Loading...
Resolution No. 97571 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 27 RESOLUTION NO. 9757 A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF VERNON DECLARING ITS INTENTION TO PURCHASE 2009 AETNA GOLDEN MEDICAL PLAN -HMO WITH EMPLOYEE OPTION TO PURCHASE AETNA MEDICARE PFFS (PRIVATE FEE FOR SERVICES) 90 OPEN PLAN BY AND BETWEEN THE CITY OF VERNON AND AETNA HEALTH INC. AND AETNA LIFE INSURANCE COMPANY INC. AND AUTHORIZING THE CITY TO DO ALL ACTIONS DEEMED NECESSARY OR ADVISABLE CONCERNING HEALTH BENEFITS FOR RETIRED EMPLOYEES OVER 65 WHEREAS, the Risk Manager has recommended that there be a separate retiree medical benefit program under which qualified retired employees over 65 would be under the Aetna Golden Medicare Plan HMO 1program with Aetna Health Inc. for an approximate annual premium of 1$515,158.00, with the employee having an option to buy up to the Aetna IMedicare PFFS (Private Fee for Services) 90 Open Plan PPO program with (Aetna Life Insurance Company Inc. for an additional per person fee of japproximately $193.00; and WHEREAS, Aetna Health Inc. and Aetna Life Insurance Company (Inc. shall hereinafter be collectively known as Aetna; and WHEREAS, Aetna has requested that the City declare its lintention to purchase a separate retiree medical benefit plan for qualified retirees over 65 prior to memorializing the agreement or amendment in writing, if necessary; and WHEREAS, the City Council intends to purchase a separate (retiree medical benefit plan for qualified retirees over 65 for 2009 based upon the recommendations of the Risk Manager; and WHEREAS, the City Council of the City of Vernon has 28 Ildetermined that, pursuant to the provisions of subsection (a) of 2 3 4 5 6 7. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 Section 2.27 of the Vernon City Code, it is in the public interest and necessity to enter into an agreement with Aetna setting forth the terms and conditions for the medical benefit plan for qualified retirees over 65 to enhance services provided to the Vernon community. NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF VERNON AS FOLLOWS: SECTION l: The City Council of the City of Vernon hereby IIfinds and determines that the recitals contained hereinabove are true and correct. SECTION 2: The City Council of the City of Vernon hereby gives notice of its intention to purchase the health plans for qualified retirees over 65 under the Plan Design & Benefits provided by Aetna for Retiree HMO and PPO plans, a copy of which are attached hereto as Exhibit A and incorporated by reference. SECTION 3: The City Council of the City of Vernon hereby gives notice of its intention to approve any agreements or amendments necessary to implement the purchase of the health plans for qualified retiree employees over 65. SECTION 4: The 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 3rd day of November, 2008. AT., ST: MPAUELA GIRON, City Clerk Name: Hilario Gonzales Title:/ Mayor Pro-Tem - 2 - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 STATE OF CALIFORNIA ) ss COUNTY OF LOS ANGELES ) I, MANUELA GIRON, City Clerk of the City of Vernon, do hereby certify that the foregoing Resolution, being Resolution No. 9757, was duly adopted by the City Council of the City of Vernon at regular meeting of the City Council duly held on Monday, November 3, 2008, and thereafter was duly signed by the Mayor or Mayor Pro-Tem of the City of Vernon. (SEAL) MANUELA GIRON, ity Clerk - 3 - EXHIBIT A Aetna Golden Medicare Man-E[1VI0 )(Aeffiff Medicare City of Vernon Aetna Golden Medicare Plan® - HMO Medicare 5 Special Plan Rx Group 012 Arizona, California, Connecticut, Colorado, Delaware, District of Columbia, Florida, Georgia, Illinois, Maryland, Maine, New Jersey, Nevada, New York, Ohio, Oklahoma, Pennsylvania, Tennessee, Texas,, Virginia PLAN DESIGN AND BENEFITS PROVIDED BY AETNA HEALTH INC Out-of-pocket Maximum Unlimited Only those out of pocket expenses resulting from the application of coinsurance percentage and copays on the following benefits may be used to satisfy the Out -of -Pocket Maximum: inpatient hospital, skilled nursing facility, inpatient mental health, inpatient substance abuse, outpatient surgery, outpatient mental health, outpatient substance abuse and DME. Lifetime Maximum Unlimited except for where otherwise indicated Primary Care Physician Selection Required Referral Requirements Required for all non -emergency, non -urgent and non -Primary Care physicians services, except direct access services. k Routine Physical Exams/Immunizations Covered 100% (One annual exam/Pneumonia, Flu, Hepatitis B) Routine Gynecological Care Exams Covered 100% Includes related lab fees for covered females age 18 and older. Direct Access to participating providers One routine GYN visit and pap smear every 365 days Routine Mammograms Covered 100% One baseline mammogram for members 35-39; and one annual mammogram for members age 40 and over Routine Digital Rectal Exams / Prostate Specific Covered 100% Antigen Test For males age 40 and over. Colorectal Cancer Screening Covered 100% For all members 50 and over. Bone Density Testing Covered 100% Routine Eye Exam Covered 100% Direct access to participating providers. One annual exam. ne Hearing Screening Covered 100% One (1) annual exam Hearing Aid Reimbursement Discounts where available Primary Care Physician Visits (Office hours) $5 copay (After Office Hours) $10 copay (does not apply to CA) Specialist Office Visits $15 copay M0001_7A_70650 Page XAetna: Medicare City of Vernon Aetna Golden Medicare Plan® - HMO Medicare 5 Special Plan Rx Group 012 Arizona, California, Connecticut, Colorado, Delaware, District of Columbia, Florida, Georgia, Illinois, Maryland, Maine, New Jersey, Nevada, New York, Ohio, Oklahoma, Pennsylvania, Tennessee, Texas, Virginia PLAN DESIGN AND BENEFITS PROVIDED BY AETNA HEALTH INC Podiatry $15 copay Limited to Medicare covered benefits only Allergy Test!ng/Treatment $15 copay For initial testing by a specialist; PCP copay for routine injections at PCP office with or without physician encounter Diagnostic Laboratory and X-Ray $15 copay nt Care Provider Emergency Room; Worldwide (waived if admitted) $50 copay Ambulance Covered 100% per trip Inpatient Coverage Covered 100% The member cost sharing applies to covered benefits incurred during a member's inpatient stay. Outpatient Surgery Covered 100% The member cost sharing applies to covered benefits incurred during a member's outpatient visit. Inpatient Mental Illness Covered 100% (Combined with Inpatient Substance Abuse) 190 Lifetime days The member cost sharing applies to covered benefits incurred during a member's Outpatient Mental Illness $25 copay The member cost sharing applies to covered benefits incurred during a member's outpatient visit. Inpatient Substance Abuse (Detox and Rehab) Covered 100% (Combined with Inpatient Mental Health) 190 Lifetime days The member cost sharing applies to all covered benefits incurred during a member's inpatient stay. Outpatient Substance Abuse (Detox and Rehab) $15 copay The member cost sharing applies to covered benefits incurred during a member's outpatient visit. Skilled Nursing Facility Covered 100% (100 days per Medicare benefit period; prior authorization from HMO required) The member cost sharing applies to covered benefits incurred during a member's inpatient stay. Home Health Care Covered 100% Hospice Care Covered by Medicare at Medicare certified Hospice M0001 _7A_70650 Page 2 XAetna City of Vernon medicare Aetna Golden Medicare Plan®- HMO Medicare 5 Special Plan Rx Group 012 Arizona, California, Connecticut, Colorado, Delaware, District of Columbia, Florida, Georgia, Illinois, Maryland, Maine, New Jersey, Nevada, New York, Ohio, Oklahoma, Pennsylvania, Tennessee, Texas, Virginia PLAN DESIGN AND BENEFITS PROVIDED BY AETNA HEALTH INC Outpatient Short -Term Therapy (speech, physical, $15 copay cardiac and occupational) Chiropractic Care $15 copay For manual manipulation of the spine to the extent covered by Medicare Durable Medical Equipment/Prosthetic Devices Covered 100% Diabetic Supplies No copay for strips, lancets and glucometer Outpatient Complex, Radiology $15 copay Outpatient Dialysis $15 copay uentai F Discounts where available Vision Eyewear Allowance $70 reimbursement every 24 months Coaching Included One phone call per week x. ,�-0001, ,_ �: Prescription drug calendar year deductible None Prescription drug calendar year deductible must be satisfied before any Medicare Prescription Drug benefits are paid. Covered Medicare Prescription Drug expenses will accumulate toward the pharmacy deductible. Retail - Cost -Sharing $10 Copay for Generic $20 Copay for Preferred Brand $35 Copay Non -Preferred Brand Up to one month (31 day) supply at indicated copay or coinsurance (Three month (90 day) supply available at retail. Dollar copayments or applicable coinsurance will apply for each month supply.) M0001_7A_70650 Page 3 XAetTla' Medicare City of Vernon Aetna Golden Medicare Plan® - HMO Medicare 5 Special Plan Rx Group 012 Arizona, California, Connecticut, Colorado, Delaware, District of Columbia, Florida, Georgia, Illinois, Maryland, Maine, New Jersey, Nevada, New York, Ohio, Oklahoma, Pennsylvania, Tennessee, Texas, Virginia PLAN DESIGN AND BENEFITS PROVIDED BY AETNA HEALTH INC Mail Order through Aetna Rx Home Delivery - Cost- $20 Copay for Generic Sharing $40 Copay for Preferred Brand $70 Copay for Non -Preferred Brand Up to a three month (90 day) supply available via our preferred vendor, Aetna Rx Home Delivery. Catastrophic Coverage Greater of $2.40 or 5% for covered generic (including brand drugs treated as generic) drugs. Greater of $6.00 or 5% for all other covered drugs. Catastrophic Coverage benefits start once $4,350 in true out-of-pocket costs is incurred. Requirements: Precertif!cation Yes Step -Therapy Yes Formulary Open Mandatory Generic (MG) Yes * Dental Riders are not available in the following service areas : DE01, ME01, NY03, VA01, and TX05 Please refer to the plan documents (Evidence of Coverage) for a complete listing of benefits, exclusions and limitations. The following is a partial listing of exclusions and limitations under the Aetna Golden Medicare Plan: • All applicable services not referred by your network primary care doctor, except for services received as a result of an emergency or urgent situation; • Services that are not medically necessary or covered under the Original Medicare Program • Plastic or cosmetic surgery unless medically necessary • Custodial care • Experimental procedures or treatments beyond Original Medicare limits • Routine foot care that is not medically necessary • Drugs used for weight loss, weight gain or anorexia • Drugs used for cosmetic purposes or to promote hair growth • Prescription vitamins and mineral products, except prenatal vitamins and fluoride preparations • Barbiturates • Outpatient drugs that the manufacturer seeks to require that associated tests or monitoring services be purchased exclusively from the manufacturer as a condition of sale M0001 _7A_70650 Page 4 City of Vernon XAetnawedicare Aetna Golden Medicare Plan® - HMO Medicare 5 Special Plan Rx Group 012 Arizona, California, Connecticut, Colorado, Delaware, District of Columbia, Florida, Georgia, Illinois, Maryland, Maine, New Jersey, Nevada, New York, Ohio, Oklahoma, Pennsylvania, Tennessee, Texas, Virginia PLAN DESIGN AND BENEFITS PROVIDED BY AETNA HEALTH INC • Drugs used to promote fertility • Drugs used for symptomatic relief of cough and colds • Non-prescription drugs (OTC) • Benzodiazepines • Drugs when used for the treatment of sexual or erectile dysfunction This material is for informational purposes only. See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Aetna does not provide care or guarantee access to health services. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Discount Programs provide access to discounted prices and are not insured benefits. While this material is believed to be accurate as of the print date, it is subject to change. Aetna receives rebates from drug manufacturers that may be taken into account in determining Aetna's Preferred Drug List. Rebates do not reduce the amount a member pays the pharmacy for covered prescriptions. You must use network pharmacies to receive plan benefits except in limited, non -routine circumstances when a network pharmacy is not available, including illness while traveling within the United States but outside of the plan's service area where there is no network pharmacy. An additional cost may be incurred for drugs received at an out -of -network pharmacy. If you qualify for extra help with the Medicare prescription drug plan, premium and costs at the pharmacy may be lower. Upon enrollment in the Aetna Medicare plan, Medicare will tell us how much extra help an individual is getting. An individual can obtain information on whether they qualify by calling 1-800- Medicare (1-800-633-4227). TTY/TDD users should call 1-877-486-2048. Benefits coverage is provided by Aetna Health Inc., Aetna Health of California Inc. and/or Aetna Health of Illinois Inc., which are Medicare Advantage organizations with a Medicare contract and benefits, limitations, service areas and premiums subject to change on January 1 of each year You must be entitled to Medicare Part A and continue to pay your Part B premium and Part A, if applicable. You must use network providers except for emergent care or out -of -area urgent care/renal dialysis. If your primary physician is part of an integrated delivery system or physician group, your primary care physician will generally refer you to specialists and hospitals that are affiliated with the delivery system or physician group. M0001 _7A_70650 Page 5 Aetna Medicare PFFS (Private Fee For Service) 90 Open Plan M XAetna°Medicare City of Vernon Aetna Medicare Open sM Plans Medicare 90 Open Plan Rx Group 012 National Service Area PLAN DESIGN AND BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY INC 4 Deductible (per calendar year)m $0 Deductible Unless otherwise indicated, the Deductible must be met prior to benefits being payable Member Coinsurance 10% lies to all expenses unless otherwise stated. Payment Limit (per calendar year) M Includes deductible. Certain other member cost sharing elements may not apply towards the Payment Limit. Lifetime Maximum Unlimited except for where otherwise indicated Primary Care Physician Selection Not Applicable Referral Requirements None Routine Physical Exams/Immunizations Covered 100% (One annual exam/Pneumonia, Flu, Hepatitis B) Routine Gynecological Care Exams Covered 100% One Routine GYN visit and pap smear every 365 days Routine Mammograms Covered 100% One baseline mammogram for members 35-39; and one annual mammogram for members age 40 and over Routine Digital Rectal Exams/ Prostate Specific Covered 100% Antigen Test For males age 40 and over. Colorectal Cancer Screening Covered 100% For all members 50 and over. Bone Density Testing Covered 100% Routine Eye Exam Covered 100% One annual exam. Routine Hearing Screening Covered 100% One (1) annual exam Hearing Aid Reimbursement Discounts where available Primary Care Physician Visits (Office hours) 10% (After Office Hours) 10% H5736_7F_70614 Prepared: 10/27/200810:47 AM Pagel City of Vernon M YAetna® Medicare PLAN DESIGN AND BENEFITS Aetna Medicare Open sM Plans Medicare 90 Open Plan Rx Group 012 PROVIDED BY AETNA LIFE INSURANCE COMPANY INC Specialist Office Visits 10% Allergy Test!ng/Treatment 10% For initial testing by a specialist; with or without phvsician encounter Diagnostic Laboratory and X-Rav 10% The member cost sharin National Service Area a member's inpatient stay. Outpatient Surgery 10% The member cost sharing applies to covered benefits incurred during a member's outpatient visit. plies to covered benefits incurred Inpatient Mental Illness 10% (Combined with Inpatient Substance Abuse) 190 Lifetime days The member cost sharing applies to covered benefits incurred during a member's inpatient stay. Outpatient Mental Illness 10% The member cost sharing applies to covered benefits incurred during a member's outpatient visit. Inpatient Substance Abuse (Detox and Rehab) 10% (Combined with Inpatient Mental Health) 1 190 Lifetime days The member cost sharing applies to all covered benefits incurred during a member's inpatient stay. Outpatient Substance Abuse (Detox and Rehab) 10% The member cost sharing applies to covered benefits incurred during a member's outpatient visit. Skilled Nursing Facility 0% per day - days 1-20; 10% per day - days 21-100 (100 days per Medicare benefit period) The member cost sharing applies to covered benefits incurred during a member's inpatient stay. Home Health Care Covered 100% Hospice Care Covered by Medicare at a Medicare certified hospice Outpatient Short -Term Therapy (speech, physical, 10% cardiac and occupational) iropractic Care 10% H5736_7F_70614 Prepared: 10/27/200810:47 AM Page 2 ^— City of Vernon XAetna® medicare Aetna Medicare Open sM Plans Medicare 90 Open Plan Rx Group 012 National Service Area PLAN DESIGN AND BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY INC For manual manipulation of the spine to the extent covered by Medicare Durable Medical Equipment/Prosthetic Devices 10% Podiatry 10% Limited to Medicare covered benefits only Diabetic Supplies Covered 100% Includes test strips, lancets and glucometer Outpatient Complex Radiology 10% Outpatient Dialysis 10% Vision Eyewear Allowance $70 reimbursement every 24 months Coaching Included One phone call per week Prescription drug calendar year deductible None Prescription drug calendar year deductible must be satisfied before any Medicare Prescription Drug benefits are paid. Covered Medicare Prescription Drug expenses will accumulate toward the pharmacy deductible. Retail - Cost -Sharing $10 Copay for Generic $20 Copay for Preferred Brand $35 Copay Non -Preferred Brand Up to one month (31 day) supply at indicated copay or coinsurance (Three month (90 day) supply available at retail. Dollar copayments or applicable coinsurance will apply for each month supply.) H5736_7F_70614 Prepared: 10/27/200810:47 AM Page 3 City of Vernon M XAetna®Medicare Aetna Medicare Open sM Plans Medicare 90 Open Plan Rx Group 012 National Service Area PLAN DESIGN AND BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY INC Mail Order through Aetna Rx Home Delivery - Cost- $20 Copay for Generic Sharing $40 Copay for Preferred Brand $70 Copay for Non -Preferred Brand Up to a three month (90 day) supply available via our preferred vendor, Aetna Rx Home Delivery. Catastrophic Coverage Greater of $2.40 or 5% for covered generic (including brand drugs treated as generic) drugs. Greater of $6.00 or 5% for all other covered drugs. Catastrophic Coverage benefits start once $4,350 in true out-of-pocket costs is incurred. Requirements: Precertification Yes Step -Therapy Yes Formulary Open Mandatory Generic (MG) Yes Please refer to the plan documents (Evidence of Coverage) for a complete listing of benefits, exclusions and limitations. The following is a partial listing of exclusions and limitations under the Aetna Medicare Open Plan: • Services that are not medically necessary or covered under the Original Medicare Program unless otherwise noted • Plastic or cosmetic surgery unless medically necessary • Custodial care • Experimental procedures or treatments beyond Original Medicare limits • Routine foot care that is not medically necessary • Drugs used for weight loss, weight gain or anorexia • Drugs used for cosmetic purposes or to promote hair growth • Prescription vitamins and mineral products, except prenatal vitamins and fluoride preparations • Barbiturates • Outpatient drugs that the manufacturer seeks to require that associated tests or monitoring services be purchased exclusively from the manufacturer as a condition of sale • Drugs used to promote fertility • Drugs used for symptomatic relief of cough and colds H5736_7F_70614 Prepared: 10/27/200810:47 AM Page 4 - City of Vernon �XAetna® Medicare Aetna Medicare Open sM Plans Medicare 90 Open Plan Rx Group 012 National Service Area PLAN DESIGN AND BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY INC • Non-prescription drugs (OTC) • Benzodiazepines • Drugs when used for the treatment of sexual or erectile dysfunction This material is for informational purposes only. See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Aetna does not provide care or guarantee access to health services. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Discount Programs provide access to discounted prices and are not insured benefits. While this material is believed to be accurate as of the print date, it is subject to change. Enrollees must use network pharmacies to receive plan benefits except under emergency circumstances. Covered Part D drugs are available at out -of -network pharmacies in special circumstances, including illness while traveling within the United States but outside of the plan's service area where there is no network pharmacy. An additional cost may be incurred for drugs received at an out -of -network pharmacy. If an individual qualifies for extra help with the Medicare prescription drug plan, premium and costs at the pharmacy may be lower. Upon enrollment in the Aetna Medicare plan, Medicare will tell us how much . extra help an individual is getting. An individual can obtain information on whether they qualify by calling 1- 800-Medicare (1-800-633-4227). TTY/TDD users should call 1-877-486-2048. Benefits coverage is provided by Aetna Life Insurance Company, a Medicare Advantage organization, with a Medicare contract and benefits, limitations, service areas and premiums subject to change on January 1 of each year. You can receive covered services from any licensed doctor or hospital that is eligible to receive payment from Medicare, agrees to treat you and accepts the Aetna Medicare Open Plan private fee -for -service terms and conditions of payment. This product does not require a contracted network. You must be entitled to Medicare Part A and continue to pay your Part B premium and Part A, if applicable. A Medicare Advantage Private Fee -for -Service plan works differently than a Medicare supplement plan. Your doctor or hospital must agree to accept the plan's terms and conditions prior to providing healthcare services to you, with the exception of emergencies. If your doctor or hospital does not agree to accept our payment terms and conditions, they may not provide healthcare services to you, except in emergencies. Providers can find the plan's terms and conditions on our website at: www.aetna.com H5736_7F_70614 Prepared: 10/27/200810:47 AM Page 5 co m CD 07 v N m 0 O n D r X X N N co (D CD co 3 3 w g W zc� -1 v co p ' INko CD �F ,� 3 a C' C S 3 Igg ���m� D MIA MI' &R, gm co 4 PM l :IN ^} '€ € ,' any f��rWNAN N N ^a _f �..� ►eZ �k+fO � A N 9 ''fit S�t� kkt 8 O V O O x 'li'k45 ..........��4xS T f `v� 7 Yx k S •, 4 i ran 1 x. j •f'�a r-4y00 ,J gpp Ii IMR � 14�i 'k O ! j ire � 1 N �smj�il4 1n 5 CA O O & ODD O A S I& 4 INA t R SON ii'm�"'i3'H�'. GO 69 V co ON coo 0) w C m a m n G v m -o ;a 70 n CD cn �, rt CD a COD G�:+=CD (p m N CD O 3 y C -+ O i CD CD O C rt w Q CD p 1 N O o OD y CITY CLERK'S OFFICE INTEROFFICE MEMORANDUM DATE: November 5, 2008 TO: Willard Yamaguchi, Chief Deputy City Attorney/Risk Manager FROM: 6 Nelly Giron, City Clerk RE: Resolution No. 9757 - A Resolution of the City Council of the City of Vernon Declaring Its Intention to Purchase 2009 Aetna Golden Medical Plan -HMO With Employee Option to Purchase Aetna Medicare PFFS (Private Fee For Services) 90 Open Plan By and Between the City of Vernon and Aetna Health Inc. and Aetna Life Insurance Company Inc. and Authorizing the City to Do All Actions Deemed necessary or Advisable Concerning Health Benefits for Retired Employees Over 65 Transmitted herewith is a copy of Resolution No. 9757 referenced above, which was approved by City Council on November 3, 2008. Thank you. NG:dr c: Karina Rueda Resolution No. 9757 RESOLUTION NO. 10,097 A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF VERNON APPROVING THE RENEWAL OF HEALTH CARE BENEFITS FOR RETIRED EMPLOYEES FOR THE CALENDAR YEAR 2010 WITH AETNA HEALTH INC. AND AETNA LIFE INSURANCE COMPANY INC. WHEREAS, on November 3, 2008, the City Council of the City of Vernon adopted Resolution No. 9756 approving the renewal of health care benefits with Aetna Life Insurance Company for Medicare Private fee -for -service (PFFS) Plan Group and HMO Group with Aetna Health Inc. (collectively, "Aetna") for the period of January 1, 2008 through December 31., 2008 and a subsequent term thereafter from January 1, 2009 to December 31, 2009; and WHEREAS, Aetna has advised the City of an increase of 9.2% for medical benefits for the Health Maintenance Organization plan (HMO) (an additional $1,817.00 per year) and an increase of 17.1% for medical benefits for Open Access Managed Choice POS (PPO) (an additional $3,032.00 per year) for retired employees under 65 years old, for an approximate total annual premium of $21,529.00 for HMO and $20,760.00 for PPO; and WHEREAS, Aetna has advised the City of an increase of 1.6% for medical benefits for the HMO (an additional $491.00 per year) and an increase of 16.4% for medical benefits for the PPO (an additional $29,104.00 per year) for retired employees over 65 years old, for an approximate total annual premium of $30,511.00 for HMO and $206,836.00 for PPO; and WHEREAS, Aetna has offered the City an HMO and PPO plan for the period of January 1, 2010 through December 31, 2010, for a one (1) year term; and WHEREAS, the City Council intends to renew the health benefit plans for 2010 based upon the recommendations of the Risk Manager. 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 approves the renewal for medical benefits with Aetna Health Inc. and Aetna Life Insurance Company Inc. for retired employees that are summarized in the Plan Design & Benefits provided by Aetna, a copy of which is attached hereto as Exhibit A and incorporated by reference. SECTION 3: The City Council of the City of Vernon hereby authorizes the City Administrator, or his designee, to take whatever action is deemed necessary or desirable for the purpose of implementing and carrying out the purpose of this Resolution and the transactions herein approved or authorized. 2 SECTION 4: The City Clerk of the City of Vernon shall certify to the passage, approval and adoption of this resolution, and the City Clerk of the City of Vernon shall cause this resolution and the City Clerk's certification to be entered in the File of Resolutions of the Council of this City. APPROVED AND ADOPTED this 9th day of November, 2009. ATTE MAMELA GIRON, City'Clerk Name: Hilaric Gonzales Title: Mayor _3_ STATE OF CALIFORNIA ) ) ss COUNTY OF LOS ANGELES ) I, MANUELA GIRON, City Clerk of the City of Vernon, do hereby certify that the foregoing Resolution, being Resolution No. 10,097, was duly passed, approved and adopted by the City Council of the City of Vernon at a regular meeting of the City Council duly held on Monday, November 9, 2009, and thereafter was duly signed by the Mayor or or Pro-Tem of the City of Vernon. Executed this �67�day of November, 2009, at Vernon, California. (SEAL) 1 � MANUELA GIRON City Clerk - 4 - EXHIBIT a )(Aetna Medicare City of Vernon - HMO MAPD Group Plan Aetna Medicare sM Plan (HMO) Medicare 5 Special Plan Rx Group 012 Arizona, California, Connecticut, Colorado, Delaware, District of Columbia, Florida, Georgia, Illinois, Maryland, Maine, New Jersey, Nevada, New York, Ohio, Oklahoma, Pennsylvania, Tennessee, Texas, Virginia PLAN DESIGN AND BENEFITS Lifetime Maximum Unlimited Primary Care Physician Selection Required Referral Requirements Required for all non -emergency, non -urgent and non - Primary Care physicians services, except direct access services. Routine Physical Exams/Immunizations Covered 100% (One annual exam/Pneumonia, Flu, Hepatitis B) Routine Gynecological Care Exams Covered 100% Includes related lab fees for covered females age 18 and older. Direct Access to participating providers One routine GYN visit and pap smear every 365 days Routine Mammograms Covered 100% One baseline mammogram for members 35-39; and one annual mammogram for members age 40 and over Routine Digital Rectal Exams / Prostate Specific Antigen Covered 100% Test For males age 40 and over. Colorectal Cancer Screening Covered 100% For all members 50 and over. Bone Density Testing Covered 100% Routine Eye Exam Covered 100% Direct access to participating providers. One annual exam. Routine Hearing Screening Covered 100% One (1) annual exam Hearing Aid Reimbursement Discounts where available Primary Care Physician Visits (Office hours) $5 copay (After Office Hours) $10 copay (does not apply to CA) Specialist Office Visits $15 copay Podiatry $15 copay Limited to Medicare covered benefits only Allergy Testing/Treatment $15 copay M0001_7A 70650 Pagel City of Vernon - HMO MAPD Group Plan )(Aetna: Medicare Aetna Medicare sM Plan (HMO) Medicare 5 Special Plan Rx Group 012 Arizona, California, Connecticut, Colorado, Delaware, District of Columbia, Florida, Georgia, Illinois, Maryland, Maine, New Jersey, Nevada, New York, Ohio, Oklahoma, Pennsylvania, Tennessee, Texas, Virginia PLAN DESIGN AND BENEFITS PROVIDED BY AETNA HEALTH INC For initial testing by a specialist; PCP copay for routine injections at PCP office with or without physician encounter �i:�� /mil .,r-� mf�� y�--,�/y�-� .�yx��-;� -.. � f i --vim vs�, ::��"l �" �ay",��t�• .� r �. � , -: � �,� w � .. J a %. -i � a�� - 6.; a, ; .lj �� �, � r.. >u; e �s � <- 1n�V s ' x> :�a"✓�,� �,..si !ti�� � / �3e f �� � ¢`�' y ..� i r � � � w .. �� " 's v,�` �� � c� �`� 1'�..vp� , �t1 vE� � •. . � s� �.,/h. �.i a � f �� „h. � �, ..,.i ?i �. / � .'� r ✓`.i t t� Y Us �� F, Ht - �.,a�:� � izrc RdF zi- ��s s e a,� J�; ,. ,,.���„"�,� 5 ,,;.w.<.d;<:;,.��u�urervo,.,nrJ ,,,.:✓r/1�, :%,_s,,.,,, �. .fit .su �?�,..cnsr<a>o,2.'r.>�;,�sca,,,�,,,,__,�1.,� � �. ,x,.,: <r..,� N'�,sx,.:,xi,. ,a.:_;s✓<.,�o..F� � ..s>i..r �S �� �r �,.,,�/,sr;�i ,.a��,�2i„r� Diagnostic Laboratory and X-Ray $15 copay '- ? ram. i�a �- z ii --r :� .� ,� r:! f t.r�, U� /efj; ii" �,�?N S. l 3 s 5�.,. -3 .� �t -�:F .k sF%s e i,`:;,'j/ ! r .� P. �;�.ry .:i.f! .;.� a ey�C$ as ?.:s. �d r'C eyi. .�.%�. e ✓,..,rf �. ,. v...,.,ta ,v. ,.., „ru,� i :.A�.e ax „`. �..,.., �INE` f_.a,/,.; sic..,, n�, �'.,r137a; �+f,,.,,;., Lr.,, ✓.sz.,,,e.x ,o_rv„r-s ,: .,.fti ,a Urgent Care Provider $35 copay 11 ' 1 Room-, Worldwide (waived if admitted) $50copay Ambulance Covered 00%i)eril• • Inpatient Coverage Covered 100% The member cost sharing applies to covered benefits incurred during a member's inpatient stay. Outpatient Surgery Covered 100% The member cost sharing applies to covered benefits incurred during a member's outpatient visit. Inpatient Mental Illness Covered 100% The member cost sharing applies to covered benefits incurred during a member's inpatient. stay. Outpatient Mental Illness $15 copay The member cost sharing applies to covered benefits incurred during a member's outpatient visit. Inpatient Substance Abuse (Detox and Rehab) Covered 100% The member cost sharing applies to all covered benefits incurred during a member's inpatient stay. Outpatient Substance Abuse (Detox and Rehab) $15 copay The member cost sharing applies to covered benefits incurred during a member's outpatient visit. Skilled -Nursing Facility Covered 100% o (100 days per Medicare benefit period; prior authorization from HMO required) The member cost sharing applies to covered benefits incurred during a member's inpatient stay. Home Health Care Covered 100% Hospice Care Covered by Medicare at Medicare certified Hospice Outpatient Short -Term Therapy (speech, physical, cardiac $15 copay and occupational Chiropractic Care $15 copay For manual manipulation of the spine to the extent covered by Medicare Durable Medical Equipment/Prosthetic Devices Covered 100% Diabetic Supplies No copay for strips, lancets and glucometer M0001_7A 70650 Page 2 XAetTla Medicare City of Vernon - HMO MAPD Group Plan Aetna Medicare SM Plan (HMO) Medicare 5 Special Plan Rx Group 012 Arizona, California, Connecticut, Colorado, Delaware, District of Columbia, Florida, Georgia, Illinois_, Maryland, Maine, New Jersey, Nevada, New York, Ohio, Oklahoma, Pennsylvania, Tennessee, Texas, Virginia PLAN DESIGN AND BENEFITS PROVIDED BY AETNA HEALTH INC Outpatient Complex Radiology $15 copay Outpatient Dialysis $15 copay Dental * Discounts where available Vision Eyewear Allowance $70 reimbursement every 24 months Coaching Included One phone call per week Prescription drug calendar year deductible None Prescription drug calendar year deductible must be satisfied before any Medicare Prescription Drug benefits are paid. Covered Medicare Prescription Drug expenses will accumulate toward the pharmacy deductible. Retail - Cost -Sharing $10 Copay for Generic $20 Copay for Preferred Brand $35 Copay Non -Preferred Brand Up to one month (31 day) supply at indicated copay or coinsurance (Three month (90 day) supply available at retail. Dollar copayments or applicable coinsurance will apply for each month supply.) Mail Order through Aetna Rx Home Delivery - Cost- $20 Copay for Generic Sharing $40 Copay for Preferred Brand $70 Copay for Non -Preferred Brand Up to a three month (90 day) supply available via our preferred vendor, Aetna Rx Home Delivery. M00012A 70650 Page 3 )(Aetna: Medicare City of Vernon - HMO MAPD Group Plan Aetna Medicare SM Plan (HMO) Medicare 5 Special Plan Rx Group 012 Arizona, California, Connecticut, Colorado, Delaware, District of Columbia, Florida, Georgia, Illinois, Maryland, Maine, New Jersey, Nevada, New York, Ohio, Oklahoma, Pennsylvania, Tennessee, Texas, Virginia Catastrophic Coverage PLAN DESIGN AND BENEFITS PROVIDED BY AETNA HEALTH INC Greater of $2.50 or 5% for covered generic (including brand drugs treated as generic) drugs. Greater of $6.30 or 5% for all other covered drugs. Catastrophic Coverage benefits start once $4,550 in true out-of-pocket costs is incurred. Requirements: Precertification Yes Step -Therapy Yes Formulary Standard * Dental Riders are not available in the following service areas : DE01, ME01, NY03, VA01, and TX05 Please refer to the plan documents (Evidence of Coverage) for a complete listing of benefits, exclusions and limitations. The following is a partial listing of exclusions and limitations under the Aetna Medicare sM Plan (HMO): • All applicable services not referred by your network primary care doctor, except for services received as a result of an emergency or urgent situation; • Services that are not medically necessary or covered under the Original Medicare Program • Plastic or cosmetic surgery unless medically necessary • Custodial care • Experimental procedures or treatments beyond Original Medicare limits • Routine foot care that is not medically necessary • Drugs used for weight loss, weight gain or anorexia • Drugs used for cosmetic purposes or to promote hair growth • Prescription vitamins and mineral products, except prenatal vitamins and fluoride preparations • Barbiturates • Outpatient drugs that the manufacturer seeks to require that associated tests or monitoring services be purchased exclusively from the manufacturer as a condition of sale • Drugs used to promote fertility • Drugs used for symptomatic relief of cough and colds • Non-prescription drugs (OTC) • Benzodiazepines • Drugs when used for the treatment of sexual or erectile dysfunction M0001_7A_70650 Page 4 )(Ae1rla° Medicare City of Vernon - HMO MAPD Group Plan Aetna Medicare sM Plan (HMO) Medicare 5 Special Plan Rx Group 012 Arizona, California, Connecticut, Colorado, Delaware, District of Columbia, Florida, Georgia, Illinois, Maryland, Maine, New Jersey, Nevada, New York, Ohio, Oklahoma, Pennsylvania, Tennessee, Texas, Virginia PLAN DESIGN AND BENEFITS PROVIDED BY AETNA HEALTH INC This material is for informational purposes only. See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Aetna does not provide care or guarantee access to health services. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Health information programs provide general health information and are not a substitute for diagnosis 'or treatment by a physician or other health care professional. Discount Programs provide access to discounted prices and are not insured benefits. While this material is believed to. be accurate as of the print date, it is subject to change. Aetna receives rebates from drug manufacturers that may be taken into account in determining Aetna's Preferred Drug List. Rebates do not reduce the amount a member pays the pharmacy for covered prescriptions. Members must use network pharmacies to receive plan benefits except in limited, non -routine circumstances when a network pharmacy is not available, including illness while traveling within the United States but outside of the plan's service area where there is no network pharmacy. An additional cost may be incurred for drugs received at an out -of - network pharmacy. If an individual qualifies for extra help with the Medicare prescription drug plan, premium and costs at the pharmacy may be lower. Upon enrollment in the Aetna Medicare plan, Medicare will tell us how much extra help an individual is getting. An individual can obtain information on whether they qualify by calling 1-800-Medicare (1-800-633- 4227). TTY/TDD users should call 1-877-486-2048. Benefits coverage is provided by Aetna Health Inc., Aetna Health of California Inc. and/or Aetna Health of Illinois Inc., which are Medicare Advantage organizations with a Medicare contract and benefits, limitations, service areas and premiums subject to change on January 1 of each year You must be entitled to Medicare Part A and continue to pay your Part B premium and Part A, if applicable. You must use network providers except for emergent care or out -of -area urgent care/renal dialysis. If your primary physician is part of an integrated delivery system or physician group, your primary care physician will generally refer you to specialists and hospitals that are affiliated with the delivery system or physician group. ***This is the end of this plan benefit summary*** M0001_7A 70650 Page 5 City of Vernon - 2010 PFFS Group Plan X1 Aetna Medicare Aetna Medicare Open sM Plans Medicare 90 Open Plan Rx Group 012 National Service Area including Puerto Rico PLAN DESIGN AND BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY INC Deductible (per calendar year) $0 Deductible Unless otherwise indicated, the Deductible must be met prior to benefits being payable. Member Coinsurance 10% Applies to all expenses unless otherwise stated. Payment Limit (per calendar year) $2,000 Includes deductible. Certain other member cost sharing elements may not apply towards the Payment Limit. Lifetime Maximum Unlimited except for where otherwise indicated Primary Care Physician Selection Not Applicable Referral Requirements None One baseline mammogram for members 35-39; and'one annual mammogram for members age 40 and over Routine Digital Rectal Exams / Prostate Specific Antigen Covered100% Test For males age 40 and over. Colo-re-ctal Cancer Screening Covered 100% For all members 50 and over. Bone Density Testing Covered 100% Routine Eye Exam Covered 100% One annual exam. Routine Hearing Screening Covered 100% One (1) annual exam Hearing Aid Reimbursement Discounts where available Primary Care Physician Visits (Office hours) 10% (After Office Hours) 10% Specialist Office Visits 10% H5736_7F_70614 Prepared: 10/16/200911:49 AM Pagel M XAetna Medicare City of Vernon - 2010 PFFS Group Plan Aetna Medicare Open SM Plans Medicare 90 Open Plan Rx Group 012 National Service Area including Puerto Rico PLAN DESIGN AND BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY INC Allergy Testing/Treatment 10% For initial testing by a specialist; with or without physician encounter Laboratory and 10% The member cost sharing applies to covered benefits incurred during a member's outpatient visit. Inpatient Substance Abuse (Detox and Rehab) 10% The member cost sharing applies to all covered benefits incurred during a member's inpatient stay. Outpatient Substance Abuse (Detox and Rehab) 10% The member cost sharing applies to covered benefits incurred during a member's outpatient visit. Skilled Nursing Facility 0% per day - days 1-20; 10% per day - days 21-100 (100 days per Medicare benefit period) The member cost sharing applies to covered benefits incurred during a member's inpatient stay. Home Health Care Covered 100% Hospice Care Covered by Medicare at a Medicare certified hospice Outpatient Short -Term Therapy (speech, physical, cardiac 10% and occupational) Chiropractic Care 10% For manual manipulation of the spine to the extent covered by Medicare Durable Medical Equipment/Prosthetic Devices 10% H5736_7F_70614 Prepared: 10/16/200911:49 AM Page 2 City of Vernon - 2010 PFFS Group Plan, XAetm M ed Ica re Aetna Medicare Open sM Plans Medicare 90 Open Plan Rx Group 012 National Service Area including Puerto Rico PLAN DESIGN AND BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY INC Podiatry 10% Limited to Medicare covered benefits only Diabetic Supplies Covered 100% Includes test strips, lancets and glucometer Outpatient Complex Radiology 10% Outpatient Dialysis 10% Prescription drug calendar year deductible must be satisfied before any Medicare Prescription Drug benefits are paid. Covered Medicare Prescription Drug expenses will accumulate toward the pharmacy deductible. Retail - Cost -Sharing $10 Copay for Generic $20 Copay for Preferred Brand $35 Copay Non -Preferred Brand Up to one month (31 day) supply at indicated copay or coinsurance (Three month (90 day) supply available at retail. Dollar copayments or applicable coinsurance will apply for each month supply.) H5736_7F_70614 Prepared: 10/16/200911:49 AM Page 3 M XAetna° Medicare City of Vernon - 2010 PFFS Group Plan Aetna Medicare Open SM Plans Medicare 90 Open Plan Rx Group 012 National Service Area including Puerto Rico PLAN DESIGN AND BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY INC Mail Order through Aetna Rx Home Delivery - Cost- $20 Copay for Generic Sharing $40 Copay for Preferred Brand $70 Copay for Non -Preferred Brand Up to a three month (90 day) supply available via our preferred vendor, Aetna Rx Home Delivery. Catastrophic Coverage Greater of $2.50 or 5% for covered generic (including brand drugs treated as generic) drugs. Greater of $6.30 or 5% for all other covered drugs. Catastrophic Coverage benefits start once $4,550 in true out-of-pocket costs is incurred. Requirements: Precertification Yes Step -Therapy Yes Formulary Standard Please refer to the plan documents (Evidence of Coverage) for a complete listing of benefits, exclusions and limitations. The following is a partial listing of exclusions and limitations under the Aetna Medicare Open Plan: • "Services that are not medically necessary or covered under the Original Medicare Program unless otherwise noted • Plastic or cosmetic surgery unless medically necessary • Custodial care • Experimental procedures or treatments beyond Original Medicare limits • Routine foot care that is not medically necessary • Drugs used for weight loss, weight gain or anorexia • Drugs used for cosmetic purposes or to promote hair growth • Prescription vitamins and mineral products, except prenatal vitamins and fluoride preparations • Barbiturates • Outpatient drugs that the manufacturer seeks to require that associated tests or monitoring services be purchased exclusively from the manufacturer as a condition of sale • Drugs used to promote fertility • Drugs used for symptomatic relief of cough and colds • Non-prescription drugs (OTC) H5736_7F_70614 Prepared: 10/16/200911:49 AM Page 4 XiAetna° Medicare - Benzodiazepines City of Vernon - 2010 PFFS Group Plan Aetna Medicare Open sM Plans Medicare 90 Open Plan Rx Group 012 National Service Area including Puerto Rico PLAN DESIGN AND BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY INC - Drugs when used for the treatment of sexual or erectile dysfunction This material is for informational purposes only. See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Aetna does not provide care or guarantee access to health services. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Discount Programs provide access to discounted prices and are not insured benefits. VAhile this material is believed to be accurate as of the print date, it is subject to change. Members must use network pharmacies to receive plan benefits except in limited, non -routine circumstances when a network pharmacy is not available, including illness while traveling within the United States but outside of the plan's service area where there is no network pharmacy. An additional cost may be incurred for drugs received at an out -of - network pharmacy. If an individual qualifies for extra help with the Medicare prescription drug plan, premium and costs at the pharmacy may be lower. Upon enrollment in the Aetna Medicare plan, Medicare will tell us how much extra help an individual is getting. An individual can obtain information on whether they qualify by calling 1-800-Medicare (1-800-633- 4227). TTY/TDD users should call 1-877-486-2048. Benefits coverage is provided by Aetna Life Insurance Company, a Medicare Advantage organization, with a Medicare contract and benefits, limitations, service areas and premiums subject to change on January 1 of each year. You can receive covered services from any licensed doctor or hospital that is eligible to receive payment from Medicare, agrees to treat you and accepts the Aetna Medicare Open Plan private fee -for -service terms and conditions of payment. This product does not require a contracted network. You must be entitled to Medicare Part A and continuetopay your Part B premium and Part A, if applicable. A Medicare Advantage Private Fee -for -Service plan works differently than a Medicare supplement plan. Your doctor or hospital must agree to accept the plan's terms and conditions prior to providing healthcare services to you, with the exception of emergencies. If your doctor or hospital does not agree to accept our payment terms and conditions, they may not provide healthcare services to you, except in emergencies. Providers can find the plan's terms and conditions on our website at: www.aetna.com ***This is the end of this plan benefit summary*** H5736_7F_70614 Prepared: 10/16/200911:49 AM Page 5 City of Vernon - 2010 Medicare Advantage Renewal Increase Summary Based on Current Enrollment PFFS Group Plan Enrolled Rate Band MDCR members Current Rate Renewal Rate Rate Inc. II 1 $234.80 $293.40 25.0% III 8 $289.80 $342.90 18.3% VI 31 $383.10 $440.80 15.1 % VI I 1 $381.70 $534.90 40.1 % National Avg 16.4% HMO MAPD Group Plan Enrolled State/Serv. Area MDCR members Current Rate California/ CA02 13 $150.80 Nevada/ NV01 1 $239.68 Renewal Rate Rate Inc. $151.20 0.3% $274.62 14.6% National Avg 1.8% 71 c O U W a`o Q c_ NU _p !t U a N N N w N N CL C O y. N C N r7 O G 'O O � d U C 0 '- O N T 8cn N W N l0 EaN N Ol t W �0 � C wg V N C N C N M r+ O m a ayi c C N C T M E m d d 10 T D a > FL- v c Q N CL c�p N U OI C > Cn ID Ip L N (1 N (p (D C CL V > N O N O Ep°��' c vi dti t O N y C O E m m E N u E �s - N N N N O � X V C a) MD � T 7 �'NO C N 7 I CITY CLERK'S OFFICE INTEROFFICE MEMORANDUM DATE: November 10, 2009 TO: illard Yamaguchi, Chief Deputy City Attorney/Risk Manager FROM: Nelly Giron, City Clerk RE: Resolution No. 10,097 A Resolution of the City Council of the City of Vernon Approving the Renewal of Health Care Benefits for Retired Employees for the Calendar Year 2010 With Aetna Health Inc. and Aetna Life Insurance Company Inc. Transmitted herewith is a copy of Resolution No. 10,097 referenced above, which was approved by City Council on November 9, 2009 Thank you. NG : di c: Resolution Nos. 9756, 9757, 10,097 Agreement No. 09-018