Agenda 12/08/2015 Item #16E1012/8/2015 16.E.10.
EXECUTIVE SUMMARY
Recommendation to approve the purchase of Group Health Reinsurance coverage for calendar year
2016 through Sun Life effective January 1, 2016 for an annual premium of $934,020.
OBJECTIVE: To protect the Group Health Insurance Fund against catastrophic losses through the
purchase of group health reinsurance coverage.
CONSIDERATIONS: The Board of County Commissioners through the Risk Management Division
administers a partially self-funded Group Health Insurance Program (the Plan) for its employees,
participating constitutional officer employees and their eligible dependents.
Group Health Reinsurance, also known as "Stop Loss ", is purchased to protect the Plan against adverse
loss experience. Two types of reinsurance coverage are generally available. Specific excess insurance
protects the Plan if a covered member incurs claims cost in excess of a "per member" deductible.
Aggregate excess insurance provides coverage to the Plan if total losses exceed an aggregate deductible for
the Plan. Currently, the County purchases specific excess insurance through SCC/United Fire Insurance
Company with a specific deductible of $325,000 per member. This coverage provides an unlimited
maximum lifetime benefit per covered member. Aggregate excess coverage is not purchased. The current
Stop Loss coverage expires at midnight, December 31, 2015.
Willis, Inc., the County's benefits brokerage and actuarial consulting firm marketed the Stop Loss program
on behalf of the County. Willis sought quotes for specific excess retention levels (deductibles) ranging
from $325,000 per claimant to $400,000 per claimant. Willis approached six carriers. Two carriers offered
proposals. The proposing carriers were SCC/United Fire and Sun Life. The common response from
carriers who did not quote was that the current rates paid by the County are significantly below their
manual rates, which negatively affects their ability to be competitive.
The incumbent carrier, SCC/United Fire proposed a rate increase of 42.8% to maintain a $325,000 self
insured retention. Further, the proposal includes terms that establish higher self insured retentions (a/k/a
"lasers ") on at least six covered members with known catastrophic loss potential. These terms present
significant financial exposure to the Plan. Consequently, staff asked Willis to perform an actuarial analysis
at each retention level and recommend the carrier and retention level that will deliver best value in terms of
the lowest Cost of Risk Transfer to the Board.
Based upon their analysis, Willis recommends the Board purchase coverage through Sun Life at the
$400,000 retention level. The following are the primary reasons for this recommendation:
1. The Sun Life quotes were less costly than SCC/United Fire at all retention levels.
2. The Sun Life quote includes no lasers. This is valuable given the number of known potential
catastrophic claimants.
3. The SCC/United Fire quote was not firm and remained open to several additional potential lasers.
4. The $400,000 retention under the Sun Life quote results in a rate increase of 6.0% versus 36.6% at
the $325,000 level
5. The simulations Willis ran suggest that the selection of a $400,000 self insured retention presents
the lowest Expected Cost of Risk Transfer (Premiums paid less Expected Recovery). Please note
the Cost of Risk Transfer chart below.
6. The Board's Group Health Insurance reserves are in excellent financial condition and able to
absorb unforeseen additional risk that might occur due to increasing the retention level.
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12/8/2015 16.E.10.
Willis Anal sis of the Cost of Risk Transfer- Sun Life
Specific Deductible
Options
Estimated
Premium
Expected
Specific
Recovery
Return on
Premium
Expected Cost
of Risk Transfer
Variance in
Cost of Risk
Transfer
$325,000
$1,230,013
$915,686
0.76
$287,327
NA
$350,000
$1,090,417
$845,875
0.78
1 $244,542
($42,785
$375,000
$785,149
1 $675,161
0.78
$226,611
($60,716)
$400,000
$934,020
1 $731,708
0.78
$202,312
($85,015
Sun Life carries a Best's "A" (Superior) financial rating. Sun Life offered an aggregate excess quote.
However, based upon the terms of coverage, Willis has determined that there is a 99% probability that the
aggregate deductible will never be exceeded. Therefore, the purchase of aggregate reinsurance is not
recommended.
Coverage will commence January 1, 2016 for a one year period.
FISCAL IMPACT: The estimated cost of group health reinsurance in calendar year 2016 is $934,020
based upon an estimated average enrollment of 1,911 employees. This represents a premium increase of
$53,281 annually. The composite rate per enrolled employee is $40.73 per month. Premiums are remitted
monthly. Stop Loss premium comprises approximately 2% of total program costs. Thus, the impact of the
premium increase on total program costs is not significant. There are sufficient funds available in Fund
517, Group Health and Life Insurance for this purchase.
GROWTH MANAGEMENT IMPACT: There is no growth management impact associated with this
item.
LEGAL CONSIDERATIONS: This item has been approved as to form and legality and requires
majority vote for approval. — CMG
RECOMMENDATION: That the Board approves the purchase of Group Health Reinsurance as
outlined in the Executive Summary and authorizes the County Manager or designee to sign the documents
necessary to commence coverage effective January 1, 2016.
PREPARED BY: Jeffrey A. Walker, CPCU, ARM, Division Director, Risk Management Division
Attachments:
• Willis 2016 Stop Loss Analysis and Recommendation Report
• Health Reinsurance Quote Summary 2016
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12/8/2015 16.E.10.
COLLIER COUNTY
Board of County Commissioners
Item Number: 16.16.E.16.E.10.
Item Summary: Recommendation to approve the purchase of Group Health Reinsurance
coverage for calendar year 2016 through Sun Life effective January 1, 2016 at a projected
annual premium of $934,020.
Meeting Date: 12/8/2015
Prepared By
Name: WalkerJeff
Title: Division Director - Risk Management, Risk Management
11/12/2015 10:54:46 AM
Submitted by
Title: Division Director - Risk Management, Risk Management
Name: WalkerJeff
11/12/2015 10:54:47 AM
Approved By
Name: GreeneColleen
Title: Assistant County Attorney, CAO General Services
Date: 11/12/2015 11:14:30 AM
Name: PriceLen
Title: Department Head - Administrative Svc, Administrative Services Department
Date: 11/16/2015 2:45:57 PM
Name: KlatzkowJeff
Title: County Attorney,
Date: 11/16/2015 3:47:55 PM
Name: WellsLaura
Title: Management/Budget Analyst, Senior, Office of Management & Budget
Date: 11/17/2015 2:17:42 PM
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12/8/2015 16.E.10.
Name:OchsLeo
Title: County Manager, County Managers Office
Date: 11/19/2015 10:06:16 AM
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12/8/2015 16.E.10.
Collier County Government November 11, 2015
2016 Medical Stop Loss Marketing Report
Introduction
Each year Willis assists the Collier County Government (CCG) in obtaining quotes, analyzing the responses and
placing stop loss protection for the medical and pharmacy plans offered to the employees of the Collier County
Government and its constitutional affiliates.
Willis seeks stop loss coverage for 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 $325,000.
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.
CCG had five claimants with total dollars exceeding the specific stop loss in 2014, with reinsured losses totaling
$404,157. Through August of 2015, there has only been one claimant exceeding the stop loss attachment point,
however that claimant payments exceeded $1.5 million. The premium paid in 2015 will be in the range of $850,000
versus reinsurance payments to the CCG of almost $1.2 million.
Due to the poor 2014 -15 experience and emerging potential large claimants, only the incumbent and one other
carrier were willing to provide quotes for 2016.
Marketing Summary and Recommendation
Willis worked to secure terms for the specific medical stop loss program from the current carrier SCR. 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 $325,000, $350,000, $375,000 and $400,000. Specific
terms were requested on a 12/24 basis which means the coverage operates on an incurred versus a paid basis. This
is consistent with past practice.
Specific and aggregate quotations were requested from the following carriers:
b Symetra (declined)
* Sun Life (quoted)
b Voya (declined)
b SCR/US Fire Insurance Co. (incumbent)
b HM Life (declined)
* Munich Re (declined)
These carriers are all rated A or better by A.M. Best. Carriers that declined to quote did so because their manual
rates were not competitive as well as concerns over past and potential large claimants. The quote submitted by Sun
Life for the current retention level is 36.6% higher than current rates, compared to the 42.8% increase offered by
SCR/ US Fire Insurance.
Sun Life provided an aggregate stop loss quote, but we are not recommending that CCG purchase that coverage.
Both quotes are subject to disclosure and lasers may be added. Sun Life's proposal includes a no new lasers at
renewal and a 50% rate increase cap guarantee.
Willis Page 1
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12/8/2015 16.E.10.
Collier County Government November 11, 2015
2016 Medical Stop Loss Marketing Report
To aid the CCG in making a selection of what level of coverage to purchase, Wills completed two separate analyses.
The purpose of each is summarized below:
1. A standard spread sheet analysis which shows what was quoted at 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.
Based on the above analysis Willis believes the risk management needs of the CCG are best met by purchasing
coverage with Sun Life at a $400,000 retention level. Here are the primary reasons for this recommendation:
1. The SunLife quotes were less than SCR at all retention levels
2. The SunLife quote includes a no new laser guarantee is valuable given potential large claimants the CCG
faces
3. The SCR/U.S.Fire was not firm and they were considering several potential lasers.
4. The simulations Willis ran suggest that the cost of likelihood of the additional claims risk offsetting the
premium savings is virtually the same at the higher retention level
5. The $400,000 retention results in an increase of 6.0% versus 36.6% for the current level
6. The reserve fund County is more than adequate to handle any unforeseen additional risk that might occur
due to increasing the retention level.
Any decision to increase the retention level should be based on an assessment of the CCG's risk tolerance during
2016. The following analysis provides the detail supporting our recommendations. .
Sun Life quoted aggregate stop loss; SCR/ US Fire did not. Past years' analyses have shown that aggregate would
represent a poor value. The CCG would have less than a 1 % probability of collecting on coverage that costs $27,748
annually. Therefore, it does not make sense to purchase aggregate coverage from SunLife.
Quote Cost Analysis
The attached document labeled Collier County Government Stop Loss Marketing Analysis outlines what SCR/ US
Fire Insurance and Sun Life quoted at each retention level. The analysis shows that SCR/ US Fire Insurance will
increase premiums 42.8% for the current retention level of $325,000. Increasing your retention level to $350,000
would cost 29.1% more than current rate, $375,000, the rate would be 17.4% more than current and the $400,000
level would be 14.4% more than current.
The corresponding increases for Sun Life are 36.6% for the current $325,000 level, 23.8% for $350,000,14.9% for a
$375,000 and 6.0% for $400,000.
The large increases are related to past and emerging high cost claimants. Stop loss renewal increases typically
range between 20% to 40% due to two factors
1. The carriers' risk expectations based on a review of emerging high cost claims /trigger diagnoses and
2. Leveraged trend. Leveraging is what happens to the amount of claims exceeding a specific level ($325,000
in the CCG's case) when claim costs are increasing.
For example, assume a claim of $400,000 occurred for an individual with cancer. In this case, the CCG would
receive $75,000 back from the reinsurer. Now let's assume costs increase 5% (which is consistent with medical
Willis
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12/8/2015 16.E.10.
Collier County Government November 11, 2015
2016 Medical Stop Loss Marketing Report
CPI). Next year the same claim would cost $420,000. Under this scenario, the amount collected under the
reinsurance would be $95,000 instead of $75,000. This represents an increase of 27 %.
As in the past, all quotes were made assuming a 12/24 basis. This means coverage applies to all claims incurred in
2016 and paid by December 31, 2017, so there is no concern at the end of the year about getting claims paid so they
will be included against coverage.
Retention Level Analysis
Willis actuaries developed a Monte -Carlo simulation model using actual large claims in 2011 -2014 to forecast the
large claims that are likely to occur in 2016. We used CCG's actual large claims frequencies over this period to
estimate the incidence of large claims, and used a larger Willis database to model the distribution of large claim
amounts. The Willis database is based on over 3 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- Analysis of Stop Loss Alternatives 2016. The first page shows the
CCG's actual and number of claimants that exceeded specific levels and the total amount of claims at each level
from 2011 through 2014. The number of claims exceeding $325,000 ranged from one in 2013 to 5 in 2012 and 2014,
and the amount of claims in excess of the deductible ranged from $341,000 to $794,000 during this period.
Page 2 of the exhibit shows the estimated annual premiums 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 is the best value. The analysis suggests virtually identical results for all higher retention levels. .
This analysis suggests that, based on the expected claims at each level, the CCG might expect savings between
$119,000 and $268,993 by choosing a higher stop loss 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.
The results are virtually the same at all higher retention levels with only a 1 in 4 chance that additional claims
payments due to the deductible would offset the premium savings.
The bottom of this page shows the distribution of additional payments that the CCG may incur by moving to a higher
deductible. The premium savings amounts are between the 75t' and 80th percentiles of additional claims according
to our model, so any of the alternative stop loss programs would represent a reasonable additional risk for CCG.
The modeling Willis completed coupled with the CCG's reserve status suggests the retention level should be
increased to $400,000 for 2016.
Aggregate Stop Loss Analysis
We did not request a quote and only Sun Life provided one. Typically a stop loss carrier will set a somewhat
conservative expected claims target and set the threshold for aggregate coverage at this level plus 25 %. The
SunLife threshold was set at approximately $38 million. Our modeling suggests less than a 1% chance of exceeding
this level.
The models suggest a less than one in one hundred chance that there would be a claim under the aggregate
program offered by SunLife. Therefore we do not recommend that the CCG purchase this coverage.
Willis Page 3
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