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®. ~ • <br />~'~.$~~,•y~y}' ~ ~ ~ ~ (713).621-0822 <br />Y Y • <br />O ~ ~~~ ~~~e~~~~~ <br />~~ <br />P. O. BOX 27246 HOUSTON, TEXAS 71027 <br />CITY OF I,A PORTE • <br />P1ara I Com~elion.sivc Aiaio: MEdica.lt; ' <br />A: ter $100 calendax yaaac deductibles progaarn would pay 80~ of <br />next $Ss000 and 100 oS balances in yeax up to a lifetime maxi3aum <br />of $2S0°000. Deductible waivEd for expen.~c: due to accident. <br />Only internal limit is on hosgit<a.l room 'and board which is s®t at <br />average semi-private of aorfin3ng hospital. <br />~ Plan z2 Comprehensive Y~iajor I4edic~.1: <br />Same as Plate I° but with deductible r~1so waived on hospital <br />and surg3.cal c~xponses and first $1s00U of hospital expense paid <br />in full. <br />® tions~ ~ . <br />A. Blanket l~iaternity Covar.~ge - 4 S00 paid in full for normal <br />eliildb~.rth, $10000 for Caesarean or Ectogic, $250 for mis- <br />carrimgo, <br />B. I;edical fieimbursemezat Prog:caru -where City of I,a Porte would <br />°s out of pocket cost under oontract up to a <br />share claLmant <br />~/ <br />ma)C'1..1num of $554 Per Y~• <br />C. 2Yiird Party Administration -wher® City of I~~Porte would <br />contract ,out clains verifications filing with insurance <br />carrier and checkigg. <br />COST COMPARISON <br />BC~BS ~ ANICO-I ANICO-II <br />F~aployee $ 22.90 <br />F~~ployee and Ore Dagondent ~ $ 5'x•51 <br />. <br />Rnployee and All D3pc~ndents $ 63.18 , <br />Sponsored Doper.dent $ 12.91 <br />Emgloyee ~- • 17.20 $ 21. ;0 <br />1-0raployee and Dopendentl-a. s~p,,$ 45.55 <br />8 <br />6 <br />2 $ . S6.9S <br />570 <br />95 <br />$3 <br />5 <br />5 <br />. <br />.Total Monthly Cost (on pre.sont census) $30853.6? $z° . <br />0 <br />t~dnSP <br />Blantcet Maternity - $3.50 gsr dependent -.Total Monthly <br />$ 175.5' <br />I~iedical Reimbursement -`B3sed.on last yoar°s losses and <br />O loaded 12~ for in.~'l.atioz~ - P4onthly $ 352.00 <br />Third k'a~•ty Administration -Monthly $ 200.00 <br />F~:ample - ANICO I plus all op-cions -Total Monthly Cast $3 r 595.'75 <br />• <br />_ __ . _ _ .. _ _ _ - _._.x_ _ _.~__.__..__ ... <br />