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HomeMy WebLinkAboutContractSLM-6291 7/23 RENEWAL PREPARED FOR City of Renton January 1, 2024 Symetra Life Insurance Company First Symetra National Life Insurance Company of New York Symetra Stop Loss IN PARTNERSHIP WITH: GALLAGHER BENEFIT SERVICES INC CAG-23-385 Renewal prepared for: City of Renton Symetra Stop Loss Prepared August 31, 2023 344608 6 days 99.9% You have challenges; we have solutions We know you have options when choosing a stop loss carrier. We also know that finding the right partner is important. You need to work with professionals who understand the self-funded industry, who realize the importance of building the right stop loss policy at the right price, and who deliver on their promises year after year. When you renew with us, you’ll find a seamless continuation of all the benefits you’ve come to expect from your Symetra stop loss policy. Things like: •Fast and fair claims practices. •Most catastrophic claims reviewed and processed within 48 hours through our Preferred ASO Claim Advance program. •Gapless option for renewal run-out contracts means claims paid outside the run-out period are still eligible for reimbursement. •No new lasers or increase on existing lasers at renewal; laser at renewal available by request. •Cost containment and alternative treatment plans to help control costs without sacrificing quality of care. •24/7 online policy administration via Group Online (GO). Put our expertise to work for you Symetra has been in the stop loss business for over 45 years, in fact, we helped pioneer it.1 Our experienced team continues to be available as needed to help you understand and protect your self-funded plan. 2022 performance highlights:2 Most claims paid within 6 business days Contract amendments average just 3 business days Claims financial accuracy score The average tenure of a Symetra stop loss client is five years, with approx. 100 clients that have been with us for over 10 years or longer (as of April 2022). 5 years3 days Renewal prepared for: City of Renton Symetra Stop Loss Prepared August 31, 2023 344608 Option 1 – keeping the same deductible at renewal Plan year 1 Plan year 2 Increase Paid claim amount $300,000 $330,000 10% Specific deductible $150,000 $150,000 0% Symetra reimbursement $150,000 $180,000 20% Option 2 – raising the deductible at renewal Plan year 1 Plan year 2 Increase Paid claim amount $300,000 $330,000 10% Specific deductible $150,000 $165,000 10% Symetra reimbursement $150,000 $165,000 10% Understanding stop loss rates Pricing stop loss is a complex process and there are many factors that impact rates, especially at renewal. Here are some things we consider when determining the best possible price for your plan: Plan design: what services are covered; how much are employee copays, coinsurance, deductibles and/or premiums; are there wellness or other value-add programs included? Group population: how many people are covered; where do members live and/or receive care; what are the demographics of the group? Managed care networks: are provider and hospital networks helping to lower plan risk; what is the network usage rate? Claims experience: what is the claims experience history; how many claims, to date, are over the Specific deductible; how many are expected before the end of the plan year? Medical trend: how much are health care costs projected to increase? Share of risk: what is your deductible threshold and risk tolerance; how will rising medical trend impact your plan and the accompanying stop loss policy? Lowering premium renewal increases through deductible leveraging Annual renewal is an opportunity to review how your plan performed over the past year, and to evaluate whether your current Specific deductible is still appropriate. This is especially true when rising medical costs are paired with higher than expected claims, as this combination typically means a rate adjustment is needed for the new plan year. Leveraged trend or, as applied, deductible leveraging, can help mitigate higher renewal rates by sharing the impact of medical trend between the health plan and Symetra stop loss via a higher Specific deductible. Here’s how it works: For illustrative purposes only. With deductible leveraging, you’re trading lower premiums for a higher Specific deductible due to medical trend increases. It can be an effective way to help control the impact of rising costs on your plan. If you’re interested in deductible leveraging for your renewal, talk with your Symetra stop loss professional. Based on Symetra renewal data from June 1, 2022, to May 31, 2023. What does a typical Symetra renewal look like? During the last five years: Renewal prepared for: City of Renton Renewal Status: Final if accepted by 09/15/2023 Symetra Stop Loss Prepared August 31, 2023 344608 SPECIFIC STOP LOSS COVERAGE Plan Description Current Option 1 Plan DescriptionCoverages Medical, Rx Medical, Rx Contract Type Paid Paid Annual Specific Deductible per Individual $250,000 $250,000 Transplant Exclusion No No No New Laser Option Included Included Maximum Lifetime Reimbursement Unlimited Unlimited Maximum Policy Period Reimbursement Unlimited Unlimited Reimbursement Percentage 100%100% Quoted Rate(s) Per Month Enrollment Single 269 $53.04 $53.04 Family 376 $170.44 $170.44 Composite 645 $121.48 $121.48 Estimated Annual Premium $940,238 $940,238 Quoted Rate(s) include Commission of 0.00%0.00% Renewal prepared for: City of Renton Renewal Status: Final if accepted by 09/15/2023 Symetra Stop Loss Prepared August 31, 2023 344608 AGGREGATE STOP LOSS COVERAGE Plan Description Current Option 1 Plan DescriptionCoverages Medical, Rx Medical, Rx Contract Type Paid Paid Aggregate Corridor 200%200% Loss Limit per Individual $250,000 $250,000 Maximum Annual Reimbursement $1,000,000 $1,000,000 Reimbursement Percentage 100%100% Estimated Annual Aggregate Deductible $22,302,888 $22,302,888 Minimum Aggregate Deductible $20,072,599 $20,072,599 Monthly Aggregate Claim Factors Enrollment Medical, Rx Card Single 269 $1,530.44 $1,530.44 Family 376 $3,848.10 $3,848.10 Composite 645 $2,881.51 $2,881.51 Quoted Rate(s) per Month Enrollment Composite 645 $.00 $.00 Estimated Annual Premium $0 $1 OVERALL COST SUMMARY Plan Description Current Option 1 Plan DescriptionEstimated Total Annual Fixed Cost $940,239 $940,239 Aggregate Variable $22,302,888 $22,302,888 Estimated Maximum Annual Liability $23,243,127 $23,243,127 OTHER OPTIONS Rate cap option: Renewal rates are capped at a maximum increase of 60%% assuming no material changes to the group plan have taken place (i.e. plan changes, changes in specific deductible, commission level or administrator). If there are material changes, first the specific rates will be produced using the rate cap, then material changes will be accounted for in order to arrive at the renewal rate level. The cap applies to both the rates and aggregating specific deductible (if applicable). Renewal prepared for: City of Renton Renewal Status: Final if accepted by 09/15/2023 Symetra Stop Loss Prepared August 31, 2023 344608 PROPOSAL QUALIFICATIONS AND CONTINGENCIES The terms of this proposal are based upon the policyholder having exercised commercially reasonable efforts to obtain and provide to Symetra all information set forth in this offer, together with all information identified in any prior proposal for coverage for the upcoming policy period. Except for the Plan Document or Plan Amendment, all requested information must be received no later than 15 days prior to the proposed effective date of coverage, otherwise we reserve the right to withdraw the proposed terms and return any premiums remitted. Any secondary documents (e.g. “stop loss agreements”, “procurement documents”, “service contracts”, etc.) must be disclosed to and approved by Symetra prior to the Employer’s acceptance of our proposal. Subsequent undisclosed agreements may not be approved. By delivering this proposal for coverage, the producer represents and warrants to Symetra that it and each of the persons or entities acting with or on behalf of the producer in the sale or solicitation of such coverage maintains such insurance producer licenses and appointments as are required by each state in which the coverage has been or will be solicited, and in all states in which the policy(ies) will be issued. This proposal is authorized for delivery only if the foregoing representation and warranty is true and correct. This is a firm offer, which may be bound with no additional underwriting requirements provided that: 1. It is accepted in writing by the expiration date as shown above; 2. The policyholder has exercised commercially reasonable efforts to obtain and provide to Symetra all information requested in this proposal and any prior proposal for coverage for the upcoming policy period; 3. The data and information submitted to Symetra is, to the best of the policyholder’s knowledge after due inquiry, materially accurate and materially complete as of the date of policyholder’s written acceptance of this firm offer. Any material inaccuracies or material omissions in the data or other information submitted may require changes in underwriting, including but not limited to changes in the terms, rates and/or factors; and 4. The policyholder and its authorized agent agree that following acceptance of this firm offer, the policyholder or its authorized agent promptly notify Symetra upon becoming aware of any covered individual who (i) receives prior authorization approval for hospital confinement exceeding 30 days or more and/or (ii) becomes a listed transplant candidate, in each case so that Symetra can initiate appropriate cost containment efforts. For the avoidance of doubt, the provision of such notice pursuant to this item 4. will not change terms of the accepted offer. If updated information is received by Symetra prior to written acceptance or the expiration date has passed, we retain the right to alter the terms, rates and/or factors. We will not be bound by any typographical errors or omissions contained herein. PRELIMINARY RENEWAL OFFER Updated carrier documented large claims as well as monthly paid claims and enrollment (medical, prescription, dental, etc.) as of 09/30/23 are needed to finalize the offer. Please provide details on any individual who has been hospital confined for 30 days or more in the most recent 12 months or is on an organ transplant list. Any unfunded or pended claims balance must be disclosed, otherwise such claims will not be considered eligible under the excess loss policy. This proposal is based upon the following network(s): Blues ASO Composite rates are illustrative and for comparative purposes only. There will be no new lasers at renewal. For inclusion of RX coverage under the specific and/or aggregate when there is a separate PBM, we require written documentation that we are in receipt of all prescription drug experience reports. Otherwise, RX will not be a covered expense under the excess loss policy. The loss limit shown in the aggregate excess loss section of the proposal applies to all coverage listed within that section regardless of what is in the individual excess loss section. Only claims up to the individual case level deductible will accumulate toward the aggregate attachment point This renewal/proposal reflects the continuation of the current plan of benefits. This quote is subject to Symetra's stop loss policy provisions, limitations and exclusions. This quote/renewal excludes state assessment fees and is based on the group (through its TPA) collecting any such fee assessed with respect to the group's self-insured benefit plan and remitting such fee to the state on the group's behalf. The group may be required to notify their TPA of any covered residents that would fall under an assessment program. Symetra's quote excludes coverage of such fees. In the event Symetra is required to be involved in the Renewal prepared for: City of Renton Renewal Status: Final if accepted by 09/15/2023 Symetra Stop Loss Prepared August 31, 2023 344608 administration or collection of an assessment fee on the group's behalf, the assessment fee will be charged to and collected monthly from the group pursuant to the Premium Taxes and State Assessments provision of the Stop Loss Insurance Policy. Renewal prepared for: City of Renton Renewal Status: Final if accepted by 09/15/2023 Symetra Stop Loss Prepared August 31, 2023 344608 Check the box next to the selected proposal option; for Specific only coverage, when both Specific and Aggregate coverages are listed, please also check the box to decline Aggregate coverage. Option Specific Aggregate 1 $250,000 / Paid $250,000 / Paid Decline Aggregate coverage This is a firm offer, which may be bound with no additional underwriting requirements provided it is accepted in writing by the expiration date as shown above. The Premium, Aggregate Deductibles and all other terms are based on the data submitted. Any inaccurate or incomplete data submitted may require changes in underwriting. If updated information is received by Symetra prior to written acceptance or the expiration date has passed, we retain the right to alter the terms, rates and/or factors. We will not be bound by any typographical errors or omissions contained herein. Please indicate your acceptance on this offer by having an authorized representative or agent of City of Renton sign below: Authorized Signature:Date: Printed Name:Printed Title: Company or Firm Name: Mayor Armondo Pavone 10-24-2023 Mayor City of Renton Attest: Jason A. Seth, City Clerk Renewal prepared for: City of Renton Symetra Stop Loss Prepared August 31, 2023 344608 Plan Sponsor’s Plan Document Submission and Symetra Acceptance Required. As stated in Symetra’s Proposal for Group Stop Loss Insurance, the Plan Sponsor’s Plan Document must be submitted to Symetra no later than 90 days after the proposed effective date of Stop Loss Insurance coverage. The Stop Loss Insurance policy (“Policy”) requires that only eligible charges payable under the terms of the Plan Document as approved by Symetra will be covered expenses eligible for reimbursement under the Policy. The policy will be issued after the Plan Document is received and approved by Symetra or a signed Confirmation of Medical Benefit Plan is submitted to Symetra by the prospective policyholder. Symetra may withhold reimbursement of covered expenses prior to the receipt and acceptance of the final signed Plan Sponsor’s Plan Document or amendment. In reviewing the Plan Document for acceptance, Symetra will consider whether the Plan Document: 1.Adequately addresses key plan components, including but not limited to eligibility rules, benefits promised, plan administration, discretionary language for court review of benefit claims, subrogation and coordination of benefits provisions. 2.Addresses the Plan’s obligations under federal law, including a.ERISA (Employee Retirement Income Security Act) required provisions, b.ACA (Affordable Care Act) required provisions; or c.a statement of grandfathered status, if applicable. Symetra will have no liability for reimbursing Plan Sponsor obligations that are not clearly stated in the Plan Document whether or not the Plan remains obligated in the absence of express inclusion. It is recommended that the Plan Document include express reference to other federal mandates and laws to which Plan is subject or a “conformity with law” provision. 3.Contains typical exclusions or limitations, including but not limited to: a.Experimental/investigations treatment (except as required by ACA), and b.non-medically necessary treatment The absence of or inadequate treatment of these subjects in the Plan Document may result in a superseding provision in the Stop Loss policy. Renewal prepared for: City of Renton Symetra Stop Loss Prepared August 31, 2023 344608 Your partner for stop loss success www.symetra.com www.symetra.com/ny Symetra® is a registered service mark of Symetra Life Insurance Company. Financial Strength Ratings: A.M. Best: A “Excellent” (3rd highest of 16); Moody’s A1 “Good” (5th highest of 21); Standard & Poor’s: A “Strong” (6th highest of 21). Ratings are subject to change. Please refer to www.symetra.com/ratings for current information. Ratings as of April 1, 2023. Symetra Life Insurance Company (est. 1957) is a direct subsidiary of Symetra Financial Corporation. First Symetra National Life Insurance Company of New York (est. 1990) is a direct subsidiary of Symetra Life Insurance Company and is an indirect subsidiary of Symetra Financial Corporation (collectively, “Symetra”). Neither Symetra Financial Corporation nor Symetra Life Insurance Company solicits business in the state of New York and they are not authorized to do so. Each company is responsible for its own financial obligations. Stop loss policies are insured by Symetra Life Insurance Company, 777 108th Avenue NE, Suite 1200, Bellevue, WA 98004. Base policy is ELC-24000 7/19. In New York, stop loss policies are insured by First Symetra National Life Insurance Company of New York, New York, NY. Mailing address: P.O. Box 34690, Seattle, WA 98124. Policy form number is ELC-24000/NY 7/19. Coverage may be subject to exclusions, limitations, reductions and termination of benefit provisions. Products are not available in any U.S. territory. 145 years for Symetra Life Insurance Company; 18 years for First Symetra National Life Insurance Company of New York as of 2021. 2 Performance highlights based on financial and quarterly audits for 2022. Symetra is a financially strong, well-capitalized company on the rise, as symbolized by our brand icon—the swift. Swifts are quick, hardworking and nimble—everything we aspire to be when serving our customers. We’ve been in business for more than half a century with a commitment to creating employee benefits products that people need and understand. We appreciate your business and look forward to the opportunity to continue serving you with professional, informative and responsive service. Our guiding principles of Value, Transparency and Sustainability (VTS) are at the core of all we do. •Value: Products and solutions people need at a competitive price—backed by outstanding customer service. •Transparency: Clear communication so people understand what they are buying. •Sustainability: Products that stand the test of time and fiscal responsibility to ensure we are there for our customers.