10THE 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
Steven Alexander, City Manager
Agenda Item NO.JP
, .-August 15, 2017
SUBJECT: A Resolution authorizing the City Manager to purchase Group Insurance
benefits from Blue Cross Blue Shield 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 group insurance coverage for
South Miami full time employees, and participating retirees for the Plan
Year 2017-2018. After negotiations, the final renewal rate decreased by
1.87% less than last year's premium amount U$579.46 to $568.64". 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 the
health insurance plans with current Blue Cross Blue Shield plans.
Amount:
Account:
Attachments:
The proposed rates are based on the current number of enrollees and as
follows:
HMO High HMO POS
Employee $ 568.64 $ '608.82 $ 719.98
Employee + Spouse $1,353.39 $1,448.98 $1,782.11
Employee + $1,046.32 $1,120.23 $1,377.77
Children
Employee + Family $1,774.19 $1,899.51 $2,246.35
The estimated total annual premiums cost paid by the City for health
benefits are about $910,000 based on today's personnel.
Premium charges for the health will be charged to the designated
departmental budge line items as proposed in the Fiscal Year 2017-2018
budget.
Proposed resolution and 2017-2018 Benefits Renewal outline.
1 RESOLUTION NO.
2 A Resolution authorizing the City Manager to purchase group health insurance benefits
3 from Blue Cross Blue Shield for the City of South Miami full time employees and
4 participating retirees.
5 WHEREAS, the City, through its Agent of Record, Brown & Brown of Florida secured more than three
6 competitive quotes for the City's 'Group Health Insurance and recommended to continue with Blue Cross Blue
7 Shield as the selected health benefits provider.
8 WHEREAS, the City, through its Agent of Record, Brown & Brown of Florida compared the insurance
9 rates, benefits plan design, provider network as well as the City's previous claims experience/ratio; and
10 WHEREAS, the City Commission wishes to approve the selection of Blue Cross Blue Shield for the
11 provision of group health insurance benefits for all full time employees and participating retirees.
12 WHEREAS, the premium shall be charged to departmental line items in their respective account
13 numbers.
14 NOW THEREFORE BE IT RESOLVED BY THE MAYOR AND CITY COMMISSION OF
15 THE CITY OF SOUTH MIAMI, FLORIDA THAT:
16 Section I. The City Commission hereby authorizes the City Manager to execute the health insurance
17 renewal policy with Blue Cross Blue Shield for full time employees and retirees for the 2017-2018
18 Fiscal Year.
19 Section 2. This resolution shall take effect immediately .upon adoption.
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PASSED AND ADOPTED this __ day of ____ , 2017.
ATTEST:
CITY CLERK
READ AND APPROVED AS TO FORM,
LANGUAGE, LEGALITY AND
EXECUTION THEREOF:
CITY ATTORNEY
APPROVED:
MAYOR
COMMISSION VOTE:
Mayor Stoddard:
Vice Mayor Welsh:
Commissioner Harris:
Commissioner Liebman:
Commissioner Edmond
BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.
HEALTH OPTIONS, INC.
ACCOUNTING AND RETENTION AGREEMENT
(Proshare)
This is an Agreement (hereinafter "Agreement") between Blue Cross Blue Shield of Florida,
Inc. d/b/a Florida Blue and Health Options, Inc., (hereinafter jointly referred to as "Florida
Blue"), located at 4800 Deerwood Campus Parkway, Jacksonville, Florida 32246 and CITY
OF SOUTH MIAMI, (hereinafter "the Group") located at 6130 SUNSET DRIVE, MIAMI, FL
33143.
WHEREAS, the Group requests Florida Blue to provide a health maintenance organization
(hereinafter "HMO") and a Point-of-Service insurance program, (hereinafter jointly referred
to as GHP "the Group Health Plan") to its employees and their covered dependents
(hereinafter "Group Member(s); and;
WHEREAS, Health Options, Inc., has agreed to provide the HMO part of the GHP, and
Florida Blue has agreed to provide the insurance part of the GHP; and
WHEREAS, each of the parties to this Agreement seeks to set forth in writing the terms and
conditions of their Agreement.
NOW THEREFORE, for good and valuable consideration, the parties agree to these terms
and conditions:
I. TERM
The initial term of this Agreement shall begin on __ , (the effective date) and shall
end on _JII, (the termination date), unless otherwise terminated or renewed in
accordance with the provisions of this Agreement.
During the term of this Agreement, the Group agrees to: a) maintain enrollment that does
not decline to one hundred (100), or fewer contracts for two consecutive months or three
nonconsecutive months during a single contract period, and b) meet or exceed the
minimum participation guidelines set forth in the True Group Application. In the event the
Group is unable to maintain adequate enrollment, this Agreement may be terminated and
no settlement will be prepared and the Group will not be eligible for this funding
arrangement in the future.
II. BENEFIT PLAN
Florida Blue will pay benefits to all eligible Group Members in accordance with the
provisions of this Agreement and the GHP.
III. PREMIUM PAYMENTS
. The Premium Rates, Prepayment Fees, and Supplemental Charges for the GHP are
payable in advance to Florida Blue at the address set forth above. The premiums for the
program are set forth in Exhibit A.
IV. SETTLEMENT ACCOUNTING
Within one hundred twenty (120) days after the end of the initial term of the Agreement and
any renewal term,· Florida Blue shall prepare and furnish to the Group a Settlement
Accounting of their operations of that term. This Settlement Accounting shall include
operations under all coverages of the Agreement and shall set forth the following:
(a) Earned Premium ,
(b)lncurred Claims less claims in excess of the pooling point
(c) Capitation Charges, if applicable
(d) Pooling Charges (not included in administrative charges)
(e)Administrative Charges as set forth on Exhibit A
If Earned Premium is greater. than the sum of Incurred Claims less claims in excess of the
pooling point, Capitation Charges, Pooling Charges and Administrative Charges, a portion
of this excess will be returned to the Group as determined by the following:
(a)After completion of the 1st policy year-
(b)After completion of the 2nd policy year-
(c) After completion of the 3rd policy year-
of the excess
of the excess
of the excess
If the Group cancels prior to the completion and acceptance of the Settlement Accounting,
no excess premium will be returned for the prior policy year or the current policy year.
Excess premium for each policy will be determined solely from the results of that year.
Prior gains or deficits will not be carried forward to subsequent years.
If Earned Premium is less than the sum of Inc;urred Claims less claims in excess of the
pooling point, Capitation Charges, Pooling Charges and Administrative Charges, the deficit
will be retained by Florida Blue.
V. TERMINATION
This Agreement may be terminated at any anniversary of the effective date by either party
by giving the other party at least 45 days prior written notice of such termination.
VI. MODIFICATION OF RATES
2
Rates for the term of this Agreement will remain in effect, as set forth in Exhibit A, provided
there is no material change to the Benefit Contracts, the enrollment, or any other risk factor,
as determined by Florida Blue. Thereafter, all rates set forth in Exhibit A of this Agreement
are subject to change by Florida Blue at any time following at least forty-five (45) days prior
written notice to the Group. The revised rates, administrative charge and pooling charge
will be set forth and presented to the Group on a revised Exhibit A. All other provisions of
this Agreement shall remain in effect without modification.
VII. LATE PAYMENT/CHARGE
In the event the Group fails to make any payment due under this Agreement, in full, prior
to the applicable due date, such payment may be made to Florida Blue up to ten (10) days
after such due date without a late payment charge. Payments received by Florida Blue
eleven (11) to thirty-one (31) days after such due date are subject to a late payment charge .
. The Group shall pay any late payment charge to Florida Blue immediately upon receipt of
the notice of such charge.
In the event any charge under this Agreement is not paid, in full, by the Group to Florida
Blue within thirty-one (31) days after the applicable due date, this Agreement will
automatically terminate as of the applicable due date. In the event this Agreement
terminates retrospectively for any reason, the Group shall be liable, in addition to all other
liabilities set forth in this Agreement, for any claim(s) paid by Florida Blue which were
incurred after the termination date.
All payments due for changes during the Agreement period must be received by Florida
Blue in order for the Group to share in any excess.
VIII. RENEWAL
This Agreement shall automatically renew/extend for additional one-year period(s), after the
termination date, at the rates then in effect (the renewal rates), unless either party notifies
the other party of its intent not to extend this Agreement at least forty-five (45) days prior to
the applicable Anniversary Date .. The renewal rates will be set forth and presented to the
Group on a revised Exhibit A.
IX. INCONSISTENCIES
If the provisions of this Agreement are, in any way, inconsistent with the provisions of the
Benefit Contract(s), then the provisions of this Agreement shall prevail, and the other
provisions shall be deemed modified but only to the extent necessary to implement the
intent of the parties expressed herein.
X. SURVIVAL
3
The rights and obligations of the parties, as set forth herein, shall survive the termination of
this Agreement to the extent necessary to effectuate the intent of the' parties as expressed
herein.
XI. WAIVER OF BREACH
The failure by either party, at any time, to enforce or to require the strict adherence to any
provision of this Agreement shall not be deemed to be a waiver of such provision or any
other provision of this Agreement.
XII. GOVERNING LAW
This Agreement and the rights of the parties hereunder, shall be construed according to the
laws of the State of Florida.
XIII. SEVERABILITY
In the event any provision of this Agreement is deemed to be invalid or unenforceable, all
other provisions shall remain in full force and effect.
XIV. AMENDMENT
This Agreement may be amended at any time upon mutual, written agreement of both
parties, except that Florida Blue may make changes necessary to comply with State and
Federal laws upon 60 days notice to the Group.
XV. ENTIRE AGREEMENT
This Agreement, including its Exhibits, the application(s) for coverage, and the Benefit
Contract(s) constitute the entire Agreement between the Group and Florida Blue. Any prior
agreements, promises, or representations, either oral or written, relating to the subject
matter of this Agreement, and not expressly set forth in this Agreement, are of no force or
effect.
XVI. NOTICES
Any notice, required or permitted under this Agreement, shall be deemed given if hand
delivered or if mailed by United States mail, or an overnight mail service (e.g., Federal
Express), postage prepaid, to the applicable address as set forth above or to such other
address as a party may designate, in writing, to the other party. Such notice shall be
deemed effective as of the date so deposited or delivered.
XVII. SEPARATE CORPORATIONS
4
Florida Blue and Health Options, Inc., are separate corporations. Nothing in this
Agreement'shall be construed, for any purpose whatsoever, to make either liable for the
actions of the other.
XVIII.PROVIDER NETWORKS
Florida Blue Health Care Provider Networks are subject to change and may be modified at
any time during the term of this Agreement without notice to or consent of the Group or any
Group Member.
BLUE CROSS & BLUE SHIELD OF FLORIDA, INC.
d/b/a FLORIDA BLUE & HEALTH OPTIONS, INC.
By:
Name: Joseph C. Gregor, Esq.
Title: Vice President, Commercial Segments
Date:
Name: S+eveo AJ~xand~
Printed
Title: Ci+y ManUl!}-c.r-
Date: .7~ 2-7-17
5
A. Premium rates effective: 10/1/2017 through 9130/2018
Blue Options Plan 03768 Rx $10/$30/$50:
Single:
EtS:
EtC:
Family:
Blue Care Plan 56 Rx $10/$30/$50:
Single:
E/S:
E/C:
Family:
Blue Care Plan 60 Rx $10/$30/$50:
Single:
EtS:
EtC:
Family:
$719.98
$1,782.11
$1,377.77
$2,246.35
$608.82
$1,448.98
$1,120.23
$1,899.51
$568.64
$1,353.39
$1,046.32
$1,774.19
B. Administrative charges effective: 10/1/2017 through 9130/2018
16.82% of earned premium -BO
17.99% of earned premium -HMO
C. Pooling effective: 10/1/2017 through 9130/2018
Pooling Level: $155,000 Per Individual
Pooling Charges: 7.01 % of earned premium -BO
Pooling Charges: 6.83% of earned premium -HMO
D. Portion of excess to be returned if applicable: 10/1/2017 through 9130/2018:
25%
6
THE CITY OF PLEASANT LIVING
Date: IJul21,2017
Florida Blue
4800 Deerwood Campus Parkway
Jacksonville, FL 32246
Re: Group Name: ICiTY OF SOUTH MIAMI
Group Number: L-12_78_7_4 ____ ---l
To Whom It May Cqncern,
Please allow this letter to serve as confirmation that I approve of the following commission to be paid to my
agent of record by Florida Blue and acknowledge that the commission is included in the rates:
Commission Percentage: .... 10 ___ --'
Agent Name: ISAMANTHA GRAVELINE
Agency Name: IBROWN & BROWN OF FLORIDA
Contract Period Effective Date: I .... o_c_t _1,_2_01_7 ___ --' Contract Period End Date: Isep 30, 2018
If you have any questions or concerns, please do not hesitate to contact me.
Thank you,
Officer of the Company Signature:
Revised: 112/1812015 HH
ENROLLMENT SUMMARY
An Indepelldent Uf!$nSH of the
Blue Cross and Blue Shield AuocIatIDII
For Groups with 51+ Eligible Employees
Medicare Secondary Payor Compliance
Multiple Employer Plan: a plan sponsored by more than one employer. Multi-employer plan: a plan jointly sponsored by employers and unions.
If you are a single employer plan:
[Z] Yes Our Company employed 20 or more employees" each working day in 20 or more calendar weeks during the current or
preceding calendar year.
If you are a single employer, multiple employer, or multi-employer plan:
[Z] Yes 0 No Our Company employed 100 or more employees" on 50 percent or more of the business days during the preceding calendar
year.
If you are a multiple employer or a multi-employer plan:
DYes
DYes
DYes
All employers in our Group Health Plan (GHP) employed 20 or more employees·' for 20 or more weeks in either the current or
proceding calendar year.
At least one of the employers in our GHP employed 20 or more employees'· for 20 or more weeks in either the current or
preceding calendar year.
All employers in our GHP employed fewer than 20 employees" for 20 or more weeks in either the current or preceding calendar
year.
""Employees" includes all full and/or part time employees
Common Ownership/Controlled Group Compliance
[Z] Yes Our Company is part of a common ownership or Controlled Group as defined by the Health Insurance Portability and
Accountability Act of1996 ("HIPAA") states that all persons treated as a single employer under sUbsection (b), (c), (m), or (0) of
section 414 of the Internal Revenue Code of 1986 shall be treated as one employer.
General Information
Group Name CITY OF SOUTH MIAMI 59-6000431
Group Number 27874 Group Sales ReplAgent Adelisa Jimeno Oct1,2017
Employer-Ccmtribution-Toward Em-ployeesPremiuffi-'.-.. ----.. -.---.----.. -.----.---.-.-.. ---.. ---------.. --
a. Small Group (required) 100% 1-3 employees, 50% 4-50 employees 100
b. !:-!!:!ile Groul?1!~co~men~~~150% 51 + ~~ployees __ . __ ._. __ .. _._. ______ . __________ . ___ .. __ ... _____ ... _________ . ________ ..
What was the average total number of all emOlo,veE~S (full-time, part-time, and seasonal) in the previous calendar
II. Recap of Employee Participation (include all employees from Common Ownership if Box checked yes above)
Participation must be collected in certain scenarios. Please use the drop down and select the option that most fits your company.
Common Ownership Company
Provide information regarding the questions listed below in the right hand column. Some cells are auto-calculated and can not be typed within.
1. How many TOTAL EMPLOYEES ON PAYROLL do you have?
2. How many TOTAL COBRA CONTINUANTS are currently enrolled in your Group Health Plan (GHP)?
3. The form will calculate the TOTAL INELIGIBLE EMPLOYEES according to answers in 3A through 3C below.
A. How many Total Part TIm.e_anq.lie!i!_~_<H.r;mp_I.QyJ~e.(!!l do you have currently have?
B. How many Total New.EmplQ!{ee!! .. (in W!i!lUngJ~_erioJ;1.1 do you currently have?
C. How many Total Other Employee(s) are not eligible or accounted for in 3A & 3B?
4. The form will calculate the TOTAL ELIGIBLE EMPLOYEES according to above answers to determine Group size.
A. How many Total Employees with Other Coverage are not enrolling in this GHP?
B. Indicate Other employee(s) totals not accounted for above that are eligible.
C. How many employees are f>,!Q! CoveI~lLbyJ;lCBSF/HOI? (Provide Total from Common Ownership Groups.)
5. The form will calculate the TOTAL ELIGIBLE FOR PARTICIPATION according to the above answers.
A. Enter the number of Total Refusals. This represents employees refusing coverage without other
coverage.
6. The form will calculate the TOTAL ENROLLED according to the answers provided above.
7. The form will calculate the total EMPLOYEE PARTICIPATION using the answers provided.
a. Small Group (required) 100% 1-3 employees, 70% 4-50 employees
b. Large Group (recommended) 65% 51+ employees
8. The form will calculate the ENROLLED PERCENT OF TOTAL (6/4) (50% RULE) using the answers provided.
Page 1 of3 Enrollment Summary Form 7823SR (Rev 0515)
157
6
44
44
0
0
119
38
0
0
81
0
81
100%
68%
Last Revised 101812015
ENROLLMENT SUMMARY
Atllnd~dent Uc»J1SH of the
Blue Crou and Blua Shield Association
For Groups with 51 + Eligible Employees
Health insurance is offered by Blue Cross and Blue Shield of Florida, Inc., D/B/A Florida Blue. HMO coverage is offered by Health Options, Inc., D/B/A Florida
Blue HMO, an HMO subsidiary of Florida Blue. These companies are independent licensees of the Blue Cross and Blue Shield Association.
f!1ft~~.fUJi!ju;Uh~Jnform;ittjpn befoJIY anc(RrQyidf;Le/ecJrolJlc_s.igl1i1t(J1J~S whenJ1J~_fiJ).k(J-'J1ent is comp-feted.
I certify that the above information is correct to the best of my knowledge. I understand that this information will be used to determine my company's compliance
with Blue Cross Blue Shield of Florida, INC. and/or Health Options, INC. eligibility and UndelWriting Guidelines, as well as the applicability of State and Federal
laws relating to my company and plan. Blue Cross Blue Shield of Florida INC. and/or Health Options, INC. reserves the right to request a UCT-6 or other
documentation as evidence of business activity at any time and from time to time in order to validate my compliance with eligibility and UndelWriting Guidelines, as
well as validate the applicability of State and Federal laws.
I certify that the applicant is a single employer under section 414 of Internal Revenue Code of 1986 (26 U.S.C. 414 (b), (c), (m), or (0)), and under any. applicable
state law.
I understand that any person who knowingly and with intent to injure, defraud, or deceive any insurer, files a statement of claim or an application
containing any false, incomplete, or misleading information is guilty of a felony of the third degree.
Officer of the Company's Signature Dateffime Field
Page 2 of3 Enrollment Summary Form 7823SR (Rev 0515) Last Revised 101812015
An Itldependent Ueensee Qf the
Blue C'QSS and Blue Shield Association
BO 03768
Rx: $10/$30/$50
Single 1
Emp/Sp 0
Emp/Ch 1
Family 0
Monthly premium 2
HMO 56
Rx: $10/$30/$50
Single 18
Emp/Sp 0
Emp/Ch 3
Family 0
Monthly premium 21
HMO 60
Rx: $10/$30/$50
Single 67
Emp/Sp 0
Emp/Ch 5
Family 1
Monthly premium 73
TOTAL PREMIUM
City of South Miami
Group #27874
Renewal Summary 10/01/2017
COMPOSITE APPROVED RENEWAL with PRO SHARE AGREEMENT
Current Plan & Rates Renewal IncreaselDecrease
$733.68 $719.98
$1,816.01 $1,782.11
$1,403.97 $1,377.77
$2,289.08 $2,246.35
$2,137.65 $2,097.75 -1.87%
$620.40 $608.82
$1,476.54 $1,448.98
$1,141.53 $1,120.23
$1,935.64 $1,899.51
$14,591.79 $14,319.45 -1.87%
$579.46 $568.64
$1,379.13 $1,353.39
$1,066.22 $1,046.32
$1,807.93 $1,774.19
$45,962.85 $45,104.78 -1.87%
$62.692.29 $61,521.97 -1.87%