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R-1997-052 Health and welfare benefit program
RESOLUTION NO. R-97- 52 A RESOLUTION authorizing the City Manager and the City Clerk to execute a professional services agreement with Sedgwick, Noble, Lowndes, a division of Sedgwick James of Washington, Inc., to provide consulting and brokerage services in connection with the health and welfare benefit programs of the City. WHEREAS, the City desires brokerage and consulting services in connection with its health and welfare benefits programs; and WHEREAS, the City does not have the staffing levels and expertise necessary to provide said brokerage and consulting services; and WHEREAS, on September 27, 1996, the City requested proposals from interested parties to provide said brokerage and consulting services; and WHEREAS, Sedgwick, Noble, Lowndes, a division of Sedgwick James of Washington, Inc. provided an acceptable proposal, has sufficient personnel and expertise necessary to provide said brokerage and consulting services, and is willing to provide these services in accordance with the terms and conditions of the attached agreement; and WHEREAS, the City Council deems it to be in the best interest of the City of Yakima to enter into an agreement with Sedgwick, Noble, Lowndes, a division of Sedgwick James of Washington, Inc. for said services in accordance with the terms and conditions of the attached agreement, now, therefore; BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF YAKIMA: The City Manager and the City Clerk are hereby authorized and directed to execute the attached and incorporated "Broker/Health Benefit Program Services Agreement" between the City of Yakima and Sedgwick, Noble, Lowndes, a division of Sedgwick James of Washington, Inc. The final agreement shall be approved as to form by the City Attorney. ADOPTED BY THE CITY COUNCIL this 15thday of April , 1997. ATTEST: City Clerk Iklres hwbp2 , pm Buchanan, Mayor ARTICLE I COMPLIANCE WITH RFP DOCUMENTS Unless otherwise provided for herein, Broker agrees to act as representative for the City as its broker of health benefits, in accordance with the provisions, terms and conditions of this Contract, the Request for Proposals, all documents related thereto, and the Broker's proposal. A list of all documents is attached hereto as Appendix A and all such documents are incorporated herein and made a part hereof. Any modifications to this proposed contract should be stipulated in the proposal. True and exact copies of this Contract and all such documents listed in Appendix A are on file in the Office of the City Clerk, City of Yakima, 129 No. 2nd Street, Yakima, WA 98901. Unless otherwise provided herein, the City's Director of Finance & Budget shall decide all disputes pertaining to the execution of the services required under this Contract and of the administration of the Contract provisions. ARTICLE II SCOPE OF SERVICES Broker shall perform the work and services specified in Appendix B - Scope of Services, attached hereto and made a part of this Contract. ARTICLE III TIME OF PERFORMANCE This Contract shall be in effect for the five-year period commencing January 1, 1997, and ending December 31, 2001 unless extended upon mutual agreement of both parties. RFP/HB Services Agreement -2- ARTICLE IV COMPENSATION/CITY RESPONSIBILITIES City agrees to pay Broker as compensation for the performance of the services set forth in this Contract in accordance with the provisions of Appendix C - Compensation, attached herein and made a part hereof. ARTICLE V CITY RESPONSIBILITIES City agrees to perform the responsibilities as described in Appendix D -- City Responsibilities, attached herein and made a part hereof. ARTICLE VI GENERAL PROVISIONS A. Broker, at its own cost, shall obtain and maintain at all times while this Contract is in effect all licenses, permits and certificates required by the laws of the State of Washington necessary to enable Broker to perform the services set forth in this Contract. Broker, upon the request of City, shall furnish City with evidence of compliance with the provisions of this paragraph. B. Broker shall not assign this Contract without the prior written consent of City. This provision shall not prohibit Broker from subcontracting for any of the activities to be performed, however, any such assignment or subcontracting will not relieve Broker of its obligations to the City under this contract. C (1) City or Broker may terminate this Contract any time upon ninety (90) days prior written notice; provided, however, in the event Broker fails, at any time during the contract period, to maintain all necessary licenses, permits or certificates as required by Article V, Paragraph A herein, City shall have the right to terminate this Contract upon three (3) days prior written notice. RFP/HB Services Agreement -3- (2) Upon termination of this Contract, Broker shall, at City's option, continue to supervise and report to City on all claims based on events which occurred during the terms of the Contract prior to its termination, until such time as the disposition of such claims is completed. (3) Failure of City to insist upon performance of any of the terms and conditions or requirements of this Contract shall not be construed as a waiver of such items, conditions or requirements, and the same shall remain in full force and effect for the duration of this Contract. City expressly retains all other rights or remedies provided by law or any violation of this Contract, and no other action by City shall constitute a waiver of any such right or remedy. D. City or Broker may, from time to time, request changes in the terms of provisions of this Contract. No change shall be effective unless it is mutually agreed upon in writing by City and Broker. E Broker will indemnify and hold harmless City from any and all loss, cost or expense to which City may be subjected solely as a consequence of the willful misconduct or negligent acts or omissions of Broker and/or its employees in connection with fulfilling its obligation under this Agreement. F. City will indemnify and hold harmless Broker from any and all loss, cost or expense incurred by Broker and/or its employees as a result of the performance of this Agreement by Broker and/or its employees caused solely by the willful misconduct or negligent act or omission of City and/or its employees. G All claims and related files generated by Broker as a result of its activity under this Contract shall remain at all times the property of City with the exception of any supporting data required by Broker to make such accountings to City or excess insurers as are required in this Agreement. H. Broker is retained by City only for the purposes and to the extent set forth in this Contract, and its relationship to the City shall be that of an independent contractor. I. City agrees during the term of this Contract and for a period of one (1) year following its termination it will not employ any person employed by Broker during the term of this Contract without the prior written consent of Broker. RFP/HB Services Agreement - 4 - J. The waiver of Broker or City of the breach of any provision of this Contract by the other party shall not operate or be construed as a waiver of any subsequent breach by either party or prevent either party thereafter enforcing any such provision. K The obligation of Broker to perform its duties hereunder is conditioned upon City's cooperation with Broker with respect to the activities of Broker including, but not limited to, responding to Broker requests for information promptly, meeting with Broker and/or third parties, as may be needed, making decisions on matters which, in the professional opinion of Broker, should be made by City; the provision of funds, and performance by City of all other obligations of this Agreement. L. All notices at any time to be served by City upon Broker shall be in writing and sent by certified mail, postage prepaid to the Broker at the address first above written. All notices at any time to be served by Broker on the City shall be in writing, sent by certified mail, postage prepaid to the City's Director of Finance and Budget, City Hall, 129 No. 2nd Street, Yakima, WA 98901. In the event the name or address of the party herein listed to receive any such notice or City or Broker shall change, City or Broker shall, within five working days thereafter, notify the other in writing of any such change. M. This Agreement sets forth in all of the terms, conditions, and agreements of parties relative to the subject matter hereof and supersedes any and all such former agreements which are hereby declared terminated and of no further force and effect upon the execution and delivery hereof. There are no terms, conditions, or agreements with respect thereto, except as herein provided and no amendment or modification of this Agreement shall be effective unless reduced to writing and executed by the parties. All terms, conditions, definitions as set forth in the Agreement will be interpreted under the laws of the State of Washington. RFP/HB Services Agreement -5- IN WITNESS WHEREOF, the parties hereto have caused this Contract to be executed this, the i ? day of 149y , 19 9? . APPROVED AND AGREED TO: CONTRACTOR n B y: Its: t\i\NA/kc-'%Oc, S'XCo- \\IC. STATE OF WASHINGTON County of } 1 } :SS. Bv• • R. A. Zis, Jr., City Manager ATTEST: City Clerk����Z crrr 03111111.14T Mo: Cf %- ' assournom 12—T7—sa On this day of , 1997, before me the undersigned, a Notary Public in and for the State of Washington, duly commissioned and sworn, personally appeared the of , and who executed the foregoing instrument, and acknowledged to me that signed and sealed the said instrument as free and voluntary act and deed for the uses and purposes therein mentioned. WITNESS my hand and official seal hereto affixed the day and year in this certificate above written. RFP/HB Services Agreement -6- NOTARY PUBLIC in and for the State of Washington, residing at My commission expires: APPENDIX A DOCUMENT LIST • Request for Proposal for Broker of Record - Health and Welfare Benefit Plans •Sedgwick Noble Lowndes' Broker of Record Proposal •Agreement for Plan Supervisor APPENDIX B SCOPE OF SERVICES • The Broker shall provide: •Local customer service, service representative personnel and access for claims approval. •Daily servicing, to include but not limited to, answering questions concerning covered benefits, contract provisions, and plan administration. Assist in the resolution of problems relating to the benefit plan such as eligibility problems, incorrect billings, service problems with claim administrators, and denied claims that are either in dispute or are being appealed. • Research and recommend solution(s) for claims which are being appealed. •Attend regular or special Board meetings and other meetings upon request. Attend and conduct employee orientation meetings that provide and overview of the Plan and its operation, funding arrangements and benefits. •Conduct employee meetings to explain Plan changes and plan choices. Assist in the implementation of Plan changes such as employee communications and enrollment process. •Participate in or initiate meetings with claims administrator and City staff as necessary or requested. •Assist City staff and Board representatives in developing health care education information programs for delivery to individual users of the health program. •Market the City's individual and aggregate stop loss and group life insurance coverage and evaluate the underwriter's financial stability. Negotiate with carrier(s) on the City's behalf. Prepare and submit a renewal report to the Board/City that provides the renewal action, renewal and benefit options and recommendation(s). •Facilitate the City's claims administration services (inclusive of utilization review and case management services) and assist the City in securing claims administration services. Claims administrative services shall also include claims investigation review and payment of claims for the City's medical, vision, dental and prescription drug programs. •Assist the Board/City in developing medical, vision and dental benefit programs while limiting City and participants exposure to large losses. Provide analysis and recommendation(s) on plan design modifications and implementation. •Prepare, submit and present a detailed accounting report annually describing each area of cost, and an Executive Summary that goes directly to the Board and Council. • Develop bid strategies and specifications to be sent to insurance or administrative markets for existing or proposed benefits. Prepare an analysis and comparison of bids and make recommendation(s) for the Board/City's review. Actively participate in the negotiation for services. • Provide monthly claims analysis reports for medical, vision, dental and prescription drug plans as well as large claim analysis and reports. • Review all Plan policies, agreements, booklets and amendments to confirm compliance with policy -order specifications. Mail documents to Plan participants as requested. •Answer questions or research questions pertaining to specific employee benefit plans as well as questions pertaining to legislation or regulation affect benefit plans. Provide information bulletins on time -sensitive issues and employee benefit trends. When legislation is proposed or enacted, provide information on the potential impact to the City's benefit plans. •Provide excess insurers such reports as they may reasonably require. •Provide information and assistance as may be reasonably required for preparation and filing of all reports required by any government agency in connection with the City's approved self-insured status. APPENDIX C COMPENSATION The Broker shall be compensated as follows: •Annual Fee - $8,500 consulting and reporting retainer. •Commissions - Commissions paid on the excess reinsurance and life insurance policies. The Broker further agrees to disclose in writing to the City commissions and returns from claims administrators fees received. Said disclosure shall be made at least once per year. APPENDIX D CITY'S RESPONSIBILITIES The City shall: •Determine eligibility of members to receive benefits. •Establish a bank account for payment of claims. •Make all payments to the bank account for the payment of eligible claims. •Make the final determination in the coverage and governance of the Plan Document. AGREEMENT FOR PLAN SUPERVISOR This agreement is effective the 1st day of January, 1997 between City of Yakima ("Company") and Healthcare Management Administrators, Inc. ("Plan Supervisor"), a Washington corporation. SECTION L The Plan 1.1 Company has adopted an employee welfare benefit Plan (the "Plan") providing means by which eligible employees of the Company can secure the benefits set forth in the Plan. 1.2 The Administrator (as defined by the Employee Retirement Income Security Act of 1974) of the Plan is the Company. 1.3 All contributions to the Plan are deposited in trust with N/A Trustee or are otherwise accounted for by the Company. Disbursements in payment of covered claims from the trust shall be made upon order of the Plan Supervisor. To aid in such disbursements, the Trustee may cause a special bank account subject to the signature of any duly authorized agent of the Plan Supervisor or of the Trustee to be opened and to be funded periodically with money required to pay covered claims and other expenses of the Plan such as premiums and administrative fees. SECTION II. The Plan Supervisor 2.1 The Plan Supervisor, within the scope of its duties under this agreement, shalt provide services for and shall assist the Company and the Administrator in the Administration of the Plan pursuant to the terms and conditions of the Plan as it may be requested and authorized from time to time. The Plan Supervisor shall prepare a Summary Plan Description (SPD) setting forth the benefits and rights of the Plan Participants. The SPD shall be reviewed and approved by the Company. 2.2 The Plan Supervisor agrees to provide the following claims processing and payment services to the Company including but not limited to: a) Providing the Company forms for use by employees and dependents (hereinafter "Participants") in submitting claims to the Plan Supervisor; b) Receiving claims and processing payment of covered benefits for Participants in accordance with the provisions of the Plan, for claims incurred on and after the commencement date as stated in this agreement; c) Obtaining from Participants and health care providers of services any additional information deemed necessary by the Plan Supervisor to process claims; d) Determining the amount of benefits payable to a Participant under the Plan and to pay those amounts to Participants from funds supplied by the employer; e) Notifying Participants of the reasons for denial of any benefits and to provide for the review of any denied claims; f) Providing for the coordination of benefits, subrogation collection activities, and collection of overpayments or improper payments made to any Participants; g) Providing adequate customer service representatives between the hours of 8:00 a.m. and 5:00 p.m. on non -holiday weekdays; h) Assisting the Company in communicating to Participants any and all subsequent changes to the Plan; I) If a fee is stated on the "Schedule of Fees" page for "Full COBRA administration," notifying Participants of continuation coverage rights upon the occurrence of a qualifying event, as required by COBRA, as well as responsibility for calculation and collection of premiums for continuation coverage; j) Preparing and assisting the Company in distributing benefit booklets to Plan Participants. Initial booklet supply is not induded as a part of the Plan set-up fee. Subsequent supplies are also at Company's cost. 2.3 The Plan Supervisor is authorized to do all things it deems necessary or convenient to carry out the terms and purposes of this agreement. 2.4 The Plan Supervisor shall have the full responsibility for approval of claims under the Plan and for arranging for the payment thereof from funds available to the Plan either by issuing a check or draft upon the Plan bank account if such account is provided for this purpose or by written order and authorization delivered to the Trustee or other person authorized to issue such check or draft in payment of claims. The Plan Supervisor shall honor any assignment of benefits of a person eligible for benefits under the Plan ("Covered Person") to any person or institution which is a proper and qualified assignee under the terms of the Plan Supervisor as to the amounts approved and the person entitled thereto and the validity of any claim. 2.5 The Plan Supervisor shall pay from the Plan bank account, if provided, or shall issue an order to the Trustee or other person with authority to disburse funds of the Plan to pay, all of the expenses of operation of the Plan incurred pursuant to the performance of this agreement (excluding plan administration fees unless specifically authorized). The Trustee or other person receiving such written order from the Plan Supervisor shall have the right to rely absolutely upon such order for the payment of such expenses. 2.6 The Plan Supervisor, subject to the approval of the Company, shall arrange for the purchase of policies of insurance to provide any of the benefits provided for in this agreement, the Plan, or the Trust. The premium for these policies of stop -loss or individual and aggregate excess risk or similar type of insurance shall be paid by the Company. 2.7 The Plan Supervisor, where applicable, shall furnish the "Schedule C information necessary for the preparation of IRS form 5500. The Plan Supervisor shall not be required to assist the Company and / or the Administrator in the preparation or filing of any report, returns, tax returns, or similar papers required by any local political subdivision, state or the Federal Government pertaining to the operation or management of the Plan. If necessary, professional fees for preparing government required forms and / or auditing of the Plan shall be the responsibility of the Company. 2.8 The Plan Supervisor shall render monthly reports to the Company which shall include the following: a) Receipts of the Plan other than deposits made by the Company from its own funds or from collections from employees; b) Disbursements, by category, made or authorized by the Plan Supervisor from the Plan; c) A statement of the fees due the Plan Supervisor. • 2.9 The Plan Supervisor shall maintain and pay the cost of a fidelity bond in the amount of not less than One Hundred Thousand Dollars ($100,000.00) covering the Plan Supervisor and any of its agents or employees Healthcare Management Administrators, Inc. Agreement -2- who may collect, disburse, or otherwise handle or have the authority to authorize or order disbursements or payments on behalf of the Plan. 2.10 The Plan Supervisor shall maintain all records relating to the investigation, processing, and payment of all applications for benefits for a period of not less than six (6) years from the date of application for benefits under this agreement. These records may be transferred to the Company at the Company's request upon termination of this agreement. SECTION III. Procedure for the Making and Payment Of Claims for Benefits from the Fund 3.1 Any Covered Person may make application for benefits from the Plan as provided by the Plan under the form or forms provided by the Plan Supervisor. The applicant shall fully and truthfully complete such application for benefits and the applicant shall supply such pertinent information from personal or professional sources as may be required by the Plan Supervisor. 3.2 The Plan Supervisor shall accept any application for benefits made in the appropriate manner, and after due investigation and verification of the statements contained in the application, determine the eligibility of the Covered Person for benefits. If the facts, as stated in such application or determined on investigation by the Plan Supervisor, entitle the Covered Person to receive payment of benefits from the Plan, the Plan Supervisor shall forthwith arrange for the proper payment from the Plan. If the Plan Supervisor finds that the Covered Person is not entitled to benefits under the Plan, the applications shall be denied and referred to the Company with the Plan Supervisor's reasons for the denial. The Plan Supervisor may compromise or adjust any disputed claim, application, or application previously denied. The Plan Supervisor shall be responsible for the review of all denials requested to be reviewed. The final determination of the Plan Supervisor made in accordance with Plan procedures on any application for benefits is final and conclusive upon the Covered Person, the Company or any other person. The Plan Supervisor shall be the primary contact for answering questions regarding benefits available under the Plan. 3.3 The Plan Supervisor shall not be liable for any failure or refusal by the Plan Administrator to pay or honor any application for benefits made pursuant to this agreement; and the Plan Supervisor is expressly indemnified by the Company against, and shall be reimbursed by the Company for, any expense, loss, damage, or legal fees incurred by the Plan Supervisor in defending any such claims or demands made against the Company, the Administrator, the Trustee, the Plan Supervisor or the Plan. SECTION IV. Costs of Administration 4.1 The Plan Supervisor shall be entitled to a fee for its services to the Plan and under this agreement which shall be payable on a monthly basis in accordance with the Schedule of Fees attached to this agreement and signed by a representative of the Company for identification. SECTION V. The Company 5.1 As of the effective date of this agreement, if requested, the Company shall provide the Plan Supervisor with a complete list of all Plan participants of the Company who are eligible for benefits from the Plan. Thereafter, the Company shall notify the Plan Supervisor on a monthly or more frequent basis of all changes in participation whether by reason of termination, change in classification, or any reason. 5.2 The Company shall collect the contributions, if any, made by the employees of the Plan in the manner it may deem appropriate and shall account for the money so collected on a monthly or more frequent basis. Healthcare Management Administrators, Inc. Agreement -3- The Company, upon notice from the Plan Supervisor, shall pay to the Plan in the manner provided in this agreement any deficiency in the Pian which the Company is obligated to pay under the terms of the Plan. 5.3 The Company shall assist in the enrollment of the employees in the Plan, cooperate with the Plan Supervisor with regard to proper settlement of claims, and transmit any inquiries pertaining to the Plan to the Plan Supervisor. The Plan Supervisor shall provide and the Company shall maintain a supply of forms, enrollment cards or other documents and shall distribute or make available such documents to the employees. 5.4 The Company shall provide directly or through the Plan Supervisor all materials and documents, including summaries for employees, reports and applications and notice forms, as may be necessary or convenient for the operation of the Plan or to satisfy the requirements of governing law as might from time to time be determined or prepared by the Plan Supervisor. Where distribution to employees is required, such materials shall be furnished in sufficient quantity and shall be appropriately distributed by the Company. 5.5 The Company shall provide a fidelity bond for fiduciaries and employees as required by the Employment Retirement Income Security Act of 1974 for the benefit of the Plan. SECTION VI. Termination of the Agreement 6.1 The initial term of this agreement is stated in the Schedule of Fees. Renewal of this agreement shall be accomplished by attaching to this agreement a revised Schedule of Fees to be signed by the parties to this agreement. Following the initial term, this agreement may be terminated by either the Company or the Plan Supervisor by written notice of intention to terminate given to the other party, to be effective as of a date certain set forth in the written notice, which shall not be less than ninety days from the date of such notice. In the event of willful misconduct by a party to this agreement, the other party may terminate this agreement immediately. All obligations of the Plan Supervisor related to the relevant rights of the employees for payment of benefits from the Plan will be terminated and extinguished on the effective date of termination given in the notice even though the claim for such benefits arose prior to termination of this agreement. 6.2 Upon termination by either party, the Plan Supervisor within thirty days after the date of termination, shall prepare and deliver a complete and final accounting and report as of the date of termination of the financial status of the Plan to the Company, together with all books and records in its possession and control pertaining to the administration of the Plan. All claim files, enrollment materials and other papers necessary for claim payments under the Plan shall be available to the Company upon the date of termination of this agreement. The Plan Supervisor, if requested, will process run -out claims (daims incurred prior to the date of termination) at the prevailing monthly fees for a mutually agreed upon length of time. The Plan Supervisor at the time of the final accounting shall deliver any funds of the Plan in its possession or control to the Company on its order. SECTION VII. Miscellaneous Provisions 7.1 In the event of resignation or inability to serve of the Plan Supervisor, the Company may appoint a successor. Any successor, upon appointment and their acceptance, shall succeed to and be invested with all powers conferred on the Plan Supervisor. 7.2 If during the operation of the Plan, the Federal Government, the government of any state, or any political subdivision or any instrumentality of either shall assess any tax against the Plan and the Plan Supervisor is required to pay such tax, the Plan Supervisor shall report the payment to the Company and make a charge against the Plan for such tax. Healthcare Management Administrators, Inc. Agreement -4- 7.3 The Plan Supervisor shall only be liable to the Company and to the employees of the Company for its actions or failure to act with regard to processing and payment of claims as provided in the Plan and this agreement at the level expected of a professional daim administrator; or for its gross negligence or willful misconduct. The Company shall hold the Plan Supervisor harmless from and indemnify it against any claims and all costs and expense or fees incurred in connection therewith, which might be asserted by the Plan, Company's employees or other persons which are beyond Plan Supervisor's control or beyond the scope of this agreement. 7.4 No person dealing with the Plan Supervisor in relation to the Plan will be obliged to determine the Plan Supervisor's authority to act pursuant to this agreement. 7.5 Where the context of the agreement requires, the singular shall include the plural and the masculine gender shall include the feminine. 7.6 This agreement may be amended by the Company and the Plan Supervisor at any time by mutual written consent of said parties; provided, however, that this agreement may not be amended to reduce any benefits which might be paid for any cause occurring prior to the amendment, or to in any way prejudice such a claim. 7.7 The Company is hereby designated the agent for service of legal process on behalf of the Plan at its principal office address in , Washington. IN WITNESS WHEREOF, the Company and the Plan Supervisor have executed this agreement this day of , 19 CITY OFYAKIMA HEALTHCARE MANAGEMENT ADMINISTRATORS, INC. By. hmaagree 12/95 By: Victor J. Meiusi, rector of Marketing Healthcare Management Administrators, Inc. Agreement -5- PLAN SUPERVISOR & AGENT/BROKER/CONSULTANT SCHEDULE OF COMMISSIONS AND FEES Effective 1 / 1 / 97 to 12 / 31 / 97 administrative fees shall be: $ 13.00 For administration of medical and vision claims; $ 2.00 For administration of dental claims; $ N/A For administration of the prescription card program; $ NJA For administration of disability claims; $ Included For consolidated billing of other insurance coverage; $ N/A For full COBRA Administration; $ N/A For administration of the Healthcare Incentive Bonus Plan; $ N/A For administration of the Preferred Provider Program; $ 1.75 For administration of the Utilization Management Program; $ Included For Agent/Broker/Consultant Monthly Service Fees. Fees shown above are payable per covered employee per month subject to a minimum monthly fee of $ N/A $ N/A HMA Plan Set -Up Fees for this Plan Year. Commissions Payable on Excess Loss Insurance Premium 0% HMA 10% Broker If applicable, administration of PCS prescription drug claims is payable monthly to Healthcare Management Administrators, Inc. and to Pharmaceutical Card Service, Inc. The total combined fee is $ 0.89 per claim paid. These fees shall remain in effect beyond the above stated term until changed by mutual agreement of the parties. IN WITNESS WHEREOF, the Company, the Broker/Consultant and the Plan Supervisor have executed this agreement this day of , 19 Agent/Broker Agent/Broker By: By: CITY OFYAKIMA HEALTHCARE MANAGEMENT ADMINISTRATORS, INC. By: N� Victor J. Meiusi,'rector of Marketing By: BUSINESS OF THE CITY COUNCIL YAKIMA, WASHINGTON AGENDA STATEMENT Item No. / 3 For Meeting Of 4/15/97 ITEM r.0 LE: Resolution Authorizing the Execution of a Professional Services Agreement for Broker Services for the Health and Welfare Benefit Program SUBMITTED BY: Greg Ahmann, Chair, Employee's Welfare Benefit Program Board Sheryl M. Smith, Deputy Personnel Officer John Hanson, Director of Finance and Budget CONTACT PERSON/TELEPHONE: Sheryl M. Smith, 575-6090 SUMMARY EXPLANATION: On September 27, 1996 the City issued a request for proposals for broker services for our self insured health and welfare benefit program. The last time such a process was undertaken was 1983 when the original administrtive services agreement was awarded to Direct Administrators. A subcommittee of the Employee's Welfare Benefit Board reviewed the responses and subsequently interviewed the two finalist firms. The subcommittee recommended to the full Employee's Welfare Benefit Board that they recommend to the City Manager that the contract be awarded to Sedgwick, Noble, Lowndes. The City has received these services for since 1983 from Direct Administrators who were purchased by the Sedgwick firm in 1996. A copy of the Request for Proposals is available in the City Clerk's office. Resolution X Ordinance Contract X Other (Specify) RFP & Sedgwick Proposal Funding Source Health Benefit Reserve Fund APPROVED FOR SUBMITTAL: City Manager STAFF RECOMMENDATION: Adopt resolution. BOARD/COMMISSION RECOMMENDATION: COUNCIL ACTION: HUMAN RESOURCES DIVISION 129 North Second Street Yakima, Washington 98901 Phone (509) 575-6090 • Fax (509) 575-6107 September 27, 1996 TO : All Interested Brokers SUBJ: Request for Proposal Ladies and Gentlemen: The City of Yakima is requesting information from qualified firms to serve as the City of Yakima Broker of Record for the City of Yakima Employee's Health and Welfare Benefit Plans. 1. You are invited to prepare a proposal to serve as Broker 2. We invite you to complete a proposal with respect to the scope of services you would provide and the experience of your firm in accordance with the attached RFP. We look forward to your response. Sincerely, Sheryl M. Smith Deputy Personnel Officer Enclosures Yakima aw+nw '1111! 1994 CITY OF YAIOMA REQUEST FOR PROPOSAL FOR BROKER OF RECORD — HEALTH AND WELFARE BENEFIT PLANS I. GENERAL INFORMATION A. Extra copies of this RFP and the proposal application form may be obtained by contacting the Human Resources Division of the City of Yakima. B. All proposals submitted become public information and may be reviewed by anyone requesting to do so at the conclusion of the evaluation process. C. The City of Yakima reserves the right to reject any or all proposals or accept any presented which would be in the best interest of the City. D. In the event it becomes necessary to revise any part of this RFP, addenda shall be provided to all proposers who received the basic RFP. E. The City of Yakima is not liable for any cost incurred by the proposer prior to issuing the contract or for any costs incurred in the development of the proposal. F. Attached as ExhibitA is a proposed agreement for services. G. Attached as Exhibit B is a copy of Yakima's health program annual reports from 1991 through 1995. Exhibit C is a listing of rate analysis and reports for the City. Exhibit D is a current Plan Document. H. The proposal in its entirety must be received in the Human Resources Office, 129 No. 2nd Street, Yakima, WA, 98901, by 5:00 p.m. Friday, October 18, 1996. I. Proposers must submit six (6) complete copies of their proposals. J. Please direct all questions to: RFP/HB Sheryl Smith, Deputy Personnel Officer 129 No. 2nd Street Yakima, WA 98901 -1- (509) 575-6090 II. PURPOSE The Request for Proposal (RFP) will provide information leading to the selection of a "Broker" to represent the City of Yakima (Health Benefit Board) hereinafter referred to as "City" in marketing excess loss insurance, providing claim administration services, and assist the City in administration of the Health and Welfare Benefit Programs of the City. This invitation for proposal is not authorization to approach the insurance marketplace on behalf of the City. The City directs that no contract solicitation of insurance markets be made on the City's behalf. Failure to comply with this requirement will be grounds for immediate disqualification of a proposal. III. BACKGROUND INFORMATION The City is a political subdivision of the State of Washington, a charter first class city with a population of approximately 62,000. As a full service municipality, it consists of some eight departments that provide a myriad of services, such as public safety; park and recreation facilities, and public works activities, which include Transit, Refuse, Street, Water and Sewer. The City has about 620 full-time equivalent employees. The health benefit program provides services to employees, dependents, certain retirees and COBRA participants totaling over 2,000 insureds. The City's Health Benefit Fund has been a self-insured program since 1979, with stop loss and aggregate loss insurance supplemental coverage to protect the plan from large, catastrophic claims. Over the past 13 years, the City has contracted with a Beard, Bench and Mendenhall subsidiary, Direct Administrators for marketing stop loss coverage, group life insurance and claims adjudication, plan management, and associated services. IV. MINIMUM QUALIFICATIONS FOR BROKER SERVICES All brokers of health benefit services meeting the following minimum qualifications are encouraged to submit proposals. All firms shall meet the following minimums: A) Must be licensed in the State of Washington; B) Five years in business as a licensed broker, preferably with an office located in Yakima County; C) A minimum of three years experience with at least five (5) self-funded accounts, preferably cities or counties or other public agencies, each with program participation levels of 250 or more employees, preference given to firms having experience managing multiple health care programs for a single account. D) Evidence of Errors and Omissions Insurance with a minimum limit of $1,000,000 per occurrence. RFP/HB -2- V. DUTIES AND RESPONSIBILITIES OF THE CITY'S BROKER SHALL INCLUDE, AT A MINIMUM: A) To assist the City's Health Benefit Board in developing medical (including vision) and dental policies for the City. B) To market City's Health Benefit individual and aggregate stop loss as well as group life insurance coverage and evaluate the underwriter's financial stability. C) To examine policies for compliance with the City's requirements. D) To obtain the City's claims administration services (inclusive of utilization review and case management services). Claims administration services shall also include claims investigation review and payment of claims for the City's Health Care Programs. E) To assist City staff and Health Benefit Board representatives in developing health care education information programs for delivery to individual users of the health program. F) To review and make recommendations for improvements and enhancements to provide the best Health Care Services while limiting City and participant exposure to large losses. G) To provide excess insurers such reports as they may reasonably require. H) To provide information and assistance as may be reasonably required for preparation and filing of all reports required by any government agency in connection with City's approved self-insured status. I) To provide "local" claims service and access for claims approval. RFP/HB -3- VI. QUESTIONNAIRE/RESPONDENT INFORMATION All firms proposing shall include the following information in their proposals: FIRM NAME: ADDRESS: 1. Sole Proprietor Partnership_ Corporation 2. Principal Ownership Names: A. B. C. 3. Date your firm was originally started in Yakima: 4. Licenses held by your firm's personnel: Life and Health Property and Casualty National Association of Securities Dealers # Reps Licensed 5. Total number of persons employed by your firm in Yakima: 6. Total number of persons presently employed in your office who perform exclusively in the area of employee benefits: A. Account Executives B. Administrative Assistants C. Technical Assistants D. Clerical 7. Has anyone on your staff worked for an insurance company as a group medical underwriter? Yes_ No RFP/HB If yes, please give details. -4- 8. Has anyone on your staff worked for an insurance company as a group medical/dental claims adjudicator? Yes No 9. Does anyone on your staff hold any of the following professional designations or degrees? A. Certified Employee Benefits Specialist (CEBS) B. Chartered Life Underwriter (CLU) C. Actuary D. Certified Pension Consultant (CPC) E. Attorney F. Certified Public Accountant (CPA) G. Registered Health Underwriter (RHU) # of Designations 10. Name professional associations to which members of your firm belong: 11. On how many group medical -dental -vision plans does your office presently act as brokers? (Total) # of Groups A. Over 1,000 Employees B. Over 500 Employees C. Over 300 Employees (less than 500) D. Over 100 Employees (less than 300) E. Less than 100 Employees 12. Of the above groups, how many fall into the following categories? # of Groups RFP/HB A. Self-insured - Admin. Services Only B. Cost Plus Funding C. Minimum Premium Financing D. Shared Funding E. Defined Liability Funding F. Fully Insured -Experience Rated G. Fully Insured -Pooled -5- 13. On how many trusteed plans does your office now act as broker? 14. Have the present personnel of your office been involved with establishing 501(c)19) Trusts? Yes 15. If appointed broker, is your firm capable of preparing all required forms to IRS and DOL, such as 5500 with Schedules A and B? Yes Would there be an extra charge for this service under the normal commission scale paid to brokers by insurance carriers? Comments: 16. Since the City is self-insured for employee medical -vision -dental, could your firm perform the following functions? No No Yes No n A. Market Stop Loss Excess Yes B. Pay Benefit Claims Yes C. Prepare Plan Documents Yes D. Prepare Summary Plan Descriptions Yes F. Perform Underwriting Functions Yes G. Perform Actuarial Functions Yes Comments: n No No No No No No 17. As a broker, the City would look to your firm for advice on cost containment, area cost factors for health care services, and benefit plan design. Please answer the following: RFP/HB A. Does your firm subscribe to Health Insurance Association of America schedules for usual, customary and reasonable allowances or equivalent on a regular basis? Comments: B. Does your local office regularly monitor Yakima area provider costs for medical -dental -vision services? -6- How is this accomplished and how frequently is it done? Comments: C. Explain what other methods or resources your company uses to keep up to date on current health care provider charges. Comments: 18. On occasion, employee groups require informational meetings which may be held in the evenings or early mornings. Would personnel from your firm be available to conduct these meetings? Yes — No Would there be an extra charge over the standard group commission paid by the carrier? 19. Name the personnel you would assign to our self-funded group: Yes No A. Key Account Executive B. Service Representative C. Other personnel 20. Furnish biographical information and references of personnel you would assign to our self-funded group. 21. Name the top six (6) insurance carriers used by your Yakima office with whom you now have group medical coverage in force. A. D. B. E. C. F. 22. On a separate attachment, submit a representative list of at least twenty (20) of your office's current group clients and the number of years you have acted as broker or consultant for each. (This information will be treated with strict confidence.) Please use the following format: Client X a m e # gf Employees # of Years as Broker RFP/HB -7- 23. If named as broker, what other services could your Yakima office personnel make available to participants? Comments: 24. If appointed as broker, key account executives may be required to meet at regular monthly meetings and at other times as circumstances require. You may also be expected to provide monthly statistical reports for premium vs. paid claims. Would your firm make additional charges for these services over and above the normal commission scale paid by the current or future insurance carrier? Comments: 25. Has any present member of your firm ever had their insurance license suspended or revoked or been fined by the Office of the Insurance Commissioner? Comments: 26. Has your firm or any staff member ever been found at fault in any errors or omissions of claim with respect to the proper placement or adequacy of insurance coverages? A. What is the limit of your firm's present errors and omissions coverage? B. What is your firm's E & 0 deductible? Per occurrence or aggregate? C. As a separate attachment, include a photocopy of the enforced E&O policy schedule page accrued on your firm. 27. Include a photocopy of your firm's current Washington State Broker's License. 28. Is any member of your firm employed by any insurance company directly as an agent? Yes No 29. Describe the claims administration services your firm provides internally or describe the procedure you would follow to assist the City in obtaining third party claims administration services. 30. Does your office have an Affirmative Action Plan? Yes No A WMBE Plan? RFP/HB Yes No -8- 31. Provide samples of monthly/quarterly statistical reports and rate analysis reports which the City could expect to receive from your firm or a TPA of claims. RPP/HB A. Of particular significance is the demonstrated ability of the firm in establishing and/or providing assistance and service to already established self-insured health care programs. B. A description of the "state of the art" services available from the firm and suggestions for limiting health care costs. C. A representative listing of other accounts the firm is serving, as well as an indication of whether the firm is willing to allow the City to contact such accounts for an appraisal of the services they are receiving from the firm. D. The precise cost to the City and methods by which the firm would expect to be compensated. The proposal should indicate what services will be included in the basic fee, plus a method for determining the cost of additional services. The proposal should also indicate some means of price protection for the City over the expected five-year term of the contract. It is important that the proposer be very specific on this subject. As a condition of selection, you must be prepared to divulge accurately any commissions included in quotations submitted or the service fees proposed. E. Please provide samples of monthly/quarterly statistical reports and rate estimating reports that we could expect to receive from a third party administrative firm with respect to paid claims. -9- VII. EVALUATION CRITERIA All proposals received shall be evaluated according to the following criteria: A. The firm's demonstrated ability to provide services for self-insured health benefit programs of a size and nature comparable to the City's. B. The qualifications, experience, philosophy and compatibility of the personnel to be assigned to the City's account. C. The firm's proven capability to provide selected support services and local access to claims administration. D. The firm's perception of the City's needs in the health benefit area, and the quality and responsiveness of the firm's proposal for meeting the needs. E. Completeness of the Request for Proposal. F. Total projected fees to the City. G. Other evaluation criteria as determined by the Health Benefit Board. All proposals will be evaluated by a panel of City staff members of the Health Benefit Board and potentially may include community representatives. The Broker selected will be chosen, based on the above Evaluation Criteria and the responsiveness of the proposal to this Request for Proposal. The City reserves the right to visit the office of the firm in order to inspect facilities, review established operating procedures and meet key personneL The City intends to review all written proposals prior to November 1. The highest evaluated proposers may be selected for interviews, if interviews are deemed appropriate. Any brokers selected for personal interviews will be notified of their selection no later than November 4, 1996. The expected term of this contract shall be five years, assuming satisfactory performance by the Broker. Attached is a proposed contract (Exhibit A). The Broker must designate, in advance, the account executive(s) who will be assigned to the City's account, and agree that any changes in personnel assigned to the account will be made only with written approval of the City. RFP/HB - 1 0 - Exhibit A Proposed Agreement for Services HEALTH BENEFIT PROGRAM BROKER/HEALTH BENEFIT PROGRAM SERVICES AGREEMENT THIS AGREEMENT, made and entered into this day of , 1996, by and between City of Yakima, a municipal corporation of the State of Washington, 129 No. 2nd Street, Yakima, WA 98901 (hereinafter referred to as "CITY", and (hereinafter referred to as "Broker"): WITNESSETH: WHEREAS, City has determined a need to contract for services and has invited proposals under Request for Proposal dated , 1996 for said services; and WHEREAS, City maintains a self-insured plan to cover its employees for Health Benefits in the State of Washington; and has agreed to perform certain services in connection therewith, as herein set forth: WHEREAS, the proposal submitted by Broker was accepted by City under the provisions of Request for Proposals dated , 1996; and WHEREAS, City and Broker desire to enter into a contract setting forth the services to be provided by Broker to City as provided herein; WHEREAS, Appendices A, B, C, and D attached hereto are incorporated herein; NOW, THEREFORE, in consideration of the mutual promises and obligations hereinafter set forth, the parties hereto agree as follows: RFP/HB Services Agreement -1- ARTICLE I COMPLIANCE WITH RFP DOCUMENTS Unless otherwise provided for herein, Broker agrees to act as representative for the City as its broker of health benefits, in accordance with the provisions, terms and conditions of this Contract, the Request for Proposals, all documents related thereto, and the Broker's proposal. A list of all documents is attached hereto as Appendix A and all such documents are incorporated herein and made a part hereof Any modifications to this proposed contract should be stipulated in the proposal. True and exact copies of this Contract and all such documents listed in Appendix A are on file in the Office of the City Clerk, City of Yakima, 129 No. 2nd Street, Yakima, WA 98901. Unless otherwise provided herein, the City's Director of Finance & Budget shall decide all disputes pertaining to the execution of the services required under this Contract and of the administration of the Contract provisions. ARTICLE H SCOPE OF SERVICES Broker shall perform the work and services specified in Appendix B - Scope of Services, attached hereto and made a part of this Contract. ARTICLE III TIME OF PERFORMANCE This Contract shall be in effect for the five-year period commencing , 1996, and ending , 2001 unless extended upon mutual agreement of both parties. ARTICLE IV COMPENSATION/CITY RESPONSIBILITIES City agrees to pay Broker as compensation for the performance of the services set forth in this Contract in accordance with the provisions of Appendix C - Compensation, attached herein and made a part hereof. RFP/HB Services Agreement -2- ARTICLE V CITY RESPONSIBILITIES City agrees to perform the responsibilities as described in Appendix D -- City Responsibilities, attached herein and made a part hereof. ARTICLE VI GENERAL PROVISIONS A. Broker, at its own cost, shall obtain and maintain at all times while this Contract is in effect all licenses, permits and certificates required by the laws of the State of Washington necessary to enable Broker to perform the services set forth in this Contract. Broker, upon the request of City, shall furnish City with evidence of compliance with the provisions of this paragraph. B. Broker shall not assign this Contract without the prior written consent of City. This provision shall not prohibit Broker from subcontracting for any of the activities to be performed, however, any such assignment or subcontracting will not relieve Broker of its obligations to the City under this contract. C. (1) City or Broker may terminate this Contract any time upon ninety (90) days prior written notice; provided, however, in the event Broker fails, at any time during the contract period, to maintain all necessary licenses, permits or certificates as required by Article V, Paragraph A herein, City shall have the right to terminate this Contract upon three (3) days prior written notice. (2) Upon termination of this Contract, Broker shall, at City's option, continue to supervise and report to City on all claims based on events which occurred during the terms of the Contract prior to its termination, until such time as the disposition of such claims is completed. (3) Failure of City to insist upon performance of any of the terms and conditions or requirements of this Contract shall not be construed as a waiver of such items, conditions or requirements, and the same shall remain in full force and effect for the duration of this Contract. City expressly retains all other rights or remedies provided by law or any violation of this Contract, and no other action by City shall constitute a waiver of any such right or remedy. D. City or Broker may, from time to time, request changes in the terms of provisions of this Contract. No change shall be effective unless it is mutually agreed upon in writing by City and Broker. RFP/HB Services Agreement -3- E. Broker will indemnify and hold harmless City from any and all loss, cost or expense to which City may be subjected solely as a consequence of the willful misconduct or negligent acts or omissions of Broker and/or its employees in connection with fulfilling its obligation under this Agreement. F. City will indemnify and hold harmless Broker from any and all loss, cost or expense incurred by Broker and/or its employees as a result of the performance of this Agreement by Broker and/or its employees caused solely by the willful misconduct or negligent act or omission of City and/or its employees. G. All claims and related files generated by Broker as a result of its activity under this Contract shall remainat all times the property of City with the exception of any supporting data required by Broker to make such accountings to City or excess insurers as are required in this Agreement. H. Broker is retained by City only for the purposes and to the extent set forth in this Contract, and its relationship to the City shall be that of an independent contractor. I. City agrees during the term of this Contract and for a period of one (1) year following its termination it will not employ any person employed by Broker during the term of this Contract without the prior written consent of Broker. J. The waiver of Broker or City of the breach of any provision of this Contract by the other party shall not operate or be construed as a waiver of any subsequent breach by either party or prevent either party thereafter enforcing any such provision. K. The obligation of Broker to perform its duties hereunder is conditioned upon City's cooperation with Broker with respect to the activities of Broker including, but not limited to, responding to Broker requests for information promptly, meeting with Broker and/or third parties, as may be needed, making decisions on matters which, in the professional opinion of Broker, should be made by City; the provision of funds, and performance by City of all other obligations of this Agreement. L. All notices at any time to be served by City upon Broker shall be in writing and sent by certified mail, postage prepaid to the Broker at the address first above written. All notices at any time to be served by Broker on the City shall be in writing, sent by certified mail, postage prepaid to the City's Director of Finance and Budget, City Hall, 129 No. 2nd Street, Yakima, WA 98901. In the event the name or address of the party herein listed to receive any such notice or City or Broker shall change, City or Broker shall, within five working days thereafter, notify the other in writing of any such change. M . This Agreement sets forth in all of the terms, conditions, and agreements of parties relative to the subject matter hereof and supersedes any and all such former agreements which are hereby declared terminated and of no further force and effect upon the execution and RFP/HB Services Agreement -4- delivery hereof. There are no terms, conditions, or agreements with respect thereto, except as herein provided and no amendment or modification of this Agreement shall be effective unless reduced to writing and executed by the parties. All terms, conditions, definitions as set forth in the Agreement will be interpreted under the laws of the State of Washington. IN WITNESS WHEREOF, the parties hereto have caused this Contract to be executed this, the day of , 19 APPROVED AND AGREED TO: CONTRACTOR By: By: R. A. Zais, Jr., City Manager Its: RFP/HB Services Agreement -5- ATTEST: City Clerk STATE OF WASHINGTON } } County of } :ss. On this day of , 1996, before me the undersigned, a Notary Public in and for the State of Washington, duly commissioned and sworn, personally appeared the of , and who executed the foregoing instrument, and acknowledged to me that signed and sealed the said instrument as free and voluntary act and deed for the uses and purposes therein mentioned. WITNESS my hand and official seal hereto affixed the day and year in this certificate above written. RFP/HB Services Agreement -6- NOTARY PUBLIC in and for the State of Washington, residing at My commission expires: Exhibit B Annual Reports 1991-1995 CITY OF YAKIMA Mandel Summary 1-1-913b 124148 6277,878 T. 6271,939 3277,417 $261,481 June $290.889 3263,660 3264.461 66,936 $3.900 59,047 39.030 10.122 60,151 *1:3,462 $12,011 312,666 $12,664 312,666 512,813 512,940 612,997 $$16.761 646,400 $30,475 536,419 $61.246 990,641 $'29.190 $36.209 101.910 118,469 77,260 37,825 $0,679 311/.406 67,06940 $7,140 1134 ,512 832,371 $62,916 536.600 $36,092 616,166 $30.646 11216,900 61146,320 $166,069 3252,100 $266,090 3296,544 6192,666 6166,029 cad 1241 671.979 $102,017 60304.186 $67.186 km Calms Per Eng Pat Mal .1998 640.62 610.04 Ave Cale Per Emp Per Month -1006 145.29 $10.06 Mnanlpe Change 9.0% 8.7% Toa paid cans at amnion Lase dens atomb el $118,000 Individual wow &ducal, Net total dame Less premium and meta pea annuity ( ) R.snss needed (16% of a m pd o4ekra) MsMwe from embody 6 month Calm Lag Andy* essInnkg clean memo Pan reenvss and surplus b dale Nat MOM calms Lase dims next oc en d under myopia men bee poky Net dem cowed by woods ds exceee toms Net Calms le Ammo* Deducible Lo.a Retlo Menge ebbs *owed by eacregehe per employee per month Mame told dean Dost per employee par month utast year aMetaps !alb dales dost per employee per month Pwoseeeps damps In amigo Post per employee 336207646 1) 16) ($86 )) (3313,490) 316,478 311,072 311,072 $11,072 $11,072 $11.07 $277.770 $1.71y'.928 (5302,418) 646.72 $278.62 $41.34 $239A6 9.4% 18.3% Fund Balance $11,367.860 sac -1111-11W1;331.-- 30,600 $631,300 $320.625 *311,790 $1,361.331 32,361.331 0.906 5364.30 11864.54 6336.17 14.5% 6360,407 761 1 0352,751 700 1 5362,378 762 626 5361,664 792 623 3367,276 774 631 3366,666 771 631 $370,310 761 636 $371.483 783 65T 1,279 *411.07 $242.10 1.287 066.19 2200.47 1,281 6330.70 $199.36 1,286 2485.37 x.42 1,306 $436.17 $267.70 1.,302 3529.60 $313.66 1,316 $343.10 $20302 1,320 8371,21 $22020 $2.921,963 6,143 4.234 10,377 3414.26 Last Yee Moray TCOMOast 6308.31 6218.24 Percentegb Menge in cost • 13.1% 159% Comae, I f eetive IMO ,000) Appnpde Mm Feeble racks. MOW, IINOMP contract Ila* PAID (*306,60) En oy a $224.86 Dependent • =367.17 36,210 Ammo) Preamlume Annual 69.500.00 5116,0001ndMat Ek Loess Re/ee Contract Bads: PAID Employee Dependent $6.72 69.70 Medial Employee AP Dependents Dana Composite Leotr I RECEIVED MAe`0or EnnPleY'e M D.pmndsnts Dental Campoene SE p 23 1996 $145.29 6201.63 666.90 7267.61 6201.63 660.99 A4tdYals Expected Cana Coat 'flits plan year $390.01 Proleeted Clain Cat Nadmt Plan Yaw Average Gam Coat $28429 Cam Lap Meet 1.00 Trend 1.12 Prat amp Exp Paid Cams 6430.62 26%Manr& AWrcamFactor 6639.15 Caned sayegele tombs on a ocanpoelle Wale %damps expeolsd 6478,6$ 13.1% 0x04�'�%fi.:AiM,A...:....,.: 700161, . Human Resources D'►v\OT •t'We NW.* * at•Mi1 &DM •M••S i•' t••M1•41 • • • • . fN NN ENV • • • • • qt•N •M WNW* • • • 1 14 • • ft tLt MM eta 1114 swot N• N••SNM • • • • M M INC N 1111* MM tern MM •••••► or N••N•L* • • • • • net MS•e • • N 1 • Nora N• N•NN*• • • . 4 0•1 UM •NS tN • N ' • • M •M••• N• Warn • 0 1 • N N• CM •M• CO 41 • • WNW M• SL•teret • 0 • • tett • O •N Met UM Stet •it SN Wall or N•M••f• 4 • • • ttt VIM OM Kt SOU NM 0011 Sete •NSU N• N•MNN • • • • Lt at 101 • am • 11 .at vas • *CCU SM Wm,* • • • as as mg •K•• KLS ' • • • • awn M• tt'•N•N • • • • Nt N Mt K vase Mt NU Net •M•1S N• M•NN*• • • • UST N Me MM MK NR UN Me • •NSM Sr N•NLh• 0 • 0 • M► Ne as MSN sem am Met sus nem N•Nih NY1SVTit • • • u SN PALO PM Stell KK au • • sarw11 111011101111011 u...m.+w A....ewNIIr• •rMe••A dSfi•• swim MM"0* yowls •0.1Mes ilt••IY Imo f•Mt aw trait *Wu& e• •sew asesares tt' wwows N•M•'ttt• • Rfi'iesef: Mt emu tMtMR all all w M ••• VW See ai11 Mt a*l M w M•aq•e• • 011111 •► 31_. "pear pea .irhw •tfi+•N•a 0t31•00/ Too1144102 •0* •u••rMPtNf wawMwsq • rmispea CITY OF YAKIMA Amadei Summery 1.1- 95 b 124146 + • • • 0 2269.263 39,168 1112.071 $26.821 57.626 527.668 $206.632 ($24.776) 2267.411 $9,116 1112.020 546.616 37,083 029,258 3109,313 ($30,725) $266.931 69.079 $12,033 $27,503 $11,251 $23.021 $200,172 ($56.858) 3271.300 $9,265 $12,183 325,010 $6.571 $28,104 $227,107 ($99.700) $272.404 $9,292 $12,336 $30.795 310,466 345.733 3171.886 ($107,826) $773,236 $9,330 512.234 036.411 54.565 327,536 31676495 (902,154) 5273.880 59,251 512,326 ' 534,078 $6,767 527,676 5223,606 (5134,208) $273.626 39,345 512.356 $30.466 38.146 $27,616 3163.325 ($120.707) 3274.262 39,363 313417 336.847 $4.048 $28.663 *165,281 (3101,064) $275.689 $3408 $12,503 330.313 $7,972 $39,424 $170,731 ($00„726) *277,329 39,436 $12,586 $25,078 $6,226 330.193 $114,743 ($19,637) X76143667 $18.720 1 61 3111.39.35 '2 400 j108.055 $4.931 931282 47 532 584 858 7 ,403 $2 13 968 16726 Ara CWms Per Eng Por Mattie -1906 $45.29 Ave Mena Par Emp Par Month -1994 $37.78 19.9% Parva mega Changs Total paid Manna al con►erapss Lase deem excess of $115,000 kedvidual excess deduohttds Net 1394 claims 160.608.1801ekns to op* to prwtotr pen year. $10.06 $9.67 4.0% Less minium and costs paid annually (egylbonver/askep Mo) Reeavw needed (16% of inn pd dolma) Rasatvee Bonn quertay 6 mord% Cahn tau Analysts deka mentos Plan reserves and sopa to dens $41.34 $40.98 0.9% $2,996,615 50 52,995,615 39.600 $449.342 $317.063 $304,684 Net told deigns 92,995,616 Wm deka rant cowed under spgempete mem toss pokey $0 Net dohs savored by sepeeste areas. 166 *996,615 Net Clalrns to Wear R 119 Amapa covered by sample per amply/es permonth Average tole claim Dost par pa man % LAM year ammo tate Maim tint tar emplopm per month Paromeaus change b avenue cot per anickspaa 0.794 $336.17 038.17 $754.08 133% $7:19.46 $207.64 15.4% Fund 8alanca $10726 57.226 $311,790 $310.866 $306,,171 $307:025 $312,0©9 $314.288 $315,670 $318,207 $316.042 :316.649 $316,176 $319.100 17.1$ 160 + + 734 515 731 509 730 5(16 739 519 741 622 736 520 743 827 745 525 748 625 754 526 767 627 75 $25 9t 6264 Last V. Amiga Torii Oot Mimentap Change N cost Comma. HfAt v. 1/1m6 Aggro,* Claim Festers Fasters looluds MO V Contract Bach PAD Employee $202.35 Dependent $314.04 A99ra4d* Premiums Annual $9.600.00 3116,0001ndh► Ex Lees pater CanaaoteaaN6 PA69 Emptor m $6.06 Depends** $9.20 Accrue% Meckel Employ,* At Depends* Dental Compost/4 Lioffl Medical Employee AU Dependents Dennie Compos -e $146.28 1201.63 $56.99 $267.81 9201.89 $68.99 :R 1.249 3401.88 1236.06 1,240 8376.08 $221.11 1,236 540638 1290.36 1,256 $423.68 8248.83 1.263 $379.66 5222.74 1,268 9300.00 $204.00 1.270 3476.37 $24946 1.270 $350.38 $206.64 1.273 5341.46 $200.64 1.260 $969.81 $211.11$ 1,264 $'086.66 3167.36 1276 $310 $185.$3 15,165 6366,61 $216,24 $312.62 $182.641 17.2% 17.7% Aggroga,* Deducllbla Andyeh &paled GlcA Oat This lit year Projected Clain Cast thea Plan V. Average Palm Cot Claim Lag Must Mend Pawn Change Exp Pahl Claim 26% Mar n Ayr Claim Fedor $336.17 140 1.12 140 9376.61 1.25 anent Pppmp a *Mr 5n • compeers boob % chew acpsaled 647044 F '1 . x 7: ,' 10:7_.1 •111 7.41130.04 s mgsseet ••misl.tmNws. tsra. 1.a1.1e..1 I1.010.. 3.4.40112. 30.1y101. lh..+osr J.m..e1 2. Ins , Passe $ 2104401,00.2 ..mese I..r• 1111.11 .•• + :mask....21 .ld.n4 we . 40 sI gewel• LW* Owe aril 444416 44014011.64 ib. PA Ira 1 pe ■w Jmw SO •e• w list 4w Dm Ps 01.120 21101419 3.14 3.4.140 •11.4r•ejtdpirdr +r, fobs sone 11t41 24724 110 11141 7441 027 144 21011 on moss 111.100.11 44.013.41 221.01) 121 • 102 0 • 7102 4073/ 11e3 07, 0$1 0 0 71/073.44 .03 42.720 114 14111 0111 10/1/ 010 234 07 71 He 411 M 114 90.12.4e .0 31.311 41 0 22 07 201 fu 14311 174 MMS Mt 011 NO 7140113.11 .4, 44.904 •7.12.•1 u.n.N 010 1113 144 111 1111 Ins 1100 11114 224 710 201 042 21.400.10 .14 20.412 22 140 212 4424 40 211 3 • 310 17014 44, • 11.0113.9) .40 21.214 • • 0 1112 N 14442 1400 24, 100 .113 143 0 11.144.41 .4, 40.471 4, • • • 307 172 • 7s 141 2011 10110 411 33.004.70 .4, 4,.140 173 240 HM 20473 1410 3104 • • 0 • 0 0 21.40.01 .04 21.02 124,7 4324 10110 M • • • • 0 43 12 0 10.101.07 .44 0.110 •w. 1.0.104 227.14142 11.010.42 • Dttt, 16 JAN 1906 Seeefit Aaalyeis Report With Clain Detail Palos 1 Claus paid Meath* period of 01-01-45 t>.soolh 12-31-95 p...4 *0101 CITY OP YAKIMA CO05 DESCRIPTION WILLED CONTRACT PAID DESCRIPTION COUNT 1VERAGE.$SLLEO 4200O COS RROOVZRABLE PAID -DENTAL DM DENTAi. 2032 DECAL - MAJOR VWDZINTAL, PR3VENTATIV1 NPDB 11Y07oc11L PAIN DTS9611CTIOO TRE ORS t11JTR490804840210LAR JOINT TRI= total Doatal 435.84 435.84 435.14 254,300.28 254,340.20 137,161.59 168,447.00 168,447.00 70,623.36 158,304.66 158,304.66 130,701.72 600.00 440.00 345.40 86,274.40 86,274.49 40,230.41 1,440.00 1,400.00 674.50 470,622.77 670,622.77 400,260.41 Provides contract vritsait .00 Sweat teemed oodssnrases 156,684.26 Monet sot covered 30,004.36 Somat sseeedisg plan limit 22,137.11 lsoent ares OCR 3,504.17 !wast previously pessod 24,587.85 COS - Other plan pays 51.712.74 Total. rot paid by this plea 297,410.51 41�L A$BULA110E 16,887.34 16,807.39 0,507.37 AMU 1u1E$T03SIR 76,330.41 76,350.41 61,682.44 110* ASSISTANT SURGEON 11,147.04 18,147.84 12,675.17 CSAR CEIRAPR1C IC SERVICER 71,210.20 71,290.20 42,756.55 f VISITS 2513 28.37 CITE CREMOTNERAPY 2,713.40 2,713.01 485.44 000. COS ASCO IODUN I PAID -MEDICAL 4,143.75 4,143.75 4,143.75 DASD D800 i ALCOHOL DEPENDENCY Mk 23,704.07 23,680.07 10,783.93 SMD 0BDUCT2>ILN AD3057XBNT -851.11 -051.14 .00 WR0O DOCTORS IN SO6PITAL VISITS 53,210.43 53,141.14 40,803.34 f VISITS 518 102.72 00131 DRS 106* VISITS MENTAL AND NER 3,124.00 3,124.00 1,554.00 f VISITS 20 136.20 0ROV DOCTORS OPT= VISITS, KIDNEY 309,054.27 309,045.83 254,112.04 f VISITS 5424 52.17 037. DIAL. LIZ i D11O. TESTS 414,601.11 411,136.50 251464.13 f TESTS 7005 54.14 EQIP DORSALS NIIDICIL SQUIP1D0IT 32,097.45 32,097.45 14,501.29 II 441=0831CT ROOM 137,123.11 128,950.01 74,308.47 RWC 0003 MALTS CARE -SUPPLIES MED* 6,035.96 4,035.46 5,670.14 S118& AUDIT S8VI008 INCENTIVE 237.01 237.81 118.90 NNW WOWPITAL ROOK i BOARD i /MILL 093,605.61 850,283.94 586,736.32 0 DAYS S34 1,673.42 NITON NOBP. MISC. Man i NERVOUS 22,100.46 20,021.44 16,041.60 NOP HOSPITAL OUT PATIENT 13,921.63 13,745.18 0,404.04 0 'WW2 63 220.41 NSOR HOSPITAL 00'2 PATIENT/SURGERY 247,373.41 232,342.40 176,530.69 0 VISITS 131 1,081.35 303 130074114TIONS 116.20 114.20 .80 INPT 31012On =RAPT 4,025.00 4,025.00 4,025.00 2NJ INJECTIOOIB 14,367.71 16,367.71 4,213.12 LAM 41 LEOPP 1DTSOR1*ED 437.18 437.18 437.14 Mali NANOGRAM 4,414.34 4,477.30 2,744.2:7 11aN3 C18N NG1@ /AUDIT/R3VIE0I Ms. 1,065.40 1,465.40 1,945.40 MYSC laSCNIALIMOUlt 11.700 NEO 52,030.10 02,402.45 47,250.71 0,44 003 IO2I3DP1 1151107. 6 103V080 108,576.01 100,412.50 57,001.95 0 VISITS 1411 76.45 PAP PRXONTWIPZ PAP 117111 2,684.30 2,114.30 1,151.90 PCS PUD AG CO -PAT DRCARD 5,110.32 0,177.30 700.64 PTR PHYSICAL =ULM 60,736.32 50,276.44 30,045.83 0107 0ADISTS=12,774.74 _ 12,053.87 6,433.51 RI PRN4CRD1100 14008; 1133 1118 1,316.06 1,311.01 844.57 MCC SUPPLIMANTRE. ACCIDENT 50,461.80 40,900.61 41,781.81 0P0C IOZCIAL 222mariT1; O028ID4 PLAN 057.00 847.00 485.60 OPTS 10E8C4 Tlissum 4,700.50 4,700.50 3,273.03 SIM MOND iORCICAL 0029104 615.06 605.00 463.84 MIR SM460010=4 NEOOVERY 1,703.14 1,743.84 -149.50 anal 80140084 IN Palm= 232,554.40 232,547.18 163,324.66 0 UNITS 184 1,230.45 SOR2 SUM= 001 PATIENT 134,113.48 139,10548 100,441.30 f 118132 1S0 736.48 SUR3 NOM= 04720* 14,603.63 56,603.63 35,704.55 f VMS 510 104.27 1004 •8 COMPENSATION 11,643.73 11,582.43 11,582.43 48X. WELLNESS MUM ADULT i CHILD IN 21,204.58 21,103.76 3:55.40 Total Nodical 3,169,324.42 3,092,335.21 2,117,343.81 Provl4er contract aritematt 76,080.41 Itogatiatioalkedittatmott 4,537.42 Amsat tousad dadmatible 70,741.94 ANoeat Umlaut ealtawassame 204,734.48 ismat sot calmmom4 144,174.70 Amowat exceedisti plias Limit 0,281.34 Ascent aver ITCH: 4,417.16 Claims paid toe the period of S1-0141 through 12-31-35 4t:sap...s 10101 CITY o0 MINA Coos as1cRXPTI031 MUM CONTRACT Dates 16 GNI 1316 3 MAID USSCRIPTION COON? AVCRACN.SELLSO Rao nt pravioasiy proesaeod 106,441.16 Patios! eapayaasat 6,113.03 COS - Other plan pays 434.550.30 Total not paid by this plena 1,047,311.76 COST CONTACT LENSES 20,003.31 20,003.11 11,345.51 TUN TRAMS, 37E CLASSES 27,533.06 27,513.06 16,403.53 LESS 1 sz1>OLI,sl OR TRITOCAL 41,115.36 41,113.36 34,123.02 18X EOOTIS= NYE VISION EXA3. 32,303.10 32,303.10 24,535.22 1 VISITS 337 61.241 Total Vision Total PCS Total Group DEL 30G6/1121 130,327.33 130,327.53 21,227.30 332,311.02 352,111.02 332,311.02 4,323,105.14 4,241,191.53 2,153,352.14 f SERIES 3633 0 3R 456 # IS3Z 131 i 006210 124 2 OMR 133 • Datei 14 JAN 1286 Sensfit analysis Raport With Clain Detail Popo 1 Claims paid for the -.gs od 81-01-25 tbrosS4 12-31-45 0roap...s 20101 CITT OF TAXI!& coos DZSCR,IPTION MIND COMM/CT PAID DESCRSPTION COUN! AVI'RAGZ.52TiUD =WORM & ALCOHOL DEPINDINCT 12PA 33.115 DOCTORS 30 2OSPITAL VISITS 33.0? DOCTORS OT7IC0 VISITS, RIMY DEL MAO. LAB i D120. TESTS 13. RXERCRWCT ROOK 81115 10SPISA2. ROOK & sOARD & UCILL. 11&11 208P. RISC. MENTAL & NZRV008 10 SOS I= OUT PATIENT 1SUR 2oSPITAL OGT PATU*T/sU4JR7 KA11 PRSVSNTATIVo MAMOR3.0 MSC XXSCOL,L NAJOR NSD OPNN OUT PATi2NT MENTAL & NERVOUS PCS PCS C0 -PAT DR= CARD PIM PHYSICAL TZERAPT RADT SADSAMZ011 T0*RAPT SACC SUPPUDOESTAL ACCIDINT S0R1 SORCERY 271 PATIENT 1082 MOUT 00T PATi1NT 'CON 'ORMAN•S COMPENSATION Rs3I. Na1.LNESS NZ .K SMOLT 4 05210 IN 140.00 144.00 108.00 422.20 443.41 141.08 1 V18 5 28.58 45.25 54.81 37.17 i 2 32.63 33,772.41 30,229.73 14,633.24 0 Tse 106 318.41 81,230.68 73,037.65 44,163.40 435,405.85 322,084.18 244,727.41 0 Dam 222 1,421.12 12,720.12 11,511.17 8,744.48 1,744.52 1,548.07 427.72 4 VIRTU 15 176.45 150,303.57 135,273.04 102,124.15 0 VIZ= 83 1,810.21 2,370.40 2,133.34 1,252.21 -4,415.28 -4,252.71 •147.38 1,443.28 1,472.51 644.14 0 Inmet 1s 01.33 100.14 07.14 .80 20,351.14 17,841.78 10,523.44 7,246.70 6,340.03 3,433.80 20,311.55 18,331.28 13,504.73 1,143.75 1,134.45 548.22 4 WS= 1 1,143.75 84.00 75.40 14.37 4 UNITS 1 84.00 412.28 551.68 551.68 143.00 57.18 -103.00 Total Radical 765,428.24 688,300.58 448,044.24 Provider contract =itself Ascent toward deductible Sweat toward coinsurance Amount not covered Amount =seeding play limit Saoast previously processed Patient =payment 008 - Other plan pays Total sot paid by this plan 330,447.47 1,315.17 44,141.67 41,214.11 1,342.23 22,473.13 2,747.58 130.215.00 Total Group 765,428.22 418,502.58 448,064.24 Mond Accrual Jiro "k • 6214.032 Feb .•'• 205843 SAM'; 207.451 Apr ,,f1. 280.896 Miryv 270,613 ivy 271.631 .Ind y ' r: 273.788 Au9; 271,216 Amen 4 tJWdal . %won Premhum UR Fees •Pd Chhns Pd Ctrin4e • ... Medical Pct Ming '.41/41Ciatins 8.833 8.641 6,594 8,538 8,689 5.644 6297 10,906 22,018 4,837 10,666 14,927 3.430 10.663 32,140 3,659 10.862 23,811 4293 10.799 27,826 8,549 10.859 35,997 10,919 12..290 36,252 9.452 12,145 29.724 10,094 S p272.0s5 6,588 12,222 27.936 9.730 Oct': v. 270• 980 8,534 12.170 22,170 5418 Nov 271.674 6.663 12.165 29.701 6,159 oeq 270396 8.60 12.131 301805 6.079 Tot 3 061 574 103 677 137 918 333 309 • . 319 7.970 9,173 6.527 16.474 24.663 37,766 27,230 15,693 20,058 39.069 25.408 24.404 256 353 147,034 108,297 163,121 142,268 137,331 183,670 106,415 177,360 480,028 126.067 120,729 149.323 2 041 804 Ave Cleon, Per Emp Per Monet -1 Ante Claims Per Emp Pet Mond • 1 Percentage Change Told paid dabs artammages Lass dine MONIS of $115,000 Indsidrod excess deducible 994 993 537.78 $9.67 51917 55.84 97.1% 74.3% Net IoW done Lass premium and coats paidennue8jr (agprlbommthetttpdslo) Reserves needed (15%8. ann pd define) Peewee Sam quederty 6 nand Clain Lag Anayale Begbning realm Assentoo Pian reserve. sod aurptue b date 376,807 384,073 0 Not fob, dolma Lairs chins not covered under aggregate moose. bee posy Net dens oaevered by agregtee maw Ices Net Peke a Aggrepie Dottnabbo WM Rollo "image dens covered by aggregate par employes per month Mao teld Odea cod pet employes par month Lest yew 1M11191 bW dela Dost per.mployee per srornli Peroenlege oh"'p" In crersQs ooet per ampbyas 12.394 323,841 726 523 63,971 34322 725 619 44,451 34649 725 620 96.325 327.019 736 525 151.210 324.892 731 521 134,861 326.061 735 524 200,365 328.913 747 625 226.066 326,786 740 523 (60.419) 326,015 741 520 (3.687) 324,729 738 518 66.064 325,604 740 520 103,194 524.309 736 519 103 194 3 903 340 8 822 6 266 640.96 5207.64 310.83 8241.42 276.2% •14.0% Fund 8aienoe 2,716.785 210.870 2,505.915 9.500 2,505,915 2.505.915 0.842 696406 6284.05 6271.55 4.6% 314,064 304.664 304,664 Minkel Dental Medd! Dentd Ave Unitsa'AAonthPet E' Tot lnIni 1.249 5278.83 $162.07 1.244 321525 312545 1.245 5314.16 6115.94 1.263 $281.59 6184.54 1,254 3296.93 317426 1,259 539289 5229.37 1.272 $789.16 3158.00 1.263 8343.65 $201.36 1.261 5754.84 344326 1.256 5291.63 5171.36 1.260 $273.70 5160.74 1.264 5318.01 3166.66 15 030 +' 12.52 8182.83 last Yew Avenge Taiga Cost • Pemerdape Charge b dost Coverage Moll 1MM Agrees*, Cline Faction Factors Dude U V.P Contract Bade: PAID EmploYae 52/0.16 Dependent 5327.18 Aggregate Premiums Armed 39.000.00 $111.000 Indy ex 1 Asa Rales Contract Banta: PAID 8637 Dependent $6.54 Aooruels AlEmployee Darenth ret Concords L.effl $145,20 5201463 35599 EmPkviti AR Dependents $267.01 $201.83 $302.16 517542 3A% 42% AGGREGATE DEDUCTIBLE ANAL Expected aim Cost Ms plan yew $353.411 Protected d Clalun Cent Mod PMn Y. Avenge (Wm Cost Leg Must "nand PYn Charge tarp Paid Cone 25% Minato Air (Ube Fedor 5214.06 120 1.12 ----1.00 6318.14 Cement apgreeP,4e fader an a composite bests % change expected 6397417 644248 •fat% • 60 0 0 0 0 0 0 0 0 0 0 0 • 9.402 9,424 9,464 9,528 9.677 9.584 9.579 9,671 9.644 9,470 9.423 9 440 114 005 11.782 7,713 12.990 11.433 13.941 14,309 10,649 9,941 0.433 13„701 12.755 180 1411847 Ave Oben. Pet Eng Pot Mounts • 1993 Ave CWna Par Emp Per Monis -1992 Pereanb g. Change • • 16,705 13,572 17,176 10,050 13,693 13.712 13.920 16.253 16.729 14,665 15.318 9897 'TY OF YAKIMA F1nent. Armory 1-1- 93 to 12-31-93 + 3.323 166.08 (207.256) 303,662 750 519 3.996 105,056 (347,319) 300.610 737 538 3,235 208,676 (596.769) 308,510 737 636 4,811 164.325 (798,712) 308,309 740 540 2.807 202,051 (1.040.901) 307.4855 742 536 8.834 205.790 (1.290.210) 310.499 746 644 5,262 4,171 241.236 (1.581.032) 306,800 742 540 4,331 6.962 136.052 (1,766.102) 307,005 738 537 4,229 7.034 114.614 (1,924.745) 310,006 749 640 4.612 8.090 195664 (2.171.357) 306,379 741 533 .3„066 12.287 181,932 (2,405.770 304.905 735 532 1 9 529 222 958 C 57717 • 304 906 735 532 49 48 093 146 480 r 677175 3 6851 • • 6 891 8 426 $19.17 $16.01 0.4% Toed paid dime M oovsr.9s. Lose eWms exon d $110.000 Individual omen deducible Net NW oldrne tome preedun and meta pied annually (agg►/corwerhI8q IO) Reeerwe reserves mated (16% or ants pd daime) Roemer Irons quaderty a meth Clean Lep Analysts legintetaidekti memos Ptto MIS!VN end surplus to dela 362.148 267,9®9 0 Net told chine Loss claim not covered undo( aggregate mom bee poll,/ Net dime covered by aggregate exam Iota Net Chime b AgGngal. Dsduc the Loss RW0 Avenge deka* emend by appnagtls pet employe per rootlet Avenge soar! *ton sett per ovedoyee per MOO Lad yew amigo isle) **a host per employe* per e10001 Paroatergs dome b everage oast per ongtoree 910.63 2,414,322 0 2,414.322 9.600 2,414,322 0 2,414,322 0.055 4271.55 $271.55 4252.74 7.4% $241.42 5244.42 •12% Fund _gt (2.677.176) (2,006.675) (2.400,075) Pewattsgs Change In oat Coverage Ethetive 1/1193 Aggregate Claim Foston Factors MwNW+MIWV/P Contract Mule: PAD Employes Dwindled =le Provolone. Co waslon 1195.03 $303.06 $9.600.00 10.00 $110,000 bar to L9s6 Estee Contract easter PMD Employ.. Dependent 95,85 $8.94 Cirtrl+it: :,::.,4t,: n: .. ..: Mika .M.InFit.M7 1,299 1.273 1.273 1.280 1.276 1.289 1,282 1.276 1,259 1,274 1.267 1 16 316 $277.40 $191.12 $34224 $271.25 $327.60 9335.00 $393.01 $250.67 1214.12 $333.09 $321.35 9163.96 9110.66 5196.14 5156.63 *190.19 9193.98 9227.47 $146.04 5124.42 $194.20 $166.42 90 ' 1 06 7.0% 6.4% AOGREGATE DEDUC110t.E ANALYSIS Expected Cella Cost TNN pen your $331.69 Projected Claim Cost Next Plan Year Average Ol01m Cost Ohio Leg Atted Trend PNn Ctwg. 3xp Pled Cessna 4271,5 1.00 1.20 25% Margin Aggf Cbkn Factor Currant aggregate tailor on a composite bass % Orange o reoled 126 $407.32 $414.48 •1.71, al, at Yakima ii.necld 3.seswry 01101M 10 12/31/92 *sustw • blew /.1 Adak i 13ew1.. •'. Viols Pi;a Modal (lswrerd Aurettile 0 " �`'+:� , "r, '1y1.J vo bit ir+ ✓ %to b Aaawt 14es�+ ' tilt Peer Md C!e#aM N Chios Pei (Wow N Claire. MW.cr 13.4.4 R.r.lae y top ' • ()3.250Psi 111 Msido ' IbM 1145149 ' 1.90 1.246 1.241 1249 1.256 1.264 1.276 1.274 1.213 1235 1.232 1.2'21 3.112 1r Pilo Mrs M lees M Awe Sep 11.. 13re jos • 10.930 13.569 13.127 10.011 /6.069 17.741 11.369 3.440 11.397 $6.266 11.272 11„10 • 1,030 4.111 5.399 3.203 4,1129 5.213 300 3.461 1.042 4.233 3.764 1.540 *191.106 5192.013 1192.941 $193.195 $193.913 $198.717 12134124 *2/2012 *21330 $213.791 1137.232 _ *212.291 2.416,4 57 107.663 143,291 161.17* 52,315 • 3,701 11.604 3.256 3.661 9.073 9.133 9.105 9.086 9.171 9.170 9.133 3,943 361 11.009 12.067 11.731 $.736 *4.942 12.113 6.233 161637 IWO *4.242 15.510 MsChien Per amp Par Nsnb•19.22 Aw Chists 140 Sapp 1tia Wade • 1991 ib.asls3s t31.s3. *13.01 $ola 0.00% '13sidpaid *isms aleswa23 e lira dim awn 11103000 1.11416.1 mow &WI* NA idol dims larepraides .1 eatl peld an* r wi I1.sh.r.edr reeee.wr.i!(1,64asropi_Wsoes /!wore. 6094. 6 •s.do Chrism 1483 Beigiro.i.3 4031* eersIves 19ws_._. ardor 114twat Alm lass Aims sstssrwsdwear wee* woo Mspalm 16t4 arbor ormird by resseenle wanIIS • 1..91 *0110 0.0095 „9,105 20.242 0 16111.1oswAwepoes 11.660111s1.09 r*s Avow skim s39wsdb 241sterlsyse1SOPA Amer 001 aim ewe pre masisysi pa' was* 03131 yaw ~go owl dim owl ps10,600per elss* ___*s *» •o» mod far employee 24400.905 119670 2.261.235 9,500 2261.235 0 2261.235 0.705 6.74 *232.74 $ato Seal` • 120.155 157.141 167.1211 169.145 311.092 211.712 174.134 95.124 24 M22 227.119 20'!,33* 292.125 39.426 37.512 11.216 1.051 44.301 (16.144) (13.619) 74.745 2.996 (56.599) (115291) (210.02) 2.126.142 (240,402) 3,649 3.947 6.233 Lw Yam Arer.3e Told ars Pera.0.3s Cop its am 224.930 264.420 262.025 263.714 265.100 266.919 269.316 263.350 271,013 271.309 270.297 269.330 • 726 723 734 731 743 750 755 755 759 751 756 750 • 521 523 507 511 513 515 521 519 526 527 526 524 *223.11 3000 0.03% Pad tirle.os (100.73!) (110212) 11 KM) IiRseliw 121192 Annea1s Clio Podsni tiap3.l.s *17132 13grrdrd *267.92 Asssases• w.soi»J1 C:.rwsiew 00.50 Amami *9.500 1100,39*1 I.,Nv M 1m.lar•. 71.41707,9 *3.53 Itrta.4sM *309 *210.93 • *12244 *270.25 *156.** *290.23 1171.66 127737 *164.01 1212.92 *125.95 *346.95 *2205.70 1210.63 1166.01 1164.12 *9747 *376.90 *12242 *361.71 1213.37 *326411 *392A3 1450.92 *765.46 2.41 $1466.43 OA% AnOSSOMIIIMIK11112 ANALYSIS Lpss#e0ari.Oe1 lw ul.. ries *236.90 Pad CoOwoda taw 'err Meow 0,660111 Chloe Thad Plea amp lbso ll Cl les 2,16 *Or Aug Chirs*Oat 125214 1101 1.90 IJ30 *303.21 135 Celeest swede hat ea ampeoks hob SehmAyearldel *379.10 =550.$1 5.7913 C 0 CITY OF YAKIMA SELF-FUNDED HEALTH CARE PLAN TWELVE-MONTH REPORT JANUARY 1, 1991 THROUGH DECEMBER 31, 1991 PLAN COSTS SUMMARY Paid Claims $ 1,829,054 Less Excess Claim Reimbursement <20.602> Net Paid Claims Expenses: Aggregate Insurance Premium Claims Processing Fees Individual Excess Insurance Premium Consulting Fee Conversion Insurance Fee Life/Accidental Death & Dismemberment Insurance Premium TOTAL PLAN COSTS Key Factors: Average Number of Average Number of Average Number of Average Number of t $ 9,500 117,670 97,389 8,500 4.263. Active Emplo frees Covered Retirees Covered COBRA Continuees Covered Families Covered $ 1,808,452 237,320 31,178 $ 2,076,950 582 158 6 517 NOTE: This report is on a paid basis only and does not show reserves or otherwise address claims incurred but un- reported as of December 31, 1991. -1- 1 - LEOFF I Police Officers 2 - I.EOFF II Police Officers 3-•LEOFF I Firefighters 4 - LEOFF II Firefighters 5 - Fire Department Employees 6 - Management • LEOFF I LEOFF 11 Regular Management Union Exempt Supervisors * 7 - AFSCME 8 - Airport TOTALS CITY OF YAKIMA SELF-FUNDED HEALTH CARE PLAN TWELVE-MONTH REPORT JANUARY 1, 1991 THROUGH DECEMBER 31, 1991 DIVISION ANALYSIS ACTIVE / RETIRED / COBRA Average Paid Claims Per Average 1 Average 1 Paid Employee Employees Families Claims Per Month 83 47 $ 253,929 64 51 153,177 91 37 243,175 24 18 51,947 12 10 30,756 28 21 127,942 2 1 5,432 40 29 98,550 15 12 28,115 15 14 57,808 366 272 745,805 6 5 32,418 746 517 $1,829,054 $ 254.95 199.45 222.69 180.37 213.58 380.78 226.33 205.31 156.19 321.16 169.81 450.25 $ 204.32 Average Administrative Expense Per Employee Per Month $ 33.07 31.68 29.49 30.01 32.93 42.91 30.60 31.38 28.93 40.80 29.26 48.16 Total o. $ 288.02 ' 231.13 252.18 210.38 246.51 423.69 256.93 236.69 185.12 361.960. 199.07 498.41 $ 31.01 • $ 235.33 * Division 6 Supervisors had 35 employees with 33 family units for 8/91 through 12/91 only. -2- Exhibit C Rate Analysis and Sample Reports CITY O" IWLCINIA Accrual Rating Pools Report fio Employee Health hog= Board The folipwjng numbers rc$oct consolidated medical and dental ram pools for the City's plan. Actual net paid gams are taken 6om the most current MA 18 -motet rept for the period ended 6130,%, and includes all voids and refl nds and is net done excess reimbursement totaling $36,590. 4 . Dem (181) LBOFF I Employees (587) Non-LEOFF 1 Employees (532) All Dependents (650) All Dental (incl. AFSCME) % Change 7-1-95 1996 7-1-96 7-1-96 Budgeted to Base Budgeted Bass Trend Trended ._Bate dcwl Assad Asmal • $270.96 3326.49 S272.67 5299.94 •c854> 147.16 137.32 162.34 178.57 1% 166.29 200.37 200.96 221.06 10% 49.90 44.89 56.66 62.33 14% • The above rates incorporate actual foxed plan expenses (SAFECO and HMA) from the 1995 plan year only. PCS claizps are allocated to each pool as a e of the total medical Excess reimbut.serneilt is Included (iin iump.suin) in pew when paid and not accrued over period the and claim is incurra Trend factor for medial and dental is 10%. There is no reserve adjustment.. Revised 7-29-96 • c wcrdld city .1 S CITY OF TANIKA DIVISION EO FORE . EMPLONEE S "WARE PLO MONNTI OF 001 Active (Police LEOFF I) 001 Retired (Police LEOFF I) 002 Active (Police LEOFF II) 002 Cobra (Police LEOFF II) 003 Active (Fire LEOVV I) 003 Retired (Fire LEOFF I) 004 Active (Fire LEOFF II) 005 Active (Fire Pore) 005 Active (Firs LEOFF I) 005 Retired (Fire Pers) . 006 Active (Mgt. Regi) (YAR/AIR) 006 Retired (Management Req) 006 Active (Mgt Police LEOFF I) 006 Retired (Mgt. Police LEOFF I) 006 Active (Mgt. Polios LEOFF II) 006 Active (Mgt. Fire LEOFF I) 006 Retired (Mgt. Fire LEOFF I) 006 Active (Mgt. Firs LEOFF II) 006 Active (Confidential) (EXP) 068 Active (Supervisory) 068 Retired (Supervisory) 006 Active (Council) 006 COBRA (Council) 007 007 007 007 Active (AF ) Retired (AF ) COBRA (AMU) Active (TRAM) TOTAL GRAND TOTAL istapo 1' su PARTICIPATION IKPLOrill REPLOTRE AN n:P ►ESTa .q ef er 't� a .� kt,poa; • -1121144 • Wir YAKIMI for S 1!K 1St0141 12 SV t9% rte. M PIT PLAN MIIIAI L.... JOS.TITLE... rre.r11C.... Insured Is 4 Aries.... MOMS SRA 901 NOV rrA.iws IMAMS OIL WI 901 res. r►r. OSLO 01111 CALOSSONSISOSS. WPM 42 MIL SALARY $IRTIw0A1R CST CAT art art 111110IrI*1111332 1343 479 417 292 3411 391 7111 1343 479 417 2911 340 391 7114 1 •A, Exhibit D Current Plan Document OkpOR,1 ri.1)_ CITY OF YAKIMA REQUEST FOR PROPOSAL for BROKER OF RECORD SEDGWICK NOBLE LOWNDES 1430 N. 16th Avenue Lake Aspen Park P.O. Box 2547 Yakima, WA 98907 800-572-9170 509-248-7460 Fax: 509-248-9007 QUALIFICATION QUESTIONNAIRE Page 1 SCOPE OF SERVICES Pase 15 EXHIBIT #1: ACCOUNT TEAM RESUMES Page 18 EXHIBIT #2: CLIENT LIST Page 21 EXHIBIT #3: EXPERIENCE REPORTS P EXHIBIT #4: E & 0 SCHEDULE EXHIBIT #5: AGENT AND BROKER LICENSES Page 31 EXHIBIT #6: RATE ANALYSIS REPORTS Page 3 EXHIBIT #7 AUDIT RESULTS page 3 HEALTH LINE Page 42 QUALIFICATION QUESTIONNAIRE FIRM'S NAME Sedgwick Noble Lowndes, a division of Sedgwick James of WA, Inc. ADDRESS 1430 North 16th Avenue, Yakima, WA 98902 P.O. Box 2547, Yakima, WA 98907 1. Sole Proprietor Partnership Corporation X Principal Ownership Names Sedgwick Group PLC (publicly held company). Date your firm was originally started in Yakima. 1952 Sedgwick James traces its roots to Chicago where Alfred James established an insurance agency in 1858. Sedgwick was established in 1879 as a London-based broker. The two organizations merged in 1985 to create one of the largest insurance brokerage firms in the world. Through outstanding internal growth and selected acquisitions, including London-based Noble Lowndes in 1993, Sedgwick has expanded its worldwide position employing 15,000 colleagues in 260 offices in 63 countries. Locally, the Yakima Sedgwick office began as the Lynn Latta Agency in 1952. In 1966, the firm was renamed Central Insurance Brokers, and merged with Sedgwick James in 1975. Since 1975, the office has grown from an agency employing 11 to one of the largest agencies in Central Washington with a staff of 36 in Yakima and 7 in our Wenatchee office. Licenses held by your firm's personnel # Reps. Licensed Life and Health 8 Property and Casualty 21 National Association of Securities Dealers 1 1 Sedgwick 1 1 1 1 I 1 1 5 Total number of persons employed by your firm in Yakima 36 6. Total number of persons presently employed in your office who work exclusively in the area of employee benefits. A. Account Executives (Consultants) 4 B. Administrative Assistants 0 C. Technical Assistants 3 D. Clerical 1 In addition to the employees referenced above (that work exclusively in employee benefits), our Benefits Department also utilizes support staff shared by the entire office for accounting, reception, mail, etc. Sedgwick Noble Lowndes (U.S.) has a Technical Unit that supports all U.S. offices in the area of employee benefits. This unit provides publications designed to keep our clients apprised of developments and trends within the arena of employee benefits. In addition, this Unit's staff provides our office with technical and legal updates that affect health, welfare and pension plans, and provide additional technical research support as needed. 1 7 Has anyone on your staff worked for an insurance company as a group medical underwriter') i No Our Seattle and Spokane offices both employ colleagues who have worked for insurance companies as group medical underwriters. As is the case with all of our Sedgwick offices, individuals with specific expertise are called upon when needed. Has anyone on your staff worked for an insurance company as a group medical/ dental claims adjudicator? Yes 1 9 Does anyone on your staff hold any of' the following professional designations or degrees? # of Designations A Certified Employee Benefits Specialist (CEBS) 0 B Chartered Life Underwriter (CLU) 0 C Actuary 0 D Certified Pension Consultant (CPC) 0 E Attorney 0 F. Certified Public Accountant (CPA) 1 G Registered Health Underwriter (RHU) 0 Please also note that our Technical Unit has attorneys on staff and that we have actuaries on staff in our Portland, Oregon office as well as in several other Sedgwick Noble Lowndes offices. Sedgwick's Seattle and Spokane offices have several colleagues with CEBS, CLU and RHU designations. 10. Name professional associations to which members of your firm belong. Washington Society of Certified Public Accountants; National Association of Securities Dealers; National Association of Health Underwriters; National Association of Life Underwriters; National Association of Insurance Women 11. On how many group medical -dental -vision plans does your office presently act as brokers? (Total) 200 #cfGroups A. Over 1,000 Employees 2 B Over 500 Employees 3 C Over 300 Employees (less than 500) 7 D Over 100 Employees (less than 300) 14 E. Less than 100 Employees 174 Please note that we are not counting additional group clients with plans that cover Life, AD&D, Disability, Pension, and other Employee benefits, and we are including only those clients served by our Yakima office. 3 12 Of the abo\ e groups, how many fall into the following categories') Groups A. Self-insured - Administration Services Only 20N/A B Cost Plus Funding 2 C Minimum Premium Financing N/A D Shared Funding 1 E Defined Liability Funding F Fully Insured - Experience Rated 9 169 G Fully Insured - Pooled 13 On how many trusteed plans does your office now act as broker') 4 14 Have the present personnel of your office been involved with establishing 501(c)(9) Trusts9 Yes 15 If appointed broker, is your firm capable of preparing all required forms to IRS and DOL, such as 5500 with Schedules A and B2 Yes Would there be an extra charge for this service under the normal commission scale paid to brokers by insurance carriers') No Assistance provided for the preparation of the 5500 falls within our normal scope of assistance for the City of Yakima, except Schedule B, which would be billed to the City of Yakima by an actuary. 4 16. Since the City of Yakima is partially self-insured for employee medical -vision -dental, could your firm perform the following functions? A. Market Stop Loss Excess Yes B Pay Benefit Claims No C Prepare Plan Documents Yes D Prepare Summary Plan Descriptions Yes E. Perform Underwriting Functions Yes F Perform Actuarial Functions Yes * * We have enrolled actuaries on staff in both our Portland office and other Sedgwick Noble Lowndes U.S. offices. 17 As a broker, the City of Yakima would look to your firm for advice on cost containment. area cost factors for health care services, and benefit plan design Please answer the following A. Does your firrn subscribe to Health Insurance Association of America schedules for usual, customary and reasonable allowances or equivalent on a regular basis`' No HIAA schedules are typically purchased by the entity that is adjudicating claims and is one method used to determine usual, customary, and reasonable charges. There are other methods used in the industry, including the use of the insurance company's or TPA's own claim data in given geographical areas. B Does your local office regularly monitor Yakima -area provider costs for medical -dental -vision services? Yes How is this accomplished and how frequently is it done'' We regularly monitor provider costs, and periodically compare various carriers' usual, customary and reasonable allowances for certain medical, vision and dental procedures. We also routinely perform specific surveys for appealed claims. C Explain what other methods or resources your company uses to keep up to date on current health care provider charges We have a large number of clients for whom we track detailed claims experience including Memorial Hospital, the Yakima County Medical Society and the Yakima Valley Farm Workers Clinic. We are current on a full range of local provider charges processed through multiple insurers, administrators and Preferred Provider contracts. 18 On occasion, employee groups require informational meetings which may be held in the evenings or early mornings Would personnel from your firm be available to conduct these meetings? Yes Would there be an extra charge over the standard group commission paid by the carrier') No We view communicating with employees and helping employees understand their benefit plans and options as an important part of our performance in representing our clients. 6 1 1 19. Name the personnel you would assign to our self-funded group A Key Account Executive B Service Representative Dan Fisher Debbie Rhode The Sedgwick Account Team assigned to the City of Yakima Health Benefit Board: DAN FISHER CONSULTANT l RONDA IDE VICE PRESIDENT CONSULTANT CARRILEE MILLSAP DEBBIE SIMONSON SERVICE REPRESENTATIVES 1 ( REGIONAL AND NATIONAL RESOURCES Actuarial Underwriting Technical Research Legislative/Regulatory Updates ?0 Furnish biographical information and references of personnel you would assign to our self-funded group Resumes of these colleagues are enclosed as Exhibit #1. 7 21 Name the top six (6) insurance carriers used by your Yakima office with whom you now have group medical coverage in force A. Aetna Life & Casualty D. Medical Service Corporation B. Blue Cross of Washington & Alaska E. Principal Mutual C. Group Health Northwest F. Yakima County Blue Shield NOTE: Our top excess loss reinsurers are Safeco Life and Sun Life. 22 On a separate attachment, submit a representative list of at least twenty (20) of your office's current group clients and the number of years you have acted as broker or consultant for each (This information will be treated with strict confidence) Please use the following format # of Employees # of Years as Broker 23 Client Name Please see Exhibit #2. • If named as broker, what other services could your Yakima office personnel make available to participants`' In addition to the services that we are committed to providing the City of Yakima (outlined in the Scope of Services section of this proposal), our office personnel can make available the following to your participants: * - Group Disability Insurance (Short Term and Long Term) * - Group Voluntary Short Term Disability Insurance (Short Term and Long Term) * - Group Long Term Care Insurance * - Group Voluntary Long Term Care Insurance * - Individual Life Insurance * - Individual Disability Insurance * - Individual Auto Insurance * - Individual Home Owners Insurance - Section 125 Flexible Spending Accounts and/or Dependent Care Plans (We would assist the Trust in obtaining an administrator for these services and in the development and implementation of the Plan.) - Employee Benefit Statements (We could assist the City in obtaining a vendor or software program for the statements and provide input to the development and design if requested.) * Please note that these services do not fall within our broker fees. 8 1 1 1 1 1 1 1 r 14. If appointed as broker, key account executives may be required to meet at regular monthly meetings and at other times as circumstances required. You may also be expected to provide monthly statistical reports for premium - vs - paid claims comm`ssould your firm make ion scale paid by the carlre�t or nal charges for these services over and above the normal future insurance carrier No Please see attached Exhibit for sample reporting. 25 Has any present member of your firm ever had their insurance license suspended or revoked or been fined by the Office of the Insurance Commissioner') No 26 Has your firm or any staff member ever been found at fault in any errors or omissions of claim with respect to the proper placement or adequacy of insurance coverages') No A. What is the limit of your firm's present errors and omissions coverage`' $1,000,000 B. What is your firm's E & 0 deductible') 0 111 Per occurrence or aggregate`' Claims Made 111 C As a separate attachment include a photocopy of the enforced E & 0 policy schedule page accrued on your firm Please see attached Exhibit #4 9 27 Include a photocopy of your firm's current Washington State broker's license Please see attached Exhibit #5. 28 Is any member of your firm employed by an insurance company directly as an agent9 No 29 Describe the claims administration services your firm provides internally or describe the procedure you would follow to assist the City of Yakima in obtaining third party claims administration services Internally, our firm does not process or administer claims. As DIRECT ADMINISTRATORS (DA), we did operate as the only health plan claims administrator (TPA) in Central Washington from 1981 to 1992. This experience provided us with the skills and understanding required to analyze the work of other claims administrators on behalf of our local clients today. These skills are regionally specific, and would have been impossible to obtain any other way. Currently, the only organization that processes health claims locally is an insurance company - Yakima County Blue Shield. We do, however, continue to operate DIRECT ADMINISTRATORS as the Yakima Customer Service extension of Healthcare Management Administrators (HMA) of Bellevue. Sedgwick now owns and operates DA - and may change the name - and is committed to providing this invaluable local services as an option for all our self-funded clients. Today, four or our eleven HMA clients utilize the local DA service. In the future, Sedgwick may set up our local, on-line customer service to allow access to multiple independent health claims administrators (TPAs), providing even more flexible alternatives for our clients without losing the local touch. Exclusive of our DA/HMA service, SEDGWICK is the largest broker/consultant of self-funded health plans in Central Washington, and we use the services of several TPAs to meet the needs of our clients. We do not "broker -out" for TPA services, a fatal error made by many in our business. We instead research the market for the best client fit, with the major qualifiers for TPAs being: 1) Domiciled in the State of Washington is preferred; 2) Experience in the Client's industry (i.e., municipalities); 3) Price 4) Reporting 5) Philosophy on service, benefits and technology; 6) Future plans for growth and stability. Since we do our own excess reinsurance marketing and negotiating, we do not rely on a TPA for access to carriers. 10 1 3p Does your office have an Affirmative Action Plan`' Yes A W'MIBE Plan`' No 3 I Provide samples of monthly/quarterly statistical reports and rate analysis reports which the City could expect to receive from your firm or a TPA of claims. See Exhibit #6. A Of particular significance is the demonstrated ability sele f -insured firmmin stabli care lishing and/or providing assistance and service to already established programs Along with the City of Yakima, we have maintained our consulting broker relationships with several more of Yakima's larger employers since the early 1980's. These employers were among the first groups to self -insure their health plans in Eastern Washington. We have maintained these relationships by staying ahead of the service and technology learning curves ever since. B A description of the "state of the art" services available from the firm and suggestions for limiting health care costs Sedgwick will continue to propose to the City's Benefits Board various methods for limiting health carcosts aneasofPlan thelstateity. What we know may not work here: for sure is that what works in other Analysis from two years ago is of little value today. Property and casualty claims experience doesn't translate to health claims expertise A consultant who works primarily on hundreds of smaller, fully -insured employer groups is generally a liability to larger employers' plans. The Yakima area's physicians will have a lot to do with what the City's Plan will look like 5 years from now. 11 "State of the art" service means that as good as we may have performed for clients in the past, it is more important what we do in the future. Some of the likely recommendations will include: multiple plan selections (dual -choice), managed care, wellness, enhancements, preventive care programs, provider assessments and discount contracting. C A representative listing of other accounts the firm is serving, as well as an indication of whether the firm is willing to allow the City to contact such accounts for an appraisal of the services they are receiving from the firm C. Please see Exhibit #2. Contact names and phone numbers are included. 12 1 1 p The precise cost to the City and methods by, hat servich e firms will would lbed expect to tinbhe basic e compensated The proposal should indicate fee, plus a method for determining: the cost of additional services The p ropod five-yearalshould also indicate some means of price protection for the City o er the e term of the contract It is important that the proposerobe ase i' ely pea eiy an this subject. As a condition of selection, you must be prepared y commissions included in quotations submitted or the service fees proposed. D. Sedgwick is currently compensated through oo the City in writing fat least once ees that have and will continue to be disclosed per year. 1996 Projected $10,818 There is a 10% commission paid on the excess reinsurance policy from SAFECO. $950 The aggregate premium also includes 10% commission. $8.500 Consulting and Reporting retainer. $20,268* Broker compensation *SAFECO pays profit bonuses on our total booked premium, of which the City's premium represents around 9%. The amount of the bonus is included on the Schedule A disclosure SAFECO is required to send the City annually. In addition to the above, Healthcare Management Administrators returns 15% of their $15.00 per employee per month administration fee to Sedgwick of Yakima to help finance the DIRECT ADMINISTRATORS service. This service is optional for the City. 111 Unless the City chooses to drop the DA service or selects another claims administrator, we do not propose any change to the compensation arrangement. We are committed to flexible compensation agreements and are open to annual reviews. Benefits and services requested by the City that are in addition to those in this RFP will be separately agreed upon in advance. 13 E Please provide samples of monthly/quarterly statistical reports and rate estimating reports that we could expect th receive from a third party administrative firm with respect to paid claims E. Please see Exhibit #3 and Exhibit #6. 14 SCOPE OF SERVICES For thep ast 5 years, I have been fortunate to be the Consultant tFi hencit ofy lry ces. JustHe it yPlanI and thee Employees' Health Benefit Board as a member of BB becameM apart of the Sedgwick team here in Yakima. I now can offer the Ci City the expertise and global lity staff have provided over and continuity of services that I and my w influence of one of the world's largest risk management organizations SEDGW1C .Inoquali have the resources behind me to deliver oure firm more thoroughly, timely and with greater than ever provided from a local brokerage Outlined below are the services we will provide the City of Yakima and are committed to continuing should Sedgwick be chosen as your consulting broker. questions that arise concerning covered benefits, Daily Servicing. We are available to answer any q contract provisions and plan administration. We provide assistance in the resolution of any problems or concerns relating to the benefit plans. This can include resolving im gtbili y roblermin s, incorrect or are billings, service problems with claim administrators, and denied clabeing appealed. On occasion, a denied claim will be appealed to the Board. In such instances, we research the issue, all possible solutions, and then make a recommendation. We know how time consuming it can be for the City's Personnel staff to obtain answers aspects of our proble s. m resolutions. We view our assistance in this area as one of the mostimportant Meetin s. We are available to attend regular monthly meetings with the an overview or of the Plan more entl andits requested. In addition, we provide orientation meetings that provide operation, funding arrangements and benefits. While employee meetings are not held every year, in those years where ehave been changes tothe Plan, we have conducted meetings explaining the changes and plan choices. are alays available to participate in employee meetings when requested. We also participate in or initiate meetings with your claims administrator (HMA) and Personnel staff as needed or requested. Renewal Process. The renewal process is a critical function of our services e City's Plan. aanDuring the years we have worked with the Board, the goals of the members have been to comprehensive Medical, Vision and Dental Plan while taking into account the impact on employee payroll deductions and balancing plan choices. 15 op to e these objectives, we've presented and recommended a number of tOns ontheB and Toaccomplish y including: cost containment provisions, for implementation over the past four ears, g� implementation of a PPO network, negotiation for a direct discount with Yakima Valley Memorial Hospital, and offering dual choice with Group Health. ThisP rocess also includes analyzing the excess carrier's renewal for us needed.writing soundness and appropriateness. We then negotiate with the carrier on your behalf We an d prepare re are and submit a renewal report to the Board that provides the renewal action, renewal and benefit options and our recommendation. All issuesrequiring meet the City's payroll deadlines. renewal implementation are handled as quickly as possible Annual Accountin . We prepare a detailed accounting report describing each area of cost, and an Executive Summary that goes directly to the Board and the City Council. te y oar arketin ? Where appropriate (because of cost, service, or other issues)) or s regi uest d by the eB for wew -l-� will develop bid strategies and specifications to be sent to insurance nd f your existing benefits or proposed benefits. We prepare our analysis and time ris o o these on bidrvices. s along with our recommendation for your review and actively participate Healthcare Management Administrators/Direct Administrators is only one option. Im lementation c Chan es. When there is a change in existing ben the enrollment where, or prnew essb n eitS are implemented, we will assist in the employee communications a available to attend and participate in the meetings and to meet with other personnel to assist with the installation process OnRE oin orfs. We analyze experience reports on a monthly basis for the Medical, Dental, Prescription Drug, and Vision plans that outline claims. The Financial Summary that HMA produces monthly was designed with our input. Plan Document Review. We review all Plan policies, agreements, booklets, and amendments to confirm compliance with policy -order specifications. We often do the mailings for the City as well. Technical & Le We are available to answer Uetons or research questions legislat on or regulation affecting pertaining to your specific employee benefit plans, and pertaining to issues). y our employee benefit plans (or in some cases those that are affecting personnel ebenefit trenddiandbute periodic bulletins, providing information on time -sensitive e issues employee legislation is proposed or enacted, we will provide you with the Technicalpotential Rpsoutoe Center in benefitact to the City's plans. Many of these advisories will come from SEDGWICK s Roseland, New Jersey. 16 Governing the entire scope of services is the Sedgwick Standards of Practice and corporate quality initiative. Quality is not taken lightly at Sedgwick. For many yearswe ave had993standards of f s ice that are defined and audited. We implemented a quality awarenesscampaign is an ongoing program for all colleagues. As a part of our quality inial ISO 9000 Quality System. tiative, SSedwick committed S began the gyear full 001(hcompliance with the comprehensive of ISO standards) and we anticipate completion by mid-1997. ISO 9001 (the most comp In Summary, this proposal is not being submitted by the same firm the local has serviced ervice h erne C t 'vess Planly n since January 1, 1983. My joining SEDGWICK provides you BBM had, with an international brokerage firm ranked #1 in performance'. I look forward to exceeding your expectations. Sincerely, Dan Fisher Consultant 17 ' Risk Management Survey, CORPORATE FINANCE, New York, Summer 1996. Team Resumes are enclosed in this Exhibit. 18 DUTIES EDUCATION, LICENSES, DESIGNATIONS BUSINESS EXPERIENCE SPECIAL EXPERTISE ACTIVITIES DANIEL W. FISHER • Client Service • Consulting • Business Development • BA, University of Washington • Certified Public Accountant • Series 6 Agent License • Washs 6 - Investments and Vtn State Life and Variable Cotracts • Series 63 - Uniform Securities Law • 7 years insurance and employee benefits • 5 years corporate financial accounting and analysis • Instructor, City University; AC422 Corporate Tax and AC350 Managerial Accounting • Self-funded healthcare plans • Group medical and disabilityplans • Retirement plans and asset management • ERISA compliance • Washington Society of CPA's - 1995-96 Chapter President of the year • Yakima Kiwanis, Board Member • Provident Services, Board Member • Chamber of Commerce, Leadership Yakima - 1990 • United Way Gold Award - 1989 • YMCA ASPIRE Program 19 X11 Sedgwick DUTIES: RONDA R. IDE VICE PRESIDENT SEDGWICK NOBLE LOWNDES - Employee Benefit & Pension Consulting - Insurance Production & Client Service - Employer Plan Design and Implementation PROFESSIONAL DESIGNATIONS: 8 years insurance experience in Employee Benefits - ashington Agent Licenses for Life/Disability and Property/Casualty - 1990 Rookie of the Year presented by Insurance Women of Yakima - 1992 CommunicathConfidence Graduate Developmen Graduate - 1995 NAIW Leadership SPECIAL EXPERTISE: - Employee benefit consulting - COBRA and other legislative compliance issues - Marketing analysis and review PROFESSIONAL ACTIVITIES: - Insurance Women of Yakima - President - Central Washington Association of Health Underwriters - Past President, - Greater Yakima Chamber of Commerce Volunteer - Leadership Yakima Executive Board - Chair 1995/96 Class Graduate 1992 - Fund raising for Leukemia Society - Fund raising for YMCA 1993 Capital Campaign - United Way Allocations Committee Member 1990, 1991, 1992, 1993 7/96 20 \\ 1 Sedgwick Sample reports are included in this Exhibit. 1 1 1 EXHIBIT 3 - Y t_rommitHitl rr 11111/116/ Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Total Financial Summary 1-1-96 to 12-31-96 Trust Excess Accrual .. Pterimiurri $275,558 $277,876 $277,938 $277,417 $281,481 $280,859 $283,650 $284,461 $284,679 $8,854 $8,935 $8,926 $8,909 $9,047 $9,030 $9,122 $9,151 $9,168 Admin .Dental • Vision....... ,... . . :PGS ' �A�dical ' Current - • 'Aggregate ' # cAlan: ••• Em�lo UR Fees Pd Claims ..Pd Claims .a?d Ole Deduct lltis...: 'd Calms �- $12,482 $12,617 $12,658 $12,654 $12,855 $12,813 $12,940 $12,997 $12,999 $28,757 $46,890 $38,475 $35,419 $51,245 $39,591 $29,198 $35,209 $39,465 $7,316 $8,468 $7,280 $7,825 $9,879 $11,408 $7,069 $7,940 $8,208 $33,512 $33,567 $32,371 $52,915 $36,609 $36,092 $16,156 $36,548 $53,884 $2,523,920 $81,141 $115,015 $344,251 $75,394 Ave Claims Per Emp Per Month - 1996 Ave Claims Per Emp Per Month - 1995 $49.70 $10.89 $45.29 $10.06 Percentage Change 9.7% 8.2% Total paid claims all coverages Less claims excess of $115,000 Individual excess deductible Net total claims Less premium and costs paid annually (aggr/conver/setup/etc) Reserves needed (15% of ann pd claims) Reserves from quarterly 6 month Claim Lag Analysis Beginning claim reserves Plan reserves and surplus to date Net total claims Less claims not covered under aggregate excess loss policy Net claims covered by aggregate excess loss Net Claims to Aggregate Deductible Loss Ratio Average claims covered by aggregate per employee per month Average total claim cost per employee per month Last year average total claim cost per employee per month Percentage change in average cost per employee _ m $216,999 ($32,362) $158,320 ($23,283) $156,059 ($1,115) $252,100 ($93,520) $255,096 ($186,771) $298,644 ($313,490) $192,686 $16,478 $188,023 $11,072 $181,904 ($9,878) ($9,878) ($9,878) ($9,878) $331,654 $1,899,832 ($323,368) $47.89 $41.34 15.8% $2,651,131 $6,562 $2,644,569 $9,500 $528,914 $328,623 $311,790 $2,644,569 $2,644,569 0.803 $381.83 $381.83 $336.17 13.6% $273.36 $239.48 14.1% Fund Balance $359,497 751 524 $362,761 759 528 $362,378 762 525 $361,664 762 523 $367,275 774 531 $366,586 771 531 $370,310 781 535 $371,483 783 537 $372,197 783 539 # Total Ave Cost Ave Cost Per Unita . •.... Per Em: Total Units 1,275 $411.07 $242.13 1,287 $355.19 $209.47 1,287 $336.70 $199.35 1,285 $486.37 $288.42 1,305 $485.17 $287.76 1,302 $529.66 $313.65 1,316 $343.10 $203.62 1,320 $371.21 $220.20 1,322 $391.34 $231.79 $3,294,151 6,926 4,773 11,699 $411.53 $243.63 ($316,806) ($326,306) ($14,516) Last Year Average Total Cost Percentage Change In cost Coverage Effective $366.31 $215.24 12.3% 13.2% 1/1/96 Aggregate Deductible Analysis Aggregate Claim Factors Factors Include M/DN/P Contract Basis: PAID Employee Dependent Aggregate Premiums $229.48 $357.17 Annual $9,500.00 $115,000 Indlv Ex Loss Rates Contract Basis: PAID Employee Dependent Accruals $5.72 $8.70 Medical Employee All Dependents Dental Composite Leoff 1 $145.28 $201.63 $58.99 Medical Employee $267.81 All Dependents Dental Composite $201.63 $58.99 Expected Claim Cost This plan year $380.50 Protected Claim Cost Next Plan Year Average Claim Cost $381.83 Claim Lag Adjust 1.00 Trend 1.12 Plan Change 1.00 Exp Paid Claims $427.65 25% Margin Aggr Claim Factor $534.56 1.25 Current aggregate factor on a composite basis % change expected $475.62 12.4% 001* c.{iVefa0et' ADMIt.• $o.251$1,000 $0.09/$1,000 Cagier: SAf=EGO' Group.. 130101 CITY OF YAKIMA Healthcare Plan Expenses January 1, 1995 through December 31, 1995 Medical Claims $2,133,968 Dental P C S Vision $403,586 $368,403 $89,658 Excess Premium $121,037 Administration $156,032 TOTAL 1995 Plan Expenses $3,272,684 Note: Average number of covered employees: 742.58 2/12/96 SEDGWICK Consulting $500 $400 $300 $200 $100 $0 CITY OF YAKIMA Healthcare Plan Total Average Monthly Cost Per Employee Includes AFSCME Dental Trust in 1994 and 1995 only Includes LEOFF I benefits for all years. Includes only those claims actually paid by the City Plan; the Plan is reimbursed for very large claims by an insurance company. 1989 1990 1991 1992 1993 1994 1995 1996 * 1994 includes AFSCME Dental claims for the first time. A comparative figure without these claims is $296.18 for 1994 and $345.08 for 1995. through September only 10/15/96 SEDGWICK Consulting i r 1 1 i a t i 1 1 1 1 1 EXHIBIT #4 A copy of our Errors and Omissions Certificate of Insurance is enclosed in this Exhibit. 29 ACORD,. CERTIFICATE OF L PRODUCEtEOGWICK JAMES OF TENNESSEE 1000 RIDGEWAY LOOP P. 0. BOX 171377 MEMPHIS, TN 38187-1377 901-761-1550 LABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIO ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICAI HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND C ALTER THE COVERAGE AFFORDED BY THE POLICIES BELO1 DATE (MM/DD/YY) 7/a2/9I COMPANIES AFFORDING COVERAGE COMPANY A INSURED Sedgwick James of Washington, Inc. P. O. Box 2547 Yakima, WA 98907 COMPANY B Royal Insurance Company COMPANY c COMPANY D COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED CO LTR EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE POUCY EFFECTIVE DATE (MM/DD/YY) TYPE OF INSURANCE POLICY NUMBER BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOt ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THI; BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERME BEEN REDUCED BY PAID CLAIMS. POUCY EXPIRATION DATE (MM/DD/YY) UMITS GENERAL UABIUTY COMMERCIAL GENERAL UABIUTY CLAIMS MADE OCCUR OWNERS & CONTRACTOR'S PROT GENERAL AGGREGATE S PRODUCTS - COMP/OP AGG S PERSONAL & ADV INJURY S EACH OCCURRENCE S FIRE DAMAGE (My one lire) S MED EXP (Any one person) S AUTOMOBILE UABIUTY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE UMIT BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE S GARAGE UABIUTY ANY AUTO AUTO ONLY • EA ACCIDENT S OTHER THAN AUTO ONLY: EACH ACCIDENT AGGREGATE S S EXCESS UABIUTY UMBRELLA FORM 7 OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND EMPLOYERS' UABIUTY A THE PROPRIETOR/ PARTNERSIEXECUTWE OFFICERS ARE. EACH OCCURRENCE S AGGREGATE $ INCL EXCL TORY LIMITS ER EL EACH ACCIDENT S S EL DISEASE - POUCY UMIT S EL DISEASE - EA EMPLOYEE S OTHER 757/CE961343 rrors & Omissions SEDGWI 6/30/96 KJAMES 6/30/97 $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS -11'96 CERTIFICATE HOLDER Pacific Mutual Insurance Co. P. 0. Box 7010 Newport Beach, CA 92660 ACORD 25-S (1/95) CANCELLATION k SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBUGATION OR UAE OF ANY KING ON 171E COMPANY ITS" -AIS -EP� AT 1 AUTHORIZED REPR 6— TATIVE O ACORD CORPORATIOF C 1 EXHIBIT #5 A copy of Sedgwick's Washington State Agent's License and Broker's License is enclosed in this Exhibit. Please note that each of our Washington State offices (Yakima, Spokane and Seattle) use our Seattle office address, as we are all licensed under one Tax Identification number. §tate ellaStrtngtatt ***AMkeE AUTHORIZED TO ACTT CIC/PIC: SEDGW0W135LA .LINE BROIC�R IN EXPIRES: 06-02-97TRASHINGTON. ** SEDGWICK JAMES OE' WASHINGTON INC ` SEDGWICK NOBLE LOWNDES 2101 4TH AVE STE 1700 SEATTLE WA 98121 2344, .. - - IIICAROLYN T TOMLINSON JOEL. E P TSSWELL RICHARD" :ti DANIEL N BUCKLEY NEVA M WALL E. - V "EREt A SURPLUS' STATE OE THE LICENSEE AND ANY' AFPILIATES1OrES RABI.E 1 f f rrrrrfrrr ;INSURANCE COMMISSIONER i L ':t&.1:' Stats of astfingtart OF INSI aNCE COMMISSIONER 0 * BROKER'S LICENSE CIC: 05 p1 9702KA EXPIRES: SEDGWICK JAMES OF WASBGTON INC SEDGWICK NO2101 �.:�� ,� 1700 SEATTLE, 8 2 • THE LICENSEE IS AUTHORIZED SELL THE F0LL011ING LINES OF INSURANCE: - LIFE, DISABILITY, PROPERTY, CASUALTY- IC - ! jN URANCE COMMISSIONii State of astingtIIn INSURANCE CON[MISSIONER OFFICE OF* * THE AGENT'S LICENSE * * CIC. SEDGWJW202KA EXPIRES: 05/01/37 SEDGWICK JAMES OF WASHINGTON SEDGWICK NOB L L.OWNDES. 2101 FOURTII AVE".STE' 170 0- S EATT LE , .WA -1798:1:-2-1-,234411, ill THE LICENSEE IS AUTHORIZED TO SELL THE FOLLONING LINES OF INSURANCE: LIFE, D(SABILITY, PROPERTY, CASUALTY THIS LICENSE MUST BE ACCOMPANIED BY A CURRENT APPOINTMENT OR AFFILIATION CERTIFICATE EAC INSUREEI OR CORP • TION REPRESENT ..01111111110.4111.0111111111111.0.11i11.1.1.1111 0.10101.1."0.1111.111.1"411-""'. 32 i 4 E i„ I • �IN IURANCE COMMISSI01 ii'~�i� EXHIBIT #6 Rate Analysis Reports are enclosed in this Exhibit. 33 CITY OF YAKIMA Accrual Rating Pools Report to Employee Health Program Board The following numbers reflect consolidated medical and dental rating pools for the City's benefit plan. Actual net paid claims are taken from the most current HMA 18 -month report for the period ended 6/30/96, and includes all voids and refunds and is net of one excess reimbursement totalling $36,590. Description (181) LEOFF I Employees (587) Non-LEOFF I Employees (532) All Dependents (650) All Dental (incl. AFSCME) % Change 7-1-95 1996 7-1-96 7-1-96 Budgeted to Base Budgeted Base Trend Trended Accrual Rate Accrual Accrual Accrual $270.96 $326.49 $272.67 $299.94 147.16 177.32 162.34 178.57 166.29 200.37 200.96 221.06 49.90 54.89 56.66 62.33 The above rates incorporate actual fixed plan expenses (SAFECO and HMA) from the 1995 plan year only. PCS claims are allocated to each pool as a percentage of the total medical claims. Excess reimbursement is included (in lump sum) in period when paid and not accrued over period the underlying claim is incurred. Trend factor for medial and dental is 10%. There is no reserve adjustment. By ban Fisher Revised 7-29-96 c:word\da\city2.1 CITY OF YAKIMA Dental Accrual Rating Alternative The following numbers reflect consolidated dental rating pools for the City's benefit plan. Actual net paid claims are taken from the most current HMA 18 -month report for the period ended 10/31/95, and includes all voids and refunds. 18 mo. Paid Base Trended # Description Claims Accrual Accrual (634) All Employees $ 229,082 $ 22.07 $ 24.28 (504) All Dependent(s) 344,868 38.01 41.82 Family $ 573,950 $ 60.08 $ 66.10 Family accrual is employee plus dependent unit rate. A three -tiered structure - separate Spouse and Child rate - is also simple to calculate for dental. Trend factor used is 10%. NOTE: 2-21-96 c:word\da\city2 By Dan Fisher The City's current dental accrual rate is a true composite and is applied only as a matter of historical City policy. A true composite means that the rate is the same whether you are a single employee or an employee with spouse and any number of children. It's also referred to as a "single" tiered rate. Composites favor large families, and are expensive for single employees. The above alternative is considered a two-tiered rate structure, since the Family rate is merely adding the first two. Employer CITY OF YAKIMA Contract Number 16-001400-00 & 01 This Schedule is for the Contract Period From 01-01-96 To 01-01-97 SAFES e SAFECO LIFE INSURANCE COMPANY P.O. BOX 34690 SEATTLE, WASHINGTON 98124-1690 EXCESS LOSS INSURANCE SCHEDULE AGGREGATE EXCESS LOSS (Coverage provided if checked) 1. Benefits to be Covered 0 Medical XO Dental El Weekly Disability Income a Vision ElOther X❑ Prescription Drugs 2. Aggregate Deductible Covered Units Monthly Factors Medical - Employee $196.93 - Dependent 304.70 Dental - Employee 32.55 - Dependent 52.47 3. Minimum Aggregate Deductible $ N/A or 95 % of the First Monthly Aggregate Deductible x 12 4. SAFECO's Rate of Payment a. 100 % of covered expenses in excess of the Deductible; or b. N/A % of the first N/A of covered expenses in excess of the Deductible, and N/A % thereafter. 5. SAFECO's Limit of Liability $ N/A Maximum aggregate reimbursement. 6. Premium $ 9.500 Annually Paid in Advance. EX INDIVIDUAL EXCESS LOSS (Coverage provided if checked) 1. Only medical benefits are covered. 2. $ 115.000 Individual Deductible per person. 3. SAFECO's Rate of Payment a. 100 % of covered expenses in excess of the Deductible; or b. N/A % of the first N/A of covered expenses in excess of the Deductible, and N/A % thereafter. 4. SAFECO's Limit of Liability $ 1.000.000 Maximum Lifetime reimbursement by SAFECO per person. 5. Monthly Premium Rate Covered Units Rate Employee $ 5.72 Dependent $ 8.70 El MEDICAL CONVERSION PRIVILEGE (Coverage provided if checked) $ N/A Annual Premium Paid in Advance $ N/A Monthly Rate per Employee OPTIONAL PROVISIONS (Apply if checked) ElIndividual Excess Loss - Advance Funding ElIndividual and Aggregate Excess Loss - Definition of Paid Claim Q LGC-831 R5 5/84 R. A. Pierson, Senior Vice President & Secretary 05-08-96 LP Audit results are enclosed in this Exhibit. EXHIBIT #7 37 STATE OF WASHINGTON DEPARTMENT OF GENERAL ADMINISTRATION DIVISION OF RISK MANAGEMENT 301 General Administration Building • P.O. Box 41027 • Olympia, Washington 98504-1027 November 16, 1995 Mr. John.Hanson Director of Finance and Budget City of Yakima 129 North Second Street Yakima, WA 98901 Re: Examination #95-27. City of Yakima Self -Insured Health and Welfare Program Dear Mr. Hanson. Enclosed is the report covering our examination of the subject self insured employee health benefit program. The examination performed tests of compliance with state laws and regulations as required by RCW 48 62 and WAC 236-22 for management, operations and solvency of self insurance programs Based on your November 14, 1995 letter, the program has been found to comply with all applicable laws and regulations reviewed under the scope of this examination_ The report includes your responses to the draft report previously sent. We appreciate the City's interest in resolving the issues discussed. This should be done within the time frames most appropriate for the program. We would like to again express our appreciation to you and other City staff for the assistance and cooperation shown during this examination process. Should you have any questions regarding the examination, please telephone me at (360) 902-7311 or Don Johnsen at (360) 902-7308. Sincerely, 914 C). t John C Nicholson Local Government Self -Insurance Program Administrator cc: David Andrews, Office of the State Auditor Enclosure • 0 EXAMINATION #95-27 CITY OF YAK NIA YAKIMA, WASHINGTON SEPTEMBER, 1995 EXAMINATION REPORT Background The State Legislature enacted RCW 48 62 giving the Department of General Administration, Division of Risk Management (hereafter DRM) authority to approve and regulate local government self-insurance programs. DRM is responsible for establishing rules and policies governing the management and operations of all local government health and welfare self-insurance programs and for setting standards for the safety and financial soundness of the programs. A Health and Welfare Advisory Board was created to assist the State Risk Manager in the administration of the program. Working together, an initial set of rules and policies were developed and adopted into Washington Administrative Code An examination book was also developed for use in the examination of the approved self-insurance programs. An annual report format was adopted and is currently in place. Objective The Division of Risk Management's mission is to protect the taxpayer assets covered by local government self-insurance programs. This mission is accomplished, in part, by performing examinations of approved programs. The purpose of examinations is twofold: (a) review the entity to determine compliance with the mandatory requirements of RCW 48.62 and WAC 236-22 and; (b) review the program and determine if certain sound business practices are being followed These objectives are designed to provide the program and DRM management with reasonable, Local Go%ernment Self Insurance Program Esamination Page 1 of 3 1 1 1 i 1 1 but not absolute, assurance that the program is operating on a sound financial basis and the communications with the program members are appropriate. Scope The examination of the City of Yakima self insured employee health benefits program (hereafter program) was conducted by reviewing and analyzing documents in the DRM office files and reviewing documents and interviewing staff in the program offices September 8 and 11 through 13, 1995. The examiner was Don Johnsen. The examination performed tests of compliance with state laws and regulations as required by RCW 48.62 and WAC 236-22 for management, operations and solvency of self-insurance programs. The areas reviewed are listed below. (a) Program Formation and Adoption Documents (b) Program Financing Plan (c) Solicitation and Disclosure Practices (d) Insurance Coverages Provided (e) Program Termination Provision (f) Third Party Administrator Contracts and Contract Procedures (g) Risk Management Program (h) Claims Administration Practices and Procedures (i) Internal Financial Reporting Practices and Procedures (j) Practices in Identifying and Eliminating Conflicts in Interest (k) Membership Complaint and Appeal Process (1) Minutes of Employee Welfare and Benefits Committee Examination Conclusions The examination results indicate that, for the items reviewed, the program has complied with all applicable laws and regulations under the scope of this examination, including those applicable policies, rules and standards for financial solvency and operations established by DRM. With respect to items not reviewed, nothing came to our attention which would cause us to believe that the program had not complied with applicable laws, regulations and standards. Communications with employees regarding the program and the extensive plan restructuring effective April, 1994 have been extensive and exemplary. The following and related subjects are discussed in more detail in the enclosed management letter dated November 16, 1995 • Competitive Service Provider Selection Process • Independent Review of Claims Administration Firm Loral Government Self Insurance Program Examination Page 2 of 3 i Acknowledgments The Division of Risk Management wishes to express appreciation to City of Yakima staff for its cooperation and assistance during the examination process. Throughout the examination, City of Yakima staff were professional and supportive of the efforts to conduct a comprehensive examination. Local Government Self Insurance Program Exunination Page 3 of 3 1 EXHIBIT #8 The following is a copy of the HealthLine newsletter 42 MEMORIAL HOSPITAL YAKIMA VALLEY MEMORIAL HOSPITAL VOL. XVI, NO. 10 SEDGWICK DIRECT. ADMINISTRATORS "Your Partners In Wellness... For Life" OCTOBER 1996 FROM THE EDITOR'S DESK... `BIG FOODS' Afriend visiting from abroad recently told me that the most astounding thing she noticed about America was that the serving sizes of foods were "so enormous" — "even on the airplanes" (!). Amazed by her comment, I started taking a closer look at magazine ads and TV commercials, and this is what I noticed: CI In cereal ads, bowls are filled to the brim — even though a 2/3 cup serving fills only half of the average cereal bowl. If you're used to filling your bowl to the top, use a measuring cup tomorrow morning. It may be that you're getting two or three times more calories than you've been counting. U In beef and pork ads, the calorie and fat counts are for 3 -ounce portions of meat — which is about the size of a deck of cards. But the photos accompanying the ads invariably show a whole roast or at least 9 ounces of meat on a garnished dinner plate. With wide eyes, you look at the photos and think, "Hey, all that meat for only 200 calories and 7 grams of fat?" ❑ In TV commercials for ice cream, people are often shown eating directly out of pint or even half -gallon containers. . �.�SWi� • 0 • In ads for chips and popcorn, people are shown eating out of "family -size" bags. The reality is that a 1/2 cup of ice cream, 10 chips, and 1 cup of pop- corn are considered to be "one serving." Ej In restaurant commercials, people are shown enjoying huge platefuls of food — salad bar fixings, a baked potato with toppings, hot bread, 6 to 12 ounces of meat, and fried shrimp. In fast-food commercials, you see people with a quarter -pounder, a large order of fries, and a large drink or shake. The food in these meals could easily satisfy two or three people. We worry about the food we eat, but maybe it's not what we're eating, but how much we're eating that's the problem. ❑ © HHI 1 'DO WHAT YOU ENJOY' —' The Tao Te Ching, the Chinese scriptures, says "In work, do what you enjoy." There's a difference between a job and work. A job is something we do to pay our bills. Work is something that touches our hearts; it also has to touch the hearts of other people. If there are two questions I would ask to awaken us to spiritual work, it would be, "How does your work touch the joy in you?" and "What joy does your work bring out in others?" E — The Reinvention of Work by Matthew Fox WHAT'S INSIDE; • What's the Flu? Page 2 • Keeping Kids Home... Head Lice Page 3 • Research News You Can Use! Page 4 • S.A.D.. .Airport Thefts... Asthma Triggers Page 6 • Breast Cancer... Recipe...Doc Talk Page 7 • This 'n That.. Space Heaters...Quotes Page 8 • and Much More! _ © HHI 1 INFLUENZA IS A CONTAGIOUS RESPIRATORY DISEASE THAT'S CAUSED BY A VIRUS. Common fears ❑ "I'm afraid of flu shot side effects." Because today's vaccines contain only noninfectious ("killed") viruses, it's impossible to get the flu from a flu shot. 25% of adults get some tempo- rary redness and tenderness at the injection site. Very rarely, people get a mild fever within six to 12 hours of their shot. This is likely a slight allergic reaction to the solution which carries the vaccine; this is not the flu. If you're "coming down" with a bug when you get your shot, your symptoms may get worse — so get the shot when you're well. When a sick person sneezes, coughs, or talks, the virus is expelled into the air and can be inhaled by anyone who's close by. Influenza is also transmitted by direct hand contact, and the virus can live for hours on doorknobs and phones. • Flu symptoms include: Sudden onset of fever (up to 104°), a dry cough, chills, weakness, loss of appetite, severe headache, and aching muscles. There may be sore throat and nausea. • Each year, 20% to 30% of the population get the flu. • Because the viruses that cause the flu change from year to year, it's necessary to get a flu shot every year to be protected. ❑ FLU SHOTS KEEP YOU ON THE JOB Employees who get flu shots in October or early November have 25% fewer episodes of upper respiratory illnesses than employees who do not get a flu shot. They also take 43% fewer days of sick leave from work, and make 44% fewer visits to doctor's offices for respira- tory illnesses. Conclusion: "Vaccination against influenza has sub- stantial health and economic benefits for healthy, working adults. "All people who wish to • avoid illness are encouraged to consider vaccination." ❑ Source: New England Journal of Medicine, Vol. 333, No. 14 HERE ARE THEIR STORIES... 'Why we never miss a flu shot' • "I got so sick with the flu a few years ago — I'll do anything not to go through that again. "Since I've been getting flu shots, I haven't been sick." • "Two years ago, I got the flu and I missed a full week of work. "After that, I pushed myself too hard and I got mono! "I was so sick over the holi- days, my parents had to drive three hours to take me home. I never want to be that sick again." • "I always go on a winter vacation — and I don't want to get sick before, during, or after that." • "I don't have time to get sick. Too many people depend on me." ❑ Source: Employees at the Interna- tional Health Awareness Center, Kalamazoo, MI ❑ "I'm allergic to feathers, so I can't get a flu shot." If you are severely allergic to eggs (i.e., it's hard to breathe after you've eaten eggs), talk to your doctor. You may be able to get your shot at your doctor's office where you can be closely observed for any allergic reaction. ❑ "I never get sick, so I don't need a shot." Great. Hope your luck holds out. ❑ "Some people who get a flu shot get the flu later when it comes around." If you do get the flu after having the flu shot, it will likely be a far milder case than you otherwise would have had. ❑ "I hate shots; I'm chicken." Flu shots are so quick that many people don't realize they got theirs until it's over. Talk to a friend, relax your arm muscle (don't tense up), and you'll hardly know it happened. ❑ "I can't get a shot because I may be pregnant." Flu shots are considered safe for pregnant women — regardless of the stage of pregnancy. ❑ Source: Seattle -King County Depart- ment of Public Health © HHI 1 h 1 1 J 1 1 1 1 i 1 1 IIIMMESIESIMIMMOM SCHOOL... When to KEEP KIDS HO • Ask your school for their written policy on when kids can return to class after contagious illnesses. • Buy a self-care book for your home library (e.g., Take Care of Yourself by Donald M. Vickery, MD and James F. Fries, MD). • Keep a child home from school when he's contagious, and/or simply feels too sick to face the demands of the day. Remember — head colds and flu are most contagious one to four days before symptoms appear. • When making a decision about whether a child should stay home, use common sense. You can't expect a sick child to function all day if the demands are heavy, but you can't keep a child home every time he has a cold, either. • Kids are resilient. A child who threw up in the middle of the night may feel great by morning. Send him to school if there are no symp- toms. • If your child is "borderline" sick, ask him what the day's activi- ties will include. Send him to school if it's a quiet study day; keep him home if there's a field trip or athletic activities. Or, try a half day at school. • Send a younger "borderline" child to school with a note, so the teacher knows how to contact you easily. • Send kids to school with the self-care know-how and comfort products they need (e.g., frequent hand -washing advice, extra fruit juices, tissues, Vaseline, nose spray cough drops). Older kids can take Tylenol at lunchtime. • Always have a backup child- care plan. Kids have a way of getting sick on the most inconven- ient mornings. © HHI • If your child often complains of stomachaches, headaches, menstrual cramps, etc., talk to your doctor. Remember that stress and relationship problems can manifest in physical symptoms. • Make sure your child is not exposed to cigarette smoke, gets eight to 10 hours of sleep a night, dresses right, eats right, and washes his hands often — to help prevent illness. • Ask your doctor about flu shots for older kids — especially if their schedule is heavy. ❑ Sources: Egleston Children's Hospital; The Hope Heart Institute BEFORE YOU BECOME PREGNANT Before you become preg- nant, get a thorough medical exam, and ask your doctor what things you should do before conception to increase your chances of having a healthy baby. You'll want to make sure you're at a healthy weight; have medical problems under control; are not using tobacco, alcohol, or other drugs; and have your finances in order. You'll also want to make sure your relationship with your partner is rock -solid. Ideally, both parents should begin practicing optimal health habits at least three (prefer- ably six) months before concep- tion. Most birth defects occur in the first eight weeks of preg- nancy — so it's especially important to take good care of yourself during the first tri- mester. ❑ For more information call. The March of Dimes (914) 428-7100 THAT TIME OF YEAR AGAIN... Head lice ead lice can happen to anyone — "clean or dirty, rich or poor." If one person in a school or family has head lice, it's likely that others will come down with the same problem unless special precautions are taken. Today, most lice infestations are easily treated with over- the-counter shampoos, such as Nix (available in supermarkets and drugstores). Read and follow directions carefully and exactly. The No. 1 symptom of lice infestation is an itchy scalp, especially at the back of the head and behind the ears. Inspection reveals tiny, silvery eggs ("nits") glued to individual hairs. A female louse lays about six eggs a day; eggs hatch in 10 days. Prevention: Remind your kids not to share combs, brushes, hats, scarves, or pullover sweaters. Day care pillows and bedding are an- other source of contamination. Travelers should be sure that seats have fresh headrest "linen." Note: Lice cannot jump or fly; they're transmitted from one infested person to another by direct contact with the hair, or something the hair has touched. Lice like to be close to a warm body at all times; they don't stay long on articles that aren't being used or worn. ❑ Source. Take Care of Yourself by Donald M. Vickery, MD and James F. Fries, MD 3 spinal cor go Actor Christo- pher Reeve was thrown from a horse and landed on his head. This fractured the upper two spinal cervical vertebrae and crushed his spinal cord. Each year, 10,000 Americans are para- lyzed from various forms of spinal cord injury. Most common causes: motor vehicle accidents, swimming, diving, and gun violence. Source: Robert J. White, MD angioplasty? l► If you have to have coronary angioplasty per- formed — where a balloon catheter is inserted into a heart artery and inflated to enlarge the opening — make sure the facility you choose performs at least 400 of these procedures a year. Patients in high- volume labs experience fewer complications. Source: Journal of the American Medical Association, Vol. 274, No. 14 salt, calcium r A high intake of sodium (salt) can increase the amount of calcium that's excreted in your urine and, therefore, increase your body's need for calcium. High -protein diets also increase the body's need for calcium. Too little calcium can set men and women up for osteoporosis in their senior years. Source: Dietary Guidelines for Americans been 40 A bottle of beer contains nearly as much alcohol as a shot of whiskey. This means you can become an alcoholic even though you drink "only" beer. Source: Alcoholics Anonymous bedwetting? v For help and information, call the National Enuresis Society: 1 -800 -NES -8080. diabetes IV If one of your parents has Type 2 diabetes, you can reduce your own risk of the disease by maintaining a healthy weight. Losing as little as 10 extra pounds may cut your risk by 30%. Type 2 diabetes — which accounts for up to 95% of the 16 million diabetes cases in the U.S. — often leads to heart disease, blindness, and kidney failure. Source: University of Pittsburgh School of Medicine study presented at the American Diabetes Association's 56th Scientific Sessions 30 niinutes I►' Both kids and adults should get at least 30 minutes of brisk exercise every day of the week. No particular type of exercise is better than another, but it should elevate the heart rate for a total of 30 minutes a day. Source: National Heart, Lung, and Blood Institute Consensus Panel big burn One CINNABON Cinnabon supplies 670 calories, 34 grams of fat, and over 12 teaspoons of sugar. Source: Center for Science in the Public Interest; (202) 332-9110 models; r The average Ameri- can model's measure- ments are 33-23-33. The Rhodes Farm clinic in London recently re- ported that one of its "sickest patients" — a severely anorexic 15 -year- old — was courted by two modeling reps. The girl is 5'7" and weighs 98 pounds. Source: Newsweek magazine, June 17, 1996 day care Is Annual flu shots are "reasonable" for kids who attend day care programs and who are prone to ear infec- tions. Day care attendance increases the risk of acute otitis media in young children. A study of kids between six and 30 months showed that those who had re- ceived a flu shot had 32% fewer episodes of acute otitis media, and 28% fewer episodes of serous otitis media during peak influenza season. Viral infections account for a large number of acute otitis media epi- sodes. Source. Archives of Pediatric and Adolescent Medicine, 149- 1113-7 DIGESTED FROM LEADING PUBLICATIONS AND AUTHORITIES...', `anti -aging' creams r The first indepen- dent scientific study of alpha -hydroxy acids (AHAs) concludes that they "work" — but the U.S. Food and Drug Administration is still concerned about their long-term safety. "Creams containing AHAs will not make you look 20 when you are 40," say researchers, "but when they're used prop- erly, there's evidence of smoother skin, reduced sallowness, and better color." For some people, AHAs cause skin irritation and increased sensitivity to sunlight, so the FDA may require that these prod- ucts carry a warning label about the need to use a sunscreen. Pond's Age Defying Complex was used in this study (about $11 for a 2 -oz. jar). Source: Archives of Dermatology, Vol. 132, No. 6 slow down, r In British English, speed bumps are known as "sleeping policemen." Source. The Working Communicator 4 0HHI 1 1 1 J 1 1 1 1 1 1 ancient floss r After studying the symmetrical markings on ancient teeth, anthro- pologists have concluded that ancient man (and woman) used bone splin- ters, animal sinews, and/or tendons for "floss." Source: Academy of General Dentistry AIDS update r Every day, world- wide, 8,500 people are infected with the AIDS virus; 22 million people already carry the virus. In the U.S., about 900,000 people are infected. Source: 11th International Conference on AIDS Cigarettes in the movies he tobacco indus- try is still doing something called "product placement" — where they pay stars and/or film companies big money to show cigarettes being used in their movies. THE FACTS • The "heroes" in today's movies smoke three times more often than their real-life counterparts. • Although far fewer Americans smoke these days, the rate of smoking in the movies has not declined in the past 30 years. stress buster 4` r If you work in a climate -controlled office with fluorescent lighting, make sure you go outside for breaks and/ or lunch — if just for a few minutes. Breathe deeply and soak up some natural light. Source. The Hope Heart Institute • 26% of real-life young adults smoke, but 45% of their movie counterparts do. • Only 19% of real- life adults with col- lege educations and big incomes smoke, but 57% of their movie counterparts do. Action on Smoking and Health (ASH) has filed a formal complaint seeking a criminal investigation of this issue. Paying to have a cigarette advertisement produced without re- quired health warnings is a federal crime. ❑ For more information call: Action on Smoking & Health (ASH) (202) 659-4310 oxygen masks` r Fires aboard air- planes are extremely rare, but it's interesting to note that passenger oxygen masks are useless in a smoke-filled cabin. This is because their purpose is to provide supplementary oxygen in the event of cabin decom- pression. Aircraft oxygen masks blend oxygen with avail- able cabin air; if that air is filled with smoke, the passengers get oxygen -rich smoke. Extinguishing the fire and/or exiting is the only way to get clean air. Source: Associated Press report crash fraud r About $130 of your annual car insurance premium goes to cover the cost of fraud. The insurance industry looks to you to help re- cover the $9 to $13 billion it pays every year in false and inflated claims. In one recent case, San Diego police arrested 14 lawyers, doctors, chiro- practors, and office work- ers for running a car insurance fraud ring. A Los Angeles lawyer and his wife raked in $20 million after planning fake car accidents. Staged crashes often involve braking suddenly, or pulling away from a curb directly in front of an oncoming car. Neck injuries, whiplash, backaches, and headaches are the most common diagnoses used on fraudu- lent medical bills. Source: Rand Institute of Civil Justice medications:' r 25% of all hospi- tal emergency room admissions are due to adverse reactions between alcohol and medications. Alcohol can signifi- cantly reduce a drug's effectiveness — or in- tensify a drug's effects. Source. National Insitute on Alcohol Abuse and Alcoholism ARTERY NARROWING CAN BE REVERSED Anew study has shown what many researchers have thought all along — cardiovascular disease (i.e., narrowing of the arteries) can be moderately reversed. The well-known secret: lifestyle changes. In this study, heart patients who had coronary artery (heart) disease — diagnosed through angiograms (X-rays of the arteries) — were: 1) put on a vegetarian diet, 2) told to stop smoking, 3) started on a mild to moderate aerobic exercise program (three hours a week), and 4) told to practice stress manage- ment techniques (e.g., meditation) one hour a day. Five-year findings: In a control group of heart patients who had not made the above lifestyle changes, 45% had coronary narrow- ing that became worse; 50% showed no change; and 5% showed improvement. By comparison, 99% of the group who made sig- nificant lifestyle changes (see above) had healthier arteries (i.e., improved blood flow) or their con- dition remained stable. ❑ Source: Journal of the American Medical Associa- tion, Vol. 274, No. 11 SEASONAL AFFECTIVE DISORDER... Are you `S.A.D.'? About 10% of Americans who live in the north- ern regions of the U.S. — where there's little winter sunlight — suffer from seasonal affective disorder (SAD). Another 20% suffer from a milder form of seasonal depres- sion, sometimes called "winter blues." Classic symptoms of SAD and "winter blues" include depression; mild anxiety; fatigue; withdrawal from social situations; overeating; a crav- ing for sweets and carbohy- drates; oversleeping; and a lack of energy, enthusiasm, and concentration. These symptoms peak in the fall and winter months, and disappear when the days become longer and brighter. TIPS • Even when there's cloud cover, try to get outside at least 30 to 45 minutes a day. (A daily exercise walk is a good way to do this.) • If you have severe symptoms that are not helped with exposure to outdoor light, regular exercise, and a winter vacation, talk to your doctor. You may need "phototherapy" or antidepres- sant medication. C Sources: Winter Blues: Seasonal Affective Disorder, What It Is and How to Overcome It by Dr. Norman Rosenthal; American Sleep Disorders Association For more information about phototherapy, write to receive a list of Sleep Disorders Centers and light box manufacturers. National Sleep Foundation 1367 Connecticut Ave., N.W. Dept. 1111 Washington, DC 20036 AIRPORT THEFTS e especially watchful for theft at airport metal detectors. There's an increasingly common situation where one thief — part of a team — sails through the metal detector without trouble. But his or her partner intention- ally wears several metal items that require a time-consuming emptying of pockets and repeated trips through the detector. If you put your carry -on or laptop computer on the detector's conveyor belt, and then get trapped behind someone who's emptying his or her pockets, the first thief has time to grab your stuff and run. Solution: Put your carry -on or laptop on the conveyor belt only as you enter the metal detector (when there's no one else in front of you). Then, keep an eye on it. ❑ Source: Media crime reports The information in this publication is meant to complement the advice of your health care providers, not to replace it. Before making any major changes in your medications, diet, or exercise, talk to your doctor AIDS AND YOUNG PEOPLE IRight now, if you get HIV in your 20s, you will die when you are about 40 years old." — Cornelius Baker, National Association of People With AIDS ASTHMA... COMMON TRIGGERS ❑ Exercise — running or playing hard, especially in cold weather ❑ Upper respiratory infec- tions (e.g., colds and flu) ❑ Laughing or crying hard ❑ Allergens • Pollens (from trees, plants, and grass) • Animal dander (i.e., fur, skin, feathers) • Dust and dust mites (in carpeting, pillows, and uphol- stery) • Molds • Cockroach droppings ❑ Irritants • Cold air • Strong smells and chemi- cal sprays (e.g., perfumes, paint and cleaning solutions, chalk dust, lawn and turf treatments) • Weather changes • Tobacco smoke ❑ Source: U.S. Department of Health and Human Services For more information call. American Academy of Allergy and Immunology (800) 822-2762 © HHI Stephen R. Yarnall, MD Fellow of the American College of Cardiology Does salt cause high blood pres- sure, or doesn't it? ctually, only 10% to 15% of Americans are "salt -sensitive." These people's hypertension is made worse by higher salt intake, and it's improved by salt restriction. African Americans are especially likely to be "salt - sensitive." WHAT SHOULD YOU DO? Check your blood pressure regularly and evaluate your diet. If your blood pressure is under 140/90 and you are feeling well — continue on. If your blood pressure is higher than 140/90 and you have a high -salt diet, conduct an experiment: Restrict the salt in your diet for six weeks, increase your amount of fluids, and measure your blood pressure again. Other dietary factors that relate to hypertension include potassium, calciiim, and magnesium. These may be protective against hypertension, and some researchers feel they may be more important than the sodium issue. Caffeine and alcohol can raise heart rate and blood pressure. Certain medications, espe- cially decongestants and sinus remedies, and even some herbal agents contain- ing stimulants, can raise the heart rate and blood pres- sure. ❑ © HHI Breast cancer update la If you're concerned about breast cancer, or have a family history of breast cancer, limit your alcohol consumption. Even the habit of having one drink a day has been associated with an increased risk of breast cancer; the biological mechanism is not yet understood. CI A good professional breast exam should take between five and 10 minutes. But, studies show many doctors devote only about two minutes to this exam. Daniel B. Kopans, MD, Director of Breast Imaging at Massachusetts General Hospital and Associate Professor of Radiology at Harvard Medical School, says "the average physician is neither interested in nor adept at doing breast exams." Reasons include: poor medical school training, no specific accredi- tation or quality standards for clinical breast exams, over -reliance on mammography, time constraints, and "feelings of embarrassment" or worries about "molestation" charges (for male doctors). 1 1 E 1 1 1 1 EATING WELL RECIPE Apple Crisp Parfait • 3 cups sliced and peeled apples (about 3 medium apples) • 1/a cup old-fashioned cooking oats • 3 Tbsp. brown sugar (or the equivalent in artificial sweetener) • 2 Tbsp. water • 1 tsp. cinnamon Topping: • 4 oz. nonfat vanilla yogurt (sweet- ened with artificial sweetener) • 1/4 tsp cinnamon • 1/8 tsp nutmeg • 3/4 cup light whipped topping Editor's Note: Through a company or community program, learn how to do a good breast self -exam. This knowledge will help you evaluate whether your doctor is giving you a thorough professional exam. If, during your home self -exams, you feel something "different," point it out to your doctor. ❑ Sources: American Cancer Society; Daniel B. Kopans, MD; Breast Center, Providence Medical Center, Seattle For more information call. Cancer Information Service (800) 422-6237 Mix apples with oats, brown sugar, water, and cinnamon. Place apples in a 1-quartmicrowave - safe micrcr and safe bowl. Cover with wax paper microwave on high for 5 to 7 minutes, rotating 1I4 turn halfway through cooking time. (Cooking time may be longer — depending on thickness of fruit.) Topping: Mix yogurt with seasonings. Fold whipped topping into yogurt. Serve a dollop of topping over hot or chilled apple crisp. SERVES 4. Per serving: 167 calories and 2 grams of fat. 1 1 1 1 1 1 1 1 1 or People Who Say k & Healthy Volume II — More Help f Source: Q b Brenda J Ponichtera, RD They Do Quick • Meals y re Don't Have Time to Cook Healthy ................................ r 7 this it that MAKE FRIENDS WITH FEAR You gain strength, courage, and confi- dence by every experience in which you really stop to look fear in the face. "You are able to say to your- self, `I lived through this horror. I can take the next thing that comes along.' "You must do the thing you think you cannot do." ❑ — Eleanor Roosevelt GOOD QUESTION Here's a question for tobacco companies... If, as they say, cigarettes are not addictive, they do not cause cancer, they do not contribute to heart disease, they do not cause emphysema, and they're simply "a safe, pleasurable lifestyle choice" — why do they say kids shouldn't smoke? ❑ NOONE'S ON THE PHONE A feel safer in this 200 mph race than I do during my morning commute. Nobody's mak- ing a phone call, putting on make- up, or reading the newspaper." ❑ — Race car driver Steve Frieson vcr Space heater reminders Do not use an extension cord for an electric space heater unless it's a heavy-duty cord rated as high as the current rating listed on your heater. LI Make sure your heater has an automatic switch that cuts off electric power if the heater is tipped over. Do not place space heaters within three feet of drapes, bedspreads, furniture, or other flammable materials. CI Do not use your heater near a shower, bathtub, or sink — to prevent electrical shock. ❑ Source: U.S. Consumer Product Safety Commission 55908 © HHI © by The Hope Heart Institute, Seattle, WA • ISSN 0891-3374 • Editor. Carol P Garzona; Graphic Designers: Marty Roselius & Sally McQuiston; Illustrator- James McFarlane; Production: Katherine Whitehall; Institute Founder and Medical Director Lester R. Sauvage, MD • Material may not be used without permission. • For individual and group subscription information, or reprint permission, contact: International Health Awareness Center, Inc., 350 East Michigan Avenue, Suite 301, Kalamazoo, MI 49007-3851 USA • (616) 343-0770 • Fax (6161343-6260 • {y 6 Printed on recycled paper with soybean ink. Dan Fisher SEDGWICK CONSULTING P.O. Box 2547 Yakima, WA 98907 BULK RATE U.S. POSTAGE PAID Grand Rapids, MI 49503 PERMIT NO. 1 body, mind, & soul 66 You may make mistakes, but you are not a failure until you start blaming someone else." — Unknown 66 TV is simply a place where people go when they get tired of thinking." — Kevin Devitte W Blessed is he who has learned to admire and not envy." — Unknown W The hardest job kids face today is learning good man- ners without seeing any." — Fred Astaire 6S Never tell a person he is losing his hair. He already knows." — Unknown 66 Sleepy drivers rest in pieces." — Grand Rapids, MI highway sign 55908 © HHI © by The Hope Heart Institute, Seattle, WA • ISSN 0891-3374 • Editor. Carol P Garzona; Graphic Designers: Marty Roselius & Sally McQuiston; Illustrator- James McFarlane; Production: Katherine Whitehall; Institute Founder and Medical Director Lester R. Sauvage, MD • Material may not be used without permission. • For individual and group subscription information, or reprint permission, contact: International Health Awareness Center, Inc., 350 East Michigan Avenue, Suite 301, Kalamazoo, MI 49007-3851 USA • (616) 343-0770 • Fax (6161343-6260 • {y 6 Printed on recycled paper with soybean ink. Dan Fisher SEDGWICK CONSULTING P.O. Box 2547 Yakima, WA 98907 BULK RATE U.S. POSTAGE PAID Grand Rapids, MI 49503 PERMIT NO. 1