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Home My WebLink AboutContract 48461 CITY SECRETA Y CONTRACT NO. I.. Stop Loss Insurance Renewal Offer Voya Employee Benefits Prepared for: City of Fort Worth Effective Date 01/01/2017 Policy Number 68412-1 Excess Risk Insurance is issued by ReliaStar Life Insurance Company a member of the Voya® family of companies. RETIREMENT I INVESTMENTS I INSURANCE V%j `. FINANCIAL y Stop Loss Insurance Renewal Offer City of Fort Worth 684121 Estimated Annual Cost Stop Loss Insurance Coverages Individual Excess Risk Insurance Current Renewal Plan Effective Date 01/01/2016 01/01/2017 Coverages Medical, RX Medical, RX Individual Deductible $1,000,000 $1,000,000 Policy Year Maximum Unlimited Unlimited Paid in 12 months and Paid in 12 months and Contract Period incurred January 1, 2014 incurred January 1, 2014 or after or after Benefit Percentage 100% 100% Quoted rates include commissions of 0.00% 0.00% Enroll Counts Rates Composite 7244 $4.35 $4.35 Estimated Annual Cost $378,137 $378,137 %Change From Current 0% Individual Adjusted Deductible: N/A N/A If not preliminary,select acceptance choice: RETIREMENT I INVESTMENTS I INSURANCE FiNANC1Al sly F Assumptions: Renewal As-Of Date: 11.3.16 Renewal Good Through: 11.15.16 Situs State TX Claim Administrator United HealthCare Corporation Network UHC Choice Plus Retirees Covered Yes Yes Are retirees age 65 and over covered? No No Waived Actively-at-Work Yes Yes Endorsements Plan Mirroring Coordination Cost Containment Programs UHC The individual stop loss renewal is based upon the current leveraged trend factors, market conditions, plan designs and current demographic factors. The aggregate renewal is based upon the experience of the group and current trend. Any plan changes may affect this renewal and need to be disclosed prior to the renewal acceptance. Cost containment services are managed and administered by independent third-party entities not affiliated with Voya Employee Benefits.Voya Employee Benefits, a division of ReliaStar Life Insurance Company, does not warrant, guaranty, or make any representations or warranties whatsoever, express or implied, or assume any liability regarding the use or the results of the cost containment services, including without limitation any financial results, any information transmitted or received, any delay in claims processing or payment,or loss of use of such cost contjinment services. �� 1 61-v�- ao�_�_ l �c Auuhhoriz d Signature Date j _JySao A �GIKI Li ST e-v/- Print Name Title �— .APPROVED AS TO r M D LEGALITY: City of Fort Worth / , Ot 68412-1 1S C' 01/01/2017 S T CITY ATTORNEY ® �F® ` _ 213 a Excess Risk Insurance is underwritten by ReliaStar Life Insurance Company. Policy form RL-SL-POL vQ vary by state). Exclusions and limitations are described in the policy. Wig° g® " Mary J. ys r, ity .. RETIREMENT I INVESTMENTS I INSURANCE "NANCIAL CERTIFICATE OF INTERESTED PARTIES FORM 3.295 loll 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. 2016-133679 ReliaStar Life Insurance Company Minneapolis, MN United States Date Filed: 2 Name of governmental entity or state agency that is a party to the contract for which the form is 11/07/2016 being filed. City of Fort Worth Date Acknowledged: //t-ll/c/ 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 68412-1 2017 Excess Risk Insurance Renewal Nature of interest 4 Name of Interested Party City,State,Country(place of business) (check applicable) Controlling Intermediary Voya Financial, Inc. Atlanta,GA United States X 5 Check only if there is NO Interested Party. ❑ 6 AFFIDAVIT I swear,or affirm,under penalty of perjury,that the above disclosure is true and correct. Signaturk of authorized agent of contracting business entity AFFIX NOTARY STAMP/SEAL ABOVE (� Sworn to and subscribed before me,by the said ' ' (m q r- 1 / ' / Urns this the day of m 20 (-,to certify which,witness my hand and seal of offs e. T0. /e.. s;.• p�a� GAYLE M. YORK? �; Nolary public,Stale of texas My Commission Exp s July 20, 2019 Sign t re of officer adi stering oath PrinteqAme of officer aamirkstering oath oath Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.277 M&C Review Page 1 of 2 official site of the City of Fort Worth,Texas I U N ' COUNCIL ACTION: Approved on 12/6/2016 DATE: 12/6/2016 REFERENCE NO.:**C-27998 LOG NAME: 14VOYASTPLOSS17 CODE: C TYPE: CONSENT PUBLIC NO HEARING: SUBJECT: Authorize Execution of Agreement with ReliaStar Life Insurance Company in an Amount Not to Exceed $378,300.00 for Stop Loss Insurance for the City's Health Benefits Plan with an Effective Date of January 1, 2017 (ALL COUNCIL DISTRICTS) RECOMMENDATION: It is recommended that the City Council authorize the execution of an Agreement with ReliaStar Life Insurance Company in an amount not to exceed $378,300.00 for Stop Loss Insurance for the City's Health Benefits Plan with an effective date of January 1, 2017. DISCUSSION: The purpose of this Mayor and Council Communication (M&C) is to seek authorization from the City Council to enter into an Agreement with ReliaStar Life Insurance Company (ReliaStar), a member of the VOYA family of companies, for Stop Loss Insurance for the City's Health Benefits Program for 2017. ReliaStar has provided the City of Fort Worth's (City) Stop Loss Insurance coverage since April 2014. On April 8, 2014, (M&C C-26750) the City Council authorized the City to enter into an Agreement with ReliaStar to provide Stop Loss Insurance coverage through December 31, 2014. On January 6, 2015, M&C C-27136 was approved to provide Stop Loss Insurance coverage through December 31, 2015. On December 15, 2015, M&C C-27557 was approved to provide Stop Loss Insurance coverage through December 31, 2016. The specific Stop Loss coverage caps the City's liability for annual claims on a per member basis. The City pays for all claims for each participant up to a specified dollar amount with the Stop Loss Insurance coverage paying for any claims beyond the per-participant threshold. The current Stop Loss coverage is for the amount of$1,000,000.00 at a cost of$4.35 per employee per month (PEPM) for each active employee and non-Medicare retiree who is a member of the City's self-funded health plan. The PEPM rate for 2017 will remain at$4.35. The amount that will be paid from Fiscal Year 2017 funds is $283,725.00 for January through September 2017. The City Manager's budget proposal for Fiscal Year 2018 will include a recommendation to fund the remaining three months of the contract term. M/WBE OFFICE-A waiver of the goal for MBE/SBE subcontracting requirements was requested by the Human Resources Department and approved by the M/WBE Office, in accordance with the BDE Ordinance, because the purchase of goods or services from source(s)where subcontracting or supplier opportunities are negligible. FISCAL INFORMATION/CERTIFICATION: The Director of Finance certifies that funds are available in the current operating budget, as appropriated, of the Group Health and Life Insurance and Retiree Healthcare Trust Funds. Funding for the balance of terms of these contracts will be requested as part of the Fiscal Year 2018 budget process. http:Happs.cfwnet.org/council_packet/mc review.asp?ID=24088&councildate=12/6/2016 12/14/2016 M&C Review Page 2 of 2 TO Fund Department Account Project Program Activity Budget Reference# I Amount ID ID Year (Chartfield 2) FROM Fund Department Account Project Program Activity Budget Reference# Amount ID ID Year (Chartfield 2) 60109 0148520 5520107 $226,980.0L0 71050 0148540 5520107 $56,745.00 Submitted for City Manager's Office by: Susan Alanis (8180) Originating Department Head: Brian Dickerson (7783) Additional Information Contact: Margaret Wise (8058) ATTACHMENTS TEC Form 1295 Certificate 100143623 (3).pdf http://apps.cfwnet.org/council_packet/Mc_review.asp?ID=24088&councildate=12/6/2016 12/14/2016