Department
Finance
Requested Action (Identify appropriate Action or Motion, purpose, cost, timeframe, etc.)
title
Request approval to renew existing contracts - Finance Department, 19-RFP060519C-MH, for Employee Healthcare Benefit Plans with (A) Anthem (BCBS) of Georgia to administer the self-funded Health Maintenance Organization (HMO), Point of Service (POS), and CDHP with Health Savings Account (HSA) Plans to active employees and Pre-65 (Non-Medicare) retirees/beneficiaries, as well as the Medicare HMO, Medicare Indemnity and PPO Plus [Closed] Plans to Medicare-eligible retirees/beneficiaries and (B) Kaiser Permanente (Atlanta, GA), to administer a fully insured HMO plan to active employees and Pre-65 (Non-Medicare) retirees/beneficiaries; and the fully insured Senior Advantage Plan to Medicare retirees/beneficiaries. This action exercises the third of four renewal options. One renewal option remains. Effective date: January 1, 2023, through December 31, 2023. (APPROVED UPON ADOPTION OF THE CONSENT AGENDA)
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Requirement for Board Action (Cite specific Board policy, statute or code requirement)
In accordance with Purchasing Code Section 102-394(6), the Purchasing Department shall present all renewal requests to the Board of Commissioners at least 90 days prior to the contract renewal date or 60 days if the contract term is six (6) months or less.
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 (First sentence includes Agency recommendation. Provide an executive summary of the action that gives an overview of the relevant details for the item.)
Scope of Work: This contract is for employer-sponsored group medical and pharmacy benefit coverage. The contract provides Medical Plan Administration, Claims Adjudication, Reporting¸ Wellness and Disease Management Programs, Employee Assistance Program (EAP), Mental Health and COBRA Administration and Pharmacy Benefits to eligible employees and retirees/beneficiaries as well as their eligible dependents. The medical plans administered by Anthem are under a self-funded arrangement and the Kaiser HMO plans are under a fully insured arrangement. Under a fully insured arrangement, the carrier pays claims from their own funds and sets premium rates to support expected payments. Under the self-funded arrangement, the carrier administers the plan, but claims are funded by the County. Anthem: Anthem’s network continues to offer the greatest estimated discount based on the utilization patterns of members and the greatest network discount guarantee. Anthem will continue to provide annual prorated wellness fund dollars at the rate of $71.81 per enrolled employee and pre-65 (Non-Medicare) retiree. Anthem continues to offer a $100,000 annual allowance towards communication, implementation and technology. Kaiser: Kaiser Permanente’s staff model is highly touted for health management in terms of efficiency and their holistic approach to health care. Kaiser continues to provide annual wellness funding to the County at $179 per enrolled employee and pre-65 (Non-Medicare) retiree. Kaiser will provide annual communication allowance of $15,000 for 2023. Kaiser’s fully insured HMO and Senior Advantage Medicare Plans continue to offer the best value in terms of cost.
Community Impact: None
Department Recommendation: The Finance Department recommends renewal of existing contracts with Anthem and Kaiser Permanente to administer medical and pharmacy benefits to eligible employees, beneficiaries, retirees and covered dependents from January 1, 2023 - December 31, 2023. For 2023, the $40.34 per member per month fee to administer the Anthem plans remain unchanged. This administration fee is guaranteed to remain flat over the duration of the contract. The 2023 Premium Rates for the Anthem and Kaiser Plans are presented as separate agenda item for approval.
Project Implications: None
Community Issues/Concerns: None
Department Issues/Concerns: None
Contract Modification
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Current Contract History |
BOC Item |
Date |
Dollar Amount |
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Original Award Amount |
19-0618 |
08/07/2019 |
Anthem: per member per month admin fees. Kaiser Plans: based approved premium rates. |
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1st Renewal |
20-0841 |
11/18/2020 |
Anthem: per member per month admin fees. Kaiser Plans: based on approved premium rates. |
|
2nd Renewal |
21-0649 |
09/01/2021 |
Anthem: per member per month admin fees. Kaiser Plans: based on approved premium rates. |
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3rd Renewal |
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Anthem: per member per month admin fees. Kaiser Plans: based on approved premium rates. |
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Total Revised Amount |
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Contract & Compliance Information (Provide Contractor and Subcontractor details.)
(A)
Contract Value: Self-funded HMO Plan
Prime Vendor: Anthem (BCBS) of Georgia
Prime Status: Non-Minority
Location: Atlanta, GA
County: Fulton County
Prime Value: self-funded HMO Plan
Subcontractor: SCR Consulting
Subcontractor Status: African American Male Business Enterprise- Certified
Location: Atlanta, GA
County: Fulton County
Contract Value: rate per employee
Subcontractor: Aegias Corporation
Subcontractor Status: African American Male Business Enterprise- Certified
Location: Atlanta, GA
County: Fulton County
Contract Value: rate per employee
Subcontractor: Resurgens Risk Management
Subcontractor Status: African American Male Business Enterprise- Non-Certified
Location: Atlanta, GA
County: Fulton County
Contract Value: rate per employee
Total Contract Value: Self-insured HMO Plan
Total M/FBE Value: TBD
(B)
Contract Value: Plan rates as specified
Prime Vendor: Kaiser Permanente
Prime Status: Non-Minority
Location: Atlanta, GA
County: Fulton County
Prime Value: Plan rates as specified
Subcontractor: All Supply Company
Subcontractor Status: African American Male Business Enterprise- Certified
Location: Atlanta, GA
County: Fulton County
Contract Value: TBD
Subcontractor: Copy One
Subcontractor Status: African American Male Business Enterprise- Non-Certified
Location: Powder Springs, GA
County: Cobb County
Contract Value: TBD
Subcontractor: Americare
Subcontractor Status: African American Female Business Enterprise- Non-Certified
Location: Norcross, GA
County: Gwinnett County
Contract Value: TBD
Subcontractor: Interprint Communication
Subcontractor Status: Hispanic Female Business Enterprise- Non-Certified
Location: Decatur, GA
County: Dekalb County
Contract Value: TBD
Subcontractor: Union Latina, Inc.
Subcontractor Status: Non-Minority
Location: Norcross, GA
County: Gwinnett County
Contract Value: TBD
Total Contract Value: Plan rates as specified
Total M/FBE Value: TBD
Exhibits Attached (Provide copies of originals, number exhibits consecutively, and label all exhibits in the upper right corner.)
Exhibit 1: Contract Renewal Agreement - Anthem
Exhibit 2: Contract Renewal Agreement - Kaiser
Exhibit 3: Contractor Renewal Evaluation Form
Exhibit 4: Contractor Performance Report - Anthem
Exhibit 5: Contractor Performance Report - Kaiser
Contact Information (Type Name, Title, Agency and Phone)
title
Ray Turner, Deputy Finance Director, 404-612-7737
Melissa Barnett, Employee Benefits Manager, 404-612-4243. Finance Department
Contract Attached
title
Yes
Previous Contracts
title
Yes
Total Contract Value
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Original Approved Amount: |
Anthem Plans: per member per month administrative fees. Kaiser Plans: based on approved premium rates. |
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Previous Adjustments: |
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This Request: |
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TOTAL: |
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Grant Information Summary
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Amount Requested: |
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☐ |
Cash |
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Match Required: |
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☐ |
In-Kind |
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Start Date: |
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☐ |
Approval to Award |
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End Date: |
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☐ |
Apply & Accept |
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Match Account $: |
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Fiscal Impact / Funding Source
Funding Line 1:
426-999-P003-1560: Group Insurance Stabilization, General Fund, Administrative
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Key Contract Terms |
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Start Date: 1/1/2023 |
End Date: 12/31/2023 |
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Cost Adjustment: |
Renewal/Extension Terms: 3 of 4 Renewals |
Overall Contractor Performance Rating:
Anthem (BCBS) 88%
Kaiser Permanente 88%
Would you select/recommend this vendor again?
Yes
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Report Period Start: |
Report Period End: |
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1/1/2022 |
6/30/2022 |