Placement: Consent Agenda
Action Requested: Motion / Vote
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Approve Stop Loss Insurance Policy with Florida Blue for Fiscal Year 2024/2025
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Submitted By: Kimberly Sala, Assistant Director, Human Resources
Strategic Plan Link: The City's Goal of a high-performing city government organization.
Summary Brief (Agreements/Contracts only)
1. Prepared by: Kimberly Sala, J.D., SHRM-CP, Human Resources
2. Parties: City of Port St. Lucie and Florida Blue/ISU
3. Purpose: To provide Stop Loss Insurance for medical claims.
4. New/Renewal/Modified: New
5. Duration: 1 year
6. Benefits to Port St. Lucie: To provide protection to the City for medical claims that exceed the threshold of $500,000.00 per claimant.
7. Cost to Port St. Lucie (Annual and Potential): The estimated expenditure for FY 24/25 is $1,514,062.00 (a 0.1% increase over FY 23/24 cost).
Presentation Information: Staff and the Gehring Group are available to answer any questions the Council may have.
Staff Recommendation: Move that the Council approve the Stop Loss insurance policy with Florida Blue.
Alternate Recommendations:
1. Move that the Council amend the recommendation and approve the Stop Loss insurance policy with Florida Blue.
2. Move that the Council reject the recommendation and provide staff with direction.
Background: Stop Loss insurance is a component of the City’s self-funded health insurance program and it provides protection to the City from the financial risk of unpredictable high costs and/or high volume claims filed under the plan. Stop Loss coverage protects against claims that could compromise the City’s financial health. On July 19, 2024, the City’s insurance broker, the Gehring Group, released an RFP to the market and solicited responses for Stop Loss insurance proposals. A total of twenty (20) proposals were received from seven (7) carriers and all proposals were vetted by the Gehring Group and the City. Florida Blue had the best coverage for the most cost-effective price. Additionally, as Florida Blue is the City’s current medical provider, there will be instant integration whereby Florida Blue has the ability to process claims, identify if the Stop Loss threshold has been reached, and thus provide reimbursement to the City in a more timely and efficient manner. Based on these factors, we are recommending selection of Florida Blue to provide Stop Loss coverage for the 2024/25 fiscal year.
Issues/Analysis: The option before the Council for consideration proposes retaining the Individual Specific Limit (ISL) at $500,000.00 per claimant. The proposed policy coverage differs in the following manner: The policy takes into consideration when the claims were incurred, with claims incurred twenty-four (24) months prior to the effective date of the policy, but billed after October 1, 2024, being covered (a 24/12 look back period). The proposed policy coverage is identical to current coverage in the following manner: Individual Specific Limit (ISL) is retained at $500,000.00 per claimant; there is an unlimited maximum annual reimbursement, which includes medical and prescription claims; and there are no higher deductibles for certain high claimants or exclusion of any claimants from coverage (no lasers).
An Example Policy Terms is attached to this agenda summary. This is not necessarily the exact terms that will be included in the City’s policy, however, is an example of the current terms requested by Florida Blue and provided for Council review.
Financial Information: Funding has been appropriated in the Medical Trust Fund / General Government / Stop Loss account (#605-1900-549353-00000).
Special Consideration: This is an annual policy and costs are based on claims data filed under the plan in the previous year. In the event that claims data increases, with additional claimants meeting or exceeding the ISL threshold, the City does have the option to reduce the ISL threshold in future years which may result in an overall premium increase.
Location of Project: N/A
Attachments:
1. Stop Loss Plan Evaluation (comparison of current plan offering versus proposed plan offering).
2. Stop Loss Proposal.
3. Example Policy Terms.
NOTE: All of the listed items in the “Attachment” section above are in the custody of the City Clerk. Any item(s) not provided in City Council packets are available upon request from the City Clerk.
Internal Reference Number: 24180-03
Legal Sufficiency Review:
Reviewed by Alyssa Lunin, Deputy City Attorney. Approved as to Legal form and sufficiency by Richard Berrios, City Attorney.