4.1. SR 11-27-2000
.
City of ~
Elk
Item #4.1.
MEMORANDUM
TO:
Mayor & City Council ~
Lori Johnson, Finance Director ~
FROM:
DATE:
November 27, 2000
SUBJECT:
Review Medica Health Insurance Quote for Deductible Plan
.
During the employee benefits discussion, the Council asked for information
and rates for a deductible insurance plan for all non-union employees. This
option is being explored because Medica would not offer both a deductible
plan and a co-pay plan to our group. Medica has provided the rates for a
$200 deductible plan for all non-union employees. In order to proceed with
January 1 implementation of the cafeteria plan, a decision on health
insurance needs to be made on November 27.
Attached is a summary of benefits from Medica for the MCS200 ($200
deductible) plan. Also attached is a cost comparison that states the monthly
premium for each type of coverage and a comparison of the employee cost for
the deductible plan to the current plan as approved by the Council on
November 13.
Please review the Plan Information and Employee Premium Savings or (Cost)
sections of the cost comparison sheet. The only sizable employee savings in
changing to the MCS200 plan is for the employees who take select family
coverage (currently two employees). The remaining 36 employees who take
select will probably realize no savings after paying out of pocket costs.
Employees who take single elect would pay more for less coverage (currently
10 employees). In fact, the employees (currently 26) who take elect coverage
most likely would not realize any savings by changing to the deductible plan
because the out of pocket costs may far exceed the premium savings. Only the
two families covered under select may realize a real savings under the
deductible plan depending upon their actual out of pocket costs.
.
Finally, under the current contribution structure, the city will realize no
savings by changing to a deductible plan. The city's contribution would need
13065 Orono Parkway. P.O. Box 490. Elk River, MN 55330. TDD & Phone (763) 441-7420. Fax (763) 441-7425
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to be decreased to provide a savings to the city. If the Council approves a
change to the deductible plan, the Council may also want to review the city's
monthly contribution amounts.
Action Reauested
The Council is asked determine if the non-union employee health insurance
plan should change to the Medica MCS200 plan. If no change is made, the
benefits will remain as approved by the Council on November 13, 2000.
2000 Employee Health Insurance
Deductible Plan Cost Comparison
. Employee Employee
Council Plan Single & Spollse & Childn'!n ~
City Contribution 310.00 460.00 460.00 600.00
Life Insurance 4.63 4.63 4.63 4.63
Single Dental 21.67 21.67 21.67 21.67
Balance Avail. For 283.70 433.70 433.70 573.70
Health Insurance
Health Insurance
MCS200 231.33 463.80 412.18 767.81
Employee Contribution (52.37) 30.10 (21.52) 1 94.11
Annual City Cost 3,720.00 5,520.00 5,520.00 7,200.00
Annual Employee Cost (628.44) 361 .20 (258.24) 2,329.32
Plan Information
Deductible
Per Person 200.00 200.00 200.00 200.00
Per Family Max 400.00 400.00 400.00
Out of Pocket
Per Person 1,200.00 1,200.00 1,200.00 1,200.00
Per Family Max 2,400.00 5,000.00 5,000.00
Total Employee Risk 1,200.00 2,400.00 5,000.00 5,000.00
Employee Premium Savings or (Cost)
. Monthly
Elect (7.831 5.46 ,., , 16.06
Select 16.98 57.61 47.17 103.09
Annual
Elect (93.961 65.52 13.32 , 92.72
Select 203.76 691 .32 566.04 , ,237.08
Plan as Approved by City Council on November 13, 2000
Employee Employee
Council Plan Single & Spouse & Children ~
City Contribution 310.00 460.00 460.00 600.00
Life Insurance 4.63 4.63 4.63 4.63
Single Dental 21.67 21.67 21.67 21.67
Balance Avail. For 283.70 433.70 433.70 573.70
Health Insurance
Health Insurance
Elect 223.50 469.26 413.29 783.87
Employee Contribution (60.20) 35.56 (20.41) 210.17
Annual City Cost 3,720.00 5,520.00 5,520.00 7,200.00
Annual Employee Cost (722.40) 426.72 (244.92) 2,522.04
Select 248.31 521.41 459.35 870.90
Employee Contribution (35.39) 87.71 25.65 297.20
. Annual City Cost 3,720.00 5,520.00 5,520.00 7,200.00
Annual Employee Cost (424.68) 1,052.52 307.80 3,566.40
Hlthins:MCS200 Rates
FROM MINNESOTA INSURANCE
PHONE NO. : 7637807927
Partial Listing 'of
Covered Services
Lifetime Maximum Benefit
Out-of-Pocket
Maximum
Member
Family
Member
Family
In-Network Benefits
These benefits apply when services
are provided by networl<: providers
or for services authorized in advance
oy Medica Health Plans.
Unlimited.
$1200 per calendar year.
$5000 per calendar year.
$200.
$400.
When you receive covered services
after deductible has been satisfied,
Medica Health Plans PAYS:
100%. The deductible does not apply.
100%. The deductible does not apply.
100%. The deductib.le does not apply.
100%. The deductible does not apply.
100%. The deductible does not apply.
100%. The deductible does not apply.
100~~o. The deductible does not apply.
80%.
100%. The deductible does not apply.
80%.
80%.
80%.
80%.
80%.
100%. The deductible does not apply.
100%~ The deductible does not apply.
Nov. 17 2000 11:23AM Pi
Out-ot-Network Beneiitsh
These benefits apply when
services are lJrovided by
llorl-networl< providtlr",.
$1,000,000.
$3000 per c~Jendar year.
--.....-.-
Does not apply.
$400 per calendar year.
--', ..---..'.
$800 per calandar year.
.....--
When you receive covered services
atter deductible has been satisfied.
Medica Insurance C?~~ny PAYS:
No coveragi;.
70%~
70%~
70%~
70%~
No coverage.
70%~
70%~
70%~
70%~
70%: limited to 120 days per
member. per calendar year for
all inpatient services combined.
70%~
70%~
70%:
70%:
70%:
80%. See below.
80%. See below.
80%. See below.
80% after In-Network deductible has been satisfied.
100%. The deductible does not apply.
70%:
100%. The de~uctible does not apply. 70%~
80%. 70%:' Liniited to 120 days per
member, per calendar year for
all inpatient services combined.
· Postnatal services ~%. ~~~c.tib~e do~~ot ~PPL...!9.o(~.:,.. __.. _. _. ~...,_,_ ___. ''._____
"Coverage is limited to the non-network provider reimbursement amount (as defined in your Certificate of Coverage) after
deductible is met.
"'It you decide to utilize your Out-at-Network Benefits, you may pay more man you would for In-NetworK Benefits.
The amount you pay could include a percentage coinsurance. a fIXed dollar copayment and/or deductible amounts. In
addition, if the amount that your non-network provider bills you is more than the non-netwoi"k provider reimbursement
amollnt (as defined in your Certificate of Coverage), you are responsible for paVing the difference, and such difference
will not be applied toward the Out-ot-Pocket Maximum.
Deductible
PREVENTIVE CARE RECEIVED IN
THE PHYSICIAN'S OFFICE OR
HOSPITAL
· Routine physical exams
· Immunizations
· Well child care
· Mammograms
· Pap smears
· Routine eye exams
· Allergy shots
SERVICES RECEIVED IN THE
PHYSICIAN'S OFFICE
. Office visits for illness Qr injury
· Lab and x-ray
· Surgical services
SERVICES RECEIVED IN A HOSPITAL
OR SURGICENTER
· Inpatient hospital
Facility
Physician
· Outpatient hospital
Facility
Physician surgical
· Lab & x-ray
Facility
Physician
......--.--
URGENT OR EMERGENCY CARE
· Urgent care center
· Hospital emergency room
~ Emergency ambulance
EMERGENCY SERVICES FROM
NON.NETWORK PROVIDERS
MATERNITY CARE RECEIVED IN THE
PHYSICIAN'S OFFICE OR HOSPITAL
· Prenatal services
· Delivery services
. Physician
Hospital
FROM : MINNESOTR INSURRNCE
PHONE NO.
Partial listing at
COld Services
-,
In-Network Benefits
These benefits apply when services
are provided by network providers
or lor services authorized in advance
by Medica Health Plans.
When you receive covered services
after deductible has been satisfied,
Medica Health Plans PAYS:
U!J ii' ;1 31-day .~uppLy for medit..'auoru
n:c:fti~d ac a nCDWOTk ph:LTTI1I1CY.
100% after $11 copayment per pre-
scription or refill for medi-
cations dispensed according
to Medica's formulary.
The deductible.cloes not apply.
100% after a $26 co payment per pre-
scriptlQn or refill for medications
not on Medica's formulary.
The'deductible does not apply.
('..tall mUSt be provi&d by a Mu1i=<.lesignau:d
mcmral hedch prO'llider. IOU mUSl receive
auth.:)ri~ from M..dU-.as d.esip;rlLlretl mental
~aM: prooid....,. {lliCJf' ra reci!lumg SG"l'viCdS.
100% after 20% coinsurance for
individual therapy or 1 Q'l/o
coinsurance for group therapy.
The deductible does not apply.
80%.
PRESCRIPTION MEDICATIONS
RECEIVED AT A PHARMACY
MENTAL HEALTH CARE
· Outpatient services
· Inpatient services
~ABUSE CARE
. Care mtcSl be providd by a Medic;~.;ignaletl
~ubsratlCc abu.s;: prouider, YOk mL<.~r receiue
aurllCrb:l.rian fr(1m.1v1edica 's i:k~ignared sub-
S1aI'1Ll: ~e pro~ider prior to receiving $ervices.
100% after 20% coinsurance for
individual therapy or 10%
coinsurance tor group therapy.
The deductible does not apply.
80%.
· Outpatient services
· Inpatient services
fHABJllTATIVE THERAPY RECEIVED
IlllE PROVIDERS OFFICE OR HOSPITAL
· Pbys\cal Ulerapy
· Occupational therapy
· Speech therapy
URABLE MEDICAL EQUIPMENT
80%.
80%_
80%.
80%.
763781217927
Nov. 17 2121121121 11:24RM P2
Out-ot-Network Benefits**
These benefits apply when
services are provided by
non-network providers.
When you receive covered services
after deductible has been satisfied
Medica Insurance Company PAYS:'
LJ /J !ll a J 1 :dt.lJI .~t<ppLy fen mc:d.ic:arior~
TE:c:eiVI'.t1 al" T1on-1lIUUr01lc pJw.TmIJi.::y.
60%~ Member pays the greater
of 40% or a $26 copayment.
70%:
70%~ limited to 120 days per
member. per calendar year for
all inpatient services cOlT1bined.
70% ~
70%7 Limited to 120 days per '
member, per calendar year for
all inpatient services combined.
700/0~
70%~
70%~
70% ~
HlROPRACTIC CARE 80%_ 70%~ Limited to 15 visits per member.
per calendar year.
Jverage is limited to the non-network provider reimbursement amount (as defined in your Certificate of Coverage) after
~ductible is met. .
you decide to utilize your Out-of-Network Benefits, you may pay more than you would for In-Network Benefits.
1e amount you pay coultl include a percentage coinsurance, a fixed dollar copayment and/or deductible amounts. In
ldition. if the amount that your non-network provider bills you is more than the non-network provider reimbursement
nourTt (as defined in your Certificate of Coverage), you are responsible for paying the difference, and such difference
ill not be applied toward the Out-of-Pocket Maximum. .
.
\'t; THIS HEALTH CARE PWI MAY NOT COVER ALL TOUR IlEiLTH CAR. ExpeNses; REAIl YOUR CONTRACT CAIlEFULLY TO OmRMlNE WHICH EXPENses ARE COVERED.
s is 3 bene/II summary only. and doe; nal oulline all QI YOIII DanelllS. WRen you enroll wUh Medica InsuraRce Company (MIC1, you will fICeiv. a CallhJ...le 01 CoveraPI.
Ie" is a discrepancy petween Inlnrmatian in Ibis 5ummarv and your Cellilleale 01 Coverage, Tile Certlli~le .f CoveraQe will taka prac:adence in determininQ your ~enellls.
Ila.c1 ClIstalller SalVlea el ~Z.g45-8DDD (Mpl!./SI. P'auJ metro ~rea). 952-992.3190 (MPIs./SI. Paul malro 3lIa memoers wilh hl..ina imaeirments). 800-952-3456 (oulsial
.PIS'/~I. !';Jut metro areal. or 8Oo-a41.Gl53 (oulslde of Mpla.lSt. hul melro area lIIembc~ "ilh hlaring imoaillR8IIliJ lor more IlIIlllmaJion III' a/I$W81S fa speellle quesUaos.