Agenda 12/11/2012 Item #16E 71100�
12/11/2012 item 16.E.7.
EXECUTIVE" rux T
Recommendation to approve the purchase of Group Health Reinsurance coverage for
calendar year 2013 in the amount of $672,290, a rate increase of 14.6 %.
OBJECTIVE: To protect the Group Health Fund from catastrophic losses through the purchase of
group health reinsurance coverage.
CONSIDERATIONS: The Board of Commissioners through its Risk Management Department
administers a partially self - funded Group Health Insurance Program (the Plan) for its employees and
their eligible dependents. Group Health reinsurance coverage, also known as "Stop Loss," is
purchased to protect the Plan against adverse loss experience. Two types of reinsurance coverage
are available. Specific excess insurance protects the Plan if a covered member incurs claims cost in
excess of a "per member' deductible. Aggregate excess insurance provides coverage to the Plan if
total losses exceed an aggregate deductible for the Plan. Currently, the. County purchases specific
excess insurance through Zurich Insurance Company with a specific deductible of $325,000 per
member. The specific excess coverage provides an unlimited maximum lifetime benefit per covered
member. Aggregate excess coverage is not purchased. Coverage expires on January 1, 2013.
Willis, Inc., the County's benefits brokerage and actuarial firm, marketed the health reinsurance
program on behalf of the County. Specific retention levels (deductibles) ranging from $325,000 per
claimant to $400,000 per claimant were sought. Proposals were sought from seventeen carriers. Five
carriers provided proposals.
Rate increases accompanied by coverage terms and limitations were proposed by each carrier. Rate
increases at the $325,000 deductible level ranged from 10.9% to_71.6 %. This is due to several large
losses related to members currently under treatment which are expected to continue into 2013.
Further, separate deductibles (a /k/a "lasers ") were proposed by several carriers on a few covered
members in addition to an increase in the rate.
Willis completed an actuarial analysis to determine which proposal presents best value. Willis
recommends that the County select a proposal from SunLife Insurance with a specific deductible of
$325,000 per member. This proposal contains a rate increase of 14.6% or $85,600 in annual premium
cost which was second to another SunLife proposal which contained more stringent terms. The
recommended proposal also contains a laser on one covered member ($500,000 deductible), while
the other proposals contained lasers on multiple members; presented significantly higher rates; or did
not respond with final terms. Finally, SunLife offered a guarantee to limit any further lasering at
renewal in 2014 should the County choose to select them at that time.
Willis reviewed the potential for premium savings to increase the retention to $350,000. In order to
realize overall savings, the breakeven point for this option would occur only if the Plan incurred less
than three speck excess claimants. Staff and Willis reviewed the current census of large loss
claimants and recommends that the County assume a risk averse position and maintain the current
$325,000 specific deductible. There were only two proposals at the $400,000 deductible level. Neither
of these proposals presented significant premium savings.
The proposal has no lifetime maximum benefit limit. SunLife carries a Best's "A" (Superior) rating.
Packet Page -3892-
12/11/2012 Item 16.E.7.
Willis also analyzed the purchase of aggregate excess insurance. SunLife (Id not offer an aggregate
proposal. Willis did, however, analyze the two proposals that offered aggregate coverage. The
actuary determined :that there is a 99% probability that the aggregate ded4� ctible will never be met.
Thus, the purchase of aggregate reinsurance is not recommended. staff concurs with these
recommendations.
FISC& IMPACT: The total estimated cost of group health reinsurance in calendar year 2013 is
$672,290 based upon an estimated average enrollment of 1,827 emploffees. This represents a
premium increase of $85,600 annually. There are sufficient funds available in Fund 517 for this
purchase.
GROWTH MANAGEMENT IMPACT: There is no growth management impact associated with this
item.
LEGAL CONSIDERATIONS: This item has been reviewed by the County Attorney's Office, requires
majority vote, and is legally sufficient for Board action. — CMG
RECOMMENDATION: That the Board approves the purchase of Group Health Reinsurance as
outlined in the Executive Summary and authorizes the County Manager nor designee to sign the
documents necessary to commence coverage effective January 1, 2013.
PREPARED BY: Jeffrey A. Walker, CPCU, ARM, Director, Risk Management
Packet Page -3893-
COLLIER COUNTY
Board of County Commissioners
Item Number: 16.E.7.
12/11/2012 Item 16.E.7.
Item Summary: Recommendation to approve the purchase of Group Health Reinsurance
coverage for calendar year 2013 in the amount of $672,290, a rate increase of 14.6 %.
Meeting Date: 12/11/2012
Prepared By
Name: WalkerJeff
Title: Director - Risk Management,Risk Management
11/16/2012 3:33:34 PM
Approved By
Name: pochopinpat
Title: Administrative Assistant,Facilities Management
Date: 11/19/2012 11:37:37 AM
Name: GreeneColleen
Title: Assistant County Attorney,County Attorney
Date: 11/26/2012 8:26:03 AM
Name: PriceLen
Title: Administrator, Administrative Services
Date: 11/28/2012 12:15:16 PM
Name: GreeneColleen
Title: Assistant County Attorney,County Attorney
Date: 11/29/2012 10:32:30 AM
Name: KlatzkowJeff
Title: County Attorney
Date: 11/29/2012 1:38:05 PM
Name: PryorCheryl
Title: Management/ Budget Analyst, Senior,Office of Manag
Date: 11/29/2012 3:42:55 PM
Packet Page -3894-
Name: OchsLeo
Title: County Manager
Date: 12/1/2012 2:39:01 PM
Packet Page -3895-
12/11/2012 Item 16.E.7.
12/11/2012 Item 16.E.7.
Collier County Government November 16, 2012
2013 Medical Stop Loss Marketing Report
Introduction
Each year Willis assists the Collier County Government (CCG) in obtaining quotes, analyzing the responses and
placing stop loss protection for the medical and pharmacy plans offered to the employees of the Collier County
Government and its constitutional affiliates.
Willis seeks stop loss coverage for both specific and aggregate coverage on behalf of the CCG. Specific stop loss
provides reimbursement of medical and pharmacy claims for an employee, spouse or dependent whose claims
exceed a specified deductible in any one year. The current retention level is $325,000.
Aggregate stop loss protects the CCG in the event that total claims for covered individuals exceed a predetermined
amount in any one year. The CCG does not currently purchase aggregate stop loss as past analysis of the terms
has shown that purchasing this coverage in conjunction with specific stop loss would offer little real protection and
represented a poor value.
While CCG had only two claimants with total dollars exceeding the specific stop loss in 2011, one of those claims
exceeded $1 million and so the dollar amount of claims is very large in comparison to the prior two years. The
amount in excess of the $325,000 specific level in 2011 for the two claimants was approximately $794,000. Through
August of 2012, there have been three claims exceeding the stop loss attachment point by almost $364,000. Despite
the recent poor experience, two carriers have provided competitive quotes.
Marketing Summary and Recommendation
Willis worked to secure terms for the specific medical stop loss program from the current carrier Zurich. In addition, a
n request for proposal document was prepared, approved by the CCG and distributed to select carriers. Quotations
were requested for specific retention levels of $325,000, $350,000 and $400,000. The terms were also requested for
aggregate stop coverage based on 125% of the expected cost for 2012. Specific terms were requested on a 12/24
basis which means the coverage operates on an incurred versus a paid basis. This is consistent with past practice.
Specific and aggregate quotations were requested from the following carriers:
r* Greenwood International (declined)
* Symetra (declined)
b ING (declined)
* Sun Life (quoted)
* Optum (declined)
* Beacon Risk (declined)
b Zurich (incumbent)
* Amwins (proposal pending)
* AIG (declined)
b Arch (declined)
* CIGNA (declined)
* Faber, Xchange Benefits/Wesco (quoted)
b HCC Life (declined)
* HM Life (quoted)
b ING Reliastar (proposal pending)
c* Munich Re (declined)
b International Assurance of Tennessee/ American Fidelity (quoted)
Willis
Packet Page -3896-
Page 1
12/11/2012 Item 16.E.7.
Collier County Government November 16, 2012
2013 Medical Stop Loss Marketing Report
All these carriers are rated A or better by A.M. Best. Carriers that declined to quote did so because their manual
rates were not competitive. Only Faber and IAT offered aggregate quotes. Only Zurich and IAT quoted at the $400K
level. The best quote at $400K is higher than the best quote offered at the current retention level, so increasing the
attachment point to $400K is not recommended.
To aid the CCG in making a selection of what carrier offers the best terms as well as what type of program to
purchase, Wills completed three separate analyses. The purpose of each is summarized below:
1. A standard spread sheet analysis which shows what each carrier quoted and who offered the most
competitive terms at the stated retention levels as well as whether aggregate terms were offered.
2. A stochastic forecast model which used detailed claims data to forecast the expected number of claims at
each retention level to assist the CCG in selecting the most appropriate retention level.
3. A loss probability study which provides data to assist the CCG in determining whether it is appropriate to
purchase aggregate stop loss coverage given the terms quoted.
Based on the above analysis Willis believes the risk management needs of the CCG are best met by purchasing
coverage with Sun Life at a $325,000 retention level. Sun Life offered two coverage options- with or without the right
to add additional lasers at the policy renewal for 2014. The difference in premium is $21,365, or about 3 %. A laser
can cost CCG significantly more than the difference in premium, so Willis recommends purchasing the no new laser
option. SunLife has one contingency associated with its quote.
There is one individual who may need a transplant. Without a transplant the individual's deductible is $425,000 and if
the transplant occurs during the 2013 policy year, the deductible will be $500,000. Even if this transplant were to
occur and the additional cost of this person in excess of the current $325,000 specific level added to the SunLife
premium the total cost is still less than Zurich renewal offer. The undiscounted cost of this transplant can be over
$900,000 and the person is high on the transplant list in Tampa. Therefore this transplant is likely to occur in 2013.
Any decision to increase the retention level should be based on an assessment of the CCG's risk tolerance during
2012. The following analysis provides the detail supporting these recommendations to assist the CCG in reaching a
decision.
Although Sun Life did not offer an aggregate quote, we did assess what Faber and IAT offered. As in past years,
aggregate would represent a poor value. The CCG would have less than a 1 % probability of collecting on coverage
that costs $54,372 annually. Therefore, it does not make sense to go approach Sun Life and request aggregate
quotes as a condition of being recommended as the carrier for the specific stop loss.
Quote Cost Analysis
The attached document labeled Collier County Government 2012 Stop Loss Analysis outlines what each of the
carriers quoted at each retention level and which carrier quoted the best terms at each retention level. The analysis
shows that Sun Life has the best terms at $325,000 and $350,000. The best quote at $400,000 was offered by IAT
American Fidelity, but as we said earlier, the premium is higher than the Sun Life quote at $325,000 so it is not under
consideration. HM Life was close, but offered less favorable terms on three members they wished to laser for 2013.
The Zurich terms for the current retention level of $325,000 represent an increase of 72% or $419,064 annually from
the current coverage. Zurich's renewal was also contingent on two lasers one at $425,000 and another for the
transplant candidate of $500,000. The total cost of premium proposed by Zurich is $1,006,750. The proposed
premium from SunLife for the no laser at renewal option is $672,409 and the Sun Life laser on the transplant is
$500,000. With accounting for the lasers, the SunLife quote is better than Zurich. ---�
Willis Page 2
Packet Page -3897-
12/11/2012 Item 16.E.7.
Collier County Government November 16, 2012
2013 Medical Stop Loss Marketing Report
This is a very unfavorable increase. Stop loss renewal increases typically range between 25 to 40% due to two
factors- -the carriers' risk expectations based on a review of emerging high cost claims /trigger diagnoses and what is
called leveraged trend. Leveraging is what happens to the amount of claims exceeding a specific level ($325,000 in
the CCG's case) when claim costs are increasing.
For example, assume a claim of $400,000 occurred for an individual with cancer. In this case, the CCG would
receive $75,000 back from the reinsurer. Now let's assume costs increase 5% (which is consistent with medical
CPI). Next year the same claim would cost $420,000. Under this scenario, the amount collected under the
reinsurance would be $95,000 instead of $75,000. This represents an increase of 27 %.
In addition to leveraged trend, the CCG is faced with a claimant that could approach $1.0 million in 2013.
As in the past, all quotes were made assuming a 12/24 basis. This means coverage applies to all claims incurred in
2013 and paid by December 31, 2014, so there is no concern at the end of the year about getting claims paid so they
will be included against coverage.
Retention Level Analysis
Willis actuaries developed a Monte -Carlo simulation model using actual large claims in 2008 -2011 and the first 9
months of 2012 to forecast the large claims that are likely to occur in 2013. Note that the expected number of claims
for quoted retention levels is generally higher than what CCG actually experienced in 2011. This is because the
modeling and forecast is based on several years' experience adjusted for trend at 5% annually. This adjustment
pushes additional claims past the stop loss attachment point and results in a projection that appears higher than the
actual results that CCG experienced in 2008 through 2011.
Refer to the attached document labeled Collier County Government — Specific Level Retention Support Analysis.
The first page shows the actual and expected number of claimants that exceed specific levels. It also shows the
expected cost of risk transfer. When the risk transfer number is negative the model is suggesting the likelihood that
the specific recoveries will exceed the premium paid. Generally a negative or smaller number suggests that specific
retention is likely to provide the best return.
This analysis suggests that, based on the expected claims at each level, the CCG is best served by increasing its
retention level to $350,000 as the expected cost of risk transfer is more than $17,000 lower than the expected cost of
the current level.
Page two is an analysis that shows the relative cost savings associated with increasing the specific level and the
number of large cost claimants that must occur to offset the savings. It further shows the relative probability that the
number of large claims will not "negate" the savings making increasing the stop loss retention a good bet.
The premium reduction CCG will receive for raising its attachment point from $325,000 to $350,000 will offset the
additional cost of paying the associated claims if CCG incurs fewer than 3 claims exceeding the $325,000 attachment
point. To put this in perspective, there were 2 claims over this level in 2008 and 2011 but only 1 in 2009 and 2010.
In 2012, you have so far experienced 3 claims of this magnitude. The analysis indicates that the probability of large
claimants not exceeding the level where the savings is negated is 69 %. Put another way, there is a 31 % probability
that if the County increases the specific stop loss level to $350,000 that the savings in premium will be offset by
greater claims payments.
Willis Page 3
Packet Page -3898-
12/11/2012 Item 16.E.7.
Collier County Government November 16, 2012
2013 Medical Stop Loss Marketing Report
Both the analysis referenced suggest that increasing the retention level to $350,000 is advised. However, more
needs to go into the decision than the model. In spite of what the model suggests Willis does not recommend that
the retention level be increased to $350,000. Here are the reasons supporting this recommendation:
• There is considerable volatility in large claimants and the benefit gained in terms of lower premium of
$71,000 annually and a $17,000 reduction in the expected cost of risk transfer. If the CCG has 3 claims in
excess of $350,000 raising the limit becomes a losing proposition.
• The CCG just raised the limit in 2012 by $50,000 per claimant
• The current $350,000 retention level is high when compared to organizations of similar size
• The CCG population is older than most and therefore open to greater risk of high cost claimants.
These factors beyond the modeling need to be taken into account in reaching a final decision.
Aggregate Stop Loss Analysis
Sun Life did not provide an aggregate quote. Of the two carriers that quoted aggregate coverage, the lower premium
and better terms were provided by IAT American Fidelity. IAT has offered to cap the total liability under the medical
and pharmacy programs at a level equal to $1,915 per month. The premium for this guarantee is estimated to be
$54,372 and $54,591 for the two specific retention levels ($325,000 and $350,000) quoted.
Please see the chart labeled "Likelihood of Medical Claims (with R)� Cost Greater than Listed $ Per Employee Per
Month for CY 2013 - - Assuming 8% Trend."
This loss probability distribution shows the likelihood of claims falling within certain ranges. The expected value of
claims for the CCG in 2013 based on the Monte Carlo simulation is $1,271. The high end of 99% confidence interval
for 2013 is $1,417 per employee per month. IATs aggregate claims level is well above this level. What this says is
the probability model suggests that there is virtually a 100% probability that per employee claims will be less than
$1,915 quoted by IAT.
Willis does not believe that purchasing aggregate stop loss would be a good investment.
Willis Page 4
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