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HomeMy WebLinkAboutPR 24508: BLUE CROSS / BLUE SHIELD RENEWAL EFFECTIVE 11/1/2025 City Of' nrl r1/rru' tas INTEROFFICE MEMORANDUM Human Resources Department Date: September 8, 2025 To: Ron Burton, CPM, City Manager From: Dr. Albert T. Thigpen, Acting Director of Human Resources Re: BCBS Renewal Effective 11/1/2025 P.R. No. 24508 - A Resolution Authorizing the City Manager to Execute Contracts Between Its Third-Party Administrator (Administrative Services Only) For the City of Port Arthur Group Medical, Dental Insurance, For Basic Life, For Basic Accidental Death and Dismemberment, And Excess Loss Indemnity with Blue Cross and Blue Shield of Texas, Inc. Nature of the request: The City of Port Arthur is self-insured and contracts with a third-party administrator to administer its Health Insurance Plan for major medical health and dental insurance, basic life insurance, and basic accidental death and dismemberment insurance are also provided for employees and City Council appointees. Additionally,the City provides access to its major medical health insurance coverage, including prescription drug coverage, for its retirees under age 65. Medicare retirees as well as their Medicare dependent(s) transitioned to the Blue Cross Medicare Advantage PPO and Prescription Drug Plan 11/1/2016. The upcoming renewal rate will be+4.6%as an overall suggested funding adjustment. The City's claim experience summary reflects an approximate 11% increase from the most recent experience period for health claims. The increase in claims relates to the nine (9) high dollar claims that exceeded the 140K individual stop loss level. Although for the last couple of years, the city has experienced nine (9) high-dollar claims, it is anticipated that next year, of the nine (9)high-dollar claims, will be reduced to (6)high-dollar claims. Other favorable news is that the prescription rebate credit increased significantly this year and as a result, overall costs (administration, individual stop loss, and aggregate stop loss) decreased slightly. BCBSTX includes a$200,000 credit for the city to use as deemed appropriate towards funding of monthly cost. The dental coverage renewal had no impacted changes to the plan premiums. Basic Life insurance and AD&D rates remained constant with no increase through 11/1/26. Staff Analysis. Considerations: The City of Port Arthur has a Preferred Provider Organization (PPO) insurance format which provides participants great latitude in selection of health care providers. This format has been deemed most beneficial for plan participants and most compatible with our organizational culture. The City also offers a lower cost Health Savings Account (HSA) option. The City is self-insured for major medical health insurance coverage. This year's renewal reflects a 4.6%increase in recommended premium funding, Attachment "A", is an analysis of this year's renewal proposal from Blue Cross Blue Shield of Texas as presented by the City's insurance consultant, Mr. Andrew Edwards. In order to continue to offer this benefit to employees and dependents in the most cost-effective manner,no change to the level of benefits is being made to the employee. BCBS of Texas has offered a bit higher stop loss corridor, $175k, which will lower the premium to approximately$345K per year.BCBSTX also offered the one-time stipend/credit of$200K to assist in the potential additional claim liability for the next year if the City chooses to move to the higher stop loss. Additional efforts regarding wellness and education (e.g., emphasizing use of Employee Health Clinic, telehealth, exercise/gym programs) regarding plan usage and alternatives will be a significant initiative in the upcoming renewal year. The 2025-2026 Open Enrollment period will be from October 1 to October 31,2025. Recommendation: It is recommended that the City Council adopt P. R. No. 24508 which authorizes the City Manager to execute contracts between its third party administrator (administrative services only) for the City of Port Arthur group medical, dental insurance; for basic life, for basic accidental death and dismemberment, and excess loss indemnity with Blue Cross and Blue Shield of Texas, Inc., and Dearborn National Life Insurance Company for its 11/1/2025- 10/31/2026 plan year. Budget Considerations: Approval of P. R. No. 24508 which authorizes the City Manager to execute contracts with the following budgetary impact for which funds are available: Fund No. 614-11-025-5411-00-00-000 (Health Insurance Fund) Expected claims $12,821,507 Administration/Stop Loss $1,946,953 Dental $426,190 Basic Life/AD8cD $ 30.000 Total $15,224,650 P. R. No. 24508 09/08/2025--ATT RESOLUTION NO. A RESOLUTION AUTHORIZING THE CITY MANAGER TO EXECUTE CONTRACTS BETWEEN ITS THIRD- PARTY ADMINISTRATOR (ADMINISTRATIVE SERVICES ONLY) FOR THE CITY OF PORT ARTHUR GROUP MEDICAL, DENTAL INSURANCE, BASIC LIFE, BASIC ACCIDENTAL DEATH AND DISMEMBERMENT, AND EXCESS LOSS INDEMNITY WITH BLUE CROSS AND BLUE SHIELD OF TEXAS,INC. FUND NO: 614 (HEALTH INSURANCE FUND) WHEREAS, the City Council of the City of Port Arthur deems it necessary and appropriate to provide major medical health care benefits for its City's employees, City Council appointees, and its retirees under the age of 65 effective on 11/01/2025; and, WHEREAS, the City Council deems it in the best interest of the citizens of Port Arthur to be self-funded and to accept the renewal from Blue Cross and Blue Shield of Texas, Inc. as a third party administrator at an estimated cost of $541,493 and a prescription drug and medical rebate of $986,513 leaving a net administrative fee credit of $445,020 (administrative charge based on the present number of employees) as well as at a cost of $1,501,933 per year for stop loss premium (excess indemnity) per recommendation of the City's insurance consultant, Andrew Edwards; and, WHEREAS, the City's group health plan coverage encompasses the enactment of the Patient Protection and Affordable Care Act (PPACA) effectuated on March 23, 2010, with continuing provisions enacted annually, and do hereby affirm to continue to make changes to its existing health plan policies or products as required to comply with the law; and,current language P. R.No. 24508 09/08/2025--ATT ties the City of Port Arthur to specific disaster declaration by the President in which the City wishes to modify to a more standard term; and, WHEREAS, such contracting with Blue Cross and Blue Shield of Texas, Inc. complies with Sections 252.021(b), Competitive Requirements for Certain Purchases. 252.024, Section of Insurance Broker,and 252.048,Change Orders,respectively,of the Local Government Code;and, WHEREAS, the nature of the premiums to be charged by the City and the summary of benefits are as delineated in Attachment "A", which reflects the costs for administration by Blue Cross and Blue Shield of Texas, Inc.,the stop loss premium, and the expected reserve; and, WHEREAS, the Basic Life Insurance will also be continued per Dearborn National Life which includes provisions to provide basic life insurance coverage to Fire Civil Service personnel at a rate of one times his/her base annual salary in accordance with the IAFF Collective Bargaining Agreement between the City $.22/per thousand dollar unit, and all other eligible employees' coverage will remain a $6,000 death policy, which will cost the City $.19/per thousand dollar unit/per employee/per month; and, WHEREAS, as part of the Dearborn National Life proposal, the City is also obtaining Accidental Death and Dismemberment Insurance on behalf of its employees which will remain at a cost of $.04/per thousand-dollar unit/per Employee (for a $5,000 accidental death and dismemberment policy for all eligible Employees)per month; and, WHEREAS,the current year's renewal provides a 4.6% increase in premium to the City, to employees, City Council appointees, and to retirees under the age 65. It is being recommended that effective 11/01/2025 all impacted plan participants will incur a 1.15%premium increase. P. R. No. 24508 09/08/2025--ATT NOW,THEREFORE,IT BE RESOLVED BY THE CITY COUNCIL OF THE CITY OF PORT ARTHUR, TEXAS: Section 1. That, the City Council of the City of Port Arthur hereby accept the following contracts to Blue Cross and Blue Shield of Texas, Inc., attached hereto and made a part hereof, as is fully delineated herein: INSURANCE COVERAGE ADMINISTRATIVE SERVICES EFFECTIVE DATE Administrative Services Blue Cross and Blue Shield November 1, 2025 City of Port Arthur's Group Medical and Stop Loss Dental Blue Cross and Blue Shield November 1, 2025 Basic Life &AD&D Dearborn National Life November 1, 2025 Section 2. That, the City Manager is hereby further authorized to execute the necessary contracts and other documents on behalf of the City of Port Arthur subject to the approval of the City Attorney, and to make payment of necessary premium and administrative charges to bind coverage subject to the terms and conditions of the contract for Third Party Administrator (Administrative Services Only) and the Contracts for Insurance attached hereto as required effectuate said services; and, Section 3. That, the City Manager is hereby directed to take all actions necessary to ensure proper funding of the City of Port Arthur's Employee Health Insurance Fund; and, Section 4. That, a copy of the caption of this Resolution be spread upon the minutes of the City Council. READ, ADOPTED AND APPROVED this day of A.D. 2025 at a Regular Meeting of the City Council of the City of Port Arthur, Texas by the following votes: P. R. No. 24508 09/08/2025--ATT AYES: Mayor Councilmembers Noes Hon. Charlotte M. Moses, Mayor ATTEST: Sherri Bellard, TRMC, City Secretary APPR • Roxann Cotroneo, City Attorney APPROVED FOR 1 MINIS RATION: AgW/ Dr. Alber V1 ••-n, Actin• . reals ' uman Resources kk 1 y, Ron Burton, C' , ity Manager APPROVED AS TO THE AVAIABILITY OF FUNDS: of . 1 4 . Q Ft2 ' y •a Boswell, Director of Finance P. R. No. 24508 09/08/2025--ATT ATTACHMENT "A" . N 0 it..4 - , . ' ' 1-:l'. -....1 . ' * . s . . -.7 f4ra,_,• _ - * : ••••:.-'.;. ' ' ; -, -_,_^.- , ..> i . liihro, 4,,or,.., •• , •.<•' •k ,t- ,,,, -1 Sti, , ,, , ' ,'... .11..1 11..,-,, - - -- , • ' ', IV., .. .4.:',..:, — ' •• ' .:-- ' ' # A".' 3iki• .. ••,--s \41106.44,14,,,, , .4. A, '1" ...11.• ;t • • -1"'• . rn. , •••••,1: 2 .„T elZ t, I • 1 cl. . . • N , Co..4 • . •-k.4.1iN- ' 'i - t 00 rs,1 .0 4sa M =1 'a - 0 'E v- t3 X (/) a -ru a) L_ •-.. .4 at( a) 4 , . c. . , ., . (/) (1.) 0 1 .. .." co 4.0 : ,_ 7.,-,..,..•A, I. i I = L. ,_ , i 0 in C t-si CD g '' 1 40:.,• 4; L - .. 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''. .. 1 \ A RlueCrussBlueShield ol'Texas City Of Port Arthur ASO Projection for the period of November 1,2025-October 31,2026 EXECUTIVE SUMMARY Group Detail Prior Period 05/01/2023-04/30/2024 Proposed PBM Prime Current Period 05/01/2024-04/30/2025 Proposed Rx Pricing Method Traditional Proposed Product PPO Rx Offer Cohort Proposed Network Blue Choice PPO Proposed RX Network Advantage Wellbeing Enable BH Proposed Drug List Performance Select ISL Deductible S 175,000 ASL Attachment Factor 125% Demographics Enrollment PPO H.S.A Total 05/01/2024.04/30/2025 650 126 776 05/01/2023-04/30/2024 624 93 717 %Change 4.2% 35.5% 8.2% Average Contract Size 1.85:1 Financial Projected Period:11/01/2025-10/31/2026 Projected Net Medical Claims S8,719,664 Projected Net Drug Claims $4,101,843 Projected Fixed Costs $1,501,933 Projected Cost as a%of Total Annualized Dollars 10.5% ❑Projected Net Medical Claims 28.6% ❑Projected Net Drug Claims ❑Projected Fixed Costs 60.9% **Specific fees can be found on the Total Projected Cost and/or Fee Comparison Page Additional Services(currently included) APR 001 APR Savings Program Virtual Visits w/o BH Bice Cross and Blue Shield of TA.a Crarsion of Health Care Seance Corporation a Mutual Legal Reserre Company an Independent Licensee of the Blue Cross and Blue Shield Association a© U BlueCross BlueShield-of Texas City Of Port Arthur ASO Projection for the period of November 1,2025-October 31, 2026 CLAIM EXPERIENCE SUMMARY ALL PLANS Current Medical Drug Total Medical Month Claims Claims Claims Enrollment 1 Apr-24 1 717 May-24 $699,703.16 $329,099.21 $1,028,802.37 726 Jun-24 $968,499.61 $273,271.62 $1,241,771.23 729 Jul-24 $693,663.07 $259,937.00 $953,600.07 734 Aug-24 $576,421.73 $300,663.41 $877,085.14 738 Sep-24 $545,646.07 $334,153.30 $879,799.37 742 i Oct-24 $434,295.67 $311,172.04 $745,467.71 752 i . Nov-24 $474,296.11 $318,964.24 $793,260.35 757 Dec-24 $542,139.34 $272,528.14 $814,667.48 763 Jan-25 - $717,149.46 $308,482.06 $1,025,631.52 762 Feb-25 1 $547,571.82 $278,054.02 $825,625.84 766 Mar-25 $666,331.57 $279,605.46 $945,937.03 773 ` Apr-25 $953,429.25 $349,009.73 $1,302,438.98 Total $7,819,146.86 $3,614,940.23 $11,434,087.09 8,959 Cost PEPM $872.77 $403.50 $1,276.27 Physician and BlueCard Network Savings $8,278,290.09 Prior Medical Drug Total Medical ;Month Claims Claims Claims Enrollment Apr-23 769 May-23 I $436,708.54 $275,616.86 $712,325.40 741 i Jun-23 $717,106.96 $348,809.75 $1,065,916.71 739 Jul-23 $738,042.02 $251,128.34 $989,170.36 743 Aug-23 $809,454.60 $298,814.79 $1,108,269.39 737 Sep-23 $558,951.95 $353,086.30 $912,038.25 736 Oct-23 $619,745.86 $322,595.85 $942,341.71 738 Nov-23 $600,197.94 $224,524.98 $824,722.92 736 Dec-23 $655,278.19 $353,452.11 $1,008,730.30 740 Jan-24 $730,087.21 $220,244.73 $950,331.94 744 Feb-24 $505,883.49 $284,689.51 $790,573.00 721 Mar-24 $854,561.72 $352,078.90 $1,206,640.62 721 Apr-24 $763,539.40 $217,589.75 $981,129.15 Total $7,989,557.88 $3,502,631.87 $11,492,189.75 8,865 Cost PEPM $901.25 $395.11 $1,296.36 Physician and BlueCard Network Savings $9,161,217.08! j Blue Cross and Blue Shield of TX,a Division of Health Care Service Corporation,a Mutual Legal Reserve Company.an Independent Licensee of the Blue:Cross and Blue Shield Association +. ,n - •C a) N o0 i N. a NN L) ., _ w + .fl a d O J i-FO O N _ - n .n ON T , 0 w a0f V d xi o N a Na 0, a rn ^ ma c enw a a v- a N w w � v. 0 C N O J N Jai a M oO.f rNn a _ N N � a N N O o 0 O O O O O r- '- N o N o _ N o O a a 'A O V 00 V. x O Ow O O O O O o W O - o o - iC W .b W .D .' - O• ,j .N- m R - V j Q ? 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BlueCross BlueShield of Texas City Of Port Arthur ASO Projection for the period of November 1,2025-October 31,2026 HIGH COST CLAIMANT SUMMARY(Medical & Rx) All Associations Current High Cost Claimants account for: 0.28%of the Overall Membership 10.13%of the Total Paid Claims High Cost Claims Percentage 100% - ,s 80a6 - z • y ' q - 4 4� +:' :--�x`'3.eii a : s 60% "789 606$3 $10,275,650 40% - 20% - - )} 0% rr ;; -� 81,158438 Prior Period(05/01/23-04/30/24) Current Period(05/01/24-04/30/25) C High Cost Claims Remaining Net Paid Claims Prior Current %Change Remaining Net Paid Claims $9,760,683 810,275,650 -5 7'` High Cost Claims ! $1,731,507 $1,158,438 Total Paid Claims $11,492,190 $11,434,088 Current High Cost Claimants (05/01/24-04/30/25) Total Claim HCSC High Cost Claimant ISL Deductible DRG Description Active/Inactive Dollars Claim Dollars Claimant 1 $175,000 8407,348 $407,348 n/a Active Claimant 2 $175,000 $290,316 $290,316 Chronic renal failure Active ;Claimant 3 $175,000 $276,886 $276,886 Complications of genitourinary devices,implants and grafts Active Claimant 4 $175,000 $183,888 $183,888 Chronic gout Active Prior High Cost Claimants (05/01/23-04/30/24) Total Claim HCSC High Cost Claimant I5L Deductible DRG Description Active/Inactive Dollars Claim Dollars Claimant 5 8175,000 $458,906 $458,906 Other septicaemia Inactive Claimant 6 I $175,000 $414,834 $414,834 Respiratory failure,not elsewhere classified Active Claimant 7 1 $175,000 $361,023 $361,023 Chronic gout Active Claimant 8 $175.000 $276,580 $276,680 n/a Active Claimant 9 $175,000 $220,064 5220.064 Other medical card Active Claimant identifiers are generic and do not determine relationship between the current and prior time periods.If is possible that a claimant may be included in both time periods. 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V • a :` CU -o E ir.— 0 au .a, - 0 ", a LL co'f o a vR m a, Qf 1 Qp ia.+� 73 L m � (0 , b4 E C N N _ Cid �.. .k " ' - ro U 0 O_ N y CX v i Ln LA i U 4' ro u .. a a ° 0 O03 p 0 L. b0 o m D w v to v Q Q p o iii D a.+ •'a+ Cr f0 N : -o "a < m m m U ` v V U a Q �.+ CD 7 L aJ a1 .0 �C o a, r a0 0 o c ' T -6- U) m 0 m p 0 0 c , Q E vi N d _ co d} V} - y 3 U Q L w 13 3 LIB mom C N o L awn a cn p or LU 4- O ° N m v 0 N NLi) Ln ° d 41 -0 • 0 O co coc0 _> N n lin •O m Q. cri iii• (> U ate-, U 0ti m- w E V�CZ O Oin fti o ( • V. �11 c 1 V /C� {1 y� 'J -N V Wry a. o O > _J o m E•y v N 2 0tfa c CY* aJ �- Ts •fi ° �a 0 .O u. X c L C d O . flu O a d► IS Q' Xi c O_ r c ,, a o, o zco N u O U p SZ CZ 0 X. ^� O = c o M c C) Nco Fil C v O tU o >a) m on Q ID E O ~ Sc y ,71 C 0 CO ° Cr m ti a. Col) V p 3 a> 5 v/ y GJ U a _I o _ •p " v c.) O on O v o �I E U U Y CO — c as a 2 s to c m Z c u ° o v arz `o CD °; 2 c c 0 m . c C Y.d 3 LO LU 13 2 - % % y in 0 \ - _ \ \• 3 Q Q Q « \ Vi CO aill ° - / k I vt I- Z 2 a2 a O \ � - ® w 2 \ \ \ [ _ m 0 \ \ in / \ MC \ \ p a ® _ _ Q a , ' \_ ( » ) \ \ / % > \ ® iv :ii ~ \ } \ L 0 \ 3 ° * ` - / k § ) _ t > \ t { \ } \ 3 / CY } - O _ - - § \ % Q : ~ ci & +la / Z � � � \ O � k » - c ak ` \ - \ \ ) \ } > § r ! E - 7 / E c. § u . { ea � E ] $ c ~ _ E I 2 - f _ t 10, k a. \ 10 t. E \ } \ i e I 7 7 £ \ co113 I- ma. { » ; I + ° k � � ` , a a) 2 ® a s 2 RI J # ( el ` n CA / E 4) / E \ LI \ \ \ GI / E vl Q \ ) \ E z 2 ` } z ^ 2 ` 2 ± $ 9461b BlucCrossBlueShield of Texas City Of.Port Arthur ASO Projection for the period of November 1,2025-October 31,2026 ***Numbers for Illustrative Purposes Only*** Rx Claims Only RX DISCOUNT COHORT OFFER Traditional Pricing Network Traditional Select Advantage Preferred Retail Discount Brand AWP minus 19.4040 20.75% 21.75% Generic AWP minus 83.40% 84.70% 85.05% Dispensing Fee Brand $0.75 $0.40 $0.40 Generic $0.75 $0.40 $0.40 Mail Discount Brand AWP minus 23.65% 23.65% 23.65% Generic AWP minus 85.85% 86.40% 87.00% Dispensing Fee Brand 80.00 $0.00 80.00 Generic 80.00 $0.00 80.00 ESN Discount Brand AWP minus 22.65% 23.65% 24.55% Generic AWP minus 85.85% 86.40% 87.00% Dispensing Fee Brand $0.00 $0.00 $0.00 Generic $0.00 $0.00 $0.00 Specialty Discount AWP minus 21.15% 21.15% 21.15% Dispensing Fee Specialty $0.00 $0.00 $0.00 Drug List Average Rebate Credit PEPM Performance Select Biosimilar ($92.96) Caveats •Members will pay the tenser of the contracted rate.USC or their applicable copayment Zero balance logic is not employed •AWP discounts are based on the actual NOC•I t dispensed AWP discounts provided do not include savings from OUR or other clinical programs •Assumes client does not have 3408 pricing -Brand drugs are defined as all drugs that have a Medi•Span mullsource code held equal to'M' N'or 0 Generic drugs are defined as all drugs available in sufficient supply that have a Medr Span multisource code held equal to'Y' -Assumes Ercfusrve Specialty through Specialty Pharmacy •Discount and dispensing fee rates a¢hide compound long term care(LTC)pharmacy home infusion(Hi)pharmacy veterans affairs(VA)pharmacy Indiandnbal/urban(I?bU)pharmacy U S territory(TER)pharmacy 340E Medicare:Medicaid out-ofneauork member-submitted(e g direct member reimbursement)coordination of benefits'COB) subrogation usual and customary(U3Ci clamps and non-specialty discount and dispensing fees also e.c/ude specialty(as defined by the specialty drug pricing filet claims The above AYVP's and Dispensing fees reflects HCSC's Rh standard product for the Nef.•scrks offered Group's estimated pricing will b?based on the Network and Drug List selected -Network options above only apply to plans with custom benefits •Products with government mandated reimbursement emergency use protocols or related to Comd-19(e g resting vaccines and treatrnent,r are e,cludem from guarantee reconciliation •The pharmacy offer above is contingent oo placement of medical:nth pharmacy •Specialty drugs dispensed through the medical benefit Al not be included in reconciliation of guarantees Blue Cross and Blue Shield of TA a Dr'psion of Health Care Service Corporation a Mutual Legal Reserve Company an Independent Licensee Sf the Blue Cross and Blue Sheld Assoaaben • 11 131ueCross BlueShield of Twos City Of Port Arthur ASO Projection for the period of November 1,2025-October 31,2026 CONDITIONS AND CAVEATS !Notwithstanding anything in the renewal or proposal to the contrary,BCBSTX reserves the right to revise or withdraw any term herein or to change our charge for the cost of coverage(premium, !fees or other amounts)at any time before or during the contract period if any local,state or federal legislation,regulation,rule or guidance(or amendment or clarification thereto)is enacted for becomes effective/implemented,which would require BCBSTX to pay.submit or forward,on its own behalf or on the Employer Group's behalf,any additional tax,surcharge,fee,or other amount(all of which may be estimated,allocated or pro-rated amounts).BCBSTX also reserves the right to change the administrative fees it charges the Employer Group at any time before or during !the contract period to the extent that any local,state or federal legislation,regulation,rule or guidance(or amendments or clarifications thereto)is enacted or becomes effective/implemented !which results in increased projected claim costs or an increase to BCBSTX's expenses or cost of plan administration. Unless otherwise stated,this renewal offer is made on the assumption the benefit program is for a plan that is not considered a"grandfathered health plans"as defined under the Affordable Care Act and related regulations.If you have questions about grandfathered heath plans,please consult your legal counsel. HCSC reserves the right to adjust the Aggregate Claim Liability if one or more of the following occurs within the coverage period. - the Account's composition changes(i.e.demographics) - the Account's number of covered employees increases or decreases by more than 10% - the Account's benefit program changes !The total annual Stop Loss premiums and ACV factors are based upon the total projected enrollment and contract distribution as indicated on this exhibit. Significant changes in the above stated enrollment and contract distribution will require a review and adjustment of the fees and factors Rates are projected to be effective for the 12-month period beginning on the effective date indicated. Final rates may vary based on actual enrollment results This renewal offer assumes BCBSTX will remain the exclusive carrier. The total annual premiums are based upon the total current enrollment and contract distribution as indicated if the enrollment or contract distribution varies by more than 10%in total or in each coverage independently,we reserve the right to re-rate The minimum participation requirement is 75%without waivers and 65%with valid waivers in order for coverages to be issued The employer maintaining the current contribution schedule. 'Annual open enrollment 'Upon inquiry from employer groups,BCBSTX will provide information to the employer group regarding commissions and other compensation paid to the employer's agent by BCBSTX in connection with the employer's policy or contract with BCBSTX. ;The Individual Stop Loss quote is being offered on a Paid basis during the policy period indicated above The Aggregate Stop Loss quote is being offered on a Paid basis during the policy period indicated above Paid Claims subject to Individual Stop Loss are paid claims from the following line(s)of coverage Medical and Drug Paid Claims subject to Aggregate Stop Loss are paid claims from the following line(s)of coverage Medical and Drug The Minimum Aggregate Point of Attachment was calculated as 90%of the Aggregate Claim Liability per employee per month multiplied by the projected cumulative contracts for the period Individual Stop Loss and Aggregate Stop Loss premiums are payable on the first day of each month ,Any amount in excess of the Individual Stop Loss deductible will not be included in the Aggregate Stop Loss Settlement The Aggregate Stop Loss benefit payment is unlimited per policy year HCSC's pharmacy benefit manager,PRIME Therapeutics(PBM).holds rebate contracts with pharmaceutical manufacturers Unless otherwise agreed by the parties.HCSC may in some circumstances,provide the Employer with a Rebate Credit,but such Rebate Credit may not equal the entire amount of the rebates provided to HCSC by the PBM Blue Cr.ss anal Clue Snie'd of TF,a Division of Health Cate Service Corpora:ion a Mutual Legal P.eserie Company an Indeependent Licensee of the Blue Cross and Blue Shield Assoc:iaf.on 000 BlueCross BlueShield of Texas City Of Port Arthur ASO Projection for the period of November 1,2025-October 31,2026 CONDITIONS AND CAVEATS Employers that do not use Prime Therapeutics as their pharmacy benefit manager are NOT eligible for a Rebate Credit under the pharmacy benefit. — HCSC's current estimate of the rebates it will receive from the PBM,for drugs covered under the pharmacy benefit,for the employer's covered members,is approximately$88.72 per script. IThe PEPM Medical Rebate Credit is subject to change as HCSC will review the PEPM credit offer for each subsequent renewal. IThe Administrative charge includes a network access fee for employees residing in HCSC service areas(IL,MT,OK,NM,TX) Claims incurred outside HCSC service !areas through the BlueCard program may be assessed a BlueCard access fee of no more than 3.31%of the discount applied,not to exceed$2,000 per claim.An estimate 'of this access fee is included in our projected claim figures. Costs associated with special services or custom materials provided by BCBSTX will be billed separate and apart from the Administrative Charges outlined on this exhibit. The employer is responsible for any administrative services taxes due for benefits paid under this agreement. This quote is contingent upon the account signing new contract documents in a timely manner.If not signed,then HCSC may withdraw and/or revise the quote. Pharmacy Rebate Credit includes estimate of rebates for all categories of drugs,including specialty drugs,based on our book of business. If the prescription drug program is not administered by Prime today but is awarded the administration of the prescription drug program,the medical claim cost will be reduced due to the integration of the medical and prescription drug program. Wellbeing Management(Health Management&Advocacy program)is included in the quoted administration fee Commissions are excluded from the quoted rates/fees.Upon inquiry from employer groups,HCSC will provide information to the employer group regarding commissions and other compensation paid to the employer's agent by HCSC in connection with the employer's policy or contract with HCSC If a non-preferred vendor is selected for automated eligibility processing,an additional charge will apply. If a third party pharmacy benefit manager is selected,additional charges will apply. This Stop Loss quote is firm through 06/16/2025 Note.For quotes/renewals that are illustrative or otherwise not locked in,HCSC will require/review updated claim data which is within 180 days of the quoted effective date kA revised and final stop loss quote/renewal will be issued at that time. I Projected Net Paid Claims for non-HMO Medical coverages on these exhibits include Estimated Value Based Care Payments and Savings. iValue Based Care payments apply to Stop Loss Coverage. f ' IBCBSTX retains the right to recoup monetary credits provided,any remaining implementation costs.shared savings or PG incentive fees from the plan sponsor in the event of early termination of the proposed coverage or contract,either in its entirety or with respect to certain custom services or programs included in this offer. •If a third party stop loss carrier is selected.a Third-Party Stop Loss Carrier fee will apply If an HMO network product is selected.mental health capitation charges may apply and be billed separate and apart from the Administrative Charges outlined on this exhibit. Offer is contingent upon proposed Wellbeing Management package design Any modifications to the proposed package will impact the Wellbeing Management fee and Administrative Fee !Administration Fee assumes Weekly claim funding •The Aggregate Stop Loss product includes a cumulative monthly aggregate accommodation This quote assumes Prime Therapeutics(PBM)Performance Select drug list and Advantage network Blue Cross and Blue Sh,etd of TX.a Dwiston of Health Care Sernce Corporation a Mutual Legal Reserve Company an Independent L,censee of the Blue Cross and Blue Shield Assoc,ation Y ° c 3 m - ° 2� >, a as -5 > c c a m c O a) ,0 T a c0 a _O m ° - c L c a C N E m N N C Q E E axi ro N c o o a) a U m ° E ° a) v) c E - O- a) m 7 U 7 O N m E U a)o ° ° t a) a a E 0 7 o c a) o Q N aa) 0 -0 a _ 9 L C N a) N a) O 'O 2 m o .� - a) W a) O• CC a a o@ N c. a E o Ea.) a) m (1)>, > m - E Q - O 7 C 0 (6 p N 2 a) 0 W a) 2 o a) E C E ° m C as E a) E E N o a) a E ° E a - o m - E 7. 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BlueCross BiueShield.of Texas City Of Port Arthur Prospective Premium Projection for the period of November 1,2025-October 31, 2026 CLAIM EXPERIENCE SUMMARY All Current Dental Dental Month Claims Enrollment i Apr-24 i 649 May-24 $27,605.17 659 t 1 Jun-24 $20,157.74 662 Jul-24 $29,018.39 668 i i Aug-24 $32,616.80 672 Sep-24 $21,279.19 678 Oct-24 $27,608.48 688 Nov-24 $24,466.24 694 Dec-24 $17,677.28 699 Jan-25 $26,704.52 699 Feb-25 $27,483.53 701 Mar-25 $32,371,37 709 Apr-25 $31,816.10 Total $318,804.81 8,178 ' Cost PEPM $38.98 Prior Dental Dental Month Claims Enrollment Apr-23 ! 692 May-23 $31,861.60 664 Jun-23 $25,606.40 664 Jul-23 $26,313.83 667 Aug-23 $29,307.91 660 Sep-23 $19,843.44 662 Oct-23 I $20,394.10 666 Nov-23 $22,424.08 666 Dec-23 i $23,015.14 669 Jan-24 i $25,639.35 673 Feb-24 i $20,968.50 653 Mar-24 $39,162.89 653 Apr-24 $37,111.50 ;Total $321,648,74 7,989 1 Cost PEPM ! $40.26 Blue Cross and Blue Shield of TX,a Division of Health Care Service Corporation,a Mutual Legal Reserve Company.an Independent Licensee of the Blue Cross and Blue Shield Association 0 0 B1ueCross BlueShield. of 3'�xas City Of Port Arthur Prospective Premium Projection for the period of November 1, 2025 - October 31, 2026 CLAIM PROJECTION All DENTAL Prior Current 05/23-04/24 05/24-04/25 A Net Paid Claims $321,649 $318,805 D Exposures 7,989 8,178 E Average Claim Value(ACV)Per Employee Per Month(PEPM): E=C/D $40.26 $38.98 Annual Trend Rate 5.3% 5.3% Trend Months(midpoint method) 30.0 18.0 F Trend Factor 13.8% 8.1% G Trended ACV PEPM:G = E*(1 + F) $45.82 $42.14 H Historical Plan Change Adjustment 0.00% 0.00% I Enrollment Shift Adjustment 0.00% 0.00% J Demographic Adjustment 0.00% 0.00% M Projected ACV PEPM by Period: M =G*(1 +H)*(1 + I)*(1 +J) $45.82 $42.14 N Experience Period Weighting 0% 100% O Blended Experience ACV PEPM $42.14 Q Credibility 100% R Total Projected ACV PEPM: R=0 *Q+ P*(1 -Q) $42.14 S Projected Plan Change Adjustment 0.00% T Total Projected ACV PEPM with Adjustments:T= R*(1 + 5) $42.14 U Stop Loss Alternate Level Adjustment 1.0000 ✓ Adjusted Projected ACV PEPM:V=T* U $42.14 W Projected Enrollment 712 X Number of Months in Policy Period 12 Y Projected Net Paid Claims:Y=V*W*X $360,044 Blue Cross and Blue Shield of TX,a Division of Health Care Service Corporation a Mutual Legal Reserve Company an Independent Licensee of the Blue Cross and Blue Shield Association Proprietary and Confidential Information of BCBSTA `lot to..,s..,r d1sclo,rs.outside BCBsr r.Employer her respective affiliated companies and third-party representat,es except N rr1 w.tten perrm.ssion ci BCES r!. o� © BlueCross BlueShield of Texas City Of Port Arthur • Prospective Premium Projection for the period of November 1, 2025 - October 31, 2026 TOTAL PROJECTED COST RENEWAL DPPO Projected Enrollment • 712 Total Projected Net Claims $360,044 Risk $8,641 Total Benefit Charges $368,685 Desired Loss Ratio (DLR) 86.51% Required Premium $426,168 Premium at Current Rates $426,190 Required Premium/Premium at Current Rates 0.0% Blue Cross and Blue Shield of TX,a Division of Health Care Service Corporation, a Mutual Legal Reserve Company. an Independent Licensee of the Blue Cross and Blue Shield Association Proprietary and Confidential Information of BCBSTX r i for use or disclosure outside BCBSTX Employer their respective affiliated companies and third-party representatives,except with written permission of BCBSTX cr N CO 00 N N X N N 00 k N b4 b4 R m U m O c 0 c c O O 4 v C1 al m Cr) 0 N _ ` Q O c — N N N 2 ^ O b.4 w co —.0 o o n O ca i • �O °a d NC 0_ o m in V co co ID CD N oo N a.) 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