PRM Health Trust FY 17-18Gallagher Benefit Services, Inc.
A Subsidiary of Arthur J. Gallagher & Co.
July 27, 2017
India Riedel
Finance Director
City of Okeechobee
55 SE 3rd Avenue
Okeechobee, FL 34974
Re: Group Health Rates for Plan Year 2017 - 2018
Dear India,
We are pleased to provide you with your Group Health Rates for the new plan year beginning October 1, 2017. The
rates illustrated below represent an increase of 11% over your current medical rate. The increase in the medical rate
is 6% higher than the pool average due to a loss ratio of 176.7 %. There is no increase in the Dental, Vision, Life,
AD &D, Dependent Life, Short Term and Long Term Disability plan rates. We believe that you will find this
renewal very reasonable in light of current market conditions.
Medical — PRM Plan PPO 0727
Medical — PRM Plan BlueODtions 05901
Funding Rates
Coverage
Medical
Medical COBRA
Medical Reduced Retiree
Employee
$725.14
$739.64
$551.78
Additional for Spouse
$1,085.20
$1,106.90
$759.63
Additional for Child
$722.45
$736.90
N/A
Additional for Family
$1,583.97
$1,615.65
N/A
Medical — PRM Plan BlueODtions 05901
One Boca Place
2255 Glades Road, Suite 200E
Boca Raton, FL 33431
Main 561 - 995 -6706
Fax 561 - 998 -6731
RECEIVED JUL 3 1 2017
Funding Rates
Coverage
Medical
Medical COBRA
Medical Reduced Retiree
Employee
$570.60
$582.01
$434.12
Additional for Spouse
$853.90
$870.98
$597.69
Additional for Child
$568.43
$579.80
N/A
Additional for Family
$1,246.35
$1,271.28
N/A
One Boca Place
2255 Glades Road, Suite 200E
Boca Raton, FL 33431
Main 561 - 995 -6706
Fax 561 - 998 -6731
RECEIVED JUL 3 1 2017
tees
Dental
High PPO
Low PPO
Coverage
Funding Rate
Funding Rate
Employee
$35.78
$28.62
Employee Family
$93.37
$74.70
Vision - NVA
Coverage
Funding Rate
Employee
$5.24
Employee Spouse
$9.83
Employee Child(ren)
$8.18
Employee Family
$16.19
We appreciate the opportunity to serve you and your employees and look forward to working with you over the new
plan year.
Should you have any questions, please contact Yvonne Blackford or me at 561- 995 -6706.
Sincerely,
Paul Hebert
Area Vice President
PH /yb
Date:
TO:
FR:
RE:
City of Okeechobee
Exhibit 13
Memo July 18, 2017
for July 18th meeting
Mayor and City Council
Admin Marco Montes De Oca and India Riedel, Finance Dept
PRM Group Health Insurance
The City's current premium structure for plan 03748:
Employee Only $ 741.52 Empl & Spouse $1,851.28
Empl & child(ren) $1,480.26 Empl Family $2,361.28
The City has had another year of large payout of benefits for our employees and
dependents. ($173.00 paid out for every $100.00 premium). As per the bylaws of the
PRM group the maximum premiums will increase is 6% over the Group. The Group (PRM
members) experience base rating is @ a 5% increase effective 10/1/17. Therefore, the
current PPO 3748 plan premium increase for this fiscal year is at 11%, or a $57,745
increase.
Health care cost and insurance premiums continue to escalate; the City's insurance cost
has increased by 33% over the past 3 years The City is taking a long term approach
regarding the health of its employees by looking at options by encouraging participation in
local fitness centers and now possibility offering a free medical clinic.
Saving cost through insurance premiums ($11,597) and an implementation of a Clinic which
is open 7 days a week with no co -pays to the employees, and many prescriptions available
for free should result in decrease claims to the insurance company and therefore minimize
future increases in premiums. The ultimate goal is a healthier employee by providing
immediate care for free, while removing the perceived loss in coverage.
Cost /Savings to the City for FY 2018
Op tz ??
Continue with existing plan(s)*, City to pay 100% of employee premium:
$57,745
City to pay for Optional 0727 plan(s)* and implement Medical Clinic for employees:
($11,597)
$30,852
$19,255
City to pay up to Plan(s) 0727 and offer the 03748 as a buy up plan to employees and
implement a Medical Clinic for employees: ($11,597)
$30,852
$19,255
55 SE Third Avenue, Okeechobee, FL 34974
(863) 763 -3372 / (863) 763 -1686 Fax
Current plan, 03748
Suggested plan, 0727
Premium
City Cost
Per Employee per
Month
Deduction
per
Employee
Pay Check
Employee Only
$823.08
$823.08
$0.00
Add'I for Spouse
$1,231.83
$150.00
$499.30
Add'I for Child (ern)
820.00
$150.00
$309.23
Add'I for Family
$1,797.93
$150.00
$760.58
Suggested plan, 0727
*ACA plan, 05901
Premium
City Cost
Per Employee per
Month
Deduction
per
Employee
Pay Check
Employee Only
$740.88
$740.88
$0.00
Add'I for Spouse
$1,108.80
$150.00
$442.52
Add'I for Child (ern)
738.10
$150.00
$271.43
Add'I for Family
$1,618.40
$150.00
$677.72
*ACA plan, 05901
*All options include the offer of the Affordable Care Act required option, 05901.
55 SE Third Avenue, Okeechobee, FL 34974
(863) 763 -3372 / (863) 763 -1686 Fax
Premium
City Cost
Per Employee per
Month
Deduction
per
Employee
Pay Check
Employee Only
$570.60
$570.60
$0.00
Add'I for Spouse
$853.90
$150.00
$324.88
Add'I for Child (ern)
568.43
$150.00
$193.12
Add'I for Family
$1,246.35
$150.00
$506.01
*All options include the offer of the Affordable Care Act required option, 05901.
55 SE Third Avenue, Okeechobee, FL 34974
(863) 763 -3372 / (863) 763 -1686 Fax
PUBLIC RISK MANAGEMENT
BLUEOPTION MEDICAL COMPARISON
EFFECTIVE OCTOBER 1, 2017
Monthly Premium
Em. to ee Onl - Cost to Cit
Em.lo ee & S.ouse
Em.lo ee & Child ren
Em to ee & Famil
2017 Current/Option 1 2018 Renewal Option 2018 Proposed Option
1 2
BlueOptions
03748
$741.52
$1,109.76
$738.74
$1,619.76
BlueOptions
03748
$823.08
$1,231.83
$820.00
$1,797.93
BlueCare
PPO 0727
$725.14
$1,085.20
$722.45
$1,583.97
Deductible (DED) (Per Person/Family
Agg)
In- Network
Out -of- Network
$0 / $0
$500 / $1,500
$0 /$0
$500 / $1,500
$500/$1,500
Combined w /In -Ntwk
Coinsurance (Member
onsibility)
Network
-of- Network
Out of Pocket Maximum (Per
Person/Family Agg)
In- Network
Out -of- Network
Includes DED,
Coinsurance, Copays;
Excludes Rx
$1,500 / $3,000
$3,000 / $6,000
Includes DED,
Coinsurance, Copays;
Excludes Rx
$1,500 / $3,000
$3,000 / $6,000
Includes DED,
Coinsurance, Copays;
Excludes Rx
$1,500 / $4,500
Combined w /In -Ntwk
Allergy Injections
In- Network Family Physician
In- Network Specialist
Out -of- Network
$10
$10
DED + 40%
$10
$10
DED + 40%
$5
$5
DED+40%
E -Office Visit Services
In- Network Family Physician
In- Network Specialist
Out -of- Network
$10
$10
aacn�..: Jnoc
$10
$10
$15
$15
DED+40%
Office Services
In- Network Family Physician
In- Network Specialist
Out -of- Network
$10
$20
DED + 40%
$10
$20
DED + 40%
$15
$15
DED+40%
Provider Services at Hospital an
ER
In- Network Family Physician
In- Network Specialist
Out -of- Network
DED +20%
DED +20%
DED +20 %
Provider Services at Other
Locations
In- Network Family Physician
In- Network Specialist
Out -of- Network
$10
$20
DED + 40%
$10
$20
DED + 40%
DED +20 %
DED +20 %
DED+40%
Radiology, Pathology and
Anesthesiology Provider Services at
Hospital or Ambulatory Surgical
Center
In- Network Specialist
Out -of- Network
$25
DED + 40%
$25
DED + 40
DED +20%
DED +40%
Preventive Care
Adult Wellness Office Services
In- Network Family Physician
In- Network Specialist
Out -of- Network
$0
$0
40% (No DED)
$0
$0
40% (No DED)
$0
$0
40 % (No DED)
Colonoscopies (Routine)
In- Network
Out -of- Network
Age 50+ then Frequency
Schedule Applies
$0
$0
Age 50+ then Frequency
Schedule Applies
$0
$0
Age 50+ then Frequency
Schedule Applies
$0
40% (No DED)
Independent Clinical Lab
In- Network
Out -of- Network
$0
40% (No Ded)
$0
40% (No DED)
Independent Diagnostic Testing
Facility
In- Network- Advanced Imaging Sery
In- Network -Other Diagnostic
Out -of- Network
$0
$0
40% (No DED)
$0
$0
40% (No DED)
$0
$0
Copy of 2017 - 18 Health Plan Comparision HMO PPO Curr (3)
PUBLIC RISK MANAGEMENT
BLUEOPTION MEDICAL COMPARISON
EFFECTIVE OCTOBER 1, 2017
2017 Current/Option 1 2018 Renewal Option 2018 Proposed Option
Mammograms (Routine and Dx)
In- Network
Out -of- Network
BlueOptions
03748
$0
$0
1 2
BlueOptions BlueCare
03748 PPO 0727
$0 $0
$0
$0
Outpatient Hospital(per visit)
In- Network
Out -of- Network
$0
$300
$0
$300
Provider Services at Outpatient
In- Network Family Physician
In- Network Specialist
Out -of- Network
$0
$0
$0
$0
$0
$0
$0
Not Covered
Well Child Office Visits (No BPM)
In- Network Family Physician
In- Network Specialist
Out -of- Network
Emergenc /Ur•ent/ConvenientCare
Ambulance Maximum (per Day)
In- Network
Out -of- Network
$0 $0 $0
$0 $0 $0
40% (No DED) 40% (No DED) 40% (No DED)
$5,500 $5,500 No Maximum
$0
$0
$0 DED + 20%
$0 In -Ntwk DED + 20%
Convenient Care Centers (CCC)
In- Network
Out -of- Network
$10
DED +40%
$10
DED + 40%
$15
DED + 40%
Emergency Room Facility Services
(also see Professional Provider
In- Network
Out -of- Network
$50
$50
$50
$50
DED + 20%
DED + 20%
Facility Services - Hosp/So c 1CL'IDTF
Unless otrur�.i, ..-
services are in addition to facility
$15
$15_
Ambulatory Surgical Center
In- Network
Out -of- Network
Independent Clinical Lab
In- Network
Out -of- Network
Independent Diagnostic Testing
Facility -
Xrays and AIS (Includes Physician
Services)
In- Network - Advanced Imaging
Services (AIS)
In- Network - Other Diagnostic
co.
Out- of- Network
$50
DED + 40%
$0
DED + 40%
$50
$50
DED + 40%
$50
DED + 40%
DED +40%
$50
$50
DED + 40%
DED + 20%
DED + 40%
20% (No DED)
40% (No DED)
$15
$15
DED + 40%
npatient Hospital (per admit)
In- Network
Out -of- Network
npatient Rehab Maximum
Outpatient Hospital (per visit)
In- Network
Out -of- Network
Option 1 - $250 / Option Option 1 - $250 / Option
2 - $500 2 - $500 DED + 20%
$750 $750 $300 PAD +DED+40%
21 Days 2' Days No Ma
Option 1 - $100 / Option Option 1 - $100 / Option
2 - $200 2 - $200
$300 $300
DED
'MUM
+ 20%
DED + 40%
Therapy at Outpatient Hospital
In- Network
Out -of- Network
Option 1 - $100 / Option
2 - $200
$300
Option 1 - $100 / Option
2 - $200
$300
DED + 20%
DED + 40%
Copy of 2017 - 18 Health Plan Comparision HMO PPO Curr (3)
PUBLIC RISK MANAGEMENT
BLUEOPTION MEDICAL COMPARISON
EFFECTIVE 3CTORFR 1. 2017
MENTAL HEALTH AND SUBSTANCE
ABUSE
2017 Current/Option 1
BlueOptions
03748
2018 Renewal Option
1
BlueOptions
03748
2018 Proposed Option
2
BlueCare
PPO 0727
Inpatient Hospitalization
In- Network
Out -of- Network
Option 1 - $250 / Option
2 $500
$750
Option 1 - $250 / Option
2 $500
$750
DED + 20%
$300 PAD +DED+40%
Outpatient Hospitalization (per visit)
In- Network
Out -of- Network
Option 1 - $100 / Option
2 - $200
$300
Option 1 - $100 / Option
2 - $200
$300
DED + 20%
DED + 40%
Provider Services at Hospital and
ER
In- Network Family Physician or
Specialist
Out -of- Network Provider
$o
$0
$o
$o
DED + 20%
DED + 40%
Physician Office Visit
In- Network Family Physician
In- Network Specialist
Out -of- Network Provider
$10
$20
DED + 40%
$10
$20
DED + 40%
$15
$15
DED + 40%
Emergency Room Facility Services
(per visit)
In- Network
Out -of- Network
$50
$50
$50
$50
DED + 20%
DED + 20%
vider Services at Locations other
n Hospital and ER
Network Family Physician
Network Specialist
Other Special Services and Locations
$10
$20
$10
$20
DED + 20%
DED + 20%
Advanced Imaging Services in
Physician's Office
In- Network Family Physician
In- Network Specialist
Out -of- Network
etwork
of- Network
Diabetic Equipment and Supplies*
In- Network
Out -of- Network
$10
$20
DED + 40%
$0.
DED + 40%
$o
DED + 40%
$10
$20
DED + 40%
$0
DED + 40
$0
DED + 40%
DED + 20%
DED + 40%
DED + 20%
DED + 40%
Durable Medical Equipment,
Prosthetics, Orthotics BPM
In- Network
Out -of- Network
Enteral Formulas:$2,500
At Other: No Maximum
$o
DED + 40%
Enteral Formulas:$2,500
All Other: No Maximum
$0
DED + 40%
No Maximum
DED + 20%
DED + 40%
Home Health Care BPM
In- Network
Out -of- Network
Hospice LTM
In- Network
Out -of- Network
Outpatient Therapy and Spinal
Manipulations BPM
Skilled Nursing Facility BPM
In- Network
Out -of- Network
20 Visits
50
DED +40
No Maximum
$0
DED + 40%
35 Visits (Includes up to
26 Spinal Manipulations)
60 Days
$D
DED +40%
20 Visits
$0
DED + 40%
No Maximum
$0
DED + 40%
35 Visits (Includes up to
26 Spinal Manipulations)
60 Days
$0
DED +40%
20 visits
DED + 20%
DED + 40%
No Maximum
DED + 20%
DED + 40
54 Visits (Includes up to
26 Spinal Manipulations
60 Days
DED + 20%
DED +40
Prescription Drugs
Deductible
In- Network
Retail (30 Days)
Generic /Preferred Brand/Non-
Preferred
Mail Order (90 Days)
Generic /Preferred Brand/Non-
Preferred
Out -of- Network
Retail (30 Days)
Generic /Preferred Brand/Non-
Preferred
Mail Order (90 Days)
Generic /Preferred Brand/Non-
Preferred
Medical Pharmacy (Provider -
Administered Rx) **
In- Network
Out -of- Network
$10/ $25/ $60
$20 /$50/$120
50% of allowance
50% of allowance
See Location of Service
See Location of Service
$10/ $25/ $60
$20 /$50/ $120
50% of allowance
50% of allowance
See Location of Service
See Location of Service
$5/$35/$35
$10/$70/$70
50% of allowance
50% of allowance
See Location of Service
See Location of Service
Copy of 2017 - 18 Health Plan Comparision HMO PPO Curr (3)
City of Okeechobee
Sample Group Health Rates - $0 Surplus Release
Medical - PRM Plan BlueOptions 03748
Overall Increase
Active Rates
Active Rates
11.0%
COBRA
Coverage
Current
Proposed 10/1/2017
Proposed 10/1/2017
Current
Proposed 10/1/2017
EE
5741.52
5823.08
$839.54
$564.22
$626.28
Additional for Spouse
$1,109.76
$1,231.83
$1,256.46
$776.80
$862.24
Additional for Child
$738.74
$820.00
$836.40
$620.52
$682.78
Additional for Family
51,619.76
51,797.93
$1,833.88
Medical - PRM Plan HMO 55
Coverage
Current
Proposed 10/1/2017
Proposed 10/1/2017
Current
Proposed 10/1/2017
EE
$694.88
$771.31
$786.73
$528.74
$586.90
Additional for Spouse
$1,039.94
51,154.33
$1,177.41
$727.90
$807.96
Additional for Child
$692.24
$768.38
$783.74
$620.52
$682.78
Additional for Family
$1,517.86
51,684.82
51,718.51
Medical - PRM Plan HMO 59
Coverage
Current
Proposed 10/1/2017
Proposed 10/1/2017
Current
Proposed 10/1/2017
EE
$667.46
$740.88
$755.69
$507.90
5563.76
Additional for Spouse
$998.92
51,108.80
51,130.97
$699.26
5776.17
Additional for Child
$664.96
$738.10
$752.86
$620.52
$682.78
Additional for Family
$1,458.02
$1,618.40
$1,650.76
Medical - PRM Plan PPO 0727
Coverage
Current
Proposed 10/1/2017
Proposed 10/1/2017
Current
Proposed 10/1/2017
EE
$653.28
5725.14
5739.64
5497.10
$551.78
Additional for Spouse
$977.66
51,085.20
51,106.90
$684.36
$759.63
Additional for Child
5650.86
$722.45
$736.89
$620.52
$682.78
Additional for Family
$1,427.00
51,583.97
$1,615.64
Medical - PRM Plan BlueOptions 05168/05169
Coverage
Current
Proposed 10/1/2017
Proposed 10/1/2017
Current
Proposed 10/1/2017
EE
5635.80
$705.73
$719.84
$483.80
$537.01
Additional for Spouse
5951.56
$1,056.23
51,077.35
5666.08
$739.34
Additional for Child
$633.44
$703.11
$717.17
$620.52
$682.78
Additional for Family
$1,388.90
51,541.67
$1,572.50
Medical - PRM Plan BlueOptions 03559
Coverage
Current
Proposed 10/1/2017
Proposed 10/1/2017
Current
Proposed 10/1/2017
EE
$628.36
5697.47
5711.41
$478.12
$530.71
Additional for Spouse
$940.44
51,043.88
$1,064.75
$658.28
$730.69
Additional for Child
$626.00
$694.86
$708.75
$620.52
$682.78
Additional for Family
$1,372.56
$1,523.54
51,554.01
Medical - PRM Plan BlueOptions 03359
Coverage
Current
Proposed 10/1/2017
Proposed 10/1/2017
Current
Proposed 10/1/2017
EE
5611.80
$679.09
$692.67
$465.54
$516.74
Additional for Spouse
5915.66
51,016.38
51,036.70
$640.96
$711.46
Additional for Child
$609.54
$676.58
5690.11
$620.52
$682.78
Additional for Family
51,336.46
$1,483.47
51,513.13
Medical - PRM Plan BlueOptions 05360
Coverage
Current
New, Lower -Cost 5360 -
Proposed 10/1/2017
Current
New, Lower -Cost
EE
5565.22
10/1/17
$639.93
5430.09
5360 - 10/1/17
EE
5592.36
5651.78
$664.81
$450.72
$495.94
Additional for Spouse
$886.52
$975.46
$994.96
$620.52
$682.78
Additional for Child
5590.12
$649.32
$662.30
Additional for Family
$1,293.90
$1,423.72
51,452.19
Medical - PRM Plan BlueOptions 05180/05181
Coverage
Base
Proposed 10/1/2017
Proposed 10/1/2017
Base
Proposed 10/1/2017
EE
5565.22
$627.39
$639.93
5430.09
$477.39
Additional for Spouse
$845.93
$938.98
5957.75
$592.14
$657.27
Additional for Child
5563.12
$625.06
$637.56
Additional for Family
$1,234.73
51,370.55
51,397.96
Medical - PRM Plan BlueOptions 05901
Coverage
Current
Proposed 10/1/2017
Proposed 10/1/2017
Current
Proposed 10/1/2017
EE
5514.06
$570.60
$582.01
$391.10
$434.12
Additional for Spouse
$769.28
5853.90
$870.97
$538.46
5597.69
Additional for Child
$512.10
5568.43
$579.79
Additional for Family
$1,122.84
$1,246.35
$1,271.27