HomeMy WebLinkAboutResolution - 2006-R0177 - Amendment To COL Employee Benefit Plan - 04_13_2006Resolution No. 2006—R01-77
April 13, 2006
Item No. 5.30
RESOLUTION
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK:
THAT the Mayor of the City of Lubbock BE and is hereby authorized and
directed to execute for and on behalf of the City of Lubbock, an Amendment to the City
of Lubbock Employee Benefit Plan. Said Amendment is attached hereto and
incorporated in this Resolution as if fully set forth herein and shall be included in the
minutes of the Council.
Passed by the City Council this 13th day of
ATTEST:
Re ecca Garza, City Secretary
APPROVED AS TO CONTENT:
'r J
Scott Snider, Director of Huma esource
APPROVED AS TO FORM:
j Linda Chamales, Senior Attorney Office Practice
as/ccdocs/Amendment-COLEmployeeBenefitPlan
April 7, 2006
April 2006.
Resolution No. 2006-RO177
AMENDMENT #1
CLIENT NAME: City of Lubbock
PLAN NAME: City of Lubbock Employee Benefit Plan
PLAN #: 3010
Effective April 1, 2006 the Plan Document is amended as follows:
1. The following provision contained in the section titled SCHEDULE OF BENEFITS
(page 19) has been deleted:
Participating pharmacies have contracted with the Plan to charge Covered Persons
reduced fees for covered Prescription Drugs. Medco Health is the administrator of
the pharmacy drug plan. The copayment amount is not a covered charge under the
medical plan. For additional information about coverage and exclusions, please
contact Medco Health.
It has been replaced with the following:
Participating pharmacies have contracted with the Plan to charge Covered Persons
reduced fees for covered Prescription Drugs. Maxor Pharmacy Benefits Management
Corporation is the administrator of the pharmacy drug plan. The copayment amount
is not a covered charge under the medical plan. For additional information about
coverage and exclusions, please contact Maxor Pharmacy Benefits Management
Corporation.
2. The following provision has been added to the section titled MEDICAL BENEFITS
(page 22) and the subsequent categories have been renumbered accordingly:
(3) Rehabilitation Facility. Facility charges for rehabilitation treatment
performed in a Rehabilitation Facility and associated services and supplies.
3. The following provision contained in the section titled DEFINED TERMS (pages 35
and 36) has been deleted:
Hospital is an institution which is engaged primarily in providing medical care and
treatment of sick and injured persons on an inpatient basis at the patient's expense
and which fully meets these tests: it is accredited as a Hospital by the Joint
Commission on Accreditation of Healthcare Organizations or the American
Osteopathic Association Healthcare Facilities Accreditation Program; it is approved
by Medicare as a Hospital; it maintains diagnostic and therapeutic facilities on the
premises for surgical and medical diagnosis and treatment of sick and injured persons
by or under the supervision of a staff of Physicians; it continuously provides on the
premises 24-hour-a-day nursing services by or under the supervision of registered
nurses (R.N.$); and it is operated continuously with organized facilities for operative
surgery on the premises.
AMENDMENT #1
CLIENT NAME: City of Lubbock
PLAN NAME: City of Lubbock Employee Benefit Plan
PLAN #: 3010
The definition of "Hospital" shall be expanded to include the following:
A facility operating legally as a psychiatric Hospital or residential treatment
facility for mental health and licensed as such by the state in which the facility
operates.
A facility operating primarily for the treatment of Substance Abuse if it meets
these tests: maintains permanent and full-time facilities for bed care and full-
time confinement of at least 15 resident patients; has a Physician in regular
attendance; continuously provides 24-hour a day nursing service by a
registered nurse (R.N.); has a full-time psychiatrist or psychologist on the
staff; and is primarily engaged in providing diagnostic and therapeutic
"services and facilities for treatment of Substance Abuse.
It has been replaced with the following:
Hospital is an institution which is engaged primarily in providing medical care and
treatment of sick and injured persons on an inpatient basis at the patient's expense
and which fully meets these tests: it is accredited as a Hospital by the Joint
Commission on Accreditation of Healthcare Organizations; it is approved by
Medicare as a Hospital; it maintains diagnostic and therapeutic facilities on the
premises for surgical and medical diagnosis and treatment of sick and injured persons
by or under the supervision of Registered Nurses (R.N.$); and it is operated
continuously with organized facilities for operative surgery on the premises.
The definition of "Hospital" shall be expanded to include the following:
A facility operating legally as a Rehabilitation Facility for rehabilitative care.
A facility operating legally as a psychiatric Hospital or residential treatment
facility for mental health and licensed as such by the state in which the facility
operates.
A facility operating primarily for the treatment of Substance Abuse if it meets
these tests: maintains permanent and full-time facilities for bed care and full
time confinement of at least 15 resident patients; has a Physician in regular
attendance; continuously provides 24-hour a day nursing service by a
Registered Nurse (R.N.); has a full-time psychiatrist or psychologist on the
staff; and is primarily engaged in providing diagnostic and therapeutic
services and facilities for treatment of Substance Abuse.
2
AMENDMENT O
CLIENT NAME: City of Lubbock
PLAN NAME: City of Lubbock Employee Benefit Plan
PLAN #: 3010
4. The following provision has been added to the section titled DEFINED TERMS
(page 38):
Rehabilitation Facility means an inpatient medical facility that is licensed as a
Hospital or freestanding Rehabilitation Facility, where licensure is required, or it may
be CARF accredited. Physicians and Registered Nurses are on staff and available.
This type of facility provides physical, occupational and speech therapy by licensed
therapists and also have available a program of structured cognitive therapy. Social
work and discharge planning are provided, to include planning for care and
equipment needs after discharge.
5. The following provision contained in the section titled DEFINED TERMS (page 38)
has been deleted:
Skilled Nursing Facility is a facility that fully meets all of these tests:
(1) It is licensed to provide professional nursing services on an inpatient basis
to persons convalescing from Injury or Sickness. The service must be
rendered by a registered nurse (R.N.) or by a licensed practical nurse
(L.P.N.) under the direction of a registered nurse. Services to help restore
patient to self -care in essential daily living activities must be provided.
(2) Its services are provided for compensation and under the full-time
supervision of a Physician.
(3) It provides 24 hour per day nursing services by licensed nurses, under the
direction of a full-time registered nurse.
(4) It maintains a complete medical record on each patient.
(5) It has an effective utilization review plan.
(6) It is not, other than incidentally, a place for rest, the aged drug addicts,
alcoholics, mental retardates, Custodial or educational care or care of
Mental Disorders.
(7) It is approved and licensed by Medicare.
3
AMENDMENT #1
CLIENT NAME: City of Lubbock
PLAN NAME: City of Lubbock Employee Benefit Plan
PLAN #: 3010
This term also applies to charges incurred in a facility referring to itself as an
extended care facility, convalescent nursing home, rehabilitation hospital, long-term
acute care facility of any other similar nomenclature.
It has been replaced with the following:
Skilled Nursing Facility is a facility that fully meets all of these tests:
(1) It is licensed to provide professional nursing services on an inpatient basis
to persons convalescing from Injury or Sickness. The service must be
rendered by a Registered Nurse (R.N.) or by a Licensed Practical Nurse
(L.P.N.) under the direction of a Registered Nurse. Services to help
restore patients to self -care in essential daily living activities must be
provided.
(2) Its services are provided for compensation and under the full-time
supervision of a Physician or with Physician services available at all times
under an established agreement.
(3) It provides twenty-four hour per day nursing services by licensed nurses,
under the direction of a full-time Registered Nurse (R.N.).
(4) It has established methods and written procedures for the dispensing and
administration of drugs.
(5) It maintains a complete medical record on each patient.
(6) It has an effective utilization review plan.
(7) It is not, other than incidentally, a place for the provision of rest, custodial
care, or education or for care required by reason of age, drug addiction,
alcoholism, mental retardation or mental disorders.
(8) It is approved and licensed by Medicare.
This term also applies to charges incurred in a facility referring to itself as an
extended care facility, convalescent nursing home or any other similar nomenclature.
4
AMENDMENT #1
CLIENT NAME: City of Lubbock
PLAN NAME: City of Lubbock Employee Benefit Plan
PLAN #: 3010
I hereby acknowledge that this Amendment, as delivered to me by American Administrative
Group, Inc., accurately describes the changes to be effected to this Plan. I hereby authorize
American Administrative Group, Inc. to administer payments in accordance with the provisions
of this document effective April 1, 2006.
IN WITNESS WHEREOF, this instrument is executed for the City of Lubbock on or as of the
day and year first below written.
BY:
Marc ougal, Mayor
ATTEST:
R ecca Garza, City Secret
APPROVED AS TO CONTENT:
Scott Snider, Director of Human Resources
APPROVED AS TO FORM:
Linda L. Chamales, Senior Attorney Office Practice