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Res. No. 137-07-12522RESOLUTION NO.: 137 -07 -12522 A RESOLUTION OF THE MAYOR AND CITY COMMISSION OF THE CITY OF SOUTH MIAMI, FLORIDA, AUTHORIZING THE CITY MANAGER TO RENEW THE CONTRACT WITH AVMED HEALTHCARE TO PROVIDE GROUP HEALTH INSURANCE FOR CITY OF SOUTH MIAMI FULL TIME EMPLOYEES; PROVIDING AN EFFECTIVE DATE. WHEREAS, the City's Agent of Record received the health insurance renewal rates for Av Med wherein the carrier proposed a (16.9 %) increase in premiums; and WHEREAS, the Agent of Record recommended that we review all insurance carriers that are currently on the market to ensure that we are being offered the most competitive rates; and WHEREAS, the Agent of Record also requested changes in current plan design that would reduce benefits as well as reduce premium rate for the upcoming year; and WHEREAS, the City Commission compared the insurance rates, benefit plan designs, provider network as well as our previous claims experience /ratio; and WHEREAS, after careful review, the City Commission recommended renewing with Av Med offering an alternative to the current plan (Triple Option Plan); and WHEREAS, the Triple Option Plan included an HMO plan with a change in the plan design which reduced the renewal increase from (16.9°/x) to (1.08 %); and, WHEREAS, with the selection of Av Med Health Care, the designated Agent of Record is Employee Benefits Consulting Group until contract expiration or until otherwise determined by either party. NOW THEREFORE BE IT RESOLVED BY THE MAYOR AND CITY COMMISSION OF THE CITY OF SOUTH MIAMI, FLORIDA, THAT; Section 1. The contract shall be effective October 1, 2007 and shall be renewable on an annual basis. Section 2. This engagement is at will and shall continue until either party terminates the engagement by giving written notice to the other party. The City shall not be charged for agent of record services; Employee Benefits Consulting Group shall be compensated by the insurer. Pg. 2 of Res. No. 137 -07 -12522 Section 3. This resolution shall take effect immediately upon approval. PASSED AND ADOPTED this day of , 2007. ATTEST: y CTfY CLERK q 6 -// '' .f . , CI ATTORNEY APPROVED: COMMISSION V TE: 5 -0 Mayor Horace Feliu: yea Vice Mayor Randy G. Wiscobe: Yea Commissioner Marie Birts: Yep, Commissioner Velma Palmer: Yea Commissioner Jay Beckman: Yea Page 2 of 4 To: The Honorable Mayor & Members of the City Commission Via: Yvonne S. McKinley, City Manager From: Jeanette Enrizo, Human Resource Manager Human Resource AM Date: August 7, 2007 Agenda Item No.: Subject: Authorizing One Year Contract Renewal with AVMED Health Care Request: A RESOLUTION OF THE MAYOR AND CITY COMMISSION OF THE CITY OF SOUTH MIAMI, FLORIDA, AUTHORIZING THE CITY MANAGER TO RENEW THE CONTRACT WITH AVMED HEALTHCARE TO PROVIDE GROUP HEALTH INSURANCE FOR CITY OF SOUTH MIAMI FULL TIME EMPLOYEES; PROVIDING FOR AN EFFECTIVE DATE. Reason/Need: We have received renewal rates from our current group health insurance carrier, AVMED, wherein they quoted a (16.9 %) percent increase in premiums from current rates. The reason for this increase was due to the claims. The City had $800,746 in claims and actually paid $579,960 in premiums. Although, the increase was much lower considering the claims ratio, the Agent of Record recommended that we seek out bids from other carriers to ensure that we are being offered competitive rates. Our Agent of Record solicited bids from eight companies. Bids were received from the following companies. AETNA Submitted proposal AVMED Submitted proposal BCBS Declined to quote CIGNA HEALTHCARE Declined to quote HUMANA Declined to quote NHP Submitted proposal UNITED HEALTH CARE Submitted proposal VISTA Submitted proposal Although AVMED presented the renewal rate, it was requested to provide the City with possible alternatives (changes in benefit plan design) that would reduce the premiums renewal rate. AVMED offered two options, the current plan design and an alternative plan design with reduced benefits. The City Commission reviewed in detail both alternatives and recommended that the Triple Option Plan be offered to the employees. This Triple Option rates are stated below: Page 3 of 4 Page 2 Health Cover Memo (HMO) $347.57 (City portion) $615.20 $684.7'1 $1025.33 (RENEWAL ENHANCED HMO) $403.32 $7'13.87 $794.54 $1189.79 (POS) $469.25 $830.57 $924.41 $1384.28 With the Triple Option, the City would cover the employee rate of $347.57 which is a 1.008 % ($4,170) increase annually instead of the 16.9 % ($87,795) increase annually. Changing the Benefit Plan Design would be a reduced cost savings to the City from the renewal rate. Cost: Funding Source: As budgeted for each department. Backup Documentation: © Proposed Resolution 0 Proposals from Insurance Vendors ® AVMED Contract Page 4 of 4 TABLE OF CONTENTS I. Executive Summary IL Proposed Medical Rates III. HMO Benefit Comparison IV. POS Benefit Comparison V. AvMed — Triple Option Employee Benefits Consulting Group Executive Summa Attached is our analysis of the medical proposals that we received on behalf of the City of South Miami. We approached the following vendors in regards to this project: Aetna Humana Av Med (incumbent) Neighborhood Health Partnership Blue Cross/Blue Shield United HealthCare CIGNA Vista The renewal increase with AvMed is 16.9% (without any plan design changes). From 2/1/06- 1131107 the City of South Miami had a 138% loss ratio with AvMed (i.e. for every $1.00 of premium AvMed paid $1.38 in claims). During this time period the City had $800,746 in claims vs. $579,960 in premium. Four plan participants had claims in excess of $50,000 ($125,077, $69,661, $57,871, and $55,214). From a plan design standpoint we are recommending a Triple Option plan with AvMed: ■ HMO ■ Enhanced HMO ■ Point -of- Service Under this scenario the City could base their contribution amount on the HMO "employee" rate. Employees would pay the entire premium amount for any additional coverage beyond the HMO "employee" rate. Aetna and Neighborhood Health Partnership submitted proposals that warrant further consideration. We appreciate the opportunity the City of South Miami has given us in regards to this project. Employee Benefits Consulting Group is prepared to assist the City of South Miami in managing healthcare costs while still maintaining the integrity of the benefits package. Employee Benefits Consulting Group Proposal Res onses Vendor Name Response Aetna Submitted a proposal. AvMed Submitted a proposal. Blue Cross/Blue Shield Declined to quote. CIGNA Healthcare Declined to quote. Humana Declined to quote. Neighborhood Health Partnership Submitted a proposal. United HealthCare Submitted a proposal. Vista Submitted a proposal. 2 Employee Benefits Consulting Croup AvMed Health Plan Large Group Financial Review Comparison City of South Miami - Statewide Incurred: February 01, 2006 through January 31,2007 Paid: April 30, 2007 % Of Total PMPM Revenue Member Months 2,191 Premium Revenue 579,960 $264.70 100.00%. Primary Care FFS 26,480 $12.09 4.57% Specialist FFS 201,834 $92.12 34.80% Total Physician Expense 228,314 $104.21 39.37% Hospital Inpatient 156,825 $71.58 27.04% Hospital Outpatient 237,301 $108.31 40.92% Emergency Room 59,132 $26.99 10.20% DME 6,209 $2.83 1.07% Home Health 730 $0.33 0.13% Prescription Drugs 76,279 $34.81 13.15% Extended Care Facilities 14,703 $6.71 2.54% Laboratory Capitation 2,872 $1.31 0.50% Reinsurance Premium 6,792 $3.10 1.17% Other Medical 11,589 $5.29 2.00% Total Medical Expenses 800,746 , 365.471 138.07% p L Q> r pf co to a)m N o �+ v c r o w a n 0) N 10 CO r- m c r �M N O n ty t00001LO S (DN mtih OZN�('7Ic2 Oa- ff3 64 69 f33 V). 64 — F (D 6 } 69 69 EI; t- .0 4f � Q:p 0- 0 =1 as ro 0- a a 0 yL� V it •stl (A q m W d d Q� QI a a >a Q> r pf co to a)m N o �+ c �3tiN� Nm00)N N o -0 coNm1" O(6COC, `' p rN�tcalN 0OOd¢In cc 1\ a7 N Cl) c a- m co r-- n co r m O! 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E 5+ ca N - a o ca cn �- O rr, 'a a c r_ c a� m 0 0 3 u. a) ca m E a' a, c - ca L S ca C y LL Z U y a s d7 a).0 F i L C C 0 V In CD m vC- Q y CIS — U E '�Stammcn co a) ui g :�E* O w bL C i± t* t* si O m q CO m ro A O Al a) Ci AvMED H E A L T H P L A N S Benefit Summary LARGE GROUP SCHEDULE OF BENEFITS COST TO MEMBER $150501,500120% participating Specialty Health Care Physician CALENDAR YEAR INDIVIDUAL / FAMILY $2501$750 annually DEDUCTIBLE The Deductible does not apply toward the Out -of- Pocket Maximum 100% coverage thereafter OUT-OF-POCKET MAXIMUM INDIVIDUAL / FAMILY $1,50013,000 annually Per Calendar Year The Out-of-Pocket Maximum includes Co ,payments and Co- duty nursing insurance amounts unless otherwise excluded ■ Laboratory and diagnostic imaging AVMED PRIMARY CARE Services at Participating Physicians' offices include, but are not $15 per visit PHYSICIAN limited to: OUTPATIENT SERVICES ■ Outpatient surgeries, including cardiac catheterizations and $250 Co- payment • Routine office visits /annual gynecological examination when ■ Outpatient therapeutic services, including: performed by Primary Care Physician ■ Drug infusion therapy $100 Co- payment ■ Pediatric care and well -child care ■ Periodic health evaluation and immunizations ■ Diagnostic imaging, laboratory or other diagnostic services ■ Minor surgical procedures ■ Vision and hearing examinations for children under 1$ MATERNITY CARE ■ Initial visit $15 Co- payment It Subsequent visits NO CHARGE AVMED SPECIALISTS' ■ Office visits $25 per visit SERVICES ■ Annual gynecological examination when performed by a participating Specialty Health Care Physician HOSPITAL Inpatient care at Participating Hospitals includes: fo day per $250 p r the he ■ Room and board —unlimited days (semi - private) first 5 days, per admission; ■ Physicians', specialists' and surgeons' services 100% coverage thereafter ■ Anesthesia, use of operating and recovery rooms, oxygen, drugs and medication Intensive care unit and other special units, general and special duty nursing ■ Laboratory and diagnostic imaging ■ Required special diets ■ Radiation and inhalation therapies OUTPATIENT SERVICES ■ Outpatient surgeries, including cardiac catheterizations and $250 Co- payment angioplasty ■ Outpatient therapeutic services, including: ■ Drug infusion therapy $100 Co- payment • Injectable Drugs (Co- payment for Injectable Drug $75 Co- payment waived if incidental to same -day drug infusion therapy) _ OUTPATIENT DIAGNOSTIC ■ CAT Scan, PET Scan, MRI 20% of the contracted TESTS ■ Other diagnostic imaging tests rate after Deductible EMERGENCY SERVICES An emergency is the sudden and unexpected onset of a condition $100 Co- payment requiring immediate medical or surgical care. (Co- payment waived if admitted) ■ Emergency services at Participating Hospitals ■ Emergency services at non - participating Hospitals, facilities, and/or physicians AvMed must be notified within 24 hours of inpatient admission following emergency services or as soon as reasonably possible URGENTIIMMEDIATE CARE ■ Medical Services at a participating Urgent/Immediate Care $40 Co- payment facility or services rendered after hours in your Primary Care Physician's office ■ MedicaI Services at a non - participating Urgent/Immediate Care $60 Co- payment AV- LG- 151250/1500/20%-06 MP- 3990(10106) Benefit Summary, continued FAMILY PLANNING Voluntary family planning services $15 per visit Sterilization $250 Co-payment MENTAL HEALTH - 20 outpatient visits $25 per visit ALLERGY TREATMENTS ■ Injections $15 per visit ■ Skin testing _ $50 per course of testing AMBULANCE - Ambulance transport for emergency services $100 Co- payment ■ Non - emergent ambulance services are covered when the skill of medically trained personnel is required and the Member cannot be safely transported by other means PHYSICAL, SPEECH, AND Short-term physical, speech or occupational therapy for acute $15 per visit OCCUPATIONAL THERAPIES conditions Coverage is limited to 30 visits per calendar year for all services combined SKILLED NURSING Up to 20 days post - hospitalization care per Calendar Year when 20% of the contracted FACILITIES AND prescribed by physician and authorized by AvMed rate after Deductible REHABILITATION CENTERS CARDIAC REHABILITATION Cardiac rehabilitation is covered for the following conditions: $15 per visit • Acute myocardial infarction • Percutaneous transluminal coronary angioplasty (PICA) Benefits limited • Repair or replacement of heart valves to $1,500 per • Coronary artery bypass graft (CABG), or Calendar Year • Heart transplant PROSTHETIC DEVICES Prosthetic devices are limited to: 20% of the contracted ■ Artificial limbs rate after Deductible IF Artificial joints --- .._.._ - Ocular prostheses FOR ADDITIONAL INFORMATION, PLEASE CALL: 1- 800- 88 -AVMED (1 -800- 882 -8533) THIS SCHEDULE OF BENEFITS IS NOT A CONTRACT. FOR SPECIFIC INFORMATION ON BENEFITS, EXCLUSIONS AND LIMITATIONS, PLEASE CONSULT YOUR AVMED GROUP MEDICAL AND HOSPITAL SERVICE CONTRACT. A V -LG- 15/25011500120 % -06 MP- 3990(10106) Coverage is limited to IS visits per Calendar Year HOME HEALTH CARE ■ Limited to 60 skilled visits per calendar year 20% of the contracted rate after Deductible DURABLE MEDICAL Equipment includes: 20% of the contracted EQUIPMENT AND ■ Hospital beds rate after Deductible ORTHOTIC APPLIANCES - Walkers ■ Crutches Benefits limited - Wheelchairs to $2,000 per Orthotie appliances are limited to: Calendar Year ■ Leg, arm, back, and neck custom -made braces PROSTHETIC DEVICES Prosthetic devices are limited to: 20% of the contracted ■ Artificial limbs rate after Deductible IF Artificial joints --- .._.._ - Ocular prostheses FOR ADDITIONAL INFORMATION, PLEASE CALL: 1- 800- 88 -AVMED (1 -800- 882 -8533) THIS SCHEDULE OF BENEFITS IS NOT A CONTRACT. FOR SPECIFIC INFORMATION ON BENEFITS, EXCLUSIONS AND LIMITATIONS, PLEASE CONSULT YOUR AVMED GROUP MEDICAL AND HOSPITAL SERVICE CONTRACT. A V -LG- 15/25011500120 % -06 MP- 3990(10106)