HomeMy WebLinkAboutRES 102720-H - Stop Loss Insurance CoverageRESOLUTION NO. IOV ZD tt
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF GEORGETOWN,
TEXAS, AWARDING CONTRACT FOR MEDICAL STOP- LOSS INSURANCE
COVERAGE, AND AUTHORIZING THE CITY MANAGER TO ENTER INTO
SUCH CONTRACTS ON BEHALF OF THE CITY.
WHEREAS, the City Council has determined that it is appropriate to accept the following health
benefit coverage proposal:
Award a renewal contract to United Healthcare in the estimated amount of $ 960,000- for medical
stop -loss insurance coverage for 1 year, from January 1, 2021 to December 31, 2021.
NOW THEREFORE BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF
GEORGETOWN TEXAS:
SECTION ONE. The facts and recitations contained in the preamble of this Resolution are hereby
found and declared to be true and correct and are incorporated by reference herein and expressly
made a part hereof, as if copied verbatim.
SECTION TWO. The City Council hereby approves the awards of the contracts listed above
ItA SECTION THREE. This Resolution shall become effective on the Z1 day of 0C,4-n &,' , 2020.
PASSED AND APPROVED on then _41 day of 0c+pbtd , 2020.
ATTEST: CITY OF GEORGETOWN, TEXAS
By: _
Robyn Densmore, City Secretary Dale Ross, Mayor
APPROVED AS TO FORM:
kye kPassonkity Attorney
00009973 I v3 J EMAREKJ HRJ GENERAL 212018
UnitedHealth care Insurance Company
A Stock Company
185 Asylum Street, Hartford, Connecticut
Phone:1-860-702-5000
AMENDMENT NO. 3
Amendment to be attached to and made a part of Group Policy No. GA-906136AL, issued by
UnitedHealthcare insurance Company (herein called "Company") to City of Georgetown (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, 2021.
UnitedHealthcare Insurance Company
William J Golden, President
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Thomas J. McGuire, Secretary
ACCEPTED BY;
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Title:
Date:
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UHIC AMEND (07/06)
UHIC AMEND (07/06)
UnitedHealth care Insurance Company
A Stock Company
185 Asylum Street, Hartford, Connecticut
Phone:1-860-702-5000
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: City ol'Georgetown
Policy Number: GA-906136AL , _ _ _ _ , T _ _ _ _ _ _ _ _ - - - -- , - _ _ _ -
Effective Date: January 1. 2021_ _ _ _ _ _ _ _ _ _ _ _ _ _ _.
Administrator: United HealthCare Services, Inc.
Coverage specified herein is applicable only during the Policy Period from January 1, 2020 through
December 31, 2020 and is further subject to all terms and conditions of this Policy.
SPECIFIC EXCESS LOSS INSURANCE
Benefit Period: Covered Expenses Incurred from January 1, 2021 through December 31, 2021 and Paid from
January 1, 2021 through December 31, 2021.
Specific Deductible per Covered Person: $150,000
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: $116.96 per subscriber per month
AGGREGATE EXCESS LOSS INSURANCE
Benefit Period: Covered Expenses Incurred from January 1, 2021 through December 31, 2021 and Paid from
January 1, 2021 through December 31, 2021.
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: 8,855,027 or 95% of the first Monthly Aggregate Deductible
amount times 12, whichever is greater
UHIELIP (07/06) SCHED
Maximum Covered Expenses per Covered Person accumulating toward the Maximum Aggregate Benefit:
$150,000
Monthly Aggregate Factors: $1,216.93 per subscriber
Aggregate Excess Loss Premium: $3.80 per subscriber per month
The premium amount reflected above includes the following:
• Aggregate Accommodation Endorsement
UHIELIP (07/06) 2 SCHED