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Home My WebLink About1992-210e wpdocs\p h eo 900 30 ORDINANCE NO. ?O -aL0 AN ORDINANCE ACCEPTING COMPETITIVE BIDS AND PROVIDING FOR THE AWARD OF CONTRACTS FOR THE PURCHASE OF EMPLOYEE GROUP HEALTH INSURANCE TO PHILADELPHIA AMERICAN LIFE INSURANCE COMPANY; PROVIDING FOR THE EXPENDITURE OF FUNDS THEREFORE, AND PROVIDING FOR AN EFFECTIVE DATE WHEREAS, the City has solicited, received and tabulated competitive bids for the purchase of employee group health insurance in accordance with the procedures of state law; and WHEREAS, the City Manager, his designee, and the City's professional insurance consultant, have received and recommended that the bid described below is the lowest responsible bid for the purchase of such insurance as described in the request for Bid No 1442 and Bid Submission Form, and WHEREAS, the City Council has provided in the City Budget for the appropriation of funds to be used for the purchase of the insurance policies and coverages approved and accepted herein, NOW, THEREFORE, THE COUNCIL OF THE CITY OF DENTON HEREBY ORDAINS SECTION I. That the bid of Philadelphia American Life Insu- rance Company for the purchase of employee group health insurance, as described in the plans and specifications contained in the City's Request for Bid No. 1442, a copy of which is attached hereto as Exhibit A, Bidder's response to the twenty-one questions raised in the City's Bid Submission Form, a copy of which is attached hereto as Exhibit B, and Bidder's clarification letter of December 1, 1992 on file in the Office of the City's Purchasing Agent, a copy of which is attached hereto as Exhibit C, and the terms and provisions of the contract contained in Ordinance No 91-169 and incorporated herein and made a part hereof for all purposes (with the exception of the amendment to Exhibit A and Exhibit B of said contract) on file in the Office of the City Secretary, is hereby accepted and approved as being the lowest responsible bid SECTION II. That the City Council hereby authorizes the ex- penditure of funds in the manner and amount as specified in the agreement. SECTION III. That this ordinance shall become effective imme- diately upon its passage and approval PASSED AND APPROVED this the day of 0961MAed0', 1992 BOB CASTLEBERRY, MAYOR ATTEST: JENNIFER WALTERS, CITY SECRETARY BY APPRO D AS O LEGAL FORM: DEBRA . DRAYOVITCH, CITY ATTORNEY BY PAGE 2 EXHIBIT A CITY OF DENTON REQUEST FOR BID BID NO. 1442 Health Insurance Program Due: November 25, 1992 cwl t;l DLNTON, t EGAL DLPT CITY OF DENTON Request for Bid for Group Medical TABLE OF CONTENTS Page Background and General Information 1 Scope of Specifications and Instructions 2 Plan Assumptions (Exhibit I) 6 Bid Submission Form (Exhibit II) 7 Current Schedule of Benefits & Proposed Schedule (Exhibit III) 11 Plan Experience (Exhibit IV) . . 18 Carrier/Underwriter Profile (Exhibit V) 19 Census Data (Exhibit VI) 20 AAAOOFFD AND GENERAL INFORMATION The City of Denton is a city of 68,000 population and was incorporated in 1866 Denton is located approximately 40 miles north of Dallas and Fort Worth It site at the apex of a triangle that encompasses the Dallas -Fort Worth metropolitan area Although it benefits from the forward thrust and continuous expansion of the largest Consolidated Metropolitan Statistical Area in the state, Denton and its economy stand proudly independent. The City of Denton has a work force of approximately 850 employees The City has had an effective safety and risk management program since 1970 The services the City provide consist of law enforcement, fire safety, paramedics/rescue, refuse collection, sanitary landfill, electric, water, sanitary sewer, storm sewer, animal control, parks/recreation, library and airport In general, we are a full -service city, however, there is no city hospital or rest home Two major universities -- University of North Texas and Texas Woman's University -- along with a fully accredited public school system, allow local citizens every educational advantage possible and a rich blend of cultures The eastern and western branches of Interstate Highway 35 meet in Denton, making it conveniently accessible to everything in Dallas and Fort Worth Denton offers worlds of opportunities to the prospective developer, business person or industrialist Texas Instruments has a plant here and other industries are expanding. Any questions regarding the City's current health plan or this bid should be directed to Ike Obi at (817) 566-8340. Questions concerning the bid submittal should be directed to Tom Shaw at (817) 383-7100 AAAOOFFD -1- SCOPE OF SPECIFICATIONS & The City will entertain proposals on fully insured managed care plan basis The specifications contained herein will encompass Network only and Non -Network Plans. Since we are presently evaluating options to reduce our cost, we are seeking optional quotes on plane designed to achieve this. We, in essence, urge innovative approaches to health care coverage The City of Denton is seeking an insurance policy/agreement to become effective January 1, 1993, for a minimum of one (1) year The policy shall provide, if not cancelled prior to December 31, 1993 in accordance with the terms of the policy/agreement, bid submission form, and/or request for bidders, for the renewal of this policy for two (2) successive twelve (12) month periods, thereafter subject to the renegotiation of the terms of this policy, if City Manager and insurance company agree, without the necessity of rebidding this insurance proposal as long as the cost of insurance during either the first or second twelve (12) month successive period does not increase more than 30% and the plan design benefits do not decrease more than 30%. However, this proposal may be terminated if insurance company and City are unable to agree in writing to a mutually agreeable plan design and insurance cost no later than seventy-five (75) days prior to the end of the preceding period The City is interested in a fully insured managed care proposal The instructions contained herein apply to all sections, otherwise, each section can stand alone, or be a part of a partial or total package. Although the City is interested in packaging these coverages, for a number of reasons, it is understood that all coverages contained within these specifications cannot necessarily be incorpo- rated into a single policy, either because of Texas law, or because some of the coverages do not lend themselves to that procedure The City is allowing for the possibility that some agencies or underwriters would prefer not, or be unable, to quote all coverages in these specifications and will not place packaging over another alternative which is clearly beneficial to the City and the taxpayers The City will also accept and encourage innovative and alternative methods of pricing and coverage of risks so long as they do not violate Texas laws however, exceptions must be noted and made in addition to the specifications, which should be adhered to for the purpose of proper comparison, and all such variations must be clearly detailed, including advantages claimed to be gained thereby. Please review the entire scope of specifications, instructions, and the specification package carefully before submitting quotations Conflicts Between Reauest for Bid and Bid Should a conflict arise between the terms and provisions of this request for bid and the bid of the insurance company (which includes insurance policies, insurance agreement, etc.) the terms and provisions of this request for bid will prevail. Incontestability Provisions Are InaDnliCable City and Bidders agree that if a conflict arises relating to an interpretation or meaning of the terms and provisions of city's request for bid and the bid of the insurance company (which includes insurance policy and insurance agreement, etc ) such conflict will not be resolved through arbitration or be waived by the parties, but will be resolved by judicial review in the courts in Denton County, Texas Duty of C rrier In order for bids to be compared on an identical basis, it is necessary that all portions of the document, including requests for specific information about coverage, ratings, services, forms and general information regarding the carrier, be completed and adhered to. AAAOOPPD -2- scope of Specifications & Instructions Carriers participating in this process must guarantee that these specifications will be used in their presentations to their underwriters without modification For purposes of comparison, it is important that quotations be submitted on this bid form (see Exhibit ii) Any amendments or innovations must be submitted by addendum to this specific package -- and so noted. Sample policies, including endorsements, must be submitted with all quotations Commitments in writing from underwriters and re -insurers are also required as a part of the quotations Any carrier which is unable or unwilling to meet the specifications shall so state (with a full explanation) and detail the coverages affected, whether or not adversely, in a supplementary letter to be attached to the submitted quotation, specifically noted and made a part thereof. Underwriters' oualifications All carriers must be licensed to do business in the State of Texas and maintain a BEST'S Insurance Guide rating of at least A (excellent) Exhibit V must also be completed caveat Although every effort has been made to provide accurate and up-to-date information, companies supplying quotations should contact the City for any questions that you might have Contract stipulation Any carrier chosen by the City of Denton will be required to cover all eligible employees of the City that are currently covered regardless of whether they are actively at work or not. The City is subject to the provisions of the Consolidated OMNIBUS Budget Reconciliation Act of 1986 (COBRA) Proposals must conform to this law Administration The successful bidder will be required to perform all necessary administrative functions in order to effectively manage the benefit plans and to comply with prevailing laws and regulations These functions include, but are not limited to, the issuing of booklets, Certificates of Insurance, I D cards and master policies as well as providing for claims auditing and processing, computer - generated experience reporting at least quarterly, enrollment materials, claim forms, and conversion forme All costs associated with the provision of such services must be included in the rates and reflected within the retention illustration The City also desires representatives from the selected carrier to be available to conduct large group meetings if deemed necessary Criteria for Bid Selection The award of the contract will not be based on cost alone The City will evaluate the bids on rates as well as the following. 1 claims processing capabilities 2 Contractual requirement (i e., billing etc.) 3 Ability or willingness to make a timely, accurate and inexpensive transition with current carrier 4 Ability to service contracts 5. Bidder's financial stability 6 Ability to provide claims data in the forms necessary to track the performance of the plan Note Bidder should provide an explanation for all items giving as much information as possible, including a transition plan samples of claims reports, and other information AAAOOFFD -3- scope of Specifications & Instructions 7 Please Provide your completed contract outlining your proposal Times and Locations for Filino Quotations Quotations shall be considered irrevocable for sixty (60) days, and the City of Denton reserves the right to accept or reject any or all quotations and waive any informalities in any quotation. Request for detailed specifications, lose experiences, and questions should be directed to Ike Obi, City of Denton at (817) 566-8340 All quotations must be submitted with two copies (in a sealed envelope, clearly marked "Insurance Quotations for the City of Denton, Texas") on or before November 25, 1992, at 2.00 p m. to: Mr Tom Shaw Purchasing Department Service Center 901 8 Texas Street Denton, Texas 76201 AAAOOFFD -4- The following exhibits and instructions are pertinent to the completion of this bid EXHIBITS I Plan Assumption II Bid Submission Form III Schedule of Benefits IV Plan Experience V Carrier/Underwriter Profile VI Census Data AAAOOFFD -5- INSTRUCTION/COMMENTS See Exhibit I Please do not submit your standard bid, rather simply complete the bid form Details of benefits provided under the current plan Exhibit III Basic information on carrier and/or underwriter must be completed EXHIBIT I ASSUMPTION 1 Plan Year January 1, 1993 - December 31, 1993 2 Contract Multi -year contract as the City of Denton is interested in a long term association with carrier The City requires a rebid of its health Insurance program every three years 3 Plan Design Two Basic Plan Designs (Exhibit III) A Network Provider B Non -Network Provider Miscellaneous provisions for exceptions such as services outside service areas, emergency service outside service areas. Bidders must agree to include the two local hospitals in the Network Provider List A fully -insured proposal 4 Funding Fully -insured managed care plan The plan will be net of commission 5. Annual Claims History See Exhibit VI. AAAOOFFD -6- EXHIBIT II CITY OF DENTON BID SUBMISSION FORM FOR FULLY -INSURED Managed Care BID Carrier/Vendor Date Completed By: Phone Number: 1 Premium Rate for the Health Plan, net of commissions: (Name & Title) Monthly Cost Active Current Benefits Proposed Benefits a Employee Only $ $ b Employee & Spouse $ $ c Employee & Child $ $ d Employee & Family $ $ e How long are rates guaranteed? mo/yr mo/yr Retirees Under 65 a Retiree Only $ S b Retiree and Spouse $ S C. Retiree and Children S $ d. Retiree and Family S $ Retirees 65 or Over (on Medicare) a Retiree Only $ $ b 2 on Medicare $ $ c 1 on, 1 off $ $ d 1 on, 1 off + Family $ $ e 2 on + Family $ $ f How long are retiree rates guaranteed? mo/yr mo/yr 2. Are there any other fees in addition to the Premium Rates? If yes, identify and state the amount PURPOSE AMOUNT Identification Card $ Medical conversion $ Large Claim Management $ Bank Reconciliation $ S AAAOOFFD -7- Exhibit II 3 a What claim payment software do you use? b Where are your claims processed? 4 Is a software system or vendor change planned for the period 01/01/93- 12/31/93? If so, to what system/vendor? 5 Assuming that the contract for the City of Denton plan will be effective January 1, 1993, provide a detailed implementation plan for the transition on a separate sheet of paper. Be specific concerning your capabilities to load detailed coverage and claims history information 6 Claim payment software features Which of the following features are inherent to your current claim payment software? Yes No a Hard coded plan design — b Direct eligibility interface _ c Deductible applied and calculated _ d Out-of-pocket applied and calculated e Duplicate payment audit f Pooled claim accounting — g Interface to pre -certification service 7 What percent of claims are subject $ to internal claim office audit? 8 What is your claims processing accuracy rate? a Transaction $ b Dollar Value % 9 Please provide the most recent internal audit report (within the last year), verifying your claims processing accuracy levels Yes No 10 Will your claim system facilitate a future _ PPO plan design, either as a per diem based, or reduced charge, of higher coinsurance percentage, etc.? Yes No 11 Can the City of Denton Human Resources _ Department access their claim files electronically and directly via an on -site modem? SOne-Time SRecurrino If so, what are costa (one-time and recurring?) AAAOOFFD -8- Exhibit II 12 Do you offer the following Utilization Review services? If so, please identify the services provided and describe your billing structure and estimated costs for each of the areas previously mentioned, i.e. initial setup fees, monthly fees/employee or fees/service, minimum fees, etc Per Service Setup Yee No EE/Mo, Fees Fees HOSPITALIZATION Pre -certification Reviews Continued Stay Reviews: Concurrent Stay Reviews SURGERY Second Surgical Opinion Reviewas Outpatient Surgery Reviews. LARGE CASE MANAGEMENT Research of Catastrophic Cases. AIDS Case Management: Mental Health Case Management. OTHER SERVICES Bill review & Claim Audits: DRG Validations. Ancillary Service Evaluations: Analysis Reports. TOTAL FEES 13 Fund Balance Statement (Recap of Check Register showing fund balances with interest earned, when deposits were made, etc ) 14 Hospital Utilization Reporting (Frequency and bed days) 15 Please provide a list of 3 client references, and a list of 3 former clients who have discontinued your services within the last two years 16 Please provide a sample specimen of all agreements/contracts, etc for all the,above listed services. AAAOOFFD -9- Exhibit II 17 Please provide the most recent audited financial statement or a "Statement of Condition" if an audited financial statement is not applicable, for your firm 18 If any insurance is quoted on a retention basis, please explain the reserves that will be established, the methodology for determining the amounts, and the disposition of the reserves upon termination of the contract 19 Please explain the COBRA administration offered by your organization and any additional costs for these services 20 Does your bid require that you provide all of the insurance and/or services specified in this bid, or will you "unbundle" the services quoted? 21 Please provide your recommended plan designs based upon the network vs non -network point of service option AAAOOFFD -10- EXHIBIT III CURRENT SCHEDULE OF BENEFITS CITY OF DENTON SERVICE NETWORK Physician's office Visit $15 per visit Preventive Care Well Baby $15 per visit (Recommended schedule) Routine $15 per visit Immunizations for children 2 and under Annual Health $15 per visit Assessment Employee/Covered Spouse 35 years or older. Includes: Cheat X-Ray, Urinalysis, EKG, Blood testing. Well Woman Exam Annual (once every $15 per visit 12 months) Routine Vision, speech, Hearing screening 0 through age 17 $15 per visit In -Hospital services (1) No limits on $50 per day up to 10 medically necessary days days Must be pre - certified by Intracorp (1) semi -private room All necessary hospital services AAAOOFFD -11- Deductible plus 30% of schedule plus any amount over schedule. Not covered Not covered Not covered Not covered Not covered $300 per admission deductible plus deductible plus 30% (7) Exhibit III SERVICE NETWORK NON -NETWORK outpatient Hospital Services Surgery or Treatment $50 per visit Deductible plus 30% of eligible charges (7) Maternity Care Physicians Visits $15 per visit Deductible plus 30% of schedule plus any amount over schedule In -Hospital Services $50 per day up to 10 $300 per admission plus days deductible plus 30% of eligible charges (7) Newborn Nursery (2) No additional copay 30% of eligible charges (7) Physicians Services Covered Not covered for Newborn Emergency or Urgent Care (In case of Accident or Sudden and Serious Illness) Hospital Emergency $50 per visit $50 per visit Room or Urgent Care Facility (3) Physician's Office $15 per visit $15 per visit Mental Health/Substance Abuse (Serious mental illness or Substance abuse) Physician's Office $15 per visit Deductible plus 30% of schedule plus amount in excess of schedule In the Hospital $50 per day up to 10 $300 per admission days deductible plus 30% of eligible charges. (7) Physical Therapy (4) $15 per visit Deductible plus 30% of eligible charges Family Planning Based on Service Not covered provided. Infertility Services $15 per visit Not covered Detection & Correction $15 per visit Deductible plus 30% of of Body Distortion (5) eligible charges Prescription Drugs (6) $100 deductible; $3 Not covered copay, generic, $10 copay, brand AAAOOFFD -12- Exhibit III 914WION Maintenance Drugs All Other Eligible Services Annual Deductible* Coinsurance* Lifetime Maximum* Up to 100 days supply, one copay Deductible plus 20% $250 plus a $100 drug deductible $1,000 (not including office visit copays) Unlimited *Family Limit is three (3) times individual maximum Not covered $SOO 30% up to $5,000 plus amount in excess of per diems & schedules. Unlimited Out -of -Service Area Residents For covered persons who reside outside service area (50-mile radius of City of Denton) plan of benefits is $250 deductible plus 80% of eligible charges up to a $1,000 out-of-pocket maximum Important Notes: 1 An additional $500 deductible will be applied if a hospital stay is not pre - certified by Intracorp. No benefits are available for days which are not determined to be medically necessary 2 No additional copayments are necessary while mother and child are confined at same time 3 If patient is admitted to Network Hospital from emergency room, $50 copay is waived. 4 Physical Therapy services are limited to 60 visits per medical condition. 5 Up to $500 in benefits for this service per year 6 If your physician permits or orders a generic drug and you decide to purchase brand, the cost will be generic copay plus the entire difference price between generic and brand. 7 Eligible charge is the per diem or schedule offered by network hospital Amounts in excess of that per diem or schedule do not apply to out -of -pocket - maximum. Network Providers are: Hospitals• Denton Regional Medical Center Denton MCA Community Hospital Physicians• Denton IPA North Texas Medical and Surgical AAAOOFFD -13- Exhibit III For services that cannot be performed at the hospitals listed above, network hospital providers are: Harris Methodist Harris HEB Humana Medical City Eligible services by non -network physicians affiliated with these facilities are paid after $250 deductible then 80% This is not a contract, this is a brief description of your benefits A booklet will be provided with more detail. AAAOOFFD -14- EXHIBIT III PROPOSED SCHEDULE OF BENEFITS SERVICE Physician's Office Visit Preventive Care Well Baby (Recommended Schedule) Routine Immunizations Annual Health Assessment Employee/Covered Spouse 35 years or older. Includes Chest X-Ray, Urinalysis, EKG, Blood testing. Well Woman Exam Annual (once every 12 months) Routine Vision, Speech, Hearing Screening 0 through age 17 In -Hospital Services (1) No limits on medically necessary days Must be pre - certified by Intracorp (1) Semi -private room All necessary hospital services EFFECTIVE 01/01/93 CITY OF DENTON NETWORK $15 per visit plug $50 copay for diagnostic services $15 per visit plus $50 copay for diagnostic services. $15 per visit plus $50 copay for diagnostic services. $15 per visit plus $50 copay for diagnostic services. $15 per visit plus $50 copay for diagnostic services. $15 per visit plus $50 copay for diagnostic services. $500 deductible, 100% AAAOOFFD -15- NON -NETWORK Deductible plus 40% of schedule plus any amount over schedule. Not covered Not covered Not covered Not covered. Not covered $300 per admission deductible plus the non - network deductible plus 40%. (7) Exhibit III SERVICE outpatient Hospital Services Surgery or Treatment maternity Care Physicians Visits In -Hospital Services Newborn Nursery (2) Physicians Services for Newborn Emergency or Urgent Care (In case of Accident or Sudden and Serious Illness) Hospital Emergency Room or Urgent Care Facility (3) Physician's Office mental Health/Substance Abuse (Serious mental illness or Substance abuse) Physician's Office (3) In the Hospital (3) Physical Therapy (4) Family Planning Infertility Services $75 per visit, 100% Deductible plus 40% of eligible charges (7) $15 per visit plus $50 Deductible plus 40% of copay for diagnostic schedule plus any amount services. over schedule $500 deductible, 100% $300 per admission deductible plus non - network deductible plus 40% of eligible charges (7) No additional copay 40% of eligible charges Covered Not covered $75 per visit, 100% $75 per visit, 100% $15 per visit plus $50 $15 per visit plus $50 copay for diagnostic copay for other services services, if any. $15 per visit plus $50 Deductible plus 40% of copay for diagnostic schedule plus amount in services excess of schedule. $500 deductible, 100% $300 per admission deductible plus the non - network plus 40% of eligible charges $15 per visit plus $50 Deductible plus 40% of copay for diagnostic eligible charges services. Based on Service Not covered provided $15 per visit plus $50 Not covered copay for diagnostic services AAAOOFFD -16- Exhibit III Detection & Correction of Body Distortion (5) Prescription Drugs (6) Maintenance Drugs All Other Eligible service■ Annual Deductible Coinsurance* Lifetime Maximum* $15 per visit plus $50 copay for diagnostic services $150 deductible, $5 copay, generic, $15 copay, brand. up to 100 days supply, one copay Deductible plus 20% $500 plus a $150 drug deductible $2,000 (not including $15 office visit copay) $1M Deductible plus 4O% of eligible charges Not covered. Not covered. $1,000 40% up to $6,000 plus amount in excess of per diems & schedules. $lM *Family Limit Is three (3) times individual maximum Out -of -Service Area Residents For covered persons who reside outside service are (50-mile radius of City of Denton) plan of benefits is $500 deductible plus 80% of eligible charges up to a $2,000 out-of-pocket maximum Important Notes 1 An additional $500 deductible will be applied if a hospital stay is not pre - certified by Intracorp. No benefits are available for days which are not determined to be medically necessary. 2 No additional copayments are necessary while mother and child are confined at same time. 3 An additional $500 deductible will be applied if a hospital stay is not pre - certified by Integrated Behavioral Health (IBH) No benefits are available for the days which are not determined to be medically necessary AAAOOFFD -17- CITY OF DENTON PLAN EXPERIENCE EXHIBIT IV JANUARY THROUGH OCTOBER 1992 *ACTIVE EMPLOYEE RATE Coverage Employee Monthly Employees' City's Counts Premiums Cost Cost Employee Only 361 $175 $10 $165 Employee + Spouse 83 272 107 165 Emplovee + Children 179 235 70 165 Employee + Family 184 340 175 165 807 > Call Ike Obi at (817) 566-8340 for Retiree Rates Month Premiums Medical Claims Prescription Drug Jan $ 171,754 $ 0 $ 4,096 Feb 202,728 41,119 8,808 Mar 190,711 186,623 9,569 Apr 196,377 229,068 13,979 May 195,177 144,166 16,679 Jun 195,962 308,488 17,636 Jul 194,517 182,947 18,010 Aug 184,223 217,513 17,132 Sep 186,736 210,015 20,603 Oct 190,724 129,955 18,000* TOTAL $1,907,909 $1,649,894 $ 144,512 (Exhibit IV continued) HIGH CLAIMANT REPORT January Through October, 1992 Diagnosis/Prognosis Amount Paid Cancer - Major surgery is over $ 43,495 Breast Cancer - Had a mastectomy 41,002 Blockage of Colon - Doing very well 39,539 Major problem with delivery - Alright now 38,206 Leg Injury - had surgery and back to work 37,598 Diagnosis information - not available 30,864 Diagnosis information - not Available 28,005 Heart Condition 26,360 Heart Condition, currently on disability 21,378 Heart Condition currently on disability 20,708 Tear in Rotator Cuff 18,680 Diagnosis information - not available 17,912 Maternity Expenses 17,857 Mental/Nervous - On -going 16,754 Hip Replacement Surgery - on disability 15,624 planxp93.prn EXHIBIT V CARRIER/UNDERWRITER PROFILE 1 Name of Firm Address 2 Name of Principal 3 ownership of Firm 4 Date Firm Was First Formed 5 Other Locations (City and State) 6 Location of Headquarters (City and State) 7 Location of claims Processing Office Tel, 8 Fidelity Bond $ (Submit Copy of Face Page of Policy or Certificate) 9 References: 1 2 3 4 city/State Name of contact Tel AAAOOFFD -19- 0 NAWN+IO NNVNNAWNI+OIG COVNNAWNA OIDNJNNAWN�ONNJNNAWNN----------- m O NNVNNAWN+ W N NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNr-----r_r"r_ W NNNWNNJVVVVVNNNNNNNNNNAAAAWN-+OONbNNNNAWN000NNNNNVVNNNNNNAWW+- +OVJ OONNNNAWW+000VNNANNNIGNNA+O OIDW OtGNAWNNAONVAVNOVNNA-N-NN-OOV)+IOWWNAW O ANNNNNNNNNNNNN+WAWNJAOON-WWAJ+VNWWWWNWAWANWAN+ANANNNANWWNWNAAAAWN- 2 ANNNOGIO NANN NCOA WANNNNGIN N+NNNAWNONOGIN ONNNNNONNNANNONANNANNNNNNOONOO C r ANNWNW++ONANOONONA+AWJO+NOON+N-NJOVNN-NNNVNNOrNONA+ NIG O N N WW J NWW0IG E N-O+AIG GINNOVOVWNNWWNWWOVWN+NNVNAWWWN-NN+NN-NNNNNOVNJNWNNNNOONN-WNN- N N NNONONONAWWWAVPNNJAONNJWOO AIGNOOWWPPJWPNNNNOANNAAWWNNVNNNANONVNVO T N NNONN OID VrNNPOONNNA+rOVWNWVNAW-VWWO-NWVNNAWJNONNONNJONIGONNNONONNN A 2 TATTTT02TNTTTTN2NTT22TNNN2TTQTTTTNTTOTTTmT2TTZOTTNTOT22TTTTliT002 O ; mIDTTTI;D9TTmT9S9DDERT999CTD2TTTT9DDImTTmTEmT;SDTVTIT;STTmmIT22; O N TT;;R6TSES;LT$TEm STTTTSLT$C3ETT;;g;;T;3T;T$EEE;Lit$iTREC;ET;S;; T O-O-OOOOOrrOr_rrOr000000000-0--000000OOOOrp0000-OrOr0000--0000000 N -NONNAIGNO+N-000NNNNNW-P-NJNVOOI➢NODA-NNNNN+NNN------NNWWNOOANWNN-- \\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\--- WON\\\\\\---- 00\\\\\ A NNO-ON-WN+ONNrN-W-O+N-r-ONNO+OON-r-NWOO--N--+NON000NON-+--000--00 ti W NNWNNOONOOJNOOOOOWNNJWAAOOPNWVNNNANVNONVN-NVJ--NNNNNAJWO-VNWIGN---- S N NNNNNNNNNWNNNNN+NNNJAANNNNNNNNAWAANANNNNWANNNNNNNWANAWAANNNNNNNN -1 NNVNONNWVNNrNNA1GJAN-WVONNN�DAVAU)-WVWNNANWVmNWNANON-NN-NIp N--NPN-AN- T F f1 Z - NaaaMaaaaNNNMNaaaaaaaaaNMaMaaaaaaaaHaaaMaaaaMaMaaaaMaaaaaaaaNaMaa N-N-NN-NN-ArNNWA-N-N++NWNN-WWNNN-N-NWWNWN-WNWN-WNN-N-NNWNWArNWNW- n < D N NANV+fGVNNJJONOVrNNNOJJWOWW-N-NNANN OIDAO-NNA--NO NIGNNONNOWOOAN-NN-O Z O O Z m -IDNVON+NN+NJNWNNNWJNNNWVNONJONNWNWN-AVNJWNNJWNWA-NNrNNNOANNVVNNVA 2 C m N WNNNOVNWVN-rNNN�NNNANO�NNPOmWWOONWWWNNNmNWAVAWVAmONWNOUINNNNONNOmO D N 2 NNANWANNNNNNNNNNOONNOONAANONNAOOONNNOONNNNNNONNNNOONWONAONAOWNONO < OOOOPOOAOOOOOOOOOOONO00000000000000000000000000000000000000000000 O a aaaaaaaaaaaaaaaaaaa aaaa aaaaaaaaaaMMaaaa as aaaaaaaaaaaaaaaaa - m NrN-WNNWNNA-NNWA-N-N NWNN WANNN-N-NAWNWN-W WN WWN+N-NNANWANNWNW P T N NNNrNO-NONN-VrNNVNIG NA+A NONWWNNN-ON+NJNN NIO MOW W 0-00"Ou" - A N 0 a 00000000000000000000 0000 0000000000000000 Oo 00000000000000000 m o c 00000000000000aa0000a0000000000000000a00a00000000000000000a m D 000000OOOOOOOOOOOOOOOOOOOOOODO00000000000000000000000000000000000 D D D m K 00000000000000000000000000000000000000000000000000000000000000000 ; 00000000000000000000000000000000000000000000000000000000000000000 0 9 ID y W -- N 0-00... 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Y « Y # Vl I ♦ ! Y 1 ! i 1 Y « # ! ! OI « N ♦ « Or M # # a. « of R a of « « m ! D ; m of # o O NI D n < O ♦ « m D o f c r n C N+ 2 r < OI n D < Z O NI T Aa m O I D D O D A m NI y Z n z NI A 9 OG + y D OI � WI O O+ 2 OI WI NY QI WI A+ O I W I m+ « O T CI W N W m W W TO 2 m 9 UI m o N A N a n O N A N O < m N A A 2 J 0 W O 2 O 9 m m ; O N A n m O w t0 m 01 N nC m m; a O J W A 2 O W W O y - N W N EXHIBIT B PHILADELPHIA AMERICAN LIFE INSURANCE COMPANY P O Box 2465 Houston Texas 77252 (713) 871 4600 November 18, 1992 Mr Dave Palatiere Consultant Coopers & Lybrand 1999 Bryan Street Suite 3000 Dallas, TX 75201 Dear Dave anL rHcompany Enclosed is the formal City of Denton renewal bid These fully insured rates are based on the schedule developed between you and John Kerr If you have any questions, please contact me ordi ly yours, J hn Rahlfs, Jr ccount Executive cc John Kerr EXHIBIT V 1 Name of Firm: Philadelphia American Lite insurance coma Address. 3121 Buffalo Speedway Houston, Texas 77098- Telephone (713) 871-4814 2 Name of Principal Mr Joseph P Crowley, President 3 Ownership of Firm- Philadelphia American Life Insu 4 Date Firm was First Formed. Philadelphia American has been 5 Other Locations (City and State) Philadelphia American nas the ' following offices throughout the United States: 1 Louisville (KY), 2 Racine (WI); 3 Houston (TX); 4 Waco (TX), 5 Sacramento (CA), 6 Agoura Hills (CA), 7 Rosemont (IL), 8 Baton Rouge (LA), I 9 Farmington, (CO) The company also maintains field sales offices in the following cities. 1 Atlanta (GA), 2 Houston (TX), 3. Dallas (TX); 4 Chicago (IL), 5 San Antonio (TX); 6 Santa Ana (CA), and 7 Sacramento (CA) 6 Location of Headquarters (City and State) I C.H is hheadauarter in Louisville Kentucky, 7 Location of Claims Processing Office Waco, Texas IJ 7 St. Paul Mercury Insurance Company, (Submit Copy of Face Page of Policy or Certificate) References Please refer to the Questionnaire portion of this proposal PHILADELPHIA AMERICAN LIFE and/ HwmP -Y EXHIBITII CITY OF DENTON PROPOSALS SUBMISSION FORM FOR FULLY -INSURED Managed Care BID Carrier/Vendor: Philadelphia American Life Insurance Company Date: November 18 1992 Completed By: Susanne I Behrens Vice -President (Name & Title) Phone Number: (713) 871-4668 1. Premium Rate for the Health Plan, net of commissions: Monthly Cost Active Current Benefits Proposed Benefits AT 1/1/93 a. Employee Only $ $ 201.25 b. Employee + Spouse $ $ 312.80 C. Employee + Child $ $ 270.25 d. Employee + Family $ $ 391.00 e. How long are rates guaranteed? mo/yr 1/YR mo/yr Retiree Under 65 a. Retiree Only $ $ 272.62 b. Retiree + Spouse $ $ C. Retiree + Children $ $ d. Retiree + Family $ $ 526.73 Retirees-65 or Over (on Medicare) a. Retiree Only $ b. 2 on Medicare $ c. 1 on, 1 off $ d. 2 on + Family $ e. How long are retiree rates guaranteed? mo/yr $ 92.56 $ 189.72 1/YR mo/yr 2. Are there any other fees in addition to the Premium Rates? If yes, identify and state the amount. PURPOSE Identification Card Medical Conversion Large Claim Management Bank Reconciliation 3. a. what claim payment software do you use? CHART/2000 is our modular Healthcare Analysis and Reimbursement Technologies (CHART) system winch acts as an umbrella within which we operate a variety of software, both internally and externally developed. Changes within the industry mandate ongoing enhancements to remain competitive in price and exceed industry averages in accuracy and production levels. To maintain this continual enhancement process, the system is supported by a full service data center and an in-house program- ming team. Our claim payment operations are processed through a fully automated Data Center located in Richardson, Texas. A network of terminals, modems and controllers are connected to an IBM 3090 mainframe. The key to our success in customer satisfaction is the emphasis on continuous improvement. Through enhancements, Philadelphia American Life is able to control operational costs, reduce processing time, be more responsive to clamant inquires, and provide more powerful cost containment tools. Our clients are kept on the leading edge of technology and in the forefront of the discipline. They benefit from evolving cost containment concepts, such as recent trends toward PPO, IPA, and DRG processing. Some of the features of CV RT/2000 are: 1. Integrated eligibility with claims history 2. Direct eligibility interface capability (tape to tape transfer or dial -up with an upload to the system) 3. Dependent eligibility information maintained (name, DOB, relationship) 4. Flexible "hard coded" plan design automatically calculates benefit payment based on client -specific plan designs 5. Administration of multiple plan options, including cafeteria plans, for one client 6. Immediate update and tracking of plan benefits accumulators such as: Mental and Nervous limitations Deductibles Coinsurance percentages Annual and lifetime maximums Reinsurance limits Out of pocket maximums Occurrence limits 7. Automated reimbursement utilizing plan deductibles and 8. Automated claims processing based on incurred date of expenses 9. Automated calculation of Usual and Customary charges based on customer selected HIAA percentile (5-t increments: 65t to 95*, recommend 85t to 90-V for surgery and dental and Medirask for radiology, pathology, etc. 10. Identification of multiple PPO memberships for providers through maintenance of extensive provider information 11. Automated PPO benefits adjudication utilizing PPO discounts, PPO per diems, PPO co -pays or PPO schedule approaches 12. Adjudication of faxed -schedule benefits 13. Interface and adjudication of Prescription Card Service benefits 14. Automated coordination of benefits and subrogation 15. Integrated pre-certification/utilization review capabilaty 16. Batch payment (issuance of checks once a day, once a week, twice a month or tailored to a client's specific needs) 17. Bulk payment (issuance of one check to employee for claima on multiple family members and one check to provider for claims from multiple patients) 18. Interface capability with third -party vendors 19. Pooled claim accounting 20. Administrative system with immediate interface to our claims administration system 21. Duplicate payment audit automatically performed based on service dates and provider 22. Advanced check processing facali ties which m7m7m7ze storage and processing costs whale maximizing check security and control 23. Electronic funds transfer capabilities which provide an optimal cash flow position for our customers 24. Automated bank reconciliation provided with full client reporting 25. Comprehensive plan analysis reporting 26. Extensive date base provides flexibility in customized (ad hoc) management reporting 27. Full 1099 reporting on medical payments for providers b. Where are your claims processed? While Philadelphia American Life has nine claims offices to process claims: 1) Houston, Texas; 2) Waco, Texas; 3) Louisville, Kentucky; 4) Racine, Wisconsin; 5) Xing of Prussia, Pennsylvania; 6) Agoura Hills, California; and 7) Sacramento, California and 8) Baton Rouge, Louisiana, and 9) Farmington, Connecticut, the City's claims would be processed by our Waco claim office which was established in 1978 and currently employs 25 people. The Waco office address is: Philadelphia American Life Insurance Company 100 North 6th Street Waco, TX 76701 Additionally, a dedicated Customer Service Unit is located in the Waco claim office. Our Customer Service Representatives (CSR's) are available to respond to employee questions regarding benefits, eligibility and claims. our Customer Service business hours are Monday through Friday, 8:00 a.m. to 5:00 p.m. (CST) The toll free number is 1-800-333-9202 4. is a software system or vendor change planned for the period O1/O1/93-12/31/93? if so, to what system/vendor? A system upgrade is not planned for that period. Our software has an open architecture and is basically modular in nature. We strive to anticipate changing client and market needs. In keeping with our commitment to utilize the very best technology for our customers, we will continue to install enhancements to the system we currently use. 5. Assuming that the contract for the City of Denton plan will be effective January 1, 1993, provide a detailed implementation plan for the transition on a separate sheet of paper. Be specific concerning your capabilities to load detailed coverage and claims history information. Should the City of Denton select Phuladelphia American Life to insure their group medical plan, we would assist the City in performing a re -enrollment of their employees. This should be performed as soon as possible after the contract has been awarded. It is most important that a complete eligibility listing be provided so that appropriate ID cards can be issued. A record format will be provided to City of Denton to create an eligibility tape which can be loaded into Philadelphia American Life's system. The eligibility list should be provided no later than the second week of December. An application for Group Insurance will be provided immediately upon contract award, as well as a sample contract indicating the complete schedule of benefits (outlined in general in this proposal) and any special provisions. ID cards would be available by late December (for January 1); booklets would be available within two weeks of signing client proofs. A Corporate Account Sxecutsve will be available to assist in the transition; assist with open enrollment, etc. 6. Claim payment software features: Which of the following features are inherent to your current claim payment software? Yen NO a. Hard coded plan design X — b. Direct eligibility interface X — c. Deductible applied and calculated X — d. out-of-pocket applied and calculated X — e. Duplicate payment audit X — f. Pooled claim accounting X — g. Interface to pre -certification service X _ 7. What percent of claims are subject to internal claim office audit? 5 (random) + 100% certain specific claims (suspect providers, analyst exceeding authority limits, system overrides, certain dollar limit claims) 8. 9. What is your claims processing accuracy rate? a. Transaction 98.3% b. Dollar Value 99.8% Please provide the most recent internal audit report (within the last year), verifying your claims processing accuracy levels. Philadelphia American Life has a formal quality management program which is administered by the Claims Administration department. The claims manager of each regional office is responsible for administering the quality program in that office. The manager guarantees that all requirements established by Claims Administration are satisfied. Each office has a full-time auditor who reports to the office manager. The auditor randomly selects and audits 5t of each claim processor's daily claim production and 100t of those claims which exceed the processor's payment authorization level. The audit consists of monetary accuracy, coding accuracy and quality (a combination of monetary and coding accuracy). A log of all claims audited is maintained and is available to Administration for review. The log references the specific claims audited, the error found and the Benefit Analyst processing the claim. Additionally, quality records are maintained for each Benefit Analyst and are available to the Benefit Analyst of Claims Administration upon request. The results of all audits are posted to a monthly quality report. This random audit procedure represents the quality control of Philadelphia American Life's claims operations. It is an important part of the service we provide our clients. SPECIFICS OF AUDIT: THE FOLLOWXNG ITEMS MUST BE AUDITED ON EACH CLAIM: Social Security Number Group Number Patient Name Ned/Dent Register complete or Updated Correctly History Loaded Correctly Pre -Existing Second Surgical Opinion Skipped Bills Correct Claim Number Correct Cause Code Correct Typecode, CPT Code Reject code necessary, correct Manual letter sent, if appropriate Override necessary, correct Received Date Charge entered correctly ASP changed Proper COB rules used Coordination on correct U&C charge Follow Instructions on IC Screen Other insurance payment indicated correctly Payment correct Provider file dated update Charge Eligible Under Plan Provider ID Assigned Properly Pend Code Necessary, Correct Requested All Necessary Information Please see attar -bed quality/production report showing the Waco office's results for 10. will your claim system facilitate a future�PPO plan design, either as a per diem based, or reduced charge, of higher coinsurance percentage, etc.? 11. Can the City of Denton Human Resources Department access their claim files electronically and directly via an on -site modem? If so, what are costs (one-time and recurring?) Yes N X x_ — $One -Time $Recurring 6,355.00 65/mo CEART/2000 has the flexibility to allow a client "inquiry" access to the client's eligibility information and claims history. The client would be responsible for the direct cost of the hardware, data communication package, and ongoing data communication costs. There is an initial set up cost which would be determined by hardware compatibility and any client -specific programming. Additionally, we have the capability to download claims history data electronically or onto a diskette to facilitate client reporting. The cost for this service is also dependent upon client -specific programming costs. 12. Do you offer the following Utilization Review services? If so, please identify the services provided and describe your billing structure and estimated costs for each of the areas previously mentionedi i.e.: initial setup fees, monthly fees/employee or fees/service, minimum fees, etc. Philadelphia American Life is pleased to be in the positron to provide The City of Denton with the services listed below at no additional cost to The City. Per Service Setup yen NO RE/Mo. RE/Mo.Fees Fees HOSPITALIZATION Pre -certification Reviews: x_ Continued Stay Reviews: x_ Concurrent Stay Reviewss x SURGERY Second Surgical Opinion X Reviews: Outpatient Surgery *_X Reviews: • Not required LARGE CASE MANAGEMENT Research of Catastrophic X Cases: AIDS Case Management: X Mental Health Case X Management: OTHER SERVICES Bill review & Claim Audits: x_ DRG Validations: x Ancillary Service x Evaluations Analysis Reports: X TOTAL FEES N/A N/A — /A N/A N/A 13. Fund Balance Statement N/A (Recap of Check Register showing fund balances with interest earned, when deposits were made, etc.) 14. Hospital Utilization Reporting (Frequency and bed days) 15. Please provide a list of 3 client references, and a list of 3 former clients who have discontinued your services within the last two years. Client: Stephen F. Austin State Contact: Cathy Allen, Personnel Telephone: (409) 568-2304 Employees: 1,275 Effective: 911190 Coverage: Medical, Life, & AD&D, University Services Stop Loss Coverage Client: Recognition Equipment, Incorporated Contact: George Lokey Telephone: (214) 579-6886 Employees: 975 Effective: 111186 Coverage: Medical, Dental, Vision, Life, Supplemental Life, Dependent Life, Stop Loss Coverage Client: Osteopathic Medical Center Contact: Anne Wilson Telephone: (817) 735-3149 Employees: 675 Effective: 611190 Coverage: Medical, Dental, Life, Stop Loss Coverage Client: Tenneco Contact: Howard Mead Telephone: (715) 757-2131 Rmployees: 12,000 Terminated: 111189 Reason for Termination: Left for reduced service levels at a reduced price. * Client: The Houston Chronicle Contact: Beverly Lundberg Telephone: (713) 220-7171 Employees: 400 Terminated: 211189 Reason for Termination: Wanted a triple option plan with Indemnity,HMO & PPO. NOTE: The Houston Chronicle was very pleased with our service and rates and we continue to provide their Group Life and AD&D coverages. Client: House of Almonds Contact: Gerald R. Riley, Manager of Human Resources Telephone: (805) 835-6000 Employees: 188 Termination: 211189 Reason for Termination: Parent company sold them and the purchasing company's group coverage absorbed House of Almonds. * Those who left due to reduced price levels generally did so to meet economic constraints within their industries. 16. Please provide a sample specimen of all agreements/contracts, etc. for all the above listed services. Please refer to the Agreement Section. 17. Please provide the most recent audited financial statement or a "Statement of Condition" if an audited financial statement is not applicable, for your firm. Please refer to the Ebchibit Section of the binder. 18. If any insurance is proposed on a retention basis, please explain the reserves that will be established, the methodology for determining the amounts, and the disposition of the reserves upon termination of the contract. The insurance is being proposed on a non -retention (non -refund basis). The claims reserves will be established and maintained at a level equal to the greater of 25t of annual earned premium or 33t of annualized claims. Upon termu nation of the policy, the reserves will remain with Philadelphia American Life since we will assume liability for the "run-off" claims. 19. Please explain the COBRA administration offered by your organization and any additional costs for these services. The following are COBRA services offered to The City of Denton. Philadelphia American Life will: a) Accept COBRA election forms from qualified beneficiaries (as defined by COBRA). b) Bill qualified beneficiaries for contribution of coverage premium. c) Collect premium from qualified beneficiaries and post the individual billing record. d) Deposit individual premium checks and issue a single check monthly to The City of Denton. e) Monitor each continues's eligibility period. f) Send cancellation of coverage notifications and conversion information. g) Provide claim suhmission information and forms. h) Provide customer service for inquiries regarding premium payment and status. i) Notify continuees of rate changes. J) Provide reports to the Policyholder regarding premium receipts and covered continuees. There would be no cost to the City of Denton for Cobra administration. We have many clients for which we provide COBRA service for medical and dental. A sample COBRA enrollment form and payment record are included in the hbcbibit Section. 20. Does your proposal require that you provide all of the insurance and/or services specified in this RFP, or will you "unbundle" the services proposed? As we are proposing only insured medical at this time, this question is not applicable. 21. Please provide your recommended plan designs based upon the network vs. non -network point of service option. PROPOSED SCHEDULE OF BENEFITS EFFECTIVE O1/01/93 CITY OF DENTON SERVICE NETWORK * NON -NETWORK Physician's Office Visit $15 per visit plus $50 copay for diagnostic services. Preventive Care Well baby (Recommended Schedule) Routine Immunizations Annual Health Assessment Employee/Covered Spouse 35 years or older. Includes: Chest X-Ray, Urinalysis, EKG, Blood Testing. Well Woman Exam Annual (once every 12 months) Routine Vision, Speech, Hearing Screening 0 through age 17 In -Hospital Services (1) $15 per visit plus $50 copay for diagnostic services. $15 per visit plus $50 copay for diagnostic services. $15 per visit plus $50 copay for diagnostic services. $15 per visit plus $50 copay for diagnostic services. $15 per visit plus $50 copay for diagnostic services. Deductible plus 40% of schedule plus any amount over schedule. Not Covered. Not Covered. Not Covered. Not Covered. Not Covered. No limits on $500 deductible, 100% $300 per admission medically necessary deductible plus days 40% of scheduled charges. (7) SEUICE Must be pre- certifiediby Intracorp (1) Semi -private room All necessary hospital services Outpatient Hospital Services Surgery or Treatment Maternity Care Physicians Visits $75 per visit, 100% $15 per visit plus $50 copay for diagnostic services NON -NETWORK Deductible plus 40'% of scheduled charges. (7) Deductible plus 40% of schedule amount over schedule In -Hospital Services $500 deductible, 100% $300 per admission deductible plus non - network deductible plus 40% of scheduled charges. Newborn Nursery (2) Physicians Services for Newborn Emergency or Urgent Care (In came oflAccident or Sudden and Serious Illness) Hospital Emergency Room or Urgent Care Facility (3) No additional copay Covered $75 per visit, 100% 40% of scheduled charges. Not covered. $75 per visit, 100% Physician's Office $15 per visit plus $50 $15 per visit plus $50 copay for diagnostic copay for other services. services, if any. ICE _ NETWORK Mental Health/Substance Abuse (Serious mental illness or Substance abuse) Physician's Office $15 per visit plus $50 (3) copay for diagnostic services In the Hospital (3) $500 deductible, 100% Physical Therapy (4) $15 per visit plus $50 copay for diagnostic services. Family Planning Based on Service provided. Infertility Services $15 per visit plus $50 copay for diagnostic services. Detection & Correction $15 per visit plus $50 of Body Distortion (5) copay for diagnostic services. Prescription Drugs (6) $150 deductible; $5 copay, generic; $15 copay, brand Maintenance Drugs up to 100 days supply; one copay All Other Eligible Deductible plus 20% Services Annual Deductible $500 plus a $150 drug deductible. NON -NETWORK Deductible plus 40% of schedule plus amount in excess of schedule. $300 per admission deductible plus 40% of scheduled charges. Deductible plus 40% of scheduled charges. Not covered Not covered Duductible plus 40`k of scheduled charges. Not covered Not covered $1,000 Coinsurance* $2,000 (not including $40% up to $6,000 plus $15 office visit copays) amount in excess of per diems & schedules. Lifetime Maximum* $1M $1K *Family Limit is three (3) times individual maximum. Out -of -Service Area Residents For covered persons who reside outside service area (50-mile radius of City of Denton) plan of benefits is $500 deductible plus 80% of eligible charges up to a $2,000 out-of-pocket maximum. Important Notes: 1. An additional $500 deductible will be applied if a hospital stay is not precertified by Intracorp. No benefits are available for days which are not determined to be medically necessary. 2. No additional copayments are necessary while mother and child are confined at same time. 3. An additional $500 deductible will be applied if a hospital stay is not precertified by Integrated Behavioral Health (IBH). No benefits are available for the days which are not determined to be medically necessary. 4. Physical Therapy services are limited to 60 visits per medical condition. S. Up to $500 in benefits for this service per year. EXHIBIT C PHILADELPHIA AMERICAN LIFE INSURANCE, COMPANY P O Box 2465 Houston, Texas 77252 (713) 071.4800 December 1, 1992 Mr. Ike Obi Human Resource Specialist, Benefits City of Denton 324 East McKinney Denton, Texas 76201 Dear Ike: 1944.' DEC -2 f, 'V11comparay This letter Is written to bring two clerical errors that were present in your renewal bid for group health insurance to your attention. First, we did not provide rates for the rest of the retiree groups, because there were no members in those groups. Second, in Exhibit H of the bid, there was a $526.73 amount shown for "Retiree under 65-Retwee and Family". This amount should have been shown for "Retiree under 65-Retwee and Spouse". Also, in the same Exhibit H, there was an amount of $189.72 shown for "Retirees 65 or Over-2 on Medicare + Family". This amount should have been shown for "Retirees 65 or Over-2 on Medicare". Please accept our apology for putting the figures in the wrong blanks. Should you have any questions, please contact me. Thank you. Rahlfs, Jr. ant Executive JR:tp