Customer Name: CITY OF VERNON
Customer Number: W0065496 Sales Representative: Brenda Chapa Group Type: Renewal License #: 0E87879
Broker Firm Name: Keenan &
Associates
Rate Tier: 4-Tier
Producer Service Fee: 0.00% Effective Date: 1/1/2026
Number of Plans: Four Rate Type: Monthly
Plan 1 HMO - Trio
Group Number(s)- W0065496HMOX0001
Benefits
Covered Benefits Proposed Plan
Code Current Benefits Renewal Benefits
Medical HMO -
CUSTOM
Custom Trio HMO Zero Admit
15 Custom Trio HMO Zero Admit
15 Rx HMO -
CUSTOM
Custom Enhanced Rx
$15/25/45 with $0 Pharmacy
Deductible
Custom Enhanced Rx
$15/25/45 with $0 Pharmacy
Deductible
Chiro Acu Rider Included Chiro Acu Rider Included Chiro Acu Rider Included Concierge Included Concierge Included Concierge Included Monthly
4-Tier Census Current Total Rates Renewal Total Rates
Single 22 $682.78 $708.32
EE+SP 19 $1,502.10 $1,558.28
EE+CH 16 $1,229.00 $1,274.96
Family 31 $2,116.60 $2,195.76
Total 88
*Monthly Gross Premium $128,840 $133,658
Annual Gross Premium $1,546,076 $1,603,899
Annual Change $57,823
% Change 3.7%
Renewal Rate Information
Overall, rates were impacted by several factors. Some are specific to your group such as average age, location, or actual claims. Others affect us all, including rising physician, pharmaceutical, and hospital costs: new medical technologies: an aging population; legislative mandates; and provider cost-shifting due to care for uninsured people.
CITY OF VERNON Renewal
No-bid proposal
Customer Name: CITY OF VERNON
Customer Number: W0065496 Sales Representative: Brenda Chapa Group Type: Renewal License #: 0E87879
Broker Firm Name: Keenan &
Associates
Rate Tier: 4-Tier
Producer Service Fee: 0.00% Effective Date: 1/1/2026
Number of Plans: Four Rate Type: Monthly
Plan 2 HMO - Full Network
Group Number(s)- W0065496HMOX0002
Benefits
Covered Benefits Proposed Plan
Code Current Benefits Renewal Benefits
Medical HMO -
CUSTOM
Custom Access+ HMO Zero
Admit 15
Custom Access+ HMO Zero
Admit 15
Rx HMO -
CUSTOM
Custom Enhanced Rx
$15/25/45 with $0 Pharmacy
Deductible
Custom Enhanced Rx
$15/25/45 with $0 Pharmacy
Deductible
Chiro Acu Rider Included Chiro Acu Rider Included Chiro Acu Rider Included Concierge Included Concierge Included Concierge Included Monthly
4-Tier Census Current Total Rates Renewal Total Rates
Single 21 $902.87 $936.64
EE+SP 16 $1,701.90 $1,765.55
EE+CH 1 $1,543.59 $1,601.32
Family 36 $2,399.29 $2,489.02
Total 74
*Monthly Gross Premium $134,109 $139,124
Annual Gross Premium $1,609,304 $1,669,492
Annual Change $60,188
% Change 3.7%
CITY OF VERNON Renewal
No-bid proposal
Customer Name: CITY OF VERNON
Customer Number: W0065496 Sales Representative: Brenda Chapa Group Type: Renewal License #: 0E87879
Broker Firm Name: Keenan &
Associates
Rate Tier: 4-Tier
Producer Service Fee: 0.00% Effective Date: 1/1/2026
Number of Plans: Four Rate Type: Monthly
Plan 3 PPO
Group Number(s)- W0065496PPOX0001
Benefits
Covered Benefits Proposed Plan
Code Current Benefits Renewal Benefits
Medical PPO - CUSTOM Custom Full PPO Combined
Deductible 15-250 90/70
Custom Full PPO Combined
Deductible 15-250 90/70
Rx PPO - CUSTOM
Custom Enhanced Rx
$15/25/45 with $0 Pharmacy
Deductible
Custom Enhanced Rx
$15/25/45 with $0 Pharmacy
Deductible
Concierge Included Concierge Included Concierge Included Monthly
4-Tier Census Current Total Rates Renewal Total Rates
Single 27 $998.62 $1,035.97
EE+SP 2 $2,196.99 $2,279.16
EE+CH 0 $1,797.53 $1,864.76
Family 3 $3,095.76 $3,211.54
Total 32
*Monthly Gross Premium $40,644 $42,164
Annual Gross Premium $487,728 $505,969
Annual Change $18,241
% Change 3.7%
CITY OF VERNON Renewal
No-bid proposal
Customer Name: CITY OF VERNON
Customer Number: W0065496 Sales Representative: Brenda Chapa Group Type: Renewal License #: 0E87879
Broker Firm Name: Keenan &
Associates
Rate Tier: 4-Tier
Producer Service Fee: 0.00% Effective Date: 1/1/2026
Number of Plans: Four Rate Type: Monthly
Plan 4 PPO
Group Number(s)- W0065496PPOX0002,W0065496PPOX0003
Benefits
Covered Benefits Proposed Plan
Code Current Benefits Renewal Benefits
Medical PPO - CUSTOM
Custom Full PPO Savings Two
Tier Embedded Deductible
2800/3300/5200 with $0
HDHP Preventive Drug
Benefit
Custom Full PPO Savings
Two Tier Embedded
Deductible 2800/3400/5200
with $0 HDHP Preventive
Drug Benefit
Rx PPO - CUSTOM
Custom Full PPO Savings Two
Tier Embedded Deductible
2800/3300/5200 with $0
HDHP Preventive Drug
Benefit
Custom Full PPO Savings
Two Tier Embedded
Deductible 2800/3400/5200
with $0 HDHP Preventive
Drug Benefit
Concierge Included Concierge Included Concierge Included Monthly
4-Tier Census Current Total Rates Renewal Total Rates
Single 75 $698.97 $725.11
EE+SP 16 $1,542.16 $1,599.84
EE+CH 4 $1,261.06 $1,308.22
Family 9 $2,174.54 $2,255.87
Total 104
*Monthly Gross Premium $101,712 $105,516
Annual Gross Premium $1,220,549 $1,266,197
Annual Change $45,649
% Change 3.7%
CITY OF VERNON Renewal
No-bid proposal
Customer Name: CITY OF VERNON
Customer Number: W0065496 Sales Representative: Brenda Chapa Group Type: Renewal License #: 0E87879
Broker Firm Name: Keenan &
Associates
Rate Tier: 4-Tier
Producer Service Fee: 0.00% Effective Date: 1/1/2026
Number of Plans: Four Rate Type: Monthly
Overall Premium Summary
Current Grand Total Renewal Grand Total
*Monthly Gross Premium $405,305 $420,463
Annual Gross Premium $4,863,657 $5,045,558
Annual Change $181,901
% Change 3.74%
Rate Filing InformaƟon:
Rate Review:
The following information is provided to large groups such as yours, as required by section 1374.21(a)(2) of the Health and Safety Code and section 10119.1(a)(2) of the California Insurance Code, as applicable. You can compare this information to your rate change to understand whether it is greater than, less than, or equal to the rate increases listed below:
• Average CalPERS 2025 Increase: 9.00%
• Average Covered California 2025 Increase: 7.90%
• Average Large Group 2024 Increase: 10.70%
* The monthly gross premium includes the total premium rate plus the Producer Service Fee. The Producer Service Fee is not part of the premium.
You can obtain copies of Blue Shield’s rate filings on the Department of Managed Health Care (DMHC) or California Department of Insurance (CDI), as applicable**, at the following web addresses:
DMHC:
http://www.dmhc.ca.gov/HealthCareinCalifornia/PremiumRateReview/HealthCareCosts.aspx CDI:
http://www.insurance.ca.gov/01-consumers/110-health/70-rates/ If the requirements listed below are applicable to your group, you have 60 days from receipt of your renewal notice to request that the Department of Managed Health Care (DMHC) or California Department of Insurance (CDI), as applicable, review your rates to determine whether the rate change is unreasonable or not justified. To be eligible for this type of review, at least one of the following criteria must apply to your group:
• The contract holder has a combined total of more than 2,000 enrollees (employees plus dependents) enrolled in all health plans.
• The rate change is from a health plan that failed to provide you with information required under Article 6.2 of the Knox-Keene Act (Review of Rate Increases), section 1385.10 of the California Health and Safety Code (Health Plan Annual Claims Reporting Requirements), or section 10181.10 of the California Insurance Code (Health Plan Annual Claims Reporting Requirements).
CITY OF VERNON Renewal
No-bid proposal
Customer Name: CITY OF VERNON
Customer Number: W0065496 Sales Representative: Brenda Chapa Group Type: Renewal License #: 0E87879
Broker Firm Name: Keenan &
Associates
Rate Tier: 4-Tier
Producer Service Fee: 0.00% Effective Date: 1/1/2026
Number of Plans: Four Rate Type: Monthly
**All your current Blue Shield medical products are regulated by the DMHC To request rate review, you can use the following
DMHC: Rate review requests may be submitted through the following website:
https://wpso.dmhc.ca.gov/LargeGroupRateReview/
CDI: If you have a CDI regulated product, we have attached an Excel form that can be used to request rate review.
Submit completed form to the following email address: [email protected] CITY OF VERNON Renewal
No-bid proposal
Account: CITY OF VERNON
Policy Period: 1/1/2026
BSC is providing a Wellness fund in the amount of $30,000 with the following assumptions:
1 Proposal Assumptions
2 Inforce Account
3 Invoice
4 Stipend Fund Carry Over
Wellness Fund Allowance Assumptions
Group is in compliance with all proposal assumptions outlined in the rate proposal.
CITY OF VERNON
Group remains with BSC for the entire policy period and has met its financial obligations (payment of premiums on a timely basis) during the course of the year. If the group terminates prior to the end of the policy period, BSC reserves the right to recoup these funds.
Group agrees to provide a detailed invoice to their assigned BSC Account Manager to demonstrate funds to the associated activities, programs or services. Allowance dollars will be reimbursed by BSC directly to the group in the form of a separate check. These funds cannot be paid to a broker or vendor.
Assumes use of wellness, transition or implementation fund during policy period described above. Any portion of the fund that remains unused after the policy period will be forfeited by the group. Funds cannot be rolled over from one policy period into the next. All receipts for wellness funds used must be submitted for payment no later than 30 days following the end of the policy period.
CITY OF VERNON Renewal
No-bid proposal
Account: CITY OF VERNON
Effective Date: 1/1/2026
1 PPACA
2 Census:
The following is a summary of the census used for rate development:
Product Single EE+SP EE+CH Family Total Total Members
Plan 1HMO -
Trio 22 19 16 31 88 228
Plan 2HMO -
Full Network 21 16 1 36 74 213
Plan 3PPO 27 2 0 3 32 43
Plan 4PPO 75 16 4 9 104 150
Total 145 53 21 79 298 634
Total Employees: 298
3 Effective Date:
4 Participation:
5 Employer Contribution:
6 Employee Definition:
7 Dependent Definition:
8 Retirees:
CITY OF VERNON
Proposed Assumptions
Proposed rates assumes there are no retirees.
Minimum employer contribution is 75% of employee dues, or 50% of employee and dependent dues. If the employer contributes 100% of employee dues, all eligible employees must enroll; except those who signed a valid waiver that confirms other group insurance or have TRICARE, formerly known as CHAMPUS, or decline for religious reasons. The contribution formula must be applied equally across all benefit plan offerings. Furthermore, the contribution formula can not select against the Blue Shield benefit plans. Supercomposite rates assume employer contributes 100% for employee and dependent costs. Our proposed rates assume that there are no changes in the contribution approach from the prior year. 75% of eligible employees must enroll in employer-sponsored medical coverage. When offering BSC coverage with another carrier, 75% of eligible employees must enroll in employer-sponsored medical coverage and, in locations where another carrier is offered, of those enrolling, a minimum of 50% must select BSC.
Eligible employees are defined as active, permanent and working a minimum of 20 hours per week.
Proposed is subject to listed assumptions below. Should any of the assumptions vary, Blue Shield of California may adjust rates. Final rates are subject to the execution of the Group Contract.
Blue Shield has undertaken its best efforts to analyze and implement the requirements of the federal Patient Protection and Affordable Care Act (“PPACA” or “ACA”). The information included in this quote includes those benefit changes and fees/taxes that we understand at this time are required by the Act.
Blue Shield has attempted to include all applicable Federal, State, and ACA fees/taxes in the rates. For calendar year 2025 and 2026, the ACA Insurer Fee does not apply. The rates include the Patient Centered Outcomes Research Institute (“PCORI”) fee. The PCORI fee is $3.47 per member per year for policy years ending on or before October 1, 2025 and $3.47 per member per year for policy years ending on or before October 1, 2026 and $3.47 per member per year for policy years ending on or before October 1, 2027. Effective for January 2025 forward, the state law managed care organization (“MCO”) tax is $0.19 per member per month for policy years ending on or before December 31, 2026 and $0.19 per member per month for policy years ending on or before December 31, 2027. Should Blue Shield be assessed any Federal, State, or ACA fees/taxes on account of any of the health benefit plans included in this quote, but not presently included in the rates, Blue Shield reserves the right to amend the rates to include such fees/taxes. In the case of federal excise taxes, Blue Shield also reserves the right to amend the rates to include any increased federal income taxes to Blue Shield associated with such federal excise taxes.
Should actual enrollment varies by more than 10% (in total, by product, or by tier) from the above, BSC reserves the right to review or modify the rates.
Eligible dependents include a legally married spouse, domestic partner, or children to age 26.
Insurer Fee & Reinsurance
Proposed rates are valid for the effective date shown. The contract duration is 12 months.
CITY OF VERNON Renewal
No-bid proposal
Account: CITY OF VERNON
Effective Date: 1/1/2026
CITY OF VERNON
Proposed Assumptions
Proposed is subject to listed assumptions below. Should any of the assumptions vary, Blue Shield of California may adjust rates. Final rates are subject to the execution of the Group Contract. 9 Workers' Compensation:
10 Producer Service Fee:
11 COBRA Participation:
12 Wellvolution Provisions:
13 General Provisions:
14 Current Carrier Offerings/Exclusivity:
15 Additional Carrier and/or Plan Offerings:
16 Benefit Designs:
17 State Mandates/Legislative Changes
18 Consistent Rate Ratios:
19 Regional versus Statewide Rates:
20 Active/Early Retiree Pricing:
21 Pooling Level:
22 Package Basis:
Proposed rates are based upon the attached proposed benefit plans for the HMO and PPO. Any deviations will require underwriting approval.
If rates are offered on a regional basis (such as North and South rates), each health plan offered must have their respective rates offered on the same regional rate basis.
BSC reserves the right to modify benefits or premium in connection with changes in federal or state premium tax, assessment, or benefit mandates that may be enacted during the course of the proposed policy year.
BSC's proposed rates assumes no changes in the product or carrier offerings. These changes include but are not limited to the following:
- New plan option (Low cost HMO, narrow network, or High Deductible Health Plan) - New carrier offering
- Elimination of plan option (eliminate self funded plan or a PPO) - Changes in current benefit plan by a competitor
- New offering to a subset employee population
All eligible employees must have Workers' Compensation coverage where required by law.
Proposed rates assume a Producer Service fee of 0.00%.
Proposed rates assume a current COBRA participation of 0.32% of total enrollment. Should current COBRA percentage increase or decrease by (+/- 2%), BSC reserves the right to adjust the final rates.
Proposed rates are for fully insured, non-refunding plans, with standard BSC provisions as outlined in the BSC Health Plan Guide, unless otherwise stated.
Proposed rates assume that BSC's plan offering are not offered alongside any other medical coverages.
Proposed rates assumes rate ratios by rate tier must be the same for all health plan offerings. For example, if the 2 Party rate is set at 2.0 (employee rate x 2.0), the 2 Party rate for all health plan offerings must be set at a 2.0 rate ratio.
Wellness has evolved. For the next generation of wellness programs and packages , please reference the Wellness flyer attached in this package for details and pricing information.
Your group will work directly with the producer of record to determine the amount of the Producer Service Fee. Blue Shield will include the Producer Service Fee on the group’s billing statement as part of the total amount due. After receiving payment, Blue Shield will pass the Producer Service Fee on to the producer, on behalf of your group. A group’s payment of the amount due to Blue Shield upon renewal will acknowledge acceptance of this Producer Service Fee arrangement.
Upon request, Blue Shield is prepared to issue a 1099 on a groups behalf. In order to accommodate this request, the Producer Service Fee Form 1099 Authorization will need to be completed and returned to Blue Shield of California no later than the first Friday in December of your plan year. Please contact your sales representative for more information about the authorization form.
The HMO proposed rates assume a pooling level of $200k.
Proposed is being offered on a package basis only. If any of the offered products are not sold or if there are any changes in any of the benefit plans (regardless of financial arrangements or carrier), rates are subject to change for any or all of the plan designs in the benefit package.
Proposed rates for each and every health plan benefit plan must be offered on the same basis, with respect to blended rates covering actives and early retirees as a single group or separate rates covering actives only and early retirees only.
CITY OF VERNON Renewal
No-bid proposal
Account: CITY OF VERNON
Effective Date: 1/1/2026
CITY OF VERNON
Proposed Assumptions
Proposed is subject to listed assumptions below. Should any of the assumptions vary, Blue Shield of California may adjust rates. Final rates are subject to the execution of the Group Contract. 23 Standard Policy:
24 Benefit Solutions:
25 HSA/ HRA Funding:
26 Integrated HSA/HRA Administration:
Rates exclude integration with Health Equity for administration of Health Service Account (HSA) without Limited Purpose Flexible Spending Account (LPFSA for vision and dental only), Health Reimbursement Account (HRA) without Flexible Spending Account (FSA). Integration features include:
- Seamless set up for employees and client (HSA and HRA) - Blue Shield sends eligibility and adjudicated claims to Health Equity (HSA and HRA) - Debit cards (HSA, HRA and FSA)
- Account activation (HSA)
- Employer and employee portals (HSA and HRA)
Blue Shield has undertaken its best efforts to ensure that health benefit plans comply with the requirements of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), as applicable. MHPAEA generally prohibits group health plans and health insurance issuers that provide mental health or substance use disorder benefits from imposing less favorable benefit limitations on those benefits than on medical/surgical benefits. The information included in this quote reflects benefits that we understand at this time are compliant with MHPAEA.
Quoted rates are based on the plan sponsor funding no more than 50% of total member cost sharing (deductibles, coinsurance, copays, etc.). If plan sponsor funds more than 50% of total member cost sharing, Blue Shield of California reserves the right to modify or rescind quoted rates.
The rates shown on the exhibit do not include Benefit Solution discounts that are offered by Blue Shield. Groups can qualify for up to 3% discount on their medical premium when adding dental (2%), vision (0.5%) or life (0.5%) coverage. To qualify, groups must have new or existing, fully insured medical coverage from Blue Shield of California, have 101-1,000 eligible employees and must add non-voluntary dental, non-voluntary vision or non-voluntary life plans. 50% participation is required in the dental and vision plans. Group must purchase a minimum of $25,000 in life insurance coverage.
For additional program rules see Benefits Solutions flyer.
The fully insured plans assume standard policies, practices, and contracts in force.
CITY OF VERNON Renewal
No-bid proposal