Title
Extension of Symetra Life Insurance Company as the Carrier for the City's Group Health Plan Specific Stop-Loss Insurance (B)
This item involves the selection as Symetra Life Insurance Company to provide the City's Group Health Plan with Specific Stop-Loss Insurance for claims in excess of $160,000.
Explanation
The City of Gainesville purchases specific stop-loss insurance to protect the City's Group Health Plan. Specific stop-loss insurance is a risk-financing tool used to transfer the risk of catastrophic health claims to a third party, in this case an insurer. Under a stop-loss arrangement, the City's Group Health Plan would be responsible to pay for a claim until it reaches a set dollar amount called the attachment point. Once the claim exceeds the attachment point, the insurer will reimburse the Group Health Plan for all costs paid above that attachment point.
The City initiated an Request for Proposals last year for this insurance product that allowed for the City to renew with Symetra, as proposed by Gallagher Benefit Services, based upon acceptability of cost, coverage, service, provider stability, and market conditions. Symetra has provided the City with its renewal terms. The terms include: maintaining the current rate, increasing the attachment point to $160,000 and increasing the maximum lifetime benefit to $4.85 million per member. These renewal terms will cover the City's entire exposure on catastrophic claims. The Health Plan currently allow for a lifetime maximum benefit of $5 million; however, the current stop loss lifetime cap is $1.85 million per person, therefore, creating a potential liability to the Health Plan of over three million dollars. With current medical trends reported between seven and nine percent, the Symetra renewal as proposed by Gallagher Benefits Services appears to be in the best interest of the City and its Group Health Plan.
The other key component on the Symetra product is the retro-spectiv...
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