Res No 102-20-15542RESOLUTION NO.102-20-15542
A Resolution authorizing the City Manager to purchase dental and vision
insurance benefits from Humana for full-time employees and participating
retirees for the 2020-2021 Fiscal Year.
WHEREAS, the City, through its Agent of Record, Brown and Brown of Florida, solicited
more than three quotes, 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 staff recommend the selection of Humana for the provision of dental
and vision 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 number.
NOW THEREFORE, BE IT RESOLVED BY THE MAYOR AND CITY
COMMISSIONERS OF THE CITY OF SOUTH MIAMI, FLORIDA:
Section 1. 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 execute the dental and -
vision insurance renewal policy with Humana 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 5. Effective Date. This resolution shall become effective immediately upon
adoption.
PASSED AND ADOPTED this 18' day of August, 2020.
ATTEST: APPROVED:
0�j rub
CITY LE MAYOR
READ AND APPROVED AS TO FORM, COMMISSION VOTE: 5-0
LANGUAGE, LEGALITY AND Mayor Philips: Yea
Pagel of 2
Resolution No. 102-20-15542
� • fir• or. •
I L
Vice Mayor Welsh: Yea
Commissioner Harris: Yea
Commissioner Liebman: Yea
Commissioner Gil:
Page 2 of 2
Agenda Item NoA.
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 dental and vision insurance benefits from Humana for
full-time employees and participating retirees for 2020-2021 Fiscal Year. 3/5 (City Manager -Human Resources)
Suggested Action:
Attachments:
Memo Vision and Dental.docx
Res o Dental and VisionCArev.docx
Final Comparison Dental.pdf
Final Comparison Vision.pdf
1
CITY OF SOUTH MIAMI
Southk i ami OFFICE OF THE CITY MANAGER
THE e:Fv OF PLEASANT LIVING INTER -OFFICE MEMORANDUM
TO: The Honorable Mayor & Members of the City Commission
FROM: Shari Kamah, City Manager
DATE: August 18, 2020
SUBJECT: A Resolution authorizing the City Manager to purchase dental and vision
insurance benefits from Humana for full-time employees and participating
retirees for Fiscal Year 2020-2021.
BACKGROUND: The City's benefits consultant, Brown and Brown of Florida, Inc., solicited
quotes from Humana, UnitedHealthcare, Guardian, Florida Blue, and Sun
Life, for the employee's dental and vision insurance coverages for South
Miami full-time employees and retirees for the 2020 — 2021 Fiscal Year.
Humana, the City's current dental and vision insurance carrier, renewal
rate represented a 0% increase from last year's rate for the DHMO dental
plan offered by the City. The dental PPO, which can be elected at the
employees' expense, also represented a 0% increase. The City currently
contributes $8.49 per eligible employee, per month, toward dental
insurance coverage and vision is voluntarily paid by the employee.
Humana's vision plan represents a .40 cent increase per month
(approximately .20 cents per pay period) for employees who opt for vision
coverage. The Humana plans provide the best coverage including rates,
and co -pays. The renewal is appropriately funded in the proposed budget
for Fiscal Year 2020-2021.
RECOMMENDATION: Based upon the proposals received, Brown and Brown and City Staff
recommend the City renew with the current Humana carrier for dental and
vision insurances.
AMOUNT: The estimated total annual premiums cost for dental benefits paid by the
City is about $13,040.00 based on today's personnel.
ACCOUNT: Premium charges for the health will be charged to the designated
departmental budget line items as proposed in the Fiscal Year 2020-2021
budget.
ATTACHMENTS: Proposed resolution
Comparison Vision
Comparison Dental
2
October 2020 Dental Comparison for City of South Miami
Plan Name
Provider Acess
Benefit Description
Preventive (Class 1)
Basic (Class II)
Major Class III
Maximum Annual
Benefit
Deductible (IndividuaUFamily)
Deductible Waived- Class I
Orthodontia coves ellifetime max
Reimbursement Schedule
Benefits
Routine Exams - 9430
Teeth Cleaning - 1110
Full Mouth/Panoramic X-rays - 0330
Simple Extractions - 7111
Root Canal (Endodontics) - 3330
Perio. Scaling/Root Planning - 4341
Full or Partial Dentures - 5110
Crowns - 6752
Employer Contribution
Minimum Participation Requirement
Waiting Period Major Services
Rate Guarantee
Employee
Employee + Spouse
Employee + Child(ren)
Family
Monthly Premium By Product
Total Monthly Premium
Total Annual Premium
%Change in Monthly Premium by Plan
S Change in Monthly Premium by Plan
$ Change in Total Monthly Premium
%Change in Total Annual Premium
$ Change in Total Annual Premium
DMO HD205 OR
PPO
In Network Only
In -Network
Out of Network
n/a
100%
100%
n/a
80%
80%
n/a
50%
50%
Unlimited
Unlimited
Unlimited
n/a
$501$150
$50/$150
n/a
Yes
Yes
$2.650 Child & Adult
$1.00OChildOnly
$1,000 Child Onl
Fee Schedule
Fee Schedule
MAC
No Charge
100%
100%
No Charge
100%
100%
No Charge
100%
100%
No Charge
80%
80%
$250
80%
80%
$55 per quad
80%
80%
$375
50%
50%
$270
50%
50%
Contributory
Contribulory
None
None
Expires 9/30120
Expires 9130120
$8.49
33
$33.39
$16.98
3
$69.70
$19.11
4
$78.55
$30.74
8
$123.23
$704.65 $2,811.01
$3,315.66
$39 787.92
DMO HD205 OR
PPO
In Network Only
In -Network
Out of Network
n/a
100%
100%
n/a
80%
80%
n/a
50%
50%
Unlimited
Unlimited
Unlimited
n/a
$50/$150
$50/$150
n/a
Yes
Yes
$2.650 Child & Adult
$1.000 Child Only
$1,000 Child Only
Fee Schedule
Fee Schedule
MAC
No Charge
100%
100%
No Charge
100%
100%
No Charge
100%
100%
No Charge
80%
80%
$250
80%
80%
$55 per quad
80%
80%
$375
50%
50%
$270
50%
50%
Contributory
Contributory
None
None
12 Months
.
12 Months
$8.49
33
$36.03
$16.98
3
$75.21
$19.11
4
$84.76
$30.74
8
$132.97
$704.65 $2,817.42
$3.522.07
$42,264.84
0.0%
7.9%
$0.00
$206AII
$206.41
6.2%
$2,476.92
Information shown is based on census dab pmMed. FW aualmlW ponposas only. The cW6hcale or coverage, rmat rates, and nlnal anmllment wa supersede any erW ag rOafodels p Wedhamk. Page 1 of 9
October 2020 Dental Comparison for City of South Miami
Plan Name
Provider Acess
Benefit Description
Preventive (Class 1)
8aslc Class II
Ma or Class III
Maximum Annual Benefit
Deductible IndividualtFami
Deductible Waived - Class I
Orthodontia covers eltifetime max
Reimbursement Schedule
Benefits
Routine Exams - 9430
Teeth Cleaning -1110
Full Mouth/Panoramic X-rays - 0330
Simple Extractions - 7111
Root Canal (lffW6 ntics) - 3330
Perlo. Scaling/Root Planning - 4341
Full or Partial Dentures - 5110
Crowns - 6752
Employer Contribution
Minimum Participation Requirement
Waltina Period Ma or Services
Rate Guarantee
Employee -
Emptoyee +Spouse -
Employee + Child(ren)
Family
Monthly Premium By Product
Total Monthly Premium
Total Annual Premium
°k 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
44
8
7
2
DMO HD205 OR
PPO
In Network Only
In -Network
Out of Network
n/a
100%
100%
n/a
80%
-80%-
n/a
50%
50%
Unlimited
Unlimited
Unlimited
n/a
$50/$150
$50/$150
n/a
Yes
Yes
$2,650 Child & Adult
$1,000 Child Only
$1,000 Child Onl
Fee Schedule
Fee Schedule
MAC
No Charge
100%
100%
No Charge
100%
100%
No Charge
100%
100%
No Charge
80%
80%
$250
80%
80%
$55 per quad
80%
80%
$375
50%
50%
$270
50%
1 50%
Contributory
Contributory
None
None
ices 9/30/20
Expires 9/30/20
$8.49
33
$33.39
$16.98
3
$69.70
$19.11
4
$78.55
$30.74
8
$123.23
$704.65 $2,611.01
$3,315.66
$39 787.92
44
8
7
2
DMO HD205 OR
PPO
In Network Only
In -Network
Out of Network
n/a
100%
100%
n/a
80%
80%
n/a
50%
50%
Unlimited
Unlimited
Unlimited
n/a,
$50/$150
$50/$150
n/a
Yes
Yes
$2.650 Child & Adult
$1,000 Child Only
$1.000 Child Only.
Fee Schedule
Fee Schedule
MAC
No Charge
100%
100%
No Charge
100%
100%
No Charge
100%
100%
No Charge
80%
80%
$250
80%
80%
$55_ per quad
80%
80%
$375
50%
50%
$270
50%
1 50%
Contributory
Contributory
None
None
12 Months
12 Months
$8.49
33
$33.39
$16.98
3
$69.70
$19.11
4
$78.55
$30.74
8
$123.23
$704.65 $2,611.01
$3,315.66 _
$39 787.92
0.0%
0.0% _
$0.00
$0.00
$0.00
0.0%
$0.00
lntormatton shown is based on census data provided For lltusfr &o purposes only. The coffiicate of coverage, final ratas, and gnat onrollment wo supersede any and all materials provided heroln. Page 2 of 9
October 2020 Dental Comparison for City of South Miami
11111111
Plan Name
Provider Acess
Benefit Description
Preventive (Class I)
Basic (Class 1I)
Major Class III
Maximum Annual Benefit
Deductible (lndhtiduaUFamily)
Deductible Waived - Class 1
Orthodontia covers ellifetime max
Reimbursement Schedule
Benefits
Routine Exams - 9430
Teeth Cleaning -1110
Full Mouth/Panoramic X-rays - 0330
Simple Extractions - 7111
Root Canal (Endo_ dontics) - 3330
Perio. Scaling/Root Planning - 4341
Full or Partial Dentures - 5110
Crowns - 6752
Employer Contribution
Minimum Participation Requirement
Waiting Period Ma or Services
Rate Guarantee
w
Employee
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
44
8
7
2
DMO HD205 OR
PPO
In Network Only
In -Network
Out of Network
n/a
100%
100%
n/a
80%
80%
n/a
50%
50%-
Unlimited
Unlimited
Unlimited
n/a
$50/$150
$50/$150
nla
Yes
Yes
$2,650 Child & Adult
$1 000 Child Only
$1,000 Child Onl
Fee Schedule
Fee Schedule
MAC
No Charge
100%
100%
No Charge
100%
100%
No Charge
100%
100%
No Charge
80%
80%
$250
80%
80%
$55 per quad
80%
80%
$375
50%
50%
$270
50%
50%
Contributory
Contributory
None
None
iris 9/30/20
Tres 9130120
$8.49
33
$33.39
$16.98
3
$69.70
$19.11
4
$78.55
$30.74
8
$123.23
$704.65 $2,611.01
$3,315.66
$39 787.92
0
.
..
DHMO Plan 52
PPO
In Network Only
In -Network
Out of Network
n/a
100%
100%
n/a
80%
80%
n/a
50%
50%
Unlimited
$1,000
$1.000
n/a
$50/$150
$50/$150
n/a
Yes
Yes
$2,400 Child & Adult
$1,000 Child Only
$1,000 Child On[
Fee Schedule
Fee Schedule
MAC
No Charge
100%
100%
$12
100%
100%
No Charge
100%
100%
$10
80%
80%
$290
80%
80%
$50 per quad
80%
80%
$325
50%
50%
$300
50%
50%
Contributory
Contributo
30%
30%
None
None
36 Months
36 Months
$7.87
33
$29.38
$15.74
3
$61.34
$17.71
4
$69.12
$28.49
8
$108.44
$653.15 $2,297.56
$2,950.71 -
$35,408.52
-7.3%
-12.0% - - -
- $51.50 -
-$313.45
4364.95
-11.0%
-$4,379.40
Information shown is based on census date provided. For AlustretMe purposes only. The ceriftate of coverage, final rates, and finel enrolment wll supersede any and all materials provided heron. Page 3 of 9
n
October 2020 Dentai Comparison for City of South Miami
Plan Name
Provider Acess
Benefit Description
Preventive (Class 1)
Basic (Class II)
Major Class ill
Maximum Annual Benefit
Deductible (Individual/Family)
Deductible Waived - Class I
Orthodontia covers ellifetime max
Reimbursement Schedule
Benefits
Routine Exams - 9430
Teeth Cleaning - 1110
Full Mouth/Panoramic X-rays - 0330
Simple Extractions - 7111
Root Canal (Endodontics) - 3330
Pedo. ScalingfRoot Planning - 4341
Full or Partial Dentures - 5110
Crowns - 6752
Employer Contribution
Minimum Participation Requirement
Waiting Period Ma or Services
Rate Guarantee
Employee
Employee + Spouse
Employee + Child(ren)
Family
Monthly Premium By Product
Total Monthly Premium
Total Annual Premium
% Change in Monthly Premium by an
$ Chen a In Monthl Premium b Plan
$ Change in Total Monthly Premium
% Change in Total Annual Premium
$ Change in Total Annual Premium
44
8
7
2
DMO HD205 OR
PPO
In Network Only
In -Network
Out of Network
n/a
100%
100%
n/a
80%
80%
We
50%
50%
Unlimited
Unlimited
Unlimited
We
$50/$150
$50/$150
n/a
Yes
Yes
$2,650 Child & Adult
$1.000 Child Only
$1,000 Child Only
Fee Schedule
Fee Schedule
MAC
No Charge
100%
100%
No Charge
100%
100%
No Charge
100%
100%
No Charge
80%
80%
$250
80%
80%
$55 per quad
80%
80%
$375
50%
50%
$270
50%
50%
Contributory
Contributory
None
None
iras 9/30/20
Expires 9/30/20
$8.49
33
$33.39
$16.98
3
$89.70
$19.11
4
$78.55
$30.74
8
$123.23
$704.65 $2,611.01
$3,315.66
$39,787.92
44
8
7
2
Florida Blue
Florida BIL10
DHMO BlueCare 305
PPO BlueChoice
In Network Only
In -Network
Out of Network
n/a
100%
100%
We
80%
80%
We
50%
50%
Unlimited
Unlimited
Unlimited
n/a
$50/$150
$50/$150
nla
Yes
Yes
$2.650 Child & Adult
$1,000 Child Only
$1,000 Child Only
Fee Schedule
Fee Schedule
MAC
No Charge
100%
100%
No Charge
100%
100%
No Charge
100%
100%
No Charge
80%
80%
$250
80%
80%
$55 per Quad
80%
80%
$375
50%
50%
$270
6 %
1 60%
Contributory
Voluntary
10 enrolled
Greater of 35%
or 4 enrolled
None
24 Months
24 Months
$9.26
33
$30.21
$18.52
3
$63.06
$20.83
4
$71.06
$33.52
8
$111.48
$768.45 $2,382.19
$3,130.64
$37,567.68
9.1%
-9.5%
$63.80
1 •$248.82
•$185.02
-5.6%
-$2,220.24
Inlannatbn shown is based on census dale MWded. For Nlustrotbo purposes only. The ceraffx9le of coverage, Mal rates, and rural enrollment Wit Supersede any end all auden la p.Wded hereln. Page 4 or 9
IM
October 2020 Dental Comparison for City of South Miami
Plan Name
Provider Acess
Benefit Description
Preventive (Class 1)
Basic (Class 11)
Major Class III
Maximum Annual Benefit
Deductible (Individual/Family)
Deductible Waived - Class I
Orthodontia (coverage/lifetime max
Reimbursement Schedule
Benefits
Routine Exams - 9430
Teeth Cleaning -1110
Full Mouth/Panoramic X-rays - 0330
Simple Extractions - 7111
Root Canal (Endodontics) - 3330
Perio. Scaling/Root Planning - 4341
Full or Partial Dentures - 5110
Crowns - 6752
Employer Contribution
Minimum Participation Requirement
Waiting Period Major Services
Rate Guarantee
r
Employee
Employee + Spouse
Employee + Child(ren)
Family
Monthly Premium By Product
Total Monthly Premium
Total Annual Premium
ye Change in_Monthly Premium by Plan
$ Change in Monthly Premium by Plan
$ Change In Total Monthly Premium
°% Change in Total Annual Premium
It Change in Total Annual Premium
44
8
1
2
HIM
DMO HD205 OR
PPO
In Network Only
In -Network
Out of Network
n/a
100%
100%
n/a
80°%
80%
n/a
50%
50%
Unlimited
Unlimited
Unlimited
n/a
$50/$150
$50/$150
n/a
Yes
Yes
$2,650 Child & Adult
$1.000 Child Only
$1,000 Child Onl
Fee Schedule
Fee Schedule
MAC
No Charge
100%
100%
No Charge
100%
100%
No Charge
100%
100%
No Charge
80%
80%
$250
80%
80%
$55 per quad
80%
80%
$375
50%
50%
$270
50%
50%
Contributory
Contributory
None
None
Tres 9/30/20
Expires 9/30120
$8.49
33
$33.39
$16.98
3
$69.70
$19.11
4
$78.55
$30.74
8
$123.23
$704.65 $2,611.01
$3,315.66
$39,787.92
4
t
0
DHMO N 100G
PPO
In Network Only
In -Network
Out of Network
n/a
100%
100%
n/a
80%
80°%
No
50%
50%
Unlimited
$2,000
$2,000
n/a
$501$150
$50/$150
n/a
Yes
Yes
$2 545 Child / $2,845 Adult
$1,000 Child Only
$1,000 Child Onl
Fee Schedule
Fee Schedule
MAC
$15
100%
100%
No Charge
100%
100%
No Charge
100%
100%
$20
80%
80%
$350
80%
80%
$75 per quad
80%
80%
$580
50%
50%
$430
50%
50%
Contributory
Contributory
85°%
None
None
12 Months
12 Months
$7.94
33
$29.03
$15.90
3
$58.93
$19.03
4
$71.93
$28.75
8
1 $108.43
$667.27 1 $2,289.94
$2,957.21
$35,486.52
-5.3°%
-12.3°%
-$37.38
-$321.07
-$358.45
-$4,301.40
Information shown is based on census data provided. For fflushadve purposes only. The cortMcete of coverage, find rates, and find enroament wo supersede any and ell materials provided herein. Page 5 of 9
October 2020 Dental Comparison for City of South Miami
Plan Name
Provider Acess
Benefit Description
Preventive (Class 1)
Basic (Class II)
Major Class III
Maximum Annual Benefit
Deductible (Individual/Family)
Deductible Waived - Class I
Orthodontia (coverage/lifetime max
Reimbursement Schedule
Benefits
Routine Exams - 9430
Teeth Cleaning - 1110
Full Mouth/Panoramic X-rays - 0330
Simple Extractions - 7111
Root Canal (Endodontics) - 3330
Perio. Scaling/Root Planning .4341
Full or Partial Dentures - 5116
Crowns - 6752
Employer Contribution
Minimum Participation Re uirement
Waiting Period Major Services
Rate Guarantee
Employee
Employee + Spouse
Employee + Chiid(ren)
Family
Monlhty Premium By Produet
Total Monthly Premium
Total Annual Premium
%Change in Monthly Premium by Plan
$ Shan! in Monthl Premium b Plan
$ Change in Total Monthly Premium
%Change in Total Annual Premium
$ Change In Total Annual Premium
Humana
Humana
DMO HU205 OR
PPO
In Network Only
In -Network
Out of Network
n/a
100%
100%
n/a
80%
80%
We
50%
50%
Unlimited
Unlimited
Unlimited
n/a
$50/$150
$50/$150
n/a
Yes
Yes
$2,650 Child & Adult
$1,000 Child Only
$1.000 Child Only
Fee Schedule
Fee Schedule
MAC
No Charge
100%
1000/a
No Charge
100%
100%
No Charge
100%
100%
No Charge
80%
80%
$250
80%
80%
$55 per quad
80%
80%
$375
50%
50%
$270
50%
50%
Contributory
Contributory
None
None
Expires 9130120
Expires 9130/20
$8.49
33
$33.39
$16.98
3
$69.70
$19.11
4
$78.55
$30.74
8
$123.23
$704.65 $2,511.01
$3,315.66
$39,787.92
Lincon
Lincoln
DHMO LDC500B
PPO
In Network Only
In -Network
Out of Network
n/a
100%
100%
n/a
80%
80%
We
50%
50%
Unlimited
$2,500
$2,500
n/a
$50/$150
$50/$150
We
Yes
Yes
$2,635 Child / $2,735 Adult
$1,000 Child On[
$1,000 Child Only
Fee Schedule
Fee Schedule
MAC
No Charge
100%
100%
No Charge
100%
100%
$45
100%
100%
$45
80%
80%
$225
80%
80%
$45 per quad
80%
80%
$260
50%
50%
$240
50%
50%
Contributory
Contributory
2 enrolled
100%
None
None
12 Months
12 Months
$14.55
33
$30.05
$25.46
3
$62.73
$31.53
4
$70.69
$40.01
8
$110.91
$1,144.61 $2,349.88
$3,494.49
$41,933.88
62.40'.
.10.0%
$439.96
-$261.13
$178.83
5.4%
$2.145.96
Inlormalan sMwn is 6asatl on tens. Cale p.,Vad Forft,1ra0m pumosos oW. no rnrtir¢ofe of comrago. foal Mies. and Mal emonmenl wll suporsede any and all maledals pmMed hereb. Page 6 of 9
October 2020 Dental Comparison for City of South Miami
Plan Name
Provider Acess
Benefit Description
Preventive (Class 1)
Basic (Class III
Major Class III
Maximum Annual Benefit
Deductible (Individual/Famlly)
Deductible Waived- Class I
Orthodontia covers ellifetime max
Reimbursement Schedule
Benefits
Routine Exams - 9430
Teeth Cleaning - 1110
Full Mouth/Panoramic X-rays - 0330
Simple Extractions - 7111
Root Canal (Endodontics) - 3330
Perin. Scaling/Root Planning - 4341
Full or Partial Dentures - 5110
Crowns - 6752
Employer Contribution
Minimum Participation Requirement
Waiting Period Major Services
Rate Guarantee
Employee
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
44
__--tiumana
Humana
DMO HD205 OR
PPO
In Network OnlyIn-Network
Out of Network
We
100%
100%
me
80%
80%
n/a
50%
50%
Unlimited
Unlimited
Unlimited
n/a
$50/$150
$50/$150
n/a
Yes
Yes
$2.650 Child & Adult
$1.000 Child Only
$1,000 Child Only
Fee Schedule
Fee Schedule
MAC
No Charge
100%
100%
No Charge
100%
100%
No Charge
100%
100%
No Charge
80%
80%
$250
80%
80%
$55 per quad
80%
80%
$375
50%
50%
$270
50%
50%
Contributory
rE�Contributory
None
None
E] ires 9l30/20
Expires 9l30/20
Current
Current
$8.49
33
$33.39
$16.98
$69.70
$19.11
4
$78.55
$30.74
0
$123.23
$704.65 $2,611.01
$3,315.66
$39,787.92
DHMO MET335
PPO
In Network Only
In -Network
Out of Network
We
100%
100%
n/a
80%
80%
n/a
50%
50%
Unlimited
$5,000
$5.000
We
$50/$150
$501$150
n/a
Yes
Yes
$3,045 Child & Adult
$1,000 Child Only
$1,000 Child Only
Fee Schedule
Fee Schedule
MAC
No Charge
100%
100%
$5
100%
100%
No Charge
100%
100%
$5
80%
80%
$305
80%
80%
$60 per quad
80%
80%
$505
50%
50%
$335
50%
50%
Contributory
Contributory
5 enrolled
10 enrolled
None
12 Months
12 Months
$9.85
33
$32.39
$17.24
3
$67.61
$20.70
4
$76.19
$29.07
8
$119.53
$774.36 $2,532.70
$3,307.06
$39,684.72
9.9 %
•3.0%
$69.71
478.311
-$8.60
-0.3%
-$103.20
100MOUon shown is based on census dots pmvldetl. l»riYas(ra(Na ourposes only. The oo fftala of...,., Mel rates, end Mel enrcJlmenf wN spparsetle sny end al/ materials proWded herein. Page 7 of 9
October 2020 Dental Comparison for City of South Miami
Plan Name
Provider Ace
Benefit Description
Preventive SClass I)_
__Basic Class II
Meor Class III
Maximum Annual Benefit
Deductible (Individual/Family)
Deductible Waived - Class I
Orthodontia covers ellifetime max
Reimbursement Schedule
Benefits
Routine Exams - 9430
Teeth Cleaning -1110
Full Mouth/Panoramtc X-rays - 0330
Simple Extractions - 7111
Root Canal (Endod_ontics) - 3330
Pedo. Scaling/Root Planning - 4341
FuIt or Partlal Dentures- 5110
Crowns - 6752
Employer Contribution
Minimum Participation Requirement
Waiting Period Major Services
Rate Guarantee
r
Employee
Employee_+ Spouse
Enployee + Child(ren)
Family
Monthly Premium By Product
Total Monthly Premium
Total Annual Premium
To Change in Monthly Premium by Plan
$ Change In Monthly Premium by Plan
$ Change In Total Mont!gy Premium
Change in Total Annual Premium
$ Change In Total Annual Premium
44
8
7
2
DMO HD205 OR
FPO
In Network Only
In -Network
Out of Network
n/a
100%
100%
n/a_
80%
80%
n/a
50%
50°%
Unlimited
Unlimited
Unlimited
n/a
$50/$150
$50/$150
n/a
Yes
Yes
$2.650 Child & Adult
$1.000 Child Only
$1,000 Child Onl
Fee Schedule
Fee Schedule
MAC
No Charge
100°%
100°%
No Charge
100°%
100°%
No _Charge
100°%
100°%
No Charge
80°%
80%
$250
80%
80%
$55 per quad
80%
80%
$375
50°%
50%
$270
50%
50%
Contributory
Contributory
None
None
Tres 9/30/20
Expires 9/30/20
$8.49
33
$33.39
$16.98
3
$69.70
$19.11
4
$78.55
$30.74
8
$123.23
$704.65 $2,611.01
$3,315.66
$39,787.92
44
8
7
2
DHMO
PPO
In Network Only
In -Network
Out of Network
n/a
100%
100°%
n/a
80%
80%
n/a -
50%
-- - 50%
Unlimited
$1,000
$1,000
n/a
$50/$150
$50/$150
n/a
Yes
Yes
$2,650 Child / $2.850 Adult
$1.000 Child Only
$1,000 Child Onl
Fee Schedule
Fee Schedule
MAC
No Charge
100%
100°%
No Charge
100%
100%
No Charge
100°%
100%
$15
80%
80%
$225
80%
80%
$75 per quad
80%
80%
$295
50%
50%
$189
50%
60%
Contributory
Congb-utory
5 enrolled
Greater of 20% or 10 enrolled
None
None
24 Months
12 Months
$8.91
33
$27.65
$14.65
3
$55.01
$19.46
4
$73.82
$25.12
8
$101.19
$695.70 $2,182.28
$2,877.98 _
$34,535.76
-1.3%
48.95 -$dzs i3
$437.68
-13.2%
$5,252.16
InformaUm shown is based on census date provided. For fiustratNo purposes only. The cartfikato of coverno, final rates, and final enrollment wU supersede any and all matodWs provided herein- Page 8 of 9
October 2020 Dental Comparison for City of South Miami
Plan Name
Provider Acess
Benefit Description
Preventive (Class 1)
Basic (Class it)
Ma'or Class III
Maximum Annual Benefit
Deductible (Individual/Family)
Deductible Waived- Class I
Orthodontia covers ellifetime max
Reimbursement Schedule
Benefits
Routine Exams - 9430
Teeth Cleaning -1110
Full Mouth/Panoramic; X-rays - 0330
Simple Extractions - 7111
Root Canal (Endodontics)-3330
Perlo. Scaling/Root Planning - 4341
Full or Partial Dentures - 5110
Crowns - 6752
Employer Contribution
Minimum Participation Requirement_
Waiting Period Major Services
Rate Guarantee
Employee
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
HUniana
Humana
DMO HD205 OR
PPO
In Network Only
In -Network
Out of Network
We
100%
100%
n/a
80%
80%
n/a
60%
50%
Unlimited
Unlimited
Unlimited
n/a
$50/$150
$50/$150
We
Yes
Yes
$2,650 Child & Adult
$1.000 Child On[
$1,000 Child Only
Fee Schedule
Fee Schedule
MAC
No Charge
100%
100%
No Charge
100%
100%
No Charge
100%
100%
No Charge
80%
80%
$250
80%
80%
$55 per quad
80%
80%
$375
50%
50%
$270
50%
50%
Contributory
Contributory
None
None
Ex ires 9130120
Expires 9/30/20
Current
Current
$8.49
33
$33.39
$16.98
3
$69.70
$19.11
4
$78.55
$30.74
8
$123.23
$704.65 $2,611.01
$3,315.86
$39 787.92
DHMO D10591 S800B
PPO
In Network Only
in -Network
Out of Network
n/a
100%
100%
n/a
80%
80%
n/a
50%
50%
Unlimited .
Unlimited
Unlimited
n/a
$501$150
$50/$150
We
Yes
Yes
$3,360 Child / $3,460 Adult
$1,00OChildOnly
$1,000 Child Onl
Fee Schedule
Fee Schedule
MAC
$5
100%
100%
No Charge
100%
100%
$50
100%
100%
$65
80%
80%
$350
80%
80%
$80 per quad
80%
80%
$502
50%
50%
$290
50%
50%
Contributory
ontributory
75%
75%
None
None
12 Months
12 Months
$9.88
33
$30.06
$17.29
3
$62.75
$21.41
4
$70.72
$27.17
8
$110.94
$777.25 $2,350.63
$3,127.88
$37,534.56
10.3% -10.0%
$72.60 4260.38
4187.78
-5.7%
-$2,253.36
Inrmmeeon shown iahased on censusdatagovido0 per r➢uslmMo purpwaa only. The wnd le or coverage, hnalrales,and /materaoYmenlwtlsuparaede any and aN meterialsprovidedhareM. Page 9of9
October 2020 Vision Comparison for City of South Miami
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
Employee
Employee + Spouse
Employee + Child
Family
Monthly Total
Annual Total
Change in Total Annual Premium
$ Change In Monthly Premium by Plan
$ Change in Total Annual Premium
EyaMed
In -Network OON
$0 Copay up to $30
Every 12 Months
Reimbursement
$0 Copay up to $25
$0 Copay up to $40
$0 Copay up to $60
Every 12 Months
Reimbursement
$200 allowance + to $100
20% discount over up
Every 24 Months
Reimbursement
100% up to $210
$200 allowance up to $160
Voluntary
Expires 9/30/2020
$6.73
$13.45
$14.41
$21.71
$900.83
$10,809.96
E eMed
In -Network CON
$0 Copay up to $30
Every 12 Months
Reimbursement
$0 Copay up to $25
$0 Copay up to $40
$o Copay up to $60
Every 12 Months
Reimbursement
$200 allowance + up to $100
20% discount over
Every 24 Months
Reimbursement
100% up to $210
$200 allowance up to $160
Voluntary
12 Months
$7.13
$14.26
$15.27
$23.01
$954.61
$11.455.32
5.97%
$53.78
$645.36
In -Network CON
$0 Copay up to $45
Every 12 Months
Reimbursement
$10 Copay up to $35
$10 Copay up to $55
$10 Copay up to $90
Every 12 Months
Reimbursement
$180 allowance + up to $105
20% discount over
Every 24 Months
Reimbursement
100% up to $225
$180 allowance up to $144
Voluntary
Greater of 30% or 10 enrolled
48 Months
$8.16
$15.51
$16.33
$24.00
$1,048.51
$12,582.12
16.39%
$147.68
$1,772.16
Rates shown are based on census date provided. Final rates are subject to underwriting and actual enrollment. This comparison is for
Illustrative purposes only. The full policy and certificate of coverage will supersede any and all materials provided herein. Page 1 of 4
u,
T
October 2020 Vision Comparison for City of South Miami
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
Employee
Employee + Spouse
Employee + Child
Family
Monthly Total
Annual Total
%Change In Total Annual Premium
$ Change in Monthly Premium by Plan
$ Change in Total Annual Premium
E eMed
In -Network OON
$0 Copay up to $30
Every 12 Months
Reimbursement
$0 Copay up to $25
$0 Copay up to $40
$0 Copay _ up to $60
Every 12 Months
Reimbursement
$200 allowance + up to $100
20 k discount over
Every 24 Months
Reimbursement
100% up to $210
$200 allowance up to $160
Voluntary
Expires 9/30/2020
$6.73
$13.45
$14.41
$21.71
$900.83
$10.809.96
In -Network OON
$10 Copay up to $40
Every 12 Months
Reimbursement
$25 Copay up to $40
$25 Copay up to $60
$25 Copay up to $80
Every 12 Months
Reimbursement
$100 allowance + up to $50
20 /o discount over -
Every 24 Months
Reimbursement
100% up to $225
$100 allowance up to $80
Voluntary
4 enrolled
12 Months
$5.98
$10.76
$11.35
$17.92
$757.29
$9,087.48
-15.93%
($143.54)
($1,722.48)
Davis
In -Network OON
$0 Copay up to $50
Every 12 Months
Reimbursement
$0 Copay up to $48
$0 Copay up to $67
SO Copay up to $86
Every 12 Months
Reimbursement
$200 allowance + up to $48
20% discount over
Eve 24 Months
Reimbursement
100% up to $210
$200 allowance up to $105
Voluntary
70%
12 Months
$9.98
$16.79
$17.13
$27.10
$1,203.35
$14.440.Y0
33.58%
$302.52
$3,630.24
Rates shown are based on census date provided. Final rates are subject to underwriting and actual enrollment. This comparison is for
Willustraflve purposes only. The full policy and certificate of coverage will supersede any and all materials provided herein. Page 2 of 4
October 2020 Vision Comparison for City of South Miami
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
Employee
Employee + Spouse
Employee + Child
Family
Monthly Total
Annual Total
%Change in Total Annual Premium
$ Change in Monthly Premium by Plan
$ Chan a in Total Annual Premium
E eMed
In -Network OON
$0 Copay up to $30
Every 12 Months
Reimbursement
$0 Copay up to $25
$0 Copay up to $40
$0 Copay up to $60
Every 12 Months
Reimbursement
$200 allowance + up to $100
20 h discount over
Every 24 Months
Reimbursement
100% up to $210
$200 allowance up to $160
Voluntary
Expires 9/30/2020
$6.73
$13.45
$14.41
$21.71
$900.83
$10,809.96
In -Network OON
$0 Copay up to $40
Every 12 Months
Reimbursement
$0 Copay up to $40
$0 Copay up to $60
$OCopay up to $80
Every 12 Months
Reimbursement
$130 allowance + up to $45
30% discount over
Every 24 Months
Reimbursement
100% ujp_to$210____
$125 allowance up to $125
Voluntary
2 enrolled
24 Months
$8.78
$16.68
$19.56
$27.52
$1,169.16
$14,029.96
29.79%
$268.33
$3.220.00
In -Network CON
$0 Copay up to $45
Every 12 Months
Reimbursement
$0 Copay up to $30
$0 Copay up to $50
SOCopay up to $65
Every 12 Months
Reimbursement
$200 allowance + up to $70
20% discount over
Every 24 Months
Reimbursement
100% up to $210
$200 allowance + 0 % up to $105
discount over
Voluntary
70%
24 Months
$6.83
$13.68
$11.58
$19.09
$846.46
$10,181.52
.5.81%
($52.37)
($628.44)
Rates shown are based on census date provided. Final rates are subject to underwriting and actual enrollment: This comparison is for
W illustrative purposes only. The full policy and certificate of coverage will supersede any and ell materiels provided herein. page 3 of 4
October 2020 Vision Comparison for City of South Miami
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
Employee
Employee + Spouse
Employee + Child
Family
Monthly Total
Annual Total
%Change in Total Annual Premium
$ Change in Monthly Premium by Plan
$ Change in Total Annual Premium
E eMed
In -Network OON
$0 Copay, up to $30
Every 12 Months
Reimbursement
$0 Copay up to $25
$0 Copay up to $40
$0 Copay up to $60
Every 12 Months
Reimbursement
$200 allowance + up to $100
20% discount over
Every 24 Months
Reimbursement
100% up to $210
$200 allowance up to $160
Voluntary
Tres 9/3012020
$6.73
$13.45
$14.41
$21.71
$900.83
$10,809.96
In -Network OON
$0 Copay up to $52
Every 12 Months
Reimbursement
$10 Copay up to $55
$10 Copay up to $75
$10 Copay up to $95
Every 12 Months
Reimbursement
$ 050 allowance + up to $57
20% discount over
Every 24 Months
Reimbursement
$10 Copay up to $210
$150 allowance up to $105
Voluntary
Greater of 20% or 2 enrolled
12 Months
$5.77
$11.53
$12.68
$18.45
$775.08
$9,300.96
13.96 %
($125.75)
($1,509.00)
In -Network OON
$0 Copay up to $40
Every 12 Months
Reimbursement
$0 Copay, up to $40
$0 Copay up to $60
$OCopay up to $80
Every 12 Months
Reimbursement
$200 allowance + up to $45
30% discount over
Every 24 Months
Reimbursement
100% up to $210
$200 allowance up to $175
Voluntary
No participation requirements
36 Months
$6.37
$12.74
$13.65
$20.56
$852.98
$10,235.76
-5.31
($47.85)
($574.20)
Rates shown are based on census data provided. Final rates are subject to underwriting and actual enrollment. This comparison is for
W
111ustra0ve purposes only. The full policy and certificate of coverage will supersede any and all materials provided herein. Page 4 of 4