7.7. SR 06-27-1994
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ITEM 7.7.
MEMORANDUM
FROM:
MAYOR & CITY COUNCIL \
LORI JOHNSON, FINANCE DIRECTOR "'yYI'J
TO:
DATE:
JUNE 23, 1994
SUBJECT: UPDATE ON EMPLOYEE HEALTH
INSURANCE
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The City's current health coverage contract through HealthPartners (Group
Health) is up for renewal on August 1, 1994. HealthPartners has indicated
that the City's insurance rates will increase 36% on August 1, 1994.
Unfortunately, HealthPartners did not provide that information to the City
until Tuesday, June 14. I had requested that the information be provided in
early May so that the City would have adequate time to re-bid the contract or
to explore other options available for providing employee insurance benefits.
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There are several attachments to this memo which better explain the health
insurance issue. The first attachment shows the monthly insurance
premiums for January 1, 1993, through the proposed August 1, 1994,
increase. The new rates proposed by Health Partners are $215.93 for single
coverage and $683.64 for family coverage. This is an increase of 53% above
the premiums paid on January 1, 1993. However, more importantly for the
employees electing family coverage, the employee share of the insurance cost
has gone from $211.06 per month to $431.52 per month or an increase of
104%. Starting with the July 14 paycheck, employees with family coverage
will pay an additional $90.29 per paycheck. This information was conveyed
to employees during employee meetings on Monday, June 20. Employees of
course were concerned about the issue, especially those electing family
coverage who will again see a decrease in pay due to the substantial
insurance premium increase. Employees electing family coverage are in
favor a changing to a 80/20 plan with co-pays in order to reduce premiums.
However, employees electing single coverage are not as eager to make a
change due to the fact that they would then have out-of-pocket costs. We
currently have 39 employees electing single coverage and 17 employees
electing family coverage. Those numbers include a total of 14 employees in
the police union, of which four elect family coverage.
P.O. Box 490 · 13065 Orono Parkway · Elk River, MN 55330 · (612) 441-7420 · Fax: (612) 441-7425
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At the employee meetings, the employees were updated on what has been
done so far in order to address this issue. In addition, some employee options
and Council options were discussed. The second attachment highlights the
options that were discussed. Some Councilmembers may recall that some of
these issues such as a cafeteria plan, reimbursement for insurance provided
by a spouse, and other requests have come before the Council previously. To
this date, the Council has not agreed to providing any of those options. This
is an appropriate time for the Council to review the options available to help
employees deal with an issue which is, for the most part, out of their control.
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In addition, to give the Council some background information on what other
cities are doing in regard to health insurance, several cities were surveyed.
The third attachment to this memo, entitled Health Care Coverage
Comparison, shows the results of this survey. For the most part, employees
electing single coverage are not required to make any contribution for health
insurance. The highest employee contribution for family coverage, excluding
the City of Elk River, is $208.35 in Blaine for their Med Center plan. The
city contribution for family coverage ranges from $230.00 in Coon Rapids to
$415.36 in St. Cloud. The City of Elk River currently contributes $280.00 for
health, life, and dental insurance. After subtracting the dental and life
insurance premiums, $252.12 are available for health insurance. The final
column of the comparison indicates whether or not the city offers a cafeteria
plan or other insurance options. Brooklyn Park, Coon Rapids, and Ramsey
have cafeteria plans whereby each employee receives the equivalent dollar
amount each month to be used on a given package of items. Champlin allows
reimbursement in cash to employees if they prove that they have health and
dental coverage elsewhere. Fridley allows employees not using their
maximum amount to apply the difference toward dental and life insurance,
and Maple Grove has a unique program whereby it pays $25.00 per month as
a match into deferred comp for employees not electing family coverage if they
choose not to purchase supplemental life insurance or use it as a pre-tax item
for medical expenses.
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Finally, state law requires that insurance for groups in excess of 25 members
be competitively bid. An ad will be in the Star News on June 29 requesting
quotes for the City's group health insurance. Bids will be received until July
19. At that time, bids will be reviewed and additional information will be
presented to the Council. In the meantime, an insurance advisory committee
may be formed which would have representation from each department and
include a cross-section of both family and single coverage employees. This
advisory committee would assist by reviewing the bids and identifying
possible alternatives for insurance benefits. The advisory committee would
also be responsible for relaying information back to its department and
voicing the opinion of the employees. Of course any change in benefits for
union employees would need to be approved by a majority vote of the union
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members and approved by the City Council. The union representative and
several union members have met with City staff regarding this insurance
issue and it is anticipated that the union will work with the City to provide
cost effective insurance to its members.
In conclusion, I have highlighted some of the major issues related to
employee insurance. I will be available at Monday's Council meeting to
update the Council in more detail and answer any questions you may have.
In the meantime, if you do have any questions, comments, or suggestions,
please contact me.
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1994 EMPLOYEE HEALTH INSURANCE
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WHAT HAS BEEN DONE SO FAR?
=> Worked with HealthPartners (Group Health) to allow two plans so employees could choose
comprehensive coverage or co-pays and 80/20. Our request was denied because our group is too
small.
=> Requested that HealthPartners quote their standard plan which would cover only "in-network"
services; the premium would be five percent less than the current.
=> Requested that HealthPartners quote their 80/20 plan which would be approximately 10 percent less
than the current.
=> Requested that PEIP (Public Employees Insurance Plan) provide a quote. Rates and coverage
information were received and made available to employees. Premiums are lower than current, the
coverage is not as good, the networks are not as large and a two year commitment is required (if the
premium increase exceeds 50 percent, you can get out of the second year; if the increase is less than
50 percent, you can not get out of the contract).
=> Asked Medica if they would be interested in providing insurance for our group.
=> There have been previous discussions with the Council regarding cafeteria plans, the City
contribution to family coverage and a request for reimbursement if insurance is provided through a
spouse's insurance.
EMPLOYEE OPTIONS
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=> Pay the higher premium. Employees with family coverage will pay $215.29 per paycheck for
insurance starting with the July 14, 1994, paycheck. This is an increase of $90.29 in the per
paycheck deduction. Because of the late receipt of the premium increase notice and the bidding
requirements, the increase will be deducted from the July 14 paycheck and a refund will be made later
if a change in coverage is approved.
=> Change to single coverage and obtain family coverage through spouse or elsewhere if available.
=> Agree to change to a plan with co-pays and deductibles in order to reduce premiums.
EMPLOYER OPTIONS
=> Approve HealthPartners contract effective August 1, 1994, and make no changes to the employee
insurance benefit package.
=> Increase the City contribution to health, dental, and life insurance. (Currently $280.00.)
=> Time the increase in the City contribution so that it coordinates with the Premium increase instead of
January 1 when it gets lost with pay increases, withholding tax changes and payment for unused
compensatory time. It would be easier for employees to see the increased City contribution if it
directly offset a premium increase. (A one time adjustment would need to be made in 1994 or 1995
to change the timing of the increase.)
=> Implement a cafeteria plan.
=> Change coverage to a co-pay plan with deductibles.
=> Allow dental coverage as an option so employees could apply those dollars to health insurance
instead. (This would require a change in our dental contract.)
=> Reimburse employees the amount paid for single insurance coverage under the City's plan if an
employee is covered elsewhere and proof of insurance is provided.
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"I1YSIClAN SERVICES
'.If,e,.;,;"
!-'r ar.: indudjn~:
Rourin~ krttninp
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ldEDlCAPREMIER
612f94S-8000
Tier I Servj,ccs
(s,r";mrf'(rl,,,Jfr,,,,,p,.,rtrttJ
J, ,.", /in,p".,,'d ,m,..,ry (Iut
,u.ie}
SIOcof".1Y
100%
T,~, 2s.c.",icc.l
(!wTvim ,"",.,t! jrP"I (I' 'i'm~
~.Kif-nifm4/~~.n,~~~)
s:!s cop..y
100%
~
~
FORI1SJPREFERREDl
6121138-5600
Authoriud Scrvicq
(f.t.""Ul1 'tin,.,.ti film., .,mo,,'
by .r-'" ',J1f'W"J /'rrfnmlJ
~ r~~')' tlIft dlnir)
~~ 0 (opay
IOO~u
RoUlin~ ph~ic.al
cum,
I'rn<c'Rlivc eye and
hearin(t c:u.ms
Immuni:r.:uions
\X'dl child cue
Pre and posmau.l
tnatc:rniry care:
Deliverylsu'lC'f)' (physician
ch"'l!')
Outpatimt (wnc da)') su1Jc'1)'
Ur~cnr Care
Outpatient menw health
Ourparic'ft( chemical
d<p<nd<nq
OliropBCtic care
Physical. speech. oc.cupational
thccapy ,
I Home hc:aJth care
100%
100%
100%
100%
100%
90%
90% sdeaed outpatient
w,@:et}'
510 copay
S 1 0 corny per indo hour or S5
copay pcr group hour; 40
hours pc' member per rear
SIO copay pcr indo hour or S5
copay pet IrouP hour; 20 viiiu
pcr member per year
SIO """Y
SIO col"Y
) 00%; alternative to hospicaJ
confinement; 90% wiled care
in.home
100%
100%
100%
100%
100%
80%
80% ~1C'Ctcd ourp2liC'nt
sUIJcI')'
S25 cora"
$10 copay p" incl. hour or SS
copa)' per ,:roup hour. 40
houn pcr mC'm~r per )'nf
SID COp:lY per ind. hour or S 5
copay pet group hour. 20 vilia
pcr mcmbn pet year
S 1 0 copay: 30 visit maximum; ~
must U,Se ChiroCare nnwork
S25 COI"Y
J 00%; a1ternativc 10 hospiuJ
confinlem~r. 80% akillcd care
in.homc
100%
S 10 cora,. thcn 90%
100%
100% lhrouFh a~C' 6
100%
90%
90% Kleacd outpatient
lur[:cf)'
SIOcopa)'
80% (1m 10 houn; additional
30 houn require aumorization
90%; up to 130 hours
SIO "'I"Y
$10 copay
90% to otu-of.pocket
maximum
Unauthoriud Sc-rv.cu
((h.'~f,uru.ri)
5~ after d~uCtibl(
50% aftcl deductihle; S300
max. co~rC'd nrcnKS per year
50% :lflct dcducliblc-; S300
max. COVC'led C'll~nsn per year
;0% a(u~l dC'ductiblc
100%
Joo% thlOugh il(:C 6
r,cn:ual: 100%; Postnatal:
;0% .FtC! deduetiblc
50% after deduaiblt
;0% after deductible
~O% ancr deductible
50% mer deduCtible fint 10
hours: addirional30 houn
r<<luiu- authoritation
50% .nrr deduaiblC' up to
J 30 noun
50% after dcduaiblr
50% aftrr deduaible
50% after deduCtible
\ ,/
~
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(Sn1-irn Nldt w "rtI",J (,om .,
Jiwr:W" ,)11'11' Jnipw.;; G,.ur
Ht4Uh ,TiIlUl,,! (1m rJinill
510 copar rer vi,il
100%
~.~. .
. ~ "
, ~
~
(S,l1"'f'1 MIU' W "UII.,.J frlJlrl II'
Ji,,(uli ~ ,,,-N' tk$'!IUItJ 8Jllt
~~!.~':' (,,,, rlm!!.!.-
5 J 0 copa~'
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
90%
90"- ,deaed outpatient
"'~'l'
$10 cop'Y
$ 1 5 copay houri 1.20; $20
copay houn 2 J-40
S10 copay'per vUlt; up to 40
houn pet)'C"
SIO cop.oy pet viUr. ..f,m!
wrcd .
SIO copay pn; visit
l~ if alrCTO.ti~ to
inplltient hospital; 90% all
od>er
90%
90% hospitaJ-b~
oUlpauenr Kf'Vica
510 copay
80% lint)O houn; 75%
next 30 houn
90%; up to 40 hours
5 10 copay offi<< vi,ir,
90% thcnpy services
S J 0 copay office visit;
9Mb therapy SCMcc:s
_ ) 00% if abernaun to
inpatient hospirali
90% aU other
HOSPITAL
General (includes matemi
M....,] b..Ith
, 00cnUaI depend.ncy
I
! Emc.rgcnc:y Room
lIO%
90%, 30 cbys pcr member per _
c:a.lendar)Uf. Must' UK' UBS. ~
Manbcr pays 20% up ro
S250; 73 chys pet member per
calendar . Must use UBS.
S40 cop>y; w.ived if admined
within 24 houri
80%
100%
90%, 30 chys per caI.ndar
,.."
~ ~; 73 chys per a1end"
50% aner deductible
50% meT deduerible: 30 chys
r ca.lendar yttr
500% mu dcd.uctiblr; 73 days
per calcndar ynr .
90%
~ $40 cop'To waived if admined SO% mer deductible
50% after deductible
100%
90%: 30 chys per alendar
90%, 73 chys per Iifetim.
S40cop.oy;
waived if admitted
80%
100%
90%, 30 d.ys per calendar
,...r
90%, 73 chys pcr akndar
ynr
S40 copay;
waivtd if admined
80%
100%
100%
90% to out-oF-pocket
maximum
50% after deduaible
100%
I Ot2J contneepuvcs
I
j Pto&thttie. dw:able: medical
j equipment
I Acdd...,.rebced cknal
I
!
i EY'CWCat
\.
i Allcq;y uea unent
,
'OTHER
Out~f area cme:rgmc:y
benefitS
Out-of.pocket maximum
, Dcduaible: {or other services
; and supplies (if applicabld
j tifmme medical maximum
In.!)
1 T WlSplanu covered
.
. Cosmetic sutp:ry
1':>\ "c.. ~
~~,\
e
57 copay per prescription or
rdiD
57 copa)' per ptcsc:riprion or
refill: 3 month supply
90%
I'. 80% if within 6 months; no
. coverage after 6 months
I:.. Discounu available through
; sdccted vendon
1:- SIOcopay(ortcning; I~
0." for injections
I'
I 80% cove"!!,,. S500
, out-of.pockct maximum
S 1.000 per ;nc!;vid..J1
52.000 per family combined
with Tier 2
N/A
Unlimited
Trc.a~ u an~' other illness
lGdner. hc::art.lung. heartl
lung..linr. cornea. and
specihed bone: marro\\".
Subjca to plan limirJtions and
medical necc:ssil)'.
NOt COVC'rcd unlcu medic:aJly
DCCCSSU)' .
57 cop')' per prescription Of
refill
$7 copay per prescription or
refill: 3 month supply
70%
70% cover:age if within 6
mos.; no coverage mer 6 mas.
Discounu availabk through
selected vmdon
$25 copay for resting; 1009&
for injections
80% COV<ng. to S500
out.of.poc:ktr maximum
S2.OOO pcr individuall
$4.000 per (amily combined
with Tier 1
N/A
Unlimircd
T rClllcd 111 any other illness
Kidn~'. hean,iunt:.. hcanl
lunt:.liver. cornea, and
spttilicd bone marrow.
Subject to plan Jimi~ations and
medical ncecssit),.
Not covered unless mcdicaJly
neccual)'.
\ 'Sa ~.'""\ ~
'$l:3\.CCI
SIO col"yIS7 (g.neric b""d)
mail order 90.-day supply.
J copay
SIO "'l"ylS7 (g....ric b..nd)
3 month supply
90%
90%
Not coY'Ued
SJO copa)' for office viJit;
90% all other scrvices
80%
51,000 per indi\idualJ
S2,OOO pcr (,milr
N/A
S2.000.000
T l"C'a~ed as any other iUnm
lunp. liver. heart. hcartllun~.
kidney. cornea, specified bone
marrcw.'. Subject to plan
limitariom and mcdic.a.l
necnsi~y.
Not covered unless medially
h<<cssa~'.
~ tt. --:r. ~
I.,
S I 0 cop.orlS7 (g....ric b..nd)
mail order 9O.-day supply.
I cop.oy
S I 0 cop.oylS7 (gcn.ne h..nd)
mail order 9O-dll)' supply.
I col"r
50% anu deduCtible
50% after deduaible
NOI cove:mi
525 copay for offi<< vu.it;
50% aU other services
50% .ncr deduCtible
53.000 pa individuaU
S6.000 pcr (,milr
$200 (per calcnd" ynr)
where applicable
S2.000,000
50% aher dcduaibk
Lunp.lh-cr. hc.an. hcanllung.
kidnc-y. cornea. specified bonc
marrow. Subjm to plan
limitations and medial
nc:ccssiry.
1':01 eO\-rred unless medically
necosary"
\ '-'. q.. ~~
Io\"',~~
Q \J C "\ -e.
57 copay per preKription
.rrefill
57 per 3 month supply
90% COV<ng'
90% if within G months; no
coverage altcr 6 months
Low member prices al Group
Haith 0 rial d enu
$10 coplr for teSting; J 00%
for injccOons
80% to $1.500; then 100%
51.000 per individuall
$2.000 per family
N/A
Unlimiffi:!
T reared as any other illness
I..ivc:r. heart. heanllung.. lunF:.
COtnCI. kidnC')'. specified
boM marrow. Subject to
plan limitations and medical
neaait)..
Nor covered unles.s medially
ncccssaty.
t'~:\
Sy,.lD').
S7 copay form war')":
$ 1 0 copay nonformulary;
(34 day or 100 unit supply)
$7 cop2y formula!')'i S I 0
cop..y non(onnulal),,:
3 month supply
90%
90% if within 6 months
ofin;ury. No COVUll!C
anu 6 months.
EycwcaJ' discounu for
memben
5 J 0 co~y for testing;
100% fOf in' ections
In-nerwork benefiu
51.000 per individuall
S2.OOO p" family
N/A
Unlimired
Treated as 1I1Y other iIIoos
Hean. hean/lunJ;.lunf:.livrr.
pancreas and specified bone:
marrow.lcidnC"o\ cornea. and
skin. Subject;o plan
limilarions and medical
necCSJi~',
Not CO\"a"rd unlelS mediall)'
nC'CC$S:ll)".
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