Addendum. Health Insurance and Related Services C11007

Transcription

1 Addendum SOLICITATION NAME Health Insurance and Related Services C11007 ADDENDUM NUMBER 2 DATE The following pages are reflective of the incumbent vendor s renewal offer.

2 Renewal for Knoxville's Community Development Corp. 901 N. Broadway Knoxville, TN Renewal Date: Produced on: 10/02/2010 Package Number:

3 Current Plan Product Specification Health Plan Highlights RN National POS COPAYH/9060 National POS Open Access Non Par Fee Schedule STANDARD Lifetime Maximum Benefit UNLIMITED Coinsurance % Par 90 Phy/Occup/Cogn/Spch/Hear Therapy Limit Visits 60 Coinsurance % NonPar 60 Skilled Nursing Day Limits 100 Individual Annual Par Deductible 3000 Home Health Care Day Limits 100 Individual Annual NonPar Deductible 9000 Injection Copay 5 Family Annual Par Deductible 6000 RX Copay Tier 1 15 Family Annual NonPar Deductible RX Copay Tier 2 30 Individual Annual Par OOP Limit 3000 RX Copay Tier 3 50 Ind Annual NonPar OOP Limit 9000 RX Coinsurance % Tier 4 25 Family Annual Par OOP Limit 6000 RX Max Out Of Pocket Tier Family Ann. NonPar OOP Limit RX Mail Order Copay Tier 1 30 PCP OV Copay 25 RX Mail Order Copay Tier 2 60 Specialist OV Copay 40 RX Mail Order Copay Tier Hospital Emergency Copay 200 RX Mail Order Coinsurance % Tier 4 25 DME Limit 5000 Medical Deductible Carry Over Credit Y EE FAM Current Subscribers Current Rates $ $1,040.13

4 Renewal Plan Product Specification Health Plan Highlights RN National POS COPAYH/9060 National POS Open Access Non Par Fee Schedule STANDARD Lifetime Maximum Benefit UNLIMITED Coinsurance % Par 90 Phy/Occup/Cogn/Spch/Hear Therapy Limit Visits 60 Coinsurance % NonPar 60 Skilled Nursing Day Limits 100 Individual Annual Par Deductible 3000 Home Health Care Day Limits 100 Individual Annual NonPar Deductible 9000 Injection Copay 5 Family Annual Par Deductible 6000 RX Copay Tier 1 15 Family Annual NonPar Deductible RX Copay Tier 2 30 Individual Annual Par OOP Limit 3000 RX Copay Tier 3 50 Ind Annual NonPar OOP Limit 9000 RX Coinsurance % Tier 4 25 Family Annual Par OOP Limit 6000 RX Max Out Of Pocket Tier Family Ann. NonPar OOP Limit RX Mail Order Copay Tier 1 30 PCP OV Copay 25 RX Mail Order Copay Tier 2 60 Specialist OV Copay 40 RX Mail Order Copay Tier Hospital Emergency Copay 200 RX Mail Order Coinsurance % Tier 4 25 DME Limit 5000 Medical Deductible Carry Over Credit Y EE FAM Renewal Rates $ $1,456.71

5 Group Information Formula Renewal 40.02% Proposed Renewal 40.02% SIC Code 8322 Industry Factor 1.05 Age/Sex Factor Eligible Subscribers 144 Large Claims Amount Diagnosis $179,614 ESRD $136,014 Colon Cancer $77,979 Hodgkins Disease $50,564 Brain cancer $46,765 Lymphoma $40,268 Chest pain / other $35,310 Cardiac dsrhythmias $25,861 Osteoarthrosis

6 Caveats The benefits outlined in this proposal represent a high level benefit summary, please refer to the Certificate of Coverage for a full description of benefits. For plan effective and renewal dates of 10/1/2010 and beyond, benefit provisions mandated by Health Care Reform may not appear in this proposal. These include changes to Lifetime Maximum, Preventive Care, Annual Dollar Limits and Nonparticipating ER benefits. The required provisions will be applied to claims payment for these services regardless of their specified benefit in this proposal. If enrollment changes by more than +/-10%, from quoted enrollment, Underwriting reserves the right to re-evaluate the rates. Humana reserves the right to change any premium rate, including on a retrospective basis, when the terms of the policy are changed or our liability has been altered because of a change in state or federal law or a substantive change in the composition of the group. The minimum employer contribution for all full time employees is 50% of the single premium. Minimum participation required is 100% of all eligible employees if employer contributes 100% of the single premium, or 75% of all eligible employees (less those opting out due to other qualifying coverage) if the employer contributes less than 100% of the premium. If the group meets the 75% participation requirement; the absolute minimum enrollment must equal 50% participation or greater of all eligible employees. Rates assume the employer will not fund an employee spending account at a level that exceeds 50% of the plan's deductible.