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HomeMy WebLinkAboutContractSLM-6291 325 RENEWAL PREPARED FOR City of Renton January 1, 2026 Symetra Life Insurance Company First Symetra National Life Insurance Company of New York Symetra Stop Loss IN PARTNERSHIP WITH: GALLAGHER BENEFIT SERVICES INC AGENDA ITEM #1. a) CAG-25-333 Renewal prepared for: City of Renton Symetra Stop Loss Prepared October 17, 2025 458590 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. Whenyourenewwithus,you’llfindaseamlesscontinuationofallthebenefitsyou’vecometo expect from your Symetra stop losspolicy. 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 nearly 50 years, in fact, we helped pioneer it. 1 Our experienced team continues to be available as needed to helpyou understand and protect your self-funded plan. 2024 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. 120 clients that have been with us for over 10 years or longer (as of Jan. 2025). 5 years3 days AGENDA ITEM #1. a) Renewal prepared for: City of Renton Symetra Stop Loss Prepared October 17, 2025 458590 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 January 1, 2024, to January 31, 2025. What does a typical Symetra renewal look like? AGENDA ITEM #1. a) Renewal prepared for: City of Renton Renewal Status: Final if accepted by 11/14/2025 Symetra Stop Loss Prepared October 17, 2025 458590 SPECIFIC STOP LOSS COVERAGE Plan Description Current Option 1 Option 2 Option 3 Pl D i tiCoverages Medical, Rx Medical, Rx Medical, Rx Medical, Rx Contract Type Paid Paid Paid Paid Annual Specific Deductible per Individual $250,000 $250,000 $275,000 $300,000 Transplant Exclusion No No No No No New Laser Option Included Included Included Included Maximum Lifetime Reimbursement Unlimited Unlimited Unlimited Unlimited Maximum Policy Period Reimbursement Unlimited Unlimited Unlimited Unlimited Reimbursement Percentage 100%100%100%100% Quoted Rate(s) Per Month Enrollment Single 270 $57.17 $86.84 $78.62 $69.70 Family 388 $186.27 $278.66 $252.29 $223.68 Composite 658 $133.30 $199.95 $181.02 $160.50 Estimated Annual Premium $1,052,504 $1,578,803 $1,429,391 $1,267,282 Quoted Rate(s) include Commission of 0.00%0.00%0.00%0.00% CASE LEVEL EXPERIENCE REFUND – NET OF COMMISSIONS Plan Description Current Option 1 Option 2 Option 3 Pl D i tiLoss Ratio Threshold 60%60%60% Share Percentage 25%25%25% Payment Cap 15%15%15% AGENDA ITEM #1. a) Renewal prepared for: City of Renton Renewal Status: Final if accepted by 11/14/2025 Symetra Stop Loss Prepared October 17, 2025 458590 AGGREGATE STOP LOSS COVERAGE Plan Description Current Option 1 Option 2 Option 3 Pl D i tiCoverages Medical, Rx Medical, Rx Medical, Rx Medical, Rx Contract Type Paid Paid Paid Paid Aggregate Corridor 200%200%200%200% Loss Limit per Individual $250,000 $250,000 $275,000 $300,000 Maximum Annual Reimbursement $1,000,000 $1,000,000 $1,000,000 $1,000,000 Reimbursement Percentage 100%100%100%100% Estimated Annual Aggregate Deductible $22,875,379 $26,683,430 $26,832,886 $26,994,952 Minimum Aggregate Deductible $20,587,841 $24,015,087 $24,149,597 $24,295,457 Monthly Aggregate Claim Factors Enrollment Medical, Rx Card Single 270 $1,530.44 $1,791.78 $1,801.81 $1,812.70 Family 388 $3,848.10 $4,484.12 $4,509.24 $4,536.47 Composite 658 $2,897.08 $3,379.36 $3,398.29 $3,418.81 Quoted Rate(s) per Month Enrollment Total Composite 658 $1.00 $.00 $.00 $.00 Estimated Annual Premium $1 $1 $1 $1 OVERALL COST SUMMARY Plan Description Current Option 1 Option 2 Option 3 Pl D i tiEstimated Total Annual Fixed Cost $1,052,505 $1,578,804 $1,429,392 $1,267,283 Aggregate Variable $22,875,379 $26,683,430 $26,832,886 $26,994,952 Estimated Maximum Annual Liability $23,927,884 $28,262,234 $28,262,278 $28,262,235 OTHER OPTIONS Rate cap option: Renewal rates are capped at a maximum increase of 50% 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). AGENDA ITEM #1. a) Renewal prepared for: City of Renton Renewal Status: Final if accepted by 11/14/2025 Symetra Stop Loss Prepared October 17, 2025 458590 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. 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. AGENDA ITEM #1. a) Renewal prepared for: City of Renton Renewal Status: Final if accepted by 11/14/2025 Symetra Stop Loss Prepared October 17, 2025 458590 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. This proposal is based on the CURRENT plan of benefits, including any changes communicated to Symetra, and the Blues ASO network. Subsequent changes to the plan design(s) and or networks may result in a change to rates and or factors. Where available, if a policyholder purchases Stop Loss and offers a Symetra Critical Illness plan to its employees, the policyholder may be eligible for our Critical Illness Step-Down Endorsement which provides a one-time, $5,000 reduction to the Stop Loss deductible for a stop loss claim submitted with an eligible critical illness diagnosis. Composite rates are illustrative and for comparative purposes only. In certain states, discounts to the specific stop loss premiums of up to 2% may be available if the group purchases, or has an in force, insured Symetra Workforce Benefits product that may include Group Life, Disability, and/or Supplemental Health insurance. This discount will apply during the first Policy Period that is either commensurate with or immediately following the effective date in which the new Group Life, Disability, and/or Supplemental Health policy becomes effective, or if already in force, the effective date of the Stop Loss Policy. If the Policyholder receives any reimbursement, recovery, discount, or other payment related to gene therapy services, supplies, drugs, or treatments under another plan, coverage, or arrangement, the Policyholder must reimburse Symetra for its share of such payment in accordance with the terms of the policy. Plan must have utilization review and case management. Network fees are excluded expenses under Specific and Aggregate coverages unless specifically state otherwise in the Conditions and Limitations section of this proposal. A current census with the final enrollment, not older than 60 days prior to the effective date, must be received by Symetra at least 14 days prior to the coverage effective date. The terms and conditions contained in this proposal are subject to change in the event the aforementioned census indicates a change of more than 10% from the enrollment contained in this proposal. In order to provide a firm quote, Symetra will need updated carrier documented large claims, monthly paid claims, and enrollment (medical, prescription, dental, etc.) as of 09/30/2025 to finalize the offer. Symetra is unable to make a decision on large claimants until updated data is received, and medical review completed. Information to complete disclosure review is required and includes: diagnosis, treatment received, current status, expected treatment and amount paid during the experience period as of the effective date of coverage. Large claimant data used for disclosure cannot be more than 30 days old. Disclosure pertains to: Any claimant on an Organ Transplant list Any claimant with a serious medical condition Any claimant in the open year that has exceeded, or regardless of the amount currently paid is expected to exceed the lesser of $30,000 or 50% of the specific deductible Employees absent from work due to disability and any dependents, retirees or COBRA beneficiaries who are hospital confined Please provide details on any individual who has been hospital confined for 30 days or more in the most recent 12 AGENDA ITEM #1. a) Renewal prepared for: City of Renton Renewal Status: Final if accepted by 11/14/2025 Symetra Stop Loss Prepared October 17, 2025 458590 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 terms of the stop loss policy. For inclusion of prescription drug (RX) coverage under the specific and/or aggregate coverage(s) 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 stop loss policy. Eligibility is assumed to be all full-time employees working 30 hours or more per week at their normal place of business. If aforementioned is not accurate, we reserve the right to modify the terms and conditions or withdraw this proposal entirely. COBRA participation enrollment growth to more than 10% of the entire enrolled group will be deemed to be a material change under the policy. In addition to the Qualifications and Contingencies contained in this proposal, this offer will be subject to Symetra's standard stop loss policy provisions, limitations, and exclusions. No producer has the authority to bind or modify the terms or conditions of this proposal without the approval of Symetra. If the policy is terminated prior to the end of the policy period, the policy will not provide coverage for run out claims. Network Access, Capitation, ACA Reinsurance, GME, Government pool surcharges or assessment fees or other fees are not eligible claim expenses under the Stop Loss policy. Additionally, this quote/renewal excludes state assessment fees and is based the group (through its TPA) collecting any such fee assessed with respect to the group's self-insured benefit plan and remitting such fee assessed 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 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. This proposal is based on data and information (data) provided to us on behalf of the prospective policyholder as part of the Request for Proposal/Renewal. Symetra does not independently verify such data but assumes its completeness and accuracy as represented by the provider thereof. Disclosure information requested in prior proposal(s) not provided that has an adverse impact to Symetra will be considered material change. To the extent that the data upon which Symetra relied in preparing this proposal contains errors and omissions that can materially alter the risk or the pricing of such risk, Symetra reserves the right to withdraw the proposal or alter the terms of the proposal. Symetra reserves the right to revise the terms and conditions of this proposal if the current administrator's claims backlog exceeds two weeks. The producer must be properly licensed and appointed in accordance with any applicable state regulations in order for any compensation to be paid, if applicable and in order for any policy to be issued. The administrator must be approved by Symetra prior to the issuance of the policy. Subject to no material changes to the health plan, there will be no new lasers at renewal. Only claims up to the Annual Specific Deductible per Individual will accumulate toward the Annual Aggregate Deductible. The Loss Limit per Individual shown in the Aggregate Stop Loss Coverage section of this proposal applies to all coverage listed within that section regardless of what is in the Specific Stop Loss Coverage section. An updated census will be needed to finalize our offer AGENDA ITEM #1. a) Renewal prepared for: City of Renton Renewal Status: Final if accepted by 11/14/2025 Symetra Stop Loss Prepared October 17, 2025 458590 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 2 $275,000 / Paid $275,000 / Paid 3 $300,000 / Paid $300,000 / 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: AGENDA ITEM #1. a) 11/13/2025 MayorArmondo Pavone City of Renton Attest:________________________________________________ Jason Seth, City Clerk Renewal prepared for: City of Renton Symetra Stop Loss Prepared October 17, 2025 458590 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. AGENDA ITEM #1. a) Renewal prepared for: City of Renton Symetra Stop Loss Prepared October 17, 2025 458590 Your partner for stop loss success www.symetra.com www.symetra.com/ny Symetra®isaregisteredservicemarkof SymetraLifeInsuranceCompany. 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 February 26, 2025. 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. 149 years for Symetra Life Insurance Company as of 2024; 21 years for First Symetra National Life Insurance Company of New York as of 2024. 2 Performance highlights based on financial and quarterly audits for 2024. 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. AGENDA ITEM #1. a)