ORDER NO. 30035 KERB COUNTY EMPLOYEE MEDICAL BENEFITS Came to be heard this the 27th day of November, 2006, with a motion made by Commissioner Williams, seconded by Commissioner Nicholson. The Court unanimously approved by vote of 3-0-0 to: Adopt the latest draft of the Kerr County Policies & Procedures, as presented by Mr. Looney, concerning opting out by the employee of the County Health Benefits Program. 3oass (, !~ 3003 6 COMMISSIONERS' COURT AGENDA REOUEST PLEASE FURNISH ONE ORIGINAL AND TEN COPIES OF THIS MADE BY: Pat Tinley OFFICE: County MEETING DATE: November 27, 2006 TIME PREFERRED: SUBJECT: Consider, discuss and take appropriate action on proposed policy to allow Kerr County employees to waive participation in employee medical benefits plan and establish County contribution to employee's cafeteria plan or flexible medical spending account for 2007. EXECUTIVE SESSION REQUESTED: (PLEASE STATE REASON) NAME OF PERSON ADDRESSING THE COURT: County Judge ESTIMATED LENGTH OF PRESENTATION: IF PERSONNEL MATTER -NAME OF EMPLOYEE: Time for submitting this request for Court to assure that the matter is posted in accordance with Title 5, Chapter 551 and 552, Government Code, is as follows: Meeting scheduled for Mondays: 5:00 P.M. previous Tuesday. THIS REQUEST RECEIVED BY: THIS REQUEST RECEIVED ON: All Agenda Requests will be screened by the County Judge's Office to determine if adequate information has been prepared for the Court's formal consideration and action at time of Court Meetings. Your cooperation will be appreciated and contribute towards your request being addressed at the eazliest opportunity. See Agenda Request Rules Adopted by Commissioners' Court. Page 1 of 1 Kerr County JudgelCommissioners' Court From: "Gary Looney" To: "Eva Hyde" ; "Pat Tinley" Cc: "Don Wallace" Sent: Wednesday, November 22, 2006 8:42 AM Attach: Kerr County Waiver of coverage draft number 2 medical savings plan.doc; Kerr County Waiver of coverage draft number 3 cafeteria plan.doc Subject: Emailing: Kerr County Waiver of coverage draft number 2 medical savings plan, Kerr County Waiver of coverage draft number 3 cafeteria plan ซKerr County Waiver of coverage draft number 2 medical savings plan.docป ซKerr County Waiver of coverage draft number 3 cafeteria plan.docป Here are two versions of the waiver, one is for deposit into the Medical Savings account and one is for contibution to the Cafeteria Plan to be used for any qualified expense which includes premium payments for voluntary products. The deposit as determined by discussion with Ms. Hyde, Don Wallace and myself was suggested to be $600 which is equal to the HRA deposit. Gary The message is ready to be sent with the following file or link attachments: Kerr County Waiver of coverage draft number 2 medical savings plan Kerr County Waiver of coverage draft number 3 cafeteria plan Note: To protect against computer viruses, a-mail programs may prevent sending or receiving certain types of file attachments. Check your e-mail security settings to determine how attachments are handled. Confidentiality Notice: Protected Health Information Enclosed: Protected Health Information (PH) is personal and sensitive Individually-identifiable information related to a person's health caze. It is being faxed/emailed to you after appropriate authorization from the individual or under circumstances that do not require authorization. You, the recipient, are obligated to maintain it in a safe, secure and confidential manner. Re-disclosure without authorization or as permitted by law is prohibited. Unauthorized re-disclosure or failure to maintain confidentiality could subject you to penalties described in federal and state law. IMPORTANT WARNING: This message is intended for the use of the person or entity to which it is addressed. If you are not the intended recipient, or the employee or agent responsible to deliver it to the intended recipient, you aze hereby notified that any disclosure, copying or distribution of this information is strictly prohibited. Please notify the sender immediately to arrange for the return or destruction of these misdirected documents. 11/22/2006 Ken County Policies and Procedures Policy hz and effort to aid those employees who have existing permanent medical insurance provided by a recognized financially stable insurance company or self funded entity providing medical insurance benefits that are equivalent to the plan offered to County employees, Kerr County offers the following option: 1. An individual employee may waive participation in the basic medical insurance plan offered at no chazge to County employees. The waiver must be executed during an annual enrollment period. 2. An individual may not re-enroll in the County insurance plan by virtue of losing coverage from another source for non-payment of premium except during an annual enrollment period. 3. An individual employee, who waives participation in the County Plan, waives coverage for all eligible dependents who aze not employees of the County. 4. An individual employee, who waives participation in the County Plan, waives only their participation in medical insurance. 5. The County will contribute to the employee's Cafeteria Plan an amount to be determined each yeaz by the Ken County Commissioner's court. The contribution amount maybe increased or decreased annually by majority vote of the Court prior to the annual open enrollment period. Procedures: 1. An employee must provide proof of equivalent medical insurance coverage annually during the open enrollment period in order to be eligible to waive participation. Proof of coverage may include the following: a. A copy of the insurance policy covering the employee they wish to be reviewed for equivalency of coverage b. A copy of a recent billing c. A copy of a evidence of current payment if no billings aze received d. If coverage is provided by another group health insurance plan you must provide: i. The name of the Insurance Company ii. The name of the sponsor of the plan (Employer) iii. A benefit summary 2. An employee may not re-enroll in the County's health insurance plan during the plan yeaz if coverage is lost due to non payment of premium. 3. An employee may re-enroll if coverage is lost due to the termination of coverage by the insurer for any reason other than non-payment of premium as allowed by the Health Insurance Portability and Accountability Act (HIPAA). 4. An employee who has waived coverage as a result of being a dependent on their spouse's insurance plan may not re-enroll until the annual enrollment period unless allowed by HIPAA. The Director of Human Resources will notify an employee who is determined to be qualified to waive participation in the County's medical plan prior to the open enrollment period. An employee who qualifies will be required to complete the standard enrollment application stating their desire to waive participation the plan. MetLife Voluntary Dental Cost and Benefit Summary for Kerr County ;'"ฐ~"~~~sN ~ki'sys~-: 11/22/2006 13NIS ~a~, ~' 249 t ~"~~~="?`~. =~'~.~~~iP+~<, All Eli ible Em to ees '"` ~ ~(: u~3 "ฐ A Child is covered u to a e 25; A student is covered u to a e 25. `~~ ~ *s~ „~?~";~„ ` 100% for em to ee covers e ~~; „~'„~, , " ?^ 100% for de octant coverage ~,~, `t ~~~rt`~a,+„ This uote assumes em Io ee artici ation of at least 25%. ` "~~i '~.., ~'~~~~^~~~ This uote assumes de octant rtici anon of at least 0%. ` _ 8~3 r w ~." t"~ ~ All Active Full Time Emplo ees (30 Hours Ir--Network... Outof-Network.. Coverage Option, Primary Primary Basis of Reimbursement -Network Negotiated PDP fee' 99th percentile of Reasonable 8 Customs R&C T' eA-Preventive 100% 100% Type B -'Basic 80ฐk 80ฐk T C - Ma'or 50ฐk 50ฐ~ "Individual Deductible Annua $50 $50 Famil Deductible nnuat 3x a r ate 3x a re ate .Deductible A Ties To T B 8 C T e 6& C -CalendarYear Maximum $1,000 $1,000 • This Ian does not rovide orthodo ntia or related services. ' ~ Lives; . Rate.; Em to ee Onl 107 $22.19 Em to ee + S ouse 39 $45.62 Em to ee+ Chiltl ran ` 25 $51.91 Em to ee+Famil 78 $75.33 -Total Number of Lives ' 249 Estimated-Total Monthl Premium $11,327.00 -Rate-Guarantee Period 01/01/2007 - 12/31/2007 • For the Effective Date Shown Above, proposal is effective for up to 90 days from posal date. • Final rates will be based on actual enrollment, participation, contribution levels, and the effective date of covers e. • If the actual enrollment avers es 3 or more children er famil unit, we reserve the ti ht to revise these rates. • State Laws -For covered employees residing in any state outside the situs state, which validly exercises extraterritorial uri~iif~iotl, the Ian will be modfied io meet a livable laws. • Individuals 70 ears of a .and older must submit roof of full time em o ant. r In Network Benefits provided under this plan for covered dental services provided by a dentist who ~ a paficipagng provider. 2 Out of Network benefits are payable for services rendered by a dentist who 's not a partidpating provider. The Reasonable end Customary charge is based on the lowest of (t) the dentist's ~tual charge (the'Adual Charge'), (~ the dentist's usual charge for the same or similar services (the'Usual Charge'), or (3) the charge of most dentists in the same peopraphlc area for the same or similar services es determined by MetLife (the'Cuatomary Charge'). Serv6ces must be ALLOCATION `OF SERVICES: PRIMARY PLAN (Subjectto Exclusions and Limitations_ TYPE A PREVENTIVE SERVICES.. TYPE B i3ASIC SERVICES TYPE C MAJOR'SERVICES • Oral Exams Periapical X-rays and Inlays/Onlays • Full Mouth X-Rays other X-rays Crowns • Bitewing X-Rays Bacteriological studies for Prefabricated Stainless • Prophylaxis/Cleaning determination of Steei and Resin Crowns • Fluoride Treatments pathological agents Pulp capping • Genetic test for Therapeutic Pulpotomy susceptibility to Pulpaltherapy oral disease Root canal treatment • Caries susceptibility tests Apexification/ • Pulp vitality tests recalcification • Diagnostic casts Periodontics • Sealants Scaling & Root Planing • Space Maintainers Periodontal Surgery • Fillings Relines/Rebases • Periodontal Maintenance Dentures • Emergency Palliative Repairs Treatment Bridges • Injections of Antibiotic Drugs Extractions • Oral Surgery • General Anesthesia • Consultations MetLife Voluntary Dental Cost and Benefit Summary for Kerr County tn-Networlt " Dut-0f=Network'.. Coverage Optton Primary Primary Basis of Reimbursement - Network Negotiated PDP feeฐ 99th percentile of ReasoSable & Customs &C T A -Preventive 100ฐ~ 100% T e B -Basic 80% 80% T C - Ma'or 50% 50% Type D -Orthodontia -Child Up to A e19 50% 50ฐ~ Individual Deductible Annua $50 $50 Famil Deductible nnual 3x a ate 3x a negate Deductible A lies To T B 8 C T B 8 C Calendar Year Maximum $1,000 $1,000 Lifetime Orthodontic Maximum $1,000 $1,000 - Lives hate'.: Em to ee Onl 107 $22.18 Em to ee + S ouse 39 $45.58 Em to ee+=Child ren ' 25 $58.02 Em to ee + Famil 78 $81.42 Total Number of Lives ' ' 249 Estimated Total Monthf Premium $11,952.14 -.Rate Guarantee Period:. 01/01/2007 - 12/31/2007 • For the Effective Date Shown Above, pro oral is effective for up to 90 days from pro sal date. • Final rates will be based on actual enrollment, partiapation, contribution levels, and the effective date of covers e. • If the actual enrollment avers es 3 or more children r famil unit, we reserve the ri ht to revise these rates. • State Laws -For covered employees residing in any state outside the situs state, which validly exerases extratenitonal 'urisdiction, the Ian will be mod~ed to meet a livable laws. • Individuals 70 ears of a e and older must submit roof of full time em o ent. a In Network Benefits provided under this plan for covered dental services provided by a dentist who is a participating provider. s Out of Network benefits are payable for services rendered try a dentist who is not a participating provider. The Reasonable and Customary charge ~ based on the lowest of (1) the dentist's actual charge (the'Adual Charge'), (~ the tleMist's usual charge for the same or similar services (the'Usual Charge'), or (3) the chame of most dentists in the same peopraDhk; area for the same or similar services as determined by MetLlte Me'Customarv Charge'). services must be ALLOCATION OF SERVICES: PRIMARY PLA N Sei "" fa Fxcli-sians antl Lireitations TYPE A TYPES ; TYPE C- :TYPED -- PREVENTNESERVICES ~ BASIC SERVICES MAJOR SERVICES OF2THODONTICS • Oral F~cams Periapical X rays and Inlays/Onlays Orthodontic Diagnostics • Full Mouth X-Rays other X-rays Crowns Orthodontic Treatment • Bitewing X-Rays Bacteriological studies for Prefabricated Stainless • Prophylaxis/Cleaning determination of Steel and Resin Crowns • Fluoride Treatments pathological agents Pulp capping • Genetic test for Therapeutic Pulpotomy susceptibility to Putpal therapy oral disease Root canal treatment • Caries susceptibility tests AperdficatioN • Pulp vitality tests recelcification • Diagnostic casts Periodontics • Sealants Scaling 8 Root Planing • Space Maintainers Periodontal Surgery • Fillings RelineslRebases • Periodontal Maintenance Dentures • Emergency Palliative Repairs Treatment Bridges • Injections of Antibiotic Drugs Extractions • Oral Surgery • General Anesthesia • Consultations Effective 1/1/2007 a `: „ F+~`i/~. ~ lv ~ " b, ฐ + r ~~ ,i '=Wn4r~ ~ ~NS - ~ aw1w.- g evx 1 tSS.M 'w= JJ.. ~~ w.p .5 e..q } x ~"~Y ` ti t K q d mr m ~. Ci W t ..p _ Spectacle Fxam $5 off normal fee Contact P~(am ~.'zl•~8'r.Y.W ~i~ r ,uJ n' ~. a w. /x ~ ).r ~n $10 off normal fee .. :n,u Priced up to $60.99 Retail $25.00 Priced from $61.00 to $80.99 Retail $35.00 Priced from $81.00 to $100.99 Retail $45.00 Priced from $101.00 and over 65% of Retail '4~eisza' NaMCYadrrdl~hCOeided' "" ,"~ s "` _ ,• ~ ~ ~-r K , x ,r ~^ ,+ Single Vision $30.00 Bifocal $50.00 Trifocal $60.00 Lenticular $100.00 Lenses e c ial t y Sp 80% of Retail ~~ j{ ~~ yy~~ ~ ~ [ ': ~a6t18 ~}yf.!Dtl~` '~e'aSF~~ T+ ,k x.k~ xN ~... ..Y~y tE N(L d . ~460.~n N,.c GrviS YnN NNpt~ 'v~ n Standard -Progressive (no-line bifocal $50.00 Polycarbonate $30.00 Scratch Resistant Coatin $12.00 Anti-Reflective Coating $35.00 Ultraviolet Coating $12.00 Solid Tint $8.00 Gradient Tint $8.00 Photochromic $30.00 for non minors) o n l y G l a ss ( $15 00 ~~ ~ ~~ y ~~~~yy,~~ { ~ y~ ~ i a{,/YI~19MLLGri;1.Gi~ '•1' i l uJ, aaY/ ~ v:TG oN +ry+;' L: ~ ti i Non-Disposable 20% discount on regular retail prices Disposable *~/y'~ }/~~{~~M •~~'}~ M:' 4'T !+ T3' w ~~_.~ x. :.... mu. m mx 'v.,, ..:':.o'..r. R.W Vltte~a4F~,/.a13T" ..lr ., - rr l+ 10% discount on regular retail prices W { 9 d M+i 54 fi!k ... .rv. -r .. '~' vrnx _, x, ne .. '. ~ w.u•~=- u.~unr.n . ik.A-l m Non-Rx Sunglasses, accessories, etc. 20% Discount from regular retail prices ~~ Ap~ yy (~~ J. y~~t,e^ 6 nl'.,~"e.r~. Yq WjY \w.{ rcrrY a,~y F. :~~i~ r ~. n5rvv.. S.s x~ fi.ys' . ~~~ Il}~.'BV~ tiS~{YilaTia~'~trG/iS,~` F 9 ~ a r ~y r 7f{~lv..kjฃP N 45~ .ai}t ~pyFyJ~^~. V ii!('A rT5M`~~",y_ ,b"3~~a .Y /.~ -.m.~,u.a. yK+9 r~)F*„ 4~~.n ~Mw ~. .. C 3. t.. 'f ~ ~ - $499 to $600 er eye $25 per eye $601 to $700 per eye $35 er eye $701 to $900 er eye $50 per eye $901 to $1,100 per eye $75 per eye $1,101 to $1,300 per eye $125 per e e $1,301 to $1,500 per eye $200 per eye $1,501 to $1,800 per eye $250 per eye 1,801 to $2,000 er eye $350 per eye $2,001 to $2,200 er eye $400 per eye Over $2,200 per eye ii,w sa,nms chmvn above are basetl on conventional LFSIK orocetloree. Now procedures ere padodiwly ep $550 per e e prored fry tha FD0. NuYrcion NeMnrk Pmriden: may oRerthese treatments th you; however, your dismount may tb ditfinen[ bacetl on the new pnxedure. In all neat, the LASIK propnm indudec: i) ComprehensHe poctapeneve care Induoine tree ennancemenrc, rt naecea, ror one full year, ~ Reimburswnent for initial prescdpliai w posFOperstlve eye dregs, d prescribed by your sutpeon (exdudea arrRidal tears). TfAOP.) pF ~J Q~tLlfe Who can use the program? With the VisionSavings Eyecare Program', you and your dependents can receive discomrts on eyecare services and eyeweaz products at participating providers nationwideYou and your dependeMS can use the program as often as you need to. How do I use the VisionSavings Eyecare Program? Simply call a~ of the participating providers to schedule an appointment, Identify yourself as a VisionSavings Eyecare Program member when making an appointment. Present your idemification number to verify participation at the time of service. (Your identification number is 47234.) The provider will apply applicable discoums at the time of service. How do I locate a provider? You can locate a provider at www celemanaeedvision com/metlifevisionsavines. Simply enter the 5-digit ZIP code for the area you are interested in finding a location and select network locations for eye examinations, eyeweaz or both Maps aze available for each location by clicking on the underlined location name. You can also use your VisionSavings Eyecane Program at these participating optical retailersZ • Peazle Vision • Sears Optical • Tazget Optical • JCPenney Optical Center How do I get the LASII~ discount? Through the NuVision LASIK Network'TM you and your dependents can receive discotmts on the surgeon's lowest advertised price for LASIK surgery. The initial consultation is always flee of charge, even if you choose not to proceed with the LASIK surgery. To schedule a free evaluation with a participating NuVision LASIK NetworkTM^ surgeon in your area, call 1-888-705- 2020. Do my dependents have to visit the same provider that I seleMY No, you and your dependents each have the freedom to choose any participating provider. Can I get an eye examination from one provider and my glasses or contact lenses from another? Yes. You can get an eye examination from one provider and your glasses or comact lenses from another, unless you are afirst- titne contact lens wearer. In this case, you must purchase your new contacts from your exam provider and return for one or two follow-up visits to ensure your lenses are fitted properly. Some states do not require doctors to release your prescription for eyeglasses to you. Ask your exam provider before he or she performs the exam if he or she is willing to release your prescription. Can I order my contact lenses through the mail? Yes, if you have worn contact lenses before and have a current prescription. Simply call Contacts Direct at 800-987-LENS, and a representative will assist you with the ordering process. If you are afirst-time contact lens weazer, you must purchase your new contacts from your exam provider and return for one or two follow-up visits to ensnre that your lenses are fitted properly. Do I ~ to submit a Claim form? No, there are no claim forms to submit The discount is applied at time of service. r me VisionSeviogs Eyecare Program is offered by Cole Vision Corporatim (d/b/a Cole Mmeged Vision), Mason, Olio. Cole Vssion Coryomtiav is not affiliated with Metropolitan Life 7nnaaoce Company and its a1Lliatce. ~ Some retail locations may not pmtiupete inthe VisionSavings Eyecare Progrm. Please catl in edvmw. NuVision I 4SIKNetwmk"fM is a rcyislaed tredemazk ofNuVisioq Ivc, wlilch is not affiliated with Metopolitan Life Insurance Company and iss affiliates. Paaicipating provider an: ivdepmdent conVactms solety responsible fm visiฎ ezamimtions acct products. s Some Pearle Vivon franchises donot participate. na OA ~J of ~ KERR COUNTY DENTAL & VISION Proposals Presented by Don Wallace & Associates Effective: January 1, 2007 DENTAL Provider Annual Deductible Coinsurance % Ortho % Annual Max UCR Percentile Waiting Periods" Employee Monthly Premium Com Benefits $50 100/80/50 50 $1,000 90th $26.54 Com Benefits $50 100/80/50 None $1,000 90th $26.26 Alwa s Care $50 100/80/50 50 $1,000 90th 0/0/12/12 $31.56 Alwa s Care $50 100/80/50 None $1,000 90th 0/0112 $31.56 Dental Select $50 100/80!50 50 $1,000 90th 0/3/12/12 $24.64 Dental Select $50 100/80/50 None $1,000 90th 0/3/12 $24.64 Mutual of Omaha $50 100/80/50 50 $1,000 90th 0/0/12/12 $27.30 Mutual of Omaha $50 100/80!50 None $1,000 90th 0/6/12 $26.63 MetLife $50 100/80/50 50 $1,000 99th None $~3~2' zz MetLife $50 100/80/50 None $1,000 99th None 2z, Humana $50 100/80/50 50 $1,000 ? ? $24.34 'Waiting Periods: Preventive/Basic/Major/Ortho VISION Provider Copays Employee Monthly Premium Com Benefits $10/25 $6.58 Alwa scare Walmart $10/0 $8.09 MetLife o Discount No Cost rfr