HomeMy WebLinkAbout20210821.tiff RESOLUTION
RE: APPROVE STOP LOSS APPLICATION AND SCHEDULE OF INSURANCE AND
AUTHORIZE CHAIR TO SIGN AND SUBMIT ELECTRONICALLY — AETNA LIFE
INSURANCE COMPANY
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with a Stop Loss Application and Schedule of
Insurance between the County of Weld, State of Colorado, by and through the Board of County
Commissioners of Weld County, on behalf of the Department of Human Resources, and Aetna
Life Insurance Company, with further terms and conditions being as stated in said application and
schedule, and
WHEREAS, after review, the Board deems it advisable to approve said application and
schedule, a copy of which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of
Weld County, Colorado, that the Stop Loss Application and Schedule of Insurance between the
County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld
County, on behalf of the Department of Human Resources, and Aetna Life Insurance Company,
be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to electronically sign and submit said application and schedule.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 22nd day of March, A.D., 2021, nunc pro tunc March 17, 2021.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
ATTEST: di:dot) ido;e1
Steve ,'oreno, Chair
Weld County Clerk to the Board
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Deputy Clerk to the Board , '' S/JL, 4._�
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: _ :: ike Freeman
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Date of signature: 3/2S/2+I , � L S
C C:H R(PR/sD) 2021-0821
3/aS74.1 PE0033
BOARD OF COUNTY COMMISSIONERS
PASS-AROUND REVIEW
PASS-AROUND TITLE: Aetna Life Insurance Company Stop Loss Application
DEPARTMENT: Human Resources DATE: 03/17/2021
PERSON REQUESTING: Staci Datteri-Frey
Brief description of the problem/issue:
This is to update our individual and aggregate stop loss policy coverage amounts with Aetna for
medical claims. This amount is reviewed and renewed annually as part of our renewal process.
What options exist for the Board? (include consequences, impacts, costs, etc. of options):
Approve - claims processing will continue and Weld County will reduce risk of high cost claims.
Disapprove - negotiate new terms with Aetna and subject to any high claims as of 1/1/2021.
Recommendation:
Approve contract as stated and reduce risk on high cost claims.
Approve Schedule
Recommendation Work Session Other/Comments:
Perry L. Buck
Mike Freeman
Scott K.James, Pro-tern
Steve Moreno,Chair
Lori Saine
2021-0821
03/
Pa0033
Aetna Life Insurance Company151 Farmington Avenue
Hartford, CT 06155
Stop Loss Application and c edule of insurance
Policyholder Information
Policyholder name (full legal name of entity): Weld County
Street: 1150 0 Street
City: Greeley State: CO Zip Code: 80631
Email: sfrey@weldgov.com Phone: 9704004235
Policy period start: 01/01/2021 Policy period end: 12/31/2021
Total number of employees/covered units covered under the policy: 1,408
Pre-65 Retirees: ❑ Included Q Excluded Retirees 65+: ❑ Included Q Excluded
Medical paid claims basis: Q Issued ❑ Cleared ❑ N/A
Business Type: El Corporation Q Government ❑ Association El Union ❑ Other
Affiliates or subsidiaries included? Q No ❑ Yes If yes, list name(s) and address state of the primary location(s) below.
Affiliate full legal name(s): Address state of Primary location(s):
Affiliate full legal name(s): Address state of Primary location(s):
Affiliate full legal name(s): Address state of Primary location(s):
Affiliate full legal name(s): Address state of Primary location(s):
Affiliate full legal name(s): Address state of Primary location(s):
Affiliate full legal name(s): Address state of Primary location(s):
Affiliate full legal name(s): Address state of Primary location(s):
Affiliate full legal name(s): Address state of Primary location(s):
Affiliate full legal name(s): Address state of Primary location(s):
Affiliate full legal name(s): Address state of Primary location(s):
Third Party Administrator? Q No ❑ Yes If yes, complete for each administrator or vendor.
Medical:
Prescription drug:
Other:
Individual Stop Loss Coverage (ISL)
Individual Stop Loss coverage? ❑ No Q Yes Individual Stop Loss amount: $300,000
Does individual Stop Loss amount differ by plan or class? Q No ❑Yes
If yes, please include the plan(s)/class(es) and amounts below.
Plan/class: Individual Stop Loss amount: $
Plan/class: Individual Stop Loss amount: $
Plan/class: Individual Stop Loss amount: $
Plan/class: Individual Stop Loss amount: $
AL HPol-App-S01-SL 02 1 CO
Plan/class: Individual Stop Loss amount: $
High risk individual Stop Loss amount(s)* included? ❑ N/A Q No ❑ Yes *See Coverage Limitations identified below.
Covered benefits: Q Medical Q Prescription drug ❑ Other
Contract type: Claims incurred from through or Q paid basis
Claims paid from 01/01/2021 through 12/31/2021
Maximum run-in claims: Q N/A or$ ❑ per covered person ❑ in total
Individual coinsurance percentage reimbursable: 100%
IOE transplant Stop Loss amount: ❑ N/A Q No or $
Family individual Stop Loss amount: ❑ N/A Q No or $
Aggregating Specific Stop loss amount: ❑ N/A Q No or $
Maximum lifetime individual Stop Loss payment amount: Q Unlimited or $
Experience Refund Option included? ❑ N/A Q No ❑ Yes
Experience refund period: Start date through
Loss ratio threshold: % Refund share:
Maximum refund: % Large claim adjustment: E No or Adjustment is:
Large claim identifier: Date of birth:
Large claim identifier: Date of birth:
Large claim identifier: Date of birth:
Large claim identifier: Date of birth:
Large claim identifier: Date of birth:
Premier product included? ❑ N/A Q No ❑ Yes
Renewal risk cap included? ❑ N/A ❑ No Q Yes Cap: 50%
Other rate cap included? Q N/A ❑ No ❑ Yes Cap: %
Terminal run-out coverage for claims incurred prior to policy termination and paid after termination? ❑ No Q Yes
Terminal reserve or liability period: 3 months
Reimbursement types:
Immediate reimbursement (Aetna as claims administrator): ❑ N/A ❑ No Q Yes
Individual accelerated claim reimbursement (TPA as claims administrator): ❑ N/A Q No ❑ Yes
Other conditions or provisions: NA
Aggregate Stop Loss Coverage (ASL)
Aggregate Stop Loss coverage? ❑ No Q Yes Aggregate Stop Loss percentage: 120%
Covered benefits: RI Medical Q Prescription Drug ❑ Dental ❑ Vision ❑ Other
Contract type: Claims incurred from through or Q paid basis
Claims paid from 01/01/2021 through 12/31/2021
Maximum run-in claims: Q N/A or $ ❑ per covered person ❑ in total
Individual Stop Loss insurer: Q Aetna or
Minimum aggregate Stop Loss amount: ❑ N/A $ 24,001,276
AL HPol-App-S01-SL 02 2 CO
Individual internal limit: ❑ N/A Q No ❑ Yes If yes, amount: $
Maximum annual aggregate Stop Loss payment amount? ❑ N/A ❑ No Q Yes If yes, amount: $1,000,000
Deficit recoup provision? ❑ N/A Q No ❑ Yes If yes, deficit cap:
Termination provision? ❑ N/A Q No ❑ Yes
Terminal run-out coverage for claims incurred prior to policy termination and paid after termination? ❑ No Q Yes
Terminal reserve or liability period: 3 months
Reimbursement types:
Monthly budget feature (Aetna as claims administrator): ❑ N/A ❑ No Q Yes
Aggregate accelerated claim reimbursement (TPA as claims administrator): ❑ N/A Q No ❑ Yes
Other conditions or provisions:
Coverage Limitations
Mental Health claim expenses are Q Included ❑ Excluded
Transplant coverage is Q Included ❑ Excluded
Is the policyholder a hospital or hospital group? Q No ❑ Yes
If yes, are drafts suppressed for domestic claims? Q N/A ❑ No ❑ Yes
If yes, domestic claims are reimbursed at? CO N/A ❑ 100% ❑ 0% ❑ Other
Are any of these limitations included under this Stop Loss policy?
Pre-existing conditions exclusion? Q No ❑ Yes
Dependent non-confinement? Q No ❑ Yes
Actively at Work? Q No ❑ Yes
High Risk Individual Stop Loss amounts:
Member Identifier Date of Birth Amount Description
Premium Rates and Factors
Premium rate:
*Composite: $91.37 per employee per month (PEPM)
*If individual and aggregate Stop Loss coverage is included, the premium rate is combined.
Terminal liability premium rate:
*Composite: $ per employee per month (PEPM) or Q N/A
*If individual and aggregate Stop Loss coverage is included, the premium rate is combined.
Aggregate Stop Loss factor:
AL HPol-App-S01-SL 02 3 CO
Composite: $1,420.53 per employee per month (PEPM) or ❑ N/A
Terminal Liability Stop Loss factor:
Composite: $ per employee per month (PEPM) or LI N/A
Certification and Signature
You hereby represent that the information contained in this Stop Loss Application and Schedule of Insurance, any
Disclosure statement, and all other information and documents provided by you to us, is true and complete to the best
of your knowledge and belief.
Printed name of authorized representative: Signature of authorized representative:
County Commission &eve/Weeo
>aE Moreno(Mar 7.?,202112 54 MDI)
Official Title: Weld County Commi Date: Mar 17, 2021
Agent of Record
Agent's name: on file
Agent's firm: on file Tax ID#: on file
(If countersignature laws require commission sharing with a duly licensed resident agent in another jurisdiction, the
above designation will be modified to the extent required by law.)
AL HPol-App-S01-SL 02 4 CO
Fraud Notice
WARNING: Any person who knowingly and with intent to defraud any insurance company or other person files an
application for insurance or statement of claim containing any materially false information or conceals for the
purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act,which
is a crime and subjects such person to criminal and civil penalties.
State-specific notices:
AL: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or who knowingly
presents false information in an application for insurance is guilty of a crime and may be subject to restitution fines or
confinement in prison, or any combination thereof.
AR: Any person who knowingly and with intent to defraud any insurance company or other person files an application
for insurance or statement of claim containing any materially false information, or conceals for the purpose of
misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime.
CO: It is unlawful to knowingly provide false, incomplete, or misleading facts or information to an insurance company
for the purpose of defrauding or attempting to defraud the company. Penalties may include imprisonment, fines,
denial of insurance and civil damages. Any insurance company or agent of an insurance company who knowingly
provides false, incomplete, or misleading facts or information to a policyholder or claimant for the purpose of
defrauding or attempting to defraud the policyholder or claimant with regard to a settlement or award payable from
insurance proceeds shall be reported to the Colorado Division of Insurance within the Department of Regulatory
Agencies.
DC: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or who knowingly
presents false information in an application for insurance is guilty of a crime and may be subject to fines and
confinement in prison.
FL: Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or
an application containing any false, incomplete, or misleading information is guilty of a felony of the third degree.
KY: Any person who knowingly and with intent to defraud any insurance company or other person files an application
for insurance or statement of claim containing any materially false information or conceals, for the purpose of
misleading, information concerning any material fact thereto, commits a fraudulent insurance act, which is a crime.
LA: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly
presents false information in an application for insurance is guilty of a crime and may be subject to fines and
confinement in prison.
ME: It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the
purpose of defrauding the company. Penalties include imprisonment, fines and denial of insurance benefits.
MD: Any person who knowingly or willfully presents a false or fraudulent claim for payment of a loss or benefit or who
knowingly or willfully presents false information in an application for insurance is guilty of a crime and may be subject
to fines and confinement in prison.
NJ: Any person who includes any false or misleading information on an application for an insurance policy is subject to
criminal and civil penalties.
NM: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly
presents false information in an application for insurance is guilty of a crime and may be subject to civil fines and
criminal penalties.
NY: Any person who knowingly and with intent to defraud any insurance company or other person files an application
for insurance or statement of claim containing any materially false information, or conceals for the purpose of
misleading, information concerning any material fact thereto, commits a fraudulent insurance act, which is a crime,
and shall also be subject to a civil penalty not to exceed five thousand dollars and the stated value of the claim for each
such violation.
OH: Any person who, with intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an
application or files a claim containing a false or deceptive statement is guilty of insurance fraud.
OK: WARNING -Any person who knowingly, and with intent to injure, defraud or deceive any insurer, makes any claim
AL HPol-App-S01-SL 02 5 CO
for the proceeds of an insurance policy containing any false, incomplete or misleading information is guilty of a felony.
OR: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly
presents false information in an application for insurance may be guilty of a crime and may be subject to civil fines and
criminal penalties.
RI: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly
presents false information in an application for insurance is guilty of a crime and may be subject to fines and
confinement in prison.
TN: It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the
purpose of defrauding the company. Penalties include imprisonment, fines and denial of insurance benefits.
VA: Any person who, with the intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an
application or files a claim containing a false or deceptive statement may have violated state law.
WA: It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the
purpose of defrauding the company. Penalties include imprisonment, fines and denial of insurance benefits.
WV: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly
presents false information in an application for insurance is guilty of a crime and may be subject to fines and
confinement in prison.
AL HPol-App-SO1-SL 02 6 CO
STOP LOSS APPLICATION AND SCHEDULE OF INSURANCE -AETNA LIFE INSURANCE
COMPANY
'PRO ED A T UBSTANCE:
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Elected Offici I or Departmen Head
APPROVED AS TO FUNDING:
Controller
APPROVED AS TO FORM:
TCo my Attorney
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