ORD 1990-10 - Employee Medical Benefit Plan 07-03-1990ORDINANCE NO. 90 -10
AN ORDINANCE OF THE CITY COUNCIL OF THE CITY OF
HUNTSVILLE, TEXAS, AMENDING THE EMPLOYEE MEDICAL
BENEFIT PLAN BY INCREASING DEDUCTIBLES, INCREASING
LEVELS OF COINSURANCE, REDUCING MAXIMUM BENEFITS FOR
CERTAIN COVERAGES, INCREASING CONTRIBUTION LEVELS, AND
MAKING OTHER PROVISIONS AND FUNDING RELATED THERETO.
BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF HUNTSVILLE, TEXAS, THAT
SECTION 1. The Employee Medical Benefit Plan for the City of Huntsville,
Texas, is amended by amending Schedule of Benefits "A" as follows:
I. Deductible
Deductible Requirement - A deductible consisting of the first $300
of Covered Expenses incurred by a Covered Person during a calendar
year (January 1 through December 31) will be applied before any
benefit is payable, except that this requirement will not apply to
expenses in connection with the first to occur of all accidents
sustained by any one Covered Person during any single period of
twelve (12) consecutive months.
The calendar year deductible will apply to each Covered Person,
except that not more than three (3) individual deductibles will be
applied against Covered Expenses of any one family which are
incurred during the same calendar year.
Deductible Carry -over
The amount of any Covered Expenses incurred during the final three
(3) months of a calendar year which applied to the satisfaction of
the deductible for that year shall also apply toward the
deductible for the following year.
Common Accident
If a participant and one or more of his Covered Dependents incur
Covered Expenses as a result of injuries received in the same
accident, all Covered Expenses resulting from such accident and
incurred during the same calendar year will be subject to no more
than one calendar year deductible for such Participant and his
Covered Dependents. This provision will not affect the deductible
requirement for any other Covered Expenses.
Hospital Admission
In addition to the other deductibles provided for by this plan, a
deductible equal to one (1) day semi-private room rate of the
hospital entered will be applied to each hospital admission of a
Covered Person before any benefit is payable for Covered Expenses
from the hospital admission.
SECTION 2: The Employee Medical Benefit Plan for the City of Huntsville,
Texas, is amended by amending Schedule of Benefits "A" by amending
Section II to read as follows:
II. Coinsurance (not applicable to mental disorders, alcoholism
or drug dependency - see "Covered Expenses")
A. After satisfaction of the deductible requirement explained
above, the Plan will pay 80% of the next $5,000 of all Covered
Expenses incurred during a calendar year by a Covered Person, then
90% of the next $2,500 in Covered Expenses incurred, and then
100%* of Covered Expenses incurred by a Covered Person during the
remainder of that calendar year, subject to Section IV. Maximum
Benefits.
* 80% in the event of Covered Expenses for which any other plan,
as defined in Section 6.04, provides payment at the rate of 20% or
more.
B. After satisfaction of the deductible requirement, the Plan
will pay 90% of covered expenses consisting of charges made by a
Physician, Hospital or Free Standing Surgical Facility in
connection with outpatient surgery.
SECTION 3: The Employee Medical Benefit Plan for the City of Huntsville,
Texas, is amended by amending Schedule of Benefits "A" by amending
Section III to read as follows:
III. Coverage at 100%
The Plan will pay for 100% of Covered Expenses for:
A. the first $300 of charges incurred within a period of
seventy-two (72) hours of the time an accident occurs, in
connection with accidental bodily injuries sustained by a Covered
Person as a result of such accident.
This benefit will apply only once to all accidents sustained in
any single period of twelve (12) consecutive months.
B. 100% of up to $100 per Covered Person per calendar year as
Wellness care.
SECTION 4: The Employee Medical Benefit Plan for the City of Huntsville,
Texas, is amended by amending Schedule of Benefits "A" by amending
Section IV to read as follows:
IV. MAXIMUM BENEFITS
The maximum amounts of benefits for charges incurred on account of
sickness and /or injury of any one Covered Person are as follows:
For all sicknesses and injuries combined - maximum lifetime
$1,000,000.
For mental disorders - maximum lifetime of $10,000.
For alcoholism and /or drug dependency, separately or combined:
Inpatient - Maximum Lifetime $10,000
Outpatient- Maximum Per Calendar Year $1,200
Outpatient- Maximum Lifetime $2,400
For chiropractic care (not including x -rays) - maximum per
calendar year $750.
SECTION 5: The rates to be charged for the Plan are:
Employee Medical
Employee Dental
Dependent Medical
Dependent Dental
$100.18
$13.76
$113.94
$179.76
$12.24
$192.00
SECTION 6: All the changes made by this Ordinance shall take effect July 1,
1990, except, however, that the increase in deductible from $200
to $300 provided for by Section I shall take effect on January 1,
1991.
PASSED AND APPROVED this (day of
APPRO ED AS 0 ORM:
Sco t Bo nds, City Attorney
1990.
CITY OF C UNTSVILLE, TEXAS
By
JANE, 'INDAY, AYOR