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Agenda 12/10/2019 Item #16E 9 (RFP #19-7581 Group Insurance - Willis of Wisconsin, Inc.)
12/10/2019 EXECUTIVE SUMMARY Recommendation to award RFP# 19-7581 “Group Insurance Brokerage and Actuarial Services” to Willis of Wisconsin, Inc., and execute the associated Agreement. OBJECTIVE: To provide group insurance brokerage, consulting, and actuarial services in support of the county’s group insurance program. CONSIDERATIONS: The Board of Commissioners through the Risk Management Division offers a comprehensive group insurance program to its employees and their eligible dependents. In order to properly manage the program, the County enters into an actuarial and benefits consulting professional services agreement to obtain the services necessary to administer the program. Services provided under this agreement can be broken down into the following categories. Regulatory, Accounting and Actuarial • The completion of the required state filings with the Florida Department of Insurance pursuant to Florida Statutes Section 112.08 • The completion of an annual actuarial evaluation of the health plan to meet external audit requirements • Completion of the bi-annual GASB 75 OPEB evaluation to meet external audit requirements • The development of prospective health, dental and disability rates for the budget • The completion of a critical factor analysis to identify health plan cost drivers • The development and monitoring of local physician/hospital fee schedules with cost estimates • The development of plan design structure and cost estimates • The provision of financial, legal and tax advice relative to 26 US Code Section 125, COBRA, HIPAA, and other regulations • Assistance with the compliance aspects of the Patient Protection Affordability and Accountability Act of 2010 Insurance Brokerage, Vendor Selection and Other Services • The marketing and placement of group health reinsurance • The marketing and placement of group life, disability, dental and other insurance products as requested • Assistance in the preparation of RFP’s for third party claims administration, flexible spending account services, and pharmacy benefit management services • The completion of employee focus groups and similar surveys On April 2, 2019, the Procurement Services Division released Request for Proposal (RFP) #19-7581 to Six Thousand Three Hundred and Thirty-Seven (6,337) vendors for the “Group Insurance Brokerage and Actuarial Services” project. Seventy-Five (75) bid packages were downloaded, and Three (3) proposals were received by the May 16, 2019 deadline. A Selection Committee convened on July 19, 2019 to review the proposals presented and rank the firms according to the criteria established in the RFP. Due to oversights during the evaluation period, the Selection Committee reconvened on September 11th and 18th, 2019. The Committee rescored and ranked the three (3) responsive/responsible vendors. Scores were ranked and award is recommended to Willis of Wisconsin, Inc. 16.E.9 Packet Pg. 2646 12/10/2019 Company Name Final Rank Willis of Wisconsin, Inc. 1 Lockton Companies 2 Gallagher Benefit Services, Inc. 3 A five (5) year agreement with the option to renew for an additional five (5) year period has been negotiated and is included as part of this request for approval. The commencement date of the agreement is January 1, 2020. FISCAL IMPACT: The annual fees are $109,000 per year for the core services provided under the contract including the preparation of the GASB 75 OPEB study every two years. The vendor is paid on a flat fee basis and is not permitted to accept commissions on employer paid insurance products. Funds are budgeted within Fund 517, Group Health and Life for this purpose. 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. -JAK RECOMMENDATION: To award RFP#19-7581 to Willis of Wisconsin for Group Benefit Brokerage and Actuarial Services and authorize the Chairman to execute the agreement for services. Prepared by: Jeff Walker, CPCU, ARM, Division Director, Risk Management Division ATTACHMENT(S) 1. 19-7581 Solicitation (PDF) 2. 19-7581 Final Rank 9-18 (PDF) 3. [linked] 19-7581 Willis_Proposal (PDF) 4. 19-7581 NORA_Executed 9-18-19 (PDF) 5. 19-7581_Contract_WillisofWisconsonInc_VendorSigned (PDF) 6. 19-7581 WillisOfWisconsin_Ins_11-19-2019 (PDF) 16.E.9 Packet Pg. 2647 12/10/2019 COLLIER COUNTY Board of County Commissioners Item Number: 16.E.9 Doc ID: 10925 Item Summary: Recommendation to award RFP# 19-7581 “Group Insurance Brokerage and Actuarial Services” to Willis of Wisconsin, Inc., and execute the associated Agreement. Meeting Date: 12/10/2019 Prepared by: Title: Division Director - Risk Management – Risk Management Name: Jeff Walker 11/19/2019 3:22 PM Submitted by: Title: Division Director - Risk Management – Risk Management Name: Jeff Walker 11/19/2019 3:22 PM Approved By: Review: Administrative Services Department Paula Brethauer Level 1 Division Reviewer Completed 11/20/2019 9:35 AM Procurement Services Opal Vann Level 1 Purchasing Gatekeeper Completed 11/20/2019 12:28 PM Procurement Services Priscilla Doria Additional Reviewer Completed 11/20/2019 1:38 PM Procurement Services Barbara Lance Additional Reviewer Completed 11/20/2019 2:06 PM Procurement Services Ted Coyman Additional Reviewer Completed 11/20/2019 4:14 PM Procurement Services Len Price Additional Reviewer Skipped 11/20/2019 4:29 PM Administrative Services Department Len Price Level 2 Division Administrator Review Completed 11/20/2019 5:21 PM County Attorney's Office Jeffrey A. Klatzkow Level 3 County Attorney's Office Review Completed 11/21/2019 8:11 AM Office of Management and Budget Valerie Fleming Level 3 OMB Gatekeeper Review Completed 11/21/2019 8:19 AM Office of Management and Budget Laura Wells Additional Reviewer Completed 11/21/2019 11:03 AM County Manager's Office Sean Callahan Level 4 County Manager Review Completed 11/25/2019 10:43 AM Board of County Commissioners MaryJo Brock Meeting Pending 12/10/2019 9:00 AM 16.E.9 Packet Pg. 2648 COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS REQUEST FOR PROPOSAL (RFP) FOR Group Insurance Brokerage and Actuarial Services SOLICITATION NO.: 19-7581 BARBARA LANCE, PROCUREMENT STRATEGIST PROCUREMENT SERVICES DIVISION 3295 TAMIAMI TRAIL EAST, BLDG C-2 NAPLES, FLORIDA 34112 TELEPHONE: (239) 252-8998 Barbara.Lance@colliercountyfl.gov (Email) This solicitation document is prepared in a Microsoft Word format (Rev 8/7/2017). Any alterations to this document made by the Vendor may be grounds for rejection of proposal, cancellation of any subsequent award, or any other legal remedies available to the Collier County Government. 16.E.9.a Packet Pg. 2649 Attachment: 19-7581 Solicitation (10925 : Award of RFP# 19-7581 Group Insurance Brokerage and Actuarial Services) SOLICITATION PUBLIC NOTICE REQUEST FOR PROPOSAL (RFP) NUMBER: 19-7581 PROJECT TITLE: Group Insurance Brokerage and Actuarial Services PRE-PROPOSAL CONFERENCE: April 16th, 2019 @ 2:00 pm LOCATION: PROCUREMENT SERVICES DIVISION, CONFERENCE ROOM A, 3295 TAMIAMI TRAIL EAST, BLDG C-2, NAPLES, FLORIDA 34112 DUE DATE: May 2nd, 2019 @ 3:00 pm PLACE OF RFP OPENING: PROCUREMENT SERVICES DIVISION 3295 TAMIAMI TRAIL EAST, BLDG C-2 NAPLES, FL 34112 All proposals shall be submitted online via the Collier County Procurement Services Division Online Bidding System: https://www.bidsync.com/bidsync-cas/ INTRODUCTION As requested by the Risk Management Division (hereinafter, the “Division”), the Collier County Board of County Commissioners Procurement Services Division (hereinafter, “County”) has issued this Request for P roposal (hereinafter, “RFP”) with the intent of obtaining proposals from interested and qualified vendors in accordance with the terms, conditions and specifications stated or attached. The vendor, at a minimum, must achieve the requirements of the Specificat ions or Scope of Work stated. Historically, County departments have spent approximately $120,000; however, this may not be indicative of future buying patterns. Collier County Government is seeking proposals for a group insurance brokerage and actuarial services to assist the Risk Management Department in the management and administration of the County's group insurance program. BACKGROUND Collier County Government offers a comprehensive group insurance program to its employees and their dependents. There are approximately 2,209 employees and 4,800 covered lives under the program. The core benefit program consists of employer paid or partially paid group health, life, dental, short and long-term disability, vision and AD&D insurance. Collier County is self-insured with excess insurance for its group health program and fully insured for its group life program. Please refer to Exhibit, “B-Premiums and Vendor Costs”, which illustrates the current vendors, fees and premium levels of these programs. The marketing and placement of these coverages and vendor services is managed under a brokerage contract. The contracted broker is remunerated on a fee basis for consultation related to the placement of these coverages and vendor services. In addition to the marketing and placement of coverage under the program, the county requires the compl etion of various actuarial projects to assure that the program is in conformance with management objectives and remains in compliance with state require d fiduciary requirements. A sample annual work plan is attached as part of Exhibit “A-Sample Workplan”. This service need requires an integrated approach to benefits consultation, which will include the marketing of the County’s insurance program in accordance with the development of actuarial modeling to appropriately evaluate the variety and effectivene ss of group insurance alternatives. Due to this integrated approach, these consultative services shall require the use of licensed brok erage professionals and qualified actuarial professionals to meet the County’s statutory obligations and to monitor pro gram performance. TERM OF CONTRACT The contract term, if an award is made, is intended to be for Five (5) year agreement with one (1) five (5) year renewal option. The contract will commence no later than January 1, 2020. However, the County may enter into this agreement at an earlier date if necessary. Prices shall remain firm for the initial term of this contract. Surcharges will not be accepted in conjunction with this contract, and such charges should be incorporated into the pricing structure. The County Manager, or designee, may, at his discretion, extend the Agreement under all of the terms and conditions contained in 16.E.9.a Packet Pg. 2650 Attachment: 19-7581 Solicitation (10925 : Award of RFP# 19-7581 Group Insurance Brokerage and Actuarial Services) this Agreement for up to one hundred eighty (180) days. The County Manager, or designee, shall give the Contractor written n otice of the County's intention to extend the Agreement term not less than ten (10) days prior to the end of the Agreement term the n in effect. DETAILED SCOPE OF WORK The successful firm shall be able to perform or provide the following services. The firm shall present proposals from a minimum of three vendors unless market conditions do not support same. These services shall include but not be limited to the following: 1) Prepare an RFP, receive proposals, prepare an analysis, and recommend vendors to provide services or financial products related to the County's self-insured group health insurance program including but not limited to the following: a. Third party claims administration b. Pre-certification, utilization review, disease management and large case management c. Managed care networks d. Group health excess insurance e. Other services or products as may be appropriate 2) Prepare an RFP, receive proposals, prepare an analysis, and recommend a fully insured group health insurance program, if requested. 3) Prepare an RFP, receive proposals, prepare an analysis, and recommend employer paid group insurance coverage to include the following: a. Group Life Insurance b. Group Accidental Death and Dismemberment c. Long Term Disability d. Short Term Disability (fully or self- funded) e. Group Dental (fully or self- funded) 4) Prepare an RFP, receive proposals, prepare an analysis, and recommend ancillary benefits or services that may include but not be limited to the following: a. Biometric Testing b. Supplemental Life c. Supplemental AD&D d. Vision e. Cancer f. Hospital Income g. Group Legal h. ACA Reporting i. On-site Employee Clinic j. Wellness Programs k. Other services or products as may be appropriate 5) Review the County's flexible spending account and health reimbursement account programs to include the solicitation, analysis, review, and recommendation of account administration firms and plan design. 6) Provide enrollment support services for the annual open enrollment period, if requested. 7) Perform a qualitative and financial due diligence analysis of the County's managed care network. Prepare an RFP, receive proposals, prepare an analysis, and recommend a vendor for managed care network services if requested. 8) Prepare an RFP, receive proposals, prepare an analysis, and recommend Pharmacy Benefit Management firms for the County’s selection to include the actuarial analysis of various pricing and benefit options. 9) Provide educational, training information and services pertaining to current issues in the area of benefits law and administration including all state and federal laws that govern group insurance programs. Communicate upcoming mandates and work with staff to assure that mandates are met. The successful proposer shall have access to qualified staff and/or outside employee benefits legal counsel. 10) Provide actuarial services to include the following: a. Complete the annual FS 112.08 actuarial study and submit for approval to the Department of Insurance. b. Review the rate structure(s) of self-funded programs to examine the adequacy of funding levels. Submit self - funded program rates to the County for budgeting purposes by December 30 th of each year. c. Prepare an update of self-funded health rates as of June 30 each year to assure rate suffic iency. 16.E.9.a Packet Pg. 2651 Attachment: 19-7581 Solicitation (10925 : Award of RFP# 19-7581 Group Insurance Brokerage and Actuarial Services) d. Prepare an annual group health rating appendix that displays rates by plan, salary tier, smoking/non - smoking, and single/family. e. Re-balance the group health rating structure periodically to assure that rates are properly distributed. f. Develop financial alternatives relative to proposed plan design options. g. Develop self-funded Short-Term Disability rates. 11) Develop group health and group benefit plan design alternatives as directed to include the following services. a. Develop the associated actuarial modeling to support plan designs. b. Perform management interviews to assess management philosophy. c. Perform employee focus groups, utilizing at least 10% of the employee group as a random sample. Develop recommendations based upon findings. d. Review plan options with management. e. Assist with the preparation of Board presentations and attend if requested. f. Assist in the development of Plan and Summary Plan Description wording. g. Assist with information technology matters as appropriate. 12) Develop a standard set of reports that measure the quantitative and qualitative aspects of the group health insurance program and review same with the County on an annual basis. Make recommendations commensurate with findings. 13) Collier County Healthcare Purchasing Consortium- In addition to the above, the firm shall possess the necessary consulting expertise to assist the County in its participation in the Collier County Healthcare Purchasing Consortium. The vendor shall possess the capability to assist in various projects including the participation in monthly meetings; the identification of cost drivers; the joint purchase of benefits and services; review of case management firms; review of managed care arrangements; review of managed care network pricing structures; assistance with the development of performance-based outcomes and measures. 14) Plan Documents- Plan documents will be provided upon request. 15) Data Warehousing-Receive and maintain claims data on a regular basis for the purposes of actuarial, underwriting, and marketing of county benefits programs. The successful vendor shall be required to sign the county’s standard HIPAA Business Associate Agreement. Special Conditions The successful firm will have the capability to access insurance markets on a regional, national or international basis to maximize the availability of options for the County's consideration. The successful firm shall demonstrate the resources at its disposal as are necessary to fulfill the requirements of the scope of services. The successful firm shall be prohibited from proposing a third-party administrator or service company that is owned by the same company or by a parent company unless such a submission is expressly permitted by Collier Count y. The successful firm shall demonstrate a proven record of providing services of this type to clients of the same size, nature, and complexity as Collier County. The successful firm must possess all necessary licenses to perform the above -mentioned services as may be required by the State of Florida. • Brokerage license in the State of Florida • Actuaries providing service shall be approved by the American Academy of Actuaries The County shall have the right to establish additional services and their as sociated fees by contract and to determine which services it may wish to utilize in a given year. An annual workplan will be developed each year which will identify th e projects anticipated for completion. Please see Exhibit A for Sample Workplan and Exhibit B for Premiums and Vendor Costs. Method of Compensation It is the intent of the County to compensate the successful firm in the following manner. 1) As regards the provision of employer-paid (partially or fully paid) insurance coverage or services relative to group health third party administrative services, group life insurance, group health reinsurance, fully insured health insurance programs (if requested), and all other services mentioned above, an annual flat fee will be paid with applicable premiums quoted net of commission payable in equal monthly installments. The proposing firm shall place all coverage and services net of commission and shall, on an annual basis, disclose all income received during the previous year for services performed, coverage placed, or services obtained on behalf of Collier County. The proposer shall also disclose all commissions that 16.E.9.a Packet Pg. 2652 Attachment: 19-7581 Solicitation (10925 : Award of RFP# 19-7581 Group Insurance Brokerage and Actuarial Services) would have been earned including normal and contingent (bonus) commissions. The successful proposer shall be fully transparent as regards remuneration resulting from services performed. A failure to comply with these requirements may be grounds for the cancellation of the agreement and/or the withholding of commensurate fees. If a vendor or carrier cannot or is unable to place coverage or services on a net of commission basis, the contractor shall immediately disclose this matter and the fee arrangement shall be re-negotiated to assure that total remuneration is comparable to the contract fee. 2) Actuarial services performed on behalf of the County shall be billed on an annual flat fee basis, payable in equal monthly installments. In certain instances, actuarial services may be required that are not anticipated. The County shall reserve the right to negotiate a fee for the project or it may choose to proceed pursuant to the vendor’s normal hourly rate. REQUEST FOR PROPOSAL (RFP) PROCESS 1.1 The Proposers will submit a qualifications proposal which will be scored based on the criteria in Evaluation Criteria for Development of Shortlist, which will be the basis for short-listing firms. The Proposers will need to meet the minimum requirements o utlined herein in order for their proposal to be evaluated and scored by the COUNTY. The COUNTY will then score and rank the firms and enter into negotiations with the top ranked firm to establish cost for the services needed. The COUNTY reserves the right to issue an invitation for oral presentations to obtain additional information after scoring and before the final ranking. With successful negotiations, a contract will be developed with the selected firm, based on the negotiated price and scope of services and submitted for approval by the Board of County Commissioners. 1.2 The COUNTY will use a Selection Committee in the Request for Proposal selection process. 1.3 The intent of the scoring of the proposal is for respondents to indicate their interest, relevant experience, financial capability, staffing and organizational structure. 1.4 The intent of the oral presentations, if deemed necessary, is to provide the vendors with a venue where they can conduct discussions with the Selection Committee to clarify questions and concerns before providing a final rank. 1.5 Based upon a review of these proposals, the COUNTY will rank the Proposers based on the discussion and clarifying questions on their approach and related criteria, and then negotiate in good faith an Agreement with the top ranked Proposer. 1.6 If, in the sole judgment of the COUNTY, a contract cannot be successfully negotiated with the top -ranked firm, negotiations with that firm will be formally terminated and negotiations shall begin with the fir m ranked second. If a contract cannot be successfully negotiated with the firm ranked second, negotiations with that firm will be formally terminated and negotiations shall begin with the third ranked firm, and so on. The COUNTY reserves the right to negotiate any element of the proposals in the best interest of the COUNTY. RESPONSE FORMAT AND EVALUATION CRITERIA FOR DEVELOPMENT OF SHORTLIST: 1.7 For the development of a shortlist, this evaluation criterion will be utilized by the COUNTY’S Selection Committee to score each proposal. Proposers are encouraged to keep their submittals concise and to include a minimum of marketing materials. Proposals must address the following criteria: Evaluation Criteria Maximum Points 1. Cover Letter / Management Summary 5 Points 2. Business Plan 25 Points 3. Cost of Services to the County 20 Points 4. Experience and Capacity of the Firm 20 Points 5. Specialized Expertise of Team Members 20 Points 6. Local Vendor Preference 10 Points TOTAL POSSIBLE POINTS 100 Points Tie Breaker: In the event of a tie at final ranking, award shall be made to the proposer with the lower volume of work previously awarded. Volume of work shall be calculated based upon total dollars paid to the proposer in the twenty -four (24) months prior to the RFP submittal deadline. Payment information will be retrieved from the County’s financial system of record. The tie breaking procedure is only applied in the final ranking step of the selection process and is invoked by the Procurement Services Division Director or designee. In the event a tie still exists, selection will be determined based on random selection by the Procurement Services Director before at least three (3) witnesses. ---------------------------------------------------------------------------------------------------------------------------------------------------------- 16.E.9.a Packet Pg. 2653 Attachment: 19-7581 Solicitation (10925 : Award of RFP# 19-7581 Group Insurance Brokerage and Actuarial Services) Each criterion and methodology for scoring is further described below. ***Proposals must be assembled, at minimum, in the order of the Evaluation Criteria listed or your proposal may be deemed non-responsive*** EVALUATION CRITERIA NO. 1: COVER LETTER/MANAGEMENT SUMMARY (5 Total Points Available) Provide a cover letter, signed by an authorized officer of the firm, indicating the underlying philosophy of the firm in providing the services stated herein. Include the name(s), telephone number(s) and email(s) of the authorized contact person(s) concerning proposal. Submission of a signed Proposal is Vendor's certification that the Vendor will accept any awards as a result of this RFP. EVALUATION CRITERIA NO. 2: BUSINESS PLAN (30 Total Points Available) In this tab, include but not limited to: • Detailed plan of approach (including major tasks and sub -tasks). • Detailed time line for completion of the project. • Include with the Business Plan or as an attachment, a copy of a report as an example of work product. This should be for one of the projects listed as a reference. • To determine the firm’s ability to complete the Scope of Services, answer questions included in attachment 1: Professional Questionnaire. EVALUATION CRITERIA NO. 3: COST OF SERVICES TO THE COUNTY (20 Total Points Available) In this tab, include but not limited to: • Provide an annual flat fee for which your firm will provide the work as described in this RFP. The Cost of Services will be scored using the following methodology: The greatest number of points allowed in this criterion will be awarded to the vendor who has the lowest cost. The next lowest cost will be divided by the lowest cost which will then be multiplied by criteria points to determine the vendor’s points awarded. Each subsequent vendor’s point score will be calculated in the same manner. For illustrative purposes only: Vendor Name Hourly Rate Points Awarded Vendor ABC $100.00 20 Vendor DEF $110.00 18 Vendor GHI $135.00 15 Initial pricing is for grading purposes and are subject to change during negotiations with the selected vendor. EVALUATION CRITERIA NO. 4: EXPERIENCE AND CAPACITY OF THE FIRM (20 Total Points Available) In this tab, include but not limited to: • Provide information that documents your firm’s and subcontractors’ qualifications to produce the required deliverables, including abilities, capacity, skill, and financial strength, and number of years of experience in providing the required services. • Describe the various team members’ successful experience in working with one another on previous projects. The County requires that the vendor submits no fewer than five (5) completed references from clients whose projects are of a similar nature to this solicitation as a part of their proposal; two of which should be Public Sector Agencies. Provide information on the projects completed by the vendor that best represent projects of similar size, scope and complexity of this project using the reference form provided. Vendors may include two (2) additional pages for each project to illustrate aspects of the completed project that provides the information to assess the experience of the Proposer on rele vant project work. 16.E.9.a Packet Pg. 2654 Attachment: 19-7581 Solicitation (10925 : Award of RFP# 19-7581 Group Insurance Brokerage and Actuarial Services) EVALUATION CRITERIA NO. 5: SPECIALIZED EXPERTISE OF TEAM MEMBERS (20 Total Points Available) In this tab, include but not limited to: • Description of the proposed contract team and the role to be played by each member of the team. • Attach brief resumes of all proposed project team members who will be involved in the management of the total package of services, as well as the delivery of specific services. • Attach resumes of any sub-vendors and attach letters of intent from stated sub-vendors must be included with proposal submission. EVALUATION CRITERIA NO. 6: LOCAL VENDOR PREFERENCE (10 Total Points Available) Local business is defined as the vendor having a current Business Tax Receipt issued by the Collier or Lee County Tax Collector prior to proposal submission to do business within Collier County, and that identifies the business with a permanen t physical business address located within the limits of Collier or Lee County from which the vendor’s staff operates and performs business in an area zoned for the conduct of such business. VENDOR CHECKLIST ***Vendor should check off each of the following items as the necessary action is completed (please see, Form 2: Vendor Check List): The Solicitation Submittal has been signed. The Solicitation Pricing Document (Bid Schedule/Quote Schedule/Proposal Pricing/etc.) has been completed and attached . All applicable forms have been signed and included, along with licenses to complete the requirements of the project. Any addenda have been signed and included. Affidavit for Claiming Status as a Local Business, if applicable. Division of Corporations - Florida Department of State – http://dos.myflorida.com/sunbiz/ (If work performed in the State). E-Verify/Immigration Affidavit (Memorandum of Understanding). 16.E.9.a Packet Pg. 2655 Attachment: 19-7581 Solicitation (10925 : Award of RFP# 19-7581 Group Insurance Brokerage and Actuarial Services) Selection Committee Scoring Sheet (STEP 1) RFP #:19-7581 Title: Group Insurance Brokerage and Actuarial Services (Reconvene) Name of Firm Carleton Case Amia Curry Lisa Olivier Sonja Sweet Total Scores Final Rank Willis Towers Watson 89 82 82 90 343.00 1 Lockton 76 82 73 80 311.00 2 Gallagher Benefit Services, Inc.63 62 53 65 243.00 3 0.00 0.00 0.00 0.00 Procurement Professional 9/18/2019 Step 1: Upon direction by the Procurement professional, the individual selection committee member should provide their scoring of the proposals. Step 2: The procurement professional will review the mathematically tabulated scores determine if consensus is reached. Step 3: The Committee by concensus will determine the number of proposers to bring back for oral presentations. Page 1 of 1 16.E.9.b Packet Pg. 2656 Attachment: 19-7581 Final Rank 9-18 (10925 : Award of RFP# 19-7581 Group Insurance Brokerage and Collier County Government County Manager Medical Plan Update February 22, 2018 1 February 22, 2018 14.0% 12.5% 10.5% 8.5% 5.5% 3.0% 0.8% 2.5% 4.0% 5.3% 8.2% 10.9% 12.9% 13.9% 11.2% 9.2% 7.7% 6.1% 5.0% 5.0% 4.0% 8.5% 4.0% 4.5% 3.0% 4.0% 3.0% 3.0% 0% 2% 4% 6% 8% 10% 12% 14% 16%1990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017Percentage Increase in Health Insurance Premiums 1990 - 2017 Background and Health Care Costs, a National Perspective On an annual basis, the Risk Management Division of the Collier County Government (CCG) in conjunction with Willis Towers Watson, provide the County Manager and Budget Office with an update covering the performance of the health plan, which next to wages is the second most costly personal services related budget line item for the County. This is the eighth report to the County Manager and provides updated information regarding goals set for the health plan, performance of the plan compared to those goals, challenges for the future and suggestions for leadership to consider. The last report was provided in February 2017. The chart below shows national health care premium increases reported by the Kaiser Family Foundation for the last 26 years. According to the Kaiser Family Foundation/Health Research & Education Trust 2017 Employer Health Benefits Survey, annual premiums for employer-sponsored family health coverage reached $18,764 this year, up 3% from last year. On average, workers contribute $5,714 towards the cost of their coverage. Most covered workers make a contribution toward the cost of the premium for their coverage. On average, covered workers contribute 18% of the premium for single coverage and 31% of the premium for family coverage. The stable rate of increase in premiums reported for the last several years is welcome. However, that moderation continues to be driven by employers transferring cost to employees via higher deductibles and copayments. Further, the increases still outpace the overall growth of the economy. 2 February 22, 2018 10.3% 14.7% 13.0% 11.3% 9.2% 8.3% 6.4% 5.3% 6.8% 6.8% 5.5% 5.5% 4.2% 4.9% 4.0% 4.4% 4.6% 5.5% 6.0% 5.0% 6.0% 9.0% 8.0% 8.0% 8.0% 8.0% 6.8% 6.0% 6.0% 5.0% 6.0% 6.0% 6.0% 8.0% 8.4% 8.0% 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 20162017^2018*20162017^2018* Health Care Trend After Plan Changes (Total Plan Costs) ^ Expected; *Projected. Mid- The chart below shows how plan design changes have masked a continued increase in cost that far exceeds the growth in GDP, as well as how employee exposure to health care cost via increased deductibles continues. Note, this data is from the Willis Towers Watson middle market survey 3 February 22, 2018 5.0%90.0%5.0% 0.9121 1.0945 0.750.800.850.900.951.001.051.101.151.201.250 1 2 3 4 5 6 7 8 Annual A/E Claims Annual A/E Claims Minimum 0.7994 Maximum 1.2484 Mean 1.0000 Std Dev 0.0556 Values 10000 Employers continue to focus on wellness with over 85% of large employers offering some type of wellness program to employees. Interest continues to grow with respect to site of care alternatives, such as telemedicine and on-site clinics. Other areas of interest focus on high performance or tiered networks, narrow networks and private exchanges. Finally, incentives to participate in wellness and health promotion programs continue to increase. One thing is clear, while the world continues to change, the CCG is challenged with a population that is much older than other local employers and hence faces greater than normal upward cost pressures. To address these challenges, it is vital that the CCG continue to diligently work to improve the health of the population and where appropriate, examine emerging strategies to address cost, use and health. Health Plan Objectives The CCG operates the health plan with the same diligence as a small insurance company, taking steps to manage and prevent losses, reinsure catastrophic losses and maintain a prudent reserve to comply with the Florida Department of Insurance requirements as well as protect the General Fund from expense volatility. The group health plan presents a significant budget risk to the CCG, due to a potential variance related, not normal volatility in a population the size of the CCG. The chart below shows the expected variance around the forecasted amount within a 90% confidence interval. 4 February 22, 2018 When converted to dollars, the possible variance ranges from a favorable variance of $3.45 million to an unfavorable variance of $3.71 million around the mean expected claims cost. The 99th percent interval would produce an unfavorable variance of $10.85 million. Such variance is normal statistically and demonstrates that total medical costs are extremely sensitive to the number of claimants with high costs. The expected number and size of large claims is by nature extremely random and volatile. This volatility can affect the financial health of the fund. In addition to the variability noted above, three other factors influence the fund balance at the end of any year. 1. Vacant positions. When an employee leaves the CCG, there is a period of time when the position is vacant. The health fund continues to receive the CCG’s portion of health care “premium” for that position. The average turnover rate over rate for 2018 is expected to be 11.2%. Continuing to contribute to the fund for vacant positions will add an additional $2.4 million to the fund versus the expected contribution based on the actual number covered under the health plan. 2. Salary changes. Employee contributions to the health fund are based on their salary. During the year it is possible for salaries to change or turnover to impact the amount that employees contribute to the fund. 3. Margin. Each year the Risk Management Division adds margin to the claims forecast to minimize the potential for budget amendments, should claims experience be unfavorable. These factors all contribute to the ending fund balance being higher than what was estimated at the beginning of each fiscal year. The majority of the difference between the forecasted and actual funds collected comes from continuing contributions for vacant positions. This practice continues to accelerate the growth of surplus, as well as a material difference between what is budgeted and actually collected by the fund. As discussed in past reports, to address the first two issues above, the CCG may want to reconsider the practice of contributing for vacant positions. To prudently manage the cost of the health plan and protect the status of the General Fund, there are specific goals that guide how Risk Management operates the plan within the small insurance company context, these are: 1. Manage plan cost trends to be 30% or more below published trends. 2. Maintain overall controllable expenses, reinsurance costs and reserves at prudent levels. 3. Protect employees from the economic impacts of illness or injury. 4. Prevent illness and stabilize chronic health states when possible, by helping employees and their spouses become aware of their health and act on that knowledge. This report is intended to present the County Manager and Budget Director with an overview of the performance of the plan with respect to these goals and offer suggested strategies to ensure the CCG continues to meet the goals outlined above. 5 February 22, 2018 Claims Employee Months Cost per Employee (annually) % Change in Claim Cost per Employee 2010 $27,147,417 24,507 $13,293 2011 $26,201,950 23,851 $13,183 -0.8% 2012 $30,814,246 22,530 $16,412 24.5% 2013 $25,977,575 21,798 $14,301 -12.9% 2014 $25,865,696 21,820 $14,225 -0.5% 2015 $26,041,236 22,649 $13,797 -3.0% 2016 $30,566,908 24,529 $14,954 8.4% 2017 $31,687,191 25,180 $15,101 1.0% Goal #1 – Manage cost trends and the preliminary fiscal 2017/2018 rate forecast The table below shows the total cost of claims on a per employee basis for the indicated fiscal years. Cost is presented on a per employee basis to eliminate distortions in total cost resulting from any changes in the total number of people covered under the plan. The average annual increase for the last four years has been virtually flat (1.8%). The average reported increase reported by the Kaiser Family Foundation for the same time period was 4.2%. In 2017, the CCG’s overall growth was 1% versus the 3% reported by the Kaiser Family Foundation. The CCG continues to meet its goal of outperforming trend by 30%. It is important to keep in mind that while the majority of other employers significantly increased the cost sharing provisions of the plan to reduce premium increases, there were no plan design changes made in 2013 through 2017. For FY 2017, the CCG contribution to the fund was unchanged from FY 2013 through FY 2017, remaining at $13,100. Using claims paid through November 2017 and a trend assumption of 6%, the estimated cost to operate the plan as compared to the revenue the current rates produce, suggests we can keep the rates unchanged for fiscal 2017/2018. Goal #2 – Maintain overall expenses, reinsurance costs and reserves at prudent levels The ACA requires health insurance issuers to submit data on the proportion of premium revenues spent on clinical services and quality improvement, also known as the Medical Loss Ratio (MLR). It also requires them to issue rebates to enrollees if this percentage does not meet minimum standards. MLR requires insurance companies to spend at least 85% of premium dollars on medical care. Although the CCG is not subject to these requirements, it does operate its health plan in a fiscally prudent manner, which far exceeds the allowed expense requirements of the ACA. 6 February 22, 2018 Administrative Fees Administrative Fees per EE (annually) Administrative and Stop Loss Fees % of Total Cost 2010 $384,114 $189.60 3.8% 2011 $374,602 $189.60 3.9% 2012 $556,192 $301.80 3.9% 2013 $814,169 $449.36 5.4% 2014 $839,220 $458.28 5.8% 2015 $755,344 $400.29 5.6% 2016 $658,358 $322.08 5.6% 2017 $675,841 $322.08 4.8% Stop Loss Premiums Stop Loss Reimbursements Stop Loss Underwriting Gain/Loss 2010 $705,019 $241,552 463,467 2011 $687,561 $1,491,309 (803,748) 2012 $591,757 $789,860 (198,103) 2013 $581,816 $802,720 (220,904) 2014 $785,167 $679,152 106,015 2015 $872,613 $1,418,313 (545,700) 2016 $999,066 $194,085 804,981 2017 $919,839 $371,421 548,418 Total $6,142,838 $5,988,412 $154,426 Historically, overall operational costs through administration and reinsurance have been between 3.8% and 5.8% of claims. For 2017, expenses to operate the plan were 4.8%, meaning that over $0.95 on every dollar contributed by the County goes towards paying medical expenses. The operation of the CCG’s health plan far exceeds the expense ratio requirements of the ACA. The cost to administer the plan has been less than 6% over the last eight years. One of the more challenging fixed cost components to manage is the cost of reinsurance, which protects the fund from claimants who accumulate high total dollar medical expenses in any given policy year. Increases in stop loss premiums are related to historical losses and the carrier’s perception of emerging large claimants. The stop loss industry attempts to manage to a 70% loss ratio where 70% of every dollar collected in premium is returned in the form of claims and 30% retained for profit and reinsurance costs. Willis Towers Watson supports the Risk Management Division in managing the cost of reinsurance via a variety of stochastic modeling processes. These processes are intended to assist the CCG in selecting the best reinsurance levels. As the table below shows via an active management process, the County has been able to keep its return on reinsurance at a more favorable level and the profit margins sought by the carriers. 7 February 22, 2018 Over the past eight years, the CCG has received $0.97 back in claims payments for each dollar spent in reinsurance and has protected itself from extremely adverse large claimant experience. In 2017, the CCG increased the retention level from $400,000 to $450,000 per claimant per year. This reduced the premium and proved to be good decision, as the additional claims did not offset the reduced premium. In addition, the CCG’s reserves are very healthy, exceeding the Florida Department of Insurance regulations by a wide margin. The department requires that any self-insured public entity be able to demonstrate the rates are adequate to cover emerging claims. Further, they must show possession of unencumbered reserves sufficient to cover the reserve for incurred but not yet paid claims. Although not backed by requirements of statute, they also wish to see an additional two months of claims available to address volatility. The sum of these two amounts would be approximately $9.1 million (excluding OPEB) versus the current carry forward in the health plan account of $31.0 million as of September 30, 2017. The CCG has met the goal of keeping expenses, reinsurance and reserves at a prudent level. Goal #3 – Protect our employees from the economic impacts of illness or injury There are several measures that can be used to assess this goal. For purposes of this report, the assessment is based on the following measures: Out-of-pocket expenses members pay in relation to national data Comparison of primary plan design features (deducible and coinsurance) to other employers Protection for large claimants Evaluating the impact demographics have on these measures There have been no major changes to the health plan since 2009, when the CCG implemented the current health plan design. That change resulted in a cost transfer of approximately 4.5% to employees via higher out-of-pocket expenses. The only changes made since then, were in 2012 when the County made plan changes that resulted in an additional 7% increase in out-of-pocket expenses. The sum of these two figures is 11%, which is far below the national average growth in out-of-pocket expenses. The overall design of the Premium health plan option under which the majority of employees have qualified, continues to benchmark far better than the coverage offered by comparable employers in the southeast region of the United States. The Premium plan, for which the majority of employees have qualified for, has an individual deductible of $400, a family deductible of $800, with a maximum out-of-pocket expense of $1800 for single and $3,600 for family. This compares very favorably to national cost share trends where the average deductible was $1,505 for employees with single coverage and $4,527 for those with family coverage. Finally, on a national basis, annual employee contributions for single coverage were $1,213 and $5,668 for family. In comparison, the average annual single contribution at the CCG was $1,692 and $4,185 for family (note: this calculation excludes constitutionals). 8 February 22, 2018 Claimant Total Paid Primary Diagnosis Secondary Diagnosis 1. Spouse $1,051,038.61 Musculoskeletal Disorders Connective Tissue Diseases 2. Employee $480,040.66 Liver Diseases Organ Transplants 3. Employee $230,983.51 Multiple Myeloma Cancer Therapies 4. Spouse $219,726.79 CAD Lung Cancer Total $1,981,789.57 Claimant Total Paid Primary Diagnosis Secondary Diagnosis 1. Dependent $1,076,838.34 Newborn Care Perinatal Disorders 2. Spouse $323,612.21 Heart Valve Disorders CAD 3. Spouse $310,339.83 Renal Failure Procedure Complications 4. Employee $290,602.40 Complicated GI Disorders Upper GI Disorders 5. Dependent $266,820.18 Procedure Complications Endocardial Diseases 6. Employee $264,961.17 ENT Cancers Misc Cancers 7. Dependent $224,402.00 Newborn Care Congenital Anomalies 8. Employee $220,398.79 Complicated GI Disorders Lower GI Disorders 9. Dependent $219,527.38 Neurotic and Personality Disorders Drug Abuse and Dependence 10. Dependent $206,782.55 Complicated Fx of Neck and Trunk Limb Fractures 11. Spouse $205,586.24 Musculoskeletal Disorders Connective Tissue Diseases Total $3,609,871.09 Claimant Total Paid Primary Diagnosis Secondary Diagnosis 1. Employee $1,589,711.75 Liver Diseases Lower Respiratory Disorders 2. Employee $425,306.73 Prostate Cancer Secondary Malignancy 3. Employee $334,378.47 Peripheral Vascular Diseases Aortic Diseases 4. Spouse $299,315.14 Multiple Myeloma Diseases of Hematopoietic Organs 5. Dependent $267,127.11 Drug Abuse and Dependence Pneumonia 6. Employee $250,509.14 Multiple Myeloma Atrial Fibrillation Total $3,166,348.34 Another goal is to ensure that employees are not compromised financially if they experience a serious illness resulting in large total overall medical expenses. The tables below provide the relationship to the employee, dollars paid, primary and secondary diagnosis associated with claimants that exceeded $200,000 in aggregate paid claims from 2013 to 2016. 2013 2014 2015 9 February 22, 2018 Claimant Total Paid Primary Diagnosis Secondary Diagnosis 1. Dependent $509,334.49 Alcohol Abuse and Dependence Drug Abuse and Dependence 2. Spouse $492,522.67 Multiple Myeloma Cancer Therapies 3. Dependent $435,666.81 Drug Abuse and Dependence Affective Disorders except Depression 4. Employee $382,281.77 Multiple Myeloma Cancer Therapies 5. Spouse $353,311.71 Complicated Misc Symptoms Female Genital Organ Cancer 6. Dependent $322,812.37 Congenital Anomalies Newborn Care 7. Spouse $319,801.21 Bone Diseases Lung Cancer 8. Spouse $267,149.92 Breast Cancer Procedure Complications 9. Spouse $265,535.80 CAD Misc Services 10. Employee $236,362.24 Cancer Therapies Leukemia 11. Employee $226,907.80 Misc Cancers Lung Cancer 12. Employee $221,228.31 CAD Procedure Complications 13. Employee $217,044.67 Renal Failure Syncope 14. Spouse $202,237.01 Procedure Complications Atrial Fibrillation 15. Spouse $202,083.03 Lung Cancer Lymphoma and Lymphosarcoma 16. Employee $201,400.77 Intervertebral Disc Disorders Procedure Complications 17. Employee $200,058.77 Aortic Diseases Thrombophlebitis Total $5,055,739.35 Claimant Total Paid Primary Diagnosis # of Chronic Conditions 1. Employee $659,354.32 Cancer 5 2. Employee $611,364.49 Endocrine/Metabolic Disorders 0 3. Spouse $312,794.60 Cardiac Disorders 7 4. Dependent $311,195.28 Congenital Anomalies 0 5. Dependent $310,166.34 Mental Health 1 6. Employee $300,525.21 Medical/Surgical Complications 10 7. Dependent $287,420.20 Mental Health 3 8. Dependent $243,621.72 Pulmonary Disorders 0 9. Spouse $242,655.33 Cancer 2 10. Spouse $242,624.17 Neurological Disorders 6 11. Employee $242,089.41 Gastrointestinal Disorders 3 12. Employee $223,326.66 Renal/Urologic Disorders 4 13. Spouse $219,467.56 Cancer 1 14. Spouse $213,360.68 Cancer 3 Total $4,419,965.97 2016 2017 As mentioned in past reports, variations in large claimants are the principal reason for cost variances when comparing the budgeted to the actual amount. These tables show there is significant volatility in the overall size and number of large claimants over the last four years. This is one of the principal reasons why it is important to maintain prudent reserves. The financial protection afforded to employees and their dependents that experienced these large accumulations of medical bills is significant. It is likely many, if not all of the individuals above, are enrolled in the premium option. Individuals enrolled in this option had to pay no more than $1,800 in expenses if they used an in network provider. Imagine the economic devastation 10 February 22, 2018 for any employee having health care expenses exceeding $200,000 if they even had to pay 10% of the bills. The charts below show the demographics of the population enrolled in the health plan for 2016 and 2017. Enrollment increased by 30 employees to 2,100. However, the age - gender distribution remained virtually unchanged across the last two years. The CCG has met the goal of providing a competitive health plan that provides significant protection to its employees in the event of an illness or injury. Goal #4 – Population health Since 2009, the CCG has invested in processes to heighten employee and spouse awareness of their health and make available, focused processes to help covered employees and spouses improve and maintain their health. This effort is jointly supported by Community Health Partners, Quest Labs (Midland Health as of 10-1), Willis Towers Watson and internal staff at the CCG. These efforts are focused on addressing what is referred to as the “care gap.” Addressing the care gap involves providing covered members with the necessary support to understand and act upon their physicians’ instructions. Such support processes are sorely lacking under the current health care delivery system. Many believe this care gap is responsible for the continued deterioration of health in the United States, as reported by the Centers for Disease Control. Over the years, due to a comprehensive screening program, the CCG has developed a deep understanding of the prevalence of chronic disease within the population. However, screening and knowledge of one’s health condition does not necessarily bring about change. Many employers are struggling with how to move beyond a process-based screening program and deliver programs bringing about meaningful reductions in patient risk. The County’s programs have achieved meaningful reductions in risk and improvements in outcomes for its population, by delivering programs that help individuals change and address health issues. Following are examples of the successes the CCG program has achieved. During the most recent qualification, there were 34 individuals identified with 4 to 5 risk factors, of these: 59% improved their A1C 51% improved their LDL 57% improved their Triglycerides 78% improved at least 1 risk factor 11 February 22, 2018 24% improved 3 risk factors 25% of those with an AIC above 7% lowered their level to the recommended level of 7% or less During the most recent qualification period, there were 120 individuals identified with diabetes, of these: 57% remained at or under the recommended 7% A1C range 32% of those above the recommended 7% A1C value had improved by at least 1% or met the goal of 7% or less 68% improved at least 1 additional risk factor Notes: Reducing A1C a little less than 1% point reduces cardiovascular risk by 45%. For every percentage decrease in A1C (e.g., 9 to 8%), there was a 35% reduction in the risk of complications (retinopathy, kidney disease, neuropathy). At the current time, employees and spouses undergo lab testing for the presence of chronic disease every other year. Participation in the program has been excellent. Over the last six years, participation has been consistently in excess of 94% for those meeting the necessary qualifiers. This participation rate far exceeds those of large employers nationwide. There are other measures that suggest what is going on with the population’s health. The Verscend system also contains two indexes that allow an employer to judge the relative risk of their population when compared to norms, as well as assess the extent to which employees/providers are adhering to appropriate clinical protocols. Quality and Risk 2013 2014 2015 2016 Average Risk Index 11.51 11.71 11.20 10.01 Average Care Gap Index 1.64 1.85 2.13 1.90 There are two measures in the table above. The first (average risk index) focuses on claims patterns and applies an algorithm that calculates the extent to which the population is at risk to exhibit higher trends than expected. The second (average care gap index) assesses the extent to which individuals are receiving the appropriate care based on a reported diagnosis. A population that has deteriorating biometric measures can still exhibit improved risk and care gap indexes if patients are receiving the appropriate care. In the fourth quarter of 2017, Community Health Partners completed a transition from the Verscend data reporting platform to Deerwalk. As a result, updated risk and care gap information is not available. There are plans to implement the Verscend System via the WillisMed platform to ensure data continuity with respect to these measures. This implementation should be completed in the second quarter and data will be available for next year’s report. In addition, Willis Towers Watson is studying the potential of replacing Verscend reporting with similar algorithms available through Deerwalk. The table above shows the average risk index has improved over the last four years. The care gap index has deteriorated since 2013. However, the more important short term measure is the risk index. 12 February 22, 2018 In addition, the demographics and the disease burden in the population demonstrate why the CCG exhibits higher overall costs when compared to the Collier County Sherriff’s Office, NCH Health Care or the School District of Collier County Florida. Good health is a difficult and long journey, not a destination. Suggestions to continue the journey are in the next section. Challenges The federal legislative front. The election of Donald Trump and a Republican Congress had generated significant speculation concerning the future of the ACA, and many of its features such as the Cadillac tax. However, expectation of reality diverged as the following summary shows: • ACA has not been repealed or replaced • Tax reform Eliminated the tax on individuals for not having coverage Eliminated the ability to deduct medical expenses that exceeded 7.5% of adjusted earnings Eliminated ability for corporations to deduct qualified transportation plan expenses • Penalties for employer mandate were eliminated but not the responsibility to continue the associated reporting • None of the proposals to repeal or replace eliminated the Cadillac tax on health plans • A two year delay in the Cadillac tax was approved by the House and the Senate The Comparative Effectiveness Research Fee will continue to be in place through October 2019. The 2017 fee payable by July 2018 will increase from $2.26 to 2.39. The estimated fee due will be $10,986. • Recommendation: None. This is a mandated cost. Cost impact based on 4,597 covered members. Pay or Play - Offer coverage to employees working more than 30 hours per week • Recommendation: ACA requires that employers must offer coverage to 95% of the eligible population or pay a tax of $2,000 per for all employees working over 30 hours per week. The CCG can exclude certain classes of employees that work 30 hours or less, provided during the look back period stipulated, no more than approximately 90 employees fit into this category. The CCG should limit the number of hours worked by “job bank” employees to 29 hours, so as to not inadvertently exceed the 5% threshold (as well as monitoring other categories of part-time employees who may creep over 29 hours). Penalties for the employer mandate were eliminated by H.R.1, known as the “Tax Cuts and Jobs Act,” but not the responsibility to continue filing and the associated reporting penalties for failing to file. Minimum coverage requirements. The minimum required benefits limit total out of pocket costs under a health plan is $7,350 per individual and $14,700 for a family. 13 February 22, 2018 • Recommendation: The CCG is well within these limits. Affordability Testing. Affordability applies to the employee only and is still in place. There is no affordability requirement with respect to family coverage. Under ACA, the required contribution for employee only coverage cannot exceed 9.5% of 400% of the federal poverty level for that employee. As a rule of thumb, Willis Towers Watson suggests that the contribution cannot exceed $89 per month. The CCG’s required single contribution for the highest salary bracket is just over $80. Although the smoker contribution is higher at just over $151, the lower threshold will apply since employees’ can lower the contribution by meeting the requirements of the plan. Further, the penalty only applies if the person obtains subsidized coverage from a public exchange. • Recommendation: It does not appear that this portion of reform will be an issue for the CCG. However, it may be advisable to look more closely at the lower paid population, since the federal property threshold does vary based on family size. There are likely to be ongoing issues, since employees self-report to the exchange whether coverage meets minimum essential standards or is affordable. Therefore, it is likely the CCG might receive inquiries from state exchanges. Willis Towers Watson will prepare actuarial certifications that the plans offered meet the minimum essential levels and are intended to be affordable. Determining a rate action for the upcoming 2018-2019 fiscal year. Since overall health plan costs have been flat, any calculated increase would be equal to expected trend. Willis Towers Watson is currently utilizing a 6% trend assumption 2019. As a result, the math would suggest a 6% increase in the rates for employees and those utilized for contributing to the fund. • Recommendation: Although the equation would suggest the necessity of a 6% increase, given continued flat trends and the surplus in the fund, the Risk Management Division notified the Budget Office that it was their recommendation no change be made to the current funding rates. Willis Towers Watson agrees with the reasoning put forth for maintaining the current rate structure. Action Items for 2018 and 2017 Recap TPA and Network In 2017, the Risk Management Division in conjunction with Willis Towers Watson conducted an extensive request for proposal process to assess the following firms: Allegiance Benefit Plan Administrator Fees associated with managing and the discounts obtained via the messenger model provider network administered by Community Health Partners for providers within Collier County CIGNA network for outside of Collier County 14 February 22, 2018 Service and fees associated with population health management support services provided by Community Health Partners. This process was run concurrently with the Collier County Public Schools and NCH Healthcare System to optimize market leverage. As a result of this process, the Collier County Government and Collier County Public Schools entered into three-year agreements with options for two additional year extensions with Allegiance Benefit Plan Administrators to provide claims administration and other services associated with the health and dental plans. This new agreement also included the use of the CIGNA network for provider services received outside of Collier County. A similar decision was reached to enter into a new agreement term matching what was negotiated with CIGNA and Allegiance with Community Health Partners. NCH Healthcare System elected to also enter into a multi-your agreement with Allegiance and CIGNA. The decision to do this was based on data that demonstrated a higher overall cost structure for Physicians Regional when compared to NCH. In addition, NCH put into place an additional discount if certain market share requirements were met. Other During 2017, Willis Towers Watson in conjunction with the Risk Management Division continued to work actively with the Collier County Health Care Consortium to monitor the financial performance of the plan, as well as all of the organizations who are members of the Consortium. Other projects included the following: Ongoing assessments of the service levels provided by the David Lawrence Center Evaluating the competitive marketplace for reinsurance alternatives and assessing reinsurance retention levels Completed an evaluation of GASB 45 and transition to GASB 75 Development of rates Contribution modeling Continual assessment of reserve levels and FS 112 filings Addressing provider requests for fee schedule revisions The purpose of these efforts is to continue to proactively identify opportunities to control costs and improve health outcomes. Physicians Regional Medical Center Facilities At the present time, the design of the CCG’s health plan contains a provision that applies a separate additional deductible for members who receive care at a PPRMC facility on either an in or outpatient basis. In return for this, NCH provided deeper discounts along with an additional annual discount settlement should certain market share targets be met. For the most recent year, this resulted in an additional discount worth approximately $20,000 to the CCG from NCH. 15 February 22, 2018 At the end of last year, Scott Lowe the CEO of Physicians Regional Medical Center approached Community Health Partners and the Risk Management Division concerning opening a dialogue regarding eliminating this additional deductible. Willis Towers Watson is updating cost and outcome information. Once this information is updated, an overall strategy will be developed to reply to PRMC’s request. Assess Reserve Status As noted earlier in this report, the reserve in the health fund has grown significantly. The suggested reserve would be in the range of $7.4 to $8.5 million (excluding the OPEB calculation). This presents a dilemma. On one hand, had the program not been self-insured this would have been an underwriting gain and profit to the insurance company. With the diligence of the Risk Management Division, the program has been administered very efficiently, producing the significant reserve that exists today. Willis Towers Watson does not suggest that rates be reduced. There are no industry experts that are predicting deflation of medical expenses at this time. All experts expect continued health care escalations. Reducing rates to reduce reserves just means rates would need to be increased by a significant amount at a later date to make up for the reduction, as well as trend. For this reason, we suggested that rates remain unchanged. If the CCG believes reserves are greater than needed, it could consider suspending contributions to the general fund and waive employee contributions for a specified period. This will return funds to both the CCG as well as employees. Significant positive messaging could be built around this, recognizing that both the CCG and the employee have struggled for several years with a declining tax base and significant revenue challenges. Another potential strategy would be to migrate from the current 80/20 split to an 85/15 in the cost of the health plan. This would substitute a tax-free contribution to the health plan with taxable cost and increase the CCG’s payroll taxes. Nonetheless, this would place additional money in employee’s pockets. In reaching any decision, it’s important to note that the plan has performed more favorably than anticipated and that the 80 twentieths split is not being achieved. The actual average split, based on actual costs, results in the employee sharing 17.3% and the County funding the remaining 82.7% during the last year. Renegotiation of Terms with EnvisionRx The current agreement with EnvisionRx allows the CCG to extend the agreement for an additional two-year period. The pharmacy benefit marketplace has been changing significantly. A negotiation strategy has been agreed upon and will be executed in conjunction with the Collier County Public Schools. The strategy will embody the following: 16 February 22, 2018 Interviews with four pharmacy benefit managers who have unique value propositions. Utilization of this interview process to negotiate the best possible terms for the upcoming year with EnvisionRx. Determine whether there are additional strategies in the marketplace that may benefit the CCG. If it appears beneficial, the contract will be extended for one year versus two and a competitive bidding process undertaken for 2020. Other projects In addition to the above, the following projects are also scheduled for this year: Competitively bid administration of the short-term disability and insured core plus buy up long-term disability and group term life insurance. As part of this process, assess the costs and benefits of outsourcing family leave administration. Market the current medical excess program, as well as assess changes to the retention level. Assess EAP options in light of the new emotional wellness program. Complete the benefit statement project. Assess access to additional life insurance for dependents and spouses Audit the performance of Allegiance Benefit Plan Administrators. Participate in the Willis Towers Waterson financial benchmarks survey. Are there any additional items the County Executive leadership believes are important for Risk Management and Willis Towers Watson to assess? PRMC vs. NCH Data Sheet Florida Agency for Health Care Administration http://www.floridahealthfinder.gov/QueryTool/QTResults.aspx?T=I Inpatient Total Results - PRMC average cost per admission is consistently 2 to 4 times NCH Commercial Results - PRMC average cost per admission is consistently 2 to 5 times NCH Total Results - PRMC has lower average length of stay Commercial Results - PRMC has lower average length of stay Outpatient Total Results - PRMC average cost per visit is consistently 1.5 to 2 times NCH Commercial Results - PRMC average cost per visit is consistently 1.5 to 2 times NCH Emergency Dept.Total Results - PRMC average cost per visit averages 20% to 30% higher than NCH Commercial Results - PRMC average cost per visit averages 20% to 30% higher than NCH Medicare.Gov https://www.medicare.gov/hospitalcompare/search.html This link can be used to compare NCH to Physicians Regional For details please see pdf file named: medicare.gov_HospitalCompare 1 Overall Rating: NCH - 5 Stars / PRMC 2 Stars Florida Hospital Association http://www.fha.org/reports-and-resources/facts-and-stats.aspx This is a site that provides interactive reporting for Florida hospitals and medical facilities. Inpatient, Outpatient, and Emergency Department statistics on Florida facilities; regarding discharges, patient days, average lengths of stay, and charges for 2014, 2015 and 2016. Data can be filtered to drill down and group by 16 additional criteria including county, facility, payer type, services, and patient demographics. There are numerous graphs and charts which could be utilized in marketing information. A cursory review seems to suggest that NCH outperforms or is equal to Physicians in most quality and patient satisfaction measures, and has a higher overall rating. (Personal note: in looking at the details on this web site I did not see a lot of differences in quality between the two hospitals.) This is based on information regarding number of hospitals beds etc. There are a set of utilization data reports which appear to provide information on discharges patient days patient service makes average length of stay and others. Limited information about PRMS. I suspect they do not belong to the FHA. Versend Billed Amounts and Records Billed Amount $Billed Amount %Record Count #Record Count %Cost per Record Inpatient: PRMC $15,139,952 47.6%2,475 22.3%$6,117 NCH $16,693,680 52.4%8,644 77.7%$1,931 Sub-Total $31,833,632 11,119 $2,863 Outpatient: PRMC $13,730,866 55.7%6,743 24.8%$2,036 NCH $10,927,354 44.3%20,406 75.2%$535 Sub-Total $24,658,220 27,149 $908 Emergency Room: PRMC $5,036,896 32.6%5,250 20.5%$959 NCH $10,425,144 67.4%20,407 79.5%$511 Sub-Total $15,462,040 25,657 $603 Total of All: PRMC $33,907,714 47.1%14,468 22.6%$2,344 NCH $38,046,178 52.9%49,457 77.4%$769 Total $71,953,892 63,925 $1,126 Records are approximately the same as the number of services. Versend Procedure Code Comparison PRMC NCH Avg Billed Avg Billed 36415 $30.80 $8.43 265% 80053 $109.49 $105.22 4% 80061 $120.79 $46.23 161% 99284 $2,969.14 $1,807.31 64% 99283 $1,629.75 $773.78 111% R710 $3,075.76 $2,328.61 32% 99285 $3,529.49 $1,913.66 84% 71020 $622.84 $477.16 31% 82550 $163.73 $159.14 3% 86900 $94.04 $83.00 13% 86901 $99.24 $62.00 60% 71010 $474.11 $389.19 22% Emergency Dept Visit Emergency Dept Visit Recovery Room Emergency Dept Visit Chest X-Ray 2Vw Frontal&Latl Difference Assay Of Ck (Cpk) Blood Typing, Abo Blood Typing, Rh (D) Chest X-Ray 1 View Frontal Comprehen Metabolic Panel Lipid Panel Routine Venipuncture Procedure Desc Using data from the Collier County Government and the Collier County Public Schools, we reviewed the cost differences for over 200 outpatient procedure codes. Overall the PRMC average was 106% higher than NCH. Recognizing that the above may not fairly portray the differences between the two facilities, (due to severity, quantity of service, statistical validity, etc.) we offer the following procedure codes as examples: Procedure Code 74176 $8,348.31 $4,599.42 82% 81025 $325.68 $190.00 71% 93017 $2,985.25 $1,418.57 110% 74177 $11,428.65 $7,009.19 63% 87040 $606.60 $543.82 12% 72125 $5,174.72 $5,048.43 3% 85025 $82.97 $131.51 -37% 80048 $83.61 $232.33 -64% Medicare Stats PRMC NCH Colonoscopy follow-up: 100%96% 100%86% Emergency department care: 36 minutes 50 minutes High Very High 10 minutes 29 minutes Preventive care: 97%98% 47%86% Surgical complications No Different No Different 2.3%2.5% Better No Different No Different No Different Infections: Better Better Better Worse 0.089 1.647 0.982 0.589 0.480 1.505 0.693 1.176 30-day death rates: 7.90%8.10% 13.4%12.6% 12.5%12.0% 15.4%16.8% 17.3%16.1% Unplanned hospital visits: 17.8%18.1% 15.4%14.2% 21.6%19.1% 16.2%14.5% 11.2%11.0% Ct Abd & Pelvis W/O Contrast Urine Pregnancy Test Metabolic Panel Total Ca Blood Culture For Bacteria Ct Neck Spine W/O Dye Complete Cbc W/Auto Diff Wbc Cardiovascular Stress Test Ct Abd & Pelv W/Contrast Average (median) time patients spent in the emergency department, before they were seen by a healthcare professional Patients assessed and given influenza vaccination Percentage of patients receiving appropriate recommendations for follow-up screening colonoscopy Percentage of patients with history of polyps receiving follow-up colonoscopy in the appropriate timeframe Average (median) time patients who came into emergency department with broken bones had to wait before getting pain medication Emergency department volume Deaths among patients with serious treatable complications after surgery Central line-associated bloodstream infections in ICUs and select wards Catheter-associated urinary tract infractions in ICUs and select wards Catheter-associated urinary tract infractions in ICUs and select wards Healthcare workers given influenza vaccination Rate of complications for hip/knee replacement patients Rate of complications for hip/knee replacement patients Serious Complications Clostridium difficile intestinal infections Death rate for COPD patients Death rate for heart attack patients Surgical site infections from colon surgery Methicillin-resistant staphylococcus aureus blood infections Rate of readmission for heart attack patients Rate of readmission for heart failure patients Death rate for stroke patients Rate of readmission for chronic obstructive pulmonary disease Death rate for heart failure patients Death rate for pneumonia patients Rate of readmission for pneumonia patients Rate of readmission for stroke patients 4.4%3.9% 16.4 16.4 15.5%13.6% Imaging: 9.3%0.5% 3.6%0.2% 7.9%5.1% 0.9%1.2% Payment: $24,072 $22,281 $16,148 $16,668 $20,132 $23,123 $15,191 $17,026 Key: No different - No different than the National Rate Better - Better than the National Rate Less - Less than the National Rate Worse - Worse than the National Rate Rate of readmission after discharge from hospital (hospital-wide) Outpatient CT scans of abdomen that were "combination" (double) scans Rate of readmission for hip/knee replacement Rate of unplanned hospital visits after an outpatient colonoscopy Payment for pneumonia patients Payment for heart failure patients Payment for hip/knee replacement patients Outpatient CT scans of chest that were "combination" (double) scans Outpatients who got cardiac imaging stress tests before low-risk outpatient Outpatients with brain CT scans who got a sinus CT at the same time Payment for heart attack patients Florida Health Finder AHCA File Number 120006 NCH HEALTHCARE SYSTEM NORTH NAPLES HOSPITAL CAMPUS 16,865 40.95%68,260 39.33%4.05 $389,385,523 20.49%$23,088 100018 NAPLES COMMUNITY HOSPITAL 14,766 35.85%70,716 40.75%4.79 $700,744,240 36.88%$47,457 23960025 PHYSICIANS REGIONAL MEDICAL CENTER - PINE RIDGE 6,317 15.34%22,950 13.22%3.63 $568,123,885 29.90%$89,936 23960057 PHYSICIANS REGIONAL MEDICAL CENTER - COLLIER BOULEVARD 3,236 7.86%11,616 6.69%3.59 $241,790,233 12.73%$74,719 41,184 100.00%173,542 100.00%4.21 $1,900,043,881 100.00%$46,135 AHCA File Number 120006 NCH HEALTHCARE SYSTEM NORTH NAPLES HOSPITAL CAMPUS 16,763 39.65%69,201 38.41%4.13 $375,169,499 20.80%$22,381 100018 NAPLES COMMUNITY HOSPITAL 16,520 39.08%76,827 42.64%4.65 $701,713,808 38.91%$42,477 23960025 PHYSICIANS REGIONAL MEDICAL CENTER - PINE RIDGE 6,003 14.20%23,193 12.87%3.86 $511,958,725 28.39%$85,284 23960057 PHYSICIANS REGIONAL MEDICAL CENTER - COLLIER BOULEVARD 2,987 7.07%10,960 6.08%3.67 $214,476,914 11.89%$71,803 42,273 100.00%180,181 100.00%4.26 $1,803,318,946 100.00%$42,659 AHCA File Number 120006 NCH HEALTHCARE SYSTEM NORTH NAPLES HOSPITAL CAMPUS 16,202 39.63%64,037 37.09%3.95 $335,444,942 19.64%$20,704 100018 NAPLES COMMUNITY HOSPITAL 15,774 38.59%71,347 41.32%4.52 $632,427,706 37.03%$40,093 23960025 PHYSICIANS REGIONAL MEDICAL CENTER - PINE RIDGE 5,921 14.48%26,003 15.06%4.39 $534,455,715 31.29%$90,264 23960057 PHYSICIANS REGIONAL MEDICAL CENTER - COLLIER BOULEVARD 2,983 7.30%11,286 6.54%3.78 $205,738,467 12.05%$68,970 40,880 100.00%172,673 100.00%4.22 $1,708,066,830 100.00%$41,782 2016 Inpatient Hospital Total Results % of Tot. % of Tot.Patient Days % of Tot.Avg. LOS Grand Total Hospital Name Discharges Total Charges % of Tot.Avg. Charges Grand Total 2015 Inpatient Hospital Total Results Avg. LOS Total Charges % of Tot.Avg. ChargesHospital Name Discharges % of Tot.Patient Days Hospital Name Discharges % of Tot.Patient Days % of Tot. 2014 Inpatient Hospital Total Results Avg. LOS Total Charges % of Tot.Avg. Charges Grand Total Florida Health Finder AHCA File Number 120006 NCH HEALTHCARE SYSTEM NORTH NAPLES HOSPITAL CAMPUS 4,022 49.45%13,025 46.12%3.24 $76,505,217 22.92%$19,022 100018 NAPLES COMMUNITY HOSPITAL 2,460 30.25%10,434 36.94%4.24 $116,373,794 34.86%$47,306 23960025 PHYSICIANS REGIONAL MEDICAL CENTER - PINE RIDGE 1,133 13.93%3,319 11.75%2.93 $104,101,986 31.18%$91,882 23960057 PHYSICIANS REGIONAL MEDICAL CENTER - COLLIER BOULEVARD 518 6.37%1,465 5.19%2.83 $36,871,859 11.04%$71,181 8,133 100.00%28,243 100.00%3.47 $333,852,856 100.00%$41,049 AHCA File Number 120006 NCH HEALTHCARE SYSTEM NORTH NAPLES HOSPITAL CAMPUS 4,039 47.29%13,127 44.96%3.25 $73,704,305 22.30%$18,248 100018 NAPLES COMMUNITY HOSPITAL 2,749 32.19%10,853 37.17%3.95 $114,144,096 34.54%$41,522 23960025 PHYSICIANS REGIONAL MEDICAL CENTER - PINE RIDGE 1,230 14.40%3,780 12.95%3.07 $106,791,016 32.31%$86,822 23960057 PHYSICIANS REGIONAL MEDICAL CENTER - COLLIER BOULEVARD 523 6.12%1,436 4.92%2.75 $35,862,071 10.85%$68,570 8,541 100.00%29,196 100.00%3.42 $330,501,488 100.00%$38,696 AHCA File Number 120006 NCH HEALTHCARE SYSTEM NORTH NAPLES HOSPITAL CAMPUS 3,789 48.13%12,223 45.10%3.23 $64,332,731 21.67%$16,979 100018 NAPLES COMMUNITY HOSPITAL 2,470 31.37%9,416 34.74%3.81 $97,164,916 32.73%$39,338 23960025 PHYSICIANS REGIONAL MEDICAL CENTER - PINE RIDGE 1,141 14.49%3,940 14.54%3.45 $103,165,418 34.75%$90,417 23960057 PHYSICIANS REGIONAL MEDICAL CENTER - COLLIER BOULEVARD 473 6.01%1,523 5.62%3.22 $32,239,865 10.86%$68,160 7,873 100.00%27,102 100.00%3.44 $296,902,930 100.00%$37,712 2016 Inpatient Hospital Commercial Insurance Results Hospital Name Discharges % of Tot.Patient Days % of Tot.Avg. LOS Total Charges % of Tot.Avg. Charges Grand Total 2015 Inpatient Hospital Commercial Insurance Results Hospital Name Discharges % of Tot.Patient Days % of Tot.Avg. LOS Total Charges Total Charges % of Tot.Avg. Charges Grand Total % of Tot.Avg. Charges Grand Total 2014 Inpatient Hospital Commercial Insurance Results Hospital Name Discharges % of Tot.Patient Days % of Tot.Avg. LOS Florida Health Finder AHCA File Number 120006 NCH HEALTHCARE SYSTEM NORTH NAPLES HOSPITAL CAMPUS 5,219 19.44%$72,889,419 12.91%$13,966 100018 NAPLES COMMUNITY HOSPITAL 7,661 28.53%$123,072,676 21.80%$16,065 23960025 PHYSICIANS REGIONAL MEDICAL CENTER - PINE RIDGE 6,950 25.89%$222,898,616 39.48%$32,072 23960057 PHYSICIANS REGIONAL MEDICAL CENTER - COLLIER BOULEVARD 7,019 26.14%$145,705,559 25.81%$20,759 26,849 100.00%$564,566,270 100.00%$21,027 AHCA File Number 120006 NCH HEALTHCARE SYSTEM NORTH NAPLES HOSPITAL CAMPUS 5,113 19.84%$65,233,273 12.92%$12,758 100018 NAPLES COMMUNITY HOSPITAL 7,478 29.02%$125,293,702 24.82%$16,755 23960025 PHYSICIANS REGIONAL MEDICAL CENTER - PINE RIDGE 6,859 26.62%$195,917,602 38.81%$28,564 23960057 PHYSICIANS REGIONAL MEDICAL CENTER - COLLIER BOULEVARD 6,319 24.52%$118,423,923 23.46%$18,741 25,769 100.00%$504,868,500 100.00%$19,592 AHCA File Number 120006 NCH HEALTHCARE SYSTEM NORTH NAPLES HOSPITAL CAMPUS 3,524 15.38%$46,037,880 10.26%$13,064 100018 NAPLES COMMUNITY HOSPITAL 7,223 31.53%$118,712,670 26.47%$16,435 23960025 PHYSICIANS REGIONAL MEDICAL CENTER - PINE RIDGE 6,947 30.32%$182,853,779 40.76%$26,321 23960057 PHYSICIANS REGIONAL MEDICAL CENTER - COLLIER BOULEVARD 5,215 22.76%$100,952,763 22.51%$19,358 22,909 100.00%$448,557,092 100.00%$19,580 2016 Outpatient Ambulatory Surgery Total Results Hospital Name Visits % of Tot.Total Charges % of Tot.Avg. Charges Grand Total 2015 Outpatient Ambulatory Surgery Total Results Hospital Name Visits % of Tot.Total Charges % of Tot.Avg. Charges Grand Total 2014 Outpatient Ambulatory Surgery Total Results Hospital Name Visits % of Tot.Total Charges % of Tot.Avg. Charges Grand Total Florida Health Finder AHCA File Number 120006 NCH HEALTHCARE SYSTEM NORTH NAPLES HOSPITAL CAMPUS 2,538 28.18%$36,927,001 20.48%$14,550 100018 NAPLES COMMUNITY HOSPITAL 2,331 25.89%$33,972,179 18.84%$14,574 23960025 PHYSICIANS REGIONAL MEDICAL CENTER - PINE RIDGE 2,302 25.56%$59,928,710 33.23%$26,033 23960057 PHYSICIANS REGIONAL MEDICAL CENTER - COLLIER BOULEVARD 1834 20.37%$49,521,133 27.46%$27,002 9,005 100.00%$180,349,023 100.00%$20,028 AHCA File Number 120006 NCH HEALTHCARE SYSTEM NORTH NAPLES HOSPITAL CAMPUS 2,453 27.88%$32,435,154 19.18%$13,223 100018 NAPLES COMMUNITY HOSPITAL 2,133 24.24%$32,008,796 18.93%$15,006 23960025 PHYSICIANS REGIONAL MEDICAL CENTER - PINE RIDGE 2,409 27.38%$61,458,285 36.34%$25,512 23960057 PHYSICIANS REGIONAL MEDICAL CENTER - COLLIER BOULEVARD 1804 20.50%$43,216,311 25.55%$23,956 8,799 100.00%$169,118,546 100.00%$19,220 AHCA File Number 120006 NCH HEALTHCARE SYSTEM NORTH NAPLES HOSPITAL CAMPUS 1,635 21.72%$22,521,326 15.58%$13,775 100018 NAPLES COMMUNITY HOSPITAL 2,049 27.21%$29,584,504 20.47%$14,439 23960025 PHYSICIANS REGIONAL MEDICAL CENTER - PINE RIDGE 2,438 32.38%$58,785,197 40.67%$24,112 23960057 PHYSICIANS REGIONAL MEDICAL CENTER - COLLIER BOULEVARD 1407 18.69%$33,634,742 23.27%$23,905 7,529 100.00%$144,525,769 100.00%$19,196 2016 Outpatient Ambulatory Surgery Commercial Insurance Results Hospital Name Visits % of Tot.Total Charges % of Tot.Avg. Charges Grand Total 2015 Outpatient Ambulatory Surgery Commercial Insurance Results Total Charges % of Tot.Avg. Charges Grand Total 2014 Outpatient Ambulatory Surgery Commercial Insurance Results Hospital Name Visits % of Tot. Total Charges % of Tot.Avg. Charges Grand Total Hospital Name Visits % of Tot. Florida Health Finder AHCA File Number 120006 NCH HEALTHCARE SYSTEM NORTH NAPLES HOSPITAL CAMPUS 46,167 35.81%$228,876,269 31.46%$4,958 100018 NAPLES COMMUNITY HOSPITAL 46,662 36.19%$261,427,657 35.93%$5,603 23960025 PHYSICIANS REGIONAL MEDICAL CENTER - PINE RIDGE 16,355 12.68%$118,338,947 16.26%$7,236 23960057 PHYSICIANS REGIONAL MEDICAL CENTER - COLLIER BOULEVARD 19,754 15.32%$118,940,436 16.35%$6,021 128,938 100.00%$727,583,309 100.00%$5,643 AHCA File Number 120006 NCH HEALTHCARE SYSTEM NORTH NAPLES HOSPITAL CAMPUS 46,751 41.31%$199,475,314 34.30%$4,267 100018 NAPLES COMMUNITY HOSPITAL 29,260 25.86%$182,178,975 31.33%$6,226 23960025 PHYSICIANS REGIONAL MEDICAL CENTER - PINE RIDGE 17,416 15.39%$96,365,057 16.57%$5,533 23960057 PHYSICIANS REGIONAL MEDICAL CENTER - COLLIER BOULEVARD 19,736 17.44%$103,506,830 17.80%$5,245 113,163 100.00%$581,526,176 100.00%$5,139 AHCA File Number 120006 NCH HEALTHCARE SYSTEM NORTH NAPLES HOSPITAL CAMPUS 47,151 42.07%$166,395,150 33.39%$3,529 100018 NAPLES COMMUNITY HOSPITAL 27,323 24.38%$145,598,148 29.22%$5,329 23960025 PHYSICIANS REGIONAL MEDICAL CENTER - PINE RIDGE 17,988 16.05%$92,406,778 18.54%$5,137 23960057 PHYSICIANS REGIONAL MEDICAL CENTER - COLLIER BOULEVARD 19,619 17.50%$93,923,756 18.85%$4,787 112,081 100.00%$498,323,832 100.00%$4,446 2016 Emergency Department Total Results Hospital Name Visits % of Tot.Total Charges % of Tot.Avg. Charges Grand Total 2015 Emergency Department Total Results Hospital Name Visits % of Tot.Total Charges % of Tot.Avg. Charges Grand Total 2014 Emergency Department Total Results Hospital Name Visits % of Tot.Total Charges % of Tot.Avg. Charges Grand Total Florida Health Finder AHCA File Number 120006 NCH HEALTHCARE SYSTEM NORTH NAPLES HOSPITAL CAMPUS 12,142 34.91%$62,867,024 31.98%$5,178 100018 NAPLES COMMUNITY HOSPITAL 13,180 37.89%$66,056,086 33.61%$5,012 23960025 PHYSICIANS REGIONAL MEDICAL CENTER - PINE RIDGE 4,663 13.41%$34,925,526 17.77%$7,490 23960057 PHYSICIANS REGIONAL MEDICAL CENTER - COLLIER BOULEVARD 4798 13.79%$32,708,438 16.64%$6,817 34,783 100.00%$196,557,074 100.00%$5,651 AHCA File Number 120006 NCH HEALTHCARE SYSTEM NORTH NAPLES HOSPITAL CAMPUS 12,488 41.76%$57,147,355 35.59%$4,576 100018 NAPLES COMMUNITY HOSPITAL 7,599 25.41%$43,858,436 27.31%$5,772 23960025 PHYSICIANS REGIONAL MEDICAL CENTER - PINE RIDGE 4,999 16.72%$29,870,688 18.60%$5,975 23960057 PHYSICIANS REGIONAL MEDICAL CENTER - COLLIER BOULEVARD 4820 16.12%$29,715,186 18.50%$6,165 29,906 100.00%$160,591,665 100.00%$5,370 AHCA File Number 120006 NCH HEALTHCARE SYSTEM NORTH NAPLES HOSPITAL CAMPUS 11,198 41.89%$43,273,624 33.88%$3,864 100018 NAPLES COMMUNITY HOSPITAL 6,255 23.40%$32,346,903 25.32%$5,171 23960025 PHYSICIANS REGIONAL MEDICAL CENTER - PINE RIDGE 4,961 18.56%$27,695,354 21.68%$5,583 23960057 PHYSICIANS REGIONAL MEDICAL CENTER - COLLIER BOULEVARD 4316 16.15%$24,413,151 19.11%$5,656 26,730 100.00%$127,729,032 100.00%$4,778 2016 Emergency Department Commercial Insurance Results Hospital Name Visits % of Tot.Total Charges % of Tot.Avg. Charges Grand Total 2015 Emergency Department Commercial Insurance Results Hospital Name Visits % of Tot.Total Charges % of Tot.Avg. Charges Grand Total Grand Total 2014 Emergency Department Commercial Insurance Results Hospital Name Visits % of Tot.Total Charges % of Tot.Avg. Charges Versend Hospital Totals Billed Amount %Record Count % PRMC $33,907,714 47.1%14,468 22.6% NCH $38,046,178 52.9%49,457 77.4% Grand Total $71,953,892 100.0%63,925 100.0% Records are approximately the same as the number of services Versend Billed Amounts and Records Billed Amount $Billed Amount %Record Count #Record Count %Cost per Record Inpatient: PRMC $15,139,952 47.6%2,475 22.3%$6,117 NCH $16,693,680 52.4%8,644 77.7%$1,931 Sub-Total $31,833,632 11,119 $2,863 Outpatient: PRMC $13,730,866 55.7%6,743 24.8%$2,036 NCH $10,927,354 44.3%20,406 75.2%$535 Sub-Total $24,658,220 27,149 $908 Emergency Room: PRMC $5,036,896 32.6%5,250 20.5%$959 NCH $10,425,144 67.4%20,407 79.5%$511 Sub-Total $15,462,040 25,657 $603 Total of All: PRMC $33,907,714 47.1%14,468 22.6%$2,344 NCH $38,046,178 52.9%49,457 77.4%$769 Total $71,953,892 63,925 $1,126 Versend Procedure Code Comparison Avg Billed Count Avg Billed Count 36415 Routine Venipuncture $8.43 1,381 $30.80 368 80053 Comprehen Metabolic Panel $105.22 815 $109.49 212 80061 Lipid Panel $46.23 570 $120.79 43 99284 Emergency Dept Visit $1,807.31 461 $2,969.14 120 99283 Emergency Dept Visit $773.78 374 $1,629.75 80 R710 Recovery Room $2,328.61 297 $3,075.76 173 99285 Emergency Dept Visit $1,913.66 239 $3,529.49 62 71020 Chest X-Ray 2Vw Frontal&Latl $477.16 147 $622.84 48 82550 Assay Of Ck (Cpk)$159.14 147 $163.73 19 86900 Blood Typing, Abo $83.00 143 $94.04 31 86901 Blood Typing, Rh (D)$62.00 143 $99.24 31 71010 Chest X-Ray 1 View Frontal $389.19 130 $474.11 59 74176 Ct Abd & Pelvis W/O Contrast $4,599.42 129 $8,348.31 38 81025 Urine Pregnancy Test $190.00 90 $325.68 43 93017 Cardiovascular Stress Test $1,418.57 75 $2,985.25 9 74177 Ct Abd & Pelv W/Contrast $7,009.19 50 $11,428.65 25 87040 Blood Culture For Bacteria $543.82 45 $606.60 16 72125 Ct Neck Spine W/O Dye $5,048.43 38 $5,174.72 8 85025 Complete Cbc W/Auto Diff Wbc $131.51 1,107 $82.97 235 80048 Metabolic Panel Total Ca $232.33 777 $83.61 103 Procedure Code Procedure Desc NCH PRMC Medicare Stats PRMC NCH Colonoscopy follow-up: 100%96% 100%86% Emergency department care: 36 minutes 50 minutes 0%1% High Very High 248 minutes 283 minutes 116 minutes 135 minutes 127 minutes 136 minutes 10 minutes 29 minutes Preventive care: 97%98% 47%86% Blood clot prevention: 4%3% Surgical complications No Different No Different 2.3%2.5% Better No Different No Different No Different Infections: Better Better Better Worse 0.089 1.647 No Different No Different 0.982 0.589 Not Available No Different No Different No Different 0.480 1.505 No Different No Different 0.693 1.176 30-day death rates: No Different No Different 7.90%8.10% No Different No Different 13.4%12.6% No Different No Different 12.5%12.0% No Different No Different 15.4%16.8% Surgical site infections from colon surgery Rate of complications for hip/knee replacement patients Serious Complications Deaths among patients with serious treatable complications after surgery Central line-associated bloodstream infections in ICUs and select wards Catheter-associated urinary tract infractions in ICUs and select wards Death rate for pneumonia patients Surgical site infections from abdominal hysterectomy Methicillin-resistant staphylococcus aureus blood infections Clostridium difficile intestinal infections Clostridium difficile intestinal infections Death rate for COPD patients Death rate for COPD patients Death rate for heart attack patients Death rate for heart attack patients Death rate for heart failure patients Death rate for heart failure patients Death rate for pneumonia patients Rate of complications for hip/knee replacement patients Catheter-associated urinary tract infractions in ICUs and select wards Surgical site infections from colon surgery Methicillin-resistant staphylococcus aureus blood infections Percentage of patients receiving appropriate recommendations for follow-up screening colonoscopy Percentage of patients with history of polyps receiving follow-up colonoscopy in the appropriate timeframe Average (median) time patients who came into emergency department with broken bones had to wait before getting pain medication Percentage of patients who left the emergency department without being seen Average (median) time patients spent in the emergency department, before they were admitted to the hospital as an inpatient Emergency department volume Patients who developed a blood clot while in the hospital who did not get treatment that could have prevented it Average (median) time patients spent in the emergency department, after their doctor decided to admit them as inpatient before leaving the emergency department for their room Average (median) time patients spent in the emergency department, before leaving from the visit Average (median) time patients spent in the emergency department, before they were seen by a healthcare professional Patients assessed and given influenza vaccination Healthcare workers given influenza vaccination No Different No Different 17.3%16.1% Not Available Better Unplanned hospital visits: No Different No Different 17.8%18.1% No Different Better 15.4%14.2% Average Average No Different Better 21.6%19.1% Average Average No Different Better 16.2%14.5% No Different No Different 11.2%11.0% Not Available No Different Not Available 11.9% No Different No Different 4.4%3.9% No Different No Different 16.4 16.4 No Different Better 15.5%13.6% Imaging: 34.10%Not Available 10.20%Not Available 9.3%0.5% 3.6%0.2% 7.9%5.1% 0.9%1.2% Payment: No different No different $24,072 $22,281 No different No different $16,148 $16,668 Less Greater $20,132 $23,123 Less No different $15,191 $17,026 Value of care: No Different No Different No Different No Different Rate of complications for hip/knee replacement patients No Different No Different No Different No Different Key: No different - No different than the National Rate Better - Better than the National Rate Less - Less than the National Rate Worse - Worse than the National Rate Rate of readmission for heart failure patients Rate of readmission for heart failure patients Hospital return days for heart failure patients Rate of readmission for pneumonia patients Death rate for stroke patients Death rate for stroke patients Death rate for CABG surgery patients Rate of readmission for chronic obstructive pulmonary disease Rate of readmission for chronic obstructive pulmonary disease Rate of readmission for heart attack patients Rate of readmission for hip/knee replacement Rate of unplanned hospital visits after an outpatient colonoscopy Rate of unplanned hospital visits after an outpatient colonoscopy Rate of readmission after discharge from hospital (hospital-wide) Rate of readmission for pneumonia patients Rate of readmission for stroke patients Rate of readmission for stroke patients Rate of readmission for coronary bypass graft surgery patients Rate of readmission for coronary bypass graft surgery patients Rate of readmission for hip/knee replacement Rate of readmission for heart attack patients Hospital return days for heart attack patients Payment for hip/knee replacement patients Rate of readmission after discharge from hospital (hospital-wide) Outpatients who got cardiac imaging stress tests before low-risk outpatient surgery Outpatient CT scans of chest that were "combination" (double) scans Outpatient CT scans of abdomen that were "combination" (double) scans Outpatients with brain CT scans who got a sinus CT at the same time Outpatients with low back pain who had an MRI without trying recommended treatments (such as physical therapy) first Outpatients who had a follow-up mammogram, breast ultrasound or breast MRI with the 45 days after a screening mammogram Payment for heart attack patients Payment for heart attack patients Payment for heart failure patients Payment for heart failure patients Payment for hip/knee replacement patients Payment for pneumonia patients Payment for pneumonia patients Death rate for heart attack patients Death rate for heart failure patients Death rate for pneumonia patients Data Sources Florida Agency for Health Care Administration http://www.floridahealthfinder.gov/QueryTool/QTResults.aspx?T=I This is a site that provides interactive reporting for Florida hospitals and medical facilities. Inpatient, Outpatient, and Emergency Department statistics on Florida facilities; regarding discharges, patient days, average lengths of stay, and charges for 2014, 2015 and 2016. Data can be filtered to drill down and group by 16 additional criteria including county, facility, payer type, services, and patient demographics. The resulting reports are then downloadable to Excel or csv files. See the following tabs for results: FHF Inpatient, FHF Outpatient, and FHF ER Florida Hospital Association http://www.fha.org/reports-and-resources/facts-and-stats.aspx This is based on information regarding number of hospitals beds etc. There are a set of utilization data reports which appear to provide information on discharges patient days patient service makes average length of stay and Limited information about PRMS. I suspect they do not belong to the FHA. Medicare.Gov https://www.medicare.gov/hospitalcompare/search.html This link can be used to compare NCH to Physicians Regional There are numerous graphs and charts which could be utilized in marketing information. A cursory review seems to suggest that NCH outperforms or is equal to Physicians in most quality and patient satisfaction measures, and has a higher overall rating. For details please see pdf file named: medicare.gov_HospitalCompare 1 Overall Rating: NCH - 5 Stars / PRMC 2 Stars (Personal note: in looking at the details on this web site I did not see a lot of differences in quality between the two hospitals.) NCH PRMS For individual admissions for which billed charges exceed Billed Charges $100,000 $150,000 $35,000.00, reimbursement will be based on DRG at $9,000.00 per CMS weight rate, up to the first $35,000.00, a discount of Stop Loss Limit $35,000 $51,500 50% will apply to the Inpatient Hospital charges in excess of $35,000.00 for that claim. Balance $65,000 $98,500 Reimbursement % on Balance 50%48% Reimbursement $ on Balance $32,500 $47,280 Reimbursement Up to the Stop Loss Limit $18,000 $27,590 (assume CMS weight of 2) Total Allowable for the Hospital $50,500 $74,870 NCH PRMC CCG INP DRG Based (Rate = 9,000) DRG Based (Rate = 13,795) OUTP Discount 49% Billed Chgs Discount 48.9% Billed Chgs CCPS INP Discount 43% Billed Chgs DRG Based (Rate = 13,795) OUTP Discount 43% Billed Chgs Discount 48.9% Billed Chgs CCSO INP Discount 43% Billed Chgs DRG Based (Rate = 13,795) OUTP Discount 43% Billed Chgs Discount 48.9% Billed Chgs Reimbursement by Employer and Facility PRMC INPATIENT HOSPITAL STOP LOSS: For individual admissions for which billed charges exceed $51,500.00, reimbursement will be based on DRG at $13,795.00 per CMS weight rate, up to the first $51,500.00, a discount of 48% will apply to the Inpatient Hospital charges in excess of $51,500.00 for that claim. NCH INPATIENT HOSPITAL STOP LOSS: Sample ClaimReimbursement Schedules August 23, 2018 1 DRAFT 6 FOR DISCUSSION A member of the Board of County Commissioners asked the County Manager to explore if there could be benefits associated with reducing the payroll deduction for health insurance in lieu of the proposed 2% general wage adjustment budgeted for October 1st. Risk Management, Human Resources and the Countys Consultant, Willis Towers Watson examined this suggestion in detail. On the surface this approach may appear to be simply shifting dollars. However, providing the raise via reduced contributions for health coverage rather than increased in pay would allow the County to avoid additional contributions to the Florida Retirement System (FRS). The FRS requires an 8.26% contribution by the County on all wages paid to employees. Providing the increase via reduced health plan contributions allows the County to avoid the additional FSRP contribution on the scheduled wage increase. Willis Towers Watson examined this suggestion in detail. Base on the analysis they would recommend against this course action The estimated cost of the 8.26% contribution to the FRS for the scheduled increase is $178,912 based on an estimated total wage increase of $2.166 million. This represents a material expense. However, the following factors impact the savings and pose risk to the County. These factors are summarized below: 1.Reducing employee contributions to the health plan will not result in a material net savings to the County. A significant portion of the 8% FRS contribution savings will be offset by increased payroll taxes. The reduction in the employee contribution will now be treated as income to the employee, requiring a social security contribution of 7.65% by both the employer and the employee. 2.Employees waiving coverage under the health plan would not see a benefit. Currently 304 full time employees do not elect health coverage.This is approximately 15% of the group. 3.This approach will reduce retirement benefits for employees (with a disproportionate impact on older employees near retirement) under both Social Security and FRS. Further, if this approach is pursued over the long term, it will have a similar compounding effect on employees who might wish to remain employed by the County over the long term. This could produce employee relations issues. 4.Lowering the employee health plan contributions may encourage employees who previously declined coverage to elect coverage increasing the total cost to the health plan. 5.Not increasing wages may impair the Countys ability to hire new talent . Over the next ten years, approximately 30% of the current workforce will be eligible to retire. 6.A similar approach is not common in the private sector. 7.Current contributions toward health insurance are based on three plans; four salary tiers; single or family coverage; and include smoker/non-smoker rates. This requires that payroll load 48 different contribution levels. Providing the scheduled 2% increase via reductions in medical plan contributions would require the calculation and loading of over 2,200 unique employee contributions. This will require significant programming in SAP. The initial programing cost to accommodate unique contributions would be between $20,000 and $30,000 with an ongoing cost associated with maintaining this approach each year. August 23, 2018 2 Item 1. above has the most significant impact on the proposed approach. On the surface, it appears reducing contributions to the health plan rather than increase salaries would allow the County to avoid the FRP contributions on the pay increase. However, employees pay contributions towards the health plan with pre-tax dollars;hence the county avoids matching FICA and Medicare taxes on what is paid for medical plan contributions. This tax is generally 7.65% of wages. As noted above the scheduled 2% wage increase would cost the county $2.166 million and the additional FSRP contributions would be $178.912. If a 2% reduction in health plan contributions replaces the scheduled 2% wage increase the county would avoid the additional FRS expense. However, reducing medical plan contributions would increase matching FICA and Medicare taxes $165,699 (7.65 % of $2,166,000) offsetting over 92%of the $178,912 saving. In the opinion of Willis Towers Watson, the diminished savings associated with the other risks do not support this approach. . Stop Loss History $400,000 $450,000 $500,000 2015 2 2 1 2016 4 2 2 2017 2 2 2 2018 Through September 3 0 0 $400,000 $450,000 $500,000 2015 $1,212,848 $1,112,848 $1,053,928 2016 $307,500 $165,045 $65,045 2017 $470,719 $370,719 $270,719 2018 Through September $93,532 $0 $0 $400,000 $450,000 $500,000 2015 $100,000 ($58,920) 2016 $142,455 ($100,000) 2017 $100,000 ($100,000) 2018 Through September $93,532 $0 Current Coverage Year Difference in Claims From Current Coverage Year Year Amount of Claims Exceeding Number of Claims Exceeding Analysis of Stop Loss Alternatives Stop Loss Deductible $400,000 $450,000 $500,000 Estimated Annual Premium (P) Based on Voya Proposal $1,139,521 $968,567 $835,631 Expected Total Claims (C)$335,493 $275,007 $224,795 Expected Cost of Risk Transfer (P-C)$804,028 $693,560 $610,836 Return on Premium (C/P)29%28%27% Premium Savings vs. Current ($170,954)$132,936 Likelihood of Better Economic Outcome 2.0%49.6% Distribution of Add'l Claims vs. Current Minimum $0 $0 Maximum ($307,731)$3,448,449 Average ($50,212)$275,007 5% Perc $0 $0 10% Perc $0 $0 15% Perc $0 $0 20% Perc $0 $0 25% Perc $0 $0 30% Perc $0 $0 35% Perc $0 $0 40% Perc ($50,000)$53,383 45% Perc ($50,000)$53,383 50% Perc ($50,000)$106,767 55% Perc ($50,000)$139,542 60% Perc ($50,000)$192,925 65% Perc ($50,000)$236,306 70% Perc ($50,000)$313,921 75% Perc ($100,000)$403,277 80% Perc ($100,000)$515,390 85% Perc ($100,000)$595,236 90% Perc ($100,000)$819,142 95% Perc ($150,000)$1,126,721 All Coverage Options Compared with This Option Number of Claims Exceeding Deductible Stop Loss Deductible $400,000 $450,000 $500,000 Distribution of Number of Claims Exceeding Deductible Minimum 0 0 0 Maximum 7 7 7 Average 1.3 1.0 1.0 5% Perc 0 0 0 10% Perc 0 0 0 15% Perc 0 0 0 20% Perc 0 0 0 25% Perc 0 0 0 30% Perc 1 0 0 35% Perc 1 0 0 40% Perc 1 1 1 45% Perc 1 1 1 50% Perc 1 1 1 55% Perc 1 1 1 60% Perc 1 1 1 65% Perc 2 1 1 70% Perc 2 1 1 75% Perc 2 2 2 80% Perc 2 2 2 85% Perc 2 2 2 90% Perc 3 2 2 95% Perc 3 3 3 Total Claims Exceeding Deductible Stop Loss Deductible $400,000 $450,000 $500,000 Minimum $0 $0 $0 Maximum $3,498,449 $3,448,449 $3,398,449 Average $335,493 $275,007 $224,795 5% Perc $0 $0 $0 10% Perc $0 $0 $0 15% Perc $0 $0 $0 20% Perc $0 $0 $0 25% Perc $0 $0 $0 30% Perc $23,750 $0 $0 35% Perc $57,731 $0 $0 40% Perc $103,383 $53,383 $3,383 45% Perc $111,804 $53,383 $3,383 50% Perc $189,542 $106,767 $11,804 55% Perc $210,018 $139,542 $89,542 60% Perc $286,306 $192,925 $102,038 65% Perc $345,604 $236,306 $186,306 70% Perc $389,689 $313,921 $258,207 75% Perc $475,848 $403,277 $279,231 80% Perc $591,853 $515,390 $374,447 85% Perc $703,787 $595,236 $495,236 90% Perc $884,778 $819,142 $681,542 95% Perc $1,232,145 $1,126,721 $1,005,616 Collier County Government 2019 Medical Stop Loss Marketing Report October 15, 2018 1 October 15, 2018 Willis Towers Watson Confidential Introduction Each year Willis Towers Watson 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 CCG and its constitutional affiliates. Willis Towers Watson sought specific stop loss 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 $450,000 and the carrier is Sun Life. Aggregate stop loss would protect 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. Marketing Summary and Recommendation Willis Towers Watson worked to secure terms for the specific medical stop loss program from the current carrier Sun Life. In addition, a request for proposal document was prepared, approved by the CCG and distributed to select carriers. Quotations were requested for specific retention levels of $400,000, $450,000 and $500,000 respectively. Specific terms were requested on a 12/24 basis, which means the coverage operates on an incurred basis. This coverage is consistent with past practice. Based on our analysis, Willis Towers Watson believes the risk management needs of the CCG are best met by purchasing coverage from Voya/ReliaStar at a $450,000 retention level, representing a 7.2% decrease from current premium rates. Specific stop loss quotations were requested from the following carriers: American Fidelity (quote received) Voya/ReliaStar (quote received) Sun Life (incumbent) Berkshire (quote received) Berkley (declined to quote) HM Insurance Group (quote received) QBE (quote received) Symetra (missed deadline) All of the carriers above are rated A or better by A.M. Best. Carriers that declined to quote did so because their manual rates were not competitive or they missed the deadline. The initial renewal quote submitted by Sun Life was 13% higher than current rates. After providing additional information, the renewal was cut to 3%. The most competitive quote for the current retention level is from Voya/ReliStar for a 7.2% decrease from current rates. American Fidelity offered a 6.8% reduction but would impose a laser of $675,000 on one claimant. This claimant was reviewed by the 2 October 15, 2018 Willis Towers Watson Confidential Willis Towers Watson retained Medical Director, Michael Neren, M.D., and we believe it is very likely this individual will have at least $650,000 in ongoing claims. The Voya/ReliStar quotes include a guarantee of no new lasers at renewal and a 40% cap on the renewal increase. The quote also includes a 15% refund if the loss ratio is less than 65%. To aid the CCG in making a selection of what level of coverage to purchase, Wills Towers Watson completed two separate analyses. The purpose of each is summarized below: 1. A standard spread sheet analysis, which shows what was quoted at each of the stated retention levels. 2. A stochastic forecast model, which used detailed claims data to forecast the expected stop loss claims at each retention level to assist the CCG in selecting the most appropriate retention level. Any decision to increase the retention level should be based on an assessment of the CCG’s risk tolerance during 2018. The following analysis provides the detail supporting these recommendations to assist the CCG in reaching a decision. Willis Towers Watson did not request aggregate stop loss quotes since past analyses have determined that this coverage is a poor value relative to the cost. Quote Cost Analysis The attached document labeled CCG- Stop Loss Marketing Analysis 2019 10-17 outlines what the carriers quoted at each retention level. Sun Life, Voya/ReliStar and American Fidelity all provided quotes at the current and higher deductible requested. Only Voya/ReliaStar quoted on the $400,000 level. The quotes from QBE, HM Insurance Group and Berkshire were not competitive. The initial 13.0% renewal increase is not surprising. Stop loss renewal increases typically range from 15% to 30%, 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 ($450,000 in the CCG’s case) when claim costs are increasing. For example, assume a claim of $550,000 occurred. In this case, the CCG would receive $100,000 back from the reinsurer. Now let’s assume costs increase 5% (which is consistent with medical CPI). Next year the same claim would cost $577,500. Under this scenario, the amount collected under the reinsurance would be $127,500 instead of $100,000. This represents an increase of 27.5%. All quotes were made on a 12/24 basis. This means coverage applies to all claims incurred in 2019 and paid by December 31, 2020, so there is no concern at the end of the year about getting claims paid as they will be included. Retention Level Analysis Willis Towers Watson actuaries developed a Monte-Carlo simulation model using CCG’s large claims experience in 2013-2017 to forecast the large claims that are likely to occur in 2019. We used CCG’s 3 October 15, 2018 Willis Towers Watson Confidential actual large claims frequencies over this period to estimate the incidence of large claims, and used a larger Willis Towers Watson database to model the distribution of large claim amounts. The Willis Towers Watson database is based on over 3.8 million life-years and provides a larger sample for this purpose than we would obtain from CCG’s large claim experience. Refer to the attached document labeled CCG-Retention Level Analysis 2019 10-17. The first page shows the CCG’s actual number of claimants that exceeded specific levels and the total amount of claims at each level from 2015 through 2017 and through September of 2018. The number of claims exceeding $450,000 was two each year 2015-2017. The amount of claims in excess of the deductible ranged from $165,000 to $1,113,000 during this period. The third table shows the difference in stop loss recoveries that would have occurred each year under each of the alternative deductibles. We will refer to this table later in the analysis. Page 2 of the exhibit shows the estimated annual premiums at each level and the expected claim amounts based on our model. The difference between these figures is the expected cost of risk transfer. Generally, the option with the lowest cost of risk transfer offers the best value. According to our analysis, the $500,000 stop loss deductible represents the best economic value. This analysis suggests that based on the expected claims at each level, the CCG would expect savings of $132,936 by choosing a higher stop loss deductible or, pay an additional $170,954 for a lower deductible. The second section of the exhibit shows the relative cost savings associated with increasing the specific level and the likelihood that additional claims incurred by the CCG will offset the premium savings. In moving from the current $450,000 deductible to the $400,000 level, the CCG would pay $170,954 more in premium. In order to recoup this premium with additional claims, CCG would need to incur at least 4 additional claims of $400,000 or more. Referring to the bottom table on the previous page, CCG had 4 claims exceeding $400,000 in 2016 but the additional claim reimbursement at this level would have been less than the premium differential at $142,455. Our model shows that there is only a 2% probability that likelihood that additional claims will exceed this added premium amount at the $400,000 level, or a 98% chance that paying the additional premium will turn out to be a poor decision. Conversely, the CCG would save $132,936 in premium annually by increasing the deductible to $500,000. Our analysis suggests that there is a 1 in 2, likelihood that the additional claims retained by CCG will result in a net loss vs. the current coverage. The chart on page 1 of this exhibit shows the difference in claims between the current $450,000 level and a $500,000 deductible would have been no more than $100,000 in the last 3 plan years. This would suggest the premium savings of $132,936 would have been a good deal for each of these past years. However the numbers of very large claims have increased and our model shows that savings are equally likely to be higher or lower than the premium savings. It is a coin toss if increasing the retention to $500,000 would save money in 2019. Date: Name: Title: Page 1 Creating a Benefits Vision/Mission/Strategy Identifying what’s Important for Benefits in 2016 and Beyond Background Vision/mission statements and strategic plans are created to facilitate reaching certain goals. This document outlines a process and specific questions to consider while building a benefit program that supports the The Organization strategy and a high performance culture. It also outlines a conceptual framework for developing a benefit road map for the future, measuring progress and results. This all starts with cost versus limited resources. All organizations are interested in effectively managing the cost of benefit programs. The reasons why organizations want to manage cost may, on the surface, seem obvious. “We need to control costs to manage to our budget and deliver acceptable returns to our shareholders.” However, once you go beyond this obvious goal, the waters can become muddy. If success is measured solely on a cost basis, why offer health care and other benefits in the first place? Why not pay the “play or pay tax” and send employees to the federal exchange for health coverage? If all benefits were eliminated, wages could be increased by a significant amount and total expense would be reduced. No large employer has eliminated benefits and rolled a good portion of the savings back into wages. They believe medical and other benefits are tax effective, needed to attract and retain employees and address other considerations. For example, what kind of image is The Organization trying to project to the community/shareholders and how important is that image? How do benefits affect the image of the organization in the community, financial success, attract a quality work force and support the organization’s strategy/vision/mission? What about health and wellness? What do you expect from employees in return for the benefits offered? For most organizations, benefit issues tend to focus primarily on health insurance. Health insurance makes up the lion’s share of the benefit pie representing over 80% of total benefit cost for most organizations. The Organization has the same concerns as any other employer with a health care bill net of employee contributions that will be approximately $70 million in fiscal 2016. Employee health and how medical care is provided has a significant impact on the cost to an organization. Due to the cost, employers are looking at evolving their approach to providing health benefits and looking at new tactics such as: • On-site or telephonic health advocacy and health support services to help people address health issues and stay well • On-site clinics to operate disease management programs and other initiatives, which are intended to improve the health of the population and improve its productivity • Fitness centers • Private exchanges where employees are given a set sum or money to purchase benefits via a benefits “supermarket” Date: Name: Title: Page 2 • High Deductible Health Plans (HDHP) where employees are spending a significant amount of their own money on medical care There are numerous choices and directions that can be taken to impact cost. However, there is no one single strategy yet proven to effectively address health care costs and health on a consistent year over year basis. How The Organization approaches the health care cost challenge and answers key questions about benefits, health care and wellness will affect the direction taken in meeting its obligations to the organization, shareholders and employees. To consider opportunities in an organized and thoughtful fashion, we need to first understand what drives health and health care costs. We then need to articulate a vision/mission of what The Organization wants to accomplish through the medical benefit programs it offers that will support the The Organization strategy and a high performance culture. Second, we need to examine the role that The Organization should play in providing health care and health support to its employees and how those efforts should integrate with health care benefits. Once these issues are considered we will be able to build on the current, or create a new health plan platform that is consistent with the strategy/vision of the organization and produces sustainable long term cost trends. We can also carefully assess the downstream implications of the strategy and tactics implemented and deployed. Supporting the Strategy and Vision The Organization has articulated the following strategy. Date: Name: Title: Page 3 Through this strategy, the organization seeks to create a high performance culture based on the following: 1. Energy – strong bias for action; do what it takes to get the job done; courageous, candid 2. Empowerment with Accountability – seek to maximize the potential of others; motivate and inspire; appropriately delegate responsibility 3. Execution – do what is promised; focus upon what is important; adhere to process; deliver results Willis believes that a parallel vision, mission and strategic plan for benefits should be developed to support and align with the overall The Organization strategy. Understanding the factors that influence health and health care cost – the largest cost component of benefits The cost of financing health care for employees and dependents is the largest component of the cost of benefits to an organization. The overall “health” of people also affects the cost of other benefits such as disability, workers compensation, life insurance, etc. There are many actions to address rising costs, all of which fall into one of the following eight general categories: 1. Make sure that service provider cost structures are reasonable; 2. Address fraud and billing accuracy concerns; 3. Increase employees’ share of the cost when they receive medical care; 4. Increase what employees pay each paycheck for health coverage; 5. Limit the size of the population that is covered; 6. Look where care is provided, appropriateness of care, outcomes and whether ancillary services purchased (disease management, coaching support, etc.) are focused on producing measurable outcomes not process alone; 7. Make sure members use the health plan wisely; 8. Reduce or manage health risks in the population. This suggests there are numerous levers that can impact costs. The first five are more direct and have been addressed by The Organization on an ongoing basis. For example, we have cost shifted and terminated programs that did not deliver value such as the disease management programs. The last three are more challenging. The Organization has terminated programs focused on the last three areas as there appeared to be little measurable impact or ROI. However, there is no doubt that addressing these last three areas will have a bigger impact if executed properly within the context of an understanding of what drives health care cost. Date: Name: Title: Page 4 Further, few understand that multiple sources impact the cost of health care to an organization, many which are influenced by covered members’ choices, expectations and background as well as what providers do and charge for medical care. It is very hard for people to make different choices and change their expectations with respect to their health. Making wellness and disease management support services free does not ensure that people will use them to better their habits. How do we get people engaged in doing what is necessary to maintain health and address disease and how strong should The Organization be with regard to the expectation that they engage? Health care reform has placed unique burdens on providers via something called payment reform to improve quality and outcome. However, the insurance industry and employers are oblivious to the opportunities of goal congruence created by payment reform. Unless the health and wellbeing of the population is managed, an organization is destined to pay for the consequences. In order to effectively manage the health of an employee population, we must develop a health plan and support processes that address the sources of cost within the health care equation. Price per unit x Source1 x Source2 x Source3 x Source4 X Source5 adjusted for Outcome = Cost Source 1 = Determined by physician practice, billing patterns and technology Source 2 = Determined by patient preferences and expectations Source 3 = Determined by patient health status and lifestyle Source 4 = Determined by payer Source 5 = Does the patient understand and comply with proposed treatment? Outcome = The benefit of the treatment or encounter to the patient Date: Name: Title: Page 5 Questions for Consideration In light of the strategy/vision/mission outlined earlier, consider and provide input to the following questions. 1. In offering a benefits package, companies must balance cost with being market competitive in order to attract and retain talent. Given this challenge, what does overall success look like? 2. How should a benefits package contribute to successfully delivering The Organization’ long-term strategic objectives? 3. Please weight the following items relative to importance: • Employer cost • Attracting and retaining great talent • High performance culture (energy and accountability) 4. How is The Organization viewed as a place to work? What role do benefits play in this perception? What role would you like benefits to play in this perception? 5. Should employees have a say in what and how The Organization makes changes to the overall benefits package? 6. In regards to benefit programs, to what extent does The Organization want to: • Innovate – we should be on the leading edge and differentiate ourselves by finding new ways solve problems. • Lead – we set the bar and are ahead of the rest in terms of comparing what we offer to others. • Lag – we want to see what others do and adopt what has worked for them. Douglas Ley Sr. Vice President / Director Employee Benefit Renewal and Marketing Presentation Collier County Government Effective: 01/01/2019 Collier County Government ANCILLARY BENEFIT/COST ANALYSIS - SUMMARY PAGE Effective: 01/01/2019 Aetna Aetna Aetna Reliance Standard The Standard Voya Current Renewal Negotiated Renewal Option 1 Option 2 Option 3 Monthly Premiums Monthly Premiums Monthly Premiums Monthly Premiums Monthly Premiums Monthly Premiums Life $21,755 $47,955 $32,048 $28,071 $28,305 $30,411 AD&D $5,848 $5,848 $5,848 $5,848 $4,679 $5,848 ASO STD $5,670 $6,188 $5,670 $3,829 $4,897 $4,808 Long Term Disability $12,727 $14,152 $12,749 $13,880 $12,749 $12,749 Total Monthly Premium $46,001 $74,144 $56,315 $51,629 $50,630 $53,816 Total Annual Premium $552,008 $889,730 $675,784 $619,543 $607,564 $645,796 Cost Difference (%)--61.2%22.4%12.2%10.1%17.0% Cost Difference ($)--$337,722 $123,776 $67,535 $55,557 $93,788 Total Cost with FMLA First Year FMLA Cost $0.00 $50,286 $50,286 $48,701 $56,941 $35,710 Total Annual Cost with FMLA $552,008 $940,016 $726,070 $668,244 $664,506 $681,506 Cost Difference (%)--70.3%31.5%21.1%20.4%23.5% Cost Difference ($)--$388,008 $174,062 $116,236 $112,498 $129,498 Performance Guarantees 5% of Fully Insured 2% of Fee Based 5% of the previous quarter's plan administration expenses, excluding commission, premium tax and risk charges 2% of Premium and Fees 1% of Life 2% of LTD (Employer and Employee Paid Premiums) Collier County Government LIFE BENEFIT/COST ANALYSIS Effective: 01/01/2019 Basic Life Aetna Current/Renewal Class Definitions Class 1 County Attorney & County Manager County Attorney & County Manager County Attorney & County Manager County Attorney & County Manager Class 2 Employees not covered in any other class Employees not covered in any other class Employees not covered in any other class Employees not covered in any other class Class 3 Retired Employees who participate in the medical plan Retired Employees who participate in the medical plan Retired Employees who participate in the medical plan Retired Employees who participate in the medical plan Class 4 Cl 2 Employees waiving taxable life benefits Cl 2 Employees waiving taxable life benefits Cl 2 Employees waiving taxable life benefits Cl 2 Employees waiving taxable life benefits Definition of Earnings Annual salary, excludes commissions, overtime pay and bonuses Annual salary, excludes commissions, overtime pay and bonuses Annual salary, excludes commissions, overtime pay and bonuses Annual salary, excludes commissions, overtime pay and bonuses Benefit Class 1 3 x BAE 3 x BAE 3 x BAE 3 x BAE Class 2 2 x BAE 2 x BAE 2 x BAE 2 x BAE Class 3 Flat $2,000 Flat $2,000 Flat $2,000 Flat $2,000 Class 4 Flat $50,000 Flat $50,000 Flat $50,000 Flat $50,000 Maximum Benefit $500,000 $500,000 $500,000 $500,000 Guarantee Issue Amount $500,000 $500,000 $500,000 $500,000 Age Reduction Reduces to:Reduces to:Reduces to:Reduces to: Age 65 -------- Age 70 40%40%40%-- Age 75 ------60% Age 80 ------35% Age 85 ------28.0% Age 90 ------20% Age 95 ------8.0% Age 100 ------5% Contract Features Waiver of Premium To age 70 if disabled prior to age 60 for 9 months To age 70 if disabled prior to age 60 for 9 months To age 70 if disabled prior to age 60 for 9 months To age 70 if disabled prior to age 60 for 9 months Accelerated Death Benefit 75% to $500,000 max, 12 months life expectancy 75% to $500,000 max, 12 months life expectancy 75% to $500,000 max, 12 months life expectancy 75% to $500,000 max, 12 months life expectancy Reliance Standard VoyaThe Standard Collier County Government LIFE BENEFIT/COST ANALYSIS Effective: 01/01/2019 Pricing Current Renewal Negotiated Renewal Total Covered Lives 2,265 2,265 2,265 Total Covered Benefit $233,928,997 $233,928,997 $233,928,997 Life Rate per $1,000 Benefit $0.093 $0.205 $0.137 Monthly Premium $21,755 $47,955 $32,048 Annual Premium $261,065 $575,465 $384,579 Cost Difference (%)--120%47% Cost Difference ($)--$314,401 $123,515 Rate Guarantee Total Covered Benefit is the sum of employee and retiree basic life benefits listed on the marketing census provided by the Collier County Government. This comparison is intended to illustrate the carrier's proposed services and rates and should not be relied upon to fully determine benefits and rates. Refer to carrier's renewal/proposal for a complete representation of coverage terms and conditions. 2,265 $233,928,997$233,928,997 $103,864 3 Years3 Years 29% 3 Years $0.121 $28,305 $75,793 $0.120 $336,858 Reliance Standard $28,071 2,265 3 Years $339,665 30% $78,600 40% Voya 2,265 $0.130 $30,411 $364,929 $233,928,997 The Standard Collier County Government BASIC AD&D BENEFIT/COST ANALYSIS Effective: 01/01/2019 Voluntary AD&D Aetna Reliance Standard The Standard Voya Class Definitions Class 1 County Attorney & County Manager County Attorney & County Manager County Attorney & County Manager County Attorney & County Manager Class 2 Employees not covered in any other class Employees not covered in any other class Employees not covered in any other class Employees not covered in any other class Class 3 Employees earning >$25,000 and not covered in any other plan Employees earning >$25,000 and not covered in any other plan Employees earning >$25,000 and not covered in any other plan Employees earning >$25,000 and not covered in any other plan Benefit Class 1 3 x BAE 3 x BAE 3 x BAE 3 x BAE Class 2 2 x BAE 2 x BAE 2 x BAE 2 x BAE Class 3 Flat $50,000 Flat $50,000 Flat $50,000 Flat $50,000 Maximum Benefit $500,000 $500,000 $500,000 $500,000 Age Reduction Reduces to:Reduces to:Reduces to:Reduces to: Age 65 ------ Age 70 --40%-- Age 75 60%60%--60% Age 80 35%35%--35% Age 85 27.5%27.5%--28.0% Age 90 20%20%--20% Age 95 7.5%7.5%--8.0% Age 100 5%5%--5% Losses Life 100%100%100%100% One limb - hand, foot 50%50%50%50% Sight of 1 eye 50%50%50%50% Hearing - both ears 50%50%50%50% Speech 50%50%50%50% Speech and Hearing (both ears)100%100%100%100% Quadriplegia 100%100%100%100% Paraplegia 50%50%50%50% Hemiplegia 50%50%50%50% Uniplegia 25%25%Not Covered 25% Thumb & index finger (same hand)25%25%25%25% Options Seat Belt Benefit 10% to $25,000 10% to $25,000 Up to $10,000 10% to $25,000 Air Bag Benefit 5% to $5,000 5% to $5,000 5% to $5,000 5% to $5,000 Education Benefit 5% to $5,000/year for 4 years (Child & Spouse) 5% to $5,000/year for 4 years (Child & Spouse) 25% to $5,000 per child per year up to 4 year 25% to $5,000 per year for spouse within 36 months of death 5% to $5,000/year for 4 years (Child & Spouse) Repatriation Benefit $5,000 $5,000 $5,000 $5,000 Child Care Benefit 3% to $2,000 per child per year up to 4 years 3% to $2,000 per child per year up to 4 years $5,000 per year maximum of $10,000 or 25%, whichever is less 3% to $2,000 per child per year up to 4 years Coma Benefit First 11 months: 5%/month, 12th month: 45%Not Included Not Included First 11 months: 5%/month, 12th month: 45% Suicide Exclusion Included Included Included Included Current/Renewal Collier County Government BASIC AD&D BENEFIT/COST ANALYSIS Effective: 01/01/2019 Pricing Current Renewal Negotiated Renewal Reliance Standard The Standard Voya Total Covered Lives 2,229 2,229 2,229 2,229 2,229 2,229 Total Covered Benefit $233,928,997 $233,928,997 $233,928,997 $233,928,997 $233,928,997 $233,928,997 Rate per $1,000 Benefit $0.025 $0.025 $0.025 $0.025 $0.020 $0.025 Monthly Premium $5,848 $5,848 $5,848 $5,848 $4,679 $5,848 Annual Premium $70,179 $70,179 $70,179 $70,179 $56,143 $70,179 Rate Guarantee 3 Years 3 Years 3 Years 3 Years Total Covered Benefit is the sum of employee and retiree basic life benefits listed on the marketing census provided by the Collier County Government. This comparison is intended to illustrate the carrier's proposed services and rates and should not be relied upon to fully determine benefits and rates. Refer to carrier's renewal/proposal for a complete representation of coverage terms and conditions. Collier County Government VOLUNTARY LIFE BENEFIT/COST ANALYSIS Effective: 01/01/2019 Voluntary Life Aetna Reliance Standard The Standard Voya Eligibility Active, full-time employees (30 hrs per week), except temporary or seasonal Active, full-time employees (30 hrs per week), except temporary or seasonal Active, full-time employees (30 hrs per week), except temporary or seasonal Active, full-time employees (30 hrs per week), except temporary or seasonal Definition of Earnings Annual salary, excludes commissions, overtime pay and bonuses Annual salary, excludes commissions, overtime pay and bonuses Annual salary, excludes commissions, overtime pay and bonuses Annual salary, excludes commissions, overtime pay and bonuses Benefit Amount Employee $10,000 Increments to $500,000 or 5x Salary $10,000 Increments to $500,000 or 5x Salary $10,000 Increments to $500,000 or 5x Salary $10,000 Increments to $500,000 or 5x Salary Spouse $10,000 Increments to $500,000, Not to exceed 100% of employee basic and suppl life amount $10,000 Increments to $500,000, Not to exceed 100% of employee amount $10,000 Increments to $500,000, Not to exceed 100% of employee basic and suppl life amount $10,000 Increments to $500,000, Not to exceed 100% of employee basic and suppl life amount Children 14 Days to 6 months: Flat $1,000 6 months to age 26: $2,500 Increments to $10,000 14 Days to 6 months: Flat $1,000 6 months to age 26: $2,500 Increments to $10,000 $2,500 to $10,000 from live birth 14 Days to 6 months: Flat $1,000 6 months to age 26: $2,500 Increments to $10,000 Maximum Benefit $500,000 $500,000 $500,000 Guarantee Issue Employee $200,000 $200,000 $200,000 $200,000 Spouse $50,000 $50,000 $50,000 $50,000 Children All Amounts All Amounts All Amounts All Amounts Age Reduction Reduces to:Reduces to:Reduces to:Reduces to: Age 65 -------- Age 70 -------- Age 75 60%60%60%60% Age 80 35%35%35%35% Age 85 27.5%27.5%27.5%28.0% Age 90 20%20%20%20% Age 95 7.5%7.5%7.5%8.0% Age 100 5%5%5%5% Contract Features Termination of Spouse benefits Same time as Employee Same time as Employee Same time as Employee Same time as Employee Accelerated Death Benefit 75% to $500,000, 12 months life expectancy 75% to $500,000, 12 months life expectancy 75% to $500,000, 12 months life expectancy 75% to $500,000, 12 months life expectancy Waiver of Premium To age 70 if disabled prior to age 60 for 9 months To age 70 if disabled prior to age 60 for 9 months To age 70 if disabled prior to age 60 for 9 months To age 70 if disabled prior to age 60 for 9 monthsConversionIncludedIncludedIncludedIncluded Portability Included Included Included Included Suicide Exclusion 2 years 2 years 2 years 2 years Participation Requirement 20%20%20%15% $500,000* Current/Renewal Collier County Government VOLUNTARY LIFE BENEFIT/COST ANALYSIS Effective: 01/01/2019 Voluntary Life Aetna Reliance Standard The Standard Voya Rates per $1,000 Benefit Current Employee Renewal Employee Current Spouse Renewal Spouse Employee Spouse Employee Spouse Employee Spouse Age Under 25 $0.090 $0.090 $0.090 $0.090 $0.090 $0.090 $0.090 $0.090 $0.090 $0.090 25-29 $0.090 $0.090 $0.090 $0.090 $0.090 $0.090 $0.090 $0.090 $0.090 $0.090 30-34 $0.130 $0.130 $0.130 $0.130 $0.090 $0.090 $0.090 $0.090 $0.090 $0.090 35-39 $0.190 $0.190 $0.190 $0.190 $0.130 $0.130 $0.130 $0.130 $0.130 $0.130 40-44 $0.260 $0.260 $0.260 $0.260 $0.190 $0.190 $0.190 $0.190 $0.190 $0.190 45-49 $0.480 $0.480 $0.480 $0.480 $0.260 $0.260 $0.260 $0.260 $0.260 $0.260 50-54 $0.720 $0.720 $0.720 $0.720 $0.480 $0.480 $0.480 $0.480 $0.480 $0.480 55-59 $1.080 $1.080 $1.080 $1.080 $0.720 $0.720 $0.720 $0.720 $0.720 $0.720 60-64 $1.590 $1.590 $1.590 $1.590 $1.080 $1.080 $1.080 $1.080 $1.080 $1.080 65-69 $2.340 $2.340 $2.340 $2.340 $1.590 $1.590 $1.590 $1.590 $1.590 $1.590 70-74 $4.250 $4.250 $4.250 $4.250 $2.340 $2.340 $2.340 $2.340 $2.340 $2.340 75-99 $4.250 $4.250 $4.250 $4.250 $4.250 $4.250 $4.250 $4.250 $4.250 $4.250 Voluntary AD&D Per $1,000 Benefit Child Per $1,000 Benefit Special Open Enrollment Special Enrollment for all enrolled and eligible up to the Guarantee Issue All members (enrolled or eligible) may increase benefit amount up to the modified guarantee issue amount of $100,000 without providing evidence of insurability. No Special Enrollment Rate Guarantee 3 Years *During the renewal process, Willis Towers Watson negotiate with Aetna to amend the Life and Supplemental Life Max from $500,000 combined to $500,000 for each coverage effective 01/01/2016. This comparison is intended to illustrate the carrier's proposed services and rates and should not be relied upon to fully determine benefits and rates. Refer to carrier's renewal/proposal for a complete representation of coverage terms and conditions. $0.050 $0.200 Current Renewal $0.200 $0.200 $0.200$0.200 3 Years3 Years $0.050$0.050 3 Years Current Renewal $0.200 $0.050 Employees/spouses without coverage (who have not been previously denied) can enroll into up to 3 increments without EOI. And those with coverage can increase by 3 increments without EOI up to GI of $200K. Collier County Government ADMINISTRATIVE SERVICES ONLY SHORT TERM DISABILITY BENEFIT/COST ANALYSIS Effective: 01/01/2019 Aetna Reliance Standard The Standard Voya STD Benefits Eligibility Class 1 All Active FT excluding those defined in Class 2 All Active FT excluding those defined in Class 2 All Active FT excluding those defined in Class 2 All Active FT excluding those defined in Class 2 Class 2 County Manager & Board Aide County Manager & Board Aide County Manager & Board Aide County Manager & Board Aide Class 3 County Manager County Manager County Manager County Manager Weekly Benefit Percent Class 1 Core 40%, Buy-Up 67%Core 40%, Buy-Up 67%Core 40%, Buy-Up 67%Core 40%, Buy-Up 67% Class 2 50%50%50%50% Class 3 67%67%67%67% Maximum Class 1 $2,000 $2,000 $2,000 $2,000 Class 2 $2,250 $2,250 $2,250 $2,250 Class 3 $2,250 $2,250 $2,250 $2,250 Minimum None None None None Benefit Duration 26 Weeks 26 Weeks 26 Weeks 26 Weeks Definition of Earnings Weekly earnings excluding commissions, overtime pay and bonuses Weekly earnings excluding commissions, overtime pay and bonuses Weekly earnings excluding commissions, overtime pay and bonuses Weekly earnings excluding commissions, overtime pay and bonuses; includes shift differential and average of the prior 12 months commission. Definition of Disability Inability to perform own occupation and 20% earnings loss Inability to perform own occupation Inability to perform own occupation and 20% earnings loss Inability to perform own occupation and 20% earnings loss Elimination Period Accident Later of 7 days or Exhaustion of Sick Leave Balance Later of 7 days or Exhaustion of Sick Leave Balance Later of 7 days or Exhaustion of Sick Leave Balance Later of 7 days or Exhaustion of Sick Leave Balance Illness Later of 7 days or Exhaustion of Sick Leave Balance Later of 7 days or Exhaustion of Sick Leave Balance Later of 7 days or Exhaustion of Sick Leave Balance Later of 7 days or Exhaustion of Sick Leave Balance Benefit Provisions Partial Included Included Included Included Rehabilitation Benefit Mandatory Mandatory Mandatory Mandatory Integration Method Does not integrate with other income Does not integrate with other income Does not integrate with other income Does not integrate with other income Limitations Pre-existing Conditions No limit No limit No limit No limit ASO / ATP Check Cutting Included Included Included Included Online Portal to View Claims Included Included Included Included Taxation W-2 Services Included Included Included Included FICA Responsibility Employer Pays Employer Pays Employer Pays Employer Pays Current/Renewal Collier County Government ADMINISTRATIVE SERVICES ONLY SHORT TERM DISABILITY BENEFIT/COST ANALYSIS Effective: 01/01/2019 Fees Current Renewal Negotiated Renewal Reliance Standard The Standard Voya Covered Lives 2,226 2,226 2,226 2,226 2,226 2,226 Monthly Administrative Fee $2.547 $2.780 $2.547 $1.720 $2.200 $2.160 Monthly # #$6,188 $5,670 $3,829 $4,897 $4,808 Annual $68,035 $74,259 $68,035 $45,945 $58,766 $57,698 Cost Difference (%)--9.1%0.0%-32%-14%-15% Cost Difference ($)--$6,224 $0 -$22,091 -$9,269 -$10,338 Contract Period 3 Years 3 Years 3 Years3 Years This comparison is intended to illustrate the carrier's proposed services and rates and should not be relied upon to fully determine benefits and rates. Refer to carrier's renewal/proposal for a complete representation of coverage terms and conditions. Collier County Government LONG TERM DISABILITY BENEFIT/COST ANALYSIS Effective: 01/01/2019 Aetna Reliance Standard The Standard Voya Current/Renewal Class Definition Class 1 Employees excluding Executive Manager to Board, County Manager & County Attorney EEs excluding Executive Manager to Board, County Manager & County Attorney Employees excluding Executive Manager to Board, County Manager & County Attorney EEs excluding Executive Manager to Board, County Manager & County Attorney Class 2 Executive Manager to Board & County Attorney Executive Manager to Board & County Attorney Executive Manager to Board & County Attorney Executive Manager to Board & County Attorney Class 3 County Manager County Manager County Manager County Manager Definition of Earnings Base rate of earnings excluding commissions, overtime pay and bonuses Base rate of earnings excluding commissions, overtime pay and bonuses Base rate of earnings excluding commissions, overtime pay and bonuses Base Salary-Includes Commissions with 12 Month Average Benefit Outline Benefit Percent Class 1 Basic: 40%, Premium: 67%Basic: 40%, Premium: 67%Basic: 40%, Premium: 67%Core 40%; Buy-up 67% Class 2 50%50.00%50%50.00% Class 3 67%67.00%67%67.00% Monthly Maximum Class 1 $9,000 $9,000 $9,000 $9,000 Class 2 $9,000 $9,000 $9,000 $9,000 Class 3 $10,000 $10,000 $10,000 $10,000 Monthly Minimum $100 $100 $100 $100 Own Occupation Period Class 1 24 Months 24 Months 24 Months 24 Months Class 2 Extended Own Occupation Extended Own Occupation Extended Own Occupation Extended Own Occupation Class 3 Extended Own Occupation Extended Own Occupation Extended Own Occupation Extended Own Occupation Benefit Duration SSNRA SSNRA SSNRA SSNRA Elimination Period Elimination Period 180 Days 180 Days 180 Days 180 Days Interruption Less than 30 Consecutive Days Less than 30 Consecutive Days Less than 30 Consecutive Days Less than 30 Consecutive Days Residual Disability Zero Day Residual Zero Day Residual Zero Day Residual Zero Day Residual Limitations Mental Illness Limitation 24 Months 24 Months 24 Months 24 Months Self Reported Limitation No Limitation No Limitation No Limitation No Limitation Pre-existing Conditions 3/12 3/12 3/12 3/12 Benefit Provisions Definition of Disability Loss of Duties and Earnings Loss of Duties Only Loss of Duties and Earnings Loss of Duties and Earnings Partial Formula Proportionate 50% Offset Proportionate Proportionate Indexed Monthly Earnings Lesser of CPI or 10%Not Included Lesser of CPI or 10%Lesser of CPI or 10% Social Security Integration Full Family Full Family Full Family Full Family Waiver of Premium Included Included Included Included Workplace Modification Included, No Limit Included, $2,000 Maximum Included, $25,000 Maximum Included, 2 x earnings to $5,000 Maximum Recurrent Disability 6 Consecutive Months 6 Consecutive Months 90 days in EP 180 days in Benefit Period 6 Consectutive months Return to Work Incentive 100% up to 12 Months 100% up to 12 Months Extending to 24 months to align with family care benefit 100% for 12 Months Rehabilitation Mandatory Mandatory Voluntary with a 10% Incentive Mandatory Child Care Expense $250 per child per month up to $500 for 24 months $250 per child per month up to $500 for 24 months family care; $250 per family member, not to exceed $500 for all family members $250 per child per month for 24 months Spouse or Elder Care Not Included Not Included Included Not Included Survivor Benefit 3x Gross Monthly Benefit 3x Gross Monthly Benefit 3x Gross Monthly Benefit 3x Gross Monthly Benefit Specific Indemnity Benefit Accidental Personal Loss Indemnity Benefit Accidental Personal Loss Indemnity Benefit Not Included Accidental Dismemberment and Loss of Sight EAP Includes 3 Face-to-Face Sessions Includes 3 Face-to-Face Sessions Includes 3 Face-to-Face Sessions Includes 3 telephonic sessions FICA Match Included Included Included Included Collier County Government LONG TERM DISABILITY BENEFIT/COST ANALYSIS Effective: 01/01/2019 Rates Current Renewal Reliance Standard The Standard Voya Basic Plan Number of Lives 1,056 1,056 2,224 2,224 2,224 2,224 Covered Payroll $4,792,943 $4,792,943 $10,281,594 $10,281,594 $10,281,594 $10,281,594 Per $100 of Covered Payroll $0.124 $0.138 $0.124 $0.135 $0.124 $0.124 Monthly Premium $5,943 $6,614 $12,749 $13,880 $12,749 $12,749 Premium Plan Number of Lives 1,168 1,168 1,168 1,168 1,168 1,168 Covered Payroll $5,488,651 $5,488,651 $5,488,651 $5,488,651 $5,488,651 $5,488,651 Per $100 of Covered Payroll $0.396 $0.440 $0.272 $0.270 $0.360 $0.299 Monthly Premium $21,735 $24,150 $14,929 $14,819 $19,759 $16,411 Monthly CCG Paid Premium $6,784 $7,538 Included in Basic Premium Included in Basic Premium Included in Basic Premium Included in Basic Premium Total Employer Paid Premium Total Employer Monthly Premium $12,727 $14,152 $12,749 $13,880 $12,749 $12,749 Total Employer Annual Premium $152,729 $169,826 $152,990 $166,562 $152,990 $152,990 Cost Difference (%)--11%0%9%0%0% Cost Difference ($)--$1,425 $22 $1,153 $22 $22 Total Employee Paid Premium Total Employee Monthly Premium $14,951 $16,612 $14,929 $14,819 $19,759 $16,411 Total Employee Annual Premium $179,411 $199,346 $179,150 $177,832 $237,110 $196,933 Cost Difference (%)--11%0%-1%32%10% Cost Difference ($)--$1,661 -$22 -$132 $4,808 $1,460 Rate Guarantee 3 Years 3 Years 3 Years Special Open Enrollment Open Enrollment offered up to the Max Benefit, subject to pre-existing condition limitations. Open Enrollment offered up to the Max Benefit, subject to 6/12 pre-existing condition limitations. Open Enrollment offered up to the Max Benefit, subject to pre-existing condition limitations. Covered Payroll based on the April 2018 Aetna Invoice for Monthly LTD Premium. 3 Years This comparison is intended to illustrate the carrier's proposed services and rates and should not be relied upon to fully determine benefits and rates. Refer to carrier's renewal/proposal for a complete representation of coverage terms and conditions. Negotiated Renewal Collier County Government FML COST/BENEFIT ANALYSIS Effective: 01/01/2019 Aetna/Hartford Reliance Standard The Standard Voya Renewal Option (Matrix)(Compysch) Total FMLA Covered Lives*2,081 2,081 2,081 2,081 Rates Initial Set-Up Fee $0.00 $5,000.00 $4,500 $0.00 Per Claim Determination**$120/claim for claims that exceed an 11% annual incidence rate $275/claim for claims that exceed a 2% annual incidence rate ---- Per Employee Per Month $1.88 $1.75 $2.10 $1.43 Minimum Annual Cost $50,286 -- Estimated First Year Cost $50,286 $48,701 $56,941 $35,710 Estimated Ongoing Cost $50,286 $43,701 $52,441 $35,710 Non-Family Medical Leave Administration State Leaves Included Additional $.07 PEPM City Leaves Additional Fee Additional $.07 PEPM Jury Duty Additional Fee Included Military Leave Included Included Bereavement Additional Fee Additional $.07 PEPM Other Additional Fee Additional $.07 PEPM Additional Services Takeover Fee (Per Open Leave)$20 - $200***$165.00 $150 No Additional Charge Number of Open Leaves****42 42 42 42 Estimated Takeover Costs $4,620 $6,930 $6,300 No Additional Charge ADA Services Available for an additional fee. ADA Advantage: $0.88 PEPM plus additional $3,500 set-up fee Additional $0.80 PEPM for ADA-AA Services Additional $.23 for ADA Tracking and another $0.67 PEPM for coaching Cost for Additional Data Feed Included in below $200/hr + $200 per exception $1,500 -- Other Any customization development work will be charged at $200 per hour. Payroll services, $2,750 annually $225 for customizable correspondence, phone numbers, intake scripts and reporting -- Contract Period 3 Years 3 Years 3 Years 3 Years *Average number of FMLA lives for 2017. **2017 Incidence Rate = 152/2,081 = 7% ****Number of open FMLA leaves (15 pending) as of 4/24/2018) State and Federal included. $.08 PEPM for up to two additional leaves; $.075 PEPM for each additional leave Covered in the above fees, but would increase the potential of the incidence rate exceeding cap. ***Leaves that are presented in an acceptable manner that clearly displays the historical time used in a spreadsheet or calendar format will be billed as a one time loading charge of $80.00 per open leave and $20.00 per closed leave. Leaves not provided in the acceptable manner, as outlined below, will be charged at $200 per hour for custom formatting. Assume Average, $110 per claim CARRIER STATUS LINE OF COVERAGE COMMISSION SCHEDULE SUB BROKER ADDITIONAL COMPENSATION FATCA COMPLIANCE MARKET SECURITY Aetna/Hartford Incumbent Life/AD&D, Vol. Life/AD&D, LTD, ASO STD, FMLA Life/AD&D, ASO STD, FMLA: Net of Commission Base LTD, Premium LTD: 10% Vol. Life: 20% ----Compliant Approved Reliance Standard See Analysis Life/AD&D, Vol. Life/AD&D, LTD, ASO STD, FMLA Life/AD&D, ASO STD, FMLA: Net of Commission Base LTD, Premium LTD: 7% Vol. Life: 20% ----Compliant Approved The Standard See Analysis Life/AD&D, Vol. Life/AD&D, LTD, ASO STD, FMLA Life/AD&D, Base LTD, ASO STD, FMLA: Net of Commission Premium LTD: 13% Vol. Life: 20% ----Compliant Approved ReliaStar (Voya)See Analysis Life/AD&D, Vol. Life/AD&D, LTD, ASO STD, FMLA Life/AD&D, Base LTD, ASO STD, FMLA: Net of Commission Premium LTD: 10% Vol. Life: 20% --2% (Can be excluded)Compliant Approved Symetra Quote Provided Life/AD&D, Vol. Life/AD&D, LTD, ASO STD, FMLA Life/AD&D, Base LTD, ASO STD, FMLA: Net of Commission Premium LTD: 10% Vol. Life: 20% ----Compliant Approved Lincoln Quote Provided Life/AD&D, Vol. Life/AD&D, LTD, ASO STD, FMLA Life/AD&D, Base LTD, ASO STD, FMLA: Net of Commission Premium LTD: 10% Vol. Life: 20% ----Compliant Approved Liberty Mutual Quote Provided Life/AD&D, Vol. Life/AD&D, LTD, ASO STD, FMLA Life/AD&D, Base LTD, ASO STD, FMLA: Net of Commission Premium LTD: 10% Vol. Life: 20% ----Compliant Approved COMPENSATION DISCLOSURE Collier County Government LIFE/DISABILITY CARRIERS SOUGHT & RECEIVED CARRIER STATUS LINE OF COVERAGE COMMISSION SCHEDULE SUB BROKER ADDITIONAL COMPENSATION FATCA COMPLIANCE MARKET SECURITY COMPENSATION DISCLOSURE Collier County Government LIFE/DISABILITY CARRIERS SOUGHT & RECEIVED Mutual of Omaha Quote Provided (Late) Life/AD&D, Vol. Life/AD&D, LTD, ASO STD, FMLA Life/AD&D, Base LTD, ASO STD, FMLA: Net of Commission Premium LTD: 10% Vol. Life: 20% ----Compliant Approved Met Life Quote Provided (Late) Life/AD&D, Vol. Life/AD&D, LTD, ASO STD, FMLA Life/AD&D, Base LTD, ASO STD, FMLA: Net of Commission Premium LTD: 10% Vol. Life: 20% ----Compliant Approved Cigna Declined to Quote Not Competitive Life/AD&D, Vol. Life/AD&D, LTD, ASO STD, FMLA ------Compliant Approved Guardian Declined to Quote Can not properly administer STD Life/AD&D, Vol. Life/AD&D, LTD, ASO STD, FMLA ------Compliant Approved Prudential Declined to Quote Not Competitive Life/AD&D, Vol. Life/AD&D, LTD, ASO STD, FMLA ------Compliant Approved Sun Life Declined to Quote Not Competitive Life/AD&D, Vol. Life/AD&D, LTD, ASO STD, FMLA ------Compliant Approved Unum Declined to Quote Not Competitive Life/AD&D, Vol. Life/AD&D, LTD, ASO STD, FMLA ----2.5%Compliant Approved Dear Jeff Walker: Above is a high level summary of the markets we approached on your behalf. We have indicated which quotes are included in the detailed summary based on what most aligns with the strategic direction you provided us in our pre-renewal strategy discussion. If you would like a copy of any quote received, please let us know and we will provide it to you. Please review the details of the proposals included to ensure that these meet your expectations. The proposals may differ from your current policy, so we recommend that you read the specifications from the carrier in their entirety and compare them to your current policy. Should you have any questions about the proposals or concerns about what is included in this summary, please let us know at once. Please provide us with your selection of coverage. We will confirm the details of this selection in writing with you and the carrier. This proposal is presented in conjunction with the Standard Terms and Conditions for Human Capital Accounts which was previously provided to you. EXECUTIVE SUMMARY Recommendation to approve the purchase of Group Life insurance, Accidental Death insurance, Long Term Disability insurance, Short Term Disability Claims and Family Medical Leave Act Administration Services (Agreement #18-7409) from Reliance Standard/Matrix Absence Management, Inc., for a three-year period effective January 1, 2019, in the estimated annual amount of $670,994. OBJECTIVE: To provide a competitive, best value Group Life and Disability insurance program as part of the County’s comprehensive group insurance package. In addition, administration of the County’s self- insured Short-Term Disability, Family Medical Leave (FMLA) and Medical Leave of Absence (MLOA). CONSIDERATIONS: The Collier County Board of Commissioners through the Risk Management Division administers a Group Insurance Program for its eligible employees and participating constitutional officer employees. As part of this program, the County provides two times salary life and accidental death insurance and a 40% short and long-term disability benefit. Employees can purchase additional short and long-term disability coverage up to a maximum benefit of 66 2/3% of salary (a 26 2/3% buy-up benefit). The short-term disability benefit is self-funded. All other benefits are fully insured. Employees may also purchase additional voluntary life and accidental death coverage on themselves and their dependents. Due to the nature of disability claims, the life insurance, long term disability insurance and short-term disability administration programs must be integrated and purchased from the carrier chosen. The County currently administers the requirements of the Family Medical Leave Act (FMLA) in-house. The FMLA is a federal law that guarantees certain employees up to 12 workweeks of unpaid leave in any 12-month period for various specified purposes, with the right for the employee to return to the same or an equivalent position after returning from FMLA leave. FMLA also requires that employers covered by the law maintain the health benefits of eligible workers just as if they were working. The law requires consistent and close administration with the County’s sick leave bank and disability programs. The law also imposes significant financial penalties if the requirements of the Act are not followed. As Federal and State leave requirements have become more complex, the Risk Management Division, Human Resources and Willis Towers Watson believe there is considerable risk in continuing to administer the requirements of these laws internally. Therefore, in conjunction with the marketing of the group insurance programs noted above, terms were obtained from the disability insurers to administer FMLA ensuring compliance with state and federal regulations; reducing the risk of violations of law; securing protected health information; and ensuring that leave requests are valid. The current Group Life and Disability program is underwritten by Aetna and expires on December 31, 2018. In anticipation of this expiration, Willis Towers Watson, the County’s benefits brokerage and actuarial firm, marketed the program. Willis Towers Watson received proposals from nine carriers including the incumbent, Aetna. After reviewing the terms and pricing of each proposal received, the list was narrowed to three carriers that provided the most competitive financial terms. Aetna was eliminated from the group due to a pricing increase of 50%, making them uncompetitive. All three carriers guaranteed rates for three years. The table below shows the price terms quoted. Carrier Total Annual Cost Cost Difference from Lowest Proposal The Standard $664,506 NA Reliance Standard $670,994 $6,488 Voya $681,506 $17,000 Staff completed a due diligence review of the three carriers to assess their ability to manage and integrate the Short-Term Disability and FMLA administration portions with the County’s practices and procedures. Although there was a marginal $3,738 annual difference in cost between Reliance Standard Life Insurance Company and the lowest carrier (The Standard), staff unanimously recommended Reliance Standard Life due to their proven service record and past experience with the carrier. The absence and disability management services quoted by Reliance Standard Life Insurance Company will be administered and managed by its sister company Matrix Absence Management, Inc., as set forth in the attached Agreement. The program will commence effective January 1, 2019. FISCAL IMPACT: The total estimated annual cost of the Group Life and Disability insurance program is $670,994 based upon current reportable payroll. The estimated annual additional cost to the Board is $118,986 per year includes the cost of FMLA and MLOA Administration and the increase over current rate. There are sufficient funds available in Fund 517, Group Health and Life, for this purchase. 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: It is recommended that the Board approves the purchase of Group Life insurance, Long Term Disability insurance, Short Term Disability Administration Services, and Accidental Death Insurance and FMLA and MLOA Administration from Reliance Standard/Matrix Absence Management, Inc. as outlined in the executive summary and authorizes the Chairman to execute the attached agreement. PREPARED BY: Sonja L. Sweet, Group Insurance Manager, Risk Management Attachments: Bid Tabulation Short Term Disability Claims and FMLA Administration Agreement November 2, 2018 Mr. Daniel Keating Actuary Florida State Insurance Department Life and Health Rates and Forms Larson Building 200 East Gaines Street Tallahassee, FL 32399-0328 SUBJECT: F.S. 112.08 Filing for Collier County Government Dear Mr. Keating: I am submitting the enclosed materials to you on behalf of Collier County Government to comply with the F.S. 112.08 filing requirements for the fiscal year ending September 30, 2018. Along with the F.S. 112.08 exhibits you will find an actuarial certification of the September 30, 2018 IBNR reserve and supporting workpapers. I believe Collier County Government is in full compliance with the F.S. 112.08 filing requirements. If you have any questions in this regard please contact me at 262-780-3288. Sincerely, Sheryl Henry, FSA, MAAA Willis Towers Watson OFFICE OF INSURANCE REGULATION Bureau of Life & Health Forms and Rates GENERAL INFORMATION ON SELF-FUNDED HEALTH BENEFIT PLANS OIR-B2-570 Rev. 12/03 PLAN FISCAL YEAR 10/1/2017-9/30/2018 PLAN NAME Collier County Government INDIVIDUAL CONTACT Jeff Walker, Risk Management Director ADDRESS 3301 E. Tamiami Trail Naples, FL 34112 FAX NUMBER 941-774-8408 PHONE NUMBER 941-774-8906 E-MAIL ADDRESS JeffWalker@colliergov.net ADMINISTRATOR Allegiance Benefit Plan Management, Inc. INDIVIDUAL CONTACT Alan Hall ADDRESS 2806 South Garfield Street Missoula, MT 59801 FAX NUMBER 406-721-2252 PHONE NUMBER 406-721-2222 x3100 E-MAIL ADDRESS Alan.Hall@AskAllegiance.com ACTUARIAL FIRM Willis Towers Watson ACTUARY Sheryl Henry F.S.A., M.A.A.A. ADDRESS 400. N. Executive Dr. Suite 300 Brookfield, WI 53005 FAX NUMBER PHONE NUMBER 262-780-3288 E-MAIL ADDRESS sheryl.henry@willistowerswatson.com OFFICE OF INSURANCE REGULATION ____ Bureau of Life & Health Forms and Rates ANNUAL REPORT OF SELF-FUNDED HEALTH BENEFIT PLANS OIR-B2-572 Rev. 12/03 FISCAL YEAR REPORT COVERING __10/1/2017_______________THROUGH______9/30/2018________________ 1. PREMIUM INCOME 38,435,953 2. OTHER INCOME (IF AMOUNT IS GREATER THAN 10% OF ITEM 1, ATTACH DETAILED EXPLANATION.)270,867 3. INVESTMENT INCOME (IF AMOUNT IS GREATER THAT 10% OF ITEM 1, ATTACH DETAILED EXPLANATION.)465,007 4. TOTAL INCOME (SUM OF ITEMS 1,2, &3.)39,171,827 5. CLAIMS PAID 33,536,925 6. CLAIM RESERVES –END OF CURRENT YEAR (ATTACH DETAILED EXPLANATION OF HOW RESERVES WERE CALCULATED.) 4,123,000 7. CLAIMS RESERVES –END OF PRIOR YEAR (MUST MATCH WITH PRIOR REPORT OR ATTACH DETAILED EXPLANATION.) 3,450,000 8. TOTAL INCURRED CLAIMS (GROSS) (SUM OF ITEMS 5 & 6,LESS ITEM 7.)34,209,925 9. REINSURANCE RECOVERABLE 0 10. TOTAL INCURRED CLAIMS (NET OF REINSURANCE) (ITEM 8 LESS ITEM 9)34,209,925 11. STOP LOSS INSURANCE PREMIUMS 1,064,406 12. EXPENSES A. SALARIES 669,389 B CONSULTING FEES 1. TPA/INSURANCE COMPANY CONSULTING FEES ______ADMIN____1,229,223 2. OTHER CONSULTING FEES _________________96,900 TOTAL CONSULTING FEES 1,326,123 C. OFFICE EXPENSES 1,747,169 D. OTHER (IF GREATER THAN 10%OF THE TOTAL OF A, B, AND C DETAIL THE COSTS.) E. TOTAL EXPENSES (SUM OF ITEMS A, B, C, & D.)3,742,681 13. TOTAL DISBURSEMENTS (SUM OF ITEMS 10, 11, 12E.)39,017,012 14. OPERATING GAIN OR LOSS (ITEM 4 LESS ITEM 13.)154,815 OFFICE OF INSURANCE REGULATION _____ Bureau of Life & Health Forms and Rates OPERATING PROJECTIONS FOR SELF-FUNDED HEALTH BENEFIT PLANS OIR-B2-573 Rev. 12/03 PLAN FISCAL YEAR REPORT COVERING 10/1/2017 THROUGH 9/30/2018 PART 1 CURRENT YEAR YEAR 1 YEAR 2 1. NUMBER OF EMPLOYEES 2,189 2,189 2,189 2. PREMIUM INCOME 39,918,000 42,313,000 44,852,000 3. OTHER INCOME (INCLUDES INVESTMENT INCOME) 225,000 225,000 225,000 4. TOTAL INCOME (SUM OF ITEMS 2 AND 3)40,143,000 42,538,000 45,077,000 5. TOTAL INCURRED CLAIMS* (NET OF REINSURANCE) 36,101,000 38,254,000 40,566,000 6. TOTAL EXPENSES 4,011,000 4,213,000 4,431,000 7. TOTAL DISBURSEMENTS (SUM OF ITEMS 5 AND 6) 40,112,000 42,467,000 44,997,000 8. TOTAL GAIN OR LOSS (ITEM 4 LESS ITEM 7)31,000 71,000 80,000 9. CHANGE IN SURPLUS DUE TO OTHER FACTORS (CONTRIBUTION, WITHDRAWAL)0 0 0 10. SURPLUS BEGINNING OF YEAR 31,154,000 31,185,000 31,256,000 11. SURPLUS END OF YEAR (SUM OF ITEMS 8, 9, AND 10) 31,185,000 31,256,000 31,336,000 PART 2-ASSUMPTIONS CURRENT YEAR (ACTUAL) YEAR 1 YEAR 2 1. PERCENT PREMIUM INCREASE 1.1% 6.0%6.0% 2. TREND (MEDICAL AND EXPENSE)6.0% 6.0%6.0% 3. PREMIUM CONTRIBUTION- SINGLE/FAMILY EMPLOYEE $140.99/$348.73 $149.45/$369.65 $158.42/$391.83 LOCAL GOVERNMENTAL UNIT $696.17/$1,655.89 $737.94/$1,755.24 $782.22/$1,860.56 4. STOP LOSS MINIMUM ATTACHMENT POINT $225,000 $225,000 $225,000 * INCLUDES PREMIUMS FOR STOP LOSS INSURANCE. OFFICE OF INSURANCE REGULATION _____ Bureau of Life & Health Forms and Rates GENERAL INFORMATION AND SURPLUS STATEMENT FOR SELF-FUNDED HEALTH BENEFIT PLANS OIR-B2-574 Rev. 12/03 GENERAL INFORMATION BENEFIT BENEFIT BENEFIT (A)(B)(C) 1. TYPE OF BENEFIT MEDICAL 2. NUMBER OF COVERED EMPLOYEES 2,189 SINGLE (EMPLOYEE ONLY)975 FAMILY (EMPLOYEE AND DEPENDENTS)1,214 3.CLAIMS INCURRED 34,209,925 4. ANNUAL CLAIM COST PER EMPLOYEE (ITEM 3 / ITEM 2)15,628 SURPLUS STATEMENT (THIS SCHEDULE TRACES THE DEVELOPMENT OF SURPLUS IN THE PLAN FROM THE PRIOR YEAR TO THE END OF THE CURRENT YEAR.) 1.SURPLUS FROM PRIOR YEAR (IF A DEFICIT, SHOW AS NEGATIVE SURPLUS) ______30,999,534__________ 2.CHANGE IN SURPLUS FROM FUND OPERATIONS (GAIN OR LOSS FOR YEAR) ________154,815__________ 3.CHANGE IN SURPLUS DUE TO OTHER FACTORS (CONTRIBUTION, WITHDRAWAL) ___________0_____________ 4.OVERALL CHANGE IN SURPLUS, PRESENT YEAR ________154,815__________ 5.SURPLUS, END OF CURRENT YEAR (SUM OF ITEM 1AND ITEM 4) ______31,154,349__________ THE SURPLUS FROM THE END OF THE PRIOR YEAR SHOULD AGREE W ITH THE STARTING SURPLUS FOR THE CURRENT YEAR. IF THEY DO NOT COINCIDE, PLEASE PROVIDE AN EXPLANATION. NOTE: IF LINE 5 IS NEGATIVE, THE PLAN IS NOT IN GOOD STANDING W ITH THE FLORIDA OFFICE OF INSURANCE REGULATION. THIS DEFICIT MUST BE REMOVED BY AN INFUSION OF AN AMOUNT AT LEAST EQUAL TO THE DEFICIT. IF THE DEFICIT IS TO BE LIQUIDATED OVER A PERIOD OF TIME, PLEASE PROVIDE THE DETAILS OF THIS PROGRAM FOR CONSIDERATION, ALONG W ITH A SUPPORTING ACTUARIAL OPINION. IF THE PLAN’S SURPLUS IS LESS THAN SIXTY DAYS OF ANTICIPATED CLAIMS, OTHER QUESTIONS MAY BE ASKED OF THE PLAN AS THE OFFICE SEES FIT. Collier County Government November 2, 2018 Collier County Government Actuarial Memorandum F.S. 112.08 Filing for Plan Year 201 8 I, Sheryl Henry, am a Vice President and Actuary for Willis, which serves as an independent consultant to the plan sponsor, the Collier County Government. I am a Fellow of the Society of Actuaries and a Member of the American Academy of Actuaries. I have prepared the F.S. 112.08 filing required for the Collier County Government’s self-insured health plan. In my opinion this plan is actuarially sound in that the expected premium revenue will make sufficient provision for expected claims and expenses. The plan is anticipated to maintain surplus in excess of required surplus. All calculations and assumptions have been prepared in accordance with generally accepted actuarial principles. Assumptions are reasonable and appropriate. This report is complete and accurate and the techniques and assumptions used are reasonable and meet the requirements of Florida Statute 112.08. Premium Rates Collier County currently offers three plans of benefits to its employees. Rates are calculated for single/family, smoker/non-smoker and salary categories within each plan. The salary group is determined as: Group 1 annual salary less the $25,000 Group 2 annual salary $25,000 -$49,999 Group 3 annual salary $50,000 -$74,999 Group 4 annual salary $75,000 and over Currently 14% of employees are enrolled in the Select plan, 3% in the Basic plan and 83% in the Premium plan. Employee contributions under each of the plans are identical. Overall, employees contribute 18% of the premium. MONTHLY HEALTH RATES FOR 2018 EE Ra tes ER Ra te s EE Ra te s ER Ra te s EE Ra tes ER Ra te s EE Ra te s ER Ra te s SALARY GRADES Gra de 1 Grade 1 Gra de 2 Gra de 2 Gra de 3 Grade 3 Gra de 4 Gra de 4 BAS IC Single Non-Sm 103.98$ 504.21$ 125.15$ 483.04$ 146.35$ 461.84$ 167.52$ 440.67$ Smoker 201.93$ 406.28$ 239.43$ 368.78$ 276.91$ 331.30$ 314.41$ 293.78$ Family Non-Sm 267.22$ 1,147.35$ 315.60$ 1,098.97$ 363.98$ 1,050.59$ 412.36$ 1,002.21$ Smoker 365.14$ 1,049.42$ 429.87$ 984.71$ 494.54$ 920.05$ 559.25$ 855.34$ SELECT Single Non-Sm 103.98$ 592.34$ 125.15$ 571.17$ 146.35$ 549.97$ 167.52$ 528.80$ Smoker 201.93$ 494.44$ 239.43$ 456.93$ 276.91$ 419.45$ 314.41$ 381.95$ Family Non-Sm 267.22$ 1,352.33$ 315.60$ 1,303.95$ 363.98$ 1,255.57$ 412.36$ 1,207.19$ Smoker 365.14$ 1,254.43$ 429.87$ 1,189.72$ 494.54$ 1,125.05$ 559.25$ 1,060.32$ PREMIUM Single Non-Sm 103.98$ 782.52$ 125.15$ 761.34$ 146.35$ 740.15$ 167.52$ 718.97$ Family Non-Sm 267.22$ 1,794.67$ 315.60$ 1,746.28$ 363.98$ 1,697.90$ 412.36$ 1,649.52$ Collier County Government November 2, 2018 Rates were calculated for the fiscal year beginning 10/1/2018 using medical and drug claims and enrollment for the past 36 months. This experience is adjusted for any anticipated benefit changes. Experience was projected to the upcoming year using a trend of 6%. Revenue at current rates is projected to be sufficient to cover costs in the 2019 plan year. Claim Experience Total medical and drug claim costs in FY2018 were $1,329 per employee per month. We are anticipating a per employee cost per month of $1,373 in FY2019. Other Expenses Non-claim expenses composed of TPA charges, plan administration costs and network access fees account for 9.6% of costs. Stop loss premium accounts for 2.7% of costs. Expenses in FY2018 included a one-time transfer to Capital to remodel the Wellness Center. IBNR We calculated the 9/30/2018 IBNR reserve using a completion factor method. The completion factor method estimates the total completed incurred claims by month based on historical payment patterns. Because the completion factors for the most recent months of incurrals are prone to wide fluctuations, the estimates for those months are replaced by an average per employee per month claim amount multiplied by the current number of employees. Surplus For the 2018 plan year, the plan experienced an operating gain of $155,000. The County holds a surplus of $31.0M as of 9/30/2018 which is roughly equivalent to 10.4 months of incurred claims and which satisfies the 60-day safe harbor threshold established by the OIR. Employer $265.17 Employee $1,269.85 # Members as of 9/30/18 4,775 Average P MPM Rate 2015 2016 2017 2018 2019 Claims Expec ted $27.7M $29.7M $32.3M $32.6M $36.1M Actual $27.6M $29.8M $30.9M $34.2M Expec ted and A ctual Claims fo r P lan Y ear Collier County Government November 2, 2018 Based on a review of the expected benefits and revenues for the upcoming plan year, the Collier County Government’s self-funded health plan is actuarially sound. Sheryl Henry, FSA, MAAA November 2, 2018 Willis Towers Watson 400 N. Executive Dr., Suite 300 Brookfield, WI 53005 T +1 262 780 3288 T +1 800 637 3550 Revenue $40,000,000 Paid Claims $35,900,000 Change in IBNR $200,000 Inc urred Claim $36,100,000 Los s Rat io 90.3% Expec ted 2019 Los s Rat io Collier County Government Postretirement Benefit Valuation Report Under GASB 75 Expense Development for Fiscal Year Beginning October 1, 2017 February 6,2019 Collier County Government 1 February 6, 2019 Table of Contents Executive Summary ..............................................................................................................................2 Changes Since Prior Valuation ............................................................................................................3 Section 1: Accounting Information......................................................................................................4 Section 1.1: Net OPEB Liability as of 9/30/2017 ...................................................................................5 Section 1.2: OPEB Liability as of 9/30/2017 by Source ................................................................................6 Section 1.3: OPEB Expense for the Fiscal Year Beginning 10/1/2017 ........................................................7 Section 1.4: Deferred Outflows of Resources and Inflows of Resources ..................................................8 Section 1.5: Historical Changes in the Net OPEB Liability..........................................................................9 Section 1.6: Annual Contributions ..............................................................................................................11 Section 1.7: Sensitivity of the Net OPEB Liability ......................................................................................12 Section 1.8: OPEB Expense Projection.......................................................................................................13 Section 1.9: Allocation to Employee Group ................................................................................................14 Section 2: Supporting Documentation ..............................................................................................15 Section 3: Basis of Valuation .............................................................................................................16 Section 3.1: Plan Participants ...........................................................................................................17 Section 3.2: Actuarial Basis .........................................................................................................................20 Section 3.3: Assumptions ..........................................................................................................................21 Section 3.4: Description of GASB 75 Terms ..............................................................................................24 Certification ..........................................................................................................................................25 Collier County Government 2 February 6, 2019 Executive Summary This report has been prepared by Willis Towers Watson for the Collier County Government for the following purposes: •To provide the September 30, 2017 reporting and disclosure information for financial statements, governmental agencies, and other interested parties as required in the Statement of Governmental Accounting Standards No. 75 (SGAS 75) •To present the SGAS 75 expense for the year beginning October 1, 2017. •To summarize the actuarial methods, assumptions, and data used in the valuation. The Collier County Government is providing a retiree medical program for employees who meet the eligibility requirements upon retirement. Under SGAS 75 retiree benefits are viewed as a form of deferred compensation. As such, the benefits are treated as being earned over the working lifetime of the employee so that the cost is fully charged to operations by the earliest date of eligibility under the plan. Collier County Government 3 February 6, 2019 Changes Since Prior Valuation The accounting has been updated to comply with the Statement of Governmental Accounting Standards No. 75 (SGAS 75). There have been no substantive plan changes since the prior valuation. The census has been updated to reflect the current population. The mortality assumption has been changed from RP-2014 Mortality Fully Generational using Projection Scale MP-2014 to RP-2014 Mortality Fully Generational using Projection Scale MP-2016. The discount rate has been changed from 3.0% to 2.8% the 20 year AA municipal bond rate. Other assumptions are consistent with those used in the prior valuation. Collier County Government 4 February 6, 2019 Section 1: Accounting Information SGAS 75 requires that certain information regarding postretirement benefits other than pension benefits be disclosed in the sponsor’s financial statements. The disclosures include a statement of the change in the net OPEB liability, the OPEB expense, deferred inflows and outflows, historical changes in the net OPEB liability and the annual contributions and a statement of assumptions and the amortization method. Presented in this section is an illustration of this information: Section 1.1: Net OPEB Liability as of 9/30/2017 Section 1.2: OPEB Liability as of 9/30/2017 by Source Section 1.3: OPEB Expense for the Fiscal Year Beginning 10/1/2017 Section 1.4: Deferred Outflows of Resources and Inflows of Resources Section 1.5: Historical Changes in the Net OPEB Liability Section 1.6: An nual Contributions Section 1.7: Sensitivity of the Net OPEB Liability Section 1.8: OPEB Expense Projection Section 1.9: Allocation to Employee Group Collier County Government 5 February 6, 2019 Section 1.1: Net OPEB Liability as of 9/30/2017 To tal OPEB Liability (a) Plan Fiduc iary Position (b) Net OPEB Liability (a) - (b) Ba la nce s a t 9/30/2016 $8,717,856 $0 $8,717,856 Cha nge s f or the Ye ar Servi ce Cos t $464,532 $464,532 Int eres t $248,849 $248,849 Changes of benefit terms $0 $0 Di fferenc es between ex pec ted and ac tual ex perienc e ($8,258)($8,258) Changes of as sumptions or other input s $0 $0 Contributions -employer $589,882 ($589,882) Net inve stment inc ome $0 $0 Benefit pay ment s ($589,882)($589,882)$0 Administrative ex pens e $0 $0 Ne t Cha nges $115,240 ($0)$115,240 Ba la nce s a t 9/30/2017 $8,833,096 $0 $8,833,096 Collier County Government 6 February 6, 2019 Section 1.2: OPEB Liability as of 9/30/2017 by Source Inac tive em ploy ees or benefic iaries current ly rec ei vi ng benefit pay ment s $2,846,749 Inac tive em ploy ees ent it led t o but not yet rec eivi ng benefit pay ment s $0 Active Employ ees $5,986,347 To tal $8,833,096 Collier County Government 7 February 6, 2019 Section 1.3: OPEB Expense for the Fiscal Year Fisca l Year Be ginning 10/1 2017 2016 Service c os t $491,865 $464,532 Int eres t $252,345 $248,849 Expec ted ret urn on inves tments $0 $0 Rec ognit ion of diffe renc e bet ween ex pec ted and ac tual ex perienc e ($1,925)$0 Rec ognit ion of changes in as sumptions or ot her input s $0 $0 OPEB Ex pe nse $742,285 $713,379 Collier County Government 8 February 6, 2019 Section 1.4: Deferred Outflows of Resources and Inflows of Resources Deferred inflow resulted from the difference between expected and actual experience. Recognition period of deferred outflows of resources and deferred inflows of resources is 4.29 years. Changes in the liability resulting from differences between expected and actual experience due to economic or demographic factors or changes of assumptions about future economic or demographic factors or other inputs are recognized over a closed period equal to the average of the expected remaining service lives of all employees provided with benefits through the OPEB plan. Changes in the liability resulting from benefit plan changes are recognized immediately. Deferred Out fl ows of Res ourc es Deferred Inflows of Res ourc es Differenc es between ex pec ted and ac tual ex peri enc e $8,258 Changes of as sumptions Net differenc e bet ween projec ted and ac tual earnings on OP EB plan inves tment s Tota l $0 $8,258 Deferred Out fl ows of Res ourc es Deferred Inflows of Res ourc es Ye ar be ginning Octobe r 1 2017 $1,925 2018 $1,925 2019 $1,925 2020 $1,925 2021 $558 Th ereaft er $0 Collier County Government 9 February 6, 2019 Section 1.5: Historical Changes in the Net OPEB Liability Ye ar be ginning Octobe r 1 2017 2016 Total OPEB Liability Service Cos t $491,865 $464,532 In teres t $252,345 $248,849 Changes of benefit terms $0 $0 Differenc es between ex pec ted and ac tual ex peri enc e $0 ($8,258) Changes of as sumptions or other input s $0 $0 Benefit pay ment s ($625,275)($589,882) Ne t Change in tota l OPEB l iability $118,935 $115,240 Tota l OPEB l ia bility-be ginning $8,833,096 $8,717,856 Tota l OPEB l ia bility-e nding (a)$8,952,031 $8,833,096 Plan fi duci ary ne t position Cont ribut ions-em ploy er $625,275 $589,882 Net inves tment income $0 $0 Benefit pay ment s ($625,275)($589,882) Administrative ex pens e $0 $0 Ne t Change in pla n fiduciary ne t position $0 $0 Plan fiducia ry ne t position-beginning ($0)$0 Plan fiducia ry ne t position-ending (b)($0)$0 Ne t OP EB l iability-e ndi ng (a ) - (b ) $8,952,031 $8,833,096 Plan fi duci ary ne t position as a perce ntage of the total OPEB l iabi lity 0.0%0.0% Cove re d e mployee payroll TB D TB D Ne t OP EB l iability a s a pe rce ntage of co ve re d e mployee payroll TB D TB D Collier County Government 10 February 6, 2019 Ye ar beginning Octobe r 1, 2017 Board of County Commissioners Clerk of Circ uit Courts Supervisor of Elections Office Tax Collector's Office Property Appraiser's Office Total OPEB Liability Service Cost $491,865 $433,734 $20,766 $10,199 $9,150 $18,016 Interes t $252,345 $226,757 $9,990 $3,530 $1,888 $10,180 Changes of benefit terms $0 $0 $0 $0 $0 $0 Differenc es between expected and actual experience $0 $0 $0 $0 $0 $0 Changes of assumptions or other inputs $0 $0 $0 $0 $0 $0 Benefit payments ($625,275)($489,142)($62,249)($27,502)($289)($46,093) Ne t Cha nge in tota l OPEB liability $118,935 $171,349 ($31,493)($13,773)$10,749 ($17,897) Tota l OPEB liability-be ginning $8,833,096 $7,909,305 $367,135 $129,634 $58,417 $368,605 Tota l OPEB liability-e nding (a)$8,952,031 $8,080,654 $335,642 $115,861 $69,166 $350,708 Ye ar beginning Octobe r 1, 2016 Board of County Commissioners Clerk of Circ uit Courts Supervisor of Elections Office Tax Collector's Office Property Appraiser's Office Total OPEB Liability Service Cost $464,532 $409,631 $19,612 $9,632 $8,642 $17,015 Interes t $248,849 $223,581 $9,873 $3,489 $1,852 $10,054 Changes of benefit terms $0 $0 $0 $0 $0 $0 Differenc es between expected and actual experience ($8,258)($68,569)$34,031 $14,515 ($9,459)$21,224 Changes of assumptions or other inputs $0 $0 $0 $0 $0 $0 Benefit payments ($589,882)($461,455)($58,725)($25,945)($273)($43,484) Ne t Cha nge in tota l OPEB liability $115,240 $103,188 $4,790 $1,691 $762 $4,809 Tota l OPEB liability-be ginning $8,717,856 $7,806,117 $362,345 $127,943 $57,655 $363,796 Tota l OPEB liability-e nding (a)$8,833,096 $7,909,305 $367,135 $129,634 $58,417 $368,605 Collier County Government 11 February 6, 2019 Section 1.6: An nual Contributions Ye ar be ginning Octobe r 1 2017 2016 Actuarially determined c ont ribut ion $742,285 $713,379 Contri but ions in relat ion t o the ac tuarially det erm ined c ontribution $625,275 $589,882 Contri but ion defic ienc y (ex cess)$117,010 $123,497 Covered em ploy ee pay roll TB D TB D Contri but ion as a perc ent age of cove red empl oy ee pay roll TB D TB D Collier County Government 12 February 6, 2019 Section 1.7: Sensitivity of the Net OPEB Liability Disc ount Ra te Sensitivity 1%Dec rease Dis count Rate 1%Increase (1.8%)(2.8%)(3.8%) Net OPEB Liability (Asset)$9,347,700 $8,833,096 $8,244,203 He althca re Trend Rate Sensitivity 1%Dec rease Healthcare Cos t Trend Rates 1%Increase (5%decreasing to 4%) (6%dec reasing to 5%) (7%decreasing to 6%) Net OPEB Liability (Asset)$8,097,749 $8,833,096 $9,681,447 Collier County Government 13 February 6, 2019 Section 1.8: OPEB Expense Projection Fiscal Year Ending 9/30 OPEB Liability (B OY)Normal Cos t Int eres t on OPEB Liability Int eres t on Assets Deferred Outfl ow/Infl ow OPEB Expens e 2018 $8,833,096 $491,865 $252,345 $0 ($1,925)$742,285 2019 $8,952,274 $464,697 $254,335 $0 ($1,925)$717,108 2020 $9,004,517 $438,838 $255,331 $0 ($1,925)$692,245 2021 $9,049,960 $416,842 $255,066 $0 ($1,925)$669,982 2022 $9,006,825 $393,418 $251,449 $0 ($558)$644,310 2023 $8,812,104 $370,740 $245,500 $0 $0 $616,240 2024 $8,599,294 $348,381 $238,915 $0 $0 $587,296 2025 $8,357,404 $327,245 $231,351 $0 $0 $558,597 2026 $8,072,677 $303,804 $222,538 $0 $0 $526,342 2027 $7,742,592 $278,865 $212,348 $0 $0 $491,213 2028 $7,359,706 $253,921 $202,378 $0 $0 $456,299 2029 $7,044,894 $231,824 $192,805 $0 $0 $424,629 2030 $6,688,897 $208,725 $183,196 $0 $0 $391,921 2031 $6,370,986 $186,601 $173,912 $0 $0 $360,513 2032 $6,038,147 $167,142 $164,432 $0 $0 $331,574 2033 $5,704,712 $146,873 $153,871 $0 $0 $300,744 2034 $5,293,831 $131,352 $142,231 $0 $0 $273,584 2035 $4,877,054 $115,411 $131,332 $0 $0 $246,743 2036 $4,520,228 $102,118 $122,284 $0 $0 $224,402 2037 $4,235,033 $88,664 $113,418 $0 $0 $202,082 2038 $3,891,661 $76,521 $104,522 $0 $0 $181,042 To tal $5,543,849 $4,103,560 ($8,258)$9,639,151 Collier County Government 14 February 6, 2019 Section 1.9: Allocation to Employee Group Em ploye e Group Service Cost OP EB Lia bility OPEB Ex pe nse PAYGO Re ti ree FY2018 Board of Count y Commissioners $433,734 $7,909,305 $657,964 $489,142 Clerk of Circ uit Court s $20,766 $367,135 $31,174 $62,249 Supervisor of Elections Office $10,199 $129,634 $13,874 $27,502 Ta x Collector's Offi ce $9,150 $58,417 $10,806 $289 Propert y Apprais er's Office $18,016 $368,605 $28,466 $46,093 Total $491,865 $8,833,096 $742,285 $625,275 * Allocation of interes t, deferred i nflow/outfl ow bas ed on OP EB liability Collier County Government 15 February 6, 2019 Section 2: Supporting Documentation Number of Pa rticipants in Va luation a s o f 9/30/2017 Inac tive employ ees or beneficiaries current ly rec eivi ng benefit pay ment s 70 Inac tive employ ees ent it led t o but not yet rec eiving benefit pay ment s 0 Active Employ ees 2,236 To tal 2,306 Weighted Ave ra ge Assu mpti ons as of 9/30/2017 Di scount Rat e 2.80% Expec ted Long-Term Rat e of Ret urn on Assets N/A Assu med Health Ca re Cost Tre nd 2018 - 2019 6.0% 2020 - 2021 5.8% 2022 - 2023 5.5% 2024 - 2025 5.3% 2026 &after 5.0% Collier County Government 16 February 6, 2019 Section 3: Basis of Valuation Section 3.1: Plan Participants Section 3.2: Actuarial Basis Section 3.3: Assumptions Collier County Government 17 February 6, 2019 Section 3.1: Plan Participants Under Florida statutes, retirees are eligible to participate in the active medical plan by paying the active rate if they have attained age 62 and have 6 years of service or have at least 30 years of service. Employees eligible for a reduced benefit under FRS prior to age 62 are also eligible to participate in the medical plan. Because most retirees select the least expensive plan, it was assumed that all future retirees would be enrolled in the Select Plan. Two of the constitutional agencies, the Board of County Commissioners and the Tax Collector’s Office, provide a subsidy to the retiree based on the amount of unused accumulated sick leave subject to age and service requirements. The valuation includes all active employees and retirees and their covered spouses who are currently receiving benefits under the medical plans. At the present time, retirees are allowed to participate in the active medical plan but no direct subsidy is provided by Collier County for the majority of retirees. A subsidy is provided to 24 retirees. Exhibit 3.1a: Count of Active Participants Exhibit 3.1b: Count of Inactive Participants Collier County Government 18 February 6, 2019 Exhibit 3.1a: Count of Active Participants Age 0 - 4 5 - 9 10 - 14 15 - 19 20 - 24 25 - 29 30+To tal Under 20 3 0 0 0 0 0 0 3 20 - 24 61 0 0 0 0 0 0 61 25 - 29 156 14 2 0 0 0 0 172 30 - 34 156 33 43 1 0 0 0 233 35 - 39 88 21 59 18 1 0 0 187 40 - 44 100 19 62 38 6 1 0 226 45 - 49 97 28 50 61 17 7 1 261 50 - 54 109 32 83 50 29 22 8 333 55 - 59 107 36 69 67 29 25 21 354 60 - 64 55 19 70 51 28 20 8 251 65 - 69 22 11 28 20 8 5 5 99 70+13 5 17 11 5 2 3 56 Total 967 218 483 317 123 82 46 2,236 Statistics for Active Participants Average A ge 47.9 Average S ervice 9.6 Perc ent Male 56.2% Years of Service Collier County Government 19 February 6, 2019 Exhibit 3.1b: Count of Inactive Participants Age Single Married Total Under 50 0 1 1 50 - 54 0 2 2 55 - 59 12 5 17 60 - 64 23 14 37 65 - 69 3 1 4 70 - 74 2 0 2 75+5 2 7 To tal 45 25 70 Medical Coverage Collier County Government 20 February 6, 2019 Section 3.2: Actuarial Basis A.Funding Policy The retiree medical plan is operated on a Pay-As-You-Go basis. There are no assets that have been segregated and restricted to provide for retiree medical benefits. B.Valuation of Assets The plan has no segregated assets. In order to be considered as an asset under GASB 75, the resource (stock, cash etc) must be segregated and restricted in a trust or equivalent arrangement. Employer contributions to the plan must be irrevocable, dedicated to providing retiree benefits and protected from creditors C.Actuarial Cost Method Entry Age Actuarial Cost Method. Collier County Government 21 February 6, 2019 Section 3.3: Assumptions Discount Rate: 2.80%(20 year AA municipal bond rate) Mortality: RP-2014 Mortality Fully Generational using Projection Scale MP-2016 New Employees: None Retirement rates were based on current retiree experience and increased by 10%at ages 60-64 in anticipation of increased numbers of retirements due to introduction of the retiree medical plan subsidy under the Board of County Commissioners plan. Salary Increases:3.0% per year Average Active Monthly Cost $845.12 based on the weighted average of current enrollment in medical plans. Assumed Rate of Return on Plan Assets:N/A Age 25 19.5% 30 16.2% 35 12.9% 40 9.7% 45 7.5% 50 5.6% 55 1.0% Annual Te rm inat ion Rat es Age 55 6.0% 56 - 59 2.5% 60 5.5% 61 8.8% 62 24.2% 63 - 64 8.8% Annual Rat es of Ret irement Age 55 $990.19 60 $1,093.25 62 $1,137.42 64 $1,183.37 Monthly Per-Capi ta Claim Cos t Collier County Government 22 February 6, 2019 Administrative Expenses: Included in claim cost Attribution Period: The attribution period is the portion of a participant's service to which the expected postretirement benefit obligation is assigned. The beginning of the attribution period is the date of hire and the end of the attribution period is the earliest eligibility date. Valuation Date:October 1, 2017 Eligibility Requirements: Enrolled in FRS Plan prior to 7/1/2011 •Age 62 and 6 years of service or 30 years of service •Eligible for early retirement benefit under FRS Enrolled in FRS Plan on or after 7/1/2011 •Age 65 and 8 years of service or 33 years of service •Eligible for early retirement benefit under FRS Eligibility Requirements for Subsidy: Board of County Commissioners •15 years of continuous service with Collier County •55 years of age or 30 years of service under FRS •Retire from Collier County •Receive an FRS benefit with no break in time •Have at least 60% of eligible accrued sick leave remaining Tax Collector’s Office •Minimum vesting of 10 years with the Tax Collector’s Office •Between 54 and 64 years of age Benefits: Medical and drug, benefits as provided under the Select plan. Retirees and spouses are covered until age 65 unless under the Voluntary Separation Incentive program. Retiree Contributions Per Participant: $845.12 Depending on length of service and amount of eligible accrued sick leave remaining, the retiree may receive a subsidy toward the cost of coverage from Collier County. 2018 - 2019 6.00% 2020 - 2021 5.75% 2022 - 2023 5.50% 2024 - 2025 5.25% 2026 and lat er 5.00% Healt h Care Cos t Trend Collier County Government 23 February 6, 2019 Board of County Commissioners Based on the current active employee population, it is anticipated that 14.3% of retirees with more than 15 years of service will have at least 60% of eligible accrued sick leave remaining at time of retirement. The average percentage of eligible accrued sick leave remaining for those eligible to participate in the retiree medical plan is 82.4%. The premium subsidy applies to retiree and dependent coverage. Tax Collectors Office Based on the current active employee population, it is anticipated that 52.4% of retirees with more than 10 years of service will have at least 800 hours eligible accrued sick leave remaining at time of retirement. 100% of the retiree only portion of the premium is paid by the Tax Collector’s Office. Plan Participation of Future Retirees: •Eligible for subsidy: 100% •Not eligible for subsidy: 80% Percent of Future Retirees with Coverage Who Elect Coverage on Spouse: •Eligible for subsidy: 100% •Not eligible for subsidy: 80% Age Difference in Spouses: Male is 3 years older Years of Service >=90%85-89%80-84%75-79%70-74%65-69%60-64% 0 - 14 Not Eligible 15 50%48%45%43%40%38%35% 16 53%51%48%45%43%40%37% 17 57%54%51%48%45%43%40% 18 60%57%54%51%48%45%42% 19 63%60%57%54%51%48%44% 20 67%63%60%57%53%50%47% 21 70%67%63%60%56%53%49% 22 73%70%66%62%59%55%51% 23 77%73%69%65%61%58%54% 24 80%76%72%68%64%60%56% 25 83%79%75%71%67%63%58% 26 87%82%78%74%69%65%61% 27 90%86%81%77%72%68%63% 28 93%89%84%79%75%70%65% 29 97%92%87%82%77%73%68% >=30 100%95%90%85%80%75%70% Perc ent age of Eligible Accrued Sick Leave Remaining Perc entage of Premium Paid Ac crual Formula Calculat ion Collier County Government 24 February 6, 2019 Section 3.4: Description of GASB 75 Terms Actuarially Determined Contribution: A target or recommended contribution to a defined benefit OPEB plan for the reporting period, determined in conformity with Actuarial Standards of Practice based on the most recent measurement available when the contribution for the reporting period was adopted. Entry Age Actuarial Cost Method: A method under which the actuarial present value of the projected benefits of each individual included in an actuarial valuation is allocated on a level basis over the earnings of the individual of the individual between entry age and assumed exit age. OPEB Liability: That portion, as determined by a particular Actuarial Cost Method, of the Actuarial Present Value of OPEB benefits and expenses which is not provided for by future Normal Costs. Service Cost: That portion of the Actuarial Present Value of OPEB benefits and expenses which is allocated to a valuation year by the Actuarial Cost Method. Collier County Government 25 February 6, 2019 Certification I have prepared the attached actuarial valuation of the Collier County Government’s Postretirement Medical Benefit Programs in accordance with Statements of Governmental Accounting Standards No. 75. We have based the valuation on financial and census data which were provided to us by Collier County Government. W e have not audited the data beyond a check for reasonableness. All costs, liabilities, and other factors associated with the valuation of this plan have been determined in accordance with generally accepted actuarial principles and procedures, and are consistent with the provisions of SGAS 75, including the Actuarial Standard of Practice No. 6 for Measuring Retiree Group Benefit Obligations (American Academy of Actuaries). The actuarial computations under Statements of Governmental Accounting Standards contained in this report are for the sole purpose of fulfilling employer accounting requirements. The use of the results of this report for other purposes may lead to inappropriate conclusions. Sheryl Henry, FSA, MAAA February 6, 2019 Willis Towers Watson 400 N. Executive Dr., Suite 300 Brookfield, WI 53005 T +1 262 780 3288 T +1 800 637 3550 Form 3: Conflict of Interest Affidavit The Vendor certifies that, to the best of its knowledge and belief, the past and current work on any Collier County project affiliated with this solicitation does not pose an organizational conflict as described by one of the three categories below: Biased ground rules – The firm has not set the “ground rules” for affiliated past or current Collier County project identified above (e.g., writing a procurement’s statement of work, specifications, or performing systems engineering and technical direction for the procurement) which appears to skew the competition in favor of my firm. Impaired objectivity – The firm has not performed work on an affiliated past or current Collier County project identified above to evaluate proposals / past performance of itself or a competitor, which calls into question the contractor’s ability to render impartial advice to the government. Unequal access to information – The firm has not had access to nonpublic information as part of its performance of a Collier County project identified above which may have provided the contractor (or an affiliate) with an unfair competitive advantage in current or future solicitations and contracts. In addition to this signed affidavit, the contractor / vendor must provide the following: 1.All documents produced as a result of the work completed in the past or currently being worked on for the above-mentioned project; and, 2.Indicate if the information produced was obtained as a matter of public record (in the “sunshine”) or through non-public (not in the “sunshine”) conversation (s), meeting(s), document(s) and/or other means. Failure to disclose all material or having an organizational conflict in one or more of the three categories above be identified, may result in the disqualification for future solicitations affiliated with the above referenced project(s). By the signature below, the firm (employees, officers and/or agents) certifies, and hereby discloses, that, to the best of their knowledge and belief, all relevant facts concerning past, present, or currently planned interest or activity (financial, contractual, organizational, or otherwise) which relates to the project identified above has been fully disclosed and does not pose an organizational conflict. Firm: Willis Towers Watson d/b/a Willis of Wisconsin, Inc. (effective 1/1/2020, our name will change to Willis Towers Watson Midwest, Inc.) Signature and Date: _________________________________________________________________ Print Name: Douglas J. Ley____________________________________________________________ Title of Signatory: Senior Director______________________________________________________ Form 4: Vendor Declaration Statement BOARD OF COUNTY COMMISSIONERS Collier County Government Complex Naples, Florida 34112 Dear Commissioners: The undersigned, as Vendor declares that this response is made without connection or arrangement with any other person and this proposal is in every respect fair and made in good faith, without collusion or fraud. The Vendor agrees, if this solicitation submittal is accepted, to execute a Collier County document for the purpose of establishing a formal contractual relationship between the firm and Collier County, for the performance of all requirements to which the solicitation pertains. The Vendor states that the submitted is based upon the documents listed by the above referenced Solicitation. Further, the vendor agrees that if awarded a contract for these goods and/or services, the vendor will not be eligible to compete, submit a proposal, be awarded, or perform as a sub-vendor for any future associated with work that is a result of this awarded contract. IN WITNESS WHEREOF, WE have hereunto subscribed our names on this 13th day of May, 2019 in the County of Waukesha, in the State of Wisconsin. Firm’s Legal Name: Willis Towers Watson d/b/a Willis of Wisconsin, Inc. (effective 1/1/2020, our name will changes to Willis Towers Watson Midwest, Inc.) Address: 400 North Executive Drive, Suite 300 City, State, Zip Code: Brookfield, WI 53005 Florida Certificate of Authority Document Number Federal Tax Identification Number *CCR # or CAGE Code *Only if Grant Funded 39-076564__________________________________________________________________ Telephone: 262-780-3340 | 414-640-2710 Signature by: (Typed and written) Douglas J. Ley Title: Senior Director Additional Contact Information Send payments to: (required if different from above) Willis of Wisconsin, Inc. (effective 1/1/2020, our name will changes to Willis Towers Watson Midwest, Inc.) Company name used as payee Contact name: Mary Sallwasser Title: Client Services Address: 93033 Network Place City, State, ZIP Chicago, IL 60673-1930 Telephone: 262-780-3465 Email: mary.sallwasser@willistowerswatson.com Office servicing Collier County to place orders (required if different from above) Willis of Wisconsin, Inc. (effective 1/1/2020, our name will changes to Willis Towers Watson Midwest, Inc.) Contact name: Douglas J. Ley Title: Senior Director Address: 400 North Executive Drive, Suite 300 City, State, ZIP Brookfield, WI 53005 Telephone: 262-780-3340 | 414-640-2710 Email: douglas.ley@willistowerswatson.com Department of State /Division of Corporations /Search Records /Detail By Document Number / Document Number FEI/EIN Number Date Filed State Status Last Event Event Date Filed Event Effective Date Detail by Entity Name Foreign Profit Corporation WILLIS OF ILLINOIS, INC. Filing Information P04102 36-2691200 11/20/1984 IL ACTIVE NAME CHANGE AMENDMENT 01/27/2000 NONE Principal Address Willis Tower 233 South Wacker Drive Suite 2000 Chicago, IL 60606 Changed: 04/06/2018 Mailing Address Willis Tower 233 South Wacker Drive Suite 2000 Chicago, IL 60606 Changed: 04/06/2018 Registered Agent Name & Address CORPORATION SERVICE COMPANY 1201 HAYS STREET TALLAHASSEE, FL 32301-2525 Name Changed: 12/20/2018 Address Changed: 12/20/2018 Officer/Director Detail Name & Address Title Treasurer DIVISION OF CORPORATIONSFlorida Department of State Page 1 of 4Detail by Entity Name 5/24/2019http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... Buchanan, Norman J. 1500 Market Street Centre Square East Philadelphia, PA 19102-4790 Title Director Oliver, Darlene 26 Century Blvd Nashville, TN 37214 Title Director Liss, Michael 233 South Wacker Drive Suite 2000 Chicago, IL 60606 Title Director McMurray, Eric 5 Concourse Parkway Suite 1800 Atlanta, GA 30328 Title Secretary Naaktgeboren, Heather D. B. 26 Century Blvd Nashville, TN 37214 Title President Vila, Mark Willis Tower 233 South Wacker Drive Suite 2000 Chicago, IL 60606 Title Asst. Secretary Adams, Erin 800 N. Glebe Road Arlington, VA 22203 Title VP Trentham , Barbara 26 Century Blvd. Nashville, TN 37214 Title VP Page 2 of 4Detail by Entity Name 5/24/2019http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... Hu, Susan 200 Liberty Street New York, NY 10281 Title VP Smartt, J. Ammon 26 Century Blvd. Nashville, TN 37214 Annual Reports Report Year Filed Date 2017 04/19/2017 2018 04/06/2018 2019 04/04/2019 Document Images 04/04/2019 -- ANNUAL REPORT View image in PDF format 12/20/2018 -- Reg. Agent Change View image in PDF format 04/06/2018 -- ANNUAL REPORT View image in PDF format 04/19/2017 -- ANNUAL REPORT View image in PDF format 04/01/2016 -- ANNUAL REPORT View image in PDF format 04/02/2015 -- ANNUAL REPORT View image in PDF format 04/03/2014 -- ANNUAL REPORT View image in PDF format 04/22/2013 -- ANNUAL REPORT View image in PDF format 04/10/2012 -- ANNUAL REPORT View image in PDF format 03/23/2011 -- ANNUAL REPORT View image in PDF format 04/09/2010 -- ANNUAL REPORT View image in PDF format 04/29/2009 -- ANNUAL REPORT View image in PDF format 03/13/2008 -- ANNUAL REPORT View image in PDF format 01/05/2007 -- ANNUAL REPORT View image in PDF format 01/10/2006 -- ANNUAL REPORT View image in PDF format 01/03/2005 -- ANNUAL REPORT View image in PDF format 01/05/2004 -- ANNUAL REPORT View image in PDF format 01/14/2003 -- ANNUAL REPORT View image in PDF format 01/22/2002 -- ANNUAL REPORT View image in PDF format 05/23/2001 -- ANNUAL REPORT View image in PDF format 05/06/2000 -- ANNUAL REPORT View image in PDF format 01/27/2000 -- Name Change View image in PDF format 04/29/1999 -- ANNUAL REPORT View image in PDF format 04/24/1998 -- ANNUAL REPORT View image in PDF format 02/11/1997 -- ANNUAL REPORT View image in PDF format 05/01/1996 -- ANNUAL REPORT View image in PDF format 03/22/1995 -- ANNUAL REPORT View image in PDF format Florida Department of State, Division of Corporations Page 3 of 4Detail by Entity Name 5/24/2019http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... Page 4 of 4Detail by Entity Name 5/24/2019http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... Form 5: Immigration Affidavit Certification This Affidavit is required and should be signed, notarized by an authorized principal of the firm and submitted with formal solicitation submittals. Further, Vendors are required to enroll in the E-Verify program, and provide acceptable evidence of their enrollment, at the time of the submission of the Vendor’s proposal. Acceptable evidence consists of a copy of the properly completed E-Verify Company Profile page or a copy of the fully executed E-Verify Memorandum of Understanding for the company. Failure to include this Affidavit and acceptable evidence of enrollment in the E-Verify program may deem the Vendor’s proposal as non-responsive. Collier County will not intentionally award County contracts to any Vendor who knowingly employs unauthorized alien workers, constituting a violation of the employment provision contained in 8 U.S.C. Section 1324 a(e) Section 274A(e) of the Immigration and Nationality Act (“INA”). Collier County may consider the employment by any Vendor of unauthorized aliens a violation of Section 274A (e) of the INA. Such Violation by the recipient of the Employment Provisions contained in Section 274A (e) of the INA shall be grounds for unilateral termination of the contract by Collier County. Vendor attests that they are fully compliant with all applicable immigration laws (specifically to the 1986 Immigration Act and subsequent Amendment(s)) and agrees to comply with the provisions of the Memorandum of Understanding with E-Verify and to provide proof of enrollment in The Employment Eligibility Verification System (E-Verify), operated by the Department of Homeland Security in partnership with the Social Security Administration at the time of submission of the Vendor’s proposal. Company Name Willis of Wisconsin, Inc. (effective 1/1/2020, our name will change to Willis Towers Watson Midwest, Inc.) Print Name Douglas J. Ley Title Senior Director Signature Date May 13, 2019 State of Wisconsin County of Waukesha The signee of these Affidavit guarantees, as evidenced by the sworn affidavit required herein, the truth and accuracy of this affidavit to interrogatories hereinafter made. Form 6: Vendor Substitute W – 9 Request for Taxpayer Identification Number and Certification In accordance with the Internal Revenue Service regulations, Collier County is required to collect the following information for tax reporting purposes from individuals and companies who do business with the County (including social security numbers if used by the individual or company for tax reporting purposes). Florida Statute 119.071(5) requires that the county notify you in writing of the reason for collecting this information, which will be used for no other purpose than herein stated. Please complete all information that applies to your business and return with your quote or proposal. 1. General Information (provide all information) Taxpayer Name: Willis of Wisconsin, Inc. (effective 1/1/2020, our name will changes to Willis Towers Watson Midwest, Inc.) (as shown on income tax return) Business Name (if different from taxpayer name) Address _400 North Executive Drive, Suite 300____ City __Brookfield_________________________________ State WI___________________________________ Zip 53005_____________________________________ Telephone __________________ Email_____________________ Order Information (Must be filled out) Address 400 North Executive Drive, Suite 300____ Remit / Payment Information (Must be filled out) Address 93033 Network Place__________________________ City Brookfield_ State WI______ Zip 53005_____ City Chicago_______ State IL_______ Zip 60673-1930___ Email douglas.ley@willistowerswatson.com______ Email wis.receivables@willistowerswatson.com_________ 2. Company Status (check only one) Individual / Sole Proprietor X Corporation Partnership Tax Exempt (Federal income tax-exempt entity under Internal Revenue Service guidelines IRC 501 (c) 3) Limited Liability Company Enter the tax classification (D = Disregarded Entity, C = Corporation, P = Partnership) 3. Taxpayer Identification Number (for tax reporting purposes only) Federal Tax Identification Number (TIN) 39-0765647____________________________________________________ (Vendors who do not have a TIN, will be required to provide a social security number prior to an award). 4. Sign and Date Form: Certification: Under penalties of perjury, I certify that the information shown on this form is correct to my knowledge. Signature ___________________________________________________________ Date ______________________________ Title Senior Director___________________________________________ Phone Number 262-780-3340 INSURANCE AND BONDING REQUIREMENTS Insurance / Bond Type Required Limits 1. Worker’s Compensation Statutory Limits of Florida Statutes, Chapter 440 and all Federal Government Statutory Limits and Requirements Evidence of Workers’ Compensation coverage or a Certificate of Exemption issued by the State of Florida is required. Entities that are formed as Sole Proprietorships shall not be required to provide a proof of exemption. An application for exemption can be obtained online at https://apps.fldfs.com/bocexempt/ 2. Employer’s Liability $__1,000,000___ single limit per occurrence 3. Commercial General Liability (Occurrence Form) patterned after the current ISO form Bodily Injury and Property Damage $__1,000,000_____single limit per occurrence, $2,000,000 aggregate for Bodily Injur y Liability and Property Damage Liability. This shall include Premises and Operations; Independent Contractors; Products and Completed Operations and Contractual Liability. 4. Indemnification To the maximum extent permitted by Florida law, the Contractor/Vendor shall defend, indemnify and hold harmless Collier County, its officers and employees from any and all liabilities, damages, losses and costs, including, but not limited to, reasonable attorneys’ fees and paralegals’ fees, to the extent caused by the negligence, recklessness, or intentionally wrongful conduct of the Contractor/ Vendor or anyone employed or utilized by the Contractor/Vendor in the performance of this Agreement. 5. Automobile Liability $_________ Each Occurrence; Bodily Injury & Property Damage, Owned/Non-owned/Hired; Automobile Included 6. Other insurance as noted: Watercraft $ __________ Per Occurrence United States Longshoreman's and Harborworker's Act coverage shall be maintained where applicable to the completion of the work. $ __________ Per Occurrence Maritime Coverage (Jones Act) shall be maintained where applicable to the completion of the work. $ __________ Per Occurrence Aircraft Liability coverage shall be carried in limits of not less than $5,000,000 each occurrence if applicable to the completion of the Services under this Agreement. $ __________ Per Occurrence Pollution $ __________ Per Occurrence Professional Liability $ __1,000,000___ Per claim & in the aggregate Project Professional Liability $__________ Per Occurrence Valuable Papers Insurance $__________ Per Occurrence Cyber Liability $1,000,000 Per Occurrence Technology Errors & Omissions $__________ Per Occurrence 7. Bid bond Shall be submitted with proposal response in the form of certified funds, cashiers’ check or an irrevocable letter of credit, a cash bond posted with the County Clerk, or proposal bond in a sum equal to 5% of the cost proposal. All checks shall be made payable to the Collier County Board of County Commissioners on a bank or trust company located in the State of Florida and insured by the Federal Deposit Insurance Corporation. 8. Performance and Payment Bonds For projects in excess of $200,000, bonds shall be submitted with the executed contract by Proposers receiving award, and written for 100% of the Contract award amo unt, the cost borne by the Proposer receiving an award. The Performance and Payment Bonds shall be underwritten by a surety authorized to do business in the State of Florida and otherwise acceptable to Owner; provided, however, the surety shall be rated as “A-“ or better as to general policy holders rating and Class V or higher rating as to financial size category and the amount required shall not exceed 5% of the reported policy holders’ surplus, all as reported in the most current Best Key Rating Guide, published by A.M. Best Company, Inc. of 75 Fulton Street, New York, New York 10038. 9. Vendor shall ensure that all subcontractors comply with the same insurance requirements that he is required to meet. The same Vendor shall provide County with certificates of insurance meeting the required insurance provisions. 10. Collier County must be named as "ADDITIONAL INSURED" on the Insurance Certificate for Commercial General Liability where required. This insurance shall be primary and non-contributory with respect to any other insurance maintained by, or available for the benefit of, the Additional Insured and the Vendor’s policy shall be endorsed accordingly. 11. The Certificate Holder shall be named as Collier County Board of County Commissioners, OR, Board of County Commissioners in Collier County, OR Collier County Government, OR Collier County. The Certificates of Insurance must state the Contract Number, or Project Number, or specif ic Project description, or must read: For any and all work performed on behalf of Collier County. 12. On all certificates, the Certificate Holder must read: Collier County Board of Commissioners, 3295 Tamiami Trail East, Naples, FL 34112 13. Thirty (30) Days Cancellation Notice required. 14. Collier County shall procure and maintain Builders Risk Insurance on all construction projects where it is deemed necessary. Such coverage shall be endorsed to cover the interests of Collier County as well as the Contractor. Premiums shall be billed to the project and the Contractor shall not include Builders Risk premiums in its project proposal or project billings. All questio ns regarding Builder’s Risk Insurance will be addressed by the Collier County Risk Management Division. 2/28/19 - CC ___________________________________________________________________________________________________________ Vendor’s Insurance Statement We understand the insurance requirements of these specifications and that the evidence of insurability may be required within five (5) days of the award of this solicitation. The insurance submitted must provide coverage for a minimum of six (6) months from the date of award. Name of Firm _______________________________________ Date ____________________________ Vendor Signature _________________________________________________________________________ Print Name _________________________________________________________________________ Insurance Agency _________________________________________________________________________ Agent Name ___________________________________ Telephone Number ________________ Willis Towers Watson d/b/a Willis of Wisconsin, Inc.; effective 1/1/2020 our name will change to Willis Towers Watson Midwest, Inc. 5-13-2019 Douglas J. Ley Willis of New York, Inc. (see Acord certificate included in our response) 877-945-7378 ADDENDUM # 1 Memorandum Date: April 10, 2019 From: Barbara Lance, Procurement Strategist To: Interested Parties Subject: Addendum # 1 – 19-7581 Group Insurance Brokerage and Actuarial Services This addendum has been issued for the following item(s) identifying clarifications, changes, deletions, or additions to the original solicitation documents and bid schedule for the above referenced solicitation. ADDITION: A “Conference Call-In number” has been created for those who wish to call in for the “Pre-Proposal Meeting” scheduled for April 16th, 2019 at 2:00 pm. Call-In Number: Phone Number: 239-252-7001 Access Code: 489812 CC: Sonja Sweet, Project Manager Please acknowledge receipt of this Addendum and include with your bid. (Signature) Date (Name of Firm) If you require additional information, please post a question on BidSync on -line or contact me using the above contact information. Email: Barbara.Lance@colliercountygov.net Telephone: 239-252-8998 5-13-2019 Willis Towers Watson d/b/a Willis of Wisconsin, Inc.; effective 1/1/2020 our name will change to Willis Towers Watson Midwest, Inc. ADDENDUM # 2 Memorandum Date: April 17, 2019 From: Barbara Lance, Procurement Strategist To: Interested Parties Subject: Addendum # 2 – 19-7581 Group Insurance Brokerage and Actuarial Services This addendum has been issued for the following item(s) identifying clarifications, changes, deletions, or additions to the original solicitation documents and bid schedule for the above referenced solicitation. ADDITIONS: Question 4: ACTUARIAL – Attachments uploaded in BidSync. Question 1: Please provide a copy of the most recent GASB 75 valuation. Answer: See Attachment: 19-7581 Addendum 2_Final Retiree Medical Valuation 2017-09-30 Question 2: Please provide a copy of the annual State of Florida 112.08 filing for your self-insured health plan. Answer: See Attachment: 19-7581 Addendum 2_FS112.08 Filing 2018 CC: Sonja Sweet, Project Manager Please acknowledge receipt of this Addendum and include with your bid. (Signature) Date (Name of Firm) If you require additional information, please post a question on BidSync on -line or contact me using the above contact information. Email: Barbara.Lance@colliercountygov.net Telephone: 239-252-8998 Willis Towers Watson d/b/a Willis of Wisconsin, Inc.; effective 1/1/2020 our name will change to Willis Towers Watson Midwest, Inc. 5-13-2019 ADDENDUM # 3 Memorandum Date: April 26, 2019 From: Barbara Lance, Procurement Strategist To: Interested Parties Subject: Addendum # 3 – 19-7581 Group Insurance Brokerage and Actuarial Services This addendum has been issued for the following item(s) identifying clarifications, changes, deletions, or additions to the original solicitation documents and bid schedule for the above referenced solicitation. CHANGE: The Bid “End Date” has been extended from 3:00 pm on May 2, 2019 To: 3:00 pm on May 16, 2019 CC: Sonja Sweet, Project Manager Please acknowledge receipt of this Addendum and include with your bid. (Signature) Date (Name of Firm) If you require additional information, please post a question on BidSync on -line or contact me using the above contact information. Email: Barbara.Lance@colliercountygov.net Telephone: 239-252-8998 Willis Towers Watson d/b/a Willis of Wisconsin, Inc.; effective 1/1/2020 our name will change to Willis Towers Watson Midwest, Inc. 5-13-2019 ADDENDUM # 4 Memorandum Date: April 29, 2019 From: Barbara Lance, Procurement Strategist To: Interested Parties Subject: Addendum # 4 – 19-7581 Group Insurance Brokerage and Actuarial Services This addendum has been issued for the following item(s) identifying clarifications, changes, deletions, or additions to the original solicitation documents and bid schedule for the above referenced solicitation. ADDITION: Below contracts have been uploaded to BidSync per Questions 15 and 27: 1. Addendum 4_Contract Template (Standard Professional Service Agreement) 2. Addendum 4_Current Contract (Willis Contract) CC: Sonja Sweet, Project Manager Please acknowledge receipt of this Addendum and include with your bid. (Signature) Date (Name of Firm) If you require additional information, please post a question on BidSync on -line or contact me using the above contact information. Email: Barbara.Lance@colliercountygov.net Telephone: 239-252-8998 Willis Towers Watson d/b/a Willis of Wisconsin, Inc.; effective 1/1/2020 our name will change to Willis Towers Watson Midwest, Inc. 5-13-2019 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2016 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY Willis of New York, Inc. c/o 26 Century Blvd P.O. Box 305191 Nashville, TN 372305191 USA Willis North America, Inc. and its subsidiaries 200 Liberty Street New York, NY 10281 This Voids and Replaces Previously Issued Certificate Dated 06/21/2018 WITH ID: W6538472. Professional Indemnity Insurance (Errors & Omission Liability) Carrier: Stone Mountain Insurance Company. All employees of Willis North America and its subsidiaries are included as Insureds under the Errors & Omissions SEE ATTACHED Collier County Board of Commissioners 3327 Tamiami Trail East Naples, FL 34112 05/10/2019 1-877-945-7378 1-888-467-2378 certificates@willis.com Zurich American Insurance Company 16535 Sentry Insurance a Mutual Company Willis Submission Carrier 24988 GENRC National Union Fire Insurance Company of P 19445 W11219106 A 5,000,000 100,000 5,000Contractual Liability 5,000,000 5,000,000 5,000,000 Y GLO014436302 07/01/2018 07/01/2019 B 1,000,000 07/01/201907/01/201890-20597-04 90-20597-01B 1,000,000No07/01/2018 07/01/2019 1,000,000 1,000,000 C Professional Liability Per ClaimSM181907/01/2018 07/01/2019 Aggregate Limit 119472717952524SR ID:BATCH: $5,000,000 $5,000,000 Page 1 of 2 ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved. THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:FORM TITLE: ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE Page of AGENCY CUSTOMER ID: LOC #: AGENCY CARRIER NAIC CODE POLICY NUMBER NAMED INSURED EFFECTIVE DATE: Willis North America, Inc. and its subsidiaries 200 Liberty Street New York, NY 10281 policy. Re: Contract Renewal for # 15-6426 - GROUP INSURANCE ACTUARIAL SERVICES For any and all work performed on behalf of Collier County. Collier County Board of Commissioners is included as an Additional Insured as respects to General Liability where required by written contract or agreement. Indemnification provided by contract is subject the policies terms and conditions. INSURER AFFORDING COVERAGE: Sentry Insurance a Mutual Company NAIC#: 24988 POLICY NUMBER: 90-20597-03 EFF DATE: 07/01/2018 EXP DATE: 07/01/2019 TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Workers Compensation & EL Each Accident $1,000,000 Employers Liability EL Disease - Each Emp $1,000,000 Per Statute EL Disease-Policy Lmt $1,000,000 INSURER AFFORDING COVERAGE: Sentry Insurance a Mutual Company NAIC#: 24988 POLICY NUMBER: 90-20597-02 EFF DATE: 07/01/2018 EXP DATE: 07/01/2019 TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Workers Compensation & EL Each Accident $1,000,000 Employers Liability EL Disease - Each Emp $1,000,000 Per Statute EL Disease-Policy Lmt $1,000,000 INSURER AFFORDING COVERAGE: National Union Fire Insurance Company of Pittsburgh NAIC#: 19445 POLICY NUMBER: 11235223 EFF DATE: 07/01/2018 EXP DATE: 07/01/2019 TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Cyber Media Liability Limit: $5,000,000 ADDITIONAL REMARKS: Third party & Privacy, Network and Security are included. 2 2 Willis of New York, Inc. See Page 1 See Page 1 See Page 1 See Page 1 25 Certificate of Liability Insurance W11219106CERT:1194727BATCH:17952524SR ID: Willis North America Inc. Subsidiaries included as insureds under the insurance policies noted in attached Accord form. Acclaris Holdings, Inc. Acclaris, Inc. Encore Insurance PCC, Limited Encore One IC, Inc Extend Health, LLC (formerly Extend Health, Inc.) Extend Insurance Services LLC Fairly Consulting Group, LLC Freberg Environmental, Inc. Liazon Benefits, Inc. Liazon Corporation PBW, LLC Premium Funding Associates, Inc. Professional Consultants Insurance Company, Inc. RSDIG Risk Purchasing Group, Inc. Special Contingency Risks Inc. – except for Professional Liability as it is covered elsewhere Stone Mountain Insurance Company The Willis Foundation Towers Perrin Capital Corp. Towers Watson Delaware Holdings LLC (Formerly Towers Watson Delaware Holdings Inc.) Willis Towers Watson US LLC (Formerly Towers Watson Delaware Inc.) Towers Watson Investment Services, Inc. Towers Watson Latin America Holdings LLC Towers Watson Middle East Holdings LLC Towers Watson Retiree Insurance Services, Inc. TPF&C International, Inc. Watson Wyatt European Investment Holdings 1, LLC Watson Wyatt European Investment Holdings, Inc. Watson Wyatt International, Inc. Market Street Holdings, Inc. Vertus Insurance Partners, LLC Vertus Insurance Agency, LLC Westport Financial Services, LLC Westport HRH, LLC Willis Administrative Services Corporation Willis Americas Administration, Inc. Willis HRH, Inc. Willis Insurance Services of California, Inc. Willis Insurance Services of Georgia, Inc. Willis NA Inc. Willis North America Inc. Willis North American Holding Company Willis of Alabama, Inc. Willis of Arizona, Inc. Willis of Colorado, Inc. Willis of Connecticut, LLC Willis of Florida, Inc. Willis of Greater Kansas, Inc. Willis of Illinois, Inc. Willis of Louisiana, Inc. Willis of Maryland, Inc. Willis North America Inc. Subsidiaries included as insureds under the insurance policies noted in attached Accord form. Willis of Massachusetts, Inc. Willis of Michigan, Inc. Willis of Minnesota, Inc. (merged into Willis of Ohio Inc. effective 1/1/19) Willis of Mississippi, Inc. Willis of New Hampshire, Inc. Willis of New Jersey, Inc. Willis of New York, Inc. Willis of North Carolina, Inc. Willis Towers Watson Midwest, Inc. (formerly Willis of Ohio, Inc.) Willis of Oklahoma, Inc. Willis of Oregon, Inc. Willis of Pennsylvania, Inc. Willis of Seattle, Inc. Willis of Tennessee, Inc. Willis of Texas, Inc. Willis of Vermont, Inc. - name change (formerly known as Smith, Bell & Thompson, Inc.) Willis of Virginia, Inc. Willis of Wisconsin, Inc. Willis of Wyoming, Inc. Willis Personal Lines, LLC Willis Processing Services, Inc. Willis Programs of Connecticut, Inc. Willis Re Inc. Willis Securities, Inc. Willis Towers Watson CAC, Inc. Willis Towers Watson Management (Vermont), Ltd. Willis Towers Watson Risk Purchasing Group, Inc. Willis US Holding Company, LLC (formerly Willis US Holding Company, Inc.) WTW Delaware Holdings LLC Collier County Board of County Commissioners RFP 19-7581 Group Insurance Brokerage and Actuarial Services May 13, 2019 RFP 19-7581 Group Insurance Brokerage and Actuarial Services 2 TABLE OF CONTENTS TABLE OF CONTENTS ................................................................................................................................ 2 TAB 1 - COVER LETTER ............................................................................................................................. 3 TAB 2 – BUSINESS PLAN ............................................................................................................................ 6 TAB 3 – COST OF SERVICES TO THE COUNTY .................................................................................... 56 TAB 4 - EXPERIENCE AND CAPACITY OF WILLIS TOWERS WATSON ............................................... 58 ATTACHMENT 2: PROFESSIONAL REFERENCES ................................................................................. 61 TAB 5 – SPECIALIZED EXPERTISE OF WILLIS TOWERS WATSON TEAM .......................................... 62 TAB 6 - LOCAL VENDOR PREFERENCE ................................................................................................. 73 FORM 7: VENDOR SUBMITTAL – LOCAL VENDOR PREFERENCE AFFIDAVIT ..................................... 74 TAB 7 - REQUIRED FORMS ...................................................................................................................... 76 FORM 2: VENDOR CHECK LIST ................................................................................................................ 77 ATTACHMENTS ......................................................................................................................................... 78 RFP 19-7581 Group Insurance Brokerage and Actuarial Services 3 TAB 1 - COVER LETTER RFP 19-7581 Group Insurance Brokerage and Actuarial Services 4 May 13, 2019 Collier County Board of County Commissioners Attention: Ms. Barbra Lance, CPPB, Procurement Strategist Solicitation RFP #19-7581 Group Insurance Brokerage and Actuarial Services Dear Ms. Lance and the Collier County Government Selection Committee: Thank you for the opportunity to provide a response to the RFP for Group Insurance and Actuarial Services. For over 20 years, we have had the privilege of being your partner in effectively managing the difficult and delicate balance of providing high quality, affordable and fiscally responsible benefit programs to employees of the Collier County Government (CCG). This is a responsibility we take very seriously. Over the tenure of our relationship, we continually evolved a strategic vision/plan with senior leadership. We sought employee input and delivered benefit programs that consistently met the following critical goals: 1. Protecting employees’ financial security, 2. Achieving lower cost trends, 3. Improving the health and well-being of employees and dependents, and 4. Meeting budgetary requirements Our approach transcends the traditional tactic of managing cost by shifting the economic burden to employees. We achieve superior financial results by critically examining cost, health and utilization information. We develop an understanding of the sources of, and factors driving health care costs and use this knowledge to develop innovative strategies that produce measurable results. The proof is in the outcomes. Since 2010, the per employee cost of the health plan increased a nominal 1.5%, less than the general inflation rate, while at the same time making no material changes in the benefit plan. While delivering measurable financial results, we also kept in mind that fiscal success is not the entire story. We have also worked in partnership with staff to deliver measurable improvements in the health and well- being of employees and dependents. Additionally, we have also addressed the broader challenge of ensuring that employees’ families are protected in the event of death or being unable to work due to an illness or injury. We have delivered millions of dollars of savings by continually challenging the status quo, asking if there is a better way and leveraging our strong relationships with the insurance and service industries. Five years ago, the CCG reaffirmed its trust in Willis Towers Watson once again by allowing us to serve as your group insurance broker and assist with actuarial needs. Following is a brief outline some of the major achievements over the past five years: On a per employee basis since 2010, the CCG would have spent almost $4 million more for medical benefits had the CCG health plan costs tracked with published Kaiser cost trends. The Kaiser trends are favorably impacted by considerable cost transfer to employees. Continued to evolve the world-class wellness program that has consistently garnered 90% participation in a comprehensive set of activities designed to raise health awareness and provide the necessary support processes to help people stay well and address chronic disease. Continued to work with other members of the Collier County Health Care Consortium (CCHCC) to better understand and act on the factors driving costs. Most recently we worked to negotiate favorable reimbursement terms with several local providers and are in the process of a more global assessment of the provider reimbursement rates to ensure that they produce the necessary financial results. We continue to stretch the envelope, come up with new ideas and then measure the results. RFP 19-7581 Group Insurance Brokerage and Actuarial Services 5 Proactively managed vendor relationships by marketing the Life/AD&D, Voluntary Life, LTD and STD, resulting in a carrier change to Reliance Standard. The estimated annual savings for all of these lines of coverage versus the Aetna renewal proposal as was over $271,000. Proactively reporting to senior leadership on our progress, accomplishments and recommendations. Through the annual stewardship process, we have earned the trust and respect of the CCG’s leadership team. We see the CCG as an innovator in the benefits landscape and that illustrates why we must continually challenge our past thinking and change to address the challenges of the future. Through your commitment to maintaining comprehensive benefits, the well-being of your employees, managing chronic disease and partnering with others, you have become well-known and respected throughout Florida and beyond. Willis Towers Watson continues to stand with you in the ongoing successful evolution of your programs. Our response to your request for brokerage and actuarial services outlines in greater detail how we will address the new challenges of the future. Your Willis Towers Watson Towers Watson service team is tenured, knows you well and is poised to provide enhanced value, attention and innovation to all that we do on your behalf. You have my personal commitment and the commitment of the team that we will continue to: Develop a thorough understanding of your organization, concerns and objectives—both short- and long-term. We will proactively address those objectives and chart a path to the future by providing comprehensive, responsive, authoritative and proactive advice and service. We will bridge the gap between what you can do yourself and that which we can do to enhance your efforts. Mindfully listen, inform and advise. We strive to develop new and innovative ideas and deliver resources and services that solve problems, provide quantifiable value and support the objectives you establish. Take what happens to your organization and your employees personally. We treat you like family. We feel a sense of ownership and responsibility to the community and your organization with all that we do. We hope our passion shows and hope to be granted to opportunity to continue the journey. Sincerely, Douglas J Ley Senior Director H&B NA Brokerage and Advisory C 414-640-2710 E douglas.ley@willistowerswatson.com RFP 19-7581 Group Insurance Brokerage and Actuarial Services 6 TAB 2 – BUSINESS PLAN RFP 19-7581 Group Insurance Brokerage and Actuarial Services 7 The following detailed business plan contains what we believe should be the minimum services provided to support the CCG’s goal of providing quality benefit programs that aid in recruiting and retaninig employees while still meeting the budgetary requirements of the CCG. Business plans are necessary but need to be dynamic. The benefit industry, especially, healthcare, continues to undergo rapid change. As a result, it is vital that the business plan be flexible and allow us to work in partnership to address emerging trends, challenges and new opportunities. Flexibility differentiates us from our competitors and allowed us to deliver the measurable results we have achieved over the term of our relationship. Our flexibility has its roots in core areas - availability and adaptability. Availability is responding to emails and phone calls on the day they are received. We pride ourselves in getting back to you immediately when you have an inquiry, acknowledging we received it and mapping out how we will address it. Adaptability is quickly reacting to changing circumstances evolving our work plan to address an emerging challenge or opportunity not contemplated today. Further, we address those challenges and opportunites without requesting additional remuneration. During the tenure of our relationship, we have never encountered a situation where we haven’t quickly adapted to address unexpected challenges and opportunities. Never once during our relationship have we stated we couldn’t do something or we needed more compensation to assist the CCG. Our avaialbity and adaptability will be even more vtal in the future, as change is accelerating. Our business plan is comprehensive, but you also have our commitment to be flexible and address the new challenges that lie ahead. We believe this has and will continue to define our relationship and ask the selection committee to keep this in mind when reviewing the comprehensive business plan for the upcomming term of our agreement, if we are selected. Service Due Date Year Strategic Planning- Our ability to react and adapt to the changing environment is guided by an overall strategic plan. This plan includes goals and how results will be measured. Through our annual strategic planning process, we will revisit our goals, the progress in meeting those goals and more importantly continually challenge the status quo. This has been and will continue to be vital to our success. February Annually General Support- Provide ongoing advice, support and information including but not limited to the administration of ACA, HIPAA, COBRA, IRS law changes, the interpretation of state and federal regulations and general advice on benefit plan legal, philosophy and administrative interpretation(s). Provide routine technical updates relative to the administration of benefit plans. Provide routine assistance and support to the County’s managed care; wellness; onsite clinic; claims administration and other vendors to troubleshoot technical and operational issues to assure that the plan(s) perform Weekly, at a minimum For the full term of the agreement RFP 19-7581 Group Insurance Brokerage and Actuarial Services 8 Service Due Date Year efficiently. Health Care Data Analytics- Utilizing both the WillisMed and Deerwalk reporting system, we proactively work to identify sources that are driving cost and utilization under the medical, pharmacy and wellness programs. Based on what we learn, we make recommendations for strategies and tactics that might be deployed to address utilization and cost drivers. We also utilize these systems to monitor the results of our efforts and fine tune them as necessary. We also continually monitor provider network performance and address provider reimbursement levels on an ongoing basis. Quarterly For the full term of the agreement Employee Focus Groups- Conduct employee focus groups with a cross section of employees (includes preparation and up to 5 days of sessions) to measure employee perceptions of the benefit plans and services provided. We use this information to assist in the ongoing management of the plans to make sure the delicate balance of cost and meeting of employee needs are met. Dependent on CCG’s needs; generally the first of the year Annually Senior Management Interaction and Interviews- The County Manager’s Report serves as the focal point for interaction regarding the goals of the benefit program and the overall values and philosophy driving the management of the plans. As necessary, we expand the scope of interviews to include other members of the leadership team to provide further input regarding goals, values and philosophy. County Mgr report – Feb 15; Interviews scheduled as necessary Annually General Plan Design Analysis- Prepare a medical and pharmacy plan design analysis that identifies the potential cost savings of new health management strategies, network contracting strategies, potential new vendor relationships and market benchmarks via our Financial Benchmarking Survey. As necessary, we also model, the impact of increased deductibles, co-payments, out of pocket and other structural changes. Analysis includes the preparation of a global budget and associated employer and employee contribution rates. This project is to be completed every three years. July 1 Annually Thought Leadership- We continually interact with new vendors entering the benefit arena, as well as survey clients regarding changes they have made or plan to make. The purpose of this is to keep the County abreast of market changes, emerging trends, vendor innovations and new product introductions. Ongoing For the full term of the agreement Wellness Program Support- We will provide general advice and assistance relative to the design and management of the County’s Incentives Based Wellness Program. We continually interact with new vendors entering the wellness arena, survey clients regarding changes they have made or plan for the future. The purpose of this is to keep the County abreast of wellness market changes, emerging trends, vendor innovations and new product introductions. We also provide assistance in the completion of the Executive Summary to the Board of Commissioners. Ongoing For the full term of the agreement RFP 19-7581 Group Insurance Brokerage and Actuarial Services 9 Service Due Date Year Provider Networks- We work with Community Health Partners (CHP) and use our data analytic and actuarial capabilities to continually assess the local network managed on behalf of the Collier County Health Care Consortium (CCHCC) by CHP. We help assess appropriate reimbursement levels to new providers entering the community or those requesting revisions to their reimbursement. We will continue to assess the use of commercial networks outside of Collier County via a formal RFP. We also provide assistance in the completion of the Executive Summary to the Board of Commissioners, if appropriate. As needed For the full term of the agreement UR and Case Management Review- Prepare an RFP and review proposals for utilization review and case management services, if requested. Perform operational due diligence on these programs to assure cost efficiency. We help negotiate a five year agreement with CHP that expires 12/31/2021. If necessary, we are allowed the opportunity to review alternatives. We also have firm rates for this period for Allegiance to assume this responsibility if CHP were unable to do so. We also provide assistance in the completion of the Executive Summary to the Board of Commissioners. March 2021 or earlier, if needed For the full term of the agreement Pharmacy Benefit Management Review- We will prepare an RFP and review proposals for pharmacy benefit management services. The current agreement with EnvisionRx extends through 2020. However, we negotiated the ability to change earlier, if necessary. We also provide assistance in the completion of the Executive Summary to the Board of Commissioners. June 2020 For the full term of the agreement Mid-Year Health Rate Review- Perform a midyear actuarial review as of June 30 of medical, pharmacy, dental, and disability rates to assure the adequacy of rates budgeted. July 30 Annually Dental Insurance Review- The CCG utilizes Allegiance to provide dental administrative services as an extension of the self-insured medical plan. Allegiance is under contract to perform this service through 2021. Annually, we will review dental utilization and make recommendations regarding plan design, based on emerging trends. If necessary, the Allegiance agreement allows CCG to terminate the agreement and for Willis Towers Watson to analyze alternatives if that should become necessary. We also provide assistance in the completion of the Executive Summary to the Board of Commissioners. June 2020 or earlier, if necessary For the full term of the agreement Open Enrollment Communication Materials- Provide assistance in the preparation of annual open enrollment communication as well as notices required by federal law. We also provide assistance with emerging regulations that may affect notices that may be required to be provided at times other than open enrollment period. September For the full term of the agreement Group Life Insurance Review- Prepare an RFP and review proposals for excess group life and AD&D insurance coverage. The current agreement with Reliance Standard runs through 12/31/2021. June 2021 or earlier, if necessary For the full term of the agreement RFP 19-7581 Group Insurance Brokerage and Actuarial Services 10 Service Due Date Year Willis Towers Watson negotiated the ability to cancel the contract earlier if service is not acceptable. On an ongoing basis, we work with Risk Management to ensure service expectations are met as well as negotiated service guarantees. We also provide assistance in the completion of the Executive Summary to the Board of Commissioners. Long Term Disability Insurance Review- Prepare an RFP and review proposals for long term disability insurance coverage. The current agreement with Reliance Standard runs through 12/31/2021. Willis Towers Watson negotiated the ability to cancel the contract earlier if service is not acceptable. On an ongoing basis, we work with Risk Management to ensure service expectations are met as well as negotiated service guarantees. We also provide assistance in the completion of the Executive Summary to the Board of Commissioners. June 2021 or earlier, if necessary For the full term of the agreement Short Term Disability Administrative Services- Prepare an RFP and review proposals for administration of the short term disability plan. The current agreement with Reliance Standard runs through 12/31/2021. Willis Towers Watson negotiated the ability to cancel the contract earlier if service is not acceptable. On an ongoing basis, we work with Risk Management to ensure service expectations are met as well as negotiated service guarantees. We also provide assistance in the completion of the Executive Summary to the Board of Commissioners. June 2021 or earlier, if necessary For the full term of the agreement FMLA Administration Review- Prepare an RFP and review proposals for administration of the FMLA. The current agreement with Reliance Standard/Matrix runs through 12/31/2021. Willis Towers Watson negotiated the ability to cancel the contract earlier if service is not acceptable. On an ongoing basis, we work with Risk Management to ensure service expectations are met as well as negotiated service guarantees. We also provide assistance in the completion of the Executive Summary to the Board of Commissioners. June 2021 or earlier, if necessary For the full term of the agreement Program Renewal- If requested, we will seek renewal proposals from existing vendors and carriers and prepare a renewal summary with expiring and renewal pricing and terms. We would analyze and opine on the appropriateness of the renewal terms. We also provide assistance in the completion of the Executive Summary to the Board of Commissioners. As requested For the full term of the agreement Review of Group Health Third Party Administration Vendors- Prepare an RFP and review proposals for administration of the health plan. The CCG utilizes Allegiance to provide medical administrative services, which is under contract to perform this service through 2021. On an ongoing basis, we evaluate service delivery and if necessary, audit the accuracy of Allegiance’s administration of the plan. If necessary, the Allegiance agreement May 2021 or earlier, if requested For the full term of the agreement RFP 19-7581 Group Insurance Brokerage and Actuarial Services 11 Service Due Date Year allows CCG to terminate the agreement and for Willis Towers Watson to analyze alternatives, if that should become necessary. We also provide assistance in the completion of the Executive Summary to the Board of Commissioners. Market Medical Plan Reinsurance- We will prepare an RFP, analyze responses and assist Risk Management in the selection of the appropriate retention level. We will also assess the risks and benefits of the CCG discontinuing medical plan reinsurance and relying on reserves. September Annually Develop Rates for Budget- Develop medical, pharmacy, dental, and disability costs for existing plans. Produce rates for budget to include employer and employee contributions. This project is to be completed year by no later than May. May Annually Prepare State Required Actuarial Study- Prepare the annual F.S. 112.08 study; submit the report and respond to Department of Insurance inquiries as needed. Report due to State of Florida by December 30. December Annually Systems Review and Recommendation- Assist the County in the review of existing or potential IT systems that will be used to provide management information to support the existing health, wellness, and other benefits programs. In process, date TBD For the full term of the agreement OPEB Calculation- Prepare the required OPEB calculation every two years. We also will perform roll forwards on an annual basis. February For the full term of the agreement ACA/Healthcare Reform- Provide consulting and actuarial assistance to fulfil the requirements of the Healthcare Reform Act. Work with Risk Management to monitor the performance of Health (e)fx, the current vendor that completes the 1095 C. As needed For the full term of the agreement On-site Employee Clinic- Assist with preparation of an RFP and review of proposals for an employee clinic. Provide assistance in the completion of the Executive Summary to the Board of Commissioners. Provide general advice and assistance relative to the design and services of the CCG’s on-site clinic. As needed For the full term of the agreement Collier County Health Care Consortium- Coordinate and facilitate quarterly financial and utilization review meetings. The purpose of these meetings is to review each individual employer’s results and roll them up to a consortium wide basis. By doing this, we identify underlying cost and utilization trends that are similar across employers that would benefit from community wide initiatives. Hold 2-4 additional meetings, which address items of global interest to all members of the consortium relating to emerging trends, regulatory compliance and monitoring the outcomes of initiatives targeted at health optimization, utilization controls and management of overall cost trends. 6-8 Meetings per year For the full term of the agreement RFP 19-7581 Group Insurance Brokerage and Actuarial Services 12 RFP 19-7581 Group Insurance Brokerage and Actuarial Services 13 ATTACHMENT 1: PROFESSIONAL QUESTIONNAIRE Professional Questionnaire Company: Willis Towers Watson Address: 400 North Executive Drive, Suite 300 Brookfield, WI 53005 Contact: Douglas J. Ley Phone: O: 262-780-3340; C: 414-640-2710 Fax: 414-475-0559 E-mail douglas.ley@willistowerswatson.com Third Party Health Claims Administration 1) Please list the three major group health TPA firms with whom you generally do business? Willis Towers Watson maintains active relationships with a large number of TPAs, which enables us to match resources with specific client needs. Three of the group health TPA firms we generally do business with include United Medical Resources (UMR), Allegiance, and Web TPA. We have found these vendors to be flexible with their administrative claims payer systems, robust with their capabilities for sharing, tracking, analyzing and monitoring information, and linked or able to be linked to networks that meet the needs of many of our clients. Other TPAs we work with include Meritain, CoreSource, and BAS Health. In addition, the major carriers that we work with can also administer plans on a fully or partially self- funded basis. We have had successful client installations with UHC, Cigna and Aetna. 2) Why do you typically recommend these firms? Each of these firms has demonstrated their capabilities and expertise in the above-noted areas. UMR has demonstrated significant flexibility with unique payor/payee relationships— particularly in the healthcare industry; Allegiance has shown flexibility with regard to working with specialty PHOs (physician hospital organization), robust reporting and provides excellent claims payment and consistency while initiating new bundled payment protocols in specific market areas; and, CoreSource has shown payment consistency and accuracy, the ability to administer unique plan designs, and excellent reporting/data capabilities. In addition, we stay current on emerging trends in the industry by: Working with a substantial percentage of major vendors’ national accounts book of business. Maintaining senior-level relationships with all major health plans and insurers, and we meet with the national health plan vendors annually to learn about their strategic direction and business plans for the coming year. Having an established process to monitor and analyze marketplace developments. RFP 19-7581 Group Insurance Brokerage and Actuarial Services 14 Negotiating meaningful performance guarantees, including financial and service-level guarantees through evidence of industry best practices in customer service, client service and administration. Managing group purchasing arrangements for pharmacy, stop loss, care management, retiree solutions and measurement. By thoroughly understanding the objectives of our clients, we are best able to utilize the most appropriate, fiscally responsible and effective claims payment platform on behalf of our clients. Our creativity and experience, rather than a standard strategy, ensures that the needs of our clients are put first. 3) What are the major factors you consider when recommending a third party administrator to clients? The most important factor is to have a clear understanding of our clients’ needs today and those anticipated in the future. Armed with that knowledge, Willis Towers Watson works in close tandem with the CCG to examine service capabilities and make a joint and thoughtful recommendation concerning which organization will best serve those needs. Vendors are also selected for service quality, funding options, network strength, claim processing standards and performance guarantees. Further, we believe another factor is to focus on a TPA’s ability to administer provider reimbursement processes unique to the CCHCC. Over the last 18 years, Willis Towers Watson has facilitated an informal group, the CCHCC, in an effort to share information, utilize economies of scale and meet the local needs of the participating employers. Toward this end, we have regularly assessed TPA services both individually and as a group. The ability to meet the unique and emerging needs of the CCG and the CCHCC will continue to be a major factor in recommending TPAs. 4) Does your firm own a third party claims Administration Company? If yes, will you be proposing their services? No, Willis Towers Watson does not own a third-party claims administration company. Group Health Reinsurance 1) Does your firm have the ability to solicit, review, analyze, and recommend excess group health reinsurance for the County’s approval? Yes, we consider this to be one of the more important services we provide to the CCG. There are many benefits to self-insurance. However, one of the principal risks associated with self- insurance is volatility when comparing forecasted costs to actual. We believe it is vital that all of our clients understand volatility risk and the role reinsurance and prudent reserves have in mitigating volatility risk. To reach this goal, we have a well-developed process to assist the CCG in understanding volatility risk. We then use that understanding to efficiently structure an appropriate reinsurance program, solicit quotations and then implement a reinsurance plan which is cost-effective and protects the financial position of the CCG. RFP 19-7581 Group Insurance Brokerage and Actuarial Services 15 2) Please list the three major carriers; the policy type (specific/aggregate, etc.) with which you generally do business and your approximate premium volume (Florida only). Willis Towers Watson maintains strong relationships with the leadership teams of virtually all major health plans and insurance carriers. We continue to leverage our broad and deep vendor relationships to broker the best possible financial arrangements for the CCG. We no longer disclose premium volumes with carriers, as we consider that information to be proprietary in nature. At the current time our top three carriers are: 1. Sun Life 2. Symetra 3. Voya Although we can approach any carrier in the market, we do maintain a panel of preferred carriers. These carriers have agreed to provide additional contractual guarantees to our clients as well as meet the requirements noted below. Our panel does change on an annual basis. We are currently in the process of negotiating with our current panel. This may result in additions or deletions. Our current panel participants are: 1. Sun Life 2. Symetra 3. Voya 4. Berkeley 5. HMIG (although they have not agreed to all of our requirements) 3) Why do you typically recommend these carriers? The stop loss market continues to be extremely price sensitive. We believe pricing is important but also place a premium on the following areas when we set up our panel and recommend carriers to clients: Contract terms (e.g., no new laser at renewal, rate caps, incurred vs paid contracts, etc.) Prompt accurate claims payment Carrier financial rating and stability (based on our market security studies) Ease of administration in filing claims. Willis Towers Watson is poised to use any suitably rated carriers that meet your objectives. We will recommend carriers that will meet your specific needs and ensure suitable standards of service are available to you. 4) Describe the process you follow when analyzing excess reinsurance quotes for recommendation to your clients. Our starting point is the prior year’s reinsurance placement, the stochastic modeling that supported that placement and an assessment of the CCG’s reserve status. Using this information in conjunction with Risk Management, we discuss and agree upon the retention levels and terms of coverage for which we will obtain quotations. We develop a draft RFP 19-7581 Group Insurance Brokerage and Actuarial Services 16 solicitation document in conjunction with risk management and then utilize that to obtain quotations. We develop a detailed comparative analysis report that compares and contrasts current reinsurance rates and contract provisions with those of the proposing vendors. Included in this analysis is the following: Disclosure of all carrier rates and consultant compensation, if any. Spreadsheet analysis of proposals at various retention (deductible) levels. Inclusion of alternative contract terms; for example, a paid contract, a contract incurred in 12 months and paid in 24 months. Inclusion of both specific and aggregate coverage. Comparison of cost variances to current expenses and total wrap up of both fixed costs along with the expected maximum plan costs under each type of contract. This shows which retention level results in the lowest overall cost given a stated number of claims in excess of the quoted retention levels. Length of rate guarantee, if any. Special contingencies that apply to each quote received. Carrier history with respect to payment of claims and identification of any past issues of concern relative to reinsurance claim processing. While this process is detailed and extremely useful in making a preliminary assessment of the marketplace, we complete additional analysis that assists in developing an appropriate recommendation. We complete a stochastic modeling, which uses detailed claims data to forecast the expected number of claims at each retention level as well as the probability of whether savings in premium and moving to a higher retention level is likely to be offset by higher claims. This assists the CCG in selecting the most appropriate retention level. Finally, we consider the overall net cost of risk, which is the expected premiums plus expected losses when compared to the overall reserve position in the County. This assists in making the best possible recommendation concerning retention level. In years past, this has supported decisions that have produced an overall lower cost of risk trend. Over the long-term, specific stop loss is a relatively inefficient risk transfer mechanism. Carriers seek to retain $0.30 on each dollar paid in premium. Later this year, we plan on assessing the risks and benefits of foregoing purchasing stop loss from the markets. It may be more appropriate to charge stop loss premiums to the health fund and pay those into reserves and maintain them in such a level that there would be almost 100% certainty they would be sufficient to cover higher than expected overall cost. Again, stochastic and additional statistical modeling will play a role in determining the most cost-effective and financially appropriate method of reinsuring the health plan. We have also utilized these models with the CCHCC to periodically assess the feasibility of public employers sharing risk through a formal process known as pooling. Once the analysis and marketing process is complete, Willis Towers Watson provides a written marketing report in order to include all of the above components and provide recommendations made as a result of this detailed process. RFP 19-7581 Group Insurance Brokerage and Actuarial Services 17 We believe that it is not sufficient to obtain quotes and present them to a client, but rather we seek answers to the questions, “How much risk are we taking?” “What stop loss level is best?” “What is the relationship between stop loss structure and risk?” By asking these questions, we can provide plan-specific consultative advice to the CCG so you can make a decision that is in the best interest of the CCG, based on your unique needs and tolerance for risk. Please see Attachments 4 (Stop Loss Alternatives Analysis) and 5 (Stop Loss MKT Report) for the most recent marketing analysis and report. In addition to support this process, the national Willis Towers Watson placement team stays abreast of the trends that affect the pricing of risk and the products available to insure it. We have also developed a panel comprised of carriers who agree to provide more favorable contract provisions to our clients. No two clients view risk the same way; therefore, we employ a customized approach to evaluating the marketplace on behalf of our clients. By leveraging our global clout and developing creative and practical solutions to insure risk, we are able to obtain the best terms, conditions and pricing available in the marketplace. Willis Towers Watson also provides continuous monitoring of the insurance carrier marketplace through our Market Security division provides the following: Immediate written reporting of any change in financial rating Recommendation of appropriate action, if necessary Maintain strict coverage placement criteria • Minimum rating: A- financial strength from AM Best’s/Standard & Poor’s equivalent • Minimum policyholder surplus (shareholder equity) Willis Towers Watson ensures that the CCG will not be seen strictly as an organization of roughly 2,200 employees, but rather a client of Willis Towers Watson, with a significant market share in the industry. Plan Design and Actuarial Consulting 1) Does your firm have the ability to review existing group health plan design and recommend options whereby plan design might be adjusted to enhance benefit goals; promote economy; and assure best value? Willis Towers Watson has worked with the leadership team at the CCG to set measurable goals for the benefits programs, assess progress in reaching those goals and if goals are not being met, identify the reasons and take corrective action. The following are the current goals set for the benefit plan: Goal 1: Manage cost trends to a level 30% below published national trends. Goal 2: Maintain overall expenses, reinsurance costs and reserves at prudent levels. Goal 3: Protect our employees from the economic impacts of illness or injury. Goal 4: Prevent illness and stabilize chronic health states when possible, by helping employees and their spouses become aware of their health and act on that knowledge. Willis Towers Watson continually reviews these goals with leadership on an annual basis. On an ongoing basis, we assess whether the plans is reaching the goals established for it and ensure value and best practices. This ongoing assessment focuses on both qualitative and RFP 19-7581 Group Insurance Brokerage and Actuarial Services 18 quantitative measures: Qualitative assessments-- Due to rising costs, sometimes the original intent of benefits are forgotten. Our work together has gone beyond cost alone and focuses on qualitative as well as quantitative measures. Qualitative goals include things such as “protect people’s financial health in the event of health claims,” “enhance the view of the CCG as a favorable employer” and “support recruiting a talented and quality work force.” These goals are set with the input of senior leadership through regular interactions and where appropriate, formal interviews. Measures are then established to determine if the goals are being met Willis Towers Watson has also conducted focus groups with random cross sections of the population to assist in making the best possible choices and to assess this also allows us to continually assess whether qualitative objectives are being met and if not, what might be done. Focus groups help identify the general direction that redesign efforts should take, uncover what the hot issues are and explore the choices that employees would make given the limited resources. Finally, focus groups allow two way communications. It is common for leadership to be concerned that focus groups can become complaint sessions. Well-constructed questions and structured focus group sessions from a highly experienced firm and facilitator ensure sessions are productive. Our approach has been to frame such sessions within the context that the CCG, like any family, has to live within a budget, and the purpose of the sessions is to allow employees to have a voice in how the limited resources are deployed. This improves the morale of the workforce and enhances the view people have of the benefit program. In short, focus groups help promote economy and assure the best value in the eyes of employees. Quantitative assessments– Health care and benefit cost is a prime source of concern to all organizations. Health care costs continue to grow at a rate far in excess of growth of gross domestic product. As such, health care consumes a bigger share of the economy and jeopardizes the ability of organizations such as the CCG to meet its mission, which is to enhance the well-being of the people, community and environment of Collier County. To ensure quantitative goals are met and that the program continually evolves in a cost- effective fashion, Willis Towers Watson has implemented a quarterly and annual process that provides a detailed assessment of the factors driving the cost of the benefit programs with a special focus on health benefits that drive over 80% of the cost. This analysis has been conducted for both the CCG individually and the CCHCC as a whole. These assessments are supported via two data warehouse systems that Willis Towers Watson and CHP maintain. These systems include detailed claims records on all claims paid in the last three years with summary data going back to 2005. These two systems known as Cotiviti (Verscend) and Deerwalk allow Willis Towers Watson to review utilization and cost patterns on a very detailed level and compare them to both age/gender/geographic adjusted and clinical norms. The tools allow active monitoring of gaps in care, the overall risk profile of the population and how it is changing over time. These efforts assist in monitoring the effectiveness of RFP 19-7581 Group Insurance Brokerage and Actuarial Services 19 the wellness program the CCG has developed and continues to evolve. They also allow monitoring of emerging utilization and provider practice patterns within Collier County, in order to identify areas where use is not consistent with expectation. Ongoing identification of this allows the continued development strategies to address utilization. Most recently, we are in the midst of an assessment of physician office infusion of medications, the cost of those medications and whether more cost-effective delivery processes can be utilized. The key to assessments that Willis Towers Watson conduct is that they go beyond addressing simply where the dollars are going and then benchmark what is happening against the past. Willis Towers Watson believes that benchmarks based on what has happened in the past are of some importance in understanding how the CCG has performed against similar organizations. However, to focus solely on benchmarks ignores one important fact. Benchmarks are based on past use of health care services and reflect a system that is financially unsustainable and not adjusted for differences in demographics. When Willis Towers Watson assesses use of health care resources, it focuses on the following objectives: • Identify the principal factors that are driving the underlying cost of the medical plan. • Benchmark these factors against best achievable clinical practices. • Develop targeted strategies to change utilization patterns and improve the overall cost picture. The Willis Towers Watson approach looks not only at what has happened, but what should happen from a best practices perspective. Any strategy to mitigate trend, promote economy and assure best value, must be implemented within the context of a comprehensive understanding of what drives health care cost. What best drives cost is defined through the following formula. Cost is determined by price per unit of service provided, multiplied by the number of units that are purchased. In health care, the number of units consumed is affected by five sources as well as the outcome the provider generates. Each of these has an impact on what and how much is purchased. In addition, what treatment chosen and the outcome associated with that treatment will also affect cost. The factors affecting volume are as follows: Source 1 = Determined by physician practice and billing patterns Source 2 = Determined by patient preferences and expectations Source 3 = Determined by patient health status and lifestyle Source 4 = Determined by payer Source 5 = Does the patient understand and comply with proposed treatment? Outcome = the benefit of the treatment or encounter to the patient The Willis Towers Watson assessment of the use of any benefit changes focuses on an understanding of each of these volumes from a clinical, best practices and human RFP 19-7581 Group Insurance Brokerage and Actuarial Services 20 perspective. Finally, when changes are made, Willis Towers Watson monitors the changes against each of these factors. Only with a thorough understanding of all of these factors can the CCG understand their cost drivers, what can be done about those costs, and if steps are taken to address them, whether those steps are garnering the desired results. The final factor taken into account when reviewing existing group health plan designs and recommending changes is market competitiveness. Although benchmarks have their limitations they are still helpful in providing an overall understanding of past trends and practices. Willis Towers Watson Financial Benchmark Survey (FBS) provides timely insight into cost and trends concerning benefits. There are several important factors that set this apart from other surveys. • The survey data is fresh; the current survey tells you what other employers did on January 1 of this year not what they did a year ago. • The survey reveals what employers are contemplating for the next year. • Rather than reflecting an average of all responses, results are adjusted for plan design, age, gender and geography, allowing greater insight into the factors that drive a survey participant’s results from others in the survey. The easiest solution most people bring to the table to control cost is to ask that employees pay more out of each paycheck and when they receive care. Our approach has demonstrated it is possible to deliver level healthcare cost trends without simply focusing on plan design and contribution changes. We believe this sets us apart from other organizations. 2) Please give two examples of where you performed this service in the past and the specific types of changes/amendments you recommended. Willis Towers Watson has used data to drive improved value for the CCG on a consistent basis since 2002, when it first began collecting detailed claims data and using that data to drive informed decisions regarding the plan. Data driven decision making and accountability in delivering results has been the cornerstone of the Willis Towers Watson assessment process used to enhance benefit goals, promote economy, and assure best value. The following is a small representative example of recent initiatives Willis Towers Watson completed using the processes outlined in Item 1 above, to support decisions made concerning the health plan: Please refer to Attachment 1 (County Manager Report 2018), the most recent report that was provided to the senior leadership team at the CCG, which shows how we have used our process and tools to monitor progress toward the four goals that the CCG has established for its benefit program. This report supported the belief that no major changes needed to be made in the design or funding levels of the health plan. Developed an in-depth study of the cost structure of NCH Healthcare versus Physicians Regional Medical Center (PRMC) to assess whether it was financially beneficial to continue RFP 19-7581 Group Insurance Brokerage and Actuarial Services 21 the plan design differential in light of the hospitalist controversy surrounding NCH Healthcare. This study relied on data from Cotiviti and Deerwalk that was specific to the CCG and the CCHCC as a whole, regarding actual payments like admissions. It also used data available from the State of Florida and the Centers for Medicare Services. Please refer to Attachment 2 (Collier Co Hosp Analysis), which supported why continuing the plan differential in place for services at PRMC was financially beneficial to the CCG. Used data to negotiate improvements in the provider contract offers made by the Bascom Palmer Eye Institute (BPEI) and Surgery Center of Naples (SCON). Data was used to quantify the financial impact of the initial offers and negotiate those payment terms down by over 6% for BPEI and over 100% for SCON. Created an analysis outlining the financial and non-financial implication of a reduction in employee medical plan contributions in lieu of pay. Please see Attachment 3 (Contribution Reduction In Lieu of Pay Analysis) 3) Does your firm have the ability to perform actuarial analysis to measure the adequacy of group health plan funding levels and to propose rates? Does your firm have the ability to actuarially estimate the financial effect of proposed plan design changes? Has your firm completed actuarial evaluations for clients as required under Florida Statutes 112.08? Willis Towers Watson approaches the health plan funding and rate setting process as if the CCG were running its own insurance company. Willis Towers Watson goes well beyond taking past experience plus trend to set rates. The CCG’s program must be operated on a sound basis actuarially so that over the long run, contributions from the employer and employees are efficient to cover the cost of the program and protect it from normal statistical variations in cost as well as catastrophic events. To reach this goal, Willis Towers Watson deploys a variety of statistical tools, an in-depth understanding of the health care community within Collier County and Florida, as well as, an understanding of emerging global factors that will drive future health care cost trends. Willis Towers Watson monitors the historical performance of the plan on an ongoing basis and deploys statistical tools and industry knowledge to measure risk and anticipated future changes in cost. We use this to set adequate future rates and help the CCG understand the impact that expected statistical risk has on the ongoing financial health of the program. This ongoing rate setting and assessment occurs on the following multiple levels: Cost to budget- This is a process where key indicators are identified on a cost and use perspective to monitor the performance of the program on an ongoing basis. This is the rear view mirror used to assess whether rates set in the past have been adequate to cover the cost of the program and either contribute to or reduce plan reserves. Willis Towers Watson assisted the CCG in developing such a process and has helped evolve the process to where the CCG currently completes a group health plan report internally. This report looks at a wide range of measures such as surplus/deficit position, number covered, number of claims, program cost allocations, etc. This allows the CCG and Willis Towers Watson to understand how the program is performing as compared to established rates. RFP 19-7581 Group Insurance Brokerage and Actuarial Services 22 Setting the appropriate trend rate- The information from the cost to budget reporting is imported into the Willis Towers Watson regression modeler. This system allows Willis Towers Watson to assess historical trends. The historical trend data unique to the CCG is used in conjunction with industry trend expectations, modeled plan design changes, and changes in employment levels to develop the appropriate trend assumptions for the upcoming fiscal and plan year. Willis Towers Watson also takes into account planned changes in provider payments, CCHCC wide cost containment initiatives, the state of the economy, changes in State and Federal Law that may affect cost and local knowledge to set an appropriate trend. For example, NCH Healthcare System is a major supplier of services to the CCG. Each year under the agreement with the CCHCC, the hospital’s charge master can change by an amount up to published medical CPI (consumer price index). This change must be factored into the rate setting process. Factoring in legislative changes- Both State and Federal laws that might have a direct or indirect impact on cost forecasts. Factoring in plan design changes- On an ongoing basis, the CCG has considered changes in the design of its plans. The expected financial impact of those changes needs to be valued. Willis Towers Watson deploys a variety of tools to price plan design changes. For quick assessments, Willis Towers Watson has a proprietary system developed called HealthMaps. This system uses a variety of parameters to model the expected impact of plan design changes. This tool allows us to quickly and efficiently price plan design changes. Once the scope of changes is narrowed, we can utilize detailed information available through Cotiviti and Deerwalk to zero in on specific historical cost and utilization and use that information to modify the output from HealthMaps, to be more specific to the utilization patterns that the CCG has experienced in the past. Using detailed claims records allows Willis Towers Watson to use its system to model the impact of plan design changes using actual CCG and CCHCC plan data. The tool can include sensitivity modeling, which allows the CCG to understand how sensitive plan design cost estimates are to behavioral and utilization changes. Finally, plan design changes cannot be contemplated in a vacuum from market and employee pressures. As a result and as part of the rate setting process, Willis Towers Watson offers the output of its Financial Benchmarking Survey, Best Practices Survey, other survey data and focus groups to assess potential employee reaction to plan changes. In short, statistics and actuarial science is vital to understanding costs and setting appropriate rates. However, such advice may be inappropriate if not deployed within the context of a solid understanding of market and employee pressures. Volatility Risk quantification- This is another important part of the rate setting process. Willis Towers Watson uses clinical and stochastic modeling to forecast the expected cost of the plans, distributions of large claims and expected variance around the rates set for the plan. This is important to the CCG for several reasons. First, it assists in selecting the appropriate retention levels for specific stop loss and whether aggregate stop loss coverage is a good value. The levels selected and whether aggregate is selected or not, impact fixed costs that are part of the forecast of future cost of the plan. The expected variance from the forecasted claims value is important, as it allows the CCG to quantity the risk it assumes by being self-funded. Willis Towers Watson models multiple RFP 19-7581 Group Insurance Brokerage and Actuarial Services 23 confidence intervals (i.e., 70%, 90% and 99%), which allow the CCG to understand how variable claims might be due to catastrophic events or trend variance. This helps the CCG determine what additional contingency reserves it might wish to hold beyond those required in Florida Statue 112.08. In addition to clinical and stochastic modeling, Willis Towers Watson maintains a database that contains loss distributions for large claimants. This allows us to model expected loss frequencies and distribution, which also aids in setting the appropriate retention levels and assessing risk. All of the above factors are incorporated into the final rates set for the CCG. These rates are used for budget purposes and for purposes of setting rates for COBRA participants. These rates are also used for the Florida Statue 112.08 filings completed by Willis Towers Watson on behalf of the CCG each year. Florida insurance statute allows county, municipality, school board, local governmental unit, and special taxing counties of the state to self-insure any plan for health, accident, and hospitalization coverage, subject to approval, based on actuarial soundness by the Department of Insurance. CCG’s reserves are very healthy and exceed the Florida Department of Insurance regulations by a wide margin. The department requires that any self-insured public entity be able to demonstrate the rates are adequate to cover emerging claims. Further, they must show possession of unencumbered reserves sufficient to cover the reserve for incurred but not yet paid claims. Although not backed by requirements of statute, they also wish to see an additional two months of claims available to address volatility. The estimated necessary reserves to satisfy the Florida Department of Insurance are approximately $7.4 million versus the $30.1 million reserve at the end of 2018. Willis Towers Watson has years of experience in such fillings, as well as experience in working directly with the Florida Department of Insurance to address rejected filings. Willis Towers Watson provides turnkey services for these fillings and assumes all responsibility for the initial filings, subsequent fillings, clarifications and corrective action plans. In summary, Willis Towers Watson works with the County in the same way that an insurance company’s Chief Actuary guides the organization to offer market competitive programs that are priced to generate satisfactory financial results and policyholder safety. 4) Will you be utilizing in-house staff for the actuarial service component of the project or will you use an external firm? Please provide the names of the actuaries who will be performing the actuarial component of the project. Willis Towers Watson does not outsource any of its actuarial services. All services are provided by in house staff. Sheryl Henry, FSA, MAAA is the lead actuary and has worked with the CCG for over 16 years. Sheryl has more than 30 years of experience in pricing of medical, dental, disability and life products, reserving calculations, trend analysis and experience monitoring. Sheryl is backed up by John Pauly, ASA, MAAA. John has over four years’ experience working with the CCG. John’s professional experience spans more than 30 years and includes the development of dynamic financial models for managing lines of medical RFP 19-7581 Group Insurance Brokerage and Actuarial Services 24 business, mitigating risks of large medical and legal claims, valuing reinsured blocks of medical business and managing pricing for new business, renewals and RFP’s for a regional PBM. Please refer to Tab 5 for additional information about the actuarial and consulting team. 5) Can your firm perform predictive modeling? If so, please provide two examples of where you performed this service in the past and how it was used. Willis Towers Watson has worked with a variety of firms that make available predictive modeling. There are three types; clinical, empirical clinical and statistical. Statistical models generally rely solely on statistics and past history to quantify variability risk using Monte Carlo simulations. Willis Towers Watson has purchased @risk and uses it and internal tools as noted above to develop trend and specific and aggregate variability studies. Any such studies using this software are included in the base fee quoted. The Cotiviti system includes several predictive models for medical pharmacy and medical and pharmacy combined. These tools show the relative risk burden of the population and the probability that it will exhibit trends higher, lower or at expected levels in the upcoming here. On a positive note these measures have been steadily improving for the CCG over the past ten years. Your local service team maintains a relationship with TruRisk, whose empirical clinical models forecast cost at the person level though a process known as decision trees. These trees are based on large populations and look at the cost people with certain treatment patterns and diagnosis have had in the past. For example, a diabetic with one set of complications will have a different historical cost forecast than one with no complications. This creates an expected cost for a person based on a pattern of treatment in the past. The cost expectations on an individual basis are then rolled up to a group level forecast. The empirical clinical models developed by TruRisk were used to create the stop loss product that the CCG purchased in 2004 and 2005 called CapCost. We are currently in the process of working with both TruRisk and Allegiance to recalibrate the models and hope to resurrect the cost project leader this year or early next. Willis Towers Watson also works with DxCG to better understand the relative efficiencies of health plans. DxCG is primarily a clinical model that predicts the presence of disease in a population, the relative disease burden within a population using prior year cost and gaps in care measurements. Although not deployed for the CCG to measure health plan efficiencies, Willis Towers Watson has used this tool to assist employers that offer multiple health plans (e.g., an Aetna HMO and Blue Cross and Blue Shield PPO) to select who would be the best choice if a health plan consolidation were to occur. The DxCG model allowed one client to benefit and risk adjust the two covered populations to determine which plan was the more effective in terms of efficient management of health care expenses. We have also used the models to show the positive impact the CCG’s efforts to improve health and health outcomes have improved the risk profile of the population over time. Pharmacy Benefit Management Services RFP 19-7581 Group Insurance Brokerage and Actuarial Services 25 1) Does your firm have the capability to review and recommend vendors for Pharmacy Benefit Management Services? If so, please describe the method you use to determine best value when evaluating these firms? Yes, Willis Towers Watson offers significant expertise and a number of tools to enable the local team to provide meaningful review and assessment of your current PBM program, as well as, to solicit proposals, review their components, and recommend both vendors, pricing strategies, and plan designs to best meet the long-term objects of the CCG. Since we responded to the last RFP for consulting and actuarial services, we merged with Willis Towers Watson. This merger has strengthened our pharmacy capabilities and provided us with access to over 42 licensed pharmacists to provide additional support to your current service team, which includes John Pauly ASA, MAAA who has extensive background in pharmacy and previously worked for a PBM. Willis Towers Watson has continued to work with other members of the CCHCC to better understand and act on the factors driving costs. One area of significant focus has been in proactively managing vendor relationships leading to the introduction of innovative vendors, such as Navitus, to the Collier County Public Schools. By continually assessing changes in the PBM landscape, we have endeavored to bring greater transparency, innovative strategies and improved terms. The new formulary recently implemented by the CCG is expected to generate savings in excess of $1 million in the next year. We are currently in the process of assessing cost patterns within physician offices that are infusing medications, which might be eligible for home infusion. The purpose of this study is to determine the extent to which there might be savings and changing where these medications are procured from, as well is how they are administered. Prescription Drug Pricing Model Willis Towers Watson works with tools developed internally to assess PBM performance and is able to model the impacts of plan design changes, changes in the terms offered by PBMs and the relative values of one PBMs terms versus another. These tools model estimated expenses for actual employee drug claims by using pricing arrangements (AWP discounts and dispensing fees) and the covered population’s age and gender distribution, in addition to employer-defined cost sharing arrangements (co-payments, deductibles, coinsurance, annual maximums). The model yields per member per month expense breakdowns on both a gross and net basis between brand/generic and formulary/non-formulary prescriptions. This model allows for better management of your population’s use patterns and characteristics. Willis Towers Watson has used these tools to assess the impact of changes in the design of the program so the CCG can better understand cost implications of changing copayments, out of pocket maximums, improved generic use and the impact of special programs designed to address utilization of emerging high cost specialty medications. Willis Towers Watson has continued to push the envelope with respect to pharmacy utilization. We continue to look at and develop strategies to analyze the impact of specialty medications that are both in use today and in the pipeline. Willis Towers Watson is a pioneer RFP 19-7581 Group Insurance Brokerage and Actuarial Services 26 in the utilization of pass through versus traditional pricing arrangements. Pass through pricing makes it possible to attempt to drive utilization to the lowest cost distribution channel. This represents a savings opportunity of up to 10%. The ability to co-opt physicians into this process is actively being explored. All members of the CCHCC are currently 100% pass through. The CCG’s program includes pass through at point-of-sale, which places the CCG far ahead of the potential implication of the Department of Health and Human Services proposed legislation to change the safe harbor treatment of rebates. Currently pharmacy benefit managers, other than Envision and Navitus, fund a significant amount of their operations through funding received directly from pharmacy manufacturers. The proposed change in the safe harbor legislation will not allow these rebates to be retained, but rather must be passed on to members at point-of-sale. This will introduce significant disruption to the industry. CCG will not be affected by this due to the nature of its current arrangement. Later this year, Willis Towers Watson plans to begin developing a PBM marketing and assessment process to check the competitive marketplace to ensure Envision represents the best solution when the current two-year contract extension expires December 31, 2020. Via the quarterly reporting process, Willis Towers Watson examines the extent to which Envision has fulfilled its performance requirements with respect to discounts and rebates. Willis Towers Watson is also planning a more detailed assessment of the performance of Envision during 2018 this summer. Specialty Pipeline Specialty pharmacy costs as a percentage of total spend has increased significantly for the CCG. This has been the principal reason driving increases in the cost of the pharmacy plan. Further accentuating this trend is the increasing number of new medications in the specialty pipeline. Willis Towers Watson will continue to be diligent in this area by helping the CCG understand the challenges that managing specialty cost present and what is in the pipeline. This will ensure that the CCG understands what factors are beyond its control with respect to specialty and where there are opportunities to mitigate trends. We will focus on the following core areas: Identifying what channel results in the lowest ultimate cost. The current J code initiative represents one step in this area to determine whether physician offices are garnering excessive markup on certain specialty medications. Construction of formulary programs using market share to obtain better pricing for bioequivalent medications. Considering whether new medications should be covered until a suitable trial period has passed. Ensuring appropriate prior authorization processes are in place for new medications and perhaps auditing those prior authorizations. Ensuring expensive drugs made up by the compounding of common generic medications are not covered. RFP 19-7581 Group Insurance Brokerage and Actuarial Services 27 Ensuring discounts are competitive and avoid mail-order procurement arbitrage where the PBM operates distribution of specialty medications as a profit center. Management Philosophy, Employee Focus Groups, and General Benefits Consulting 1) Has your firm worked with a client’s senior management to develop an overall benefits philosophy for that firm? If so, please provide an example, including your method and approach to such a project. There is generally more than one way to get from point A to point B. The same holds true for benefits. Willis Towers Watson works proactively to engage senior leadership in understanding the challenges the CCG has faced and will continue to face in addressing the health care challenge. We will work proactively to engage senior leadership in understanding the new challenges of the future and provide guidance in identifying what steps can be taken to develop new solutions to address the ever-changing landscape. In order to do this, Willis Towers Watson engages in an organized process it referred to as the “Willis Towers Watson Way” shown below. This is the process Willis Towers Watson has used on an ongoing basis with the CCG to develop an overall philosophy/strategy for its benefit plans, set goals and measure progress. RFP 19-7581 Group Insurance Brokerage and Actuarial Services 28 As the chart shows, assessing the strategic direction is the process that occurs in conjunction with two other additional processes that make up Phase 1 of our overall client management process. These additional processes are: Assessing CCG’s current state (where are you today) Identification of cost drivers Leadership input is obtained via annual reviews and, if necessary, we conduct one-on-one interviews with key leadership. On an annual basis, the report provided to the leadership team is used to garner leadership input in the following major areas: 1. What are The CCG’s “people objectives” for the benefits? What should benefits do for people, what are the key messages, and what is expected from people in return for the benefits provided? 2. What are the CCG’s financial and non-financial objectives for benefits? What is the budget, what image is projected vs. wanted, what are the key messages to employees, etc.? 3. What choices would employees make with regard to the allocation of limited resources? For example, would they prefer to increase their contribution per paycheck and keep the same benefits, or keep the same contribution and pay more when they see the doctor? 4. How does the CCG get people to use the programs offered to help them? Additional topical issues are added to the above where appropriate. At that point, leadership can confirm the direction or step back and reassess direction by engaging in an organized process to reassess the plan and potentially make changes in the guiding philosophy, goals and measurement process. Executive input has been vital to the continued evolution in the benefit plans provided to employees. Annual reviews with the County Administrator, Administrative Services Administrator and Risk Management Director have provided a formal mechanism to ensure Willis Towers Watson is appropriately serving the CCG, the overall strategic direction is modified as appropriate, goals set and performance to those goals measured and reported on an ongoing basis. To further delve into leadership’s perception of the benefit program, we utilize a questionnaire tailored to the current challenges that the CCG faces or topics it deems should be discussed in more depth with senior leadership. An example of a recent leadership interview process is, see Attachment 6 (Leadership Interview Questionnaire). A similar document customized to the CCG would be used to interview select member of the leadership team on a one-on-one basis. What is learned through these interviews, coupled with an environmental assessment outlining where the CCG is today, employee input if appropriate and the principal benefit plan cost drivers, is combined into an overall report. This report is then used by senior leadership, with our guidance, to make informed choices regarding future philosophy direction and goals. RFP 19-7581 Group Insurance Brokerage and Actuarial Services 29 Our best example of how we have created a method and approach to developing a benefit philosophy and goals is what we created and continue to evolve with the CCG. We live the process every day we work with you. 2) Who will staff this project for Collier County? Tab 5 outlines the entire team assigned to the CCG. Of that team, the following will be working with senior leadership to develop an overall benefits philosophy/strategy. Doug Ley Matt Deininger Jill Goehrig Sheryl Henry 3) Has your firm performed employee focus group sessions to assess employee attitudes regarding their benefit program? Yes, your Willis Towers Watson team is highly experienced at developing and managing focus groups and other employee input methods to determine employee attitudes towards their benefit programs and input relative to their priorities. The value of your employee benefit program truly lies in its perceived value by your employees. Soliciting feedback is a great way to measure the perceived value and can also help aid in steering the direction of future benefit offerings. There have been four focus group processes conducted over the last 18 years for CCG and they have been structured and conducted by Doug Ley. Sessions were done in 2001 to assess employee perceptions of communications, how well they understood the current plans and which were most important to them. This information was instrumental to the development of the new cafeteria plan the CCG offered in 2002. Focus groups were conducted again in 2004 to measure how benefit communications had improved since 2001, how satisfied employees were with the new plans, employee perceptions of the behaviors necessary to support a consumer driven health plan and how satisfied employees were with the service provided by the firms involved in providing benefits. This feedback was instrumental in the decision not to pursue a consumer driven health plan and in providing feedback to service providers and Risk Management. During the third set of focus group meetings held in 2008, Wills Towers Watson assisted the CCG by sharing preliminary information about their proposed plans for a behavioral based health plan. The sessions also focused on obtaining input from participants with regard to uncovering concerns about the new plan, how to best address those concerns and how to best communicate the changes to employees. The information obtained through these sessions allowed for a roll out process that supported a favorable view of the changes and a successful implementation. Willis Towers Watson considers focus group to be a vital component of the ongoing management of benefit programs. Most recently, Doug and select members of the team conducted focus groups for the Collier County Public Schools in 2018. These sessions explored employee perceptions of benefit communications and the annual enrollment process. RFP 19-7581 Group Insurance Brokerage and Actuarial Services 30 4) Describe how you perform these sessions and the information you seek to gain? Who will perform these sessions on your behalf? The immediate service team will be responsible for conducting the focus groups. Following is a summary of how the process is managed. First, we will need CCG’s assistance in selecting participants for the focus groups, as well as the employee groups that will participate in the process. The ideal group size we want to work with is 8-12 people. Beyond 12, it is difficult to get good participation from everyone and it is difficult to cover the topics in-depth. Fewer than eight will work, but fewer than six puts too much attention on each participant and reduces the information obtained. We suggest conducting 20 focus group sessions over a five day period. When scheduling the focus groups and selecting participants, keep the following guidelines in mind: Sessions should be planned for about an hour and a half. Choose people from a diverse set of jobs, areas and work experiences (randomly selecting participants from a list of employees is a good idea but often difficult to do). Use judgment in selecting people that are fairly “typical” of the work force. Choose employees with varying opinions, if generally known (but not extremists on either side). Please avoid any disgruntled individuals that are known to employer-bash, as well as the sycophant that worships the CCG. Choose employees who are comfortable discussing these particular topics and who are willing to share their opinions, especially with other employees present. Keep in mind that a focus group is an informal discussion group and is not some scientifically driven sample. Don’t get bogged down in the mechanics of getting purely “representative” groups together. Do not choose intact work groups. These people know each other too well and the dynamics of a group discussion are often fixed by their prior relationships. Do not mix union, exempt and non-exempt employees in the same focus groups. It is helpful to make participation mandatory and part of the job versus an option. This helps ensure a sufficient group size and avoids the need to over schedule in the hope that a sufficient number of employees will attend. If questions are received, assure participants of the neutrality and professionalism of Willis Towers Watson and that their individual opinions will not be revealed, only a summary of all participants’ views. Once the participants have been selected, Willis Towers Watson will begin the sessions by explaining the following. This particular example pertains to communications: The purpose(s) for the sessions • To understand the “whys” of having the focus groups and provide feedback. • Provide background on benefit communications and current enrollment processes (or the subject of the focus group). RFP 19-7581 Group Insurance Brokerage and Actuarial Services 31 • Obtain specific feedback concerning what they know about and how they perceive benefit communications and the enrollment process (or their knowledge and perception of the subject of the focus group). • To get real examples of how people would change communications and the enrollment process, as well as discuss the concerns they may have if the processes are changed (or their ideas regarding the subject of the focus group). Willis Towers Watson will work as an independent consultant during the session • No hidden agendas • Maintain neutrality to any response from participants • Resolve to demonstrate good faith interest in their answers Following is how we identify the information we seek to obtain. Planning/Objectives – First, we want to define the purpose of the feedback session. The purpose needs to be clear and concise and should seek specific information such as concerns employees may have about a planned change, choices involving the allocation of limited dollars, how enrollments are conducted, etc. Identifying Participants – It is rarely feasible to solicit feedback from an entire population due to costs and time constraints. When we consider the target audience, we need to make certain the sample includes a variety of members that are most ideal to provide feedback. The process to select participants is outlined above. Those involved in selecting the respondents need to be careful not to select individuals simply because they are easier to reach, known to respond and are typically vocal as this skews the results. Feedback Vehicle – The next step is to determine how you will solicit your feedback. We favor focus groups due to their interactive nature. However, as mentioned earlier, there are several ways to request feedback including surveys (paper and/or web) and focus groups. Designing the Questions – The questions should be designed with the study objectives in mind. We take steps to ensure questions are appropriately structured so as not to bias responses and where appropriate, facilitate discussion. Processing the Data – Responses are tabulated and analyzed. When the process is complete, Willis Towers Watson will write an executive report based on the findings of the feedback. We believe it’s important to share the results of the feedback with the employees to continue gaining their support for why decisions are being made within the CCG. 5) Does your firm employ full-time staff benefits/labor attorneys? If not, with whom do you consult regarding the legal analysis of various benefit matters when counseling clients? You and your Willis Towers Watson team are supported internally by our Health and Benefits Compliance team. This team of attorneys and paralegals are industry thought leaders who participate in several professional organizations at a senior level. They participate in discussions about the most innovative ideas and issues with other professionals throughout RFP 19-7581 Group Insurance Brokerage and Actuarial Services 32 the U.S. They have expertise and hands-on experience in ERISA, the Internal Revenue Code and other laws affecting employer-sponsored benefit plans. Our Health and Benefits Compliance team has years of practical experience and in-depth knowledge regarding the application of the laws and regulations that affect employee benefit plans, and it regularly monitors releases from the federal government in order to guide clients. Services for education, compliance-related questions and Compliance Gap Assessments (Benefit Plan Responsibility Map) are assessed by your local team and are provided by the Health and Benefits Compliance team. Health and Benefits Compliance offers a wide range of services and expertise that are included in Willis Towers Watson’s fees. Rebecca Lawrence, an attorney in our St. Louis office, has worked directly with the CCG and the CCHCC on a variety of issues relative to compliance. In addition to her ongoing involvement, we are able to provide the following services. Compliance Gap Assessments (Benefit Plan Responsibility Map) Understanding your organization’s ownership and responsibility of various compliance tasks is key to effective program management and governance. Our gap assessment tools cover areas such as group health plan mandates, ERISA, cafeteria plans, HIPAA and COBRA. These assessments help identify any areas that may need to be addressed to support a compliant program. As legislation changes and interpretations are released from our Health and Benefits Compliance Team and your carrier/vendors, your Willis Towers Watson team will address changes relevant to your program with you and discuss any adjustments required (as appropriate) to become or to remain compliant. Employer guides and tools Health and Benefits Compliance offers numerous employer guides as shown below, as well as one dedicated to health care reform coverage mandates: Cafeteria plans COBRA administration Spending accounts Group term life benefits Select fringe benefits HIPAA privacy and security Medicare (MSP, Part D and payer reporting) USERRA ERISA reporting and disclosure (not applicable, unless the CCG should elect to voluntarily comply with ERISA Annual enrollment toolkit Health care reform Health and Benefits Compliance leads our focused effort around the Affordable Care Act (ACA), commonly referred to as health care reform. Examples of the consulting expertise and tools developed include employer guides, FAQs, educational webcasts, and Legislative RFP 19-7581 Group Insurance Brokerage and Actuarial Services 33 and Regulatory Updates to assist employers with their planning and potential transition to a new plan design under health care reform. HIPAA compliance Compliance with HIPAA privacy, security and breach notification requirements is technical, complex and confusing. Willis Towers Watson often receives requests to assist clients in their compliance efforts, and we have found that different clients need and want different types of assistance. Therefore, we offer a range of options for assisting clients in their efforts to comply with HIPAA privacy, security and breach notification requirements. Any live or customized training will incur an additional fee, but all recorded webcasts and non- customized webcasts are available at no additional charge. In 2014, Willis Towers Watson conducted a day long session with all members of the CCHCC, where they were engaged in a process to update HIPAA compliance policies and procedures. Live and recorded webcasts cover the fundamentals related to HIPAA privacy, security and breach notification and are included in the Willis Towers Watson offering. Customized HIPAA training for employees within and outside of the HIPAA firewall can be had for an additional charge. This could be performed via a webcast, a live session or a web-based session housed within the employer’s intranet. HIPAA privacy and security assessments and creation of customized policies and procedures are available for an additional fee. Plan document services Compliance with ERISA and the Internal Revenue Code has become more complex and scrutinized by federal agencies. Creating and maintaining accurate and complete plan documents and summary plan descriptions (SPDs) is the responsibility of the plan administrator. Health and Benefits Compliance assists with this compliance requirement by maintaining strategic partnerships with respected national law firms that can draft plan documents and SPDs. When our clients engage in this service, they pay the firms directly, and an attorney-client relationship is formed. The client benefits from preferred pricing through Willis Towers Watson as well as having the support of our paralegals to assist with preliminary information and document delivery. These services help our clients meet compliance obligations with federal ERISA and IRC requirements in a cost-effective manner. 6) Which materials, methods or training services do you use to keep your clients informed as to current issues relative to the area of benefit administration? With Willis Towers Watson, you get the benefit of our thought leaders across each specialty practice (HR Partner, Communication, Health Management, and Health and Benefits Compliance) working within their respective fields to identify and educate you on emerging and timely issues. Subject matter experts track and report legislative activity on the federal level, issuing publications as needed to highlight key topics. In the area of state law and the numerous jurisdictions within the states, Health and Benefits Compliance reports on information that may be of interest to the general public and may affect employee benefits on a national level. RFP 19-7581 Group Insurance Brokerage and Actuarial Services 34 Health and Benefits updates and education include: HR Digest: HR Digest is a monthly email compendium of news, research and analysis important to senior HR executives. It also features relevant news, webcasts and events, monthly survey questions, survey results and product highlights. Legislative and Regulatory Updates: To cover ongoing compliance activity, Legislative and Regulatory Updates are developed and distributed by our Research and Innovation Center (RIC). RIC is constantly analyzing and interpreting laws and regulations, as well as legislative activity, to bring our clients the most timely and accurate compliance-related communications. Local seminars: To bring relevant and timely Willis Towers Watson industry knowledge directly to our clients, we host local seminars annually. These events provide education around topics such as employee engagement, compliance, health care reform, effective communication, implementing wellness programs and Total Rewards strategies. Client workshops: Smaller group sessions allow Willis Towers Watson subject matter experts to provide a deep dive into issues relevant to our clients, such as compensation strategies and compliance review. These events provide a hands-on review of strategies and solutions, as well as Willis Towers Watson tools and resources. Workshops also offer an opportunity for clients to discuss challenges and successes among peers. The HR Trove Diamond Membership: The HR Trove Diamond Membership is a powerful client tool that complements the daily services of your dedicated Collier County service team with around-the-clock access to employer best practices guides, templates, benefits and wellness education, newsletters, posters, and flyers on a variety of topics. These resources help clients streamline everyday work tasks and drive organizational success. 7) Does your firm have experience in the negotiation and development of discounted fee arrangements with managed care networks? Do you have experience analyzing the fee structures of managed care networks? Does your firm have experience reviewing and recommending software platforms such as Deerwalk? If so, is the platform in-house or an outside vendor. Describe. RFP 19-7581 Group Insurance Brokerage and Actuarial Services 35 Your Willis Towers Watson Team has extensive experience in the development of network discounted fee arrangements on a direct basis as well as analyzing the fee structures and relative discounts of networks provided by the major carriers. Since 2002 we have worked in partnership with the CCG, CCHCC and CHP to manage a local network that is unique to the CCHCC, which allows a greater level of control over in- network providers and how they are reimbursed if this process was left to a major carrier. We have also assisted in assessing network scope and financial terms for services that are provided outside of Collier County were it would not be efficient to operate a direct contracted state and national network. The CCG and the CCHCC have found it beneficial to direct contract with providers in Collier County. Maintaining agreements with providers locally recognizes that the CCG and CCHCC employers provide necessary and vital services to the community on a year round basis. The CCG, CCHCC and their employees are a significant part of the community and play an essential role in making Collier County the desirable community that it is. The CCG and CCHCC seek to partner with the community in which its members serve to fulfill its mission and keep Collier County that way and continue to make it better. The CCHCC seeks to maintain as all of inclusive network as possible and provide comparable reimbursement for similar services performed at facilities throughout Collier County Here are just some examples of what Willis Towers Watson has done in partnership with CHP and Allegiance to achieve the goals noted above. Assessing the old provider agreements offered by CHP in 2001 and negotiating a reimbursement approach based on percentage of Medicare that has endured until today. This was groundbreaking, as most contracts at that time were based on percentage of billed charges. It is only within the last few years that interest is grown in contracting based on Medicare’s reimbursements. Developed and supported the administration of a risk sharing arrangement with local providers from 2003 through 2005. Assessed and modeled the financial impact of numerous requests by providers within Collier County to modify the reimbursement terms over the last 18 years. Most recently Willis Towers Watson worked to negotiate updated agreements with the Surgery Center of Naples and Bascom Palmer Eye Institute. These efforts resulted in significantly more favorable reimbursement terms than were original proposed. Prepared a comprehensive analysis detailing the cost and quality differentials for NCH Healthcare System and Physicians Regional Medical Center, which supported the decision for plan design differentials between the two systems. In 2017, completed a detailed assessment of the networks offered by the five major carriers (Aetna, Florida Blue, Cigna, Humana and United Healthcare). We are currently engaged in a global re-contracting effort, the goal of which is to implement for all local providers a reimbursement process based on Medicare. RFP 19-7581 Group Insurance Brokerage and Actuarial Services 36 Willis Towers Watson has an in-depth knowledge of provider reimbursement approaches, the local marketplace and is prepared to continue to assist the CCG in continually assessing provider agreements to make sure that they are cost effective to the CCG and other members of the CCHCC. Willis Towers Watson is also active in assisting health care providers throughout the United States in negotiating terms with major carriers. Willis Towers Watson understands this issue from the standpoint of the insurer, the employer and the provider. Finally, Willis Towers Watson has developed a proprietary network assessment tool known as NetRPM, which continually assesses on a national basis, relative discounts produced at the SMA level by the major carriers. With respect to data analysis systems, Willis Towers Watson continually assesses the availability of software on the market. Willis Towers Watson uses Cotiviti as the data analysis platform to host the WillisMed reporting platform. CHP and Allegiance use Deerwalk as its health plan data analysis platform. We have worked with the Deerwalk system for the CCG, the CCHCC and other clients. We have full access and are proficient in the use of both Cotiviti and Deerwalk. We access and use both platforms on an ongoing basis to identify cost drivers, monitor cost/utilization patterns and measure the results of efforts to mitigate cost trends, use and health outcomes. More importantly the Willis Towers Watson actuarial team maintains relationships with and the ability to run reports from the following systems: Verisk (D2) Zywave Thompson Healthcare Ingenix Blue Insights CMS Interactive Willis Towers Watson does not seek to limit its clients to one solution. If needed, we can assist the CCG find the best solution, and more importantly, Willis Towers Watson staff is prepared to learn the system and use it to create reports for the CCG. Willis Towers Watson maintains a complete database with complete medical claims records for the last three years and reports from January 1, 2003 through April 30, 2019. The WillisMed database is updated on a quarterly basis and Deerwalk is updated monthly. 8) Do you have experience consulting clients in the setup and management of onsite medical clinics? Describe. Members of your local team assisted its first client with the setup of an onsite clinic in 1997. Since then, Willis Towers Watson has been involved with numerous organizations that seek to set up and manage their own clinics. Additional clients whose names you might recognize that we have assisted in the last year include Land’s End, Milwaukee Tool and Hearthside Foods. In 2014, Willis Towers Watson assisted the CCG and an internal task team in reviewing the evolving on-site clinic marketplace and various models which ran across the span from a RFP 19-7581 Group Insurance Brokerage and Actuarial Services 37 total replacement of primary care to the center of a medical home to support population health management programs. Willis Towers Watson also assisted in the development and execution of an RFP process that led to the selection of Millennium as the CCG’s new partner to manage its on-site health and wellness center. The transition to the new provider opens the doors to significant opportunities for thought leadership in the future. Exploring how Millennium can evolve in supporting the efforts of the CCG to manage its costs and the health of its employees will be a continued focus in the future. Our philosophy towards on-site clinics is to continually explore what the objectives of the clinic are, how to best achieve those objectives and proactively manage the results of those efforts in terms of the overall impact the clinic can have on cost trajectories and health outcomes. The following outlines our philosophy towards managing on-site clinics on an ongoing basis. We continually explore the following key areas and their appropriateness for the CCG. For example, should the clinic be: A comprehensive replacement to the primary care physician? A choice in primary care? An urgent care center, an occupational health center, or both? Is it intended to be an overall wellness coordinator? The first tier in a POS service medical plan design? The “advocacy” component of a behavioral or engagement based health plan? Another provider choice for employees? The direction taken will significantly affect many things with respect to the design of the clinic. If a replacement to current primary care, how will you get people to use it? Will you redesign your medical plan into a three tier option where the highest level of benefits is provided at the clinic, a lesser level for all preferred providers and third level for all other? If it is just a choice, how do you know if people will use it? What type of care do you seek to provide? Is it a comprehensive model where the patient recognizes the clinic’s physician as the deliverer and coordinator of all care? Will it encompass adult care, pediatrics and OBGYN initially and a broader scope in the future? Will it be based on a family practitioner or internist model? Family practitioners are professionals with comprehensive training in all areas; pediatrics, OBGYN, and minor surgery. They guide patients through a continuum of life and treat the whole family. On the other hand, internists are comprehensively trained but lack the background in pediatrics, OBGYN and minor surgery. What kind of model you are seeking will determine what type of providers you need and the structure of the clinic. How should the clinic fit into the overall design and cost structure of the medical plans offered today and what role should it play in the future? Is the design of today’s medical plan sufficient to support the needs of tomorrow or is a different model needed? Once these high level goals are determined, you can step back and set metric driven objectives. These may include, but not be limited to the following. Reduce costs RFP 19-7581 Group Insurance Brokerage and Actuarial Services 38 Reduce utilization Improve health status Manage chronic conditions Reduce paid time off Educate employees The type of model and objectives should be determined before you look at vendors, create an RFP or work plan. Broad Operational Issues After the strategic objectives are determined, you need to consider the following operational issues. The cost of the services and staffing model will be contingent upon the scope of services and what you are trying to accomplish through the clinic. This requires examining issues such as: What services should and can be provided (for example if you say minor surgical procedures, do you mean to include just simple procedures such as wart removal or more complex procedures such as endoscopies)? How will the clinic interface with the employee’s primary care physician and external resources? Do you want all services provided at one place or a “traveling” show for things such as screening and immunizations? How should the clinic integrate with current occupational health services? Integration with third party administrator’s disease and case management services? Integration into medical plan history files? Integration with sick leave and disability management providers? Support the wellness culture and personal responsibility to care for one’s self? Nature and scope of educational services? Who will own it the organization that sets it up, a local provider or a firm that specializes in setting up and running on site clinics? Support to understanding where the dollars are going and what can be done about it (more effectively using clinical and claims data). These issues will affect cost and the willingness of providers to participate. Sample Objectives and Positioning Here are examples of the issues that organizations have considered in looking at the overall strategic and operational objectives for an on-site clinic. Position the clinic as an “extension” of the individual’s current primary care physician to avoid conflict with the local providers who would see what you are doing as competition. You also avoid the initial expense of record transfer the time associated with establishing a new patient record and relationship. The clinic can serve as the focal point for “advocacy” for all employees and their dependents in helping them better understand their health and maintain it. RFP 19-7581 Group Insurance Brokerage and Actuarial Services 39 The educational affect - the clinic can be used as a source of information for employees. The source of information can allow employees to more efficiently access specialty services, as well as provide information to assist in the compliance with formulary programs under the pharmacy program and other such programs the schools may be implementing in the future. Improved efficiency, accessing specialty services and compliance with cost management programs produces additional savings. An on-site clinic can serve as a focal point for activities targeted toward increasing the overall wellness of the employees and dependents. In this fashion, the clinic can act as an extension to and compliment to individual’s current relationship with their primary care physician. Finally, screening services and services for health risk appraisals the corner stone of wellness initiatives can be centralized and done on a very cost effective basis. Patients who are seeking to establish a relationship with a provider could be directed to the most efficient providers. Outsourcing to an external provider in the community would allow you to tie in with the clinic’s facility, therefore making it possible to service dependents. If you take dependents into account in the analysis, the break-even analysis can change significantly. Ancillary gains – the ability of the onsite clinic to integrate with the activities of claims administrator in terms of addressing people who have chronic case management needs, disability management, pharmacy management and a host of other things, can enhance the effectiveness of the programs currently in place. The following is a detailed check list of tactical issues that must be considered Design Issues Goals – the clinic will do “what” for us? Scope of services to provide (office, lab, pre-employment physicals, DOT testing, Workers Compensation etc.) • Service location • Size and configuration of clinic site • Staffing requirements • Hours of operation and term of agreement • After-hours access • Urgent care • Employees only or employees and dependents – Tribal members? • Service standards (appointment time, wait time, patient satisfaction) Funding Issues Method of compensation – (e.g., fee schedule or capitation or mix) Degree of risk assumed by either party of capitated Performance based incentives Pricing modeling versus plan design incentives Ownership of clinic infrastructure Risk financing RFP 19-7581 Group Insurance Brokerage and Actuarial Services 40 Administration Issues Processing of claims or encounters (if capitated) Cooperation with claims administrator requirements Impacts on rates if the medical plan is insured versus self-insured Whether services will be considered a covered expense under the plan Establishing clinical, utilization and patient satisfaction objectives (what do we want to accomplish?) Measuring the extent to which all established objectives are met Medical record system (electronic) Practice philosophy Liability and medical malpractice Hold harmless Communication Issues How is the clinic branded Why should people use it Clinic focused, Shelby Schools focused or both Educational activities Regulatory Compliance Issues Due diligence and ERISA Licensing – credentialing HIPPA Privacy issues ADA access Adherence to evidence based medicine protocols Willis Towers Watson will continue to work with the CCG through the administration and continued strategic planning process to assess the clinics current focus, whether its focus needs to change in the future and whether an RFP process is warranted to address any needed redirection. If an RFP process is warranted, Willis Towers Watson will assist in that effort. Wellness Programs 1) How do you believe wellness programs can be integrated with the group health plan to promote a healthier population and to reduce or control costs? Willis Towers Watson is a strong proponent that wellness must be an integrated part of any group health plan that attempts to mitigate cost by improving the health of the population. These programs just cannot function as separate pieces. Willis Towers Watson will continue to assist the CCG in integrating the wellness efforts in the health care plan so it is viewed not only as a vehicle for financial protection but also a program that helps employees be health and lead the best possible life. We will continue to work with the CCG and CHP on processes that that integrate medical records, claims, advocate interactions, bio metric data and qualifiers into a single data source that is available to employees and advocates. This will also serve as the data source to allow continued measurement of improvements in cost, trend and health outcomes. RFP 19-7581 Group Insurance Brokerage and Actuarial Services 41 We will help the CCG be a national leader in continued efforts to improve the health of the population. Beyond the plan design platform selected, contributions and communications, the emerging and most important challenge today is to get employees engaged in taking responsibility for their health and using programs designed to help them maintain it and address disease. Another significant challenge is that consumers are not sufficiently engaged in the cost of care, medications and what needs to happen to improve health. For example; Simvastatin will reduce lipid levels for under $300 a year in most people; other medications may cost much more. Walking which is almost free will do the same thing as a $1,000 annual gym membership. Fitness and good health does not need to be fancy; just faithful. We will continue to work with the CCG on cost and health improvement. We will also ensure a continued focus on the following core component of the current wellness and health management process: 1. Understanding ones current health status. 2. Understand what needs to be done to maintain health or address disease. 3. Use of the resources offered to help people stay well, address disease and address catastrophic medical events. 4. Getting moving; some type of exercise which can be as simple as walking. The support processes linked to the behavioral based health plan that was implemented in 2009 continue to evolve and the results as evidenced by improving biometric measures continue. Willis Towers Watson and CCG will continue to monitor the program and, where necessary, work with CHP, internal resources and other local resources to refine strategies that will continue to improve the outcomes of the program. Further, though the strategic planning process steps must be taken to ensure that new strategies associated with the health are embraced and driven by senior management, overseen by Risk Management, holistic in nature and support continued moderate cost trends and improve the health and well-being of the Population. Willis Towers Watson will also continue to assess results, make changes were necessary and help introduce new programs to address chronic disease and maintain health. We will continue to work toward a program where vendors, providers and patients work together to maintaining. The CCG has a population that older and contains a large percentage of people treating for chronic conditions. The community advocacy process was designed to address the gap in care and help people address health issues. Our efforts will continue to focus on improving the interactions that advocates have with employees and evolving the process to where employees and spouses embrace the process as a way to lead healthily and productive lives There are many opportunities to better manage costs and wellness is a key cornerstone of success. Long term success will be contingent upon continuing to having a well thought out RFP 19-7581 Group Insurance Brokerage and Actuarial Services 42 wellness plan containing engagement incentives, goals and measurements that are well communicated, consistent with the CCG’s vision and mission, support the overall health of the population and are integrated with the medical plan. We also believe the top priority for the future is to expand the focus of the program from physical well-being to also include emotional financial and social aspects. The CCG has already moved in this direction with deploying dedicated emotional wellness support staff to assist with emotional well-being. We are prepared to assist the CCG in building on its current programs and evolving them to a more global integrated well-being strategy as outlined in the schematics below. These outline how the concept of well-being is becoming more important for all employers both from the standpoint of controlling cost as well as optimizing the employee experience. 2) How must the various health program components/vendors coordinate to assure successful program management? RFP 19-7581 Group Insurance Brokerage and Actuarial Services 43 As noted earlier, any process to reduce the cost of health care and improve the health of the population requires an integrated process where all program components and vendors work as a team. We help instill in all vendors and staff an entrepreneurial zeal to address health care resource utilization issues, improve the heath of the population and help members faced with costly health care crisis. All of the elements of the heath care equation outlined earlier in this the questionnaire must be understood by and acted upon by all involved. We support ever-increasing coordination and integration by focusing on the following: Health care reform was a catalyst to create goal congruence with providers as well as vendors. Willis Towers Watson continues to explore how to optimize integration where all vendors and providers work together to address: Utilization, Improve the health Provide better health and clinical outcomes Manage chronic disease. Promote holistic well-being for employees and there dependents Through the provider contracting assessment currently underway we are going to expand the focus from merely how providers are paid to how providers can work in partnership with the CCG and its vendors to Integrate their efforts with the with the current advocacy programs Manage patients across a continuum of care. Work jointly on cost-savings opportunities. Promote patient centered care, evidence based medicine and care coordination. The implementation of systems to support valid and reliable performance measurements in terms of both quality and cost. Continue to evaluate Centers of Excellence for the provision of high cost surgical and medical procedures outside the Collier County area. Evaluate the benefits of and lobby for a communitywide integrated electronic personal medical records to support: • Improve health awareness and health — assessing the development of a system to integrate biometric screenings. • Improve care coordination. • Integration of claims data, plan qualifications, health advocate interactions into a single data source. Continue to work with the CCHCC and the CCG to understand the factors that drive costs, develop strategies to address them and address them that are shared amongst all vendors. The current quarterly financial review meetings have served as the catalyst for sharing challenges and potential solutions to address. RFP 19-7581 Group Insurance Brokerage and Actuarial Services 44 In our last response to your broker RFP we talked about reengineering the EAP program. This is become a reality with the emotional wellness program. We will continue to evaluate the results of that program and how it can be integrated with the efforts of vendors other initiatives. Leveraging the Deerwalk and Cotiviti systems to better understand how the partnership between the employers, employees, advocates and local providers can modify the risk index of the chronically ill population while improving outcomes and driving down cost. Assess opportunities to leverage and perhaps expand the focus of the current onsite clinic – can we achieve greater integration with the health plan, screening, and advocacy process to improve outcomes and reduce costs related to the population with chronic diseases. Do further opportunities exist to get clinic staff involved in working with CHP in managing large claimants? Watch for performance outliers – we will continue to look for and act upon areas that appear to fall outside of normal practice and cost parameters. The current J code project focusing on medications used in the doctor’s office is one example of initiatives in this area. Continue to assess and redefine the role of the health advocates – The advocates have done a good job at seeing that people are getting screened and understand their health. Are there new ways that we could consider deploying these assets so they better understand the key cost issues they need to focus on, what significant care events they need to be talking about and get them focused on supporting overall improvements in the health of the population. Improve case management processes – By continuously assessing this process we are working on methods to ensure case management is impact based versus process based and develop steps to make this a part of the qualifiers and making sure that we are generating measurable results through this program. Leveraging health care reform and the evolving payment process to engage physicians in the case management process represents an area of significant opportunity which will be explored in the upcoming year Support development of new disease management support programs – Currently the CCG has programs in place for smoking, diabetes, lipid management and hypertension. Willis Towers Watson will utilize the total well-being concept and work with internal and external resources as well as Millennium to continually explore the structure of support programs to ensure they address areas of opportunity and truly support people in making change. Group Life and Disability Insurance 1) Does your firm have the ability to solicit, review, analyze, and recommend employer paid group life and disability insurance? Yes, Willis Towers Watson provides a comprehensive approach to marketing any line of coverage or service addressed. The three year agreement with Aetna was set to expire on December 31 of last year. Aetna’s proposed renewal for the life, AD&D and disability coverages would have resulted in an increase of 61.2% or $337,000 annually. Willis Towers Watson marketed these programs and as a result, we were able to obtain much more attractive renewal terms from Reliance Standard resulting in a reduction of over $276,000 compared to Aetna’s renewal terms. As RFP 19-7581 Group Insurance Brokerage and Actuarial Services 45 part of this process, we also assessed the costs and benefits of outsourcing family medical leave to Reliance Standard. We maintain a dedicated placement practice. The specialist assigned to you is Lisa Whiteman. Lisa has significant experience in the placement arena and is backed up by a national practice with significant experience in the placement of ancillary coverages such as life, AD&D, short and long-term disability as well as family medical leave administration. The placement team includes individuals with backgrounds in all aspects of benefits from brokerage to underwriting to reinsurance. The way in which Willis Towers Watson approaches marketing is comprehensive and ensures an outcome that meets the needs of the CCG, is detailed, and is in full compliance with any internal policies or methodologies required by the CCG. This process includes data collection and analysis, an understanding of the issues, objectives, and challenges involved with managing the CCG’s programs. Regardless of the service or line of coverage being marketed, the marketing process generally includes the following steps: Develop RFP document Approval of RFP document Identify potential carriers Distribute RFP document Conduct pre-bid conference and respond to all questions (verbal and written) Respond to all additional questions Follow up with carriers to encourage proposal response Analysis of responses Selection of finalists Interview finalists Work with the selection committee to reach a final decision Support in writing a final summary and recommendation to the Board of Commissioners This process and the manner in which we participate is flexible, in order to meet the CCG’s procurement requirements. Having worked with CCG in the past, we understand local government in Florida, have established procedures and ordinances that may require modifications from time-to-time and strict adherence to your process. We are comfortable with modifications and experienced with dealing with various approaches to procurement. In addition, Willis Towers Watson takes seriously the financial strength of the carriers with which we do business and utilize a market security division of Willis Towers Watson to track carrier financial ratings. Willis Towers Watson is poised to use any suitably rated carriers that meet your objectives. We will recommend carriers with which we feel your needs will be effectively met and ensure suitable standards of service are available to you. Willis Towers Watson is also ready to offer many enhanced pricing and service protocols due to our size and impact in the marketplace. Willis Towers Watson is licensed and appointed with over 200 health, life and disability carriers. As a result, CCG is not seen strictly as an organization of roughly 2,200 employees and retirees, but rather a client of Willis Towers Watson with a significant market share in the industry. With roughly $40 billion in premium placed with major carriers, we have the leverage to favorably impact the terms and conditions for coverage selected by the CCG. RFP 19-7581 Group Insurance Brokerage and Actuarial Services 46 Upon receipt of the proposals, we will evaluate each respondent’s appetite for the risk, and ensure all key provisions of the program are addressed. To maintain the integrity of the process the purchasing department generally utilizes an evaluation team. Willis Towers Watson has worked with the CCG and other client’s selection committees acting as the facilitator for the team’s evaluation process. We can assist an evaluation team with analyzing the financial terms and summary of qualitative aspects of the RFP responses, tabulating scores and establishing scoring mechanisms to assist them with their evaluation process. Our written evaluation process incorporates the following elements: Carrier financial ratings Adherence to program design requirements Quality of service with other clients Premiums and fees Risk sharing arrangements (if applicable) Performance guarantees Additional tools/services that are unique to the respondent Implementation strategy As one of the largest brokers in the world, Willis Towers Watson leverages its size and market share on behalf of any client. Willis Towers Watson utilizes experienced underwriters who have worked with the major carriers that our clients do business with. Understanding the underwriting process, strategy and techniques enables our team to talk to carriers in their own knowledge and negotiate effectively come renewal time. All of our clients, large and small; public and private seek our expertise to help manage their benefit costs, and through our experience and significant impact in the marketplace, we negotiate the financial rates, service levels, and quality components using that leverage. 2) Please list the three major group life carriers with which you generally do business and the approximate premium volume (Florida only). As was the case for reinsurance, we consider premium volumes by carrier to be proprietary. However, we can provide you with the carriers we most frequently have worked with during the last year. For life insurance the top carriers we saw clients selecting were: 1. MetLife 2. Prudential 3. Securian (formerly known as Minnesota Mutual) For disability the three top carriers we saw clients selecting were: 1. Hartford 2. UNUM 3. Lincoln Financial RFP 19-7581 Group Insurance Brokerage and Actuarial Services 47 The marketplace is dynamic and ever-changing. Carriers a year ago may be different a year from now. For example, Lincoln Financial recently acquired Liberty Mutual. Since the acquisition we have seen a marked deterioration in service and underwriting terms. For this reason, we anticipate Lincoln would not be in the top three this year. We believe it is vital that we evaluate all viable carriers on an ongoing basis. This includes their sensitivity to the unique needs of the clients as well as changes in the financial strength or service capabilities. As noted in our response to the life insurance question above, we are licensed with all major carriers and recommend those which we feel will effectively meet your needs and service standards. 3) Why do you typically recommend these firms? We recognize that the group life and disability market is extremely price sensitive, so pricing is a major consideration. However, a placement decision must be made with significant consideration towards carrier rating, fast and accurate claims payments, and ease of administration in filing claims. Group life carriers often provide additional riders for supplemental services as described below. After initial determination of the top several carriers in terms of financial terms, we look further at contract type and supplemental benefits to assist with making a recommendation. Making sure the carrier is able to meet our clients’ service needs is foremost. We recommend carriers which we feel will effectively meet your needs and service standards. 4) Describe the process you follow when analyzing group life proposals for recommendation to your clients. After initial determination of the top several carriers in terms of financial terms, we look further at contract type and supplemental benefits to assist with making a recommendation. We will recommend carriers with which we feel your needs will be effectively met and ensure suitable standards of service are available to you. Our corporate charter requires we be be 100% transparent and disclose any market derived income we may receive from any carrier whom we have jointly determined we wish to seek quotations from. It is our goal to be fully transparent and help the CCG choose the vendor it believes offers the best balance of stability, service and attractive pricing Ancillary Benefit Services 1) Can your firm provide ancillary benefit proposals for the County's Flexible Benefit program such as Supplemental Life, Vision, Cancer, etc.? Willis Towers Watson has provided these services to the CCG in the past, resulting in significant plan enhancements and reductions in cost. Willis Towers Watson maintains RFP 19-7581 Group Insurance Brokerage and Actuarial Services 48 knowledge and information about the marketplace in order to advise the CCG when potential cost savings opportunities or new benefit enhancements are available. The process we follow is identical to what is outlined for the life and disability programs 2) How do you determine which of these provide value to the overall benefit philosophy and what is the process you go through when recommending same? It is our job to work collaboratively with the CCG to identify service needs, coverage levels sought and any other pertinent items that should be a factor in making a decision. We convert this information to a detailed request for proposal, seek quotations analyze them and work with the CCG to choose the vendor best equipped to meet the needs of the CCG. We also will present ideas or suggestions to the CCG when new approaches, products or pricing opportunities arise. For example, we have had periodic discussions about returning to a self-funded dental plan and made the change when it became a priority. We discussed the potential costs and benefits of outsourcing family medical leave and assisted staff and the selection committee in reaching a decision to outsource that function. We have been deeply involved in the post implementation to make sure service is consistent with expectations and proactive corrective action is taken if necessary. We meet with CCG staff regularly to discuss service and plan information such as claims experience and benefit changes, or for planning purposes. Best Value Group Insurance Program 1) If you were asked to review the overall group insurance program for the County, how would you analyze the structure of the program to deliver best value to both the employer and employee? We have an organized process to meet this goal. Refer to the Willis Towers Watson Way process outlined earlier (page 26) in the response to the questions regarding executive interviews, focus groups and continually evaluating changes. Consortium Services 1) Have you performed work for a multiple employer consortium group in the past? If so, please describe the services provided and the accomplishments completed. The Collier County Health Care Consortium (“CCHCC”) is comprised of the Collier County Government, Collier County Sherriff’s Office, Collier County Public Schools and NCH Healthcare System. Collectively these four entities are responsible for funding over $110,000,000 in health care expenditures for employees and dependents annually. This group dedicates their time, resources and expertise to better understand and collectively act on the factors that that drive health care costs and make it increasingly difficult to finance health care benefits for employees. The CCHCC collectively believes that by working in partnership with vendors and providers, they can make a difference and help keep private health insurance affordable. RFP 19-7581 Group Insurance Brokerage and Actuarial Services 49 The CCHCC is a group of employers who believe the following: The cost of providing health care benefits has continued to escalate at a rate in excess of the growth in the economy for several years. Although published trends suggest a declining rate of increase in “premiums,” this has been brought about by increasingly transferring more of the cost of healthcare to employees. This simply transfers the burden to parties other than the employer and does not address the root causes driving cost. The CCHCC has worked in partnership with vendors and providers to achieve level heath care cost trends since 2001. Containing costs and improving health is a continuous journey not a destination. Hence the efforts to address health and health care costs needs to be a continuing effort. Escalation in the cost of providing quality health care benefits impacts our ability to efficiently serve our "customers” and our employees’ ability to raise their standard of living since they will need to participate financially in the increases. In addition to understanding the adverse impact of cost, we recognize that historically our health care system is focused on treatment as opposed to prevention. Published data from the Center for Disease Control suggests Americans’ health is declining. Poor health impacts not only the cost of health benefits, but also productivity and the quality of life of our employees and their dependents. Consortium participants believe that affordable health insurance, health care and improved health is attainable provided the following "facts" are recognized: • No one party is responsible for the current situation; providers, employers, employees and patients have all shared equally in creating the cost and health problem. • Assigning blame for the cost and health problem is counterproductive and will not address the root causes of the increase in the cost of providing health care benefits and the health of the covered population. All stakeholders must realize their part in contributing to the problem and that all must contribute to the solution. • Data is just data, "information is king.” To solve the problem, we must have information that tells where the money is going, for what and then compare it to best achievable results not the benchmarks of the past which represent an unsustainable system. We also seek to better understand the aggregate health status of our members, how we can prevent disease and effectively treat it. • Armed with information, it is possible to ask the question "Is this best use of our money or, is there a better use that will lead to the same outcome?” • Better quality and health leads to lower cost. By focusing on quality and health we can keep heath care affordable. Our efforts focus on fair pricing, quality care at the right time/place and that employees are engaged in understanding their health and acting on that knowledge. The CCHCC has adopted the following to articulate its position on key issues that affect the affordability of health care and health care benefits. What Defines "Cost'' in the Health Care Environment? Cost is determined by more than just cost per unit or how big a discount can be negotiated. Cost in health care is more complex as the following outlines: RFP 19-7581 Group Insurance Brokerage and Actuarial Services 50 Usually, cost is seen as a function of price per unit times volume where: Price per unit x Volume = Cost In health care, "Cost" is a more complex function were volume is influenced by multiple sources: Price per unit times Volume adjusted for Sources and Outcome = Cost Source 1 = Determined by physician practice and billing patterns Source 2 = Determined by patient preferences and expectations Source 3 = Determined by patient health status and lifestyle Source 4 = Determined by payer Source 5 = Does the patient understand and comply with proposed treatment Outcome = Benefit to the patient as determined by: a. Efficacy: Which treatment produces the best result for the patient? b. Effectiveness: Does the treatment result in superior outcomes when applied in the delivery system? c. Appropriateness: Is the treatment used appropriately at the right time in the right place? d. Execution: How well does the provider perform the procedure? e. Patient Compliance: Does the patient understand and comply with the treatment plan? At the consortium level, we have consistently focused on how we can, as a collective group, manage the sources noted above. We also believe there are certain responsibilities that are required of each stakeholder in the healthcare delivery system. These are as follows: Responsibilities of Health Care Providers Physicians and Other Health Care Professionals Hospitals and equipment are inanimate objects and cost nothing unless they are used. The only way that these “things” generate cost is if a physician writes on a piece of paper that they can be used. As such, we believe physicians and other health care professionals: Play a significant role in controlling sources of cost and outcome. They have significant control over treatment choices, outcomes and must be engaged in understanding the costs of those choices. Must take a leadership role supporting the analysis of utilization, cost and biometric data and support the creation and execution of process to eliminate waste, improve outcomes and health status. Evidence based medicine is a must. Have the responsibility to internalize and follow the programs and processes that are designed to control utilization, adhere to best practices and provide the best possible outcome to patients. Should be committed to providing the highest quality of care at the right time and in the right place. Providers must screen and educate participants about their health care risks. Should not tolerate or hide substandard performance of peers. RFP 19-7581 Group Insurance Brokerage and Actuarial Services 51 Must manage the patient not the encounter: Stand up to non-compliant patients or patients that demand unnecessary services. Embrace, learn and use new clinical and health related technologies and processes secure shared medical records. Measure and report on clinical outcomes. Openly communicate with all stakeholders and work as an integrated team to address all sources that affect the cost of health services and outcomes. Hospitals Hospitals can no longer be viewed as expensive hotels that no one can use unless a physician says it is all right to stay there. Through integration and ownership of physician practices they have the ability to influence cost. As such, we expect that hospitals: Will freely provide the resources to assist physicians in identifying best practices and the development of evidence-based medicine. Be as efficient and prudent as possible in the acquisition of new equipment/technologies so as not to needlessly duplicate services. Provide adequate nursing support and a safe environment for patients. Adopt a continuous quality improvement approach to technological and human support systems. Measure and report on clinical outcomes. Support the development of automated medical record systems. "Managing" care is not a process to say no, it must be a form of continuing medical education. Responsibilities of Plan Participant and Patients Individuals who receive employer provided medical benefits and patients who receive benefits under them must play an active role in controlling costs. Toward that end, participants and patients must: Access screening services as required – know their numbers. Follow the directions of care givers. Take medications prescribed by physicians as directed. Work to maintain and improve overall health. Actively participate in programs and activities to improve health. Make sure that billing is accurate. Become educated consumers – shop for the best price when possible, ask questions and be informed patients. Our Responsibilities as Employers and Vendor Partners Requiring certain behaviors from providers and patients also places responsibilities on the employers, plan sponsors, and payers. As such, the member employers of the CCHCC will: RFP 19-7581 Group Insurance Brokerage and Actuarial Services 52 Constantly review the design of their medical benefit plans to make sure they cover what is appropriate and exclude what is not. Constantly review the administrative requirements of their plans and vendors, and reduce unnecessary involvement and effort by health care providers. Maintain local utilization review processes recognizing that they are more effective when delivered and controlled locally. Incorporate into their reimbursement structure financial rewards for "efficient" providers; explore the implementation of additional non-monetary rewards for that same group of providers. Incorporate into their plans elements of consumerism to foster responsible consumption of resources. Provide coverage for screening services for all individuals so they know there health status, and we can measure changes in the overall health of the population over time. Pursue behavior based health plans that strongly encourage total population health screening as a condition of participation in the medical plans in order to establish measurable baselines for the overall improvement of the health of the population. Reward participant/patient behavior modification and compliance with treatment plans to the extent allowed by law. Use only claim administrators that provide prompt payment and quality customer service for providers and employees. Listen to providers and address their concerns when consistent with the overall objectives of the CCHCC. Where possible, vendors will have a presence onsite at the employers and the employers will take steps to ensure these local resources are utilized. Our Collective Responsibilities as Employers, Plan Sponsors, Payers, Vendors and Providers Recognize that a small number of people drive most of the cost of the health care plan. Success in mitigating trend is contingent on managing a favorable outcome from a health and cost perspective for the small number of people who drive over 50% of the cost. Maintain a focus that emphasizes quality. There is a definite relationship between quality, outcome and cost. This relationship needs to be better understood and a continued focus of our collective future efforts. Develop impact based processes to help those with chronic and catastrophic disease and measure the results via improvements in biometric measures, cost, the risk scores of those individuals and the population as a whole. As a group, we will ensure complete confidentially of individual’s medical information to the extent allowed by law. Expect that vendor partners (insurance companies, TPAs, pharmacy benefit managers, providers and other vendors involved in the delivery of health care benefits) offer competitive pricing for services provided, are transparent in their dealings with you and are responsive to our needs. Health care data collected through these processes will not be used for the individual gain of the any of the parties (employers, patients, providers vendors) participating with or in the CCHCC. Key Goals of the CCHCC RFP 19-7581 Group Insurance Brokerage and Actuarial Services 53 The health care environment and delivery system is undergoing fundamental change. The focus is moving away from discounts off of unit per service with a greater focus on adherence to best practices, population health, quality outcomes and global payments versus fee for service. For the first time, there is goal congruence between the patient, provider and payers. The CCHCC will take steps support and address the following key goals on an ongoing basis: 1. Provider payments will increasingly be focused on rewarding performance and outcome not solely the cost of the unit of service. 2. A continued dialog and partnership with all stakeholders at the table, providers, employers and vendors. 3. The prices of services provided are competitive and transparent and consistent across providers. 4. Our approach to working with all stakeholders is direct, transparent, mutually respectful, fair and independent; recognizing that we can’t always chose sides. 5. Supportive of the community wide Blue Zones Initiative. 6. The factors that drive health care costs are identified and strategies developed to address them. 7. Programs to help people maintain health and address health issues will deliver measurable results not just activity – evolving from process to outcome. 8. Socially embedded wellness (participants are aware of their health and act on that knowledge) develops within the work place and the community. Through the journey that was started in 2001, much has been accomplished. What is written above is not simply words on paper, but a true expression of how we have lived this vision as individual employers and the CCHCC. Each year we set goals and at the end of the year review our progress toward those goals. We set meaningful metrics to measure our progress, report on it and take corrective action where necessary. In our cover letter and throughout this response we have demonstrated the measurable economic benefits that have accrued via working directly with the CCG and where it makes sense collectively with the other public employers to maintain a locally controlled network. This has been accomplished without a formal or costly governance structure. The process works because all employers see value in sharing, and the CCHCC also avoids the duplication of effort associated with four organizations doing the same thing independently. Since 2009, the CCHCC has successfully continued to assess cost drivers, implemented a behavioral based health plan for three of the four members, used the Deerwalk and Cotiviti systems to house and analyze health care data and stayed on top of regulatory issues that surround health care reform. More importantly, the cost performance of the CCHCC over the last five years outperformed published trends by 30% without the significant cuts in benefits other employers have had to make. In total, the cost for the CCHCC on a per employee basis is only 5% higher than it was 10 years ago. We have the opportunity to mold and new future and leave a path for others to follow. Providers, payers and carriers can no longer exist as separate silos. Working together to understand the factors that drive health care costs, collectively working on solutions and measuring the results is imperative to not only keeping health care competitive but for the good of our community. We also recognize that this is not a perfect process. There have RFP 19-7581 Group Insurance Brokerage and Actuarial Services 54 been some things that the group has attempted to do that have not been as successful as we would like. The key is we continue to collaborate and learn from that experience. The CCG is an innovator in adopting community-wide initiatives such as wellness and the Blue Zones. The CCG is also a leader in working in partnership with all stakeholders to raise the bar with respect to cost and outcome. Willis Towers Watson eagerly looks forward to continuing the journey to produce measurable results that outperform published trends and set an example for the US to follow with respect to delivering superior health and superior health outcomes. Principle Service Contacts 1) Please provide the names of the primary individuals who will be providing service to the County. Please attach their resumes. We have provided a stable service team for over ten years and introduce additional colleagues to bring new ideas and help us question the status quo. Douglas Ley, Senior Director, will continue to be the senior consultant responsible for the primary strategic direction, performance and service. Doug has extensive consulting expertise spanning more than 40 years working with organizations in developing their benefits strategy, changing behavior, enhancing financial outcomes and facilitating both the organizational change and technical applications of a complex benefit plan. Doug is supported closely by Matt Deininger, Jill Goehrig, Sheryl Henry, John Pauly, Mike Clark, Lisa Whiteman and Steve Buell. These team members have been involved with supporting the CCG for many years. They have a history with the CCG and most importantly a desire to continue to raise the bar with respect to the future. Following are key members of the CCG team, including tenure with the CCG and contact information. Complete biographies are included in Tab 5. Team Member Title Phone Email Years working with CCG Doug Ley Sr. Director 414-640-2710 douglas.ley@willistowerswatson.com 19 Steve Buell Financial Analyst 404-964-7749 stephen.buell@willistowerswatson.com 11 Jill Goehrig Associate 414-759-8050 jill.goehrig@willistowerswatson.com 3 Matt Deininger Director 262-623-2969 matt.deininger@willistowerswatson.com <1 Sheryl Henry Sr. Associate/Actuary 414-550-9145 sheryl.henry@willistowerswatson.com 15 John Pauly Associate Director/Actuary 920-530-4647 john.pauly@willistowerswatson.com 5 Mike Clark Financial Analyst 715-347-0555 mike.clark@willistowerswatson.com 12 Lisa Whiteman Sr. Associate 757-805-0568 lisa.whiteman@willistowerswatson.com 2 Rebecca Lawrence Director 636-856-4399 rebecca.lawrence@willistowerswatson.com 10 Michael Neren, MD Medical Director 651-983-9857 mikeneren@gmail.com 17 RFP 19-7581 Group Insurance Brokerage and Actuarial Services 55 2) Where is the location of the primary service office? The primary local service office is located at 4100 Corporate Square, Suite 102, Naples, FL 34104. This is a satellite office of Willis of Wisconsin, Inc. (Willis MIDWEST) located at 400 North Executive Drive, Suite 300, Brookfield, WI 53005. This office houses approximately 75 employees dedicated to the Brokerage and Advisory segment of our business. The satellite office in Naples is staffed at minimum of one week per month by one or more members of the service team assigned to the CCG. As has been our past practice, we recognize the necessity of being flexible and having staff present at the office more frequently than one week per month. Both Douglas Ley and Stephen Buell maintain local residences in Naples. Compensation 1) Do you agree to provide the Scope of Services for a flat fee? Yes. Willis Towers Watson is proposing a fee of $102,000 annually. A separate charge of $7,500 is made for GASB 75 valuations which must be completed every other year. These two fees are inclusive of all services noted in the work plan outline as required earlier in our response. Willis Towers Watson also proposes placing 20% of our fees at risk in accordance with the following schedule and as outlined in the above-noted document: Analysis and Reporting - 5% Renewal and Negotiations - 5% Client Management - 10% 2) Does your firm accept contingency commissions and what steps has your firm taken to assure the County that the disclosure of all income paid on behalf of the County for purchases made under this program are appropriately accounted? Prior to the placement of any insurance service or vendor agreement, Willis Towers Watson discloses any and all compensation received. This enables the County to confirm their acceptance of any compensation and confirmation of rates. We will provide annual statement of any additional compensation received which can be validated against our placement disclosures. We also receive commissions on any coverages that are 100% paid by employees 3) Are you proposing a different fee arrangement? If so, please describe. Looking at our current revenue streams for all of our clients, we receive approximately 40% of our compensation from commissions, 40% from flat annual fees and 20% from hourly project work. We are agnostic with respect to how we are compensated. We believe the current process with the CCG works well. We also believe flexibility is a cornerstone of all our relationships. If for any reason the CCG would like to move to a different compensation arrangement, we would be more than happy to discuss other methods. RFP 19-7581 Group Insurance Brokerage and Actuarial Services 56 TAB 3 – COST OF SERVICES TO THE COUNTY RFP 19-7581 Group Insurance Brokerage and Actuarial Services 57 Fee Proposal 1) What is your annual fee proposal for Brokerage and General Benefit Consulting services? The remuneration outlined is inclusive of the items listed in our work plan requested is a vital component to the response to request for proposal. 2020 and 2021 flat fee of $102,000 per year includes both Brokerage/General Benefit Consulting and Actuarial Services. $7,500 per GASB 75 valuation. Commissions on coverages 100% paid by employees 2022, 2023 and 2024 flat fee of $108,000 per year includes both Brokerage/General Benefit Consulting and Actuarial Services. $8,000 per GASB 75 valuation. Commissions on coverages 100% paid by employees 2) What is your annual fee proposal for Actuarial Services? The proposed fees noted above include Actuarial Services. RFP 19-7581 Group Insurance Brokerage and Actuarial Services 58 TAB 4 - EXPERIENCE AND CAPACITY OF WILLIS TOWERS WATSON RFP 19-7581 Group Insurance Brokerage and Actuarial Services 59 Several years ago we had a client whose CEO had a favorite catchphrase. That phrase was “let your actions thunders so loudly I don’t hear your words.” We took that statement to heart with all of our clients, including the CCG. It’s one thing to talk about what you’re going to do it’s another thing to do it. We believe our work plan, response to your questions and the measurable results we have delivered are the actions that thunder more loudly than what could be written. We recognize the response to this section is important to the selection committee and will be important in assessing whether you make a change in your consulting and actuarial partner. We don’t believe it will add anything to restate much of what has been said throughout the balance of this response, as we believe our statement concerning the capacity of our firm is best stated through our accomplishments over the last 20 years and our commitment to continue delivering thought leadership and measurable results in the future. In 2016, Willis merged with Towers Watson. This significantly increased our experience and capacity to deliver thought leadership and measurable results. We don’t think there is a question you could have where we don’t have someone who has thought about that question before and can provide guidance. That’s the benefit of working with the firm that is global in scope yet provides a dedicated service team that is intimately knowledgeable of your situation and challenges. Below are five key reasons why the CCG should continue to engage with Willis Towers Watson: Specialization in public entities: Your team has significant experience serving public entity clients. Our ability to service public sector clients is evidenced by the longevity of our relationships. Our track record of innovation and success: Our public entity clients want solutions that balance the often conflicting needs of bargaining groups, management, boards and taxpayers. We will strive to bring the right mix of strategic planning to uncover areas of opportunity and deliver measurable results to all stakeholders. Our point of view and approach: We will draw on many years of diverse experience working with public entity clients on the design and ongoing management of your benefits program. We listen carefully to clearly understand your unique challenges so we can leverage our experience with other entities to deliver a benefit program that protects your employees, while at the same time being fiscally efficient. Our approach to client service: We view our relationship with you as more than being a vendor - we view ourselves as an extension of the CCG. We have delivered innovative leading-edge advice and delivered measurable results. As noted in our cover letter “we take what happens to you and every employee personally.” Our passion: We endeavor to understand the CCG’s challenges and deliver measurable outcomes through thought leadership, setting goals and leveraging our strong relationships with insurance and administrative service vendors. This passion has shown through in the results we have achieved and more important, how excited we are to continue the journey in helping the CCG effectively manage the benefit program. RFP 19-7581 Group Insurance Brokerage and Actuarial Services 60 Willis Towers Watson (NASDAQ: WLTW) is a leading global advisory, broking and solutions company that helps clients around the world turn risk into a path for growth. With roots dating to 1828, Willis Towers Watson has 45,000 employees serving more than 140 countries and markets. We design and deliver solutions that manage risk, optimize benefits, cultivate talent, and expand the power of capital to protect and strengthen institutions and individuals. Our unique perspective allows us to see the critical intersections between talent, assets and ideas — the dynamic formula that drives business performance. Together, we unlock potential. Learn more at www.willistowerswatson.com. A strong client focus, an emphasis on teamwork, unwavering integrity, mutual respect and a constant striving for excellence are the core values of Willis Towers Watson’s rich history. Many of our clients have been with us from our earliest days. Whether they first came to us for brokerage services or actuarial work, we met them with respect, a strong sense of advocacy and an emphasis on excellence. These values will continue to define our approach to business and our relationship with our clients, now and in the future. While Willis Towers Watson was formed in 2016 with the merger of Towers Watson and Willis Group, the company’s origins date back to the mid-1800s. The merger has blessed us with many additional capabilities, access to abundant information and new ideas. We have the capacity and experience to help the CCG meet the challenges of the future. We welcome the opportunity to continue the journey. RFP 19-7581 Group Insurance Brokerage and Actuarial Services 61 ATTACHMENT 2: PROFESSIONAL REFERENCES Please provide a listing of five employer references that employ in excess of 1000 employees, two of which should be Public Sector Agencies. Employer Name: Collier County Public Schools Address: 5775 Osceola Trail, Naples, FL 34109 Contact: Jane Knoble-Manalich, Director of Benefits and Wellness Phone: 239-377-0355 Employer Name: Enlarged City School District of Middletown Address: 223 Wisner Avenue, Middletown, NY 10940 Contact: Linnette Chillino, Director of Benefits Phone: 845-326-1166 Employer Name: City of Milwaukee Address: City Hall, 200 East Wells Street, Milwaukee, WI 53202 Contact: Renee Joos, Employee Benefits Director Phone: 414-286-2938 Employer Name: Milwaukee County Address: 901 North 9th Street, Milwaukee, WI 53233 Contact: Tony Maze, Director of Benefits Administration Phone: 414-278-4326 Employer Name: Oak Creek Franklin Public Schools Address: 7610 South 10th Street, Oak Creek, WI 53145 Contact: Troy Hamblin, Director of Human Resources Phone: 414-768-6155 RFP 19-7581 Group Insurance Brokerage and Actuarial Services 62 TAB 5 – SPECIALIZED EXPERTISE OF WILLIS TOWERS WATSON TEAM RFP 19-7581 Group Insurance Brokerage and Actuarial Services 63 Douglas J. Ley Senior Director – H&B NA Brokerage and Advisory Experience and Tenure with Collier County Government Doug has worked with the CCG for 19 years and will continue to be responsible for high level analytical reporting, financial planning, actuarial compliance and facilitating meetings and project management for the CCHCC. Doug has significant experience working with large, self-funded organizations over his 40-year history and has worked with the CCG since 2001. Specific project responsibilities for CCG will be strategic planning and data analysis, vendor cost/performance assessments and interface with senior leadership. Doug also manages the actuarial staff and his technical expertise with consulting in large complex organizations enables him to effectively integrate the various components of the healthcare arena, especially provider payment processes, the impact of population health programs and the impacts of onsite clinics. Doug has been assisting clients with the management of on-site clinics since 1997. Doug has 40 years of experience in employee benefits. He consults with employers, insurance carriers, coalitions and health care providers on a wide variety of issues involving the design and management of employee benefits. His experience includes strategic planning, population management, wellness programs, onsite clinic implementation and management, benefit captives, engagement health plans, consumer driven health plans, data analysis, funding arrangements, plan design, cost management system design/evaluation and clinical analysis of health claims data. Doug also served as an Assistant Vice President in the National Accounts Department of a major insurance company. His account responsibilities included several Fortune 500 companies and involved servicing, underwriting, claims processing and designing employee benefit programs. Doug provides clients with results orientated solutions specifically tailored to their individual needs. Doug's accomplishments have included: ■ Designing and implementing integrated cost management processes for employers, providers and insurers, which provided significant return on investment and improved control of medical, dental, disability and workers compensation claim costs. ■ Performed diagnostic assessments of overall insurance company operations and managed care processes. ■ Developed processes and systems to identify health cost increase drivers and measurable strategies to address them. ■ Designed and conducted focus groups and employee/employer surveys designed to provide an understanding of employee and employer perceptions of compensation and benefit programs. RFP 19-7581 Group Insurance Brokerage and Actuarial Services 64 ■ Worked with employers, insurance carriers and health care providers to explore techniques of measuring the quality of health care and its impact on costs. ■ Worked jointly with management and organized labor to implement redesigned benefit programs which lead to lower overall costs and improved employee satisfaction. ■ Designed actuarial evaluation systems to analyze captive financing, reinsurance programs, alternative funding, and employer owned clinics, integrated health systems. ■ Developed strategic approaches to managing total compensation costs leading to improved expense control and employee retention. ■ Advised clients on regulatory compliance issues affecting welfare plans and their impact on employee relations. ■ Advised clients on post retirement benefit issues, costs and valuation issues associated with SAFS 106 and GS 45 ■ A frequent speaker on engagement health plans, integrated health systems, captives and cost forecast methodologies ■ Evaluated the relationship of plan design to clinical practice patterns and their effect on cost and utilization patterns. Education and Credentials Doug holds a degree in Business Administration and Marketing from the University of Wisconsin Madison. He has also served as an adjunct professor at Purdue University, conducting courses on national account administration and health care economics. He is a frequent speaker nationally on wellness, health care cost and employee benefit issues. He is a past President of the Greater Milwaukee Employee Benefits Council and the Quality Committee to the Board of Aurora Health Care a nationally recognized integrated health care system. RFP 19-7581 Group Insurance Brokerage and Actuarial Services 65 Stephen J. Buell Financial Director - H&B NA Brokerage and Advisory Experience and Tenure with Collier County Government Steve has worked with the CCG for 12 years and provides underwriting and financial support, analyzes plan renewals, conducts financial projections and creates, manages and peer reviews financial reporting. Relevant Experience/Specialization Steve has 40 years of experience in numerous client management and underwriting roles. In addition, he possesses strong organizational and analytical skills that have allowed him to provide exceptional service to his clients. Steve’s responsibilities include: Budget forecasting for claims and plan expenses. Preparing annual premium equivalent rate calculations. Employee contribution modeling. Reviewing insured and self-funded renewals for reasonableness and provides negotiating expertise. Reviewing plan alternatives to reduce cost or improve plan performance. Assist in the calculation of reserves for medical and dental plans. Marketing of self-funded and insured plans. Pharmacy marketing and analysis of PBM renewal terms. Resolves service issues for clients. Credentials Steve holds a bachelor’s degree in Business Administration from the University of Kentucky RFP 19-7581 Group Insurance Brokerage and Actuarial Services 66 Jill Goehrig Associate - H&B NA Brokerage and Advisory Experience and Tenure with Collier County Government Jill has worked with the CCG for 3 years and is responsible for managing the client service and day-to-day account management issues and service team. Jill supports clients with marketing, presentations, compliance and implementation activities. Jill was worked with Doug Ley for over 25 years. Relevant Experience/Specialization Jill currently works with self-funded public entity employer groups on all aspects of employee benefit plans, including medical, dental, pharmacy, vision, life, disability, reinsurance and voluntary plans. Jill’s major focus is to be a valued resource and solutions partner for her clients by developing a working relationship with clients and their organization so that she can get a better understanding of each client’s specific benefits needs. Current responsibilities include: Day to day support of our valued clients Partnering with clients and the account management team to develop strategies to guide employers to achieve their goals Assist account management team and clients with analysis, administration, communication, policy development and design of benefit and human resource programs Managing renewal activities Educating employers on state and federal legislation changes Benchmarking plan design and various financial aspects Updating clients regarding trends in benefits and human resources management, state and federal legislation changes Marketing and implementing programs that increase employer profitability and employee productivity Monitoring financial /utilization data In addition to focusing on client collaboration, Jill is actively involved in the Learning and Development Work Stream at Willis Towers Watson Credentials Jill holds a license in Accident, Health & Life, and Property & Casualty. She attends educational courses and seminars encompassing all lines of insurance. RFP 19-7581 Group Insurance Brokerage and Actuarial Services 67 Matt Deininger, GBDS Director – H&B NA Brokerage and Advisory Experience and Tenure with Collier County Government Matt jointed Willis Towers Watson in 2018 and is the newest member to join the CCG team earlier this year. Matt is responsible for day-to-day client service. Specific account responsibilities include coordinating marketing and renewals, consulting on plan/contract review, designing plan summaries and comparisons, and facilitating the coordination of project objectives between insurance providers and the CCG, as well as the CCHCC. Relevant Experience/Specialization Matt has over 30 years of experience in the employee benefits industry. His employment background includes both the broker and carrier perspectives on all types of employee benefits. Matt’s clients include mid to large size employers, both fully insured and self-funded in a variety of industries. Matt’s expertise includes: ■ Assisting clients to develop a multi-year benefit strategy that supports organizational goals ■ Evaluating and benchmarking benefit programs to make sure they are aligned with employer objectives ■ Monitoring, reporting and analyzing plan cost information ■ Coordination and plan marketing to achieve optimal financial results ■ Vendor management ■ Providing updates on regulatory changes ■ Identifying areas where additional resources can further assist clients achieve their overall needs and objectives Prior to joining the Willis Towers Watson Team, Matt provided benefits expertise to clients for a Wisconsin based, regional insurance broker. Additionally, Matt has managed multiple markets for several national insurance companies, including markets in the Midwest and southeast United States. Education and Credentials Matt holds a BBA from the University of Wisconsin-Madison with a degree in finance. Matt is also is a Group Benefits Disability Specialist (GBDS). RFP 19-7581 Group Insurance Brokerage and Actuarial Services 68 Sheryl Henry, FSA, MAAA Senior Associate/Actuary - H&B NA Brokerage and Advisory Experience and Tenure with Collier County Government Sheryl has worked as the lead actuary for the CCG for 15 years and will continue in this role. She has been responsible for cost projections, plan design modeling, FS 112.08 filings, GASB 45 valuations and other projects relative to the ongoing administration of the benefit programs. Relevant Experience/Specialization Sheryl has more than 30 years of experience in pricing of medical, dental, disability and life products, reserving calculations, analysis and experience monitoring. Her experience includes: ■ FASB ASC No. 715 valuations ■ SGAS No. 45 valuations ■ IAS No. 19 valuations ■ IBNR valuations ■ Pricing for Fee for Service, PPO, POS and HMO medical products and Fee for Service and capitated dental products ■ Developing forecasts incorporating premium, claim, sales and persistency projections ■ Creating monitoring tools for medical and dental business ■ Calculating stop loss premiums ■ Preparing rate filings, annual statement exhibits, actuarial memorandums and certifications ■ Guiding underwriters in interpretation of large group experience at issue and renewal ■ Calculating medical, dental and LTD reserves ■ Assisting provider contracting in calculating hospital and physician capitation rates Education and Credentials Sheryl has a Bachelor’s degree in mathematics from the University of Wisconsin, Milwaukee. Sheryl is a Fellow of the Society of Actuaries and a Member of the American Academy of Actuaries. RFP 19-7581 Group Insurance Brokerage and Actuarial Services 69 John Pauly, ASA, MAAA Associate Director/Actuary - H&B NA Brokerage and Advisory Experience and Tenure with Collier County Government John has worked with the CCG for 5 years and assists with health insurance and health benefits; risk management; product development; and financial analysis. John also has experience in the pharmacy benefit management industry in business development and financial analysis. John has developed dynamic financial models used for managing lines of medical business, mitigating risks of large medical and legal claims, valuing reinsured blocks of medical business, testing revenue streams for business partnerships, pricing new products and data analytics. John has been involved in the ongoing assessment of the pharmacy programs in place at the CCG and supports Sheryl Henry. Relevant Experience/Specialization John has over 30 years of experience in health and benefits administration and risk management, working with health insurers and pharmacy benefit managers on product design, pricing, reserving, underwriting, financial forecasting, analytics, budgeting and product management. He has been advising employers for ten years on employee benefit programs, including: ■ Setting premiums and COBRA rates for self-insured groups on their health, dental, and vision benefits, ■ Determining claim reserves for their annual budgeting process and year-end financial reporting, ■ Pharmacy benefit analytics - evaluation of group pharmacy costs and risks and evaluation of vendor contract proposals and pricing performance, ■ Pricing and modelling benefit plan designs and strategy, ■ Evaluating retiree benefit plans that include • The Retiree Drug Subsidy, • Employer Group Waiver plans, and • Medicare advantage plans ■ Assessing compliance and plan design options for health care reform. Education and Credentials John graduated from the University of Wisconsin-Oshkosh with a B.S. in computer science emphasizing numerical methods, and a minor in mathematics. He is a member of the American Academy of Actuaries and an associate in the Society of Actuaries. RFP 19-7581 Group Insurance Brokerage and Actuarial Services 70 Mike Clark Financial Analyst - H&B NA Brokerage and Advisory Experience and Tenure with Collier County Government Mike has worked with the CCG for 12 years and will continue to be responsible for the ongoing analysis of medical, dental claims and biometric data. Mike will continue to support the CCG’s data needs with respect to the operation of its plans as well as ad hoc reporting. Mike is also responsible for preparing CCHCC and employer-based reporting related to the ongoing financial performance of the plan analysis of discounts and health outcomes reports. Mike is proficient on both the Cotiviti and Deerwalk systems. Relevant Experience/Specialization Mike has over 15 years of experience in various project and client management roles. His experience coupled with strong organizational and analytical skills has allowed him to provide valuable service and support for our clients. Mike’s responsibilities include: Design and maintain monthly reporting for clients. Maintain various plan and claim reports to meets client needs. Assist in client claim analysis, trend analysis and annual premium rate calculations. Assist in the development of data analysis models allowing employers to model benefit plan alternatives using their own claims data. Assist in the calculation of reserves for medical and dental, retiree medical, and LTD plans. Perform the initial setup and review for various cost analysis and critical factor analysis reports. These reports identify the main cost drivers and potential problem areas for our clients’ health plans. Handle any client requests for any custom reporting and claim analysis. Credentials Mike holds a bachelor’s degree in mathematics from Carthage College. RFP 19-7581 Group Insurance Brokerage and Actuarial Services 71 Lisa Whiteman Senior Associate - H&B NA Brokerage and Advisory Experience and Tenure with Collier County Government Lisa began working with the CCG in 2017 and serves as the placement specialist. Lisa assisted with the successful negotiation and placement of the CCG’s life, disability, and FMLA administration with Reliance Standard/Matrix. Relevant Experience/Specialization Lisa brings 10 years of experience in insurance and employee benefits. She offers perspectives from the brokerage, vendor/carrier and employer sides of the industry. Previous roles include Benefits Account Manager, Agency Director of Operations, Medical Economics Analyst, Human Resources Specialist and Group Risk Underwriter. Specific areas of expertise include: ■ Insurance and medical services price negotiations ■ Life and absence management ■ Vendor relationship management Education and Credentials Lisa holds a bachelor’s degree in economics with a minor in mathematics from Gonzaga University. She also earned a master of business administration (MBA) from the University of Scranton’s Kania School of Management. RFP 19-7581 Group Insurance Brokerage and Actuarial Services 72 Rebecca Lawrence, JD Director, Health & Benefits Compliance Team Experience and Tenure with Collier County Government Rebecca has worked with the CCG for ten years and provides support regarding the application of the laws and regulations that affect employee benefit plans. Relevant Experience/Specialization Rebecca Lawrence is an Employee Benefits Attorney in the National Legal & Research Group, North America and has been with Willis since 1998. Her areas of expertise include the Health Insurance Portability and Accountability Act of 1996 (HIPAA), COBRA, cafeteria plans, life insurance plans, Qualified Medical Child Support Orders, Medicare Secondary Payer, ERISA, subrogation, Plan Document and SPD preparation and compliance, and health care reform. Prior to joining Willis Towers Watson, Rebecca headed up the health & welfare compliance department for a large health care corporation and worked closely with division, market, and local facility contacts. Credentials Southern Advent University Washington & Lee University School of Law RFP 19-7581 Group Insurance Brokerage and Actuarial Services 73 TAB 6 - LOCAL VENDOR PREFERENCE RFP 19-7581 Group Insurance Brokerage and Actuarial Services 74 Form 7: Vendor Submittal – Local Vendor Preference Affidavit (Check Appropriate Boxes Below) State of Florida (Select County if Vendor is described as a Local Business) Collier County Lee County Vendor affirms that it is a local business as defined by the Procurement Ordinance of the Collier County Board of County Commissioners and the Regulations Thereto. As defined in Section XV of the Collier County Procurement Ordinance: Local business means the vendor has a current Business Tax Receipt issued by the Collier County Tax Collector prior to bid or proposal submission to do business within Collier County, and that identifies the business with a permanent physical business address located within the limits of Collier County from which the vendor’s staff operates and performs business in an area zoned for the conduct of such business. A Post Office Box or a facility that receives mail, or a non-permanent structure such as a construction trailer, storage shed, or other non- permanent structure shall not be used for the purpose of establishing said physical address. In addition to the foregoing, a vendor shall not be considered a "local business" unless it contributes to the economic development and well-being of Collier County in a verifiable and measurable way. This may include, but not be limited to, the retention and expansion of employment opportunities, support and increase to the County's tax base, and residency of employees and principals of the business within Collier County. Vendors shall affirm in writing their compliance with the foregoing at the time of submitting their bid or proposal to be eligible for consideration as a "local business" under this section. A vendor who misrepresents the Local Preference status of its firm in a proposal or bid submitted to the County will lose the privilege to claim Local Preference status for a period of up to one year under this section. Vendor must complete the following information: Year Business Established in Collier County or Lee County: ________ Number of Employees (Including Owner(s) or Corporate Officers):_________ Number of Employees Living in Collier County or Lee (Including Owner(s) or Corporate Officers):_______ If requested by the County, vendor will be required to provide documentation substantiating the information given in this affidavit. Failure to do so will result in vendor’s submission being deemed not applicable. Vendor Name: _________________________________________ Date: ________________________ Address in Collier or Lee County: _________________________________________________________ Signature: ____________________________________________ Title: ________________________ As noted in our response to the request for proposal, we maintain a local office in Naples, Florida, located at 4100 Corporate Square, Suite 102, Naples Florida 34104-4704. This is a satellite office of Willis of Wisconsin, Inc. (effective 1/1/2020 our name will change to Willis Towers Watson Midwest, Inc.) located at 400 North Executive Drive, Suite 300, Brookfield, WI 53005. This office houses approximately 75 employees dedicated to the Brokerage and Advisory segment of our business. Two of the service team assigned to the Collier County Government maintain residences within Naples. We are committed to maintaining this presence and, if appropriate, in accordance with local business growth, will expand the size of the office and/or staffing. We are happy to provide receipts of office lease invoices and payments. This office was established to service the Naples area after the Willis of Florida, Inc. Naples office closed in early 2017. Willis Towers Watson d/b/a Willis of Wisconsin, Inc. (effective 1/1/2020 our name will change to Willis Towers Watson Midwest, Inc. 5/13/2019 Senior Director RFP 19-7581 Group Insurance Brokerage and Actuarial Services 75 1.0 LOCAL VENDOR PREFERENCE (LVP) 1.1 The County is using the Competitive Sealed Bid methodology of source selection for this procurement, as authorized by Ordinance Number 2017-08 establishing and adopting the Collier County Procurement Ordinance. 1.2 Local business means the vendor has a current Business Tax Receipt issued by the Collier County Tax Collector prior to bid or proposal submission to do business within Collier County, and that identifies the business with a permanent physical business address located within the limits of Collier County from which the vendor’s staff operates and performs business in an area zoned for the conduct of such business. A Post Office Box or a facility that receives mail, or a non-permanent structure such as a construction trailer, storage shed, or other non-permanent structure shall not be used for the purpose of establishing said physical address. In addition to the foregoing, a vendor shall not be considered a "local business" unless it contributes to the economic development and well-being of Collier County in a verifiable and measurable way. This may include, but not be limited to, the retention and expansion of employment opportunities, support and increase to the County's tax base, and residency of employees and principals of the business within Collier County. Vendors shall affirm in writing their compliance with the foregoing at the time of submitting their bid or proposal to be eligible for consideration as a "local business" under this section. A vendor who misrepresents the Local Preference status of its firm in a proposal or bid submitted to the County will lose the privilege to claim Local Preference status for a period of up to one year. 1.3 Under this solicitation, bidders desiring to receive local preference will be invited and required to affirmatively state and provide documentation as set forth in the solicitation in suppor t of their status as a local business. Any bidder who fails to submit sufficient documentation with their bid offer shall not be granted local preference consideration for the purposes of that specific contract award. Except where federal or state law, or any other funding source, mandates to the contrary, Collier County and its agencies and instru mentalities, will give preference to local businesses in the following manner. 1.4 Competitive bid (local price match option). Each formal competitive bid solicitation shall clearly identify how the price order of the bids received will be evaluated and determined. When a qualified and responsive, non-local business submits the lowest price bid, and the bid submitted by one or more qualified and responsive local businesses is within ten percent of the price submitted by the non-local business, then the local business with the apparent lowest bid offer (i.e., the lowest local bidder) shall have the opportunity to submit an offer to match the price(s), less one (1) dollar, offered by the overall lowest, qualified and responsive bidder. In such instances, staff shall first verif y if the lowest non-local bidder and the lowest local bidder are in fact qualified and responsive bidders. Next, the Procurement Services Division shall determine if the lowest local bidder meets the requirements of Fla. Stat. Sec.287.087 (Preferences to businesses with drug-free workplace programs). If the lowest local bidder meets the requirements of Fla. Stat. Sec. 287.087, the Procurement Services Division shall invite the lowest local bidder to submit a matching offer, less one (1) dollar, within five (5) business days thereafter. If the lowest local bidder submits an offer that fully matches the lowest bid, less one (1) dollar, from the lowest non-local bidder tendered previously, then award shall be made to the local bidder. If the lowest local bidder declines or is unable to match the lowest non-local bid price(s), then award will be made to the lowest overall qualified and responsive bidder. If the lowest local bidder does not meet the requirement of Fla. Stat. Sec 287.087, and the lowest non-local bidder does, award will be made to the bidder that meets the requirements of the reference state law. 1.5 Bidder must complete and submit with their bid response the Affidavit for Claiming Status as a Local Business which is included as part of this solicitation. Failure on the part of a Bidder to submit this Affidavit with their bid response will preclude said Bidder from being considered for local preference on this solicitation. 1.6 A Bidder who misrepresents the Local Preference status of its firm in a bid submitted to the County will lose the privilege to claim Local Preference status for a period of up to one (1) year. 1.7 The County may, as it deems necessary, conduct discussions with responsible bidders determined to be in contention for being selected for award for the purpose of clarification to assure full understanding of, and responsiveness to solicitation requirements. RFP 19-7581 Group Insurance Brokerage and Actuarial Services 76 TAB 7 - REQUIRED FORMS Please see below and Attachments RFP 19-7581 Group Insurance Brokerage and Actuarial Services 77 Form 2: Vendor Check List IMPORTANT: THIS SHEET MUST BE SIGNED. Please read carefully, sign in the spaces indicated and return with your Proposal. Vendor should check off each of the following items as the necessary action is completed: The Solicitation Submittal has been signed. The Solicitation Pricing Document (Bid Schedule/Quote Schedule/etc.) has been completed and attached. All applicable forms have been signed and included, along with licenses to complete the requirements of the project. Any addenda have been signed and included. Affidavit for Claiming Status as a Local Business, if applicable. Division of Corporations - Florida Department of State – http://dos.myflorida.com/sunbiz/ (If work performed in the State). E-Verify/Immigration Affidavit (Memorandum of Understanding). ALL SUBMITTALS MUST HAVE THE SOLICITATION NUMBER AND TITLE Name of Firm: ________________________________________________________ Address: ________________________________________________________ City, State, Zip: ________________________________________________________ Telephone: ________________________________________________________ Email: ________________________________________________________ Representative Signature: ________________________________________________________ Representative Name: ________________________________________ Date ___________ x x x x x x Willis Towers Watson d/b/a Willis of Wisconsin, Inc. effective 1/1/2020 our name will change to Willis Towers Watson Midwest, Inc. 400 North Executive Dr., Suite 400 Brookfield, WI 53005 262-780-3340 / 414-640-2710 douglas.ley@willistowerswatson.com Douglas J. Ley 5/13/2019 RFP 19-7581 Group Insurance Brokerage and Actuarial Services 78 ATTACHMENTS Attachment 1: County Manager Update 2018 Attachment 2: Collier County Hospital Analysis Attachment 3: Contribution Reduction In Lieu of Pay Analysis Attachment 4: Stop Loss Alternatives Analysis Attachment 5: Stop Loss Marketing Report Attachment 6: Leadership Interview Questionnaire Attachment 7: 2019 Ancillary Renewal and Marketing Results Attachment 8: Executive Summary- Group Life and Disability Insurance Attachment 9: 2018 FS112.08 Filing Attachment 10: Retiree Medical Valuation 2017-09-30 Attachment 11: Form 3: Conflict of Interest Affidavit Attachment 12: Form 4: Vendor Declaration Statement Attachment 13: Form 5: Immigration Affidavit Certification Attachment 14: E-Verify Attachment 15: Form 6: Vendor Substitute W-9 Attachment 16: Willis Towers Watson d/b/a Willis of Wisconsin, Inc. W-9 Attachment 17: Willis Towers Watson Insurance Certificate Attachment 18: Douglas J. Ley Florida Insurance License INSTRUCTIONS TO PROPOSERS 1. QUESTIONS 1.1 Direct questions related to this RFP to the Collier County Procurement Services Division Online Bidding System website: https://www.bidsync.com/bidsync-cas/. 1.2 Proposers must clearly understand that the only official answer or position of the County will be the one stated on the Collier County Procurement Services Division Online Bidding System website. For general questions, please call the referenced Procurement Strategist noted on the cover page. 2. PRE-PROPOSAL CONFERENCE 2.1 The purpose of the pre-proposal conference is to allow an open forum for discussion and questioning with County staff regarding the RFP with all prospective vendors having an equal opportunity to hear and participate. Oral questions will receive oral responses, neither of which will be official, nor become part of the RFP. Only written responses to written questions will be considered official, and will be included as part of the RFP as an addendum. 2.2 All prospective vendors are strongly encouraged to attend, as, this will usually be the only pre-proposal conference for this solicitation. If this pre-proposal conference is denoted as “mandatory”, prospective Vendors must be present in order to submit a proposal response. 3. COMPLIANCE WITH THE RFP Proposals must be in strict compliance with this RFP. Failure to comply with all provisions of the RFS may result in disqualification. 4. AMBIGUITY, CONFLICT, OR OTHER ERRORS IN THE RFP It is the sole responsibility of the vendor if they discovers any ambiguity, conflict, discrepancy, omission or other error in the RFP, to immediately notify the Procurement Professional, noted herein, of such error in writing and request modification or clarification of the document prior to submitting the proposal. The Procurement Professional will make modifications by issuing a written revision and will give written notice to all parties who have received this RFP from the Procurement Services Division. 5. PROPOSALS, PRESENTATIONS, AND PROTEST COSTS The County will not be liable in any way for any costs incurred by any Vendor in the preparation of its proposal in response to this RFP, nor for the presentation of its proposal and/or participation in any discussions, negotiations, or, if applicable, any protest procedures. 6. VALIDITY OF PROPOSALS No proposal can be withdrawn after it is opened unless the vendor makes their request in writing to the County. All proposals shall be valid for a period of one hundred eighty (180) days from the submission date to accommodate evaluation and selection process. 7. METHOD OF SOURCE SELECTION 7.1 The County is using the Competitive Sealed Proposals methodology of source selection for this procurement, as authorized by Ordinance Number 2017-08, establishing and adopting the Collier County Procurement Ordinance. 7.2 If the County receives proposals from less than three (3) firms, the Procurement Director shall review all the facts and determine if it is in the best interest of the County to solicit additional proposals or request that the Selection Committee rank order the received proposals. 8. EVALUATION OF PROPOSALS 8.1 The County’s procedure for selecting is as follows: 8.1.1 The Procurement Services Director shall appoint a selection committee to review all proposals submitted. 8.1.2 The Request for Proposal is issued. 8.1.3 Subsequent to the receipt closing date for the proposals, the Procurement Professional will review the proposals received and verify each proposal to determine if it minimally responds to the requirements of the published RFP. 8.1.4 Selection committee meetings will be open to the public and publicly noticed by the Procurement Services Division. 8.1.5 In an initial organization meeting, the selection committee members will receive instructions, the submitted proposals, and establish the next selection committee meeting date and time. After the first meeting, the Procurement professional will publicly announce all subsequent committee meeting dates and times. The subsequent meeting dates and times will be publicly posted with at least one (1) day advanced notice. 8.1.6 Selection committee members will independently review and score each proposal based on the evaluation criteria stated in the request for proposal using the Individual Selection Committee Score and Rank Form and prepare comments for discussion at the next meeting. The Individual Selection Committee Score and Rank Form is merely a tool to assist the selection committee member in their review of the proposals. 8.1.7 At the publicly noticed selection committee meeting, the members will present their independent findings / conclusions / comments based on their reading and interpretation of the materials presented to each other, and may ask questions of one another. Time will be allowed for public comment. 8.1.8 Collier County selection committee members may consider all the material submitted by the Proposer and other information Collier County may obtain to determine whether the Proposer is capable of and has a history of successfully completing projects of this type, including, without limitation, additional information Collier County may request, clarification of proposer information, and/or additional credit information. 8.1.9 Once the individual scoring has been completed, the Procurement professional will read the results publicly. The committee will make a determination if oral presentations are needed and which firms will be invited to give oral presentations by short listing the proposals submitted. The selection committee may ask for additional information, present materials, interview, ask questions, etc. The members may consider any and all information obtained through this method in formulating their final ranking. 8.1.10 The selection committee’s overall rank of firms in order of preference (from highest beginning with a rank of one (1) to the lowest) will be discussed and reviewed by the Procurement Professional. By final tabulation, and having used all information presented (proposal, presentation, references, etc.), the selection committee members will vote and thus create a final ranking and staff will subsequently enter into negotiations. 8.2 The County reserves the right to withdraw this RFP at any time and for any reason, and to issue such clarifications, modifications, addendums, and/or amendments as it may deem appropriate, including, but not limited, to requesting supplemental proposal information. 8.3 Receipt of a proposal by the County offers no rights upon the proposer nor obligates the County in any manner. 8.4 Acceptance of the proposal does not guarantee issuance of any other governmental approvals. 9. REFERENCES The County reserves the right to contact any and all references submitted as a result of this solicitation. 10. RESERVED RIGHTS Collier County reserves the right in any solicitation to accept or reject any or all bids, proposals or offers; to waive minor irregularities and technicalities; or to request resubmission. Also, Collier County reserves the right to accept all or any part of any bid, proposal, or offer, and to increase or decrease quantities to meet additional or reduced requirements of Collier County. Notwithstanding any other provisions of this Article, if none or only one responsive and responsible bid or proposal is received following any solicitation, the County Manager, or designee, reserves the right to reject all bids, proposals or offers and to negotiate with any responsible providers to secure the best terms and conditions in the sole interest of the County unless otherwise provided by law. 11. INSURANCE AND BONDING REQUIREMENTS 11.1 The Vendor shall at its own expense, carry and maintain insurance coverage from responsible companies duly authorized to do business in the State of Florida as set forth in the Insurance and Bonding attachment of this solicitation. The Vendor shall procure and maintain property insurance upon the entire project, if required, to the full insurable value of the scope of work. 11.2 The County and the Vendor waive against each other and the County’s separate Vendors, Contractors, Design Vendor, Subcontractors agents and employees of each and all of them, all damages covered by property insurance provided herein, except such rights as they may have to the proceeds of such insurance. The Vendor and County shall, where appropriate, require similar waivers of subrogation from the County’s separate Vendors, Design Vendors and Subcontractors and shall require each of them to include similar waivers in their contracts. 11.3 Collier County shall be responsible for purchasing and maintaining, its own liability insurance. 11.4 Certificates issued as a result of the award of this solicitation must identify “For any and all work performed on behalf of Collier County.” 11.5 The General Liability Policy provided by Vendor to meet the requirements of this solicitation shall name Collier County, Florida, as an additional insured as to the operations of Vendor under this solicitation and shall contain a severability of interests provisions. 11.6 Collier County Board of County Commissioners shall be named as the Certificate Holder. The Certificates of Insurance must state the Contract Number, or Project Number, or specific Project description, or must read: For any and all work performed on behalf of Collier County. The "Certificate Holder" should read as follows: Collier County Board of County Commissioners Naples, Florida 11.7 The amounts and types of insurance coverage shall conform to the minimum requirements set forth in Insurance and Bonding attachment, with the use of Insurance Services Office (ISO) forms and endorsements or their equivalents. If Vendor has any self-insured retentions or deductibles under any of the below listed minimum required coverage, Vendor must identify on the Certificate of Insurance the nature and amount of such self- insured retentions or deductibles and provide satisfactory evidence of financial responsibility for such obligations. All self-insured retentions or deductibles will be Vendor’s sole responsibility. 11.8 Coverage(s) shall be maintained without interruption from the date of commencement of the Work until the date of completion and acceptance of the scope of work by the County or as specified in this solicitation, whichever is longer. 11.9 The Vendor and/or its insurance carrier shall provide 30 days written notice to the County of policy cancellation or non renewal on the part of the insurance carrier or the Vendor. The Vendor shall also notify the County, in a like manner, within twenty-four (24) hours after receipt, of any notices of expiration, cancellation, non-renewal or material change in coverage or limits received by Vendor from its insurer and nothing contained herein shall relieve Vendor of this requirement to provide notice. In the event of a reduction in the aggregate limit of any policy to be provided by Vendor hereunder, Vendor shall immediately take steps to have the aggregate limit reinstated to the full extent permitted under such policy. 11.10 Should at any time the Vendor not maintain the insurance coverage(s) required herein, the County may terminate the Agreement or at its sole discretion shall be authorized to purchase such coverage(s) and charge the Vendor for such coverage(s) purchased. If Vendor fails to reimburse the County for such costs within thirty (30) days after demand, the County has the right to offset these costs from any amount due Vendor under this Agreement or any other agreement between the County and Vendor. The County shall be under no obligation to purchase such insurance, nor shall it be responsible for the coverage(s) purchased or the insurance company or companies used. The decision of the County to purchase such insurance coverage(s) shall in no way be construed to be a waiver of any of its rights under the Contract Documents. 11.11 If the initial or any subsequently issued Certificate of Insurance expires prior to the completion of the scope of work, the Vendor shall furnish to the County renewal or replacement Certificate(s) of Insurance not later than ten (10) calendar days after the expiration date on the certificate. Failure of the Vendor to provide the County with such renewal certificate(s) shall be considered justification for the County to terminate any and all contracts. 12. ADDITIONAL ITEMS AND/OR SERVICES Additional items and / or services may be added to the resultant contract, or purchase order, in compliance with the Procurement Ordinance. 13. COUNTY’S RIGHT TO INSPECT The County or its authorized Agent shall have the right to inspect the Vendor’s facilities/project site during and after each work assignment the Vendor is performing. The County reserves the right to take into consideration a vendor’s past performance under a prior or current County contract when it is considering the granting of a new contract, the assignment of a work order, or any additional work. Past poor performance may result in the County deeming the vendor non-responsible and therefore refraining from awarding such work. 14. VENDOR PERFORMANCE EVALUATION The County has implemented a Vendor Performance Evaluation System for all contracts awarded in excess of $25,000. To this end, vendors will be evaluated on their performance upon completion/termination of this Agreement. 15. ADDITIONAL TERMS AND CONDITIONS OF CONTRACT 15.1 The selected Vendor shall be required to sign a standard Collier County contract. 15.2 The resultant contract(s) may include purchase or work orders issued by the County’s project manager. 15.3 The County reserves the right to include in any contract document such terms and conditions, as it deems necessary for the proper protection of the rights of Collier County. A sample copy of this contract is available upon request. The County will not be obligated to sign any contracts, maintenance and/or service agreements or other documents provided by the Vendor. 15.4 The County’s project manager shall coordinate with the Vendor / Contractor the return of any surplus assets, including materials, supplies, and equipment associated with the scope or work. 16. PUBLIC RECORDS COMPLIANCE 16.1 Florida Public Records Law Chapter 119, including specifically those contractual requirements in 119.0701(2)(a)-(b) as follows: IF THE CONTRACTOR HAS QUESTIONS REGARDING THE APPLICATION OF CHAPTER 119, FLORIDA STATUTES, TO THE CONTRACTOR’S DUTY TO PROVIDE PUBLIC RECORDS RELATING TO THIS CONTRACT, CONTACT THE CUSTODIAN OF PUBLIC RECORDS AT: Communication and Customer Relations Division 3299 Tamiami Trail East Suite 102 Naples, FL 34112-5746 Telephone: (239) 252-8383 16.2 The Contractor must specifically comply with the Florida Public Records Law to: 16.2.1 Keep and maintain public records required by the public agency to perform the service. 16.2.2 Upon request from the public agency’s custodian of public records, provide the public agency with a copy of the requested records or allow the records to be inspected or copied within a reasonable time at a cost that does not exceed the cost provided in this chapter or as otherwise provided by law. 16.2.3 Ensure that public records that are exempt or confidential and exempt from public records disclosure requirements are not disclosed except as authorized by law for the duration of the contract term and following completion of the contract if the Contractor does not transfer the records to the public agency. 16.2.4 Upon completion of the contract, transfer, at no cost, to the public agency all public records in possession of the Contractor or keep and maintain public records required by the public agency to perform the service. If the Contractor transfers all public records to the public agency upon completion of the contract, the Contractor shall destroy any duplicate public records that are exempt or confidential and exempt from public records disclosure requirements. If the Contractor keeps and maintains public records upon completion of the contract, the Contractor shall meet all applicable requirements for retaining public records. All records stored electronically must be provided to the public agency, upon request from the public agency’s custodian of public records, in a format that is compatible with the information technology systems of the public agency. 17. WORK ORDERS ON FIXED TERM CONTRACTS 17.1 The County reserves the right to order such services from selected firms as may be required during said period, but does not guarantee any minimum or maximum services to be ordered during the period specified from any given firm. Work Order service assignments shall be at the sole discretion of the County. 17.2 Agreements issued that are determined to be “CONTINUING CONTRACTS” where services will be requested by Work Orders in excess of $200,000 shall be approved by the Board of County Commissioners. 17.3 Should any project that is active on a work order extend past the contract termination date, that work order will be active and extended as necessary until completion of such project. 18. PAYMENT METHOD 18.1 Payments are made in accordance with the Local Government Prompt Payment Act, Chapter 218, Florida Statutes. Vendor’s invoices must include: 18.1.1 Purchase Order Number 18.1.2 Description and quantities of the goods or services provided per instructions on the County’s purchase order or contract. Invoices shall be sent to: Board of County Commissioners Clerk’s Finance Department ATTN: Accounts Payable 3299 Tamiami Trail East, Suite 700 Naples FL 34112 Or Emailed to: bccapclerk@collierclerk.com 18.2 Payments will be made for articles and/or services furnished, delivered, and accepted, upon receipt and approval of invoices submitted on the date of services or within six (6) months after completion of contract. Any untimely submission of invoices beyond the specified deadline period is subject to non-payment under the legal doctrine of “laches” as untimely submitted. Time shall be deemed of the essence with respect to the timely submission of invoices under this agreement. 18.3 In instances where the successful contractor may owe debts (including, but not limited to taxes or other fees) to Collier County and the contractor has not satisfied nor made arrangement to satisfy these debts, the County reserves the right to off-set the amount owed to the County by applying the amount owed to the vendor or contractor for services performed of for materials delivered in association with a contract. 18.4 Invoices shall not reflect sales tax. After review and approval, the invoice will be transmitted to the Finance Division for payment. Payment will be made upon receipt of proper invoice and in compliance with Chapter 218 Florida Statutes, otherwise known as the “Local Government Prompt Payment Act.” Collier County reserves the right to withhold and/or reduce an appropriate amount of any payment for work not performed or for unsatisfactory performance of Contractual requirements. 19. ENVIRONMENTAL HEALTH AND SAFETY 19.1 All Vendors and Sub Vendors performing service for Collier County are required and shall comply with all Occupational Safety and Health Administration (OSHA), State and County Safety and Occupational Health Standards and any other applicable rules and regulations. Vendors and Sub Vendors shall be responsible for the safety of their employees and any unsafe acts or conditions that may cause injury or damage to any persons or property within and around the work site. All firewall penetrations must be protected in order to meet Fire Codes. 19.2 Collier County Government has authorized OSHA representatives to enter any Collier County facility, property and/or right-of-way for the purpose of inspection of any Vendor’s work operations. This provision is non-negotiable by any department and/or Vendor. 19.3 All new electrical installations shall incorporate NFPA 70E Short Circuit Protective Device Coordination and Arc Flash Studies where relevant as determined by the engineer. 19.4 All electrical installations shall be labeled with appropriate NFPA 70E arch flash boundary and PPE Protective labels. 20. POLLUTION PREVENTION The vendor is required to implement industry relevant pollution prevention and best management practices. Should pollution incidents occur, Collier County Pollution Control must be notified immediately. 21. LICENSES 21.1 The Vendor is required to possess the correct Business Tax Receipt, professional license, and any other authorizations necessary to carry out and perform the work required by the project pursuant to all applicable Federal, State and Local Law, Statute, Ordinances, and rules and regulations of any kind. Additionally, copies of the required licenses must be submitted with the proposal response indicating that the entity proposing, as well as the team assigned to the County account, is properly licensed to perform the activities or work included in the contract documents. Failure on the part of any Vendor to submit the required documentation may be grounds to deem Vendor non- responsive. A Vendor, with an office within Collier County is also required to have an occupational license. 21.2 All State Certified contractors who may need to pull Collier County permits or call in inspections must complete a Collier County Contractor License registration form and submit the required fee. After registering the license/registration will need to be renewed thereafter to remain “active” in Collier County. 21.3 If you have questions regarding professional licenses contact the Contractor Licensing, Community Development and Environmental Services at (239) 252-2431, 252-2432 or 252-2909. Questions regarding required occupational licenses, please contact the Tax Collector’s Office at (239) 252-2477. 22. SURVIVABILITY The Vendor agrees that any Purchase Order/Work Order/Solicitation Documents that extends beyond the expiration date of the original Solicitation will survive and remain subject to the terms and conditions of that Agreement until the completion or termination. 23. PRINCIPAL/COLLUSION By submission of this Proposal the undersigned, as Vendor, does declare that the only person or persons interested in this Proposal as principal or principals is/are named therein and that no person other than therein mentioned has any interest in this Proposal or in the contract to be entered into; that this Proposal is made without connection with any person, company or parties making a Proposal, and that it is in all respects fair and in good faith without collusion or fraud. 24. RELATION OF COUNTY It is the intent of the parties hereto that the Vendor shall be legally considered an independent Vendor, and that neither the Vendor nor their employees shall, under any circumstances, be considered employees or agents of the County, and that the County shall be at no time legally responsible for any negligence on the part of said Vendor, their employees or agents, resulting in either bodily or personal injury or property damage to any individual, firm, or corporation. 25. TERMINATION Should the Vendor be found to have failed to perform services in a manner satisfactory to the County, the County may terminate this Agreement immediately for cause; further the County may terminate this Agreement for convenience with a thirty (30) day written notice. The County shall be sole judge of non performance. In the event that the award of this solicitation is made by the Procurement Services Director, the award and any resultant purchase orders may be terminated at any time by the County upon thirty (30) days written notice to the awarded vendor(s) pursuant to the Board’s Procurement Ordinance. 26. LOBBYING After the issuance of any solicitation, no current or prospective vendor or any person acting on their behalf, shall contact, communicate with or discuss any matter relating to the solicitation with any Collier County employee or elected or appointed official, other than the Procurement Services Director or his/her designees. This prohibition ends upon execution of the final contract or upon cancellation of the solicitation. Any current or prospective vendor that lobbies any Collier County employee or elected or appointed official while a solicitation is open or being recommended for award (i) may be deemed ineligible for award of that solicitation by the Procurement Services Director, and (ii) will be subject to Suspension and Debarment outlined in section Twenty-eight of County Ordinance 2017-08. 27. CERTIFICATE OF AUTHORITY TO CONDUCT BUSINESS IN THE STATE OF FLORIDA (FL Statute 607.1501) In order to be considered for award, firms must be registered with the Florida Department of State Divisions of Corporations in accordance with the requirements of Florida Statute 607.1501 and provide a certificate of authority (www.sunbiz.org/search.html) prior to execution of a contract. A copy of the document may be submitted with the solicitation response and the document number shall be identified. Firms who do not provide the certificate of authority at the time of response shall be required to provide same within five (5) days upon notification of selection for award. If the firm cannot provide the document within the referenced timeframe, the County reserves the right to award to another firm. 28. SINGLE PROPOSAL Each Vendor must submit, with their proposal, the required forms included in this RFP. Only one proposal from a legal entity as a primary will be considered. A legal entity that submits a proposal as a primary or as part of a partnership or joint venture submitting as primary may not then act as a sub-vendor to any other firm submitting under the same RFP. If a legal entity is not submitting as a primary or as part of a partnership or joint venture as a primary, that legal entity may act as a sub-vendor to any other firm or firms submitting under the same RFP. All submittals in violation of this requirement will be deemed non-responsive and rejected from further consideration. 29. PROTEST PROCEDURES 29.1 With respect to a protest of the terms, conditions and specifications contained in a solicitation, including any provisions governing the methods for evaluation of bids, proposals or replies, awarding contracts, reserving rights for further negotiation or modifying or amending any contract, the protesting party shall file a notice of intent to protest within three (3) days, excluding weekends and County holidays, after the first publication, whether by posting or formal advertisement of the solicitation. The formal written protest shall be filed within five (5) days of the date the notice of intent is filed. Formal protests of the terms, conditions and specifications shall contain all of the information required for the Procurement Services Director, to render a decision on the formal protest and determine whether postponement of the bid opening or proposal/response closing time is appropriate. The Procurement Services Director's decision shall be considered final and conclusive unless the protesting party files an appeal of the Procurement Services Director's decision. 29.2 Any actual proposer or respondent to who desires to protest a recommended contract award shall submit a notice of intent to protest to the Procurement Services Director within three (3) calendar days, excluding weekends and County holidays, from the date of the initial posting of the recommended award. 29.3 All formal protests with respect to a recommended contract award shall be submitted in writing to the Procurement Services Director for a decision. Said protests shall be submitted within five (5) calendar days, excluding weekends and County holidays, from the date that the notice of intent to protest is received by the Procurement Services Director, and accompanied by the required fee. 29.4 Complete form and instructions for formal protest are set forth in Section 23 of Collier County Ordinance 2017-08. The protesting party must have standing as defined by established Florida case law to maintain a protest. 30. PUBLIC ENTITY CRIME A person or affiliate who has been placed on the convicted Vendor list following a conviction for a public entity crime may not submit a bid, proposal, or reply on a contract to provide any goods or services to a public entity; may not submit a bid, proposal, or reply on a contract with a public entity for the construction or repair of a public building or public work; may not submit bids, proposals, or replies on leases of real property to a public entity; may not be awarded or perform work as a contractor, supplier, subcontractor, or vendor under a contract with any public entity; and may not transact business with any public entity in excess of the threshold amount provided in s. 287.017 for CATEGORY TWO for a period of 36 months following the date of being placed on the convicted Vendor list. 31. SECURITY AND BACKGROUND CHECKS 31.1 The Contractor is required to comply with County Ordinance 2004-52, as amended. Background checks are valid for five (5) years and the Contractor shall be responsible for all associated costs. If required, Contractor shall be responsible for the costs of providing background checks by the Collier County Facilities Management Division for all employees that shall provide services to the County under this Agreement. This may include, but not be limited to, checking federal, state and local law enforcement records, including a state and FBI fingerprint check, credit reports, education, residence and employment verifications and other related records. Contractor shall be required to maintain records on each employee and make them available to the County for at least four (4) years. 31.2 All of Contractor’s employees and subcontractors must wear Collier County Government Identification badges at all times while performing services on County facilities and properties. Contractor ID badges are valid for one (1) year from the date of issuance and can be renewed each year at no cost to the Contractor during the time period in which their background check is valid, as discussed below. All technicians shall have on their shirts the name of the contractor’s business. 31.3 The Contractor shall immediately notify the Collier County Facilities Management Division via e-mail (DL-FMOPS@colliergov.net) whenever an employee assigned to Collier County separates from their employment. This notification is critical to ensure the continued security of Collier County facilities and systems. Failure to notify within four (4) hours of separation may result in a deduction of $500 per incident. 31.4 CCSO requires separate fingerprinting prior to work being performed in any of their locations. This will be coordinated upon award of the contract. If there are additional fees for this process, the vendor is responsible for all costs. 32. CONFLICT OF INTEREST Vendor shall complete the Conflict of Interest Affidavit included as an attachment to this RFP document. Disclosure of any potential or actual conflict of interest is subject to County staff review and does not in and of itself disqualify a firm from consideration. These disclosures are intended to identify and or preclude conflict of interest situations during contract selection and execution. 33. PROHIBITION OF GIFTS TO COUNTY EMPLOYEES No organization or individual shall offer or give, either directly or indirectly, any favor, gift, loan, fee, service or other item of value to any County employee, as set forth in Chapter 112, Part III, Florida Statutes, the current Collier County Ethics Ordinance and County Administrative Procedure 5311. Violation of this provision may result in one or more of the following consequences: a. Prohibition by the individual, firm, and/or any employee of the firm from contact with County staff for a specified period of time; b. Prohibition by the individual and/or firm from doing business with the County for a specified period of time, including but not limited to: submitting bids, RFP, and/or quotes; and, c. immediate termination of any contract held by the individual and/or firm for cause. 34. IMMIGRATION LAW AFFIDAVIT CERTIFICATION 34.1 Statutes and executive orders require employers to abide by the immigration laws of the United States and to employ only individuals who are eligible to work in the United States. 34.2 The Employment Eligibility Verification System (E-Verify) operated by the Department of Homeland Security (DHS) in partnership with the Social Security Administration (SSA), provides an Internet-based means of verifying employment eligibility of workers in the United States; it is not a substitute for any other employment eligibility verification requirements. The program will be used for Collier County formal Invitations to Bid (ITB) and Request for Proposals (RFP) including Request for Professional Services (RFP) and construction services. 34.3 Exceptions to the program: 34.3.1 Commodity based procurement where no services are provided. 34.3.2 Where the requirement for the affidavit is waived by the Board of County Commissioners 34.4 Vendors / Bidders are required to enroll in the E-Verify program, and provide acceptable evidence of their enrollment, at the time of the submission of the Vendor’s/bidder’s proposal. Acceptable evidence consists of a copy of the properly completed E-Verify Company Profile page or a copy of the fully executed E-Verify Memorandum of Understanding for the company. Vendors are also required to provide the Collier County Procurement Services Division an executed affidavit certifying they shall comply with the E-Verify Program. The affidavit is attached to the solicitation documents. If the Bidder/Vendor does not comply with providing the acceptable E-Verify evidence and the executed affidavit the bidder’s / Vendor’s proposal may be deemed non-responsive. 34.5 Additionally, Vendors shall require all subcontracted Vendors to use the E-Verify system for all purchases not covered under the “Exceptions to the program” clause above. 34.6 For additional information regarding the Employment Eligibility Verification System (E-Verify) program visit the following website: http://www.dhs.gov/E-Verify. It shall be the Vendor’s responsibility to familiarize themselves with all rules and regulations governing this program. 34.7 Vendor acknowledges, and without exception or stipulation, any firm(s) receiving an award shall be fully responsible for complying with the provisions of the Immigration Reform and Control Act of 1986 as located at 8 U.S.C. 1324, et seq. and regulations relating thereto, as either may be amended and with the provisions contained within this affidavit. Failure by the awarded firm(s) to comply with the laws referenced herein or the provisions of this affidavit shall constitute a breach of the award agreement and the County shall have the discretion to unilaterally terminate said agreement immediately. Yes No Certification: I certify that I am in agreement, to the best of my knowledge, with the Instructions To Proposers above. 16.E.9.d Packet Pg. 2657 Attachment: 19-7581 NORA_Executed 9-18-19 (10925 : Award of RFP# 19-7581 Group Insurance Brokerage and Actuarial Services) 16.E.9.ePacket Pg. 2658Attachment: 19-7581_Contract_WillisofWisconsonInc_VendorSigned (10925 : Award of RFP# 19-7581 Group Insurance Brokerage and Actuarial 16.E.9.ePacket Pg. 2659Attachment: 19-7581_Contract_WillisofWisconsonInc_VendorSigned (10925 : Award of RFP# 19-7581 Group Insurance Brokerage and Actuarial 16.E.9.ePacket Pg. 2660Attachment: 19-7581_Contract_WillisofWisconsonInc_VendorSigned (10925 : Award of RFP# 19-7581 Group Insurance Brokerage and Actuarial 16.E.9.ePacket Pg. 2661Attachment: 19-7581_Contract_WillisofWisconsonInc_VendorSigned (10925 : Award of RFP# 19-7581 Group Insurance Brokerage and Actuarial 16.E.9.ePacket Pg. 2662Attachment: 19-7581_Contract_WillisofWisconsonInc_VendorSigned (10925 : 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: Award of RFP# 19-7581 Group Insurance Brokerage and Actuarial 16.E.9.ePacket Pg. 2682Attachment: 19-7581_Contract_WillisofWisconsonInc_VendorSigned (10925 : Award of RFP# 19-7581 Group Insurance Brokerage and Actuarial 16.E.9.ePacket Pg. 2683Attachment: 19-7581_Contract_WillisofWisconsonInc_VendorSigned (10925 : Award of RFP# 19-7581 Group Insurance Brokerage and Actuarial 16.E.9.e Packet Pg. 2684 Attachment: 19-7581_Contract_WillisofWisconsonInc_VendorSigned (10925 : Award of RFP# 19-7581 Group Insurance Brokerage and Actuarial 16.E.9.fPacket Pg. 2685Attachment: 19-7581 WillisOfWisconsin_Ins_11-19-2019 (10925 : Award of RFP# 19-7581 Group Insurance Brokerage and Actuarial Services) 16.E.9.fPacket Pg. 2686Attachment: 19-7581 WillisOfWisconsin_Ins_11-19-2019 (10925 : Award of RFP# 19-7581 Group Insurance Brokerage and Actuarial Services) 16.E.9.fPacket Pg. 2687Attachment: 19-7581 WillisOfWisconsin_Ins_11-19-2019 (10925 : Award of RFP# 19-7581 Group Insurance Brokerage and Actuarial Services) 16.E.9.fPacket Pg. 2688Attachment: 19-7581 WillisOfWisconsin_Ins_11-19-2019 (10925 : Award of RFP# 19-7581 Group Insurance Brokerage and Actuarial Services)