HomeMy WebLinkAbout18323 ORD - 07/10/1984AN ORDINANCE
AUTHORIZING MODIFICATION OF THE GROUP HOSPITALIZATION
PROGRAM TO PROVIDE FOR CHANGES IN PREMIUMS, CONTRIBUTION
RATES, AND BENEFITS; PRESCRIBING COST-CONTAINMENT MEASURES
AND OPTIONAL PARTICIPATION IN THE HEALTH MAINTENANCE
ORGANIZATION; AUTHORIZING THE CITY MANAGER TO EXECUTE
LETTERS OF AGREEMENT OR UNDERSTANDING WITH THE COLLECTIVE
BARGAINING UNITS; AUTHORIZING THE CITY MANAGER TO MAKE
SUBSEQUENT MODIFICATIONS IN ALL AREAS OF THE PROGRAM
PURSUANT TO THE POLICIES SET FORTH HEREIN; REPEALING ALL
CONFLICTING ORDINANCES.
WHEREAS, the City is faced with the problem of escalating health care
costs; and
WHEREAS, it is anticipated that these costs will continue to rise
unless employers such as the City adopt active cost-containment measures; and
WHEREAS, the City, as a self-funded health care provider, paid
approximately $3,500,000 in medical claims during the 12 -month period ending
December 31, 1983, and expects to pay $5,157,774 in claims for the 12 -month
period between August 1, 1984, and August 1, 1985:
NOW, THEREFORE, BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF
CORPUS CHRISTI, TEXAS:
SECTION 1. That any and all ordinances, motions, and resolutions
heretofore enacted in conflict hereunto are hereby repealed, specifically
including: Section 707 of the City's Compensation Ordinance No. 8127; Ordinance
No. 17995; Ordinance No. 15179; Ordinance No. 16828; Ordinance No. 16781;
Ordinance No. 16434; Ordinance No. 15929; M83-0384; M82-0207.
SECTION 2. That the City's current health care plan as adopted by
motion on December 1, 1983, is hereby modified as follows:
Elimination of present first dollar benefits: Provide 80
percent payment for (1) elective surgical procedure with a
second (or third) affirmative opinion; (2) non -elective
surgical procedures; and (3) accident benefits.
Second surgical opinions: Second opinion shall be required
only on surgical procedures as set forth in the City's
Health Care Programs Manual, with costs for same to be
covered at 100 percent by the plan. Without a second
opinion the listed surgeries will be paid by the plan at 50
percent after the deductible. Other costs related to the
surgery would not be -subject to the 50 percent penalty.
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Outpatient surgery: Outpatient surgery will be paid by the
plan at 100 percent after the deductible for outpatient
surgery.
Pre -admission testing: The cost associated with
pre -admission testing will be paid by the plan at 100
percent after the deductible.
Pre-existing conditions: Where medical conditions exist at
the time of, or prior to employment, full benefits would
become applicable for an employee or dependent on the
earliest to occur of the following:
1. Completion of 3 consecutive months without treatment or
expense for that condition prior to employment; or
2. Completion of a 6 -month period of continuous coverage
and active full-time work without treatment or expense for
that condition; or
3. Completion of 12 months of coverage.
Substance abuse: The Plan shall not include coverage for
detoxification treatment and instead will provide coverage
only for rehabilitation treatments in legally certified
rehabilitation centers.
Psychological Treatment: The Plan shall pay 50 percent of
eligible charges for outpatient treatment of mental or
nervous conditions. The maximum eligible charge per visit
shall be $65.
Rates --Contribution rates shall be as set forth in the
attached Exhibit A.
SECTION 3. All benefits, contribution rates, premiums, and optional
coverages shall be set forth in the City's Health Care Programs Manual, which
shall be modified from time to time by the authority of the City Manager, with
notice to the City Council, as necessitated by the best interest of the City,
insurance industry standards, claims experience, collective bargaining
agreements, available funds, employee participation, health care costs and
expenses related to the programs. The City Manager is further authorized, with
notice to the City Council, to modify the contractual Administrative Services
Only (ASO) Rates and reinsurance rates consistent with the City Health Care
Programs needs and the guidelines set forth above.
Employee Only
Spouse Only
Child(ren) Only
Family
Medicare
Exhibit n
HEALTH CARE/PLANNED HEALTH PROGRAMS
Current Plan/Proposed Rates
Average 35%
Total. Employee - City
Monthly/Biweekly Monthly/Biweekly Monthly/Biweekly
72.28/33.36
146.31/67.53
79.93/36.89
168.14/77.60
51.42/23.73
1.00/.46
73.15/33.76
39.96/18.44
84.07/38.80
25.71/11.86
Proposed Plan/Proposed Rates
Average 12.7%
71.28/32.90
73.16/33.77
39.97/18.45
84.07/38.80
25.71/11.87
Total Employee City
Monthly/Biweekly Monthly/Biweekly Monthly/Biweekly
Employee Only 65.64/30.30 2.00/.92 63.64/29.38
Spouse Only 113.53/52.41 56.76/26.20 56.77/26.21
Child(ren) Only 62.02/28.63 31.01/14.31 31.01/14.31
Family 130.49/60.23 65.24/30.11 65.25/30.12
Medicare 42.87/19.79 21.43/9.89 21.44/9.90
Proposed HMO Rates
20%
Total Employee City
Monthly/Biweekly Monthly/Biweekly Monthly/Biweekly
Employee Only 69.10/31.90 5.46/2.52 63.64/29.38
Spouse Only 116.35/53.71 59.58/27.50 56.77/26.21
Child(ren) Only 63.98/29.53 32.97/15.22 31.01/14.31
Family 137.38/63.41 72.13/33.29 65.25/30.12
Medicare 45.60/21.05 24.16/11.15 21.44/9.90
APPENDIX/hlth ord
6
That the foregoing ordinance was. read for t first time and pas ed
second reading on this the y'Sj day of 19$ ,
following vote:
Luther Jones
Betty N. Turner
David Berlanga, Sr.
Welder Brown
Leo Guerrero
Dr. Charles W. Kennedy
Joe McComb
Frank Mendez
Mary Pat Slavik
to its
by the
That the foregoing ordinance was read for th• sec.nd time and p d to its
third reading on this the (3,4f/ day of 4 i , 19 , by the
following vote:
Luther Jones
Betty N. Turner
David Berlanga, Sr.
Welder Brown
Leo Guerrero
Dr. Charles W. Kennedy
Joe McComb
Frank Mendez
Mary Pat Slavik
That the forego g ordinanw-s read for th t ird time and passed finally
on this the 1 Oay /�, - -� , 19,6-r , by the follow g vote:
i
Leo Guerrero
Dr. Charles W. Kennedy 1
Joe McComb IF
Frank Mendez 1.,_,
�.
Luther Jones
Betty N. Turner
David Berlanga, Sr.
Welder Brown
Mary Pat Svik
PASSED AND APPROVED, this the 16 day of
ATTEST: -
ity Secretary
APP VED:
DAY OF
J TRUCE
CITY ATTORNEY
Assistant City Attorney
1
MAYOR
THE CIT" OF CORPUS CHRISTI, TEXAS
18323