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Home My WebLink About060598-R1 - General - Contract - Aetna Life InsuranceCSCNo.60598-R1 CITY OF FORT WORTH REQUEST TO EXERCISE RENEWAL OPTION July 28, 2026 Aetna Life Insurance Attn: Richard A. Frommeyer 2777 Stemmons Frwy STE 300 Dallas, TX 75207 Re: Contract Renewal Notice Contract No. 60598 ("Contract") Renewal Term No. 1: December 6, 2026, to December 7, 2027 The above -referenced Contract with the City of Fort Worth expires on December 6, 2026 ("Expiration Date"). Pursuant to the Contract, renewals are at the mutual agreement of the parties. This letter is to inform you that the City is requesting to renew the Contract for an additional one- year period, which will begin immediately after the Expiration Date. All other terms and conditions of the Contract remain unchanged. To agree to renew the Contract for an additional one-year period, please sign and return this request to exercise renewal option, along with a copy of your current insurance certificate, to the address set forth below. Please log onto PeopleSoft Purchasing at hit2:Hfortworthtexas.gov/purchasing to ensure that your company information is correct and up to date. If you have any questions concerning this Contract Renewal Notice, please contact me at the telephone number listed below. Sincerely, Er&YL, L. 2oAe,v Erin, Roden, MPA Purchasing Supervisor 817-392-7455 Erin.Roden@fortworthtexas.gov OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX Contract Renewal Page 1 of 2 CSC No. ACCEPTED AND AGREED: CITY OF FORT WORTH: Dianna Giordano (Aug 11, 2026 19:37:08 CDT) Flame: Dianna Giordano Title: Assistant City Manager Date: 08/11 /2026 AL RECOMMENDED: /l2Gd�YG �� Name: Kristen Smith Title: Human Resources Director ATTEST: o� WA-Q°a v 6 �8 � PPdrt°�# a C�%�'�11.1L-l�R. CyC nEXAso4'� By: Flame: Jannette Goodall VENDOR: Aetna Life Insurance Date: 08/06/2026 By: (� A` Name: Richard A. Frommeyer CONTRACT COMPLIANCE MANAGER: By signing, I acknowledge that I am the person responsible for the monitoring and administration of this contract, including ensuring all performance and reporting requirements. jv� /iaXfi� a%y� Heather Wiggins Sr. Admin. Services Manager APPROVED AS TO FORM AND LEGALITY: By: Name: Jordan Alvarez Title: Assistant City Attorney lI CONTRACT AUTHORIZATION: M&C: 23-0621 Form 1295: N/A OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX Contract Renewal Page 2 of 2 ,vaetna"', CITY OF FORT WORTH Aetna MedicareSM Plan (PPO) Medicare (CO3) ESA PPO Rx $10/$30/$50/20% Benefits and Premiums are effective January 1, 2027 through December 31, 2027 PLAN DESIGN PROVIDED BY AETNA LIFE INSURANCE COMPANY Primary Care Physician (PCP): You have the option to choose a PCP. When we know who your provider is, we can better support your care. Referrals: Your plan doesn't require a referral from a PCP to see a specialist. Keep in mind, some providers may require a recommendation or treatment plan from your doctor in order to see you. Prior Authorizations: Your doctor will work with us to get approval before you receive certain services or drugs. Benefits that may require a prior authorization are listed with an asterisk (*) in the benefits grid. PLAN FEATURES Network & out -of -network providers. Annual Deductible $0 This is the amount you have to pay out of pocket before the plan will pay its share for your covered Medicare Part A and B services. Annual Maximum Out -of -Pocket Amount Annual maximum out-of-pocket limit amount $1,000 includes any deductible, copayment or coinsurance that you pay. It will apply to all medical expenses except Hearing Aid Reimbursement, Vision Reimbursement, Dental Coverage and Medicare prescription drug coverage that may be available on your plan. HOSPITAL CARE* This is what you pay for network & out -of - network providers. Inpatient Hospital Care $250 per stay The member cost sharing applies to covered benefits incurred during a member's inpatient stay. Observation Stay Your cost share for Observation Care is based upon the services you receive Frequency: per stay Outpatient Services & Surgery 5% Ambulatory Surgery Center 5% July 2026 42792_1_42793_1 CW t n aTm CITY OF FORT WORTH Aetna MedicareSM Plan (PPO) Medicare (CO3) ESA PPO Rx $10/$30/$50/20% PHYSICIAN SERVICES This is what you pay for network & out -of - network providers. Primary Care Physician Visits 5% Includes services of an internist, general physician, family practitioner for routine care as well as diagnosis and treatment of an illness or injury and in -office surgery. Physician Specialist Visits 5% PREVENTIVE CARE This is what you pay for network & out -of - network providers. Alcohol Misuse Screening & Counseling $0 -1 screening and up to 4 counseling sessions every 12 months for those who qualify Annual Wellness Visit $0 - 1 visit every 12 months Bone Mass Measurement $0 - 1 visit every 24 months or more frequently if medically necessary Cardiovascular Disease Screening Test $0 - 1 test every 5 years (60 months) Cervical Cancer Screening with Human $0 - 1 visit every 5 years (60 months) Papillomavirus (HPV) Test Colorectal Cancer Screening $0 - Once every 120 months (10 years) or 48 months after a previous sigmoidoscopy; $0 - Once every 24 months (unless patient got a screening flexible sigmoidoscopy; then we may cover a screening colonoscopy only after at least 47 months) Counseling to Prevent Tobacco Use $0 - 2 cessation attempts per year (each attempt may include a maximum of 4 intermediate or intensive sessions, with the patient getting up to 8 sessions per year) COVID-19 Vaccine & Administration $0 - Review the FDA emergency use authorization (EUA) criteria for each vaccine Depression Screening $0 -1 screening every 12 months in a primary care setting Diabetes Screening $0 - 2 screenings within the 12-month period following the date of the patient's most recent diabetes screening test Diabetes Self -Management Training (DSMT) $0 - up to 10 hours within the first 12 months of the first year and 2 hours of follow-up training every following year July 2026 42792_1_42793_1 M #*Cwtna CITY OF FORT WORTH Aetna MedicareSM Plan (PPO) Medicare (CO3) ESA PPO Rx $10/$30/$50/20% Flu Shot & Administration $0 -1 per year or more if medically necessary Glaucoma Screening $0 -1 glaucoma screening each year Hepatitis B Screening $0 -1 screening every 12 months, 2 screenings every 12 months if pregnant Hepatitis B Shot & Administration $0 - 2, 3, or 4 doses depending on vaccine or condition Hepatitis C Screening $0 -1 screening every 12 months, if qualified HIV screening & HIV PrEP $0 -1 screening exam every 12 months; $0 - Up to 3 screening exams during a pregnancy. Up to 8 screening exams and/or counseling sessions when using FDA -approved lab tests and point -of -care tests. Intensive Behavior Therapy (IBT) for $0 - 1 visit every 12 months with your PCP Cardiovascular Disease (CVD) Intensive Behavior Therapy (IBT) for Obesity $0 - Up to 22 visits every 12 months for those who qualify Initial Preventive Physical Exam (IPPE) $0 -1 time visit within the first 12 months you have Medicare Part B. Lung Cancer Screening with Low Dose $0 -1 screening every 12 months, if qualified Computed Tomography (LDCT) Mammography Screening $0 -1 screening exam every 12 months; $0 - each diagnostic mammogram when medically necessary Medical Nutritional Therapy $0 - up to 1215-minute session or 3 hours within the first 12 months of the first year and up to 2 hours every following year for those with a qualifying diagnosis Medicare Diabetes Prevention Program $0 -1 per lifetime per procedure for those who (MDPP) qualify Pneumococcal Shot & Administration $0 -1 per year or more if medically necessary Prolonged Preventive Services $0 - Frequency varies according to the specific Medicare preventive service. Prostate Cancer Screening $0 -1 screening every 12 months Screening Pap Test $0 -1 every 24 months or one every 12 months if at high risk July 2026 42792_1_42793_1 %*CWtnaTM CITY OF FORT WORTH Aetna MedicareSM Plan (PPO) Medicare (CO3) ESA PPO Rx $10/$30/$50/20% Screening Pelvic Exams $0 - 1 every 24 months or one every 12 months if at high risk Sexually Transmitted Infection Screening & $0- 1 screening every 12 months or at certain times High Intensity Behavioral Counseling(HIBC) to during pregnancy. Prevent STI Ultrasound Abdominal Aortic Aneurysm (AAA) $0 - one screening per lifetime Screening EMERGENCY AND URGENT MEDICAL CARE This is what you pay for network & out -of - network providers. Emergency Care; Worldwide $50 Urgently Needed Care; Worldwide $35 DIAGNOSTIC PROCEDURES* This is what you pay for network & out -of - network providers. Diagnostic Radiology 5% CT scans Diagnostic Radiology 5% Other than CT scans Lab Services 5% Diagnostic testing & procedures 5% Outpatient X-rays 5% HEARING SERVICES This is what you pay for network & out -of - network providers. Routine Hearing Screening $0 We cover 1 exam every 12 months Medicare Covered Hearing Examination 5% Hearing Aid Reimbursement $2,000 once every 36 months DENTAL SERVICES This is what you pay for network & out -of - network providers. Aetna Enhanced Preventive Dental Value ESA Coverage for preventive dental services including cleanings, exams and x-rays Annual Benefit Maximum - $750 $0 dental deductible 0% coinsurance for each covered dental service July 2026 42792_1_42793_1 #*CWtnaTM CITY OF FORT WORTH Aetna MedicareSM Plan (PPO) Medicare (CO3) ESA PPO Rx $10/$30/$50/20% Medicare Covered Dental* 5% Non -routine care covered by Medicare. VISION SERVICES This is what you pay for network & out -of - network providers. Routine Eye Exams $0 One annual exam every 12 months. Diabetic Eye Exams $0 Medicare Covered Eye Exam 5% Vision Eyewear Reimbursement $200 once every 24 months Applies to in or out of network MENTAL HEALTH SERVICES* This is what you pay for network & out -of - network providers. Inpatient Mental Health Care $250 per stay The member cost sharing applies to covered benefits incurred during a member's inpatient stay. Outpatient Mental Health Care 5% Individual visit Partial Hospitalization 5% Intensive Outpatient Services 5% Inpatient Substance Abuse $250 per stay The member cost sharing applies to covered benefits incurred during a member's inpatient stay. Outpatient Substance Abuse 5% Individual visit SKILLED NURSING SERVICES* This is what you pay for network & out -of - network providers. Skilled Nursing Facility (SNF) Care 0% per day, days 1-20; 5% per day, days 21-100 Limited to 100 days per Medicare Benefit Period. The member cost sharing applies to covered benefits incurred during a member's inpatient stay. A benefit period begins the day you go into a hospital or skilled nursing facility. The benefit period ends when you haven't received any inpatient hospital care (or skilled care in a SNF) for 60 days in a row. If you go into a hospital or a skilled nursing facility after one benefit period has ended, a new benefit period begins. There is no limit to the number of benefit periods. July 2026 42792_1_42793_1 CW t n a CITY OF FORT WORTH Aetna MedicareSM Plan (PPO) Medicare (CO3) ESA PPO Rx $10/$30/$50/20% OUTPATIENT REHABILITATION SERVICES* This is what you pay for network & out -of - network providers. Outpatient Rehabilitation Services 5% (Speech, physical, and occupational therapy) AMBULANCE SERVICES This is what you pay for network & out -of - network providers. Ambulance Services 5% Prior authorization rules may apply for non -emergency transportation services received in -network. Your network provider is responsible for requesting prior authorization. Our plan recommends pre - authorization of non -emergency transportation services when provided by an out -of -network provider. TRANSPORTATION SERVICES This is what you pay for network & out -of - network providers. Transportation (non -emergency) 24 one-way trips with 60 miles allowed per trip MEDICARE PART B PRESCRIPTION DRL GS* This is what you pay for network & out -of - network providers. Medicare Part B Prescription Drugs $0 Medicare Part B Prescription Drugs - Insulin $0 MEDICARE PART D PRESCRIPTION DRUGS This is what you pay for network & out -of - network providers. Part D drugs are covered. See PHARMACY - PRESCRIPTION DRUG BENEFITS section below for your plan benefits at each part D stage, including cost share and other important pharmacy benefit information. July 2026 42792_1_42793_1 #*CWtna CITY OF FORT WORTH Aetna MedicareSM Plan (PPO) Medicare (CO3) ESA PPO Rx $10/$30/$50/20% ADDITIONAL PROGRAMS AND SERVICES (MEDICARE -COVERED) This is what you pay for network & out -of - network providers. Allergy Shots $0 Allergy Testing 5% Blood $0 All components of blood are covered beginning with the first pint. Cardiac Rehabilitation Services 5% Intensive Cardiac Rehabilitation Services 5% Chiropractic Services* Medicare covered benefits only. 5% Continuous Glucose Monitors* $0 Continuous Glucose Supplies $0 Diabetic Supplies* $0 Includes supplies to monitor your blood glucose from Accu-Chek/Roche and TRUE/Trividia, or from a non -preferred provider when a prior authorization is received. Durable Medical Equipment/ Prosthetic Devices* 5% Home Health Agency Care* $0 Hospice Care Covered by Original Medicare at a Medicare certified hospice. Medical Supplies* Your cost share is based upon the provider of services Acupuncture Medicare covered benefits only. 5% Outpatient Dialysis Treatments* 5% Podiatry Services Medicare covered benefits only. 5% Pulmonary Rehabilitation Services 5% Supervised Exercise Therapy (SET) for PAD Services 5% Radiation Therapy* 5% July 2026 42792_1_42793_1 CITY OF FORT WORTH CW t n a - Aetna MedicareSM Plan (PPO) Medicare (CO3) ESA PPO Rx $10/$30/$50/20% ADDITIONAL PROGRAMS AND SERVICES This is what you pay for network & out -of - (NOT COVERED BY ORIGINAL MEDICARE) network providers. Routine Physical Exams $0 One exam per calendar year Smoking and Tobacco Use Cessation $0 Supplies Frequency unlimited visits every year TeladocTM $0 Telemedicine services with a TeladocT"° provider. State mandates may apply. Telehealth Covered Telemedicine Services. Member cost share will apply based on services rendered. Telehealth PCP 5% Telehealth Specialist 5% Telehealth Occupational Therapy Services 5% Telehealth PT and SP Services 5% Telehealth Other Health care Providers 5% Telehealth Individual Mental Health 5% Telehealth Group Mental Health 5% Telehealth Individual Psychiatric Services 5% Telehealth Group Psychiatric Services 5% Telehealth Individual Substance Abuse 5% Services Telehealth Group Substance Abuse Services 5% Telehealth Kidney Disease Education Services $0 Telehealth Diabetes Self -Management $0 Training Telehealth Opioid Treatment Program 5% Services Telehealth Urgent care $35 Wigs* $0 Maximum $400 Frequency every year July 2026 42792_1_42793_1 CITY OF FORT WORTH CW t n a - Aetna MedicareSM Plan (PPO) Medicare (CO3) ESA PPO Rx $10/$30/$50/20% OPTIONAL PROGRAMS AND SERVICES This is what you pay for network & out -of - (NOT COVERED BY ORIGINAL MEDICARE) network providers. Fitness Benefit SilverSneakers° Healthy Rewards Covered Meals Discharge Type Number of meals Number of Days Vendor Over-the-counter (OTC) items OTC Kit Allowance Frequency Are you offering Nicotine Replacement Therapy (NRT) as a Part C OTC benefit? Are you offering Naloxone coverage as a Part C OTC benefit? Mode of Delivery Resources For Living° For help locating resources for every day needs. �0 npatient Acute Hospital, Inpatient Psychiatric dospital or Skilled Nursing Facility 4 71 JationsMarket $0 N/A $30 Yes Catalogue Purchase Covered Benefits that may require a prior authorization are listed with an asterisk (*) in the benefits grid. See next page for Pharmacy -Prescription Drug Benefits. July 2026 42792_1_42793_1 ,vaetna", CITY OF FORT WORTH Aetna MedicareSM Plan (PPO) Medicare (CO3) ESA PPO Rx $10/$30/$50/20% PHARMACY - PRESCRIPTION DRUG BENEFITS Pharmacy Network P1 Your Medicare Part D plan uses the network above. To find a network pharmacy, you can visit our website (http://www.aetnaretireeplans.com.) Formulary (Drug List) Classic Plus Calendar -Year Deductible for Prescription Drugs $100 Prescription drug calendar year deductible must be satisfied before any Medicare Prescription Drug benefits are paid. Covered Medicare Prescription Drug expenses will accumulate toward the pharmacy deductible. The deductible does not apply to covered insulins and most Part D vaccines. Initial Coverage Phase - The table below represents cost sharing after the deductible, if applicable, has been reached. 30-day Supply through 90-day Supply through Retail or Mail Retail 4 Tier Plan Preferred Standard Preferred Preferred Standard Retail Mail Retail or Mail Tier 1 - Generic $8 $10 $20 $20 $25 Generic Drugs Tier 2 - Preferred Brand $30 $30 $75 $75 $75 Preferred Brand Drugs Tier 3 - Non -Preferred $50 $50 $125 $125 $125 Brand Non -Preferred Brand Drugs Tier 4 - Specialty 20%, but not 20%, but not Limited to Limited to Limited to Includes high- more than more than one -month one -month one -month cost/unique generic and $200 $200 supply supply supply brand drugs If you reside in a long-term care facility, your cost share is the same as a 30 day supply at a retail pharmacy and you may receive up to a 31 day supply. July 2026 42792_1_42793_1 ,vaetna CITY OF FORT WORTH Aetna MedicareSM Plan (PPO) Medicare (CO3) ESA PPO Rx $10/$30/$50/20% You won't pay more than $35 for a one -month supply or $105 for up to a three-month supply of each covered insulin product regardless of the cost -sharing tier. Catastrophic Coverage: You pay $0 for covered Part D prescription drugs. Catastrophic Coverage benefits start once the CMS -determined annual out-of-pocket threshold of $2,400 for covered Part D prescription drugs is reached. Requirements: Precertification Applies Step -Therapy Applies Non -Part D Supplemental Benefit • Agents used for cosmetic purposes or hair growth • Agents used to promote fertility • Agents when used for the symptomatic relief of cough and colds • Agents when used for the treatment of sexual or erectile dysfunction (ED) • Agents when used for weight loss • Miscellaneous agents • Prescription vitamins and mineral products, except prenatal vitamins and fluoride preparations Medical Disclaimers The provider network may change at any time. You will receive notice when necessary. Participating physicians, hospitals and other health care providers are independent contractors and are neither agents nor employees of Aetna. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change. July 2026 42792_1_42793_1 ,vaetna CITY OF FORT WORTH Aetna MedicareSM Plan (PPO) Medicare (CO3) ESA PPO Rx $10/$30/$50/20% In case of emergency, you should call 911 or the local emergency hotline. Or you should go directly to an emergency care facility. The complete list of services can be found in the Evidence of Coverage (EOC). The following is a partial list of what isn't covered or limits to coverage under this plan: • Services that are not medically necessary unless the service is covered by Original Medicare or otherwise noted in your Evidence of Coverage • Plastic or cosmetic surgery unless it is covered by Original Medicare • Custodial care • Experimental procedures or treatments that Original Medicare doesn't cover • Outpatient prescription drugs unless covered under Original Medicare Part B You may pay more for out -of -network services. Prior approval from Aetna is required for some network services. For services from a non -network provider, prior approval from Aetna is recommended. Providers must be licensed and eligible to receive payment under the federal Medicare program and willing to accept the plan. Out-of-network/non-contracted providers are under no obligation to treat Aetna members, except in emergency situations. Please call our Customer Service number or see your Evidence of Coverage for more information, including the cost -sharing that applies to out -of -network services. Aetna will pay any non contracted provider (that is eligible for Medicare payment and is willing to accept the Aetna Medicare Plan) the same as they would receive under Original Medicare for Medicare covered services under the plan. Pharmacy Disclaimers Aetna's retiree pharmacy coverage is an enhanced Part D Employer Group Waiver Plan that is offered as a single integrated product. The enhanced Part D plan consists of two components: basic Medicare Part D benefits and supplemental benefits. Basic Medicare Part D benefits are offered by Aetna based on our contract with CMS. We receive monthly payments from CMS to pay for basic Part D benefits. Supplemental benefits are non -Medicare benefits that provide enhanced coverage beyond basic Part D. Supplemental benefits are paid for by plan sponsors or members and may include benefits for non -Part D drugs. Aetna reports claim information to CMS according to the source of applicable payment (Medicare Part D, plan sponsor or member). July 2026 42792_1_42793_1 ,vaetna CITY OF FORT WORTH Aetna MedicareSM Plan (PPO) Medicare (CO3) ESA PPO Rx $10/$30/$50/20% The formulary and/or pharmacy network may change at any time. You will receive notice when necessary. You must use network pharmacies to receive plan benefits except in limited, non -routine circumstances as defined in the EOC. In these situations, you are limited to a 30 day supply. Pharmacy clinical programs such as precertification, step therapy and quantity limits may apply to your prescription drug coverage. Members who get "extra help" don't need to fill prescriptions at preferred network pharmacies to get Low Income Subsidy (LIS) copays. Specialty pharmacies fill high -cost specialty drugs that require special handling. Although specialty pharmacies may deliver covered medicines through the mail, they are not considered "mail-order pharmacies." Therefore, most specialty drugs are not available at the mail-order cost share. The typical number of business days after the mail order pharmacy receives an order to receive your shipment is up to 10 days. Enrollees have the option to sign up for automated mail order delivery. There are three general rules about drugs that Medicare drug plans will not cover under Part D. This plan cannot: • Cover a drug that would be covered under Medicare Part A or Part B. • Cover a drug purchased outside the United States and its territories. • Generally cover drugs prescribed for "off label" use, (any use of the drug other than indicated on a drug's label as approved by the Food and Drug Administration) unless supported by criteria included in certain reference books like the American Hospital Formulary Service Drug Information, the DRUGDEX Information System and the USPDI or its successor. Additionally, by law, the following categories of drugs are not normally covered by a Medicare prescription drug plan unless we offer enhanced drug coverage for which additional premium may be charged. These drugs are not considered Part D drugs and may be referred to as "exclusions" or "non -Part D drugs". These drugs include: • Drugs used for the treatment of weight loss, weight gain or anorexia • Drugs used for cosmetic purposes or to promote hair growth • Prescription vitamins and mineral products, except prenatal vitamins and fluoride preparations • Outpatient drugs that the manufacturer seeks to require that associated tests or monitoring services be purchased exclusively from the manufacturer as a condition of sale July 2026 42792_1_42793_1 ,vaetna CITY OF FORT WORTH Aetna MedicareSM Plan (PPO) Medicare (CO3) ESA PPO Rx $10/$30/$50/20% • Drugs used to promote fertility • Drugs used to relieve the symptoms of cough and colds • Non-prescription drugs, also called over-the-counter (OTC) drugs • Drugs when used for the treatment of sexual or erectile dysfunction Your plan includes supplemental coverage for some drugs not typically covered by a Medicare Part D plan. Refer to the "Non -Part D Supplemental Benefit" section in the chart above. Non -Part D drugs covered under the enhanced drug benefit can be purchased at the appropriate plan copay. Copayments and other costs for these prescription drugs will not apply toward the deductible, initial coverage limit or true out-of-pocket threshold. Some drugs may require prior authorization before they are covered under the plan. Plan Disclaimers Aetna Medicare is a PPO plan with a Medicare contract. Enrollment in our plans depends on contract renewal. Participating physicians, hospitals and other health care providers are independent contractors and are neither agents nor employees of Aetna. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change. Plans are offered by Aetna Health Inc., Aetna Health of California Inc., and/or Aetna Life Insurance Company (Aetna). You must be entitled to Medicare Part A and continue to pay your Part B premium and Part A, if applicable. See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by service area. If there is a difference between this document and the Evidence of Coverage (EOC), the EOC is considered correct. You can read the Medicare & You 2027 Handbook. Every year in the fall, this booklet is mailed to people with Medicare. It has a summary of Medicare benefits, rights and protections, and answers to the most frequently asked questions about Medicare. If you don't have a copy of this booklet, you can get it at the Medicare website (http://www.medicare.gov) or by calling 1-800-MEDICARE (1- 800-633-4227), 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048. You can also visit our website at http://www.aetnaretireeplans.com. As a reminder, our website has the most up-to-date information about our provider network (Provider Directory) and our list of covered drugs (Formulary/Drug List). July 2026 42792_1_42793_1 ,Vaetna- CITY OF FORT WORTH Aetna MedicareSM Plan (PPO) Medicare (CO3) ESA PPO Rx $10/$30/$50/20% Information is believed to be accurate as of the production date; however, it is subject to change. For more information about Aetna plans, go to http://www.aetna.com. This document is not intended to be member -facing as it does not include the required disclosures. ***This is the end of this plan design*** ©2026 Aetna Inc. Y0001_G RP_1099_3732a_2021_M Approved By: Date: July 2026 42792_1_42793_1 ,P►aetna TM Proprietary and Confidential Trade Secrets/Commercial and Financial Information Not for Further Distribution Date: July 15, 2026 PS ID: 191 - PS Name: CITY OF FORT WORTH Product Name: ESA Only Plan Year: January 01, 2027 - December 31, 2027 Claims Period: May 01, 2025 - April 30, 2026 Experience Exhibit: CITY OF FORT WORTH This exhibit displays the historical experience used in the development of the rates. Incurred Medical Claims have been normalized for Benefit and Demographic changes. Historical Experience Incurred Normalized Normalized Month Members Medical Claims Medical Claims Claims PMPM TOTALS 32,662 $39,184,057 $39,358,566 $1,205.03 Net Incurred Claims PMPM $1,205.03 Premium Development Current Members Current Monthly Premium $255,874 Current Members 2,771 Total: 2,771 Current Premium PMPM $92.34 May-25 2,698 $3,251,085 $3,273,293 $1,213.23 Jun-25 2,707 $3,283,292 $3,305,719 $1,221.17 Jul-25 2,703 $3,344,668 $3,367,515 $1,245.84 Aug-25 2,700 $3,092,869 $3,113,996 $1,153.33 Sep-25 2,703 $2,895,001 $2,914,776 $1,078.35 Oct-25 2,712 $3,687,402 $3,712,590 $1,368.95 Nov-25 2,728 $2,826,529 $2,845,836 $1,043.20 Dec-25 2,729 $3,166,848 $3,188,480 $1,168.37 Jan-26 2,737 $3,259,431 $3,259,431 $1,190.88 Feb-26 2,738 $3,129,716 $3,129,716 $1,143.07 Mar-26 2,752 $3,457,747 $3,457,747 $1,256.45 Apr-26 2,755 $3,789,467 $3,789,467 $1,375.49 TM ,vaetna Proprietary and Confidential Trade Secrets/Commercial and Financial Information Not for Further Distribution Date: July 15, 2026 PS ID: 191 - PS Name: CITY OF FORT WORTH Product Name: ESA Only Plan Year: January 01, 2027 - December 31, 2027 Claims Period: May 01, 2025 - April 30, 2026 Rate Change Development The components of your renewal rate change are detailed below: 2027 Rate Development 1. Incurred Claims PMPM $1,205.03 (5/1/2025 - 4/30/2026) 2. Annual Claim Trend 8.3% Experience Period: (51112025 - 413012026) 111112025 Renewal Rate Period: (11112027 - 1213112027) 7/1/2027 3. Months to Trend Experience 20 4. Trended Incurred Claims (#1 x (1 + #2)^(#3 /12)) $1,376.32 5. Renewal Plan Change Factor 1.0000 6. (a) Add: Pooling Charge PMPM ($400,000 high -cost pooling threshold) $7.75 (b) Subtract: Pooling Credit PMPM ($6.95) 7. Projected Incurred Claims PMPM ((#4 x #5 + #6a + #6b) $1,377.12 8. Target Loss Ratio 89.00% 9. Total Quote Year Required Revenue PMPM (#7 / #8) $1,547.33 (includes additional admin and commissions, if applicable) 10. Projected CMS Revenue PMPM $1,420.09 11. Required Premium PMPM (#9 - #10) $127.24 *vaetna TM Proprietary and Confidential Trade Secrets/Commercial and Financial Information Not for Further Distribution Date: July 15, 2026 PS ID: 191 - PS Name: CITY OF FORT WORTH Product Name: Integrated PD Plan Year: January 01, 2027 - December 31, 2027 2027 Rate Development The components of your renewal rate are detailed below: 1. Allowed Claims net of Rebates 2. Member Cost Share/LICS 3. Mfr Discount Program 4. Net Reinsurance/Selected Drug Subsidy 5. Net Claims PMPM (#1 + #2 + #3 + #4) 6. Target Loss Ratio 7. Required Revenue PMPM (#5 / #6) 8. Projected CMS Revenue PMPM 9. Required Premium PMPM (#7 - #8) 10. Gross Savings for Unbundling (#9 PDP - #9 PD) 11. Fees for Unbundling 12• Net Savings for Unbundling (#10 + #11) PD Development PDP Development $467.22 ($41.22) ($47.94) ($66.24) $311.83 89.0% $350.37 $162.33 $241.41 $188.04 $108.96 ($79.08) $5.00 ($74.08) TM ***aetna Proprietary and Confidential Trade Secrets/Commercial and Financial Information Not for Further Distribution Date: July 15, 2026 PS ID: 191- PS Name: CITY OF FORT WORTH Product Name: ESA Only with Integrated PD Plan Year: January 01, 2027 - December 31, 2027 2027 MAPD Rate Development MA PD Total Current Members 2,771 2,771 2,771 #1 Current Premium PMPM $92.34 $158.98 $251.32 Required Renewal Premium Development #2 Projected Incurred Claims PMPM $1,377.12 $311.83 $1,688.95 #3 Target Loss Ratio 89.0% 89.0% 89.0% #4 Required Revenue PMPM (#2 / #3) $1,547.33 $350.37 $1,897.70 #5 Projected CMS Revenue PMPM $1,420.09 $162.33 $1,582.42 #6 Required Renewal Premium PMPM (#4 - #5) $127.24 $188.04 $315.28 Final Renewal Premium #7 Renewal Premium PMPM before Other Adjustment $127.24 $188.04 $315.28 #8 Other Adjustment PMPM ($29.90) ($29.06) ($58.96) #9 Final Renewal Premium PMPM (#7 + #8) $97.34 $158.98 $256.32 #10 Final Renewal Rate Change PMPM (#9 - #1) $5.00 $0.00 Financial Conditions Proprietary & Confidential Trade Secrets/Commercial and Financial Information - Not for Further Distribution City of Fort Worth January 1, 2027 through December 31, 2027 Definitions For the purpose of this document: (1) "MA" means a group Medicare Advantage MA HMO and/or PPO plan without Medicare prescription drug coverage; (2) "MAPY means a group MA HMO and/or PPO plan with Medicare prescription drug coverage; (3) "PDP" means a group standalone Medicare prescription drug plan; and (4) "ESA" means an MA PPO plan that uses a CMS -established waiver of service area requirements to offer coverage to eligible retirees/dependents who reside in an extended service area that does not offer a provider network that meets CMS network adequacy requirements. Please refer to Rate Guarantee for additional conditions applicable to the 2027 calendar year. Effective Date The rates and benefit plan designs provided in this renewal are effective January 1, 2027 through December 31, 2027. We will issue a new Financial Conditions with each year's renewal that will govern for that year, and contract will be amended to include the latest version when applicable. Automatic renewal of your plan if we don't hear from you by October 1, 2026 If you plan to change or terminate your Aetna Group Medicare Plan you need to notify us in writing as soon as possible. We must hear from you by October 1, 2026.Otherwise, we will assume you consider the information in this renewal to be accurate, and you have chosen to renew your Aetna Group Medicare Plan for 2027. If you do not respond to this renewal, we will automatically renew your plan with the benefits, cost sharing, premium rates and terms and conditions described in this renewal and enclosed materials, and in your agreement with Aetna. The following conditions allow us to assess the potential financial impact and adjust premium rates, subject to applicable state and federal mandates: Enrollment Assumptions - We reserve the right to rerate or restructure our rating if: a) the total enrollment varies by more than 10 percent from the enrollment assumption used in the enclosed rating or, b) if any site's enrolled membership expressed as a percent of total enrolled membership varies by more than +/- 10 percent from that assumed when rating the case or, c) if any plans' enrolled membership expressed as a percent of total enrolled membership varies by more than +/- 10 percent from that assumed when rating the case. Aetna group retiree coverage does not extend to additional employer groups unless we are able to review supplemental census information and other underwriting information for appropriate financial review. Q003759.00_20260714_183419 vcw`na Page 1 Financial Conditions Proprietary & Confidential Trade Secrets/Commercial and Financial Information - Not for Further Distribution City of Fort Worth January 1, 2027 through December 31, 2027 Full replacement - Aetna reserves the right to revise or terminate all components of this renewal at any time if the Aetna MAPD Plan is not full replacement coverage for all 2,771 Members enrolled in the MAPD Plan or is not the only group Medicare Advantage plan offered to all of City of Fort Worth's current and future retirees and dependents who are eligible to enroll in the MAPD Plan. Legislative, Regulatory, CMS Changes, Executive Orders or Enforcement Action - Aetna reserves the right to revise or terminate all components of this renewal at any time if there are any legislative, regulatory, CMS changes, Executive Orders and/or enforcement actions that cause a change to taxes, fees, assessments, required benefits, Medicare Advantage program revenue or level of reimbursement that CMS will make to Aetna for Members, or the manner and/or cost of providing MAPD Plan medical benefits, including, but not limited to: o any changes in methodology used to calculate CMS funding for the MAPD Plans; o any changes to the Medical/Pharmacy program, including, but not limited to, any current proposals or legislation that have not yet been finalized; and/or o implementation of the Risk Adjustment Data Validation Audit (RADV) rule as published on January 30, 2023, and any related regulatory guidance Plan eligibility for MAPD -This renewal assumes all members are retired and enrolled in Medicare Part A and Part B. If you have retirees that are not eligible for premium free Part A they must be enrolled in an Aetna Medicare Part B only plan and separate rates will be provided to cover these members. Additionally, you represent that actively working employees and their dependents are not permitted to enroll in your group Medicare Advantage and/or Medicare Advantage with prescription drug plan(s) ("Plan(s)"), and that by offering the Plan(s) you intend to create and maintain a retiree plan that is separate from your active plan. • Employer contribution requirements -This renewal assumes your average employer contribution level is 75% of the group premium for the Medical/Pharmacy plan. If the actual employer contribution differs from this assumed percentage, the MAPD Plan rates and/or the plan offering are subject to revision. Q003759.00_20260714_183419 **cw`na Page 2 Financial Conditions Proprietary & Confidential Trade Secrets/Commercial and Financial Information - Not for Further Distribution City of Fort Worth January 1, 2027 through December 31, 2027 • Medicare Part D Aetna reserves the right to terminate this renewal, change the Medical/Pharmacy Plan premium or restructure the Part D plan design or formulary at any time if there are any legislative, regulatory or CMS changes, Executive Orders and/or enforcement actions that cause a change to taxes, fees, assessments, required benefits, Part D program revenue or level of reimbursement that CMS will make to Aetna for Members, or the manner and/or cost of providing Part D benefits, including, but not limited to: • elimination of safe harbor protection under the federal Anti -Kickback Statute (AKS) for drug manufacturer rebates or other price concessions, • establishment of new safe harbor protection under the AKS for certain point -of - sale reductions in drug pricing, • changes to the drug manufacturer discount program, • changes to federal Part D subsidies, including changes to catastrophic reinsurance, • drugs selected for Drug Price Negotiation and Maximum Fair Prices, • changes due to Part D reform.* * The renewal Plan Rates for 2027 includes adjustments to reflect known Part D program changes. However, additional updates to the Part D program that are not known at the time of this document's release, including potential changes resulting from the GREAT Healthcare Plan, may require future adjustments to rates. This renewal excludes any additional income -related Medicare Part D premium payments required of Medicare -eligible Members in order for the Member to be eligible for the Part D product. Aetna reserves the right to communicate with Members regarding opportunities to reduce out of pocket prescription drug costs. • Medicare Part D Formulary The supplemental premium rates are limited to prescription drugs covered by the quoted formulary. Aetna reserves the right to adjust the level of the renewal increase per any request for formulary coverage expansion. Unless specifically addressed in this document, all previously provided Financial Conditions also apply to this renewal. • Rate and benefit approval -This renewal is subject to Centers for Medicare and Medicaid Services ("CMS") annual filing approval for the Medicare Advantage and Medicare prescription drug contracts, applications, and service areas for calendar year 2027. Filed benefits, including cost sharing amounts and premiums, are subject to Q003759.00_20260714_183419 vcw`na M Page 3 Financial Conditions Proprietary & Confidential Trade Secrets/Commercial and Financial Information - Not for Further Distribution City of Fort Worth January 1, 2027 through December 31, 2027 regulatory approval(s), where applicable, and are effective January 1, 2027 through December 31, 2027. Timely premium payments - If a premium payment is not paid in full on or before the premium due date, a late payment charge of one and one-half percent of the total amount due per month may be added to the amount due, beginning with the premium due date. We also have the right to assess late premium payment and costs of collection of any unpaid premiums or fees, including reasonable attorney's fees and cost of suit. End stage renal disease - This section applies to Aetna's group MAPD Plan (collectively, "Aetna Group Medicare Plans"). We assume that you don't enroll retirees and their dependents who are Medicare beneficiaries diagnosed with End Stage Renal Disease ("ESRD Beneficiaries") in the Aetna Group Medicare Plans during their 30-month coordination period, unless the ESRD beneficiaries maintain coverage under your commercial group health plan as the primary payer during their 30-month coordination period and the Aetna Group Medicare Plan is the secondary payer. We will only offer Aetna Group Medicare Plans to ESRD Beneficiaries in a manner that is consistent and complies with applicable laws, rules, and regulations, including, but not limited to, 42 C.F.R. § 422.50(a)(2) and other Medicare Advantage and Medicare Secondary Payer ("MSP") laws, rules and regulations and Centers for Medicare and Medicaid Services ("CMS") instructions ("MSP Requirements"). If an ESRD Beneficiary is eligible for or entitled to Medicare based on End Stage Renal Disease, federal law requires your commercial group health plan ("GHP") to be the primary payer for the first thirty months of the ESRD Beneficiary's Medicare eligibility or entitlement ("30-month coordination period"), regardless of the number of employees and regardless of whether the ESRD Beneficiary is a current employee or retiree. Therefore, you must confirm whether ESRD Beneficiaries are in their 30-month coordination period and not enroll ESRD Beneficiaries in our Aetna Group Medicare Plan during their 30-month coordination period unless coverage under the GHP is maintained for such ESRD Beneficiaries for that period. Aetna's understanding of the 21st Century Cures Act is that MSP Requirements continue to apply to ESRD Beneficiaries. This means that ESRD Beneficiaries will continue to have the option of enrolling in an Aetna Group Medicare Plan after they complete their 30- month coordination period, as permitted under MSP requirements. If CMS or any other federal agency with jurisdiction later indicates that MSP Requirements relating to ESRD Beneficiaries have changed as a result of the 21st Century Cures Act or any other applicable law, rule or regulation, Aetna reserves the right to revise or restructure the rates in this renewal. Q003759.00_20260714_183419 vcw`na M Page 4 Financial Conditions Proprietary & Confidential Trade Secrets/Commercial and Financial Information - Not for Further Distribution City of Fort Worth January 1, 2027 through December 31, 2027 • Medical deductible and/or OOP (Out of Pocket) Max credits - This quote excludes medical deductible and/or Out of Pocket max credits from our proposed medical plan. • Use of pharmacy data for medical management - The enclosed medical rates assume that either, a) we are the pharmacy benefit administrator or PDP carrier or, b) we receive weekly pharmacy data feeds in an appropriate format from either you or your designated third party. The medical rates are subject to revision if either of these conditions does not occur. Additional products and services- We will bill you for the cost of special services that are not included or assumed in the pricing. For example, you'll be subject to additional charges for customized communication materials. Costs will depend on the actual services performed and are determined at the time the service is requested. Inaccurate or incomplete information - We're relying on information from you and your representatives in establishing the rates and terms of this renewal. If any of this information is inaccurate or incomplete and has a material impact on the cost of the programs, we reserve the right to adjust our rates and terms. Proprietary and Confidential- This renewal contains trade secrets and commercial and financial information that Aetna deems proprietary and confidential and cannot be further released to any third party by City of Fort Worth without Aetna's prior written consent. Aetna Intellectual Property Under your Agreement with Aetna for the group Medicare Plans ("Agreement"), you may have access to certain of Aetna's Customer reporting systems. Aetna represents that it has either the ownership rights or the right to use all of the intellectual property used by Aetna in providing services under the Agreement ("Aetna IP"). Aetna will grant you, as the Customer, a nonexclusive, non -assignable, royalty free, limited right to use certain of the Aetna IP for the purposes described in the Agreement. You agree not to modify, create derivative product from, copy, duplicate, decompile, dissemble, reverse -engineer or otherwise attempt to perceive the source code from which any software component of the Aetna IP is compiled or interpreted. Nothing in the Agreement shall be deemed to grant any additional ownership rights in, or any right to assign, sublicense, sell, resell, lease, rent or otherwise transfer or convey, the Aetna IP to you. Q003759.00_20260714_183419 vcw`na M Page 5 Financial Conditions Proprietary & Confidential Trade Secrets/Commercial and Financial Information - Not for Further Distribution City of Fort Worth January 1, 2027 through December 31, 2027 Conclusion We present this renewal on the condition that it will be accepted in its entirety. Furthermore, we've assumed that you'll continue to offer all other coverages, products, and services that you purchased previously. If there is a material change in this regard, we reserve the right to review and reprice this renewal. If you're interested in a subset of our renewal, then we will review and reprice, if necessary. Before accepting the rates in this renewal, you must disclose any material deviation, current or expected, from these assumptions. The most recent version of this document issued by Aetna to you, including any attachments to this document (collectively, "Financial Documents") are part of your agreement with Aetna to offer Medicare Advantage plans and/or standalone Medicare prescription drug plans ("Group Agreement"). In the event of a conflict between the terms of the Financial Documents and your Group Agreement and the documents incorporated into the Group Agreement, the order of priority shall be as described in your Group Agreement. Any riders, amendments, inserts and attachments shall have the same priority as the document to which they are attached. Q003759.00_20260714_183419 vcw`na M Page 6 Broker Compensation/Plan Sponsor Fees Proprietary & Confidential Trade Secrets/Commercial and Financial Information - Not for Further Distribution City of Fort Worth January 1, 2027 through December 31, 2027 Broker commissions - The enclosed rates exclude broker commissions. We honor `Agent of Record' or `Broker of Record' letters when an agent, broker, or consultant sells new business or takes over an Aetna case from another agent, broker, or consultant. Please have an appropriate representative from your organization sign the letter using your organization's letterhead. The change will become effective on the first day of the month after our payment unit receives the `Agent of Record' or `Broker of Record' letter unless another future date is designated in the letter. Q003759.00_20260714_183419 vcw`na Page 7 Aetna Plan and Benefit Information Proprietary & Confidential Trade Secrets/Commercial and Financial Information - Not for Further Distribution City of Fort Worth January 1, 2027 through December 31, 2027 Thank you for choosing Aetna°. We appreciate your business and are pleased to provide the enclosed 2027 Group Retiree Medicare plan renewal documents for City of Fort Worth for the Medical/Pharmacy ("Aetna Medicare plan") (collectively, the "Renewal package"). Automatic renewal of your plan Unless you request a change to this Renewal package by October 1, 2026, your plan will automatically renew on January 1, 2027, consistent with the terms described in the documents included in this Renewal package and your agreement with Aetna for the Aetna Medicare plan ("Group Agreement"). There will be no exceptions to making changes to benefits after October 1, 2026. If you choose to terminate your Aetna Group Medicare plan you must notify Aetna in writing by first class mail or email no later than October 1, 2026. The following plan benefit information is being provided to notify City of Fort Worth of some important information related to Aetna's Medicare Advantage and Part D plans. Medicare Advantage - Medical Plan Information CMS Changes Each year, CMS sets cost sharing threshold amounts on specific MA plan benefits to ensure access to care and prevent discrimination against certain classes of Medicare beneficiaries. CMS has made the following changes to these thresholds for 2027. Changes to maximum -out-of-pocket (MOOP) limit for some MA PPO plans CMS provides you with the ability to establish different values for your plan. Plans offering an in -network MOOP in the Lower, Intermediate or Mandatory range must also offer a plan level MOOP in the same range. The chart below helps to define the 2027 thresholds for MA PPO plans. Lower MOOP Intermediate MOOP Mandatory MOOP $0 - $4,450 In -network $4,451 - $7,150 In -network $7,151 - $9,850 In -network $0 - $6,700 Plan Level $4,451 - $10,750 Plan Level $7,751 - $14,800, Plan Level (combined) (combined) (combined) To encourage members to receive the most effective health care CMS has adjusted the cost share thresholds for specific service categories. These changes have been implemented with respect to the Aetna standard plan portfolio. It is important that you review each service category in your Summary of Benefits for any year -over -year changes. 0003759.00_20260714_183419 vcwtna U Page 1 Aetna Plan and Benefit Information Proprietary & Confidential Trade Secrets/Commercial and Financial Information - Not for Further Distribution City of Fort Worth January 1, 2027 through December 31, 2027 Your Aetna account representative can assist you with understanding these year -over - year changes and any additional adjustments you may want to make to your plan. Network Changes in Aetna Medicare Advantage network -based service areas for 2027 PPO: The MA PPO network -based service area will be reduced by 7 counties in 2027. Please see the 2027 Aetna Medicare Advantage PPO network -based withdrawal counties exhibit in the Index to this renewal. CMS group enrollment waiver CMS has established a waiver of network service area requirements ("Waiver") for some employer/union groups. Under this waiver, the employer/union may enroll their retirees in an MA HMO or PPO plan even if they reside in a service area that does not have access to network providers. We refer to these non -network service areas as "Extended Service Areas" (ESA). In order to be eligible for the Waiver, at least 51 percent of your retirees and dependents must live in a service area that provides adequate access to network providers. Aetna will apply the CMS network requirements when determining if a county or service area meets adequate access requirements. It is important to know that: • Members in an ESA plan may not have access to the Aetna network of providers that meets CMS network adequacy requirements. • Providers that are not contracted with Aetna are not required to accept the Aetna ESA PPO plan except for emergency and urgently needed care. We will monitor the network adequacy throughout the year to confirm that standards are met. Our network teams will work to strengthen our provider networks to meet CMS network adequacy requirements to help avoid potential disruption to our members. As of June 2026, 97.29% of your members reside in service areas that meet CMS network adequacy requirements. If the total percentage of members falls below 51 percent by the date of your Aetna MA PPO plan renewal, we cannot offer you our MA PPO ESA plan. However, we will work with you to evaluate other group health plan options that can be offered in these extended service areas to help reduce potential Member disruption. 0003759.00_20260714_183419 vcwtna U Page 2 Aetna Plan and Benefit Information Proprietary & Confidential Trade Secrets/Commercial and Financial Information - Not for Further Distribution City of Fort Worth January 1, 2027 through December 31, 2027 US Territories Aetna offers Medicare Advantage PPO plans to retirees throughout the 50 states, Washington, DC, and the US Territories through use of a CMS service area waiver ("MA PPO ESA plans"). Please be advised that coverage under the MA PPO ESA plan in the US Territories is limited to medical coverage. Aetna MA PPO ESA plans do not offer fully insured Medicare prescription drug coverage in the US Territories. Therefore, if one of your MA PPO ESA plan members moves to a US Territory and Medicare prescription drug coverage is offered under that plan, the member will no longer be eligible for the plan. In this scenario, please contact Aetna to discuss plan options. Aetna may offer a MA PPO ESA plan with medical coverage only for your members who reside in the US Territories, and we will discuss with you available pharmacy coverage options. We are making you aware of these rules because of the potential impact to your account structure and eligibility files in this scenario. Please reach out to your Account Management Team for more information. Part D Information Prescription drug coverage Our retiree pharmacy coverage consists of two components: basic Medicare Part D benefits and supplemental benefits. • We offer Medicare Part D plan coverage pursuant to our contract with the CMS. We receive monthly payments from CMS for the Part D portion of your coverage. • We offer supplemental coverage that wraps around the basic Medicare Part D benefits, allowing you to offer enhanced pharmacy benefits. We receive monthly premium payments from you and/or your retirees for the supplemental coverage. Depending on your plan design, supplemental coverage may also include benefits for non -Part D covered drugs. We will report drug claims information to CMS, based on the source of the applicable coverage payment - Medicare Part D, plan sponsor or member. When the IRA was enacted in 2022 significant changes were made to the Medicare Part D benefit such as reducing True Out -of -Pocket (TrOOP) and limiting cost share for vaccines, insulin, and in the catastrophic coverage phase. In addition, the Medicare negotiated Maximum Fair Price (MFP) program began January 1, 2026. Ten highly utilized drugs (Eliquis, Enbrel, Entristo, Farxiga, Imbruvica, Januvia, Jardiance, Stelara, Xarelto, and Fiasp/Novolog) were included in 2026. Beginning January 1, 2027,15 additional drugs will be included in MFP (Ozempic/Rybelsus/Wegovy, Trelegy Ellipta, Xtandi, Pomalyst, Ibrance, Ofev, Linzess, Calquence, Austedo/Austedo XR, Breo Ellipta, Tradjenta, Xifaxan, Vraylar, Janumet/Janumet XR, Otezla). These drugs must be Q003759.00_20260714_183419 vcw`na U Page 3 Aetna Plan and Benefit Information Proprietary & Confidential Trade Secrets/Commercial and Financial Information - Not for Further Distribution City of Fort Worth January 1, 2027 through December 31, 2027 included in all forms on all formularies. The MFP is applied prospectively at point of sale based on rates directly negotiated and contracted by Medicare. This price will be less than the pharmacy purchase price. Manufacturers will make pharmacies whole by paying the MFP discount to a Medicare Transaction Facilitator (MTF) who will pay the pharmacy. The Manufacturer Discount Program does not apply to MFP drugs. CMS changes The CMS Part D standard benefit parameters change annually. For details specific to Part D coverage you offer to your retirees, you should refer to the plan design document, included with this renewal. These changes, which are summarized below, will impact all plan designs this year. 2026 2027 Deductible cannot exceed: $615 $700 Amount required to move members into $2,100 $2,400 the Catastrophic phase True Out -of -Pocket True Out -of -Pocket (TrOOP) threshold (TrOOP) threshold Catastrophic copayments $0 for all covered Part $0 for all covered D drugs Part D drugs Our rider documents are updated annually. Covered drug categories are based on what is found in the member's MAPD: Schedule of Cost Sharing. Members may contact the number on the back of their card for current coverage information. Please note: Cost shares for non -Part D drugs covered under a rider or supplemental benefit, if applicable, do not count towards the CMS True Out -of -Pocket (TrOOP) threshold to move members into the Catastrophic phase. Changes to the Aetna prescription drug plan for 2027 Aetna's Part D formulary changes Formularies change on an annual basis. Members should review the updated formulary that aligns with their plan to determine if a drug they are taking will still be covered, the tier of such coverage, and what they will pay for their drugs in 2027. Updated plan year formularies are made available online on October 1st. Members may also request that a printed copy of this formulary be mailed to them by contacting Aetna customer service. Q003759.00_20260714_183419 **►aet n a Page 4 Aetna Plan and Benefit Information Proprietary & Confidential Trade Secrets/Commercial and Financial Information - Not for Further Distribution City of Fort Worth January 1, 2027 through December 31, 2027 2027 Description Formulary Name Comprehensive Plus • Richest option; open; covers all Part D drugs • Generic drugs reside on defined generic tier(s) Strategic Saver Plus • Rich option; covers most Part D drugs but considered closed because of some strategic exclusions to maximize rebate value • Generic drugs reside on defined generic tier(s) Signature Plus • Closed; broad Part D drug coverage with strategic exclusions • Generic drugs reside on defined generic tier Classic Plus . Closed; covers a subset of Part D drugs; medium coverage • Generic drugs reside on defined generic tier(s) Classic • Closed; covers a subset of Part D drugs; medium coverage • Generics reside on all tiers Core Plus • Closed; lean coverage • Generic drugs reside on defined generic tier(s) Core • Closed; lean coverage Generics reside on all tiers The P1 Preferred Network plan option This option provides a lower price point through use of a pharmacies with preferred status. Members generally pay a lower cost share when utilizing pharmacies that are preferred. Members will also have access to standard pharmacies within the network; however, they will likely pay a higher cost share when receiving covered medications at standard pharmacies. To find a network pharmacy, members can visit our website: http://www.aetnaretireeplans.com. Aetna Mail Order Aetna's mail order benefits are filled by CVS Caremark° Mail Service Pharmacy. This mail order service supplies medications for drugs taken on a regular basis, sometimes referred to as maintenance drugs. Examples of maintenance drugs include medications used to treat chronic conditions such as arthritis, high cholesterol, asthma, or high blood pressure. CVS Caremark° Mail Service Pharmacy does not supply medications used for short-term illnesses, such as cold medications or antibiotics. Additionally, certain drugs that require special handling may not be available through CVS Caremark° Mail Service Pharmacy. These drugs are sometimes called specialty drugs and may require storage at controlled temperatures or other unique handling requirements which cannot be accommodated through a traditional mail order arrangement. Therefore, most specialty drugs are not available at the mail order benefit (cost share) and instead will pay at the retail benefit (cost share). Also, specialty drugs are generally limited to a 30-day fill, to reduce waste of these high -cost drugs. Q003759.00_20260714_183419 **►aetna Page 5 Aetna Plan and Benefit Information Proprietary & Confidential Trade Secrets/Commercial and Financial Information - Not for Further Distribution City of Fort Worth January 1, 2027 through December 31, 2027 Medicare Part D creditable coverage If an applicant cannot demonstrate that he/she had prior creditable coverage, the applicant may incur late enrollment penalties, consistent with laws, rules, and regulations applicable to the Part D program. CMS Notifications We will notify members of plan changes as required by CMS CMS requires that Aetna provide each member enrolled in our group Medicare Advantage plan or Medicare prescription drug plans an Annual Notice of Change (ANOC) letter along with the new plan year Schedule of Member Cost Sharing (SOC) which provides a detailed description of the benefits and coverage provisions of the plan. The Evidence of Coverage (EOC) provides Medicare -specific information about the health plan and is available to members online or by calling customer service to request a written copy. Medicare members must receive detailed benefit information for their current plan no later than 15 days before the start of your annual open enrollment period. If you don't have an open enrollment period, Medicare members must receive this benefit information no later than 15 days before the start of the new plan year. If you wish to receive a copy of these plan documents for your records, please reach out to your Aetna account representative. Premiums Medicare Advantage - Premium Requirements - The following requirements apply only if Aetna is offering a Medicare Advantage HMO or PPO Plan to your members, and you and your members are paying any portion of the premium for the Medicare Advantage benefit ("MA Premium"). CMS requires that we notify you of these requirements. You must comply with the following conditions with respect to any subsidization of MA Premium and any required MA Premium contribution by the member: You may subsidize different amounts of MA Premium for different classes of members and their dependents, provided such classes are reasonable and based on objective business criteria, such as years of service, date of retirement, business location, job category, and nature of compensation (e.g., salaried vs. hourly). 2. MA Premium contribution levels cannot vary for members within a given class. Q003759.00_20260714_183419 vcwtna " Page 6 Aetna Plan and Benefit Information Proprietary & Confidential Trade Secrets/Commercial and Financial Information - Not for Further Distribution City of Fort Worth January 1, 2027 through December 31, 2027 3. Direct subsidy payments from CMS to Aetna must be passed through to reduce the amount of any required MA Premium payment by the member. Billing Arrangement - Aetna offers three different methods for billing premiums with our group Medicare Advantage and standalone Medicare prescription drug plans. A monthly premium can either be billed to the member ("Direct Billing"), to you ("Contract Holder Billing") or to both you and the Member ("Split Billing"). You have elected to use Contract Holder Billing. • Premium and Low Income Subsidy ("LIS") Requirements and Late Enrollment Penalty ("LEP") - City of Fort Worth will comply with the following conditions with respect to any subsidization of that portion of premiums paid by City of Fort Worth for the Medicare Prescription Drug benefit ("PD Premium") and any required PD Premium contribution by members enrolled in MAPDs or PDPs ("Members"): - City of Fort Worth may subsidize different amounts of PD Premium for different classes of Members and their dependents, provided such classes are reasonable and based on objective business criteria, such as years of service, date of retirement, business location, job category, and nature of compensation (e.g., salaried vs. hourly). Classes of Members and their dependents cannot be based on eligibility for the Low -Income Subsidy ("LIS"). - PD Premium contribution levels cannot vary for Members within a given class. - Direct subsidy payments from CMS to Aetna must be passed through to reduce the amount of any required PD Premium payment by the Member ("Member Contribution") so the Member in no event shall be required to pay more than the sum of: a) the standard Medicare Part D premium, net of the direct subsidy payment from CMS, and b) one hundred percent (100%) for any supplemental coverage selected by the Member. City of Fort Worth will comply with the following conditions with respect to any LIS payment received from CMS for any LIS-eligible Member: - Any monthly LIS payment received from CMS for an LIS-eligible Member shall be used to reduce any Member Contribution. Any remainder may then be used to reduce the amount of the City of Fort Worth's PD Premium contribution. However, if the sum of the Member Contribution and City of Fort Worth's PD Premium is less than the LIS payment, any portion of the LIS payment will be returned to CMS by Aetna. 0003759.00_20260714_183419 vcwtna U Page 7 Aetna Plan and Benefit Information Proprietary & Confidential Trade Secrets/Commercial and Financial Information - Not for Further Distribution City of Fort Worth January 1, 2027 through December 31, 2027 - If the LIS payment for any LIS-eligible Member is less than the Member Contribution required by such individual (including the Member Contribution for supplemental benefits, if any), City of Fort Worth shall communicate with the LIS-eligible Member about the cost of remaining enrolled in City of Fort Worth's Plan versus obtaining coverage as an individual under another Medicare Part D Prescription Drug plan. - In the event that the LIS-eligible Member is due a refund of the LIS payment (i.e., there was no upfront reduction of the PD Premium by the LIS amount), such refund shall be completed by Aetna or City of Fort Worth, as applicable, within 45 days of the date Aetna receives the LIS payment for that Member from CMS. Group Billed- If Aetna is billing and collecting the entire plan premium from City of Fort Worth and City of Fort Worth chooses to receive group list invoices, Aetna will apply LIS subsidy credits and LEP debits to the group invoice. City of Fort Worth must apply the LIS subsidy and collect the LEP consistent with applicable law. Direct Billed - If City of Fort Worth chooses direct billing (i.e., Aetna directly bills and collects the entire plan premium from Members), Aetna will apply LIS to the Member invoice and will add LEP debits consistent with applicable law. Additional Retiree Programs Helping your retirees obtain Medicaid coverage and access to community assistance programs We're pleased to provide plan sponsors with a Medicaid outreach program through BeneLynk. This program provides continuous monitoring of social program eligibility and enrollment status to ensure appropriate access to benefits for which members are entitled. This program includes: Initial Outreach and enrollment assistance with Medicaid or Medicare Savings Programs and the Low -Income Subsidy • Annual Recertification to maintain enrollment in these programs We believe our Medicaid outreach program provides a valuable service to potentially eligible members by educating them about and screening for Medicaid programs. Medicaid eligibility may help reduce member out-of-pocket cost sharing and premiums. It can also help us reduce annual plan premium increases due to the additional payment we receive from CMS for these beneficiaries. If your organization doesn't wish to participate and have your retirees contacted by BeneLynk, your organization may "opt -out" of our Medicaid outreach program. To do so, please contact your Aetna representative no later than October 1, 2026. Q003759.00_20260714_183419 v cw`n a U Page 8 Aetna Plan and Benefit Information Proprietary & Confidential Trade Secrets/Commercial and Financial Information - Not for Further Distribution City of Fort Worth January 1, 2027 through December 31, 2027 Please Note: If we don't receive your "opt -out" notification by October 1, 2026, your organization will be included in our Medicaid outreach program. Contract Termination Rights If you fail to meet Aetna's contribution or participation requirements (as described in this Financial Document) or you change your plan eligibility or participation requirements without Aetna's consent, Aetna may terminate the contract between you and Aetna for your plan offerings ("Contract") consistent with the terms of the Contract. Federal Information Employer Reporting Requirements: Under Internal Revenue Code (IRC) Section 6055 health insurance issuers, certain employers, government agencies and other entities that provide Minimum Essential Coverage (MEC) to individuals must report to the IRS information about the type and period of coverage and furnish related statements to covered individuals. This information is used by the IRS to administer the individual shared responsibility provision and by individuals to show compliance with the individual shared responsibility provision. For Medicare plans (including Medicare Advantage), the reporting obligation under Section 6055 is on the Centers for Medicare and Medicaid Services (CMS) to the extent it applies. CMS will report the required information to the IRS about the type and period of coverage provided to each individual member enrolled in these plans and will furnish the required statements to subscribers. IRC Section 6056 requires large employers (those having employed an average of 50 or more full-time employees during the preceding calendar year) to report to the IRS information about the health care coverage they have offered and also furnish applicable statements to employees. The purpose is to allow the IRS to enforce the employer responsibility provisions. To satisfy the 6056 employer reporting requirements, you must file the required returns with the IRS by no later than February 28 of the year following coverage (if filing on paper) or March 31 (if filing electronically) and furnish a statement to all full-time employees by January 31st of the year following the calendar year to which the return relates (i.e., January 31, 2027 for the 2026 calendar year). Q003759.00_20260714_183419 **►aetna Page 9 Aetna Plan and Benefit Information Proprietary & Confidential Trade Secrets/Commercial and Financial Information - Not for Further Distribution City of Fort Worth January 1, 2027 through December 31, 2027 Plans are offered by Aetna Health Inc., Aetna Health of California Inc., Aetna Life Insurance Company, SilverScript Insurance Company and/or their affiliates (Aetna). Aetna Medicare is a brand name used for group fully -insured standalone Medicare prescription drug plan (PDP), group Medicare Advantage HMO, and group Medicare Advantage PPO products provided by Aetna under a Medicare contract with the Centers for Medicare and Medicaid Services. Enrollment in our plans depends on contract renewal. Limitations, co -payments, and restrictions may apply. Benefits, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Q003759.00_20260714_183419 vcwtna M Page 10 Aetna Plan and Benefit Information Proprietary & Confidential Trade Secrets/Commercial and Financial Information - Not for Further Distribution City of Fort Worth January 1, 2027 through December 31, 2027 Index 0003759.00_20260714_183419 vcwtna M Page 11 Aetna Plan and Benefit Information Proprietary & Confidential Trade Secrets/Commercial and Financial Information - Not for Further Distribution City of Fort Worth January 1, 2027 through December 31, 2027 2027 Aetna Medicare Advantage PPO network -based withdrawal counties The MA PPO network -based service area will reduce by 7 counties for 2027. State County AZ Yavapai IA Story NC Rutherford SC Cherokee TX Henderson TX Kaufman UT Cache 0003759.00_20260714_183419 vcwtna M Page 12 4 tna TM Proprietary & Confidential Trade Secrets/Commercial and Financial Information - Not for Further Distribution MEDICARE ADVANTAGE RATE PROPOSAL Plan Sponsor Name: City of Fort Worth Policy Period Start Date: 1/1/2027 Policy Period End Date: 12/31/2027 Medical Plan: Medicare (CO3) ESA PPO Pharmacy Plan: Rx $10/$30/$50/20% • Please refer to the Financial Conditions and Plan Design Exhibits for an outline of the level of benefits quoted, as well as the terms and conditions of this proposal. • Your Aetna Group Medicare Plan for January 1, 2027 will be automatically renewed if we do not hear from you by October 1, 2026. • Benefits, premium, deductible, and/or copayments/coinsurance may change on January 1 of each year and are subject to CMS contract approval. • All rates are on a Per Member Per Month (PMPM) basis. • These rates exclude commissions. Medical Rate I Pharmacy Rate I Total Rate Current $92.34 $158.98 $251.32 Proposed $97.34 $158.98 $256.32 Change 1 $5.00 $0.00 $5.00 Total Medicare Eligible Members 1 2,771 State Medicare Eligible Members Medical Rate Pharmacy Rate Total Rate Alabama 7 $97.34 $158.98 $256.32 Alaska 0 $97.34 $158.98 $256.32 Arizona 3 $97.34 $158.98 $256.32 Arkansas 17 $97.34 $158.98 $256.32 California 1 $97.34 $158.98 $256.32 Colorado 7 $97.34 $158.98 $256.32 Connecticut 0 $97.34 $158.98 $256.32 Delaware 0 $97.34 $158.98 $256.32 District of Columbia 0 $97.34 $158.98 $256.32 Florida 13 $97.34 $158.98 $256.32 Georgia 6 $97.34 $158.98 $256.32 Hawaii 2 $97.34 $158.98 $256.32 Idaho 1 $97.34 $158.98 $256.32 Illinois 0 $97.34 $158.98 $256.32 Indiana 2 $97.34 $158.98 $256.32 Iowa 1 $97.34 $158.98 $256.32 Kansas 0 $97.34 $158.98 $256.32 Kentucky 1 $97.34 $158.98 $256.32 Louisiana 1 7 $97.34 $158.98 $256.32 Maine 0 $97.34 $158.98 $256.32 Q003759.00 20260714 183419 M PDT: 427921427931 Maryland 5 $97.34 $158.98 $256.32 Massachusetts 2 $97.34 $158.98 $256.32 Michigan 0 $97.34 $158.98 $256.32 Minnesota 0 $97.34 $158.98 $256.32 Mississippi 1 $97.34 $158.98 $256.32 Missouri 5 $97.34 $158.98 $256.32 Montana 3 $97.34 $158.98 $256.32 Nebraska 0 $97.34 $158.98 $256.32 Nevada 0 $97.34 $158.98 $256.32 New Hampshire 1 $97.34 $158.98 $256.32 New Jersey 3 $97.34 $158.98 $256.32 New Mexico 7 $97.34 $158.98 $256.32 New York 3 $97.34 $158.98 $256.32 North Carolina 9 $97.34 $158.98 $256.32 North Dakota 0 $97.34 $158.98 $256.32 Ohio 3 $97.34 $158.98 $256.32 Oklahoma 12 $97.34 $158.98 $256.32 Oregon 3 $97.34 $158.98 $256.32 Pennsylvania 1 $97.34 $158.98 $256.32 Rhode Island 0 $97.34 $158.98 $256.32 South Carolina 1 $97.34 $158.98 $256.32 South Dakota 0 $97.34 $158.98 $256.32 Tennessee 10 $97.34 $158.98 $256.32 Texas 2,628 $97.34 $158.98 $256.32 Utah 2 $97.34 $158.98 $256.32 Vermont 0 $97.34 $158.98 $256.32 Virginia 0 $97.34 $158.98 $256.32 Washington 3 $97.34 $158.98 $256.32 West Virginia 0 $97.34 $158.98 $256.32 Wisconsin 0 $97.34 $158.98 $256.32 Wyoming 1 $97.34 $158.98 $256.32 Q003759.00 20260714 183419 M PDT: 427921427931 M&C Review Page I of 3 CITY COUNCIL AGENDA Create New From This M&C DATE: 8/8/2023 REFERENCE **M&C 23- NO.: 0621 CODE: P TYPE: CONSENT Official site of the City of Fort Worth, Texas FoRTWoRTH LOG NAME: 13P RFP 23-0068 MEDICARE ADVANTAGE PLAN TD HR PUBLIC NO HEARING: SUBJECT: (ALL) Authorize Execution of an Agreement with Aetna Life Insurance Company for a Fully Insured Medicare Advantage Prescription Drug Preferred Provider Organization Plan for a Three -Year Initial Term for an Annual Amount Up to $9,000,000.00 for the Human Resources Department RECOMMENDATION: It is recommended that the City Council authorize execution of an agreement with Aetna Life Insurance Company for a fully insured preferred provider organization Medicare advantage prescription drug plan for a three-year initial term for an annual amount up to $9,000,000.00 and authorize two, one-year renewals for the same amount for the Human Resources Department. DISCUSSION: The Human Resources Department approached the Purchasing Division to procure an agreement for a fully insured Medicare Advantage Prescription Drug Plan (MAPD). The MAPD will be for post-65 Medicare eligible and non -eligible retirees and spouses as part of the City's health benefits program. This plan assists retirees and spouses with costs not covered by Medicare. In order to procure these goods, staff issued Invitation to Bid (RFP) No. 23-0068. The RFP consisted of detailed specifications for the MAPD. The RFP was advertised in the Fort Worth Star -Telegram on May 3, 2023, May 10, 2023, May 17, 2023, May 24, 2023, and May 31, 2023. The City received two (2) responses. An evaluation panel consisting of representatives of the Human Resources Department and retirees reviewed and scored the remaining submittals using Best Value criteria. The individuals scores were averaged for each criteria and the final scores are listed in the table below. Bidders Evaluation Factors a b c d e Total Scores Aetna Life Insurance Company 19.38 14.00 10.50 10.50 16.67 71.05 Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation (HCSC), a Mutual Legal Reserve Company 12.50 10.50 7.88 7.88 25.00 63.75 Best Value Criteria: a. Administration & Services (Includes Customer Service/Account Management/Technology Resources) b. Ability to provide a Medicare Advantage product on a local and/or national basis c. Quality Performance: Centers for Medicare and Medicaid Services (CMS) Five -Star Quality Ratings and accreditations d. Ability to offer access to network proprietary facilities and providers of choice e. Cost After evaluation, the panel concluded that Aetna Life Insurance Company presented the best value to http://apps. cfwnet. org/council_packet/mc_review. asp?ID=31248&councildate=8/8/2O23 12/ 10/2025 M&C Review Page 2 of 3 the City. Therefore, the panel recommends that Council authorize this purchase with Aetna Life Insurance Company and certifies that the recommended vendor bid met specifications. Funding will be budgeted in the Retiree Healthcare Trust Fund for Fiscal Year 2024. DIVERSITY AND INCLUSION (DVIN) - A waiver of the goal for Business Equity subcontracting requirement is approved by the DVIN-BE, in accordance with the Business Equity Ordinance, because the purchase of goods or services is from sources where subcontracting or supplier opportunities are negligible. AGREEMENT TERMS - Upon City Council approval, this agreement shall begin upon execution and expire three years from that date. RENEWAL TERMS -This agreement may be renewed for two additional one-year renewal periods. This action does not require specific City Council approval provided that the City Council has appropriated sufficient funds to satisfy the City's obligations during the renewal term. ADMINISTRATIVE CHANGE ORDER: An administrative change order or increase may be made by the City Manager up to the amount allowed by relevant law and the Fort Worth City Code and does not require specific City Council approval as long as sufficient funds have been appropriated. FISCAL INFORMATION/CERTIFICATION: The Director of Finance certifies that upon approval of the above recommendation and adoption of the Fiscal Year 2024 Budget by the City Council, funds will be available in the Fiscal Year 2024 operating budget, as appropriated, in the Retiree Healthcare Trust Fund. Prior to an expenditure being incurred, the Human Resources Deparment has the responsibility to validate the availability of funds. BQN\\ Fund Department Account Project Program Activity Budget Reference # Amount ID ID I Year I (Chartfield 2) Fund Department Account Project Program Activity Budget Reference ID ID Year I (Chartfield Submitted for City Manager's Office by: Originating Department Head: Additional Information Contact: ATTACHMENTS Reginald Zeno (8517) Jesica McEachern (5804) Reginald Zeno (8517) Dianna Giordano (7783) Jo Ann Gunn (8525) Taylor Dean (7648) 13 RFP 23-0068 Medicare Advantage.docx (CFW Internal) FIDS table Medicare Advantage RFP 23-0068.xlsx (CFW Internal) Form 1295 SAMS Aetna Life Insurance Company.pdf (CFW Internal) MWBE Waiver.pdf (CFW Internal) Amount http://apps. cfwnet. org/council_packet/mc_review. asp?ID=31248&councildate=8/8/2O23 12/ 10/2025 M&C Review Page 3 of 3 SAMS Aetna Life Insurance Companypdf (CFW Internal) http://apps. cfwnet. org/council_packet/mc_review. asp?ID=31248&councildate=8/8/2O23 12/ 10/2025 FORT WORTH. City Secretary's Office Contract Routing & Transmittal Slip Contractor's Name: Aetna Life Insurance Subject of the Agreement: fully insured preferrec provider organization Medicare Advantage RX plan ffA NA NA M&C Approved by the Council? * Yes N No ❑ If so, the M&C must be attached to the contract. Is this an Amendment to an Existing contract? Yes ❑ No If so, provide the original contract number and the amendment number. Is the Contract "Permanent"? *Yes ❑ No 0 If unsure, see back page for permanent contract listing. NA Is this entire contract Confidential? *Yes N No ❑ If only specific information is Confidential, please list what information is Confidential and the page it is located. Proprietary and Trade Secrets NA Effective Date: 12/06/2026 If different from the approval date. Expiration Date: 12/07/2027 If applicable. Is a 1295 Form required? * Yes ❑ No IN *If so, please ensure it is attached to the approving M&C or attached to the contract. Project Number: Ifapplicable. NA *Did you include a Text field on the contract to add the City Secretary Contract (CSC) number? Yes 0 No ❑ Contracts need to be routed for CSO processing in the followingorder: rder: 1. Katherine Cenicola (Approver) 2. Jannette S. Goodall (Signer) 3. Allison Tidwell (Form Filler) *Indicates the information is required and if the information is not provided, the contract will be returned to the department.