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Home My WebLink About2000-018x • �{ k'�r.��> t si-q•�MSc-s i�z-��t��F� FZ h� � 3� � LqS d� -_ S � � T � Er �'f�i i i T'y�'-" +ryJ � 5 ri'a,, .F �s�`o INDIAN RIVER COUNTY MEMORANDUM TO: James E. Chandler ='= County Administrator ! YS F THRU: Joe Baird t f . Assistant County Administrator FROM: Ann Rankin -k. . Benefits/Payroll Administrator DATE: June 14, 2000 SUBJECT: Insurance RFP #2044 Staff requests consideration of the following information at the June 20, 2000, regular meeting of the Board of County Commissioners. Background The Board approved utilizing Interisk Corporation as the consultant to assist the County in evaluating proposals for its Health Benefit Plan Claims Administration & Utilization Review Services, Mental Health Benefits, Excess/Stop-Loss Insurance for Group Self -Insured Medical Benefits, Prescription Benefits Plan, Group Life Insurance and Accidental Death & Dismemberment, Group Employee Voluntary Supplemental Life Insurance, and Voluntary Long Tenn Disability. In April 2000, Interisk Corporation prepared and distributed a Request for Proposal (RFP) to all interested prospective proposers for the purpose of soliciting competitive proposals for Indian River County, Florida, Board of County Commissioners and affiliated constitutional offices. Several organizations submitted multiple proposals. The proposals were reviewed by Interisk for completeness and responsiveness to the RFP requirements and have been analyzed in relation to the lowest overall cost, while maintaining an adequate level of benefits. Attached is Interisk's Analysis and Recommendation for the Board to review. Interisk's recommendation is based on the following! Lowest overall annual cost – Substantial provider network accessibility Aggressive preferred provider discount arrangements Recommendation The Board of County Commissioners award the bids as follows: Health Insurance ts: Blue Cross Blue Shield of Florida - Health Benefit Plan Claims Administration Modified Plan Utilization Review Services Prescription Benefits Plan Bradman/UniPsych - Mental Health Benefits a%6 et, James E. Chandler June 14, 2000 Page 2 Recommendation - Cont. ARMS/Lincoln Re - Excess/Stop-Loss Insurance for Group Self -Insured Modified BCBS Plan Medical Benefits Life Insurance HighMark Life Insurance - Lon Bryan Group Life Insurance and Accidental Death & Dismemberment Group Employee Voluntary Supplemental Life Insurance Voluntary Long Term Disability UNUM Insurance Company - Voluntary Long Term Disability The Consultant reviewed employee dependent contribution and is recommending an increase as will be presented at the meeting. This will be addressed further at the appropriate time in conjunction with bargaining. APPROVED FOR AGENDA: ges E. Chandler, County Administrator L, -,? r)1) Admin. Approval ♦ c Date f• Le: al 11r`7 - Bud :et De.t. Risk Mgmt. Interisk Corporation Analysis ofProposals and Recommendation for Selection To: Ann Rankin / Benefits Administrator, Indian River County, Florida From: Lawton Swan / lnterisk Corporation Date: June 14, 2000 Re: Employee Benefits Renewal 2000-2001, RFP # 2044 This report is submitted in accordance with our assignment to assist the County in evaluating proposals for its medical claim administration. prescription. life. disability and mental health benefits. A Request for Proposals. (RFP), document was prepared and distributed to all interested prospective proposers. Fifteen organizations submitted proposals for all or panial benefits. Several ams submitted multiple proposals or options. The proposals were reviewed for completeness and responsiveness to the RFP requirements and have been analyzed in relation to the lowest overall cost while maintaining an adequate level of benefits. We believe the proposals received permit the Cowny to continue to offer a high level of benefits to its employees and their dependents and control costs. The County provides a generous package of benefits and funds nearly all of the costs. Employees currently pay S12.50 monthly for their dependent health care coverage. 1111 No. Westshore Blvd., Ste. 208, Tampa, FL 33807-4711 Telephone 813-287.1040 Facsimile 813.287-1041 June 14, 2000 Health Insurance Recommendation It is recommended that the County continue its generous benefits by selecting the Blue Cross Blue Shield proposal with modified medical benefits and select the Lincoln Re as its stop -loss insurer. The Blue Cross proposal provides the lowest overall cost projection and maintains the current hospital and physician network. Prescription benefits are recommended to be included in the Blue Cross Blue Shield proposal. We recommend that the County pay 100% of the employee cost and that the County subsidy be set at a maximum of S400 per month for dependent medical coverage. We recommend that the Group Employee Life and Accidental Death & Dismemberment Insurance, the Supplemental Life Insurance and the Voluntary Dependent Life Insurance benefits be purchased from the Highmark Life Insurance Company as it represents the lowest cost propostd. We recommend that the Group Life Insurance and AD&D benefits be removed from the current Section 125 Plan to avoid possible adverse income tax consequences. We recommend that the Mental Health benefits continue to be purchased from the Unipsych organization. '41 We recommend that the Voluntary Long -Term Disability benefits be purchased from the UNUM Insurance Company and also removed from the current Section 125 Plan and provided as a separate plan to avoid adverse income tax consequences. The total cost to the County, based on the current enrollment of 1,368 employees is displayed in the following chart. 14 71 2 June 14, 2000 Overall Cost Comparison Medical Benefits Administration, Stop -loss Insurance, Prescription & Mental Health Benefits Expected Claims Proposal Current Year Blue Cross Blue McCreary Brown & Cross Bre Modified Administration $688,353 $872,839 $820,836 5362,048 5291,384 Costs Stop/Loss 5386,268 5435,881 5411,221 $480,188 5554,167 Mental Health 588,648 588,646 588,848 588,848 588,648 Sub -total 51.181,267 51.397.188 81.320.503 5930.882 5934.197 Claims $5,653,821 $5,753.128 $5,821,628 58,225,341 58,574.224 Total 56,815,088 57,160,302 56,942,129 57,188,2033 57, 506421 Maximum Plan Liability Current Year Blue Cross Blue McCreary Brown & Cross Brown Modified Administration 5686, 353 5872, 839 5820,838 5382,048 5291,384 Costs Stop/Loss 5386,268 5435,681 5411,221 5480,168 5554,167 Mental Health 588,848 588,646 588,848 588,846 588,848 Sub -total 51,181,267 51,397,186 51,320,503 5930,862 $934,197 Claims 57,048,240 57,191,420 $7,027,033 57,781,878 $8217,782 Total 58,207,507 58,588,885 58,347,536 38,712,538 59,151,879 Funding Level Current Year Blue Crow Blue McCreary Brown & Cross Brown Modified Administration $41.81 $53.17 49.99 $21.75 $17.75 Costs Stop/Loss 523.53 528.54 25.05 529.25 532.54 Mental Heath $5.40 $5.40 5.40 55.40 55.40 Total 570.74 588.11 550.44 588.40 555,66 f n.• Thirty-eight separate proposals were received from fifteen proposers. We consider this a good response to the RFP #2044. The following chart displays the proposals received: Summary of Proposers 2000-2001 Employee Benefits Proposer Medical Administration U R Mental Health Excess Plan Insurance R X Group Life & AD&D Vol. Stipp!. Life Vd. Dep Life VoL LTD BCBS X X X X X X X Robey Bryan/ Browning X X X X Unipsvch X Ostrom/ McCreary X X X X Brown & Brown X X X X X Willis Corroon X X X Innovative Solutions X X PM X X National Insurance X X X O'Neil Lee & West X PPSC X PBA X Lon Bryan X X X UNUM X (note 1: thirty-eight different proposals were received from fifteen sources. Some proposals included multiple sub -parts) (note 2: Robey-Barber proposal separately submitted by two different agents) June 14, 2000 Medical Claim Administration / Utilization Review l Managed Cam / Large Case Management Reason for selection of Blue Cross. Blue Cross provides the overall lowest cost for both the expected claims analysis and the maximum cost analysis for the County. Their claims administration cost includes claim handling, network management, utilization review, large case management. managed care and prescription management. Their network comprises 85% of providers in Indian River County and their fee structure agreement with providers eliminates the possibility of employees being billed for charges not paid for under the Blue Cross fee schedule. A comparison of claim payment codes shows that the maximum charges allowed under the Blue Cross fee schedule are considerably less than fee schedules used by other proposers. The result is a lower overall cost projection for the County's Self-insured Plan. The modified Blue Cross proposal assumes implementation of pending plan changes by the County. Other proposers did not offer such a large network or analysis did not produce a lower overall cost. Indian River County Health Plan Claims Administration Services Third Party Adminbtrator BCBS McCreary Brown & Brown Robey Barber PBA PAI Innovative Medial Solntioas Account Representative Grokhowsky B. Bane Macombe r TBA Hargrove K.Gratiois GBA What services are included? Claim Ad, Network UR,CM, MC & RX Claim Ad, Network UR,CM, MC & RX Claim Ad, Network UR,CM MC Claim Ad, Network UR,CM, MC & RX Claim Ad RX Claim Ad Claim Ad Network UR, RX is network proposed? If so, is directory included? Yes Yes Yes No No Yes Yes No Out of area hospital access Countrywide Network Yes Yes Not attached No Yes Yes Centers of Excellency Included Not included Not available Not attached No Not available Yes. Provide Actuarial assistance? No No Yes No No No Yes. Actuarial worksheets & calculation available to county? No No Yes No No No Yes. Is actuarial cost included? No No Yes No No No No Avg. Turnaround for claims 10 days 92% 10 days 10 days 10-15 days 5-10 days 28 days 10 days (85%) Average error ratio performance & 3% 2-4% 3% I% I% 1% 1% 6 biz sad' hrn :41 • _h4 June 14, 2000 How was it calculated Math Ratio Formula Math i not Ratio available. not available Math Ratio Meth Ratio Agree to penalties if error ratio is exceeded or service staadard not achieved No Per Adminators Standards Negligent Negouable Negligent Yes No Restores attached? No No Yes No No Yes Yes Are any TPA services subcontracted? RX Only Pre-Cenif. & UR Pre-Cenif & UR No No No No Are references attached? Yes Yes Yes Yes Yes Yes — No Govt. agys No Case load of adjustas assigned to BCC 580 125 per day Dedicated Adjuster 500 pa week Unk. Not available 1 per 1000 emplovees Any initial or set-up fee No Yes S5,000 No Yes Yes S5,000 No S8,500 Sample claims & statistical reports included Yes Yes Yes Yes No Yes Yes Sample contract Yes Yes Yes Yes Yes Yes Yes Third Party Administrator BCBS McCreary Brown & Brown Robev Barber PBA PAI Laovadve Solations Rates Mod'fd Employee $22.78 518.25 517.75 S266.56 $9.45 S17.95 Fee not Family $61.50 S Included S590.64 $9.45 Included Scheduled Retiree Same $18.25 517.75 5324.08 $9.45 $17.95 On response Other S49.89 549.99 S2.25 SPD Various Additional charges Plan DOC., COBRA, On-line access, in- house prograntng Forms State enrollment requirements None Not available None Not available None None Will adjust Assist with enrollment Yes Yes Yes Yes Yes Yes Yes Provide annual enrollment Yes Yes Yes Yes Yes Yes Yes Guaranteed Network access 1 yr. PPO & Traditional Available No Yes No No Yes Not available Excess Stop loss Insurance for Self-insured Medical Plan The Stop -loss insurance protection for the Lincoln Re proposal submitted by the O'Neil. Lee & West Insurance Agency is based on the lower expected claims of the Blue Cross administration proposal. That proposal was used in the Blue Cross analysis and produces the lowest overall cost proposal. It is recommended for selection. The proposal cannot be used with another medical administralioo proposal without adjustment for expected higher claims paid under another fee schedule and network. We recommend selection of the $ 100.000 specific retention level. • .927_3 b'f Indian River County Excess Stop -Loss Insurance for Group Self -Insured Medical Benefits Proposer O'Neil, Lee, West O'Neil, Lee, Wes id) Ostrom McCreary Excess Brown & Brown Robey Bryan/ Browning PAI Brown A Brown Insurance Company ARMS Lincoln National RE ARMS Lincoln National RE Mega Life Legion HCC Life/ Houston Casualty AIG Legion A M Best Rating A A A A A+ A++ A Agent has binding authority? No No Yes No No No No Is intermediary used to access insurer? If so, who? No No No Yes Yes Yes Yes Waiver of all active at work limitations and accept all enrolled participants? If not, why? Yes Yes Yes Yes Review of disclosure statement Yes Yes Are premiums monthly based on enrollment? Yes Yes Yes Yes Yes Yes Yes 90 day notice of modification? Yes Yes Yes Yes Yes Yes Yes 90 -day notice of rate changes? Yes Yes Yes Yes Yes Yes Yes 90 day notice of termination/non- renewal? Yes Yes Yes Yes Yes Yes Yes Effective date of coverage 10/1/00 10/1/00 10/1/00 10/1/00 1011/00 10/1/00 10/1100 How long quote valid? 10/1/00 10/1/00 Not known 10/1/00 11/1/00 8/8/00 10/1/00 Is paid coverage basis proposed for stop -loss? 12-15 SP &AG 12-15 SP &AG 12-15 SP &AG No 12-15 SP &AG No No Can insurer provide access to conversion cov? Yes Yes No Yes No No Yes Limit of liability? 1 Mil 1 Mil 1 Mil 1 Mil 1 Mil 1 Mil 1 Mil Has stop -loss carrier approved plan document? Yes Yes Yes No No No No June 14, 2000 Proposer O'Neil, Lee, West O'Neil, Lee, West (mom Ostrom McCreary Excess Inc. Brown & Brown Robey- Bryant Browning PAI Brown & Brown Retention? 5100,000 5100,000 5100,000 5100,00 0 5100,000 5150,000 5100,000 Aggregate Limit? 51 Mil 51 Mil 81 Mil 81 Mil 81 Mil 81 Mil 81 Mil What is aggregate calculation method? Claims+ Trend+ 125% Claims+ Trend+ 125% NetPd/ setback EnroIIX trend X Corridor Claims X 125% Not known Expected Claim X 125% Claims x 125% Monthly aggregate attachment point 5599,285 $585,308 5474.03 per ee 5848,473 5684,81 5 5601,498 $283.85 ee $681.24F 5884,815 Specific rates? 524.76 523.27 527.25 515.35/ 839.63 835/22.59 811.69 ee 828.05 F 815.851 839.63 Aggregate 81.78 81.78 82.00 51.22 81.39 81.52 81.22 Split Rate 819.81 815.62 Not applicable Not appNcabl 1 Not applicable Nd applicable Nd applicable Does aggregate accumulation include prescription claims? Yes Yes Yes Yes No Yes Yes Sample fors included? Yes Yes Yes Yes No Yes Yes Disclosure for required? No No Yes Yes No Yes Yes Is proposal fir? No No Yes No No No No Fi June 14, 2000 Recommendation for Contribution Levels for Benefits Program for 2000 — 2001 Background of Employee Contribution Level Our original review and report of the County's Benefit Plan dated February 2000 discussed the level of current employee contribution. The Report indicates that employees of the Board of County Commissioners of Indian River County currently pay S12.50 monthly as their share of the cost for their dependent coverage. This is considered quite generous compared to surrounding governmental bodies and with our knowledge of other governmental entities statewide. We believe the contribution levels should be changed to be more in line with similar employers. Findings It is reasonable for governmental entities to provide the majority or the entire single employee rate. Many also contribute some portion of the dependent and family rate. The attached chart shows Mat the surrounding governmental bodies vary in their connibutions for active employees and their dependents. In instances where employees contribute towards the single rate, it is higher than employee contributions in Indian River County. These results are consistent with our experience with governmental bodies in the State of Florida. For dependent and family coverage, employees contribute a portion of the rates in all of the trine bodies shown on the chart. Those amounts are also higher than what employees currently contribute in Indian River County. Elsewhere. it is common for employees to pay all or a portion of the dependent or family rate. Retiree information on the chart shows that retired individuals are frequently required to pay for or contribute towards their coverage. The amounts. where available. are considerably higher than what retirees cuurently pay in Indian River County. The amount presently paid by Indian River retirees does not cover the fixed charges the County has to pay to the self-insured plan. An adjustment is Deeded Retired county employees are eligible for direct subsidy for medical insurance premiums from the State of Florida based upon an amount of $5.00 per year of service. up to a maxirnum of S150.00. This subsidy is paid monthly and can be used to offset the cost of retiree paid premiums. The cost of health care is increasing at an annual rate of 8% - 12% while the general inflation rate remains at 2% - 3°/n. It is recommended that the County change its current contribution method to pay 100% of the employee rate and fix the amount of its contribution at $400.00 monthly for the family rate. This will result in employees with dependents contributing S37.50 instead of the current S 12.50 monthly. As rates increase, employees with dependents will be required to contribute the difference between the $400.00 county paid amount and the total family rate. The amount will vary depending upon the family annual rate. Over time. the amount of future increases paid by employees will adjust to place s.. 9 a76 the employee contribution amount more closely in relation to other employers in the area. This method is also easier to financially administer than some of the other options. It is recommended that county retirees contribute by paying 75% of the current rates for employee and family rates. The retired employees will continue to be eligible for subsidy from the State of Florida to offset the costs. Currently this will result in retirees paving S210 monthly. less their state subsidy for single coverage and $328.13 monthly. less their state subsidy for family coverage. The amount of state subsidy will vary for each retiree based upon years of service. This approach also provides the County with the flexibility to continue its self-insured benefits plan and consider new alternatives that arise in the future. Employee Group Ufa insurance / Accidental Death & Dismemberment I Supplemental Life Insurance / Voluntary Dependent Life Insurance The most advantageous proposal for Life. Accidental Death & Dismemberment and Voluntary Supplemental and Dependent Life Insurance was submitted through the Lon Bryan lnswana Agency using Highmark Life Insurance Company. It is recommended for selection Other proposals were either incomplete or result in higher cost. Proposer Insurance Company A M Best Rating Purchase Indep. Match Desired Limits? Exceptions Indian River County Life and Accidental Death & Dismemberment Coverage Voluntary Employee Supplemental Life Voluntary Dependent Life Reductions due to age Sample Policy? Waiver of Premium? Acceleration of Benefits for terminal illness? Conversion provision? Coverage for retirees? Rate Guarantee? 90 day notice of rate increase Basic Life AD&D Conversion Lon Bryan Highmark A Yes Yes No Age 70 -50% Yes Yes Yes Yes Yes 2 yrs. Yes Lon Bryan Standard Ins. Co. A Yes No Different Limits Age 65 -65% 70-50% 75.35% Yes Yes Yes Yes Yes 2 yrs. Yes National Services Standard Security A Yes Yes No Age 75 -50% Yes Yes Yes Yes Current Pian 2 yrs. Yes BCBS Florida Combined A Yes Yes None Age 70 -50% Yes Yes Yes Yes Life only Yes Yes Willis Corroon Reliastar A+ Yes Yes Age 70 -50% No Yes Yes Yes 2 yrs. Not known 5.27 5.04 Yes 5.29 5.04 Yes 5.35 5.04 Yes 5.41 5.04 Yes 5.47 5.03 Not known June 14, 2000 Lon Bryan National Services Retiree Life Optional life — employee Optional Life — spouse Optional Life — Children) 3.381.04 PM 8.49 PM 8.09/9.60 Blended 8.09! 10.48 Blended $.38/.04 PM 3.60 PM 8.60 PM 85.491 10.98 Blended 85.49/ 10.98 Blended 8.08/85.0 1 Blended 87.10/ 14.20 Blended 87.10/ 14.20 Blended Authorized offer? Signed my authorized person r Voluntary Long Term Disability Insurance The UNUM Life Insurance Company submitted the most advantageous proposal for Voluntary Long Term Disability Benefits. Their rates are the lowest and they offer a two year rate guarantee. Their policy form is acceptable and the company is rated very high by one of the leading insurance rating organizations. Their proposal is recommended for selection Indian River County Disability Income Protection Coverage Proposer UNUM BCBS National Services Insurance Company UNUM Florida Combined Standard Security A M Best Rating A++ A A Purchase Indep. Yes Yes Long Term Disability? Yes Yes Yes Sample? Yes Yes Yes Definition of Disability 24 mo. Own occ. 24 mo. Own occ. 24 mo. Own occ. Partial? Yes Yes Yes Definition of Partial 80% of comp. All material duties 80% of comp. How are benefits paid? Monthly Monthly Monthly Rates Guaranteed? 2 yrs. 12 mo. not known Minimum benefit 100 mo. 100 mo. 50 mo. Maximum benefit 4000 mo. 4000 mo. 4000 mo. RATE: LTD $.10/1.24 $.11/1.31 $.11/1.24 Is this authorized Yes Yes Not known Assist in BCC take-over/ Enrollment Yes N/A Not known Has proposal been signed by authorized person? Yes Yes No Exceptions to present plan UNUM Form None Not known 13 tisrTo' tYUn 2. June 14, 2000 The only stand-alone mental health benefit proposal was received from Unipsych through the Bradman organization. This is the current plan offered by the County and the benefits are acceptable. The proposed cost structure is considered acceptable. It is recommended for acceptance. Indian River County Mental Health Benefit Pian Bradman Brown & Brown Name of Provider Unipsych Included in medical program Are requests services inc;_ded in price? Substance abuse Crisis Management Mediation Management Psychotherapy In & Out Patient Services subcontracted? Not known Resumes attached? Yes References induded? Yes Minimum fee $5.40 per employee per month Exceptions of specifications Not known Description of Mental Health Services See above Billing procedures? Monthly Schedule of benefits $45 outpatient visits $31 Hospital $15 Co -pay $200 per Hospital Co -pay EAP Staffing qualifications Yes Compliance with all licensing requirements? Yes Sample contract included? Yes FE Conclusion June 14, 2000 Based upon the County's current benefit program RFP #2041 the results are favorable and permit the County to continue to provide generous benefits and funding for its employees and their dependents. The best overall benefit program is achieved by selecting the following insurance contracts and services: For medical administration. including utilization review services. managed care. large case management Blue Cross modified proposal based upon the County's planned changes to the benefit plan Stop -loss insurance for protection of specific and aggregate losses Lincoln RE proposal submitted through the O'Neil Lee & West Agency For Group Life Insurance and Accidental Death & Dismemberment Highmark Life Insurance Company through the Lon Bryan Agency Voluntary Employee Supplemental Life Insurance Highmark Life Insurance Company through the Lon Bryan Agency Voluntary Dependent Life Insurance Highmurk Life Insurance Company through the Lon Bryan Agency Voluntary Long Term Disability UNUM Insurance Company Prescription Drug Plan Blue Cross modified proposal based upon the County's planned changes to the benefit plan Mental Health Services The Unipsych Plan through the Bradman organization We are available to discuss any of the above information and assist you if you wish. Interisk Corporation President 15 76. Entity Indian Rivir Co. Martin Co. St. Lucia Co. Cicada Co. Cly of Meiboume Cty of Vara Bch Vaal@ Co. Marlin Co. Sch. Bd. &ward Co. Indian Riv. Sch. Bd Employee EE pays 280.00 0.00 267.88 66.97 305.00 33.55 210.04 0.00 235.96 0.00 228.0D 0.00 258.46 0.00 381.00 0.00 317.00 20.00 288.34 0.00 Benefit Plan Survey Summary Family EE pays 437.50 12.50 670.36 167.59 855.00 98.25 573.60 97.51 655.54 327.77 629.62 176.29 571.99 571.99 802.00 802.00 740.00 162.00 535.22 288.34 Retiree Rat pays 280.00 187.52 not avad. not avail. 50.00% not avail. not avad. (1) (3) not avail. not Mit 117.98 not avail. not avail. not avaH. yrs. Benda 82.50 82.50 (2) (2) Ret Dap Rat pays 437.50 (1) 469.25 (3) not avail. not avail. not avail. not avail. 100.00% 419.68 not oval. not avail. not avail. not avail. not avail. yrs. Service 130.00 130.00 (2) (2) (1) Indian River Co. Retiree Schedule 'Current (Proposed (2) Indian River Sch. 8d. Retiree Schedule (3) Martin Co. Retiree Schedule Medicare Sum:foment Rotes Retiree 65 & spouse 465 Retiree 465 8 opium '65 Retiree 65 & spouse 65 Retiree single & 65 Rat pays 139.50 328.13 128.50 328.13 100.50 328.13 42.00 210.00 Rat pays 432.51 432.51 288.34 144.17 Rat pays 444.10 239.43 208.07 41.62 ti 'S `IAJFti I i Substance Abuse Prex Skilled Nursing Facility Preventive Health Services(Adult) Preventive Health Senvices(Chlid) Physical Therapy 11 K Out of Pocket Per Admission Deductible Office services Oral Surgery Mammograms Mental/Nervous Hospice Independent Clinical Laboratories _J Elective Abortions Emergency Room Dependent Daughter Maternity Durable Medical Equipment Deductible Deducible Carryover_ Contraceptive Injections Coeay Blood and Blood Plasma Coinsurance Annual Restoration of Benefits Birthing Centers 1, Y covered under drug card 0 No limitations(Indudes Cardiac, Pulmonary, Occupational, and Speech) BlueScript $8416/ Oral Contraceptives Not Covered / Sexual Dysfunction Covered/ Mall Order 90 Days 1x N li $15 copay - Covered C 'N N 88 ; N/A S2500 LTM $5000 LTM i Not Covered N/A Np v 1,„ Not Covered S15(ofice visit) Covered 80%/60% 80%0°n -eligibles) Subject to Ded. and Coins. 80% First $500 paid at 100% Covered y .s � . .,_ 'Q Isubject to deductible and co insurance I g Ofzyi g N $200 CYM (par all adults ) Not Subject to Deductible $2500 PCY(Indudes Spinal Manipulations. PhysicaUMassage Therapy. Occupational, Speech, and Cardiac Therapy. BlueScript $5/$15430/lndudes Oral Contraceptives and Devices and Mail Order (2x copay for 90 day supply) N $15 Primacy 425 Specialist (Par Docs) I Covered N 1g�8r 2�0 v ; (pMNM m .1NN iii CCC not covered Subject to Ded. and Coins. Covered Subject to Ded. and Coins. $200/5400 3 month carryover Covered S15 Primacy 425 Specialist (Par Docs) Covered 80%/60% . E C N � Nn N� 88 �rt L r a Ammo mem urripui FM: