CM-2022-024 - 1/28/2022TERMS AMENDMENT
This Amendment ("Amendment") is made to the Administrative Services Agreement ("Agreement") by and between
United HealthCare Services, Inc. ("United") on behalf of itself and its affiliates and City of Round Rock ("Customer"),
Contract No. 925175, and is effective on January 1, 2022 unless otherwise specified.
Any capitalized terms used in this Amendment have the meanings shown in the Agreement. These terms may or may
not have been capitalized in prior contractual documents between the parties but will have the same meaning as if
capitalized.
The agreements that are being amended include any and all amendments, if any, that are effective prior to the effective
date of this Amendment.
Nothing shown in this Amendment alters, varies oraffects any of the terms, provisions or conditions of the agreements
other than as stated herein.
The parties, by signing below, agree to amend the agreements as contained herein.
City of Round Rock
By
Laurie Hadley, City Manager
Date e
Z Q -2b Z Z
62�
United HealthCare Services, Inc.
By -f, -
Authorized Signature
Print Name Lisa Sekely
Print Title Regional Contract Manager
Date January 14, 2022
Proprietary Information of UmtedHealth Group
Renewal4Q2021 v2
The Administrative Services Agreement is amended on January 1, 2022 as noted below.
This Amendment will not affect any of the terms, provisions or conditions of the Agreement except as stated herein.
Following the Effective Date and after Customer has provided one (1) months' worth of claims funding, this
Amendment is deemed executed by the parties.
1. All references to out of network programs in the Asreement, each as applicable, are replaced in
their entirety. As such, Section All Network in Exhibit A is amended to include the followine sub-
section:
Out of Network Programs. United offers out of network programs that strive to increase savings to Customer by
accessing discounts or negotiating reductions on out of network claims. United offers a mix of out of network programs
that offer varying degrees of discounts, consumer advocacy, and cost controls. Customers elected out of network
programs are identified in Exhibit B -- Fees. Programs are subject to change or termination at United's discretion.
11. The followine re lace the Navi card row in the Other Fees table in Exhibit B — Fees:
Other Fees
Consolidated Appropriations Act, 2021 ("CAA") Support
Services. United will support Customer's compliance with the
requirements of the CAA, including the No Surprises Act
("NSA"), by the respective enforcement date as follows:
• NSA medical billing and the independent dispute
resolution ("IDR"):
o United will determine if a claim is subject to the NSA
billing protections.
o If United and a provider are unable to come to an
agreement within the prescribed negotiation period
for a claim subject to the NSA billing protections,
United will manage, direct, and make decisions and
submissions to support the IDR for Customer.
o All qualifying payment amounts under the NSA will
be calculated based on an insurance market across all
self -insured group health plans administered by
United.
o United will not use third party provider networks for
services covered by the NSA.
a The fees for programs in which the parties share in
the savings achieved off a provider's billed charge
will continue to apply to all services covered under
the NSA.
a Customer shall fund all settlement amounts and
payments required as a result of any IDR process
decision through the Bank Account,
a Customer shall fund the $50 IDR administration fee
and all [DR arbitrator fees through the Bank Account.
• Revised medical Plan ID cards (if United provides Plan
Participants with ID cards currently).
• Provider directory enhancements.
• Continuity of care and external appeals support for surprise
medical bills-
• Support related to Mental Health Parity Non -Quantified
Treatment Limitations audits initiated by the U.S.
Department of Labor, U.S- Department of Health and
Human Services or the U.S. Department of Treasury-
• Provide language to support Customer's anti -gag clause
attestation
For the 2022 plan year, United will not charge separate
services fees outside of base rates for the CAA Support
Services. Customer remains responsible for the $50
government agency administration assessment and fees
charged by the IDR arbitrator.
Fees for CAA Support Services for plan years after 2022
will be provided at a future date once regulatory guidance
is received and final compliance requirements are
determined.
2
Proprietary Infommm;ion ofGnued}{ealth Group
Naviguard Program $2.50 per Employee per month
• Offers a reimbursement methodology applicable to
out of network claims which calculates allowed
amounts based on what a healthcare provider
generally accepts for the same or similar service.
• Includes an advocacy component where Participants
can access dedicated resources, and on-line tools and
materials to help Participants stay in network and
where assistance is provided in explaining
reimbursement methodologies.
• If the provider objects to what it was paid from the
application of the allowed amount, or member
contacts United for support with resolving a balance
bill, United will increase compensation for a
particular claim if. (a) United reasonably concludes
that the particular facts and circumstances related to a
claim provide justification for reimbursement greater
than that which would result from the application of
the allowed amount, and (b) United believes that it
would serve the best interests of the Plan and its
Participants (including interests in avoiding costs and
expenses of disputes over payment of claims).
111. The followins replaces the Net Cost Guarantee in Exhibit C R Performance Guarantees:
The rest ofthis page is intentionally blank.1
3
Proprietary Information of UnitedHealth Group
UnitedHealthcare
Net Cost
Guarantee
Effective for Policy January 1,
Year Beginning: 2022
UHC ASO Billable
Admin Fee $51.83
Percent of Fees rrr
Risk 40%
Fees @,, Risk
Target Claim Factor
Claim PEPM
Lessthan
$806.43
$20.73
$919.97
Annual ASO
$562,000 Base Fees
Annual Fees
$225,000 Risk
Number of
903 Employees
$806.43
up to $827.09
$827.10
up to
$848.30
$848.31
up to
$870.05
$870.06
up to
$892.36
Risk Free
Corridor»
$892.37
up to
$947.57
$947.58
up to
$981.68
$981.69
up to
$1,017.02
$1,017.03
$1,053.65
$1,091.58
Assumptions and Caveats:
up to $1,053.64
up to $1,091.57
up to $1,128.06
Amount at
Rick
$90 aoo
$7z 000
$54,000
$36,000
$18 000
$0
$45,000
$90,000
$135 000
$180 000
$225 000
Guarantee is effective for the quoted
1 plan year only.
Illustration assumes the following services/programs will be included in
2 the employee benefit plan:
PHS 3.0 High - Texas Custom
The number of covered employees assumed in this pruposal is listed below
3 by plan offering:
Assumed
Ouoted Choice Monthly Claim Target
I
Proprietary Information of UnuedHealth Grii..�,
Customer
Pay UHC
UHC pays the
customer
and Choice Plus
Covered
Factors
_ Plans
Enrollees
PSPM
Choice - Premium
Designation
433
$927,30
Nexus EPO OA
470
$913.22
COMPOSITE
903
$919.97
Reconciliation will be based actual covered lives by plan during the plan year and the claim target
4 factors by plan listed above.
Reconciliation will be based actual claims INCURRED from January I,
5 2022 to December 31, 2022
and PAID from January 1, 2022 to
March 31, 2023
Reconciliation will be performed within 180 days but no earlier than 120 days after the close of the
6 plan year.
Actual claims include all Medical claims and Pharmacy claims if
7 applicable, except for the following:
Benefits for services incurred prior to the effective
date of the policy.
Losses in excess of $200,000 per covered individual.
Losses in excess of usual and customary for out of
network claims.
Losses associated with benefits not covered by the underlying employee benefit plan, but paid by
the employee benefit plan.
Maximum guarantee payout is
8 $225,000.
Assumes UnitedHealthcare is the only
9 carrier offered.
10 United Healthcare reserves the right to adjust the projected target claim factor or rescind this guarantee
under any of the following circumstances:
Fnrollment in total or by plan varies - 151�0 or more from the
assumptions listed in this proposal.
An award is not made within 90 days of the issuance
of this proposal.
Changes in federal, state or other applicable legislation or regulation
require changes to this proposal
Changes to any of the included servicesiprograms
listed in item 2 above.
Any changes made to the plan of benefits offered
covered by this guarantee.
In the event of a pandemic, UHC reserves the right to revisit or revoke
this guarantee.
UHC will work with the customer to adjust for any claims utilization impact of COVID-19 in the
202012021 baseline period and the guarantee period. The intent is to stay true to our Net Cost
Guarantee (NCG) commitment but normalize (1 f-) for unforeseen impacts of the pandemic,
including not just direct COVID-19-related costs but also the potential material reduction in care
2
Proprietary Information of UnitedHeiilt;i Group
during the pandemic -and subsequent pent-up demand after the pandemic for non-
emergent/elective services, in an actuarial based fair manner for both parties. We will itemize and
reconcile these claim costs accordingly in the Net Cost Guarantee.
Guarantee is provided in lieu of any Network Discount Guarantees
previously quoted.
Proprietary Information of UnitedHealth Group
IEOU
ND ROCK
XAS
City of Round Rock
Agenda Item Summary
Agenda Number:
Title: Consider executing a Terms Amendment to the Administrative Services
Agreement with United Healthcare (UHC) Services, Inc.
Type: City Manager Item
Governing Body: City Manager Approval
Agenda Date: 1/28/2022
Dept Director: Valerie Francois
Cost:
Indexes:
Attachments: LAF - Amendment to UHC ASA (0120 22), City of Round Rock ASA Amend Terms
Other 1.1.2022_UHC signed 1.14.22
Department: Human Resources
Text of Legislative File CM-2022-024
This amendment is a cost reduction for the Naviguard Program in the current agreement. The rate reduced
from
$4.50 to $2.50 per employee per month.
City of Round Rock Page 1 of 1