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CC SR 20181016 04 - Health Benefit OptionsRANCHO PALOS VERDES CITY COUNCIL MEETING DATE: 10/16/2018 AGENDA REPORT AGENDA HEADING: Regular Business AGENDA DESCRIPTION: Consideration and possible action to change the City’s Broker of Record for health and ancillary benefits from Maniaci Insurance Services to USI Insurance Services to provide more benefit options for the same or less cost. RECOMMENDED COUNCIL ACTION: (1) Change the City’s Broker of Record, from Maniaci Insurance Services to USI Insurance Services, Inc.; (2) Adopt the new health benefit options for the 2018 open enrollment period with benefits that become effective for the 2019 calendar year; and, (3) Adopt Resolution No. 2018-__, A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF RANCHO PALOS VERDES, REVISING THE CITY’S MAXIMUM MONTHLY CONTRIBUTION AMOUNTS FOR EMPLOYEE AND COUNCIL MEMBER HEALTH INSURANCE PREMIUMS FOR CALENDAR YEAR 2019 AND RESCINDING AND REPLACING RESOLUTION NO. 2017-58; FISCAL IMPACT: None Amount Budgeted: $1,344,000 Additional Appropriation: N/A Account Number(s): Finance will allocate the cost according to Budget Program ORIGINATED BY: Mary Ortiz Bradley, Human Resources Manager REVIEWED BY: Gabriella Yap, Deputy City Manager APPROVED BY: Doug Willmore, City Manager ATTACHED SUPPORTING DOCUMENTS: A. Projected Monthly Cost Summary (page A-1) B. USI Insurance Services, Inc. Benefit Proposal (page B-1) C. Maniaci Insurance Services, Inc. Renewal and Proposal (page C-1) D. Draft Resolution No. 2018-__ revising Health Benefit Maximum Contribution Limits (page D-1) E. City Council Policy No. 19 (page E-1) EXECUTIVE SUMMARY: The Mayor previously requested the City review the benefits plans, and the Rancho Palos Verdes Employee Association (RPVEA) also requested a review with the hope of 1 providing more plan options and benefits. Staff is recommending that the City change its broker of record from Maniaci Insurance Services (Maniaci) to USI Insurance Services (USI) because USI’s larger purchasing power and access to municipal pools enable them to provide additional benefit plans at the same or lower cost than what our current broker would be for many benefits. USI works with 100+ municipalities in California, offering access to the dental , vision, life, disability and employee assistance program (EAP) pools. BACKGROUND: The City typically conducts an annual review of the City’s health insurance plans for the purposes of analyzing utilization trends, carrier-proposed premium increases, and any necessary adjustments for the following Plan Year. On August 10, 2018, the Rancho Palos Verdes Employee Association (RPVEA) formally requested to meet and confer regarding additional and alternate benefit options to increase employee choices with either no additional cost to the City or a potential decrease in cost for benefits available for the 2019 calendar year. At the August 21, 2018, meeting, the City Council authorized reopening this item for exploration and directed Staff to obtain information regarding additional and/or alternate benefit options. Attached to this report are the benefit presentations/proposals provided by Maniaci (Attachment C) and USI (Attachment B). Both brokers were instructed to do the following: 1) provide the City with the best rates possible for the current City benefits that they could negotiate; 2) other benefit options presented should be comparable to the existing plans; and 3) the options presented should include quotes for the preference for certain plan providers/insurance carriers expressed by both represented and non-represented employees, e.g. Delta Dental for dental plans, VSP for vision plans, and Kaiser for the medical plan. These specific requests were for plans that were available to employees prior to Maniaci becoming the broker of record. DISCUSSION: The City currently offers medical, dental, vision, an employee assistance program (EAP), long term disability plan, and group term life insurance with accidental death and dismemberment (AD&D) for employees and their dependents, all of which will be discussed in more detail below. Voluntary benefits that employees can purchase include the following: 1) AFLAC products (accident, hospital indemnity, cancer, and short-term disability); 2) voluntary life insurance for employees and their dependents; 3) pre-paid legal plan; and 4) pet insurance. All of the aforementioned benefits, with the exception of the AFLAC products, are provided through Maniaci. Listed below and summarized in Attachment A is the information presented by each broker and the differences between them. Attachments B and C are copies of the brokers’ presentations, which include details on the current and proposed plans, their composition, rates (final and composite), as well as benefit enhancements or reductions associated with each plan proposed. 2 Medical The City currently offers the following three medical plans: an HMO plan (Blue Shield Platinum), a standard PPO plan (Blue Shield Gold with $450 deductible), and a high deductible PPO with an HSA (Blue Shield Spectrum Silver). As an employer with fewer than 100 employees, the City must purchase medical insurance using small-group rates, where employees are assigned individualized monthly premiums based on several factors, such as age and number of dependents. This also means that the monthly premiums billed to the City for the same medical plans will not change from broker to broker. If the City’s workforce demographics remain the same in the 2019 calendar year, the medical premiums would be expected to increase by 3.35%. Although the City is billed using small-group rates, the City utilizes composite rates produced by the broker, rather than individualized rates. This means that all employees and Council Members, regardless of their age and number of dependents, would receive the same deduction for the same level of coverage selected if it was for the same medical plan. Each year the health premiums increase and the corresponding health benefit maximum contribution limits previously adopted also need to increase. Accordingly, the resolution attached to this report (Attachment D) would clarify that the City’s contribution limits are based on composite rates. No specific dollar figures are listed in the resolution because the rates will depend on what medical plan options are approved City Council. Similarly, no dollar figure is specified for the cash-in-lieu benefit for opting out of the City’s medical plans because this can vary based on the lowest cost plan offered for employee only coverage. However, the calculation for arriving at this dollar figure is clearly set forth in the resolution and that will not change. Both brokers presented information that would allow the City to add two (2) additional medical plan options (Kaiser and Blue Shield HMO Trio), the addition of which could potentially result in savings to the City due to employee migration to these lower-cost medical plans. For example, the two Blue Shield Platinum HMO plans provide exactly the same level of benefit but the Trio can do so at a much lower cost because it does not have as broad of a physician network. As noted above, Kaiser was previously a benefit the employees had the option of choosing prior to Maniaci becoming the City’s broker. The amount of actual savings the City will achieve will depend on if employees move from a higher cost plan to Trio or Kaiser for the 2019 calendar year. (A summary of projected monthly costs, based on current medical premiums is included in Attachment A) Maniaci recommended that the composite rates for the current Blue Shield plans be increased by 4% while USI recommended that rates remain the same. Maniaci recommended lower composite rates for the addition of the two medical plans while the USI plans are slightly higher. Listed below is a table that shows the composite rates each broker proposed, based on each medical plan and level of coverage. 3 MANIACI MANIACI USI Plan Names Coverage Level 2018 Current Monthly Composite Rate 2019 Renewal Monthly Composite Rate $ Change in Total Monthly Rate (+/-) 2019 New Monthly Composite Rate $ Change in Total Monthly Rate (+/-) Blue Shield Silver PPO w/ HSA Employee Only $705.21 $733.42 $28.21 $705.21 $0.00 Blue Shield Silver PPO w/ HSA Employee + 1 $1,410.42 $1,466.84 $42.31 $1,410.42 $0.00 Blue Shield Silver PPO w/ HSA Employee + Family $1,833.55 $1,906.89 $50.78 $1,833.55 $0.00 Blue Shield Gold PPO 500 Deductible Employee Only $1,198.71 $1,246.66 $47.95 $1,198.71 $0.00 Blue Shield Gold PPO 500 Deductible Employee + 1 $2,174.29 $2,261.26 $67.46 $2,174.29 $0.00 Blue Shield Gold PPO 500 Deductible Employee + Family $2,927.96 $3,045.07 $82.53 $2,927.96 $0.00 Blue Shield Platinum HMO Employee Only $728.27 $757.40 $29.13 $728.27 $0.00 Blue Shield Platinum HMO Employee + 1 $1,410.77 $1,467.20 $42.78 $1,410.77 $0.00 Blue Shield Platinum HMO Employee + Family $1,809.77 $1,882.16 $50.76 $1,809.77 $0.00 Blue Shield Platinum Trio HMO Employee Only $496.86 $613.43 Blue Shield Platinum Trio HMO Employee + 1 $1,192.46 $1,188.59 Blue Shield Platinum Trio HMO Employee + Family $1,490.57 $1,527.42 Kaiser HMO Employee Only $499.26 $682.44 Kaiser HMO Employee + 1 $1,198.23 $1,321.55 Kaiser HMO Employee + Family $1,497.79 $1,699.26 Dental The City currently offers two dental plans: a Point of Service (POS) plan with Principal Dental and a dental HMO plan with California Dental. Although both brokers presented plan and rate information for dental plans that reflected the desire expressed by represented and non-represented employees for Delta Dental (a leading dental carrier with one of the largest dental networks, covering 92% of the dentists in California), the rates provided by USI for these plans are considerably lower due to USI’s ability to leverage its purchasing power and access to municipal pools for these two benefits, something Maniaci does not have. (page 8 of Attachment B-1 for USI and page 5 of Attachment C-1 for Maniaci) The Delta Dental plans presented by Maniaci did not include the orthodontia benefit that employees can currently access but only through the dental HMO plan (California Dental). The Delta Dental PPO presented by USI had a lower cost, included an orthodontia benefit, and did not restrict the use of this benefit to certain providers (page 38 of Attachment B-1 for USI and page 33 of Attachment C-1 for Maniaci). Under the current plan, if an employee wishes to utilize the orthodontia benefit, they are restricted to the narrow HMO network for service providers. The City has received mixed reviews from represented and non-represented employees regarding the current POS plan and orthodontia benefit. 4 Primarily, the City has heard of issues regarding: 1) not being able to go to an existing family/child’s dentist because their dentist doesn’t accept the Principal POS plan; 2) not being able to go to the orthodontist of their choice; 3) the limited/lack of coordination of benefits between the Principal POS plan and their spouse’s dental plan; and 4) employee unwillingness to enroll/recommend/re-enroll in the City’s dental plans due to the various benefit/claim issues they’ve experienced. Generally, employees that have had Delta Dental in the past have stated the superiority of Delta Dental over the Principal POS plan because they had less out-of-pocket expenses due to the more generous provisions Delta Dental has regarding the coordination of benefits between two dental plans, e.g. the employee’s plan and the spouse’s dental plan. Under the current POS plan, if the employee’s spouse’s dental plan pays more towards the claim than the Principal POS plan would, Principal would not pay anything more towards the claim because the maximum benefit paid towards a claim includes what another insurance carrier has paid. The maximum benefit paid towards a claim by Delta Dental does not include monies paid by another carrier. The current Principal POS plan also requires excessive pre-authorization of services in order for the claim to be paid, something that is common with POS plans but not with PPO plans. This means that if an employee does not get a service pre-authorized, the employee will be responsible for the entire cost of the service, which, depending on the service, can get very expensive, and is also inconvenient. The majority of City employees are enrolled in the City’s POS plan (58 in the POS vs. 7 in the HMO). Based on current plan enrollment and coverage levels for the dental plans, the monthly cost for the PPO/POS would be $5,253 or $5,818.93 (USI vs. Maniaci) and for the HMO plan it would be $201 or $171 (USI vs. Maniaci). Listed below is a table that shows the rates each broker provided, based on level of coverage for the recommended insurance carrier. MANIACI MANIACI USI Plan Names Coverage Level 2018 Current Monthly Rate 2019 Renewal Monthly Rate $ Change in Total Monthly Premium (+/-) 2019 New Monthly Rate $ Change in Total Monthly Premium (+/-) Principal POS Employee Only $56.34 $56.34 $0.00 Principal POS Employee + 1 $105.62 $105.62 $0.00 Principal POS Employee + Family $160.03 $160.03 $0.00 Delta Dental PPO Employee Only $66.50 $10.16 $50.86 -$5.48 Delta Dental PPO Employee + 1 $130.98 $25.36 $95.35 -$10.27 Delta Dental PPO Employee + Family $199.67 $39.64 $144.47 -$15.56 California Dental Employee Only $14.44 $14.44 $0.00 California Dental Employee + 1 $24.44 $24.44 $0.00 California Dental Employee + Family $37.78 $37.78 $0.00 Delta Dental HMO Employee Only $21.77 $7.33 $16.73 $2.29 Delta Dental HMO Employee + 1 $35.92 $11.48 $30.24 $5.80 Delta Dental HMO Employee + Family $53.12 $15.34 $44.55 $6.77 Vision 5 The City offers a vision plan using Medical Eye Services (MES). Both represented and non-represented employees expressed an interest in having VSP available, as it was in the past, and the rates provided by USI for these plans are considerably lower. The VSP plan for which Maniaci provided quotes was not obtained through a municipal pool; consequently, the rates were considerably higher (page 35 of Attachment C-1 for Maniaci). Maniaci did not recommend the VSP plan because the rates reflected a 60.78% increase over the current plan premiums. With the VSP municipal pool plan offered through USI, employees would have a higher allowance for frames than under the current plan, from $130 to $150. However, there would be a decrease in benefit when it comes to the purchase of a second pair of glasses, e.g. a $20 copay for the second pair vs. a 20% discount with VSP. But the allowance for progressive standard lenses under VSP could be greater than that which is offered through MES, e.g. $50- $160 vs. up to $89.50. (page 44 of Attachment B-1) Listed below is a table that shows the rates each broker provided, based on level of coverage for the recommended insurance carrier. MANIACI MANIACI USI Plan Names Coverage Level 2018 Current Monthly Rate 2019 Renewal Monthly Rate $ Change in Total Monthly Premium (+/-) 2019 New Monthly Rate $ Change in Total Monthly Premium (+/-) MES Employee Only $16.75 $16.75 $0.00 MES Employee + 1 $30.15 $30.15 $0.00 MES Employee + Family $43.22 $43.22 $0.00 VSP Choice Employee Only $28.58 $11.83 $17.28 $0.53 VSP Choice Employee + 1 $44.40 $14.25 $25.05 -$5.10 VSP Choice Employee + Family $70.43 $27.21 $44.57 $1.35 Long-Term Disability and Life Insurance with Accidental Death and Dismemberment (AD&D) Principal is the plan provider for the City’s long term disability plan, group term life insurance with AD&D for employees and their dependents. Both brokers presented plans and rates for group term life insurance for employees and their dependents and long-term disability, recommending one insurance carrier (Hartford by USI and Principal Financial by Maniaci) to provide all of these lines of coverage due to the discounted rates provided for bundling multiple lines of insurance. It should be noted that, to make the most of these discounts, the City would also obtain voluntary life insurance through the same insurance carrier. USI presented product information and rates for Hartford, an insurance carrier that would provide the same level of coverage as Principal Financial but at a significantly lower cost (page 14 of Attachment B-1 for USI and pages 37-42 of Attachment C-1 for Maniaci) Employees who currently purchase voluntary life insurance through Principal Financial would see a decrease cost as the rates offered through Hartford are also considerably lower. Listed below is a table that shows the cost for each benefit, based on each broker’s recommended insurance carrier. MANIACI MANIACI USI 6 Plan Names Current Monthly Cost Insurance Carrier 2019 Renewal Monthly Cost % Change Insurance Carrier 2019 New Monthly Cost % Change Life and AD&D - Principal $2,598 Principal $2,598 0.00% Hartford $2,040 -21.48% Long Term Disability - Principal $2,404 Principal $2,404 0.00% Hartford $763 -68.26% Voluntary Life and AD&D $433 Principal $433 0.00% Hartford $232 -46.39% $5,435 $5,435 0.00% $3,035 -44.16% Employee Assistance Program (EAP) The City provides an EAP using the Holman Group. Maniaci provided product and plan information for an EAP that could be provided at zero cost, which would be a savings of the premium of the current plan offered through the Holman Group (from $88.45 per month to $0 per month). They would be offered by Principal, through its long-term disability plan. If the City did not select Principal for its long-term disability plan, this option would not be available. The product and plan information provided by USI reflected a modest decrease in monthly cost over the City’s current plan, from $88.45 to $78. But, unlike the current or other plans proposed by Maniaci, this plan also includes child care and elder care assistance (referral service) as well as ID theft assistance (identify theft recovery and monitoring). No preference was expressed by represented or unrepresented employees for a particular provider; however, the City has recently received several negative reviews for the City’s current EAP provider, Holman Group, and the usefulness of advice provided by their counselors/representatives. Listed below is a table that shows the rates each broker provided for the recommended insurance carrier. MANIACI MANIACI USI Plan Names 2018 Current Monthly Rate 2019 Renewal Monthly Rate $ Change in Total Monthly Premium (+/-) 2019 New Monthly Rate $ Change in Total Monthly Premium (+/-) EAP - Holman Group $1.45 EAP - Principal $0.00* -$1.45 EAP - Anthem $1.20 -$0.25 *The zero cost option from Maniaci would only be available if Principal is selected as the insurance carrier. Other Factors to Consider Representatives from Maniaci are local and available to respond to employee/council member benefit or claim questions and concerns in person as they have offices on the Palos Verdes Peninsula. This is not an option that is available through USI. However, if the City has USI as their Broker of Record, part of the services provided at no additional charge would include a full-scope health advocacy program. This service would provide one-on-one support to employees and their dependents on a variety of issues and concerns related to their healthcare. The services included that are not provided by Maniaci include, but are limited to, the following: 1) Providing employees 7 with access to a medical librarian for personalized research; 2) Arranging for second opinions; 3) Helping participants understand treatments, tests and procedures recommended by their doctors; 4) Preparing covered participants for doctor visits and surgeries with checklist(s) of questions to ask; and 5) Helping to address quality of care concerns and providing appeals and grievance advice. CONCLUSION: The City could potentially improve its ability to retain and attract a highly-qualified workforce through enhancing its health benefits options. This could be done by adding more medical plan options, and offering dental and vision plans that have name recognition and broader networks and benefits, like Delta Dental, Kaiser, and VSP. The City could also achieve cost savings in this way. Staff is recommending changing brokers from Maniaci to USI to achieve better benefits while maintaining or lowering the costs in many areas. ALTERNATIVES: In addition to the Staff recommendations, the following alternative actions are available for the City Council’s consideration: 1. Direct Staff to retain its current Broker of Record (Maniaci) and coverage for the 2019 calendar year. 2. Direct Staff to research additional Brokers of Record and/or coverage for consideration in a subsequent calendar year. 8 ATTACHMENT 1 PROJECTED MONTHLY COST SUMMARY Benefit with Current Providers and Broker CURRENT MONTHLY COST MANIACI 2019 Renewal Monthly Cost % Change y USI 2019 New Monthly Cost % Change Employee Breakdown MEDICAL PLANS Blue Shield Platinum HMO 11,016$ Blue Shield Platinum HMO 10,996$ -0.18%Blue Shield Platinum HMO 10,996$ -0.18%8 Blue Shield Gold PPO 450 Deductible 2,282$ Blue Shield Gold PPO 500 Deductible 2,434$ 6.64%Blue Shield Gold PPO 500 Deductible 2,434$ 6.64%4 Blue Shield Spectrum Silver PPO w/ HSA 49,959$ Blue Shield Spectrum Silver PPO w/ HSA 51,950$ 3.98%Blue Shield Spectrum Silver PPO w/ HSA 51,950$ 3.98%47 Blue Shield Platinum Trio HMO -$ Blue Shield Platinum Trio HMO -$ 0 Kaiser Platinum 90 HMO (0/15) -$ Kaiser Platinum 90 HMO (0/15) -$ 0 63,257$ SUBTOTAL 65,379$ 3.35%SUBTOTAL 65,379$ 3.35%59 DENTAL PLANS California Dental 171$ California Dental 171$ 0.00%Delta Dental HMO 201$ 17.48%7 Principal Dental 5,819$ Principal Dental 5,819$ 0.00%Delta Dental PPO 5,253$ -9.73%58 5,990$ SUBTOTAL 5,990$ 0.00%SUBTOTAL 5,454$ -8.95% VISION PLAN VISION - Medical Eye Services (MES)1,909$ Medical Eye Services (MES)1,909$ 0.00%VSP Choice 1,863$ -2.41%67 GROUP LIFE-LONG TERM DISABILITY-VOLUNTARY LIFE Life and AD&D - Principal 2,598$ Principal 2,598$ 0.00%Hartford 2,040$ -21.48%66 Long Term Disability - Principal 2,404$ Principal 2,404$ 0.00%Hartford 763$ -68.26%56 Voluntary Life and AD&D 433$ Principal 433$ 0.00%Hartford 232$ -46.39% 5,435$ SUBTOTAL 5,435$ 0.00%SUBTOTAL 3,035$ -44.16% EMPLOYEE ASSISTANCE PLAN Employee Assistance Prog - Holman Group 88$ Principal -$ -100.00%Anthem 78$ -11.81%61 TOTAL CURRENT MONTHLY COST 76,680$ TOTAL PROPOSED MONTHLY COST 78,713$ TOTAL PROPOSED MONTHLY COST 75,809$ Change over current cost 2.65%Change over current cost with Maniaci -1.14%870$ Change over renewal cost with Maniaci -3.69%2,904$ A-1 CO N F I D E N T I A L A N D P R O P R I E T A R Y : T h i s p r e s e n t a t i o n a n d t h e i n f o r m a t i o n c o n t a i n e d h e r e i n i s c o n f i d e n t i a l a n d p r o p r i e t a r y i n f o r m a t i o n o f U S I I n s u r a n c e S e r v i c e s , L L C ( " U S I " ) . R e c i p i e n t a g r e e s n o t t o c o p y , r e p r o d u c e o r d i s t r i b u t e t h i s d o c u m e n t , i n wh o l e o r i n p a r t , w i t h o u t t h e p r i o r w r i t t e n c o n s e n t o f U S I . E s t i m a t e s a r e i l l u s t r a t i v e g i v e n d a t a l i m i t a t i o n , m a y n o t b e c u m u l a t i v e a n d a r e s u b j e c t t o c h a n g e b a s e d o n c a r r i e r u n d e r w r i t i n g . © 2 0 1 4 - 2 0 1 8 U S I I n s u r a n c e S e r v i c e s . A l l r i g h t s r e s e r v e d . Ga r y L . D e l a n e y , C E B S , S r . V i c e P r e s i d e n t | F e r e n c z D av i d , C E B S , S r . A c c o u n t E x e c u t i v e | w w w . u s i . c o m MA R K E T I N G A N A L Y S I S F O R CI T Y O F R A N C H O P A L O S V ER D E S O c t o b e r 0 9 , 2 0 1 8 B-1 Ta b l e o f c o n t e n t s : I. An n u a l C o s t S u m m a r y II . De n t a l P P O & H M O P l a n s II I . Vi s i o n P l a n s IV . Li f e a n d D i s a b i l i t y P l a n s a. Vo l u n t a r y L i f e P l a n s V. Em p l o y e e A s s i s t a n c e P r o g r a m B-2 Se c t i o n I Ex e c u t i v e S u m m a r y B-3 | 4 An n u a l C o s t S u m m a r y Co v e r a g e s / C a r r i e r s Co v e r e d Em p l o y e e s Cu r r e n t C o s t P r o p o s e d C o s t Change Co m p a r e d to C u r r e n t $ Change Compared to Current % Me d i c a l P l a n : B l u e S h i e l d o f C A 5 9 $8 3 5 , 4 9 4 $8 3 5 , 4 9 4 $0 0 . 0 % De n t a l P l a n : P r i n c i p a l F i n a n c i a l / D e l t a D e n t a l o f C A 65 $7 1 , 8 8 0 $6 5 , 4 4 4 -$6,436 - 9 . 0 % Vi s i o n P l a n : M e d i c a l E y e S e r v i c e s / V S P C h o i c e 67 $2 2 , 8 7 1 $2 2 , 3 5 5 -$516 - 2 . 3 % Li f e a n d A D & D P l a n s : P r i n c i p a l F i n a n c i a l / H a r t f o r d 66 $2 9 , 3 2 6 $2 4 , 4 7 6 -$4,850 - 1 6 . 5 % Lo n g T e r m D i s a b i l i t y : P r i n c i p a l F i n a n c i a l / H a r t f o r d 56 $3 0 , 3 6 7 $9 , 1 6 1 -$ 2 1 , 2 0 6 - 6 9 . 8 % Em p l o y e e A s s i s t a n c e P r o g r a m : H o l m a n G r o u p / An t h e m 65 $1 , 1 3 1 $9 3 6 -$195 - 1 7 . 2 % To t a l A n n u a l C o s t $9 9 1 , 0 7 0 $9 5 7 , 8 6 6 $ C h a n g e t o c u r r e n t -$ 3 3 , 2 0 4 % C h a n g e t o c u r r e n t -3 . 3 5 % B-4 | 5 An n u a l C o s t S u m m a r y – M e d i c a l P l a n O p t i o n s Co v e r a g e s / C a r r i e r s Co v e r e d Em p l o y e e s Cu r r e n t C o s t P r o p o s e d C o s t Change Co m p a r e d to C u r r e n t $ Change Compared to Current % Me d i c a l P l a n : B l u e S h i e l d o f C A / B l u e S h i e l d o f C A & Ka i s e r 59 $8 3 5 , 4 9 4 $8 2 4 , 1 3 7 - $ 1 1 , 3 5 7 - 1 . 4 % De n t a l P l a n : P r i n c i p a l F i n a n c i a l / D e l t a D e n t a l o f C A 65 $7 1 , 8 8 0 $6 5 , 4 4 4 -$6,436 - 9 . 0 % Vi s i o n P l a n : M e d i c a l E y e S e r v i c e s / V S P C h o i c e 67 $2 2 , 8 7 1 $2 2 , 3 5 5 -$516 - 2 . 3 % Li f e a n d A D & D P l a n s : P r i n c i p a l F i n a n c i a l / H a r t f o r d 66 $2 9 , 3 2 6 $2 4 , 4 7 6 -$4,850 - 1 6 . 5 % Lo n g T e r m D i s a b i l i t y : P r i n c i p a l F i n a n c i a l / H a r t f o r d 56 $3 0 , 3 6 7 $9 , 1 6 1 -$ 2 1 , 2 0 6 - 6 9 . 8 % Em p l o y e e A s s i s t a n c e P r o g r a m : H o l m a n G r o u p / An t h e m 65 $1 , 1 3 1 $9 3 6 -$195 - 1 7 . 2 % To t a l A n n u a l C o s t $9 9 1 , 0 7 0 $9 4 6 , 5 0 9 $ C h a n g e t o c u r r e n t -$ 4 4 , 5 6 0 % C h a n g e t o c u r r e n t -4 . 5 0 % N O T E : T h e p r o p o s e d r a t e s f o r B l u e S h i e l d a n d K a i s e r a r e i l l u s t r a t i v e t h r e e t i e r e d r a t e s ( a c t u a l r a t e s w i l l b e b a s e d o n i n d i v i d u a l a g e a n d g e n d e r ) a n d a s s u m e a n e f f e c t i v e d a t e of 0 1 / 0 1 / 2 0 1 9 . E n r o l l m e n t w a s o b t a i n e d f r o m c e n s u s p r o v i d e d b y t h e C i t y . A s s u m e s a n e n r o l l m e n t m i g r a t i o n t o t h e T r i o a n d K a i s e r H M O p l a n s f r o m t h e c u r r e n t A c c e s s + HM O p l a n . B-5 Se c t i o n I I Me d i c a l P l a n s B-6 | 7 Me d i c a l P l a n s - C o s t C o m p a r i s o n Pl a n s / C a r r i e r s Co v e r e d Cu r r e n t Bl u e S h i e l d 2 0 1 8 Pr o p o s e d Bl u e S h i e l d 1 / 1 / 2 0 1 9 Bl u e S h i e l d S p e c t r u m S i l v e r P P O H S A P l a n E mp l o y e e O n l y 24 $7 0 5 . 2 1 $7 0 5 . 2 1 Em p l o y e e + 1 13 $1 , 4 1 0 . 4 2 $1 , 4 1 0 . 4 2 Em p l o y e e + F a m i l y 10 $1 , 8 3 3 . 5 5 $1 , 8 3 3 . 5 5 Mo n t h l y H S A P P O S u b t o t a l 47 $5 3 , 5 9 6 $5 3 , 5 9 6 A n n u a l H S A P P O S u b t o t a l $6 4 3 , 1 5 2 $6 4 3 , 1 5 2 % C h a n g e t o C u r r e n t 0. 0 0 % Bl u e S h i e l d G o l d P P O H S A P l a n Em p l o y e e O n l y 4 $1 , 1 9 8 . 7 1 $1 , 1 9 8 . 7 1 Em p l o y e e + 1 0 $2 , 1 7 4 . 2 9 $2 , 1 7 4 . 2 9 Em p l o y e e + F a m i l y 0 $2 , 9 2 7 . 9 6 $2 , 9 2 7 . 9 6 Mo n t h l y P P O S u b t o t a l 4 $ 4 , 7 9 5 $4 , 7 9 5 A n n u a l P P O S u b t o t a l $5 7 , 5 3 8 $5 7 , 5 3 8 % C h a n g e t o C u r r e n t 0. 0 0 % Bl u e S h i e l d P l a t i n u m A c c e s s + H M O P l a n Em p l o y e e O n l y 3 $7 2 8 . 2 7 $7 2 8 . 2 7 Em p l o y e e + 1 0 $1 , 4 1 0 . 7 7 $1 , 4 1 0 . 7 7 Em p l o y e e + F a m i l y 5 $1 , 8 0 9 . 7 7 $1 , 8 0 9 . 7 7 Mo n t h l y H M O S u b t o t a l 8 $1 1 , 2 3 4 $1 1 , 2 3 4 A n n u a l H M O S u b t o t a l $1 3 4 , 8 0 4 $1 3 4 , 8 0 4 % C h a n g e t o c u r r e n t 0. 0 0 % To t a l M e d i c a l M o n t h l y C o s t 5 9 $6 9 , 6 2 5 $6 9 , 6 2 5 To t a l M e d i c a l A n n u a l C o s t $8 3 5 , 4 9 4 $8 3 5 , 4 9 4 $ C h a n g e t o c u r r e n t N / A $0 % C h a n g e t o c u r r e n t N / A 0. 0 0 % NO T E : E n r o l l m e n t w a s o b t a i n e d f r o m c e n s u s p r o v i d e d b y t h e C i t y . B-7 | 8 Me d i c a l P l a n O p t i o n s - C o s t C o m p a r i s o n Pl a n s / C a r r i e r s Co v e r e d Cu r r e n t Bl u e S h i e l d 2 0 1 8 Pr o p o s e d Bl u e S h i e l d & K a i s e r 0 1 / 0 1 / 2 0 1 9 Bl u e S h i e l d S p e c t r u m S i l v e r P P O H S A P l a n E mp l o y e e O n l y 24 $7 0 5 . 2 1 $7 0 5 . 2 1 Em p l o y e e + 1 13 $1 , 4 1 0 . 4 2 $1 , 4 1 0 . 4 2 Em p l o y e e + F a m i l y 10 $1 , 8 3 3 . 5 5 $1 , 8 3 3 . 5 5 Mo n t h l y H S A P P O S u b t o t a l 47 $5 3 , 5 9 6 $5 3 , 5 9 6 An n u a l H S A P P O S u b t o t a l $6 4 3 , 1 5 2 $6 4 3 , 1 5 2 % C h a n g e t o C u r r e n t 0. 0 0 % Bl u e S h i e l d G o l d P P O H S A P l a n Em p l o y e e O n l y 4 $1 , 1 9 8 . 7 1 $1 , 1 9 8 . 7 1 Em p l o y e e + 1 0 $2 , 1 7 4 . 2 9 $2 , 1 7 4 . 2 9 Em p l o y e e + F a m i l y 0 $2 , 9 2 7 . 9 6 $2 , 9 2 7 . 9 6 Mo n t h l y P P O S u b t o t a l 4 $4 , 7 9 5 $ 4 , 7 9 5 An n u a l P P O S u b t o t a l $5 7 , 5 3 8 $5 7 , 5 3 8 % C h a n g e t o C u r r e n t 0. 0 0 % Bl u e S h i e l d P l a t i n u m A c c e s s + H M O P l a n Em p l o y e e O n l y 1 $7 2 8 . 2 7 $7 2 8 . 2 7 Em p l o y e e + 1 0 $1 , 4 1 0 . 7 7 $1 , 4 1 0 . 7 7 Em p l o y e e + F a m i l y 1 $1 , 8 0 9 . 7 7 $1 , 8 0 9 . 7 7 Mo n t h l y H M O S u b t o t a l 2 $2 , 5 3 8 $ 2 , 5 3 8 An n u a l H M O S u b t o t a l $3 0 , 4 5 6 $3 0 , 4 5 6 % C h a n g e t o c u r r e n t 0. 0 0 % Bl u e S h i e l d T r i o H M O P l a n Em p l o y e e O n l y 1 $7 2 8 . 2 7 $6 1 3 . 4 3 Em p l o y e e + 1 0 $1 , 4 1 0 . 7 7 $1 , 1 8 8 . 5 9 Em p l o y e e + F a m i l y 2 $1 , 8 0 9 . 7 7 $1 , 5 2 7 . 4 2 Mo n t h l y H M O S u b t o t a l 3 $4 , 3 4 8 $ 3 , 6 6 8 An n u a l H M O S u b t o t a l $5 2 , 1 7 4 $4 4 , 0 1 9 % C h a n g e t o c u r r e n t -1 5 . 6 3 % Ka i s e r H M O P l a n Em p l o y e e O n l y 1 $7 2 8 . 2 7 $6 8 2 . 4 4 Em p l o y e e + 1 0 $1 , 4 1 0 . 7 7 $1 , 3 2 1 . 5 5 Em p l o y e e + F a m i l y 2 $1 , 8 0 9 . 7 7 $1 , 6 9 9 . 2 6 Mo n t h l y H M O S u b t o t a l 3 $4 , 3 4 8 $4 , 0 8 1 An n u a l H M O S u b t o t a l $5 2 , 1 7 4 $4 8 , 9 7 2 % C h a n g e t o c u r r e n t -6 . 1 4 % To t a l M e d i c a l M o n t h l y C o s t 5 9 $6 9 , 6 2 5 $6 8 , 6 7 8 To t a l M e d i c a l A n n u a l C o s t $8 3 5 , 4 9 4 $8 2 4 , 1 3 7 $ C h a n g e t o c u r r e n t N/ A -$ 1 1 , 3 5 7 % C h a n g e t o c u r r e n t N/ A -1 . 3 6 % NO T E : T h e p r o p o s e d r a t e s f o r B l u e S h i e l d a n d K a i s e r ar e i l l u s t r a t i v e t h r e e t i e r e d r a t e s ( a c t u a l r a t e s w i l l b e b a s e d o n i n d i v i d u a l a g e a n d g e n d e r ) a n d a s s u m e a n e f f e c t i v e d a t e o f 0 1 / 0 1 / 2 0 1 9 . E n r o l l m e n t w a s o b t a i n e d fr o m c e n s u s p r o v i d e d b y t h e C i t y . A s s u m e s a n e n r o l l m e n t m i g r a t i o n t o t h e T r i o a n d K a i s e r H M O p l a n s f r o m t h e c u r r e n t A c c e s s + H M O p l a n . B-8 Se c t i o n I I I De n t a l P l a n s B-9 | 10 De n t a l P P O & H M O P l a n s - C o s t C o m p a r i s o n Pl a n s / C a r r i e r s Co v e r e d Cu r r e n t P r i n c i p a l F i n a n c i a l Pr o p o s e d De l t a D e n t a l De n t a l P P O R a t e s E mp l o y e e O n l y 25 $ 5 6 . 3 4 $5 0 . 8 6 Em p l o y e e + 1 16 $1 0 5 . 6 2 $9 5 . 3 5 Em p l o y e e + F a m i l y 17 $1 6 0 . 0 3 $1 4 4 . 4 7 Mo n t h l y P P O D e n t a l C o s t 58 $5 , 8 1 9 $5 , 2 5 3 A n n u a l P P O D e n t a l C o s t $6 9 , 8 2 7 $6 3 , 0 3 7 $ C h a n g e t o c u r r e n t -$ 6 , 7 9 0 % C h a n g e t o c u r r e n t -9 . 7 2 % De n t a l H M O R a t e s Em p l o y e e O n l y 4 $1 4 . 4 4 $1 6 . 7 3 Em p l o y e e + 1 0 $2 4 . 4 4 $3 0 . 2 4 Em p l o y e e + F a m i l y 3 $3 7 . 7 8 $4 4 . 5 5 Mo n t h l y D H M O D e n t a l C o s t 7 $1 7 1 $201 A n n u a l D H M O D e n t a l C o s t $ 2 , 0 5 3 $2 , 4 0 7 $ C h a n g e t o c u r r e n t $354 % C h a n g e t o c u r r e n t 17 . 2 2 % To t a l A n n u a l D e n t a l C o s t 6 5 $7 1 , 8 8 0 $6 5 , 4 4 4 $ C h a n g e t o c u r r e n t N / A -$ 6 , 4 3 6 % C h a n g e t o c u r r e n t N / A -8 . 9 5 % Ra t e G u a r a n t e e 2 y e a r s N o t e s : P a r t i c i p a t i o n i n t h e D e n t a l p l a n s i s b a s e d o n c u r r e n t d e n t a l e l e c t i o n s . R a t e s a b o v e a r e b a s e d o n t h e c e n s u s d a t a p r o v i d e d b y C i t y o f R a n c h o P a l o s V e r d e s a n d a s s u m e a n 1 / 1 / 2 0 1 9 e f f e c t i v e d a t e . B-10 Se c t i o n I V Vi s i o n P l a n B-11 | 12 Vi s i o n P l a n – C o s t C o m p a r i s o n Pl a n s / C a r r i e r s Co v e r e d Cu r r e n t M E S Pr o p o s e d Ey e M e d Proposed VSP Choice Vi s i o n R a t e s E mp l o y e e O n l y 29 $1 6 . 7 5 $1 0 . 3 2 $17.28 Em p l o y e e + 1 17 $3 0 . 1 5 $1 9 . 6 0 $25.05 Em p l o y e e + F a m i l y 21 $4 3 . 2 2 $2 8 . 7 8 $44.57 Mo n t h l y P P O D e n t a l C o s t 6 7 $1 , 9 0 6 $1 , 2 3 7 $1,863 An n u a l P P O D e n t a l C o s t $2 2 , 8 7 1 $1 4 , 8 4 2 $22,355 $ C h a n g e t o c u r r e n t -$ 8 , 0 2 9 -$516 % C h a n g e t o c u r r e n t -3 5 . 1 0 % -2.26% Ra t e G u a r a n t e e 4 y e a r s 2 years N o t e s : P a r t i c i p a t i o n i n t h e V i s i o n p l a n i s b a s e d o n c u r r e n t d e n t a l e l e c t i o n s . R a t e s a b o v e a r e b a s e d o n t h e c e n s u s d a t a p r o v i d e d b y C i t y o f R a n c h o P a l o s V e r d e s a n d a s s u m e a n 1 / 1 / 2 0 1 9 e f f e c t i v e d a t e . B-12 Se c t i o n V Li f e a n d D i s a b i l i t y P l a n B-13 | 14 Li f e a n d A D & D P l a n s – C o s t S u m m a r y Pl a n s / C a r r i e r s Co v e r e d C u r r e n t P r i n c i p a l F i n a n c i a l Pr o p o s e d H a r t f o r d Li f e & A D & D P l a n L if e V o l u m e 66 $1 1 , 4 9 8 , 0 0 0 $1 1 , 4 9 8 , 0 0 0 Li f e r a t e p e r $ 1 , 0 0 0 0. 1 5 9 0. 1 4 6 AD & D V o l u m e 61 $1 1 , 2 4 8 , 0 0 0 $1 1 , 2 4 8 , 0 0 0 AD & D r a t e p e r $ 1 , 0 0 0 $0 . 0 5 $0 . 0 2 7 De p e n d e n t L i f e R a t e P e r U n i t 36 $1 . 4 8 $1 . 5 9 Mo n t h l y L i f e a n d A D & D C o s t $2 , 4 4 4 $2 , 0 4 0 An n u a l L i f e a n d A D & D C o s t $2 9 , 3 2 6 $2 4 , 4 7 6 $ C h a n g e t o c u r r e n t -$ 4 , 8 5 0 % C h a n g e t o c u r r e n t -1 6 . 5 4 % Lo n g T e r m D i s a b i l i t y LT D V o l u m e 56 $4 2 1 , 7 6 6 $4 2 1 , 7 6 6 LT D R a t e P e r $ 1 0 0 C o v e r e d P a y r o l l $0 . 6 0 0 $0 . 1 8 1 Mo n t h l y L T D C o s t $2 , 5 3 1 $7 6 3 An n u a l L T D C o s t $3 0 , 3 6 7 $9 , 1 6 1 $ C h a n g e t o c u r r e n t -$ 2 1 , 2 0 6 % C h a n g e t o c u r r e n t -6 9 . 8 3 % Mo n t h l y L i f e & D i s a b i l i t y C o s t $4 , 9 7 4 $2 , 8 0 3 An n u a l L i f e a n d D i s a b i l i t y C o s t $5 9 , 6 9 3 $3 3 , 6 3 7 $ C h a n g e t o c u r r e n t -$ 2 6 , 0 5 7 % C h a n g e t o c u r r e n t -4 3 . 6 5 % N o t e s : E n r o l l m e n t a n d v o l u m e p r o v i d e d b y t h e C i t y . R a t e s a b o v e a r e b a s e d o n t h e c e n s u s d a t a p r o v i d e d b y C i t y o f R a n c h o P a l o s V e r d e s a n d a s s u m e a n 1 / 1 / 2 0 1 9 e f f e c t i v e d a t e . B-14 | 15 Vo l u n t a r y L i f e a n d A D & D P l a n s – C o s t S u m m a r y Pl a n s / C a r r i e r s Co v e r e d Cu r r e n t P r i n c i p a l F i n a n c i a l Pr o p o s e d Ha r t f o r d Vo l u n t a r y L i f e a n d A D & D E mp l o y e e V o l u n t a r y T e r m L i f e 17 $3 4 3 . 9 7 $1 7 9 . 6 3 Em p l o y e e V o l u n t a r y T e r m A D & D 17 $5 5 . 6 6 $3 3 . 8 8 Sp o u s e V o l u n t a r y T e r m L i f e 5 $2 0 . 5 3 $1 2 . 0 7 Sp o u s e V o l u n t a r y T e r m A D & D 5 $7 . 5 9 $4 . 6 2 Ch i l d V o l u n t a r y T e r m L i f e 5 $5 . 0 0 $1 . 4 3 Mo n t h l y V o l u n t a r y L i f e & A D & D C o s t 4 9 $4 3 3 $2 3 2 An n u a l V o l u n t a r y L i f e & A D & D C o s t $5 , 1 9 3 $2 , 7 8 0 $ C h a n g e t o c u r r e n t -$ 2 , 4 1 3 % C h a n g e t o c u r r e n t -4 6 . 4 7 % B-15 | 16 Vo l u n t a r y L i f e a n d A D & D P l a n s – D e t a i l e d C o s t S u m m a r y La s t N a m e F i r s t N a m e EE S u p p . Li f e & A D & D Sp s S u p p . Li f e & A D & D Ch i l d L i f e E E S u p p . L i f e EE S u p p . AD & D Sp o u s e Su p p . L i f e Sp o u s e Su p p . A D & D Ch i l d T o t a l EE S u p p . Li f e EE S u p p . AD & D Sp o u s e Su p p . L i f e Spouse Supp. AD&D Child T o t a l $1 0 0 , 0 0 0 $3 1 . 1 0 $ 4 . 6 0 $3 5 . 7 0 $ 1 7 . 0 0 $ 2 . 8 0 $19.80 $2 0 , 0 0 0 $1 0 . 0 4 $ 0 . 9 2 $1 0 . 9 6 $ 5 . 4 4 $ 0 . 5 6 $6.00 $5 0 , 0 0 0 $6 . 7 0 $ 2 . 3 0 $9 . 0 0 $ 3 . 3 5 $ 1 . 4 0 $4.75 $3 0 , 0 0 0 $2 5 . 4 7 $ 1 . 3 8 $2 6 . 8 5 $ 1 5 . 3 6 $ 0 . 8 4 $16.20 $1 0 0 , 0 0 0 $1 9 . 5 0 $ 4 . 6 0 $2 4 . 1 0 $ 1 0 . 2 0 $ 2 . 8 0 $13.00 $4 0 , 0 0 0 $5 2 . 6 8 $ 1 . 8 4 $5 4 . 5 2 $ 2 0 . 4 8 $ 1 . 1 2 $21.60 $1 5 0 , 0 0 0 $4 6 . 6 5 $ 6 . 9 0 $5 3 . 5 5 $ 2 5 . 5 0 $ 4 . 2 0 $29.70 $2 0 , 0 0 0 $5 , 0 0 0 $ 1 0 . 0 4 $ 0 . 9 2 $1 . 0 0 $ 1 1 . 9 6 $ 7 . 9 0 $ 0 . 5 6 $0.29 $ 8 . 7 5 $3 0 , 0 0 0 $1 5 . 0 6 $ 1 . 3 8 $1 6 . 4 4 $ 8 . 1 6 $ 0 . 8 4 $9.00 $5 0 , 0 0 0 $3 . 8 0 $ 2 . 3 0 $6 . 1 0 $ 2 . 1 0 $ 1 . 4 0 $3.50 $1 0 0 , 0 0 0 $5 0 . 2 0 $ 4 . 6 0 $5 4 . 8 0 $ 2 7 . 2 0 $ 2 . 8 0 $30.00 $9 0 , 0 0 0 $ 2 5 , 0 0 0 $1 2 . 0 6 $ 4 . 1 4 $ 4 . 8 8 $ 1 . 1 5 $2 2 . 2 3 $ 6 . 0 3 $ 2 . 5 2 $ 1 . 8 0 $ 0 . 7 0 $11.05 $5 0 , 0 0 0 $9 . 7 5 $ 2 . 3 0 $1 2 . 0 5 $ 5 . 1 0 $ 1 . 4 0 $6.50 $5 0 , 0 0 0 $ 2 5 , 0 0 0 $ 5 , 0 0 0 $ 6 . 7 0 $ 2 . 3 0 $ 3 . 3 5 $ 1 . 1 5 $ 1 . 0 0 $ 1 4 . 5 0 $ 3 . 3 5 $ 1 . 4 0 $ 1 . 8 0 $ 0 . 7 0 $ 0 . 2 9 $ 7 . 5 4 $1 0 , 0 0 0 $ 5 , 0 0 0 $ 5 , 0 0 0 $ 1 . 3 4 $ 0 . 4 6 $ 1 . 5 6 $ 0 . 2 3 $ 1 . 0 0 $ 4 . 5 9 $ 1 . 0 2 $ 0 . 2 8 $ 0 . 5 5 $ 0 . 1 4 $ 0 . 2 9 $ 2 . 2 7 $2 0 , 0 0 0 $ 1 0 , 0 0 0 $ 5 , 0 0 0 $ 2 . 6 8 $ 0 . 9 2 $ 1 . 3 4 $ 0 . 4 6 $ 1 . 0 0 $ 6 . 4 0 $ 1 . 3 4 $ 0 . 5 6 $ 0 . 7 2 $ 0 . 2 8 $ 0 . 2 9 $ 3 . 1 9 $3 0 0 , 0 0 0 $ 1 0 0 , 0 0 0 $ 5 , 0 0 0 $ 4 0 . 2 0 $ 1 3 . 8 0 $ 9 . 4 0 $ 4 . 6 0 $ 1 . 0 0 $ 6 9 . 0 0 $ 2 0 . 1 0 $ 8 . 4 0 $ 7 . 2 0 $ 2 . 8 0 $ 0 . 2 9 $ 3 8 . 7 9 $3 4 4 $ 5 6 $ 2 1 $ 8 $ 5 $ 4 3 3 $ 1 8 0 $ 3 4 $ 1 2 $ 5 $ 1 $ 2 3 2 $4 , 1 2 8 $ 6 6 8 $ 2 4 6 $ 9 1 $ 6 0 $ 5 , 1 9 3 $ 2 , 1 5 6 $ 4 0 7 $ 1 4 5 $ 5 5 $ 1 7 $ 2 , 7 8 0 Mo n t h l y T o t a l An n u a l T o t a l En r o l l e d / P l a n s / C a r r i e r s V o l u m e Cu r r e n t P r i n c i p a l F i n a n c i a l Pr o p o s e d Ha r t f o r d B-16 Se c t i o n V I Em p l o y e e A s s i s t a n c e Pr o g r a m B-17 | 18 Em p l o y e e A s s i s t a n c e P r o g r a m – C o s t C o m p a r i s o n Pl a n s / C a r r i e r s Co v e r e d C u r r e n t H o l m a n P r o p o s e d A n t h e m P r o p o s e d M H N Em p l o y e e A s s i s t a n c e P r o g r a m E AP R a t e P E P M 65 $1 . 4 5 $1 . 2 0 $2.09 Mo n t h l y V i s i o n C o s t $9 4 $7 8 $136 A n n u a l V i s i o n C o s t $1 , 1 3 1 $9 3 6 $1,630 $ C h a n g e t o c u r r e n t N/ A -$ 1 9 5 $499 % C h a n g e t o c u r r e n t N/ A -1 7 . 2 4 % 44.14% Ra t e G u a r a n t e e 3 y e a r s 2 years N o t e s : P a r t i c i p a t i o n i n t h e E A P p l a n s i s b a s e d o n c u r r e n t d e n t a l e l e c t i o n s . R a t e s a b o v e a r e b a s e d o n t h e c e n s u s d a t a p r o v i d e d b y C i t y o f R a n c h o P a l o s V e r d e s a n d a s s u m e a n 1/ 1 / 2 0 1 9 e f f e c t i v e d a t e . B-18 CO N F I D E N T I A L A N D P R O P R I E T A R Y : T h i s d o c u m e n t a n d t h e i n f o r m a t i o n c o n t a i n e d h e r e i n i s c o n f i d e n t i a l a n d p r o p r i e t a r y i n f o r m a t i o n o f U S I I n s u r a n c e Se r v i c e s , L L C ( " U S I " ) . R e c i p i e n t a g r e e s n o t t o c o p y , r e p r o d u c e o r d i s t r i b u t e t h i s d o c u m e n t , i n w h o l e o r i n p a r t , w i t h o u t t h e p r i o r w r i t t e n c o n s e n t o f U S I . Es t i m a t e s a r e i l l u s t r a t i v e g i v e n d a t a l i m i t a t i o n , m a y n o t b e c u m u l a t i v e a n d a r e s u b j e c t t o c h a n g e b a s e d o n c a r r i e r u n d e r w r i t i n g . © 2 0 1 8 U S I I n s u r a n c e S e r v i c e s . A l l r i g h t s r e s e r v e d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r e m i u m s Co v e r a g e Mo n t h l y C i t y E m p l o y e e D e d u c t i o n p e r Pl a n N a m e Le v e l Pr e m i u m P a i d P a i d P a y c h e c k C O B R A Bl u e S h i e l d G o l d P P O 4 5 0 D e d u c t i b l e E m p l o y e e O n l y 6 1 1 . 17 61 1 . 1 7 - - * Bl u e S h i e l d G o l d P P O 4 5 0 D e d u c t i b l e E m p l o y e e + 1 1 , 5 1 0 . 0 0 1, 0 6 0 . 5 9 44 9 . 4 2 207.42 * Bl u e S h i e l d G o l d P P O 4 5 0 D e d u c t i b l e E m p l o y e e + F a m i l y 2 , 3 2 0 . 0 0 1, 4 6 5 . 5 9 85 4 . 4 2 394.35 * Bl u e S h i e l d A c c e s s + Em p l o y e e O n l y 8 0 7 . 1 5 80 7 . 1 5 - - * Bl u e S h i e l d A c c e s s + Em p l o y e e + 1 1 , 5 6 3 . 9 4 1, 1 8 5 . 5 5 37 8 . 4 0 174.64 * Bl u e S h i e l d A c c e s s + Em p l o y e e + F a m i l y 2 , 0 0 9 . 7 6 1, 4 0 8 . 4 6 60 1 . 3 1 277.53 * ** B l u e S h i e l d T r i o H M O Em p l o y e e O n l y 6 4 5 . 7 2 64 5 . 7 2 - - * Bl u e S h i e l d T r i o H M O Em p l o y e e + 1 1 , 2 5 1 . 1 5 94 8 . 4 4 3 0 2 . 7 2 139.71 * Bl u e S h i e l d T r i o H M O Em p l o y e e + F a m i l y 1 , 6 0 7 . 8 1 1, 1 2 6 . 7 7 48 1 . 0 4 222.02 * Bl u e S h i e l d S p e c t r u m S i l v e r P P O w / H S A E m p l o y e e O n l y 7 0 3 . 2 0 70 3 . 2 0 - - * Bl u e S h i e l d S p e c t r u m S i l v e r P P O w / H S A E m p l o y e e + 1 1 , 4 0 6 . 3 8 1, 0 5 4 . 7 9 35 1 . 5 9 162.27 * Bl u e S h i e l d S p e c t r u m S i l v e r P P O w / H S A E m p l o y e e + F a m i l y 1 , 8 2 8 . 3 0 1, 2 6 5 . 7 5 56 2 . 5 4 259.63 * ** K a i s e r H M O Em p l o y e e O n l y 7 1 8 . 3 6 71 8 . 3 6 - - 7 3 2 . 7 3 Ka i s e r H M O Em p l o y e e + 1 1 , 3 9 1 . 9 1 1, 0 5 5 . 1 4 33 6 . 7 8 155.43 1,419.75 Ka i s e r H M O Em p l o y e e + F a m i l y 1 , 7 8 8 . 6 9 1, 2 5 3 . 5 3 53 5 . 1 7 247.00 1,824.46 B-57 ( / ( 3 ! ! '5 Co v e r a g e Mo n t h l y C i t y E m p l o y e e D e d u c t i o n p e r Pl a n N a m e Le v e l Pr e m i u m P a i d P a i d P a y c h e c k C O B R A De l t a D e n t a l P P O Em p l o y e e O n l y 5 2 . 4 3 52 . 4 3 - - 53.48 De l t a D e n t a l P P O Em p l o y e e + 1 98 . 3 0 75 . 3 7 2 2 . 9 4 10.59 100.27 De l t a D e n t a l P P O Em p l o y e e + F a m i l y 1 4 8 . 9 4 10 0 . 6 9 48 . 2 6 22.27 151.92 De l t a C a r e D H M O Em p l o y e e O n l y 1 6 . 7 3 16 . 7 3 - - 17.06 De l t a C a r e D H M O Em p l o y e e + 1 30 . 2 4 23 . 4 9 6. 7 6 3.12 30.84 De l t a C a r e D H M O Em p l o y e e + F a m i l y 4 4 . 5 5 30 . 6 4 1 3 . 9 1 6.42 45.44 Ey e M e d Em p l o y e e O n l y 1 0 . 3 2 10 . 3 2 - - 10.53 Ey e M e d Em p l o y e e + 1 19 . 6 0 14 . 9 6 4. 6 4 2.14 19.99 Ey e M e d Em p l o y e e + F a m i l y 2 8 . 7 8 19 . 5 5 9. 2 2 4.26 29.36 An t h e m ( E A P P l a n ) $1 . 2 0 $ 1 . 2 0 $ 0 $0 1 . 2 2 30 6 . 0 0 $ Op t O u t M o n t h l y A m o u n t (C a s h - i n - l i e u = 1 / 2 x L o w e s t m e d i c a l r a t e f o r " E m p l o y e e O n l y " c o v e r a g e ) * C o m p o s i t e r a t e s f o r m e d i c a l i n s u r a n c e d o n o t a p p l y f o r C O B R A ; C O B R A r a t e s a r e sp e c i f i c t o s e p a r a t i n g m e m b e r / d e p e n d e n t . ** T h e p r o p o s e d r a t e s f o r B l u e S h i e l d T r i o H M O a n d K a i s e r H M O a r e i l l u s t r a t i v e t h r e e t i e r e d r a t e s ( a c t u a l r a t e s w i l l b e b a s e d o n in d i v i d u a l a g e a n d g e n d e r ) a n d a s s u m e a n e f f e c t i v e d a t e o f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inancial Summary January 1, 2019 Presented by: Daniel V. Maniaci Maniaci Insurance Services, Inc. Pro. 9/17/18mo Lic. 0441220 www.maniaciinsurance.com (866) 541-4824 500 Silver Spur Road, Suite 121 Palos Verdes, CA 90275 Lic. 0600161 C-1 Health Summary C-2 $ 11,016.15 $ 2,281.97 $ 49,959.31 $ 63,257.43 $ 50,602.64 $ 10,996.11 $ 2,433.54 $ 51,949.69 $ 65,379.34 3.35% $ 52,377.48 3.51% $ 8,986.75 $ 2,433.54 $ 49,945.34 $ 61,365.63 -2.99% $ 49,337.99 -2.50% Kaiser HMO Platinum 90 0/15 (8 ees) $ 10,260.70 Blue Shield 1 PPO Gold Full 500/30 (4 ees) $ 2,433.54 Kaiser HSA (HMO) Silver 70 2000/20% (46 ees)4 $ 32,811.13 $ 45,505.37 -28.06% $ 36,380.75 -28.11% $ 12,553.48 $ 3,598.94 $ 57,781.46 $ 73,933.88 16.88% $ 59,350.70 17.29% $ 11,763.67 $ 2,387.87 $ 51,453.22 $ 65,604.76 3.71% $ 52,444.52 3.64% $ 12,255.47 $ 2,392.59 $ 50,570.95 $ 65,219.01 3.10% $ 52,077.55 2.91% $ 11,431.32 $ 2,490.41 $ 53,221.52 $ 67,143.25 6.14% $ 53,750.43 6.22% TOTAL MONTHLY PREMIUM TOTAL EMPLOYER CONTRIBUTION 2 HEALTH NET3 TOTAL EMPLOYER CONTRIBUTION 2 TOTAL MONTHLY PREMIUM TOTAL EMPLOYER CONTRIBUTION 2 HMO Platinum Deductible $15/30 0 Ded (8 ees) PPO Gold OA Managed Choice 80/50 750 Ded (4 ees) HSA (PPO) Bronze OA Managed Choice 100/50 6550 Ded (47 ees) RATES ARE BASED ON A JANUARY 1, 2019 EFFECTIVE DATE. FINAL RATES WILL BE DETERMINED BY HEALTH, DEMOGRAPHICS, AND UNDERWRITING GUIDELINES. FINAL RATES WILL BE DETERMINED BY UNDERWRITING. AETNA3 ANTHEM BLUE CROSS3 UNITED HEALTHCARE3 HMO Platinum Full Network $20 (8 ees) PPO Gold Value 80 750/10 (4 ees) HSA (PPO) Silver 70 1350/40 (47 ees) TOTAL MONTHLY PREMIUM TOTAL EMPLOYER CONTRIBUTION 2 4. One current enrollee is not in Kaiser service Area. 3. January 2019 rates are not available. Rates illustrated are based on a 12/1/18 effective date. HMO Platinum 10/10%/2000 (8 ees) PPO Gold 500/20%/6500 (4 ees) HSA (PPO) Silver 2000/20%/6000 (47 ees) TOTAL MONTHLY PREMIUM TOTAL EMPLOYER CONTRIBUTION 2 2. Total employer contribution is based on 100% of employee premium and 50% of dependent premium. TOTAL EMPLOYER CONTRIBUTION 2 1. Blue Shield rates illustrated are based on a 1/1/19 effective and were manually calculated using Blue Shield's January 2019 rates. Final rates may vary based on final enrollment KAISER3 - ALONGSIDE BLUE SHIELD HMO Platinum Trio 0/20 (8 ees) PPO Gold Full 450/30 (4 ees) PPO Silver Full 2000/45 (47 ees) TOTAL MONTHLY PREMIUM TOTAL EMPLOYER CONTRIBUTION 2 BLUE SHIELD - OPTION1 TOTAL MONTHLY PREMIUM HMO Platinum Signature 20-40/500d (8 ees) PPO Gold Select Plus 25/500/25% (4 ees) HSA (PPO) Silver Select Plus 2000/20% (47 ees) TOTAL MONTHLY PREMIUM HMO Platinum Access+ 0/20 (8 ees) PPO Gold Full 450/30 (4 ees) HSA (PPO) Silver Full Savings 2000/20% (47 ees) HMO Platinum Access+ 0/20 (8 ees) PPO Gold Full 500/30 (4 ees) HSA (PPO) Silver Full Savings 2000/20% (47 ees) BLUE SHIELD - CURRENT BLUE SHIELD - RENEWAL1 TOTAL MONTHLY PREMIUM TOTAL EMPLOYER CONTRIBUTION 2 CITY OF RANCHO PALOS VERDES HEALTH SUMMARY MANIACI INSURANCE SERVICES, INC.LIC. 0600161 C-3 Ancillary Summary C-4 Principal/CDN Dental HMO Plan Advantage 75 (7 ees) $ 2,053.20 Principal Dental POS Plan (58 ees) $ 69,827.16 MES Vision Plan (68 ees) $ 23,072.04 Principal Employer Paid Life/AD&D & Dep Life Plan (66 life ees / 61 AD&D ees / 42 Dep Life) $ 29,901.60 Principal LTD Plan (56 ees) $ 28,848.84 Holman EAP Plan (61 ees) $ 1,061.40 $ 154,764.24 Principal/CDN Dental HMO Plan Advantage 75 (7 ees) $ 2,053.20 0.00% Principal Dental POS Plan (58 ees) $ 69,827.16 0.00% MES Vision Plan (68 ees) $ 23,072.04 0.00% Principal Employer Paid Life/AD&D & Dep Life Plan (66 life ees / 61 AD&D ees / 42 Dep Life) $ 31,176.00 4.26% Principal LTD Plan (56 ees) $ 28,848.84 0.00% Holman EAP Plan (61 ees) $ 1,061.40 0.00% $ 156,038.64 0.82% Delta Dental Dental HMO Plan 10A (7 ees) $ 2,957.28 44.03% Delta Dental Dental PPO Classic Premier Enhanced Plan (58 ees) $ 85,830.84 22.92% Principal POS plan w/ $2,500 Calendar Year Maximum (58 ees) $ 73,483.44 5.24% MES Vision plan w/ $150 Frame Allowance (68 ees) $ 24,292.92 5.29% EyeMed Vision Plan (68 ees) $ 13,856.40 -39.94% EyeMed Vision plan w/ $150 Frame Allowance (68 ees) $ 14,816.28 -35.78% VSP Vision Plan (68 ees) $ 37,094.76 60.78% Principal EAP Plan (61 ees) - included in LTD plan at no additional cost $ - 0.00% Magellan Health EAP Plan (61 ees) $ 1,178.52 11.03% ComPsych EAP Plan (61 ees) $ 1,950.00 83.72% Espyr EAP Plan (61 ees) $ 4,800.00 352.23% Health Adovate EAP Plan (61 ees) $ 878.40 -17.24% EAP Options TOTAL ANNUAL PREMIUM MANAGEMENT REQUESTED CHANGES Dental Options RATES ARE BASED ON A JANUARY 1, 2019 EFFECTIVE DATE. FINAL RATES WILL BE DETERMINED BY HEALTH, DEMOGRAPHICS, AND UNDERWRITING GUIDELINES. FINAL RATES WILL BE DETERMINED BY UNDERWRITING. *Summary above does not include Voluntary Coverage with NationWide Pet Insurance and Principal Voluntary Life Coverage. We negotiated a 1 Year Rate Pass for the Principal Voluntary Life Policy. Monthly totals vary by enrollment. ANCILLARY - CURRENT ANCILLARY - NEGOTIATED RENEWAL TOTAL ANNUAL PREMIUM Vision Options CITY OF RANCHO PALOS VERDES ANCILLARY SUMMARY MANIACI INSURANCE SERVICES, INC.LIC. 0600161 C-5 Financial Summary C-6 CURRENT RENEWAL INCREASE $ 132,193.80 $ 131,953.32 -0.18% $ 27,383.64 $ 29,202.48 6.64% $ 599,511.72 $ 623,396.28 3.98% $ 759,089.16 $ 784,552.08 3.35% $ 2,053.20 $ 2,053.20 0.00% $ 69,827.16 $ 69,827.16 0.00% $ 23,072.04 $ 23,072.04 0.00% $ 29,901.60 $ 31,176.00 4.26% $ 28,848.84 $ 28,848.84 0.00% $ 1,061.40 $ 1,061.40 0.00% $ 913,853.40 $ 940,590.72 2.93% CURRENT RENEWAL INCREASE $ 92,725.56 $ 92,613.18 -0.12% $ 27,383.64 $ 29,202.48 6.64% $ 487,122.48 $ 506,714.10 4.02% $ 607,231.68 628,529.76$ 3.51% 1,633.08$ 1,633.08$ 0.00% 54,519.96$ 54,519.96$ 0.00% 18,370.08$ 18,370.08$ 0.00% 29,901.60$ 31,176.00$ 4.26% 28,848.84$ 28,848.84$ 0.00% 1,061.40$ 1,061.40$ 0.00% $ 741,566.64 764,139.12$ 3.04% $ - $ 22,572.48 3.04% Blue Shield - HMO1 Blue Shield - PPO1 Principal Dental POS Plan MES Vision Plan Principal Employer Paid Life/AD&D & Dep Life Plan Holman EAP Plan TOTAL ANNUAL PREMIUM Blue Shield - HMO1 Blue Shield - PPO1 Blue Shield - HSA1 BLUE SHIELD - HSA EMPLOYER CONTRIBUTION ANNUAL SUBTOTAL ALL LINES OF COVERAGE - TOTAL PREMIUM2 ALL LINES OF COVERAGE - CITY COST2 Principal LTD Plan Holman EAP Plan TOTAL ANNUAL PREMIUM TOTAL ANNUAL INCREASE Blue Shield - HSA1 California Dental Network DMO Plan Advantage 75 Principal Dental POS Plan MES Vision Plan Principal Employer Paid Life/AD&D & Dep Life Plan Principal LTD Plan ANNUAL SUBTOTAL California Dental Network DMO Plan Advantage 75 TOTAL ANNUAL EMPLOYER CONTRIBUTION 3 3. Total annual HSA employer contribution is based on $3,000 for individual coverage and $6,000 for family coverage. Assumptions illustrate current enrollees on the HSA medical plan. $ 72,000.00 $ 138,000.00 $ 210,000.00 Employee Only (24 ees) Employee/Dependent (23 ees) 2. Summary above does not include Voluntary Coverage with Nationwide Pet Insurance, Legal Access, and Principal Voluntary Life Coverage as these are not the financial responsibilities of the City. Monthly totals vary by enrollment. 1. Blue Shield January 2019 rates were manually calculated. Final rates may vary based on final enrollment. CITY OF RANCHO PALOS VERDES FINANCIAL SUMMARY MANIACI INSURANCE SERVICES, INC.LIC. 0600161 C-7 Premium Modeling Tool C-8 Tier*# in Each Tier ER% EE Only 4 100% EE + 1 0 50% EE + 2 4 8 Tier # of Employees Composite Rate ER Portion EE Portion Total EE Only 4 $728.27 $728.27 $0.00 $2,913.09 EE + 1 0 $1,410.77 $1,069.52 $341.25 $0.00 EE + 2 4 $1,809.77 $1,269.02 $540.75 $7,239.08 $10,152.16 $7,989.17 Tier*# in Each Tier ER% EE Only 5 100% EE + 1 0 50% EE + 2 0 5 Tier # of Employees Composite Rate ER Portion EE Portion Premium EE Only 5 $1,198.71 $1,198.71 $0.00 $5,993.56 EE + 1 0 $2,174.29 $1,686.50 $487.79 $0.00 EE + 2 0 $2,927.96 $2,063.33 $864.62 $0.00 $5,993.56 $5,993.56 Tier*# in Each Tier ER% EE Only 23 100% EE + 1 11 50% EE + 2 11 45 Tier # of Employees Composite Rate ER Portion EE Portion Premium EE Only 23 $705.21 $705.21 $0.00 $16,219.88 EE + 1 11 $1,410.42 $1,057.82 $352.61 $15,514.67 EE + 2 11 $1,833.55 $1,269.38 $564.17 $20,169.07 $51,903.63 $41,819.09 Premium $68,049.35 $55,801.82 Total Monthly Premium Total Monthly Employer Contribution Blue Shield Totals Total Monthly Premium Total Monthly Employer Contribution Total Monthly Premium Total Monthly Employer Contribution CITY OF RANCHO PALOS VERDES HSA (PPO) Silver Full Savings 2000/20% Plan Total Monthly Premium - based on current composite rates illustrated above (58 EES)$68,049.35 Total Monthly Premium - based on January 2018 Invoice (58 EES)$63,360.60 Net $4,688.75 Composite rating calculations are for illustrative purposes only and not intended as legal representation TOTAL MONTHLY PREMIUM COMPARISON - CURRENT * Enrollment assumptions are based on enrollment as of January 1, 2018 enrollment. EFFECTIVE: 1/1/2019 BLUE SHIELD - CURRENT* JANUARY 2019 COMPOSITE RATE MODEL (BASED ON JANUARY 1, 2018 ENROLLMENT) HMO Platinum Access+ 0/20 Plan Total Monthly Premium Total Monthly Employer Contribution PPO Gold Full 450/30 Plan C-9 Tier*# in Each Tier ER% EE Only 3 100% EE + 1 0 50% EE + 2 5 8 Tier # of Employees Composite Rate ER Portion EE Portion Total EE Only 3 $728.27 $728.27 $0.00 $2,184.81 EE + 1 0 $1,410.77 $1,069.52 $341.25 $0.00 EE + 2 5 $1,809.77 $1,269.02 $540.75 $9,048.85 $11,233.66 $8,529.92 Tier*# in Each Tier ER% EE Only 4 100% EE + 1 0 50% EE + 2 0 4 Tier # of Employees Composite Rate ER Portion EE Portion Premium EE Only 4 $1,198.71 $1,198.71 $0.00 $4,794.85 EE + 1 0 $2,174.29 $1,686.50 $487.79 $0.00 EE + 2 0 $2,927.96 $2,063.33 $864.62 $0.00 $4,794.85 $4,794.85 Tier*# in Each Tier ER% EE Only 23 100% EE + 1 13 50% EE + 2 10 46 Tier # of Employees Composite Rate ER Portion EE Portion Premium EE Only 23 $705.21 $705.21 $0.00 $16,219.88 EE + 1 13 $1,410.42 $1,057.82 $352.61 $18,335.52 EE + 2 10 $1,833.55 $1,269.38 $564.17 $18,335.52 $52,890.93 $42,665.35 Premium $68,919.43 $55,990.11 Total Monthly Premium TOTAL MONTHLY PREMIUM COMPARISON - CURRENT Total Monthly Premium - based on current composite rates illustrated above (58 EES)$68,919.43 Total Monthly Premium - based on September 2018 Invoice (58 EES)$63,015.03 Net $5,904.40 * Enrollment assumptions are based on enrollment as of September 1, 2018. Composite rating calculations are for illustrative purposes only and not intended as legal representation Total Monthly Employer Contribution Total Monthly Premium Total Monthly Employer Contribution Blue Shield Totals Total Monthly Employer Contribution HSA (PPO) Silver Full Savings 2000/20% Plan Total Monthly Premium CITY OF RANCHO PALOS VERDES EFFECTIVE: 1/1/2019 BLUE SHIELD - CURRENT* JANUARY 2019 COMPOSITE RATE MODEL (BASED ON SEPTEMBER 1, 2018 ENROLLMENT) HMO Platinum Access+ 0/20 Plan PPO Gold Full 450/30 Plan Total Monthly Premium Total Monthly Employer Contribution C-10 Tier*# in Each Tier ER% EE Only 3 100% EE + 1 0 50% EE + 2 5 8 Tier # of Employees Composite Rate ER Portion EE Portion Total Increase EE Only 3 $757.40 $757.40 $0.00 $2,272.21 EE + 1 0 $1,467.20 $1,112.30 $354.90 $0.00 EE + 2 5 $1,882.16 $1,319.78 $562.38 $9,410.80 $11,683.01 4.00% $8,871.11 4.00% Tier*# in Each Tier ER% EE Only 4 100% EE + 1 0 50% EE + 2 0 4 Tier # of Employees Composite Rate ER Portion EE Portion Premium Increase EE Only 4 $1,246.66 $1,246.66 $0.00 $4,986.64 EE + 1 0 $2,261.26 $1,753.96 $507.30 $0.00 EE + 2 0 $3,045.07 $2,145.87 $899.21 $0.00 $4,986.64 4.00% $4,986.64 4.00% Tier*# in Each Tier ER% EE Only 23 100% EE + 1 13 50% EE + 2 10 46 Tier # of Employees Composite Rate ER Portion EE Portion Premium Increase EE Only 23 $733.42 $733.42 $0.00 $16,868.68 EE + 1 13 $1,466.84 $1,100.13 $366.71 $19,068.94 EE + 2 10 $1,906.89 $1,320.16 $586.74 $19,068.94 $55,006.56 4.00% $44,371.96 4.00% Premium Increase $71,676.21 4.00% $58,229.72 4.00% CITY OF RANCHO PALOS VERDES EFFECTIVE: 1/1/2019 Total Monthly Premium BLUE SHIELD - RENEWAL* JANUARY 2019 COMPOSITE RATE MODEL HMO Platinum Access+ 0/20 Plan PPO Gold Full 450/30 Plan Total Monthly Premium Total Monthly Employer Contribution Total Monthly Premium Total Monthly Employer Contribution Blue Shield Totals Total Monthly Employer Contribution HSA (PPO) Silver Full Savings 2000/20% Plan Total Monthly Premium * Enrollment assumptions are based on enrollment as of September 1, 2018. Total Monthly Employer Contribution Composite rating calculations are for illustrative purposes only and not intended as legal representation C-11 References C-12 LIC. 0600161 EMPLOYEE BENEFIT COUNSELING SERVICE Big Affordable Care Act (ACA) Change for 2018 Large Premium Increases for Children and Teenagers C-13 500 Silver Spur Road, Suite 121 Palos Verdes, CA 90275 310.541.4824 maniaciinsurance.com LIC. 0600161 Eligible Medical Expenses Your HSA covers a wide variety of medical costs. Below is a list of just some of the eligible expenses. An eligible expense is defined as an expense which pays for care as described in Section 213 (d) of the Internal Revenue Code. This list is not comprehensive, is meant to serve as a quick reference, and is provided to you with the understanding that Maniaci Insurance Services, Inc. is not engaged in rendering tax advice. The information provided is not intended to be used to avoid federal tax penalties. For more detailed information, please refer to IRS Publication 502 titled, “Medical and Dental Expenses,” Catalog Number 15002Q. Publications can be ordered directly from the IRS by calling 1-800-TAXFORM. If tax advice is required, you should seek the services of a professional. *Beginning in 2011, tax-free HSA funds no longer can be used to purchase over-the-counter drugs that are not prescribed by a doctor. Health insurance may not be purchased with HSA funds. However, HSA funds can be used to pay for: 1.) Health plan premiums during any period of continuation coverage required under any Federal (COBRA) 2.) A qualified long-term care insurance contract ALTERNATIVE THERAPY Acupuncture Chiropractor Christian Science Practitioner DENTAL Braces Dental treatment Dental X-rays Dentures Fluoridation unit Gum treatment EYE AND EAR Contact lenses Eyeglasses Guide-dog Hearing aids and batteries Ophthalmologist Optician Optometrist Telephone or TV equipment to assist the hard-of-hearing EQUIPMENT Air conditioner (when necessary for relief from difficulty in breathing) Autoette (when used for relief of sickness/disability) Cardiograph Oxygen and oxygen equipment Therapy equipment FEES Ambulance Diagnostic Fees Fees paid to health institute prescribed by a doctor FICA and FUTA tax paid for medical care service Hospital bills Legal fees Operating room costs Special school costs for the handicapped Transportation expenses GENERAL CARE Dermatologist Neurologist Nursing Orthopedist Osteopath Pediatrician Physician Podiatrist LIVING EXPENSES Convalescent home (for medical treatment only) Lodging (away from home for outpatient care) MEDICINE* Prescription drugs and medicines MENTAL HEALTH Psychiatrist Psychoanalyst Psychologist Psychotherapy PREVENTIVE Lead paint removal Vaccines PROSTHETICS Artificial limbs RECOVERY AIDS Abdominal supports Arch supports Crutches Orthopedic shoes Splints Wheelchairs REPRODUCTION Abortion Birth control pills (by prescription) Childbirth/Delivery Contraceptive devices (by prescription) Gynecologist Obstetrician Prenatal care Postnatal treatments Sterilization Vasectomy SUBSTANCE ABUSE Alcoholism treatment Drug addiction therapy SURGERY Anesthetist Oral surgery Organ transplant (including donor’s expenses) Surgeon TESTS Blood tests Lab tests Metabolism tests Spinal fluid test X-rays THERAPY Elastic hosiery (by prescription) Hydrotherapy Physiotherapist Radium therapy TREATMENT Blood transfusions Ultra-violet ray treatment C-14 500 Silver Spur Road, Suite 121 | Palos Verdes, CA 90275 | 866.541.4824 | www.maniaciinsurance.com | LIC. 0600161 Maniaci Insurance Services, Inc. A United Benefit Advisors® (UBA) Company Employee Benefit Solutions Plan Administration Services Compliance Services Annual Comparative Premium Study Enrollment Support Employee Meetings Creative Plan Strategies Printed Employee Communication Compliance Alert and Webinar Series Legislative Advisement SPDs, MMDs, CMS Filings HRInsider® (Forms, Documents, Resources) Compliance Audits Advocacy and Care Services Technology Services Dedicated Employee Call Center Appeals Assistance Elder Care Assistance Wellness Resources Claims and Billing Assistance Online Enrollment and Administration Employee Benefits Website HR Management System Employee Resource Center Employee Benefits Video Library Overview of Maniaci Services C-15 Tier # in Each Tier ER% EE Only 2 100% EE + 1 0 50% EE + 2 3 5 Tier # of Employees Composite Rate ER EE Total EE Only 2 $496.86 $496.86 $0.00 $993.72 EE + 1 0 $1,192.46 $844.66 $347.80 $0.00 EE + 2 3 $1,490.57 $993.72 $496.86 $4,471.72 $5,465.44 $3,974.87 Total Monthly Premium Total Monthly Employer Contribution Composite rating calculations are for illustrative purposes only and not intended as legal representation CITY OF RANCHO PALOS VERDES EFFECTIVE: 1/1/19 BLUE SHIELD - OPTION Platinum Trio HMO 0/20 Plan C-16 Tier # in Each Tier ER% EE Only 3 100% EE + 1 0 50% EE + 2 5 8 Tier # of Employees Composite Rate ER EE Total EE Only 3 $499.26 $499.26 $0.00 $1,497.79 EE + 1 0 $1,198.23 $848.75 $349.48 $0.00 EE + 2 5 $1,497.79 $998.53 $499.26 $7,488.96 $8,986.75 $6,490.43 Total Monthly Premium Total Monthly Employer Contribution Composite rating calculations are for illustrative purposes only and not intended as legal representation CITY OF RANCHO PALOS VERDES EFFECTIVE: 1/1/19 KAISER - OPTION Platinum 90 HMO 0/15 Plan C-17 CITY OF RANCHO PALOS VERDES Group Health Details & Ancillary Plans January 1, 2019 Presented by: Daniel V. Maniaci Maniaci Insurance Services, Inc. Pro. 9/17/18mo Lic. 0441220 www.maniaciinsurance.com (866) 541-4824 500 Silver Spur Road, Suite 121 Palos Verdes, CA 90275 Lic. 0600161 C-18 Medical Cost Comparison C-19 HMO Plan Details (Rates Based on a 12/1/18 Effective Date) C-20 Side By Side Detail City of Rancho Palos Verdes (2019) - Platinum Access HMO 20 Prepared by Daniel Maniaci Rancho Palos Verdes, Los Angeles, 90275 Effective December 01, 2018 CURRENT PLAN RENEWAL PLAN Blue Shield Blue Shield Blue Shield Platinum Access+ HMO® 0/20 OffEx Platinum Access+ HMO® 0/20 OffEx Platinum Trio HMO® 0/20 OffEx Broad Network Broad Network Narrow Network In Network Out of Network In Network Out of Network In Network Out of Network Individual Deductible $0 $0 $0 Family Deductible $0 $0 $0 Individual OOP Limit $1,350 $1,350 $1,350 Family OOP Limit $2,700 $2,700 $2,700 PC/Specialist $20/$40; $40 Access+ SP $20/$40; $40 Access+ SP $20/$40; $40 Access+ SP Lab/X-Ray $10/$30 $10/$30 $10/$30 Inpatient Hospital $500/admit $500/admit $500/admit Outpatient Facility $100/$150 (ASC/Hospital)$100/$150 (ASC/Hospital)$100/$150 (ASC/Hospital) Emergency Room $200 (waived if admitted)$200 (waived if admitted)$200 (waived if admitted) Urgent Care $20 $20 $20 Rx Generic $5 $5 $5 Rx Preferred $15 $15 $15 EE's Included 8/59 8/59 8/59 EE Cost $4,438.11 $4,422.52 $3,618.19 Dep Cost $6,578.04 $6,539.06 $5,349.82 Total $11,016.15 $10,961.58 $8,968.01 ER Total $4,438.11 $4,422.52 $3,618.19 Increase (Change)($54.57) (0%)($2,048.14) (-19%) Use of this site constitutes acceptance of HealthConnect's Terms of service and Privacy Policy. The rates and benefits displayed within are for discussion and estimation purposes only and is not a substitute for an insurance quote prepared by an insurance carrier. Final benefits and rates must be based on insurance carrier confirmation and final enrollment. City of Rancho Palos Verdes (2019) - Platinum Access HMO 20 Effective Date: 12-01-2018 Run Date: 09-18-2018 #6521801 Maniaci Insurance Services Maniaci Insurance Services License: 0600161 C-21 Side By Side Detail City of Rancho Palos Verdes (2019) - Platinum Access HMO 20 Prepared by Daniel Maniaci Rancho Palos Verdes, Los Angeles, 90275 Effective December 01, 2018 Kaiser UnitedHealthcare Anthem Blue Cross Platinum 90 HMO 0/15 + Child Dental Signature Platinum 20-40/500d (BJ-KS)Platinum HMO 10/10%/2000 Broad Network Broad Network Broad Network In Network Out of Network In Network Out of Network In Network Out of Network Individual Deductible $0 $0 $0 Family Deductible $0 $0 $0 Individual OOP Limit $3,350 $2,250 $2,000 Family OOP Limit $6,700 $4,500 $4,000 PC/Specialist $15/$30 $20/$40 $10/$30 Lab/X-Ray $15/$30 $15 $10 Inpatient Hospital $250/day up to 5 days $500/day; 4 days/admit $250/day; 3 days/admit Outpatient Facility $125 $250 $100 Emergency Room $150 (waived if admitted)$400 $100 Urgent Care $15 $20/$50 (in/out of area)$10 Rx Generic $5 $15 $5/$15 Rx Preferred $15 $35 $35 EE's Included 8/59 8/59 8/59 EE Cost $4,100.22 $4,612.03 $4,746.13 Dep Cost $6,160.48 $6,819.29 $7,017.54 Total $10,260.70 $11,431.32 $11,763.67 ER Total $4,100.22 $4,612.03 $4,746.13 Increase (Change)($755.45) (-7%)$415.17 (4%)$747.52 (7%) Use of this site constitutes acceptance of HealthConnect's Terms of service and Privacy Policy. The rates and benefits displayed within are for discussion and estimation purposes only and is not a substitute for an insurance quote prepared by an insurance carrier. Final benefits and rates must be based on insurance carrier confirmation and final enrollment. City of Rancho Palos Verdes (2019) - Platinum Access HMO 20 Effective Date: 12-01-2018 Run Date: 09-18-2018 #6521801 Maniaci Insurance Services Maniaci Insurance Services License: 0600161 C-22 Side By Side Detail City of Rancho Palos Verdes (2019) - Platinum Access HMO 20 Prepared by Daniel Maniaci Rancho Palos Verdes, Los Angeles, 90275 Effective December 01, 2018 Health Net Aetna Full Network HMO Platinum $20 HMO Deductible Platinum CA $15/30 0 Ded Broad Network Narrow Network In Network Out of Network In Network Out of Network Individual Deductible $0 $0 Family Deductible $0 $0 Individual OOP Limit $3,000 $3,350 Family OOP Limit $6,000 $6,700 PC/Specialist $20/$40 $15/$30 Lab/X-Ray $10 $15/$30 Inpatient Hospital $700/admit $250/day days 1-5 Outpatient Facility $200/$500 (ASC/Hospital)$100 Emergency Room $150 (waived if admitted)$150 (waived if admitted) Urgent Care $40 $15 Rx Generic $5 $5 Rx Preferred $30 $15 EE's Included 8/59 8/59 EE Cost $4,944.53 $5,064.76 Dep Cost $7,310.94 $7,488.72 Total $12,255.47 $12,553.48 ER Total $4,944.53 $5,064.76 Increase (Change)$1,239.32 (11%)$1,537.33 (14%) Use of this site constitutes acceptance of HealthConnect's Terms of service and Privacy Policy. The rates and benefits displayed within are for discussion and estimation purposes only and is not a substitute for an insurance quote prepared by an insurance carrier. Final benefits and rates must be based on insurance carrier confirmation and final enrollment. City of Rancho Palos Verdes (2019) - Platinum Access HMO 20 Effective Date: 12-01-2018 Run Date: 09-18-2018 #6521801 Maniaci Insurance Services Maniaci Insurance Services License: 0600161 C-23 PPO Plan Details (Rates Based on a 12/1/18 Effective Date) C-24 Side By Side Detail City of Rancho Palos Verdes (2019) - Gold PPO 450 Prepared by Daniel Maniaci Rancho Palos Verdes, Los Angeles, 90275 Effective December 01, 2018 CURRENT PLAN RENEWAL PLAN Blue Shield Blue Shield Anthem Blue Cross Gold Full PPO 450/30 OffEx Gold Full PPO 450/30 OffEx Gold PPO 500/20%/6500 Broad Network Broad Network Broad Network In Network Out of Network In Network Out of Network In Network Out of Network Individual Deductible $450 $900 $450 $900 $500 $1,000 Family Deductible $900 $1,800 $900 $1,800 $1,500 (embedded) $2,000 (embedded) Individual OOP Limit $7,000 (incl ded) $10,000 (incl ded) $7,000 (incl ded) $10,000 (incl ded) $6,500 (incl ded) $13,000 (incl ded) Family OOP Limit $14,000 (incl ded) $20,000 (incl ded) $14,000 (incl ded) $20,000 (incl ded) $13,000 (incl ded) $26,000 (incl ded) PC/Specialist $30/$50 ded waived 40% after ded $30/$50 ded waived 40% after ded $30/$60 ded waived 50% after ded Lab/X-Ray 20% after ded 40% after ded; $350 benefit max/day Hospital 20% after ded 40% after ded; $350 benefit max/day Hospital 20% after ded 50% after ded Inpatient Hospital 20% after ded 40% after ded; $2,000 benefit max/day 20% after ded 40% after ded; $2,000 benefit max/day 20% after ded 50% after ded; $650 benefit max/day Outpatient Facility 20% after ded 40% after ded; $350 benefit max/day 20% after ded 40% after ded; $350 benefit max/day 20% after ded 50% after ded; $380 benefit max/admit Emergency Room $200 (waived if admitted) + 20% after ded $200 (waived if admitted) + 20% after ded $200 (waived if admitted) + 20% after ded $200 (waived if admitted) + 20% after ded $250 + 20% after ded Paid as in-network Urgent Care $30 ded waived 40% after ded $30 ded waived 40% after ded $60 ded waived 50% after ded Rx Generic $15 ded waived Not covered $15 ded waived Not covered $5/$20 ded waived Not covered Rx Preferred $40 ded waived Not covered $40 ded waived Not covered $40 after $250 Not covered EE's Included 4/59 4/59 4/59 EE Cost $2,281.97 $2,415.02 $2,387.87 Dep Cost $0.00 $0.00 $0.00 Total $2,281.97 $2,415.02 $2,387.87 ER Total $2,281.97 $2,415.02 $2,387.87 Increase (Change)$133.05 (6%)$105.90 (5%) Use of this site constitutes acceptance of HealthConnect's Terms of service and Privacy Policy. The rates and benefits displayed within are for discussion and estimation purposes only and is not a substitute for an insurance quote prepared by an insurance carrier. Final benefits and rates must be based on insurance carrier confirmation and final enrollment. City of Rancho Palos Verdes (2019) - Gold PPO 450 Effective Date: 12-01-2018 Run Date: 09-18-2018 #6521837 Maniaci Insurance Services Maniaci Insurance Services License: 0600161 C-25 Side By Side Detail City of Rancho Palos Verdes (2019) - Gold PPO 450 Prepared by Daniel Maniaci Rancho Palos Verdes, Los Angeles, 90275 Effective December 01, 2018 Health Net UnitedHealthcare Aetna Gold 80 Value PPO 750/10 + Child Dental Alt Select Plus Gold 25/500/20% (AU-S5) OA Managed Choice POS Gold CA 80/50 750 Ded Broad Network Broad Network Broad Network In Network Out of Network In Network Out of Network In Network Out of Network Individual Deductible $750 $2,250 $500 $1,000 $750 $1,500 Family Deductible $1,500 $4,500 $1,000 $2,000 $1,500 (embedded) $3,000 (embedded) Individual OOP Limit $7,150 (incl ded) $14,300 (incl ded) $6,000 (incl ded) $12,000 (incl ded) $6,500 (incl ded) $13,000 (incl ded) Family OOP Limit $14,300 (incl ded) $28,600 (incl ded) $12,000 (incl ded) $24,000 (incl ded) $13,000 (incl ded) $26,000 (incl ded) PC/Specialist $10 ded waived/$30 after ded 50% after ded $25/$50 ded waived 50% after ded $20/$50 ded waived 50% after ded Lab/X-Ray $20 after ded 50% after ded $250 + 20% after ded $250 + 50% after ded $25/20% ded waived 50% after ded Inpatient Hospital 30% after ded 50% after ded $250/admit + 20% after ded $250/admit + 50% after ded 20% after ded 50% after ded Outpatient Facility 20%/30% after ded (ASC/Hospital) 50% after ded $250 + 20% after ded $250 + 50% after ded Hosp-30% after ded; FS-20% after ded 50% after ded Emergency Room $250 after ded $250 after ded $150 ded waived Paid as in-network 20% after ded Paid as In-Network Urgent Care $30 after ded 50% after ded $75 ded waived 50% after ded $50 ded waived Paid as In-Network Rx Generic $10 ded waived Not covered $15 ded waived $15 ded waived $15 ded waived Not covered Rx Preferred $25 after ded Not covered $35 ded waived $35 ded waived $55 after $300 Not covered EE's Included 4/59 4/59 4/59 EE Cost $2,392.59 $2,490.41 $3,598.94 Dep Cost $0.00 $0.00 $0.00 Total $2,392.59 $2,490.41 $3,598.94 ER Total $2,392.59 $2,490.41 $3,598.94 Increase (Change)$110.62 (5%)$208.44 (9%)$1,316.97 (58%) Use of this site constitutes acceptance of HealthConnect's Terms of service and Privacy Policy. The rates and benefits displayed within are for discussion and estimation purposes only and is not a substitute for an insurance quote prepared by an insurance carrier. Final benefits and rates must be based on insurance carrier confirmation and final enrollment. City of Rancho Palos Verdes (2019) - Gold PPO 450 Effective Date: 12-01-2018 Run Date: 09-18-2018 #6521837 Maniaci Insurance Services Maniaci Insurance Services License: 0600161 C-26 HSA Plan Details (Rates Based on a 12/1/18 Effective Date) C-27 Side By Side Detail City of Rancho Palos Verdes (2019) - Silver HSA 2000 Prepared by Daniel Maniaci Rancho Palos Verdes, Los Angeles, 90275 Effective December 01, 2018 CURRENT PLAN RENEWAL PLAN Blue Shield Blue Shield Kaiser Silver Full PPO Savings 2000/20% OffEx Silver Full PPO Savings 2000/20% OffEx Silver 70 HDHP HMO 2000/20% + Child Dental Broad Network Broad Network Broad Network In Network Out of Network In Network Out of Network In Network Out of Network Individual Deductible $2,000 ind only; $2,700 ind w/family $4,000 $2,000 ind only; $2,700 ind w/family $4,000 $2000 ind only; $2,700 ind w/family Family Deductible $4,000 (embedded)$8,000 $4,000 (embedded)$8,000 $4,000 (embedded) Individual OOP Limit $5,550 (incl ded) $10,000 (incl ded) $5,550 (incl ded) $10,000 (incl ded) $6,550 (incl ded) Family OOP Limit $6,500 (incl ded) $20,000 (incl ded) $6,500 (incl ded) $20,000 (incl ded) $13,100 (incl ded) PC/Specialist 20% after ded 50% after ded 20% after ded 50% after ded 20% after ded Lab/X-Ray 20% after ded 50% after ded; $350 benefit max/day Hospital 20% after ded 50% after ded; $350 benefit max/day Hospital 20% after ded Inpatient Hospital 20% after ded 50% after ded; $2,000 benefit max/day 20% after ded 50% after ded; $2,000 benefit max/day 20% after ded Outpatient Facility 20% after ded 50% after ded; $350 benefit max/day 20% after ded 50% after ded; $350 benefit max/day 20% after ded Emergency Room $150 (waived if admitted) + 20% after ded $150 (waived if admitted) + 20% after ded $150 (waived if admitted) + 20% after ded $150 (waived if admitted) + 20% after ded 20% after ded Urgent Care 20% after ded 50% after ded 20% after ded 50% after ded 20% after ded Rx Generic $15 after ded Not covered $15 after ded Not covered 20% after ded; $250 max/script Rx Preferred $50 after ded Not covered $50 after ded Not covered 20% after ded; $250 max/script EE's Included 47/59 47/59 46/59 EE Cost $31,227.77 $32,992.86 $20,722.36 Dep Cost $18,731.54 $19,808.86 $12,088.77 Total $49,959.31 $52,801.72 $32,811.13 ER Total $31,227.77 $32,992.86 $20,722.36 Increase (Change)$2,842.41 (6%)($17,148.18) (-34%) Use of this site constitutes acceptance of HealthConnect's Terms of service and Privacy Policy. The rates and benefits displayed within are for discussion and estimation purposes only and is not a substitute for an insurance quote prepared by an insurance carrier. Final benefits and rates must be based on insurance carrier confirmation and final enrollment. City of Rancho Palos Verdes (2019) - Silver HSA 2000 Effective Date: 12-01-2018 Run Date: 09-18-2018 #6521888 Maniaci Insurance Services Maniaci Insurance Services License: 0600161 C-28 Side By Side Detail City of Rancho Palos Verdes (2019) - Silver HSA 2000 Prepared by Daniel Maniaci Rancho Palos Verdes, Los Angeles, 90275 Effective December 01, 2018 Blue Shield Health Net Anthem Blue Cross Silver Full PPO 2000/45 OffEx Silver 70 HDHP 1350/40 PPO + Child Dental Alt Silver PPO 2000/20%/6000 w/HSA - RxC Broad Network Broad Network Broad Network In Network Out of Network In Network Out of Network In Network Out of Network Individual Deductible $2,000 $4,000 $1,350 $2,700 $2,000 ind only; $2,700 ind w/family $4,000 ind only; $5,400 ind w/family Family Deductible $4,000 $8,000 $2,700 $5,400 $4,000 (embedded) $10,800 (embedded) Individual OOP Limit $7,000 (incl ded) $10,000 (incl ded) $6,550 (incl ded) $13,100 (incl ded) $6,000 (incl ded) $12,000 (incl ded) Family OOP Limit $14,000 (incl ded) $20,000 (incl ded) $13,100 (incl ded) $26,200 (incl ded) $12,000 (incl ded) $24,000 (incl ded) PC/Specialist $45/$60 ded waived 50% after ded $40/$60 after ded 50% after ded 20% after ded 50% after ded Lab/X-Ray 40% after ded 50% after ded; $350 benefit max/day Hospital 30% after ded 50% after ded 20% after ded 50% after ded Inpatient Hospital 40% after ded 50% after ded; $2,000 benefit max/day 30% after ded 50% after ded 20% after ded 50% after ded; $650 benefit max/day Outpatient Facility 40% after ded 50% after ded; $350 benefit max/day 20%/30% after ded (ASC/Hospital) 50% after ded 20% after ded 50% after ded; $380 benefit max/admit Emergency Room $250 (waived if admitted) + 40% after ded $250 (waived if admitted) + 40% after ded 30% after ded 30% after ded 20% after ded Paid as in-network Urgent Care $45 ded waived 50% after ded $60 after ded 50% after ded 20% after ded 50% after ded Rx Generic $15 after ded Not covered $19 after ded Not covered $5/$20 after ded Not covered Rx Preferred $55 after ded Not covered $40 after ded Not covered $40 after ded Not covered EE's Included 47/59 47/59 47/59 EE Cost $29,672.04 $31,598.97 $32,150.27 Dep Cost $17,815.12 $18,971.98 $19,302.95 Total $47,487.16 $50,570.95 $51,453.22 ER Total $29,672.04 $31,598.97 $32,150.27 Increase (Change)($2,472.15) (-5%)$611.64 (1%)$1,493.91 (3%) Use of this site constitutes acceptance of HealthConnect's Terms of service and Privacy Policy. The rates and benefits displayed within are for discussion and estimation purposes only and is not a substitute for an insurance quote prepared by an insurance carrier. Final benefits and rates must be based on insurance carrier confirmation and final enrollment. City of Rancho Palos Verdes (2019) - Silver HSA 2000 Effective Date: 12-01-2018 Run Date: 09-18-2018 #6521888 Maniaci Insurance Services Maniaci Insurance Services License: 0600161 C-29 Side By Side Detail City of Rancho Palos Verdes (2019) - Silver HSA 2000 Prepared by Daniel Maniaci Rancho Palos Verdes, Los Angeles, 90275 Effective December 01, 2018 UnitedHealthcare Aetna Select Plus HSA Silver 2000/20% (AX-FK) OA Managed Choice POS Bronze HDHP CA 100/50 6550 Ded HSA Broad Network Broad Network In Network Out of Network In Network Out of Network Individual Deductible $2,000 ind only; $2,700 ind w/family $13,000 $6,550 $13,100 Family Deductible $2,700 $26,000 $13,100 (embedded) $26,200 (embedded) Individual OOP Limit $6,500 (incl ded) $26,000 (incl ded) $6,550 (incl ded) $14,500 (incl ded) Family OOP Limit $13,000 (incl ded) $52,000 (incl ded) $13,100 (incl ded) $29,000 (incl ded) PC/Specialist 20% after ded 50% after ded 0% after ded 50% after ded Lab/X-Ray 20% after ded 50% after ded 0% after ded 50% after ded Inpatient Hospital 20% after ded 50% after ded 0% after ded 50% after ded Outpatient Facility 20% after ded 50% after ded 0% after ded 50% after ded Emergency Room 20% after ded Paid as in-network 0% after ded Paid as In-Network Urgent Care 20% after ded 50% after ded 0% after ded Paid as In-Network Rx Generic $20 after ded $20 after ded 0% after ded Not covered Rx Preferred $50 after ded $50 after ded 0% after ded Not covered EE's Included 47/59 47/59 EE Cost $33,255.17 $36,103.81 Dep Cost $19,966.35 $21,677.65 Total $53,221.52 $57,781.46 ER Total $33,255.17 $36,103.81 Increase (Change)$3,262.21 (7%)$7,822.15 (16%) Use of this site constitutes acceptance of HealthConnect's Terms of service and Privacy Policy. The rates and benefits displayed within are for discussion and estimation purposes only and is not a substitute for an insurance quote prepared by an insurance carrier. Final benefits and rates must be based on insurance carrier confirmation and final enrollment. City of Rancho Palos Verdes (2019) - Silver HSA 2000 Effective Date: 12-01-2018 Run Date: 09-18-2018 #6521888 Maniaci Insurance Services Maniaci Insurance Services License: 0600161 C-30 Dental Plans C-31 HMO BENEFITS E N R O L L E D PRINCIPAL CA Dental Network Advantage Plan 75 (Current) PRINCIPAL CA Dental Network Advantage Plan 75 (Renewal) PRINCIPAL CA Dental Network Advantage Plan 75 w/ Implants (Option 1) DELTA DENTAL HMO Plan 10A (Option 2) Deductible None None Maximum Benefit Unlimited Unlimited Copays: Preventive Services: Cleaning No Charge No Charge Office Visits No Charge No Charge X-Rays No Charge No Charge Basic Services: Fillings - Amalgam No Charge (Up to four or more services) No Charge (Up to four or more surfaces) Oral Surgery No Charge $0 - $70 Major Services: Crowns $175 - $225 per crown $135 - $195 per crown Dentures $90 per denture $100 per denture Implants Covered Not Covered Orthodontia: Children $1,775 $1,700 Adults $1,975 $1,900 Rate Guarantee -1 Year Negotiated Rate Pass 1 Year 1 Year MONTHLY RATES 0.00%4.38%44.03% Employee 7 $ 14.44 $ 14.44 $ 15.19 $ 21.77 Additional +1 Dependent 0 $ 10.00 $ 10.00 $ 10.50 $ 14.15 Additional + 2 or more Dependents 3 $ 23.34 $ 23.34 $ 24.09 $ 31.35 Employee Monthly Total $ 101.08 $ 101.08 $ 106.33 $ 152.39 Additional + 1 Dependent Monthly Total $ - $ - $ - $ - Additional + 2 or more Dependents Mthly Ttl $ 70.02 $ 70.02 $ 72.27 $ 94.05 MONTHLY TOTAL PREMIUM:171.10$ 171.10$ 178.60$ 246.44$ ANNUAL TOTAL PREMIUM:2,053.20$ 2,053.20$ 2,143.20$ 2,957.28$ No Charge No Charge No Charge (Up to four or more services) No Charge None Unlimited No Charge The benefits shown here are only a summary and intended only for comparison purposes. Specific limitations and restrictions ARE NOT COVERED in this report. Refer to certificate for full benefit descriptions and limitations. Rates subject to change based on total enrollment and final group underwriting approval. Optional Rider premiums are NOT included in the premium totals on this report. $175 - $225 per crown $90 per denture Not Covered $1,775 $1,975 CITY OF RANCHO PALOS VERDES DENTAL DMO PLAN (EFFECTIVE 1/1/2019) MANIACI INSURANCE SERVICES, INC.LIC. 0600161 C-32 PPO BENEFITS E N R O L L E D PRINCIPAL POS Plan (Current) PRINCIPAL POS Plan (Renewal) 1 Year Negotiated Rate Pass PRINCIPAL POS Plan (Option 1) DELTA DENTAL Classic PPO Premier Enhanced Plan w/ D&P Waiver2 (Option 2) Deductible:EPO / PPO / OON In Network / Out of Network Individual $25 / $25 / $25 $25 / $50 Period Calendar Year Calendar Year Maximum Family Limit 3x Per Member Waived for Preventive (EPO & PPO Only)Preventive Coinsurance: Preventive Services 0% / 0% / 0%0% / 0% Basic Services:20% / 20% / 20%20% / 20% Endodontics 20% / 20% / 20%20% / 20% Periodontics 20% / 20% / 20%20% / 20% Periodontal Surgery 20% / 20% / 20%20% / 20% Major Services:50% / 50% / 50%60% / 50% Implants 50% / 50% / 50%60% / 50% Waiting Period None None Plan Maximum $2,500 1 / $2,500 1 / $2,500 1 $2,000 / $2,000 Orthodontia Not Covered Not Covered UCR 80th Percentile 51st Percentile MONTHLY RATES 0.00%5.24%22.92% Employee 58 $ 56.34 $ 56.34 $ 59.29 $ 66.50 Additional +1 Dependent 16 $ 49.28 $ 49.28 $ 51.86 $ 64.48 Additional +2 or more Dependents 17 $ 103.69 $ 103.69 $ 109.12 $ 133.17 Employee Monthly Total $ 3,267.72 $ 3,267.72 $ 3,438.82 $ 3,857.00 Additional +1 Dependent Monthly Total $ 788.48 $ 788.48 $ 829.76 $ 1,031.68 Additional +2 or more Dep Mthly Ttl $ 1,762.73 $ 1,762.73 $ 1,855.04 $ 2,263.89 MONTHLY TOTAL PREMIUM:5,818.93$ 5,818.93$ 6,123.62$ 7,152.57$ ANNUAL TOTAL PREMIUM:69,827.16$ 69,827.16$ 73,483.44$ 85,830.84$ 80th Percentile $2,000 1 / $1,500 1 / $1,500 1 Not Covered The benefits shown here are only a summary and intended only for comparison purposes. Specific limitations and restrictions ARE NOT COVERED in this report. Refer to certificate for full benefit descriptions and limitations. Rates subject to change based on total enrollment and final group underwriting approval. Optional Rider premiums are NOT included in the premium totals on this report. 1. Includes Maximum Accumulation Feature 2. D&P Waiver feature waives Diagnostic and Preventive services to accumulate towards the annual plan maximum. EPO / PPO / OON $25 / $25 / $25 Calendar Year 3x Preventive (EPO & PPO Only) 0% / 0% / 0% 20% / 20% / 20% 20% / 20% / 20% 20% / 20% / 20% 20% / 20% / 20% 50% / 50% / 50% 50% / 50% / 50% None CITY OF RANCHO PALOS VERDES DENTAL PPO PLAN (EFFECTIVE 1/1/2019) MANIACI INSURANCE SERVICES, INC.LIC. 0600161 C-33 Vision Plans C-34 VISION BENEFITS E N R O L L E D MES VISION (Current) MES VISION (Renewal) Pending MES VISION (Option 1) VSP DIRECT (Option 2) Deductible - Exam / Materials: $0 copay (1st pair) $20 copay (2nd pair) $0 copay (1st pair) $20 copay (2nd pair) Eye Exam: Maximum Allowable Cost 100% / $40 100% / $50 Frequency Once every 12 Months Once every 12 Months Standard Lenses:** Maximum Allowable Cost 100%*** / $30 - $65 100%*** / $50 - $100 Frequency 2 pairs every 12 Months 2 Pairs every 12 Months Frames:** Maximum Allowable Cost Up to $150*** / $75 Up to $130*** / $70 Frequency 2 frames every 12 Months 2 frames every 12 Months Contact Lenses:** Maximum Allowable Cost Up to $150*** / $150 (Allowance includes cost of fitting & evaluation) Up to $130*** / $105 (Allowance does not include cost of fitting & evaluation) Frequency Twice every 12 Months Twice every 12 Months Rate Guarantee -4 Year Negotiated Rate Pass 4 Years 4 Years MONTHLY RATES 0.00%5.29%60.78% Employee 68 16.75$ 16.75$ 18.43$ 28.58$ Additional 1 Dependent 17 13.40$ 13.40$ 14.74$ 15.82$ Additional Family 21 26.47$ 26.47$ 24.79$ 41.85$ Employee Monthly Total $ 1,139.00 $ 1,139.00 $ 1,253.24 $ 1,943.44 Additional 1 Dependent Monthly Total $ 227.80 $ 227.80 $ 250.58 $ 268.94 Additional Family Monthly Total $ 555.87 $ 555.87 $ 520.59 $ 878.85 MONTHLY TOTAL PREMIUM: $ 1,922.67 $ 1,922.67 2,024.41$ 3,091.23$ ANNUAL TOTAL PREMIUM: $ 23,072.04 $ 23,072.04 $ 24,292.92 $ 37,094.76 The benefits shown here are only a summary and intended only for comparison purposes. Specific limitations and restrictions ARE NOT COVERED in this report. Refer to certificate for full benefit descriptions and limitations. Rates subject to change based on total enrollment and final group underwriting approval. Optional Rider premiums are NOT included in the premium totals on this report. $0 copay (1st pair) $20 copay (2nd pair) 100% / $40 Once every 12 Months 2 frames every 12 Months Up to $130*** / $130 (Allowance includes cost of fitting & evaluation) Twice every 12 Months 100%*** / $30 - $65 2 pairs every 12 Months Up to $130*** / $75 ** In lieu of other eyewear *** 2nd pair of glasses or contact lenses in a 12 month period at same dollar allowance as the first pair with a $20 deductible for the 2nd pair. CITY OF RANCHO PALOS VERDES VISION PLAN (EFFECTIVE 1/1/2019) MANIACI INSURANCE SERVICES, INC.LIC. 0600161 C-35 VISION BENEFITS E N R O L L E D EYEMED (Option 3) EYEMED (Option 4) Deductible - Exam / Materials:$0 / $0 $0 / $0 Eye Exam: Maximum Allowable Cost 100% / $40 100% / $40 Frequency Once every 12 Months Once every 12 Months Standard Lenses:*** Maximum Allowable Cost 100% / $30 - $70 100% / $30 - $70 Frequency 1 pair every 12 Months 1 pair every 12 Months Frames:** Maximum Allowable Cost Up to $130 / $91 Up to $150 / $105 Frequency One frame every 12 Months One frame every 12 Months Contact Lenses:** Maximum Allowable Cost Up to $130 / $130 (Allowance does not include cost of fitting & evaluation) Up to $150 / $150 (Allowance does not include cost of fitting & evaluation) Frequency Once every 12 Months Once every 12 Months Rate Guarantee 4 Years 4 Years MONTHLY RATES -39.94%-35.78%-100.00%-100.00% Employee 68 9.55$ 10.22$ -$ -$ Additional 1 Dependent 17 8.60$ 9.18$ -$ -$ Additional Family 21 17.10$ 18.27$ -$ -$ Employee Monthly Total $ 649.40 $ 694.96 $ - $ - Additional 1 Dependent Monthly Total $ 146.20 $ 156.06 $ - $ - Additional Family Monthly Total $ 359.10 $ 383.67 $ - $ - MONTHLY TOTAL PREMIUM: $ 1,154.70 $ 1,234.69 -$ -$ ANNUAL TOTAL PREMIUM: $ 13,856.40 $ 14,816.28 $ - $ - The benefits shown here are only a summary and intended only for comparison purposes. Specific limitations and restrictions ARE NOT COVERED in this report. Refer to certificate for full benefit descriptions and limitations. Rates subject to change based on total enrollment and final group underwriting approval. Optional Rider premiums are NOT included in the premium totals on this report. ** Frames and Contacts Allowance can be utilized in the same benefit year *** In lieu of contact lenses CITY OF RANCHO PALOS VERDES VISION PLAN (EFFECTIVE 1/1/2019) MANIACI INSURANCE SERVICES, INC.LIC. 0600161 C-36 Life & AD&D Plans C-37 LIFE & AD&D BENEFITS V O L U M E PRINCIPAL (Current) PRINCIPAL (Renewal) Maximum Benefit* Benefit Schedule Class 1: All Others Class 2: Council Members Guarantee Issue* Spouse Maximum Benefit Dependent Maximum Benefit MONTHLY RATES 4.26% Employee Life $11,885,948 $ 0.159 $ 0.168 $ 0.145 Employee AD&D (not available for Council Members and dependents)$11,836,048 $ 0.046 $ 0.046 $ 0.046 Dependent Units 42 $ 1.35 $ 1.35 $1.35 Employee Life Monthly Total $ 1,890.64 $ 1,996.84 $ 1,723.46 Employee AD&D Monthly Total $ 544.46 $ 544.46 $ 544.46 Dependent Monthly Total $ 56.70 $ 56.70 $ 56.70 MONTHLY TOTAL:2,491.80$ 2,598.00$ 2,324.62$ ANNUAL TOTAL:29,901.56$ 31,175.97$ 2,925.78$ $350,000 2 x Annual Salary up to $350,000 $50,000 (Life Only) $300,000 $5,000 * Age Reduction Schedule Applies The benefits shown here are only a summary and intended only for comparison purposes. Specific limitations and restrictions ARE NOT COVERED in this report. Refer to certificate for full benefit descriptions and limitations. Rates subject to change based on total enrollment and final group underwriting approval. Optional Rider premiums are NOT included in the premium totals on this report. $2,000 CITY OF RANCHO PALOS VERDES LIFE & AD&D PLAN (EFFECTIVE 1/1/2019) MANIACI INSURANCE SERVICES, INC.LIC. 0600161 C-38 Long Term Disability Plans C-39 LTD BENEFITS V O L U M E PRINCIPAL (Current) PRINCIPAL (Renewal) PRINCIPAL (Negotiated Renewal) PRINCIPAL (Option) Maximum Benefit1 Monthly $10,000 $10,000 Benefit Percentage 66 2/3%66 2/3% Elimination Period 90 Days 365 Days Benefit Period SSNRA SSNRA Own Occupation 24 Months 24 Months Pre-existing Clause 3/12 3/12 Return to Work Yes Yes Premium Waiver Yes Yes Survivorship Yes Yes Taxable Benefit Yes Yes EAP Program Premier EAP Plan Core EAP Plan Rate Guarantee -1 Year Negotiated Rate Pass 1 Year Negotiated Rate Pass 1 Year MONTHLY RATES 0.00%0.00%-21.05% Employee Long Term Disability $421,766 $ 0.570 $ 0.570 $ 0.570 $ 0.450 Employee Monthly Total $ 2,404.07 $ 2,404.07 $ 2,404.07 $ 1,897.95 MONTHLY TOTAL:2,404.07$ 2,404.07$ 2,404.07$ 1,897.95$ ANNUAL TOTAL:28,848.79$ 28,848.79$ 28,848.79$ 22,775.36$ $10,000 66 2/3% 90 Days SSNRA 24 Months 1. Council members are not eligible. The benefits shown here are only a summary and intended only for comparison purposes. Specific limitations and restrictions ARE NOT COVERED in this report. Refer to certificate for full benefit descriptions and limitations. Rates subject to change based on total enrollment and final group underwriting approval. Optional Rider premiums are NOT included in the premium totals on this report. 3/12 Yes Yes Yes Yes Core EAP Plan CITY OF RANCHO PALOS VERDES LONG TERM DISABILITY PLAN (EFFECTIVE 1/1/2019) MANIACI INSURANCE SERVICES, INC.LIC. 0600161 C-40 Voluntary Life & AD&D Plans C-41 Minimum Group Size Employee Maximum Benefit* Guarantee Issue* Minimum Benefit Increments Accidental Death & Dismemberment Spouse*** Maximum Benefit* Guarantee Issue* Minimum Benefit Increments Dependent (Life only) Maximum Benefit Guarantee Issue Minimum Benefit Increments Rate Guarantee MONTHLY RATES Per $1,000 of Coverage Employee Spouse (SP rate based on SP age)Employee Spouse (SP rate based on SP age) Thru age 29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69** 70 & over** Dependent Rates AD&D - Employee / Spouse AD&D - Children Included in Life RateIncluded in Life Rate Included in Life Rate $0.241 $0.357 $0.548 $0.895 $1.363 PRINCIPAL (Current) PRINCIPAL (Renewal) Requires 25% of eligible group Requires 25% of eligible group $0.122 The benefits shown here are only a summary and intended only for comparison purposes. Specific limitations and restrictions ARE NOT COVERED in this report. Refer to certificate for full benefit descriptions and limitations. Rates subject to change based on total enrollment and final group underwriting approval. Optional Rider premiums are NOT included in the premium totals on this report. -1 Year Negotiated Rate Pass $0.122 $4.952 $0.50 / $2,500 in coverage or $1.00 / $5,000 in coverage $0.140 $0.180 $2.483 PRINCIPAL $300,000 $100,000 up to age 70 $10,000 $10,000 Yes * Council Members are not eligible for voluntary life ** Age Reduction Schedule Applies $4.952 $0.50 / $2,500 in coverage or $1.00 / $5,000 in coverage Included in Life Rate $0.140 $0.180 $0.241 $0.357 $0.548 $0.895 $1.363 $2.483 PRINCIPAL $2,500 $2,500 or $5,000 $100,000 not to exceed 50% of employee's coverage $25,000 up to age 70 $5,000 $5,000 $5,000 not to exceed 50% of employee's coverage $5,000 CITY OF RANCHO PALOS VERDES VOLUNTARY LIFE INSURANCE PLAN (EFFECTIVE 1/1/2019) This proposal is presented by Maniaci Insurance Services, Inc. License # 0600161 C-42 Employee Assistance Program Plan Details C-43 EAP BENEFITS E N R O L L E D THE HOLMAN GROUP (Current) PRINCIPAL1 (Option 1) Included in Principal's LTD Policy at No Additional Cost MAGELLAN HEALTH (Option 2) COMPSYCH3 (Option 3) Frequency (# of visits per incident)Up to 3 Up to 3 Up to 3 Up to 3 Type Face-to-Face Face-to-Face2 Face-to-Face2 Face-to-Face Copayment $0 $0 $0 $0 Worklife Service Hours of Operation 24 hours, 7 days a week Phone or Online 24 hours, 7 days a week Phone or Online 24 hours, 7 days a week Phone or Online 24 hours, 7 days a week Phone or Online Type Face-to Face, Telephone or Online Face-to Face, Telephone or Online Face-to Face, Telephone or Online Face-to Face, Telephone or Online Additional Worklife Services Available (additional fees may apply) Available (additional fees may apply) Available (additional fees may apply) Available (additional fees may apply) Copayment $0 $0 $0 $0 Legal or Financial Topics Initial 30-minute telephone consultation, 25% discount for future legal services beyond initial consultation Free 60-minute consultation plus online tools and resources * Two free 30-minute telephone consultations w/ financial coach * Free 60-minute attorney consultation Initial 30-minute telephone consultation, 25% discount off if in- person representation Onsite Professional Training Seminars 1 free hour - Optional seminars at an additional cost Optional seminars at an additional cost 10 hours of employee/supervisor orientations or training are available annually; additional hours are fee for service Optional seminars at an additional cost Well Being Feature TriWellness Feature Included Included Included HealthyGuidance Telephonic Coaching Program Included Rate Guarantee In the Middle of a Rate Guarantee; Renews on 1/1/2020 N/A 3 Years 5 Years MONTHLY RATES Included in Principal's LTD Policy at No Additional Cost 11.03%83.72% Employee 61 $ 1.45 $ - $ 1.61 $ 2.66 EMPLOYEE MONTHLY TOTAL: $ 88.45 $ - $ 98.21 $ 162.50 MONTHLY TOTAL:88.45$ -$ 98.21$ 162.50$ ANNUAL TOTAL:1,061.40$ -$ 1,178.52$ 1,950.00$ The benefits shown here are only a summary and intended only for comparison purposes. Specific limitations and restrictions ARE NOT COVERED in this report. Refer to certificate for full benefit descriptions and limitations. Rates subject to change based on total enrollment and final group underwriting approval. Optional Rider premiums are NOT included in the premium totals on this report. 1. Principal's EAP is provided by Magellan Health. 2. Magellan Health face-to-face visits cannot be combined with Principal's face-to-face visits. Members can access 3 face-to-face visits only with Magellan Health or Principal. 3. Compsych requires a 3-year minimum contract agreenment. CITY OF RANCHO PALOS VERDES EMPLOYEE ASSISTANCE PROGRAMS (EFFECTIVE 1/1/2019) MANIACI INSURANCE SERVICES, INC.LIC. 0600161 C-44 EAP BENEFITS E N R O L L E D ESPYR (Option 4) HEALTH ADVOCATE (Option 5) Frequency (# of visits per incident)Up to 3 Up to 3 Type Face-to-Face Face-to-Face Copayment $0 $0 Worklife Service Hours of Operation 24 hours, 7 days a week Phone or Online 24 hours, 7 days a week Phone or Online Type Face-to Face, Telephone or Online Face-to Face, Telephone or Online Additional Worklife Services Available (additional fees may apply) Available (additional fees may apply) Copayment $0 $0 Legal or Financial Topics Unlimited consultations up to 30 minutes per unique issuer per year Free 30-minute consultation with a legal specialist; access to discounted legal services Onsite Professional Training Seminars $300 per hour for onsite training sessions Optional seminars at an additional cost Well Being Feature Included Not Included (Separate Wellness policy available) Rate Guarantee 3 Years 3 Years MONTHLY RATES 352.23%-17.24%-59.38%-75.45% Employee 61 $ - $ 1.20 $ 2.66 $ 1.61 EMPLOYEE MONTHLY TOTAL:$400.00 1 $ 73.20 $ 162.50 $ 98.21 MONTHLY TOTAL:400.00$ 73.20$ 162.50$ 98.21$ ANNUAL TOTAL:4,800.00$ 878.40$ 1,950.00$ 1,178.52$ The benefits shown here are only a summary and intended only for comparison purposes. Specific limitations and restrictions ARE NOT COVERED in this report. Refer to certificate for full benefit descriptions and limitations. Rates subject to change based on total enrollment and final group underwriting approval. Optional Rider premiums are NOT included in the premium totals on this report. 1. Espyr charges a monthly fee of $400. CITY OF RANCHO PALOS VERDES EMPLOYEE ASSISTANCE PROGRAMS (EFFECTIVE 1/1/2019) MANIACI INSURANCE SERVICES, INC.LIC. 0600161 C-45 Legal Services Plan Details C-46 LEGAL SERVICES BENEFITS LEGAL ACCESS PLANS, LLC (Current) Telephone Legal Services General Consultation/Advice Small Claims Standard Will Preparation Document Review In-Office Legal Services Trial Defense Services (Civil Lawsuits) Trial Defense Services (Criminal Lawsuits) Uncontested Court Adoption Uncontested Divorce Wills with Minor Trust Tenant Protection IRS Audit Protection/Collection Defense DUI Representation (1st Offense) MVA Hearing District Court Apprearance Motor Vehicle Legal Expense Services Reduced Hourly Rate Other covered matters Other Value-Added Services Online Legal Resources Financial and Tax Planning Services Personal Financial Counseling Interactive Financial Website Identity Theft Services Identity Theft Victim Action Kit Geriatric Care Specialist MONTHLY COST PER: Employee/Family: Legal Services Only 12.00$ $170.00 25% discount off attorney's normal hourly rate (tenant only) The benefits shown here are only a summary and intended only for comparison purposes. Specific limitations and restrictions ARE NOT COVERED in this report. Refer to certificate for full benefit descriptions and limitations. Rates subject to change based on total enrollment and final group underwriting approval. Optional Rider premiums are NOT included in the premium totals on this report. 0.00% 12.00$ No Fee Consultations in-person or by telephone 25% Discount No Fee 25% Discount 25% Discount Not Covered 25% Discount off attorney's normal hourly rate $210.00 Not Covered Yes Yes Yes Yes LEGAL ACCESS PLANS, LLC (Renewal) 1 Year Negotiated Rate Pass $89.00 25% minimum discount Yes Yes Yes 25% discount off attorney's normal hourly rate Not Covered CITY OF RANCHO PALOS VERDES VOLUNTARY LEGAL SERVICES PLAN (EFFECTIVE 1/1/2019) MANIACI INSURANCE SERVICES, INC.LIC. 0600161 C-47 Voluntary Pet Insurance Plan Details C-48 PET INSURANCE BENEFITS My Pet Protection My Pet Protection with Wellness Avian & Exotic Annual Deductibles $50 per incident Reimbursement Level Benefit schedule Annual Maximum $7,000 Lifetime Maximum No Enrollment Age No age limitation No age limitation No age limitation Routine Care No Yes Available on Avian Wellness rider Chronic Conditions Yes if listed on Benefit Schedule Annual Holistic Coverage Yes if listed on Benefit Schedule Annual Wellness Coverage No Yes Available on Avian Wellness rider Vet Helpline Yes Parasites Available on Avian Wellness rider Diagnostic Testing Yes Accident Yes Illness Yes Hospitalization Yes Spay / Neuter No Yes No Elective & Preventive Procedures (ear crop, tail dock, declaw, etc.) No for elective; No for Preventive Yes No Cancer Coverage Yes Pre-Existing Conditions No Hereditary Disease No Pets covered Avian & Exotic Exclusions Exclusively Offered to Employer Groups Only No Monthly Rates: The benefits shown here are only a summary and intended only for comparison purposes. Specific limitations and restrictions ARE NOT COVERED in this report. Refer to certificate for full benefit descriptions and limitations. Rates subject to change based on total enrollment and final group underwriting approval. Optional Rider premiums are NOT included in the premium totals on this report. RATES ARE DETERMINED BY THE SPECIES AND STATE OF RESIDENCE Pre-existing, breeding, grooming, boarding, tax, medical waste and non-veterinary services. $250 90% Yes Yes No NATIONWIDE PET INSURANCE (Plan Options) $7,500 No Yes Yes Yes Yes Dogs and Cats Yes Yes Yes Yes Yes CITY OF RANCHO PALOS VERDES VOLUNTARY PET INSURANCE PLAN (EFFECTIVE 1/1/2019) MANIACI INSURANCE SERVICES, INC.LIC. 0600161 C-49 Notations C-50 Rates Final premium rates may vary if actual enrollment demographics vary by more than 5%. Additionally, premium rates quoted are subject to change if the insurance carrier has not received approval for the 2019 plan designs or completed the premium rate review process by the DHMC and DOI. Renewal Letter Please review your renewal letter for rate and contract / language changes. Please distribute any plan modification/change and renewal notices to applicable enrolled employees. Any insurance company's letters or documents received will take precedence over the material presented. Generic vs Brand When the physician or member requests a brand-name drug and a generic drug equivalent is available, the member is responsible for paying the difference between the cost to the carrier of the brand-name drug and its generic drug equivalent, as well as the applicable formulary generic drug copayment. When a drug deductible applies, the deductible must be satisfied first. The drug formulary can be changed at any time by the carrier. The provider network is not part of your contract and can be changed by the carrier at any time. Optional Plan Riders Within 30 days of your renewal, some carriers offer the option to add the following riders to your plan with additional cost: * Infertility Benefits * Chiropractic Benefits Time Frame Any changes to your current plan design must be made within 30 days of the renewal date. Preventive Care Specific frequencies apply for adult preventive care.Preventive Care guidelines are established as prescribed by the American Medical Association.Please refer to your plan summary for details. Stop Loss Transfers When a group changes carriers,any members currently enrolled with the previous group carrier who enrolls on the new group/qualified plan cannot transfer any out of pocket expenses they have satisfied in the current calendar year to the new plan. Deductible Transfers When a group changes carriers,any members currently enrolled with the previous group carrier who enrolls on the new group/qualified plan can transfer any medical PPO plan deductible amount they have satisfied in the current calendar year to the new plan. Rx deductibles will not transfer to the new group plan. Misinformation Group coverage applications are based on information provided by the applicant group.Any misinformation,incomplete or omitted information,or misrepresentation could result in the termination or rescission of your policy by the carrier. We recommend all applications are completed accurately and completely. This proposal is to be used for comparative purposes only.While we believe the rates and information herein to be accurate based on the information provided,final rates,benefits,and group acceptability will be determined at the time of enrollment by the underwriting carrier.Changes in enrollment and effective date of coverage may impact final rates.If there are any differences between the illustrated benefits and final benefits according to the benefit booklet,the benefit booklet will be deemed accurate. This information is intended to present only an outline of the benefits. The contract will have all details, limitations and exclusions. This proposal was prepared 90 days in advance, therefore, actual enrollment may differ from the material presented. Do not cancel your current coverage until an application for coverage has been approved in writing. GENERAL NOTATIONS This proposal is presented by Maniaci Insurance Services, Inc. License # 0600161 C-51 Resolution No. 2018-__ Page 1 of 3 RESOLUTION NO. 2018-__ A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF RANCHO PALOS VERDES, INCREASING THE CITY’S MAXIMUM MONTHLY CONTRIBUTION AMOUNTS FOR EMPLOYEE AND COUNCIL MEMBER HEALTH INSURANCE PREMIUMS FOR CALENDAR YEAR 2019 AND RESCINDING AND REPLACING RESOLUTION NO. 2017-58 WHEREAS, as an employer with fewer than 100 employees, the City must purchase insurance using small-group rates, where employees are assigned different monthly premiums based on several factors, such as age and number of dependents; and WHEREAS, the City is billed for the small-group rates associated with each employee, based on their age and number of dependents; and WHEREAS, the City has utilized so-called composite rates, rather than individual rates, to determine the employee’s contribution for each level of coverage offered for each medical plan such that all employees and Council Members, regardless of their age and number of dependents, receive the same deduction for the same level of coverage selected if it is for the same medical plan; and WHEREAS, the maximum City contribution limits the City publishes are based on medical composite rates that are for illustration purposes, and the City’s actual maximum contribution for medical premiums can vary from employee to employee, based on their age and number of dependents; and WHEREAS, on October 17, 2017, the City Council adopted Resolution No. 2017-58 establishing maximum City contributions towards employee health insurance premiums for FY 2018; and WHEREAS, the City has been advised of an increase in employee health insurance premiums for the City’s current health benefits for calendar year 2019 which have the potential to exceed the current published maximum City contributions towards employee health insurance premiums established for FY 2018; and WHEREAS, the City desires to sufficiently contribute to employee health insurance premiums by providing sufficient maximum City contributions towards same for its active full-time employees, City council persons, and part-time employees eligible for an ACA offer of medical coverage. WHEREAS, it is uncertain whether the maximum City contributions limits towards health insurance premiums established for calendar year 2018 will be sufficient for calendar year 2019 because the small group medical rates have not yet been published but are expected to be published by the end of October; and WHEREAS, the City may approve a change in the City’s Benefits Broker of Record, the addition of new health benefit options and revision of new insurance carriers that could result in potential savings to the City that could impact the maximum health contribution limits previously adopted; and D-1 Resolution No. 2018-__ Page 2 of 3 NOW, THEREFORE THE CITY COUNCIL OF THE CITY OF RANCHO PALOS VERDES DOES HEREBY FIND, DETERMINE AND RESOLVE AS FOLLOWS: Section 1: The City’s contribution for each full-time employee or active City Council person shall have a maximum amount which may be applied toward the full cost of the active full- time employee’s or active council person’s medical, dental, vision and mental health benefits, and pay up to 50% of the cost of medical, dental, vision and mental health benefits for eligible dependents (based on the composite medical rates, such that there may be instances wherein the actual City contribution to an individual is less/more than 50% of the maximum limits). Section 2: The City’s contribution for part-time employees that are considered “full-time employees,” as defined by the Affordable Care Act, shall have the maximum amount applied only toward the cost of the medical premium and up to 50% of the cost for eligible dependents (based on the composite medical rates, such that there may be instances wherein the actual City contribution to an individual is less/more than 50% of the maximum limits). Section 3: The City will pay towards the participant’s deductible in the HSA Plan $3,000 for Employee Only and $6,000 for Employee + 1 and Family (3 or more). This City contribution is not available to part-time employees that have been deemed “full-time” under the ACA. Section 4: Any amounts remaining between the necessary contributions required and the maximum amounts specified in Sections 1 and 2 of this Resolution are not to be paid to the active full-time or part-time employee or active City Council person, as applicable. Section 5: If a full-time employee or City Council member can provide proof of group medical coverage that is generally similar to the City’s medical coverage, and declines the medical coverage offered by the City, the City will make a cash-in-lieu payment to the opting out full-time employee or City Council member under the City’s cafeteria plan as governed by Section 125 of the Internal Revenue Code. The cash-in-lieu payment shall be equal to 50% of the lowest cost medical plan (based on the medical composite rates) available to employees for employee only coverage. Section 6: The City shall pay the full cost for each active full-time employee’s life insurance premium with accidental death & dismemberment premium for employees and their dependents as well as the long term disability premium for employees. The City shall pay the full cost for each active City Council member’s life insurance premium. Section 7: The Health Savings Account will be funded semi-annually in accordance with Rancho Palos Verdes Employee Association’s Memorandum of Understanding as may be modified from time to time. Section 8: The City Manager or his/her designee, is authorized to adopt rules and procedures for the implementation of this Resolution. Section 9: Resolution No. 2017-58 is hereby rescinded and replaced by this Resolution. D-2 Resolution No. 2018-__ Page 3 of 3 PASSED, APPROVED and ADOPTED this 16th day of October 2018. /s/ Susan Brooks Mayor Attest: /s/ Emily Colborn City Clerk STATE OF CALIFORNIA ) COUNTY OF LOS ANGELES ) ss CITY OF RANCHO PALOS VERDES ) I, Emily Colborn, City Clerk of the City of Rancho Palos Verdes, hereby certify that the above Resolution No. 2018-__was duly and regularly passed and adopted by the said City Council at a regular meeting thereof held on October 16, 2018. ____________________________ City Clerk D-3 E-1