HomeMy WebLinkAboutContract 42425 (2)May 31, 2011
Ms. Margaret Wise - Assistant Director of Human Resources
City of Fort Worth
1000 Throckmorton
Fort Worth, TX 76102
Dear Ms. Wise:
Trudy Corcoran
Senior Benefit Consultant
Finance Actuarial, Stop Loss
Aetna
151 Farmington Avenue, RE2R
Hartford, CT 06156
Phone: 860-273-9024
Fax: 860-273-2291
e-mail: CorcoranG@aetna.com
CITY SECRETARY
CONTRACT
TRACT
Enclosed is a rider to the Stop Loss policy for City of Fort Worth. This rider replaces the Policy
in its entirety with the removal of Aggregate Stop Loss coverage effective January 1, 2011.
Your signature is required on the rider. Please return the signed rider to me in the enclosed
addressed envelope. You should retain a copy of the signed rider for your files.
Please contact your Account Manager, Louwanna Pope at 972-881-4652 if you have any
questions.
Thank you in advance for your prompt attention to this matter.
Sincerely,
(24- CtietauC
Trudy Corcoran
cc: Louwanna Pope, Account Manager, Aetna, TX, F73O
Deborah Collins, Account Executive, Aetna, TX, F73O
Paula Lowe, Underwriting Consultant, Aetna, CT
0
_3l_'111 A 1:03 IN
OFF#041- RECORD
CITY SECRETARY
Ft WORTH, T
Rider
Attached to and made a part of Policy No. SL-889000
a policy between
Aetna Life Insurance Company
and the Insured
City of Fort Worth
It is understood and agreed that the policy effective January 1, 2008 is replaced in its entirety with the attached policy
effective January 1, 2011.
Nothing contained in this rider shall be held to alter or affect any of the terms of the policy other than as herein specifically
stated.
In Witness Whereof, the Aetna Life Insurance Company has signed this rider at Hartford, Connecticut, to become
effective January 1, 2011.
Signed by the Insurance Company May 31, 2011.
Cittlxv& ateciati
Registrar
U.
see
Mark T. Bertolini
Chairman, Chief Executive Officer and President
Signed by the Insured
SignaNk
APPROVE
F�
ASS iA
1114,4c
GR-96523-R1
ic)-97 /
Date
AS TO
LEGALITY:
•
554.
Official Title
Attested by.
CITY ATTORNEY Marty Hendrix, ry Sec
2.4 75°1
eve'
Art OR fib,,,,
ot0
Apjau
e 4
alp°
fri eta °a
0 a
d
4-90
o0
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
Stop Loss Insurance Policy
Aetna Life Insurance Company
Hartford, Connecticut 06156
(A Stock Company herein called Aetna)
This Policy will be construed in accordance with the law of the jurisdiction in which it is delivered.
In consideration of premium payments by the Insured in the amounts and at the times provided, Aetna agrees with the Insured to
provide insurance in accordance with the Policy terms.
For the purpose of effective dates and termination dates under this Policy, all days begin and end at 12:00 midnight.
This Policy is non -participating.
In Witness Whereof, Aetna Life Insurance Company has signed this Policy at Hartford, Connecticut.
gediock &asap
Mark T. Bertolini
Chairman, Chief Executive Officer and President Registrar
This is not a policy of workers' compensation insurance. The Policyholder does not become a subscriber to the
workers' compensation system by purchasing this policy, and if the Policyholder is a non -subscriber, the
Policyholder loses those benefits which would otherwise accrue under the workers' compensation laws. The
Policyholder must comply with the workers' compensation law as it pertains to non -subscribers and the required
notifications that must be filed and posted.
The Employer understands the liability assumed under the portion of the employee benefit plan which he is self -
insuring and further understands that he is exempted from Chapter 101 of the Texas Insurance Code only if a
qualified employee benefits plan has been filed and meets the requirements of ERISA.
GR-96476 Page 1
Aetna Life Insurance Company
151 Farmington Avenue
Hartford, Connecticut 06156
Section 1. Declarations
STOP LOSS INSURANCE POLICY FOR:
INSURED:
City of Fort Worth
1000 Throckmorton
Fort Worth, TX 76102
POLICY NUMBER:
SL-889000
POLICY EFFECTIVE DATE: DATE OF ISSUE:
January 1, 2011 May 31, 2011
POLICY DELIVERED IN:
Texas
GR-96476 Page 2
Section 2. Schedule of Insurance
Individual Stop Loss Specifications:
FIRST POLICY YEAR: January 1, 2011 through December 31, 2011
PREMIUM RATE: $22.71 per employee per month
INDIVIDUAL STOP LOSS AMOUNT: $400,000
INDIVIDUAL LIFETIME STOP LOSS PAYMENT AMOUNT: Unlimited
CONTRACT BASIS: Eligible Claim Expenses include claims paid between
January 1, 2011 through December 31, 2011 (regardless
of incurred date)
COVERED BENEFITS: Medical Benefits
The information provided in this Schedule of Insurance for each Policy Year after the first shall be indicated in a written notice
sent to the Insured and shall be effective on the date stated in such notice.
GR-96476 Page 3
Section 3. Insuring Agreement
Aetna will reimburse the Insured for Eligible Claim Expenses during a Policy Year, which are in excess of the Individual Stop
Loss Amount for any one Participant
Such payments are hereafter called Stop Loss payments.
In no event will Stop Loss payments for all Eligible Claim Expenses with respect to a Participant during his or her lifetime
exceed the Individual Lifetime Stop Loss Payment Amount shown in the Schedule of Insurance.
Section 4. Definitions
As used in this Policy:
1. "Contract" means Administrative Services Agreement No. ASA-889000, an Agreement between the Insured and Aetna.
2. "Contract Basis" establishes the time period during which Eligible Claim Expenses must be incurred by a Participant through
the Plan and the time period during which those expenses must be paid by Aetna in order for those Eligible Claim Expenses
to be included in the calculation of benefits under this Policy.
3. "Covered Benefits" are the benefits provided for Participants by the Plan as indicated on the Schedule of Insurance.
4. "Eligible Claim Expenses" are expenses for Covered Benefits that are paid by the Insured pursuant to the Plan and are not
excluded under the terms of this Policy. Payment for Eligible Claim Expenses is considered to be paid when the payment
has been validly presented to the bank on which it is drawn or when a Benefit payment has been made by electronic funds
transfer or other reasonable transfer method Eligible Claim Expenses will include payments made in New York on behalf of
the Insured to fund indigent care and graduate medical education when paid directly into the New York state pool.
5. 'Employee' means a U.S. based employee of the Insured who is regularly working at least 20 hours per week and for whom
the Insured is deducting any required U.S. FICA taxes.
6. "Experimental and Investigational" means a drug, device, procedure, or treatment that Aetna determines is not accepted as
standard medical treatment of a condition or illness Examples of Aetna's experimental and investigational determinations
are found at Aetna.com under Clinical Policy Bulletins.
7. "Individual Lifetime Stop Loss Payment Amount" means the maximum amount of Eligible Claim Expenses funded by
Individual Stop Loss under this Policy on any one Participant during his/her lifetime In the event the Eligible Claim
Expenses funded by Individual Stop Loss reach the Individual Lifetime Stop Loss Payment Amount, all subsequent Eligible
Claim Expenses for that individual will be funded by the Insured.
8. "Individual Stop Loss Amount" is the dollar amount of Eligible Claim Expenses per Participant that must be paid by the
Insured prior to any Individual Stop Loss Benefit becoming payable under this policy.
9. "Insured" is the plan sponsor identified in the Declarations section of the Policy.
10. ' Medically Necessary' means a service or supply that is furnished by a provider that Aetna determines is appropriate for the
diagnosis the care or the treatment of a disease or the injury Examples of Aetna's medically necessary determinations are
found at Aetna.com under Clinical Policy Bulletins
11. "Participant" means an Employee (or a retired employee) of the Insured, or a dependent of an Employee (or retired
employee), on whose behalf Eligible Claim Expenses are payable under the Plan. "Participant" also means an employee or
dependent who is entitled to extended benefits under the Plan or who elects COBRA coverage, following termination of
eligibility Employees who qualify for extended benefits under the Plan will include employees who are laid off, on leave of
absence, Temporary Disability or Long Term Disability.
GR-96476 Page 4
12. "Plan" means the self -funded medical benefit plan established by the Insured and described in the Appendix which is
attached to the Contract.
13. "Policy" means all of the following:
(a) The Insured's Application for Stop Loss Insurance.
(b) This policy and any riders to it.
14. A "policy month" shall coincide with a calendar month; except that the first policy month shall commence on the Effective
Date of this Policy and the last policy month shall end on termination of this Policy.
15. A 'policy year" shall coincide with a Plan year under the Plan; except that the first policy year shall commence on the
Effective Date of this Policy and the last policy year shall end on termination of this Policy.
Section 5. Exclusions
The following are not included as Eligible Claim Expenses:
1. Expenses paid on the direction of the Insured that Aetna determines are not payable under the Contract in accordance with
Aetna's then current standard claim practices established for insured group accident and health insurance plan administered
by Aetna. This includes expenses for services or supplies which are not Medically Necessary or expenses for drugs,
treatment, services or supplies which are considered Experimental or Investigational
2 If the Insured has valid and collectible insurance, reinsurance or indemnity or any reimbursement agreements covering a loss
also covered by this Policy the insurance afforded by this Policy shall be in excess of and shall not contribute with such
other insurance, reinsurance or indemnity.
3. Expenses incurred by an individual who is not a Participant under the Plan when the expense is incurred.
4. Expenses paid with respect to an employee and his/her dependents who did not enroll in accordance with the terms of the
Plan, until such time as they are enrolled in accordance with the terms of the Plan.
5. Expenses that are incurred prior to the Effective Date of this Policy unless otherwise specified in the Schedule of Insurance.
6. Expenses paid with respect to a Participant following termination of coverage under the Contract with respect to a class of
employees and their dependents that includes the Participant.
7. Benefits paid for expenses incurred for treatment of an illness or injury for which a Participant is entitled to Benefits under
any Workers' Compensation law, occupational disease law or under any other legislation of similar purpose.
8. Expenses paid for Covered Benefits not listed on the Schedule of Insurance.
9. Expenses for taxes, fees and surcharges that may be imposed on the Plan by any government body This exclusion does not
apply to New York Health Care Reform Act surcharges unless they are excess or punitive payments made on behalf of an
Insured to fund indigent care and graduate medical education solely as a result of that Insured's decision not to pay directly
into the New York state pool.
10. Benefits paid with respect to Medicare A retirees over 65 and their Medicare A dependents over 65.
11. Expenses for any other benefits which the Insured and Aetna mutually agree will not be subject to the Stop Loss insurance.
GR-96476 Page 5
Section 6. Conditions
Premiums
The first Policy Year's monthly premium rate is shown in Section 2. Schedule of Insurance
Premium Calculation: An estimated premium will be calculated which will be payable on a monthly basis or any other basis
mutually agreed upon by the Insured and Aetna. The estimated premium will be based on the Premium Rate shown in the
Schedule of Insurance and the estimated number of employees.
Premium Payments: Aetna will issue a Stop Loss premium invoice for the payment of estimated premium. Within 120 days
following the end of each Policy Year, Aetna will prepare and submit to the Insured a financial accounting as to the total actual
premium for that Policy Year. The total actual premium will be the sum of the products, for each month of that Policy Year, of:
(a) the Premium Rate, times
(b) the number of employees.
Grace Period: The Insured will pay all estimated premium payments as directed on the invoice, but no later than 31 days after
the due date shown on the invoice (the grace period).
Right to Recalculate: Aetna reserves the right to make adjustments in the premium rate or the estimated premium on the first
day of any Policy Month, as of the date any of the following events occur:
(a) any change of 10% +/- in the number of employees;
(b) any change in the coverage or types or amounts of benefits offered under the Plan which will change expected cost of
coverage*
(c) any change in this Policy;
(d) any addition or deletion of a unit, division, subsidiary, affiliated or associated company from this Policy; and
(e) any other change in factors bearmg on the risk assumed (including but not limited to: age, sex geographic changes,
occupations etc.) which Aetna determines change the nature of the risk by more than 10%.
Failure to adjust the Premium Rate or the estimated Premium during a Policy Year will not preclude making an adjustment during
any subsequent Policy Year.
If the total actual Premium (determined at the financial accounting) is less than the amount of estimated premiums paid, the
difference will be paid to the Insured at the time the accounting is submitted If the total actual Premium exceeds the amount
paid, the difference will be paid to Aetna within 31 days of the date the accounting is furnished to the Insured
Modification of Policy
Changes in this Policy may be made by written mutual agreement between Aetna and the Insured.
Optional Policy Renewal
The Policy will renew on the Policy anniversary date, upon the Insured's acceptance of the renewal terms, unless it has otherwise
terminated or is subject to termination in accordance with the Termination provisions. Changes to Section 2, Schedule of
Insurance, for each Policy Year after the first shall be indicated in a written notice sent to the Insured and shall be effective on the
date stated in such notice.
GR-96476 Page 6
Stop Loss Payments
Aetna will make payment, not later than 120 days after the end of each Policy Year to or on behalf of the Insured of the Stop Loss
payment due under the terms of this Policy. The amount of any premiums due but unpaid may be deducted from the Stop Loss
payment otherwise payable to the Insured This right will not prevent the termination, of this Policy, for non-payment of
premium under the Termination provisions of this Policy.
Subrogation/Right of Recovery
The Plan is required to include a comprehensive provision for subrogation/reimbursement in its Summary Plan Description and
the Plan must pursue enforcement of this provision Should the Plan fail to pursue any claims or action against a responsible
party then Plan Sponsor agrees that Aetna shall be subrogated to or assigned Plan Sponsor's reimbursement rights and shall
assume the Plan's rights to pursue any claims against any and all parties and the Plan will be responsible for any reasonable
expenses incurred in the pursuit of such claims including the fees and costs charged by any contracted subrogation vendor or
attorney and any additional legal costs. Aetna has the right to pursue any and all claims covered under this Policy and paid by the
Plan and to pursue recovery in the name of the Plan, of the entire claim, including both the portion of the Plan benefits for which
the Plan has been paid under this Policy and the portion of the claim consisting of benefits paid by the Plan but not payable under
this Policy.
The Plan must notify Aetna within 30 days of receiving any information that may give rise to the Aetna's subrogation rights.
Further, the Plan shall cooperate fully with Aetna and do all things necessary and required for Aetna to pursue any action to
recover against a responsible party The Plan may not take any action, or neglect to take any action, that will prejudice or impair
the rights of Aetna to pursue recovery from any other responsible party. The Plan may not, without consent of Aetna, settle or
give release for any claim to any other party if domg so would impair or prevent Aetna from exercising its rights of recovery.
Aetna is entitled to recover first, in full, any amount paid by Aetna under this Policy as well as any expenses of collection
incurred by Aetna, before the Plan shares in any amount so recovered. Aetna will reduce its recovery amount by a pro rata share
to reflect the Net Recovery obtained by the Plan. Net Recovery is the gross amount recovered by the Plan, less such factors as
costs incurred by the Plan in obtaining the recovery, comparative fault issues involving the Plan member or factors involving the
Plan member s inability to fully recover for their injuries. In the event Aetna recovers an amount greater than its reimbursement,
the excess reduced by the costs to obtain the recovery, will be returned to the Plan. If the Plan recovers any such payment from a
responsible party, the recovered amount cannot be used to satisfy any retention requirement Individual Stop Loss Specifications
noted in Section 2. Schedule of Insurance, until Aetna's recovery rights are satisfied.
If the Plan receives a recovery prior to Aetna reimbursing any covered expenses under the Policy, the Plan must deduct the
amount of such recovery from any reimbursement request. If the Plan receives a recovery after Aetna has made payment to the
Plan for some or all of a particular claim, then the Plan must reimburse Aetna to the full extent of the payment by the Aetna, less
a pro rata reduction to reflect the Net Recovery obtained by the Plan. Net Recovery is the gross amount recovered by the Plan,
less such factors as costs incurred by the Plan in obtaining the recovery comparative fault issues involving the Plan member or
factors involving the Plan member's inability to fully recover for their injuries. The obligation of the Plan to reimburse Aetna
remains, regardless of whether this Policy is still in force on the date of recovery and such reimbursement to Aetna must occur
within 30 days of any recovery by the Plan or Plan Sponsor. The Plan shall account to Aetna for all amounts recovered. These
rights and obligations imposed on the Plan and Aetna under this section shall survive termination of the Pohcy.
Stop Loss Overpayments
If Aetna determines that the Insured has been overpaid due to a claim credit which may be the result of a Coordination of Benefit
change, a Subrogation Recovery, Audit and /or billing/payment error, the Insured will promptly refund such overpayment to
Aetna. If this Policy terminates, any reimbursements made for claims paid by the Insured after the date of termination will
immediately be refunded to Aetna. If the Insured fails to refund any overpayments to Aetna in a timely manner, Aetna reserves
the right to obtain such overpayments from future payments due under this Policy.
GR-96476 Page 7
Termination of Policy
Aetna may terminate this Policy on any Policy anniversary date by providmg at least 30 days prior written notice to the Insured.
The Insured may termmate this Policy on any premium due date by providing at least 30 days prior written notice to Aetna. The
Policy may also be terminated on any date mutually agreed to by Aetna and the Insured
If the Insured does not comply with any terms and conditions of the Policy, including but not limited to providing required
reports or other information reasonably requested by Aetna, Aetna reserves the right to terminate the Policy effective on the date
of any such failure.
This Policy shall also terminate automatically upon the occurrence of any of the following:
a. If the Insured fails to pay any premium in full within the Grace Period, this Policy will terminate as of the due date
shown on the invoice.
b If the Contract terminates, this Policy will terminate on the same date and at the same time that the Contract terminates.
c If the Insured fails to meet the underwriting requirements established by Aetna, including but not limited to the
minimum number of 51 Employees, the Policy will terminate as of the first of day of the first month following the date
the underwriting requirement was not met.
d If the Insured fails to pay claims under the Plan or make available funds to pay claims as required by the Plan, the Policy
will terminate on the first day that the Insured failed to fund benefits.
Reports
The Insured shall fumish Aetna with all information Aetna determines to be necessary to carry out the provisions of the Policy.
Inspection and Audit
Aetna shall be permitted to inspect the Insured's records pertainmg to the Contract at any reasonable time during the effectiveness
of this Policy and within three years after termination of this Policy, to the extent that they relate to the premium basis or Eligible
Claim Expenses under this Policy.
Fraud
This entire Policy will be void if, whether before or after a claim or loss, the Insured has concealed or misrepresented any
material fact or circumstance concerning this Policy or the subject of this Policy, including any claim under this Policy, or in any
case of fraud by the Insured relating to this Policy.
Incontestability
The validity of this Policy shall not be contested, except for non-payment of premium, after it has been in force for two years
from the Policy Effective Date.
Liability and Indemnification
Aetna has neither the right nor the obligation under this Policy to directly pay any Participant or provider of covered services for
any benefit the Insured has agreed to provide through the terms of the Plan(s). Aetna's sole liability under this Policy is to the
Insured, subject to the terms, conditions, and limitations of this Policy.
GR-96476 Page 8
Assignment
Assignment of interest under this Policy shall not bind Aetna without its written consent.
Notice of Actions
The Insured agrees to give Aetna prompt notice of any event or development which might result in an action at law or equity
related to this Policy and to forward promptly to Aetna copies of any pleadings and reports of investigation that Aetna requests.
A copy of any document filed by or against the Insured in any court in connection with such litigation under the Plan must
immediately be furnished to Aetna.
The Insured shall pay all attorneys' fees, expenses of experts and investigations, and any damages (including exemplary or
punitive damages) payable by Aetna in connection with any litigation in which Aetna shall, without Aetna's fault, become
involved through or on account of this Policy or the Plan.
If any time limitation in this Policy is less than that permitted by the law of the state in which the Application was taken, the
limitation is hereby extended to agree with the minimum penod permitted by the law.
GR-96476 Page 9
M&C Review
Page 1 of 3
COUNCIL ACTION: Approved on 3/1/2011
Official site of the City of Fort Worth, Tcxas
FORT WORTI I
DATE* 3/1/2011 REFERENCE NO.: C-24759 LOG NAME* 14AETASOSSL2011
NON- PUBLIC
CODE C TYPE: CONSENT HEARING:
NO
SUBJECT: Authorize the Sixth Renewal of an Agreement with Aetna Life Insurance Company for
Administration of the City's Self -Funded Group Health Benefits Program with Estimated
Administrative Fees, Stop Loss Insurance Premiums, and Premiums for the Fully -Funded
Medicare Advantage Plan Totaling $6,150,300.00
RECOMMENDATION:
It is recommended that the City Council authorize the City Manager to execute a sixth renewal of an
Agreement with Aetna Life Insurance Company for the administration of the City' s self -funded group
health benefits program, for the purchase of specific stop Toss insurance coverage, and for the
purchase of the fully -funded Medicare Advantage Plan for the period January 1, 2011, through
December 31, 2011, with a total estimated cost of $6,150,300.00.
DISCUSSION:
The purpose of this M&C is to seek authorization from the City Council to enter into a contract
renewal with Aetna Life Insurance Company (Aetna) encompassing all of calendar year 2011 for
services and products related to the City's health benefits programs. In adopting its Fiscal Year 2011
budget, the City Council approved funds for renewal of this agreement.
Aetna's initial contract that was approved in 2004 did not have a M/WBE goal. Before moving
forward with a request to renew for this fiscal year, staff felt it was critical that a M/WBE goal was
designated for this contract. The negotiations to reach a viable M/WBE goal took longer than
anticipated, with an approval from M/WBE office achieved on January 28, 2011.
The City of Fort Worth's health benefits program is self -funded and utilizes a third party administrator
to process claims. The City's program also employs a financial back stop in the form of third party
specific stop loss insurance, which is used to defray costs when claims are higher than anticipated for
an individual program participant. In the past, the City also purchased aggregate stop loss coverage
for the plan as a whole. After conducting a cost -benefits analysis, Aon Hewitt, the City s benefits
consultant, recommended that the City eliminate the aggregate stop loss coverage, which results in
an annual savings of $94,000 00.
Aetna has served the City as third party administrator and stop loss insurance provider since January
1 2005. On June 22, 2004, (M&C C-20123) the City Council provided initial authorization for the City
Manager to enter into an agreement with Aetna to administer the self -funded group health benefits
program and provide stop loss insurance coverage. The Agreement was for a one year period
covering the year 2005, and included one year renewal options. Renewals were authorized by the
Council for the following periods: January 1, 2006, through December 31 2006 (M&C C-21220);
January 1, 2007, through December 31, 2007 (M&C C-21907); January 1, 2008 through December
31, 2008 (M&C C-22590); January 1, 2009, through December 31, 2009 (M&C G 16402); and
January 1, 2010, through December 31, 2010 (M&C C-24184). This M&C is seeking the City
Council's authority to engage Aetna for a sixth renewal period encompassing the year 2011.
The recommendation to continue the Aetna agreement is based in part on Aetna's performance in
assisting the City to control the costs of the health benefits program, maintaining an acceptable level
of member satisfaction with the program and also based on issues associated with the stabilization of
http://apps.cfwnet.org/council_packet/mc review.asp?ID=14581&councildate=3/1/2011 9/28/2011
M&C Review Page 2 of 3
the Enterprise Resource Planning (ERP) system. In October 2011, staff will submit an M&C
requesting to continue the relationship with Aetna for calendar year 2012 to allow for the
implementation and testing of remaining ERP Phase I modules and to provide for continuation of
service while a new bidding process is conducted and a new agreement is negotiated
City staff anticipates issuing a medical RFP for the City's health benefits program in April 2011, with a
final selection in January 2012, and a recommendation to the City Council in March 2012 for a new
agreement to go into effect beginning with the January 1, 2013 plan year.
Breakdown of Costs — The associated costs include administration fees, federal cost reporting, stop
loss insurance premiums, and Medicare Advantage Plan premiums for calendar year 2011 as
follows:
Administration Fee — Aetna will receive a monthly administrative fee of $38.77 per employee or
retiree who is not eligible for Medicare and $24.53 for each retiree eligible for Medicare There is no
increase in the administrative fee for 2011 During calendar year 2011, the City is expected to pay
Aetna approximately $3,625,420.00 in administrative fees.
Federal Cost Reporting:
1. Medicare Retiree Drug Subsidy (RDS) Reporting.— In 2010 the City paid Aetna $7,500.00 to
provide reports of City prescription costs that are eligible for a partial reimbursement under Medicare
Part D. This reporting service will cost $7 800.00 in 2011.
2. Early Retiree Reinsurance Program (ERRP) Reporting — Aetna will be preparing reports of the
City's benefit costs that are eligible for a partial reimbursement under the federal Early Retiree
Reinsurance Program of the Healthcare Reform Act. The cost for these reports for 2011 is
$8,600.00.
3. Stop Loss Insurance Premium — The City will pay a monthly premium of $22.71 per person for
$400,000.00 in individual stop loss coverage, which equates to a total premium of $1,898,102.00 for
the year
4. Medicare Advantage Plan (fullv-funded) — The Medicare Advantage Plan is an optional insurance
product that Medicare -eligible retirees can enroll in as an alternative to continuing under the City's
self -funded plan. The Medicare Advantage Plan charges a lower co —pay on prescriptions and allows
a retiree to obtain spouse/dependent coverage at a cost that is approximately $50.00 less per month
than under the self -funded plan. For each individual who opts to participate, the City saves about
$67.00 per month compared to the self -funded plan. Enrollment increased 19% (from 84 to 100
retirees) compared to 2010, which equates to a savings to the City of about $80,400.00 during 2011.
Based on current enrollment, premiums for 2011 will not exceed $610,378.00.
Summary of expected charges from Aetna during calendar year 2011:
Administration Fees
Stop Loss Premium
Cost Reports (RDS and ERRP)
Medicare Advantage Plan
Total
Summary of expected charges from Aetna through end of Fiscal Year,
Administration Fees
Stop Loss Premium
Cost Reports (RDS and ERRP)
Medicare Advantage Plan
Total
$3,625,420.00
$1,898,102.00
$16,400.00
$610.378.00
$6,150,300.00
ending September 30, 2011:
$2,719,065.00
$1,423,576.00
$12,300.00
$457.784.00
$4,612,725.00
The amounts listed below reflect anticipated expenses through the end of the current Fiscal Year,
September 30, 2011. Appropriations for anticipated expenses for the remainder of the plan/calendar
year will be requested as part of the Fiscal Year 2012 budget proposal.
M/WBE — Aetna is in compliance with the City's M/WBE requirements by continuing to utilize M/WBE
firms in its discretionary spending consistent with its supplier/diversity program and the City's M/WBE
http://apps.cfwnet.org/council_packet/mc review.asp9ID=14581&councildate=3/1/2011 9/28/2011
M&C Review
Ordinance.
Page 3 of 3
FISCAL INFORMATION/CERTIFICATION,:
The Financial Management Services Director certifies that funds are available in the current operating
budget, as appropriated, of the Group Health Insurance Fund.
TO Fund/Account/Centers FROM Fund/Account/Centers
FE85 534830 0148520 $2.039.299.00
FE85 534840 0148520 $1.195.234.00
FE85 534830 0148540 $692.066.00
FE85 534840 0148540 $228.342.00
FE85 539120 0148540 $457.784.00
Submitted for Citv Manager's Office by: Karen Montgomery (6222)
Originating Department Head: Karen Marshall (7783)
Additional Information Contact:, Margaret Wise (8058)
ATTACHMENTS
http : //app s . c fwn et . o
council packet/mc review.asp?ID=14581&councildate=3/1/2011 9/28/2011