HomeMy WebLinkAboutContract 47336 (2)DECRECEIVED
17 2015
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Voya Itrnployee Benefits
Prepared for:
City of Fort Worth
Effective Date
January 1, 2016
Policy Number
68412-1
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Excess Risk Insurance is issued by ReliaStar Life Insurance Company, a member of the Voya ° family of companies.
R TIRM5NT I INV S rM$ NTS I INSURANC
OFFICIAL RECORD
CITY SECRETARY
(F7: WORm, TX
FINANCIAL
11/17/2015
Renewal offer presented to:
City of Fort Worth
c/o Arthur J. Gallagher & Co.
221 W. 6th Street, Suite 1980
Austin, TX 78701
Renewal effective date
01 /01 /2016
Policy number
68412-1
Dear Justin,
Thank you for your continued business with Voya Employee Benefits. We are pleased to offer the
enclosed renewal for the above client and effective date.
Voya Employee Benefits, a division of ReliaStar Life Insurance Company, is dedicated to providing
innovative products, competitive pricing and exceptional customer service. Our broad product portfolio
is designed to meet a wide range of employer and employee needs. Our client services model puts
local sales and account managers at the forefront of the customer service experience. If we can assist
with any additional products, please contact me at your earliest convenience.
We welcome the opportunity to renew this business with you. Thank you again for your continued
business with Voya Employee Benefits.
Sincerely,
Clifton Browning
Executive Regional Manager
RETIREMENT I INVESTIA NTS I INSURANCE
CC: Jessica Ayala
Account Executive
FINANCIAL
Individual Excess Risk Insurance
Stop Loss Insurance Renewal Offer
City of Fort Worth
684121
Estimated Annual Cost
Stop Loss Insurance Coverages
•
Current Renewal
Plan Effective Date 01 /01 /2015 01 /01 /2016
Coverages Medical, RX Medical, RX
Individual Deductible $1,000,000 $1,000,000
Policy Year Maximum Unlimited Unlimited
Contract Period
Benefit Percentage
Quoted rates include commissions of
Composite
Estimated Annual Cost
% Change From Current
Paid in 12 months and Paid in 12 months and
incurred January 1, 2014 incurred January 1, 2014
or after or after
100% 100%
0.00% 0.00%
Enroll Counts Rates
6,997 $4.57 $4.35
$383,715 $365,243
If not preliminary, please check acceptance box:
PriliR NI NT I INVtSTMLNTS I INSURANCE
.5%
FINANCIAL_
Assumptions:
Renewal As -Of Date: 11/17/2015
Renewal Offer Good Through: 12/21/2015
Situs State TX
Claim Administrator UHC
Network UHC Choice Plus
Retirees Covered Yes Yes
Are retirees age 65 and over covered?
Waived Actively -at -Work
Endorsements:
Plan Mirroring Coordination
Yes Yes
Yes Yes
The individual stop Toss 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.
Authot ize• ignature
Susan Alanis
Print Name
City of Fort Worth
68412-1
01/01/2016
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Assistant City Manager
Title
PROD AS TO FORM AND LEGALITY:
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Excess Risk Insurance is underwritten by ReliaStar Life Insurance Company. Policy form RL-SL-POL-2013 (may
vary by state).
RETIREMENT I INVESTMENTS I INSURANCE
OFFICIAL RECORD
ITY SECRETARY
t WORTH, TX voyA