2018 033 Ordinance - Laserfiche WebLink

Home Browse Search

? MEDICAL M.U'f"UALa Pully Insured Proposal for Mayfield Village • As part of the Affordable Care Act, health insurance issuers and group health plans are required to provide a Summary of Benefits and Coverage (SBC) to all participants (and their dependents if they reside at a different address). Benefits and Coverage (SBC) to all participants (and their dependents if they reside at a different address). The SBC(s) applicable to your current plan(s) will be available on EmployerLink or from your sales representative or broker. As the plan sponsor, you are responsible for distributing SBCs to your participants with other written application materials during open enrollment. An SBC must be provided for each benefit package in which a participant or dependent is eligible. If you do not require a written application from your participants to renew, you must provide each participant with the SBC specffic to the plan in which he or she is enrolled no later than 30 days prior to the first day of the new plan or policy year. ° • Please review your applicable SBC(s) carefully. if you are making a change that affects the information in your SBC, please contact your sales representative or broker to initiate the change and ensure new SBCs are available for your open enrollment period. • The rates in this proposal may include Patient-Centered Outwmes Research Institute Fee (PCORI), Risk Adjustment, Reinsurance Fee, Exchange Fee, and Market Share Fee when applicable which are federally mandated. Additionally, this policy, Med+cal Mutual, or you as a Pian Sponsor may become su6ject to taxes, fees or other charges imposed by State, Local, or Federal govemments (colleciively, °fees"). Medical Mutual reserves the right to adjust your premium or funding rate (or add the fees to the invoice) consistent with the effective date of the new fees imposed by the government. To fuily disclose the charges, the adjustments may be noted in a line item on monthiy invoices. All fees are subject to change during the contract period. • Group employees residing in the State of California may enroll their domestic partners as eligible dependents. • Due to a change in Ohio law, effective with the first renewal on or after January 1, 2016, all existing over-age dependent children (26 and 27 years old) will maintain coverage until they attain the limiting age of 28. No new over-age dependent children will be eligible for coverage. Please note that children with a physical or inteilectual disability are not impacted by the change in Ohio law. - The quoted rates must be accepted by the effective date stated in the proposal or the rates are subject to be re-evaluated. • The quoted rates require that Medical Mutual will become the group's sole health insurance provider. - The quoted rates require a minimum of 51 eligible employees. - The quoted rates were developed based on 72 eligible with 71 enrolling. • Further re-evaluation of the rates will be required if the actual number of enrolled contracts changes, and/or the final medical risk changes such that, either individually or jointly, the overall risk evaluation of the group is impacted. • At least 75% of the net eligible employees must be covered under this contract. A wage and tax statement may be required by Underwriting to verify that the group meets Medical Mutual's participation and eligible employee requirements. • A minimum of 75% of the certificate holders must reside in Ohio. The group's minimum contribution must be at least 50% of the premium for each ceriificate holder, including retirees, but excluding any certificate holder continuing coverage under this plan, as allowed by state or federal law (example: COBRA). • For groups comprised of multiple companies, a minimum of 50% common ownership by one person or a specific group is required. Quote ID: 0066524-01