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Agenda 09/23/2014 Item #16E 39/23/2014 16.E.3. EXECUTIVE SUMMARY Recommendation to self fund the Group Dental Insurance program and amend Agreement 11 -5729, "Third Party Administrator for Health Benefits" with Allegiance Benefit Plan Management, Inc. to provide claims administration services for a two year period effective January 1, 2015, at an estimated annual cost of $58,509. OBJECTIVE: To administer the Board's Group Dental Insurance Plan in an efficient, cost effective manner. CONSIDERATIONS: The Board of Commissioners through the Risk Management Department administers a Group Dental Insurance program for the County Manager's agency and participating Constitutional Officers. Coverage is provided by Cigna Dental Plan, Inc., under a fully insured arrangement. The current multi -year rate guarantee will end on January 1, 2015. Staff requested renewal proposals through the County's contracted benefits brokerage and actuarial firm, Willis, Inc. Three firms provided proposals. The proposed premium is as follows: Carrier Estimated Premium Increase in Dollars Increase % Cigna $1,547,590 $80,670 5.5% Guardian $1,564,456 $97,539 6.6% Reliance $1,613,516 $146,596 10.0% Cigna proposed a 5.5% rate increase which equates to a premium increase of $80,670. The increase is due, in part, to a 1.75% premium tax imposed upon insurance carriers under the Affordable Care Act. Staff requested that Willis analyze the option of self funding as an alternative. The use of self funding allows the employer to avoid the payment of premium taxes as well as the carrier's profit margin. Further, the cost of self funding dental insurance is quite predictable. Willis completed the analysis and determined that self- funding will reduce overall plan costs by 1.27% compared to 2014 rates. Staff also requested that Willis seek self- funded administrative services only (ASO) proposals from interested firms. Willis sought proposals from six firms. Four firms provided proposals. They are Cigna, Delta Dental, Guardian and Allegiance Benefit Plan Management. Each firm has access to a local preferred provider network of dentists. Price quotes were as follows, based upon estimated enrollment of 1,773 employees. Carrier 2015 Cost Rate Guarantee Cigna $58,509 Rate increases 2.9% r 2 and 2.8% r 3 Delta Dental $56,381 3 year rate guarantee Guardian $59,573 2 year rate guarantee Allegiance $58,509 3 year rate guarantee Willis also performed a disruption analysis of the PPO dental networks utilized by each firm in order to determine the potential negative impact on members that might result from losing their dentist. Willis determined that the existing Cigna network utilized by both Cigna and Allegiance, presented no disruption to members; offered the largest number of dentists in network; and the Packet Page -3039- 9/23/2014 16.E.3. highest percentage of dentists using the standard of "2 general dentists within 10 miles" of each zip code. Staff further determined that utilizing Allegiance to manage dental claims will provide additional ancillary benefits to members and staff. Claims administration can be automatically coordinated with members existing flex accounts to allow for automatic reimbursement. Coordination of Benefits delays between the dental plan and group health plan will be improved. Monthly electronic enrollment census transmission between the County's SAP system and Allegiance is already in place which will eliminate additional programming costs. Finally, banking arrangements and financial controls needed to service the program are already in place with Allegiance. A single ID card will suffice for both health and dental claims. Based upon the price quotes presented, the rate guarantee, the favorable disruption analysis, and the ancillary benefits of the Allegiance proposal, staff is recommending that a self funded dental program be implemented utilizing Allegiance Benefit Plan Management, Inc. as the claims administrator. The schedule of benefits under the plan will not change nor will the provider network. FISCAL IMPACT: The estimated annual cost of claims administration services in calendar year 2015 based upon average enrollment of 1,773 employees is $58,509. The estimated paid claims cost for calendar year 2015 is $1,443,853. Thus, the total estimated savings from self funding is $45,228 when compared to the Cigna renewal quote. Sufficient funds are available within Fund 517, Group Health and Life Insurance for this purchase and payment of claims. GROWTH MANAGEMENT IMPACT: There is no growth management impact associated with this item. LEGAL CONSIDERATIONS: This item is approved as to form and legality, and requires majority vote for Board approval. —SRT RECOMMENDATION: That the Board authorizes staff to move to a self funded Group Dental Insurance program, approves an Amendment to the Agreement 11 -5729, "Third Party Administrator for Health Benefits with Allegiance Benefit Plan Management, Inc. to provide Group Dental Insurance claims administration services for a two year period effective January 1, 2015, and authorizes the Chairman to sign the Amendment. PREPARED BY: Jeffrey A. Walker, CPCU, ARM, Director, Risk Management Attachment: Amendment #2 to Agreement 11 -5729 Packet Page -3040- 9/23/2014 16.E.3. COLLIER COUNTY Board of County Commissioners Item Number: 16.16.E.16.E.3. Item Summary: Recommendation to self fund the Group Dental Insurance program and amend Agreement 11 -5729, "Third Party Administrator for Health Benefits" with Allegiance Benefit Plan Management, Inc. to provide claims administration services for a two year period effective January 1, 2015, at an estimated annual cost of $58,509. Meeting Date: 9/23/2014 Prepared By Name: WalkerJeff Title: Director - Risk Management, Risk Management 8/27/2014 9:39:31 AM Submitted by Title: Director - Risk Management, Risk Management Name: WalkerJeff 8/27/2014 9:39:32 AM Approved By Name: pochopinpat Title: Administrative Assistant, Administrative Services Division Date: 8/28/2014 8:21:27 AM Name: MarkiewiczJoanne Title: Director - Purchasing/General Services, Purchasing & General Services Date: 8/29/2014 7:57:15 AM Name: TeachScott Title: Deputy County Attorney, County Attorney Date: 8/29/2014 8:56:29 AM Name: PriceLen Title: Administrator - Administrative Services, Administrative Services Division Date: 9/8/2014 4:46:43 PM Packet Page -3041- Name: KlatzkowJeff Title: County Attorney, Date: 9/10/2014 3:02:08 PM 9/23/2014 16.E.3. Name: KimbleSherry Title: Management/Budget Analyst, Senior, Office of Management & Budget Date: 9/12/2014 5:12:48 PM Name: OchsLeo Title: County Manager, County Managers Office Date: 9/15/2014 10:27:21 AM Packet Page -3042- 9/23/2014 16.E.3. EXHIBIT A -2 Contract Amendment #2 to Contract #11 -5729 "Third Party Administrator for Health Benefits" This amendment, dated , 2014 to the referenced agreement shall be by and between the parties to the original Agreement, Collier County Government (to be referred to as "the Plan Sponsor") and Allegiance Benefit Plan Management, Inc., (to be referred to as "the TPA "). Statement of Understanding RE: Contract # 11 -5729 "Third Party Administrator for Health Benefits" In order to continue the services provided for in the original contract document referenced above, the TPA agrees to amend the Contract by replacing in its entirety Appendix A, I Fee Schedule and R Funding and Fee Payment Terms with the attached Exhibit A2 -A and is hereby made an integral part of this Amendment. This amendment will be effective on January 1, 2015 and will run concurrently with Contract #11 -5729. All other terms and conditions of the agreement shall remain in force. IN WITNESS WHEREOF, the parties have each, respectively, by an authorized person or agent, have executed this Amendment on the date(s) indicated below. Dwight E. Brock, Clerk ffiv Accepted: . 2014 THE PLAN SPONSOR: BOARD OF COUNTY COMMISSIONERS OF COLLIER COUNTY, FLORIDA By: Deputy Clerk Tom Henning, Chairman TPA's First Witness: THE TPA: Allegiance Benefit Plan Management, Inc. By: Print Name TPA's Second Witness: By: Print Name Approved as to Form and Legality: Scott R. Teach, Deputy County Attorney 0 Print Name and Title Packet Page -3043- 9/23/2014 16.E.3. EXHIBIT A2 -A Amendment #2 to Contract #11 -5729 "Third Party Administrator for Health Benefits" 1 Fee Schedule The Plan Sponsor and the TPA hereby agree to the compensation schedules set forth below as being the sole compensation to the TPA for the performance of its obligations under this Agreement. Monthly fees are based upon Plan Participant enrollment as of the beginning of each month. A. Administration fees are guaranteed from January 1, 2012 through December 31, 2016, as follows: CCHCC Member 2012 2013 2014 2015 1 2016 Collier County Government $15.50 $15.50 $15.97 $16.44 1 $16.94 The above fees shall include services for production and maintenance of Plan Documents/Summary Plan Description, plan building, amendment production, plan document compliance, and HIPAA compliance, regulatory compliance (if applicable) and production and mailing via bulk mail to the Plan Sponsor of health plan identification cards, and all of the following services that are checked: X Medical Claims X Vision Claims X PPO Management and Provider Network Coordination X Predictive Modeling Disease Management Data Extracts X Consolidated Billing X COBRA services and HIPAA Certificates of Creditable Coverage, provided by Allegiance COBRA Services, Inc. pursuant to the COBRA Administrative Services and Certification of Creditable Coverage Agreement Appendix C, attached hereto. (In addition to this fee, the TPA will also retain two (2) percent of all COBRA premiums as fees for COBRA services.) X any administrative fees charged by the Pharmacy Benefit Management (PBM) company that is utilized by the Plan Distribution of plan materials will be delivered to the Plan Sponsor. An additional postage and handling fee will be paid to the TPA for mailing materials to individual Plan Participants, except for Welcome Packets and identification cards.. B. Dental claims processing services of $2.75 per Employee per Month. A pass through fee paid by Plan Sponsor for Medical Identification Card reprint required by adding dental benefits based upon TPA's Cost MEDICAL ASA MED STD SNGL EMP ALLEGIANCE BENEFIT PLAN MANAGEMENT, INC. Page 1 of 4 REV. 2D11 -2 (6.11) Packet Page -3044- 9/23/2014 16.E.3. C. Run Out Fees: Run Out services shall be based upon a separate run out agreement executed at the time Run Out is requested. However, the fees therefore shall be calculated as follows: There shall be a single fee payable in advance, equal to three (3) times the administration fee paid for the month immediately preceding the date Run Out Services are requested to process claims for a twelve (12) month period beginning January 1, 2012 and ending December 31, 2012. D. Hourly fee of $125.00 for welfare plan consulting. Such services must be agreed to in advance by the Plan Sponsor. E. Hourly fee of $125.00 for stop-loss reimbursement services, audit assistance services and any other services provided by the TPA after termination of this Agreement and in the absence of a separate Run-Out Services Agreement F. Hourly fee of $125.00 for special programming requests or research including production of any special claims history reports. Such services must be agreed to in advance by the Plan Sponsor. G. Special Reports requested by the Plan Sponsor and produced by the TPA upon prior agreement as to report(s) and fee(s), if any. H. Final fee of $500.00 for forwarding magnet diskette of eligibility/enrollment file in DBC or ASCII format to the Plan Sponsor (if requested). I. Final fee of $1,500.00 for forwarding magnetic diskette of Claims history file in DBC or ASCII format to the Plan Sponsor (if requested). J. Check customization, customized printed material, special statistical reports other than those enumerated in this contract, special medical underwriting, new taxes assessed against the Plan, or other services mutually agreed upon will be billed separately at the rate of $125.00 per hour for such services. Such services must be agreed to in advance by the Plan Sponsor. K. A fee equal to the actual costs for printing Summary Plan Description Booklets, together with costs of shipping for each booklet L. A fee of $125.00 per hour for time expended producing and providing information to agents, consultants or brokers for whom the Plan Sponsor requests Plan information be provided, together with any postage, shipping and copying costs. Paper copies will be billed at fifteen ($.15) cents per copy and electronic copies shall be billed at $500.00 per disk in DBC or ASCII format only. MEDICAL ASA MED STD SNGL EMP ALLEGIANCE BENEFIT PLAN MANAGEMENT, INC. Page 2 of 4 REV. 2011 -2 (611) 0.1 Packet Page -3045- 9/23/2014 16.E.3. M. PPO access fees for any PPO organization or claim negotiation company that assesses a per Plan Participant fee, a per Claim fee, or a percentage of claims savings fees not to exceed twenty-five (25 %) percent of the actual savings amount between the charges billed by the Health Care Provider and the discounted amount agreed to between the PPO or Claims Negotiation Company and the Health Care Provider, except for those entities specifically listed below, for which no service fee applies. The amount charged under this Agreement shall be equal to the amount charged by the PPO or Claims Negotiation Company. The TPA, its parents or its affiliates, may be paid a service fee by the PPO for claim repricing or other administrative services associated with the claims discount or negotiation. The Plan Sponsor will receive a report that outlines the total billed charges, the total discounts obtained, the net claims cost and the total claim savings to the Plan. Any additional fee in excess of this amount must be approved in advance by the Plan Sponsor. The TPA may be paid a fee not to exceed twenty -five (25 %) percent of net savings payable to TPA, its parent or its affiliates, realized as a result of any negotiation or reduction in the amount of claims paid or any recovered funds obtained by TPA through employment of cost containment companies. Specific fees at the inception of this contract for which a per Participant per month rate is charged are: $ -0- per Plan Participant per month for Community Health Partners PHO The network access fee for the Cigna PPA network is $5.50 PPPM N. Funds held in accounts by TPA, until paid out for benefits, may accrue interest The interest accrued will be retained by TPA as reasonable compensation and fees for fees assessed on the accounts, for paper, printing and postage, record keeping and account reconciliation, bank service fees, trust tax return preparation; and SAS 70 and related trust activities audit fees. MEDICAL ASA ALLEGIANCE BENEFIT PLAN MANAGEMENT, INC. Page 3 of 4 Packet Page -3046- MED STD SNGL EMP REV. 2011 -2 (6.11) 9 9/23/2014 16.E.3. if Funding and Fee Payment Terns Plan Sponsor will establish and maintain a zero balance Claims Payment Account for payment and reimbursement of Covered Services. TPA will notify Plan Sponsor or its designee on a weekly basis of amount required to be deposited to the Claims Payment Account to pay claims after they have been processed for payment Notification of the amount required to be deposited will take place as follows: On Monday of each week (Tuesday, if Monday coincides with a recognized Federal holiday), an electronic notification will be provided to Plan Sponsor that the weekly report of claims processed for payment is available on TPA's secured website. Upon approval from Plan Sponsor, TPA will release the claims checks issued for the batch approved for that week. . TPA will generate a monthly bill for fees. Payment of monthly billing will be as follows: On or about the 25th of each month, TPA will provide an electronic notification to Plan Sponsor that the monthly bill is available on TPA's secured website. Upon approval from Plan Sponsor, TPA will effect an electronic withdrawal of funds from an account designated by Plan Sponsor on the Debit Authorization Form. MEDICAL ASA MED STD SNGL EMP ALLEGIANCE BENEFIT PLAN MANAGEMENT, INC. Page 4 of 4 REV. 2011 -2 (6-11) Packet Page -3047- fb J WaF 0 0 'AZ N ID r zs 0 0 Co 2 Co cc m 9/23/2014 16.E.3. Packet Page -3048- a� WE LL Q L ._.! w O J U D D W W v w 2 c� O Cn J Q F- Z W G N C O C O U .O C R N E d E- C N G Z Z Z Z O O O O U U U U W W W W Cn Cn N N Packet Page -3049- 9/23/2014 16.E.3. cn (li :D C) 0 CD kw 1 Lj < a- 0 < Lli D Pa :ket Page -3050- 9/23/2014 16.E.3. vi 7F- 'D 'D "D 'D "D "0 a) a) CD a) a) a) p 2 2 2 2 P 0. CL CL a OL OL • • < Q Q < CD Z z z z co z • z z z z z z • z z z z < < z z z z z z • -0 (1) U) 0 0 cn 0 U) < < Cl) < < < — a U- • co 0- a) co is a) a) C) 0 5: C) 0 0 6 6 6 .2 E :3 a =3 0 a 0 a) 0 0 C -6 0 :3 4 'A NN-W"2 N, Er CDO I-Ki Ag, c, ,L N low Pa :ket Page -3050- 9/23/2014 16.E.3. vi 7F- Cn: :W W� � U"d $.. .,.,.. 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