HomeMy WebLinkAboutResolution - 2001-R0501 - Contract For Insurance Renewal - Bluecross Blushield Of Texas - 12/03/2001Resolution No. 2001-R0501
December 3, 2001
Item No. 25
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, a Contract between the City
of Lubbock and B1ueCross B1ueShield of Texas for insurance renewal for the City of
Lubbock, and all related documents. Said Contract is attached hereto and incorporated in
this resolution as if fully set forth herein and shall be included in the minutes of the City
Council.
Passed by the City Council this
3rd day of December , 2001.
f
Y SIT N, AYOR
ATTEST:
" 8 . C)N�
Reb cca Garza
City Secretary
APPROVED AS`TO CONTENT:
Mary Ho e
Managing Director of Human Resources
APPROVED AS TO FORM:
William de Haas
Contract Manager/Attorney
Dh/Cedocs/B1ueCross Blue Shield.res
November 26, 2001
Resolution No. 2001-RO501
December 3, 2001
Item No. 25
AMENDMENT #1 TO MINIMUM PREMIUM AGREEMENT
(Blue Cross Blue Shield of Texas)
This amendment to. the October 14, 1999, Minimum Premium Agreement
between the City of Lubbock and Blue Cross Blue Shield of Texas, to provide group
health insurance benefits for the City of Lubbock, effective as of January 1, 2002, the
"Effective Date."
WHEREAS, City entered into an Agreement with Blue Cross Blue Shield of
Texas dated October 14, 1999, to provide group health insurance benefits for the City of
Lubbock, and
WHEREAS, both parties desire to renew and amend this Agreement; and
NOW THEREFORE, for and in consideration of the mutual covenants herein, the
parties do agree to amend the Agreement as follows:
1. Exhibit Number One is deleted and replaced with Exhibit Number Three
attached hereto and made a part of this Agreement.
2. All other provisions contained in the Original Contract shall remain in full
force and effect and shall not be affected by this Amendment.
Executed as of the Effective Date.
Windy Sitton
Mayor
ATTEST:
_ 2
- e. — � 2a�
Rebecca Garza
City Secretary
BLUE CROSS BLUE SHIELD OF TEXAS
Jon W. Worley
Chief Operating Officer
West Texas Division
Minimum Premium Agreement, City of Lubbock & Blue Cross Blue Shield of Texas
I
APPROVED AS TO CONTENT:
—744� -4
ot
Mary Hou
Managing Director of Human Resources
APPROVED AS TO FORM:
._A-.
William de Haas
Contract Manager/Attorney
Minimum Premium Agreement, City of Lubbock & Blue Cross Blue Shield of Texas.
Page 2
Resolution No. 2001—RO501
EXHIBIT NUMBER THREE
Schedule Of Specifications
For the
MINIMUM PREMIUM AGREEMENT
(the Agreement)
between
BLUE CROSS AND BLUE SHIELD OF TEXAS
(BCBSTX)
And
CITY OF LUBBOCK
(Employer, Policyholder)
Group Number: 60167
The specifications are to apply for the period of time indicated herein and shall continue in force and effect
until the end of the Policy Period, the Agreement is terminated or this Exhibit is superseded in whole or in part
by a later executed Exhibit.
Item I
Contract Coverage
This Minimum Premium Agreement will apply to benefits provided under the BCBSTX Group Contract(S)
listed below:
• Experience Rated Group PPO Managed Health Care Contract with Prescription Drug Program
• Experience Rated Group Traditional Indemnity Benefit Contract with Prescription Drug Program
• Experience Rated Group Comprehensive Dental Care Contract
Item II
Contract Year
These specifications are for the current Contract Year, which shall commence on January 1, 2002 and end
on December 31, 2002.
Item III
Accounting Period
The current Accounting Period shall commence on January 1, 2002 and end on December 31, 2002.
Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, A Mutual Legal Reserve
Company, an Independent Licensee of the Blue Cross and Blue Shield Association
FORM NO. MPA/EX 1 60167JAN.02
Item IV
Draft Authority
Draft Authority shall be calculated monthly and shall be equal to the sum of the amounts obtained by
multiplying the number of certificates exposed for a particular month by:
A. $229.36
for each Employee or Retiree Only Health Certificate
$380.74
for each Employee or Retiree/Child(ren) Health Certificate
$424.31
for each Employee or Retiree/Spouse Health Certificate
$584.86
for each Employee or Retiree/Family Health Certificate
B. $17.85 for each Employee Only Dental Certificate
$29.63 for each Employee/Child(ren) Dental Certificate
$33.02 for each Employee/Spouse Dental Certificate
$45.51 for each Employee/Family Dental Certificate
The amounts shown shall apply for the current Contract Year.
Item V
Health Stop -Loss Insurance
Health Stop -Loss Insurance applicable for benefits covered under the Health Contracts (excluding the
Prescription Drug Program) is shown below. All monetary amounts and percentages shown shall apply for
the current Contract Year.
A. Specific Health Stop -Loss Insurance:
Specified Paid Health Benefits in excess of the Point of Attachment which is $150,000 per
Participant per Accounting Period.
B. Aggregate Stop -Loss Insurance:
None - not applied for.
Item VI
Settlement Payment Option
The following Settlement Payment Options will apply:
A. Specific Health Stop -Loss Insurance:
1. Monthly settlements
2. Time Period: 12 months
3. Applicable Contracts (from Item I):
• Experience Rated Group PPO Managed Health Care Contract with Prescription
Drug Program
• Experience Rated Group Traditional Indemnity Benefit Contract
FORM NO. MPA/EX 2 60167JAN.02
B. Aggregate Stop -Loss Insurance:
Annualized Draft Authority percentage for deficit carry forward: 20.0%
ITEM VII
Termination Coverage Options
The Termination Coverage Options shown below will apply for the Run -Off Period:
Run -Off Administration Charge Factors for calculating the Run -Off Period:
1. $13.88
for each Employee or Retiree Only Health Certificate
$23.04
for each Employee or Retiree/Child(ren) Health Certificate
$25.68
for each Employee or Retiree/Spouse Health Certificate
$35.44
for each Employee or Retiree/Family Health Certificate
2. $1.72 for each Employee Only Dental Certificate
$2.84 for each Employee/Child(ren) Dental Certificate
$3.16 for each Employee/Spouse Dental Certificate
$4.36 for each Employee/Family Dental Certificate
Run -Off Liability Factors for calculating the Run -Off Draft Authority:
1. $166.36
for each Employee or Retiree Only Health Certificate
$276.16
for each Employee or Retiree/Child(ren) Health Certificate
$307.76
for each Employee or Retiree/Spouse Health Certificate
$424.20
for each Employee or Retiree/Family Health Certificate
2. $11.56
for each Employee Only Dental Certificate
$19.20
for each Employee/Child(ren) Dental Certificate
$21.40
for each Employee/Spouse Dental Certificate
$29.52
for each Employee/Family Dental Certificate
ITEM VIII
Home Bank or Employer's Bank Information
The name and address of the Employer's Bank and financial contact person shall be maintained on file in
accordance with procedures established between the Employer and the Comptroller Division of the
Accounting Services Department of BCBSTX.
Item IX
Administration Charge
The Administration Charge for the Contract Year shall be calculated monthly by multiplying the number
of certificates exposed for a particular month by:
A. $22.93
for each Employee or Retiree Only Health Certificate
$38.06
for each Employee or Retiree/Child(ren) Health Certificate
$42.42
for each Employee or Retiree/Spouse Health Certificate
$58.47
for each Employee or Retiree/Family Health Certificate
FORM NO. MPA/EX 3 60167JAN.02
B. $2.63 for each. Employee Only Dental Certificate
$4.36 for each Employee/Child(ren) Dental Certificate
$4.86 for each Employee/Spouse Dental Certificate
$6.70 for each Employee/Family Dental Certificate
The amounts shown shall apply for the current Contract Year.
Item X
Health Contract Stop -Loss Premium
The Health Contract Stop -Loss Premium is the sum of the Specific Health Stop -Loss Premium and
Aggregate Stop -Loss Premium amounts calculated as follows (amounts shown shall apply for the current
Contract Year):
A. Specific Health Stop -Loss Premium shall be calculated monthly and shall be equal to the sum of the
amounts obtained by multiplying the number of Health Certificates exposed for a particular month by:
$ 9.93
for each Employee or Retiree Only Health Certificate
$16.49
for each Employee or Retiree/Child(ren) Health Certificate
$18.38
for each Employee or Retiree/Spouse Health Certificate
$25.33
for each Employee or Retiree/Family Health Certificate
B. Aggregate Stop -Loss Premium shall be calculated monthly and shall be equal to the sum of the
amounts obtained by multiplying the number of Health Certificates exposed for a particular month by:
NA
Item XI
Minimum Balance
The Minimum Balance to be deposited by the Employer and held in the Employer's Account under the
Banking Arrangement is $388,683 for the period beginning January 1, 2002 through December 31, 2002.
Item XII
Additional Charges/Fees/Rates
The following charges and interest rates shall apply for the current Contract Year:
A. The Daily Charge rate for the Contract Year shall be .0329% (which would equate to an annual
percentage rate of 12%).
B. Subrogation recoveries are subject to 15.0% of any amounts recovered.
C. BlueCard® Program (Out -of -Area Program) fees shall be the lesser of 10% of the discount or $2,000
per claim (Refer to ARTICLE I, Benefit Checks, for additional explanation)
FORM NO. MPA/EX 4 60167JAN.02
Item XIII
Letter of Credit
The Letter Of Credit is not required under this Employer's Agreement.
Item XIV
If this Exhibit of Schedule of Specifications is not rejected in writing by the Employer within thirty (30) days
of its receipt by the Employer, it shall be deemed to have been accepted by the Employer and will be in full
force and effect for the Accounting Period and Contract Year identified herein.
SIGNED THIS DAY THE 12th OF December , 2001
Blue Cross and Blue Shield of Texas City of Lubbock
J n W. Worley Windy itto , ayor
Chief Operating Officqr
West Texas Division
ATTEST:
Rebecca Garza,
City Secretary
APPROVED AS TO CONTENT:
Mary Hous
Managing Director of Human Resources
APPROVED AS TO FORM:
William de Haas,
Contract Manager
FORM NO. MPA/EX 5 60167JAN.02
Resolution No. 2001-RO501
December 3, 2001
Item No. 25
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, a Contract between the City
of Lubbock and B1ueCross BlueShield of Texas for insurance renewal for the City of
Lubbock, and all related documents. Said Contract is attached hereto and incorporated in
this resolution as if fully set forth herein and shall be included in the minutes of the City
Council.
Passed by the City Council this
3rd day of December ,2001.
ATTEST:
.�,
crecaGarza
City Secretary
APPROVED AS -TO CONTENT:
Mary Ho e
Managing Director of Human Resources
APPROVED AS TO FORM:
William de Haas
Contract Manager/Attorney
Dh/CcdoesBlueCross Blue Shield.res
November 26, 2001
Resolution No. 2001-RO501
December 3, 2001
Item No. 25
AMENDMENT #1 TO MINIMUM PREMIUM AGREEMENT
(Blue Cross Blue Shield of Texas)
This amendment to. the October 14, 1999, Minimum Premium Agreement
between the City of Lubbock and Blue Cross Blue Shield of Texas, to provide group
health insurance benefits for the City of Lubbock, effective as of January 1, 2002, the
"Effective Date."
WHEREAS, City entered into an Agreement with Blue Cross Blue Shield of
Texas dated October 14, 1999, to provide group health insurance benefits for the City of
, Lubbock, and
WHEREAS, both parties desire to renew and amend this Agreement; and
NOW THEREFORE, for and in consideration of the mutual covenants herein, the
parties do agree to amend the Agreement as follows:
1. Exhibit Number One is deleted and replaced with Exhibit Number Three
attached hereto and made a part of this Agreement.
2. All other provisions contained in the Original Contract shall remain in full
force and effect and shall not be affected by this Amendment.
Executed as of the Effective Date.
CITY OF LUBBOCK
Windy Sitton
Mayor
ATTEST:
".4
Rebecca Garza
City Secretary
BLUE CROSS BLUE SHIELD OF TEXAS
. Lye -0-4-z
Jon W. Worley
Chief Operating Officer
West Texas Division
Minimum Premium Agreement, City of Lubbock & Blue Cross Blue Shield of Texas
APPROVED AS TO CONTENT:
—7/4x
Mary Hou
Managing Director of Human Resources
APPROVED AS TO FORM:
William de Haas
Contract Manager/Attorney
Minimum Premium Agreement, City of Lubbock & Blue Cross Blue Shield of Texas.
Page 2
Resolution No. 2001—RO501
EXHIBIT NUMBER THREE
Schedule Of Specifications
For the
MINIMUM PREMIUM AGREEMENT
(the Agreement)
between
BLUE CROSS AND BLUE SHIELD OF TEXAS
(BCBSTX)
And
CITY OF LUBBOCK
(Employer, Policyholder)
Group Number: 60167
The specifications are to apply for the period of time indicated herein and shall continue in force and effect
until the end of the Policy Period, the Agreement is terminated or this Exhibit is superseded in whole or in part
by a later executed Exhibit.
Item I
Contract Coverage
This Minimum Premium Agreement will apply to benefits provided under the BCBSTX Group Contract(S)
listed below:
• Experience Rated Group PPO Managed Health Care Contract with Prescription Drug Program
• Experience Rated Group Traditional Indemnity Benefit Contract with Prescription Drug Program
• Experience Rated Group Comprehensive Dental Care Contract
Item II
Contract Year
These specifications are for the current Contract Year, which shall commence on January 1, 2002 and end
on December 31, 2002.
Item III
Accounting Period
The current Accounting Period shall commence on January 1, 2002 and end on December 31, 2002.
Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, A Mutual Legal Reserve
Company, an Independent Licensee of the Blue Cross and Blue Shield Association
FORM NO. MPA/EX 1 60167JAN.02
Item IV
Draft Authority
Draft Authority shall be calculated monthly and shall be equal to the sum of the amounts obtained by
multiplying the number of certificates exposed for a particular month by:
A. $229.36
for each Employee or Retiree Only Health Certificate
$380.74
for each Employee or Retiree/Child(ren) Health Certificate
$424.31
for each Employee or Retiree/Spouse Health Certificate
$584.86
for each Employee or Retiree/Family Health Certificate
B. $17.85 for each Employee Only Dental Certificate
$29.63 for each Employee/Child(ren) Dental Certificate
$33.02 for each Employee/Spouse Dental Certificate
$45.51 for each Employee/Family Dental Certificate
The amounts shown shall apply for the current Contract Year.
Item V
Health Stop -Loss Insurance
Health Stop -Loss Insurance applicable for benefits covered under the Health Contracts (excluding the
Prescription Drug Program) is shown below. All monetary amounts and percentages shown shall apply for
the current Contract Year.
A. Specific Health Stop -Loss Insurance:
Specified Paid Health Benefits in excess of the Point of Attachment which is $150,000 per
Participant per Accounting Period.
B. Aggregate Stop -Loss Insurance:
None - not applied for.
Item VI
Settlement Payment Option
The following Settlement Payment Options will apply:
A. Specific Health Stop -Loss Insurance:
Monthly settlements
2. Time Period: 12 months
Applicable Contracts (from Item I):
• Experience Rated Group PPO Managed Health Care Contract with Prescription
Drug Program
• Experience Rated Group Traditional Indemnity Benefit Contract
FORM NO. MPA/EX 2 60167JAN.02
B. Aggregate Stop -Loss Insurance:
Annualized Draft Authority percentage for deficit carry forward: 20.0%
ITEM VII
Termination Coverage Options
The Termination Coverage Options shown below will apply for the Run -Off Period:
Run -Off Administration Charge Factors for calculating the Run -Off Period:
$13.88
for each Employee or Retiree Only Health Certificate
$23.04
for each Employee or Retiree/Child(ren) Health Certificate
$25.68
for each Employee or Retiree/Spouse Health Certificate
$35.44
for each Employee or Retiree/Family Health Certificate
2. $1.72 for each Employee Only Dental Certificate
$2.84 for each Employee/Child(ren) Dental Certificate
$3.16 for each Employee/Spouse Dental Certificate
$4.36 for each Employee/Family Dental Certificate
Run -Off Liability Factors for calculating the Run -Off Draft Authority:
$166.36
for each Employee or Retiree Only Health Certificate
$276.16
for each Employee or Retiree/Child(ren) Health Certificate
$307.76
for each Employee or Retiree/Spouse Health Certificate
$424.20
for each Employee or Retiree/Family Health Certificate
2. $11.56
for each Employee Only Dental Certificate
$19.20
for each Employee/Child(ren) Dental Certificate
$21.40
for each Employee/Spouse Dental Certificate
$29.52
for each Employee/Family Dental Certificate
ITEM VIII
Home Bank or Employer's Bank Information
The name and address of the Employer's Bank and financial contact person shall be maintained on file in
accordance with procedures established between the Employer and the Comptroller Division of the
Accounting Services Department of BCBSTX.
Item IX
Administration Charge
The Administration Charge for the Contract Year shall be calculated monthly by multiplying the number
of certificates exposed for a particular month by:
A. $22.93
for each Employee or Retiree Only Health Certificate
$38.06
for each Employee or Retiree/Child(ren) Health Certificate
$42.42
for each Employee or Retiree/Spouse Health Certificate
$58.47
for each Employee or Retiree/Family Health Certificate
FORM NO. MPA/EX 3 60167JAN.02
B. $2.63 for each. Employee Only Dental Certificate
$4.36 for each Employee/Child(ren) Dental Certificate
$4.86 for each Employee/Spouse Dental Certificate
$6.70 for each Employee/Family Dental Certificate
The amounts shown shall apply for the current Contract Year.
Item X
Health Contract Stop -Loss Premium
The Health Contract Stop -Loss Premium is the sum of the Specific Health Stop -Loss Premium and
Aggregate Stop -Loss Premium amounts calculated as follows (amounts shown shall apply for the current
Contract Year):
A. Specific Health Stop -Loss Premium shall be calculated monthly and shall be equal to the sum of the
amounts obtained by multiplying the number of Health Certificates exposed for a particular month by:
$ 9.93 for each Employee or Retiree Only Health Certificate
$16.49 for each Employee or Retiree/Child(ren) Health Certificate
$18.38 for each Employee or Retiree/Spouse Health Certificate
$25.33 for each Employee or Retiree/Family Health Certificate
B. Aggregate Stop -Loss Premium shall be calculated monthly and shall be equal to the sum of the
amounts obtained by multiplying the number of Health Certificates exposed for a particular month by:
NA
Item XI
Minimum Balance
The Minimum Balance to be deposited by the Employer and held in the Employer's Account under the
Banking Arrangement is $388,683 for the period beginning January 1, 2002 through December 31, 2002.
Item XII
Additional Charges/Fees/Rates
The following charges and interest rates shall apply for the current Contract Year:
A. The Daily Charge rate for the Contract Year shall be .0329% (which would equate to an annual
percentage rate of 12%).
B. Subrogation recoveries are subject to 15.0% of any amounts recovered.
C. BlueCard® Program (Out -of -Area Program) fees shall be the lesser of 10% of the discount or $2,000
per claim (Refer to ARTICLE I, Benefit Checks, for additional explanation)
FORM NO. MPA/EX 4 60167JAN.02
Item XIII
Letter of Credit
The Letter Of Credit is not required under this Employer's Agreement.
Item XIV
If this Exhibit of Schedule of Specifications is not rejected in writing by the Employer within thirty (30) days
of its receipt by the Employer, it shall be deemed to have been accepted by the Employer and will be in full
force and effect for the Accounting Period and Contract Year identified herein.
SIGNED THIS DAY THE 12th
Blue Cross and Blue Shield of Texas
bwfilpA,�-
16n W. Worley
Chief Operating Offic
West Texas Division
OF December 2001
City of Lubbock
Lm/lawnw, ww"w - num"
OMMY=
ATTEST:
Rebecca Garza,
City Secretary
APPROVED AS TO CONTENT:
Mary Hous
Managing Director of Human Resources
APPROVED AS TO FORM:
��=- �" �
William de Haas,
Contract Manager
FORM NO. MPA/EX 6 60167JAN.02