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R-2024-294 - 11/7/2024 RESOLUTION NO. R-2024-294 WHEREAS, the City of Round Rock (the "City") previously entered into an Administrative Services Agreement ("Agreement") with United Healthcare Insurance Company ("United Healthcare") for Stop Loss insurance on December 16, 2021 by Resolution No. R-2021-333, and WHEREAS, the City Council desires to renew said Agreement for Stop Loss insurance for the period of January 1, 2025 through December 31, 2025, Now Therefore BE IT RESOLVED BY THE COUNCIL OF THE CITY OF ROUND ROCK,TEXAS, That the Council hereby authorizes renewal of the Administrative Services Agreement with United Healthcare for insurance coverage for the guarantee period of January 1, 2025 through December 31, 2025 as set forth in the Stop Loss Renewal document from United Healthcare attached as Exhibit"A." 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 7th day of November, 2024. CRAI ORG , Mayor City of ound k, Texas ATTEST: 11)L ANN 1 ANKLIN, City Clerk 0112.20242;4887-4737-3044 EXHIBIT ,A,, tiU�eate(llthcare CITY OF ROUND ROCK 2025 Administrative Services Fees III�� H ASO MEDICAL FEES Fees assume an Average Contract Size of 2.21 ASO Fees(PE i"' Currc.t Year I Year2 -. 1:1:2025 1/1/2026 Plan Year through through I2)31r2025 12131/2026 Choice+PD r.79 $52.31 $53.88_..._......_... _._......_._ _. _._. 2.31 EPO ...................._ 5579 $5 loll__$553.68 Rx Rebate Great eidt _ ._.-_..._.__._...__$40.040.00 —... TBD Credits Communication Credit $5,000 $5,000 $5,000 ..._..._ Wellness Credit 525000 $25,000 $25,000 The following services may require an additional cost as noted below: Current Year 1 Year 2 Additional Disease Management,Specialty and Wellness 1/1/2024 1/1/2025 1/1/2026 Programs(Fees are on a PEPM basis unless specifically noted) through through through 12/31/2024 12/31/2025 12/31/2026 Disease Management Programs: Congestive Heart Failure(VOM) ..__._._....___._._.......__._._.______..._._..._._._.........__.._.._......... Chroonicc Obshuctive Pulmonary Disease(VOM) Coronary Artery Disease(VOM) Included In Personal Health Support Included in Personal Health Support Included in Personal Health Support Diabetes Program(VOM) .._..._..._..._.........._..._.._..............................................._..._._.._..._.._._. Asthma Program(VOM) Clinical Specialty Network Program: Banah¢Resource Services(BRSI I Intiuded I — Included __1 I _ Included _J grrm Medical Management Pro Core Medical Necessity I Included I Included I Included I Physical Health Solutions: Chiropractic Network Included Included Included . a_......_..._.._.._,..__..,,....__.l Therapy/Speech Network .................._......_..._._.l._ ._..._..._..._..._......_......___...__..._.__.._.ncu.._..._..._.._..._._.._..._.... _.._.._................_........_... Physical therapy/Occupatitnal Therapy/Speech Therapy Network Included Included Included .opem._._a_..._l.er__..._ene_._..._..._...__wor._..._.aag_.__._.._..._.._..._..._..._......_......n_ll._d.__..._..._. ........._..._...__..._..._.__._cu.._..._.__.._..._._..._..._.............................In.c_..._.,._..........._..._..._.__.. Complementary Alternative Medicine(CAM)Network Management Included Included Included Other Programs/Services: TX Custom PHS 3.0 Included Included Included .._..._.._oal..._et_.._o._._.o_.__..._..._......_..._._._.._._._..._..._..._......_.._..._.__..._........................__.._ ._.............__._..._..._..._. .._..._..._..._..._._.__..._......__...._..._.._..._...__.____._..._..........._..._..._... Behavioral Health Solutions Included Included Included ......._..__.___._.-- Claim Fiduciary Included Included Included ew._rk_._u._,.._.,._,.._.,._,_.,._._.osti_......_..___._._.__aio_...._..._..._..._...__.._..._._...............n_l.___._...._..._..._...................................._..._.__l__,.._..._......._._..._..._......_......_.__..._..._.....I_.c_._e._..._.........._.._._ Network Customization-Aimosti/Onsite Clinic Integration Included Included Included .roar_ ._. ___.__.__ ............ ....._..._.. ......._..._. Included ...._.._ __............._ ......._........._... External Files(data extracts) Included Included Included OOrer hograaelNwlss Fees aa6dlsd S mougls**&Amur* Child and Family Behavioral Coaching $240 Per Case $240 Per Case $240 Per Case Child and Family Behavioral Coaching Month 2+ 44 Per Cas-..._..._..._......_._..._.._._ .._..._._..._..._......_....._......................er Ce 3144 Per Case $14a Per Case 8144 Per Case Mayen Maternity 12 Month Program N/A $925 Per Case $925 Per Case .............._._.__.__....._.._.._..._..._$.1_..._...Pageme.__.__..__...._....__._. gm.._..._..._.._... Neonatal Resource Services N/A $1 700 Per Engagement jt 700 Per Engagement Mn_,.._.__.e__.S._. ._._._.�.. .___..._.._..._.__...__.. St.500 Case_._ ......_......_..._..._.S_.._._.._..er Case Management Solutions N/A j1,500 Per Case $1 500 Per Case rtuaBehavioral._...._h_,.._..._. -_.__. _._.._.2_Pe.r..__,_.i_______..___.._...__.$72_P_.r..S_.ss._..._._._.___......_......_..._.._.$7..__e_.Sessi._....._..._...__. Virtual Behavioral Coaching $72 Per Session $72 Per Session $72 Per Session Virtual h n................_._..___.._._.._..._..._..._......_..._..._...__. ..._..._..._..._....$5._Po..._.._.._......_....._..._..._._..._.$55_,._.r._._..._..o..._.._._..._..._............._......_$5__Per o.........._..._.__... Virtual Behavioral Coaching Weekly Call $55 Per Session $55 Per Session $55 e Session UHC Nub Vendors: Fees for the following will be collected through the Bank Account Arc Fingerstick N/A..._..._..._.._._._.._.__.__._ __..._......_.._._..._..._._ ._._.._.._.._.._ .............._......_........_..._..._......_..._..._.__...._..._..._..._.__._. 331 Per Participant TBD Full Lipid Profile Fingerstick -......._..._.__.._.._...___N._..................__.__.__._....._._..._.__......_r__._.___._....___.__._____._.__.._.._..._..._..__. N/A j54.50 Ptt Participant TBD ._..._.... ........_...._ .. .._.._..._. ......_.__.._ .. ._.._.,._..._N.__ .__.___•___._..___.c.._.a_.._._._.__.._._. _.Pero__._._err_ea._._. K Health N/A E615 Per Participant Per Year $615 Per Participant Per Year Let's Get Checked Colorectal Cancer At Home Screening Kit(Primary) N/A 315.50 Per Ki Kit Shipped TBD LtsGeC__._.._..DuceesA_..._..t.._.o_..._..ScngKit.._P.rim`__. ._._..._._25.50 t_ippe._._..._..._......_. __........._.____... Let's Get Checked Diabetes A1c At Home Screening Kit(Primary) N/A $25.50 Per Kit Shipped TBD ... .,.,.._.._....._.._..Hea.._..._....._._..eSrg_.,._.(.Pi._._..._..roar.-� N_.�__ _._._.__. .__.__..Kit__.,._._..._.._......� —__.._...._._..__... Let's Get Checked Heart Health At Home Screening Klt(Primary) N/A $25.50 Per Kit Shipped TBD .._.,_._..._...Rs_.l_..Fod______..__.._..._......._..._._......_.__.._ _._..__._ _._.,.-._._.___.__..P._.._o._.__..._._.._._..__. ._.._...._..._.._._._ Physician Results Form(printed results) N/A 313.75 Per Form_. TBD __ ._..._.._._._..i_._...._.._............._..._......_.__.__.._.._._..._..._........_......_....._....... .�_.._.._._ . .____._._....__._._.__. _ �._._ _...._..._..._._... Secondd Opinion Services N/A $2,136 Per Case $2,736 Per Case Teladoc Chronic Care Mgmt Plus N/A $69 PEMPM $69 PEMPM The following are not included in the above ASO Fees: Additional Services Fee Naviguard._............... _.._....._ —._......_..._......_._______._..._..,_,__$275PEPM_._.t._.._. ._ ....... S ..._...___._._— Transplant Resource Services Transplant Cost Negotiation Program 1,!333 ern baton ----Pamrd Integrity(Fees collected through Bank Account): Enhanced Abuse and Fraud Management Program 22%of recoveries Advanced Analyti d R very Services AARS) __- 24%of recoverles ._... ..roar_ Credit Balance . .roar..Recovery Program._. .__._.._.. ....__._._.._ not to exceed f 0%of recoveries Subrogation al Bill Audit Program..........................._...._._.._._. ._ not to exceed 2e%of savings..._.._..._..._....._._._..roll_—._._._......_..._..._._. roar —._. .....__.___..._.....................__..._..._..._..._._._._._._. .._..._.„_._..._..._.__...____.___._.. roar Subrogation Services 37.3%of recoveries j._._ __.._,.ve_..._..._......................__._._...._.._..._.._._._..._..._..._._..._..._..._..._...._........_..._.._._..._..._..._..._......_..33._.._._.f_..._..._..._....__..._..._..._..._._..._..._..._..._..._._.._..._.__..._._..._..._..._..._....._.._..._.._.. roar I �Coordination Coverage 33.3%of recoveries .._...._.._...___._.._.._.._..__.._.._._.__.___...___.._.__..__.__.a___ ._____.___..._.._.__._....._._._.._.__._._....._..._.__.._._ __.. Focused Claim Review 22%of savings 'Naviguard pricing will increase annually by$1 00 pepm(or more,now group specific). The followina are included in the ASO Fees(applies to Active and Pre-65 Retiree population only): • UnitedHealthcare Pharmacy.If the pharmacy is carved out to another vendor,the ASO fees and Credits are subject to change. • eServices Reporting-(interactive fully Web-based reporting) • Federal External Review Program(third level appeals)-our Medical ASO fee includes a maximum of 5 reviews.Reviews in excess of this limit will be charged at$500 per review. • Advocate4Me Customer Service Model that provides participants with access to a one-stop advocacy resource for an unprecedented range of needs,including support and access to services across medical benefits,claims,pharmacy,clinical,incentives,and more. • Customer Service,our quoted customer service model offers members a high-touch,personal guide who provides support in navigating benefits, This document is confidential and proprietary UnitedHealthcare information and may be used only by personnel in relation to this quote. 1 of 6 understanding payment options,resolving claim issues and working through the health care system. In addition to acting as a one-stop shop where members can be directed to the most appropriate existing services,representatives can provide additional information relevant to personal needs and take ownership of inquires end-to-end.For those not resolved during the initial call,customer service representatives take ownership until resolution including call back to the member. • Employer Internet Solution—wmw.emolovereservices.com • UnitedHealthcare Behavioral Health Solutions • Personal Health Support Personal Health Support is a dinical solution designed to help enhance member engagement. increase medical cost savings,and improve health outcomes,providing the full spectrum of clinical services in a condition-agnostic way.The solution: • Provides personalized health improvement support across the full spectrum of care including complex and chronic condition case management • Intelligently calibrates the level of support provided across condition by assigning estimated monetary savings to members'holistic health improvement needs and prioritizing support based on • Connects with members on an emotional level to influence desire for behavior change and interaction with resources via inbound/outbound,multi-modal engagement opportunities • Calibrated to client specific budget and intervention priorities to maximize the return on investment • The Value Opportunity Methodology(VOM)is an analytic model that maximizes savings by combining economic value and the likelihood to engage to produce an expected realized economic value. Members with higher VOM(who represent the highest opportunities for better outcomes,savings and likelihood to engage)are prioritized for phone outreach. • Our quote includes the management of over 100 disease states/conditions,as part of our Personal Health Support(PHS)program.We believe this approach will adequately address the clinical conditions present within the population-though we are open to discussing and proposing alternative programs,should clinical prevalence indicate an appropriate ROI. • Consumer Activation,including basic navigation guide,health statements with individualized messaging,advanced concierge call services, and access to member portal with consumer activation messaging • UnitedHealthcare will duplicate requested plan of benefits in principle and in a manner compatible with our understanding of the basic plan designs.Our quotation maybe adjusted contingent upon review of all Medical plan design specifics.Our fees may be adjusted,or changes to the plans may be required to enable us to administer claim payments. Pricing Assumptions • The Plan or its sponsor is responsible for state or federal surcharges,assessments,or similar taxes or fees imposed by governmental entities or agencies on the Plan,Plan Sponsor or us,including but not limited to those imposed pursuant to the Patient Protection and Affordable Care Act of 2010(PPACA),as amended from time to time.This includes responsibility for determining the amount due,funding, and remitting the PPACA Transitional Reinsurance fee and the PCORI fee which are remitted to the government(federal and/or state). • The fees quoted do not include state or federal surcharges,assessments,or similar taxes/fees imposed by governmental entities or agencies on the Plan,Plan Sponsor or UnitedHealthcare.We reserve the right to adjust the rates(i)in the event of any changes in federal,state or other applicable legislation or regulation;(ii)in the event of any changes in plan design or procedures required by the applicable regulatory authority or by the sponsor;and(iii)as otherwise permitted in the Administrative Services Agreement. • The administrative fees set forth herein do not include fees related to the requirements set forth in the Consolidated Appropriations Act,2021,including the No Surprises Act.Additional fees for these new regulatory requirements will be provided at a future date once regulatory guidance is received and final compliance requirements are determined. • UnitedHealthcare reserves the right to revise this quotation under the following circumstances: • The total number of enrolled medical employees varies by more than 10 percent from the assumed medical enrollment of 1014 • The average contract size,defined as the total number of enrolled employees plus dependents divided by the total number of enrolled employees,varies by 10 percent or more from the assumed average contract size of 2.21. • The benefits or service requirements requested and/or quoted change prior to or after the effective date. • In the event of any changes in federal,state or other applicable legislation or regulation that require changes to this quotation. • In the event of any changes in plan design required by the applicable regulatory authority or by the Plan sponsor. • In the event that any taxes,surcharges,assessments,or similar charges are imposed by governmental entities or agencies on the Plan or UnitedHealthcare,in its role as administrator or insurer. • As otherwise permitted in our Administratives Services Agreement • Our mature quotation includes the processing of runout claims for 6 months following the termination of our contract. • If pharmacy benefits are carved out the ASO fees quoted above may be revised. • Customer will only receive Rebates to the extent that Rebates are actually received by United.For example,if a government action or a major change in pharmaceutical industry practices eliminates or materially reduces manufacturer Rebate programs,Customer's payment amount may be reduced or eliminated. In such event,United shall promptly notify Customer and revise or eliminate such payment effective with the date of the reduction or elimination in Rebate payments. In addition,reduction or elimination of Rebates in this event shall constitute a change in the Agreement as described in the Fees Section such that United has the right to increase the fees for the Pharmacy Benefits Management services or increase the percentage of Rebate dollars retained by United. • We reserve the right to adjust our rebate guarantee if changes made to our prescription drug list(PDL)for the purpose of achieving lower net drug cost for CITY OF ROUND ROCK and our other ASO customers result in significant reductions to the rebate level. • CITY OF ROUND ROCK will receive 80.0%of rebates on prescription drug products dispensed under the medical benefit plan. • Commissions are excluded. • This quotation assumes UnitedHealthcare will retain claim fiduciary responsibility • United will provide a Communication Credit,Wellness Credit to help CITY OF ROUND ROCK mitigate costs associated with communication to Participants,additional wellness services from United These credits are available as follows: • The parties must have an executed Agreement. • The first month of service fees under the Agreement has been received by United. • CITY OF ROUND ROCK's enrollment with United must always exceed 913 Employees. • Credits must be used between 01/01/2025 and 01/01/2026.Any Credits not used during this time period are forfeit. • Upon request from CITY OF ROUND ROCK,a credit will be issued in United's fee billing system. • Upon presentation of receipts for costs,a credit will be issued in United's fee billing system in the amount of the receipted expenses,total amount not to exceed the full credit. • If CITY OF ROUND ROCK terminates the Agreement prior to I2/31/2026,CITY OF ROUND ROCK will repay United a prorated portion of the credit paid in the year of termination based on the termination date.Credits in prior years are not subject to repayment.All unpaid credits are forfeit. • If enrollment with United falls below the enrollment threshold,CITY OF ROUND ROCK will repay United an amount proportional to the enrollment reduction based on the amount of the credit paid at the time enrollment falls below the threshold. • The amount of the credit not yet paid is reduced proportional to the enrollment reduction. • If during the course of the first year unforeseen or additional expense items arise related to the CITY OF ROUND ROCK implementation,UHC reserves the right to use a portion of this credit to offset such expenses. • CITY OF ROUND ROCK acknowledges that UHC Hub products and services are offered and provided by third-party vendors that are not affiliated with United,and CITY OF ROUND ROCK agrees that United is not responsible or liable in any way for such performance or financial return guarantees.Certain UHC Hub products are subject to state sales Tax.United will invoice and CITY OF ROUND ROCK agrees to pay United for any required taxes. A third-party vendor's participation in UHC Hub may terminate in the middle of the Initial Term or Renewal Term of this Agreement.In that instance,the product or service will no longer be provided from that vendor and no further Fees will be charged for that product or service.Fees for UHC Hub products and services will be paid through a withdrawal from the Bank Account. This document is confidential and proprietary UnitedHealthcare information and may be used only by personnel in relation to this quote. 2 of 6 II United Healthcare CITY OF ROUND ROCKIStop Loss Exhibit J Effective Date:1/1/2025-12/31/2025 This document may contain protected health information(PHI)and should only be shared with individuals designated to view such ISL Proposed Option 1 Individual Stop Loss ISL Total Quoted Subscribers 1,014 ISL Rate PEPM $161.41 ISL Deductible $200,000 ISL Liability Limit(per individual) Unlimited ISL Contract Basis P12 ISL Includes Early Retirees Yes ISL Includes Medicare Retirees No ISL Includes RX Yes Lasered Claimants** No ASL Proposed Option 1 Aggregate Stop Loss ASL Total Quoted Subscribers 1,014 ASL Rate PEPM $3.80 ASL Corridor 125% ASL Liability Limit(per policy period) $1,000,000 ASL Contract Basis P12 ASL Includes Early Retirees No ASL Includes Medicare Retirees No ASL Includes Rx Yes ASL Includes Commissions No Monthly Accommodation Yes Total Stop Loss Premium PEPM $165.21 Monthly Stop Loss Premium Cost $167,520 Annual Stop Loss Premium $2,010,239 Expected Claims PEPM $1,162.76 Composite Attachment Factor PEPM(illustrative) $1,453.45 Projected Monthly Aggregate Liability $1,473,798 Projected Annual Aggregate Attachment Point $17,685,580 Monthly Maximum Stop Loss Liability $1,641,318 Annual Maximum Stop Loss Liability $19,695,818 Stop Loss Rating Assumptions • The stop loss attachment points and premium rates provided by UnitedHealthcare in this quotation will be effective from 1/1/2025-12/31/2025. • Our quotation is based on claims with dates of loss on or after when Stop Loss Exhibit enrolled with UHC and paid on or after the effective date of 1/1/2025. • Aggregate Stop Loss applies to medical claims after the effective date of the stop loss policy,before the policy year end. Paid claim accumulations are based on cashed claim drafts. • Aggregate Stop Loss applies to medical and pharmacy claims,i.e.Healthcare dollars only.The pharmacy plan must be administered by UnitedHealthcare. • UnitedHealthcare will be the exclusive health care administrator. • Participation of at least 75 percent of the eligible enrollees is required. Confidential/Proprietary/Competitively Sensitive Information 3 of 6 IJUnited Healthcare CITY OF ROUND ROCK 2025 ASO Expense Summary Exhibit Proposed Option 1 Subscribers 1014 Members 2244 Administration Composite Administration Fee-PEPM $12.31 Monthly Fees $12,482 Annual Fees $149,788 Credits (annual) ($30,000) Annual Net Administration $119,788 Stop Loss ISL Deductible $200,000 ISL Rate- PEPM $161.41 ASL Corridor 125% ASL Rate- PEPM $3.80 Total Stop Loss Rates-PEPM $165.21 Monthly Premium $167,520 Annual Premium $2,010,239 Claims Expected Claims- PEPM $1,162.76 Attachment Point- PEPM $1,453.45 Total Expected- Monthly $1,179,039 Total Expected-Annual $14,148,464 Total Maximum - Monthly $1,473,798 Confidential/Proprietary/Competitively Sensitive Information 4 of 6 Total Maximum -Annual $17,685,580 Total Cost Summary Expected Annual $16,278,490 Expected Maximum $19,815,606 Imprest Balance Current Req. Deposit Required Medical Deposit* Imprest Balance $330,000 $330,000 Option Weekly ACH Weekly ACH Frequency 5 5 * If additional lines are sold (ancillary, HRA, FSA, etc.), additional imprest amounts could be needed Confidential/Proprietary/Competitively Sensitive Information 5 of 6 /J United Healthcare CITY OF ROUND ROCK Performance Guarantees Effective Date:01/01/2025 Performance Standards and Credits Effective for the period: January 01,2025 through January 01,2026 Credit Category Guarantee Description Measurement Criteria Amount Claim Operations 1.Time to Process:percent of claims paid in 10 94.00%in ten business days Site level,by standard claim operations business days Gradients are reports. 94.00%within 11 business days $3,082 94.00%within 12 business days 86,163 94.00%within 13 business days 89,245 94.00%within 14 business days $12,327 94.00%within 15 or more business days $15,408 2. Dollar Accuracy:Percentage of claims dollars 99.00% Office level. processed accurately. Gradients are 98.99%-98.50% $3,082 98.49%-98.00% $6,163 97.99%-97.50% $9,245 97.49%-97.00% $12,327 Below 97.00% $15,408 3. Procedural Accuracy:percent of claims processed 97.00% Office level. without non-financial error. Gradients are 96.99%-96.50% $3,082 96.49%-96.00% $6,163 95.99%-95.50% $9,245 95.49%-95.00% $12,327 Below 95.00% $15,408 Customer Phone Service 1.Average Speed to Answer. 30 seconds or less Team level Gradients are 32 seconds or less $3,082 34 seconds or less $6,163 36 seconds or less 59,245 38 seconds or less $12,327 Greater than 38 seconds 815,408 2.Abandonment Rate. 1.80% Team level Gradients are 1.81%-2.30% $3,082 2.31%-2.80% $6,163 2.81%-3.30% $9,245 3.31%-3.80% $12,327 Greater than 3.80% $15,408 3.Call Quality Score 93.00% Office level Gradients are 92.99%-91.00% $3,082 90.99%-89.00% $6,163 88.99%-87.00% $9,245 86.99%-85.00% $12,327 Below 85.00% $15,408 Member Satisfaction 1.Claimant&Key Customer Overall Satisfaction 80%satisfaction score based on%responding:Completely Satisfied,Very Satisfied Telephone Survey $7,704 and Somewhat Satisfied Based on UNET Service Center Products are PPO,POS,EPO,Managed Indemnity,HMO performance scores.Key Customer study may be conducted for an additional charge. Overall UHC Satisfaction 1. Employer health care decision makers Based on the response to the question,"Overall,how satisfied are you with Based on Employer health care 87,704 UnitedHealthcare?"If the response is a score of 5-10 on the 0-10 scale where 0 decision makers'overall satisfaction means very dissatisfied and 10 means very satisfied,the guarantee has been met. with UnitedHealthcare.. Total At Risk $107,857 Medicare Supplemental plans are excluded from Performance Guarantees. Confidential/Proprietary/Competitively Sensitive Information