Loading...
HomeMy WebLinkAbout2007-12-26 Council Minutes - Special Meeting (2)AGENDA KENAI CITY COUNCIL - SPECIAL MEETING DECEMBER 26, 2007 5:00 P.M. KENAI CITY COUNCIL CHAMBERS http://ww-w.ei.kenai.ak.us ITEM A: CALL TO ORDER Pledge of Allegiance Roll Call Agenda Approval ITEM B: PUBLIC HEARINGS (Testimony limited to 3 minutes per speaker.) Resolution No. 2007-78 -- Authorizing Participation in the State of Alaska Group Health Care and Life Insurance Benefits Plan. ITEM C: KENAI CITY COUNCIL SPECIAL MEETING DECEMBER 26, 2007 KENAI CITY COUNCIL CHAMBERS 5:00 P.M. MAYOR PAT PORTER, PRESIDING 1:7:1 Y I.1;i:L{I �iiai ITEM A: CALL TO ORDER Mayor Porter called the meeting to order at approximately 5:01 p.m. in the Council Chambers in the Kenai City Hall Building. A-1. PLEDGE OF ALLEGIANCE Mayor Porter led those assembled in the Pledge of Allegiance. A-2. ROLL CALL The City Clerk took roll. Present were: Pat Porter, Mayor Linda Swarner, Vice Ma or Bar Eldrid e Rick Ross Robert Molloy Absent were: Mike Boyle and Hal Smalley. A quorum was present. Also absent: A-3. MOTION: Brittany Harding, Student Representative AGENDA APPROVAL Council Member Swarner MOVED for approval of the agenda and requested UNANIMOUS CONSENT. Council Member Eldridge SECONDED the motion. There were no objections. SO ORDERED. ITEM B: PUBLIC HEARINGS (Testimony limited to 3 minutes per speaker.) B-1. Resolution No. 2007-78 -- Authorizing Participation in the State of Alaska Group Health Care and Life Insurance Benefits Plan. Porter: Council, we have before us —is there anyone from the general public who would like to be heard at this time that's not scheduled to be heard? Clerk: You need to read the title of the resolution. KENAI CITY COUNCIL SPECIAL MEETING PARTIAL VERBATIM DECEMBER 26, 2007 PAGE 2 Porter: Oh, you know what, sorry, you know I was just doing the regular little with the three minute thing if you weren't scheduled. Sorry. We have before us Resolution No. 2007-78 authorizing participation in the State of Alaska Group Health Care and Life Insurance Benefit Plan. Pleasure of council? Councilman Molloy. Molloy: Thank you Mayor Porter. Move to approve Resolution No. 2007-78. Porter: Is there a second? Eldridge: Second. Porter: It's been moved and seconded. Is there anyone from the general public who would like to be heard on Resolution 2007-78? Seeing none, bring it back to council. Pleasure of council? Comments from council... Councilman Eldridge. Eldridge: I would like hear from the city manager what kind of response we had from the employees at the employees meeting last Friday. Porter: Mr. Koch. Koch: Madam Mayor, members of the Council, Mr. Semmens and I met with the employees last Friday and we spent, I want to say, almost an hour on the phone with representatives with Aetna and AML to answer any questions they may have had about the plan. It was my, my strong impression of that group that they were pleased with the, with the answers to the questions they had about the specific coverage and, and limitations of coverage and how the program worked. Porter: Okay, thank you. Other comments? Councilman Eldridge. Eldridge: Just as a follow up, concerning the change of carriers from Premera to Aetna, what does that do to individuals as far as pre-existing conditions and some of that, you know, that we've been carrying them as insured under the Premera, and I noticed, it seems that the Aetna policy would not pick them up for a period of time under pre-existing. Koch: No, they, they would be immediately picked up. There is, in fact, that was one of the questions that was asked and there is a process that individuals would normally would go through that identifies a pre-existing condition that was under our, our, our past or present health care program that becomes covered under the new coverage without any lapse in coverage. What the representative told us is that could probably be handled in a single document and it wouldn't be necessary for all employees that had pre-existing conditions to have to go through that process. I'd, I'd ask Larry, I guess join us up, up front if you would Larry, if you would, or if you're more comfortable back there, if you have stuff spread out, either way you'd like to, to KENAI CITY COUNCIL SPECIAL MEETING PARTIAL VERBATIM DECEMBER 26, 2007 PAGE 3 do that... Larry, was your understanding any different in regards to pre-existing conditions in that? Semmens: No, what you said is my understanding. Porter: Thank you. Councilman Ross. Ross: Could you, the, the two emails I received and the one phone call from employees were on the basis that they felt the vision and the dental was not equivalent to what they were receiving now. Porter: Mr. Koch. Koch: There, there are differences. The, I'll, I'll speak to dental first. The dental that we presently have, preventative coverage, the deductible is waived and the, the overall dental maximum is two thousand, two thousand dollars. Under Aetna, for preventative coverage, the deductible is waived. It is, it is covered a hundred percent, the maximum is one -thousand -five -hundred for all dental coverage. Porter: Per year Koch: Per year, so there's a difference of five hundred dollars. That, that includes the other two categories of dental coverage, restorative and prosthetic as well. In restorative coverage, under the existing policy we have is covered at eighty percent; the deductible is waived; the two thousand dollars comes in, into play under the Aetna policy, it's covered eighty, there's a fifty -dollar deductible. That fifty -dollar deductible would not be borne by the employee, that would be part of the self -insured deductible plan that the city has in place that's administered by Flex -Plan. The, under the prosthetic, the same, the details are similar, it's covered at fifty percent on both the Premera policy, the Aetna policy, there is a fifty -dollar deductible, however, it is, it is covered under the, the city's self-insurance and then, then there's the maximum thousand -five -hundred, but the deductible and the, you know, maximums are, include all three of those categories of dental coverage. Porter: Councilman Ross. Ross: Under the dental where the dental maximum is fifteen hundred, is that number the maximum that the co-insurance is on or is that the cap on the whole plan? Koch: That's the cap on the whole plan. It's two thousand for the Premera, fifteen hundred under the Aetna... Ross: So that's the maximum cap insurance, is that, it's not just the deductible cap... KENAI CITY COUNCIL SPECIAL MEETING PARTIAL VERBATIM DECEMBER 26, 2007 PAGE 4 Koch: That's not just the... Ross: ...1 mean, the co-insurance cap. Koch: ...correct. Yea, it's not paid for hundred... oh hold on, Larry's got his hand up. Semmens: That is per individual. Ross: Okay, per individual. Porter: Per year. Ross: Per year. Semmens: Per covered life, not family coverage or anything like that. We've got 260 people on the plan. Everyone of them has a fifteen hundred dollar maximum annually. Koch: Most of these, these things that are contained in here are going to be for, for covered body, not for a family or a spouse and, and employee. Now, you also asked about vision. Let me just get to vision here, I think it's on the previous page if you've been following along here. The routine eye exams are covered under both poli..., under the existing Premera policy and the proposed Aetna policy a hundred percent, the deductible is waived, and there's one per calendar year per covered individual. The vision hardware, under the Premera, the existing plan, is covered one hundred percent, the deductible is waived to a maximum of three hundred dollars per calendar year. There's forty-five dollar limit on frames. Porter: But on the Aetna, it's two hundred dollars. Koch: Right. That is what is considered reasonable and customary under the Aetna plan. Now there, there's little, I mean, their, their deductible and co-insurance, you know, applies. Now there are two lenses per calendar year, one frame every two calendar years, with a two -hundred dollar frame limit. Ross: Okay. The difference is, is under Premera, the deductible does not apply? And under Aetna it does? Koch: That is correct. Is that the way you understand it too Larry? Semmens: Yes. Ross: So, in real terms to a family, you know, with a couple, two or three people with glasses, what does that mean? KENAI CITY COUNCIL SPECIAL MEETING PARTIAL VERBATIM DECEMBER 26, 2007 PAGE 5 Semmens: Well, there's another component of this that, that needs to be factored in and that is that because under Aetna, it is covered under the deductible, then it is possible that if you have not met your three -thousand dollar family deductible, that you would pay nothing for glasses, because the city is going to reimburse you thirteen hundred dollars or twenty-six hundred dollars if you haven't used up all your deductible. So, you know, there, there are some variables here. Now, if, if the person did hit their deductible, if they did hit their family deductible, then this eight -twenty would come in. Frames alone, I mean that, that's where the expense in glasses is really nowadays is in frames, when you go and look at frames they're about two hundred dollars. Under Premera, you get forty-five dollars for your frames so your, this plan is better for frames. You're going to get eight percent of two hundred dollars or a hundred -sixty dollars covered or a hundred percent covered if you're still under the deductible. Porter: Okay, any other council... Councilman Swarner. Swarner: Excuse me, thank you Madam Mayor. If this resolution is approved, is there a cost for Premera, do we, because we didn't give them thirty days notice or anything before the Aetna insurance would kick in. Porter: Mr. Koch. Koch: Not to the best of my knowledge. Larry? Semmens: No, the answer's no. At renewal, we don't have to give them a thirty -day notice. Swarner: And renewal is... Semmens: January one. Swarner: January one and how, how soon before January one do we need to notify Aetna that, that we want to use them? Koch: Well, we, they are, they are prepared, at this point, to hear whatever the, what comes out of this meeting this evening. I mean, they will, they will know first thing in the morning and there will be a signed document on the way to Juneau so that this coverage can be put in place by January first, on January first. Swarner: Okay, well I guess my concern is employees cards, employees that maybe on vacation, and that type of thing. Koch: The, it takes about ten days to get cards, but the information that an employee will need for their, their health care benefits will be given to them so that they will have it on, on January first. It will be a piece of paper that tells the policy numbers and the information that a care provider will need to have to access that, the health insurance. KENAI CITY COUNCIL SPECIAL MEETING PARTIAL VERBATIM DECEMBER 26, 2007 PAGE 6 Swarner: But what about the employees that may be on vacation right now? Koch: Well... Swarner: Or shift employees that may not be back at work? Koch: We will do what it takes to get information to them. Somebody who's on vacation isn't going to have the new card, wouldn't have the new card from Premera either. They would have a, they would have an old card. Swarner: So they get a new card from Premera every year? Koch: Every time, every year you get a new one. Porter: Councilwoman Swarner, I'm in the state retirement system, and they switched carriers and sometimes it takes a little while to get the card, but your coverage, my coverage was there... Swarner: Um-hmm, okay. Porter: ...in the, in the changeover. Okay, Councilman Ross. Ross: Okay, it looks to me like, since our last meeting, the city did fill the whole on the dental by moving that into the self-insurance. I, I think, and I don't want to speak for all of council, but the sense I picked up from council from my point of view, was that since we were doing this mid -year, and pretty much faced with making a decision, that the employees should be maintained whole as far as the type of coverage. Are there any holes in here that should have been filled by the city picking up more in its deductible or self-insurance program. As I look down it, I don't see any once you answer the glass question. Porter: Excuse me. Mr. Semmens, do you want to come up here? Koch: I'm not aware that there are any holes of that nature. There are things that are different, like on vision and how that works with the forty-five dollar, two - hundred dollar. There are things that are different, say for instance on an emergency room visit. You know, it's better that there's not a hundred -dollar -per -visit cost to go in there. There are, there is, for instance, there's a difference for spinal. Under the existing Premera policy, there, it is an unlimited number of visits to a, to a chiropractor paid under the medical portion of the plan, eighty -twenty. Under the Aetna plan, it's limited to twenty-five visits, two per month and I, it seems like a fair amount of visits, so I don't know if there is a, you know, any significant difference there or not, if... You know, I did have a question on, on one of these because, and I, got it answered when I, when I called Aetna today, having to do with colorectal cancer screening. The Aetna policy, or the Premera policy, excuse me, I called them today, it's covered a hundred percent, deductible waived, and the question has come up, is KENAI CITY COUNCIL SPECIAL MEETING PARTIAL VERBATIM DECEMBER 26, 2007 PAGE 7 that a, it came up as it, in regard to Aetna. Under, under Aetna, it's covered a hundred percent, deductible waived, five hundred dollar maximum. And so, one has a five hundred dollar maximum. One doesn't. You know, is that a, a coionoscopy. i found out it's not. It's, it's a blood test that costs much less than, than five hundred dollars. So, so, I mean there are differences in, in the coverage, in language of the coverage, but I don't think the application is, there are significant differences at all. Porter: Okay. You want to ask... Mr. Semmens: Koch: Larry, is that.... Semmens Right. I, I'm not aware of anything. We, we tried to think of all those items and get them answered during our meeting with the employees and Aetna. The employees didn't ask all the questions. The administration asked a number of questions to, to draw out the answers to every question, frankly, that we could think of and I thought they did a very good job of answering it. Porter: Okay. Thank you. Coun... Ross: One more. I'm sorry... Porter: Yea, Councilman Eldridge. Eldridge: Yeah, I was wondering, I notice there's some preferred care and non - preferred care, I notice Central Peninsula Hospital is one of the approved or of hospitals, are there any other individual providers that would be a problem with shifting from Premera to Aetna, as far as any of the doctors, local care, and different types of medical attention that people might have to change if they, when we change this policy? Porter: Mr. Koch. Koch: There are not preferred providers under either plan. There are preferred hospitals. Eldridge: Okay. Koch: But, we are in a, the existing Premera plan we have is one that is not provi..., does not have preferred providers. We, I mistakenly going through all of these things, had looked at some of these plans that had a h-p designation on them and was, was told, was educated by Premera that those aren't going to work for you because there aren't, we don't have a number of preferred providers on the Kenai Peninsula. If you were in Anchorage, it would be, it would be different. So, the, the hospitals are the preferred providers. The pharmacies are, are providers isn't there, preferred hospitals, preferred pharmacies, but there are not preferred providers. Larry? KENAI CITY COUNCIL SPECIAL MEETING PARTIAL VERBATIM DECEMBER 26, 2007 PAGE 8 Porter: The pharmacies are all the ones that we have here primarily anyway, yeah. Eldridge: Yeah, right, no I was just wondering as fax as the doctors, yeah any doctors... Porter: Yeah, all part of it. Eldridge: ...you might go to, to for... Semmens: No problem. Porter: It's not a part of it. Eldridge: Not a problem. Porter: Councilman Ross, do you have a question? Ross: Yeah, Larry, you've dealt with AML for a number of years and looked at insurance issues. Have you heard any comment from any of the other political subdivisions about their services under Aetna? Semmens: I talked to them, yes, and some of them have expressed a certain amount of frustration dealing with Aetna, but I think if you went around and talked to employees around here, you would, you would find a certain amount of frustration dealing with Premera and as, as City Manager Koch and I discussed this issue today, a certain amount of difficulty dealing with the insurance company from the employer's standpoint is not altogether bad. Not that employees shouldn't get the benefits that they're due under the program, but it shouldn't just be a spend -as -much -as -you - want -we're -never -going -to -question -you type situation. Ross: You know, and, and, I haven't had the experience with Blue, Premera Blue Cross, you know, PERS only went back to that I think a year or two ago, but under Aetna I found myself filing appeals. Now, I have to admit, not a single one of them was from local medical services and some of them were from Anchorage where it was a limited provider in Alaska and I found they were trying to lump in northwest rates and I won most of those appeals, but it was just, just a time-consuming process... Semmens: I think... Ross: ...and I don't know that... Semmens: Yeah... Ross: ...Blue Cross would be any different. KENAI CITY COUNCIL SPECIAL MEETING PARTIAL VERBATIM DECEMBER 26, 2007 PAGE 9 Semmens: No, I don't think it would and one of the great things that I'm looking forward to personally, is that Aetna has a program called navigator and whereas Premera, when you call them up and ask them, "What is tine reasonable and customary amount for this procedure that I'm going to have?", they won't tell you... Ross: Yeah, I know... Semmens: they will not tell you. It is so frustrating because you do not know, as the person who's money is on the line above reasonable and customary, they will not tell you. On the other hand, using the Navigator tool with Aetna, you can not only find out what every procedure code is worth, you can find that out. You can find out, what, if you find out that you have some long-term medical problem, they will estimate how much it's going to cost monthly. They will put together a plan for you on how to deal with this issue and how much it's going to cost then. I, I'm frankly quite impressed that difference and the reason they say, that they do it that way, is because it's a fifteen -hundred dollar deductible and people need to know and they will better manage their health care if they do know. Porter: Any other comments from council? Ross: I see they have audio benefits. (laughter) Semmens: They do. Porter: I saw that ... a hundred percent. Councilman Ross, I was going to bring that to your attention. Semmens: Could you repeat that? (laughter) Porter: Councilman Swarner. Swarner: Thank you Madam Mayor. I guess, since we have some employees in the audience, I, you know, were you going to open it up to public test... Porter: Well, we already had a public testimony, but a... Swarner: Okay. Porter: ...if you want to, I don't know, we had two other employees walk in, is there any, this is very unusual because we normally don't do this, but it involves the employees, so, if we have an employee out there who has not had an opportunity to come before us and speak, if anyone would like to, you're welcome to do that. Okay? Bring it back to council. Councilman Eldridge? KENAI CITY COUNCIL SPECIAL MEETING PARTIAL VERBATIM DECEMBER 26, 2007 PAGE 10 Eldridge: I was just wondering, I see Alaska Regional Hospital's not on the approved list. Semmens: They are not a preferred hospital. Eldridge: Okay. Semmens: Now if a person got referred to Regional because a preferred hospital did not have that equipment or whatever is necessary to treat that patient, then Premera says that they will cover it at the normal rate. Eldridge: Aetna. Semmens: Excuse me, Aetna. Porter: When we used to have Aetna insurance through the kind of insurance Rick and I are involved with through the state, my husband actually, was Providence Hospital, at that time was not an approved provider, it was Humana, but just because we requested the other hospital, they approved it. So, you know, there's probably some of that goes on too, I mean, if you prefer a hospital, there might be an opportunity in the same community, if it's the same doctor and I don't know. Anyway, so I didn't find that too much of an issue up there. Any other comments from council? Seeing none, Clerk please call the roll Clerk: Porter. Porter: Yes. Clerk: Swarner. Swarner: Yes. Clerk: Eldridge. Eldridge: Yes. Clerk: Ross. Ross: Yes. Clerk: Molloy. Molloy: Yes. Porter: Thank you. Seeing no other business to come before the council, this meeting is adjourned. KENAI CITY COUNCIL SPECIAL MEETING PARTIAL VERBATIM DECEMBER 26, 2007 PAGE I I Verbatim prepared and submitted by: Carol L. Freas, City Clerk