R2022-172 Resolution Authorizing Agreement with BlueCross BlueShield of Illinois for Administration of the City Group Health Benefit Plan for Calendar Year 2023

Home Browse Search

0(�'�.. UlucCross BlueShield iii � Of Illinois City Of Decatur ASO Projection January 1,2023'December 31,2023 1/112023 ASO Medical Renewal CONDITIONS AND CAVEATS Notwithstanding anything in the renewal or proposal to the contrary,BCBSIL reserves the light to revise or withdraw any term herein or to change our charge for the cost of coverage(premium, fees or other amounts)at any time before or during the contract period if any local,state or federal legislation,regulation,rule or guidance(or amendment or clarification thereto)is enacted or becomes effectivefimplemented,which would require BCBSIL to pay,submit or forward,on Its own behalf or on the Employer Group's behalf,any additional tax,surcharge,fee,or other amount(all of which may be estimated,allocated or prorated amounts).BCBSIL also reserves the right to change the administrative fees it charges the Employer Group at any time before or during the contract period to the extent that any local,state or federal legislation,regulation,rule or guidance(or amendments or clarifications thereto)is enacted or becomes effectivelimplemented which results in increased projected claim costs or an Increase to BCBSIL's expenses or cost of plan administration. Unless otherwise stated,this renewal offer is made on the assumption the benefit program is for a plan that is not considered a"grandfathered health plans"as defined under the Affordable Care Ad and related regulations.If you have questions about grandfathered health plans,please consult your legal counsel. The total annual Stop Loss premiums and ACV factors are based upon the total projected enrollment and contract distribution as indicated on this exhibit. Significant changes in the above stated enrollment and contract distribution will require a review and adjustment of the fees and factors. This renewal is being provided for the period indicated above. This renewal offer expires as of the effective date indicated above. This renewal offer assumes HCSC will remain the exclusive carrier for Medical and Rx coverage. Upon inquiry from employer groups,BCBS will provide Information to the employer group regarding commissions and other compensation paid to the employer's agent by SCBS in connection with the employees policy or contract with BCBS. The Individual Stop Loss quote is being offered on a Paid basis during the policy period indicated above. The Aggregate Stop Loss quote Is being offered on a Paid basis during the policy period Indicated above. Paid Claims subject to Individual Stop Loss are paid claims from the following line(s)of coverage:Medical,Drug,Illinois Access Fee s Paid Claims subject to Aggregate Stop Loss are paid claims from the following line(s)of coverage:Medical,Drug,Illinois Access Fee HCSC reserves the right to adjust the Aggregate Claim Liability if one or more of the following occurs within the coverage period: -the Account's composition changes(i.e.demographics) -the Account's number of covered employees increases or decreases by more than 10% -the Account's benefit program changes The Minimum Aggregate Point of Attachment was calculated as 90%of the Aggregate Claim Liability per contract per month multiplied by the projected cumulative contracts for the period. Aggregate Stop Loss premium is payable annually and is due by the first day of Me policy period. Individual Stop Loss premiums are payable on the first day of each month. Any amount in excess of the Individual Stop Loss deductible will not be included in the Aggregate Stop Loss Settlement. HCSC's pharmacy benefit manager,PRIME Therapeutics(PBM),holds rebate contracts with pharmaceutical manufacturers.Unless otherwise agreed by the parties,HCSC may,in some circumstances,provide the Employer with a Rebate Credit,but such Rebate Credit may not equal the entire amount of the rebates provided to HCSC by the PBM. Employers that do not use Prime Therapeutics as their pharmacy benefit manager are NOT eligible for a Rebate Credit under the pharmacy benefit. HCSC's current esfimate of the rebates it will receive from the PBM,for drugs covered under the pharmacy benefit,for the employer's covered members,is approximately$43.96 per script. The PEPM Medical Rebate Credit is subject to change as HCSC will review the PEPM credit offer for each subsequent renewal. Slue Crass and Slue Shield of IL,a Diwlan of Health Care Service Cwixxiegon,a Mul-I Legal Reserve Cmilie y,an Independent Limemi efthe axis Cron aM Slue Shield Amdafi n nmplany as cvAtlw/HomaM a BCaeL wa suuiss ecass,e.aertr.u+mrsai+aama .anv.+...ie naep,ry,werr.mq rrM rrMa„ewn+.wn a e W 8L