4THE CITY OF PLE,\SANT LlVINC
To:
FROM:
DATE:
SUBJECT:
BACKGROUND:
CITY OF SOUTH MIAMI
OFFICE OF THE CITY MANAGER
INTER-OFFICE MEMORANDUM
The Honorable Mayor & Members of the City Commission
Steven Alexander, City Manager
Agenda Item NO.:.!:l..-August 11, 2014
EMPLOYEE BENEFITS
The City's benefits consultant, Sapoznik Health & Wellness,
solicited quotes for the employee group insurance coverage for
South Miami full time employees for the 2014-2015 benefit year.
Florida Blue, the City's health insurance carrier's, first proposed
renewal rate represented a 15.68% increase. Despite the City's
high medical loss ratio of 125% for the current benefit year, after
negotiations, the final renewal increase is 10.32%. This is in-line
with this year's industry standard increase of 10%.
The City currently contributes $493.76 per eligible employee per
month toward health insurance coverage. This amount will
increase to $543.98 under the proposed renewal. The increase is
appropriately funded in the proposed Budget for Fiscal Year 2014-
2015.
The UHC DentalNision proposed renewal rates were not
competitive with comparable plans this year with a proposed
renewal increase of 22%. Staff recommends the selection of
MetLife as the provider for its dental and vision plans for the 2014-
2015 benefit year. In addition to the lower rate, MetLife offers
comparable or increased benefits with a significantly larger plan
network.
Based upon the proposals received, staff recommends the City
renew the current health insurance plans with Blue Cross Blue
Shield. Staff further recommends a change in carriers to MetLife
for the dental and vision coverage. The proposed rates are based
on the current number of enrollees and as follows:
THE CITY OF PLEASANT UVII"C;
CITY OF SOUTH MIAMI
OFFICE OF THE CITY MANAGER
INTER-OFFICE MEMORANDUM
AMOUNT:
Low HMO HLgh HMO POS
Employee $543.98 580.80 628.31
Employee + $1294.68 1382.28 1495.38
Spouse
Employee + 1000.93 1068.66 1156.09
Children
Employee + 1697.23 1812.08 1960.33
Family
DHMO DPPO
Employee. 11.86 37.42
Employee + Spouse 20.75 78.12
Employee + 24.90 88.03
Children
Employee + Family 34.99 138.11
Vision
Employee 6.60
Employee + Spouse 13.22
Employee + Children 11.19
Employee + Family 18.46
The City will continue to provide life insurance for 1 x annual salary
up to a maximum of $75,000 and Long Term Disability Insurance
for 60% of salary for full time employees. Staff recommends the
continuation of coverage under the current policies with Lincoln
Financial Group at the same rate as the current policy year.
The projected total annual employer costs is $753,476.28.
ACCOUNT: Premium charges for the health, dental and vision benefits will be
charged to the designated departmental budget line items as
proposed in the Fiscal Year 2015 Budget.
DEPARTMENT ACCT#
CRA-ADMINISTRATIVE 6101110-5132310
CRA-PROTECTIVE SERVICES 6101110-5212310
CRA-PROPERTY MANAGEMENT 6101110-5542310
CRA-PUBLIC ASSISTANT SERVICES 6101110-5692310
CITY CLERK 0011200-5122310
CITY MANAGER 0011310-5132310
CITY OF SOUTH MIAMI
OFFICE OF THE CITY MANAGER
INTER-OFFICE MEMORANDUM
THE CITY OF PLEASANT LIVING
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-SOLI D 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
ATTACHMENTS: Proposed resolution
2014 Benefits Renewal Summary from Sapoznik Insurance
1 RESOLUTION NO. _____ _
2
3 A Resolution authorizing the City Manager to purchase group health
4 insurance benefits from Blue Cross Blue Shield and dental and vision
5 insurance benefits from MetLife for the City of South Miami full time
6 employees and participating retirees.
7
8 WHEREAS, the Benefits Consultant, Sapoznik Health & Well ness secured more than three
9 competitive quotes for the City's Group Health, Dental and Vision Insurance and recommended Blue
10 Cross and Blue Shield and MetLife as the selected providers; and
11
12 WHEREAS, the City's Benefits Consultant compared the insurance rates, benefit plan
13 design, provider network as well as the City's previous claims experience/ratio; and
14
15 WHEREAS, the City Commission wishes to approve the selection of Blue Cross Blue
16 Shield for the provision of group health insurance benefits and MetLife for the provision of
17 dental and vision group benefits for all full time employees and participating retirees.
18
19 WHEREAS, the City Commission further wishes to continue to provide life insurance
20 and long term disability insurance to full time employees through Lincoln Financial Group under
21 the existing rate guaranteed policy; and
22
23 WHEREAS, the premium charges shall be charged to departmental line items in account
24 numbers:
25 6101110-5132310, 6101110-5212310, 6101110-5542310, 6101110-5692310, 0011200-5122310,
26 0011310-5132310, 0011320-5132310, 0011330-5132310, 0011410-5132310, 0011610-5242310,
27 00 I 1620-5242310, 0011640-5242310, 0011710-5192310, 0011720-5342310, 0011730-5412310,
28 I I I 1730-5412310, 0011750-5192310, 00 I 1760-5192310, 00 I 1770-5192310, 00 I 1790-5192310,
29 00 I 1910-5212310, 0012000-5722310, 0012020-5192310.
30
31
32 NOW THEREFORE BE IT RESOLVED BY THE MAYOR AND CITY
33 COMMISSION OF THE CITY OF SOUTH MIAMI, FLORIDA THAT;
34
35 Section I. The City Manager is hereby authorized to purchase group health insurance benefits from
36 Blue Cross Blue Shield and dental and vision insurance benefits from MetLife for the City of South Miami
37 full time employees and participating retirees for the 2015 fiscal year in conformity with the quotes
38 obtained and to be charged to the accounts listed in the recitals to this resolution.
39
40
1
2
3
4
5
6
7
8
9
10
11
12
l3
14
15
16
17
18
Section 2. This resolution shall take effect immediately upon adoption.
PASSED AND ADOPTED this _ day of ____ " 2014.
ATTEST:
CITY CLERK
READ AND APPROVED AS TO FORM,
LANGUAGE, LEGALITY AND
EXECUTION THEREOF:
CITY ATTORNEY
APPROVED:
MAYOR
COMMISSION VOTE:
Mayor Stoddard:
Vice Mayor Harris:
Commissioner Welsh:
Commissioner Liebman:
Commissioner Edmond
2014 Benefits Renewal Summary
CITY Of SOUTH MiAMI
i!'\lTROOUCnON
Sapoznik Insurance is pleased to provide The City of South Miami with our renewal analysis for the 2014-
201 5 benefits period. The City currently offers a comprehensive benefits package to its 1 36 Full-Time
employees; including health, dental, and basic life insurance fully subsidized for employees only. In addition
employees have the option of Voluntary benefits including, Vision insurance, Employee, Spousal and Child Life
insurance, Short-Term and Long-Term disability insurance.
H AlT~i INSURANCE
The City currently offers 3 medical plans through Florida Blue (formerly Blue Cross Blue Shield), with an
average of 1 1 0 employees enrolled. Employees have the option to enroll on an HMO plan, fully subsidized
by The City or 2 buy-up options partially subsidized. Dependent coverage is also offered for all benefits,
and are partially subsidized by The City.
Carrier renewal increases in the large group market (100+ Employees) are largely due to a group's medical
claims experience. The medical claims time period reviewed for the 2014 renewal was October 2013 to
March 201 4. In one month, The City experienced an increase in claims expenditure of 1 17% as illustrated
below.
Month
June 2014
July 2014
Medical Claims Spent
$154,877
$499,034
Medical Loss Ratio (claims vs premiums)
57%
125%
It is also important to note that during the renewal review period, there were two (2) members each having
claims in excess of $25,000; claims billed and paid were as follows:
Claimant
#1
#2
Claims Billed
$62,873.72
$850,114.63
Claims Paid
$15,849.82
$300,531.44
We can see from this data that one member's claims expenditure equals 60% of the total claims paid for the
entire group for the renewal review period.
Along with claims expenditures, medical trend increases and new Affordable Care Act fees and taxes, the
renewal increase with BCBS are as follows (see Exhibit A):
Initial Renewal Increase Negotiated Increase Final Increase
15.68% 13.48% 10.32%
Page 1
CITY OF SOUTH MIAMI
Currently The City contributes 100% of the cost of the employee only tier for Base HMO plan. Based on
this contribution level and current enrollment below are the City's true proposed costs for all Florida Blue
plans offered (see Exhibit B):
Current Costs Projected Renewal Costs Projected Renewal Cost % Increase
$679,913 $704,998 3.69% Increase
As part of our due diligence we reviewed alternate plan combinations with Florida Blue to lower The
City's overall costs and have included a scenario (see Exhibit C & DJ that reduces the City's costs as follows.
The downside to this option is that employees will assume more of the financial responsibility with higher
co-pays and deductibles.
Current Costs Projected Alternate Renewal Projected Alternate Renewal Cost % Increase
$679,913 $677,575 0.34% Decrease
We examined the marketplace to find similar plan options with alternate carriers and our findings are as
follows (see Exhibits E & FJ:
NHP -Option 1 NHP Option 2 Humana
1 0.7% Increase 11 .20% Increase 11 .79% Increase
Other carriers were also approached for our market analysis, but based on current claim experience and
carrier history, the following carriers were non-competitive and declined to provide a quote:
Aetna / Coventry AvMed Cigna
HEALTH !NSURANC MM NDA iON
Our recommendation this year is for The City to renew with Florida Blue with the current plans offered.
This is based in consideration of current claims expenses, this being a first year renewal and with
alternate carrier options available the disruption of a carrier change would not result in any substantial
savings.
Page 2
CITY OF SOUTH MIAMI
o NTAl 11 Vi ION INSURANC
The City's dental and vision plans are currently offered through United Healthcare. City employees have
two dental plan options to choose from; a base DHMO plan and a buy-up DPPO option. Currently there
are 94 employees enrolled on the DHMO plan and 1 8 on the DPPO plan. Currently The City contributes
100% of the cost of the employee only tier for Base DHMO plan.
Employees also have one vision plan option with UHC, with 78 employees enrolled. Vision coverage is
100% voluntary.
There are no claims expenditure details available for any of the dental or vision plans offered because
enrollment is below 100 employees and therefore the renewal increase is based on manual rates with
minimal flexibility. The renewal increase on the DHMO plan was 22% and 10% on the DPPO. The
vision plan has a rate guarantee until 2015.
Based on The City's contribution level for dental coverage and current enrollment below are the City's
true proposed costs for all plans offered (see Exhibit G):
Current Costs Projected Renewal Costs Projected Renewal Cost % Increase
$14,757 $18,010 22% Increase
We also examined the marketplace for dental to find similar plan options with alternate carriers and our
findings are as follows (see Exhibits H, I & J):
Plan
DHMO
DPPO
Vision
o NTAl
UHC Renewal
+22.04%
+10.01 %
0%
Met Life
+3.9%
+9.38%
-9.16%
V! N INSURAN
Guardian Humana BCBS
+15.88% +16.06% +41.71%
+7.48% +4.32% +0.87%
-0.94% -5.83% -15.59%
Our recommendation for The City's dental and vision coverage is to consider a change of carriers to
MetLife. This is based on the fact that the DHMO plan, which is the cost driver with the highest number of
enrollment, received the highest renewal increase and as such Met Life is the most competitive increase.
For the DPPO, although there would still be an increase the proposed plan with Met Life would change
from annual max of $1,000 (FEE) to $5,000 (UCR). Employee would also see a savings on their vision
coverage with Met Life as well. In terms of carrier comparison, Met Life is the largest provider of Dental
coverage with the stronger network both local and nationwide as compared to UHC.
Page 3
CITY OF SOUTH MIAMi
City employees are all given life insurance fully subsidized for one times their annual salary and offered
by Lincoln Financial Group. Employees also have the option of purchasing voluntary Life insurance on
themselves, their spouse and children. The Life insurance benefit has a rate guarantee until 2015.
Current annual expenditure for The City for the employer paid Basic Life benefit is approximately
$15,395.40.
DISABIUTY INSiURANC
The City also fully subsidizes Long Term Disability (LTD) insurance for all City employees, covering 40%
of their salary up to $6,000 a month and offered by Lincoln Financial Group. Employees can purchase a
buy-up option for their LTD benefit to cover 60% of their salary and/or fully voluntary Short Term
Disability (STD). Both the STD and LTD benefits have a rate guarantee until 2015. Current annual
expenditure for The City for the employer paid LTD benefit is approximately $17,142.96.
ORDA. L CAR A
The Affordable Care Act (ACA) now requires employers with 100+ employees to comply with the
requirement of offering compliant healthcare coverage to all of their employees. Requirements under
ACA call for compliant plans to meet two requirements;
(1) Minimum Essential Coverage / Minimum Value and
(2) Affordability -cost of coverage to employee cannot exceed 9.5% of their W2 income.
In order for The City to be compliant with the ACA's Minimum Value requirement, Florida Blue plans will
now change to include an employee's prescription expenses in the annual out of pocket maximum.
With this change, and with current employer contribution levels, The City will be compliant for the 2014-
2015 benefit year with both requirements of The Affordable Care Act.
Page 4
s "P'<')Z ........ I .......
Therapy
3:41 PM
Group Name: City of South Miami
Effective Date: October 1, 2014
$80 CO-PAY
$200 CO-PAY
$25/$45 CO-PAY
$275 CO-PAY
$325 CO-PAY PER DAY,
5 DAY MAX
IVERED 100%
COVERED 100%
60 VISITS
$45 CO-PAY
30 VISITS
YES
Current: DED, CO-PAY & CO-INS
Renewal: OED, CO-PAY, CO-INS & RX
RENEWAL -EXHIBIT A
$100 CO-PAY
I $80 CO-PAY $200 CO-PAY
I $100 CO-PAY $200 CO-PAY
I $15/$35 CO-PAY $20/$45 CO-PAY
$150 CO-PAY $300/ $600 CO-PAY
$200 CO-PAY PER DAY, 5 DAY MAX $700/ $1000 CO-PAY
0
COVERED 100% DED THEN 100%
60 VISITS 20 VISITS
$35 CO-PAY $45 CO-PAY
30 VISITS 35 VISITS
NONE $250/$750
N/A
90'
$2500!,
Current: CO-PAY & CO-INS
Renewal: CO-PAY, CO-INS & RX
Information provided by Sapoznik Insurance is proprietary. It may not be copied, emulated or distributed without express permission.
$200 CO-PAY
DED & 50%
DED & 50%
DED & 50%
DED& 50%
DED& 50%
DED & 50%
20 VISITS
DED &50%
35 VISITS
$1000/$300
8/8/2014
City of Soutli Miami
2014-2015 Tmp{o1,fer Contribution :Jtna{1,fsis
ExhibitB
2013/2014 Benefit Year -Service Fee Structnre<J 2014/2015 Benefit Year -Commission Structure
Current Employer Contributions
Florida Blue BlueCare '60. HMO
Number ofl Current I Total Employer's Employee's
Employees Premium Monthly Monthly % Monthly
Premium Contribution Deduction
iEE 72
ES 2
EC 11
FA 2
$ 493.76 $ 35,550.72 $ 493~'16 100% $
$ 1,175.15 $ 2,350.30 $ 493.76 42% $ 681.39
$ 908.52 $ 9,993.72 $ 493:76 .. 54% $ 414.76
$1,540.52 $ 3,081.04 $ 4~3.76· 32% $ 1,046.76
MONTHLYEMJ'LOl('ERcoN:rRf'lU:LTION
Current
ANNUAL EMPLOYER CONTRlBUTION
MONTlILY.EMPLOYEEDEDUCTIONS
ANNUAL EMPLOYEE DEDUCTIONS
To;rALMONTlfLiYJ>~:EMll:lM
ANNUAL PREMIUM
:rOTALP~R:rlcrpAN:rs
50,975.78
Total
Monthly
Employer's
Monthly
56,160.61
Current
ANNUAL EMPLOYER CONTRIBUTION
MONTHi::Y £MPCO¥'EElDEUUCnONS·
ANNUAL EMPLOYEE DEDUCTIONS
TOTAL MON;THLVPREMl.t)M .
TOTAL ANNUAL PREMIUM
MONTHLY EMPLOYER CONTRIBUTION
ANNUAL EMPLOYER CONTRIBUTION
ANNUAL CONSULTING FEE
MONTHLY EMPLOYEE DEDUCTIONS
ANNUAL EMPLOYEE DEDUCTIONS
TOTAL MONTHLY PREMIUM
TOTAL ANNUAL PREMIUM
TOTAL PARTICIPANTS
ANNUAL EMPLOYER CONTRIBUTION
N/A
MONTHLY EMPLOYEE DEDUCTIONS
ANNUAL EMPLOYEE DEDUCTIONS
TOTAL MONTHLY PREMIUM
TOTAL ANNUAL PREMIUM
TOTAL PARTICIPANTS
S \'I>(~:JZ" I h.
Deductible
Co-Insurance
Dentist
Specialist
Cleanings
Preventive
Network
Non Network
Basic Coverage
Network
Non Network
Major Coverage
Orthodontic
Coverage
Orthodontic
Maximum
Rate Guarantee
ual Maximum
Premium Breakdown
Employee
Employee/ Spouse
Employee / Child(ren)
Employee/Family
ments
Monthly Total
**This data is
Group Name: City of South Miami
Effective Date: October 1, 2014
DHMO
NONE
100%
COVERED 100%
CO-PAY APPLIES
1 EVERY 6 MONTHS
MOST PROCEDURES
COVERED 100%
SOME PROCEDURES
COVERED 100%
MOST PROCEDURES
HAVE CO-PAYS
CO-PAY APPLIES
CO-PAY APPLIES
1 YEAR
NONE
NONE
100%
$5 CO-PAY
CO-PAY APPLIES
1 EVERY 6 MONTHS
MOST PROCEDURES
COVERED 100%
SOME PROCEDURES
HAVE CO-PAYS
SOME PROCEDURES
COVERED 100%
MOST PROCEDURES
CO-PAY APPLIES
CO-PAY APPLIES
1 YEAR
NONE
UP TO AGE 26 UP TO AGE 26
Current Renewal
62 $10.98 $13.40 $11.86
11 $22.84 $27.87 $20.75
13 $22.07 $26.93 $24.90
8 $36.19 $44.17 $34.99
94 Current Increase 22.04% Increase 3.90%
$1,508.43 $1,840.82 $1,567.19
. The
ff:tiR:>PrMation provided by Sapoznik Insurance is proprietary. It may not be copied, emulated or distributed without express pen81i15tiIIDt4
S \. P(')z ..... I ""
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
Group Name: City of South Miami
Effective Date: October 1, 2014
DPPO
IN/OUT: $50/$150
IN/OUT: 100%/80%/50%
1 EVERY 6 MONTHS
IN/OUT: DED WAIVED,
COVERED 100%
IN/OUT: DED & 80%
IN/OUT: DED & 50%
BASIC
50% CO-INS
CHILD(REN) TO 19
$1000 UFETIME MAX
$1,000
IN/OUT: $50/$150
IN/OUT: 100%/80%/50%
1 EVERY 6 MONTHS
IN/OUT: DED WAIVED,
COVERED 100%
IN/OUT: DED & 80%
IN/OUT: DED & 50%
BASIC
50% CO-INS
CHILD(REN) TO 19
$1000 UFETIME MAX
1 YEAR
o
UP TO AGE 26
a binding obligation. The
carrier**
ff:mbi"tMation provided by Sapoznik Insurance is proprietary. It may not be copied, emulated or distributed without express pen81itttlID1.4
City of South Miami
2014-2015 'Em12(01,{er Contr-t~MtJQl1_~na[\fsis
ExhibitG
2013/2014 Benefit Year -Service Fee Structure 2014/2015 Benefit Year -Commission Structure
Current Employer Contributions
UHCDHMO
Total Employer's Employee's Employee Total
Number ofl Current I Monthly Monthly 0/0 Monthly Semi-Employer's
Employees Premium Premium Contribution Deduction Monthly Monthly
~
EE 62 $ 10.98 $ 680.76 $ 10.98 100% $ -$ -$ 680.76
ES 11 $ 22.84 $ 251.24 $ 10.98 48% $ 11.86 $ 5.93 $ 120.78
EC 13 $ 22.07 $ 286.91 $ 10.98 50% $ 11.09 $ 5.55 $ 142.74
FA 8 $ 36.19 $ 289.52 $ 10.98 30% $ 25.21 $ 12.61 $ 87.84
MONTHLY EMPLOYER CONTRIBUTION $ 1,032.12
ANNUAL EMPLOYER CONTRIBUTION $ 12,385.44
MONTHLY EMPLOYEE DEDUCTIONS $ 476.31
ANNUAL EMPLOYEE DEDUCTIONS $ 5,715.72
TOTAL MONTHLY PREMIUM $ 1,508.43
ANNUAL PREMIUM $ 18,101.16
TOTAL PARTICIPANTS 94
1,508.43 1,652.87
UHCDPPO
Total Employer's Employee's Employee Total
Number ofl Current I Monthly Monthly % Monthly Semi-Employer's
Employees Premium Premium Contribution Deduction Monthly Monthly
n .• r
EE 13 $ 34.76 $ 451.88 $ 10.98 32% $ 23.78 $ 11.89 $ 142.74
ES 1 $ 70.10 $ 70.10 $ 10.98 16% $ 59.12 $ 29.56 $ 10.98
EC 1 $ 78.12 $ 78.12 $ 10.98 14% $ 67.14 $ 33.57 $ 10.98
FA 3 $ 125.21 $ 375.63 $ 10.98 9% $ 114.23 $ 57.12 $ 32.94
MONTHLY EMPLOYER CONTRIBUTION $ 197.64
ANNUAL EMPLOYER CONTRIBUTION $ 2,371.68
MONTHLY EMPLOYEE DEDUCTIONS $ 778.09
ANNUAL EMPLOYEE DEDUCTIONS $ 9,337.08
TOTAL MONTHLY PREMIUM $ 975.73
ANNUAL PREMIUM $ 11,708.76
TOTAL PARTICIPANTS 18
UHCVISION
Number ofl Current
Employees Premium
Total
Monthly
Premium
Employer's
Monthly
Contribution
0/0
Employee's
Monthly
Deduction
EE I 48 1$
ES I 7 1$
EC I 10 1$
FA I 9 1$
6.66 I $ 319.68 I $ -I 0% I $
13.32 I $ 93.24 I $ -I 0% I $
12.66 I $ 126.60 I $ -I 0% I $
26.21 I $ 235.89 I $ -I 0% I $
MONTHLY EMPLOYER CONTRIBUTION
ANNUAL EMPLOYER CONTRIBUTION
MONTHLY EMPLOYEE DEDUCTIONS
ANNUAL EMPLOYEE DEDUCTIONS
TOTAL MONTHLY PREMIUM
TOTAL ANNUAL PREMIUM
TOTAL PARTICIPANTS
775.41
MONTHLY EMPLOYER CONTRIBUTION
ANNUAL EMPLOYER CONTRIBUTION
ANNUAL CONSULTING FEE
TOTAL ANNUAL EMPLOYER COSTS
MONTHLY EMPLOYEE DEDUCTIONS
ANNUAL EMPLOYEE DEDUCTIONS
TOTAL MONTHLY PREMIUM
TOTAL ANNUAL PREMIUM
6.66
13.32
12.66
26.21
Employee
Semi-
Monthly
$ 3.33
$ 6.66
$ 6.33
$ 13.11
$
$
$
~
~
!
$
$
$
Total
Employer's
Monthly
775.41
9,304.92
775.41
LE04·92
74
$ 1,229.76
$ 14,757.12
$ 14,757.12
$ 2,029.81
$ 24,357.72
$ 3,259.57
$ 39,114.84
MONTHLY EMPLOYER CONTRIBUTION
ANNUAL EMPLOYER CONTRIBUTION
N/A
TOTAL ANNUAL EMPLOYER COSTS
MONTHLY EMPLOYEE DEDUCTIONS
ANNUAL EMPLOYEE DEDUCTIONS
TOTAL MONTHLY PREMIUM
TOTAL ANNUAL PREMIUM
s "P('~Z '" I h.
Exam
Materials
Maximum Allowances
Eye Exam
Lenses
Contacts-Necessary
(Legally Blind)
Contacts-Elective
Frames
Employee
Employee Spouse
Employee Children
Employee Family
Comments
Total Monthly
Group Name: City of South Miami
Effective Date: October 1, 2014
55
5
12
6
78
VISION
**$10 CO-PAY
(EVERY 12 MONTHS)
*$10 CO-PAY
Lenses: (EVERY 12 MONTHS)
Frames: (EVERY 24
NON-NElWORK
NElWORK DOCTOR I DOCTOR
REIMBURSEMENT
PAID IN FULL UP TO $40
AFTER CO-PAY REIM BURSEM ENT
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 REIM BURSEM ENT
UP TO $105 ALLOWANCE UP TO $105
REIM BURSEM ENT
UP TO $l30 ALLOWANCE I UP TO $45
+ 30% OFF BALANCE REIMBURSEMENT
Current
$6 .. 66
$13.32
$12.66
$26.21
Next Renewal: 10/1/2015
$742.08
**$10 CO-PAY
(EVERY 12 MONTHS)
10 CO-PAY
Lenses: (EVERY 12 MONTHS)
Frames: (EVERY 24 Mn~ITI .. IC"
NON-NElWORK
NElWORK DOCTOR I DOCTOR
PAID IN FULL
AFTER CO-PAY
PAID IN FULL
AFTER CO-PAY
PAID IN FULL
AFTER CO-PAY
REIMBURSEMENT
UP TO $45 ALLOWANCE
UP TO $30 SINGLE
$50 BIFOCAL
$65 TRIFOCAL
$100 LENTICULAR
UP TO $210 ALLOWANCE
UP TO $130 ALLOWANCE I UP TO $105 ALLOWANCE
UP TO $130 ALLOWANCE I UP TO $70 ALLOWANCE
$6 .. 60
$l3.22
$11.19
$18.46
Decrease 9.16%
$674.14
ff:6RlRMation provided by Sapoznik Insurance is proprietary. It may not be copied, emulated or distributed without express pen81~~.4