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Burnham Benefits Insurance Services’ Response to: County of La Quinta Request for Proposal for Employee Benefits Broker/Consultant Services Prepared by: Ann Stawicki, MPH | Vice President March 23, 2021 2211 Michelson Drive, Suite 1200 p. 949 833 2983 f. 949 833 9549 Insurance Services Irvine, CA 92612 burnhambenefits.com License No. 0D86695 2 Burnham Benefits Response to City of La Quinta Request for Proposal for Employee Benefits Broker/Consultant Services Cover Letter March 23, 2021 City of La Quinta Attn: Human Resources Division 78495 Calle Tampico La Quinta, CA 92253 RE: Employee Benefits Broker/Consultant Services Dear Human Resources Division, Thank you for providing Burnham Benefits the opportunity to respond to The City of La Quinta’s Request for Proposal for Employee Benefits Broker/Consultant Services. Enclosed in our response is a detailed description of our firm, the team that will work with the City directly, our account management approach and unique offerings, strategic partnerships, and a sample work product. Burnham Benefits is heavily invested in the public sector segment. We support 81 public sector clients throughout California, representing 71,000 public sector employees. Our response highlights our expertise, capabilities, client references, and strategic approach. Our case studies and client references will speak to our ability to support the City. Burnham has vast experience working with public agencies who are exploring creative ways to stem costs. Our evaluation process considers timing, financial impacts (immediate and future), member engagement, communications and more. Burnham views itself as a trusted partner to our clients with compliance support to meet federal and state law requirements. We collaboratively help clients create and implement benefit strategies designed to control costs, grow participation, and incent members towards better health and well-being. Burnham is the right partner to steward the City through this evaluation and decision process. Based on our team’s background, experience, and knowledge of the City thus far, we believe we are the consultants with the right skills and services to help the City achieve its goals. These skills and services include: • Strong negotiating skills to ensure the most competitive pricing for the City’s fixed costs • ACA compliance expertise, analytics and support • Compliance resources to help navigate the ever changing and highly-regulated benefits environment • Member communications designed to boost member engagement 2211 Michelson Drive, Suite 1200 p. 949 833 2983 f. 949 833 9549 Insurance Services Irvine, CA 92612 burnhambenefits.com License No. 0D86695 3 Burnham Benefits Response to City of La Quinta Request for Proposal for Employee Benefits Broker/Consultant Services • Technology resources to help the City evaluate, procure, implement and maintain benefits and administrative products and systems • Support to streamline day-to-day benefit plan administration We invite and highly encourage the City to contact our provided client references. Please let us know if there is any additional information that can be provided to assist you in selecting Burnham Benefits as the City’s exclusive employee benefits consultant. Thank you again for your consideration. We look forward to hearing from you. Best Regards, Kristen Allison President and CEO 2211 Michelson Suite 1200 Irvine, CA 92612 949.833.2983 main 949.252.4580 direct allison@burnhambenefits.com Ann Stawicki, MPH Vice President 2211 Michelson Suite 1200 Irvine, CA 92612 949.833.2983 main 949.252.4585 direct stawicki@burnhambenefits.com Additional Information Firm’s Main Office: Burnham Benefits | 2211 Michelson Suite 1200 | Irvine, CA 92612 Site that would service the City: Burnham Benefits | 2211 Michelson Suite 1200 | Irvine, CA 92612 All Information and pricing provided in the proposal will be valid for one hundred twenty (120) days. We certify that all individuals who will perform work for the City is free from any conflict of interest. 4 Burnham Benefits Response to City of La Quinta Request for Proposal for Employee Benefits Broker/Consultant Services Table of Contents Cover Letter ..................................................................................................................... 2 Firms Background, Qualifications, and Experience .................................................... 5 References of California government agencies (preferably cities utilizing) .......... 28 Cost Outline ................................................................................................................... 30 List of Complementary Services Offered by Proposer along with Corresponding Prices .............................................................................................................................. 31 Staffing and Project Organization .............................................................................. 32 Subcontracting Services .............................................................................................. 33 Disclosures ...................................................................................................................... 34 Appendix ....................................................................................................................... 35 5 Burnham Benefits Response to City of La Quinta Request for Proposal for Employee Benefits Broker/Consultant Services Firms Background, Qualifications, and Experience a. Number of years in business 26 years—Since 1995 b. Taxpayer identification number 33-0643611 c. Firm ownership and, if incorporated, list the state in which the firm is included and the date of incorporation Burnham is a limited liability corporation (LLC). d. If the firm is a subsidiary of a parent company, identify the parent company Founded in 1995 as a privately held business and headquartered in Irvine, California, Burnham has operated as a full-service employee benefits and property and casualty consulting brokerage. In January 2021, Burnham partnered with Baldwin Risk Partners Group, Inc. (BRP), a publicly held company, to drive continued growth and continue expanding the breadth and depth of services we offer clients. As a subsidiary of BRP, Burnham benefits from a nationwide footprint while still operating independently as the boutique firm our clients love. BRP has 1,150 employees and counting across more than 50 offices. 6 Burnham Benefits Response to City of La Quinta Request for Proposal for Employee Benefits Broker/Consultant Services e. Resumes of the Project Manager and key personnel who will be responsible for performance if any agreement results from this RFP The City’s Burnham Benefits Support Team Ann Stawicki, MPH Vice President In Industry | October 2005 At Burnham | July 2012 Strategic Leadership City’s Core Team Member • Strategic advisor to clients • Works with clients to meet strategic goals and develop a custom health and welfare strategy, including the design and implementation of their short and long-term goals • Career in healthcare administration before becoming a benefits consultant–understands healthcare market and system intimately • Involved in all aspects of the clients’ renewal process ranging from aggressively negotiating the most financially competitive benefits package to identifying, recommending, and implementing efficient solutions to achieve client objectives • Prides herself on her ability to act as an advocate for her clients • Role encompasses vendor management, data analysis and integration, identification of program cost drivers and trends, and comprehensive project management support • Bachelor of Arts and Science degree in Health Services from San Diego State University • Master of Public Health (MPH) degree with an emphasis is Health Services Administration from San Diego State University 7 Burnham Benefits Response to City of La Quinta Request for Proposal for Employee Benefits Broker/Consultant Services Kelly Fox Senior Account Executive Irvine, CA In Industry | June 2000 At Burnham | July 2013 Execution Leadership City’s Core Team Member •Responsible for overall client management: -Performing market analysis -Renewal strategy and negotiation -Coordinating employee benefits communications, open enrollment, implementation, and ongoing plan administration -Managing group carriers / administrators relationships -Ensuring group compliance -Supporting wellness initiatives •More than 15 years of industry experience with a combination of health and welfare consulting and employer experience managing benefits for mid-size and large public and private organizations -Provides her with a unique and well-rounded perspective to address challenges that employers may face with viable cost containment strategies and benefits communications Alicia Bergsto Senior Account Manager Irvine, CA In Industry | October 2008 At Burnham | Dec. 2015 Service Leadership City’s Core Team Member •Responsible for overall account management: −Service −Marketing −Implementation −Renewal −Compliance •Assists with: −On-going plan administration −Online benefit management systems −Open enrollment coordination and employee meetings •Works closely with clients to provide exceptional customer service and satisfaction •Favorite part of job is meeting clients’ employees, helping them and their families, and making sure their questions are answered •Bachelor of Science in Biology from Long Beach State University 8 Burnham Benefits Response to City of La Quinta Request for Proposal for Employee Benefits Broker/Consultant Services City’s Burnham Benefits Shared Services Richard P. Asensio, JD, MBA VP/Director of Compliance Los Angeles, CA In Industry | May 1999 At Burnham | Feb. 2013 City’s Compliance Consultant • Primary responsibilities include delivering health and welfare benefit consulting services to Burnham’s clients • Consults with clients regarding various health and welfare compliance issues regarding eligibility and plan administration, including implementing the provisions of health care reform (ACA) and nondiscrimination testing • Monitors and analyzes new / ongoing federal and state legislation • Reviews employee benefit communication and enrollment materials, benefits descriptions and SPDs • Drafts various health and welfare plan documents • Coordinates benefit-related filings with government agencies • Performs in-depth legal research and analyses of complex federal tax and ERISA matters • Helps clients choose appropriate strategic options and safely navigates increasingly complicated compliance requirements • Responsible for the content and delivery of Burnham’s legislative and compliance webinars • More than 19 years of experience consulting on both qualified and non-qualified plan compliance issues, as well as extensive knowledge of state and federal requirements that impact employee benefit plans • Previously worked for Aon Hewitt Consulting, Arthur Anderson and Fidelity Federal Bank • Areas of special expertise include IRS, ERISA, COBRA and HIPAA compliance, healthcare reform (ACA) implementation, and document and operational compliance reviews of retirement and health and welfare plans • Juris Doctorate from the University of San Diego • MBA from Babson College in Wellesley, MA • Member of the State of California Bar 9 Burnham Benefits Response to City of La Quinta Request for Proposal for Employee Benefits Broker/Consultant Services Leslie Ouellette Director of Client Communications and Marketing Irvine, CA In Industry | May 1994 At Burnham | Jan. 2005 City’s Communications Consultant • Manages, develops, and oversees benefit communication strategies • Provides the City with a comprehensive array of creative services • Objective is to: - Communicate the details and value of the City‘s employer- provided benefits - Provide materials that are tailored specifically to their benefits package and corporate culture - Meet legal requirements for disclosure • Deliverables include employee benefit guides, open enrollment materials, wellness communications, and educational information Meagan Jackson Benefits Technology Consultant Irvine, CA In Industry | April 2015 At Burnham | August 2016 City’s Technology Consultant • Works with clients to evaluate technology solution needs - Finding a solution for a new issue, or - Replacing a solution that no longer meets client’s needs • Helps clients troubleshoot and resolve ongoing issues • Assists with carrier integration implementations • Stays up to date on current trends and changes in the marketplace • Evaluates new products and solutions that emerge 10 Burnham Benefits Response to City of La Quinta Request for Proposal for Employee Benefits Broker/Consultant Services Whitney Ehret Voluntary Benefits Consultant Irvine, CA In Industry | April 2011 At Burnham | Jan. 2017 City’s Voluntary Benefits Consultant As medical cost trends continue to increase for both employers and employees, implementing the right voluntary benefits strategy can increase financial stability, employee well-being, and workforce loyalty. • Assists teams with day-to-day account management duties: - The marketing, sale, and implementation of voluntary benefit plans • Creates the right voluntary benefits strategy for clients and pairs the product solution with optimal enrollment and technology solutions • Background in Human Resources - Provides a unique perspective when evaluating and understanding client needs Julie Johnson Wellness Consultant Irvine, CA In Industry | Sept. 2000 At Burnham | July 2017 City’s Wellness Consultant • 15+ years of industry experience with a combination of: - Benefits administration - Health and wellness consulting - Managing wellness programs for a large, national, multi-state organization • Well equipped to address challenges employers face with workplace wellness programs including: - Multiple locations - Technology challenges - A diverse workforce–generational, knowledge of technology, education and salary levels • Strategically aligns wellness programs with vendor selection/management, creative incentive designs and communications to: - 1) increase engagement to maintain a healthy and productive workforce, and - 2) create a desirable program for recruitment/retention. • Bachelor of Arts in Economics from the University of California, Irvine 11 Burnham Benefits Response to City of La Quinta Request for Proposal for Employee Benefits Broker/Consultant Services f. Applicable certifications and licenses g. Discuss your firm's resources and activities as they relate to knowledge and understanding of municipalities Burnham Benefits’ experience in the public sector began 14 years ago, in 2007, with a K-12 school district in Santa Barbara County. Since then, Burnham Benefits invested in an internal Public Sector team of advisors that has proven to establish strong relationships and a deep knowledge and understanding of the unique demands and needs of public entities. Burnham Benefits now works with 81 public sector clients throughout California, representing 71,000 public sector employees. This accounts for 16% of the firm’s total revenue. Burnham will stand out as a benefits consultant in the following areas: • We are an objective consulting firm that does not try to sell clients any proprietary products, pools, or services. Nor are we compensated in any way by the pools for actuarial, marketing, underwriting, administrative, or other services provided. We pick best-fit vendors and carriers for our clients. We are an all-in model—no separate invoices for communications, legal, and wellness consulting. • Extensive experience working with and presenting to bargaining units, benefit committees, and advisory committees • Burnham has assisted many public entities in evaluating non-CalPERS pool options with a timeline and transition plan - We are experienced working with other cities and counties in plan analysis, financial costs, and deliverable timelines when evaluating a departure from CalPERS • Recognized presence in the public sector space including representation at industry conferences and seminars APPENDIX: CA Department of Insurance License APPENDIX: CA Secretary of State Electronic Filing 12 Burnham Benefits Response to City of La Quinta Request for Proposal for Employee Benefits Broker/Consultant Services Burnham Benefits excels in the public sector as we understand the unique needs and concerns cities and counties must manage through their employee benefits programs. A few recent noteworthy successes include the following: College District • Performed full benefits marketing • Conducted rigorous analysis of the cost and benefits of the options presented • Educated insurance committee, management, Board of Trustees through various meetings and presentations • Supported through transition process, anticipating needs and preparing the client in advance • Projected savings in year one is $10million+ County • Performed full marketing as programs hadn’t been out to bid in five years • Utilized marketing leverage and knowledge of industry-standard programs to negotiate more favorable renewal positions • Introduced Kaiser to address employee desires • Enhanced dental program with multi-year rate caps • Added life insurance coverage for a portion of the population who hadn’t received it historically and negotiated multi-year rate caps and guarantees • Final renewal action was rated reduction of 2% with plan design enhancements resulting in savings of $500,000 Southern CA City • Took over from prior broker and performed rate validation on all renewals - Bundled dental, vision, life and disability lines under a single carrier • Annual savings amounted to $130,000 • Received a significant communications stipend to enhance employee communication activities 13 Burnham Benefits Response to City of La Quinta Request for Proposal for Employee Benefits Broker/Consultant Services h. Describe your firm's resources and services provided. Include both the services outlined in this request, as well as additional services that you would like to recommend and/or provide Burnham’s core competencies include providing professional, customary, thoughtful and effective consulting services. Health and welfare consulting is one of our primary functions–successfully managing these programs on behalf of our clients. Burnham has preferred relationships with all large state and national medical carriers. We have elite broker status and sit on all major insurance carrier executive boards. This enables Burnham to provide unique leverage for our clients and results in favorable business decisions made by the carriers. It also provides Burnham with unique opportunities to offer clients new employee benefit products and services before they are available to most other brokers/consultants. One main priority is to establish long-term, financially advantageous, carrier and service provider partnerships for our clients, have appropriate coverage for employees that align with corporate strategy, and ensure the highest level of service available. Medical Benefit Program In specializing in employee benefits, all our clients offer medical programs. Our consultants work with their clients to identify the best provider within their local region. This analysis includes network access, pricing and customer service. In addition to identifying the best fit carrier, we take our role as an employee advocate very seriously. We are experts at assisting employees in both understanding their benefits and fixing claim issues that inevitably arise. Pharmacy Benefit Programs In addition to medical benefits consulting, Burnham understands the importance of managing the pharmacy benefit programs as well. Pharmacy costs continue to escalate, particularly regarding specialty medications, and pharmacy trend now exceeds medical trend. It is imperative to analyze the pharmacy benefits costs and understand the cost drivers to closely manage this component as part of the overall healthcare spend. Burnham formed a separate company called 360 Rx Solutions with a mission to provide greater transparency and lower pricing for outpatient prescription drugs purchased through e mployers’ benefit plans. This focus has allowed for Burnham to offer Rx savings to groups between 8 percent and 25 percent of Rx claims through a non-profit employer purchasing coalition with over 800,000 covered lives. Often these savings are achieved without even changing the current PBM. 360 Rx Solutions also provides our own pharmacist for the review and interpretation of claims allowing for a focused response to any escalating cost or health issues. 14 Burnham Benefits Response to City of La Quinta Request for Proposal for Employee Benefits Broker/Consultant Services Dental Benefit Programs Nearly all of Burnham’s clients offer dental programs. Our consultants work with their clients to identify the best dental provider within their local region. This analysis includes network access, pricing and customer service. Vision Benefit Programs We regularly consult with clients on their vision plans and offerings. As there are more proven linkages between vision health and overall health we keep apprised of emerging trends and how programs can be enhanced to best-fit population needs and claim drivers. Life and AD&D Insurance Burnham Benefits works with our clients to evaluate the best options for life and AD&D insurance. We find that many consultants focus on the larger budget items of medical and dental programs and life insurance is often neglected. We realized significant savings with several clients in these programs upon obtaining the consulting contract and understand the financial protection and peace of mind offering these coverages can provide to our clients. Short-term and Long-term Disability Similar to life insurance, this is an area of neglect with non-Burnham clients. In addition to evaluating the cost of the programs, your Burnham team is very knowledgeable about the provisions and terms of the disability plans. It is important to have a consultant who understands that small existing deviations can have large consequences for a particular employee years into a contract. We also recommend clients evaluate the taxability of the long-term disability program to ensure employees are receiving the most beneficial benefit during their disability. Reimbursement Accounts Burnham is well versed and consults with clients across all types of reimbursement accounts, including flexible spending accounts (healthcare and dependent care), health reimbursement accounts, and health savings accounts. We consult our clients on the nuances of the plans and keep them up to date on limits and guidance on these programs. While HRA plans have been around for quite some time, employers interest in offering these arrangements increased significantly since the ACA was implemented. As such, Burnham has worked with many clients to explore and implement programs. In addition, we have several clients located within San Francisco where HRA plans are utilized as a solution to the San Francisco Healthcare Security Ordinance. 15 Burnham Benefits Response to City of La Quinta Request for Proposal for Employee Benefits Broker/Consultant Services Employee Assistance Programs (EAP) Until 2020 and the onset of the pandemic, EAPs were one of the most under-utilized employee benefit offerings. Burnham works with our clients to ensure employees understand the value of the EAP program beyond just the initial clinical visits. We partner with the EAP vendor to take full advantage of the programs offered to employers (brown bag lunches, manager training, management referrals) and employees (legal, financial, referrals). Voluntary Benefits Burnham has a specialized voluntary benefits department that oversees all aspects of voluntary benefit programs. We help clients: • Determine which type of voluntary benefits make sense within a specific population • Perform and manage vendor searches, and oversee implementation and ongoing program management Burnham’s voluntary benefits team will work closely with the Burnham core consulting team to implement and roll-out various voluntary products that fit within the City’s culture to ensure you remain competitive in this segment of the industry. Wellness Programs Wellness is a core area of focus for Burnham as the vast majority of our clients provide wellness programs to their employees. We understand the importance of these programs and how to look holistically at total well-being. Burnham’s value and approach center around defining what wellness means to the organization and your employees. Once defined, we will help build programs, resources, and incentives that directly center around the City’s wellness philosophy. In addition to assisting the City with your wellness strategy, we also provide wellness compliance guidance and help review and develop wellness communication resources. 16 Burnham Benefits Response to City of La Quinta Request for Proposal for Employee Benefits Broker/Consultant Services i. Describe your firm's resources or methods to provide education on best practices, trends, or hot topics Employer Education and Marketplace Trends Burnham provides more than 300 on-demand courses for both management and employees through our partnership with ThinkHR and HR360. Popular subject categories include Employment, Workplace Safety, Environmental Compliance, Unlawful Harassment Prevention, Customer Service, and Wellness. We also provide monthly webinars, regular legislative updates, and on-site education for your staff and leadership. We will provide executive education sessions, management meetings, and town hall meetings for various updates on health care trends, reforms, and updates. We also find that targeting certain topics for either your benefit committee or union representatives can improve re lations between management and the various stakeholders. This approach allows for a cohesive message and a better understanding of why specific recommendations are made during the renewal process. During our trends review we identify and recommend contemporary products, goods and/or services to ensure a fiscally balanced and culturally fit comprehensive and complementary plan design. HR360 and ThinkHR Comprehensive HR consulting resources, hotline and unlimited online training with access to HR advisors, documents, tools, templates and checklists, HR training, research on complex issues, compliance alerts, webinars and whitepapers (including mandatory sexual harassment training) HR Hotline & Advisors • Live calls with advisors • Senior level experienced HR professionals with PHR® and SPHR® designations HR Online Library • Interactive guidance & resources • Downloadable content • Employment law per state • Community forum • Leave of absence management Training for HR, Staff & Employees • Professionally produced videos • Sexual harassment training • Safety & OSHA • Environmental compliance • Wellness 17 Burnham Benefits Response to City of La Quinta Request for Proposal for Employee Benefits Broker/Consultant Services Legal Compliance Burnham offers a comprehensive menu of federal and state law compliance support. Vice President and Director of Compliance Richard Asensio, JD, MBA leads Burnham’s Compliance Resource Team. Since 1999 Richard has been consulting with employers on both qualified and non-qualified plan compliance issues and has extensive knowledge of state and federal requirements that impact employee benefit plans. Asensio’s areas of special expertise include IRS, ERISA, COBRA and HIPAA compliance, ACA implementation, and non-discrimination testing. Richard is highly proficient in performing plan document and operational compliance reviews of retirement and health and welfare plans. Burnham’s clients have direct access to Richard and his services. These services include, but are not limited to, the following: • Compliance Audit – Burnham developed a proprietary tool, known as the Compliance Toolkit, containing a 50+ page comprehensive review of all current policies and procedures to ensure that NCPA’s benefit plans and materials meet the latest regulatory requirements • Cafeteria plan preparation and compliance • ACA compliance, including the employer shared responsibility and employer reporting consulting • ACA, COBRA, HIPAA, and other federal law and state legislative compliance • Contract review and required notice disclosures • Annual compliance calendar • Non-discrimination testing and other compliance requirements related to welfare and health plans under the Internal Revenue Code • Wrap plan document and summary plan description (SPD) preparation, review and updates • CMS Medicare Part D disclosure reminder and instructions • HIPAA privacy and data security compliance 18 Burnham Benefits Response to City of La Quinta Request for Proposal for Employee Benefits Broker/Consultant Services Burnham works proactively to keep client benefits program and administration compliant with federal and state regulations. We make every effort to shield clients from serious legal and financial risk through specialized resources and tools used by our compliance team. Burnham’s team subscribes to: • Lexis Nexis on-line research library • Thompson Reuters’ Checkpoint (resource for federal related laws and regulations) • Zywave (supplements internal legal resources) • ThinkHR and HR360 Client Resources Burnham provides a variety of resources targeted toward keeping clients informed of legislative changes. These include: • Webinars and webcasts • Ongoing bulletins and updates • Educational seminars • Online library of benefits and HR forms, documents, tools, and templates • 200+ on-demand HR web courses for managers and employees and online If a new federal, state or local ruling or regulation has the potential to impact Burnham’s clients, we issue either ACA Pathways or Legislative Updates. Burnham follows-up with clients directly with ready templates they can use if needed. We also conduct monthly webinars for our clients. Most of Burnham’s webinars focus on compliance-related issues. 19 Burnham Benefits Response to City of La Quinta Request for Proposal for Employee Benefits Broker/Consultant Services j. Describe your firm's legal research capabilities and how you communicate legislative updates to your clients Vice President and Director of Compliance Richard Asensio, JD, MBA leads Burnham’s Compliance Resource Team. Richard has more than 22 years of experience consulting with employers on both qualified and non-qualified plan compliance issues, and he has extensive knowledge of state and federal requirements that impact employee benefit plans. His areas of special expertise include IRS, ERISA, COBRA and HIPAA compliance, ACA implementation, nondiscrimination testing. Also, he is highly proficient in performing plan document and operational compliance reviews of retirement and health and welfare plans. Before joining Burnham, Richard worked for Aon Hewitt Consulting, Arthur Anderson and Fidelity Federal Bank. Richard is a member of the California State Bar. Outside Legal Counsel To ensure correct tactical execution of keeping clients compliant with the law, our services are supported and complemented by the attorneys of Fisher & Phillips. There are no additional fees for access to Richard and our Compliance team for questions and small research projects. However, for more complex legal issues or projects, there would be a potential fee per project. Client Communication If a new federal, state or local ruling or regulation has the potential to impact Burnham’s clients, we issue either ACA Pathways or Legislative Updates. Burnham follows up with clients directly with any necessary compliance templates. Burnham commits extensive resources to ensure clients have the support needed to stay in compliance with benefits related legal and financial requirements. We offer shared resources that the City can use independently or with guidance from the Burnham service team. Compliance Resource Team Direct access to compliance team to discuss specific compliance-related issues and strategies MyWave A personalized website offering valuable HR and benefits information, including current ADA, FMLA, COBRA, HIPAA, and ACA regulations, downloadable forms, legislative guides, FAQs and more 20 Burnham Benefits Response to City of La Quinta Request for Proposal for Employee Benefits Broker/Consultant Services Webinars and Newsletters Highlights of recent legislative changes and industry trends APPENDIX: Burnham COVID-19 Webinar Series 2020 APPENDIX: Burnham Educational Series 2020 APPENDIX: Legislative Update ACA Central Offers Affordable Care Act information to guide healthcare reform-related decisions Exclusive ACA Pathways Program Includes Burnham’s customized health care reform consulting service, e- newsletters, and other Affordable Care Act resources APPENDIX: ACA Pathways ThinkHR and HR360 Comprehensive HR resource with access to HR advisors, documents, tools, templates and checklists, HR training, research on complex issues, compliance alerts, webinars and whitepapers 21 Burnham Benefits Response to City of La Quinta Request for Proposal for Employee Benefits Broker/Consultant Services k. Describe your renewal process and timeliness Not all renewals and timelines are the same, so we design the annual renewal process working in concert with the City’s team and incorporating all relevant deadlines. Burnham takes a comprehensive approach when working on the City’s renewals—we start with a strategic conversation around overall strategy desired for the upcoming plan year and for future years. We make it a priority to have a firm grasp on the direction of the City’s company vision, objectives, values, and desires, as well as the ability to evolve employee benefits offerings within the changing environment. These conversations, along with the firm’s understanding of legislative requirements and industry trends, contribute to a well-planned renewal and long-term strategy. Renewal and Negotiation Process Timeline Burnham uses our annual timeline / work plan to ensure appropriate key milestones are being met, including providing budget estimates and cost projections, finalizing funding rates and employee contributions, and producing customized communications for open enrollment. Strategy, Cost Control and Pre-Renewal Planning Burnham’s approach for the renewal process, inclusive of cost containment metrics, is outlined below: • Request renewals from respective carriers based on the established timelines for budgets and open enrollment • Analyze budget, claim cost, employee contribution and enrollment migration trends before carrier / vendor renewal receipt • Coordinate all plan design changes and underwriting requests to carriers / vendors • Analyze, validate and negotiate carrier / vendor renewal terms • Go to market if necessary • Provide in-depth analysis of proposed alternatives and assist with the process of selecting the most favorable annual renewal options • Perform discount analysis / network repricing • Perform network disruption analysis • Secure performance-guarantee metrics with the carriers / vendors • Negotiate wellness budgets / programs • Model employee / employer contribution scenarios and finalize employee / employer contribution strategies • Develop and document next year’s budget and premium rates by plan and total, including development of funding rates and contribution modeling • Perform actuarial review and certification of IBNR (reserves), as well as funding rates 22 Burnham Benefits Response to City of La Quinta Request for Proposal for Employee Benefits Broker/Consultant Services Negotiation Process Burnham’s underwriting models capture and track the major components of a health plan. These items include: • Evaluating capitation increases from year to year • Ensuring pooling charges are adequately priced • Determining that proposed retention fees are within acceptable ranges and that ACA fees (if applicable) are adequate • Verifying plan design factors • Noting demographic changes • Evaluating current claim performance against historical claim perspectives • Accurately estimating overall multi-year profitability We utilize this data to assess the current plan performance, to then derive an appropriate renewal percent increase that will sustain the plan. Burnham negotiates with the incumbent carrier to satisfy the City’s needs and achieve the appropriate price. Marketing Process If Burnham is unable to reach a desirable conclusion from the negotiations, we will place the line of coverage in the marketplace to ascertain the true market value. We start by crafting a detailed request for proposal (RFP) and present the City’s company and data in the marketplace that will uphold the City’s brand. During this process, Burnham pays close attention to explain company culture and history, and outlines requests clearly and concisely. We do not believe in the “shotgun” approach; instead, we are strategic in the markets we go to and the items we request. This cultivates positive relationships with Burnham’s carrier / vendor partners as they see RFP responses from Burnham as viable opportunities. When all marketing results are received, analyzed, and finalized, we utilize these results as market leverage to further the negotiation process. Burnham believes this process is fair to all parties involved and is well respected with carrier partners, while providing a valuable service to the City. Vendor Selection For Burnham’s self-insured clients, we have a vigorous vendor selection process and have developed a proprietary vendor scorecard to assist the City in selecting the appropriate carrier partner. Between the provider network, third party administrator (TPA), pharmacy benefit manager (PBM) and many other self-funded components, we find the scorecard provides a recommendation based on the best solution for the organization, rather than the lowest price. As each line of coverage is unique, the scorecard is made 23 Burnham Benefits Response to City of La Quinta Request for Proposal for Employee Benefits Broker/Consultant Services custom to the product and desired outcome. Burnham assigns credibility weightings for major categories such as quoted price, carrier/vendor financial viability, account management, implementation, underwriting methodology, reporting capabilities, claim management and escalation, performance guarantees, etc. A score is placed in each category to reach an overall carrier/vendor score and provide a holistic recommendation. This scorecard is a one-page executive summary that is easily understood. This allows Burnham to provide a ranking system based on all services provided rather than price, making our clients informed buyers. l. Resources your firm offers to assist with the administration of a benefits program (i.e., online benefits enrollment and management, COBRA administration, and flexible spending account administration) Burnham has deep experience with online enrollment solutions, including technology solutions related to Human Capital Management. Because we are vendor agnostic, we approach each project in a true consultative manner and provide unbiased feedback. Many solutions are designed for specific markets and company types. Burnham helps find the best system to drive efficiencies within the City’s business. If you already have or are interested in a different benefit administration solution, Burnham’s in- house technology team will assist with issues or questions and manage an RFP to acquire a solution, if needed. We usually work with our technology experts behind-the-scenes. Burnham can also accommodate one-on-one enrollers, call-centers, outbound call and text campaigns, appointment schedulers, avatars, and interactive voice response (IVR) options. Additionally, Burnham provides at no additional cost, an online administration platform, Ease. Capabilities include but are not limited to: • Open enrollment • Ongoing onboarding needs • HRIS functions: - Time/attendance - Org chart - Employee directory - Surveys - Performance review • Reporting • Repository for annual notices and employee education • Spanish capabilities 24 Burnham Benefits Response to City of La Quinta Request for Proposal for Employee Benefits Broker/Consultant Services m. Describe your firm's capabilities concerning communication. Include ongoing employee communication/open enrollment and web-based communications. Employee Communication – Engagement Resources Burnham recognizes that benefits must be understood and ap preciated by employees before they can produce any return on investment. We also know that the process of educating and enrolling employees must be efficient. Burnham will review your current communication strategy and make suggestions for improvement as it relates to the content, design and distribution channel. As part of Burnham’s standard services, we can provide a full array of employee communications including: Online Employee Benefits Basics Burnham provides short, entertaining, easy-to-understand educational videos to help employees better understand how benefits work. • Medical Plan Terms http://video.burnhambenefits.com/terms • HDHP + HSA http://video.burnhambenefits.com/hdhp • FSAs http://video.burnhambenefits.com/fsa Online Employee Education Burnham also leverages technology to address education through: • Decision Tools offers advice regarding benefit plan options • Virtual Benefit Guides live links to provider networks, carrier websites, and educational resources—sample http://online.flipbuilder.com/wuay/vyih/ • Online benefits presentation (Sample Here) interactive tool for onboarding new hires and open enrollment. Allows employees access to pertinent information throughout the year, at home or at work, at a time that works best for them. Clients find this tool valuable because it reduces onboarding time while also providing a clear and consistent message. 25 Burnham Benefits Response to City of La Quinta Request for Proposal for Employee Benefits Broker/Consultant Services Employee Mobile App Capabilities Burnham can provide clients with a mobile app that lets employees access benefi ts information anytime they need it. Our mobile app provides employees with: • Easy access to benefit plan details • Links to carriers’ online provider finder directories • Key documents including SPCs, SPDs, annual notices, and carrier forms • Carrier contacts, with the ability to call directly from the app • Ability to save copies of ID cards and easily fax or email them to providers • Personalized healthcare information, including doctors, urgent care facilities, preferred pharmacies, health conditions, and notes from doctor’s appointments The mobile app also comes with a web portal that allows employees to view more robust benefit details and includes a plan comparison tool. Full Spectrum Communication Consulting Burnham’s in-house marketing and communications design team also provides traditional forms of employee communications including but not limited to: • New hire and on-boarding communications • Branded, customized benefit communications for open enrollment and beyond • Year-round communication campaigns designed to help engage employees in benefits (monthly, bi-monthly or quarterly) • Employee surveys, employee engagement and sensing • Electronic total compensation/benefit statements • Market-ready collateral (ACA, wellness, financial tips, etc.) • Recruitment communications • Wellness campaigns APPENIDX: La Quinta Guide Benefits Guides SAMPLE APPENIDX: La Quinta Know Your Benefits SAMPLE APPENIDX: La Quinta Guide Cover Options SAMPLE 26 Burnham Benefits Response to City of La Quinta Request for Proposal for Employee Benefits Broker/Consultant Services n. Describe your firm's transition plan indicating how you will assume the current vendor's services in a smooth and orderly manner. Account Transition Information Gathering From the start of Burnham’s partnership with the City, our focus is understanding the organization, financial goals, corporate values and the way these are reflected in the employee benefits offering. Burnham’s process of formulating a benefit strategy begins with a review of current plans and their performance: How have they met expectations? What are the shortcomings or areas for improvement? What is the current return on investment? Burnham gathers information on current plans from carriers and vendors to build a historical account of the plans. A transition planning session is also conducted and includes a discussion of the City’s short- and long-term goals as well as a review of key program elements, funding mechanisms, network, and market conditions. Transition Planning Session Burnham’s Strategic Planning Session includes discussion focused on: • the City’s stated benefit principles • the City’s demographics • Overall program design • Benchmark findings • Compliance • Specific details of the City’s plans, from copayments to contributions, to determine whether the current plans reflect the City’s goals and objectives • Funding mechanisms and viability • Carrier review and marketing • HR/Benefits Resources • Benefits administration vendors, including COBRA administration • Employee communication strategy • Technology needs analysis • Overall transition including implementation dates and project timeline By defining the current state and targeting future objectives, Burnham builds an effective, proactive blueprint for managing change. 27 Burnham Benefits Response to City of La Quinta Request for Proposal for Employee Benefits Broker/Consultant Services Transitional Planning Timeline Once agreed upon and solidified, Burnham develops a strategic planning timeline that takes into consideration current and future overall objectives and goals, renewal management, and analysis including: • Competitive marketing, to ensure greatest value • Benchmarking data • Employee sensing • Claims reporting • Special or unique projects, such as funding transitions and ongoing services o. Submit a sample of annual and periodic reports you provide similar clients. APPENDIX: Sample Transition Timeline APPENDIX: 2020 Planning Meeting APPENDIX: 2020 Insurance Committee Strategy and Market Updates APPENDIX: 2021 Insurance Committee Renewal Presentation APPENDIX: Renewal Selection 28 Burnham Benefits Response to City of La Quinta Request for Proposal for Employee Benefits Broker/Consultant Services References of California government agencies (preferably cities utilizing) Please only include California government agencies your firm has provided similar services to within th e past three (3) years. a. Client name, client project manager, telephone number, and email address b. Services provided c. Start date, and end date d. Staff assigned to each project by the firm e. Number of years firm has provided employee benefits broker/consultant services to municipalities f. Include the number of employees for each agency. #1) Client name, client project manager, telephone number, and email address: City of Fullerton Christine Pilapil (714) 738-6834, christinep@ci.fullerton.ca.us Services provided Full benefits consulting Start date, and end date January 1, 2019 - present Staff assigned to each project by the firm Kris Dopera, Julie Johnson, and Carolyn Reed Number of years firm has provided employee benefits broker/consultant services to municipalities 14 years Include the number of employees for each agency. 500 #2) Client name, client project manager, telephone number, and email address: City of Newport Beach Jill Ortiz (949) 644-3310, jortiz@newportbeachca.gov Services provided Full benefits consulting Start date, and end date January 1, 2020 - present Staff assigned to each project by the firm Ann Stawicki, Kris Dopera, and Kelly Fox Number of years firm has provided employee benefits broker/consultant services to municipalities 14 years Include the number of employees for each agency. 700 full-time employees and 200 retirees 29 Burnham Benefits Response to City of La Quinta Request for Proposal for Employee Benefits Broker/Consultant Services #3) Client name, client project manager, telephone number, and email address: City of Tulare Janice Avila 559-684-4203; javila@tulare.ca.gov Services provided Full benefits consulting Start date, and end date June 2019 - present Staff assigned to each project by the firm LeRoy Tucker and Jennifer Vincent Number of years firm has provided employee benefits broker/consultant services to municipalities 14 years Include the number of employees for each agency. 370 full-time employees and 20 retirees (Post-65) 30 Burnham Benefits Response to City of La Quinta Request for Proposal for Employee Benefits Broker/Consultant Services Cost Outline Proposal shall include a detailed fee schedule for the services requested by this RFP. Describe your method of compensation for your services. Does your company accept any carrier "overrides"? If on a commission basis, would your company be taking any form of compensation beyond the commission built into o ur premium rates? If selected, what are your disclosing compensation methods to the City and the frequency of that disclosure? The City intends to contract with a vendor to provide the best overall service and value to the City. While the price is a significant factor, other criteria will form the basis of the City's decision. A full description is available in "Section 8 – Explanation of Methodology." Burnham is flexible in terms of how the firm is compensated for the work it performs for the City. Given the anticipated scope of work for the City, Burnham proposes to assume the same commissions schedule as the City currently has in place with the current broker. Alternatively, Burnham Benefits is amenable to entering into a service contract, in which commissions are removed from rates and offered on a fixed basis of $35,000 per year. The fees could be payable on a quarterly or semi-annual basis. Burnham further proposes to include this issue as a dialogue point in the renewal discussions each policy period to provide complete transparency and full disclosure of the upcoming years forecasted agreed upon compensation. Engagement with the City is what is most important to Burnham. We are confident that the assembled team and client tools and resources will exceed the City’s expectations. Burnham will continually “earn the right” to work with and represent the City. Our final determined compensation structure, although a critical component of this overall project, is not as important to us as the chance to work together and represent the City’s best interest for years to come. Overrides Burnham receives override compensation from carriers. Overrides are a standard practice among insurance carriers and do not impact any individual client’s rates. These are received at the corporate level, are generally based on the company’s overall book and retention with a carrier, and are not shared with the individuals who market or service our clients. In fact, our consultants and underwriters are not familiar with the programs in place so that their sole focus is on what is best for the client. Transparency is important to us— we will disclose overrides related to business placed for the City, should we receive any. As noted above, we believe compensation should be fair and transparent. This is another reason Burnham does not sponsor its own product pools, which usually contain margins and fees that are not reportable as compensation and can be very profitable to the sponsoring agency. 31 Burnham Benefits Response to City of La Quinta Request for Proposal for Employee Benefits Broker/Consultant Services List of Complementary Services Offered by Proposer along with Corresponding Prices Burnham’s goal is to include all brokering services within our overall Scope of Services and quoted fee. We want the City to feel confident they are receiving a comprehensive scope at an all-inclusive price. If a project arises that is clearly outside the proposed scope, we will discuss with the City to find a mutually agreeable approach. Burnham will not commence any work without expressly discussing with the City why the project is considered out of scope and any associated additional fees. An example of services not included are: • Benefit Outsource Administration (enrollment, billing, password recovery, etc) • HR/Benefit Technology such as online enrollment, billing services, or employee benefit portal • International consulting services • Actual ACA reporting – though we will provide guidance The partners within Burnham have business holdings that compliment Burnham Benefits’ offerings— these entities share a common philosophy of providing high quality, client centric solutions customized to the unique needs of each business. Each entity has its own executive management team, staff, and resources that are unique to its discipline. Burnham Lines of Business Burnham Risk and Insurance Solutions Property and Casualty Consulting Tailored risk management and insurance programs to protect your business Ongoing Propriety Stewardship Process High net worth personal lines Burnham Gibson Wealth Management Consulting Plan, strategy & design Fiduciary compliance and benchmarking Investment due diligence 360Rx Solutions Pharmacy Benefits Consulting Leverage Rx costs and power through PBM plan pricing Pharmacy rebates back to employers up to 25% of Rx spend Analyze claims data and provide repricing 32 Burnham Benefits Response to City of La Quinta Request for Proposal for Employee Benefits Broker/Consultant Services Staffing and Project Organization Burnham believes open, regular, and honest communication is crucial to ensuring a successful partnership. Our goal is to limit personnel changes on the City’s Burnham team to the greatest extent possible. Once we identify the team and establish relationships, we do not change account teams unless it is at the request of the client or in the event a member of the team leaves Burnham Benefits. In the event of necessary personnel changes, we will involve the City immediately. We will be upfront regarding potential changes and ensure the City plays an active role in determining any newly proposed team members. Due to Burnham’s unique and collaborative culture, we maintain a low employee turnover and an excellent reputation for being one of the top career firms in the insurance industry. Since turnover within Burnham is rare, averaging less than 5%, the response and collaboration around client experience are paramount. Leadership is quick to apply resources to ensure no loss in service. City’s Dedicated Team Organizational Chart Strategic/Executive Leadership Ann Stawicki Vice President Execution Leadership Service Leadership Kelly Fox Senior Account Executive Alicia Bergsto Senior Account Manager In-House Resource Team Leads Risk Management Compliance Communications Luis Milla Chief Strategy Officer Richard Asensio, JD Vice President and Director of Compliance Leslie Ouellette Director of Client Communications Benefits Technology Wellness Voluntary Benefits Meagan Jackson Benefits Technology Consultant Cathy Rodriguez Wellness Consultant Whitney Ehret Voluntary Benefits Specialist 33 Burnham Benefits Response to City of La Quinta Request for Proposal for Employee Benefits Broker/Consultant Services Subcontracting Services Subcontracting any portion(s) of the Scope of Services is not preferable; however, if a proposer can demonstrate to the City's satisfaction that is in the best interest of the project to permit a portion of the service(s) to be subcontracted by the proposer, it may be considered. Provide details on the role of any subcontractor that will be used. Assignment is prohibited. N/A 34 Burnham Benefits Response to City of La Quinta Request for Proposal for Employee Benefits Broker/Consultant Services Disclosures Disclosure of any alleged significant prior or ongoing agreement failure, any civil or criminal litigation or investigation pending, which involved the proposer or in which the proposer has been judged guilty or liable within the last five (5) years. If there is no information to disclose, the proposer must affirmatively state there is no negative history. N/A 35 Burnham Benefits Response to City of La Quinta Request for Proposal for Employee Benefits Broker/Consultant Services Appendix APPENDIX: CA Department of Insurance License APPENDIX: CA Secretary of State Electronic Filing APPENDIX: Burnham COVID-19 Webinar Series 2020 APPENDIX: Burnham Educational Series 2020 APPENDIX: Legislative Update APPENDIX: ACA Pathways APPENIDX: La Quinta Guide Benefits Guides SAMPLE APPENIDX: La Quinta Know Your Benefits SAMPLE APPENIDX: La Quinta Guide Cover Options SAMPLE APPENDIX: Sample Transition Timeline APPENDIX: 2020 Planning Meeting APPENDIX: 2020 Insurance Committee Strategy and Market Updates APPENDIX: 2021 Insurance Committee Renewal Presentation APPENDIX: Renewal Selection burnhambenefits.com/COVID-19 CA License # 0D86695 COVID-19 Webinar Series The COVID-19 pandemic affected businesses immediately, and Burnham reacted immediately to provide an online Response Center and a weekly webinar series to cover the most up-to-date information. We are dedicated to being a calm, clear and educated resource for our clients on information that impacts you and your employees so you can focus on your business and have peace of mind knowing we have you covered. Weekly Updates From carrier and compliance updates to helping our clients prepare to reopen their businesses, the webinar series brings the expertise from our Burnham team as well as industry experts to cover a broad range of topics and perspectives. Our goal is to provide quality and reputable information quickly. March 25 Carrier Coverage, Furloughs and Retirement Changes April 1 CARES Act, Carrier Coverage and Leave Legislation April 8 Carrier Coverage, Financial Modeling and Business Risk Insurance April 15 FFCRA, Families First Tax Impact, Voluntary Benefits & Mental Wellness April 22 Regulatory Developments and Preparing for Reopening April 29 Return to Work with guest speaker from Kaiser Permanente April 30 Parenting During COVID-19 with guest speaker from InnerFokus May 6 Preparing the Workplace May 13 Reopening Best Practices May 20 Coping & Resilience--Tools Your Workforce Needs to Move Forward June 3 Demystifying Vaccine and Testing with guest speaker from Cigna June 17 Evolution of the Workplace COVID-19 Webinar Series burnhambenefits.com/events CA License # 0D86695 EDUCATIONAL SERIES 2020 webinars · in-person sessions · round tables The Burnham Educational Series is a balance of webinars, in-person seminars, and C-suite round tables throughout the year. We carefully select topics that are pertinent and leading-edge to help you stay informed about industry changes. Presented by subject matter experts, each session is designed to support employers with the practical aspects of HR, employee benefits, business strategy, and compliance. Webinars Join us for online presentations with topic experts to stay up-to-date throughout the year In-Person Sessions Interact with peers and enjoy the personal aspect of participating in group seminar sessions CFO Round Tables C-suites: we are introducing new round table sessions for leaders to share insight on hot topics January 22 Webinar New Law Changes for 2020 February 26 Webinar Retirement Changes: Understanding the SECURE Act March 31 Webinar Paid Leave & Absence Management April 29 Webinar What it Means to be B Corp May In-Person Healthcare Trends & Tips (Orange County) June Round Table CFO Round Table 1: Self-Funding Captive Plans July 29 Webinar Ben Admin 101 Training August In-Person Cybersecurity & Workplace Tips (Los Angeles) September 30 Webinar Sexual Harassment Training October Round Table CFO Round Table 2 November 4 Webinar California Compliance Update 2020 Calendar & Topics *Dates are subject to change Legislative Updates ACA Pathways WELCOME! City of La Quinta is proud to offer comprehensive, high-quality benefits at a reasonable cost. We’ve designed our benefits to give you choices so you can pick the benefits that are best for you and your family. City of La Quinta benefits are broken into two major categories: Core Benefits Plans and programs automatically available to you at no cost Benefit Choices Plans and programs you can elect to join or purchase This package contains a summary of your benefit options and is designed to help you make choices and enroll for coverage. If you would like more information about any of the benefits described here, please contact the Human Resources Department. CONTENTS Online Enrollment 4 Benefits at a Glance 5 Contributions 6 Eligibility & Enrollment 7 Medical Plan Choices 9 Telemedicine 11 Prescription Drugs 12 Health Savings Accounts 13 Dental Plan Choices 14 Vision Plan 15 Employee Assistance Program 16 Life/AD&D 17 Disability 18 Flexible Spending Accounts 19 Travel Assistance 20 Legal 20 ID Theft 20 Supplemental Benefits 21 Pet Insurance 22 Retirement Savings 23 Employee Perks 24 Annual Notices 25 ACA 25 Carrier Contacts 26 Ease Online Enrollment www.LaQuinta.Ease.com With the Ease Online Enrollment System, you and your family can access your benefits information whenever you want, from home or any place where you have internet access. Use Ease to view plan details, coverage amounts and costs. To Enroll or Make Changes to Your Benefits For optimal performance, it is recommended that you use Chrome or Firefox as your internet browser. • Log in to Ease • Username & Password: You will receive an email with information that is unique to you. Once you are logged into the website, follow the prompts on each page to complete your benefit enrollment. You will be asked to verify that your personal information is correct and enter in any of your dependent information. Be sure to save Ease as a favorite in your web browser! ONLINE ENROLLMENT With Ease, you’ll find documents posted such as the Summary of Benefits and Coverage (SBC), annual notices, carrier benefit summaries, evidence of coverage booklets, claim forms, and much more. These documents include detailed information about the City of La Quinta benefit plans and can help you plan for upcoming services. From work or home, 24 hours a day, 7 days a week, you and your eligible dependents may access Ease. ENROLLMENT Who may enroll City of La Quinta Employees • Regular, full-time employees working at least 30 hours per week Dependents • Your legally married spouse • Your registered domestic partner (as defined by the state of California) • Your children, stepchildren or children of your registered domestic partner to age 26, regardless of marital or student status • Any children for whom you are required to provide coverage under a Qualified Medical Child Support Order • Your unmarried children, step-children or children of your registered domestic partner of any age, if they are incapable of self-care due to a physical or mental disability Your spouse, domestic partner and children can be enrolled in our medical, dental, vision, voluntary life/ad&d, and supplemental insurance plans. Required Information At enrollment you are required to enter the Social Security Number for all covered dependents. Health Care Reform law requires the company to report this information to the IRS each year to show that you and your dependents have coverage and are not subject to a penalty. This information will be securely submitted to the IRS and will remain confidential. When you may enroll As an Eligible Employee • As a new hire, you may participate in the company ’s benefits on the first day of the month following the completion of 60 days of full-time employment • As a new hire, you are eligible for the company’s 401(k) plan on the first day of the month following the completion of 1 month of employment • Each year, during open enrollment • Within 30 days of a qualifying event as defined by the IRS • You may enroll in Voluntary Life/AD&D insurance at any time, subject to proof of good health and carrier approval Benefits Plan Year: January 1 - December 31 Changes to enrollment Open Enrollment During our annual open enrollment period, you may make new benefit elections for the following January 1st effective date. Qualifying Event Once you make your benefit elections, you cannot change them throughout the year unless you experience a qualifying event as defined by the IRS. Examples include, but are not limited to: Marriage, divorce, legal separation, or annulment Birth, adoption, or death of a child or spouse Qualified Medical Child Support Order (QMCSO) Change in your dependent’s eligibility status Loss of coverage from another health plan Change in your residence or workplace (if your benefit options change) Loss of coverage through Medicaid or Children’s Health Insurance Program (CHIP) Eligibility for a state’s premium assistance program under Medicaid or CHIP Coverage for a new dependent is not automatic. If you experience a qualifying event, you have 30 days to update your coverage. Please contact the Human Resources Department immediately following a qualifying event to complete the appropriate election forms as needed. You may login to Ease to update your dependent information as needed. Ease login information is located on page X of this guide. If you do not update your coverage within 30 days of the qualifying event, you must wait until the next annual open enrollment period to update your coverage. ENROLLMENT MEDICAL PLAN CHOICES Finding a Medical Provider Go to www.website.com. • HMO: Refer to the [Network Name] network • PPO: Refer to the [Network Name] network • HSA: Refer to the [Network Name] network Anthem Blue Cross | HMO Plan With the HMO plan, you must choose a primary care physician (PCP) or medical group within the network. All of your care must be directed through your PCP or medical group. Any specialty care you need will be coordinated through your PCP and will generally require a referral or authorization. You will receive benefits only if you use the doctors, clinics, and hospitals that belong to the medical group in which you are enrolled, except in the case of an emergency. Anthem Blue Cross | PPO Plan The PPO plan requires that you meet a calendar year deductible before Anthem Blue Cross starts paying for certain services. Once the deductible has been met, most services will be covered at a coinsurance or a copay, For certain services, such as office visits and urgent care, Anthem Blue Cross has waived the deductible and cost sharing begins immediately, PPO: Access to Care The PPO and the HSA PPO plans are Preferred Provider Organization (PPO) plans and use Anthem Blue Cross’s [Network Name] network. PPO plans allow you to direct your own care. You have the freedom to choose your doctor without the requirement of selecting a PCP and you may self-refer to specialists. You may use a network provider whose negotiated rates provide richer levels of benefits with claim forms filed by the providers. You may also obtain services using a non-network provider; however, you will be responsible for the difference between the covered amount and the actual charges, and you may be responsible for filing claims. Anthem Blue Cross | HSA PPO Plan With the [Plan Name] plan, you can pay for qualified healthcare expenses now and grow your savings for future healthcare needs. This plan combines a High Deductible Health Plan (HDHP) with a special, tax-qualified Health Savings Account (HSA). You and the company can contribute tax-free money to your HSA up to IRS maximums. The money in your account is yours to pay for current healthcare expenses - or you can save toward future healthcare expenses. More details about the HSA medical plan are located on page X. Educational Video Health Insurance Terms http://video.burnhambenefits.com/terms MEDICAL PLAN Plan Name Anthem Blue Cross HMO Anthem Blue Cross PPO Network Name [Network Name] [Network Name] Non-Network Plan Differences Employee Premiums $ $$ Health Savings Account - City of La Quinta Funded - Employee Funded ✓ ✓ Employee Cost Sharing Contribution, Copay Contribution, Deductible, Copay, Coinsurance Network - Network Size - In-Network Benefits - Non-Network Benefits ✓ ✓ ✓ Access to Providers Managed by Your PCP Managed by You Health Benefits Lifetime Maximum Benefit Unlimited Unlimited Calendar Year Deductible - Individual - Family $0 $0 $500 $1,000 $1,000 $2,000 Out-of-Pocket Maximum - Individual - Family $2,000 $4,000 $4,000 $8,000 $8,000 $16,000 Coinsurance (Plan Pays) 100% 80% 60% Office Visit Copay - Preventive Care - Primary Care Physician - Specialist - Urgent Care - [Telemedicine Name] No Charge $20 Copay $40 Copay $20 Copay $50 Copay No Charge $20 Copay $20 Copay $20 Copay $50 Copay Deductible, 40% Deductible, 40% Deductible, 40% Deductible, 40% N/A Hospitalization - Inpatient - Outpatient Surgery $350 Copay $175 Copay Deductible, 20% Deductible, 20% $250/Admit, 40% Deductible, 40% Lab and X-Ray - Diagnostic - Complex No Charge $100 Copay Deductible, 20% Deductible, 20% Deductible, 40% Deductible, 40% Emergency Services $150 Copay Deductible, $150 Copay, 20% Chiropractic $10 Copay $30 Copay Deductible, 40% Max 20 Visits/Year Max 20 Visits/Year HEALTH SAVINGS ACCOUNTS SAVINGS • Providers (Doctors, Nurses) • Prescription Drugs • Inpatient Hospital Services • Laboratory & X-Ray • Emergency Services • Acupuncture / Chiropractic • Providers (Optometrists, Ophthalmologists) • Exams • Glasses • Contact Lenses • Lasik Surgery • Providers (Dentists, Orthodontists) • Teeth Cleaning • Dental Treatment • Orthodontia Examples of Eligible HSA Expenses • COBRA • Long-Term Care • Medicare Examples of Ineligible HSA Expenses Ineligible HSA expenses include expenses that are not medical or health-related as well as cosmetic The opportunity to establish and contribute to a Health Savings Account is available when you elect the HSA Plan medical plan option. It’s like a personal, tax-free savings account for health care expenses that earns interest. Any unused money rolls over from year to year. In 2019, City of La Quinta will make the following quarterly HSA contributions into your account: • Employee: $125 • Family: $500 In addition to City of La Quinta’s contribution, you may elect to make contributions into your account up to IRS maximums. IRS maximums for 2019 are: • Employee: $3,500 • Family: $7,000 • Catch-up (Age 55+): $1,000 The portion of your paycheck that you contribute to your HSA will be taken out before you pay federal income taxes, Social Security taxes and most state taxes (excluding state taxes in AL, CA and NJ). Any contributions you make can be increased or decreased over the course of the year. The money in your HSA is yours to save and spend on eligible health care expenses whenever you need it, whether in this plan year or in future plan years. Your account balance earns interest and the unused balance rolls-over from year to year. The money is yours to keep even if you leave City of La Quinta, no longer participate in a high deductible health plan (like the HSA Plan), or retire. MEDICAL DENTAL VISION PREMIUMS Educational Video Health Insurance Terms http://video.burnhambenefits.com/terms The EAP can help with the following issues: Stress, Anxiety or Depression Relationship Issues Grief and Loss Legal Assistance Financial Services and Referrals Childcare Resources and Referrals Senior Care Pet Care Identity Theft and More! EMPLOYEE ASSISTANCE PROGRAM Employee Assistance Program This coverage is provided by City of La Quinta at no cost to you The Employee Assistance Program (EAP) provides you and your household members with free, confidential assistance to help with problems that may interfere with work or family responsibilities. EAP Services • 24/7 phone consultations with licensed mental health professionals and referrals to supportive resources. • Up to 3 face-to-face counseling sessions with a licensed mental health practitioner per person in your household, per problem, per year. • Online programs to offer something different that traditional counseling. • Access to quick and confidential help from legal and financial experts. Accessing the EAP Call (000) 000-0000 or visit www.website.com (User Name: Username / Password: Password) ANNUAL NOTICES ACA City of La Quinta plans are partially arranged by City of La Quinta and governed by it’s plan rules and documents. ERISA and various other state and federal laws require that employers provide disclosure and annual notices to their plan participants. City of La Quinta distributes annual notices to new-hires, and each year during open enrollment. You may also request a copy by contacting the Human Resources Department, or download a copy from Ease. The following are a list of Annual Notices: • Medicare Part D Notice of Creditable Coverage: Plans are required to provide each covered participant and dependent a Certificate of Creditable Coverage to qualify for enrollment in Medicare Part D prescription drug coverage when qualified without a penalty. • HIPAA Notice of Privacy Practices: This notice is intended to inform employees of the privacy practices followed by City of La Quinta’s group health plan. It also explains the federal privacy rights afforded to you and the members of your family as plan participants covered under a group plan. • Women's Health and Cancer Rights Act (WHCRA): This act contains important protections for breast cancer patients who choose breast reconstruction with a mastectomy. • Newborns’ and Mothers’ Health Protection Act: This act affects the amount of time a mother and her newborn child are covered for a hospital stay following childbirth. • Special Enrollment Rights: Plan participants are entitled to certain special enrollment rights outside of City of La Quinta’s open enrollment period. This notice provides information on special enrollment periods for loss of prior coverage or the addition of a new dependent. • Medicaid & Children’s Health Insurance Program: Some states offer premium assistance programs for those who are eligible for health coverage from their employers, but are unable to afford the premiums. This notice provides information on how to determine if your state offers a premium assistance program. • Summary of Benefits and Coverage (SBC): Health insurance issuers and group health plans are required to provide you with an easy-to-understand summary about your health plan’s benefits and coverage. The Affordable Care Act (ACA) requires applicable large employers to make affordable coverage available to their employees or risk paying a penalty. Although the individual mandate is no longer effective beginning January 1, 2019, it is important that you understand your options for health insurance coverage. You may consider these options below: • Enroll in a medical plan offered by City of La Quinta or another group plan • Purchase coverage through a health insurance marketplace • Enroll in coverage through a government -sponsored program if eligible Because City of La Quinta’s medical plans are considered affordable and meet minimum value under the Affordable Care Act, you will not generally see lower premiums or out-of- pocket costs through the marketplace. In addition, employer contributions to your medical benefits will be lost if you choose to purchase coverage through the marketplace, and your portion of medical premiums will no longer be paid via payroll deductions on a pre-tax basis. For More Information Go to www.healthcare.gov. CARRIER CONTACTS Anthem Blue Cross Medical HMO Member Services ….………………………..…………………………..…….……………………………………... HSA Member Services …………………………..………..………….……………………………………………………... PPO Member Services ….………………………..…………………………..……………………………………………... 24/7 Nurse Line …………………………………………..………………………….…………………………………………. Home Delivery Rx ………………………………………………………………………………………………………………. Act Wise ……………………………………………………………………………………………………………………………. Carrier Website ………………………………………………………………….………………………………………………. (800) 888-8288 (866) 207-9878 (800) 888-8288 (800) 700-9186 (866) 297-1013 (844) 860-3535 www.anthem.com/ca Dental Member Services …………………………………….………………….……………………………………………………... Carrier Website ………………………………………………………………….………………………………………………. (877) 567-1804 www.anthem.com/ca Vision Member Services …………………………………….………………….……………………………………………………... Carrier Website ………………………………………………………………….………………………………………………. (866) 723-0515 www.anthem.com/ca Flexible Spending Accounts Member Services …………………….……………….………………….…………………………………………………….. Carrier Website …………………….……………………………………………………………………………………………. (844) 860-3535 www.anthem.com/ca Anthem Blue Cross Life/AD&D & Disability Member Services …………………………………………..……………..……………………………………………………. Carrier Website ………..…………………………………………..…………………………………………………………… (800) 552-2137 www.anthem.com/ca Employee Assistance Program Counselor Services ……………………………………………….……….…………………………………………………... Carrier Website ……………………..………………...………….……………………………………………………………. (888) 209-7840 www.resourceadvisorca.anthem.com Trustmark Voluntary Worksite Benefits Member Services …………………….……………….………………….…………………………………………………….. Carrier Website …………………….……………………………………………………………………………………………. (866) 797-3236 www.trustmarksolutions.com Vanguard Retirement Plan Member Services …………………….……………….………………….…………………………………………………….. Carrier Website …………………….……………………………………………………………………………………………. (800) 662-2003 www.vanguard.com The Burnham Advocate Help -Line: (800) 391-6812 The Burnham Advocate toll-free customer service help-line can provide assistance with insurance related issues when you are unable to resolve them directly with your insurance carriers. You will receive fast, skilled assistance with Medical and Dental provider issues, referral assistance, and claims management. For help, simply call the Burnham Advocate help-line at (800) 391-6812. For more complicated questions or claims issues, the Burnham claims specialist works as your insurance advocate, researching and resolving problems quickly and effectively. If further action is required, the Burnham Advocate will provide regular updates until the issues are resolved. 2211 Michelson Drive, Suite 1200 | Irvine, California 92612 Telephone: (949) 833-2983 | Fax: (949) 833-9549 Learn more at www.burnhambenefits.com This Employee Benefits Guide provides an overview of some of your benefit plan choices. It is for informational purposes only. It is not intended to be an agreement for continued employment. Neither is it a legal plan document. If there is a disagreement between this guide and the plan documents, the plan documents will govern. In addition, the plans described in this guide are subject to change without notice. Continuation of any benefit plan or coverage is at the company’s discretion and in accordance with federal and state laws. If you need additional information or have any questions about the benefit program, please contact the Human Resources Department. Copyright © Burnham Benefits Insurance Services - all rights reserved THIS GUIDE IS A SAMPLE PREPARED BY Common Insurance Terms Your health insurance plan is important to you and your family. But sometimes, some terms may get confusing. Let's focus on a few to help you make sense of it all. Deductibles, copays, coinsurance, and out-of-pocket maximums. Deductibles If your plan includes a deductible, you are required to pay for services out-of-pocket before your plan starts paying, but you'll only pay up to a fixed dollar amount each year. This is your deductible amount. Some plans will allow you to visit your doctor, re ceive prescription drugs, and obtain no cost preventive care services, even before you've met your deductible. Once your deductible has been met, your full benefits will kick in. Copayment A copayment, sometimes referred to as a copay, is another way your plan may s hare in your medical costs. You pay a flat fee for medical expenses, such as office visits or for prescription drugs while your plan pays the rest. Coinsurance Coinsurance is the amount you pay to share the cost of covered services with your plan. Your p lan pays a percentage of the cost and you pay the remaining percentage - and if your plan includes a deductible - coinsurance will kick in after your deductible has been met. Out-of-Pocket Maximum Those three terms are all out-of-pocket costs associated with your plan. But did you know there's a limit on these costs? The out -of- pocket maximum protects you financially from significant medical claims. All of the money you pay towards your plan's deducti ble, co-pays, and coinsurance are applied to your out-of-pocket maximum. Once the out-of-pocket maximum has been reached, your plan will pay 100% of the allowed amount for covered health benefits for the rest of the plan year. So how do all these terms work together? Let's have a look at John's health plan as an example. John's in-network benefits feature an annual deductible of $750, a $30 copay, an 80/20 coinsurance, and an annual out -of-pocket maximum of $3,000. Let's say John has an unexpected illness or accident and accumulates $20,000 of in network cover ed medical expenses in one plan year, but who pays this $20,000? First, John pays his $750 in-network deductible. After his deductible is paid, his plan starts to pay its portion of health care costs. John is still responsible for any co -pays or coinsurance at this point, but once his total expenses for the plan year add up to $3,000, his out-of-pocket maximum, the plan pays 100% of his in-network medical costs for the rest of the plan year. Questions? Contact the Human Resources Department. 2211 Michelson Drive, Suite 1200 | Irvine, California 92612 Telephone (949) 833-2983 | Fax (949) 833-9549 www.burnhambenefits.com EmployeeBenefits 2021-2022 E M P L O Y E E B E N E F I T S 2 0 2 1 -2 0 2 2 E M P L O Y E E B E N E F I T S 2 0 2 1 -2 0 2 2 B E N E F I T S G U I D E 2 0 2 1 -2 0 2 2 Transition Timeline: Big Picture 2021 April May June July August September October November December January (Renewal) Ongoing Services Annual Operational Cycle continues Start Work Processes with Anthem for medical/vision, stop loss, HSA* Signature-ready 5500/SAR Prepared and Mailed to Client Sample Transition Timeline Self-funding Claims Analysis and Dashboard Development Monthly Claims Dashboard Implement Burnham’s Service Contract and Package* Initial onboarding categories starting April and May are marked with an asterisk and can be viewed in detail on the other side of this page Burnham Marketing Process Takes Place Renewal Results meeting (varies, depending on plan) Discuss recommendations Narrow down carrier, plan and design options Final negotiations Budget/employee contribution modeling Final decisions made Online Enrollment System Selection and Build-out Open Enrollment Planning Process Carrier Feeds and/or Census Enrollment Processes Managed with Online System and HR Enrollment meeting preparations Open Enrollment Submit Enrollment files to Carriers Pre-Renewal Meeting Open Enrollment Materials development Weekly Service Call Annual Notices Communicated Open Enrollment Communications distributed Dependent Audit—determine vendor/process • ACA Pathways Newsletter • ACA Education & Guidance • ACA Financial Modeling • Burnham Webinars/Seminars/ Education/Guidance • Vendor Management • Day-to-Day Administrative Support • Compliance Education and Guidance • Strategic Planning Review and Implementation Focus on Transition: April – May Start Work Processes with Carriers Process Self-funded Medical, HSA and Anthem Vision Broker of Record letter Obtain current rates, plan summaries, EOCs, SBCs, updated claims reports Obtain two years prior renewals Send introduction letter to key service people Identify any open service issues with each carrier Setup on ThinkHR for Station Managers Review current Anthem set up, file feed dates/processes, understand enrollment process HR Team Continue weekly Review calls and update agenda for those meetings Update Client Profile with Self-funded Medical, HSA and Vision Review Compliance gaps; develop action plan for corrective measures if necessary Obtain current census for marketing Implement Burnham Service Package Finalize Service Contract Roll out underwriting services • Determine current reporting requirements and delivery dates • Obtain data from carrier; set new expectations with carriers if appropriate. • Develop monthly dashboard template; collaborate with HR • Review all plan rates, benefits, contributions and participation to determine recommendations. Pre-Renewal Meeting Review current self-funding plan goals Discuss all lines, based upon Burnham review, and make recommendations Determine marketing strategy and financial goals for all lines of coverage and ser- vice vendors. Set calendar Burnham marketing process begins Compliance Setup and Audit 5500 processing Begin reviewing Collective Bargaining Agreements (CBA) and provide feedback Complete Wrap Doc SPD for various eligibility groups (15) Review Leave of Absence needs and action items Review city requirements for living wage, transit, and health care ordinances Total Compensation Statements 1 burnhambenefits.com INSURANCE COMMITTEE MEETING: 2020 STRATEGY AND MARKET UPDATES Presented on: May 20, 2020 Presented to you by: Kris Dopera, Vice President Ann Stawicki, Vice President Kelly Fox, Senior Account Executive 1.Who is Burnham? 2.2020 Renewal Overview 3.Demographic Overview & Benchmarking 4.Claims Experience & Utilization 5.CalPERS 6.Renewal Timeline Agenda I N T R O D U C T I O N 7.Employee Communications •Digital Wallet Pass 8.HR Update 9.Exhibits •Current Plan Designs WHO IS BURNHAM? 4 Pictures linked Largest Independent Benefits Firm in CA Office Locations Nationwide Clients Globally Average Client Retention Rate #1 9 650+95% Annual Growth Rate 10-year-average 19% Burnham Snapshot W H O I S B U R N H A M ? 5 Pictures linked 2013 | 2014 | 2015 | 2016 | 2017 | 2018 Notable Recognitions W H O I S B U R N H A M ? 6 Pictures linked ETHICAL •Balancing profit and purpose 4-year certified B Corp SUSTAINABLE •Positive impact for employees, community and environment B Corporation W H O I S B U R N H A M ? 7 Strategic Leadership In-House Resources Underwriting Benefits Technology Communications Voluntary Benefits WellnessCompliance, Legal Support Account Management Pictures linked Strategic Leadership Your Burnham Team W H O I S B U R N H A M ? 2020 RENEWAL OVERVIEW 9 2020 Renewal Overview R E N E W A L R E C A P Line of Coverage 2019 2020 Change Cigna DMO 223 [1]$63,373 $66,231 4.5% Cigna DPPO (High)692 [1]$860,497 $915,464 6.4% MES (CSAC EIA) Vision 675 [1]$101,882 $101,882 0.0% Cigna (CSAC EIA) Basic Life and AD&D 708 $39,186 $39,186 0.0% Cigna (CSAC EIA) Long Term Disability 708 $319,302 $319,302 0.0% Cigna (CSAC EIA) Short Term Disability 708 $7,636 $7,636 0.0% Cigna (CSAC EIA) EAP 708 $13,914 $13,914 0.0% Total Annual Premium $1,405,790 $1,463,615 Annual $ Change $57,825 Annual % Change 4.1% [1] Enrollment for dental and vision plans includes full-time employees and retirees. Subscribers DEMOGRAPHIC OVERVIEW & BENCHMARKING 11 Demographic Overview D E M O G R A P H I C O V E R V I E W & B E N C H M A R K I N G Demographics Total Norms Enrolled 708 - Distribution %100%- Demographics Average Age 43 44 % Male 72%49% Yrs. of Service 13 - Average Salary $102,422 - Baby Boomer Gen X Millenial Total Year of Birth 1946-1964 1965-1976 1977-1995 # Counts 85 234 389 708 % Distribution 12%33%55%100% Demographics Average Age 60 50 35 43 Years of Service 22 17 9 13 Average Salary $108,198 $114,671 $93,792 $102,422 Based on Employee Census Spring 2020 12 Dental Benchmarking D E M O G R A P H I C O V E R V I E W & B E N C H M A R K I N G National Survey of Employer-Sponsored Health Plans 2018 Survey Report City of Newport Beach Government Agencies California 500-999 Employees All Employers Type of Plan: Dental PPO Median In-Network Deductible Individual $0 $50 $50 $50 $50 Family $0 $100 $150 $150 $150 Maximum Benefit Annual Maximum $2,000 $1,500 $1,500 $1,500 $1,500 Orthodontic Lifetime Maximum $2,000 $1,500 $1,500 $1,500 $1,500 % of Employers Providing Ortho Coverage Child(ren) only 47%19%55%33% Adults and Children ✓45%63%34%25% CLAIMS EXPERIENCE & UTILIZATION 14 Funding Dental Paid Claims Plan Performance Month EE Count Premium In-Network1 Non-Network Total Premium PEPM Paid PEPM Paid L/R Apr-19 665 $68,105 $43,011 $26,601 $69,612 $102.41 $104.68 102.2% May-19 668 $68,425 $41,739 $25,112 $66,851 $102.43 $100.08 97.7% Jun-19 663 $68,094 $34,414 $22,407 $56,821 $102.71 $85.70 83.4% Jul-19 663 $68,021 $37,737 $21,589 $59,326 $102.60 $89.48 87.2% Aug-19 662 $67,831 $41,088 $19,792 $60,880 $102.46 $91.96 89.8% Sep-19 663 $67,635 $33,903 $19,865 $53,768 $102.01 $81.10 79.5% Oct-19 663 $67,755 $32,502 $22,085 $54,587 $102.19 $82.33 80.6% Nov-19 661 $67,641 $39,074 $17,935 $57,009 $102.33 $86.25 84.3% Dec-19 662 $67,698 $30,905 $19,588 $50,493 $102.26 $76.27 74.6% Jan-20 666 $71,867 $38,856 $25,328 $64,184 $107.91 $96.37 89.3% Feb-20 670 $72,276 $41,953 $31,217 $73,170 $107.87 $109.21 101.2% Mar-20 673 $72,346 $40,435 $18,379 $58,814 $107.50 $87.39 81.3% Rolling 12 665 $827,693 $455,615 $269,898 $725,513 $103.73 $90.93 87.7% Plan Year 2020 670 $216,489 $121,243 $74,924 $196,167 $107.76 $97.64 90.6% Plan Year 2019 671 $823,815 $548,113 $194,974 $743,087 $102.39 $92.35 90.2% Plan Year 2018 666 $777,672 $722,433 $0 $722,433 $97.31 $90.39 92.9% Notes 1 Prior to April 2019 In-Network claims include Non-Network amounts $0 $40 $80 $120 Paid Expenses by Category -PEPM Plan Year 2020 Non-Network In-Network Premium 80.0% 85.0% 90.0% 95.0% 100.0% 105.0% Paid Loss Ratio -Monthly vs. Cumulative Plan Year 2020 Monthly Claims L/R Cumulative Claims L/R Dental PPO Claims Experience C L A I M S E X P E R I E N C E & U T I L I Z A T I O N 15 EAP Utilization C L A I M S E X P E R I E N C E & U T I L I Z A T I O N Last Year April 2018 - December 2018 Year to Date July 2019 - December 2019 MHN Norm Subscribers, Monthly Average 708 Call Activity 55 31 Calls Received 10.4%8.8%7.8% Annualized Utilization Rate EAP Case Activity Routine Cases 8 10 Crisis Cases 0 0 Total 8 10 Annualized Utilization Rate 1.5%2.8%4.1% CalPERS 17 C a l P E R S •Preliminary renewal delayed until June •Rates finalized in July •Combine with other benefit lines and proceed with open enrollment activities •Open Enrollment Confirmed, September 21 –October 16 Update RENEWAL TIMELINE 19 Proposed Timeline January Market Ancillary Lines of Coverage -May BIC Meeting #1 –May 20 Marketing Analysis -June Renewal Decisions –Early August Open Enrollment Closes –October 16 Open Enrollment Opens – September 21 Open Enrollment Processing New Plan Year Starts –January 1 May September November December October August June July Present Marketing Findings –Early July BIC Meeting #2 –Late July R E N E W A L T I M E L I N E Transmission of enrollment changes to carriers 20 EMPLOYEE COMMUNICATION 21 Digital Wallet Pass E M P L O Y E E C O M M U N I C A T I O N 22 HR UPDATE EXHIBITS 24 Current Plan Design –Dental HMO E X H I B I T S 25 Current Plan Design –Dental PPO E X H I B I T S 26 Current Plan Design –Vision E X H I B I T S 27 Current Plan Design –Life and AD&D E X H I B I T S 28 Current Plan Design –Short Term and Long-Term Disability E X H I B I T S Thank you. PRESENTED BY: Ann Stawicki, Vice President Kelly Fox, Senior Account Executive DATE: July 23, 2020 Insurance Committee MEETING #2 BENEFIT RENEWALS AND ALTERNATIVES burnhambenefits.com Presentation Agenda I N T R O D U C T I O N 1.Executive Summary 2.Enrollment & Demographics 3.Ancillary Benefits 4.Next Steps EXECUTIVE SUMMARY 4 Benefits Program Overview E X E C U T I V E S U M M A R Y 21 Benefit Plans CalPERS Medical –7 HMO plans and 4 PPO plans Cigna Dental –DMO and DPPO MES through CSAC Vision PPO Cigna through CSAC Basic Life and AD&D Cigna through CSAC Voluntary Life and AD&D Cigna through CSAC Short-Term Disability (STD) Cigna through CSAC Long Term Disability (LTD) MHN Employee Assistance Program (EAP) Workterra COBRA Administration Workterra Flexible Spending Account HFSA / DPSA 5 2021 Renewal Summary E X E C U T I V E S U M M A R Y The City of Newport Beach has received a decrease on the basic life and AD&D insurance and rate passes on dental, vision, supplemental life and AD&D, short term disability, and long-term disability. There is a slight rate decrease year over year. 6 Renewal Summary E X E C U T I V E S U M M A R Y City of Newport Beach Renewal Rate Summary - Gross Cost Current Renewal Guardian Combined monthly premium $85,354 Combined annual premium $1,024,251 $1,022,122 Annual relationship to current rates $($2,129) Annual relationship to current rates %-0.2% Product Carrier Enrollment Total Total % diff Dental DMO Cigna (direct)156 $4,045 $4,045 0.0% DPPO Cigna (direct)372 $43,772 $43,772 0.0% Vision MES (CSAC EIA)417 $5,610 $5,610 0.0% Basic life / AD&D Cigna (CSAC EIA)710 $3,725 $3,548 -4.8% STD Cigna (CSAC EIA)710 $639 $639 0.0% LTD Cigna (CSAC EIA)710 $27,563 $27,563 0.0% January 1, 2021 $85,177 ENROLLMENT & DEMOGRAPHICS 8 Your Employees E N R O L L M E N T & D E M O G R A P H I C S Female, 198, 28% Male, 512, 72% Gender Female Male Age 2020 Average age 42 Males: Average age 42 Females: Average age 42 9 Dental Plan Participation E N R O L L M E N T & D E M O G R A P H I C S HMO, 156, 29% PPO, 376, 71% Plan Types 4 372 156 DPPO Low DPPO High DMO 0 200 400 Plan Participation 226 85 221 Employee + 2 or more Employee + 1 Employee Only 0 100 200 300 Plan Tier 10 Vision Plan Participation E N R O L L M E N T & D E M O G R A P H I C S 169 63 185 Employee + 2 or more Employee + 1 Employee Only 0 50 100 150 200 Plan Tier ANCILLARY BENEFITS 12 R E N E W A L A N D R A T E S U M M A R Y G r o s s C o s t The recommended MetLife option significantly enhances the dental and vision plans while lowering overall costs by more than $95,000 per year •Dental plan annual maximum $3,000 •Vision plan frames allowance $200 City of Newport Beach Renewal Rate Summary - Gross Cost Current Renewal Guardian MetLife Recommendation MetLife Unum Combined monthly premium $85,354 $76,173 $77,407 Combined annual premium $1,024,251 $1,022,122 $894,424 $914,071 $928,887 Annual relationship to current rates $($2,129)($129,827)($110,180)($95,364) Annual relationship to current rates %-0.2%-12.7%-10.8%-9.3% Product Carrier Enrollment Total Total % diff Total % diff Change Total % diff Change Total % diff Change Dental DMO Cigna (direct)156 $4,045 $4,045 0.0%$3,843 -5.0%($202)$3,876 -4.2%($169)$3,876 -4.2%($169) DPPO Cigna (direct)372 $43,772 $43,772 0.0%$41,584 -5.0%($2,188)$39,637 -9.4%($4,135)$39,637 -9.4%($4,135) Vision MES (CSAC EIA)417 $5,610 $5,610 0.0%$5,610 0.0%$0 $5,498 -2.0%($112)$6,733 20.0%$1,123 Basic life / AD&D Cigna (CSAC EIA)710 $3,725 $3,548 -4.8%$4,080 9.5%$355 $4,080 9.5%$355 $4,080 9.5%$355 STD Cigna (CSAC EIA)710 $639 $639 0.0%$1,548 142.2%$909 $2,485 288.9%$1,846 $2,485 288.9%$1,846 LTD Cigna (CSAC EIA)710 $27,563 $27,563 0.0%$17,870 -35.2%($9,692)$20,596 -25.3%($6,966)$20,596 -25.3%($6,966) January 1, 2021 $85,177 $74,535 15 D E N T A L M a r k e t i n g R e s u l t s b y P l a n City of Newport Beach Dental Renewal and Marketing January 1, 2021 Cigna (direct)Guardian MetLife MetLife Current Negotiated Renewal Proposed Proposed Proposed Combined monthly premium $47,817 $47,817 $45,427 $43,513 $45,890 Combined annual premium $573,803 $573,803 $545,122 $522,157 $550,684 Annual relationship to current $$0 ($28,681)($51,646)($23,119) Relationship to current %0.0%-5.0%-9.0%-4.0% Total dental enrollment 532 DMO DMO DMO DMO DMO Employee 69 $14.63 $14.63 $13.90 $14.03 $14.03 Employee + 1 Dependent 31 $26.33 $26.33 $25.01 $26.65 $26.65 Employee + 2 or more dependents 56 $39.63 $39.63 $37.65 $37.17 $37.17 Monthly premium 156 $4,045 $4,045 $3,843 $3,876 $3,876 Monthly relationship to current $$0 ($202)($169)($169) Annual relationship to current $$0 ($2,426)($2,031)($2,031) Relationship to current %0.0%-5.0%-4.2%-4.2% PPO DPPO DPPO DPPO DPPO Employee 152 $60.26 $60.26 $57.25 $54.57 $57.84 Employee + 1 Dependent 54 $122.62 $122.62 $116.49 $111.04 $117.70 Employee + 2 or more dependents 166 $168.62 $168.62 $160.19 $152.69 $161.85 Monthly premium 372 $43,772 $43,772 $41,584 $39,637 $42,015 Monthly relationship to current $$0 ($2,188)($4,135)($1,757) Annual relationship to current $$0 ($26,255)($49,615)($21,088) Relationship to current %0.0%-5.0%-9.4%-4.0% 16 D E N T A L D M O B e n e f i t s City of Newport Beach Dental Renewal and Marketing - DMO Benefits January 1, 2021 Cigna Guardian MetLife Proposed Proposed Diagnostic / preventive Office visit $0 $0 $5 Oral exam $0 $0 $0 X-rays $0 $0 $0 Prophylaxis (cleaning) $0 $0 $0 Restorative (fillings) Permanent amalgam $0 $0 $0 Resin-based composite - anterior $0 $0 $0 Resin-based composite - posterior $35 / $45 / $50 $0 $25 Periodontics (gum treatment) Scaling & root planing (per quadrant) $25 $25 $25 Endodontics (root canal therapy) Root canal $50 / $70 / $135 $70 / $80 / $140 $40 / $65 / $95 Oral surgery Single tooth extraction $2 $5 $0 Partial bony impaction $45 $70 $40 Crowns & bridges Crown - porcelain fused to noble metal $100 $95 $100 Prosthetics (dentures) Partial - cast metal w. resin base $120 $130 $150 Complete - upper or lower $120 $110 $125 Orthodontia (24 months banding) Child $1,100 $1,000 $1,450 Adult $1,600 $2,175 $1,450 17 D E N T A L P P O B e n e f i t s City of Newport Beach Dental Renewal and Marketing - PPO Benefits January 1, 2021 Cigna Guardian MetLife MetLife Current Plan Proposed Proposed Proposed PPO DPPO DPPO DPPO DPPO In-Network Non-Network In-Network Non-Network In-Network Non-Network In-Network Non-Network Maximum benefit Benefits annual maximum $2,000 $2,000 $3,000 $5,000 Orthodontia lifetime maximum $2,000 $2,000 $2,000 $2,000 Deductible Individual $0 $50 $0 $50 $0 $50 $0 $50 Family $0 $150 $0 $150 $0 $150 $0 $150 Deductible waived for preventive yes yes yes yes yes yes yes yes Preventive services 100%100%100%100%100%100%100%100% Basic services 90%80%90%80%90%80%90%80% Major services 60%50%60%50%60%50%60%50% Orthodontia 50%50%50%50%50%50%50%50% Child / adult Adult & Child Adult & Child Adult & Child Adult & Child R&C percentile UCR 90th UCR 90th UCR 90th UCR 90th Services per category X-rays / exams / cleanings preventive preventive preventive preventive Restorative basic basic basic basic Oral surgery basic basic basic basic Endodontics basic basic basic basic Periodontics basic basic basic basic Crowns / bridges / prosthetics major major major major Implants major major major major Cosmetic dentistry not covered not covered not covered not covered Contract provisions Cleaning frequency twice per year twice per year twice per year twice per year Crowns replacement limitation 5 years 5 years 5 years 5 years Rollover feature / maximum rollover no yes / $800 no no Participation requirement currently met currently met currently met currently met 18 Dental PPO Premium and Paid Claims D E N T A L U T I L I Z A T I O N Funding Dental Paid Expenses Plan Performance Month EE Count Premium In-Network Non-Network Total Premium PEPM Paid PEPM Paid L/R Jul-19 662 $68,021 $37,737 $21,589 $59,326 $102.75 $89.62 87.2% Aug-19 662 $67,831 $41,008 $19,792 $60,800 $102.46 $91.84 89.6% Sep-19 663 $67,635 $33,903 $19,865 $53,768 $102.01 $81.10 79.5% Oct-19 663 $67,755 $32,502 $22,085 $54,587 $102.19 $82.33 80.6% Nov-19 659 $67,641 $39,074 $17,935 $57,009 $102.64 $86.51 84.3% Dec-19 661 $67,698 $30,905 $19,588 $50,493 $102.42 $76.39 74.6% Jan-20 665 $71,867 $38,856 $25,328 $64,184 $108.07 $96.52 89.3% Feb-20 669 $72,276 $41,953 $31,217 $73,170 $108.04 $109.37 101.2% Mar-20 672 $72,346 $40,435 $18,379 $58,814 $107.66 $87.52 81.3% Apr-20 679 $72,703 $14,884 $3,250 $18,134 $107.07 $26.71 24.9% May-20 680 $293 $11,617 $8,066 $19,683 $0.43 $28.95 6717.7% Jun-20 684 $73,297 $33,351 $20,865 $54,216 $107.16 $79.26 74.0% Rolling 12 668 $769,363 $396,225 $227,959 $624,184 $1,152.91 $934.06 81.1% Plan Year 2020 675 $362,782 $181,096 $107,105 $288,201 $89.60 $71.18 79.4% $0 $20 $40 $60 $80 $100 $120 Paid Expenses by Category -PEPM Plan Year 2020 Non-Network In-Network Premium 0.0% 1000.0% 2000.0% 3000.0% 4000.0% 5000.0% 6000.0% 7000.0% 8000.0% Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20 Paid Loss Ratio -Monthly vs. Cumulative Plan Year 2020 Monthly Claims L/R Cumulative Claims L/R 19 Provider Participation D E N T A L DPPO Network Cigna Guardian Met Life Utilized Providers In Network 554 514 480 % of total 76%71%66% Utilized Providers Out of Network 175 215 249 % of Total 24%29%34% DHMO Network Cigna Guardian Met Life Utilized Providers In Network 122 102 102 % of total 95%81%81% Utilized Providers Out of Network 6 24 24 % of Total 5%19%19% Note: Cigna data shows providers utilized in the month of May 2020, not discrete providers 22 V I S I O N B e n e f i t s City of Newport Beach Vision Renewal and Marketing January 1, 2021 MES (CSAC EIA)Guardian (VSP network) Current Negotiated Renewal Proposed Proposed Proposed Combined monthly premium $5,610 $5,610 $5,610 $5,498 $6,733 Combined annual premium $67,322 $67,322 $67,322 $65,976 $80,792 Annual relationship to current $$0 $0 ($1,346)$13,470 Relationship to current %0.0%0.0%-2.0%20.0% Rate guarantee rate guarantee through 2021 2 years 2 years 2 years Total vision enrollment 417 Employee 185 $7.30 $7.30 $7.30 $7.15 $8.76 Employee + spouse 63 $13.99 $13.99 $13.99 $13.71 $16.79 Employee + child(ren)169 $19.99 $19.99 $19.99 $19.59 $23.99 In-Network Non-Network In-Network Non-Network In-Network Non-Network In-Network Non-Network Exam $10 up to $40 $10 up to $39 $10 up to $45 $10 up to $45 Materials copay $0 Standard lenses Single vision 100%up to $30 100%up to $23 100%up to $30 100%up to $30 Bifocal vision 100%up to $50 100%up to $37 100%up to $50 100%up to $50 Trifocal vision 100%up to $65 100%up to $49 100%up to $65 100%up to $65 Frames up to $100 up to $40 up to $130 up to $46 up to $130 up to $80 up to $200 up to $80 Contact lenses - In lieu of frames & lenses up to $105 / $115 up to $100 / $110 Frequency date of service date of service date of service date of service Exams 12 months 12 months 12 months 12 months Lenses 12 months 12 months 12 months 12 months Frames 12 months 12 months 12 months 12 months $10 $0 MetLife (VSP+ network)MetLife (VSP+ network) $0 24 L I F E A N D D I S A B I L I T Y R e n e w a l a n d M a r k e t i n g S u m m a r y City of Newport Beach Life and Disability Renewal and Marketing January 1, 2021 Cigna (CSAC EIA)Guardian MetLife Unum Current Initial Renewal Proposed Proposed Proposed Combined monthly premium $31,927 $31,750 $23,498 $27,161 $24,757 Combined annual premium $383,126 $380,997 $281,980 $325,938 $297,088 Annual relationship to current $($2,129)($101,146)($57,188)($86,037) Relationship to current %-0.6%-26.4%-14.9%-22.5% Basic life and AD&D Life rate - per $1,000 0.085 0.081 0.095 0.081 0.000 AD&D rate - per $1,000 0.020 0.019 0.020 0.034 0.020 Benefit amount Class 1 1X earnings, $50,000 max 1X earnings, $50,000 max 1X earnings, $50,000 max 1X earnings, $50,000 max Monthly total $3,725 $3,548 $4,080 $4,080 $3,725 Rate guarantee renews 2021 2 years 3 years 3 years Short term disability PMPM $0.90 $0.90 $2.18 $3.50 $2.32 Benefits Benefit percentage 67%67%67%67% Maximum weekly benefit $1,846 $1,846 $1,847 $1,846 Monthly total $639 $639 $1,548 $2,485 $1,647 Rate guarantee renews 2021 2 years 3 years 2 years Long term disability Rate per $100 of covered payroll $0.46 $0.46 $0.30 $0.34 $0.32 Benefits Benefit percentage 67%67%67%67% Maximum monthly benefit $15,000 $15,000 $15,000 $15,000 Monthly total $27,563 $27,563 $17,870 $20,596 $19,385 Rate guarantee renews 2021 2 years 3 years 3 years 26 V O L U N T A R Y / S U P P L E M E N T A L L I F E A N D A D & D B e n e f i t s a n d R a t e s City of Newport Beach Voluntary Life/AD&D Renewal and Marketing January 1, 2021 Cigna (CSAC EIA)Guardian MetLife Proposed Proposed Proposed Sample monthly costs life and AD&D Age 30 at $100k $10.10 $10.10 $10.10 Age 35 at $100k $14.50 $14.50 $14.50 Age 40 at $100k $20.90 $20.90 $20.90 Age 45 at $100k $37.70 $37.70 $37.70 Age 50 at $100k $57.30 $57.30 $57.30 Age 55 at $100k $85.00 $85.00 $85.00 Age 60 at $100k $119.50 $119.50 $119.50 Child(ren) at $10K $1.87 $1.87 $1.57 Rate guarantee 1 year 2 years 3 years Employee coverage (maximum)$500,000 $500,000 $500,000 or 5 x annual earnings Purchase amounts $10,000 $10,000 $10,000 Guarantee issue $40,000 $100,000 $100,000 or 1 x annual earnings Spouse coverage (maximum)$500,000 or 100% employee's amount $500,000 or 100% employee's amount 50% of EE purchase amount, $100,000 max Purchase amounts $10,000 $10,000 $5,000 Guarantee issue $40,000 $50,000 $25,000 Child coverage (maximum)$10,000 $10,000 $10,000 Purchase amounts Increments of $2,500 to $10,000 $2.5k, $5k, $7.5k, or $10k $1k, $2k, $4k, $5k, or $10k Guarantee issue full amount full amount full amount Child age limitations birth to 6 months - $1,000 birth to 14 days - $0 <15 days - $100, 15 days to 6 mos - $250 Contract provisions Age reduction 60% at age 70, 35% at age 80, 27% at age 85, 20% at age 90, 8% at age 95 60% at age 75, 35% at age 80, 27% at age 85, 20% at age 90 none Earnings definition wages wages wages Rounding next higher $1,000 next higher $1,000 next higher $1,000 Accelerated death 50% to $250,000 50% to $250,000 80% to $500,000 Waiver of premium included prior to age 60 included prior to age 70 included prior to age 60 Conversion included included included Portability included included included Open enrollment Implementation true open enrollment n/a yes yes Participation requirement currently met currently met currently met •Medical HMO Rate Action •Anthem HMO Select +3.2% •Anthem HMO Traditional +11.9% •Blue Shield HMO Access+ +3.2% •Blue Shield HMO Trio N/A •Health Net HMO Salud y Mas +5.4% •Health Net HMO Smart Care +6.9% •Kaiser Permanente HMO +3.8% •Sharp Health HMO +4.3% •UnitedHealthcare HMO Alliance +7.8% •Medical PPO Rate Action •Anthem PPO PERS Choice +6.4% •Anthem PPO PERS Select +5.6% •Anthem PPO PERSCare +13.1% •Anthem PPO PORAC coming soon 30 2021 Renewal Summary C A L P E R S M E D I C A L CalPERS has released the preliminary rates for 2021; we are awaiting final rates. A new rating methodology has been implemented, and the final rates are not expected to be significantly different. NEXT STEPS 33 •Virtual Health Fair •Benefit Guide •Know Your Benefits Campaign •Virtual Wallet Cards Benefit Update E M P L O Y E E E N G A G E M E N T 34 Modern, state-of-the-art mobile and web experience •Direct Teledoc Calls •Access to Insurance Cards •Educational Videos STRIVE E M P L O Y E E E N G A G E M E N T Proposed Timeline January Market Ancillary Lines of Coverage -May the Insurance Committee Meeting #1 – May 20 Marketing Analysis -June Renewal Decisions –July 30 the Insurance Committee Meeting #3 –August 6 Open Enrollment Closes –October 16 Open Enrollment Opens –September 21 Virtual Health Fair –September 28-October 2 Open Enrollment Processing New Plan Year Starts –January 1 May September November December October August June July Present Marketing Findings –Early July the Insurance Committee Meeting #2 – July 23 N E X T S T E P S Transmission of enrollment changes to carriers 36 Disclosures C O M P L I A N C E 1.The following renewal premium rates may include an estimated allocation for fees imposed on health insurers as a result of The Patient Protection and Affordable Care Act that become effective on January 1, 2014.Accordingly,the health insurers have reserved the right to modify these rates subsequent to the effective date of this renewal in the event the estimated amount be materially understated or unanticipated legislative action results in an additional fee assessment to the insurer(s). 2.The following rate and benefit analysis is based upon the financial and underwriting information compiled from your existing company benefit plan data.In the event of significant enrollment change,or if we are missing benefit eligible employee census data,the terms and conditions,premium,or even availability of the insurance plan rates and benefits included in this summary may change. If changing carriers,actual rates will be based upon insurance carrier approval based and final enrollment. 3.This market summary proposal is intended to reflect accurate premium costs of the plans benefits under consideration for illustrative purposes.Please refer to the insurance carrier's proposed plan benefit summary for actual terms,conditions,limitations,and exclusions. If there is a discrepancy in this marketing summary proposal and the insurance carrier plan benefits, the insurance carrier plan benefits will prevail. 4.Insurance carrier plan administration,billing procedures,and network providers vary by company and should be reviewed prior to any carrier change. 5.Active at work take-over provision: It is imperative any new carrier be notified of any employee or dependent who is hospitalized or otherwise disabled and not actively at work on the effective date of any new contract as coverage may not be available for these individuals. The information contained in this Marketing Summary Report was obtained from insurance carrier proposals.It is intended to be used for comparative rate and benefit purposes only.If there are any discrepancies in the actual insurance carrier benefits summary and the following benefits summary, the insurance company contract will prevail. THANK YOU! APPENDIX Current Plans Current Plan Design –Dental HMO E X H I B I T S Current Plan Design –Dental PPO E X H I B I T S Current Plan Design –Vision E X H I B I T S Current Plan Design –Life and AD&D E X H I B I T S Current Plan Design –Short-Term and Long-Term Disability E X H I B I T S PRESENTED BY: Ann Stawicki, Vice President Kelly Fox, Senior Account Executive DATE: August 6 , 2020 INSURANCE COMMITTEE MEETING #3 BENEFITS SELECTIONS burnhambenefits.com Presentation Agenda I N T R O D U C T I O N 1.Ancillary Plan Selections 2.CalPERS Update 3.Next Steps ANCILLARY PLAN SELECTIONS B A L L O T R E S U L T S C o n s o l i d a t e a l l p l a n s w i t h M e t L i f e The ballot results are in, and the Insurance Committee voted to move all ancillary lines of coverage to MetLife. •Enhanced dental PPO plan, increasing annual maximum from $2,000 to $3,000 •Enhanced vision plan, increasing frames and contact lens allowance from $100 to $200 •Enhanced vision network with VSP+ •Lower rates on dental HMO and dental PPO •Extended rate guarantees D E N T A L ͠ M a r k e t i n g R e s u l t s 5 City of Newport Beach Dental Renewal and Marketing January 1, 2021 Cigna (direct)MetLife Current Negotiated Renewal Proposed Combined monthly premium $47,817 $47,817 $43,513 Combined annual premium $573,803 $573,803 $522,157 Annual relationship to current $$0 ($51,646) Relationship to current %0.0%-9.0% Total dental enrollment 532 DMO DMO DMO Employee 69 $14.63 $14.63 $14.03 Employee + 1 Dependent 31 $26.33 $26.33 $26.65 Employee + 2 or more dependents 56 $39.63 $39.63 $37.17 Monthly premium 156 $4,045 $4,045 $3,876 Monthly relationship to current $$0 ($169) Annual relationship to current $$0 ($2,031) Relationship to current %0.0%-4.2% PPO DPPO DPPO Employee 152 $60.26 $60.26 $54.57 Employee + 1 Dependent 54 $122.62 $122.62 $111.04 Employee + 2 or more dependents 166 $168.62 $168.62 $152.69 Monthly premium 372 $43,772 $43,772 $39,637 Monthly relationship to current $$0 ($4,135) Annual relationship to current $$0 ($49,615) Relationship to current %0.0%-9.4% D E N T A L DMO ͠ B e n e f i t s City of Newport Beach Dental Renewal and Marketing - DMO Benefits January 1, 2021 Cigna MetLife New Plan Diagnostic / preventive Office visit $0 $5 Oral exam $0 $0 X-rays $0 $0 Prophylaxis (cleaning) $0 $0 Restorative (fillings) Permanent amalgam $0 $0 Resin-based composite - anterior $0 $0 Resin-based composite - posterior $35 / $45 / $50 $25 Periodontics (gum treatment) Scaling & root planing (per quadrant) $25 $25 Endodontics (root canal therapy) Root canal $50 / $70 / $135 $40 / $65 / $95 Oral surgery Single tooth extraction $2 $0 Partial bony impaction $45 $40 Crowns & bridges Crown - porcelain fused to noble metal $100 $100 Prosthetics (dentures) Partial - cast metal w. resin base $120 $150 Complete - upper or lower $120 $125 Orthodontia (24 months banding) Child $1,100 $1,450 Adult $1,600 $1,450 6 D E N T A L PPO ͠ B e n e f i t s City of Newport Beach Dental Renewal and Marketing - PPO Benefits January 1, 2021 Cigna MetLife Current Plan New Plan PPO DPPO DPPO In-Network Non-Network In-Network Non-Network Maximum benefit Benefits annual maximum $2,000 $3,000 Orthodontia lifetime maximum $2,000 $2,000 Deductible Individual $0 $50 $0 $50 Family $0 $150 $0 $150 Deductible waived for preventive yes yes yes yes Preventive services 100%100%100%100% Basic services 90%80%90%80% Major services 60%50%60%50% Orthodontia 50%50%50%50% Child / adult Adult & Child Adult & Child R&C percentile UCR 90th UCR 90th Services per category X-rays / exams / cleanings preventive preventive Restorative basic basic Oral surgery basic basic Endodontics basic basic Periodontics basic basic Crowns / bridges / prosthetics major major Implants major major Cosmetic dentistry not covered not covered Contract provisions Cleaning frequency twice per year twice per year Crowns replacement limitation 5 years 5 years Rollover feature / maximum rollover no no Participation requirement currently met currently met 7 V I S I O N ͠ R a t e s a n d B e n e f i t s 8 City of Newport Beach Vision Renewal and Marketing January 1, 2021 MES (CSAC EIA) Current Negotiated Renewal New Plan Combined monthly premium $5,610 $5,610 $6,733 Combined annual premium $67,322 $67,322 $80,792 Annual relationship to current $$0 $13,470 Relationship to current %0.0%20.0% Rate guarantee rate guarantee through 2021 2 years Total vision enrollment 417 Employee 185 $7.30 $7.30 $8.76 Employee + spouse 63 $13.99 $13.99 $16.79 Employee + child(ren)169 $19.99 $19.99 $23.99 In-Network Non-Network In-Network Non-Network Exam $10 up to $40 $10 up to $45 Materials copay $0 Standard lenses Single vision 100%up to $30 100%up to $30 Bifocal vision 100%up to $50 100%up to $50 Trifocal vision 100%up to $65 100%up to $65 Frames up to $100 up to $40 up to $200 up to $70 Contact lenses - In lieu of frames & lenses Medically necessary 100%up to $250 100%up to $210 Elective (cosmetic or convenience)up to $105 / $115 up to $100 / $110 up to $200 up to $105 Frequency date of service date of service Exams 12 months 12 months Lenses 12 months 12 months Frames 12 months 12 months MetLife (VSP+ network) $0 L I F E A N D D I S A B I L I T Y ͠ M a r k e t i n g R e s u l t s 9 City of Newport Beach Life and Disability Renewal and Marketing January 1, 2021 Cigna (CSAC EIA)MetLife Current Renewal New Plan Combined monthly premium $31,927 $31,750 $24,314 Combined annual premium $383,126 $380,997 $291,772 Annual relationship to current $($2,129)($91,354) Relationship to current %-0.6%-23.8% Basic life and AD&D Life rate - per $1,000 0.085 0.081 0.081 AD&D rate - per $1,000 0.020 0.019 0.034 Benefit amount Class 1 1X earnings, $50,000 max 1X earnings, $50,000 max Monthly total $3,725 $3,548 $4,080 Rate guarantee renews 2021 3 years Short term disability PMPM $0.90 $0.90 $3.50 Benefits Benefit percentage 67%67% Maximum weekly benefit $1,846 $1,847 Monthly total $639 $639 $2,485 Rate guarantee renews 2021 3 years Long term disability Rate per $100 of covered payroll $0.455 $0.455 $0.293 Benefits Benefit percentage 67%67% Maximum monthly benefit $15,000 $15,000 Monthly total $27,563 $27,563 $17,749 Rate guarantee renews 2021 3 years V O L U N T A R Y / S U P P L E M E N - T A L L I F E A N D A D & D ͠ B e n e f i t s a n d R a t e s 10 City of Newport Beach Voluntary Life/AD&D Renewal and Marketing January 1, 2021 Cigna (CSAC EIA)MetLife Current Plan New Plan Sample monthly costs life and AD&D Age 30 at $100k $10.10 $10.10 Age 35 at $100k $14.50 $14.50 Age 40 at $100k $20.90 $20.90 Age 45 at $100k $37.70 $37.70 Age 50 at $100k $57.30 $57.30 Age 55 at $100k $85.00 $85.00 Age 60 at $100k $119.50 $119.50 Child(ren) at $10K $1.87 $2.00 Rate guarantee 1 year 3 years Employee coverage (maximum)$500,000 $500,000 or 5 x annual earnings Purchase amounts $10,000 $10,000 Guarantee issue $40,000 $100,000 or 1 x annual earnings Spouse coverage (maximum)$500,000 or 100% employee's amount $250,000 or 100% employee's amount Purchase amounts $10,000 $5,000 Guarantee issue $40,000 $25,000 Child coverage (maximum)$10,000 $10,000 Purchase amounts Increments of $2,500 to $10,000 $1k, $2k, $4k, $5k, or $10k Guarantee issue full amount full amount Child age limitations birth to 6 months - $1,000 birth to 6 months - $1,000 Contract provisions Age reduction 60% at age 70, 35% at age 80, 27.5% at age 85, 20% at age 90, 7.5% at age 95 none Earnings definition wages wages Rounding next higher $1,000 next higher $1,000 Accelerated death 50% to $250,000 80% to $500,000 Waiver of premium included prior to age 60 included prior to age 60 Conversion included included Portability included included Open enrollment Implementation true open enrollment n/a yes Participation requirement currently met currently met CALPERS UPDATE •Medical HMO Rate Action •Anthem HMO Select +3.2% •Anthem HMO Traditional +11.9% •Blue Shield HMO Access+ +3.2% •Blue Shield HMO Trio N/A •Health Net HMO Salud y Mas +5.4% •Health Net HMO Smart Care +6.9% •Kaiser Permanente HMO +3.8% •Sharp Health HMO +4.3% •UnitedHealthcare HMO Alliance +7.8% •Medical PPO Rate Action •Anthem PPO PERS Choice +6.4% •Anthem PPO PERS Select +5.6% •Anthem PPO PERSCare +13.1% •Anthem PPO PORAC -3.0% 12 2021 Renewal Summary C A L P E R S M E D I C A L CalPERS has released the final proposed rates for 2021; we are awaiting final confirmed rates. A new rating methodology has been implemented, and the final rates are not expected to be significantly different. 13 2021 Final Proposed Rates –Region 2 C A L P E R S M E D I C A L 14 2021 Final Proposed Rates –Region 3 C A L P E R S M E D I C A L 15 Medical HMO Networks C A L P E R S All the HMO plan designs are the same, but the networks vary. Anthem HMO Select Employee Rate: $674.69 •MemorialCare Medical Group •Monarch Healthcare Anthem HMO Traditional Employee Rate: $1,046.04 •Edinger Medical Group •Hoag Affiliated •Mission Heritage •St. Joseph Affiliated •St. Joseph Heritage •St. Jude Affiliated •St. Jude Heritage Blue Shield Access+ Employee Rate: $938.96 •GNP-Hoag •Hoag Affiliated •MemorialCare Medical Group •Mission Heritage •Monarch Healthcare •St. Joseph Heritage •St. Joseph Affiliated •St. Jude Affiliated •St. Jude Heritage Blue Shield Trio Employee Rate: $722.56 •Mission Heritage •Hoag Affiliated •St. Joseph Heritage •St. Joseph Affiliated •St. Jude Affiliated •St. Jude Heritage Health Net Salud y Más Employee Rate: $458.66 Health Net SmartCare Employee Rate: $769.11 United Healthcare Signature Alliance Employee Rate: $723.84 •Edinger Medical Group •MemorialCare Medical Group •Monarch Healthcare Please note: this information is current as of August 6, 2020. Carrier-provider contracts can expire or change throughout the year. NEXT STEPS 17 Modern, state-of-the-art mobile and web experience •Direct Teledoc Calls •Access to Insurance Cards •Educational Videos STRIVE E M P L O Y E E E N G A G E M E N T 18 •Plan balances •Administer surveys •Push notifications •Benefits •ID Card Storage •Access Benefits Guides •Find Providers •Connect to Telemedicine Providers •Invite Your Family 19 STRIVE E M P L O Y E E E N G A G E M E N T Proposed Timeline January Market Ancillary Lines of Coverage -May the Insurance Committee Meeting #1 – May 20 Marketing Analysis -June Renewal Decisions –July 30 the Insurance Committee Meeting #3 –August 6 Open Enrollment Closes –October 16 Open Enrollment Opens –September 21 Virtual Health Fair –September 28-October 2 Open Enrollment Processing New Plan Year Starts –January 1 May September November December October August June July Present Marketing Findings –Early July the Insurance Committee Meeting #2 – July 23 N E X T S T E P S Transmission of enrollment changes to carriers 21 Disclosures C O M P L I A N C E 1.The following renewal premium rates may include an estimated allocation for fees imposed on health insurers as a result of The Patient Protection and Affordable Care Act that become effective on January 1, 2014.Accordingly,the health insurers have reserved the right to modify these rates subsequent to the effective date of this renewal in the event the estimated amount be materially understated or unanticipated legislative action results in an additional fee assessment to the insurer(s). 2.The following rate and benefit analysis is based upon the financial and underwriting information compiled from your existing company benefit plan data.In the event of significant enrollment change,or if we are missing benefit eligible employee census data,the terms and conditions,premium,or even availability of the insurance plan rates and benefits included in this summary may change. If changing carriers,actual rates will be based upon insurance carrier approval based and final enrollment. 3.This market summary proposal is intended to reflect accurate premium costs of the plans benefits under consideration for illustrative purposes.Please refer to the insurance carrier's proposed plan benefit summary for actual terms,conditions,limitations,and exclusions. If there is a discrepancy in this marketing summary proposal and the insurance carrier plan benefits, the insurance carrier plan benefits will prevail. 4.Insurance carrier plan administration,billing procedures,and network providers vary by company and should be reviewed prior to any carrier change. 5.Active at work take-over provision: It is imperative any new carrier be notified of any employee or dependent who is hospitalized or otherwise disabled and not actively at work on the effective date of any new contract as coverage may not be available for these individuals. The information contained in this Marketing Summary Report was obtained from insurance carrier proposals.It is intended to be used for comparative rate and benefit purposes only.If there are any discrepancies in the actual insurance carrier benefits summary and the following benefits summary, the insurance company contract will prevail. THANK YOU It is our sincere pleasure to work with you! APPENDIX Medical Plan Summaries In-Network Only Annual Deductible None Annual Out-of-Pocket Maximum $1,500 individual $3,000 family Office Visit - PCP $15 Office Visit- Specialist $15 Preventive Services No charge Chiropractic Care & Acupuncture $15 (20 visits per year) Durable Medical Equipment No charge Lab & X-ray No charge Inpatient Hospitalization No charge Urgent Care $15 Emergency Room $50 (waived if admitted) Prescriptions 30-day supply Generic $5 Brand $20 Non-formulary $50 Note: Kaiser does not cover non-formulary drugs C U R R E N T M E D I C A L P L A N D E S I G N ͠ A l l H M O P l a n s In-Network Out-of-Network Annual Deductible $1,000 individual $2,000 family $1,000 individual $2,000 family Annual Out-of-Pocket Maximum $3,000 individual $6,000 family Unlimited Office Visit - PCP $10 if enrolled with a personal doctor You pay 40% after he deductible is met Office Visit- Specialist $35 You pay 40% after he deductible is met Preventive Services No charge You pay 40% after he deductible is met Chiropractic Care & Acupuncture $15 (20 visits per year)You pay 40% after he deductible is met Durable Medical Equipment You pay 20% after deductible You pay 40% after he deductible is met Lab & X-ray You pay 20% after deductible You pay 40% after he deductible is met Inpatient Hospitalization You pay 20% after deductible You pay 40% after he deductible is met Urgent Care $35 You pay 40% after he deductible is met Emergency Room $50, then 20% after deductible You pay 40% after he deductible is met Prescriptions 30-day supply Generic $5 $5 Brand $20 $20 Non-formulary $50 $50 C U R R E N T M E D I C A L P L A N D E S I G N ͠ P E R S S e l e c t PPO In-Network Out-of-Network Annual Deductible $500 individual $1,000 family $500 individual $1,000 family Annual Out-of-Pocket Maximum $3,000 individual $6,000 family Unlimited Office Visit - PCP $20 You pay 40% after he deductible is met Office Visit- Specialist $35 You pay 40% after he deductible is met Preventive Services No charge You pay 40% after he deductible is met Chiropractic Care & Acupuncture $15 (20 visits per year)You pay 40% after he deductible is met Durable Medical Equipment You pay 20% after deductible You pay 40% after he deductible is met Lab & X-ray You pay 20% after deductible You pay 40% after he deductible is met Inpatient Hospitalization You pay 20% after deductible You pay 40% after he deductible is met Urgent Care $35 You pay 40% after he deductible is met Emergency Room $50, then 20% after deductible You pay 40% after he deductible is met Prescriptions 30-day supply Generic $5 $5 Brand $20 $20 Non-formulary $50 $50 C U R R E N T M E D I C A L P L A N D E S I G N ͠ P E R S C h o i c e PPO C U R R E N T M E D I C A L P L A N D E S I G N ͠ P E R S C a r e PPO In-Network Out-of-Network Annual Deductible $500 individual $1,000 family $500 individual $1,000 family Annual Out-of-Pocket Maximum $2,000 individual $4,000 family Unlimited Office Visit - PCP $20 You pay 40% after he deductible is met Office Visit- Specialist $35 You pay 40% after he deductible is met Preventive Services No charge You pay 40% after he deductible is met Chiropractic Care & Acupuncture $15 (20 visits per year)You pay 40% after he deductible is met Durable Medical Equipment You pay 10% after deductible You pay 40% after he deductible is met Lab & X-ray You pay 10% after deductible You pay 40% after he deductible is met Inpatient Hospitalization $250 admint, you pay 10% after deductible You pay 40% after he deductible is met Urgent Care $35 You pay 40% after he deductible is met Emergency Room $50, then 10% after deductible You pay 40% after he deductible is met Prescriptions 30-day supply Generic $5 $5 Brand $20 $20 Non-formulary $50 $50 In-Network Out-of-Network Annual Deductible $300 individual $900 family $600 individual $1,800 family Annual Out-of-Pocket Maximum $2,000 individual $4,000 family Unlimited Office Visit - PCP $10 You pay 20% after he deductible is met Office Visit- Specialist $35 You pay 20% after he deductible is met Preventive Services No charge No charge Chiropractic Care & Acupuncture $20 (20 visits per year)You pay 20% after he deductible is met Durable Medical Equipment You pay 20% after deductible You pay 20% after he deductible is met Lab & X-ray You pay 20% after deductible You pay 20% after he deductible is met Inpatient Hospitalization You pay 20% after deductible You pay 20% after he deductible is met Urgent Care $35 You pay 20% after he deductible is met Emergency Room You pay 20% after deductible You pay 20% after he deductible is met Prescriptions 30-day supply Generic $10 $10 Brand $25 $25 Non-formulary $45 $45 C U R R E N T M E D I C A L P L A N D E S I G N ͠ P O R A C P P O Page 12 of 14 ATTACHMENT 2 INSURANCE REQUIREMENTS ACKNOWLEDGEMENT Must be executed by proposer and submitted with the proposal I, ________________________________________ (name) hereby acknowledge and confirm that __________________________________ (name of company) has reviewed the City’s indemnification and minimum insurance requirements as listed in Exhibits E and F of the City’s Agreement for Contract Services (Attachment 1); and declare that insurance certificates and endorsements verifying compliance will be provided if an agreement is awarded. I am _________________________________ of ______________________________, (Title) (Company) Commercial General Liability (at least as broad as ISO CG 0001) $1,000,000 (per occurrence); $2,000,000 (general aggregate) Must include the following endorsements: General Liability Additional Insured General Liability Primary and Noncontributory Commercial Auto Liability (at least as broad as ISO CA 0001) $1,000,000 (per accident) Personal Auto Declaration Page if applicable Errors and Omissions Liability $1,000,000 (per claim and aggregate) Worker's Compensation (per statutory requirements) Must include the following endorsements: Worker's Compensation Waiver of Subrogation; or Declaration Regarding California Workers’ Compensation if applicable Cyber Liability $1,000,000 (per occurrence) $2,000,000 (general aggregate) Steve Vilas Burnham Benefits Insurance Services CFO Burnham Benefits Insurance Services Page 13 of 14 ATTACHMENT 3 NON-COLLUSION AFFIDAVIT FORM Must be executed by proposer and submitted with the proposal I, ________________________________________ (name) hereby declare as follows: I am _________________________________ of ______________________________, (Title) (Company) the party making the foregoing proposal, that the proposal is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation; that the proposal is genuine and not collusive or sham; that the proposer has not directly or indirectly induced or solicited any other proposer to put in a false or sham proposal, and has not directly or indirectly colluded, conspired, connived, or agreed with any proposer or anyone else to put in a sham proposal, or that anyone shall refrain from proposing; that the proposer has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the proposal price of the proposer or any other proposer, or to fix any overhead, profit, or cost element of the proposal price, or of that of any other proposer, or to secure any advantage against the public body awarding the agreement of anyone interested in the proposed agreement; that all statements contained in the proposal are true; and, further, that the proposer has not, directly or indirectly, submitted his or her proposal price or any breakdown thereof, or the contents thereof, or divulged information or data relative hereto, or paid, and will not pay, any fee to any corporation, partnership, company, association, organization, proposal depository, or to any member or agent thereof to effectuate a collusive or sham proposal. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Proposer Signature: __________________________________________________ Proposer Name: __________________________________________________ Proposer Title: __________________________________________________ Company Name: __________________________________________________ Address: __________________________________________________ Ann Stawicki Vice President Burnham Benefits Insurance Services Ann Stawicki Vice President Burnham Benefits Insurance Services 2211 Michelson Dr, Ste 1200, Irvine, CA 92618 Page 14 of 14 ATTACHMENT 4 ACKNOWLEDGEMENT OF RECEIPT OF ADDENDA Must be executed by proposer and submitted with the proposal. If no addenda has been issued, mark "N/A" under Addendum No. indicating Not Applicable and sign ADDENDUM NO. SIGNATURE INDICATING RECEIPT N/A