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09-25-2017 - Regular 1 City of Edgewater 104 N.Riverside Drive Edgewater,FL 32132 Ciyof EDGEWATER Meeting Minutes City Council Michael Ignasiak,Mayor Christine Power,District 1 Amy Vogt,District 2 Dan Blau,District 3 Gary T.Conroy,District 4 Rlondas.September 25,2017 6:00 PM Council ('hanibers 1. CALL TO ORDER, ROLL CALL,PLEDGE OF ALLEGIANCE, INVOCATION Present: 5- Mayor Mike Ignasiak,Councilwoman Christine Power,Councilwoman Amy Vogt, Councilman Dan Blazi,and Councilman Gary Conroy Also Present: 3- City Manager Tracey Barlow,City Clerk/Paralegal Robin Matusick,and City Attorney Aaron Wolfe 2. APPROVAL OF MINUTES a. AR-2017-2885 Minutes of the September 18,2017 Council Meeting A motion was made by Councilman Blazi, second by Councilman Conroy, to approve Minutes from the September 18, 2017 Council Meeting. The MOTION was APPROVED by the following vote: Yes: 5- Mayor Ignasiak,Councilwoman Power,Councilwoman Vogt,Councilman Blazi and Councilman Conroy 3. PRESENTATIONSIPROCLAMATIONS/PLAQUES/CERTIFICATESIDONATIONS a. AR-2017-2857 Proclamation for Manufacturing Month during the month of October 2017 This Presentation was read into the record. 3.a. Proclamations Presented Outside Chambers None at this time. 4. CITIZEN COMMENTS Michael Visconti, 316 Pine Breeze Drive: Would like to see a monument built to represent the history of Edgewater. William Dailey, 1680 Needle Palm Drive: Spoke about disagreeing with the proposed change in health care benefits. Tim Web, address restricted: Spoke about how important the current health care benefits are for Edgewater employees. City of Edgewater Page 1 Printed on 10/5/2017 City Council Meeting Minutes September 25, 2017 Arthur Slack, 3031 Umbrella Tree Drive: Suggests that the city find a better way to secure street signs. Miles Lawler, address restricted:Spoke about disagreeing with the proposed health care change. Eric Rainbird, 2225 Fern Palm Drive: Suggests that the city find another way to save money other than taking away health care benefits. David Woods, 248 Navigators Way:Asked for an update on the hurricane debris cleanup. Michael M, 346 Admiralty Ct:Asked for more information in regards to the proposed tax increase. David Carter, 126 E Yelkca Terr: Spoke about the lump sum cost plan for stormwater and solid waste. Sharron Bigger, 2709 Juniper Drive:Asked how the residents were notified of proposed tax increase. Arthur Slack, 3031 Umbrella Tree Drive: Suggested adding important upcoming information into the Pennysaver. Don Garner, 2703 Tamarind Drive: Asked if he had the chance to speak again before motion is made. Alice Haldeman, 930 Lake Ave: Announced that she finds out about upcoming events by coming to the Council Meetings and suggests that her fellow residents do the same. 5. APPROVAL OR CHANGES/MODIFICATIONS TO THE AGENDA City Manager Tracey Barlow requested to remove items IOe and 10f 6. CITY COUNCIL REPORTS Mayor Ignasiak reported: Visiting Indian River and Edgewater Elementary schools after Hurricane Irma. After speaking with both principals he was informed that both schools only had minor damage and are now both fully operational. He also visited the YMCA and reported minor damage to the roof but they are now back open and fully up and running. Councilwoman Power reported: Her daughter attends a local high school and the school still does not have working A/C. Councilwoman Vogt:Nothing at this time. Councilman Blazi reported: That he will be looking into different street signs that will be more wind resistant. Also suggested looking into the Hometown News Journal and robo calls to better City of Edgewater Page 2 Printed on 10/5/2017 City Council Meeting Minutes September 25, 2017 communicate with Edgewater resisdents. Councilman Blazi discussed the upcoming change in insurance packages and wants to make sure that the city is dotting every i and crossing every t when it comes to paperwork and requirements. He also asked that the city keep lines of information and communication open when it comes to the upcoming change in health care benefits. Councilman Conroy reported: That he is not happy with the insurance changes. Conroy believes that it will be hard for the city to hire or retain quality employees with the change in health care benefits and thinks that the health care increase is doable. He thinks that the council should make time to come and sit down with different Edgewater employees to learn more about how the city runs on a day to day basis. Believes the city has spent too much on consultants throughout the year and wants the City Council to be more involved by hosting more workshops to better educate themselves on these types of occurances. After Councilman Conroy's report and his discusion on possible insurance changes, City Manager requested of Mayor if the consensus from the last meeting on insurance was the same. Mayor stated he wanted it to remain the same Motion by Councilman Conroy with second by Councilwoman Vogt to keep insurance as is. Motion failed by the following vote: Yes: 2- Councilwoman Vogt and Councilman Conroy No: 3- Mayor Ignasiak.Councilwoman Power and Councilman Blazi 7. CONSENT AGENDA A motion was made by Councilwoman Vogt, second by Councilwoman Power, to approve the Consent Agenda.The MOTION was APPROVED by the following vote: Yes: 5- Mayor Ignasiak,Councilwoman Power,Councilwoman Vogt.Councilman Blazi and Councilman Conroy a. AR-2017-2882 Vacant Land Contract for purchase of property located at 504 Eaton Road (Parcel #8402-43-00-0610) b. AR-2017-2883 Lines of Coverage Insurance for FY 2018 8. PUBLIC HEARINGS,ORDINANCES AND RESOLUTIONS a. 2017-0-36 2nd Reading - Ordinance No. 2017 -0-36: Amending Article IIl of the Land Development Code. City Attorney Wolfe read Ordinance No. 2017-0-36 into the record. City Manager Barlow made a staff presentation. Mayor Ignasiak opened and closed the public hearing. A motion was made by Councilwoman Power, second by Councilman Blazi, to approve Cite of Edgewater Page 3 Printed on 10/5/2017 City Council Meeting Minutes September 25,2017 Ordinance No.2017-0-36. The MOTION was APPROVED by the following vote: Yes: 5- Mayor Ignasiak,Councilwoman Power,Councilwoman Vogt.Councilman Blazi and Councilman Conroy b. 2017-R-35 Resolution 2017-R-35 Approving the Local Agency Program (LAP) Agreement FPN #435487-1-58/68-01 between the City and Florida Department of Transportation (FDOT) to facilitate construction of the project "Flagler Avenue Sidewalk from 12th Street to Park Avenue" City Attorney Wolfe read Resolution No. 2017-R-35 into the record. City Manager Barlow made a staff presentation. Don Garner, 2703 Tamarind Drive: Suggested this project be put off due to the financial restraints the city is under. Alice Haldeman, 930 Lake Ave: Discussed how happy she is to see the city move forward with this project. Councilman Blazi:Asked what the out of pocket cost is for the project. Mayor Ignasiak opened and closed the public hearing. A motion was made by Councilwoman Power, second by Councilwoman Vogt, to approve Resolution No.2017-R-35. The MOTION was APPROVED by the following vote: Yes: 3- Mayor Ignasiak,Councilwoman Power and Councilwoman Vogt No: 2- Councilman Blazi and Councilman Conroy c. 2017-R-39 Resolution No. 2017-R-39 - Repealing Resolution No. 2016-R-41 (Non-Ad Valorem Special Assessments) City Attorney Wolfe read Resolution No. 2017-R-39 into the record. City Manager Barlow made a staff presentation. Don Garner. 2703 Tamarind Drive: Would like the city to do away with Resolution 2017-R-39 all together as opposed to repealing it for another year. Joann Cowell, 3045 Vista Palm Drive: Announced that she is the landlord of her son's home and that she is responsible for the utility bill. She also asked if there are any new stores coming to Edgewater to help pick up tax money. Sharon Boyer. 2119 Royal Palm: Commended the Council for listening to the residents at the September 18th Council meeting. City of Edgewater Page 4 Printed on 10/5/2017 City Council Meeting Minutes September 25, 2017 Carlisle Holder, 1325 Queen Palm Drive: Spoke about changing the law for landlords and tenants. Carlisle also spoke about how the city can save money other ways than by raising the residents taxes. Marion Raak, 2216 Queen Palm Drive: Wanted to say that many seniors can't afford to pay the up front lump sum cost and feels that the resolution should be cancelled as opposed to revisiting it in 2018. Agnes Witter, 223 Flagler Ave: Feels the city should have done a better job explaining why the tax increase is needed. Corrie Sapp, 2630 Travelers Palm: Asked what the cost of repealing and revisiting the resolution will be. William Gilmartin, 3322 Needle Palm: Proposed to the Council that they should require the rental properties to be added to the lump sum payer plan as opposed to all Edgewater residents. Kevin Purdie, 134 West Palm Way: Asked what benefits the residents will recieve because of the tax increase. Mayor Ignasiak opened and closed the public hearing. A motion was made by Councilman Blazi, second by Councilwoman Power, to approve Resolution No.2017-R-39.The MOTION was APPROVED by the following vote: Yes: 5- Mayor Ignasiak,Councilwoman Power,Councilwoman Vogt,Councilman Blazi and Councilman Conroy d. 2017-R-24(2) Resolution No. 2017-R-24-Fee Resolution City Attorney Wolfe read Resolution No. 2017-R-24 into the record. City Manager Barlow made a staff presentation. Cindy Black, 2723 Umbrella Tree Drive: Feels that a 9% increase is to much in two years and suggests that we take a further look into out sourcing garbage pick-up. Don Garner, 2703 Tameron Drive:Asked if Council would look into saving money on garbage costs. Kevin Purdie, 134 West Palm Way:Said that the city garbage pickup is not up to his standards. Arthur Slack, 3031 Umbrella Tree Drive: Disagrees with changing garbage pickup to once a week. Mayor Ignasiak opened and closed the public hearing. A motion was made by Councilman Blazi, second by Councilwoman Power, to approve Resolution No.2017-R-24.The MOTION was APPROVED by the following vote: City of Edgewater Page 5 Printed on 10/5.201 City Council Meeting Minutes September 25,2017 Yes: 4- Mayor Ignasiak.Councilwoman Power,Councilwoman Vogt and Councilman Blazi No: 1 - Councilman Conroy 9. BOARD APPOINTMENTS-None at this time 10. OTHER BUSINESS a. AR-2017-2858 Rotary Club of Edgewater, Florida requesting City Council waives the Special Activity Permit Fee. A motion was made by Councilman Conroy, second by Councilman Blazi, to approve the Rotary Club's request to waive the Special Activity Permit Fee. The MOTION was APPROVED by the following vote: Yes: 5- Mayor Ignasiak.Councilwoman Power,Councilwoman Vogt,Councilman Blazi and Councilman Conroy b. AR-2017-2863 Team Volusia Development Corporation,Inc. Agreement Renewal A motion was made by Councilman Conroy, second by Councilman Blazi, to approve the Team Volusia Development Corporation Agreement Renewal. The MOTION was APPROVED by the following vote: Yes: 5- Mayor Ignasiak,Councilwoman Power,Councilwoman Vogt,Councilman Blazi and Councilman Conroy c. AR-2017-2876 Request for Proposals (RFP l7-11R-014) - Insurance Agent-Broker Services for Group Health and Other Employee Benefits A motion was made by Councilman Conroy, second by Councilwoman Vogt, to engage The Assured Partners Request for our Broker Services. The motion failed by the following vote: Yes: 2- Councilwoman Vogt and Councilman Conroy No: 3- Mayor Ignasiak,Councilwoman Power and Councilman Blazi A motion was made by Councilman Blazi, second by Councilwoman Power, to accept Brown and Brown for the contract. The MOTION was APPROVED by the following vote: Yes: 3- Mayor Ignasiak,Councilwoman Power and Councilman Blazi No: 2- Councilwoman Vogt and Councilman Conroy d. AR-2017-2878 Boston Whaler Police Services Agreement A motion was made by Councilman Blazi, second by Councilwoman Power, to approve Boston Whaler Police Services Agreement The MOTION was APPROVED by the following vote: Yes: 4- Mayor Ignasiak Councilwoman Power,Councilwoman Vogt and Councilman Blazi Cio,of Edgewater Page 6 Printed on 10/5/201 City Council Meeting Minutes September 25. 2017 No: I - Councilman Conroy e. AR-2017-2879 Ratification of Edgewater Professional Firefighter International Association of Fire Fighters (IAFF) Local 4575, Firefighter and Driver Engineer Collective Bargaining Agreement. This Other Business Item was withdrawn. f. AR-2017-2880 Ratification of Edgewater Professional Firefighter International Association of Fire Fighters(IAFF)Local 4575,Lieutenants Collective Bargaining Agreement. This Other Business Item was withdrawn. 11. OFFICER REPORTS a. City Clerk City Clerk Robin Matusick reported: A reminder to everyone of the upcoming CRA and City Council meeting scheduled for Monday October 2nd at 6:30 pm. Also, the 2018 Council schedule has been handed out and will be posted when Council approves the schedule. b. City Attorney City Attorney Wolfe reported: A pre suit claim that the City of Edgewater's insurance company has been handling in regards to a police department arrest and an accidental discharge of a police riffle. The insurance company would like approval to settle this claim pre suit up to $20,000.00. Also Attorney Wolfe received an appraisal from the land owner of an open eminent domain case. Mediation was unsuccessful but Attorney Wolfe believes we will have another chance at mediation again in the future. The next step in the process will be to do discovery to potentially expose their unreasonable position. We are working hard to prepare for those depositions. A motion was made by Councilman Blazi, second by Councilwoman Power, to grant our insurance company the authorization to go ahead and settle this claim up to $20,000.00. The MOTION was APPROVED by the following vote: es: 5- Mayor Ignasiak,Councilwoman Power,Councilwoman Vogt.Councilman Blazi and Councilman Conroy c. City Manager City Manager Tracey Barlow reported: Receiving 5 resignation letters out of the 7 board members from the Citizens Code Board. Asked if the council would like to sunset the board or back fill the empty positions. City Manager asked if Council would like him to reach out to a remaining member if she would be interested in filling the open position on the Fire Pension Board. City Manager Barlow discussed looking into the pay of our Edgewater Sergeant's due to recent information brought to his attention and assures Council that the issue will be addressed. He also discussed actively negotiating with the Fire Union Reps in regards to PTO time. Lastly asked for direction from the Council about negotiating labor agreements. City of Edgewater Page 7 Printed on 10/5/2017 City Council Meeting Minutes September 25,2017 12. CITIZEN COMMENTS Agnes Witter, 223 Flagler Ave: Asked if the 9% utility increase will become affective this October 1st or next October? Leo Towsley, 2828 Unity Tree Drive: Announced that a previous complaint about his mother was untrue. 13. ADJOURN Minutes submitted by: Kelsey Arcieri, Records Clerk ATTEST. APPROVED: L'":" --7<filvve27Robin Matusick, City_Clerk/Paralegal Mike Ignasiak, Mayor Councilman Blazi made a motion to adjourn at 9:21 pm City of Edgewater Page 8 Printed on 10/5/2017 lee (1.111) _ _ cl) l V rD Crct!� e 7 l 1 kpommil • 7p • 0.e rr 11 et O 1.1 Isle \ 1 .10 CD O W •N D *110 011 CD O U4 � ii 4 0 CD CD Imit '6 ' 4 Cly? I .• (,) = Cp = ,_ f-,.. CD CD a- o 00 N O • mi0 PRIO omit D CD 0.0 d � rD o cD orc? 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'0 cri m m H 23 T 04 •04:, 1' _ I Trs. - t r (-1- - • o n c r° . , = 0_. • r) 7c _ CD n a O O Cr Cla f—ts. ec-1 CD cr N CSD 4 CU ~s n c„ . C N -. . r...f, ""h Lam.. Cr4 O CD W �. (r4 J - - - The amett Vacant Land Contract am'0. roup, Inc. Real Estate Services 1+ 1. Sale and Purchase: The City of Edgewater ("Seller") 2* and Tamara Kuhn ("Buyer') 3 (the"parties") agree to sell and buy on the terms and conditions specified below the property("Property") 4 described as: 5• Address: 504 Eaton Rd., Edgewater, FL 32132 6- Legal Description: Parcel#8402-43-00-0610 The City of Edgewater will retain a 10 ft easement on the West side 7 of the property that shall be recorded. 8 9 10 11+ SEC /TWP_/RNG_of County, Florida. Real Property ID No.: 12+ including all improvements existing on the Property and the following additional property: 13 14. 2. Purchase Price: (U.S. currency) $ 7,500.00 15 All deposits will be made payable to"Escrow Agent" named below and held in escrow by: 16• Escrow Agent's Name: Professional Title Company 17* Escrow Agent's Contact Person: Terry 18• Escrow Agent's Address: 400 Canal Street 19• Escrow Agent's Phone: 386-424-9994 20• Escrow Agent's Email: 21 (a) Initial deposit($0 if left blank) (Check if applicable) 22* 0 accompanies offer 23* 0 will be delivered to Escrow Agent within 5 days (3 days if left blank) 24* after Effective Date $ 500.00 25 (b) Additional deposit will be delivered to Escrow Agent(Check if applicable) 26• 0 within days (10 days if left blank)after Effective Date 27* ❑ within days(3 days if left blank)after expiration of Feasibility Study Period $ 0.00 28* (c) Total Financing(see Paragraph 5)(express as a dollar amount or percentage) $0.00 29• (d) Other: $ 0.00 30 (e) Balance to close (not including Buyer's closing costs, prepaid items, and prorations) 31• to be paid at closing by wire transfer or other Collected funds $ 7,000.00 32• (f) ❑ (Complete only if purchase price will be determined based on a per unit cost instead of a fixed price.)The 33• unit used to determine the purchase price is 0 lot 0 acre 0 square foot 0 other(specify): 34• prorating areas of less than a full unit. The purchase price will be$ per unit based on a 35 calculation of total area of the Property as certified to Seller and Buyer by a Florida licensed surveyor in 36 accordance with Paragraph 7(c). The following rights of way and other areas will be excluded from the 37• calculation: 38 3. Time for Acceptance; Effective Date: Unless this offer is signed by Seller and Buyer and an executed copy 39• delivered to all parties on or before , this offer will be withdrawn and Buyer's deposit, if 40 any, will be returned. The time for acceptance of any counter offer will be 3 days after the date the counter offer is 41 delivered. The"Effective Date"of this contract is the date on which the last one of the Seller and Buyer 42 has signed or initialed and delivered this offer or the final counter offer. 43- 4. Closing Date: This transaction will close on August 31,2017 ("Closing Date"), unless specifically 44 extended by other provisions of this contract. The Closing Date will prevail over all other time periods including, 45 but not limited to, Financing and Feasibility Study periods. However, if the Closing Date occurs on a Saturday, 46 Sunday, or national legal holiday, it will extend to 5:00 p.m. (where the Property is located) of the next business 47 day. In the event insurance underwriting is suspended on Closing Date and Buyer is unable to obtain property 48 insurance, Buyer may postpone closing for up to 5 days after the insurance underwriting suspension is lifted. If 49 this transaction does not close for any reason, Buyer will immediately return all Seller provided documents and 50 other items. Buyer( l )(f - )and Seller( )( )acknowledge receipt of a copy of this page,which is 1 of 7 pages. VAC-11 Rev 6117 02017 Florida Realtors' Serial#:072121-100150.1166539 U i 7 i 2 xl S PA k J;' ' .. - ', ;.''`",�` 4 I..... - '' i -; c; f.' ''..'" e ;--t ! _ _ l - , ' q44t17' ,f k \a.:#• t t.z,,,,\fr i I \ A 4 `• (, fit, 0tr .4. 1 ` ! , \C P * k t-tt ii,lf ' ' k 1 " T 1j �j1/ '',.), .1; C.4.7. ,,h. ',, 1 , -. , inr.,„ • I / ./ 'RoP__ ° e441; 1\- 1. ,. .........t,\,---......._,//1.- r i ,\ f 1)67 Ito Ci-t li-: i1,414-41 i - - t`A tri 9 /1,1 G A c.C, CCRtJt T to .7 : I w Fff a. - -._a S U to I 1 FtAGt Rt. • a—r-- 1 I- _hi 1. • .'' STia tie b . -e,. . . l i /,, ( bL)1r1 !3c "I SP •i $ok' f: - - - f _ ALJ / I s r4 o c ‹ _,-__ I. - 1 c k 4 c. { is v 0 417'1 Garbage (includes recycling) & Storm Water Rates (Year) Garbage (Proposed) Storm Water (Proposed) Edgewater $324.00 (353.16) $108.00 ($120.00) New Smyrna $230.64 $87.00 ($88.00) Port Orange $224.04 $100.00 (120.00)* S. Daytona $225.72 $108.00 Daytona $232.20 $104.04 Ormond $230.52 $96.00 Deltona $173.96 ($173.96) $108.00 ($108.00) Deland $190.00 ($210.00) $72.00 ($72.00) Orange City $167.52 $48.28 ($50.20) Volusia $190.00 ($210.00) $72.00 ($72.00) Edgewater - Daytona = $353.16 - $232.20 = $120.96 * Note: Port Orange listed major projects to justify Storm Water increase. CITY CLERK REPORT—October 2, 2017 ITEM 1411.a. 1) Since no one had changes other than the start times which have all been changed to 6:30 pm to the "draft" 2018 Council Meeting Schedule that was handed out during the August meeting, I have handed out the FINAL version of our Council dates for regular council & CRA meetings and budget workshops These dates will be posted on the city website calendar for everyone's information 2) Don't forget, we have another Council meeting for next Monday, October 2' at 6:30 pm (Clerk/Council/Clerk Reports/01-09-2017) iici, 2018 CITY COUNCIL MEETING DATES& TIMES January 8 Regular CRA Board Meeting 6:30 pm January 8 Regular Council Meeting 6:30 pm (2" Monday due to New Year's Holiday) February 5 Regular Council Meeting 6:30 pm March 5 Regular Council Meeting 6:30 pm April 2 Regular CRA Board Meeting 6:30 pm April 2 Regular Council Meeting 6:30 pm May 7 Regular Council Meeting 6:30 pm May 14 Budget Workshop 6:30 pm June 4 Regular Council Meeting 6:30 pm June 11 Budget Workshop 6:30 pin July 9 Budget Workshop 6:30 pm July 16 Regular Council Meeting 6:30 pm (3' Monday due to Budget) August 6 Tentative Budget Workshop (if needed) 6:30 pm August 6 Regular CRA Board Meeting(moved from 09/10) 6:30 pm August 6 Regular Council Meeting 6:30 pm September 10 Regular Council Meeting 6:30 pm (2'Monday due to Labor Day Holiday) September 24 Regular Council Meeting 6:30 pm (3' ' Monday due to Budget) October 1 Regular CRA Board Meeting 6:30 pm October 1 Regular Council Meeting 6:30 pm November 19 Regular Council Meeting 6:30 pm (3rd Monday due to Budget - & Veterans Day) December 3 Regular Council Meeting 6:30 pm (Counc ilAgenda/M iscel laneous-20I BCityCouncilMeetingDates-C ounci I-FINA L) i1CLJ 0 > v "I'' > O 0 0 0 u7 O 0 0 Lr a� Ln Ol N N O u rl r-I rl N c I— — -(1)- - )- -( )- -(1)- co 'u s Imm a co CD > O O 0 0 073 ul CN C co Q (11) = aL 0 00 0= 0 Ll� 00 0 c = O Ln a, M C (0 vl CO Q I ' ^ To v CD 0 1 oC p o Q .- La-) O + + a) a) p a) a) > a) I c o 0 O >' '- _>- 0_ 0_ C '- > To E E E co c LU W WLL u o C - Q • • • • Large Group HMOFlorida r Health Care Plans Health Benefit Plan TB4 "`" e • ,de "ge` Amount Member Pays Schedule of Benefits for Covered Services In-Network Out-of-Network Financial Features Medical Benefits Deductible(DED )(PBP2) $250 per person NIA (DED is the amount the member is responsible for before FHCP pays) $750 per family Drug Benefits Deductible(DED )(PBP2) SO per person N/A (DED is the amount the member is responsible for before FHCP pays) SO per family Coinsurance 10%of Allowed Amount N/A (Coinsurance is the percentage the member pays for services) Out-of-Pocket Maximum(PBP) $2,000 per person N/A (Out-of-Pocket Maximum includes DED,Coinsurance,Copayments and Pharmacy) $4,000 per family Office Services Physician Office Services(per visit) Primary Care Office $20 Copay N/A Specialist $35 Copay N/A Maternity(Cost Share for initial visit only) Primary Care Physician $20 Copay N/A Specialist $35 Copay N/A Allergy Injections(per visit) Primary Care Physician $0 N/A Specialist $0 N/A Medical Pharmacy-Physician-Administered Medications including but not limited to: *Therapeutic Injections Deductible+10% N/A *Infusions Deductible+10% N/A *Chemotherapy Deductible+10% N/A Dialysis Drugs _ Deductible+10% N/A Physician-Administered Medications—These medications require the administration to be performed by a health care provider.The medications are ordered by a provider and administered in an office or outpatient setting.Physician-Administered medications are covered under the medical benefit. *Prior Authorization is required. Preventive Care Routine Adult&Child Preventive Services,Wellness Services, Blood Work and SO N/A Immunizations Mammogram Screening SO N/A Bone Density Screening $0 N/A Colonoscopy(Routine for age 50+then frequency schedule applies) $0 N/A Emergency Medical Care Urgent Care Centers(per visit) $60 Copay $60 Copay Hospital Emergency Room or Stand-Alone Emergency Facility Services(per visit) $100 Copay $100 Copay (waived if admitted) Ambulance Services Deductible+10% Deductible+10% 1 DED=Deductible 2 PBP=Per Benefit Period Florida Health Care Plans is an Independent Licensee of the Blue Cross and Blue Shield Association. TB4—1/18 Page 1 of 4 ph Large Group HMO �© Flor/daP Health a/+s Health: Health Benefit Plan TB4 Amount Member Pays Schedule of Benefits for Covered Services In-Network Out-of-Network Outpatient Diagnostic Services•services with an asterisk*require prior authorization Independent Diagnostic Testing Facility/Provider's Office Allergy Testing $0 N/A X-rays and Ultrasounds $35 Copay N/A Diagnostic Services(except AIS) Deductible+10% N/A *Advanced Imaging Services(AIS)(MRI,MRA,PET,CT,Nudear Med.) $75 Copay N/A Independent Clinical Lab(diagnostic testing of blood and specimens) $0 N/A Outpatient Hospital Facility Services(per visit) X-rays and Ultrasounds Deductible+10% N/A Diagnostic Services(except AIS) Deductible+10% N/A *Advanced Imaging Services(AIS)(MRI,MRA,PET,CT,Nudear Med.) j Deductible+10% N/A Important:Diagnostic or therapeutic services rendered in physician offices,testing centers or other outpatient locations that are owned and operated by a hospital system are considered by the hospital system to be departments of the hospital.As a result,FHCP will be billed by the hospital for such services,and the member's outpatient hospital benefit will be applied to these daims.FHCP's Provider Directories and online Provider Search application provides information regarding which provider offices are actually hospital outpatient departments.Members should contact FHCP's cost estimation center to determine if havi •the di.•nostic test or service•-donned in a hos•ital or hos•ial owned fadli will result in hi•her cost shad •. Hospital/Surgical•*all services require prior authorization *Ambulatory Surgical Center Facility(ASC) Deductible+10% N/A *Outpatient Hospital Facility Services(surgical)(per visit) Deductible+10% N/A Inpatient Hospital Facility(per admit) Deductible+10% N/A Mental Health I Substance Dependency-services with an asterisk*require prior authorization *Inpatient Hospitalization Facility Services(per admit) Deductible+ 10% N/A Outpatient Facility Service(per visit) $35 Copay N/A *Partial Hospitalization(per admit) Deductible+10% N/A *Residential/Rehabilitation Facility(per day) Deductible+10% N/A Hospital Emergency Room or Stand-Alone Emergency Facility Services(per visit) S100 Copay $100 Copay (waived if admitted) Provider Services at Hospital/Crisis Unit Primary Care Physician 1 Specialist Deductible+10% N/A Provider Services at Locations other than Office,Hospital and ER Primary Care Physician/Specialist Deductible+10% N/A Outpatient Office Visit Primary Care Physician $20 Copay N/A Specialist $35 Co•a N/A Other Provider Services Provider Services at ER $0 $0 Provider Services at Hospital Inpatient/Outpatient Deductible+10% N/A Provider Services at an Ambulatory Surgical Center(ASC) Deductible+10% N/A TB4—1/18 Page 2 of 4 Large Group HMO ® NFlorida Health Cells Plans Health Benefit Plan TB4 Amount Member Pays Schedule of Benefits for Covered Services In-Network Out-of-Network Other Special Services-services with an asterisk*require prior authorization Combined Limit for Outpatient Occupational, Physical and Speech Therapy(per visit) Deductible+ 10% N/A Combined Limit for Outpatient Cardiac and Pulmonary Rehabilitation Therapy(per visit) Deductible+10% N/A Chiropractic Care(per visit) Deductible+10% N/A *Durable Medical Equipment Deductible+10% N/A *Prosthetics and Medical Brace Device Deductible+10% N/A *Home Health Care(per visit) Deductible+10% N/A *Skilled Nursing Facility(per day) Deductible+10% NIA Hospice Deductible+10% N/A Hearing Exam(Audiologist/Specialist) $35 Copay N/A *Radiation(per visit) $35 Copay N/A Telehealth Services PCP/Specialist) $10I$30 Cosa N/A Diabetes Care Management Diabetes Outpatient Self-Management Education $0 N/A Glucometer $0 N/A Annual Complete Diabetic Eye Exam(Optometrist/Ophthalmologist) $20/$35 Copay N/A 50 Test Strips/Sensors(per box) $10 Copay NIA Lancets(per box) $10 Copay N/A *Prior Authorization is Required:There are certain medical services for which members are required to obtain Prior Authorization before receiving that service.If you don't obtain prior authorization from FHCP,you will have to pay the entire cost of the service. Before a specialty or testing appointment you should visit www.thcp.com or call toll-free 1-877-615-4022 to see if prior authorization is required. Any one individual in a covered family can satisfy the individual out-of-pocket maximum for your plan. The entire family amount can be satisfied by any or all of the other covered dependents. Schedule of Benefits for Covered Services Amount Member Pa s Prescription Drug Program Network Provider Services: A Network Provider pharmacy must be used when a member needs to have a prescription filled or the member will have to pay the full cost of the drug(except in certain situations such as emergencies). Members should log into their member account at www.fhcp.com and click Find a Provider/Facility to locate a Network Provider pharmacy.Mail Order is only available through FRCP Pharmacy. Network Pharmacy Mail Order (1 month supply) (3 month supply) FHCP Walgreens FHCP Only Generic Drugs Preventive(e.g.,oral contraceptives) $0 Not Covered SO Preferred Generic $3 Copay $15 Copay $6 Copay Non Preferred Generic $10 Copay $15 Copay $27 Copay Preferred Brand Drugs $30 Copay $35 Copay $87 Copay Non-Preferred Brand Drugs $55 Copay $60 Copay $162 Copay Specialty drugs(Prior authorization is required) Preferred Specialty 15%Coinsurance Not Covered Not Covered Non Preferred Specialty 25%Coinsurance Not Covered Not Covered If a Brand Name Prescription Drug is requested when there is a Generic Prescription Drug available,the member will be responsible for paying the Average Wholesale Price (AWP)for that prescription. FHCP Pharmacy benefit provides coverage for Generic contraceptive medications or devices(e.g.,oral contraceptives,emergency contraceptive,and diaphragms)at no cost when obtained from a pharmacy owned and operated by FHCP. FHCP's Pharmacy Benefit also covers certain preventive medications at no cost in accordance with the United States Preventative Task Force(USPSTF)Affordable Care Act A and B recommendations as long as all criteria are met and the medication is obtained from a FHCP owned and operated pharmacy. TB4—1/18 Page 3 of 4 Florda Large Group HMO Q HealthiCare rag Plans Health Benefit Plan TB4Schedule of of Benefits for Covered Services Amount Member Pa s-Network Provider Pediatric Vision Network Provider Services: The services listed below must be received from a Network Provider or the member will have to pay the full cost of the service(except in certain situations such as emergencies). Members should log onto www.fhcp.com and click Find a Provider/Facility to locate a Network Provider near them. Exam Not Covered Eyeglass Lenses Not Covered Frames Pediatric Selection:Not Covered Non-Selection:Not Covered Contact Lenses(Instead of eyeglasses) Pediatric Selection:Not Covered Includes contact lenses.evaluation.fitting and follow up care. Non-Selection:Not Covered Note:An hin over the allowance will not count toward our out-of-.ocket maximum limitation. Pediatric Dental Preventive,basic and major Not Covered Benefit Maximums Home Health Care 60 Visits PBP OT,PT,ST Outpatient Rehabilitation Therapy 20 Visits PBP Cardiac and Pulmonary Therapy 20 Visits PBP Chiropractic Care 20 Visits PBP Skilled NursinglRehabilitation Facility 20 Days PBP Behavioral Health Residential Facility 20 Days PBP Additional Benefits and Features • To find out more about their benefits and/or treatment options,members are encouraged to call the Member Services Department at 1-877-615-4022.This can help them save time and money. • Members have online access to view their health benefit plan information as well as self-service tools through the Member Portal at www.fhcp.com. This is not an insurance contract or Benefit Booklet.This Benefit Schedule is only a partial description of the many benefits and services provided or authorized by Florida Health Care Plans.This does not constitute a contract. For a complete description of benefits and exclusions, please see the Florida Health Care Plans Certificate of Coverage;its terms prevail. TB4—1/18 Page 4 of 4 Large Group HDHP HMO (HSA Compatible) o� Q H ai�h car Plans Health Benefit Plan T83 Amount Member Pays Schedule of Benefits for Covered Services In-Network Out-of-Network Financial Features Medical Deductible(DED')(PBP2) $1,500 per person N/A (DED is the amount the member is responsible for before FHCP pays) $3,000 per family' Drug Benefits Deductible(DED')(PBP2) Integrated with Medical N/A (DED is the amount the member is responsible for before FHCP pays) Coinsurance 10%of Allowed Amount N/A (Coinsurance is the percentage the member pays for services) Out-of-Pocket Maximum(00P3)(PBP) $3,000 per person N/A Out-of-Pocket Maximum includes DED, Coinsurance,Cosa ents and Pharma $6.000 s r famil 3 Office Services Physician Office Services(per visit) Primary Care Office Deductible+10% N/A Specialist Deductible+10% N/A Maternity(Cost Share for initial visit only) Primary Care Physician Deductible+10% N/A Specialist Deductible+10% N/A Allergy Injections(per visit) Primary Care Physician Deductible+10% N/A Specialist Deductible+10% N/A Medical Pharmacy-Physician-Administered Medications including but not limited to: *Therapeutic Injections Deductible+10% N/A *Infusions Deductible+10% N/A *Chemotherapy Deductible+10% N/A Dialysis Drugs Deductible+10% N/A Physician-Administered Medications—These medications require the administration to be performed by a health care provider.The medications are ordered by a provider and administered in an office or outpatient setting.Physician-Administered medications are covered under the medical benefit. *Prior Authorization is res uired. Preventive Care Routine Adult&Child Preventive Services,Wellness Services,Blood Work and Immunizations $0 N/A Mammogram Screening $0 N/A Bone Density Screening $0 N/A Colonoscopy(Routine for age 50+then frequency schedule applies) $0 N/A Emergency Medical Care Urgent Care Centers(per visit) Deductible+10% Deductible+ 10% Emergency Room Facility Services(per visit) Deductible+10% Deductible+10% Ambulance Services Deductible+10% Deductible+10% 'DED=Deductible in Non-Embedded 2 PBP=Per Benefit Period 300P=Out of Pocket Maximum is Non-Embedded Florida Health Care Plans is an Independent Licensee of the Blue Cross and Blue Shield Association. T83—1/17 Page 1 of 4 Florida Large Group HDHP HMO (HSA Compatible) > 0 Hep bane ria Health Benefit Plan T83 ��°----�--��� -��- - Amount Member Pays Schedule of Benefits for Covered Services In-Network Out-of-Network Outpatient Diagnostic Services•services with an asterisk*require prior authorization Independent Diagnostic Testing Facility/Provider's Office Allergy Testing Deductible+10% N/A X-rays and Ultrasounds Deductible+10% N/A Diagnostic Services(except AIS) Deductible+10% N/A *Advanced Imaging Services(AIS)(MRI,MRA,PET.CT,Nuclear Med.) Deductible+10% N/A Independent Clinical Lab(diagnostic testing of blood and specimens) Deductible+10% N/A Outpatient Hospital Facility Services(per visit) Blood Work Deductible+10% N/A X-rays and Ultrasounds Deductible+10% N/A Diagnostic Services(except AIS) Deductible+10% N/A *Advanced Imaging Services(AIS)(MRI,MRA, PET,CT,Nuclear Med.) Deductible+10% N/A Important:Diagnostic or therapeutic services rendered in physician offices,testing centers or other outpatient locations that are owned and operated by a hospital system are considered by the hospital system to be departments of the hospital.As a result FHCP will be billed by the hospital for such services,and the member's outpatient hospital benefit will be applied to these claims.FHCP's Provider Directories and online Provider Search application provides information regarding which provider offices are actually hos.ital ouo.tient de.artments. Hospital I Surgical-*all services require prior authorization *Ambulatory Surgical Center Facility(ASC) Deductible+10% N/A *Outpatient Hospital Facility Services(surgical)(per visit) Deductible+10% N/A Inpatient Hospital Facility(per admit) Deductible+10% N/A Mental Health!Substance Dependency-services with an asterisk*require prior authorization Inpatient Hospitalization Facility Services(per admit) Deductible+10% N/A Outpatient Facility Service(per visit) Deductible+10% N/A *Partial Hospitalization(per admit) Deductible+10% N/A *Residential/Rehabilitation Facility(per day) Deductible+10% N/A Emergency Room Facility Services(per visit) Deductible+10% Deductible+10% Provider Services at Hospital/Crisis Unit Primary Care Physician/Specialist Deductible+10% N/A Provider Services at Locations other than Office,Hospital and ER Primary Care Physician/Specialist Deductible+10% N/A Outpatient Office Visit Primary Care Physician Deductible+10% N/A - ialist Deductible+10% N/A Other Provider Services Provider Services at ER Deductible+10% Deductible+10% Provider Services at Hospital Inpatient/Outpatient Deductible+10% N/A Provider Services at an Ambulatory Surgical Center(ASC) Deductible+10% N/A T83—1/17 Page 2 of 4 wow— Fl Large Group HDHP HMO (HSA Compatible) © 0 Heap Care are Health Benefit Plan T83 M�°---�--��-� �°-- °- Amount Member Pays Schedule of Benefits for Covered Services In-Network Out-of-Network Other Special Services•services with an asterisk*require prior authorization Combined Limit for Outpatient Occupational,Physical and Speech Therapy(per visit) Deductible+10% N/A Combined Limit for Outpatient Cardiac&Pulmonary Rehabilitation Therapy(per visit) Deductible+10% N/A Chiropractic Care(per visit) Deductible+10% N/A *Durable Medical Equipment Deductible+10% N/A *Prosthetics and Medical Brace Device Deductible+10% N/A *Home Health Care(per visit) Deductible+10% N/A *Skilled Nursing Facility(per day) Deductible+10% N/A Hospice Deductible+10% N/A Hearing Exam Deductible+10% N/A *Radiation(per visit) Deductible+10% N/A Telehealth Services(PCP/Specialist) Ded+S10/Ded+$30 N/A Co.a Diabetes Care Management Diabetes Outpatient Self-Management Education $0 N/A Glucometer $0 N/A Annual Complete Diabetic Eye Exam (Optometrist/Ophthalmologist) Deductible+10% N/A 50 Test Strips/Sensors(per box) $10 Copay N/A Lancets(per box) $10 Copay N/A *Prior Authorization is Required:There are certain medical services for which members are required to obtain Prior Authorization before receiving that service.If you don't obtain prior authorization from FHCP,you will have to pay the entire cost of the service.Before a specialty or testing appointment you should visit www.thcp.com or call toll-free 1-877-615-4022 to see if prior authorization is required. The family deductible and out-of-pocket maximum amounts are non-embedded;meaning no individual in the family has satisfied the deductible or out-of-pocket maximum until the entire family amount has been satisfied. Schedule of Benefits for Covered Services Amount Member Pa s Prescription Drug Program Network Provider Services: A Network Provider pharmacy must be used when a member needs to have a prescription filled or the member will have to pay the full cost of the drug(except in certain situations such as emergencies).Members should log into their member account at www.fhcp.com and click Find a Provider/Facility to locate a Network Provider pharmacy. Mail Order is only available through FHCP Pharmacy. Network Pharmacy Mail Order (1 month supply) (3 month supply) FHCP Walgreens FHCP Only Generic Drugs Preventive(e.g.,oral contraceptives) SO Not Covered $0 Preferred Generic Deductible+$3 Copay Deductible+$15 Copay Deductible+$6 Copay Non Preferred Generic Deductible+$10 Copay Deductible+$15 Copay Deductible+$27 Copay Preferred Brand Drugs Deductible+$30 Copay Deductible+$35 Copay Deductible+S87 Copay Non-Preferred Brand Drugs Deductible+$55 Copay Deductible+$60 Copay Deductible+$162 Copay Specialty and Self-Injectable Drugs (Prior authorization is required) Deductible+S125 Copay Not Covered Not Covered If a Brand Name Prescription Drug is requested when there is a Generic Prescription Drug available,the member will be responsible for paying the Average Wholesale Price(AWP)for that prescription. FHCP Pharmacy benefit provides coverage for Generic contraceptive medications or devices(e.g.,oral contraceptives,emergency contraceptive,and diaphragms)at no cost when obtained from a pharmacy owned and operated by FHCP. FHCP's Pharmacy Benefit also covers certain preventive medications at no cost in accordance with the United States Preventative Task Force(USPSTF)Affordable Care Act A and B recommendations as long as all criteria are met and the medication is obtained from a FHCP owned and operated pharmacy. T83—1/17 Page 3 of 4 Large Group HDHP HMO (HSA Compatible) I Hea1care Health Benefit Plan T83 Schedule of Benefits for Covered Services Amount Member Pa s-Network Provider Pediatric Vision Network Provider Services: The services listed below must be received from a Network Provider or the member will have to pay the full cost of the service(except in certain situations such as emergencies).Members should log onto www.fhca.com and click Find a Provider/Facility to locate a Network Provider near them. Exam Not Covered Eyeglass Lenses Not Covered Frames Pediatric Selection:Not Covered Non-Selection:Not Covered Contact Lenses(Instead of eyeglasses) Pediatric Selection: Not Covered Includes contact lensesevaluation.fitting and follow up care. Non-Selection:Not Covered Note:An hin over the allowance will not count toward our out-of-socket maximum limitation. Pediatric Dental Preventive,basic and major Not Covered Benefit Maximums Home Health Care 60 Visits PBP OT,PT,ST Outpatient Rehabilitation Therapy 20 Visits PBP Cardiac and Pulmonary Therapy 20 Visits PBP Chiropractic Care 20 Visits PBP Skilled Nursing/Rehabilitation Facility 20 Days PBP Behavioral Health Residential Facility 20 Days PBP Additional Benefits and Features • To find out more about their benefits and/or treatment options,members are encouraged to call the Member Services Department at 1-877-615-4022.This can help them save time and money. • Members have online access to view their health benefit plan information as well as self-service tools through the Member Portal at www.fhcp.com. This is not an insurance contract or Benefit Booklet.This Benefit Schedule is only a partial description of the many benefits and services provided or authorized by Florida Health Care Plans.This does not constitute a contract.For a complete description of benefits and exclusions, please see the Florida Health Care Plans Certificate of Coverage;its terms prevail. 183—1/17 Page 4 of 4 Florida Large Group HMO Health Health Benefit Plan G42 Amount Member Pays Schedule of Benefits for Covered Services In-Network Out-of-Network Financial Features Medical Benefits Deductible(DED')(PBP2) $0 per person N/A (DED is the amount the member is responsible for before FHCP pays) $0 per family Drug Benefits Deductible (DED')(PBP2) $0 per person N/A (DED is the amount the member is responsible for before FHCP pays) Steer family Coinsurance N/A N/A (Coinsurance is the percentage the member pays for services) Out-of-Pocket Maximum(PBP) $1,500 per person N/A (Out-of-Pocket Maximum includes DED,Coinsurance and Copayments) $3,000 per family Pharmac not Included Office Services Physician Office Services(per visit) Primary Care Office $20 Copay N/A Specialist $35 Copay N/A Maternity(Cost Share for initial visit only) Primary Care Physician $20 Copay N/A Specialist $35 Copay N/A Allergy Injections(per visit) Primary Care Physician $0 N/A Specialist $0 N/A Medical Pharmacy•Physician-Administered Medications including but not limited to: *Therapeutic Injections $0 N/A *Infusions $0 N/A *Chemotherapy $0 N/A Dialysis Drugs $0 N/A Physician-Administered Medications—These medications require the administration to be performed by a health care provider.The medications are ordered by a provider and administered in an office or outpatient setting. Physician-Administered medications are covered under the medical benefit. *Prior Authorization is resuired. Preventive Care Routine Adult&Child Preventive Services,Wellness Services,Blood Work $0 N/A and Immunizations Mammogram Screening $0 N/A Bone Density Screening $0 N/A Colonoscopy(Routine for age 50+then frequency schedule applies) $0 N/A Emergency Medical Care Urgent Care Centers(per visit) $60 Copay $60 Copay Emergency Room Facility Services(per visit)(copayment waived if admitted) $100 Copay $100 Copay Ambulance Services $100 Copay S100 Copay 1 DED=Deductible 2 PBP=Per Benefit Period Florida Health Care Plans is an Independent Licensee of the Blue Cross and Blue Shield Association. G42—1/17 Page l of 4 Florida Large Group HMO 0 Health Care Health Benefit Plan G42 Amount Member Pays Schedule of Benefits for Covered Services In-Network Out-of-Network Outpatient Diagnostic Services-services with an asterisk*require prior authorization Independent Diagnostic Testing Facility/Provider's Office Allergy Testing $0 N/A X-rays and Ultrasounds $0 N/A Diagnostic Services(except AIS) SO N/A *Advanced Imaging Services(AIS)(MRI,MRA,PET,CT,Nuclear Med.) SO N/A Independent Clinical Lab(diagnostic testing of blood and specimens) SO N/A Outpatient Hospital Facility Services(per visit) Blood Work SO N/A X-rays and Ultrasounds $0 N/A Diagnostic Services(except AIS) $0 N/A *Advanced Imaging Services(AIS)(MRI,MRA,PET,CT, Nudear Med.) $0 N/A Important:Diagnostic or therapeutic services rendered in physician offices,testing centers or other outpatient locations that are owned and operated by a hospital system are considered by the hospital system to be departments of the hospital.As a result,FHCP will be billed by the hospital for such services,and the member's outpatient hospital benefit will be applied to these claims.FHCP's Provider Directories and online Provider Search application provides information regarding which provider offices are actually hospital outpatient departments. Hospital/Surgical-=all services require prior authorization *Ambulatory Surgical Center Facility(ASC) $0 N/A *Outpatient Hospital Facility Services(surgical)(per visit) $0 N/A *In•atient Hos•itai Facili ser admit $200 Cosa N/A Mental Health I Substance Dependency-services with an asterisk*require prior authorization *Inpatient Hospitalization Facility Services(per admit) $200 Copay N/A Outpatient Hospitalization Facility Service(per visit) $35 Copay N/A *Partial Hospitalization(per admit) $100 Copay N/A *Residential/Rehabilitation Facility(per day) $50 Copay N/A Emergency Room Facility Services(per visit) $100 Copay $100 Copay Provider Services at Hospital/Crisis Unit Primary Care Physician 1 Specialist $0 N/A Provider Services at Locations other than Office,Hospital and ER Primary Care Physician/Specialist $0 N/A Outpatient Office Visit Primary Care Physician $20 Copay N/A S•ecialist $35 Co.a Other Provider Services Provider Services at ER $0 SO Provider Services at Hospital Inpatient/Outpatient $0 N/A Provider Services at an Ambulatory Surgical Center(ASC) $0 N/A G42—1/17 Page 2 of 4 da in Large Group HMO Florida . Piens Health Benefit Plan G42 Amount Member Pays Schedule of Benefits for Covered Services In-Network Out-of-Network Other Special Services •services with an asterisk*require prior authorization Combined Limit for Outpatient Occupational Physical and Speech Therapy(per visit) S15 Copay N/A Combined Limit for Outpatient Cardiac and Pulmonary Rehabilitation Therapy(per visit) S15 Copay N/A Chiropractic Care(per visit) S15 Copay N/A *Durable Medical Equipment 15%Coinsurance N/A *Prosthetics and Medical Brace Device $0 N/A *Home Health Care(per visit) $15 Copay N/A *Skilled Nursing Facility(per day) $50/Day N/A Hospice $0 N/A Hearing Exam (Audiologist/Specialist) $0 N/A *Radiation(per visit) $35 Copay N/A Telehealth Services PCP/S•ecialist $10/S30 Co.- N/A Diabetes Care Management Diabetes Outpatient Self-Management Education $0 N/A Glucometer $0 N/A Annual Complete Diabetic Eye Exam (Optometrist/Ophthalmologist) $20/S35 Copay N/A 50 Test Strips/Sensors $10 Copay N/A Lancets $10 Copay N/A *Prior Authorization is Required:There are certain medical services for which members are required to obtain Prior Authorization before receiving that service. If you don't obtain prior authorization from FRCP,you will have to pay the entire cost of the service. Before a specialty or testing appointment you should visit www.fhcp.com or call toll-free 1-877-615-4022 to see if prior authorization is required. Any one individual in a covered family can satisfy the individual out-of-pocket maximum for your plan. The entire family amount can be satisfied by any or all of the other covered dependents. Schedule of Benefits for Covered Services Amount Member Pa s Prescription Drug Program Network Provider Services: A Network Provider pharmacy must be used when a member needs to have a prescription filled or the member will have to pay the full cost of the drug(except in certain situations such as emergencies).Members should log into their member account at www.fhcp.com and click Find a Provider/Facility to locate a Network Provider pharmacy.Mail Order is only available through FHCP Pharmacy. Network Pharmacy Mail Order (1 month supply) (3 month supply) FHCP Walgreens FHCP Only Generic Drugs Preferred Generic S3 Copay $15 Copay $6 Copay Non Preferred Generic $10 Copay $15 Copay S27 Copay Preferred Brand Drugs $30 Copay $35 Copay S87 Copay Non-Preferred Brand Drugs $55 Copay $60 Copay $162 Copay Specialty and Self-Injectable Drugs (Prior authorization is required) $100 Copay Not Covered Not Covered If a Brand Name Prescription Drug is requested when there is a Generic Prescription Drug available,the member will be responsible for paying the Average Wholesale Price(AWP)for that prescription. Schedule of Benefits for Covered Services Amount Member Pays-Network Provider G42—1/17 Page 3 of 4 Large Group HMO Florida _ rM.r Health Benefit Plan G42 M-..�...4s.�M..46.....e..Y�. Pediatric Vision Network Provider Services: The services listed below must be received from a Network Provider or the member will have to pay the full cost of the service(except in certain situations such as emergencies).Members should log onto www.fhcp.com and click Find a Provider/Facility to locate a Network Provider near them. Exam Not Covered Eyeglass Lenses Not Covered Frames Pediatric Selection:Not Covered Non-Selection:Not Covered Contact Lenses(Instead of eyeglasses) Pediatric Selection:Not Covered Includes contact lenses.evaluation,fitting and follow up care. Non-Selection:Not Covered Note:An hin. over the allowance will not count toward our out-of-I ket maximum limitation. Pediatric Dental Preventive,basic and major Not Covered Benefit Maximums Home Health Care 60 Visits PBP OT,PT,ST Outpatient Rehabilitation Therapy 20 Visits PBP Cardiac and Pulmonary Therapy 20 Visits PBP Chiropractic Care 20 Visits PBP Skilled Nursing/Rehabilitation Facility 20 Days PBP Behavioral Health Residential Facility 20 Days PBP Additional Benefits and Features • To find out more about their benefits and/or treatment options,members are encouraged to call the Member Services Department at 1-877-615-4022.This can help them save time and money. • Members have online access to view their health benefit plan information as well as self-service tools through the Member Portal at www.fhcp.com. This insurance issuer believes this plan is a"grandfathered health plan"under the Patient Protection and Affordable Care Act(the Affordable Care Act). As permitted by the Affordable Care Act,a grandfathered health plan can preserve certain basic health coverage that was already in effect when that law was enacted. Being a grandfathered health plan means that your plan may not include certain consumer protections of the Affordable Care Act that apply to other plans,for example,the requirement for the provision of preventive health services without any cost sharing. However.grandfathered health plans must comply with certain other consumer protections in the Affordable Care Act,for example,the elimination of lifetime limits on benefits. This is not an insurance contract or Benefit Booklet.This Benefit Schedule is only a partial description of the many benefits and services provided or authorized by Florida Health Care Plans.This does not constitute a contract. For a complete description of benefits and exclusions, please see the Florida Health Care Plans Certificate of Coverage:its terms prevail. 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VN? m U m W LU H C _O O M m NiO O M 3 t 0 N N 00 n Ln Ln c0 .-I M M ."1 c O O O a0 r-i .1 I� 00 tri to .--i +-' O N N M Ln c0 L0 N 1-, N N r1 C 0 V? N N M N lD tD 00 .-1 LA LA N W 0 V? Vf to V? V? V? V? V? V? LU O LU N v 7. /� ‘47--,CD_ N N N N N 0 rn On � LOn O O N 00 00 h +cn O' LD (.0 Cl O 0 M Q1 cc) c0 1, Q. 0 R N O O N ul LA 00 0) M M c0 co %Id ev-I .-I .--i .--I Vim? .-I .-I r-1 {j? .-i .--I .-1 ,i / O in- V? V? V? V? V? V? V? V? L --s. N N N 01 0 O O Lu o U 10 N vt 4—J CU 00 0^, 0 v m v CO W ? T ~ A F OJ Val to + (+ U f + 'E Z 0 Q I W W W LL I W W W Il I W W W Il ARTICLE 26 IMSl'RANCE The City agrees to furnish Bargaining Unit members a health and dental group insurance plan. For employees hired prior to October 1, 2004. the City agrees to pay the entire amount of the health insurance premium for the Bargaining Unit member and fifty percent (50%) of the health insurance premium for their dependents. Employees hired after October 1, 2004 1.0l have the opportunity to purchase dependent health insurance coverage. the City agrees to pay 50°.a of all dental coverage. The City shall provide life insurance for all employees covered by this Agreement in an amount equivalent to one (1) year's base salary rounded up to the next thousand dollars; however no employee's life insurance coverage shall be less than fifteen thousand ($15.000.00) dollars. The City and members of the 1UOE will agree to evaluate HSA as a potential funding source for retiree medical stipend. Internati.•W(ni.'n at'Operating Engineers Agwivril 45 oclotscr I.2016—Ser.embrr 30.2O )09.14 20 15 ARTICLE 9 INSURANCE The City agrees to furnish Bargaining Unit members a health and dental group insurance plan. For non-supervisory employees hired prior to January 10, 2005. the City agrees tc pay the entire amount of the health insurance premium for the Bargaining Unit member and fifty percent (50%) of the health insurance premium for their dependents. Non-supervisory employees hired after January 10, 2005 will have the opportunity to purchase dependent health insurance coverage. The City agrees to pay 50% of all dental coverage for non-supervisory employees. The City agrees to pay the entire amount of the health insurance premium for the Bargaining Unit Supervisor and seventy-five percent (75%) of their health and dental dependent coverage. The City shall provide life insurance coverage for all employees covered by this Agreement in an amount equivalent to one year's base salary rounded up to the next thousand dollars. The City shall provide 550.000.00 Accidental Death, $50.000.00 Fresh Pursuit. $150,000.00 Intentional Death for all officers,and a long-term disability plan for all employees. 19 PBA Agreement 10/112016- 9130/2019 ARTICLE 26—INSURANCE 26.1 The Union shall have the opportunity to discuss and provide input on any proposed changes to insurance of union bargaining member through the employee-management committee prior to implementation by the City. 26.2 The City agrees to furnish Bargaining Unit members a health and dental group insurance plan. For employees hired prior to October 1, 2004, the City agrees to pay the entire amount of the health insurance premium for the Bargaining Unit member and fifty percent (50%) of the health insurance premium for their dependents. Employees hired after October 1,2004 will have the opportunity to purchase dependent health insurance coverage. 26.3 The City shall provide life insurance for all employees covered by this agreement in an amount equivalent to one (1) year's base salary rounded up the next thousand dollars: however no employee's life insurance coverage shall be less than fifteen thousand ($15,000)dollars. 26.4 The City shall provide a maximum $155,000 accidental death and dismemberment policy for all bargaining unit members. 26.5 The City agrees to pay 50%of all dental coverage. 40 IAFF FF/DE Agreement 10/1/2016—9/30/2019 0 Tracey T. Barlow From: Tracey T. Barlow Sent: Friday, September 01, 2017 3:14 PM To: Tiana Dewees; District3; Dan Koehler; Herb Epstein; Brenda Dewees Cc: Tim Webb;William Dailey; Dave Arcieri; Steve Cousins;Julie Christine Subject: FW: Insurance Claims Information Attachments: City of Edgewater - Q2 Review vCommission 8 30 2017.pdf Insurance Committee Members, I wanted take a moment to not only share the most recent health insurance claims review that has been shared with the City Council for their review in preparation for additional discussion, but also advise you that the City Council will have a presentation and discussion regarding such under agenda item 10a at their September 11th meeting. Tracey T. Barlow City Manager City of Edgewater From: Tracey T. Barlow Sent: Friday, September 01, 2017 3:08 PM To: City Council Cc: directors; Jessica Scott(JScott( )BBDAYTONA.com) Subject: Insurance Claims Information Mayor and Council, In preparation for the discussion regarding our health insurance claims history that you all had requested for me to place on the agenda, I am forwarding you this attached detailed report outlining such. Agenda item 10a you will have a presentation and open discussion with our current Insurance Broker Brown 86 Brown as well as a representative from Florida Healthcare. They will not only discuss how our claims history has an influence on our future insurance premiums but will also discuss initiatives going forward that would support a stabilization and possibly a reduction of future insurance premiums. Tracey T. 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O = CD = CD _ 3 = CZ (FD i.5. .< a C O -p -• n C� v (D a < N A A •J CD co O -, O• O — N 0 O �< n- o co CD (D (A O< co -Sr- S p cD D c fl."- O Q cn O = 3 m N O Oc O ,- CD n p CD v o" cn N .-« = cA a a C2 CD v O CD Z/ o `< ° o o o cD cn 0 11 0 3 < rn (D N -r - T 'mtl . City of ILED G Fl ori d ATER 1 it rottamatton 0#'6e o f de Are- WHEREAS, the manufacturing industry is vital to the health of our City, County, State and Nation; and WHEREAS, manufacturing is a cornerstone of our local economy, helping to sustain our quality of life as well as a solid and diversified tax base within the City of Edgewater; and WHEREAS, the City of Edgewater is home to various manufacturers that produce a wide variety of products some of which are in the boating industry and are sold to customers around the world. The City supports all types of manufacturing and manufacturing careers; and WHEREAS, public awareness of the value of manufacturers add to our economy and is essential to the maintenance of good community-industry relationships; and WHEREAS, all residents are encouraged to take time to salute the City of Edgewater manufacturers, and their employees for the positive economic impact they make in our City, State and Nation. NOW, THEREFORE, I, Michael Ignasiak, by virtue of the authority vested in me as Mayor of the City of Edgewater, Florida do hereby proclaim the month of October, 2017 as MANUFA CT URING MONTH 1rr Avitne.50 J Oreof / koe xedy,tut,e0 sit Art kird acrd mad cS'eafoif tee 64 o/F(pewatee to k alifixed Presented at the Council Chambers, _' Edgewater, County of Volusia, STATE OF e . ..� FLORIDA this 25th day of September, 2017. (044) i _ � .