Res No 100-23-16033RESOLUTION NO. 100-23 -16033
A RESOLUTION OF THE MAYOR AND CITY
COMMISSION OF THE CITY OF SOUTH MIAMI,
FLORIDA, AUTHORIZING THE CITY MANAGER TO
ENGAGE CIGNA FOR THE PURCHAS E OF HEAL TH
INSURANCE COVERAGE FOR EMPLOYEES AND
PARTICIPATING RETIREES FOR FISCAL YEAR 2023-
2024; PROVIDING FOR IMPLEMENTATION,
CORRECTIONS, AND AN EFFECTIVE DATE.
WHEREAS, the C ity of South M iam i (the "Cit y") is in need of essential h ealth in s urance
coverage for full -time e mployees and par ticipat ing retirees for Fisca l Year 2023 -2024 ("Services")
o n an exp e d ient bas is to maintain continuous coverage; and
WHEREAS, Section 5.H. of Article III, of the C ity's C ha rter, provides that competitive
b i ds are not app li cable to t he purchase of expert servic es that arc approved by th e City
Commiss ion; and
WHEREAS, th e C ity, throug h its in surance agent of record A & A Insu rance Services,
Inc. ("A & A Ins u rance"), solic ited quotes from fiv e (5) health in s urance providers; a nd
WHEREAS, City Staff wor ked with A & A In s urance to renegotiate its existing p lan or
find an acceptable a lternat ive p la n from a lternative carriers; and
WHEREAS, based upon the quotes and C ity Staffs r ecomm e nda tion on the m ost
bene ficial pl ans avai lable, the C ity Commi ssion d esi res to approve the purchase o f the Services
from Cigna Health care ("C igna") and Pros p erity L i fe Group ("Prosperity Life Group") for Fisca l
Year 2023-2024 in th e amount of approximately $1,2 I 0,5 90.00 based on the budgeted fu ll-time
positions for Fiscal Year 2023-2024, all as set fort h in th e C ity Manager m e m o randum presen ted
with t his R eso lu tion; and
WHEREAS, the C ity Co mm iss ion further des ires to authorize the City Ma n ager to execute
any necessary agreemen ts with C igna for t he ins uran ce se rv ices; a nd
Page 1 of 3
Res. No. 100-23-16033
WHEREAS, the premium amount shall be paid from various line items from various
departments, as applicable, and charged to departmental budget line items as proposed in the Fiscal
Year 2023-2024 Budget; and
WHEREAS, the City Commission finds that this Resolution is in the best interest and
welfare of the City, its employees and participating retirees.
NOW THEREFORE, BE IT RESOLVED BY THE MAYOR AND CITY
COMMISSION OF THE CITY OF SOUTH MIAMI, FLORIDA, AS FOLLOWS:
Section 1. Recitals. The above-stated recitals are true and correct and are incorporated
herein by this reference.
Section 2. Authorizing City Manager to Engage Cigna for the Services. The City
Commission hereby authorizes the City Manager to engage Cigna and Prosperity for the Services
for Fiscal Year 2023-2024 in the amount of approximately $1,210,590.00 based on the budgeted
full-time positions for Fiscal Year 2023-2024 , all as set forth in the City Manager memorandum
presented with this Resolution. The premium amount shall be paid from various line items from
various departments, as applicable, and charged to departmental budget line items as proposed in
the Fiscal Year 2023-2024 Budget.
Section 3. Authorization. The City Manager is hereby authorized to enter into any
necessary agreements with Cigna to execute the policy, subject to the approval of the City Attorney
as to form and legal sufficiency.
Section 4. Implementation. The City Manager is hereby authorized to take any and
all necessary action to implement the purposes of this Resolution.
Page 2 of 3
Res . No. 100-23 -16 033
Section 5. Corrections. Confonning la ng ua ge o r technica l scri vener-type co rrecti o ns
m ay be made by the C ity Atto rney for any co nforming amend ments to be inc orporated into the
fin a l r esolutio n for s ig n a ture .
Section 6. Effective Date. This R eso lution s hall beco m e effective immediately u pon
ad o ption.
PASSED AN D ADOPTED thi s 15 th d ay o f A u gust, 2023 .
A TTEST:
READ AND A PPROVED AS TO FORM,
LAN GU AGE, LEG ALITY AN D
E XECUTION THE REOF
WE IS
& BIERMAN, P.L.
C ITY A TTORNEY
AP P RO VED:
COMMISSION VOTE: 4-0
Mayor F e rnandez: Y e a
V ice May or Bonic h: o ut of ro o m
Commissione r Ca ll e: Yea
Com m issio n e r L ie bman : Yea
Commis s io n e r Corey : Yea
Page 3 of 3
Agenda Item No:5.
City Commission Agenda Item Report
Meeting Date: August 15, 2023
Submitted by: Samantha Fraga-Lopez
Submitting Department: City Manager
Item Type: Resolution
Agenda Section:
Subject:
A RESOLUTION OF THE MAYOR AND CITY COMMISSION OF THE CITY OF SOUTH MIAMI, FLORIDA,
AUTHORIZING THE CITY MANAGER TO ENGAGE CIGNA FOR THE PURCHASE OF HEALTH INSURANCE
COVERAGE FOR EMPLOYEES AND PARTICIPATING RETIREES FOR FISCAL YEAR 2023-2024;
PROVIDING FOR IMPLEMENTATION, CORRECTIONS, AND AN EFFECTIVE DATE. 3/5 (CITY
MANAGER-HUMAN RESOURCES)
Suggested Action:
Attachments:
Memo Health Ins 23-24.docx
4722271_-_Health_Insurance_-_Cigna.docx
Medical Market Analysis Aug 9 2023.pdf
DTQ Aetna.pdf
DTQ AvMed.pdf
DTQ Florida Blue.pdf
1
CITY OF SOUTH MIAMI
OFFICE OF THE CITY MANAGER
TO:The Honorable Mayor, Vice Mayor & Members of the City Commission
FROM:Genaro “Chip” Iglesias, City Manager
DATE:August 15, 2023
SUBJECT: Health Insurance for Full-Time Employees and Participating Retirees for FY 23-
24
RECOMMENDATION:City Staff recommend the City purchase medical insurance from Cigna.
BACKGROUND:The City’s agent of record, A&A Insurance, solicited quotes from Humana,
Aetna, Cigna, and Florida Blue,as well as from United Healthcare (the City’s
current carrier),for the medical health insurance coverages for South
Miami full-time employees and retirees for the 2023 –2024 Fiscal Year.
Based on the City’s high claims experience, Aetna, AvMed, and Florida Blue
declined to quote, as they could not offer a competitive rate.
After several rounds of negotiation, UnitedHealthcare offered a renewal
representing a 9.87% increase.A&A offered an alternate plan with Cigna
and a GAP plan offered by Prosperity Life Group. The combination of the
proposed plan and the GAP, represents a 5.05% increase from FY 22-23.
The GAP plan will cover all the out-of-pocket costs for participating
employees (co-pays, hospital admissions, outpatient surgeries, urgent care
visits, ER services, labs, diagnostic testing, etc.). Therefore, an employee
on the plan will not incur any out-of-pocket costs during the plan year.
Cigna is also offering a 1.5% credit on the City’s first month’s invoice
(approximately $13,500).
Based on the plan, the network, and the cost associated, the City
recommends purchasing medical insurance coverage for FY23-24 from
Cigna with a GAP plan from Prosperity Life Group.
AMOUNT:The estimated total annual premium cost for dental benefits paid by the
City is approximately $1,210,590 based on the budgeted full-time positions
in FY 23-24.
2
CITY OF SOUTH MIAMI
OFFICE OF THE CITY MANAGER
ACCOUNT:Premium charges for health insurance coverages will be charged to the
designated departmental budget line items as proposed in the Fiscal Year
2023-2024 budget.
ATTACHMENTS:Proposed resolution
Comparison Medical
Decline to Quote Letters (Aetna, AvMed, Florida Blue)
3
7Current/Renewal Plan 1:J] UnitedHealthcare .,_ '1•r••• , .. BXLH RXPl,on: NHDS Choice NHP HMO Open Access Prima,y Office \/",sits $15 Copay Specially Office Visits $30 Copay Virtual Visits (Telemediclne) $30 Copay Preventive Care covered 1 oo-;. Prescription Rx $10 / $35 / $70 Mail Order Rx 2.Sx Retail In Networtc Deductible $500 Family Deduellble $1,000 Coinsurance 100% Out of Poelcet Max $1,500 Family 00P Max $3,000 Included In MOOP Ded/Colns/Copays/RX Hospital Admission Covered 100% After Ded Outpatient Survery Covered 100% After Ded Urgent Care $50 Copay ER Services $350 Copay Ind. Lab Diagnostic Testing $0 Copay (bloodwork, x-rays Major Diagnostic Designated network: SO cost Non-designated networ1c 50% after ded Rates ! Cun-ent Rates Renewal Rates ! Employee 76 $720.,6 $791.56 0 Employee & Spouse 1 $1,11,.10 $1,883.92 0 Employee & Chlld(ren) 10 $1,325.65 $1,456.47 0 Family 1 $2,247.8' $2,469.67 1 To1al Monthly 88 $71,97'.00 $79,076.85 1 Peroen-1% I vs. Current ■ I 9.87% •% South,,Miami 11 II l II, ', U J'lf ,\S,\:-,,. 1 11\ l"'-1( Medical Market Analysis October 1, 2023 Current/Renewal Plan Proposed Plan fl" UnitedHealthcare· .•. ~(~Cigna -~ ... ~, ..•. ,.. ... CRUD-M (NHP Flex 2023) Local Plus In Networ1< RXPi,on NHDS Choice NHP HMO LCPIN (21,17587) Open Access OpenAceess $15 Copay $30 Copay $30 Copay 5'0 Copay $30 Copay $30 Copay Covered 100% Covered 100'4 $10 / $35 / $70 $10 / $35 / $70 2.Sx Retail 2.Sx Retall lnNetwortc lnNetwortc $500 $5.000 $1,000 $10,000 100% 80'4 $1,500 $7,500 $3,000 $15,000 De<I/Colns/Copays/RX Deel/Coins/Copays/RX Covered 100% After Ded Covered 80% after Ded Covered 100% After Oed Covered 80'1. after Oed $50 Copay $50 Copay $350 Copay $350 Copay SO Copay 80% afterded Designated network: SO cost 80%afterded Non-designated network: so•-'o after ded Current Rates Renewal Rates ! Proposed Rates Includes GAP Rates $762.77 $895.38 76 $785.52 s1,815.,o $2,131.01 1 $1,759.37 $1,'°3.50 $1,647.50 10 $1,375.86 $2,379.85 $2,793.59 1 $2,3'0.36 $2,379.85 $2,793.59 88 $76,037.85 I vs. Cumnt ■ I vs.current I vs. Renewal I 17.39% -~ 5.65'4 I -3.8'% ! 76 1 10 2 89 ■ I -.,. I •nus overview 1s prOYlded as a summary only It does r10t andude al benefits and llm1tat10ns in the plan Presented by Ana Roque INSU~VICES M,_ .. .,,.."'""-/·, .. .:;, .• ,,. ... $7,500 Proposed GAP Plan Proposed Plan .•. PR@SPERITY i)tcigna Prosperity Life Group Open Access Plus POV Gap OAP (21,1758a) 100% EMPLOYER PAID OpenAcceu $30 Copay 5'0 Copay Included in Annual Benefrt $30 Copay Covered 100% NIA $10 / $35 / $70 NIA 2.Sx Retail In Networ1< Out of Networtc $5,000 $10,000 $10,000 $20,000 $7,500 Annual Benefit (2X Family) 80% 60% Maxlmlm $15,000 for all persons covered $7,500 $15,000 $15,000 $30,000 Deel/Coins/Copays/RX Oed / Coins Inpatient Benerrt Covered 80% after Ded Included in Annual Benertt Outpatient Beneftt Covered 80o/. after Oed Included in Annual Benefit Included In Annual Benefit $50 Copay $350 Copay 80"!.afterded Covered 100•-'o ao•-'o after ded Proposed GAP Rates ! Proposed Rates Includes GAP Rates $118.75 0 $808.97 $220.08 0 $1,862.81 $185.83 0 $1,'55.8' $322.-&6 1 $2,475.96 $11,7'8.30 1 $2,475.96 I ■ I vs. Current I vs. Renewal I •• I 4.°'% I -11.37%
8151 Fmmiugtou Avemic,P26S, Hartfonl,C'I' 0616!1 aetna~ Commnation of Request for Group Health Coverage Aetna has recently completed a review of CITY OF SOUTH MIAMI's request for a quote of group health coverage (the "Request''). We have determined that we are not currently positioned to provide a competitive proposal. However, as an entity that offers health coverage and consistent with direction provided under Section 2702 of the Patient Protection and Affordable Can:: Act, we will provide a response to your Request and proceed with an insured quote should CITY OF SOUTH MIAMI continue to be interested in this information. If it is still CITY OF SOUTH MIAMI's position to have us provide a quote for group health coverage, please a) Furnish the information indicated below that has not already been provided (when:: available), and b) Sign and return this notification to us as indicated below. In order for us to provide you the quote, a signed request along with all requested data items is required no later than 30 days prior to the requested g_uote effective date. ··-········-·-··-········-···-·------------REQUIRED DATA: • Please provide a detailed summary of the plan design(s) requested. • Please provide the contribution strategy for the current and proposed plans. • Please provide the following historical information: 0 Monthly claims and corresponding enrollment counts for a recent 12 months minimum, up to a 24•month period. • Please identify the basis for the claim information (i.e., paid vs. incurred and if incurred whether a completion factor has been applied). Provide the information broken down for each unique plan offering. • Please identify if any of the plans are capitated. If so, indicate whether capitations are included/excluded from the claim information. • Large claim information for individual claims in excess of $25,000 based on the same time period as the claims data provided. • For H01Pital or Health Systems only: Claims need to be split by domestic and non-domestic. Also please provide home/host/domestic payment arrangement (i.e. discount off billed charges, fee schedules, etc.) • Individual Medical Questionnaires (IMQ)) (When:: allowed by state) -will be required if/when monthly claim data is not available 0 Plan designs: A description of the plans which wen:: in place during the experience period along with a description of any plan changes that occurred during this period and the date the change went into effect • Current and/or Renewal Rates • Please provide a complete census file including the following for all eligible employees: Age/DOB, Gender, Dependent Tier Status, COBRA Participant indicator, Waiver indicator, Retiree indicator, Home Zip Code, and Current Medical Plan Election. Additlonal Requested Data: • Current Medical Management programs in place • S•year carrier history • Large Claim Data: including diagnosis and claimant status information. Identify if amounts in excess of any pooling threshold have been included/excluded from the claim experience provided. • Current commission level • A recent utilization report from the current carrier. This should include historical achieved discount and trend information as well as utilization information relative to the use of inpatient hospital, outpatient hospital, and physician/other services. The report should also identify the top utilized facilities • Please provide information/reason on any required data noted as not available ·-························-········-···-··-----------···-------------·----·--------------·-------------------CITY OF SOUTH MIAMI Certification: I understand Aetna position on its product offerings' alignment with our request, but CITY OF SOUTH MIAMI requests a quote from Aetna as allowed under Section 2702 of the Patient Protection and Affordable Care Act. Signature Title Date Please send this form back c/o Mercedes Del Castillo via email mmdelcastill@aetna.com HeaUh lnsUl'8lloe plalls lltC offen,d, underwritten or adminiJtered by Aetna Life lnaUl'8lloe Company and ilS afflllates (Adna). Heald! informalion progr11111.1 provido gencnJ bealdl information and lltC not a sobslitute for dlagnosia or trealment by a physician or odler health care professional. lnformalion Is believed to be acx:urate as of die prodoc:clon date; however, it Signatme Tille Date Is subject to change. Por more informalion about Adna plans, refer to www .ac:tna.com.
9~ Av Med Embrace better health~ ~ August 3, 2023 Dan Wollansky Warner Pacific 1111 Suite 100 Miami, FL 33178 RE: City of South Miami Dear Dan: Thank you for giving us the opportunity to quote the health care benefits for your client. While we appreciate the opportunity, we are unable to provide a quote at this time based on AvMed not being competitive in comparison to their renewal rates with their current carrier. However, we hope to assist you in the near future on another quote. If you have any questions, please do not hesitate to call me. Respectfully, Iliana 9,f.enentfez Iliana Menendez Large Group Sr. Sales Representative 786-306-4170 9400 S. Dadeland Boulevard. Miami. FL 33156 I 800.432.6676 I AvMed.org
10July 31st, 2023 Florida Blue 4800 Deerwood Campus Parkway Jacksonville, FL 32246 Re: RFP for City of South Miami To Whom It May Concern, Please allow this letter to serve as confirmation that Florida Blue's rates are not competitive. If you have any questions or concerns, please do not hesitate to contact me. Thank you, Adelisa Jimeno I Mid-Market Account Executive -Sales ,:'; (w) 954-714-3611 I '' u (c) 954-290-8280 I r8I Adelisa.Jimeno@floridablue.com