Department
Finance
Requested Action (Identify appropriate Action or Motion, purpose, cost, timeframe, etc.)
title
Request approval to extend an existing contract - Finance Department, 19-RFP060519C-MH, Employee Healthcare Benefit Plan with Aetna Insurance Company Inc. (Atlanta, GA) to administer: (1) Basic Medicare Advantage Plan and (2) Enhanced Medicare Advantage Plan (Buy-Up Option) to provide medical and pharmacy benefits as a fully insured option to Medicare eligible retirees/beneficiaries and dependents for an additional 12-month period. Effective dates: January 1, 2025, through December 31, 2025. (APPROVED)
body
Requirement for Board Action (Cite specific Board policy, statute or code requirement)
In accordance with Purchasing Code Section 102-420, contract modifications within the scope of the contract and necessary for contract completion of the contract, in the specifications, services, time of performance or terms and conditions of the contract shall be forwarded to the Board of Commissioners for approval.
Strategic Priority Area related to this item (If yes, note strategic priority area below)
Open and Responsible Government
Commission Districts Affected
All Districts ☒
District 1 ☐
District 2 ☐
District 3 ☐
District 4 ☐
District 5 ☐
District 6 ☐
Is this a purchasing item?
Yes
Summary & Background: This request is to extend the existing contract for an additional 12-month period to provide Medicare Advantage Plan (Buy-Up Option) to provide medical and pharmacy benefits to Medicare eligible retirees and beneficiaries/dependents.
Scope of Work: Aetna presently provides two fully insured Medicare options to eligible retirees and beneficiaries/dependents. Aetna was the only provider to submit a bid award for these services in response to a 2024 procurement effort, with a blended rate increase of approximately 18%. Finance Department is recommending approval instead to extend Aetna’s contract previously procured in 2019, and to plan for a new solicitation in 2026 plan year that will foster other providers to submit bids for these services. This includes obtaining additional detailed cost analysis data from Aetna (the current provider), and possibly changing plan options or coverages. Segal, the health care consultant, indicates adverse recent claim experience and recent federal government changes with CMS (Medicare plan) are the primary drivers of this year’s increase to the premium rate. Changes in annual deductibles were reviewed, and Finance has opted to not change the MAPD deductibles for Aetna plans for fiscal 2025. Rate increases in past years for these plans vary from 0% to 5.3% in 2021, and average 3% annually over the last four years. The services described under Scope of Work herein shall be performed by Contractor for a total amount not to exceed $846.72 for family coverage with the Basic Medicare Advantage plan and $1,036.23 for family coverage with the Enhanced Medicare Advantage plan.
Community Impact: None
Department Recommendation: The Finance Department recommends extending the existing contract for an additional 12-month period for Aetna to administer the two fully insured options to Medicare eligible retirees and beneficiaries/dependents. The 2025 premium rates for the Basic and Enhanced Medicare Advantage Plans are presented as a separate agenda item for approval.
Project Implications: None
Community Issues/Concerns: None
Department Issues/Concerns: None
Contract Modification
|
Current Contract History |
BOC Item |
Date |
Dollar Amount |
|
Original Award Amount |
19-0619 |
0/7/2019 |
Monthly premium rates per enrolled Medicare-eligible member. |
|
1st Renewal |
20-0828 |
11/18/2020 |
Monthly premium rates per enrolled Medicare-eligible member. |
|
2nd Renewal |
21-0646 |
09/01/2021 |
Monthly premium rates per enrolled Medicare-eligible member. |
|
3rd Renewal |
22-2487 |
09/07/2022 |
Monthly premium rates per enrolled Medicare-eligible member. |
|
4th Renewal |
23-0548 |
08/16/2023 |
Monthly premium rates per enrolled Medicare-eligible member. |
|
Amendment No. 1 (Extension) |
|
|
Monthly premium rates per enrolled Medicare-eligible member. |
|
Total Revised Amount |
|
|
|
Contract & Compliance Information (Provide Contractor and Subcontractor details.)
Contract Value: Based on enrollment per approved rates.
Prime Vendor: Aetna Life Insurance Company
Prime Status: Non-Minority
Location: Alpharetta, GA
County: Fulton County
Prime Value: Based on enrollment per approved rates
Subcontractor: SCR Consulting
Subcontractor Status: African American Male Business Enterprise
Location: Atlanta, GA
County: Fulton County
Contract Value: TBD (Enrollment Services & Education)
Subcontractor: PMI Solutions, LLC
Subcontractor Status: African American Male Business Enterprise
Location: Atlanta, GA
County: Fulton County
Contract Value: TBD (Enrollment Services)
Total Contract Value:
Total Certified Value:
Exhibits Attached (Provide copies of originals, number exhibits consecutively, and label all exhibits in the upper right corner.)
Exhibit 1: Amendment No. 1 to Form of Contract
Exhibit 2: Performance Evaluation Report
Contact Information (Type Name, Title, Agency and Phone)
title
Verna Thomas, Benefits Manager (404) 612-7639
Ray Turner, Deputy Finance Director (404) 612 -7737
Contract Attached
title
Yes
Previous Contracts
title
Yes
Total Contract Value
|
Original Approved Amount: |
Based on enrollment per approved rates. |
|
Previous Adjustments: |
|
|
This Request: |
|
|
TOTAL: |
|
Grant Information Summary
|
Amount Requested: |
|
☐ |
Cash |
|
Match Required: |
|
☐ |
In-Kind |
|
Start Date: |
|
☐ |
Approval to Award |
|
End Date: |
|
☐ |
Apply & Accept |
|
Match Account $: |
|
|
|
Fiscal Impact / Funding Source
Funding Line 1:
426-999-P003-1560: Group Insurance Stabilization, General Fund, Administrative
|
Key Contract Terms |
|
Start Date: 1/1/2025 |
End Date: 12/31/2025 |
|
Cost Adjustment: |
Renewal/Extension Terms: Extension for 12 additional months |
Overall Contractor Performance Rating: 88%
Would you select/recommend this vendor again?
Yes
|
Report Period Start: |
Report Period End: |
|
4/1/2024 |
6/30/2024 |