HomeMy WebLinkAboutResolution - 2013-R0430 - Amendment #14 To Master Welfare Benefit Plan - 12/12/2013RESOLUTION
(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 inthe "Master WelfareBenefitPlan"and "Summary Plan Description;"
WHEREAS,as a result of the Acts, the City is required to makecertain mandatory changes to the
City's group health benefits 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 changes to its 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 membersof 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 14 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 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 Amendment Number 14 to the City's 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
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
ATTEST:
Reb cca Garza, City Secretary
APPR AS T ONTENT:
liecemoer i
Leisa Hutcheson, Human Resources Director
�, 2013.
GL C. ROBERTSON, MAYOR
Q:\CCDOCS\RES.ACA Changes to Group Health Plan (2.0).2014.doc
Amendment Number Fourteen (14)
to the City of Lubbock, Texas
Master Welfare Benefit Plan and
the Summary Plan Description
The City of Lubbock, Texas Master Welfare Benefit Plan and the Summary Plan
Description are hereby amended and revised to include the following required benefits:
Speech and Hearing Services — (i) The calendar year maximum benefit of
$1,000 per participant is removed. (ii) Benefit will be amended to one hearing aid
per ear per 36-month period. (iii) This benefit shall be payable at 80% of
Allowable Amount after $500 Deductible for in -network providers and at 50% of
Allowable Amount after $1,000 Deductible for out -of -network providers.
2. Chiropractic Services — In -Network Only — (i) The calendar year maximum
benefit of $1,000 per participant is removed. (ii) The in -network benefit for
Chiropractic Services is amended to 35 visits annually per participant. (iii)
Benefits for Office Visit will be paid at 100% of Allowable Amount after $25 Co -
payment Amount. (iv) All Other Services, in the office and all services in the
Outpatient setting will continue to be paid at 80% of Allowable Amount after
calendar year deductible.
3. Pre -Existing Conditions Exclusions — (i) Pre -Existing Conditions Exclusions
may no longer be applied for any member or dependent covered under the City's
health plan effective January 1, 2014.
These changes to the Master Welfare Benefit Plan and the Summary Plan Description are
intended to ensure compliance with the requirements of the Affordable Care Act (ACA)
for grandfathered health plans. Any provisions of the plans which conflict with the
above -described plan benefits shall be conformed to include these required benefits.
SIGNED this December 12, 2013.
GL O RT ON, MAYOR
ATTEST:
eb cca Garza, City ecreta y
APPROVED AS TO CONTENT:
Leisa Hutcheson, Human Resources Director
Q:\CCDUCS\Am. 14 - Global Changes to Group Health Plan Documents (2.1).doc