Municipal Authority

MINUTES Sand Springs Municipal Authority M3A November 18, 2019 Room #B106 Following City Council Billie A. Hall Public Safety Center 602 W. Morrow Road Sand Springs, Oklahoma 74063 MEMBERS PRESENT: Chairman Jim Spoon (5-2) Vice Chairman Patty Dixon (6-1) Trustee Phil Nollan (7-0) Trustee Mike Burdge (7-0) Trustee Nancy Riley (3-0) Trustee Beau Wilson (7-0) Trustee Brian Jackson (7-0) ALSO PRESENT: City Manager Elizabeth A. Gray City Attorney David Weatherford Secretary Kristin S. Johnston MEMBERS ABSENT: None The Sand Springs Municipal Authority met in regular session on November 18, 2019, in Room No. B106 of the Billie A. Hall Public Safety Center pursuant to the agenda filed with the City Clerk’s office and posted at 11:00 a.m., on November 14, 2019, on the window located at the front entrance of former Fire Station #1, 217 N. McKinley Ave., Sand Springs, Oklahoma 74063. 1. Call to Order Chairman Spoon called the meeting to order at the noted time of 7:35 p.m. 2. Roll Call Chairman Spoon called for an individual roll call with members replying in the following manner: Trustee Jackson, here; Trustee Nollan, here; Trustee Burdge, here; Vice Chairman Dixon, here; Chairman Spoon, here; Trustee Riley, here; Trustee Wilson, here. 3. Consent Agenda (A-E) Chairman Spoon informed Trustees that all matters listed under Consent Agenda to be considered by Trustees are to be routine and will be enacted by one motion.  MUNICIPAL AUTHORITY MINUTES NOVEMBER 18, 2019 PAGE 2 Chairman Spoon noted that questions or clarification on any Consent Agenda items may be addressed prior to taking action. Chairman Spoon requested if Trustees had questions or needed clarification on any Consent Agenda items or whether any items needed to be considered separately. There being none, Chairman Spoon called for a motion regarding Consent Agenda Items No. 3A through 3B. A motion was made by Trustee Burdge and seconded by Trustee Nollan to approve the Consent Agenda Items No. 3A through 3B: A) The minutes of the October 28, 2019, regular Municipal Authority meeting. B) The Shell Lake Dam Breach Plan, Revision 14, and authorization for the Chairman to sign said document. Chairman Spoon called for the vote recorded as follows: Trustee Wilson, aye; Trustee Riley, aye; Chairman Spoon, aye; Vice Chairman Dixon, aye; Trustee Burdge, aye; Trustee Nollan, aye; Trustee Jackson, aye. The motion carried 7-0-0. 4. Correspondence The following correspondence was provided to Trustees for their review and information: A) Regular monthly bills. 5. City Manager’s and Trustees’ Report There was nothing further to report at this time. 6. Adjournment The meeting adjourned at the noted time of 7:35 p.m. _______________________________ Kristin S. Johnston, Secretary  MINUTES M3B Sand Springs Municipal Authority November 25, 2019 – 6:30 p.m. Pecan Street and Morrow Road Intersection Sand Springs, Oklahoma 74063 Chairman Jim Spoon, Trustee Mike Burdge, Trustee Nancy Riley, and Trustee Brian Jackson gathered for the purpose of Funeral Mass for Assistant City Manager Mike Tinker. This meeting was for honorary-purposes only, with no business to be acted upon by Trustees. Janice L. Almy, City Clerk  M3C Agenda Item #________ CITY OF SAND SPRINGS COUNCIL/AUTHORITY STAFF REPORT MEETING DATE: December 16, 2019 SUBJECT: Health Care – Mid-year benefit change option STAFF RECOMMENDATION: Approval of a mid-year benefit change adding a high-deductible option for Health Care benefits to existing benefits. BACKGROUND AND HISTORY: Presently Community Care of Oklahoma provides group health insurance to City employees. The City pays 75% of the premium cost, with the remaining 25% coming from the employees for the base plan. Additionally, employees may elect to pay a differential in premiums to receive a lower deductible plan. It has been expressed by many employees the want to have a high deductible option with a lower premium. This option is a more cost effective option to the younger employee population with minimal need for health care. By providing such an option, the City ensures we remain in compliance with the Affordable Health Care Act while also providing a benefit rich insurance plan at no additional cost to the employer. BUDGETARY IMPACT: The City budgetary impact will be $0.00 Total budgetary impact will be $0.00 COMPILED BY AND PRESENTED: Amy Fairchild/Human Resources ATTACHMENTS: Medical Rates from Gallagher  Mid-Year Plan Change Review Prepared For City of Sand Springs Presented By: Kat Knapp & Coleman Crawley Gallagher Benefit Services, Inc. 918.407.3768 & 405.639.3814 Kat_Knapp@ajg.com & Coleman_Crawley@ajg.com This proposal is an outline of the coverages proposed by the carrier(s) based upon the information provided by your company. It does not include all the terms, coverages, exclusions, limitations, and conditions of the actual contract language. See the policies and contracts for actual language. This proposal is not a contract and offers no contractual obligation on behalf of GBS. Policy forms for your reference will be made available upon request. This analysis is for illustrative purposes only, and is not a guarantee of future expenses, claims costs, managed care savings, etc. There are many variables that can affect future health care costs including utilization patterns, catastrophic claims, changes in plan design, health care trend increases, etc. This analysis does not amend, extend, or alter the coverage provided by the actual insurance policies and contracts. Please see your policy or contact us for specific information or further details in this regard. Gallagher 1 Medical Plan Design - Option 1 Current Mid-Year Plan Change Community Care of OK Community Care of Oklahoma Network HMO Select HMO Select Option 1 In-Network In-Network In-Network In-Network In-Network Plan Number / Code IDEA Plus 1 IDEA Plus 3 IDEA Plus 1 IDEA Plus 3 IDEA Plus 6 CR17 PROVISIONS Effective Date 7/1/2019 7/1/2019 7/1/2019 7/1/2019 1/1/2020 Deductible Individual $500 $1,000 $500 $1,000 $2,500 Family $1,000 $2,000 $1,000 $2,000 $5,000 Out of Pocket Maximum Individual $2,500 $3,000 $2,500 $3,000 $4,500 Family $5,000 $6,000 $5,000 $6,000 $9,000 Coinsurance (Member Pays) 20% 20% 20% 20% Varies Office Visit / Services Primary Care Physician $25 Copay $35 Copay $25 Copay $35 Copay $35 Copay Specialist $35 Copay $45 Copay $35 Copay $45 Copay $60 Copay Lab / Outpatient Radiology No Copay No Copay No Copay No Copay 10% Coinsurance MRI, CT Scan and PET Scan $150 Copay, after Ded $150 Copay, after Ded $150 Copay, after Ded $150 Copay, after Ded $750 Copay Preventive Care No Copay No Copay No Copay No Copay No Copay Chiropractic $35 Copay $45 Copay $35 Copay $45 Copay $60 Copay Emergency Room $75 Copay, after Ded $150 Copay, after Ded $75 Copay, after Ded $150 Copay, after Ded $350 Copay, after Ded Urgent Care $50 Copay $50 Copay $50 Copay $50 Copay $50 Copay Ouptatient Surgical Facility $50 Copay, after Ded $200 Copay, after Ded $50 Copay, after Ded $200 Copay, after Ded $350 Copay, after Ded Inpatient Hospital Care $100 Copay per Day up to max $250 Copay per Day up to max $100 Copay per Day up to $250 Copay per Day up to $350 Copay per Day up to max of $500 per admission, after of $1,000 per admission, after max of $500 per admission, max of $1,000 per of $1,750 per admission, after Ded Ded after Ded admission, after Ded Ded Prescription Drug Benefit Retail Tier I $15 $15 $15 $15 $15 Tier II $40 $40 $40 $40 $40 Tier III $85 $85 $85 $85 $85 Specialty $260 $260 $260 $260 $260 Mail Order Tier I $30 $30 $30 $30 $30 Tier II $80 $80 $80 $80 $80 Tier III $170 $170 $170 $170 $170 COSTS Enroll Enroll Enroll Enroll Enroll Rates Employee Only 19 $735.18 48 $668.36 19 $735.18 40 $668.36 8 $562.12 Employee / Spouse 15 $1,462.70 21 $1,329.74 15 $1,462.70 17 $1,329.74 4 $1,118.38 Employee / Child(ren) 2 $1,121.28 13 $1,019.36 2 $1,121.28 11 $1,019.36 2 $857.33 Employee / Family 13 $1,883.73 38 $1,712.52 13 $1,883.73 32 $1,712.52 6 $1,440.30 Monthly Premium 49 $62,639.97 120 $138,333.26 49 $62,639.97 100 $115,353.58 20 $19,326.94 Combined Monthly Cost $200,973.23 $197,320.49 Combined Annual Cost $2,411,678.76 $2,367,845.88 Dollar Difference NA -$43,832.88 Percent Change NA -1.82% *The information contained herein is subject to the disclosures and disclaimers on the Disclaimers tab of this marketing presentation. Gallagher 2  EE/ER Cost Comparison - Option 1 Mid-Year Plan Change Date: January 1, 2020 Current Community Care of OK IDEA Plus 1 IDEA Plus 3 PLAN COSTS Enroll Enroll Rates Employee Only 19 $735.18 48 $668.36 Employee / Spouse 15 $1,462.70 21 $1,329.74 Employee / Child(ren) 2 $1,121.28 13 $1,019.36 Employee / Family 13 $1,883.73 38 $1,712.52 Monthly Premium 49 $62,639.97 120 $138,333.26 Annual Premium $751,679.64 $1,659,999.12 Combined Annual Cost $2,411,678.76 IDEA Plus 1 IDEA Plus 3 Employee Employer Employee Employer CONTRIBUTION SCHEDULE Contribution Contribution Contribution Contribution Employee Only $233.90 $501.28 $167.08 $501.28 Employee / Spouse $465.40 $997.30 $332.44 $997.30 Employee / Child(ren) $356.76 $764.52 $254.84 $764.52 Employee / Family $599.33 $1,284.40 $428.12 $1,284.40 Employee Contribution $239,158.92 $414,990.72 Employer Contribution $512,520.72 $1,245,008.40 Total Employee Annual Contribution $654,149.64 Total Employer Annual Contribution $1,757,529.12 Mid-Year Plan Change Option 1 Community Care of OK IDEA Plus 1 IDEA Plus 3 IDEA Plus 6 CR17 PLAN COSTS Enroll Enroll Enroll Rates Employee Only 19 $735.18 40 $668.36 8 $562.12 Employee / Spouse 15 $1,462.70 17 $1,329.74 4 $1,118.38 Employee / Child(ren) 2 $1,121.28 11 $1,019.36 2 $857.33 Employee / Family 13 $1,883.73 32 $1,712.52 6 $1,440.30 Monthly Premium 49 $62,639.97 100 $115,353.58 20 $19,326.94 Annual Premium $751,679.64 $1,384,242.96 $231,923.28 Dollar Difference $0.00 -$275,756.16 Percent Change 0.00% -16.61% Combined Annual Cost $2,367,845.88 Dollar Difference -$43,832.88 Percent Change -1.82% IDEA Plus 1 IDEA Plus 3 IDEA Plus 6 CR17 Employee Employer Employee Employer Employee Employer CONTRIBUTION SCHEDULE Contribution Contribution Contribution Contribution Contribution Contribution Employee Only $233.90 $501.28 $167.08 $501.28 $60.84 $501.28 Employee / Spouse $465.40 $997.30 $332.44 $997.30 $121.08 $997.30 Employee / Child(ren) $356.76 $764.52 $254.84 $764.52 $92.81 $764.52 Employee / Family $599.33 $1,284.40 $428.12 $1,284.40 $155.90 $1,284.40 Employee Contribution $239,158.92 $346,053.12 $25,104.72 Employer Contribution $512,520.72 $1,038,189.84 $206,818.56 Total Employee Annual Contribution $610,316.76 Employee Dollar Difference -$43,832.88 Employee Percent Change -6.70% Employee Percent of Plan Change Differential -1.82% Total Employer Annual Contribution $1,757,529.12 Employer Dollar Difference $0.00 Employer Percent Change 0.00% Employer Percent of Plan Change Differential 0.00% Gallagher 3 Medical Plan Design - Option 2 Current Mid-Year Plan Change Community Care of OK Community Care of Oklahoma Network HMO Select HMO Select Option 2 In-Network In-Network In-Network In-Network In-Network Plan Number / Code IDEA Plus 1 IDEA Plus 3 IDEA Plus 1 IDEA Plus 3 CC 70 / 4000 CR17 PROVISIONS Effective Date 7/1/2019 7/1/2019 7/1/2019 7/1/2019 1/1/2020 Deductible Individual $500 $1,000 $500 $1,000 $4,000 Family $1,000 $2,000 $1,000 $2,000 $8,000 Out of Pocket Maximum Individual $2,500 $3,000 $2,500 $3,000 $6,200 Family $5,000 $6,000 $5,000 $6,000 $12,400 Coinsurance (Member Pays) 20% 20% 20% 20% 30% Office Visit / Services Primary Care Physician $25 Copay $35 Copay $25 Copay $35 Copay $20 Copay Specialist $35 Copay $45 Copay $35 Copay $45 Copay $50 Copay Lab / Outpatient Radiology No Copay No Copay No Copay No Copay 30% Coinsurance, after Ded MRI, CT Scan and PET Scan $150 Copay, after Ded $150 Copay, after Ded $150 Copay, after Ded $150 Copay, after Ded $750 Copay Preventive Care No Copay No Copay No Copay No Copay No Copay Chiropractic $35 Copay $45 Copay $35 Copay $45 Copay $50 Copay Emergency Room $75 Copay, after Ded $150 Copay, after Ded $75 Copay, after Ded $150 Copay, after Ded 30% Coinsurance, after Ded Urgent Care $50 Copay $50 Copay $50 Copay $50 Copay $50 Copay Ouptatient Surgical Facility $50 Copay, after Ded $200 Copay, after Ded $50 Copay, after Ded $200 Copay, after Ded 30% Coinsurance, after Ded Inpatient Hospital Care $100 Copay per Day up to max $250 Copay per Day up to max $100 Copay per Day up to $250 Copay per Day up to 30% Coinsurance, after Ded of $500 per admission, after of $1,000 per admission, after max of $500 per admission, max of $1,000 per Ded Ded after Ded admission, after Ded Prescription Drug Benefit Retail Tier I $15 $15 $15 $15 $15 Tier II $40 $40 $40 $40 $40 Tier III $85 $85 $85 $85 $85 Specialty $260 $260 $260 $260 $260 Mail Order Tier I $30 $30 $30 $30 $30 Tier II $80 $80 $80 $80 $80 Tier III $170 $170 $170 $170 $170 COSTS Enroll Enroll Enroll Enroll Enroll Rates Employee Only 19 $735.18 48 $668.36 19 $735.18 40 $668.36 8 $496.52 Employee / Spouse 15 $1,462.70 21 $1,329.74 15 $1,462.70 17 $1,329.74 4 $987.87 Employee / Child(ren) 2 $1,121.28 13 $1,019.36 2 $1,121.28 11 $1,019.36 2 $757.29 Employee / Family 13 $1,883.73 38 $1,712.52 13 $1,883.73 32 $1,712.52 6 $1,272.23 Monthly Premium 49 $62,639.97 120 $138,333.26 49 $62,639.97 100 $115,353.58 20 $17,071.60 Combined Monthly Cost $200,973.23 $195,065.15 Combined Annual Cost $2,411,678.76 $2,340,781.80 Dollar Difference NA -$70,896.96 Percent Change NA -2.94% *The information contained herein is subject to the disclosures and disclaimers on the Disclaimers tab of this marketing presentation. Gallagher 4  EE/ER Cost Comparison - Option 2 Mid-Year Plan Change Date: January 1, 2020 Current Community Care of OK IDEA Plus 1 IDEA Plus 3 PLAN COSTS Enroll Enroll Rates Employee Only 19 $735.18 48 $668.36 Employee / Spouse 15 $1,462.70 21 $1,329.74 Employee / Child(ren) 2 $1,121.28 13 $1,019.36 Employee / Family 13 $1,883.73 38 $1,712.52 Monthly Premium 49 $62,639.97 120 $138,333.26 Annual Premium $751,679.64 $1,659,999.12 Combined Annual Cost $2,411,678.76 IDEA Plus 1 IDEA Plus 3 Employee Employer Employee Employer CONTRIBUTION SCHEDULE Contribution Contribution Contribution Contribution Employee Only $233.90 $501.28 $167.08 $501.28 Employee / Spouse $465.40 $997.30 $332.44 $997.30 Employee / Child(ren) $356.76 $764.52 $254.84 $764.52 Employee / Family $599.33 $1,284.40 $428.12 $1,284.40 Employee Contribution $239,158.92 $414,990.72 Employer Contribution $512,520.72 $1,245,008.40 Total Employee Annual Contribution $654,149.64 Total Employer Annual Contribution $1,757,529.12 Mid-Year Plan Change Option 2 Community Care of OK IDEA Plus 1 IDEA Plus 3 CC 4000 / 70 CR17 PLAN COSTS Enroll Enroll Enroll Rates Employee Only 19 $735.18 40 $668.36 8 $496.52 Employee / Spouse 15 $1,462.70 17 $1,329.74 4 $987.87 Employee / Child(ren) 2 $1,121.28 11 $1,019.36 2 $757.29 Employee / Family 13 $1,883.73 32 $1,712.52 6 $1,272.23 Monthly Premium 49 $62,639.97 100 $115,353.58 20 $17,071.60 Annual Premium $751,679.64 $1,384,242.96 $204,859.20 Dollar Difference $0.00 -$275,756.16 Percent Change 0.00% -16.61% Combined Annual Cost $2,340,781.80 Dollar Difference -$70,896.96 Percent Change -2.94% IDEA Plus 1 IDEA Plus 3 CC 4000 / 70 CR17 Employee Employer Employee Employer Employee Employer CONTRIBUTION SCHEDULE Contribution Contribution Contribution Contribution Contribution Contribution Employee Only $233.90 $501.28 $167.08 $501.28 $0.00 $501.28 Employee / Spouse $465.40 $997.30 $332.44 $997.30 $0.00 $997.30 Employee / Child(ren) $356.76 $764.52 $254.84 $764.52 $0.00 $764.52 Employee / Family $599.33 $1,284.40 $428.12 $1,284.40 $0.00 $1,284.40 Employee Contribution $239,158.92 $346,053.12 $0.00 Employer Contribution $512,520.72 $1,038,189.84 $206,818.56 Total Employee Annual Contribution $585,212.04 Employee Dollar Difference -$68,937.60 Employee Percent Change -10.54% Employee Percent of Plan Change Differential -2.86% Total Employer Annual Contribution $1,757,529.12 Employer Dollar Difference $0.00 Employer Percent Change 0.00% Employer Percent of Plan Change Differential 0.00% Gallagher 5 Contribution Affordability (Rate of Pay Safe Harbor) Affordability Percentage 9.86% Affordable Contribution Limits Monthly Semi-Monthly Bi-Weekly Weekly Annual Limit (12 Pay Periods) (24 pay periods) (26 Pay Periods) (52 Pay Periods) Hourly Wage $7.25 $1,115.17 $92.93 $46.47 $42.89 $21.45 $8.00 $1,230.53 $102.54 $51.27 $47.33 $23.66 $8.50 $1,307.44 $108.95 $54.48 $50.29 $25.14 $9.00 $1,384.34 $115.36 $57.68 $53.24 $26.62 $9.50 $1,461.25 $121.77 $60.89 $56.20 $28.10 $10.00 $1,538.16 $128.18 $64.09 $59.16 $29.58 $10.50 $1,615.07 $134.59 $67.29 $62.12 $31.06 $11.00 $1,691.98 $141.00 $70.50 $65.08 $32.54 $11.50 $1,768.88 $147.41 $73.70 $68.03 $34.02 $12.00 $1,845.79 $153.82 $76.91 $70.99 $35.50 $13.00 $1,999.61 $166.63 $83.32 $76.91 $38.45 $14.00 $2,153.42 $179.45 $89.73 $82.82 $41.41 $15.00 $2,307.24 $192.27 $96.14 $88.74 $44.37 $16.00 $2,461.06 $205.09 $102.54 $94.66 $47.33 $17.00 $2,614.87 $217.91 $108.95 $100.57 $50.29 $18.00 $2,768.69 $230.72 $115.36 $106.49 $53.24 $19.00 $2,922.50 $243.54 $121.77 $112.40 $56.20 $20.00 $3,076.32 $256.36 $128.18 $118.32 $59.16 Annual Salary $25,000 $2,465.00 $205.42 $102.71 $94.81 $47.40 $30,000 $2,958.00 $246.50 $123.25 $113.77 $56.88 $35,000 $3,451.00 $287.58 $143.79 $132.73 $66.37 $40,000 $3,944.00 $328.67 $164.33 $151.69 $75.85 $45,000 $4,437.00 $369.75 $184.88 $170.65 $85.33 $50,000 $4,930.00 $410.83 $205.42 $189.62 $94.81 $55,000 $5,423.00 $451.92 $225.96 $208.58 $104.29 $60,000 $5,916.00 $493.00 $246.50 $227.54 $113.77 $65,000 $6,409.00 $534.08 $267.04 $246.50 $123.25 $70,000 $6,902.00 $575.17 $287.58 $265.46 $132.73 $75,000 $7,395.00 $616.25 $308.13 $284.42 $142.21 $80,000 $7,888.00 $657.33 $328.67 $303.38 $151.69 $85,000 $8,381.00 $698.42 $349.21 $322.35 $161.17 $90,000 $8,874.00 $739.50 $369.75 $341.31 $170.65 $95,000 $9,367.00 $780.58 $390.29 $360.27 $180.13 $100,000 $9,860.00 $821.67 $410.83 $379.23 $189.62 Notes - Affordability calculated assuming 30 hour work week per health care reform - Affordability is based on the employee's required contribution for employee-only coverage Gallagher 6 Disclaimer Coverage Disclaimer This proposal (analyses, report, etc.) is an outline of the coverages proposed by the carrier(s) based upon the information provided by your company. It does not include all the terms, coverages, exclusions, limitations, and conditions of the actual contract language. See the policies and contracts for actual language. This proposal (analyses, report, etc.) is not a contract and offers no contractual obligation on behalf of GBS. Renewal / Financial Disclaimer This analysis is for illustrative purposes only, and is not a proposal for coverage or a guarantee of future expenses, claims costs, managed care savings, etc. There are many variables that can affect future health care costs including utilization patterns, catastrophic claims, changes in plan design, health care trend increases, etc. This analysis does not amend, extend, or alter the coverage provided by the actual insurance policies and contracts. See your policy or contact us for specific information or further details in this regard. Legal The intent of this analysis [report, letter, etc.] is to provide you with general information regarding the status of, and/or potential concerns related to, your current employee benefits environment. It should not be construed as, nor is it intended to provide, legal advice. Laws may be complex and subject to change. This information is based on current interpretation of the law and is not guaranteed. Questions regarding specific issues should be addressed by legal counsel who specializes in this practice area. Gallagher 7 A.M. Best Ratings and Compensation Health Carriers (medical, dental, HMO, stop loss, vision, EAP) Carrier Coverage Compensation Supplemental Compensation Community Care of OK Medical $30 PEPM N/A While Gallagher does not guarantee the financial viability of any health insurance carrier or market, it is an area we recommend that clients closely scrutinize when selecting a health insurance carrier. There are a number of rating agencies that can be referred to including, A.M. Best, Fitch, Moody's, Standard & Poor's, and Weiss Ratings (The Street.com). Generally, agencies that provide ratings of Health Insurers, including traditional insurance companies and other managed care organizations, reflect their opinion based on a comprehensive quantitative and qualitative evaluation of a company's financial strength, operating performance and market profile. However, these ratings are not a warranty of an insurer's current or future ability to meet its contractual obligations. Gallagher 8 Gallagher 9  Financial Exhibits - City of Sand Springs Effective Date: 7/1/19 Renewal Options Pharmacy Benefit $0 deductible, then $0/$15/$40/$85/$260 copay 2 x mail order Enrollment Assumptions 61 38 14 55 Indicate if Insure OK In Net-DED OON-DED Single/ Coinsurance- OV - PCP/ Indv OOP MAX - Employee + Employee + Total Monthly electing to renew Plan Name Qualified Single/ Family Family In/Out Specialist IN/Out Network Employee Only Spouse Child(ren) Family Premium with this option HMO Plans B12A Yes None None Copays $20/$30 $3,000 Select $756.11 $1,504.34 $1,153.21 $1,937.36 $225,987.37 B12A Yes None None Copays $20/$30 $3,000 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! IDEA Plus 250 Yes $250/$500 None Copays $25/$35 $2,250 Select $753.78 $1,499.72 $1,149.66 $1,931.40 $225,292.18 IDEA Plus 250 Yes $250/$500 None Copays $25/$35 $2,250 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! IDEA Plus 1A Yes $750/$1,500 None Copays $25/$35 $2,750 Select $716.57 $1,425.67 $1,092.90 $1,836.04 $214,169.03 IDEA Plus 1A Yes $750/$1,500 None Copays $25/$35 $2,750 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! IDEA Plus 2 Yes $750/$1,500 None Copays $30/$40 $2,750 Select $701.21 $1,395.13 $1,069.48 $1,796.70 $209,579.97 IDEA Plus 2 Yes $750/$1,500 None Copays $30/$40 $2,750 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! IDEA Plus 2A Yes $1,000/$2,000 None Copays $30/$40 $3,000 Select $682.61 $1,358.10 $1,041.10 $1,749.02 $204,018.51 IDEA Plus 2A Yes $1,000/$2,000 None Copays $30/$40 $3,000 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! IDEA Plus 4 Yes $1,500/$3,000 None Copays $35/$45 $3,000 Select $651.90 $1,297.02 $994.27 $1,670.35 $194,841.69 IDEA Plus 4 Yes $1,500/$3,000 None Copays $35/$45 $3,000 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! IDEA Plus 5 Yes $2,000/$4,000 None Copays $35/$45 $3,000 Select $633.76 $1,260.92 $966.60 $1,623.87 $189,419.57 IDEA Plus 5 Yes $2,000/$4,000 None Copays $35/$45 $3,000 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! IDEA Plus 6 No $2,500/$5,000 None Copays $35/$45 $4,500 Select $603.52 $1,200.76 $920.48 $1,546.39 $180,381.77 IDEA Plus 6 No $2,500/$5,000 None Copays $35/$45 $4,500 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! IDEA Plus 7 No $4,000/$8,000 None Copays $30/$40 $6,000 Select $566.77 $1,127.64 $864.43 $1,452.22 $169,397.41 IDEA Plus 7 No $4,000/$8,000 None Copays $30/$40 $6,000 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! IDEA Plus 8 No $5,000/$10,000 None Copays $35/$45 $6,000 Select $537.93 $1,070.25 $820.44 $1,378.31 $160,776.44 IDEA Plus 8 No $5,000/$10,000 None Copays $35/$45 $6,000 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! For benefit details, please consult your broker or visit the broker web page at: http://www.ccok.com/Brokers/benefit-plans.asp '*If you are interested in these alternative plan designs, please contact your Account Manager so that we may provide the Summary of Benefits and Coverage (SBC). '*If you change benefits after your group's renewal date, the change(s) will not take effect until the first of the month following 60 calendar days after the date CommunityCare was notified of the change(s). Name: City of Sand Springs; Quote Number: C07084 City of Sand Springs IEDEA2019 Revised Options 1  Financial Exhibits - City of Sand Springs Effective Date: 7/1/19 Renewal Options Pharmacy Benefit $0 deductible, then $0/$15/$40/$85/$260 copay 2 x mail order Enrollment Assumptions 61 38 14 55 Indicate if Insure OK In Net-DED OON-DED Single/ Coinsurance- OV - PCP/ Indv OOP MAX - Employee + Employee + Total Monthly electing to renew Plan Name Qualified Single/ Family Family In/Out Specialist IN/Out Network Employee Only Spouse Child(ren) Family Premium with this option HMO Plans IDEA PLUS 250 CR 17 Yes $250 / $500 None Copays $25/$50 $3,000 Select $727.27 $1,446.96 $1,109.22 $1,863.46 $217,367.33 IDEA PLUS 250 CR 17 Yes $250 / $500 None Copays $25/$50 $3,000 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! IDEA PLUS 1 CR17 Yes $500 / $1,000 None Copays $25/$50 $3,000 Select $704.47 $1,401.61 $1,074.45 $1,805.05 $210,553.90 IDEA PLUS 1 CR17 Yes $500 / $1,000 None Copays $25/$50 $3,000 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! IDEA PLUS 1 A CR17 No $750 / $1,500 None Copays $25/$50 $3,200 Select $682.61 $1,358.10 $1,041.10 $1,749.02 $204,018.51 IDEA PLUS 1 A CR17 No $750 / $1,500 None Copays $25/$50 $3,200 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! IDEA IP2 CR17 No $750 / $1,500 None Copays $30/$60 $3,200 Select $673.77 $1,340.52 $1,027.62 $1,726.38 $201,377.31 IDEA IP2 CR17 No $750 / $1,500 None Copays $30/$60 $3,200 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! IDEA IP2 A CR17 No $1,000 / $2,000 None Copays $30/$60 $3,500 Select $650.51 $1,294.24 $992.14 $1,666.78 $194,425.09 IDEA IP2 A CR17 No $1,000 / $2,000 None Copays $30/$60 $3,500 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! IDEA IP3 CR17 No $1,000 / $2,000 None Copays $35/$60 $3,500 Select $645.85 $1,284.98 $985.05 $1,654.86 $193,034.09 IDEA IP3 CR17 No $1,000 / $2,000 None Copays $35/$60 $3,500 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! IDEA IP4 CR17 No $1,500 / $3,000 None Copays $35/$60 $3,750 Select $614.68 $1,222.97 $937.51 $1,574.99 $183,717.93 IDEA IP4 CR17 No $1,500 / $3,000 None Copays $35/$60 $3,750 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! IDEA IP5 CR17 No $2,000 / $4,000 None Copays $35/$60 $4,000 Select $589.56 $1,172.99 $899.19 $1,510.63 $176,210.09 IDEA IP5 CR17 No $2,000 / $4,000 None Copays $35/$60 $4,000 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! IDEAIP6 CR17 No $2,500/$5,000 None Copays $35/$60 $4,500 Select $562.11 $1,118.38 $857.32 $1,440.30 $168,006.13 IDEAIP6 CR17 No $2,500/$5,000 None Copays $35/$60 $4,500 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! IDEAIP7 CR17 No $4,000/$8,000 None Copays $30/$60 $6,000 Select $516.53 $1,027.67 $787.80 $1,323.48 $154,380.39 IDEAIP7 CR17 No $4,000/$8,000 None Copays $30/$60 $6,000 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! IDEAIP8 CR17 No $5,000/$10,000 None Copays $35/$60 $6,250 Select $484.89 $964.73 $739.55 $1,242.43 $144,925.38 IDEAIP8 CR17 No $5,000/$10,000 None Copays $35/$60 $6,250 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! For benefit details, please consult your broker or visit the broker web page at: http://www.ccok.com/Brokers/benefit-plans.asp '*If you are interested in these alternative plan designs, please contact your Account Manager so that we may provide the Summary of Benefits and Coverage (SBC). '*If you change benefits after your group's renewal date, the change(s) will not take effect until the first of the month following 60 calendar days after the date CommunityCare was notified of the change(s). Name: City of Sand Springs; Quote Number: C07084 Signature___________________________________ Date______________ City of Sand Springs IEDEA2019 Revised Options 2  Financial Exhibits - City of Sand Springs Effective Date: 7/1/19 Renewal Options Pharmacy Benefit $0 deductible, then $0/$15/$40/$85/$260 copay 2 x mail order Enrollment Assumptions 61 38 14 55 Indicate if Insure OK In Net-DED OON-DED Single/ Coinsurance- OV - PCP/ Indv OOP MAX - Employee + Employee + Total Monthly electing to renew Plan Name Qualified Single/ Family Family In/Out Specialist IN/Out Network Employee Only Spouse Child(ren) Family Premium with this option HMO Plans CC 80/250 CR17 Yes $250 / $500 None 80%/None $25/$50 $3,000 Select $698.89 $1,390.50 $1,065.93 $1,790.74 $208,885.01 CC 80/250 CR17 Yes $250 / $500 None 80%/None $25/$50 $3,000 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! CC 80/500 CR17 No $500 /$1,000 None 80%/None $25/$50 $4,500 Select $667.25 $1,327.56 $1,017.69 $1,709.69 $199,430.14 CC 80/500 CR17 No $500 /$1,000 None 80%/None $25/$50 $4,500 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! CC 80/1000 CR17 No $1,000 / $2,000 None 80%/None $25/$50 $5,000 Select $628.18 $1,249.81 $958.09 $1,609.56 $187,750.82 CC 80/1000 CR17 No $1,000 / $2,000 None 80%/None $25/$50 $5,000 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! CC 80/1000 (OE) CR17 Yes $1,000/$2,000 None 80%/None $20/$50 $3,000 Select $648.65 $1,290.54 $989.30 $1,662.01 $193,868.92 CC 80/1000 (OE) CR17 Yes $1,000/$2,000 None 80%/None $20/$50 $3,000 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! CC 80/1500 CR17 No $1,500 / $3,000 None 80%/None $25/$50 $6,000 Select $593.29 $1,180.39 $904.87 $1,520.16 $177,322.49 CC 80/1500 CR17 No $1,500 / $3,000 None 80%/None $25/$50 $6,000 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! CC 80/2000 CR17 No $2,000 / $4,000 None 80%/None $25/$50 $5,500 Select $572.82 $1,139.67 $873.65 $1,467.71 $171,204.63 CC 80/2000 CR17 No $2,000 / $4,000 None 80%/None $25/$50 $5,500 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! CC 80/2500 CR17 No $2,500/$5,000 None 80%/None $35/$60 $5,000 Select $554.67 $1,103.57 $845.98 $1,421.23 $165,781.90 CC 80/2500 CR17 No $2,500/$5,000 None 80%/None $35/$60 $5,000 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! CC 80/3500 CR17 No $3,500 / $7,000 None 80%/None $20/$50 $6,000 Select $518.39 $1,031.38 $790.64 $1,328.25 $154,936.94 CC 80/3500 CR17 No $3,500 / $7,000 None 80%/None $20/$50 $6,000 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! CC 80/4000 CR17 No $4,000 / $8,000 None 80%/None $20/$50 $6,200 Select $503.03 $1,000.83 $767.22 $1,288.91 $150,347.50 CC 80/4000 CR17 No $4,000 / $8,000 None 80%/None $20/$50 $6,200 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! CC 80/5000 CR17 No $5,000 / $10,000 None 80%/None $20/$50 $6,350 Select $477.45 $949.92 $728.20 $1,223.35 $142,700.46 CC 80/5000 CR17 No $5,000 / $10,000 None 80%/None $20/$50 $6,350 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! CC 70/500 CR17 No $500 / $1,000 None 70%/None $25/$50 $4,500 Select $644.46 $1,282.21 $982.92 $1,651.28 $192,617.32 CC 70/500 CR17 No $500 / $1,000 None 70%/None $25/$50 $4,500 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! CC 70/1000 CR17 No $1,000 / $2,000 None 70%/None $25/$50 $5,000 Select $608.17 $1,210.01 $927.58 $1,558.31 $181,771.92 CC 70/1000 CR17 No $1,000 / $2,000 None 70%/None $25/$50 $5,000 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! CC 70/1000 (OE) CR17 Yes $1,000/$2,000 None 70%/None $20/$50 $3,000 Select $634.69 $1,262.77 $968.02 $1,626.25 $189,697.38 CC 70/1000 (OE) CR17 Yes $1,000/$2,000 None 70%/None $20/$50 $3,000 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! CC 70/1500 CR17 No $1,500 / $3,000 None 70%/None $25/$50 $6,000 Select $573.28 $1,140.59 $874.36 $1,468.91 $171,343.59 CC 70/1500 CR17 No $1,500 / $3,000 None 70%/None $25/$50 $6,000 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! CC 70/2000 CR17 No $2,000 / $4,000 None 70%/None $25/$50 $5,500 Select $557.46 $1,109.12 $850.24 $1,428.38 $166,615.88 CC 70/2000 CR17 No $2,000 / $4,000 None 70%/None $25/$50 $5,500 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! CC 70/3500 CR17 No $3,500 / $7,000 None 70%/None $20/$50 $6,000 Select $510.01 $1,014.71 $777.86 $1,306.79 $152,433.08 CC 70/3500 CR17 No $3,500 / $7,000 None 70%/None $20/$50 $6,000 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! CC 70/4000 CR17 No $4,000 / $8,000 None 70%/None $20/$50 $6,200 Select $496.52 $987.87 $757.29 $1,272.23 $148,401.49 CC 70/4000 CR17 No $4,000 / $8,000 None 70%/None $20/$50 $6,200 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! CC 70/5000 CR17 No $5,000 / $10,000 None 70%/None $20/$50 $6,350 Select $474.66 $944.37 $723.94 $1,216.20 $141,866.48 CC 70/5000 CR17 No $5,000 / $10,000 None 70%/None $20/$50 $6,350 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! CC 100/3000 OE CR17 Yes $3,000 / $6,000 None 100% / None $20/$50 $3,000 Select $592.35 $1,178.54 $903.45 $1,517.78 $177,044.07 CC 100/3000 OE CR17 Yes $3,000 / $6,000 None 100% / None $20/$50 $3,000 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! For benefit details, please consult your broker or visit the broker web page at: http://www.ccok.com/Brokers/benefit-plans.asp *If you are interested in these alternative plan designs, please contact your Account Manager so that we may provide the Summary of Benefits and Coverage (SBC). '*If you change benefits after your group's renewal date, the change(s) will not take effect until the first of the month following 60 calendar days after the date CommunityCare was notified of the change(s). City of Sand Springs IEDEA2019 Revised Options 3  Name: City of Sand Springs; Quote Number: C07084 City of Sand Springs IEDEA2019 Revised Options 4  Financial Exhibits - City of Sand Springs Effective Date: 7/1/19 Renewal Options Pharmacy Benefit $0 deductible, then $0/$15/$40/$85/$260 copay 2 x mail order Enrollment Assumptions 61 38 14 55 Indicate if Insure OK In Net-DED OON-DED Single/ Coinsurance- OV - PCP/ Indv OOP MAX - Employee + Employee + Total Monthly electing to renew Plan Name Qualified Single/ Family Family In/Out Specialist IN/Out Network Employee Only Spouse Child(ren) Family Premium with this option HMO Plans CC 80/500 No $500/$1,000 None 80%/None $25/$35 $4,500 Select $677.95 $1,348.85 $1,034.01 $1,737.10 $202,627.89 CC 80/500 No $500/$1,000 None 80%/None $25/$35 $4,500 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! CC 80/1000 (OE) Yes $1,000/$2,000 None 80%/None $20/$35 $3,000 Select $667.25 $1,327.56 $1,017.69 $1,709.69 $199,430.14 CC 80/1000 (OE) Yes $1,000/$2,000 None 80%/None $20/$35 $3,000 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! CC 80/1000 No $1,000/$2,000 None 80%/None $25/$35 $5,000 Select $650.51 $1,294.24 $992.14 $1,666.78 $194,425.09 CC 80/1000 No $1,000/$2,000 None 80%/None $25/$35 $5,000 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! CC 80/1500 No $1,500/$3,000 None 80%/None $25/$35 $6,000 Select $624.92 $1,243.33 $953.12 $1,601.22 $186,777.44 CC 80/1500 No $1,500/$3,000 None 80%/None $25/$35 $6,000 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! CC 80/2000 No $2,000/$4,000 None 80%/None $25/$35 $5,500 Select $611.43 $1,216.49 $932.54 $1,566.65 $182,745.16 CC 80/2000 No $2,000/$4,000 None 80%/None $25/$35 $5,500 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! CC 70/500 No $500/$1,000 None 70%/None $25/$35 $4,500 Select $655.62 $1,304.42 $999.95 $1,679.89 $195,954.03 CC 70/500 No $500/$1,000 None 70%/None $25/$35 $4,500 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! CC 70/1000 (OE) Yes $1,000/$2,000 None 70%/None $20/$35 $3,000 Select $653.76 $1,300.72 $997.11 $1,675.12 $195,397.86 CC 70/1000 (OE) Yes $1,000/$2,000 None 70%/None $20/$35 $3,000 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! CC 70/1000 No $1,000/$2,000 None 70%/None $25/$35 $5,000 Select $630.50 $1,254.44 $961.63 $1,615.52 $188,445.64 CC 70/1000 No $1,000/$2,000 None 70%/None $25/$35 $5,000 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! CC 70/1500 No $1,500/$3,000 None 70%/None $25/$35 $6,000 Select $605.38 $1,204.46 $923.32 $1,551.15 $180,937.39 CC 70/1500 No $1,500/$3,000 None 70%/None $25/$35 $6,000 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! CC 70/2000 No $2,000/$4,000 None 70%/None $25/$35 $5,500 Select $595.61 $1,185.02 $908.42 $1,526.12 $178,017.45 CC 70/2000 No $2,000/$4,000 None 70%/None $25/$35 $5,500 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! CC 80/2500B No $2,500/$5,000 None 80%/None $20/$35 $5,500 Select $597.47 $1,188.72 $911.26 $1,530.89 $178,573.62 CC 80/2500B No $2,500/$5,000 None 80%/None $20/$35 $5,500 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! CC 80/3500 No $3,500 / $7,000 None 80%/None $20/$35 $6,000 Select $571.42 $1,136.89 $871.52 $1,464.14 $170,787.42 CC 80/3500 No $3,500 / $7,000 None 80%/None $20/$35 $6,000 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! CC 80/4000 No $4,000 / $8,000 None 80%/None $20/$35 $6,200 Select $560.26 $1,114.68 $854.49 $1,435.53 $167,450.71 CC 80/4000 No $4,000 / $8,000 None 80%/None $20/$35 $6,200 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! CC 80/5000 No $5,000 / $10,000 None 80%/None $20/$35 $6,350 Select $542.58 $1,079.51 $827.53 $1,390.23 $162,166.83 CC 80/5000 No $5,000 / $10,000 None 80%/None $20/$35 $6,350 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! CC 70/3500 No $3,500 / $7,000 None 70%/None $20/$35 $6,000 Select $563.05 $1,120.23 $858.75 $1,442.68 $168,284.69 CC 70/3500 No $3,500 / $7,000 None 70%/None $20/$35 $6,000 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! CC 70/4000 No $4,000 / $8,000 None 70%/None $20/$35 $6,200 Select $553.74 $1,101.72 $844.56 $1,418.84 $165,503.54 CC 70/4000 No $4,000 / $8,000 None 70%/None $20/$35 $6,200 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! CC 70/5000 No $5,000 / $10,000 None 70%/None $20/$35 $6,350 Select $539.79 $1,073.95 $823.27 $1,383.08 $161,332.47 CC 70/5000 No $5,000 / $10,000 None 70%/None $20/$35 $6,350 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! CC 100/3000 (OE) Yes $3,000/$6,000 None 100%/None $20/$35 $3,000 Select $637.95 $1,269.25 $972.99 $1,634.59 $190,670.76 CC 100/3000 (OE) Yes $3,000/$6,000 None 100%/None $20/$35 $3,000 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! CC 80/6850 No $6,850 None 80%/None $25/$35 $6,850 Select $512.34 $1,019.34 $781.41 $1,312.75 $153,128.65 CC 80/6850 No $6,850 None 80%/None $25/$35 $6,850 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! CC 100/6600 No $6,600 None 100% / None $35 (1st 3) $6,600 Select $482.57 $960.11 $736.00 $1,236.47 $144,230.80 CC 100/6600 No $6,600 None 100% / None $35 (1st 3) $6,600 Standard #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! For benefit details, please consult your broker or visit the broker web page at: http://www.ccok.com/Brokers/benefit-plans.asp '*If you change benefits after your group's renewal date, the change(s) will not take effect until the first of the month following 60 calendar days after the date CommunityCare was notified of the change(s). '*If you are interested in these alternative plan designs, please contact your Account Manager so that we may provide the Summary of Benefits and Coverage (SBC). Name: City of Sand Springs; Quote Number: C07084 City of Sand Springs IEDEA2019 Revised Options 5 M4A