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Home My WebLink AboutR-2005-124 AvMed Health Plan RESOLUTION NO. 2005-124 A RESOLUTION OF THE CITY OF DANIA BEACH, FLORIDA, AUTHORIZING THE PROPER CITY OFFICIALS TO EXECUTE AN AGREEMENT WITH AVMED HEALTH PLANS TO PROVIDE A SELF- FUNDED OPEN ACCESS POS PLAN TO ELIGIBLE EMPLOYEES; PROVIDING FOR CONFLICTS; FURTHER, PROVIDING FOR AN EFFECTIVE DATE. BE IT RESOLVED BY THE CITY COMMISSION OF THE CITY OF DANIA BEACH, FLORIDA: Section 1. That since an agreement has been reached between the City of Dania Beach and the Dania Beach Employees Association, AFSCME Local 3535 AFL-CIO, to accept a health plan upon approval of the City Commission, such plan to become effective October 1, 2005, the City Commission approves the plan and the proper City officials are authorized to execute the documents pertaining to the plan. The plan, an AvMed Health Plan, will provide a self-funded open access POS plan to eligible employees, which program shall be inclusive of third party administrative services, network access services, utilization review services, organ transplant services through LifeTrac, and disease management, at a cost not to exceed $44.94 per employee, reinsurance underwritten by Combined Insurance Company to include specific reinsurance not to exceed $61.45 per employee per month and $128.75 per family per month and aggregate reinsurance in an amount not to exceed $11.15 per employee per month. Section 2. That since an agreement has been reached between the City of Dania Beach and the Dania Beach Fire Union, IAFF Local 3080 to accept the health plan mentioned above in Section 1 upon approval of the City Commission, such plan to be effective October 1, 2005, the City Commission approves the plan and the proper City officials are authorized to execute the documents pertaining to the plan. The plan, an AvMed Health Plan, will provide a self-funded open access POS plan to eligible employees as such plan is described above. Section 3. That premium contributions will be negotiated consistent with the applicable bargaining agreements. Section 4. That all resolutions or parts of resolutions in conflict with this Resolution are repealed to the extent of such conflict. Section 5. That this Resolution shall be in force and take effect immediately upon its passage and adoption. PASSED AND ADOPTED on August 23, 2005. Q,,, azz., ANNE CASTRO MAYOR-COMMISSIONER ATTEST: ROLL CALL: COMMISSIONER ANTON - YES T COMMISSIONER BERTINO - YES LO-ISE STILSON COMMISSIONER MCELYEA - YES • CITY-CLERK VICE MAYOR FLURY - YES MAYOR CASTRO - YES APPROVED AS TQ FO AND CORRECTNESS BY: THOMAS J. O CITY ATTORNEY • 2 RESOLUTION#2005-124 I CITY OF DANIA BEACH N DEPARTMENT OF HUMAN RESOURCES AND RISK r MANAGEMENT TO: Mayor Castro Vice-Mayor Flury Commissioner Anton Commissioner Bertino Commissioner McElyea Cc: Ivan Pato, City Manager FROM: Mary McDonald, Director Human Resources DATE: August 18, 2005 SUBJECT: HEALTH PLAN RESOLUTION In early July the City issued a bid for heath plan proposals. Responses were received in late July and given to each Union for review. Last week, the Unions and the City participated in a recommendation meeting. Based on the responses received, the Avmed proposal emerged as the front-runner. Although the plan proposed was very good, both Unions asked us to negotiate for improvements. I'm happy to say that these negotiations were successful and we have produced a plan design very similar to the current plan, with added benefits of an expanded network and greater discounts. Under our current provider network agreement, our discounts range from15%- 37%. Under the proposed agreement, our discount rates will increase to as much as 65%. A cursory analysis of claims paid to just one provider, Memorial Hospital, showed a savings potential of just under $100,000 had we been in the Avmed network. As discussed in past workshops, the City is leaving a significant amount of money "on the table" as a result of a rented network. A simple shift to a managed care network should produce the cost containment results we seek. Attached is a copy of the summary of benefits being proposed for October 1, 2005. Information on providers can be found on the Avmed Website (click on "physician Care Provider", a new menu will come up, to the left of this you'll see "online provider directory", click that. Then select AVMED CHOICE and check "self insured"). If you have any questions, please feel free to call me. • I s AvMED HEALTH PLANS Benefit Summary • CITY OF DANIA BEACH - SCHEDULE OF BENEFITS AvMed Choice Network AvMed Expanded Choice Out-of-Network Network/PHCS Network HIGH MID LOW Where Services are Rendered In AvMed's Service In or Out of AvMed's I or Out of Service Area Service Area n Area DEDUCTIBLE(accumulates across all benefit levels) INDIVIDUAL(per calendar year) $150 $2 0 $500 FAMILY(per calendar year) $300 5 $1,000 The Deductible does not apple toward the Out-of-Pocket Maximum. OUT-OF-POCKET MAXIMUM (accumulates across all benefit levels) INDIVIDUAL(per calendar year) 0 $ 500 2, 00 FAMILY(per calendar year) $ 0 $3, 00 $4,000 The Out-of-Pocket Maximum i des s and ur ce amounts unless otherwi e!u LIFETIM 1 $2,000,000 PREVENTI R Preventive ca a 'c d a s is 's of a 10 0 of the 20%of the 40%of the UCR include,but are o t to Contracted Rate,not Contracted Rate; charge,not subject • Well-chiI e i t ne uding subject to the not subject to to the Deductible vision 'i 1 rformed by their Deductible the Deductible pediatric 1 under 18 years of age Calendar year • • Well-worn xa inations,including pap smears maximum benefit of$400 PRIMARY CARE PHYSICIAN Services in physicians' offices include,but are not limited to: 10%of the 20%of the 40%of the UCR • Routine office visits Contracted Rate,after Contracted Rate,after charge,after • Maternity-outpatient visits Deductible Deductible Deductible • Diagnostic imaging,laboratory or other diagnostic services • Minor surgical procedures SPECIALISTS' SERVICES Office visits or procedures 10%of the 20%of the 40%of the UCR Contracted Rate,after Contracted Rate,after charge,after Deductible Deductible Deductible MATERNITY CARE All obstetrical care and services,including pre-natal care, 10%of the 20%of the 40%of the UCR office visits and delivery Contracted Rate,after Contracted Rate,after charge,after Deductible Deductible Deductible SECOND MEDICAL OPINION Office visits—not subject to the Deductible 10%of the 20%of the Fcharge f the UCR Contracted Rate Contracted Rate SF-City of Dania Beach(IAA)(8.05) Benefit Summary, continued HOSPITAL(Prior Authorization Required for Inpatient Care) Hospital inpatient care includes: No Charge after 20%of the 40%of the UCR • Room and board—unlimited days(semi-private) Deductible Contracted Rate,after charge,after • Physicians', specialists' and surgeons' services Deductible Deductible • Anesthesia,use of operating and recovery rooms, oxygen,drugs and medication • Intensive care unit and other special units,general and special duty nursing • Laboratory and diagnostic imaging • Required special diets • Radiation and inhalation therapies Hospital outpatient care includes: U th f t e 4 % e • Outpatient surgery t ed e, er C ed te, tr t R e, • Outpatient diagnostic tests u e D e r D ductible • Outpatient laborato st OUTPATIEN H HE TH FACILITIES • Outpa n rg ne rdi c No r a er 20%of the 40%of the UCR cathete ti s io ty Dedu ible Contracted Rate,after charge,after Deductible Deductible . • Physicians',s e ialt ts' and surgeons' services 10%of the 20%of the 40%of the UCR • Drug infusion therapy Contracted Rate,after Contracted Rate,after charge,after Deductible Deductible Deductible OUTPATIENT DIAGNOSTIC TESTS • CAT Scan,PET Scan,MRI No Charge 20%of the 40%of the UCR • Other diagnostic imaging tests Contracted Rate,after charge,after Deductible Deductible • Outpatient laboratory tests No Charge 20%of the 40%of the UCR Contracted Rate,after charge,after Deductible Deductible Mammography • Mammography(not subject to the Deductible) No Charge No Charge subject to Preventive Care maximum benefit of$400 EMERGENCY SERVICES An emergency is the sudden and unexpected onset of a S100 Co-payment S100 Co-payment S100 Co-payment condition requiring immediate medical or surgical care. (Co- payment waived if admitted) AvMed must be notified within 24 hours of inpatient admission following emergency services or as soon as • reasonably possible. SF-City of Dania Beach(IAA)(8.05) Benefit Summary, continued URGENTIIMMEDIATE CARE Medical services at an Urgent/Immediate Care facility or $40 Co-payment $60 Co-payment S60 Co-payment services rendered after hours in your Primary Care Physician's office. INPATIENT MENTAL HEALTH AND PARTIAL HOSPITALIZATION BENEFITS (Prior Authorization Required) • Inpatient treatment of mental/nervous disorders No C g 0 o e t CR shall be provided when a Participant is admitted to r ti n a e a ft a Hospital or Other Health Care Facility. u tb d i e • Partial hospitalization for mental healt t s is covered when provided in lieu tie hospitalization. Two da f Il hos 'ta a n will count as one da w i atien to health bene Coverage is Ii to i 0 day er Participant,p r. OUTPATIENT • 30 outpatient is 10%of the 20%of the 40%of the UCR Contracted Rate,after Contracted Rate,after charge,after • Deductible Deductible Deductible FAMILY PLANNING • Voluntary family planning services 10%of the 20%of the 40%of the UCR • Sterilization Contracted Rate,after Contracted Rate,after charge,after Deductible Deductible Deductible ALLERGY TREATMENTS • Injections 10%of the 20%of the 40%of the UCR • Skin testing Contracted Rate,after Contracted Rate, after charge,after • Office visits Deductible Deductible Deductible AMBULANCE • Ambulance transport for emergency services 10%of the Same as Choice Same as Contracted Rate,after Network Benefit Choice Deductible Network Benefit • Non-emergent ambulance services are covered when the skill of medically trained personnel is l 0%of the 20%of the 40%of the UCR required and the Participant cannot be safely Contracted Rate,after Contracted Rate,after charge,after transported b other means. Deductible Deductible Deductible • SF-City of Dania Beach(IAA)(8.05) Benefit ,summary, continued PHYSICAL AND OCCUPATIONAL THERAPIES • Short-term physical or occupational therapy for 10%of the 20%of the 40%of the UCR acute conditions Contracted Rate,after Contracted Rate,after charge,after Deductible Deductible Deductible Coverage is limited to 60 visits per calendar year for all services combined. SPEECH THERAPIES • Benefit limited to 24 visits per calendar year 10%of the 2 ° th \WUCR Contracte a er tr d e, er Dedu 1 e c SKILLED NURSING FACILITIES A REHABILITATION CENTS i r rizatt No 201 o 40%of the UCR Required) Con ac Rat , after charge,after • Up t 0 a ho aliz ion e e per l da ed tib e Deductible year r b b ys 'an an auth 'z by A 4 HOSPICE SER No Charge No Charge 40%of the UCR charge,after Deductible • CARDIAC REHABILI ION • Cardiac rehabilitation is covered for the following 10%of the 20%of the 40%of the UCR conditions: acute myocardial infarction, Contracted Rate,after Contracted Rate,after charge,after percutaneous transluminal coronary angioplasty Deductible Deductible Deductible (PTCA),repair or replacement of heart valves, coronary artery bypass graft(CABG),or heart transplant. Coverage is limited to a maximum of 18 visits per calendar year or$1,500,whichever is exhausted first. HOME HEALTH CARE • Limited to 100 skilled visits per calendar year No Charge 20%of the 40%of the UCR Contracted'Rate,after charge,after Deductible Deductible • SF-City of Dania Beach(1 AA)(8.05) nenefit Summary, continued DURABLE MEDICAL EQUIPMENT AND ORTHOTIC AND ORTHOPEDIC APPLIANCES Equipment includes: 10%of the 20%of the 40%of the UCR • Hospital beds Contracted Rate,after Contracted Rate,after char e,after • Walkers Deductible Deductible d tible • Crutches • Wheelchairs Orthotic appliances are limited to: • Custom-made leg,arm,back,and neck braces PROSTHETIC DEVICES Prosthetic devices are limited to: % he 2 he O t R • Artificial limbs tr d C d R e,a er ge,after • Artificial joints De ct b De c Deductible • Ocular prosth SUBSTANC An intensive s s e re en ogra 1 e 20%of the 40%of the UCR Con ted Rate,after Contracted Rate,after charge,after Coverage is limi i u 30 'si p Deductible Deductible Deductible calendar year.Co i t o f d tible. ALL OTHER COV I 10%of the 20%of the 40%of the UCR Contracted Rate,after Contracted Rate,after charge,after Deductible Deductible Deductible PRIOR AUTHORIZATION IS REQUIRED FOR SPECIFIC COVERED SERVICES. THE PENALTY FOR NON-NOTIFICATION IS $500. FOR ADDITIONAL INFORMATION, PLEASE CALL: 1-800-88-AVMED (1-800-882-8633) For specific information on benefits, exclusions and limitations, please see your Summary Plan Description (SPD) with Point of Service Amendment. SF-City of Dania Beach(IAA)(8.05)