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HomeMy WebLinkAboutResolution - 2011-R0499 - Purchase Stop Loss Insurance Coverage - HM Life Insurance Company - 11/16/2011Resolution No. 2011-RO499 November 16, 2011 Item No. 5.4 RESOLUTION W IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK: THAT the City Mananger of the City of Lubbock BE and is hereby authorized and directed to purchase for and on behalf of the City of Lubbock and its health benefits program, specific and aggregate stop loss insurance coverage, by and between the City of Lubbock and HM Life Insurance Company pursuant to the terms and conditions attached hereto as Exhibit "A"; offering the same benefits as set forth in Exhibit "A" hereto; for which the individual -specific per -member, per -month premium amount shall not exceed $7.52 for a single employee and $21.14 for a family; and in a final form and substance acceptable to the City Manager and City Attorney, as well as execute any related documents required in connection therewith; and THAT the City Manager or designee may execute any routine documents and forms associated with said insurance coverage. assed by the City Council this November 16 . 2011. ATTEST: City PROVED AS TO CONTENT: Hutcheson, Director of Risk Management PROVED AS T Attorney gs docs/High Mark life Insurance Resolution. 11 10.19.11 TOM MARTIN, MAYOR Resolution No. 2011—RO499 EXHIBIT A STOP LOSS PROPOSAL FOR City of Lubbock Sales Representative: J. Albert Lucio Effective Date: 01101/2012 Broker: No Writing Agent Through Date: 1213112012 TPA: H'CSC - BCBS of Texas (Austin) Provider Network(s): HCSC - BCBS of Texas (Austin) Utilization Review Vendor(s): Blue Cross Blue Shield of Texas Specific: $2,95 $93,382 p Option Specific Deductible (per Covered Individual) $350,000 $350,000 $375,000 $400,000 Lifetime Maximum Specific Benefit Inforce Unlimited Unlimited Unlimited Covered Benefits Med, Rx Card Med, Rx Card Med, Rx Card Med, Rx Card Specific Premium 2,665 $182.45 $182.81 $183.18_ Single Rate 1,320 $6.72 $7.52 $6.80 $6.23 Family Rate 1,345 $18.90 $21.14 $19.38 $17.94 Total Lives _ 2,665 125% 125% 125% Estimated Contract Specific Premium $411,491 $460,316 $420,505 $388,235 Contract Basis 12115 12115 12115 12115 Commission 0.00% - 0.00% 0.00% C.00% Aggregate: $2,95 $93,382 $94,341 0-00% Covered Benefits Med, Rx Card Med, Rx Card Med, Rx Card Med, Rx Card Policy Year Maximum $1,000,000 $1,000,000 $1,000,000 $_1,000,000 Aggregate Factors Composite New Factor Factor 2,665 $182.45 $182.81 $183.18_ Estimated Contract Attachment Point $26,512,379 $34,416,556 $34,554,390 Contract Minimum Attachment Point (100%) $26,512,379 $34,416,556 _$34,485,313 $34,485,313 $34„554,390 Aggregate Corridor 125% 125% 125% Contract Basis 12115 12115 12115 12115 Aggregate Premium Composite Rate 2,665 $2.31 $2.89 Estimated Contract Aggregate Premium 2,665 $73,874 $92,422 Commission 0.00% 0.00% Total Combined Estimated Contract Premium $485,365 $552,739 _ $2.92 $2,95 $93,382 $94,341 0-00% 0.00% $513,887 $482,576 rn�, (( MnhNY Note: This proposal is not complete unless accompanied by the proposal notes, the basis of offer and the exclusions noted on the following pages. Individual Special Requirements: Underwriters BKS (October 18. 2011) 10096893987-2011-125459-2-3 Page 1 of 4 STOP LOSS PROPOSAL FOR fm� City of Lubbock LIFE INSURANCE COMPANY PROPOSALNOTES • The rates and factors in this proposal are firm. You have 30 days to provide a signed proposal. • The above specific stop loss rates include the HM Stop Loss Bridge Renewal Option, • The rates and factors in this proposal are based on the disclosure of all individuals considered a special enrollee due to having previously satisfied tate plan's lifetime maximum. Written acceptance by HM must be acknowledged before terms of coverage for such individuals are included under HM's stop loss policy. PROPOSAL ACCEPTANCE Please acknowledge acceptance of the terms in this proposal by returning this proposal no later than 15 days from the proposal effective date. Please also indicate which option is chosen and whether Aggregate is to be included, by checking the appropriate boxes on the previous page. Failure to remit the signed agreement within the same period will result in updated large claim disclosure (and claims) being required for our review, Signature: 1141 Title: t �1iCe`r� Accepted on the day of, 201_ Stop Loss coverage is underwritten by HM Life Insurance Company: Pittsburgh, PA, under policy farm HL 601 (905) or similar, in certain states the requested coverage may not be available. As included herein; "HMEG` refers to the Stop Loss carrier. Underwriter: BKS (October 18, 2011) 10096893987-2011-125459-2-3 Page 2 of 4 STOP LOSS PROPOSAL FOR City of Lubbock BASIS OF OFFER Assumptions ("k LIFE INSURANCE COMPANY Initials: — date:Imo_ • Aggregate coverage is on4y available when purchased with Specific coverage. • This proposal is subject to revision if there is a change in effective or renewal dates, or a change in the plan of benefits. • This proposal is based on the utilization of the Provider Network(s) and the Utilization Review Vendor(s) listed on this proposal. • This proposal assumes a minimum participation level of 75% applies for all eligible enrollees under a contributory plan, and 100% under a non- contributory plan, • This proposal assumes the plan of benefits includes a pre -certification, utilization review and large case management program with a benefit penalty for non-compliance, • This proposal is based on a description of the employee benefit plan(s) provided and approved by HMIG, employee and dependent census data, plus any other information relevant to the underwriting risk. If any of the information was incorrect or changes the risk involved, the rates and factors will be modified, and the specific and aggregate claims wild be adjusted accordingly. • The bad debt and charity surcharge portion of the New York Reform Act will be applicable under the stop loss if services are rendered in New York State. Other surcharges, pool charges and/or covered lives assessments will not be covered under the stop loss. • All standard Policy provisions apply. Certain exclusions, limitations and laws of the state where the Policy is issued, may apply, See "Exclusions" for details. • Retirees are included In the stop loss coverage. • This proposal will expire 15 days after the proposed effective date. • Human Organ Transplant benefits are payable in accordance with the underlying plan and subject to the individual lifetime maximum. • Lifetime Maximum Specific Benefit will follow underlying plan, up to the proposed maximums offered within this proposal. • Expenses arising out of any treatment for mental or nervous disorders will follow the underlying plan. • Expenses arising out of any treatment for drug or substance abuse or alcoholism will follow the underlying plan. • The Agent is properly licensed and appointed by HMIG. • The initial rates are guaranteed for the proposed policy period, unless otherwise noted. • There are not more than 5% COBRA participants. Qualifications • Should the number of employees, either in total and/or by singlelfamily mix, change by 10% or more, the premium rates are subject to change. • If the descriptions of the benefits or plan provisions differ from what was initially utilized to underwrite the risk, an updated Plan Document or other acceptable plan description is required within 60 days of the proposed effective date, and the premium rates and aggregate retention factors may be subject to re -raking, retro -active to the effective date. • HIPAA Privacy rules permit the release of Protected Health Information (PHI) for the purpose of evaluating and accepting risk associated with the Plan Sponsor as part of "Health care operations". HMIG will use this information solely for the purpose of evaluating and accepting the risk and will not disclose any PH1 collected except to perform this risk evaluation. Underwriter: BKS (October 18. 2011) 90096893987-2011-125459-2-3 Page 3 of 4 STOP LOSS PROPOSAL FOR City of Lubbock EXCLUSIONS rm�j. RANCE CON,WANY initials: date: -7. !% • Any amount incurred / paid: (1) when the underlying medical plan is not in effect; by a person who is not a plan participant; (2) not specifically covered by the underlying medical plan; or (3) by any plan that has not been identified as included; or (4) that the policyholder is not required to pay in accordance with the terms of the underlying medical plan. • Caused or contributed to by war or an act of war unless a person is required to be in a location where a war or act of war has or may occur as a condition of employment. • For any injury or illness which is eligible for coverage under a workers' compensation or occupational disease policy or agreement, whether or not such policy or agreement is actually in force and whether or not such benefits are received (subject to applicable laws). • Caused or contributed to by a person committing or attempting to commit an assault or felony, participating in an illegal occupation, or actively participating in a violent disorder or riot (does not include being at the scene of a violent disorder or riot while performing his or her official duties). • Treatment received in person, by mail or otherwise outside the U.S. if the purpose of such travel or communication is to obtain treatment. • Expense incurred prior to the initial incurred date, or the date another affiliate I class of employees is acquired or established. • Any known medical conditions not accurately Disclosed prior to the effective date, the date another affiliate is acquired, another class of employees established, the date of renewal, or upon request the date a person becomes eligible for benefits through the underlying medical plan. • For drugs, procedures, services, supplies or treatments which are considered experimental or investigational, or which are not medically necessary and appropriate. • For any expenses for benefits payable by another medical plan, which when combined with the benefits payable through the underlying medical plan would cause the total benefits payable to exceed 100% of the person's actual expenses. • Amounts paid for administrative costs, including but not limited to, administrative costs for claim payments, networks, case management fees, in excess of the usual and customary charge, PPO access fees and Prescription Drug administration fees. • For a person's out-of-pocket expense(s), or any amount incurred by a person for the cost of drugs, procedures, services, supplies or treatment in excess of any reimbursement negotiated with, scheduled to be paid or due a provider or facility. • Amounts over fee, reimbursement percentage or other form of payment negotiated with a provider or facility as total reimbursement to the provider or facility. • Excluded claim expenses. • Capitation fees, • For the expense of litigation, extra contractual damages, compensatory damages, or punitive damages. • Lost provider discounts due to untimely payment of claims. Underwriter: BKS (October 18, 2011) 10096893987-2011-125459-2-3 Page 4 of 4