16th Amendment to the Health PlanHealth Plan Amendment
SIXTEENTH AMENDMENT
TO THE CITY OF CARMEL
EMPLOYEE HEALTH BENEFIT PLAN
WHEREAS, the City of Carmel ("Plan Sponsor"), by action of its governing body, adopted the City of
Carmel Employee Health Benefit Plan (the "Plan") effective February 1, 1992, and subsequently modified
the Plan by a full restatement effective January 1, 2004, and fifteen amendments to the restated Plan;
and
WHEREAS, Plan Sponsor wishes to amend the restated Plan; and
WHEREAS, authority to amend the Plan is granted therein.
NOW, THEREFORE, effective January 1, 2016, the Plan is amended as follows.
1. The Third Party Administrator section is amended to read as follows (BAS is deleted as the dental
TPA):
NAME ADDRESS AND TELEPHONE NUMBER OF THE THIRD PARTY ADMINISTRATOR:
Anthem Blue Cross and Blue Shield
220 Virginia Avenue
Indianapolis, IN 46204
844-453-4508
The Third Party Administrator is contracted by the Plan Administrator to provide claims payment,
eligibility management and other administrative and consulting services.
2. The benefit for hearing aids in Plan A is amended to read as follows:
PREFERRED BENEFIT NON -PREFERRED BENEFIT
HEARING AIDS 100% of allowable amount* 100% of allowable amount*
Deductible Applies: Yes Yes
Maximum per 60 -Month Period One hearing aid per ear
*The allowable amount for a hearing aid is determined by the Third Party Administrator based on
reasonable and customary charges. Any amount over the allowable amount, and any charges for
upgraded or add-on devices, are the responsibility of the covered member and are not covered by
this Plan.
3. The benefit for hearing aids in Plan B is amended to read as follows:
PREFERRED BENEFIT NON -PREFERRED BENEFIT
HEARING AIDS 80% of allowable amount* 60% of allowable amount*
Copay Applies: No No
Deductible Applies: Yes Yes
Maximum per 60 -Month Period One hearing aid per ear
*The allowable amount for a hearing aid is determined by the Third Party Administrator based on
reasonable and customary charges. Any amount over the allowable amount, and any charges for
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Health Plan Amendment
upgraded or add-on devices, are the responsibility of the covered member and are not covered by
this Plan.
4. Human growth hormones are deleted from the list of Prescription Drug Exclusions. (Human growth
hormones may be covered as a medical expense if certain stringent criteria are met.)
In all other respects the Plan remains unchanged.
CITY OF CARMEL, INDIANA
By and through its Board of Public Works and Safety
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