Att F2 - 2021 Final Renewal Medica.pdf

A b r a A u t o B o d y & G l a s s | May 2018

RATES & PREDICATIONS

Dunn County

EFFECTIVE JANUARY 2021

Dunn County Page 2 of 9 August 10, 2020

Renewal Rates for Dunn County Effective January 1, 2021

A wellness credit of $25,000 is included in Medica’s 2021 renewal. Please refer to predications exhibit for additional details related to the offered wellness credit.

MSI PP ASO

3000-0% HSA

Ded/Coins; No Prev Rx

Current Rate Renewal Rate

Administrative Fee (PSPM) $30.80 $30.67

Case Management/Utilization Review Included Included

My Health Rewards by Medica Included Included

Medicare Part D Notices (annual & ongoing) Included Included

Medica Behavioral Health (MH/SA) Included Included

Medica CallLink Nurse Line Included Included

Specific Stop Loss (3.0%)

Deductible Level Per Member $150,000 $150,000

Eligible Claims (Contract Basis) 24/15 24/15

Monthly Rates: Single $118.57 $122.13

Family $321.12 $330.75

Aggregate Stop Loss (17.5%)

Eligible Claims (Contract Basis) 24/15 24/15

Est. Monthly Claims: Single $831.28 $976.92

Family $2,251.18 $2,645.59

Aggregate Attachment 125% 125%

Monthly Factors: Single $1,039.10 $1,221.15

Family $2,813.98 $3,306.99

Aggregate Stop Loss (PSPM) $5.38 $5.38

Dunn County Page 3 of 9 August 10, 2020

Stop Loss Alternates Alternate Plans and Specific Stop Loss Options with Applicable Aggregate Stop Loss Factors Aggregate Attachment Point: 125%

Contract Basis: 24/15 Specific Stop Loss Rates $150,000 Single $122.13 Family $330.75

Expected Claims Plan 1: MSI PP ASO 3000-0% HSA Single $976.92 Family $2,645.59 Plan 2: MSI MHS ASO 3000-0% HSA Single $908.53 Family $2,460.40 Plan 3: MSI PP ASO 5000-0% HSA Single $849.58 Family $2,300.76 Plan 4: MSI MHS ASO 5000-0% HSA Single $790.12 Family $2,139.72 Plan 5: MSI PP ASO 6000-0% HSA Single $804.57 Family $2,178.87 Plan 6: MSI PP ASO 6350-0% HSA Single $788.07 Family $2,134.18 Plan 7: MSI PP ASO 3000-20% HSA Single $912.08 Family $2,469.99 Plan 8: MSI PP ASO 3000-20% HSA Single $857.58 Family $2,322.42 Plan 9: MSI PP ASO 5500-0% HSA + Rx copays Single $808.90 Family $2,190.57 Plan 10: MSI PP ASO 5000-20% HSA Single $736.01 Family $1,993.19

Aggregate Factors Plan 1: MSI PP ASO 3000-0% HSA Single $1,221.15 Family $3,306.99 Plan 2: MSI MHS ASO 3000-0% HSA Single $1,135.67 Family $3,075.50 Plan 3: MSI PP ASO 5000-0% HSA Single $1,061.98 Family $2,875.95

Dunn County Page 4 of 9 August 10, 2020

Stop Loss Alternates Continued

Contract Basis: 24/15 Specific Stop Loss Level $150,000

Plan 4: MSI MHS ASO 5000-0% HSA Single $987.65 Family $2,674.65 Plan 5: MSI PP ASO 6000-0% HSA Single $1,005.72 Family $2,723.58 Plan 6: MSI PP ASO 6350-0% HSA Single $985.09 Family $2,667.73 Plan 7: MSI PP ASO 3000-20% HSA Single $1,140.09 Family $3,087.49 Plan 8: MSI PP ASO 3000-20% HSA Single $1,071.98 Family $2,903.02 Plan 9: MSI PP ASO 5500-0% HSA+ Rx Copays Single $1,011.12 Family $2,738.22 Plan 10: MSI PP ASO 5000-20% HSA Single $920.01 Family $2,491.49

All other fees, rates, and assumptions included in the quote for the Current Plan apply.

Plan Descriptions:

Plans 1 and 2

Current

MSI PP/MHS ASO

3000-0% HSA

Par:$3000/6000 Ded, 100% coins to $3000/6000 OOP max Rx: Ded/Coins & No Prev Rx.

Nonpar: $3500/7000 ded, 100% to $3500/7000 OOP

Plans 3 and 4 Current

MSI PP/MHS ASO

5000-0% HSA

Par:$5000/10000 Ded, 100% coins to $5000/10000 OOP max Rx: Ded/Coins & No Prev Rx. Nonpar: $5500/11000 ded, 100% to $5500/11000 OOP

Plan 5 MSI PP ASO

6000-0% HSA

Par:$6000/12000 Ded, 100% coins to $6000/12000 OOP max Rx: Ded/Coins & No Prev Rx. Nonpar: $9000/18000 ded, 80% to $18000/36000 OOP

Plan 6 MSI PP ASO

6350-0% HSA

Par:$6350/12700 Ded, 100% coins to $6350/12700 OOP max Rx: Ded/Coins & No Prev Rx. Nonpar: $10000/20000 ded, 80% to $20000/40000 OOP

Plan 7 MSI PP ASO

3000-20% HSA

Par:$3000/6000 Ded, 80% coins to $4000/8000 OOP max Rx: Ded/Coins & No Prev Rx.

Nonpar: $6000/12000 N ded, 60% to $12000/24000 OOP

Plan 8 MSI PP ASO

3000-20% HSA

Par:$3000/6000 Ded, 80% coins to $6000/12000 OOP max Rx: Ded/Coins & No Prev Rx.

Nonpar: $6000/12000 ded, 60% to $12000/24000 OOP

Plan 9 MSI PP ASO

5500-0% HSA +

Rx copays

Par:$5500/11000 Ded, 0% coins to $6500/13000 OOP max Rx: 12/50/90 Nonpar: $11000/22000 ded, 50% to $19500/39000 OOP

Plan 10 MSI PP ASO

5000-20% HSA

Par:$5000/10000 Ded, 80% coins to $10000/20000 OOP max Rx: Ded/Coins & No Prev Rx Nonpar: $10000/20000 ded, 50% to $15000/30000 OOP

Dunn County Page 5 of 9 August 10, 2020

Self-Insured Renewal Worksheet

COMPANY NAME: Dunn County

GROUP NUMBER(S): 25342

RENEWAL EFFECTIVE DATE: 1/1/2021

SPECIFIC DEDUCTIBLE: 150,000

EXPERIENCE PERIOD:

ANNUAL TREND: 7.6%

1 2 3 4 5

NUMBER OF TREND MONTHS: 16.0 24.0

1/1/2020 1/1/2019 TOTALS

4/30/2020 12/31/2019

CLAIMS EXPERIENCE: 2,067,920 8,508,332 10,576,252

SPECIFIC CLAIMS: - 0 1,003,372 1,003,372

NET CLAIMS: 2,067,920 7,504,960 9,572,879

TREND x 1.102 1.157

BENEFIT/DED ACCUM ADJ FACTOR:x 1.034 0.988

EXPECTED CLAIMS: 2,358,132 8,580,125 10,938,257

SETBACK MEMBER MONTHS: / 3,153 10,065 13,218

PMPM 747.90 852.47 827.53

AGGREGATE ATTACH: x 1.25 1.25 0 0 0 1.25

CLAIMS PMPM $934.88 $1,065.59 $1,034.41

1.000

1.000

Total $1,034.41

CURRENT AGG FACTORS: CURRENT CURRENT CURRENT CURRENT REQUIRED

MSI PP ASO 3000-0% HSA SUBS MBRS AGG FACTORS PMPM AGG FACTORS

SINGLE 16 16 $1,039.10 1,221.15$

FAMILY 39 137 $2,813.98 3,306.99$

MSI MHS ASO 3000-0% HSA

SINGLE 56 56 $966.36 1,135.67$

FAMILY 169 528 $2,617.00 3,075.50$

MSI PP ASO 5000-0% HSA

SINGLE 2 2 $903.66 1,061.98$

FAMILY 3 6 $2,447.21 2,875.96$

MSI MHS ASO 5000-0% HSA

SINGLE 13 13 $840.41 987.64$

FAMILY 9 27 $2,275.90 2,674.64$

TOTAL 307 785 $844.99

REQUIRED ACTION: 1.224

REQUESTED ACTION: 1.175

August 10, 2020

Dunn County Page 6 of 9 August 10, 2020

Additional Information

In order to ensure your plan is benefit-ready for your employees, your purchase decision is requested at least 30 days in advance of the effective date.

Passport proposal utilizes UnitedHealthcare Options PPO network

Network Management Fee:

Medica provides 100 percent pass-through of contracted discounts with no access fees or withholds.

No commissions are included

Stop Loss Coverage includes: Medical, Pharmacy, Mental Health benefits

Specific Liability Limit per Lifetime:

In-Network & Out-of-Network: Unlimited, less the specific stop loss deductible amount

A Minimum Aggregate Amount will be set at 90% of the estimated Annual Aggregate dollar amount.

This amount will be determined once final plan options are selected. If multiple plan options are selected, this amount will be determined based on initial enrollment in each plan. This amount will be included in the stop loss contract.

Dunn County Page 7 of 9 August 10, 2020

Self-Insured Predications

Rates are subject to the following predications:

Covered Persons Only bona-fide employees and their dependents are eligible under the group plan. Any other class of covered individuals must be reviewed and approved by Medica. If retirees are included as eligible members in the current group, Medica's quote is subject to revision if 10% or more of the covered population is early and/or Medicare-eligible retirees, and/or if the employer does not contribute at least 50% of the cost of single coverage for all eligible retirees.

Dunn County warrants that it, along with any affiliated employers that employ covered employees, are not a Multiple Employer Welfare Arrangement (MEWA), as defined under ERISA (or under state law, if non-ERISA).

Total Replacement Medica shall be the only health care plan offered by the employer.

Contributions The employer shall contribute a minimum of 50% towards the single monthly premium rate.

Participation The minimum participation requirement is 75% of eligible employees not waiving due to other group coverage and no less than 50% of the total number of eligible employees regardless of waivers.

Stop Loss Situs An offer of MIC Stop Loss assumes the group situs of business is in Minnesota, Wisconsin, North Dakota or South Dakota.

ASO/Stop Loss Quote Packaging Medica's administrative services quote assumes that Medica will also be providing the stop loss coverage. Any other arrangement requires prior approval by Medica and may result in modification or withdrawal of the ASO quote.

If Aggregate Stop Loss is purchased, Specific Stop Loss is also required.

Assumed Plan Year Basis The proposal assumes that the benefit plan year is currently on a Calendar year basis for applications of deductible and out-of-pocket limits. Please note that the proposal is subject to change if this assumption is not correct.

Rx Rebates Medica retains 100% of pharmacy rebates. Pricing subject to change if rebate revenue is materially decreased because brand drugs move off-patent to generic status, due to another action by a manufacturer, or due to a change in federal or state law, or other applicable legislative changes.

Contingencies Medica reserves the right to revise this quote under the following circumstances:

1) The number of covered subscribers and dependents increases or decreases by more than 10% from what is shown in our proposal,

2) The average contract size (total members divided by total subscribers) varies by more than 10% from 2.56.

3) The benefits or services requested change before or after the effective date,

4) An award is not made within 90 days of the issuance of this quote, and/or,

5) Changes in federal, state or other applicable legislation require changes in this quote.

Recovery of Costs In the unlikely event that this arrangement is terminated by Dunn County during the implementation phase, implementation costs incurred by Medica will be the responsibility of Dunn County.

Dunn County Page 8 of 9 August 10, 2020

PPACA Reinsurance Fees The cost of the PPACA reinsurance fees are not included in Medica's proposed rates or fees.

HRA

If a quote for HRA administration is included, the quote assumes employer funding of the HRA account at 50% of the deductible, rollover cap of 2 times the annual HRA contribution, only benefits covered under the medical plan are eligible for reimbursement, and the funds are not portable.

The quote is subject to change if these assumptions are modified. The vendor fees for HRA administration will be billed separately from the other fees at the indicated PSPM rates, if the HRA account is administered by Medica.

FSA Only If a quote for FSA administration is included, the fee will be billed separately from other fees at the indicated PSPM fee.

Broker commissions, if applicable, do not apply to the separate FSA fee. FSA administration may only be sold in conjunction with a Medica medical plan.

HSA Only If a quote for HSA administration is included, the vendor fees for the HSA fund will be billed separately from other fees at the indicated PSPM fee if the HSA fund is administered by Medica. Broker commissions, if applicable, do not apply to the separate HSA fee. HSA administration may only be sold in conjunction with a Medica medical plan.

Wellness Credit A wellness credit of $25,000 is available in the initial contract year only. This credit will be applied to the monthly invoices of fixed expenses starting with the first month and continuing until the total credit amount is exhausted.

Please refer to the enclosed benefit plan(s) for specific details.

Dunn County Page 9 of 9 August 10, 2020

Services Included in Self-Insured Administrative Fee

PROGRAMS & SERVICES

My Health Rewards by Medica wellness programs

Medica CallLink® Nurse Line Services – 24/7/365

Medica Healthy Savings discount program

Medica Behavioral Health

Integrated case management

Quality programs (including full NCQA accreditation)

Pharmacy vendor management

Network management (including negotiated discounts)

Specialty contracts for Centers of Excellence:

organ transplants and bariatric surgery

Provider education (including best practice guidelines)

CLAIMS, ENROLLMENT & BILLING ADMINISTRATION

Electronic submission of in-network claims through WebMD

High-touch monitoring for unique claims (high claims review, cost control system edits)

Utilization review

Subrogation services

Coordination of Benefits

Average turnaround time for claims from date of receipt to date paid is under 10 days

Financial accuracy rate: 99% of all claims paid

Employer eServices for reporting, billing and eligibility management

MEMBER SERVICES

Toll-free customer service (including TDD/Translator Services)

Member identification cards

Online provider directory www.mymedica.com member Web portal (including benefits, claims information and health resources)

Medica CallLink Nurse Line services – 24/7/365

Bi-monthly member emails

MEDICA ACCOUNT MANAGEMENT TEAM & SUPPORT RESOURCES

Designated account service team

Plan document preparation/printing

Open enrollment materials and meetings

Administrative Service Agreement

Administrative Guide

Monthly claims reporting

Annual health care utilization reports

Web-Based Automated Employer Reporting System

HIPAA compliance support

Preparation/set-up of automated banking agreements

Medica Service Center for employers and brokers

Health & Wellness consulting services

Communication consulting service

Onsite workshops and presentations

Regulatory compliance

Information services

STOP LOSS AND UNDERWRITING SERVICES

Underwriting services

Competitive specific & aggregate stop loss pricing

No lasers upon renewal standard

Specific: immediate claim credit

Aggregate: annual reconciliation

OPTIONAL SERVICES (ADDITIONAL FEES APPLY)

HSA, HRA and FSA administration

Medica® Employee Assistance Program

Fit Choices® by Medica health club reimbursement

My Health Rewards by Medica – Results

My Health Rewards by Medica – Invest (HSA Only)

Wellthy

Omada Health – Digital Lifestyle Change Program

ConsumerMedical

Health Savings Fresh Produce http://www.mymedica.com/