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REQUEST FOR CITY COUNCIL AGENDA ITEM <br />Budget <br />Agenda Date Requested:December 9, 2013 <br />Source of Funds: <br />Requested By:Allison Curry, HR Manager <br />Account Number: <br />Department:Administration <br />Amount Budgeted: <br />Report: Resolution: Ordinance: <br />Amount Requested: <br />Exhibits:PPACA Mandates Out-of-Pocket MaxChanges <br />Budgeted Item:YESNO <br />Exhibits: <br />Exhibits <br />SUMMARY & RECOMMENDATION <br />The Patient Protection and Affordable Care Act (PPACA)mandates that plans cannot have a <br />combined medical and RX out-of-pocket maximum greater than $6,300 (Individual) or $12,700 <br />(Family) starting January 1, 2014.These limits only apply to In-Network; there are no limits for <br />Non-Network.Plans that have a separate RX administrator can invoke a “Safe Harbor” for 2014 <br />and not have the RX count towards the overall maximum.Since AETNA uses Caremark to <br />administer their RX program, the City is able to invoke the Safe Harbor for the PPO500 plan. <br />(The Health Fund plans already credit the out-of-pocket maximum for any RX copay) <br />In order to be compliant with PPACA, the City must make the below changes to the plans. <br />must <br />PPO500-In-Network Deductibles and copays start counting towards In-Network <br />Out-of-Pocket Maximums <br />HF1500-The Family Out-of-Pocket maximum of $13,500 exceeds the $12,700 allowable <br />under PPACA. Therefore, the City must lower the individual out-of-pocket max from <br />$4,500 to $4,200, and make the Family out-of-pocket max three (3) times the Individual <br />max from $13,500 to $12,600. <br />Additionally, staff recommends invoking the “Safe Harbor”provision for the PPO500to prevent <br />RX copays fromaccumulating towards the Out-of-Pocket maximum for 2014 only (will have to <br />change going forward in 2015). <br />All changes proposed either maintain benefits at current levels or represent a greater benefit to <br />the employees and retirees. There are no decreasesin benefits.The Chapter 172 Board met and <br />recommended adoption of these changes. <br />Action Required by Council: <br />Consider approval or other action of changes mandated by PPACA: <br />Invoking the “Safe Harbor” provision for the PPO500 and <br />Loweringthe individual out-of-pocket maximum from $4,500 to $4,200, and the Family <br />out-of-pocket maximum from $13, 500 to $12,600 on the Health Fund 1500 plan. <br />Approved for City Council Agenda <br />CorbyD.Alexander, City Manager Date <br /> <br />