City of Gainesville - File #: 090218.

• File #: 090218.
• Version: 0
• Name: Selection of Administrator, Specific Stop-Loss Provider, and Agent of Record for the City of Gainesville's Self-Funded Group Health Plan (B)
• Type: Staff Recommendation
• Status: Passed
• File created: 8/6/2009
• In control: City Manager
• Final action: 8/6/2009
• Title: Selection of Administrator, Specific Stop-Loss Provider, and Agent of Record for the City of Gainesville's Self- Funded Group Health Plan (B) This item involves a request for the City Commission to approve the rankings and selection of vendors for administering, providing specific stop-loss insurance and agent services for the City's self-funded group health plan.

Date	Ver.	Action By	Action	Result
8/6/2009	0	City Commission	Approved as Recommended	Pass

Title
Selection of Administrator, Specific Stop-Loss Provider, and Agent of Record for the City of Gainesville's Self- Funded Group Health Plan (B)

This item involves a request for the City Commission to approve the rankings and selection of vendors for administering, providing specific stop-loss insurance and agent services for the City's self-funded group health plan.

Explanation
Recently, the City conducted a comprehensive Request for Proposal (RFP) process to select the various components of administering and providing stop-loss insurance for the City of Gainesville's Group Health Benefit. To help with the process, the City contracted with Siver Insurance Consultants for the design of the RFP and to help facilitate the review and analysis of the various responses. The City, with the help of Siver Insurance Consultants solicited proposals for both fully insured options and all the components necessary to provide a self-funded health plan. The services solicited included, fully insured health plan options, claims and network administration for a self-funded plan, both specific and aggregate stop-loss insurance, pharmacy benefit management services and agent/broker services.

To best understand the evaluation process, a general knowledge of the various cost and risk financing components associated with providing the group health benefit are essential. The total cost of providing the health benefit can be summarized into three components: Administration, Claims, and Risk Transfer Costs.

For the purposes of this RFP process, administration refers to the external administration of the group health plan. Services associated with administration include, but are not limited to, network development, access and administration, claims processing, customer service, plan document distribution and utilization review. The claims component can be further separated into medical claims costs and pharmacy benefit claims. The two claims components can be e...