HomeMy WebLinkAboutContract 60637CSC No. 60637
PartnerRe
Excess Loss Insurance Application
PartnerRe America Insurance Company
Wilmington, DE
NAIC# 11835
Mailing Address:
6900 Wedgwood Road, Suite 120
Maple Grove, MN 55311
612 234 4920
The Applicant hereby applies for the Excess Loss Insurance Policy.
1. POLICYHOLDER: City of Fort Worth
Principal Address: 200 Texas Street
Fort Worth, TX 76102
Are subsidiary or associated entities to be included? ❑ Yes ® No
2. POLICY PERIOD: Effective Date: January 01, 2024
Termination Date: January 01, 2025
3. POLICYHOLDER INFORMATION:
i. Standard Industrial Classification (SIC): 9111
ii. ❑ Corporation ❑ Partnership ❑ Sole Proprietorship
❑ Labor Union ® Other
If other, please specify: Government
iii. Nature of Policyholder's Business: General Government
4. CLAIM ADMINISTRATOR: Meritain
Type of Coverage: Medical
Address: 300 Corporate Parkway
Amherst, NY 14226
CLAIM ADMINISTRATOR:
Type of Coverage:
Address:
Optum Rx
Rx
2300 Main Street
Irvine, CA 92614
❑ MEWA
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
ESL-APP-200-US-2021 Page 1 of 3 Issue Date: 10/25/2023
5. EXCESS LOSS INSURANCE:
a. Specific Excess Loss Insurance: ® Yes ❑ No
i. Specific Deductible: $1,000,000 per Covered Person
Covered Persons subject to an Adjusted Specific Deductible: Member ID#: PRECIT-
0124-01 at $1,800,000
ii. Coverage Period:
Eligible Expenses Incurred from January 01, 2022 through January 01, 2025 and
Paid from January 01, 2024 through January 01, 2025
b. Aggregate Excess Loss Insurance: ❑ Yes ❑ No
6. The following endorsement(s) are elected:
® Yes ❑ No Specific Advanced Funding Endorsement
The coverage afforded by this Application is based upon the Excess Loss Quotation dated
October 25, 2023 attached hereto, incorporated herein, and is conditioned upon receipt, review
and acceptance by PartnerRe America Insurance Company ("PartnerRe"), on or before November
8, 2023, of all outstanding information as detailed in Special Notations section of the quotation.
Additional underwriting adjustments, including changes to terms, premium or specific deductibles
on certain individuals, may be required.
I, the undersigned, understand and agree that:
This Application is based upon claim details, enrollment, eligibility, Benefit Plan and other
information provided by Applicant to PartnerRe. Any known material change in such information
must be reported to and agreed upon by PartnerRe prior to coverage becoming effective.
The coverage afforded by this Application is to be effective from 12:01 A.M. standard time on the
Effective Date stated above at the Policyholder's address, provided the first month's premium is
paid in full and that the Claim Disclosure Statement and this Application are accepted and
approved by PartnerRe. The coverage afforded by this Application is subject to all terms and
conditions of the Policy in current use by PartnerRe. This Application and Claim Disclosure
Statement will become a part of the Policy when issued.
This Application assumes the Producer/Agent of Record is duly licensed as required by law and
has been appointed with PartnerRe America Insurance Company in the state in which the
Policyholder is located and the Policy is to be delivered.
By signing this Application and the Claim Disclosure Statement, the Applicant represents that all
statements, answers and information provided to PartnerRe are complete and true to the best of
its knowledge. Applicant further acknowledges and agrees (i) that such statements, answers and
information provided and in the Claim Disclosure Statement, together with a copy of the Benefit
Plan and other information attached to this Application or furnished to PartnerRe, are submitted
by the Applicant as an inducement to and will be relied upon by PartnerRe in underwriting this risk
ESL-APP-200-US-2021 Page 2 of 3 Issue Date: 10/25/2023
and determining whether to accept this Application and issue the policy being applied for; (ii) if
such statements, answers and information is/are incomplete or untrue and such incompleteness
or falsity is material to the risk to be insured by PartnerRe, any policy issued by PartnerRe may
be rescinded and/or any benefits that might otherwise be payable thereunder may be denied; and
(iii) the Applicant has fully read and understands this completed Application and the Claim
Disclosure Statement.
I hereby agree to the terms as stated above and warrant that I am duly authorized to execute this
acceptance:
Applicant Signed By:
Its Corporate Officer or Authorized Representative
Assistant City Manager
Title
Accepted by PartnerRe America Insurance Company:
mortt 4p,r►,a a e,n,
Signature U
Senior Group Underwriter
Title
Dec 22, 2023
Date
75-6000528
FEIN#
12/18/2023
Date
INSURANCE FRAUD WARNING
Any person who with intent to defraud or knowing that he/she is facilitating a fraud against
an insurer, submits an application or files a claim containing a false or deceptive statement,
or conceals information for the purpose of misleading, is guilty of insurance fraud and is
subject to criminal and/or civil penalties.
ESL-APP-200-US-2021 Page 3 of 3 Issue Date: 10/25/2023
Proposal
City of Fort Worth Adam Nelson
Stealth Partner Group adam.nelson@partnerre.com,
Matthew Janssen
Effective: 01 /01 /2024
matthew.janssen@partnerre.com,
partnerre.com/risk-solutions/health
10/25/2023, Quotation 4 City of Fort Worth
Cornerstones of our ESL Value Proposition
"Our team offers a unique customer experience, combining personalized
`small town' warmth with `big city' capabilities and expertise."
Ease of doing business
Smooth customer journey
Ongoing education & insights
• We believe true partnerships are built on
trust and straight -forward
communication
• We provide direct access to the breadth
and depth of our expertise
• We ensure a seamless onboarding
process by providing active guidance
and support
• We deliver on our promises, offering an
efficient claim handling process
• Our PULSE + Plus° team offers
complementary services customized to
each employer group to achieve the
best clinical and financial outcomes
10/25/2023, Quotation 4 City of Fort Worth 2
Financial Quote
SPECIFIC STOP LOSS COVERAGE
Annual Specific Deductible per Individual $ 1,000,000
Except for
PRECIT-0124-01 $ 1,800,000
Plan Benefits Included Medical, Rx Card
Coverage Period 36/12
Specific Lifetime Maximum Unlimited
Specific Annual Maximum Unlimited
Specific Advancement Included
Quoted Rate(s) Per Month Enrollment
Composite 5,927 $ 11.20
Estimated Annual Premium $ 796,589
Commission % 0.00 %
10/25/2023, Quotation 4 City of Fort Worth 3
PROPOSAL QUALIFICATIONS AND CONTINGENCIES
1. This quote is subject to the completion and signature of the application.
2. For inclusion of prescription drug (Rx) coverage under the Specific and/or Aggregate coverage(s) when there is a
separate PBM, PartnerRe requires written documentation for underwriting purposes that all Rx experience reports
have been received. Otherwise, Rx will not be a covered expense under the Stop Loss Policy. PartnerRe is not
responsible for aggregating medical and Rx claims data during quotation or Policy coverage periods.
3. All claim reporting submitted from the selected Administrator should be provided to PartnerRe in a sortable
Microsoft Excel format throughout the Policy and Proof of Loss Periods. Failure to do so could result in a delay of
claim reimbursements.
4. Actively at Work is waived with receipt and acceptance of the PartnerRe Claim Disclosure Statement.
5. This quote assumes that the Agent/Broker is operating under the appropriate license in which the risk is domiciled.
The Agent/Broker license and appointment with PartnerRe will be required prior to binding coverage.
6. The statements herein may vary from the final Policy wording. The final Policy wording along with the Excess Loss
Insurance Application and Claims Disclosure Statement shall govern over any inconsistency with the wording
herein.
7. This quote is subject to the verification and approval of the Policyholder by PartnerRe through the economic and
trade sanction watch lists enforced by the Office of Foreign Assets and Control (OFAC).
8. TPA: Meritain Network: Aetna PPO.
9. Pre 65 Retiree coverage is included.
10. Indication based on Retirees over 65 are Medicare Primary.
11. Contract:36/12
10/25/2023, Quotation 4 City of Fort Worth
OPTIONS SUMMARY
PROPOSAL ACCEPTANCE PROCEDURES
Please check next to the selected proposal option:
❑ 1 $ 1,000,000 36/12 $ 0 $ 796,589 ❑ 1 $ 0 $ 0
10/25/2023, Quotation 4 City of Fort Worth
About Us
PartnerRe
Key Facts and Figures
• Founded in 1993, headquartered in
Bermuda
• Privately owned by Covea since July 2022
• When engaging with our partners we live
by our values:
• Integrity
• Performance
• Straightforward Communication
• Collaboration
• Respect & Care
PartnerRe US Health
We are a financially strong leader with a
focus on exceptional partner relationships.
• Direct writer of Employer Stop Loss
business for 25+ years
• Broad and deep industry experience
across all U.S. Health market segments,
including HMO Reinsurance, Medical
Excess Reinsurance, and Provider Excess
Financial Strength Ratings
A+ A+ Al
A.M. Best S&P Moody's
Total Capital
$7.5bn
Gross Premium Written in 2021
$8.2bn
As at September 30, 2022
Gross Written Premiums
$350+ Million
Clients
350+
Experience of ESL Underwriters
(average)
20+ Years
As of December 31. 2021
10/25/2023, Quotation 4 City of Fort Worth 6
partnerre.com
ACCEPTED AND AGREED:
CITY:
City of Fort Worth
By �t
Name: Jesica McEachern
Title: Assistant City Manager
Date: Dec 22, 2023
Approval Recommended:
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ByH.11y H Moyer (AS 202315 23 CST)
Name: Holly H Moyer
Title: Assistant Human Resources Director
Attest:
By: A
Name: Jannette S. Goodall
Title: City Secretary
VENDOR:
By:
Name:
Title:
Date:
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Contract Compliance Manager:
By signing I acknowledge that I am the person
responsible for the monitoring and administration
of this contract, including ensuring all
performance and reporting requirements.
By: 9'—'"w
Name: Joanne Hinton
Title: Benefits Manager
Approved as to Form and Legality:
uL
By: /
Name: Jessika J. Williams
Title: Assistant City Attorney
Contract Authorization:
M&C: 23-1047
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
12/18/23, 2:38 PM M&C Review
Official site of the City of Fort Worth, Texas
CITY COUNCIL AGENDA FflR
Create New From This M&C
DATE: 12/12/2023 REFERENCE **M&C 23- LOG NAME: 14STOPLOSS2024
NO.: 1047
CODE: C TYPE: CONSENT PUBLIC NO
HEARING:
SUBJECT: (ALL) Authorize Execution of Agreement with PartnerRe America Insurance Company in
an Amount Not to Exceed $850,000.00 for Stop Loss Insurance for the City of Fort
Worth's Health Benefits Plan with an Effective Date of January 1, 2024 for a One Year
Term
RECOMMENDATION:
It is recommended that the City Council authorize the execution of an agreement with PartnerRe
America Insurance Company in an amount not to exceed $850,000.00 for Stop Loss Insurance for
the City of Fort Worth's Health Benefits Plan with an effective date of January 1, 2024 for a one year
term.
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 PartnerRe America Insurance Company, for Stop Loss
Insurance for the City of Fort Worth's (City) Health Benefits Plan for 2024.
If approved, effective January 1, 2024, PartnerRe America Insurance Company
would provide specific stop loss coverage for the City's self -insured health plan. 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 $1 million per -participant threshold at a cost of $11.20 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. In 2023, the City's Healthcare Plan had three members exceed the $1 million
in claims cost and will be receiving stop -loss payments which will help offset the increased stop -loss
cost for Fiscal Year 2024.
The City's benefits consultant, IMA, conducted a Request for Proposal and PartnerRe America
Insurance Company was selected due to cost and experience in the stop loss industry.
DVIN: Insurance is an exception to bidding per the Law Department, therefore the business equity
goal requirement is not applicable.
Funding is budgeted in the HR Retired Employee Insurance and HR Active Employee Insurance
Departments within the Group Health Insurance and Retiree Healthcare Trust Funds, as
appropriated. Funding for the balance of terms of these contracts will be requested as part of the
Fiscal Year 2025 budget process.
FISCAL INFORMATION/CERTIFICATION:
The Director of Finance certifies that upon approval of the recommendation, funds are available in the
current operating budget, as previously appropriated, in the Group Health Insurance and Retiree
Healthcare Trust Funds. Prior to an expenditure being incurred, the Human Resources
Department has the responsibility to validate the availability of funds.
TO
Fund Department Account Project Program Activity Budget Reference # Amount
ID ID Year (Chartfield 2)
apps.cfwnet.org/counci I_packet/mc_review.asp? I D=31672&counci ldate=12/12/2023 1 /2
12/18/23, 2:38 PM
M&C Review
FROM
Fund Department Account Project Program Activity Budget Reference # Amount
ID ID I Year (Chartfield 2)
Submitted for City Manager's Office by_ Jesica L. McEachern (5804)
Originating Department Head: Dianna Giordano (7783)
Additional Information Contact:
ATTACHMENTS
,(Dept.) Request for Waiver of Business Equity Goal -2021 Ston Loss Request 11.13.2023 signed byDVIN.p. f (CFW
Internal)
14Stop Loss 2024.docx (CFW Internal)
PartnerRe Form 1295 Certificate 101129335 - City of Fort Worth 2023.pdf (CFW Internal)
Stop Loss PartnerRe America Insurance Company FID Table 2024.pdf (CFW Internal)
apps.cfwnet.org/counci I_packet/mc_review.asp? I D=31672&counci ddate=12/12/2023 2/2