HomeMy WebLinkAboutResolution - 2006-R0512 - Purchase Specific And Aggregate Stop Loss Insurance- High Mark Life Insurance Co - 10_13_2006Resolution No. 2006-R0512
October 13, 2006
Item No. 6.11
RESOLUTION
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 purchase for and on behalf of the City of Lubbock, specific and aggregate stop
loss insurance coverage, by and between the City of Lubbock and High Mark Life
Insurance Company pursuant to the terms and conditions attached hereto as Exhibit "A"
within the amount budgeted for said coverage, offering the same benefits as set forth in
;Exhibit "A" hereto, and in a final form and substance acceptable to the City Manager and
City Attorney, for the City's health benefits program; and
THAT the City Manager or designee may execute any routine documents and
forms associated with said insurance coverage.
Passed by the City Council this 13th day of October , 2006.
DAVID A./MILLER, MAYOR
iey
I Stop Loss Proposal for Resolution No. 2006-RO512
City of Lubbock (BCBS of TX) WIEUISIT A"
LIFE IN5URANCL
COMPANY Carrier: HM Life Insurance Company
Effective Date: 1/1/2007
TPA: BCBS of TX
Broker.
Lives
Specific Deductible (per Covered Person)
Lifetime Maximum Specific Benefit
Covered Benefits
Specific Premium:
Single Rate 1,287
Family Rate 1,072
2,359
Estimated Contract Specific Premium:
,Contract Basis
,Commission
AGGREGAT€
Covered Benefits
Policy Year Maximum
;Aggregate Factors
'Composite Medical Factor: 2,359
;Composite Rx Factor. 2,359
Istimated Contract Attachment Point 0 4718
Contract Minimum Attachment Point %)
RENEWAL I OPTION 11 1 OPTION 2
$175,000
$200,000
$225,000'
$825,000
$800,000
$775,000i
Medical, Rx
Medical, Rx
Medical, Rx!
$8.33
$6.92
$5.74 i
$19.48
$16.52
$13.971
$379,239
$319,386
$268,359
12/15 12115 121151
0.0°% 0.0% 0.0%�
Medical, Rx
Medical, Rx
Medical, Rx1
$1.000.000
$1,000,000
$1.000,000
$499.36
$502.86
$505.35
$142.93
$142.93
$142.931
$18,181,945
$18,281,023
$18,351,510 1
$18,181,945 $18,281,023 $18,351,510
I
Aggregate Corridor
.12M
Contract Basis
1
12/15
�
T2J15
'Aggregsts Premium Rate
Composite 2,359
$2.05
$2.06
$2.07
Estimated Contract Aggregate Premium .2,359
$58,031
$58,314
$58,598
Commission
0.0%
0.0%
0.0%
TOTAL COIMIBIN12, CONTRACT PREMIUM.
$437.271
$377,700
$326,956
• This proposal is not complete unless accompanied by the Assumption and Qualifications sections noted in
the next page.
* The above rates and factors are tentative and will be subject to review or
change based on up-to-date experience
and large claim information.
This proposal excludes coverage for transplants. To include it would increase the specific rates 4%.
Please acknowledge acceptance of the above terms by signing and returning the proposal no later than 30 days from the
date of the proposal offer. 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:
Title:
Accepted the day of , 20
Coverage provided under policy form HL6901 (905); in certain states the requested coverage may not be available, or may be
underwritten by Highmark Life Insurance Company,
Underwriter: MAC 09/29/2006 08:31 AM
HM Life Insurance Company Stop Loss Insurance
Basis of Offer
Group Name: City of Lubbock (BCBS of TX) 9/29/2006
Assumptions
Initials: Date:
* This proposal is based on duplication of the current plan of benefits, including utilization of the BCBS of TX network and the BCBS of TX
Utilization Review vendor.
* 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 benefits provided, 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 will be adjusted accordingly.
• The 8.18% bad debt and charity surcharge portion of the New York Reform Act will be applicable under the stop loss.
* All standard Policy provisions apply. Certain exclusions, limitations and laws of the state where the Policy is issued, may apply. Please contact
your HMIG Sales Representative for details.
* Retirees are included in the stop loss coverage.
* Coverage for any occupational illness or injury is excluded from this proposal.
* This proposal will expire 15 days after the proposed effective date.
* Eligible claim expenses arising out of any treatment for human organ transplants will not exceed $0 per lifetime.
* Minimum aggregate deductible percentage will be 100%.
* 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 rate guarantee is 12 months from the approved effective date.
• There are not more than 5% COBRA participants.
Qualifications
* Actively -at -work, disabled, hospital confined, or similar provisions will apply unless a completed and signed Disclosure Form, or other
information acceptable to HMIG, is received and approved by underwriting. Other information acceptable by HMIG must be approved prior to final
underwriting acceptance.
* Completed Disclosure Form, Application, first month's premium check, final census, and any other required information as stated under the
Assumptions or Individual Special Requirements, must be received within 30 days prior to, but no later than 15 days following the proposed
effective date. Information contained on the Disclosure Form should be current up to the date of signature, and be completed in its entirety.
Failure to do so will result in approval being denied or delayed until a later effective date.
* Should the number of employees, either in total and/or by single/family mix, change by 10% or more, both the premium rates and the aggregate
retention factors are subject to change.
* Aggregate retention factors and aggregate premium rates are subject to change upon receipt and review of monthly paid claims, monthly
enrollment, and shock claimant information for 11 months in the current plan year. HMIG may approve earlier firm up with underwriter approval.
* Specific rates and/or individual deductible amounts are subject to change upon receipt and review of shock loss information for claimants that
exceed or are expected to exceed 50% of the specific deductible for 11 months in the current plan year. Information should include total amount
of the claim, date incurred, diagnosis, prognosis, age, course of treatment, and pended claims. HMIG may approve earlier firm up with
underwriter approval.
* A signed and dated Plan Document is required within 60 days of the proposed effective date. If the description of the benefits or plan provisions
differ from what was initially utilized to underwrite the risk, the premium rates and aggregate retention factors may be subject to re -rating, retro-
active to the effective date.
* HIPPA 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 PHI collected except to perform this risk evaluation.
* Individual Special Requirements:
Specific
Individual Deductible Required Information
Current Policy Individual Limitations to be continued
Underwriter: MAC 09/29/2006 08:31 AM