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Home My WebLink AboutContract CAG-1 9-320 01 HMA CLIENT INTENT & EXHIBIT A SCHEDULE OF FEES For City of Renton 4034/5034 1/1/2020 through 12/31/2020 Renewal Account Information 1 a Group Name: City of Renton 4034/5034 Group#(s): #4034/5034 Group Size: 656 Employees Network: HMA Contract Period:1 year 1,567 Members Enrollment Web Open Enrollment: Open Enrollment Period: Type: Changes Only Broker(firm): USI Insurance Services LLC 11/1/2019- 11/30/2019 Seattle Contact Info Name Phone# Email Broker Mark Esteb (206)676-7447 Mark.esteb@usi.com Contact: Broker Tony Ciez (206)577-5592 Tony.Ciez@usi.com Contact: Broker Kassie Radwick (206)577-6825 Kassie.radwick@usi.com Contact: Acct. Cole Harrison (425)-289-5236 cole.harrison@accesstpa.com Manager HMA Client Intent&TPA Exhibit A-City of Renton 4034/5034 Page 2 of 8 Locations Check the box to the left of locations you wish to remove or change. ❑ ACT(Active) ❑ COBR (COBRA) ❑ Benefit Information and Change Requests Medical Benefits Please review and indicate desired changes. If you have changes for more than 6 plans,attach a list to your email when you send this form back to(Brand). If you don't need changes to any of the below benefit levels,skip to the next section. Preferred (P) Participating (N) Out-of-network(M) 4034A 4034ACTIVE Deductible NONE I NONE NONE CHANGES(if any): Out-of-pocket $500 Individual $500 Individual $500 Individual maximum $875 Family $875 Family $875 Family CHANGES(if any): Copay Doctor's $30 Co-Pay $30 Co-Pay $30 Co-Pay Office Visit Paid 100% Paid 100% Paid 100% CHANGES(if any): Apply all co-pays to OOPM&remove co-pay for In-Network Preventive Care Preferred(P) Participating (N) Out-of-network(M) 5034LR 5034LEOFFI Deductible 1 NONE i NONE i NONE CHANGES(if any): j L Out-of-pocket N/A N/A N/A maximum CHANGES(if any): Copay-Doctor's Paid 100% Paid 100% Paid 100% Office Visit CHANGES(if any): 9/25/2019 HMA Client Intent&TPA Exhibit A-City of Renton 4034/5034 Page 3 of 8 Vendors Below are the vendors you contract with. Indicate any changes in the textboxes in the right column. Current Vendor Specify changes Care Navigator HMA Terminate 12/31/19 CDHP* N/A COBRA HMA Dental HMA Dialysis N/A Fiduciary City of Renton Maternity N/A PBM Costco Health Solutions StopLoss Symetra Telehealth MDLive Vision Hardware HMA *Consumer-driven Health Plan(CDHP),e.g.HRA,FSA,etc Fees Rates for the contracted time period apply to services administered by HMA. Fees for outside vendors are subject to change at any time. HMA fees and commissions may remain in effect beyond the above-stated term until changed by mutual written agreement of the parties. Claim Administrative Fees Fee Description $22.80 PEPM for Medical Plan Administration Includes Pharmacy Interface +Integrated OOP Maximum/QHDHP Administration If all documents are signed and returned by 11/1/2019,the new PEPM with discount (-$0.20)will be$22.60 Paid direct- USI/ Broker Commission Fee payable to USI Insurance Services LLC-Seattle City of Renton $3.75 PEPM Care Management Base Services 30%of savings Claims Negotiation,Hospital Bill Audit,and Out-of-Network Claim Re-pricing Services as outlined in TPA Agreement Section 4 27%of Recovered Subrogation Services as outlined in Section 4(k)of Exhibit B Funds The plan will receive 73%of recovered funds. Of the remaining,22%is retained by PHIA, and 5%is retained by HMA.* * In the event of litigation to enforce the Plan's right of recovery, PHIA's fee will increase to 33.3%and shall not retain any compensation. 10-18%of recovered Overpayment Prevention&Recovery as outlined in Section 4(k)of Exhibit B amount charged as o 16%-18%recovery fee retained by Accent* contingency fee o 10%of savings identified via COB Smart 9/25/2019 HMA Client Intent&TPA Exhibit A-City of Renton 4034/5034 Page 4 of 8 30%of savings Fraud,Waste,and Abuse as outlined in Section 4(k)of Exhibit B charged as o 17.5%of savings retained by Change Healthcare Solutions contingency fee o 12.5%administrative allowance retained by HMA * Note,the contingency fee charged by Accent varies based on the age of the underlying claim. In no instance will the total fee to the Plan exceed 20%of the amount recovered. Additional Services Review the below services and indicate desired changes. No changes?No need to indicate anything! � I Current 0 I Q Service Description&Cost $3.25 PEPM ❑ ® $3.25 PEPM for Dental Plan Administration $1.50 PEPM ❑ V $1.50 PEPM for HMA National Dental Network Access (In addition to the Dental Plan Administration fees) $0.65 PEPM ❑ r $0.65 PEPM Vision Hardware Administration $1.35 PEPM COBRA Services(Select those you want to add) ❑ ® Medical/Rx $1.35 PEPM ❑ ® Vision ❑ ® Dental ❑ ❑ FSA administered by HMA HealthEquity ❑ I ❑ Flexible Spending Account(FSA)administration $500 annual fee Annual fee invoiced through HealthEquity Employer Portal. $3.95 Per Account Per Month(PAPM) Visa card: Up to 2 FREE and additional or replacement cards at$10 per card ***FSA and HRA are purchased only,l fee applies at$3.95 PAPM ❑ ❑ Limited Purpose FSA(LPFSA)administration $500 annual fee Annual fee invoiced through HealthEquity Employer Portal. $1.95 Per Account Per Month(PAPM) Visa card: Up to 3 FREE and additional or replacement cards at$5 per card (No set-up fees) ***Limited Purpose FSA(LPFSA)can be added only with HSA offering. ❑ ❑ Health Reimbursement Account(HRA)administration $500 annual fee Annual fee invoiced through HealthEquity Employer Portal. $3.95 Per Account Per Month(PAPM) Visa card: Up to 2 FREE and additional or replacement cards at$10 per card 1***FSA and HRA are purchased only,l fee applies at$3.95 PAPM 9/25/2019 HMA Client Intent&TPA Exhibit A-City of Renton 4034/5034 Page 5 of 8 ❑ ❑ Health Savings Account(HSA)administration $500 annual fee (invoiced through HealthEquity Employer Portal) $2.70 Per Account Per Month (PAPM) Visa card: Up to 3 FREE and additional or replacement cards at$5 per card (No set-up fees) ❑ ❑ $2.00 PEPM The Plan-Appointed Claim Evaluator"PACE"Fiduciary Service ❑ ❑ $1.50 PEPM-Healthcare Bluebook and the cost of the Go Green to Get Green Rewards ❑ Program. Rewards are $25- $100 per service. ❑ $2.00 PEPM- Healthcare Bluebook, Doctor Quality,and the cost of the Go Green to Get Green Rewards Program. MDLive Telehealth: ❑ ❑ $1.60 PEPM Medical plus Behavioral Health(BH)and Dermatology + $38/visit fee for Medical/Dermatology l+ $80-$260/visit consulting fee for Behavioral Health ❑ ❑ $1.35 PEPM Medical plus Behavioral Health + $38/visit fee for Medical + $80-$260/visit consulting fee for Behavioral Health ❑ ❑ $1.30 PEPM Medical plus Dermatology + $38/visit $1.00 PEPM ❑ ® $1.00 PEPM Medical Only+ $38/visit ❑ $1.50 PEPM-Care Navigator ❑ C $6.50 PEPM-Disease Management,Wellness Hub&Wellness Coaching * Incorporates $1.00 PEPM discount for buying all three services in a bundle. ❑ ❑ $4.40 PEPM- Disease Management&Wellness Hub The Disease Management program includes nurse coaching and outreach for six major chronic conditions—diabetes, asthma, coronary artery disease (CAD), congestive heart failure (CHF),chronic obstructive pulmonary disease (COPD)and hypertension along with the Wellness Hub features listed above. ❑ [ $3.50 PEPM- Disease Management— Includes nurse coaching and outreach for six major chronic conditions—diabetes, asthma, coronary artery disease (CAD), congestive heart failure(CHF),chronic obstructive pulmonary disease (COPD)and depression. ❑ ❑ i$1.50 PEPM-Wellness Hub- includes a personal health assessment, individual and company challenges, fitness device and app integration, health decision support tools, and a customizable wellness incentive tracker. ❑ ❑ $2.50 PEPM-Wellness Coaching-Includes unlimited inbound health coaching via phone, ,email or video conferencing for working on wellness goals such as stress management, tobacco cessation,eating healthier and being more physically active. ❑ ❑ Incentive Administration - In addition to the Wellness Hub full incentive administration support for outcomes-based incentives is available.This includes complete administration of customized incentive campaign, including design,creation, management,tracking and reporting is available. 5 Hours are included. Additional hours are available for$125/hr. 9/25/2019 HMA Client Intent&TPA Exhibit A-City of Renton 4034/5034 Page 6 of 8 ❑ ❑ $350.00 Per Case-Maternity Program ❑ ❑ $0.65 PEPM- 24 Hour Nurse Line ❑ ❑ $2.00 PEPM-Consolidated Billing-Option 1-with Premium Remittance and NO Eligibility Administration ❑ ❑ Consolidated Billing-Option 2-with Premium Remittance and Eligibility Administration $3.00 PEPM and$0.50 PEPM for any vendor(s)other than WDS,Willamette Dental Group or VSP ID recard fee-$2.00 per employee (Incidental reissue no cost) Excess Less Services In compensation for the work that HMA does to support excess loss carriers, HMA receives an administrative allowance of 2.5%from most of our preferred carriers. If you are using a non-preferred carrier,there will be an interface fee of 3.0%of excess loss premium that is assessed to the group in lieu of the administrative allowance.These excess loss fees will be reflected on the invoice on a PEPM basis. HMA reserves the right to decline to work with non-preferred excess loss carriers. If we agree to administer a plan with an excess loss carrier that is not preferred,we will charge an interface fee of 3.0%of excess loss premium and will ask for a signed waiver of liability from the group. For carriers where we are not an approved benefit administrator, HMA reserves the right to decline to proceed with the approval process at our discretion. For new groups,the interface fee for non-preferred carriers is based on the carriers projected enrollment and premium rates. For renewing groups,the interface fee for non-preferred carriers is calculated based on the final stop loss renewal premium rates and enrollment for the last month of the prior contract period. The rates are calculated as follows: [.03 x(single Specific Stop Loss Premium Rate x single enrollment)+(family Specific Stop Loss Premium Rate x family enrollment)+(Aggregate Stop Loss Premium Rate x total enrollment)]/_Total Enrollment ❑I've read and accept the above terms regarding Excess Loss Services. Other Comments Please use the below section to include other notes or comments. • RENEWAL with HMA ACCEPTED Accept the proposed renewal of 2.5%, but remove Care Navigator, $1.50 PEPM • DENTAL PLAN UPDATES: Increase Calendar Year Benefit Max from $1,800 to $2,000 Increase Type III Services from 50%to 80% Increase Ortho from $1,250 to $2,000 Change OON from 100%/100%/50%to 80%/80%/50% • VISION PLAN UPDATES: Cover Eye Exam at 100% and do not apply towards benefit maximum Cover Eye Exam every year(currently every other year) Add Laser Surgery$1,000 per eye lifetime benefit The $650 hardware benefit that is currently available every two years will continue, and can be used towards Laser Surgery or for hardware such as glasses or contacts. 9/25/2019 HMA Client Intent&TPA Exhibit A-City of Renton 4034/5034 Page 7 of 8 • MEDICAL PLAN UPDATES: Maintaining Grandfather Status (NOT increasing the OOP Max) Apply all copays to out of pocket max& remove copay for in-network preventive care Change mental health coverage from 50%to 100% Add Fertility Benefits at$20,000 Lifetime Max at 100%/Ensure male fertility is included. This benefit is for employee and spouse only. See pages 9&10 below for requested SPD language updates to Eligibility. 9/25/2019 DocuSign Envelope ID:CEB0666D-0181-4FC7-B043-3A2E40DE846E HMA Client Intent&TPA Exhibit A-City of Renton 4034/5034 Page 8 of 8 I Acceptance IN WITNESS WHEREOF,the parties have caused this Agreement to be executed by their duly authorized representatives on the respective dates set forth below,effective as of the day and year first above written. ' Note,the contingency fee charged by Accent varies based on the age of the underlying claim. In no Instance will the total fee to the Plan exceed 20%of the amount recovered. By: City of Renton 4034/5034 By: Healthcare Management Administrators ; c4r,tic) �DocuSIgned by: X XL Sabl RarriS \—EE4575688AF346B... Lindsay Harris • Name: I Dent 5 Lc ' Name: 1ch1ef Growth officer Title: I I ,a 01� Title: i Date: Click or tap to enter a date. Date: itw mob.et;A'crnn j t7:52 AM PST Attest A r f� *�.�� It �r,a. J: ,n .Seth,C ,City Clerk 4A 1., 1 5 * ' SEAL : * : yC� �'i `,A`��q ' . ? /�� , //4„°RATED5Ep�6�'`,� 9/25/2019 Agenda item 4e2 Current Plan Document Language ELIGIBILITY AND ENROLLMENT PROVISIONS ELIGIBILITY Employee Eligibility You are defined as an employee if you are an individual who is: (1) directly involved in the regular business of and compensated for services by the City of Renton; (2) regularly scheduled to work at least the minimum number of hours, as indicated below, on an active,full-time basis; or(3)you are an individual listed below who is eligible for coverage. You are eligible for coverage under this Plan if: You are an active full-time or part-time employee of City of Renton who is regularly scheduled to work 20 hours or more per week. If you are an active regular employee, you are entitled to coverage on a pro-rated basis depending on your scheduled weekly hours of work in accordance with the following accrual rate ratio: • 20 but less than 25 hours-50% • 25 but less than 30 hours-62.5% • 30 but less than 35 hours-75% • 35 hours or more- 100% If you are a regular full-time employee, you and your dependents are eligible for full coverage. If you are a regular part-time employee covered by the City of Renton Employee Health Care Plan as of 12/31/92, you are eligible to receive either full medical and/or dental benefits for yourself only. Effective 1/1/93, if you are a regular part-time employee scheduled to work 20 hours or more per week, you can elect to pay a pro-rated portion of the full premium for employee only.The dollar amount paid for the medical package and/or dental package is based on the number of hours worked. The percentage of the total premium the employee pays for themselves is listed on the rate sheet. Employee must pay the full premium amount for any dependent coverage. You are ineligible if, regardless of the number of hours worked,you are:a part-time employee regularly scheduled to work less than 20 hours per week, a seasonal employee or a temporary employee per City policy. Page 13 Agenda Item 4e2 Proposed Plan Document Language ELIGIBILITY AND ENROLLMENT PROVISIONS ELIGIBILITY Employee Eligibility You are defined as an employee if you are an individual who is: (1) directly involved in the regular business of and compensated for services by the City of Renton; (2) regularly scheduled to work at least the minimum number of hours, as indicated below, on an active,full-time basis; or(3)you are an individual listed below who is eligible for coverage. You are eligible for coverage under this Plan if: You are an active, regular full-time or part-time employee of City of Renton who is regularly scheduled to work 20 hours or more per week. If you are an active, regular full-time employee, scheduled to work 35 hours or more a week, you and your dependents are eligible for full coverage. If you are an active, regular part-time employee, scheduled to work at least 20, but less than 35 hours a week, you are eligible for full coverage for yourself only. Your dependents are eligible for coverage with a pro-rated portion of the premiums covered by the City. If you elect to cover your dependents, you must pay the remainder of the premiums not covered by the City. Prorated coverage for dependents of part-time employees is based on scheduled weekly hours of work in accordance with the following accrual rate ratio: • 20 but less than 25 hours- 50% • 25 but less than 30 hours-62.5% • 30 but less than 35 hours- 75% • 35 hours or more- 100% You are ineligible if, regardless of the number of hours worked,you are:a part-time employee regularly scheduled to work less than 20 hours per week, a seasonal employee or a temporary employee per City policy. Page 14 Proving What's Possiale in Healthcare +4,1mA ..,,,,,, ,, Vociccl Ac ministrEtive RenewEl City of Renton Agent /Brokerage: Mark Esteb &Tony Ciez 1 USI Quote Assumes an Effective Date of: January 1, 2020 Fees Based On: 654 Total Employees 911 Total Dependent Units =ase Medical Administration Fees Current Renewal Renewal Option Medical Plan Administration $22.25 $22.80 $22.80 HMA Preferred with PHCS National Network Access $5.50 $5.50 $5.50 Care Management-Preauthorization,Large Case Management and Managed Behavioral Health Services $3.75 $3.75 $3.75 I Claim Bank Account Reconciliation Included Included Included Plan Documents(SPD and SBC) Included Included Included PBM Administration' included included included Stop Loss Administration Included Included Included Total Base Administration $31.50 $32.05 $32.05 Early Renewal Confirmation Credit A..lies if si.ned renewal documents are.rovided b 11/1 ($0.20) ($0.20) ($0.20) •dditional Services PEPM Fee PEPM Fee PEPM Fee Dental Administration $3.25 $3.25 $3.25 Dental PPO Network Access $1.50 $1.50 $1.50 Vision Hardware Administration $0.65 $0.65 $0.65 Flexible Spending Account F S A N/A N/A N/A Health Reimbursement Account H R A N/A N/A N/A Health Savings Account H S A N/A N/A N/A COBRA Administration $1.35 $1.35 $1.35 Consolidated Billing N/A N/A N/A Fiduciary Service N/A N/A N/A Care Navigator $1.50 $1.50 N/A Wellness Hub N/A N/A N/A Wellness Hub with Wellness Coaching N/A N/A N/A Disease Management with Wellness Hub N/A N/A N/A Disease Management N/A N/A N/A 24 Hour Nurse Line N/A N/A N/A MD Live with Medical plus Behavioral Health and Dermatology N/A Available 1/1/20 NEW N/A MD Live with Medical and Behavioral Health N/A N/A N/A MD Live with Medical and Dermatology Available 1/1/20 NEW N/A N/A MD Live Medical Only $1.00 $1.00 $1.00 Healthcare Bluebook plus Doctor Quality Available 1/1/20 NEW N/A N/A Healthcare Bluebook N/A N/A N/A Total Additional Services $9.25 $9.25 $7.75 Grand Total Admin Fee $40.55 $41.10 $39.60 Active Plan(4034)estimated expense '561 employees: Monthly- $22,748.55 $22,215.60 Yearly- $272,982.60 $266,587.20 Retiree Plan(5034)estimated expense "84 Retirees Monthly- $3,406.20 $3,326.40 Yearly- $40,874.40 $39,916.80 "Enrollment count as of 9/18/2019 4