HomeMy WebLinkAboutResolution - 2015-R0172 - Amendment To Master Welfare Benefit Plan - 05/28/2015Resolution No. 2015-RO172
May 28, 2015
Item No. 6.22
RESOLUTION
(Amending and Revising the City of Lubbock, Texas
Master Welfare Benefit Plan
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK:
THAT the Amendment Number One (1) to the City of Lubbock Master Welfare
Benefit Plan is hereby adopted and approved, concerning certain adjustments to
participant deductible, co -payment, and out-of-pocket co -share amounts. Said
Amendment is attached hereto and incorporated in this resolution as if set forth herein
and shall be included in the minutes of the City Council.
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
TTEST:
Garza, City
AS TO CONTENT—.
Human Resources Director
AS TO
2015.
z4V
GLtW,!`k0BtRTSON, MAYOR
City Attorney
No 1 Employee Benefit Plan
Resolution No. 2015-RO172
City of Lubbock
Employee Benefit Plan
Plan Amendment No. I
This Amendment to the City of Lubbock employee Benefit Plan Document (the "Plan
Document") is executed on this, the 28th day of May, 2015, to be effective January 1,
2016.
All capitalized terms shall have the same meaning as those terms are defined in the Plan
Document. The following benefit changes are hereby made to the Plan Document:
• Deductible - $625 individual - $1,250 family
• Co -Share Out -of Pocket Maximum (excludes Deductible) - $2,500 individual -
$5,000 family
• Office Visit Co -pay - $30
• Emergency Room Co -pay - $95
• Prescription Drug Co -payments
Retail - $5 Generic, $35 Preferred Name Brand, and $60 Non -Preferred Name
Brand
• Prescription Drug Co -payments
Mail Order - $12.50 Generic, $87.50 Preferred Name Brand, and $150 Non -
Preferred Name Brand
4",�Wx
Glen . Robert on, Mayor
ATTEST:
Reb fcca Garza, City Secret
AP R ED AS CONTENT:
Leisa flutcheson, Director Human Resources
and Risk Management
i