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2021-07-06 Ex 10City of Okeechobee Memo 1 | Page 1 Date: for July 6 meeting TO: Mayor and City Council FR: Gary Ritter, City Administrator and India Riedel, Finance Director RE: PRM Group Health Insurance The City’s current premium structure for plan 0727: Employee Only $ 888.98 Empl & Spouse $2,219.37 Empl & child(ren) $1,774.66 Empl Family $2,830.85 The City’s’ claim experience based on the lookback period for rates continues to be stable. The medical claims this year (so far this year) did not include any large claims (i.e. $150,000 or more) which can severely impact an entity our size. With the application of the City’s claims experience rating, the renewal premium for FY 2021- 2022 is at 5.4% increase, which is slightly higher as compared to the PRM Group of 4.4%. The fiscal impact based on the number of employees equates to a $34,175.16 for the renewal. The City is continuing to take a long term approach regarding the health of its employees by continuing the current benefits including the Clinic. Current PPO plan, 0727 Affordable Care Act option, 05901 Premium City Cost Per Employee per Month Deduction per Employee Pay Check Employee Only $937.25 $937.25 $0.00 Add’l for Spouse $1,402.63 $150.00 $578.14 Add’l for Child (ern) $933.77 $150.00 $361.74 Add’l for Family $2,047.31 $150.00 $875.69 Premium City Cost Per Employee per Month Deduction per Employee Pay Check Employee Only $737.50 $737.50 $0.00 Add’l for Spouse $1,103.67 $150.00 $440.16 Add’l for Child (ern) $734.68 $150.00 $269.85 Add’l for Family $1,610.92 $150.00 $674.27 Product BlueChoice BlueOptions Segment Large Group Large Group Plan Family PPO PPO Plan Number 0727 05901 Cost Sharing - Member's Responsibility Deductible (DED) (Per Person/Family Aggregate)Embedded Non-Embedded In-Network $500 / $1,500 $2,000 / NA Out-of-Network Combined with In- Network $6,000 / NA Coinsurance (Member pays) In-Network 20%50% Out-of-Network 40%50%Out of Pocket Maximum (Per Person/Family Aggregate) (Includes Ded/Coins/Copays/Rx) (Includes Ded/Coins/Copays/Rx) In-Network $1,500 / $4,500 $6,350 / $12,700 Out-of-Network Combined with In- Network $12,800 / $25,600 Medical / Surgical Care by a Physician Virtual Visits In-Network Family Physician $15 Copayment $35 Copayment In-Network Specialist $15 Copayment $75 Copayment Out-of-Network Not Covered Not Covered Office Services In-Network Family Physician $15 Copayment $35 Copayment In-Network Specialist $15 Copayment $75 Copayment Out-of-Network DED + 40% DED + 50% Allergy Injections (Office) In-Network Family Physician $5 Copayment $10 Copayment In-Network Specialist $5 Copayment $10 Copayment Out-of-Network DED + 40% DED + 50% Maternity Office Services In-Network Family Physician $15 Copayment $35 Copayment In-Network Specialist $15 Copayment $75 Copayment Out-of-Network DED + 40% DED + 50% Convenient Care Center In-Network $15 Copayment $35 Copayment Out-of-Network DED + 40% DED + 50% Physician Services at Hospital In-Network DED + 20% DED + 50% Out-of-Network DED + 40%INN DED + 50% Radiology, Pathology and Anesthesiology Provider Services at Hospital In-Network DED + 20% DED + 50% Out-of-Network DED + 20% INN DED + 50% Radiology, Pathology and Anesthesiology Provider Services at ASC In-Network DED + 20% DED + 50% Out-of-Network DED + 40% INN Ded + 50% Page 1 of 5 Printed on 6/21/2021 Product BlueChoice BlueOptions Segment Large Group Large Group Plan Family PPO PPO Plan Number 0727 05901 Physician Services at Locations other than Office, Hospital and ER In-Network Family Physician DED + 20% DED + 50% In-Network Specialist DED + 20% DED + 50% Out-of-Network DED + 40% DED + 50% Preventive Services-Adult & Child Wellness Services Office Services In-Network Family Physician $0 Copayment $0 Copayment In-Network Specialist $0 Copayment $0 Copayment Out-of-Network 40%50% Independent Clinical Laboratory In-Network $0 Copayment $0 Copayment Out-of-Network 40%50% Mammograms In-Network $0 Copayment $0 Copayment Out-of-Network $0 Copayment $0 Copayment Colonoscopies (Routine Only) In-Network $0 Copayment $0 Copayment Out-of-Network 40%$0 Copayment Medical / Surgical Care at a Facility Ambulatory Surgical Center (ASC) In-Network DED + 20% DED + 50% Out-of-Network DED + 40% DED + 50% Inpatient Hospital Facility (per admit) In-Network DED + 20% Option 1: $2,000 Copayment Option 2: $3,000 Copayment Out-of-Network $300 PAD + DED + 40% DED + 50% Inpatient Rehabilitation Benefit Maximum 30 Days PBP (Combined INN & OON) 30 Days PBP (Combined INN & OON) Outpatient Hospital Facility (per visit) In-Network DED + 20% Option 1: $300 Copayment Option 2: $400 Copayment Out-of-Network DED + 40% DED + 50% Emergency and Urgent Care Emergency Room Facility (per visit) In-Network DED + 20% DED + 50% Out-of-Network DED + 20% INN DED + 50% Physician Services at ER In-Network DED + 20% DED + 50% Out-of-Network DED + 20% INN DED + 50% Urgent Care Centers In-Network $15 Copayment $75 Copayment Out-of-Network $15 Copayment $75 Copayment Ambulance In-Network DED + 20% DED + 50% Out-of-Network DED + 20% INN DED + 50% Page 2 of 5 Printed on 6/21/2021 Product BlueChoice BlueOptions Segment Large Group Large Group Plan Family PPO PPO Plan Number 0727 05901 Diagnostic Testing (e.g., Lab, x-ray) Physician Office In-Network Family Physician $15 Copayment $35 Copayment In-Network Specialist $15 Copayment $75 Copayment Out-of-Network DED + 40% DED + 50% Independent Clinical Laboratory In-Network 20% $0 Copayment Out-of-Network 40%DED + 50% Independent Diagnostic Testing Center In-Network $15 Copayment $50 Copayment Out-of-Network DED + 40% DED + 50% Outpatient Hospital Facility In-Network DED + 20% Option 1: $300 Copayment Option 2: DED + 20% Out-of-Network DED + 40% DED + 50% Advanced Imaging (AIS) (MRI, MRA, PET, CT & Nuclear Medicine) Physician Office In-Network Family Physician $15 Copayment DED + COINS In-Network Specialist $15 Copayment DED + 50% Out-of-Network DED + 40% DED + 50% Independent Diagnostic Testing Center In-Network $15 Copayment $200 Copayment Out-of-Network DED + 40% DED + 50% Outpatient Hospital Facility In-Network DED + 20% Option 1: $300 Copayment Option 2: $400 Copayment Out-of-Network DED + 40% DED + 50% Outpatient Therapy Physician Office In-Network Family Physician $15 Copayment $35 Copayment In-Network Specialist $15 Copayment $75 Copayment Out-of-Network DED + 40% DED + 50% Benefit Maximums 54 Days PBP (Including 26 spinal manipulations) 35 Visits PBP (Including 26 Spinal Manipulations) Outpatient Rehabilitation Facility In-Network DED + 20% $75 Copayment Out-of-Network DED + 40% DED + 50% Outpatient Hospital Facility In-Network DED + 20% Option 1: $80 CopaymentOption 2: $90 Copayment Out-of-Network DED + 40% DED + 50% Page 3 of 5 Printed on 6/21/2021 Product BlueChoice BlueOptions Segment Large Group Large Group Plan Family PPO PPO Plan Number 0727 05901 Mental Health & Substance Abuse Services Physician Office In-Network Family Physician $15 Copayment $35 Copayment In-Network Specialist $15 Copayment $75 Copayment Out-of-Network DED + 40%50% Inpatient Hospital Facility In-Network DED + 20%Option 1: $2000 Copay Option 2: $3000 Copay Out-of-Network $300 PAD + DED + 40%50% Benefit Maximums 30 Days PBP Combined INN and OON Outpatient Hospital Facility In-Network DED + 20%Option 1: $300 Copay Option 2: $400 Copay Out-of-Network DED + 40%50% Emergency Room Facility(per visit) In-Network DED + 20%DED + 20% Out-of-Network DED + 20% INN DED + 50% Physician Services at Hospital In-Network DED + 20%$0 Copayment Out-of-Network DED + 20% $0 Copayment Physician Services at ER In-Network DED + 20%$0 Copayment Out-of-Network DED + 20% $0 Copayment Physician Services at Locations other than Office, Hospital and ER In-Network Family Physician DED + 20%DED + 50% In-Network Specialist DED + 20%DED + 50% Out-of-Network DED + 40%DED + 50% Other Special Services and Locations Durable Medical Equipment (Including Orthotics & Prosthetics) In-Network DED + 20% DED + 50% Out-of-Network DED + 40% DED + 50% Skilled Nursing Facility In-Network DED + 20% DED + 50% Out-of-Network DED + 40% DED + 50% Benefit Maximums 60 Days PBP 60 Days PBP Home Health Care In-Network DED + 20% DED + 50% Out-of-Network DED + 40% DED + 50% Benefit Maximums 20 Visits PBP 20 Visits PBP Page 4 of 5 Printed on 6/21/2021 Product BlueChoice BlueOptions Segment Large Group Large Group Plan Family PPO PPO Plan Number 0727 05901 Hospice In-Network DED + 20% DED + 50% Out-of-Network DED + 40% DED + 50% Prescription Drugs In-Network - Retail Generic/Brand/Non-Preferred $5 / $35 / $35 $10 / $60 / $100 / $120 - Mail Order Generic/Brand/Non-Preferred $10 / $70 / $70 $30 / $180 / $300 /$360 Out-of-Network - Retail Generic/Brand/Non-Preferred 50% of allowance 50% of allowance - Mail Order Generic/Brand/Non-Preferred 50% of allowance 50% of allowance Additional Enhancements Infertility: Assisted Reproductive Therapy Coverage (LTM) Telemedicine (Teladoc)Standalone Telemedicine (includes General Medicine/ Dermatology/Behavioral Health) In-Network Visits 5+: $15 Copayment Visits 5+: $35 Copayment Out-of-Network Not Covered Not Covered Hearing Aid (1x every 36 months; $500 allowance 1st hearing aid; $300 allowance 2nd hearing aid, once every 3 years) In-Network Not Covered Out-of-Network Not Covered Acupuncture 24 visits $75 cap per visit Covered Not Covered Confidential & Proprietary © 2012 Florida Blue is a trade name of Blue Cross and Blue Shield of Florida, Inc., an Independent Licensee of the Blue Cross and Blue Shield Association. In-Network or Out of Network Covered up to Allowance $20,000 LTM Not Covered Page 5 of 5 Printed on 6/21/2021