6To:
Via:
From:
CITY OF SOUTH MIAMI
OFFICE OF THE CITY MANAGER
INTER-OFFICE MEMORANDUM
The Honorable Mayor & Members of the City Commission
Hector Mirabile, Ph.D., City Manager /" ~
LaTasha Nickle, Human Resources Director
South Miami .,0*_
rrrrr
2001
Date: August 15,2012 Agenda Item No.:____._
Subject: Health Insurance Resolution
Request: A Resolution approving the selection of Neighborhood Health Partnership to
provide group health insurance for the City of South Miami full time employees to
be charged to departmental account numbers respectively; providing for an
effective date.
ReasonlNeed: The City's Benefits Consultant, Sapoznik Health & Wellness solicited quotes from all
carriers in the market. The companies responded as follows:
Aetna Declined to quote
AvMed Declined to quote
Blue Cross Blue Shield Submitted proposal
Cigna Healthcare Declined to quote
Coventry Submitted proposal
Humana Submitted proposal
Neighborhood Health Partnership Submitted proposal
Staff recommends that the City Commission select Neighborhood Health Partnership as
health, dental and vision insurance provider for the 2012-2013 benefit plan year.
Neighborhood Health Partnership has proposed the following monthly premium rates for
the upcoming plan year.
LOW HMO HIGH HMO POS
(NHP HMO FV5) (NHP HMO EVF) (NHP POS DV6)
Employee $474.39 (14% increase) $542.60 $694.97
Employee/ Children $839.50 $1,068.70 $1,229.84
Employee/ Spouse $934.35 $950.92 $1368.80
Employee/ Family $1,399.13 $1,600.31 $2,049.71
Dental Rates:
DMO PPO
Employee $14.36 $34.03
Employee/ Children $28.86 $68.65
Employee/ Spouse $29.21 $76.51
Employee/ Family $47.32 $122.61
Vision Rates:
Employee $7.39
Employee/ Children $14.05
Employee/ Spouse $14.78
Employee/ Family $29.08
The FY 2013 health plan rates represent an increase of 14.1 % above the current FY 2012
rates. The City currently contributes $416.26 per covered employee per month toward
health coverage which will increase to $474.39. In order to keep costs increase at a
minimum, we proposed several changes to the current plan design. Most significantly,
the current plan includes a deductible of $1,500 individual/$3,000 family and increased
co-payments.
Premium charges for the health, dental and vision benefits shall be charged to the
following budget line items as proposed in the Fiscal Year 2013 Budget.
DEPARTMENT ACCT#
CRA-ADMINISTRA TIVE 6101110-5132310
CRA-PROTECTIVE SERVICES 6101110-5212310
CRA-ECONOMIC DEVELOPMENT EMPLOYMENT 6101110-5212310
CRA-PROPERTY MANAGEMENT 6101110-5542310
CRA-PUBLIC ASSISTANT SERVICES 6101110-5692310
CRA-SPECIAL EVENTS 6101110-5742310
CITY CLERK 0011200-5122310
CITY MANAGER 0011310-5132310
CENTRAL SERVICES 0011320-5132310
HUMAN RESOURCES 0011330-5132310
FINANCE 0011410-5132310
BUILDING DEPT 0011610-5242310
PLANNING 0011620-5242310
CODE ENFORCEMENT 0011640-5242310
PW-BLDG MAINT 0011710-5192310
PW-SOLID WASTE 0011720-5342310
PW-STREETS 0011730-5412310
STORM WATER 1111730-5412310
PW -LANDSCAPE 0011750-5192310
PW-EQUIP MAINT 0011760-5192310
PW-OFFICE OF DIR 0011770-5192310
PW-ENGINEERING 0011790-5192310
POLICE 0011910-5212310
PARKS & REC 0012000-5722310
COMMUNITY CENTER 0012020-5192310
Backup Documentation:
I:l Proposed resolution.
I:l Sapoznik Health & Wellness Summary Report
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RESOLUTION NO.: ______ _
A Resolution approving the selection of Neighborhood Health Partnership to provide
group health insurance for the City of South Miami full time employees to be charged to
departmental account numbers respectively.
WHEREAS, the Benefits Consultant, Sapoznik Health & Wellness secured more than
three competitive quotes for the City's Group Health, Dental and Vision Insurance and
recommended Neighborhood Health Partnership as the selected provider; and
WHEREAS, the City Commission compared the insurance rates, benefit plan design,
provider network as well as the City's previous claims experience/ratio; and
WHEREAS, the City Commission wishes approve with the selection of Neighborhood
Health Partnership for the provision of Group Health, Dental and Vision Insurance Benefits for
all full time employees and participating retirees.
WHEREAS, the premium charges shall be charged to departmental line items in account
numbers 6101110-5132310, 6101110-5212310, 6101110-5212310, 6101110-5542310, 6101110-
5692310,6101110-5742310,0011200-5122310, 0011310-5132310, 0011320-5132310, 0011330-
5132310, 0011410-5132310, 0011610-5242310, 0011620-5242310, 0011640-5242310, 0011710-
5192310,0011720-5342310,0011730-5412310, 1111730-5412310,0011750-5192310,0011760-
5192310,0011770-5192310, 0011790-5192310, 0011910-5212310, 0012000-5722310, 0012020-
51923.10.
NOW THEREFORE, BE IT RESOLVED BY THE MAYOR AND CITY
COMMISSION OF THE CITY OF SOUTH MIAMI, FLORIDA, THAT:
Section 1: The City Commission hereby approves and selects Neighborhood Health
Partnership to provide of Group Health, Dental and Vision Insurance for the City of South
Miami full time employees for the 2013 fiscal year.
Section 2: This resolution shall take effect immediately upon adoption.
PASSED AND ADOPTED this __ day of ____ " 2012.
ATTEST:
CITY CLERK
READ AND APPROVED AS TO FORM
LANGUAGE, EXECUTION AND
LEGALITY:
CITY ATTORNEY
Approved:
MAYOR
COMMISSION VOTE:
Mayor Stoddard:
Vice Mayor Liebman:
Commissioner Newman:
Commissioner Harris:
Commissioner Welsh:
Group Name. .~y of South Miami
Effective Date: October 1, 2012
~
Deductible
Co-Insurance
Dentist
Specialist
Cleanings
Preventive
Network
Non Network
Basic Coverage
Network
Non Network
Major Coverage
Periodontic &. Endodontic
Coverage
Orthodontic
Coverage
Orthodontic
Maximum (Age Limits)
Rate Guarantee
Annual Maximum
Dependent Child/Student
Age
Reimbursement Level
Premium Breakdown
Employee
Employee/ Spouse
Employee / Child(ren)
Employee/Family
Comments
Monthly Total
---
18
4
2
2
26
iI~[Eii3I:Jill 3 iJ i~ ~ .}
~
IN/OUT: $50/$150
IN/OUT: 100/80/50
DED & CO-INS
DED & CO-INS
ONCE EVERY 6 MONTHS
IN/OUT: DED WAIVED, COVERED
100%
IN/OUT: DED & 80%
IN/OUT: DED & 50%
BASIC
50%
CHILD(REN) TO AGE 18
LIFETIME MAX $500
1 YEAR
$1,000
UPTO AGE 26
OON:UCR
CURRENT I RENEWAL
$34.60
$69.79
$77.78
$124.65
RATE PASS
$1,306.82
-
s '-... ,:') z:. " ......
DPPO
@BifiTlj,'~11:iD ffiIrj m:u!lil3
IN/OUT: $50/$150 IN/OUT: $50/$150 IN/OUT: $50/$150
IN/OUT: 100/80/50 IN/OUT: 100/80/50 IN/OUT: 100/80/50
DED & CO-INS DED & CO-INS DED & CO-INS
DED & CO-INS DED & CO-INS DED & CO-INS
ONCE EVERY 6 MONTHS ONCE EVERY 6 MONTHS ONCE EVERY 6 MONTHS I
IN/OUT: DED WAIVED, COVERED IN/OUT: DED WAIVED, COVERED IN/OUT: DED WAIVED, COVERED I
100% 100% 100%
IN/OUT: DED & 80% IN/OUT: DED & 80% IN/OUT: DED & 80%
I
IN/OUT: DED & 50% IN/OUT: DED & 50% IN/OUT: DED & 50%
BASIC BASIC BASIC
50% 50% 50%
CHILD(REN) TO AGE 19 CHILD(REN) TO AGE 19 CHILD(REN) TO AGE 19
LIFETIME MAX $500 $1,000 LIFETIME MAX $1,000 LIFETIME MAX
1 YEAR 1 YEAR 1 YEAR
$1,000 $1,000 $1,000
UP TO AGE 26 UP TO AGE 2ij, UPTO AGE 26
OON:UCR OON:UCR OON:UCR
$33.85 $34.03 $35.17
$68.56 $68.65 $73.14
$75.48 $76.51 $86.40
$123.98 $122.61 $133.86
1.86% Decrease 1.6% Decrease 4.5% Increase
$1,282.46 $1,285.38 $1,366.14
1:44 PM 8/114f00l1l~tion provided by Sapoznik Insurance is proprietary. It may not be copied, emulated or distributed without express permission . 1
Group Name: City of South Miami
Effective Date: October 1, 2012
Physician
I Ennerge •• cy Room -Waived if
Surgery -Hospital
Inpatient Hospital
Provider Services Hospital & ER
Home Health
Outpatient Therapy
Deductible
Included in Out of Pocket Max
12:08 PM 8/14/2012
$15 CO-PAY
COVERED 100%
NO MAX
COVERED 100%
$100 CO-PAY
$50 CO-PAY
$250 CO-PAY
COVERED 100%
$250 CO-PAY
$250 CO-PAY PER DAY
5 DAY MAX
COVERED 100%
COVERED 100%
60 VISITS
$20 CO-PAY
60 VISITS
NONE
N/A
, , ~NHP HMO FV5 ::,~
,~$25/45/200/1500 . 1
$25 CO-PAY
$45 CO-PAY
COVERED 100%
NO MAX
COVERED 100%
$200 CO-PAY
$200 CO-PAY
OED & $250 CD-PAY
DED THEN 100%
& $250 CO-PAY
OED & $250 CO-PAY PER
ADMIN
OED THEN 100%
DED THEN 100%
60 VISITS
$50 CO-PAY
20 VISITS
$1,500/$3,000
NO
NHP Altemates -PaciuJge 8
$15 CO-PAY $30 CO-PAY
CO-PAY
COVERED 100% COVERED 100%
NO MAX NO MAX
COVERED 100% COVERED 100%
$50 CO-PAY $200 CO-PAY
COVERED 100% $200 CO-PAY
COVERED 100% DED & $250 CO-PAY
COVERED 100% OED THEN 100%
100% OED
$500 CO-PAY PER ADMIN OED & $250 CO-PAY PER ADMIN
COVERED 100% OED THEN 100%
COVERED 100% DED THEN 100%
60 VISITS 60 VISITS
COVERED 100% $50 CO-PAY
60 VISITS 20 VISITS
NONE $1,000/$2,000
N/A NO
$15 CO-PAY OED & 70%
DED & 70%
COVERED 100% DED & 70%
NO MAX NO MAX
COVERED 100% OED & 70%
$50 CO-PAY
COVERED 100% OED & 70%
COVERED 100% DED & 70%
COVERED 100% DED & 70%
COVERED 100% OED & 70%
$500 CO-PAY PER OED & 700/. ADMIN
COVERED 100% DED & 70%
COVERED 100% DED & 70%
60 VISITS 60 VISITS
COVERED 100% DED & 70%
60 VISITS 60 VISITS
NONE $500/$1,000
NO
$45 CO-PAY
COVERED 100%
NO MAX
COVERED 100%
DED &. 80%
DED &. 80%
NO MAX
DED &80%
$200 CO-PAY
$200 CO-PAY DED &80%
DED, $250 CO-PAY & DED &. $250 CO-PAY 80%
DED TIiEN 100% OED &. 80%
DED & $250 CO-PAY OED,
OED & $250 CO-PAY PER DED II. $250 CO-PAY PER
ADMIN ADMIN &. 80%
OED & 80%
OED THEN 100% OED &80%
60 VISITS 60 VISITS
$50 CO-PAY DED &80%
20 VISITS 20 VISITS
$1,500/$3,000 $3,000/$6,000
NO
Information provided by Sapoznik Insurance is proprietary. It may not be copied. emulated or distributed without express permission.
$45 CO-PAY
COVERED 100%
NO MAX
COVERED 100%
DED
OED &. 80%
NO MAX
DED &80%
$200 CO-PAY
$200 CO-PAY DED & 80%
DED, $250 CO-PAY &. DED &. $250 CO-PAY 80%
DED THEN 100% OED &. 80%
OED & $250 CO-PAY
DED II. $250 CO-PAY PER
ADMIN
100% DED &. 80%
OED THEN 100% OED &. 80%
60 VISITS 60 VISITS
$50 CO-PAY DED & 80%
20 VISITS 20 VISITS
$1,000/$2,000 $2,000/$4,000
NO
15
Group Name: City of South Miami
Effective Date: October 1, 2012
Physician
&. Child Wellness
Surgery -Hospital
Inpatient Hospital
Provider Services Hospital &. ER
Home Health
Therapy
in Out of Pocket Max
12:08 PM 8/14/2012
$15 CO-PAY
$25 CO-PAY
COVERED 100%
NO MAX
COVERED 100%
$100 CO-PAY
$50 CO-PAY
$250 CO-PAY
COVERED 100%
$250 CO-PAY PER DAY
5 DAY MAX
COVERED
COVERED 100%
60 VISITS
$20 CO-PAY
60 VISITS
NONE
N/A
I I " ..... ·e:;'NHP HMO FVS ~ I'~. $2S/4S/200/i500 ~ --
$25 CO-PAY
$45 CO-PAY
COVERED 100%
NO MAX
COVERED 100%
$200 CO-PAY
$200 CO-PAY
OED & $250 CO-PAY
OED THEN 100%
OED & $250 CO-PAY
OED & $250 CO-PAY PER
ADMIN
OED THEN 100%
60 VISITS
$50 CO-PAY
20 VISITS
$1,500/$3 ,000
NO
NHP Alternates -Package 9
II
$15 CO-PAY
$15 CO-PAY $45 CO-PAY
COVERED 100% COVERED 100%
NO MAX NO MAX
COVERED 100% COVERED 100%
$50 CO-PAY OED TI1EN 100%
COVERED 100% OED &. $100 CO-PAY
COVERED 100% OED TI1EN 100%
COVERED 100% COVERED 100%
COVERED 100% OED TI1EN 100%
$500 CO-PAY PER ADMIN OED TI1EN 100%
COVERED 100%
COVERED 100% COVERED 100%
60 VISITS 60 VISITS
COVERED 100% $50 CO-PAY
60 VISITS 20 VISITS
NONE $1,000/$2,000
N/A NO
$15 CO-PAY OED & 70% $25 CO-PAY OED &80%
$15 CO-PAY OED & 70% $45 CO-PAY OED &. 80%
COVERED 100% OED & 70% COVERED 100% OED &. 80%
NO MAX NO MAX NO MAX NO MAX
COVERED 100% OED & 70% COVERED 100% OED &. 80%
$50 CO-PAY $200 CO-PAY
COVERED 100% OED & 70% $200 CO-PAY OED &80%
COVERED 100% OED & 70% OED &. $250 CO-PAY OED, $250 CO-PAY &.
80%
COVERED 100% OED & 70% OED TI1EN 100% OED &. 80%
COVERED 100% OED & 70% OED &. $250 CO-PAY
$500 CO-PAY PER OED & 70% OED & $250 CO-PAY PER
ADMIN ADMIN
COVERED 100% OED & OED &. 80%
COVERED 100% OED & 70% OED THEN 100% OED &. 80%
60 VISITS 60 VISITS 60 VISITS 60 VISITS
COVERED 100% OED & 70% $50 CO-PAY OED &. 80%
60 VISITS 60 VISITS 20 VISITS 20 VISITS
NONE $500/$1,000 $1,500/$3,000 $3,000/$6,000
NO NO
Information provided by Sapoznik Insurance is proprietary. It may not be copied. emulated or distributed without express permission.
.;"""""~~
S \.Iohz" I ....
$25 CO-PAY OED &. 80%
COVERED 100% OED &80%
NO MAX NO MAX
COVERED 100% OED &. 80%
$200 CO-PAY
$200 CO-PAY OED & 80%
OED &. $250 CO-PAY OED, $250 CO-PAY &.
80%
OED TI1EN 100% OED &80%
OED THEN 100% OED &. 80%
OED THEN 100% OED &80%
60 VISITS 60 VISITS
$50 CO-PAY OED &80%
20 VISITS 20 VISITS
$1,000/$2,000 $2,000/$4,000
NO
16
Group Name: City ut South Miami
Effective Date: October 1, 2012
~lJ.1JI. ·1f.Ti1
Physician
Specialist
Adult & Child Wellness
Adult Wellness Max
Mammograms
Emergency Room -Waived if
Admitted
Urgent care
Independent Clinical Lab
Diagnostic Testing I MRI, CAT
Scans
Outpatient Surgery -Ambulatory
Surgical Center
Provider Services Ambulatory
Surgery Center (ASC)
Outpatient Surgery -Hospital
Inpatient Hospital
Provider Services Hospital & ER
Home Health
Outpatient Therapy
Deductible
Included in Out of Pocket Max
Co-Insurance
Maximum Out of Pocket
Out of Pocket Includes
Prescription
lifetime Maximum
Premium Breakdown
Emolovee
Emolovee/Soouse
Emolovee/Child(ren)
Emolovee/Familv
Comments
Monthlv Total
12:08 PM 8/14/2012
82
1
15
2
100
BCSS -Package 2 -RECOMMENDED.1
t.:Iil.t; .~ .... : , .i} • , , • , , ,
I, ffi!L<:l~
$15 CO-PAY $15 CO-PAY $15 CO-PAY $15 CO-PAY DED & 70%
$25 CO-PAY $15 CO-PAY $35 CO-PAY $15 CO-PAY DED& 70%
COVERED 100% COVERED 100% COVERED 100% COVERED 100% DED & 70%
NO MAX NO MAX NO MAX NO MAX NO MAX
COVERED 100% COVERED 100% COVERED 100% COVERED 100% DED & 70%
$100 CO-PAY $50 CO-PAY $100 CO-PAY $50 CO-PAY
$50 CO-PAY $25 CO-PAY $35 CO-PAY $25 CO-PAY DED& 70%
COVERED 100% COVERED 100% COVERED 100% COVERED 100% OED & 70%
$50 CO-PAY COVERED 100% $75 CO-PAY COVERED 100% DED& 70%
$250 CO-PAY COVERED 100% $250 CO-PAY COVERED 100% DED &. 70%
COVERED 100% COVERED 100% COVERED 100% COVERED 100% DED& 70%
$250 CO-PAY COVERED 100% $350 CO-PAY COVERED 100% OED & 70%
$250 CO-PAY PER DAY $500 CO-PAY PER ADMIN $500 CO-PAY $500 CO-PAY PER ADMIN DED & 70% 5 DAY MAX
COVERED 100% COVERED 100% COVERED 100% COVERED 100% DED& 70%
COVERED 100% COVERED 100% COVERED 100% COVERED 100% DED& 70%
60 VISITS 60 VISITS 60 VISITS 60 VISITS 60 VISITS
$20 CO-PAY COVERED 100% $55 CO-PAY COVERED 100% DED & 70%
60 VISITS 60 VISITS 30 VISITS 60 VISITS 60 VISITS
NONE NONE $500/$1,000 NONE $500/$1,000
N/A N/A YES NO
100% 100% 90% 100% 70%
$1,500/$3,000 $1,500/$3,000 $3,500/$7,000 $1,500/$3,000 $3,000/$6,000
CO -PAYS & RX CO-PAYS CO-PAYS DED, CO-PAYS & CO-INS CO-PAYS & CO-INS
$20/40/60/20% $20/40/60/20% $10/30/50 $20/40/60/20%
UNLIMITED UNLIMITED UNLIMITED UNLIMITED
CURRENT RENEWAL CURRENT RENEWAL CURRENT RENEWAL
$416 .26 5623 .97 17 $482 .80 $723 .72 99 $512.74 3 $560.28 $839 .86
_$1119 .86 $1 228 .96 4 S950.92 $1425.43 5 $1220.31 0 $1103.52 $1654.18
$736 .63 $1 104.20 2 $854 .37 $1 280 .71 17 $943.44 0 $991.49 $1486.24
$J 227 .69 $1 840 .3_0. 0 $1 423.96 $2134 .52 2 $1 599.74 0 $1652.46 52477.04
49.9% Increase 23 49.9% Increase 123 22.4% Increase 3 49.9% Increase
548458.01 _$72638.10 _S_13 720.02 $20566.38 $76100.77 $1680.84 $2519.58
Current Monthlv Total $&2178.03 49.9% Increase Renewal Monthly Total $93204.48
Information provided by Sapoznik Insurance is proprietary. It may not be copied, emulated or distributed without express permission.
_'.,.pu,/ ..
s'\. .,.l-,;;" • ....
l.:I!!.i.:! IE.. %
;"'
$10 CO-PAY DED&60%
$25 CO-PAY DED&60%
COVERED 100% 60%
NO MAX NO MAX
COVERED 100%
$100 CO-PAY
$30 CO-PAY DED&60%
COVERED 100% DED &60%
$125 CO-PAY DED&60%
$50 CO-PAY DED &.60%
$25 CO-PAY
$150/$250 CO-PAY DED&60%
$250/$500 CO-PAY $750 CO-PAY
COVERED 100%
DED THEN 100% DED&60%
20 VISITS 20 VISITS
$45/$60 CO-PAY DED&60%
35 VISITS 35 VISITS
NONE $500/$1,500
YES
100% 60%
$1,500/$3,000 $3,000/$6,000
DED, CO-PAYS & CO-INS
$10/30/50 50%
UNLIMITED
$626 .20
~ 1 49 0.36
$1152.21
~ 1 953.74
11.8% Increase
$1878.60
18
Group Name: City of South Miami
Effective Date: October 1, 2012
. •. ,".t.iI.lITil
Physician
Specialist
Adult & Child Well ness
Adult Wellness Max
Mammograms
Emergency Room -Waived if
Admitted
Urgent Care
Independent Clinical Lab
Diagnostic Testing I MRI, CAT
Scans
Outpatient Surgery -
Ambulatory Surgical Center
Provider Services Ambulatory
Surgery Center (ASC)
Outpatient Surgery -Hospital
Inpatient Hospital
Provider Services Hospital a. ER
Home Health
Outpatient Therapy
Deductible
Included in Out of Pocket Max
Co-Insurance
Maximum Out of Pocket
Out of Pocket Includes
Prescription
Lifetime Maximum
Premium Breakdown
Employee
Employee/SDouse
Emj)loyeejChild(ren)
EmDloyee/Familv
Comments
Monthly Total
12:08 PM 8/14/2012
82
1
~5
2
100
SCSS -Package 3 -RECOMMENDED 2
W;I:AI;{tl-'1IU', :'-:j 1-.:1.t£1I'J'~!J' l\Ji1i.l' u. 'A!'B' l.!'na." ~ -1 M" :JI: .. : L'I, .1I .. ..,a~:Jillj.1J , ~ -... ..... lJjl~rn;. l!l!l,~0.
$15 CO-PAY $15 CO-PAY $15 CO-PAY $15 CO-PAY $15 CO-PAY DED & 70%
$25 CO-PAY $35 CO-PAY $15 CO-PAY $35 CO-PAY $15 CO-PAY DED & 70%
COVERED 100% COVERED 100% COVERED 100% COVERED 100% COVERED 100% DED & 70%
NO MAX NO MAX NO MAX NO MAX NO MAX NO MAX
COVERED 100% COVERED 100% COVERED 100% COVERED 100% COVERED 100% DED & 70%
$100 CO-PAY $100 CO-PAY $50 CO-PAY $100 CO-PAY $50 CO-PAY
$50 CO-PAY $35 CO-PAY $25 CO-PAY $35 CO-PAY $25 CO-PAY DED & 70%
COVERED 100% COVERED 100% COVERED 100% COVERED 100% COVERED 100% DED & 70%
$50 CO-PAY $75 CO-PAY COVERED 100% $80 CO-PAY COVERED 100% DED & 70%
$250 CO-PAY $250 CO-PAY COVERED 100% $100 CO-PAY COVERED 100% DED & 70%
COVERED 100% COVERED 100% COVERED 100% COVERED 100% COVERED 100% DED & 70%
$250 CO-PAY $350 CO-PAY COVERED 100% $150 CO-PAY COVERED 100% DED & 70%
$250 CO-PAY PER DAY $500 CO-PAY $500 CO-PAY PER ADMIN $200 CO-PAY PER DAY $500 CO-PAY PER DED& 70% 5 DAY MAX 5 DAY MAX ADMIN
COVERED 100% COVERED 100% COVERED 100% COVERED 100% COVERED 100% DED & 70%
COVERED 100% COVERED 100% COVERED 100% COVERED 100% COVERED 100% DED & 70%
60 VISITS 60 VISITS 60 VISITS 60 VISITS 60 VISITS 60 VISITS
$20 CO-PAY $55 CO-PAY COVERED 100% $55 CO-PAY COVERED 100% DED & 70%
60 VISITS 30 VISITS 60 VISITS 30 VISITS 60 VISITS 60 VISITS
NONE $500/$1,000 NONE NONE NONE $500/$1,000
N/A YES N/A N/A NO
100% 90% 100% 90% 100% 70%
$1,500/$3,000 $3,500/$7,000 $1 ,500/$3,000 $2,500/$7,500 $1,500/$3,000 $3,000/$6,000
CO-PAYS & RX CO-PAYS DED, CO-PAYS & CO-INS CO-PAYS CO-PAYS & CO-INS CO-PAYS & CO-INS
$20/40/60/20% $10/30/50 $20/40/60/20% $10/30/50 $20/40/60/20%
UNLIMITED UNLIMITED UNLIMITED UNLIMITED UNLIMITED
CURRENT RENEWAL CURRENT RENEWAL CURRENT RENEWAL
$416 .26 $623.97 $512.74 17 $482 .80 $723 .72 $545.18 3 $560.28 $839 .86
$819.86 $1228.96 $1220.31 4 $950 .92 $1425.43 $1297 .53 0 $1103.52 $1654.18
$736 .63 $1104.20 $943.44 2 $854 .37 $1280.71 $1003.13 0 $991.49 $1486.24
$1227.69 $1840.30 $1599.74 0 $1423.9 6 $2134.52 $1700.96 0 $1652.46 $2477.04
49.9% Increase 25.1% Increase 23 49.9% Increase 20% Increase 3 49.9% Increase
$48 458.01 $72638.10 $60616.07 $13720.02 $20566.38 $16464.44 $1,680.84 $2519.58
Information provided by Sapoznik Insurance is proprietary. It may not be copied, emulated or distributed without express permission .
.~~/I";~-
S _ ~ ptll Z ;, I K
mnTl t rr:q
-~
$20 CO-PAY DED &50%
$45 CO-PAY DED & 50%
COVERED 100% 50%
NO MAX NO MAX
COVERED 100%
$200 CO-PAY
$50 CO-PAY DED &50%
COVERED 100% DED & 50%
$200 CO-PAY DED &50%
$200 CO-PAY DED &50%
$45 CO-PAY
$300/$600 CO-PAY DED &50%
$700/$1,000 CO-DED & 50% PAY
$50 CO-PAY
DED THEN 100% DED &50%
20 VISITS 20 VISITS
$45/$60 CO-PAY DED &50%
35 VISITS 35 VISITS
$250/$750 $1,000/$3,000
YES
100% 50%
$3,000/$6,000 $6,000/$12,000
DED , CO-PAYS & CO-INS
$10/30/50 50%
UNLIMITED
$581.06
$1382.92
$1069.15
$1812.91
3.7% Increase
$1743.18
19
Group Name: City of South Miami
Effective Date: October 1, 2012
~'-U1I: . '/~
Physician
Specialist
Adult & Child Well ness
Adult Well ness Max
Mammograms
Emergency Room -Waived if
Admitted
Urgent Care
Independent Clinical Lab
Diagnostic Testing I MRI, CAT
Scans
Outpatient Surgery -
Ambulatory Surgical Center
Provider Services Ambulatory
Surgery Center (ASC)
Outpatient Surgery -Hospital
Inpatient Hospital
Provider Services Hospital & ER
Home Health
Outpatient Therapy
Deductible
Included in Out of Pocket Max
Co-Insurance
Maximum Out of Pocket
Out of Pocket Includes
Prescription
Lifetime Maximum
Premium Breakdown
EmQioyee
Employee/Spouse
Emj2!oyee/Child( ren)
Employee/Family
Comments
Monthly Total
12:08 PM 8/14/2012
82
1
15
2
100
Coventry -Package A
~~.1.!::"U~)1 Coventry FDOAZ020 OPT. 9 lam.. I I ~~C!:f!!1J:l!E Coventry FDOA1520 OPT. 7 1(m;Jf:;'".an'l: J;.., ""'fjI..::J.(IJ~"ItJl!
..]0 f.,"t-h'.1'f I rn!l.CI~[
$15 CO-PAY $20 CO-PAY $15 CO-PAY $15 CO-PAY $15 CO-PAY DED & 70%
$25 CO-PAY $40 CO-PAY $15 CO-PAY $30 CO-PAY $15 CO-PAY DED & 70%
COVERED 100% COVERED 100% COVERED 100% COVERED 100% COVERED 100% DED & 70 %
NO MAX NO MAX NO MAX NO MAX NO MAX NO MAX
COVERED 100% COVERED 100% COVERED 100 % COVERED 100% COVERED 100% DED & 70%
$100 CO-PAY $100 CO-PAY $50 CO-PAY $100 CO-PAY $50 CO-PAY
$50 CO-PAY $40 CO-PAY $25 CO-PAY $30 CO-PAY $25 CO-PAY DED & 70%
COVERED 100% COVERED 100% COVERED 100% COVERED 100% COVERED 100% DED & 70%
$50 CO-PAY HOSP: DED & $80 CO-PAY COVERED 100% HOSP: DED & $60 CO -PAY COVERED 100% DED & 70% FAC: $40 CO-PAY FAC: $30 CO-PAY
$250 CO-PAY $125 CO-PAY COVERED 100% $100 CO-PAY COVERED 100% DED & 70%
COVERED 100% COVERED 100% COVERED 100 % COVERED 100 % COVERED 100% DED & 70%
$250 CO-PAY DED & $250 CO-PAY COVERED 100% DED & $200 CO-PAY COVERED 100% DED & 70%
$250 CO-PAY PER DAY DED & $250 CO -PAY PER DAY $500 CO-PAY PER ADMIN DED & $200 CO-PAY PER DAY $500 CO-PAY PER DED & 70% 5 DAY MAX 5 DAY MAX 5 DAY MAX ADMIN
COVERED 100% COVERED 100% COVERED 100% COVERED 100% COVERED 100% DED& 70%
COVERED 100% COVERED 100% COVERED 100% COVERED 100% COVERED 100% OED & 70%
60 'VISITS 60 VISITS 60 VISITS 60 VISITS 60 VISITS 60 VISITS
$20 CO-PAY HOSP: DED & $40 CO-PAY/FAC: COVERED 100% HOSP : OED & $30 CO -PAY/FAC: COVERED 100% DED& 70%
60 VISITS $40 CO-PAY/60 VISITS 60 VISITS $30 CO-PAY/60 VISITS 60 VISITS 60 VISITS
NONE HOSP: $1,000 NONE HOSP: $500 NONE $500/$1,000
N/A NO N/A NO NO
100% 100% 100% 100% 100 % 70%
$1,500/$3,000 $2,000/$6,000 $1,500/$3,000 $1,500/$4,500 $1 ,500/$3,000 $3,000/$6,000
CO-PAYS & RX CO-PAYS CO-PAYS CO-PAYS CO-PAYS CO-PAYS & CO-INS
$20/40/60/20% $20/40/60/20% $20/40/60/20% $10/35/50/20% $20/40/60/20%
UNLIMITED UNLIMITED UNLIMITED UNLIMITED UNLIMITED
CURRENT RENEWAL CURRENT RENfWAl. CURRENT RENEWAL
$416.26 $623.97 $582 .92 17 $482 .80 $723.72 $638 .01 3 $560.28 $839 .86
$819.86 $1228.96 $1148.11 4 $950 .92 $1425.43 $1256.63 0 $1103 .52 $1654.18
$736.63 $1104.20 $1031.56 2 $854.37 $1280.71 $1129 .04 0 $991.49 $1486.24
$1227.69 $1840.30 $1719.22 0 j1423 .96 $2134.S2 $1881.74 0 $1 652.46 $2477.04
49.9% Increase 40% Increase 23 49.9% Increase 32.1% Increase 3 49.9% Increase
$48 458.01 $72.638.10 $67859.39 $13720.02 $20566.38 $18130.77 $1680.84 $2519.58
Information provided by Sapoznik Insurance is proprietary. It may not be copied. emulated or distributed without exoress oermission.
s " I~ l:J Z " I ....
CoventrY Premier Choice 100"500
In-Network Out-Network
$25 CO-PAY DED & 60%
$50 CO-PAY DED &60%
COVERED 100% NOT COVERED NO MAX
COVERED 100% DED & 60%
$250 CO-PAY
$50 CO-PAY DED &60%
COVERED 100% DED & 60%
HOSP: DED THEN 100% DED &60% FAC: $50 CO-PAY
$250 CO-PAY DED &60%
COVERED 100% DED &60%
DED THEN 100% DED &60%
DED THEN 100% OED &60%
COVERED 100% DED & 60%
DED THEN 100% DED & 60%
60 VISITS 60 VISITS
DED THEN 100% DED &60%
60 VISITS 60 VISITS
$500/$1,000 $1 ,000/$2,000
YES
100% 60%
$1,500/$3 ,000 $5,000/$10,000
OED , CO-PAYS & CO-INS
$10/30/55/20% NOT COVERED
UNLIMITED
$652.63
$1285.41
$1154.91
$1924.83
16.5% Increase
$1957 .8 9
21
Gn ~ame: City of South Miami
Effective Date: October 1, 2012 '" " .» C ... Z .......
DNO
~ • -:lJ.l'/Ai4.E:lil i:LWllr!wN:\"ITn l1m-ttl.1'i'}:PI lw 1::11 •• ; =!J."'I.C?.,:'!-"f,\ [C1IT!':~.",H.1 :'IIJ
:
Deductible NONE NONE NONE NONE
Co-Insurance NONE NONE NONE NONE
Dentist COVERED 100% COVERED 100% COVERED 100% $5 CO-PAY
Specialist CO-PAY APPLIES CO-PAY APPLIES CO-PAY APPLIES CO-PAY APPLIES
Cleanings ONCE EVERY 6 MONTHS ONCE EVERY 6 MONTHS ONCE EVERY 6 MONTHS ONCE EVERY 6 MONTHS
Preventive MOST PROCEDURES COVERED 100% MOST PROCEDURES COVERED 100% MOST PROCEDURES COVERED 100% MOST PROCEDURES COVERED 100% Network
Non Network SOME PROCEDURES HAVE CO-PAYS SOME PROCEDURES HAVE CO-PAYS SOME PROCEDURES HAVE CO-PAYS SOME PROCEDURES HAVE CO-PAYS
Basic Coverage SOME PROCEDURES COVERED 100% SOME PROCEDURES COVERED 100% SOME PROCEDURES COVERED 100% SOME PROCEDURES COVERED 100% Network MOST PROCEDURES HAVE CO-PAYS MOST PROCEDURES HAVE CO-PAYS MOST PROCEDURES HAVE CO-PAYS MOST PROCEDURES HAVE CO-PAYS Non Network
Major Coverage CO-PAY APPLIES CO-PAY APPLIES CO-PAY APPLIES CO-PAY APPLIES
Orthodontic
Coverage CO-PAY APPLIES CO-PAY APPLIES CO-PAY APPLIES CO-PAY APPLIES Orthodontic
Maximum (Age Limits)
Rate Guarantee 1 YEAR 1 YEAR 1 YEAR 1 YEAR
Annual Maximum UNLIMITED UNLIMITED UNLIMITED UNLIMITED
Dependent Child/Student UPTO AGE 26 UPTO AGE 26 UP TO AGE 26 UPTO AGE 26 Age
Premium Breakdown CURRENT /RENEWAl
Employee 75 $22.23 $14.36 $14.82 $21.85
Employee/ Spouse 13 $45.22 $29.21 $25.94 $44.50
Employee / Child(ren) 11 $44.68 $28.86 $31.13 $43.88
Employee/Family 7 $73.26 $47.32 $43.73 $71.55
Comments 106 RATE PASS 35.4% Decrease 35.7% Decrease 1.8% Decrease
Monthly Total $3,259.41 $2,105.43 $2,097.26 $3,200.78
12:12 PM 8/14/2012 Information provided by Sapoznik Insurance is proprietary. It may not be copied, emulated or distributed without express permission . 25
Group Name: City of South Miami
Effective Date: October 1, 2012
I I~" ,'I iA.f.\l.iJ
Exam
Materials
Maximum Allowances
Eye Exam
Lenses
Contacts-Necessary
(Legally Blind)
Contacts-Elective
Frames
Employee
Employee Spouse
Employee Children
Employee Family
Comments
Total Monthly
12:08 PM 8/14/2012
60
9
10
7
86
VISION
Iil'J ~l l':'I=I •• t~;#~.~·} (c1IL\~WfJ[Jl!J.. :I."1(<1.I::I:41:i
**$10 CO-PAY **$10 CO-PAY **$10 CO-PAY
(EVERY 12 MONTHS) (EVERY 12 MONTHS) (EVERY 12 MONTHS)
**$lS CO-PAY **$15 CO-PAY **$20 CO-PAY
Lenses: (EVERY 12 MONTHS) Lenses: (EVERY 12 MONTHS) Lenses: (EVERY 12 MONTHS)
Frames: (EVERY 24 MONTHS) Frames: (EVERY 24 MONTHS) Frames: (EVERY 24 MONTHS)
**$15 CO-PAY NON-NETWORK NON-NETWORK NON-NETWORK
Lenses: (EVERY 12 DOCTOR NETWORK DOCTOR DOCTOR NETWORK DOCTOR DOCTOR
MONTHS) REIMBURSEMENT REIMBURSEMENT REIMBURSEMENT
PAID IN FULL UP TO $35 PAID IN FULL UP TO $35 PAID IN FULL UP TO $50
AFTER CO-PAY REIMBURSEMENT AFTER CO-PAY REIMBUSEMENT AFTER CO-PAY REIMBURSEMENT
UP TO $25 SINGLE UP TO $25 SINGLE UP TO $48 SINGLE
PAID IN FULL $40 BIFICAL PAID IN FULL $35 BIFOCAL PAID IN FULL $67 BIFOCAL
AFTER CO-PAY $60 TRIFOCAL AFTER CO-PAY $45 TRIFOCAL AFTER CO-PAY $86 TRIFOCAL
$100 LENTICULAR $126 LENTICULAR
PAID IN FULL UP TO $210 $250 ALLOWANCE UP TO $250 PAID IN FULL UP TO $210
AFTER CO-PAY REIMBURSEMENT REIMBURSEMENT AFTER CO-PAY REIMBURSEMENT
UP TO $100 UPTO $100 FORMULARY $20 CO-PAY, NON-UP TO $105 $105 ALLOWANCE $135 ALLOWANCE FORMULARY UP TO $120 REIMBURSEMENT REIMBURSEMENT ALLOWANCE REIMBURSEMENT
$40 WHOLESALE UP TO $35 $100 RETAIL ALLOWANCE UP TO $65 $120 RETAIL ALLOWANCE UPTO $48
REIMBURSEMENT REIMBURSEMENT REIMBURSEMENT
CURRENT /RENEWAL
$5.85 $5.40 $5.85
$11.70 $10.80 $11.70
$11.12 $11.12 $11.12
$23.02 $15.39 $23.02
RATE PASS 12.1% Decrease NO INCREASE
$728.64 $640.13 $728.64
Information provided by Sapoznik Insurance is proprietary. It may not be copied, emulated or distributed without express permission .
••
**$10 CO-PAY
(EVERY 12 MONTHS)
**$10 CO-PAY
Lenses: (EVERY 12 MONTHS)
Frames: (EVERY 24 MONTHS)
NON-NETWORK
NETWORK DOCTOR DOCTOR
REIMBURSEMENT
PAID IN FULL UP TO $40
AFTER CO-PAY REIMBURSEMENT
UP TO $40 SINGLE
PAID IN FULL $60 BIFOCAL
AFTER CO-PAY $80 TRIFOCAL
$80 LENTICULAR
PAID IN FULL UP TO $210
AFTER CO-PAY REIMBURSEMENT
UP TO $105 $105 ALLOWANCE REIMBURSEMENT
$130 RETAIL UP TO $45
ALLOWANCE REIMBURSEMENT
$7.39
$14.78
$14.05
$29.08
26.3% Increase
$920.48
27
4:22 PM
NHP/UHC
Number or Current Total
Monlhly Seml-Monlh1y
TOTAL MONTHLY PREMIUM
TOTAL MONTHLY DEDUCTIONS
ANNUAL PREMIUM
TOTAL PARTICIPANTS
Numbel of Current
Number of
z.
TOTAL MONTHLY PREMIUM
TOTAL MONTHLY DEDUCTIONS
ANNUAL PREMIUM
TOTAL PARTICIPANTS
TOTAL MONTHLY PREMIUM
TOTAL MONTHLY DEDUCTIONS
ANNUAL PREMIUM
TOTAL PARTICIPANTS
TOTAL MONTHLY PREMIUM
TOTAL MONTHLY DEDUCTIONS
ANNUAL PREMIUM
TOTAL PARTICIPANTS
DENTAL HUMANA
TOTAL MONTHLY PREMIUM
TOTAL MONTHLY DEDUCTIONS
ANNUAL PREMIUM
TOTAL PARTICIPANTS
HEALTH MONTHLY EMPLOYER CONTRIBUTION
UHC Dental & Vision Monthly Line Item C['edil
tl1l AI MUJomn y ~ I\>I VMII;O m""II'fIU>I
TOTAL PREMIUM
% OF EMPLOYER CONTRIBUTION
TOTAL EMPLOYER COST
City if South :Miami 2012-2013 1{enewa{
Number of
Number of
Number of
I ••
Number-of
26
53,948,28
647.37936
Current -~a£ 2012 -2013
NHPIUHC
Renewal Total
TOTAL MONTHLY PREMIUM
TOTAL MONTHLY DEDUCTIONS
ANNUAL PREMIUM
TOTAL PARTICIPANTS
TOTAL MONTHLY PREMIUM
TOTAL MONTHLY DEDUCTIONS
ANNUAL PREMIUM
TOTAL PARTICIPANTS
Renewal
TOTAL MONTHLY PREMIUM
TOTAL MONTHLY DEDUCTIONS
ANNUAL PREMIUM
TOTAL PARTICIPANTS
Renewal
TOTAL MONTHLY PREMIUM
TOTAL MONTHLY DEDUCTIONS
ANNUAL PREMIUM
TOTAL PARTICIPANTS
DENTAL-UHC
TOTAL MONTHLY PREMIUM
TOTAL MONTHLY DEDUCTIONS
ANNUAL PREMIUM
TOTAL PARTICIPANTS
Seml-Monlhly
HEALTH MONTHLY EMPLOYER CONTRIBUTION
UHC Denial & Vision Monthly Line ](em CndH
niTA! \I(\"W V nip! OYItl1CtiNlltlKUJION
TOTAL PREMIUM
% OF EMPLOYER CONTRIBUTION
TOTAL EMPLOYER COST
FINAl. RECOMMENDATIONS (2)
Total Mo.,'hl.1 T' ••• I
79,567,98
1,090,00
lUJU.
99,114.87
~1l .'I1S ,76
Currenl Tolal
Monthly
NHP/UHC Alternate
TOTAL MONTHLY PREMIUM
TOTAL MONTHLY DEDUCTIONS
ANNUAL PREMIUM
TOTAL PARTICIPANTS
TOTAL MONTHLY PREMIUM
TOTAL MONTHLY DEDUCTIONS
ANNUAL PREMIUM
TOTAL PARTICIPANTS
TOTAL MONTHLY PREMIUM
TOTAL MONTHLY DEDUCTIONS
ANNUAL PREMIUM
TOTAL PARTICIPANTS
TOTAL MONTHLY PREMIUM
TOTAL MONTHLY DEDUCTIONS
ANNUAL PREMIUM
TOTAL PARTICIPANTS
DENTAL-UHC
TOTAL MONTHLY PREMIUM
TOTAL MONTHLY DEDUCTIONS
ANNUAL PREMIUM
TOTAL PARTICIPANTS
HEALTH MONTHLY EMPLOYER CONTRIBUTION
UHC Denial & Vision Monthly Line Item Credit
rn rAI MlWTlrL \ [""toYER W.iTRIBUTIO,,"
TOTAL PREMIUM
% OF EMPLOYER CONTRIBUTION
TOTAL EMPLOYER COST
60,720.90
1,090,00
lUJUO
76,120,23 ......
715,570.110
811512012