HomeMy WebLinkAbout1993-05-25; City Council; 12251; AMENDMENT TO CITY'S CONTRACT WITH NORTHWESTERN NATIONAL LIFE INSURANCE COMPANY TO PROVIDE HEALTH AND LIFE INSURANCEr
-
3 6
Q- 4
E
z
k 0 -
o a d z 3 0 0
CIT~F CARLSBAD - AGEN~RI BILL -+5
AB # .B+LEL-- TITLE: DEPT.
MTG. 5-25-93 NORTHWESTERN NATIONAL LIFE INSURANCE CITY i
CITY I DEPT. HR
RECOMMENDED ACTION:
AMENDMENT TO THE CITY’S CONTRACT WITH
COMPANYTO PROVIDE HEALTH AND UFE INSURANCE
Adopt Resolution No. 93-159 confirming the change in the contract with
Northwestern National Life Insurance Company (NWNL) from a “Split Risk
Agreement” to an “Administrative Services Only” (ASO) agreement and
recognizing prior amendments and riders since the date of the original
contract.
ITEM EXPLANATION:
The City currently has a contract with Northwestern National Life
Insurance Company (NWNL) as one of two group health plans and for the
Group Life insurance policies.
The City’s original health insurance agreement with NWNL was a “split
risk agreement,” a type of insured plan. With some important exceptions,
the split risk agreement provided that the City was responsible for the
claims paid.
determined prior to the beginning of each year based on estimated claims
for the upcoming year.
The Human Resources staff and Towers Perrin, the City’s benefits
consultant, reviewed the administrative fee structure with NWNL and
investigated the option of converting to a Self-insured, or AdministrativE
Services Only (ASO) agreement. Under a split risk agreement, the risk is
shared between NWNL and the City. By comparison, under the
Administrative Services Only (ASO) agreement, the risk to NWNL is
eliminated, substantially lowering the premiums and the quoted rates.
detailed comparison of the two contract types can be found in the
attached staff report. (Exhibit 2)
It was the opinion of Towers Perrin that the City was large enough to be
self-insured. This opinion was strengthened by the City’s favorable
utilization over the prior two year period. The City converted to an
Administrative Services Only agreement with Northwestern on April 1,
1992. The City’s initial contract period was from April I, 1992 through
December 31, 1992, with subsequent contracts to be on a calendar year
basis.
The administrative fees, including a premium fee, were
A
? e e
PAGE 2 OF AB # \2i2S (
The purpose of this Agenda Bill is to clarify the current agreement with
Northwestern National Life Insurance Company, and to recognize all prior
amendments and riders that have been added since the original contract
was adopted. In the past, amendments and riders to the City’s health
insurance contracts have not been approved by the City Council. Since the
effective date of the original contract with NVJNL, there have been seven
(7) amendments and four (4) riders to the original contract. These
amendments and riders are detailed in Exhibit 3.
Both Towers Perrin and the Human Resources Department staff will
continue to evaluate tee benefit of continuing under an AS0 agreement.
The City retains the ability to convert back to a split risk agreement at
the conclusion of any contract year.
FISCAL IMPACT:
It is estimated that the conversion to an AS0 agreement will save the Cit)
from $29,000 to $65,000 annually. This savings is due to the fee
structure of the split risk plan compared to the monthly fixed fees for the
AS0 plan. As claims go down, the annual savings to the City increases
proportionately.
savings in the range of $29,000 to $65,000, for claims of $1.5 million
down to $.9 million respectively.
EXHIBITS:
1 II Resolution No. ci3- 15 9
2. Staff Report - AS0 Agreement
3. Amendments and Riders to Contract
It is estimated that the City will realize an annual
w
1
1
2
3
4
5
6
7
8
9
10
11
l2
13
14
15
16
17
18
19
20
21
22
23
24
z5
26
27
28
w w
RESOLUTION NO. 93-159
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF
CARLSBAD, CALIFORNIA, CONFIRMING THE AMENDMENT OF
THE CITY’S CONTRACT WITH NORTHWESTERN NATIONAL
LIFE INSURANCE COMPANY TO AN “ADMINISTRATIVE
SFRVICES ONLY” PLAN.
WHEREAS, effective January 1, 1986, the City of Carlsbad
contracted with Northwestern National Life Insurance Company
(NWNL) to be the claims payor for the City’s group comprehensive
medical plan (Plan); and
WHEREAS, the above Plan was established as a “split risk
agreementy9 pian where the administrative fees are determined
before the Plan year begins, based on estimated claims, and include
a premium fee; and
WHEREAS, under an “Administrative Services Only” (ASO)
plan, a self-insured plan, the City does not have to pay a premium
fee, and most of the administrative fees are based on actual claims
paid; and
WHEREAS, by amending the contract with NWNL to an AS0 Plai
the City reduces its administrative expenses for the group Health
Plan.
///
/I/
-
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
e e
NOW, THEREFORE, BE IT RESOLVED by the City Council of the
City of Carlsbad, California, as follows:
1.
2.
That the above recitations are true and correct.
That the City Council confirms the amendment to the
City’s contract with NWNL to an Administrative Services Only
agreement effective April 1, 1992.
3. That the City Council authorizes the attached
amendments and riders to the contract with NWNL contained in
Exhibit 3.
PASSED, APPROVED, AND ADOPTED at a regular meeting of the
Carlsbad City Council held on the 25th day of MEW
1993, by the following vote, to wit:
?
AYES: Council Members Lewis, Stanton, Kulchin, Nygaard, and Fin1
NOES: None
ABSENT: None
ATTEST:
- A-
ALETHA L. RAUTENKRANZ, city Cle&
(SEAL)
0
EXHIBIT 3
Copies of Amendments and Riders to the Group Health Contract
with Northwestern National Life Insurance Company.
8
Amendments;
a) Dated September 30, 1986; effective January 1, 1986: amend
Plan to pay 90% benefit for certain services not available
through the Preferred Provider Organization (PPO).
Dated April 8, 1987; effective January 1, 1987: amend Plan to
provide modified family deductible of $300.
Dated April 15, 1987; effective January 1, 1987: amend Plan to
provide a $1 million lifetime Major Medical benefit.
Dated May 21, 1987; effective January 1, 1987: amend Plan to
set up Account #6 for COBRA Claims.
Dated January 6, 1989; effective January 1, 1989: change split
risk pooling level from $50,000 to $75,000.
Dated January 22, 1990; effective January 1, 1990: the Police
Unit is no longer covered for Health benefits through NWNL.
Dated March 9, 1992; effective April 1 y 1992: cancels split
risk contract and replaces it with ASO/Excess Risk plan.
b)
c)
d)
e)
f)
g)
Riders;
a) Effective January 1, 1986; NR-07886: modifications of
p r ov i s i o n s affect i ng “ p re - e x i st i n g co n d it i o n s” and “take o ve r
deductible and out-of-pocket expenses.”
Effective January 1, 1986; NR-07887: modifications of the
p ro vi si o n s affect i n g “e m p I o y ee I s i n s u ran ce” and “de pe n d en ts ’
insurance.”
Dated March 31, 1989; effective January 1, 1989: policy is
nonparticipating as a result of NWNL‘s conversion to a stock
life insurance company.
Effective July 1, 1991; NC-287: modifications of provisions
affecting “Basic Life Insurance” and “Supplemental Life
Insurance;” insurance will decrease to 65% on the employee’s
65th birthday.
b)
c)
d)
0:- 0 1 e m
ROL To : Northwestern National Life Insurance Company Box 20 - Minneapolis, Minnesota 55440
Request for Amendment of Group PoIicy(ies) i Insurancc
(Prepare in Triplicate) Lyr, Prcce‘c.:
City of Carlsbad
Please be complete and specific in your request.
Group Policyholder
Group Policy Number(s)
Effective Date for Amendment(s)
GH-192354
January It 1986
t If possible, the effective date should be the first day of a policy month)
Request is hereby made to Northwestern National Life Insurance Company for the following revtkt, to the Group Policy(ies) indicated above:
Please amend our policy to pay P€Q benefit (90%) for the followingl since these services are not currently available through the PPO:
Wulance
Podiatrist
Psych/Marriage Counselor Nutritionist Physical Therapy
Dental - (Wr X-Ray, Lab) ‘AT’,J? ‘’ - I*- - Ophthalmologist (treatment of diseases only, not standard exam C lens prescrj Durable Medical Equipment
Acupuncture - by an M.D. only Prescript ions
Services received by all providers outside of San Diego County are also cover
at PW benefits.
If both PPO hospital & physician are usedr all ancillary services are covered
ppo benefits as well.
-.
(If additional space is needed, please use reverse side)
Dated , 19& Group Policyholder city Of Car1sbad
BY 3-
Title - gd-h 77
PLEASE NOTE: Northwestern National Life Insurance Company will provide amendment (s) tc plish the requested revisions, provided it deems the result to be legal, appropriate for the type of i plan involved and acceptable based on its underwriting requirements, subject to necaury adjus’ any, in premium rates. In case of problem, we will contact you promptly.
e Rout To : Northwestern National Life Insurance Company Box 20 - Minneapolis, Minnesota 55440
Rqest for Amendment of Group Policy(ies)
:
1
1 Insurance use (Prepare in Triplicate) ! I 5i-F Please be complete and specific in your request.
Group Policyholder City of Carlsbad
Group Policy Number (s) GH-19 2 3 5-0
Effective Date for Amendment(s) January It 1987
Request is hereby made to Northwestern National Life Insurance Company for the following revisio to the Group PoIicy(ies) indicated above:
( If possible, the effective date should be the first day of a policy month)
- *
Please amend plan to provide a modified family deductible of $300.-
(If additional space is needed, pleasc uae reverse side)
Dated - ,19n GmuzlFL;;
BY
Tit1
PLEASE NOTE: Northwestern National Life Insurance Company will provide amendmentb) to plish the requested revisions, provided it deems the result to be legal, appropriate for the type of in plan involved and acceptable based on its underwriting requirements, subject to necessary adjustr any, in premium rates. In cw of problem, we will contact you promptly.
0 0
Rot To : Northwestern National Life Insurance Company BOX 20 - Minneapolis, Minnesota 55440
Request for Amendnient of Group Policy(ies)
(Prepare in Triplicate)
Please be complete and specrfic in your request.
I
I
Insurano
us I t'-c.- J
Group Policyholder The City of Carlsbad
Group Policy Number(s) GH-1923 5-0
Effective Date for Amendment(s) January 1, 1987
Request is hereby made to Northwestern National Life Insurance Company for the following revlsl to the Group Policy (ies) indicated above:
( If possible, the effective date should be the first day of a policy month)
Please amend the plan to provide a $l,OOO,OOO lifetime EIajor Medical benefit for all covered employees.
(If additional space is needed, please use reverse side)
Dated ApdJ 15 ,19R7.
Title Personnel Director
PLEASE NOTE: Northwestem National Life Insurance Company will provide amendment($) tl plish the requested revisions, provided it deems the result to be legal, appropriate for the type of plan involved and acceptable based on its underwriting requirements, subject to necessary adjus any, in premium rates. In case of problem, we will contact you promptly.
0 0
Roul To : Northwestern National Life Insurance Company Box 20 - Minneapolis, Minnesota 53440
Rc~uest for Amendment of Group Policy(ies)
(Prepare in Triplicate)
I
I Insurance use I I. 1 . I-- -
Please be complete - I specrfic in your request.
Group PolicyholderC of Carlsbad
Group Policy Number(s) GH-19235-0
Effective Date for Amendment(s1 1/1/87
Request is hereby made to Northwestern National Life Insurance Company for the following revisio to the Group Policy(ies) indicated above:
(If possible, the effective date should be the first day of a policy month)
Please amend plan to have Account 116 set up for COBRA Claim.*,
(If additional space is needed, please use reverse side) , 19-. 87 Group Policyholder tv of Carlsbad Dated- May 21 .
ersonnel Director
PLEASE NOTE: Northwestern National Life Insurance Company will provide amendment(s) to plish the r quested revisions, provided it deems the result to he legal, appropriate for the type of ix plan involved and ,cceptable based on its underwriting requirements, subject to necsary adjust any, in premium rates. In case of problem, we will contact you promptly.
w W
'ELE 1200 ELM AVENUE CARLSBAD. CA 92008-1989 1619) d
@iQ of Ghrlsbah
PERSONNEL DEPARTMENT
January 9, 1989
CAREN FRIEDMAN
Group Field Representative Northwestern Nationial Life
18400 Von Karman Ave., Suite 730 Irvine, CA 92715
Dear Caren:
The City of Carasbad has agreea to increase their pooling level
from $50,000 to $75,000. According to your figures, the rates will increase by 24.6%. addition, here is your copy of the amendment to the split risk agreement.
Please call me if you need additional information.
Sincerely,
This will be effective January 1, 1989.
In
VL MARSHA PAYNE
Acting Person..al Director
jm
Enclosure
e 0
MASTER AMENDMENT REQUEST FOR REVISED SPLIT RISK AGRE~~
The City of Carlsbad GH - 19235-0
Group Numbr Plan Sponsor
* the Plan Sponsor requests Northwester Effect ivs National Life Insurance Company, ("NW'NL'') to amend. and restita i its entirety the Split Risk Agreement previously made between th
parties to incorporate, among others, the following summarized changes and provisions.
1. Interest on deficits
1/1/89
Interest charged on deficits will be paid by the Plan Sponsc
arrd will not be st?bjsct to inclusion in the maxirnun. monthly reimbursement level or any other limitation.
2. Mimimum monthly claims car,
A minimum monthly claims cap will be established by "L at
the time of renewal or amepdment underwriting. "L m8y reimburse itself for claims up to this limit regardless of
other fluctuation in the determination of monthly claims limitations.
Two month emplovee/dependent count laq
For purposes of setting the maximum monthly claima cap, the employee/dependent count will come from the second precedini
plan month.
3.
4. Calculation of Reserves
Reserves will be calculated by multiplying 12 times the reseme rates times the greater of the following employee/dependent counts in the last policy year.
* * Number at the end of the year; *
Number at the beginning of &he year;
Average number during the year.
5. Terminrtl on O~tions
At termination, a retrospective premium in the amount of tk re8eme will be transferred to "L.
liability for Incurred but not reported claims.
The Plan Sponsor may retain tho resot~es and assume liabil:
for all run-off claims if the following condition8 are met
The plan sponsor pays "L any outstanding accumul
deficit; h approved claima administrator handles the claim T%re plan sponsor gives "L an acceptrblo
hold-harmless agreement;
"L will a8sume all
*
* *
* "L 89r808.
e
6. Claim Liability ODtions (Choose A or B)
‘3 A. Plan Sponsor to repay deficits - recovery in future montha/years with remaining deficit due on termination.
Monthly claims cap and deficit limitation must be qreater than of ecrual to 120%. (Choose one)
’I
13
100% monthly claims cap / 20% deficit limitation
- monthly claims cap (minimum cap of 100%) / - deficit limitation
’3 B. Deficit to be recovered in future months/years only as monthly claims cap allows. Monthly claims cap, deficit limitation, and year-end payment (if any) must be qreater than or ecrual to 125%. (Choose one)
‘3
f!!
‘I
‘3
110% monthly claims cap / 15% deficit limitation
- 11OZnonthly claims cap (minimum cap of 110%) / - 25Xdeficit limitation
100% monthly claims’Lap / 10% year end payment / I X deficit limitation
7 monthly claims cap (minimum cap of 100%) / 10% year end payment / - deficit limitation
7. Insulated deficits
For those plan sponsors in a deficit poaition when they increase their monthly claims caps from 100% (or 105%) to 11(
or more, NWNL will continue to recover existing deficits on the First of each month subject to the deficit carry-forward
limitations and the new monthly cap.
8. Dividend Offset
If the Plan Sponsor is in a deficit (either insulated of not and is entitled to a dividend on any other coverage, NWNL wi
apply that dividend to the accumulated Split Risk deficit.
NWNL will promptly prepare an amended and re8tated Split Ris Agreement, the terms and condition8 of which shall constitut the contract between the parties, for delivery to the Plan
Sponsor. By it’a signature hereunder, the Plan Sponsor agre that, in the absense of any written notification to “L of
objections made within thirty days of it8 receipt of the amended and restated Agreement, the contract a8 amended and
restated shall become effective on the date specified there:
without further action or signature of either party.
Plan Sponsor
> m 0 b To: HortBuartrrn Nattonrl Lftr Iarutrace Company Bes 2fl - Nh~eagoflr, tlhuuotr Sfu0 /
a-w-t for -t of droop ?olicl(lu)
(Rape8 ia Triglieat.) \
PlWO be tmpd8C# ad Spacfffc fn your rrqurrt.
Qroup ?oLicyholdet ad
Group PsU- Nuab.g( 1) rn-~'R7
ff?8CtfV4 DlZ8 tat handpant( a) f 1. (?f po*8ib1r, eh@ df8attva data sb!a th St day Of b pifC9 nrslrrh)
RWUWt f8 h8rr mad. C3 NOE%&Utrm htiOU.1 Lif8 IaSUmC8 fcrprny for th8 tWi8iOds) to 3 ? a Group Polieflfu) iadicatd &ova:
aust Atam nn ?!a rw m YottxNmG VIE
1. Tho Folic8 hat ( tha -1-e- md Chit d.$W&at8 U 8CWOILt ana )
E"t Will athU0 to e- ua BO 1m-t cocrosod tor Hafth bonrfita thm
baaditr ritb NyHt.
at tot CfAf88'shAt Umtl CUttd bafOr8 1/1/90, 1. Zba pIiC8 Ult Ut1 P 8ttff arbtah thair fifS md Xaimburruant lCcouOt
\
(1: additional rpum ir add, plU80 wa tar@-. rid.)
0.t. frouu? 22 b 1990. fftsup Mli-lda
w 337.4e,
tttlo Sarrior Kamrmant Andyat
PLSUS HQnr -- Urtbaal Life X~3ruraacr c4.pms will pmid am 2T. pa 4 -we SI- inrs17ad md rccagtabh bud QLL iU uad8m?i
manta, a jm u mwa~7 d4tu-t. it art, ia pram taer~. 28 CU*'C
lf8h tb -td ta-8 pmidd &t drm tb rUd8 to k 1-1
UifI -ta8 - mLr* __
I
Instttaacc tI m Nortbutra oaaA UAEW &-u-.-- r-w-z
Rmt Bort -t of Group Polfol(1w)
Box 20 - d .polis, nimmaotr 55440 - '' 6:
<*- h ~~41i-t.)
PI-. k -8fO d 8pSOfffa h poOt ?@-.6tt.
Gratlp Pelfcy&ol& sw of Cathb.4
Group Policy Nnabar(s) (BBIw
Effaetivo b8te fax &-Ma)
8.qo-t Fs hose
Ma first dry of a policy math) (?f F88fbha th. @ffOCtfV* bat0 I
Il).d. to Northmatarn Natfonal Life Zuaursaco Cempaay foz tha follc rWuion(8) t0 2 t 0 arotS, POlidiU) hdiU8t.d rbovs
PI-+ - 1 tb !Mi$ W.ak cuau it u an MQ/8%C&a
k dan. 411 -ita and bran fu+luu vi11 r-
Data ? 1923
m NQL2t No-ostm NctiolPrl Ufs Irmarmc. Corg- will prooid. maadsu lis& thr toqautod ravhioar;, provided it a thr rouult to bo 10..1, ma :o=.a of - pha hv0h.d d aso.gtrbh bad 08 it8 --it* I
malt. * la -0 of prol will camtaut yuu prarptlf. at a -8- dJtutmaata ii my, fn promium rat-.
-4
@
0 0
NORTHWESTERN NATIONAL LIFE INSURANCE COMPANY rm WOYE OFFICE - MINNEAPOLIS MINNESOTA
CER~CATEBOOKLETRIDER
city of cubbad
Certain provisions in your certificate may be modified if you and your dependents were insured on
the effective date of the Group Policy, January 1, 1986. These provisions are:
GH-192334
Pre-Extaing Condittoas
The pre-existing conditions provision in your certificate may not apply to you or your insured depen-
dent if the Group Policy replaces the Policyholder’s previous group health insurance policy. The pro-
vision does not apply to you or your insured dependent if all of these are true:
You or your insured dependent -
was insured under the Policyholder’s previous policy on the day before the Group Policy’s Ef-
becomes insured under the Group Policy on its Effective Date.
incurs an expense chat would have been covered under the previous policy but is not covered
incurs the expense on or after the Group Policy‘s Effective Date.
fective Date.
under the Group Policy because of the pre-existing conditions provision.
When all of the above are me, we will pay a benefit equal to the 1- of the total expenses covered
under - the previous policy, or
the Group Policy, disregarding its pre-existing conditions provision.
Tkkmver Deductible and Out+f-poclrct Expame8
was insured under the Policyholder’s previous policy on the day before the Group Policy’s Effec-
met any part of the deductible or incurred any out-of-pocket expenses under the policy the
we will use that part of the deductible and the out-of-pocket expenses towards meeting the deducti-
ble and the out-of-pocket expenses under the Group Policy.
.
If you or your insured dependent -
tive Date, and
Group Policy replaced,
* - Registrar
NR-07886
NORTHWESTERN NATIO Im LIFE INSURANCE COMPANY ‘rm HOME OFFICE * MINNEAPOLIS MINNESOTA
CERTIFICATEBcmKLETRIDER
city of Cubbd
GH-19235-4
EMPLOYEE’S mswa
The following provision is added to the Employee’s Insurance section of your certificate for Medical
Insurance.
We waive the actively at work requirements of the Employee’s Insurance section of your certificate if
dl of the following conditions are met:
You are eligible for insurance except for meeting the actively at work requirements on the Group
You were insured under the group policy the Group Policy replaced on the day before the Group
If these conditions are met, your insurance, including any Dependents’ Medical Insurance, will Stan
on the Effective Date of the Group Policy.
For Medical Insurance, we pay benefits only for expenses that were covered expenses under the
group medical policy which the Group Policy has replaced.
Before you return to active work, the benefit amounts and limits will be the same as the benefits ur
der the prior group policy. We reduce the amount we pay by any benefits still payable under the pric
group policy.
If you return to active work, we pay benefits according to the Schedule of Benefits and covered e3
penses of your certificate.
If you were not totally disabled on the day before the Group Policy‘s Effective Date, then your insul
ance stops according to the “When does your insurance stop?” section of your certificate.
If you were totally disabled on the day before the Group Policy‘s Effective Date, your insurance srol
on the earlier of the following dates:
For Major Medical Insurance, the end of the 12 month period following the date you becan
For any other Medical Insurance, the end of the 90 day period following the date you becan
Policy’s Effective Date.
Policy’s Effective Date.
Whichupenrcsarecovdapmrarl
How much do we py?
When doc8 your Mdd Insurance stop?
totally disabled.
totally disabled.
DEPENDENTSp INSURANCE
The following piovision is added to the Dependents’ Insurance section of your certificate for Medic
Insurance .
We waive the requirement in the Dependents’ Insurance section of your certificate that a dependc
must not be confined in a hospital in order to become insured, if dl of the following conditions :
met:
Your dependent is eligible for insurance on the Group Policy‘s Effective Date, except for bei
Your dependent was insured under the group policy the Group Policy replaced on the @’ befi
If these conditions are met, your dependent’s insurance will start on the Effective Date of the Grc
Policy.
hospital confined.
the Group Policy‘s Effective Date.
NR-07887-1
0 0
NORTHWESTERN NATIONAL
LIFE INSURANCE COMPANY M HOME OFFICE . MINNEAPOLIS, MINNESOTA
CER”ICATEBOOKIETRIDER
City of Carlsbad
GH-19235-0
Your certificate has been changed as follows. Please insert this rider in your certificate. This rider is
subject to all of the terms of the Group Policy.
I. Medical Insurance
A. The following provision under the Schedule of Benefits Major Medical Insurance “Maximum Life-
time Benefit” section on page 4 is deleted.
*Your maximum lifetime benefit will decrease to $25,000 on your 70th birthday.
page 4 is changed to read as follows:
B. The “Deductible” provision under the Schedule of Benefits Major Medical Insurance section on
neductible
?or an accidental injury ..................................................... none
,x Non-Emergency Surgery Expenses for opinions
.lade by the second and third doctor ......................................... none
For Outpatient Preadmission Testing Expenses .................................. none
For Home Health Care Seryices Expenses ...................................... none
For Hospital Admission Expenses per admission
(if no preadmission certification is obtained) .................................... $250
For all other covered expenses:
. individual .............................................................. $100
family ................................................................. $300
12 months
C. The “Family Deductible” provision under the Schedule of Benefits Major Medical Insurance
r Ily Deductible
Accumulation Period (January 1 through December 31) ......................
section on page 4 is changed to read as follows:
Amount used to meet the individual deductible for each member of your family is aIso used
irds meeting the family deductible.
2 consider the deductible met by you and all your insured dependents for the rest of a benefit
period if two or more insured members of your family meet the family deductible in that benefit
period. If one insured member of your family meets the individual deductible, we consider the de-
ductible met for that insured member.
The carry over deductible does not apply.
-
NR.10455-1
0 W
NORTHWESTERN NATIONAL
LIFE INSURANCE COMPANY nn HOME OFFICE MINNEAPOLIS MINNESOTA
POLICY RIDER
Issued by Northwestern National Life Insurance Company (NWNL)
This Rider is made a part of your policy, effective the date of NWNL's conversion to a stock life insur-
ance company, or, if later, the effective date of your policy.
Your policy is revised as follows:
This policy is nonparticipating and will not be entitled to share in the surplus earnings of NWNL.
After each policy year this policy, for purposes of determination of a retroactive rate credit, if any,
will be subject to experience rating with respect to the prior policy year. The experience rating plan
oc 'VNL in effect at the time of the experience rating will be used. The experience rating plan will
tL nto account those reserves and expenses which NWNL determines to be necessary and advis-
at NWNL, in its discretion, may combine the financial experience of this policy with the finan-
cia. dxperience of other group policies or coverages issued by NWNL to the policyholder. If a
retroactive rate credit results, it will be paid in cash to the policyholder.
Any conversion policy to which this policy refers is nonparticipating and will not be entitled to
share in the surplus earnings of NWNL.
NORTHWESTERN NATIONAL LIFE INSURANCE COMPANY
'k?L&r-
resident
3 R-05362
I 0 m l-
,-
Northwestern
National Life
Home Office Minneapolis MN
M
CERTIFICATE BOOKLET RIDER
City of Carisbad
GL-192368
Your certificate C-2847 has been changed. The page attached replaces the one presently included in your certif
icate. Please insert the new page into your certificate. This rider is subject to all of the terms of the Group
Policy.
Page 3 is replaced.
This Certificate Booklet Rider is effective on the latest of the following dates:
* July 1, 1991.
The effective date of your insurance.
The date you return to active work if you are not actively at work on the date this Rider would otherwise sta
i.
NC.ZS47
0 0
SCHEDULE OF BENEFITS
BASIC LIFE INSURANCE
Class Amount of Life Insurance+
Active Mayor, Council Members $25.000
and Elected Offcials
City Manager. Assistant City Managers,
Department Heads and all other
Management Employees
All Other Active Employees
Two times your Basic Yearly
Earnings** to a maximum of $200,000,
but not less than $15,000.
One times your Basic Yearly
Earnings** to a maximum of $200,000.
but not less than $15.OOO.
.
SUPPLEMENTAL LIFE INSURANCE
Class Amount of Life Insurance*
Active Mayor, Council Members $25,000
and Elected Officials
Active Managers, Assistant Managers,
Department Heads and all other
Management Employees
All Other Active Employees
Two times your Basic Yearly Earnings**, but
the total amount of Basic and Supplemental Life
Insurance will not be over $4OO,OOO.***
One times your Basic Yearly Earnings**, but
the total amount of Basic and Supplemental Life
Insurance will not be over $4OO.O00.***
*Your amount of insurance will decrease to 65% OR your 65th birthday.
**Basic Yearly Earnings means the basic yearly salary or waze you receive for work done for the Policyholdc
It does not include bonuses, commissions, overtime pay, uniform allowances, car allowances, “stand-by” or “ca
back’ pay, educational incentive, or insurance rebate. To determine benefits, your mount of insurance is
rounded to the next higher $1,OOO multiple, unless the amount equals a $1,O00 multipie.
***For amounts of Supplemental Life Insurance or a combination of Basic and Supplemental Life Insurance o
$235.000, you must give us proof of good health we accept, without expense to us.
DEPENDENT LIFE INSURANCE
Class Amount of Insurance
Spouse $1,500
under 6 months $100
Child (each)
- 6 months but less t$an 19 y-,
Student age 19 but less than age 24.
$1.500
Effective July 1, I
3
.I
TO : Northwestern q ational Life Insurance Company 0 Route bi Insuranc
Box 20 - Minneapolis, Minnesota 55440
Request for Amtnt3nent of Group Policy(ies)
(Prepare in Triplicate)
Please be complete and specific in your request.
Group Policyholder CITY OF CARLSBAD
Group Policy Numbcr(s) GL-19236-8
Effective Date for Amendment(s) 7/1/91 (If possible, the effective date should be the first day of a policy month)
Request is hereby made to Northwestern National Life Insurance Company for the foll revision(s) to the Group Policy(ies) indicated above:
Please amend the age reduction on our life plan as follows:
From :
65th birthday to age 70 NWNt pays 65%
70th birthday and after NWNL pays $1000
TO :
65th birthday and after "L pays 65%
(If additional space is needed, please use reverse side)
Group Policyholder a7 0 CARC, u Date ge 3 , l99/ .
BY
Title coMpe@
PLEASE NOTE: Northwestern National Life Insurance Company will provide amende accomplish the requested revisions, provided it deems the result to be legal, apF for the type of insurance plan involved and acceptable based on its underwriting ments, subject to necessary adjustment, if any, in premium rates. In case of prc
will contact you promptly.
12014
0 0
EXHIBIT 2
Staff Report - AS8 Agreement with Northwestern
National Life insurance Company.
0 W
. May 18, 1993
TO: ASSISTANT CITY MANAGER
FROM: Human Resources Director
STAFF REPORT - AS0 AGREEMENT WITH NORTHWESTERN NATIONAL
LIFE INSURANCE COMPANY
As you are aware, Northwestern National Life Insurance Company (NWNL)
is one of two health insurance providers for the City’s General,
Management and Fire employees. The original health insurance agreement
with NWNL was a “split risk” agreement, a type of insured plan. The
Human Resources staff, together with Towers Perrin, the City’s benefits
consultant, reviewed the administrative fee structure with NWNL and
investigated the option of converting to a self-insured, or Administrative
Services Only (ASO) agreement.
The risk to the City under an AS0 agreement is reduced through the
purchase of aggregate excess risk (stoploss) insurance. The charges for
these insurance coverages are the same for both the split risk and the ASC
contract types. The aggregate excess risk coverage provides a maximum
claim liability to the City for the total covered population.
NWNL calculates a projected claim expense for the upcoming year;
however, given the size of the City’s covered population, the actual claim:
experience can be subject to fluctuation and can be difficult to predict
with certainty. To limit the City’s overall liability, aggregate excess risk
coverage is purchased.
projected claims estimate. The City also purchases individual excess risk
coverage under both contract types. The individual excess risk coverage
limits the City’s claim liability to $75,000 per individual, per calendar
year. Any claim dollars in excess of $75,000 are NWNL’s liability.
A split risk contract is an insured type of contract and premium fees are
leveled at a rate of approximately 2.5% of paid claims. As an AS0 type of
plan is self-insured, premium fees are not charged.
Each year
This limits the City’s liability to 125% of the
c e W
J
t Page 2
Staff Report - AS0 Agreement with NWNL
May 18, 1992
Under both contract types, monthly administration fees are charged. The
bulk of the charges are for the claims administration and claims paying
functions. These charges are identical under both contract types. The
main difference in the fee structures is that under the split risk plan,
which is an insured plan, a “risk charge” is included in the administrative
fees. This risk charge is used to recoup losses generated by accounts that
terminate in a deficit position (ie: more claims were paid and
administration expenses incurred than what was collected in premium) as
well as to ensure an adequate rate of return on investment for the
insurance company. The risk charge for the City of Carlsbad is
approximately 4 - 4.5% of premium. As the claim liability under the AS0
plan is assumed by the City, the risk charge is eliminated under the self-
insured plan.
Fixed Costs Split Risk Plan LlsQE!m
Retention/Administration Charges:
Premium Fee 2.50% None
Claim Administration Charged Charged
Risk Charge Charged None
Excess Risk Charges:
Individual ($75,000) Charged Charged
Aggregate (1 25%) Charged Charged
Towers Perrin advised that, given the size of the City’s insured
population, it was in the City’s best interests to be self-insured.
opinion was strengthened by the City’s favorable utilization over the prioi
two year period. The City converted to an Administrative Services Only
agreement with Northwestern on April 1, 1992. The City’s initial contrac
period was from April 1, 1992 through December 31, 1992, with
subsequent contracts to be on a calendar year basis. The City’s affected
bargaining units were notified of the change from the split risk agreemen
to the AS0 agreement with NWNL.
This
1. e 9
* Page 3
Staff Report - AS0 Agreement with NWNL
May 18, 1992
We have prepared an Agenda Bill for City Council consideration on May 25,
1993. In the past, amendments and riders to the City’s health insurance
contracts have not been approved by the City Council. The purpose of this
Agenda Bill is to clarify the current AS0 agreement with Northwestern
National Life Insurance Company, and to recognize all prior amendments
and riders that have been added since the original contract with NWNL was
adopted.
If you have any questions, please contact me on extension 2955. LgpQ4P ANMI9 SEN