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Home My WebLink About2007-12-26 Council PacketAK PAC T COUNCIL PACKET DISTRIBUTION COUNCIL MEETING DATE: I~f~(ol~''7 Ma or/Council / Attorne Ta for/Sprin er Clerk / Cit Mana er Kebschull/Carver Police De artment Finance ~C En ineer Senior Center X Air ort Kim Librar `~ Parks & Recrention Clarion Fire De artment ;~ Schmidt ~ Mellish Student Re . KSRM AGENDA DISTRIBUTION DELIVER Council and Student Representative Packets to Police Department Dispatch desk. The Clarion, KSRM, Mellish & Schmidt's Office will pick their packet up in my office. The portion of the ngenda published by the Clarion should be emailed ns soon as possible on packet dny. The camera-ready agenda c:/myfiles/documents/minutes/agenda form for paper) is emailed to Denise at Peninsu/a C/arion (at email folder Work Session/Special Meetings, or Composition in Contacts or (bell@acsalaska.net). Home Page documents (agendn, resolutions, ordinances for public hearing, and ordinances for introduction) nre usually emailed to me and T hold them in my NTML file. Place information (meeting e-packet and agenda, resolutions and ordinances for public hearing, etc. on the city's webpage as soon as possible before lenving the office for the weekend. PREMERA CURRENT BENEFITS-2007 Monthly Annual Plan Component Description Charges Costs Medical HS $ 1,000/20%/$ 2,000 $ 64,490.31 $ 773,883.72 MH 12 Visits OP/6 days IP $ 236.44 $ 2,837.28 Unlimited Spinal $ 2,719.50 $ 32,634.00 Pharmacy Rx $ 0-$ 10/$ 20 $ 11,609.00 $ 139,308.00 Vision V-1 Exam PCY/$ 300 PCY $ 3,895.42 $ 46,745.04 Dental DOpt $ 0/0%/20%/50%/$ 2,000 $ 9,326.42 $ 111,917.04 Sub-Total $ 92,277.09 $ 1,107,325.08 Flex-Plan Administration $ 833.33 $ 9,999.96 Employee Share of Premium $ (7,392.00) $ (88,704.00) Commission Rebate $ (4,613.85) $ (55,366.25) Self Insurance Deductible $ 14,733.33 $ 176,799.96 Total $ 95,837.90 $ 1,150,054.75 PREMERA CURRENT BENEFITS-2008 (18.74% Increase) Monthly Annual Plan Component Description Charges Costs Medical HS $ 1,000/20%/$2,000 $ 77,624.79 $ 931,497.48 MH 12 Visits OP/6 days IP $ 279.56 $ 3,354.72 Unlimited Spinal $ 3,273.43 $ 39,281.16 Pharmacy Rx $ 0-$ 10/$ 20 $ 13,976.25 $ 167,715.00 Vision V-1 Exam PCY/$ 300 PCY $ 4,342.31 $ 52,107.72 Dental DOpt $ 0/0%/20%/50%/$ 2,000 $ 10,076.41 $ 120,916.92 Sub-Total $ 109,572.75 $ 1,314,873.00 Flex-Plan Administration $ 833.33 $ 9,999.96 Employee Share of Premium $ (7,392.00) $ (88,704.00) Commission Rebate $ (5,478.64) $ (65,743.65) Self Insurance Deductible $ 14,733.33 $ 176,799.96 Total $ 112,268.77 $ 1,347,225.27 PREMERA MODIFIED BENEFITS-2008 (7.40% Increase) Monthly Annual Plan Component Description Charges Costs Medical HS $ 1,000/20%/$ 3,000 $ 75,149.63 $ 901,795.56 MH 12 Visits OP/6 days IP $ 283.57 $ 3,402.84 Unlimited Spinal $ 3,170.02 $ 38,040.24 Pharmacy Rx $ 0-$ 15/$ 25/$ 40 $ 11,279.37 $ 135,352.44 Vision V-1 Exam PCY $ 1,085.06 $ 13,020.72 Dental DOpt $ 0120%/20%150%/$ 1,500 $ 8,139.51 $ 97,674.12 Sub-Total $ 99,107.16 $ 1,189,285.92 Flex-Plan Administration $ 833.33 $ 9,999.96 Employee Share of Premium $ (7,392.00) $ (88,704.00) Commission Rebate $ (4,955.36) $ (59,464.30) Self Insurance Deductible $ 14,733.33 $ 176,799.96 Total $ 102,326.46 $ 1,227,917.54 COMPARISON OF EXISTING, CONSIDERED PROPOSED EMPLOYEE HEALTH BENEFIT PLANS FOR CY 2008 AETNA-POLITICAL SUBDIVISIONS PLAN IV (15.06% Decrease) Plan Component Description Medical $ 1,500/20%/$ 2,000 & $10 per visit MH 25 Visits 50%/IP 21 Days 50% Spinal -Included under Medical Pharmacy Deductible Applies, After Deductible $ 10 Generic, $ 20 Formulary Brand Name, $ 35 Non-Formulary (mail order is cheaper) Vision Exam 100% 1 PCY, Lenses 80% 2 PCY Frames 80% 1 P2CY Dental Preventative 80%, Restorative 80%, Prosthetic 50%, $ 50 Deductible, $ 0 Deductible for Preventative, $ 1,500 per year maximum Audio Exam 100%, $ 800 maximum for three consecutive years Sub-Total $ 67,420.40 $ 404,522.40 $ Flex-Plan Administration $ 833.00 $ 4,998.00 $ Employee Share of Premium $ (7,392.00) $ (44,352.00) $ Commission Rebate $ - $ - $ Self Insurance Deductible $ 17,175.00 $ 103,050.00 $ Total $ 78,036.40 $ 468,218.40 $ Monthly 1/1/08 - 6/30!08 711108 - 12/31108 Charges Costs Costs* $ 67,420.40 $ 404,522.40 $ 444,974.64 Total for AETNA Plan IV 1!1108-12/31108 $ 976,889.04 * Includes Estimated 10% Premium Increase Beginning July 1, 2008 444,974.64 4,998.00 (44,352.00) 103,050.00 508,670.64 AETNA Premera Difference AETNA vs Current (2007)Premera Coverage $ 976,889.04 $ 1,150,054.75 $ (173,165.71) AETNA vs Current (2008)Premera Coverage $ 976,889.04 $ 1,347,225.27 $ (370,336.23) AETNA vs Modified (2008) Premera Coverage $ 976,889.04 $ 1,227,917.54 $ (251,028.50) 0 0 N ER N T N - a t7 > i W F- O t d l0 O o "- Z U O tQ ~ ~ ~ G N w d O U ~ O U ^ ~ ~ ~ ~ ~ T ~ ~ Q'f ~ N N '~ N (/! 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U V3 ^ ^ ^ d ^ U r ^ d J U ^ eH } U ~ a a a a d ~ -o a ~ > > > > > ~ ~ c y >. ~ ` c ° a a E _ o _ c w E ~ a~ _ o _ 0 _ _ 0 ° _ o _ a~ ~ a~ _ > ` x 0 w ~ O N N 9 ~ N ~ N N A N N N N '~ ~ J 9 p ~ ' O ~ M ~ 0 U U U U U U U C U U U U U U U U N U p ~( W C 0 N T _ N ~p C C N C (0 O a O a C N O a ~ G N C a C N G (6 G N C (6 O a O a E O a N Q x M Ef~M,~ S N ~ U~ °' ^ °' ^ ~ ~1I ~ ^ UI (~ ~ ^ ~ N ~ N ~ N ~ N ° ^ °'~ ^ °'~ ^ ~ V3 C C + C C C C C C C ~ T U v~ O _ ~ O o o O o O O ° 0 0 O O o o~ \ W cC E ~ .~ } a O U y U O O (\j O U U o O D U U U o O ~, O o E O' W v U> L a ~ > ~ O O N ~ N N ~ N N N N v fA ~- X r t9 er o~ m ~ ~° a~ a a .~ a ~ a a a a .Q .o a a>- a~ p , o d ° °o 00 0 ~ ~ 0 ~ o ~ o m ~ ~ ~ > > ~ ~ ~ ~ ~ ~ } a ~i _ 0 0^ i a a > > a > a a > a a a a > U > o > c o n N a -~ o ~ m o o m o m m o o a~ o 0 o n. o 0 0 0 eA N (A~ N 3 ^ d3^ U U ^ U ^ ^ U ^ ^ ^ ^ U~ U(`~ U ^ N N (6 U F- ~ O N W E E ,u ° E m 2 N c ~ ~ ~ ~ w ° E J ~ w d 01 H ,p ~ ~ ~ 2 U ° ~ >. m N ~ t6 U t6 x o >. = ° ^ O (6 C ' ~p U w O a O d L U X w ° .~ U N N E ~ .U O N N U E N ~ O ~ N LL U ~ O Q o ~ O a o .~ '° O t ° ~ ° ' a w m m U o c U ~ ~. ul m a o c o '- . m U O ~ c ~ O T -Q N Z U O .... >. L N T ~ C ~ U O Z = -~ - O > N N t6 m O N O S G . v N d U N a ° O) C ~ 07 N E C ~ C ~ N N ~ t6 a N C ~ C (6 ° c > v ~ ' - w ~ ~ ' `o a ~ c o ~ "o a ~ E o °~ ° o o a o n e ~ 'a o N N ^ U ~ O w ~ ~ d ~ ~ ~ cn U ~ O cn <n K > ^ _~ ~_ ~ G ~ ~ N C = N w ~ ~ y N~ O C X m ` ~Q U mQ U w ~a¢ a d ~ d ~ C p i C N C (6 Ol p p N (6 'O p O Y G ~~ Y y 3 y~ N N N~ N C C p C p ~ X N~ N c6 w ~«-.a ~.-.o ~dN~ ~ u m i ~ °~ m~ m > n ~ 9 U - ~ ~ U :... ~ N p 0 > ~ ~ ~ N ~ iJ U O U O CJ EA 4A d ~~ ~~ N N a N n N~ ~ ~ ~ Uv> a~a» mo m >i N m c c U cp~ U ° Q~Qa QU ~ ~ ~ o o aS aS y E ~ ~ `~ ~ E ui ~ a ~ a V~ C O ~ O ~ O } C Q t9 ? ~ O N~ N~ U U N E~ T ~.- ~~ U o m ~ o E °- °~' O'ff d °m o w- ~ QUO a " 64 E H3 E £ 6? C N N C N o .~ o ~ O X W o U~ ~U' O p ~- ~ N N ~ t(J c7 N~ N CJ g g ~ ~ p N~ n ~ ~ m N ~ ~ ~ ~ ~ d) ~ ~ N > C > C p ~' N > ~ O C C N (6 t6 U~ U~ ~ U ~Qea~~ ~ o ~ N ~ o O d d b? N U C N > ~ N > ~ f6 (6 C tb V ~ ~ ~ "'- E ~ o U N ~ oo U N Q EA C Q ~ ~ EH ~ ~ EH ~ p ~ C UI p E p E > -O m o E o E - . m ~a-o O ~X O ~JC p U p U ~ ~ ~ OJ t4 N t6 - N N ` p p U f a m ~ > ~ a U U ~ p~ > U ~ U ~ Z Z ~° Q ~ a~ > U ro O ~ ~ O N L o w . r ... ~ ~ ~ .. U m m L m ~ ~, p E m 0 o C = a a State of Alaska Political Subdivisions Proposed Effective Date: 07-01-2007 Open Choice®(PPO) -Insured PLAN DESIGN AND BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY Deductible (per calendar year) $1,500 Individual $3,000 Family $2,000 Individual $4,000 Family All covered expenses including prescription drugs accumulate toward both the preferred and non-preferred Deductible. Unless otherwise indicated, the Deductible must be met prior to benefits being payable. Once family deductible is met, all family members will be considered as having met their deductible for the remainder of the calendar year. There is no individual deductible to satisfy within the family deductible. Member Coinsurance 20% 40%- facility only Applies to all expenses unless otherwise stated. Payment Limit (per calendar year) $2,500 Individual $3,000 Individual $5,000 Family $7,000 Family All covered expenses including deductible and prescription drugs accumulate toward both the preferred and non-preferred Payment Limif. Certain member cost sharing elements may not apply toward the Payment Limit. Only those out-of-pocket expenses resulting from the application of coinsurance percentage, deductibles, and prescription drug copays (except any penalty amounts) may be used to satisfy the Payment Limit. Once family payment limit is met, all family members will be considered as having met their payment limit for the remainder of the plan year. There is no individual payment limit to satisfy within the family payment limit. Lifetime Maximum member's lifetime. Primary Care Physician Selection Not applicable Not applicable Certification Requirements - Certification for certain types of Non-Preferred care must be obtained to avoid a reduction in benefits paid for that care. Certification for Hospital Admissions, Treatment Facility Admissions, Convalescent Facility Admissions, Home Health Care, Hospice Care and Private Duty Nursing is required -excluded amount applied separately to each type of expense is $400 per occurrence. Referral Requirement None None Routine Adult Physical Exams/ Covered 100%; Immunizations $500 maximum. 1 exam per 12 months for members age 18 to age 65; 1 exam per 12 months for adults age 65 and older Routine Well Child Exams/Immunizations Covered 100%; deductible waived, same $500 maximum. 7 exams in the first 12 months of life, 2 exams in the 13th-24th months of life; 1 exam per 12 months thereafter to age 18. Routine Gynecological Care Exams Covered 100%; deductible waived, same Included Pap smear and related lab fees $500 maximum. Routine Mammograms Covered 100%; deductible waived, same For covered females age 40 and over. $500 maximum. Routine Digital Rectal Exam /Prostate- Covered 100%; deductible waived, same specific Antigen Test $500 maximum. For covered males age 40 and over Colorectal Cancer Screening Covered 100%; deductible waived, same For all members age 50 and over. $500 maximum. Routine Eye Exams Covered 100%; deductible waived same 1 routine exam per 12 months Routine Hearing Exams Covered 100%; deductible waived same 1 routine exam per 24 months PHYSICIAN SERVICES PE2~FEt2RED CAE2E NQN-PREFI:RI2~I) CqR~ 12/26/2007 Page 1 ~~n PLAN DESIGN AND BENEFITS State of Alaska Political Subdivisions Proposed Effective Date: 07-01-2007 Open Choice®(PPO) -Insured PROVIDED BY AETNA LIFE INSURANCE COMPANY Office Visits to Non-Specialist 20% 20% Includes services of an internist, general physician, family practitioner or pediatrician. Specialist Office Visits 20% 20% Allergy Testing Covered as either PCP or specialist 20% Diagnostic Laboratory and X-ray 20% 20 If performed as a part of a physician office visit and billed by the physician, expenses are covered subject to the applicable ohvsician's office visit member cost sharina Urgent Care Provider 20% 20% (benefit availability may vary by location) Non-Urgent Use of Urgent Care Provider Not Covered Not Covared Emergency Room 20% Same as preferred care. Non-Emergency care in an Emergency 50% 50% Inpatient Coverage 20% 40% The member cost sharing applies to all covered benefits incurred during a member's inpatient stay Inpatienf Maternity Coverage 20% 40% The member cost sharing applies to all covered benefits incurred during a member's inpatient stay Outpatient Hospital Expenses (including 20% 40% surgery) Inpatient 50% 40% Limited to 30 days per calendar year. The member cost sharina applies to all covered benefits incurred durina a member's inpatient stav Outpatient 50% 50% Limited to 20 visits per calendar year. The member cost sharing applies to all covered benefits incurred during a member's ou tpatient visit Maximum are a combined limit for preferred and non-preferred services. A<:COHOIJDRUG l~Bt1SE $EF2~tC~S PREF~~2RED CARE NON~PR~FERRED CARE Inpatient 20% 40% Limited to 30 days per calendar year. The member cost sharing applies to all covered benefits incurred during a member's inp atient stay Outpatient 50% 50% Limited to 20 visits per calendar year. The member cost sharing applies to all Covered Benefits incurred during a member's o utpatient visit Maximums are a combined limit for preferred and non-preferred services. Convalescent Facility 20% 20% Limited to 120 days per calendar year. The member cost sharing applies to all covered benefits incurring during a member's inpatient stay Home Health Care 20% 20% Limited to 60 visits per calendar year. Each visit by a nurse or therapist is one visit. Each visit uo to 4 hours by a home health care aide is one visit. Hospice Care -Inpatient 20% Limited to 30 days per lifetime. 12/26/2007 Page 2 ~~ #- State of Alaska Political Subdivisions ~~~~ Proposed Effective Date: 07-01-2007 Open Choice® (PPO) -Insured PLAN DESIGN AND BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY The member cost sharing applies to all covered benefits incurred durino a member's inpatient sta Hospice Care -Outpatient 20% 20% Up to a maximum benefit of $5,000 The member cost sharing applies to all covered benefits incurred during a member's outpatient visit Private Duty Nursing -Outpatient (Limited to 20% 20% 70 eight hour shifts per calendar year) Outpatient Short-Term Rehabilitation 20% 20% Includes speech, physical, and occupational therapy. Spinal Manipulation Therapy 20% 20% Limited to 25 visits per calendar year Durable Medical Equipment 20% 20% Maximum annual benefit of $10,000 per member per calendar year same as any other medical Covered same as any other medical expense. expense. Contraceptive drugs and devices not 20% (payable as any other covered 20% (payable as any other covered obtainable at a pharmacy (includes coverage expense) expense) Vision Eyewear J>d~t°~rs~v~_'' Transplants 20% Preferred coverage is provided 40% Non-Preferred coverage is at an IOE contracted facility only provided at a Non-IOE "Other" Health Care - 20% member coinsurance after the preferred (per calendar year) deductible for services that are neither "preferred" nor "non-preferred" FAMILY PLANNING PREFERRED CARE NON-PREFERRED CARE Infertility Treatment Member cost sharing is based on the Member cost sharing is based on the Diagnosis and treatment of the underlying type of service performed and the type of service performed and the medical condition. place of service where it is rendered place of service where it is rendered Voluntary Sterilization Member cost sharing is based on the Member cost sharing is based on the Including tuba) ligation and vasectomy type of service performed and the type of service performed and the place of service where it is rendered place of service where it is rendered The full cost of the drug is applied to the deductible before benefits are considered for payment under the pharmacy plan. Retail Covered 100% after combined Not Covered medical/Rx plan deductible and $10 copay for generic drugs, $20 copay for formulary brand-name drugs, and $35 copay for non-formulary brand-name drugs up to a 30 day supply at participating pharmacies. Mail Order Covered 100% after combined Not Covered medical/Rx plan deductible and $20 copay for generic drugs, $40 copay for formulary brand-name drugs, and $60 copay for non-formulary brand-name drugs up to a 31-90 day supply from Aetna Rx Home Delivery. No Mandatory Generic (NO MG) - Member is responsible to pay the applicable copay only. Plan Includes: Devices obtainable from a pharmacy, Oral fertility drugs, Diabetic supplies. glasses, lenses and one calendar year for eyeglass lenses and 2 calendar 12/26/2007 Page 3 `Y" 1 Y1 # -, State of Alaska Political Subdivisions •y•~ -~ Proposed Effective Date: 07-01-2007 Open ChoiceO (PPO) -Insured PLAN DESIGN AND BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY Lens Option Contact lenses following cataract surgery or if vision cannot be corrected by conventional lenses: $400 lifetime maximum Deductible $50. Does not apply to oral exams, cleanings, x-ray, fluoride applications and sealants for children to age 18 ren from birth to aae 19 or to Pre-existing Conditions Rule On effective date: Waived After effective date: Full Postponement This plan imposes apre-existing condition exclusion, which may be waived in some circumstances and may not be applicable to you. Apre-existing condition exclusion means that if you have a medical condition before coming to this plan, you may have to wait a certain period of time before the plan will provide coverage for that condition. This exclusion applies only to conditions for which medical advice, diagnosis, care, or treatment was recommended or received or for which the individual took prescribed drugs within 90 days.Generally, this period ends the day before your coverage becomes effective. However, if you were in a waiting period for coverage, 90 days ends on the day before the waiting period begins. The exclusion period, if applicable, may last up to 365 days from your first day of coverage, or, if you were in a waiting period, from the first day of your waiting period. If you had prior creditable coverage within 90 days immediately before the date you enrolled under this plan, then the pre-existing conditions exclusion in your plan, if any, will be waived. If you had no prior creditable coverage within the 90 days prior to your enrollment date (either because you had no prior coverage or because there was more than a 90 day gap from the date your prior coverage terminated to your enrollment date), we will apply your plan's pre-existing conditions exclusion. In order to reduce or possibly eliminate your exclusion period based on your creditable coverage, you should provide us a copy of any certificates of creditable coverage you have.Please contact Aetna Member Services at 1-888-982-3862 if you need assistance in obtaining a certificate of creditable coverage from your prior carrier or if you have any questions on the information noted above. The pre-existing condition exclusion does not apply to pregnancy nor to a child who is enrolled in the plan within 31 days of birth, adoption, or placement for adoption. Note: For late enrollees, coverage will be delayed until the plan's next open enrollment, and the pre-existing condition exclusion will be applied from the individual's effective date of coverage. This plan does not cover all health care expenses and includes exclusions and limitations. Members should refer to their plan documents to determine which health care services are covered and to what extent. The following is a partial list of services and supplies that are generally not covered. However, your plan documents may contain exceptions to this list based on state mandates or the plan design or rider(s) purchased by your employer. All medical or hospital services not specifically covered in, or which are limited or excluded in the plan documents; Charges related to any eye surgery mainly to correct refractive errors; Cosmetic surgery, including breast reduction; Custodial care; Dental care and X-rays; Donor egg retrieval; Experimental and investigational procedures; Hearing aids; Immunizations for travel or work; Infertility services, including, but not limited to, artificial insemination and advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI and other related services, unless specifically listed as covered in your plan documents; Nonmedically necessary services or supplies; Orthotics; Over-the-counter medications and supplies; Reversal of sterilization; Services for the treatment of sexual dysfunction or inadequacies, including therapy, supplies, or counseling; and special duty nursing. This material is for informational purposes only and is neither an offer of coverage nor medical advice. It contains only a partial, general description of plan benefits or programs and does not constitute a contract. Aetna does not provide health care services and, therefore, cannot guarantee results or outcomes. Consult the plan documents (i.e. Group Insurance 12/26/2007 Page 4 Coinsurance 80% for all services, except 50% for inlays, onlays, crowns, fixed and removable bridgework and dentures ,~,.... ~~~, State of Alaska Political Subdivisions Proposed Effective Date: 07-01-2007 Open Choice® (PPO) -Insured PLAN DESIGN AND BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY Certificate and/or Group Policy) to determine governing contractual provisions, including procedures, exclusions and limitation relating to the plan. With the exception of Aetna Rx Home Delivery, all preferred providers and vendors are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Aetna Rx Home Delivery, LLC, is a subsidiary of Aetna Inc. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change without notice. Some benefits are subject to limitations or visit maximums. Certain services require precertification, or prior approval of coverage. Failure to precertify for these services may lead to substantially reduced benefits or denial of coverage. Some of the benefits requiring precertification may include, but are not limited to, inpatient hospital, inpatient mental health, inpatient skilled nursing, outpatient surgery, substance abuse (detoxification, inpatient and outpatient rehabilitation). When the Member's preferred provider is coordinating care, the preferred provider will obtain the precertification. When the member utilizes anon-preferred provider, Member must obtain the precertification. Precertification requirements may vary. Depending on the plan selected, new prescription drugs not yet reviewed by our medication review committee are either available under plans with an open formulary or excluded from coverage unless a medical exception is obtained under plans that use a closed formulary. They may also be subject to precertification or step-therapy. Non-prescription drugs and drugs in the Limitations and Exclusions section of the plan documents (received after open enrollment) are not covered, and medical exceptions are not available for them. While this information is believed to be accurate as of the print date, it is subject to change. Plans are provided by Aetna Life Insurance Company. 12/26/2007 Page 5 MEDICAL PLAN HS $1,000/20%!$2,000 MEDICAL COST SHARE OPTIONS • ' • • • " Individual Deductible PCY (Family Deductible 3x Individual) $1,000 PCY Shared with In-Network Deductible Coinsurance (Member's percentage of costs after deductible 20 % HospitallCD Facility: 40%; Other Facilities based on allowable charges) & All Professionals: Same as In-Network Cost Share Individual Out of Pocket Maximum PCY, Excludes Copay $2,000 PCY Not Applicable (Family OOP Max 3x Individual) Office Visit Cost Share Deductible/Coinsurance Same as Office Visit In-Network Cost Share COVERED SERVICES PREVENTIVE CARE OPTIONS AND HEALTH EDUCATION Preventive Office Visit (Unlimited) Covered in ulI ame as In-Network Preventive Office Visit Cost Share Immunizations (Unlimited) Covered in Full Same as In-Network Immunization Cost Share Health Education (HE) (Unlimited) Covered in Full Covered in Full Community Wellness, Prevention and Safety Programs (CW) Covered in Full Covered in Full ($250 PCY) Nicotine Dependency Programs (NO) ($250 PCY) Covered in Full Covered in Full Diabetes Health Education (DE) (Unlimited) Covered in Full Covered in FuII PROFESSIONAL CARE Professional Office Visit Including Urgent Care DeductiblelCoinsurance Same as Office Visit In-Network Cost Share Inpatient Professional Services DeductiblelCoinsurance Hospital/CD Facility: 40 % ;Other Facilities & All Professionals: Same as In-Network Cost Share DIAGNOSTIC SERVICE OPTIONS Professional Diagnostic Imaging and Laboratory Services - Covered in Full Hosptal/CD Facility: Includiny PAP/PSA, Preventive Deductible/Coinsurance; Other Facilities & Professionals Same as In-Network Cost Share Other Professional Diagnostic Imaging and Laboratory Deductible/Coinsurance HospitallCD Facility. Services Deductible/Coinsurance; Other Facilities & Professionals: Same as In-Network Cost Share Mammography Covered in Full Hospital/CD Facility. Deductible/Coinsurance; Other Faciiities: Same as In-Network Cost Share FACILITY CARE OPTIONS Inpatient Facility Deductible/Coinsurance Hospital/ D Facility. 40 % Other Facilities: Same as In-Network Cost Share Outpatient Surgery Facility Deductible/Coinsurance Hospital/CD Facility: Deductible/Coinsurance; Ofher Facilities: Same as In-Network Cost Share Skilled Nursing Facility (60 days PCY) Deductible/Coinsurance Hospital/CD Facility. 40% Other Facilities- Same as In-Network Cost Share PCY =Per calendar year. Balance billing may apply if a provider is not contracted with Premera Blue Cross Blue Shield of Alaska. Members are responsible for amounts In excess of the allowable charge. City of Kenai ,..~ ,~, ,~~.:;[ ,.~~~~' ~~~".~~ Group Number: 1023228 Any deductibles, copays, and coinsurance percentages shown are amounts for which you're responsible. Effective date: 1/1/2007 This is not a romple,'e explanation of covered services, exGus7ons, limitations, reductions or the tears under which the program maybe continued In force. This benefit highlight is not a confract For full coverage provlslons, /ncluding a description of waiting periods, /irritations and exclusions please City of Kenai Group Number: 1023228 Any deductibles, copays, arid coinsurance percentages shown are amounts for which you're responsible. Effective date: 1/112007 EMERGENCY CARE OPTIONS ~' + 9 ®' Emergency Care (Waive copay if admitted, always subject to 100 opay, De ucti le/ oinsurance 100 Copay, ubject to n- etwor deductible and coinsurance) Deductible/Coinsurance Ambulance Transportation DeductiblelCoinsurance Same as In-Network Deductible/Coinsurance Air Ambulance (Unlimited) Deductible/Coinsurance Same as In-Network D e d u ct i b l e/Coinsurance Air or Surface Transportation Deductible/Coinsurance Same as In-Network Ded uctib I elCo i n su ran ce OTHER SERVICES Acupuncture (12 visits PCY) Deductible/Coinsurance Same as Office Visit In-Network Cost Share Chemical Dependency ($14,495 per 24 Months; $28,985 per Covered as Any Other Service Hospital/CD Facility: 40%; Other Facilities Lifetime) & All Professionals: Same as In-Network Cost Share Home Health Care (130 visits PCY) Deductible/Coinsurance Hospital/CD Facility: 40%; Other Facilities & All Professionals: Same as In-Network Cost Share Hospice (Inpatient: 'IO days', Respite: 240 hours; 6 month limit) DeductiblelCoinsurance Hospital/CD Facility: 40%; Other Facilities & All Professionals: Same as In-Network Cost Share Manipulations (spinal and other)(Unlimited) DeductiblelCoinsurance Same as Office Visit In-Network Cost Share Medical Supplies (MS), Equipment (ME), Prosthetics (Pro) and DeductiblelCoinsurance Hospital/CD Facility: 40%; Other Facilities Orthotics (Orth) (MS: $10,000 PCY; ME $10,000 PCY Shared & All Professionals: Same as In-Network with MS', Pro: $10,000 PCY Shared with MSI Orth: $300 PCY, Cost Share Shared with MEj Mental Health Inpatient Facility Care(6 days PCY) Same as In-Network Medical Inpatient Same as Out-of-Network Medical Cost Share Inpatient Cost Share Mental Health Outpatient Professional Care(12 visits PCY) Same as In-Network Medical Office Same as Out-of-Network Medical Office Visit Cosi Share Vlstt Cost Share Naturopathy (Unlimited) DeductblelCoinsurance Same as Ofhce Visit In-Netork Cost Share Rehab Inpatien4 Facility (30 days PCY) Deductible/Coinsurance Hospital/CD Facility. 40% Other Facilities. Same as In-Network Cost Share Rehab Outpatient Care, Including Physical, Occupational, Covered as Any Other Service Same as Office Visit In-Network Cost Speech and Massage Therapy; Cardiac & Pulmonary Rehab.; Share and Chronic Pain (45 visits PCY) Transplants ($250,000 per lifetime; combined inpatient and Covered as Any Other Service Not Covered outpatient limit) SUPPLEMENTAL BENEFITS Routine Vision Exam (1 PCY) Office Visit Cost Share Same as In-Network Cost Share; (Plus plans only - MD/DO/DPM/O pthalmologist. OON Deductible/Coinsurance) Vision Hardware ($300 PCY) Covered in Full Covered In Full LIFETIME MAXIMUM $2,000,000 PCY= Per calendar year. t3alance billing may apply If a provider Is not contracted with Premera Hlue Cross Blue Shield of Alaska. Members are responsible for amounts in excess of [he allowable charge. This is nor a oomplete explanation of covered services, exclusions, limitations, redr;ctions or the terms under which the program may be continued in force. This benefit hignllghf is not a contract For full coverage provisions, including a doscnption ofwaiting periods, limitations end exclosions please contracC Customer Service. Document ID' CTPn'134.95 -21'L865 12/19/2006 730 am Page 2 of 13 DENTAL PLAN DOPT $0/0%!20°i°150%t$2000 COVERED SERVICES IndividuallFamily Deductible PCY 0 PCY / 0 PCY Diagnostic/Preventive 0% -initial 8 routine oral exams -cleanings -fluoride treatments -routine dental x-rays sealants Basic 20% -emergency & other non-routine exams -non-routine dental x-rays -space maintainers (for members age 12 8 under) -simple extractions -fillings -periodontal maintenance -recementing of crowns, inlays, and bridgework -emergency palliative treatment Major _ ____ ___ 50% -oral surgery consisting of surgical extractions -periodontal surgery -periodontal scaling -full mouth debddement -general anesthesia -inlays, onlays 8 crowns -endodontics -dentures 8 fixed bridgework -repair of crowns, inlays, brid ework 8 dentures o _ _ Annual Maximum _ X2,000 PCY Diagnostic and Preventive Care Services aren't subject to the calendar year deductible- PCY =Per calendar year. Balance billing may apply if a provider is not contracted with Premera Blue Cross Blue Shield of Alaska. Members are responsible for amounts in excess of the allowable charge- CitvofKenai rs s' 'T ~ ;, '._t: ~.'rsx~ ~,E,%f Group Number: '1023228 Any deductibles, copays, and coinsurance percentages shown are amounts for which you're responsible. EffBCtlVB data: 111/2007 rnisis not a complete explanation of covered services, exclusions, (imitations, reduc[ions or the terms under which the program may be continued in force. This benefit highlight is not a contract Porfull coverage provisions, including a descrlpPlon of waiting periods, lirnlfations and exclusions please Tier 1 =Generic Pharmacy Benefits Tier2=Preferred Brand Below is a brief overview of what you can expect to pay for a prescription drug, depending on which "tier" category it falls under in the Preferred Drug List for your plan when using an In-Network Pharmacy. For more information on your pharmacy benefits, including Out-of-Network benefts, see your beneft booklet To find out what tier applies to a specific medication, see our Preferred Drug List in your pharmacy packet or at www.premera.com. Any deductibles, copays, and coinsurance percentages shown are amounts for which you're responsible. Effective date: 111/2007 PHARMACY PLAN RX $0-$10/$20 OUTPATIENT PRESCRIPTION DRUGS Cost Share Category Tier 1/Tier 2 Retail Cost Shares Up to 90 day supply per prescription, 1 Copay required for each 30-day supply 10! 20 ______ __ Mail Cost Shares Up to 90 da supply per prescription, 1 Copay per prescription _ $20/$40 _ _ Individual Deductible PCY _ $0 Out of Pocket Max Unlimited _ Annual Benefit Maz Unlimited PCY =Per calendar year- Balance billing may apply It a provider is not contracted with Premera Blue Cross Blue Shield of Alaska. Members are responsible for amounts in excess of the allowable charge. City of Kenai ~ ~ '~ ~ ~ ° ~ ~^ - ~ '~``'° Group Number: 1023228 This is not a complete explanation of covered services, ©xclusions, limita(ions, reductlons or fhe terrris under which the program maybe continued in force. This benefit highlight is not a contract. Forfull coverago provisions, including a description of waiting periods, limifa6ons and exclusions please ~ oul O.r o O!W~ ~ .-Im .-i O N .-! .-' ~- m I r[ W ~n L- .-I~-' Oi~ d' O ao~ V- o l 0 cn o t0 O ` ~iM e~ O N fD V'I M~ N ' N N NKDiN Ni CO M M ! O Nod cO~Ol o~ 00 d''N ~ I~ N N o0 c0 M M~ d N ~ N N M f0 ~ 7 M of TIN tiles N. tp1 CO ~ McO V ~M ~ O W ~~ O I~:~ n R ^ r a i ~ O ~O ~,. rnrna~ 0 ol O rn O rn rn wa~rnc'1 O O ~~ i I i _ i ~ i _ . ~ [O r tD N N tS M M ! c0 ip ~ ~ I ~ O ~ t~ O ~ I~O M c 0 ~ M r ~ r ~ f0 N M O~ ~ o~ V N ~ w W f0 Q7 f0 W 01 ~ ~!' m 001 m ~ ~ ~ T ~ O~1 m ~ m ~ T mI~ I ~ rn j rnrnrn ol; molalrn ~ ' _ _ L L._ ~I~ ~ _ ~ ~ ! I I_ ~ i - _ I i I _ ~ f6 I ~ ~ 1 C ~ U ! L_ ~ I ~~ i ~ L.. to YYI Q;Q Y I`S Qj Y S"IY ¢! a Y,,"" C~ YI ¢ Y Y Q Y iY Y Y I QIQ ¢ Q Y Q Y Q YiYi QIQ Z O ~ ~ ~~ ~ N 1 ~ ~~ ~ I TI " - ~ ~ N r V F m -:G ~ i R . O ~ R I I O `-' ' O i - ~ C mC RS L Y I j D O Y I 'BI L 3 I N'' d O_i LT' nl IQ iC -O O ~ ' y ~ O "6 . -O U (0 ~ ` t6 i C O C ~ U' (O -= U LL ~ i 0 Y cq~ Z ~ Q Y y m S > 6R ~iO ffi i i m' G ~ ___{ _ i , ~ i i - ~ *- .! . , i ?,, - . m ._ ~n Q t ~ i ~ i I ~ ~ N i i t i t O O ( N t ~ i ~ ! t d~ i t d > ~ L ~ I d: U w! ~ ~ t ~ i O C i i N N O~Ni ~ Chi l ' .L ~ i ~ ~ ... _ C~c U1 C ~- 0 C . cp V .? > O~ O >> d C ~ C N ~j N O N C E ~ j 0 i O~ y N C N O ~ C~ N 3 01 0~ O! ~ v'j ~ R ~ ~O 3 Iw Q N' Y 14 N N ~ U- O-' N Q QI Q N ~ 2'~ O - W n.'O_ N13 ~; C ~OT N i E ~pi N Y QI> Ni'Cj ~ (n ~ ~i , Ci NI G . 'nI j~ N 4C.. N O Ni = a 1 m70 ~U (6 O C YF- O U i O m L ¢. R W• O) 19 inQ ~QI ~ ~ ~ ~ ~~ Q L E O 0 ~ LL ~ t l w ,w 3 o ' c I t N I E t $ ~ Q ( 0 0 N ~ M N NI~' O'tD CD c-~ O O N O N COM N ~ O' OJ O N O N M ~ 01' ~- I"~',O O O ~~N O M Ct~NV ~i ~6J - N ~ t V~'O ~O LL t~. ' ~ ro,, i 0 O_' '>' O O 'O i f ~ ~ ,.. I "" N I N ~ rn ~ ' O V! O ~ ~ L UL ~ L ~ '~, Ci I ~~ U M ii 0 d'~ C I O I ~ I i .0. Ul Gid ~ ~ I ~. wR- N! O O> rn ~ c y w i ~° i s i3j o I •y ~ U- ~ ~ U ~ lI V1S ! I a ~ d io ~ ~ t a' ~ U Q N ~ .a N U ~ ~ ~ m.- v!. O ~ o U I d m .o ~ ~ .c I i ! 9 i . N ~ O ` N c ~ C t0 I d C N N O y ! O i i ~ ~ Q ~2 N C O Ci N N ~~ V1 E ~NdCY _ O i O i C N F° d to N t4 ~0 i N y , N o ' >,m C d _ 21m ~ 0 ,o ~ U R `Y V~ ° o~ z ~ ~ : ~2 U~ ~ L R .al a ~C v, L .~ u ' S R 17 ' ~ ~C ~ O E it6 d. L = N O N ' [Y~ (II O a Y y m (6 ~ 1 N I 3 . ~ ~ - `° T E [' I O E I l ~ ~ p tq (0 ~ ~ j Q~ ~ a cjc Ei d ~a~ o~ ~ .ol ~ Q pi Yl mio I y~ c ~ c R U 3 ~~~ I m m, ' of E ~ i N SIG m ~~ O y = !E C9. C ~ E ~ N EjELc Ei E ' y O ~I I G ~I ~ ff I, O O I ~y Win. UIY~ ~ Yi C Gi O, > O ~ tl G U G I Vi G:(nIE C Oii O ~ C I N ~ ~n' !.O O N ca~C ~!Y:m~ ~ a I m > mj d~ O_a U. 2 ~1Y m o; E~ w I ; °' E' ~I~ ~I~i ~ U W o ~ ; ~ ~I~ R=, a d ~'io ' l al ~l =' R ~ , 3 i 16 C (d d i I 0 ~p ~ ~ C c0 d ~ O N J O L O L O E~~i L (0 O' - (6 _ R N~Y 0 ~ ~ W O s O ~ t U ~ -1 z m UI ti U Y Y ~ z a a a a U1 <n cn l> > j ~ >- 2 O t- ~ , _ i l I I roLITICAI, susnlvlslows GROITP HEALTH AND ,LIFE INSUR~INC'E NIEMEBERS As of Judy 2007 A 02/01/85 Akutan, City of (Anchorage) 03/01/00 Aleutians East Borough 07/01/76 Aleutian Region School District (Plan II) 07/01189 Aleutian West Coastal Resource Service Area (Plan I) RX 07/01/84 Anderson, City of C 02/01/85 Chignik, City of (Plan II) D M 04/01!84 McGrath, City of (Plan III/RX) N 07/01106 Nenana, City of {Plan I) 07/01/02 Nome, City of (Plan III/RX) 07/01/03 Nome, City Schools (Plan IVlRX) 07/01/02 Nome Joint Utility System (Plan III/RX) 0'7/01!77 North Pacific Fishery Management Council (Anchorage) P 05/01/83 Delta Junction, City of (Plan III) 1011/91 Denali Borough E 08/01/95 Egegik, City of F 08/01/91 False Pass, City of (Plan II) RX H 10/01/02 Hydaburg City School District (Plan II) K 01/01/99 Kaktovik, City of 03/01/00 King Cove, City of (Plan II) 07/01/07 Kodiak, City of (Plan III/RX) 01/01/80 Kodiak Island Borough (Plan ll/RX) 08/01/92 Kodiak Island Housing Authority (Plan II) 07/01/86 Petersburg, City of S 07/01183 Saint Mary's, City of 07/01/00 Sand Point, City of (Plan II) 10/01/83 Saxman, City of (Plan II/RX) 11/01/77 Seldovia, City of 08/01100 Soldotna, City of (Plan II) 09/01/86 Special Education Service Agency (Anch) T 04/01/04 Tanana, City of (Plan III) 09/01/89 Thorne Bay, City of (Plan II) V 01/01/91 Voc.Rehabilitation- Blind Vendors Plan III W 07/01/74 Whittier, City of (Plan II) Updated 12/20/2007 Participati~~ Pharmacies t1I.,A~F~A KETCHIKAN GATEIN CARRS PHARMACY COSTCO PHARMACY EAGLE PHARMACY FRED MEYER SAFEWAY PHARMACY SAM'S PHARMACY WAL-MART PHARMACY ANCHORAGE Anchorage ANo-loRa.aE mBNRRHO PHA _._. rzeT E rom Ave 4 RJIEC PHARMACY 4'GK laks 0'is 'kwy ,7206 ARRS PHARMArY __.. .._. P=I locations C04 0 F*+ARMACY ~ Ali locations FnGU IAE: eN _ AI! locations GENEVA sN00PS fHARMAC" 1200 Airport HH Ste i]0 GENEVA WUCUS PHARMACY__ _.__ SOt W Intrntl Arptl Rd 6RE4i LAND INFOSICN PHCY _ ....... 2421 E Tutlar Rd ,7107 I-CARE PHARMACY._.... ____ __, 403 W Nfhrn Lights BNd LAKE GTI$ PNA.4MACV.___....._ _.. ____ d201 Lake Ciis ?ky MEDICAL ARiS P4A$MALY _.._ _______._. Po Sox 196L76 SAM'S PHARUA(Y ___. __....... AIi locations WAl-WART PHARMACY _.... ___-__ Ali locatons Eagle River CARRS PHARMACY.. _............_... _...... __All loaVons FAlvItLY PHARMACY ..__... 1th32 Rosiness Blvd FRf6 M[YER _ .....__. Nl loa6ons WACdSART P ARtUACY.-.... __.-. AG (oca:ions FAIRBANKS N STA Fairbanks CARRS P.'iAAlW1CY..-..... __.__........ All loca~tlons ChAEP AM1DRF.W ISMC PHCY ..__.. ':408 ?9th Ave PENAL; PHARMACY __._. 1650 Cowles Si FAIRBANKS PRG 'l IARMACY -___.. 1001 Noble SY FRED MEVEk _. _._ ____ NI loafions PRESCRIPTION CEIVTEA _-.-__...-.-_ _... 1919 Lathrop St ;1109 SAFEWAY PHARMACY.. _.,___.,-._ ......._.-......_ Akl locations SAM'S PHAR'vIACY _.___ _..__. Afl loctions WAJ.-MARL P(1ARMACY__.. ____ Ail loatlacs North Pole CA0.RS PHARMACY....__....__ ..... ............. ___-!ill locations JUNEAU Juneau CARRS P,9ARMACV___......__.. _____-....__..-All locations FOCDL4ND SU?ER DRU6._.. __... 671 Willougbq' Ave FRED M.EYEft ...... _...___. AIf locadons IUNPAU DRUG ... 202 Front Si BONS APO H6CAR~ S~iOpPE 9101 Mendenhall Mall Rd KENAIPENINSULA Homer E,4GLE PNARMACV _.__- Al lxatfons UL~LEfl DR..6 8 I AR~AARE __ __ 3819 lake St d5 Kenai CARRS PHM4IACY __. All io~tions THflEE BCAILS BNARN~A[V___. _.___ 105]5 Kenia Spur Hwy Seward SAFEWAY Ph+ARMAC~__.... ___. -All locations Sofdotna CARRS PtiA`+MACv -.,___ ,........-All locatons FRED MCVCR _.._. All ioaAons SOLDOTNA PRC PIiARMACV _._.. _.-..-....._ 299 N Binkley 4 Ketchikan CARIES PHFlRMA<" _-.-- _._ Ali Icca6ons Do1RN~own DR;,e s~CRF __ -_.. Eoo Fren~ sf IS;AND P;,P,RMACY ___ 3526 Tongass Ave WAC~MART PHARMAC`!______..-.-..__.. _.___ All locatia:¢ KODIAK 4SLAND Kodiak SAFEWAY PHARMACY ___- ____. Ali lo~C,ons WAS-MAR' I+HARMAC" __.._ ____. Ali locziiom' NIATANUSKA SUSIT Palmer CARES PNARMACV __ -.-. _..._.. All locztions FRfP MS`ffR.__.. _. _ NI locatons rHftff 8@ARS PNARMACV _. 8151 r~Imer Walla Hwy Wasilla CARPS PfiFlRMACY _ _ -__.. Ali locations H2CD M~V£R_.... All iota?foes GENEVA WCOUS M/CSU o4CY __. 3675 E Country Field #A GENEVA WOODS PHARNJACY...- ___. ?6]n E Country Fid Cir MYDOKGiCRS PNARMACV ..__ ___ _.__ 950 E Bogard Rd SUSITNA PRO PHAeMACV..-.-._-. .._ D51 F Gardner Way SG TKO PHA(IMACY _ __. _. 490 E RailroaG Ava WAL-MAPi Pe1A9MACY ___ _. AI! loction5 NOME Nome NOR70N SND HLTR COR.P PNCV_.......__. _. 306 W 5th qve NORTH SLOPE Barrow SAMUEL SIMMCNDS MEM HOSP.._-_____. 1296 Ag~nk St PRINCE WALES KE Craig wHArE T'r~r PFIAaMACV......________.-._... aoo R Euy sr VALDEZCORDOVA Cordova CGRDOVA DRUG ___ ._ ... __. 516 Plrst :it Glennallen CROSSROAD PPARNACY _ __ ~'N.IIe Ifl7 Glenn Hwy Valdez V(CtAo'c ?dAR,MACY _.... ... _.._. Meals & Pioneor WRANGELL PETERS Petersburg PETERSBURG REXAIL DRUG ____.........___ 275 N Nordic Dr Open 24 hours g O ~ ® rnr cn D cn ~ ~ ~ o~ O x o ~ ~ ~ p ~ o rn rn ~ z ~ m ~ m z p N 0 0 '- ~ ~ ~ O O D O ~ O ~ D ~ ~ r ~ -c o ~ ~ z m ~ m Z ~ m ~ o o ~ ~ a o ~ c ~ - ~ p -c p r ~ z m ~ m z o m ~ p v ~ G ~ O ~ ~ m ~ cn D cn ~ -n ~ o~ ~ = ~ o U' o m m -c m Z ~ Z ~ m ~ ~ <'. ~ ~ rn cn cn v m = o ~ o ~ Z m m °-z ~ rn ~ ~ ~ p N ~, < g O ~ D m ~ cn D cn ~ -o ~ m ~ = ~ O V' p m m -t m m ,~ z ~ ~ z ~ n 0 c z n °r rn m z O m ~a m ti 0 -„ `,~ AGENDA KENAI CITY COUNCIL -SPECIAL MEETING DECEMBER 26, 2007 5:00 P.M. KENAI CITY COUNCIL CIiAMBERS http: / /www.ci.kenai.ak.us YTEM A: CALL TO ORDER 1. Pledge of Allegiance 2. Roll Call 3. Agenda Approval ITEM B: PUBLIC HEARINGS (Testimony limited to 3 minutes per speaker.) 1. Resolution No. 2007-78 -- Authorizing Participation in the State of Alaska Group Health Care and Life Insurance Benefits Plan. ITEM C: ADJOURNMENT Suggested by: Administration CITY OF KENAI RESOLUTION NO. 2007-78 A RESOLUTION OF THE COUNCIL OF THE CITY OF KENAI, ALASKA, AUTHORIZING PARTICIPATION IN THE STATE OF ALASKA GROUP HEALTH CARE AND LIFE INSURANCE BENEFITS PLAN. WHEREAS, the City of I{enai, herein called the "Employor" through its Council desires to make formal request to the Commissioner of Administration (herein called the "State Agency") forsnclusion of its e1i$ible employees in the State of Alaska Group Health Care and Life Insurance Benefits PIan (herein called the "Program") offered to employees of the State of Alaska, pursuant to Alaska Statutes 39.30.090 through 39.30.100; and, WHEREAS, the Employer is prepared to administer the Program as required and has applied to flze State Agency for coverage under the Program far all of the Employer's eligible employees; and, WHEREAS, the Employer is prepared to pay the required premiums and submit same directly to the State's Group Health Care and Life Insurance Plan carriers. NOW, THEREFORE, BE lT RESOLVED BY THE COUNCIL OF THE GITY OF I{ENAI, ALASKA, that: Section 1; the Authorized Agent, as the representative of the Employer, is further authorized and directed to conduct all negotiations, conclude all arrangements and sign all agreements and 'instruments which may be necessary to carry out the letter and intent of the aforesaid request and to do so in conformity with all applicable Federal and State laws, rules and regulations; and, Section 2: the Employer is authorized to pay any and all premiums in accordance with the terms set up by the State Agency; and, Section 3: the Employer agrees to give at least 90 days notice prior to terminating this agreement PASSED BY THE COUNCIL OF THE CITY OF KENAI, ALASKA, this 26~ day of Dc;cember, 2007. PAT PORTER, MAYOR ATTEST; Carol L. Freas, City Clerk~~j Approved by Finance:_. kl~, f "!/i~la~e with a Past, ~i~ went a Futua~e" ~~;J'.~ 210 Fidalgo Avenue, Kenai, Alaska 99611-7794 m ~~~„ Telephone: 907-2&3-7535! FAX; 907-283-3014 ~, ~~ - ~~^ -""- v5z theu''yaf KENpI~~At~~ASKA s TO: City Council FROM: Rick Koch DATE: December 19, 2007 SUBJECT: Health Insurance The purpose of this cozrespondence is to discuss the employee health insurance plan, including the renewal quotation, modified. coverage :froze the same pz'ovider, and quotations from other providers. The city presently (CY07) provides health insurance coverage tlu~ough Premera Flue Cross at a cost of approximately $ 1,227,000 per year. That cost includes aself-insurance program for $ 800 of an employees $ 1,000 deductible administered by Flex-Plan. hz response to a quoted rate increase of 19.77°/n last year, the city increased the deductible from $ 200 to $ 1,000 and self-uzsured the difference. This resulted in an annual savings of $ 176,703 from the renewal quote, and an annual savings of $ 97,061 from fhe actual cost of coverage in CY 06. We received a renewal quote from Premera Blue Cross for CY 08. The quote was an increase of 18.74% over the previous year's rates. The total cost to the city, n~eluding the self-insured deductible, would be approximately $ '1,424,000, or an increase of $ 197,000. Adnunistration wanted to bring to Council. a renewal rate no greater than 8% above the present rate. ftrr insurance plan meeting that budgetary criteria, resulted. in a premiwn. of approximately $ 1,305,000, or an nzcrease of $ 78,000. The moth &cations ui coverage necessary to 'limit the increase to less than 8% were as follows: Maximum. out ofpocket for each plan participazrt{to a nraxirnutn of 3}was izxcreasefl from $ 2,000 to $ 3,000 Pharmaceuticals -The existing plan provided for $ 10 co-pay for generic 'Y $ 20 co-pay for name brand. The new plan would provide fox $ 15 co-pay for 2 Administration recommends entering into an agreement with. AETNA, through the AIaslca Municipal League to provide employee health care insurance. Ii is easiest if this change in provider takes place on 7anuary 1, 2047. This will require a special meeting of the Comicil to pass a resolution as required by the plot. Admhustration has scheduled a meeting for this Friday at 9:00 AM with employees to discuss„this new information, and recommendation. Please find the following attaclunents: 1. Comparison o£Existing, Considered &Proposed Employee Elealth BenefitPlans for CY 2008. 2. AE'I'NA-AML Political Subdivision Ilealih Plan, Benefit Summary, Plan 1V. 3. Sam'pleResohttion 4 COMP/~RISON OF EXISTING, CONSIDERED & PROPOSED EMPLOYEE HEALTH EENEFIT PLANS FOR GY 2a0~ ~REtvIER~, CURRENT BENEEiTS-2007 Monthly Annual Plan Component Description Charges Costs Medical HS $ 1,000/20%I$ 2,000 $ 64,490.31 $ 773,883.72 MH 12 Visits OP/6 days IP $ 236.44 $ 2,837.28 Unlimited Spinal $ 2,719.50 $ 32,634.00 Pharmacy Rx $ 0-$ 101$ 20 $ 11,609.00 $ 139,308.00 Vision V-1 Exam PCY/$ 300 PCY $ 3,895.42 $ 46,745.04 Dental DOpt $ 0?0%/20%/50%!$ 2,000 $ 9,326.42 $ 111,917.04 Sub-Total $ 92,277.09 $ 1,107,325.08 Cammission Rebate $ (4,613.85) $ (55,366.25} Self Insurance Deductible $ 14,583.33 $ 174,999.96 Total $ 102,246.57 $ 1,226,958.79 I~RE~ERQc CURRENT 93ENEEIT s-2008 (18.74% Increase} Monthly Annual Plan Component Description Charges Costs Medical HS $ 1,000/20%/$2,000 $ 77,624.79 $ 931,497.48 MH 12 Visits OPl6 days IP $ 279.56 $ 3,354.72 Unlimited Spinal $ 3,273.43 $ 39,281.16 harmacy Rx $ 0-$ 10?$ 20 $ 13,976.25 $ 167,715.00 Vision V-1 Exam PCY?$ 300 PCY $ 4,342.31 $ 52,107.72 Dental DOpt $ 010%120°Jol50%/$ 2,000 $ 10,076.41 $ 120,916.92 Sub-Total $ 109,572.75 $ 1,314,873.00 Commission Rebake $ (5,478.64} $ (65,743.65) Self Insurance Deductible $ 14,583.33 $ 174,999.96 Total $ 118,677.44 $ 1,424,129.31 PREfVIERA I~C~DIFIED EENEF(T~-2008 (7.40% Increase) Monthly Annual Plan Component Description Charges Costs Medical HS $ 1,000/20%/$ 3,000 $ 75,149.63 $ 901,795.56 MH 12 Visits OPl6 days IP $ 283.57 $ 3,402.84 Unlimited Spinal $ 3,170.02 $ 38,040.24 Pharmacy Rx $ 0-$ 15!$ 25/$ 40 $ 11,279.37 $ 135,352.44 Vision V-1 Exam PCY $ 1,085.06 $ 13,020.72 Dental DOpt $ 0(20%/20%/50%I$ 1,500 $ 8, i 39.51 $ 97,674.12 Sub-Total $ 99,107.16 $ 1,189,285.92 Commission Rebate $ (4,955.36) $ (59,464.30) Self Insurance Deductible $ 14,583.33 $ 174,999.96 Total $ 108,735.13 $ 1,304,821.58 5 COMPARISON OF EXISTING, CONSIDERED PROPOSED EMPLOYEE HEALTH BENEFIT PLANS FOR CY 200 A~~-NA~P®LITI~AL sU~Q1~IS1oN~ PLAN 11/ Plan Component Description Medical $ 1,500/20%/$ 2,000 & $10 per visit MH 25 Visits 50%/lP 21 Days 50% Spinal -Included under Medical Pharmacy Deductible Applies, After Deductible $ 10 Generic, $ 20 Formulary Brand Name, $ 35 Non-Formulary (mail order is cheaper) Vision Exam 100% 1 PCY, Lenses 80% 2 PCY Frames 80% 1 P2CY Dental Preventative 80°10, Restorative BO%, Prosthetic 50%, $ 50 Deductible, $ 0 Deductible for Preventative, $ 1,500 per year maximum Audio Exam t00%, $ 800 maximum for three consecutive years Sub-Total Commission Rebate Self Insurance Deductible Total Monthly 1/1108 - 6/30/OS 7/1108 • 12/31108 Gharges Costs Costs" $ 67,420.40 $ 404,522.40 $ 444,974.64 $ 67,420.40 $ $ - $ $ 17,175.00 $ $ 84,595.40 $ Total for AETNA Plan !V 1l1 /0 8-1 2131!08 $ 1,D55,597.04 "Includes Estimated 10% Premium Increase Beginning July 1, 2008 404,522.40 $ 444,974.64 103,050.00 $ 103,050.00 507,572.40 $ 548,024.64 6 r--. PLAN DESIGN AND BENEFITS ~ BY AETNA LIFE INSURANCE State of Alaska Political Subdivisions Proposed Effective Date. 07-01-2006 Open Choice®(PPO) - ASC Deductible (per calendar year) $1,500 Individual $2,000 Indivitlual $3,DOD Family $4,000 Family AI! covered expenses including prescription drugs accumulate toward both the preferred and non-preferred Deductible, Unless otherwise indicated, the Deductible must be met prior to benefits being payable. Once family deductible is met, all family members will be considered as having met their deductible for the remainder of the calendar year There is no individual deductible to satisfy within the family deductible. Member Coinsurance 20% 40%- facility only App'ies to all expenses unless othennrise stated Payment Limit (per calendar year) $2,500 Individua( $3,000 Individual $S,COC Family $7,000 Family All covered expenses including deductible and prescription drugs accumulate toward both the preferred and non-preferred Payment Limit. Certain member cost sharing elements may not apply toward the Payment Limit Only those out-of-pocket expenses resul`,ing from tfie application of coinsurance percentage, deductibles, and prescription drug copays (except any penalty amounts) may be used to satisfy the Payment Limit. Once family payment limit is met, all family members will be considered as having met their payment limit for the remainder of *h~ plan year Th~~e is no indiv`dua! oayment iim''t to satisfy within the family payment limit Lifetime Maximum $2 000 C00 per member's lifetime Primary Care Physician Selection Not applicable Not applicable Certification Requirements - Certification for certain types of Non-Preferred care must be obtained to avoid a reduction in benefits paid for khat care Certification for Hospital Admissions, Treatment Facility Admissions, Convalescent Facility Admissions, Home Health Care, ~espice Care and Private Duty Nursing is required -excluded amount applied separately io each type of expense is $400 per ccurrence. Referral Requirement None None ......-..~,.......~...~-:~-.~ •.~;. nnvrconan rrtbc ^' F-, ~r.-RILIAI_'DDCGfii?RI-^r1 CIl'RG ,. r. ... Routine Adult Physical Exams/ Covered 100%; deductible waived, Immunizations $500 maximum. 1 Axam per 12 months for members aqe 1 & to aae 65' 1 exam per 12 months for adults aqe 65 and older. Routine Well Child Examsllmmunizations Covered 100°Jo; deducfibla waived, same $500 maximum. 7 exams in the first 12 mor'hs of life 2 exams in the 13th-24th months of life 1 exam per 12 months thereafter to aqe 18. Routine Gynecological Care Exams Covared 100%; deductible waived, same Included yap smear and related lab `ees $500 maximum. Routine Mammograms Covered 100%, deductible waived, same For covered females aqe 40 and over $500 maximum. Routine Digital Rectal Exam 1 Prostate- Covered 100%; deductible waived, same specific Antigen Test $500 maximum For covered males age 40 and over Colorectal Cancer Screening Cavere6 100%; deductible waived, same For all members age 50 and over $50D maximum. Routine Eye Exams Covered "1D0%; deductible waived same 1 routine exam per 12 months Routine Hearing Exams Covered 100%, deductible waived same 1 routine exam per 24 months 12%ig12007 Page 1 7 .-~... State of Alaska Political Subdivisions Proposed Effective Date: 0"-01-2006 Open Choices (PPO) - ASC PLAN DESIGN AND BENEFITS PROVIDED BYAETNA LIFEINSURANCE COMPANY -- Office Visits to Non-Specialist 20% 2 0 Includes servi^es of an internist general physician family practitioner or pediatrician. Specialist Office Visits 20% 20% Allergy Testing Covered as either PCP or soeaahst 20% office visit Gllarnv Iniacfiinns 20% 20% Diagnostic Laboratory and X-ray ZO to to If performed as a part of a physician office visit and billed by the physician, expenses are covered subject to the applicable Urgent Care Provider care in an Emergency 50°1° 50% )npatient Niaternit Coverage 20% y 9 p o 40°/> The member cost s^a•In a plies to all cover d benefits incurred during a member's Inpatient sta Outpatient Hospital Expenses (including 20% 40% surgery) The member cost sharing applies to ail Covered Benefits incurred durng a member's outpatent visit Inpatient 50% au /o Limited to 30 days per calendar year. The member cost sharing applies tc ail covered benefits incu~red during a member's inpatient stay Outpatient 50% 50% Limited fo 20 visits per calendar year. The member cost sharing appiias to all covered benefits incurred during a member's outpatient visit Maximum are a combined limi± for preferred and. non-preferred services Limited to 30 days per calendar year. Th m tuber cost sharing applies to all covered benefits incurred during a member's inpatient stay Outpatient 50% 50% Limited to 20 visits per calendar year. The member cost sharing appiies to all Covered Benefits incurred during a member's outpatient visit Maximums are a combined limit for preferred and non-preferred services. Convalescent Facility cu r° Limited to 120 days per calendar year. The member cost sharina applies to ail covered benefits Home Health Care 20% Limited to EO visits per calendar yeas VIS It )ISt IS On= VISft. Ea Hospice Care -Inpatient. Limited to 30 days per lifetime. 12/19!2007 4 hours by a home 8 20% visit. Page 2 ... p......... ~... ...-.~ The member cost sharina applies to all covered benefits incurred during a member's inpatient stay ~~ ;~~~~° State of Alaska Paliiical Subdivisions Proposed Effective Date: G7-Oi-2006 Open Choice®{PPO) - ASC PLAN DESIGN AND BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY The member cost sitarinq applies k Hospice Care -Outpatient Up to a maximum benefit of $5,000 20% beh Private Duty Nursing -Outpatient (Limited to 20% 2u i° 70 eight hour shifts p r calendar year) - Outpatient Short-Term Rehabilitation 2~7% 20% In^ludes scree^h pf ysical and occupationa therapy Spinal Manipulation Therapy 20% 20°I° Limited to 25 visits er calendar ear Durable Medical Equipment 20% 20% Diabetic of red same as any other m Contraceptive drugs and devices not 20% (payable as any obtainable at a pharmacy (includes ccverage expense) ransplants coverage is provided 40%Non-Preferred coverage at ~r IOE contracted racnity oniy pruviucu a, a ,~~~,-,u~ ,a~,,,,Y, "Other" Health Care - 20% member coinsurance after the preferred (per calendar year) deductible for services that are neither `referred ror'non- referred FAMILY PLANNING ' PREFERRED`CARE;: NON=PREFERRED,CRRE: `?"' Infertility Treatment Member cost sharing is based on the Member cost sharing is based on the diagnosis and treatment of the underlying type of service performed and the type of service performed and the n,.,,;,..,~ ^^.,~~,;,.,, olace of service where It is rendered place of service where Ii is rendered Voluntary Sterilization Member cost sharing is based on the Member cost sharing is based on the including tuba) ligation and vasectomy type of service performed and the type of service performed and the mace of service where it is rendered place of service where it is rendered PHARMACY ,;r- rcceccrsncu:v.,nc ,: ..,, ..._.._ .___ _. __ The full cost of the drug is applied to the deductible before benefits are considered `or payment under the oharmacy plan. medicaVRx plan deductible and $10 copay for generic drugs, $20 copay for formulary brand-name drugs, and $35 copay for non-formulary brand-name drugs up to a 30 day supply at artici atin harmacies. Mail Order Covered 100% after combined Not Covered medical/Rx plan deductible and $20 copay for generic drugs, $40 copay for fcrmuiary brand-name drugs, and $60 copay for non-formulary brand-name drugs up fo a 31-90 day supply from Aetna Rx Home Delivery®. same as any covered 2G% (payable as any etner expense) 9 1 2 /1 912 0 07 Page 3 1~x~~, State of Alaska Political Subdivisions Proposed Effective Date: G7-01-2006 Open. Choice® (PPO) • ASC PLAN DESIGN AND BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY. Pre-existing Conditions Rule On effective date. Waived After effective date: Full Postponement This plan imposes apre-existing condition exclusion, which may be waived in some circumstances and may not be applicable to you. Apre-existing condition exclusion means that if you have a medical condition, before coming to this plan, you may have to wait a certain period of time before the plan will provide coverace for that condition. This exclusicn applies only to conditions for which medical advice, diagnosis, care, or treatment was recommended or received or for which the individual took prescribed drugs within 90 days.Generally, this period ends the day before your coverage becomes effective. However, if you were In a waiting period for coverage, 90 days ends on the day before the waiting period begins. The exclusion period, if applicable, may last up to 365 days from your first day of coverage, or, if you were in a waiting period, from the first day of your waiting period. If you had prior creditable coverage within 90 days immediately before the date you enrolled under this plan, then the pre-existing conditions exclusion in your plat., if any, will be waived. If you had no prior creditable coverage within the 90 days prior to your enrollment date (either because you had ne prior coverage or because th>re was more than a 9D day gap from the date your prior coverage terminated to your enrollment date), we will apply your plan's pre-existing conditions exclusion. In order to reduce or possibly eliminate ycur exclusion period based ;,n your cradltabfe coverage, you should provide us a copy of any certificates of creditable coverage you have,Please contact Aetna Member Services at 1-888-952-3862 if you need assistance in obtaining a certificate of creditable coverage from your prior carrier or if you have any questions on the information no±ed above. The pre-existing condition exclusion does not apply to pregnancy nor to a child who is enrolled in the plan within 31 days of birth; adoption, or placement for adoption. Note: For late enrollees, coverage will be delayed until the plan's next op2n enrallmenY, and the pre-existing condition exclusion will be applied from the individuaPs effective date of coverage _ This plan does not cover all health care expenses and includes exclusions and limitations. Members should refer ko their plan. documen±s to de#ermine which healthcare services are covered and to what extent. The following is a partial list of services and supplies that are generally r,ot covered. However, your plan documents may contain exceptions to this list based on state mandates ar the plan design cr rider; s) purchased by your employer. All medical or hospital services nat specifically covered in, or which are limited or excluded in the plan documents, Gharges related to any eye surgery mainly to correct refractive errors, Cosmetic surgery, including breast reduction; Custodial care; Denta( care and X-rays; Donor egg retrieval; Experimental and investigational procedures; Hearing aids; Immunizations for (ravel or work; Infertility services, including, but not limited to, artificial insemination and advar==cod reproductive technologies such as 1VF, ZIFT, GIFT, ICSI and other related services, unless specifically listed as covered in your plan documents; Nonmedicahy necessary services or supplies; Orthotics, Over-the-counter medications and supplies; Reversal of sterilization,. Services for the treatment of sexual dysfunction or inadequacies, including therapy, supplies, or counseling; and special duty nursing. This material is for informational purposes only and s neither an offer of coverage nor medical advice. It contains only a partial, general description of plan benefits or programs and does not constitute a contract. Aetna does not provide health care services and, therefore, cannot guarantee results or outcomes. Consult the p{an documents (i.e. Group Insurance Certificate andtor Group Policy) to determine governing contractual provisions, including procedures, exclusions and limitation relating to the plan. With the exception of Aetna Rx Home Delivery, all preferred providers and venders are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Aetna Rx Home Delivery, LLC, is a subsidiary of Aetna Ina The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change without notice. Some benefits are subject to limitations or visit maximums. Certain services require precerti#ication, or prior approval of coverage. Failure to precertify for these services may lead to substantially reduced benefits or denial of coverage, Some of the benefits requiring precertification may include, but are not limited to, inpatient hospital, inpatient mental health, inpatient skii(ed nursing, outpatient surgery, substance abuse {detoxification, inpatient and outpatient rehabilitation). When tna Member's preferred provider Is coordinating care, the preferred provider will obtain the precertification. When the member utilizes anon-preferred provider, Member must obtain the precertification. Precertification requirements may vary. Depending on the plan selected; new prescription drugs not yet reviewed by our medication review committee are either available under plans with an open formulary or excluded from coverage unless a medical exception is obtained under plans that use a dosed 12/19/2007 Page 4 10 .~~... ~l ¢t State of Alaska Political Subdivisions ° ft 1~k.i~~~ Proposed Effective Date, 07-01-20G6 Open ChoiceC~ (PPO) - ASC PLAN DESIGN P.ND BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY formulary. They may also be subject to precertification orstep-therapy. Non-prescription drugs and drupe in the Limitations and Exclusions section of the plan documents (received after open enrollment) are not covered, and medical exceptions are r,ot available for them, White this information is be!leved to be accurate as cf the print date, it is subject to change. Plans are provided by Aetna Life Insurance Company, 12/19/2D0? Page 5 11 I~irector~r Pharmacy Listing We want you to knows r'ti~-» A~t~~ I~n.~orta~:t Infor~t~c~n How to Use This Directory Use this directory as a reference to identify the pharmacles partidpating in the Aetna network. Keep this directory handy so that you or your covered family members can find a partidpating pharmady when you need a prescription filled, Please refer to your plan documents for information regarding your prescription drug benefits. Tha directoryfirst lists all participating pharmacies alphabetically by city, both chain and independently owned. In addition, pharmacies that generally are open 24 hours are indicated in boltl. Other pharmacles may have after-hours emergency coverage. You should verify particpatinn in the Aetna network and exact operating hours directly with the pharmacy. For up-to-date listings, visit our DocFinde' online provider directory at www.aetna.mm. Contact Member Services either amine or at the toll-free number on your ID card to find pharmacies In your area. Provider Compensation Pharmades are reimbursed based upon a combination of the following payment methodologies. . Discount from Average Wholesale Price: Pharmacy receives an agreed upon percentage discount from the Average Wholesale Price of the pharmaceutcal product dispensed. c Fee Schedule: Pharmacy is paid a fee established by Aetna far each pharmaceutical product dispensed, Professional Dispensing fee: Pharmacy is paid a professional tee as agreed upon by Pharmacy and Aetna for each pharmaceutical product dispensed. Prescription Drugs If your plan covers outpatient prescription drugs, your plan may indude a preferred drug list (also known as a ° drug formulary"}. The preferred drug list includes a list of prescription drugs that, depending an your prescription drug benefits plan, are mvered on a preferred basis. Many drugs, including many of those listed on the preferred drug list, are subject to rebate arrangements between Aetna and the manufacturer of the drugs. Such rebates are not reflected in and do not reduce the amount you pay to your pharmacy for a prescription drug. In addition, in circumstances where your prescription plan utilizes copayments or coinsurance wkuiated on a percentage basis or a deductible, your costs may be higher for a preferred drug than they would be for a nonpreferred drug, far information regarding how medications are reviewed and selected for the preferred drug IisY, please refer to Aetna's website at www.aetna.com or the Aetna Preferred Drug (Formulary) Guide. Printed Preferred Drug Guide information will be provided, upon request or'rf appiirable, annually for currant members and upon enrallmerrt for new members. Additional Information can be obtained by calling Member Services at the toll-free number listed on your ID card: The medications listed on the preferred drug list are subject to change in accordance with applicable state law. Your prescription drug benefit Is generally not limited to drugs Fisted on the preferred drug.list. Medications that are not listed on the preferred drug lirt (nonpreferred or nonfonnulary drugs) may be mvered subject to the limits and exclusions set forth In your plan documents.Covered norrformulary prescription drugs may be subject m higher eapayments or coinsurance under some benefit plans. Some prescription drug benefit plans may exclude from coverage certain nonformtilary drugs that are not listed on the preferred drug list. tf h is medkaliy necessary for you to use such drugs, your physician (or pharmacist In the case of antlblotics and analgesics) may contact Aetna to requert coverage as a medical exception. Check your plan documents for details, In addition, certain drugs may require precerUfication or step-therapy before they wilt be covered under some prescription drug benefit plans. Step-therapy is a different farm of precertiflcationwhlch requires a trial of one or more "prerequisite therapy" medications before a "step therapy" medication will be covered. If it Is medically necessary for you to use a medication subject to these requirements, your physician tan request coverage of such drug as a medical exception. In addition, some benefft plans Include a mandatory generic drug cost-sharing requirement. in these plans, you maybe required to pay the difference in cost between a covered brand name drug and its generic equivalent in addition to your copayment if you obtain the brand-name drug. Nonprescdption drugs and drugs In the Limitations and Exdusions section of the plan documents (received andlor available upon enrollment) are not covered, and medical exceptions are not available for them.Depending on the plan selected, new prescription drugs not yet reviewed for possible additEon to the preferred drug list are either avalable at the highest mpay under plans with an "open" formulary, or excluded from coverage unless a medical exception is www.aetna,com 13 obtained under plans that use a "dosed" formulary. These new drugs may also be subject to precertification or step- therapy. You should consult vvith your treating physician(s) regarding questions about specific medications. Refer to your plan documents or contact Member Services for Information regarding terms, conditions and limitations of coverage. If you use the mail order prespiptbn program of Aetna Rx Home Delivery, LLC, or the Aetpa Specialty PharmacysM specialty drug program, you will be acquiring these prascriptlons through an affiliate of Aetna. Aetna's negotiated tharga with Aetna Rx Home Delivery and Aetna Specially Pharmacy may be higher than their cost of purchasing drugs and providing pharmacy servkes. For these purposes, Aetna Rx Home Delivery's and Aetna Specialty Pharmacy's mst of purchasing drugs takes into account discounts, cradlts and other amounts that they may receive from wholesalers, manufacturers, suppliers and distributors. Updates to the Drug Formulary You can obtain formulary information from the Intemat at vaww.aetna.comtformulary/, or by ca{ling your Member Services tol!-free numhar. Aetna Rx Horne Delivery Aetna Rx Home Delivery is Aetna's mai4 order prescription drug service. For those members with a mail order benefits, prescription medications can be ordered through Aetna Rx Home Delivery to treat chronic conditions or diseases such as: ^ Arthritis ^ Asthma Diabetes High cholesterol Hypertension Aetna Rx Home Delivery offers you: ^ Convenience -Quick, confidential shipping of your maintenance medications right to your home, place of work or any other location of your choite. Ease of Use -Aetna Rx Home Delivery's simple, iwo - step process makes ordering your maintenance medics#ions easy. ^ Quality Service -Pharmacists check orders for accuracy and are available 24 hours a day, 7 days a week in case of emergency. ^ Cost Savings -Depending on your Aetna pharmacy benefits plan, you could save money by using Aetna Rx Home Delivery and standard shipping is always fraa. Ta learn more about Aetna Rx Home Delivery, visit their website at vvww.AemaRxMorneDelivery.com or please call 1.866-6t 2-3862.Other languages are serviced including Spanish Aetna Specialty Pharmacy Some medications used to treat chronic medical conditions like rheumatoid arthrit~, cancer, hemophilia, mukipie sderosis and hepatitis C are not always available at retail pharmacies. These medications may also require special storage such as refrigeration. Aetna Specialty Pharmacy can delivar injedables and other spatially medications right to your home, dockor's office or location of choice. Working closely with your doctor, Aetna Spedaity Pharmacy affars you access to a team of registered nurses, pharmacists, benefit specialists and patient care coordinators who know your benefits and can offer care support. To learn more about Aetna Spedaity Pharmacy, please call 1.866.353-1892 ar visit their website at vvww.AetnaSpecialtyRx.com. Aetna Spedaity Pharmaty 5D3 Sunpart Lana Orlando, Fl. 328D9 1-866.782-2779 (t-866-782-ASRX) Other languages serviced including Spanish. Health benefits and health insurance plans are offered, untlervnittan ar administered by: Aetna Health inc., Aetna Healffi of taGfornia Inc., AeGu Heelth of the Carolinas Inc., Aetna Wealth of Illinois Inc. and{or Aetna Ltfe Insurance Company, tntormatton subject to change. Providers are independent contratrors and are not agents of Retna. Provider participation may change without notice. Aetna does not provide care or guarantee accwss to health services. Not all health servirxs are covered. See plan documents for a complete daspiption of benefits, exclusions, limitations and conditions of coverage. Plan features and availability may varX by location end are subject to change. trot more Information about Aetna plans, refer to wwwaetna,com. 14 lParticipating Pharmacies n~osrsn CARRS PHARMACY COS7C0 PHARMACY EAGLE PHARMACY FRED MEY£R SAFEWAY PHARMACY SAM'S PHARMACY WAL•MARTPHARMACY T ,. Ketchikan CARRS PHARMACY .........................._........,._. All IocaUOns DOWMOWN bRUG iTORE ............................. 303 Front St IitANp PHARMACY........_ ...................... 3526'ton4ass Ace wa.MAar PxaftMarv._.........._.... ............... Ao m[ations ra ~~ s ~r I{xq Kodiak G~J SAFEWAY PHARMACY.........._ ......................... All locatioas WAL-MART PHARMACY......_....._ .............._... All ~ca1Wm Anchorage ANCHORAGE 0.GH9RH0 PHCY .................. 1217E 10th Ave.. BEANRS PHAAMACV ..........._...., 41W Lake Obis Pkwy 8200 CAMS PHABMALY .............................._...._.. All bcafbnsa COSTCD PHAAMACY.._ ................................. AIf lo[atlons ' GENEVA WOOpS PHAAMAGY...........~501 l GREAT LAND INFUSION PHCY........~.. 2427 4CARE PHARMACY 403 W ~~~15~'d Paimar CARPS PHARMACY ..........................._............ All lo[atWns FRED MEYER_._ ............................................ All Iocatiam THREE HEART PNAAMACY...._.... 8157 E Polrtrer Wasilla Hw/ ........» ...... E ................... ....... 1 Sk i Wast3la lA% Oi15 PHARMACY..._.,.... MEDICAL RATS PHARMACY .... ......_....... 420 tnka W s y .................: Po Rrn t962I6 .. CARRS PHARMACY....................... .................. All locations SAM'S PHARMACY .............:.. ............._:........ All laatiwss FRED MEYER.............................L. .................. Ali MUti00F WADMAAT PHARMACY..._ ...: ...:...........:..:.::... AI! lomtians GENEVA VJOOpS MATSU PHCY...... 367A E Gauntry Flefd RA GENEVA VJ09p6 Pt1ARMACY........ ... 3674 E Country fld Cv Eagle River MYpOKOTOAi PHARMACY .......... ..........: 950 E Bogard Rtl CARRS PHARMACY ................ ....._..............,... All Wcata~ns 5U61TNA PRO PHAAMACY,...:....._. . 1751 E GaMAer Way AG FAMILY PHARMACY:..._ .......... .....~,~...,. F 1432 Buslneas Bhd TKO PHARMACY ..................._.... ...:»._ 490 E Railmatl Ave FRED MEYfR ......................... .......:................ All laalions WALMAAT PHARMACY.,..,....,...... ...._........,... AI6locbfbM WA4MpRi PWA.4MACY ......... ............_..._...... All Wcatb(n p ~ ~ p~ s ' r ( (p~ ) , s I M1 r' 0.3uW w/d .. ,.N2b b > A Nome Fairbanks CAMS PHARMACY......_ ............. ................._. All bcafbm CNIEi ANDBfW ISAAC PHCY ........ ............... 7440 19th Ave DENAU PHAAMA{Y ..................... .............. 1650 Cowles St PAIMANKi PRO PHARMACY ... ~.... .~.~.._....... 1601 LMbN 5t FRED MEYEft ..........................._ .........._. ...... All IocatWns PREACRNTION CENTER ................ ._... 1919 taUxoP St #109 SAFEWAY PNAAMACY........... ~.~ ... ............._..... AIi lorollons SAM'S PHAAMACI'.........~..~......_ .................... All IacaUan$ WAl-MART PNAAMItCY ....:......... .................... All Ioalions North Pola CAAAS PHARMACY ...................._ .....,...,._...... All kHatiax Juneau NORTON SND HLTH CORP PHCY .................. 306 W 5th Ave Cordova LAMi PHARMACY ......................................... AR lomdons FOOptANO SUPER ORVG ....................... fi31 Wflougby Ave FRED MEYER ...............~..............................~... AU locailons IUNEAU ORUG._ ...............__.................~....... 202 Font St RINDS APOTHECARY BHOPPE .._.... 9101 MetttknLall Mall Rd &~M~4~D"`LW3~dkV~~ : G. ~a.NLN[Ar Homer FAGLF PI TARMACY .................... ..................... All bcafions t1lMEft DRUG & HARDWARE ....... ........._...3898 take 6t XS Kenai CARRS PHARMACY ............... ~.... .............,...~... Atl laafi0ns THREE 8FAR5 PHARAMCY ........... .._, (0575 Kenia Spu[ Hwy Seward SAFEWAY PHARMACY..._ ........... ..................... All to<ati0ns Soidotna CAMS PHARMACY .................... _.................. All bwtwns FRED MEYER......._._.__..........._ ..........:......... WI Iacations SDIADTNA PRO PkipRAMCY.._.. __........... 299 N &nk~ St LORDWA DRUG ................_.............. ~......_:... 576 Finl St GtennaElen CROi5R0AD PHANdACY _.........__.... F7aYe 187 Glenn Hwy Vaidez VILLAGE PHARM[A~CY... _ ............................ Meals& Pioneer i~~ S Petersburg PETERiOURG ftE%AIL DRU'v ................._.... 215 N NorGc Dr Open 7k hours 15 ,q:.. pn the We(a a '- Yau can also access Information - ~ ~ about physidans' hospital affiliations, ~ ty~ ?r~r ~. . ~ medical education, board certification ~ ,~hiY,iVJ~~ } - status and languages spoken. a„Rrua r ~ "'> ~ Connect to the Aetna website ~ f~ y~~~~~! $ - '~ , ~ ~ ~ a for fast access to other resources %, ~ b Y '11 ~ ~ 4+k ~~ ~ rr;~,, {f11+: ~ ' ~~ " , ers. ou ., available W our mem Iearn more about our commitment " r ~ ' to making quality health attessi6le, ' '1 ~ ~ affordable and convenient. r±«~"' f' ~.,w.r.,;v~~»., t4. We want you to know® n.aa.aae~e (aw) ~zooz aemb ins, www.aetna.mm 16 t:.° State of Alaska Political Subdivisions Proposed Effective Data: D7.01-2006 Open Choice® (PPC} - ASC $3,OOD Family $4,000 Family Ail covered expenses including prescription drugs accumulate toward both the preferred and non-preferred Deductible. Untess otherwise indicated, the peductibie must bs met prior to benefits being payable. Once family deductlBte is mat, all family members will be considered as having met their deductible for the remainder of the calendar year There is no individual deductible tb sat{sfy within the family deductible. Member Coinsurance 2D°k 40%- facility only Applies to all expenses unless otherwise stated Paym®nt Lfmif (per calendar year} $2;500 Individual $3A00 Individual $5,000 Family $7,000 Family Ali covered expenses including deduaiibie and prescription drugs accumulate toward both the preferred and nan•praferred Payment Limit. Certain member cost sharing elements may not apply toward the Payment Limit. Only those out-of•pocket expanses resulting from the application of croinsurance percentage, deductibles, and prescription drug capays (except any penalty amounts} maybe used to satisfy the Payment Limfl, Once family payment limit is met, ail family members w01 be considered as having mat their payment limit for the remainder of the plan veer Thera is no individual payment limit to satisfy within the family payment limit, Lifetime Maximum 44T141114i4GIV 11 i~ClrV lI G111G11 Lp Csrf(fication for certain types of Non-Preferred care must be obtained to avoid a reduction In benefits pa(d for that care. Cartificafion for Hospital Admisstons, Treatment Facility Admissions, Convalesoent Facility Admissions, Home Health Care, Hospice Care and Private Duty Nursing is required -excluded amount applied separately to each type of expense is $400 per 7 exams in the first 12 months of life, 2 exams in the 13th-24th monfhs of life; 1 exam Routino Gynecological Care Exams Covered 100%; deductible waived, same included Pap smear and related lab fees $500 maximum, Routine Mammograms Covered 100%; deductible waived, same For covered females age 40 and over $500 maximum. Routine Olgital Rectal Exam (Prostate- Covered 100%; deductible waived, same spectfic Antigen Tsst $500 maximum. For covered males age 40 and over Colorectal Cancer Screening Covered 100%; deductible waived, same For all members age 50 and over, $5DD maximum. Routine Eye Exams Covered 100°!0; deductible waived same 1 routine exam per 12 monfhs Rauttne Hearing Exams Covered 100°/°; deductible waived same 1 routine exam er 24 monfhs ~„`1~'IC~y1. N;r~'`E`F~YI"d~S.E','ir~:s.,~'S~'~ri ~i'.<'~f.~n,~~+t~~P~;,,$~'~r,`P.~k'E~E'RR~`I3'K1L.'~17~.''.; ~N~,~:~">!di.',t"i;-..Ct f~ ~~~'s"~rT^'l~h'`..~~~ ~:~1'~' ~'~ia .~,.f,$%'•~a`. 12/20/2007 Page 1 17 PLAN DESIGN AND BENEFITS Immunizations $500 maximum, 1 exam per 12 months for members age 16 to aoe 6B 1 exam par 12 months for adults ape 65 and older, Rout[ne Weil Child Examsllmmunizations Covered 100°f°; deductible waived, same $500 maximum. State of Alaska Political Subdivisions Proposed Effective Date: 07-01-2006 Open Choice® {PPO) - ASC PLAN DESIGN AND BENEFITS PROVIDED BY AETNA LfFE INSURANCE COMPANY Office Vistts to Non-Specialist 20% 20Mo includes services of an internlat. oanara! nhvsician. famliv orsotlfioner or pediatrician. Specialist pfflce Visits 24°!° 2D% Allergy Testing Covered as either PCP or specialist 20% Diagnostic Labarataryand !F perFormed as a part of a pt office visit and blued by the physician, expanses are covered subject to the applicable 20% Non-Emergency care in an surgery} to Expenses (including 20% Limited to'~0 days per calendar year. The member cost sharing applies to aii caversd benefits incurred during a member's inpatient eta Outpatient 50% 54°k Limited to 20 visits per calendar year. The member cost sharing applies to all covered benefits incurred during a member's outpatient visit Inpatient 20% 40% Limited to 30 days. per calendar yeas Tha member cost sharing applies to aii covered benefiks incurred during a member's inpatient stay Outpatient ~ 50% 50% Limited to 20 visits per calendar year, The member cost sharing applies to aii Covered Benefits incurred during a member's outpatient visit CanvalescenE Facl0ty 20S'o 2D% Limited to 120 days per calendar year. The member cost sharin applies to aii covered benefits Incurring during a member's inpatient stay _ Home Health Care 20% 20% Limited to 60 visits per calendar year. Each visit by a nurse or therapist is one visit. Each visit up to 4 hours by a home health care aide is one vislf. _ _______ Hospice Care - inpatient 2D% 40% Limited to 3fl days par lifetime. 12/20/2007 Page 2 18 The member cost sharing applies to aii covered benefits incurred d'urina a member's Inpatient st„~ tnpatient Matsrntfy Coverage 20% 40°!° .,~ ~a° State of Alaska Palltical Subdivisions Prapased Effective Date: 07-01-2006 Open Choice®(PPO) - ASC PLAN DESIGN AND BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY The member cost sharing applies to all covered benefits incurred during a member's inpatient eta Hospice Care -Outpatient 20% 20% Up to a maximum benefit df $5,000 The memhar cost sharinn annlies to alt covered henafits incurred during a member's aUtnatient visit Private Duty Nursing -Outpatient (Llmfted to 24% zu/° 70 eight hour shifts par calendar veer) Outpatient SharbTerm Rahabiiltatlan 20% 20% Includes speech Rhysicai and occupafionaifherapy. Spinal Manipulation Therapy 20% 20°l0 Limited to 25 visits per calendar Vear Durable Medical Equipment 20% 20% Maximum annual benefit of $10,000 per member per calendar year Diabetic Supplies Covered same as any other medical Covered same as any other medical obtainable at a pharmacy {includes coverage expense) as any other cavered 20% (payable as any Transplants 20% Preferred coverage is provided 40%Non-Preferred coverage is at an iDE cnntracied facility only provided at a Non-IOE facGity, "Other" Health Care - 20% member coinsurance after the preferred {per calendar year) deductible for services that are medicaURx plan deductible and $10 copay for generic drugs, $20 copay for formulary brand-name drugs, and $35 copay for non-formulary brand-name drugs up to a 30 day supply at _ ___ participating pharmacies. MaEI Order ~ ~ Covered 100% after combined Not Covered medicaURx plan deductible and $20 copay far generic drugs, $40 copay for formulary brand-name drugs, and $60 copay for non-formulary brand-name drugs up to a 31-90 day supply from Aetna Rx Home Deiivery3. 12/20/2007 Page 3 19 Infertility Treatment Member cost sharing is based on the Member cost sharing is based on the Diagnosis and treatment of the underlying type of service perfarmed and the type of service performed and the medical condition _ _ place of service where it Is rendered place of service where It Is rendered Voluntary Sterilization ~ Member cost sharing is based on the Member cost sharing fs based on the including tubas ligation and vasectomy type of service performed and the type of service performed and the ~~rr" o State of Alaska Political Subdivisions f 4 ~(.~ Probpsad Effective Data: 07-01-2006 Open ChalcaC~ {PPO} - ASC PLAN DESIGN ANp BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY Pre-existing Conditions Rule On effective date: Waived After affective date: Full Postponement This plan imposes apre-existing condition exclusion, which may be waived in some circumstances and may not ba app(icabla to you, Apre-existing condition exclusion moans that if you have a medical condition before coming to this plan, you may have to wait a certain period of tlma before the plan will provide coverage for that condition. This exclusion applies only to conditions For which medical advice, diagnosis, care, or treatment was recommended or received or for which the Individual took prescribed drugs within 80 days.Genarally, this period ands the day before your coverage becomes affective. However, if you were in a waiting period for coverage, 90 days ands on the day before fhe welting period begins, The exclusion period, if applicable, may last up to 365 days from your first day of coverage, or, if you were in a waiting period, from the first day of your waHing period. If you had prior creditable coverage within 90 days immediately before the date you enrolled under this plan, then the pre-existing conditions exclusion (n your plan, if any, wAl ba waived. If you had no prior creditable coverage within the 90 days prior to your enrollment date (either because you had no prior coverage or because there was more than a 90 day gap from the date your prior coverage terminated to your enrollment data), wa will apply your plan's pro-existing conditions exclusion. in order to reduce or possibly eliminate your exclusion period based on your creditable coverage, you should provide us a copy of any certificates of creditable coverage you have.Please contact Aetna Member 5ervlcas at t-868-982-3862 if you need assistance in obtaining a certificate of credi#able coverage from your prior carrier or if you have any questions on the information noted above. The pro-exist(ng condikion exclusion does not apply to pregnancy nor to a child who is enrolled in the plan within 3t days of birth, adoption; ar placement fior adoption, Note: For late enrollees, coverage will be delayed until the plan's next open enrollment, and the pro-existing condition exclusion will be applied from the individual's effective date of coverape, This plan does not cover ail health care expanses and includes exclusions and limitations. Members should refer to their plan documents to determine which health card services are covered and to what extant. The following Is a partial list of services and supplies that are generally not covered. However, your plan documents may contain exceptions to this list based on state mandates or the plan design ar rider{s} purchased by your employer. Ail medical or hospital services not specifically aovered !n, or which era limited or excluded in the plan documents; Charges related to any eye surgery mainly io correct refractive errors; Cosmetic surgery, including breast reduction; Custodialcare; Dental care and X-rays; Donor egg retrieval; Experimental and investlgatlonal procedures; Haaring aids; Immunizations for travel or work; Infertility sewlees, Including, but naf limited to, artificial Insaminaiion and advanced reproductive technologies such as iVF, ZIFT, GIFT, ICSI and other related services, unless specifically listed as covered {n your plan documents; Nonmediaaliy necessary services ar supplies Orthotics; Over-the-taunter medications and supplies; Reveesal of sterilization; Services for the treatment of sexual dysfunction or Inadequacies, including therapy, supplies, or counseling; and special duty nursing. This material Is for informational purposes only and is neither an offer of coverage nor medical advice. It contains only a partial, genera! description of plan benefits or programs and does not constitute a contract. Aetna does not prov(da Health Cara services and, therefore, cannot guarantee results or outcomes. Consult the plan documents (Le. Group insurance Certificate and/ar Group Policy} to determine governing contractual provisions, Including procedures, exclusions and limitation relating to the plan, W ifh fhe exception of Aetna Rx Home Delivery, all preferred providers and vendors are independent contractors in private practice and are neither employees nor aganis of Aetna or Its affiliates. Aetna Rx Hama Delivery, LLC, is a subsidiary of Aetna inc. Tha availability of any particular provider cannot be guaranteed, and provider network composition is subject to change without notice. Some benefits are subJecf to Ifmitations or vis;t maximums. Certain services require pracertification, or prior approval of coverage. Failure to precertify for these services may lead to substantially reduced benefits or dania( of coverage, Some of fhe benefits requiring pracertification may include, but are not Lmitad to, inpatient hospital, inpa#lant mental health, inpatient skilled nursing, outpatient surgery, substanoa abuse (detoxificafian, inpatient and outpatient rahabllftation}. When the Mambor's preferred provider Is coordinating care, the preferred provider will obtain fhe pracertification. When the member utilizes anon-preferred provider, Member must obtain fhe precerfification. Pracertification requirements may vary. Depending on the plan selected, new prescription drugs not yet reviewed by our madicafion review committee era either available under ;laps with an open formulary or excluded from coverage unless a medical exception is obtained under plans that use a closed t 2l20J2007 Page 4 20 ~ a State of Alaska Pollfical Subdivisions Proposed Effective Dafa: 07-g4.20g8 Open Chotca~ (PPO} - ASG PLAN DESIGN ANp BENEFITS PR[6VIDED BY AETNA LIFE INSURANCE CCMPANY formulary. They may also be subject to precertiflcafion orstep-therapy. Non-prescription drugs and drugs in the Limitations and Exotusions section of the plan tloaumants (received after open enrollment} are not covered, and medical exceptions are not available for them. While this Information is kielievei to be accurate as of the print date, it is subJect fo change. Plans are provided by Aetna Lifa Insurance Company, 12t2gt2g0~ Page 5 21 PPO Hospital Overview Effective July 1, 20D5, the State of Alaska Political Subdivision health plan will implement ahospital-only preferred provider organization (PPO) plan when hospital services are sought in the Municipality of Anchorage, the lower 48, and Hawaii. The PPO plan will create financial incentives and steerage to preferred hospitals in those geographical areas, but wilt not penalize thase receiving services outside of Anchorage while still in Alaska. NOTE: The plan will reduce benefits by 20 percent rfi anon-preferred hospital, either in Anchorage or outside the state of Alaska, is utilized: The employee out-of-pocket coinsurance amount will double ifi anon-preferred facility is utilized. This arrangement will be implemented into the Economy, the Standard, and the Premium health plans. Additional Details The PPO incentives apply to all services provided by an Alaskan hospital within the Municipality of Anchorage or a hospital in the remaining 49 states. All services provided by a.hospitai, including testing or outpatient surgery, are subject to this provision except for: ^ Services received when following a referral from Magellan for mental health/chemical dependency treatment, or o Services that can not be preformed at Providence hospital. n Services received for emergency treatment defined by the p{an as follows: A medical emergency is the sudden and unexpected onset of a condition or an injury-including severe pain-such that a prudent 4ayperson, who possesses average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in serious jeopardy to the person's health, ar with respect to a pregnant woman, the health of the woman and her unborn child. There are many conditions that may determine medical emergencies-what they all have in common is the need for quick action. 22 O1N7 O ~~10?c- r-.~-.~ r;Yllr ~- ~6f O~(D1O I O ~^~O 09~O I'NI +"=051 r"h O CIO=V O 400 .05 ~1tJ O t~N;m CIM (N `N NN ICD N~ N ~tD [;JM I SGJ ODIW ~ILCJ (Ir NIM ~tY'IN M.1o IV' M W N O~ M C6 iC0O C N NVCJ (OM N NI<C Nf3~C IM ~IC"~P- d' m10)IC91NIt01'cTIN (p v1'II+tDlm l~' ' >= N ~~ N V ~f' m NOS it V !` tt5 e{ N N f+ N N r. l IX514(5 O Hitt til~+ N I~h- hII~!~ r`-Ir. r1t~ r-IN NIr tiI I I ,C IO Ip OOO0O O1OI~0 C~OIO O~OOO I ~p.~wjwmloe~w m a51a5 m m mlrn~m~o>Jw rn,a5~a~~s5~ ~ , ~ ~- }~ ~ Iw~vi~icn~~~~o c.i~Ni{~.w u~f~vjm~nlrlml~n rn rn -I 101 h~ O I'~O M f0 M ~ ~ t6 N M O W 'V N O' ~+' I. I Im ~o;n n Lnla+ w r~ ro rnmlm r~:mwl~ m m~~n~ ~ ~ rrnco wlmwim rnlw m m m rn rnlas mirnlrn mlo5 d' Irn lm rn I I 1 I ~ ILL ..;IY Y' YIY IY ISCIYIYIYY °1,?£ Y YIY Y Y Y Y I.eI !m (tA d14dN!Q,I~'d'~d~d ~faCIGId S dd Q d,dL~~l ~N dry 11 l6 N YID Rfl ,a RI I ~ 'IL m I yl I~~1O C Y ;S1 SL-~ ~ , N :T v R I 'p ~ ~ O O~RI05i 1 Im:~ L ro lO O: N m. m~°f C mI L ~ro I a`gi~~~ 5'~Y~Elmluv ~ s E~.~Im~ m o ;.. ~ ~ c y^c olo ~m ol¢, clo~mro lo~m m m' a .c ..~ U~~Irnla~al~ ~ ~ zla'a~Y~Im wixl~a~?:~I,E i yid I! 1 ,I 1 ~ ~ ~~ I II I I I Ii I s II E )ii ~ d l u~ 'j I_ I' m l ~+ ~ ~ ( ~ ICS ~ :m ~~ ~ ~ ~~I ~ ~ r iL~~L ~roG I ILIA i i l L C1 d a a~ ylo mI ~ O1"'f i L.' clc~ ,v of Ic.~ m m m~ml~ y, ml I o It. mlm m ~Sm m. c E~ 'rmn;'- I.'cya;..s > i mcl coral i m m 1 R m m L c ..; o i ~ ~IOImt/~~t°m~~ I~~c NI=~~~~m m ~~a'S~' m~a ISIS i , 9; C y I~ O1 d, C. > >~ la LQ m r/r m I (;~:ia~dl di;°clm yl m;~-'al2' ~7iJ~dl mdj~l~2) «, ~ a~ a.=: ml.,.,ro mm m:~y ,,,lyY yO ^~m ~o~n o~~ (aaa~ilm o~lmlo °c~t/~~EIOi~Q'o~m~mlca~a~~-o~ ,c~~ ~~Ic w~ZIO.~UY{- o~p ~tyWrn~d °CO m[md~o i.- ~:o yip 2IU oolo ~ cLL o ~n TI ~lol~W ~ ~ o ~'¢ ~o~oN rnoo,N~-I lolr r- ~Im o,~- ~n wlo~ ~~ I a`o THIN ~ O;t61O rIN 45:0IN Qf~ N OM ~a-I~ O' C n. i i~ Q M N c0 ~~f0 M N~If~{N M ~ _V_~~N+~I'10)~CS ~11h-..._~ R~ ~O E ' lu LI-~ ~ i =~ I•~ °' ~l IO I I ~~ ~ L m `~~ 1~ 1 m ;~+~ ~Nm _ I jmi I 1 I °: ~ c n l Iml I °~ c ': I _ c °' u', I of OIL I ol9 'I~ , U !~~ I~~~IC~Is I 1L1 'lam ~a5c .R., O. :R1~ ~ 10 I ' ICI= IQI ~ I~ a~ `~°I ~lo~~ u-a ~i•c ' 'ms IU ~ cmil c'cmi a m w Ica!o rot ! `~ 1'' cl ICI is ~_: glro~m',acimlm~a~5lal~ao isaroi !d'ml m~ m m m`- Zlv°i o Ul~ls~'a~~ o ~IS~ m~ I ~'c 'o, Id ( al~,.''IL!ro ~ o~m~m~.~Y°R`o1~:2~~4',L1'_' C71E~ ~'o~m io~a ~.~^. ~ al~lo'~QIL S mlu w'v 31c('^m c _ rol._ o ° s a m rn E~N m m ~~omlolyl aItE o~ m :,~ E IQ i :a cIE m;Zlml~ro mdYwiE~~IreIE~-ol^'o ~i~lro olm o. m c E rn m c ot~l It9E c ~m d diEE~c E~y Ix a to I y ~ a a muulrJ~ ~ clalo~ ~ Im rn a-m c m141U Irl m~c'o o c cl c~ m 1 ~ al I i.c IN K. ro c m m~~', a'mlm a._I O~ ~U SIm Y: I~,c ~Ic Ir'I ~°fII~I~~°~a~m~w ci~nl~ ~I~c~Ir~°-~~ly,lo5c ~ ~m c,~ ~ o~ , r-i a ~ m m^ oI l o. 3I Il~~mllacio~.m!mlm to Flo oIo miY olm mI~~~ o ~ IL) -~ Iz1mIUlUlta_ YID' ~~zLLla`ala`w~lu~ ~ >>ISlrl x10 Ii- ° 23 POLITICAL SUBDIVISION HEALTH FLAN BENEFTT SUIVIMAItY PLAN IV This is a summary of coverage's provided by the selaered plan. Please refer m the Insurance Fnformatian. Booklet for State of Alaska Po(rticai Subdivisions and dre addendum summary changes Medteal Benefifs En Network Deductibles (applies W Medical and Rx) , ,,,,,,,,,,,,,,,$1,500 per person Catendn' Year Individual .................~............................~... ... _............... Calendar Year Fnmil ._ ............................_.,........._.........$3,000 per family ........................................................ y ................................................ Out of Network Deductibles lapplics to Hospitnl Expevaes) ,,, ,,,,,$2,000 per person Calendar Ycar Individuai .................................................................._.... _...._........................,............. Calrnder Year Family ......................................................._....:.....................~......................................._...~...................,......$4,000 per family In-Network Coinaurame(Outof NatworkRnspital Expanses covaradat 6D°!°o{wverad expenses} g0%of covered expenses Most Medical Expenses ....................................................................~........ ~..............~.....,......................................... Second Surgical Opinions .................... .......,..._........................,........................,80°.0 of covered expenses .................._........._........................ 80°1° of covetnd expenses Preo erative Testin ......................_............................................,...................,......................... P 8 ................................ .......................,..............80%of covered expenses Outpatien: Tesnng ...................... .....~......,..........,......,.......~........,.............. .............................. ......... .80% of covered axPenses Hnspitai Expenaes .............._. ........................................... ......_......................_.............., Chemical Dependency Treatment ................................................_....................._.............._.,__......,.......................,80%of covered expenses .............................._.........................._.50% of covered expenses Mental or Nervous Disorders ......................................................................... Out-of-Pocket Limit (includes deductible noted above) Afar the deductible, the p}an will pay the 86%in-network coinsurance shown above and the member is responsible for 20%. Wnen an individual's 20% coinsurance, together with the deductible, reach Ene 52,560 Out of Pocket Shnit, the plan will pay 100% of rnest covered medical expenses far that person for the remainder of the calendar yeaz. Expenses paid at a coinsurance different than 60% are nol credited to this limit. Nate: The Oru of Poakat limit when an individual is seeking out of network hospital ear i5 $3,OD0 per Individuall $7,OOD for Family 1 exam par 12 months for members age 18 to age 65; I exam per 12 months for adults age 65 and olds[ Routine WeI1 Chad Exams/Immunizations Covered 100%; deductible waived, 5500 maximum. ? exams ir. the first 12 months of fife, 2 exams in the 13ih•24eh monNrs of life; 1 examper 12 months thereafter to age 18. Routine Gynecological Care Exams Coveted I00°h; dadnaibia waived, 5540 maximum. Included Pap smear and related lab fees For covered females age 40 azrd over. For covered mates age 40 and over Test mnxrmum. Colorectal Cancer Sereeniap Covered IDO%; deducdbte waived, $500 maximum. Far all members age 30 and over. Routine Eye Exams Covered 100%; deductible waived 1 routine exam per t2 months Routine Rearing Exams Coverd 100%; deductible waived 1 routine exzm per 24 months Benefit Maximums-Individun( Chemical Dependency Treatment ................3G days ......................._._........ .. irpafient Calendar year ....................................................................................... . ............................. ....._......................__....,....26 visits .........._.._ ................_...... Outpatient Calendar Year .._ ................._..................... ~........................_._._........ Mental and Nervous Disorders , 30 drys ................................................ Inpatient Calendar Year .................................:...................................__...~........~ ......................_,.......... ...........................................30 visits .......... .. Outpaden[Calendar Yea[ ......................................................._........ .. .. .................................... .... V1220e9 24 ~~~u~ ^ ~r~L ~~ .~ Prascriptton Druga Tnt member is rasponsiLle fo[ the following copay afrer the daductibie is mat: Retail Pharmacy: Generic Drugs :............ :.....:......... ................""$10 coaPY ry Drugs :......... Formauta Hrand Name ...................420 wpay Non-Formulary Brand Name Dmg :...... ...................436 caay Malt Order Drugs up to e 40 day supply Generic Ih+tg< ::........................... .....................$2D coaPY Formeulary Hrand Name Dmgs :......... .......... ..........$40 copay Nora-FormutarY Brand Name Dmg:. ~.. ~ ....................460 noway Dental Rene£its DaducEible Individual Calendar Yeaz (Class II and III combined) ........................... ~..,. Coinsurance Cass I (preventive) services..,......~ ............................................_....,..,........ Class 11(restorative) services_ ....................._.......~..........................~...,....... Class Ill (prosthetic) services......~ ................................................................ HenetYt Mnxlmum Individual Calendar Year ...................................................................._...... Vision Seaefits Coinsurance Frames............ HtneSit Maximums Andto Benefcts Coinaarence Ali Covered Services ............................. Banefft Maximum Individual/3 consecutive calendar years 111212ne> 80% 50% 41,500 ... 80% ... BO% 80% ............. I ner calmdaryear .............2 per calendar year I set every 2 calendar years _. _.. _. _. _ ............. 80% 25 AGENDA KENAI CITY COUNCIL- SPECIAL MEETING „~-- DECEMBER 26, 2007 ~~-' 5:60 P.M. ~~ h / KENAI CITY COUNCIL CHAMBERS REXHI.PlASX11 http:/7www.ci.kenai.ak.us U ITEM B: PUBLIC HEARINGS (Testimony limited to 3 minutes per speaker) 1. Resolution No. 2007-78 -- Authorizing Participation in the State of Alaska Group Health Care antl Life Insurance benefits Plan. EXECUTIVE SESSION -- None scheduled ITEM N: ADJOURNMENT The public is invited to attend and participate. Additional information is available through the City Clerk's office at 210 Fidalgo Avenue, or visit our website at htto://www.ci.kenai.ak.us. Carol L Freas, City Clerk D/211