Res No 097-22-15850RESOLUTION NO. 097-22-15850
A Resolution authorizing the City Manager to purchase group health insurance
benefits from Neighborhood Health Plan (NHP) for full-time employees and
participating retirees for Fiscal Year 2022-2023.
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 NH P's HMO 2022 OA
BXLH/Rx NHSY 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 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 authorized the City Manager to purchase group health
insurance benefits from NHP for their HMO 2022 OA BXLH/Rx NHSY plan for the City of South
Miami full-time employees and participating retirees for the 2022-2023.
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 16 th day of August, 2022.
Page 1 of 2
Res. No. 097 -22-15850
A TT EST: APPROVED:
tJ i ~
CITY ~
READ AND APPROVED AS TO FORM, COMM ISSION VOTE : 5-0
LANGUAG E, LEGA LI TY AN D Mayor Phi l ips : Yea EXE~UTIO:;;~ Commiss i oner Corey: Yea
Commissioner Harris: Yea
Commissioner Liebman: Yea cl2SNEV Comm iss ioner Gil : Yea
Pa ge 2 of2
Agenda Item No:4.
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 group health insurance benefits from Neighborhood
Health Plan (NHP) for full-time employees and participating retirees for Fiscal Year 2022-2023. (City Manager)
Suggested Action:
Attachments:
Updated_Memo_Health_Insurance.docx
Reso_Health Ins 22-23.docx
Comparison_Medical REV_2022_CSM.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 group health
insurance benefits from Neighborhood Health Plan (NHP) for full-time
employees and participating retirees for Fiscal Year 2022-2023.
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 2022-2023benefit year. Afternegotiations, NHP, the City’s current
health insurance carrier, proposed a renewal rate which represented an
9.9% increase in premiums for a plan identical to the current plan. The
alternate plan proposed by NHP has higher co-pays and out-of-pocket
maximums and would ultimately be more costly to the employees.
Florida Blue offered a quote with a 9.9% increase over our current plan as
well, but the plan provides for more expensive co-pays and medications.
Humana offered quotes that were not competitive at 10.6% and 21.7%
increases and Aetna and Cigna declined to quote.
Based on prior plan rates, coverage offered including co-pays for
employees, and overall cost, the NHP HMO 2021 OA BXLH/Rx NHSY offers
the best plan for the City and its employees. Monthly rates are as follows:
Coverage 2021-2022
Employee $720.46
Employee &
Spouse
$1,714.70
Employee &
Children
$1,325.65
Family $2,247.84
The City currently contributes $655.56 per eligible employee per month
toward health insurance coverage. As outlined above, this amount will
increase to $720.46 which is 9.9% more than Fiscal Year 2021-2022. The
2
THE CITY OF PLEASANT LIVING
CITY OF SOUTH MIAMI
OFFICE OF THE CITY MANAGER
INTER-OFFICE MEMORANDUM
City and its benefits broker Brown and Brown are in the process of
negotiating a lower rate or a one-time credit to help lower the cost of the
plan. Once the credit is negotiated and received, the cost to the City will
decrease.
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 is approximately $1,072,000 based full-time personnel.
ACCOUNT:Premium charges for the health insurance will be charged to the
designated departmental budget line items as proposed in the Fiscal Year
2022-2023 budget.
ATTACHMENTS: Proposed resolution
2022-2023 Benefits Renewal Summary
Health Insurance Quote Comparison Chart
3
THE CITY OF PLEASANT LIVING
October 2022 Medical Plan Comparison for City of South Miami
Carrier Name UnitedHealthcare UnitedHealthcare UnitedHealthcare UnitedHealthcare
Plan Type NHP HMO 2021 OA NHP HMO 2022 OA NHP HMO 2022 OA NHP HMO 2022 OA
Product name BXLH / Rx NHSY BXLH / Rx NHSY BXLH / Rx NHSY BXLI-M / Rx NHWY
IN-NETWORK Current Renewal Negotiated Renewal Alternate
Calendar Year Deductible (CYD)
Individual / Family $500 / $1,000 $500 / $1,000 $500 / $1,000 $500 / $1,000
Coinsurance 100%100%100%90% / 10%
Provider Services Open Access Open Access Open Access Open Access
Primary Care Office Visit $15 $15 $15 $25
Specialist Office Visit $30 $30 $30 $45
Virtual Visit-Designated Virtual Provider $0 $0 $0 $0
Preventative Care $0 $0 $0 $0
Hospital Services
Inpatient Hospital Facility 0% Aft Ded 0% Aft Ded 0% Aft Ded $325/day to $1,625
Hospital Physician Services 0% Aft Ded 0% Aft Ded 0% Aft Ded $0
Outpatient Hospital Facility 0% Aft Ded 0% Aft Ded 0% Aft Ded $275
Emergency Room Facility $350*$350*$350*$100*
Outpatient Facility/Diagnostic
Ambulatory Surgery Center 0% Aft Ded 0% Aft Ded 0% Aft Ded $275
ASC Physician Services 0% Aft Ded 0% Aft Ded 0% Aft Ded $45
Lab / X-Ray $0 $0 $0 $0
Major Diagnostic (MRI,CAT,CT,PET)0% Aft Ded DDP: 0% Aft Ded / 50% Aft Ded DDP: 0% Aft Ded / 50% Aft Ded $80
Urgent Care $50 $50 $50 $45
Annual Out-of-Pocket Maximum
Includes Deductible (Yes / No)Yes Yes Yes Yes
Individual / Family $1,500 / $3,000 $1,500 / $3,000 $1,500 / $3,000 $3,500 / $7,000
Lifetime Maximum Unlimited Unlimited Unlimited Unlimited
Prescription Drugs
Tier 1/Tier 2/Tier 3/Tier 4/Tier 5 $10/$35/$70 $10/$35/$70 $10/$35/$70 $10/$50/$85
Mail Order (90 Day Supply)$25/$87.50/$175 $25/$87.50/$175 $25/$87.50/$175 $25/$125/$212.50
Preferred Specialty Retail Network $10/$150/$500 $10/$150/$500 $10/$150/$500 $10/$150/$500
Out-Of-Network Benefits
Coinsurance n/a n/a n/a n/a
Emergency Room Facility $350 $350 $350 $100
All Other Services n/a n/a n/a n/a
Deductible - Individual/Family n/a n/a n/a n/a
Annual Out-of-Pocket - Indiv/Family n/a n/a n/a n/a
Lifetime Maximum n/a n/a n/a n/a
Rates Walgreens is Excluded Walgreens is Excluded Walgreens is Excluded Walgreens is Excluded
Employee 70 $655.56 70 $747.34 70 $720.46 70 $691.54
Employee & Spouse 1 $1,560.24 1 $1,778.68 1 $1,714.70 1 $1,645.87
Employee & Child(ren)12 $1,206.23 12 $1,375.11 12 $1,325.65 12 $1,272.43
Family 1 $2,045.35 1 $2,331.70 1 $2,247.84 1 $2,157.61
Monthly Total by Product $63,969.55 $72,925.50 $70,302.54 $67,480.44
Annual Total $767,634.60 $875,106.00 $843,630.48 $809,765.28
$ Change in Monthly Premium $8,955.95 $6,332.99 $3,510.89
% Change in Total Annual Premium 14.0%9.9%5.5%
$ Change in Total Annual Premium $107,471.40 $75,995.88 $42,130.68
* Per FL Statute, Must Be Medical Emergency Defined by 641.31097
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 36
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October 2022 Medical Plan Comparison for City of South Miami
Carrier Name UnitedHealthcare
Plan Type NHP HMO 2021 OA
Product name BXLH / Rx NHSY
IN-NETWORK Current
Calendar Year Deductible (CYD)
Individual / Family $500 / $1,000
Coinsurance 100%
Provider Services Open Access
Primary Care Office Visit $15
Specialist Office Visit $30
Virtual Visit-Designated Virtual Provider $0
Preventative Care $0
Hospital Services
Inpatient Hospital Facility 0% Aft Ded
Hospital Physician Services 0% Aft Ded
Outpatient Hospital Facility 0% Aft Ded
Emergency Room Facility $350*
Outpatient Facility/Diagnostic
Ambulatory Surgery Center 0% Aft Ded
ASC Physician Services 0% Aft Ded
Lab / X-Ray $0
Major Diagnostic (MRI,CAT,CT,PET)0% Aft Ded
Urgent Care $50
Annual Out-of-Pocket Maximum
Includes Deductible (Yes / No)Yes
Individual / Family $1,500 / $3,000
Lifetime Maximum Unlimited
Prescription Drugs
Tier 1/Tier 2/Tier 3/Tier 4/Tier 5 $10/$35/$70
Mail Order (90 Day Supply)$25/$87.50/$175
Preferred Specialty Retail Network $10/$150/$500
Out-Of-Network Benefits
Coinsurance n/a
Emergency Room Facility $350
All Other Services n/a
Deductible - Individual/Family n/a
Annual Out-of-Pocket - Indiv/Family n/a
Lifetime Maximum n/a
Rates Walgreens is Excluded
Employee 70 $655.56
Employee & Spouse 1 $1,560.24
Employee & Child(ren)12 $1,206.23
Family 1 $2,045.35
Monthly Total by Product $63,969.55
Annual Total $767,634.60
$ Change in Monthly Premium
% Change in Total Annual Premium
$ Change in Total Annual Premium
* Per FL Statute, Must Be Medical Emergency Defined by 641.31097
UnitedHealthcare Florida Blue Florida Blue
UHC 2022 OA Choice +BlueCare BlueOptions
BWRD / Rx H54Y 60 03769
Alternate
$500 / $1,500 $500 / $1,000 $500 / $1,500
80% / 20%90% / 10%80% / 20%
Open Access Open Access Open Access
$25 DNP: $0 / $25 DNP: $0 / $25
$60 DNP $20 / $45 DNP; $20 / $60
$0 PCP $0 / Spc $45 PCP $0 / Spc $60
$0 $0 $0
20% Aft Ded $325/day to $1,625 20% Aft Ded
20% Aft Ded $0 $100
20% Aft Ded $275 20% Aft Ded
$300*$100 $300
20% Aft Ded $200 20% Aft Ded
20% Aft Ded $45 $60
$0 $0 / $45 $0 / $50
20% Aft Ded $80 20% Aft Ded
$65 DNP $0 1-2 visits / $45 DNP $0 1-2 visits / $65
Yes Yes Yes
$3,000 / $6,000 $3,500 / $7,000 $3,000 / $6,000
Unlimited Unlimited Unlimited
$10/$50/$85 $10/$50/$80 $10/$50/$80
$25/$125/$212.50 $25/$125/$200 $25/$125/$200
$10/$150/$500 Cost share based on Rx tier Cost share based on Rx tier
50% / 50%n/a 50% / 50%
$300 $100 $300
50% Aft Ded n/a 50% Aft Ded
$1,500 / $4,500 n/a $1,500 / $4,500
$6,000 / $12,000 n/a $6,000 / $12,000
Unlimited n/a Unlimited
Walgreens is Excluded
70 $791.88 70 $731.76 70 $749.89
1 $1,884.68 1 $1,668.41 1 $1,709.75
12 $1,457.06 12 $1,463.51 12 $1,499.78
1 $2,470.67 1 $2,341.62 1 $2,399.65
$77,271.67 $72,795.35 $74,599.06
$927,260.04 $843,602.20 $895,188.72
$13,302.12 $8,825.80 $10,629.51
20.8%9.9%16.6%
$159,625.44 $75,967.60 $127,554.12
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 37
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October 2022 Medical Plan Comparison for City of South Miami
Carrier Name UnitedHealthcare
Plan Type NHP HMO 2021 OA
Product name BXLH / Rx NHSY
IN-NETWORK Current
Calendar Year Deductible (CYD)
Individual / Family $500 / $1,000
Coinsurance 100%
Provider Services Open Access
Primary Care Office Visit $15
Specialist Office Visit $30
Virtual Visit-Designated Virtual Provider $0
Preventative Care $0
Hospital Services
Inpatient Hospital Facility 0% Aft Ded
Hospital Physician Services 0% Aft Ded
Outpatient Hospital Facility 0% Aft Ded
Emergency Room Facility $350*
Outpatient Facility/Diagnostic
Ambulatory Surgery Center 0% Aft Ded
ASC Physician Services 0% Aft Ded
Lab / X-Ray $0
Major Diagnostic (MRI,CAT,CT,PET)0% Aft Ded
Urgent Care $50
Annual Out-of-Pocket Maximum
Includes Deductible (Yes / No)Yes
Individual / Family $1,500 / $3,000
Lifetime Maximum Unlimited
Prescription Drugs
Tier 1/Tier 2/Tier 3/Tier 4/Tier 5 $10/$35/$70
Mail Order (90 Day Supply)$25/$87.50/$175
Preferred Specialty Retail Network $10/$150/$500
Out-Of-Network Benefits
Coinsurance n/a
Emergency Room Facility $350
All Other Services n/a
Deductible - Individual/Family n/a
Annual Out-of-Pocket - Indiv/Family n/a
Lifetime Maximum n/a
Rates Walgreens is Excluded
Employee 70 $655.56
Employee & Spouse 1 $1,560.24
Employee & Child(ren)12 $1,206.23
Family 1 $2,045.35
Monthly Total by Product $63,969.55
Annual Total $767,634.60
$ Change in Monthly Premium
% Change in Total Annual Premium
$ Change in Total Annual Premium
* Per FL Statute, Must Be Medical Emergency Defined by 641.31097
Humana Humana Aetna Cigna
OA HMO 16 NPOS 16
COPAYI/100 COPAYI/10070
$500 / $1,000 $500 / $1,000
100%100%
Open Access Open Access
$20 $20
$35 $35
$20 PCP Only $20 PCP Only
$0 $0
0% Aft Ded 0% Aft Ded
0% Aft Ded 0% Aft Ded
0% Aft Ded 0% Aft Ded
$350 $350
0% Aft Ded 0% Aft Ded Declined to Quote Declined to Quote
0% Aft Ded 0% Aft Ded
$0 $0
$300 $300
$50 $50
Yes Yes
$2,000 / $4,000 $2,000 / $4,000
Unlimited Unlimited
$10/$40/$70/25%$10/$40/$70/25%
$25/$100/$175/25%$25/$100/$175/25%
25% (Pre authorization req.)25% (Pre authorization req.)
n/a 70% / 30%
$350 $350
n/a 30% Aft Ded
n/a $1,500 / $3,000
n/a $6,000 / $12,000
n/a Unlimited
70 $750.44 70 $797.79
1 $1,786.05 1 $1,898.74
12 $1,380.81 12 $1,467.93
1 $2,341.38 1 $2,489.10
$73,227.95 $77,848.30
$848,793.40 $934,179.60
$9,258.40 $13,878.75
10.6%21.7%
$81,158.80 $166,545.00
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 3 of 38
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