Res No 095-22-15848RESOLUTION NO. 095-22-15848
A Resolution authorizing the City Manager to purchase dental and vision
insurance benefits from Humana for full-tim e employees and participating
retirees for the 2022-2023 Fiscal Year.
WHEREAS, th e City, through it s Agent of Record , Brown and Brown of Florida.
so licited more than t hr ee quotes, compared the in surance rates, dental a nd vis io n p lan desig n,
provider network , as wel l as the C ity's previou s c laim s experi ence/ratio ; and
WHEREAS, City staff recommend th e sele ct ion of Humana for the prov is ion of dental
and v is ion insurance benefits for all fu ll-tim e employees a nd participating retiree s: and
WHEREAS, the premium s hall be cha rged to departmenta l lin e items in the ir re specti ve
account number.
NOW THEREFORE, BE IT RESOLVED BY THE MAYOR AND CITY
COMMISSIONERS OF THE CITY OF SOUTH MJAMI, FLORIDA :
Section 1. The foregoing recital s are hereby rat ified and con firm ed as being true and they
are incorporated into thi s re so lution by reference as if set fo rth in full herein.
Section 2. The Comm iss io n hereb y authorized the City Ma nager to execute the dental
and vision insurance renewal policy with Humana for the C it y of So uth Miami full -time
emp loyees and part ic ipatin g retiree s for th e 2022-2023.
Section 3. Corrections. Conformi ng language or techn ica l sc ri ve ner-ty pe correction s
may be made by the City Atto rn ey for any conforming amendments to be inco rp orated in to the
final resolution for s ignature.
Section 4. Severability. If any se cti on c lause. s entence, or phra se of thi s re so lu tion is for
any rea so n held invalid or un const ituti ona l by a cou1i of competent juri sdiction , the holding s hall
not affect the va lidity of the rem a ining po1iion s of thi s re so luti o n.
Section 5. Effective Date. Thi s re s olu ti on s hal l become effective immediatel y upo n
adoption.
PASSED AND ADOPTED thi s 16th day of August, 2022.
A0~~J .0 ?i~~
C ITYLERK~ /MAY~ /
READ AND APPROV E D AS TO FORM, COMMISSION VOTE: 5-0
LANGUAGE, LEGALITY AND Mayo r Philip s : Yea
Page 1 of 2
Res. No. 095-22-15848
NTH E Com mi ssioner Cor ey: Yea
Com mi ssioner Harri s : Yea
Commissioner Liebman: Yea
Commissio ner G il: Yea
Page 2 of 2
Agenda Item No:2.
City Commission Agenda Item Report
Meeting Date: August 16, 2022
Submitted by: Samantha Fraga-Lopez
Submitting Department: City Manager
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 the 2022-2023 Fiscal Year. 3/5 (City Manager)
Suggested Action:
Attachments:
Memo Vision and Dental 22-23.docx
Reso Dental and Vision 22-23.doc
Comparison_Dental_2022_CSM.pdf
COSM_Vision_EyeMed_2022.pdf
1
CITY OF SOUTH MIAMI
OFFICE OF THE CITY MANAGER
INTER-OFFICE MEMORANDUM
TO:The Honorable Mayor & Members of the City Commission
FROM: Shari Kamali, City Manager
VIA:Samantha Fraga-Lopez, Assistant City Manager
DATE: August 16, 2022
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 2022-2023.
BACKGROUND:The City’s benefits consultant, Brown and Brown of Florida, Inc., solicited
quotes from Humana, MetLife, Aetna, Cigna, Florida Blue, and Guardian
for the employee’s dental and vision insurance coverages for South Miami
full-time employees and retirees for the 2022 – 2023 Fiscal Year. Humana,
the City’s current dental and vision insurance carrier’s 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, was quoted at a $1.75 monthly increase. The City
currently contributes $8.49 per eligible employee, per month, toward
dental insurance coverage and vision is voluntarily paid by the employee.
The City currently offers vision insurance through Humana for 2022-2023
there is a flat renewal with no plan changes and no rate increases. The
renewal is appropriately funded in the proposed budget for Fiscal Year
2022-2023.
RECOMMENDATION:Based upon the proposals received, 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 $11,720 based on today’s full-time personnel.
ACCOUNT:Premium charges for the health will be charged to the designated
departmental budget line items as proposed in the Fiscal Year 2022-2023
budget.
ATTACHMENTS: Proposed resolution
Comparison Vision
Comparison Dental
2
THE CITY OF PLEASANT LIVING
October 2022 Dental Comparison for City of South Miami
Carrier Humana Humana
Plan Name DMO HD205 OR DMO HD205 OR
Provider Acess In Network Only In-Network Out of Network In Network Only In-Network Out of Network
Benefit Description
Preventive (Class I)n/a 100%100%n/a 100%100%
Basic (Class II)n/a 80%80%n/a 80%80%
Major (Class III)n/a 50%50%n/a 50%50%
Maximum Annual Benefit Unlimited Unlimited Unlimited Unlimited Unlimited Unlimited
Deductible (Individual/Family)n/a $50/$150 $50/$150 n/a $50/$150 $50/$150
Deductible Waived - Class I n/a Yes Yes n/a Yes Yes
Orthodontia (coverage/lifetime max)$2,650 Child & Adult $1,000 Child Only $1,000 Child Only $2,650 Child & Adult $1,000 Child Only $1,000 Child Only
Reimbursement Schedule Fee Schedule Fee Schedule MAC Fee Schedule Fee Schedule MAC
Benefits
Routine Exams - 9430 No Charge 100%100%No Charge 100%100%
Teeth Cleaning - 1110 No Charge 100%100%No Charge 100%100%
Full Mouth/Panoramic X-rays - 0330 No Charge 100%100%No Charge 100%100%
Simple Extractions - 7111 No Charge 80%80%No Charge 80%80%
Root Canal (Endodontics) - 3330 $250 80%80%$250 80%80%
Perio. Scaling/Root Planning - 4341 $55 per quad 80%80%$55 per quad 80%80%
Full or Partial Dentures - 5110 $375 50%50%$375 50%50%
Crowns - 6752 $270 50%50%$270 50%50%
Employer Contribution Contributory Contributory
Minimum Participation Requirement
Waiting Period Major Services None None
Rate Guarantee Expires 9/30/22 12 Months
Rates Current Renewal
Employee 34 $8.49 39 34 $8.49 39
Employee + Spouse 6 $16.98 4 6 $16.98 4
Employee + Child(ren)7 $19.11 1 7 $19.11 1
Family 4 $30.74 6 4 $30.74 6
Monthly Premium By Product $647.27 $647.27
Total Monthly Premium
Total Annual Premium
% Change in Monthly Premium by Plan 0.0%
$ Change in Monthly Premium by Plan $0.00
$ Change in Total Monthly Premium
% Change in Total Annual Premium
$ Change in Total Annual Premium
4.9%
$125.73
$125.73
3.9%
$1,508.76
$40,080.00$38,571.24
$35.73
$78.23
$138.32
$88.17
$3,340.00
$74.58
$131.86
$84.05
$2,567.00
$3,214.27
$2,692.73
$37.48
PPO
Humana
Current
Humana
Renewal
Contributory
PPO
Expires 9/30/22
Contributory
None None
12 Months
Information shown is based on census data provided. For illustrative purposes only. The certificate of coverage, final rates, and final enrollment wll supersede any and all materials provided herein.Page 1 of 85
1-------------11 1----1 -----I
October 2022 Dental Comparison for City of South Miami
Carrier Humana
Plan Name DMO HD205 OR
Provider Acess In Network Only In-Network Out of Network
Benefit Description
Preventive (Class I)n/a 100%100%
Basic (Class II)n/a 80%80%
Major (Class III)n/a 50%50%
Maximum Annual Benefit Unlimited Unlimited Unlimited
Deductible (Individual/Family)n/a $50/$150 $50/$150
Deductible Waived - Class I n/a Yes Yes
Orthodontia (coverage/lifetime max)$2,650 Child & Adult $1,000 Child Only $1,000 Child Only
Reimbursement Schedule Fee Schedule Fee Schedule MAC
Benefits
Routine Exams - 9430 No Charge 100%100%
Teeth Cleaning - 1110 No Charge 100%100%
Full Mouth/Panoramic X-rays - 0330 No Charge 100%100%
Simple Extractions - 7111 No Charge 80%80%
Root Canal (Endodontics) - 3330 $250 80%80%
Perio. Scaling/Root Planning - 4341 $55 per quad 80%80%
Full or Partial Dentures - 5110 $375 50%50%
Crowns - 6752 $270 50%50%
Employer Contribution Contributory
Minimum Participation Requirement
Waiting Period Major Services None
Rate Guarantee Expires 9/30/22
Rates Current
Employee 34 $8.49 39
Employee + Spouse 6 $16.98 4
Employee + Child(ren)7 $19.11 1
Family 4 $30.74 6
Monthly Premium By Product $647.27
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
$38,571.24
$35.73
$74.58
$131.86
$84.05
$2,567.00
$3,214.27
PPO
Humana
Current
Contributory
Expires 9/30/22
None
Humana
DMO HD205 OR
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
None
12 Months
Renewal
34 $8.49 39
6 $16.98 4
7 $19.11 1
4 $30.74 6
$647.27
0.0%
$0.00
0.0%
$0.00
$0.00
Humana
PPO
Contributory
None
12 Months
Negotiated Renewal
$35.73
$74.58
$84.05
$131.86
$2,567.00
$3,214.27
$38,571.24
0.0%
$0.00
Information shown is based on census data provided. For illustrative purposes only. The certificate of coverage, final rates, and final enrollment wll supersede any and all materials provided herein.Page 2 of 86
1-------------11 1----1 -----I
October 2022 Dental Comparison for City of South Miami
Carrier Humana
Plan Name DMO HD205 OR
Provider Acess In Network Only In-Network Out of Network
Benefit Description
Preventive (Class I)n/a 100%100%
Basic (Class II)n/a 80%80%
Major (Class III)n/a 50%50%
Maximum Annual Benefit Unlimited Unlimited Unlimited
Deductible (Individual/Family)n/a $50/$150 $50/$150
Deductible Waived - Class I n/a Yes Yes
Orthodontia (coverage/lifetime max)$2,650 Child & Adult $1,000 Child Only $1,000 Child Only
Reimbursement Schedule Fee Schedule Fee Schedule MAC
Benefits
Routine Exams - 9430 No Charge 100%100%
Teeth Cleaning - 1110 No Charge 100%100%
Full Mouth/Panoramic X-rays - 0330 No Charge 100%100%
Simple Extractions - 7111 No Charge 80%80%
Root Canal (Endodontics) - 3330 $250 80%80%
Perio. Scaling/Root Planning - 4341 $55 per quad 80%80%
Full or Partial Dentures - 5110 $375 50%50%
Crowns - 6752 $270 50%50%
Employer Contribution Contributory
Minimum Participation Requirement
Waiting Period Major Services None
Rate Guarantee Expires 9/30/22
Rates Current
Employee 34 $8.49 39
Employee + Spouse 6 $16.98 4
Employee + Child(ren)7 $19.11 1
Family 4 $30.74 6
Monthly Premium By Product $647.27
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
$38,571.24
$35.73
$74.58
$131.86
$84.05
$2,567.00
$3,214.27
PPO
Humana
Current
Contributory
Expires 9/30/22
None
Guardian
DHMO N100G
In Network Only In-Network Out of Network
n/a 100%100%
n/a 80%80%
n/a 50%50%
Unlimited $2,000 $2,000
n/a $50/$150 $50/$150
n/a Yes Yes
$2,545 Child / $2,845 Adult $1,000 Child Only $1,000 Child Only
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
None
12 Months
34 $8.90 39
6 $17.81 4
7 $21.30 1
4 $32.18 6
$687.28
6.2%
$40.01
0.4%
$170.52
$83.21
$130.54
$2,541.20
$3,228.48
$38,741.76
-1.0%
-$25.80
$14.21
Guardian
PPO
Contributory
85%
None
12 Months
$35.37
$73.83
Information shown is based on census data provided. For illustrative purposes only. The certificate of coverage, final rates, and final enrollment wll supersede any and all materials provided herein.Page 3 of 87
.-------------,1 .------1 -------1
October 2022 Dental Comparison for City of South Miami
Carrier Humana
Plan Name DMO HD205 OR
Provider Acess In Network Only In-Network Out of Network
Benefit Description
Preventive (Class I)n/a 100%100%
Basic (Class II)n/a 80%80%
Major (Class III)n/a 50%50%
Maximum Annual Benefit Unlimited Unlimited Unlimited
Deductible (Individual/Family)n/a $50/$150 $50/$150
Deductible Waived - Class I n/a Yes Yes
Orthodontia (coverage/lifetime max)$2,650 Child & Adult $1,000 Child Only $1,000 Child Only
Reimbursement Schedule Fee Schedule Fee Schedule MAC
Benefits
Routine Exams - 9430 No Charge 100%100%
Teeth Cleaning - 1110 No Charge 100%100%
Full Mouth/Panoramic X-rays - 0330 No Charge 100%100%
Simple Extractions - 7111 No Charge 80%80%
Root Canal (Endodontics) - 3330 $250 80%80%
Perio. Scaling/Root Planning - 4341 $55 per quad 80%80%
Full or Partial Dentures - 5110 $375 50%50%
Crowns - 6752 $270 50%50%
Employer Contribution Contributory
Minimum Participation Requirement
Waiting Period Major Services None
Rate Guarantee Expires 9/30/22
Rates Current
Employee 34 $8.49 39
Employee + Spouse 6 $16.98 4
Employee + Child(ren)7 $19.11 1
Family 4 $30.74 6
Monthly Premium By Product $647.27
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
$38,571.24
$35.73
$74.58
$131.86
$84.05
$2,567.00
$3,214.27
PPO
Humana
Current
Contributory
Expires 9/30/22
None
UnitedHealthcare
D1059 - S800B
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
$3,360 Child / $3,460 Adult $1,000 Child Only $1,000 Child Only
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
75%
None
12 Months
34 $8.89 39
6 $15.56 4
7 $19.26 1
4 $24.44 6
$628.20
-2.9%
-$19.07
$70.55
$79.51
$124.74
$2,428.35
$3,056.55
$36,678.60
UnitedHealthcare
PPO
Contributory
75%
12 Months
$33.80
-5.4%
-$138.65
-$157.72
-4.9%
-$1,892.64
Information shown is based on census data provided. For illustrative purposes only. The certificate of coverage, final rates, and final enrollment wll supersede any and all materials provided herein.Page 4 of 88
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October 2022 Dental Comparison for City of South Miami
Carrier Humana
Plan Name DMO HD205 OR
Provider Acess In Network Only In-Network Out of Network
Benefit Description
Preventive (Class I)n/a 100%100%
Basic (Class II)n/a 80%80%
Major (Class III)n/a 50%50%
Maximum Annual Benefit Unlimited Unlimited Unlimited
Deductible (Individual/Family)n/a $50/$150 $50/$150
Deductible Waived - Class I n/a Yes Yes
Orthodontia (coverage/lifetime max)$2,650 Child & Adult $1,000 Child Only $1,000 Child Only
Reimbursement Schedule Fee Schedule Fee Schedule MAC
Benefits
Routine Exams - 9430 No Charge 100%100%
Teeth Cleaning - 1110 No Charge 100%100%
Full Mouth/Panoramic X-rays - 0330 No Charge 100%100%
Simple Extractions - 7111 No Charge 80%80%
Root Canal (Endodontics) - 3330 $250 80%80%
Perio. Scaling/Root Planning - 4341 $55 per quad 80%80%
Full or Partial Dentures - 5110 $375 50%50%
Crowns - 6752 $270 50%50%
Employer Contribution Contributory
Minimum Participation Requirement
Waiting Period Major Services None
Rate Guarantee Expires 9/30/22
Rates Current
Employee 34 $8.49 39
Employee + Spouse 6 $16.98 4
Employee + Child(ren)7 $19.11 1
Family 4 $30.74 6
Monthly Premium By Product $647.27
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
$38,571.24
$35.73
$74.58
$131.86
$84.05
$2,567.00
$3,214.27
PPO
Humana
Current
Contributory
Expires 9/30/22
None
Cigna
Not Quoted
Aetna
Declined to Quote
Information shown is based on census data provided. For illustrative purposes only. The certificate of coverage, final rates, and final enrollment wll supersede any and all materials provided herein.Page 5 of 89
--------ii -: -------1
October 2022 Dental Comparison for City of South Miami
Carrier Humana
Plan Name DMO HD205 OR
Provider Acess In Network Only In-Network Out of Network
Benefit Description
Preventive (Class I)n/a 100%100%
Basic (Class II)n/a 80%80%
Major (Class III)n/a 50%50%
Maximum Annual Benefit Unlimited Unlimited Unlimited
Deductible (Individual/Family)n/a $50/$150 $50/$150
Deductible Waived - Class I n/a Yes Yes
Orthodontia (coverage/lifetime max)$2,650 Child & Adult $1,000 Child Only $1,000 Child Only
Reimbursement Schedule Fee Schedule Fee Schedule MAC
Benefits
Routine Exams - 9430 No Charge 100%100%
Teeth Cleaning - 1110 No Charge 100%100%
Full Mouth/Panoramic X-rays - 0330 No Charge 100%100%
Simple Extractions - 7111 No Charge 80%80%
Root Canal (Endodontics) - 3330 $250 80%80%
Perio. Scaling/Root Planning - 4341 $55 per quad 80%80%
Full or Partial Dentures - 5110 $375 50%50%
Crowns - 6752 $270 50%50%
Employer Contribution Contributory
Minimum Participation Requirement
Waiting Period Major Services None
Rate Guarantee Expires 9/30/22
Rates Current
Employee 34 $8.49 39
Employee + Spouse 6 $16.98 4
Employee + Child(ren)7 $19.11 1
Family 4 $30.74 6
Monthly Premium By Product $647.27
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
$38,571.24
$35.73
$74.58
$131.86
$84.05
$2,567.00
$3,214.27
PPO
Humana
Current
Contributory
Expires 9/30/22
None
Declined to Quote
Florida Blue Lincoln
Not Quoted
Information shown is based on census data provided. For illustrative purposes only. The certificate of coverage, final rates, and final enrollment wll supersede any and all materials provided herein.Page 6 of 810
--------11 1--------1
October 2022 Dental Comparison for City of South Miami
Carrier Humana
Plan Name DMO HD205 OR
Provider Acess In Network Only In-Network Out of Network
Benefit Description
Preventive (Class I)n/a 100%100%
Basic (Class II)n/a 80%80%
Major (Class III)n/a 50%50%
Maximum Annual Benefit Unlimited Unlimited Unlimited
Deductible (Individual/Family)n/a $50/$150 $50/$150
Deductible Waived - Class I n/a Yes Yes
Orthodontia (coverage/lifetime max)$2,650 Child & Adult $1,000 Child Only $1,000 Child Only
Reimbursement Schedule Fee Schedule Fee Schedule MAC
Benefits
Routine Exams - 9430 No Charge 100%100%
Teeth Cleaning - 1110 No Charge 100%100%
Full Mouth/Panoramic X-rays - 0330 No Charge 100%100%
Simple Extractions - 7111 No Charge 80%80%
Root Canal (Endodontics) - 3330 $250 80%80%
Perio. Scaling/Root Planning - 4341 $55 per quad 80%80%
Full or Partial Dentures - 5110 $375 50%50%
Crowns - 6752 $270 50%50%
Employer Contribution Contributory
Minimum Participation Requirement
Waiting Period Major Services None
Rate Guarantee Expires 9/30/22
Rates Current
Employee 34 $8.49 39
Employee + Spouse 6 $16.98 4
Employee + Child(ren)7 $19.11 1
Family 4 $30.74 6
Monthly Premium By Product $647.27
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
$38,571.24
$35.73
$74.58
$131.86
$84.05
$2,567.00
$3,214.27
PPO
Humana
Current
Contributory
Expires 9/30/22
None
Not Quoted
Mutual of Omaha
Declined to Quote
MetLife
Information shown is based on census data provided. For illustrative purposes only. The certificate of coverage, final rates, and final enrollment wll supersede any and all materials provided herein.Page 7 of 811
------ti l_-----1
October 2022 Dental Comparison for City of South Miami
Carrier Humana
Plan Name DMO HD205 OR
Provider Acess In Network Only In-Network Out of Network
Benefit Description
Preventive (Class I)n/a 100%100%
Basic (Class II)n/a 80%80%
Major (Class III)n/a 50%50%
Maximum Annual Benefit Unlimited Unlimited Unlimited
Deductible (Individual/Family)n/a $50/$150 $50/$150
Deductible Waived - Class I n/a Yes Yes
Orthodontia (coverage/lifetime max)$2,650 Child & Adult $1,000 Child Only $1,000 Child Only
Reimbursement Schedule Fee Schedule Fee Schedule MAC
Benefits
Routine Exams - 9430 No Charge 100%100%
Teeth Cleaning - 1110 No Charge 100%100%
Full Mouth/Panoramic X-rays - 0330 No Charge 100%100%
Simple Extractions - 7111 No Charge 80%80%
Root Canal (Endodontics) - 3330 $250 80%80%
Perio. Scaling/Root Planning - 4341 $55 per quad 80%80%
Full or Partial Dentures - 5110 $375 50%50%
Crowns - 6752 $270 50%50%
Employer Contribution Contributory
Minimum Participation Requirement
Waiting Period Major Services None
Rate Guarantee Expires 9/30/22
Rates Current
Employee 34 $8.49 39
Employee + Spouse 6 $16.98 4
Employee + Child(ren)7 $19.11 1
Family 4 $30.74 6
Monthly Premium By Product $647.27
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
$38,571.24
$35.73
$74.58
$131.86
$84.05
$2,567.00
$3,214.27
PPO
Humana
Current
Contributory
Expires 9/30/22
None
Standard
Declined to Quote
Information shown is based on census data provided. For illustrative purposes only. The certificate of coverage, final rates, and final enrollment wll supersede any and all materials provided herein.Page 8 of 812
October 2022 Vision Comparison for City of South MiamiCarrierNetwork ProviderNetwork StatusIn-NetworkOONIn-NetworkOONIn-NetworkOONEye Care WellnessEye Exam$0 Copayup to $30$0 Copayup to $30$0 Copayup to $30FrequencyLensesReimbursementReimbursementReimbursementSingle Vision$0 Copayup to $25$0 Copayup to $25$0 Copayup to $25Bifocals$0 Copayup to $40$0 Copayup to $40$0 Copayup to $40Trifocal$0 Copayup to $60$0 Copayup to $60$0 Copayup to $60FrequencyFramesReimbursementReimbursementReimbursementSelected Frames$200 allowance + 20% discount overup to $100$200 allowance + 20% discount overup to $100$200 allowance + 20% discount overup to $100FrequencyContactsReimbursementReimbursementReimbursementMedically Necessary100%up to $210100%up to $210100%up to $210Elective Contacts$200 allowance up to $160$200 allowance up to $160$200 allowance up to $160Contribution TypeParticipation RequirementsRate GuaranteeRatesEmployee565656Employee + Spouse888Employee + Child111111Family666Monthly TotalAnnual Total% Change in Total Annual Premium$ Change in Monthly Premium by Plan$ Change in Total Annual Premium$0.00$7.13$14.26$15.27$23.01$819.39$9,832.680.00%$0.00HumanaEyeMedEvery 12 MonthsEvery 12 MonthsEvery 24 MonthsVoluntary24 MonthsNegotiated RenewalHumanaEyeMedHumanaEyeMed$23.01$819.39$9,832.68Every 12 MonthsEvery 12 MonthsEvery 24 MonthsExpires 9/30/2022$15.27Current$7.13$14.26Voluntary$579.6024 MonthsRenewal$7.55$10,412.28$16.17$15.10$24.37$867.69$48.305.89%VoluntaryEvery 12 MonthsEvery 12 MonthsEvery 24 MonthsPage 1 of 513 ---•s-I 11 I Rate:s shown arer b~0soo' on cens1i1s data pr-ovTd'ed.. f°lflal mtn ,are s-l!ibjeot lo un.oeri...,rjfjlg and a.cllJ'itl SflrotkminL This OOmP@r,ison i!i ror s-lratlve pt1rpc1M-s only. The hi I policy and oertllical.e or oov.mi,ge wil supersede:· HY and au materials 1provi:!ed her-m.