]TITLE
title
UNITED HEALTHCARE (UHC) STOP LOSS COVERAGE FOR 2021 PLAN YEAR
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SPONSOR
sponsor
Joanette Freeman (Carol Campbell), Human Resources
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BACKGROUND
background
Guilford County sponsors a self-funded health insurance plan for eligible employees and retirees. This plan covers claims up to $425,000. A separate "stop loss plan" reimburses the County for claims that exceed $425,000 per individual claimant. The County's consultant, USI, requested bids from eight (8) stop loss carriers and received bids from two (21) for plan year 2021 coverage. United Healthcare (the current carrier with a rate of $30.75 per member per month) and one other company, Sun Life, were the only bidders who responded. While Sun Life offers a better fixed monthly renewal rate ($42.14 for Sun Life vs. UHC's $46.13), their bid requires the exclusion of three (3) high cost-claimants from coverage. The three (3) claimants Sun Life proposes to exclude have projected 2020 gross claims costs of $2,725,000, of which $1,450,000 would ordinarily be paid by stop loss coverage.
The UHC 2020 contract contained a rate cap of 50% for the 2021 plan year, and the proposed UHC contract for 2021 includes a max rate cap of 50% for 2022 as well. Sun Life's bid also gives it the option of expanding the three (3) claimant exclusion to five (5) at renewal. As information, the County currently has five (5) claimants who have met the stop loss deductible for 2020 - three (3) spouses, one (1) employee and one (1) child, and there will likely be a second child who meets the deductible by year end.
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BUDGET IMPACT
budget impact
NO ADDITIONAL COUNTY FUNDS REQUIRED
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REQUESTED ACTION
requested action
Authorize staff to enter into a price only contract with United Healthcare (UHC) for stop loss coverage for the 2021 plan year in the amount of $46.13 per member per month to be effective January 1, 2021 for a term of one (1) year at an annual cost not expected to exceed $1,526,165, with an optional one year renewal with same or better rate cap.
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