R-97-06-12-11E - 6/12/1997 RESOLUTION NO. R-97-06-12-11 E
WHEREAS, the City of Round Rock previously entered into a
Stop-Loss Insurance Agreement ("Agreement") with Blue Cross and
Blue Shield of Texas, Inc . for re-insurance for the City' s self-
funded heath plan, and
WHEREAS, the Agreement provides for multiple one year
renewals, and
WHEREAS, the City Council wishes to renew the Agreement for
an additional one year period of time, Now Therefore
BE IT RESOLVED BY THE COUNCIL OF THE CITY OF ROUND ROCK,
TEXAS,
That the Mayor is hereby authorized and directed to execute on
behalf of the City an extension of the Agreement with Blue Cross
and Blue Shield of Texas, Inc. for re-insurance for the City' s
self-funded health plan, a copy of said extension being attached
hereto and incorporated herein for all purposes.
RESOLVED this 12th day of June, 1997 .
CHARLES CTIEPPWER, Mayor
City of Round Rock, Texas
ATTEST:
io
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J E LAND, City Secretary
R:\WPDOCS\RBSOLUTI\RS70611S.WPD/scg
Exhibit No.1
Schedule of Specifications
to
Stop-Loss Policy
City of Round Rock
Account Number 36076
These specifications shall apply to the Stop-Loss Policy between BCBSTX and the above Stop-Loss
Policyholder for the current Policy Year beginning December 1, 1996,and ending November 30, 1997.
Item I—Statement of Benefits
The benefits which shall be covered under this Stop-Loss Policy are those described in the attached
Master Benefit Plan Document.
All exclusions and limitations contained in the Master Benefit Plan Document shall apply, including
specifically those described in the Limitations and Exclusions Section(s)of such Document.
Item II—Stop-Loss Premium
The Stop-Loss Premium is the sum of the Individual Stop-Loss Premium and Aggregate Stop-Loss
Premium amounts calculated as follows (amounts shown are applicable for the current Policy Year). In
order for Policy benefits shown below to be available, Stop-Loss Premium must be paid for the entire
Policy period.
A. Individual Stop-Loss Premium shall be calculated monthly and shall be equal to the sum of the
amounts obtained by multiplying the number of Employees covered for a particular month by:
$ 22.27 for each Employee only
$ 60.13 for each Employee/child(ren)
$ 60.13 for each Employee/spouse
$ 60.13 for each Employee/family
B. Aggregate Stop-Loss Premium shall be calculated monthly and shall be equal to the sum of the
amounts obtained by multiplying the number of Employees covered for a particular month by:
$ 2.54 for each Employee only
$ 2.54 for each Employee/child(ren)
$ 2.54 for each Employee/spouse
$ 2.54 for each Employee/family
Form No.ASO-SLP-6(Rev.10/95 12/12)
Item III—Claim Liability Factors
Claim Liability (Monthly Maximum)for medical claims shall be calculated monthly and shall be equal to
the sum of the amounts obtained by multiplying the number of Employees covered for a particular month
by the following factors:
$ 219.00 for each Employee only
$ 219.00 for each Employee/child(ren)
$ 219.00 for each Employee/spouse
$ 219.00 for each Employee/family
Item IV—Stop-Loss Insurance Options
A. Individual Stop-Loss Insurance
Applied For.
1. For N/A, the amount of Paid Claims (claims incurred and paid during the current Policy Year, as
defined in the Stop Loss Policy) in excess of the Point of Attachment of $ N/A per Participant.
Individual Stop-Loss benefit payments shall not exceed a maximum of $ N/A for N/A for the
indicated Policy Year.
2. For each other Participant, the amount of Paid Claims (claims incurred and paid during the
current Policy Year, as defined in the Stop Loss Policy) in excess of the Point of Attachment of
$30,000 per Participant. Individual Stop-Loss benefit payments shall not exceed a maximum of
$970,000 per Participant for the indicated Policy Year.
Not Applied For.
B. Aggregate Stop-Loss Insurance
4 Applied For.
The amount of Paid Claims (claims incurred and paid during the current Policy Year, as defined in the
Stop Loss Policy) which exceeds 125% of Expected Paid Claims. less claims paid under the Individual
(Specific) Stop Loss. Such percentage shall apply for 12 months for the indicated Policy Year.
Aggregate Stop-Loss benefit payments shall not exceed a maximum of $1,000,000 for the indicated
Policy Year.
Not Applied For.
Form No.ASO-SLP-6(Rev.10/95 12/12)
Item V—Daily Charge
The daily charge rate shall be .05%per day (which would equate to an annual percentage rate of 18%).
For Blue Cross and Blue Shield of Texas,Inc.(BCBSTX)
By: May 27, 1997
Rogers KUoleman,President Date
For City un k(Stop-Loss Policyholder)
By: Jo- JO -97-
Date
Title:
Form No. ASO-SLP-6(Rev.10/95 12/12)
DATE: June 10. 1997
SUBJECT: City Council Meeting, June 12, 1997
ITEM: 11. E. Consider a resolution authorizing the Mayor to extend the agreement with
Blue Cross and Blue Shield of Texas, Inc. for re-insurance for the City's self-funded
health plan.
STAFF RESOURCE PERSON: David Kautz
This agreement provides coverage for the City's health plan claims payments
which exceed limits set by the City. This coverage protects the City 's plan from
catastrophic losses.
The premiums charged for this service are included in the City's budget.