HomeMy WebLinkAboutES10-045 - Original - #15 - LifeWise - Funding Rider - 1/1/24 FOR CITY OF KENT OFFICIAL USE ONLY
Sup/Mgr:
Agreement Routing Form DirAsst:
• For Approvals,Signatures and Records Management Dir/Dep:
KENT This form combines&replaces the Request for Mayor's Signature and Contract Cover (Optional)
WASHINGTON Sheet forms. (Print on pink or cherry colored paper)
Originator: Department:
Laura Horea Human Resources
Date Sent: Date Required:
c 10/08/2024 10/10/24
QAuthorized to Sign: Date of Council Approval:
Q ❑✓ Mayor or Designee 10/01/2024
Budget Account Number: Grant? Yes No�✓
Budget?❑✓ Yes E]No Type: N/A
Vendor Name: Category:
LifeWise Contract
Vendor Number: Sub-Category:
Amendment
0
Project Name: LifeWise
OProject Details:
C
40
C
Basis for Selection of Contractor:
Agreement �8C2,590 Other
Memo to Mayor must be attached .1111
Start Date: fl/1/2024 Termination Date: 12/31/2024
a Local Business? Yes F]No*If meets requirements per KCC 3.70.100,please complete"Vendor Purchase-Local Exceptions"form on Cityspace.
Business License Verification: El Yes In-Process F1 Exempt(KCC 5.01.045) FlAuthorized Signer Verified
Notice required prior to disclosure? Contract Number:
F—]YesF—]No ES10-045
Comments:
n LifeWise Contract Amendment #15
a
� c
a,
a
Date Received:City Attorney: 10/9/24 Date Routed:Mayor's Officl 10/16/24 City Clerk's Office 10/17/24
adccW22373_7_20 Visit Documents.KentWA.gov to obtain copies of all agreements
rev.20221201
AMENDMENT NO. 15
To be attached to and made part of Policy WA 518212 issued to City of Kent as Policyholder.
It is hereby agreed the Policy shall be amended as follows:
Effective January 1, 2024:
The following Section has been replaced:
Section 1, Declarations.
The following page has been replaced:
Table of Contents.
The following Riders have been added:
Surplus Rider; and
Rate Cap Rider.
The following Rider renews for the 2024 Policy Year:
• Specific Advance Funding Rider.
All other terms and conditions of the contract remain unchanged.
Dana Ralph, Mayor LifeWise Assurance Company
Name and Title of Officer
ignature of Officer
Ben Helsel
10/16/2024 President
Date of Signature LifeWise Assurance Company
1. Sign and return copy to LifeWise Assurance Company.
2. Retain copy with Your Policy.
PSL-500 WA AM (9-18) Amendment
TABLE OF CONTENTS
Effective January 1, 2024
Section1. Declarations........................................................................................................................1
Section2. Definitions...........................................................................................................................4
Section3. Benefits...............................................................................................................................7
Section 4. Exclusions and Limitations ..................................................................................................8
Section 5. Claim Administrator.............................................................................................................8
Section 6. Claim Provisions .................................................................................................................8
Section7. Material Changes................................................................................................................9
Section 8. Termination and Renewal....................................................................................................9
Section9. Premiums..........................................................................................................................10
Section 10. General Provisions............................................................................................................11
Section 11. Records and Reports ........................................................................................................12
Section 12. Liability and Indemnification...............................................................................................13
Section 13. Entire Contract, Changes..................................................................................................13
Section 14. Incontestable Clause.........................................................................................................13
Section15. Legal Actions ....................................................................................................................13
Section16. Insolvency.........................................................................................................................13
Section17. Assignment.......................................................................................................................13
Specific Advance Funding Rider............................................................................................................14
RateCap Rider......................................................................................................................................15
SurplusRider.........................................................................................................................................16
PSL-500 WA(9-18)
This Declarations for Policy Number WA 518212 apply to the Policy Term January 1, 2024 through
December 31, 2024 in its entirety.
SECTION 1 — DECLARATIONS
A. POLICY INFORMATION
1. Policy Number WA 518212
2. Policyholder City of Kent
3. Policy Term January 1, 2024 through December 31, 2024
4. Covered Underlying Plan City of Kent's Health Plan
5. Claim Administrator Premera Blue Cross
B. SPECIFIC BENEFIT SCHEDULE
For all Eligible Losses except those to which a Special Risk Limitation applies:
1. Covered Loss Basis
Covered Services Incurred from January 1, 2010 through December 31, 2024 and Paid from
January 1, 2024 through December 31, 2024.
If an Eligible Claim Expense is denied by the Covered Underlying Plan and that denial is
subsequently reversed by an Independent Review Organization (IRO), the date such Eligible
Claim Expense was originally denied by the Covered Underlying Plan will be considered the
"Paid"date under the above referenced Policy.
2. Covered Services include
Medical
Prescription Drug
3. Number of Covered Units
Composite 711
4. Specific Deductible per Participant $275,000
Please note: The minimum Specific Deductible per Participant shall not exceed the lesser of 5%
of expected claims or$100,000.
5. Specific Payable Percentage (in excess of Specific Deductible) 100%
6. Maximum Specific Benefit in excess of the Specific Deductible
Per Policy Term Unlimited
Per Lifetime Unlimited
PSL-500 WA(9-18) 1
C. AGGREGATE BENEFIT SCHEDULE
For all Eligible Losses except those to which a Special Risk Limitation applies:
1. Covered Loss Basis
Covered Services Incurred from January 1, 2010 through December 31, 2024 and Paid from
January 1, 2024 through December31, 2024.
If an Eligible Claim Expense is denied by the Covered Underlying Plan and that denial is
subsequently reversed by an Independent Review Organization (IRO), the date such Eligible
Claim Expense was originally denied by the Covered Underlying Plan will be considered the
"Paid"date under the above referenced Policy.
2. Covered Services include
Medical
Prescription Drug
3. Number of Covered Units
Composite 711
4. Aggregate Payable Percentage in excess of Deductible 100%
5. Aggregate Corridor 200%
(Please note: Aggregate Corridor will never be less than 120%of expected claims).
6. Minimum Aggregate Deductible
The greater of:
A. $29,451,013.56; or
B. The sum of Aggregate Monthly Factors, multiplied by the corresponding number of
Covered Units used to calculate premium in the first month of the Policy Term, multiplied
by the number of months in the Policy Term, multiplied by 95%.
7. Annual Aggregate Deductible
Is equal to the greater of A or B, where:
A =The sum of the Monthly Aggregate Deductible Amounts applicable to each Policy Month
in the Policy Term
B =The Minimum Aggregate Deductible
Please Note:Annual Aggregate Deductible cannot be finalized until the Monthly Aggregate
Deductible Amounts are calculated for each Policy Month of the Policy Term.
8. Aggregate Monthly Factor per Covered Unit
Composite $3,451.83
9. Maximum Aggregate Eligible Loss per Participant $275,000
10. Maximum Aggregate Benefit per Policy Term $1,000,000
PSL-500 WA(9-18) 2
D. PREMIUM
Specific Monthly Premium Rate
Composite $108.40
Specific Rate Guarantee Period 12 Months
Aggregate Monthly Premium Rate Per Covered Unit
Composite $0.02
Aggregate Rate Guarantee Period 12 Months
The Specific Monthly Premium Rate and the Aggregate Monthly Premium Rate apply only to this
Policy Term.
E. SPECIAL RISK LIMITATIONS
Retirees Included Yes
An employee of the City of Kent is eligible to enroll on the date he or she satisfies the following:
• Becomes a retired LEOFF I employee, provided such employee:
- Has attained age 50;
- Has at least 5 or more years of credited service with the employer; and
- Is eligible to receive a retirement benefit under the LEOFF I Retirement Plan.
• Becomes a retired, disabled LEOFF I employee who is eligible to receive a retirement benefit
under the LEOFF I Retirement Plan.
Other: No lasers or other limitations
apply to the 2024 contract year.
F. AFFILIATE
Name Covered Underlying Plan
None
PSL-500 WA(9-18) 3
RATE CAP RIDER
To be attached to and made part of Policy WA 518212 issued to City of Kent as Policyholder.
Effective January 1, 2024, it is hereby agreed Section 9 paragraph B, Changes in Premium Rates, is
amended by the addition of:
7. At renewal, any increase in the Specific Premium Rates will be limited to 50%for the next Policy
Term.
At renewal, We will not apply any new Special Risk Limitation, including but not limited to an Alternate
Specific Deductible or Excluded Loss, unless requested in writing by You.
We reserve the right to revise the Deductibles and other terms and conditions of this Policy at the end of
any Policy Term by providing written notice to You.
All other terms and conditions of the Policy will continue to apply including but not limited to reapplication
of the Specific Deductible or Aggregate Deductible in the next Policy Term.
LifeWise Assurance Company
by
Ben Helsel
President
LifeWise Assurance Company
PSL-500 WA RC (2-20) 15 Rate Cap Rider
SURPLUS RIDER
To be attached to and made part of Policy WA 518212 issued to City of Kent as Policyholder.
Effective January 1, 2024, it is hereby agreed the Policy shall be amended as follows:
Policy Cover is changed to reflect a Participating contract;
Section 10 Item D is deleted; and
The following items are added:
Definitions
A. Actual Loss Ratio means the result when the Claims for the Policy Term are divided by the
Premium. For example, if We reimbursed $85,000 in Claims during the Policy Term, and You paid
$125,000 in Premiums during the Policy Tenn; then the Loss Ratio is equal to 68% (85,000/125,000 =
.68).
B. Claims means the Specific Stop Loss Covered Services paid during the Policy Term.
C. Gross Premium means the Specific Stop Loss premiums that are paid during a Policy Term. All
premiums must be paid when due throughout the Policy Term.
D. Maximum Loss Ratio (MLR) is the percentage calculation and is used to define the maximum loss
ratio for a surplus refund. It is calculated as follows: (X1% Refund Cap/X2% Risk Share =X3%);
XX%TLR-X3% = MLR%). The maximum refund will be payable if the Actual Loss Ratio is MLR% or
lower. The Maximum Loss Ratio for your contract is 32.5%.
E. Net Premium means the Gross Premium received less premium tax and commissions.
F. Policy Term means a period of consecutive months during which the experience for the Specific
Benefit Coverage will be used to determine if a Surplus is payable.A Surplus will be calculated at the
end of each Policy Term and will be finalized for credit or payment at the end of the Policy Term. The
Policy Term is shown under the Surplus Rider Details.
G. Refund Cap means the maximum amount of Surplus available for a Surplus payment. This maximum
amount will be equal to 15% of the Net Premium received during the Policy Period.
H. Surplus means an amount that will be paid or credited to You if the Specific Stop Loss Actual Loss
Ratio is below the Target Loss Ratio during the Policy Term. There is no impact to You if the Surplus
calculation results in a deficit.
I. Risk Share means the percentage of the funds available for the Surplus. The Risk Share is shown
under the Surplus Rider Details.
J. Target Loss Ratio means the highest Loss Ratio where a Surplus may be payable. If the actual Loss
Ratio during the Policy Term is equal to or greater than the Target Loss Ratio, then a Surplus will not
be payable. The Target Loss Ratio is shown under the Surplus Rider Details.
PSL-500 WA SR (2-20) 16 Surplus Rider
Surplus Rider Details
1. Policy Term Consecutive months beginning with January 1, 2024
and ending December 31, 2024
2. Target Loss Ratio 70%
3. Refund Cap 15% of Net premium
4. Risk Share 60%—LifeWise Assurance Company
40%—City of Kent
We will calculate the amount of Surplus payable for the Policy Term. If the Actual Loss Ratio is equal to or
less than the Target Loss Ratio, You will be eligible for a Surplus credit or payment, subject to the
limitations below. If the Actual Loss Ratio exceeds the Targeted Loss Ratio, You will not be eligible for a
Surplus payment. The surplus credit or payment is calculated as the Net Premium x (Target Loss Ratio—
Actual Loss Ratio)x Risk Share%. The Surplus credit or payment may not exceed the Refund Cap.
A Surplus payment/credit will be calculated by Us on or about the 4th month after the end of the Policy
Term and if a Surplus is payable, it will be paid/credited to You. For a policy that includes a run-out
period, the Surplus will be calculated on or about the 4th month after the end of the run-out period.
LIMITATIONS
The following Limitations apply to the Surplus payment or credit:
1. The Stop Loss policy must remain in-force during the Surplus Policy Term.
2. All premiums must be paid throughout the Surplus Policy Term.
3. The policy must be in-force on the date the Surplus would be paid or credited.
4. No interest is earned or payable on the Surplus amount.
All other terms and conditions of the Policy will continue to apply.
LifeWise Assurance Company
by
.I
Ben Helsel
President
LifeWise Assurance Company
PSL-500 WA SR (2-20) 17 Surplus Rider