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1992-210e wpdocs\p L~co , 900 30 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 ~ 1992 ATTEST: BOB CASTLEBERRY, ~YOR/ JENNIFER WALTERS, CITY SECRETARY BY APPRO~D AS~ LEGAL FO~. DEB~. D~YOVITCH, CITY ATTO~EY PAGE 2 EXHIBIT A CITY OF DENTON REQUEST FOR BID BID NO. 1442 Health Insurance Program Due: November 25, 1992 ~ EGAL- DLPT CITY OF DENTON Request for Bid for Group Medical T~BLE OF CONTENTS paqe Background end General Information 1 Scope of Specifications end 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 Date (Exhibit VI) 20 AAA00FFD BACKGROUND AND GENERAL INFORMATION The Caty of Denton is a city of 68,000 populataon and was ancorporated an 1866 Denton as located approximately 40 miles north of Dallas and Fort Worth It sits at the apex of a triangle that encompasses the Dallas-Fort Worth metropolitan area Although it benefits from the forward thrust and contanuous expansion of the largest Consolidated Metropolitan Statastacal Area an the state, Denton and ars economy stand proudly independent. The Caty of Denton has a work force of approximately 850 employees The City has had an effective safety and risk management program sance 1970 The services the City provide consist of law enforcement, fire safety, paramedics/rescue, refuse collection, sanatary landfall, electrac, water, sanatary sewer, storm sewer, animal control, parks/recreation, library and aarport In general, we are a full-service city, however, there as no city hospatal or rest home Two ma]or universaties -- University of North Texas and Texas Woman's Unaversaty -- along with a fully accredited public school system, allow local citazens every educataonal advantage possible and a rich blend of cultures The eastern and western branches of Interstate Haghway 35 meet an Denton, making at convenaently accessible to everything in Dallas and Fort Worth Denton offers worlds of opportunitaas to the prospective developer, business person or industraalist Texas Instruments has a plant here and other andustries are expandang. Any questions regarding the City's current health plan or this bid should be darected to Ike Obi at (817) 566-8340. Questaons concernang the bid submattal should be darected to Tom Shaw at (817) 383-7100 AAA00FFD - 1 - The City will entertain proposals on fully insured managed care plan basis The specaficat£ons contained herein will encompass Network Only and Non-Network Plans. Since we are presently evaluating optaons to reduce our cost, we are seeking optional quotes on plans 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 thia policy for two (2) successive twelve (12) month periods, thereafter subject to the renegotiation of the terms of this policy, af City Manager and insurance company agree, without the necessity of rebiddang thas insurance proposal as long as the cost of insurance durang either the farst 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 writang to a mutually agreeable plan desagn and insurance cost no later than seventy-fzve (75) days prior to the end of the precedang peraod The city is interested in a fully insured managed care proposal The instructzons contained herein apply to all sections, otherwise, each sectaon can stand alone, or be a part of a partial or total package. Although the Caty is interested an packaging these coverages, for a number of reasons, it is understood that all coverages contained within these specifications cannot necessarily be ancorpo- 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 as allowing for the possibility that some agencies or underwriters would prefer not, or be unable, toquote all coverages in these specifications and wall 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 law; however, exceptions must be noted and made in addition to the specifacations, whach 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, anstructaons, and the specafication package carefully before submitting quotations Conflicts Between Reauost for Bid and Bid Should a conflict arise between the terms and prov~saons of this request for bad and the bid of the ansurance company (which includes Lnsurance policies, ~nsurance agreement, etc.) the terms and provasaons of this request for bid will prevail. Igcontestabilitv P~ovisions Are lnaDulicable City and Bidders agree that if a conflict arises relatang to an interpretation or meanang of the terms and provisions of Caty's request for bid and the bid of the insurance company (whach includes insurance policy and insurance agreement, etc ) such conflict will not be resolved through arbatrataon or be waaved by the partaes, but will be resolved by judicaal review an the courts in Denton County, Texas In order for bids to be compared on an identical baaas, it as necessary that all portions of the document, including requests for specafic informataon about coverage, ratings, services, forms and general information regarding the carrier, be completed and adhered to. ~cope of Spec~facat~ons & Instructions Carraers 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 ~mportant that quotations be submitted on this bid form (see Exhibit II) Any amendments or ~nnovat~ons must be submitted by addendum to this specific paokage -- 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 carrler which xs unable or unw%lling 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 submatted quotation, specifically noted and made a part thereof. Uederwriters' ouslifications All carriers must be licensed to do business an the State of Texas and maintaLn 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 provade accurate and up-to-date ~nformataon, companLes supplying quotations should contact the City for any questaons that you might have Contract StiDulatxon Any carraer chosen by the CLty 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 Ls subject to the provasLons of the Consoladsted OMNIBUS Budget Reconciliation Act of 1986 (COBRA) Proposals must conform to thas law The successful b~dder 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 lamited to, the issuing of booklets, certifioates of Insurance, I D cards and master policaes as well as providing for claLms auditing and processing, computer- generated experience reportLng at least quarterly, enrollment materaals, claim forms, and conversion forms Ail costs assocaated with the provision of such services must be included in the rates and reflected withLn the retention ~llustration The City also desires representataves from the selected carrier to be available to conduct large group meetings ~f deemed necessary Criteria for Bid Selection The award of the contract w~ll not be based on cost alone The City will evaluate the bids on rates as well as the following. i Claims processing capabilities 2 contractual requirement (i e., bLlling etc.) 3 Ability or willingness to make a tamely, accurate and anexpensLve transition with current carrier 4 Abality to servLce contracts 5. Bidder's financial stability 6 Ability to provide claims data Ln the forms necessary to track the performance of the plan Note Bidder should provide an explanation for all items giving as much informs=ion 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 ~ntions for Filine Ouotations 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 ~nformali~lea in any quotation. Request for de=ailed specifications, loss experiences, and questions should be dLrected to Ike Obi, City of Denton at (817) 566-8340 All quotatLons must be submitted with two copies (in s 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 B Texas Street Denton, Texas 76201 AAA00PPD - 4 - The following exhabits and instructaons are pertanent to the completaon of thas bad EEHZBIT~ INSTRUCTION/COMMENTS I Plan Assumption See Exhibit I II Bid Submassion Form Please do not submat your standard bid, rather simply complete the bad form III Schedule of Benefits Detaals of benefits provaded under the current plan Exhibat III IV Plan Experience V Carrier/Underwriter Profile Basic information on carraer and/or underwriter must be completed VI Census Data 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 provaeions for exceptions such as services outsade service areas, emergency service outsade servace areas. Bidders must agree to include the two local hospitals in the Network Provider Last A fully-~nsured proposal 4 Fundxng Fully-insured managed care plan The plan wall be net of commission 5. Annual Claims Hastory See Exhibit VI. AAAOOFFD - 6 - EXHIBIT II CITY OF DENTON BID SUBMISSION FORM FOR FULLY-INSURED Managed Care BID Carrier/Vendor Date Completed Byz (Name & Title) Phone Number~ ( ) 1 Premium Rate for the Health Plan, net of comm~ssionsz Monthly Cost Active CurFent Benefits PropQsed Benefits a Employee Only $ $ b Employee & Spouse c Employee & child $. $ d Employee & Family $ $ e How long are rates guaranteed? mo/yr mo/yr res e 65 a Retiree Only $ $ b Retiree and Spouse $ $ c. Retiree and Children $ $ d. Retiree and Family $ $ 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 feea in addition to the PremLum Rates? If yes, · dentify and state the amount PURPOSE AMOUNT Identification Card $. Medical Conversion $. Large Claim Management Bank Reconciliation $. $ $ Exhab~t II 3 a What claim payment software do you use? b Where ere your claims processed? 4 Is a software system or vendor change planned for the period 01/01/93- 12/31/937 If so, to what system/vendor? 5 Assuming that the contract for the City of Denton plan wall be effectave 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 claams h~story anformat~on 6 Claim payment software features Which of the following features are inherent to your current claim payment software? yes N__o 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 ~nternal 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 (w~th~n the last year), verifying your claims processing accuracy levels Yes No 10 Wall your claim system facilitate a future PPO plan design, either as a per diem based, or reduced charge, of h~gher coinsurance percentage, etc.? yes ~o 11 Can the City of Denton Human Resources Department access their claim files electronically end directly via an on-site modem? SOns-Time SRecurrin~ If so, what are costs (one-time and recurring?) AAAOOFFD - 8 - Exh~b~i II 12 Do you offer the following Utilization Review services? If so, please lden=ify 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 Yes No EE/Mo. Fees Fees Pre-certification Reviews Continued Stay Reviews= Concurrent Stay Reviews SURGERY Second Surgical Opinion Reviews= Outpatient Surgery Reviews. LARGE CASE MANAGEMENT Research of Catastrophic AIDS case Management= Mental Health Case Management. OTHER SERVICES Hill 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 servxces w~th~n the last two years 16 Please provide a sample specimen of all agreements/contracts, etc for all the. above listed services. Exhibit II 17 Please provide the most recent audited f~nanc~al statement or a "Statement of Condition" ~f an audited financial statement is not applicable, for your firm 18 If any insurance is quoted on a retention basks, 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 spe=ified 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 -10- EXHIBIT III CURRENT SCHEDULE OF BENEFITS CITY OF DENTON SERVICE NETWORK NON-NETWORK Physician's Of£ice Visit $15 per visit Deductible plus 30% of schedule plus any amount over schedule. Preventive Care Well Baby $15 per visit Not covered (Recommended Schedule) Routine $15 per v~sit Not covered Immunizations for children 2 and under Annual Health $15 per visit Not covered Assessment Employee/Covered Spouse 35 years or older. Includes~ Chest X-Ray, Urinalysis, EKG, Blood testing. Well Woman Exam Annual (once every $15 per visit Not covered 12 months) Routine Vision, Speech, Roaring S~reening 0 through age 17 $15 per visit Not covered In-Hospital Services (1) No limits on $50 per day up to 10 $300 per admission medically necessary days deductible plus days deductible plus 30% (7) Must be pre- certified by Intracorp (1) Semi-private room Ail necessary hospital services AAA00~PD -11- Exhibit III SERVICE NETWORK NON-N~TWO~K outpatient Hospital SeFY~ces 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 vxsit $50 per v~sit Room or Urgent Care Facility (3) Physician's Office $15 per visit $15 per visit Mental Health/Substance Abuse (Serious mental · llness or Substance abuse) Physician's Office $15 per v~sit Deductible plus 30% of schedule plus amount an excess of schedule In the Hospital $50 per day up to 10 $300 per admission days deductible plus 30% of eligible charges. (7) Physical Thersp~ (4) $15 per visit Deductible plus 30% of eligible charges Family Planning Based on Service Not covered provided. Infe~tilit~ services $15 per visit Not covered Detection & ~rrection $15 per visit Deductible plus 30% of of Bod~ Disto~tion (5) eligible charges Prescription Drugs (6) $100 deductible; $3 Not covered copay, generic, $10 copay, brand AAA00~FD -12- Exh~bi~ III SERVICE NETWORK N°N-NETWORK Maintenance D~ugs Up to 100 days supply, Not covered one copay All other Eligible Deductible plus 20% Services A~nual Deducti~le* $250 plus a $100 drug SSO0 deductible ~insurancs* $1,000 (not including 30% up to $5,000 plus office visit copays) amount in excess of per diems & schedules. Lifetime Maximum* Unlimited Unlimited *Famaly Limit is three (3) times individual maximum Out-of-Service Area Resxdents For covered persons who reside outside service area (50-male 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- certifxed 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 confaned at same time 3 If patient is admitted to Network Hospital from emergency room, $50 copay as weaved. 4 Physical Therapy services are limited to 60 visits per medical condition. 5 Up to $500 xn benefits for this service per year 6 If your physxcian permits or orders a generic drug and you decide to purchase brand, the cost will be generic copay plus the entire difference prace between generic and brand. 7 Elxgible 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- Network Providers are: HosDitals~ Denton RegLonal Medical Center Denton HCA community Hospital Phvsiciens~ Denton IPA North Texas Medical and Surgical -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 ia e brief deacrLption of your benefits A booklet will be provided with more detail. AAA00~TD -14- EXHIBIT III PROPOSED SCHEDULE OF BENEFITS EFFECTIVE 01/01/93 CITY OF DENTON ~ERWCE N~TWO~ ~ Physician's Office Visit $15 per visit plus $50 Deductible plus 40% of copay for diagnostic schedule plus any amount services over schedule. Well Baby $15 per visit plus $50 Not covered (Recommended copay for diagnostic Schedule) services. Routine $15 per vLsit plus $50 Not covered Immunizations copay for diagnostic serviceB. Annual Health $15 per visit plus $50 Not covered Assessment copay for diagnostic services. Employee/covered Spouse 35 years or older. Includes Chest X-Ray, UrinalysLs, EKG, Blood testing. Well Woma~ Exam Annual (once every $15 per visit plus $50 Not covered. 12 months) copay for diagnostic services. Routine Vision, Speech, Hearing Screening 0 through age 17 $15 per visit plus $50 Not covered copay for diagnostic services. Xn-Hospital Be~'vices (1) No limits on $500 deductible, 100% $300 per admission medically necessary deductible plus the non- network deductible plus days 40%, (7) Must be pre- certified by Intra¢orp (1) Semi-private room All necessary hospital services AAA00~FD -15- Exhibit III SERVICE ~ NON-NETWORK Outpatient Hospital Services Surgery or Treatment $75 per visit, 100% Deductible plus 40% of eligible charges (7) Physicians Visits $15 per visit plus $50 Deductible plus 40% of copay for diagnostic schedule plus any amount services, over schedule In-Hospital Services $500 deductible, 100% $300 per admission deductible plus non- network deductible plus 40% of eligible charges (7) Newborn Nursery (2) No additional copay 40% of eligible charges Physicians Services Covered Not covered for Newborn Emergency or Urgent Care (In case of Accident or Sudden and Serious Illness) Hospital Emergency $75 per visit, 100% $75 per visit, 100% Room or Urgent Care Facility (3) Physician's Office $15 per visit plus $50 $15 per visit plus $50 copay for diagnostic copay for other services services, if any. Mental Health/Substance Abuse (Serious men=al ~llness or Substance abuse) Physician's Office $15 per visit plus $50 Deductible plus 40% of (3) copay for diagnostic schedule plus amount in services excess of schedule. In the Hospital (3) $500 deductible, 100% $300 per admission deductible plus the non- network plus 40% of eligible charges Physical Therapy (4) $15 per visit plus $50 Deductible plus 40% of copay for diagnostic eligible charges services. Family Planning Based on Service Not covered provided Infe~tility Services $15 per visit plus $50 Not covered copay for diagnostic AAA001;TD -16- Exhxb ~t III SERVICE NE~ORK NON-N~TWORK Detection & C~rrection $15 per vasit plus $50 Deductible plus 40% of of B~dy Disto~ion (5) copay for diagnostic eligible charges services Prescription Drugs (6) $150 deductible, $5 Not covered. copay, generic, $15 copay, brand. Maintenance Drugs up to 100 days supply, Not covered. one oopay All Other Eligible Deductible plus 20% Annum1 Deductible $500 plus a $150 drug $1,000 deductible Coinsurance* $2,000 (not including 40% up to $6,000 plus $15 office visit copay) amount an excess of per diems & schedules. Lifetime Maximum* $1M $1M *Family Limit is three (3) times individual maximum Out-of-Service Area Residents For covered persons who resLde outside service are (50-mile radius of city of - Denton) plan of benefLts ~s $500 deductible plus 80% of eligible charges up to a $2,000 out-of-pocket maxLmum Important Notes 1 An additional $500 deductible will be applied if a hospital stay ia 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 ~f a hospital stay ~s not pre- certified by Integrated Behavioral Health (IBH) No benefits are available for the days whLch are not determLned to be medically necessary AAA00~PD -17- CITY OF DENTON PLAN EXPERIENCE EXHIBIT IV JANUARY THROUGH OCTOBER 1992 ~ACTIVE EMPLOYEE RATE Coverage Employee Month]y Employees' City's Counts Premiums Cost Cost Employee Only 361 $175 $10 $165 Employee + Spouse 83 272 107 165 Employee + Children 179 235 70 165 Employee + Family 184 340 175 165 807 Call [ke Ob1 at (817) 566-8340 for Rettree Rates Nonth Premlu~s Medical Claims Presqrlptlon Dru9 Jan $ 171 754 $ 0 $ 4,098 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 185 736 210 015 20,603 Oct 190 724 129 955 18,000. TOTAL $1,907,909 $1,649,894 $ 144,512 (Exhibit IV contlnu~) HIGH CLAII~ANT REPORT January Through October, 1992 Dla~nosls/Proqnosls 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 18,580 Diagnosis Information - not available 17,912 Maternity Expenses 17,857 Mental/Nervous - On-going 16,754 H~p Replacement Surgery - on disability 15,624 planxp93,prn EXHIBIT V CARRIER/UNDERWRITER PROFILE i Name of Firm Address Tel. 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 8 Fidelity Bond $ (Submi= Copy of Face Page of Policy or Certificate) 9 References: ~ e o Con ct Tel ~ 1 2 3 4 AAA00~FD -19- 0 0 m -oooooo0ooooo000ooooooo0ooo00000000000°00-~°0000000000000000°000° ~ ~ 0 0 m oo_oo-oooooo-oooooooooooooo.ooo-ooo-oooooo-oooooooooooo---ooooooo ~ 00000000000000~0000000000000000000000000000000000000000000000000-- ~ ~ m oooo~0.oooooooo----ooooooo--o--o--ooo0oooo--oooooooooooo~oo~oooo----°o°°° ~ ~ --000000000000000000000000~00~0000000000~00000000000000~000000-00 ~ ~ 0--000--000.00000000000000000000--0~00000'00000--000--000000000000--00~ ~ ~ --0~0~00000000000000000000000-0000000000~000000000~00-0000-0~000~0 ~ 0000000000000000000.00~00000000--0000000000000000~0000000000000000 ~ --00~ OOO--O00--~O0000~0000000000~0'0000000-0'-~000000000000000''- 0--00000000000000000~000000000~000-00000000000000000-0~000000~000 ~ 00000000--.00000000.0000000000000000--000000000000000000°000--000°00 ~ ~ 0_0000000000~0_0~0__00_0~0000.00000000000.00~000000--0000000--0--000 ~ o00000--000000--00----000000~0~-00000o000000000'-0'0000~000-©0000'000 ~ 000000000000~0000000000~0000000000000o--00~00000000o00000~0o000~o ~ 000~000000_000000000~000~000_00000~0000o00000o00000000000o000~0~ m 0 m O00_O000000OO000000..OOMO0000000~----O000~O000--O0--O00000--O00000000- ~ 0--000000--00000--0000000000~0000''00'00000~000~000000'000000-000~0 ~ 0000~00000~0~000000000000000--00000000000000000000000000--0000~--000 ~ ~ m 000000000000000000000000~000000000000000000-000'0~000000'00~000-0 ~ O000.OOOO0000000000~O0.O000000000000--o--O0~O000000000000000~O00000 ~ ~ m --0000000.000~00~--00000~00000--00000000--00000--00----0--00-- 00~00000~000 ~ 00000_~000~0000_~000000000000.00000000~000~0--~00~0000----00000~0000 ~ 0000000000~00000.----.0.00--000000000000000000000000000----00'--0000000 ~ ~ EXHIBIT B PHILADELPHIA AMERICAN LIFE INSURANCE COMPANY P O Box 2465 ICH Houston Texas 77252 (713) 871 4600 November 18, 1992 Mr Dave Palatlere Consultant Coopers & Lybrand 1999 Bryan Street State 3000 Dallas, TX 75201 Dear Dave Enclosed ~s the formal C~ty of Denton renewal btd These fully ansured rotes are based on the schedule developed between you and John Kerr If you have any questions, please contact me rs, J~hn Rahlfs, Jr Account Executive cc John Kerr EXHIBIT V 1 Name of Firm: Philadelphia American Life Insurance Company Address. 3121 Buffalo Speedway, Houston, Texas 77098-1805 Telephone (715) 871-4814 2 Name of Principal Mr Joseph P Crowley, President 3 Ownership of Firm- PhiladelDhza Amerzcan Life Insurance Company zS a subszdiarv of the 95.5 billzon asset I.C H. Corporation, an insurance holdznG company wzth corporate o~flce in LOUiSville. KY. 4 Date Firm was Fzrst Formed. PhzladelDhza Amerzcan has been successfully performing as Group insurer and claims admznlstrator since its orlGznal zncorDoratzon in 1906 under the name of Philadelphza Life Insurance Company. The present name was adopted in 1983. 5 Other Locatzons (City and State) Phzladelphia Amerzcan has the follow%ng offices throuahout 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), 9 Farmington, (CO) The company also maintains field sales offices zn the followin9 citzes. 1 Atlanta (GA), 2 Houston (TX), 3. Dallas (TX); 4 Chzcago (IL), 5 San Antonzo (TX); 6 Santa Ana (CA), and 7 Sacramento (CA) 6 Location of Headquarters (Czty and State) I C.H is ke~dquarter in Louisville, Kentucky. 7 Location of Claims Processin90ffzce Waco. Texas 8 Fidelzty Bond $ Philadelphia American's employees are covered under the ICH Corporation's blanket bond number 400th 8906. The coverage Derzod is 1-31-92 to 1-31-~3 and it is written for a $5.000.000 limit of liabilzty. The ~olicy is written by St. Paul Mercury Insurance Company. (Submzt Copy of Face Page of Policy or Certzfzcate) 9 References Please refer to the Questzonnazre portion of thzs proposal PHILADELPHIA AMERICAN LIFE EXHIBITII CITY OF DENTON PROPOSALS SUBMISSION FORM FOR ~u~LY-INSU~ Managed Care BID Carrier/Vendor~ Philadeluhia ~A~i-~- Life Insurance Company Date~ November 18. 1992 Completed By~ ~u~n-~e I. B~h~ens. Vice-President (Name & Title) Phone ~her~ (713) 871-%668 1. Premium Rate for the Health Plan, net of Active Cr_gX_~_e_~_Benefit~ Proposed Benefits AT 1/1/93 * a. En~loyee Only $ $ 201.25 b. ~....mloyee + Spouse $ $ 312.80 c. r.-.mloyee + Child $ $ 270.25 d. ~loyee + Family $ $ 391.00 e. How long are rates g~aranteed? mo/yr 1/YR mo/yr ee U r a. Retiree Only $ $ 272,62 b. ~etiree + Spouse $ $. c. Retiree + Children $ $. d. Retiree + Family $ $ 526~73 Retirees 6~ or Over (on Medicare) a. ~etiree Only $ $ 92.56 b. 2 on Medicare $ $ c. i on, i off $ d. 2 on + Family $ $ 189,72 e. How long are retiree rates guaranteed? mo/yr 1/YR mo/yr 2. Are there any other fees in addition to the Premium Rates? If yes, identify and state the amount. PURPOSE AMOUNT Identifica~ion Card $ NO additional char=e Medical Conversion $ $,60/Der employee/month Large ClaimManagement $ NO additional char=e Bank Reconciliation $ No~ Applicable what ~la~n payment so£twaFe do you use? CT~RT/2000 lS our modular Healthcare $,~lyslsand Reimbursement Te~h-olog/es (CZ{AET) s}rstem which acts as an -mhrella w~th~n wh/ch we operate a variety of software, both /nternall¥ and externally developed. ~-ges wa~h~- the /ndustry mandate o~golng ~h~Cefl~-DtS CO r~msln co~etltlve la pr/ce ~dexceed · ndustry averages ~fll accuracy and production levels. To ma~ntaan th4s continual ~h~cement process, the s]~st~m ~s su~portedbya full service datacenterandanin-house program- m4ng te~m, Our cl~mpayment operations are processed ~hrough a f~llv automated Data Center located ~n Richardson, Texas. A network of term4nm]S, ~od~mmaDd controllers are connected to an IBM3090ms~n~rame. The key ~o our success in customer satisfaction is the ~mp~as/s on continuous ~mprovement. Through ~nh~nc~ments, Philadelphia American Llfe is able to control operational costs, reduce processing time, be more responsive to c3~,m~nt /nqu~res, and provide more powerful cost con~nmmJat tools. Our clients are kept od the leading edge of te~h,ology~nd in the forefront of the disclpline. The]~ benefit from evolv/ng cost containment concepts, such as recent trends toward PPO, IPA, and DRG processing. Some of the features of C~RT/2000 are: 1. Integrated eligibllity wath cla, m, history 2. Direct eligibility ~nterface capability (tape to tape transfer or d/al-up w~th an upload to the system) 3. Dependent ellgib/llty ~nformatlon maintained (~me, DOB, relat/onsh~p) 4. Flex~hle "h,~d coded, plandes/gnautom;t/cally calculates benef~t~ayment based on cl/ent-spec/f~cplan designs 5. Ddm~,~etrat~on of multiple plan options, ~ncludzng cafeteria plans, for ode client 6. Tmmed/ate update and tracking of plan beneflts accumulators such as: Mental and Nervous ] ?m~ tatlous Deductibles Coinsurance percentages ~-nual and lifetime Reinsurance 1 Out of pocket maxamums Occurrence 1 ~ m{ ts 7. Automated re~mhursement ut~l~zang plan deduct/hies and Colnsur~31ce 8. Automated cla,m- processing based on ~ncurred dace of 9. Aurora=ted calculation of Usual add Custom~}' ~rges based on customer selected ~ percentile (5~ ~ncreme~uts: to 95~, recomm~d 85~ Me~r~sk for ra~olo~, ~olo~, etc. 10. Id~Cif~ca~on of ~ciple PPO m;mhers~ps for Brov~ders ~h~ugh ~~ce of 11. Auto~ed P~ b~efits ad3u~catlon utlliz~g PPO ~sco~ts, P~ per ~ ~- , PPO co-~Fs or PPO s~edule a~a~es 12. AdJu~cation of f=ed-s~edule b~efits 13. Interface ~d ad3u~cataon of Prescription C~d Se~ce b~ef i ts 14. Auto--ted coor~tlon of b~ef~ts ~d s~rogation 15. Inte~ated pre-certification/ut~l~zation rev~ ca~l~ 16. ~t~ ~t (iss,,~-ce of ~e~s once a ~F, once a ~, ~ce a ~n~ or ~lored to a cla~t's ~ec~fic nee~) 17. Bulk ~t (~ssu~ce of one ~e~ to ~loyee for cla,m, on ~ltiple f~m4ly m-~hers ~d one ~eck to provider for cl.,m, from ~lti~le 18. Interface ca~ili~ ~ th4rd-~ v~rs 19. Pooled cla~ acco~t~g 20. D~4-~atlve ~st~ ~ ~e~ate ~nterface to o~ 21. ~plicate ~t aunt auto~t~cally perfo~ed ~sed on se~lce ~tes ~d provlder 22. Ad--ced ~eckprocessing facllitles ~ m,-,m~ze storage ~d p~cess~g costs ~le ~zlng ~e~ se~l~ ~d consol 23. Elec~o~c f~ tr~sfer ca~lit~es opt,~l cash fl~ ~sltion for o~ ~stomers 24. Aut~ted ~-~ reconclliat~on provided ~ full cl~t r~rt~g 25. Co~r~slve pl~ ~,~lFsls re~rtlng 26. Extensive date base provides fle, w~b~lit~ ~n custom, zed (ad hoc) m-~gement reporting 27. Full 1099 re~orting on medical payments for providers b. Where are your ola~- processed? While Philadelphia American L~fe has ~ne claim, offices to process cla · ~.: 1) Houston, Texas; 2) Waco, T~xas; 3) Lo~svalle, Kent~Icky; 4) Racane, Wisconsan; 5) K~ng of Prussia, p...sylv~.4a;6) Agoura Hills, Calafor~a; and 7) Sacramento, California and 8) Baton Houge, Louasa~-~ , and 9) Farm~ .gton , Co-.ecti cut , the City's claims would be processed by our Waco claim office which was established ~n 1978 and currently ~mploys 25 people. The Waco offace address ~s: Philadelphia Ameracan Lafe InsurAnce Company 100 North 6th Street Waco, TX 76701 Addltlonally, a dedicated Customer Servace Unit ~s located ~n the Waco claim office. Our Customer Servace Representatives (CSR's) are avaalable to respond to ~ployee questions regarding benefits, eligibility and cl~,~.. Our Customer Servace business hours are Monday through Friday, 8:00 a.m. to 5:00 p.m. (CST) The toll free s-mher Ks 1-800-333-9202 4. Is a software system or vendor change planned for the period 01/01/93-12/31/9~? If so, to what system/vendor? A s~stem u~grade Ks not pl~-,ed for ~hmt peraod. Our software has an open architecture and Ks basacally modular ~n nature. We strive to antacapate ch~-gang clapt and market needs. In kee~,~g w~th our c~,~.,t~ent to utilize the very best te~h.ology for our customers, we will contanue to ~nstall e-h~-c~ments 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 im~lementation 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 Cit~ of Denton select Philadelphia American Life to insure their group medical plan, we would assist the C~ty ~n performing a re-~.~o3 ?sent of their ~lo~ees. This should be performed as soon as possible after the contract has bee_u awarded. It lB most 7~r~--t that a co.plate eligibility llstlng be provided so appropriate ID cards can be issued. A record foz'.~t wall be provided to Clt~ of Denton to create an eligibility tape which can be loaded =nrc Philadelphia American Life's system. The elig~bilaty should be provided no later ~- the second week of Dec~mher. An application for Group Insurance wall be provaded ~m~ediately upon contract award, as well as a s~.~ Ze contract ~nchcating the complete schedule of benefits (outlined in genera/ in ~h4e proposal) and any specaal provlsaons. ID cards would be available by late Dec-m~er (for January 1); booklets would be available wiehTn two weeks of signing client proofs. A Corporate Account Executive wall be available to assist the transition; assist with open ..rollment, etc. 6. Claim paymen~ software features~ Which of the following features are inherent to your current claim payment software? ~es 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 e. Duplicate payment audit f. Pooled claim accounting X g. Interface to pre-certification service X 7. What percent of cla4~- ara subject to in~ernal claim office audit? 5 % (random) + 100% certain specific claims (suspect providers, analyst exceeding authority limits, system overrides, certain dollar limit claims) 8. What is your claims processing accuracy rate? a. Transaa~ion 98.3% b. Dollar Value 99.84 9. Please provide the mos= recent internal audit report (within the las~ year), verifying your claims processing accuracy levels. Philadelphia American Llfe has a for~; quallt~ .~-~gement program whach is sw~.~n,steredbFthe ClalmsAdm, n~stratzon department. The claim. -~-~ger of each regio.~; offzce ~s responsable for a~m~ster/ng the ~,~TztF program /n that office. The m-~ger guarantees ~h~t all requirements established by Claim. Adm, n,strat~on are satisfied. Each office has a full-time auditor who re~orts to the offlce m~-~ger. The auditor random~F selects and auchts 5~ of each claim processor's da~l¥ c3~,~ production and 100~ of those claim, which exceed the processor's ~ayment authorization level. The audat consasts of m~netary accuracy, coding accuracy and quality (a comb,..tion of monetary and coding accuracy). A log of all cla~. audited ~s -~-r~,-ed and ~s avazlable to Adm, nistration for review. The log references the specmfic audited, the error found and the Benefit $-~¥st processang the claim. Additionally, qualit~ records are m~,ntalned for each Benefmt ~ ~yst and are available to the Benefit ~.~lyst of Cla ~ m~ AW..,nistration u~on request. The results of all audits are ~osted to a mon~-hTy quality report. Th~s random audit procedure represents the quala ty control of Philadelphia American L~fe's claims operations. It ~s an ~port~t part of the servace we provide our clients. SPECIFICS OF AUDIT: THE FO~.T~3WIA~ I','~S ~UST BE AUDI'Imm ON EACH CL~W: Social Securlty/~,mher Hegect code necessary, correct Group /~,mher MA.ual letter sent, ~f a~roprzate Patzent Name Overr~de necessary, correct Med/De~t RegAster complete HeceAv~d Date or Updated Correctly ~ge entered cozxectl¥ History Loaded Correctly ASP Pre-Exasting Proper COB rules used Second $~rglcal Opiz~on Coord~nmtlon on correct U&C Follow Instructions on IC Screen Other ~nsurancepayment l~dicated correctly Sk~ppedBills Payment correct Correct Cl~mb~mher Provider file dated update Correct Cause Code ~h~rge Eliglble Under Plan Correct Ty~ecode, CPT Code Provider ID Assigned Properly Pend Code Necessary, Correct Requested Ail Necessary Infor.~c~on Please see at~ached ~ ~ iris~production report showang the Waco office's results for No 10. Will your claim system facilitate a X future ,PPO plan design, either as a per diem based, or reduced charge, of higher coinsurance percentage, etc. ? 11. Can the City of Den=on Human Resources X Department access their claim files electronically and directly via an on-site modem? S One- Time I£ so, what are costs (one-time 6.355.00 65/mo and recurring?) CIB~RT/2000 has the flex~bil~t~, to allow a cl~enC "inqu~-y" access the client's el~g~bilit]r ~nform~C~on and cl~4m, hlstol~. The would be responsible for ~he direct cosC of the h~dware, da~a co.~.~.4ca~ion ~ackage, and ongoing data c~m~4cation costs. There · s an Sn~tial sec up cost which would be detez',~lned by h~dware compatibility and a~ client-s~ecific Ad~4t~to~s~ly, we h~ve the ca~abilit]~ Co download claims hlstory da~a electronically or onto a diskette to facilitate client reporting. The cost for ~s service is also dependent upon cl~ent-mpecif~c progr~.....~ug costs. 12. Do you offer the following Utilization Review services? If so, please identify the services provided and describe your billing structure and eet4~ted costs for each of the areas previously mentioned! i.e.~ initial setup fees, monthly fees/employee or fees/service, minimum fees, etc. Philadelphia Amerlcan L/fa is pleased to be =n the position to provide The Cit~ of Denton w~h the services l~sted below at no additional cost to The Cit~. Per Service Setup Yes N~ EE/Mo. Fees Fees Pre-certification Reviews~ X Continued Stay Reviewe~ ~ Concurrent Stay Reviews~ ~ Second Surgical Opinion * X Reviews~ Outpatient Surgery * X Reviews~ · Not required t~U~E CASE MANAG~E~T Research of Catastrophic X Cases~ AIDS Case Management: X Mental Health Case X Management~ Bill review & Claim Audits~ ~ DR~ Validations~ X Ancillary Service ~ Evaluations Analysis Reports~ X TOTAL FEES N/A N/A N/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 X Reporting (Frequency and bed days) 15. Please provide a list of 3 alient references, and a list of 3 former clients who have discontinued your services within the last two years. Client: Stephen F. Austin State U~verslty Contact: Cathy Allen, Personnel Services Telephoue: (409) $68-2304 ~mployees: 1,275 Effective: 9/1/90 Coverage: Medical, Life, & ADaD, Stop Loss Coverage Client: Recognition Equl~ment, Incorporated Contact: George Lokey Telephone: (214) 579-6886 R~ployees: 975 Effective: 1/1/86 Coverage: Medical, Dent~7, Vision, Life, Supplemental Life, Dependent Life, Stop Loss Coverage Client: Osteopa,~,c Medical Center Contact: ~--e Wilson Telephone: (817) 735-3149 ~mployees: 675 Effective: 6/1/90 Coverage: Medical, Dental, L~fe, Stop Loss Coverage · r~MIN~TED CLIENTS Cllent: T~eCO Contact: Howard Mead Telephone: (?15) 757-2131 ~-=,loFees: 12,000 Term,.~ted: 1/1/89 Reason for Term3-~t~on: Left for reduced service levels at a reduced prlce. * Client: The Houston ~hTOZLIcle Contact: Beverly Lundberg Telephoue: (713) 220-7171 ~'.-=,loFees: 400 Term~ n~ted: 2/1/89 Reason for Termination: Wanted a triple option plan w~th Ind~mn~t~,~60 & PPO. NOTE: The Houston ~hToz~zcle was very pleased w~th our service and rates and we continue to provide their Group Life and AD&D coverages. Client: House of D7,~uds Contact: Gerald R. Riley, M--~ger of H-.~. Resources Telephone: (805) 835-6000 E,~loyees: 188 Term~nation: 2/1/89 Reason for Term,-~t~on: Parent co ~mpan¥ sold them ~d the pur~h~lng co~ln¥'s group coverage absorbed House of * Those who left due to reduced price levels generally d~d so to meet econom'c constraints wi~h{n their Industries. 16. Please provide a s-~le speoimen of all agreements/contracts, etc. for all the above listed ser~ioes. Please refer to the Agreement Section. 17. Please provide the most reaent audited financial statement or a .Statement of Condition" i~ an audited financial statement is not applicable, for your firm. Please refer to the Exh~Dit Section of the b~nder. 18. If any ~nsuranoe 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 claim, reserves w/ll be establlshedandm~zutalned at a level equal to the greater of 25~ of mnnual earned pr-m, umor 33~ of ~,.uallzed claim.. Upon termanation ofthepol~c~, the reserves w=ll r,m~,,withPhiladelphlaAmericanLlfe s~ncewewall assume liability for the "rub-off" c2~m~. 19. Please explain the COB~A a~ministration of£ered by your organization and any additional costs for these services. The following are COBRA services offered to The City of Denton. Phmladelph~a American Life wmll : a) Accept COBRA electlo~ foJ,~ from qualified beneficiaries (as defi~ed by COBRA). b) Bill qualified beneficiaries for contribution of coverage pr~.4 um. c) Collect premium from qualified beneficiaries and post i~d~vldual billing record. d) Deposit l~dividual premium checks a~d issue a s~ugle check m~m~h7y to The City of De22to~. e) Monitor each co~t~-uee's eligmbllity per~od. f) Se~d caucellatio~ of coverage notificatloms and conversion information. g) Provide clai~ sz~m~slo~ l~lform~lom a~d for~B. h) Provide customer service for Inquiries regardA~g premium payment a~d stacus. l) Notify co~Ci~ueee of rate Provide re~orCs to the Policyholder regardm~g premium receipts a~d covered conC~nueee. There would be no cos= ~o the City of Denton for Cobra ~dm~e~ra~lOn. We have m~y clients for whlch we provide COBRA service for medical and deu~al. A s~.~. le COBRA ~-rollment form and paymen~ record are included in the Exhibit Section. 20. Does your proposal require that you provide all of the insurance and/or services speoified in this ~FP, or will you "~undle" the services proposed? As we are proposlng only l~sured medmcal a~ t~s ~e, t~e question is not applicable. 21. Please provide your recommended plan designs based upon the network vs. non-network point of service option. PROPOSED S~=~u~LE OF BENEFITS EFFECTIVE 01/01/93 CITY OF DENTON SERVICE ~ NON-NETWORK Physician's Office Visit $15 per visit plus $$0 Deductible plus 404 of copay for diagnostic schedule plus any~mount services, over schedule. Preventive Care Well baby $15 per visit plus $50 Not Covered. (Reoon~ended oopay for diagnostic Schedule) services. Routine $15 per visit plus $50 Not Covered. I---unizations copay for diagnostic services. ~-~ual Health $15 per visit plus $50 Not Covered. Assessment oopay for diagnostic services. Employee/Covered Spouse 35 years or older. Includes~ Chest X-Ray, Urinalysis, EKG, Blood Testing. Well Woman Exam Annual (once every $15 per visit plus $50 Not Covered. 12 months) copay for diagnostic services. Routine Vision, Speech, Hearing Screening 0 through age 17 $15 per visit plus $50 Not Covered. copay for diagnostic services. In-Hospital Services (1) No limits on $500 deductible, 100~ $300 per admission medically necessary deductible plus 40~ of scheduled days charges. (?) SERVICE NETWORK * NON-NETWORK Must be pre- certifiedlby Intracorp (1) Semi-private room Ail necessary hospital services Outpatient Hospital Services Surgery or Treatment $?5 per visit, 100% Deductible plus 404 of scheduled charges. (?) Maternity Care Physicians Visits $15 per visit plus $50 Deductible plus 40% of copay for diagnostic schedule amount services over schedule In-Hospital Services $500 deductible, 1004 $300 per admission deductible plus non- network deductible plus 404 of scheduled charges. Newborn Nursery (2) No additional oopay 404 of scheduled charges. Physicians Services Covered Not covered. for NewboTn Emergency or Urgent Care (In case cfi Accident or Sudden and Serious Illness) Hospital Emergency $75 per visit, 1004 $75 per visit, 1004 Room or Urgent Care Facility (3) Physician's Office $15 per visit plus $50 $15 per visit plus $50 oopay for diagnostic copey for other services, services, if any. SERVICE NE~O~* NON-NETWORK Mental Health/Substance Abuse (Serious mental illness or Substance abuse) Physician's Office $15 per visit plus $50 Deductible plus 404 of (3) copay for diagnostic schedule plus amount in services excess of schedule. In the Hospital (3) $500 deductible, 100~ $300 per admission deductible plus 40~ of scheduled charges. Physical Therapy (4) $15 per visit plus $50 Deductible plus 404 of copay for diagnostic scheduled charges. services. Family Planning Based on Service Not covered provided. Infertility Services $15 per visit plus $50 Not covered copay for diagnostic services. Detection & Correction $15 per visit plus $50 Duductible plus 404 of of Body Distortion (5) copay for diagnostic scheduled charges. services. Prescription Drugs (6) $150 deductible~ $5 Not covered copay, generio~ $15 copay, brand Maintenance Drugs U~ to 100 days supply; Not covered one copay All Other Eligible Deductible plus 20% Services A-~ual Deductible $500 plus a $150 drug $1,000 deductible. Coinsurance* $2,000 (not including $40~ up to $6,000 plus $15 office visit copays) amount in excess of per diems & schedules. LifetimeMaximume $1M $1M *Family Limit is three (3) times individual maximum. Out-o£-Servioe Area l~esidents 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 ~-~imum. Important Notes~ 1. An additional $500 deductible will be applied if a hospital stay is not preoertified by Intraoor~. No benefits are available for days which are not determined to be medically necessary. 2. No additional copa~ments are necessary while mother and child are confined at same time. 3. An additional $500 deduotible will be applied if a hospital stay is not preoertified by Integrated Behavioral Health (IBH). No benefits are available for the days which are not determined to be medically necessary. 4. Physical Therapy servioes are limited to 60 visits per medical condition. 5. Up to $500 in benefits for this service per year. EXHIBIT C PHILADELPHIA AMERICAN LIFE INSURANCE, COMP_A_NY P o Box ~, 19,0,' 0~_C -2 t,.~,,l~j3-[~ompa~,...~ Houston, Texas 77252 (713) 871-4600 December 1, 1992 Mr. Ike Obi Human Resource Specialist, Benefits City of Denton 324 East McICinney Denton, Texas 76201 Dear Ike: This letter is written to bring two clerical errors that were present m your renewal ind 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 m those groups. Second, in Exhibit I] of the bid, there was a $526.73 amount shown for **Retiree under 65-Retiree and Family". This amount should have been shown for **Retiree under 65-Retiree and Spouse". Also, in the same l~hibit U, 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 puttin~ tho figures in the wrong blanks. Should you have any questions, pleaso ceutoet mo. Thank you. ~R:tp