R2018-116 Authorizing Agreement with BlueCross BlueShield of IL for Adminstration of the City Group Health Benefit Plan for Calendar Year 2019

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City Of Decatur ASO Projection January 1,3018-December 01,3079 1/112019 ASO Medical Renewal CONDITIONS AND CAVEATS Please refer to the ACA Disclaimer regarding benefts and final pricing. Notwithstanding anything in the renewal or Proposal to the contrary,BCBSIL reserves the right to revise or withdraw our offer,or to change our administrative is,,(and/or pass-through amounts) at any time before or during the contract period(all of which may be estimates,allocated or pro-rated amounts)d any local,state or federal legislation,regulation,rule or guidance (or amendments or clanficeton thereto)u enacted or becomes effecbvelimplemanted,which would increase projected claim costs or BCBSIL's expenses or cost of plan administration,or would othenwse require BCBSIL te pay,submit or forward,on its own behalf or on the Employer Group's behalf,any additional tax,surcharge,fee,or other amount NOTICE'ACA provided for the establishment of a temporary reinsurance program(s)for a three(3)year period(2014-2016),wtach is funded by reinsurance contributions("Reinsurance Fees")collected from health insurance issuers and self-funded group health plains,beginning in 2014 Infomration as to how trema fees are calculated re provided by federal and state governments Federal mgulabons establish a flat,per member,Par month fee. ACA also provides that self-funded plan sponsors are responsible for the Reinsurance Fee BCBSIL w it not asvat m the remtbncce of those is,,to the federal government,however,upon request, we can make available to our self-funded/ASO wstem airs,existing data and information that may be helpful m determining,reporting on,and remitting their Reinsurance Fee amounts This renewal is being provided for the pend mdhceted above This rimmmil offer expires as of the effective data md—ted above This renewal offer assumes HCSC will remain the exclusive carrier for Medical and Rx covemge Upon inquiry from employer groups,BC BS will provide information to the employer group regarding commissions and other compensation paid to the employees agent by BCBS in connection cath the employees policy or contract with BCBS The renewal he being offered on a paid basis Health Paid Claims subject to Stop Loss are claims paid during the policy period indicated above Health Paid Claims subject to Individual Stop Loss are paid claims from the follovring lines)of coverage.Medical,Drug.Illinois Access Fee Heath Paid Claims subject te Aggregate Stop Loss are paid claims from the follovang Ime(s)of coverage Medical.Drug,Illinois Access Fee The total annual Health Stop Loss premiums are based upon the total current enrollment HCSC reserves the right to adjust the Average Claim Value if one or more of the following occurm with the coverage period -the Accounts compos on changes(Le demographics) -the Accounts number of covered employees increases or decreases by more than 10% -the Accounts benfit program changes The minimum Aggregate Attachment Point was calculated as 90%of the ASL Limit per contract per month mulbplZ by the projected cumulative contracts for the pend Aggregate Heath Stop Loss premium is payable annually and is due by the first day of the policy period Individual Heath Stop Loss premiums are payable on the first day of each month. Any amount in excess of the IrhdN dual Heath Stop Loss limit will not be included in the Aggregate Hearth Stop Loss Settlement. HCSC's pharmacy benefit manager,PRIME Thempeuhcs(PBM),holds rebate contracts oath pharmaceutical manufacturers HCSC may,in some a rmateraes,provide the Employer cath a Rebate Credit,but such Rebate Crack may not equal the entire amount of the rebates provided to HCSC by the PBM. Employers that do not use Prim Thempeutics as their pharmacy benefit manager are NOT eligible for a Rebate Credit HCSC's current estimate of the rebates it mil receive from the PBM,for drugs covered under the pharmacy benefit,for the employees covered members,is approximately E20 37 per script HCSC's current estimate of the rebates n will receive from the PBM,for drags covered under the medical benefit on an aggregate basis for the policy period,is approximately$0.60 per employee per month. ss'sssc>c>+m�omu�a�wi ae:�wcaro.�x r masrsmm�m.ahh.ansae:sin a�.snisa assasaus