Res No 100-20-15540RESOLUTION NO.100-20-1SS40
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
quotes for the City's Group Health Insurance and recommended Neighborhood Health Plan (NHP)
as the selected provider; and
WHEREAS, the City staff and 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 Manager wishes to recommend the selection of NHP 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 L The foregoing recitals are hereby ratified and confirmed as being true and they
are incorporated into this resolution by reference as if set forth in full herein.
Section 2. The Commission hereby authorizes the City Manager to purchase group health
insurance benefits from NHP for the City of South Miami full-time employees and participating
retirees for the 2020-2021.
Section 3. Corrections. Conforming language or technical scrivener -type corrections
may be made by the City Attorney for any conforming amendments to be incorporated into the
final resolution for signature.
Section 4. Severability. If any section clause, sentence, or phrase of this resolution is for
any reason held invalid or unconstitutional by a court of competent jurisdiction, the holding shall
not affect the validity of the remaining portions of this resolution.
Section S. * Effective Date. This resolution shall become effective immediately upon
adoption.
PASSED AND ADOPTED this 18'h day of August2020.
Page 1 of 2
Resolution No
100-20-15540
ATTEST:
i
READ AND APPROVED AS TO FORM,
LANGUAGE, LEGALITY AND
EXECUTION THERE F
l_'' . t ATTORN EY
APPROVED:
MAYOR
COMMISSION VOTE:
5-0
Mayor Philips:
Yea
Vice Mayor Welsh:
Yea
Commissioner Harris:
Yea
Commissioner Liebman:
Yea
Commissioner Gil:
Yea
Page 2 of 2
Agenda hem No:2.
City Commission Agenda Item Report
Meeting Date: August 18, 2020
Submitted by: Samantha Fraga-Lopez
Submitting Department: Human Resources
Item Type: Resolution
Agenda Section:
Subject:
A Resolution authorizing the City Manager to purchase group health insurance benefits from Neighborhood
Health Plan for full-time employees and participating retirees. 3/5 (City Manager -Human Resources)
Suggested Action:
Attachments:
Memo Health Insurance.docx
Reso—He aIth_I nsCA rev. d ocx
Final Comparison Health Insurance.pdf
Aetna and Cigna Decline to Quote Letters.pdf
South Miami
TH ITY Of PLEASANT LIVING
CITY OF SOUTH MIAMI
OFFICE OF THE CITY MANAGER
INTER -OFFICE MEMORANDUM
To: The Honorable Mayor & Members of the City Commission
FROM: Shari Karnali, City Manager
DATE: August 18, 2020
SUEUECT: A Resolution authorizing the City Manager to purchase group health
insurance benefitsfrom Neighborhood Health Plan forfull-time employees
and participating retirees for Fiscal Year 2020-2021.
BACKGROUND: The City's Benefit Consultant, Brown and Brown, solicited quotes for the
employee group insurance coverage for South Miami full-time employees
for the 2020-2021 benefit year. After lengthy negotiations, Humana, the
City's current health insurance carrier, proposed a renewal rate which
represented a 9.4% increase in premiums. Neighborhood Health Partners
(NHP) offered an 8.3% increase along with a plan that includes lower co -
payments than current for Primary Care visits as well as for Specialists and
medications.
Due to expensive employee claims for serious health issues experienced
during Fiscal Year 2019-2020, Aetna and Cigna declined to quote since they
were unable to offer a competitive rate and Humana was unable to lower
their rate or co -pays. NHP offered the best plan with the most competitive
rates.
Based on prior plan rates, coverage offered including co -pays for
employees, and overall cost, the NHP HMO 2020 CIA offers the best plan
for the City and its employees. Monthly rates are as follows:
Coverage
2019-2020
Employee
$608.83
Employee &
Spouse
$1,449.02
Employee &
Children
$1,120.25
Family
$1,899.55
2
CITY OF SOUTH MIAMI
South Miami OFFICE OF THE CITY MANAGER
THE CITY OF PLEASANT LIVING INTER -OFFICE MEMORANDUM
The City currently contributes $562.31 per eligible employee per month
toward health insurance coverage. As outlined above, this amount will
increase to $608.83, which is 8.3% more than Fiscal Year 2019-2020.
Through ongoing health and wellness initiatives, the City hopes to reduce
the rates in Fiscal Year 2021-2022. The proposal is appropriately funded in
the proposed budget for Fiscal Year 2020-2021.
RECOMMENDATION: Based upon the proposals received, City staff recommends the City
purchase the health insurance plan offered by NHP.
AMOUNT: The estimated total annual premiums cost paid by the City for health
benefits are approximately $935,163 based on today's personnel.
ACCOUNT: Premium charges for the health insurance will be charged to the
designated departmental budget line items as proposed in the Fiscal Year
2020-2021 budget.
ATTACHMENTS: Proposed resolution
2020-2021 Benefits Renewal Summary
Aetna Decline to Quote Letter
Cigna (Lincoln) Decline to Quote Letter
October 2020 Medical Plan Comparison for City of South Miami
Carrier Name
Plan Type
Product name
Calendar Year Deductible (CYD)
Individual / Family
Coinsurance
Provider Services
Primary Care Office Visit
Specialist Office Visit
Preventative Care
Hospital Services
Inpatient Hospital Facility
Hospital Physician Services
Outpatient Hospital Facility
Emergency Room Facility
Outpatient Facility/Diagnostic
Ambulatory Surgery Center
ASC Physician Services
Lab / X-Ray
Major Diagnostic (MRI,CAT,CT,PET)
Urgent Care
Annual Out -of -Pocket Maximum
Includes Deductible (Yes / No)
Individual / Family
Lifetime Maximum
Prescription Drugs
Tier 1/Tier 2/Tier 3/Tier 4/Tier 5
Mail Order (90 Day Supply)
Coinsurance
Emergency Roam Facility
All Other Services
Deductible - Individual/Family
Annual Out -of -Pocket - Indiv/Family
Lifetime Maximum
Employee
Employee & Spouse
Employee & Child(ren)
Family
Monthly Total by Product
Annual Total
S Change in Monthly Premium
%Change In Total Annual Premium
S Change In Total Annual Premium
Humana
HMO Premier
16 Copay 01100-C
None
100 %
Open Access
$25
$40
$0
$500
$0
$500
$250
$500
$0
$0
$250
$75
Yes
S4,000 / $8,000
t
$562.31
$1,338.30
$1,034.65
L4.40
$,030.38
$696 364.56
Humana
HMO Premier
16 Copay G/100-C
None
100 %
Open Access
$25
$40
s0
$500
$0
$500
$250
$500
$0
$0
$250
$75
Yes
$4.000 / $8,000
Unlimited
$10/$40/$70/25 %
$25/$100/$175/25 %
n/a
$250
n/a
n/a
n/a
n/a
$702.33
$1,671.54
$1,292.28
$2,191.25
$72,480.35
$869 764.20
$14.449.97
24.97�
$173 399.64
Humana
HMO Premier
16 Copay G/100-C
None
100 %
Open Access
$25
$40
$0
$500
$0
$500
S250
$500
$0
$0
$250
$75
Yes
S4,000 / S8,000
Unlimited
$10/$40/$70/25%
$25/$100/$175/25 %
We
$250
n/a
n/a
n/a
We
$615.17
$1,464.10
$1,131.91
$1.919.31
$63,485.49
$761 825.88
9.4%
$65 461.32
Florida Blue
BlueCare
45
$1,500 / $4.500
90% / 10 %
Open Access
$30
$55
$0
10% Aft Ded
10% Aft Ded
S400
$250
$200
$55
$0/$50
$250
$60
Yes
$4,000 / $8,000
Unlimited
$10/$50/$80
$25/$125/$200
n/a
$250
n/a
n/a
nla
We
$771.54
$1,836.27
l $1,481.37
$2,468.94
$80,425.50
$965 106,00
ell Inn+l
313.6%
$268 741.44
L.
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October 2020 Medical Plan Comparison for City of South Miami
Carrier Name
Plan Type
Product name
Calendar Year Deductible (CYD)
Individual I Family
Coinsurance
Provider Services
Primary Care Office Visit
Specialist Office Visit
Preventative Care
Hospital Services
Inpatient Hospital Facility
Hospital Physician Services
Outpatient Hospital Facility
Emergency Room Facility
Outpatient Facility/Diagnostic
Ambulatory Surgery Center
ASC Physician Services
Lab I X-Ray
Major Diagnostic (MRI,CAT,CT,PET)
Urgent Care
Annual Out -of -Pocket Maximum
Includes Deductible (Yes / No)
Individual / Family
Lifetime Maximum
Prescription Drugs
Tier 1/Tier 2/Tier 3/Tier 41Tier 5
Mail Order 90 Da Sup I
Coinsurance
Emergency Room Facility
All Other Services
Deductible - Individual/Family
Annual Out-of-pocket - Indiv/Family
Lifetime Maximum
Employee
Employee & Spouse
Employee & Child(ren)
Family
m thly Total by Product
Annual Total
$ Change in Monthly Premium
%Change in Total Annual Premium
$ Change in Total Annual Premium
Humana
HMO Premier
16 Copay Gil 00-C
None
100%
Open Access
$25
$40
$0
$500
$0
$500
$250
$500
$0
$0
$250
$75
Yes
$4,000 / $8,000
Unlimited
$10/$401$70/25%
$25/$100/$175/25%
We
$250
n/a
We
nla
We
$562.31
$1,338.30
$1.034.65
$1,754.40
$58,030.38
$696 364.56
NHP
NHP HMO 2020 OA
BXLG-M I Rx NHAL
None
100%
Open Access
$25
$40
$0
$500
$0
$500
$250
$500
$0
$0
$250
$75
Yes
$4,0001$8,000
Unlimited
$5l$50/$1501$300
$12.501$1251$375/$750
nla
$250
We
n/a
We
n/a
$614.98
$1,463.65
$1,131.56
$1,91 B.74
$63,465.90
$761 590.80
$5,435.52
9.4 %
$65.226.24
NHP
NHP HMO 2020 OA
BXLG-M21 Rx NH21
None
100%
Open Access
$10
$25
$0
$500
$0
$500
$250
$500
$0
$0
$250
$75
Yes
$4,000 / $8,000
Unlimited
$10/$35/$70
$25/$87.50/$175
nla
$250
n/a
nla
We
We
$608.83
$1,449.02
$1,120.25
$1,899.55
$62,831.29
$753 975.48
$4,800.91
8.3%
$57,610.92
fnfonmahoa shown d haaod on mnws data pmvldod. For Gusbofwo pary os only. The oeNAzro of comWe. Mal roles, and final ao dlmenl wa aupomodp any and au melenabpovHod hm m. Page 2 of 2
vaetna"
261 N. University Drive
Plantation, FL33324
July 22, 2020
Maria E. Panizo
Brown & Brown, Inc.
1201 W. Cypress Creek Rd. Suite 130
Fort Lauderdale, FL 33309
mpanizo@bbftlaud.com
Re: City of South Miami
Dear Ms. Panizo:
Aetna thanks you for the opportunity to prepare a medical benefit quote for City of South
Miami. After reviewing the submitted information, UW is declining to generate a quote as our
proposal will not be competitive.
Thank you for your confidence and trust in Aetna and our family of health benefit solutions.
We look forward to serving you and your valuable clients in the future. Please call meat (954)
593-2951 if you have any questions, or if I can be of further assistance.
Sincerely,
-Adrian Perez
Account Executive
Proprietary 8
Daniel Imme
New Business Manager
Sunrise, FL 33323
July 13, 2020
Samantha Graveline
Brown & Brown of Florida, Inc.
1201 W. Cypress Creek Road, Suite 130
Fort Lauderdale, FL33309
RE: City of South Miami
Dear Samantha Graveline,
Thank you for considering Cigna HealthCare for City of South Miami.
Based upon our evaluation of the information provided with your request
for proposal, we do not believe that we can offer a competitive proposal for
health insurance coverage. Therefore, we respectfully decline to offer a
quote for group health insurance coverage at this time.
The rules under the Affordable Care Act require issuers to offer all
products approved for sale in the market. Accordingly, we will provide a
proposal if you indicate in writing that you are still interested in receiving
one, notwithstanding the fact that we do not believe that we can provide a
competitive quote for health insurance coverage. In such case, we may
request additional information from you in order to provide a quote for
insurance coverage.
In order to provide a quote, all of the following information listed below will
need to be provided at least 30 days prior to the coverage effective date.
• Benefit summaries for all plans currently offered
• A detailed description of the plan(s) the employer would like to offer
• A detailed description of the enrollment strategy - which groups of
employees would be offered the plan(s) quoted
• If excepted benefits are offered to the employees we are quoting,
also provide the plan designs, rates and contribution strategy for
each of the plan offerings
• Identify any plan(s) that are paid on a capitated basis and the
employer contribution strategy for each plan
• Current and proposed renewal rates
• Large claim data including diagnosis and claimant status
Current commission level _
3 year carrier history, including rates by plan
• Monthly paid claims and enrollment data for the most recent 12
months (minimum). Underwriting may require longer look back
periods on a case by case basis. The data should include:
o Identification of the basis for the claim data, paid or incurred
o Claim information for individual claims in excess of
$25,000.00
o A breakdown of any capitated data imbedded within the
claim information
We appreciate being given the opportunity to review your request for a
proposal and we look forward to working with you on future prospects.
Please do not hesitate to contact me if you have any questions.
Sincerely,
Daniel Imme
New Business Manager
(954) 514-6847
Attention California Agents/Brokers: A copy of this letter must immediately
be forwarded to the client in order to comply with California law, SB 1163
(2010).
10