HomeMy WebLinkAboutResolution - 2010-R0632 - City Manager For Changes To Master Welfare Benefit Plan And Benefit Plan - 12/15/2010Resolution No. 2010-RO632
December 15, 2010
Item No. 5.5
RESOLUTION
(Amending and Revising the City of Lubbock, Texas
Master Welfare Benefit Plan and Summary Plan Description)
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK:
WHEREAS, on March 23, 2010, Congress enacted the Patient Protection and Affordable
Care Act;
WHEREAS, on March 30, 2010, Congress enacted the Health Care and Education
Reconciliation Act;
WHEREAS, these Acts have a significant and far-reaching impact on the nation's health
care delivery system and on group health care plans;
WHEREAS, Interim Final Rules for Group Health Plans and Health Insurance Coverage
Relating to Status as a Grandfathered Health Plan Under the Patient Protection and
Affordable Care Act, were published in the Federal Register on June 17, 2010;
WHEREAS, the Interim Final Rules mandate certain changes to the City's Group Health
Plan in order to permit that plan to continue in effect as a "grandfathered" group health
plan;
WHEREAS, the City of Lubbock has determined that it is in the best interest of the
citizens, taxpayers and employees of the City to ensure that the City's existing group
health plan be considered a "grandfathered" group health plan;
WHEREAS, in order to maintain "grandfathered" status, certain changes must be made to
the City's plan, as set forth in the "Master Welfare Benefit Plan" and "Summary Plan
Description;"
WHEREAS, as a result of the Acts, the City is required to offer certain mandatory group
health benefits as part of its group health care plan:
WHEREAS, it is necessary to amend the City of Lubbock, Texas Master Welfare Benefit
Plan to advise the City's third -party benefits administrator, and the members of the City's
group health plan, of the City's intended welfare benefits;
WHEREAS, it is necessary to amend the City of Lubbock, Texas Summary Plan
Description to instruct the City's third -party benefits administrator to update and revise
the "Summary Plan Description" which is distributed to the members of the City's group
health plan;
WHEREAS, the substantive changes which must be made to the City's group health plan
are mandated by the Patient Protection and Affordable Care Act and the Health Care and
Education Reconciliation Act, and are not discretionary;
NOW THEREFORE BE IT RESOLVED THAT the Mayor of the City of Lubbock BE
and is hereby directed to execute Amendment Number 7 to the City's Master Welfare
Benefit Plan, in substantially the form attached hereto, together with any related
documents, which amendments are legally necessary to ensure that the City's group
health plan is, and continues to be, administered in such a way as to preserve and
Q:.CCDOCS\RES.ACA Changes to Group Health Plan 11-30-2010.doc
maintain the plan's "grandfathered" status, pursuant to the Interim Final Rules for Group
Health Plans and Health Insurance Coverage Relating to Status as a Grandfathered Health
Plan Under the Patient Protection and Affordable Care Act, published in the Federal
Register on June 17, 2010.
BE IT FURTHER RESOLVED 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,
Amendment Number 8 to the Summary Plan Description, in substantially the form
attached hereto, together with any related documents, which amendments are legally
necessary to ensure that the City's group health plan is, and continues to be, administered
in such a way as to preserve and maintain the plan's "grandfathered" status, pursuant to
the Interim Final Rules for Group Health Plans and Health Insurance Coverage Relating
to Status as a Grandfathered Health Plan Under the Patient Protection and Affordable
Care Act, published in the Federal Register on June 17, 2010.
BE IT FURTHER RESOLVED THAT the City Manager or designee may execute any
routine documents and forms associated with said group health plan.
Passed by the City Council this
December 15 2010.
TOM MARTIN, MAYOR
ATTEST:
Rebekca Garza, City Secretary
APPROVED AS TO CONTENT:
e><sa ut heson, Human Resources Director
Q:ICCDOCS+.RES.ACA Changes to Group Health Plan 11-30-2010.doc
Resolution No. 2010-RO632
Amendment Number Seven (7)
to the City of Lubbock, Texas
Master Welfare Benefit Plan
The City of Lubbock, Texas Master Welfare Benefit Plan is hereby amended and revised
as follows:
[add] 1.3 Grandfathered Group Health Care Plan Disclosure. The City believes
that this group health plan is a "grandfathered health plan" under the Patient Protection
and Affordable Care Act. As permitted by the Affordable Care Act, a grandfathered
health plan can preserve certain basic health coverage that was already in effect when that
law was enacted. Being a grandfathered health plan means that the plan may not include
certain consumer protections of the Affordable Care Act that apply to other plans, for
example, the requirement for the provision of preventive health services without any cost
sharing. However, grandfathered health plans must comply with certain other consumer
protections in the Affordable Care Act, for example, the elimination of lifetime limits on
benefits.
[add] 1.4 Questions Regarding Grandfathered Health Plans. Questions
regarding which protections apply and which protections do not apply to a grandfathered
health plan and what might cause a plan to change from grandfathered health plan status
can be directed to the City Manager at 1-806-775-2003 or www.ci.1ubbock.tX.us. You
may also contact the Employee Benefit Security Administration, U.S. Department of
Labor at 1-866-444-3272 or www.dol.gov/ebsa/healthreform. This website has a table
summarizing which protections do and do not apply to grandfathered health plans. You
may also contact the U.S. Department of Health and Human Services at
www.healthreform.gov.
3.1 Eligibility and Participation.
(c) The Plan shall comply with the provisions of the Patient Protection and
Affordable Care Act of 2010, as amended, such that the Plan will maintain
its status as a "grandfathered" group health plan.
3.2 Termination of Participation.
(c) The Plan shall comply with the provisions of the Patient Protection and
Affordable Care Act of 2010, as amended, such that no Participant who is
otherwise eligible to receive benefits will have coverage under the Plan
rescinded except in the case of fraud or intentional misrepresentation.
3.3 Benefits.
Q:\CCDOCS\RES - Am 7 - Changes to Group Health Plan Documents (11-30-2010).doc
(c) It is the express intention of the City that this Plan be considered, and
maintain its status as, a "grandfathered" group health plan, in accordance
with the Patient Protection and Affordable Care Act of 2010, as amended.
3.4 Continuation Coverage.
(a) [add] ...; or (iv) the Patient Protection and Affordable Care Act of 2010,
as amended;...
4.1 Contributions by Participants.
(a) [add] ..., provided, however, that the Employee's contribution rate shall
not be increased if the increase would constitute a "significant change"
under the Patient Protection and Affordable Care Act of 2010, as
amended.
5.2 Plan Administrator's General Powers, Rights, and Duties.
(h) To ensure that the Plan is administered in such a way so as to maintain the
Plan's status as a grandfathered group health in accordance with the
Patient Protection and Affordable Care Act of 2010, as amended.
6.1 Amendment and Termination of Plan.
[add] No amendment or modification of the Plan shall be interpreted to relinquish
the Plan's "grandfathered" status under the Patient Protection and Affordable
Care Act of 2010, as amended, unless the intent to relinquish "grandfathered"
status is expressly stated in clear and unambiguous language.
6.13 Compliance with State and Federal Mandates.
[add] Patient Protection and Affordable Care Act of 2010, as amended.
6.14 Insurance Policy or Governing Document Controls.
[add] No amendment or modification of the Policies or governing plan documents
shall be interpreted to relinquish the Plan's "grandfathered" status under the
Patient Protection and Affordable Care Act of 2010, as amended, unless the intent
to relinquish "grandfathered" status is expressly stated in clear and unambiguous
language.
6.17 Governing Law.
[add] Patient Protection and Affordable Care Act of 2010, as amended.
Q:\CCDOCS\RES - Am 7 - Changes to Group Health Plan Documents (11-30-2010).doc
SIGNED this December 15 2010.
TOM MARTIN, MAYOR
ATTEST:
4Rebca Garza, City Secretary
APPROVED AS TO CONTENT:
Leisa Hutcheson, Human Resources Director
Q: CCDOCS\RES - Am 7 - Changes to Group Health Plan Documents (11-30-2010).doe
Resolution No. 2010-RO632
Amendment Number Eight (8)
to the City of Lubbock, Texas
Summary Plan Description
The City of Lubbock, Texas Summary Plan Description is hereby amended and revised to
include the following required benefits:
1. No lifetime limits on essential health benefits -- No lifetime limits for
benefits listed in #2, below.
2. Minimum annual limits on dollar value of essential health benefits -
Essential health benefits include, at a minimum, ambulatory patient
services; emergency services; hospitalization; maternity and newborn
care; prescription drugs; rehabilitative or habilitative services and devices;
laboratory services; preventive and wellness services and chronic disease
management; and pediatric services, including oral and vision care.
3. Coverage of children to age 26 - This includes married or unmarried
children; however, the City can, and does hereby, require the child be
covered under his/her employer-sponsored health plan, if available;
4. No rescission except for fraud - Coverage cannot be rescinded except with
respect to "an individual who has performed an act or practice that
constitutes fraud or makes intentional misrepresentation of material fact as
prohibited by the terms of the plan."
5. No pre-existing condition exclusions for children under age 19.
Any provision of the Summary Plan Description which conflicts with the above-
described plan benefits shall be conformed to include these required benefits.
SIGNED this December 15 2010.
TOM MARTIN, MAYOR
ATTEST:
eb cca Garza, City Secretary
APPROVED AS TO CONTENT:
Q:`,CCDOCS\RES - Am. 8 - Changes to Group Health Plan Documents (11-30-2010).doc
t (�
Leisa Hutcheson, Human Resources Director
Q:^ICCDOCS\RES - Am. 8 - Changes to Group Health Plan Documents (11-30-2010).doc