HomeMy WebLinkAboutA018 - Resolution approving contract renewal with EMC Risk Services to provide 3rd party administration of the City's Workers Compensation & Municipal Fire & Police 411 System claims 07/0126-06/30/27ITEM #:19
DATE:06-09-26
DEPT:HR
SUBJECT:WORKERS COMPENSATION AND MUNICIPAL FIRE AND POLICE SYSTEM
MEDICAL CLAIMS ADMINISTRATION
COUNCIL ACTION FORM
BACKGROUND:
The City contracts third-party administration services for workers’ compensation and Municipal
Fire and Police “411 System” injury medical claims. EMC has provided these services since at
least 2009. For FY 2025/26, the City posted a Request for Proposal for Third Party Claims
Administration Services. EMC Claims Solutions was awarded a one-year contract with four (4)
optional 1-year extensions. The City’s current contract with EMC is set to expire on June 30,
2026. FY 2026/27 is the first of the optional extension years.
Services provided by EMC in this contract include workers’ compensation claims
administration for all City employees, medical bill review, self-insured loss fund management,
and pharmacy and medical expense consultation. EMC also performs regulatory filings and
maintains an online claims database accessible to City staff. Additionally, EMC collects for
medical bill review and savings identified through that process. The fees, along with actual
claims expenses are charged to individual departments.
The table below compares the FY 2025/26 fees to the proposed FY 2026/27 fees. There are
slight increases for medical claim set up and lost time claim set up.
Fee Component Fee Components
FY2025/26
Fee Components
FY2026/27 Change
Claim Set Up, Incident
Only $35 per claim $35 per claim 0%
Claim Set Up, Medical
Only $260 per claim $265 per claim 2%
Claim Set Up Lost Time $1,142 per claim $1,150 per claim .7%
Medical Bill Review Fees
& Reimbursement
$9.50/invoice
30% of Savings
Capped at $10,000
$9.50/invoice
30% of Savings
Capped at $10,000
0%
In addition to the per claim fees and the medical bill review fees listed above, EMC is
requesting an annual administrative/reporting fee of $5,350 and an OSHA 300 Reporting fee
of $3,000.
The FY 2026/27 budget contains $35,000 for the per-claim fees, administrative/reporting fees
and the OSHA 300 reporting fees. The medical bill review fees are paid from the claim fund
account.
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ALTERNATIVES:
1. Approve the contract renewal with EMC Risk Services, LLC, of Des Moines Iowa, to
provide third party administration of the City’s worker ’s compensation and municipal fire
and police “411 System” claims for July 1, 2026 through June 30, 2027.
2. Reject the EMC renewal option and direct City staff to seek other claims administration
alternatives.
CITY MANAGER'S RECOMMENDED ACTION:
EMC Risk Services, LLC, continues to be an effective provider of professionally
administered workers’ compensation claims and associated services. Its staff has been
responsive and sensitive to the needs of City employees in managing their injury and
disability claims. The online claims system makes cost and other data accessible to
City staff and provides a frequently utilized tool for analyzing injury types and safety
program effectiveness. Therefore, it is the recommendation of the City Manager that the City
Council adopt Alternative No. 1, as described above.
ATTACHMENT(S):
2026-2027 Claims Handling Proposal City of Ames Final
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717 Mulberry Street Des Moines, IA 50309 | P.O. Box 9399 Des Moines, IA 50306 | 515.345.4532 | 800.741.5302 | F 866.504.6598 | emcclaimssolutions .com
Employers Mutual Casualty Company Illinois EMCASCO Insurance Company Union Insurance Company of Providence EMC Underwriters, LLC
EMCASCO Insurance Company Dakota Fire Insurance Company Hamilton Mutual Insurance Company EMC National Life Company (affiliate)
EMC Reinsurance Company EMC Property & Casualty Company EMC Risk Services, LLC
EXHIBIT C
SERVICE FEE SCHEDULE
Claims Program–City of Ames
Renewal terms 7/1/2026
Claim Fees
Claim Fees shall be effective as of the Effective Date, or upon the agreed established date. The
claim fees will include all Medicare and State EDI filings as required.
City of Ames agrees to pay EMC Claims Solutions the following Claims Handling fees:
Workers Compensation Claims
Incidents Only $35.00 per claim
Medical Only and 411 $265.00 per claim
Indemnity $1,150.00 per claim
Subrogation/Recovery 20% of the amount of recovery
OSHA Reporting $3,0000 Annually
.
Medical Bill Review Services
Our in-house Bill Review audit team of nurses review each bill for coding accuracy and then
apply the best possible discounts via multiple PPO networks and negotiated discounts. Our
Pharmacy Program provides both savings and clinical management of prescription drugs for
injured workers, keeping costs down and preventing abuse. As one of the largest writers of
Workers Compensation in Iowa, EMC has the buying power to achieve the best results in
medical bill savings.
Per bill fee $9.75
PPO/Bill Review 30% of savings on the bill capped at $10,000
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717 Mulberry Street Des Moines, IA 50309 | P.O. Box 9399 Des Moines, IA 50306 | 515.345.4532 | 800.741.5302 | F 866.504.6598 | emcclaimssolutions .com
Employers Mutual Casualty Company Illinois EMCASCO Insurance Company Union Insurance Company of Providence EMC Underwriters, LLC
EMCASCO Insurance Company Dakota Fire Insurance Company Hamilton Mutual Insurance Company EMC National Life Company (affiliate)
EMC Reinsurance Company EMC Property & Casualty Company EMC Risk Services, LLC
Miscellaneous Fees
On-Line Claims Submission, Reporting and Administration
Annual Administration Software Maintenance Fee $3,500.00
This includes system maintenance in the format of your choosing, file reviews and loss reporting
as requested. Reports available include a variety of loss and safety reports available on demand,
as well as reports which can be tailored to your business needs.
Additional Users One Time Fee $500.00
Optional Services
We can tap into extensive resources to take advantage of tools such as: Medical or Legal Review
services to coordinate or facilitate the right medical treatment for your injured employee so
return to work is primary and we can minimize downtime, scheduling issues and lost
productivity.
Medical/Legal Review
We have Registered Nurses available who can review legal issues and resolve disputes.
$128.00 per hour
Loss Control Services - tailored to the specific needs of your business
Environmental, Ergonomic, or Material Handling Testing, Safety Training and Site Evaluation as
requested by EMC’s Risk Improvement Specialists.
$220.00 per hour
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