CCR1985029.
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0 RESOLUTION #29-85
AUTHORIZING EXECUTION OF HEALTH INSURANCE
AGREEMENTS FOR 1985
(Blue Cross/Blue Shield, Compcare and Maxicare)
WHEREAS, the City of Muskego currently provides several health
Shield, Compcare and Maxicare, and
insurance plans for the employees, including Blue Cross/Blue
WHEREAS, the Finance Committee has reviewed the 1985 Agreements
and has recommended approval as follows:
Associated Hospital Service, Inc. (renewal of existing
Single Coverage - $87.97 Family Coverage - $237.72
Associated Hospital Service, Inc. (COMPCARE Benefits)
Under 5 Contracts:
Single Coverage - $90.41 Family Coverage - $234.52
Over 5 Contracts:
Single Coverage - $82.19 Family Coverage - $213.20
Maxicare Health Insurance Company Single Coverage - $80.00 Family Coverage - $213.35
THEREFORE, BE IT RESOLVED that the Common Council of the City of
Muskego, upon the recommendation of the Finance Committee, does
hereby authorize the Mayor and Clerk to execute the necessary
Agreements with the above insurance carriers.
Blue Cross/Blue Shield Plan)
DATED THIS /arJ DAY OF F~lnMa- , 1985.
E COMMITTEE
A
#GJ
Ald. Ralph Tomczyk
ATTEST :
City Clerk
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0 GROUP ENROLLMENTAGREEMENT
benefltm of the Cornmare Health Plan to the alioible erndovees of Citv of ?luskexo Cornpcere Health SONICO~ Insurance Corporatlon. herein called “Cornpcare,” hereby egrws to provide the - ..
, herein called “Group,”
according to the terms and condltlons of thir Agreement as set forth below.
the following month‘s coverage together with such data as may be necessary for the administration of this Agreement. 1. The Group agrees to remit subscription fees to Compcare on or before the twentieth 17.Othl day of each month for
shall be guaranteed from the effective date of this Agreement until the 2. Subscription fee rates shall be those set forth in Attachment A for the applicable wrvica areafsl. Such rates
and thereefier shall be changed from time to time as deemed necessary or appropriate by Compcare.
28 day of Februarv ,19 86,
3. The sBrvica areafsl to which this Agreement applies is fare) checked below:
Appleton -
Eau Claire
Other Areafsl
Lacrosse -
Madison -
Milwaukee x
Racine -
. Sheboygan -
-
Compcare shall make available to Group employees any and all health care providers affiliated with the Compcare Health
Plan in the designated service arealsl. subject to the terms and conditions of the Compcare Health Plan.
time employee of the employer (other than a seasonal or temporary employee) who is: fa) actively performing the
4. An employee shall be eligible for coverage hereunder provided he or she is a regular full-time or permanent pan-
dutiea of hs or her principal occupation for a minimum of 30 hours a week. and; fbl eligible for all fringe benefits
applicable to the class of employees to which he or she belongs.
5. Coverage hereunder shall become effective for employees enrolled during an open enrollment period on a date
mutually agreed to in writing by the Group and Compare. Employees shall not be allowed to enroll in the Compare
Health Plan in between open enrollment periods except as othemise provided by the Compcare undemriting
regulations. Coverage for employees enrolled in between open enrollment periods shall take effect on the date authorized in writing to the Group by Compare’s home office.
conveyed to the Group prior to the effective date of coverage. 6. Coverage hereunder may be subject to a minimum enrollment requirement which, if applicable. shall be
7. Upon the termination of employment of an employee covered by the Compcare Health Plan. the Group shall
8. This Agreement shall remain in effect until it or portions thereof are amended or terminated pursuant to the rights
9. The provisions of the Agreement shall be subject to the terms and conditions of the Group Master Contract or
10. Thm Agreement shall take effect on the I day of March .19 85.
comply with provisions of the Group Master Contract and state law relating to continuation of group coverage.
) of either party to do so upon thirty 130) days advance written notice.
1 i Certificstesand Amendment, if any, in effect for the Group.
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COMPCARE HEALTH SERVICES
INSURANCE CORPORATION
City of Muskego
Grcup Name
Authorized Official (Print) Tide
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XAXICARE HEALTH INSURANCE COXPANY
(Hereinafter called
733 NORTH VAN BUREN
UILWAUKEE, WISCONSIN 53202
APPLICATION iu hereby made to lIAX by the Applicant, named below,
for the purpose of making available to eligible individuals
under subscription certificates insued by HAX certain medical,
hospital and surgical services and benefits. The arrangement of
the provision of such services and benefits shall be the subject
of a Contract between MAX and the Applicant and shall be based
on the statementu and representation8 contained in this
Application, a copy of which shall be attached to and made a
part of the Contract.
1. Applicant:
"-CifY-Qf"uskeso_""""""""""""""
Address: """""""""""""""""-"""""" Box 25
city: State: WISCONSIN 53150 _""" """""""" Muskego
2. The Contract shall be effective 12:Ol A.H. on -,
19L.
3. Classes of Persons to be covered under Subscription
TO THE RULES OF MAXICARE AND SAID EMPLOYER GROUP-
Certificates: ALL ELIGIBLE EMPLOYEES ACCORDING
4. Coverage for ?amily Dependents is /x / is not / / to be
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provided.
0
5- Rul08 Of Eligibility: ~ll eligible employees according to
the rules of Maxicare and the City of Muskego. Covered to the
month the marry or to the birthdate of a e 19. 6. Depen 5 ents vho aro fulltime students 8 3 all be oligibla
until age 25 .(to the birthdate of age 25 if fulltime
student or IRS dependent)
7. Copaymente or Limitations Applicable:
Outpatient Mental Health: NO. of Visit8 20
Copayment NONE
.Inpatient Mental Health: NO. Of Day8 70
Other
In-Area Emergency Copayment SNoNE
Outpatient Prescription Drugs $-cription. 30
day supply max. MUS^ be filled at a participating
pharmacy. Deductible
NONE """""""""""
Other """""""""----- _""""""""""""
!. i~ 8. Honthly Premium:
Holder Group Subscriber Total ! -_-S~~E--,----,----,,, 0 """""""""""""- """" $80.00
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0 _"""""""""""" "_"""""""""""" """"
FAMILY $213.35 _"""""""""""" "_"""""""""""" """"
HOLDER CROUP
Date: ""-""""""""" """"_""""""""" City of Muskego
Place: By : """"""""""_ """""_""""""""
Title: """""_""""""""
Medicare Rates :
1 Party over 65 = $48.78
2 Parties over 65 = $97.56
1 Party over 65 + 1 Party under 65 = $128.78
2 Parties over 65 + 1 or more under 65 = $150.91
1 Party over 65 + 2 or more under 65 = $182.13