Ordinance No. 7,786960912 -9
ORDINANCE NO. 7786
AN ORDINANCE RENEWING AN AGREEMENT WITH J. E. STONE &
ASSOCIATES FOR ADMINISTRATION OF THE MEDICAL AND DENTAL
BENEFITS .PROGRAM..OF THE CITY._OF BAYTOWN;.AUTHO.RIZING..AND
DIRECTING THE MAYOR TO EXECUTE AND THE CITY CLERK TO ATTEST
TO SAID CONTRACTS; AUTHORIZING PAYMENT OF THREE HUNDRED
TWENTY -TWO THOUSAND, THREE HUNDRED FORTY -FIVE AND NO/ 100
DOLLARS ($322,345.00) PURSUANT TO THE TERMS OF SAID CONTRACTS;
AND PROVIDING FOR THE EFFECTIVE DATE THEREOF.
*********************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF BAYTOWN, TEXAS:
Section 1: That the City Council of the City of Baytown, Texas, hereby renews the
agreement of J. E. Stone & Associates for individual and aggregate stop loss coverage for the sum
of ONE HUNDRED EIGHTY -FIVE THOUSAND THREE HUNDRED TWENTY -EIGHT AND
NO /100 DOLLARS ($185,328.00) and authorizes payment thereof,
Section 2: That the City Council of the City of Baytown, Texas, hereby renews the
agreement of Philadelphia American Life Insurance Company (PALICO) as third party administrator
of the benefit claims administration for the sum of EIGHTY -THREE THOUSAND THREE
HUNDRED THIRTY -ONE AND NO /100 DOLLARS ($83,331.00) and authorizes payment thereof.
Section 3: That the City Council of the City of Baytown, Texas, hereby renews the
agreement of Cost Care as a PPO network for individual managed care for the sum of FIFTY -
THREE THOUSAND SIX HUNDRED EIGHTY -SIX AND NO 1100 DOLLARS ($53,686.00) and
authorizes payment thereof.
Section 4: That the Mayor and City Clerk are hereby authorized and directed to execute
and attest to the contract with J. E. Stone & Associates, a copy of which is attached hereto as Exhibit
Section 5: That the Mayor and City Clerk are hereby authorized and directed to execute
and attest to the contract with Philadelphia American Life Insurance Company (PALICO), a copy
of which is attached hereto as Exhibit "B."
Section 6: That the Mayor and City Clerk are hereby authorized and directed to execute
and attest to the contract with Cost Care, a copy of which is attached hereto as Exhibit "C."
Section 7: This ordinance shall take effect immediately from and after its passage by the
City Council of the City of Baytown.
CJ
960912 -9a
INTRODUCED, READ and PASSED by the affirmative vote of the City Council of the City
of Baytown this the 12th day of September, 1996.
PETE C. ALFAR , Mayor
ATTEST:
EILEEN P. HALL, City Clerk
APPROVED AS TO FORM:
ACIO RAMIREZ, Skt,City Attorney
0 c:l councillmeetingslseptembe lstone.12
Principals
®J. A. Currie
J. E. Ford
K. L. Haynes. A.S.A.. E.A.
T. F. McCord
C. P. Peters III
C. R. Rennpage
E. B. Sanborn
J. E. Stone
•
J. E. STONE & ASSOCIATES, INC.
Actuaries. Benefit and Compensation Consultants
Marathon Oil Tower
5555 San Felipe, Suite 1 100
Houston, Texas 77056
713/622 -8930
Fax: 713/622 -6705
CITY OF BAYTOWN
Annual Consulting/Brokerage Agreement
E. Stone & Associates, Inc. is currently recognized as consultantfbroker of record for
the following City of Baytown employee group health & welfare benefit plans:
Medical and Dental Plan
Group Life and Accidental Death Plan
Voluntary DentiCare Dental Plan
In consideration of continuing to be recognized and compensated as broker of record for
the excess indemnity coverage associated with the medical and dental plan for the period
from October 1, 1996 through September 30, 1997, J. E. Stone & Associates, Inc. will
continue to provide the following services in connection with the above referenced
employee group health & welfare plans during that period of time:
Consulting/Brokerage Services Applicable to the Health & Welfare Plans
• Annual review of benefit design
• Annual renewal planning (identification of specific areas to review in renewal
process)
• Annual self- funded medical/dental plan cost projections
• Annual IBNR (incurred but not reported reserve) estimation
• Annual stop loss (excess indemnity coverage) renewal andRFP specifications
and market analysis if requested
• Annual development of funding/budget rates
• Annual development of COBRA rates
• Annual EAP (Employee Assistance Plan) renewal negotiations
• Annual assistance with development of employee contribution levels
• Annual mid -year review of plan costs vs. budget, revise budget as needed
• Service provider (claims administrator, managed care network, etc.) RFP
specifications and market analysis if requested
• Annual evaluation and negotiation of insured plan renewals
• Insured plan RFP specifications and market analysis if requested
EXHIBIT A
L
City of Baytown
Annual Consulting/Brokerage Agreement
Page 2
Additional Services Applicable -to the Health & Welfare Plans, including the
Flexible Benefit Plan (Fringe Benefit Plan)
• Assistance with the preparation of Annual Report Form 5500 for the Section
125 premium conversion plan
• Review of SPD (Summary Plan Description) drafts
• Review of insurance policies /contracts
• Review of service provider agreements
• Day to day inquiries
• Plan administration support
• Claim administration support
• Legalflegislative updates
• Coordinate activities with service providers
• Assistance with drafting routine communications
• Assistance with drafting routine administrative forms
It is understood that additional engagements of J. E. Stone & Associates, Inc. to provide
any of the following types of services would be consider to be separate
projects /engagements, and therefore, outside of the scope of this agreement:
• Consulting Services/Engagements Outside of the Annual Health & Welfare
ConsultingBrokerage Agreement
Outsourced benefit administration services
• Participation in collective bargaining negotiations
• Establishment of an entirely new benefit plan
• Special communications projects such as Summary Plan Description drafting,
design of a package of coordinated employee benefits communications, or
participation in a series of employee meetings
• Re- engineering of in -house benefits administration systems
• Services in other employee benefits and human resource areas (qualified plan
design, administration, and investments, compensation, actuarial, etc.)
• Surveys and employee/city management focus groups
J. E. Stone & Associates, Inc.
By: / G
Title: f
Date:
Agreed By:
Title:
Date:
City of Baytown
J. E. STONE & ASSOCIATES, INC.
PHILADELPHIA AMERICAN LIFE INSURANCE COMPANY
0 HOUSTON, TEXAS
AMENDMENT NUMBER III
to be attached to and made a part of Administrative Services Agreement issued to City of Baytown of
Baytown, Texas, Gp. No. 36511.
Effective October 1, 1996, the Administration Charge as stated in Section IV of the Administrative
Services Agreement for the period of October 1, 1996 through September 30, 1997 will be as follows:
The Administration Charge per employee is $9.78 per employee per month for medical
claims and $1.97 per employee per month for dental claims.
Nothing contained in this amendment shall alter or amend the terms of the Agreement except as expressly
stated herein. All the terns of the Agreement not conflicting with the terms of this amendment shall be
applicable hereto.
IN WITNESS WHEREOF, The Philadelphia American Life Insurance Company has caused this
endorsement to be signed by its Vice President this 5th day of September, 1996,
PHILADELPHIA AMERICAN LIFE
INSURANCE COMPANY Cily of Baytown
Vice President
0
Dated at
Signature:
Date:
EXHIW B
AMENDMENT TO THE
SERVICE AGREIVI'MENT
BETWEEN
CITY OF BAYTOWN
AND
COST- CARE, INCORPORATED ( "C.C.I: ")
Effective - October 1, 1996
Schedule H of the Service Agreement between and Cost Care, Incorporated is hereby changed to the following:
FROM:
1. SCHEDULE II, SCHEDULE OF FEES
VERED
Hospital /Continued Stay Review
Home Health Care: Short Term Case Management
Outpatient Surgical Review
Large Case Management (Fee for Service)
MaterniCall
Outpatient Diagnostic Review
Network Management Services
Managed Referral Program (Open List)
Reconsideration Process
Retrospective Review Process
$7.35 per employee per month
Fees for Psychiatric/Substance Abuse and Large Case Management $120.00 per hour
Fee for Retrospective Reviews $150.00 per case
TO:
1. SCHEDULE H. SCHEDULE OF FEES
PROGRAMS COVERED:
Hospital /Continued Stay Review
Home Health Care: Short Tenn Case Management
Outpatient Surgical Review
Large Case Management (Fee for Service)
MaterniCall
Outpatient Diagnostic Review
Network Management Services
Managed Referral Program (Open List)
Reconsideration Process
Retrospective Review Process
$7.57 per employee per month
Fees for Psychiatric/Substance Abuse and Large Case Management $120 .00 per hour
Fee for Retrospective Reviews
CITY OF BAYTOWN
DATE
Amend Sched II: 9/5196
$150.00 per case
COS E, IN ORPORATED
IA 141,
DATE
City of Baytown
EXHIBIT C
B. Thomason