HomeMy WebLinkAboutResolution - 2018-R0401 - 1 Stop Loss Insurance - BCBS - 11/15/2018Resolution No. 2018-RO401
Item No. 6.7
November 15, 2018
RESOLUTION
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK:
THAT the Mayor of the City of Lubbock is hereby authorized and directed to
purchase and renew for and on behalf of the City of Lubbock and its health benefits
program, specific stop loss insurance coverage from Blue Cross Blue Shield of Texas,
consistent with the terms and conditions attached hereto, and all related documents.
Passed by the City Council this November 15 , 2018.
DANIEL M. POPE, MAYOR
ATTEST:
Reb ca Garza, City Secr tar
AP7S,-TO-CONTENT:
Leisa Hutcheson, Director of Human Resources and Risk Management
ttorney
ccdocs//Res. Stop Loss Insurance Coverage — Blue Cross Blue Shield of Texas
October 29, 2018
BlueCross B1ueShield
of Texas
APPLICATION FOR STOP LOSS COVERAGE
Employer Group Name: City of Lubbock
Employer Group Address: 1625 131h Street
City: Lubbock State of Situs: TX Zip Code: 79401
Account Number: 010097
Employer Group Number(s): 219476
Current Effective Date of Policy 01/01/2019
Current Policy Period: These specifications are for the Policy Period commencing on 01/01/2019 and ending on
12/31 /2019
The specifications below shall become effective on the first day of the Policy Period specified above and shall continue in
full force and effect until the earliest of the following dates: (1) The last day of the Policy Period; (2) The date the Policy
terminates; or (3) The date this Application is superseded in whole or in part by a later executed Application.
A. Aggregate Stop Loss Coverage: ❑ Yes ® No
If yes, complete items 1 through 9 below.
1. ❑ New Coverage ❑ Renewal of Existing Coverage
2. Stop Loss Coverage during the current Policy Period:
❑ New Coverage (Select one from below):
❑ Incurred and paid during the Claims incurred and paid from to
Policy Period:
❑ Incurred with Run -Out: Claims incurred from to
and Claims paid from to
❑ Run-in coverage: Claims incurred from to
and Claims paid from to
If coverage is for claims incurred prior to the effective date of the Policy and paid by Policyholder's
prior claim administrator, then such claims must be reported by the Policyholder to the Company
(Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual
Legal Reserve Company) and paid by the Policyholder's prior claim administrator by the end of
the current Policy Period.
❑ Renewal of Existing Coverage:
❑ Claim Administrator's Claims: Claims incurred on or after the original Effective Date of Policy and paid
during the Policy Period.
❑ Incurred with Run -Out:
Claims incurred from to
and Claims paid from to
A Division of Health Care Service Corporation, a Mutual Legal Reserve Company
an Independent Licensee of the Blue Cross and Blue Shield Association
TXStopLossApp-06/17
Aggregate Stop Loss Coverage shall apply to:
4
91
❑ Medical Claims
❑ Outpatient Prescription Drug Claims with Company's Pharmacy Benefit Manager
❑ Outpatient Prescription Drug Claims with Policyholder's Pharmacy Benefit Manager:
❑ Dental Claims
❑ Other (please specify):
Average Claim Value: (per Employee per Month)
Attachment Factor: % of the Average Claim Value
Aggregate Claim Liability and Run -Off Claim Liability Factors
a. Employer's Claim Liability for each Policy Period shall be the sum of the Monthly amounts obtained by
multiplying the number of Individual and Family Coverage Units for each Month by the following factors:
$ for each Coverage Unit
$ for each Family Coverage Unit
Please use the continuous text field directly below for any other structure (leaving the fields above blank).
Note: you can use the "return" key to create additional rows, if needed:
b. Employer's Run -Off Claim Liability shall be calculated by multiplying the sum average of the total of all
Coverage Units during each of the three calendar Months immediately preceding termination by the factors
shown below. Settlement for the final accounting period will be described in the section of the Policy entitled
SETTLEMENTS.
$ for each Coverage Unit
for each Family Coverage Unit
Please use the continuous text field directly below for any other structure (leaving the fields above blank).
Note: you can use the "return"key to create additional rows, if needed:
CAP Arrangement ❑ Yes ❑ No
Aggregate Stop Loss Claims
a. The amount of Paid Claims during the current Policy Period, less:
i. Individual (Specific) Stop Loss Claims
ii. Any claims in excess of the Individual (Specific) Stop Loss Claims per Covered Person per
Lifetime Maximum
iii. Any claims in excess of the Individual (Specific) Stop Loss Claims maximum Point of Attachment
that exceeds the Aggregate Point of Attachment. The Aggregate Point of Attachment shall equal the sum of
the Employer's Claim Liability amounts calculated Monthly as described in item A.S.a. above for the current
Policy Period.
b. In the event of termination at the end of a Policy Period, the Final Settlement Aggregate Point of Attachment
shall equal the sum of the Employer's Claim Liability amount for the Final Policy Period and the Employer's
Run -Off Claim Liability calculated as described in item A.5.b. above. However, for the current Policy Period
the minimum Aggregate Point of Attachment shall be $
TXStopLossApp-06/17 2
8. Stop Loss Premium (Select one):
❑ Annual Premium (Due on the first day of the current Policy Period): $
❑ Monthly Premium shall be equal to the amounts obtained by multiplying the number of Individual and Family
Coverage Units for a particular Month by:
$ for each Coverage Unit
$ for each Family Coverage Unit
Please use the continuous text field directly below for any other structure (leaving the fields above blank). Note:
you can use the "return" key to create additional rows, if needed:
9. The premium is based upon a current membership of Individual Coverage Units and Family
Cc,,=-e Ur.its.
B. Individual (Specific) Stop Loss Coverage: ® Yes ❑ No
If yes, complete items 1 through 6 below.
1. ❑ New Coverage ® Renewal of Existing Coverage
2. Stop Loss Coverage Period:
❑ New Coverage (Select one from below):
❑ Incurred and paid during the Claims incurred and paid from to
Policy Period:
❑ Incurred with Run -Out: Claims incurred from to
and Claims paid from to
❑ Run-in coverage: Claims incurred from to
and Claims paid from to
If coverage is for claims incurred prior to the effective date of the Policy and paid by Policyholder's
prior claim administrator, then such claims must be reported by the Policyholder to the Company
(Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual
Legal Reserve Company) and paid by the Policyholder's prior claim administrator by the end of the
current Policy Period.
® Renewal of Existing Coverage:
❑ Claim Administrator's Claims: Claims incurred on or after the original Effective Date of Policy and paid
during the Policy Period.
® Incurred with Run -Out: Claims incurred from 01/01/2019 to 12/31/2019
and Claims paid from 01/01/2019 to 03/31/2020
3. Individual (Specific) Stop Loss Coverage shall apply to:
® Medical Claims
® Outpatient Prescription Drug Claims with Company's Pharmacy Benefit Manager
❑ Outpatient Prescription Drug Claims with Policyholder's Pharmacy Benefit Manager:
❑ Dental Claims
❑ Vision Claims
TXStopLossApp-06/17 3
❑ Other (please specify):
4. Individual (Specific) Stop Loss Claims
a. For NA who is identified by the health identification (ID) number NA, the amount of Paid Claims during the
current Policy Period in excess of the Individual Point of Attachment of $NA. Such amount shall apply for
the current Policy Period.
b. For each other Covered Person:
The amount of Paid Claims during the current Policy Period in excess of the Individual Point of Attachment
of $700,000 per Covered Person but not to exceed a maximum Point of Attachment of $ UNLIMITED per
Policy Period. Paid Claims in excess of the maximum point of attachment shall not be eligible to satisfy the
Aggregate Point of Attachment. Such amount shall apply for the current Policy Period.
c. Covered Person per Lifetime Maximum:
The Individual (Specific) Stop Loss Claims shall not exceed UNLIMITED per Covered Person Der Lifetime.
Paid Claims in excess of the Covered Person per Lifetime Maximum shall not be eligible to satisfy the
Aggregate Point of Attachment.
Point of Attachment ® Includes Claim Administrator's Provider Access Fee
❑ Excludes Claim Administrator's Provider Access Fee
5. Stop Loss Premium (select one):
® Annual Premium (Due on the first day of the current Policy Period): $
® Monthly Premium shall be equal to the amounts obtained by multiplying the number of Individual and Family
Coverage Units for a particular Month by:
$ for each Coverage Unit
$ for each Family Coverage Unit
Please use the continuous text field directly below for any other structure (leaving the fields above blank). Note:
you can use the "return"key to create additional rows, if needed:
12.29
The premium is based upon a current membership of 1215 Individual Coverage Units and 1298 Family
Coverage Units.
Additional Provisions:
12/15 Stop Loss Policy - Claims incurrred 01/01/2019 through 12/31/2019 and paid 01/01/2019 through 03/31/2020.
Premium is based on 2,513 enrolled.
TXStopLossApp-06/17 4
The undersigned person represents that he/she is authorized and responsible for purchasing stop loss coverage on behalf
of the Employer. It is understood that the actual terms and conditions of coverage are those contained in Application the
Stop Loss Coverage Policy into which this Application shall be incorporated at the time of acceptance by Blue Cross and
Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company ("HCSC"). Upon
acceptance, HCSC shall issue a Stop Loss Coverage Policy to the Employer. Upon acceptance of this Application and
issuance of the Stop Loss Coverage Policy, the Employer shall be referred to as the "Policyholder."
Tave Lawhorn
Sales Representative Signature of Authorized Purchaser
Ertl: Gcrza
Name of Underwriter
Signature of Underwriter
Planing M. Pcpc 44N'Y'C
Title of Authorized Purchaser
November 15, 2018
Date
INTERNAL USE ONLY Date Application approved by Underwriting:
TXStopLossApp-06/17 5
ATTEST:
— Q, olwt�
R.ebe a Garza, City Secre r
APPRPY,E AD S TO CONTENT:
Leisa Hutt.;iieson, DireQLoi of riunian
Resources and Risk Management
OrSeat
PARTNER GROUP
Stealth Partner Group
5949 Sherry Lane, Suite 1170
Dallas, TX 75225
Stealth Marketing Summary
Prepared for; City of Lubbock
Effective Date: 11112019
Dan Harlow
Phone: (214) 453-1943
E-Mail: DHarlow@stealthpartnergroup.com
Carrier:
Rating
Marke!teJ
Quoted
Declined
Comments
J
American Fidelity
A+
x
Uncompetitive Rates
Anthem
A+
x
Underwriting Guidelines - Minimum Premium
a
Berkley
A+
x
Berkshire Hathaway
A++
0
x
Ongoing Large Claims
HCC
A+
x
HIIG
A
x
Uncompetitive Rates
HM
A
x
Uncompetitive Rates
Liberty Mutual
A+
x
Ongoing Large Claims
Optum
A
x
Ongoing Large Claims
QBE
A
x
Uncompetitive Rates + 4S% over current
RSLI
A+
x
Uncompetitive Rates
Sun Life
A+
0
x
Uncompetitive Rates
Swiss Re
A+
x
Uncompetitive Rates
Symetra
A
F±1
x
Uncompetitive Rates
Unum
A
0
x
Uncompetitive Rates
voya
A
El
x
Uncompetitive Rates
10/18/2018