09-28-99MAYOR:
VICE MAYOR:
COMMISSIONER:
COMMISSIONER:
COMMISSIONER:
...........................
Julio Rob aina
Armando Oliveros, Jr.
Horace G. Feliu
David D. Bethel
Mary Scott Russell
CITY MANAGER:
CITY ATTORNEY:
CITY CLERK:
Charles D. Scurr
Earl G. Gallop
Ronetta Taylor
SPECIAL CITY COMMISSION AGENDA
City Commission Meeting
Meeting date: September 28, 1999 6130 Sunset Drive, South Miami, FL
Next Regular Meeting date: October 5, 1999 Phone: (305) 663 -6340
Time: 6:30 PM
PURSUANT TO FLA STATUTES 286.0105, "THE CITY HEREBY ADVISES THE PUBLIC THAT IF A PERSON DECIDES
TO APPEAL ANY DECISION MADE BY THIS BOARD, AGENCY OR COMMISSION WITH RESPECT TO ANY MATTER
CONSIDERED AT ITS MEETING OR HEARING, HE OR SHE WILL NEED A RECORD OF THE PROCEEDINGS, AND THAT
FOR SUCH PURPOSE, AFFECTED PERSON MAY NEED TO ENSURE THAT A VERBATIM RECORD OF THE PROCEEDINGS IS
MADE WHICH RECORD INCLUDES THE TESTIMONY AND EVIDENCE UPON WHICH THE APPEAL IS TO BE BASED. THIS
NOTICE DOES NOT CONSTITUTES CONSENT BY THE CITY FOR THE INTRODUCTION OR ADMISSION OR OTHERWISE
INADMISSIBLE OR IRREVELANT EVIDENCE, NOR DOES IT AUTHORIZE CHALLENGES OR APPEALS NOT OTHERWISE
ALLOWED BY LAW.
City of South Miami. Ordinance No. 6 -86 -1251 requires all persons appearing in a paid or
remunerated representative capacity before the City Staff, Boards, Committees and the City
Commission, to fill out the appropriate form and file it with the City Clerk prior to engaging in
lobbying activities.
CALL TO ORDER:
ITEMS (S) FOR THE COMMISSION'S CONSIDERATION:
1. 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 TO PROVIDE
GROUP HEALTH INSURANCE FOR CITY OF SOUTH MIAMI FULL -
TIME EMPLOYEES.
2. Adjournment
SPECIAL CITY COMMISSION
AGENDA - September 28, 1999
1
{ Y-
CITY OF SOUTH MIAMI
INTER - OFFICE MEMORANDUM
To: Mayor and City Commission Date: September 28, 1999
From: Charles D. Scurr Re: AGENDA ITEM #
City Manager City Commission Meeting
of Sept. 28, 1999
Health Insurance.
REQUEST
The attached resolution seeks the City Commission's authorization to award the contract for
health insurance for the City of South Miami to Blue Cross Blue Shield of Florida.
BACKGROUND
Last year, the City approved a contract renewal with Prudential Health Systems for group health
insurance coverage for its full time employees. The City recently received notice that the Baptist
Health Systems network of hospitals would no longer be in the Prudential system effective
September 30, 1999. Baptist Health Systems includes South Miami Hospital and Baptist
Hospital.
Access to the Baptist Health Systems network of hospitals is an essential component of any City
health insurance plan. These hospitals are the principal facilities in the South -Dade area. They
are the primary hospitals used by our employees and are the principal hospitals where doctors
used by City employees admit patients. This situation has made it necessary for the City to rebid
the health insurance contract.
Our Agent of Record solicited bids from six different companies. Of these companies, the three
companies listed below responded.
Blue Cross Blue Shield of Florida
Cigna Health Plan
Neighborhood Health Plan
A Committee was established to review the proposals. The Committee consisted of the Agent of
Record, personnel manager, and employee representatives from the PBA, AFSCME, and general
employees.
C
The Committee completed a review of the proposals prior to the September 21" Commission
meeting. However, it was decided that a more thorough review of the proposals, including
presentations by each of the companies, was required.
The Committee has completed it's deliberations and has unanimously recommended the
selection of Blue Cross Blue Shield of Florida. The Committee considered many factors
including network of physicians, scope of coverage and cost. Blue Cross Blue Shield was felt to
have the best overall qualifications and benefits.
The City pays 100 % of the cost of individual coverage for the employee. The employee pays
100% of the additional cost of family coverage. Two options are offered, a Health Maintenance
Organization (HMO) option and a Point of Service (POS) option.
The cost to the City of the Blue Cross Blue Shield proposal is lower than the renewal rates
quoted previously by Prudential and included in the FY 1999 -2000 budget. These rates include:
Individual (Paid by City)
Family (Paid by Employee)
Pru - HMO Pru -POS
$ 189 $ 248
$ 263 $ 346
BCBS -HMO BCBS -POS
$ 189 $ 203
$ 265 $ 426
The lower BCBS rates will yield a projected savings to the City of $35,000 in the FY 1999 -2000
budget. This is $15,000 lower than the earlier projected savings of $50,000. The difference will
be realized through additional cost savings or use of contingency funds.
RECOMMENDATION
Approval is recommended.
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RESOLUTION NO.
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 BLUE CROSS BLUE SHIELD TO PROVIDE GROUP
HEALTH INSURANCE FOR CITY OF SOUTH MIAMI FULL -TIME
EMPLOYEES.
WHEREAS, in order to ensure adequate health insurance
for City employees and their families, the City has found it
necessary to seek an insurance plan that will provide
quality coverage including the use ; and
WHEREAS, the City Agent of Record has solicited
proposals from six (6) different companies on the group
health insurance plan; and
WHEREAS, three (3) companies submitted proposals; and
WHEREAS, a review committee consisting of the Agent of
Record, the Human Resources Director, representatives of the
PBA, AFSCME and general employees carefully reviewed the
proposals and unanimously recommended the selection of Blue
Cross Blue Shield.
NOW, THEREFORE, BE IT RESOLVED BY THE MAYOR AND CITY
COMMISSION OF THE CITY OF SOUTH MIAMI, FLORIDA:
Section 1. The City Manager is hereby authorized
to contract with Blue Cross Blue Shield of Florida for the
city group health insurance;
Section 2. The contract shall be effective
October 15, 1999 and shall be renewable on an annual basis;
Section 3. This resolution shall take effect
immediately upon approval.
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PASSED AND ADOPTED this day of
1999.
ATTEST:
CITY CLERK
READ AND APPROVED AS TO FORM:
CITY ATTORNEY
APPROVED:
MAYOR
r r,
RESOLUTION NO.
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 BLUE CROSS BLUE SHIELD TO PROVIDE GROUP
HEALTH INSURANCE FOR CITY OF SOUTH MIAMI FULL -TIME
EMPLOYEES.
WHEREAS, in order to ensure adequate health insurance
for City employees and their families, the City has found it
necessary to seek an insurance plan that will provide
quality coverage including the use ; and
WHEREAS, the City Agent of Record has solicited
proposals from six (6) different companies on the group
health insurance plan; and
WHEREAS, three (3) companies submitted proposals; and
WHEREAS, a review committee consisting of the Agent of
Record, the Human Resources Director, representatives of the
PBA, AFSCME and general employees carefully reviewed the
proposals and unanimously recommended the selection of Blue
Cross Blue Shield.
NOW, THEREFORE, BE IT RESOLVED BY THE MAYOR AND CITY
COMMISSION OF THE CITY OF SOUTH MIAMI, FLORIDA:
Section 1. The City Manager is hereby authorized
to contract with Blue Cross Blue Shield of Florida for the
city group health insurance;
Section 2. The contract shall be effective
October 15, 1999 and shall be renewable on an annual basis;
Section 3. This resolution shall take effect
immediately upon approval.
PASSED AND ADOPTED this day of
1999.
ATTEST:
CITY CLERK
READ AND APPROVED AS TO FORM:
CITY ATTORNEY
APPROVED:
MAYOR
SUMMARY OF BENEFITS
BLUE CROSS AND BLUE SHIELD OF FLORIDA
CARE MANAGER POINT -OF- SERVICE
BENEFITS
Lifetime Maximum
Calendar Year Deductible
Individual
Aggregate Family
BlueScript Prescription Drug Program
(Including Oral Contraceptives)
AUTHORIZED
Services provided by or on referral
of Insured's Care Manager
No Maximum
$0
$0
$7.00 Generic
$20.00 Name Brand
PLAN A 16
WITH BLUESCRIPT®
NON - AUTHORIZED
Services provided without
authorization or referral from
the Insured's Care Manager
$1,000,000
$300
$900
$7.00 Generic
$20.00 Name Brand
The deductible does not apply to services with a copayment or where indicated.
Coinsurance Requirement Limit
Individual
Aggregate Family
Hospital Per Admission Deductible
(PAD)
Physician Office Services
• Routine Services
• Preventive Care
• Well -Child Care
• Allergy Injection
(Without Office Visit)
$0
$0
ER
$5 Copay, 100% Allowed Amount
$ 2,000
$6,000
$300
80% Allowed Amount
$5 Copay, 100% Allowed Amount Not Covered
$5 Copay, 100% Allowed Amount 80% Allowed Amount
No Deductible
$5 Copay, 100% Allowed Amount 80% Allowed Amount
• Annual Gynecological Examination
By An HOI OB /GYN Physician
Up To $150 Per Calendar Year
(Does Not Require Authorization
By Care Manager)
$5 Copay,
100% Allowed Amount
Not Covered
• Specialty Care
$5 Copay,
100% Allowed Amount
80% Allowed Amount
• Maternity Care
First Office Visit
$5 Copay,
100% Allowed Amount
80% Allowed Amount
Total Maternity Care
No Copay,
100% Allowed Amount
80% Allowed Amount
A1600714 Rev. 3/99
BCBSF /CM (A1608)
SUMMARY OF BENEFITS
BLUE CROSS AND BLUE SHIELD OF FLORIDA PLAN Al 6
CARE MANAGER POINT -OF- SERVICE WITH BLUESCRIPTO
BENEFITS
AUTHORIZED NON - AUTHORIZED
Hospital Services
• Inpatient
Care Manager No Copay, 100% Allowed Amount Not Applicable
Facility PAD, then 100% Allowed. Amount PAD, Then 80%
Allowed Amount
All Other Providers No Copay, 100% Allowed Amount 80% Allowed Amount
• Outpatient Hospital /Surgical Center
Care Manager
No Copay,
100% Allowed Amount
Not Applicable
Facility(Applies To Outpatient
No Copay,
100% Allowed Amount
80% Allowed Amount
Surgery Only)
All Other Providers
No Copay,
100% Allowed Amount
80% Allowed Amount
• Non- Routine X -Rays
(Inpatient Or Outpatient)
No Copay,
100% Allowed Amount
80% Allowed Amount
Other Health Care Services
• Hospice Care
Lifetime Maximum
• Home Health Care
Calendar Year Maximum
• Skilled Nursing Facility
90 Day Calendar Year Maximum
No Copay, 100% Allowed Amount
No Limit
No Copay, 100% Allowed Amount
No Limit
No Copay, 100% Allowed Amount
80% Allowed Amount
$5,200
80% Allowed Amount
$ 1,000
80% Allowed Amount
• Outpatient Speech Therapy No Copay, 100% Allowed Amount Not Covered
Calendar Year Maximum 20 Visits Not Covered
• Outpatient Physical/
Occupational Therapy No Copay, 100% Allowed Amount 80% Allowed Amount
40 Visits Calendar Year Maximum
• Outpatient Cardiac /Pulmonary
Rehabilitation No Copay, 100% Allowed Amount 80% Allowed Amount
$1,200 Calendar Year Maximum
• Ambulance, DME Suppliers, No Copay, 100% Allowed Amount 80 % Allowed Amount
And Prosthetic /Orthotic Suppliers
A1600714 Rev. 3/99
BCBSF /CM (A1608)
SUMMARY OF BENEFITS
BLUE CROSS AND BLUE SHIELD OF FLORIDA PLAN A 16
CARE MANAGER POINT -OF- SERVICE WITH BLUESCRIPTO
Other Services That Do Not Require Authorization From The Insured's Care Manager
• Emergency Care Services
Hospital Emergency Room*
(Copay Waived If Admitted)
HOI Providers
$25 Copay, 100% Allowed Amount
Location other than Emergency
Room:
Primary Care Physician $5 Copay, 100% Allowed Amount
All Other Providers $5 Copay, 100% Allowed Amount
• Routine X -Rays/
Routine & Non - Routine Lab
(Performed In Location Other
Than Physician's Office)
• Alcohol And Drug
Dependency Lifetime Maximum
Inpatient One Episode
Of Detox
Outpatient 20 Visits
• Mental & Nervous Disorder
Per Calendar Year
Inpatient 31 Days
Outpatient 20 Visits
No Copay, 100% Allowed Amount
PAD, Then 100% Allowed Amount
$30 Copay Per Visit,
100% Allowed Amount
PAD, Then 100% Allowed Amount
$30 Copay Per Visit,
100% Allowed Amount
• Spine And Back Disorder $5 Copay, 100% Allowed Amount
Treatment
26 Visits Calendar Year Maximum
• Podiatric Office Services $5 Copay, 100% Allowed Amount
Non -HOI Providers
$25 Copay, 100%
Allowed Amount
Not Applicable
$5 Copay, 100%
Allowed Amount
80% Allowed Amount
PAD, Then 80%
Allowed Amount
80% Allowed Amount
PAD, Then 80%
Allowed Amount
80% Allowed Amount
80% Allowed Amount
80% Allowed Amount
• Dermatology Office Services
Five Visits For Medically Necessary
Minor Surgery, Tests And Office Visits
Per Insured Per Calendar Year $5 Copay, 100% Allowed Amount 80% Allowed Amount
Follow -up treatment must be provided or arranged by the Insured's Care Manager in order to receive the higher Authorized Services benefit level
of coverage.
A1600714 Rev. 3/99 BCBSF /CM (A1608)
Li
SUMMARY OF BENEFITS
BLUE CROSS AND BLUE SHIELD OF FLORIDA PLAN A 1 G
CARE MANAGER POINT -OF- SERVICE WITH BLUESCRIPTO
EXCLUSIONS
• Services and supplies which are, in our opinion, experimental, investigational, or not medically
necessary;
• Private duty nursing services;
• Dental care except as covered under the Physician Care and the Accident Dental Care
Sub - Sections;
• Cosmetic surgery (surgery performed solely to improve appearance of an individual);
• Eye refractions, eye glasses and hearing aids or examinations for their prescription or fitting,
except as specified in the Preventive Health Services Sub - Section;
• Routine health examinations, except as covered under the Well -Child Care Sub - Section and the
Preventive Health Services Sub - Section;
• Rehabilitative services except as provided in the Cardiac Rehabilitation and Pulmonary
Rehabilitation Sub - Sections;
• Care obtained without cost;
• Services rendered by an individual who is related by blood or marriage;
• Treatment in a VA hospital or government facility (due to service - related disability);
• Treatment of any condition arising out of a felony, riot, rebellion, or war;
• Treatment of any condition or an intentionally self - inflicted condition, suicide, or attempted
suicide;
• Speech therapy, except as provided under Home Health Care Services and Therapeutic Services
Sub- Sections;
• Diagnostic admissions;
• Occupational therapy, except as provided under Home Health Care Services and Therapeutic
Services Sub - Sections;
• Services or supplies related to sexual reassignment;
• Travel expenses, even if prescribed by a physician (this exclusion does not apply to medically
necessary transportation of a newborn child);
• Custodial care;
• Exercise programs of any kind;
• Non - prescription drugs, vitamins, mineral supplements, or fluoride drugs;
• Contraceptive medication, devices, appliances or other supplies when used for contraception,
except oral contraceptives provided under the BlueScript Pharmacy Endorsement;
• Work - related injuries;
• Services associated with autopsy or postmortem examination; and
• Services and supplies not specifically covered under the BCBSF Care Manager Point Of Service
Plan.
This is not a contract. The above Summary of Benefits is only a partial description of the many benefits and service covered by Blue Cross and Blue
Shield of Florida, Inc. These benefits apply only to groups of 51 or more employees. For a complete description of benefits and exclusions, please see
Blue Cross and Blue Shield of Florida's Care Manager Point of Service Contract #15482- 1096SR, Schedule of Benefits #15499- 1096SR and Pharmacy
Endorsement #11929- 994SR; its terms prevail. Blue Cross and Blue Shield of Florida, Inc. is an Independent Licensee of the Blue Cross and Blue Shield
Association.
A1600714 Rev. 3/99
BCBSF /CM (A1608)
i i
♦ Indep
Btde
s
BlueCare For Large Groups — Plan 4
BENEFIT HIGHLIGHTS
Care must be received from or arranged by your HOI Primary Care Physician
BENEFITS COPAYMENT
Physician Office Services
• Primary Care Physician Office Services
• Participating Specialist Office Services
• One Annual Self- Referral to Participating GYN
for Well -Woman Exam
These Office Services May Include:
- Pediatric and Well -Baby Care
- Periodic Health Evaluation & Immunizations
- Other Diagnostic Services
- Health Education
- Professional Counseling (Family Planning, Nutritional
and Medical Social Services)
- Vision and Hearing Screening
- Family Planning Services
- In -Office Surgery
Additional Services (Office or Outpatient Facility)
$10 Copay Per Visit
$10 Copay Per Visit
$10 Copay Per Visit
• Allergy Testing No Copay
• Allergy Injection, Including Serum $5 Copay
• Outpatient Physical, Speech, Cardiac and Occupational Therapies $5 Copay Per Visit
• Diagnostic lab and X -Ray No Copay
Hospital Services (Inpatient Facility)
• Room and Board
These Inpatient Hospital Services May Include:
- Anesthesia, Use of Operating and Recovery Rooms,
Oxygen, Drugs and Medications
- Intensive Care Unit and Other Special Units
- Laboratory and X -Ray Services
- Inpatient Physical, Speech, Cardiac and Occupational Therapies
Hospital or Ambulatory Surgical Center (Outpatient Facility)
• Outpatient Surgical Services May Include:
Anesthesia, Use of Operating and Recovery Rooms, Oxygen,
Drugs and Medication, Including:
- Hospital or Surgical Center
- Surgeon's Fees
- Outpatient Laboratory, X -Ray and Other Tests
No Copay
No Copay
,r x
BlueCros BlueSbield
of Florida
Health Uptionsi
r Independent ueensees of the 3 r'
BIUe.Cross and Blue Shield Ass -iatlon
BlueCare For Large Groups — Plan 4
BENEFIT HIGHLIGHTS
Emergency Services (Hospital)
• Use of Emergency Rooms and Emergency Services $50 Copay Per Visit
at Participating Hospitals
• Use of Emergency Rooms and Emergency Services $50 Copay Per Visit
Outside of Service Area Or At Non - Participating Hospitals
BENEFITS COPAYMENT
Maternity Services
• Primary Care Physician Office Services $10 Copay
• Participating Specialist Office Services - Initial OB Visit Only $10 Copay
• Certified Nurse Midwife or Midwife No Copay
• Inpatient Hospital Services No Copay
• Birthing Center Services No Copay
Behavioral Health Services
Mental Health Care
• Outpatient Visits - 20 Per Calendar Year $25 Copay Per Visit
• Inpatient Facility - 30 Days Per Calendar Year No Copay
• Partial Hospitalization (2 Partial Days for 1 Inpatient Day) No Copay
Substance Dependency
• Outpatient Visits - 20 Per Calendar Year $15 Copay Per Visit
• Inpatient Hospitalization (Detoxification Only) No Copay
Infertility Services
• Primary Care Physician $10 Copay Per Visit
• Participating Specialist $10 Copay Per Visit
Special Services
• Hospice Care No Copay
• Skilled Nursing Facility - 90 Days Per Calendar Year No Copay
• Home Health Care No Copay
• Ambulance (Medically Necessary) No Copay
• Durable Medical Equipment No Copay
• Prosthetics and Orthotics No Copay
BlueCare Rx: Pharmacy Program
Retail Pharmacy
• When Prescribed By A Participating Physician $7 Generic
And Filled At A Participating Pharmacy $20 Brand
(Includes Oral Contraceptives)
Mail Order Pharmacy
• For Your Convenience, A 90 -Day Supply of Maintenance $14 Generic
Medication Is Available Through The Mail $40 Brand
(Includes Oral Contraceptives)
2
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fflueCross B 6Sbhald
of Florida i
Health Options
Independent Ucense65 of the
Blue Cross and Blue Shield Asaogs6on r
BlueCare For Large Groups — Plan 4
BENEFIT HIGHLIGHTS
Maximum Out -of- Pocket
Additional information related to access to Providers
can be found in the Provider Directory.
SELECT EXCLUSIONS AND LIMITATIONS
$1,500 Per Member
$3,000 Per Family
The following is a partial listing of services that are excluded from coverage under this agreement,
but only if, and to the extent that, such exclusion is permitted under law. For a complete listing please
refer to the Master Policy
• All services not specifically listed in the schedule of benefits or in any rider or endorsement,
unless such services are specifically required by state or federal law
• Elective cosmetic surgery
• Hearing aids or eyeglasses, dental care, or oral appliances
• Physical for insurance, licensing, school, or recreational purposes
• Elective abortions
• Workers compensation
• Prescription drugs (unless included through BlueCare Rx)
• Complementary and Alternative Healing Methods (CAM)
The copayments are the responsibility of the Member and must be paid to the provider at the time
service is rendered.
Should it become necessary, a grievance procedure is available to all members, as detailed in the
Master Policy.
A pre - existing condition limitation applies for those who do not have previous creditable coverage at
enrollment. Please refer to the Master Policy for details.
All health care services must be provided or authorized by your Primary Care Physician. This Summary of Benefits is only a
partial description of the many benefits and services covered by Health Options, the HMO subsidiary of Blue Cross and Blue
Shield of Florida, Inc. These benefits apply only to groups of 51 or more employees. Health Options, Inc. and Blue Cross and
Blue Shield of Florida, Inc. are Independent Licensees of the Blue Cross and Blue Shield Association. This does not
constitute a contract. For a complete description of benefits and exclusions, please see Master Policy 86002 R0399 SR; its
terms prevail.
BlueCrom BlueSh eld'
of Florida
An Independent Licensee of the
' - Blue Cross and Blue Shield Assoc aeon
CITY OF SOUTH MIAMI
Rate Analysis
DUAL OPTION SPLIT RATES:
z,
{
HMO LG PLAN 4 RX $7/$20:
Employee:
$ 188.01
Employee & Family:
$ 453.52
BCCM A16 RX $7/$20:
Employee:
$ 203.37
Employee & Family:
$ 629.40
I
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## #333333
F �
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e
This Proposal Expires: 11/30/99
— r
See Accompanying Proposal Assumption Page
All rates, benefits, and effective dates are subject to
final rating of the actual
_
enrollment, and subject to Home Office approval.
A proposal for
City of South Miami
From:
N eighborhoalHealth
Partnership
Agent
Susan Redding
PROPM DOC
0
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..... .......:: .... : :.:.....: :: co. tam
:..:.:
CAP
Health Care Services
• Office visit - PCP
$10
• Office visit - Specialist
$10
• Routine pediatric exam
$10
• Routine immunizations
$10
• Gynecological exam (S examsperyear zithomt a rrferrao
$10
• Maternity care
$10
• Family Plug
$10
• Infertility (i2,S001ifetime maximum)
$10
• Sterilization (reversals not cornered)
$0
• Allergy testing and treatment
$10
• Chiropractic (12 vidapercalendaryear)
$10
• Podiatry (no referral needed)
$10
• Vision exam (to age 17 only)*
$10
• 'Therapies 60 day limit - per calendar ear
$0
Hospital Services
• Inpatient per admission deductible
$0
• Outpatient department
$0
• Emergency Room co pay
$50
Mental Heahb
• Inpatient per admission (30 day limit -per cakndar year
$0
• Outpatient 0 vidis per calendar year maximum
$10
Substance Abuse
• Inpatient per admission (Detax onfy)
$0
• Outpatient 0 t&ts er calendar ear nr �mum
$10
Supplemental Benefts
• Skilled Nursing Facility (120 day limitper calendaryear)
$0
• Home Health Care (60 day limitpercalendaryear)
$0
• Hospice (180 day limit - lifetime)
$0
• Prosthetic Devices
$0
• Durable Medical Equipment and disposable medical supplies - (;2,500
$0
lifetime maedmum)
• Miscellaneous services - X- ray /Lab, diagnostic, outpatient surgical,
$0'c'
ambulance
Presce ption Drugs (indudes oral contracepaw)
Generic On
$10
* Neighborhood Health Partnership HMO is proud to offer its members the benefit of
reduced prices on contact lenses, eyeglasses, eye exams and more at Visionworks ®. See the
enclosed brochure for details.
City of South Miami HMO Summary
� t (73 e ff� e4,
City of South Miami POS Summary
Hospital Services
• Inpatient per admission copay or deductible
$0
$250
deductible per
• Outpatient department
$0
• Eme ncy Room co pay or deductible
$50
calendar year individual,
Health Care Services
• Office visit - PCP
$10
$500 family *,
• Office visit - Specialist (referral required in- network)
$10
• Routine immunizations
$10
the plan pays
• Maternity care
$10
• Family planning
$10
70% of Reasonable and
• Infertility ( ;2,500 lifetime maximum)
$10
Customary to a
• Sterilization (hwnair not cot md)
$0
$3,000 individual,
• Allergy testing and treatment
$10
$6,000 family
• Chiropractic (12 vidaper calendaryear)
$10
out of pocket maximum,
• Podiatry
$10
• The ies 60 day limit -per calendar ear
$0
then the plan pays
Supplemental benefits
• Hospice (180 day limit - lifetime)
$0
100% to a lifetime
• Prosthetic devices, durable medical equipment
$0
maximum of $1,000,000
(;2,S001ifed= maximum)
per covered person
• X-ray/Lab, di ostic, outpatient surgical, ambulance
$0
Mental Health
• Inpatient
$0 per admission to a 30
day limit - per
calendar year.
In Network Only
• Outpatient
20 visits per calendar
ear maximum.
Substance Abuse
• Inpatient
$0 per admission
Detox only
• Outpatient
$10 to a $2,000 calendar
In Network Only
year maximum.
Miscellaneous Services
• Prescription DrtW (tndudes oral contraceput+er)
$10 (generic only)
• Gynecological exam (S examfier cahndaryear tv /out
$10
rrfefr4
In Network Only
• Vision exam (to age 17 onii )
$10
• Routine pediatric exam
$10
• Home Health Care
$0 co -pay 60 days per
60 Visits per calendar year
calendar year
maximum
• Skilled Nursing Facility
$0 co -pay 60 days per
Subject to deductible and
coinsurance — 20 days per
calendar ear
calendar ear maximum.
* Deductible waived for child health su rvision services
City of South Miami POS Summary
_ ..
... .. j
;, ... ��y ♦ 0 'j@ �1 ...: . .. <.^^ .: is .. .::: %:::..: i.:::. f ♦M
Sine
$1: 59_!.;77
Faml mm�
$423.38
..................... .
Sin a
$194.92
Family
$516.53
Final rates will be determined based on the actual census and the medical underwriting of the group,
upon formal request for coverage.
hmoppo.doc
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Benefit Summaries
CHMO Benefit Proposal for
Page 16
CIGNA HealthCare
Primary Care Physician Services
➢
Preventive Care
$10 Copay
➢
Adult Medical Care
$10 Copay
➢
Adult Physical Exams
$10 Copay
➢
Well Child Care
$10 Copay
➢
Routine Immunizations & Injections
$10 Copay
➢
Vision & Hearing Screening (for members through age 17)
$10 Copay
➢
Lab and X -rav
No Charge
Specialty Physician Services
➢ Office Visits $ 10 Copay
➢ Referral Physician Services $10 Copay
➢ Allergy Testing and Treatment $10 Copay
➢ Lab and X-ray No Charge
Pre & Postnatal Exams No Charge
Inpatient Hospital Services
➢ Semi - Private Room and Board No Charge
➢ Physician and Surgeon Charges
➢ Newborn Delivery Charges
➢ Diagnostic and Therapeutic Lab and X -ray Services
➢ Drugs and Medications
➢ Operating and Recovery Room
➢ Hemodialvsis
Outpatient Hospital Services
➢ Operating and Recovery Room No Charge
➢ Physician Services
➢ Laboratory and X -ray
➢ Hemodialysis
➢ Radiation and Chemotheravv
Emergency Care
➢ Participating or Non - Participating Physician's Office $10 Copay
➢ Hospital Emergency Room, Oupatient Facility or other Urgent Care $50 Copay,
Facility waived if admitted
➢ Ambulance No Charge
Other Health Care Facilities
(Skilled Nursing and Rehabilitation)
➢ Maximum of 60 days per contract year No Charge
Home Health Care No Charge
Outpatient Short Term Rehabilitation
➢ Maximum of 60 consecutive days per condition $10 Copay
TS
A(M.1MIUM W1171
CHMO Benefit Proposal for
Page 17
Family Planning
➢ Tests, counseling
$10 Copay
➢ Surgical sterilization procedures
Inpatient Facility Charge
No Charge
Outpatient Facility Charge
No Charge
Surgery in Physician's Office
No Charge
Infertility
➢ Office visit
$20 Copay
Treatment/surgery Treatment/surgery
50% coins.
Mental Health
➢ Inpatient Copay
$50 /day
➢ Inpatient Days
30 MH &SA
➢ Outpatient Individual Copay
$20 Copay
➢ Outpatient Group Copay
$10 Copay
➢ Outpatient Individual Visits
30 Visits
Substance Abuse
➢ Inpatient Copay
$50 /day
➢ Inpatient Days
30 MH &SA
➢ Outpatient Individual Copay
$20 Copay
➢ Outpatient Group Copay
$10 Copay
➢ Outpatient Visits
30 Visits
Out-of-Pocket Limits
$1,500/$3,000
Deductible
None
Pre-Existing Condition Limitations
None
Li etime Maximum
Unlimited
111CJC VC11C11.a 1CF1CJC111 "" J1411UG1U VC11C111J. 111C1C 1114 �' VC 111VU111C411V11J 1VL JV111C JIG ICJ UUC lV 111u11uulCu
benefis that are not reflected in this benefit plan design.
CHMO Benefit Proposal for
Page 18
. _.. :,, ,, __ -�,: �,c.,. �h,:. � `... ... ' ^,:F t .., .. '"°re�,:v "';`;;WS'ti45•"�?�v`= f'aY,:,
Primary Care Physician Services
➢ Preventive Care
➢ Adult Medical Care
➢ Adult Physical Exams
➢ Well Child Care
➢ Routine Immunizations & Injections
➢ Vision & Hearing Screening (for members through age 17)
➢ Lab and X -rav
Specialty Physician Services
➢ Office Visits
➢ Referral Physician Services
➢ Allergy Testing and Treatment
➢ Lab and X -ray
Pre &r Postnatal Exams
Inpatient Hospital Services
➢ Semi - Private Room and Board
➢ Physician and Surgeon Charges
➢ Newborn Delivery Charges
➢ Diagnostic and Therapeutic Lab and X -ray Services
➢ Drugs and Medications
➢ Operating and Recovery Room
➢ Hemodialvcic
Outpatient Hospital Services
➢ Operating and Recovery Room
➢ Physician Services
➢ Laboratory and X -ray
➢ Hemodialysis
➢ Radiation and Chemotherapv
Emergency Care
➢ Participating or Non - Participating Physician's Office
➢ Hospital Emergency Room, Oupatient Facility or other Urgent Care
Facility
➢ Ambulance
Other Health Care Facilities
(Skilled Nursing and Rehabilitation)
➢ Maximum of 60 days per contract year
Home Health Care
Outpatient Short Term Rehabilitation
➢ Maximum of 60 consecutive days per condition
$10 Copay
$10 Copay
$10 Copay
$10 Copay
$10 Copay
$10 Copay
No Charge
$10 Copay
$10 Copay
$10 Copay
No Charge
No Charge
$250 Copay per
admission'
$ 75 Copay
No Charge
No Charge
No Charge
No Charge
$10 Copay
$50 Copay,
waived if admitted
No Charge
$250 Copay per
admission
No Charge
10
CHMO Benefit Proposal for
Page 19
Family Planning
Tests, counseling
$10 Copay
➢ Surgical sterilization procedures
Inpatient Facility Charge
$250 /admission
Outpatient Facility Charge
$75 Copay
Surgery in Physician's Office
No Charge
Infertility
➢ Office visit
$20 Copay
➢ Treatment/surgery Treatment/surgery
50% coins.
Mental Health
➢ Inpatient Copay
$50 /day
➢ Inpatient Days
30 MH &SA
➢ Outpatient Individual Copay
$20 Copay
➢ Outpatient Group Copay
$10 Copay
➢ Outpatient Individual Visits
30 Visits
Substance Abuse
➢ Inpatient Copay
$50 /day
➢ Inpatient Days
15 MH &SA
➢ Outpatient Individual Copay
$20 Copay
➢ Outpatient Group Copay
$10 Copay
➢ Outpatient Visits
30 Visits
Out-of-Pocket Limits
$2,000/$4,000
Deductible
None
Pre-Existing Condition Limitations
None
Li etime Maximum
Unlimited
'Inpatient copay will be waived it a member is readmitted for the same condition within thirty (30) days of the
initial confinement. This waiver applies to the admission to a Skilled Nursing Facility if it occurs within thirty
(30) days of the hospital admission for the same condition.
These benefits represent the "standard" benefits. There may be modifications for some states due to mandated
benefis that are not reflected in this benefit plan design.
CHMO Benefit Proposal for
Page 20
-•— -.� _.' ..T . I �. - -._ .— .,_— ^� -,.uf ..�, .. ., -.:.,, ...._: ,,:. ���, - sue, �9��Jr .Y:�S.�'ia`��5. � ��mi'�ifF`�R,
Ib
CHMO Benef t Proposal for
Page 21
r. .,r , r . --„ " __ ,. ,a . -....x 'W `1$9 . �—..�',
GI NA Ma IIJ i
Ben
Cz a fSOUth
ZLL%%t
IGNA HeaXth
Access PAS Plan
fn Network
t.
Primary Care Physician Services:
➢ Adult & Child Medical Care /Allergy
Treatment
$10 Copay
70 %/30% Coinsurance
➢ Preventive Care
➢ Adult Physical Exams
$10 Copay
Not Covered
➢ Well Child Care
$10 Copay
$10 Copay
Not Covered
Not Covered
➢ Routine Immunizations & Injections
$10 Copay
Not Covered
Vision & Hearing Screening (for
$10 Copay
Not Covered
members age 17 and under)
➢ Lab and X-ray
Specialty Physician Services:
No Charge
70%/30% Coinsurance
➢ Office Visits
➢ Referral Physician Services
$10 Copay
$10 Copay
70 %/30% Coinsurance
70 %/30%
➢ Allergy Testing and Treatment
$10 Copay
Coinsurance
70%/30% Coinsurance
➢ Well Woman Visit (1 /year)
➢
$10 Copay
Not Covered
Lab and X-ray
No Charge
70 %/30% Coinsurance
Pre & Postnatal Exams
No Charge
70 %/30 %Coinsurance
Inpatient Hospital Services:
➢ Semi - Private Room and Board
➢ Physician and Surgeon Charges
No Charge
$250 Copay per
➢ Newborn Deliver Charges
g
No Charge
g
No Charge
admission
70 %/30% Coinsurance
➢ Diagnostic and Therapeutic Lab and X-
No Charge
Precertication applies
ray Services
➢ Drugs and Medications
No Charge
➢ Operating and Recovery Room
No Charge
➢ Hemodial sis
No Charge
Outpatient Hospital Services:
➢ Operating and Recovery Room
➢ Physician Services
No Charge
70%/30% Coinsurance
Laboratory and X -ray
No Charge
No Charge
Precertification applies
➢ Hemodialysis
No Charge
➢ Radiation and Chemotherapy
No Charge
Emergency Care:
➢ Participating Physician's or Non-
Participating Physician's Office
$10 a Co
Copay
Emergency care meeting
➢ Hospital Emergency Room, Outpatient
Facility, or other Urgent Care Facility
$50 Copay, waived if
emergency definition s
de n tionsis
➢ Ambulance
admitted
paid at in- network levels
No Charge
regardless of the
rovider
Ib
CHMO Benef t Proposal for
Page 21
r. .,r , r . --„ " __ ,. ,a . -....x 'W `1$9 . �—..�',
CrGN A HeWthCare Bet'Ce ummacr}�
E� 3
Ci o f ,youth �Vliam�
CINAtHeaith
AcGessPOS flan
h;
Gene is '
In Network .
Ozct :Q ; . Network .
Other Health Care Facilities
(Skilled Nursing and Rehabilitation):
$250 Copay per
➢ Maximum of 60 days per contract year
No Charge
admission
70 %/30% Coinsurance **
Precertification applies
70 %/30% Coinsurance
Home Health Care
No Charge
limited to 40 visits per
contract. ear **
$10 Copay
70 %/30% Coinsurance
Outpatient Short Term
— Maximum of 60
— Maximum of 60
Rehabilitation
consecutive days per
consecutive days per
condition
contract ear **
Family Planning:
➢ Tests, counseling
$10 Copay
$250 Copay per
➢ Surgical sterilization procedures
admission
(vasectomy, tubal ligation):
70 %/30% Coinsurance
• Inpatient Facility Charge
No Charge
Precertification applies
• Outpatient Facility Charge
No Charge
• Surgery in Physician's Office
No Charge
Infertility.
➢ Office visit
$20 Copay
Covered in- network
➢ Treatment /surgery
50 %/50% Coinsurance
only
➢ Exclusions (where allowed by state):
• Invitro fertilization
• Infertility drugs (oral,
injectable, suppository)
• Costs connected with
collection, preparation, storage
of sperm, for artificial
insemination, including donor
fees
DME Outpatient
No Charge
g
70 %/30% Coinsurance
$ 700 per contract ear **
External Prosthetics
$200 Deductible
70 %/30% Coinsurance
$1,000 per contract
$1,000 Maximum
ear **
ro
CHMO Benefit Proposal for
Page 22
I 4C ]
NOTE: All out -of- network services are subject to the contract year deductible and reasonable and customary
charge limitations. The out -of- network inpatient per admission deductible (if any) does not apply to the out -
of- network deductible or OOP. All out -of- network hospital admissions, outpatient surgeries and Mills must be
precertified. Hospital admissions are subject to Continued Stay Review (CSR). Penalty for non - compliance
with precertification or CSR is 50 %. Non - certified admissions /days result in the denial of benefits. The 50%
penalty or cost of denied benefits does not apply to deductible or OOP. The following services are covered
in- network only: Organ Transplant, TMJ, Injectable Drugs, Chiropractic Services.
These benefits represent the "standard" benefits. There may be modifications for some states due to mandated
benefits that are not reflected in this benefit plan design.
CHMO Bene f t Proposal for
Page 23
CIGNA Healthcare: Bp in Summary
3
C pry osouthi arnz
'CIGNA- Heafith'Access
=Pf)S Play
Bene is
In Nerivork
-
taut Q ;Network,
Mental Health:
➢ Inpatient Copay
MH /SA Rider A
$250 Copay per
admission
➢ Inpatient Days
70 %/30% Coinsurance
30 combined with SA **
➢ Outpatient Individual Copay
Precertification applies
➢ Outpatient Group Copay
50 % /50% Coinsurance
➢ Outpatient Individual Visits
50 1/6/50% Coinsurance
20 Visits combined
Substance Abuse:
w /SA **
➢ Inpatient Copay MH /SA Rider A
$250 Copay per
admission
➢ Inpatient Days
70%/30% Coinsurance
30 combined with MH **
➢ Outpatient Individual Copay
Precertification applies
➢ Outpatient Group Copay
50 0/o/50% Coinsurance
➢ Outpatient Individual Visits
50%/50% Coinsurance
20 Visits combined
Prescription Drugs Selected Drug Rider
w /MH **
70 %/30%
Out-Of-Pocket Limits $1,500/$3,000
Coinsurance * **
Deductible
$3,000/$6,000
N/A
Li etime Maximum
$300/$600
** Unlimited
In- network visits /days reduce this
$1,000,000
maximum.
* *' Must be prescribed by a physician for illness or injury.
NOTE: All out -of- network services are subject to the contract year deductible and reasonable and customary
charge limitations. The out -of- network inpatient per admission deductible (if any) does not apply to the out -
of- network deductible or OOP. All out -of- network hospital admissions, outpatient surgeries and Mills must be
precertified. Hospital admissions are subject to Continued Stay Review (CSR). Penalty for non - compliance
with precertification or CSR is 50 %. Non - certified admissions /days result in the denial of benefits. The 50%
penalty or cost of denied benefits does not apply to deductible or OOP. The following services are covered
in- network only: Organ Transplant, TMJ, Injectable Drugs, Chiropractic Services.
These benefits represent the "standard" benefits. There may be modifications for some states due to mandated
benefits that are not reflected in this benefit plan design.
CHMO Bene f t Proposal for
Page 23
Iq
CHMO Benefit Proposal for
Page 24
CINAealth+arE Bcr�te fi�t_Summaly
o �rout� Miami
.
d d k Heath Access POS PYan
>�ion
HPrimary
Bene fs "
In Network
:Qua oNetwar�C
Care Physician Services:
➢
Adult & Child Medical Care /Allergy
$10 Copay
70 %/30% Coinsurance
Treatment
➢
Preventive Care
$10 Copay
Not Covered
➢
Adult Physical Exams
$10 Copay
Not Covered
➢
Well Child Care
$10 Copay
Not Covered
➢
Routine Immunizations & Injections
$10 Copay
Not Covered
➢
Vision & Hearing Screening (for
$10 Copay
Not Covered
members age 17 and under)
➢
Lab and X-ray
No Charge
70%/30% Coinsurance
Specialty Physician Services:
➢
Office Visits
$10 Copay
70%/30% Coinsurance
➢
Referral Physician Services
$10 Copay
70%/30% Coinsurance
➢
Allergy Testing and Treatment
$10 Copay
70%/30% Coinsurance
➢
Well Woman Visit (1 /year)
$10 Copay
Not Covered
➢
Lab and X-ray
No Charge
70 %/30% Coinsurance
Pre &r Postnatal Exams
No Charge
70%/30% Coinsurance
Inpatient Hospital Services:
➢
Semi - Private Room and Board
$250 Copay per
70%/30% Coinsurance
➢
Physician and Surgeon Charges
admission
$250 Copay per
➢
Newborn Deliver Charges
admission
➢
Diagnostic and Therapeutic Lab and X-
Precertication applies
ray Services
➢
Drugs and Medications
➢
Operating and Recovery Room
➢
Hemodial sis
Outpatient Hospital Services:
➢
Operating and Recovery Room
$75 Copay
70 %/30% Coinsurance
➢
Physician Services
No Charge
Precertification applies
➢
Laboratory and X -ray
No Charge
➢
Hemodialysis
No Charge
➢
Radiation and Chemotherapy
No Charge
Emergency Care:
➢
Participating Physician's or Non-
$10 Copay
Emergency care meeting
Participating Physician's Office
CIGNA HealthCare's
➢
Hospital Emergency Room, Outpatient
$50 Copay, waived if
emergency definition is
Facility, or other Urgent Care Facility
admitted
paid at in- network levels
➢
Ambulance
No Charge
regardless of the
provider
CHMO Benefit Proposal for
Page 24
"t ', a $
w CINA SedIthGare Bene 'Summary ..... .
Cif o South Mxdm
�r
;
u,
LISA Healt'A ess �'()S I'layt
(;
tiOt #2.:
r
Benej�its
- lac Network
d
but o f network;
Other Health Care Facilities
(Skilled Nursing and Rehabilitation):
70 %/30% Coinsurance **
➢ Maximum of 60 days per contract year
$250 Copay per
$250 Copay per
admission
admission
Precertification applies
70%/30% Coinsurance
Home Health Care
No Charge
limited to 40 visits per
contract ear **
$10 Copay
70%/30% Coinsurance
Outpatient Short Term
— Maximum of 60
— Maximum of 60
Rehabilitation
consecutive days per
consecutive days per
condition
contract ear **
Family Planning:
➢ Tests, counseling
$10 Copay
70 %/30% Coinsurance
➢ Surgical sterilization procedures
$250 Copay per
(vasectomy, tubal ligation):
admission
• Inpatient Facility Charge
$250 Copay per
Precertification applies
admission
• Outpatient Facility Charge
$ 75 Copay
• Surgery in Physician's Office
No Charge
Infertility.
➢ Office visit
$20 Copay
Covered in- network
➢ Treatment /surgery
50 %/50% Coinsurance
only
➢ Exclusions (where allowed by state):
• Invitro fertilization
• Infertility drugs (oral,
injectable, suppository)
• Costs connected with
collection, preparation, storage
of sperm, for artificial
insemination, including donor
fees
DME Outpatient
No Charge
g
70 %/30% Coinsurance
$ 700 per contract ear **
External Prosthetics
$200 Deductible
70 %/30% Coinsurance
$1,000 per contract
$1,000 Maximum
ear **
" �� k1l: M. MM
CHMO Benefit Proposal for
Page 25
r .— . a. 1 a
Mental Health:
➢ Inpatient Copay
➢ Inpatient Days
➢ Outpatient Individual Copay
➢ Outpatient Group Copay
➢ Outpatient Individual Visits
MH /SA Rider A
$250 Copay per
admission
70 %/30% Coinsurance
30 combined with SA **
Precertification applies
50 %/50% Coinsurance
50 %/50% Coinsurance
20 Visits combined
—is A **
Substance Abuse:
➢ Inpatient Copay
MH /SA Rider A
$250 Copay per
admission
70 %/30% Coinsurance
➢ ' Inpatient Days
30 combined with MH **
Precertification applies
➢ Outpatient Individual Copay
50 %/50% Coinsurance
➢ Outpatient Group Copay
50 %/50% Coinsurance
➢ Outpatient Individual Visits
20 Visits combined
w /MH **
Prescription Drugs
Selected Drug Rider
70 %/30%
Coinsurance * **
Out-of-Po ket Limits
$1,500/$3,000
$1,500/$3,000
Deductible
N/A
$300/$600
Lifetime Maximum
Unlimited
$1,000,000
** In- network visits /days reduce this maximum.
* ** Must be prescribed by a physician for illness or injury
NOTE: All out -of- network services are subject to the contract year deductible and reasonable and customary
charge limitations. The out -of- network inpatient per admission deductible (if any) does not apply to the out -
of- network deductible or OOP. All out -of- network hospital admissions, outpatient surgeries and MRIs must be
precertified. Hospital admissions are subject to Continued Stay Review (CSR). Penalty for non - compliance
with precertification or CSR is 50 %. Non - certified admissions /days result in the denial of benefits. The 50%
penalty or cost of denied benefits does not apply to deductible or OOP. The following services are covered
in- network only: Organ Transplant, TMJ, Injectable Drugs, Chiropractic Services.
These benefits represent the "standard" benefits. There may be modifications for some states due to mandated
benefits that are not reflected in this benefit plan design.
CHMO Benefit Proposal for
Page 26
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