Wyoming Borough 277 Wyoming Avenue
Wyoming, Pa 18644
REQUEST FOR PROPOSALS
FOR EMPLOYEE HEALTH, DENTAL, AND VISION INSURANCE
INFORMATION IN SUPPORT OF PROPOSAL SUBMISSIONS
Wyoming Borough is seeking a single insurance agent/representative to provide the Borough with employee health, dental and vision insurance. At its meeting on September 13, 202 1, Council of the Borough of Wyoming approved a motion approving solicitation of requests for proposal for the Borough’s Health Insurance coverages.
All qualified prospective bidders must be licensed to sell and provide insurance in the Commonwealth of Pennsylvania. All insurance companies providing coverage must be licensed in Pennsylvania, and carry a B+ or higher rating, and otherwise have a strong record of business history and responsible practice.
Wyoming Borough reserves the right to reject all or any proposals, for any reason or no reason, and is not bound to accept the lowest bid if, in its discretion, the Borough does not desire to accept any proposal.
ALL PROPOSALS MUST BE RECEIVED BY THE BOROUGH MANAGER ON OR
BEFORE 2:00 P, M, September 13, 2021, Submissions may be made by United States Postal Service or hand delivered to the above address to the Borough Manager, Roseanne Colarusso.
Please use the attached information to provide proposals for the requested coverages. If you have any questions please contact the Borough Manager, Roseanne Colarusso at 570-693-0291 Ext. 5
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EMPLOYEE INSURANCE REQUESTED WYOMING BOROUGH
HEALTH, DENTAL AND VISION
Coverage requested: PLEASE QUOTE COVERAGE FOR 8 EMPLOYEES Types of Insurance: Highmark PPO
Geisinger PPO
Geisinger HMO
Quote for the following:
| EMPLOYEE=2 |
| EMPLOYEE & SPOUSE =1 |
| EMPLOYEE & CHILD =1 |
| FAMILY= 4 |
Outline of requested coverage
| DEDUCTIBLE OPTION | $500.00 / $1,000.00 |
| Co-Pays | $20.00/$40.00 |
| ER Co-Pays | $150.00 |
| Rx Retail | $3 I $25 / $50 /$70 |
| X-Rays | 100% after deductible |
| MRI CAT Scan | $75.00 after deductible |
| Maximum out of pocket | |
| Hospitalization (inpatient) | 100% after deductible |
Next 3 pages shows the current coverage currently offered to Borough Full-Time Employees
* * Police are contracted under a Collective Bargaining Agreement **
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BlueCare® PPO $1000 0% 3/25/50/70
Benefits
| -Individual deductible $1,000 $4,000 -Family deductible $2,000 $8,000 I -Coinsurance -Individual coinsurance maximum 2 None Not Applicable 20% of allowable charge $3,000 -Family coinsurance maximum Not Applicable $6,000 -Precertification penalty (facility) None $500 Preventive Care Services -Childhood immunizations (not subject to deductible) No Charge 20% -Routine gynecological examination and pap smears (not subject to deductible) No Charge 20% -Screening mammograms (not subject to deductible) No Charge 20% |
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Outline of Coverage
Dependent V Student Age limitation: 26 throu9h the end of the month
Insured Responsibility
Preferred Non-Preferred
Benefit Year
Emergency Services 3
-Ambulance services, emergency transport (not subject to deductible)
-Ambulance services, non-emergency transport
-Outpatient emergency room visit (not subject to deductible or coinsurance, copayment waived if admitted to hospital)
-Retail clinic care (preferred not subject to deductible)
-Urgent care (preferred not subject to deductible)
Inpatient Services
-Inpatient hospital services (unlimited days per benefit period)
-Maternity services
-Skilled nursing care (60 days per benefit period)
Outpatient Services
-Diagnostic testing (lab tests, x-rays, etc.)
-High-tech imaging (MRI, MRA, CT scan, PET scans, nuclear cardiology)
-Physical (20 visits per benefit period), speech (12 visits per benefit period), and occupational therapy (12 visits per benefit period)
-Pulmonary and respiratory therapy (18 visits per benefit period per therapy)
-Radiation, dialysis, and chemotherapy
Other Services
-Chiropractic manipulative benefits (12 visits per benefit period ages 13 and up)
-Durable medical equipment, orthotics and prosthetics (unlimited maximum)
-Home health care/Home infusion (nurse visit)
-Hospice care (180-day maximum per lifetime)
-Surgery
-Maternity services (physician office visits) (preferred not subject to deductible)
-Primary care office visits (preferred not subject to deductible; unlimited visits)
-Specialty care office visits (preferred not subject to deductible; unlimited visits)
Mental Health and Substance Abuse Services
-Inpatient mental health services (unlimited days)
-Outpatient mental health services (unlimited visits)
-Outpatient substance abuse services (unlimited visits)
-Detoxification (unlimited days)
-Inpatient non-hospital residential substance abuse treatment (unlimited days)
Prescription Drugs
-Deductible
-Retail, 31-day supply
-Mail order program (up to a 90-day supply)
-Contraceptives
No Charge
No Charge after deductible
$150
$20
$40
No Charge after deductible
No Charge after deductible No Charge after deductible
No Charge after deductible
$75 per test, after deductible
$40 after deductible
No Charge after deductible No Charge after deductible
$40 after deductible
No Charge after deductible
$40 after deductible
No Charge after deductible No Charge after deductible
No Charge
$20
$40
No Charge after deductible No Charge after deductible No Charge after deductible
No Charge after deductible No Charge after deductible
None
$3 / $25 / $50 / $70
$6 / $50 / $100 I $140 Covered
Amounts in excess of allowable charge
20% after deductible
$150
20% after deductible
20% after deductible
20% after deductible
20% after deductible
20% after deductible
20% after deductible
20% after deductible
20% after deductible
20% after deductible
20% after deductible
20% after deductible
20% after deductible
20% after deductible
20% after deductible
20% after deductible
20% after deductible
20% after deductible
20% after deductible
20% after deductible
20% after deductible
20% after deductible
20% after deductible
20% after deductible
None
Special Circumstances Only Not Applicable
Not Covered
| In-Network Benefits – Non-Voluntary | Fashion Advantage I | ||
| Eye Examination (including dilation when professionally indicated) | 12 months under age 19/ 24 months age 19 or older | ||
| Spectacle Lenses | 12 months under age 19/ 24 months age 19 or older | ||
| Frame | 24 months | ||
| Contact Lenses (in lieu of eyeglass lenses) | 12 months under age 19/ 24 months age 19 or older | ||
| Eye Examination Spectacle Lenses | $0 $0 n/a | ||
| Contact Lens Evaluation, Fitting Q & Follow-Up Care | |||
| Non-Collection Frame Allowance (Retail): | Up to $130 | Up to $60 | |
| Davis Vision Frame Collection11 (in lieu of Allowance): Fashion levelDesigner levelPremier level | Up to $125 Up to $175 Up to $225 | Included $20 copayment $40 copayment | |
| Clear plastic single-vision. lined bifocal, trifocal or lenticular lenses (any Rx) | $60-$120 | Included | |
| Oversize Lenses | $20 | Included | |
| Tinting of Plastic Lenses | $20 | $11 | |
| Scratch-Resistant Coating | $25-$40 | Included | |
| Scratch Protection Plan Single Vision | $60-$120 | $20 | |
| Scratch Protection Plan Multifocal | $60-$120 | $40 | |
| Polycarbonate Lenses12 | $60-$75 | $0 or $30 | |
| Ultraviolet Coating | $25-$30 | $12 | |
| Standard Anti-Reflective (AR) Coating | $50-$70 | $35 | |
| Premium AR Coating | $65-$90 | $48 | |
| Ultra AR Coating | $100-$125 | $60 | |
| Standard Progressive Lenses | $150-$195 | $50 | |
| Premium Progressives (Varilux®, etc.) | $195-$225 | $90 | |
| Ultra Progressive Lenses | $225-$300 | $140 | |
| Intermediate-Vision Lenses | $150-$175 | $30 | |
| High-Index Lenses | $90-$150 | $55 | |
| Polarized Lenses | $95-$110 | $75 | |
| Plastic Photosensitive Lenses | $95-$150 | $65 | |
| Non-Collection Contact Lenses: Materials Allowance Evaluation, Fitting & Follow-Up Care – Standard Lens TypesEvaluation, Fitting & Follow-Up Care – Specialty Lens Types | Up to $85 Not Covered Not Covered | ||
| Collection Contact Lenses11 (in lieu of Allowance): Materials DisposablePlanned ReplacementEvaluation, Fitting & Follow-up Care | Covered In Full Covered In Full Included | ||
| Medically Necessary Contact Lenses (with prior approval) – Materials Evaluation, Fitting& Follow-Up Care | Included | ||
| Eve Examination: $32 | Single Vision Lenses: $25 | Trifocal Lenses: $46 | Elective Contact Lenses: $85 |
| Frame: $30 Bifocal/Progressive Lenses: $36 Lenticular Lenses: $72 Medically Necessary CL: $225 | |||
Schedule of Benefits
Concordia Flex
Group Name: WYOMING BOROUGH
The grid below provides information related to Covered Services under this Plan. If a service is a Covered Service, a percentage greater than zero in the column titled “Plan Pays” will be indicated. If a Covered Service has a Waiting Period, the Waiting Period will be listed in the column titled “Waiting Period”. Some services will be covered in full prior to the Deductible being met. If this is the case, the “Deductible Application” column will indicate “no”. If the Deductible must be met prior to a service being covered at the indicated coinsurance, then “yes” will appear in the “Deductible Application column. Only Covered Services are subject to reimbursement. All services on this Schedule of Benefits are subject to the Schedule of Exclusions and Limitations. Consult Your Certificate for more details on the services listed. Riders may affect coverage levels. Participating Dentists accept the Maximum Allowable Charge as payment in full.
| Service Category | Waiting Period | Plan Pays | Deductible Application |
| Diagnostic Services | |||
| Oral Evaluations (Exams) | None | 100% | No |
| Radiographs (X-Rays) | |||
| Bitewings | None | 100% | No |
| Full mouth | None | 100% | No |
| Preventive Services | |||
| Prophylaxis (Cleanings) | None | 100% | No |
| Topical fluoride | None | 100% | No |
| Sealants | None | 100% | No |
| Space Maintainers | None | 100% | No |
| Restorative Services | |||
| Amalgam Restorations | None | 100% | Yes |
| Resin Based Composite -Anterior (White Fillings) | None | 100% | Yes |
| Resin Based Composite-Posterior (White Filling) | None | 100% | Yes |
| Single Crowns | None | 50% | Yes |
| Stainless Steel Crowns | None | 100% | Yes |
| Inlays | None | 50% | Yes |
| Onlays | None | 50% | Yes |
| Inlay Repairs | None | 100% | Yes |
| Onlay Repairs | None | 100% | Yes |
| Crown Repair | None | 100% | Yes |
| Endodontic Services | |||
| Endodontic Therapy (Root canals, etc.) | None | 100% | Yes |
| Root Canal Retreatment | None | 100% | Yes |
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