Resolution No. 90651
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RESOLUTION NO. 9065
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF
VERNON APPROVING AND RATIFYING ACTIONS TAKEN
REGARDING RENEWAL OF THE MEDICARE PART D PROGRAM
WHEREAS, on November 16, 2005, the City Council of the City
of Vernon adopted Resolution No. 8909 approving the filing of an
application for federal subsidies for medicare drug purchases and
approving an Agreement for Medicare Part D Implementation Services
with Part D Advisors, Inc. ("Part D"); and
WHEREAS, on February 15, 2006, the City Council of the City
of Vernon adopted Resolution No. 8973 ratifying the approval of a
Business Associate Agreement with Part D to satisfy the requirements
of the Health Insurance Portability and Accountability Act of 1996 and
45 CFR Parts 160-164 (the "Privacy Rule"); and
WHEREAS, the Retiree Drug Subsidy ("RDS") program renews
each year based on Medicare Part D plan year of September 1; and
WHEREAS, in order to meet the renewal -processing deadline of
120 days in advance of the plan year, the Chief Deputy City
Attorney/Acting Risk Manager executed a renewal confirmation that drug
benefits and costs remain unchanged for the upcoming plan year,
subject to ratification by the City Council.
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE
CITY OF VERNON AS FOLLOWS:
SECTION 1: The City Council of the City of Vernon hereby
finds and determines that the recitals contained hereinabove are true
and correct.
SECTION 2: The City Council of the City of Vernon hereby
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ratifies the execution of the Confirmation of Retiree Drug Plan
Information executed on May 22, 2006, a copy of which is attached
hereto as Exhibit A and incorporated by reference.
SECTION 3: The Acting City Clerk of the City of Vernon
shall certify to the passage of this resolution, and thereupon and
thereafter the same shall be in full force and effect.
APPROVED AND ADOPTED this 7th day of June, 2006.
ATTEST:
BRUCE 1 LKENHORST, JR.
Acting y Clerk
EONIS C. MALB RG, Mayor
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STATE OF CALIFORNIA )
) ss
COUNTY OF LOS ANGELES )
I, BRUCE V. MALKENHORST, JR., Acting City Clerk of the City of
Vernon, do hereby certify that the foregoing Resolution, being
Resolution No. 9065, was duly adopted by the City Council of the City
of Vernon at a regular meeting of the City Council duly held on
Wednesday, June 7, 2006, and thereafter was duly signed by the Mayor of
the City of Vernon. _
(SEAL)
BRUCj' �. MALKENHORST, JR.
Acti City Clerk
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EXHIBIT
0
s s F
Part D Advisors is confirming that the following information was submitted to the Centers for Medical and
Medicaid Services (CMS) or used by Part D Advisors in connection with the Plan Sponsor's application for
Medicare Part D subsidies. If any information in this Part I is incorrect or has been changed, please contact us
immediately with the correct(revised information:
A. General Information
Plan Sponsor Name: City of Vernon
Address: 4305 Santa Fe Ave.
Vernon, California 90058
Plan Name: City of Vernon Employee Benefits Plan.
Plan Year Begins: September 1, 2006
B. Drug Benefit Provider Wormation
[Drug Benefit Program Name]'
Provider 1: Mutual of Omaha. Group Number: G0002R05
Provider 2: N/A
C. Required ConWbution Rates under the Plan (for Medicare Eligible Retirees)
[Drug Benefit Program Name]:
1. Combined or Separate Contribution
There are separate contribution amounts for Medical and Drug Coverages
x There exists only a single contribution amount that covers both Medical and
Drug coverages
2. Contribution Amount
Single Monthly Rate: $289.00
Two -person Monthly Rate: N/A
Page 2 of 4
D. Authorized Representative
Name: Willard Yamaguchi
Business address: 4305 Santa Fe Ave.
Vernon, California 90058
Phone number(s): 323-583-8811 ext. 175
E. EFT Information
Bank: Bank of America
Last Four Digits of Account Number: 0483
Approved In Process
A. Retiree & Spouses: 50 12
B. Disabled &ESRD:
Total: 50* 12*
* This information is as of 1-24-06, based upon the initial list of eligible individuals submitted as part of
the subsidy application. It may be increased or decreased based on fiuther information provided to CMS
and any further findings by CMS.
Provide below an estimate of the expected drug rebates and other price concessions, attributable to the gross
retiree costs under the plan and incurred during the plan year.
A. City of Vernon Employee Benefit Plan:
Plan Year: 2.95%
Expected Total Amount of Rebate and Other Price Concessions: $
B. City of Vernon Employee Benefit Plan:
Plan Year:
Expected Total Amount of Rebate and Other Price Concessions: $
A. . City of Vernon Employee Benefit Plan:
Part D Advisors, Inc.
409 Plymouth Rd. Suite100, Plymouth, Michigan 48170
734-459-8940 - 1-888-447-2783 - 734-459-9733(fax)
www.partdadvisors.com
Page 3 of 4
1. Contribution Rate Confirmation
i
(Choose One)
X Since September, 2005 there has been no chaW to the Contribution Rates for
Medicare Eligible Retirees.
Since September, 2005 Contribution Rates for Medicare -Eligible Retirees
have been been or will be changed in the future in the following
manner**
** Please attach applicable documentation, such as enrollment forms or SPD.
2. Other Features Confirmation
(choose one)
X Since September, 2005 there has been no change to any of the following
features of our drug benefit program for Medicare -Eligible Retirees:
deductibles
co-insurance
benefit maximums
out-of-pocket maximums
other significant benefit changes
Since September, 2005 there have been changes either made, or planned to
take effect in the future, to the following features of our drug benefit program
for Medicare -Eligible Retirees:***
(Check all appropriate changes and provide details. Attach separate page if
needed. For each change, please also attach applicable documentation,
such as enrollment forms or SPD)
deductibles:
co-insurance:
benefit maximums :
out-of-pocket maximums:
Part D Advisors, Inc.
409 Plymouth Rd. Suite100, Plymouth, Michigan 48170
734-459-8940 - 1-888-447-2783 - 734-459-9733(fax)
ww-RAWadvisors.com
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other significant benefit changes:
*** If the plan is subject to Employee Retirement Income Security Act of
1974, as amended (MUSA), plan changes that may be considered a material
reduction in benefits may require prior notice. Please consult with your
employee benefits attorney for further information and guidance.
* s
Date:
P1 Spons Sig
Name: Willard G. guchi
Title: Chief Depu istrict Attorney
Part D Advisors, Inc.
409 Plymouth Rd. Suitel00, Plymouth, Michigan 48170
734-459-8940 - 1-888-447-2783 - 734-459-9733 (fax)
www.t@rtdadvisors.com