Resolution No. 10096RESOLUTION NO. 10,096
A RESOLUTION OF THE CITY COUNCIL OF THE CITY
OF VERNON APPROVING THE RENEWAL OF HEALTH CARE
BENEFITS FOR ACTIVE EMPLOYEES, IDENTIFIED
CONSULTANTS, AND CITY COUNCIL MEMBERS FOR THE
CALENDAR YEAR 2010 FROM AETNA HEALTH OF
CALIFORNIA 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 of California 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
6.1% for medical benefits for HMO (an additional $100,568.00 per
year) and an increase of 10.1% for medical benefits for Open
Access Managed Choice POS (PPO) (an additional $215,801.00 per
year) for active employees; and
WHEREAS, the rates for City Council member benefits
shall remain the same; and
WHEREAS, Aetna Health of California Inc. has offered the
City a Health Maintenance Organization plan (HMO) and Open Access
Managed Choice POS (PPO) plan for the period of January 1, 2010
through December 31, 2010, for a one (1) year term; and
WHEREAS, the Risk Manager has recommended that the City
renew medical benefits for active employees, identified
consultants and City Council members for the calendar year 2010
based on an approximate annual premium for HMO of $1,749,0.54.00
and an approximate annual premium for PPO of $2,352,361.00, and an
approximate annual premium for City Council of $296,519.00; and
WHEREAS, the annual premiums cited herein are
approximate because they are based on employees, enrollment
choices in 2009 and may change if enrollees switch plans during
open enrollment in 2010; 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 of medical benefits with Aetna Health
of California Inc. and Aetna Life Insurance Company Inc. for
active employees, identified consultants and City Council members
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.
ATTEST:
i�EUELA- GIRON, C y Clerk
Name: Hilario Gonzales
Title: Mayorer—
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.
10,096, 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 Mayor Pro-Tem of the City of Vernon.
j�,�
Executed this/6 'k day of November, 2009, at Vernon,
California.
(SEAL)
MANUELA GIRON, Ci�tyC 1 �er
- 4 -
EXHIBIT A
City of Vernon
Effective date: 01-01-2010
Open Access® Managed Choice® POS - California
PLAN DESIGN & BENEFITS
PROVIDED BY AETNA LIFE INSURANCE COMPANY
Deductible (per calendar year) $500 Individual $500 Individual
$1,000 Family $1,000 Family
All covered expenses, excluding prescription drugs, accumulate separately toward the preferred or non -preferred
Deductible.
Unless otherwise indicated, the Deductible must be met prior to benefits being payable.
Once Family Deductible is met, all family members will be considered as having met their Deductible for the remainder
of the calendar year.
Applies to all expenses unless otherwise stated.
Payment Limit (per calendar year) $2,000 Individual $5,000 Individual
$4,000 Family $10,000 Family
All covered expenses, excluding prescription drugs, accumulate separately toward the preferred or non -preferred
Payment Limit.
Certain member cost sharing elements may not apply toward the Payment Limit.
Only those out-of-pocket expenses resulting from the application of coinsurance percentage (except any deductibles,
and penalty amounts) may be used to satisfy the Payment Limit.
Once Family Payment Limit is met, all family members will be considered as having met their Payment Limit for the
remainder of the calendar year.
Lifetime Maximum
Primary Care Physician Selection Optional Not applicable
Certification Requirements -
Certification for certain types of Non -Preferred care must be obtained to avoid a reduction in benefits paid for that care.
Certification for Hospital Admissions, Treatment Facility Admissions, Convalescent Facility Admissions, Home Health
Care, Hospice Care and Private Duty Nursing is required - excluded amount applied separately to each type of
expense is $400 per occurrence.
Precertification for certain procedures/treatments - excluded amount is $200 per occurrence
Referral Re 2
uirement None None
Routine Adult Physical Exams/ $10 office visit copay; deductible 40%
Immunizations waived
1 exam every 12 months for members age 18 and older.
Routine Well Child Exams/Immunizations $10 office visit copay; deductible 40%
waived
7 exams in the first 12 months of life, 2 exams in the 13th-24th months of life; 1 exam per 12 months thereafter to age
18.
Routine Gynecological Care Exams Covered 100%; deductible waived 40%
One exam per calendar year. Includes routine tests and related lab fees.
Members may choose obstetrician/gynecologist as PCPs
Routine Mammograms Covered 100%; deductible waived 40%
One baseline mammogram for covered females age 35-39, one mammogram per calendar year for covered females
age 40 and over.
Routine Digital Rectal Exam Member cost sharing is based on Member cost sharing is based on
For covered males age 40 and over. the type of service performed and the type of service performed and
the place of service where it is the place of service where it is
rendered; deductible waived rendered.
Prostate -specific Antigen Test Member cost sharing is based on Member cost sharing is based on
For covered males age 40 and over. the type of service performed and the type of service performed and
the place of service where it is the place of service where it is
rendered; deductible waived rendered.
Prepared: 09/11/2007 05:51 PM Page 1
City of Vernon
Effective date: 01-01-2010
Open Access® Managed Choice® POS - California
PLAN DESIGN & BENEFITS
PROVIDED BY AETNA LIFE INSURANCE COMPANY
Colorectal Cancer Screening Member cost sharing is based on Member cost sharing is based on
For all members age 50 and over. the type of service performed and the type of service performed and
the place of service where it is the place of service where it is
rendered rendered
Routine Eye Exams Not Covered Not Covered
Office Visits to PCP
$10 office visit copay; deductible
40%
waived
Includes services of an internist,
general physician, family practitioner or pediatrician
Specialist Office Visits
$10 office visit copay; deductible
40%
waived
Allergy Testing
Member cost sharing is based on
Member cost sharing is based on
the type of service performed and
the type of service performed and
the place of service where it is
the place of service where it is
rendered; deductible waived
rendered
Allergy Injections
Member cost sharing is based on
Member cost sharing is based on
the type of service performed and
the type of service performed and
the place of service where it is
the place of service where it is
rendered
rendered
Diagnostic Laboratory and X-ray 10% 40%
(other than Complex Imaging Services)
If performed as a part of a physician office visit and billed by the physician, expenses are covered subject to the
applicable physician's office visit member cost sharing
Diagnostic X-ray for Complex Imaging 10% 40%
Urgent Care Provider 10% after $25 copay 10% after $25 Copay
(benefit availability may vary by location)
Non -Urgent Use of Urgent Care Provider Not Covered Not Covered
Emergency Room 10% after $25 copay; deductible Same as preferred care.
waived
Non -Emergency Care in an Emergency Not Covered Not Covered
Room
Ambulance 10% 40%
Inpatient -Coverage 10% - 40%
The member cost sharing applies to all covered benefits incurred during a member's inpatient stay.
Inpatient Maternity Coverage 10% 40%
The member cost sharing applies to all covered benefits incurred during a member's inpatient stay.
Outpatient Hospital Expenses (including 10% 40%
surgery)
The member cost sharing applies to all covered benefits incurred during a member's outpatient visit.
Inpatient 10% 40%
The member cost sharing applies to all covered benefits incurred during a member's inpatient stay.
Outpatient $10 copay; deductible waived 40%
The member cost sharing applies to all covered benefits incurred during a member's outpatient visit
Inpatient 10% 40%
The member cost sharing applies to all covered benefits incurred during a member's inpatient stay.
Prepared: 09/11/2007 05:51 PM Page 2
City of Vernon
Effective date: 01-01-2010
Open Access® Managed Choice® POS - California
PLAN DESIGN & BENEFITS
PROVIDED BY AETNA LIFE INSURANCE COMPANY
Outpatient $10 copay; deductible waived 40%
The member cost sharing applies to all covered benefits incurred
Convalescent Facility
10%
40%
Limited to 120 days per calendar year
The member cost sharing applies to all covered benefits incurring during a member's inpatient stay.
Home Health Care
10%
40%
Limited to 120 visits per calendar year
Each visit by a nurse or therapist is one visit. Each visit up to 4 hours by a home health care aide is one visit.
Hospice Care - Inpatient
10%
40%
The member cost sharing applies to all covered benefits incurred during a member's inpatient stay.
Hospice Care - Outpatient
10%
40%
Up to a maximum benefit of $5,000
The member cost sharing applies to all covered benefits incurred during a member's outpatient visit.
Private Duty Nursing -Outpatient (Limited to
10%
40%
70 eight hour shifts per calendar year)
Each period of private duty nursing of up to 8 hours will be deemed to be one private duty nursing shift.
Outpatient Short -Term Rehabilitation
$10 copay; deductible waived
40%
Includes Speech, Physical, Occupational, and Spinal Manipulation Therapy, limited to 60 visits per calendar year
Durable Medical Equipment
10%
40%
Maximum annual benefit of $10,000 per member per calendar year
Diabetic Supplies -- (if not covered under
Covered same as any other
Covered same as any other
Pharmacy benefit)
medical expense.
medical expense.
Contraceptive drugs and devices not
Covered same as any other
Covered same as any other
obtainable at a pharmacy (includes
medical expense.
medical expense.
coverage for contraceptive visits)
Vision Eyewear
Not Covered
Same as preferred care
Transplants
10%
40%
Preferred coverage is provided at
Non -Preferred coverage is
an IOE contracted facility only
provided at a Non-IOE facility.
Bariatric Surgery
Not Covered
Not Covered
The member cost sharing applies to all covered benefits incurred during a member's inpatient stay.
Out of Area Dependents Coverage provided at the non -preferred benefit level of the plan.
Infertility Treatment Member cost sharing is based on Member cost sharing is based on
the type of service performed and the type of service performed and
the place of service where it is the place of service where it is
rendered rendered
Diagnosis and treatment of the underlying medical condition.
Comprehensive Infertility Services Not Covered Not Covered
Advanced Reproductive Technology (ART) Not Covered Not Covered
ART coverage includes: In vitro fertilization (IVF), zygote intra-fallopian transfer (ZIFT), gamete intrafallopian transfer
(GIFT), cryopreserved embryo transfers, intracytoplasmic sperm injection (ICSI) or ovum microsurgery.
Prepared: 09/11/2007 05:51 PM Page 3
City of Vernon
Effective date: 01-01-2010
Open Access® Managed Choice® POS - California
PLAN DESIGN & BENEFITS
PROVIDED BY AETNA LIFE INSURANCE COMPANY
Voluntary Sterilization
Member cost sharing is based on
. Member cost sharing is based on
Including tubal ligation and vasectomy.
the type of service performed and
the type of service performed and
the place of service where it is
the place of service where it is
rendered
rendered
NZIMINEM
Retail
$5 copay for generic drugs and
$15 copay for brand -name drugs
up to a 30 day supply at
participating pharmacies.
Mail Order
$10 copay for generic drugs and
Not applicable
$30 copay for brand -name drugs
up to a 31-90 day supply from
Aetna Rx Home Delivery®.
No Mandatory Generic (NO MG) - Member is responsible to pay the applicable copay only.
Plan Includes: Diabetic supplies, Contraceptive drugs and devices obtainable from a pharmacy and Performance
Enhancing Medication.
Precert for growth hormones included.
Expanded Precert included
Dependents Eligibility Spouse, children from birth to age 19 or age 23 if in school
Pre-existing Conditions Exclusion On effective date: Waived
After effective date: Waived
This plan does not cover all health care expenses and includes exclusions and limitations. Members should refer to
their plan documents to determine which health care services are covered and to what extent. The following is a partial
list of services and supplies that are generally not covered. However, your plan documents may contain exceptions to
this list based on state mandates or the plan design or rider(s) purchased by your employer.
All medical or hospital services not specifically covered in, or which are limited or excluded in the plan documents;
Charges related to any eye surgery mainly to correct refractive errors; Cosmetic surgery, including breast reduction;
Custodial care; Dental care and X-rays; Donor egg retrieval; Experimental and investigational procedures; Hearing
aids; Immunizations for travel or work; Infertility services, including, but not limited to, artificial insemination and
advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI and other related services, unless specifically listed
as covered in your plan documents;
Nonmedically necessary services or supplies; Orthotics; Over-the-counter medications and supplies; Reversal of
sterilization; Services for the treatment of sexual dysfunction or inadequacies,, including therapy, supplies, or
counseling; and special duty nursing. Weight control services including surgical procedures, medical treatments, weight
control/loss programs, dietary regimens and supplements, appetite suppressants and other medications; food or food
supplements, exercise programs, exercise or other equipment; and other services and supplies that are primarily
intended to control weight or treat obesity, including Morbid Obesity, or for the purpose of weight reduction, regardless
of the existence of comorbid conditions.
This material is for informational purposes only and is neither an offer of coverage nor medical advice. It contains only
a partial, general description of plan benefits or programs and does not constitute a contract. Aetna does not provide
health care services and, therefore, cannot guarantee results or outcomes. Consult the plan documents (i.e. Group
Insurance Certificate and/or Group Policy) to determine governing contractual provisions, including procedures,
exclusions and limitation relating to the plan. With the exception of Aetna Rx Home Delivery, all preferred providers
and vendors are independent contractors in private practice and are neither employees nor agents of Aetna or its
affiliates. Aetna Rx Home Delivery, LLC, is a subsidiary of Aetna Inc. The availability of any particular provider cannot
be guaranteed, and provider network composition is subject to change without notice.
Prepared: 09/11/2007 05:51 PM Page 4
City of Vernon
Effective date: 01-01-2010
Open Access® Managed Choice® POS - California
PLAN DESIGN & BENEFITS
PROVIDED BY AETNA LIFE INSURANCE COMPANY
Some benefits are subject to limitations or visit maximums. Certain services require precertification, or prior approval of
coverage. Failure to precertify for these services may lead to substantially reduced benefits or denial of coverage.
Some of the benefits requiring precertification may include, but are not limited to, inpatient hospital, inpatient mental
health, inpatient skilled nursing, outpatient surgery, substance abuse (detoxification, inpatient and outpatient
rehabilitation). When the Member's preferred provider is coordinating care, the preferred provider will obtain the
precertification. When the member utilizes a non -preferred provider, Member must obtain the precertification.
Precertification requirements may vary. Depending on the plan selected, new prescription drugs not yet reviewed by
our medication review committee are either available under plans with an open formulary or excluded from coverage
unless a medical exception is obtained under plans that use a closed formulary. They may also be subject to
precertification or step -therapy. Non-prescription drugs and drugs in the Limitations and Exclusions section of the plan
documents (received after open enrollment) are not covered, and medical exceptions are not available for them. While
this information is believed to be accurate as of the print date, it is subject to change.
Plans are provided by Aetna Life Insurance Company.
Prepared: 09/11/2007 05:51 PM Page 5
City of Vernon
Effective date: 01-01-2010
HMO - California
PLAN DESIGN AND BENEFITS
PROVIDED BY AETNA HEALTH OF CALIFORNIA INC. - FULL RISK
Routine Adult Physical Exams / Immunizations
$20 copay
(Age and frequency schedules apply)
Well Child Exams / Immunizations
$20 copay
(Age and frequency schedules apply)
Routine Gynecological Care Exams
$20 copay
Includes Pap smear, HPV screening, and related lab fees.
Direct access to participating providers without a referral.
Members may choose ob/gyns as PCPs:
One exam per calendar year.
Routine Mammograms
$20 copay
One baseline mammogram for females age 35-39; and one annual
mammogram for females age 40 and over
Routine Digital Rectal Exams / Prostate Specific Antigen
Member cost sharing is based on the type of service
Test
performed and the place of service where it is
For males age 40 and over
rendered.
Colorectal Cancer Screening
Member cost sharing is based on the type of service
For all members 50 and over.
performed and the place of service where it is
Frequency schedule applies
rendered.
Routine Eye Exam
Not Covered
Age/Frequency Schedule may apply.
Routine Hearing Screening Subiect to Routine Phvsical Exam cost sharina
Primary Care Physician Visits Office Hours: $20 copay
After Office Hours/Home: $25 copay
Specialist Office Visits $20 copay
Maternity OB Visits $20 copay for initial visit only, thereafter covered 1000/o
Allergy Treatment Same as applicable participating provider office visit
member cost sharing
Allergy Testing Same as applicable participating provider office visit
member cost sharing
Diagnostic Laboratory $20 copay
If performed as a part of a physician's office visit and billed by the physician, expenses are covered subject to the
applicable physician's office visit cost sharing.
Prepared: 09/11/2007 05:51 PM Page 1
City of Vernon
Effective date: 01-01-2010
HMO - California
PLAN DESIGN AND BENEFITS
PROVIDED BY AETNA HEALTH OF CALIFORNIA INC. - FULL RISK
Diagnostic X-ray $20 copay
Outpatient hospital or other Outpatient facility
(except for Complex Imaaina Services)
Diagnostic X-rav for Complex Imaaina Services $20 copav
Urgent Care $100 copay
Non -Urgent use of Urgent Care Provider Not Covered
Emeraencv Room $100 copav
-Emergency Care in an Emergency Room Not Covered
_Non
"Ambulance
Covered 100%
Inpatient Coverage
Covered 100% per admission
The member cost sharing applies
to all covered benefits incurred during a member's inpatient stay.
Inpatient Maternity Coverage Covered 100% per admission
The member cost sharing applies
to all covered benefits incurred during a member's inpatient stay.
Outpatient Surgery
Covered 100% per visit
The member cost sharino aeRlies
to all covered benefits incurred durin a member's out atient visit.
Inpatient Serious Mental Illness and Serious Emotional Covered 100% per admission
Disturbances of a Child
The member cost sharing applies
to all covered benefits incurred during a member's inpatient stay.
Inpatient Non -Serious Mental Illness Covered 100% per admission
Limited to 30 days per calendar year
The member cost sharing applies
to all covered benefits incurred during a member's inpatient stay.
Outpatient Serious Mental Illness and Serious Emotional $20 copay per visit
Disturbances of a Child
The member cost sharing applies
to all covered benefits incurred during a member's outpatient visit.
Outpatient Non -Serious Mental Illness $20 copay per visit
Limited to 20 visits per calendar year
The member cost sharin a
lies to all covered benefits incurred durin a member's out atient visit.
Inpatient Detoxification
Covered 100% per admission
The member cost sharing applies
to all covered benefits incurred during a member's inpatient stay.
Outpatient Detoxification
$20 copay
The member cost sharing applies
to all covered benefits incurred during a member's outpatient visit.
Inpatient Rehabilitation
Covered 100% per admission
The member cost sharing applies
to all covered benefits incurred during a member's inpatient stay.
-Outpatient Rehabilitation
$20 copay
The member cost sharin a
lies to all covered benefits incurred during a member's outpatient visit.
Skilled Nursing Facility
Covered 100% per admission
The member cost sharing applies
to all covered benefits incurred during a member's inpatient stay.
Home Health Care
Covered 100%
Hospice Care - Inpatient
Covered 100% per admission
The member cost sharing applies
to all covered benefits incurred during a member's inpatient stay.
Hospice Care - Outpatient
Covered 100%
The member cost sharina applies to all covered benefits incurred durina a member's outpatient visit.
Private Duty Nursing Not Covered unless pre -authorized
Outpatient Rehabilitation Therapy (includes speech, $20 copay
physical and occupational therapy)
Treatment over a 60-day consecutive period per incident of
illness or injury beginning with the first day of treatment.
Prepared: 09/11/2007 05:51 PM Page 2
City of Vernon
Effective date: 01-01-2010
HMO - California
PLAN DESIGN AND BENEFITS
PROVIDED BY AETNA HEALTH OF CALIFORNIA INC. - FULL RISK
Subluxation $15 copay
Direct access to participating providers without a referral.
Limited to 20 visits per calendar year
Durable Medical Equipment 20%
Limited to $10,000 per calendar year
Diabetic Supplies Pharmacy cost sharing applies if Pharmacy coverage
is included; otherwise PCP office visit cost sharing
applies.
Dental Not Covered
Vision Eyewear Not Covered
Transplants Covered 100% per admission
Coverage is provided at an IOE contracted facility only
Barlatric Surgery Covered 100% per admission
The member cost sharing applies to all covered benefits incurred during a member's inpatient stay.
Infertility Treatment Member cost sharing is based on the type of service
Diagnosis and treatment of the underlying medical condition. performed and the place of service where it is
rendered.
Comprehensive Infertility Services Not Covered
Coverage includes Artificial Insemination and Ovulation Induction
Advanced Reproductive Technology (ART) Not Covered
ART coverage includes In -Vitro Fertilization (IVF), Zygote Intra-Fallopian Transfer (ZIFT), Gamete lntra-Fallopian
Transfer (GIFT), cryopreserved embryo transfers, Intra-Cytoplasmic Sperm Injection (ICSI) or ovum microsurgery.
Voluntary Sterilization Subject to applicable service type member cost sharing
Including tubal ligation and vasectomy.
Retail $15 copay for formulary generic drugs, $35 copay for
formulary brand -name drugs, and $50 copay for non -
formulary brand -name and generic drugs up to a 30
day supply at participating pharmacies.
Mail Order $30 copay for formulary generic drugs, $70 copay for
formulary brand -name drugs, and $100 copay for non -
formulary brand -name and generic drugs up to a 31-90
day supply from Aetna Rx Home Delivery®.
Pharmacy Managed Self lnjectables (PMSI)
First prescription fill at any retail or mail order drug facility. Subsequent fills must be through Aetna Specialty
Pharmacy®
-No-Mandatory Generic (NO MG) - Member is responsible to Dav the apDlicable coDav only.
Plan Includes : Contraceptive drugs and devices obtainable from a pharmacy and Performance Enhancing
Medication.
Precert included
Step Therapy included with 90 day Transition of Care
Exclusions and Limitations
*"For this plan, "participating providers" refers to the Aetna Value Network participating providers. For any questions or
concerns about accessing and obtaining services from Aetna Value Network specialty physicians, please call Member
Services at 1-888-98-AETNA (1-888-982-3862).
This plan does not cover all health care expenses and includes exclusions and limitations. Members should refer to
their plan documents to determine which health care services are covered and to what extent. The following is a partial
list of services and supplies that are generally not covered. However, your plan documents may contain exceptions to
this list based on state mandates or the plan design or rider(s) purchased.
Prepared: 09/11/2007 05:51 PM Page 3
i
City of Vernon
Effective date: 01-01-2010
HMO - California
PLAN DESIGN AND BENEFITS
PROVIDED BY AETNA HEALTH OF CALIFORNIA INC. - FULL RISK
• All medical and hospital services not specifically covered in, or which are limited or excluded by your plan documents,
including costs of services before coverage begins and after coverage terminates.
• Cosmetic surgery.
• Custodial care.
• Dental care and dental x-rays.
-Donor egg retrieval.
• Durable medical equipment.
• Experimental and investigational procedures, (except for coverage for medically necessary routine patient care costs
for Members participating in a cancer clinical trial).
• Hearing aids.
• Home births
• Immunizations for travel or work
• Implantable drugs and certain injectable drugs including injectable infertility drugs.
• Infertility services including, but not limited to, artificial insemination and advanced reproductive technologies such as
IVF, ZIFT, GIFT, ICSI and other related services unless specifically listed as covered in your plan documents.
• Nonmedically necessary services or supplies.
• Outpatient prescription drugs (except for treatment of diabetes), unless covered by a prescription plan rider and over-
the-counter medications (except as provided in a hospital) and supplies
• Radial keratotomy or related procedures.
• Reversal of sterilization.
• Services for the treatment of sexual dysfunction or inadequacies including therapy, supplies or counseling.
• Special duty nursing.
• Therapy or rehabilitation other than those listed as covered in the plan documents.
This material is for informational purposes only and is neither an offer of coverage nor medical advice. It contains only a
partial, general description of plan benefits or programs and does not constitute a contract. Aetna does not provide
health care services and therefore, cannot guarantee any results or outcomes. Consult the plan document (i.e.
Schedule of Benefits, Certificate of Coverage, Evidence of Coverage, Group Agreement, Group Insurance Certificate
and/or Group Policy) to determine governing contractual provisions, including procedures, exclusions and limitations
relating to the plan. The availability of a plan or program may vary by geographic service area. Some benefits are
subject to limitations or visit maximums. With the exception of Aetna Rx Home Delivery, all participating physicians,
hospitals and other health care providers are independent contractors and are neither agents nor employees of Aetna.
The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change.
Notice of the change shall be provided in accordance with applicable state law.
Aetna Pharmacy Management refers to an internal business unit of Aetna Health Management, LLC. If your plan
covers outpatient prescription drugs, your plan may include a drug formulary (preferred drug list). A formulary is a list of
prescription drugs generally covered under your prescription drug benefits plan on a preferred basis subject to
applicable limitations and conditions. Your pharmacy benefit is generally not limited to the drugs listed on the formulary.
The medications listed on the formulary are subject to change in accordance with applicable state law. For information
regarding how medications are reviewed and selected for the formulary, formulary information, and information about
other pharmacy programs such as precertification and step -therapy, please refer to Aetna's website at www.aetna.com,
or the Aetna Medication Formulary Guide. Many drugs, including many of those listed on the formulary, are subject to
rebate arrangements between Aetna and the manufacturer of the drugs. Rebates received by Aetna from drug
manufacturers are not reflected in the cost paid by a member for a prescription drug.
Prepared: 09/11/2007 05:51 PM Page 4
City of Vernon
Effective date: 01-01-2010
HMO - California
PLAN DESIGN AND BENEFITS
PROVIDED BY AETNA HEALTH OF CALIFORNIA INC. - FULL RISK
In addition, in circumstances where your prescription plan utilizes copayments or coinsurance calculated on a
percentage basis or a deductible, use of formulary drugs may not necessarily result in lower costs for the member.
Members should consult with their treating physicians regarding questions about specific medications. Refer to your
plan documents or contact Member Services for information regarding the terms and limitations of coverage. Aetna Rx
Home Delivery® refers to Aetna Rx Home Delivery, LLC, a subsidiary of Aetna Inc., that is a licensed pharmacy
providing mail-order pharmacy services. Aetna's negotiated charge with Aetna Rx Home Delivery may be higher than
Aetna Rx Home Delivery's cost of purchasing drugs and providing mail-order pharmacy services.
Certain primary care providers are affiliated with integrated delivery systems or other provider groups (such as
independent practice associations and physician -hospital organizations), and members who select these providers will
generally be referred to specialists and hospitals within those systems or groups. However, if a system or group does
not include a provider qualified to meet member's medical needs, member may request to have services provided by a
non -system or non -group providers. Member's request will be reviewed and will require prior authorization from the
system or group and/or Aetna to be a covered benefit.
Certain services require precertification, or prior approval of coverage. Failure to precertify for these services may lead
to substantially reduced benefits or denial of coverage.
Some of the benefits requiring precertification may include, but are not limited to, inpatient hospital, inpatient mental
health, inpatient skilled nursing, outpatient surgery, substance abuse (detoxification), inpatient and outpatient
rehabilitation). When the Member obtains covered services from participating providers, the provider will obtain
precertification. If the Member obtains covered services from a nonparticipating provider, the Member must obtain the
precertification. Precertification requirements may vary. Members may refer to their plan documents for a complete list
of medical services that require precertification. Certain benefits like comprehensive infertility and advanced
reproductive technology (ART) services, if covered under your plan, are subject to a select network of participating
providers, from which you will be required to seek care to receive covered benefits.
Members or providers may be required to precertify, or obtain prior approval of coverage for certain services such as
non -emergency inpatient hospital care. Certain benefits like comprehensive infertility and advanced reproduction
technology (ART) services, if covered under your plan, are subject to a select network of participating providers, from
which you will be required to seek care to receive covered benefits.
Prepared: 09/11/2007 05:51 PM Page 5
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3
CITY CLERK'S OFFICE
INTEROFFICE MEMORANDUM
DATE: November 10, 2009
TO: Willard Yamaguchi, Chief Deputy City Attorney/Risk Manager
FROM: Nelly Giron, City Clerk
RE: Resolution No. 10,096 - A Resolution of the City Council of
the City of Vernon Approving the Renewal of Health Care
Benefits for Active Employees, Identified Consultants, and
City Council Members for the Calendar Year 2010 From Aetna
Health of California Inc. and Aetna Life Insurance Company
Inc.
Transmitted herewith is a copy of Resolution No. 10,096 referenced
above, which was approved by City Council on November 9, 2009.
Thank you.
NG : dj
c: Resolution No. 9834, 10,096
Agreement No. 09-018
APPROVED NOVO9 '09 CITY COUNCIL.
RO V 0 3 2009
LERKS OFFICE Staff Report
Risk Management
DA: November 3, 2009
Qr
TO: Honorable Mayor and City Council
FR: Willard G. Yamaguchi, Risk Manager rr';
RE: Aetna Medical Insurance Renewal 2010 v�
Active Employees, Identified Consultants, and City Council Members
Agenda Item for November 9, 2009
Our insurance broker for medical benefits, Arthur J. Gallagher, solicited bids from Aetna,
Vernon's current provider, CIGNA, and United Health Care ("UHC") for active employees and
retirees. Upon review of said bids, Risk Management recommends the renewal of the Aetna
medical insurance benefit package for active employees, identified consultants, and city council
members with no change in benefits at a cost of $4,397,934. This represents an increase of
$316,368, or 7.8% over 2009.
Fiscal Impact
The cost for medical, dental and basic life premiums for active employees, identified consultants,
and city council members is $4,397,934. $5,500,000 has been budgeted for this expenditure.
Recommendation
Risk Management recommends the renewal of the Aetna medical insurance benefit package for
active employees, identified consultants, and city council members with no change in benefits at
a cost of $4,397,934.
cc: Donal O'Callaghan
C EIVED
NOV 0 3 2009
Inter Office Memorandum
Risk Management
DA: November 3, 2009\-k
NUV 0 3 2009
rITY rl Fau,c (iPFICF
TO: Donal O'Callaghan, City Administrator
FR: Willard G. Yamaguchi, Risk Manager
RE: Aetna Medical Insurance Renewal 2010
Active Employees, Identified Consultants, and City Council Members
Agenda Item for November 9, 2009
Our insurance broker for medical benefits, Arthur J. Gallagher, solicited bids from Aetna,
Vernon's current provider, CIGNA, and United Health Care ("UHC") for active employees and
retirees. Upon review of said bids, Risk Management recommends the renewal of the Aetna
medical insurance benefit package for active employees, identified consultants, and city council
members with no change in benefits at a cost of $4,397,934. This represents an increase of
$316,368, or 7.8% over 2009.
Fiscal Impact
The cost for medical, dental and basic life premiums for active employees, identified consultants,
and city council members is $4,397,934. $5,500,000 has been budgeted for this expenditure.
Recommendation
Risk Management recommends the renewal of the Aetna medical insurance benefit package for
active employees, identified consultants, and city council members with no change in benefits at
a cost of $4,397,934.
R CEIVED
NOV 0 3 1009
Page 1 of 2
Juarez, Debbie
From: Rueda, Karina
Sent: Wednesday, November 18, 2009 3:49 PM
To: Juarez, Debbie
Subject: FW: City of Vernon - 1/1/10 Aetna Medical Renewal Plans
Debbie,
Here is the confirmation for the Aetna medical benefit renewals for both active employees and retirees.
Karina
From: Brenda_Lee@ajg.com [ma iIto: Brenda_Lee@ajg.com]
Sent: Monday, October 19, 2009 12:11 PM
To: RadiusR@aetna.com
Cc: Allyn_Heck@AJG.com; ivana_wong@ajg.com; Yamaguchi, Willard; Rueda, Karina
Subject: City of Vernon - 1/1/10 Medical Renewal Confirmation
Dear Rob:
On behalf of City of Vernon, this e-mail confirms acceptance of the 1/1/10 Aetna medical renewal, as follows:
ACTIVE EMPLOYEES:
Effective 1/1/10, benefits will remain unchanged. Listed below are the rates for the period 1/1/10 through
12/31/10:
HMO:
Employee: $348.57
EE + 1 Dep: $749.43
EE + Family: $1,028.28
PPO:
Employee: $542.20
EE + 1 Dep: $1,165.71
EE + Family: $1,599.47
PPO CITY COUNCIL:
Employee: $3,922.21
EE + 1 Dep: $8,432.75
Family: $11,570.52
RETIREES:
Effective 1/1/10, benefits will remain unchanged. Attached are the rates for the period 1/1/10 through 12/31/10.
Please confirm WHEN Aetna will be notifying retirees of the 1/1/10 renewal rates.
11/18/2009
Page 2 of 2
Rob, thank you for your assistance through this renewal. Please let us know if you see any discrepancies on the
enclosed. Thank you.
Brenda K Lee
Area Assistant Vice President
Phone: 818.539.1321 1 Mobile: 818.298.5922
Fax: 818.539,1621 1 Main: 818.539.2300 x1321
Gallagher Benefit Services, Inc. I T h i n k i n g A h e a d
505 N. Brand Blvd. 6th Floor I Glendale, CA 91203
Corp. Lic. #OD36879
Brenda_Lee@ajg.com I Learn More About Gallagher Benefit Services
Please consider the environment before printing this e-mail
Confidentiality Note: This e-mail and any files transmitted with it are intended only for the person or entity to
which it is addressed and may contain confidential and/or privileged material. Any review, retransmission,
dissemination or other use of, or taking of any action in reliance upon, this information by persons or entities other
than the intended recipient is prohibited. If you received this in error, please contact the sender and delete the
material from any computer.
11/18/2009