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AGENDA ITEM REVIEW FORM |
3.A.
Special Employee Benefit Trust Board Meeting
- Meeting Date:
- 04/23/2025
- Department Head:
- Adela Cortez
- Submitted By:
- Maria Barajas Gutierrez, Human Resources Coordinator, Human Resources Department
ITEM:
Discussion and review on any and all matters regarding the Employees' Health Benefits Plan. (Jennifer Aragon, CBIZ Account Executive)
SUMMARY:
This presentation provides an overview of the Employees’ Health Benefits Plan performance during Fiscal Year 2024-25, along with the proposed renewal and funding projection for Fiscal Year 2025-26.
During the current fiscal year, the plan experienced several high-cost claims that significantly impacted the renewal cost of Stop Loss Insurance. To date, three claims have exceeded the policy deductible of $100,000, with one potential claim is expected to trigger a Stop Loss Laser set at $200,000.
As a result of renewal negotiations, the Stop Loss carrier has agreed to:
It is recommended to expand dental coverage to include dental implants, classifying them as major services under the plan. The proposed coverage will have:
During the current fiscal year, the plan experienced several high-cost claims that significantly impacted the renewal cost of Stop Loss Insurance. To date, three claims have exceeded the policy deductible of $100,000, with one potential claim is expected to trigger a Stop Loss Laser set at $200,000.
As a result of renewal negotiations, the Stop Loss carrier has agreed to:
- Remove two existing lasers ($235,000 and $135,000), and
- Waive administrative fees ($8.00 per employee per month)
It is recommended to expand dental coverage to include dental implants, classifying them as major services under the plan. The proposed coverage will have:
- 50% coverage for major services after the deductible
- $25 individual deductible
- $2,250 annual maximum benefit per person (including replacements and all dental services)
- Pre-authorization required for all major services
RECOMMENDATION / SUGGESTED MOTION:
ITEM FOR DISCUSSION ONLY. NO ACTION REQUIRED.