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Address Info: 1150 O Street, P.O. Box 758, Greeley, CO 80632   |    Phone: (970) 400-4225   |    Fax: (970) 336-7233   |    Email: egesick@weld.gov   |    Official: Esther Gesick - Clerk to the Board
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HomeMy WebLinkAbout20243363.tiffgratetna An Aetna Renewal Presented to Weld County Government Annual Renewal Rating: January 01, 2025 through December 31, 2025 Plan Sponsor Numbers: 109724 Contzxw+ l/ZZ/Z5 Zo24-5'�ta3 PE 0031 Lynda Bott Sr Analyst, Account Executive Phone: 314-506-1966 Email: Isbott@aetna.com October 29, 2024 Weld County Government 1150 O Street Greeley, CO 80631 Dear Weld County Government: Shannon Blakeslee Ld Dir,Underwriting 151 Farmington Avenue Hartford, CT 06156 Phone: 860-273-3600 Email: BlakesleeS@aetna.com Thank you for allowing us to serve your health insurance and health benefit needs during the past year. This package provides 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 January 01, 2025 through December 31, 2025 contract period. It's important to understand the full financial picture of your benefit plan. Therefore, the enclosed package provides the following important information about the cost of your current program and the value we bring to you and your company. • Future Program Costs This section illustrates the cost projections to operate your current benefit program. • Self -Funded Medical Plans Your medical fees will not change. • Programs 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 this section thoroughly. 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 Renewal Package prevails. https://www.aetna.com/content/dam/aetna/pdfs/aetnacom/legal-noticesidocuments/large-group-and-public-labor-self-funded-medical- underwriting-disclosures-as-of-05-01-2024.pdf Your renewal package remains in effect until December 31, 2025. If there are no changes that impact the conditions of this renewal as outlined in our Caveats section, the fees will remain in effect through December 31, 2025. This renewal package is considered an amendment to your existing Agreement. Continuance of your benefit plan and payment of fees constitutes your acceptance of this renewal. If you'd like to make any plan changes or if you have any questions, please contact me by December 01, 2024 at 314-506-1966. It's been a pleasure working with you and I look forward to our continued relationship. Sincerely, Lynda Bott Sr Analyst, Account Executive Each insurer has sole financial responsibility for its own products. Health benefits and health insurance plans contain limitations and exclusions. Shannon Blakeslee L� Dir,Underwriting Weld County Government Why Aetna? Effective Date: January 01, 2025 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/abc ut-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. 10/29/2024 Proprietary aetna Value Prop Aetna Weld County Government Contact Information/Assumptions Account Manager: Email: Telephone: Lynda Bott SIC Code: 0 Isbott@aetna.com 314-506-1966 Mem/EE Ratio: 2.11 Administrative Service Fees Effective Date: January 01, 2025 Your fees include a savings for Pharmacy. If actual lines of business awarded differs from our proposed package of benefits, we reserve the right to revise our quoted fees. End Date: December 31, 2025 Current Year 1 Year 2 Year 3 Guarantee Period Effective Date Fee Basis January 01, 2024 Mature January 01, 2025 Mature January 01, 2026 Mature January 01, 2027 Mature Medical Fees as Billed (PEPM)* Estimated Enrollment Current Year 1 Year 2 Year 3 Choice POS II (HSA) 1,466 $50.12 $50.12 $50 12 $50.12 Plan Year Service Fees 1,466 $881,711 $881,711 $881,711 $881,711 Discounts Included in Fees (PEPM) Current Year 1 Year 2 Year 3 Pharmacy Integration Offset* ($50.12) ($50.12) ($50.12) ($50.12) Service Fee Summary (Plan Year) Current Year 1 Year 2 Year 3 Administrative Service Fees Service Fee Guarantee % Change* $0 $0 0.0% $0 0.0% $0 0.096 *Clarifications • PEPM is defined as Per Employee Per Month • Please see Programs and Services for additional information. Some services may come at additional cost to the fees shown above. • Broker Compensation, if applicable, is subject to customer approval. • Any Plan Year costs are based on the Estimated Enrollment and subject to change based on actual enrollment. Runoff Claims Processing Your original service fees did not include the expenses associated with processing runoff claims following termination. To process runoff claims for one year, we will charge a runoff fee, estimated at $176,342 which is billed upon termination. Prescription Drug Benefits Our quotation assumes that prescription drug benefits are included and will be provided by Aetna. If you terminate your prescription drug benefits with us, we will increase the ASC Service Fees and the medical trend assumption used for any applicable claim projections or guarantees. You may also be subject to additional charges to integrate data with external Pharmacy vendors. Refer to the reporting charges outlined in the Programs and Services exhibit for more information. Medical Only Composite Fee - S50.12 PEPM Pharmacy Integration Offset We have offered an alternative to our standard rebate share. Your monthly medical fee has been reduced and in exchange, we will keep the projected pharmacy rebates generated under your pharmacy program. Depending on your member utilization, the rebates we keep may be more. or less, than the reduced fee. There is no true up of rebates under this option. Service Fee Guarantee Our offer includes a service fee guarantee for the guarantee period January 01, 2025 to December 31, 2027 The guaranteed service fees excluding broker compensation are listed above. The service fee guarantee is subject to the terms and conditions as stated in the caveats and is contingent upon the customer maintaining all lines of business with Aetna. BOARD OF COUNTY COMMISSIONERS ATTEST: WELD COUNTY, COLORADO BY: Clerk to the Board Deputy Clerk to the Board Perry L. Buck, Chair 10/29/2024 Proprietary taetna JAN 2 2 2825 ASC Fees zozq -33��1 Weld County Government Programs and Services — Self -Funded Effective Date: January 01, 2025 Program Summary Choice POS II (HSA) Programs & Services Included in the Service Fee Mature Base Service Fee $0.00 General Administration Experienced Account Management Team Included Designated billing, eligibility, plan set up, underwriting Included Onsite Open Enrollment Meeting Preparation Included Open Enrollment Marketing Material (non -customized) Included ID Cards" Included Review or draft plan documents Included Summary of Benefits and Coverage (SBC) Included Claim Fiduciary Option 1 Included External Review Included Claim Administration , Included Plan Sponsor Liaison Included Special Investigations / Zero Tolerance Frauc Unit Included Network Services Full National Reciprocity' Included Custom Network - Low (up to 300 providers. Included Institutes of Excellence'' Included Institutes of Quality'`' (IOU) Network Included Gene -Based, Cellular and other Innovative Therapies (GOP') network Included National Medical Excellence Programs Included Network access Included Care Management Aetna Compassionate Care'" Included Aetna Advice Included MedQuery'-' Included Preventive Care Considerations (Electronic) Included Utilization Management (Inpatient Precertification, Concurrent Review, Discharge Planning, Retrospective Review) Included Member Resources Designated Service Center Included Aetna Concierge (includes First Impression Treatment) Included Provider search (online provider directory) Included Health Decision Support - Basic Included Member Website and Mobile Experience Included MindChecksm Included Online Programs Included Wellness 24 -Hour Nurse Line: 1-800#1 Only Included Aetna Health Your Way'' Health Assessment and Digital Support Included Personal Health Record` Included Allowances Health Plan Allowance ($235,000) Included Reporting and Integration Analytic Consultation from Plan Sponsor Insights (10 Hours) Included ART Reports - New analytic reporting platform Included Aetna Health Information Advantage' (AHIA) Included Monthly Financial Claim Detail Reports Included Monthly Banking Reports Included Monthly 3rd Party Stop Loss Vendor Reports (12 total reports) $6,000.00 Additional Large Claim Data for 3rd Party Stop Loss Vendors $0.10 PEPM Behavioral Health Managed Behavioral Health Included Behavioral Health Condition Management Program - Standard Included Applied Behavior Analysis (ABA) Included AbleTo Network - member cost share may apply Included Aetna Discount Program at home products, fitness, hearing, LifeMart' shopping website, natural products and services, oral health care, vision, weight management Included Total Fees $0.00 Programs & Services Included in the Claim Wire* No Surprises Act - Fees* No Surprises Act (NSA) claim administration fee (per NSA eligible claim) $90 No Surprises Act (NSA) Independent Dispute Resolution (IDR) initial fee (per arbitration case) Applicable fees are as set by law and passed through to the plan 10/29/2024 Proprietary vaetna Programs and Services ASC Weld County Government Programs and Services — Self -Funded Effective Date: January 01, 2025 Program Summary Choice POS II (HSA) No Surprises Act (NSA) Independent Dispute Resolution (IDR) arbitration expenses (per arbitration case) Applicable fees are as set by law and passed through to the plan Network Services CVS Health Virtual Care'" (PEPM) * $0.40 Subrogation' 37.5% of savings Contracted Services* (Coordination of Benefits, Retro Terminations, Medical Bill and Hospital Bill Audits, Workers Compensation, DRG and Implant Audits) 37.5% of savings Claim and Code Review Program* 30% of savings National Advantage'" Program — includes Facility Charge Review and Itemized Bill Review* We will retain 50% of savings National Advantage' Program Cap — includes Facility Charge Review and Itemized Bill Review $100,000 Cap of per individual claim Care Management Aetna Ones Flex (per engaged member, per month)* $735.00 *Additional Program Details Claim Wire Billing, ID Cards, Subrogation, Contracted Services, Claim and Code Review Details can be found in our UW Disclosure document located at the following URL: https://www.aetna.com/content/dam/aetna/pdfs/aetnacom/legal-notices/documents/large-group-and- public-Tabor-self-funded-medical-underwriting-disclosures-as-of-05-01-2024.pdf Claim and Code Review Program This financial proposal includes enhancements 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 assumes 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. No Surprises Act - IDR Fees IDR fees are required by the NSA rules 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 current NSA fees are set by federal agencies. Both the initial fee and the arbitration expense fee are subject to future adjustments by the agencies (and any such adjustments shall be applied to your plan). Aetna Ones Flex Engagement begins upon a two-way interaction (i.e. telephonic, email, secured messaging, etc.) with a member of the multi -disciplinary care team (i.e. nurse, registered social worker, pharmacist, health coach, or behavioral health specialist). After one month without a two-way interaction a member is no longer considered engaged. CVS Health Virtual Care' In addition to the administrative fees 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. Specific charges are available upon request. Full National Reciprocity Excludes some standalone Aetna Whole Health networks. Details are available upon request. Institutes of Excellence's (1OE) This program includes a steerage component by educating members on the benefits of using an IOE designated facility. However, benefit differential steerage is not supported for IOE Infertility network. Institutes of Quality° (KM) Benefit Differential This buy -up option provides flexibility to tier benefits, offering different levels of co-insurance and shifting out of pocket costs to the member when IOQs are not utilized thus encouraging use of IOQs. Members will have a higher benefit when selecting care at a facility designated as an IOQ. It is this benefit differential enhancement for which we will apply a charge. Does not apply to Aetna Whole Health or Joint Ventures (including those offered as part of APCN Plus.) National Advantage' Program (including the Contracted Rates, Facility Charge Review and Itemized Bill Review Components) NAP includes a Contracted Rates component and two optional components: Facility Charge Review (FCR) and Itemized Bill Review (IBR). In addition, some plans also elect Data iSight (DiS) as their out -of -network plan rate for professional services. NAP's Contracted Rates component offers access to contracted rates for many medical claims from non - network providers (including claims for emergency services and claims by hospital -based specialists such as anesthesiologists and radiologists who do not contract with insurers) and ad hoc negotiations (when a contracted rate is not available). We retain a percentage of savings achieved through NAP, including savings achieved through FCR, IBR, and DiS, if elected. This NAP Fee is in addition to the per employee, per month administrative service fees. Personal Health Record (PHR) PHR requires the purchase of MedQuery° 10/29/2024 Proprietary taetna Programs and Services ASC Weld County Government Allowances - Self -Funded Effective Date: January 01, 2025 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 must be used for your commercial Aetna medical plans and Aetna medical members. Annual Allowance Type Year 1 Year 2 Year 3 flan Year Effective ate WNW O1/0/2025 al 01/01/2 26 i /O1/2027 Health Plan $235,000 $235,000 $235,000 Annual allowance amounts may be adjusted if actual enrollment changes by 15 percent or more from our enrollment assumptions. Health Plan Allowance • The Health Plan allowance can be used to offset reasonable documented expenses applicable to the Guarantee Period(s) for which it is offered. Your allowance can be used for implementation, communication, reporting, and audit associated with your Aetna Medical plan. Examples of reimbursable expenses include: — implementing your contract with us — promoting our products, programs or services, such as, educational content and materials for enrollees or prospective enrollees — Aetna required technology platforms or our system front-end charges to support our plans — communicating with our members — auditing our readiness — recurring or ad hoc reporting with us — reporting costs to integrate our data with third -party vendors. • Your allowance can also be used to offset reasonable documented wellness -related programs or activities incurred during the Guarantee Period for which the allowance is offered. Wellness allowance expenses must be for wellness -related programs or activities that are reasonably designed to promote the health and well-being of Aetna members, or to educate Aetna members about healthy lifestyles and/or prevent disease. This means that there must be a connection to the health and well-being of the members, with a focus on preventative measures or healthy living (i.e., diet, exercise), not on acute care. Wellness programs and activities funded by allowance funds are not covered benefits under your Aetna plan. • Claims audit expenses must be incurred during the Guarantee Period for which the allowance is offered. • Should you terminate your contract with us, the allowance cannot be used to fund implementation/communication expenses related to the new carrier's contract. • Any expenses associated with the implementation, administration or communication of another carrier's plans, programs or services are also ineligible. The above referenced fund(s) will be available after the effective date of each plan year. 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. Your normal business operation expenses, including employee salaries and overtime, are not eligible under the allowance. Our preferred method of payment is directly to the third -party vendor. We require submission of appropriate documentation detailing charges for the services provided by the vendor. Acceptable documentation includes, but is not limited to, detailed vendor invoices itemizing services provided, specific cost -elements and associated line -item charges. On an exception basis, we can reimburse you directly provided you submit both the detailed invoice and receipt showing payment to the third -party vendor. You should submit documentation within 60 days of the invoice date. We must receive all documentation no later than 60 days following the close of the plan year to be considered for reimbursement. The allowance amounts indicated above for the following Allowance Type(s) are available for the years indicated in the chart. These allowances are forfeited at the end of each plan year if not fully utilized. There is no roll over of unused funds to the next policy year. Any unredeemed wellness incentives that may be offered through a "reward program" are forfeited at the end of each plan year. • Health Plan 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 P an. 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 allowances 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 allowance amounts used. Payment is due to us within 31 days of the invoice. 10/29/2024 Proprietary taetna Allowance ASC Weld County Government Caveats - Self -Funded Effective Date: January 01, 2025 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". 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 happers, 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 15 percent change in the total number of enrolled employees for all commercial medical products combined. O ur 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 15 percent from the 2.1 ratio assumed in this quote. Projected Processed Claim Transactions (PCT) Per Employee The actual PCT ratio changes by more than 15 percent from the 29.00 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 15 percent from the 49 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. Termination You terminate the Agreement and we incur charges for maintaining plan structure to report and/or process runoff claims. N ational Advantage TM Program You change or terminate the National AdvantageTM Program (NAP), Facility Charge Review (FCR), Itemized Bill Review (IBR), or Data iSightTM (DiS) programs. Bundle up Discount If additional products quoted are not sold, or if additional and/or existing products terminate during the multi -year Guarantee Period, any applicable Bundle up Discounts as outlined in your fee exhibit will be removed. Multi -Year Provision You place the products, programs and services included in this multi -year fee guarantee out to bid with an effective date prior to December 31, 2027, then this guarantee is no longer valid. Total Replacement Any of the quoted lines of coverage are offered with an additional carrier. Assumptions Agreement Provisions O ur 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. 10/29/2024 Proprietary taetna Caveats ASC Weld County Government Caveats - Self -Funded Effective Date: January 01, 2025 Plan Design This renewal is based on the current benefit plan designs, plus any noted deviations, subject to the terms of our Benefit Review document. Claim Fiduciary - Option 1 O ur renewal assumes we've been delegated claim fiduciary responsibilities. As claim fiduciary, we'll be responsible for final claim determination and the legal defense of disputed benefit payments. Our appeal administrative services are automatically included when we've been delegated claim fiduciary responsibilities. External Review We've included external review in our renewal. External review uses outside vendors who coordinate medical review through their network of outside physician reviewers. Member Communications Pricing assumptions include 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 vendors, 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 taxable 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 includes but is not limited to, the Health Insurance Portability Act (HIPAA), the Americans With Disabilities Act (ADA) and the Genetic Information Nondiscrimination Act (GINA). • Distribute notices 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 (cash, cash equivalent, or other tangible property) and provided by us or our third -party vendor to your members. • Assume any and all liability for your noncompliance with any tax withholding or information reporting requirements. You may wish to consult 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 assumes that prescription drug benefits are included and will be provided by Aetna. If you terminate your prescription drug benefits with us, we will increase your ASC medical fees and the medical trend assumption used for any applicable claim projections or guarantees. You may also be subject to additional charges to integrate data with external Pharmacy vendors. Refer to the reporting charges outlined in the Programs and Services exhibit for more information. Pharmacy Integration Offset We have offered an alternative to our standard rebate share. Your monthly medical fee has been reduced and in exchange, we will keep the projected pharmacy rebates generated under your pharmacy program. Depending on your member utilization, the rebates we keep may be more, or less, than the reduced fee. There is no true up of rebates under this option. Stop Loss Reporting O ur quotation assumes stop loss coverage is not provided by Aetna and reporting to an external vendor is excluded. • The cost for 12 annual reports is not included in your PEPM fees and is displayed on the Programs & Services exhibit. Medical Pharmacy Rebates Rebates for pharmacy products administered and paid through the medical benefit rather than the pharmacy benefit will be retained by Aetna as compensation for our efforts in administering this program. 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 10/29/2024 Proprietary vaetna Caveats ASC Weld County Government Caveats - Self -Funded Effective Date: January 01, 2025 costs for these types of services will depend upon the actual services performed and will be determined at the time the service is requested. Ming 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 rates as follows: • if you fail to pay plan benefit payments the same day of the request • if you fail to pay administrative service fees within 31 days of the due date 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. Incurred interest for a late claim wire payment will be added to the next claim wire request and collected through that claim wire. Incurred interest for late fee payments will be collected through the year-end accounting process. Producer Compensation The quoted fees don't include producer compensation. Claim and Me t Runoff Claims Processing Your renewal administrative service fees are mature. However, your original service fees did not include the expenses associated with processing runoff claims following termination. If you request that we process runoff claims for one year, we'll charge you a fee upon contract termination. The determination of the runoff fee, which is billed upon termination, is as follows: average PEPM fee over the last 3 months x the average employees over the last 3 months x 3 x 80 percent average PEPM fee over the last 3 months x the estimated average number of employees covered during the first year of your Agreement x 3 x 80 percent If you've previously paid a portion of your runoff claims processing fees and you have a change in enrollment that impacts these fees, we'll advise you if additional runoff claims processing charges will be due. Medical Service Center We've assumed that claim administration and member services for the quoted plans will be maraged centrally by the Fresno, CA 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). 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 rights or the right to use all of the intellectual property used by Aetna in providing the Services under the Agreement ("Aetna IP")_ 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 rights in, or any right to assign, sublicense, sell, resell, lease, rent, or otherwise transfer or convey, the Aetna IP to you. Data Integration (Historical) O ur renewal assumes one historical medical and one historical pharmacy data integration feed. Additional fees will apply if feeds from more than one historical vendor are required. Data Integration (Ongoing) 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 Termination Upon Agreement termination, we agree to cooperate with succeeding administrators in produc ng and transferring required claim and enrollment data. Data will be transferred within 30 days after determination of specific format and content requirements, subject to a charge that is based on direct labor cost and data processing time. Banking 10/29/2024 Proprietary g►aetna Caveats ASC Weld County Government Caveats - Self -Funded Effective Date: January 01, 2025 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 use no more than three primary banking lines which are shared across all self -funded products, excluding Flexible Spending Account (FSAs). Additional wire lines and customized banking arrangements will result in an adjustment to the proposed pricing. 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. hops://www.aetna.com/content/dam/aetna/pdfs/aetnacom/legal-notices/documents/large-group-and-public-labor-self-funded- medical-underwriting-disclosures-as-of-05-01-2024.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 O ctober 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. N SA 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. Recovery of Overpayments O ur process of recovering overpayments attempts to recoup money in the most accurate, effective, and cost-efficient manner. When seeking recovery 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 that provider involving your or other health and welfare plans that are administered by us) by the amount of the overpayment, and 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. 10/29/2024 Proprietary vaetna Caveats ASC Houstan Aragon From: Sent: To: Cc: Subject: Byron Howell Wednesday, January 15, 2025 2 36 PM Jill Scott, Esther Gesick, Kann McDougal Allison Palmer, Amy Dyer, Houstan Aragon, Bruce Barker RE Renewal for Aetna It is good the self -enrolled employees were notified There is no need for further information or additional steps. Also, there is no need for another resolution, we can let it ride. I ran this past Bruce, and he approves Byron L Howell Assistant Weld County Attorney Weld County Attorney's Office 1150 O Street Greeley, Colorado 80632 970-400-4394 STATEMENT OF CONFIDENTIALITY & DISCLAIMER The information contained in this email message is attorney privileged and confidential, intended only for the use of the individual or entity named above If the reader of this message is not the intended recipient, you are hereby notified that any dissemination, distribution or copy of this email is strictly prohibited If you have received this email in error, please notify us immediately by replying and delete the message Thank you From: Jill Scott <jscott@weld gov> Sent. Wednesday, January 15, 2025 10 55 AM To. Byron Howell <bhowell@weld gov>, Esther Gesick <egesick@weld gov>, Karin McDougal <kmcdougal@weld gov> Cc. Allison Palmer <apalmer@weld gov>, Amy Dyer <adyer@weld gov>, Houstan Aragon <haragon@weld gov>, Bruce Barker <bbarker@weld gov> Subject: RE Renewal for Aetna Thank you for this — yes, we had several employees self -enroll into this Hinge program and all have been communicated to regarding the removal ofithe services prior to the end of 2024 so they had the time necessary to find other resources This is not a universal service on our health insurance If additional information is needed, please let me know Please let us know next steps WELD COUNTY, CO Join Our Team > Jill Scott MBA. PHR, SHRM-CP Chief Human Resources Officer & Director of Administration ��- 970 400-4230 M jscott(aweld.gov P.O. Box 758, 1150 O St Greeley, CO 80632 Mission Statement: Weld County Human Resources is a strategic business partner dedicated to enhancing the employee experience, collaborating with individual departments, and supporting the values and goals of Weld County Government. Vision Statement: To cultivate a thriving workforce through exemplary leadership and strategic talent management, ensuring organizational success and employee fulfillment. IMPORTANT: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please immediately notify sender by return e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited. From: Byron Howell <bhowell@weld.gov> Sent: Tuesday, January 14, 2025 2:51 PM To: Jill Scott <jscott@weld.gov>; Esther Gesick <egesick@weld.gov>; Karin McDougal <kmcdougal@weld.gov> Cc: Allison Palmer <apalmer@weld.gov>; Amy Dyer <adyer@weld.gov>; Houstan Aragon <haragon@weld.gov>; Bruce Barker <bbarker@weld.gov> Subject: RE: Renewal for Aetna Good afternoon all, In the Aetna plan submitted for approval by Resolution, I found Hinge Health under the Choice POSII (HSA) on pages 13 and 26. I copied these pages to a Word document in the attachment to this email so you can see what it was about. The pages describe the program and costs. In the 'later' Aetna renewal plan submitted, Aetna submitted an accompanying letter saying this plan is a "renewal and amendment" to the previous plan. I found a lump sum cost of $881,711 for Choice POSII (HSA), and I could not find an individual breakdown for any costs for Hinge health. I ran a search for Hinge and found none. I cannot tell whether any Hinge costs were within the total $881,711, but I don't think they were. It might be technically and legally prudent for another Resolution to exclude the Hinge health program from the agreement per Aetna's letter and 'later' plan submittal which did not detail any costs for Hinge health program and due to party's mutual understanding. On the other hand, if we did not do another Resolution, it may not matter much if HR is comfortable that the pricing is accurate as detailed in the `later' Aetna document. It appears the Hinge health program was more of an employee driven type plan for a choice of particular services, and those services do not appear in the 'later' Aetna document under Choice POSII (HSA). In sum, we approved by Resolution a plan containing Hinge health program, yet in Aetna's letter explaining renewal and amendment and plan summary of costs, it was gone. An 2 amended Resolution would clear this up. On the other hand, if no amended Resolution were done, there is enough information that the `later' submitted Aetna document without Hinge health program would work from a business standpoint as Aetna declared it an amendment. Jill, an inquiry for you: Did you have any employees participating in the Hinge program? If so, would some type of clarification/notification be necessary so that those employees would understand the program is no longer available and/or the reasons therefore? It is necessary to ask because the Resolution for the plan submitted says Hinge is available. Byron L. Howell Assistant Weld County Attorney Weld County Attorney's Office 1150 O Street Greeley, Colorado 80632 970-400-4394 STATEMENT OF CONFIDENTIALITY & DISCLAIMER: The information contained in this email message is attorney privileged and confidential, intended only for the use of the individual or entity named above. If the reader of this message is not the intended recipient, you are hereby notified that any dissemination, distribution or copy of this email is strictly prohibited. If you have received this email in error, please notify us immediately by replying and delete the message. Thank you. From: Jill Scott <jscott@weld.gov> Sent: Tuesday, January 14, 2025 12:54 PM To: Esther Gesick <egesick@weld.gov>; Karin McDougal <kmcdougal@weld.gov>; Byron Howell <bhowell@weld.gov> Cc: Allison Palmer <apalmer@weld.gov>; Amy Dyer <adyer@weld.gov>; Houstan Aragon <haragon@weld.gov> Subject: RE: Renewal for Aetna Hinge Health was removed — it was an add on service that we discontinued affective 12/31/2024. WELD COUNTY, CO Join Our Team > Jill Scott MBA. PHR, SHRM-CP Chief Human Resources Officer & Director of Administration 4.970-400-4230 E1 Iscott(c�weld.gov 0 P.O. Box 758, 1150 O St Greeley, CO 80632 Mission Statement: Weld County Human Resources is a strategic business partner dedicated to enhancing the employee experience, collaborating with individual departments, and supporting the values and goals of Weld County Government. Vision Statement: To cultivate a thriving workforce through exemplary leadership and strategic talent management, ensuring organizational success and employee fulfillment. IMPORTANT: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please immediately notify sender by return e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited. 3 From: Esther Gesick <egesick@weld.gov> Sent: Tuesday, January 14, 2025 11:55 AM To: Jill Scott <jscott@weld.gov>; Karin McDougal <kmcdougal@weld.gov>; Byron Howell <bhowell@weld.gov> Cc: Allison Palmer <apalmer@weld.gov>; Amy Dyer <adyer@weld.gov>; Esther Gesick <egesick@weld.gov>; Houstan Aragon <haragon@weld.gov> Subject: RE: Renewal for Aetna I would defer that question to legal. I've attached what was approved by the Board as comparison to what you provided. You referenced something was removed — can you identify what/where that is? Legal - Pending Jill's added information, please advise. Esther E. Gesick Clerk to the Board 1150 O Street) P.O. Box 758 J Greeley, CO 80632 tel: (970) 400-4226 Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please immediately notify sender by return e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited. From: Jill Scott <jscott@weld.gov> Sent: Tuesday, January 14, 2025 10:44 AM To: Esther Gesick <egesick@weld.gov> Cc: Karin McDougal <kmcdougal@weld.gov>; Allison Palmer <apalmer@weld.gov>; Amy Dyer <adyer@weld.gov> Subject: Renewal for Aetna Good morning Esther We already have the signed agreement for Aetna with the Chair's signature, however we just received the "updated final" removing one line of service. Does not really impact the agreement, do we need to go back through the process and have this signed by the BOCC Chair again? WELD COUNTY, CO Join Our Team > Jill Scott MBA, PHR, SHRM-CP Chief Human Resources Officer & Director of Administration .1970 400-4230 El Iscott(a�weld.gov P.O. Box 758, 1150 O St Greeley, CO 80632 Mission Statement: Weld County Human Resources is a strategic business partner dedicated to enhancing the employee experience, collaborating with individual departments, and supporting the values and goals of Weld County Government. Vision Statement: To cultivate a thriving workforce through exemplary leadership and strategic talent management, ensuring organizational success and employee fulfilment. 4 IMPORTANT: This electronic transrr ission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please immediately notify sender by return e-mail and destroy The communication. Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited. 5 Karla Ford From: Sent: To: Cc: Subject: Sent from my iPhone Perry Buck Wednesday, December 11, 2024 4:58 PM Karla Ford Mike Freeman; Lori Saine; Scott James Re: Please Reply- - HR Pass -around Aetna On Dec 11, 2024, at 4:49 PM, Karla Ford <kford@weld.gov>wrote: I approve Thank you Please advise if you support recommendation and to have department place on the agenda. Karla Ford K Office Manager, Board of Weld County Commissioners 1150 0 Street, P.O. Box 758, Greeley, Colorado 80632 :: 970.336-7204 :: kford(weld.gov :: www.weldgov.com **Please note my working hours are Monday -Thursday 7:00a.m.-4:00p.m. ** <image009.jpg> Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you hove received this communication in error, please immediately notify sender by return e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited. From: Allison Palmer <apalmer@weld.gov> Sent: Wednesday, December 11, 2024 4:35 PM To: Karla Ford <kford@weld.gov> Cc: Jill Scott <jscott@weld.gov>; Cheryl Pattelli <cpattelli@weld.gov> Subject: Pass -around Aetna Hi Karla, Attached is a Pass -around for Aetna renewal. Thanks, Karla Ford From: Sent: To: Cc: Subject: Approve Sent from my iPhone Mike Freeman Wednesday, December 11, 2024 5:24 PM Karla Ford Lori Saine; Perry Buck; Scott James Re: Please Reply- - HR Pass -around Aetna On Dec 11, 2024, at 6:49 PM, Karla Ford <kford@weld.gov>wrote: Please advise if you support recommendation and to have department place on the agenda. Karla Ford Office Manager, Board of Weld County Commissioners 1150 0 Street, P.Q. Box 758, Greeley, Colorado 80632 :: 970.336-7204 :: kford@weld.gov :: www.weldgov.com **Please note my working hours are Monday -Thursday 7:00a.m.-4:00p.m." <image009.jpg> Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please immediately notify sender by return e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited. From: Allison Palmer <apalmer@weld.gov> Sent: Wednesday, December 11, 2024 4:35 PM To: Karla Ford <kford@weld.gov> Cc: Jill Scott <jscott@weld.gov>; Cheryl Pattelli <cpattelli@weld.gov> Subject: Pass -around Aetna Hi Karla, Attached is a Pass -around for Aetna renewal. Thanks, Karla Ford From: Sent: To: Cc: Subject: I support ** Sent from my iPhone ** Scott James Thursday, December 12, 2O24 4:54 AM Karla Ford Mike Freeman; Lori Saine; Perry Buck Re: Please Reply- - HR Pass -around Aetna Scott K. James Weld County Commissioner, District 2 115O O Street, P.O. Box 758, Greeley, Colorado 80632 97O.336.72O4 (Office) 970.381.7496 (Cell) Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please immediately notify sender by return e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited. On Dec 11, 2O24, at 4:49 PM, Karla Ford <kford@weld.gov>wrote: Please advise if you support recommendation and to have department place on the agenda. Karla Ford X Office Manager, Board of Weld County Commissioners 1150 0 Street, P.O. Box 758, Greeley, Colorado 80632 :: 970.336-7204 :: kford weld.gov :: www.weldgov.com **Please note my working hours are Monday -Thursday 7:00a.m.-4:00p.m.** <imageOO9.jpg> ageOO9. j pg> Confidentiality Notice: This electronic transmission and any attached documents or other writings ore intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please immediately notify sender by return e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited. 1 Karla Ford From: Sent: To: Subject: yes Lori Saine Weld County Commissioner, District 3 1150 0 Street PO Box 758 Greeley CO 80632 Phone: 970-400-4205 Fax: 970-336-7233 Email: Isaine@weidgov.com Website: www.co.weld.co.us In God We Trust Lori Saine Wednesday, December 11, 2024 8:02 PM Karla Ford RE: Please Reply- - HR Pass -around Aetna Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please immediately notify sender by return e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited. From: Karla Ford <kford@weld.gov> Sent: Wednesday, December 11, 2024 4:49 PM To: Mike Freeman <mfreeman@weld.gov>; Lori Saine <lsaine@weld.gov>; Perry Buck <pbuck@weld,gov>; Scott James <sjames@weld.gov> Subject: Please Reply- - HR Pass -around Aetna Importance: High Please advise if you support recommendation and to have department place on the agenda. 1 RESOLUTION RE: APPROVE RENEWAL FOR SELF -FUNDED EMPLOYEE MEDICAL INSURANCE PLAN AND AUTHORIZE CHAIR TO SIGN -AETNA, INC. 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 Renewal for the Self -Funded Employee Medical Insurance Plan 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, Inc., commencing January 1, 2025, and ending December 31, 2025, with further terms and conditions being as stated in said renewal plan, and WHEREAS, after review, the Board deems it advisable to approve said renewal plan, 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 Renewal for the Self -Funded Employee Medical Insurance Plan 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, Inc., be, and hereby is, approved. BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to sign said renewal plan. The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 23rd day of December, A.D., 2024. BOARD OF COUNTY COMMISSIONERS WELD COUNTY RA ATTEST: �� J Weld County Clerk to the Board BY:Oath-al • Oah I,o Ji APP Deputy Clerk to the Bord ounty ey / 430Date of signature: 7 — Kevin D. Ross, Chair EXCUSED Perry L. Buck, Pro-Tem Mike Freeman tt K. James CUSED ri Saine CC'. Pg(nS / AU/AP/$P) o1/2.Va5 2024-3363 PE0036 Lor*vctc4 It3StftCZe BOARD OF COUNTY COMMISSIONERS PASS -AROUND REVIEW PASS -AROUND TITLE: Aetna Self -Funded Medical Plan Renewal DEPARTMENT: HR DATE: 12/11/2024 PERSON REQUESTING: Allison Palmer & Jill Scott Brief description of the problem/issue: The Final Self -Funded document needs to be signed in order to finalize Aetna's renewal for the upcoming year (January 1, 2025 — December 31, 2025). The renewal documents outline the fees and terms for your self -funded medical plans and associated services. What options exist for the Board? Approve and Sign the Renewal. This is the recommended option. By signing the documents, we ensure that the benefits program remains unchanged, and no additional fees or adjustments are incurred. Consequences: If the renewal documents are not signed on time, there may be delays in securing coverage for the upcoming year. Impacts: May be delays in securing coverage for all benefit -eligible employees, potentially causing disruptions to medical benefits for the upcoming year. Costs (Current Fiscal Year / Ongoing or Subsequent Fiscal Years): As stated in the documents, the medical fees for the 2025 period will remain unchanged, assuming no deviations from the outlined terms. Recommendation: We recommend moving forward with the renewal process as outlined. The terms are consistent with our current program, and no changes to fees are expected. Support Recommendation Schedule Place on BOCC Agenda Work Session Other/Comments: Perry L. Buck, Pro -Tern Mike Freeman Scott K. James Kevin D. Ross , Chair Lori Saine \jic* matt. \Jtcx Vtet JemAl 2024-3363 1 2/Z3 PEC03(0 Karla Ford From: Sent: To: Cc: Subject: Sent from my iPhone Perry Buck Wednesday, December 11, 2024 4:58 PM Karla Ford Mike Freeman; Lori Saine; Scott James Re: Please Reply- - HR Pass -around Aetna On Dec 11, 2024, at 4:49 PM, Karla Ford <kford@weld.gov>wrote: 1 approve Thank you Please advise if you support recommendation and to have department place on the agenda. Karla Ford X Office Manager, Board of Weld County Commissioners 1150 O Street, P.O. Box 758, Greeley, Colorado 80632 :: 970.336-7204 :: kford@weld.gov :: www.weldgov.com :: *Please note my working hours are Monday -Thursday 7:00a.m.-4:00p.m.** <imageOO9.jpg> Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please immediately notify sender by return e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited. From: Allison Palmer <apalmer@weld.gov> Sent: Wednesday, December 11, 2024 4:35 PM To: Karla Ford <kford@weld.gov> Cc: Jill Scott <jscott@weld.gov>; Cheryl Pattelli <cpattelli@weld.gov> Subject: Pass -around Aetna Hi Karla, Attached is a Pass -around for Aetna renewal. Thanks, Karla Ford From: Sent: To: Cc: Subject: Approve Sent from my iPhone Mike Freeman Wednesday, December 11, 2024 5:24 PM Karla Ford Lori Saine; Perry Buck; Scott James Re: Please Reply- - HR Pass -around Aetna On Dec 11, 2024, at 6:49 PM, Karla Ford <kford@weld.gov>wrote: Please advise if you support recommendation and to have department place on the agenda. Karla Ford Office Manager, Board of Weld County Commissioners 1150 0 Street, P,O. Box 758, Greeley, Colorado 80632 :: 970.336-7204 :: kford(cweld.gov :: www.weldgov.com **Please note my working hours are Monday -Thursday 7:00a.m.-4:00p.m.** <image009. jpg> Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, pleose immediately notify sender by return e-mail and destroy the communication, Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited. From: Allison Palmer <apalmer@weld.gov> Sent: Wednesday, December 11, 2024 4:35 PM To: Karla Ford <kford@weld.gov> Cc: Jill Scott <jscott@weld.gov>; Cheryl Pattelli <cpattelli@weld.gov> Subject: Pass -around Aetna Hi Karla, Attached is a Pass -around for Aetna renewal. Thanks, Karla Ford From: Sent: To: Cc: Subject: I support ** Sent from my iPhone ** Scott James Thursday, December 12, 2024 4:54 AM Karla Ford Mike Freeman; Lori Saine; Perry Buck Re: Please Reply- - HR Pass -around Aetna Scott K. James Weld County Commissioner, District 2 1150 O Street, P.O. Box 758, Greeley, Colorado 80632 970.336.7204 (Office) 970.381.7496 (Cell) Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please immediately notify sender by return e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited. On Dec 11, 2024, at 4:49 PM, Karla Ford <kford@weld.gov>wrote: Please advise if you support recommendation and to have department place on the agenda. Karla Ford X Office Manager, Board of Weld County Commissioners 1150 O Street, P.O. Box 758, Greeley, Colorado 80632 :: 970.336-7204 :: kford weld.gov :: www.weldgov.com **please note my working hours are Monday -Thursday 7:00a.m.-4:00p.m.** <image009.jpg> Confidentiality Notice: This electronic transmission and any attached documents or other writings ore intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please immediately notify sender by return e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited. 1 Karla Ford From: Sent: To: Subject: yes Lori Saine Weld County Commissioner, District 3 1150 O Street PO Box 758 Greeley CO 80632 Phone: 970-400-4205 Fax: 970-336-7233 Email: Isaine@weldgov.com Website: www.co.weld.co.us In God We Trust Lori Saine Wednesday, December 11, 2024 8:02 PM Karla Ford RE: Please Reply- - HR Pass -around Aetna Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please immediately notify sender by return e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited. From: Karla Ford <kford@weld.gov> Sent: Wednesday, December 11, 2024 4:49 PM To: Mike Freeman <mfreeman@weld.gov>; Lori Saine <lsaine@weld.gov>; Perry Buck <pbuck@weld.gov>; Scott James <sjames@weld.gov> Subject: Please Reply- - HR Pass -around Aetna Importance: High Please advise if you support recommendation and to have department place on the agenda. 1 Annual Renewal Rating: January 01, 2025 through December 31, 2025 Plan Sponsor Numbers: 109724 Lynda Bott Sr Analyst, Account Executive - S Field Columbia, SC 29217 Phone: 314-506-1966 Email: Isbott@aetna.com June 13, 2024 Weld County Government 1150 O Street Greeley, CO 80631 Dear Staci J. Datteri-Frey: Shannon Blakeslee Ld Dir,Underwriting 151 Farmington Avenue Hartford, CT 06156 Phone: 860-273-3600 Email: BlakesleeS@aetna.com Thank you for allowing us to serve your health insurance and health benefit needs during the past year. This package provides 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 January 01, 2025 through December 31, 2025 contract period. It's important to understand the full financial picture of your benefit plan. Therefore, the enclosed package provides the following important information about the cost of your current program and the value we bring to you and your company. • Future Program Costs This section illustrates the cost projections to operate your current benefit program. • Self -Funded Medical Plans Your medical fees will not change. • Programs 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 this section thoroughly. 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 Renewal Package prevails. https://www.aetna.comicontentidamiaetna/pdfsiaetnacomjlegal-noticesidocumentsilarge-group-and-public-labor-self- funded-medical-underwriting-disclosures-as-of-01-01-2024.pdf Your renewal package remains in effect until December 31, 2025. If there are no changes that impact the conditions of this renewal as outlined in our Caveats section, the fees will remain in effect through December 31, 2025. This renewal package is considered an amendment to your existing Agreement. Continuance of your benefit plan and payment of fees constitutes your acceptance of this renewal. If you'd like to make any plan changes or if you have any questions, please contact me by December 01, 2024 at 314-506-1966. It's been a pleasure working with you and I look forward to our continued relationship. Sincerely, Lynda Bott Shannon Blakeslee Sr Analyst, Account Executive - S Ld Dir,Underwriting Each insurer has sole financial responsibility for its own products. Health benefits and health insurance plans contain limitations and exclusions. Weld County Government Why Aetna? Effective Date: January 01, 2025 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 E bout 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. 6/13/2024 Proprietary taetna Value Prop Aetna Weld County Government Contact Information/Assumptions Account Manager: Email: Telephone: Lynda Bott SIC Code: 9199 Isbott@aetna.com 314-506-1966 Mem/EE Ratio: 2.11 Administrative Service Fees Effective Date: January 01, 2025 Your fees include a savings for Pharmacy. If actual lines of business awarded differs from our proposed package of benefits, we reserve the right to revise our quoted fees. End Date: December 31, 2025 Current Year 1 Year 2 Year 3 Guarantee Period Effective Date Fee Basis January 01, 2024 Mature January 01, 2025 Mature January 01, 2026 Mature January 01, 2027 Mature Medical Fees as Billed (PEPM)* Estimated Enrollment Current Year 1 Year 2 Year 3 Choice POS II (HSA) 1,466 $50.12 $50.12 $50.12 $ 50.12 Plan Year Service Fees 1,466 $881,711 $881,711 $881,711 $881,711 Discounts Included in Fees (PEPM) Current Year 1 Year 2 Year 3 Pharmacy Integration Offset* ($50.12) ($50.12) ($50.12) ($50.12) Service Fee Summary (Plan Year) Current Year 1 Year 2 Year 3 Administrative Service Fees Service Fee Guarantee % Change* $0 $0 0.0% $0 0.0% $0 0.0% *Clarifications • PEPM is defined as Per Employee Per Month • Please see Programs and Services for additional information. Some services may come at additional cost to the fees shown above. • Broker Compensation, if applicable, is subject to customer approval. • Any Plan Year costs are based on the Estimated Enrollment and subject to change based on actual enrollment. Runoff Claims Processing Your original service fees did not include the expenses associated with processing runoff claims following termination. To process runoff claims for one year, we will charge a runoff fee, estimated at $176,342, which is billed upon termination. Prescription Drug Benefits Our quotation assumes that prescription drug benefits are included and will be provided by Aetna. If you terminate your prescription drug benefits with us, we will increase the ASC Service Fees and the medical trend assumption used for any applicable claim projections or guarantees. You may also be subject to additional charges to integrate data with external Pharmacy vendors. Refer to the reporting charges outlined in the Programs and Services exhibit for more information. Medical Only Composite Fee - $50.12 PEPM Pharmacy Integration Offset We have offered an alternative to our standard rebate share. Your monthly medical fee has been reduced and in exchange, we will keep the projected pharmacy rebates generated under your pharmacy program. Depending on your member utilization, the rebates we keep may be more, or less, than the reduced fee. There is no true up of rebates under this option. Service Fee Guarantee Our offer includes a service fee guarantee for the guarantee period January 01, 2025 to December 31, 2027 The guaranteed service fees excluding broker compensation are listed above. The service fee guarantee is subject to the terms and conditions as stated in the caveats and is contingent upon the customer maintaining all lines of business with Aetna. i AUTHORIZE THE R : PROGRAMS FO SIGNATURE By: Kevin D. R ;tea ATTEST: IC ."fir' By. HE 1/1/2025 RENEWAL. Chair, Board of Weld County Commissioners CYAC. 2d .►. 4_ can erktoth and Deputy Clerk to the Boar 6/13/2024 Proprietary �Yl Orr' risk). M C.ti V ASC Fees zozy-333 Weld County Government Programs and Services — Self -Funded Effective Date: January 01, 2025 Program Summary Choice POS II (HSA) Programs & Services Included in the Service Fee Mature Base Service Fee $0.00 General Administration Experienced Account Management Team Included Designated billing, eligibility, plan set up, underwriting Included Onsite Open Enrollment Meeting Preparation Included Open Enrollment Marketing Material (non -customized) Included ID Cards* Included Review or draft plan documents Included Summary of Benefits and Coverage (SBC) Included Claim Fiduciary Option 1 Included External Review Included Claim Administration Included Plan Sponsor Liaison Included Special Investigations / Zero Tolerance Fraud Unit Included Network Services Full National Reciprocity* Included Custom Network - Low (up to 300 providers) Included Institutes of Excellence"' * Included Institutes of Quality'' (1OO) Network Included Gene -Based, Cellular and other Innovative Therapies (GCIT®) network Included National Medical Excellence Programs Included Network access Included Care Management Aetna Compassionate Care'' Included Aetna Advice Included MedQuery'`v Included Preventive Care Considerations (Electronic) Included Utilization Management (Inpatient Precertification, Concurrent Review, Discharge Planning, Retrospective Review) Included Member Resources Designated Service Center Included Aetna Concierge (includes First Impression Treatment) Included Provider search (online provider directory) Included Health Decision Support - Basic Included Member Website and Mobile Experience Included MindChecksM Included Online Programs Included Wellness 24 -Hour Nurse Line: 1-800# Only Included Aetna Health Your Way''h' Health Assessment and Digital Support Included Personal Health Record* Included Allowances Health Plan Allowance ($235,000) Included Reporting and Integration Analytic Consultation from Plan Sponsor Insights (10 Hours) Included ART Reports - New analytic reporting platform Included Aetna Health Information AdvantageTM (ARIA) Included Monthly Financial Claim Detail Reports Included Monthly Banking Reports Included Behavioral Health Managed Behavioral Health Included Behavioral Health Condition Management Program - Standard Included Applied Behavior Analysis (ABA) Included AbleTo Network - member cost share may apply Included 6/13/2024 Proprietary vaetna Programs and Services ASC Weld County Government Programs and Services — Self -Funded Effective Date: January 01, 2025 Program Summary Choice POS II (HSA) Aetna Discount Program at home products, fitness, hearing, LifeMart® shopping website, natural products and services, oral health care, vision, weight management Included Total Fees $0.00 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) fee p p p initial (per arbitration case) Applicable fees are as set by law and passed through to the plan No Surprises Act (NSA) Independent Dispute Resolution (IDR) arbitration expenses (per arbitration case) Applicable fees are as set by law and passed through to the plan Network Services CVS Health Virtual Caren" (PEPM) * $0.40 Subrogation* 37.5% of savings Contracted Services* Compensation, DRG and (Coordination of Benefits, Implant Audits) Retro Terminations, Medical Bill and Hospital Bill Audits, Workers 37.5% of savings Claim and Code Review Program* 30% of savings National Advantage"' Program — includes Facility Charge Review and Itemized Bill Review* We will retain 50% of savings National Advantage`" Program Cap — includes Facility Charge Review and Itemized Bill Review $100,000 Ca. of .er individual claim Care Management Aetna One® Flex (per engaged member, per month)* $735.00 Optional Programs & Services Included in the Claim Wire* Member Resources ALEX® (owned by Jellyvision) Essentials ALEX® (owned by Jellyvision) Advanced Refer to Alex® fee exhibit Refer to Alex® fee exhibit Network Services CVS Health Virtual Prima Carer" (PEPM) * $1.65 Wellness Aetna Back and Joint Care '� (per engaged member, per year)* $995 *Additional Program Details Claim Wire Billing, ID Cards, Subrogation, Contracted Services, Claim and Code Review Details can be found in our UW Disclosure document located at the following URL: https://www.aetna.com/content/dam/aetna/pdfs/aetnacom1legal-notices/documents/large-group-and-public-labor-self-funded-medical-underwriting-disclosures-as- of-01-01-2024.pdf Claim and Code Review Program This financial proposal includes enhancements that have been made to our claim and code review programs. Some of these capabilities were previously a component of oL. fees, but this proposal assumes 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. No Surprises Act - IDR Fees IDR fees are required by the NSA rules 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 additiona 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 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' included in the batch case. The current NSA fees are set by federal agencies. Both the initial fee and the arbitration expense fee are subject to future adjustments by the ag (and any such adjustments shall be applied to your plan). 6/13/2024 Proprietary vaetna Programs and Services ASC Weld County Government Programs and Services — Self -Funded Effective Date: January 01, 2025 Program Summary Choice POS II (HSA) Aetna Back and Joint Care'" Includes Aetna predictive analytics and care management coordination and digital MSK therapy programs from Hinge Health. For any single engaged member, the maximu year is $995, regardless of how many programs the member has engaged in. For Chronic Care - The fee associated with an enrolled member in the Chronic program and their Cohort will be paid in accordance with the 3 milestones for member engagement and pain reduction noted below. "Cohort" means all enrolled members under your plan who sign up for the program within any given month. Milestone Payments Milestone 1: A member enrolls in the program, receives the kit, and completes at least 1 exercise therapy session with a Hinge Health coach. Milestone 2: Cohort completes at least 4 exercise therapy sessions within the first 30 days of enrolling in the program and such Cohort achieves at least a; reduction in pain. Milestone 3: Cohort completes at least 8 exercise therapy sessions within the first 60 days of enrolling in the program and such Cohort achieves at least a reduction in pain With respect to each member enrolled in the program, the Milestone 1 payment of $331 is due once the member achieves Milestone 1; the Milestone 2 payment of when the member's Cohort achieves Milestone 2; and the Milestone 3 payment of $332 is due when such Cohort achieves Milestone 3. If the applicable Cohort doe Milestone 2 or Milestone 3 then payment for such Milestone is not due. For Acute Care - The fee associated with an enrolled member in the Acute program is $250 per year. This fee is not subject to Milestone payments. For Prevention - There is no fee associated with enrolled members in the Prevention Program. Aetna One® Flex Engagement begins upon a two-way interaction (i.e. telephonic, email, secured messaging, etc.) with a member of the multi -disciplinary care team (i.e. nurse, registered so pharmacist, health coach, or behavioral health specialist). After one month without a two-way interaction a member is no longer considered engaged. CVS Health Virtual Cares" In addition to the administrative fees as oLtlined above, there is a per consultation charge which will be shared by the member and plan sponsor based on type of service p member's benefit plan. Specific charges are available upon request. CVS Health Virtual Primary Care' (CVSH VPC) CVSH VPC requires CVS Health Virtual Care"". CVSH VPC is not available on gated plans (plans requiring a primary care physician referral.) CVSH VPC cannot be offered with network arrangements. Specific exclusions are available upon request. Full National Reciprocity Excludes some standalone Aetna Whole Health networks. Details are available upon request. Institutes of Excellence"" (IOE) This program includes a steerage component by educating members on the benefits of using an IOE designated facility. However, benefit differential steerage is not suppoi Infertility network. National AdvantageTM Program (including the Contracted Rates, Facility Charge Review and Itemized Bill Review Components) NAP includes a Contracted Rates component and two optional components: Facility Charge Review (FCR) and Itemized Bill Review (IBR). In addition, some plans also elect C iSight (DiS) as their out -of -network plan rate for professional services. NAP's Contracted Rates component offers access to contracted rates for many medical claims from n' network providers (including claims for emergency services and claims by hospital -based specialists such as anesthesiologists and radiologists who do not contract with insi and ad hoc negotiations (when a contracted rate is not available). We retain a percentage of savings achieved through NAP, including savings achieved through FCR, IBR, ar if elected. This NAP Fee is in addition to the per employee, per month administrative service fees. Personal Health Record (PHR) PHR requires the purchase of MedQuery. 6/13/2024 Proprietary netna Programs and Services ASC Weld County Government Allowances - Self -Funded Effective Date: January 01, 2025 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 1 Year 2 Year 3 Plan Year Effective Date 01/01/2025 01/01/2026 01/01/2027 Health Plan $235,000 $235,000 $235,000 Total $235,000 $235,000 _ $235,000 Annual allowance amounts may be adjusted if actual enrollment changes by 15 percent or more from our enrollment assumptions. Health Plan Allowance • You can use the Health Plan allowance to offset expenses applicable to the Guarantee Period(s) for which it is offered. Your allowance can be used for implementation, communication, reporting, and audit associated with your Aetna Medical plan. Example: of reimbursable expenses include expenses related to implementing your contract with us, promoting our products, programs or services, our system front-end charges, or auditing our readiness. Reporting examples include recurring or ad hoc reporting with us, or reporting costs to integrate our data with third -party vendors. • Your allowance can also be used for wellness -related programs or activities incurred during the Guarantee Period for which the allowance is offered. Wellness programs must be 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 onsite biometric screening and flu vaccination clinics or wellness fairs. • Claims audit expenses must be incurred during the Guarantee Period for which the allowance is offered. • Allowance dollars are for the exclusive benefit of your Aetna medical plan(s) and Aetna medical members. • 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. The above referenced fund(s) will be available after the effective date of each plan year. 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 • Invoices or other documentation summarizing any other miscellaneous expenses incurred 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. • Health Plan 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 allowances 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 allowance amounts used. Payment is due to us within 31 days of the invoice. 6/13/2024 Proprietary vaetna Allowance ASC Weld County Government Caveats - Self -Funded Effective Date: January 01, 2025 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' . If fees are adjusted, the caveats aelow 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 15 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 15 percent from the 2.1 ratio assumed in this quote. Projected Processed Claim Transactions (PCT) Per Employee The actual PCT ratio changes by more than 15 percent from the 29.00 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 15 percent from the 49 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. Termination You terminate the Agreement and we incur charges for maintaining plan structure to report and/or process runoff claims. National AdvantageTM Program You change or terminate the National AdvantageTM Program (NAP), Facility Charge Review (FCR), Itemized Bill Review (IBR), or Data iSightTM (DiS) programs ALEX For any of the ALEX tools/products, an adjustment to the pricing will be made if there is a change in the medical eligible employees of: • 15 percent if you have less than 29,999 medical eligible employees • 5 percent if you have more than 30,000 medical eligible employees Bundle up Discount If additional products quoted are not sold, or if additional and/or existing products terminate during the multi -year Guarantee Period, any applicable Bundle up Discounts as outlined in your fee exhibit will be removed. Multi -Year Provision You place the products, programs and services included in this multi -year fee guarantee out to bid with an effective date prior to December 31, 2027, then this guarantee is no longer valid. 6/13/2024 Proprietary aetna Caveats ASC Weld County Government Caveats - Self -Funded Effective Date: January 01, 2025 Total Replacement Any of the quoted lines of coverage are offered with an additional carrier. 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. Plan Design This renewal is based on the current benefit plan designs, plus any noted deviations, subject to the terms of our Benefit Review document. Claim Fiduciary - Option 1 Our renewal assumes we've been delegated claim fiduciary responsibilities. As claim fiduciary, we'll be responsible for final claim determination and the legal defense of disputed benefit payments. Our appeal administrative services are automatically included when we've been delegated claim fiduciary responsibilities. External Review We've included external review in our renewal. External review uses outside vendors who coordinate medical review through their network of outside physician reviewers. Member Communications Pricing assumptions include 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 vendors, 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 taxable 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 includes but is not limited to, the Health Insurance Portability Act (HIPAA), the Americans With Disabilities Act (ADA) and the Genetic Information Nondiscrimination Act (GINA). • Distribute notices 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 (cash, cash equivalent, or other tangible property) and provided by us or our third -party vendor to your members. • Assume any and all liability for your noncompliance with any tax withholding or information reporting requirements. You may wish to consult 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 assumes that prescription drug benefits are included and will be provided by Aetna. If you terminate your prescription drug benefits with us, we will increase your ASC medical fees and the medical trend assumption used for any applicable claim projections or guarantees. You may also be subject to additional charges to integrate data with external Pharmacy vendors. Refer to the reporting charges outlined in the Programs and Services exhibit for more information. 6/13/2024 Proprietary vaetna Caveats ASC Weld County Government Caveats - Self -Funded Effective Date: January 01, 2025 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. Medical Pharmacy Rebates Rebates for pharmacy products administered and paid through the medical benefit rather than the pharmacy benefit will be retained by Aetna as compensation for our efforts in administering this program. 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 rates as follows: • if you fail to pay plan benefit payments the same day of the request • if you fail to pay administrative service fees within 31 days of the due date 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 renewal administrative service fees are mature. However, your original service fees did not include the expenses associated with processing rune' claims following termination. If you request that we process runoff claims for one year, we'll charge you a fee upon contract termination. The determination of the runoff fee, which is billed upon termination, is as follows: average PEPM fee over the last 3 months x the estimated average number of employees covered during the first year of your Agreement x 3 x 80 percent If you've previously paid a portion of your runoff claims processing fees and you have a change in enrollment that impacts these fees, we'll advise you if additional runoff claims processing charges will be due. Medical Service Center We've assumed that claim administration and member services for the quoted plans will be managed centrally by the Fresno, CA 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). 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 rights or the right to use all of the intellectual property used by Aetna in providing the Services under the Agreement ("Aetna IP"). 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 rights in, or any right to assign, sublicense, sell, resell, lease, rent, or otherwise transfer or convey, the 6/1 tbt24 to you. Proprietary iraetna Caveats ASC Weld County Government Caveats - Self -Funded Effective Date: January 01, 2025 Data Integration (Historical) Our renewal assumes one historical medical and one historical pharmacy data integration feed. Additional fees will apply if feeds from more than one historical vendor are required. Data Integration (Ongoing) Options 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 Termination Upon Agreement termination, we agree to cooperate with succeeding administrators in producing and transferring required claim and enrollment data. Data will be transferred within 30 days after determination of specific format and content requirements, subject to 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 use no more than three primary banking lines which are shared across all self -funded products, excluding Flexible Spending Account (FSAs). Additional wire lines and customized banking arrangements will result in an adjustment to the proposed pricing. 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/content/dam/aetna/pdfs/aetnacom/legal-noticesidocuments/large-group-and-public-labor-self-funded- medical-underwriting-disclosures-as-of-01-01-2024.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. 6/13/2024 Proprietary vaetna Caveats ASC Weld County Government Caveats - Self -Funded Effective Date: January 01, 2025 Recovery of Overpayments Our process of recovering overpayments attempts to recoup money in the most accurate, effective, and cost-efficient manner. When seeking recovery 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 that provider involving your or other health and welfare plans that are administered by us) by the amount of the overpayment, and 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. 6/13/2024 Proprietary vaetna Caveats ASC Weld County Government Guarantee Summary Effective Date: January 01, 2025 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 15 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 excludes: • 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 • Aetna Back and Joint Care 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 multi -year Guarantee Period, December 31, 2027. • You fail to meet your obligations under the Agreement (for example, a submission of incomplete eligibility or failure to fund claim payments) Aetna Back and Joint Care ROI Guarantee Guaranteed Medical Metric Guaranteed Target Fees at Risk Back and Joint ROI 1.5:1 $995 per engaged member 6/13/2024 Proprietary vaetna Guarantee Summary Weld County Government Aetna Back and Joint Care ROI Guarantee Effective Date: January 01, 2025 Guarantee Period: January 01, 2025 through December 31, 2025 Guaranteed ROI: 1.5:1 Aetna is providing this Back and Joint Care ROI Guarantee on the Chronic Program on Hinge Health's behalf. This guarantee does not include the Prevention and Acute programs. We have no legal or other responsibility for meeting this ROI guarantee and/or any payments due to you for missing the guarantee. If the guarantee is missed and you are due any payment from Hinge Health, we agree to reasonably help you in settling any related payment issues that may arise with Hinge Health. Guarantee: Hinge Health guarantees that the projected savings associated with the Chronic Program, also known as the Core Digital Care Program, of the Aetna Back and Joint Care program will be equal to one and a half (1.5) times the Guarantee Period administrative service fee of $995 per engaged member. Cost savings are assessed based on the reduction of pain as measured by the visual analog scale (VAS), before and after participating in the Hinge Health intensive 12 -week phase. To achieve a 1.5:1 ROI, the following calculated value needs to equal one and a half times the cost of the program: [((Pain at screening) - (Pain at 12 weeks) / (Pain at screening)) x 100] x $71.09* x number of participants = projected total cost saved *Based on Hinge Health's published clinical studies, the Chronic digital care pathway saves $71.09 in Musculoskeletal (MSK) costs per participant per year for every 1 percent decrease in pain. Example: By way of example, assume 1,000 participants go through the Chronic Program the total cost would be $995,000 (1,000 participants multiplied by $995). If the average pain reduction is 12% per participant, then the total program savings would equal (12 x $71.09 x 1,000) = $853,080. Thus the Program did not achieve the guaranteed ROI of 1.5:1. Payment and Measurement Criteria: If Hinge Health does not achieve a 1.5:1 ROI according to the metric above, you will receive a prorated refund up to 100 percent of the Chronic Program of the Aetna Back and Joint Care Guarantee Period administrative service fee. Example: By way of example, based on the scenario described above the formula set forth would yield you a refund of $426,280 (calculated by [(1,492,500 - $853,080) / $1,492,500]*$995,000 = $426,280. Conditions for the guarantee We reserve the right to revise or remove the guarantee if any of the following conditions are not met. • This guarantee requires a minimum of 50 participants engage in the Hinge Health Chronic Program by the end of the Guarantee Period. • Member eligibility (complete, accurate and viable enrollment data; including member phone numbers) is fully loaded in our eligibility system at least 35 days prior to the effective date. 6/13/2024 Proprietary taetna Aetna Back and Joint Care ROI ALEX® Aetna Life In WELD COUNTY GOVERNMENT From enrollment to daily savings, ALEX helps your employees avoid costly benefits mistakes. At the heart of ALEX is Benefits Counselor -- a personalized, virtual experience that improves benefits awareness by walking empl( medical, vision, dental, voluntary benefits and retirement plans. With ALEX, employees have a human -based, engaging experienc( of humor to keep them interested - helping them overcome natural biases, make smarter decisions, and understand financial imp Once your employees finish talking to ALEX, they'll have a recommendation for the best possible benefits choices for them and th opportunities to save money along the way. ALEX identifies many of the common benefits pitfalls and steers employees towards t for them —based on their own personal health and finances. Far from a one -size -fits -all benefits decision tool, ALEX learns your er chronic conditions, and more to deliver tailored advice all year round. Plan Medical Sponsor Eligible ALEX Annual Comprehensive Pricing WELD COUNTY GOVERNMENT 1,466 ALEX Product Component Essentials ALEX Benefits Counselor License Included 2024/2025 OE & New Hire Onboarding URL Included Decision • Rx, • • • • • • • • • • • • Medical Tax Retirement Dental Vision Life AD&D Disability Critical Accident EAP Pharmacy Three Medicare) Savings "More Support Illness (Networks, Savings (FSA/HSA and/or Benefits" Deductibles, Guidance, text Education -only HRA/HSA/FSA, Dependent modules on: OOP, Care Benefit Preventive & Care, Covered Benefit) Procedures, Included Commuter Jellyvision Implementation Support Included Customer Success and Marketing Support Included Real Time Analytics Dashboard Included Employee Survey Verbatim Results Included Benefits Sneak Peek Videos (2) -- Open Enrollment + New Hire engagement Included ALEX Homepage ALEX Chat ALEX Consumerism Tips (15) Total Proposed Fee - ANNUAL FEE $26,478 Billing of Fees ALEX fees are claim wire billed to the plan sponsor on a one time basis once the tool(s) are launched, unless otherwise specified. 6/13/2024 isurance, a CVS Company 1/1/2025 pyees through your major with just enough of a sense lications of picking a plan. eir families, understanding :he right plans and decisions nployees' family needs, Advanced Included Included Included Included Included Included Included Included Included Included Included $63,221 6/13/2024 Contract Form Entity Information Entity Name* AETNA INC Contract Name* AETNA MEDICAL PLAN RENEWAL Contract Status CTB REVIEW Entity ID* 000009916 Contract ID 8962 Contract Lead * BPETERSON Contract Lead Email bpeterson@weld.gov New Entity? Parent Contract ID Requires Board Approval YES Department Project # Contract Description * AETNA MEDICAL PLAN MEDICAL RENEWAL FOR THE JANUARY 01, 2025 THROUGH DECEMBER 31, 2025 CONTRACT PERIOD. Contract Description 2 Contract Type * AMENDMENT Amount * $0.00 Renewable* NO Automatic Renewal Grant IGA Department HUMAN RESOURCES Department Email CM- HumanResources@weld.g ov Department Head Email CM -Hu man Re sou rces- DeptHeadgweld.gov County Attorney GENERAL COUNTY ATTORNEY EMAIL County Attorney Email CM- COUNTYATTORNEY@WEL D.GOV If this is a renewal enter previous Contract ID If this is part of a MSA enter MSA Contract ID Requested BOCC Agenda Date * 12/23/2024 Due Date 12 19 2024 Will a work session with BOCC be required?* HAD Does Contract require Purchasing Dept. to be included? 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 01/01/2025 Termination Notice Period Contact Information Contact Info Contact Name Purchasing Purchasing Approver Approval Process Department Head JILL SCOTT DH Approved Date 12/18'2024 Final Approval BOCC Approved BOCC Signed Date BOCC Agenda Date 12/23/2024 Review Date * 10/31/2025 Committed Delivery Date Contact Type Contact Email Finance Approver CHERYL PATTELLI Renewal Date Expiration Date* 12/31;2025 Contact Phone 1 Purchasing Approved Date Finance Approved Date 12 19/2024 Tyler Ref # AG 122324 Originator BPETERSON Legal Counsel BYRON HOWELL Contact Phone 2 Legal Counsel Approved Date 12,,.19 2024 Hello