23-02 - Scope of Services.pdf

Issued on April 25, 2026

SCOPE OF SERVICES

FOR

RFP #26-71-P

EMPLOYEE HEALTH AND WELFARE BENEFITS

OVERVIEW

Client: City of Lewisville

Industry: Municipality

Group to be Covered: All Eligible Employees working 30 hours per week Pre and Post-65 Retirees

Size: 910 Active Employees 23 Retirees

1 COBRA

Location: 151 W. Church Lewisville, TX 75057

Coverages to Bid: Third Party Administrator

Pharmacy Benefit Manager Medical/Rx Stop Loss ASO Dental Fully Insured Vision Basic Life/AD&D Voluntary Life/AD&D Long Term Disability

EAP

HSA

FSA

COBRA

Commission: ALL COVERAGES TO BE QUOTED NET OF

COMMISSION

New Coverage Effective 1/1/2027

Consultant comments: The City of Lewisville, located in North Texas and is required to conduct an RFP for Employee Health and Welfare Benefits. The City is not requesting the services of a Consultant/Agent/Broker. Carved in and carved out PBM solutions are being requested. It is requested to reach out to charlotte.starks@hubinternational.com for the census, claims, disruption and repricing files. There may be a best and final process for all coverages.

Stop Loss may not be finalized until such time that reporting is available to receive firm offers closer to the effective date. Only Pre-65 Retirees are eligible for medical. Pre and Post 65 Retirees are eligible for dental and vision. Any retiree with 10 years of service receives the $15,000 life insurance policy and AD&D is not available to retirees.

ASSUMPTIONS AND EXPECTATIONS

Assumptions are as follows:

1. The proposal is to be based on the proposed plan of benefits.

2. The quote is to be based upon the census provided in the RFP.

3. All participants enrolled in the Employee Benefits Plan as of December 31, 2026 are to receive immediate coverage under the new plan. All health services incurred on or after January 1, 2027, for currently enrolled participants are to be eligible expenses. The City’s enrollment records are to be the basis for “take-over.”

4. All Respondent proposal offerings will comply with the Patient Protection and

Affordability Care Act.

5. Coverage for employees (full time) becomes effective after 30 days of employment and terminates on the last day of employment. Retirees are eligible for continued coverage up to Medicare eligibility, provided they were enrolled in benefits the day preceding the date of retirement.

COVERAGE / FUNDING MATRIX

COVERAGE Current or New

Current Carrier

Contributory Non- Contributory

Funding Retiree Coverage

TPA Current Cigna X N/A Traditional Pre-65

PBM Current Cigna X N/A Partial Self- Funded

Pre-65

Medical Stop Loss Current Cigna X N/A Partial Self- Funded

Pre-65

Dental ASO Current Cigna X N/A Fully Insured Pre-65 & Post 65 COBRA Only

Vision Current Superior Vision

X N/A Fully Insured Pre-65 & Post 65

FSA Current Flores X N/A

HSA Current Cigna N/A N/A Employee Paid Pre-65 & Post 65

EAP Current Cigna N/A N/A Full Insured Pre-65

COBRA Current Flores

VENDOR SELECTION CRITERIA

Selection Criteria: In addition to cost, the City of Lewisville is looking for carriers or vendors who can provide a high level of service and whose products hold with long term cost containment goals.

Length: 5 Years

Option I: 3-Year rate guarantee with options to renew for the 2030, and 2031 plan years

Option II: 2-Year rate guarantee with options to renew for the 2029, 2030 and 2031 plan years.

Option III: 1-Year rate guarantee with options to renew for the 2028, 2029, 2030 and 2031 plan years.

Opportunity for Presentation: To be determined

Carrier Credits: Today, the following allowances and guarantees are provided by Cigna healthcare for administering the Medical, Pharmacy and Dental Programs.

• Wellness Credits ($100k per year)

• Communication Credits ($20k)

• Independent Claims Audit ($30k per year)

It is important for each provider vendor to propose allowances and credits to help offset the City’s administrative, technology and auditing costs. These will be taken into consideration when scoring proposals.

CITY OF LEWSIVILLE

CURRENT BENEFIT SUMMARIES

CITY OF LEWISVILLE

MEDICAL PLANS

DENTAL PLAN

VISION PLAN

LIFE AND AD&D AND LTD

EAP

Cigna/Evernorth

BENEFITS CURRENT

Home Office Bloomington, MN 24 / 7 Access Center Included National Network Included Gatekeeper Services Not Included Management Training 21 services hours included Legal and Financial Services Included EAP Website Access Included Orientation Included Program Promotion Included Account Management Included Comprehensive Utilization Reporting Included Specialty Onsite Services:

Employee Orientation, Management Training, Seminars 21 services hours included

Critical Incident Services Included $285 per hour once hours exhausted Department of Transportation/Substance Abuse Professionals Services $950 per Case Work-Life Services / Work Life and HelpNet Included For All Members of Household Included & Parttime Safe Ride Program Not Included Number of Visits 6

CITY OF LEWISVILLE RATE HISTORY

CURRENT MEDICAL / RX CONTRUBITIONS

WELLNESS

NON-WELLNESS

Purple Plan Medical Rate Employer Rate Employee Rate

Employee $872.31 $846.31 $26.00 Employee + Spouse $1,854.53 $1,730.53 $124.00 Employee + Child(ren) $1,593.55 $1,495.55 $98.00 Employee + Family $2,868.81 $2,642.81 $226.00

Green Plan Medical Rate Employer Rate Employee Rate

Employee $811.31 $782.31 $29.00 Employee + Spouse $1,729.49 $1,455.49 $274.00 Employee + Child(ren) $1,486.08 $1,287.08 $199.00 Employee + Family $2,675.36 $2,208.36 $467.00

Purple Plan Medical Rate Employer Rate Employee Rate

Employee $872.31 $796.31 $76.00 Employee + Spouse $1,854.53 $1,630.53 $224.00 Employee + Child(ren) $1,593.55 $1,395.55 $198.00 Employee + Family $2,868.81 $2,542.81 $326.00

Green Plan Medical Rate Employer Rate Employee Rate

Employee $811.31 $732.31 $79.00 Employee + Spouse $1,729.49 $1,405.49 $324.00 Employee + Child(ren) $1,486.08 $1,237.08 $249.00 Employee + Family $2,675.36 $2,158.36 $517.00

CURRENT DENTAL CONTRUBITIONS

Dental Plan Dental Rate Employer Rate Employee Rate Employee $46.31 $36.31 $10.00 Employee + Spouse $94.93 $52.93 $42.00 Employee + Child(ren) $105.46 $58.46 $47.00 Employee + Family $152.79 $69.79 $83.00

CURRENT VISION CONTRUBITIONS

FINANCIALS VOLUNTARY- SUPERIOR

Effective 10/1/2017 – 9/30/2025

Employee Only $4.15 Employee & Spouse $7.90 Employee & Child(ren) $7.80 Employee & Family $12.20

Vision Plan Vision Rate Employer Rate Employee Rate Employee $4.15 $4.15 $0.00 Employee + Spouse $7.90 $4.15 $3.75 Employee + Child(ren) $7.80 $4.15 $3.65 Employee + Family $12.20 $4.15 $8.05

FSA BENEFIT SUMMARY

Benefits Flores Proposed

Minimum Monthly Billing $100 Monthly Maintenance Fee $3.95 PPPM One Time Set up Fee Waived Annual Fee N/A Bank Account Set up Fee Included Plan Documents and SPD Included Renewal Fee Waived Enrollment Material Included View Account Balances Included

Email Claim Submission Online, Mobile App, upload, mail, fax On-line Eligibility Included 24 Hour Internet & Voice Response System Included Toll Free Number Included Direct Deposit Included Check Claim Status Included

Communication Meeting Web meetings are no charge Reports Included

Claims Processing Frequency Daily, client determines frequency Flex Spending Benefit (Health & Dep. Day Care, Limited Purpose) Included

Requires prefunding / impresssed balance 5% at beginning of plan year Debit Card Included Total Per Participant Per Month $3.95 Estimated 1st year Administraion Fee $13,224.60

Rate Guarantee 5 years Effective Date 10/1/2020

HSA BENEFIT SUMMARY

Fees CIGNA/HSA Bank

Initial Debit Card Included

Monthly Maintenance $4.94

ATM Withdrawal $2.00

Overdraft Fee $10.00

Stop Payment Fee $25.00

Interest Rate Varies

HSA checks / Deposit Tickets $10.65 for 50 checks

Periodic Paper Statements $1.25 Printed Account Summary

Replacement of lost debit Card $6.00

Copy of check, statement or tax documents

$4.00 Check $4.00 Statement $4.00 Tax Document

Close account fee $25.00

Excess contribution distribution $25.00

Deposited item returned unpaid $30.00

RATE HISTORY (TPA)

THIRD PARTY ADMINISTRATION 2025 2026

Medical Administration $33.71 $33.71 Dental Administration $2.53 $2.53 PPO Network Access Fee included included HSA Administration Fee $4.94 $4.94 Utilization Review / Case Management included included Disease Management included included Telemedicine included included Fiduciary Responsibility included included Excess Loss/ External Reporting included included Wellness Program included included

STOP LOSS

TPA

STOP LOSS

2023-2024 Cigna Cigna

Cigna Cigna

Cigna Cigna

Cigna Cigna

Specific Deductible $175,000 $175,000 $175,000 $175,000 Specific Contract Type

Paid Paid Paid Paid

Specific Maximum Unlimited Unlimited Unlimited Unlimited

Specific Coverages Med / Rx Med / Rx Med / Rx Med / Rx

Specific Rates:

Employee Only Employee & Family

$214.26

$250.48

$250.48

Aggregate Corridor 125% 125% 125% n/a

Aggregate Contract Paid Paid Paid n/a

Aggregate Maximum Unlimited Unlimited Unlimited n/a

Aggregate Coverages Med/Rx Med/Rx Med/Rx n/a

Aggregate Premium $4.42 $4.71 $4.42 n/a

Aggregate Factors:

Employee Employee & Family

Composite

$1278.62

$1278.62

Composite

$1319.49

$1319.49

Composite

$1320.50

$1320.50 n/a

Lasers

None None None None

Gene Therapy n/a n/a n/a n/a

The city dropped aggregate coverage effective 1/1/2026

COBRA: $0.55 PEPM

ATTACHMENTS

Plan documents - Medical

No questions may be submitted to Hub International, any questions submitted to them will be redirected to the City of Lewisville's Bonfire project page. At no time will Hub International respond to any inquiries other than file requests for the files listed below:

Census Claim Files

Medical Rx Claims Medical Rx Large Claims

Medical/Dental Rx Files for Disruption and Repricing Vision Premium vs. Claims

Vision Top Provider Life & DI Experience

HSA Dashboard Report