R2013-21 AUTHORIZING CITY MANAGER TO EXECUTE COLLECTIVE BARGAINING AGREEMENT

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Wellness benefit of $250 per covered family member. The Wellness Benefit is available to each participating member of your family and can be used for annual physicals, well baby care checkups, and school physicals. Immunizations(such as flu shots and immunizations for babies)are not eligible expenses under this benefit. There is no deductible or co-pay for this Wellness Benefit. Health credits can be earned by each covered family member. Each year, you and/or your covered family members can earn one, two, three or four health credits toward your annual deductible by: (1) Abstaining from tobacco products; (2) having blood pressure in the American Heart Association recommended acceptable range; (3) keeping cholesterol in the American Heart Association recommended acceptable range; and (4) having height/weight ratio appropriate for age, sex and body frame. To receive credit(s), your physician must certify that the criteria have been met. A separate certificate must be submitted to Blue Cross for each family member seeking credit(s). Attached is the certificate form. Additional forms are available on the City's Intranet under "FORM" or from Risk Management. Disease management program. Participants with specific diseases will be provided information and suggestions to help them become better managers of their medical situations. 3-tier drug program. The Blue Cross Formulary/preferred drug list will be used to determine the level of prescription drug benefit. Your co-pay will be: 1. GENERIC (medications approved by USFDA that are as safe and effective as brand-name drugs, but that cost less) Maximum$10 2. FORMULARY OR PREFERRED(brand-name prescriptions on the formulary list) Maximum$20 3. NON-FORMULARY(brand-name prescriptions not on the formulary List) Maximum$50. There is no deductible. The amount you pay will not be applied to your annual out-of-pocket maximum. There is no coordination of benefits with other insurance companies. Only you and your doctor can make decisions about your health care. Ask your doctor which generics or brand-name drugs might be right for you. Smoking cessation prescription drug benefit. Expenses not covered: A charge for prescription drugs, such as nicotine gum or smoking deterrent patches. Expenses covered: A twelve (12) week program using the smoking cessation drug, Chantix, is covered at a 60% benefit amount, not subject to deductible, with an annual maximum benefit of $375. This may be obtained by presenting your medical identification card at the pharmacy. If you successfully complete the program and stop smoking, you are entitled to one health credit. Morbid obesity weight management. Morbid Obesity is a diagnosed condition in which the body weight exceeds the medically recommended weight by either 100 pounds or is twice the medically recommended weight for a person of the same height, age, and mobility as the Covered Person. Prescribed dietary supplements will be covered under this diagnosis subject to deductible and an 80% medical benefit. For procedures such as gastric bypass surgery, bariatric or lap banding, approval under the medical plan may be authorized after two doctor supervised weight management programs within one (1) year have failed to achieve the desired weight goal. Consideration of either surgery can be authorized once every five(5)years. Weight management program. Expenses not covered: Fitness center fees and non-prescribed dietary products. This program does not apply to individuals who are medically classified as morbidly obese. Expenses covered: To qualify for participation in this program, you must be overweight as determined by a medical doctor, and the program you are enrolled in must be doctor supervised. The physician will be required to provide Blue Cross with your plan regimen, the length of time you are expected to be on the plan and monthly progress reports. For programs offered by your family physician, benefits will be allowed for the office visit, labs, and any prescribed dietary supplements. The weight loss program offered at Decatur Memorial Hospital is also covered under the Plan, and either program is allowable at an 80% benefit amount, not subject to deductible. You must complete the program, and when successful at weight management, you will be entitled to one health credit. If you terminate the program, you may not re-enroll for two(2)calendar years. Enrollment Changes. Changes in enrollment, except for COBRA qualifying events, will only be permitted on a two (2) year cycle, at renewal time. The Plan Selection Period is in December of the odd-numbered year, effective the following January 1. 41