HomeMy WebLinkAboutRES 900408 - Primary Health Benefit PlanApr^,motfurow
A RESOLUKON' YI ACCEPT"IHE HID OF PCA HEALTH PLANS
OFEXAS.INC, TOBETHE PRIMA Y' HEALTH BIt'NEFITPLAN
FOR CITY EMPLOYERS, AND AVAR)RIZING THY MAYOR TO
SIGN AND!TH F CITY SMWARY ATTEST,
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lN(OWt THEREFORE, n BE I'1' HEWN BY IRE GUY COUNCIL OF THE CITY OF
(IEVITIVI lGW)i A.lmsrs .
SECTION I
'M i _.i Gn ..w :fit .v..,�p .:�pi, rt G.... .
SECTION 11
v�
,n .,c..ir .r,i. ]fa is .rs ikz WitJa 9aG
iX ..i1n„ur;;
SEL"1'ION III
7 1 U..'+'.iITE u 1 a'
and he
a Yi sr, ,.a %I 5t,
PA`R'SE AN IT, APPROVED {'Elia 28th DAY OF AUGOS'T" 1950.
v
Iry
El] r i,, JMV't y y6 .8'y Yz _auu. ,.' a ��„n.., r*_.,.Il•; J.-.^
THE CITY OF GEORGETOWN
PROPOSED RATES
FOR
PLAN TYPE SWY
EFFECTIVE DATE
OCTOBER 11 1-990
EMPLOYEE
ONLY
$113;69
E14PLOYEE
& SPON3E
5244,4;
EMPLOYEE
& CHILD REN
$204,64
EMPLOYEE
&'FAMILY
3384.21
F14
Summary of Benefits
Plan 5WA
Asa PCAHealth Plans Member, yourpnmary Care Physiaanmustprovide orcoord nateall of your care, includ-
ing after boars care, referrals to consuntmgspeciahsts, and any medically necessarghospitaVzadon,
Primary Care Physician Services
IPinery Core physician office Visit
$lovisir
Includes; bu not limited to, the following serviea:
e Pendc �wnahzedph) s:OItYdPS
I Immurdmdona
(rrGuencydependenrupon age and
a Annual synecological win
medial wndiion)
a SpOsh and hedngRetains
0 Was child ON
+ Vision scool
SIDlvud
No Charge
Nochuge
VasecmmyS7Scopayarent
Tubel'u'ga5on 92Wropayment
IlmerWttysea¢es-Mia l&Hcoplalsenores
(except asolheawsemcluded) NI`Arepayment
.
Hospital Care
I Semiperve{enorm, mdudingmoce➢areooshospital
:
services No Charge'.
I PhysieienHospital visits and am(including sorgeons,assktant
surgeons,anesihesiotoght;, adiologuls eh) _ No Charge
Opeatingnbm recharge.
1 X-ay,laboratory, drogreade,and therepeunc senvices No Charge
Medications Nil
Intensive Care No Charge
Outpatient Surgery
1" At participating Haspialorfacillly No Charge
IPhysidanservices No Charge
Reconstructive Surgery
(Including Medical and Hospital Serines)
Whera Medically Necessary torescrenornaiphysiologiral
functioning cNoCharge.
Prosthetics and Durable Medical Equipment
(Y1est be preauthonzed by PCA Health Plans)
1 PmstHetics(Imttedlowtialporc5aseofarWiiial
devices Nochaurs
1Rental ofDurable Wild :Eyapment,such asba ;oxygen,
nheelgliai;s hospimltypebed,andmerhamalegmpment
necessary for treatment of resphafory failure _No Charge
(limited to$N,G fair ontract year)
Shot -Term Physical, Occupational & Speech Therapy
1 tnMcipaMgPhysichi8ot ceoronmoutpatientbasi at
ParEcipaMgHNpiWsorothetAppmvedHeathCare.
Facility No Charge
(hmiled in twomonn mommum fanshond pre authomdon byFCA
HealthPlans)
Home Health Services
I When Medically Neassayandpre authorzed by
PCAHoahh9bors No Charge
Mentil Health
(Maatbihhul llYNrassaryandpeawhonzedbyPCAHeallda
pairs)
In Participating Physidadsoffice _$20.repayment ppr
visit not to exceed Hlonehourvisits; tnany one Conamh Year
In Hops 20%m ayrrent
not to exceed N days in any one Con use t Year
Treatment for Alcohol Dependency
Mast be Medically Noosseany end pre-authonzed by Had lh
Plans)
I In Paridpatinglehysiddsoffice SINvsit
IlnHcspial No Cause
Emergency Care
1
Enol CmSeroiseaprovided onanoutpadeutbasivbya
PaidipadngHcopital S'Sropaywent
(noehargeitedmitCedl
I Can anywheremthe world for anemergency asdefined 'tithe
nex(secfion $2 copayment
(noehargedadmided)
1 Arema ceszrom when ilediailvNecessary _NoChole
Important:
I If you choose PCA Health Pains, your old maayCam Physician
must provide or arrange all of your health aieservices ,. except
m an Emergency. "Emergency deal runs horn fide eanergency
service provided ahem the sudden onset of a medical condition
mmifantal; iteself by ante symptoms of sufficient severeily,.
medial affen tan could reasonably be expected to runic in
placing the patient's health he serious jeopardy; serious
onpahment to bodily functions; or serious dyshoutlim of any
bodilyorganorpn.
This b; only summary of the PCA Hotta all benefits
whenpaevided orauthoriiedbyyour finally Care Physicun. A
complete description of 6emlit; and hmahtions is. provided in
the PCA HaaWPla ns' Group ContmrVCenifinte of Covenge.
5
preseriptionDrug Benefit
YoutPreenptionDrug coverage
iudv&PHrva/
FG Health Plans of Teeas; Inc is pleased to offer you an
"lion with goner drug name, the shenglh, the dose and the
additional benefit > prescription drug onymefor onlya$SW
andeweofthe ding towhich thegel yinguequivelent.
copayseentfor each prescription orrefill,
The legis subject to periodic review and modification by FCA
Whenever You need aprescription filed, grvemy participating
Healthlee"
phyarec tyour PCA Hek Rental card along with your PCA
FEDERAL AND STATE RES71MfED DRUGS Any reedidml
Heady Plonsphyscran'sprescription Your phurraeistAfill the
suhttencewhich maybe dispersed bypreshlonly, recording
ferexrphon and charge only the copayment amount shown on
toStneard FederaHaw
yourlD card.
COMPOUNDED MEDICATIONS: A compounded prescription
Your phourl WhI complete the clam form, then have You
a dosage form mencedy prepared by the croon, ads
sigti(ld mak khatfire dmgstveterereared ThaYsaVlhemete
ORALCONIRACEMVES
it
INSULIN
Dispensing limitations
Drugs and Items Not Covered
TheamountafadmgwhchmaybesuppVedNrpteunphonor
TeaDuhadevices orappVaneesigghIeolemucneedles,
rcedlisthe quantity prescribed, up to and including
amzvimum of
syringes, suppod garments or other non -medial suhatantts),
M41aysupply, comudmgtodirections. Otherdrylmeyapply
regardless ofthem intended use ,
HedIbu)4rlm
Over the counter produce are not a covered benefit unless.
Drugs Covered
specifically included (i.e.insuln).
Be following prescnphon dregs are a coseced benefit w`ten
EzpervnenmlDrugs Ed Agents
N¢orehegum, appeliesupprsnts;vitamIrs,ergot akell
anchomeedb➢aperhnpahngrAHdonTansphysidalr
(HydergmeJ, mgame shampm.
DRUGS INCLUDED ON PEA HEALTH PLMJS' APPROM
DRUG LIST FORMLLARY a genedclisting of prescription meal-
BartieipatingRarmaeies
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VALUE ADDED PROGiiAMS
PCA Health Plans is proud to present our Value Added Programs, These programs are designed to promote
ways to maintain your health by providing savings from area retailers and fitness facilities. Just present your
PCA Health Plans' I D card at the time of service and begin receiving your savings. Your partidpafionin this
program is voluntary and payment for services is solely your responsibility. This program is not part of the
benefits guaranteed under the Group ContraccCerhhcateofCoverage and issubject tochange without notice,
CHILD CARE PROGRAM
PCA Health Plank members are eligible to participate an the foiovmg professional child care programs offered
through the Lo Petite Academy's in me Austin, Texas area,
' waiver of initial registration fee (S3Sper child savings) s 10%discountonweeklytuilion
' First week free upon registration ' Two weeks of free vacation time
' complete educational programs includingrcagnitive,social, emotional and physical growth for
each child
THE ABOVE ANti JAL SAVINGS CAN AMOUNT TO AS MUCH AS 6 WEEKS OF FREE CARD,
La Petite locations
*AM
3909
Adelph Lane
835.9853
1609
North Bell Pkwy:
259-0246
8105
Boodle Lane
282.9789
805
Cypress Creek Blv4
331.7457
9315
Chbholmtiane
2827792
' PFLUGERVELE
1414
Kramer Lane
8342495
204
10th Street
2510317
11812
MillwnghtpkwV.
250.9193
+ R-01=
13171
Pond Springs Rd.
3316142
1510
GreerdawnBlvd,
338-1231
14611
WellsPortDrive.
990.1700
3620
HtilsideDnve
338-3906
6906
WestneekDrve
8923960
1317
Sam Bass Rd,
338-1A11
322
William Cannon West
4478141
' Locations
subject to space availability.
COMMUNITY HEALTH EDUCATION PROGRAMS
Community Health Education Programsincludethe following classee
' Weightloss ' ShessManagemenl ' Prepared Childbirth
' SmokingCessation ' Nutrition Education " CPR
' AerobicE4ercise ' IamaaeClassas r FimessFaiilties
Community Health Education Programs provider list
BRACKENRIDGE HOSPITAL ROUND ROCK COMMUNITY HOSPITAL SOUTH AUSTIN MEDICAL CENTER
Conmct Ms. Sm GaVle Coned &dyBla�hetl Conrad GwonHoUmn
(512)476&161 (512) 2S5 (512)41.2211
Dsrounn 20%onclam Dncaura ]OT ondzes Dkoun[ 10%onnlasses.
Value Added Dental Progam
PCA Health Flo ofTau, 1pe'sValue Added Dental Program
often a variety of dental sees ether at no charge or at a
discount Listed on the reverse side are the Value Added Dentists
Ed their locations.
When scheduling anappramment, idently yourself as a PCA
Health Plansmember. the dental oNire staff will review the details
of the ptograin with you and answer your questions Be sure to
bring your PCA Health Plana' I.D. cud to your appointment and
present itwhen check'mgin,That isall there a toit! Noclaim ioims
tommpiere and no waiting peo r for reimbursements
Value Added Dentists
PCA Hra th Plars a proud to provide this Pont at no
monthly cost to you This program a not pal of your regular
benefit package Yourparticipstioo Is volunmry and Payment
for dental services is solely your responsh f oy
AUSTIN AND SURROUNDING COMMUNITIES BRYAN
HodzonDenHl •Cenlml
HoriconDenfal•Nonhwest
Plumose Dental Center
1351cHighway 290
133761e eatchBlvd..
13138dancoutDrive'
Amb, TX
Austin, TX.
BryaeTX
(512)451-w
(5n))3B.5v.
(409)7764164
HonzenDental - North Control HorizonDentzl-South
Bumetlr Research Blvd. VIS1amuBlvd .
'15%devoaatonall denmiservices such asGeneral Dentistry,
Austin TX AutiniTX
ChddimsDemrshy,PenecdontalDentistry, OrelSurgery,
(512)8357576 (512)447-1101
Dentures ,Cosmetic Dentistry, Bonding, Ciaming,FDirgi,
Root Cauls, and Crowns:
Horizon Der, oflocations provide the following services:.
`24hogrEmergeneyArewediigService
'}yajy¢tofthe $2ismglewtrztionfee orj0farri, action fee
required to join Horizons Preferred DenW Progim o
No Chi rgefor Bite Wing X-Rays;diagncsticXaRays,General
WACO
5M, and Or hodondc&reening Evaluations: Tempera a Xdtays:
notincluded.)
Wayne Pula; D.D.S.
'HonionDental will charge only $19,00per member forrouhne
7106anger
demiingDoes not include deciding, Root Planning, Penodormlor
'Waro,TX
Cup.Cluning
(817)7M775
'20%discount onall other genermdmvt myservices such 6:
rXtravUon,,FBlings;RoolCenals;Cmwns,Denturos;etGDoes
nor Include Orthodontic servim T5%disommlonaBdental services such asCenetalDendsnh
'Not valid with other offers (ie:coupons) CleaningFillings, and other services performed byWayne
Parks,DD.S.
Nate: The Value Added Denied Program isnot pan ofthe beneftts
gomantreduhear, the Cron pContrncVCenifirateofCoverage
:
and a subject to change wthoo f goitre:
Value Added Matemity Cate
r
r PCA Health Plans of Texas, Inc :thinksyou and your new baby deserve fie BEST CARE POSSIBLE Thmes;why we've de.
veloped a program ESPECIALLY FOR YOU! PCA Health Plans of Texas, Inc.'smaternity program includes
:
Comprehensive Prenatal care,
r Home Visit byaRegistered Norse & Professional Homemaker,
4 Well BabyCare After Birth
.
Comprehensive Prenatal Care
Your care %III stert with yourparthipating Plan physician monitoring0 your developing baby's progress throughout your
pregnancy. Most physicians agree you'll be befterprapared if you talosadvantage of prepared childbirth classes, prenatal ex
ercise classes, or smoking cessation dasses. If Von have other smal children,you may even want to take advantage ofSib.
ng Preparation dasses.IEyou are interested in any such classes, contact the PCA Health Plans Parhapabng Hospital
whereyou will be delivering for information on discounts that may be available to you as a PCA Health Plans member,
Home Health Care& Homemaker5ervides
Your PCA Health Plans of Texas, benefits don't end with yourhospital sm ' vi During the first days after your dismissal
from the hospied, if you were discharged within Hhours for a vaginal delivery or72 hours fora caesarean delivery,a Re -0
islandNurse (experienced in obstetrical and newbnm nursing will visit you at your home to cheek your health and the
health of your new baby at Health Plans of Tessa, Inc'sexpense, Ifanyproblemsare identified, your physician will be
notified immediately.
As an added benefit, you may receive one 8hourvisit or two 4hour visits from a Professional Homemaker within the first
week after you are discharged from $ahospka1 The Homemaker will do light cleaning, laundry, orcooking.
Wel-Baby Care
Giving birth isusually a healthy, natural and exciting event! Wewant your care during your pregnancy, during the baby's
bid and after the specidevent tobefilled withthe CARE YOU DESERVE, If you have any questions about PCA Health
Plans of Texas, Inc's'EspeciatiyFor You' Program, please contact theMedics] ServicesDepartment atPCA Health Plans.