Res No 170-17-14971RESOLUTION NO. 170-17-14971
A Resolution authorizing the City Manager to purchase dental and vision insurance
benefits from Humana for full time employees and participating retirees.
WHEREAS, the City, through its Agent of Record, Brown & Brown of Florida secured more than three
competitive quotes for the City's Group Dental and Vision Insurance and recommended Humana as the selected
dental and vision Insurance provider.
WHEREAS, the City, through its Agent of Record, Brown & Brown of Florida compared the insurance
rates, dental and vision 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 Humana for the provision of dental
and vision insurance benefits for all full time employees and participating retirees.
WHEREAS, the premium shall be charged to departmental line items in their respective account
numbers.
NOW THEREFORE BE IT RESOLVED BY THE MAYOR AND CITY COMMISSION OF
THE CITY OF SOUTH MIAMI, FLORIDA THAT:
Section I. The City Commission hereby authorizes the City Manager to execute the dental and vision
insurance renewal policy with Humana for full time employees and retirees for the 2017-2018 Fiscal Year.
Section 2. This resolution shall take effect immediately upon adoption.
PASSED AND ADOPTED this15th day of August, 2017.
ATTEST:
~te4U£v
ITY ERK I
APf'ROVED~
ill-
COMMISSION VOTE: 5 -0
Mayor Stoddard: Yea
Vice Mayor Welsh: Yea
Commissioner Harris: Yea
Commissioner Liebman: Yea
Commissioner Edmond Yea
THE CITY OF PLEASANT LIVING
TO:
FROM:
DATE:
CITY OF SOUTH MIAMI
OFFICE OF THE CITY MANAGER
INTER-OFFICE MEMORANDUM
The Honorable Mayor & Members of the City Commission
August 15, 2017 Agenda Item No.:ll
Steven Alexander, City Manager
SUBJECT: A Resolution authorizing the City Manager to purchase dental and vision
insurance benefits from Humana for full. time employees and participating
retirees.
Background: Typically, healthcare costs are expected to increase 10-15% each year
and based on that industry forecast the city budgeted for an increase of
15% to allow for proper assumptions in this regard. The City's benefits
agent on record, Brown & Brown of Florida, Inc. per Resolution #137-16-
14692, solicited quotes for the employee's dental and vision insurance
coverages for South Miami full time employees for the Plan Year 2017-
2018. Humana, the City's current dental and vision insurance carrier,
renewal rate represented 0% increase from last year. The City currently
contributes $8.49 per eligible employee, per month, toward dental
insurance coverage and the vision is voluntary paid by employee. The
renewal is appropriately funded in the proposed Budget for Fiscal Year
2017-2018.
Recommendation: Based upon the proposals received, staff recommends the City renew
with the current Humana carrier for dental and vision insurances.
Amount: The estimated total annual premium cost for dental benefits paid by the
City is about $10,000 based on today's personnel.
Account: Premium charges for the dental insurances will be charged to the
designated departmental budget line items as proposed in the Fiscal Year
2017-2018.
Attachments: Proposed resolution and 2017-2018 comparison.
October 2017 Dental Comparison for City of South Miami
C~rner ----Humana . !-iumana
Plan DM0205 PPO
Provider Acess In-Network Out of Network
Benefrt Description
Preventive (Class I) NA 100% 100%
Basic (Class II) NA 8oolo 80"J!,
Major (Class III) NA 50% 50%
Maximum Annual Benefit NA Unlimited Unlimited
Deductible (lndividuallFamily) NA $501$150 $50/$150
Deductible Waived -Class I NA Yes Yes
OrthodonHa (coveragenltetime max) $2.650 Child & Adult $1.000 Child Only $1,000 Chnd Only
Reimbursement Schedule" Fee Schedule MAC
Benefits
Routine Exams -9430 No Charge 100% 100%
Teeth Cleaning -1110 No Charge 100% 100%
Fun MouthlPanoramic X-rays -0330 No Charge 100% 100%
Simple Extractions -7111 No Charge 80% 80%
Root Canal (Endodontics) -3330 $250 80% 80%
. odonUcs ScafJllgiRoot Planning -4341 $55 per quad 80% 80%
Full or Partial Dentures -5110 $375 50% 50%
Crowns -6752 $270 50% 50%
Specially Services performed by an
participating specialist-not a general Contracted I:>iscount NlA N/A
dentist
Employer Conlribution Contributory Contributory
Minimum Participation Requirement Combined 50%
Waiting PeriOd Major Services" None None
Rate Guarantee Umil 9130120 17 Until 913012017
R2tes Current Current
Employee 53 $8.49 21 $31.10
Employee + Spouse $16.98 $64.92
Employee + Child(ren) 7 $19.11 $73.16
Family 4 $30.74 $114.78
Monthly Premium By Product $825,56 $1,836,00
Total Monthly Premium $2,661.56
Total Annual Premium $31,938.72
% Change In Monthtv Premium by Plan
$ Change in Monthly Premium by Plan
$ Change in Total Mon1h1y Premium
% Change In Total Annual Premium
$ Change In Total Annual Premium
63
Humana Humana
DM0205 PPO
NA
NA
NA
NA
NA
NA
$2,650 Child & Adult
No Charge
No Charge
No Charge
No Charge
$250
$55 per quad
$375
$270
Contracted Discounl
Contribulory
None
12 Monlhs
Renewal
$8:49
$16.98
$19.11
$30.74
$825.56
0.0%
$0.00
I
I
In-Network Out of Network
100% 100%
80% 80%
50% 50%
Unlimited Unlimited
$501$150 $501$150
Yes Yes
$1,000 Child Onty $1,000 Child Only
Fee Schedule MAC
100% ... ~" 100%
100% 100%
100% 100%
80% 80%
,'-
80% 80%
80% 80%
"50% 50%
50% 50%
N/A N/A
Contributory
Combined 50%
None
12 Months
Renewal
21 $31.69
8 $66.15
3 $74.55
5 $116.96
$1,870.84
$2,696.40
$32,356.80
1;9%
$34.84
$34.84
1.3%
$418.08
Rates shown are based on census data provided. Final rates are subject tD underwriting and actual ,enr·o/lmeni ThIs oDmparisonis for
illustrative pUrpDSescmly. The ftrIJportey and certifrcate of ci!verage will supersede any and all materials provided herein. Page 1 of8
\1
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-,<' .,."., """;;"'","'··r,;~7:··""'·~;'!'~"""""·""(".,:':",:,':r:n'S'7, ;'.'.' .. ':"" ". .... . . . .' .
October 2017 Dental Compariso~for C'lty of South Miami
Carner Humana Humana MetLife MetLlfe
Plan DM0205 PPO DHMOSGX290 PPO
Provider Acess In·Network Out of Network In·Network Out of Network
Benefit Description
Preventive (Class I) NA 100% 100% NA 100% 100%
Basic (Class II) NA 80% 80% NA 80% 80%
Major (Class III) NA 50% 50% NA 50% 50%
Maximum Annual Benefit NA Unlimited UnlimHed NA $3,000 $3,000
Deductible (IndividuaUFamDy) NA $50/$150 $501$150 NA $50/$150 $50/$150
Deductible Waived· Class I NA Yes Yes NA Yes Yes
Orthodontia (coveragelllfetime max) $2,650 Child & Adult $1,000 Child Only $1,000 Child Only $2,680 Child & AduH Not Covered Not Covered
Reimbursement Schedule" Fee SchedLie MAC Fee Schedule 90th Percenhle
Benefits
Routine Exams -9430 No Charge 100% 100% No Charge 100% .. -:.' 100%
T eelh Cleaning -1110 No Charge 100% 100% $5 100°,!, 100%
Full MoulhlPanoramic X-rays • 0330 No Charge 1000k 100% No Charge 80% 80% .
Simple Ex1ractlons· 7111 No Charge 80% 80% $5 80% 80%
Root Canal (Endodontics) • 3330 $250 80% 80% $265 80%
, .... !
80%
riodonlics ScafingiRoot Planning· 4341 $55 per quad 80% 80% $50 per quad 80% 80%
Fun or Partial Dentures· 5110 $375 50% 50% $440 50'10 50%
Crowns -6752 $270 50% 50% $290 50% 50%
Specially Services performed by an
participating specialist-not a general Conlraded Discount NlA N/A ConlraCled Rates N/A N/A
dentist
Employer Contribution Contributory Contributory Contributory Contributory
Minimum Participation Requirement Combined 50% 95% Combined (Min. 5 in OHMO. Min. 10 in OPPO)
Waiting Period Major Services" Noae None
Rate Guarantee Until 9130/2017 Until !;!130/2017
Rates Current Current
Employee 53 $8.49 21 $31.10 53
Employee + Spouse $16.98 $64.92
Employee + Child(ren) $19.11 $73.16
Family $30.74 $114.78
Monthly Premium By Product $825.56 $1,836,00
Total Monthly Premium $2,661.56 $3,515,38
Total Annual Premium $31,938.72 $42,184.56
% Change in Monthly Premium by Plan
$ Change In Monthly Premium by Plan
$ Change in Total Monthly Premium
18.1% 38.4%
$149.64 $704.18
$853.82
% Change In Total Annual Premium
$ Change in Total Annual Premium
32.1%
$10,245.84
Rates sh:OY/n, ar.e based 00 census· data provided. Final rates are subject ·to underwrlting an<l actual elll'Dllmem. 1iI1:iS .cDmparisDns for
U1ustrativepurposes on.ly. The fun policy and certificate of coverage will $upersede any and all materials provided 'nerein.
.:27 ........ :gg;;:;:.
Page4of8
October 2017 Dental Comparison for City of South Miami
Carner
Plan
provider Acess
Benefit Description
PreventiVe (Class I)
Basic (Class II)
Major (Class III)
Maximum Annual Benefrt
Deductible (IndlviduallFamlly)
Deductible Waived -Class I
Orthodontia (coverageilifetime max)
Reimbursement Schedule"
Benefits
Routine Exams -9430
Teeth Cleaning -1110
Full MouIhiPanoramlc X-rays -0330
Simple Extractions -7111
Root Canal (Endodontics) -3330
riodontics ScalinglRoot Planning -4341
Full or Partial DenlIJlBS -5110
Crowns -6752
SpeCialty Services performed by an
participating speCialist-not a general
dentist
Employer Contribution
Minimum PartiCipation Requirement
Waiting Period MajOr services·
Rate Guarantee
Rates
Employee 53
EmplOyee ... Spouse
Employee'" Child(ren)
Family
Monthly Premium By Product
Total Monthly Premium
Total Annual Premium
% Change in Monthly Premium by Plan
$ Change In Monthly Premium by Plan
$ Change in Total Monthly.Premium
% Change In Total Annual Premium
$ Change in Total Annual Premium .
Humana Hurnana
DM0205 PPO
In-Nalwork Out of Nelwork
NA 100% 100%
NA 80% 80%
NA 50% 50%
NA Unlimited Unlimited
NA $501$150 $501$150
NA Yes Yes
$2,650 Child & Adult $1,000 Chnd Only $1,000 Child Only
Fee Schedule MAC
No Charge 100% 100%
No Charge 100% 100%
No Charg~ 100% 100%
No Charge 80% 80%
$250 80% 80%
$55 per quad 80% 80%
$375 50'% 50%
$270 50% 50%
Contracted Discount N/A N/A
Contributory Contributory
Combined 50%
None None
Unli1913012017 Until 913012017
Curront Current
$8.49
$16.98
$19.11
$30.74
$825.56
21
$2,661.56
$31,938.72
$31.10
$64.92
$73.16
$114.78
$1,836.00
53
PrinCipal (Solstice) Principal
DMO S800B-SHP PPO
In-Nelwork Out Of Networl<
NA 100% 100%
NA 80% 80%
NA 50% 50%
NA $3,000 $3,000
NA $50/$150 $501$150
NA Yes Yes
$3.360 Child 1 $3,460 Adult $1,000 Child Only $1,000 Child Only
Fee Schedule MAC
.:~:.
$5 100% 100%
No Charge 100% 100%
$50 100% .,.. 100%
'" $65 80% 80%
$350 80% 800k
$80 per quad ; 800la 800la
$502 50% 500/.
$290 50% 50%
Contracted Rates NIA NIA
Conbibutory Conbibutory
75% Combined (Min. 2 In DHMO, Min. 20% in DPPOl
None
12 Months
$10.62
$18.59
$23.01
$29.21
$970.90
17.6%
$145.34
$2,841.40
$34,096.80
$179.84
6.8%
$2,158.08
None
$65.06
$74.99
$111.93
$1,870.50
1.9%
$34.50
Rates shown are based on census data provided. Final rates are subject to underwriting and actual enrollment. This comparison, is for
iIIlJ'.Srrative .PlrrpDSes onlY. The full poncy and certificate of coverage will supersede allY and allrnaterlais provided ·he~ein. Page5Of8
October 2017 Dental Comparison for City of South Miami
Carner Humana Humana UHC (Solstice) United Healthcare
Plan DM0205 PPO DMOD1058 PPO
Provider Acess In-Network Out of Network In-Network Out of Network
Benefrt Description
Preventive (Class I) NA 100% 100% NA 100% 100%
Basic (Class II) NA 80% 80% NA 80% 80%
Major (ClaSS III) NA 50% 50% NA 50% 50%
Maximum Annual Benefit NA Unlimited Unfimited NA $5,000 $5,000
Deductible (IndlviduaUFamlly) NA $501$150 $501$150 NA $501$150 $501$150
Deductible Waived -Class I NA Yes Yes NA Yes Yes
Orthodontia (coverageJJlfetime max) $2,650 Child & Adult $1,000 Child Only $1,000 Child Only $2,835 ChRd 1 $2,935 Adult $1,000 ChRd Only $1,000 Child Only
Reimbursement Schedule" Fee Schedule MAC Fee Schedule MAC
Benefits
~.:::
Routine Exams -9430 No Charge 100% 100% No Charge 100% 100%
Tee1h Cleaning -1110 No Charye 10oo'!' 10oo/. No Charge 100% 100%
Full MoutillPanoram/c X-rays -0330 No Charge 100% 1000k
Simple Extractions -7111 . No Charye 80% 80%
$50 1000k .' 100%
"t.~
$50 80% 80%
Root Canal (Endodontics) -3330 $250 80% 80% $245 80% 80%
riodontics SealinglRoot Planning -4341 $55 per quad 80% 80% $50 per quad .80% 80%
Full or Partial Dentures -5110 $375 50% 50% $325 50% 50%
Crowns -6752 $270 50% 50% $245 50% 50%
Specially Services performed by an
participating speciaBst-not a general Contracted Discount N/A N/A Conlracted Rates N/A N/A
dentist
Employer Contriblllion Conlnbulory Contributory Conbibulory Contributory
Minimum Participation Requirement Combined 50% 75% Combined
Waiting Period Major Services· None None None None
RaUl Guarantee Until 9130/2017 Until 9130/2017
Rates Current Curr~nt
Efl1lloyee 53 $8.49 21 $31.10 53 $12.61
Employee + Spouse $16.98 $64.92
Employee + Chi/d(ren) $19.11 $73.16 $27.31
Family
Monthly Premium By Product
$30.74 $114.78
$825.56 $1,836.00 ,743.87
Total Monthly Premium $2,661.56 $2,896.47
Total Annual premium $31,938.72 $34,757.64
% Change in Monthly Premium by Plan
$ Change in Monthly Premium by Plan
$ Change In Total Monthly Premium
39.6% -5.0%
$327.04 ·$92.13
$234.91
% Change in Total Annual Premium
$ Change in Total Annual Premium
8.8%
$2,818.92
Rates sttown are based on: census data pmvidled. Final rates are sUibJect to underwriting ani:l actual 'enrollment, Thiisco<mparisOnis for
i11lJ'Strative PUrpDSeSOn-Iy. The fuJI pofiey and certificate of coverage will supersede allY '8.ndall materials pr-ovidedherein. Page8of8
1 __ 1
October 2017 Dental Comparison for City of South Miami
Carner Humana Humana The Standard Tho Standard
Plan DM0205 PPO"''l!'' PPO PPO
Provider Acess In-NetWork Out of Network In-Nelwork Out of Nelwork In-Network Out of Network
Benef"rt Description
Preventive (Class I) NA 100% 100% 100% 100% 100% 100%
Basic (Class II) NA 80% 80% 50% 50% 80% 80%
Major (Ctass III) NA 50% 50% 25% 25% 50% 50%
Maximum Annual Benefit -NA Unlimited Unlimited $750 $750 $3.000 $3.000
Deductible (lndlviduallFamily) NA $50/$150 $50/$150 $15 pervis~ $15 per visit $501$150 $501$150
Deductible Waived -Class I NA Yes Yes No No Yes Yes
Orthodontia (coveragenifetime max) $2,650 Child & Adult $1 ,000 Child Only $1,000 Child Only Not Covered Not Covered $1,000 Child Only $1.000 Child Only
Reimbursement Schedule" Fee Schedule MAC Fee Schedule MAC Fee Schedule MAC
-Benefits
Routine Exams -9430 No Charge 100% 100% 100% 100% 100% 100%
Teeth Cleaning -1110 No Charge 100% 100% 100% 100% 100% 100%
Full MouthlPanoramlc X-rays -0330 No Charge 100% 100% 100% 100",(, '~% 100%
Simple ExtraClions -7111 No Charge 80% 80% 50% 50010 80",(, 80"10
Root Canal (Endodontics) -3330 $250 80% 80% 25% 25% 80% 80%
riodontics ScaiinglRoot Planning -4341 $55 per quad 80% 80% 25% 25% 80DAo 80%
Full or Partial Dentures -5110 $375 50% 50% 25% 25% 50% 50%
Crowns -6752 $270 50% 50% 25% 25% 50% 50%
Specialty Services performed by an
participating speciallst-not a general Contracted Discount N/A N/A N/A N/A NlA N/A
dentist
Employer Contribution Contributory Contnbutory Contributory Contributory
Minimum Participation Requirement Combined 50% 100% Combined
Wailing Period Major Services" None None None None
Rate Guarantee Until 913012017 Until 9130/2017 12 Months
Rates Current Current
Employee 53 $8.49 21 $31.10 53 $13.66
Employee + Spouse
Employee + Child(ren)
Family
Monthly Premium By Product
Total Monthly Premium
Total Annual Premium
$16.98 $64.92
$19.11 $73.16
$30.74 $114.78
$825.56 $1,836.00
$2,661.56
$31,938.72
$28.74
$33.12 $69.50
$48.19 $109.04
,349.76 $1;744.27
$3,094.03
$37,128.36
% Change in Monthly Premium by Plan
$ Change In Monthly Premium by Plan
$ Change In Total Monthly Premium
% Change In Total Annual Premium
$ Change in Total Annual Premium
63.5% -5.0%
$524.20 -$91.73
$432.47
16.2%
$5,189.64
Rates shown are based on census data provided. Final rates Me slJ1bject tOlJ1lderwriting and actual enrollment. Thisoomparison is for
Hlustrative purpases on.Jy. The full policy and certificate of coverage will supersede any and all marerialsprovided herein.
\. .. ..: ___ " _I
Page60f8
October 2017 Vision Comparison for City of South Miami
Carrier
Network Provider
Network Status
Eye Care Wellness
Eye Exam
Frequency
Lenses
Single Vision
Bifocals
Trifocal
Frequency
Frames
Selected Frames
Frequency
Contacts
Medically Necessary
Elective Contacts
Contribution Type
Participation Requirements
Rate Guarantee
Rates
Employee
Employee + Spouse
Employee + Child
Family
Monthly Total
Annual Total
% Change in Total Annual Premiu
$ Change in Monthly Premium by
$ Change In Total Annual Premiu
Humana
. EyeMed
In-Network I OON
$0 Copay 1 up to $30
Every 12 Months
Reimbursement
$OCopay up to $25
$OCopay up to $40
$.0 Capay up to $60
Every 12 Months
Reimbursement
$200 allowance + 20% up to $100 discount over
Every 24 Months
Reimbursement
Covered 100% up to $210
$200 allowance + 15% up to $160 discount over
Voluntary
50%
Until 9/3012018
Current
The Standard
VSP
'In-Network I OON
$0 Capay 1 up to $45
Every 12 Months
Reimbursement
$0 Capay up to $30
$0 Copay up to $50
$0 Capay up to $65
Every 12 Months
$180 allowance + 20%
discount over
100%
$180 allowance
Voluntary
75%
24 Months
Reimbursement
up to $70
Reimbursement
up to $210
up to $145
60$8.14 60
10 $13.70 10
10 $13.97 10
6 $22.11 6 r-------------~~~----------~ r-------------~$8~9=7.~76~----------~
$10,773.12
Sun Life
In-Network I OON
$10 Copay I up to $52
Every 12 Months
Reimbursement
$10 Copay up to $55
$10 Copay up to $75
$10 Capay up to $95
Every 12 Months
Reimbursement
.~~:.
$130 allowance + 20% up to $57 discount over
'\---:
Every 24 Months
Reimbursement
100% up to $210
$130 allowance up to $105
Voluntary
76%
12 Months
$5.75
$11.49
$12.31
$18.55
$694.30
$8,331.60
Rates ShDWIl-are based on. census data provided. Fin,al rates are subject tD umJerwritin,g .and actual ennl'lIment. This .cDmparistJ<llis for
illustrative PUrpDSes only. The fuJI policy an.d certificateD! CD'o'erage will Sl1persede any an.d all materials prwided·herein. Page 50f8
.~----~--~----
October 2017 Vision Comparison for City of South Miami
Carner Humana
Network Provider EyeMed
Network Status In-Network L OON
Eye Care Wellness
Eye Exam
Frequency
$0 Capay 1 up to $30
Every 12 Months
Lenses Reimbursement
~ingle Vision $OCopay up to $25
Bifocals $0 Copay up to $40
Trifocal $0 Copay up to $60
Frequency Every 12 Months
Frames Reimbursement
Selected Frames $200 allowance + 20% up to $100 discount over
FrequencY Every 24 Months
Contacts Reimbursement
Medically Necessary Covered 100% up to $210
Elective Contacts $200 allowance + 15% up to $160 discount over
Contribution Type Voluntary
Participation Requirements 50%
Rate Guarantee UnUI913012018
Rates Current
Employee
Employee + Spouse
Employee + Child
I
VSP
In-Network I OON
$0 Capay I up to $45
Every 12 Months
Reimbursement
$0 Copay up to $30
$0 Copay up to $50
$0 Copay up to $65
Every 12 Months
$180 allowance + 20%
discount over
100%
$180 allowance
Voluntary
51 enr'Oned
48 Months
Reimbursement
up to $70
Reimbursement
up to $210
up to $105
60 $23.34
10 $37.34
10 $38.12
Family
Monthly Total
r-____________ :=~~----------~6~----------~~$~61~.4~6~----------~
$2,523.76
Annual Total $30,285.12
% Change in Total Annual Premiu 272.60%
$ Change in Monthly Premium by $1,846.42
$ Change in Total Annual Premiu $22,157.04
Rates allown, are based on census data provided. Final rates are sub]ecUo underwriting and actual enroDment. This cDmPsr.isol1: is for
illustrative purposes on.ly. The fun poliCy and certificate of coverage will supersede any and a~ materials provided l\erejn.
-_ ... --_._-------
. -. . -' '.~' .
. -. ~-.. ,_.-.•... ---.._.. .
PageSofS