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City of Paris Council Benefits Subcommittee <br />December 8, 2003 <br />Page 5 <br />rate, they pay what the pool may give. Councilman Bell said the insurance <br />company is going to pay it after that deductible. Councilman Bell said based on <br />experience with the city employees, employees that the city has right now, do we <br />have a lot of out of network claims, what is our network, describe that and who <br />determines the network. Mr. Anderson advised that TML determines the <br />network and that is whoever they can negotiate an agreement. Mr. Anderson <br />advised that the network covers many providers all over the state. It does not <br />necessarily cover every doctor that might be in town and there are two or three <br />hospitals in Dallas, for example, that are not covered. Councilman Bell asked <br />if Christus St Joseph's Hospital and Essent were covered. Mr. Anderson said <br />that Christus is covered, but until Essent gets here, TML can come in and <br />negotiate an agreement. <br />Chairman Guest said the next item is in network family and currently the <br />deductible is $600.00 and it is going to $1,500.00 traditionally it is three times <br />the deductible. Mr. Anderson said that the first three that hits the $200.00 <br />deductible satisfied the family deductible. Chairman Guest advised that out of <br />network family is going from $1,500.00, and he suggested that $3,000.00 might <br />represent more of the cost in talking to other people in the industries. <br />Chairman Guest said that out of pocket maximum in network is $1,000.00 and <br />Mr. Anderson has proposed $2,000.00. Out of pocket and out of network is <br />currently $2,000.00 and he did not put a figure there. Mr. Anderson said he did <br />not put a figure in there because it is deluding the limits because the employee <br />could pay a large amount. He explained that an employee can go to basically any <br />doctor in Paris and the hospital, most are all in the network. If they go to Dallas <br />all they have to do is pick up the telephone or get on the web site and find out if <br />the doctor that the employee is being referred to is in the network or no. If not <br />they need to ask for one that is. Mr. Anderson said unless an employee is care <br />flighted on an emergency situation, that is something that all employees needs to <br />do to help hold the cost down. <br />Chairman Guest said that in network copay it is currently 90% and the proposal <br />is 80%. Out of network copay is currently 80% and the proposal is 50%. <br />