviving Spouse Marital Status: ❑ Single ❑ Married ❑ Divorced ❑ Widowed ❑ Separated Medical Plan Choice - Please check only one appropriate box below: ❑ Bridger ❑ Madison ❑ Mission ❑ HDHP ❑ Custom Add/Drop spouse or dependent (Open enrollment & Qualifying Event Only) Medicare eligible provide copy of card or letter ❑ Retiree Status ❑ ❑ Death Other (reason): ❑ Ineligible Dependent (reason): ❑ ❑ Address Change (former address): Name Change (former name): Part C - Termination ofCovera a Ifstaying on coverage as a retiree see Part B Medical Plan Choice - Open Enrollment & Qualifying Events Only ❑ Bridger ❑ Madison ❑ Mission ❑ HDHP ❑ Custom (if applicable) Last day worked Last day eligible for benefits ❑ Voluntary by employee ❑ Involuntary by employer Type of Qualifying Event (Term, Resignation, Reduce Hrs, Death): Coverage will end the last day of the month in which employee was terminated. Must provide supporting legal documentation of divorce, marriage, adoption, etc. with this form Notes: Use this se2ce for clarification on anZ of the above SEC7ION2� rNDrc4irENRoumeNrRrQUESTS$YCHELKINGONLYBOXESTHATAPPLY7VCVRRENTCHANCE(S)ORNEWENROLLMENr Note: Yourgroupmaynotoftrallcoverageslirted FIRST MI LAST SOCIAL SECURITY # (Required)DATE New enrollee - must complete employee info also OF BIRTH RELATIONSHIP heh g�a� Q0c �yti `�Qjm ,o add Drop Add I D p AM JD,. -1 Drop Add Dg Employee: ❑ ❑ ❑ ❑ ❑ 01010101010101 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ Spouse: Child(ren): (list) NOTE: IF YOU OR YOUR DEPENDENTS ARE ENROLLING DUE TO A LOSS OF OTHER COVERAGE, PLEASE ATTACH VERIFICATION OF CREDITABLE COVERAGE PARTICIPATION CERTIFICATION: I CERTIFY THAT THE ABOVE ANSWERS ARE TRUE TO THE BEST OF MY KNOWELDGE AND 1 HAVE READ AND UNDERSTAND THE PARTICIPANT AUTHORIZATION AND STATEMENT OF HIPAA PORTABILITY RIGHTS ON THE REVERSE SIDE OF THIS FORM. 1 HEREBY AUTHORIZE MY EMPLOYER TO DEDUCT FROM MY EARNINGS ANY REQUIRED CONTRIBUTIONS FOR THE COST OF BENEFITS FOR WHICH I AM OR MAY BECOME ELIGIBLE. Participant's Signature (New enrollment or changes only) Date: Please refer to reverse side of form Rev. 4/13/17 SECTION 3 N OTHER INSURANCE: Will you, your spouse or your children have any other coverage while on any of the coverages listed above? If yes, please provide the required information below: Employer Name, Insurance Carrier Name & Address ❑ Yes ❑ No Self TYPE OF COVERAGE MED DEN VIS Spouse ❑ ❑ ❑ Child (ren) ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ PARTICIPATION CERTIFICATION: I CERTIFY THAT THE ABOVE ANSWERS ARE TRUE TO THE BEST OF MY KNOWELDGE AND 1 HAVE READ AND UNDERSTAND THE PARTICIPANT AUTHORIZATION AND STATEMENT OF HIPAA PORTABILITY RIGHTS ON THE REVERSE SIDE OF THIS FORM. 1 HEREBY AUTHORIZE MY EMPLOYER TO DEDUCT FROM MY EARNINGS ANY REQUIRED CONTRIBUTIONS FOR THE COST OF BENEFITS FOR WHICH I AM OR MAY BECOME ELIGIBLE. Participant's Signature (New enrollment or changes only) Date: Please refer to reverse side of form Rev. 4/13/17 Enrollment: Enrolled Employees: 67 If enrollment differs by 10°% or more, the rate guarantee is void and subject to a new rating evaluation. If plan(s) quoted below are not purchased with 75 days of effective date stated above, the rate guarantee is void and subject to a new rating evaluation. Contract Period: 12 month rate only Medical Deductible Credit: Included at no charge Medical OOP Credit: NOT Included, unavailable option Rx, Dental, Vision and other deductible and OOP credits are not available. Commissions: 1.32% COBRA Administration: COBRA administration through PacificSource Administrators is included in premium. Eligibility: Employees must work a normal workweek minimum of 20 or more hours PacificSource requires a minimum of 75% of all eligible employees to participate in the plan. Note: Waiving to Individual coverage is counted against participation • PacificSource requires that the employer contribute a minimum of 75% to the employee rate or 50°x6 of the total rate. Based on the information submitted, this is at 100% EE and fixed varying amount for dep and must be maintained by employer. Yes No ✓ Are there retirees under 65 (Early Retirees)? ✓ Are there retirees over 65 (Medicare Eligible)? ✓ Are there COBRA participants? Other: Refer to Value Added Services Quote Information: Standard PacificSource benefit structure, limitations and exclusions apply. Yes No ✓ Matching, as best as possible, Groups Ded/Coins/OOP/Copay structure ONLY? ✓ Benefits are Standard "chassis" PacificSource structure, limitations and exclusion? ✓ Matching Groups current benefit limitations and exclusions? ✓ if applicable, is the Copay bundling option defined (PS Standard, Option B, Option A)? MDL Rx Formulary? Which Copay bundling option? Any other Notes: ER Copay match does not apply i f icSDUCCe 31u,LT,4 PA.NS Date Printed: May 31, 2018 Group Name: City Of Laurel Effective Date: July 1, 2018 Agent: EdcAilen Enrollment: Enrolled Employees: 67 If enrollment differs by 10°% or more, the rate guarantee is void and subject to a new rating evaluation. If plan(s) quoted below are not purchased with 75 days of effective date stated above, the rate guarantee is void and subject to a new rating evaluation. Contract Period: 12 month rate only Medical Deductible Credit: Included at no charge Medical OOP Credit: NOT Included, unavailable option Rx, Dental, Vision and other deductible and OOP credits are not available. Commissions: 1.32% COBRA Administration: COBRA administration through PacificSource Administrators is included in premium. Eligibility: Employees must work a normal workweek minimum of 20 or more hours PacificSource requires a minimum of 75% of all eligible employees to participate in the plan. Note: Waiving to Individual coverage is counted against participation • PacificSource requires that the employer contribute a minimum of 75% to the employee rate or 50°x6 of the total rate. Based on the information submitted, this is at 100% EE and fixed varying amount for dep and must be maintained by employer. Yes No ✓ Are there retirees under 65 (Early Retirees)? ✓ Are there retirees over 65 (Medicare Eligible)? ✓ Are there COBRA participants? Other: Refer to Value Added Services Quote Information: Standard PacificSource benefit structure, limitations and exclusions apply. Yes No ✓ Matching, as best as possible, Groups Ded/Coins/OOP/Copay structure ONLY? ✓ Benefits are Standard "chassis" PacificSource structure, limitations and exclusion? ✓ Matching Groups current benefit limitations and exclusions? ✓ if applicable, is the Copay bundling option defined (PS Standard, Option B, Option A)? MDL Rx Formulary? Which Copay bundling option? Any other Notes: ER Copay match does not apply .:fBII® O. - HEALTH FLANS Citv of Laurel Rates: Medical Plans: PSN 500 2520 2500 $779.77 $1,729.93 $1,240.65 $1,967.66 $584.83 $1,169.66 2x Family Ded/OOP Rx 100, 10/40160% to $200 2x Mail Order Note: EAP is not included Benefit Period: Calendar Year PSN 1500 35_30 PSN 1000 25_20 3500 2500 $701.93 EE $746.91 $1,557.63 $1,295.02 ES $1,657.02 $1,788.82 $1,487.62 EC $1,188.36 $1,052.90 EF $1,903.89 Rx 100, 10/40160% to $200 2x OON Ded/OOP Smed $560.18 Prev Rx 2P Med $1,120.36 2x Family Ded/OOP Rx 100, 10/40/60% to $200 2x Mail Order PSN 500 2520 2500 $779.77 $1,729.93 $1,240.65 $1,967.66 $584.83 $1,169.66 2x Family Ded/OOP Rx 100, 10/40160% to $200 2x Mail Order Note: EAP is not included Benefit Period: Calendar Year PSN 1500 35_30 3500 PSN 3500+Rx $701.93 $583.61 $1,557.63 $1,295.02 $1,115.14 $927.94 $1,788.82 $1,487.62 $526.45 $1,052.90 2x Family Ded/OOP 2x Family Ded/OOP Rx 100, 10/40160% to $200 2x OON Ded/OOP 2x Mail Order Embedded Ded Prev Rx Conditions: ✓ Offer assumes the contract situs and issuance of contract is in Montana This quote assumes PacificSource will be the only carrier providing coverage to the employer group's employees Open Enrollment will be one month prior to the renewal date ✓ Regulations require PacificSource to determine, based on the information provided in the quoting process, whether an employer is subject to Chapter 26 of the Montana Code Annotated. This proposal is made on the condition you are not a Small Employer ✓ Employer will promptly notify PacificSource of any change in participation and Employer contribution ✓ ACA established a number of taxes and fees that are incorporated into your premiums. Two of those fees are: (1) the Annual Fee on Health Insurers or "HIT(Health Insurer Tax)": and (2) the Transitional Reinsurance Fee. Both fees began in 2014. (1) Section 9010(a) of ACA requires that ("health insurers") pay an annual fee to the federal government, commonly referred to as the Health Insurer Fee. The amount of this fee will be determined by the federal government. This fee helps fund premium tax credits and cost-sharing subsidies offered to certain individuals who purchase coverage on health insurance exchanges. As of late 2015, this fee currently has been suspended for 2017 only. The fee still applies in 2016 and, pending any further legislation, could recontinue in 2018. (2) Section 1341 of ACA provides for the establishment of a temporary reinsurance program (for a three year period (2014-2016) which is funded by Reinsurance Fees collected from health insurance issuers and self-funded group health plans. Federal and state governments provide information as to how these fees are calculated. Federal regulations establish a flat, per member, per month fee. The temporary reinsurance programs, funded by these Reinsurance Fees, help to stabilize premiums in the individual market. fieair:Sdurce corn fD�) Pacif icS.ource Outline of Coverage HEALTH PLANS PSN 500+25_20 S2 City of Laurel Option B Bundling This outline of coverage provides a very brief description of important policy features. Please note: this outline is not intended to be part of the insurance contract. Only the actual policy provisions are final and binding. The policy details your rights and obligations, as well as those of PacificSource. PLEASE READ YOUR MEMBER HANDBOOK CAREFULLY. Provider Network: PSN ,W"r Oir �4 I N A j3fflwa , ' N P zlffil �Wv All Provid 6 rs' er?r�an� Pew e woaNalififfia 10-4,11smiMan A' Please note: Your actual costs for services provided by a non -participating provider may exceed this policy's out-of-pocket limit for non -participating provider services. In addition, non -participating providers can bill you for the difference between the amount charged by the provider and the amoun allowed by the insurance company, and this amount is not counted toward the non -participating out- of-pocket limit. Trend Data PacificSource bases large group premiums on data accumulated from the entire Montana large group population. Certain factors such as demographics are incorporated into the rating process. PacificSource bases trend projections on a combination of PacificSource Montana large group data and the PacificSource Oregon group book of business. The large group premium increases for the last five years were 2017 7.4%, 2016 15.0%, 2015 4.6%, 2014 10.1 %, and 2013 9.7%. The member is responsible for the above deductible and the following amounts: Service Well baby/Well nnnnll child caret Preventive physicals Well woman visits No charge* "ohge�� Preventive mammograms Immunizations Preventive colonoscopy No charges Prostate cancer screening Qtz Office and home visits W e 0 rfab No Uma ra Naturopath office visits Specialist office and home visits . . . . . . . . . . . . . . . . . . Telemedicine visits : ig pW_,__,7� HCHT 07,RE, 'y PSGOOCIVITIG.0118 Service Office procedures and Surgery Outpatient rehabilitation Deductible then 209/o coxmsurance D �tr3ti • e ` o co=f: js �a,e services Y z t�ospataf�Servaces ,� �,.•. ��, �-� � �� �j� �� Inpatient room and board Deductible then 20%0'co msurance eb'ef a oo -� ra°ce' Inpatient rehabilitation Deductible then 20% co msurance �D -u b e' " sf° ra k f services Skilled nursing facility care �D`eductibI then 20% co msurance"�D C uc b e t. era ° a sura ee _ _ I;,- ,$,v'c.,y.,:: € v 3.":.».5*^'3 t rx✓,n tr'" `^y ,tz, ^='y "`c`., a.: z3�: xis. -S, x.; s� x' ,� ?''t.,i ya".,,•sr, ,,.,r >tJutpat�enSeruices� Outpatient surgery/services Deductible then x20% co msurance �De : uo i e= ' . x M cox x Advanced diagnostic Deductible then 20% co °insurance "educfitb:: e; ao msu se ima in Diagnostic and therapeutic Deductible then 20% co insurance kDeci c he 36°o G t s ra a�e radiology/lab tl�rgentand Emergency Services _ . 4* . E_ urgent care center visits $25 co pay/visit*"'Al e,�d�c1719-A,1-- ante Emergency room visits — Deductible then $100 co pay/visit bedrei . e en1t00wco a> ;Ives medical emergency lus 20°l0 `co insurance^ s0°�0Q 'lea Emergency room visits — Deductible then $100 co pay/visa: ODed tib: e . Q0 co /ups t non -emergency i,_Ius,20°t° co.,msuraace^o co res r= ce Ambulance, ground Deductible then 20�o eo insurance Ambulance, air Deductible then' 20°lo co insurancet►b e0° cod �a cel r moms� a e xMaterniterv�ce vx Physician/Provider services Deductible then 2Q% cormsurand T- -0o ceDetib� h0IW; 5°l�#c tt�s a� , lobal charge)_ - Hospital/Facility services Deductible then 2(J% co msuranceeuct� e e ° _ tclSura :v:� ., .`*..z i.. k>=� '�`�e:-;''� sfiy ,� "�`' r..;. sf>� s .'i "S`"^.."-k`..r,'.:_� -��i a�+,t,zH•ra j �'��e•i,�r��"'-,�^ :.'e�:;�.�`:,.,,,.y,:.c_..+`_^'x+..mak<.}cY<.,.,,,.::.�.:a.ac..�' rx v'sz�iC�✓ »i. z.a'� .�t-3.,^u�+....d's>t`X-Y�.. '.a. --1, ,>: `-v -r .. .. ^.y-rT`ev.wx�.4."r"�;.�^ Si&�L�`dti.�i .� ur =s Office v�s�ts t _- � w $25 co pay/visa De • ��#E� � . t 'L Inpatient care petluct�ble then 20°lotto ms arance DP7,ge rf l' e:: 5i°� ,d" ���d Residential programs Deductible then 20% co msurancee; _ 5°0 �o t�►s �� Allergy mtections � $5 co pay/visit � �,� �;�.,���., Durable medical a ui ment 'Deduct�ble�-then 20°/a co �ipsurance� ®eot�b e •� ,� .o o= x spa a � ee�, Home ealth care Deductiljle then 20%Jco msurance -ed. a `x a e: or me Chiropractic manipulations, p pgY 4 F x$25 co pay/ isit ®e e b l or and acupuncture r s Transn(anfis De'ductibleathen.,Noicharge r 'Dtl tc;`, e `:.ergle®rrne This is a brief summary of benefits. Refer to your handbook for additional information or a further explanation of benefits, limitations, and exclusions. ^ Co -pay waived if admitted into hospital. PSGOOC.MT.LG.0118 * Not subject to annual deductible. + Non -participating air ambulance coverage is covered at 200 percent of the Medicare allowance, except as required by law. You may be held responsible for the amount billed in excess. Please see your handbook for additional information or contact our Customer Service team with questions. PSGOOC.MT.LG.0118 Pac® o i i Prescription Drug Benefit Summary HEALTH PIANS MT 10-40-60P 100D S2 MDL City of Laurel This PacificSource health plan includes coverage for prescription drugs and certain other pharmaceuticals, subject to the information below. This plan complies with federal health care reform. PRESCRIPTION DRUG DEDUCTIBLE $100 per person The deductible is an amount of covered pharmacy expenses the member pays for brand medications each calendar year before the following benefits begin. Co -payments, differential between brand and generic drugs, drugs obtained without using the PacificSource member ID card, and non -participating pharmacy charges do not accumulate toward the deductible. The deductible does not apply to Tier one drugs. The amount you pay for covered prescriptions at participating and non -participating pharmacies applies toward your plan's participating medical out-of-pocket limit, which is shown on the Medical Benefit Summary. The co -payment and/or co-insurance for prescription drugs obtained from a participating or non -participating pharmacy are waived during the remainder of the calendar year in which you have satisfied the medical out-of-pocket limit. Each time a covered pharmaceutical is dispensed, you are responsible for the amounts below: _ u ParticipatingPharmacy^ x` >j Deductible then the Deductible then Up to a 30 day supply: $TO co pay* - lesser of $200 co pay $40 co pay Pa`rtic►pat►ng_Ma�1 Carder PharmacY_...�_: ' `_ d_.,_._.ti ,_ ___ ... _t:.. ___�_.� w ,_. z.:. �. ..._ .. :;:4-,. Deductifjle thenYthe Deductible then Up to a 30 day supply: $10 co pay* lesser of $200 co pay $40 co pay or 60%, co insurance: then Detluctible theri the 31 — 90 day supply: $2'0 co pay* --Deductible lesser of $400 co pay $80. co pay or�601°_co insurance= Non art�c� at�n Ptiarmac �< 30 day max fill, no more than Deductible then 90% co insurance three fills allowed per year: Tier 4 Spectalfy Drugs Partic�patmg 5pec�alty Pharmacy - << Up to a 30 day supply: Deductible then the lesser of $200 co pay or 20%' co insurance Tier 4 Specialty Drugs Not fi![ed through Parflc�pating Specjait Pharmac � ' '�' 30day max fill, no more than - � f ° Deductible then 90 /° co insurance Up to a 30 day supply: Deductible then the lesser of $200 co pay a`r 60% co insurance ^ Remember to show your PacificSource member ID card each time you fill a prescription at a retail pharmacy. If your ID card is not used, your benefits cannot be applied and may result in higher out-of-pocket cost. * Not subject to annual prescription drug and/or medical deductible. "Compounded medications are subject to a preauthorization process. Compounds are generally covered only when all commercially available formulary products have been exhausted and all the ingredients in the compounded medication are on the applicable formulary. MAC B - Unless the prescribing provider requires the use of a brand name drug, the prescription PSGBS.MT.LG.RX.0118 will automatically be filled with a generic drug when available and permissible by state law. if you receive a brand name drug when a generic is available, you will be responsible for the brand name drug's co -payment andlor co-insurance plus the difference in cost between the brand name drug and its generic equivalent after the deductible is met. If your prescribing provider requires the use of a brand name drug, the prescription will be filled with the brand name drug and you will be responsible for the brand name drug's co -payment andlor co-insurance after the deductible is met. The cost difference between the brand name and generic drug does not apply toward the medical plan's deductible or out-of-pocket limit. See your member handbook for important information about your prescription drug benefit, including which drugs are covered, limitations, and more. PSGBS.MT.LG.RX.0118 Outline of Coverage PSN 1000+25_20 S2 City of Laurel Option B Bundling This outline of coverage provides a very brief description of important policy features. Please note: this outline is not intended to be part of the insurance contract. Only the actual policy provisions are final and binding. The policy details your rights and obligations, as well as those of PacificSource. PLEASE READ YOUR MEMBER HANDBOOK CAREFULLY. Provider Network: PSN { All Providers $1,000 $2,000 e o o I 10 11 0MR All Providers $2,500 $5,000 Please note: Your actual costs for services provided by a non -participating provider may exceed this policy's out-of-pocket limit for non -participating provider services. In addition, non -participating providers can bill you for the difference between the amount charged by the provider and the amount allowed by the insurance company, and this amount is not counted toward the non -participating out- of-pocket limit. Trend Data PacificSource bases large group premiums on data accumulated from the entire Montana large group population. Certain factors such as demographics are incorporated into the rating process. PacificSource bases trend projections on a combination of PacificSource Montana large group data and the PacificSource Oregon group book of business. The large group premium increases for the last five years were 2017 7.4%, 2016 15.0%, 2015 4.6%, 2014 10.1 %, and 2013 9.7%. The member is responsible for the above deductible and the following amounts: Service .. . - . . - Prevent�ve Care Well baby/Well child care No charge*. P 35 o c=insurance � _ IRONER Preventive physicals No charge*35%"corrsV ce�`"�� Well woman visits No charge Preventive mammograms No char e*rgN g. Nochr eNIM Immunizations No",' t ;Noc_hage �y #-0 Preventive colonosco No char e.Deductible t e ,35oca=i 3 sur=.aCr�ce PY Prostate cancer screeningNo char e� ,_ �"5°lo cans nce Office and home visits $25 co a Ivisit� De�uct� ie�t e ���� _ .* "cam-�-�, •�'Y'• `-w,z�"�.;`v�. 3rd'~` '3 :",�'i.�`'.�`� �� Naturopath office visits $25 co,pay/Visit rDe�d��b�hen,�3o,��eo�s�u,ra��,��-. S ecialist office and home p$25 co paylvis�t ®educt�blethe X35% on nce visits Telemedicine visits $25 co paylVisit �Dedue�thefr3:5 Qco�njura PSGOOC.MT.LG.0118 Service - Office procedures and No charge supplies Deductible then 2Q% co insurance icflbfe ./0. co ace Surgery r Outpatient rehabilitation Deductible co ble t= x'35°0 aQ srance Cheri 20°lo insurance 19e0uct services y+y s,"^.ssFf r3r.� T l'S x. ..ii' ta' i'• i fit~ S Y''.4 f,}S'jI Hos�Jltal Servrces ys"M�Tr .,.„ .+, 1 +R yF..�kf.` 20%Tco insurance WAdctibee°o Inpatient room and board Deductible Cheri Inpatient rehabilitation then 20% co insuranceDeductible to ^ l ors r 'ce r Deductrble services Skilled nursing facility care so Deductible Cheri 20% co insurance; Deductib efhe�3�a�lco[risrance + ;.h.... v"b. x- $ 'h My f. �' $�hv`L,r'+'....t^z �. [Sa Servrces _, x $ _ P, 99 - .... r� Outpatient surgery/services Deductible then 20% co rnsurance p duciblethr35°omsunce Advanced diagnostic g t ~z., .9 o �Coms Deductrble then 20 /°co insurance peductrbleEM—Mid Imaging in �61 �-2581 NO - Diagnostic and therapeutic s � �� � Z. rnsura"nee Deductible then 20% co insurance ,Deuctiblehera35 �o co radiology/lab llrgen%Land Emergency Serurces Urgent care center visits tl �i � +Y{f1'�`�'a+.�*J+.3i;1b $25 co pay/visit* Deduct�bleJIM 5°Icotsurarrce Emergency room visits — ...� 'i+Pa'i>t:.# i `�. M Deductrble then $100 co pay/visrt Deductrble t en �1rOQ pay v9 �x medical emergency lus 20% Co rnsurance" lusfl20 eco has r�ar� Emergency room visits — Deductible then $100 co a /visitDeductrble#he= 00 co a visits>> ius 20% co rnsurance" lus5/o non -emergency Ambulance, ground W.. Deductrble then 20°I° co rnsurance = e�uctible�20°00ra i Deductrble then 20 /o°co insuranceDeducrblt e (°o c,�r she+ Ambulance, air Physician/Provider services 20°10 '®�ed:uct„�ble°;then35'%' onsuapce Deductrble then co insurance _.�::� ce Deucfib e en then 20%:66insuranzn Hospital/Facility services Deductrble Menta Nealh'/Ctiemrcal Dependency ServicesY�� 'G '•"m " r*LTt+� �.3... f 'S _-.......,a.3. ...-.... .ex...3.....C. .. ..._.d.-.. ._-..:i» _ 1. "i /vrsit�pe ctrb e`t�e a at�ce /?�� Office visits $25 co a g35°.0� P.,. Y.�p ��� _ �`'�.�.a+, Deductrble Cheri 20%o co rnsurance �Dedu�rle s pQoa ansuan,e Inpatient care }35 a rMqo Deductrble then 2Q% co rnsurance{� educ�b�,11e� suan�c Residential programs Other�C`ouered rSeruices � � � � " � ' ; � Deducfible,h,;,e�,3�.%c"ai�t1s Tanc�e Allergy in�ectrons _,$5.co..pay/visit* __ _ then 20%`co rnsurance �D��u�fif? e fly x'�� �%o ��`�ns"'�nce Durable medical equipment Deductrble Deductible then 20% coinsurance �uetrllet� ®� e Home health care Chiropractic manipulations c $25 co pay/visit e� e' ctrble t e .. 5Y� ' ,o S r nee i and acupuncture Deductible then No char e edu�ctr e the.5%0 ori s:. ren e g i Transplants _w.. ,._ ... , «: � :-1 r x This is a brief summary of benefits. Refer to your handbook for additional information or a further explanation of benefits, limitations, and exclusions. " Co -pay waived if admitted into hospital. PSGOOC.MT.LG.0118 * Not subject to annual deductible. + Non -participating air ambulance coverage is covered at 200 percent of the Medicare allowance, except as required by law. You may be held responsible for the amount billed in excess. Please see your handbook for additional information or contact our Customer Service team with questions. PSGOOC.MT.LG.0118 -Paciti.c.Source. HEALTH PLANS Outline of Coverage PSN 1500+3530 S2 City of Laurel Option B Bundling This outline of coverage provides a very brief description of important policy features. Please note: this outline is not intended to be part of the insurance contract. Only the actual policy provisions are final and binding. The policy details your rights and obligations, as well as those of PacificSource. PLEASE READ YOUR MEMBER HANDBOOK CAREFULLY. Provider Network: PSN All Providers $11500 $3,000 All Providers $3,500 $7,000 Please note: Your actual costs for services provided by a non -participating provider may exceed this policy's out-of-pocket limit for non -participating provider services. In addition, non -participating providers can bill you for the difference between the amount charged by the provider and the amount allowed by the insurance company, and this amount is not counted toward the non -participating out- of-pocket limit. Trend Data PacificSource bases large group premiums on data accumulated from the entire Montana large group population. Certain factors such as demographics are incorporated into the rating process. PacificSource bases trend projections on a combination of PacificSource Montana large group data and the PacificSource Oregon group book of business. The large group premium increases for the last five years were 2017 7.4%, 2016 15.0%, 2015 4.6%, 2014 10.1 %, and 2013 9.7%. The member is responsible for the above deductible and the following amounts: Service i Z Well woman visits ff Preventive mammograms No char �- SM 0- 1 Immunizations No charge*` NUMMca r e IS m Preventive colonoscopy Gfac, - Us, n Prostate cancer screeningcharge MEN Office and home visits `; $35 co pay/visit* _ Deduct�e;E ern X4`5°o�e�os�ra7� Naturopath office visits $ 5 co 'pay/visa `ec% � (able . . . . . . . . . . . . .... c e Specialist office and home IN :142000 100 Isi ;PI6 $35 co pay/visit IN_ q 1-0 IWO. visits zm% 64 ,�_1'4_0W._1___, N - WN M Telemedicine visits ImUrance PSGOOC.MT.LG.0118 Service - Office procedures and supplies Surgery . _ Ded_ uctible=then 30% co ms°urance = e_dcehe '°o Ycsu ;range- Outpatient rehabilitation o Ue ible t e a� /o Deductible then 30 /o co msurance. De'��` � . ° �' F _ =''s ranee services�� Deductible then`30% co InsuranceDe �i��tiblhe 4�5�°�,o coo insu�'''an e Inpatient room and board Inpatient rehabilitation Deductible ther130n/o co insurance �ped`uctibl��thert,'���'lo e� .�u a services - , Skilled nursing facility care Deductible then 30% co insurance. Dedoctib e��`5crnce - 5.,. A wkC""-�'A`'lr.L S` .•a 'ii..•ff .A "^-txc x t vd a ..., then 30% co insurance`,®ecttileN h4' Qansu arse Outpatient surgery/services Deductible Advanced diagnostic Deductible then 30% co msurance,DeductibJe�te:`A5%coRinsuYance; imaging Diagnostic and therapeutic Deductible then 30°l° co insurance Dedcf b1ei5°ate opsrace radiology/lab _ ll? { rgent`:and Emergency Services /v'isit* `Deuctible Mien X45°loeoinsuraee Urgent care center visits $35 co a p Y sL Emergency room visits - Deductible then $100 co pay/visit (Deductiplehen 100 coayus�f medical emergency (us 30 /o 'ca msurancei e 30°�eornsurance Emergency room visits - Deductible then $100 co pay/visit�Deuctibleihein�fQO co�payluisi. 30% co insurance" �is4°lam c�o�rns�ra�rLce�� non-emergencylus Ambulance, ground °� Deductible then 30 /° co msurance �Ded�rtle *e0lco i�nsance Ambulance, air Deductible then 30% co msurance L ecrble thriOQ/oInsu ac -Ni I,.,, ..L -.� z,,.ep ., : 3 zg- �Matern`ty=Servicesx Physician/Provider services D� , then /o emt Deductible then 30% co msurance ctib e Deductible then 30% co msurance De iitibiie 5 odons�M-an e Hospital/FaciUty services � �De�d et�be�e,� 5o ca��. uVtrace Office visits < � $35 ca pay/Visit* .. _ . L Detluctiblethen `30%o'co msurance Dec�u�ble�PP•e�5�.o.c�o ins,`�ira Inpatient care then 30%"co InsuranceDgc#�b7e er�5°o co �t !e Residential programs ;Deductible the Covered Sexu�cesr Tx Z Deduct�tthe'4;o,.era cri e Allergy injections $5 co a /visit* �duc%a140°l�o 30%co co Durable medical equipm ent _Deductible then insurance ,a Deductible then 30% co msurance �I3edac be o o ns = ra ee Home health care Chiropractic manipulations the 5% a�msur cel $35 c. yvisit* Deductible t pal�� and acupuncture x Deductible thenyN6,36 hagedctiblethe ' 4 % co tr�s�trance Transplants , This is a brief summary of benefits. Refer to your handbook for additional information or a further explanation of benefits, limitations, and exclusions. " Co -pay waived if admitted into hospital. PSGOOC.MT.LG.0118 * Not subject to annual deductible. + Non -participating air ambulance coverage is covered at 200 percent of the Medicare allowance, except as required by law. You may be held responsible for the amount billed in excess. Please see your handbook for additional information or contact our Customer Service team with questions. PSGOOC.MT.LG.0118 P a i o • r. HEALTH PLANS City of Laurel Outline of Coverage PSN HSA 3500+Rx S2 This outline of coverage provides a very brief description of important policy features. Please note: this outline is not intended to be part of the insurance contract. Only the actual policy provisions are final and binding. The policy details your rights and obligations, as well as those of PacificSource. PLEASE READ YOUR MEMBER HANDBOOK CAREFULLY. Provider Network: PSN B A A i 6Fixe r€. Participating Providers $3,500 $7,000 Non -participating Providers $7,000 $14,000 _ .. s ® physicals e Participating Providers $3,500 $7,000 Nan -participating Providers $7,000 $14,000 Please note: Participating provider deductible and out-of-pocket limit accumulates separately from the non -participating provider deductible and out-of-pocket limit. Even though you may have the same benefit for participating and non -participating providers, your actual costs for services provided by a non -participating provider may exceed this policy's out-of-pocket limit for non -participating provider services. In addition, non -participating providers can bill you for the difference between the amount charged by the provider and the amount allowed by the insurance company, and this amount is not counted toward the non -participating out-of-pocket limit. Trend Data PacificSource bases large group premiums on data accumulated from the entire Montana large group population. Certain factors such as demographics are incorporated into the rating process. PacificSource bases trend projections on a combination of PacificSource Montana large group data and the PacificSource Oregon group book of business. The large group premium increases for the last five years were 2017 7.4%, 2016 15.0%, 2015 4.6%, 2014 10.1 %, and 2013 9.7%. The member is responsible for the above deductible and the following amounts: Service , ,� .?' -' � C4' �$`.I7,.� N'�" �:J tit.., .E'x�i' t`��'�.Sr+t ..`� �1"�'S'-_t's+.2r .,�y r,r`h� ^w �"i..'T'-•*�':*� - Yx' Lh., 'k ;✓w `� Wel( bab IWell child care No charge* � o.�c ar� '� =� ;��.�.�.� Preventive No charge* '���No�e age •- ,����;� physicals Well woman visits No charge*�Nhg Preventive mammograms No charged Mocha r Immunizations No char e'� rNouc ar=e� fi Preventive colonoscopy No charge, Dett1+✓ _ �Noo arge Prostate cancer screeningNo char e o c aT e ,- Profess��onal Services _ L, ,_ { a.:4"+�` 'a....�....=. ....yam ✓.,a .._... .t.,� .. ,-,.,x.:,c..,'::r�'° w.�" � _ s ��;... .... �,.e'g7. YaS rC.,. `"'--�..c..,x...� +.i` � 6 �...}:r... �...�'. Office and home visits .. � :arm- � v � �..�. 3 �"��'4S Deductible then No charge ped x ctib�e�tiNoca„rgee Naturopath office visits Deductible ,then No charge�pctblefhe o r900, PSGOOC.MT.LG.0118 PSGOOC.MT.LG.0118 This is a brief summary of benefits. Refer to your handbook for additional information or a further explanation of benefits, limitations, and exclusions. Not subject to annual deductible. + Non -participating air ambulance coverage is covered at 200 percent of the Medicare allowance, except as required by law. You may be held responsible for the amount billed in excess. Please see your handbook for additional information or contact our Customer Service team with questions. PSGOOC.MT.LG.0118 ON) Paciticsource HEALTH PLANS City of Laurel Prescription Drug Benefit Summary MT 3500D S2 MDL This PacificSource health plan includes coverage for prescription drugs and certain other pharmaceuticals, subject to the information below. This plan complies with federal health care reform. MEDICAL PLAN DEDUCTIBLE You must meet the medical plan deductibles, which are shown on the Medical Benefit Summary, before your prescription drug benefits begin for Tier one, Tier two, Tier three, compound, and/or Tier four prescription drugs. The amount you pay for covered prescriptions at participating and non -participating pharmacies applies toward your plan's participating medical out-of-pocket limit, which is shown on the Medical Benefit Summary. The co -payment and/or co-insurance for prescription drugs obtained from a participating or non -participating pharmacy are waived during the remainder of the calendar year in which you have satisfied the medical out-of-pocket limit. PACIFICSOURCE PREVENTIVE RX Your prescription benefit includes certain outpatient drugs as a preventive benefit at no charge*. This includes specific drugs that are taken regularly to prevent a disease or to keep a specific disease or condition from progressing. Preventive drugs are taken to help avoid many illnesses and conditions. These preventive drugs are not subject to the deductible. You can get a list of covered preventive drugs by contacting our Customer Service team or visit PacificSource.com/druq-list/. Each time a covered pharmaceutical is dispensed, you are responsible for the amounts below: ^ Remember to show your PacificSource member ID card each time you fill a prescription at a retail pharmacy. If your ID card is not used, your benefits cannot be applied and may result in higher out-of-pocket cost. * Not subject to annual medical deductible. **Compounded medications are subject to a preauthorization process. Compounds are generally covered only when all commercially available formulary products have been exhausted and all the ingredients in the compounded medication are on the applicable formulary. MAC B - Unless the prescribing provider requires the use of a brand name drug, the prescription PSGBS.MT.LG.RX.0118 will automatically be filled with a generic drug when available and permissible by state law. If you receive a brand name drug when a generic is available, you will be responsible for the brand name drug's co -payment andlor co-insurance plus the difference in cost between the brand name drug and its generic equivalent after the deductible is met. If your prescribing provider requires the use of a brand name drug, the prescription will be filled with the brand name drug and you will be responsible for the brand name drug's co -payment andlor co-insurance after the deductible is met. The cost difference between the brand name and generic drug does not apply toward the medical plan's deductible or out-of-pocket limit. If your physician prescribes a non -formulary drug due to medical necessity it may be subject to preauthorization. See your member handbook for important information about your prescription drug benefit, including which drugs are covered, limitations, and more. PSGBS.MT.LG.RX.0118 r What is the annual deductible? Your plan's deductible is the amount of money that you pay first, before your plan starts to pay. You'll see that many services, especially preventive care, are covered by the plan without you needing to meet the deductible. The individual deductible applies if you enroll without dependents. If you and one or more dependents enroll, the individual deductible applies for each member only until the family deductible has been met. Deductible expense is applied to the out-of-pocket limit. Note that there is a separate category for participating and non -participating providers when it comes to meeting your deductible. Only participating provider expense applies to the participating provider deductible and only non -participating provider expense applies to the non -participating provider deductible. What is the'out-of-pocket limit? The out-of-pocket limit is the most you'll pay for covered medical expenses during the plan year. Once the out-of-pocket limit has been met, the plan will pay 100 percent of covered charges for the rest of that year. The individual out-of-pocket limit applies only if you enroll without dependents. If you and one or more dependents enroll, the individual out-of-pocket limit applies for each member only until the family out-of-pocket limit has been met. Be sure to check your Member Handbook, as there are some charges, such as non-essential health benefits, penalties and balance billed amounts that do not count toward the out-of-pocket limit. Note that there is a separate category for participating and non -participating providers when it comes to meeting your out-of-pocket limit. Only participating provider expense applies to the participating provider out-of-pocket limit. Only non -participating provider expense applies to the non -participating provider out-of-pocket limit. Payments to providers Payment to providers is based on the prevailing or contracted PacificSource fee allowance for covered services. Participating providers accept the fee allowance as payment in full. Non -participating providers are allowed to balance bill any remaining balance that your plan did not cover. Services of non -participating providers could result in out-of-pocket expense in addition to the percentage indicated.. Allowable fee for non -participating providers Outside the PacificSource service area and in areas where our members do not have reasonable access to a participating provider through one of our third party provider networks, the allowable fee, depending upon the services and supply, will be based on the use of the UCR or the participating provider contracted rate, whichever is greater. For more detailed information, please refer to the Non- participating Providers section of your policy. Preauthorization Coverage of certain medical services and surgical procedures requires a benefit determination by PacificSource before the services are performed. This process is called 'preauthorization'. Preauthorization is necessary to determine if certain services and supplies are covered under this plan, and if you meet the plan's eligibility requirements. You'll find the most current preauthorization list on ourwebsite, PacificSource.com/member/preauthorization.aspx. PSGOOC.MT.LG.0118 The Patient's right to know the costs of medical procedures. The insured, or the insured's agent, may request an estimate of the member's portion of provider charges for any service or course of treatment that exceeds $500. PacificSource shall make a good faith effort to provide accurate information based on cost estimates and procedure codes obtained by the insured from the insured's health care provider. The estimate may be provided in writing or electronically. It is not a binding contract between PacificSource and the member, and is not a guarantee that the estimated amount will be the charged amount, or that it will include charges for unforeseen conditions. Contact Customer Service at (877) 590-1596 to request an estimate. Emergency medical conditions For emergency medical conditions, non -participating providers are paid at the participating provider level. Emergency medical condition means a medical condition that manifests itself by acute symptoms of sufficient severity, including severe pain that a prudent layperson possessing an average knowledge of health and medicine would reasonably expect that failure to receive immediate medical attention would place the health of a person, or an unborn child in the case of a pregnant woman, in serious jeopardy, result in serious impairment to bodily functions; or result in serious dysfunction of any bodily organ or part. With respect to a pregnant woman who is having contractions, for which there is inadequate time to affect a safe transfer to another hospital before delivery or for which a transfer may pose a threat to the health or safety of the woman or the unborn child. PSGOOC.MT.LG.0118 0'. PacificSource HEALTH PLANS PacIfIcSource Health Plans Member Guide We're Here to Help At PacificSource, everything we do revolves around taking care of people. That's why we offer quality customer service that you can access by phone or email. Our average hold time for calls is less than 20 seconds. If you call, you'll talk with a live person—not an automated response system. Or email us, if you prefer. Our friendly, professional Customer Service Representatives will be happy to help you. Your PacificSource ID Card Your ID cards will be mailed directly to your home within a few weeks of enrollment. Once you receive them, you can discard any old cards. Please begin using your new card for your healthcare services. When you visit your doctor or pharmacy, be sure to present your card. This ensures they have the correct insurance information. If you need your ID card before it arrives, you can print a temporary ID card on our secure member site at InTouch.PacificSource.com/members/lDcard/ temporary. You may also access your ID card using our free myPacificSource mobile app. See the "Online and Mobile Tools" section for more information. If you have any questions or haven't received your ID cards, please contact our Customer Service Department. Provider Network Your plan uses a participating provider network to ensure maximum access to providers for all members. Visit PacificSource.com/find-a-provider or call Customer Service for assistance finding participating providers in your plan's network. Tip: Be sure to select the appropriate network for your area and plan. Your network information is listed on your ID card. You can search by specialty, last name, location, or other details to access a list of providers. Or you can create your own personalized provider directory to download and print. Note that some health plans require you to select a primary care provider (PCP). Outside Our Service Areas If you live or are traveling outside of Idaho, Montana, Oregon, or select Washington counties (Clark, Cowlitz, Klickitat, Pacific, Skamania, and Wahkiakum counties), use one of these networks: • Alaska and Washington (except for the counties noted above): First Choice Health" Network • All other states (except Alaska, Washington, and those noted above): First Health® Network To find providers in the First Choice Health Network or the First Health Network, visit PacificSource.com/find-a- provider. Dental Network Plans For Dental Advantage Network plans (Idaho and Oregon only), you can save money by using Dental Advantage Network providers. You'll pay your plan's co -pay and/or co-insurance at the participating provider (in -network) level In most cases, when you visit an Advantage dentist, we'll waive your deductible. For Dental Advantage Essentials plans, you're only covered when you see a provider who participates in the Dental Advantage Essentials Network. Pharmacy PacificSource Drug Lists The PacificSource drug lists are guides to help your doctor identify medications that can provide the best clinical results at the lowest cost. To find out which list applies to your prescription drug plan, check your Summary of Benefits or PacificSource member ID card. If no "drug list"i is noted on your card, use the "PDL" list. Access our drug lists at PacificSource.com/drug-list. Using the CVS Caremark° Pharmacy Network We contract with CVS Caremark for pharmacy management services. If your health plan includes a prescription drug benefit, you can enjoy automatic savings from CVS Caremark. Just show your PacificSource ID card when you buy your prescriptions. CVS Caremark's network includes nearly 98% of all walk-in pharmacies in the United States. Ask your local pharmacy's staff if they participate with CVS Caremark, or look up the pharmacy at Caremark.com/wps/portal. Mail Order Services If your plan includes prescription drug coverage, mail order service may be a convenient, cost-saving option for you. We partner with both CVS Caremark and Wellpartner Pharmacy to provide you this service. Visit PacificSource. com/member/mail-order-rx for more information. P9a;ificsourfp f'!tartnq.rr/ Services (541) 225-3784 ! (800) 624-6052, ext. 3784 Caremark.com I (866) 329-3051 Wellpartner.com 1 (877) 568-6460 Online and Mobile Tools At PacificSource.com, and the myPacificSource mobile app, you can access tools, information, and resources to help you make the most of your PacificSource benefits. InTouch You can access coverage and benefit information through InTouch, our secure web portal at PacificSource.com. It allows you to easily and conveniently manage your insurance coverage and health, 24/7. Sign into InTouch to: • Look up coverage information in your member handbook/policy, or read benefit summaries. • Look up claims. • View explanations of benefits. • Review your family's enrollment history. • Check deductible and your out-of-pocket status. • Track preauthorizations. • Look up your share of your family's healthcare expenses. • Change your address. • Order replacement ID cards. • Estimate healthcare costs using ourTreatment Cost Navigator. • Access the CafeWell health and wellness resource. myPacificSource Mobile App Our free mobile app gives you secure, on -the -go access to all your coverage information, no matter where you are. The myPacificSource app is available for both iPhone° and Android'". Visit PacificSource.com/mobile for more information. J�� Health Management Programs and Services Condition Support Our Condition Support Program offers education and support to members with asthma, diabetes, heart failure, chronic obstructive pulmonary disease, coronary artery disease, or juvenile diabetes. This program is available to eligible PacificSource members with medical coverage. AccordantCare With AccordantCare, we offer rare disease management and specialty pharmacy programs that provide individual support and coordination for our members with certain rare diseases, or those requiring injectable medications or biotech drugs. For more about health management programs and other health and wellness extras, visit PacificSource.com/ extras. Submitting a Claim Usually, your provider will submit claims for you. If you need to fill a covered prescription or see a provider for a covered service before you receive your new ID card, or if you see a nonparticipating provider, you can pay and then submit a copy of the provider's itemized receipt or statement for reimbursement. On our website, you'll find details about how to submit a claim. Visit PacificSource.com/YourPlan/#Claim for more information. PacificSource Health Plans Value-added Extras Your PacificSource coverage also includes the following no -cost wellness programs and services. For details about these programs and more, visit PacificSource.com/extras. 24 -Hour NurseLine Have a health-related question? Our 24 -Hour NurseLine is staffed around the clock, 7 days a week—so you'll never be without a registered nurse to talk to. Call them toll-free at (855) 834-6150. CafeWell This secure online health engagement portal helps you keep track of, and make the most of, your health. To access CafeWell, sign into InTouch, go to Benefits, and select Wellness – CafeWell. Weight Management Programs As part of your PacificSource medical coverage, you can enjoy special offers for one of the following programs: • Weight Watchers°: Be reimbursed for some program costs when you participate in person or in the online program. • Jenny Craig°: Join the Jenny All Access program for 50% off the enrollment fee, plus 5% off all Jenny Craig food. Tobacco Cessation Program With your PacificSource medical coverage, you can participate in the Quit For Life° tobacco cessation program. Kick tobacco for good with nicotine replacement therapy and one-on-one phone support. The Quit For Life° Program is brought to you by the American Cancer Society® and Optum. Virtual Healthcare Visits with Teladoc° We've partnered with Teladoc as of January 1, 2018, to offer you virtual healthcare visits. Teladoc is a national network of U.S. board-certified physicians and pediatricians that you can see on -demand, 24/7, via phone or online video consultations, from wherever you happen to be; some limitations apply. For a virtual visit with Teladoc, you pay the same as you would a regular office visit. Depending on your plan, this could be a co -pay amount or you may first need to meet your deductible. Assist America° Global Emergency Services If you have a medical emergency 100 or more miles from home or abroad, Assist America is on call to coordinate your care and help ensure you get the treatment you need. Hospital-based Education Classes Get reimbursed up to $150 per plan year for health and wellness classes offered by hospitals, including first aid, CPR, financial planning, and more. Prenatal Program If you're expecting, our free Prenatal Program offers you support, useful information, and resources during this very important time for you and your baby Prenatal vitamins: Women between the ages of 15 and 45 with prescription drug coverage are eligible to receive select physician -prescribed prenatal vitamins at no cost—all co -pays and deductibles are waived—when filled through an in -network pharmacy. Visit our website for details. Gym Membership Program With the Active&Fit® gym membership program, you can access any gym within your plan's network for a one-time initiation fee of $25 plus a monthly fee of $25 per member. Visit PacificSource.com/extras for details about these and other no -cost programs and services. Customer Service Direct: (208) 333-1596 Toll-free: (800) 688-5008 llijoniaga Direct: (406) 442-6589 Toll-free: (877) 590-1596 Direct: (541) 684-5582 Toll-free: (888) 977-9299 Toll-free: (800) 735-2900 En Esonfiol Direct: (541) 684-5456 Toll-free: (866) 281-1464 cs@pacificsource.com For more information, visit PacificSource.com/YourPlan C1 Bion Access to Administration Online Services for Your Group Health Plan At PacificSource, we're committed to providing you with flexible, personalized service. One way we do that is through PacificSource InTouch for Employers—a secure, employers -only area of our website. Once you log in, you can enroll new members in your plan, access your plan's contract documents, pay your bill, and much more -24 hours a day. If you prefer doing business online, you'll appreciate the convenience of InTouch. Use InTouch to: Administer enrollment and generate reports • Enroll new members in your plan and update information for existing members, ensuring your employees can get important benefit information as soon as possible • View, change, or download enrollment and census information • View and download enrollment totals for your group by family composition category • Verify employee and dependent enrollment by name or member number • Print temporary ID cards for one or all employees with the click of a button View and pay your bill • View statements in our Payment Center • Pay your bill online with our eCheck option and review your eCheck payment history Access information and request ID cards • View the contact information for your Membership Representative • Access the most up-to-date benefit handbook • Access your plan's contract documents and benefit summaries • Request ID cards Manage InTouch account access • Setup access for members of your administration team with the Group Administrator feature • Administer all of your groups and their subgroups through a single login InTouchAdmin salesMT0314 Getting Started Is Easy! To start using PacificSource InTouch for Employers, simply visit, PacificSource.com and click "Employers.' Then click the "Register Now" link, which you'll find under the InTouch login button in the right column. A x' �I MEMBERS `.;r_;,I PROVIDERS I AGENTS I CAREERS InTouch for Employers _. Access our PacificSource account information Zan Once your registration is processed, you will receive an email message indicating that your new user ID has been activated. If you need to add access for additional staff members, you can log in and add them yourself (in the Group Administrator role), or we can help with the setup. continued on reverse PacificSource H,ALTH PLANS Questions and Answers Can I change my password? Yes, you may change your password at any time. From your InTouch home page, click'Account" in the top menu, and then click the "Change Password" link. What happens if I forget my password? If that happens, you can click the "Forgot My Password" link on the login page. You will be prompted to answer two hint questions and can then select a new password. Can I access multiple group accounts without having to log in and out? Yes.You can administer all of your groups and their subgroups through a single login. When you first log in, you'll be able to select from a list of your groups. Once you are logged in, you'll see the current group name on the green button near the top of the page. When you're ready to work with a different group, simply click on this green button to pull................... ..................................................... ' "' ..... ........ down a list of your available groups.There's no need to log in and out. Why can't I access all of our group accounts? If you are not able to access one of your groups, it may mean that your InTouch "Group Administrator" has not yet granted you that permission.Your InTouch Group Administrator is the primary user and has access to all of your group or subgroup accounts. In this role, they can grant other staff members, "Users;' full or limited access. What if I have questions or comments? To start using PacificSource In Touch for Employers, simply visit, PacificSource.com and click "Employers." Then click the "Register Now" link, which you'll find under the InTouch login button in the right column. If you have questions or comments about InTouch, you may contact the InTouch for EmployersTeam:................................................................................................................... • Call (800) 624-6052, ext. 3742 • Email intouchforemployers@pacificsource.com In addition, you are welcome to contact your Membership Services Representative. Your Representative's contact information appears on your InTouch Contact Us page and on your monthly billing statement. Or you can reach us by phone toll-free at (866) 999-5583 to be connected to the appropriate person. Paci f icsource Helena: 406.422.1008 9 855.422.1008 PacificSource.com PacificSource PacificSource Preventive Drug List The Preventive Drug List is included in our individual and small group plans*, and is an optional benefit for large groups. With this new benefit, the drugs listed below are paid at 100 percent. A full list of covered drugs can be found on our website at PacificSource.com/drug-list. Show your PacificSource ID card each time you purchase prescriptions at a participating pharmacy to ensure you're receiving the bestbenefit. If you have questions, please email our Customer Service Department at cs@pacificsource.com, or call toll-free: (800) 688-5008 in Idaho, (877) 590-1596 in Montana, or (888) 977-9299 in Oregon. Heart/Blood Pressure acebutolol HCL isradipine amiloride-HCTZ labetalol HCL amlodipine besylate lisinopril amlodipine besylate- benazepril lisinopril -HCTZ atenolol losartan potassium atenolol- chlorthalidone losartan -HCTZ benazepril HCL methyclothiazide benazepril HCTZ metolazone bisoprolol fumarate metoprolol tartrate bisoprolol -HCTZ metoprolol -HCTZ bumetanide moexipril-HCL captopril nadolol chlorothiazide nicardipine HCL chlorthalidone nifedipine ER clonidine HCL pindolol diltiazem ER propranolol HCL diltiazem HCL propranolol -HCTZ enalapril maleate quinapril HCL enalapril -HCTZ spironolactone felodiprine ER spironolactone -HCTZ fosinopril sodium torsemide fosinopril -HCTZ trandolapril furosemide triamterene -HCTZ guanfacine HCL valsartan-HCTZ hydrochlorothiazide verapamil ER indapamide verapamil ER PM irbesartan irbesartan-HCTZ verapamil HCL *Except for the Oregon Standard Bronze, Silver, or Gold plans. none meann alendronate sodium ibandronate sodium Cholesterol atorvastatin calcium pravastatin sodium lovastatin simvastatin Preventive Drug List 0916 Updated September 12, 2016 Diabetes glimepiride glipizide -metformin glipizide glyburide glipizide ER metformin HCL glipizide XL metformin HCL ER Mental Health bupropion HCL olanzapine carbamazepine olanzapine ODT citalopram HBR olanzapine -fluoxetine HCL fluoxetine HCL paroxetine HCL imipramine HCL quetiapine fumarate imipramine pamoate risperidone lithium carbonate sertraline HCL nortriptvline HCL venlafaxine HCL Preventive Drug List 0916 Updated September 12, 2016 OnlineTools and Resources at PacificSource.com InTouch for Members Members can access their benefit information by logging on to the secure InTouch area of our website.They can view their claims, the status of preauthorizations and referrals, the accumulated expenses towards their plan's deductible, and more. Health Manager Health Manager is an online health and wellness center available through InTouch. Powered by WebMD® it includes personalized wellness information and a variety of helpful, easy-to-use online tools including a health risk assessment. myPacificSource Mobile App Members can stay "InTouch" with their PacificSource coverage, no matter where they are, with our free mobile app.The myPacificSource app is available for both iPhon& and AndroidIm Visit PacificSource.com/mobile. WebMD Daily Victorys' Mobile App The Daily Victory mobile app helps beginners form a sustainable exercise habit, starting with as little as five minutes a day. Log in authentication and progress tracking is accessible through the Health Manager. Provider Directory Members can find up-to-date participating provider information based on their location or the provider's name. Members can also make a personalized directory. Wellness and Care Management Programs 24 -Hour NurseLine Most medical situations don't happen during business hours. Our 24 - Hour NurseLine is staffed around the clock, 7 days a week, so members will never be without a registered nurse to talk to if they have health- related questions.The member toll-free number is (855) 834-6150. Prenatal Care Program Our Prenatal Care Program helps expectant mothers learn more about their pregnancy and the development of their child. Participants receive educational materials and toll-free telephone access to a nurse consultant. High-risk members receive additional proactive nurse support. ValueAdded_sa IesMT0914 Prenatal Vitamins Pregnant members with pharmacy coverage are eligible to receive up to nine months of physician - prescribed prenatal vitamin supplements at no cost (all copays and deductibles are waived).This program covers two generic prenatal vitamins, which are only available through Wellpartner mail order pharmacy. Tobacco Cessation Our Quit For Life® program, brought to you by Alere Wellbeing and the American Cancer Society, can help tobacco users kick the habit. Members receive phone and online support, as well as a Quit Kit with nicotine replacement therapy patches or gum to help keep them on track. (bupropion, bupropion SR, or Chantix are doctor prescribed.) Member toll-free number: (866) 784-8454. Hospital -Based Education Classes Members can receive a reimbursement of up to $50 per eligible health and wellness class or series offered by hospitals, and up to $150 per member per plan year. Weight Management Programs Members with medical coverage can: • Participate in a Weight WatchersO program and receive an annual reimbursement of $100 ($40 if an online Weight Watchers participant) for their Weight Watchers membership. • Choose a Jenny Craig® program discount: free 30 -day trial with Jenny As You Go, or 30 percent off the enrollment fee with Jenny All Access. For full details and eligibility requirements, visit the Members > Extras and Wellness area of PacificSource.com. continued on reverse -6) Paci icS®utrC.. HEALTH PLANS Discounted Gym Membership PacificSource members have access to discounted gym memberships of up to $120 per year through GlobalFit. Brown Bag Wellness Seminars We offer Brown Bag Wellness Seminars tailored to the specific wellness interests of employers with 100 or more employees. These informational seminars for employees are held at the worksite or other convenient locations. Wellness for Kids Nine- and six -year-olds currently covered by a PacificSource medical plan may be invited by mail to join HealthKicks!, a children's program that promotes healthy behaviors. Parents will receive an invitation to enroll their child in HealthKicks! If enrolled, children will receive age-appropriate, fun activity books on health and wellness topics to encourage healthy habits. Contact us for more information. Condition Support Program Our Condition Support Program offers support and information to members with asthma and diabetes (including members age 18 and younger), heart failure (HF), chronic obstructive pulmonary disease (COPD), and coronary artery disease (CAD).The program includes personal support to help participants reach their health and wellness goals; ongoing support to help them maintain healthy lifestyle changes; and newsletters with current and helpful information about their health condition. Participants may also contact our nurses and registered dietitian via email or toll-free phone number to ask — ? health questions. AccordantCare® Rare Disease Management Program Our members with certain chronic, rare conditions receive ongoing one-on-one support and care coordination to ensure optimal care, decrease complications, and improve health outcomes. Caremark' Specialty Pharmacy Caremark® Specialty Pharmacy Services is our provider for injectable medications and biotech drugs. A pharmacist -led CareTeam provides individual follow-up care and support to our members with certain conditions. Nurse Case Management Our Health Services Department provides individual case management for members who require specific help in managing their healthcare needs. Nurse Case Managers work collaboratively with providers and members to improve members' health, financial outcomes, and quality of life. LifeTracs-Transplant Network We partner with LifeTracTransplant Network to ensure that our members requiring transplant services have access to nationally recognized centers of excellence. Our Case Managers assist members by coordinating all phases of transplant services. Serving clients since 1988, LifeTrac is a national network of more than 50 carefully selected facilities that perform organ and bone marrow transplants— one of the most comprehensive networks in the United States. Travel Program Assist America® Global Emergency Services Members with medical coverage who experience a medical emergency when traveling 100 or more miles from home or abroad can call Assist America for help. Services include medical consultation and evaluation, medical referrals, foreign hospital admission guarantee, critical care monitoring, and when medically necessary, evacuation to a facility that can provide treatment.These services are provided at no cost to members when arranged and provided by Assist America. Member toll-free number within the United States: (800) 872- 1414; from outside the United States: 00-1-(609) 986-1234. Please note: These value-added programs are not available with all plans. Check with your PacificSource Sales Representative for details. ...................................................................................... .. ------- - .. Questions? You're welcome to contact your PacificSource Sales Representative for more information about any of these value-added programs. .................................................................................................................................................. C-) PacificSource HEALTH PLANS Helena: 406.422.1008 • 855.422.1008 PacificSOurcexom 0 TELADOC C Paci f icSource HEALTH PLANS .� �., ',lam ; • i You have access to a doctor 24 hours, 7 days a week with Teladoco. You already have access to Teladoc and you can talk to a doctor now for or less. Set up your account by web, phone or mobile app. SET UP YOUR ACCOUNT IN 3 EASY STEPS Contact Teladoc 24/7/365 Access to Teladoc's nationwide network of board-certified doctors is available to you by phone, video or mobile app. Talk with a physician A doctor will review your medical history and contact you in minutes. Resolve the issue A doctor will diagnoseand prescribe medication, if medically necessary, to the pharmacy of your choice. Teladoc isjust a click or call away! f\ ) Teladoc.com MMI 01• Pon - 1 -855-201-7488 02002 201 1—d. L¢ A , q•d5 •es —nI C."'r- a d sc , nm• al e:,tloc co•n n:ue.rW t• Aoa a oqu d r. 1•atle•nu u of Aone P,c reef slen!tl a, Ino 6 5 a -[W aunp c1 Ano $lua: s a m. v u. ...i 4 W Mr- bn: Healthcare via phone, video, or moque app ^s a PacificSource member, you have access to a U.S. board-certified doctor 24 hours a day, 7 days a week, year-round with Teladoc. Here's how to get started and what you need to know. 1. Set up your account Talk to a There are three convenient ways to get started. When asked to doctor anytime! enter the name of your employer or insurance carrier, please enter PacificSource. Teladoc.com Online: Log in or register with InTouch for Members through PacificSource.com.You'll find the Teladoc Remote link under Tools. (g55) 201 7488 This will provide a direct link for you to set up your Teladoc account. Mobile app: Download the app and click 'Activate account" Visit Teladoc.com/mobile to download the app. Teladoc.com/mobile By phone: Teladoc can help you register your account over the phone. Call toll-free (855) 201-7488. EE E 2. Provide medical history ` Your medical history provides Teladoc doctors with the information they need to make an accurate diagnosis. 3. Request consult Once your account is set up, request a consult anytime you need care. And talk to a doctor by phone, web, or mobile app. See reverse for FAQ. PacificSource HEALTH PLANS Teladoc° Member Frequently Asked Questions What is Teladoc? you have anonymous call blocker on, you will be returned Teladoc is the first and largest provider of telehealth to the bottom of the waiting list. The consult request is cancelled if you miss three calls. medical consults in the United States, giving you 24/7/365 access to quality medical care through phone and video consults. Is there a time limit when talking with a doctor? Who are the Teladoc doctors? Teladoc doctors are U.S. board certified in internal medicine, family practice, or pediatrics. They average 20 years practice experience, are licensed in your state, and incorporate Teladoc into their day-to-day practice as a way to provide people with convenient access to quality medical care. Does Teladoc replace my doctor? No. Teladoc does not replace your primary care physician. Teladoc should be used when you need immediate care for nonemergent medical issues. It is an affordable, convenient alternative to urgent care and ER visits. What kind of medical care does Teladoc provide? Teladoc provides general medical care for adults and children, and behavioral healthcare for adults. Examples of common medical conditions Teladoc can address include: sinus problems, pink eye, bronchitis, allergies, flu, ear infection, urinary tract infections, and upper respiratory infections. What consult methods are available? You can talk with aTeladoc doctor via a phone consult, video consult within the secure member portal, or video consult within the Teladoc mobile app. How do I set up my Teladoc account? You can set up your account through InTouch at PacificSource.com, or through the Teladoc website or mobile app. You can also call Teladoc to get started. If setting up your account online, when asked to enter the name of your employer or insurance carrier, please make sure to enter PacificSource. How do I request a consult to talk to a doctor? Visit the Teladoc website, log into your account, and click "Request a Consult" You can also call Teladoc to request a consult by phone. How quickly can I talk to the doctor? Median call back time is just 10 minutes. If you miss the doctor's call, whether you are away from the phone or There is no time limit for consults. Can Teladoc doctors write a prescription? Yes. Teladoc doctors can prescribe short-term medication for a wide range of conditions when medically appropriate. Teladoc doctors do not prescribe substances controlled by the DEA, nontherapeutic, and/or certain other drugs, which may be harmful because of their potential abuse. How do I pay for a prescription called in by Teladoc? When you go to your pharmacy of choice to pick up the prescription, you may use your health/prescription insurance card to help pay for the medication. You will be responsible for the co -pay based on the type of medication and your plan benefits. Is the consult fee the same price, regardless of the time? The exact amount you will pay is based on your plan design. This dollar amount is shown on your summary of benefits. How do I pay for the consult? You can pay with your HSA (health savings account) card, credit card, prepaid debit card, or by PayPal. If the Teladoc doctor recommends that I see my primary care physician or a specialist, do I still have to pay the Teladoc consult fee? Yes. Just like any doctor appointment, you must pay for the consulting doctor's time. Can I provide consult information to my doctor? Yes. You have access to your electronic medical record at anytime. Download a copy online from your account or call Teladoc and ask to have your medical record mailed or faxed to you. C PacificSource HEALTH PLANS The Active&Flt Direct TM -ter The Active&Fit Direct program provides you with access to a broad network of participating fitness centers and participating YMCAs. Freedom and flexibility Active&Fit Direct program gives you access to 9,000+ fitness centers nationwide. You can switch fitness centers to ensure you find the right fit. The program also includes access to the Active&Fit Direct website, which features a fitness center locator and online fitness tracking. Get started Visit PacificSource.com/ActiveAndFit for more information. A $25 enrollment fee, $25 for the current month (regardless of the enrollment date within that month), and $25 plus applicable taxes for the next month are due when you enroll ($75 plus applicable taxes). Each month's fee is $25 (plus applicable taxes). After a 3 -month commitment, participation is month-to- month. Once enrolled, you may view or print your fitness card and take it to any fitness center/YMCA in the Active&Fit Direct network. Once the fitness center verifies your enrollment in the Active&Fit Direct program, you will sign a standard membership agreement and receive a card or key tag from the fitness center to check in for future visits. Try out a fitness center Many fitness centers/YMCAs offer guest passes so you can try out their location. You may request a guest -pass letter through the Active&Fit Direct website to take to the fitness center, where available. Note: You will need to register and sign in to request the guest -pass letter. The Active&Fit Direct program is provided by American Specialty Health Fitness, Inc., a subsidiary of American Specialty Health Incorporated (ASH). Active&Fit Direct is a trademark of ASH and used with permission here. Direct: (208) 333-1596 Toll-free: (800) 688-5008 Direct: (406) 442-6589 Toll-free: (877) 590-1596 Direct: (541) 684-5582 Toll-free: (888) 977-9299 Toll-free: (800) 735-2900 Direct: (541) 684-5456 Toll-free: (800) 624-6052 ext. 1009 cs@pacificsource.com a i"s"L C)Ui C:-.CGfiI C Paci f icSource HEALTH PLANS .� . � . CL . � , yy ( . u y� yy , • . � . _ . ® Ln . e ® 2 ^ , _ . . _ . . . .a. ■ - a e . . .. � _ ® `4-2 x e , .3 _ : i 75 ^ ` \\ , ■ . 2 e • . ' . � C e . + < s . < \ , ro y ' - z« . .2 .. » _ « . 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M- }i I _ 4. x k. is �. i f....� � , ,v_ t;,, ;� L � ,; ._ �'ca U. a�'' 0 0 Ln rn v U V) V) Q) U U 3 0 I I ro 0 '00 'VY, Q) 4, IS Qj 4 CN Nztz o i00 Qj 0 LU Z (D U) C MINUTES INSURANCE COMMITTEE JUNE 12, 2018 9:00 A.M. COUNCIL CHAMBERS CONFERENCE ROOM MEMBERS PRESENT: OTHERS PRESENT: Mayor Nelson Bruce McGee, City Council Member Heidi Sparks, City Council Member Kelly Strecker, Clerk's Office Stan Langve, Union 303 Jessica McCartney, Union 303 Monica Salo, Union 316 Sheri Phillips, Union 316 Roy Voss, Union 316 Dave Allen, Allen and Associates Eric Allen, Allen and Associates Each union and non-union representatives gave feedback they received from their respective groups. Both Stan and Jessica asked for feedback from their union members. Stan received one email back stating their preference was to stay with Blue Cross Blue Shield of Montana (BCBS). Jessica had had discussions with as many members as possible. The overall consensus was they wanted to stay on BCBS. No one was in favor of moving to MMIA or the Health Co-op. Most expressed their desire to stay on BCBS as the benefits were known. There were no strong oppositions to Pacific Source, just the unknown of exactly what the plan would be. Roy, Monica, and Sheri had Allen and Associates present all plans at their union meeting the previous day. No one was in favor of MMIA or the Health Co-op. After the presentation, their union took a vote and endorsed the move to Pacific Source as the Cities insurance provider. The key points that sold them on Pacific Source were the brick and mortar store opening soon, customer service, the cost savings, and the offering of two 80/20 plans with either $500 or $1,000 deductible. Kelly followed up with the non-union employees. No one was in favor of MMIA or the Health Co-op. Four stated they didn't mind staying and four stated they didn't mind changing. She questioned if employees could potentially need to change physicians. Eric clarified that while BCBS has between 94% to 95% of all physicians in -network, Pacific Source has 89% to 90% of physician's in -network. There may be a small percentage of employees that see a provider who is not in -network. He also stated that Billings Clinic recently transitioned their employees to Pacific Source from BCBS. He reiterated that Pacific Source does offer the City savings this year and that if in this year the City is not satisfied with its coverage they can ask for quotes for next year and consider changing service providers. Council Workshop Minutes of June 7, 2018 Insurance Committee was reminded that BCBS is changing their framework soon and that the City is grandfathered into its policy for this year and those same offerings most likely will not be available next year. Jessica spoke to her personal experience of dealing with BCBS and how some things were not billed as she had expected. Dave reminded the Committee that he has had employees call and ask him to drill down why something was billed the way it was. While he is unable to change how things are billed, he can help identify why the insurance company processed the claim the way they did. He has found errors in the coding and was able to assist the employee in remedying the situation. Currently, the City is in a month to month contract with BCBS. Pacific Source is also a month to month plan. The City is guaranteed the stated rate for the next 12 months. Pacific Source is also willing to give credit for the deductible already incurred by the employee. They will hold processing claims for July to see what claims BCBS process to ensure the proper deductible credit is given. The Mayor received a question why Billings is able to keep their costs so low. The Mayor looked into what Billings does and found that they are self-insured and that they use EBMS to manage their claims. This is not an option for the City at this time. Due to both unions coming forward with different recommendations and the non-union employees not voicing a strong opinion, either way, the Committee discussed which option they felt their respective groups would be ok with. Both unions agreed with Kelly that they did not encounter anyone who strongly felt the need to stay with BCBS. They discussed the cost savings are moving to Pacific Source could offer the employee when they add their family and/or children. It was reiterated that both plans mirror one another and that the employee would not lose coverage. There was a question if the City would need to reduce the cap on what the employer will contribute to the employees' health benefit. It was clarified that the cap should not be an issue. Union 316 discussed this issue, and no one voiced an issue. It was questioned if Pacific Source is chosen, which plan would allow the City to pay for employee only. Both the $1000 and $500 deductible were less than what the City is currently spending. It was clarified that Council would need to clarify which plan the City would pay for. It was also clarified that Pacific Source would automatically enroll employees into the plan they currently have. If they want to make a change to a different plan, they would need to fill out the appropriate form. Council Member McGee stated that he sat down and looked over these plans as if he were purchasing a policy for him and his family. Which plan was the most comprehensible and for what cost? He independently concluded that Pacific Source was the best option, not only by what the plans covered but also by cost. N Council Workshop Minutes of June 7, 2018 Council Member Sparks reviewed the documents in a similar manner. She also concluded that Pacific Source was the best option for the City at this time. Dave clarified that Pacific Source would be able to get temporary cards to all employees by 7/1/2018 if the Council choose them as the insurance provider. The Insurance Committee voted to recommend Pacific Source's quote to Council for final approval. All present in favor of the recommendation. The Insurance Committee adjourned at 9:42 a.m. Respectfully submitted, Brittney Moor n Administrative Assistant 3 CITY OF LAUREL BOARDS, COMMISSIONS, AND COMMITTEES REAPPOINTMENT FORM Date: !f� Name of Member: �F I I presently serve on the : and wish (Board/Commission/Committee) to be considered for reappointment to another term. Signature: Date: Please submit this form to: Administrative Assistant City of Laurel P.O. Box 10 Laurel, MT 59044 Date: Name of Member: As r Z) J C, I presently serve on the --rl, -e- <- &0 C'� (C. and wish (Board/Commission/Committee) to be considered for reappointment to another term. Signature: /9, Date: �Z CLv S C, t Please submit this form to: Administrative Assistant City of Laurel P.O. Box 10 Laurel, MT 59044 CITY OF LAUREL BOARDS, COMMISSIONS, AND COMMITTEES REAPPOINTMENT FORM Date: Name of Member: l I presently serve on the �� �Yz ,12 .�. , Li/ and wish (Board/Commission/Committee) to be considered for reappointment to another term. Signature: Date: Please submit this form to: Administrative Assistant City of Laurel P.O. Box 10 Laurel, MT 59044 CITY OF LAUREL BOARDS, COI EWISSIONS, AND Comm rrTEES REAPPOINTMENT FORM Date: 3 i. aU/ r Name of Member: 21�ti,- I presently serve on the 1 ��v and wish (Board/Commi on/Committee) to be considered for reappointment to another term. Signature: UA4 Date: - Please submit this form to: Administrative Assistant City of Laurel P.O. Box 10 Laurel, MT 59044 RESOLUTION NO. R18-29 A RESOLUTION OF THE CITY COUNCIL RESETTING ITS JULY 3 REGULAR COUNCIL MEETING TO JULY 2 IN ORDER TO AVOID CONFLICTS WITH EVENTS AND FESTIVITIES PLANNED FOR THE JULY 4TH CELEBRATION. WHEREAS, Regular meetings of the Laurel City Council are scheduled for the first and third Tuesdays of each month; and WHEREAS, the City Council has the discretion to reset meetings due to conflicts that arise with state and federal holidays pursuant to LMC 2.10.030; and WHEREAS, the City of Laurel has a substantial number of events and festivities scheduled during the week of July 4th and the City Council desires to reset the meeting to avoid conflicts with scheduled events to encourage and enable public attendance and participation during its first regular meeting. NOW, THEREFORE, BE IT RESOLVED by the City Council of the City of Laurel, Montana, the regular meeting of the City Council of the City of Laurel, Montana currently scheduled for Tuesday, July 3, 2018 is reset to Monday, July 2, 2018. Notice of the change shall be posted at City Hall and sent to the Laurel Outlook. Introduced at a meeting of the City Council on Junel9, 2018, by Council Member PASSED and ADOPTED by the City Council of the City of Laurel, Montana, this 19" day of June 2018. CITY OF LAUREL Thomas C. Nelson, Mayor ATTEST: Bethany Langve, Clerk -Treasurer APPROVED AS TO FORM: Sam Painter Civil City Attorney Resolution No. RI 8-29 Move July Yd meeting to July 2nd RESOLUTION NO. R18-30 RESOLUTION AUTHORIZING THE MAYOR AND. CITY CLERK TO UTILIZE AVAILABLE REVENUE IN THE CITY'S WATER FUND TO PREPAY AND RETIRE DNRC LOAN WRF-10-188. WHEREAS, in 2009 the City previously obtained a loan from the Montana Department of Natural Resources and Conservation ("DNRC") Revolving Fund Program in order to finance and pay for a water system improvement project; and WHEREAS, the City successfully constructed and completed the water system improvement project and has been making payments on Loan WRF-10-188 including principle and interest; and WHEREAS, the City Clerk and Mayor determined there are sufficient funds available in the City's Water Fund to prepay the loan in its entirety which will save the City interest and improve the City's capacity to obtain financing for other water projects; and WHEREAS, DNRC provided a payoff amount of $335,424.83 which will completely retire the debt; and WHEREAS, the City Clerk and Mayor are recommending the City Council's authorization and approval of the proposed loan payoff since it appears to be in the City's best interest at this time. NOW, THEREFORE, BE IT RESOLVED the City Council hereby resolves, authorizes, and approves the following: 1. Pursuant to the City Mayor and City Clerk's recommendation, the City Council hereby authorizes and approves the use of the available funds in the City's Water Fund to pay off the DNRC Loan #WRF-10-188 in the amount of $335,424.83 as provided in the attached payoff statement; and 2. The Mayor and City Clerk are authorized to execute any documents required to effectuate the payoff authorized herein. Introduced at a meeting of the City Council on June 19, 2018, by Council Member PASSED and ADOPTED by the City Council of the City of Laurel, Montana, this 19'h day of June 2018. CITY OF LAUREL Thomas C. Nelson, Mayor ATTEST: Bethany Langve, Clerk -Treasurer APPROVED AS TO FORM: Sam Painter Civil City Attorney R18-30 Payoff DNRC Loan #WRF-10-188 To: From: Date: Re: DEPARTMENT OF NATURAL RESOURCES AND CONSERVATION STEVE BULLOCK, GOVERNOR 1539 ELEVENTH AVENUE STATE OF MONTANA DIRECTOR'S OFFICE: (406) 444-2074 PO SOX 201601 FAX: (406) 444-2684 HELENA, MONTANA 59620-1601 Bethany Langne, Clerk City of Laurel Anna M. Miller Conservation and Resource June 7, 2018 Laurel Loan WRF-10-188 Payoff The payoff for this loan is as of 6/26/2018: Interest $ 4,424.83 Principal $ 331,000.00 Total $ 335,424.83 Send your check to the Saint Paul address. If you mail the check June 20th, this will be just fine. Please see attached. Let me know if you have questions. Cc: Greg Skutnik, USB, w/ Cid Sivils w/ Laurel WRF 10-188 w/ AMM:dc DIRECTOR'S CONSERVATION & RESOURCE OFFICE DEVELOPMENT DIVISION (406) 444-2074 (406) 444-6667 BOARD OFOIL & GAS TRUST LAND MANAGEMENT CONSERVATION DIVISION DIVISION (406) 444-6675 (406) 4442074 0 W. 0 LOL 0 S2 ZO W Z - /nr WOE z -qt-: Iew C, $z M E 0). 60 Wmz <W .8 0 -, 2 jr to 0 C) W W () a. z q Cobank. FnxScttSctvittGrtarantad '� Corporate 'crust Services PO Box 64111 June 7, 201$ St. Paul, MN 55164-0111 - -- DNRC Borrowers Participating in the SRF/WRF Loan. Programs Re: Invoice for Loan Payment Due July 01, 2018 If payment is made by wire or ACH, please fax or e-mail this memo per the instructions below at least one the day prior to payment. Please reference the BORROWER NAME and LOAN NUMBER for proper credit. Fax to Maria Rosado (651) 466-7415 or e-mail to rnaria.rosado(a),usbank.com BORROWER NAME I LOAN NUMBER I DOLLAR AMOUNT Total Wire By Wire U.S. Bank NA ABA 091000022 Account#180121167365 Reference: Petrodata DNRC Loan Borrower NamelLoan Number Attn: Maria Rosado By U.S. Bank Montana ABA 091000022 Account# 152011599486 Reference: Petrodata DNRC Loan Borrower Name/Loan Number IMPORTANT If payment is made by check, please include either the tear -off stub (if part of the form) or a copy of the Amortization Schedule. Please make sure that SpA Lockbox CM9695 is on the check. By Check U.S. Bank Trust -SpA Lockbox CM9695 (This is is the Payee that should be on the check) Attn: Operations Center PO Box 70870 1200 Energy Park Drive St. Paul, MN 55170 New Audit Confirmation Request Process Announced See page -2- for information and register at: https:/Iwww.confirmation.co'm/ If needed, the breakdown between principal and interest due can be found on the Final Schedule B provided at the time the loan was completed. If you should have any questions please contact Greg.Skutnik@usbank.com (206) 344-4607, Deborah.Kuykendan@usbank.eom (206) 344-4681 or Julie.Kammucller@usbault.coin 651-466-6113. RESOLUTION NO. R18-31 A RESOLUTION OF THE CITY COUNCIL ADOPTING A MANAGEMENT BUDGET TO ASSIST THE CITY'S DEPARTMENT HEADS WITH PROJECTING AND MANAGING THEIR RESPECTIVE BUDGETS FOR THE FISCAL YEAR. WHEREAS, the City will adopt its final budget in August or September 2018 pursuant to Montana law; and WHEREAS, the City wishes to implement a management budget for its department heads to increase consistency in the planning and completion of various City projects during the available construction months in Montana. NOW, THEREFORE, BE IT RESOLVED by the City Council of the City of Laurel, Montana, that the City Council hereby adopts the management budget provided to assist the City's department heads to uniformly and consistently manage their respective budgets. The management budget is available for public inspection and review at the City Clerk's Office in City Hall. Introduced at a meeting of the City Council on June 19, 2018, by Council Member PASSED and ADOPTED by the City Council of the City of Laurel, Montana, this 19`" day of June 2018. CITY OF LAUREL Thomas C. Nelson, Mayor ATTEST: Bethany Langve, Clerk -Treasurer APPROVED AS TO FORM: Sam Painter Civil City Attorney R18-31 Adopt Management Budget 1 .9 D&TS) Itil I 113004A !'�Klm BE IT RESOLVED by the City Council of the City of Laurel, Montana, Section 1: Approval. The Agreements between the City of Laurel and Laurel Rural Fire District No. 5, relating to fire protection for the respective fiscal years: 2018- 2019, 2019-2020, 2020-2021, copies attached hereto, be and the same are hereby approved. Section 2: Execution. The Mayor and the City Clerk of the City of Laurel are hereby given authority to execute said agreements on behalf of the City. Introduced at a meeting of the City Council on June 19, 2018, by Council Member PASSED and ADOPTED by the City Council of the City of Laurel, Montana, this 19`h day of June 2018. CITY OF LAUREL Thomas C. Nelson, Mayor ATTEST: Bethany Langve, Clerk -Treasurer 991101TA 0 • WeIR'U" Sam Painter Civil City Attorney R18-32 Fire District No. 5 AGREEMENT THIS AGREEMENT, made and entered into this 1" day of July, 2018, by and between the CITY OF LAUREL, a municipal Corporation, Yellowstone County, Montana, hereinafter known as the City, and RURAL FIRE DISTRICT NO. 5, a rural fire district, organized and established by the Board of County Commissioners, of Yellowstone County Montana, pursuant to the laws of Montana, made and provided, hereinafter called the FIRE DISTRICT. WHEREAS, the said Fire District has requested the City to provide fire protection to the said district and the said City is agreeable to provide said fire protection. NOW, THEREFORE, for the mutual benefit and advantage of each, it is herewith agreed as follows: I. That the said City, in consideration of the covenants and agreements of the said Fire District hereafter agrees as follows: 1. To dispatch the City fire equipment and personnel to fight fires, explosions, or to answer emergency resuscitation calls to endangered property within the said Fire District upon notification to the City. 2. It is expressly agreed and understood that the amount dispatched, the type of equipment, the number of personnel dispatched, the manner of fighting the fire or explosion, etc., shall be at the sole discretion of the City and its personnel. 3. It is further mutually covenanted, agreed and understood that in the event fire or explosion or resuscitation calls shall occur simultaneously in the District and within the municipal boundaries that the said City shall have the preference to use its equipment and manpower in protecting the City property first, and that protection of City inhabitants and property shall have preference and priority over all call, demand of the District. 4. The City shall have the responsibility for investigating all fires within the District or explosions and attempting to determine the cause of same. II. The District in consideration of the covenants and agreements of the City, as herein stated, agrees as follows: 1. To pay to the City the total sum of $16,568.34, the same to be divided into two equal payments due December 31, 2018 and June 30, 2019. 2. In the event the District is enlarged or additional homes or buildings built therein, the City may adjust the compensation upwards as required for the additional protection. 3. The District agrees to cooperate with the City and City Fire Department in the inspection of property to be protected and to cooperate in reducing fire risks as may be suggested from time to time by Fire Department personnel. It is mutually covenanted, agreed and understood that the term of the Agreement shall be for one (1) year, commencing on the 1St day of July, 2018 and ending on the 30th day of June 2019. RURAL FIRE DISTRICT NO.5 CITY OF LAUREL Thomas C. Nelson, Mayor ATTEST: Bethany Langve, Clerk/Treasurer r -- AGREEMENT THIS AGREEMENT, made and entered into this 1st day of July, 2018, by and between the CITY OF LAUREL, a municipal Corporation, Yellowstone County, Montana, hereinafter known as the City, and RURAL FIRE DISTRICT NO. 5, a rural fire district, organized and established by the Board of County Commissioners, of Yellowstone County Montana, pursuant to the laws of Montana, made and provided, hereinafter called the FIRE DISTRICT. WHEREAS, the said Fire District has requested the City to provide fire protection to the said district and the said City is agreeable to provide said fire protection. NOW, THEREFORE, for the mutual benefit and advantage of each, it is herewith agreed as follows: I. That the said City, in consideration of the covenants and agreements of the said Fire District hereafter agrees as follows: 1. To dispatch the City fire equipment and personnel to fight fires, explosions, or to answer emergency resuscitation calls to endangered property within the said Fire District upon notification to the City. 2. It is expressly agreed and understood that the amount dispatched, the type of equipment, the number of personnel dispatched, the manner of fighting the fire or explosion, etc., shall be at the sole discretion of the City and its personnel. 3. It is further mutually covenanted, agreed and understood that in the event fire or explosion or resuscitation calls shall occur simultaneously in the District and within the municipal boundaries that the said City shall have the preference to use its equipment and manpower in protecting the City property first, and that protection of City inhabitants and property shall have preference and priority over all call, demand of the District. 4. The City shall have the responsibility for investigating all fires within the District or explosions and attempting to determine the cause of same. II. The District in consideration of the covenants and agreements of the City, as herein stated, agrees as follows: 1. To pay to the City the total sum of $17,065.39, the same to be divided into two equal payments due December 31, 2019 and June 30, 2020. 2. In the event the District is enlarged or additional homes or buildings built therein, the City may adjust the compensation upwards as required for the additional protection. 3. The District agrees to cooperate with the City and City Fire Department in the inspection of property to be protected and to cooperate in reducing fire risks as may be suggested from time to time by Fire Department personnel. It is mutually covenanted, agreed and understood that the term of the Agreement shall be for one (1) year, commencing on the 1St day of July, 2019 and ending on the 30' day of June 2020. RJJRAL FIRE DISTRICT NO. S CITY OF LAUREL Thomas C. Nelson, Mayor ATTEST: Bethany Langve, Clerk/Treasurer i AGREEMENT THIS AGREEMENT, made and entered into this 1" day of July, 2018, by and between the CITY OF LAUREL, a municipal Corporation, Yellowstone County, Montana, hereinafter known as the City, and RURAL FIRE DISTRICT NO. 5, a rural fire district, organized and established by the Board of County Commissioners, of Yellowstone County Montana, pursuant to the laws of Montana, made and provided, hereinafter called the FIRE DISTRICT. WHEREAS, the said Fire District has requested the City to provide fire protection to the said district and the said City is agreeable to provide said fire protection. NOW, THEREFORE, for the mutual benefit and advantage of each, it is herewith agreed as follows: I. That the said City, in consideration of the covenants and agreements of the said Fire District hereafter agrees as follows: 1. To dispatch the City fire equipment and personnel to fight fires, explosions, or to answer emergency resuscitation calls to endangered property within the said Fire District upon notification to the City. 2. It is expressly agreed and understood that the amount dispatched, the type of equipment, the number of personnel dispatched, the manner of fighting the fire or explosion, etc., shall be at the sole discretion of the City and its personnel. 3. It is further mutually covenanted, agreed and understood that in the event fire or explosion or resuscitation calls shall occur simultaneously in the District and within the municipal boundaries that the said City shall have the preference to use its equipment and manpower in protecting the City property first, and that protection of City inhabitants and property shall have preference and priority over all call, demand of the District. 4. The City shall have the responsibility for investigating all fires within the District or explosions and attempting to determine the cause of same. II. The District in consideration of the covenants and agreements of the City, as herein stated, agrees as follows: 1. To pay to the City the total sum of $17,577.35, the same to be divided into two equal payments due December 31, 2020 and June 30, 2021. 2. In the event the District is enlarged or additional homes or buildings built therein, the City may adjust the compensation upwards as required for the additional protection. 3. The District agrees to cooperate with the City and City Fire Department in the inspection of property to be protected and to cooperate in reducing fire risks as may be suggested from time to time by Fire Department personnel. It is mutually covenanted, agreed and understood that the term of the Agreement shall be for one (1) year, commencing on the 1 s'day of July, 2020 and ending on the 30ch day of June 2021. RU (�FI ISTRICT NO.5 CITY OF LAUREL Thomas C. Nelson, Mayor ATTEST: Bethany Langve, Clerk/Treasurer BE IT RESOLVED by the City Council of the City of Laurel, Montana, Section 1: Approval. The Agreements between the City of Laurel and the Laurel Urban Fire Service Area ("LUFSA") relating to fire protection for the respective fiscal years: 2018-2019, 2019-2020, 2020-2021, copies attached hereto, be and the same are hereby approved. Section 2: Execution. The Mayor and the City Clerk of the City of Laurel are hereby given authority to execute said agreements on behalf of the City. Introduced at a meeting of the City Council on June 19, 2018, by Council Member PASSED and ADOPTED by the City Council of the City of Laurel, Montana, this 19th day of June 2018. CITY OF LAUREL Thomas C. Nelson, Mayor ATTEST: Bethany Langve, Clerk -Treasurer APPROVED AS TO FORM: Sam Painter Civil City Attorney R18-33 Fire Protection Agreements: Laurel Urban Fire Service Area ("LUFSA") AGREEMENT FOR LAUREL URBAN FIRE SERVICE AREA (LUFSA) FIRE SERVICES THIS AGREEMENT is made and entered into this I" day.of July, 2018, by and between the City of Laurel, Montana, a municipal corporation, hereinafter referred to as the "City" and the Laurel Urban Fire Service Area, hereinafter referred to as the "LUFSA". WITNESSETH WHEREAS, the City maintains a fire department and is willing to provide fire protection, prevention, and investigation services to properties within the LUFSA at the same level as such services are provided to properties within the limits of the City, upon the terms and conditions hereinafter provided; and, WHEREAS, the LUFSA has been duly and properly created by the Board of County Commissioners of Yellowstone County pursuant to the provisions of Sections 7-33-2401 through 7-33-2404, inclusive, of the Montana Code Annotated; and, WHEREAS, attached hereto and by this reference made a part hereof; is the LUFSA boundary description and map; and, WHEREAS, the LUFSA desires to obtain the said fire services from the City by entering into a contract with the City for such services; and, WHEREAS, the Board of County Commissioners for Yellowstone County has transferred the management of the LUFSA to a Board of Trustees in accordance with Section 7-33-2403, MCA. NOW, THEREFORE, it is agreed by and between the parties hereto as follows: 1. Services. The City will furnish the following services to properties and residents within the LUFSA, at the same level as such services are provided to properties and residents within the limits of the fire districts served by the City: 1 a. fire protection and suppression; b. fire prevention; C. fire investigations; The City further agrees to provide grassland, rangeland, and timberland fire protection services to properties located within the LUFSA. This fire protection service will be financed under separate contracts between Yellowstone County and the City of Laurel. 2. SERVICE AREA Fire services will be provided to all properties located within the boundaries of the LUFSA as specified in the resolution of the Yellowstone County Commissioners creating said LUFSA, and as amended from time to time by agreement of the parties. Any enlargement of the LUFSA will not receive fire service unless approved in writing by the City. 3. ANNEXATION In the event the City or its fire districts annex property located with the LUFSA said properties will automatically be excluded from the LUFSA only at the expiration of the contract term or at such time as this Agreement is otherwise .terminated. Any properties within the LUFSA which are annexed into the City or its fire districts will continue to be responsible for payments of charges to LUFSA, attributable to the remainder of the contract period following the date of annexation. On the beginning of the new Contract period annexed property will no longer be required to pay charges for services provided through the LUFSA. 4. EFFECTIVE This agreement shall be effective on July 1, 2018, and shall terminate on June 30, 2019. 5. RENEWAL This Agreement may be renewed, with the terms and conditions of the renewal Agreement to be as mutually agreed upon by the parties. 6. CHARGES AND PAYMENTS The fee for providing services for this Agreement shall be eighty-eight thousand six hundred eighteen dollars and 61/100 ($88, 618.61). One-half of the said fee shall be paid by Yellowstone County on behalf of the LUFSA, on or before December 31, 2018. The remaining one-half shall be paid on or before June 30, 2019. The parties understand and agree that the Yellowstone County Commissioners shall annually establish, levy and collect an assessment against all structures located within the LUFSA, sufficient to pay all charges against LUFSA under this Agreement. These assessments shall be included on the annual property tax bills processed by Yellowstone County and shall be collected in the same manner as property taxes are collected. 2 7. INDEMNIFICATION The City will be liable for any injury to person or damage to property caused by negligence of the City or its employees in performance of its obligations under this Agreement. The City hereby agrees to indemnify and hold harmless the LUFSA from any claims for such injury or damage. 8. ANNUAL REPORT The City will furnish an annual written report to LUFSA, which will include the number, and type of incidents responded to within the LUFSA by City personnel. 9. MODIFICATION This Agreement cannot be modified or amended except in writing executed by the parties. IN WITNESS WHEREOF, the parties have executed by this Agreement the day and year first above written. LAU LRE URB YF S E -AREA Trustee Trustee CITY OF LAUREL Thomas C. Nelson, Mayor ATTEST: Bethany Langve, Clerk/Treasurer AGREEMENT FOR LAUREL URBAN FIRE SERVICE AREA (LUFSA) FIRE SERVICES THIS AGREEMENT is made and entered into this 1st day of July, 2018, by and between the City of Laurel, Montana, a municipal corporation, hereinafter referred to as the "City' and the Laurel Urban Fire Service Area, hereinafter referred to as the "LUFSA". WITNESSETH WHEREAS, the City maintains a fire department and is willing to provide fire protection, prevention, and investigation services to properties within the LUFSA at the same level as such services are provided to properties within the limits of the City, upon the terms and conditions hereinafter provided; and, WHEREAS, the LUFSA has been duly and properly created by the Board of County Commissioners of Yellowstone County pursuant to the provisions of Sections 7-33-2401 through 7-33-2404, inclusive, of the Montana Code Annotated; and, WHEREAS, attached hereto and by this reference made a part hereof, is the LUFSA boundary description and map; and, WHEREAS, the LUFSA desires to obtain the said fire services from the City by entering into a contract with the City for such services; and, WHEREAS, the Board of County Commissioners for Yellowstone County has transferred the management of the LUFSA to a Board of Trustees in accordance with Section 7-33-2403, MCA. NOW, THEREFORE, it is agreed by and between the parties hereto as follows: 1. Services. The City will furnish the following services to properties and residents within the LUFSA, at the same level as such services are provided to properties and residents within the limits of the fire districts served by the City: 1 a. fire protection and suppression; b. fire prevention; C. fire investigations; The City further agrees to provide grassland, rangeland, and timberland fire protection services to properties located within the LUFSA. This fire protection service will be financed under separate contracts between Yellowstone County and the City of Laurel. 2. SERVICE AREA Fire services will be provided to all properties located within the boundaries of the LUFSA as specified in the resolution of the Yellowstone County Commissioners creating said LUFSA, and as amended from time to time by agreement of the parties. Any enlargement of the LUFSA will not receive fire service unless approved in writing by the City. 3. ANNEXATION In the event the City or its fire districts annex property located with the LUFSA said properties will automatically be excluded from the LUFSA only at the expiration of the contract term or at such time as this Agreement is otherwise terminated. Any properties within the LUFSA which are annexed into the City or its fire districts will continue to be responsible for payments of charges to LUFSA, attributable to the remainder of the contract period following the date of annexation. On the beginning of the new Contract period annexed property will no longer be required to pay charges for services provided through the LUFSA. 4. EFFECTIVE This agreement shall be effective on July 1, 2019, and shall terminate on June 30, 2020. 5. RENEWAL This Agreement may be renewed, with the terms and conditions of the renewal Agreement to be as mutually agreed upon by the parties. 6. CHARGES AND PAYMENTS The fee for providing services for this Agreement shall be ninety one thousand two hundred seventy seven dollars and 17/100 ($91,277.17). One-half of the said fee shall be paid by Yellowstone County on behalf of the LUFSA, on or before December 31, 2019. The remaining one-half shall be paid on or before June 30, 2020. The parties understand and agree that the Yellowstone County Commissioners shall annually establish, levy and collect an assessment against all structures located within the LUFSA, sufficient to pay all charges against LUFSA under this Agreement. These assessments shall be included on the annual property tax bills processed by Yellowstone County and shall be collected in the same manner as property taxes are collected. 2 7. INDEMNIFICATION The City will be liable for any injury to person or damage to property caused by negligence of the City or its employees in performance of its obligations under this Agreement. The City hereby agrees to indemnify and hold harmless the LUFSA from any claims for such injury or damage. 8. ANNUAL REPORT The City will furnish an annual written report to LUFSA, which will include the number, and type of incidents responded to within the LUFSA by City personnel. 9. MODIFICATION This Agreement cannot be modified or amended except in writing executed by the parties. IN WITNESS WHEREOF, the parties have executed by this Agreement the day and year first above written. ` ' • '1i `��f� '� moi' ` ' ` r_ Trustee CITY OF LAUREL Thomas C. Nelson, Mayor ATTEST: Bethany Langve, Clerk/Treasurer AGREEMENT FOR LAUREL URBAN FIRE SERVICE AREA (LUFSA) FIRE SERVICES THIS AGREEMENT is made and entered into this I" day of July, 2018, by and between the City of Laurel, Montana, a municipal corporation, hereinafter referred to as the "City" and the Laurel Urban Fire Service Area, hereinafter referred to as the "LUFSA". WITNESSETH WHEREAS, the City maintains a fire department and is willing to provide fire protection, prevention, and investigation services to properties within the LUFSA at the same level as such services are provided to properties within the limits of the City, upon the terms and conditions hereinafter provided; and, WHEREAS, the LUFSA has been duly and properly created by the Board of County Commissioners of Yellowstone County pursuant to the provisions of Sections 7-33-2401 through 7-33-2404, inclusive, of the Montana Code Annotated; and, WHEREAS, attached hereto and by this reference made a part hereof, is the LUFSA boundary description and map; and, WHEREAS, the LUFSA desires to obtain the said fire services from the City by entering into a contract with the City for such services; and, WHEREAS, the Board of County Commissioners for Yellowstone County has transferred the management of the LUFSA to a Board of Trustees in accordance with Section 7-33-2403, MCA. NOW, THEREFORE, it is agreed by and between the parties hereto as follows: 1. Services. The City will furnish the following services to properties and residents within the LUFSA, at the same level as such services are provided to properties and residents within the limits of the fire districts served by the City: 1 a. fire protection and suppression; b. fire prevention; C. fire investigations; The City further agrees to provide grassland, rangeland, and timberland fire protection services to properties located within the LUFSA. This fire protection service will be financed under separate contracts between Yellowstone County and the City of Laurel. 2. SERVICE AREA Fire services will be provided to all properties located within the boundaries of the LUFSA as specified in the resolution of the Yellowstone County Commissioners creating said LUFSA, and as amended from time to time by agreement of the parties. Any enlargement of the LUFSA will not receive fire service unless approved in writing by the City. 3. ANNEXATION In the event the City or its fire districts annex property located with the LUFSA said properties will automatically be excluded from the LUFSA only at the expiration of the contract term or at such time as this Agreement is otherwise terminated. Any properties within the LUFSA which are annexed into the City or its fire districts will continue to be responsible for payments of charges to LUFSA, attributable to the remainder of the contract period following the date of annexation. On the beginning of the new Contract period annexed property will no longer be required to pay charges for services provided through the LUFSA. 4. EFFECTIVE This agreement shall be effective on July 1, 2020, and shall terminate on June 30, 2021. 5. RENEWAL This Agreement may be renewed, with the terms and conditions of the renewal Agreement to be as mutually agreed upon by the parties. 6. CHARGES AND PAYMENTS The fee for providing services for this Agreement shall be ninety four thousand fifteen dollars and 49/100 ($94,015.49). One-half of the said fee shall be paid by Yellowstone County on behalf of the LUFSA, on or before December 31, 2020. The remaining one-half shall be paid on or before June 30, 2021. The parties understand and agree that the Yellowstone County Commissioners shall annually establish, levy and collect an assessment against all strictures located within the LUFSA, sufficient to pay all charges against LUFSA under this Agreement. These assessments shall be included on the annual property tax bills processed by Yellowstone County and shall be collected in the same manner as property taxes are collected. 2 7. INDEMNIFICATION The City will be liable for any injury to person or damage to property caused by negligence of the City or its employees in performance of its obligations under this Agreement. The City hereby agrees to indemnify and hold harmless the LUFSA from any claims for such injury or damage. 8. ANNUAL REPORT The City will furnish an annual written report to LUFSA, which will include the number, and type of incidents responded to within the LUFSA by City personnel. 9. MODIFICATION This Agreement cannot be modified or amended except in writing executed by the parties. IN WITNESS WHEREOF, the parties have executed by this Agreement the day and year first above written. LAUREL' RB / SE E AREA Tniczeen 1 rus= Trustee CITY OF LAUREL Thomas C. Nelson, Mayor ATTEST: Bethany Langve, Clerk/Treasurer RESOLUTION NO. R18-34 A RESOLUTION AUTHORIZING THE MAYOR TO EXECUTE A CONTRACT FOR THE CHIEF ADMINISTRATIVE OFFICER POSITION BETWEEN THE CITY OF LAUREL AND MATTHEW R. LURKER, SR. BE IT RESOLVED by the City Council of the City of Laurel, Montana: Section l: Approval. The contract negotiated between the City's Mayor and Matthew R. Lurker, Sr. for the Chief Administrative Officer position is accepted and hereby approved. A copy is attached hereto for convenience. Section 2: Execution. The Mayor and City Clerk -Treasurer of the City of Laurel are hereby given authority to accept and execute said agreement on behalf of the City. Introduced at a meeting of the City Council on June 19, 2018, by Council Member PASSED and ADOPTED by the City Council of the City of Laurel, Montana, this 19th day of June 2018. CITY OF LAUREL Thomas C. Nelson, Mayor ATTEST: Bethany Langve, Clerk -Treasurer Sam Painter Civil City Attorney R18-34 Chief Administrative Officer Contract Chief Administrative Officer This employment contract is made and effective this 20u' day of June, 2018 by and between the City of Laurel, Montana, hereinafter referred to as "City" and Matthew R. Lurker Sr., hereinafter referred to as the "Employee." When the term "parties" is utilized in this contract, the term means the "City and Employee," jointly. Inconsideration of their mutual promises set forth herein, the parties hereby agree as follows: 1 Employment. City hereby employs Employee in accordance with Article III, Section 3 of the City's Charter and Employee hereby accepts such employment, upon the terms and conditions set forth in this written contract of employment. The parties intend to create a written contract of employment in accordance with MCA §39-2-912(2) and therefore agree that this contract and the City's Job Description attached hereto constitutes the entire agreement between the parties and that no oral promises, representations or warranties have been made or are an enforceable part of this contract. 1.1 Employee shall serve as the City's Chief Administrative Officer "CAO." The City has classified the position as an Exempt/Non-Union Position as contained in the Job Description attached hereto and incorporated herein. Employee shall commence employment under this Contract upon approval by the City Council. 1.2 Employee shall perform the essential duties and responsibilities contained in the attached Job Description and shall report directly to the City's Mayor. 1.3 The CAO shall not be reassigned from the position of City CAO to another position without the CAO's prior express written consent. 2 Salah. City shall compensate Employee, as an Exempt Non -Union Salary Employee as follows: 2.1 City shall pay Employee for services rendered pursuant hereto an annual salary in the sum of $73,000 payable in equal installments at the same time as other employees of the City are paid. Employee shall serve a six-month (180 calendar day) probation period. Upon successful completion of the probation period, Employee's annual salary shall increase to $78,000 for the Exempt Position. Employee thereafter is eligible for an annual increase on the anniversary of the Employee's start date of this Contract. Employee's annual increase shall be calculated at 1.5% of the then current salary of the Employee. 2.2 Expenses: City recognizes that certain expenses of a non -personal and generally job - affiliated nature are incurred by Employee, and hereby agrees to reimburse or to pay reasonable expenses and the City Clerk, upon approval by the Mayor, is hereby authorized to disburse such monies upon receipt of duly executed expense or petty cash vouchers, receipts, statements or personal affidavits. 1 2.3 Taxes: All payments made to and on behalf of Employee under this contract are subject to withholding of any required federal, state or local income and employment taxes. 3 Term. 3.1 The term of this contract shall be for four (4) years commencing the date the City Council approves the contract. The City Council may extend or renew the contract as desired. 3.2 Nothing in this contract shall prevent, limit or otherwise interfere with the authority of the Mayor to terminate the services of Employee at any time, subject only to the provisions set forth in Section 7, Paragraphs 7.1 through 7.5, of this contract. 3.3 Nothing in this contract shall prevent, limit or otherwise interfere with the right of the Employee to resign at any time from the position with City, subject only to the provision set forth in Section 7, Paragraphs 7.4 and 7.6 of this contract. 3.4 Employee agrees to remain in the exclusive employ of City and to not accept any other employment or to become employed by any other employer unless termination is affected as hereinafter provided. The term "employ and/or employed" shall not be construed to include occasional teaching, writing, consulting or military (Reserve, National Guard, or Auxiliary) service performed on Employee's time off. Provided that, with the prior written consent of the Mayor, Employee may continue outside professional employment (i.e. family business) which shall not in any way interfere with the performance of the city CAO's duties. 4 Suspension. The Mayor may suspend the Employee in accordance with the City's Personnel Policy Manual at any time during the term of this contract. Notice of suspension shall be made by the Mayor, in writing, identifying the start and end dates of suspension and reason for suspension. 5 Benefits. The City shall provide Employee the following benefits: 5.1 The City shall provide Employee the same benefits provided its other non-union exempt employees under the City's Personnel Policy Manual, as amended, and as required by applicable state and federal law. 6 Representations and Warranties. Employee represents that he/she shall attain and maintain the standard of personal and professional conduct required by City; the resume and/or employment application furnished to City are true and accurate in all respects, are not misleading, and do not omit the provision of any material information; that the education and experience of Employee is as stated in the resume and/or application; that Employee is in good health; that Employee knows of no present condition which now or in the future may adversely affect his/her health or his/her ability to perform his/her job; and that Employee has fully disclosed to City all facts which are material to City's decision to employ the Employee. 7 Termination of Employment. 7.1 This contract and Employee's employment immediately terminate upon Employee's death or finding or determination of a disability that prevents the Employee from performing the essential duties and responsibilities of the City's CAO. 7.2 If the Mayor terminates Employee without cause and Employee is willing and able to perform his/her duties under this contract then City shall pay Employee a severance payment equivalent to four (4) calendar months of Employee's then current salary. Employee shall also be compensated for all accrued and remaining vacation leave, computed on an hourly basis determined by dividing the Employee's then current annual salary by 2080 hours, and in accordance with the City's Personnel Policy Manual. City shall comply with all IRS rules and regulations governing severance pay and tax withholding requirements. However, if Employee is terminated "for cause" or voluntarily resigns his/her employment the City has no obligation to pay the severance payment provided in this paragraph. Employee shall receive payment for any remaining vacation balance as described in this paragraph. For cause means any legitimate business reason, or as otherwise defined by Montana law. 7.3 During the effective date of this contract, if City involuntarily reduces Employee's salary or otherwise refuses to comply with any provision of this contract that benefits Employee, he/she, at his/her option, may elect to be considered terminated without cause entitling him/her to the severance payment provision contained in paragraph 7.2. 7.4 If Employee resigns following a formal suggestion by the Mayor that he/she resign for no cause, Employee, may at his/her option, elect to be considered terminated at the date of such suggestion entitling him/her to the severance payment provision contained in paragraph 7.2. 7.5 If City's Mayor terminates Employee without cause at any time during the six (6) calendar months subsequent to the seating and swearing-in of a newly elected Mayor while Employee is willing and able to perform his duties under this contract, Employer shall pay the severance sum provided in paragraph 7.2 above. 7.6 If Employee voluntarily resigns his/her position with City he/she must provide the City with thirty (30) calendar days advance notice, unless the parties otherwise agree in writing. 7.7 If Employee's termination results from death or disability, City's final compensation to Employee is limited to payment for services rendered to date and payment for any accrued and remaining vacation leave in accordance with Section V of the City's Personnel Policy Manual 7.8 If Employee's termination results from cause, Employer's final compensation to Employee is limited to payment for services rendered to date in accordance with Section V of the City's Personnel Policy Manual, and payment for any accrued and remaining vacation leave calculated at the then current salary. 7.9 Conditioned upon the City fulfilling its obligations to pay the Severance Amount, the Severance Benefits and the Current Obligations, upon a Unilateral Severance, the CAO waives and releases the CAD's rights to continued employment with the City and the parties waive and release the right to a hearing on the issue of good cause. In the event of a Unilateral Severance, the parties agree not to make disparaging comments or statements about each other. 8 Confidentiality. Employee acknowledges that during his/her course of employment he/she might obtain and gather confidential information regarding the City's operations or employees. Employee further acknowledges that all confidential information is the City's property and in no event shall Employee disclose such information to any person or entity unless disclosure is requested by the City or required by law. 9 Performance Evaluation. The Mayor shall review and evaluate the performance of Employee at least once annually. The review and evaluation shall be in accordance with specific criteria developed jointly by the Mayor and Employee. Criteria may be added or deleted as the Mayor may from time to time determine necessary and proper, in consultation with the Employee. Each year, on a date agreed between the Employee and the Mayor, Employee shall provide the Mayor a self-evaluation based upon mutually agreed upon goals and performance objectives. The Mayor shall personally review the evaluation with the Employee and provide Employee an adequate opportunity to discuss the evaluation with the Mayor. 9.1 In the event the Mayor determines that the evaluation instrument, format and/or procedure are to be modified, and such modifications would require new or different performance expectations, then the Employee shall be provided a reasonable period of time to demonstrate such expected performance before being evaluated. 9.2 Unless the Employee expressly requests otherwise in writing, except to the extent prohibited by or in material conflict with Applicable Laws and Authorities, the evaluation of the Employee shall at all times be conducted in a meeting with the Mayor and shall be considered private to the maximum and full extent permitted bylaw. Nothing herein shall prohibit the Mayor or the Employee from sharing the content of the Employee's evaluation with their respective legal counsel. 10 Professional Development. City shall budget and pay for the travel and subsistence expenses of Employee for short courses, instates, certifications, and seminars that are necessary for his/her professional development for the good of the City, if funding is available. The City desires Employee join and participate in local organizations including, but not limited to, the local Rotary Club, Laurel Chamber of Commerce, Montana League of Cities and Towns, Great Open Spaces City Management Association, and the International City/County Management Association. City shall pay Employee's membership dues and annual conference fees to encourage such membership and attendance. 4 11 Bonding. City shall bear the full cost of any fidelity or other bonds required of the Employee under its Charter or any applicable law or ordinance. 12 OtherTerms and Conditions of Employment. The Mayor, in consultation with the Employee, shall fix other terms and conditions of employment, as they may determine necessary from time to time, relating to the performance of Employee provided such terms and conditions are not inconsistent with or in conflict with the provisions of this contract, the City's Charter, Ordinances or any other applicable law. 13 Indemnification. City shall defend, save harmless and indemnify Employee against any tort, professional liability claim or demand or other legal action, costs and attorney's fees incurred in any legal proceedings, whether groundless or otherwise, arising out of an alleged act or omission occurring in the performance of Employee's duties. City may compromise and settle any such claim or suit and will pay the amount of any settlement orjudgment rendered thereon. The obligations of City under this section shall not apply if: 13.1 The conduct of Employee complained of constitutes oppression, fraud or malice, or for any reason does not arise out of the course and scope of Employee's employment; or, 13.2 The conduct of Employee complained of constitutes a criminal offense as defined under Montana law; or, 13.3 Employee compromised or settled the claim without the consent of City; or, 13.4 Employee fails or refuses to cooperate reasonably in the defense of the case. 14 Availability. Employee acknowledges that the CAO must be available by either cell or telephone after work hours in cases of emergency. Employee shall provide the Mayor and appropriate department heads his/her contact information for after hour emergency notifications. The City does not require the CAO to be on-call, simply available by telephone if an emergency should arise for purposes of notification. 15 Miscellaneous. This contract contains the entire agreement and supersedes all prior agreements and understandings, oral or written, with respect to the subject matter hereof. This contract may be changed only by an agreement in writing signed by the party against whom any waiver, change, amendment or modification is sought. This contract shall be construed and enforced in accordance with the City's Charter, Ordinances and applicable laws of the State of Montana. 16 Personal Contract. The obligations and duties of the Employee hereunder shall be personal and not assignable to any person or entity, although the contract is binding and shall inure to the benefit of Employee's heirs and executors at law. 17 Notices. Notices pursuant to this agreement shall be given in writing by deposit in the custody of the United States Postal Services, certified postage prepaid, addressed as follows: • If to CITY: Office of the Mayor, P.O. Box 10, Laurel, MT 59044; and o If to CAO: Matthew R. Lurker Sr., 4005 Pine Cove Rd., Billings, MT 59106 Notice shall be deemed delivered and received as of three business days after the date of deposit of such written notice in the course of transmission in the United States Postal Service. Either party may, from time to time by written notice to the other party, designate a different address for notice purposes. 18 Renegotiation. The Parties may commence negotiation of a subsequent employment contract six (6) months prior to the expiration of this employment contract. IN WITNESS WHEREOF, the parties hereto have executed this Contract the day and year first above written. This contract is contingent upon its approval via Resolution of the City Council. EMPLOYEE Matthew R. Lurker Sr. N. CITY OF LAUREL Tom C. Nelson, Mayor ATTEST: Bethany Keeler, City Clerk -Treasurer