HomeMy WebLinkAbout20240125.tiffRESOLUTION
RE: APPROVE STOP LOSS APPLICATION AND SCHEDULE OF INSURANCE, AND
AUTHORIZE CHAIR TO SIGN AND SUBMIT ELECTRONICALLY - AETNA LIFE
INSURANCE COMPANY
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with a Stop Loss Application and Schedule of
Insurance between the County of Weld, State of Colorado, by and through the Board of County
Commissioners of Weld County, on behalf of the Department of Human Resources, and Aetna
Life Insurance Company, commencing January 1, 2024, and ending December 31, 2024, with
further terms and conditions being as stated in said application and schedule, and
WHEREAS, after review, the Board deems it advisable to approve said application and
schedule, a copy of which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of
Weld County, Colorado, that the Stop Loss Application and Schedule of Insurance between the
County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld
County, on behalf of the Department of Human Resources, and Aetna Life Insurance Company,
be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to electronically sign and submit said application and schedule.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 17th day of January, A.D., 2024, nunc pro tunc January 1, 2024.
BOARD OF COUNTY COMMISSIONERS
ATTEST: dzavo w .4
; 1,
Weld County Clerk to the Board
BY: jAt,0 r ( IL
Deputy Clerk to the Board
APP' C ' ' D AS 'o • RM:
ounty orney
Date of signature: /(_D IZ4
WELD COUNTY
oss, Chair
Perry L. Buc
Mike Freeman
K. James
me
2024-0125
PE0036
cc: QE Os/MRADO
O2/04 /2-4
CoOvack 15r1
BOARD OF COUNTY COMMISSIONERS
PASS -AROUND REVIEW
PASS -AROUND TITLE: Aetna Life Insurance Company Stop Loss Application
DEPARTMENT: Human Resources DATE: November 6, 2023
PERSON REQUESTING: staci Datteri-Frey / JiII Scott
Brief description of the problem/issue:
This is to update our individual and aggregate stop loss policy coverage amounts with Aetna for medical claims. This amount is reviewed and renewed
annually as part of our renewal process with the carrier.
What options exist for the Board?
Approve - claims processing will continue and Weld County will reduce risk of high cost daims.
Disapprove - negotiate new terms with Aetna and subject to any high claims as of 1/1/2024.
Consequences:
Impacts:
Cost (Current Fiscal Year/Ongoing or Subsequent Fiscal Years:
Recommendation:
Approve contract as stated and reuce risk on high cost claims.
Support Recommendation Schedule
Place on BOCC Mends Work Session Other/Comments:
Perry L. Buck, Pro -Tern
Mike Freeman, Chair
Scott K. James
Kevin D. Ross
Lori Saine
MP
2024-0125
l /l 1- 003(P
Aetna Life Insurance Company
Stop Loss Application and Schedule of Insurance
151 Farmington Avenue
Hartford, CT06156
Policyholder Information
Policyholder name (full legal name of entity): WELD COUNTY GOVERNMENT
Street: 1150 O STREET
City: GREELEY State: CO Zip Code: 80631
Email: sfrey@weld.gov
Policy period start: 01/01/2024 Policy period end: 12/31/2024
Total number of employees/covered units covered under the policy: 1,421
Pre -65 Retirees: ❑ Included Q Excluded I Retirees 65+: ❑ Included 0 Excluded
Medical paid claims basis: 2 Issued or ❑ Cleared or ❑ N/A
Affiliates or subsidiaries included? 0 No El Yes If yes, list name(s) and address state of the primary location(s)
below.
Affiliate full legal name(s): Address state of primary location(s):
Affiliate full legal name(s): Address state of primary location(s):
Affiliate full legal name(s): Address state of primary location(s):
Affiliate full legal name(s): Address state of primary location(s):
Affiliate full legal name(s): Address state of primary location(s):
Affiliate full legal name(s): Address state of primary location(s):
Affiliate full legal name(s): Address state of primary location(s):
Affiliate full legal name(s): Address state of primary location(s):
Affiliate full legal name(s): Address state of primary location(s):
Affiliate full legal name(s): Address state of primary location(s):
Third Party Administrator? Q No ❑ Yes If yes, complete for each administrator or vendor.
Medical:
Prescription drug:
Other:
Individual Stop Loss Coverage (ISL)
Individual Stop Loss coverage? ❑ No 0 Yes I Individual Stop Loss amount: $350,000
Does individual Stop Loss amount differ by plan or class? Q No ❑ Yes
If yes, please include the plans)/class(es) and amounts below.
Plan/class: Individual Stop Loss amount: $
Plan/class: Individual Stop Loss amount: $
Plan/class: Individual Stop Loss amount: $
Plan/class: Individual Stop Loss amount: $
Plan/class: Individual Stop Loss amount: $
AL HPoI-App-S0I-SL 04
1
CO
High risk individual Stop Loss amount(s)* included? ❑ N/A 0 No ❑ Yes *See Coverage Limitations identified
below.
Covered benefits: RI Medical 0 Prescription drug ❑ Other
Contract type: Claims incurred from through or 0 paid basis
Clams paid from 01/01/2024 through 12/31/2024
Maximum run-in claims applied: Q N/A or $ ❑ per covered person ❑ in total
Individual coinsurance percentage reimbursable: 100%
IOE transplant Stop Loss amount: ❑ N/A 0 No or $
Family individual Stop Lass amount: ❑ N/A 0 No or $
Aggregating Specific Stop Loss amount: ❑ N/A 0 No or $
Maximum annual individual Stop Loss payment amount: 0 Unlimited or $
Experience Refund Option included? ❑ N/A 0 No ❑ Yes
Experience refund period: Start date through
Loss ratio threshold: % Refund share:
Maximum refund: % Large claim adjustment: Q No or Adjustment is:
Large claim identifier: Date of birth:
Large claim identifier: Date of birth:
Large claim identifier: Date of birth:
Large claim identifier: Date of birth:
Large claim identifier: Date of birth:
Premier product included? ❑ N/A Q No ❑ Yes
Renewal risk cap included? ❑ N/A ❑ No 0 Yes Cap: 40%
Terminal run -out coverage for claims incurred prior to policy termination and paid after termination? ❑ No Q Yes
Terminal reserve or liability period: 0 months
Reimbursement types:
Immediate reimbursement (Aetna as claims administrator): ❑ N/A ❑ No 0 Yes
Individual accelerated claim reimbursement (TPA as claims administrator): ❑ N/A 1 I No ❑ Yes
Other conditions or provisions:
Aggregate Stop Loss Coverage (ASL)
Aggregate Stop Loss coverage? ❑ No 0 Yes Aggregate Stop Loss percentage: 120%
Covered benefits: 0 Medical Q Prescription Drug ❑ Dental ❑ Vision ❑ Other
Contract type: Clams incurred from through or Q paid basis
Clams paid from 01/01/2024 through 12/31/2024
Maximum run-in claims applied: 0 N/A or $ ❑ per covered person ❑ in total
Individual Stop Loss insurer: Q Aetna or
AL HPol-App-SOI-SL 04
2
CO
Minimum aggregate Stop Loss amount: ❑ N/A or $ 33,200,756
Individual internal limit: ❑ N/A Q No ❑ Yes If yes, amount: $
Maximum annual aggregate Stop Loss payment amount? ❑ N/A ❑ No Q Yes If yes, amount: $1,000,000
Deficit recoup provision? ❑ N/A 0 No ❑ Yes If yes, deficit cap: %
Termination provision? ❑ N/A 0 No ❑ Yes
Terminal run -out coverage for claims incurred prior to policy termination and paid after termination? ❑ No Q Yes
Terminal reserve or liability period: a months
Reimbursement types:
Monthly budget feature (Aetna as claims administrator): ❑ N/A ❑ No 0 Yes
Aggregate accelerated claim reimbursement (TPA as claims administrator): ❑ N/A 0 No ❑ Yes
Other conditions or provisions:
Coverage Limitations
Mental Health claim expenses are 0 Included ❑ Excluded
Transplant coverage is 0 Included ❑ Excluded
Is the policyholder a hospital or hospital group? 0 No ❑ Yes
If yes, domestic claims are reimbursed at:
ISL: 0 N/A ❑ 100% ❑ 0% / Suppressed ❑ Other ❑%
ASL: 0 N/A ❑ 100% ❑ 0%/Suppressed ❑ Other ■%
High Risk Individual Stop Loss amounts:
Member Identifier Date of Birth Amount Description
Premium Rates and Factors
Premium rate:
*Composite: $152.79 per employee per month (PEPM)
*If individual and aggregate Stop Loss coverage is included, the premium rate is combined.
Terminal liability premium rate:
*Composite: $152.79 per employee per month (PEPM) or ❑ N/A
*If individual and aggregate Stop Loss coverage is included, the premium rate is combined.
AL HPol-App-SOI-SL 04
3
CO
Aggregate Stop Loss factor:
Composite: $1,947.03 per employee per month (PEPM) or ❑ N/A
Terminal liability Stop Loss factor:
Composite: $1,947.03 per employee per month (PEPM) or ❑ N/A
Certification and Signature
You hereby represent that the information contained in this Stop Loss Application and Schedule of Insurance, any
Disclosure statement, and all other information and documents provided by you to us, is true and complete to the best
of your knowledge and belief.
Printed name of authorized representative:
Kevin D Ross
Official Title: Chairman of the Board of Commissioners
Signature of authorized representative:
kCl v/n 1 ko r
(.vin J Hoss iJan 1 i, l�Jt414 HS7'.
Date: Jan 17, 2024
Agent of Record
Agent's name: on file
Agent's firm: on file Tax ID #: on file
(If countersignature laws require commission sharing with a duly licensed resident agent in another jurisdiction, the
above designation will be modified to the extent required by law.)
AL HPol-App-S0I-SL 04
4 CO
Fraud Notice
WARNING: Any person who knowingly and with intent to defraud any insurance company or other person files an
application for insurance or statement of claim containing any materially false information or conceals for the
purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is
a crime and subjects such person to criminal and civil penalties.
State -specific notices:
AL: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or who knowingly
presents false information in an application for insurance is guilty of a crime and may be subject to restitution fines or
confinement in prison, or any combination thereof.
AR: Any person who knowingly and with intent to defraud any insurance company or other person files an application
for insurance or statement of claim containing any materially false information, or conceals for the purpose of
misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime.
CA: For your protection, California law requires the following to appear on this form: Any person who knowingly
presents false or fraudulent information to obtain or amend insurance coverage or to make a claim for the payment of
a loss is guilty of a crime and may be subject to fines and confinement in state prison.
CO: It is unlawful to knowingly provide false, incomplete, or misleading facts or information to an insurance company
for the purpose of defrauding or attempting to defraud the company. Penalties may include imprisonment, fines, denial
of insurance and civil damages. Any insurance company or agent of an insurance company who knowingly provides
false, incomplete, or misleading facts or information to a policyholder or claimant for the purpose of defrauding or
attempting to defraud the policyholder or claimant with regard to a settlement or award payable from insurance
proceeds shall be reported to the Colorado Division of Insurance within the Department of Regulatory Agencies
DC: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or who knowingly
presents false information in an application for insurance is guilty of a crime and may be subject to fines and
confinement in prison.
FL: Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an
application containing any false, incomplete, or misleading information is guilty of a felony of the third degree.
KY: Any person who knowingly and with intent to defraud any insurance company or other person files an application
for insurance or statement of claim containing any materially false information or conceals, for the purpose of
misleading, information concerning any material fact thereto, commits a fraudulent insurance act, which is a crime.
LA: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly
presents false information in an application for insurance is guilty of a crime and may be subject to fines and
confinement in prison.
ME: It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the
purpose of defrauding the company. Penalties include imprisonment, fines and denial of insurance benefits.
MD: Any person who knowingly or willfully presents a false or fraudulent claim for payment of a loss or benefit or who
knowingly or willfully presents false information in an application for insurance is guilty of a crime and may be subject
to fines and confinement in prison.
NJ: Any person who includes any false or misleading information on an application for an insurance policy is subject to
criminal and civil penalties.
NM: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly
presents false information in an application for insurance is guilty of a crime and may be subject to civil fines and
criminal penalties.
AL HPol-App-SOI-SL 04
5 CO
NY: Any person who knowingly and with intent to defraud any insurance company or other person files an application
for insurance or statement of claim containing any materially false information, or conceals for the purpose of
misleading, information concerning any material fact thereto, commits a fraudulent insurance act, which is a crime, and
shall also be subject to a :ivil penalty not to exceed five thousand dollars and the stated value of the claim for each such
violation.
OH: Any person who, wi _h intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an
application or files a clan containing a false or deceptive statement is guilty of insurance fraud.
OK: WARNING - Any person who knowingly, and with intent to injure, defraud or deceive any insurer, makes any claim
for the proceeds of an insurance policy containing any false, incomplete or misleading information is guilty of a felony.
OR: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly
presents false information in an application for insurance may be guilty of a crime and may be subject to civil fines and
criminal penalties.
RI: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly
presents false information in an application for insurance is guilty of a crime and may be subject to fines and
confinement in prison.
TN: It is a crime to knowngly provide false, incomplete or misleading information to an insurance company for the
purpose of defrauding thy company. Penalties include imprisonment, fines and denial of insurance benefits.
UT: Any person who knowingly; and with intent to defraud any insurance company; or other person; files an
application for insurance or statement of claim; containing any materially false information; or conceals for the
purpose of misleading; information concerning any material fact thereto; commits a fraudulent insurance act; which is a
crime; and shall also be subject to a civil penalty not to exceed five thousand dollars; and the stated value of the claim
for each such violation.
VA: Any person who, with the intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an
application or files a claim containing a false or deceptive statement may have violated state law.
WA: It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the
purpose of defrauding thy company. Penalties include imprisonment, fines and denial of insurance benefits.
WV: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly
presents false informations in an application for insurance is guilty of a crime and may be subject to fines and
confinement in prison.
AL HPol-App-SOI-SL 04
6 CO
t
- '
•
r
1
to
f
i
•r
l
grae na
An Aetna Renewal
Presented to
Weld County Government
Annual Renewal Rating: January 01, 2024 through December 31, 2024
Control Number: 109724
Tabra Mumm
Account Executive - S
4582 S Ulster St
Denver, CO 80237
Phone: 303-229-7226
Email: MummT@aetra.com
July 6, 2023
Weld County Government
Staci Datteri-Frey
1150 O Street
Greeley, CO 80631
Dear Staci Datteri-Frey:
Cassandra Newman
Ld Dir,Underwriting
151 Farmington Ave Rogers Bldg
Hartford, CT 06156
Phone: 860-273-3294
Email: NewmanC@aetna.com
Thank you for allowirg us to serve your health insurance and health benefit needs during the past year.
This package provide, information to help you develop the future benefits program for Weld County Government. As we
approach the anniversary of our relationship in the journey to better health, we are pleased to present you with your medical
renewal for the Janua ry 01, 2024 through December 31, 2024 contract period.
It's important to understand the full financial picture of your benefit plan. Therefore, the enclosed package provides the
following important i iformation about the cost of your current program and the value we bring to you and your company.
• Program s and Services
This section provides a summary of programs and services included in your plan of benefits.
• Caveats
Our renewal offer is contingent upon the parameters outlined here. It is important to note that deviations from
these assumptions may result in additional charges and/or adjustments on our Medical quotations. Please
review t its section thoroughly.
Please review the additional important information found at the following URL. This information is incorporated by reference
into this package a-ic considered part of your Agreement. This quote is subject to all the terms and conditions set
forth in this URL. Jr the event that any information contained herein conflicts or is inconsistent with the information in the
Underwriting Disclos ire Document, the information in your Renewal Package prevails.
https://www.aetna.cpm/document-library/lame-group-public-labor-self-funded-medical-underwriting-disclosures-5-15-
2022.pdf
Your renewal package remains in effect until December 31, 2024.
If there are no Chang 2s that impact the conditions of this renewal as outlined in our Caveats section, the fees will remain in
effect through December 31, 2024. This renewal package is considered an amendment to your existing
Agreement. Continua nce of your benefit plan and payment of fees constitutes your acceptance of this renewal. If you'd like to
make any plan changers or if you have any questions, please contact me by December 01, 2023 at 303-229-7226. It's been a
pleasure working witi you and I look forward to our continued relationship.
Sincerely,
Tabra Mumm Cassandra Newman
Account Executive - E Ld Dir,Underwriting
Each insurer has solc financial responsibility for its own products.
Health benefits and iealth insurance plans contain limitations and exclusions.
Weld County Government
Why Aetna? Effective Date: January 01, 2024
We're more than products and programs. We offer a health care experience that's more caring, more connected and closer to
home. With a holistic approach we join members on their personal health journey, removing barriers along the way. And we
work proactively to help every member achieve their goals and stay on a path to better health.
Because you have unique needs we offer customized, tailored solutions. And we have a plan to take care of each of your
employees, helping to increase engagement, improve outcomes and boost productivity.
We know health care can be overwhelming. So we work together with you to help make each member of your team a stronger
individual. Stronger individuals lead to a stronger workforce. And when you have a stronger workforce, you can achieve
stronger results.
You can learn more about Aetna here:
https://www.aetna.com/about-us.html
"Aetna" is the brand name used for products and services provided by one or more of the Aetna group of subsidiary
companies.
The Aetna companies include:
Aetna Health Inc., Aetna Health of California Inc., Aetna Health of the Carolinas Inc., Aetna Health of Washington Inc., Aetna
Health Insurance Company of Connecticut, Aetna Health Insurance Company of New York, Corporate Health Insurance
Company; Aetna Life Insurance Company; Aetna Dental Inc.; and/or Aetna Dental of California Inc.; Aetna Health of Utah Inc.
Certain dental plans are available only for groups of a certain size in accordance with underwriting guidelines. Managed care
plans may not cover all health care expenses. Contracts should be read carefully to determine which health care services are
covered. While this material is believed to be accurate as of the print date, it is subject to change. For more specific
information about the coverage details, including limitations, exclusions, and other plan requirements, please contact an Aetna
representative.
Aetna has various programs for compensating producers (agents, brokers and consultants). If you would like information
regarding compensation programs for which your producer is eligible, payments (if any) which Aetna has made to your
producer, or other material relationships your producer may have with Aetna, you may contact your producer or your Aetna
account representative. Information regarding Aetna's program compensating producers is also available at:
www.aetna.com
The information contained in this proposal is confidential and should not be shared with anyone other than your broker or
benefit plan consultant.
7/6/2023
Proprietary
aetna
Aetna
Weld County Government
Medical Fees (PEPM)
Estimated
Enrollment
1/1/2022 through
12/31/2024
Composite Service Fees (PPM)
Basic Administrative Sery ces
Allowances
Wellness Allowance ($10C,000 annual)
Implementation Allowanc? ($60,000 annual)
General Administration Al owance ($75,000 annual)
Additional Services/Programs/Allowances Included
MedQuery
Aetna Concierge
Aetna One Flex
Personal Health Record
Aetna Healthy Actions
Aetna Health Fund Expense Fee
Subtotal
Medical Service Fee (PEP 4/1)
1,422
$50.12
$40.97
Included
Included
Included
$1.80
$1.60
$2.35
$0.50
$0.15
$2.75
$9.15
$50.12
Discounts Included in Fees (PEPM)
1/1/2022 through
12/31/2024
Pharmacy Rebate Offset
1,422
($50.12)
Medical Fees Including Offset & Broker Commission (PEPM)
Estimated
Enrollment
1/1/2022 through
12/31/2024
Choice POS II (Aetna Health Fund)
Composite Service Fees (PEPM) - less offest
1,421
1,421
$50.12
$0.00
Clarifications
• PEPM is defined as Per E mployee Per Month
• The above Administrative Service Fee assumes Aetna retains both Medical and Pharmacy coverage.
• We have provided a tee guarantee tor each ot the first three contract periods trom January 01, 2022 through December
31, 2024 for the self -fund ed coverages included in this proposal (each a "Guarantee Period"). The mature fees are
guaranteed according to tie per -employee, per -month fees as illustrated on the financial exhibit(s). If you place the
products and services included in this multi -year fee guarantee out to bid, this guarantee is nullified.
• Please see Programs & ! ervices for additional information. Some services may come at at additional cost to the fees
• Broker Compensation, it applicable, is subject to customer approval.
• The above Administrative Service Fees were effective 1/1/2022.
• The fees above exclude :harges for items such as printing, special reports and late fees. These will be billed separately.
• The above ASC fees assi. me that Aetna will be Claim Fiduciary.
• The National Advantage with Facility Charge Review programs have been included in the renewal at a charge of 50% of any attained savings.
• Included in fees is a $10J,000 Wellness Allowance, $60,000 Implementation Allowance and a $75,000 General
Administration Allowance.
I authorize the adminik trative services for 1/1/2024. $50.12 pepm offset by Rx rebates for a monthly admin fee of $0
Name
Signature Date
7/6/2023
Proprietary
ta-etna
ASC Fees (2)
Weld County Government
Programs and Services — Self -Funded
Effective Date: January 01, 2024
Program Summary
Choice POS II (Aetna Health Fund)
Programs & Services Included in the Service Fee
Mature Base Service Fee
$50.12
Implementation, Account Management & Plan Administat
Designated Account Management Team
Included
Designated Implementation Manager
Included
Designated Service Center
Included
Onsite Open Enrollment Meeting Preparation
Included
Open Enrollment Marketing Material (Standard) Onsite Meeting Preparation
Included
ID Cards'
Included
Summary of Benefits and Coverage (SBC)
Included
Claim Fiduciary Option 1
Included
External Review
Included
Non-ERISA
Included
Network
Services
Custom Network
Included
Institutes of Excellence' t
Included
institutes of Quality' (1OQ) Broad Network
Included
National Medical Excellence Program"
Included
Network access
Included
Care Management
Aetna Compassionate Care Program
Included
Aetna Ones Flex
Included
MedQuery' with physician messaging'
Included
Utilization Management
Included
Member Resources
Aetna Concierge (includes First Impression Treatment)
Included
Member Website and Mobile Experience
included
MindCheck`r`'
Included
Wellness
24 Hour Nurse Line: 1-800h Only
Included
Aetna Healthy Commitments"`' - Core
Included
Personal Health Record*
Included
Simple Steps to Healthier Life! Health Assessment
Included
Allowances
Implementation/Communication Allowance
Included
Wellness Allowance
Included
General Allowance
Included
Reporting and Integration
Analytic Consultation from Plan Sponsor insights
10 Hours
Behavioral
Health
Managed Behavioral Health
Included
Behavioral Health Condition Management Program - Standard
Included
Applied Behavior Analysis (ABA)
Included
AbleTo Network - subject to member cost share
Included
Total Fees
Additional Available Programs & Services
Member Resources
ALEX" (owned by Jellyvision) Advanced
$59,291
ALEX (owned by Jellyvision) Essentials
$38,640
Programs & Services Included in the Claim Wire*
No Surprises Act - Fees*
No Surprises Act (NSA) claim administration fee (per NSA eligible claim)
$50
No Surprises Act (NSA) Independent Dispute Resolution (IDR) initial fee (per arbitration case)
$350
No Surprises Act (NSA) Independent Dispute Resolution (IDR) arbitration expenses (per arbitration case)
- $200 to $900+
7/6/2023
Proprietary
vaetna
Programs and Services ASC
Weld County Government
Programs and Services — SeI--Funded
Effective Date: January 01, 2024
Program Summary
Choice POS II (Aetna Health Fund)
Network Services
Subrogation*
37.5% of savings
Contracted Services*
37.5% of savings
Claim and Code Review Program*
30% of savings
National Advantage"- Program*
We will retain 50% of savings
Facility Charge Review (FCR) — Star dard
Included
Itemized Bill Review
Included
Teladoc Health (Standard) Genera Medical (PMPM)*
$0.20
Teladoc Health Behavioral Hea th PMPM)*
Included in General Medical
Teladoc Health Dermatology (FMFM)"
Included in General Medical
Teladoc Health Caregiver (PMPM) -
_ Included in General Medical
Care Management
Enhanced Clinical Review Program — High Tech Imaging (PMPM)'
$0.35
Enhanced Clinical Review Program — Diagnostic Cardiac (PMPM)"
$0.10
Enhanced Clinical Review Prograrr — Sleep Management (PMPM)*
$0.05
Enhanced Clinical Review Program — Cardiac Implantable Devices (PMPM)*
50.05
Enhanced Clinical Review Prograrr — Interventional Pain (PMPM)"
$0.10
Enhanced Clinical Review Program - Hip and Knee Arthroplasties (PMPM)"
S0.05
Enhanced Clinical Review Program — SmartChoice (PMPM)'
$0.10
*Additional Program Detail-
Claim Wire Billing, ID Cards, Subngation, Contracted Services, Claim and Code Review
Details can oe fauna in our UW U 3closure aocument located at the following URL:
https://www.aetna.com/do• ument-library/large-group-public-labor-self-funded-medical-underwriting-disclosures-5-15-2022.pdf
Claim and Code Review Program
This financial proposal includes erhancements that have been made to our claim and code review programs. Some of these capabilities were previously a component of our base
fees, but this proposal assume; they will now instead be part of our standard shared savings arrangement.
No Surprises Act - Fees
Refer to the NSA Payment Practices in our Caveats for information on our payment practices for NSA eligible claims.
IDR fees are required by the NSA ules and are payable to the IDR entity. There is an initial fee to begin an arbitration, which applies to each case. There is also an additional fee for the
arbitration expenses; the losing party within the dispute is liable for this fee. For batch cases, the NSA permits IDR entities to charge a different arbitration fee based on a set fee range
and/or percentage of the batch fee The fees are passed through (with no mark up by Aetna) to a customer based on the number of line items for their plan that were included in the batch
case. The above are the currert NSA fees as set by federal agencies. These fees are subject to future adjustments by the agencies (and any such adjustments shall be applied to your plan).
Enhanced Clinical Review
This fee will only be charged b3sei upon those members who fall into service areas where the program is available.
Institutes of Excellence'" (IOE)
This program includes a steerage :omponent by educating members on the benefits of using an IOE designated facility. However, benefit differential steerage is not supported for IOE
Infertility network.
MedQuery* with physician messaging
Physician messaging is included a no additional charge.
National AdvantagetM Program
Details can be found in our UV/ Disclosure document located at the following URL:
https://www.aetna.com/document-library/large group-public-labor-self-funded-medical-underwriting-disclosures-5-1S-2022.pdf
Personal Health Record (PHR)
PHR requires the purchase of McIQueryi.
Teladoc Health
In addition to the administrative gees as outlined above, there is a per consultation charge which will be shared by the member and plan sponsor based on type of service provided and
member's benefit plan. Specif c charges are available upon request.
With standard Teladoc setup, mennber cost share follows the underlying medical plan design, either the plan's copay or deductible amount. Customization to the member's copay is not
allowed. If your plan deviates frov the standard, Teladoc custom pricing rates will apply. See Programs and Services for included Teladoc programs.
7/6/2023
Proprietary
i►aetna
Programs and Services ASC
Weld County Government
Allowances - Self -Funded
Effective Date: January 01, 2024
We are including allowance(s) for your Aetna plans applicable to each year of the Guarantee Period as outlined in the chart below.
Allowance dollars are intended to be used for your Aetna medical plans and Aetna medical members.
Annual
Allowance
Type
Year
3
Plan Year Effective
Date
j 01/01/2024
'
Implementation/Communication
$60,000
Wellness
$100,000
General
$75,000
Total
$235,000
Annual allowance amounts may be adjusted if actual enrollment changes by 10 percent or more from our enrollment assumptions.
Implementation/Communication and General Allowances
• Can be used for reasonable implementation/communication and general expenses applicable to the plan year for which they are
offered.
• You can use the allowance(s) to offset expenses you incur as a result of implementing your contract with us, promoting products,
programs or services, communicating with our members, and our system front-end charges.
• Should you terminate your contract with us, the allowance(s) cannot be used to fund implementation/communication expenses
related to the new carrier's contract.
Wellness Allowance
• Can be used to pay for reasonable wellness -related programs or activities incurred during the Guarantee Period year for which the
allowance was applicable.
• Wellness allowance expenses must be for wellness -related programs or activities that are designed to promote the health and
well-being of members, or to educate participants about healthy lifestyles and choices. Any wellness -related allowance amounts
we pay you directly to offset or reimburse you for any expense or costs you reimbursed a vendor for directly, must comply with
these conditions. Examples of reimbursable wellness related activities include programs or activities such as wellness fairs and
biometric screenings.
The above referenced fund(s) will be available after your first administrative fee payment for the applicable plan year has been
recorded or after the effective date of each plan year, whichever is later. Only those expenses performed and billed by a third party
are payable; reimbursement for time and materials incurred directly by the plan sponsor (e.g. hours worked by the plan sponsor's own
employees) are not eligible. Our preferred method of payment is directly to the vendor. We will pay allowance related expenses directly
to the vendor only after you send us proper documentation outlining the expenses you have incurred. On an exception basis, we can
reimburse you directly. In the event the exception is granted, we'll require you to submit detailed paid receipts from the vendor.
To facilitate allowance processing, documentation should be submitted within 60 days of the invoice date, whenever possible.
All documentation must be submitted no later than 60 days following the end of the plan year for which expenses were incurred.
Acceptable documentation includes, but is not limited to:
• Vendor invoice(s) summarizing level of work completed, hourly rate and hours spent; and
• Invoices or other documentation summarizing any other miscellaneous expenses incurred (such as travel, and other business
expenses related to service rendered)
The allowance amounts indicated above for the following Allowance Type(s) are available for the years indicated in the chart. Each
allowance is forfeited at the end of each plan year if not fully utilized (it does not get rolled over to the following plan year for
a cumulative amount). If you have elected to offer wellness incentives through a product reward site, unredeemed vouchers are
forfeited at the end of each plan year.
• Implementation/Communication
• Wellness
• General
7/6/2023
Proprietary
taetna
Allowance ASC
Weld County Government
Allowances - Self -Fended Effective Date: January 01, 2024
We assume the funding of any allowance dollars is either at the request of your Plan Administrator acting in its fiduciary capacity or for
the exclusive benefit of your Plan. You are responsible for determining that your use of allowance dollars is appropriate and legally
compliant. With respect to allowance dollars that are used in connection with a wellness program, you are responsible for ensuring that
the program and any incentives/rewards comply with applicable laws, including limitations on maximum allowable incentives/rewards.
We will pay any allowarces in accordance with applicable law. We suggest you seek appropriate accounting and legal counsel for all
payments to ensure they comply with applicable accounting principles and laws.
If you terminate your medical plan with us in whole or in part (defined as a 50 percent or greater membership reduction from the
membership we assumEd in this renewal prior to the end of the multi -year Guarantee Period, you'll be responsible for remitting
payment for any allowa ice amounts used. Payment is due to us within 31 days of the invoice.
7/6/2023
Proprietary
taetna
Allowance ASC
Weld County Government
Caveats - Self -Funded
Effective Date: January 01, 2024
For the purposes of this document, Aetna may be referred to using "we", "our" or "us"and Weld County Government may be
referred to using "you" or "y
our".
.
If fees are adjusted, the caveats below will apply and be based on the new assumptions.
Underwriting Caveats
Your pricing considers all the products, programs and services you have with us and will be in effect for the full 12 months of
the plan year. Pricing for some programs and services are amortized over a 12 -month period. Therefore, fees will not be
reduced if termination occurs prior to the end of the plan year. We also assume the renewal assumptions below remain
consistent throughout the plan year. We require notice to properly terminate before the plan year ends in accordance with
the Termination provision in your Agreement. Otherwise, you may be charged for the cost until that notice is met.
If any of the changes outlined below occur, we may adjust your Guaranteed Fees. If this happens, you'll have to pay any
difference between the fees collected and the new fees calculated back to the start of the Guarantee Period. If you are not
notified of the change in advance, such difference will be reconciled in the annual accounting for the Guarantee Period.
If fees are adjusted, the caveats below will be based on the new assumptions.
During the Guarantee Period we may adjust your Guaranteed Fees if:
Enrollment
There is a 10 percent change in the total number of enrolled employees for all commercial medical products combined.
Our renewal assumes coverage will not be extended to additional employee groups without review of supplemental
census information and other underwriting information for appropriate financial review.
Member -to -Employee Ratio
The member -to -employee ratio changes by more than 10 percent from the 2.2 ratio assumed in this quote.
Projected Processed Claim Transactions (PCT) Per Employee
The actual PCT ratio changes by more than 10 percent from the 28.70 ratio assumed in this quote.
Age 65 and Over Enrollment
The number of enrolled employees age 65 and over (excluding those enrolled on Medicare Direct plans) exceeds 3 percent
of the total enrolled group or changes by more than 10 percent from the 50 enrollees assumed in this quote. Patient
Management programs are excluded for Medicare primary members.
Quoted Benefits and Administration
A material change is initiated by you or by legislative or regulatory action which materially affects the cost of the plan.
This includes, but is not limited to, changes impacting standard contract provisions, claim settlement practices, plan
administration, plan benefits or changes to the programs and services we offer you.
National AdvantageTM Program
You change or terminate the National Advanta e'T Program NAP Facility Charge Review (FCR), Bill Review (IBR),
g g (NAP), g ( )� ( ),
or Data iSight`TM (DiS) programs.
Total Replacement
We're the sole carrier for the quoted lines of coverage.
Performance Guarantees
If any of the conditions outlined above occur, then any performance guarantees may be changed or terminated based on the
caveats outlined in those guarantee documents.
Assumptions
Underwriting
Agreement Provisions
Our quotation assumes our standard Agreement provisions and claim settlement practices apply unless otherwise stated.
Participation
A minimum of 150 enrolled employees is required to administer the proposed products on a self -funded basis.
7/6/2023
Proprietary
taetna
Caveats Self -Funded
Weld County Government
Caveats - Self-Func ed Effective Date: January 01, 2024
Plan Design
This renewal is based c n the current benefit plan designs, plus any noted deviations.
Claim Fiduciary
Our renewal assumes we've been delegated claim fiduciary responsibilities. As claim fiduciary, we'll be responsible for final
claim determination ar d the legal defense of disputed benefit payments. Our appeal administrative services are automatically
included when we've keen delegated claim fiduciary responsibilities.
External Review
We've included extern 3I review in our renewal. External review uses outside vendors who coordinate medical review through
their network of outsic e physician reviewers.
Non-ERISA
For non-ERISA plan, th ?, risk and responsibilities are different from those under ERISA plans, since the ERISA preemption and
ERISA standard of performance do not apply. Our charge for non-ERISA plans must account for the additional liability risk as
compared to known rig ks under an ERISA plan. An additional $0.35 PEPM is charged for non-ERISA plans and is included in
our fees.
Member Communications
Pricing assumptions in:lude direct communications access to Aetna membership through both ongoing Aetna Health
communications and relevant ongoing included product/program specific communications. These communications can reduce
member and plan costs by guiding in care navigation, managing chronic conditions, promoting preventive services, and more.
Wellness Incentives and Rewards
We offer several different wellness incentives and rewards programs that you may choose from to offer to your members. We,
or our third -party venc ors, will administer and distribute to your members any wellness incentives or rewards earned based on
the programs selected under the direction and control of your plan. The wellness incentives and rewards earned through these
programs may be taxa ole for your members. We will provide you with reporting which will identify members who have earned
such wellness incentives or rewards. These reports will provide the data needed for any tax information reporting
requirements that you determine are necessary.
With regard to these wellness incentives and rewards, you, as the Plan Sponsor have the following responsibilities:
• Ensure any incentives or rewards offered to your members comply with applicable law and any limitations imposed
thereunder. This ircludes but is not limited to, the Health Insurance Portability Act (HIPAA), the Americans With Disabilities
Act (ADA) and the 3enetic Information Nondiscrimination Act (GINA).
• Distribute notice ; and/or obtain any authorizations required by law.
• Comply with all tax information reporting requirements regarding any wellness incentives or rewards earned through
these programs (cz sh, cash equivalent, or other tangible property) and provided by us or our third -party vendor to your
members.
• Assume any and 311 liability for your noncompliance with any tax withholding or information reporting requirements.
You may wish to cona It with your legal counsel or other advisors as to the proper tax treatment of such wellness incentives
or rewards and to ensure that the incentives or rewards offered under your program comply with applicable law.
Mental Health/Substance Abuse Benefits
O ur quotation assumes that mental health/substance abuse benefits are included.
Prescription Drug Benefits
O ur quotation assume -3 that prescription drug benefits are included and will be provided through Aetna Integrated Pharmacy
Solutions. If you termi late your Aetna prescription drug benefits, we will increase your Guaranteed Fees and medical trend
assumption used for aiy applicable claim projections or claim target guarantee, and you may also be subject to additional
charges to integrate data with external Pharmacy vendors.
Additional charges mai apply if you change your Pharmacy Benefit Manager and/or change the number or frequency of
pharmacy data feeds.
7/6/2023
Proprietary
aetna
Caveats Self -Funded
Weld County Government
Caveats - Self -Funded Effective Date: January 01, 2024
Aetna Specialty Pharmacy"' Program
The Aetna Specialty Pharmac `'v program covers specialty prescription drugs when filled through a network retail or specialty
p v Y p 8 p Yp p g g p Y
CVS Specialty Pharmacy. CVS Specialty is an ideal specialty pharmacy for members needing injectables
pharmacy, including p Y� p Y� 1
and specialty medications. Members receive the full support of CVS Specialty's clinical staff, including pharmacists, registered
nurses, certified pharmacy technicians and regional clinical liaisons. In addition to providing convenient access to specialty
medications, CVS Specialty provides educational support to help members, their family members and caregivers manage self -
injectable medications. CVS Specialty also offers enhanced care coordination and access to health care providers, so care
delivery is streamlined and effective.
Each prescription is limited to a maximum supply. Depending on plan design, members may be required to fill specialty drug
prescriptions at a network specialty pharmacy, unless an emergency exists
Stop Loss Reporting
Our quotation assumes stop loss coverage is provided by Aetna and therefore reporting to an external vendor is not required.
If we are no longer the stop loss carrier, external reporting charges will apply.
Aetna HealthFund® (AHF)
Our quotation assumes that any Health Reimbursement Account (HRA) for our Aetna HealthFune plan(s) is funded by you.
Additional Products, Programs and Services
Costs for special services rendered that are not included or assumed in the pricing guarantee will be billed through the claim
wire, on a single claim account, when applicable, to separately identify charges. Additional charges that are not collected
through the claim wire during the year will either be direct -billed or reconciled in conjunction with the year-end accounting
and may result in an adjustment to the final administration charge. For example, you will be subject to additional charges for
customized communication materials, as well as costs associated with custom reporting, booklet and SPD printing, etc. The
costs for these types of services will depend upon the actual services performed and will be determined at the time the service
is requested.
Billing Information
Advanced Notification of Fee Change
We'll notify you of any off -anniversary fee change within 31 days of the fee change.
Late Payment
We'll assess a late payment charge at a 12 percent interest rate if you fail to pay plan benefit payments or administrative
service fees on a timely basis as outlined in the Agreement. We'll notify you of any changes in late payment interest rates. The
late payment charges described in this section are without limitation to any other rights or remedies available to us under the
Agreement or at law or in equity for failure to pay.
Producer Compensation
The quoted fees don't include producer compensation.
Claim and Member Services
Runoff Claims Processing
Your administrative service fees are mature. The expenses associated with processing runoff claims following termination are
covered for one year.
Medical Service Center
We've assumed that claim administration and member services for the quoted plans will be managed centrally by the
Service Center. Members will be able to reach the Member Service representatives Monday through Friday,
from 8 a.m. to 6 p.m., local time (based on where the member resides).
7/6/2023
Proprietary
vaetna
Caveats Self -Funded
Weld County Government
Caveats - Seif-Funced
Effective Date: January 01, 2024
Reporting and Data Transfer
Aetna Intellectual Property
Under the Agreement, you may have access to certain of Aetna's Plan Sponsor reporting systems. Aetna represents that it has
either the ownership r ghts or the right to use all of the intellectual property used by Aetna in providing the Services under the
Agreement ("Aetna IP'l. Aetna will grant you, as the Plan Sponsor, a nonexclusive, non -assignable, royalty free, limited right to
use certain of the Aetna IP for the purposes described in the Agreement. You agree not to modify, create derivative product
from, copy, duplicate, decompile, dissemble, reverse engineer or otherwise attempt to perceive the source code from which
any software component of the Aetna IP is compiled or interpreted. Nothing in the Agreement shall be deemed to grant any
additional ownership r ghts in, or any right to assign, sublicense, sell, resell, lease, rent, or otherwise transfer or convey, the
Aetna IP to you.
Data Integration (Hi! torical)
O ur renewal assumes one historical medical and one historical pharmacy data integration feed. Additional fees will
apply if feeds from mo-e than one historical vendor are required.
Data Integration (Or going)
O ptions and pricing for integrating claims data from an external vendor into one or more of our systems will vary depending
on the scale of your integration needs.
Data Transfer at Ter nination
Upon Agreement term nation, we agree to cooperate with succeeding administrators in producing and transferring required
claim and enrollment c ata. Data will be transferred within 30 days after determination of specific format and content
requirements, subject =o a charge that is based on direct labor cost and data processing time.
Banking
We've assumed that you provide funds through a bank initiated Fedwire wire transfer for drafts issued under the self -funded
arrangement assumed in this renewal.
When claims have accumulated to more than $20,000, a request will be sent to you and/or your bank requesting funds for the
total claims from the previous day(s). For most customers, this will mean daily claim wire transfers. In addition, there will be a
month end close out request on the first banking day of each subsequent month.
The proposed banking arrangement is subject to change based on results of a credit risk evaluation. We will complete an
evaluation upon notification of sale.
We've assumed you'll _Ise no more than three primary banking lines which are shared across all self -funded products,
excluding Flexible Speeding Account (FSAs). Additional wire lines and customized banking arrangements will result in an
adjustment to the proposed pricing.
Network Services
Custom Network
We've quoted a Cus:om Network in order to support your specific needs. A Custom Network can include, but is not limited to:
• Providers that we add to our standard network at your request
• Providers that ycii add through a third -party network to our standard network
• You negotiate a cifferent reimbursement contract with providers
A Custom Network may assume:
• You designate ce-lain providers, either added to or already in our standard network, for purposes of benefit level
• You incent members, through plan design steerage, to use the designated hospital(s) and affiliated physician(s) for their
care
Typically, this plan des gn provides for two in -network benefit levels where a higher reimbursement level is associated with a
set of providers desigrated by you. The Custom Network with the corresponding incentives through plan design steerage is an
Integrated Delivery Sy tern.
7/6/2023
Proprietary
taetna
Caveats Self -Funded
Weld County Government
Caveats - Self -Funded Effective Date: January 01, 2024
O ur quoted fees include the cost for establishing and maintaining your Custom Network. Our charge is partially based on the
actual number of physicians and hospitals in the Custom Network. For purposes of our quote, we assume that your Custom
N etwork has less than 300 hospitals/physicians. Our charge may change if the number of physicians and hospitals differs from
our assumption.
If your Custom Network includes adding providers not currently in our network ("customer -specific provider"), we assume
these customer -specific providers will be in addition to our standard network.
O ur pricing for administration of claims associated with the customer -specific providers assumes that we'll receive this data in
one electronic file in our standard layout from one administrator. If the information required for automated claims
adjudication:
• is not provided by your vendor, or
• more than one electronic file is provided, or
• the files come from more than one administrator,
we may charge additional amounts. If we don't receive the required data and contracts by the date in the implementation
timeline provided or 60 days before the effective date of our administration, we may not be able to pay claims on the effective
date. If so, related performance guarantees may no longer be applicable.
Final pricing will be determined after we have assessed the overlap between our standard network and your Custom Network
along with additional administrative requirements and specifications.
Additional
Please review the additional important information found at the following URL. This information is incorporated by reference
into this package and considered part of your Agreement. This quote is subject to all the terms and conditions set
forth in this URL. In the event that any information contained herein conflicts or is inconsistent with the information in the
Underwriting Disclosure Document, the information in your package prevails.
https://www.aetna.com/document-libraryilarge-group-public-labor-self-funded-medical-underwriting-disclosures-5-15-2022.pdf
Legislative and Regulatory Requirements
Affordable Care Act (ACA) Taxes and Fees - Notice to Self -Funded Group Health Plan's Financial Liability
The Affordable Care Act (ACA) imposed Patient -Centered Outcome Research Trust Fund fee (PCORI) on the issuers of specified
health insurance policies and plan sponsors of applicable self -insured health plans. The fee was set to end in 2019, but it was
extended for 10 years through 2029. The fee applies to policy or plan years ending on or after October 1, 2012, and before
October 1, 2029.
Any taxes or fees (assessments) related to the Affordable Care Act that apply to the self -insured health plans are your
obligation. The Administrative Service Fee does not include any such liability or the remittance of the fees on your behalf.
NSA Payment Practices
The No Surprises Act (NSA) applies to certain out of network claims at participating facilities when the member doesn't have
a choice or is unaware the provider is out of network. The law protects plan participants by limiting cost sharing to the
preferred benefit level and prohibits balance billing by out of network providers. For NSA eligible claims, we will pay the
out of network provider an initial payment amount. In most cases, the initial payment will be an amount equal to the
qualifying payment amount as defined in NSA regulations (generally, the median contracted rate for a specific service in a
geographic area). A provider may choose to go to independent dispute resolution (IDR) if the provider does not accept our
payment as payment in full. During the IDR process, you authorize us to pay more than the qualified payment amount in
order to reasonably settle the matter when it appears expedient to do so.
7/6/2023
Proprietary
iraetna
Caveats Self -Funded
Weld County Government
Caveats - Self -Funded Effective Date: January 01, 2024
Recovery of Overpayments
Our process of recover ng overpayments attempts to recoup money in the most accurate, effective, and cost-efficient manner.
When seeking recovers of overpayments from a provider, we have established the following process: If unable to recover the
overpayment through other means, we may offset one or more future payments to that provider for services rendered to
Plan Participants by an amount equal to the prior overpayment. We may reduce future payments to the provider (including
payments made to tha- provider involving your or other health and welfare plans that are administered by us) by the amount
of the overpayment, ar d we will credit the recovered amount to the plan that overpaid the provider. By entering into an
agreement with us, you are agreeing that its right to recover overpayments shall be governed by this process and that it has
no right to recover any specific overpayment unless otherwise provided for in the Agreement.
7/6/2023
Proprietary
vaetna
Caveats Self -Funded
Weld County Government
Guarantee Summary Effective Date: January 01, 2024
We believe that measuring the activities described below is an important indicator of how well we service your account, as such,
we have included the following performance guarantee(s) as part of our proposed offering.
This information pertains to any performance guarantee(s) shown below, or for any additional guarantees which may be offered
for the same Guarantee Period. Refer to the guarantee documents for additional conditions and details.
The performance guarantee(s) described herein will not apply if the Agreement is terminated prior to the end of the Guarantee
Period. In addition, all included performance guarantee(s) are subject to enrollment requirements as outlined in the financial
conditions of each included guarantee.
Aggregate Maximum
The maximum payout for all guarantees combined is 17 percent of the fees at risk based on the calculation as noted in the
provisions below.
General Guarantee Provisions
1. Fees at risk are calculated at the year-end reconciliation, using the paid medical administrative service fees for
employees covered under each guarantee before Pharmacy Integration Offset for the Guarantee Period and
• Allowance(s)
• Any charges for services performed which are not included on the monthly administrative service fee bill
2. Results are estimated to be available at the end of the quarter noted below, following the close of the Guarantee Period:
Second Quarter
• Service Performance Guarantee
Third Quarter
• Care Management ROI
3. If the guarantee(s) have not been met, we will either:
• Provide reimbursement to you for the amount due, or
• Reduce future administrative fee payment(s) by the amount due to you.
4. These guarantee(s) are considered an amendment to your existing services Agreement. Continuance of your benefit plan and
payment of fees constitutes an acceptance of these guarantee(s).
5. We reserve the right to revise or remove these guarantee(s) if a material change to the plan is initiated by you or legislative or
regulatory action which:
• Impacts our standard claim adjudication process, member services functions, medical management or network
management
• Changes the products, programs and services we offer you
6. The guarantee(s) are considered met if:
• You terminate participation in products, programs and services tied directly to guarantee(s), prior to the end of the Guarantee
Period
• You terminate your Aetna medical plan in whole or in part (defined as 50 percent or greater membership reduction from the
membership we assumed in this renewal) prior to the end of the Guarantee Period, December 31, 2024.
• You fail to meet your obligations under the Agreement (for example, a submission of incomplete eligibility or failure to fund
claim payments)
7/6/2023
Proprietary
taetna
Guarantee Summary
Weld County Government
Guarantee Summary
Effective Date: January 01, 2024
Service Performance Guarantees
We guarantee the acministration of your medical and behavioral health product(s) in the following areas:
Performance Category Minimum Standard Maximum Fees
ID Card Production L Distribution 97% within 15 days 1.5%
Y.
Account Management
illa
Overall Account Ma iagement Average score of 3.0 3.0%
Administration
Turnaround Time (TAT) 14 days for 90.0P, 2.5%
Financial Accuracy 99.0% 2.5%
Total Cairn Accuracy 95.0% 2.5%
Average Speed of Answer (ASA) 30 seconds 2.5%
Abandonment Rate 2.5% 2.5%
Total 17.0%
Care Management ROI Guarantee
We guarantee the swings associated with your Care Management Program.
Care Management
Model
Fees at
Risk
Savings ROI
Aetna One Flex
$5.58
PEPM
2:1
7/6/2023
Proprietary
vaetna
Guarantee Summary
Weld County Government
Performance Guarantee
Effective Date: January 01, 2024
Guarantee Period: January 01, 2024 through December 31, 2024
Service Performance Guarantees
We guarantee the administration of your medical and behavioral health product(s) in the following areas:
Performance Category
Minimum
Standard
Maximum
Fees
at
Risk
ID Card
Production &
Distribution
97% of ID
cards
mailed
within
15
business days
1.5%
ccount
Management
Overall
Account
Management
Average evaluation
score of
3.0
3.0%
Turnaround
Time
14 calendar
days
for 90.0% of
the
processed
claims
2.5%
Financial
Accuracy
99.0% 2.5%
Total
Claim
Accuracy
95.0% I 2.5%
Average Speed
of
Answer (ASA)
30 seconds
2.5%
Abandonment
Rate
2.5%
2.5%
Total _
17.0%
The performance guarantees below will apply to the following self -funded medical plan(s) serviced under the Administrative
Services Only arrangement (through a "Services Agreement" or "Master Services Agreement", as the case may be, but each
from this point on referred to as the "Agreement").
• Aetna Choice POS II (CPII)
• Behavioral Health
Implementation
Open Enrollment ID Card Production and Distribution
This guarantee requires a minimum lead time of 90 days from the effective date.
Guarantee:
We guarantee that 97 percent of Open Enrollment printed ID cards will be produced and mailed to your members within
15 business days following the receipt of complete, accurate and viable electronic enrollment files.
Digital ID Cards are available via the member website or the Aetna Mobile Application (iPhone and Android) for members
with non -critical changes. Digital ID Cards are not included in this guarantee.
Payment and Measurement Criteria:
An adjustment of 0.30 percent will apply for each full business days that we fail to produce and mail ID cards within 15 business days.
The maximum adjustment is 1.5 percent. Our records are used to determine whether ID cards were produced and mailed within the
specified time frame.
7/6/2023
Proprietary
vaetna
Performance Guarantee ASC
Weld County Government
Performance Guarantee Effective Date: January 01, 2024
Account Management
Overall Account Management Guarantee
Guarantee:
We guarantee that tele services we provide you (i.e., on -going account management, financial, eligibility, drafting and
benefit administration during the Guarantee Period will be satisfactory to you.
https://aetna.col.qualtrics.com/1fe/form/SV 6DPuqukxiAAwwTTFFttPP
Payment and Measure ment Criteria:
Via semi-annual responses to the Account Management Evaluation Tool at the link above, you agree to make us aware of
possible sources of dissatisfaction throughout the Guarantee Period. Your responses will evaluate account management
services in the followirg categories:
• technical knowledge
• professionalism
• proactive n- anagement
• accessibi
• responsiveness of personnel
Each category will be given a rating of 1 - 5 with 1 = lowest, 5 = highest. We will tally the results from the report card(s)
when received. The results of the survey(s) are used to facilitate a discussion between you and your Account Team
regarding the results achieved and opportunities for improvement.
If all report cards base J on the frequency of the guarantee are not completed and returned within 15 days after the
six month period, it s assumed that the service provided to you is satisfactory and the guarantee is deemed met.
If the score on the first report card and the report card(s) for the subsequent survey(s) average a 3.0 or higher,
no credit is due. Satisfactory service would equal a score of 3.0 and would be based on the total average of
24 questions with a -a- ing scale of 1 to 5. Should the score from the first report card and the average of the remaining
report card(s) fall Belo N a 3.0 (meaning that service levels have not improved), we will make a mutually agreed upon
adjustment. The maximum adjustment is 3.0 percent.
Claim Administration
Turnaround Time (TAT)
Guarantee:
We guarantee that the claim TAT during the Guarantee Period will not exceed 14 calendar days for 90.0 percent of the
processed claims on a cumulative basis each year.
Definition:
We measure TAT frcm the claimant's viewpoint; that is, from the date the claim is received in the service center to the date
that it is processed (paid, denied or pended). TAT excludes those claims identified as rework. Weekends and holidays are
included in turnaroun i time. This guarantee may not apply and a payment may not be made, if results are not achieved due to
severe weather events which directly or indirectly impact performance during the Guarantee Period.
Payment and Measurement Criteria:
An adjustment of 0.50 percent will apply for each full day the TAT exceeds 14 calendar days for 90.0 percent of the processed claims.
The maximum adjusts- ent is 2.5 percent.
If you have more than 3,000 enrolled members, a computer generated TAT report for your specific claims will be provided
on a quarterly basis. If you have less than 3,000 enrolled members, results will be reported at the site level.
Financial Accuracy
Guarantee:
We guarantee that the financial accuracy will be 99.0 percent or higher.
7/6/2023
Proprietary
aetna
Performance Guarantee ASC
Weld County Government
Performance Guarantee Effective Date: January 01, 2024
Definition:
Financial accuracy is measured using industry accepted stratified audit methodology. Each overpayment and underpayment
is considered an error; they do not offset each other. Financial accuracy includes both manual and auto adjudicated claims.
Accuracy in each stratum (a subset of the claim population) is calculated by:
Dollars Paid Correctly
Total Dollars Paid
We then extrapolate the results based on the size of the population and combine them with the extrapolated results of the
other strata.
Payment and Measurement Criteria:
An adjustment of 0.50 percent will apply for each full 1.0 percent that financial accuracy drops below 99.0 percent. The maximum
adjustment is 2.5 percent.
Our audit results for the unit(s) processing your claims are used. Those results include our performance in processing ALL
customers' claims handled by the unit(s) in question during the Guarantee Period, not just your plan's claims.
Total (Overall) Claim Accuracy
Guarantee:
We guarantee that the total (overall) claim accuracy will be 95.0 percent or higher.
Definition
Overall accuracy is measured using industry accepted stratified audit methodology. Accuracy in each stratum (a subset of
the claim population) is calculated by:
Number of claims processed correctly
Total number of claims audited
We then extrapolate the results based on the size of the population and combine them with the extrapolated results of the
other strata.
Payment and Measurement Criteria:
An adjustment of 0.50 percent will apply for each full 1.0 percent that total claim accuracy drops below 95.0 percent. The maximum
adjustment is 2.5 percent.
Our audit results for the unit(s) processing your claims are used. Those results include our performance in processing ALL
customers' claims handled by the unit(s) in question during the Guarantee Period, not just your plan's claims.
Member Services
Average Speed of Answer (ASA)
Guarantee:
We guarantee that the ASA for the phone skill(s) providing your customer service will not exceed 30 seconds.
Definition
ASA is defined as the amount of time that elapses between the time a call is received into the telephone system and the
time a Customer Service Professional (CSP) responds to the call. The result is calculated as follows:
Sum of all waiting times for all calls answered by the queue
Number of incoming calls answered
ASA measures the average speed of answer for all calls answered. Interactive Voice Response (IVR) system calls are not
included in the measurement of ASA. In the event there is an outage or when experiencing peak volumes, calls may be
transferred to other Aetna call centers. This guarantee may not apply and a payment may not be made, if results are not
achieved due to severe weather events which directly or indirectly impact performance during the Guarantee Period.
7/6/2023
Proprietary
taetna
Performance Guarantee ASC
Weld County Government
Performance Guarantee Effective Date: January 01, 2024
Payment and Measurement Criteria:
An adjustment of 0.50 Dercent will apply for each full second that the ASA exceeds 30 seconds. The maximum adjustment is 2.5
percent. The phone ski 1(s) providing your customer service are used.
Abandonment Rate
Guarantee:
We guarantee that the average rate of telephone abandonment for the phone skill(s) providing your customer services will
not exceed 2.5 percent
Definition:
The result is calculated as follows:
Total number of calls abandoned
Number of calls accepted into the skill(s)
In the event there is ar outage or when experiencing peak volumes, calls may be transferred to other Aetna call centers.
This guarantee may no: apply and a payment may not be made, if results are not achieved due to severe weather events which
directly or indirectly impact performance during the Guarantee Period.
Payment and Measurement Criteria:
An adjustment of 0.50 aercent will apply for each full 1.0 percent that the average abandonment rate exceeds 2.5 percent. The
maximum adjustment s 2.5 percent. The phone skill(s) providing your customer service are used.
General Performar ce Guarantee Provisions
These guarantees do n )t apply to third party benefit administrators contracted by Aetna.
This offer does not cortemplate significant changes in volume and calls that may occur with novel conditions or circumstances
affecting broad popula:ions that place a significant strain on the health care system and/or your plan(s). These conditions include but
are not limited to COV D-19. We reserve the right to adjust the terms and factors of this guarantee in response to these conditions
and/or circumstances F necessary.
If we process runoff clE ims from a prior carrier or administrator, the performance guarantees described in this document
(other than Account Management Guarantees) will begin 3 months after the Guarantee Period effective date.
If we process runoff clt ims upon termination of the Agreement, the Turnaround Time, Financial Accuracy, and/or Total Claim
Accuracy performance guarantees will not apply to runoff claims.
7/6/2023
Proprietary
1Paretna
Performance Guarantee ASC
Weld County Government
Care Management Guarantees Effective Date: January 01, 2024
Guarantee Period: January 01, 2024 through December 31, 2024
Guaranteed ROI: 2:1
Guarantee:
We will guarantee that the savings associated with the Care Management Program will be equal to two times
the Guarantee Period administrative service fee of $5.58 per employee, per month (PEPM) to a maximum of the total fee.
The guaranteed fee includes program fees for the following:
• Concurrent review
• Precertification
• Aetna One Flex
• CareEngine/MedQuery
• Aetna Advice
Reconciliation:
The Guarantee Period administrative service fees will be calculated at the end of the Guarantee Period and will be based on the
total number of employees actually enrolled in the underlying medical plans that also offer the Care Management guarantee
throughout the Guarantee Period.
The guarantee will be reconciled annually using the MedQuery Savings Report, the Program Savings Report and the Aetna
Advice Savings Report. For customers with 2,000 or more employee lives, customer specific results will be used. For
customers with fewer than 2,000 employee lives, book of business results will be used. Book of business results are
available on a calendar year basis only.
Payment and Measurement Criteria:
If the achieved Care Management ROI savings result in savings ratio less than 2:1, we will make an adjustment by the amount
necessary to achieve a savings of two times the fees paid.
Example:
If the Guarantee Period administrative fees for the care management program are $150,000, and the care management
program savings are $200,000, we will reduce the Guarantee Period administrative fees by $50,000. This $50,000 reduction
would lower the administrative service fees paid to $100,000, resulting in a 2:1 ratio of program savings to program costs.
Financial Conditions:
We reserve the right to revise or remove the guarantee if any of the following conditions are not met:
• If actual Aetna medical enrollment stays within 10 percent of the enrollment assumed within this guarantee.
Guarantee assumes at least 500 eligible subscribers.
• Medical and pharmacy products are provided by Aetna.
• The average member age is 35 or older or the average employee age of enrolled participants is 40 or older.
• The member to employee ratio is at least 2.0.
• Member eligibility (complete, accurate and viable enrollment data; including member phone numbers) is fully loaded in our
eligibility system 35 days prior to effective date.
• You agree to not prevent or otherwise restrict us from contacting your members for purposes of the Aetna Advice
program, except where required by law or regulation.
• You do not turn off any of the Aetna Advice campaigns.
7/6/2023
Proprietary
iraetna
CM ROI Guarantee
Weld County Government
Account Management Evaluation Survey Tool
Effective Date: January 01, 2024
Evaluation Period:
We would like to better J ierstond how you view your relationship with us. In responding to this survey, we ask you to look at the services received from
your Account Managemen Team for the time period listed above. Your feedback will enable us to better meet your needs. Thank you for your participation.
Knowledge:
Indicate
the e:tent to which you agree that
your Account Management
Team:
Rating
or any "Disagre: " or
plea rovid • sp
"Strongly Disagree"
is comments in
responses,
the area below
• understands
your plan of benefits
Please Select
• understands the business needs of your company Please Select
• understands the
servic expectations of your company
'
- .se Select
• displays knowledge regarding our products and services Please
lect
. clearly explains report
-esults Please
Sele
Total Rating
I.0
Professionalism:
Indicate
-he extent
to which
you agree that your Account
Management
Team:
or any "Di agree" or "Strongly Disagree" responses,
Rating
ple
e provide specific comments in the area below
actively listens to and acknowledges your issues and concerns
Please
Select
• provides appropriate verbal
communication
PI-
-se -
-ct
• provides appropriate v-ritten communication PI
se Selec
works with you to develop a positive working relationship Pleas-
elec
Total
Ratin:
0.0
.Proactive Management:
Jr
dicate
the extent to which you agree that
your Account
Management
Team:
Ra • •
For an "Disagree" or "Strongly Disagree" responses,
.lea •e provide specific comments in the area below
monitors your account on an on -going basis ,
Please
Self
ct
communicates potential problematic
issues
'
-ase S' lect
provides viable
alternaives to meet your business needs
Pleas-
elect
• manages system conversions and changes in plan design
in an o •anized '
-ase Select
• sets realistic expectations regarding turn -around time
Please Select
• sets realistic expectations regarding cost P
-ase Select
Total • . ing 0.0
Accessibility:
Indicate the extent to which
you agree
that your Account Management
Team:
WFor any "Disagree" or "Strongly Disagree" responses,
Rating please provide specific comments in the area below
is available
to you
Please
Select
• allocates
appropriate t me when meetin:.
with
•u Please
Select
demonstrates
flexibilit, with regard
to sc
ledu
• c
ang:s
Please
Select
provides/communicates
al - . a ontacts •
the
event •
eir absence Please Select
• advises
you of schedul
imitations
Please Select
Total Rating 0.0
Responsiveness:
Indicate
The
?xtent to which
you agree that
your Account Management Team:
ye For any "Disagree" or "Strongly Disagree" responses,
\
Rating please provide specific comments in
the area below
• responds
to your inqui sin a ti
y •anne
Please Select
• provides
thorough responses to your nquiries Please Select
• follows
-through regarc ing outstand g issues/ite► s Please Select
• solicits
the
assistance cdf our product
- -• •+
en needed Please Select
.
Total Rating 0.0
Overall
Account Management Team Evaluation:
Total Overall Rating
Average Overall Rating
0.0
0.00
Any other
comments or suggested action steps:
7/6/2023
Propietary
i►aetna
Account Management Survey
FLEXIBLE. EXPERIENCED. RESULTS ORIENTED.
Stop Loss Insurance
Marketing Report
Weld County Government
1,14
B E N E ! I 1'
AN AL!RA GROUP COMPANY
Table of Contents
Stop -Loss Market Submission Summary
S top -Loss Insurance Marketing Results
Underwriting Projection
S top -Loss Risk Decision Support Analytics
P roposal Qualifications & Contingencies
Disclaimers and Definitions
All rights reserved. Unauthorized use of this document is strictly prohibited. 2
10/19/2023
//1 shirtizi
B E N E F I TS
AN AURA GROUP COMPANY
Stop -Loss Market Response Summary
All rights reserved. Unauthorized use of this document is strictly prohibited.
10/19/2023
3
FlAtini
BENEF 1 TS
AN ALBRA GROUP COMPANY
Stop -Loss Market Response Summary
Stop -Loss Market
Market Response
Berkley Accident and Health
Berkshire Hathaway Specialty Insurance Company
Granular Insurance Company
HM Insurance Group
ISU, a division of Companion Life Insurance Company
Optum
QBE A&H
Sun Life Financial
Swiss Re
Symetra
Tokio Marine HCC
Voya Financial
Wellpoint Stop Loss
All rights reserved. Unauthorized use of this document is strictly prohibited.
10/19/2023
Declined
Declined
Quoted - Firm
Quoted - Contingent
Declined
Pending
Declined
Quoted - Contingent
Quoted - Contingent
Declined
Declined
Quoted - Contingent
Pending
4
Uncompetitive Rates
Adverse Large Claims History
Adverse Large Claims History
Adverse Large Claims History
Adverse Large Claims History
Uncompetitive Rates
IFS titan
BENEF ITS
AN ALBRA GROUP COMPANY
Stop -Loss Marketing Detail
All rights reserved. Unauthorized use of this document is strictly prohibited.
10/19/2023
5
rsdtrizi
BENEF ITS
AN ALERA GROUP COMPANY
Stop -Loss Terms
Current
Renewal 1
Renewal 2
Option 1
Stop -Loss Market
Stop -Loss Carrier and Financial Rating
AS0/TPA
Provider Network
Individual Stop -Loss (ISL) Terms
Deductible
Deductible Accumulation
Separate Laser Liabilities
Separate Aggregating Specific Deductible
Maximum Coverage Limit
Contract Basis
Coverages Included
Terminal Liability Option Provision
No New Laser at Renewal Provision
Premium Rate Cap at Renewal Provision
Plan Mirroring Provision
Advance Reimbursement Provision
Experience Refund Provision
Retirees Covered
Aggregate Stop -Loss (ASL) Terms
Deductible Corridor
Contract Basis
Annual Maximum Benefit
Coverages Included
Minimum Annual Attachment Point
Run -In / Run -Out Limit
Terminal Liability Option Provision
Aggregate Accommodation
Retirees Covered
Status
Commission
Aetna, Inc.
Aetna, Inc.
Aetna, Inc.
Aetna
$300,000
Per Individual
None
SO
Unlimited
Paid
Medical;Prescription Drugs
Included
Included
Included; 40%
Included; Subject to plan
document approval
Included
Not Included
No
120%
Paid
S1,000,000
Medical;Prescription Drugs
$32,557,538
SO
Included - 3 Months
Annual
No
Current
0.00%
Aetna, Inc.
Aetna, Inc.
Aetna, Inc.
Aetna
$300,000
Per Individual
None
$0
Unlimited
Paid
Medical;Prescription Drugs
Included
Included
Included; 40%
Included; Subject to plan
document approval
Included
Not Included
No
120%
Paid
$1,000,000
Medical;Prescription Drugs
532.557, 538
$0
Included - 3 Months
Annual
No
Quoted - Firm
0.00%
Claimant 3434
Claimant 2274
Aetna, Inc.
Aetna, Inc.
Aetna, Inc.
Aetna
$300,000
Per Individual
- Deductible:
$950,000
- Deductible:
$700,000
$0
Unlimited
Paid
Medical;Prescription Drugs
Included
Included
Included; 40%
Included; Subject to plan
document approval
Included
Not Included
No
120%
Paid
$1,000,000
Medical;Prescription Drugs
$34,424.441
$0
Included - 3 Months
Annual
No
Quoted - Firm
0.00%
Granular Insurance
Company
Granular Insurance Company
A -
Aetna, Inc.
Aetna
$300,000
Per Individual
Claimant with Hereditary
Factor VIII (2274) -
Deductible: $2,500,000 ; In
the event of Gene Cell
Therapy
$0
Unlimited
24/12
Medical;Prescription Drugs
Included
Included
Included; 40%
Included; Subject to plan
document approval
Included
Not Included
No
120%
24/12
$1,000,000
Medical;Prescription Drugs
$32,130,513
$0
Included - 3 Months
Annual
No
Quoted - Firm through
10/31/2023
0.00%
Stop -Loss Premium (Fixed Cost)
Lives
Individual Stop -Loss (ISL) Composite
Annual Premium Subtotal
Aggregate Stop -Loss (ASL) Composite
Annual Premium Subtotal
Total Annual Premium/Fees
Change from Current ($)
Change from Current (%)
1,409
1,409
1,409
1.409
$120.62
$2.039,442.96
512.73
$215,238.84
$2,254,681.80
$167.88
52,838,515.04
$15.06
5254,634.48
$3,093,149.52
$838,467.72
37.19%
$129.53
$2,190,093.24
$15.35
$259,537.80
$2,449,631.04
$194,949.24
8.65%
$152.93
$2,585,740.44
$11.30
$191,060.40
$2,776,800.84
$522,119.04
23.16%
Stop -Loss Aggregate Claim Liability (Variable Cost)
Lives
Aggregate Factors Composite
Maximum Claim Liability (Aggregate Attachment Point)
Change from Current ($)
Change from Current (%)
Expected Claim Liability
Expected Plan Cost
Maximum Plan Cost (Includes Separate Aggreqatinu Specific Deductible)
Change from Current ($)
Change from Current (%)
1,409
1.409
$1,925.57
$32,557.537.56
$27,131,281.30
$29,385,963.10
$34.812,219.36
$1,925.57
$32,557,537.56
$0.00
0.00%
$27,131,281.30
$30,224,430.82
$35.650,687.08
$838,467.72
2.41%
$1,961.46
$33.164,365.68
$606,828 12
1 86%
$27,636,971.40
$30,086,602.44
$35.613.996.72
$801, 777.36
2.30%
$1,905.86
$32.224,280.88
-$333, 256.68
-1.02%
$26,853,567.40
$29,630,368.24
$35.001,081.72
$188, 862.36
0.54%
All rights reserved. Unauthorized use of this document is strictly prohibited.
10/19/2023
6
Stop -Loss Terms
Option 2
Option 3
Option 4
Stop -Loss Market
Stop -Loss Carrier and Financial Rating
ASO/TPA
Provider Network
Individual Stop -Loss (ISL) Terms
Deductible
Deductible Accumulation
Separate Laser Liabilities
Separate Aggregating Specific Deductible
Maximum Coverage Limit
Contract Basis
Coverages Included
Terminal Liability Option Provision
No New Laser at Renewal Provision
Premium Rate Cap at Renewal Provision
Plan Mirroring Provision
Advance Reimbursement Provision
Experience Refund Provision
Retirees Covered
Aggregate Stop -Loss (ASL) Terms
Deductible Corridor
Contract Basis
Annual Maximum Benefit
Coverages Included
Minimum Annual Attachment Point
Run -In / Run -Out Limit
Terminal Liability Option Provision
Aggregate Accommodation
Retirees Covered
Status
Commission
Aetna, Inc.
Aetna, Inc.
Aetna, Inc.
Aetna
$325,000
Per Individual
None
SO
Unlimited
Paid
Medical:Prescription Drugs
Included
Included
Included; 40%
Included; Subject to plan
document approval
Included
Not Included
No
120%
Paid
S1,000,000
Medical:Prescription Drugs
S32.557,538
SO
Included - 3 Months
Annual
No
Quoted - Firm
0.00%
Claimant 3434
Claimant 2274
Aetna, Inc.
Aetna, Inc.
Aetna. Inc.
Aetna
$325,000
Per Individual
- Deductible:
$950,000
- Deductible:
$700,000
$0
Unlimited
Paid
Medical:Prescription Drugs
Included
Included
Included; 40%
Included; Subject to plan
document approval
Included
Not Included
No
120%
Paid
$1,000,000
Medical:Prescription Drugs
$34,424,441
SO
Included - 3 Months
Annual
No
Quoted - Firm
0.00%
Granular Insurance
Company
Granular Insurance Company
: A -
Aetna, Inc.
Aetna
$325,000
Per Individual
Claimant with Hereditary
Factor VIII (2274) -
Deductible: $2,500,000 ; In
the event of Gene Cell
Therapy
$0
Unlimited
24/12
Medical:Prescription Drugs
Included
Included
Included; 40%
Included: Subject to plan
document approval
Included
Not Included
No
120%
24/12
$1,000.000
Medical:Prescription Drugs
$32,884.438
$0
Included - 3 Months
Annual
No
Quoted - Firm through
10/31/2023
0.00%
Stop -Loss Premium (Fixed Cost)
Lives
Individual Stop -Loss (ISL)
Composite
Annual Premium Subtotal
Aggregate Stop -Loss (ASL) Composite
Annual Premium Subtotal
Total Annual Premium/Fees
Change from Current ($)
Change from Current (%)
1,409
1,409
1.409
1,409
$151.97
S2,569,508.76
S15.15
S256,156.20
$2,825,664.96
$570,983.16
25.32%
$117.25
S1,982,463.00
$15.43
S260,890.44
$2,243,353.44
$11,328.36
-0.50%
$141.24
$2,388.085.92
$11.56
$195,456.48
$2,583,542.40
$328,860.60
14.59%
Stop -Loss Aggregate Claim Liability (Variable Cost)
Lives
Aggregate Factors Composite
Maximum Claim Liability (Aaaregate Attachment Point)
Change from Current ($)
Change from Current (%)
Expected Claim Liability
Expected Plan Cost
Maximum Plan Cost (Includes Separate Aggregatinc7 Specific Deductible)
Change from Current ($)
Change from Current (%)
1,409
1,409
All rights reserved. Unauthorized use of this document is strictly prohibited.
10/19/2023
S1,936.83
$32,747,921.64
$190,384.08
0.58%
$27,289,934.70
$30,115,599.66
$35,573,586.60
$761,367.24
2.19%
7
$1,972.73
$33,354,918.84
$797,381.28
2.45%
$27,795,765.70
$30,039,119.14
$35,598,272.28
$786,052.92
2.26%
$1,950.58
$32,980,406.64
$422, 869 08
1.30%
$27,483,672.20
$30,067,214.60
$35,563,949.04
$751,729.68
2.16%
thkazi
BENEFI TS
AN AURA GROUP COMPANY
Stop -Loss Terms
Option 5
Option 6
Option 7
Stop -Loss Market
Stop -Loss Carrier and Financial Rating
AS0/TPA
Provider Network
Individual Stop -Loss (ISL) Terms
Deductible
Deductible Accumulation
Separate Laser Liabilities
Separate Aggregating Specific Deductible
Maximum Coverage Limit
Contract Basis
Coverages Included
Terminal Liability Option Provision
No New Laser at Renewal Provision
Premium Rate Cap at Renewal Provision
Plan Mirroring Provision
Advance Reimbursement Provision
Experience Refund Provision
Retirees Covered
Aggregate Stop -Loss (ASL) Terms
Deductible Corridor
Contract Basis
Annual Maximum Benefit
Coverages Included
Minimum Annual Attachment Point
Run -In / Run -Out Limit
Terminal Liability Option Provision
Aggregate Accommodation
Retirees Covered
Status
Commission
Stop -Loss Premium (Fixed Cost)
Individual Stop -Loss (ISL)
Composite
Annual Premium Subtotal
Aggregate Stop -Loss (ASL) Composite
Annual Premium Subtotal
Total Annual Premium/Fees
Change from Current ($)
Change from Current (%)
Stop -Loss Aggregate Claim Liability (Variable Cost)
Aggregate Factors Composite
Maximum Claim Liability (Aggregate Attachment Point)
Change from Current ($)
Change from Current (%)
Expected Claim Liability
Expected Plan Cost
Maximum Plan Cost (Includes Separate Acjcyredatinq Specific Deductible)
Change from Current ($)
Change from Current (%)
1,409
1,409
1,409
1,409
Lives
1,409
1,409
Granular Insurance
Company
Granular Insurance Company
: A -
Aetna, Inc.
Aetna
$350,000
Per Individual
Claimant with Hereditary
Factor VIII (2274) -
Deductible: $2,500,000 ; In
the event of Gene Cell
Therapy
$0
Unlimited
24/12
Medical;Prescription Drugs
Included
Included
Included; 40%
Included: Subject to plan
document approval
Included
Not Included
No
120%
24/12
$1,000,000
Medical:Prescription Drugs
533.578,515
SO
Included - 3 Months
Annual
No
Quoted - Firm through
10/31/2023
0.00%
$130.95
52,214,102.60
$11.80
S199,514.40
$2,413,617.00
$158,935.20
7.05%
Aetna, Inc.
Aetna, Inc.
Aetna, Inc.
Aetna
$350,000
Per Individual
None
$0
Unlimited
Paid
Medical;Prescription Drugs
Included
Included
Included; 40%
Included; Subject to plan
document approval
Included
Not Included
No
120%
Paid
$1,000.000
Medical:Prescription Drugs
534,171,187
$0
Included - 3 Months
Annual
No
Quoted - Firm
0.00%
$137.56
52,325,864.48
$15.23
$257,508.84
$2,583,373.32
$328,691.52
14.58%
Aetna, Inc.
Aetna, Inc. :
Aetna, Inc.
Aetna
$350,000
Per Individual
Claimant 3434 - Deductible:
$950,000
Claimant 2274 - Deductible:
$700.000
$0
Unlimited
Paid
Medical:Prescription Drugs
Included
Included
Included; 40%
Included; Subject to plan
document approval
Included
Not Included
No
120%
Paid
$1,000,000
Medical;Prescription Drugs
$34,801,187
$0
Included - 3 Months
Annual
No
Quoted - Firm
0.00%
$106.14
$1,794,615.12
$15.51
$262,243.08
$2,056,858.20
-$197,823.60
-8.77%
All rights reserved. Unauthorized use of this document is strictly prohibited.
10/19/2023
S1,991.75
$33,676,509.00
$1,118,971.44
3.44%
$28,063,757.50
$30,477,374.50
$36,090,126.00
$1,277,906.64
3.67%
8
$1,947.03
$32,920,383.24
$362, 845.68
1.11%
$27,433,652.70
$30,017,026.02
$35,503,756.56
$691,537.20
1.99%
$1,982.93
$33,527,380.44
$969,842 88
2.98%
$27,939,483.70
$29,996,341.90
$35,584,238.64
$772.019.28
2.22%
BENEFITS
AN ALIRA GROUP COMPANY
Qualifications & Contingencies
All rights reserved. Unauthorized use of this document is strictly prohibited.
10/19/2023
9
rfithistei
BENEF I TS
AN *LIRA GROUP COMPANY
C _
ualifications & Contingencies
Granular
Insurance
Company
Quoted rates are binding
Quoted rates include the following:
- 0% commission
- No new lasers upon renewal
- Multi -Year Guarantee Eligibility for this Opportunity
- U Of Renewals: 1
- Price Limit Per Year: 40%
- Exercising the terminal liability option for 3 months of run out will require 2 additional months of premium; for 6 months of run out will require 3 months of additional premium.
- This proposal will require the completion of Granular's Disclosure statement.
Laura as i1 ILIiLutL.0 Liu lb
- [Diagnosis - Hereditary Factor Viii Deficiency 1- Conditional $2.5M if member receives gene cell therapy
Rates and Factors subject to attached Qualifications and
Contingencies and Plan Document Assumptions
All claims are reported/paid in U.S. dollars.
The proposal is based on the data provided. The proposal may be modified if data changes or under other conditions
as specified in this document.
This proposal is based on the continuation of the current plan(s) of benefits.
If the number of covered employees or the percentage of family participants change by more than 15% this proposal
may be revised.
If this proposal includes an offer of aggregate coverage, the monthly aggregate factor cannot be finalized more than
90 days from the effective date.
Advance Funding is included.
Retirees are covered under the Granular Insurance Policy. It is the responsibility of the employer to identify to
Granular Insurance all retirees to be covered under the Granular Insurance Policy. If a group does not have retirees,
their rate will not be impacted.
This proposal is valid only if presented by a licensed insurance agent or broker who is appointed by Granular
Insurance Company.
The agent/broker does not have the authority to bind or modify the terms of his offer without prior approval of
Granular.
We require notification 30 days prior to the acquisition date of any employer completed merger or acquisition.
Underwriting serves the right to modify coverage terms when a new division is added or deleted from coverage or
when plan and/or network changes occur.
Granular agrees to accept for claims reimbursement the employer's plan document.
If the aggregate is quoted, then the minimum annual aggregate total is 90% of the first month's enrollment times
monthly aggregate attachment points.
All rights reserved. Unauthorized use of this document is strictly prohibited. 10
10/19/2023
BENEF ITS
AN AURA GROUP COMPANY
Disclaimers & Definitions
All rights reserved. Unauthorized use of this document is strictly prohibited.
10/19/2023
11
tirazi
BEN I F ITS
AN ALERA GROUP COMPANY
Disclaimers
This proposal/summary has been prepared based on financial and underwriting information supplied to us by you and/or your current carrier/administrator.
In the event that there have been changes or we're missing material data, you must supply the data to us so that we in turn can forward the information to
the insuring companies for consideration.
This proposal is intended to be a summary, The actual policies issued by the insuring companies will contain the legally binding terms, conditions and
exclusions. Upon receipt of the policies, we urge you to thoroughly review them for accuracy and expected coverage. If you have any questions regarding
your understanding or acceptance, please notify us immediately.
The information displayed is intended to be a brief review of limits and coverages. It is not intended to be a complete description of all coverages,
exclusions, terms or conditions. Please refer to the policy for a complete explanation of coverages.
Our standard is to provide only proposals from insurers with A- or better financial ratings as determined by A.M. Best. If a proposal is presented from an
insurer with an A.M. Best financial rating below an A-, a separate disclosure will be provided. A.M. Best's Financial Strength Rating (FSR) is an opinion of
an insurer's ability to meet its obligations to policyholders. Rating Modifiers and Affiliation Codes may also be associated with these ratings. The following
list outlines their rating scale and associated descriptions.
A.M.
Best
Financial
Rating Scale
A++, A+ (Superior)
A, A- (Excellent)
B++,
B+(Very Good)
B,
B- (Fair)
C++,
C+
(Marginal)
C, C- (Weak)
D (Poor)
E (Under
Regulatory
Supervision)
F (In
Liquidation)
S (Rating
Suspended)
All rights reserved. Unauthorized use of this document is strictly prohibited.
10/19/2023
12
FS Nitta
BENEF ITS
AN ALBRA GROUP COMPANY
Stop -Loss Definitions
Specific Stop Loss (Reinsurance)
Coverage provided to limit a company's cost for eligible medical expenses for each covered individual. The stop -loss carrier assumes responsibility for claims in
excess of the individual stop -loss deductible.
Aggregate Stop Loss (Reinsurance)
Coverage which limits a company's overall policy period cost for self -funded benefit plan, protecting them against catastrophic losses on the entire plan.
Aggregate Attachment Point
The aggregate attachment point is determined annually and is the overall limit of claim liability for the entire group. It is based on a monthly factor determined by
the claims experience of the group, plus trend and a "risk corridor". The risk corridor is usually 25% above what the carrier expects the actual paid claims to be. It
is calculated by multiplying the monthly factor by the group's monthly enrollment and adding the twelve policy months together.
Aggregate Accommodation
An optional contract feature that can be purchased to provide monthly reimbursement under an aggregate policy when the cumulative paid claims exceed the year-
to-date accumulated attachment point.
Minimum Aggregate Attachment Point
Policyholder liability threshold established by the carrier that is typically 90% or 100% of the attachment point. It is established to protect the stop -loss carrier from
significant reductions in the employee population.
Advanced Funding (Specific Accommodation)
An optional contract feature which provides the policyholder a cash flow enhancement. Once an individual's paid claims exceed the specific stop loss deductible
the remaining eligible claims payments are made by the stop loss carrier. One carrier may define this element differently from another.
Laser Deductible
A stop loss carrier sets a higher specific deductible on an individual member at the time of underwriting. The person must exceed the established "lasered" amount
in paid claims for the policyholder to be eligible for a specific reimbursement.
All rights reserved. Unauthorized use of this document is strictly prohibited.
10/19/2023
13
Orti tirazi
BENEFITS
AN ALBRA GROUP COMPANY
Stop -Loss Definitions (cont.)
Aggregating Specific
An additional policy deductible which allows a self -funded plan to pay a lower stop -loss premium in exchange for retaining an initial layer of catastrophic liability.
The policyholder must pay the dollar amount additionally selected towards one or more individuals paid claims before any specific reimbursement is made under
the policy. In most cases, aggregating specific options are a dollar -for -dollar exchange; however, in some cases there may be an additional cost.
Run -Iii Liiriii
The claims dollar limit established by the carrier for claims incurred three months preceding the effective date of coverage.
Actively at Work Clause
Contract provision which requires an individual employee to be performing, on a full- time basis, the regular duties of his or her normal occupation on the effective
date of the policy or on his or her last regularly scheduled work day prior to the policy effective date.
Terminal Liability Provision
An aggregate contract feature that provides an additional period of coverage for claims incurred while the agreement is in force and are paid during the selected
period following termination of the agreement. Terminal liability must be purchased at the time the policy application is written. Policyholders may elect 90 to 120
days of extended coverage.
Contract Types
12/12 Incurred and Paid
Eligible claims under this contract type must be both incurred and paid during the 12 months of the policy period
12/15 Incurred and Paid
Eligible claims under this contract type must be incurred during the 12 month policy period and paid during the policy period plus the 3 months after the policy
termination date.
15/12 Incurred and Paid
Eligible claims under this contract type must be paid during the 12 month policy period and incurred during the policy period plus the 3 months prior to the
Paid Contract
Eligible claims under this contract type are paid within the policy period regardless of the incurred date. Available for policy renewal only.
All rights reserved. Unauthorized use of this document is strictly prohibited. 14
10/19/2023
Weld County Government
Stop Loss Financials
Effective Date: January 01, 2024
Control 4109724
Policy Period: January 01, 2024 through December 31, 2024
Status:
Final/Firm
Valid Until: 10/28/2023
• Please refer to the Stop Loss Assumptions and Caveats for additional information.
• Stop Loss rates and factors will be billed on a Composite PEPM basis.
Quote Specifications
Current Option 2
Contract Situs
Colorado
Colorado
Policy Period Length (months)
12
12
Total Enrollment
1,402
1,421
Producer Commission
None
None
Terminal Liability Option
TLO-3
TLO-3
Individual Stop Loss (ISL) Coverage
Current Option 2
Covered Benefits
Medical/Rx
Medical/Rx
Individual Stop Loss Amount
$300,000
$350,000
Lasering (High Risk Claimants)
Contract Type
ISL Coinsurance %
No
No
Paid
Paid
100% 100%
Maximum Annual ISL Payment Amount
Unlimited Unlimited
Renewal Risk Cap
40%
40%
ISL Composite PEPM Rate
$120.62
$137.56
Estimated ISL Policy Period Premium
$2,029,311
$2,345,673
% Change in Individual Stop Loss Premium
14.0%
Aggregate Stop Loss (ASL) Coverage
Current Option 2
Covered Benefits
Medical/Rx
Medical/Rx
Aggregate Stop Loss Percentage
120%
120%
Contract Type
Paid
Paid
Maximum Annual ASL Payment Amount
$1,000,000 $1,000,000
ASL Composite PEPM Rate
$12.73 $15.23
Estimated ASL Policy Period Premium
$214,170 $259,702
Projected Policy Period Total Claims
$26,996,499 $28,475,989
Projected Policy Period Aggregate Corridor
$32,395,790 $34,171,187
Aggregate Stop Loss Factor PEPM
$1,925.57
$1,947.03
Minimum Aggregate Stop Loss Amount
$32,395,790 $34,171,187
Financial Summary
Current Option 2
Total ISL & ASL Composite PEPM Rate
$133.35
5152.79
Estimated Monthly Premium
$186,957
$217,115
Estimated Policy Period Stop Loss Premium
$2,243,481
$2,605,375
% Change in Total Stop Loss Premium
14.6%
TLO Total PEPM Rate
$133.35 $152.79
TLO Premium Due at Termination
2 Months 2 Months
Projected TLO Claim Liability
$37,795,086 $36,449,266
This quotation is issued or underwritten by Aetna Life Insurance Company.
I authorize the renewal of stop loss for 1/1/2024 with Option 2-
$350,000 ISL. Aggregate, TLO3 (No lasers) for a total monthly
premium rate of S152.79 pepm
N ame
S ignature Date
Weld County Government
Stop Loss Assumptions & Caveats Effective Date: January 01, 2024
For the purposes of this document, Aetna may be referred to using "we", "our", or "us" and Weld County Government may be
referred to using "you" or "your".
We are pleased to provide you with our renewal for Stop Loss insurance. These Assumptions and Caveats,
in conjunction with the Stop Loss Financials exhibit, combine to form the entirety of this renewal. Please
review them carefully and notify us immediately if any of the features do not meet your expectations or if any of
our assumptions are incorrect. Changes in the features or assumptions may affect premium rates or claim factors.
Additional state -specific notices should be reviewed at this link:
https://www.aetna.com/content/dam/aetna/pdfs/aetnacom/legal-notices/documents/stop-loss-underwriting-disclosures-06-06-
2023.pdf
If you renew Aetna's Stop Loss coverage, you will receive your application for insurance electronically. You will access
it via a link delivered by email and endorse it using electronic signature capabilities. You will also receive your policy
electronically. This process requires a web browser which supports the HTTPS protocol, HTML, and cookies. You will also
need to view PDF documents using software such as Adobe Reader or similar.
You have the right to request that these transactions occur by regular mail using paper copies, which would require you to
physically sign your application and mail it back to us. Please contact your broker and/or your Aetna Account Manager
to make this request.
Stop Loss policies and applications/schedules of insurance are updated annually upon renewal. Please contact your broker
and/or your Aetna Account Manager for a copy of the Stop Loss policy.
This proposal assumes you have notified us of any known applicants for gene replacement therapy.
Renewal Status
This is a final, firm offer. You must accept the rates by 10/28/23.
If you fail to accept the rates by 10/28/23, we reserve the right to request updated underwriting data,
which may alter the rates and terms of the offer.
Assumptions
• The policy period is indicated on the Stop Loss Financials. The Stop Loss policy period must agree with the
self -funded plan's contract period, both of which must end on the next renewal date.
• Eligible medical claim expenses are funded on an issued basis.
• It is assumed Aetna is also the claim fiduciary for the self -funded plan(s) covered by Stop Loss. Claims approved by fiduciary
override/exception are not covered by Stop Loss.
• Eligibility for Stop Loss coverage will apply as described in the self -funded benefit plan(s) and in accordance
with the Stop Loss policy provisions.
• In at least one quoted option, Pre -65 and post -65 retirees, and their dependents, have been excluded from Stop Loss coverage.
Retirees will need separate account structure from the active population covered by Stop Loss.
• There must be common ownership among all participating divisions or subsidiaries for this quote to remain valid.
• Your business and/or Standard Industrial Code is 9111.
What Is Covered
• Self -funded benefit plans covered by Stop Loss are identified on the Stop Loss Financials. All other benefit plans are
excluded
• NEW! Aetna will not apply High Risk Individual Stop Loss Amounts (lasers) for FDA -approved or pipeline gene replacement
therapy drugs dispensed for specific conditions. Gene replacement therapy drug claims will also not be included in the ISL
10/16/2023
Proprietary
taetna
SL Caveats
Weld County Government
Stop Loss Assumptions & Caveats Effective Date: January 01, 2024
claim experience used for rating purposes at the Stop Loss renewal.
Gene replacement therapies use genetic engineering to replace or repair mutated genes, effectively treating a patient's
medical condition. This new feature specifically applies to the gene replacement therapy drugs approved to treat specific
disease, age, and gene expressions via one-time gene replacement treatments — or curative treatments — for previously
untreatable, often fatal, conditions. As of June 29, 2023, there are seven FDA -approved gene replacement therapy drugs:
Zolgensma, Luxturna, Zynteglo, Skysona, Hemgenix, Elevidys, and Roctavian.
Please note the terms under which this applies:
— Existing High Risk Individual Stop Loss Amounts established for gene replacement therapy drugs are not impacted and
will be maintained for the duration of the policy period.
— Existing High Risk Individual Stop Loss Amounts set up due to the member's underlying condition or other reasons will
apply, but will not be increased any further specifically for gene replacement therapy drugs.
— High Risk Individual Stop Loss Amounts may apply for all other diseases or drugs, including medical costs associated
with the underlying condition or medical services associated with the gene replacement therapy treatment.
• Coverage of gene replacement therapy drugs will apply as follows:
— When a gene replacement therapy drug is administered for the indicated disease, age, and gene expression by one of
Aetna's "Gene -based, Cellular, and other Innovative Therapies" (GCIT) network providers, we will consider the eligible
claim expense for the gene replacement therapy drug less the ISL amount shown on the Stop Loss Financials exhibit.
— When the gene replacement therapy drug is not administered for the indicated disease, age, and gene expression by one o
Aetna's "Gene -based, Cellular, and other Innovative Therapies" (GCIT) network providers, Aetna will consider the eligible
claim expense for the gene replacement therapy drug up to 100 percent of the Wholesale Acquisition Cost (WAC) and
reimburse you for that amount less the ISL amount shown on the Stop Loss Financials exhibit. You are responsible for
any amount exceeding the WAC.
• The Stop Loss Financials displays the projected policy period Aggregate Corridor, calculated as
the projected total enrollment x the ASL claim factor x the number of months in the policy period.
The actual Aggregate Corridor will be updated to reflect actual monthly enrollment during the policy period.
The Aggregate Corridor is also subject to the minimum Aggregate Stop Loss Amount, which is calculated as the ASL claim
factor x (the greater of the quoted enrollment or the actual enrollment in the first month of the policy period).
• Contract Type - As indicated on the Stop Loss Financials, eligible claim expenses will be covered for incurred
and paid dates based on:
— A Paid contract type - Claims paid during the policy period, regardless of the incurral date, are included under Stop
Loss. However, if the prior policy period was covered by any Stop Loss policy with a run -out contract type or provision,
claims paid during the prior policy's run -out period are not covered by this Stop Loss proposal.
• Terminal Liability Option (TLO) - This renewal includes TLO coverage for run -out protection upon termination of the
Stop Loss policy in at least one quotation. The terms of the coverage are identified in the Stop Loss Financials. The TLO
may be exercised by giving 31 days written notice prior to the termination of the Stop Loss Policy.
The total TLO premium due by the termination date, using rates and factors on the Stop Loss Financials, is calculated as:
TLO PEPM rate x enrollment covered on the first day of the last policy month x the number of months indicated
Upon termination, the final policy period's Individual Stop Loss amount will continue through the TLO run -out period.
The Aggregate Stop Loss amount for the final policy period will be increased to include the TLO period based on the
enrollment covered on the first day of the last policy month, the number of months in the TLO period, and subject to the
Minimum Aggregate Stop Loss amount.
The TLO run -out period will be reconciled and any reimbursement made after the end of the run -out period.
• A Maximum Annual Aggregate Stop Loss Payment amount is included in the coverage options on the Stop Loss Financials.
It reflects the maximum reimbursement we will pay for Aggregate Stop Loss coverage during the policy period.
If you elect this coverage feature, it will create a gap in coverage between your benefit plan(s) and your Stop Loss policy.
If the total eligible claim expenses funded by Aggregate Stop Loss reach the Maximum Annual Aggregate Stop Loss
Payment amount during a policy period, all subsequent eligible claim expenses will be funded by you until the renewal
date.
What Is Not Covered
10/16/2023
Proprietary
taetna
SL Caveats
Weld County Government
Stop Loss Assumptions & Caveats Effective Date: January 01, 2024
Coverage exclusions include but are not limited to the following:
• Expenses that are not payable under the plan or in accordance with Aetna's clinical policy and established claim practices.
This includes expenses that are experimental or investigational, not medically necessary, in excess of the reasonable
and customary charge, or any claim exception;
• Eligible claim expenses covered by another valid Stop Loss policy, including another Aetna policy, during the same time period,
or run-in claims also covered by a prior policy carrier's run -out provision;
• Plan administration expenses including, but not limited to cost containment administrative tees, care management fees,
and network access fees, with the exception of shared savings fees associated with our National Advantage Program (NAP);
• Assessments or surcharges applied to claims by any government body, with the exception of the MA Uncompensated
Care Pool, Minnesota Care Provider Tax, or New York Health Care Reform Act surcharges;
• Incentive or risk share payments, care coordination payments, and other non -fee -for -service payments associated
with any agreement with an accountable care or similar provider organization;
• Expenses for non -emergency services, treatment, or related complications provided outside the United States. This includes
prescription drugs or medical supplies provided by non-U.S. based companies;
• Capitation payments excluded from Individual Stop Loss but included under Aggregate Stop Loss.
Stop Loss Guarantees
A Renewal Risk Cap is included on Individual Stop Loss quotations on the Stop Loss Financials. This feature caps the renewal
policy period's Individual Stop Loss rate increase and guarantees we will not set new High Risk Individual Stop Loss amounts
(lasers) for additional covered persons at renewal. The Renewal Risk Cap will apply assuming there are no material changes
to the quotation assumptions during the policy period or at the subsequent renewal. Material changes are outlined within the
Underwriting Requirements, Right to Recalculate caveat.
Adjustments for contract type changes at renewal (e.g.: 12/12 to a Paid basis) are not included in the Renewal Risk Cap.
The Renewal Risk Cap may be renewed, modified or cancelled for subsequent renewals at our discretion.
Stop Loss Reimbursement
• When Aetna is also the plan's administrator and the Stop Loss policy is in -force, eligible claims are funded by Stop Loss
immediately, as they are approved for payment under the plan. This "Immediate Reimbursement" means that your cash
flow is not impacted by waiting for reimbursement of claims exceeding the Stop Loss amount and claim reports are
not required. Additional reconciliation is necessary when run-in or run -out is covered, or when other than a 12/12 or
Paid contract type is utilized.
When Aetna is not the claims administrator, reconciliation for reimbursable amounts is performed at the end of
the policy period once you provide appropriate claim details and other necessary information.
• The Monthly Budget Feature standardly applies to Aggregate Stop Loss claims as long as we are the claims administrator
and the Stop Loss policy remains in -force. This feature provides cash flow protection by capping your monthly claim
liability. However, when you choose to fund claims:
— through multiple primary wire lines, or
— through one primary wire line and report through one or more internal wire lines,
additional, final reconciliation is necessary after the close of the policy period.
When Aetna is not the claims administrator, reconciliation for reimbursable amounts is performed at the end of
the policy period once you provide appropriate claim details and other necessary information.
Underwriting Requirements
• We reserve the right to amend or withdraw our offer to reflect the underwriting impact of any additional information
we obtain or in the event you are unable to provide us any of the information we need to fully underwrite the risk.
• If you fail to meet the our underwriting requirements, including but not limited to a minimum of 101 eligible subscribers,
our Stop Loss offer will be withdrawn. If failure to meet this requirement occurs after a Stop Loss policy has been
issued, the policy will terminate as of the first day of the first month following the month in which the underwriting
requirement was not met.
10/16/2023
Proprietary
taetna
SL Caveats
Weld County Government
Stop Loss Assumptions & Caveats Effective Date: January 01, 2024
• We reserve the right to adjust the premium rate or any aggregate Stop Loss factor as of the date of any change to the
underlying assumptions that impacts the risk assumed. Changes include, but are not limited to:
— Any change of +/- 15 percent in enrollment
— Any change to the plan document(s) that will change the risk assumed under the policy
— Any change to this policy
— Any addition or deletion of a unit, division, subsidiary, affiliated or associated company exceeding 10 percent
of existing enrollment
— Any change in federal or state law or regulation that impacts the policy or the coverage provided
— Any change impacting the risk we have assumed, including but not limited to: age, gender, geography, occupation,
incorrect or incomplete information provided in Disclosure statements, etc., that impacts the nature of the risk
by more than 10 percent
— Any change in claims administrator, provider network or cost containment vendor, provided we have consented
to the change in writing
— Any change in the claims administrator's claim payment system or payment practices that causes a variation of
+/- 5 percent versus the most recent 12 month average claim processing time.
New units, subsidiaries, etc., will be underwritten. Claim reports may be requested. If this information is not provided,
we reserve the right to require a completed and signed Disclosure and may apply AAW/DNC rules on the acquired group.
•
10/16/2023
Proprietary
taetna
SL Caveats
Contract Form
Entity Information
Entity Name*
AETNA INC
Entity ID*
@00009916
Contract Name
AETNA HEALTH INSURANCE AND HEALTH BENEFITS
PROGRAM RENEWAL
Contract Status
CTB REVIEW
O New Entity?
Contract ID
7587
Contract Lead *
MRAIMER
Contract Lead Email
mraimer@co.weld.co.us
Parent Contract ID
Requires Board Approval
YES
Department Project #
Contract Description *
AETNA HEALTH INSURANCE AND HEALTH BENEFITS PROGRAM RENEWAL FOR 1/1/2024 - 12/31/2024.
Contract Description 2
Contract Type"
CONTRACT
Amount*
$235,000.00
Renewable*
YES
Automatic Renewal
Grant
IGA
Department
HUMAN RESOURCES
Department Email
CM-
HumanResources@weldgo
v.com
Department Head Email
CM-HumanResources-
DeptHead@weldgov.com
County Attorney
GENERAL COUNTY
ATTORNEY EMAIL
County Attorney Email
CM-
COUNTYATTORNEY@WEL
DGOV.COM
Requested BOCC Agenda Due Date
Date* 12/02/2023
12/06/2023
Will a work session with BOCC be required?*
YES
Does Contract require Purchasing Dept. to be
included?
NO
If this is a renewal enter previous Contract ID
If this is part of a MSA enter MSA Contract ID
Note: the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts
are not in OnBase
Contract Dates
Effective Date
Termination Notice Period
Contact Information
Review Date *
10/21/2024
Renewal Date*
11/13/2024
Committed Delivery Date Expiration Date
Contact Info
Contact Name Contact Type Contact Email Contact Phone 1 Contact Phone 2
Purchasing
Purchasing Approver Purchasing Approved Date
Approval Process
Department Head Finance Approver Legal Counsel
JILL SCOTT CHRIS D'OVIDIO KARIN MCDOUGAL
DH Approved Date Finance Approved Date Legal Counsel Approved Date
01/10/2024 01/10/2024 01/11/2024
Final Approval
BOCC Approved Tyler Ref #
AG 011724
BOCC Signed Date Originator
MRAIMER
BOCC Agenda Date
01/17/2024
Hello