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Home My WebLink AboutAGENDA REPORT 1990 0418 CC REG ITEM 08J' MOORPARK ITEM8,J: PAUL W. LAWRASON, Jr. STEVEN KUENY City Manager CHERYL J. KANE City Attorney Mayor SCOTT MONTGOMERY Mayor Pro Tern ELOISE BROWN Council member CLINT HARPER, Ph.D. PATRICK RICHARDS, A.I.C.P. Director of Community Development Council member BERNARDO M. PEREZ Council member LILLIAN KELLERMAN City Clerk R. DENNIS DELZEIT City Engineer JOHN V. GILLESPIE Chief of Police RICHARD T. HARE City Treasurer TO: FROM: DATE: SUBJECT: BACKGROUND HONORABLE CITY COUNCIL RICHARD HARE, DEPUTY CITY April 11, 1990 HEALTH INSURANCE RENEWAL The City of Moorpark currently has health insurance coverage through Western Life. Our broker, Tolman & Wiker, was not able to forward the new rates for the next twelve month period to the City until this week. The new premiums for the period of May 1, 1990 to April 30, 1991 increased approximately 15 % • In addition, there were several changes in the plan itself. These changes included an expanded network of hospitals and physicians, an increased doctor office co-pay provision, application of a deductible to prescriptions and a required in-~atient hospital and surgical services pre-authorization review. Staff also requested a quote for health insurance coverage from the Southern California Joint Powers Insurance Authority (the Authority). The Authority's plan documents were received this week. The Authority's staff and contracted carrier representatives can meet with the City some time after the 19th of this month. A Western Life and Tolman & Wiker representative will also be available to meet with employees later this month. The City's agreement with PEAVC requires the review of the health insurance plan prior to renewal, however, adequate time is not available to perform a review and analysis of the two plans or to negotiate plan changes. An employee meeting was held on April 13th with all available employees currently covered by the Western Life plan to explain the plan changes proposed by Western Life. Additionally, staff working with Tolman & Wiker contacted the Western Life 799 Moorpark Avenue Moorpark, California 93021 (805) 529-6864 underwriters in order to extend the current plan and the current premiums while we reviewed plan changes and rate changes. CONCLUSION Western Life has agreed to extend the same premium for May and June with the premium to be requoted for a twelve month period running from July 1, 1990 to ~une 30, 1991. The plan changes would still take effect May 1, 1990, however, this will allow time for the review of the plan and alternative coverages during the next month, as well as, allow for analysis of the budget impacts of any rate increases prior to accepting a twelve month agreement with Western Life or the Insurance Authority. RECOMMENDATION: Staff recommends remaining with Western Life for another two months while options are reviewed. To do so, City Council must authorize the City Manager to execute the necessary agreements with Western Life to extend the health insurance program for May and June . . :.)ORPARK, CALIFORNIA C:i1y Caul/' Meeting of 'i I Y 199P ~ ACTION:_....,,_,.~.._.,__._. WESTERN LIFE INSURANCE COMPANY THE GROUP COMPANY WESTERN EMPLOYER RATE CHANGE NOTIFICATION member AMEV-group Enclosed is your semi-annual illustration showing your plan benefits, current premiums and new premium to be effective on the rate change date indicated. Effective with the rate change, your group insurance program will automatically change from the Med$ense provider network to the PHCS WesternCare provider network. The PHCS WesternCare network consists of numerous hospitals and thousands of physicians_ (primary care and specialists) in the Southern California area. A provider directory illustrating the comprehensive network is enclosed. We are giving you advanced notice so that you have time to inform your employees of the provider network changes. Your employees will be pleased to find that many of the current providers they are now using are in the PHCS network. However, there are also several that are not in the PHCS network. It is very important that your employees are advised of this so that, if they want to receive enhanced benefits they have time to change their choice of physicians and hospitals before the rate change date. Enhanced benefits will only be paid as of your rate change date if the PHCS network providers are used. Pre-admission authorization is another very important change to be effective on your rate change date. All hospital admissions will require pre-admission authorization. WesternCare used Private Healthcare Systems Ltd. (PHCS) as its pre-admission authorization review service for the greater Southern California area. PHCS offers a quality provider network and prompt, efficient pre-authorization for hospital stays. Enclosed are handouts for each of your insured employees which include highlights of the plan changes and a review of the pre-admission authorization process. It is very important that these are distributed immediately so that everyone is aware of the changes. Just prior to your rate change date, we will be mailing new employee packets which will include details on the plan changes, along with new certificate schedule pages, new ID cards, and a preferred provider directory. AT THAT TIME, YOUR EMPLOYEES WILL NEED TO TURN IN THEIR MED$ENSE ID CARDS TO YOU. Your agent has received a copy of this notice and can provide more information about coverage options and plan changes. Or, you can call one of the toll-free numbers noted below to have any questions answered or to review a quotation on alternate plan options. We appreciate the opportunity of insuring your employee benefit program and look forward to providing continued service to your firm. GROUP OPERATIONS DEPARTMENT Toll Free: 1-800-328-1001 MEDRLVR.DOC P.O. Box 64271 St. Paul, Minnesota 55164 Telephone (612) 738-4000 Ext. 5275 (ClassicCare 15-49) Customer Service for questions Ext. 4066 (ClassicCare 15-49) Group Underwriting for proposals on alternative plans RECE\VEO APR \ O \990 City ot Moorpari: Quality ... because we care DATE: 03/22/90 WESTERN LIFE INSURANCE COMPANY RATE CHANGE NOTIFICATION GROUP NAME: POLI CY NUMBER: CITY OF MOORPARK 9000133444 EFFECTIVE DATE LENGTH OF RATE OF RATE CHANGE: 05/01/90 PERIOD: 06 MONTHS COVERAGE EMPLOYEE AD+D INSURANCE $100 EMPLOYEE MEDICAL OED $300 FAMILY MEDICAL OED 80% COINSURANCE TO $5,000 PCS DRUG BENEFIT 5/7 COPAY WESTERN DRUG BENEFIT PREGNANCY PAID AS A SICKNESS LIFE INSURANCE FOR EMPLOYEE COVERAGE EMPLOYEE AD+D INSURANCE $100 EMPLOYEE MEDICAL OED $300 FAMILY MEDICAL OED 80% COINSURANCE TO $5,000 PRE-ADMISSION AUTHORIZATION PCS DRUG BENEFIT 5/7 COPAY WESTERN DRUG BENEFIT PREGNANCY PAID AS A SICKNESS LIFE INSURANCE FOR EMPLOYEE CURRENT RATES RENEWAL RATES EMPLOYEE DEPENDENT .06 143.78 228.59 .30 EMPLOYEE DEPENDENT .06 166.08 * 258.71 .34 * MAJOR MEDICAL COVERAGE INCLUDES WESTERNCARE CITY OF MOORPARK 799 MOORPARK AVE MOORPARK CA 93021 TOLMAN AND WIKER INC 790 E SANTA CLARA ST P O BOX 1388 VENTURA CA 93002 505 48 PAGE 01 WESTERN LIFE INSURANCE COMPANY THE GROUP COMPANY WESTERN member AMEV-group WELCOME TO THE NEW PHCS WESTERNCARE NETWORK!l Effective May 1, 1990, our new PHCS Westerncare physician and hospital network will replace your current Med$ense provider network. The PHCS WesternCare network consists of numerous hospitals and thousands of physicians (primary care and specialists) in the Southern California area. Western Life has expanded their WesternCare Preferred Provider network in Southern California. Private Healthcare Systems Ltd. lPHCS) is a nationally proven Preferred Provider network. Your employer has been given some of the new directories which list your new preferred providers. To receive enhanced benefits after May 1, 1990, you must use the physicians and hospitals shown in the new listing. PLAN CHANGE HIGHLIGHTS New PHCS/WesternCare Network of Hospitals & Physicians Doctor Office Visit Co-pay Prescriptions (If the PCS card option is included in your plan, this does not apply.) In-Patient Hospital and Surgical Services National $10 Deductible applies, 80% Coverage 100%; pre-authorization required for all hospital confinements. Current Regional $3, $5, $7, $10 No deductible, 80% coverage 100% when admitted by Med$ense physician to a Med$ense facility. WesternCare requires that ALL hospital admissions be pre-authorized. But, it's easy!! All you need to do is give your doctor the completed pre-admission form. He will call the toll-free number, 1-800-225-5548, to obtain pre-admission authorization. Failure to obtain pre-authorization will result in a reduction in benefits. For emergency admissions, the doctor must call within one working day. Within the next few weeks you will receive a new insurance packet with your new ID cards, and all the details of your new coverage with PHCS WesternCare. AT THAT TIME YOU MUST RETURN YOUR MED$ENSE ID CARD TO YOUR EMPLOYER. Please see your employer if you have any questions. WELCOME.DH P.O. Box 64271 St. Paul, Minnesota 55164 Telephone (612) 738-4000 Quality ... because we care A PRESENTATION FOR THE CITY OF MOORPARK SOUTHERN CALIFORNIA JOINT POWERS INSURANCE AUTHORITY AND CAL-SURANCE BENEFIT PLANS, INC. 2790 SKYPARK DRIVE, SUITE 200 TORRANCE, CALIFORNIA 90505 (213) 530-5525 APRIL 6, 1990 THE CAL-SURANCE GROUP CITY OF MOORPARK I. OPERATION OF SCJPIA EMPLOYEE BENEFIT PROGRAM A. PARTICIPATION B. ENROLLMENT C. CLAIM PROCESSING II. FINANCIAL OPERATION OF SCJPIA EMPLOYEE BENEFIT PROGRAM A. DEPOSIT RATES B. RETROSPECTIVE PREMIUM ARRANGEMENT C. INTERNAL STOP-LOSS POOLING ARRANGEMENT D. SPECIFIC STOP-LOSS ARRANGEMENT E. CONTINGENCY EQUITY RESERVE III. BENEFITS OF SCJPIA EMPLOYEE BENEFIT PROGRAM A. MEDICAL B. DENTAL C. VISION D. LI FE THE CAL-SURANCE GROUP SCJPIA EMPLOYEE BENEFIT PLAN PARTICIPANTS LA VERNE LIFE, MEDICAL, DENTAL, VISION LAKEWOOD LIFE, MEDICAL, DENTAL, VISION CAMARILLO LIFE, MEDICAL BELL GARDENS LIFE, MEDICAL, DENTAL MAYWOOD LIFE, MEDICAL, DENTAL LOMA LINDA LIFE HAWAIIAN GARDENS LIFE, MEDICAL, DENTAL, VISION SEEACA LIFE, MEDICAL LAWNDALE LIFE, DENTAL, VISION ARTESIA LIFE, MEDICAL, DENTAL, VISION IMPERIAL LIFE, MEDICAL, DENTAL, VISION LOMITA VISION RANCHO PALOS VERDES LIFE, MEDICAL, DENTAL MISSION VIEJO LIFE, MEDICAL, DENTAL, VISION PICO RIVERA DENTAL, VISION SCJPIA LIFE, MEDICAL, DENTAL, VISION LA HABRA HEIGHTS DENTAL, VISION CITY OF COMMERCE MANAGED HEALTH NETWORK (MHN} DANA POINT LIFE, MEDICAL, DENTAL, VISION ROLLING HILLS ESTATES LIFE, MEDICAL, DENTAL SAN JUAN CAPISTRANO LIFE, MEDICAL TEMPLE CITY LIFE I. THE OPERATON OF THE SCJPIA EMPLOYEE BENEFIT PROGRAM HOW TO ENTER THE PROGRAM Members enter the program by council approval of specified resolution (agreeing, as well to a minimum of three years in the plan) and submitting an enrollment card for each eligible employee. Upon entering the program, the following material will be presented to the member: 1. 2. 3. 4. 5. El iqibil ity Summary Plan Description Certificates of Life Insurance Identification Card Claim Forms Other Administrative Forms PLAN PROVISIONS The following are eligible to participate in the programs made available by a SCJPIA member: 1. Full-time employees, according to the member's requirements, but no less than 30 hours per week. 2. Retiree coverage is not necessary in order to participate in the program, but may be elected by a member for its retirees. Life insurance would not be available if coverage is offered to full- time employees. 3. Elected official may also be covered by a member, at its option. Dependents are eligible until age 19, or up to age 23, if unmarried, and attending an accredited college or university as a full-time student. New employees are covered after a waiting period as determined by the member city. CLAIM SERVICES -ENROLLMENT -ELIGIBILITY SCJPIA ADMINISTRATIVE SERVICES -MEDICAL, DENTAL, CLAIMS ADJUDICATION -CLAIMS ADMINISTRATION MANAGEMENT REPORT -QUALITY CONTROL -INTEGRATION W/REINSURERS GENERAL ADMINISTRATION SERVICES HELLER ASSOCIATES YES YES YES YES YES YES -LIST BILLINGS YES -RECONCILIATION OF LIST BILLING YES -COMPLETE PREMIUM COLLECTIONS AND ACCOUNT RECEIVABLES YES -GENERATION OF ELIGIBILITY REPORTS FOR OTHER VENDORS SUCH AS VSP, PCS AND MHN YES -MAINTENANCE OF RECORDS AND FILES YES II. FINANCIAL OPERATION OF SCJPIA EMPLOYEE BENEFIT PROGRAM COVERAGE LIFE/AD&D MEDICAL EMPLOYEE EMPLOYEE+ 1 EMPLOYEE+ 2 OR MORE DENTAL EMPLOYEE EMPLOYEE+ 1 EMPLOYEE+ 2 OR MORE SCJPIA 7/89 -7/90 RATE SUMMARY SCJPIA $.38/$1,000 (W/SAFETY) $.34/$1,000 (W/OUT SAFETY) PPO EPO $145.97 $138.19 316.14 302.22 422.19 401.68 FEE FOR SERVICE PREPAID $18.63 $ 9.41 32.56 16.45 46.54 23.51 DEDUCTIBLE SOUTHERN CALIFORNIA JOINT POWERS INSURANCE AUTHORITY VISION SERVICE PLAN $ 0 $ 5.00 $ 7.50 $10.00 $15.00 $20.00 $25.00 PLAN A {Exam every 12 months -Lenses every 24 months -Frames every 24 months.) 3-RATE BASIS Employee Only 8.81 7.91 7.40 7.00 6.16 5.48 4.69 Employee+ 1 15.59 13.90 13.05 12.31 10.85 9.54 8.30 Employee+ 2 22.15 19. 77 18.53 17.51 15.42 13.50 11.81 2-RATE BASIS Employee Only 8.81 7.91 7.40 7.00 6.16 5.48 4.69 Employee With Dependents 18.98 17 .97 16.83 15.87 14.01 12.37 10.73 COMPOSITE 17.06 15.20 14.24 13.45 11.86 10.39 9.10 DEDUCTIBLE $ 0 $ 5.00 $ 7.50 $10.00 $15.00 $20.00 $25.00 PLAN B {Exam every 12 months -Lenses every 12 months -Frames every 24 months.) 3-RATE BASIS Employee Only 9.38 8.36 7.85 7.40 6.50 5.76 5.03 Employee+ 1 16.50 14.74 14.01 13.28 11.69 10.23 8.93 Employee+ 2 23.50 21.02 19.94 18.76 16.55 14.58 12.60 2-RATE BASIS Employee Only 9.38 8.36 7.85 7.40 6.50 5.76 5.03 Employee With Dependents 21.30 19.10 18.08 17.06 15.08 13.28 11. 41 COMPOSITE 18.08 16.16 15.37 14.46 12.82 11.19 9.72 DEDUCTIBLE $ 0 $ 5.00 $ 7.50 $10.00 $15.00 $20.00 $25.00 PLAN C {Exam -Lenses -Frames every 12 months). 3-RATE BASIS Employee Only 11.30 10.28 9. 72 9.15 8.19 7.34 6.49 Employee+ 1 20.28 18.13 17.17 16.38 14.69 13.10 11.69 Employee+ 2 28.81 25.82 24.40 23.28 20.90 18.70 16.55 2-RATE BASIS Employee Only 11.30 10.28 9. 72 9.15 8.19 7.34 6.49 Employee With Dependents 26.10 23.33 22.15 21.19 18.98 16.95 15.08 COMPOSITE 22.14 19.83 18.76 17.97 16.10 14.46 12.82 SCJPIA INTERNAL STOP-LOSS POOLING SINGLE CLAIM INCREMENT TO SCJPIA MEMBER TO SCJPIA POOL (Retained Loss) $ 0 to $2,500 100% None $2,501 to $5,000 40% 60% $5,001 to $10,000 20% 80% $10,001 and Over None 100% Maximum member retained loss per cause, prior to retro calcula- tion= $4,500 Retro exposure allocated based upon total deposit funding for the account period. SPECIFIC STOP-LOSS STOP-LOSS LEVEL: $100,000 MONTHLY PREMIUM RATE: $12.33 Per Employee (Included in deposit funding rates) The $100,000 "specific" provides reimbursement to SCJPIA on any single claim that exceeds the $100,000 point, for the portion of the claim that exceeds $100,000 to a maximum reimbursement of $1,000,000. CONTINGENCY EQUITY RESERVE This is one-time charge equal to 15% of total annual deposits. This charge can be paid through a "retro call" or surpluses. III. BENEFITS OF SCJPIA EMPLOYEE BENEFIT PROGRAM BENEFIT DESCRIPTION LI FET !ME MAXIMUM ANNUAL PLAN DEDUCTIBLE EMERGENCY ROOM DEDUCTIBLE HOSP IT AL CARE HOME HEALTH SERVICES HOSPITAL PRE-ADMISSION TESTING PHYSICIAN SERVICES ACCIDENTAL INJURY BENEFIT SURGEON FEES NURSING CARE EMERGENCY TRANSPORTATION SERVICES X-RAY AND LABORATORY EXAMS RADIATION THERAPY ANESTHETICS MEDICAL SUPPLIES SCJPIA SUMMARY OF MEDICAL BENEFITS -OPTION I (PPO) - NON-NETWRK For care by any licensed hospital or physician s1,ooo,ooo $200 Individual; $400 Family S25 per occurrence 70% to $1,000 out-of- pocket (does not include deductible) 100%, after deductible 90%, no deductible 70% subject to deductible 100% of the first $500 70% subject to deductible 70% subject to deductible 70% subject to deductible 70% subject to deductible 70% subject to deductible 70% subject to deductible 70% subject to deductible For care by licensed CappCare hospital or physician $1,000,000 $200 Individual; $400 Fami Ly $25 per occurrence 90% to $1,000 out-of- pocket (does not include deductible) 100%, after deductible 90%, no deductible 90% deductible subject to deductible (in- patient); 100% after a S5.00 co-payment for preferred providers only (out-patient) 100% of the first $500 90% subject to deductible 90% subject to deductible 90% subject to deductible 90% subject to deductible 90% subject to deductible 90% subject to deductible 90% subject to deductible - -OPTION II (EPO) -(1) NETWRK ONLY For care by CappCare licensed hospital or physician $1,000,000 No Deductible S25 co-payment 100% 100% 100% $5.00 co-payment, 100% thereafter S25 Co-payment 100% 100% 100% 100% 100% 100% 100% COST CONTAINMENT OUT-PATIENT SURGERY PRE-ADMISSION REVIEW TEMPOROMANDIBULAR JOINT DYSFUNCTION RADIAL KERATOMY PODIATRY CHIROPRACTIC PREVENTIVE CARE Well-Baby Care (Thru Age 2) IJT111Unizations (Children Through Age 12) Routine Physical (One Every 5 Years) Annual Pap Tests Marnnography PRESCRIPTION DRUGS (PCS) -OPTION I (PPO) - NON-NET\klRK 70% subject to deductible; must call 1-800-Capping 70% subject to deductible; must call 1-800-Capping 70% subject to deductible; $1,000 lifetime maxinun 50% subject to deductible; $1,500 lifetime 50% subject to deductible; $1,000 lifetime 80% subject to deductible; $1,000 calendar year Not Covered Not Covered Not Covered Not Covered Not Covered Not Covered -$3.00 Generic -$7.00 Brand NET\klRK 90% subject to deductible; must call 1-800-Capping 90% subject to deductible; must call 1-800-Capping 90% subject to deductible; $1,000 lifetime maxi nun 50% subject to deductible; $1,500 lifetime 90% subject to deductible (in- patient); 100% after a $5.00 a co-payment for preferred providers only (out- patient) 80% subject to deductible; $1,000 calendar year Covered $5.00 Co-Payment (PPO only) $5.00 Co-Payment (PPO only) 90% to a maxillUll $100 (PPO only) $5.00 per office visit (PPO only) 90%; no deductible (PPO only) (Includes Oral Contraceptives) - -OPTION II (EPO) -(1) NET\klRK ONLY 100%; must call 1-800-Capping 100%; must call 1-800-Capping 100%; $1,000 lifetime maxinun 50%; $1,500 lifetime $5.00 co-payment, 100% thereafter 80% subject to deductible; $1,000 calendar year Covered $5.00 Co-Payment $5.00 Co-Payment 90% to a maximum $100 $5.00 per office visit 90%; no deductible -$3.00 Generic -$7.00 Brand (Includes Oral Contraceptives) (1)No benefits are paid in or out of the service area without prior approval. Specific exceptions paid at 80% to $1,000 out of pocket (not including deductible); $200 calendar year deductible include: -Genuine emergency care. -Services not available in network (prior approval). -Medical services for eligible dependents living outside service area and living away from the insured. - - - - - - - - - -OPTION I (PPO) - -OPTION 11 (EPO) - ALL MENTAL AND NERVCl.lS/SUBSTANCE ABUSE BENEFITS ARE PROVIDED THRClJGH MANAGED HEALTH NET\KlRK (MHN) MANAGED HEALTH NET\JORK IN-PATIENT MENTAL HEALTH AND CHEMICAL DEPENDENCY OUT-PATIENT MENTAL HEALTH AND CHEMICAL DEPENDENCY Coverage is 100% at contracting MHN facilities up to a maxinun of 30 days per year, $50,000 lifetime maxinun. Alternate care facilities (intensive out- patient treatment) is also covered. Subject to a $250 deductible and 2 episodes per lifetime. 1 - 5 Visits: S 0 5 -10 Visits: S10 11 -15 Visits: $20 Balance: S30 (No Maxinun) The above schedule is based upon using one of their providers. If you use a non-contracting provider, reirrbursement is made up to½ the amount paid to a contracting provider, to a S750 subscriber family- unit calendar year maxinun benefit. Coverage is 100% at contracting MHN facilities up to a maximun of 30 days per year, $50,000 lifetime maxilTUll. Alternate care facilities (intensive out-patient treatment) is also covered. Subject to a $250 deductible and 2 episodes per lifetime. 1 - 5 Visits: SO 5 -10 Visits: $10 11 -15 Visits: S20 Balance: $30 (No Maxi1TU11) The above schedule is based upon using one of their providers. If you use a non- contracting provider, reimbursement is made up to½ the amount paid to a contracting provider, to a $750 subscriber family-unit calendar year maxi1TU11 benefit. ANNUAL DEDUCTIBLE INDIVIDUAL FAMILY MAXIMUM PLAN PAYS PREVENTIVE CARE (EXAMS, CLEANING, FLUORIDE, ETC.) BASIC CARE (FILLINGS, EXTRACTIONS, ROOT CANAL, ETC.) MAJOR CARE (DENTURES, CROWNS, BRIDGES) ANNUAL INDIVIDUAL MAXIMUM ORTHODONTIA SCJPIA DENTAL BENEFITS FEE-FOR-SERVICE $50 $100 100%, NO DEDUCTIBLE 80% 50% $1,000 NOT COVERED PREPAID (SAFEGUARD) N/A N/A 100% CO-PAYMENTS RANGE FROM OTO $35 CO-PAYMENTS RANGE FROM $80 TO $125 FULL BANDED -$1,350 PARTIAL BANDED -$ 675 ORTHODONTIA COVERAGE (OPTIONAL) LIFETIME MAXIMUM DEDUCTIBLE COINSURANCE $1,000 $50 50% OF REASONABLE AND CUSTOMARY CHARGES SOUTHERN CALIFORNIA JOINT POWERS INSURANCE AUTHORITY VISION SERVICE PLAN PLAN EXAM LENSES FRAMES DEDUCTIBLE MAXIMUM EXAMS LENSES FRAMES A Every 12 Months Every 24 Months Every 24 Months SUMMARY OF BENEFITS B Every 12 Months Every 12 Months Every 24 Months Member Doctor 0 -$25 Deductible CONTACT LENSES 100% Every 12 or 24 Months 100% Every 12 or 24 Months 100% Every 12 or 24 Months 100% Necessary $130 Elective CONTACT LENSES C Every 12 Months Every 12 Months Every 12 Months Non-Member Doctor 0 -$25 Deductible $40 $30 -$125 $45 $250 Necessary $130 Elective Necessary: Contact lenses are furnished under the VSP plan when the VSP panel doctor obtains prior approval for any of the following conditions: 1. Following cataract surgery. 2. To correct extreme visual acuity problems that cannot be corrected with spectacle lenses. 3. Certain conditions of anisometropia. 4. Keratoconus. When the VSP Panel Doctor receives prior approval for such cases, they are fully covered by VSP and are IN LIEU OF ALL OTHER BENEFITS. CONTACT LENSES ONCE FURNISHED UNDER THIS PLAN AS DESCRIBED ABOVE CAN BE REPLACED ONLY WITH PRIOR AUTHORIZATION BY VSP, BUT IN NO EVENT MORE FREQUENTLY THAN EVERY TWENTY-FOUR (24) MONTHS. Elective: When covered persons choose contact lenses for reasons other than those mentioned above, VSP will make an allowance toward their costs equivalent, under the VSP program, to a standard eye examination, spectacle lenses, and frame IN LIEU OF ALL OTHER BENEFITS. VISION SERVICE PLAN ELECTIVE CONTACT LENS PROGRAM BENEFITS Persons covered under this additional benefit are entitled to contact lenses for "cosmetic" purposes, as opposed to extreme "necessary" conditions. A condition is deemed "necessary" when the visual problem is so acute that it cannot be corrected with spectacle lenses, such as following cataract surgery. Persons seeking services under this additional benefit from a panel doctor are fully covered for the initial fitting period of up to 90 days, which may be extended, at the discretion of the VSP doctor. The patient pays a $50 deductible whether they are prescribed regular, soft or multi-focal contact lenses. Because the elective contact lens program is an additional benefit, the patient is still eligible for spectacle lenses and frames under the standard SCJPIA Vision Service Plan. Exclusions under this additional benefit include orthokeratology, replacement of lost or damaged lenses, modifications of lenses, routine maintenance, such as polishing, cleaning, etc. Refitting after the initial fitting will be the responsibility of the patient. COST The cost to add the contact lens benefit is as follows: Rate Structure Two Tier: Employee Employee+ Dependents (Family) Three Tier: Employee Employee+ 1 Dependent Employee+ 2 or More Dependents Composite Rate Rates $1.80 $5.10 $1.80 $3.90 $5.60 $4.35 The above rates are additional costs which need to be applied to the standard VSP Plan rates. LIFE INSURANCE AND ACCIDENTAL DEATH & DISMEMBERMENT EMPLOYEES EMPLOYERS MAY OFFER A FLAT AMOUNT OF BENEFIT WITH A $10,000 MINIMUM OR MULTIPLE OF SALARY. GUARANTEE ISSUE AMOUNTS ARE SUBJECT TO REVIEW BY BEST LIFE. DEPENDENTS TWO PLANS ARE AVAILABLE PLAN I PLAN II Spouse $1,000 Spouse $1,500 Child (14 Days to 6 Months) $ 100 Child (14 Days to 6 Months) $ 100 Child (6 Months to 19 Years) $1,000 Child (6 Months to 19 Years) $1,000 SUPPLEMENTAL GROUP LIFE ADDITIONAL LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE rs AVAILABLE TO EMPLOYEES AT LOW TERM RATES IN INCREMENTS OF $10,000, SUBJECT TO AN EVIDENCE OF INSURABILITY STATEMENT. EMPLOYEE RATES DEPENDENT ON WHETHER THE MEMBER CITY ELECTS TO INCLUDE THEIR FIRE AND POLICE, THE FOLLOWING RATES WILL APPLY (WHICH INCLUDES A COMPREHENSIVE GUARANTEE MEDICAL CONVERSION POLICY): PER 1,000 OF INSURANCE PLAN I $ .48 PER DEPENDENT UNIT INCLUDING FIRE & POLICE $ .38 DEPENDENT RATES EXCLUDING FIRE AND POLICE $ .34 PLAN II $ .63 PER DEPENDENT UNIT s\scjpia\jpiamas.089