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AGENDA ITEM REVIEW FORM |
3.A.
Special City Council Meeting
- Meeting Date:
- 04/30/2025
- Department Head:
- Adela Cortez
- Submitted By:
- Maria Barajas Gutierrez, Human Resources Coordinator, Human Resources Department
Action Requested:
Discussion Item - No Action to be Taken
ITEM:
Discussion and review on any and all matters regarding the Employees' Health Benefits Plan. (Dave Madden, CBIZ Benefits Consultant)
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:
Additionally, 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)
Additionally, 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 is required for all major services
RECOMMENDATION / SUGGESTED MOTION:
DISCUSSION ITEM ONLY, NO ACTION REQUIRED.
Fiscal Impact
- IS THERE FISCAL IMPACT ASSOCIATED WITH THIS ITEM:
- N/A
- CITY/STATE/FEDERAL FUNDS:
- N/A
- TOTAL:
- N/A
- BUDGETED AMOUNT:
- N/A
- AVAILABLE AMOUNT TO TRANSFER:
- N/A
- ACCT NAME & GL#/REMAINING BALANCE BEFORE PURCHASE:
- N/A
FISCAL IMPACT STATEMENT (IF THIS IS A BUDGET TRANSFER, YOU MUST ATTACH THE BUDGET ADJUSTMENT FORM):
There is no fiscal impact associated with this item.