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HomeMy WebLinkAboutResolution No. R18-28A RESOLUTION OF THE CITY COUNCIL AUTHORIZING THE MAYOR TO SIGN AN AGREEMENT WITH PACIFIC SOURCE HEALTH, DELTA DENTAL AND VSP FOR THE PROVISION OF THE EMPLOYEE HEALTH INSURANCE BENEFIT PROGRAM. WHEREAS, the City Council previously authorized the City's Health Insurance Committee to seek bids to provide health insurance for the City's employees and dependents; and WHEREAS, the City of Laurel complied with its procurement policy and Montana Law by utilizing a competitive bid process to ensure the selected bidder will provide satisfactory health care coverage and in the City's best interest; and WHEREAS, City staff reviewed the proposals and detennined the proposal submitted by PacificSource was the most responsive to the City's request, and hereby recommends selection of the same. NOW THEREFORE BE IT RESOLVED by the City Council of the City of Laurel, Montana, that the Mayor is authorized to sign an agreement with PacificSource Health for the employee health insurance program, a copy of which is attached hereto; and BE IT FURTHER RESOLVED, the Mayor is authorized to sign agreements with Delta Dental and VSP for the employee dental and health insurance. Introduced at a regular meeting of the City Council on June 19, 2018 by Council Member McGee PASSED and ADOPTED by the City Council of the City of Laurel, Montana, this 19th day of June, 2018. APPROVED by the Mayor this 19th day of June, 2018. CITY OF LAUREL Thomas C. Nelson, Mayor Clerk -Treasurer to Sam Pairife—r Civil City Attorney R18-28 Accept Agreement. PacificSource Health Plan, VSP and Delta Dental Group Mester A Pac, f acs©urce p plication � HEALTH PLANS i Legal Name of Group City of Laurel Requested Effective Date 7/1/2018 Form of Organization DBA Name (appears on bills) SIC or NAICS Code 9910 (check all that apply) Physical Address Required (no PO Box) 115 West 1st Street City Laurel State MT Zip 59044 County Yellowstone Mailing Address (if different than Physical Address) City FederalTax ID No. 816001283 Name(s) of All Owners and Partners State ZIP County Company Headquarters State MT Nature of Business City Government Limited Liability Company Sole Proprietorship Subchapter S -Corp eGovernment Partnership Association Nonprofit C -Corp MEVVA Church Union Trust Ilig 111! 11! i e i Name for Eligibility and Benefits Kelly Strecker Phone 406-628-7431 Ext 1 Email kstrecker(a)laurel.mt.90 Fax 406-628-2289 Name for Billing Kelly Strecker phone 406-628-7431 Ext 1 Email kstrecker(ZilIaurel.mt= Fax 406-628-2289 Is your company affiliated with any other? Yes No Will it be insured with PacificSource? Yes, Common Ownership form is attached No Name of Affiliates) Address of Affiliate(s) No. of Employees Should each affiliate be billed separately? Yes No Mail: 828 Great Northern Blvd, Ste 101, Helena, MT 59601 PSGA.MT.MASTERAPP,0116 Fax: (406) 422-1010 i Email: Mon tanaSalesfpacificsouIce. corn CL8173._09 i % 2 Medical Dental Who was eligible for your Existing Workers' Compensation Carrier Blue Cross Blue Shield Carrier prior dental plan? Carrier MMIA Policy No. 138674 Policy No. Children Only Policy No. " Adults and Children Term Date 06/30/2018Term Date Mail: 828 Great Northern Blvd, Ste 101, Helena, MT 59601 PSGA.MT.MASTERAPP,0116 Fax: (406) 422-1010 i Email: Mon tanaSalesfpacificsouIce. corn CL8173._09 i % 2 �eiiefilnforaion: `77% 7-7777 Small Yes No Medical— ............... ...... ......... ............ Plan Name(s) — Group Deductible based on Calendar yr. Indicate The medical policy you are applying for does not include coverage for pediatric dental care, which is considered an essential health benefit coverage with under the ACA for small groups. Pediatric dental care is available in the market and can be purchased as a stand-alone product. Contact your "yes" or "no" agent, your health insurance compan), or Marketplace if you wish to purchase a stand-alone dental care product. YesNo Dental....................................................................... Plan Names) Yes No Cosmetic Orthodontia (16+ enrolled employees only) Pian Name _ Large Yes No Medical and Pharmacy ......... ..................Plan Name(s) See Attached Quote Group , Deductible based onatendar yr. Contract yr. Indicate Yes No Chiropractic Manipulations and Acupuncture .... Maximum $ coverage with Yes No Vision................................................................Plan Name yes or "no': Yes No Additonal Accident.............................................Amount S Yes No Dental................................................................Plan Name(s) Yes No Cosmetic Orthodontia (16+ enrolled employees only) Plan Name r ' ' ' 1111111010f e Medical: Employee $8t73s2 Dependent See attached Dental: Employee Dependent Probationary Waiting Period Firsl of the month following your selection t/Date of hire 30 days 60 days 90 calendar days; effective on 91 st calendar day (premium prorated first month) If the last day of the probationary period falls on first day of the month, when will the new employee be effective? ✓1ligible that day Must wait until the first day of the following month or 91 st day, whichever comes first (default if not marked) Initial Enrollment If the group has no prior coverage, then allow employees to waive probationary period at initial enrollment? Yes No Minimum Hours How many hours per week must employees work to be eligible for coverage? Class All Employees Hours per week 20 Class Hours per week Eligible Members Plan covers: ve<nployee + spouse/domestic partner + children Employee only (only for small group) Employee + children (only for large group) Retiree �- Is the group a local government (school, city, cou �s� No If yes, is group coverage available to retirees? Y o If you offer health or dental coverage to your retirees, please attach the requirements and employer contribution (if any). PSGA.MTMASTERAPP.0118 Ct.ti178_0917 3 : accounts your group has Party Administrator Name HSA HRA FSA (-,.COBRA Admin _) EAP Employer Contribution to HRA or HSA Address Phone t, 132 Total number of employees (full-time, part-time, owner, partner, principal, probationary, and waiver; exclude continuation) 2.3 Total no. former employees currently on Continuation or Retiree with your group health plan (submit Application and Waiver of Coverage A. 135 TOTAL NUMBER OF EMPLOYEES: Add numbers 1 and 2 above 3.70 Total number of employees who do not qualify due to hourly requirement 4. Total number of employees who do not qualify due to waiting period requirement 5. Total number of employees waiving coverage due to other qualified coverage' (submit Application and Waiver of Coverage Form) 'Qualified Coverage: Employer Plan, Medicare, Medicaid, Tricare, and Indian Health Service 6. Total number of employees not insured for reasons not stated above Please explain reason (e.g., classification not eligible, chose not to participate): B. 70 TOTAL NUMBER OF EMPLOYEES NOT ENROLLING: Add numbers 3 through 6 above C. 62 TOTAL NUMBER OF EMPLOYEES ENROLLING, including continuation: Subtract B from A above SERVICE AREA: Do all employees reside within the PacificSource service area? Yes No If no, what state(s): ERISA: Is your group comprised of employees of a government entity or church that is not subject to ERISA? Yes No COBRA: Did you employ 20 or more total employees (fulkime, part-time, seasonal) at least 50% of your business days in the preceding calendar year? Form) Yes No Employees on Conversion or COBRA continuation of coverage: Application and Waiver of Coverage Form must be submitted for each employee on continuation. Name Continuation Effective Date Qualifying Event Prior to Policy Effective Date Group Master Application—Dental Copy of Sold Rates Enrollment Application and Waiver Forms Binder Payment (est. first month premium; refunded if coverage not effectuated Electronic FundsTransfer Form, if you want monthly premium withdraw from a bank account Common Ownership Form, if applicable PSGA.MT.MASTERAPP.0118 CLB178_0917 4 I #70, Aw ai 0) O 0 O a) -r- 0 0 0V C: (U a) a) 0. P -"- LAI T- CD m V— co CD (D CL IE 11) u co 2 Ln M 0= Ln C ill Ln Q) E; c C 0 757 w 00 z fu T C'I C9 Oo CN C) 00 U10- WP - a Quote Assu. nnpfions Date Printed: June 20, r: Group Name: City of Laurel Effective Date: July 1, 2018 Agent: EricA)len Enrollment: Enrolled Employees: 67 if enrollment differs by 10% or more, the rate guarantee is void and subject to a new rating evaluation. If plants) quoted below are not purchased wilt 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: 1.32'4 COBRA Administration: COBRA administration through PacificSource Administrators is included in premium Eligibility: Employees must work a normal workweek minimum of 20 or more hours • PaaficSource requires a minimum of 75% of all eligible employees to participate in the pian. Note: Waiving to Individual coverage is counted against partipnatrnn • PacificSource requires that Oro employer contribute a minimum or 75;6 to the employee rate or 501/. or the total rate. Based on the information submitted, this is at 1001 EE and fixed varying amount far 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 DedtCoinst00PICopay structure ONLY? Benefits are Standard "chassis" PacificSource structure, limitations and exclusion? ✓ Matching Groups current benefit limitations and exclusions? 11 If applicable, is the copay bundling option defined (PS Standard, option B, Option A)? MOL --77 Rx Formulary? I JWhich copay bundling option? Any other Nates: ER copay match does not apply Rates: Medical Plans: PSN 500 25_20 2500 $779.77 3 $1.240.65 1 51.987 36 V69.l 0 $939.91 2x Family DedlOOP Rx 100, 10/40160% to $200 2x Mail Order PSN 1500 35 —30 PSN 1000 25 20 3500 2500 $701.93 1 EE $746.91 5129502 $1.115.14 ES 5I.657.02 Si.d87.02 $423.04 EC $1,188.26 ?x Family Ded100P EF $1.903.89 Zx CON Ded1OOP 2x Mail Order Smed 5450.15 Prev Rx 2P Med 5900.30 2x Family Ded/OOP Rx too, 10140160% to $200 2x Mail Order PSN 500 25_20 2500 $779.77 3 $1.240.65 1 51.987 36 V69.l 0 $939.91 2x Family DedlOOP Rx 100, 10/40160% to $200 2x Mail Order PSN 1500 35 —30 3500 PSN 3500+Rx $701.93 1 5583,61 1 $1.557.63 1 5129502 $1.115.14 5927.94 L11 $1.788.82 Si.d87.02 $423.04 $646.08 ?x Family Ded100P 2x Family DedlOOP Rx IGO. 10140100% to $200 Zx CON Ded1OOP 2x Mail Order Embedded Red Prev Rx Signet tj�.. gain' Note: EAP is not included Benefit Period: Calendar Year Conditions: Offer assumes the contract sites 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 feriher legislation, could recontinue in 2018, (2) Section 1341 of AGA provides for the establishment of a temporary reinsurance program (for a three year period (2014-2016) which is funded by Reinsurance Fees collected Irani 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. W IN = f-mmin mis City of laurel Additional Attachment Contribution Schedule as of 06-20-2018 The City of laurel provides a flat $ contribution cap as follows: Employee $803.52 Employee +Child/ren $803.52 Employee +Spouse $1100.00 Employee +Family $1100.00 PEAKS AvHwSMTIO y City of Laurel Benefit Contact PO Bax 10 Laurel, MT 59044 April 2, 2018 RE: July 2018 VSP Renewal Dear Benefit Contact J'A ►4'z 6--a6.4g We appreciate your business and thank you for choosing VSP and Peaki Administration. We are pleased to present you with our VSP contract renewal information. We are committed to providing you with quality plan designs combined with excellent customer service. As part of the law, callers are required to apply additional taxes to their Taus. r uur nnw [am Uruuae alt or Ile new Pj ma0le trare Hct (HtiA) taxes require0 Dy r'eaeral Law. Rates thru 613012018 ; Rates E Qn lY $6 79 EE+Spouse $13.59 EE+Spouse $13.61 EE#Chlld(rert). ' $14.55. ` EE*C6iid(ery}` $t4 59 . EE+Famliy $23.25 EE+Family $23.28 nuaw sign Delves tnat you agree to Ile rates Statea eoDve ane wrlr renew as is: If you need to make arty changes, please complete the attached employer agreement and we will update accordingly. Your business is very Important to us. Thank you for allowing Peakl Administration to serve your insurance and account based product needs. If you have any questions about your renewal, please give us a call at 877.404.9443 or email boneft@mypeaki.com. We appreciate your continued confidence in VSP and Peaki Administration. Sincerely, OyU I K \ Pall- K&vYN Amy Markham Implementation Coordinator Peaki Administration 608 Northwest Boulevard Ste. 200 Coeur d'Alene, Idaho 83814 /J mypeakl.com