36ee breast

Transcription

36ee breast

ADMINISTRATIVE REPORT
MEETING DATE: June 10, 2015
AGENDA SECTION: Action Items
ITEM: 10. C
APPROVED BY
DEPARTMENT DIRECTOR
GENERAL MANAGER
TO:
Honorable Members of the Board
FROM:
Kevin Kalman. General Manager
DATE:
June 4, 2015
SUBJECT:
Healthcare Benefits for Full-Time Staff and Board Members
RECOMMENDATION:
To authorize the General Manager to negotiate and execute a contracts with United
Healthcare/Guardian for the provision of employee health and welfare insurance plans for fiscal
year 2016.
BACKGROUND:
The District’s insurance broker, Employer Resource Group (ERG), solicited proposals for the
District’s medical insurance plan as part of the renewal process for the various lines of
employee group health and welfare benefits. Due to the District’s policy of extending coverage
to board members, the pool of providers is limited to two, Aetna and United Healthcare (UHC).
ERG received proposals from incumbent vendor Aetna and United Healthcare.
Administrative Report - Subject: Healthcare Benefits for Full-Time Staff and Board Members
Page 1
The District is no longer qualified for large group aggregate insurance rates as there are less
than 50 team members eligible to participate in the plan. In January 2016 large group will
transition to 100+ eligible team members further cementing the District as a small group
provider under the current healthcare reform laws. This change affects the method of
calculation for premiums moving forward. Each team member’s premium will be based on the
age of the insured, employee and dependents.
Aetna has agreed to extend aggregate pricing for one more renewal. However, Aetna proposes
a significant rate increase (approximately 25%) for the July 1, 2015 renewal. Aetna’s proposal
plan includes one HMO and one PPO plan option. Both plan options increase out of pocket
expense for co-pays, hospitalization, and prescribed medication.
UHC pricing, and future pricing with any alternate provider, is based on the age of the insured.
UHC proposal includes two HMO and two PPO plan options allowing for team members to
choose the plan that best suits their individual situation and budget. The plan choices offer
similar benefits as Aetna at a lower total cost. However, it should be noted that while overall
cost is lower with UHC, each team member will be impacted differently due to the individual
pricing structure.
Effective July 1, 2014 the District implemented an employer contribution cap of $1,380 per
month for medical premiums. This action was intended to control the District’s liability for the
continuous increase in insurance premiums. The cap was set at an amount that would allow all
team members to select a plan that would cover 100% of the employee and their dependent
premiums in the first year of implementation. This policy was initiated with the understanding
that team members would need to contribute to escalating premiums in future years. As a
result, team members selected plans that required the least amount of employee contribution
based on their individual situation. Only 1 of 34 team/board members elected a plan that
required the employee/board member to contribute to their premium.
Premiums are projected to continue to rise at unprecedented rates (14-18%) as mandates of
the Affordable Care Act continue to be implemented. During the Study Session of May 13, 2015
it was suggested that the employer contribution cap be raised to $1,725 (25%) to cover 100% of
employee and dependents on the Aetna’s proposed HMO plan and to renew with Aetna. Staff
does not recommend increasing the employer contribution cap at this time. In order for the
District to consider adding the much needed full time team members to implement the Boards
vision, it is critical that these cost be controlled and shared.
Page 2
Based on the analysis of caps $1,380, $1,500, $1,769 and implementing an Employer Sponsored
Base Plan (ESBP) staff has determined the following:
1. ESBP provides 100% coverage for Employees and Dependents
2. ESBP provides the most equitable distribution of cost should team members choose to
buy up to another plan.
3. ESBP provides the District and team members a lower cost than all cap scenarios
4. United Healthcare is the more affordable choice in all scenarios
Therefore staff is recommending the Board move to United Healthcare under the ESBP
structure.
PREVIOUS BOARD AND/OR STAFF ACTION:
May 13, 2015 the Board continued Study Item 9. A Healthcare Benefits for Full-Time Staff and
Board Members.
May 28, 2016 the Board passed Resolution 14-33 Revising the Compensation and Benefits Plan
for FY2015.
FINANCIAL IMPACT
The maximum financial impact for FY2016 with 38 eligible team/board members is $629,280.
Page 3
ATTACHMENT MEMORANDUM
MEETING DATE: June 10, 2015
AGENDA SECTION: Action Items
ITEM: 10. C
TO:
Honorable Members of the Board
FROM:
Kevin Kalman, General Manager
DATE:
June 5, 2015
Documents related to the Subject:
Healthcare Benefits for Full-Time Staff and Board Members
1.
2.
3.
4.
5.
Employer Sponsored Base Plan Structure
United Healthcare Medical Benefits Proposal
Guardian Vision, Dental, Etc. Proposal
Healthcare Benefits Analysis Presentation
ERG Study Session Presentation
Page 1
Employer Sponsored Base Plan
Aetna Renewal
HMO
Age
44
36
33
33
54
47
36
51
27
52
62
61
43
33
45
56
27
51
40
24
35
51
59
60
50
50
46
Coverage
EE/CH
EE/SP
EE
FAM
EE/SP
FAM
FAM
FAM
FAM
EE/SP
EE/SP
EE/SP
FAM
FAM
FAM
FAM
EE
FAM
EE/CH
EE
EE
EE/CH
EE/SP
EE/SP
EE
EE
FAM
Totals
DRD
$ 1,027.00
$ 1,255.00
$ 571.00
$ 1,769.00
$ 1,255.00
$ 1,769.00
$ 1,769.00
$ 1,769.00
$ 1,769.00
$ 1,255.00
$ 1,255.00
$ 1,255.00
$ 1,769.00
$ 1,769.00
$ 1,769.00
$ 1,769.00
$ 571.00
$ 1,769.00
$ 1,027.00
$ 571.00
$ 571.00
$ 1,027.00
$ 1,255.00
$ 1,255.00
$ 571.00
$ 571.00
$ 1,769.00
$ 34,751.00
Aetna Monthly
Aetna Annually
TM
$ ‐
$ ‐
$ ‐
$ ‐
$ ‐
$ ‐
$ ‐
$ ‐
$ ‐
$ ‐
$ ‐
$ ‐
$ ‐
$ ‐
$ ‐
$ ‐
$ ‐
$ ‐
$ ‐
$ ‐
$ ‐
$ ‐
$ ‐
$ ‐
$ ‐
$ ‐
$ ‐
$ ‐
$ 34,751
$ 417,012
PPO
DRD
$ 1,027.00
$ 1,255.00
$ 571.00
$ 1,769.00
$ 1,255.00
$ 1,769.00
$ 1,769.00
$ 1,769.00
$ 1,769.00
$ 1,255.00
$ 1,255.00
$ 1,255.00
$ 1,769.00
$ 1,769.00
$ 1,769.00
$ 1,769.00
$ 571.00
$ 1,769.00
$ 1,027.00
$ 571.00
$ 571.00
$ 1,027.00
$ 1,255.00
$ 1,255.00
$ 571.00
$ 571.00
$ 1,769.00
$ 34,751.00
TM
$ 393.00
$ 480.00
$ 218.00
$ 676.00
$ 480.00
$ 676.00
$ 676.00
$ 676.00
$ 676.00
$ 480.00
$ 480.00
$ 480.00
$ 676.00
$ 676.00
$ 676.00
$ 676.00
$ 218.00
$ 676.00
$ 393.00
$ 218.00
$ 218.00
$ 393.00
$ 480.00
$ 480.00
$ 218.00
$ 218.00
$ 676.00
$ 13,283.00
No TM Cost Plan
YES
NO
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26
0
HMO Platinum
DRD
TM
$ 775.52 $ 118.50
$ 752.25 $ 114.96
$ 348.35 $ 53.24
$ 1,250.65 $ 191.11
$ 1,096.25 $ 167.52
$ 1,763.01 $ 269.42
$ 1,089.27 $ 166.45
$ 1,805.74 $ 275.98
$ 794.13 $ 121.35
$ 1,043.03 $ 159.40
$ 1,707.75 $ 261.00
$ 1,437.91 $ 219.75
$ 1,149.17 $ 175.61
$ 890.66 $ 136.11
$ 1,183.78 $ 180.89
$ 1,970.91 $ 301.41
$ 304.74 $ 46.57
$ 1,352.41 $ 206.70
$ 1,137.83 $ 173.78
$ 290.78 $ 44.44
$ 355.33 $ 54.31
$ 833.08 $ 127.33
$ 1,350.09 $ 206.34
$ 1,437.62 $ 219.71
$ 519.33 $ 79.37
$ 519.33 $ 79.37
$ 1,410.01 $ 215.46
$ 28,568.93 $ 4,366.08
HMO Gold
DRD
$ 775.52
$ 752.25
$ 348.35
$ 1,250.65
$ 1,096.25
$ 1,763.01
$ 1,089.27
$ 1,805.74
$ 794.13
$ 1,043.03
$ 1,707.75
$ 1,437.91
$ 1,149.17
$ 890.66
$ 1,183.78
$ 1,970.91
$ 304.74
$ 1,352.41
$ 1,137.83
$ 290.78
$ 355.33
$ 833.08
$ 1,350.09
$ 1,437.62
$ 519.33
$ 519.33
$ 1,410.01
$ 28,568.93
TM
$ ‐
$ ‐
$ ‐
$ ‐
$ ‐
$ ‐
$ ‐
$ ‐
$ ‐
$ ‐
$ ‐
$ ‐
$ ‐
$ ‐
$ ‐
$ ‐
$ ‐
$ ‐
$ ‐
$ ‐
$ ‐
$ ‐
$ ‐
$ ‐
$ ‐
$ ‐
$ ‐
$ ‐
United Healthcare Monthly
United Healthcare Annually
United Healthcare
PPO Gold
DRD
TM
$ 775.52 $ 252.88
$ 752.25 $ 245.30
$ 348.35 $ 113.60
$ 1,250.65 $ 407.83
$ 1,096.25 $ 357.47
$ 1,763.01 $ 574.89
$ 1,089.27 $ 355.20
$ 1,805.74 $ 588.83
$ 794.13 $ 258.95
$ 1,043.03 $ 340.12
$ 1,707.75 $ 556.88
$ 1,437.91 $ 468.89
$ 1,149.17 $ 374.73
$ 890.66 $ 290.44
$ 1,183.78 $ 386.01
$ 1,970.91 $ 642.69
$ 304.74 $ 99.37
$ 1,352.41 $ 441.01
$ 1,137.83 $ 371.03
$ 290.78 $ 94.82
$ 355.33 $ 115.87
$ 833.08 $ 271.66
$ 1,350.09 $ 440.25
$ 1,437.62 $ 468.79
$ 519.33 $ 169.35
$ 519.33 $ 169.35
$ 1,410.01 $ 459.78
$ 28,568.93 $ 9,315.99
$ 28,569
$ 342,827
PPO Silver
DRD
TM
$ 775.52 $ 31.72
$ 752.25 $ 30.79
$ 348.35 $ 14.26
$ 1,250.65 $ 51.17
$ 1,096.25 $ 44.85
$ 1,763.01 $ 72.14
$ 1,089.27 $ 44.57
$ 1,805.74 $ 73.90
$ 794.13 $ 32.49
$ 1,043.03 $ 42.68
$ 1,707.75 $ 69.89
$ 1,437.91 $ 58.84
$ 1,149.17 $ 47.02
$ 890.66 $ 36.45
$ 1,183.78 $ 48.43
$ 1,970.91 $ 80.65
$ 304.74 $ 12.47
$ 1,352.41 $ 55.36
$ 1,137.83 $ 46.56
$ 290.78 $ 11.90
$ 355.33 $ 14.54
$ 833.08 $ 34.10
$ 1,350.09 $ 55.26
$ 1,437.62 $ 58.83
$ 519.33 $ 21.26
$ 519.33 $ 21.26
$ 1,410.01 $ 57.68
$ 28,568.93 $ 1,169.07
No TM Cost Plan
YES
NO
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26
0
PROPOSAL FOR
Desert Recreation District
RATES SHOWN ARE VALID FROM:
June 1, 2015 - June 15, 2015
Presented by: ERG Insurance Services, Inc
Sales Representative: Shirley Mejia
Telephone: (949) 885-1742
SIC Code: 7997 State & Zip: CA 92201
Created: March 17, 2015
PLAN DESIGN
We offer comprehensive benefits plans that can be customized to the needs of employers. To help you evaluate the plans, we
have provided detailed benefits summaries within this package.
RATES
Rates and premiums presented are based on the employee data submitted in your request for a proposal. Final rates and
premiums are based on the plans selected and the information provided on the enrollment forms.
BROAD RANGE OF PRODUCTS
We offer a variety of flexible, cost-effective employee benefits plans that can help employers meet the needs of employees and
their families, and manage costs at the same time. Our benefits plans include Dental, Disability, Life, Vision, Critical Illness, and
many more.
WHY GUARDIAN?
• Enrollment Support – Dedicated professionals help ensure smooth plan implementation
• Multi-Product Discounts – Combine plans to meet customer needs and save money
• Convenient Access to Service – One phone number and one secure website
• Streamlined Billing – All plans billed on one invoice
• Experience & Expertise – Over 50 years group benefits experience with exemplary ratings
The Guardian Life Insurance Company of America 7 Hanover Square, New York, NY 10004-4025
John Henry Garcia
Basic Term Life
RATES per $1,000
Census
Life Rate
AD&D Rate
Volume
Monthly Premium
Annual Premium
34
$0.200
$0.020
$1,725,000
$379.50
$4,554.00
Rate Guarantee
2 Years
Minimum Participation
Contributory plans assume a minimum of 75% participation of eligible employees.
Non-contributory plans assume a minimum of 100% participation of eligible employees.
Evidence of Insurability
Medical Underwriting may be required for amounts in excess of Guaranteed issue amount.
Future entrants age 70 and over are limited to $10,000 of life insurance without evidence of insurability.
Guarantee Issue
$100,000
Proposal Assumptions:
• *Package Sale: Life, Voluntary Life, Dental & Vision + one supplemental line (CI, Accident or Cancer)
BENEFITS
All Eligible Employees
Employee Benefit
100% of salary to a maximum of $100,000 with a minimum of $15,000
Enhanced Employee AD&D
100% of Life Benefit to a maximum of $100,000
Common Carrier
Not Included
Accelerated Life
75% of the death benefit, Minimum: $10,000, Maximum: $250,000
Waiver of Premium
If disabled, insurance will continue until age 70 or no longer disabled.
Portability
Included with Evidence of Insurability
Conversion
Included
Benefit Reduction (of
original amount)
Age
70
75
Reduction
35%
55%
PLAN HIGHLIGHTS
Enhanced AD&D Features Include:
• Education & Retraining Benefit
• Repatriation Benefit
• Day Care Expense
• Seatbelt & Airbag Benefit
• Catastrophic Loss
• Child Education Benefit
IMPORTANT NOTES
Rates and premiums are based on the employee data submitted. Final rates and premiums are based on the plan and
employee/dependent data provided on the enrollment forms. State specific requirements may apply.
• Life rate is only valid if sold with another Guardian coverage.
• Waiver of Premium: Insured must be totally disabled prior to age 60.
• Portability ceases on attainment of age 70.
• Earnings Definition for salary based plans will match Disability earnings definition.
SUMMARY OF PLAN LIMITATIONS AND EXCLUSIONS
Life Plan
• In order to be eligible for coverage: Employees must be legally working: (a) in the United States or (b) outside the United States, for a US
based employer, in a country or region approved by Guardian.
• Employees must be working full-time on the effective date of your coverage; otherwise, your coverage becomes effective after the completion
of the specific waiting period GP-1-A-GP-90-1, et al.
• Evidence of Insurability is required for all late enrollees. Benefit increases may require underwriting.
Accidental Death and Dismemberment Plan
• We pay no Accidental Death and Dismemberment benefits for an insured where death or dismemberment occurs as the result of a disease or
a bodily infirmity; through willful self-injury; by declared or undeclared war, act of war, armed aggression, or while a member of armed forces;
while driving motor vehicle without a current, valid driver’s license; while legally intoxicated; while participating in civil disorder or committing a
felony; traveling on any type of aircraft while having any duties on that aircraft; while voluntarily using a non prescription controlled substance
GP-1-R-ADCL1-00 et al.
• Guardian Basic Term Life Insurance is underwritten by The Guardian Life Insurance Company of America, New York, NY and will not be
effective until approved by a Guardian underwriter. This proposal is subject to satisfactory financial evaluation. Please refer to certificate of
coverage for full plan description; plan documents are the final arbiter of coverage.
Valid from 06/01/15 to 06/15/15
Tracking Code# 00160409662-03
Page 1 of 20
John Henry Garcia
Voluntary Term Life
RATES per $1,000
Age
<30
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70+
Rates
$0.075
$0.085
$0.126
$0.226
$0.350
$0.531
$0.839
$1.418
$2.333
$4.540
Census
Child
34
$0.167
Rate Guarantee
2 Years
Minimum Participation
Voluntary, Greater of 25% or 10 enrolled employees.
Re-enrollment
Annual Election Option: allows an employee to annually enroll for an increase of coverage, by an electable
amount up to $50,000, not to exceed the case Guarantee Issue.
Underwriting
Requirements
Employee
<65
Spouse <65
Child
Employee
65<70
Spouse
65<70
Employee
70+
Spouse 70+
Guarantee Issue
$50,000
$10,000
$10,000
$50,000
$10,000
$10,000
$0
BENEFITS
Employee Benefit
$10,000 to $300,000 in $10,000 increments
Spouse Benefit
$5,000 to $50,000 in $5,000 increments, not to exceed 100% of Employee's amount
Child Benefit
$1,000 to $10,000 in $1,000 increments, not to exceed 10% of Employee's amount
Infant Benefit
$500
Dependent Age Limits
14 days to 26 years (26 if full time student). Infant Age: Birth to 14 days. Spouse terminates at 70.
Accelerated Life
50% of the death benefit, Minimum: $10,000, Maximum: $250,000
Waiver of Premium
If disabled, insurance will continue until age 65 or no longer disabled
Portability
Included, without Evidence of Insurability
Conversion
Included
Seatbelt/Airbag
Employee: $10,000/$15,000, Dependent: $5,000/$7,500
original amount)
Age
65
70
Reduction
35%
50%
PLAN HIGHLIGHTS
Will Prep Services:
• Provides resources to prepare wills and other planning documents. Will Prep Services include: free Estate Planning documents, access to
Estate Planners and Resource Library. For a small fee, Attorney Assisted Will Preparation is also available.
IMPORTANT NOTES
employee/dependent data provided on the enrollment forms. State specific requirements may apply.
• Life rate is only valid if sold with another Guardian coverage.
• Waiver: must be disabled prior to age 60. Total Disability is required.
• Portability ceases on attainment of age 70.
• Spouse rate is based on employee's age bracket. Child rate is a per $1,000 for all children. Dependent life insurance will not take effect if a
dependent, other than a newborn, is confined to a hospital or other health care facility or is unable to perform the normal activities of someone
of like age and sex.
Life Plan
• In order to be eligible for coverage: Employees must be legally working (a) in the United States or (b) outside the United States, for a US
based employer, in a country or region approved by Guardian.
• We pay no benefits if the insured’s death is due to suicide within two years from the insured’s original effective date. This two year limitation
also applies to any increase in benefit. This exclusion may vary according to state law. GP-1-A-GP-90-1-et al.
(continued)
Valid from 06/01/15 to 06/15/15
Page 2 of 20
John Henry Garcia
Voluntary Term Life
SUMMARY OF PLAN LIMITATIONS AND EXCLUSIONS (continued)
• Employees must be working full-time on the effective date of your coverage; otherwise, coverage becomes effective after the completion of
the specific waiting period.
• Evidence of Insurability is required for all late enrollees. Benefit increases may require underwriting.
• Guardian Voluntary Term Life Insurance is underwritten by The Guardian Life Insurance Company of America, New York, NY and will not be
Valid from 06/01/15 to 06/15/15
Page 3 of 20
John Henry Garcia
Long Term Disability
RATES Per $100 of Monthly Covered Payroll
Census
Employee Rate
Monthly Payroll
Monthly Premium
Annual Premium
29
$0.478
$133,333
$637.33
$7,647.96
Rate Guarantee
2 Years
BENEFITS
All Eligible Non-Board Member Employees
Contribution/Participation
Non-contributory/100%
Elimination Period
90 days
Duration of Benefits
Social Security normal retirement age
Definition of Disability
2 year Own Occupation/Any Occupation thereafter
Monthly Benefit
60% to $6,000
Guarantee Issue
$6,000
Evidence of Insurability
Medical Underwriting may be required for amounts in excess of GI
Interruption of Elimination
Period
Unlimited, no set number of days
Return to Work
Zero Day Residual
Work Incentive
12 month
Maximum Partial Disability
Earnings
80% Indexed Own Occ/ 80% Indexed Any Occ
Partial Disability
Calculation
Greater of direct reduction or proportionate loss
Income Recovery
Included
Integration Method
Direct Offset, Family
Salary Continuation
/Association IDI
No offset
Minimum Benefit
$50
Mental Health & Substance
Abuse
24 Month lifetime payment limit, combined
Pre-Existing Conditions
3 months prior, 12 months after Exclusion, Continuity of Coverage
Earnings Definition
Standard, excluding bonus & commission
State Integration
CA SDI
Rehabilitation Services
110% benefit amount, voluntary participation, Includes Dependent care expense
Survivor Benefit
3 months net, accelerated
Worksite Modification
$2,500
PLAN HIGHLIGHTS
• Guardian’s Financial Strength: Guardian has a long history of earning exemplary ratings from independent rating services which provide
1
essential measures of a company’s value as well as common ground for valid comparison. For additional details, visit our web site:
http://www.guardianlife.com/AboutGuardian/FinancialHighlights/Ratings/index.htm
• Experienced and Innovative Disability Service Team: Our services help disabled employees return to maximum potential by having a
dedicated claims analyst work closely with the employer, disabled employee and physicians to encourage and support successful outcomes.
For additional details, see our disability page: https://www.guardiananytime.com/gafd/wps/portal/fdhome/employers/products-andcoverage/disability
• Income Recovery Benefit: This provision continues a monthly benefit payment to a claimant who is recovered from disability and returns to
full-time work in his or her own occupation but is unable to earn 80% of pre-disability earnings. This benefit will continue up to 12 months or
until the claimant is able to earn 80% of indexed pre-disability earnings.
1
Financial information concerning The Guardian Life Insurance Company of America as of December 31, 2013 on a statutory basis: Admitted
Assets = $42.1 Billion; Liabilities = $37.1 Billion (including $32.7 Billion of Reserves); and Surplus = $5.0 Billion.
Valid from 06/01/15 to 06/15/15
Page 4 of 20
John Henry Garcia
Long Term Disability
IMPORTANT NOTES
Rates and premiums are based on the employee data submitted. Final rates and premiums are based on the plan and employee/dependent
data provided on the enrollment forms. State specific requirements apply.
• If an Own Occupation/Any Occupation plan is selected: During the elimination period and the own occupation period, the employee must
be unable to perform, on a full-time basis, the major duties of his or her own occupation. After the end of the own occupation period, the
employee must be unable to perform, on a full-time basis, the major duties of any gainful work. The employee is not disabled if he or she
earns, or is able to earn, more than this plan’s maximum allowed income earned during disability.
• These rates are contingent upon LTD being purchased with Guardian Life coverage and without Guardian STD coverage.
• We limit the duration of payments for long term disabilities caused by mental or emotional conditions, or alcohol or drug abuse.
• We do not pay benefits for charges relating to a covered person: taking part in any war or act of war (including service in the armed forces)
committing a felony or taking part in any riot or other civil disorder or intentionally injuring themselves or attempting suicide while sane or
insane, and for the voluntary use of any poison, chemical, prescription or non-prescription drug or controlled substance unless it has been
prescribed by a doctor and is used as prescribed.
• We do not pay benefits during any period in which a covered person is confined to a correctional facility, an employee is not under the care of
a doctor, an employee is receiving treatment outside of the US or Canada and the employee’s loss of earnings is not solely due to disability.
• During the exclusion/limitation period, this disability plan does not pay charges relating to a pre-existing condition. A pre-existing condition
includes any condition for which an employee, in a specified period of time prior to coverage in this plan, consults with a physician, receives
treatment, or takes prescribed drugs. If this plan is transferred from another insurance carrier, the time an insured is covered under that plan
will count toward satisfying Guardian’s pre-existing condition exclusion /limitation period. Please refer to the plan details for specific time
periods. Contract # GP-1-LTD07-1.0 et al. (AG09)
• In order to be eligible for coverage; employees must be legally working: (a) in the United States or (b) outside the United States, for a US
based employer in a country or region approved by Guardian.
• This policy provides disability income insurance only. It does not provide "basic hospital", "basic medical", or "major medical" insurance as
defined by the New York State Insurance Department.
• Evidence of Insurability is required on all late enrollees.
• Guardian Long Term Disability Insurance is underwritten by The Guardian Life Insurance Company of America, New York, NY and will not be
Valid from 06/01/15 to 06/15/15
Page 5 of 20
John Henry Garcia
Dental
RATES
Monthly Rate
Employee
Employee &
Spouse
Employee &
Child(ren)
Full Family
Monthly
Premiums
Annual
Premium
$39.44
$75.54
$88.95
$133.67
$3,025.31
$36,303.72
11
6
3
14
Census
Rate Guarantee
1 Year
BENEFITS
DentalGuard Alliance
Deductible
DentalGuard Preferred
Out-of-Network
Contributory, Assumes 80% of eligible employees. Dental is sold with Guardian Life coverage.
$0
$50
$50
Calendar Year
Calendar Year
Calendar Year
Family Limit
3 per family
3 per family
3 per family
Waived For
Preventive
Preventive
Preventive
$2,500 plus Maximum Rollover
Period
Annual Maximum
Maximum Rollover
Threshold
$700
Rollover Amount
$350
In-Network only Rollover
$500
Account Limit
Claim Payment Basis
Network
Coinsurance - Preventive
$1,250
Negotiated Fee Schedule
DentalGuard Alliance
DentalGuard Preferred
None
100%
100%
100%
w Oral Exams (twice/12 mos.) w Cleanings (twice/12 mos.) w X-Rays (Full-mouth series once/60 mos.) w
Fluoride Treatment (to age 19, twice/12 mos.) w Sealants (to age 16, once/36 mos.) w Space
Maintainers/Harmful Habit Appliances
Coinsurance - Basic
100%
90%
80%
w Fillings w Perio Maintenance Procedure (twice/12 mos.) w Periodontal Services (eg Scaling and Root Planing)
w Periodontal Surgery w Simple Extractions w Complex Extractions w Endodontic Services (eg. Root Canal)
Coinsurance - Major
100%
60%
50%
w Bridges & Dentures w Single Crowns w Repair & Maintenance of Crowns, Bridges & Dentures w General
Anesthesia w Inlays, Onlays & Veneers
Coinsurance - Orthodontia
Orthodontia Lifetime
Maximum
Waiting Periods
Plan Type & Code
50% for children
(Orthodontia in Progress - covered)
$1,500
$1,500
To Age 26
None
Freedom Plan (I5E3)
PLAN HIGHLIGHTS
Strong Network Coverage Nationwide
• Guardian's DentalGuard Preferred network is the #2 network nationally and we're growing fast. In many parts of the country, Guardian offers
more providers than any other network (Netminder, 3/12).
• Guardian has over 100,000 dentists at more than 256,000 locations.
• Network dentists charge discounted fees - savings average 34%.
• Guardian has an easy to use provider online search. Just visit GuardianLife.com and select 'Find a Provider'.
(continued)
Valid from 06/01/15 to 06/15/15
Page 6 of 20
John Henry Garcia
Dental
PLAN HIGHLIGHTS (continued)
Guardian Freedom Plan
• The Guardian Freedom plan helps employers more actively manage plan costs. This plan allows employees to choose between:
• DentalGuard Alliance (More Savings): This smaller network offers greater discounts on dental care and richer benefits with more procedures
covered in full.
• DentalGuard Preferred (More Choice): One of the nation's largest networks, DentalGuard Preferred dentists offer discounts averaging 30%.
• Out-of-Network (More Freedom): While in-network dentists provide the most value, members can see any dentist they want without being
penalized. Depending on plan design, they will be reimbursed at UCR or set fee schedule.
• This choice makes the Guardian Freedom Plan one of the most flexible dental programs ever devised. Even better, employees don't have to
decide which network to use when they enroll. They can go in-network to get the most value from the plan, or go to any dentist outside the
network and still get Guardian Freedom benefits.
International Dental Travel Assistance
• While traveling internationally, Guardian members can get a referral to a local dentist for immediate dental care through the International
Dental Travel Assistance Program. This service is available 24/7, in over 200 countries. Coverage will be considered under the out-of-network
benefits.
• International Dental Travel Assistance services are administered by AXA Assistance USA, Inc. AXA Assistance is not affiliated with Guardian
Life Insurance, and the services they provide are separate and apart from the benefits provided by Guardian Life Insurance.
IMPORTANT NOTES
Rates and Premiums were determined using a census of eligible employees and dependents. Final rates and premiums are based on
the plan and employee/dependent data provided on the enrollment forms. State specific requirements apply.
• We reserve the right to adjust rates if actual participation is below assumed level. We also reserve the right to adjust rates if there is an
average of more than 4 children per dependent unit (EE+CH or FAM).
• We reserve the right to withdraw this proposal if actual employee participation is below the greater of 25% or 5 enrolled employees. This
requirement does not apply to any pre-paid dental plans quoted.
• Cleanings and Perio Maintenance Procedures share the frequency. Limited to a total of two cleanings or two perio maintenance procedures
in any 12 consecutive month period.
• If your plan includes Section 125/Flex Plan, open enrollment must be held the month prior to the renewal/anniversary date.
• Orthodontia, when covered, is for dependent children who are less than age 19 when active appliance is first placed.
Please see the Summary of Plan Limitations and Exclusions that appears either on this page or the last page of this coverage.
• Coverage is limited to charges that are necessary to prevent, diagnose or treat dental disease, defect or injury. Depending on plan type,
deductibles, waiting periods, per service frequency limitations, and payment limits may apply.
• The list of dental services shown is not exhaustive.
• This coverage will not be effective until approved by a Guardian underwriter. Please refer to certificate of coverage for full plan description.
This plan does not pay for:
• Any restoration procedure, appliance or dental prosthesis used solely to: a) alter vertical dimension; b) restore or maintain occlusion, except to
the extent that this plan covers orthodontic treatment; c) splint or stabilize teeth for periodontal reasons; or d) treat a condition caused by
abrasion or attrition.
• Cosmetic or experimental treatments, unless specifically listed in the BENEFIT DETAIL section of this proposal as a covered cosmetic
service.
• Replacing a lost, stolen or missing appliance or prosthetic device; or making a spare appliance or device.
• Treatment needed due to: a) an on-the-job or job-related injury; or b) a condition for which benefits are payable by Workers' Compensation or
similar laws.
• Replacing an appliance or prosthetic device with a like appliance or device, unless: a) it is damaged while in the covered person's mouth in an
injury suffered while insured, and can't be fixed; or b) can't be made usable and meets the replacement age criteria selected by the employer.
• Treatment for which no charge is made.
• The replacement of extracted or missing third molars/wisdom teeth.
• Treatment of congenital or developmental malformations, or the replacement of congenitally missing teeth.
• Evaluations and consultations for non-covered services; detailed and extensive oral evaluations.
• Any procedure performed in conjunction with, as part of, or related to a non-covered procedure.
• Any procedure not specifically listed as a covered benefit.
• GP-1-DG2000 et al.
• Guardian Dental is underwritten by The Guardian Life Insurance Company of America, New York, NY. Products are not available in all states.
Policy limitations and exclusions apply. Optional riders and/or features may incur additional costs. Plan documents are the final arbiter of
coverage.
Valid from 06/01/15 to 06/15/15
Page 7 of 20
John Henry Garcia
Vision
RATES
Employee
Employee &
Spouse
Employee &
Child(ren)
Full Family
Monthly
Premium
Annual
Premium
$7.85
$13.22
$13.48
$21.33
$504.73
$6,056.76
11
6
3
14
Monthly Rate
Census
Rate Guarantee
1 Year
BENEFITS
Voluntary, Assumes 91% of eligible employees. Vision is sold with Dental.
To Age 26
Network/Plan
VSP/Full Feature - Choice B
Copay
Split(Exams/Materials)
$10/$25
SERVICE FREQUENCIES
Once Every:
Eye Exams
Calendar Year
Lenses Benefit
Calendar Year
Contact Lenses
Calendar Year
Frames
Other Calendar Year
REIMBURSEMENT SCHEDULE
In Network (Copay)
Out Network (After Copay)
$10
$39 max
Single Vision
$25
$23 max
Bifocal
$25
$37 max
Trifocal
$25
$49 max
Lenticular
$25
$64 max
Covered after copay
$210 max
$130 max (Copay waived)
$100 max (Copay waived)
$130 retail max + 20% off balance
$46 max
Eye Exams Benefit
Lenses Benefit
Contact Lenses Benefit**
Medically Necessary
Elective
Frames Benefit
**In lieu of complete set of glasses
PLAN HIGHLIGHTS
• Guardian's affiliation with Vision Service Plan (VSP) offers one of the largest vision care networks in the industry with over 50,000 provider
locations nationwide. On average 95% of members use an in-network provider. Just visit GuardianLife.com and select 'Find a Provider'.
• Guardian's affiliation with Vision Service Plan (VSP) Choice Network offers access to over 50,000 provider locations nationwide which is a
lower cost plan with higher out of pocket costs for the members compared to a Signature Plan. On average 95% of members use an in
network provider. Just visit GuardianLife.com and select 'Find a Provider'.
• Choice plans offer 20% off any additional pairs of glasses purchased within 12 months of the exam. Members also receive 20% off the
amount exceeding the copay and allowance on frames purchased as well as 15% off providers' professional services for prescription contact
lenses. These discounts only apply to services from an in network provider.
(continued)
Valid from 06/01/15 to 06/15/15
Page 8 of 20
John Henry Garcia
Vision
PLAN HIGHLIGHTS (continued)
• With our Choice plans, members will receive significant discounts on lens options, discounts will range from 20-25% off the U&C. For
example, standard progressive plastic lenses will cost the member $55 and scratch resistant coating will cost $17. Solid tints and dyes are
covered in full.
IMPORTANT NOTES
employee/dependent data provided on the enrollment forms. State specific requirements apply.
• The covered person must remain enrolled until the plan's next vision annual open enrollment period. Someone who waives or drops coverage
can't enroll until the plan's next vision annual open enrollment period. These requirements do not apply if the vision plan is sold on a noncontributory basis or if enrollment is tied-to a dental or medical plan.
• If an employee has employee/spouse vision coverage and the spouse obtains new employment and elects vision coverage with the new
employer, Guardian lock-in does not apply to that spouse and the spouse is free to move with no negative impact.
• If an employee has employee/spouse vision coverage and both the employee and spouse elect to move over to the spouse's new employer's
vision plan, again, Guardian lock-in does not apply to either spouse or employee.
• If an employee gets married and wishes to go on the new spouse's plan, the member may decline outside of open enrollment only if the
member actually goes on the new spouse's plan.
• We reserve the right to adjust rates if actual participation is below assumed level. We reserve the right to withdraw this proposal if actual
participation is below 25%.
• Coverage is limited to those charges that are necessary to prevent, diagnose and treat a vision condition.
• For a calendar year plan A or B, if a member purchases contact lenses they must wait 2 calendar years to purchase frames.
• Members cannot bank unused allowance amounts for future use, they must use their allowance during the same office visit.
The plan does not pay for:
• Orthoptics or vision training and any associated supplemental testing.
• Medical or surgical treatment of the eye.
• Eye examination or corrective eyewear required by an employer as a condition of employment.
• Lenses and frames furnished under this plan, which are lost or broken (except when services are otherwise available).
• The plan limits benefits for blended lenses, oversized lenses, photochromic lenses, coated or laminated lenses, a frame that exceeds plan
allowance, cosmetic lenses, U-V protected lenses, and optional cosmetic processes.
• Medically necessary contact lenses are covered only if needed: (1) after cataract surgery; (2) to correct extreme visual acuity problems that
cannot be corrected with eyeglasses; (3) for certain conditions of Anisometropia; or (4) for Keratoconus.
• The services, exclusions and limitations listed above do not constitute a contract and are a summary only.
• GP-1-VSN-96-1 et al.
Valid from 06/01/15 to 06/15/15
Page 9 of 20
John Henry Garcia
Critical Illness
MONTHLY PREMIUM
Employee
Benefit Amounts
<20
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65+
$5,000
$3.49
$4.01
$4.64
$5.49
$6.81
$9.25
$13.05
$18.13
$24.48
$33.82
$49.81
$10,000
$5.84
$6.71
$7.79
$9.44
$12.11
$16.95
$24.45
$34.48
$46.93
$65.12
$95.61
$15,000
$8.19
$9.41
$10.94
$13.39
$17.41
$24.65
$35.85
$50.83
$69.38
$96.42
$141.41
$20,000
$10.54
$12.11
$14.09
$17.34
$22.71
$32.35
$47.25
$67.18
$91.83
$127.72
$187.21
$25,000
$12.89
$14.81
$17.24
$21.29
$28.01
$40.05
$58.65
$83.53
$114.28
$159.02
$233.01
Spouse
Benefit Amounts
<20
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65+
$1,000
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Child (ren)
$1,000
Rate Guarantee
1 Year
Eligible Lives
34
Premiums
Premiums listed are for Issue Age and will not increase due to an insured aging
Underwriting
Requirements
Employee <70
Spouse <70
Child (ren)
Employee 70+
Spouse 70+
Conditional Issue
Health questions are
required for all
amounts.
Health questions are
required for all
amounts.
All child amounts are
guaranteed
Health questions
required.
Health questions
required.
BENEFITS
Contribution/
Participation
Voluntary/Minimum of 5 enrolled employees.
Employee Critical
Illness Benefit
Amounts
Employee may choose a lump sum benefit of $5,000 to $25,000 in increments of $5,000
Dependent Critical
Illness Benefit
Amount
Spouse: $1,000 Lump Sum Benefit
Child: $1,000 Lump Sum Benefit
Covered Conditions
(lump sum payments)
Condition
First Ever Occurrence
Second Ever Occurrence
Invasive Cancer:
100%
50%
Heart Attack
100%
50%
Kidney Failure
100%
50%
Stroke
100%
50%
Carcinoma In Situ
25%
0%
Total Amount Payable
During an insured's lifetime, this plan will not pay more than 300% of the lump sum benefit for all critical illnesses
combined
Critical Illness Benefit
Waiting Period
30 days starting on the insured’s effective date for this coverage
Hospital Admission
Benefit
Provides $50 per day for each day employee is hospitalized for a condition other than the critical illnesses listed
above, 10 day per year limit after a 2 day elimination period
Dependent Hospital
Admission Benefit
Spouse: $50 per day benefit
Child: $50 per day benefit
0 days to 26 years (26 if full time student)
Pre-Existing
Condition Limitation
3 month look back period, 12 month exclusion period
(continued)
Valid from 06/01/15 to 06/15/15
Page 10 of 20
John Henry Garcia
Critical Illness
BENEFITS (continued)
original amount)
Age
65
70
75
80
Reduction
35%
60%
75%
85%
PLAN HIGHLIGHTS
• Guardian’s Critical Illness Product provides ability for an insured to receive a lump sum benefit payment upon first ever and second ever
diagnosis of any qualified Critical Illnesses listed under covered conditions.
• Benefits are paid directly to the insured when they need it most. Expenditure for claim proceeds are not limited to cover medical expenses,
funds can be used under the discretion of the insured for things such as childcare, transportation and to fill in gaps in their medical plan, like
co-pays and deductibles.
• An insured must port Critical Illness coverage prior to age 70.
• An insured must port Specified Disease coverage prior to age 70.
• The Hospital Admission Benefit pays a daily benefit for each day an employee is hospitalized for a condition other than the covered critical
illness.
IMPORTANT NOTES
employee/dependent data provided on the enrollment forms. States specific requirements apply.
Rates Notes
• These rates are contingent upon Critical Illness being purchased with another Guardian coverage.
• Spouse rate is based on employee's age bracket. Child rate is for all children. Dependent Critical Illness insurance will not take effect if a
dependent, other than a newborn, is confined to the hospital or other health care facility or is unable to perform the normal activities of
someone of like age and sex.
Benefits Notes
• Major Organ Transplant & Coronary Artery Bypass Graft are not covered conditions under the Critical Illness benefit of your policy. To
constitute this Critical Illness policy as a permitted insurance in conjunction with a Health Savings Account (refer to IRS code 223), these
conditions were excluded. This means that insureds who are covered by this Critical Illness benefit and who are otherwise eligible to
contribute to a Health Savings Account (HSA) remain eligible to make HSA contributions.
• Flat dependent benefits are standardly limited to 50% of the employee benefit.
• The policy has exclusions and limitations that may impact the eligibility for or entitlement to benefits under each covered condition. See the
actual policy or contact your sales representative for full details.
• Employees age 70 & older must answer health questions for all amounts.
• The applicant will be required to answer health questions in order to qualify for coverage.
• The policy has exclusions and limitations that may impact the eligibility for or entitlement to benefits under each covered condition. There are
limitations & special requirements for each condition. See the certificate of coverage or contact your sales representative for full details.
• We do not pay benefits for a first ever occurrence of a critical illness that occurs less than 3 months after the first ever occurrence of a
different critical illness for which this plan paid benefits.
• We do not pay benefits for a second ever occurrence of a critical illness if the insured has exhibited symptoms or received treatment for that
critical illness within the past 12 months (care or treatment does not include: (a) preventive medications in the absence of disease; and (b)
routine scheduled follow-up visits to a doctor.)
• First ever & second ever occurrence refers to the first & second time ever in an insured's lifetime that he/she experiences or is diagnosed with
a covered critical illness.
• We do not pay benefits for a third or later occurrence of a Critical Illness.
• A pre-existing condition includes any condition for which an employee, in the three month period prior to coverage in this plan, consults with a
physician or receives treatment. Please refer to the plan documents for specific time periods. State variations may apply.
• If the plan is new (not transferred): During the exclusion period, this Critical Illness plan does not pay charges relating to a pre-existing
condition. If this plan is transferred from another insurance carrier, the time an insured is covered under that plan will count toward satisfying
Guardian's pre-existing condition limitation period. Please refer to the plan details for specific time periods. State variations may apply.
• We do not pay benefits for charges relating to a covered person: taking part in any war or act of war (including service in the armed forces)
committing a felony or taking part in any riot or other civil disorder or intentionally injuring themselves or attempting suicide while sane or
insane.
• In order to be elibigle for coverage: Employees must be legally working: (a) in the United States or (b) outside the United States, for a US
based employer, in a country or region approved by Guardian. Subject to state specific variations.
• Employees must be working full-time on the effective date of coverage; otherwise, coverage becomes effective after the completion of the
specific waiting period.
(continued)
Valid from 06/01/15 to 06/15/15
Page 11 of 20
John Henry Garcia
Critical Illness
• Health questions are required on all late enrollees, Benefit increases may require underwriting.
• This coverage will not be effective until approved by a Guardian underwriter. This proposal is subject to a satsfactory financial evaluation.
Please refer to certificate of coverage for full plan description; plan documents are the final arbiter of coverage.
Valid from 06/01/15 to 06/15/15
Page 12 of 20
John Henry Garcia
Accident
MONTHLY RATES
Plan #1
Plan #2
Plan #3
Employee
$13.59
$18.04
$22.10
Employee & Spouse
$22.31
$29.63
$36.31
Employee & Child
$23.08
$30.48
$37.14
Family
$31.80
$42.07
$51.35
Census
34
34
34
Rate Guarantee
2 Years
2 Years
2 Years
Plan #1
Plan #2
Plan #3
Value Plan
Advantage Plan
Premier Plan
Voluntary / 5 enrolled employees
BENEFITS
Schedule
Accident Coverage
Off Job
Off Job
Off Job
Included without Evidence
Child(ren) Age Limits
Birth to 26 years (26 if full time
student), subject to state limitations
Accident Emergency
Treatment
$150
$175
$200
$25 up to 6 treatments
Air Ambulance
$500
$1,000
$1,500
Ambulance
$100
$150
$200
Appliance
$100
$125
$125
$300
$300
$300
9 sq inches to 18 sq inches:
$0/$2,000
$1,000/$4,000
Over 35 sq inches: $3,000/$12,000
$0/$2,000
$1,000/$4,000
Over 35 sq inches: $3,000/$12,000
$0/$2,000
$1,000/$4,000
Over 35 sq inches: $3,000/$12,000
Portability
Accident Follow-Up Visit Doctor
Blood/Plasma/Platelets
2nd
3rd
Burns ( Degree/
Degree)
Burn – Skin Graft
Child Organized Sport
Chiropractic Visits
Coma
50% of burn benefit
50% of burn benefit
50% of burn benefit
20% increase to child benefits
No Benefit
$25 per visit up to 6 visits
$50 per visit up to 6 visits
$7,500
$10,000
$12,500
Concussions
$50
$75
$100
Dislocations
Schedule up to $3,600
Diagnostic Exam (Major)
$100
$150
$200
Emergency Dental Work
$200/Crown $50/Extraction
Epidural Pain Management
$100, 2 times per accident
$200
$300
$300
Family Care
$20/day up to 30 days
Fracture
Eye Injury
Hospital Admission
$750
$1,000
$1,250
$175/day – up to 1 year
$1,500
$2,000
$2,500
Hospital ICU Confinement
$350/day – up to 15 days
Initial Physician’s
office/Urgent Care Facility
Treatment
$50
$75
$100
Hospital Confinement
Hospital ICU Admission
(continued)
Valid from 06/01/15 to 06/15/15
Page 13 of 20
John Henry Garcia
Accident
Plan #1
Plan #2
Plan #3
$500
$500
$750
$1,500/$750/$750
$2,500/$1,250/$1,250
$3,500/$1,750/$1,750
Schedule up to $300
Schedule up to $400
Schedule up to $500
$100/day, up to 30 days for
companion hotel stay
1: $500
2 or more: $1,000
1: $500
2 or more: $1,000
1: $750
2 or more: $1,500
$500
$500
$750
Hernia: $125
Hernia: $150
Hernia: $200
Surgery – Exploratory or
Arthroscopic
$150
$250
$350
Tendon/Ligament/Rotator
Cuff
1: $250
2 or more: $500
1: $500
2 or more: $1000
1: $750
2 or more: $1500
$20
$30
$40
Knee Cartilage
Joint Replacement
(hip/knee/shoulder)
Laceration
Lodging
Occupational or Physical
Therapy
Prosthetic Device/Artificial
Limb
Rehabilitation Unit
Confinement
Ruptured Disc with Surgical
Repair
Surgery (Cranial, Open
Abdominal, Thoracic)
Transportation
X-Ray
PLAN HIGHLIGHTS
• No underwriting required.
IMPORTANT NOTES
The benefits listed are payable if the service, treatment or procedure is due to injuries incurred in a covered accident.
• Appliance - Benefit is paid if a wheelchair, leg or back brace, crutches, walker, walking boot that extends above the ankle or brace for the
neck is prescribed by a physician as necessary due to an injury sustained as the result of a covered accident.
• Child Organized Sport - Benefit is paid if the covered accident occurred while your covered child is participating in an organized sport that is
governed by an organization and requires formal registration to participate. This benefit is only payable if child coverage is included on the
plan.
• Family Care - Benefit is payable for each child attending a Child Care center while the insured is confined to the hospital, ICU or Alternate
Care or Rehabilitative facility due to injuries sustained in a covered accident.
• Lodging - Benefit is paid for a companion’s hotel stay while the insured is confined to the hospital as the result of a covered accident. The
hospital must be more than 50 miles from the insured’s residence.
• Transportation - Benefit is paid if you have to travel more than 50 miles one way to receive special treatment at a hospital or facility due to a
covered accident.
• Employees must be legally working in the United States in order to be eligible for coverage. Underwriting must approve coverage for
employees on temporary assignment: (a) exceeding 1 year ; or (b) in an area under travel warning by the US Department of State, subject to
state specific variations.
• This proposal summarizes the major features of the Guardian Accident benefit plan. It is not intended to be a complete representation of the
proposed plan. For full plan features, including exclusions and limitations, please refer to your Policy.
• This proposal is hedged subject to satisfactory financial evaluation.
This plan will not pay benefits for any injury caused by or related to:
• Declared or undeclared war, act of war, or armed aggression; taking part in a riot or civil disorder; or commission of, or attempt to commit a
felony; Intentionally self inflicted injury, while sane or insane; suicide or attempted suicide, while sane or insane.
• The covered person being legally intoxicated.
• Treatment rendered or hospital confinement outside the United States or Canada.
• Travel or flight in any kind of aircraft, including any aircraft owned by or for the employer except as a fare-paying passenger on a common
carrier.
(continued)
Valid from 06/01/15 to 06/15/15
Page 14 of 20
John Henry Garcia
Accident
•
•
•
•
•
•
•
Participation in any kind of sporting activity for compensation or profit, including coaching or officiating.
Riding in or driving any motor-driven vehicle in a race, stunt show or speed test.
Participation in hang gliding, bungee jumping, sailgliding, parasailing, parakiting, ballooning, parachuting, and/or skydiving.
Job related or on the job injuries.
Injuries to a dependent child received during the birth.
An accident that occurred before the covered person is covered by this plan.
Sickness, disease, mental infirmity or medical or surgical treatment.
Policy #: GP-1-AC-IC-12.
Guardian's Accident Insurance is underwritten and issued by The Guardian Life Insurance Company of America, New York, NY. Products are
not available in all states. Policy limitations and exclusions apply. Optional riders and/or features may incur additional costs. Plan documents
are the final arbiter of coverage.
Valid from 06/01/15 to 06/15/15
Page 15 of 20
John Henry Garcia
Cancer
MONTHLY RATES
Plan #1
Plan #2
Plan #3
Employee
$13.09
$22.14
$34.60
Employee & Spouse
$25.42
$42.43
$66.24
Employee & Child
$14.92
$24.95
$38.58
Full Family
$27.25
$45.24
$70.22
34
34
34
2 Years
2 Years
2 Years
Conditional Underwriting required
Census
Rate Guarantee
Issue Underwriting
BENEFITS
Plan #1
Plan #2
Plan #3
Value
Advantage
Premier
12 month look back period, 12
month exclusion period
$250/trip, limit 2 trips per hospital
confinement
$1,500/trip, limit 2 trips per hospital
confinement
$2,000/trip, limit 2 trips per hospital
confinement
No Benefit
No Benefit
$50/visit up to 20 visits
Ambulance
confinement
confinement
confinement
Anesthesia
25% of surgery benefit
Schedule
Portability
Child(ren) Age Limits
Pre-Existing Condition
Limitation
Air Ambulance
Alternative Care
Anti-Nausea
No Benefit
$50/day up to $150 per month
$50/day up to $250 per month
$25/day while hospital confined.
Limit 75 visits.
Limit 75 visits.
Limit 75 visits.
Blood/Plasma/Platelets
$50/day up to $5,000 per year
Bone Marrow/Stem Cell
No Benefit
Bone Marrow: $7,500
Stem Cell: $1,500
nd
50% benefit for 2 transplant
$1,000 benefit if a donor
Bone Marrow: $10,000
Stem Cell: $2,500
nd
50% benefit for 2 transplant
$1,500 benefit if a donor
Experimental Treatment
No Benefit
$100/day up to $1,000/month
$200/day up to $2,400/month
Government or Charity
Hospital
No Benefit
$300/day in lieu of all other benefits
$400/day in lieu of all other benefits
Hormone Therapy
$25/Treatment up to 12 treatments
per year
per year
per year
Hospital Confinement
$300/day for first 30 days;
$600/day for 31st day thereafter per $600/day for 31st day thereafter per $800/day for 31st day thereafter per
confinement
confinement
confinement
ICU Confinement
$600/day for 31st day thereafter per $600/day for 31st day thereafter per $800/day for 31st day thereafter per
confinement
confinement
confinement
Attending Physician
Immunotherapy
$500 per month
$2500 lifetime max
$500 per month
$2500 lifetime max
$500 per month
$2500 lifetime max
Inpatient Special Nursing
No Benefit
$100/day up to 30 days per year
$150/day up to 30 days per year
Medical Imaging
No Benefit
$100/image up to 2 per year
$200/image up to 2 per year
Outpatient or Ambulatory
Surgical Center
No Benefit
$250/day, 3 days per procedure
$350/day, 3 days per procedure
(continued)
Valid from 06/01/15 to 06/15/15
Page 16 of 20
John Henry Garcia
Cancer
Plan #1
Plan #2
Plan #3
Outpatient and Family
Member Lodging
No Benefit
$75/day, up to 90 days per year
$100/day, up to 90 days per year
Physical or Speech
Therapy
No Benefit
$25/visit up to 4 visits per month,
$400 lifetime max
$50/visit up to 4 visits per month,
$1,000 lifetime max
Prosthetic
Surgically Implanted:
$2,000/device, $4,000 lifetime max
Non-Surgically: $200/device, $400
lifetime max
lifetime max
lifetime max
Radiation Therapy
Chemotherapy
Schedule amounts up to a $4,000
benefit year maximum
Reconstructive Surgery
No Benefit
Breast TRAM Flap $2,000
Breast reconstruction $500
Breast Symmetry $250
Facial reconstruction $500
Breast TRAM $3,000
Breast reconstruction $700
Breast Symmetry $350
Facial reconstruction $700
Reproductive Benefit
No Benefit
No Benefit
$1500 egg harvesting, $500 egg or
sperm storage, $2,000 lifetime max
$200/surgical procedure
Biopsy Only: $100
Reconstructive Surgery: $250
Excision of a skin cancer: $375
Excision of a skin cancer with flap
or graft: $600
Biopsy Only: $100
or graft: $600
Biopsy Only: $100
or graft: $600
Schedule amount up to $2,750
No Benefit
$0.50/mile up to $1,000 per round
trip/equal benefit for companion
$0.50/mile up to $1,500 per round
trip/equal benefit for companion
Included
Included
Included
Second Surgical Opinion
Skin Cancer
Surgical Benefit
Transportation/Companion
Transportation
Waiver of Premium
IMPORTANT NOTES
• Cancer means an insured has been diagnosed with a disease manifested by the presence of a malignant tumor characterized by the
uncontrolled growth and spread of malignant cells in any part of the body. This includes leukemia, Hodgkin's disease, lymphoma, sarcoma,
malignant tumors and melanoma. Cancer includes carcinomas in-situ (in the natural or normal place, confined to the site of origin, without
having invaded neighboring tissue). Pre-malignant conditions or conditions with malignant potential, such as myelodyplastic and
myeloproliferative disorders, carcinoid, leukoplakia, hyperplasia, actinic keratosis, polycythemia, and nonmalignant melanoma, moles or
similar diseases or lesions will not be considered cancer. Cancer must be diagnosed while insured is under the Guardian Cancer plan.
• Alternative Care - Benefit is paid for palliative care (bio-feedback or hypnosis) or lifestyle benefits such as visits to an accredited practitioner
for smoking cessation, yoga, meditation, relaxation techniques and nutritional counseling.
• Blood/Plasma/Platelets - Benefit is paid each day you receive blood, plasma and/or platelets for the treatment of internal cancer.
• Experimental Treatment - Benefits will be paid for experimental treatment prescribed by a doctor for the purpose of destroying or changing
abnormal tissue. All treatment must be NCI listed as viable experimental treatment for Internal Cancer.
• Outpatient and Family Member Lodging - Benefit is paid if you stay in a hotel while receiving treatment for internal cancer and treatment
cannot be obtained locally. A benefit is also payable if a family member stays in a hotel while you are confined in a hospital for internal cancer
treatment. Lodging must be more than 50 miles from your home.
• Transportation/Companion Transportation - Benefit is paid if you have to travel more than 50 miles one way to receive treatment for
internal cancer.
• Waiver of Premium - If you become disabled due to cancer that is diagnosed after the employee’s effective date, and you remain disabled for
90 days, we will waive the premium due after such 90 days for as long as you remain disabled.
Unless otherwise noted, the benefits listed are payable if the service or treatment is due to the insured’s diagnosis of cancer while
covered.
• Conditional Underwriting is one medical question as a part of the enrollment form.
• State variations may apply.
• A pre-existing condition includes any condition for which an employee, in the specified time period prior to coverage in this plan, consults with
a physician, receives treatment, or takes prescribed drugs. Please refer to the plan documents for specific time periods. State variations may
apply.
(continued)
Valid from 06/01/15 to 06/15/15
Page 17 of 20
John Henry Garcia
Cancer
• This plan will not pay benefits for (state variations may apply):
• Services or treatment not included in the Schedule of Insurance.
• Services or treatment provided by a family member.
• Services or treatment rendered for hospital confinement outside the United States.
• Any cancer diagnosed solely outside of the United States.
• Services or treatment provided primarily for cosmetic purposes.
• Services or treatment for non-cancer sicknesses.
• Cancer arising from war or act of war, even if war is not declared.
Guardian's Cancer Insurance is underwritten and issued by The Guardian Life Insurance Company of America, New York, NY. Products are not
available in all states. Policy limitations and exclusions apply. Optional riders and/or features may incur additional costs. Plan documents are the
final arbiter of coverage. Contract #: GP-1-CAN-IC-12
Valid from 06/01/15 to 06/15/15
Page 18 of 20
John Henry Garcia
Employee Assistance Plan (EAP)
WORKLIFE MATTERSsm
Comprehensive Employee Assistance Program
sm
1
WorkLife Matters , Guardian’s comprehensive Employee Assistance Program (EAP) is available at no cost to groups purchasing three or more
2
sm
of Guardian’s Group products! With WorkLife Matters , employees can receive expert support services to assist them and their families with a
variety of life issues from family care, stress, depression, or addiction. In today’s environment, addressing work-life balance issues is more
important than ever. Not only will employers be providing a program that employees will appreciate, they will also be helping to ensure a
productive workplace.
Key Employer Services
• Employers can receive expert support service to assist in implementing a Drug-Free Workplace Program.
• Managers and supervisors will have access to human resource consultants to address workplace issues, including performance problems.
Key Employee Services
• Unlimited Telephonic Counseling through a convenient toll-free number. Up to three face-to-face visits per family member, per year, with a
doctoral psychologist or other behavioral health professional.
• Variable resources to assist persons who are facing life challenges such as locating childcare, providing elder care, planning for adoption or
learning about pregnancy or child development.
• A comprehensive, online database including information on everyday home and family issues – accessible twenty-four hours a day, seven
days a week.
• Financial consultation for insureds and their beneficiaries who receive a death benefit of $50,000 or more, or are receiving Long-Term
Disability payments. The purpose is to educate the beneficiaries on options available to protect the benefit received; no solicitation is done.
• Unlimited legal advice by telephone, referral to a local attorney for a free 30 minute session, and any additional legal service at a 25%
3
discount. These services may include, but are not limited to real estate living wills and estate and probate law.
sm
See for yourself how WorkLife Matters can complete your group’s benefit package.
Call your Guardian Group Benefits Expert today for more information or visit www.guardianlife.com
1
sm
WorkLife Matters
is administered by Integrated Behavioral Health, an independent national employee assistance program.
2
Available at no cost if three or more qualified Guardian Group products are purchased and if at least one of these products is employer
sponsored with 75% participation.
3
WillPrep Services are provided by Integrated Behavioral Health, Inc., and its contractors. The Guardian Life Insurance Company of America
(Guardian) does not provide any part of WillPrep Services. Guardian is not responsible or liable for care or advice given by any provider or
resource under the program. This information is for illustrative purposes only. It is not a contract. Only the Administration Agreement can provide
the actual terms, services, limitations and exclusions. Guardian and IBH reserve the right to discontinue the WillPrep Services at any time
without notice. Legal services will not be provided in connection with or preparation for any action against Guardian, IBH, or your employer.
Rates and premiums are based on the employee data submitted. Final rates and premiums are based on the
plan and employee/dependent data provided on the enrollment forms.
Valid from 06/01/15 to 06/15/15
Page 19 of 20
John Henry Garcia
College Tuition Benefit® Rewards
Employees now have an added incentive to participate in Guardian’s Dental Plan.
Employees can earn Tuition Rewards that can be used to pay up to one year’s tuition at over 330 SAGE Scholar private colleges and
universities across the nation. That’s one third of the National Association of Independent Colleges and Universities (NAICU). 80% of SAGE
colleges have received an “America’s Best” ranking in US News and World Report. One Tuition Reward point = 1 USD.
What you can expect from the College Tuition Benefit?
• 2,000 Tuition Rewards® are given to each Guardian plan subscriber when he/she registers an eligible student or students. Subscriber
Tuition Rewards® can be allocated to any registered student.
• 500 Tuition Rewards are given to each student registered. Student Tuition Rewards® can only be used by the specific registered student.
• 2,000 additional Tuition Rewards® are given to the subscriber, annually in the month following the Guardian’s Plan’s renewal.
• 2,500 bonus Tuition Rewards® are given to the subscriber the month following the Guardian’s Plan’s third renewal (4th year) for a total
reward of 4,500 for that year.
The example below shows how the program would help a 12 year old in the family of a Guardian dental subscriber. If the registered student
attends a participating SAGE Scholar College, the tuition will be reduced by $17,000 spread evenly over four years.
College Tuition Benefit® Rewards
Policy Year
Subscriber Reward*
Subscriber’s Reward Balance (balance does not accrue interest)
Initial Registration Subscriber and Student Rewards
2,500 (2000+500)
2
2,000
4,500
3
2,000
6,500
4
4,500 (Bonus Year)
11,000
5
2,000
13,000
6
2,000
15,000
7
2,000
17,000
IMPORTANT NOTES
• In order to be registered for the College Tuition Benefit: Planholder’s must complete a Planholder Service Agreement and each employee
must provide a valid email address. By accepting this optional program you acknowledge that SAGE Scholars Tuition Reward points are
discounts applied towards the full tuition cost of SAGE member colleges and universities, and are not cash and do not accrue interest. It will
be disclosed to employees that providing a personal user name and password to SAGE CTB LLC and/or SAGE Scholars is authorization for
you to provide the employee’s employment status and information essential to the administration of this program. The service fee is $0.33 per
employee per month (PEPM), which shall be included in your billed premium amount. Such service fee will be paid to SAGE CBT by Guardian
on a monthly basis.
• Every Dental plan enrollment, subscribers receive a Welcome email. Check your spam folder. If you do not receive a welcome email contact
Admin@CollegeTuitionBenefit.com
• The welcome email is notification that an online account is established. Subscribers can log in to see the points posted to their account, and
add additional eligible students as they wish. If you do not log in to your account in the first 6 months, your Tuition Reward may be
reduced.
• Eligible students include children, grandchildren, nieces, and nephews.
• The maximum rewards you can use, per registered student, cannot exceed one year’s tuition at a participating school.
• Families do not select a college ahead of time.
• Each Tuesday, registered employees receive Market Cap and Gown, an e-newsletter that details events and topics related to college
financing, and notifies employees of new colleges in the network.
Deadline dates:
• To use Tuition Rewards, a child must be registered by August 24th of the year he/she enters 11th grade.
• The Scholarship credits are held in the subscriber’s account until they are pledged to a registered student. When a Subscriber has a
registered student in 11th grade, the subscriber will be emailed and asked if he/she wants to pledge some or all of the Tuition Rewards to the
Registered Student. If the subscriber wants to use Tuition Rewards, he/she must go online before August 24th of the year the registered
student enters 12th grade and transfer Tuition Rewards to that registered student’s account.
• Guardian's Group Dental Insurance is underwritten by The Guardian Life Insurance Company of America (Guardian) or its subsidiaries.
• The Tuition Rewards program is provided by College Tuition Benefit. The Guardian Life Insurance Company of America (Guardian) does not
provide any services related to this program. College Tuition Benefit is not a subsidiary or an affiliate of Guardian.
• To find out more information, go to https://guardian.collegetuitionbenefit.com #2014-15023 Exp. 12/2016
Valid from 06/01/15 to 06/15/15
Page 20 of 20
Healthcare
Benefits
FY2016
ITEM 10.C
DRD Healthcare Benefits FY2016
▪ Review May 13, 2015 Study Session
▪ Present New Information on Caps and Team Member Polling
▪ Choose Provider - Aetna vs. United Healthcare
▪ Set Employer Contribution to Premium
▪ Approve Staff Recommendation or Provide Alternative Motion
▪ ERG Provided an update on impacts of the Affordable Care Act
▪ District is now a small group with under 50 eligible team members
▪ January 2016 small group designation with be under 100 team members
▪ Pricing structure is now based on age – no longer eligible for aggregate
pricing.
▪ Premiums are expected to continue to increase at 14-18% per year
▪ ERG provided 2 plan options for FY2016
▪ Carrier choice is limited due to board members receiving benefits
▪ Aetna and United Healthcare are our only choices
▪ Aetna will extend aggregate pricing 1 year with 25% increase to premiums
Aetna
United Healthcare/Guardian
▪ Benefits
▪ Benefits
▪ Less staff time to implement
▪ Flat rate structure
▪ No changes to doctors/dentists
▪ Drawbacks
▪ Higher cost
▪ Short term solution/long term
problem
▪ Lower cost
▪ More choice of plans
▪ Sets structure for long term
▪ Drawbacks
▪ More staff time to implement
▪ Employee based premiums
▪ May require changing doctors/dentist
▪ Board Requested Items
▪ Poll Team Members for their input regarding health benefits vs. COLA
▪ Look at raising the Employer Contribution Cap From $1,380 to $1,769
▪ Continue as action item on future agenda
▪ New information on Caps and Team Member Polling
▪ Team Member Polling
▪ FT Team Members would like to have an option that provides 100%
coverage for themselves and their dependents
▪ FT Team Members believe COLA is important for PT Team Members
▪ PT Team Members want COLA but are not concerned with FT benefits
▪ Grant funded positions do not receive merit – COLA is built in to contracts
▪ Team Member/Board Member Goals derived from Polling and Study
Session
1.
2.
3.
4.
5.
100% Employer paid coverage for Team Member and their dependents
Control cost for the District and Team Members
Equitable Distribution of Employee contributions if necessary
Greatest amount of choice possible
FT benefits treated separately from COLA
▪ Caps reviewed at $1,380 - $1,500 - $1,769
▪ Every scenario shows United Healthcare to provide the lowest total cost
▪ Used the premise that each Team Member would maximize buying power
without coming out of pocket
▪ No Cap Scenario met 100% of Board/Team Member Goals
Aetna Renewal
HMO
Age
Coverage
44 EE/CH
$
DRD
1,027.00 $
36 EE/SP
$
33 EE
33 FAM
PPO
- $
DRD
1,380.00 $
TM
40.00
1,255.00 $
- $
1,380.00 $
$
$
571.00 $
1,380.00 $
- $
389.00 $
54 EE/SP
47 FAM
36 FAM
51 FAM
27 FAM
$
$
$
$
$
1,255.00
1,380.00
1,380.00
1,380.00
1,380.00
389.00
389.00
389.00
389.00
52 EE/SP
$
1,255.00 $
62 EE/SP
$
1,255.00 $
61 EE/SP
43 FAM
33 FAM
45 FAM
56 FAM
$
$
$
$
$
1,255.00
1,380.00
1,380.00
1,380.00
1,380.00
27 EE
51 FAM
40 EE/CH
$
$
$
571.00 $
1,380.00 $
1,027.00 $
24 EE
$
35 EE
51 EE/CH
$
$
$
$
$
TM
No TM Cost Plan
YES
NO
a
$
355.00
a
$
789.00 $
1,380.00 $
1,065.00
a
1,380.00
1,380.00
1,380.00
1,380.00
1,380.00
$
$
$
$
$
355.00
1,065.00
1,065.00
1,065.00
1,065.00
a
- $
1,380.00 $
355.00
- $
1,380.00 $
867.21 $
a
$
401.59 $
$ 1,380.00 $
a
a
a
a
$
$
$
$
$
-
$
-
$
$
DRD
775.52 $
$
752.25 $
-
$
997.55 $
- $
348.35 $
61.76 $ 1,250.65 $
-
$
$
461.95 $
1,380.00 $
$
$
$
$
$
1,380.00
1,380.00
1,380.00
1,380.00
1,053.08
$
-
- $
362.61 $
278.48 $ 1,301.82 $
-
a
a
$
$
$
$
$
455.15
499.64
-
a
1,380.00 $
3.15 $ 1,085.71 $
-
a
884.63 $ 1,380.00 $
397.64
355.00
a
$ 1,380.00 $
588.75 $ 1,380.00 $
327.75 $
1,380.00 $
$
$
$
$
$
355.00
1,065.00
1,065.00
1,065.00
1,065.00
a
$
$
$
$
$
277.66
892.12
57.91
590.91
$
$
$
$
$
1,380.00
1,380.00
1,181.10
1,380.00
1,380.00
- $
389.00 $
- $
789.00 $
1,380.00 $
1,380.00 $
1,065.00
40.00
a
-
$
$
$
404.11 $
1,380.00 $
1,380.00 $
571.00 $
- $
789.00 $
$
$
571.00 $
1,027.00 $
- $
- $
789.00 $
1,380.00 $
59 EE/SP
$
1,255.00 $
- $
60 EE/SP
$
1,255.00 $
- $
50 EE
$
571.00 $
- $
789.00 $
-
50 EE
46 FAM
Totals
$
571.00 $
$ 1,380.00 $
$ 30,472.00 $
- $
389.00 $
4,279.00 $
789.00 $
1,380.00 $
33,714.00 $
1,065.00
14,320.00
a
1,380.00
1,324.78
1,026.77
1,364.67
1,380.00
$
$
$
$
$
$ 1,043.03 $
$
$
$
$
$
1,380.00
1,149.17
890.66
1,183.78
1,380.00
$
$
$
$
$
-
$
$
$
$
$
$
$
$
$
$
73.72
957.90
64.47
1,014.57
-
526.80
143.90
189.79
1,233.60
$
$
$
$
$
$
$
$
$
$
1,141.10
1,380.00
1,133.84
1,380.00
826.62
1,380.00
1,196.19
927.11
1,232.21
1,380.00
a
a
a
a
a
$
$
$
$
$
116.75
671.56
a
a
a
- $
317.21 $
413.42 $ 1,380.00 $
128.86 $ 1,184.39 $
27.77
-
a
a
a
a
a
$
351.31 $
$ 1,380.00 $
$ 1,311.71 $
a
$
335.22 $
-
$
290.78 $
-
$
385.60 $
-
$
302.68 $
-
a
40.00
a
a
$
$
409.64 $
960.41 $
-
$
$
355.33 $
833.08 $
-
$
$
471.20 $
1,104.74 $
-
$
$
369.87 $
867.18 $
-
a
a
1,380.00 $
355.00
a
$ 1,380.00 $
176.43 $ 1,350.09 $
-
$
1,380.00 $
410.34 $ 1,380.00 $
25.35
1,380.00 $
355.00
a
$ 1,380.00 $
277.33 $ 1,380.00 $
57.62 $
1,380.00 $
526.41 $ 1,380.00 $
116.45
a
$
-
a
16
a
10
598.70 $
- $
304.74 $
179.11 $ 1,352.41 $
- $ 1,137.83 $
383.01
425.74
-
a
a
-
a
a
a
a
$
$
$
$
$
No TM Cost Plan
YES
NO
-
$ 1,202.43 $
1,380.00
1,380.00
1,380.00
1,380.00
1,380.00
1,096.25
1,380.00
1,089.27
1,380.00
794.13
PPO Silver
DRD
TM
807.24 $
783.04 $
a
$
$
$
$
$
$
$
$
$
$
TM
652.43
701.72
-
389.00
389.00
389.00
389.00
1,263.77
1,380.00
1,255.72
1,380.00
915.48
-
United Healthcare
PPO Gold
DRD
TM
$ 1,028.00 $
HMO Gold
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
HMO Platinum
DRD
TM
894.02 $
-
-
$
519.33 $
$
598.70 $
- $
519.33 $
$ 1,380.00 $ 245.47 $ 1,380.00 $
$ 28,882.13 $ 4,052.78 $ 26,695.98 $
-
$
688.68 $
- $
688.68 $
30.10 $ 1,380.00 $
1,873.04 $ 30,544.69 $
-
$
540.59 $
-
- $
540.59 $
489.79 $ 1,380.00 $
87.69
7,339.83 $ 27,340.00 $ 2,398.00
a
a
a
a
20
a
6
Under Current Policy - $1,380 Cap
•
•
•
•
•
•
Aetna - 16 TM’s Covered 100%
Aetna – TM contributions equal
Aetna – More $$ for TM & DRD
UHC – 20 TM’s Covered 100%
UHC – TM contributions all over
UHC – Less $$ for DRD/most
TMs
Aetna Renewal
HMO
Age
Coverage
44 EE/CH
36 EE/SP
33 EE
33 FAM
54 EE/SP
47 FAM
36 FAM
51 FAM
27 FAM
52 EE/SP
62 EE/SP
61 EE/SP
43 FAM
33 FAM
45 FAM
56 FAM
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
DRD
1,027.00
1,255.00
571.00
1,380.00
1,255.00
1,380.00
1,380.00
1,380.00
1,380.00
1,255.00
1,255.00
1,255.00
1,380.00
1,380.00
1,380.00
1,380.00
27 EE
51 FAM
40 EE/CH
$
$
$
- $
1,380.00 $
1,027.00 $
24 EE
$
- $
35 EE
51 EE/CH
59 EE/SP
60 EE/SP
$
$
$
$
50 EE
$
- $
50 EE
46 FAM
Totals
$
- $
$ 1,380.00 $
$ 27,617.00 $
1,027.00
1,255.00
1,255.00
PPO
TM
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
DRD
389.00
389.00
389.00
389.00
389.00
389.00
389.00
389.00
389.00
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
No TM Cost Plan
YES
NO
TM
-
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
-
a
a
a
- $
389.00 $
- $
789.00 $
- $
- $
-
a
- $
789.00 $
-
789.00
-
a
a
a
a
a
a
a
a
a
a
a
a
a
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
HMO Platinum
DRD
TM
- $
- $
- $
- $
1,263.77 $
- $
1,255.72 $
- $
- $
1,202.43 $
- $
- $
1,324.78 $
- $
1,364.67 $
- $
HMO Gold
DRD
-
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
TM
1,380.00
1,380.00
1,380.00
1,380.00
1,380.00
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
383.01
425.74
327.75
57.91
590.91
United Healthcare
PPO Gold
DRD
TM
$ 1,028.00 $
$
997.55 $
$
461.95 $
$
- $
$
- $
$
- $
$
- $
$
- $
$ 1,053.08 $
$
- $
$
- $
$
- $
$
- $
$ 1,181.10 $
$
- $
$
- $
-
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
PPO Silver
DRD
TM
- $
- $
- $
1,301.82 $
- $
- $
- $
- $
- $
- $
- $
- $
- $
- $
- $
- $
No TM Cost Plan
YES
NO
-
a
a
a
a
a
a
a
a
a
a
a
a
a
a
a
- $
- $
- $ 1,352.41 $
- $
- $
-
$
$
$
404.11 $
- $
- $
-
$
$
$
-
$
$
$
-
a
a
a
-
a
$
-
$
- $
-
$
385.60 $
-
$
-
$
-
a
$
$
$
$
-
a
a
a
a
$
$
$
$
-
$
$
$
$
-
$
$
$
$
-
$
$
$
$
-
$
$
$
$
-
a
a
a
- $
789.00 $
-
a
$
-
$
- $
$
688.68 $
-
$
-
$
-
a
- $
389.00 $
4,279.00 $
789.00 $
- $
3,945.00 $
-
a
- $
30.10 $
1,873.04 $
688.68 $
- $
8,464.69 $
-
$
- $
$
- $
$ 1,301.82 $
-
a
$
$
$
$
16
a
10
$
- $
$
- $
$ 7,723.08 $
-
$
$
- $
$
- $
$ 1,350.09 $
$ 1,380.00 $
-
$
- $
- $
- $ 1,380.00 $
- $ 12,362.50 $
57.62
-
$
$
$
$
471.20
1,104.74
-
• Aetna – $378,744 DRD
• Aetna - $51,348 TM
a
$
- $
$
- $
$ 1,311.71 $
a
$1,380 Cap
a
20
a
6
• UHC - $358,225 DRD
• UHC - $22,476 TM
Aetna Renewal
HMO
Age
Coverage
44 EE/CH
$
36 EE/SP
$
DRD
- $
1,255.00 $
33 EE
33 FAM
54 EE/SP
47 FAM
36 FAM
51 FAM
27 FAM
52 EE/SP
62 EE/SP
61 EE/SP
43 FAM
33 FAM
45 FAM
56 FAM
$
$
$
$
$
$
$
$
$
$
$
$
$
$
1,500.00
1,255.00
1,500.00
1,500.00
1,500.00
1,500.00
1,255.00
1,255.00
1,255.00
1,500.00
1,500.00
1,500.00
1,500.00
27 EE
51 FAM
40 EE/CH
$
$
$
- $
1,500.00 $
- $
24 EE
$
- $
35 EE
51 EE/CH
59 EE/SP
60 EE/SP
$
$
$
$
50 EE
$
- $
50 EE
46 FAM
Totals
$
- $
$ 1,500.00 $
$ 25,285.00 $
PPO
- $
- $
1,255.00
1,255.00
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
- $
$ 1,441.46 $
$
- $
$
- $
$
- $
$
- $
$
- $
$
- $
$
- $
$
- $
$ 1,324.78 $
$
- $
$ 1,364.67 $
$
- $
-
1,500.00
1,500.00
1,500.00
1,500.00
a
$
- $
$
- $
$ 1,311.71 $
- $
- $
- $
- $
- $
- $
- $
- $
- $
-
a
$
- $
- $
- $
- $
$
$
$
$
$
$
$
$
-
a
a
a
a
$
$
$
$
-
-
-
-
- $
789.00 $
-
a
$
- $
- $
269.00 $
2,959.00 $
789.00 $
- $
8,994.00 $
-
a
- $
- $
DRD
1,420.00 $
- $
TM
-
a
a
$
$
$
$
$
$
$
$
$
$
$
$
$
$
-
a
- $
269.00 $
- $
789.00 $
- $
1,420.00 $
-
a
- $
789.00 $
269.00
269.00
269.00
269.00
269.00
269.00
269.00
269.00
269.00
-
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
789.00
-
789.00
1,420.00
-
$
$
a
a
a
a
a
a
a
a
a
a
a
a
a
a
16
a
10
HMO Platinum
DRD
TM
- $
- $
United Healthcare
PPO Gold
DRD
TM
- $ 1,028.00 $
- $
997.55 $
HMO Gold
DRD
TM
- $
- $
TM
No TM Cost Plan
YES
NO
$
$
$
$
$
- $
$
- $
$ 5,442.62 $
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
- $
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
- $
- $
- $
- $
- $
- $ 6,000.00 $
263.01
305.74
207.75
470.91
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
- $
No TM Cost Plan
YES
NO
-
a
a
$
- $
$
- $
$
- $
$
- $
$
- $
$
- $
$
- $
$
- $
$
- $
$ 1,496.75 $
$
- $
$
- $
$
- $
$
- $
-
a
a
a
404.11 $
- $
- $
- $
- $
- $ 1,407.77 $
- $
- $
-
a
a
a
385.60 $
- $
- $
-
a
$
- $
$
- $
$ 1,405.35 $
$ 1,496.45 $
-
a
a
a
a
- $
-
a
- $
- $
- $ 1,467.69 $
- $ 7,274.01 $
-
a
a
22
461.95
1,453.72
1,444.47
1,053.08
1,383.15
1,181.10
-
471.20
1,104.74
-
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
688.68 $
- $
688.68 $
- $
- $
1,247.41 $ 12,746.03 $
- $
- $
PPO Silver
DRD
TM
- $
- $
-
-
- $
$1,500 Cap
• Aetna – $411,348 DRD
• Aetna - $35,508 TM
a
a
a
a
a
a
a
a
a
a
a
4
• UHC - $377,551 DRD
• UHC - $14,968 TM
Aetna Renewal
HMO
Age
Coverage
44 EE/CH
$
36 EE/SP
$
DRD
33 EE
33 FAM
54 EE/SP
47 FAM
36 FAM
51 FAM
27 FAM
52 EE/SP
62 EE/SP
61 EE/SP
43 FAM
33 FAM
45 FAM
56 FAM
$
$
$
$
$
$
$
$
$
$
$
$
$
$
1,769.00
1,769.00
1,769.00
1,769.00
1,769.00
1,769.00
1,769.00
1,769.00
1,769.00
27 EE
51 FAM
40 EE/CH
$
$
$
- $
1,769.00 $
- $
24 EE
$
35 EE
51 EE/CH
59 EE/SP
60 EE/SP
PPO
- $
- $
$
- $
$
- $
$
- $
$
- $
$
- $
$
- $
$
- $
$
- $
$
- $
$ 1,657.66 $
$
- $
$
- $
$
- $
$
- $
-
1,763.01
1,769.00
1,707.75
1,769.00
a
a
a
$
- $
$ 1,559.11 $
$
- $
- $
- $
- $
- $
- $
- $
- $
- $
- $
404.11 $
- $
1,508.86 $
-
a
$
- $
- $
- $
385.60 $
$
$
$
$
-
a
a
a
a
$
- $
$
- $
$ 1,556.43 $
$ 1,657.33 $
-
-
-
- $
789.00 $
-
a
$
- $
- $
- $
- $
789.00 $
- $
21,139.00 $
-
a
a
26
$
- $
$ 1,625.47 $
$ 8,056.00 $
- $
- $
DRD
1,420.00 $
1,735.00 $
-
789.00
1,735.00
1,735.00
1,735.00
1,735.00
-
TM
-
a
a
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
-
a
a
a
a
a
a
a
a
a
a
a
a
a
a
- $
- $
- $
789.00 $
- $
1,420.00 $
-
- $
- $
789.00 $
$
$
$
$
-
-
50 EE
$
- $
50 EE
46 FAM
Totals
$
- $
$ 1,769.00 $
$ 19,459.00 $
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
789.00
1,420.00
1,735.00
1,735.00
0
HMO Platinum
DRD
TM
- $
- $
United Healthcare
PPO Gold
DRD
TM
- $ 1,028.00 $
- $
997.55 $
HMO Gold
DRD
TM
- $
- $
TM
- $
- $
No TM Cost Plan
YES
NO
- $
- $
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
- $
- $
- $
- $
- $
- $ 7,008.76 $
36.74
201.91
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
- $
461.95
1,658.48
1,453.72
1,444.47
1,053.08
1,383.15
1,523.90
1,181.10
1,569.79
-
471.20
1,104.74
-
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$1,769 Cap
- $
- $
PPO Silver
DRD
TM
- $
- $
No TM Cost Plan
YES
NO
-
a
a
$
$
$
$
$
$
$
$
$
$
$
$
$
$
-
a
a
a
a
a
- $
- $
- $
- $
- $
- $
-
a
a
a
- $
- $
-
a
-
-
$
$
$
$
-
a
a
a
a
-
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
-
• Aetna – $487,176 DRD
• Aetna - $0 TM
a
a
a
a
a
a
a
a
a
688.68 $
- $
- $
-
a
- $
688.68 $
- $
- $
238.65 $ 19,007.06 $
- $
- $
- $
- $
- $
- $
-
a
a
24
2
• UHC - $408,861 DRD
• UHC - $2,863 TM
Aetna Renewal
HMO
Age
Coverage
DRD
PPO
TM
DRD
TM
No TM Cost Plan
YES
NO
HMO Platinum
DRD
TM
United Healthcare
PPO Gold
DRD
TM
HMO Gold
DRD
TM
PPO Silver
DRD
TM
No TM Cost Plan
YES
NO
44 EE/CH
$
1,027.00 $
-
$
1,027.00 $
393.00
a
$
775.52 $
118.50 $
775.52 $
-
$
775.52 $
252.88 $
775.52 $
31.72
a
36 EE/SP
$
1,255.00 $
-
$
1,255.00 $
480.00
a
$
752.25 $
114.96 $
752.25 $
-
$
752.25 $
245.30 $
752.25 $
30.79
a
33 EE
$
571.00 $
-
$
571.00 $
218.00
a
$
348.35 $
53.24 $
348.35 $
-
$
348.35 $
113.60 $
348.35 $
14.26
a
33 FAM
$
1,769.00 $
-
$
1,769.00 $
676.00
a
$ 1,250.65 $
191.11 $ 1,250.65 $
-
$
1,250.65 $
407.83 $ 1,250.65 $
51.17
a
54 EE/SP
$
1,255.00 $
-
$
1,255.00 $
480.00
a
$ 1,096.25 $
167.52 $ 1,096.25 $
-
$
1,096.25 $
357.47 $ 1,096.25 $
44.85
a
47 FAM
$
1,769.00 $
-
$
1,769.00 $
676.00
a
$ 1,763.01 $
269.42 $ 1,763.01 $
-
$
1,763.01 $
574.89 $ 1,763.01 $
72.14
a
36 FAM
$
1,769.00 $
-
$
1,769.00 $
676.00
a
$ 1,089.27 $
166.45 $ 1,089.27 $
-
$
1,089.27 $
355.20 $ 1,089.27 $
44.57
a
51 FAM
$
1,769.00 $
-
$
1,769.00 $
676.00
a
$ 1,805.74 $
275.98 $ 1,805.74 $
-
$
1,805.74 $
588.83 $ 1,805.74 $
73.90
a
27 FAM
$
1,769.00 $
-
$
1,769.00 $
676.00
a
$
121.35 $
794.13 $
-
$
794.13 $
258.95 $
794.13 $
32.49
a
52 EE/SP
$
1,255.00 $
-
$
1,255.00 $
480.00
a
$ 1,043.03 $
159.40 $ 1,043.03 $
-
$
1,043.03 $
340.12 $ 1,043.03 $
42.68
a
62 EE/SP
$
1,255.00 $
-
$
1,255.00 $
480.00
a
$ 1,707.75 $
261.00 $ 1,707.75 $
-
$
1,707.75 $
556.88 $ 1,707.75 $
69.89
a
61 EE/SP
$
1,255.00 $
-
$
1,255.00 $
480.00
a
$ 1,437.91 $
219.75 $ 1,437.91 $
-
$
1,437.91 $
468.89 $ 1,437.91 $
58.84
a
43 FAM
$
1,769.00 $
-
$
1,769.00 $
676.00
a
$ 1,149.17 $
175.61 $ 1,149.17 $
-
$
1,149.17 $
374.73 $ 1,149.17 $
47.02
a
33 FAM
$
1,769.00 $
-
$
1,769.00 $
676.00
a
$
136.11 $
890.66 $
-
$
890.66 $
290.44 $
890.66 $
36.45
a
45 FAM
$
1,769.00 $
-
$
1,769.00 $
676.00
a
$ 1,183.78 $
180.89 $ 1,183.78 $
-
$
1,183.78 $
386.01 $ 1,183.78 $
48.43
a
56 FAM
$
1,769.00 $
-
$
1,769.00 $
676.00
a
$ 1,970.91 $
301.41 $ 1,970.91 $
-
$
1,970.91 $
642.69 $ 1,970.91 $
80.65
a
27 EE
$
571.00 $
-
$
571.00 $
218.00
a
$
304.74 $
-
$
304.74 $
304.74 $
12.47
a
51 FAM
$
1,769.00 $
-
$
1,769.00 $
676.00
a
$ 1,352.41 $
206.70 $ 1,352.41 $
-
$
1,352.41 $
441.01 $ 1,352.41 $
55.36
a
40 EE/CH
$
1,027.00 $
-
$
1,027.00 $
393.00
a
$ 1,137.83 $
173.78 $ 1,137.83 $
-
$
1,137.83 $
371.03 $ 1,137.83 $
46.56
a
24 EE
$
571.00 $
-
$
571.00 $
218.00
a
$
290.78 $
35 EE
$
571.00 $
-
$
571.00 $
218.00
a
$
51 EE/CH
$
1,027.00 $
-
$
1,027.00 $
393.00
a
$
59 EE/SP
$
1,255.00 $
-
$
1,255.00 $
480.00
a
60 EE/SP
$
1,255.00 $
-
$
1,255.00 $
480.00
50 EE
$
571.00 $
-
$
571.00 $
218.00
50 EE
$
571.00 $
-
$
571.00 $
46 FAM
$
1,769.00 $
-
$
$ 34,751.00 $
-
$
Totals
794.13 $
890.66 $
304.74 $
46.57 $
99.37 $
44.44 $
290.78 $
-
$
290.78 $
94.82 $
290.78 $
11.90
a
355.33 $
54.31 $
355.33 $
-
$
355.33 $
115.87 $
355.33 $
14.54
a
833.08 $
127.33 $
833.08 $
-
$
833.08 $
271.66 $
833.08 $
34.10
a
$ 1,350.09 $
206.34 $ 1,350.09 $
-
$
1,350.09 $
440.25 $ 1,350.09 $
55.26
a
a
$ 1,437.62 $
219.71 $ 1,437.62 $
-
$
1,437.62 $
468.79 $ 1,437.62 $
58.83
a
a
$
519.33 $
79.37 $
519.33 $
-
$
519.33 $
169.35 $
519.33 $
21.26
a
218.00
a
$
519.33 $
79.37 $
519.33 $
-
$
519.33 $
169.35 $
519.33 $
21.26
a
1,769.00 $
676.00
$ 1,410.01 $
215.46 $ 1,410.01 $
-
$
1,410.01 $
459.78 $ 1,410.01 $
57.68
34,751.00 $
13,283.00
a
26
$ 28,568.93 $ 4,366.08 $ 28,568.93 $
-
$ 28,568.93 $
a
26
0
9,315.99 $ 28,568.93 $ 1,169.07
DRD Sponsored Base Plan
• Aetna – $417,012 DRD
• Aetna - $0 to $13,283 BOTMC
• UHC - $342,827 DRD
• UHC - $0 to $9,315 BOTMC
0
▪ Team Member/Board Member Goals derived from Polling and Study
Session
1.
2.
3.
4.
5.
100% Employer paid coverage for Team Member and their dependents
Control cost for the District and Team Members
Equitable Distribution of Employee contributions if necessary
Greatest amount of choice possible
FT benefits treated separately from COLA
Team Members Covered 100%
30
25
20
15
10
5
0
$1,380 Cap
$1,500 Cap
$1,769 Cap
Aetna
United Healthcare
ESBP
Control Cost to DRD/TM
500,000
450,000
400,000
350,000
300,000
250,000
200,000
150,000
100,000
50,000
0
$1,380 Cap
$1,500 Cap
$1,769 Cap
Aetna
United Healthcare
ESBP
Greatest Choice of Plans
4
4
3
3
2
2
1
1
0
$1,380 Cap
$1,500 Cap
$1,769 Cap
Aetna
United Healthcare
ESBP
Equitable Distribution of Cost
Aetna
UHC
$1,380 Cap
Yes
No
$1,500 Cap
Yes
No
$1,769 Cap
Yes
No
ESBP
Yes
Yes
▪ Choose Provider - Aetna vs. United Healthcare
▪ United Healthcare meets all TM/Board goals
▪ Set Employer Contribution to Premium
▪ The Employer Sponsored Base Plan meets all TM/Board Goals
▪ Staff Recommendation or Provide Alternative Motion
▪ To authorize the General Manager to negotiate and execute a contracts
with United Healthcare/Guardian for the provision of employee health
and welfare insurance plans for fiscal year 2016.
ADMINISTRATIVE REPORT MEETING DATE: May 13, 2015 AGENDA SECTION: Study Session ITEM: 9. A TO: FROM: DATE: Honorable Members of the Board Kevin Kalman, General Manager April 24, 2015 SUBJECT: Discussion Regarding Healthcare Benefits for Full‐Time Staff and Board Members RECOMMENDATION: To provide staff direction regarding healthcare benefits for full‐time staff and board members. BACKGROUND: The Desert Recreation District maintains the following health and welfare plans for fulltime team members and board members paying $1,380 of the medical premium costs and 100% of all other benefits, which includes dependent coverage. These benefits renew each July 1, with Board of Directors’ approval:  Medical benefits through Aetna Blue Cross (HMO and PPO options);  Dental benefits through Principal;  Life, Long‐term Disability and Accidental Death & Dismemberment benefits through Principal;  Vision benefits through Vision Services Plan (VSP) John Henry Garcia of Employer Resource Group (ERG) will present information on renewal pricing for current plans, as well as discuss the impact of the Affordable Care Act. Staff requests board direction for health and welfare benefit plans effective July 1, 2015 and will present Administrative Report ‐ Subject: Discussion of healthcare benefits for fulltime staff and board members Page 1 ADMINISTRATIVE REPORT several options to the board for discussion. These options take into consideration budget constraints and the impact of the Affordable Care Act. BOARD STRATEGIC GOALS OR KEY OBJECTIVES ADDRESSED: A qualified, committed staff that is motivated and customer oriented, whose skills are competitively compensated, and whose achievements are recognized. Administrative Report ‐ Subject: Discussion of healthcare benefits for fulltime staff and board members Page 2 Health & Welfare
Benefits
FY16
Presented by:
John Henry Garcia
Employer Resource Group & Insurance
Services
License #0E52001
FY16 EMPLOYEE BENEFITS RENEWAL
2
 Due to the reduction in team members, DRD is now considered “small
group” employer. Currently, we have 27 team members enrolled.
 Beginning in 2016 all employers with less than 100 full time employees will
be considered a small group employer under ACA.
 In small group, premiums are calculated by age, compared to composite
(avg.) rates in large group.
 In small group, plan designs are not as flexible and fall within 4 categories:
Platinum, Silver, Gold or Bronze. These plans are highly regulated by the
State.
 Aetna’s rate increase: 25% (still in negotiations)—this is due to the
reduction in team members, new ACA plans and older demographics.
 Aetna is allowing another year with composite rates, but with new ACA
plans.
 Consideration: Renewing with Aetna at composite rating structure or
changing to a small group, age-rated carrier.
AETNA RENEWAL
3
Employee
Employee+Spouse
Employee+Ch/rn
Employee+Fam
#
2
4
1
10
17
HMO Aetna FY15
$
445.00
$
979.00
$
802.00
$
1,380.00
$
19,408.00
Total Monthly Billing:
PPO Aetna FY15
$
615.00
$
1,354.00
$
1,107.00
$
1,907.00
$
10,643.00
$
30,051.00
#
2
4
1
10
17
HMO Aetna FY16
$
556.00
$
1,224.00
$
1,002.00
$
1,725.00
$
24,260.00
25%
#
4
3
2
1
10
27
PPO Aetna FY16
$
769.00
$
1,692.00
$
1,384.00
$
2,384.00
$
13,304.00
$
37,564.00
HMO
PPO In Network
HMO (New)
PPO In (New)
$15/$20
None
$250Admit
$2,500
$100copay
$15/$25/$40/20%
None
Full Network
$15/$15
$300
Ded+20%
$2,500
$100ded+20%
$15/$25/$40/20%
None
PPO Network
$20/$25
None
$500Admit
$2,500
$100copay
$20/$35/$50/20%
None
Full Network
$20/$20
$500
Ded+20%
$3,500
$100ded+20%
$20/$35/$50/20%
None
PPO Network
Benefits
Office Visits-PCP/Spec
Deductible-Indv
Hospital-Indv
Annual Max
ER
Rx-Gen/Brand/NonForm/Spec
Rx-Ded Brand/NF/Spec only
#
4
3
2
1
10
27
Actual Cost to District with HMO Family Cap or less:
Total Monthly District Cost:
Total Annual District Cost:
Costs are based on current elections
#
27
Aetna FY15
$
1,380.00
$
29,524.00
$
354,288.00
#
27
Aetna FY16
$
1,725.00
$
36,349.00
$
436,188.00
23%
4
SMALL GROUP HMO & PPO OPTIONS
Consider changing to United Healthcare under
“small group” and offer multiple plan options.
UHC is our only option in small group due to W-2
salary amounts for board members.
Group will be “age rated”, including dependents.
4 plans to chose from: High/Low HMO and
High/Low PPO.
Due to ACA plan structures (Platinum, Gold, Silver,
Bronze) benefits and out of pocket costs are higher
than the current Aetna plan.
See small group structure handout.
COSTS & BENEFITS
5
Aetna HMO Plan - Large Group (Renewal)
Office Visits/PCP/Spec
Deductible/Individual
Hospital/Individual
Annual Max
ER
Rx-Ded Brand/NF/Spec Only
$24,260.00
HMO
$15/$20
None
$250Admit
$2,500
$100copay
$15/$25/$40/20%
None
Full Network
$13,304.00
PPO
$15/$15
$300
Ded+20%
$2,500
$100ded+20%
$15/$25/$40/20%
None
PPO Network
Current Enrollment - 17 HMO & 10 PPO
United Health Care Small Group HMO Option
Hospital/Individual
Annual Max
ER
$21,740.00
HMO Platinum
$20/$40
None
$250/day; max 4
$4,000
$100
$15/$35/$50/25% up to $300
None
Full Network
$18,858.00
HMO Gold
$30/$50
None
$1,000/day; max 4
$6,350
$300
$15/$35/$70/25% up to $300
None
Reduced Network
United Health Care Small Group PPO Option
Hospital/Individual
Annual Max
ER
$12,878.00
$10,109.00
PPO Gold
$15/$30
$500
$250 then 10% after ded
$4,000
$100
$15/$35/$60/25%
None
PPO Network
PPO Silver
$35/$60
$1,800
$250 then 30% after ded
$6,250
$200
$25/$50/$70/20% after $200
$200/Brand/NF
PPO Network
DENTAL & VISION
6
Dental Plan
Principal
Principal
Guardian
FY15 De ntal
FY 16 De ntal
FY 16 De ntal
POS
Employee
7
$
Re ne w al
43.23
$
45.78
Re com m e nde d
$
39.44
Employee+Spouse
8
$
85.05
$
90.07
$
75.54
Employee+Ch/rn
3
$
97.50
$
103.25
$
88.95
15
$
144.77
$
153.31
$
133.67
33
$
3,447.06
$
3,650.42
$
3,152.30
Employee+Fam
M onthly Cos t:
Dental Benefits
Preventive
Basic
Major
Annual Max
Deductible
Ortho-child only
Vision Plan
100%/100%/100%
100%/100%/100%
100%/100%/100%
100%/90%/80%
100%/90%/80%
100%/90%/80%
100%/60%/50%
100%/60%/50%
100%/60%/50%
$2k/$1500/$1500
$2k/$1500/$1500
$2500/$2000/$1500
$0/$50/$50
$0/$50/$50
$0/$50/$50
Child Only
Child Only
Child Only
VSP
VSP
VSP-Guadian
FY15 Vis ion
FY16 Vis ion
FY16 Vis ion
Curre nt
Employee
11
$
10.75
Re ne w al
$
10.75
Re com m e nde d
$
7.85
Employee+Spouse
6
$
18.42
$
18.42
$
13.22
Employee+Ch/rn
3
$
18.81
$
18.81
$
13.48
14
$
30.32
$
30.32
$
21.33
34
$
709.68
$
709.68
$
504.73
Employee+Fam
M onthly Cos t:
Exam/Lens/Frames
Copays:
12e/12L/24f
12e/12L/24f
12e/12L/12f
$10exam/$25mat
$10exam/$25mat
$10exam/$25mat
LIFE & LTD
7
Life/AD&D
Principal
Principal
Guardian
Group Life,AD&D
Group Life,AD&D
Group Life,AD&D
1xAnnual
1xAnnual
1xAnnual
.24/$1000
.24/$1000
.22/$1000
Board Volume
125000*(.203)/1000
125000*(.203)/1000
125000*(.2)/1000
Staff Volume
1493000*(.24)/1000
1493000*(.24)/1000
1493000*(.22)/1000
$
$
Team Members
32
Monthly Prem ium :
LTD
Staff Volume
Monthly Prem ium :
Monthly Total:
Annual Savings vs. Current:
Annual Savings vs. Renewal:
377.97
377.97
$
353.46
Principal
Principal
Guardian
LTD
LTD
LTD
$.53/$100
$.56/$100
$.48/$100
132934*.53%cme
132934*.56%cme
132934*.48%cme
$
699.74
$
744.43
$
638.08
$
5,234.45
$
5,482.50
$
4,648.57
$
$
7,030.56
10,007.16
8
EE/DEP COSTS ( SMALL GROUP)
WORKSHEETS

36ee breast

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