HomeMy WebLinkAboutMIN OCTOBER 15 1996 M II N U T IE S d CITY OF B EAUMONT
Lulu L.Smith DAVID W. MOORE, MAYOR Andrew P.Cokinos, Mayor Pro Tem
Guy N.Goodson CITY COUNCIL MEETING Becky Ames
John K.Davis OCTOBER 15, 1996 Bobbie J. Patterson
Lane Nichols, City Attorney Ray A. Riley,City Manager Patrice Fogarty,City Clerk
The City Council of the City of Beaumont, Texas, met in a regular session on October 15, 1996,
at the City Hall Council Chambers, 801 Main Street, Beaumont, Texas, at 1:30 p.m. to consider the
following:
OPENING
*Invocation Pledge of Allegiance Roll Call
*Presentations and Recognition
*Public Comments: Persons may speak on scheduled agenda items
*Consent Agenda
Mayor Moore called the meeting to order at 1:30 p.m. Mr. Gene Landry, Chairman of the Drug
Free Beaumont Commission gave the invocation. Mr. Tom Harken (owner of the Casa Ole'
Restaurants) led in the pledge of allegiance.
Present at the meeting were: Mayor Moore, Mayor Pro Tem Cokinos, Councilmen Ames, Smith,
Goodson, and Davis. Councilman Bobbie Patterson was absent. Also, present were Ray A. Riley,
City Manager, Lane Nichols, City Attorney, Patrice Fogarty, City Clerk, and Barbara Liming, Deputy
City Clerk.
Mayor Moore announced an executive session to be held in accordance with Section 551.071 of
the Government Code to discuss pending or contemplated litigation regarding the claims of
Reginald Sorrell and James Matthews v. City of Beaumont.
Two Proclamations were issued: "Red Ribbon Week," (ribbons worn in favor of a drug-free
Beaumont) October 20-27, 1996; and " Business Women's Week," October 21-25, 1996.
Mayor Moore announced that the City of Beaumont has won the Clean City 2000 Award for its
recycling program and complimented City staff and those citizens who participate in the effort.
Citizens were invited to comment on the Consent and Main Agendas.
Mr. Todd Freeland, 3 Keith Lane, spoke in support of passage of the Southern Building Code with
the American Disabilities Act requirements in tact. He said this would be a wise move to prepare
Beaumont for the future.
CONSENT AGENDA
The following consent agenda items were considered:
* Approval of minutes of the October 8, 1996, meeting;
a. Authorize the pledge or release of collateral for City bank deposits - No pledge or release;
b. Confirmation of committee appointments - Resolution No. 96-249.
Mayor Pro Tem Cokinos moved to approve the consent agenda.
Councilman Ames seconded the motion. MOTION PASSED.
Ayes: Mayor Moore, Mayor Pro Tem Cokinos, Councilmen
Smith, Goodson, Ames, and Davis
Noes: None
GENERAL BUSINESS
1. Consider adopting the 1994 Standard Building Code.
Councilman Smith questioned grandfathering of buildings already
approved for moving by the Landmark Commission and those to be
relocated because of construction at the Ogden School site.
Councilman Smith moved to adopt Ordinance No. 96-57 ENTITLED AN
ORDINANCE TO ADOPT THE 1994 STANDARD BUILDING CODE; ESTABLISH
AUTHORITY FOR SETTING FEES; PROVIDING FOR SEVERABILITY, PROVIDING
FOR REPEAL,AND PROVIDING A PENALTY. Councilman Ames seconded
the motion. MOTION PASSED.
Ayes: Mayor Moore, Mayor Pro Tem Cokinos. Councilmen
Smith, Goodson, Ames, and Davis
Noes: None
Mayor Moore made a motion to amend Ordinance No. 96-57 to add
Councilman Patterson's appointment of Samuel Peterson to the
Construction Board of Adjustment and Appeals for a two-year term
expiring October 14, 1998, thereby increasing the present board to
fifteen (15), until the total number readjusts to nine (9) as defined in
Article II, Section 108.1. Mayor Pro Tem Cokinos seconded the
motion. MOTION PASSED.
Ayes: Mayor Moore, Mayor Pro Tem Cokinos, Councilmen
Smith, Goodson, Ames and Davis
Noes: None
Minutes;10/15/96;Page 2
2. Consider adopting the 1994 Standard Plumbing Code.
Mayor Pro Tem Cokinos moved to adopt Ordinance No. 96-58
ENTITLED AN ORDINANCE AMENDING CHAPTER 6, SECTION 6-140 OF THE
CODE OF ORDINANCES OF THE CITY OF BEAUMONT TO ADOPT THE 1994
EDITION OF THE STANDARD BUILDING CODE. Councilman Goodson
seconded the motion. MOTION PASSED.
Ayes: Mayor Moore, Mayor Pro Tem Cokinos, Councilmen
Smith, Goodson, Ames, and Davis
Noes: None
3. Consider adopting the 1994 Standard Gas Code.
Councilman Smith moved to adopt Ordinance No. 96-59, ENTITLED AN
ORDINANCE AMENDING CHAPTER 6, SECTION 6-130 OF THE CODE OF
ORDINANCES OF THE CITY OF BEAUMONT TO ADOPT THE 1994 EDITION OF
THE STANDARD GAS CODE AND REPEALING 6-130.1 AND 6-131 RELATING TO
AMENDMENT TO THE CODE AND FEES; PROVIDING FOR SEVERABILITY;
PROVIDING FOR REPEAL AND PROVIDING A PENALTY. Councilman
Goodson seconded the motion. MOTION PASSED.
Ayes: Mayor Moore, Mayor Pro Tem Cokinos, Councilmen
Smith, Goodson, Ames, and Davis
Noes: None
4. Consider adopting the 1996 International Mechanical Code.
Mayor Pro Tem Cokinos moved to adopt Ordinance No. 96-60,
AMENDING CHAPTER 6, SECTIONS 6-170 AND 6-171 OF THE CODE OF
ORDINANCES OF THE CITY OF BEAUMONT TO ADOPT THE 1996 EDITION OF
THE INTERNATIONAL MECHANICAL CODE WITH AMENDMENTS; PROVIDING
FOR SEVERABILITY; PROVIDING FOR REPEAL AND PROVIDING A PENALTY.
Councilman Ames seconded the motion. MOTION PASSED.
Ayes: Mayor Moore, Mayor Pro Tem Cokinos, Councilmen
Smith, Goodson, Ames, and Davis
Noes: None
5. Consider repealing the provisions establishing and regulating the Electrical Board of
Review.
Councilman Smith moved to adopt Ordinance No. 96-61, ENTITLED AN
ORDINANCE AMENDING CHAPTER 6 OF THE CODE OF ORDINANCES OF THE
CITY OF BEAUMONT TO REPEAL THE PROVISIONS ESTABLISHING AND
REGULATING THE ELECTRICAL BOARD OF REVIEW; PROVIDING FOR
Minutes;10/15196;Page 3
SEVERABILITY AND PROVIDING FOR REPEAL. Councilman Ames seconded
the motion. MOTION PASSED.
Ayes: Mayor Moore, Mayor Pro Tem Cokinos, Councilmen
Smith, Goodson, Ames, and Davis
Noes: None
6. Consider adopting a schedule of permit and inspection fees.
Mayor Pro Tem Cokinos moved to adopt Resolution No. 96-250,
establishing Plumbing Permit, Building Permit, Electrical Permit, Gas
Permit, Mechanical Permit and Inspection Fees. Councilman Smith
seconded the motion. MOTION PASSED.
Ayes: Mayor Moore, Mayor Pro Tem Cokinos, Councilmen
Smith, Goodson, Ames and Davis
Noes: None
7. Consider approving a lease agreement with the Young Men's Business League.
Councilman Smith moved to adopt Resolution No. 96-251, authorizing
a five-year lease agreement with the Young Men's Business League
(YMBL) at$4,800 per year. Councilman Ames seconded the motion.
MOTION PASSED.
Ayes: Mayor Moore, Mayor Pro Tem Cokinos, Councilmen
Smith, Goodson, Ames, and Davis.
Noes: None
8. Consider approving the City of Beaumont's FY97 Section 9 Grant Application for the
Beaumont Municipal Transit System.
Mayor Pro Tem Cokinos moved to adopt Resolution No. 96-252,
authorizing filing an application for grant funding in the amount of
$1,070,000 and executing an agreement with the Federal Transit
Administration to partially fund operation of the Beaumont Municipal
Transit for FY97. Councilman Goodson seconded the motion.
MOTION PASSED.
Ayes: Mayor Moore, Mayor Pro Tem Cokinos, Councilmen
Smith, Goodson, Ames, and Davis.
Noes: None
Minutes;10/15/96;Page 4
Councilman Davis asked how a determination is made for placement
of bus shelters or benches at stops, and Mayor Moore added
supportive comments for placement of these amenities at most bus
stops to serve patrons and possibly increase ridership and requested
information and a feasibility study of the proposal.
9. Consider authorizing a contract with Statewide Consolidated Community
Development Corporation (SCCDC) for financial assistance for prospective home
buyers in the Charlton Pollard Neighborhood.
Councilman Davis moved to adopt Resolution No. 96-253, authorizing
a contract with Statewide Consolidated Community Corporation to
provide funding to assist in the purchase of eleven (11) new homes in
the Charlton-Pollard neighborhood with HOME funds totaling
$169,000. Councilman Smith seconded the motion MOTION
PASSED.
Ayes: Mayor Moore, Mayor Pro Tem Cokinos, Councilmen
Smith, Goodson Ames and Davis
Noes: None
OTHER BUSINESS
Review the Managed Health Care Plan for City employees, as attached hereto and
made a part hereof.
Councilmembers comment on various matters.
Councilman Smith reported that a week ago she attended the National
League of Cities' Human Development Committee meeting and briefly
touched on problems that will affect cities and encouraged contacting
state and federal legislators regarding proposed legislation. She said
some of the proposals need to be read thoroughly.
Councilman Goodson said an important meeting is being conducted
today by the Lower Neches Valley Authority to discuss a continuing
problem with our fresh water supply and problems with construction of
the salt water barrier on the Neches River. He advocated that Council
work closely with the Commissioner's Court and the LNVA and
communicate with our Senatorial and Congressional delegations to
keep the process moving. Councilman Goodson reported a very
successful Kid-Vote Program at Austin Middle School this morning.
Mayor Moore added that Councilman Goodson served as the
Minutes;10/15/96;Page 5
moderator, said there was a great mixture of public and private school
students, the interaction was great and the quality of questions and
articulation was most impressive.
Councilman Davis again asked Staff to address the pot holes on Ewing
Street from Long to the Interstate, to consider additional street lighting
near Edwards School and told Councilman Smith that he would
appreciate any information and insight she could share regarding
proposed legislation she referenced.
Mayor Moore supported keeping aware of proposed legislation and the
effect that will be felt by cities. He commented about the productive
community meeting sponsored by LULAC Council 4410 last Sunday
morning, ribbon cutting and and grand opening of the Books A Million
Store, the success of the Southeast Texas Fair, an effort of our
Convention and Visitors Bureau to promote jet air service to the
Jefferson County Airport, the possibility of a major company locating in
Beaumont that would generate a great infusion of capital and
permanent jobs to our community and said a positive attitude attracts
new business.
Public Comment (Persons are limited to 3 minutes)
Mrs. Dee Lukeman, Executive Director for the Boys and Girls Clubs of
the Salvation Army addressed Council to explain the financial crisis of
the organization and the cuts that will have to be made in the program
unless financial assistance is gained and asked for Council help.
Mr. Joseph Egland, 4920 Park Street, spoke of the recent flood, said
ditches are not maintained for good drainage, asked if construction of
a drainage project contributed to the flooding, said pumps were not
turned on until 2:30 pm., complained that he has had no response from
DD6 to his inquiries and asked why the City doesn't assist in obtaining
grants. Mayor Moore explained that the City does not have pumps,
that the drainage project has been in place for several years and that
the rainfall received was of unparalleled intensity.
Mr. Kinnard Ross, 1195 Gunter, also discussed flooding caused by the
September 27th rainfall, said that 25 damaged homes qualifies for a
disaster area and that at least 35 homes in his neighborhood were
flooded and asked for assistance in applying to FEMA.
Mrs. Alma Petry, 3695 West Lynwood, complained that her 15-year-old
son was arrested last week for riding his bicycle on the wrong side of
the street and for running a stop sign, said she thinks he was
Minutes;10/15/96;Page 6
wrongfully arrested and that facing traffic while riding a bicycle is safer.
Mr. Lynn Demary, 430 East Elgie, distributed a Citizen on Patrol
Summary for September to Council, commented about the forum
sponsored by LULAC last Sunday, announced that applications may
be received by calling 833-2056 for an application to attend a Cops on
Patrol training school the evenings of October 22 and 24, reminded
citizens of the 3:00 p.m. Drug Free meeting Sunday and the Cops and
Kids picnic on October 26.
There being no further business, the meeting recessed at 3:30 p.m. to reconvene in executive
session.
ayor David W. Moore
Patrice Fogarty, C& Clerk
Minutes;10/15/96;Page 7
INTEROFFICE MEMORANDUM
CITY OF BEAUMONT, TEXAS
Date: October 10, 1996
TO: Ray A. Riley, City Manager
FROM: Glenda` undy, Human Resources Director
SUBJECT: Managed Care Plan
Specifications were developed and proposals were solicited for a managed care plan in August
1996. The specifications requested proposal pricing for one or more of the following funding
options: fully insured, minimum premium plan (MPP), or administrative services only(ASO) for
three years commencing January 1, 1997. The specifications also requested that the proposed
plan design provide the same or greater level of benefits than currently exist for the plan
participants.
On Monday, September 9, 1996 the City received a total of six proposals. The four companies
which submitted proposals with fully insured pricing were PCA Health Plans of Texas, Inc., FHP
Healthcare, Memorial Sisters of Charity, NYLCare; one minimum premium plan (MPP) pricing
by Cigna Healthcare and two administrative services only (ASO) by Blue Cross/Blue Shield of
Texas and Cigna Healthcare.
A fully insured plan limits the City's liability to the annual premium cost. The annual premium
is based on the quoted or fixed rates per monthly enrolled employee/retiree. This premium is paid
monthly and varies as changes occur in enrollment due to employment or termination of
employees. The City pays the premium monthly even if the employee does not access any medical
care. A minimum premium plan provides the City with increased cash flow and has a partially
insured provision. The partially insured provision limits the City's liability on the claim funding.
Administrative services only funding provides claims processing and administration. Under this
arrangement the City absorbs the first $150,000 of claims liability per individual. The individual
stop loss protection coverage will assume the risks for any claims in excess of the $150,000. This
funding approach is the same as currently exists with our indemnity plan.
Proposals were evaluated based on the criteria established in the specifications 'Attachment A
is a cost comparison of all proposals received. The evaluation criteria were availability of a
comprehensive range of managed care services providing value, access, quality and accountability;
network coverage; service reputation, experience and financial condition; deviations to
specifications; references and cost.
ATTACHMENT
1
After an initial review of each bid, Prudential Service Bureau, Inc. was eliminated from further
consideration. Prudential Service Bureau, Inc. would provide Cobra administration only. Cobra
administration involves a service which offers each participant and qualified beneficiary under the
medical plan the option to pay for continued coverage after termination. Phase II of the process
involved a teleconference discussion/interview with PCA Health Plans of Texas, Inc., FHP
HealthCare, and Memorial Sisters of Charity to further clarify their network coverage, range of
managed care services, benefits and specifications deviations. These companies were eliminated
from further consideration due to their limited network coverage - hospitals and physicians,
retirees exclusion and/or deviations from the current level of benefits offered.
Phase III of the process involved on-site discussions/interviews and teleconference
discussions/interviews with Blue Cross/Blue Shield of Texas, NYLCare and Cigna to further
discuss and clarify their plan design benefits and network coverage. These interviews and
discussions provided additional information and clarification of data submitted for staff to further
evaluate each bid. Favorable responses were received from references of these three companies.
Each of these companies is highly regarded in the health care industry. However, it was concluded
that the liability risks associated with an administrative services only arrangement would not be
in the best financial interests of the City. Again, Blue Cross/Blue Shield of Texas and Cigna
HealthCare submitted administrative services only proposals.
The quotes received from NYLCare and Cigna on a fully insured and minimum premium plan
respectively were further evaluated. It was determined after a thorough evaluation process that
the fully insured proposal submitted by NYLCare will limit the City's total liability to the annual
premium. It also represents the lowest cost based on the monthly enrollment as of August 1996.
NYLCare Health Plans of the Gulf Coast, Inc. (formerly Sanus Health Plan, Inc.) has been in
operation since 1984 in Houston. In August 1994 NYLCare enrolled its first group in the Golden
Triangle. On January 1, 1996 Sanus changed its name to NYLCare Health Plans of the Gulf
Coast, Inc. It is a wholly-owned-for-profit subsidiary of New York Life Insurance Company
dedicated exclusively to managing employee health and related benefits.
Evaluation of the proposals of the two finalists indicates the following for Cigna:
♦ provides all the basic benefits;
♦ has a comprehensive network with open access to approximately 500 primary care
physicians and specialists and eleven hospitals;
♦ network coverage includes Beaumont, Houston, Austin, San Antonio, Corpus Christi,
Lufkin/Nacogdoches and Lake Charles, LA;
♦ referral by the primary care physician to a specialist within the network is not limited to
to a physician group;
♦ and has approximately 28,900 covered lives in the Golden Triangle area.
A review of the proposal from NYLCare indicates the following:
♦ offers most of the current basic benefits;
♦ has richer inpatient hospital, outpatient surgery and preventive care benefits of$100, $25
and no copay respectively;
2
♦ has a network of approximately 400 primary care physicians and specialists and six
hospitals;
♦ referral by the primary care physician to a specialist is usually limited to the physician
group;
♦ network coverage includes Beaumont, Houston, Austin, San Antonio, Corpus Christi,
Lufkin, Lafayette and Lake Charles, LA;
♦ and has approximately 14,500 covered lives in the Golden Triangle area.
A more detailed comparison of the benefits and network coverage for each of the finalist
companies is included in Attachment B.
When considering the evaluation criteria, NYLCare's fully insured HMO best meets the cost
criteria. It will allow the City to continue to offer a managed care plan with emphasis on
preventive care at an affordable rate for the employees and their dependents. Staff is
recommending the NYLCare plan because of its premium rates. NYLCare also has richer benefits
in the areas of inpatient hospital, outpatient surgery and preventive care. However, the network
access referral to a specialist is more limiting than what exists with the current plan.
The City's current contract with Cigna Healthcare will terminate on December 31, 1996. The
City has received quality services from Cigna Healthcare. In the month of August 1996, the City
paid$270,026 for administration services and claims which includes capitation/network access
fees,pooling(stop loss) coverage,and actual claims. This total cost was based on the medical plan
enrollment of 804 einployees/retirees. The projected monthly premium cost for NYLCare will be
approximately $287,364. The monthly premiums will be based on the number of enrolled
employees/retirees.
It is recommended that a contract be awarded to NYLCare Health Plans of the Gulf Coast, Inc.
at the rates of$145.13 per month for employee only, $349.77 per month for an employee with
one dependent and$497.80 per month for an employee with two or more dependents for one year
with an option to renew for one additional year at a maximum rate increase of 5%. The effective
date of the contract will be January 1, 1997. Funds are available in the appropriate line item in
the Employee Benefits Fund for this expenditure.
chin
3
Attachment A
MANAGED CARE PROPOSAL EVALUATION
Total % of
Projected Projected Current
Company EO E1 E2+ Monthly Monthly Monthly
Claims Cost Base
(247) (174) (383) 1 1 (804) 1 ($270,026)
NYLCare 35,847 60,860 190,657 N/A 287,364 106%
CIGNA 38,668 65,697 205,893 N/A 310,258 115%
PCA Health Plans 29,647 50,373 157,865 N/A 237,885 88%
of Tx,
FHP Healthcare 28,719 48,791 152,909 N/A 230,419 85%
Memorial Sisters of 30,571 51,937 162,775 N/A 245,283 91%
Charity
Blue Cross/Blue 7,585 8,091 22,187 240,833 278,696 103%
Shield of Texas
(ASO)
CIGNA(ASO) 9,228 11,388 32,858 240,833 294,307 109%
Prudential Service Provided quote for COBRA administration only--
Bureau, Inc. not considered for further evaluation.
MANAGED CARE PROPOSAL RATE EVALUATION
Company EO E1 E2+
NYLCare 145.13 349.77 497.80
CIGNA(MPP) 156.55 377.57 537.58
PCA Health Plans of Tx. 120.03 289.50 412.18
FHP Healthcare 115.27 280.41 399.24
Memorial Sisters of Charity 123.77 298.49 425.00
Blue Cross/Blue Shield of Texas (ASO) 30.71 46.50 57.93
CIGNA (ASO) 37.36 65.45 85.79
4
Attachment B
MANAGED CARE PROPOSAL ANALYSIS
All Print,
3 yr. Same Open Golden On- mail, COBRA EAP Provide
Company rate benefit network Triangle line cards, Admin. Coor. All Rpts
guar. level hospitals or books,
in PC etc
network
NYLCare No No No No Yes Yes Yes Yes No
CIGNA No Yes Yes Yes Yes Yes Yes Yes Yes
Blue Cross Yes No Yes Yes Yes Yes Yes Yes No
Blue Shield
of Texas
NETWORK COVERAGE COMPARISON
NYLCARE CIGNA
Number of network PCP's in the Golden Number of network PCP's in the Golden
Triangle is approximately 100. Triangle is approximately 196.
Number of network specialists in the Golden Number of network specialists in the Golden
Triangle is approximately 287. Triangle is approximately 310.
Golden Triangle network hospitals include St. Golden Triangle network hospitals include St.
Elizabeth, Beaumont Regional Medical Elizabeth, St. Mary, Beaumont Regional
Center, Baptist-Beaumont, Baptist Orange, Medical Center, Baptist-Beaumont/Orange/
Park Place and Mid-Jefferson; negotiating with Liberty, Park Place, Mid-Jefferson, Doctor's-
Jasper Memorial and Baptist-Liberty Silsbee/Groves and Jasper Memorial
14,500 covered lives in the Golden Triangle. 28,900 covered lives in the Golden Triangle.
Golden Triangle clients include Chevron, Golden Triangle clients include Mobil Oil, Star
Coca-Cola, Chemical Waste Management, Enterprises, Ameripol Synpol, E.I. Dupont,
Channel 12, Texas Commerce Bank, Austin Temple-Inland Forest, Petrocon,Allied Signal,
Industrial, Bayer, Beaumont Chamber of BASF,Taylor Medical, Rhodes Furniture, Sun
Commerce, Turner Construction, Cargill, Life Assurance, Systemduse, Sunamerica, _
Texaco, Dillard's, Hearst Corp., Sysco Food Southern Pacific Rail, Hydrochem Industrial,
Service, Trinity Industries Gensler&-Assoc., General Electric Insurance.
Uses the physician group model. Referral to Open network allowing referrals to specialists
a specialist normally occurs within the chosen in Houston, Galveston, Corpus Christi, San
physician group. Antonio, Austin, Lufkin/Nacogdoches.
College students are covered out of network College students are covered out of network
for emer encv care only. for urgent and emergency care.
5
Attachment B
MANAGED CARE
COVERAGE,/COST COMPARISON
PROPOSED CURRENT
COVERAGE NYLCARE PLAN CIGNA`PLAN
GENERAL PROVISIONS
Lifetime Maximum Unlimited Unlimited
Calendar Year Deductible None None
Out-of-Pocket Maximum $850 individuaV$2,000 family None
PREVENTIVE CARE
Well Woman
Routine-Physical Exam including pap No charge (one self referral $10 co-pay(one self referral
test per year) per year)
Routine Mammography No charge if part of routine No charge if part of routine
physical physical
Rectal/Colon No charge if part of routine No charge if part of routine
physical physical
Well Man
Routine Physical Exam No charge $10 co-pay
Prostate Exam No charge if part of routine No charge if part of routine
physical physical
Rectal/Colon No charge if part of routine No charge if part of routine
physical physical
Well Bally/Child
Routine Preventive Care including No charge $10 co-pay
immunizations up to age 2
Initial vision/hearing screening by No charge $10 co-pay(children under
PCP for dependent children 17)
OUTPATIENT DR'S OFFICE
VISITS:AND TREATMENT ?:
Physician Office Visits $10 co-pay $10 co-pay
Allergy Testing $10 co-pay $10 co-pay
Allergy Treatments (inclusive of $10 co-pay $10 co-pay
serum/shots)
Allergy serum only $10 per 30 day supply $10 per 30 day supply
6
Attachment B
PROPOSEIJ' CURRENT
COVERAGE MICARE PLAN CIGNA`PLA1V
HOSPITAL
Inpatient Hospital Services (including $100 per admission $250 per admission
inpatient hos-pital professional
services)
SURGERY
Physician's Office $10 co-pay $10 co-pay
Outpatient HospitaVSiirgical Center $25 co-pay $100 co-pay
Day Treatment Center $25 co-pay $100 co-pay
EMERGENCY/URGENT CARE
Hospital Emergency Room $50 co-pay $50 co-pay
Urgent Care Facility $25 co-pay S10 co-pay
Physician's Office (after hours) $25 co-pay $10 co-pay
Ambulance No charge No charge
CHEMICAL DEPENDENCY
Outpatient Services $10 co-pay $10 co-pay
Inpatient Hospital Care $100 per admission $250 per admission
MENTAL HEALTH
Outpatient Service $25 co-pay; up to 25 visits per S25 co-pay; up to 30 visits
calendar year per calendar year
Inpatient Hospital Care $100 per admission up to 30 $50 per day up to 30 days
days per calendar year per calendar year
Serious Mental Illness-Inpatient $100 per admission $250 per admission
HOMECARE
Skilled Nursing Visits $10 co-pay; limited to 60 days No charge
per medical condition per
year
Home Physician Visits $10 co-pay No charge
Skilled Nursing Facility S25 per day $250 per admission
7
Attachment B
PROPOSED CURRENT
COVERAGE NYLCARE'PLAN 1. CIGNA PLAN
ORGAN TRANSPLANTS
Transplants including Physician's $100 per admission; through $250 per admission; through
Services Centers of Excellence- covers Lifesource-covers two
• Bone marrow expenses for one companion parents if child is recipient or
► Heart until recipient is no longer in one companion for an adult;
► Heart/Lung acute care pays expenses for entire
► Lung length of stay for
► Cornea companion(s)
► Kiidney
► Liver
MATERNITY
Prenatal (Maternity Care) $10 first visit $10 first visit
All subsequent prenatal/postnatal No charge No charge
visits SL delivery
Hospital Admission $100 per admission - charge $250 per admission - charge
for mother only for mother only
FAMILY:PLANNING
Tests, counseling $10 co-pay $10 co-pay
Surgical sterilization procedures
(vasectomy, tubal ligation):
► Inpatient $100 per admission $250 per admission
► Outpatient $25 co-pay $75 co-pay
► Dr.'s Office S25 co-pay No charge
INFERTILITY
Office visit $10 co-pay $20 co-pay
Treatment/surgery 50% co-pay; some exclusions 50% co-pay, some exclusions
PHYSICAL THERAPY,
CHIROPRACTIC &REHAB
Physical Therapy $10 co-pay; limited to 60 $10 co-pay; limited to 60
consecutive days per consecutive days per
condition per year condition per year
Chiropractic Not covered $10 co-pay; limited to 60
consecutive days per
condition per year
Short Term Rehabilitation $10 co-pay; limited to 60 $10 co-pay; limited to 60
consecutive days per consecutive days per
condition per year condition per year
8
Attachment B
PROPOSED CURRENT
COVERAGE NYLCARE PLAN:. CIGNA PLAN'
PROSTHETICS &DURABLE
MEDICAL EQUIPMENT
External Prosthetic Appliances No charge, no limit $200 co-pay up to$10,000
per calendar year
Durable Medical Equipment No charge, no limit $200 co-pay up to$10,000
per calendar year
MISCELLANEOUS
Independent Lab &-X-ray No charge No charge
Speech &Hearing S 10 co-pay $10 co-pay
Attention Deficit Hyperactivity Not covered $10 co-pay
Disorder
9