HomeMy WebLinkAbout000187.tiff Sedgwick James
— 11,E Shirazi &
Consulting Group ,� Associates
SUMMARY OF COVERAGES
FOR
WELD COUNTY
JANUARY 1 , 1991 - DECEMBER 31 , 1991
Prepared By:
SHIRAZI & ASSOCIATES/SEDGWICK JAMES
March 1990
187
WELD COUNTY
SUMMARY OF COVERAGES
TABLE OF CONTENTS
Section I Introduction
Section II Shirazi/Sedgwick James Consulting Services
Section III Key Contacts for Employee Benefit Plans
Section IV Statement of Benefit Objectives
Section V Highlights of Current Plans
Section VI History of Plan Changes
Section VII Premium and COBRA Rate History
Section VIII Government Compliance & ERISA Information
Section IX Annual Report (Ending 12/31/90)
SUMMARY OF COVERAGES
WELD COUNTY
January 1, 1991
INTRODUCTIQN
Shirazi & Associates/Sedgwick James Consulting Group provides a Summary of
Coverages to Weld County as a resource tool and an overview of your employee benefit
programs. The Summary of Coverages aids you in answering questions from your
employees, management, and financial personnel.
In addition, the Summary of Coverages can be used during the budgeting and planning
process and as a training tool for new employees. Most importantly, all of your employee
benefit information is contained in one resource document.
The Summary of Coverages contains the following information:
o Services provided by Shirazi & Associates/Sedgwick James for
Weld County.
o Overview of key contact people for Weld County's benefit plans.
o Statement of your benefit objectives.
o Highlight of current benefits.
o History of plan changes.
o Premium rate history.
o COBRA rate history.
o Government Compliance Calendar and ERISA Information.
Shirazi & Associates/Sedgwick James has prepared this material from information
gathered from Weld County and your insurance providers. In order for the Summary of
Coverages to continue being a valuable management tool, Shirazi &Associates/Sedgwick
James updates the Summary of Coverages on an as-needed basis.
Shirazi & Associates/Sedgwick James Consulting Group is pleased to be working with
Weld County in developing, managing and communicating your employee benefit
program. The Shirazi & Associates/Sedgwick James team is available to assist you with
all of your benefit concerns and needs.
SHIRAZI/SEDGWICK JAMES CONSULTING SERVICES
March 15, 1991
Mr. Don Warden, Director of Finance
Mr. Dave Warden, Director of Personnel
WELD COUNTY
P.O. Box 758
Greeley, Colorado 80631
Gentlemen:
Shirazi & Associates/Sedgwick James Consulting Group is pleased to be associated with
Weld County as your employee benefits consultant for your group Life, Medical, Vision,
and Dental benefit plans. Shirazi/Sedgwick James agrees to provide the following
services for Weld County (plus any other related services as required by the County from
time to time):
o Legislative and Regulatory Awareness
1. Inform Weld County of applicable Federal and State legislation
and compliance requirements;
2. Inform Weld County of legislative trends and issues; and
3. Inform Weld County of necessary government filings including
5500's, Summary Plan Description booklets, Summary Annual
Reports, etc..
o Financial Analysis and Funding
1. Claim analysis:
a. Annual Financial Report by line of coverage detailing
prior year's claims and expenses; trends; cost
containment; funding levels; large claims; etc..
b. Quarterly review of Paid Claims in comparison to funding
levels and maximum claim liability.
2. Recommendations for appropriate funding levels for the self
funded plans, including paid claims, retention and reserves.
Page Two
3. Recommendation of COBRA rates.
4. Review and negotiate renewals with current carrier.
5. Review funding alternatives that are available to Weld County
and the pro's and con's of the alternatives.
o Marketing/Product Awareness
1. Inform Weld County of marketplace changes and trends -
national and local.
2. If appropriate, prepare marketing specifications for Weld
County and solicit alternative product/financial proposals from
competitive markets.
a. Interview potential insurance providers/administrators.
b. Analyze proposals and contracts;
c. Prepare executive summary and recommendation(s) for
Weld County; and
d. Assist Weld County in implementing new program.
o Account Management
1. Day-to-day service and resource for Weld County.
2. Liaison between Weld County and the insurance
provider/administrator.
3. Act as a technical informational resource for Weld County.
4. Develop and review Benefit objectives.
5. Develop and maintain a Summary of Coverages for Weld County
that includes highlights of benefit program; key contacts;
history of premiums; rates and benefit changes; government
compliance; and other necessary information to maintain
day-to-day working knowledge of Weld County's benefit
program.
Page Three
Annually, Shirazi/Sedgwick James will review with Weld County the services being
provided. It is Shirazi/Sedgwick James' intent to continue serving Weld County
in a professional manner and to provide the expertise that Weld County requires
to maintain a cost-effective and competitive employee benefit program.
Sincerely,
Masoud S. Shirazi Richard W. Joh n
KEY CONTACTS FOR EMPLOYEE BENEFIT PLANS
THE WELD COUNTY BENEFITS TEAM
o Address: Weld County
P.O. Box 758
Greeley, Colorado 80631
o Phone: (303) 356-4000
Fax: (303) 352-0242
o Contact Names: Don Warden, Finance Director
Dave Worden, Personnel Director
Patti May, Personnel Secretary
THE SHIRAZI & ASSOCIATES BENEFITS TEAM
o Address: Shirazi & Associates
1770 25th Ave. #302
Greeley, Colorado 80631
o Phone: (303) 356-5151
Fax: (303) 356-4154
o Contact Names: Masoud Shirazi, President/Consultant
Greg Harp, Benefit Analyst
Sharon Woodson, Admin. Assistant
THE SEDGWICK JAMES BENEFITS TEAM
o Address: Sedgwick James Consulting Group
2000 South Colorado Blvd. #5000
Denver, Colorado 80222
o Phone: (303) 691-1300 or 800-666-5263
Fax: (303) 758-2302
o Contact Names: Rich Johnson, VP/Consultant
Kathie Wagner, Sr. Account Mgr.
Elaine Flint, Sr. Benefit Analyst
Maureen Hagan, Executive Asst.
Pearl Carlin, Asst. Account Mgr.
Harold Klausner, Sr VP/Benefit Mgr.
LIFE PLAN
o Carrier: The Hartford
o Effective Date: January 1, 1983
o Anniversary Date: January 1, 1991
o Renewal Date: January 1, 1992
o Group Number: GL-19628
o Address: The Hartford
Group Dept 3rd Floor
P.O. Box 3615
San Francisco, California 94119
o Phone: (415) 995-3590 800-426-9701
Fax: (415) 777-3863
o Contacts: Jinnie Simonsen, Group Mgr.
Jon McGraw, Asst. Group Mgr.
Lastenita Schuster, Service Rep.
LIFE AND MEDICAL PLAN
o Carrier: Lincoln National Life
o Effective Date: January 1, 1991
o Anniversary Date: January 1, 1991
o Renewal Date: January 1, 1992
o Group Number: 50,158
o Address: Sales/Service - Lincoln National Health Plan
2629 Redwing Road #150
Ft. Collins, Colorado 80526
Regional Office - Lincoln National
(Claims/Underwriting) P.O. Box 49309
Colorado Springs, CO 80919
o Phone: Ft. Collins - 800-999-5309 or (303) 223-9898
Fax: (303) 223-0341
o Phone: Colorado Springs - 800-255-1139 or (719) 522-6000
Fax: (719) 522-7904
0 Contacts: Greeley/Ft. Collins - Bruce Bohde, Mgr. Sales/Service
Patricia Boyde, Service Rep.
LIFE AND MEDICAL - LINCOLN NATIONAL (CONT.)
o Contacts: Ft. Collins Elaine Taylor, HMO Plan Director
Colo. Springs Lori Lesle, Billings Suprv.
Connie Radestock, Claims
Dave Smith, Underwriter
DENTAL AND VISION PLANS
o Carrier: Self-funded, administered internally
o Anniversary Date: January 1
GROUP AUTO PLAN
o Carrier: Merastar (NWNL General)
o Effective Date: January 1, 1988
o Anniversary Date: January 1
o Renewal Date: Open-ended
o Group Number: 87100-001
o Address: Merastar
P.O. Box 180100
Chattanooga, TN 37401-7100
NWNL Group
5251 DTC Parkway #935
Englewood, Colorado 80111
o Phone Number: Colo - (303) 796-2400
o Fax Number: Colo - (303) 796-2919
o Contacts: Colo - Gary Carlson, Regional Group Mgr.
Sara Aarvig, Service Representative
WELD COUNTY
HIGHLIGHTS OF CURRENT PLANS
January 1, 1991
LIFE BENEFITS
Hartford _ G3ts C
All Eligible Employees Two x Annual Salary Life Amount
Two x Annual Salary AD&D Amount
Amounts rounded to the next $1,000 multiple.
Benefit Reduction Schedule Benefits reduce by 35% at age 65, and o
an additional 35% at age 70, and terminate a/
upon retirement. Amounts are rounded to
the next higher $500 multiple.
Maximum Benefit Amount $00,000
Guarantee Issue Amount $'.00,000
Other Special Features Employee may purchase additional voluntary
benefit up to 2 x salary to %1Q0,000.
�Pi✓��Tvk� Spouse may purchase voluntary life benefit
up to 1/2 of employee amount to $50,000
Dependent Life Benefits Children (birth-6mos) - $500
(6mos-23yrs) - $5,000
LINCOLN NATIONAL
All Eligible Employees One x Annual Salary Life Amount
One x Annual Salary AD&D Amount
Amounts rounded to nearest $1,000.
Benefit Reduction Schedule Benefits reduce by 40% of current earnings
at age 70 ($1,000 multiple), and by 60% of-
current earnings at age 75 ($500 multiple),
and by 70% of current earnings at age 80
$500 multiple), and terminate at retirement.
Maximum Benefit Amount $100,000 ($10,000 minimum)
Guarantee Issue Amount $100,000
MEDICAL BENEFIT
LINCOLN NATIONAL PREFERRED PLAN (PPO OPTION)
Lifetime Maximum $2,000,000 (PPO/NonPPO)
Mental/Nervous/Chemical Dependency Annual limits only
Heart/Heart-Lung/Liver Transplants $100,000
Deductible PPO - $150 ($300/family)
NonPPO - Combined with above
Coinsurance Percentage PPO - 80%
NonPPO - 80%
Coinsurance Maximum PPO - $5,000 ($10,000/family)
NonPPO - Combined with above
Office Visit Copayment PPO - $15 per visit
NonPPO - N/A
Outpatient Emergency Room (Facility & Dr) PPO - $50 copay, then 100%
NonPPO - Deductible, then 80%
Routine Physicals:
Adults $150 per person/year (PPO/NonPPO)
Children (2yrs-17 yrs) $150 per person/year (PPO/NonPPO)
Well Child Care (Birth - 2 yrs) PPO - $15 copay, then 100%
NonPPO - Not Covered
Prescription Drug PPO - $5 Generic copay (King Soopers)
$8 Brandname copay
NonPPO- Ded/Coinsurance
Mental Illness, lnpt: PPO - Deductible/80% to 45 days
Substance Abuse, NonPPO- Same as above
Alcoholism
OutPt: PPO - $30 copay/100%
NonPPO- Deductible/50%
($1,000 mental/nervous, $500 alcohol,
$500 substance abuse annual maximums).
Hospital PreAdmission Review Yes, non-compliance penalty of $250
Mandatory Second Opinion No, only if requested by Lincoln
Physical Therapy Maximum $1,000 per year
LINCOLN NATIONAL HEALTH PLAN (HMO OPTION)
Lifetime Maximum Unlimited
Mental/Nervous/Chemical Dependency 45 days per year
Copays: Physician $10/visit
Hospital $100/admission
Outpt Surgery $50/surgery
Emergency Room $30/visit
(Admissions waived)
Outpt Mental $0/visit
Inpt Mental $100 per admission,
$25/day to 45 days
Eye Refractions $10/exam (1/yr)
Coinsurance Percentage 100%
Out-of-Pocket Maximum $1,000/person ($2,500/family)
Excluding Prescription Drugs
Prescription Drug $5 copay
Routine Care Covered same as any illness for
adults and children
— DENTAL BENEFIT - SELF-FUNDED PLAN
Annual Maximum $500 per person and/or family per year
Deductible Not applicable
Coinsurance Percentages:
I - Preventative 100% of covered expenses
_ II - Restorative/Endodontic/ 50% of covered expenses
Prosthodontic
VISION BENEFIT - SELF-FUNDED PLAN
Annual Maximum $150 per person per year
MN 43007Ptrnu-y
Deductible Not applicable
Coinsurance Percentage 50% of covered expenses
MAJOR PLAN PROVISIONS - ALL PLANS (EXCEPT AS NOTED)
Eligibility Regular fulltime and part time
employees working 32 hours mre
per weekic?t �z u�IAq �m0144A. C4.
$ levy )tiftkt ra .1clC ba-ilL•
Eligible dependents include the
spouse and children from birth (if
enrolled within 31 days) to age 19,
students to age 23. Benefits cease
at end of calendar month of age 19, or
age 23.
Waiting Period Coverage is effective the first of
the month following a full month's
pay period. Employee must be actively
at work on effective date.
Termination of Coverage End of the month in whicht
cnds: Costa '41)
Mg're.d.intat5
Extension of Coverage Personal leaves as approved, Medical
Leaves up to sick leave accumulation f/QA,ud IAp
plus 31 days with contribution, all 5/C- 3 Y9
other as allowed under COBRA.
— Coordination of Benefits Full COB, birthday rule applies.
Pre-Existing Conditions PPO/Indemnity - 3/12, waived for$1,000
HMO - Does not apply
Retiree Coverage Not Covered.
WELD COUNTY
HISTORY OF PLAN CHANGES
LIFE BENEFIT
HARTFORD
1/1/91 Plan Year No plan changes.
VOID ?)wn VY,vIA-
1/ /9 Plan Year Increased Basic Benefit to 2x vs 1x salary.
LINCOLN NATIONAL
1/1/91 Plan Year Added 1 x salary benefit, thus bringing total
benefit to 3 x salary.
MEDICAL BENEFIT
1/1/91 Plan Year Replaced self-funded plan with Alta/Hartford with
Lincoln National dual choice PPO/Indemnity and
HMO plan.
Continued same HMO benefits, but consolidated all
with one carrier. Plan placed on a "community-
rated" basis for the HMO, and an "experience-
rated" basis for the PPO/Indemnity. Plans will
be allowed to cross-subsidize one another.
Previous indemnity plan contained $100 deductible,
$2,000 ($4,000 family) coinsurance maximum.
DENTAL/VISION BENEFIT
1/1/91 Plan Year No plan changes.
1/1/90 Plan Year No plan changes.
WELD COUNTY
PREMIUM AND COBRA RATE HISTORY
EMPLOYEE
LIFE BENEFIT ACTIVE RATE PORTION COBRA
1/1/91
Hartford - Life $.23 0% N/A
- AD&D 0% N/A
0%
Lincoln National - Life $.23 0% N/A
- AD&D $.03 0% N/A
1/1/90
Hartford - Life $.25 0% N/A
- AD&D $.035 0% N/A
- DEP $.71 0% N/A
Lincoln National Not inforce
VOLUNTARY LIFE - HARTFORD
Employee/Spouse rate/$1,000
Under 30 $ .07
30 - 34 $ .11
35 - 39 $ .14
40 - 44 $ .23
45 - 49 $ .40
50 - 54 $ .68 •
_ 55 - 59 $ 1.05
60 - 64 $ 1.88
65 - 69 $ 3.63
70 - 74 $ 5.94
75 + $11.85
MEDICAL BENEFIT
1/1/21
Lincoln National - HMO EE $111.00 $16 med/den/vis $113.22
DEP $194.00 $210 med/den/vis $197.88
- PPO EE $128.00 $33 med/den/vis $130.56
DEP $221.00 $237 med/den/vis $225.42
1/1/90
Lincoln National - HMO EE $ 87.31 $ 31.31 m/d/v $ 89.06
DEP $196.45 $216.45 m/d/v $200.38
,00
Self-Funded Plan EE $ .00 $16 m I t (V $ 95.88
DEP $),5300 $155 nil*/ $158.10
137.00
DENTAL/VISION BENEFIT
1 1 91
Self-Funded Plan EE $10.00 0 $10.20
DEP $16.00 0 $16.32
1/1/90
Self-Funded Plan Included in Medical
WELD COUNTY
ERISA REPORTING AND DISCLOSURE CALENDARS
Note: Due to its status as a governmental unit, the County is not
required to comply with ERISA reporting requirements. However, we
— have included the following information for your general reference.
The Section 125 plan Is subject to Form 5500 filing requirements as
— shown herein. Also, the County may choose to utilize parts of the
ERISA Summary Plan Discription Information. See format herein.
ERISA Compliance/Summary Plan Description Information
Benefit Plan:
o Name of Plan:
o Name and address of Plan Sponsor/Plan Administrator:
o Employer Identification Number:
o Plan Number:
o Plan Year:
o Type of Plan:
o Contributions:
o Name, address and phone number of the Claims Administrator:
o Name, address and phone number of Agent for Service of Legal
Process:
ERISA REPORTING DISCLOSURE FOR WELFARE PLANS COVERING 100 OR MORE PARTICIPANTS •
File Disclose to Who's
llsm What it ig With Participants When Due Resoons ole
5500 Annual Report Descriptive information IRS On written request Last day of Client with
with financial data available for viewing the 7th month Sedgwicx ar^es
after the end
of the plan year
Schedule A Insurance information IRS On written request Last day of Not Regwrea
available for viewing the 7th month
after the end
of the plan year
SPD Summary of the plan Partici- Yes 120 days after Sedgwick,James
written to be under- pants the plan be-
- stood by the average only comes effective.
participant For new partici-
pants thereafter,
90 days after
becoming a
participant.
SMM Summary of significant Partici- Yes 210 days after Sedgwick _a—es
changes in plan pants the end of plan
only year in which
.., the change
occurs
SAR Summary of information None Yes Last day of 9th Not Reguirea
and financial data month after the
derived from Form 5500 end of plan year
• If the welfare plan covers fewer than 100 participants AT THE BEGINNING of the plan year, it does NOT have •o • e
Form 5500 or distribute a Summary Annual Report for that plan year, even if the plan covers 100 or more panic ca-'s
•
later dung that plan year.
Ben 21:
fatSedgwick James
if
Shirazi &
Consulting Group Associates s
WELD COUNTY
ANNUAL REPORT
FOR
PLAN YEAR ENDING
DECEMBER 31, 1990
Presented By:
SHIRAZI & ASSOCIATES
1770 25th Avenue #302
Greeley, Colorado 80632
(303) 356-5151
SEDGWICK JAMES CONSULTING GROUP
2000 South Colorado Blvd. #5000
Denver, Colorado 80222
(303) 691-1300
WELD COUNTY
TABLE OF CONTENTS
r I . Introduction
II . Financial Information
A. Claims History by Year
B. Claims History by Month
C. Incurred Claims Run-off (1/1/91 - 2/28/91)
D. Large Claims
E. COBRA Participation
F. Claims by Type
G. Admission Information
H. Estimated Plan Status
—
I . IBNR Claims Liability
— III. Renewal Analysis
A. Projected Claims
—
B. Renewal Figures
C. Projected Costs and Deposits
—
IV. Summary
WELD COUNTY
ANNUAL REPORT
I. INTRODUCTION
The following report has been prepared as a management tool in
comparing the results of the 1990 plan year end financial data to
the past and future years.
The data provided in this report should prove useful in comparing
the self-funded plan position to any future cost projections for
the new insured plan with Lincoln National. This will assist us in
determining the future funding approach for the plan with Lincoln
National.
We will gather and analyze similar data for the Lincoln National
plan(s) as it comes available, and offer comparison to the past
self-funded plan arrangement.
We appreciate our relationship with Weld County and look forward to
offering continued guidance for its employee benefit program.
SHIRAZI & ASSOCIATES SEDGWICK JAMES CONSULTING GROUP
1
4soud S. Shir zx Richard W. J h on
Consultant Consultant
WELD COUNTY
II . FINANCIAL INFORMATION
_ A. Claims History-by-Year
Medical ---Average $$
Plan Enrollment Claims # of Claims PER / EE / MO
Year EEs/Deps Medical Dental /100 EEs/Mo Medical Dental
1/1/86 676/226 $671, 661 $52 , 143 59 $89 . 23 N/A
1/1/87 685/255 $970, 382 $58, 453 72 $118 . 05 $7 . 00
- 1/1/88 693/260 $1, 293 , 032 $71, 648 86 • $155. 47 $8 . 29
1/1/89 722/286 $1, 877 , 795 $72 , 769 84 $216. 71 $8 . 02
1/1/90 708/248 $1, 333 , 918 $74 , 153 69 $156. 75 $8 . 22
—
B. Claims History-by-Month
Medical Dental
— Enrollment* Enrollment* Claims
Period EEs Deps EEs Deps Medical** Dental
--- ---- --- ----
- Jan-90 694 269 725 288 $152 , 892 $5, 876
Feb 685 259 729 284 $109 , 045 $7, 496
Mar 680 252 726 279 $100, 731 $6, 831
Apr 687 250 732 276 $77 , 109 $2 , 456
— May 704 242 739 278 $64 , 043 $7 , 565
Jun 729 250 760 269 $43 , 638 $4 , 245
Jul 718 244 762 268 $73 , 748 $4 , 768
- Aug 720 242 766 268 $147, 205 $9, 946
Sep 720 242 770 266 $105, 450 $1, 133
Oct 720 242 770 266 $157, 050 $10, 963
Nov 720 242 770 266 $201, 655 $8 , 284
Dec 720 242 770 266 $99, 352 $4 , 590
TOTALS : 8 , 497 2 , 976 9, 019 3 , 274 $1, 331, 918 $74 , 153
AVERAGES:
—
/Mo 708 248 752 273 $110, 993 $6, 179
/EE/Mo $156. 75 $8 . 22
— Jan-89 710 283 746 302 $80, 389 $5, 850
Feb 709 278 745 297 $146, 024 $5, 198
Mar 721 287 758 308 $147 , 694 $8 , 627
- Apr 724 286 762 307 $341, 564 $3 , 876
May 729 290 765 311 $211, 935 $5, 612
Jun 733 293 767 314 $135, 766 $6, 904
Jul 739 294 774 314 $128 , 948 $4 , 807
- Aug 745 295 781 315 $141, 401 $6, 361
Sep 734 290 766 309 $160, 076 $4 , 891
Oct 716 287 747 307 $136, 804 $6, 606
— Nov 704 273 732 291 $110, 958 $6, 171
Dec 701 276 733 295 $136, 236 $7 , 866
TOTALS: 8 , 665 3 , 432 9 , 076 3 , 670 $1, 877 , 795 $72 , 769
AVERAGES :
/Mo 722 286 756 306 $156, 483 $6, 064
/EE/Mo $216. 71 $8 . 02
*All enrollment figures include active participants, retirees and
— COBRA participants.
WELD COUNTY
_ C. Incurred Claims Run-off (1/1/91 - 2/28/91)
Medical Dental Total
- January '91 $106, 621 $7, 472 $114 , 093
February $138 , 009 $3 , 032 $141, 041
March
— April
May
June
- July
August
September
October
— November
December
- Total YTD $244, 630 $10, 504 $255, 134
— Estimated IBNR Liability: $275, 581
— Large Claims: RAW $52 , 745
PGG $9, 989
AS $22 , 017
RRB (E) $12 , 291
CE (B) $15, 317
Total $112 , 359
45. 9% of total medical claims to date
WELD COUNTY
D. Large Claims Over $10 , 000
- 1/1/90 -12/31/90 1/1/89 - 12/31/89
EE Relation Amount EE Relation Amount
— TOD EE $36, 516 JHA(B) * DEP $17 , 052
GEL EE $14 , 345 LEC* EE $27 , 453
ETS EE $39 , 218 DDD(W) * DEP $11 , 091
AS EE $169 , 587 CJH* EE $234 , 127
HJ(V) SP $59 , 225 JJS* EE $28 , 699
PAN(R) SP $21, 103 ASS* EE $14 , 805
TLB EE $12 , 354 MJC EE $12 , 038
- CEQ EE $19, 509 EC EE $10 , 742
BEL EE $11, 478 MCD EE $46 , 245
BSK(P) SP $10, 809 CAH EE $11 , 082
_ EAS (D) DEP $27 , 549 DEJ EE $21 , 299
DLB EE $38 , 259 EKH EE $19 , 577
FML EE $11, 158 CEQ EE $19 , 328
JAH EE $19 , 161 TER EE $12 , 656
-
YAM EE $11, 629 AS EE $39 , 510
AJO EE $25, 475 JHW EE $10, 241
TLR EE $11, 754 GDJ (C) SP $135, 052
- LKW EE $11, 154 HE (E) SP $12 , 958
RRB(E) DEP $12 , 881 JLW(L) SP $19 , 418
BCC (R) DEP $13 , 761 CAC(A) DEP $15 , 896
_ BSK(P) DEP $10, 980 SMF(R) DEP $323 , 937
TLR(Z) DEP $15, 113 DB(S) DEP $14 , 661
PMC(J) DEP $17 , 608
DLG(N) DEP $30 , 903
-
*COBRA Participants SGM(K) DEP $55, 540
DRR(J) DEP $16, 668
— 22 Claims = $603 , 018 26 Claims = $1, 178 , 586
45 . 2% Of Medical Claim 62 . 8% Of Medical Claims
These large claims do not take into consideration that the Individual
Stop Loss has a 12 month accumulation period and an additional 12 month
reimbursement period.
E. COBRA Participation (as of 12/31/90)
— Enrollment
Medical 6 Single 2 Family
Dental 11 Single 2 Family
Paid Claims
Medical $54 , 547 $757 . 60 /Participant/Month
Dental $2 , 384 $20 . 38 /Participant/Month
- TOTAL $56, 931
WELD COUNTY
F. Claims by Type -1/1/90 - 12/31/90- -1/1/89 - 12/31/89-
— AMOUNT PERCENT AMOUNT PERCENT
MEDICAL
Total Submitted Claims $1, 638, 761 $2 , 173 , 317
Total Eligible Charges $1, 556, 175 $2 , 109, 806
—
Total Eligible Payments $1, 337, 142 100. 0% $1, 892 , 443 100. 0%
Total Paid Claims $1, 333 ,415 99 .7% $1, 877 , 794 99 . 2%
COB Claims $3 ,727 0. 3% $14 , 649 0 . 8%
Employees $854, 267 63 . 9% $615, 860 32 . 5%
Spouses $301, 127 22 . 5% $326, 689 17 . 3%
— Other Dependents $143 ,441 10. 7% $569, 449 30 . 1%
COBRA Participants $38, 307 2 . 9% $380, 446 20 . 1%
Hospital, Inpatient $567 , 915 42 . 5% $1, 038 , 350 54 . 9%
Hospital, Outpatient $36, 382 2 .7% $54 , 440 2 . 9%
Surgery, Inpatient $124 , 434 9 . 3% $190, 594 10. 1%
Surgery, Outpatient $82 , 760 6 . 2% $65, 848 3 . 5%
— Anesthesia $35, 472 2 . 7% $37 , 898 2 . 0%
Second Surgical Opinion $75 0. 0% $233 0 . 0%
Pre-Admission Testing $38 0. 0% $0 0 . 0%
Psychiatric, Inpatient $36, 329 2 . 7% $78 , 977 4 . 2%
Psychiatric, Outpatient $20, 412 1. 5% $20, 833 1 . 1%
X-Ray Lab $120, 824 9 . 0% $101, 672 5 . 4%
Birthing Center $8 , 718 0. 7% $5, 994 0 . 3%
— Extended Care $4 , 399 0. 3% $2 , 956 0 . 2%
Accident Benefit $47 , 802 3 . 6% $47 , 696 2 . 5%
Prescription Drugs $75, 213 5. 6% $68, 265 3 . 6%
— Chiropractic $15, 017 1. 1% $11, 331 0 . 6%
Routine Exam $20, 809 1. 6% $21, 715 1 . 1%
Medical Visits $62 , 583 4 . 7% $59, 996 3 . 2%
—
Vision $31, 791 2 . 4% $28 , 674 1 . 5%
Other Expenses $46, 169 3 . 5% $56, 973 3 . 0%
Number of Claims 6, 599 NA 7, 292 NA
— The number of claims for the 1990 plan year annualized (6, 599)
represents a 9. 5% decrease over the 1989 plan year.
— DENTAL
Total Submitted Claims $143 , 604 $136, 853
Total Eligible Charges $119, 862 $117, 172
_ Total Eligible Payments $74 , 282 100. 0% $73 , 088 100. 0%
Total Paid Claims $74 , 153 99 . 8% $72 , 770 99 . 6%
COB Claims $129 0. 2% $318 0 . 4%
— Employees $71, 185 95. 8% $68, 994 94 . 4%
Spouses $616 0. 8% $337 0 . 5%
Other Dependents $440 0. 6% $205 0 . 3%
.- COBRA Participants $2 , 042 2 . 7% $3 , 552 4 . 9%
Diagnostic $14 , 853 20. 0% $14 , 045 19 . 2%
— Preventive $13 , 785 18 . 6% $15, 104 20. 7%
Basic $41, 131 55. 4% $38 , 187 52 . 2%
Major $4 , 513 6. 1% $5, 752 7 . 9%
Number of Claims 1, 413 NA 1, 149 NA
WELD COUNTY
G. Admission Information
1/1/90 - 12/31/90 EE SP DEP COBRA TOTAL
# Admissions 68 27 22 5 122
# Hospital Bed Days 362 131 88 24 605
Average Length of Stay 5. 3 4 .9 4 . 0 4 . 8 5 . 0
1/1/89 - 12/31/89
# Admissions 78 43 75 34 230
# Hospital Bed Days 301 199 393 132 1025
Average Length of Stay 3 . 9 4 . 6 5. 2 3 . 9 4 . 5
H. Estimated Plan Status (1/1/90 - 12/31/90)
1990 1990
SUGGESTED ACTUAL
Estimated Deposits (Med, Den & Vision) $1, 519, 862 $1, 259, 998
Employee Rate $123 . 90 $94 . 00
Dependent Rate $156. 95 $155 . 00
Estimated Expenses
ASL Premium $8 , 400
ISL Premium ($75, 000 Ded) $137 , 860
$9. 64/EE, $18 . 80/Dep
Conversion Costs $0
Administration/Consulting Fee $74 , 264
$8 . 74/EE
Paid Medical & Vision Claims $1, 333 , 415
Paid Dental Claims $74 , 153
TOTAL $1, 628 , 092
Surplus/ (Deficit) ($108, 230) ($368, 094)
Assumptions: YTD Employees 8, 497
YTD Dependents 2 , 976
WELD COUNTY
-
I. Incurred But Not Reported (IBNR) Claims Liability
Actual Reserve Requirements from Claims Analysis Report
(as of 12/31/90) :
Medical - Average Lag Time (Days) 60 . 5
—
- Actual Dollar Liability $220, 981
Dental - Average Lag Time (Days) 66. 3
— - Actual Dollar Liability $13 , 469
TOTAL $234 , 450
Formula Generated IBNR Liability (as of 12/31/90) * :
Medical Liability $266, 683
— Dental Liability $8 , 898
TOTAL $275, 581
*Formula reserves are based on 20% (Medical & Vision) and
12% (Dental) of one years' projected annual claims. This
—
represents the suggested reserve deposits level . However,
due to claims fluctuation, some employers prefer a more
conservative approach. Under VEBA legislation, an employer
— is allowed to fund the trust up to 35% of the prior years'
benefit plan costs.
— Medical : $1, 333 , 415 x . 20 = $266, 683
Dental: $ 74 , 152 x . 12 = $ 8, 898
WELD COUNTY
III. RENEWAL ANALYSIS
A. Projected Claims for the 1991 Plan Year
Medical/
Vision Dental
Assumptions
Covered Employees 720 770
12 Months of Enrollment 8 , 458 8 , 921
Lagged 3 Months
Paid Claims for 12 Months $1, 331, 918 $74 , 153
1/1/90 - 12/31/90
Projected Claims for 1/1/91 - 12/31/91
Paid Claims $1, 331, 918 $74 , 153
Claims Credit* $94 , 587 N/A
Divided by Lagged Enrollment 8 , 458 8 , 921
Claim Cost per Employee on $146 . 29 $8 . 31
Lagged Enrollment Basis
Times Trend Adjustments** 1. 18 1. 12
Adjustment for Plan Design Changes*** N/A N/A
Times Enrollment, Annualized 8 , 640 9, 240
TOTAL PROJECTED CLAIMS $1, 491, 455 $86, 021
ALL COVERAGES $1, 577, 476
Monthly Claims Cost per Employee $172 . 62 $9 . 31
All Coverages 181. 93
ASL Projection****
Aggregate Attachment Percentage 130% 125%
ASL Attachment Factor $224 . 41 $215 . 78
ASL Attachment Point $1, 938, 902 $1, 864 , 339
*One large claim for 1990 exceeded the ISL Deductible of $75, 000.
**Assumes 1. 5% (Medical) and . 96% (Dental) per month times the
number of months from the midpoint of the experience period
to the midpoint of the next plan year.
Midpoint of the experience period: 7/1/90
Midpoint of the plan year: 7/1/91
12 months at 1. 50% per month = 18 . 0% for Medical
12 months at . 96% per month = 12 . 0% for Dental
***No adjustments for plan design changes were required.
****The ASL Projections are based on one year of experience. The
reinsurance carrier, Hartford, also used one year of experience
but used a differenct twelve month time period in their ASL
calculations. ASL covers medical expenses only.
WELD COUNTY
B. Renewal Figures
1) Life Renewal
Life AD&D Dep. Life
Renewal Carrier /$1000 /$1000 /Unit
1/1/87 Hartford $. 40 $. 06 $ . 33/. 71
1/1/88 Hartford $ . 25 $. 035 $ . 33/. 71
1/1/89 Hartford $ . 25 $. 035 $ . 71
1/1/90 Hartford $ . 25 $. 035 $ . 71
1/1/91 Hartford $ . 33 $. 035 $ . 71
1/1/91 Renegotiated $ . 23 $. 035 $ . 71
2) Stop Loss Renewal
ISL ISL Rates ASL ASL
Renewal Carrier Ded. /Month Premium Factor Conversion
1/1/87 Hartford $75, 000 $4 . 10/EE $6, 000 $119 . 25 $375/Cony.
$8 . 00/Dep
1/1/88 Hartford $75, 000 $4 . 10/EE $6, 000 $182 . 64 $375/Cony.
$8 . 00/Dep
1/1/89 Hartford $75, 000 $5. 66/EE $7 , 350 $212 . 80 $375/Cony.
$11 . 04/Dep
1/1/90 Hartford $75, 000 $ 9 . 64/EE $8 , 400 $246. 56 $375/Cony.
$18 . 80/Dep
1/1/91 Hartford $75, 000 $13 . 70/EE $8, 400 $210 . 52 $375/Cony.
$25 . 70/Dep
ISL = Individual Stop Loss - Rolling 12 Months Contract
ASL = Aggregate Stop Loss - Paid Contract
3) Administration/Consulting Fee Renewal
Rate/
Renewal TPA EE/Month
1/1/87 Alta $7 . 20
1/1/88 Alta $7 . 50
1/1/89 Alta $8 . 20
1/1/90 Alta $8 . 74
1/1/91 Alta $9 . 80
WELD COUNTY
C. Projected Costs and Deposit Rates for the 1991 Plan Year
Medical/Vision Dental
Assumptions
Covered Employees 720 770
— Covered Dependents 242 266
Conversions 0 0
Projected Costs
— Projected Claims $1,491, 455 $86, 021
ASL Premium (25% corridor) $8, 400 N/A
ISL Premium ($75, 000) $193 , 001 N/A
$13 . 70/ee, $25. 70/dep
Administration/Consulting $65, 837 $20, 143
$7 . 62/Med. $2 . 18/Den
Conversions $0 $0
TOTAL $1, 758, 693 $106, 164
All Coverages $1, 864 , 857
— Maximum Costs
The maximum costs to Weld County can be determined by replacing
the Medical Projected Claims with the Aggregate Attachment Point
of $1, 818, 893 for a total maximum costs threshold of $2 , 192 , 294
— or 17 . 5% more exposure.
SUGGESTED ACTUAL
— Current Deposits $1, 526, 279 $1, 262 , 280
Employee Deposit Rate $123 . 90 $94 . 00
Dependent Deposit Rate $156. 95 $155. 00
— Surplus/ (Deficit) ($338, 578) ($602 , 577)
Required Increase 22 . 2% 47 . 7%
— Suggested New Deposit Rates
Employee Deposit Rate $151. 40 $138 .85
Dependent Deposit Rate $191. 79 $228 . 94
— Suggested Rates-By-Line
Employee Medical $139 . 89 $128 . 30
Dependent Medical $177 . 22 $211. 54
Employee Dental $8. 63 $7 . 91
Dependent Dental $10. 93 $13 . 05
— Employee Vision $2 . 88 $2 . 64
Dependent Vision $3 . 64 $4 . 35
WELD COUNTY
IV. SUMMARY
_ The following information highlights the experience information for
the past plan year ended versus the prior plan year. In addition,
we have included an overview of the run-off claims position year to
date.
Experience Highlights
• The claims cost per employee composite reduced by 27 . 6% over the
prior plan year. By removing the large claim amount of $169 , 587
the claims per employee would have been $136 . 79 vs. $156 . 75 .
• Dental claims increased just 2 . 5% over the prior plan year.
• Enrollment declined this year by 2% for employees and by 13%
for dependents.
• Claims run-off shows a total of $255, 134 for the two months
ending in February. This includes a large claim of $52 , 745,
plus another 4 claims over $10, 000 .
• Large claims for 1990 totalled 45% of all claims vs. 63% last
year. Only one claim over $100, 000 vs. three last year.
• COBRA claims ran $757 . 60 per employee composite per month.
• Hospital and inpatient surgical claims were both down
substantially over the prior year, as was psych inpatient.
• Prescription drugs increased by 10% over last year' s claims.
• Routine exams continued around $20, 000 per year and the vision
- claims ran about $32 , 000 for an increase of 10%
• X-Ray and Lab benefits increased by 18% over the prior year.
• Admissions ran at about 1/2 of last year, with 122 . The number
of days stayed were 605 versus 1025.
• As compared to estimated deposits, the plan ran a deficit of
$368 , 094 .
• Incurred but not reported claims were estimated at $275, 581 .
Due to the large claims activity, actual run-off has already
generated $255 , 134 in claims.
• Projected claims for the coming year for the self-funded plan
are at $1, 577 , 476 for medical . Overall the rate increase called
for 47 .7% higher rate than the former deposits.
Hello