08-03-04 Item 5(t"tl South Miami
AlChy
CITY OF SOUTH MIAMI l.nm�� NTEROFFICE MEMORANDUM
2001
TO: Honorable Mayor, Vice Mayor DATE: August 3, 2004
& City Commission j
FROM: Maria V. Davis ITEM No.of
City Manager k RE: Selection of
Group Health Insurance
RESOLUTION
A RESOLUTION OF THE MAYOR AND CITY COMMISSION OF
THE CITY OF SOUTH MIAMI, - FLORIDA, AUTHORIZING THE
CITY MANAGER TO ENTER INTO A CONTRACT WITH AVMED
HEALTHCARE TO PROVIDE GROUP HEALTH INSURANCE FOR
CITY OF SOUTH MIAMI FULL -TIME EMPLOYEES PROVIDING
AN EFFECTIVE DATE.
REQUEST
The attached resolution seeks approval from the City Commission for the City Manager to sign a one -year
contract with Avmed HealthCare to provide health insurance coverage for City of South Miami's full
time employees.
BACKGROUND
We have received renewal rates from our current group health insurance carrier — Cigna HealthCare and
noted a forty percent (40 %) increase in premiums. The Agent of Record found it necessary to seek an
insurance plan that would provide quality coverage at competitive rates. Our Agent of Record solicited
bids from several companies. Bids were received from the following: Aetna, AvMed, Blue Cross Blue
Shield, Humana and Vista Health Care.
A review committee consisting of the Agent of Record, the Human Resource Manager,
representatives of the PBA, AFSCME and the general employees carefully reviewed the
proposals and unanimously recommended the selection of AvMed Health Care.
ANALYSIS
It is estimated that selection of a new carrier will result in projected annual savings of
approximately $52,222 in the next fiscal year's budget, without resulting in reduced benefits for
our employees.
RECOMMENDATION
Approval is recommended.
Attachments: EBCG Insurance Bid Proposal
I RESOLUTION NO.
2
3 A RESOLUTION OF THE MAYOR AND CITY COMMISSION OF
4 THE CITY OF SOUTH MIAMI, FLORIDA, AUTHORIZING THE
5 CITY MANAGER ` TO ENTER INTO A CONTRACT WITH
6 AVMED HEALTHCARE TO PROVIDE GROUP HEALTH
7 INSURANCE FOR CITY OF SOUTH MIAMI FULL -TIME
8 EMPLOYEES; PROVIDING AN EFFECTIVE DATE.
9
10 WHEREAS, the City's Agent of Record received the health insurance renewal
11 rate wherein the current carrier proposed a forty percent (40 %) increase in premiums; and
12
13 WHEREAS, the Agent of Record has recommended that, due to this increase, we
14 seek out other carriers in an effort to get a more competitive rate; and
15
16 WHEREAS, the companies that submitted their proposals were: Aetna, AvMed,
17 BCBS, Humana, United HealthCare and Vista; and
18
19 WHEREAS, a review committee consisting of the Agent of Record, the Human
20 Resource Manager, representative of the PBA, AFSCME and general employees
21 carefully reviewed the proposals and unanimously recommended the selection of AvMed
22 HealthCare; and
23
24 WHEREAS, with the selection of the new health insurance provider AvMed
25 HealthCare; the designated Agent of Record will be Employee Benefits Consulting
26 Group until contract expires or until otherwise determined by either party.
27
28 NOW THEREFORE BE IT RESOLVED BY THE MAYOR AND CITY
29 COMMISSION OF THE CITY OF SOUTH MIAMI, FLORIDA;
30
31 Section 1. The City Manager is hereby authorized to contract with AvMed
32 HealthCare for the City's group health insurance.
33
34 Section 2. The contract shall be effective October 1, 2004 and shall be
35 renewable on an annual basis.
36
37 Section 3. This contract is at will and shall continue until either party terminates
38 the contract by giving written notice to the other party. The City shall not be charged for
39 agent of record services. Employee Benefits Consulting Group shall be compensated by
40 the insurer.
41
42
43
44
45
46
Additions shown by underlining and deletions shown by evetstFiking.
1
2
3
Section 4. This resolution shall take effect immediately upon approval.
4
5
PASSED AND ADOPTED this
day of , 2004.
6'
7
ATTEST:
APPROVED:
8
9
10
11
12
CITY CLERK
MAYOR
13
14
15
16
Commission Vote:
17
READ AND APPROVED AS TO FORM:
Mayor Mary Scott Russell:
18
Vice Mayor Velma Palmer:
19
Commissioner Randy G. Wiscombe:
20
Commissioner Marie Birts- Cooper:
21
Commissioner Craig Z. Sherar:
22
23
CITY ATTORNEY
24
City of South Miami
6130 Sunset Drive -, South Miami, Florida 33143
Health Insurance Selection
Aetna
AvMed
Blue Cross / Blue Shield
Humana
NHP
United Health Care
Vista
s,l'FU 7- jj`
r
a
40
2004 -2005
Please select one vendor:
Declined to quote
Human Resources Department
305- 668 -2515 (305) 668 -3877 Fax
mil/ js fj
cX, ol6e M�po s
Insurance Committee Member A�
Signature / Print Name
F
City of South Miami
6130 Sunset Drive., South Miami, Florida 33143
Health Insurance Selection
>OuTis
µ .H.._E4 =.7 �
2004 -2005
Please select one vendor:
Aetna
AvMed
Blue Cross / Blue Shield
Humana
NE? Declined to quote
United Health Care
Vista
Insurance Committee Member
S gnatu / Print Name
Human Resources Department
305- 668 -2515 (305) 668 -3877 Fax
City of South Miami
6130 Sunset Drive., South Miami, Florida 33143
Health Insurance Selection
Aetna
AvMed
Blue Cross / Blue Shield
Humana
NIP
United Health Care
Vista
Insurance Committee Member
acni?'Y C7AtL5�
2004 -2005
Please select one vendor:
Declined to quote
/ -1 1" o
Human Resources Department
305- 668 -2515 (305) 66 &3877 Fax
Po ,9 -- , ,Te �t-rp-er
T'� �f C�ji`tYb) to
gnature / Print Name "
City of South Miami
6130 Sunset Drive., South Miami, Florida 33143
Health Insurance Selection
Aetna
AvMed
Blue Cross / Blue Shield
Humana
NHP
United Health Care
Vista
Insurance Committee Member
x�.�y�T.. +{rppJ,7CP
fi #h k7ldT � �
2004 -2005
Please select one vendor:
f 11KO1p6s..
Declined to quote
Signature / Print Name
Human Resources Department
305- 668 -2515 (305) 668 -3877 Fax
City of South Miami
6130 Sunset Drive, South Miami, Florida 33143
Health Insurance Selection
Aetna
AvMed
Blue Cross / Blue Shield
Humana
NIP
United Health Care
Vista
Insurance Committee Member
S Ct LE r�1
w"Y 4
S
v4GC„F�C4r41YS? -
2004 -2005
Please select one vendor:
0 —0
Declined to quote
Signature / Print WAffe
Human Resources Department
305- 668 -2515 (305) 668 3877 Fax
MEDICAL PROPOSAL ANALYSIS
JULY 2004
Employee Benefits Consulting Group
TABLE OF CONTENTS
I. Executive Summary
II. Proposed Medical Rates
III. HMO Benefit Comparison
IV. POS/PPO Benefit Comparison
V. Survey Results
Employee Benefits Consulting Group
Executive Summary
Attached is our analysis of the medical proposals that we received on behalf of the City
of South Miami. We approached the following vendors in regards to this project:
Aetna Humana
Av Med Neighborhood Health Partnership
Blue Cross /Blue Shield United HealthCare
CIGNA (incumbent) Vista
CIGNA has proposed a 40% rate increase. The primary factor behind this rate increase is
the claims experience. From 10/1/03 - 3/31/04 the City of South Miami had a 120.8% loss
ratio with CIGNA:
a) Premium from 10/1/03- 3/31/04 $322,457
b) Claims paid from 10/1/03 - 3/31/04 $389,467
c) Loss ratio (b /a) 120.8%
During this time period there was one large individual claim of $120,608. It appears this
claim is no longer on- going.
From an underwriting perspective we feel that CIGNA's renewal is inappro rp iate. There
are currently 119 employees enrolled in the group medical plan. At this size the claim
experience is not very "credible." In our opinion the City of South Miami should receive
a rate action that is more indicative of CIGNA's entire pool /book of business.
Three other vendors proposed viable alternatives to the City of South Miami (Av Med,
Humana, and Vista). These companies quoted plans that are competitive to the current
rate structure and the proposed benefits are comparable to the CIGNA program.
Here are some of the municipalities /government sector groups that each of these vendors
currently have as clients:
Av Med
Miami Dade County
City of Fort Lauderdale
Village of Key Biscayne
Humana
Miami Dade County
City of Miami Beach
City of Hialeah Gardens
Broward Sheriff's Office
Broward County Schools
Vista
Miami Dade County
Broward Sheriff's Office
Broward County Schools
City of Hallandale
=► = esc_J
Employee Benefits Consulting Group
We are also performed a Benefit Survey with other municipalities in Dade County similar
in size to the City of South Miami. This survey can be used to evaluate the current benefit
structure (the results are enclosed). The following municipalities participated in the
survey:
Village of Bal Harbour
City of Florida City
City of Hialeah Gardens
Town of Medley
City of Miami Shores Village
City of Miami Springs
City of North Miami
City of North Miami Beach
Village of Pinecrest
City of Sunny Isles Beach
City of Sweetwater
We appreciate the opportunity the City of South Miami has given us in regards to this
project. Employee Benefits Consulting Group is prepared to assist the City of South
Miami in managing healthcare costs while still maintaining the integrity of the benefits
package.
2 Employee Benefits Consulting Group
Proposal Responses
Vendor Name Response
Aetna Submitted a proposal.
AvMed Submitted a proposal.
Blue Cross /Blue Shield Submitted a proposal.
Humana Submitted a proposal.
Neighborhood Health Partnership
United HealthCare
Declined to quote.
Submitted a proposal.
Vista Submitted a proposal.
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Proposed Medical Rates
Employer /Employee Cost Sharing
Gross Monthly Premium
HMO
Current (CIGNA)
Av Med
Employee only
$325.92
$289.04
Employee + child(ren)
$586.65
$504.63
Employee + spouse
$651.83
$560.73
Employee + child(ren) + spouse
$977.74
$841.10
POS
Employee only
$391.12
$355.91
Employee + child(ren)
$704.02
$621.37
Employee + spouse
$782.24
$690.46
Employee + child(ren) + spouse
$1,173.36
$1,035.68
Monthly Employee Contributions
HMO
Employee only
$0.00
$0.00
Employee + child(ren)
$260.73
$215.59
Employee + spouse
$325.91
$271.69
Employee + child(ren) + spouse
$651.82
$552.06
POS
Employee only
$65.20
$66.87
Employee + child(ren)
$378.10
$332.33
Employee + spouse
$456.32
$401.42
Employee + child(ren) + spouse
$847.44
$746.64
Enrollment Assumptions
HMO
Employee only
82
82
Employee + child(ren)
14
14
Employee + spouse
7
7
Employee + child(ren) + spouse
6
6
109
109
POS
Employee only
5
5
Employee + child(ren)
2
2
Employee + spouse
0
0
Employee + child(ren) + spouse
2
2
9
9
a) Gross Annual Premium Costs
$612,938
$537,978
b) Annual Employee Contributions
$151,435
$128,697
c) Employer /City's Cost (a -b)
$461,503
$409,281
City's Annual Savings (AvMed vs. CIGNA) = $52,222
Employee Contribution Savings (AvMed vs. CIGNA) $22,738
TOTAL SAVINGS $74,960
Page 3 Employee Benefits Consulting Group
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Survey Participants
Village of Bal Harbour
City of Florida City
City of Hialeah Gardens
Town of Medley
Village of Miami Shores
City of Miami Springs
City of North Miami
City of North Miami Beach
Village of Pinecrest
City of Sunny Isles Beach
City of Sweetwater
Employee Benefits Consulting Group
F�
HMO
Office Visit: Primary Care Physician
Office Visit: Specialist
Inpatient Hospital
Outpatient Hospital
Emergency Room
Prescription Drugs
Generic
Brand - Formulary
Brand - Non Formulary
POS
In- Network
Office Visit: Primary Care Physician
Office Visit: Specialist
Inpatient Hospital
Outpatient Hospital
Emergency Room
Prescription Drugs
Generic
Brand - Formulary
Brand - Non Formulary
Out-of-Network
Deductible
Coinsurance
Out -of- Pocket Maximum
Overall Survey Results
City of South Miami vs. Survey Results
City of South Miami
$10 copay /visit
$20 copay /visit
No copay
No copay
$50 copay /visit
$7 copay
$25 copay
$50 copay
$10 copay /visit
$20 copay /visit
No copay
No copay
$50 copay /visit
$7 copay
$25 copay
$50 copay
$500 /person
70%
$4,000 1person
Page 2
Median Survev Response
$15 copay /visit
$15 copay /visit
$250 copay /admission
$100 copay /visit
$50 copay /visit
$10 copay
$25 copay
$40 copay
$15 copay /visit
$15 copay /visit
$100 copay /day
up to $500 /admission
$100 copay /visit
$50 copay /visit
$10 copay
$20 copay
$40 copay
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