R-2018-6091 - 11/20/2018 RESOLUTION NO. R-2018-6091
WHEREAS, the City of Round Rock (the "City") desires to continue to retain professional
services to provide independent third-party administration of the City's self-funded health plan;
WHEREAS, Aetna Life Insurance Company ("Aetna") has been providing said professional
services and has submitted a proposal to continue to provide said services; and
WHEREAS,pending the final negotiation of the terms and provisions of a new Administrative
Services Agreement, the City Council desires to approve a Letter of Understanding with Aetna
accepting the submitted proposal,Now Therefore
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF ROUND ROCK,
TEXAS:
That the Mayor is hereby authorized and directed to execute on behalf of the City a Letter of
Understanding with Aetna, a copy of said Letter of Understanding being attached hereto as Exhibit
"A" and incorporated herein for all purposes.
The City Council hereby finds and declares that written notice of the date, hour, place and
subject of the meeting at which this Resolution was adopted was posted and that such meeting was
open to the public as required by law at all times during which this Resolution and the subject matter
hereof were discussed, considered and formally acted upon, all as required by the Open Meetings Act,
Chapter 551, Texas Government Code, as amended.
RESOLVED this 20"' day of November, 2018.
-/,
CRAIG Rrck,
Mayor
City o Round Texas
ATTEST:
SARA L. WHITE, City Clerk
0112.1804;003075;/ss2
EXHIBIT
Cassandra Newman
na
A Regional Director
cwtAetna
151 Farmington Ave,
RE11
Hartford, CT 06156
860-273-3294
November 11, 2018
City of Round Rock
Tyler Jarl, Benefits Manager
231 East Main Street, Ste. 100
Round Rock, TX 78664
Re: City of Round Rock- Confirmation of Services and Administrative Services Only Fees
Dear Mr. Jarl:
Thank you for selecting Aetna and we look forward to continuing our business relationship with
City of Round Rock. Based on our original proposal and subsequent discussions, we have
outlined the products and services City of Round Rock has purchased for the plan effective
January 1, 2019. Please review and confirm this information accurately reflects City of Round
Rock's understanding. If you have any questions, you may contact John Heerwagen to discuss
any necessary changes.
The contract period begins on the effective date of January 1, 2019. Our contracts provide for
automatic renewal upon the completion of each contract period unless either party invokes the
termination provision, which requires 31 days advance written notice of termination to the
other party. This provision may be invoked at any time during the continuance of the contract
and is not limited to termination occurring on the renewal date, subject to the terms of the
contract.
Coverages and Financial Arrangements
The following illustrates the funding arrangements by line of coverage:
Coverage Funding Arrangement
Open Access Aetna Select Self-Funded
Choice POS II Self-Funded
Page 2
Administrative Service Fees
Based on the package of services selected and enrollment awarded to Aetna, the per employee
per month administrative services fees by plan for each of the three contract periods, as revised
and quoted on January 1, 2019, are:
Plan Projected 01/01/2019 01/01/2020 01/01/2021
Enrollment
Aetna CPOSII 403 $37.86 $37.86 $37.86
Aetna Select ACO 425 $39.41 $39.41 $39.41
We would also extend our contract for two additional years (01/01/2022 and 01/01/2023) with
3% increases on the two outlying years.
Self Funded Fees include:
Included Services/Programs in Above Administrative Fees
Implementation&Communications
$10,000 Wellness Allowance,annual restoration, no carry-over
Designated Implementation Manager
Open Enrollment Marketing Material (noncustomized)
Onsite Open Enrollment Meeting Preparation
Standard ID Cards
General Administration
Experienced Account Management Team
Designated billing,eligibility,plan set up, underwriting and drafting services
Review or draft plan documents
Summary of Benefits and Coverage(SBCs)
Aetna Claim Fiduciary-Option 4(1st and 2nd Level Appeals)
Aetna provides External Review
Alternate stockpiling
Member and Claim Services
Claim Administration
Member Services
Aetna Voice Advantage
Plan Sponsor Liaison
Special Investigations/Zero Tolerance Fraud Unit
Network
Network Access/Full National Reciprocity
Care Management
Utilization Management Inpatient Precertification
Utilization Management Outpatient Precertification
Utilization Management Concurrent Review
Utilization Management Discharge Planning
Utilization Management Retrospective Review
Aetna Compassionate Care Program (ACCP)
Infertility Case Management
National Medical Excellence®
Aetna Health Connections Disease Management
Page 3
MedQuery®
Beginning Right Maternity Program
Informed Health® Line-24-hour Nurseline 1-800#
Simple Steps To A Healthier Life®-Health Assessment
Behavioral Health
Managed Behavioral Health
Focused Psychiatric Review
Web Tools
DocFind®(online provider directory)
Aetna Navigator®-Member Self Service Web
Web-Chat Technology-Virtual Assistant Ann
Online Programs
Health Decision Support-Basic
InteliHealth
Reporting
5 Hours of Ad Hoc Reports,Annual Restoration
Monthly standard broker reports
Aetna Health Information Advantage
e.Plan Sponsor Monitor—Level B Reporting(Standard Quarterly Utilization Reports)
Monthly Financial Claim Detail Reports
Monthly Banking Reports
Data Integration Services
Monthly Universal File Feeds(Outbound)
One(1) Exact Copy of Universal File(Outbound)
Aetna Discount Program
at home products, books,fitness, hearing, national products and services,oral health care,
vision and weight management
Services included through the claim wire:
Claim Wire Billing Programs Charged throuah the claim wire.Not included in
the PEPM fees above.
Subrogation 37.5%of recovered amount will be retained
Cotiviti-Coordi nation of Benefits, Retro 37.5%of recovered amount will be retained
Terminations, Medical Bill and Hospital Bill
Audits,Workers Compensation, DRG and
Implant Audits
National Advantage TM Program 50%of savings will be retained
Standard Facility Charge Review 50%of savings will be retained
Enhanced Clinical Review $0.70 per member per month
Underwriting Assumptions and Caveats
Self Funded Medical and Pharmacy Financial Assumptions
Please refer to the Self-Funded Medical Financial Assumptions document provided for additional
information.
Page 4
Self-Funded Dental Fee Exhibit
Please refer to the Self Funded Dental Fee Exhibit document for additional information.
Guarantees
Performance Guarantees—Medical
In total, we will put 15%of our applicable guarantee period administrative service
fees/premium at risk through Performance Guarantees. The guarantee period administrative
service fees/premium will be calculated at the end of each guarantee period and will be based
on the total number of employees actually enrolled in the plans listed below.
The guarantees described herein will be effective from January 1, 2019 through December 31,
2019 (hereinafter"guarantee period").
The performance guarantees will apply to the self-funded Open Access Aetna Select, Aetna
Choice POS II plans administered under the Administrative Services Only Agreement ("Services
Agreement")/Group Agreement. These guarantees do not apply to non-Aetna benefits or
networks.
Please refer to the Medical Performance Guarantee document for additional information.
Please let us know if you have any questions or concerns regarding the information outlined in
this letter and the attachments. We appreciate City of Round Rock's business and look forward
to a successful plan implementation.
Sincerely,
�r
Cassandra Newman, Regional Director
Public & Labor Underwriting
Aetna
cc: John Heerwagen,Account Executive
Joan Buchanan, Senior Underwriting Consultant
CERTIFICATE OF INTERESTED PARTIES
FORM 1295
101`1
Complete Nos.1-4 and 6 if there are interested parties. OFFICE USE ONLY
Complete Nos.1,2,3,5,and 6 if there are no interested parties. CERTIFICATION OF FILING
1 Name of business entity filing form,and the city,state and country of the business entity's place Certificate Number:
of business.
Aetna Life Insurance Company
2018-423338
Hartford,CT United States Date Filed:
2 Name of governmental entity or state agency that is a party to the contract for which the form is 11/07/2018
being filed.
City of Round Rock Date Acknowledged:
3 Provide the identification number used by the governmental entity or state agency to track or identify the contract,and provide a
description of the services,goods,or other property to be provided under the contract.
00000
Medical,Dental, Rx,and Vision Insurance Services Renewal
4 Nature of interest
Name of Interested Party City,State,Country(place of business) (check applicable)
Controlling Intermediary
5 Check only if there is NO Interested Party.
X
6 UNSWORN DECLARATION
My name is Mark Sternat and my date of birth is ----------
My
-"'-""My address is__1 51 Farmington Avenue Hartford CT 06156 USA
(street)) (city) (state) (zip code) (country)
I declare under penalty of perjury that the foregoing is true and correct.
Executed ii -Hartford County, state of CT 7th November 18
—. tY� ,on the day of ,20
- (month) (year)
-roDD EICO ER
NOTARYPUBLIC ,-
MY COMMISSION EXPIRES DEC,31,2022 Signature of authorized agent of contracting business entity
(Declarant)
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.6711
CERTIFICATE OF INTERESTED PARTIES FORM 1295
1 of 1
Complete Nos.1-4 and 6 if there are interested parties. OFFICE USE ONLY
Complete Nos.1,2,3,5,and 6 if there are no interested parties. CERTIFICATION OF FILING
1 Name of business entity filing form,and the city,state and country of the business entity's place Certificate Number:
of business.
Aetna Life Insurance Company 2018-423338
Hartford, CT United States Date Filed:
2 Name of governmental entity or state agency that is a party to the contract for which the form is 11/07/2018
being filed.
City of Round Rock Date Acknowledged:
11/21/2018
3 Provide the identification number used by the governmental entity or state agency to track or identify the contract,and provide a
description of the services,goods,or other property to be provided under the contract.
00000
Medical, Dentat, Rx, and Vision Insurance Services
4 Nature of interest
Name of Interested Party City,State,Country(place of business) (check applicable)
Controlling Intermediary
5 Check only if there is NO Interested Party.
X
6 UNSWORN DECLARATION
My name is and my date of birth is
My address is
(street) (city) (state) (zip code) (country)
I declare under penalty of perjury that the foregoing is true and correct.
Executed in County, State of on the day of 20
(month) (year)
Signature of authorized agent of contracting business entity
(Declarant)
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.6711