Res No 157-18-15190RESOLUTION NO. 157-18-15190
A Resolution authorizing the City Manager to purchase group health
insurance benefits from Neighborhood Health Plan (NHP) for full time
employees and participating retirees.
WHEREAS, the Benefits Consultant, Brown and Brown of Florida secured more than three
competitive quotes for the City's Group Health Insurance and recommended Neighborhood Health Plan
as the selected provider; and
WHEREAS, the City, through its Agent of Record, Brown and Brown of Florida,
compared the insurance rates, benefits 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 Neighborhood
Health Plan for the provision of group health insurance benefits for all full-time employees and
participating retirees; and
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 Commission hereby authorized the City Manager to purchase group health insurance
benefits from Neighborhood Health Partners for the City of South Miami full time employees and
participating retirees for the 20 IB-20 19.
Section 2. This resolution shall take effect immediately upon adoption.
PASSED AND ADOPTED this 4th day of SeRtember, 20 lB.
ATTEST: APPROVED:
(l/ptliJd.;J
MAYO
COMMISSION VOTE: 5-0
Mayor Stoddard: Yea
Vice Mayor Harris: Yea
Commissioner Welsh: Yea
Commissioner Liebman: Yea
Commissioner Gil Yea
City Commission Agenda Item Report
Meeting Date: September 4,2018
Submitted by: Samantha Fraga-Lopez
Submitting Department: Human Resources
Item Type: Resolution
Agenda Section: CONSENT AGENDA
Subject:
Agenda ~em No:2.
A Resolution authorizing the City Manager to purchase group health insurance benefits from Neighborhood
Health Plan (NHP) for full-time employees and participating retirees. 3/5 (City Manager-Human Resources)
Suggested Action:
Attachments:
Memo Final_HealthJns.docx
Reso_Health Ins.WL.docx
Comparison_Medical_2018_City of South MiamiJinalPresentation.pdf
1
THF. (lTY OF 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
September 4, 2018 Agenda Item No.: __
A Resolution authorizing the City Manager to purchase group health
insurance benefits from Neighborhood Health Plan (NHP) for full-
time employees and participating retirees.
The City's Benefit Consultant, Brown and Brown, solicited quotes for
the employee group insurance coverage for South Miami full-time
employees for the 2018 -2019 benefit year. After negotiations,
Florida Blue, the City's current health insurance carrier, proposed a
renewal rate which represented a 17.3% increase in premiums.
NHP's quote offers a 5.3% decrease in the current premium amount
with a richer plan.
The City currently contributes $568.64 per eligible employee per
month toward health insurance coverage. This amount will decrease
to $549.89 under NHP. The proposal is appropriately funded in the
proposed budget for Fiscal Year 2018-2019.
RECOMMENDATION: Based upon the proposals received, City staff recommends the City
purchase the health insurance plan offered by Neighborhood Health
Plan.
AMOUNT:
The proposed rates are based on the current number of enrollees
and are as follows:
Emplovee $549.89
Employee + $1,318.63
Spouse
Employee + $1,011.80
Children
Employee + $1,715.65
Family
The estimated total annual premiums cost paid by the City for health
benefits are about $890,000 based on today's personnel.
2
THE ClTY OF PLEASANT LIVING
ACCOUNT:
ATTACHMENTS:
CITY OF SOUTH MIAMI
OFFICE OF THE CITY MANAGER
INTER-OFFICE MEMORANDUM
Premium charges for the health will be charged to the designated
departmental budget line items as proposed in the Fiscal Year 2018-
2019 budget.
Proposed resolution
2018-2019 Benefits Renewal Summary
3
October 2018 Medical Plan Comparison for City of South Miami
Carrier Name FloridaBlue FloridaBlue FloridaBlue FloridaBlue Florida81ue
Plan Type 81ueCare BlueCare BlueOptions BlueCare BlueCare
Product name HMO 60 HMO 56 PPO 03768 HM060 HMO 56 ..
Calendar Year Deductible (eYD)
Individual I Family $500 { $1,000 None $250 I $750 $500 I $1 ,000 None
Coinsurance 90% 110% 90% 110% 100% 90% 110% 90% / 10%
Provider Services Open Access Open Access Open Access Open Access Open Access
Primary Care Office Visit $25 $15 $20 $25 $15
Specialist Office Visit $45 $35 $45 $45 $35
Adult Wellness (Includes Preventive Lab) $0 $0 $0 $0 $0
Hospital Services Opt. 1 / Opt. 2
Inpalient Hospital Facility $325/day to $1,625 $200fday to $1,000 $700/$1000 $325/day 10 $1,625 $200/day to $1 ,000
Hospilal Physician Services $0 $0 $50 $0 $0
Outpatient Hospital Facility $275 $150 $300/$600 $275 $150
Emergency Room Facility $100 $100 $200 $100 $100
Outpatient FacilitylDiagnostic
Ambulatory Surgery Center $200 $100 $200 $200 $100
ASC Physician Services $45 $35 $45 $45 $35
Lab I X-Ray $0/$45 $0/$35 $0/$50 $0/$45 $01$35
Major Diagnostic (MRI,CAT,CT,PET) $80 $80 $200 $80 $80
Urgent Care $45 $35 $50 $45 $35
Annual Out-at-Pocket Maximum
Includes Deductible (yes 1 No) Ye, NIA Ye, Ye, NIA
Individual/ Family $3,500 f $7,000 $2,500! $7,500 $3,000/$6,000 $3,500! $7,000 $2,500! $7,500
Lifetime Maximum Unlimited Unlimited Unlimited Unlimited Unlimited
Prescription Drugs
Tier 1fTier 2/Tier 3/Tier 4fTier 5 $10/$30/$50 $10/$30/$50 $10/$30/$50 $10/$30/$50 $10/$30/$50
Mail Order (90 Day Supply) $25/$75/$125 $25/$75/$125 $25/$75/$125 $25/$75/$125 $25/$75/$125
Out-Of-Network Benefits
COinsurance nla nla 50% /50% nla nla
Emergency Room Facility $100 $100 $200 $100 $100
All other Services nla nla 50% Aft CYD nla nla
Deductible -Indiv.lFamily nla nla $1,000/$3,000 nla nla
Annual Oul-of-Pocket -IndivJFamily nla nla $6,000/$12,000 nla nla
Lifetime Maximum nla nla Unlimited nla nla
Rates
Employee 67 $568.64 18 $608.82 0 $719.98 67 $740.85 18 $778.83 0
Employee & Spouse 0 $1,353.39 0 $1,448.98 0 $1,782.11 0 $1,763.21 0 $1,853.62 0
Employee & Child(ren) 6 $1,046.32 $1,120,23 1 $1,377.77 6 $1,363.16 $1,433.05
Family $1,774.19 $1,899,51 0 $2,246.35 $2,311.43 $2,429.96 0
Monthly Total by Product $46,150.99 $14,319.45 $1,377.77 $60,127.34 $18,318.09
Monthly Total $61,848.21 $80,058.51
Annual Total $742,178.52 $960,702.12
% Change in Total Annual Premium 29.4%
$ Change in Total Annual Premium $218,523.60
Rates,shnwn are based M census <lata provided. Fmal rates are subject to underwrmg and_8_ctu,al :enroDment This comparison is for
ilIustnalW.,<purposes "nty< rne< fullpoficyand certifiCate <of ctlvera!l" will s~persede any and aJmalerlals llrovide<!llerein.
FloridaBlue
BlueOptions
PPO 03768
$250 { $750
100%
Open Access
$20
$45
$0
Opt. 11 Opt. 2
$700 I $1000
$50
$300/$600
$200
$200
$45
$0/$50
$200
$50
Ye,
$3,000/$6,000
Unlimited
$10/$30/$50
$25/$75/$125
50% / 50%
$200
50% Aft CYD
$1,000/$3,000
$6,000/$12,000
Unlimited
$876.68
$2,086.48
$1,613.08
$2,735.22
$1,613.08
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Page 1 of3
October 2018 Medical Plan Comparison for City of South Miami
Carrier Name FloridaBJue FloridaBlue FloridaBlue FloridaBlue FloridaBlue
Plan Type BlueCare BlueCare BlueOptions BlueCare BlueCare
Product name HMOSD HM056 PPO 03768 HMO 60 HMO 56 ,--.. . -, ~ - -
Calendar Year Deductible (CYD)
Individual f Family $500 I $1,000 None $250 I $750 $500 I $1,000 None
Coinsurance 90% / 10% 90% / 10% 100% 90% r 10% 90% 110%
Provider Services Open Access Open Access Open Access Open Access Open Access
Primary Care Office Visil $25 $15 $20 $25 $15
Specialist Office Visit $45 $35 $45 $45 $35
AduH Wellness (Includes Preventive Lab) $0 $0 $0 $0 $0
Hospital Services Op1.110pt.2
Inpatient Hospital Facility $325/day to $1,625 $200/day to $1,000 $700/$1000 $325/day to $1,625 $200/day to $1,000
Hospital Physician Services $0 $0 $50 $0 $0
Outpatient Hospital Facility $275 $150 $3001$600 $275 $150
Emergency Room Facility $100 $100 $200 $100 $100
Outpatient Facility/Diagnostic
Ambulatory Surgery Center $200 $100 $200 $200 $100
ASC Physician Services $45 $35 $45 $45 $35
Lab 1 X-Ray $0/$45 $0/$35 $01$50 $01$45 $0/$35
Major Diagnostic (MRI,CAT,CT,PET) $80 $80 $200 $80 $80
Urgent Care $45 $35 $50 $45 $35
Annual Out-of-Pocket Maximum
Includes Deductible (yes I No) Ye, NfA Ye, Ye, NfA
Individual! Family $3,5001$7,000 $2,5001$7,500 $3,000/$6,000 $3,500/$7,000 $2,5001$7,500
lifetime Maximum Unlimited Unlimited Unlimited Unlimited Unlimited
Prescription Drugs
Tier 11Tier 2fTier 31Tier 4/Tier 5 $101$30/$50 $10/$30/$50 $101$301$50 $101$301$50 $10/$301$50
Mail Order (90 Day Supply) $25/$751$125 $25/$75/$125 $25/$75/$125 $25/$75/$125 $25/$75/$125
Out-Of-Network Benefits
Coinsurance ofa ofa 50% 1 50% ofa o'a
Emergency Room Facility $100 $100 $200 $100 $100
All other Services o'a o'a 50% Aft CYD o'a o'a
Deductible -IndivJFamily o'a ofa $1,000 I $3,000 ofa o'a
Annual Out-of-Pocket -lndiv.lFamily o'a ofa $6,000/$12,000 o'a ofa
lifetime Maximum o'a o'a Unlimited o'a o'a
Rates
Employee 67 $568,64 18 $608.82 0 $719.98 67 $671.2? 18 $705.70 0
Employee & Spouse $1,353.39 0 $1,448.98 0 $1,782.11 $1,597.65 $1,679.57 0
Employee & Child(ren) 6 $1,046.32 3 $1,120.23 $1,377.77 6 $1,235,16 3 $1,298.49 1
Family $1,774.19 0 $1,899.51 0 $2,246.35 $2,094.40 0 $2,201.79 0
Monthly Total by Product $46,150.S9 $14,319.45 $1,377.77 $54,481.12 $16,598.07
Monthly Total $61,848.21 $72,540.81
Annual Total $742,178.52 $870,489.72
% Change in Total Annual Premium 17.3%
$ Change in Total Annual Premium $128,311.20
Rates shown are based on census data pr-ovided. Final rates are sid:~ie.ct to, underwriting and-actual enronment. This comparison is for
iUustrairJ'e purposes only. The fuB policy and certifICate. of c()verage wm supersede any and.aD materials. provided herein.
FloridaBlue
elueOptions
PPQ 03768
-.. --. ~ - -
$250 I $750
100%
Open Access
$20
$45
$0
Opt. 11 Opt. 2
$700/$1000
$50
$300 r $600
$200
$200
$45
$0/$50
$200
$50
Ye,
$3,000 I $6,000
Unlimited
$10/$301$50
$25/$75/$125
50% 1 50%
$200
50% Aft CYD
$1,000/$3,000
$6,000/$12,000
Unlimited
$794.36
$1,890.57
$1,461.62
$2,47B.39
$1,46'1.62
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Page2of3
October 2018 Medical Plan Comparison for City of South Miami
Carrier Name Florida81ue FloridaBlue FloridaBlue NHP
Plan Type BlueCare BlueCare BlueOptions HMO 2018 OA
Product name HMO 60 HMO 56 PPO 03768 FOS1 Rx NH1 .-
Calendar Year Deductible (eYD)
Individual I Family $500 I $1,000 None $250 f $750 None
Coinsurance 90% 110% 90% 110% 100% 100%
Provider Services Open Access Open Access Open Access Open Access
Primary Care Office Visit $25 $15 $20 $15
Specialist Office Visit $45 $35 $45 $25
AduH WeHness (Includes Preventive Lab) $0 $0 $0 $0
Hospital Services Opl. 1 I Opt. 2
Inpalient Hospital Facility $325/day to $1,625 $200/day to $1 ,000 $700 I $1000 $2501day to $1 ,250
Hospital Physician Services $0 $0 $50 $0
Outpatient Hospital Facility $275 $150 $300/$600 $250
Emergency Room Facility $100 $100 $200 $100
Outpatient Facility/Diagnostic
Ambulatory Surgery Center $200 $100 $200 $250
ASC Physician Services $45 $35 $45 $0
Lab f X-Ray $Of$45 $01$35 $0/$50 $0
Major Diagnostic (MRI,CAT,CT,PET) $80 $80 $200 $50
Urgent Care $45 $35 $50 $50
Annual Out~of-Pocket Maximum
Includes Deductible (yes 1 No) Ye, N'A Ye, Ye,
Individual 1 Family $3,500/$7,000 $2,500/$7,500 $3,0001$6,000 $1,500/$3,000
Lifetime Maximum Unlimited Unlimited Unlimited Unlimited
Prescription Drugs
$101$301$50 (Spc
Tier 1fTier 2fTier 3/Tier 4fTier 5 $10/$30f$50 $10f$30f$50 $101$30f$50 $101$125/$250)
Mail Order (90 Day Supply) $25f$75/$125 $25/$75/$125 $25f$75f$125 $25/$75/$125
Out-Of-Network Benefits
Coinsurance 0" 0" 50% r 50% 0"
Emergency Room Facilily $100 $100 $200 $100
All other Services 0" 0" 50% Aft CYD 0"
Deductible -Indlv./Family 0" 0" $1,000 I $3,000 0"
Annual Oul-of-Pockel -Indiv.lFamily 0" 0" .$6,0001 $12,000 0"
Lifetime Maximum 0" 0" Unlimiled 0"
Rates
Employee 67 $568.64 18 $608.82 $719.98 85 $549.89
Employee & Spouse 0 $1,353.39 0 $1,448.98 $1,782.11 0 $1,308.73
Employee & Child(ren) 6 $1,046.32 $1,120.23 $1,377.77 10 $1,011.80
Family $1,774.19 $1,899.51 $2,246.35 $1,715.65
Monthly Total by Product $46,150.99 $14,319.45 $1,377.77 $58,574.30
Monthly Total $61,848.21 $58,574,30
Annual Total $742,178.52 $702,891,60
% Change in Total Annual Premium -5,3%
$ Change in Total Annual Premium -$39,286.92
Rates shown are based ·on census data 'provided. Final rates are subje,ct to-uno(rrwrmng and-aduaJ enrolknent. This comparison -is for
iIIuslralrlepul:poses only. The fullpoflcy an<! certiftcale of co'lerag" will Supersede any and aH.materials provided 1>e<ein.
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