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HomeMy WebLinkAboutResolutions - 2007.06.14 - 284474 MISCELLANEOUS RESOLUTION 107145 MISCELLANEOUS ORDINANCE # 27 June 14, 2007 BY: Finance Committee, Mike Rogers, Chairperson IN RE: AN ORDINANCE TO CONFIRM AND RESTATE OAKLAND COUNTY'S EXISTING CONTRACTUAL OBLIGATIONS TO PROVIDE FOR MEDICAL BENEFITS FOR CERTAIN RETIRED COUNTY EMPLOYEES AND THEIR ELIGIBLE DEPENDENTS TO THE OAKLAND COUNTY BOARD OF COMMISSIONERS Chairperson, Ladies and Gentlemen: THE COUNTY OF OAKLAND ORDAINS: Section 1. Title of ordinance. This ordinance shall be known and may be cited as the Retiree Medical Benefits Contractual Obligations Ordinance. Section 2. Intent and purpose. The Oakland County Board of Commissioners is empowered by statute to provide group health care benefits for County retirees and their dependents ("retiree medical benefits") and has done so since 1965. The County's longstanding contractual obligations to provide retiree medical benefits to eligible retired and active employees of the County are documented in contracts, resolutions, booklets and other documents and written communications available to County active and retired employees, but not collectively in one place. The intent and purpose of this ordinance are to provide a clear, comprehensive confirmation, reaffirmation and restatement of the County's contractual obligations to provide retiree medical benefits, as befits these important County obligations. Section 3. History of the County's obligations for retiree medical benefits. A. The County has provided retiree medical benefits to eligible County retirees and their dependents continuously since 1965. In a 1987 resolution, the Oakland County Board of Commissioners recognized that the established rights of eligible County retirees and employees to receive retiree medical benefits should not be subject to repudiation by future Boards of Commissioners and determined that it would be a "prudent fiscal policy to actuarially accrue and fund the liability for these vested future health care benefit payments." Accordingly, in 1987, the County established a system of two trusts to fund its retiree medical benefits obligations. For the same purpose, the County established a voluntary employees benefit association trust ("VEBA trust") under Section 501(c)(9) of the Internal Revenue Code in 2000 to replace the prior two trusts as a vehicle for funding its obligation to provide retiree medical benefits. At significant expense, the County has funded this ongoing, long-term liability continually since 1987. B. Since their inception, these legally binding County contractual obligations for current and future retiree medical benefits have been expressly subject to the County's reserved right to reasonably modify from time to time the portion of the total cost to be borne by retirees for receiving such benefits (e.g., co-pays and deductibles) and the scope and details of the provided retiree medical benefits, as appropriate to comport with evolving changes in medical research, technology, drug development, the practice of medicine, health care delivery and the costs thereof, but not modifications tantamount to providing less than an appropriate core package of retiree medical benefits. At various times, accordingly, the County has increased and/or decreased the cost of coverage to its retirees and the scope and details of the retiree medical benefits provided. C. Throughout its long history of performing its retiree medical benefits obligations, including currently, the County has maintained various negotiated agreements with health care insurers, health care providers, managed care organizations and others that specify at any given time the medical benefits then available to County retirees and their families. D. The documentation for the County's contractual obligations to provide retiree medical benefits to eligible retired and active employees of the County, and a chronological listing of the County's actions, practices and continuous course of dealing in providing retiree medical benefits since 1965, are described in Exhibit A at the end (and hereby made a part) of this ordinance. E. In recognition of the magnitude and financial significance of many governmental employers' unfunded liabilities for retiree medical benefits, which previously were not reported in their financial statements under generally accepted governmental accounting principles, the 2 • • .. I Government Accounting Standards Board has recently required that employers, such as the County, must now report in their financial statements the reasonably estimated true cost of their unfunded accrued actuarial liabilities for post-employment medical benefits. This has presented an independent, additional reason for this ordinance to bring desirable clarity to identifying the same binding contractual commitments that the County has always acknowledged and paid when due since their inception and for which it has established, funded and maintained the VEBA trust since 2000. Section 4. Confirming existing contractual obligations for retiree medical benefits. A. The County Board of Commissioners hereby confirms, reaffirms and restates the County's existing contractual obligations to provide retiree medical benefits to eligible retired and active County employees and their dependents, and acknowledges and agrees that these are binding contractual obligations of the County to eligible retired and active County employees and their dependents that future County Boards of Commissioners cannot repudiate. B. The retired and the currently active County employees who are eligible to receive County-provided retiree medical benefits are described in Exhibit B at the end (and hereby made a part) of this ordinance. They perform their side of the County's contractual commitments to provide retiree medical benefits to them and their dependents by providing their services to the County as its employees and by meeting the applicable age and length-of-service criteria described in Exhibit B. C. The scope of benefits currently included in the County's retiree medical benefits program ("RMB program") is summarized in Exhibits C and D at the end (and hereby made a part) of this ordinance. Such scope of benefits shall continue to be the core package of retiree medical benefits in the RMB program that will be provided by the County for eligible current and future retirees in fulfillment of its existing, binding, contractual obligations which are confirmed, reaffirmed and restated in this ordinance; provided, that the County has the right, subject to and strictly limited to the extent of any conflicting collective bargaining agreement obligation, to reasonably modify from time to time the RMB program, taking into account then prevailing customs and standards for governmental employers reasonably comparable to the County: (1) with respect to the amounts retirees may have to contribute to the costs of their and 3 their dependents' coverage (for example and without limitation, co-pays and deductibles) and the scope of coverage and range of benefits provided, as appropriate to comport with evolving changes in medical research, technology, drug development, the practice of medicine, health care delivery and the costs thereof (for example and without limitation, if developments in medical treatment and technology allow for replacing certain services and treatments that are currently provided with different services and treatments that are better suited to achieve the intended clinical results), but not modifications tantamount to providing less than an appropriate core package of retiree medical benefits; (2) to introduce programs designed to help participants in the RMB program better maintain their health, encourage preventive care and better control and manage chronic conditions; and provided, further, that any modifications by the County to the RMB program's scope of coverage shall maintain a level of coverage after their implementation reasonably comparable to the level of coverage immediately prior to their implementation; and (3) insofar as necessary so as not to violate any Michigan statutory law that prohibits the County from providing retiree medical benefits at the cost and scope of coverage for which the County is contractually obligated on the date of adoption of this ordinance. D. Notwithstanding anything to the contrary in this ordinance, in the event that any other health care benefits plan, program or arrangement becomes effective which, at no further expense to the County and with no lapse in coverage for any retirees or their dependents, incontrovertibly provides comparable or superior retiree medical benefits coverage in any respect to the persons then covered under the County's RMB program, the County's existing, binding, contractual obligations which are confirmed, reaffirmed and restated in this ordinance may be satisfied to that extent, in whole or in part, by such other retiree medical benefits provided by such other plan, program or arrangement. Section 5. Dispute resolution. In the event that any person with standing asserts that any necessary provision is missing from the County's contractual commitment to provide retiree medical benefits to any eligible person, either side may require the other to submit the reasons for its position, in writing, and to then enter into good faith negotiations to attempt to agree on supplying the allegedly missing provision. If, however, they subsequently cannot so agree, the County and such other side shall 4 each select one arbitrator to determine the issue. If the two arbitrators still disagree, then the two arbitrators originally selected shall select a third arbitrator, and the decision of the majority of the arbitrators shall be binding. Such arbitration shall proceed in accordance with the Commercial Arbitration Rules of the American Arbitration Association ("Rules") insofar as such Rules are not inconsistent with the provisions expressly set forth in the County's contractual commitments to provide retiree medical benefits, unless the parties mutually agree otherwise, and pursuant to the following procedures: (i) Notice of the demand for arbitration by either side shall be filed in writing with the other side and with the American Arbitration Association ("Association"). Each side shall appoint an arbitrator, and those party-appointed arbitrators shall appoint a third neutral arbitrator within 10 days. If the party-appointed arbitrators fail to appoint a third, neutral arbitrator within 10 days, such third, neutral arbitrator shall be appointed by the Association in accordance with the governing Rules. A determination by a majority of the panel shall be binding. (ii) Reasonable discovery shall be allowed in arbitration. (iii) All proceedings before the arbitrators shall be held in Oakland County, Michigan, and the governing law shall be the law of Michigan. (iv) The costs and fees of the arbitration shall be borne by each side to the extent each side incurs costs and the other side shall only be asked to share the actual administrative costs of the neutral arbitrator in accordance with the rules of the Association. (v) The decision rendered by the arbitrators shall be final and judgment may be entered in accordance with applicable law and in any court having jurisdiction thereof Section 6. Severability. If any provision of this ordinance is held invalid, the invalidity does not affect other provisions that can be given effect without the invalid provision. Section 7. Effective date. 5 This ordinance shall become effective upon adoption by the Board of Commissioners and approval by the County Executive. Section 8. Authority to adopt ordinance. The Oakland County Board of Commissioners is granted authority by Section 6 of Public Act No. 139 of the Public Acts of Michigan of 1973, as amended, to adopt ordinances necessary for the conduct of county business. Chairperson, on behalf of the Finance Committee, I move the adoption of the foregoing Ordinance. FINANCE COMMITT las.r11-ocvb5 6 DATED: Lassl 1 -ocvb5 , 2007 A roll call vote on the foregoing Ordinance was then taken, and was as follows: YES: NO: ABSTAIN: The Ordinance was declared adopted. STATE OF MICHIGAN ) )ss. COUNTY OF OAKLAND ) CERTIFICATION The undersigned, being the Clerk of the County of Oakland, hereby certifies that the foregoing is a true and complete copy of an Ordinance duly adopted by the County of Oakland Board of Commissioners at its meeting held on the day of , 2007, at which meeting a quorum was present and remained throughout and that an original thereof is on file in the records of the County. I further certify that the meeting was conducted, and public notice thereof was given, pursuant to and in full compliance with Act No. 267, Public Acts of Michigan, 1976, as amended, and that minutes of such meeting were kept and will be or have been made available as required thereby. COUNTY CLERK 7 EXHIBIT A 1. Documentation for the County's Contractual Obligations to Provide Retiree Medical Benefits The County's contractual obligations to provide retiree medical benefits to eligible retired and active employees of the County are documented in contracts, resolutions, booklets and other documents and written communications available to County active and retired employees, but not collectively in one place. This documentation includes without limitation the following: • Resolutions of the Oakland County Board of Commissioners with respect to retiree medical benefits specifically, and some with respect to retirement benefits generally • Booklets entitled the "Oakland County Employees' Retirement Program," the last of which was published in 1999 and has been redistributed in that form since then. Prior versions included without limitation ones from 1970, 1973, 1976, 1981, 1984, 1987, 1992 and 1998. • Oakland County Merit System Rules • Policies of the Oakland County Merit System • Collective bargaining agreements between the County and the unions representing certain of its employees • VEBA trust agreement entered into effective October 1, 2000, between the County and the Trustees described therein • Oakland County Employees Retirement System Restated Resolution of 1996, as amended October 2000 (Defined Benefit), being the "plan document" for the defined benefit part of the Oakland County Retirement System • Oakland County Employees Retirement System Restated Resolution of 1996, as amended October 1999 (Defined Benefit) • Oakland County Employees Retirement System Restated Resolution, June 1989. • Rules and Regulations Governing the Oakland County Employees' Retirement System, dated June 1, 1980; June 1, 1981; July 1, 1984; January 1988; and June 1991. • Letters to Oakland County retirees regarding changes to retiree medical benefits • Schedules of Benefits for Blue Cross Blue Shield Michigan ("BCBS") retiree coverage for eligible persons • Actuarial Valuation Reports from Gabriel, Roeder Smith & Co. for the Oakland County Employees' Retirement System and the Oakland County Retirees' Health Care Trust • Annual Reports of the Oakland County Employees' Retirement System. Effective Date Changes to Retiree Plan Documentary Support • Charts summarizing the establishment of the County's retiree medical benefits program in 1965 and the changes to the retiree medical benefits since then 2. Chronology of the County's Retiree Medical Benefits Program A chronological listing of the County's actions, practices and continuous course of dealing in providing retiree medical benefits includes without limitation the following: January 1, 1965 January 1, 1967 Health care benefits granted to retirees County to pay 50% of premium County to pay full cost of premium Misc. Res. # 43761 Misc. Res. #4623 (approving 1967 budget which appropriated funds for this purpose) (October 5, 1966) January 1, 1983 Retirees allowed to purchase dental benefits September 21, 1985 Employee switched from "old Plan B" to "new Plan A," this included: (i) no retiree life insurance unless employee remained on Plan B or elected frozen paid- up Plan, (ii) stop accrual of sick leave, (iii) schedule for retiree health changes to 8 years for single coverage; 15 years for family, if direct retirement and 15 years for single, 20 years for family if deferred retirement. January 1, 1987 (i) add vision care for retirees, (ii) add second surgical opinion to traditional medical, (iii) increase orthodontia reimbursement from $500 to $750, (iv) add precertification requirement to traditional medical, (v) change master medical to increase deductible from $50/id. and $100/family to $100/individual and $200/family, (vi) change drug co-pay from $2 to $3 per prescription Misc. Res. #86313 (11/6/86) 1 "NOW THEREFORE BE IT RESOLVED that the policy of the County participation in the payment of hospitalization insurance premiums for County employees be extended to include present and future eligible retireants and beneficiaries on the rolls of the Oakland County Employees Retirement System until such time as other adequate medical coverage is provided." The sum of $15,000 was appropriated for this benefit. 9 January 1, 1989 October 1, 1993 July 1, 1994 January 1, 1995 Misc. Res. #90005 referenced Misc. Res. #94185 (6/23/94) Misc. Res. #94292 (10/27/94) January 1, 1997 Deleted requirement for second surgical opinion New hires not eligible for traditional BCBS, as either active or retiree Increased drug co-pays from $3 to $5 for all future retirees 1/14/99 letter from S. Fayne to BCBS Misc. Res. #99101 (4/29/90) October 27, 1987 Established mechanism to pre-fund retiree medical benefits Misc. Res. #87280 (10/22/87)2 July 1, 1998 January 1, 2000 New employees not eligible for Medicare reimbursement. 2% increase paid into Health Care Fund to cover employee portion of the premium Retirement incentive program, using rule of 69 established. Defined contribution plan created within Oakland County Retirement System Employees hired on or after 1/1/95 shall be eligible for retiree medical benefits after 15 years of service at which time the County will pay 60%. For each year after the County will pay additional 4% until after 25 years the County will pay 100%. Retirees to pay the part of premium not paid by the County. Modified outpatient mental health to unlimited maximum for current retirees Clarified glitch in retiree health coverage to those who transferred from defined benefit plan to defined contribution plan. Extended retire medical coverage to surviving spouses and surviving dependent children of a deceased retiree and to all dependent children of retiree at time of retirement and those added later. 3/24/98 letter from D. Shackelford to BCBS 2 Expressly referenced the retiree benefits established by Misc. Res. #4376 in 1965 as "vested benefits" and deemed it "prudent fiscal policy to actuarially accrue and fund the liability for these vested future health care benefit payments." 10 January 1, 2000 Increased maximum for orthodontic services from $750 to $1,000 11/1/99 letter from D. Shackelford to retirees February 1, 2000 Mammograms, PAP smears and PSA testing 11/5/99 letter from S. added to retiree coverage Fayne to BCBS October 1, 2000 VEBA trust established Misc. Res. #00210 (8/24/2000) January 1, 2001 Eligibility for paid dental and vision coverage Misc. Res. #00062 for retirees and dependents to be on same basis as age and service requirements for paid retiree medical. Dental coverage at $25/%50 deductible with Summary chart 15%/50% co-pay and no co-pay for preventive care; optical coverage with $5 co-pay per examination and $7.50 co-pay for glasses January 1,2003 July 22, 2004 January 1, 2005 January 1, 2006 January 1,2007 Prescription drug co-pay to three-tier: Misc. Res. $5 generic,$10 brand name, $15 non-formulary #03114 brand name ($20 for HAP members) (5/8/03) Extra $50 million paid into VEBA trust Add dental PPO Change retiree health benefits for new hires. Misc. Res. (Not relevant to this ordinance) #05258 (10/27/05) (i) increase Master Medical deductible to $200/single Misc. Res. and $400/family for BCBS Traditional and Blue #06114 Preferred PPO, (ii) increase office copay to $20 for (5/25/06) Blue PPO and Blue POS and HAP, (iii) increase HAP emergency room co-pay to $25, (iv) change three-tier retiree drug copayment to the same as for actives: $5 generic, $10, brand name and $25 non-formulary brand name. 11 EXHIBIT B This Exhibit B describes the criteria for retired and currently active Oakland County employees (whether retired or active, each called "Employee" below) to be eligible to receive County-provided retiree medical benefits as of the effective date of the ordinance of which this exhibit is a part ("Effective Date"). 1. On the Effective Date, the Employee must be eligible for a pension benefit under the Oakland County Retirement System upon his or her retirement or separation from service. 2. On the Effective Date, if Employee was hired by the County before September 21, 1985, the County pays the entire cost of Employee's retiree medical benefits coverage. 3. On the Effective Date, if Employee was hired by the County on or after September 21, 1985, but no later than December 31, 1994, Employee is eligible for the package of retiree medical benefits offered, but under the following payment scheme: Total Service with the County Paid Health Care Coverage Direct Retirement Less than 8 years 8-14 years None Single Person, though retiree has option to pay the difference for family coverage. 15 years or more Family coverage Deferred Retirement Less than 15 years None 15-19 years Single Person, though retiree has option to pay the difference for family coverage. 20 years of more Family coverage 4. On the Effective Date, if Employee was hired on or after January 1, 1995, but not later than December 31, 2005 (though these dates may vary by bargaining unit), Employee is eligible for the package of retiree medical benefits offered, but under the following payment scheme: Total Service with the County Paid Health Care Coverage Less than 15 years No coverage 15 years 60% paid coverage 16 years 64% paid coverage 17 years 68% paid coverage 18 years 72% paid coverage 19 years 76% paid coverage 20 years 80% paid coverage 21 years 84% paid coverage 22 years 88% paid coverage 23 years 92% paid coverage 24 years 96% paid coverage 25 years or more 100% paid coverage 5. On the Effective Date, any employee who was hired by the County on or after January 1, 2006, is not eligible for any retiree medical benefits under the County's contractual obligations which are confirmed, reaffirmed and restated in this ordinance (although he or she may be eligible for certain post-employment health care benefits under what is commonly called a "defined contribution" plan, which is outside the scope of this ordinance). 13 MEDICAL OPTIONS COMPARISON RETIREE (NON-MEDICARE) Important Note: The information contained on this comparison is intended to be an easy-to-read summary to help you and your family make a choice among the different options available to you. Be sure to carefully study each option before making your choice. This comparison summarizes some of the provisions and certain features of each plan. It cannot modify or affect the coverage or benefits provided in any way. No right will accrue to you and/or your eligible dependents because of any statement, error, or omission from this comparison. Its provisions do not constitute amendments, modifications, or changes in any existing contract. knife:Ili toRitiiiiiiiiiiid rifilir . Ail III Iè V Ai?allab1e Ii4JI It 't-i A.1111i hleito sittltkireis fable tifiiillItelitees ni0l:11iil , '" ' ,, apce PI -i BlueCrossIIIue Shieil Ci , . , OW t , eI ._ itce,..,. ert -cd -P l'thi• . - BIgNEFItS Tra1itwuaJ Finn Shue iI mnrolibriSIA* .e 10 j 0 • ' lea V VV i e HOS0.44100:1C40.141/Siriglp_41 esith Lcanpr;lictstv'e Mari Med I c al ,.1Itit1 kNAviiv,-al,":,u.rg owl at Servi e LIMO .... Master Micheal' ' Plan V Macicrivi-edi64 INPATIENT HOSPITAL CARE , ' . General Conditions 120 days, 60-day renewal ; 80% after deductible 120 days, 60-day renewal; Covered Covered • Semi-Private Room additional days under MM with additional days under MM with • Drugs not deductible, co-pays no deductible, co-pay • Intensive Care Unit • Meals • Hospital Equipment • Special Diets • Nursing Care OUTPATIENT HOSPITAL CARE Emergency Room • Accidental Injuries Covered 80% after deductible Covered Covered, $25 Co-pay Covered; $25 Co-pay • Medical Emergencies Covered for approved diagnosis 80% after deductible Covered Covered, $25 Co-pay Covered; $25 Co-pay Physical Therapy 60 consecutive days per 80% after deductible 60 consecutive days per Covered 60 visits per condition 60 Visits per condition condition; additional days under condition; additional days under Per life time MM; 90% after deductible MM, 90% after the deductible MENTAL HEALTHCARE . , .. ., Inpatient Mental Health Care 30 days, 60 day renewal; 80% atter deductible 30 days, 60-day renewal; Covered up to 30 days per 45 days, 60-day renewal additional days under MM; 75% additional days under MM; 75% calendar year after deductible after deductible Inpatient Substance Abuse Unused mental health care days( 80% after deductible Unused mental health care days Covered up to 30 days per 45 days, 60-day renewal Care no MM benefits) (no MM benefits) calendar year Outpatient Mental Health Care 75% under MM after deductible 50% after deductible 75% under MM after deductible Covered; $20 Co-Pay, up to 50 20 visits/calendar year visits per calendar year. $20 Co-pay Outpatient Substance Abuse Covered up to the state Covered up to the state- Covered up to the state- Covered up to the state- 35 visits/calendar year or Care mandated level mandated level mandated level mandated level; $20 Co-pay per state-mandated level; $20 co- visit ay SPECIAL WSPITALPIWCRAMS,:::: ,':.:::;-.- , . " ' _r-N: '1244 Hospice Care Covered up to a lifetime 80% up to a maximum that is Covered up to a lifetime Covered up to a lifetime Covered if authorized maximum that is adjusted that is adjusted annually maximum that is adjusted maximum annually annually Specified Human Organ Covered up to program 80% after deductible, in Covered up to program Covered up to program Covered if authorized Transplants maximums in approved facilities approved facilities maximums in approved facilities maximum in approved facilities. D.MIlats \ My rinr.iimentc\RenFrirrne\rnmn Chart Pptirpec '711(17 Available tdRiliiies 'n-hi Id lk viifibig &il .iir.e..i A iilableitiil liii Available Aiiiiilitiltirl'il'ltheet ..,,, f . ,, . af .. Il Lfi 1 th *611 a 11 110 C'10011t1 el -' .-. g A: e ue- .,11 fe,re UIC a e BENEF]TS Tt7A A pil 0 , 1 i i It §1Ye tE . ., , •.i4 . Hospital R . ,0 . -al.yi 1 . iitIP '4.e:0 4 ii- 0,1 OlkAillegtc f... e n•• diCal !..',-'• .1‘1EDICAL ANDSURGICAL q.ARE:' '' : Surgery Voluntary second surgical 80% after deductible; Voluntary second surgical Covered Voluntary second surgical opinion on certain surgeries voluntary second surgical opinion; $20 Co-pay opinion; $20 Co-pay opinion on certain surgeries. • Technical Surgical Assist. Covered 80% after deductible Covered Covered Covered • Anesthesia Covered 80% after deductible Covered Covered Covered Maternity Care • Delivery Covered 80% after deductible Covered Covered Covered • Pre- and Post-Natal Care 90% under MM after deductible 80% after deductible 100% under basic; no co-pay Covered $20 Co-pay i Inpatient Medical Care General-unlimited 80% after deductible General — unlimited Covered Covered 1 Mental health care-45 days Mental health care —45 Mental health care —45 days days Inpatient Consultations Covered 80% after deductible Covered Covered Covered Emergency Care* (Physician) • Accidental Injuries 90% under MM after deductible 80% after deductible I00%under MM after deductible Covered Covered • Medical Emergencies 90% under MM after deductible 80% after deductible 100%under MM after deductible Covered Covered * Life threatening emergencies Laboratory & Pathology Covered-$5 or 10% co-pay 80% after deductible Covered Covered Covered Diagnostic Services Covered-$5 or 10% co-pay 80% after deductible Covered Covered Covered Diagnostic and Therapeutic Covered-$5 or 10% co-pay 80% after deductible Covered Covered Covered Radiology ' ADDITIONAL BENEFITS Office Visits 90% under MM after deductible 80% after deductible $20 Co-pay $20 Co-pay** $20 Co-pay*** Well-Baby Care Not covered Not Covered $20 Co-pay (up through 1 year) $20 Co-pay** $20 Co-pay*** Immunizations Not covered Not Covered $20 Co-pay (up through age 6) Covered Covered Allergy Testing 90% under MM after deductible 80% after deductible Covered $20 Co-pay $20 Co-payttt Allergy Therapy 90% under MM after deductible 80% after deductible Covered $20 Co-pay** $20 Co-pay*** Ambulance Services 90% under MM after deductible 80% after deductible 90% under MM after deductible Covered Covered Prosthetic Appliances 90% under MM after deductible 80% after deductible 90% under MM after deductible Covered Covered Durable Medical Equipment _ 90% under MM after deductible 80% after deductible 90% under MM after deductible Covered Covered Private Duty Nursing 75% under MM after deductible 80% after deductible 75% under MM after deductible Covered Not Covered Skilled Nursing Facility Covered 80% after deductible Covered Covered (120 days/year) Covered if authorized Voluntary Sterilization Not covered 80% after deductible Covered Covered Covered Routine Pap Smear Covered 80% after deductible Covered* Covered Covered Routine Mammogram Covered 80% after deductible Covered Covered Covered Routine Physical Not covered Not covered $20 co-pay; labs not covered* $20 Co-pay $20 Co-pay *If a routine PAP smear and physical **All services performed during one *** All services performed during are performed separately, only one is visit have a one time $20 Co-pay. one visit will have a one time $20 covered in a 12 month period – not Co-pay. both. •n•• - DA$Data\Nly documents1BenForms\Comp Chart Retirees 2007.doc Available & Ritiiiii hired prior ,.A1ilableih all Retirees AvailkbltoalfRetiiCes ziViilliblairillit tii-é tvallâble to all Retire _ to 1/1. ,., , pi 1 ! flE ,§ Or( 1 . . ,,,, .. . n. - I , , , To! #.1!lan i 1 1 r -,-,, . ! C t 1 1 ' . • ,,f,,, ,- e ,s- . •„ ,,, P. § .A. .UQSpllaI,'Od dig Sagi c .1.1 PI, l.Ji 11 , ...A. — . HMO- Wield 1 1 ,11 I i ,.. ?. -A ' ',If I` F. - ;TtlEselopTIONtratuppRoo -,, . , ,. Participating /Network Participating /Network Participating /Network Participating /Network Participating /Network Pharmacies: Covered, co-pays Pharmacies: Covered, co- Pharmacies: Covered, co-pays Pharmacies: Covered, co-pays Pharmacies: *Covered, co-pays $5 Generic; $10 Brand name; pays $5 Generic; $10 Brand $5 Generic; $10 Brand name; $5 Generic; $10 Brand name; $5 Generic; $10 Brand name; $25 Non-formulary. name; $25 Non-formulary. $25 Non-formulary. Birth $25 Non-formulary. Birth $25 Non-formulary. Birth Birth Control Pills covered. Control Pills covered. Control Pills covered. Control Pills covered. *If a prescription is written Non-participating/Non-network Non-participating/Non- Non-participating/Non-network Non-Participating/Non- DAW (Dispense as Written) by Pharmacies: Paid at 75% of network Pharmacies: Paid at Pharmacies: Paid at 75% of Network Pharmacies: Covered, a physician for a brand name allowed cost, less $5, $10 or $25 75% of allowed cost, less $5, allowed cost, less $5, $10 or $25 30% Co-pay. drug and a generic is available, Co-pay. $10 or $25 Co-pay. Co-pay. Also, available is the mail order you're responsible for the full Also, available is the mail order Also, available is the mail Also, available is the mail order program for drugs taken on a cost of the brand and the co- program for drugs taken on a order program for drugs program for drugs taken on a long-term basis. A three — pay of the generic drug, unless long-term basis. A three —month taken on a long-term basis. long-term basis. A three —month month supply can be ordered the physician has filed an supply can be ordered for a one- A three —month supply can supply can be ordered for a one- for a one-month co-pay. approved medical exception. month co-pay. be ordered for a one-month month co-pay. co-pay. Non-Network Pharmacies: Not Covered. Also, available is the mail order program for drugs taken on a long-term basis. A three — month supply can be ordered and is discounted by $5 total. PROORAM.PROVISIONS:2 : . ,, , "` . - — :-.• - V :,- -=.4 "'" Jc '' -, Vi 'i , Deductibles, Co-payments and Basic: Deductible: Basic: In-network: Co-pays as noted. Dollar Limitations No deductible, Co-pays as $350 per person, $700 per No deductible, Co-pays as noted: No deductible; co-pays as noted. No deductibles. noted: family per calendar year. Co-pays as noted. Master Medical: Deductible; $200 Out-of-network: Master Medical: Per Person, $400 per family per $150 deductible per person; Deductible: $200 per person, Co-payments: calendar year. $300 deductible per family. $400 family per calendar year. 20% general services ($1000 per person max. $2000 per Co-payments: 0%-10% for general Co-payments: 30% to a Co-payments: 10% for general family max.); 50% services ($1,000 out-of-pocket maximum of $1250 per person services ($1,000 out-of- pocket psychiatric care 8c substance maximums); 25% for mental health and $2,500 per family. maximums); 25% for mental abuse treatment; 20% private care and private duty nursing. health care and private duty duty nursing. nursing. D:\.$1)ata\Mv documents\BenForms\Comn Chart Retirees 2007.doc ' Mailable' tatR6e1air7„ lit:litedtiOr -:' vailabletnall Retie es ' Aiiilibl to all katife'eS: '' . ffillabiE,t6 illitetiiiii:'d AYailabli-tifillitetire'' . , : . . alt ,A1 lance Plan.. lilac rdss ag le . r1 0 11111e _Preterit- LE a ow OS IIENEFFTS'.'. , , ra !:tion4 la i I Fasiye e a or c 4I ik)-— , 1 Hospital and coinprefiensiye, aj f Nfe'clical 11 spin] R:Mcclicnalurgic:11witif _Hint of Service lIMO , , .,, , llMasterMeclieal _Plan i l.114iiiRA,11c111/N1'4) Maximum: Maximum: Maximum: Maximum: None on Basic. $1 million per $1 million per member per $1 million per covered type of $1 million per member in member per covered type of covered type of organ organ transplants. $5 million per network. $1 million out of organ transplant. transplant. $5 million per member life time other services, network. member life time other services. . . Payment of Covered Services Participating Hospitals I Preferred (Network) Hospitals: ' Covered services are paid in full, 100% of covered benefits, less 100% of covered benefits, less except where noted, when applicable co-pays. applicable co-pays. performed at Health Alliance Plan facilities/offices or Non participating Hospitals : ' FI Non Network Hospitals: authorized in advance by Health .1.1= -t- „ Inpatient care in acute-care - 85% of BCBSMS approved Alliance Plan providers hospital-$70 a day, less applicable payment amount, less applicable co-pays. co-pays (refer to non-participating ** If you choose an HMO under under Traditional option). the Health Maintenance Inpatient care in other hospitals-$15 Organization Option, you agree a day, less applicable co-pays. Preferred (Network) Physicians: to receive all of your health care• 100% of BCBSM's scheduled services through the HMO's Medicare Surgical: payment amount, less applicable .;:l.:.:', providers. If you choose to go to 100% of BCBSM's approved co pays a non-HIVIO provider, in a non- amount, less applicable co-pays. emergency situation, services Non network Physicians: will not be covered. 85% of BCBSM's scheduled payment amount, less applicable co-pays. . . DASDataWly documents\BenForms\Comp Chart Retirees 2007.doc 14 • DELTA DENTAL DeltaPreferred Option point-of-service USA Summary of Dental Plan Benefits For Group#0009936-0004 OAKLAND COUNTY This Summary of Dental Plan Benefits should be read in conjunction with your Dental Care Certificate. Your Dental Care Certificate will provide you with additional information about your Delta Dental plan, including information about plan exclusions and limitations. In the event that you seek treatment from a dentist that does not participate in any of Delta Dental' s programs, you may be responsible for more than the percentage indicated below. Control Plan - Delta Dental Plan of Michigan Benefit Year - January 1 through December 31 DPO Member DeltaPremier or Dentist Non-Participating Dentist Covered Services - Plan Pays You Pay Plan Pays You Pay Class I Benefits Diagnostic and Preventive Services - Used to diagnose and/or prevent dental q 00% l' . , abnormalities or disease (includes exams, cleanings and fluoride treatments Emergency Palliative Treatment - Used to temporarily relieve pain lt..I ° g Class 11 Benefits Radiographs - X-rays . 77. Oral Surgery Services - Extractions and dental surgery, including preoperative and , • • sto • : 4've care Endodontic Services - Used to treat teeth with diseased or damaged nerves (for ' _ .. . exam .1e, root canals - --;.;,,-- --, Periodontic Services - Used to treat diseases of the gums and supporting structures of the teeth , Relines and Repairs - Relines and repairs to bridges and dentures Minor Restorative Services - Used to repair teeth damaged by disease or injury (for exam • le, fillin : s) _..., Major Restorative Services - Used when teeth can't be restored with another filling material (for exam • le, crowns) Class III Benefits Prosthodontic Services - Used to replace missing natural teeth (for example, bridges and dentures A. VA. .0.... ..... - . ... Class IV Benefits Orthodontic Services (to age 19) - Used to correct malposed teeth and/or facial 5 0% 5 4 bones (for exam • le, braces) , Benefits for prophylaxes, fluoride treatment, oral examinations and bitewing X-rays are payable twice per calendar year. Benefits for full mouth X-rays (which include bitewing X-rays) are payable once in any three-year period. If you're planning on traveling outside the United States, you can receive emergency dental treatment through a worldwide dental network of English-speaking dentists. English-speaking customer service is available 24 hours a day, seven days a week, to help you find a dentist. Contact your benefits representative to obtain our international dental emergency brochure before you travel. Maximum Payment - $1,000 per person total per benefit year on Class I, Class II and Class III Benefits. Delta Dental's payment for Class IV Benefits will not exceed a lifetime maximum of $1,000 per eligible person. September 1, 2004 Ruth Johnson, County Clerk Resolution #07145 — (Ordinance #27) June 14, 2007 Moved by Rogers supported by Coulter the resolution be adopted. AYES: Coulter, Crawford, Douglas, Gershenson, Gingell, Gosselin, Gregory, Greimel, Hatchett, Jacobsen, KowaII, Long, Middleton, Nash, Potter, Potts, Rogers, Scott, Spector, Suarez, Woodward, Zack, Bullard, Burns. (24) NAYS: None. (0) A sufficient majority having voted in favor, the resolution was adopted. •••""" STATE OF MICHIGAN) COUNTY OF OAKLAND) I, Ruth Johnson, Clerk of the County of Oakland, do hereby certify that the foregoing resolution is a true and accurate copy of a resolution adopted by the Oakland County Board of Commissioners on June 14, 2007, with the original record thereof now remaining in my office. In Testimony Whereof, I have hereunto set my hand and affixed the seal of the County of Oakland at Pontiac, Michigan this 14th day of June, 2007.