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Agenda Packet 10-27-2026
CITY COMMISSION MEETING AGENDA FOR OCTOBER 27, 2026 5:00 PM CITY HALL COMMISSION CHAMBERS 300 SOUTH FIFTH STREET Any member of the public who wishes to make comments to the Board of Commissioners is asked to fill out a Public Comment Sheet and place it in the box located at the end of the Commissioner’s desk on the left side of the Commission Chambers. The Mayor will call on you to speak during the Public Comments section of the Agenda. ROLL CALL INVOCATION PLEDGE OF ALLEGIANCE ADDITIONS/DELETIONS NEW EMPLOYEE INTRODUCTION Assistant City Engineer Taylor Mullins - G. GUEBERT PROCLAMATION First Responders Day PRESENTATION Insurance Update - DJ Story, Benefit Advisor, HUB PUBLIC COMMENTS MAYOR'S REMARKS Items on the Consent Agenda are considered to be routine by the Board of Commissioners and will be enacted by one motion and one vote. There will be no separate discussion of these items unless a Board member so requests, in which event the item will be removed from the Consent Agenda and considered separately. The City Clerk will read the items recommended for approval. I. CONSENT AGENDA A. Approve Minutes for October 13, 2026, Board of Commissioners Meeting B. Receive & File Documents C. Appointment of Isaac Marrs to the Joint 911 Parcel Fee Appeals Board. D. Appointment of Kevin Terry to the Board of Adjustment E. Reappointment of Alex "Trey" Griffin to the Paducah Planning Commission F. Personnel Actions G. Declaration and Sale of Surplus Property 1938 Center Street - C. GAULT H. Use of Spending Credits for Eligible Employees Pursuant to the City's Group Health Plan for the 2027 Plan Year - S. WILCOX I. Approve Strategic Health Risk Advisor & Strategic Benefit Placement Services with HUB – S. WILCOX J. Administrative Services Only (ASO) Agreement with Anthem Blue Cross Blue Shield - S. WILCOX K. Health, Vision, and Dental Benefit Plan Premiums for 2027 - S. WILCOX L. Stop Loss Insurance with Voya Financial Advisors. Inc. - S. WILCOX M. Authorize the Application and Acceptance of a Department of Justice Bulletproof Vest Grant in the Amount of $8,180 - H. REASONS II. DISCUSSION A. Street Rehabilitation Update - G. GUEBERT III. COMMENTS A. Comments from the City Manager B. Comments from the Board of Commissioners IV. EXECUTIVE SESSION October 13, 2026 At a Regular Meeting of the Paducah Board of Commissioners held on Tuesday, October 13, 2026, at 5:00 p.m. CDT, (6:00 p.m. EDT), in the Commission Chambers of City Hall located at 300 South 5th Street, Mayor Pro Tem Wilson presided. Upon call of the roll by City Clerk, Lindsay Parish, the following answered to their names: Commissioners Henderson, Smith, Thomas, and Mayor Pro Tem Wilson. (4) Mayor Bray was unable to attend. (1) INVOCATION PLEDGE OF ALLEGIANCE PRESENTATION: Hotel Metropolitan Update PUBLIC COMMENTS • Kimberly Yates spoke about animal breeding practices • Marshall Davis spoke about business licensing MAYOR PRO TEM COMMENTS: • Boil Water Advisory: Clarified that there is no boil water advisory in Paducah, Kentucky. A social media post circulating on Facebook regarding a boil water advisory pertains to Paducah, Texas, not Paducah, Kentucky. • Stray Dogs at Noble Park: Addressed concerns regarding stray dogs in Noble Park. Noted that, under Kentucky law, animal control services are a county responsibility. In the previous year, the City of Paducah contributed approximately $363,000 to McCracken County for its share of animal control services. The City hopes to engage in further discussions with the County regarding these services. October 13, 2026 • Convention Center Funding: Addressed misconceptions regarding funding for the Convention Center and recent comments concerning the Showroom Lounge. Clarified that Convention Center funding is provided through the Transient Room Tax, which is overseen by the County, rather than the County's general tax revenues. She then provided City Manager Daron Jordan an opportunity to respond to statements made during Monday evening's McCracken County Fiscal Court meeting. CITY MANAGER COMMENTS: City Manager Jordan read a prepared statement addressing and correcting inaccurate information presented during Monday evening’s McCracken County Fiscal Court meeting. CONSENT AGENDA Mayor Pro Tem Wilson asked if the Board wanted any items on the Consent Agenda removed for separate consideration. No items were removed. Mayor Pro Tem Wilson asked the City Clerk to read the items on the Consent Agenda. I(A) Approve Minutes for October 2, 2026, Special Called Meeting of the Board of Commissioners Meeting I(B) Receive and File Documents: Contract File: 1. Agreement to purchase two compact SUV’s $67,600 – Paducah Ford-Mazda, Inc. – No commission action required – signed by Daron Jordan, City Manager 2. Commonwealth of Kentucky – Highway Safety Grant – Paducah Police Department – MO #3197 3. U.S. Department of Housing and Urban Development – CDBG Grant Annual Action Plan – MO #3239 4. Professional Services Agreement – Paducah Fire Department – BFW – Water Main Extension – See MO #3304 5. Employment Agreement with Travis Counts – MO #3315 6. Renewed Employment Agreement Daron Jordan, City Manager – MO #3319 Bids and Proposals File: 1. Two Compact SUVs for the Parks Department – a. Paducah Ford Mazda, Inc. b. Linwood Motors Financials: 1. Paducah Water Works – months ending May, 2026, June, 2026, July, 2026 and August, 2026 I(C) A MUNICIPAL ORDER AUTHORIZING THE MAYOR TO EXECUTE AN APPLICATION FOR AN FY2026 KENTUCKY LEAGUE OF CITIES LIABILITY GRANT IN THE AMOUNT OF $3,000 FOR PARTIAL REIMBURSEMENT OF EXPENSES FOR MUSIC PLAYGROUND EQUIPMENT REPLACEMENT, CERTIFIED PLAYGROUND SAFETY INSPECTOR CERTIFICATIONS AND SAMBA SAFETY – MVR MONITORING FEES AND ACCEPTING ANY GRANT October 13, 2026 FUNDS AWARDED BY KLC, AND AUTHORIZING THE MAYOR TO EXECUTE ALL DOCUMENTS RELATED TO SAME (MO #3322; BK 15) I(D) A MUNICIPAL ORDER AUTHORIZING THE MAYOR TO EXECUTE A DECLARATION OF TRUST AND TRUST PARTICIPATION AGREEMENT WITH THE KENTUCKY LEAGUE OF CITIES INSURANCE SERVICES FOR THE WORKER’S COMPENSATION TRUST (MO #3323; BK 15) Commissioner Henderson offered motion, seconded by Commissioner Smith, that the items on the consent agenda be adopted as presented. Adopted on call of the roll: yeas, Commissioners Henderson, Smith, Thomas, and Mayor Pro Tem Wilson (4). MUNICIPAL ORDER CONTRACT MODIFICATION FOR CITY HALL STABILIZATION PROJECT Commissioner Smith offered motion, seconded by Commissioner Henderson, that the Board of Commissioners adopt a Municipal Order entitled, “A MUNICIPAL ORDER APPROVING A CONTRACT MODIFICATION WITH PFGW ARCHITECTS FOR THE CITY HALL STABILIZATION PROJECT IN THE AMOUNT OF $14,920, FOR HISTORIC PRESERVATION SERVICES RELATED TO TAX CREDITS, AND AUTHORIZING THE MAYOR TO EXECUTE THE CONTRACT MODIFICATION Adopted on call of the roll yeas, Commissioners Henderson, Smith, Thomas, and Mayor Pro Tem Wilson (4). (MO #3324; BK 15) CITY COMMISSIONERS’ COMMENTS Commissioner Thomas expressed the need for increased City oversight of animal control services and recommended holding public forums to provide opportunities for citizen input and feedback. ADJOURN Commissioner Henderson offered Motion, seconded by Commissioner Smith, that the meeting be adjourned. Adopted on call of the roll yeas, Commissioners Henderson, Smith, Thomas, and Mayor Pro Tem Wilson. (4). MEETING ADJOURNED: 5:45 p.m. ADOPTED: October 27, 2026 October 13, 2026 October 27, 2026 RECEIVE AND FILE DOCUMENTS: Deed File: 1. Quitclaim Deed – City of Paducah to Kentucky Modern Housing Development LLC – 1411 Burnett Street – MO #3272 2. Quitclaim Deed City of Paducah to Paducah-McCracken County Board of Health, Inc. Alley Closure - Ord. 2026-08-8891 3. Quitclaim Deed City of Paducah to E-Tel/Murray, LLC – Alley Closure - Ord. 2026-08-8891 4. Quitclaim Deed City of Paducah to 1369 Properties, LLC – Alley Closure – Ord. 2026-08-8891 Contract File: Contract with Commonwealth of Kentucky – Stand By The Badge Grant - Memorandum of Agreement – MO #3246 Bids and Proposals File: Quote of Inspired Technologies – FY27 Parks Camera RFP – MO #3320 Financials Paducah Water Works – Financial Statements – Years Ended June 30, 2026 and 2025 Agenda Action Form Meeting Date: October 27, 2026 Short Title: Declaration and Sale of Surplus Property 1938 Center Street - C. GAULT Category: Municipal Order Staff Work By: Nancy Upchurch Presentation By: Carol Gault Background Information: The City acquired this property on February 21, 2022. The building on the property was demolished several years ago. The applicant Twin Rivers Equity Group LLC submitted a proposal to construct a single-family (three- bedroom, two-bath) home using the Bellemeade design provided by the city. The proposed investment is $155,000. They provided a letter confirming financial ability to complete the project from the Paducah Bank. Does this Agenda Action Item align with a Commission Priority? No If yes, please list the Commission Priority: Quality Housing- Communications Plan: Funds Available: Account Name: Account Number: Staff Recommendation: Staff recommends acceptance of the proposal submitted by Twin Rivers Equity Group LLC, to purchase the lot at 1938 Center Street and transfer the lot for $100, subject to the inclusion of a clause stating that the property will revert to the City if the owner fails to comply with the submitted proposal to substantially complete the project within one year. Attachments: 1. MO prop sale– 1938 Center Street 2. City Commission Staff Report 19358 Center St 3. 1938 Center Street Twin Rivers Equity Group MUNICIPAL ORDER NO. ______ A MUNICIPAL ORDER DECLARING THE REAL PROPERTY LOCATED AT 1938 CENTER STREET, PADUCAH, KENTUCKY TO BE SURPLUS PROPERTY, ACCEPTING THE BID OF TWIN RIVER EQUITY GROUP LLC IN THE AMOUNT OF ONE HUNDRED DOLLARS ($100.00) AND AUTHORIZING THE MAYOR TO EXECUTE THE DEED AND ALL DOCUMENTS RELATED TO SAME WHEREAS, pursuant to KRS 82.083, a written determination has been made that the City does not have any use at this time or in the future for property located at 1938 Center Street, Paducah, Kentucky, which constitutes surplus real estate; and WHEREAS, the City has advertised for bids several times, the last time being in May 2026. No bids were received by the deadline; and WHEREAS, Twin Rivers Equity Group LLC submitted a request to purchase the property located at 1938 Center Street for One Hundred Dollars ($100.00) to construct a single- family (three bedroom/two bath) home using the Bellemeade design on this property; and WHEREAS, the estimated value of the proposed investment is approximately $155,000, and the goal is to complete the project within one year of transfer of title; and WHEREAS, the City desires to accept the proposal for sale to Twin Rivers Equity Group LLC, in the amount of One Hundred Dollars ($100.00). NOW THEREFORE, BE IT ORDERED BY THE CITY OF PADUCAH, KENTUCKY: SECTION 1. The Board of Commissioners hereby declares the property located at 1938 Center Street, Paducah, Kentucky to be surplus property as it relates to the operations of the City. Further, the Board of Commissioners hereby accepts the bid of Twin Rivers Equity Group LLC in the amount of One Hundred Dollars ($100.00) for the purchase of real property located at 1938 Center Street, Paducah, Kentucky. The deed shall contain a reversionary clause providing that title shall revert to the City if the project is not substantially completed in accordance with the submitted proposal within one (1) year of conveyance. SECTION 2. The Mayor is hereby authorized to execute a deed and any necessary documents relating to same to complete the sale of the real property approved in Section 1 above. SECTION 3. This Order shall be in full force and effect from and after the date of its adoption. Adopted by the Board of Commissioners, October 2, 2026 Recorded by Lindsay Parish, City Clerk, October 2, 2026 \mo\prop sale– 1938 Center Street STAFF REPORT Board of Commissioners APPLICATION INFORMATION ADDRESS 1938 Center Street CASE NO. SOA2025-0029 OWNER Urban Renewal and Community Development Agency (URCDA) APPLICANT Twin Rivers Equity Group LLC REQUEST Sale of Asset Meeting DATE Oct. 27, 2026 GENERAL SITE INFORMATION CURRENT LAND USE Vacant SURROUNDING AREA INFORMATION SURROUNDING ZONING SURROUNDING LAND USE NORTH R-2 Single-Family SOUTH R-2 Multi-Family EAST R-2 Single-Family WEST R-2 Single-family GENERAL INFORMATION The disposition of surplus or excess property is governed by City Code Section 2-668; which references KRS 82.083. The disposition of any property requires a written determination that includes: a description of the property; its intended use at the time of acquisition; the reason why it is in the best interest CURRENT IMPROVEMENTS None FLOODPLAIN No PUBLIC UTILITIES PUBLIC Power, gas, water Paducah Fire, Paducah CURRENT ZONING R-2 SOA of the City to dispose of the item; and the method of disposition to be used. DESCRIPTION OF THE PROPERTY: 1938 Center Street 1938 Center Street PVA Pin: 105-33-06-0002 Lot Size: 40’ X 120” INTENDED USE AT THE TIME OF ACQUISITION The City acquired this property on February 21, 2022. The building on the property was demolished several years ago. This property has been advertised several times, the last time being in May, 2026. No bid was submitted prior the the deadline. KRS 82.083(5) states “If a city receives no bids for the real or personal property, either at public or electronic auction or by sealed bid the property may be disposed of, consistent with the public interest, in any manner deemed appropriate by the City. In those instances, a written description of the property, the method of disposal, and the amount of compensation, if any, shall be made.” METHOD OF DISPOSITION-Sealed Bids Typically, it is in the best interest of the board to transfer ownership of underutilized parcels to a responsible citizen, thereby placing the property back on the tax rolls and eliminating the maintenance and liability costs. BID INFORMATION BID #1 Twin Rivers Equity Group LLC Bid Amount: $100 The applicant submitted a proposal to construct a single-family (three-bedroom, two-bath) home using the Bellemeade design provided by the city. The proposed investment is $155,000. They provided a letter confirming financial ability to complete the project from the Paducah Bank. STAFF RECOMMENDATION Staff recommends acceptance of the proposal submitted by Twin Rivers Equity Group LLC, to purchase the lot at 1938 Center Street and transfer the lot for $100, subject to the inclusion of a clause stating that the property will revert to the City if the owner fails to comply with the submitted proposal to substantially complete the project within one year. Agenda Action Form Meeting Date: October 27, 2026 Short Title: Use of Spending Credits for Eligible Employees Pursuant to the City's Group Health Plan for the 2027 Plan Year - S. WILCOX Category: Municipal Order Staff Work By: Stefanie Wilcox, Kristi Gray, McKenzie Murphy Presentation By: Stefanie Wilcox Background Information: The City makes financial contributions to subsidize the cost of the premium charges in the approved health and wellness plan. Allocation of spending credits towards the purchase of certain benefits such as health, dental or vision pursuant to the City's group health insurance plan shall be $10,470 per employee; this remains unchanged in 2027. Health Insurance Premiums for each plan are increasing by $600 annually. This will be a $25 per pay period increase for each employee taking the City’s Health Insurance. For those employees who opt out of the City's group health insurance, who were hired prior to January 1, 2014, and can show proof of coverage under another sponsored group health insurance plan are recommended to receive an employer contribution of $2,850. New participants to the waiver credit, with a hire date after January 1, 2014, are subject to a $500 maximum employer contribution. In addition, any employee should be able to increase their allotment, at the minimum, by participating in the wellness program. This can be achieved through biometric readings ($1,000), completing an annual physical ($250), not using nicotine ($250), getting a physical and turning in lab work ($250) and participating in six events ($750) such as walking a 5k. There will be another increase in the deductible on the Investor Plan in 2027, to comply IRS regulations. The individual will go to $3,500 per individual, and $6,600 per family. The out-of-pocket maximum will remain the same for the Investor Plan. The Elite Plan will not have any deductible increases and will add Office Visit copays of $40 for Primary Care Physician and $80 for Specialist. See attachment for details. Does this Agenda Action Item align with a Commission Priority? No If yes, please list the Commission Priority: Commission Priorities List Communications Plan: Funds Available: Account Name: Account Number: Staff Recommendation: Approve the use of spending credits for eligible employees pursuant to the City's group health insurance plan for the 2027 plan year. Attachments: 1. MO - ins policy spending credits 2027 2. COP WELLNESS MANUAL (1) MUNICIPAL ORDER NO. ________ A MUNICIPAL ORDER ESTABLISHING POLICY FOR USE OF SPENDING CREDITS TOWARD THE PURCHASE OF CERTAIN BENEFITS SUCH AS HEALTH, DENTAL OR VISION PURSUANT TO THE CITY’S GROUP HEALTH INSURANCE PLAN FOR THE 2027 PLAN YEAR WHEREAS, the City makes financial contributions to subsidize the cost of the premium charges in the approved health and wellness plan; and WHEREAS, allocation of spending credits towards the purchase of certain benefits such as health, dental and vision pursuant to the City’s group health insurance plan shall be $10,470 per year. BE IT ORDERED BY THE BOARD OF COMMISSIONERS OF THE CITY OF PADUCAH, KENTUCKY: Section 1. To be eligible for the benefits provided in Section 2, employees must timely enroll in that portion of the City’s group health insurance plan referred to as medical and prescription drug coverage. The City shares the cost of medical, prescription drug, dental and vision coverage with the City employees by contributing $10,470 per employee (“base credit”) to be used under the Plan and other applicable credits which may be earned pursuant to the applicable City policy. In addition, any employee should be able to increase their allotment, at the minimum, by participating in the wellness program. This can be achieved through biometric readings ($1,000), not using nicotine ($250), getting a physical and turning in lab work ($250) and participating in six free events ($750) such as walking a 5k. There will be another increase in the deductible on the Investor Plan in 2027 to comply with IRS regulations. The deductibles will go to $3,500 per individual and $6,600 per family. The out-of-pocket maximum will remain the same for the Investor Plan. The Elite Plan will not have any deductible increases and will add Office Visit copays of $40 for Primary Care Physicians and $80 for Specialists. Section 2. All eligible employees who timely apply for coverage under the City’s group health insurance plan (medical and prescription drug coverage) shall be permitted to redirect any unspent employer contribution toward the applicable pre-tax vehicle (HSA, FSA, HRA) subject to all applicable federal and state laws and regulations and as may be amended from time to time by order of the Board of Commissioners. Any changes requested by the employee due to change in family status shall be considered on a pro-rata basis from the effective date of timely enrollment pursuant to the plan documents of any affected benefit plan. Section 3. A. Employees who opt out of the City’s group health insurance, who were hired prior to January 1, 2014, and can show proof of coverage under another sponsored group health insurance plan shall receive an employer contribution of $2,850. New participants to the waiver credit, with a hire date after January 1, 2014 are subject to a $500 maximum employer contribution which can be applied to an HRA, deposited on an as accrued basis, as established by the City and which can be amended from time to time by order of the Board of Commissioners. In the event the City in its sole discretion does not accept the creditability of the spouse’s employer-sponsored group health insurance plan, other group sponsored health insurance plan, or non-group sponsored health insurance plan, and the employee chooses to remain covered under such group health insurance plan, then such employee shall be governed under the procedures established in Section 4. B. All eligible employees who opt out of the City’s group health insurance plan to enroll in a health insurance plan that is not under a spouse’s employer-sponsored group health insurance or other group sponsored health insurance plan shall not be permitted to participate in an employer contribution of any unspent health insurance credits. Section 4. All eligible employees who opt out of the City’s group health insurance plan (medical and prescription drug coverage) for any reason other than those stated in Section 3 above, shall not be entitled to an employer contribution of unspent credits. Section 5. All eligible employees and their spouse may receive the maximum wellness credit that can be earned and that is $2,250 for an employee and $1,000 for a spouse. Section 6. For all employees who subsequently become eligible for coverage under the City’s group health insurance plan because of initial employment or a qualifying event (i.e., change in family status), and is timely enrolled under the Plan or opts out of the Plan, shall be governed under the same procedures described in Sections 1-4 above, except any benefits shall be applied on a pro-rata basis. Section 7. Except as provided under the applicable plan document covering any benefit plan, or HIPAA’s special enrollment rights or the United States Internal Revenue Code, or any other applicable federal or state law or regulation, or any participant in the City’s group health plan as described in Section 2 or any employee who has opted out of the plan as described in Sections 3 or 4 above, shall be precluded from making any changes to pre-tax elections (HSA, FSA, HRA) once the plan year starts except as otherwise permitted by this Municipal Order. Section 8. This Order shall be in full force and effect from and after the date of its adoption. _____________________________ George Bray, Mayor ATTEST: ________________________________ Lindsay Parish, City Clerk Adopted by the Board of Commissioners, October 27, 2026 Recorded by Lindsay Parish, City Clerk, October 27, 2026 \mo\ins policy spending credits 2027 B r i n g i n g L e a d e r s t o L i f e . City of Paducah Wellbeing Manual 2027 Edition your step-by-step guide to feeling great at work Y O U R M U U V W E L L P R O G R A M Your Health & Well-being Partner MuuvWell partners with the City of Paducah to help every team member feel their best physically, mentally, and professionally. Utilize your MuuvWell program for optimal health and well-being. 🏆 Health & Wellness Challenges Join fun challenges designed to keep you moving and motivated. Every step counts and every win is celebrated. 💬 One-on-One Coaching Sessions Talk live with an exercise coach, dietitian, or physical therapist at anytime. Real experts, just for you, on your schedule. 🧘♀️ Complete Your Daily Muuv Strive for Five helps you build momentum by making exercise simple enough to fit into any workday. Take a five minute rest with us today! 📱 MuuvWell App Access Everything in one place! Workouts, meal tracking, expert content, chatting with your coach, and more. Free, simple, and built to keep you going. App Store Google Play Download the MuuvWell App Today Scan the QR code with your phone camera. Your journey to your best self starts here. MUUVWELL® Your Dedicated Wellness Team Real people, ready to help. Reach out anytime. We’re in your corner. Tori Riley R E G I S T E R E D D I E T I T I A N Stephanie Anklan Nevaeh Nahid Tyler Hardin D O C T O R O F P H Y S I C A L T H E R A P Y Wade Weatherholt Kevin Winn 💬 Fastest Way to Reach Us Send a chat message in the MuuvWell app — straight to your coach. ✉ General Questions Email us at info@muuvwell.com 🎁 Submit Reward Points Message "incentive points" in the app. E X E R C I S E C O A C H E X E R C I S E C O A C H E X E R C I S E C O A C H G O A L S E T T I N G & A C H I E V E M E N T C O A C H E V E R Y T H I N G Y O U N E E D Resources & Quick Links Download the app, log in online, or call us. Here’s everything in one place. Bookmark this page. These are the only links and numbers you’ll ever need to get help, log in, or submit your rewards. 🌐 W E B L O G I N www.MuuvWell.com Log in to access your wellness dashboard, challenges, and content from any browser. 📞 Q U E S T I O N S A B O U T M U U V W E L L 364.888.9433 Call us if you have any questions — we’re happy to help walk you through anything. 🎁 S U B M I T R E W A R D P O I N T S Message "incentive points" in the app Or send a secure email to info@muuvwell.com ✉ G E N E R A L Q U E S T I O N S info@muuvwell.com Email us any time. We usually respond within one business day. Welcome Video Watch the Welcome Video Point your phone camera at the QR code. Tap the link that pops up. C I T Y O F P A D U C A H / W E L L N E S S P R O G R A M C O P W E L L N E S S P R O G R A M Core Elements Complete Between Oct-Sept | Employees & Spouse Are Eligible A N N U A L P H Y S I C A L Your annual physical is covered 100% under your health plan. Annual physicals are important opportunities for healthcare professionals to observe trends and changes that occur with your physical health over time. H E A L T H R I S K A S S E S S M E N T An HRA is a brief survey containing questions about a broad variety of health habits and risks. Log in to MuuvWell to complete the Health Risk Assessment. Your personal responses are private within MuuvWell and not shared with your employer. B I O M E T R I C S C R E E N I N G Good health is built upon a foundation of knowledge. One of the most important things you can do for your health is to “know your numbers.” You will earn incentives for maintaining your levels within the stated ranges, or by improving your previous levels by 5%. Your individual lab results will never be shared with your employer or anyone representing your employer. I N C E N T I V E S Earn $200 per biometric marker within range, or when you improve by 5%, up to 5 biometric markers. INCENTIVES EMPLOYEE SPOUSE Completion of Annual Physical + Biometric Screening $250 $200 BMI ≤ 25 or Total Percent Body Fat: Men ≤ 17% | Women ≤ 24%$200 $100 Blood Pressure ≤ 120/80 $200 $100 Blood Sugar ≤ 106 $200 $100 Total Cholesterol ≤ 200 $200 $100 HDL: Men ≥ 35 | Women ≥ 45 $200 $100 LDL ≤ 100 $200 $100 Triglycerides ≤ 200 $200 $100 TOTAL POSSIBLE BIOMETRIC DOLLARS $1,250*$700* *NOTE:These biometric standards are based off advice and recommendations provided to your wellness provider. These are a guidelines. Please consult your doctor to determine the best standards for your health. Just for completing the screening and physical you earn $250 ($200 for spouses). You can earn $200 per biometric ($100 for spouses) within range, or if you improve by 5%, up to 5 biometric markers. C O R E E L E M E N T S / W E L L N E S S P R O G R A M C I T Y O F P A D U C A H C I T Y O F P A D U C A H / W E L L N E S S P R O G R A M C O P W E L L N E S S P R O G R A M Approved Activities Complete Up To 6 Approved Activities | Employees & Spouse Are Eligible A P P R O V E D A C T I V I T I E S / W E L L N E S S P R O G R A M C I T Y O F P A D U C A H C I T Y A P P R O V E D F I T N E S S E V E N T Q U A R T E R L Y C H A L L E N G E INCENTIVES A C T I V I T I E S C O M P L E T E D EMPLOYEE SPOUSE 1 COMPLETED $125 $50 2 COMPLETED $250 $100 3 COMPLETED $375 $150 4 COMPLETED $500 $200 5 COMPLETED $625 $250 6 COMPLETED $750 $300 P R E V E N T A T I V E E X A M C O M M U N I T Y E N G A G E M E N T VOLUNTEER, ETC. | UP TO 2* E D U C A T I O N S E S S I O N S F I N A N C I A L P R O G R A M STRIVE FOR FIVE, 1-ON-1 VISITS | UP TO 4 M U U V W E L L A P P THE MUUVWELL APP | 1 PER QUARTER WALK/RUN EVENT OR 50 DAYS OF 5K* VISION, DENTAL, ETC. | UP TO 3* You have a variety of activities to choose from, each activity is designed to educate and encourage you to make healthy lifestyle choices. Complete up to six approved activities during the 2026-2027 program in order to receive the incentive. Log in to your online wellness account to see approved activities available and complete an approved activity challenge. Other approved activities may be added throughout the program year. SEMINAR | 1 PER QUARTER THE MUUVWELL APP *PLEASE NOTE: All proof of preventative exams, community engagement, and city approved 5Ks must be sent via secure email to info@muuvwell.com. Y O U R H E A L T H B E N E F I T HealthWorks Services As a City of Paducah team member, you have access to real medical care — right from your phone. Here’s how to use it. HealthWorks is a free benefit for City of Paducah employees. Use it for quick medical help during the workday or after hours. No long waits, no big bills. T E L E H E A L T H — C A L L A P R O V I D E R B Y P H O N E 📱 2 2 Get care fast A provider will assist you for common issues: colds, allergies, sore throat, fever, minor injuries, and more. Tip: You don’t need to leave your desk. Telehealth is done entirely by phone. 🩺 1 Call HealthWorks Dial 270-408-9355. Tell the receptionist you need medical help and that you work at the City of Paducah. 1 T E L E H E A L T H A V A I L A B L E 2 4 /7 W O R K F O R C E P E R F O R M A N C E • E X E C U T I V E W E L L N E S S Bringing Leaders To Life Your health is the foundation of everything you do at work, at home, and in your community. We’re here to help you build it. Want more tips, motivation, and wellness resources? Follow us on social media! f in @MuuvWell Agenda Action Form Meeting Date: October 27, 2026 Short Title: Approve Strategic Health Risk Advisor & Strategic Benefit Placement Services with HUB – S. WILCOX Category: Municipal Order Staff Work By: McKenzie Murphy, Stefanie Wilcox, Kristi Gray Presentation By: Stefanie Wilcox Background Information: The City has utilized the Health Risk Advisor services with HUB (formerly Peel & Holland) since July 1999 pertaining to issues regarding the administration, renewal, claim resolution, cost containment and bidding process of the City's health insurance plan. In 2026, Staff completed a review of other Benefit Consultants and it is recommended to enter into a contract with HUB to continue these services for calendar year 2027. This is a 1-year contract with HUB that includes a decrease of $20,000 in 2027. This fee is payable on four equal installments of $15,475 to be billed quarterly. Authorize the Mayor to execute a contract between the City of Paducah and HUB pertaining to the administration of the City's health insurance. Does this Agenda Action Item align with a Commission Priority? No If yes, please list the Commission Priority: Commission Priorities List Communications Plan: Funds Available: Account Name: Account Number: Staff Recommendation: Approve and sign the one-year agreement with HUB for Employee Benefit Services. Attachments: 1. MO - contract – HUB (formerly Peel & Holland) Health Risk Advisor & Benefit Placement Services 2027 2. Signed_2027_City_of_Paducah__Employee_Benefits_Service_Agreement MUNICIPAL ORDER NO. ______ A MUNICIPAL ORDER AUTHORIZING THE MAYOR TO EXECUTE A CONTRACT FOR A STRATEGIC HEALTH RISK ADVISOR & STRATEGIC BENEFIT PLACEMENT SERVICES WITH HUB (FORMERLY PEEL & HOLLAND) FOR ADMINISTRATION OF THE CITY OF PADUCAH’S HEALTH INSURANCE IN AN AMOUNT OF $61,900 BE IT ORDERED BY THE CITY OF PADUCAH, KENTUCKY: SECTION 1. The City of Paducah hereby authorizes the Mayor to execute a contract for a Strategic Health Risk Advisor and Strategic Benefit Placement Services with HUB (formerly Peel & Holland), in the amount of $61,900, payable in four equal installments of $15,475 each, for administration services pertaining to the administration of the City of Paducah’s health insurance. SECTION 2. Said contract authorized in Sections 1 and 2 above will be for the 2027 calendar year. SECTION 3. This order will be in full force and effect from and after the date of its adoption. George Bray, Mayor ATTEST: Lindsay Parish, City Clerk Adopted by the Board of Commissioners, October 27, 2026 Recorded by Lindsay Parish, City Clerk, October 27, 2026 mo\contract – HUB (formerly Peel & Holland) Health Risk Advisor & Benefit Placement Services 2027 1 EMPLOYEE BENEFITS FEE FOR SERVICES AGREEMENT THIS EMPLOYEE BENEFITS FEE FOR SERVICES AGREEMENT (this “Agreement”), dated as of January 1, 2027 (the “Commencement Date”), is hereby entered into by and between City of Paducah (the “Client”), and HUB International- Mid-South (“Hub”). WHEREAS, the Client desires to continue to engage Hub to perform certain services with respect to certain of the Client’s employee benefits plans and related insurance coverages, if applicable; and WHEREAS, HUB desires to perform such services for the Client, in each case in accordance with and subject to the terms and conditions set forth in this Agreement. NOW, THEREFORE, in consideration of the mutual promises contained herein, and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the parties agree as follows: 1. Services. Hub shall perform the insurance brokerage services set forth in the scope of services attached hereto as Exhibit A (collectively, the “Services”). For the avoidance of doubt, Hub shall have no obligation pursuant to this Agreement to perform any service for or with respect to any employee benefit plan that is not identified on Exhibit A. 2. Consulting Fee. Quarterly Fee- In consideration of the Services, the Client shall pay to Hub a quarterly fee in an amount equal to fourteen thousand two hundred and eighty three dollars and zero cents ($14,283.00) (the “Consulting Fee”) and a quarterly fee in an amount equal to one thousand one hundred and ninety two dollars and zero cents ($1,192.00) (the “Data Analytics Fee”), for a total quarterly fee of fifth teen thousand four hundred and seventy five dollars and zero cents ($15,475.00) - The Client shall pay to Hub the Consulting Fee promptly (but in no event later than thirty (30) days) following the date of any applicable invoice Client acknowledges that the majority of Hub’s services are performed in the first six months following the Commencement Date or any annual anniversary thereof. Therefore, Hub reserves the right to invoice the Client for six (6) months’ worth of the repeating Consulting Fee during the first month of any annual term of this Agreement. The Client acknowledges that Hub reserves the right to reasonably adjust the Consulting Fee upon notice to the Client in the event that the nature or extent of the Services changes, including, for example, as a result of a significant change in the size of Client’s benefits-eligible workforce. In further consideration of the Services, Hub will be paid by each applicable insurance carrier core commissions which are currently expected to be as follows: • Dental: 10% of monthly premium • Vision: 10% of monthly premium • Group Term Life: 15% of monthly premium • Vol. Life: 15% of monthly premium 2 • LTD: 15% of monthly premium • Colonial: 35% of monthly premium (first year) / 3% of monthly premium (renewal) Core commissions may increase or decrease as determined by the applicable insurance carrier. In addition, Hub may be paid from time to time by each such carrier or agent contingent commissions, guaranteed supplemental commissions, profit sharing payments, bonuses, override commissions, or other profit-, volume- or incentive-based non-standard commissions, which commissions may or may not relate, in whole or in part, to the employee benefits plans for which the Client appoints and maintains Hub as broker of record from time to time. Hub also may be paid other commissions or fees from other third parties that may from time to time perform employee benefits-related services on behalf of the Client. The Client acknowledges that it has read Hub’s “How We Get Paid” disclosure statement available at hubinternational.com. 3. Independent Contractor. Hub shall perform the Services as an independent contractor. The parties intend to have an independent contractor relationship, and do not intend to have a relationship in the nature of an employer-employee, partnership, joint venture or agency. 4. Representations and Warranties. Hub represents and warrants that it has all necessary authority and approval to enter into this Agreement and that it will perform the Services in a professional manner in accordance with prevailing insurance brokerage industry standards. Except as otherwise provided for herein, all services performed pursuant to this Agreement, whether the services are performed by Hub or a third party, are performed on an “as is”, “as available” basis without representation or warranty of any kind. Hub makes no express or implied representations or warranties with respect to such services, including without limitation any express or implied warranty of merchantability or fitness for a particular purpose or intended use. 5. Information Submission. The Client shall timely submit to Hub all information in the Client’s control or possession that is necessary for Hub to perform the Services, and the Client is responsible for the accuracy and completeness of such information. Such information includes, but is not limited to, historical benefits plan documentation, plan census information or other information that Hub must provide to carriers, benefits vendors or other third parties for underwriting, marketing, quoting, servicing or other purposes. If Hub establishes a deadline by which the Client is required to provide certain information to Hub, the Client agrees to provide the information by that deadline, unless Hub agrees to an extension. The Client hereby consents to Hub sharing with third parties, whether engaged by Hub or the Client, information Hub receives from the Client as necessary or advisable to provide the Services or as otherwise requested by the Client. The Client shall be responsible for obtaining all individual consents and all other legally necessary consents or permissions required or advisable to disclose, process, retrieve, transmit or view the information it submits or receives in connection with Hub’s performance of the Services. The Client shall be responsible for retaining for its own use information that it delivers to, or receives from, Hub and for taking other precautions the Client deems necessary in the event that such information or other materials delivered to Hub are lost or destroyed. 6. Nature of Services; Plan Operation. The Client acknowledges that the Services are not of a legal nature and that Hub will in no event give, or be required to give, any legal or tax opinion or advice, 3 or otherwise provide any legal or tax representation to the Client. The Client is responsible to procure its own legal or tax advice to the extent required or prudent for the Client to obtain the full benefit of the Services or otherwise. The Client acknowledges that Hub will in no event assume any responsibility or authority for or with respect to any of the following: the selection, design, funding or operation of any employee benefits plan or the compliance of any such plan with applicable plan documents or law; duties incumbent upon or required to be performed by a plan sponsor, plan administrator, fiduciary or “covered entity” under applicable law; funding claims for benefits under any employee benefits plan; or insuring or underwriting any liability to provide any benefit under any employee benefits plan. Without limiting the generality of the foregoing, the Client acknowledges that Hub is not a fiduciary with respect to any of the Client’s employee benefits plans and that Hub has no discretion with respect to the management or administration, or control or authority over any assets, of the Client’s employee benefits plans. All such discretion and control shall remain with the Client and other fiduciaries to the Client’s employee benefits plans. 7. Non-Core Functions. From time to time, Hub may perform or provide, or arrange for the performance by third parties of, services that are not directly related to the Services, including the provision to the Client of sample documents or forms, whether or not related to those employee benefits plans identified on Exhibit A (collectively, the “Non-Core Functions”). Hub performs or arranges for the Non- Core Functions, if at all, as a courtesy to the Client and does not warrant the Non-Core Functions in any regard. Without limiting the generality of Section 6, the Client acknowledges that it is the Client’s responsibility to ensure that the Non-Core Functions are performed, and that any template or sample document or form that is provided to the Client by Hub is utilized, properly and in accordance with applicable plan documents and law. The Client acknowledges and agrees that Hub shall have no liability arising out of or relating to the performance of the Non-Core Functions. Except as otherwise agreed to between the parties from time to time, Hub shall not be responsible to make payment on behalf of the Client to any third party for any of the Non-Core Functions. 8. Term and Termination. This term of this Agreement shall begin on the Commencement Date and continue in full force and effect unless earlier terminated in accordance with this Section. Either party may terminate this Agreement upon at least ninety (90) days advance written notice to the other party; provided, however, that no such termination shall be effective prior to the first annual anniversary of the Commencement Date. In the event of termination of this Agreement for any reason, Hub’s obligation to perform the Services shall terminate immediately. 9. Business Associate Agreement. In connection with the execution of this Agreement, the parties shall use good faith efforts to execute a Business Associate Agreement in substantially the same form as attached hereto as Exhibit B, unless (a) as of the Commencement Date, the parties have entered into an enforceable Business Associate Agreement (in which case such Business Associate Agreement shall continue in full force and effect in accordance with its terms) or (b) the parties determine that applicable law does not require that they enter into a Business Associate Agreement (and, for the avoidance of doubt, in either case, references in this Agreement to “Exhibit B” shall be disregarded). 10. LIMITATION OF LIABILITY. IN NO EVENT WILL A PARTY HERETO OR ITS AFFILIATES BE LIABLE TO THE OTHER PARTY OR ANY OF ITS AFFILIATES UNDER THIS AGREEMENT FOR INCIDENTAL, CONSEQUENTIAL, INDIRECT, PUNITIVE, SPECIAL OR SIMILAR DAMAGES (INCLUDING LOSS OF PROFITS, DATA, BUSINESS OR GOODWILL) 4 CAUSED BY ITS ACTS OR OMISSIONS UNDER THIS AGREEMENT, REGARDLESS OF WHETHER SUCH LIABILITY IS BASED ON BREACH OF CONTRACT, TORT, STRICT LIABILITY, BREACH OF WARRANTIES, FAILURE OF ESSENTIAL PURPOSE OR OTHERWISE, EVEN IF SUCH PARTY IS ADVISED OF THE LIKELIHOOD OF SUCH DAMAGES. 11. Intellectual Property Rights. Nothing herein shall be construed to grant to the Client any intellectual property right in any insurance or insurance brokerage know-how, expertise, technique, methodology or strategy, or any form, template, source or similar documentation or program, that from time to time have been, is or may be utilized by Hub in connection with the operation of its business or the performance of the Services. 12. Limited Use of Name and Logo. The Client authorizes Hub to use the Client’s name and logo for the express and sole purpose of identifying the Client as a client of Hub in the marketing materials of Hub; provided, however, that Hub’s use pursuant to this Section shall be subject to any restrictions or guidelines which may be provided from time to time by the Client to Hub. In the event that the Client withdraws the authorization set forth in this Section, Hub shall use commercially reasonable efforts to promptly remove any uses of the Client’s name or logo from any marketing materials of Hub. 13. Governing Law; Venue. This Agreement will be governed by, and construed in accordance with, the substantive laws of the State or Commonwealth where the Hub office is located (as reflected at the address that applies for purposes of notices to Hub as provided in Section 16 (the “Hub Office”)), without regard to its choice of law rules. The parties consent to exclusive venue and personal jurisdiction of any federal or state court located in the county where the Hub Office is located (provided that if no such court is located in that county, venue and personal jurisdiction will be exclusively exercised by the nearest applicable court having jurisdiction over that county). 14. Counterparts. This Agreement may be executed and delivered (including by facsimile, “pdf” or other electronic transmission) in any number of counterparts, each of which shall be deemed an original, but all of which together shall constitute one and the same instrument. 15. Entire Agreement. Except as provided in Section 9, this Agreement sets forth the entire agreement and understanding, and supersedes any and all prior or contemporaneous agreements and understandings, oral or written, between the parties regarding the subject matter hereof. 16. Notice. Unless otherwise agreed to by the parties, all notices required under this Agreement (except, for the avoidance of doubt, those ordinary course communications relating to product pricing, changes, etc.) will be deemed effective when received and made in writing by (a) registered mail, (b) certified mail, return receipt requested, or (c) a national overnight courier service, in each case sent to the applicable address set forth immediately below the applicable party’s signature (or such other address as either party may designate in writing in accordance with this Section). 17. Amendments and Waivers. This Agreement may not be amended or waived except by an instrument in writing signed, in the case of an amendment, by an authorized representative of each party to this Agreement or, in the case of a waiver, by the party against whom such waiver is to be effective. No course of conduct or failure or delay by any party in exercising any right, power or privilege hereunder 5 shall operate as a waiver thereof, nor shall any single or partial exercise thereof preclude any other or further exercise thereof or the exercise of any other right, power or privilege. 18. No Third Party Beneficiaries. Nothing in this Agreement, express or implied, is intended or shall be construed to confer upon any third party other than the parties hereto and their respective successors and permitted assigns any right, remedy or claim under or by reason of this Agreement. 19. Assignment. This Agreement, and the parties’ rights and obligations hereunder, may not be assigned or assumed by another without the prior written consent of the other party; provided, however, that Hub’s rights and obligations hereunder may be assigned to an affiliate of Hub without the consent of the Client. This Agreement shall inure to the benefit of, and be binding upon the parties hereto, their successors and permitted assigns. 20. Force Majeure. Neither of the parties shall be liable to the other for any failure to satisfy an obligation under this Agreement due to any cause beyond a party’s reasonable control including, but not limited to, inclement weather, Acts of God, war, riot, terrorist acts, malicious acts of damage, civil commotion, industrial dispute, power failure or fire. 21. Severability. Each party agrees that all covenants and agreements set forth in this Agreement constitute a series of separate covenants and are severable. The invalidity, illegality or unenforceability of any provision of this Agreement will not affect the validity, legality and enforceability of the remaining provisions of this Agreement. [Remainder of page left intentionally blank] 6 IN WITNESS WHEREOF, the parties hereto have duly executed this Agreement as of the Commencement Date. For Notices, a copy (which will not constitute notice) shall be sent to: Hub International Limited c/o Legal Department 150 North Riverside Plaza, 17th Floor 7 Exhibit A SCOPE OF SERVICES Benefit Advisory Services GENERAL ADVISORY SERVICES 1. Review all insurance contracts and employer forms relating to health, vision, dental, and drug benefits, HRA, H.S.A. and make recommendations to the CLIENT on such contracts. 2. Coordinate on-site enrollers or web-based enrollments and assistance with annual open enrollment for eligible employees during the period(s) contracted. 3. Provide assistance with questions on behalf of CLIENT including but not limited to health insurance claims, eligibility, plan selection for employees. 4. Provide consultation on issues relating to cost share, stop-loss and plan administration, and oversight in bid processes annually. 5. Review and provide commentary on plan data such as claims, administrative and reinsurance costs and comparisons of data for varying years on a quarterly basis agreed to committees and/or the City Commission, or City Manager as agreed to by CLIENT. 6. Prepare annual request for proposals (RFP) for years CLIENT requests formal bid processes. Provide oversight and coaching services in review of bids, assembly of data received by bidders and make specific recommendations to CLIENT for placement or procurement of health/drug, dental and vision insurance contracts. 7. Review preferred provider agreements and assist client in comparing and selecting preferred provider organizations (PPO). 8. Assist CLIENT with meetings and coach on benefit plan issues with employee groups as requested by CLIENT. 9. When qualified provide advice for all other areas of health, dental and drug plan operations as requested by CLIENT. 10. Provide COBRA administrative services via a separate administrative party as per a separate agreement between, Flores & Associates and CLIENT. 11. Provide expert witness services in connection for employer and employee bargaining, legal matters, disputes, or similar issues, as requested by the employer or the employer’s legal counsel. 8 12. Provide data analytics with customized reporting and care management integration with disease management firms chosen independently by CLIENT. 13. Access to the HUB International Compliance Team. 9 Exhibit B FORM OF BUSINESS ASSOCIATE AGREEMENT See attached. Agenda Action Form Meeting Date: October 27, 2026 Short Title: Administrative Services Only (ASO) Agreement with Anthem Blue Cross Blue Shield - S. WILCOX Category: Municipal Order Staff Work By: Stefanie Wilcox, Kristi Gray, McKenzie Murphy Presentation By: Stefanie Wilcox Background Information: DJ Story of HUB recommends that the city continue with Anthem Blue Cross Blue Shield for the 2027 plan year, effective January 1, 2027, as the City's Third-Party Administrator (TPA) to provide claims administrative services related to the City's health insurance plan. Remaining with Anthem offers the best overall option for quality of plans, administrative services and competitive discount rates and factors. A summary of Anthem's administrative fees, rates and factors is attached. Does this Agenda Action Item align with a Commission Priority? No If yes, please list the Commission Priority: Commission Priorities List Communications Plan: Funds Available: Account Name: Account Number: Staff Recommendation: Authorize the Mayor to execute ASO agreement and other required documents with Anthem Blue Cross Blue Shield for administrative services only. Attachments: 1. City of Paducah- 2027 Anthem Signature Binder 2. Medicare_Sec Payer_ER_Status_Form (Rev 1 07) 3. MO - administrative services - Anthem 2027 CITY OF PADUCAH Your Anthem Blue Cross and Blue Shield Renewal Packet Connecting you to the coverage you need Administrative Services Only (ASO) renewal for: CITY OF PADUCAH Group Number: W29698 Effective January 1, 2027 through December 31, 2027 Created on: October 6, 2026 Broker: HUB INTERNATIONAL MIDWEST LIMITED Anthem Sales Contact: Angie Meadows 859-226-5324 angie.meadows@anthem.com CITY OF PADUCAH - 0673594-03 - 10/6/2026 12:37:10 PM Save up to $3.00 PEPM on your ASO medical fee when adding new dental, vision, accident, critical illness, hospital indemnity or life & disability from our partner, The Standard.* * Applies to large group clients with up to 5,000 employees. Other restrictions apply. Ask your Anthem representative for complete details. 1 Anthem internal data, Q2 2025. 2 Sydney Health is offered through an arrangement with CareMarket, Inc., a separate company offering mobile application services on behalf of Anthem Blue Cross and Blue Shield ©2021-2022. 3 Anthem internal data, 2020. 4 Anthem internal data, 2020, and Anthem Ebase, 2020. Thank you for partnering with Anthem We’re reimagining what’s possible for every moment of health. Your renewal includes the latest innovations from Anthem to deliver: Your success is our success. We’re here to help build confidence in care and support you every step of the way. We are deeply committed to helping your employees feel covered and confident in their healthcare. We’re here to help you promote an effective healthcare strategy by working closely with you and your broker. Our associates live and work in the same places you do. We are both members of the communities we serve and partners in helping those communities thrive. In Kentucky, Anthem is proud to have:¹ in the local marketyearsassociatesmembers 1.9M Kentucky Fixed Administrative Costs (ASO) CITY OF PADUCAH Effective January 1, 2027 through December 31, 2027 Current 1/1/2027 through through through through through 284 284 571 571 $48.84 $49.99 $0.00 $0.00 $0.00 $0.00 ($37.04)($38.15)$0.00 $0.00 $0.00 $0.00 $5.00 $5.00 $0.00 $0.00 $0.00 $0.00 $1.85 $1.85 $0.00 $0.00 $0.00 $0.00 $63,559 $63,696 $0 $0 $0 $0 Authorized Signature:_____________________________________________ Title:____________________ Date:____________________ Additional Fee Disclosures: 0673594-03 Fixed Administrative Costs CITY OF PADUCAH - 0673594-03 - 10/6/2026 12:37:10 PM Benefit Information CITY OF PADUCAH Effective January 1, 2027 through December 31, 2027 Deductible (individual/family) Coinsurance Out-of-pocket maximum (individual/family) Office Visit (PCP / Specialist) Copay Inpatient / Outpatient Copay (Surgery) Emergency Room / Urgent Care Copay Prescription Drugs – Retail Prescription Drugs – Mail Order OON Deductible (individual/family) OON Coinsurance OON OOP Max (individual/family) Benefit categories reflect In-network benefits unless noted as Out-Of-Network (OON) Benefit amounts reflect member cost-share unless otherwise noted Be n e f i t C a t e g o r i e s Ded & Coins/Ded & Coins Ded & Coins/Ded & Coins 50% $3,500 / $6,600 $3,000 / $6,000 Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Kentucky, Inc. Independent licensee of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. - 0673594-03 $6,600 / $13,200 $6,600 / $13,200 30% Ded & Coins/Ded & Coins Ded & Coins/$75 $3,500 / $6,600 $3,400 / $6,600 $3,500 / $6,600 $1,500 / $3,000 Ded & Coins/Ded & Coins $40/$80 0%20% Renewal Plan Designs (Custom) Anthem Blue Access PPO HSA $3,500 Essential Ded & Coins/Ded & Coins $15/$35/$55/25% to $150 Ded & Coins/Ded & Coins $45/$105/$165/25% Services included and buy-up options (ASO) CITY OF PADUCAH Effective January 1, 2027 through December 31, 2027 PCPM fee EAP Basic 3-Visit $0.57 EAP Enhanced 4-Visit $1.15 EAP Enhanced 6-Visit $1.59 Anthem Solutions HSA $2.45 Fee Billed Per ParticipantPer Month Add ASA FSA, Commuter, or Dependent Care FSA*$3.55 Discounted cost of FSA buy-up (*when adding to HRA)$0.80 Discounted cost of FSA buy-up (*when adding to HSA)$1.15 Notes 0673594-03 Services Included in fixed administrative costs Buy-Up Options Spending Account & Other Buy-up Options (charged separately) vendor charges that have a direct positive impact on the cost of care. Since these charges are considered claim-related by Anthem, they are incorporated into the claims projection (available upon request). These charges are excluded from PCPM Administrative Fees above, are CITY OF PADUCAH - 0673594-03 - 10/6/2026 12:37:10 PM Assumptions and conditions (ASO) CITY OF PADUCAH Effective January 1, 2027 through December 31, 2027 SIC Code: 9199 Administrative Services Only (ASO) • The proposed services, rates and fees are effective from 1/1/2027 through 12/31/2027. • This contract will be issued in KY. - This is an integrated medical and pharmacy offering. • The proposal assumes 284 employees will be enrolling for medical coverage, with an average member to employee ratio of 2.01. • The proposal assumes the same enrollment for medical and pharmacy. • Anthem reserves the right to revise this proposal or modify these fees or rates under any of the following circumstances: - Due to any taxes, fees and assessments prescribed by any statutory, regulatory or other legal authority, that in Anthem's discretion, invalidates this quote. - Legislation or other matters that impact Anthem's costs or revenues under this proposal - Should the total enrollment or enrollment distribution by membership type, product or location change by 10% or more from that assumed when preparing the pricing for this package. - Actual Member to Subscriber ratio is not within +/-5% of 2.01. - A change to the plan benefits that result in substantial changes in the service, networks, or benefit design, as determined by Anthem. - Changes in proposal terms, conditions, services or product from this quotation. - Any of the plan benefits administered by Anthem are moved to another third party administrator or private exchanges. - Anthem is not the sole medical carrier. - Change in nature of Employer’s business. - A material reduction in Provider’s billed or published charges that results in a decrease in Anthem’s discount of 10% or more. • The final relationship between the Parties will be subject to and described in an Administrative Services Agreement and this agreement will be the binding agreement between the parties. • If subject to regulatory approval, and the applicable regulator has not yet approved, these benefits and rates may need to be adjusted. • Unless otherwise noted, fees are quoted on a per contract per month (PCPM) basis. PCPM is equivalent to, and will be described as per subscriber per month in the Administrative Services Agreement. • Employers, as plan sponsors and administrators, are responsible for complying with all applicable laws. • Eligibility data will be provided in Anthem’s standard format. Additional charges may apply for non-standard formats. • This quote assumes ACH withdraws from group's bank account for claims and fixed fees Weekly, with payment required within 3 business days from receipt of invoice. • This quote assumes Anthem will accept fiduciary responsibility for claims administration and the handling of the claims complaint and appeals. To the extent ERISA applies, the employer remains the Named Fiduciary of the plan. • Commissions and consultant fees are excluded unless otherwise noted. • The processing of claims incurred prior to the effective date is the responsibility of the prior claims administrator. • Since Anthem is neither a Hawaii authorized insurer nor a Hawaii Health Care Contractor, our benefits may not match the requirements of the Prepaid Health Care Act. We recommend that you obtain direct quotes for either an individual policy for employees who live and work in Hawaii or if there are several employees within an employer group to obtain group coverage from a Assumptions and conditions (ASO) CITY OF PADUCAH Effective January 1, 2027 through December 31, 2027 SIC Code: 9199 Administrative Services Only (ASO) • Anthem's rates assume no self-insuring by the employer of underlying member cost shares. The benefits purchased from Anthem must be communicated to the members without changes. A member's financial responsibilities, including, but not limited to, deductibles, coinsurance, copays, out-of-pocket maximums or, for nonparticipating providers, balance-billed charges must be paid solely by the member. The client may not partially pay, reimburse or otherwise lower the member's costs of care. Any deviation will must be notified if particular classes of employees will be offered an HRA integrated with individual health insurance coverage, and a Anthem. Documentation includes, but is not limited to, claims, case management, utilization management records, audit records Authorized Signature: ___________________________________________________________________________________ Title: _________________________________________________________________________________________________ Date: _________________________________________________________________________________________________ Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Kentucky, Inc. Independent licensee of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. - 0673594-03 Additional service fees (ASO) CITY OF PADUCAH Effective January 1, 2027 through December 31, 2027 Overpayment Identification and Claims Prepayment Analysis Activities ● The access fee is charged at a percentage no greater than 3.11% of the discount/differential subject to a maximum of $2,000 per claim. ● The AEA Fee is $5.00 per professional provider claim and $11.00 per institutional claim. The AEA fee is $3.00 per claim for non- network providers. ● Occasionally, Anthem and a Host Blue may contract for a lower fee by combining the Access Fee and the AEA fee. ● BlueCard fees are not charged in Anthem states. For a complete description of these fees, please consult your ASO Agreement. The fee will be equal to 50% of Traditional network discounts. Traditional network discount is the difference between billed charges for covered services and the traditional provider negotiated amount. Prescription drug claims, claims paid on a capitated basis and Payment Innovation program payments are excluded from the fee calculation. No Surprises Act - Qualifying Payment Amount Program Fee The fee is equal to 15% of the savings achieved on No Surprises Act claims priced using the Qualifying Payment Amount for provider reimbursement. No Surprise Act claims repriced through the QPA Program are not subject to out of network shared savings fees. Additional service fees Runout Period Claims Processing Fee Types Fees associated with claims processed during the runout period, including without limitation subrogation fees, recovery fees, and network access fees, will be charged during the runout period. Runout Period Claims Processing Fee Costs The cost of processing runout claims is excluded. The charge for processing 12 months of runout claims is 9.0% of all runout claims. In addition, direct charges may be incurred following termination that are not included in the standard runout processing fee (e.g., data feeds to other vendors). Discount Share The fee will be equal to 2.00% of in-network discounts. In-network discount is the difference between billed charges for covered services and the negotiated amount. Prescription drug claims, claims paid on a capitated basis, Traditional network fee schedule and Payment Innovation program payments are excluded from the fee calculation. This fee will be limited as follows: up to $5,000 per Claim, up to an aggregate maximum of $24.23 PCPM per Agreement Period, no less then an aggregate minimum of $19.83 PCPM per Agreement Period. Out of Network Savings Fees The fee will be equal to 50% of the savings achieved on certain non-network claims. Traditional Network Provider Savings Fee BlueCard Fees The charge to Employer is 25% of (i) the amount recovered from review of Claims and membership data and audits of Provider and Vendor activity to identify overpayments and (ii) the difference between the amount Employer would have been charged absent prepayment analysis activities and the amount that was charged to Employer following performance of the prepayment analysis activities. This includes, but is not limited to, activities related to COB, Host Blue activities, contract compliance, and eligibility. The fee will not exceed $25,000 per claim. External appeals The PPACA requires that ASO groups provide a process for external claims appeals to be available in situations where adverse benefit determinations have been made. Employer may contract with Anthem for this service or arrange to work directly with an external vendor. The fee will be $500 per external appeal for the service contracted with Anthem. Reporting Management reports (e.g., standard account reporting package, performance guarantee reporting, lag reports, online reporting tool/access are included in our fees. In addition to these reports, Anthem will provide 20 hours of time needed to generate custom or ad- hoc reports (e.g., care management and utilization review reports) at no charge per year. The charge beyond 20 hours per year is $150 Independent Dispute Resolution Fee for Independent Dispute Resolution. Fees charged to Anthem as part of independent dispute resolution processes, including arbitrator fees, will be charged to Employer. Enhanced Personal Health Care (EPHC) Program Administration The fee for Anthem’s oversight of EPHC with providers or vendors is 25% of the per attributed member per month amount charged to the Employer for the provider performance bonus portion of the EPHC program. Subrogation services The charge is 25% of gross subrogation recovery. Data Feeds CITY OF PADUCAH - 0673594-03 - 10/6/2026 12:37:10 PM Additional service fees (ASO) CITY OF PADUCAH Effective January 1, 2027 through December 31, 2027 Engagement on Claims Audits $150 per hour in situations where Anthem is asked to perform research on claim audit findings. Maximum of 250 claims will be reviewed by Anthem. Stop Loss Carve-out Coordination Fee Anthem shall provide up to one Monthly data feed to a supported outside vendor in Anthem’s standard format , not to exceed 12 feeds. The charge is $1,000 for each additional feed. Each time a report is sent to a supported vendor electronically, it is considered a feed, even if the same report is sent to the same vendor monthly. For example, if monthly feeds are sent to two supported vendors, 24 electronic data feeds will have been used on an annual basis. The charge for Weekly data feeds to a single supported vendor, not to exceed 52 feeds, is $15,000 annually. The charge for Daily data feeds to a single supported vendor, not to exceed 365 feeds, is $20,000 annually. Additional fees would be required for Stop Loss interfaces, Rx integration feeds and telemedicine. provider or vendor charges that have a direct positive impact on the cost of care, are included in Paid Claims on the invoice, and may accumulate towards aggregate stop loss purchased from Anthem. The charges year one are as follows: Behavioral Health $1.55 PCPM, Care Support $0.52 PCPM, Musculoskeletal $1.41 PCPM, Oncology $1.01 PCPM, and Radiology $2.41 PCPM. Clinical programs included as part of Anthem's Core Foundational Program are not available for opt-out. A la Carte clinical program(s) Claim Related Charges Pharmacy Benefit Administration See Pharmacy Pricing Summary. CITY OF PADUCAH - 0673594-03 - 10/6/2026 12:37:10 PM Attachments (ASO) CITY OF PADUCAH Effective January 1, 2027 through December 31, 2027 EPHC.pdf CITY OF PADUCAH - 0673594-03 - Printed:10/6/2026 12:37:10 PM Page 1 of 9 Your summary of benefits Anthem® Blue Cross and Blue Shield Your Plan: CITY OF PADUCAH: Anthem Blue Access PPO $1500 Your Network: Blue Access Visits with Virtual Care-Only Providers Cost through our mobile app and website Primary Care, and medical services for urgent/acute care No charge medical deductible does not apply Mental Health & Substance Use Disorder Services No charge medical deductible does not apply Specialist care $80 copay per visit medical deductible does not apply Covered Medical Benefits Cost if you use an In-Network Provider Cost if you use an Out-of-Network Provider Overall Deductible $1,500 person / $3,000 family $3,000 person / $6,000 family Overall Out-of-Pocket Limit $3,400 person / $6,600 family $6,600 person / $13,200 family The family deductible and out-of-pocket limit are embedded, meaning the cost shares of one family member will be applied to the per person deductible and per person out-of-pocket limit; in addition, amounts for all covered family members apply to both the family deductible and family out-of-pocket limit. No one member will pay more than the per person deductible or per person out-of-pocket limit. All medical and prescription drug deductibles, copayments and coinsurance apply to the out -of-pocket limit (excluding Out-of- Network Human Organ and Tissue Transplant (HOTT), Cellular and Gene Therapy services). In-Network and Out-of-Network deductibles and out-of-pocket limit amounts are separate and do not accumulate toward each other. Doctor Visits (virtual and office) You are encouraged to select a Primary Care Physician (PCP). Preferred PCP virtual and office (Providers reflected in our Find Care tool as: EPHC.) $5 copay per visit medical deductible does not apply Not covered Primary Care (PCP) virtual and office $40 copay per visit medical deductible does not apply 50% coinsurance after medical deductible is met Mental Health and Substance Use Disorder Services virtual and office $40 copay per visit medical deductible does not apply 50% coinsurance after medical deductible is met Specialist Provider virtual and office $80 copay per visit medical deductible does not apply 50% coinsurance after medical deductible is met Page 2 of 9 Covered Medical Benefits Cost if you use an In-Network Provider Cost if you use an Out-of-Network Provider Other Practitioner Visits Maternity Doctor services (prenatal/postpartum care and delivery) 20% coinsurance after medical deductible is met 50% coinsurance after medical deductible is met Retail Health Clinic for routine care and treatment of common illnesses; usually found in major pharmacies or retail stores. $40 copay per visit medical deductible does not apply 50% coinsurance after medical deductible is met Manipulation Therapy Coverage is limited to 30 visits per benefit period. $40 copay per visit medical deductible does not apply 50% coinsurance after medical deductible is met Other Services in an Office Allergy Testing 20% coinsurance after medical deductible is met 50% coinsurance after medical deductible is met Allergy Injections $10 copay per visit medical deductible does not apply 50% coinsurance after medical deductible is met Prescription Drugs Dispensed in the office 20% coinsurance after medical deductible is met 50% coinsurance after medical deductible is met Surgery $80 copay per visit medical deductible does not apply‡ 50% coinsurance after medical deductible is met Preventive care / screenings / immunizations No charge 50% coinsurance after medical deductible is met Preventive Care for Chronic Conditions per IRS guidelines No charge Cost share is based on the setting services are received. Diagnostic Services Lab Office No charge 50% coinsurance after medical deductible is met Freestanding Lab/Reference Lab No charge 50% coinsurance after medical deductible is met Outpatient Hospital 20% coinsurance after medical deductible is met 50% coinsurance after medical deductible is met Diagnostic Services X-Ray Office No charge 50% coinsurance after medical deductible is met Page 3 of 9 Covered Medical Benefits Cost if you use an In-Network Provider Cost if you use an Out-of-Network Provider Outpatient Hospital 20% coinsurance after medical deductible is met 50% coinsurance after medical deductible is met Diagnostic Services Advanced Diagnostic Imaging for example: MRI, PET and CAT scans Office 20% coinsurance after medical deductible is met 50% coinsurance after medical deductible is met Freestanding Radiology Center 20% coinsurance after medical deductible is met 50% coinsurance after medical deductible is met Outpatient Hospital 20% coinsurance after medical deductible is met 50% coinsurance after medical deductible is met Emergency and Urgent Care Urgent Care $75 copay per visit medical deductible does not apply 50% coinsurance after medical deductible is met Emergency Room Facility Services 20% coinsurance after medical deductible is met Covered as In-Network Emergency Room Doctor and Other Services 20% coinsurance medical deductible does not apply Covered as In-Network Ambulance Authorized Out-of-Network non-emergency ambulance services are limited to an Anthem maximum payment of $50,000 per trip. The $50,000 limit does not apply to air ambulance services. 20% coinsurance after medical deductible is met Covered as In-Network Outpatient Mental Health and Substance Use Disorder Services at a Facility Facility Fees 20% coinsurance after medical deductible is met 50% coinsurance after medical deductible is met Doctor Services 20% coinsurance after medical deductible is met 50% coinsurance after medical deductible is met Outpatient Surgery Facility Fees Hospital 20% coinsurance after medical deductible is met 50% coinsurance after medical deductible is met Page 4 of 9 Covered Medical Benefits Cost if you use an In-Network Provider Cost if you use an Out-of-Network Provider Ambulatory Surgical Center 20% coinsurance after medical deductible is met 50% coinsurance after medical deductible is met Physician and other services including surgeon fees Hospital 20% coinsurance after medical deductible is met 50% coinsurance after medical deductible is met Ambulatory Surgical Center 20% coinsurance after medical deductible is met 50% coinsurance after medical deductible is met Hospital (Including Maternity, Mental Health and Substance Use Disorder Services) Facility Fees 20% coinsurance after medical deductible is met 50% coinsurance after medical deductible is met Human Organ and Tissue Transplants Cornea transplants are treated as medical procedures, with benefits and cost sharing determined by the setting in which the services are received. You must get certain covered transplant procedures from an Approved In - Network Provider to receive the In-Network level of benefits. No charge 50% coinsurance after medical deductible is met Physician and other services including surgeon fees 20% coinsurance after medical deductible is met 50% coinsurance after medical deductible is met Home Health Care Coverage is limited to 100 visits per benefit period. 20% coinsurance after medical deductible is met 50% coinsurance after medical deductible is met Therapy Services Rehabilitation and Habilitation services including physical, occupational and speech therapies. You are responsible for cost shares no greater than the PCP office visit when Covered Services are performed by a Physical Therapist or Occupational Therapist. Coverage for physical, occupational and speech therapies is limited to 20 visits combined per benefit period. Office $40 copay per visit medical deductible does not apply 50% coinsurance after medical deductible is met Page 5 of 9 Covered Medical Benefits Cost if you use an In-Network Provider Cost if you use an Out-of-Network Provider Outpatient Hospital physical and occupational therapy- $40 copay per visit medical deductible does not apply speech therapy-20% coinsurance after medical deductible is met 50% coinsurance after medical deductible is met Pulmonary rehabilitation Office $80 copay per visit medical deductible does not apply 50% coinsurance after medical deductible is met Outpatient Hospital 20% coinsurance after medical deductible is met 50% coinsurance after medical deductible is met Cardiac rehabilitation Coverage is limited to 36 visits per benefit period. Office $80 copay per visit medical deductible does not apply 50% coinsurance after medical deductible is met Outpatient Hospital 20% coinsurance after medical deductible is met 50% coinsurance after medical deductible is met Dialysis/Hemodialysis Office $80 copay per visit medical deductible does not apply 50% coinsurance after medical deductible is met Outpatient Hospital 20% coinsurance after medical deductible is met 50% coinsurance after medical deductible is met Chemo/Radiation Therapy Office $80 copay per visit medical deductible does not apply‡ 50% coinsurance after medical deductible is met Outpatient Hospital 20% coinsurance after medical deductible is met 50% coinsurance after medical deductible is met Skilled Nursing Care (facility) Coverage for Skilled Nursing is limited to 90 days per benefit period. 20% coinsurance after medical deductible is met 50% coinsurance after medical deductible is met Inpatient Hospice No charge No charge Page 6 of 9 Covered Medical Benefits Cost if you use an In-Network Provider Cost if you use an Out-of-Network Provider Additional Services, Equipment and Devices Durable Medical Equipment 20% coinsurance after medical deductible is met 50% coinsurance after medical deductible is met Prosthetic Devices 20% coinsurance after medical deductible is met 50% coinsurance after medical deductible is met Wigs Coverage for wigs is limited to 1 item per benefit period. 20% coinsurance after medical deductible is met 50% coinsurance after medical deductible is met Hearing Aids Coverage is limited to 1 item per ear every 36 months for members under 18 years of age. 20% coinsurance after medical deductible is met 50% coinsurance after medical deductible is met Covered Prescription Drug Benefits Cost if you use an In-Network Pharmacy Cost if you use an Out-of-Network Pharmacy Pharmacy Deductible Not applicable Not applicable Pharmacy Out-of-Pocket Limit $2500 Person (does not apply to tiers 1-3 drugs) $2500 Person (does not apply to tiers 1-3 drugs) Prescription Drug Coverage Network: Base Network Drug List: National Drugs not included on the National drug list will not be covered. For more information, refer to “National Drug List” at https://www.anthem.com/pharmacy-information/. Day Supply Limits Retail Pharmacy: 30 day supply (cost shares noted below) Home Delivery Pharmacy: 90 day supply (maximum cost shares noted below). Maintenance medications are available through our home delivery pharmacy. You will need to call us on the number on your ID card to sign up when you first use the service. Specialty Pharmacy: 30 day supply at retail and home delivery (cost shares noted below apply). We may require certain drugs with special handling, provider coordination or patient education be filled by our designated specialty pharmacy. Tier 1 - Typically Generic $15 copay per prescription (retail) and $45 copay per prescription (home delivery) Greater of $55 or 50% coinsurance (retail) and Not covered (home delivery) Tier 2 - Typically Preferred Brand $35 copay per prescription (retail) and $105 copay per Greater of $55 or 50% coinsurance (retail) and Not covered (home Page 7 of 9 Covered Prescription Drug Benefits Cost if you use an In-Network Pharmacy Cost if you use an Out-of-Network Pharmacy prescription (home delivery) delivery) Tier 3 - Typically Non-Preferred Brand $55 copay per prescription (retail) and $165 copay per prescription (home delivery) Greater of $55 or 50% coinsurance (retail) and Not covered (home delivery) Tier 4 - Typically Specialty (brand and generic) 25% coinsurance up to $150 per prescription with OOP max $2500 (retail) 25% coinsurance up to $150 per prescription with OOP max $2500 (per 30 day supply home delivery) Greater of $55 or 50% coinsurance (retail) and Not covered (home delivery) Notes: • Dependent Age Limit: to the end of the month in which the child attains age 26. • Members are encouraged to always obtain prior approval when using Out-of-Network Providers. Precertification will help the member know if the services are considered not medically necessary. • No charge means no deductible / copayment / coinsurance up to the maximum allowable amount. 0% means no coinsurance up to the maximum allowable amount. However, when choosing an Out-of-Network Provider, the member is responsible for any balance due after the plan payment. • If you have an office visit with your Primary Care Physician, Specialist or Urgent Care at an Outpatient Facility (e.g., Hospital or Ambulatory Surgical Facility), benefits for Covered Services will be paid under “Outpatient Facility Services”. • Costs may vary by the site of service. Other cost shares may apply depending on services provided. Check your Certificate of Coverage for details. • Screening and diagnostic imaging for the detection of breast cancer, including diagnostic mammograms, 3D mammography, breast ultrasounds and MRIs are covered in full as required by state mandate. • The limits for physical, occupational, and speech therapy, if any apply to this plan, will not apply if you get care as part of the Mental Health and Substance Use Disorder benefit. • ‡ You will pay your PCP or Specialist office visit copay for certain services provided in their office. This summary of benefits is a brief outline of coverage, designed to help you with the selection process. This summary does not reflect each and every benefit, exclusion and limitation which may apply to the coverage. For more details, important limitations and exclusions, please review the formal Evidence of Coverage (EOC). If there is a difference between this summary and the Evidence of Coverage (EOC), the Evidence of Coverage (EOC), will prevail. Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Kentucky, Inc. Independent licensee of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Questions: (833) 578-4443 or visit us at www.anthem.com KY/LG/Anthem Blue Access PPO Option 11 with Rx Option E2//2027 Page 8 of 9 Your Plan: CITY OF PADUCAH: Anthem Blue Access PPO $1500 Your Network: Blue Access This summary of benefits is intended to be a brief outline of coverage. The entire provisions of benefits and exclusions are contained in the Group Contract, Certificate, and Schedule of Benefits. In the event of a conflict between the Group Contract and this description, the terms of the Group Contract will prevail. By signing this Summary of Benefits, I agree to the benefits for the product selected as of the effective date indicated. Authorized group signature (if applicable) Date Underwriting signature (if applicable) Date 63658MUMENMUB 10/24 #AG-GEN-001# Page 9 of 9 We’re here for you – in many languages The law requires us to include a message in all of these different languages. Curious what they say? Here’s the English version: “You have the right to get help in your language for free. Just call the Member Services number on your ID card.” Visually impaired? You can also ask for other formats of this d ocument TTY/TTD:711 It’s important we treat you fairly We follow federal civil rights laws in our health programs and activities. Members can get reasonable modifications as well as free auxiliary aids and services if you have a disability. We don’t discriminate, on the basis of race, color, national origin, sex, age or disability. For people whose primary language isn’t English (or have limited proficiency), we offer free language assistance services like interpreters and other written languages. Interested in these services? Call the Member Services number on your ID card for help (TTY/TDD: 711) or visit our website. If you think we failed in any areas or to learn more about grievance procedures, you can mail a complaint to: Compliance Coordinator, P.O. Box 27401, Richmond, VA 23279, or directly to the U.S. Department of Health and Human Services, Office for Civil Rights at 200 Independence Avenue, SW; Room 509F, HHH Building; Washington, D.C. 20201. You can also call 1-800- 368-1019 (TDD: 1-800-537-7697) or visit https://ocrportal.hhs.gov/ocr/portal/lobby.jsf Page 1 of 8 Your summary of benefits Anthem® Blue Cross and Blue Shield Your Plan: CITY OF PADUCAH: Anthem Blue Access PPO HSA $3500 Your Network: Blue Access Visits with Virtual Care-Only Providers Cost through our mobile app and website Primary Care, and medical services for urgent/acute care No charge deductible does not apply Mental Health & Substance Use Disorder Services No charge deductible does not apply Specialist care No charge after deductible is met Covered Medical Benefits Cost if you use an In-Network Provider Cost if you use an Out-of-Network Provider Overall Deductible $3,500 person / $6,600 family $3,500 person / $6,600 family Overall Out-of-Pocket Limit $3,500 person / $6,600 family $6,600 person / $13,200 family The family deductible and out-of-pocket limit are embedded, meaning the cost shares of one family member will be applied to the per person deductible and per person out-of-pocket limit; in addition, amounts for all covered family members apply to both the family deductible and family out-of-pocket limit. No one member will pay more than the per person deductible or per person out-of-pocket limit. All medical and prescription drug deductibles, copayments and coinsurance apply to the out -of-pocket limit (excluding Out-of- Network Human Organ and Tissue Transplant (HOTT), Cellular and Gene Therapy services). In-Network and Out-of-Network deductibles and out-of-pocket limit amounts are separate and do not accumulate toward each other. Doctor Visits (virtual and office) You are encouraged to select a Primary Care Physician (PCP). Primary Care (PCP) virtual and office No charge after deductible is met 30% coinsurance after deductible is met Mental Health and Substance Use Disorder Services virtual and office No charge after deductible is met 30% coinsurance after deductible is met Specialist Provider virtual and office No charge after deductible is met 30% coinsurance after deductible is met Other Practitioner Visits Maternity Doctor services (prenatal/postpartum care and delivery) No charge after deductible is met 30% coinsurance after deductible is met Retail Health Clinic for routine care and treatment of common illnesses; usually found in major pharmacies or retail stores. No charge after deductible is met 30% coinsurance after deductible is met Manipulation Therapy Coverage is limited to 30 visits per benefit period. No charge after deductible is met 30% coinsurance after deductible is met Page 2 of 8 Covered Medical Benefits Cost if you use an In-Network Provider Cost if you use an Out-of-Network Provider Other Services in an Office Allergy Testing No charge after deductible is met 30% coinsurance after deductible is met Allergy Injections No charge after deductible is met 30% coinsurance after deductible is met Prescription Drugs Dispensed in the office No charge after deductible is met 30% coinsurance after deductible is met Surgery No charge after deductible is met 30% coinsurance after deductible is met Preventive care / screenings / immunizations No charge 30% coinsurance after deductible is met Diagnostic Services Lab Office No charge after deductible is met 30% coinsurance after deductible is met Freestanding Lab/Reference Lab No charge after deductible is met 30% coinsurance after deductible is met Outpatient Hospital No charge after deductible is met 30% coinsurance after deductible is met Diagnostic Services X-Ray Office No charge after deductible is met 30% coinsurance after deductible is met Outpatient Hospital No charge after deductible is met 30% coinsurance after deductible is met Diagnostic Services Advanced Diagnostic Imaging for example: MRI, PET and CAT scans Office No charge after deductible is met 30% coinsurance after deductible is met Freestanding Radiology Center No charge after deductible is met 30% coinsurance after deductible is met Outpatient Hospital No charge after deductible is met 30% coinsurance after deductible is met Emergency and Urgent Care Urgent Care No charge after deductible is met 30% coinsurance after deductible is met Emergency Room Facility Services No charge after deductible is met Covered as In-Network Emergency Room Doctor and Other Services No charge after deductible is met Covered as In-Network Ambulance Authorized Out-of-Network non-emergency ambulance services are limited to an Anthem maximum payment of $50,000 per trip. The $50,000 limit does not apply to air ambulance services. No charge after deductible is met Covered as In-Network Page 3 of 8 Covered Medical Benefits Cost if you use an In-Network Provider Cost if you use an Out-of-Network Provider Outpatient Mental Health and Substance Use Disorder Services at a Facility Facility Fees No charge after deductible is met 30% coinsurance after deductible is met Doctor Services No charge after deductible is met 30% coinsurance after deductible is met Outpatient Surgery Facility Fees Hospital No charge after deductible is met 30% coinsurance after deductible is met Ambulatory Surgical Center No charge after deductible is met 30% coinsurance after deductible is met Physician and other services including surgeon fees Hospital No charge after deductible is met 30% coinsurance after deductible is met Ambulatory Surgical Center No charge after deductible is met 30% coinsurance after deductible is met Hospital (Including Maternity, Mental Health and Substance Use Disorder Services) Facility Fees No charge after deductible is met 30% coinsurance after deductible is met Human Organ and Tissue Transplants Cornea transplants are treated as medical procedures, with benefits and cost sharing determined by the setting in which the services are received. You must get certain covered transplant procedures from an Approved In - Network Provider to receive the In-Network level of benefits. No charge after deductible is met 30% coinsurance after deductible is met Physician and other services including surgeon fees No charge after deductible is met 30% coinsurance after deductible is met Home Health Care Coverage is limited to 100 visits per benefit period. No charge after deductible is met 30% coinsurance after deductible is met Therapy Services Rehabilitation and Habilitation services including physical, occupational and speech therapies. You are responsible for cost shares no greater than the PCP office visit when Covered Services are performed by a Physical Therapist or Occupational Therapist. Coverage for physical, occupational and speech therapies is limited to 20 visits combined per benefit period. Office No charge after deductible is met 30% coinsurance after deductible is met Outpatient Hospital No charge after deductible is met 30% coinsurance after deductible is met Page 4 of 8 Covered Medical Benefits Cost if you use an In-Network Provider Cost if you use an Out-of-Network Provider Pulmonary rehabilitation office and outpatient hospital No charge after deductible is met 30% coinsurance after deductible is met Cardiac rehabilitation office and outpatient hospital Coverage is limited to 36 visits per benefit period. No charge after deductible is met 30% coinsurance after deductible is met Dialysis/Hemodialysis office and outpatient hospital No charge after deductible is met 30% coinsurance after deductible is met Chemo/Radiation Therapy office and outpatient hospital No charge after deductible is met 30% coinsurance after deductible is met Skilled Nursing Care (facility) Coverage for Skilled Nursing is limited to 100 days per benefit period. No charge after deductible is met 30% coinsurance after deductible is met Inpatient Hospice No charge after deductible is met No charge after deductible is met Additional Services, Equipment and Devices Durable Medical Equipment No charge after deductible is met 30% coinsurance after deductible is met Prosthetic Devices No charge after deductible is met 30% coinsurance after deductible is met Wigs Coverage for wigs is limited to 1 item per benefit period. No charge after deductible is met 30% coinsurance after deductible is met Hearing Aids Coverage is limited to 1 item per ear every 36 months for members under 18 years of age. No charge after deductible is met 30% coinsurance after deductible is met Covered Prescription Drug Benefits Cost if you use an In-Network Pharmacy Cost if you use an Out-of-Network Pharmacy Pharmacy Deductible Combined with In- Network medical deductible Combined with Out-of- Network medical deductible Pharmacy Out-of-Pocket Limit Combined with In- Network medical out- of-pocket limit Combined with Out-of- Network medical out- of-pocket limit Prescription Drug Coverage Network: Base Network Drug List: National For more information, refer to “National Drug List” at https://www.anthem.com/pharmacy-information/. Day Supply Limits Retail Pharmacy: 30 day supply (cost shares noted below) Home Delivery Pharmacy: 90 day supply (maximum cost shares noted below). Maintenance medications are available through our home delivery pharmacy. Specialty Pharmacy: 30 day supply at retail and home delivery (cost shares noted below apply). We may require certain drugs Page 5 of 8 Covered Prescription Drug Benefits Cost if you use an In-Network Pharmacy Cost if you use an Out-of-Network Pharmacy with special handling, provider coordination or patient education be filled by our designated specialty pharmacy. Tier 1 - Typically Generic 0% coinsurance after deductible is met (retail and home delivery) 30% coinsurance after deductible is met (retail) and Not covered (home delivery) Tier 2 - Typically Preferred Brand 0% coinsurance after deductible is met (retail and home delivery) 30% coinsurance after deductible is met (retail) and Not covered (home delivery) Tier 3 - Typically Non-Preferred Brand 0% coinsurance after deductible is met (retail and home delivery) 30% coinsurance after deductible is met (retail) and Not covered (home delivery) Tier 4 - Typically Specialty (brand and generic) 0% coinsurance after deductible is met (retail) 0% coinsurance after deductible is met (per 30 day supply home delivery) 30% coinsurance after deductible is met (retail) and Not covered (home delivery) Notes: • Dependent Age Limit: to the end of the month in which the child attains age 26. • Members are encouraged to always obtain prior approval when using Out-of-Network Providers. Precertification will help the member know if the services are considered not medically necessary. • No charge means no deductible / copayment / coinsurance up to the maximum allowable amount. 0% means no coinsurance up to the maximum allowable amount. However, when choosing an Out-of-Network Provider, the member is responsible for any balance due after the plan payment. • If you have an office visit with your Primary Care Physician, Specialist or Urgent Care at an Outpatient Facility (e.g., Hospital or Ambulatory Surgical Facility), benefits for Covered Services will be paid under “Outpatient Facility Services”. • Costs may vary by the site of service. Other cost shares may apply depending on services provided. Check your Certificate of Coverage for details. • Screening and diagnostic imaging for the detection of breast cancer, including diagnostic mammograms, 3D mammography, breast ultrasounds and MRIs are covered in full after deductible as required by state mandate. • The limits for physical, occupational, and speech therapy, if any apply to this plan, will not apply if you get care as part of the Mental Health and Substance Use Disorder benefit. Page 6 of 8 This summary of benefits is a brief outline of coverage, designed to help you with the selection process. This summary does not reflect each and every benefit, exclusion and limitation which may apply to the coverage. For more details, important limitations and exclusions, please review the formal Evidence of Coverage (EOC). If there is a difference between this summary and the Evidence of Coverage (EOC), the Evidence of Coverage (EOC), will prevail. Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Kentucky, Inc. Independent licensee of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Questions: (833) 578-4443 or visit us at www.anthem.com KY/LG/Anthem Blue Access PPO HSA Option E4//2027 Page 7 of 8 Your Plan: CITY OF PADUCAH: Anthem Blue Access PPO HSA $3500 Your Network: Blue Access This summary of benefits is intended to be a brief outline of coverage. The entire provisions of benefits and exclusions are contained in the Group Contract, Certificate, and Schedule of Benefits. In the event of a conflict between the Group Contract and this description, the terms of the Group Contract will prevail. By signing this Summary of Benefits, I agree to the benefits for the product selected as of the effective date indicated. Authorized group signature (if applicable) Date Underwriting signature (if applicable) Date 63658MUMENMUB 10/24 #AG-GEN-001# Page 8 of 8 We’re here for you – in many languages The law requires us to include a message in all of these different languages. Curious what they say? Here’s the English version: “You have the right to get help in your language for free. Just call the Member Services number on your ID card.” Visually impaired? You can also ask for other formats of this d ocument TTY/TTD:711 It’s important we treat you fairly We follow federal civil rights laws in our health programs and activities. Members can get reasonable modifications as well as free auxiliary aids and services if you have a disability. We don’t discriminate, on the basis of race, color, national origin, sex, age or disability. For people whose primary language isn’t English (or have limited proficiency), we offer free language assistance services like interpreters and other written languages. Interested in these services? Call the Member Services number on your ID card for help (TTY/TDD: 711) or visit our website. If you think we failed in any areas or to learn more about grievance procedures, you can mail a complaint to: Compliance Coordinator, P.O. Box 27401, Richmond, VA 23279, or directly to the U.S. Department of Health and Human Services, Office for Civil Rights at 200 Independence Avenue, SW; Room 509F, HHH Building; Washington, D.C. 20201. You can also call 1-800- 368-1019 (TDD: 1-800-537-7697) or visit https://ocrportal.hhs.gov/ocr/portal/lobby.jsf Fully Insured Renewal City of Paducah Group Number(s): W29698 Effective Date: 1/1/2027 - 12/31/2028 Anthem Sales Representative: Angie Meadows Frequency Full Service Exam 12 months Lenses 12 months Frames 24 months Contact Lenses 12 months In Network Copayments Exam $10.00 Materials $10.00 In Network Plan Allowance Frame Allowance $130 Contact Lens Allowance $130 ENROLLMENT Subscriber Only Subscriber + Spouse Subscriber + Child Subscriber + Children Subscriber + Family Total Number of Contracts RATES Subscriber Only Subscriber + Spouse Subscriber + Child Subscriber + Children Subscriber + Family Total Monthly Premium Total Annual Premium % Rate Increase NOTES:Benefits may be subject to approval by CET. The rates quoted are guaranteed for 2 years.Authorized Signature Authorized Signature Authorized Signature Authorized Signature Rates are Net of Commissions Date Date Date Date Refer to your sales brochure(s) for benefit details and limitations. This benefit description is intended to be a brief outline of coverage. The entire provisions of benefits and exclusions are contained in the Group Contract. In the event of a conflict between the Group Contract and this description, the terms of the Group Contract will prevail. Bullitt County Fiscal Court\2020\Anicllary\Vision\2019-10-01_Bullitt County Fiscal Court_FI_Vision_Negotiated_Renewal Benefit Sheet Total Blue View Vision Core Plan Renewal Voluntary Group Size: 250-499 Option 25 36 111 25 12 239 55 $6.97 $12.20 $13.26 $13.26 $20.24 $2,816.69 $33,800.28 $16,622.28 $0.00 $0.00 $0.00 $16,622.28 0.0% Contract code: 35NX Blue View VisionSM FS.B.10.10.130.130 Welcome to your Blue View Vision plan! You have many choices when it comes to using your benefits. As a Blue View Vision plan member, you have access to one of the nation’s largest vision networks. You may choose from many private practice doctors, local optical stores, and national retail stores including LensCrafters®, Target Optical®, and most Pearle Vision® locations. You may also use your in-network benefits to order eyewear online at Glasses.com and ContactsDirect.com. To locate a participating network eye care doctor or location, log in at anthem.com, or from the home page menu under Care, select Find a Doctor. You may also call member services for assistance at 1-866-723-0515. Out-of-Network – If you choose to, you may instead receive covered benefits outside of the Blue View Vision network. Just pay in full at the time of service, obtain an itemized receipt, and file a claim for reimbursement up to your maximum out-of-network allowance. YOUR BLUE VIEW VISION PLAN BENEFITS IN-NETWORK OUT-OF-NETWORK FREQUENCY Routine Eye Exam Eyeglass Frames Eyeglass Lenses (instead of contact lenses) Single vision lenses Bifocal lenses Trifocal lenses Eyeglass Lens Enhancements When obtaining covered eyewear from a Blue View Vision provider, you may choose to add any of the following lens enhancements at no extra cost Lenses (for a child under age 21) Standard polycarbonate (for a child under age 21) Factory Scratch Coating Contact Lenses (instead of eyeglass lenses) Contact lens allowance will only be applied toward the first purchase of contacts made during a benefit period. Any unused amount remaining cannot be used for subsequent purchases in the same benefit period, nor can any unused amount be carried over to the following benefit period. Elective conventional (non-disposable) OR Elective disposable OR Non-elective (medically necessary) (no additional discount) Covered in full This is a primary vision care benefit intended to cover only routine eye examinations and corrective eyewear. Blue View Vision is for routine eye care only. If you need medical treatment for your eyes, visit a participating eye care doctor from your medical network. Benefits are payable only for expenses incurred while the group and insured person’s coverage is in force. This information is intended to be a brief outline of coverage. All terms and conditions of coverage, including benefits and exclusions, are contained in the member’s policy, which shall control in the event of a conflict with this overview. This benefit overview is only one piece of your entire enrollment package. EXCLUSIONS & LIMITATIONS (not a comprehensive list – please refer to the member Certificate of Coverage for a complete list) Not to be combined with any offer, coupon, or in-store advertisement. Excess Amounts. Amounts in excess of covered vision expense. Sunglasses. Plano sunglasses and accompanying frames. Safety Glasses. Safety glasses and accompanying frames. Not Specifically Listed. Services not specifically listed in this plan as covered services. Any lost or broken lenses or frames are not eligible for replacement unless the insured person has reached his or her normal service interval as indicated in the plan design. Non-Prescription Lenses. Any non-prescription lenses, eyeglasses or contacts. Plano lenses or lenses that have no refractive power. Orthoptics. Orthoptics or vision training and any associated supplemental testing Transitions are registered trademarks of Transitions Optical, Inc. Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Kentucky, Inc. Independent licensee of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield Names and symbols are registered marks of the Blue Cross and Blue Shield Association. OPTIONAL SAVINGS AVAILABLE FROM BLUE VIEW VISION IN-NETWORK PROVIDERS ONLY In-Network Member Cost (after any applicable copay) Retinal Imaging – at member’s option, can be performed a time of eye exam Not more than $39 Eyeglass lens upgrades When obtaining eyewear from a Blue View Vision provider, you may choose to upgrade your new eyeglass lenses at a discounted cost. Eyeglass lens copayment applies. lenses (Adults) Standard Polycarbonate (Adults) Tint (Solid and Gradient) UV Coating Progressive Lenses1 Standard Premium Tier 1 Premium Tier 2 Premium Tier 3 Anti-Reflective Coating2 Standard Premium Tier 1 Premium Tier 2 Other Add-ons $75 $40 $15 $15 $65 $85 $95 $110 $45 $57 $68 20% off retail price Additional Pairs of Eyeglasses Anytime from any Blue View Vision network provider Complete Pair Eyeglass materials purchased separately 40% off retail price 20% off retail price Eyewear Accessories Items such as non-prescription sunglasses, lens cleaning supplies, contact lens solutions, eyeglass cases, etc. 20% off retail Contact lens fit and follow-up A contact lens fitting and up to two follow-up visits are available to you once a comprehensive eye exam has been completed. Standard contact lens fitting3 Premium contact lens fitting4 Up to $55 10% off retail price Conventional Contact Lenses Discount applies to materials only 15% off retail price 1 Please ask your provider for his/her recommendation as well as the available progressive brands by tier. 2 Please ask your provider for his/her recommendation as well as the available anti-reflective brands by tier. 3 Standard fitting includes spherical clear lenses for conventional wear and planned replacement. Examples include but are not limited to disposable and frequent replacement. 4 Premium fitting includes all lens designs, materials and specialty fittings other than standard contact lenses. Examples include but are not limited to toric and multifocal. Cannot be combined with any other offer. Discounts are subject to change without notice. Discounts are not covered benefits under your vision plan and will not be listed in your certificate of coverage. Discounts will be offered from in-network providers except where State law prevents discounting of products and services that are not covered benefits under this plan. Discounts on frames will not apply if the manufacturer has imposed a no discount on sales at retail and independent provider locations. Some of our in-network providers include: ADDITIONAL SAVINGS AVAILABLE THROUGH ANTHEM’S SPECIAL OFFERS PROGRAM anthem.com, select discounts, then Vision, Hearing & Dental. * Discounts cannot be used in conjunction with your covered benefits. OUT-OF-NETWORK If you choose to receive covered services or purchase covered eyewear from an out-of-network provider, network discounts will not apply and you will be responsible for payment of services and/or eyewear materials at the time of service. Please complete an out-of-network claim form and submit it along with your itemized receipt to the fax number, email address, or mailing address below. To download a claim form, log in at anthem.com, or from the home page menu under Support select Forms, click Change State to choose your state, and then scroll down to Claims and select the Blue View Vision Out-of-Network Claim Form. You may instead call member services at 1-866-723-0515 .to request a claim form. TO FAX:866-293-7373 TO EMAIL:oonclaims@eyewearspecialoffers.com TO MAIL:Blue View Vision Attn: OON Claims P.O. Box 8504 Mason, OH 45040-7111 Authorized Signature:Title: Date Get Help in Your Language Curious to know what all this says? We would be too. Here’s the English version: You have the right to get this information and help in your language for free. Call the Member Services number on your ID card for help. (TTY/TDD: 711) Separate from our language assistance program, we make documents available in alternate formats for members with visual impairments. If you need a copy of this document in an alternate format, please call the customer service telephone number on the back of your ID card. Spanish Tiene el derecho de obtener esta información y ayuda en su idioma en forma gratuita. Llame al número de Servicios para Miembros que figura en su tarjeta de identificación para obtener ayuda. (TTY/TDD: 711) Arabic .(TTY/TDD:711)ﺓﺪﻋﺎﺴﻤﻠﻟ ﻚﺑ ﺔﺻﺎﺨﻟﺍ ﻒﻳﺮﻌﺘﻟﺍ ﺔﻗﺎﻄﺑ ﻰﻠﻋ ﺩﻮﺟﻮﻤﻟﺍ ﺀﺎﻀﻋﻷﺍ ﺕﺎﻣﺪﺧ ﻢﻗﺮﺑ ﻞﺼﺗﺍ .ﺎًﻧﺎﺠﻣ ﻚﺘﻐﻠﺑ ﺓﺪﻋﺎﺴﻤﻟﺍﻭ ﺕﺎﻣﻮﻠﻌﻤﻟﺍ ﻩﺬﻫ ﻰﻠﻋ ﻝﻮﺼﺤﻟﺍ ﻚﻟ ﻖﺤﻳ Chinese 您有權使用您的語言免費獲得該資訊和協助。請撥打您的 ID 卡上的成員服務號碼尋求協助。(TTY/TDD: 711) French Vous avez le droit d’accéder gratuitement à ces informations et à une aide dans votre langue. Pour cela, veuillez appeler le numéro des Services destinés aux membres qui figure sur votre carte d’identification. (TTY/TDD: 711) German Sie haben das Recht, diese Informationen und Unterstützung kostenlos in Ihrer Sprache zu erhalten. Rufen Sie die auf Ihrer ID-Karte angegebene Servicenummer für Mitglieder an, um Hilfe anzufordern. (TTY/TDD: 711) Japanese この情報と支援を希望する言語で無料で受けることができます。支援を受けるには、IDカードに記載されているメンバーサービス番号に電話 してください。(TTY/TDD: 711) Kirundi Ufise uburenganzira bwo gufashwa mu rurimi rwawe ku buntu. Akura umunywanyi abikora Ikaratakarangamuntu yawe kugira ufashwe. (TTY/TDD: 711) Korean 귀하에게는 무료로 이 정보를 얻고 귀하의 언어로 도움을 받을 권리가 있습니다. 도움을 얻으려면 귀하의 ID 카드에 있는 회원 서비스 번호로 전화하십시오. (TTY/TDD: 711) Nepali तपाईंले यो जानकारी तथा सहयोग आफ्नो भाषामा निःशुल्क प्राप्त गर्ने तपाईंको अधिकार हो। सहायताको लागि तपाईंको ID कार्डमा दिइएको सदस्य सेवा नम्बरमा कल गर्नुहोस्। (TTY/TDD: 711) Oromo Odeeffanoo kana fi gargaarsa afaan keetiin kaffaltii malee argachuuf mirga qabda. Gargaarsa argachuuf lakkoofsa bilbilaa tajaajila miseensaa (Member Services) waraqaa enyummaa kee irratti argamu irratti bilbili. (TTY/TDD: 711) Pennsylvania Dutch Du hoscht die Recht selle Information un Helfe in dei Schprooch mitaus Koscht griege. Ruf die Member Services Nummer uff dei ID Kaarte fer Helfe aa. (TTY/TDD: 711) Russian Вы имеете право получить данную информацию и помощь на вашем языке бесплатно. Для получения помощи звоните в отдел обслуживания участников по номеру, указанному на вашей идентификационной карте. (TTY/TDD: 711) Serbian Imate pravo da dobijete sve informacije i pomoć na vašem jeziku, i to potpuno besplatno. Pozovite broj Centra za podršku članovima koji se nalazi na vašoj identifikacionoj kartici. (TTY/TDD: 711) Tagalog May karapatan kayong makuha ang impormasyon at tulong na ito sa ginagamit ninyong wika nang walang bayad. Tumawag sa numero ng Member Services na nasa inyong ID card para sa tulong. (TTY/TDD: 711) Vietnamese Quý vị có quyền nhận miễn phí thông tin này và sự trợ giúp bằng ngôn ngữ của quý vị. Hãy gọi cho số Dịch Vụ Thành Viên trên thẻ ID của quý vị để được giúp đỡ. (TTY/TDD: 711) It’s important we treat you fairly That’s why we follow federal civil rights laws in our health programs and activities. We don’t discriminate, exclude people, or treat them differently on the basis of race, color, national origin, sex, age or disability. For people with disabilities, we offer free aids and services. For people whose primary language isn’t English, we offer free language assistance services through interpreters and other written languages. Interested in these services? Call the Member Services number on your ID card for help (TTY/TDD: 711). If you think we failed to offer these services or discriminated based on race, color, national origin, age, disability, or sex, you can file a complaint, also known as a grievance. You can file a complaint with our Compliance Coordinator in writing to Compliance Coordinator, P.O. Box 27401, Mail Drop VA2002-N160, Richmond, VA 23279. Or you can file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights at 200 Independence Avenue, SW; Room 509F, HHH Building; Washington, D.C. 20201 or by calling 1-800-368-1019 (TDD: 1- 800-537-7697) or online at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf. Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html. Large Group benefit changes for Kentucky For groups with 51+ members. Effective at renewal on or after January 1, 2027. We appreciate the opportunity you have given us to offer Anthem Blue Cross and Blue Shield (Anthem) healthcare coverage. We want to make you aware of a few important changes that may affect your plan. Changes are effective upon your 2027 renewal date (unless otherwise noted). Ask your Account Management Executive for full details on these features. Medical Plan Changes Medical Benefits Product Type 2026 Benefit 2027 Renewing Benefit Hyperhidrosis All Plans Hyperhidrosis (excessive sweating) excluded in Evidence of Coverage Covered with medical necessity review (ASO 250+ can Opt Out) Dichoptic Digital Therapy All Plans Exclusion: Eye Exercises Orthoptics and vision therapy Exclusion: Eye Exercises Orthoptics and vision therapy. This Exclusion does not apply to Medically Necessary therapy to treat amblyopia (ASO 250+ can Opt Out) Physical Therapy and Occupational Therapy All Plans 20 visits per benefit period, combined for rehabilitative and habilitative physical therapy and occupational therapy 40 visits per benefit period, combined for rehabilitative and habilitative physical therapy and occupational therapy (FI & ASO 100+ can Opt Out) Global Maternity Benefit All Plans Professional Global Maternity benefit is bundled to include physician charges for Prenatal Care, Delivery Care (includes labor management), Postpartum Care Professional Global Maternity benefit is replaced with separate benefits for physician charges for Prenatal Care, Delivery Care (includes labor management), Postpartum Care Gene Therapy Solution Rider Stop Loss Available as a buy-up offering Will be built into the Stop Loss product at no additional cost. This will include all FDA approved Gene Therapies Medical Cost Share Changes Medical Benefits Product Type 2026 Benefit 2027 Renewing Benefit Increase to deductible as a result of IRS limit increases HSA Non-embedded HSAs: Deductible: $1,700 Single/$3,400 Family Embedded HSAs: Deductible: $3,400 Single/$6,800 Family Non-embedded HSAs: Deductible: $1,750 Single/$3,500 Family Embedded HSAs: Deductible: $3,500 Single/$7,000 Family 2027 Renewal Document 2 Increase ACA Maximum Out- of-Pocket All Plans Out-of-Pocket Maximum: $10,600 Individual/$21,200 Family Out-of-Pocket Maximum: $12,000 Individual/$24,000 Family Clear Choice Copay EPHC Providers: $5 Preferred PCP (Anthem Diamond) Providers: $10 Preferred Specialist (Anthem Diamond) Providers: $50 Anthem Essential Plan Anthem Essential Primary Care/Specialist: $35 for first 3 visits, then deductible/coinsurance Out of Pocket Maximum: $9,200/$18,400 Primary Care/Specialist: $30 for first 3 visits, then deductible/coinsurance Out of Pocket Maximum: $9,000/$18,000 Pharmacy Changes Pharmacy Benefits Product Type 2026 Benefit 2027 Renewing Benefit Cost Relief Expansion ABF ERISA Only No program High-touch member Specialty Rx experience with $0 cost share for enrolled members (post deduction on HSA plans) Legislative updates Kentucky’s legislative session took place in early 2026. There is some legislation that could impact groups at their renewal. Mandate Description HB169 – Feeding & Eating disorder coverage disorders and must not deny, limit, or restrict coverage based solely on weight- related metrics such as body mass index, ideal body weight, or any requirement to achieve a specific weight. Insurers may evaluate for medical necessity of treatment and determine the appropriate level of care by considering several factors including an individual’s eating behaviors, the need for supervised meals, or supportive interventions, relevant laboratory results (such as heart rate, renal or cardiovascular function, and blood pressure), the individual’s recovery environment, and the HB164 – Hearing aid coverage for children benefit coverage from $1,400 to $2,500 for hearing aids per hearing-impaired ear for eligible children. SB97 – Protheses and Orthoses orthoses. Coverage must, at a minimum, be equivalent to that provided under federal statutes and regulations for the aged and disabled, including specific U.S. Code sections and C.F.R. provisions. This act requires coverage for prescribed prostheses and orthoses deemed medically necessary by licensed professionals, materials and components necessary for their use, instruction on usage, and repair or replacement under certain conditions. Coverage may be subject to cost-sharing requirements, but cost-sharing cannot be higher than that subject for inpatient physician and surgical services. It also limits the number of prostheses and orthoses per affected limb within a three-year period to a limit of three (3) prostheses and orthoses per affected limb and specifies that such coverage is considered habilitative or rehabilitative services. Utilization review decisions must be nondiscriminatory and cannot deny coverage based solely on actual or perceived disability. Insurers must provide detailed denial letters if coverage is denied. Insurers are required to submit annual reports detailing claims data related to this coverage, and the Commissioner must aggregate and report this data to legislative committees. 2027 Renewal Document 3 Client decisions are required for the following items: Consolidated Appropriations Act (CAA) RxDC Reporting Client Action Needed Scope Summary • Opt-in ____________ • Opt-out ___________ FI & ASO Clients business we administer) on behalf of the client. This confirmation replaces the need for clients to respond to annual surveys for inclusion. If Opting In – we will need the average monthly percentage of premium that is covered by your employee/member and you, the employer/group. (must equal 100) ________% by Employee/Member AND ________% by Employer/Group Signature: ________________________________________________ Date: _______________ This summary is for notification of benefit modifications. All product offerings are subject to regulatory review and approval and therefore subject to change. We have also updated your plan benefits to reflect recent changes in applicable law. For more information, contact your broker or account representative. Note: This benefit overview is for illustrative purposes, and some content may be pending Division of Insurance approval It is intended to be a brief outline of coverage. The entire provisions of benefits and exclusions are contained in the Group Contract, Certificate, and Schedule of Benefits. In the event of a conflict between the Group Contract/Benefit Booklet and this description, the terms of the Group Contract/Benefit Booklet will prevail. CarelonRx, Inc. is an independent company providing pharmacy benefit management services on behalf of your health plan.. Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Kentucky, Inc. Independent licensee of the Blue Cross and Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc. Proactive support MyHealth Check-in. After you take this short health assessment, we’ll send you personalized health tips and details on programs that can help you lower health risks, reach your personal goals, and prevent future health problems. MyHealth Advantage. We provide a confidential health summary that includes reminders for checkups, tests, and exams; lists of claims and prescriptions; and general health tips. 24/7 NurseLine. Talk to a trained, registered nurse over the phone and quickly get answers to common health concerns. Mental health resources Behavioral Health Advantage (BHA). If you’re trying to manage a behavioral health condition or substance use disorder, our behavioral health case managers are licensed mental health professionals who can help. They offer caring support for you and your family, including 24/7 drug and alcohol assistance. You can also access tools and resources for things like suicide prevention, autism, attention deficit hyperactivity disorder (ADHD), and post-traumatic stress disorder (PTSD). Emotional Wellbeing Resources. Learn how to develop resilience, reduce stress, and practice mindfulness through online programs and personalized coaching. Digital tools help you identify thoughts and behavior patterns that affect your emotional well-being. Autism Spectrum Disorder Program. Receive support for a covered family member with an autism spectrum disorder. Our licensed behavior analysts can help you navigate the healthcare system and will work with the whole family to help you understand services and access care. We want to support your whole health the best way possible. That’s why your health plan includes Wellbeing Solutions, a suite of programs to help you with everyday health and your overall well-being. Making your well-being a priority Explore Wellbeing Solutions programs on the Sydney Health app Wellbeing Solutions Supporting your whole health matters U eht es S yendyS M H htlae dna ppa elibom a moc.mehtn snoituloS gnieblleW ssecca ot emityna dna smargorp r .sdeen erachtlaeh ruoy teem taht secruose Condition-based support Concierge Care. This program pairs eligible members with a personal health advocate to provide coaching and digital resources on health conditions, such as type 2 diabetes and heart failure, as well as when you are being discharged from an inpatient setting. Cancer Care. If you or a family member is facing a cancer diagnosis or have started treatment, the Cancer Care Navigator program offers one-on-one guidance and digital support when it matters most. Case Management. After an illness or hospital stay, you can receive one-on-one support and care coordination from our team of medical professionals. They can help guide you through the healthcare system and make the most of your benefits. Their goal is to understand your needs and help you get the best care possible. Building Healthy Families. Whether you’re planning for a family, are pregnant, or are postpartum, you can access digital tools and educational resources to support the needs of your growing family. ConditionCare. Receive one-on-one, digital support from a healthcare professional for a chronic condition, like asthma or diabetes. We care about you Connect with Sydney Health Sydney Health offers useful health and wellness tips and personalized action plans that can help you reach your unique well-being goals. Download, open, register, and/or sign into the Sydney Health mobile app. 1.Go to homepage > Scroll down > Select My Health Dashboard > Choose Programs. 2.Browse the wellness programs included in your plan. Scan this QR code with your smartphone to download the Sydney Health app. 1 096350M DOPV SBANEMU 52/60 S .nalp htlaeh ruoy fo flaheb no secivres noitacilppa elibom gnireffo ynapmoc etarapes a ,smroftalP latigiD noleraC htiw tnemegnarra na hguorht dereffo si htlaeH yendy C fo flaheb no secivres tnemeganam erac gnidivorp ynapmoc etarapes a si cnI ,htlaeH nolera A dleihS eulB dna ssorC eulB mehtn . 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Medicare Secondary Payer Employer Status Form Please complete this form to assist with compliance with the Medicare Secondary Payer regulations of the Centers for Medicare and Medicaid Services (CMS). You may want to check with your legal counsel to confirm the Medicare Secondary Payer requirements. Group name Group contact Group identification no. Telephone no. The business or organization (“Group”) named above: Does NOT Does have 20 or more employees for each working day in each of 20 or more calendar weeks in the current calendar year or the preceding calendar year, and Does NOT Does have 100 or more employees on 50 percent or more of its regular business days during the preceding calendar year. “Employees” include (even if they are not eligible for Anthem group health plan benefits): x Part-time, full-time and leased employees; x Persons not working but receiving payments normally subject to FICA taxes, such as persons on disability for the first six months. If the Group is part of a controlled group of employers under IRC Sec. 52(a) and (b) or an affiliated service under IRC Sec. 414(m), then all employees in the aggregated group of employers must be included in the count of the Group’s employees. The Group agrees to notify Anthem Blue Cross and Blue Shield as soon as the statement above is no longer true. The Group employed _____________ (number) of such “employees” as of _____________(date). If this form states a change in the category (i.e., under 20, over 20 or over 100 employees) for the Group, then a copy of the business’ or organization’s latest wage and tax statement must be attached and returned with this form. I certify that the information provided above is true to the best of my knowledge and belief. Group administrator signature Date Life and Disability products are underwritten by Anthem Life Insurance Company. In Indiana: Anthem Blue Cross and Blue Shield is a trade name of Anthem Insurance Companies, Inc. In Kentucky: Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Kentucky, Inc. In most of Missouri, Anthem Blue Cross and Blue Shield is the trade name of RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC) and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc.). RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Ohio: Anthem Blue Cross and Blue Shield is the trade name of Community Insurance Company. In Wisconsin, Blue Cross Blue Shield of Wisconsin ("BCBSWi") underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation ("Compcare") underwrites or administers the HMO policies; and Compcare and BCBSWi collectively underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. Rev. 1/07 ® Anthem is a registered trademark. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. MUNICIPAL ORDER NO. ________ A MUNICIPAL ORDER AUTHORIZING AN AGREEMENT FOR ADMINISTRATIVE SERVICES WITH ANTHEM BLUE CROSS BLUE SHIELD FOR THE GROUP HEALTH INSURANCE PLAN FOR THE CITY OF PADUCAH, KENTUCKY FOR THE 2027 PLAN YEAR AND AUTHORIZING THE MAYOR TO EXECUTE ALL DOCUMENTS RELATING TO SAME BE IT ORDERED BY THE BOARD OF COMMISSIONERS OF THE CITY OF PADUCAH, KENTUCKY: SECTION 1. That the City of Paducah authorizes and approves an agreement with Anthem Blue Cross Blue Shield as the City’s Third-Party Administrator to provide claims administrative services related to the City’s health insurance plan. The effective date of this Agreement is January 1, 2027, and ending December 31, 2027. SECTION 2. The Mayor is hereby authorized to execute all documents relating to administrative services as authorized in Sections 1 above. SECTION 3. This Order shall be in full force and effect from and after the date of its adoption. _________________________________ George Bray, Mayor ATTEST: __________________________________ Lindsay Parish, City Clerk Adopted by the Board of Commissioners, October 27, 2026 Recorded by Lindsay Parish, City Clerk, October 27, 2026 \mo.\ administrative services - Anthem 2027 Agenda Action Form Meeting Date: October 27, 2026 Short Title: Health, Vision, and Dental Benefit Plan Premiums for 2027 - S. WILCOX Category: Municipal Order Staff Work By: Presentation By: Background Information: Premiums, by plan, for the 2027 calendar year are listed below. These rates, as presented by DJ Story, of HUB, are a twenty-five dollar per pay period increase for all plans from last year for the City of Paducah. The health plan’s claims have steadily increased over the last few years with both severity and frequency being high in 2025 and 2026. This increase will allow us to maintain an acceptable escrow levels to and bring the plan back up to cover expected claims and plan costs in 2027. As a note, the City’s health insurance premiums increased last year for the first time since 2013. Health Insurance: Investor Plan 2026 Emp Annual 2027 Emp Annual 2027 Monthly Bi-Weekly Amt Annual EE Increase EE Only $774.00 $1,374.00 $114.50 $ 57.25 $600.00 EE + SP $3,480.00 $4,080.00 $340.00 $170.00 $600.00 EE + CH $1,410.00 $2,010.00 $167.50 $ 83.75 $600.00 Family $5,628.00 $6,228.00 $519.00 $ 259.50 $600.00 Elite Plan 2026 Emp Annual 2027 Emp Annual 2027 Monthly Bi-Weekly Amt Annual EE Increase EE Only $1,854.00 $2,454.00 $204.50 $102.25 $600.00 EE + SP $5,928.00 $6,531.00 $544.25 $272.00 $600.00 EE + CH $3,552.00 $4,155.00 $346.25 $173.00 $600.00 Family $8,520.00 $9,123.00 $760.25 $380.00 $600.00 Vision Premiums - The following will reflect the monthly Vision Premium rates for the 2027 calendar year. The renewal rates will not increase from last year. Blue View Vision Monthly Premium Employee - $6.97 Employee/Spouse - $12.20 Employee / Child(ren) - $13.26 Family - $20.24 Dental Premiums - The following will reflect the recommended monthly Delta Dental Plan Premiums for the 2027 Calendar year. The premium renewal percentage rate is a 3% increase from last year. Delta Dental of KY Monthly Premium Employee - $28.08 Employee/Spouse - $57.30 Employee / Child(ren) - $59.93 Family - $97.50 Does this Agenda Action Item align with a Commission Priority? No If yes, please list the Commission Priority: Commission Priorities List Communications Plan: Funds Available: Account Name: Account Number: Staff Recommendation: Attachments: 1. MO - Health Vision & Dental Premiums 2027 2. City of Paducah - Dental Renewal 2027 UPDATED 3% 3. City of Paducah- 2027 Anthem Signature Binder 4. City_of_Paducah_REN_030807_ASO_exec 5. Medicare_Sec Payer_ER_Status_Form (Rev 1 07) MUNICIPAL ORDER NO. _______ A MUNICIPAL ORDER APPROVING AND ADOPTING THE COMPREHENSIVE HEALTH INSURANCE BENEFIT PLAN PREMIUMS, THE VISION INSURANCE PLAN PREMIUMS, AND THE DENTAL INSURANCE PLAN PREMIUMS FOR CALENDAR YEAR 2027 FOR EMPLOYEES OF THE CITY OF PADUCAH, AND AUTHORIZING THE MAYOR TO EXECUTE ALL DOCUMENTS RELATED TO SAME BE IT ORDERED BY THE BOARD OF COMMISSIONERS OF THE CITY OF PADUCAH, KENTUCKY: SECTION 1. That the City of Paducah approves and adopts the following monthly health insurance premiums for calendar year 2027 for employees of the City of Paducah: Health Insurance: Investor Plan 2027 Annual 2027 Monthly Bi-Weekly Annual Increase Employee $1,374.00 $114.50 $57.25 $600.00 Employee/Spouse 4,080.00 340.00 170.00 600.00 Employee Child 2,010.00 167.50 83.75 600.00 Family 6,228.00 519.00 259.50 600.00 Elite Plan 2027 Annual 2027 Monthly Bi-Weekly Annual Increase Employee $2,454.00 $204.50 $102.25 $600.00 Employee/Spouse 6,531.00 544.25 272.00 600.00 Employee Child 4,155.00 346.25 173.00 600.00 Family 9,123.00 760.25 380.00 600.00 SECTION 2. That the City of Paducah hereby approves the following monthly premiums for the Blue View Vision Plan through Anthem BlueCross BlueShield for vision care for employees for calendar year 2027: Vision Insurance: Monthly Premium SECTION 3. That the City of Paducah hereby approves the following monthly premiums for the Delta Dental Plan for optional dental care for employees for calendar year 2027: Dental Insurance Monthly Premium SECTION 4. That the premiums for the Comprehensive Health Insurance Benefit Plan, the Blue View Vision Plan and the Delta Dental Plan for employees of the City of Paducah, adopted in Sections 1, 2 and 3 above, shall become effective January 1, 2027. SECTION 5. That the Mayor is hereby authorized to execute all documents related to the premiums approved in Sections 1, 2 and 3 above. SECTION 6. This order shall be in full force and effect from and after the date of its adoption. ______________________________ George Bray, Mayor ATTEST: ______________________________ Lindsay Parish, City Clerk Adopted by the Board of Commissioners, October 27, 2026 Recorded by Lindsay Parish, City Clerk, October 27, 2026 \mo\Health Vision & Dental Premiums 2027 Delta Dental of Kentucky Renewal Rates for: CITY OF PADUCAH 692290-4001 Effective: 01/01/2027 DENTAL RATES - per subscriber per month Coverage Type Current Rates Renewal Rates Subscriber Only $27.26 $28.08 Subscriber and Spouse $55.63 $57.30 Subscriber, Spouse, Children $94.66 $97.50 Subscriber and 1 Child $58.18 $59.93 Subscriber and 2+ Children $58.18 $59.93 Overall Percentage Change 3.0% Rating Requirements Covered Persons choosing this dental plan are required to remain enrolled for a period of 12 months. Should a Covered Person choose to drop coverage after that time, he or she may not re-enroll prior to the date on which 12 months have elapsed. An election may be revoked or changed at any time if the change is the result of a qualifying event as defined under Internal Revenue Code Section 125. Rating Assumptions • Rates do not include any applicable claims taxes. The rates are valid only for the effective date noted above and are guaranteed for a one year contract. • Self-billing is not allowed and you agree to pay as invoiced each month. • Subscriber materials which are produced by Delta Dental will be updated and provided when plan changes apply and are always available to view or print at DeltaDentalKY.com. • Dentist directorites are not included. You can find participating dentists on our website at DeltaDentalKY.com Delta Dental of Kentucky | deltadentalky.com | 800-955-2030 ®Registered Mark of Delta Dental Plans Association Rev. 01/2021 CITY OF PADUCAH Your Anthem Blue Cross and Blue Shield Renewal Packet Connecting you to the coverage you need Administrative Services Only (ASO) renewal for: CITY OF PADUCAH Group Number: W29698 Effective January 1, 2027 through December 31, 2027 Created on: October 6, 2026 Broker: HUB INTERNATIONAL MIDWEST LIMITED Anthem Sales Contact: Angie Meadows 859-226-5324 angie.meadows@anthem.com CITY OF PADUCAH - 0673594-03 - 10/6/2026 12:37:10 PM Save up to $3.00 PEPM on your ASO medical fee when adding new dental, vision, accident, critical illness, hospital indemnity or life & disability from our partner, The Standard.* * Applies to large group clients with up to 5,000 employees. Other restrictions apply. Ask your Anthem representative for complete details. 1 Anthem internal data, Q2 2025. 2 Sydney Health is offered through an arrangement with CareMarket, Inc., a separate company offering mobile application services on behalf of Anthem Blue Cross and Blue Shield ©2021-2022. 3 Anthem internal data, 2020. 4 Anthem internal data, 2020, and Anthem Ebase, 2020. Thank you for partnering with Anthem We’re reimagining what’s possible for every moment of health. Your renewal includes the latest innovations from Anthem to deliver: Your success is our success. We’re here to help build confidence in care and support you every step of the way. We are deeply committed to helping your employees feel covered and confident in their healthcare. We’re here to help you promote an effective healthcare strategy by working closely with you and your broker. Our associates live and work in the same places you do. We are both members of the communities we serve and partners in helping those communities thrive. In Kentucky, Anthem is proud to have:¹ in the local marketyearsassociatesmembers 1.9M Kentucky Fixed Administrative Costs (ASO) CITY OF PADUCAH Effective January 1, 2027 through December 31, 2027 Current 1/1/2027 through through through through through 284 284 571 571 $48.84 $49.99 $0.00 $0.00 $0.00 $0.00 ($37.04)($38.15)$0.00 $0.00 $0.00 $0.00 $5.00 $5.00 $0.00 $0.00 $0.00 $0.00 $1.85 $1.85 $0.00 $0.00 $0.00 $0.00 $63,559 $63,696 $0 $0 $0 $0 Authorized Signature:_____________________________________________ Title:____________________ Date:____________________ Additional Fee Disclosures: 0673594-03 Fixed Administrative Costs CITY OF PADUCAH - 0673594-03 - 10/6/2026 12:37:10 PM Benefit Information CITY OF PADUCAH Effective January 1, 2027 through December 31, 2027 Deductible (individual/family) Coinsurance Out-of-pocket maximum (individual/family) Office Visit (PCP / Specialist) Copay Inpatient / Outpatient Copay (Surgery) Emergency Room / Urgent Care Copay Prescription Drugs – Retail Prescription Drugs – Mail Order OON Deductible (individual/family) OON Coinsurance OON OOP Max (individual/family) Benefit categories reflect In-network benefits unless noted as Out-Of-Network (OON) Benefit amounts reflect member cost-share unless otherwise noted Be n e f i t C a t e g o r i e s Ded & Coins/Ded & Coins Ded & Coins/Ded & Coins 50% $3,500 / $6,600 $3,000 / $6,000 Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Kentucky, Inc. Independent licensee of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. - 0673594-03 $6,600 / $13,200 $6,600 / $13,200 30% Ded & Coins/Ded & Coins Ded & Coins/$75 $3,500 / $6,600 $3,400 / $6,600 $3,500 / $6,600 $1,500 / $3,000 Ded & Coins/Ded & Coins $40/$80 0%20% Renewal Plan Designs (Custom) Anthem Blue Access PPO HSA $3,500 Essential Ded & Coins/Ded & Coins $15/$35/$55/25% to $150 Ded & Coins/Ded & Coins $45/$105/$165/25% Services included and buy-up options (ASO) CITY OF PADUCAH Effective January 1, 2027 through December 31, 2027 PCPM fee EAP Basic 3-Visit $0.57 EAP Enhanced 4-Visit $1.15 EAP Enhanced 6-Visit $1.59 Anthem Solutions HSA $2.45 Fee Billed Per ParticipantPer Month Add ASA FSA, Commuter, or Dependent Care FSA*$3.55 Discounted cost of FSA buy-up (*when adding to HRA)$0.80 Discounted cost of FSA buy-up (*when adding to HSA)$1.15 Notes 0673594-03 Services Included in fixed administrative costs Buy-Up Options Spending Account & Other Buy-up Options (charged separately) vendor charges that have a direct positive impact on the cost of care. Since these charges are considered claim-related by Anthem, they are incorporated into the claims projection (available upon request). These charges are excluded from PCPM Administrative Fees above, are CITY OF PADUCAH - 0673594-03 - 10/6/2026 12:37:10 PM Assumptions and conditions (ASO) CITY OF PADUCAH Effective January 1, 2027 through December 31, 2027 SIC Code: 9199 Administrative Services Only (ASO) • The proposed services, rates and fees are effective from 1/1/2027 through 12/31/2027. • This contract will be issued in KY. - This is an integrated medical and pharmacy offering. • The proposal assumes 284 employees will be enrolling for medical coverage, with an average member to employee ratio of 2.01. • The proposal assumes the same enrollment for medical and pharmacy. • Anthem reserves the right to revise this proposal or modify these fees or rates under any of the following circumstances: - Due to any taxes, fees and assessments prescribed by any statutory, regulatory or other legal authority, that in Anthem's discretion, invalidates this quote. - Legislation or other matters that impact Anthem's costs or revenues under this proposal - Should the total enrollment or enrollment distribution by membership type, product or location change by 10% or more from that assumed when preparing the pricing for this package. - Actual Member to Subscriber ratio is not within +/-5% of 2.01. - A change to the plan benefits that result in substantial changes in the service, networks, or benefit design, as determined by Anthem. - Changes in proposal terms, conditions, services or product from this quotation. - Any of the plan benefits administered by Anthem are moved to another third party administrator or private exchanges. - Anthem is not the sole medical carrier. - Change in nature of Employer’s business. - A material reduction in Provider’s billed or published charges that results in a decrease in Anthem’s discount of 10% or more. • The final relationship between the Parties will be subject to and described in an Administrative Services Agreement and this agreement will be the binding agreement between the parties. • If subject to regulatory approval, and the applicable regulator has not yet approved, these benefits and rates may need to be adjusted. • Unless otherwise noted, fees are quoted on a per contract per month (PCPM) basis. PCPM is equivalent to, and will be described as per subscriber per month in the Administrative Services Agreement. • Employers, as plan sponsors and administrators, are responsible for complying with all applicable laws. • Eligibility data will be provided in Anthem’s standard format. Additional charges may apply for non-standard formats. • This quote assumes ACH withdraws from group's bank account for claims and fixed fees Weekly, with payment required within 3 business days from receipt of invoice. • This quote assumes Anthem will accept fiduciary responsibility for claims administration and the handling of the claims complaint and appeals. To the extent ERISA applies, the employer remains the Named Fiduciary of the plan. • Commissions and consultant fees are excluded unless otherwise noted. • The processing of claims incurred prior to the effective date is the responsibility of the prior claims administrator. • Since Anthem is neither a Hawaii authorized insurer nor a Hawaii Health Care Contractor, our benefits may not match the requirements of the Prepaid Health Care Act. We recommend that you obtain direct quotes for either an individual policy for employees who live and work in Hawaii or if there are several employees within an employer group to obtain group coverage from a Assumptions and conditions (ASO) CITY OF PADUCAH Effective January 1, 2027 through December 31, 2027 SIC Code: 9199 Administrative Services Only (ASO) • Anthem's rates assume no self-insuring by the employer of underlying member cost shares. The benefits purchased from Anthem must be communicated to the members without changes. A member's financial responsibilities, including, but not limited to, deductibles, coinsurance, copays, out-of-pocket maximums or, for nonparticipating providers, balance-billed charges must be paid solely by the member. The client may not partially pay, reimburse or otherwise lower the member's costs of care. Any deviation will must be notified if particular classes of employees will be offered an HRA integrated with individual health insurance coverage, and a Anthem. Documentation includes, but is not limited to, claims, case management, utilization management records, audit records Authorized Signature: ___________________________________________________________________________________ Title: _________________________________________________________________________________________________ Date: _________________________________________________________________________________________________ Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Kentucky, Inc. Independent licensee of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. - 0673594-03 Additional service fees (ASO) CITY OF PADUCAH Effective January 1, 2027 through December 31, 2027 Overpayment Identification and Claims Prepayment Analysis Activities ● The access fee is charged at a percentage no greater than 3.11% of the discount/differential subject to a maximum of $2,000 per claim. ● The AEA Fee is $5.00 per professional provider claim and $11.00 per institutional claim. The AEA fee is $3.00 per claim for non- network providers. ● Occasionally, Anthem and a Host Blue may contract for a lower fee by combining the Access Fee and the AEA fee. ● BlueCard fees are not charged in Anthem states. For a complete description of these fees, please consult your ASO Agreement. The fee will be equal to 50% of Traditional network discounts. Traditional network discount is the difference between billed charges for covered services and the traditional provider negotiated amount. Prescription drug claims, claims paid on a capitated basis and Payment Innovation program payments are excluded from the fee calculation. No Surprises Act - Qualifying Payment Amount Program Fee The fee is equal to 15% of the savings achieved on No Surprises Act claims priced using the Qualifying Payment Amount for provider reimbursement. No Surprise Act claims repriced through the QPA Program are not subject to out of network shared savings fees. Additional service fees Runout Period Claims Processing Fee Types Fees associated with claims processed during the runout period, including without limitation subrogation fees, recovery fees, and network access fees, will be charged during the runout period. Runout Period Claims Processing Fee Costs The cost of processing runout claims is excluded. The charge for processing 12 months of runout claims is 9.0% of all runout claims. In addition, direct charges may be incurred following termination that are not included in the standard runout processing fee (e.g., data feeds to other vendors). Discount Share The fee will be equal to 2.00% of in-network discounts. In-network discount is the difference between billed charges for covered services and the negotiated amount. Prescription drug claims, claims paid on a capitated basis, Traditional network fee schedule and Payment Innovation program payments are excluded from the fee calculation. This fee will be limited as follows: up to $5,000 per Claim, up to an aggregate maximum of $24.23 PCPM per Agreement Period, no less then an aggregate minimum of $19.83 PCPM per Agreement Period. Out of Network Savings Fees The fee will be equal to 50% of the savings achieved on certain non-network claims. Traditional Network Provider Savings Fee BlueCard Fees The charge to Employer is 25% of (i) the amount recovered from review of Claims and membership data and audits of Provider and Vendor activity to identify overpayments and (ii) the difference between the amount Employer would have been charged absent prepayment analysis activities and the amount that was charged to Employer following performance of the prepayment analysis activities. This includes, but is not limited to, activities related to COB, Host Blue activities, contract compliance, and eligibility. The fee will not exceed $25,000 per claim. External appeals The PPACA requires that ASO groups provide a process for external claims appeals to be available in situations where adverse benefit determinations have been made. Employer may contract with Anthem for this service or arrange to work directly with an external vendor. The fee will be $500 per external appeal for the service contracted with Anthem. Reporting Management reports (e.g., standard account reporting package, performance guarantee reporting, lag reports, online reporting tool/access are included in our fees. In addition to these reports, Anthem will provide 20 hours of time needed to generate custom or ad- hoc reports (e.g., care management and utilization review reports) at no charge per year. The charge beyond 20 hours per year is $150 Independent Dispute Resolution Fee for Independent Dispute Resolution. Fees charged to Anthem as part of independent dispute resolution processes, including arbitrator fees, will be charged to Employer. Enhanced Personal Health Care (EPHC) Program Administration The fee for Anthem’s oversight of EPHC with providers or vendors is 25% of the per attributed member per month amount charged to the Employer for the provider performance bonus portion of the EPHC program. Subrogation services The charge is 25% of gross subrogation recovery. Data Feeds CITY OF PADUCAH - 0673594-03 - 10/6/2026 12:37:10 PM Additional service fees (ASO) CITY OF PADUCAH Effective January 1, 2027 through December 31, 2027 Engagement on Claims Audits $150 per hour in situations where Anthem is asked to perform research on claim audit findings. Maximum of 250 claims will be reviewed by Anthem. Stop Loss Carve-out Coordination Fee Anthem shall provide up to one Monthly data feed to a supported outside vendor in Anthem’s standard format , not to exceed 12 feeds. The charge is $1,000 for each additional feed. Each time a report is sent to a supported vendor electronically, it is considered a feed, even if the same report is sent to the same vendor monthly. For example, if monthly feeds are sent to two supported vendors, 24 electronic data feeds will have been used on an annual basis. The charge for Weekly data feeds to a single supported vendor, not to exceed 52 feeds, is $15,000 annually. The charge for Daily data feeds to a single supported vendor, not to exceed 365 feeds, is $20,000 annually. Additional fees would be required for Stop Loss interfaces, Rx integration feeds and telemedicine. provider or vendor charges that have a direct positive impact on the cost of care, are included in Paid Claims on the invoice, and may accumulate towards aggregate stop loss purchased from Anthem. The charges year one are as follows: Behavioral Health $1.55 PCPM, Care Support $0.52 PCPM, Musculoskeletal $1.41 PCPM, Oncology $1.01 PCPM, and Radiology $2.41 PCPM. Clinical programs included as part of Anthem's Core Foundational Program are not available for opt-out. A la Carte clinical program(s) Claim Related Charges Pharmacy Benefit Administration See Pharmacy Pricing Summary. CITY OF PADUCAH - 0673594-03 - 10/6/2026 12:37:10 PM Attachments (ASO) CITY OF PADUCAH Effective January 1, 2027 through December 31, 2027 EPHC.pdf CITY OF PADUCAH - 0673594-03 - Printed:10/6/2026 12:37:10 PM Page 1 of 9 Your summary of benefits Anthem® Blue Cross and Blue Shield Your Plan: CITY OF PADUCAH: Anthem Blue Access PPO $1500 Your Network: Blue Access Visits with Virtual Care-Only Providers Cost through our mobile app and website Primary Care, and medical services for urgent/acute care No charge medical deductible does not apply Mental Health & Substance Use Disorder Services No charge medical deductible does not apply Specialist care $80 copay per visit medical deductible does not apply Covered Medical Benefits Cost if you use an In-Network Provider Cost if you use an Out-of-Network Provider Overall Deductible $1,500 person / $3,000 family $3,000 person / $6,000 family Overall Out-of-Pocket Limit $3,400 person / $6,600 family $6,600 person / $13,200 family The family deductible and out-of-pocket limit are embedded, meaning the cost shares of one family member will be applied to the per person deductible and per person out-of-pocket limit; in addition, amounts for all covered family members apply to both the family deductible and family out-of-pocket limit. No one member will pay more than the per person deductible or per person out-of-pocket limit. All medical and prescription drug deductibles, copayments and coinsurance apply to the out -of-pocket limit (excluding Out-of- Network Human Organ and Tissue Transplant (HOTT), Cellular and Gene Therapy services). In-Network and Out-of-Network deductibles and out-of-pocket limit amounts are separate and do not accumulate toward each other. Doctor Visits (virtual and office) You are encouraged to select a Primary Care Physician (PCP). Preferred PCP virtual and office (Providers reflected in our Find Care tool as: EPHC.) $5 copay per visit medical deductible does not apply Not covered Primary Care (PCP) virtual and office $40 copay per visit medical deductible does not apply 50% coinsurance after medical deductible is met Mental Health and Substance Use Disorder Services virtual and office $40 copay per visit medical deductible does not apply 50% coinsurance after medical deductible is met Specialist Provider virtual and office $80 copay per visit medical deductible does not apply 50% coinsurance after medical deductible is met Page 2 of 9 Covered Medical Benefits Cost if you use an In-Network Provider Cost if you use an Out-of-Network Provider Other Practitioner Visits Maternity Doctor services (prenatal/postpartum care and delivery) 20% coinsurance after medical deductible is met 50% coinsurance after medical deductible is met Retail Health Clinic for routine care and treatment of common illnesses; usually found in major pharmacies or retail stores. $40 copay per visit medical deductible does not apply 50% coinsurance after medical deductible is met Manipulation Therapy Coverage is limited to 30 visits per benefit period. $40 copay per visit medical deductible does not apply 50% coinsurance after medical deductible is met Other Services in an Office Allergy Testing 20% coinsurance after medical deductible is met 50% coinsurance after medical deductible is met Allergy Injections $10 copay per visit medical deductible does not apply 50% coinsurance after medical deductible is met Prescription Drugs Dispensed in the office 20% coinsurance after medical deductible is met 50% coinsurance after medical deductible is met Surgery $80 copay per visit medical deductible does not apply‡ 50% coinsurance after medical deductible is met Preventive care / screenings / immunizations No charge 50% coinsurance after medical deductible is met Preventive Care for Chronic Conditions per IRS guidelines No charge Cost share is based on the setting services are received. Diagnostic Services Lab Office No charge 50% coinsurance after medical deductible is met Freestanding Lab/Reference Lab No charge 50% coinsurance after medical deductible is met Outpatient Hospital 20% coinsurance after medical deductible is met 50% coinsurance after medical deductible is met Diagnostic Services X-Ray Office No charge 50% coinsurance after medical deductible is met Page 3 of 9 Covered Medical Benefits Cost if you use an In-Network Provider Cost if you use an Out-of-Network Provider Outpatient Hospital 20% coinsurance after medical deductible is met 50% coinsurance after medical deductible is met Diagnostic Services Advanced Diagnostic Imaging for example: MRI, PET and CAT scans Office 20% coinsurance after medical deductible is met 50% coinsurance after medical deductible is met Freestanding Radiology Center 20% coinsurance after medical deductible is met 50% coinsurance after medical deductible is met Outpatient Hospital 20% coinsurance after medical deductible is met 50% coinsurance after medical deductible is met Emergency and Urgent Care Urgent Care $75 copay per visit medical deductible does not apply 50% coinsurance after medical deductible is met Emergency Room Facility Services 20% coinsurance after medical deductible is met Covered as In-Network Emergency Room Doctor and Other Services 20% coinsurance medical deductible does not apply Covered as In-Network Ambulance Authorized Out-of-Network non-emergency ambulance services are limited to an Anthem maximum payment of $50,000 per trip. The $50,000 limit does not apply to air ambulance services. 20% coinsurance after medical deductible is met Covered as In-Network Outpatient Mental Health and Substance Use Disorder Services at a Facility Facility Fees 20% coinsurance after medical deductible is met 50% coinsurance after medical deductible is met Doctor Services 20% coinsurance after medical deductible is met 50% coinsurance after medical deductible is met Outpatient Surgery Facility Fees Hospital 20% coinsurance after medical deductible is met 50% coinsurance after medical deductible is met Page 4 of 9 Covered Medical Benefits Cost if you use an In-Network Provider Cost if you use an Out-of-Network Provider Ambulatory Surgical Center 20% coinsurance after medical deductible is met 50% coinsurance after medical deductible is met Physician and other services including surgeon fees Hospital 20% coinsurance after medical deductible is met 50% coinsurance after medical deductible is met Ambulatory Surgical Center 20% coinsurance after medical deductible is met 50% coinsurance after medical deductible is met Hospital (Including Maternity, Mental Health and Substance Use Disorder Services) Facility Fees 20% coinsurance after medical deductible is met 50% coinsurance after medical deductible is met Human Organ and Tissue Transplants Cornea transplants are treated as medical procedures, with benefits and cost sharing determined by the setting in which the services are received. You must get certain covered transplant procedures from an Approved In - Network Provider to receive the In-Network level of benefits. No charge 50% coinsurance after medical deductible is met Physician and other services including surgeon fees 20% coinsurance after medical deductible is met 50% coinsurance after medical deductible is met Home Health Care Coverage is limited to 100 visits per benefit period. 20% coinsurance after medical deductible is met 50% coinsurance after medical deductible is met Therapy Services Rehabilitation and Habilitation services including physical, occupational and speech therapies. You are responsible for cost shares no greater than the PCP office visit when Covered Services are performed by a Physical Therapist or Occupational Therapist. Coverage for physical, occupational and speech therapies is limited to 20 visits combined per benefit period. Office $40 copay per visit medical deductible does not apply 50% coinsurance after medical deductible is met Page 5 of 9 Covered Medical Benefits Cost if you use an In-Network Provider Cost if you use an Out-of-Network Provider Outpatient Hospital physical and occupational therapy- $40 copay per visit medical deductible does not apply speech therapy-20% coinsurance after medical deductible is met 50% coinsurance after medical deductible is met Pulmonary rehabilitation Office $80 copay per visit medical deductible does not apply 50% coinsurance after medical deductible is met Outpatient Hospital 20% coinsurance after medical deductible is met 50% coinsurance after medical deductible is met Cardiac rehabilitation Coverage is limited to 36 visits per benefit period. Office $80 copay per visit medical deductible does not apply 50% coinsurance after medical deductible is met Outpatient Hospital 20% coinsurance after medical deductible is met 50% coinsurance after medical deductible is met Dialysis/Hemodialysis Office $80 copay per visit medical deductible does not apply 50% coinsurance after medical deductible is met Outpatient Hospital 20% coinsurance after medical deductible is met 50% coinsurance after medical deductible is met Chemo/Radiation Therapy Office $80 copay per visit medical deductible does not apply‡ 50% coinsurance after medical deductible is met Outpatient Hospital 20% coinsurance after medical deductible is met 50% coinsurance after medical deductible is met Skilled Nursing Care (facility) Coverage for Skilled Nursing is limited to 90 days per benefit period. 20% coinsurance after medical deductible is met 50% coinsurance after medical deductible is met Inpatient Hospice No charge No charge Page 6 of 9 Covered Medical Benefits Cost if you use an In-Network Provider Cost if you use an Out-of-Network Provider Additional Services, Equipment and Devices Durable Medical Equipment 20% coinsurance after medical deductible is met 50% coinsurance after medical deductible is met Prosthetic Devices 20% coinsurance after medical deductible is met 50% coinsurance after medical deductible is met Wigs Coverage for wigs is limited to 1 item per benefit period. 20% coinsurance after medical deductible is met 50% coinsurance after medical deductible is met Hearing Aids Coverage is limited to 1 item per ear every 36 months for members under 18 years of age. 20% coinsurance after medical deductible is met 50% coinsurance after medical deductible is met Covered Prescription Drug Benefits Cost if you use an In-Network Pharmacy Cost if you use an Out-of-Network Pharmacy Pharmacy Deductible Not applicable Not applicable Pharmacy Out-of-Pocket Limit $2500 Person (does not apply to tiers 1-3 drugs) $2500 Person (does not apply to tiers 1-3 drugs) Prescription Drug Coverage Network: Base Network Drug List: National Drugs not included on the National drug list will not be covered. For more information, refer to “National Drug List” at https://www.anthem.com/pharmacy-information/. Day Supply Limits Retail Pharmacy: 30 day supply (cost shares noted below) Home Delivery Pharmacy: 90 day supply (maximum cost shares noted below). Maintenance medications are available through our home delivery pharmacy. You will need to call us on the number on your ID card to sign up when you first use the service. Specialty Pharmacy: 30 day supply at retail and home delivery (cost shares noted below apply). We may require certain drugs with special handling, provider coordination or patient education be filled by our designated specialty pharmacy. Tier 1 - Typically Generic $15 copay per prescription (retail) and $45 copay per prescription (home delivery) Greater of $55 or 50% coinsurance (retail) and Not covered (home delivery) Tier 2 - Typically Preferred Brand $35 copay per prescription (retail) and $105 copay per Greater of $55 or 50% coinsurance (retail) and Not covered (home Page 7 of 9 Covered Prescription Drug Benefits Cost if you use an In-Network Pharmacy Cost if you use an Out-of-Network Pharmacy prescription (home delivery) delivery) Tier 3 - Typically Non-Preferred Brand $55 copay per prescription (retail) and $165 copay per prescription (home delivery) Greater of $55 or 50% coinsurance (retail) and Not covered (home delivery) Tier 4 - Typically Specialty (brand and generic) 25% coinsurance up to $150 per prescription with OOP max $2500 (retail) 25% coinsurance up to $150 per prescription with OOP max $2500 (per 30 day supply home delivery) Greater of $55 or 50% coinsurance (retail) and Not covered (home delivery) Notes: • Dependent Age Limit: to the end of the month in which the child attains age 26. • Members are encouraged to always obtain prior approval when using Out-of-Network Providers. Precertification will help the member know if the services are considered not medically necessary. • No charge means no deductible / copayment / coinsurance up to the maximum allowable amount. 0% means no coinsurance up to the maximum allowable amount. However, when choosing an Out-of-Network Provider, the member is responsible for any balance due after the plan payment. • If you have an office visit with your Primary Care Physician, Specialist or Urgent Care at an Outpatient Facility (e.g., Hospital or Ambulatory Surgical Facility), benefits for Covered Services will be paid under “Outpatient Facility Services”. • Costs may vary by the site of service. Other cost shares may apply depending on services provided. Check your Certificate of Coverage for details. • Screening and diagnostic imaging for the detection of breast cancer, including diagnostic mammograms, 3D mammography, breast ultrasounds and MRIs are covered in full as required by state mandate. • The limits for physical, occupational, and speech therapy, if any apply to this plan, will not apply if you get care as part of the Mental Health and Substance Use Disorder benefit. • ‡ You will pay your PCP or Specialist office visit copay for certain services provided in their office. This summary of benefits is a brief outline of coverage, designed to help you with the selection process. This summary does not reflect each and every benefit, exclusion and limitation which may apply to the coverage. For more details, important limitations and exclusions, please review the formal Evidence of Coverage (EOC). If there is a difference between this summary and the Evidence of Coverage (EOC), the Evidence of Coverage (EOC), will prevail. Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Kentucky, Inc. Independent licensee of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Questions: (833) 578-4443 or visit us at www.anthem.com KY/LG/Anthem Blue Access PPO Option 11 with Rx Option E2//2027 Page 8 of 9 Your Plan: CITY OF PADUCAH: Anthem Blue Access PPO $1500 Your Network: Blue Access This summary of benefits is intended to be a brief outline of coverage. The entire provisions of benefits and exclusions are contained in the Group Contract, Certificate, and Schedule of Benefits. In the event of a conflict between the Group Contract and this description, the terms of the Group Contract will prevail. By signing this Summary of Benefits, I agree to the benefits for the product selected as of the effective date indicated. Authorized group signature (if applicable) Date Underwriting signature (if applicable) Date 63658MUMENMUB 10/24 #AG-GEN-001# Page 9 of 9 We’re here for you – in many languages The law requires us to include a message in all of these different languages. Curious what they say? Here’s the English version: “You have the right to get help in your language for free. Just call the Member Services number on your ID card.” Visually impaired? You can also ask for other formats of this d ocument TTY/TTD:711 It’s important we treat you fairly We follow federal civil rights laws in our health programs and activities. Members can get reasonable modifications as well as free auxiliary aids and services if you have a disability. We don’t discriminate, on the basis of race, color, national origin, sex, age or disability. For people whose primary language isn’t English (or have limited proficiency), we offer free language assistance services like interpreters and other written languages. Interested in these services? Call the Member Services number on your ID card for help (TTY/TDD: 711) or visit our website. If you think we failed in any areas or to learn more about grievance procedures, you can mail a complaint to: Compliance Coordinator, P.O. Box 27401, Richmond, VA 23279, or directly to the U.S. Department of Health and Human Services, Office for Civil Rights at 200 Independence Avenue, SW; Room 509F, HHH Building; Washington, D.C. 20201. You can also call 1-800- 368-1019 (TDD: 1-800-537-7697) or visit https://ocrportal.hhs.gov/ocr/portal/lobby.jsf Page 1 of 8 Your summary of benefits Anthem® Blue Cross and Blue Shield Your Plan: CITY OF PADUCAH: Anthem Blue Access PPO HSA $3500 Your Network: Blue Access Visits with Virtual Care-Only Providers Cost through our mobile app and website Primary Care, and medical services for urgent/acute care No charge deductible does not apply Mental Health & Substance Use Disorder Services No charge deductible does not apply Specialist care No charge after deductible is met Covered Medical Benefits Cost if you use an In-Network Provider Cost if you use an Out-of-Network Provider Overall Deductible $3,500 person / $6,600 family $3,500 person / $6,600 family Overall Out-of-Pocket Limit $3,500 person / $6,600 family $6,600 person / $13,200 family The family deductible and out-of-pocket limit are embedded, meaning the cost shares of one family member will be applied to the per person deductible and per person out-of-pocket limit; in addition, amounts for all covered family members apply to both the family deductible and family out-of-pocket limit. No one member will pay more than the per person deductible or per person out-of-pocket limit. All medical and prescription drug deductibles, copayments and coinsurance apply to the out -of-pocket limit (excluding Out-of- Network Human Organ and Tissue Transplant (HOTT), Cellular and Gene Therapy services). In-Network and Out-of-Network deductibles and out-of-pocket limit amounts are separate and do not accumulate toward each other. Doctor Visits (virtual and office) You are encouraged to select a Primary Care Physician (PCP). Primary Care (PCP) virtual and office No charge after deductible is met 30% coinsurance after deductible is met Mental Health and Substance Use Disorder Services virtual and office No charge after deductible is met 30% coinsurance after deductible is met Specialist Provider virtual and office No charge after deductible is met 30% coinsurance after deductible is met Other Practitioner Visits Maternity Doctor services (prenatal/postpartum care and delivery) No charge after deductible is met 30% coinsurance after deductible is met Retail Health Clinic for routine care and treatment of common illnesses; usually found in major pharmacies or retail stores. No charge after deductible is met 30% coinsurance after deductible is met Manipulation Therapy Coverage is limited to 30 visits per benefit period. No charge after deductible is met 30% coinsurance after deductible is met Page 2 of 8 Covered Medical Benefits Cost if you use an In-Network Provider Cost if you use an Out-of-Network Provider Other Services in an Office Allergy Testing No charge after deductible is met 30% coinsurance after deductible is met Allergy Injections No charge after deductible is met 30% coinsurance after deductible is met Prescription Drugs Dispensed in the office No charge after deductible is met 30% coinsurance after deductible is met Surgery No charge after deductible is met 30% coinsurance after deductible is met Preventive care / screenings / immunizations No charge 30% coinsurance after deductible is met Diagnostic Services Lab Office No charge after deductible is met 30% coinsurance after deductible is met Freestanding Lab/Reference Lab No charge after deductible is met 30% coinsurance after deductible is met Outpatient Hospital No charge after deductible is met 30% coinsurance after deductible is met Diagnostic Services X-Ray Office No charge after deductible is met 30% coinsurance after deductible is met Outpatient Hospital No charge after deductible is met 30% coinsurance after deductible is met Diagnostic Services Advanced Diagnostic Imaging for example: MRI, PET and CAT scans Office No charge after deductible is met 30% coinsurance after deductible is met Freestanding Radiology Center No charge after deductible is met 30% coinsurance after deductible is met Outpatient Hospital No charge after deductible is met 30% coinsurance after deductible is met Emergency and Urgent Care Urgent Care No charge after deductible is met 30% coinsurance after deductible is met Emergency Room Facility Services No charge after deductible is met Covered as In-Network Emergency Room Doctor and Other Services No charge after deductible is met Covered as In-Network Ambulance Authorized Out-of-Network non-emergency ambulance services are limited to an Anthem maximum payment of $50,000 per trip. The $50,000 limit does not apply to air ambulance services. No charge after deductible is met Covered as In-Network Page 3 of 8 Covered Medical Benefits Cost if you use an In-Network Provider Cost if you use an Out-of-Network Provider Outpatient Mental Health and Substance Use Disorder Services at a Facility Facility Fees No charge after deductible is met 30% coinsurance after deductible is met Doctor Services No charge after deductible is met 30% coinsurance after deductible is met Outpatient Surgery Facility Fees Hospital No charge after deductible is met 30% coinsurance after deductible is met Ambulatory Surgical Center No charge after deductible is met 30% coinsurance after deductible is met Physician and other services including surgeon fees Hospital No charge after deductible is met 30% coinsurance after deductible is met Ambulatory Surgical Center No charge after deductible is met 30% coinsurance after deductible is met Hospital (Including Maternity, Mental Health and Substance Use Disorder Services) Facility Fees No charge after deductible is met 30% coinsurance after deductible is met Human Organ and Tissue Transplants Cornea transplants are treated as medical procedures, with benefits and cost sharing determined by the setting in which the services are received. You must get certain covered transplant procedures from an Approved In - Network Provider to receive the In-Network level of benefits. No charge after deductible is met 30% coinsurance after deductible is met Physician and other services including surgeon fees No charge after deductible is met 30% coinsurance after deductible is met Home Health Care Coverage is limited to 100 visits per benefit period. No charge after deductible is met 30% coinsurance after deductible is met Therapy Services Rehabilitation and Habilitation services including physical, occupational and speech therapies. You are responsible for cost shares no greater than the PCP office visit when Covered Services are performed by a Physical Therapist or Occupational Therapist. Coverage for physical, occupational and speech therapies is limited to 20 visits combined per benefit period. Office No charge after deductible is met 30% coinsurance after deductible is met Outpatient Hospital No charge after deductible is met 30% coinsurance after deductible is met Page 4 of 8 Covered Medical Benefits Cost if you use an In-Network Provider Cost if you use an Out-of-Network Provider Pulmonary rehabilitation office and outpatient hospital No charge after deductible is met 30% coinsurance after deductible is met Cardiac rehabilitation office and outpatient hospital Coverage is limited to 36 visits per benefit period. No charge after deductible is met 30% coinsurance after deductible is met Dialysis/Hemodialysis office and outpatient hospital No charge after deductible is met 30% coinsurance after deductible is met Chemo/Radiation Therapy office and outpatient hospital No charge after deductible is met 30% coinsurance after deductible is met Skilled Nursing Care (facility) Coverage for Skilled Nursing is limited to 100 days per benefit period. No charge after deductible is met 30% coinsurance after deductible is met Inpatient Hospice No charge after deductible is met No charge after deductible is met Additional Services, Equipment and Devices Durable Medical Equipment No charge after deductible is met 30% coinsurance after deductible is met Prosthetic Devices No charge after deductible is met 30% coinsurance after deductible is met Wigs Coverage for wigs is limited to 1 item per benefit period. No charge after deductible is met 30% coinsurance after deductible is met Hearing Aids Coverage is limited to 1 item per ear every 36 months for members under 18 years of age. No charge after deductible is met 30% coinsurance after deductible is met Covered Prescription Drug Benefits Cost if you use an In-Network Pharmacy Cost if you use an Out-of-Network Pharmacy Pharmacy Deductible Combined with In- Network medical deductible Combined with Out-of- Network medical deductible Pharmacy Out-of-Pocket Limit Combined with In- Network medical out- of-pocket limit Combined with Out-of- Network medical out- of-pocket limit Prescription Drug Coverage Network: Base Network Drug List: National For more information, refer to “National Drug List” at https://www.anthem.com/pharmacy-information/. Day Supply Limits Retail Pharmacy: 30 day supply (cost shares noted below) Home Delivery Pharmacy: 90 day supply (maximum cost shares noted below). Maintenance medications are available through our home delivery pharmacy. Specialty Pharmacy: 30 day supply at retail and home delivery (cost shares noted below apply). We may require certain drugs Page 5 of 8 Covered Prescription Drug Benefits Cost if you use an In-Network Pharmacy Cost if you use an Out-of-Network Pharmacy with special handling, provider coordination or patient education be filled by our designated specialty pharmacy. Tier 1 - Typically Generic 0% coinsurance after deductible is met (retail and home delivery) 30% coinsurance after deductible is met (retail) and Not covered (home delivery) Tier 2 - Typically Preferred Brand 0% coinsurance after deductible is met (retail and home delivery) 30% coinsurance after deductible is met (retail) and Not covered (home delivery) Tier 3 - Typically Non-Preferred Brand 0% coinsurance after deductible is met (retail and home delivery) 30% coinsurance after deductible is met (retail) and Not covered (home delivery) Tier 4 - Typically Specialty (brand and generic) 0% coinsurance after deductible is met (retail) 0% coinsurance after deductible is met (per 30 day supply home delivery) 30% coinsurance after deductible is met (retail) and Not covered (home delivery) Notes: • Dependent Age Limit: to the end of the month in which the child attains age 26. • Members are encouraged to always obtain prior approval when using Out-of-Network Providers. Precertification will help the member know if the services are considered not medically necessary. • No charge means no deductible / copayment / coinsurance up to the maximum allowable amount. 0% means no coinsurance up to the maximum allowable amount. However, when choosing an Out-of-Network Provider, the member is responsible for any balance due after the plan payment. • If you have an office visit with your Primary Care Physician, Specialist or Urgent Care at an Outpatient Facility (e.g., Hospital or Ambulatory Surgical Facility), benefits for Covered Services will be paid under “Outpatient Facility Services”. • Costs may vary by the site of service. Other cost shares may apply depending on services provided. Check your Certificate of Coverage for details. • Screening and diagnostic imaging for the detection of breast cancer, including diagnostic mammograms, 3D mammography, breast ultrasounds and MRIs are covered in full after deductible as required by state mandate. • The limits for physical, occupational, and speech therapy, if any apply to this plan, will not apply if you get care as part of the Mental Health and Substance Use Disorder benefit. Page 6 of 8 This summary of benefits is a brief outline of coverage, designed to help you with the selection process. This summary does not reflect each and every benefit, exclusion and limitation which may apply to the coverage. For more details, important limitations and exclusions, please review the formal Evidence of Coverage (EOC). If there is a difference between this summary and the Evidence of Coverage (EOC), the Evidence of Coverage (EOC), will prevail. Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Kentucky, Inc. Independent licensee of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Questions: (833) 578-4443 or visit us at www.anthem.com KY/LG/Anthem Blue Access PPO HSA Option E4//2027 Page 7 of 8 Your Plan: CITY OF PADUCAH: Anthem Blue Access PPO HSA $3500 Your Network: Blue Access This summary of benefits is intended to be a brief outline of coverage. The entire provisions of benefits and exclusions are contained in the Group Contract, Certificate, and Schedule of Benefits. In the event of a conflict between the Group Contract and this description, the terms of the Group Contract will prevail. By signing this Summary of Benefits, I agree to the benefits for the product selected as of the effective date indicated. Authorized group signature (if applicable) Date Underwriting signature (if applicable) Date 63658MUMENMUB 10/24 #AG-GEN-001# Page 8 of 8 We’re here for you – in many languages The law requires us to include a message in all of these different languages. Curious what they say? Here’s the English version: “You have the right to get help in your language for free. Just call the Member Services number on your ID card.” Visually impaired? You can also ask for other formats of this d ocument TTY/TTD:711 It’s important we treat you fairly We follow federal civil rights laws in our health programs and activities. Members can get reasonable modifications as well as free auxiliary aids and services if you have a disability. We don’t discriminate, on the basis of race, color, national origin, sex, age or disability. For people whose primary language isn’t English (or have limited proficiency), we offer free language assistance services like interpreters and other written languages. Interested in these services? Call the Member Services number on your ID card for help (TTY/TDD: 711) or visit our website. If you think we failed in any areas or to learn more about grievance procedures, you can mail a complaint to: Compliance Coordinator, P.O. Box 27401, Richmond, VA 23279, or directly to the U.S. Department of Health and Human Services, Office for Civil Rights at 200 Independence Avenue, SW; Room 509F, HHH Building; Washington, D.C. 20201. You can also call 1-800- 368-1019 (TDD: 1-800-537-7697) or visit https://ocrportal.hhs.gov/ocr/portal/lobby.jsf Fully Insured Renewal City of Paducah Group Number(s): W29698 Effective Date: 1/1/2027 - 12/31/2028 Anthem Sales Representative: Angie Meadows Frequency Full Service Exam 12 months Lenses 12 months Frames 24 months Contact Lenses 12 months In Network Copayments Exam $10.00 Materials $10.00 In Network Plan Allowance Frame Allowance $130 Contact Lens Allowance $130 ENROLLMENT Subscriber Only Subscriber + Spouse Subscriber + Child Subscriber + Children Subscriber + Family Total Number of Contracts RATES Subscriber Only Subscriber + Spouse Subscriber + Child Subscriber + Children Subscriber + Family Total Monthly Premium Total Annual Premium % Rate Increase NOTES:Benefits may be subject to approval by CET. The rates quoted are guaranteed for 2 years.Authorized Signature Authorized Signature Authorized Signature Authorized Signature Rates are Net of Commissions Date Date Date Date Refer to your sales brochure(s) for benefit details and limitations. This benefit description is intended to be a brief outline of coverage. The entire provisions of benefits and exclusions are contained in the Group Contract. In the event of a conflict between the Group Contract and this description, the terms of the Group Contract will prevail. Bullitt County Fiscal Court\2020\Anicllary\Vision\2019-10-01_Bullitt County Fiscal Court_FI_Vision_Negotiated_Renewal Benefit Sheet Total Blue View Vision Core Plan Renewal Voluntary Group Size: 250-499 Option 25 36 111 25 12 239 55 $6.97 $12.20 $13.26 $13.26 $20.24 $2,816.69 $33,800.28 $16,622.28 $0.00 $0.00 $0.00 $16,622.28 0.0% Contract code: 35NX Blue View VisionSM FS.B.10.10.130.130 Welcome to your Blue View Vision plan! You have many choices when it comes to using your benefits. As a Blue View Vision plan member, you have access to one of the nation’s largest vision networks. You may choose from many private practice doctors, local optical stores, and national retail stores including LensCrafters®, Target Optical®, and most Pearle Vision® locations. You may also use your in-network benefits to order eyewear online at Glasses.com and ContactsDirect.com. To locate a participating network eye care doctor or location, log in at anthem.com, or from the home page menu under Care, select Find a Doctor. You may also call member services for assistance at 1-866-723-0515. Out-of-Network – If you choose to, you may instead receive covered benefits outside of the Blue View Vision network. Just pay in full at the time of service, obtain an itemized receipt, and file a claim for reimbursement up to your maximum out-of-network allowance. YOUR BLUE VIEW VISION PLAN BENEFITS IN-NETWORK OUT-OF-NETWORK FREQUENCY Routine Eye Exam Eyeglass Frames Eyeglass Lenses (instead of contact lenses) Single vision lenses Bifocal lenses Trifocal lenses Eyeglass Lens Enhancements When obtaining covered eyewear from a Blue View Vision provider, you may choose to add any of the following lens enhancements at no extra cost Lenses (for a child under age 21) Standard polycarbonate (for a child under age 21) Factory Scratch Coating Contact Lenses (instead of eyeglass lenses) Contact lens allowance will only be applied toward the first purchase of contacts made during a benefit period. Any unused amount remaining cannot be used for subsequent purchases in the same benefit period, nor can any unused amount be carried over to the following benefit period. Elective conventional (non-disposable) OR Elective disposable OR Non-elective (medically necessary) (no additional discount) Covered in full This is a primary vision care benefit intended to cover only routine eye examinations and corrective eyewear. Blue View Vision is for routine eye care only. If you need medical treatment for your eyes, visit a participating eye care doctor from your medical network. Benefits are payable only for expenses incurred while the group and insured person’s coverage is in force. This information is intended to be a brief outline of coverage. All terms and conditions of coverage, including benefits and exclusions, are contained in the member’s policy, which shall control in the event of a conflict with this overview. This benefit overview is only one piece of your entire enrollment package. EXCLUSIONS & LIMITATIONS (not a comprehensive list – please refer to the member Certificate of Coverage for a complete list) Not to be combined with any offer, coupon, or in-store advertisement. Excess Amounts. Amounts in excess of covered vision expense. Sunglasses. Plano sunglasses and accompanying frames. Safety Glasses. Safety glasses and accompanying frames. Not Specifically Listed. Services not specifically listed in this plan as covered services. Any lost or broken lenses or frames are not eligible for replacement unless the insured person has reached his or her normal service interval as indicated in the plan design. Non-Prescription Lenses. Any non-prescription lenses, eyeglasses or contacts. Plano lenses or lenses that have no refractive power. Orthoptics. Orthoptics or vision training and any associated supplemental testing Transitions are registered trademarks of Transitions Optical, Inc. Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Kentucky, Inc. Independent licensee of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield Names and symbols are registered marks of the Blue Cross and Blue Shield Association. OPTIONAL SAVINGS AVAILABLE FROM BLUE VIEW VISION IN-NETWORK PROVIDERS ONLY In-Network Member Cost (after any applicable copay) Retinal Imaging – at member’s option, can be performed a time of eye exam Not more than $39 Eyeglass lens upgrades When obtaining eyewear from a Blue View Vision provider, you may choose to upgrade your new eyeglass lenses at a discounted cost. Eyeglass lens copayment applies. lenses (Adults) Standard Polycarbonate (Adults) Tint (Solid and Gradient) UV Coating Progressive Lenses1 Standard Premium Tier 1 Premium Tier 2 Premium Tier 3 Anti-Reflective Coating2 Standard Premium Tier 1 Premium Tier 2 Other Add-ons $75 $40 $15 $15 $65 $85 $95 $110 $45 $57 $68 20% off retail price Additional Pairs of Eyeglasses Anytime from any Blue View Vision network provider Complete Pair Eyeglass materials purchased separately 40% off retail price 20% off retail price Eyewear Accessories Items such as non-prescription sunglasses, lens cleaning supplies, contact lens solutions, eyeglass cases, etc. 20% off retail Contact lens fit and follow-up A contact lens fitting and up to two follow-up visits are available to you once a comprehensive eye exam has been completed. Standard contact lens fitting3 Premium contact lens fitting4 Up to $55 10% off retail price Conventional Contact Lenses Discount applies to materials only 15% off retail price 1 Please ask your provider for his/her recommendation as well as the available progressive brands by tier. 2 Please ask your provider for his/her recommendation as well as the available anti-reflective brands by tier. 3 Standard fitting includes spherical clear lenses for conventional wear and planned replacement. Examples include but are not limited to disposable and frequent replacement. 4 Premium fitting includes all lens designs, materials and specialty fittings other than standard contact lenses. Examples include but are not limited to toric and multifocal. Cannot be combined with any other offer. Discounts are subject to change without notice. Discounts are not covered benefits under your vision plan and will not be listed in your certificate of coverage. Discounts will be offered from in-network providers except where State law prevents discounting of products and services that are not covered benefits under this plan. Discounts on frames will not apply if the manufacturer has imposed a no discount on sales at retail and independent provider locations. Some of our in-network providers include: ADDITIONAL SAVINGS AVAILABLE THROUGH ANTHEM’S SPECIAL OFFERS PROGRAM anthem.com, select discounts, then Vision, Hearing & Dental. * Discounts cannot be used in conjunction with your covered benefits. OUT-OF-NETWORK If you choose to receive covered services or purchase covered eyewear from an out-of-network provider, network discounts will not apply and you will be responsible for payment of services and/or eyewear materials at the time of service. Please complete an out-of-network claim form and submit it along with your itemized receipt to the fax number, email address, or mailing address below. To download a claim form, log in at anthem.com, or from the home page menu under Support select Forms, click Change State to choose your state, and then scroll down to Claims and select the Blue View Vision Out-of-Network Claim Form. You may instead call member services at 1-866-723-0515 .to request a claim form. TO FAX:866-293-7373 TO EMAIL:oonclaims@eyewearspecialoffers.com TO MAIL:Blue View Vision Attn: OON Claims P.O. Box 8504 Mason, OH 45040-7111 Authorized Signature:Title: Date Get Help in Your Language Curious to know what all this says? We would be too. Here’s the English version: You have the right to get this information and help in your language for free. Call the Member Services number on your ID card for help. (TTY/TDD: 711) Separate from our language assistance program, we make documents available in alternate formats for members with visual impairments. If you need a copy of this document in an alternate format, please call the customer service telephone number on the back of your ID card. Spanish Tiene el derecho de obtener esta información y ayuda en su idioma en forma gratuita. Llame al número de Servicios para Miembros que figura en su tarjeta de identificación para obtener ayuda. (TTY/TDD: 711) Arabic .(TTY/TDD:711)ﺓﺪﻋﺎﺴﻤﻠﻟ ﻚﺑ ﺔﺻﺎﺨﻟﺍ ﻒﻳﺮﻌﺘﻟﺍ ﺔﻗﺎﻄﺑ ﻰﻠﻋ ﺩﻮﺟﻮﻤﻟﺍ ﺀﺎﻀﻋﻷﺍ ﺕﺎﻣﺪﺧ ﻢﻗﺮﺑ ﻞﺼﺗﺍ .ﺎًﻧﺎﺠﻣ ﻚﺘﻐﻠﺑ ﺓﺪﻋﺎﺴﻤﻟﺍﻭ ﺕﺎﻣﻮﻠﻌﻤﻟﺍ ﻩﺬﻫ ﻰﻠﻋ ﻝﻮﺼﺤﻟﺍ ﻚﻟ ﻖﺤﻳ Chinese 您有權使用您的語言免費獲得該資訊和協助。請撥打您的 ID 卡上的成員服務號碼尋求協助。(TTY/TDD: 711) French Vous avez le droit d’accéder gratuitement à ces informations et à une aide dans votre langue. Pour cela, veuillez appeler le numéro des Services destinés aux membres qui figure sur votre carte d’identification. (TTY/TDD: 711) German Sie haben das Recht, diese Informationen und Unterstützung kostenlos in Ihrer Sprache zu erhalten. Rufen Sie die auf Ihrer ID-Karte angegebene Servicenummer für Mitglieder an, um Hilfe anzufordern. (TTY/TDD: 711) Japanese この情報と支援を希望する言語で無料で受けることができます。支援を受けるには、IDカードに記載されているメンバーサービス番号に電話 してください。(TTY/TDD: 711) Kirundi Ufise uburenganzira bwo gufashwa mu rurimi rwawe ku buntu. Akura umunywanyi abikora Ikaratakarangamuntu yawe kugira ufashwe. (TTY/TDD: 711) Korean 귀하에게는 무료로 이 정보를 얻고 귀하의 언어로 도움을 받을 권리가 있습니다. 도움을 얻으려면 귀하의 ID 카드에 있는 회원 서비스 번호로 전화하십시오. (TTY/TDD: 711) Nepali तपाईंले यो जानकारी तथा सहयोग आफ्नो भाषामा निःशुल्क प्राप्त गर्ने तपाईंको अधिकार हो। सहायताको लागि तपाईंको ID कार्डमा दिइएको सदस्य सेवा नम्बरमा कल गर्नुहोस्। (TTY/TDD: 711) Oromo Odeeffanoo kana fi gargaarsa afaan keetiin kaffaltii malee argachuuf mirga qabda. Gargaarsa argachuuf lakkoofsa bilbilaa tajaajila miseensaa (Member Services) waraqaa enyummaa kee irratti argamu irratti bilbili. (TTY/TDD: 711) Pennsylvania Dutch Du hoscht die Recht selle Information un Helfe in dei Schprooch mitaus Koscht griege. Ruf die Member Services Nummer uff dei ID Kaarte fer Helfe aa. (TTY/TDD: 711) Russian Вы имеете право получить данную информацию и помощь на вашем языке бесплатно. Для получения помощи звоните в отдел обслуживания участников по номеру, указанному на вашей идентификационной карте. (TTY/TDD: 711) Serbian Imate pravo da dobijete sve informacije i pomoć na vašem jeziku, i to potpuno besplatno. Pozovite broj Centra za podršku članovima koji se nalazi na vašoj identifikacionoj kartici. (TTY/TDD: 711) Tagalog May karapatan kayong makuha ang impormasyon at tulong na ito sa ginagamit ninyong wika nang walang bayad. Tumawag sa numero ng Member Services na nasa inyong ID card para sa tulong. (TTY/TDD: 711) Vietnamese Quý vị có quyền nhận miễn phí thông tin này và sự trợ giúp bằng ngôn ngữ của quý vị. Hãy gọi cho số Dịch Vụ Thành Viên trên thẻ ID của quý vị để được giúp đỡ. (TTY/TDD: 711) It’s important we treat you fairly That’s why we follow federal civil rights laws in our health programs and activities. We don’t discriminate, exclude people, or treat them differently on the basis of race, color, national origin, sex, age or disability. For people with disabilities, we offer free aids and services. For people whose primary language isn’t English, we offer free language assistance services through interpreters and other written languages. Interested in these services? Call the Member Services number on your ID card for help (TTY/TDD: 711). If you think we failed to offer these services or discriminated based on race, color, national origin, age, disability, or sex, you can file a complaint, also known as a grievance. You can file a complaint with our Compliance Coordinator in writing to Compliance Coordinator, P.O. Box 27401, Mail Drop VA2002-N160, Richmond, VA 23279. Or you can file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights at 200 Independence Avenue, SW; Room 509F, HHH Building; Washington, D.C. 20201 or by calling 1-800-368-1019 (TDD: 1- 800-537-7697) or online at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf. Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html. Large Group benefit changes for Kentucky For groups with 51+ members. Effective at renewal on or after January 1, 2027. We appreciate the opportunity you have given us to offer Anthem Blue Cross and Blue Shield (Anthem) healthcare coverage. We want to make you aware of a few important changes that may affect your plan. Changes are effective upon your 2027 renewal date (unless otherwise noted). Ask your Account Management Executive for full details on these features. Medical Plan Changes Medical Benefits Product Type 2026 Benefit 2027 Renewing Benefit Hyperhidrosis All Plans Hyperhidrosis (excessive sweating) excluded in Evidence of Coverage Covered with medical necessity review (ASO 250+ can Opt Out) Dichoptic Digital Therapy All Plans Exclusion: Eye Exercises Orthoptics and vision therapy Exclusion: Eye Exercises Orthoptics and vision therapy. This Exclusion does not apply to Medically Necessary therapy to treat amblyopia (ASO 250+ can Opt Out) Physical Therapy and Occupational Therapy All Plans 20 visits per benefit period, combined for rehabilitative and habilitative physical therapy and occupational therapy 40 visits per benefit period, combined for rehabilitative and habilitative physical therapy and occupational therapy (FI & ASO 100+ can Opt Out) Global Maternity Benefit All Plans Professional Global Maternity benefit is bundled to include physician charges for Prenatal Care, Delivery Care (includes labor management), Postpartum Care Professional Global Maternity benefit is replaced with separate benefits for physician charges for Prenatal Care, Delivery Care (includes labor management), Postpartum Care Gene Therapy Solution Rider Stop Loss Available as a buy-up offering Will be built into the Stop Loss product at no additional cost. This will include all FDA approved Gene Therapies Medical Cost Share Changes Medical Benefits Product Type 2026 Benefit 2027 Renewing Benefit Increase to deductible as a result of IRS limit increases HSA Non-embedded HSAs: Deductible: $1,700 Single/$3,400 Family Embedded HSAs: Deductible: $3,400 Single/$6,800 Family Non-embedded HSAs: Deductible: $1,750 Single/$3,500 Family Embedded HSAs: Deductible: $3,500 Single/$7,000 Family 2027 Renewal Document 2 Increase ACA Maximum Out- of-Pocket All Plans Out-of-Pocket Maximum: $10,600 Individual/$21,200 Family Out-of-Pocket Maximum: $12,000 Individual/$24,000 Family Clear Choice Copay EPHC Providers: $5 Preferred PCP (Anthem Diamond) Providers: $10 Preferred Specialist (Anthem Diamond) Providers: $50 Anthem Essential Plan Anthem Essential Primary Care/Specialist: $35 for first 3 visits, then deductible/coinsurance Out of Pocket Maximum: $9,200/$18,400 Primary Care/Specialist: $30 for first 3 visits, then deductible/coinsurance Out of Pocket Maximum: $9,000/$18,000 Pharmacy Changes Pharmacy Benefits Product Type 2026 Benefit 2027 Renewing Benefit Cost Relief Expansion ABF ERISA Only No program High-touch member Specialty Rx experience with $0 cost share for enrolled members (post deduction on HSA plans) Legislative updates Kentucky’s legislative session took place in early 2026. There is some legislation that could impact groups at their renewal. Mandate Description HB169 – Feeding & Eating disorder coverage disorders and must not deny, limit, or restrict coverage based solely on weight- related metrics such as body mass index, ideal body weight, or any requirement to achieve a specific weight. Insurers may evaluate for medical necessity of treatment and determine the appropriate level of care by considering several factors including an individual’s eating behaviors, the need for supervised meals, or supportive interventions, relevant laboratory results (such as heart rate, renal or cardiovascular function, and blood pressure), the individual’s recovery environment, and the HB164 – Hearing aid coverage for children benefit coverage from $1,400 to $2,500 for hearing aids per hearing-impaired ear for eligible children. SB97 – Protheses and Orthoses orthoses. Coverage must, at a minimum, be equivalent to that provided under federal statutes and regulations for the aged and disabled, including specific U.S. Code sections and C.F.R. provisions. This act requires coverage for prescribed prostheses and orthoses deemed medically necessary by licensed professionals, materials and components necessary for their use, instruction on usage, and repair or replacement under certain conditions. Coverage may be subject to cost-sharing requirements, but cost-sharing cannot be higher than that subject for inpatient physician and surgical services. It also limits the number of prostheses and orthoses per affected limb within a three-year period to a limit of three (3) prostheses and orthoses per affected limb and specifies that such coverage is considered habilitative or rehabilitative services. Utilization review decisions must be nondiscriminatory and cannot deny coverage based solely on actual or perceived disability. Insurers must provide detailed denial letters if coverage is denied. Insurers are required to submit annual reports detailing claims data related to this coverage, and the Commissioner must aggregate and report this data to legislative committees. 2027 Renewal Document 3 Client decisions are required for the following items: Consolidated Appropriations Act (CAA) RxDC Reporting Client Action Needed Scope Summary • Opt-in ____________ • Opt-out ___________ FI & ASO Clients business we administer) on behalf of the client. This confirmation replaces the need for clients to respond to annual surveys for inclusion. If Opting In – we will need the average monthly percentage of premium that is covered by your employee/member and you, the employer/group. (must equal 100) ________% by Employee/Member AND ________% by Employer/Group Signature: ________________________________________________ Date: _______________ This summary is for notification of benefit modifications. All product offerings are subject to regulatory review and approval and therefore subject to change. We have also updated your plan benefits to reflect recent changes in applicable law. For more information, contact your broker or account representative. Note: This benefit overview is for illustrative purposes, and some content may be pending Division of Insurance approval It is intended to be a brief outline of coverage. The entire provisions of benefits and exclusions are contained in the Group Contract, Certificate, and Schedule of Benefits. In the event of a conflict between the Group Contract/Benefit Booklet and this description, the terms of the Group Contract/Benefit Booklet will prevail. CarelonRx, Inc. is an independent company providing pharmacy benefit management services on behalf of your health plan.. Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Kentucky, Inc. Independent licensee of the Blue Cross and Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc. Proactive support MyHealth Check-in. After you take this short health assessment, we’ll send you personalized health tips and details on programs that can help you lower health risks, reach your personal goals, and prevent future health problems. MyHealth Advantage. We provide a confidential health summary that includes reminders for checkups, tests, and exams; lists of claims and prescriptions; and general health tips. 24/7 NurseLine. Talk to a trained, registered nurse over the phone and quickly get answers to common health concerns. Mental health resources Behavioral Health Advantage (BHA). If you’re trying to manage a behavioral health condition or substance use disorder, our behavioral health case managers are licensed mental health professionals who can help. They offer caring support for you and your family, including 24/7 drug and alcohol assistance. You can also access tools and resources for things like suicide prevention, autism, attention deficit hyperactivity disorder (ADHD), and post-traumatic stress disorder (PTSD). Emotional Wellbeing Resources. Learn how to develop resilience, reduce stress, and practice mindfulness through online programs and personalized coaching. Digital tools help you identify thoughts and behavior patterns that affect your emotional well-being. Autism Spectrum Disorder Program. Receive support for a covered family member with an autism spectrum disorder. Our licensed behavior analysts can help you navigate the healthcare system and will work with the whole family to help you understand services and access care. We want to support your whole health the best way possible. That’s why your health plan includes Wellbeing Solutions, a suite of programs to help you with everyday health and your overall well-being. Making your well-being a priority Explore Wellbeing Solutions programs on the Sydney Health app Wellbeing Solutions Supporting your whole health matters U eht es S yendyS M H htlae dna ppa elibom a moc.mehtn snoituloS gnieblleW ssecca ot emityna dna smargorp r .sdeen erachtlaeh ruoy teem taht secruose Condition-based support Concierge Care. This program pairs eligible members with a personal health advocate to provide coaching and digital resources on health conditions, such as type 2 diabetes and heart failure, as well as when you are being discharged from an inpatient setting. Cancer Care. If you or a family member is facing a cancer diagnosis or have started treatment, the Cancer Care Navigator program offers one-on-one guidance and digital support when it matters most. Case Management. After an illness or hospital stay, you can receive one-on-one support and care coordination from our team of medical professionals. They can help guide you through the healthcare system and make the most of your benefits. Their goal is to understand your needs and help you get the best care possible. Building Healthy Families. Whether you’re planning for a family, are pregnant, or are postpartum, you can access digital tools and educational resources to support the needs of your growing family. ConditionCare. Receive one-on-one, digital support from a healthcare professional for a chronic condition, like asthma or diabetes. We care about you Connect with Sydney Health Sydney Health offers useful health and wellness tips and personalized action plans that can help you reach your unique well-being goals. Download, open, register, and/or sign into the Sydney Health mobile app. 1.Go to homepage > Scroll down > Select My Health Dashboard > Choose Programs. 2.Browse the wellness programs included in your plan. Scan this QR code with your smartphone to download the Sydney Health app. 1 096350M DOPV SBANEMU 52/60 S .nalp htlaeh ruoy fo flaheb no secivres noitacilppa elibom gnireffo ynapmoc etarapes a ,smroftalP latigiD noleraC htiw tnemegnarra na hguorht dereffo si htlaeH yendy C fo flaheb no secivres tnemeganam erac gnidivorp ynapmoc etarapes a si cnI ,htlaeH nolera A dleihS eulB dna ssorC eulB mehtn . 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RVP Underwriting II October 28, 2025 President, Pharmacy Benefit Management & Supply Chain October 28, 2025 Medicare Secondary Payer Employer Status Form Please complete this form to assist with compliance with the Medicare Secondary Payer regulations of the Centers for Medicare and Medicaid Services (CMS). You may want to check with your legal counsel to confirm the Medicare Secondary Payer requirements. Group name Group contact Group identification no. Telephone no. The business or organization (“Group”) named above: Does NOT Does have 20 or more employees for each working day in each of 20 or more calendar weeks in the current calendar year or the preceding calendar year, and Does NOT Does have 100 or more employees on 50 percent or more of its regular business days during the preceding calendar year. “Employees” include (even if they are not eligible for Anthem group health plan benefits): x Part-time, full-time and leased employees; x Persons not working but receiving payments normally subject to FICA taxes, such as persons on disability for the first six months. If the Group is part of a controlled group of employers under IRC Sec. 52(a) and (b) or an affiliated service under IRC Sec. 414(m), then all employees in the aggregated group of employers must be included in the count of the Group’s employees. The Group agrees to notify Anthem Blue Cross and Blue Shield as soon as the statement above is no longer true. The Group employed _____________ (number) of such “employees” as of _____________(date). If this form states a change in the category (i.e., under 20, over 20 or over 100 employees) for the Group, then a copy of the business’ or organization’s latest wage and tax statement must be attached and returned with this form. I certify that the information provided above is true to the best of my knowledge and belief. Group administrator signature Date Life and Disability products are underwritten by Anthem Life Insurance Company. In Indiana: Anthem Blue Cross and Blue Shield is a trade name of Anthem Insurance Companies, Inc. In Kentucky: Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Kentucky, Inc. In most of Missouri, Anthem Blue Cross and Blue Shield is the trade name of RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC) and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc.). RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Ohio: Anthem Blue Cross and Blue Shield is the trade name of Community Insurance Company. In Wisconsin, Blue Cross Blue Shield of Wisconsin ("BCBSWi") underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation ("Compcare") underwrites or administers the HMO policies; and Compcare and BCBSWi collectively underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. Rev. 1/07 ® Anthem is a registered trademark. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Agenda Action Form Meeting Date: October 27, 2026 Short Title: Stop Loss Insurance with Voya Financial Advisors. Inc. - S. WILCOX Category: Municipal Order Staff Work By: Stefanie Wilcox Presentation By: Stefanie Wilcox Background Information: Since January 1, 2023, the City of Paducah has purchased stop loss insurance with Voya to protect the City's health insurance plan in the event of a catastrophic claim(s). It is recommended, for the 2027 plan year beginning on January 1, 2027, the Commission renew the agreement with Voya Financial Advisors, Inc. to purchase stop loss insurance which is set at a $175,000 maximum city liability per person (individual stop loss), Voya assumes liability for all claims in excess of this amount, and $4,401,466 maximum city liability of total claims combined (aggregate stop loss limit), Voya assumes liability for all claims in excess of the aggregate total up to $1,000,000. Premium rates are $210.55 per member per month for individual stop loss insurance; and $6.80 per member per month for aggregate stop loss insurance. This is a total of 50% increase from last year. The Gene Therapy Stop-loss (GTS) coverage $3.90 per member per month to assist with high prescription drug costs related to gene therapy, is a 4% decrease from the previous year. The producer/agent of record where monthly premium payments will be made is Strategic Benefit Resources. Does this Agenda Action Item align with a Commission Priority? No If yes, please list the Commission Priority: Commission Priorities List Communications Plan: Funds Available: Account Name: Account Number: Staff Recommendation: Authorize the Mayor to execute a Stop Loss Agreement and any other documents related to such with Voya Financial Services, Inc. for stop loss, GTS, and aggregate insurance coverage. Attachments: 1. MO - health ins-stop loss coverage – Voya- 2027 2. Proposal_City of Paducah-01-01-2027-Renewal MUNICIPAL ORDER NO. _______ A MUNICIPAL ORDER ACCEPTING THE RATES FOR STOP LOSS INSURANCE COVERAGE, AUTHORIZING AN AGREEMENT WITH VOYA FINANCIAL ADVISORS, INC., FOR THE CITY OF PADUCAH, KENTUCKY FOR THE 2027 CALENDAR YEAR AND AUTHORIZING THE MAYOR TO EXECUTE ALL DOCUMENTS RELATING TO SAME BE IT ORDERED BY THE BOARD OF COMMISSIONERS OF THE CITY OF PADUCAH, KENTUCKY: SECTION 1. That the City of Paducah accepts the rates offered through Voya Financial Advisors, Inc., for Stop Loss Insurance Coverage for the group health insurance plan for the City of Paducah, Kentucky. Effective January 1, 2027. The stop loss rates are as follows: 1) Individual Stop Loss - $175,000 maximum City liability per person with a monthly rate of $210.55 per member; and 2) Aggregate Stop Loss - $4,401,466 maximum City liability of total claims combined with a monthly rate of $6.80 per member. Voya assumes liability for all claims in excess of the aggregate total up to $1,000,000. 3) Gene Therapy Stop Loss (GTS) $3.90 per member per month to assist with high prescription drug costs related to gene therapy. SECTION 2. The Mayor is hereby authorized to execute all documents relating to stop loss insurance coverage as authorized in Sections 1 above. SECTION 3. The producer/agent of record where monthly premium payments will be made is Strategic Benefit Resources. SECTION 4. This Order shall be in full force and effect from and after the date of its adoption. _________________________________ George Bray, Mayor ATTEST: ____________________________ Lindsay Parish, City Clerk Adopted by the Board of Commissioners, October 27, 2026 Recorded by Claudia S. Meeks, Assistant City Clerk, October 27, 2026 \mo.\health ins-stop loss coverage – Voya- 2027 Page 1 Issued by ReliaStar Life Insurance Company A member of the Voya® family of companies Stop Loss Insurance Renewal Offer Voya Health Solutions Prepared for: City of Paducah Effective Date 01/01/2027 Policy Number 733059 Excess Risk Insurance is issued by ReliaStar Life Insurance Company, a member of the Voya® family of companies. Page 2 Issued by ReliaStar Life Insurance Company A member of the Voya® family of companies Stop Loss Proposal for City of Paducah Individual Excess Risk Insurance Plan Description Current Renewal Option 1 Renewal Option 2 Plan Effective Date January 1, 2026 January 1, 2027 January 1, 2027 Coverages Medical, Rx Medical, Rx Medical, Rx Individual Deductible $ 175,000 $ 175,000 $ 185,000 Policy Year Maximum Unlimited Unlimited Unlimited Lifetime Maximum Unlimited Unlimited Unlimited Coverage Period Paid in 12 Months and incurred Jan 01, 2022 or after Paid in 12 Months and incurred Jan 01, 2022 or after Paid in 12 Months and incurred Jan 01, 2022 or after Benefit Percentage 100%100%100% Rates Include Commissions of:None None None Endorsements Renewal Advantage (No New Laser)Included Included Included Renewal Rate Cap 50.00 %50.00 %50.00 % Plan Mirroring Included Included Included ASO Expedited Reimbursement Included Included Included Coverage Description Enrollment Composite 284 $ 140.37 $ 210.55 $ 204.29 Cost Estimated Monthly Costs $ 39,865 $ 59,796 $ 58,018 Estimated Annual Costs $ 478,380 $ 717,554 $ 696,220 % Change from Current 50.00%45.54% Page 3 Issued by ReliaStar Life Insurance Company A member of the Voya® family of companies Aggregate Excess Risk Insurance Plan Description Current Renewal Option 1 Renewal Option 2 Plan Effective Date January 1, 2026 January 1, 2027 January 1, 2027 Coverages Medical, Rx Medical, Rx Medical, Rx Aggregate Adjustment Corridor 125 %125 %125 % Individual Deductible $ 175,000 $ 175,000 $ 185,000 Maximum Annual Reimbursement $ 1,000,000 $ 1,000,000 $ 1,000,000 Coverage Period Paid in 12 Months and incurred Jan 01, 2022 or after Paid in 12 Months and incurred Jan 01, 2022 or after Paid in 12 Months and incurred Jan 01, 2022 or after Rates Include Commissions of:None None None Coverage Description Enrollment Composite 284 $ 6.18 $ 6.80 $ 7.12 Monthly Aggregate Corridor* PEPM 284 $ 1,119.68 $ 1,291.51 $ 1,300.94 Aggregate Deductible $ 3,815,869 $ 4,401,466 $ 4,433,604 Minimum Aggregate Deductible at 85%$ 3,243,489 $ 3,741,246 $ 3,768,563 Select Acceptance Choice *Monthly Aggregate Corridor means the Monthly Aggregate Factor (amount of expected claims per month per covered person) multiplied by the Aggregate Adjustment Corridor. Page 4 Issued by ReliaStar Life Insurance Company A member of the Voya® family of companies Individual Excess Risk Insurance Plan Description Renewal Option 3 Renewal Option 4 Plan Effective Date January 1, 2027 January 1, 2027 Coverages Medical, Rx Medical, Rx Individual Deductible $ 195,000 $ 200,000 Policy Year Maximum Unlimited Unlimited Lifetime Maximum Unlimited Unlimited Coverage Period Paid in 12 Months and incurred Jan 01, 2022 or after Paid in 12 Months and incurred Jan 01, 2022 or after Benefit Percentage 100%100% Rates Include Commissions of:None None Endorsements Renewal Advantage (No New Laser)Included Included Renewal Rate Cap 50.00 %50.00 % Plan Mirroring Included Included ASO Expedited Reimbursement Included Included Coverage Description Enrollment Composite 284 $ 198.04 $ 194.77 Cost Estimated Monthly Costs $ 56,243 $ 55,315 Estimated Annual Costs $ 674,920 $ 663,776 % Change from Current 41.08%38.75% Page 5 Issued by ReliaStar Life Insurance Company A member of the Voya® family of companies Aggregate Excess Risk Insurance Plan Description Renewal Option 3 Renewal Option 4 Plan Effective Date January 1, 2027 January 1, 2027 Coverages Medical, Rx Medical, Rx Aggregate Adjustment Corridor 125 %125 % Individual Deductible $ 195,000 $ 200,000 Maximum Annual Reimbursement $ 1,000,000 $ 1,000,000 Coverage Period Paid in 12 Months and incurred Jan 01, 2022 or after Paid in 12 Months and incurred Jan 01, 2022 or after Rates Include Commissions of:None None Coverage Description Enrollment Composite 284 $ 7.36 $ 7.39 Monthly Aggregate Corridor* PEPM 284 $ 1,310.38 $ 1,301.66 Aggregate Deductible $ 4,465,775 $ 4,436,057 Minimum Aggregate Deductible at 85%$ 3,795,909 $ 3,770,648 Select Acceptance Choice *Monthly Aggregate Corridor means the Monthly Aggregate Factor (amount of expected claims per month per covered person) multiplied by the Aggregate Adjustment Corridor. Page 6 Issued by ReliaStar Life Insurance Company A member of the Voya® family of companies Stop Loss Proposal for City of Paducah Account Assumptions Renewal As Of Date October 1, 2026 Renewal Good Through October 31, 2026 Situs State Kentucky Claim Administrator Anthem Blue Cross Blue Shield (KY) Network 2027-01 BlueCross BlueShield (State) Additional Contract Specifications: No fully insured lives are covered. Any FDA approved cell and gene therapies are covered under our Stop Loss policy, provided they are also covered under the group’s medical plan and used for the purpose for which they were approved. This includes any new approvals that occur mid-policy year. We also exclude these high-cost claims from the following year’s renewal package, helping to lower the impact of this cutting-edge care on self-funded employer costs. In addition to base commissions, certain brokers and/or service providers may receive compensation related to factors such as overall sales of Company products, total premium for products sold through the broker/service provider, growth in the number of customers, and retention of existing customers. Compensation and fees may also be paid to brokers and/or service providers for administrative services in connection with Company products. Please contact us if you would like additional detail on compensation and fees payable on your case. Quote assumes pharmacy benefits are not carved out to a separate Pharmacy Benefit Manager. Plan designs and contribution levels are assumed as submitted to underwriting. Any changes may require an adjustment to the individual excess risk rates and/or monthly aggregate corridor. Plan must have medical case management and utilization review. All claims are reported/paid in U.S. dollars. The monthly aggregate corridor cannot be finalized more than 90 days prior to the effective date. Claims data must include a minimum of 9 months in the most recent experience period. Any costs charged by the claim administrator for reports required to substantiate claims will be paid by the employer. The proposal is based on the data submitted. Any changes to this data may allow us to modify the proposal. There is no coverage for retirees. We reserve the right to (i) recalculate Monthly Aggregate Factor(s) [if applicable] and Individual Excess Risk Monthly Premium Rates as shown on the Excess Risk Schedule and continue this Policy, or (ii) terminate this Policy in accordance with the Policy Termination provision of this Policy if an increase or decrease in the number of Covered Persons and Covered Dependents that exceeds 15% of the current number covered under the Employee Benefit Plan. Premium rates were adjusted via filed and approved underwriting discretion in consideration of the carrier reporting fees assessed by the PBM or TPA, which are directly associated with the claims information we require to administer our Policy. Please Note: We are removing the No New Laser Provision for claimant C.K. At the next renewal we reserve the right to laser this individual to a higher specific deductible. Rates are firm through 10/31/26. The individual stop loss renewal is based upon the current leveraged trend factors, market conditions, plan designs and current demographic factors. The aggregate renewal is based upon the experience of the group and current trend. Any plan changes may affect this renewal and need to be disclosed prior to the renewal acceptance. Authorized Signature Date Page 7 Issued by ReliaStar Life Insurance Company A member of the Voya® family of companies City of Paducah 01/01/2027 Excess Risk Insurance is underwritten by ReliaStar Life Insurance Company. Policy form RL-SL-POL-2025 (may vary by state). Exclusions and limitations are described in the policy. Page 8 Issued by ReliaStar Life Insurance Company A member of the Voya® family of companies Economic Factors: Manage the Effects of Leveraged Trend (Illustrative) Medical trend is the anticipated annual increase in the cost of medical claims from year to year. Medical costs generally increase every year through inflation, and there are many additional factors that determine the actual medical trend for a specific health plan. Components of medical trend include: Plan Design Technology Network Utilization Patterns Demographics Cost Shifting Medical trend gets leveraged when parties responsible for medical claims do not maintain the same proportional share of the risk from year to year. Put simply, rising medical costs affect stop loss carriers differently than employers. But rather than passing our increasing risk back on to you in the form of large rate increases, we can compensate with small increases in deductibles. Here's an example. In Year 1, the plan elects a $150,000 individual stop loss deductible. If there is an individual claim of $225,000, the first $150,000 is the employer’s responsibility and the remaining $75,000 is reimbursed by the stop loss carrier. In Year 2, assuming an 8% increase in medical costs, a claim that would have been $225,000 in Year 1 now costs $243,000. If the deductible doesn't change, the first $150,000 is the employer’s responsibility and the remaining $93,000 reimbursed by the stop loss carrier. So that 8% trend produces a 24% cost increase to the stop loss carrier’s claim and 0% increase to the employer. If the stop loss deductible is left at the same dollar level year after year, the employer’s risk actually decreases as a percentage of the overall claim. Conversely, the insurer’s risk is increasing -- and, in response, the insurer has to increase rates well beyond medical trend. In order to eliminate the leveraging effect, the employer should increase its individual deductible by trend each year. This essentially retains the exact same proportion of the risk. In an effort to mitigate the effects of leveraged trend, your underwriter has included an optional quote during this year’s renewal. Excess Risk Insurance is issued by ReliaStar Life Insurance Company, a member of the Voya® family of companies. Agenda Action Form Meeting Date: October 27, 2026 Short Title: Authorize the Application and Acceptance of a Department of Justice Bulletproof Vest Grant in the Amount of $8,180 - H. REASONS Category: Municipal Order Staff Work By: Hope Reasons, Mary Farrell Presentation By: Brian Laird Background Information: The U.S. Department of Justice (DOJ) Bulletproof Vest Partnership (BVP) Grant Program, an online application, provides a maximum 50-percent reimbursement for the purchase of body armor for police. The National Institute of Justice, the research, development and evaluation agency of the United States Department of Justice, sets the only nationally accepted standards for body armor worn by law enforcement officers. NIJ recognizes an industry standard of a five-year life span on body armor. The Department of Justice BVP also recognizes a five-year life span on body armor. In light of these industry standards and endorsements by the preeminent law enforcement agencies, the Paducah Police Department follows a five-year replacement plan for body armor worn by law enforcement officers. The Police Department is requesting funding for 20 body armor vests for a total cost of $16,360. The cost per vest on the state contract price is $818. This grant requires a 50-percent match; therefore, the Police Department will request $8,180 from the BVP program and provide $8,180 from FY27 operating funds. Does this Agenda Action Item align with a Commission Priority? No If yes, please list the Commission Priority: Commission Priorities List Communications Plan: Funds Available: Account Name: Field Operating Supplies Account Number: 1000-1602-535130 Staff Recommendation: Approve the application and acceptance of the Department of Justice Bulletproof Grant and authorize the Mayor to sign all documentation related to same. Attachments: 1. MO - app & award – DOJ – Bulletproof Vest Grant 2026 MUNICIPAL ORDER NO. ________ A MUNICIPAL ORDER AUTHORIZING THE MAYOR TO EXECUTE AN APPLICATION FOR A U. S. DEPARTMENT OF JUSTICE (DOJ) BULLETPROOF VEST GRANT PROGRAM IN THE AMOUNT OF $8,180 FOR THE PURCHASE OF TWENTY (20) BODY ARMOR VESTS, ACCEPTING ANY GRANT FUNDS AWARDED BY THE U. S. DEPARTMENT OF JUSTICE, AND AUTHORIZING THE MAYOR TO EXECUTE ALL DOCUMENTS RELATED TO SAME BE IT ORDERED BY THE CITY OF PADUCAH, KENTUCKY: SECTION 1. The Mayor is hereby authorized to execute an application to obtain a U. S. Department of Justice (DOJ) Bulletproof Vest Partnership Grant in the amount of $8,180 for purchase of twenty body armor vests. The cost per vest on the State contract is $818 for a total cost of $16,360. This grant requires a fifty percent (50%) match; therefore, the Police Department will request $8,180 from the BVP program and provide $8,180 from FY2027 operating funds. SECTION 2. That the City of Paducah hereby authorizes the acceptance of any and all grant funds awarded by the U. S. Department of Justice (DOJ) Bulletproof Vest Program Grant and authorizes the Mayor to execute the Grant Agreement and all related documents. SECTION 3. The fifty percent (50%) match will be paid from Field Operating Supplies, Account Number 1000-1602-535130. SECTION 4. This order will be in full force and effect from and after the date of its adoption. ______________________________ George Bray, Mayor ATTEST: ________________________________ Lindsay Parish, City Clerk Adopted by the Board of Commissioners, October 27, 2026 Recorded by Lindsay Parish, City Clerk, October 27, 2026 \mo\grants\app & award – DOJ – Bulletproof Vest Grant 2026