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Res No 127-24-16232RESOLUTION NO. 127-24-16232 A RESOLUTION OF THE MAYOR AND CITY COMMISSION OF THE CITY OF SOUTH MIAMI, FLORIDA, AUTHORIZING THE CITY MANAGER TO ENGAGE CURATIVE INSURANCE COMPANY FOR THE PURCHASE OF HEALTH INSURANCE COVERAGE FOR ELIGIBLE EMPLOYEES AND PARTICIPATING RETIREES FOR FISCAL YEAR 2024-25 IN THE APPROXIMATE PREMIUM AMOUNT OF $1,131,710; PROVIDING FOR IMPLEMENTATION, CORRECTIONS, AND AN EFFECTIVE DATE. WHEREAS, the City of South Miami (the "City") is in need of essential health insurance coverage for all eligible employees, dependents and-participating retirees for Fiscal Year (FY) 2024-2025 (the "Services,,) on an expedient basis to maintain continuous coverage; and WHEREAS, the City, through its insurance broker ofrecord, US-I Insurance Services Inc., Inc. ("Insurance Broker,'), solicited quotes from six ( 6) health insurance carriers; and WHEREAS, City Staff worked with the Insurance Broker to renegotiate its existing plan or find an acceptable alternative plan from other carriers; and WHEREAS, based upon acceptable quotes received from three (3) providers, and City Staff's recommendation on the most beneficial plans available, the City Commission desires to approve the purchase of the Services from Curative Insurance Company ("Curative") in the amount of approximately $1,131,710 cost to the City, based on the budgeted full-time positions for FY 2024-25, all as set forth in the City Manager's memorandum presented with this Resolution; and WHEREAS, the City Commission further desires to authorize the City Manager to execute any necessary agreements with Curative for the Services; and Page 1 of3 Res. No. 127-24-16232 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 FY 2024-25 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. Authol'izing City Manager to Engage Curative for Health Insurance Coverage for Eligible City Employees. The City Commission hereby authorizes the City Manager to engage Curative for the Services in the amount of approximately $1 ,131,710 cost to the City based on the budgeted full-time positions for FY 2024-25, as set forth in the City Manager's 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 FY 2024-25 Budget. Section 3. Implementation. The City Manager is hereby authorized to take any and all necessary action to implement the purposes of this Resolution, including executing any necessary agreement(s) with Curative for the Services, subject to the approval of the City Attorney as to form and legal sufficiency. Section 4. Corrections. Confo1ming language or technical scrivener-ty pe corrections may be made by the City Attorney for any conforming amendments to be incorporated into the final resolution for signature. Page 2 of 3 Res . No. 127-24-16232 Section 5. Effective Date. This Resolution shall become effective immediately upon adoption . PASS ED AND ADOPTED this 20th day of August, 2024. ATTEST: CnY ~hJ READ AND APPROVED AS TO FORM, LANGUAGE, LEGALITY AND EXECUTION THEREOF APPROV ~ M€ COMMISSION VOTE: Mayor Fernandez: Vice Mayor Bonich : Commissioner Calle: 4-0 Yea Absent Yea Commissioner Liebman : Yea Commissioner Corey : Yea Page 3 of 3 Agenda Item No:17. City Commission Agenda Item Report Meeting Date: August 20, 2024 Submitted by: Samantha Fraga-Lopez Submitting Department: Human Resources 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 CURATIVE INSURANCE COMPANY FOR THE PURCHASE OF HEALTH INSURANCE COVERAGE FOR ELIGIBLE EMPLOYEES AND PARTICIPATING RETIREES FOR FISCAL YEAR 2024-25 IN THE APPROXIMATE PREMIUM AMOUNT OF $1,131,710; PROVIDING FOR IMPLEMENTATION, CORRECTIONS, AND AN EFFECTIVE DATE. 3/5 (CITY MANAGER-HUMAN RESOURCES & RISK MANAGEMENT DIVISION) Suggested Action: Attachments: Manager Memo - 2024-25 Health Insurance for FTEs and Participating Retirees.docx 49E723002-Reso Authorizing CM to Engage Curative for Purchase of Health Insurance FY 24 25.DOCX Manager Memo - Attachment A - Medical Market Comparison.pdf Curative Florida Presentation.pptx General_Auto Approval_Curative Zero Card_One Pager_240515v.2 (2).pdf Manager Memo - Attachment B1 - Decline to Quote Letters (Aetna & United Healthcare).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 20, 2024 SUBJECT: Health Insurance for Eligible Employees and Participating Retirees for Fiscal Year (FY)2024-25 RECOMMENDATION:Authorize the City Manager to engage Curative Insurance Company for medical insurance for the City’s Eligible Employees and Participating Retirees. BACKGROUND:The City’s Broker of Record,US-I Insurance Services Inc., solicited quotes from Aetna, AvMed, Florida Blue,United Healthcare,Curative Insurance Company, as well as from Cigna Healthcare (the City’s current carrier),for the medical health insurance coverages for South Miami full-time employees and retirees for the FY 2024-25. Based on the City’s high claims experience, Aetna and United Healthcare declined to quote, as they could not offer a competitive rate.AvMed quoted several variations of the City’s plan in an attempt to be “competitive,” however,the proposal that most closely matched the City’s plan was 9.7% higher than the City’s renewal and offered a lesser plan,thus was deemed non-competitive. Cigna Healthcare, Florida Blue,and Curative Insurance Company all provided competitive quotes.Curative Insurance Company submitted a quote for it’s PPO plan that includes zero-dollar copays and zero-dollar deductibles with the completion of one (1)baseline visit (per year, per employee and dependents 18+) within 120 days from the plan start date. Based on the employee only cost and 136 eligible employees, the annual cost to the City would be approximately $1,131,710 a savings of approximately $110,649 from current when you factor in the GAP plan the City currently funds as part of its health insurance coverage. Not only would the City see a savings, but across the board, employees who have coverage for their dependents would also see a savings. Employees who have their spouse on the plan would see an annual reduction of approximately $2,702 on their premiums, employees with their children on the plan would see an approximate reduction of $291 2 CITY OF SOUTH MIAMI OFFICE OF THE CITY MANAGER annually on their premiums and employees with their families on the plan would see an approximate annual reduction of $1,148.28. With completion of the baseline visit, employees will benefit from $0 co-pays and deductibles for the plan year. Curative utilizes the widely recognized First Health Network. 24/7 virtual care options are also available on-demand. Based on the plan, the network, and the cost savings associated, the City recommends purchasing the PPO Plan as medical insurance coverage for FY 2024-25 from Curative Insurance Company. AMOUNT:The estimated total annual premium cost for health benefits paid by the City is approximately $1,131,710.40 based on the budgeted eligible positions in FY 2024-25. ACCOUNT:Premium charges for health insurance coverages will be charged to the designated departmental budget line items as proposed in the Fiscal Year 2024-25 budget. ATTACHMENTS: A. Medical Market Comparisons B. Decline to Quote Letters (Aetna and United Healthcare) C. AvMed Proposal – Non-Competitive D. Proposed Resolution E. Curative Informational PowerPoint 3 City of South MiamiCost SummaryOctober 1, 2024 Renewal DateCarriers Current Renewal Option 1 Option 2 Option 3 Option 4 Option 5Medical Administration Cigna Cigna CignaFlorida Blue Florida Blue Curative CurativeMedical Stop Loss Cigna Cigna CignaN/A N/A N/A N/ALimited Benefit Group Supplemental Insurance Prosperity Life Prosperity LifeN/A N/A N/A N/ATotal Annual CostMedical Claims Liability at Max. $564,879 $565,133 $676,242Medical Administration $311,951 $312,109 $326,062Medical Stop Loss $1,118 $45,086 $45,295Limited Benefit Group Supplemental Insurance $155,653 $155,653 $0$0 $0PCORI Fee (119 Estimated Members) $383 $383 $383 $0 $0 $0 $0Annual Total $1,033,984 $1,078,365 $1,047,981 $971,299 $992,835 $955,328 $939,653Change from Current$44,380 $13,997 -$62,686 -$41,149 -$78,656 -$94,331Percentage Change4.3% 1.4% -6.1% -4.0% -7.6% -9.1%$992,835$971,299 $955,328 $939,653 CONFIDENTIAL | © 2024 USI Insurance Services. All rights reserved. 7 City of South MiamiMedical PlanBenefit Outline and Cost SummaryOctober 1, 2024 Renewal DateCurrent Renewal Option 1 Option 2Benefit Outline LocalPlus IN Open Access LocalPlus IN Open Access LocalPlus IN Open Access Blue Care 47 BlueOptions 05771Carrier Cigna Cigna Cigna Cigna Cigna Cigna Florida Blue Florida BluePlan Type, Name, Network HMO PPO HMO PPO HMO PPO HMO PPODeductible (Individual / Family)$5,000 / $10,000 $5,000 / $10,000 $5,000 / $10,000 $5,000 / $10,000$1,500 / $4,500 $1,500 / $4,500 $1,500 / $4,500 $1,500 / $4,500Non-Network Deductible (Individual / Family)N/A $10,000 / $20,000 N/A $10,000 / $20,000 N/A$4,500 / $13,500N/A$4,500 / $13,500Out-of-Pocket Maximum (Individual / Family)$7,500 / $15,000 $7,500 / $15,000 $7,500 / $15,000 $7,500 / $15,000$4,500 / $9,000 $4,500 / $9,000 $3,500 / $7,000 $3,500 / $7,000Non-Network OOP Max (Individual / Family)N/A $15,000 / $30,000 N/A $15,000 / $30,000 N/A$9,000 / $18,000N/A$9,000 / $18,000Deductible / OOP Embedded / Non-Embedded Embedded Embedded Embedded Embedded Embedded Embedded Embedded EmbeddedPrescription Deductible (Individual / Family)$0 $0 $0 $0 $0 $0Prescription OOP Max (Individual / Family)$0 $0 $0 $0 $0 $0Coinsurance (In / Out)80% / 0% 80% / 60% 80% / 0% 80% / 60% 80% / 0% 80% / 60% 80% / 0% 80% / 50%Wellness / Preventive Care 100% (dw) 100% (dw) 100% (dw) 100% (dw) 100% (dw) 100% (dw) 100% (dw) 100% (dw)Primary Care Office Visit $30 copay $30 copay $30 copay $30 copay $30 copay $30 copay $30 copay $30 copaySpecialist Office Visit $40 copay $40 copay $40 copay $40 copay$55 copay $55 copay $55 copay $55 copayWalk-In / Urgent Care Visit $50 copay $50 copay $50 copay $50 copay$60 copay $60 copay $60 copay $60 copayEmergency Room $350 copay $350 copay $350 copay $350 copay$250 copay $250 copay $250 copay $250 copayOutpatient Lab / X-Ray 80% (ad) 80% (ad) 80% (ad) 80% (ad) 100% 100%ICL: 100% (dw)DTC: $50 copayICL: 100% (dw)DTC: $50 copayComplex Imaging (MRI, CAT, PET, et al.)80% (ad) 80% (ad) 80% (ad) 80% (ad)$250 copay $250 copay $250 copay $250 copayOutpatient Surgical Facility 80% (ad) 80% (ad) 80% (ad) 80% (ad)$200 copay $200 copay ASC: $200 copay ASC: $200 copayInpatient Hospital Facility 80% (ad) 80% (ad) 80% (ad) 80% (ad) 80% (ad) 80% (ad) 80% (ad) 80% (ad)Retail Prescription Drug Copays $10 / $35 / $70 $10 / $35 / $70 $10 / $35 / $70 $10 / $35 / $70$10 / $50 / $80 $10 / $50 / $80 $10 / $50 / $80 $10 / $50 / $80Mail Order Prescription Drug Copays $25 / $88 / $175 $25 / $88 / $175 $25 / $88 / $175 $25 / $88 / $175$25 / $125 / $200 $25 / $125 / $200 $25 / $125 / $200 $25 / $125 / $200Specialty Prescription Drugs Tier Above Tier Above Tier Above Tier Above$250 copay $250 copay $250 copay $250 copayRates & Total Cost LocalPlus INOpen AccessEmployee 84 3 $642.50 $685.54 $674.97 $720.26 $765.88 $823.39 $699.78 $750.93Employee + Spouse 0 0 $1,529.14 $1,631.60 $1,606.40 $1,714.23 $1,822.76 $1,959.70 $1,595.50 $1,712.11Employee + Child(ren) 8 1 $1,182.20 $1,261.41 $1,241.94 $1,325.29 $1,409.21 $1,515.07 $1,399.56 $1,501.86Employee + Family 0 3 $2,004.60 $2,138.90 $2,105.88 $2,247.21 $2,389.53 $2,569.00 $2,239.30 $2,402.97Total Employees 92 7Annual Subtotal $761,131 $116,817 $799,596 $122,732 $907,291 $140,307 $839,736 $131,563Percent Change by Plan5.1% 5.1% 19.2% 20.1% 10.3% 12.6%HSA / HRA TotalAnnual Premium Total (w/out HSA/HRA)$877,948 $922,328 $1,047,598 $971,299Change from Current$44,380 $169,650 $93,351Percentage Change5.1% 19.3% 10.6%Annual Total Expected Costs$826,595 $870,953 $986,122 Annual Total Maximum Costs$877,948 $922,328 $1,047,598 Notes(dw) = deductible waived(ad) = after deductible(ad&c) = after deductible & coinsuranceICL = Independent Clinical LabDTC = Diagnostic Testing Center CONFIDENTIAL | © 2024 USI Insurance Services. All rights reserved. 8 City of South MiamiMedical PlanBenefit Outline and Cost SummaryOctober 1, 2024 Renewal DateCurrentBenefit Outline LocalPlus IN Open AccessCarrier Cigna CignaPlan Type, Name, Network HMO PPODeductible (Individual / Family)$5,000 / $10,000 $5,000 / $10,000Non-Network Deductible (Individual / Family)N/A $10,000 / $20,000Out-of-Pocket Maximum (Individual / Family)$7,500 / $15,000 $7,500 / $15,000Non-Network OOP Max (Individual / Family)N/A $15,000 / $30,000Deductible / OOP Embedded / Non-Embedded Embedded EmbeddedPrescription Deductible (Individual / Family)Prescription OOP Max (Individual / Family)Coinsurance (In / Out)80% / 0% 80% / 60%Wellness / Preventive Care 100% (dw) 100% (dw)Primary Care Office Visit $30 copay $30 copaySpecialist Office Visit $40 copay $40 copayWalk-In / Urgent Care Visit $50 copay $50 copayEmergency Room $350 copay $350 copayOutpatient Lab / X-Ray 80% (ad) 80% (ad)Complex Imaging (MRI, CAT, PET, et al.)80% (ad) 80% (ad)Outpatient Surgical Facility 80% (ad) 80% (ad)Inpatient Hospital Facility 80% (ad) 80% (ad)Retail Prescription Drug Copays $10 / $35 / $70 $10 / $35 / $70Mail Order Prescription Drug Copays $25 / $88 / $175 $25 / $88 / $175Specialty Prescription Drugs Tier Above Tier AboveRates & Total Cost LocalPlus INOpen AccessEmployee 84 3 $642.50 $685.54Employee + Spouse 0 0 $1,529.14 $1,631.60Employee + Child(ren) 8 1 $1,182.20 $1,261.41Employee + Family 0 3 $2,004.60 $2,138.90Total Employees 92 7Annual Subtotal $761,131 $116,817Percent Change by PlanHSA / HRA TotalAnnual Premium Total (w/out HSA/HRA)$877,948Change from CurrentPercentage ChangeAnnual Total Expected Costs$826,595Annual Total Maximum Costs$877,948Notes(dw) = deductible waived(ad) = after deductible(ad&c) = after deductible & coinsuranceICL = Independent Clinical LabDTC = Diagnostic Testing CenterOption 3Blue Care 47 BlueOptions 05771Florida Blue Florida BlueHMO PPO$1,500 / $4,500 $1,500 / $4,500N/A$4,500 / $13,500$2,500 / $5,000 $2,500 / $5,000N/A$9,000 / $18,000Embedded Embedded$0 $0$0 $080% / 0% 80% / 50%100% (dw) 100% (dw)$30 copay $30 copay$55 copay $55 copay$60 copay $60 copay$250 copay $250 copayICL: 100% (dw)DTC: $50 copayICL: 100% (dw)DTC: $50 copay$250 copay $250 copayASC: $200 copay ASC: $200 copay80% (ad) 80% (ad)$10 / $50 / $80 $10 / $50 / $80$25 / $125 / $200 $25 / $125 / $200$250 copay $250 copay$715.20 $768.24$1,630.66 $1,751.58$1,430.40 $1,536.48$2,288.64 $2,458.36$858,240 $134,59512.8% 15.2%$992,835$114,88713.1% CONFIDENTIAL | © 2024 USI Insurance Services. All rights reserved. 9 City of South MiamiMedical PlanBenefit Outline and Cost SummaryOctober 1, 2024 Renewal DateCurrentBenefit Outline LocalPlus IN Open AccessCarrier Cigna CignaPlan Type, Name, Network HMO PPODeductible (Individual / Family)$5,000 / $10,000 $5,000 / $10,000Non-Network Deductible (Individual / Family)N/A $10,000 / $20,000Out-of-Pocket Maximum (Individual / Family)$7,500 / $15,000 $7,500 / $15,000Non-Network OOP Max (Individual / Family)N/A $15,000 / $30,000Deductible / OOP Embedded / Non-Embedded Embedded EmbeddedPrescription Deductible (Individual / Family)Prescription OOP Max (Individual / Family)Coinsurance (In / Out)80% / 0% 80% / 60%Wellness / Preventive Care 100% (dw) 100% (dw)Primary Care Office Visit $30 copay $30 copaySpecialist Office Visit $40 copay $40 copayWalk-In / Urgent Care Visit $50 copay $50 copayEmergency Room $350 copay $350 copayOutpatient Lab / X-Ray 80% (ad) 80% (ad)Complex Imaging (MRI, CAT, PET, et al.)80% (ad) 80% (ad)Outpatient Surgical Facility 80% (ad) 80% (ad)Inpatient Hospital Facility 80% (ad) 80% (ad)Retail Prescription Drug Copays $10 / $35 / $70 $10 / $35 / $70Mail Order Prescription Drug Copays $25 / $88 / $175 $25 / $88 / $175Specialty Prescription Drugs Tier Above Tier AboveRates & Total Cost LocalPlus INOpen AccessEmployee 84 3 $642.50 $685.54Employee + Spouse 0 0 $1,529.14 $1,631.60Employee + Child(ren) 8 1 $1,182.20 $1,261.41Employee + Family 0 3 $2,004.60 $2,138.90Total Employees 92 7Annual Subtotal $761,131 $116,817Percent Change by PlanHSA / HRA TotalAnnual Premium Total (w/out HSA/HRA)$877,948Change from CurrentPercentage ChangeAnnual Total Expected Costs$826,595Annual Total Maximum Costs$877,948Notes(dw) = deductible waived(ad) = after deductible(ad&c) = after deductible & coinsuranceICL = Independent Clinical LabDTC = Diagnostic Testing CenterOption 4 Option 5EPO PPO PPO+ PPOCurative Curative Curative CurativeEPO PPO PPO+PPO$5,000 / $10,000 $5,000 / $10,000 $5,000 / $10,000 $5,000 / $10,000N/A$10,000 / $20,000$5,000 / $10,000$10,000 / $20,000 $7,500 / $15,000 $7,500 / $15,000 $7,500 / $15,000 $7,500 / $15,000N/A$15,000 / $30,000$7,500 / $15,000$15,000 / $30,000Embedded Embedded Embedded Embedded$0 $0 $0 $0$0 $0 $0 $080% / 80% 80% / 50% 80% / 80% 80% / 50%100% (dw) 100% (dw) 100% (dw) 100% (dw)$25 copay (ad) $25 copay (ad)$25 copay (ad)$25 copay (ad)$50 copay (ad) $50 copay (ad) $50 copay (ad) $50 copay (ad)80% (ad) 80% (ad)80% (ad)80% (ad)80% (ad) 80% (ad)80% (ad)80% (ad)80% (ad) 80% (ad) 80% (ad) 80% (ad)80% (ad) 80% (ad) 80% (ad) 80% (ad)80% (ad) 80% (ad) 80% (ad) 80% (ad)80% (ad) 80% (ad) 80% (ad) 80% (ad)$50 / $50 / $100 (ad) $50 / $50 / $100 (ad) $50 / $50 / $100 (ad) $50 / $50 / $100 (ad)TBD TBD TBD TBD25% (ad) 25% (ad) 25% (ad) 25% (ad)54 $647.05 30 $761.53 3 $836.49 87 $693.450 $1,358.81 0 $1,599.21 0 $1,756.63 0 $1,456.246 $1,190.57 2 $1,401.22 1 $1,539.15 9 $1,275.950 $2,018.81 0 $2,375.81 3 $2,609.87 3 $2,163.57$505,009 $307,780 $142,539 $939,653 $955,328 $939,653$77,380 $61,7058.8% 7.0% CONFIDENTIAL | © 2024 USI Insurance Services. All rights reserved. 10 City of South Miami Medical PlanAssumptions and ConditionsOctober 1, 2024 Renewal DateCigna / Open Access / Local Plus IN1.Employee 87 $118.75Employee w/Spouse 0 $220.08Employee w/Child(ren) 9 $185.83Family 3 $322.462. Month One Month Two Employee Only $206.42 $309.62 Employee w/Spouse $491.27 $736.91 Employee w/Child(ren) $379.81 $569.71Family $644.02 $966.033. Month One Month Two Employee Only $222.48 $333.72 Employee w/Spouse $529.52 $794.28 Employee w/Child(ren) $409.38 $614.07Family $694.17 $1,041.25Curative1.2.3. $10,000 Transition Credit LocalPlus IN Terminal Attachment Factors: OAP Terminal Attachment Factors: With completion of Baseline Visit in the first 120 days, deductibles and copays are waived for the balance of the plan year when visiting in-network provider or using in-network pharmacies for preferred medications. Renewal Rate Cap - 10%Prosperity Life Group (Limited Benefit Group Supplemental Insurance) CONFIDENTIAL | © 2024 USI Insurance Services. All rights reserved. 11 1Curative All rights reserved. A New Kind of Health Insurance 12 Curative © 2023, All rights reserved. Curative Insurance Company, PPO. BR-230215-1 Meet Curative: A proven track record of solving the unsolvable. We created the nation’s largest COVID-19 testing company practically overnight. During our time solving the nation-wide shortage in testing, we saw the opportunity payers have to better health and lower costs. We’re dedicated to using this agile mindset to make a difference as a next generation health plan. Our COVID-19 highlights: 36M COVID-19 test results 2M+Vaccines administered 40+States available 19k Testing sites 3 CLIA-certified labs The Story Behind Curative Video 13 Curative © 2023, All rights reserved. Curative Insurance Company, PPO. BR-230215-1 We have the financial strength and stability to succeed.Rated A- (Excellent) from AM Best 3Curative © 2023, All rights reserved. Curative Insurance Company, PPO. BR-230215-1 14 Curative © 2023, All rights reserved. Curative Insurance Company, PPO. BR-230215-1 8,000 Hospitals 170K ~1M Professional Providers Ancillary Facilities National Network Broad national network of ~1M providers 598 Hospitals 15K 51K Professional Providers Ancillary Facilities Florida Network 4 15 Curative © 2023, All rights reserved. Curative Insurance Company, PPO. BR-230215-1 5 We’ve become numb to the status quo of traditional health insurance. High out-of-pocket expenses Complex systems Minimal guidance 16 Curative © 2023, All rights reserved. Curative Insurance Company, PPO. BR-230215-1 6Sources: Curative Original Study, May 2023. of Americans could not afford their out-of-pocket costs if they had a major medical event or were diagnosed with a chronic illness. … and result in significant consequences for employees have deferred seeking medical care because they were worried about paying for it in the past year. have skipped their preventive health services, including yearly check-ups, routine medical tests, and treatments. didn’t take their medications as directed. Within the past year, due to cost: Curative © 2023,All rights reserved. Curative Insurance Company, PPO. BR-230215-1 41% 52% in Texas 55% in Florida 35% 42% in Texas 35% in Florida 50% 57% in Texas 59% in Florida 42% 46% in Texas 43% in Florida Even with health insurance: of working Americans have outstanding debt for medical expenses covering expenses not paid for by insurance 31% 38% in Texas 32% in Florida 17 © 2023, Curative Insurance Company 7 Traditional health plans can be a vicious cycle. CONDITIONED AVOIDANCE Members are conditioned to avoid care, disillusioned with the system entirely. MEMBER DISSATISFACTION Members only experience health insurance during their worst times instead of proactive points of value. WORSE HEALTH, PRODUCTIVITY AND FINANCIAL OUTCOMES Members defer care until it becomes more complicated and costlier, often resulting in worse health outcomes, medical debt, and poorer work performance. LACK OF AFFORDABILITY + CONFUSION Deductibles and copays are high and unpredictable. The system is hard to navigate and it’s unclear where to turn for help. Vicious Cycle of Traditional Health Plans 18 Slide 7 1 @marco.negrete@superside.com could we have a version of this slide with a stamp over it that says "It's time to break the cycle" Jessica Scodary, 9/22/2023 19 Curative © 2023, All rights reserved. Curative Insurance Company, PPO. BR-230215-1 8 Cost-Sharing & High-Deductible Health Plans have long-term costs. National Bureau of Economic Research, 2015, What Does a Deductible Do? The Impact of Cost-Sharing on Health Care Prices, Quantities, and Spending Dynamics Of chronic diseases can be averted by leveraging prevention https://www.ncbi.nlm.nih.gov/books/NBK53914/# “When faced with complex, high-dimensional choice problems, patients respond in simple, perverse ways.” Initial Savings: Large employer switching from $0 deductible to High Deductible Health Plans drives 12% annual spending decrease in 1st year. Savings Mainly in Prevention: Members reduce preventative spend (e.g. 32% reduction in indicated colonoscopies) more than services determined to be wasteful (e.g. only 17% reduction in imaging). Long-term Costs: Consumers do not behave rationally (on average), they do not price shop and they put off care leading to short term decreased spending but much greater long term spending. 20 Curative © 2023, All rights reserved. Curative Insurance Company, PPO. BR-230215-1 Introducing a sustainable healthcare plan that makes it easy to actually achieve better health. One competitive monthly premium, and with the completion of the Baseline Visit in the first 120 days, no copays, and no deductibles for in-network care and preferred prescriptions. No…really. Yes, even specialty and advanced care. 9Curative © 2023, All rights reserved. Curative Insurance Company, PPO. BR-230215-1 21 Curative © 2023, All rights reserved. Curative Insurance Company, PPO. BR-230215-1 10 We’re offering a plan your employees deserve. Bringing copays and deductibles down to zero including on most prescriptions so members are not prevented from seeking care when they need it. Affordable. With our Baseline Visit and trusted, ongoing support from a care navigator, members are actively engaged in their health from day 1. Engaging. Designing a simple, modern experience so healthcare is streamlined, integrated, and stress- free. Simple. No copays and deductibles With the completion of the Baseline Visit within 120 days Increased participation up to 50% higher than expected employee enrollment. 22 Curative © 2023, All rights reserved. Curative Insurance Company, PPO. BR-230215-1 11 Coverage Curative In-Network (Copay deductible, copay insurance when compliant with Baseline Visit) Curative In-Network (Copay deductible, copay insurance when didn’t complete Baseline Visit) Curative Out-of-Network Annual Deductible $0 $5,000/person and $10,000/family $10,000/person and $20,000/family Coinsurance Percentage 0%20% Medical 25% Pharmacy 50% Annual Out-of-Pocket Maximum (Medical)$0 $7,500/person and $15,000/family $15,000/person and $30,000/family Lifetime Maximum Benefit No Limit No Limit No Limit Office/Virtual Visit - Family Practice, Internal Medicine, OB/GYN, Pediatrics $0 $25 copay after deductible $50 copay after deductible Specialist Office/Virtual Visit $0 $50 copay after deductible $100 copay after deductible Telemedicine - Urgent Care with a 24/7/365 On Demand Doctor Visit $0 $0 copay No coverage Urgent Care $0 20% coinsurance after deductible 50% coinsurance after deductible Preferred Drugs - Includes certain Generic, Brand Name, & Specialty drugs $0 $50 copay after deductible 50% coinsurance after deductible Hospital / Free Standing Emergency Room $0 20% coinsurance after deductible 20% coinsurance after deductible Emergency Room Physicians $0 20% coinsurance after deductible 20% coinsurance after deductible Outpatient Surgery - Physician $0 20% coinsurance after deductible 50% coinsurance after deductible Outpatient Lab and X-Ray $0 20% coinsurance after deductible 50% coinsurance after deductible Hospital - Semi-private Room and Board $0 20% coinsurance after deductible 50% coinsurance after deductible Hospital Inpatient Surgery $0 20% coinsurance after deductible 50% coinsurance after deductible Benefits Summary: Available as a PPO, PPO+ and EPO network options 23 Curative © 2023, All rights reserved. Curative Insurance Company, PPO. BR-230215-1 12 At Curative, we’re committed to helping our members engage and get the most out of their health plan from day one. The Baseline Visit is designed to simplify the member experience for all. It’s an in-person or virtual meeting with a Care Navigator to orient to the plan and a Clinician to discuss a personal health roadmap. It is confidential with zero impact on premiums. We want to welcome our members back to health care they can trust. What is the Baseline Visit? completion of the Baseline Visit. High engagement 24 © 2023, Curative Insurance Company 13 The Baseline Visit starts a two-way conversation towards member health goals. 55% 94%•of Type 2 diabetes members were identified in the Baseline Visit in first 120 days. In other words, we don’t need to wait for claims to reach out with support. •of Type 2 diabetes members are in a Curative condition management program. Type 2 diabetes members who are in a condition program are in more than one 80% 25 © 2023, Curative Insurance Company 14 Condition management programs empower members to be their best self. 14 Current PartnersWeight Management Diabetes and Pre-Diabetes Hypertension Mental Health Maternal Health 26 © 2023, Curative Insurance Company 15 High-touch member communication builds trust and engagement. “Curative is very communicative, with calls or texts, knowledgeable, reliable, and kind!” Morgan, 2023 Curative Member Focused educational campaigns to demystify benefits. Member newsletters with latest resources. Two-way call and text communication, including just-in- time messages. Your prescription was received by an out-of-network pharmacy. To take full advantage of your Curative benefits, use an in-network pharmacy. curative.com/pharamacy or call Member Services 87 High NPS 27 Curative © 2023, All rights reserved. Curative Insurance Company, PPO. BR-230215-1 Preferred Non-Preferred Consists of generic and select brand and specialty medications Consists of lower value generics, brands, and specialty medications $0 Copay*$50/$250 Copay* 16 We’ve made our pharmacy benefit simple to increase compliance and lower costs. 97% of our pharmacy utilization $0 copay 1.Get your Baseline Visit within 120 days of your start date. 2.Visit an in- network provider who prescribes a preferred medication. 3.Use our preferred in- network pharmacies. 28 Curative © 2023, All rights reserved. Curative Insurance Company, PPO. BR-230215-1 17 Curative Adherence Average PBM Adherence Hypertension - CCB 93.2%76.5% Hypertension - RASA 91.5%79.4% Diabetes 94.9%75.7% Cholesterol - STATIN 94.3%75.7% COPD - LABA 92.2%41.2% And we have the data to show higher adherence. 29 Curative © 2023, All rights reserved. Curative Insurance Company, PPO. BR-230215-1 Pharmacy choice: from exclusive to everywhere. 18 Our in-network pharmacies include all locations across the United States. Don’t see a retailer?If a member is not near an in-network retail pharmacy and not in range of the Curative Pharmacy, Curative will use find an alternative custom option using the CapRx network to each person that is convenient. Curative Pharmacy National Retail Pharmacy Options Curative Pharmacy Same or next-day delivery Austin, Dallas, Houston and San Antonio Coming 2024: Tampa, Orlando and Miami Albertsons Pharmacy Companies: Acme Pharmacy, Albertsons Pharmacy, Albertsons Market Pharmacy, Amigos Pharmacy, Carrs Pharmacy, Haggen Pharmacy, Jewel-Osco Pharmacy, Market Street Pharmacy, Pavilions Pharmacy, Randalls Pharmacy, Safeway Pharmacy, Say-On Pharmacy, Star Market Pharmacy, Shaws Pharmacy, Tom Thumb Pharmacy, United Coalition Pharmacy, United Pharmacy, Vons Pharmacy Publix Pharmacy H-E-B Pharmacy Out of standard service area: CapRx Wrap Network* includes major partners, such as Walgreens, CVS, RiteAid, and Walmart 30 Curative © 2023, All rights reserved. Curative Insurance Company, PPO. BR-230215-1 Curative Pharmacy: making health and savings easy. Engagement with our pharmacy and members Communication Two-way text messaging Pharmacist consultations Follow-up after new start medications High-Level Care Personalized welcome packet with adherence aids Care coordination with your prescribers (refills, prior authorizations) Medication optimization — helping members get to the $0 option 19 31 Curative © 2023, All rights reserved. Curative Insurance Company, PPO. BR-230215-1 20Sources: 1CDC 2PEW Research Ditch the status quo. Learn what good can be for you and your employees. Sustainable cost savings through better health Employees engaged in maintaining their health and wellness Easy and clear health benefits for employers and their employees The average HDHP may save money in the first year but leads to delayed care and higher costs over time Our plan enables members to get the right care at the right time and setting, to deliver sustainable cost savings to employers Absenteeism caused by major chronic health conditions / unhealthy behaviors cost US employers $36.4B per year1 We catch problems early and eliminate the stress of navigating a complex system so employers can have healthy employees and a healthy company 1 in 2 workers left a job after finding better benefits3 We provide a simple, trustworthy plan that keeps employees satisfied and positively impacts retentionStatus QuoCurative32 Curative © 2023, All rights reserved. Curative Insurance Company, PPO. BR-230215-1 Let’s partner up. Better health. Better outcomes for all. 21 33 Call Member Services, available 24/7/365 at 855-428-7284. *To maintain $0 copays and deductibles, a Baseline Visit must be completed within the first 120 days of plan activation. Curative Zero Card Visa® Commercial Credit cards are issued by Celtic Bank. Additional Terms & Conditions can be found in your Member Portal Account at health.curative.com. Questions? As the fresh face in health plans, we know some doctors might not recognize us just yet. But your health shouldn't have to wait. This handy card takes care of your costs* and reassures you of your benefits. Your Backup for Care Prescriptions, non-covered plan benefits Office visits, urgent care visits, and certain outpatient visits at approved providers listed in the Curative Provider Search* or that you nominate What’s usually approved? What will not be approved? VIP Access: Nominate Your Provider, Amplify Your Care In addition to being a ticket to in-network care, we’re rolling out the red carpet for employees with a brand new Curative Zero Card feature. Starting 7/1/24, you can nominate your preferred healthcare providers—be it your family doctor, your go-to therapist, or the specialist you swear by. Following a quick nomination process, you can bring your go-to providers into the fold through the Zero Card. We’re removing barriers to top notch healthcare. Curative All rights reserved. 34 Next-steps for Hassle-free Healthcare 2 To get started, you’ll first need to activate the Curative Zero Card by logging into the member portal at health.curative.com and selecting “Zero Card” to follow the activation steps. Once completed, you’ll have access to the digital Curative Zero Card instantly. You’ll receive a physical card in the mail shortly after your plan start date. Note: Curative members must be 18 or older to access the card. If your provider is not on the Curative Provider Search at curative.com/providers, call Member Services at 855-428-7284 for approval or nominate your provider. Skip this step if your provider is listed. Simply give the provider’s office your Zero Card for payment and you’re all set! Here’s how you can access your Zero Card: Step 1 Step 2 Step 3 Curative All rights reserved. To submit a nomination, visit cur.tv/zero-card-nominate. We'll review your nomination, ensuring minimal wait times before you hear back from us. Once approved, your healthcare journey continues uninterrupted with your preferred provider, using the Zero Card. If you exceed the typical spending amount with this provider in the future, you might need to contact Member Services to request additional usage. Step 1 Step 2 Step 4 Step 3 Here’s how to nominate a preferred provider: 35 151 Farmington Avenue, F265, Hartford CT 06156 Proprietary Confirmation 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”) and 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 Care 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 the information. If it is still CITY OF SOUTH MIAMI’s position to have Aetna provide a quote for group health coverage, please a)Furnish the information indicated below that has not already been provided (where available), and b)Sign and return this notification to Aetna as indicated below. In order for Aetna 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 quote 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: o 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 if a completion factor has been applied) and provide the information broken down for each unique plan offering. Please identify if any of the plans are capitated and if so, 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 Hospital 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) (Where allowed by state) – will be required if/when monthly claim data is not available o Plan designs: A description of the plans which were 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. Additional Requested Data: ·Current Medical Management programs in place ·5 year carrier history ·Large Claim Data: including diagnosis and claimant status information and should 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 to 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 as well as identification of the top utilized facilities ·Please provide information/reason on any required data noted as not available CITY OF SOUTH MIAMI Certification: I understand Aetna’s 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 or at via fax. Health Insurance plans are offered, underwritten or administered by Aetna Life Insurance Company and its affiliates (Aetna). Health Information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Information is believed to be accurate as of the production date; however it is subject to change. For more information about Aetna Plans, refer to www.aetna.com. 36 3100 SW 145th Ave, 2nd Floor Miramar, Florida 33027 Jorge Godoy Account Executive UnitedHealthcare 3100 SW 145th Avenue Miramar, FL 33027 Tel (954) 378-0553 Cell (786) 712-5676 Uncompetitive Quote Notification Date: 07/23/2024 Requested Effective Date: 10/01/2024 Dear Lisa, Thank you for your recent proposal request on **City of South Miami**. After a thorough evaluation of the information provided, our decision is to decline to quote this request at this time. The reason for this declination is as follows: ▪ We are unable to provide a quote competitive with the current or renewal rates. We appreciate being given the opportunity to review this request and we look forward to working with your office on future prospects. If you have any questions or need assistance please contact me. Again, thank you for considering UnitedHealthcare. Sincerely, Jorge Godoy Key Accounts Account Executive Office - 954-378-0553 Cell - 786-712-5676 Email- jorge_l_godoy@uhc.com 37