HomeMy WebLinkAboutResolution - 2008-R0494 - Purchase Transplant Insurance - AIG Medical Express - 12/17/2008Resolution No. 2008-80494
December 17, 2008
Item No. 5.4
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, transplant insurance
coverage, by and between the City of Lubbock and AIG Medical Express, with first dollar
coverage pursuant to the terms and conditions attached hereto as Exhibit "A," 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, 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 17th day of December , 2008.
ATTEST:
Rebe ca Garza, City Secretary
APPROV AS TO CONTENT:
Leisa Hutcheson, Director of Risk Management
APPROVED ASJO FORM:
Attorney
gslccdocs/AIG Medical Expressses
1213108
TOM MARTIN, MAYOR
Resolution No. 2008-RO494
Medical Excess
One MacArthur Place, Suite 620
South Coast Metro, CA 92727
"Exhibit All Phone: (714) 436-3600
Tall Free: (800) 634-7462
Fax: (714)436-3620
October 20, 2008
Ms. Marta Alvarez, Purchasing Manager
City of Lubbock
162513 1h Street, Room 204
Lubbock, TX 79401
Re: Renewal of Organ & Tissue Transplant Policy
Policyholder: City of Lubbock
Policy Anniversary Date: January 1, 2009
Policy Number: 280-6492
Dear Ms. Alvarez:
The Organ & Tissue Transplant Policy issued to the above captioned group is approaching its
anniversary date, and we are looking forward to renewing it with you.
Attached is the renewal proposal for the group. You will notice a rate change which is mainly the
result of recent increases in physician, hospital, and pharmaceutical expenses related to transplants.
Please respond to this letter within 15 days of the renewal date. This will allow us to prepare your
renewal Policy in a timely manner.
Your response should include an update regarding those individuals that were originally excluded
from coverage under this Policy.
In addition, please identify:
1. Any new potential transplant exposures and related medical information (clinical or case
management notes - including type of transplant, date of evaluation, hospital listing and current
diagnosis).
2. Any significant census changes (current and/or future).
3. Any change in the group's third party administrator.
Please forward the information requested in Items 1&2 (above) to my attention within 45 days prior
to the renewal date.
In the event that any Plan participants are covered under a High Deductible Health Plan (as defined
under Title 26, Subtitle A, Chapter 1, Subchapter B. Part VII, § 223 of the Internal Revenue Code),
the Plan's Deductible Amount must be met prior to benefits being paid under the Organ & Tissue
Transplant Policy. This stipulation will appear on the Declarations page of your renewal Policy.
Thank you very much for this opportunity to continue our relationship. Should you have any
questions, please do not hesitate to call.
Sincerely,
Jim Colwell
Underwriting Technician
(714) 436-3623
cc: Russ Jehs, Vice President, Organ Transplant Product Management
E2V_%6V_A Medical Excess
One MacArthur Place Suite 620, South Coast Metro, CA 92707 Toll Free: 800-634-7462
Organ Transplant Proposal
Employer:
CITY OF LUBBOCK
Underwriter
Josefina Panopio
Proposal:
55166
Sales:
Stanley Self
Producer:
Sanford & Tatum Insurance Agency
Quote Date:
10/20/2008
Claims Admin.:
Blue Cross and Blue Shield of Texas, a division of
Quote Valid Until:
01101/2009
Carrier:
AIG Life
Effective Date:
01/0112009
This proposal contemplates the utilization of the above captioned Claims Administrator. Any deviation is a material change of fact rendering this proposal nail and void.
Summary of Coverage
Lifetime Maxmium : $1,000,040
Policy Deductible : $4
Notification 1 Coordination : See requirements in attached policy specimen
Transplant Benefit Period : Evaluation through 365 days post transplant
Reimbursement : ` 100% of covered transplant -related costs, including organ procurement, when
performed in -network.
` 80% of covered transplant -related costs up to scheduled maximum amount ,per
transplant when performed out -of -network (see policy)
Transportation : $200 per day, 510,000 maximum for patient and companion
Experimental : Coverage of NCI Clinical Trials Phase III and IV for adults, all phases for pediatric
Pre -Existing Requirements : Pre -Ex is waived for current Participants (unless they are completing an established
Pre -Ex Waiting Period). However, Participants added from the acquisition of a new
group, affiliate, division, and/or subsidiary, are subject to a 12 month Pre -Ex Waiting
Period that begins on the date the acquisition is covered under the Policy. A Pre -Existing
Condition is any condition for which the Participant has within the past 24 months: been
advised that a transplant may be necessary; had a transplant consultation, workup, or
evaluation; been scheduled for a transplant consultation, workup, or evaluation, received
or has been listed to receive a transplant.
Other Coverage / Services
Carrier
Rate
Premium
Commission
Please refer to policy specimen
AIG Life
$ 6.77 Single
$ 15.55 Family
$ 324,654.97
Rates include 0% commission
Rates and benefits are subject to state approval.
Russ Jehs
Vice President, Organ Transplant Product Management
No coverage of any kind is made effective by this quote transmitted. Sales Representatives, and brokers or agents, have no authority to make effective coverage, or enter into contracts on
behalf of the company. Coverage wilt be effective only after. (1) a quotation is issued by the company; (2) a completed and signed application and disclosure is received by the company; (3J the
application is approved by the company; 14) Written notice confirming effective coverage is issued by the company. This proposal supersedes alt others previously issued to you, and all other
Proposals and Rate Quotations previously issued to you are void.
JCOLWELL 14120/200815:02:49 Frage 1 of 2 Medical Excess
,t„ I„J Medical Excess
One MacArthur Place Suite 620, South Coast Metro, CA 92707 Toll Free: 800-634-7462
Organ Transplant Proposal
Employer:
CITY OF LUBBOCK
Underwriter:
Josefina Panopio
Proposal:
55166
Sales:
Stanley Self
Producer:
Sanford & Tatum insurance Agency
Quote Date:
10/20/2008
Claims Admin.:
Blue Cross and Blue Shield of Texas, a division of
Quote Valid Until:
01/01/2009
Carrier:
AIG Life
Effective Date:
0110112009
This proposal contemplates the utilization of the above captioned Claims Administrator_ Any deviation is a material change of fact rendering this proposal null and void.
Contin encies
For All Producers / Groups
Explanation of any upcoming significant census changes (20%) within 30 days of effective date.
Groups with employees in multi -state locations may be subject to rate revision.
Contract period is for 12 months from effective date, unless otherwise stipulated.
In the event that Plan participants are covered under a High Deductible Health Plan (as defined under Title 26, Subtitle A, Chapter 1,
Subchapter B. Part VII, § 223 of the Internal Revenue Code), the Plan's Deductible Amount must be met prior to benefits being paid
under the Organ and Tissue Transplant Policy.
For Non -Pooled Producers: In addition to the Information requested above, please provide the following:
(Attached Proposal is 'indication only' based on AIG Pooled Producer rates. The information requested below is to determine any variance from
pooled rates in order to determine our final underwriting position.)
Three year history of transplants by type and paid amounts (from 1st dollar).
Current Transpiants in waiting (diagnosis/transplant type, when evaluated or approved, transplant facility, billed/paid amounts
to date, current clinical analysis).
` Single t Family census split, Indicate the number and location of employees located outside the group's state of domicile.
Explanation of any upcoming significant census changes if known.
' Transplant hospitals historically accessed.
` Current Transplant network, if any.
Historic % of transplant performed in -network vs. out -of -network.
Complete copy of SL Policy and Plan Document, if non -AIG
Current Specific Deductible and Stop Loss carrier name.
" Single i Family SL rates, if non -AIG.
` Discount % offered by carrier for carving out transplant risk_
Administrator name and location.
UM 1 UR I Pre Cert vendor (if not TPA).
State commission desired (net to 10%).
Lifetime maximum requested - option of $1 M or $2M.
Complete copy of Transplant Policy, if non -AIG.
Complete copy of comprehensive Medical Policy, if no Stop Loss.
No coverage of any kind is made effective by this quote transmitted. Safes Representatives, and brokers or agents, have no authority to make effective coverage, or enter into contracts ort
behalf or the company. Coverage will be effective only afferr (11 a quotation is issued by the company; (2) a completed and signed application and disclosure is received by the company; iii the
application is approved by the company; 14) Written notice confirming effective coverage is issued by the company. This proposal supersedes all others previousfy issued to you, and ail other
Proposals and Rate Quotations previously issued to you are void.
JCOLWELL 10/20/2008 15 02:49 Page 2 of 2 Medical Excess