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MUNICIPAL ORDER NO. q/ S
A MUNICIPAL ORDER ADOPTING AMENDMENTS TO THE MEDICAL AND
PRESCRIPTION DRUG PLAN OF THE COMPREHENSIVE HEALTH INSURANCE BENEFIT PLAN
SUMMARY FOR FULL TIME EMPLOYEES OF THE CITY OF PADUCAH
BE IT ORDERED BY THE CITY OF PADUCAH, KENTUCKY:
SECTION 1. That the City of Paducah amends its health insurance program as follows,
effective July 1, 2002:
a)
b)
C)
d)
e)
fl
g)
Increase Stop -loss coverage to $100,000.00 deductible per covered person.
Presently the City's reinsurance contract contains an $80,000 deductible per
covered person.
Establish Plan A premium charges of single $475.00 per month, family $642.00
per month.
Increase Plan A prescription drug out-of-pocket maximum from $500 per person
per calendar year to $1,000 per person per calendar year.
Establish Plan B premium charges of single $541.67 per month, family $687.00
per month.
Increase Plan B out-of-pocket maximum from $500 per person to $1,000 per
person per calendar year (maximum of 3 per family).
Increase Plan B prescription drug out-of-pocket maximum increased from $500
per person per calendar year to $1,000 per person per calendar year.
Eliminate Plan C
SECTION 2. In order to streamline the appeals procedures for all claims made on the
medical, dental, vision and drug plan, amend the plan as follows, effective on adoption:
"Provide that a request for claims appeal must be received in writing and sent to EBC
within the time specified within the plan provisions.
EBC will review the appeal and provide for an internal appeal decision. Notice be sent to
the participant in writing by EBC.
a) If rejected, the participant may then escalate the appeal by making a second
appeal notice in writing, sent to the Human Resources Department requesting a
formal external claims appeal.
1) EBC will coordinate with a URAC accredited independent firm, which
will review the claim, possibly request further information then make a
determination and provide the decision in writing.
EBC will notify the City Human Resources Department and the participant of the
external appeal decision.
All provisions of this section shall be reviewed and amended according to federal law or
other similar statutes which ma effect the plan from time to time."
SECTION 3. This order shall be in full force and effect from and afteZM
e its
adoption.
ATTEST:
Tammara S. Brock, Asst. City Clerk
Adopted by the Board of Commissioners, May 28, 2002
Recorded Tammara S. Brock, Asst. City Clerk, May 28, 2002
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