HomeMy WebLinkAboutResolution - 6439 - Contract - Trustmark Insurance Company - Medical And Dental Coverage - 08_12_1999Resolution No. 6439
Aug. 12, 1999
Item No. 29
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK:
THAT the Mayor of the City of Lubbock BE and is hereby authorized and
directed to execute for and on behalf of the City of Lubbock, a Contract to administer
the minimum premium plan for the medical and dental coverage, by and between the
City of Lubbock and Trustmark Insurance Company, and related documents. Said
contract is attached hereto and incorporated in this resolution as if fully set forth herein
and shall be included in the minutes of the City Council.
Passed by the City Council this 12th
AT -TEST:
I wt�' 4-
Ka a arnell
City etary
APPROVED AS O CONTENT:
—;e.,
Mary ews
Director of Human Resources
APPROVED AS TO FORM:
day of
William de Haas
Competition and Contracts Manager/Attorney
rkb/ccdocs/trustmark.res
July 28, 1999
1999.
Resolution No. 6439
Aug. 12, 1999
Item No. 29
MINIMUM PREMIUM AGREEMENT
This Minimum Premium Agreement ("Agreement") is made between Trustmark Insurance Company
(Mutual)
("Trustmark"), an Illinois corporation and CITY OF LUBBOCK, TEXAS ("Policyowner") a municipality,
effective December 1, 1997.
The purpose of this Agreement is to define the financial obligations of the parties relative to the
Group Policy or Policies issued to the Policyowner by Trustmark. Under this Agreement, the
Policyowner and Trustmark shall divide between each other responsibility and liability for the
payment of benefits. This Agreement also specifies the type and calculation of Premium owed by the
Policyowner to Trustmark.
TABLE OF CONTENTS
Begins on
Page
ARTICLE I:
DEFINITIONS............................................................
2
ARTICLE II:
CLAIM RESPONSIBILITIES.................................................
5
ARTICLE III:
ACCOUNTING...........................................................
6
ARTICLE IV:
PREMIUM, TERMINAL RESERVE FUNDS AND RECOVERIES ...................
10
ARTICLE V:
BANKING..............................................................
12
ARTICLE VI:
AMENDMENTS.........................................................
14
ARTICLE VII:
TERMINATION.........................................................
14
ARTICLE Vill:
LEGAL PROVISIONS.....................................................
15
SCHEDULE(S)
MIN PREM 3/2198
1
ARTICLE I - DEFINITIONS
Agreement: This Minimum Premium Agreement by and between the Policyowner and Trustmark.
Bank Account(s): The bank account(s) established by the Policyowner from which Trustmark is
authorized to draw the Policyowner's funds for Benefit Payments paid under the Group Policy, as well
as any Premium or Recoveries.
Benefit Payments: Checks issued for eligible claims for insured employees and dependents under
Minimum Premium Coverages.
Carry Over Deficit: For any Contract Period, the deficit carried forward from the prior Contract
Period as determined by the End of the Contract Period Experience Accounting (Article 111, Section B.)
for the prior Contract Period. The Carry Over Deficit includes deficits created by Minimum Premium
Coverages, Other Experience Refunding Coverages listed on Schedule A, and any deficit which exists
on the effective date of this Agreement and was created by refunding coverages under the Group
Policy.
Claim Payor: The entity designated by Trustmark to perform claim payment administration.
Contract Month: A calendar month while this Agreement is in effect. The first Contract Month shall
begin on the effective date of this Agreement, and the last Contract Month shall end on the
termination date of this Agreement.
Contract Period: The length of time specified on Schedule A. The first Contract Period shall begin on
the effective date of this Agreement, and the last Contract Period shall end on the termination date
of this Agreement.
Conventional Premium Equivalent: The monthly premium due from the Policyowner to Trustmark as
described in Article VII, Section B. if this Agreement terminates prior to the Group Policy terminating.
The Conventional Premium Equivalent Monthly Rates are shown on Schedule A.
Cumulative Claim Liability Limit: For any Contract Month, that Contract Month's Monthly Claim
Liability Limit plus the sum of the Monthly Claim Liability Limits for all previous Contract Months in
that Contract Period.
Cumulative Non -Pooled Claims: For any Contract Month, that Contract Month's Monthly Non -Pooled
Claims for all Minimum Premium Coverages, plus the sum of the Monthly Non -Pooled Claims for all
Minimum Premium Coverages for all previous Contract Months in that Contract Period.
Cumulative Recoveries: For any Contract Month, the sum of that Contract Month's Recoveries plus
the sum of the monthly Recoveries for all previous Contract Months in that Contract Period.
Cumulative Transfers: For any Contract Month, the sum of that Contract Month's Transfers plus the
sum of the monthly Transfers for all previous Contract Months in that Contract Period.
Exposure: For a Minimum Premium Coverage during a Contract Month, the number of insured
employees and dependent units having that Minimum Premium Coverage at the beginning of the
second prior Contract Month. For the first three Contract Months of the first Contract Period, the
Exposure for a Minimum Premium Coverage is the number of insured employees and dependent units
having that Minimum Premium Coverage at the beginning of the first Contract Month.
Group Policy: The insurance polic(ies) or insurance contract(s) issued to the Policyowner by
Trustmark.
Individual Pooling: Individual pooling as described in Article III., Section G.
MIN PREM 312198
Individual Pooling Premium: The monthly premium due from the Policyowner to Trustmark as
described in Article IV, Section B., to cover Individual Pooling charges.
Minimum Premium: The monthly premium due from the Policyowner to Trustmark, as described in
Article IV, Section A., to cover retention costs.
Minimum Premium Coverages: The types of benefits, as specified in the Group Policy, that are
covered by this Agreement. The Minimum Premium Coverages are listed on Schedule A.
Monthly Claim Liability Limit: For any Contract Month, the product of (1) multiplied by (2), where:
(1) is the Exposure for each Minimum Premium Coverage for that Contract Month; and
(2) is the corresponding Monthly Maximum Benefit Factor for each Minimum Premium Coverage.
Monthly Maximum Benefit Factors: Dollar amounts set by Trustmark which are used for calculating
the Policyowner's Monthly Claim Liability Limits. The Monthly Maximum Benefit Factors are listed in
Schedule A.
Monthly Non -Pooled Claims: The sum of Benefit Payments paid during a particular Contract Month
from the Policyowner's Bank Account, less recoupments, voids, or other Benefit Payment credits. If
Individual Pooling is elected, medical Benefit Payments for any insured employee or dependent that
exceed the Individual Pooling Liability Amount during the Contract Period shall not be included in
Monthly Non -Pooled Claims, except during the Post Termination Period.
Policyowner: The entity indicated as such at the top of page 1 of this Agreement.
Post Termination Period: The period following termination of this Agreement during which the
Terminal Benefit Limit applies. Schedule A indicates whether the Terminal Benefit Limit applies, and
if it does apply, the period for which the Terminal Benefit Limit applies.
Post Termination Premium: The product of (1) multiplied by (2), where:
(1) is the Minimum Premium for the last Contract Month of the last Contract Period; and
(2) is the Post Termination Premium Factor shown on Schedule A.
Premium: The Minimum Premium, Individual Pooling Premium, and/or the Post Termination
Premium, if applicable.
Recoveries: For any Contract Month, the amount due from the Policyowner to Trustmark for that
Contract Month as calculated in Article III, Sections A., B., and C; and after termination of the
Agreement, the amount due from the Policyowner to Trustmark as calculated in Article III, Section F.
Reserves: Funds used to pay Run -Out Claims following the termination of this Agreement. Reserves
are an obligation with Minimum Premium funding and may be held by either Trustmark or the
Policyowner. The holder of the Reserves is indicated on Schedule A.
Run -Out Claims: Those Benefit Payments which are paid after the termination of this Agreement and
are:
1. incurred while this Agreement is in effect; or
2. payable under any extension of benefits provision of the Group Policy.
MIN PREM 3/2/98
Surplus Position for the Last Contract Period: The amount determined by (1) minus (2) plus (3) minus
(4) where:
(1) is the Cumulative Claim Liability Limit for the last Contract Month of the last Contract Period;
(2) is Cumulative Non -Pooled Claims for the last Contract Month of the last Contract Period;
(3) is Cumulative Transfers due or paid up to the last Contract Month of the last Contract Period; and
(4) is Cumulative Recoveries due or paid up to the last Contract Month of the last Contract Period,
plus any Recoveries due or paid as a result of the Monthly or Annual Claim Liability Accounting
for the last Contract Month of the last Contract Period, plus any Recoveries due or paid as a result
of the End of the Contract Period Experience Accounting for the last Contract Period.
If the above calculation yields an amount greater than zero, then the Surplus Position for the Last
Contract Period is equal to this amount. If the above calculation yields an amount less than or equal
to zero, then the Surplus Position for the Last Contract Period is equal to zero.
Surplus Position for the Prior Contract Period: The amount determined by (1) minus (2) plus (3) minus
(4) where:
(1) is the Cumulative Claim Liability Limit for the last Contract Month of the prior Contract Period;
(2) is Cumulative Non -Pooled Claims for the last Contract Month of the prior Contract Period;
(3) is Cumulative Transfers due or paid up to the last Contract Month of the prior Contract Period
and
(4) is Cumulative Recoveries due or paid up to the last Contract Month of the prior Contract Period,
plus any Recoveries due or paid as a result of the Monthly or Annual Claim Liability Accounting
for the last Contract Month of the prior Contract Period, plus any Recoveries due or paid as a
result of the End of the Contract Period Experience Accounting for the prior Contract Period.
If the above calculation yields an amount greater than zero, then the Surplus Position for the Prior,
Contract Period is equal to this amount. If the above calculation yields an amount less than or equal
to zero, then the Surplus Position for the Prior Contract Period is equal to zero.
Terminal Benefit Limit: The product of (1) multiplied by (2), where:
(1) is the average number of insured employees and dependent units for each Minimum Premium
Coverage for the final two months of the last Contract Period; and
(2) is the corresponding Terminal Benefit Limit Factors for each Minimum Premium Coverage.
Terminal Benefit Limit Factors: Dollar amounts set by Trustmark which are used for calculating the
Policyowner's Terminal Benefit Limit. The Terminal Benefit Limit Factors are listed in Schedule A.
Terminal Reserve Funds: Dollar amounts collected to cover Reserves if Reserves are held by
Trustmark.
Transfers: For any Contract Month, the amount due from Trustmark to the Policyowner for that
Contract Month as calculated in Article III, Sections A., B., and F.
MIN PREM 312198
4
ARTICLE II - CLAIM RESPONSIBILITIES
A. Claims Incurred Prior to the Effective Date of this Agreement
For claims incurred prior to the effective date of this Agreement, the Policyowner shall be financially
liable for benefit amounts and responsible for claim payment administration.
B. Claims Incurred and Paid While this Agreement is in Effect
For claims incurred and paid while this Agreement is in effect, the Policyowner shall be financially
liable for Benefit Payments in accordance with Article 111, and Trustmark shall be responsible for claim
payment administration.
C. Claims Paid After Termination of this Agreement
1. If Schedule A indicates Reserves are held by the Policyowner and a Terminal Benefit Limit does
apply, the Policyowner shall be financially liable for all Run -Out Claims except that there shall be a
limit to the Policyowner's financial liability during the Post Termination Period. The maximum
amount of Run -Out Claims for which the Policyowner shall be financially liable during the Post
Termination Period shall be determined by the Post Termination Final Accounting as described in
Article III, Section F.1. Trustmark shall be responsible for claim payment administration during the
Post Termination Period. The Policyowner shall be financially liable for Run -Out Claims and
responsible for claim payment administration for all Run- Out Claims after the Post Termination
Period. Trustmark shall not be financially liable for Run -Out Claims or responsible for claim
payment administration for Run -Out Claims after the Post Termination Period.
2. If Schedule A indicates Reserves are held by the Policyowner and a Terminal Benefit Limit does
not apply, the Policyowner shall be financially liable for all Run -Out Claims and responsible for
claim payment administration for all Run -Out Claims. Trustmark shall not be financially liable for
any Run -Out Claims or responsible for claim payment administration for any Run -Out Claims.
3. If Schedule A indicates that Reserves are held by Trustmark, Trustmark shall be financially liable
for all Run -Out Claims and responsible for claim payment administration for all Run -Out Claims.
However, the Policyowner may be liable for payment of Recoveries as calculated in Article III,
Section F.2.
The obligations for claims paid after termination of this Agreement shall survive the termination of
this Agreement and remain in effect while any Run -Out Claims are outstanding and payable.
D. Benefit Payment Determination
During the period of this Agreement, Trustmark has the right to make final determinations of the
Benefit Payments. Following termination of this Agreement, Trustmark reserves the right to make
final Benefit Payment determinations for all Run -Out Claims. Trustmark shall determine Benefit
Payments in the same manner it would determine benefits under the Group Policy in the absence of
this Agreement. In the event Trustmark exercises its right to make final Benefit Payment
determinations, the Policyowner agrees to accept Trustmark's final Benefit Payment determinations.
Nothing in this paragraph shall be construed to negate the Policyowner's obligation to pay Run -Out
Claims as described in this Article 11, Sections C.1 and 2.
E. Claim Submission
If the Policyowner receives claims from insureds, the Policyowner is obligated to submit those claims
to the Claim Payor within five business days of receipt.
MIN PREM 3/2/98
5
F. Records
The Policyowner agrees to furnish Trustmark information relating to this Agreement upon request.
All claim files, insured records, and other relevant records are the property of Trustmark during the
term of this Agreement and following termination.
G. Reporting
1. Trustmark is responsible for Form 1099 reporting.
2. Trustmark is responsible for providing Form 5500 Schedule A information to the Policyowner.
The Policyowner is responsible for reporting Form 5500 information to applicable government
agencies.
3. Trustmark is responsible for FICA withholding administration and reporting and payments of
withheld amounts to applicable government agencies and the Policyowner. The Policyowner is
responsible for making employer matching FICA payments to applicable government agencies.
ARTICLE III - ACCOUNTING
A. Monthly or Annual Claim Liability Limit Accounting
1. If Schedule A indicates that the Claim Liability Limit Accounting Period is Monthly, then for each
Contract Month Trustmark shall perform the following Monthly Claim Liability Limit Accounting
calculation:
The Cumulative Claim Liability Limit for that Contract Month, plus
Any Surplus Position Carry Over, minus
Cumulative Non -Pooled Claims for that Contract Month, plus
Cumulative Transfer due or paid up to that Contract Month, minus
Cumulative Recoveries due or paid up to that Contract Month.
If the above Monthly Claim Liability Limit Accounting calculation yields an amount less than zero,
Trustmark shall pay to the Policyowner a Transfer equal to the absolute value of this amount.
If the above Monthly Claim Liability Limit Accounting calculation yields an amount greater than or
equal to zero, the Policyowner shall pay to Trustmark Recoveries equal to the lesser of (a) or (b)
where:
(a) is the amount resulting from the Monthly Claim Liability Limit Accounting calculation above;
and
If Schedule A indicates that the Deferred Carry Over Deficit Recovery does not apply, then:
(b) is the absolute value of the Carry Over Deficit, plus Cumulative Transfers due or paid up to
that Contract Month, minus Cumulative Recoveries due or paid up to that Contract Month.
If Schedule A indicates that the Deferred Carry Over Deficit Recovery does apply, then:
(b) is Cumulative Transfers due or paid up to that Contract Month, minus Cumulative Recoveries
due or paid up to that Contract Month.
2. If Schedule A indicates that the Claim Liability Limit Accounting Period is Annual, then for the last
Contract Month of each Contract Period, Trustmark shall perform the following Annual Claim
Liability Limit Accounting calculation:
The Cumulative Claim Liability Limit for the last Contract Month of the Contract Period, plus
Any Surplus Position Carry Over, minus
MIN PREM 3/2/98
6
The Cumulative Non -Pooled Claims for the last Contract Month of the Contact Period.
If the above Annual Claim Liability Limit Accounting calculation yields an amount less than zero,
Trustmark shall pay to the Policyowner a Transfer equal to the absolute value of this amount.
If the above Annual Claim Liability Limit Accounting calculation yields an amount greater than or
equal to zero, the Policyowner shall pay to Trustmark Recoveries equal to the lesser of:
(a) the amount resulting from the Annual Claim Liability Limit Accounting calculation above; or
(b) the absolute value of the Carry Over Deficit.
3. Medical Benefit Payments paid by Trustmark which exceed the Individual Pooling Liability
Amount during the Contract Period shall not be included in Monthly Non -Pooled Claims used in
the Monthly or Annual Claim Liability Limit Accounting formula.
B. End of the Contract Period Experience Accounting
The End of the Contract Period Experience Accounting shall be performed by Trustmark after the last
Contract Month of each Contract Period and shall include any Carry Over Deficit and deficits or
surpluses created by other experience refunding coverages which are listed on Schedule A. It shall
also include deficits or surpluses resulting from differences between actual and estimated Minimum
Premium, Individual Pooling Premium, and Terminal Reserve Fund Factor amounts, unless Schedule A
indicates that the Policyowner has selected the Premium Guarantee and Terminal Reserve Funds
Guarantee as indicated on Schedule A.
1. If the Monthly or Annual Claim Liability Limit Accounting calculation for the last Contract Month
of the Contract Period yields an amount greater than zero, and the End of the Contract Period
Experience Accounting indicates that no deficit exists, no Transfer is due from Trustmark and no
Recoveries are due from the Policyowner.
2. If the Monthly or Annual Claim Liability Limit Accounting calculation for the last Contract Month
of the Contract Period yields an amount greater than zero, and the end of the contact period
accounting indicates that a deficit exists, the Policyowner shall pay to Trustmark Recoveries equal
to the lesser of:
(a) the result of the Monthly or Annual Claim Liability Limit Accounting calculation for the last
Contract Month of the Contract Period, minus any Recoveries due or paid as a result of the
monthly or annual Claim Liability Limit Accounting for the last Contract Month of the
Contract Period; or
(b) the absolute value of the deficit determined by the End of the Contract Period Experience
Accounting.
C. Carry Over Deficit Recovery Limit
1. If Schedule A indicates that the Carry Over Deficit Recovery Limit does apply, then for each
Contract Period, except for the last Contract Period while this Agreement is in effect, the amount
of Carry Over Deficit that is recoverable from Recoveries shall be limited to the lesser of:
(a) The absolute value of the Carry Over Deficit for that Contact Period; or
(b) The product of (i) multiplied by (ii) where:
(i) is the Carry Over Deficit Recovery Limit Percentage indicated on Schedule A; and
(ii) is the product of (A) multiplied by (B) where:
MIN PREM 3/2/98
7
(A) is the Cumulative Claim Liability Limit for the last Contract Month of the prior
Contract Period, divided by the number of Contract Months in the prior Contract
Period; and
(B) is 12.
2. If there is a deficit which exists as of the effective date of this Agreement created by experience
refunding coverages under the Group Policy, then, for the first Contract Period, the Cumulative
Claim Liability Limit referenced in Article III, Section C.1.b.(ii)(A) is replaced by earned premium
for the experience refunding coverages under the Group Policy.
D. Aggregate Pooling
If Schedule A indicates Aggregate Pooling does apply, then the amount of Carry Over Deficit will be
reduced by any deficit which developed as a result of Minimum Premium Coverages.
E. Surplus Position Carry Over
If Schedule A indicates that the Surplus Position Carry Over does apply, then for each Contract Period
the amount of surplus that will be carried over shall be limited to the lesser of:
1. The absolute value of the Surplus Position for the Prior Contact Period; or
2. The product of (a) multiplied by (b) where:
(a) is the Surplus Position Carry Over Percentage indicated in Schedule A; and
(b) is the product of (i) multiplied by (ii) where:
(i) is the Cumulative Claim Liability Limit for the last Contract Month of the prior
Contract Period, divided by the number of Contract Months in the prior Contract
Period; and
(ii) is 12.
F. Post Termination Final Accounting and Reserves
1. If Schedule A indicates that Reserves are held by the Policyowner and Terminal Benefit Limit does
apply, Trustmark shall perform the following Terminal Benefit Limit accounting calculation after
the Post Termination Period:
The Terminal Benefit Limit minus Run -Out Claims during the Post Termination Period.
Since Individual Pooling terminates when this Agreement terminates, medical Benefit Payments
paid during the Post Termination Period which exceed the Individual Pooling Liability Amount
shall be included in Run -Out Claims in the above Terminal Benefit Limit accounting formula.
(a) If the above Terminal Benefit Limit accounting calculation yields an amount less than zero,
Trustmark shall pay to the Policyowner a Transfer equal to the absolute value of this amount,
minus the Surplus Position for the Last Contract Period.
(b) If the above Terminal Benefit Limit accounting calculation yields an amount greater than or
equal to zero, and the End of the Contract Period Experience Accounting for the last Contract
Period indicates that no deficit exists, no Transfer is due from Trustmark and no Recoveries
are due from the Policyowner.
(c) If the above Terminal Benefit Limit accounting calculation yields an amount greater than or
equal to zero, and the End of the Contract Period Experience Accounting for the last Contact
MIN PREM 3/2/98
8
Period indicates that a deficit exists, the Policyowner shall pay to Trustmark Recoveries equal
to the lesser of:
(i) The amount resulting from the above Terminal Benefit Limit accounting calculation;
or
(ii) The absolute value of the deficit determined by the End of the Contract Period
Experience Accounting for the last Contract Period.
2. If Schedule A indicates that Reserves are held by Trustmark, Trustmark shall perform the
following calculation after it has been determined by Trustmark that all Run -Out Claims have
been paid:
Reserves established at the End of the Contract Period Experience Accounting for the last
Contract Period, minus Run -Out Claims.
(a) If the above calculation yields an amount less than zero, and the Surplus Position for the
Last Contract Period is greater than zero, the Policyowner shall pay to Trustmark
Recoveries equal to the lesser of:
(i) The amount by which the Run -Out Claims exceed the Reserves established at the End
of the Contract Period Experience Accounting for the last Contract Period; or
(ii) The Surplus Position for the last Contract Period.
(b) If the above calculation yields an amount greater than zero, and there is a Carry Over
Deficit for the last Contract Period, any unused Reserves shall be used to offset such
deficit. Reserves remaining after this calculation shall be returned to the Policyowner
after it executes a Hold Harmless Agreement, releasing Trustmark from any liability for
additional claims not considered in the final accounting.
G. Individual Pooling
If Schedule A indicates that Individual Pooling is included, Trustmark shall pool per Contract Period,
certain individual medical Benefit Payments over a specified amount, referred to as the Individual
Pooling Liability Amount which is indicated on Schedule A. Prescription drug card and mail order
drug coverages, if applicable, are not considered "medical" coverages.
The administration of Individual Pooling shall be as follows:
1. Trustmark shall be financially liable for medical Benefit Payments for any insured employee or
dependent that exceed the Individual Pooling Liability Amount during the Contract Period.
2. Any medical Benefit Payments paid by Trustmark which exceed the Individual Pooling Liability
Amount during the Contract Period shall not be included in Monthly Non -Pooled Claims used in
the Monthly or Annual Claim Liability Limit Accounting formula.
3. Any medical Benefit Payments paid by Trustmark which exceed the Individual Pooling Liability
Amount during the Contract Period shall not be drawn from the Policyowner's Bank Account.
4. Individual Pooling terminates on the date this Agreement terminates.
MIN PREM 3/2/98
9
H. Refunds, Recoupments, Voids, and Credits
1. Except for recoupments received in connection with medical Benefit Payments paid in excess of
the Individual Pooling Liability Amount, any refund or recoupments of Benefit Payment amounts,
or voids or credits received or applied, shall reduce Benefit Payments paid during the Contract
Month in which the refund or recoupments is received, or the void or credit adjustment is made.
2. If Trustmark paid medical Benefit Payments for a claim in excess of the Individual Pooling Liability
Amount during the Contract Period, with subsequent recoupments by Trustmark or the
Policyowner of monies paid on this claim either by the Policyowner or Trustmark, Trustmark has
the right of receipt of such monies up to the total amount of such Benefit Payments paid by
Trustmark. The Policyowner agrees to immediately pay to Trustmark any such monies received by
the Policyowner and authorizes Trustmark to negotiate payment of instruments written in the
name of the Policyowner, on behalf of the Policyowner. Recoupments of Individual Pooling
Liability Amounts shall not be used to reduce the total amount of Benefit Payments during the
Contract Period in which the Benefit Payment was originally paid or in the Contract Period in
which the recoupments are received. This provision shall apply regardless of the cause of the
recoupment or when it is received. This provision survives the termination of this Agreement and
the Group Polity.
ARTICLE IV - PREMIUM, TERMINAL RESERVE FUNDS AND RECOVERIES
A. Minimum Premium
1. The Policyowner shall pay to Trustmark for each Contract Month that this Agreement is in effect a
Minimum Premium equal to the product of (a) multiplied by (b), where:
(a) is the applicable rates for all Minimum Premium Coverages shown on Schedule A for the
Contract Month; and
(b) is the corresponding number of insured employees and dependent units for that Contract
Month.
2. Each Minimum Premium shall be due on the first day of the month for which it applies.
B. Individual Pooling Premium
1. The Policyowner shall pay to Trustmark for each Contract Month that this Agreement is in effect
an Individual Pooling Premium equal to the product of (a) multiplied by (b), where:
(a) is the applicable rates for Individual Pooling Premium shown on Schedule A for the Contract
Month; and
(b) is the corresponding number of insured employees and dependent units for that Contract
Month.
2. Each Individual Pooling Premium shall be due on the first day of the month for which it applies.
C. Post Termination Premium
1. If Schedule A indicates Reserves are held by the Policyowner and a Terminal Benefit Limit does
apply, the Policyowner shall pay to Trustmark a Post Termination Premium following termination
of this Agreement equal to the product of (a) multiplied by (b), where:
(a) is the Minimum Premium for the last Contract Month of the last Contract Period; and
MIN PREM 3/2/98
10
(b) is the Post Termination Premium Factor shown on Schedule A.
2. The Post Termination Premium shall be due immediately upon written notification by Trustmark
to the Policyowner of the Post Termination Premium amount due.
3. The Terminal Benefit Limit option can only be elected or canceled by written agreement of both
parties, typically at renewal. If the Terminal Benefit Limit is elected, it can not be unilaterally
canceled by the Policyowner at any time, including at termination of this Agreement. Unless
Trustmark consents to the cancellation of the Terminal Benefit Limit, the Policyowner must pay
the Post Termination Premium.
D. Terminal Reserve Funds
1. If Schedule A indicates that Trustmark holds Reserves:
(a) the Policyowner shall pay Terminal Reserve Funds to Trustmark for each Contract Month that
this Agreement is in effect in an amount equal to the product of (i) multiplied by (ii), where:
(i) is the applicable factors for all Minimum Premium Coverages shown on Schedule A for the
Contract Month; and
(ii) is the corresponding number of insured employees and dependent units for that Contract
Month.
(b) Terminal Reserve Funds shall be due on the first day of the month for which they apply.
2. At the time of termination of the Agreement, Trustmark shall perform the following calculation:
(a) minus (b), where:
(a) is the the product of (i) multiplied by (ii), where:
(i) is the average number of insured employees and dependent units for each Minimum
Premium Coverage for the final two months of the last Contract Period; and
(ii) is the corresponding Terminal Benefit Limit Factors for each Minimum Premium
Coverage; and
(b) is the Terminal Reserve Funds collected.
If the above calculation yields an amount greater than zero, the Policyowner shall pay to
Trustmark such amount upon 30 days prior written notice. If the above calculation yields an
amount less than or equal to zero, no additional amounts are due and the Terminal Reserve
Funds shall equal the amount previously collected.
E. Non -Payment of Premium
A grace period of the same length as that provided by the Group Policy shall be granted for the
payment of each Premium due after the first Premium.
1. If any Premium is not paid by the Policyowner to Trustmark within the grace period, this
Agreement shall automatically terminate at the end of that grace period. No written notice of
such automatic termination is required. If this Agreement terminates for any reason, the
Policyowner shall be liable for all Premium due and unpaid, including a pro rata Premium for any
time this Agreement is in effect during the grace period.
MIN PREM 3/2/98
11
2. If Trustmark is notified that there were not sufficient funds (NSF) in the Policyowner's Bank
Account(s) to cover a check or automatic fund transfer (AFT) in payment of Premium due, then
this Agreement shall automatically terminate on the date on which the grace period for such
Premium ends. No written notice of such automatic termination is required. This shall be the case
even if the check presented for payment by Trustmark is found to be NSF after the end of the
grace period. Trustmark reserves the right to recover from the Policyowner charges related to
non -sufficient funds (NSF) in the Policyowner's Bank Account(s) plus any applicable interest.
F. Non -Payment of Terminal Reserve Funds
A grace period of the same length as that provided by the Group Policy for payment of premium shall
be granted for each subsequent payment of Terminal Reserve Funds due after the first.
1. If any Terminal Reserve Funds are not paid by the Policyowner to Trustmark within the grace
period, this Agreement shall automatically terminate at the end of that grace period. No written
notice of such automatic termination is required. If this Agreement terminates for any reason,
the Policyowner shall be liable for all Terminal Reserve Funds due and unpaid, including a pro
rata amount for any time this Agreement is in effect during the grace period.
2. If Trustmark is notified that there were not sufficient funds (NSF) in the Policyowner's Bank
Account(s) to cover a check or automatic fund transfer (AFT) in payment of Terminal Reserve
Funds due, then this Agreement shall automatically terminate on the date on which the grace
period for such Funds ends. No written notice of such automatic termination is required. This
shall be the case even if the check presented for payment by Trustmark is found to be NSF after
the end of the grace period. Trustmark reserves the right to recover from the Policyowner
charges related to non -sufficient funds (NSF) in the Policyowner's Bank Account(s) plus any
applicable interest.
G. Recoveries
1. Recoveries for any Contract Month, as calculated in Article III, Sections A., B., C. and F., is the
amount due from the Policyowner for that Contract Month to Trustmark. The Policyowner shall
make such funds available for Trustmark to transfer via automatic fund transfer (AFT)
immediately upon written notice.
2. If Trustmark is notified that there were not sufficient funds (NSF) in the Policyowner's Bank
Account(s) to cover automatic fund transfer (AFT) in payment of Recoveries due, then this
Agreement shall automatically terminate on the date on which the Bank Account(s) were not
sufficiently funded. No written notice of such automatic termination is required. Trustmark
reserves the right to recover from the Policyowner charges related to non -sufficient funds (NSF) in
the Policyowner's Bank Account(s) plus any applicable interest.
ARTICLE V - BANKING
A. The Policyowner shall establish a checking account upon which Trustmark is authorized to draw
checks for Benefit Payments paid by Trustmark, and for which Trustmark is allowed to act on the
Policyowner's behalf with regard to the administration of this account for purposes of
establishing and changing signature(s) which appear on checks issued for Benefit Payments, for
printing of check stock, and for establishing automatic fund transfer (AFT) arrangements.
B. Trustmark may initiate automatic fund transfers (AFT) from one of the Policyowner's Bank
Accounts for Benefit Payments, Recoveries, and Post Termination Premium due to Trustmark.
C. The Policyowner agrees to maintain funds in its Bank Account(s) both before and after
termination of this Agreement which are adequate to cover checks for Benefit Payments paid by
Trustmark, Recoveries and Post Termination Premium.
MIN PREM 312198
12
D. If Schedule A indicates Trustmark requires a Letter of Credit, the Policyowner must establish and
maintain an irrevocable Letter of Credit, satisfactory to Trustmark, in an amount specified in
Schedule B. A copy of such Letter of Credit shall be supplied by the Policyowner to Trustmark.
1. Trustmark is authorized to draw on such Letter of Credit without prior notice to the
Policyowner in the event that the Policyowner fails to maintain funds in its Bank Account(s) as
herein required or as deemed necessary by Trustmark. The date of such withdrawal shall be
the date such Benefit Payments or Premium are due or the earliest of:
(a) Any date within the 30 days prior to the expiration date of such Letter of Credit held
under this Agreement, unless the issuing bank has notified Trustmark that such Letter of
Credit has been extended for an additional year following such expiration date or has
been replaced by an irrevocable Letter of Credit in an amount and for a term approved in
advance in writing by Trustmark; or
(b) The sixth day following the date Trustmark furnishes the Policyowner written notice that
such Letter of Credit cannot be held by Trustmark as an admitted asset under applicable
law.
2. If Trustmark draws funds on such Letter of Credit, it shall furnish the issuing bank a written
notification stating that funds are due Trustmark under this Agreement. Trustmark shall also
furnish written notice to the Policyowner within 30 days following such withdrawal, stating
that all such funds shall be used by Trustmark for outstanding claim payments under the
Group Policy. Any of Trustmark's Vice Presidents shall be authorized to execute a withdrawal.
3. The irrevocable Letter of Credit shall remain in force during the Contract Period and may or
may not be extended for successive one-year periods or replaced by another irrevocable
Letter of Credit in an amount, and for a term approved in advance in writing by Trustmark. In
addition, the irrevocable Letter of Credit shall remain in force throughout the Post
Termination Period and until such time as a Hold Harmless Agreement is executed by the
Policyowner, releasing Trustmarkfrom any liabilityfor additional claims not considered in the
final accounting. This paragraph 3 shall survive termination of this Agreement.
E. Trustmark shall imprint the routing and account number of the Policyowner's designated Bank
Account(s) at the bottom of its check stock when Trustmark is the Claim Payor.
F. To establish the requisite banking arrangements under this Agreement, the Policyowner is
responsible for all of the following:
• A bank resolution;
• W-9form;
• Automatic fund transfer (AFT) authorization forms;
• Any special forms or instructions for making fund transfers;
• All banking fees, unless indicated otherwise on Schedule A;
• Establishing and maintaining a Letter of Credit as required; and
• Bank account reconciliation.
Trustmark is responsible for all of the following:
• Establishing a bank account with the Trustmark designated bank, if used; and
• Administering escheats based on outstanding Benefit Payment check information
received from the Policyowner.
G. Trustmark reserves the right to recover from the Policyowner charges related to non -sufficient
funds (NSF) in the Policyowner's Bank Account(s) plus any applicable interest.
MIN PREM 312198
13
ARTICLE VI - AMENDMENTS
Trustmark has the right to change the rates and/or the factors of this Agreement at any time if:
A. The provisions of the Group Policy have to be changed because of a change in law or regulation;
B. There is an addition or deletion of coverage for subsidiary or affiliated companies or corporate
divisions;
C. The Group Policy allows for a rate change;
D. There is a change in the Minimum Premium Coverages or other provisions of this Agreement;
E. There is a change in enrollment exceeding 10% of the first month enrollment of the current
Contract Period or the 9th month of the prior Contract Period;
F. There is any substantive change in risk, as determined by Trustmark; or
G. The Policyowner requests any changes in the benefits or coverages under the Group Policy.
The effective date of the change in rates and factors shall be the first day of the Contract Month of
the event allowing such change.
ARTICLE VII - TERMINATION
A. This Agreement shall terminate:
1. Upon 31 days prior written notice of termination by either the Policyowner or Trustmark to
the other party;
2. Immediately upon termination of the Group Policy issued by Trustmark to the Policyowner;
3. The earlier of the following:
(a) Immediately upon failure of the Policyowner to comply with any term or condition of this
Agreement, such as, but not limited to, failure to Pay any Premium or Terminal Reserve
Funds as specified in this Agreement;
(b) As of the first of the month in which the Policyholder fails to adequately fund the Bank
Accounts established to cover Benefit Payments, Premium, Terminal Reserve Funds or
Recoveries;
4. If any state or other jurisdiction enacts or amends a law or regulation which, in the opinion of
Trustmark prohibits the continuance of this Agreement. This Agreement shall terminate on
the effective date of the law, regulation or amendment, as determined by Trustmark.
5. Automatically, if any Letter of Credit is either not secured or not maintained as required.
Termination shall be retroactive to the date the Letter of Credit is required to be obtained or
subsequently terminated.
B. If this Agreement terminates prior to the Group Policy terminating and Schedule A indicates that
Reserves are held by:
1. The Policyowner, then the Policyowner shall owe, and immediately pay Reserves to Trustmark
at termination of this Agreement. The amount of Reserves owed by the Policyowner to
Trustmark is equal to the Terminal Benefit Limit and shall be treated as Premium due under
the Group Policy; and
MIN PREM 3/2/98
14
2. The Policyowner or Trustmark, then the following shall apply:
(a) Rates and factors listed on Schedule A shall convert to the Conventional Premium
Equivalent amount listed on Schedule A at termination of this Agreement and shall be
treated as Premium due under the Group Policy; and
(b) The Policyowner shall owe and immediately pay any Post Termination Premium to
Trustmark. The Post Termination Premium shall be treated as Premium due under the
Group Policy.
The Reserve liability shall remain the responsibility of the Policyowner until such time as the Reserves
are actually transferred to Trustmark. This Section B. shall survive termination of this Agreement.
ARTICLE Vlll - LEGAL PROVISIONS
Entire Agreement
This Agreement contains the entire agreement between the parties and sets forth in full the services
to be rendered by Trustmark. It may only be modified or amended by written agreement by the
parties; however, if required by law, Trustmark may amend or change this Agreement at any time,
without the consent of the Policyowner. Any amendment shall be without prejudice to any claim
incurred prior to the effective date of such amendment.
No agent has authority, implied or express, to make any contract in the name of Trustmark or waive,
alter or amend any provision of this Agreement.
Indemnification and Hold Harmless
The Policyowner agrees to indemnify and hold Trustmark harmless from any liability or cost from any
demand, claim or action brought against, or settlement, award or judgment, including attorney fees
and attorney expenses, levied against Trustmark in connection with the Policyowner's failure to meet
its obligations under the terms of this Agreement.
Trustmark agrees to indemnify and hold the Policyowner harmless from any liability or cost from any
demand, claim or action brought against, or settlement, award or judgment, including attorney fees
and attorney expenses, levied against the Policyowner in connection with Trustmark's failure to meet
its obligation under the terms of this Agreement.
These indemnification and hold harmless provisions shall survive termination of this Agreement.
Invalid Provisions
If a provision of this Agreement is found to be illegal for any reason by statute, regulation, or court,
the finding shall not affect the remaining provisions of this Agreement. This Agreement shall be
construed and enforced as if the invalid or illegal provision had not been included in this Agreement
either on the effective date or the date the provision is held to be invalid or illegal. It is provided,
however, that the basic purpose of this Agreement must be achieved through the remaining valid
and legal provisions.
No Waiver
Failure to enforce any term or provision of this Agreement shall not constitute a waiver of any term or
provision.
MIN PREM 3/2/98
15
Litigation
If a lawsuit is brought with respect to a claim subject to this Agreement and processed by Trustmark
pursuant to Trustmark's right to make final Benefit Payment determinations, Trustmark shall defend
that suit.,Trustmark has the right to settle any lawsuit when, in Trustmark's judgment, it appears
expedient to do so> If any settlement or judgment is paid from Trustmark funds and the Policyowner
is obligated to pay those Benefits Payments in accordance with the terms of this Agreement, the
Policyowner shall reimburse Trustmark for the amount of Benefit Payments included in the
settlement or judgment.
Tax and Assessment Responsibility
If Trustmark is required, by competent authority in any jurisdiction where the Policyowner has
employees, to pay an amount as a tax, an assessment, or in lieu of a tax or assessment, an amount
based on benefits paid by or for the Policyowner, from its funds, as set forth in this Agreement; then
Trustmark shall notify the Policyowner in writing of the amount of such payment and of any interest
or other charge thereon paid by Trustmark. The Policyowner shall pay such sum to Trustmark within
30 days of such notification. This responsibility section shall survive termination of this Agreement.
Obligation of the Parties
Trustmark and the Policyowner are mutually exclusive. Neither party shall have the liability to pay
benefits which are, according to the terms of this Agreement, to be paid by the other party. If, for
any reason, benefits which are to be paid by one party are paid from the funds of the other, then
repayment shall be made within 30 days of the date it is determined that the funds have been
misapplied.
Notice
Unless otherwise specified in this Agreement, any notice required or permitted under the terms of
this Agreement shall be in writing, postage prepaid, and sent by U.S. mail or personal delivery to the
other party at the address listed below. Any such notice shall be effective on the third business day
from the date the notice was deposited in a U.S. mail box or U.S. postal center; and in the case of
personal delivery, on the date of receipt. The following addresses may be changed by the provision
of notice to the other party pursuant to this section.
TO TRUSTMARK: Trustmark Insurance Company
Attn: Group Sales, Vice President
400 Field Drive, 2nd Floor
Lake Forest, IL 60045
TO POLICYOWNER:
City of Lubbock, Texas
1625 13th Street
Lubbock, TX 79401
Clerical Error
In the event of a clerical error, the parties agree to revert to the position in which they would have
been had the clerical error not occurred.
MIN PREM 3/2/98
16
Headings
The headings used in this Agreement have been inserted for convenience and do not constitute
matter to be construed or interpreted in connection with this Agreement.
TRUSTMARK INSURANCE
COMPANY (MUTUAL)
aw�/-'
David Meyer
Vice President Administration, Group
POLICYOWNER
By
Signature
Title
Date
Passed by the City Council this 1st day of
A EST:
ayt le Darnell "
City Sobretary
APPROVED AS TO CONTENT:
Mary A ews
Director of Human Resources
APPROVED AS TO FORM:
William de Haas
Competition and Contracts Manager/Attomey
MIN PREM
17
December 1998.
3/2/98
Schedule A Effective: From December 1, 1998 to December 1, 1999 or termination of the Minimum
Premium Agreement, if earlier.
Policyowner: CITY OF LUBBOCK, TEXAS
Group Policy Number(s): ET609
Contract Period: From December 1, 1998 to December 1,1999.
Individual Pooling: Individual pooling is accumulated per Contract Period and applies to Medical
coverage.
❑ Is not included.
XJ Is included. Effective December 1, 1997, the Individual Pooling Liability Amount
per insured employee or dependent is $150,000.
Aggregate Pooling:
❑X Does not apply.
❑ Does apply.
Reserves Are Held By:
X❑ Policyowner
❑ Trustmark
Letter of Credit:
X❑ Does not apply.
❑ Does apply. (see Schedule B).
Banking:
❑ Trustmark's Bank
❑ Trustmark pays banking fees
❑ Policyowner pays banking fees
0 Policyowner's Bank (Policyowner pays banking fees)
Claim Liability Limit Accounting Period:
❑X Monthly
❑ Annual
Carry Over Deficit Recovery Limit:
❑ Does not apply.
X❑ Does apply with a Carry Over Deficit Recovery Limit Percentage of 15%.
Deferred Carry Over Deficit Recovery:
X❑ Does not apply.
❑ Does apply.
MIN PREM 11/24/97
1
Surplus Position Carry Over:
QX Does not apply.
Does apply. The Surplus Position Carry Over Percentage is %.
Terminal Benefit Limit:
Does not apply.
0 Does apply for a period of 90 days with a Post Termination Premium Factor of 2.5.
Minimum Premium Coverage(s) for Which the Policyowner Is Assuming Liability under this Minimum
Premium Agreement:
Medical, Prescription Drugs and Dental
Other Experience Refunding Coverage(s):
None
Premium Guarantee and Terminal Reserve Funds Guarantee:
Are not in effect for the Contract Period.
0 Are in effect for the Contract Period, subject to the provisions below.
If the Premium Guarantee and Terminal Reserve Funds Guarantee are effective for the
Contract Period, Trustmark guarantees that retention, Individual Pooling charges, and any
Reserve charges shall equal the premium and/or Terminal Reserve Funds generated by the
monthly premium rates, Terminal Reserve Fund Factors and the enrollment during the
Contract Period; however, the Terminal Reserve Funds Guarantee terminates 12 months
prior to the termination of the Agreement.
These guarantees do not apply if any law or regulation affecting expenses becomes
effective during the Contract Period, or if any law or regulation is interpreted by a
governmental, judicial or administrative body in a manner which affects expenses.
MIN PREM 11/24/97
2
Monthly Rates and Factors:
Individual
Terminal
Minimum
Monthly
Pooling
Reserve
Premium
Maximum
Premium
Funds
Coverage Rate
Benefit Factor
Rate
Factor
MEDICAL:
Active Employees & Retired
Employees not eligible for
Medicare
Employee/Retiree $12.49
$176.36
$6.63
N/A
Spouse $10.22
$149.49
$5.42
N/A
Child(ren) $ 7.94
$116.09
$4.21
N/A
Spouse and Child(ren) $18.70
$273.60
$9.93
N/A
Dependent of Retiree $19.83
$184.05
$9.90
N/A
Retired Employees eligible for Medicare
Employee $18.64
$82.68
$9.90
N/A
Dependent $18.64
$84.91
$9.90
N/A
PRESCRIPTION DRUGS:
Active Employees & Retired
Employees not eligible for
Medicare
Employee/Retiree $2.36
$14.67
N/A
NIA
Spouse $1.93
$12.44
N/A
N/A
Child(ren) $1.50 $ 9.65
N/A
N/A
Spouse and Child(ren) $3.53
$22.75
N/A
N/A
Dependent of Retiree $2:30g." $12.44
N/A
N/A
Retired Employees eligible for Medicare
,
Employee $3.52
"$14.67
N/A
N/A
Dependent $30,3.6�2,
$12.44
N/A
N/A
DENTAL
Active Employees
,�q
Employee
$'tom 1,0
$15.57
N/A
N/A
Spouse
$1.08 J�`
$13.17
N/A
N/A
Child(ren)
$0.84
$10.23
N/A
N/A
Spouse and Child(ren)
$1.98
$24.13
N/A
N/A
MIN PREM 11/24/97
3
. H ,�il , :1, -f U. t
Terminal Benefit Limit Factors:
Coverage Factor
MEDICAL:
Active Employees & Retired
Employees not eligible for
Medicare
Employee/Retiree $426.26
Spouse $291.39
Child(ren) $280.39
Spouse and Child(ren) $660.76
Dependent of Retiree $291.39
Retired Employees eligible for Medicare
Employee $224.53
Dependent $224.53
PRESCRIPTION DRUGS:
Active Employees & Retired
Employees not eligible for
Medicare
Employee/Retiree
$16.59
Spouse
$16.59
Child(ren)
$10.91
Spouse and Child(ren)
$25.72
Dependent of Retiree
$16.59
Retired Employees eligible for Medica
Employee $8.74
Dependent $8.74
DENTAL
Active Employees
Employee $32.64
Spouse $27.61
Child(ren) $21.44
Spouse and Child(ren) $50.59
Conventional Premium Equivalent Monthly Rates:
Coverage Rate
MEDICAL:
Active Employees & Retired
Employees not eligible for
Medicare
Employee $199.39
Spouse $168.43
Child(ren) $130.80
Spouse and Child(ren) $308.27
Dependent of Retiree $218.06
MIN PREM 11 /24/97
4
Retired Employees eligible for Medicare
Employee $113. 4
Dependent $115.72
PRESCRIPTION DRUGS:
Active Employees & Retired
Employees not eligible for
Medicare
Employee $199.39
Spouse $168.43
Child(ren) $130.80
Spouse and Child(ren) $308.27
Dependent of Retiree $218.06
Retired Employees eligible for Medicare
Employee $113.44
Dependent $115.72
DENTAL
Active Employees
Employee $17.16
Spouse $14.54
Child(ren) $11.29
Spouse and Child(ren) $26.63
TRUSTMARK INSURANCE
COMPANY (MUTUAL)
d-#'
David Meyer
Vice President Administration, Group
March 10,1999
POLICYOWNER
Title
Date
by thh CitMunci ' 1st day of December 199&
MAYOR
MIN PREM
APPROVED AS TO ONTENT:
.._ A
Mary Andrea
of man Resources
APPROVED AS TO FORM:
William de Haas
ComIpetition and Contracts Manager/Attomey 11/24/97
5