HomeMy WebLinkAboutResolution - 2015-R0364 - Application For Renewal - Blue Cross Blue Shield - Stop Loss Coverage Policy - 11/05/2015Resolution No. 2015-RO364
Item No. 5.5
November 5, 2015
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
execute for and on behalf of the City of Lubbock.. an Application for renewal of a Stop
Loss Coverage Policy, by and between the City of Lubbock and Blue Cross Blue Shield
of Texas, and related documents. Said Application 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.
THAT the City Manager may execute any routine documents and forms associated
with said coverage.
Passed by the City Council on November 5. 2015
- -., 0 /�X
GL C. ROB RTSON, MAYOR
ATTEST:
Reb I
cca Garza, CitASecret
APPROVED AS TO CONTENT:
for 'le ;St
Hutcheson
irector of Human Resources and Risk Management
APPROVED AS TO FORM:
M tc ell Satterwhi ssi ant City Attorney
RES.Risk Mgmt-Application-Stop Loss Coverage Policy
10.14.2015
Resolution No. 2015-RO364
BlueCross BlueShield
of Texas
APPLICATION FOR STOP LOSS COVERAGE
Employer Group Name: City of Lubbock
Employer Group Address: 1625 13th Street
City: Lubbock State of Situs: TX Zip Code: 79401
Account Number: 010097
Employer Group Number(s): 010097, 106837
Effective Date of Policy 01/01/16
Policy Period: These specifications are for the Policy Period commencing on 01/01/16 and ending on 1231/16
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terminates; or (3) The date this Application for Stop Loss Coverage (herein called the "Application") is superseded in
whole or in part by a later executed Application.
A. Aggregate Stop Loss Insurance: ❑ Yes ® No
If yes, complete items 1 through 9 below.
1. ❑ New Coverage ❑ Renewal of Existing Coverage
2. Stop Loss Coverage Period:
❑ New Coverage (Select one from below):
❑ Standard: Claims incurred and paid during the Policy Period.
❑ "Run-in" included: Claims incurred on or after and paid during the Policy Period.
"Run-in" includes claims paid by Policyholder's prior claim administrator: Yes ❑ No ❑
If yes, 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) within 12
months of the Policy Effective Date and paid by the Policyholder's prior claim administrator within 6
months after the Policy Effective Date.
❑ Renewal of Existing Coverage:
Claims incurred on or after the original Effective Date of Policy and paid during the Policy Period.
3. Aggregate Stop Loss Insurance shall apply to:
❑ Medical Claims
❑ Outpatient Prescription Drug Claims
❑ Dental Claims
❑ Other (please specify):
A Division of Health Care Service Corporation, a Mutual Legal Reserve Company
an Independent Licensee of the Blue Cross and Blue Shield Association
TXStopLossApp-11/10
4
5.
0
Average Claim Value: per Employee
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 Coverage Units for each Month by the following factors:
$ for each Employee Coverage Unit
$ for each Employee/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 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, Run -Off Period subsection of the Policy.
$ for each Employee Coverage Unit
$ for each Employee/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 5.a. above for the indicated
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 5.b. above. However, for the indicated Policy Period
the minimum Aggregate Point of Attachment shall be $
c. Aggregate Stop Loss Claims shall not exceed a lifetime maximum of for the indicated Policy Period.
Premium (Select one):
❑ Annual Premium (Due on the first day of the Policy Period): $
❑ Monthly Premium shall be equal to the amounts obtained by multiplying the number of Coverage Units for a
particular Month by
$ for each Employee Coverage Unit
$ for each Employee/Family Coverage Unit
TXStopLossApp-11/10 2
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
Coverage Units.
B. Individual (Specific) Stop Loss Insurance: ® 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):
❑ Standard: Claims incurred and paid during the Policy Period.
❑ "Run-in" included: Claims incurred on or after and paid during the Policy Period
"Run-in" includes claims paid by Policyholder's prior claim administrator: Yes ❑ No ❑
If yes, 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) within
months of the Policy Effective Date and paid by the Policyholder's prior claim administrator within
months after the Policy Effective Date.
® Renewal of Existing Coverage:
Claims incurred on or after the original Effective Date of Policy and paid during the Policy Period.
3. Individual (Specific) Stop Loss Insurance shall apply to:
® Medical Claims
® Outpatient Prescription Drug Claims
❑ Dental Claims
❑ Vision Claims
❑ 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 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 $350,000 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 Policy Period.
c. Covered Person per Lifetime Maximum:
The Individual (Specific) Stop Loss Claims shall not exceed Unlimited per Covered Person per 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
TXStopLossApp-11/10
5. Premium (select one):
❑ Annual Premium (Due on the first day of the Policy Period): $
® Monthly Premium shall be equal to the amounts obtained by multiplying the number of Coverage Units for a
particular Month by
$ for each Employee Coverage Unit
$ for each Employee/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:
521.45 Composite
6. The premium is based upon a current membership of 1,382 Individual Coverage Units and 1,398 Family
Coverage Units.
Additional Provisions:
12115 Stop Loss Policy - Claims incurred 01/0112016 through 12./31/2016 and paid 01/01/2016 through 03/31:2017. Premium is based
on 2,780 enrolled.
The undersigned person represents that he/she is authorized and responsible for purchasing stop loss coverage on behalf
of the Employer Group. It is understood that the actual terms and conditions of coverage are those contained in this
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 Group. Upon acceptance of
this Application and issuance of the Stop Loss Coverage Policy, the Employer Group shall be referred to as the
"Policyholder."
Tave Lawhorn
Sales Representative
Trang Nguyen
Name of Underwriter
Sig ture of A46thorized Purchaser
Glen C. Robertson, Mayor
Title of Authorized Purchaser
INTERNAL USE ONLY Date Application approved by Underwriting: _
TXStopLossApp-11/10 4
BlueCross BlueShield
19 of Texas
APPLICATION FOR STOP LOSS COVERAGE
Employer Group Name:
Employer Group Address:
City:
Account Number:
Employer Group Number(s):
Effective Date of Policy
City of Lubbock
1625 13th Street
Lubbock State of Situs: TX
010097
010097, 106837
01/01/16
Zip Code: 79401
Policy Period: These specifications are for the Policy Period commencing on 0 1/0 1/16 and ending on 12/31/16
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 for Stop Loss Coverage (herein called the "Application") is superseded in
whole or in part by a later executed Application.
A. Aggregate Stop Loss Insurance: ❑ Yes ® No
If yes, complete items 1 through 9 below.
1. ❑ New Coverage ❑ Renewal of Existing Coverage
2. Stop Loss Coverage Period:
❑ New Coverage (Select one from below):
❑ Standard: Claims incurred and paid during the Policy Period.
❑ "Run-in" included: Claims incurred on or after and paid during the Policy Period.
"Run-in" includes claims paid by Policyholder's prior claim administrator: Yes ❑ No ❑
If yes, 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) within 12
months of the Policy Effective Date and paid by the Policyholder's prior claim administrator within 6
months after the Policy Effective Date.
❑ Renewal of Existing Coverage:
Claims incurred on or after the original Effective Date of Policy and paid during the Policy Period.
3. Aggregate Stop Loss Insurance shall apply to:
❑ Medical Claims
❑ Outpatient Prescription Drug Claims
❑ Dental Claims
❑ Other (please specify):
A Division of Health Care Service Corporation, a Mutual Legal Reserve Company
an Independent Licensee of the Blue Cross and Blue Shield Association
TXStopLossApp-1 1/10
4. Average Claim Value: per Employee
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 Coverage Units for each Month by the following factors:
$ for each Employee Coverage Unit
for each Employee/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 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, Run -Off Period subsection of the Policy.
$ for each Employee Coverage Unit
$ for each Employee/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:
6. CAP Arrangement ❑ Yes ❑ No
7. 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 5.a. above for the indicated
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 5.b. above. However, for the indicated Policy Period
the minimum Aggregate Point of Attachment shall be $
c. Aggregate Stop Loss Claims shall not exceed a lifetime maximum of for the indicated Policy Period.
Premium (Select one):
❑ Annual Premium (Due on the first day of the Policy Period): $
❑ Monthly Premium shall be equal to the amounts obtained by multiplying the number of Coverage Units for a
particular Month by
$ for each Employee Coverage Unit
$ for each Employee/Family Coverage Unit
TXStopLossApp-11/10 2
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
Coverage Units.
B. Individual (Specific) Stop Loss Insurance: ® Yes ❑ No
If yes, complete items 1 through 6 below.
1. ❑ New Coverage ® Renewal of Existing Coverage
Stop Loss Coverage Period:
❑ New Coverage (Select one from below):
❑ Standard: Claims incurred and paid during the Policy Period.
❑ "Run-in" included: Claims incurred on or after and paid during the Policy Period
"Run-in" includes claims paid by Policyholder's prior claim administrator: Yes ❑ No ❑
If yes, 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) within
months of the Policy Effective Date and paid by the Policyholder's prior claim administrator within
months after the Policy Effective Date.
® Renewal of Existing Coverage:
Claims incurred on or after the original Effective Date of Policy and paid during the Policy Period.
3. Individual (Specific) Stop Loss Insurance shall apply to:
® Medical Claims
® Outpatient Prescription Drug Claims
❑ Dental Claims
❑ Vision Claims
❑ 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 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 $350,000 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 Policy Period.
c. Covered Person per Lifetime Maximum:
The Individual (Specific) Stop Loss Claims shall not exceed Unlimited per Covered Person per 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
TXStopLossApp-11 /10
5. Premium (select one):
❑ Annual Premium (Due on the first day of the Policy Period): $
® Monthly Premium shall be equal to the amounts obtained by multiplying the number of Coverage Units for a
particular Month by
$ for each Employee Coverage Unit
$ for each Employee/Family Coverage Unit
Please use the continuous text field directly below for any other structure fleavinq the fields above blank). Note:
you can use the "return" key to create additional rows, if needed.-
$21.45
eeded.
$21.45 Composite
6. The premium is based upon a current membership of 1,382 Individual Coverage Units and 1,398 Family
Coverage Units.
Additional Provisions:
12/15 Stop Loss Policy - Claims incurred 01/01/2016 through 12:'3112016 and paid 01/01,12016 through 03131'2017. Premium is based
on 2,780 enrolled.
The undersigned person represents that he/she is authorized and responsible for purchasing stop loss coverage on behalf
of the Employer Group. It is understood that the actual terms and conditions of coverage are those contained in this
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 Group. Upon acceptance of
this Application and issuance of the Stop Loss Coverage Policy, the Employer Group shall be referred to as the
"Policyholder." 1
Tave Lawhorn
Sales Representative
Trang Nguyen
Name of Underwriter
Sign re of Authorized Purchaser
Glen C. Robertson, Mayor
Title of Authorized Purchaser
November 5, 2015
Date
INTERNAL USE ONLY I Date Application approved by Underwriting:
TXStopLossApp-11 /10 4
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A im
LIFE INSURANCE
COMPANY
li��.liySLik�l+t�t GROUP � hmsg.mm
Sales Representafive:
Broker.
TPA.-
Provider
PA:Provider Network(s):
Utilization Review Vendor(s):
J. Albert Lucio
Mc & H Life Agency Inc
Blue Cross Blue Shield of Texas
Blue Cross Blue Shield of Texas
Blue Cross Blue- Shield of Texas -
STOP LOSS PROPOSAL_ FOR
City of Lubbock Texas
Effective Date: 01/01/2016
Through Date: 12/31/2016
Specific Deductible (per Covered Individual)
$350,000
$375,000
$400,000
$30,000
Policy Year Maximum Specific Benefit
Unlimited
Unlimited
Unlimited
Unlimited
Lifetime Maximum Specific Benefit
Unlimited
Unlimited
Unlimited
Unlimited
Covered Benefits
Med, Rx Card
-
Med, Rx Card
Med, Rx Gard
Med, Rx Card
Specific Premium
-
Composite Rate 2,594
$2147
$19 83
$1840
$19.63
Total Lives 2,594
Estimated Contract Specif c Premium
$668,318
$617.268
$572,755
$611043
Contract Basis
12115
12/15
12/15
12/12
Commission
000%
000%
0 M
000%
Note: This proposal is not complete unless accompanied by the proposal notes and the basis of offer noted on the following pages
Individual Special Requirements:
Underwriter: DMS (September 29, 2015) 10466846003-2015-457072-2-1 Page 1 of 6
�
(1.2".)
1
Milliman
1120 South 101 s1 Street
3.0'o
Suite 400
Rx Rebates
Omaha, NE 68124
(.},90 o)
USA
0.0° 0
Tel +1402 393 9400
Individual Stop -Loss
Fax +1 402 384 5776
0.000
milliman.com
September 2, 2015
Mr. Travis Sartain
Partner
NIHBT
8144 Walnut Hill Lane
Dallas, TZ 75231
Re: City of Lubbock Renewal Evaluation for the 2016 Plan Year
Dear Mr. Sartain:
At your request, `Iilliman, Inc. (`Iilliman) has completed an evaluation of City of Lubbock's 2016
renewals. This letter includes the executive summary, detailed analysis, methodology, reliance, and
limitations of our findings.
Executive Summary
CM- of Lubbock currently offers its eligible employees various medical, dental, life, disability, and
other types of coverage. You engaged Milliman to evaluate the 2016 plan year Qanuary 1, 2016 -
December 31, 2016) medical and dental renewals proposed by the insurance carrier. Our evaluation
of the carriers' proposals is shown in the table below:
Medical - _-lctive,'COBR1 (Self Insured`.
Claims Cost
(1.2".)
(I.20 0)
Claims _administration
3.0'o
3.00 o
Rx Rebates
(4.90o)
(.},90 o)
Organ Transplant Fee
0.0° 0
5.00 0
Individual Stop -Loss
25.50,0
0.000
ACA Fees
36.60.0)
(36.60o)
Total Medical - Active/COBRA
(0.6%)
(1.2%)
Offices in Principal Cities Worldwide
M Milliman September 2, 2015
Medical - Retirees (Self -Insured)
Claims Cost
18.0910
18.0°o
Claims -administration
3,0%
3.00o
Rt Rebates
(4.9" 0)
(4.9"o)
Organ Transplant Fee
0.00'0
5.0° 0
Individual Stop -Loss
25.50 0
0.0'0
ACA Fees
(36.6%)
36.6° 01
Total Medical - Retirees
17.2%
16.8%
Dental (Self -Insured)
Claims Cost
(24.1%) 0)
(2-1.100)
Claims _administration
0.000
5.0°o
Total Dental
0? 701
111) e0i.
We estimate that self-insured annual claims and expenses for the 2016 plan year will be
approximately:
• $21.75 million for Active/COBRA medical and prescription drugs based on current
enrollment levels of 2,135 employees and a projected premium of $849.00 per
employee per month (PEPM). However, we recommend that City of Lubbock
continue to budget at $854.43 PEPM for an annual budget of $21.89 million; and
• $9.36 million for Retiree medical and prescription drugs based on current enrollment
levels of 644 employees and a projected premium of $1,211.24 per employee per
month (PEPM); and
• $1.36 million for dental based on current enrollment levels of 2,675 employees and a
projected premium of $42.41 PEPM. However, we recommend that City of Lubbock
continue to budget at $54.89 PEPM for an annual budget of $1.76 million.
See Attachments #14 for more details. We will use these figures in our projection of budgets for
the upcoming plan year. Note that these figures also depend on current plan designs, claims
experience that was available to us, and proposed expenses. If enrollment levels, plan designs,
vendors, or locations should change dramatically, this number should be updated with the new
information.
2
■
Milliman September 2, 2015
Detailed Analysis
L Renewal Evaluation — Medical & Prescription Drugs (self-insured)
Prq eaed Chaiig 111 Prei11llU11 - Clai,,v � � E %pews — Adive/ COBR.=1
Attachment #5 shows our calculation of estimated claims costs and expenses for the
Active,/COBRA medical and prescription drug plan. Using the carrier's proposed increases to
expenses listed in the Executive Summar- above and shown in Attachment #2, we estimate that
City of Lubbock's claims and expenses ,vill be $849.00 PEPM which is 0.60 0 less than current
premiums. Based on current enrollment, this amounts to $21.75 million in annual premium.
However, we recommend that Citi- of Lubbock continue to budget at $854.43 for an annual budget
of S21.89 million. If claims do not trend as much as our estimate or Citv of Lubbock is able to
reduce expenses, then this amount could be lower.
1'rojected Change in Premium - Claizvs E Expenses — Retiree
Attachment #6 shows our calculation of estimated chains costs and expenses for the Retiree medical
and prescription dnig plans. Using the carrier's proposed increases to expenses listed in the
Executive Summary above and shown in Attachment #3, we estimate that City of Lubbock's claims
and expenses «-ill be S1,211.24 PEPM which is 17.2'o more than current premiums. Based on
current enrollment, this amounts to $9.36 million in annual premium. If claims do not trend as
much as our estimate or City of Lubbock is able to reduce expenses, then this amount could be
lower.
E %penes - Ada11n1strat1o11 Fees
ees
Blue Cross Blue Shield of Texas (BCBS of TZ and other vendors perform carious services for the
efficient administration and financial stability of the plan. As referenced earlier, Attachments #2-3
show a summary of the current and proposed fees for 2016 with our assessment. BCBS of IN is
proposing a 4.8° o increase to claims administration fees. Since this is with the 3-50 o increase we
typically see, we recommend accepting this proposal.
Etipenses— Individual Stop -Loss Preilli MIS
Attachments #7-9 show our analysis of the risks of large claims and stop -loss coverage. Details of
the risk associated with various levels of individual stop -loss can be found in Attachment #7 and are
summarized in the table below:
■
Milliman September 2, 2015
Individual Stop-
Probability of a Claim
Number of
Loss Deductible
over the Deductible
Members
$400,000
0.050 0
1.9
$375,000
0.04'o
17.2
$550,000
0.050o
2.6
$325,000
0.050 o
5.0
Additionally, Attachment #8 shows expected stop -loss reimbursements at various lei -els of
individual stop -loss coverage. Note that as the individual deductible increases, the expected
reimbursements decrease. Generally, the guideline is that the appropriate deductible would be one
where the additional claims liability is minimized compared to the corresponding premium savings.
Should BCBS of TZ provide quotes at additional levels, we will include these figures in our analysis.
Attachment #9 compares recent years' paid stop -loss premiums to reimbursements received and
calculates a loss ratio over the time period. The combined loss ratio since 2012 has been 3.10 o.
Stop -loss carriers typically target paid loss ratios between 700 o and 800 o for groups of this size. The
stop -loss carrier may wish to base the proposed premium more heavily- on their risk pool and less on
City- of Lubbock's actual experience. City- of Lubbock should take this into account «hen
considering increasing the deductible level with this carrier or another one.
BCBS of TZ has proposed a 25.5'o increase to the current individual stop -loss premium levels. We
believe this increase is much too high given actual and expected loss ratios. Further, we believe a
0.0% increase to premiums is fair and subsequently recommend further negotiations with the carrier.
In this calculation, we have used the proposed individual stop -loss pretnitun rates from BCBS of T,"--
with.
Zwith the current deductible.
E %penises — .14,gregate Stop -Loss Prenaiarnzr
Self-insured employers may also purchase aggregate stop -loss coverage to protect against aggregate
claim fluctuation. Groups with fewer employees will generally have a lower tolerance for risk than
groups of a larger size. Typically, for a group this size, the probability- of an aggregate
reimbursement occurring is insignificant. The followmi g table highlights the inherent variability of
aggregate medical claims. The "No Deductible" and current ISL deductible scenarios are displayed
in Attachments #10-11.
tA■
Milliman
September 2, 2015
Individual Stop-
Loss Deductible
Probability ofAggregate Claims Exceeding
105% of Expected
115% of Expected
125% of Expected
No Deductible
16.60 0
0.70o
— 0.00 0
$400,000
.14.30o
0.20 0
-- 0.00 0
$375,000
14.1'o
0.20 0
— 0.00 0
$350,000
13.800
0.20 0
— 0.000
$325,000
13.60o
0.100
— 0.000
To assess the aggregate stop -loss risk, we performed a Monte Carlo simulation on the current
enrollment. The spread of expected claims without and with individual stop -loss is shown in these
attachments. The vertical axis shows the probability of exceeding a certain level of expected claims.
The horizontal axis shoes a range as a percent of expected average claims. Assuming that City of
Lubbock's 2,779 enrollees in the census data correspond to 5,569 covered lives, we simulated 10,000
scenarios, or 10,000 rears of claims experience. The results of our Monte Carlo analysis indicate
that, with no individual stop -loss as displayed in Attachment #10, there is a 0.70 o probability that
City of Lubbock will realize an aggregate claim total greater than 1150 0 of the expected claims
resulting from pure randomness. This probability drops to approximately 0.00% at a level of 1250 0.
With individual stop -loss set at 5350,000, as displaced in Attachment #11, the probability of
aggregate claims greater than 1150 0 of the expected claims drops to 0.10 0, and the chance of having
aggregate claims greater than 1250 0 of the expected claims is approximately 0.00 0. Note that this
assumes that the attachment point is set correctly.
Trend : lnalysis — Claiiiis — <-elf irel COBRf=1
Using a six-month rolling average, we performed a linear regression analysis of City of Lubbock's
monthly paid claims and enrollment to calculate that the claims in the Active/COBRA self-insured
plan have been increasing at an annualized rate of 3.80 o for medical and 103'o for prescription
drugs. Note that prescription drug trend includes combined claims data from both the
Active/COBRA plan and the Retiree plans due to limited reporting data. The results are displayed
in Attachments # 12-13. Nationally, based on the Rlilliman sllirl illarket Sreruey of employers, annual
trend for medical and prescription drugs combined is approximately- 5-9° o for 2014 with
expectations for 2015 at the same or slightly higher level. Additionally, the Milliman Medieallrade-v
(_1 L111), which examines the total cost to deliver healthcare, saw increases of 63"o from 2014 to
2015. In order to mitigate variations due to the inherent variability in claims data on individual
groups, we blended the calculated trends for City of Lubbock v-ith national averages as appropriate
to arrive at the trend levels used in the budget calculations.
■
Milliman September 2, 2015
Trend Analysis — Claims — Retiree
Using a six-month rolling average, we performed a linear regression analysis of City of Lubbock's
monthly paid claims and.enroUment to calculate that the claims in the Retiree self-insured plans have
been increasing at an annualized rate of 5.3% for medical and MY o for prescription drugs. Note
that prescription drug trend includes combined claims data from both the Active/COBRA plan and
the Retiree plans due to limited reporting data. The results for annualized medical trend is displayed
in Attachment #14. Nationally, based on the Alillinran [laid -Market Sumg of employers, annual trend
for medical and prescription drugs combined is approximately 5-90 o for 2014 with expectations for
2015 at the same or slightly higher level. Additionally, the Milliman Aledieallndev (MVI), which
examines the total cost to deliver healthcare, saw increases of 6.3% from 2014 to 2015. In order to
mitigate variations due to the inherent variability in claims data on individual groups, we blended the
calculated trends for Citi- of Lubbock with national averages as appropriate to arrive at the trend
levels used in the budget calculations.
Preliminary Budgeting— Prerni!lAV Equivalencies for the 2016 Plan Y ear—: lctiue/COBRA
Attachment #15 contains our findings and recommendations for distributing the previously
calculated total premium on a PEPiLM basis over the relevant tier options. We expect tier pricing
levels for a 4 -tier plan to be 1.000 for EE Only, 2.135 for EE + Spouse, 1.674 for EE + Child(ren),
and 2.971 for Family. That is, the cost of a spouse is expected to be about 14% greater than the cost
of an employee.
Citi- of Lubbock's current tier factors vary from our expectation of the cost of coverage for each
tier. For this analysis, we kept the current tier pricing levels in place.
Based on the factors above, we "spread" the premiums over the tiers to reflect the assumed
variances, while maintaining the same average total premiums calculated in Attachment #5.
Referring to Attachment #15, we arrive at the "CY 2016 Proposed" premiums. The variances
between these and the current premiums are shown in the bottom rows of the attachment, and the
total costs are shown in the far right column.
Employer Subsidies and Employee Contributions — Activel COBRA
At this time, we have assumed that Citj- of Lubbock will keep the employer subsidy for 2016 at the
same percent as it is currently. As a result, City of Lubbock's portion of total medical costs is
remaining flat at 80.2°'0 of the total cost. Please refer to Attachment #16 for details.
Preliminary Budgeting — Premium Equivalencies for the 2016 Plan Year — Retiree
Attachment #17 contains our findings and recommendations for distributing the previously
calculated total premium on a PEPM basis over the relevant plan and tier options. Based on our
Milliman
September 2, 2015
actuarial cost model, Health Cost Guidelines, x-.2014, the relative values of Citi- of Lubbock's
medical plan designs, including expenses, are 100.00 o for the Non --Medicare Retiree plan and 49.10 0
for the -Medicare Retiree plan. That is, the cost of the -Medicare Retiree plan is expected to be about
510 0 less than the cost of the Non --Medicare Retiree plan. Addidonallv, tier pricing levels for a 4 -tier
plan should be 1.000 for EE Only, 2.135 for EE + Spouse, 1.674 for EE + Child(ren), and 2.971 fot
Family-. That is, the cost of a spouse is expected to be about 14% greater than the cost of an
employee.
Citi- of Lubbock's current plan pricing lei -els vary from our plan pricing relativities and their tier
factors vary from our expectation of the cost of coverage for each tier. For this analcsis, we have
combined the Non --Medicare and -Medicare Retiree plan premium equivalencies at the request of
Citi- of Lubbock using-Milliman's recommended tier factors.
Based on the factors above, we "spread" the premiums over the tiers to reflect the assumed
variances, while maintaining the same average total premiums calculated in Attachment #r6.
Referring to Attachment #17, we arrive at the "CY 2016 Proposed" premiums. The variances
between these and the current premiums are shown in the bottom rot -,-s of the attaclunent, and the
total costs are shorn in the far right column.
Elllployer Subsidies- and Employee Conttibutioms — Retiree
At this time, we have assumed that CM- of Lubbock will keep the employer subsidy- for 2016 at the
same percent as it is currently-. As a result, Citi- of Lubbock's portion of total medical costs .N -M
decrease to 53.50 0 of the total cost due to the changes in premium equivalencies discussed above.
Please refer to Attachment # IS for details.
■
Milliman
September 2, 2015
2. Renewal Evaluation —Dental (self-insured)
Projected Change in Premittm — Claims � � E %penes
Attachment 4#19 shows our calculation of estimated claims costs and expenses for the self-insured
dental plans. Using proposed expenses, we estimate that City- of Lubbock's claims and expenses will
be $42.41 PEPM which is 22.7'o less than current premiums. Based on current enrollment, this
amounts to $1.36 million in annual premium. However, we recommend that Citi of Lubbock
continue to budget at $54.89 PEPNI for an annual budget of $1.76 million. If claims do not trend as
much as our estimate or Citv of Lubbock is able to reduce expenses, then this amount could be
lower.
E- penes - Administration & Other Fees
BCBS of TZ has proposed a 0.0'o increase to claims administration fees. Since this is below the 3-
5% increase we typicallv see, we recommend accepting this proposal.
Trend _'hall sis - Claims
Using a six-month rolling average, we performed a linear regression analysis of Citi- of Lubbock's
monthly- paid claims and enrollment to calculate that the claims in the self-insured dental plans have
been decreasing at an annualized rate of 7.0'o. The results are displayed in Attachment #20.
Nationallv, based on the Millinaan Mid-Afarket Survey of employers, annual trends are approximately
0-50 o for 2014 with expectations for 2015 at the same or slightly- lower level. In order to mitigate
variations due to the inherent variability in claims data on individual groups, we blended the
calculated trends for City of Lubbock with national averages as appropriate to arrive at the trend
levels used in the budget calculations.
Prelimiit,rry Bredgeting — Premium Equivalencies for the 2016 Plait Year
Attachment #21 contains our findings and recommendations for distributing the previously -
calculated total premium on a PEPM basis over the relevant tier options. We expect tier pricing
levels for a 4 -tier plan to be 1.000 for EE Only, 2.043 for EE + Spouse, 2.421 for EE + Child(ren),
and 3.804 for Family. This indicates that, on average, children in a family unit incur more claims
than a spouse incurs.
City of Lubbock's current tier factors vary- from our expectation of the cost of coverage for each
tier. For this analysis, we kept the current tier pricing levels in place.
Based on the factors above, we "spread" the premiums over the tiers to reflect the assumed
variances, while maintaining the same average total premiums calculated in Attachment #19.
Referring to Attachment #21, we arrive at the "CY 2016 Proposed" premiums. The variances
Milliman
September 2, 2015
between these and the current premiums are shown in the bottom rows of the attachment, and the
total costs are shown in the far right column.
Etrplger Sitbsidier and Etvployee Conttibutions
At this time, we have assumed that Citi- of Lubbock will keep the employer subsidy- for 2016 at the
same percent as it is currently-. As a result, Citi- of Lubbock's portion of total dental costs is
remaining flat at 73.60 o of the total cost. Please refer to Attachment #22 for details.
Milliman
Assumptions and Methodology
The steps we used to arrive at the results are outlined below:
September 2, 2015
1. We collected enrollment information from various vendors through 1IHBT. We assumed
that those employees electing coverage would continue to elect that same coverage and that
employees waiving coverage would continue to waive coverage.
2. Chums and expense information was also provided by various vendors through IIHBT.
3. Our expected claims range encompasses the current plan designs offered to employees.
Should plan designs change, the Benefit Plan Design Factor should be updated accordingly.
4. We calculated trends using a regression analysis and blended those results with national
averages where appropriate.
5. For the specified plans, we calculated a manual rate on the group based on demographics
and plan designs using our proprietary- actuarial pricing model, Healtb Cort Guidelines, U. 2014.
G. Using claims experience, the calculated manual rate where indicated, and assumed trend
factors, we calculated a projected claims costs on a per employee per month basis.
7. We performed an analysis of aggregate claim variability to determine an appropriate level of
individual stop -loss coverage.
8. Using plan pricing levels, tier pricing levels and enrollment assumptions, ,-,-e calculated
premium equivalency rates by plan and coverage tier.
9. Using employer subsidy assumptions, we calculated employer subsidies and employee
contributions by plan and coverage tier.
Reliance and Limitations
In performing our analysis for City of Lubbock, we relied on the data provided to us from various
vendors through NIHBT. We have not audited this data, but we performed a limited review for
reasonableness and we found no material defects in the data used in this report. If the underlying
data is inaccurate or incomplete, then the results of our review may be inaccurate or incomplete.
Differences between our projections and actual amounts depend on the extent to which future
experience conforms to the assumptions made for this analysis. It is likely that actual experience will
not conform exactly to the assumptions used in this analysis. actual amounts will differ from
projected amounts to the extent that actual experience deviates from expected experience.
10
Milliman
September 2, 2015
The services provided for this project were performed under the signed Consulting Services
Agreement between Milliman and MHBT dated January- 31, 2003 as well as the signed Services
Agreement between 1lilliman and City- of Lubbock dated June 11, 2012. This letter and its
attachments have been prepared for the use of MHBT in their relationship with City- of Lubbock
and are only to be relied upon by these organizations. No portion may be provided to any other
partly without i\Iillunan's prior written consent. "NElliman does not intend to benefit anc other
recipient of this report, even if Milliman consents to the release of this report to that recipient.
Please contact us if you have any questions.
Sincerely-,
Jason E. Speer, F.S.A., M. A.A.A.
Principal & Consulting Actuary -
/34't,4 t
Blaine A. Weber
Senior Benefits Consultant & Underwriter
Paul Penke
Benefits Consultant & Financial Anal-st
11
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Milliman
Renewal Evaluation Summa - Medical Active/COBRA Onl
- City of Lubbock -
GdrWer BCBS of TX
ANachnnent#2
1. Enrollment is taken from the June 2015 FMR.
2. Current Rates represent the premium equivalencies based on current enrollment.
3. See attachments for additional details on Milliman calculation.
4. Pricing calculations incorporate Milliman's expectation of claims in conjunction the carrier's 2016 PY proposed expenses.
5. Aggressive and Conservative budgets are presented for illustrative purposes and should not be taken as Milliman's recommended budgeting
levels
Prepared on: ptp
9/2/2015 Milliman, Inc.
City of Lubbock Pricing 2016RE_RE
Aggressive
Budget'
CY 2015
CY 2016
Milliman
Milliman
Total Medical - Self -Insured
$20,761,429
$22,741,241
Percent Increase Over Current
Claims &
Claims &
Total Annual Cost Over Current
($1,129,091)
Current
Carrier
Milliman
10%
Coverage
Enrollment/ Rates Total Annual
Initial
Projected
... - .
Basis
Volume' (PEPW Cost
Expenses
Expenses4
Expected Claims Cost (PEPM)3
ilEmployees
1 2.1351 1182.351 $20.043,785
$772.76
$772.76
Percent Increase Over Current
Total Annual Cost Over Current
(1.291.)
($245,667)
(1.2%)
($245,667)
Claims Administration
lEmplovees
1 2.1351 $42.31 T $1.083.982
$43.581
$43.58
Percent Increase Over Current
3.0%
3.0%
Total Annual Cost Over Current
$32,537
$32,537
Rx Rebates
lEmolovees
1 2.135 ($7.72) ($197,786)
(37.341
(57.34)
Percent Increase Over Current
Total Annual Cost Over Current
(4.9%)
$9,736
(4.9%)
$9,736
Organ Transplant Fee
JEE Only
1,069 56.08 $77,994
EE + Family1,066
514.60 $186.763
Total
2.135 $10.33 $264.757
S10.331
$10.85
0.0%
5.0%
Percent Increase Over Current
Total Annual Cost Over Current
$0
$13,238
Individual Stop -Loss
lEmoloyees
1 21351 $20.051 $513.681
_$25_1_6F
$20.05
Percent Increase Over Current
25.5%
0.0%
Total Annual Cost Over Current
$130,918
$0
ACA Fees
lEmolovees 1
2,1351 $7.111 $182.101
S4.501
$4.50
ncludes PCORI & Transibcnal Reinsurance Fees
Percent Increase Over Current
(36.6%)
(36.6%)
Total Annual Cost Over Current
($66,710)
($66,710)
Composite
JEmployees 1
2,1351 $854.431 $21,890,520
$849.001
$844.40
Total Medical - Self -Insured
2,1351 $21,890,520
--s--ii-7751,3357$211,633,654
Percent Increase Over Current
(0.6%)
(1.251.)
Total Annual Cost Over Current
($139,185)
($256,866)
1. Enrollment is taken from the June 2015 FMR.
2. Current Rates represent the premium equivalencies based on current enrollment.
3. See attachments for additional details on Milliman calculation.
4. Pricing calculations incorporate Milliman's expectation of claims in conjunction the carrier's 2016 PY proposed expenses.
5. Aggressive and Conservative budgets are presented for illustrative purposes and should not be taken as Milliman's recommended budgeting
levels
Prepared on: ptp
9/2/2015 Milliman, Inc.
City of Lubbock Pricing 2016RE_RE
Aggressive
Budget'
Conservative
Budgets
Composite PEPM
$810
$888
Total Medical - Self -Insured
$20,761,429
$22,741,241
Percent Increase Over Current
(5%)
4%
Total Annual Cost Over Current
($1,129,091)
$850,721
Chance of Exceeding Budget
75%
10%
1. Enrollment is taken from the June 2015 FMR.
2. Current Rates represent the premium equivalencies based on current enrollment.
3. See attachments for additional details on Milliman calculation.
4. Pricing calculations incorporate Milliman's expectation of claims in conjunction the carrier's 2016 PY proposed expenses.
5. Aggressive and Conservative budgets are presented for illustrative purposes and should not be taken as Milliman's recommended budgeting
levels
Prepared on: ptp
9/2/2015 Milliman, Inc.
City of Lubbock Pricing 2016RE_RE
Milliman
Renewal Evaluation Summa - Medical Retirees Onl
- City of Lubbock -
Carrier BCBS of TX
Attachment #3
1. Enrollment is taken from the June 2015 FMR.
2. Current Rates represent the premium equivalencies based on current enrollment.
3. See attachments for additional details on Milliman calculation.
4. Pricing calculations incorporate Milliman's expectation of claims in conjunction the carrier's 2016 PY proposed expenses.
5. Aggressive and Conservative budgets are presented for illustrative purposes and should not be taken as Milliman's recommended budgeting
levels
Prepared on:
9/2/2015 pfP
Milliman, Inc. City of Lubbock Pricing 2016_RE
Aggressive
Budgets
Conservative
Budgets
CY 2015
CY 2016
$1,268
Milliman
Milliman
$9,799,311
Percent Increase Over Current
12%
23%
Total Annual Cost Over Current
Claims &
Claims &
Chance of Exceeding Budget
75%
10%
Current
Carrier
Milliman
Coverage
Enrollment/
Rates Total Annual
Initial
Projected
Basis
I Volume'
(PEPM)2 Cost
Expenses
Expenses°
Expected Claims Cost (PEPM)3
lEmployees
1 644
$962.11111111 $7,435,218
$1,135,661
$1.135.66
Percent Increase Over Current
18.0%
18.0%
Total Annual Cost Over Current
$1,341,193
$1,341,193
Claims Administration
lEmplovees
1 644 $42.311 $326,972
$43.58
$43.58
Percent Increase Over Current
3.0%
3.0%
Total Annual Cost Over Current
$9,815
$9,815
Rx Rebates
Emplovees
644 ($7.72) (559,660)
(57.34)
$7.34)
Percent Increase Over Current
(4.9%)
(4.951.)
Total Annual Cost Over Current
$1,937
$2,937
Organ Transplant Fee
JEE Only
315 16.08 $22,982
EE + Family329
$14.60 557,641
$10.431
$10.95
Total
644 $10.431 $80,623
0.0%
5.0%
Percent Increase Over Current
Total Annual Cost Over Current
$0
$4,031
Individual Stop -Loss
JEmployees
644 $20.051 $154,946
$25,16
$20.05
Percent Increase Over Current
15.5%
0.0%
Total Annual Cost Over Current
$79,490
$0
ACA Fees
lEmployees
1 6441 $5.91 J $45,698
$3.75
$3.75
nc�udes PCORI & Transitional Reinsurance Fees
Percent Increase Over Current
(36.6%)
(36.6%)
Total Annual Cost Over Current
(S16,741)
($16,741)
Composite
Employees
6441 $1,033.101 $7,983,797
$1,211.24
$1,206.66
Total Medical - Self -Insured
644 $7,983,797
$9,360,491
$9,325,032
Percent Increase Over Current
17.2%
16.8%
Total Annual Cost Over Current
$1,376,694
$1,341,235
1. Enrollment is taken from the June 2015 FMR.
2. Current Rates represent the premium equivalencies based on current enrollment.
3. See attachments for additional details on Milliman calculation.
4. Pricing calculations incorporate Milliman's expectation of claims in conjunction the carrier's 2016 PY proposed expenses.
5. Aggressive and Conservative budgets are presented for illustrative purposes and should not be taken as Milliman's recommended budgeting
levels
Prepared on:
9/2/2015 pfP
Milliman, Inc. City of Lubbock Pricing 2016_RE
Aggressive
Budgets
Conservative
Budgets
Composite PEPM
$1,154
$1,268
Total Medical -Self-Insured
$8,921,670
$9,799,311
Percent Increase Over Current
12%
23%
Total Annual Cost Over Current
$937,873
$1,815,514
Chance of Exceeding Budget
75%
10%
1. Enrollment is taken from the June 2015 FMR.
2. Current Rates represent the premium equivalencies based on current enrollment.
3. See attachments for additional details on Milliman calculation.
4. Pricing calculations incorporate Milliman's expectation of claims in conjunction the carrier's 2016 PY proposed expenses.
5. Aggressive and Conservative budgets are presented for illustrative purposes and should not be taken as Milliman's recommended budgeting
levels
Prepared on:
9/2/2015 pfP
Milliman, Inc. City of Lubbock Pricing 2016_RE
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