RESOLUTION NO. RS2010-1338
A resolution approving the account based self-insured medical benefits plan for employees and pensioners, effective January 1, 2011, pursuant to section 3.08.110(E) of the Metropolitan Code.
WHEREAS, the Metropolitan Council has adopted a system of employee benefits for officers, employees and pensioners of the Metropolitan Government that includes medical care benefits; and,
WHEREAS, section 3.08.110(E) of the Metropolitan Code provides that in “addition to the self-insured medical benefits plan that is administered on a PPO/non-PPO basis, the Employee Benefit Board is authorized to adopt other types of self-insured medical plan design structures”; and,
WHEREAS, section 3.08.110(E) of the Metropolitan Code provides that no additional self-insured medical benefits plan shall become effective until such plan is approved by resolution of the Council receiving twenty-one (21) affirmative votes; and,
WHEREAS, effective January 1, 2011, the Metropolitan Employee Benefit Board has adopted the account based self-insured medical benefit plan, described as follows:
Health reimbursement arrangement: A notional account shall be established and maintained for each participant. At the beginning of each plan year until the participant becomes eligible for Medicare, the amounts of $1,100 for individual coverage and $2,200 for family coverage shall be added to the account. Balances remaining in the notional account at the end of each plan year will be added to the participant’s beginning balance the following plan year. Plan benefits shall be paid at 100% of reasonable and customary charges until the notional account is exhausted.
Incentives for healthy behaviors: Additional amounts as determined by the Benefit Board may be added to the health reimbursement arrangement. Incentives for the 2011 plan year are as follows:
• Completion of health risk assessment $100
• Participation in certain disease management programs $100
• Participation in smoking cessation program $ 50
• Participation in healthy pregnancy program Up to $150
Preventive care services: covered at 100% with no deduction from the health reimbursement arrangement and without regard to any deductible or coinsurance.
Copays: There will be no copays for any services or prescription drugs.
Deductibles: Participants shall be responsible for 100% of reasonable and customary charges after the health reimbursement account is exhausted. Participant deductible responsibility shall be no greater than $500 for individual coverage and $1,000 for family coverage. The participant share of the deductible may be less, however, as a result of incentives and health reimbursement account rollovers from prior years.
Coinsurance: Upon exhaustion of the health reimbursement account and deductible, plan co-insurances will be applied. Medical service benefits shall be paid at 90% of reasonable and customary charges for in-network services, and 70% of reasonable and customary charges for out-of-network services. Prescription drug benefits shall be paid at 90% for generic drugs and 70% for brand-name drugs.
Annual out-of-pocket maximum: The maximum participant responsibility for a plan year, including deductible and coinsurances, shall be $1,150 for individual coverage and $2,300 for family coverage. The out-of-pocket maximum for out-of-network services shall be $5,000 for individual coverage and $10,000 for family coverage. The total participant out-of-pocket maximum may be less, however, as a result of incentives and health reimbursement account rollovers from prior years.
NOW, THEREFORE, BE IT RESOLVED BY THE COUNCIL OF THE METROPOLITAN GOVERNMENT OF NASHVILLE AND DAVIDSON COUNTY:
Section 1. That the account based self-insured medical benefit plan, adopted by the Metropolitan Employee Benefit Board, and effective January 1, 2011, is hereby approved.
Section 2. That this resolution shall take effect from and after its adoption, the welfare of The Metropolitan Government of Nashville and Davidson County requiring it.
Sponsored by: Ronnie Steine, Phil Claiborne
|Referred to:||Budget & Finance Committee
|Introduced:||August 17, 2010|
|Adopted:||August 17, 2010|
|Approved:||August 18, 2010|