R-2016-3988 - 12/15/2016 RESOLUTION NO. R-2016-3988
WHEREAS, the City of Round Rock has previously entered into an Administrative Services
Agreement ("Agreement") with Aetna Life Insurance Company ("Aetna") for stop loss insurance, and
WHEREAS, the City Council desires to renew said Agreement with Aetna,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
Aetna for insurance coverage for the guarantee period of January 1, 2017 through December 31, 2017
as set forth in the document package from Aetna 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 15t1i day of December, 2016.
4 ' t
ALAN MCGRAW, Mayor
City of Round Rock, Texas
ATTEST:
- 4�il- -
SARA L. WHITE, City Clerk
0112.1604;00368505
EXHIBIT
"A„
Stop Loss Renewal
City of Round[luck Acmn Life Insurance Company
Jam"1.2017 th rough December31.2017 Customer Number-819919
Firm Stop Loss Quote
-This exhibit outlines your firm renewal rates effective January I,2017.
-Pricing assumes plan enrollment of 760 employees. If actual enrollment varies by more than 10%in
total midlor tite plan design chan�cs we reserve the right to readjust the stop loss premium.
- In an environment wliere healthcare costs arc increasing,maintaining the same deductible shifts more of the claim
cost to the slop loss provider.
To help reduce the effect of Ievemeing,it is recommended that a plan sponsor consider increasing their
Stop loss deductible to keep pace with medical trend.
-Please refer to the slop loss policy fur detailed Stop Loss information.
Current Firm Renewal
01/01/2016 01/01/2017
STOP LOSS COVERAGE.SPECIFICATIONS
Policy Period Length(months): 12 12
Number of Employees Covered Under Stop Lass: 739 760
Producer Compensation: 0.0:0 0.0%
Terminal Liability Option: None None
Claims Paid Basis for Medical Coverages: Cleared Cleared
Claims Paid Basis for APM Rx coverage is on a cleared basis
INDIVIDUAL STOP LOSS COVERAGE SPECIFICATIONS
Individual Slop Loss Level: $200,000 5200,000
Contract Type: Paid Paid
Coinsurance W 100% 1001/6
M/N Claims Apply to ISL(Aetna Administered only): Yes Yes
Rx Claims Applied to IS[.(Aetna Administered only): Yes Yes
Individual Specific Stop Loss Limits(Lasering): TBD TBD
Individual Lifctinie Stop Loss Payment Amount: Unlimited Unlimited
Reimbursement Method: Immediate Immediate
:\GGIZEGA"I'E SLOP LOSS CON'ERAGE SPECIFICATIONS
Aggregate Stop Loss Percentage: 125% 125%
Contract Type: Paid Paid
Maximmn Annual ASL Payment Amount: 51,000,000 S1,000,OW
Reimbursement Jiethod: Monthly Budget Feature Monthly Budget Feature
Prior Carver Runoff Cap: s0 s0
Total Claims Applied to Aggregate Stop Loss: 57,883,047 $9,435,942
Benefits that apply to ASL-Medical: 55,549,019 S6,466.231
Benefits that apply to ASL-Drug: $2,334,028 $2,969,711
Lasering Adjustment: so s0
Pooling and Coinsurance Adjustment: s0 so
FINANCIAL INFORMATION
Stop Loss Premium: S925,731 51,090,205
State Assessment pee s0 so
Total Stop Loss Premium: $925,731 S1,090,205
Total Premium(PEPM)Composite Rale: 510439 5119.54
Individual Stop Loss premium as°o ofTuud Premium: 92.27% 92.82%
Stop Loss Aggregate Limit": $9,853,809 SI 1,794,928
Slop Loss Aggregate Limit(PEP11)Composite Factor: 51,111.16 S1,293.30
ISL rale: 597.94 5112.89
ASL rate: S6.45 $6.65
•Nlinimunn Slop Loss Aggregate Limit will be set using the first month enrollment x Slop Loss Aggregate Limit(PEPM)Composite Factor x 0
ofcontracl Months.
Premium rates are billed and Aggregate Factors are administered on a composite basis.
May 2013 www.aetna.com Page 1
r�t
2017 Renewa�
U ROIJIND ROCK TEXAS
,J HUMAN RESOURCES
RETENTIONAetna 14
SPECIFIC
Contract Type 24/12 24/12
Individual Stop-Loss Level (Deductible) $200,000 $200,000
Lives/contracts 800 800
Composite $97.94 $115.78
Monthly Premium $78,352 $92,624
Commission (PEPM)
Monthly Commission
Annual Premium $940,224 $1,111,488 18% $171,264
• �` {'.��tl�l�jlX { PEPM $17.84
Contract Type 24/12 24/12
Maximum Annual Reimbursement $1,000,000 $1,000,000
Attachment Percentage-Corridor 1 125% 125%
,Aggregate
Lives/contracts 799 799
Composite(maximum attachment factor) $1,111.16 $1,293.30
Monthly Maximum Attachment Amount $887,817 $1,033,347 16% $145,530
Annual Maximum Attachment Amount $10,653,802 $12,400,160 PEPM $15.16
ike Rates
Lives/contracts 800 800
Rate- Composite $6.45 $6.65 3% $0.20
Monthly Premium $5,160 $5,320
Commission (PEPM)
Monthly Commission
Annual Premium $61,920 $63,840 3% $1,920
PEPM $0.20
Total Fixed Expenses $1,002,144 $1,175,328 17% $173,184
PEPM $18.04
Total Maximum Claims $10,653,802 $12,400,160 16% $1,746,358
Total Laser Liability $0 $0 PEPM $181.91
r • 4 .a s' _-' $13,575,488 16% $1,919,542
$13,575,488 PEPM $199.95
$1,175,328 17% $173,184
„ . $1,175,328 PEPM $18.04
TOTAL DIFFERENCE: $2,092,926
PEPM: $218.01
CERTIFICATE OF INTERESTED PARTIES
FORM 3:295
1of1
Complete.Nos.1-4 and 6 If there are interested partles. 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.pity,state and country of the business entity's place Certificate Number:
of business. 2016434567
Aetna
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 11J0912016
being filed,
City of Round Rock Date Acknowledged:
g 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.
819919
Stop Loss Insurance Contract
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. E
6 AFFIDAVIT I swear,or affirm,and r penalty of perjury,that the above disclosure is true and correct. E
yQ�Y
� John Privet
VP
My Commission Explros
� 12/28/2016
il,A,
Signatilreiaf author' .agent of contracting business entity
AFFIX NOTARY STAMP/SEAL ABOVF_
Sworn to and subscribed before me,by the saidf VI C�a 2 this the day of
20 /(e .to certify which,witness rT hand and seal of office.
)0\,& V C
Signatur of officer administering oath Printed name of officer administering oath Title of officer adfiministering oath
Forms provided by Texas Ethics Commission www,ethics.state.tx.us Version V1.0.277
a
CERTIFICATE OF INTERESTED PARTIES
FORM 1295
1 0f 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. 2016-134567
Aetna
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 11/09/2016
being filed.
City of Round Rock Date Acknowledged:
11/10/2016
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.
819919
Stop Loss Insurance Contract
Nature of interest
4
Name of Interested Party City,State,Country(place of business) (check applicable)
Controlling I Intermediary
5 Check only if there is NO Interested Party.
X
6 AFFIDAVIT I swear,or affirm,under penalty of perjury,that the above disclosure is true and correct.
Signature of authorized agent of contracting business entity
AFFIX NOTARY STAMP/SEAL ABOVE
Sworn to and subscribed before me,by the said this the day of
20 ,to certify which,witness my hand and seal of office.
Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.277