ESBD_360338_1716477846068_Attachment O - Stop Loss amendment (2024).pdf
PDF 139 KB Posted
- Solicitation number
- RFp2024-P11
- Issued by
- Hays County, Texas
About this file
This document is an amendment to Group Policy No. GA-912772AL, issued by UnitedHealthcare Insurance Company to the County of Hays. The amendment replaces the Schedule of Benefits and will be effective January 1, 2024. The policy provides Specific Excess Loss Insurance with a $200,000 deductible and 100% reimbursement, as well as Aggregate Excess Loss Insurance with a $15,842,305 minimum annual aggregate deductible and a $1,000,000 maximum aggregate benefit per policy year.
The related state and local contract opportunity is an RFP issued by Hays County, Texas, seeking proposals for Employee Health, Dental, and Employee Assistance Plans. The County is looking for a comprehensive benefits package to be implemented effective January 1, 2025, with open enrollment starting October 1, 2024. The County is seeking to partner with insurance companies that can provide competitive and stable financial terms while offering a robust benefits package.
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Text version
UHIC AMEND (07/06)
UnitedHealthcare Insurance Company
A Stock Company
185 Asylum Street, Hartford, Connecticut
Phone: 1-877-294-1429
AMENDMENT NO. 6
Amendment to be attached to and made a part of Group Policy No. GA-912772AL, issued by UnitedHealthcare Insurance Company (herein called "Company") to County of Hays (herein called "Policyholder").
It is agreed by and between the Company and the Policyholder that
1. The page entitled "Schedule Of Benefits" as contained in the Policy is hereby replaced with the attached page entitled "Schedule Of Benefits".
2. This Amendment will hereby be effective as of January 1, 2024.
UnitedHealthcare Insurance Company
ACCEPTED BY:
Title:
Date:
UnitedHealthcare Insurance Company
Jessica Paik, President
Tracy A. Arney, Secretary
UHIC AMEND (07/06)
UHIELIP (07/06) 1 SCHED
A Stock Company
185 Asylum Street, Hartford, Connecticut
Phone: 1-877-294-1429
SCHEDULE OF BENEFITS
This Schedule of Benefits is only applicable to Excess Loss Insurance provided by the Company during the Policy Period shown below.
Policyholder: County of Hays
Policy Number: GA-912772AL
Effective Date: January 1, 2024
Administrator: United HealthCare Services, Inc.
Coverage specified herein is applicable only during the Policy Period from January 1, 2024 through December 31, 2024, and is further subject to all terms and conditions of this Policy.
SPECIFIC EXCESS LOSS INSURANCE
Benefit Period: Covered Expenses Incurred from January 1, 2017 through December 31, 2024 and Paid from January 1, 2024 through December 31, 2024.
Specific Deductible per Covered Person: $200,000
Specific Percentage Reimbursable: 100%
Maximum Specific Benefit per Covered Person: Unlimited
Specific Excess Loss Insurance includes:
• Medical
• Stand Alone Prescription Drug Program
Specific Excess Loss Premium: $112.04 per subscriber per month
AGGREGATE EXCESS LOSS INSURANCE
Benefit Period: Covered Expenses Incurred from January 1, 2017 through December 31, 2024 and Paid from January 1, 20234through December 31, 2024.
Aggregate Excess Loss Insurance includes:
• Medical
• Stand Alone Prescription Drug Program
Aggregate Percentage Reimbursable: 100%
Maximum Aggregate Benefit: $1,000,000 per Policy Year
Minimum Annual Aggregate Deductible: $15,842,305 or 95% of the first Monthly Aggregate Deductible amount times 12, whichever is greater
UHIELIP (07/06) 2 SCHED
Maximum Covered Expenses per Covered Person accumulating toward the Maximum Aggregate Benefit:
$200,000
Monthly Aggregate Factors: $1,396.66 per subscriber
Aggregate Excess Loss Premium: $8.38 per subscriber per month
The premium amount reflected above includes the following:
• Aggregate Accommodation Endorsement
| UnitedHealthcare Insurance Company |
| A Stock Company |
| AMENDMENT NO. 5 |
| UnitedHealthcare Insurance Company |
| UnitedHealthcare Insurance Company |
| SCHEDULE OF BENEFITS |
| SPECIFIC EXCESS LOSS INSURANCE |
| AGGREGATE EXCESS LOSS INSURANCE |
File details come from the government source that posted it. Updated .