An ordinance amending section 3.08.110 of the Metropolitan Code of Laws, by authorizing the adoption of other self-insured medical plan design structures.

Whereas, the Metropolitan Council has adopted a system of employee benefits for officers and employees of the Metropolitan Government; and

Whereas, the system of employee benefits adopted by the Metropolitan Council includes medical care benefits for officers and employees of the Metropolitan Government; and

Whereas, the medical care benefits for officers and employees of the Metropolitan Government includes a self-insured plan administered on a preferred provider ("PPO")-nonpreferred provider ("non-PPO") basis; and

Whereas, the Study & Formulating Committee has issued a Final Report, dated April 5, 2006, recommending that the Metropolitan Code of Laws be amended to allow options for self-insuring other medical plan design structures; and

Whereas, the Metropolitan Employee Benefit Board has reviewed and approved the Study & Formulating Committee's recommendation that the Metropolitan Code of Laws be amended to allow options for self-insuring other medical plan design structures.

NOW, THEREFORE, BE IT ENACTED BY THE COUNCIL OF THE METROPOLITAN GOVERNMENT OF NASHVILLE AND DAVIDSON COUNTY:

Section 1. That Section 3.08.110(E) of the Metropolitan Code of Laws is hereby amended by deleting the following language:

The self-insured medical benefits plan shall be administered on a preferred provider (PPO)-nonpreferred provider (non-PPO) basis, with the term preferred provider meaning a preferred provider organization (PPO) which may include hospitals, physicians, and other health care providers which have entered into an agreement with the board or one of its agents, to provide services under the plan pursuant to a negotiated pricing arrangement. The aggregate maximum lifetime benefit shall be unlimited in regard to services performed by preferred providers (PPO) within the network and one million dollars for services provided by non-preferred providers (non-PPO) in the network. PPO benefits shall be paid at eighty percent of reasonable and customary charges and non-PPO benefits at sixty percent of reasonable and customary charges. The Employee Benefit Board may temporarily modify these percentages by exception through an affirmative vote to provide incentives for participants in special programs or provisions under this plan. Such exceptions to this section will expire one year after board adoption unless and until affirmed by another positive vote by the board.

The annual out-of-pocket maximum for individual PPO coverage shall be one thousand dollars and for family coverage two thousand dollars. The individual out-of-pocket non-PPO maximum shall be five thousand dollars and family shall be ten thousand dollars.

All other terms and conditions of the self-insured plan shall be as approved by the board.

and substituting in lieu thereof the following language:

The self-insured medical benefits plan shall be administered on a preferred provider (PPO)-nonpreferred provider (non-PPO) basis, with the term preferred provider meaning a preferred provider organization (PPO) which may include hospitals, physicians, and other health care providers which have entered into an agreement with the board or one of its agents, to provide services under the plan pursuant to a negotiated pricing arrangement. The aggregate maximum lifetime benefit shall be unlimited in regard to services performed by preferred providers (PPO) within the network and one million dollars for services provided by non-preferred providers (non-PPO) in the network. PPO benefits shall be paid at eighty percent of reasonable and customary charges and non-PPO benefits at sixty percent of reasonable and customary charges. The Employee Benefit Board may temporarily modify these percentages by exception through an affirmative vote to provide incentives for participants in special programs or provisions under this plan. Such exceptions to this section will expire one year after board adoption unless and until affirmed by another positive vote by the board.

The annual out-of-pocket maximum for individual PPO coverage shall be one thousand dollars and for family coverage two thousand dollars. The individual out-of-pocket non-PPO maximum shall be five thousand dollars and family shall be ten thousand dollars.

In addition to the self-insured medical benefits plan that is administered on a PPO/non-PPO basis, the Employee Benefit Board is authorized to adopt other types of self-insured medical plan design structures. Each such self-insured medical plan design structure shall be adopted by the Benefit Board only following an actuarial determination of the effect of the particular plan on the soundness of the system's design of benefits as well as its effect on the cost of the system.

All other terms and conditions of the self-insured plans shall be as approved by the board.

Section 2. That this ordinance shall take effect from and after its passage, the welfare of The Metropolitan Government of Nashville and Davidson County requiring it.

Sponsored by: Diane Neighbors, Mike Jameson

Amendment No. 1
To
Ordinance No. BL2006-1180

Mr. President:

I move to amend Ordinance No. BL2006-1180 adding the following provision at the end of Section 1:
"No additional self-insured medical benefits plan authorized by the section shall become effective until such plan is approved by resolution of the council receiving twenty-one (21) affirmative votes. Beginning January 1, 2007, the employee benefit board shall submit a quarterly report to the budget and finance and personnel committees of the council providing information regarding other self-insured medical benefits plans being reviewed by the commission and the progress being made toward implementation of an additional plan or plans."

Sponsored by: Diane Neighbors, Mike Jameson

LEGISLATIVE HISTORY
Introduced:	August 29, 2006
Passed First Reading:	August 29, 2006
Referred to:	Budget & Finance Committee Personnel Committee
Amended:	September 19, 2006
Passed Second Reading:	September 19, 2006
Passed Third Reading:	October 3, 2006
Approved:	October 10, 2006
By: