5THE CITY O F PLEASANT LIVING
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.: 6 September 1, 2015
A Resolution authorizing the City Manager to purchase group health
insurance benefits from Blue Cross Blue Shield and dental and vision
insurance benefits from MetLife for the City of South Miami full time
employees and participating retirees.
The City's benefits consultant, Sapoznik Health & Well ness, solicited
quotes for the employee group insurance coverage for South Miami
full time employees for the 2015-2016 benefit year. Florida Blue, the
City 's health insurance carrier's, first proposed renewal rate
represented a 26.28% increase. Despite the City's high medical loss
ratio of 108.75 % for the current benefit year , after negotiations, the
final renewal increase was reduced to 12.20%. This reflects a
53.58% reduction due to negotiations.
The increase is appropriately funded In the proposed Budget for
Fiscal Year 2015-2016.
Staff further recommends the renewal of MetLife as the provider for
its dental and vision plans for the 2015-2016 benefit year . MetLife
proposes an increase of 6 % on the Dental HMO Plan and no
increase on the vision plan for the upcoming benefit year. The
Dental PPO Plan proposed increase is 12.51% negotiated down from
an initial increase of 15%. Representing a 16.60% decrease due to
negotiation.
Based u·pon the proposals received, staff recommends the City renew
the current health insurance plans with Blue Cross Blue Shield and
MetLife for the dental and vision coverage. The proposed rates are
based on the current number of enrollees and as follows:
THE CITY O F PLEASANT LIV I NG
AMOUNT:
ACCOUNT:
CITY OF SOUTH MIAMI
OFFICE OF THE CITY MANAGER
INTER-OFFICE MEMORANDUM
Low HMO High HMO POS
Employee $610.32 $653.98 $752.08
Employee + $1452.57 $1556.47 $1789.95
Spouse ' . .",
Employee + $1122.99 $1203.32 $1383.133
Children
Employee + $1904.21 $2040.41 $2346.49
Family
DHMO DPPO
Employee $12.57 $42.10
Employee + Spouse $22.00 $87.89
Employee + $26.39 $99.04
Children
Employee + Family $37.09 $155.38
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.
The projected total annual employer costs for health, dental, life and
LTD benefits is $1 ,060,424 .
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 2016 Budget.
THE CITY OF PLEASANT LI V ING
CITY OF SOUTH MIAMI
OFFICE OF THE CITY MANAGER
INTER-OFFICE MEMORANDUM
DEPARTMENT ACCT#
CRA-ADMINISTRA TIVE 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
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
AlTACHMENTS: Proposed resolution
2015 Benefits Renewal Summary from Sapoznik Insurance
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RESOLUTION NO. _____ _
A Resolution authorizing the City Manager to purchase group health
insurance benefits from Blue Cross Blue Shield and dental and vision
insurance benefits from MetLife for the City of South Miami full time
employees and participating retirees.
WHEREAS, the Benefits Consultant, Sapoznik Health & Well ne ss secured more than three
competitive quotes for the City's Group Health, De ntal and Vision Insuranc e and recommended Blue
Cross and Blue Shield and MetLife as the selected prov iders; and
WHEREAS, the City's Benefits Consultant 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 to approve the selection of Blue Cross Blue
Shield fo r the provision of group health insurance benefits and MetLife for the provision of
dental and vision group benefits for all full time employees and participating retirees.
WHEREAS, the City Commission further wishes to continue to provide life insurance
and long term disability insurance to full time employees through Linco ln Financial Group under
the existing policy; and
WHEREAS, the pre mium charges shall be charged to departmental line item s in account
numbers :
6101110-5132310 ,
0011310-5132310 ,
00 I 1620-52423 10 ,
1111730-5412310 ,
0011910-5212310,
6101110-5212310 ,
0011320-5132310,
00 I 1640-5242310,
0011750-5192310,
0012000-5722310,
6101110-5542310,
0011330-5132310 ,
0011710 -5192310,
00 I 1760 -51923 10 ,
0012020-5192310 .
6101110-5692310,
00 I 1410 -51 323 10 ,
00 I 1720 -53423 10,
0011770-5192310 ,
0011200 -5 122310,
0011610 -5242310,
0011730 -5412310,
0011790-5 192310 ,
NOW THEREFORE BE IT RESOLVED BY THE MAYOR AND CITY
COMMISSION OF THE CITY OF SOUTH MIAMI, FLORIDA THAT;
Section I . The City Manag e r is hereby authorized to purchase group he alth in s urance benefits from
Blue Cross Blue Shield and dental and vi sion insurance benefits from MetLife for the City of South Miami
full time employees and participating retirees for th e 2016 fiscal year in conformity with the quotes
o btained and to be charged to th e accounts listed in the re citals to thi s res olution .
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Section 2. This resolution shall take effect immediately upon adoption .
PASSED AND ADOPTED this _ day of ____ , 2015.
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
Group Name: City of South Miami
S '" p ,.,. Z 1-"': I K Effective Date' October 1 2015 , ..
" , Ii
I"',·",·· $25 co.PAY "SC<>PAY $10 ""PAY DEO.,,,,,
15 po<1"", $<5 co.PAY 13SC<>PAY , .. ""PAY OED 0 50%
I~~'~ ~.C.~'" :~'::~ COVERED 100% COVERED 100% COVERED 100% 50%
(NO MAX) (NO MAX) (NO MAX) (NO MAX)
COVERED '00% COVERED '00% COVI'RED '00% OED"'"
Room -Waived if $100 CO-PAY $100 (o'PAY $200 (o'PAY
IAdm""
lu""., c.~ $<5 co.PAY "SC<>PAY 'ISO arPAY DEDO 51)%
.. C".""". COVERED '00% (OVERED '00% DEDOSO"
15Q
"
T.eting / MRJ , CAT $80 (O.PAY $80 CO-PAY $200 CO-PAY OED 8< 50%
,
$200 CO-PAY $100 (O.PAY $200 CO-PAY DEC 8< 50%
Ipro"'" "N'~ Am"""",
I'''"..,
$25/$45 ((}PAY $15/$35 (o'PAY $20/$45 ((}PAY CEO 8< 50%
Ho,pltal $275 CO-PAY $I SO((}PAY $300 I $600 ((}PAY OED &. 50·.\1
Iin patient Ho.pltai $325 CO-PAY PER DAY, $200 (O.PAY PER DAY,S DAY MAX POO/SII))JCo-PAY OED &.50% 5 DAY MAX
Ip ro,"" "N'~ "oop",,' COVERED '00% ISOco."Y
COVERED 100% COVERED 100% OED THEN 100% DEC 8< 50%
60 VISITS 60 VISITS 20 VI SIT S 20 VI SITS
$45 CO-PAY US (o'PAY $45 CO-PAY OED&. SO%
30 VISITS 30 VISITS 35 VISITS 35 VISITS , ISOO,"OOO liD" \25011'SO ~
I e Included In Out of YES ,I" "5
9~' 9'" '00% I 50%
IM .. 'm,m D".IPock,' "5001$7000 ,25001$7500 "OOO'I6IJOO I
"',d,'u I, (1)-111 .. RX (l)-PAY, (1)-111,. RX I, co. "" RX
"01"01$50 "01$301$50 I 50%
ILIf."m. M .. 'm,m UIIUMmD UllLlMITED UIILlMITEO
I·romlom,ro.kd.w, C"ro.' "",w.' _.,.,,,'" fl •• , C,~., ',.,w.' -.,.".,,,, fI .. , C",,", , .. , .. , -.,.""., , fI .. ,
IEmp.,re 160 1S43,98 ,686.96 6654.37 66"·10 '610.32 l IS IS"" "'6.10 ,701.18 ,67 •. 21 6653.98 66".31 "".52 6806.35 6775.30 1'5 2.08 , 61,290.68 61,63 •. 96 61,557.39 ",.",,9 61,052.57 I ' 61,382." 61,751 .91 61,668.79 61,"'.61 61,556." ~ --;;:o;:;:n --..:= ~ ... '" 5 61,000.9) 61,2".00 61,21>1.03 6I,1S7.72 61. 2.59 I 6 61,"",." 61,35'-'2 61,290.16 61,2.,." 61,10). 61,156.09 61,557.59 61, • .",0 61,.".63 , . ., . .,
; , 61,697.2) ,2,1"-"'1>1 '.62 61,96).10 61,91>1.21 I ' 61,"2.08 $1,296.62 $2,187 ." $2,10).52 !2,O<I." ~ !2:641.iJ ~ -,,;;i9.06 <i: "'-"
I"""'""'~ I" Co",", I 'oc,~~ ".,,% I ,oc~ 1S.67% I" (,,"., I ,oc~~ 10."" I ,oc~ 16.08% I,oc,~~ 12.60% (,"~, I ,oc,_. ".30% , "9.7~A
IM,,'hI, Too., I "0,,,"," "',315,0: ''',88'.'' ,07,001.19 ''',m .'' ,23,'''.'' ""m, "',2"," ''',m,,, I ,~" •. " $3,961,70 --..;m:7s $3,"'.60 ~
"Thl. , ... ,"" .. ,., , ,,'hi. , .. ",.coe "m' b,
12:30 PM Information provided by Sapoznik In surance is proprietary. It may not be copied, emulated or distributed without exp ress permi ssion. 8/14/2015
Group Name: City of South Miami
Effective Date: October 1, 2015
UHC 00037 800 Humana HS210 Lincoln LDC S700
Deductible
Co-Insurance
Dentist
Specialist
Cleanings
Preventive
Network
Non Network
Basic Coverage
Network
Non Network
Major Coverage
Orthodontic
Coverage
Orthodontic
Annual Maximum
Dependent Child/Student
A e
Premium Breakdown
Employee 7
Employee/ Spouse 6
Employee / Child(ren) 8
Employee/Family 5
Comments 26
Monthly Total
NONE
100%
$5 CO-PAY
CO-PAY APPLIES
1 EVERY 6 MONTHS
MOST PROCEDURES
COVERED 100%
SOME PROCEDURES
SOME PROCEDURES
COVERED 100%
MOST PROCEDURES
CO-PAY APPLIES
CO-PAY APPLIES
1 YEAR
NONE
UPTO AGE 26
Current Renewal
$11.86 $12 .57
$20.75 $22.00
$24.90 $26.39
$34.99 $37.09
Current Increase 6%
$581.67 $616.56
NONE
100%
$5 CO-PAY
25% REDUCTION
1 EVERY 6 MONTHS
MOST PROCEDURES
COVERED 100%
SOME PROCEDURES
SOME PROCEDURES
COVERED 100%
MOST PROCEDURES
CO-PAY APPLIES
25% REDUCTION
1 YEAR
NONE
UP TO AGE 26
$10.90
$19.10
$23.41
$30.00
Decrease 9.20%
$528.18
NONE NONE
100% 100%
$10 CO-PAY COVERED 100%
CO -PAY APPLIES CO-PAY APPLIES
1 EVERY 6 MONTHS 1 EVERY 6 MONTHS
MOST PROCEDURES MOST PROCEDURES
COVERED 100% COVERED 100%
SOME PROCEDURES SOME PROCEDURES
SOME PROCEDURES SOME PROCEDURES
COVERED 100% COVERED 100%
MOST PROCEDU RES MOST PROCEDURES
CO-PAY APPLIES CO-PAY APPLIES
CO-PAY APPLIES CO-PAY APPLIES
1 YEAR 1 YEAR
NONE NONE
UPTO AGE 26 UP TO AGE 26
$11.96 $15.56
$23.91 $27.07
$26.90 $33.30
$43 .28 $42.63
Increase 13.34% Increase 29.09%
$658.78 $750.89
**This data is provided for information purposes only. It is not intended to represent a binding obligation. The governing document for this
ur w I r i r**
llflltil"ltMtion provided by Sapoznik Insurance is proprietary . It may not be copied, emulated or distributed without express per6l1!lll1lfl15
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
Group Name: City of South Miami
Effective Date: October 1, 2015
DPPO
IN/OUT : $50/$150
IN/OUT : 100%/80%/50%
IN/OUT: DED & CO-INS
IN/OUT: DED & CO-INS
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 LIFETIME MAX
1 YEAR
IN : $5000
OUT: $2500
UP TO AGE 26
OON-FEE
Current Renewal Negotiated
23 $37.42 $43.03 $42.10
5 $78.12 $89.84 $87.89
4 $88.03 $101.23 $99.04
3 $138.11 $158.83 $155.38
35 Current Increase 15 % Increase 12 .51%
$2,017.71 $2,320.30 $2,270.05
.. ' --:I 1~1 r.r. i1
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%
IN/OUT: DED & CO-INS IN/OUT : DED & CO-INS IN/OUT: DED & CO-INS
IN/OUT: DED & CO-INS IN/OUT: DED & CO-INS IN/OUT: DED & CO-INS
1 EVERY 6 MONTHS 1 EVERY 6 MONTHS 1 EVERY 6 MONTHS
IN/OUT : DED WAIVED, IN/OUT: DED WAIVED, IN/OUT : DED WAIVED,
COVERED 100% COVERED 100% COVERED 100%
IN/OUT: DED & 80% IN/OUT: DED & 80% IN/OUT: DED & 80%
IN/OUT: DED & 50% IN/OUT: DED & 50% IN/OUT: DED & 50%
BASIC BASIC BASIC Oral Surg ery: Major
50% CO-INS 50% CO-INS 50% CO-INS
CHILD(REN) TO 19 CHILD(REN) TO 19 CHILD(REN) TO 19
$1000 LIFETIME MAX $1000 LIFETIME MAX $1000 LIFETIME MAX
1 YEAR 1 YEAR 1 YEAR
$2,000 UNLIMITED IN: $5000
OUT: $2500
UP TO AGE 26 UP TO AGE 26 UP TO AGE 26
OON-FEE OON -FEE OON-FEE
$29.53 $33.33 $37.42
$61.65 $69.57 $78.12
$69.47 $78.40 $88.03
$108.99 $123.00 $138.11
De crease 21.08% Decrease 10.94% No Increase
$1,592.29 $1,797.04 $2,017.71
•• This data Is provided for information purposes only . It is not intended to represent a binding obligation. The governing document for this purpose
would be the COC issued by the carrier··
lIfllliTl\Mtion provided by Sapoznik Insurance is proprietary. It may not be copied, emulated or distributed without express per8ilStllW1.5
S ,PC)z ............
Exam
...•• ~ .....
Allowances
I Eye Exam
Lenses
Contacts-Necessary
ICL _II, Blind)
I~"'"'vy"
, Spouse
, Children
~m~
Total Monthly
Group Name: City of South Miami
Effective Date: October 1, 2015
**$10 CO·PAY
(EVERY 12 MONTHS)
**$10 CO·PAY
Lenses: 12 MONTHS)
Frames: (EVER' . 24
NETWORK NON·NETWORK
DOCTOR DOCTOR
PAID IN FULL UP TO $4S
AFTER CO·PAY REIMBURSEMENT
UP TO $30 SINGLE
PAID IN FULL $50 BIFOCAL
AFTER CO·PAY $65 TRIFOCAL
$100 LENTICULAR
PAID IN FULL UP TO $210
AFTER CO'PAY REIMBURSEMENT
UPTO $130 UPTO $10S
ALLOWANCE REIMBURSEMENT
UP TO $130 UP TO $70 ALLOWANCE + 20% REIMBURSEMENT OFF BALANCE
Current
50 $6.60
5 $13.22
10 $11.19
5 $18.46
70 Next Renewal: 10/1/2017
$600.30
,
,
... ,-.-'
,
**$10 CO·PAY
(EVERY 12 MONTHS)
**$25 CO·PAY
Lenses: 12 MONTHS)
Frames: (EVET Y 24
NETWORK NON-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 UP TO $105
ALLOWANCE REIMBURSEMENT
UP TO $100 UP TO $45 ALLOWANCE+ 30% REIMBURSEMENT OFF BALANCE
SO/50 ' Saving
$5 PEPM
$4.99
$9.99
$8.46
$13.96
Decrease 24.40%
$453.85
" a'i 11i~~ ~'H~~f\~~
**$10 CO·PAY **$10 CO·PAY **$10 CO'PAY
(EVERY 12 MONTHS) (EVERY 12 MONTHS) (EVERY 12 MONTHS)
**$15 CO·PAY **$2S CO·PAY **$10 CO'PAY
Lenses: 12 MONTHS) Lenses: 12 MONTHS) Lenses: (EVERY 12 MONTHS)
Frames: (EVERY 24 Frames: (EVH . 24 Frames: (EVERY 24
NETWORK NON-NETWORK NETWORK NON-NETWORK NON-NETWORK
DOCTOR DOCTOR NETWORK DOCTOR DOCTOR DOCTOR DOCTOR REIMBURSEMENT REIMBURSEMENT
PAID IN FULL UP TO $35 PAID IN FULL UPTO $40 PAID IN FULL UP TO $40
AFTER CO·PAY ALLOWANCE AFTER CO·PAY REIMBURSEMENT AFTER CO'PAY REIMBURSEMENT
UP TO $25 SINGLE UP TO $40 SINGLE UP TO $40 SINGLE
PAID IN FULL PAID IN FULL $60 BIFOCAL PAID IN FULL $60 BIFOCAL
AFTER CO·PAY $40 BIFOCAL AFTER CO· PAY $80 TRIFOCAL AFTER CO·PAY $80 TRIFOCAL $60 TRIFOCAL $80 LENTICULAR $80 LENTICULAR
PAID IN FULL UPTO $210 PAID IN FULL UPTO $210 PAID IN FULL UP TO $210
AFTER CO·PAY ALLOWANCE AFTER CO'PAY REIMBURSEMENT AFTER CO·PAY REIMBURSEMENT
UP TO $150 ALLOWANCE UP TO $125 UP TO $125 UP TO $130 ., , UP TO $130
ALLOWANCE REIMBURSEMENT REIMBURSEMENT
UP TO $50 UP TO $45 UP TO $130 UPTO $45 UP TO $130 UP TO $45 ALLOWANCE ALLOWANCE ALLOWANCE + 30% REIMBURSEMENT ALLOWANCE+ 30% OFF REIMBURSEMENT WHOLESALE RETAIL OFF BALANCE BALANCE
Voluntary Voluntary Voluntary
$6.49 $6.38 $7.14
$12.99 $12.09 $14.30
$11.00 $14.18 $12.10
$18.14 . $19:95 $19.96
Decrease 1.69% Increase 3.45% Increase 8.16%
$590.15 $621.00 $649.30
**This data is provided for information purposes only. It is not intended to represent a binding obligation. The governing document for this purpose would be the eoe issued by the carrier**
11:20AM Information provided by Sapoznik Insurance is proprietary. It may not be copied, emulated or distributed without express permission. 8/24/2015
Group Name: City of South Miami
s-" p <:> Z " I.... Effective Date: October 1, 2015
~LIFE
Class 1: 1x Annual ~ I Life Amount Maximum Weekly
Class 2: 2x Annual Benefit Amount
Class 1: All other Employees Period Class Definition I~'"
Class 2: City Managers Accident
Benefits Class 1: $75,000 Elimination Period
Class 2: $320,000 Sickness
35% AT AGE 65 u,
15% AT AGE 70 IU~"~'" Period
Guu" Class 1: $75,000
Issue Amount Class 2: $320,000 Rate Guarantee
Rate Guarantee Next Renewal 10/1/2017 IPremium Breakdown
Breakdown Current Renewal Rate Per $10 of Benefit
Life $0.160 $0.190
.ft~ $0,020 $0,020 Volume
Monthly
Prpmium
Volume $5,968,500 $5,968,500
Monthly $1,074.33 $1,253.39
Approx.
STD ~ LTD
60% TO $1000 Benefit Amount 40% TO $6000 60% TO $6000
7 DAYS Issue Amount $6,000 $6,000
7 DAYS Benefit Period LATER OF AGE 65 OR SSNRA LATER OF AGE 65 OR SSNRA
13 WEEKS Elimination Period 90 DAYS 90 DAYS
Next Renewal 10/1/2017 Own 24 MONTHS 24 MONTHS
Current I Renewal Pre-Existing 3/12 3/12 Period
Age Banded Rate Guarantee Next Renewal 10/1/2017 Next Renewal 10/1/2017
No Increase Premium Current I Renewal Current I Renewal Breakdown
$12,016.00 Rate Per $100 of $0,24 Age Banded I Income
$456.97 No Increase No Increase
\lftl, $201,406,00 $38,853.00
$3,308.86 Monthly $1,208.52 $569.04
$3,487.92
**This data is provided for information purposes only. It is not intended to represent a binding obligation. The governing document for this purpose would be the COC issued by the carrier**
Information provided by Sapoznik Insurance is proprietary,
11:20AM It may not be copied, emulated or distributed without express permission. 8/24/2015