| Chairperson
Everett School Employee Benefit Trust P.O. Box 2098 Everett, WA 98203 |
B.
Financial Services
i.
Develop effective strategies to meet program objectives, including initial recommendations concerning Trust and employee contributions, age and family subsidies and risk transfer
ii.
Introduce new ideas and approaches to improve benefit design, the delivery of benefits and the financial success of the plan
iii.
Analyze the feasibility of modifying or changing the present method of funding and make recommendations where appropriate for alternate funding methods, including the alternative risk transfer arrangements
iv.
Prepare annual projected revenue and expense calculations for the Trust
v.
Prepare annual calculation of premium rates and COBRA rates for the plans
vi.
Prepare annual calculation of employee contribution requirements prior to each annual open enrollment period
vii.
Analyze loss ratios, retention levels and billing margins requested by carriers during renewal
viii.
Prepare experience report for medical and vision plans to monitor claims experience against fully-insured premiums and provide regularly to the Trust throughout the year
C.
Plan Review
i.
Review federal and state legislation and other regulatory requirements and advise the Trust on potential application to the benefit plans
ii.
Review instruments and documents, such as insurance contracts and booklets
D.
Meetings/Meeting Preparation
i.
Provide general consulting on all benefit issues, including at least six meetings per year
ii.
Participate in annual or bi-annual cost and utilization review meeting(s) with medical carriers
E.
General Administration
i.
Assist with billing, claim filing procedures and eligibility
ii.
Monitor performance guarantees
iii.
Completion of any required reports requested by the State
iv.
Respond to Trust/HR staff questions, benefit clarification
v.
Project management
Special Projects Not Included in Routine Services
(Consulting Services Typically Designated as Special Projects):
vi.
Drafting bid specifications, analyzing responses, making recommendations and assisting in implementing changes in carriers and other vendors unless specifically listed above
vii.
Claims data analysis
viii.
Development of special communications projects (handbooks, benefit statements, newsletters, etc.)
ix.
Conducting a claim adjudication review, including focused claim audit
x.
Conducting a systems audit and recommending changes to enhance work flow and administrative efficiency
xi.
Developing new programs not currently available to employees
xii.
Other services not specifically identified in Routine Services and mutually agreed between the parties
3.
Description of client responsibilities: Provide data as required.
4.
Period of time over which work will be performed: July 1, 2016 through June 30, 2017 and automatically renews for one-year periods as agreed to by the Trust and Mercer.
5.
Compensation/fees:
We will receive a combination of compensation from third parties in the form of base commissions and fees from you that are the subject of our disclosure and your consent on our “Transparency Form” for the Services performed hereunder.
We will bill you monthly with such invoices due within thirty (30) days of your receipt of an undisputed invoice. If any invoice remains unpaid after longer than ninety days from the date of the invoice, we may either suspend the provision of the services until payment is received or terminate this Letter with immediate effect.
The following table outlines the estimated budget for the 2016/2017 year. Services provided under the Renewals/Carrier Relations, Consultant Meetings, and Financial Services categories will be paid for by the commissions we receive. Services provided under the remaining service areas will be invoiced.
| 2015-2016 Estimated Budget (REVISED) | 2015-2016 YTD Actual through April (10 months) | Core Consulting Services | 2016-20176 Estimated Budget |
$35,000
| $44,638 actual charges | General Administration:
• District questions • Benefit Clarifications • Carrier Follow-up • Appeal Research • Problem Resolution • Monitor Performance Guarantees | $35,000
|
$30,000 (covered by commissions)
| $96,448 1 commissions received | Renewals/Carrier Relations:
• Evaluate Cost Containment • Negotiate Preferred Rates and Contract Terms • Renewal Rate Analysis • Create Renewal Report | $30,000 (covered by commissions6
|
$25,000 (covered by commissions)
| Included in actual charges above | Consultant Meetings:
• Preparation for and Attendance at Trust Meetings • Participate in medical carrier annual or bi-annual cost and utilization meetings • Project Management | $25,000 (covered by commissions)
|
$25,000
| Included in actual charges above | Financial Services:
• Benefit Cost Impact • Cost and Contribution Calculations • Prepare Premium and COBRA Rate Calculations • Prepare and provide regular experience reporting for insured medical and vision plans | $25,000 (covered by commissions)
|
$10,000 (covered by commissions)
| Included in commissions received above
| Plan Review:
• Contract Review • Benefit Summary Review • Compliance Reviews | $10,000
|
$125,000
| $141,086
| Total | $125,000
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