R08-099
, I I
I
2 RESOLUTION NO. R08- Oq 9
3
4
5 I A RESOLUTION OF THE CITY COMMISSION OF
6: BOYNTON BEACH, FLORIDA, AUTHORIZING THE
7 CITY MANAGER TO EXECUTE A LETTER OF
8 I INTENT WITH BLUE CROSS/BLUE SHIELD OF
9 FLORIDA, TO PROVIDE VOLUNTARY FULL Y-
10 INSURED BLUE MEDICARE HMO AND PRIV A TE-FEE-
II FOR-SERVICE EMPLOYER GROUP WAIVER PLANS
12 TO REIREES OF THE CITY; AND PROVIDING AN
13 EFFECTIVE DATE.
14
15
16 WHEREAS, currently Medicare eligible retirees only have the option of remaining
17 on the City's medical plan by paying 100% of the premium. The BlueMedicare Plans HMO
18 and Private-Fee-for-Service are alternative plans for Medicare eligible retirees that provide
19 excellent benefits to retirees at a reduced cost.
20 NOW, THEREFORE, BE IT RESOLVED BY THE CITY COMMISSION OF
21 THE CITY OF BOYNTON BEACH, FLORIDA, THAT:
22 Section 1. The foregoing "Whereas" clauses are hereby ratified and confirmed
23 as being true and correct and are hereby made a specific part of this Resolution upon adoption
24 hereof.
25 Section 2. Upon recommendation of staff, the City Commission of the City of
26 Boynton Beach, Florida does hereby approve and authorize the City Manager to execute a
27 Letter of Intent with Blue Cross/Blue Shield of Florida to provide voluntary fully-insured
28 BlueMedicare HMO and Private-Fee-for-Service Employer Group Waiver Plans to the
29 retirees of the City, a copy of which is attached hereto as Exhibit "A" .
30 Section 3. That this Resolution shall become effective immediately upon passage.
S:\CA \RESO\Agreements\BCBS Retirees.doc
- I -
H .
I PASSED AND ADOPTED this dUb day of September, 2008.
2
3 CITY OF BOYNTON BEACH, FLORIDA
4 ~~iJf(.?~
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6
#yor - Je ay
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14
]5 Commissioner - Woodrow
16 - i f
'7 '.~
17 - I' "7~; ~.. /'. ?~_
18 Commissioner - Marlene Ross
]9
20 ATTEST:
21
22 m. ~
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S:\CA \RESO\Agreements\BCBS Retirees.doc
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101-of1
LETTER OF INTENT
-;U08
THIS LEITER OF INTENT is made on the ~ day of Se&... by and between by and among Blue
Cross Blue Shield of Florida, a Florida non-profit corporation, ("B BSF"), having a principal place of business
at 4800 Deerwood Campus Parkway, Jacksonville, Florida 32246 (hereinafter called "BCBSF")and The City of
Boynton Beach, a Florida municipality duly organized and existing under the laws of the state of Florida,
having a principal place of business at 100 East Boynton Beach Boulevard, Boynton Beach, Florida, 33425
(hereinafter called the "City").
BACKGROUND
In accordance with the terms of this Letter ofIntent, The City has chosen to offer and BCBSF has agreed to
provide a voluntary fully-insured BlueMedicare Employer Group Waiver Plan (EGWP) to the retirees of the
City in exchange for the premiums described herein. This Letter ofIntent, sets forth the basic terms upon which
the parties have agreed.
NOW, THEREFORE, the parties agree as follows:
1. The City has chosen to offer to its group retirees voluntary fully-insured BlueMedicare EGWPs for
which the Summary of Benefits have been attached hereto as Exhibit 1.
2. BCBSF and City agree that this BlueMedicare group plan shall be subject to the terms and conditions of
the BlueMedicare Group Master policy attached hereto as Exhibit 2 as a separate document.
3. The term of this Group Plan shall begin on October 1, 2008 and shall run until the annual enrollment of
September 30,2009 unless sooner terminated in accordance with the provisions ofthe Group Master
policy attached hereto.
4. The specific Covered Services, Exclusions and Limitations, and eligibility terms are covered in a
separate benefit booklets that BCBSF shall issue to retirees and/or their dependents who choose to enroll
in the BlueMedicare EGWPs.
IN WITNESS WHEREOF, the parties hereto have executed this Letter ofIntent by their respective officers
thereunto duly authorized, as of the date hereinabove written. This Letter of Intent may be executed in
counterpart and all of such counterparts taken together shall be deemed to constitute one and the same
instrument
Se~\-. ~ J Qa..<:::>o<6
City of Boynton Beach Date
KURT BRESSNER
CITY MANAGER
BOYNTON BEACH, Fl
Jane Tuten, Vice-President Date
BlueCross BlueShield of Florida
APPROYEDW'(r
f) '\ L
CITY ATTORNEY
I Exhibit 1 I
.Q~~
~ 0 of FlorIda
M..........~_
· · ..GIIIMI.....~ -
City of Boynton Beach
2008 BlueMedicare Group HMO* Health Benefits
Benefits BlueMedicare Group HMO
Premium $ 330.25 (includes Custom Rx)
Deductible N/A
Out-of Pocket Max N/A
~i8tliet
Primary Care (per visit) $5
Specialist Care (per visit) $10
Podiatry Services $10
(Routine foot care up to 6 visits per year)
Chiropractic Services $10
For each Medicare covered visit (manual
Manipulation of the spine to correct
Subluxation)
Outpatient Mental Health Care (per visit) $10
For individual or group therapy
Outpatient Substance Abuse Care (per visit) $10
Part B drugs $5/1 0 office visit
No charge for injection
Allergy Injections $5
Otbet'Sen4Ces
Outpatient Surgery $200 for each outpatient hospital facility visit.
$100 for each visit to an ambulatory surgical
center.
$0 for Physician Services
Diagnostic Tests, X-Rays and Lab Services $0
(Office or free standing) *Office visit copay may apply
Outpatient hospital $75
Diagnostic Tests, X-Rays and Lab Services
Excluding Mammograms
Urgently Needed Care $10 for each visit.
(This is not emergency care, and in most cases, is
out of the service area.)
Benefits BlueMedicare Group HMO
Emergency Services $50
Worldwide coverage.
Dental $10
Medicare approved
Home Health $0
Ambulance $100 for Medicare covered ambulance services
Outpatient Mediad Setrict!s ...d SupPlies
Durable Medical Equipment $500
Electric customized wheelchairs, electric scooters
All other Medicare-covered items $0
Prosthetic Devices $0 for Medicare covered items
Outpatient Rehabilitation (Free Standing: $20
Services (per visit)
Occupational Therapy
Physical Therapy
Speech and Language Therapy
Cardiac Rehab
Outpatient Rehabilitation (Outpatient Hospital: $50
Services (per visit)
Occupational Therapy
Physical Therapy
Speech and Language Therapy
Cardiac Rehab
Renal Dialysis $0
Inpatieat Care
Inpatient Hospital Care $100 per day (1-5 days)/
(includes Substance Abuse and Rehabilitation $0 per day (6-90 days) for a Medicare-covered
Services) stay in a network hospital
Inpatient Mental Health Care $100 per day (1-5 days)/
(may also include Substance Abuse and $0 per day (6-90 days) for a Medicare-covered
Rehabilitation Services) stay in a network
190-day lifetime limit in a psychiatric hospital.
Skilled Nursing Facility (in a Medicare-certified $0 (days 1-20).
skilled nursing facility) $75 (days 21-100)
There is a limit of 100 days for each benefit
period.
3-day prior hospital stay is not required.
Hospice Member must receive care from a Medicare-
certified hospice
-
Benefits BlueMedicare Group HMO
Preveative Servkes
Annual Screening - Mammograms (for women $0 for Medicare-covered Screening
with Medicare age 40 and older) Mammogram
$0 for each additional screening - You are
covered for an unlimited number of Screening
Mammograms
Pap Smears and Pelvic Exams (for women with $0 per Pap smear.
Medicare) $0 per pelvic exam.
$0 for each additional screening - You are
covered for an unlimited number of Pap
Smears and Pelvic Exams
Bone Mass Measurement (for people with $0 for each Medicare-covered Bone Mass
Medicare who are at risk) Measurement
Colorectal Screening Exams (for people with $0 for Medicare-covered Colorectal screening
Medicare age 50 and older) exam
$0 for each additional screening - You are
covered for an unlimited number of Colorectal
Screening Exams.
Prostate Cancer Screening Exams (for men with $0 for Medicare-covered Prostate Cancer
Medicare age 50 and older) Screening exams. You are covered for an
unlimited number of Prostate Cancer
Screening exams.
Diabetic Supplies $0
. Medicare Part B- the premium provided under this proposal excludes the Medicare Part B
premium payments
. Plan Eligibility - The rates provided are applicable to Medicare-eligible retirees and Medicare
eligible dependents that enroll in BCBSF's Medicare Advantage or Medicare Prescription Drug
plans.
. Part D Creditable Coverage - The enrolling member may incur late enrollment penalties as
defined and set by CMS in accordance with Part D guidelines if prior creditable coverage cannot
be proven.
..~ Q BIueCmuB"'~
ip U of FlorIda
. . :.":===--=-
City of Boynton Beach
2008 BlueMedicare Group Private-Fee-for-Service*
Health Benefits
r Members can see any Medicare provider that acceptS' Medicare-payment and accepts the terms and
. conditions for payment of BCBSF. H a doctor or hospital does not agree to accept our payment terms
and conditions, th should not rovide healthcare services to you except in emergencies.
Benefits BlueMedicare Group PFFS* Plan 1
__ ________________.___________,_._ "_.'~_'U ____.. _______._____._.______
Premium $340.08 (includes Custom Rx)
~--_.__.~~---~----_.._~--------_.,,_. ~_. - - - ... - -. --.. --.------.....---.---.. .--..--..-.--..-.. ._-
Deductible NA
____..~___...____...__n.._ _. _...._ _..___________ __.___
Out-of Pocket Max $2,000 all plan services
_._-_.__._-~---_.-..._.__..__.._.._... .. -"---'
Physician Office
-..--- ---------..-----..----. -_..__._----_.,._~_.--,
Primary Care (per visit) $10
-- -- ---. ---.--..-..----,.- -- ------.- --.--..-.--...-.----.--.---- --<--.... .--._--
Specialist Care (per visit) $25
.__' __._.__.____... ___..._.,. n_._ _ ______". _______~_,_______.__
Podiatry Services (per visit) $25
(Routine foot care up to 6 visits per year)
_._u.____ .._______...____._.__.__________.._ _..... .._.u_.__..._.__.._.___ ____ _ _____ ._____ __
Chiropractic Services (per visit) $25
For each Medicare covered visit (manual
manipulation of the spine to correct
subluxation)
__________.__.___.__._.__..._ ________________ ____ _ ._.._.____..__.._. ___ _______m_ _ .. _.._. .. _. ...__.._. ._...._........._ ___. __________.__. ..__ ._.~.. __ ___.__ __ _ .__
Outpatient Mental Health Care (per visit) $25
For individual or group therapy
----.. ----..-. -...".. -----..--...---.--" --~-----------------_.~----~---_._-----------_.__...----~.-_..__._-~.-
Outpatient Substance Abuse Care (per visit) $25
------.-...--..----.--.." - - --- -- -- ---'--"-."-'-'---'-'--'--"'---' -- --..- --' -- -
Part B drugs $10/$25 office visit
$0 for injection
- .-.--.--'--'- .---- ..-.... -.-....--.-..---------.
Allergy Injections $5
-.---..--.----------.----.--.------...-----..
Other Services
-------_._~._._---- .---.... -. ---- - ----_._--_._~._--_...-_...-_..>
Outpatient Surgery $200 for each outpatient hospital facility visit
$100 for each visit to an ambulatory surgical center
-.'- -- .----- -~- -.- --.. - -- -.. ~ --~
Diagnostic Tests, X-Rays and Lab Services $0
(Office or free standing) ! Office visit copay may apply
-------~.--_.._--.-
Outpatient hospital- Diagnostic Tests, X-Rays $75
and Lab Services
(Excluding Mammograms)
----..-. '~-''''-. -'- ---- -- '-.---..---
Urgently Needed Care $25
(This is not emergency care, and in most cases Worldwide coverage
is out of the service area.)
--~-------_.. "--,,. -.- -- ~..- - --. ~---------_._._.-
- ----
I Members can see any Medicare provider that accepts Medicare payment and accepts the terms and
I conditions for payment of BCBSF. H a doctor or hospital does not agree to accept our payment terms
and conditions, th should not rovide heaIthcare services to ou exce t in eme enc:ies.
Benefits BlueMedicare Group PFFS* Plan 1
-->. ~--_... ---....-.------..-
Emergency Services $50
Worldwide coverage
- ~-_.~--- .- --"-'--" .---.-
Dental- Medicare approved (No Preventive) $25
--.....-..----...-- -- --- --- . -....-.-------..-- ---.- ----.. -- ----_..,,~.._-----_..._-~ '-'-'.
Home Health $0
, , - --..-.-.-...--------- n. ._._._..10- .....- ...-.. ------_..-._..__._--.-._.._----_._~_..- - .--- --.. -_..._-~- ------
Ambulance ; $100 for Medicare covered ambulance services
Outpatient Medical Services and Supplies =]-~, ~,-_=u
Durable Medical Equipment
Electric customized wheelchairs, electric i $500
scooters
All other Medicare-covered items $0
.-----...-..----...----..----------.- - --..--..-----------.------ --.-------.- ---. --.--------,
Prosthetic Devices ! $0 for Medicare covered items
_ _ _____.... ____..________.__._ _ ____._.___.______......_._~..._....." __.._._ ~'_ __ ___...___.~__._...._.J
Outpatient Rehabilitation - Freestanding $25 (per visit)
Facility Services:
. Occupational Therapy
. Physical Therapy
. Speech and Language Therapy
. Cardiac Rehab
~, --- ---...-...--.---------.
Outpatient Rehabilitation - Outpatient Hospital $50 (per visit)
Services:
. Occupational Therapy
. Physical Therapy
. Speech and Language Therapy
. Cardiac Rehab
.-- .-.----- __.._.______n____._________ _. ..__ __ "_. __._.__....____.__..___ _._.>_._____ ... ._._.__ ___ '._.~_. .~______~__..___.
Renal Dialysis ! $0
- - --- --~--~- ... ----......-....-..-. --.--.-r.-----.- ---.--------.------- __n_._..___,,_ -------~._-_....._- ...-- .-------.-...------
Inpatient Care i I
---.---.-.-....-...-....------.- ---1-- --~_.__..-
Inpatient Hospital Care ' $150 each day for day(s) 1-5
(includes Substance Abuse and Rehabilitation for a Medicare-covered stay
Services)
__.. ___..n_..___..__.m_..______..
Inpatient Mental Health Care $150 each day for day(s) 1-5
(may also include Substance Abuse and for a Medicare-covered stay
Rehabilitation Services) 190-day lifetime limit in a psychiatric hospital
__u._______.__._. -- .
Skilled Nursing Facility $0 (days 1-6)
(in a Medicare-certified skilled nursing facility) $100 (days 7-25)
$0 (days 26-100)
There is a limit of 100 days for each benefit period
3-day prior hospital stay is not required
..--... -_.._----------"' ---.--- ----- --... ---
: Members can see any Medicare provider that accepts Medicare payment and accepts the terms and
I conditions for payment of BCBSF. H a doctor or hospital does not agree to accept our payment terms
I and conditions, they should not provide heaIthcare services to you except in emergencies.
I Benefits C BlueMedicare Group PFFS* Plan 1
L__~___..___._.___~______",...______. .- -------.-.' .-.--.. ----.-..---.-~--.--,-.- .----------------
i Hospice ! Member must receive care from a Medicare- certified
i hospice
.- .--.----..-.--,,-- ------------- -~~J--~ _m_ _ _~ _ _ _ __ ~~..,.."_ ._.___.,~._.___...
- .--.-.---.----- -._,-,._,--.._-,.~..,._,-".,-------_._- ----~ -----
Annual Screening Mammograms ! $0 for Medicare-covered Screening Mammogram
(~o~,wotne_~~!~~,_~~~~~~e_~e 4~_~d o!~e~)_ _,J$O for each additional_~~~e~~in_g, _
Pap Smears and Pelvic Exams ! $0 per Pap smear
(for women with Medicare) I $0 per pelvic exam
I $0 for each additional screening
-....- -- - - - t ..-- - ------,,- --- -.- .,.
Bone Mass Measurement i $0 for each Medicare-covered Bone Mass Measurement
(for people with Medicare who are at risk)
T
Colorectal Screening Exams I $0 for Medicare-covered Colorectal screening exam
(for people with Medicare age 50 and older) 1 $0 for each additional_~c~~~~i~._.. __ __. ____________,_.
-- - "--- ---.-.
Prostate Cancer Screening Exams ! $0 for Medicare-covered Prostate Cancer Screening
(for men with Medicare age 50 and older) 1 exams
- --------
* BlueMedicare Group PFFS out-of-pocket maximum includes all covered health services member cost-share
on a calendar year basis. Rx costs are not applied to the out-of-pocket maximum.
* Payment for services under this plan is based on the Medicare Allowed Amount minus the member cost-
share.
* Medicare Part B - The premium provided under this plan excludes the Medicare Part B premium payments.
(Members must continue to pay the Medicare Part B premium.)
*Blue Medicare Group Private-Fee-for-Service is a Medicare Advantage contract approved by the Centers for
Medicare & Medicaid Services. BCBSF contracts with the federal government to administer BlueMedicare
Group Private-Fee-for-Service in the state of Florida. These contracts are renewed annually, and availability
beyond the end of the current contract year is not guaranteed.
.Q ~Bh_
lit 0 of FlorIda
. . :.-===--=-
City of Boynton Beach
2008 BlueMedicare Group Rx *
I
Deductible $0
,~ ~-
Tier 1 - Generics $5.00
Tier 2 - Preferred Brand $15.00
Tier 3 - Non-Preferred Brand $30.00
Tier 4 - Specialty drugs $30.00
Mail Order 2x normal co-pay for 90-cial'mailorder medications
Formulary Type Added coverage for selected CMS excluded drugs.
Generic & multi-source brand prescription drugs will be
covered for the following categories:
. Cough
. Cold
. Barbiturates
. Benzodiazepines
Gap Tier 1 - Generics $5.00
- -.-
, Gap Tier 2 - Preferred, B~~,!c! $15.00
Gap Tier 3 - Non-Preferred Brand $30.00
Gap Tier 4 - Specialty drugs $30.00
Catastrophic Standard $2.25/$5.60/5%
. Prescription drug copays do not accumulate towards the health plan calendar year maximum out-of-
pocket.
. Part D Creditable Coverage - The enrolling member may incur late enrollment penalties as defined and
set by CMS in accordance with Part D guidelines if prior creditable coverage cannot be proven.
*Blue Cross and Blue Shield of Florida contracts with the federal government to administer BlueMedicare Rx,
the Medicare Part D Prescription Drug benefit, in the state of Florida. This contract is renewed annually, and
availability beyond the end of the current contract year is not guaranteed.
CITY CLERK'S OFFICE
MEMORANDUM
TO: Sharyn Goebelt
Director, Human Resources
FROM: Janet M. Prainito
City Clerk
DATE: September 8, 2008
RE: ROS-09g Letter of Intent with Blue Cross/Blue Shield of Florida
Attached is a copy of the above mentioned resolution and the partially executed Letter of
Intent. Once the document has been fully executed, please return original document to
the City Clerk's Office for Central File
(r,m. p~~
,- -'
Attachment (2)
CC: Central Files & Followup
s:\CC\WP\AFTER COMMISSION\Departmental Transmittals\2008\Sharyn Goebelt-R08-099.doc