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Home My WebLink AboutAgreement A-25-631 with RetireeFirst.pdf Agreement No. 25-631 AMENDMENT TO LABOR FIRST RETIREE BENEFIT MANAGEMENT SERVICES AGREEMENT This Amendment (this "Amendment") to the RETIREE BENEFIT MANAGEMENT SERVICES AGREEMENT between LABOR FIRST LLC dba RETIREE FIRST ("CONTRACTOR") and COUNTY OF FRESNO (the"COUNTY")dated OCTOBER 22,2019(the"Agreement")is made and entered into by Manager and Client effective on OCTOBER 31 sT 2025. WHEREAS, CONTRACTOR and COUNTY desire to amend the Agreement in accordance with the terms and conditions of the Agreement. NOW,THEREFORE,Manager and Client hereby amend the Agreement as follows: l. The COMPENSATION addressed in section 5 shall be revised to$293.08 for the Medicare Supplement Plan, $346.65 for the Medicare Supplement Plan G,and$344.50 for the EGWP plan. Additionally,the supporting document Exhibit B shall be replaced with Exhibit B 1 (attached). 2. The Termination date of December 31512022 in Section 3.Term shall be replaced with December 3 1"2026. 3. This Amendment may be executed in two(2)or more counterparts each of which shall be deemed an original and all of which taken together shall constitute one and the same Amendment. 4. This Amendment shall supersede any previous Amendments. 5. Subsidiaries and Affiliates. Client acknowledges and agrees that certain services hereunder may be performed or provided by Manager's subsidiaries or affiliates, including, without limitation, Retiree First LLC. Client further acknowledges that all insurance products and services offered may be provided by Labor First Insurance Solutions, LLC in CA and Labor First Insurance Brokerage,LLC in NY,a licensed insurance agency,on behalf of one or more insurance companies. All descriptions or illustrations of coverage provided by Labor First are for general informational purposes only and do not amend, alter, or modify any insurance policy or guarantee any specific price,quote or coverage.Not all products and services are available in all states or to all customers. Nothing herein is intended or should be interpreted as the sale or solicitation of insurance by Retiree First. To the extent any of Manager's subsidiaries or affiliates provide services hereunder,Manager represents and warrants that such subsidiaries and affiliates shall adhere to all terms and conditions of this Agreement. IN WITNESS WHEREOF,CONTRACTOR and COUNTY hereto have executed this Amendment. COUNTY OF FRESNO RETIREE FIRST Authorized Signature �y reetwnrks Print Name Ernest Buddy Mendes Authorized Signature Print Title Chairman of the Board of Supervisors of the County of Fresno Print Name David Zawrotny Date /a -9 aOR5' Print Title CSO Date 11/03/2025 ATTEST: BERNICE E.SEIDEL Clerk of the Board of Supervisors County of Fresno,State of C ifornia By Deputy 1 Exhibit 1: Medical Supplement Financial Rate Summary Prepared for: County of Fresno Plan: Med Supp - County of Fresno - 2026 - Plan F Rate Period: 1/1/2026 - 12/31/2026 Medical Supplement Rate - $293.08 PMPM Medicare Part A Services Member Pays Part A Deductible $0 Part A Coinsurance $0 Skilled Nursing Facility Care $0 (days 1-100) Emergency Room $0 Medicare Part B Services Part B Deductible $0 Part B Coinsurance $0 Primary Care Visit $0 Specialist Visit $0 Part B Excess Covered Yes Medical Supplement Coverage Specifications Medical Out-of-Pocket Maximum N/A Ancillary Benefit Coverage Foreign Travel Coverage $250 deductible and 20% coinsurance for medically necessary emergency care services beginning during the first 60 days of each trip outside the USA up to a $50,000 lifetime maximum. Hearing Medicare covered services only Vision Medicare covered services only Dental Medicare covered services only Podiatry Medicare covered services only Chiropractic Medicare covered services only Acupuncture Medicare covered services only Private Duty Nursing N/A Additional Medical notes Medical Supplement Stipulations • Network open to any medical facility that accepts Medicare in all 50 states to include U.S.territories. • The proposed plan rate includes all insurance fees and administrative costs. • The rates provided are quoted on a full replacement basis. • Price above is based on census provided.We reserve the right to rerate this policy pending any new census information. • During this policy term, if there are changes by CMS or federal law in relation to MAPD, MA, Med Supp, or EGWP plans there may be changes to the rates and/or benefit provisions. In the event that this were to occur,any changes will be communicated to the Group not less than 60 days before the effective date of any such change(other than mutually agreed changes)or shorter notice as may be required to comply with CMS or federal law. 2 Plan: Med Supp - County of Fresno - 2026 - Plan G WA State Only Rate Period: 1/1/2026 - 12/31/2026 Medical Supplement Rate - $246.65 PMPM Medicare Part A Services Member Pays Part A Deductible $0 Part A Coinsurance $0 Skilled Nursing Facility Care $0 (days 1-100) Emergency Room $0 Medicare Part B Services Part B Deductible Standard CMS Part B Deductible Part B Coinsurance $0 Primary Care Visit $0 Specialist Visit $0 Part B Excess Covered Yes Medical Supplement Coverage Specifications Medical Out-of-Pocket Maximum N/A Ancillary Benefit Coverage Foreign Travel Coverage $250 deductible and 20% coinsurance for medically necessary emergency care services beginning during the first 60 days of each trip outside the USA up to a $50,000 lifetime maximum. Hearing Medicare covered services only Vision Medicare covered services only Dental Medicare covered services only Podiatry Medicare covered services only Chiropractic Medicare covered services only Acupuncture Medicare covered services only Private Duty Nursing N/A Additional Medical notes Medical Supplement Stipulations • Network open to any medical facility that accepts Medicare in all 50 states to include U.S.territories. • The proposed plan rate includes all insurance fees and administrative costs. • The rates provided are quoted on a full replacement basis. • Price above is based on census provided.We reserve the right to rerate this policy pending any new census information. • During this policy term, if there are changes by CMS or federal law in relation to MAPD, MA, Med Supp, or EGWP plans there may be changes to the rates and/or benefit provisions. In the event that this were to occur,any changes will be communicated to the Group not less than 60 days before the effective date of any such change(other than mutually agreed changes)or shorter notice as may be required to comply with CMS or federal law. 3 Part D Financial Rate Summary Prepared for: County of Fresno Plan: EGWP-UHC-County of Fresno-2026 Rate Period: 1/1/2026- 12/31/2026 Part D Pharmacy Rate-$344.50 PMPM Pharmacy Coverage Member Pays Prescription Deductible $0 Retail 30 Day Supply Tier 1-A(Preferred Generics) N/A Tier 1 (Generics) $0 Tier 2 (Pref. Brands) $20 Tier 3 (NP Brands) $30 Tier 4 (Specialty)" $20 Retail 90 Day Supply Tier 1-A(Preferred Generics) N/A Tier 1 (Generics) $0 Tier 2 (Pref. Brands) $50 Tier 3 (NP Brands) $75 Tier 4 (Specialty) Limited to one-month supply Mail-Order 90 Day Supply Tier 1-A(Preferred Generics) N/A Tier 1 (Generics) $0 Tier 2 (Pref. Brands) $50 Tier 3 (NP Brands) $75 Tier 4 (Specialty) Limited to one-month supply Part D Coverage Specifications RX Tiers 4 Tier Prescription Out-of-Pocket Maximum N/A($2,100 IRA Limit) Drug Formulary Most Comprehensive(Open) Lifestyle Drugs Covered Yes All Non-Part D Drugs Covered Yes Part B Diabetic Rider No ACA Preventative Drug No Utilization Management Prior Authorizations, Quantity Limits and Step Therapy Coverage Gap Full-Coverage Catastrophic Coverage Member pays$0 *Most specialty drugs can only be dispensed up to a 31-day supply at retail Part D Stipulations • The plan rate includes all Medicare Part D subsidies with no additional subsidy filing needed. • The catastrophic coverage for 2026-member cost share post-TrOOP ($2100)is$0. • Pharmacy network of over 60,000+locations including all major chains,supermarkets,and independently owned pharmacies. • All Part D drug plans are creditable coverage;therefore, Creditable Coverage Notices are not required. • Price above is based on census provided. We reserve the right to rerate this policy pending any new census information 4 • During this policy term, if there are changes by CMS or federal law in relation to MAPD, MA, Med Supp, or EGWP plans there may be changes to the rates and/or benefit provisions. In the event that this were to occur,any changes will be communicated to the Group not less than 60 days before the effective date of any such change (other than mutually agreed changes)or shorter notice as may be required to comply with CMS or federal law. 5