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15THE CITY OF PLEASANT LIVING To: FROM: Via: DATE: SUBJECT: BACKGROUND: ACCOUNT: EXPENSE: ATTACHMENTS: CITY OF SOUTH MIAMI OFFICE OF THE CITY MANAGER INTER-OFFICE MEMORANDUM The Honorable Mayor & Members of the City Commission Steven Alexander, City Manager Rachel Cata, Personnel Manager July 12, 2016 I t:)~ Agenda Item No.: . :> A Resolution authorizing the City Manager to negotiate and enter into an agreement with Brown & Brown of Florida, Inc., for insurance brokerage services for an initial term of three (3) years and one (I) two year option to renew for a total term of five (5) consecutive years. The City published Request for Qualifications No. HR2016-07 ("RFQ") and after thorough evaluation, the City's Insurance Committee ("Committee") determined that Brown & Brown of Florida ("Brown & Brown") is the most . qualified respondent proposing to provide all of the requested services in the most cost efficient and effective manner. The Committee evaluated (3) Insurance Brokerage Services to provide independent insurance brokerage and employee benefits consulting for (3) three years with a one-time option, at the City Manager's discretion, to renew for an additional two years for a total term of (5) five consecutive years. Brown & Brown has agreed to perform the required services in accordance with the terms and conditions set forth in the agreement and in accordance with the City's RFQ. Brown & Brown is proposing brokerage services pertaining to Medical Insurance (including retirees), Dental Insurance, Vision Insurance, Short Term Disability Insurance, Long Term Disability Insurance, Group Life Insurance, Voluntary Life and AD&D Insurance and Ancillary/Supplemental Insurances. Brown & Brown also provides years of experience with several municipalities and is well versed in employee benefits and ACA compliance. 001-1330-513-3450, Human Resources Contractual Services, beginning October I, 2016 The annual cost of $25,000. Resolution for approval Pre Bid Sign-In sheet RFQ Advertisement Demand Star Insurance Brokerages RFQ + Addendums Bid Opening Report Proposal Summary References Brown & Brown Cost Proposal Sun Biz Registration RESOLUTION NO.: _________ _ 2 3 A Resolution authorizing the City Manager to negotiate and enter into an agreement 4 with Brown & Brown of Florida, Inc., for insurance services for an initial term of three 5 (3) years and one (1) two year option to renew for a total term of five (5) consecutive 6 years. 7 8 WHEREAS, the City is in need of an independent insurance brokerage and insurance consulting 9 services to assist in negotiating and administrating its employee benefits program in order to meet the 10 goals of enhancing the City's benefits program while cutting its overall costs and ensuring that the City 11 receives the lowest competitive rates; and, 12 13 WHEREAS, the City published a Request for Qualifications No. HR2016-07 ("RFQ") and received 14 responses from three Brokerage firms, one of which was Brown & Brown of Florida ("Brown & Brown"). 15 The City's Insurance Committee ("Committee") determined that Brown & Brown of Florida ("Brown & 16 Brown" is the most qualified respondent proposing to provide all of the requested services in the most 17 cost efficient manner; and, 18 19 WHEREAS, the City desires to retain Brown & Brown to perform the required services based on 20 the recommendations of the Committee who reviewed and evaluated the responses from the three 21 Brokerage firms that submitted their qualifications in response to the RFQ and on Brown & Brown 22 warranty that it is qualified and capable of performing said services in a provessional and timely manner 23 and in accordance with the City's goals and requirements as set forth in the RFQ; and, 24 25 WHEREAS, Brown & Brown has agreed to perform the required services in accordance with the 26 terms and conditions set forth in the RFQ and the professional services agreement contained therein. 27 28 NOW, THEREFORE, BE IT RESOLVED THE MAYOR AND CITY COMMISSION OF THE CITY OF 29 SOUTH MIAMI, FLORIDA: 30 31 Section 1. The City Commission approves and authorizes the City Manager to negotiate and 32 execute an agreement with Brown & Brown Brokerage of Florida for insurance brokerage and consutting 33 services.for an initial (3) year term with (1) two year option to renew the agreement for a possible total 34 offive years 35 36 Section 2. Effective Date: This resolution shall take effect immediately upon adoption. 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 PASSED AN D APPROVED this _. _ day of ____ -', 2016. ATTEST: CITY CLERK READ AND APPROVED AS TO FORM, LANGUAGE, LEGALITY AND EXECUTION THEREOF CITY ATTORNEY APPROVED: MAYOR COMMISSION VOTE: Mayor Stoddard: Vice Mayor Welsh: Commissioner Edmond: Commissioner Harris: Commissioner Liebman: . i 11 Date: RFQ Title: RFQ No.: THE CITY OF PLEASANT LIVING Pre-Bid Conference Sign-In Sheet April 12, 2016 Insurance Brokerages Services HRlOl6-07 X:\Purchasing\Request for Proposals & Qualification (RFPs)\Insurance Brokerage Services\2016\Pre Bid\Pre-Bid Meeting Sign-In Sheet Insurance Brokerage Services 4.12.16.doc MIAMI DAILY BUSINESS REVIEW Published Daily except Saturday, Sunday and Legal Holidays Miami, Miami-Dade County, Florida STATE OF FLORIDA COUNTY OF MIAMI-DADE: Before lhe undersigned authority personally appeared MARIA MESA, who on oath says that he or she is the LEGAL CLERK, Legal Notices of the Miami Daily Business Review flkla Miami Review, a daily (except Saturday, Sunday and Legal Holidays) newspaper, published at Miami in Miami-Dade County, Florida; that the attached copy of advertisement, being a Legal Advertisement of Notice in the matter of CITY OF SOUTH MIAMI-RFQ #HR2016-07 in the XXXX.Court, was published in said newspaper in the issues of 0312912016 Affiant further says that the said Miami Daily Business Review is a newspaper published at Miami, in said Miami-Dade County, Florida and that the said newspaper has heretofore been continuously published in said Miami -Dade County, Florida each day (except Saturday, Sunday and Legal Holidays) and has been entered as second class mail matter at the post office in Miami in said Miami-Dade County, Florida, for a period of one year next preceding the first publication of the attached copy of advertisement; and affiant further says that he or she has neither paid nor promised any person, firm or corporation any discount, rebate, commission or refund for the purpose of securing this advertisement for (SEAL) MARIA MESA personally known to me 'i~':':"~!~--RHONDA M PELTIER ::~,I,::§ MY COMMISSION /I FF231407 1 "~/!'';'h'?-'' EXPIRES May 17 2019 ••••• 1 h: . : •. ,.t,'!.:: .. ,otKJ.1Nn:a·,Sc .... k •. .:c,n· Member Name Bid Number Bid Name 7 Document(s) found for this bid 20 Planholder(s) found. Supplier Name AETNA Arthur J. Gallagher & Co. Brown & Brown Daytona Brown & Brown Insurance Danial Construction FBMC Benefits Management Florida League of Cities, Inc. Gehring Group Humana J.T. Worthy Consultants Link Systems LLC McKinley Financial Services, Inc. Public Risk Insurance Agency (PRIA) The Rhodes Insurance Group The Travelers Indemnity Company The Travelers Indemnity Company Wells Fargo, Govt and Institutional Banking World Risk Management World Risk Management (FFIB) Worryless, LLC City of South Miami RFQ-RFQ #HR2016-07-0-2016/SK Insurance Brokerage Services Address 1 1340 Concord Terrace 2255 Glades Road 220 S Ridgewood Ave 14900 N.w. 79th Court PO Box 48 3101 Sessions. Road 125 East Colonial Drive 11505 Fairchild Gardens Ave 8983 Winged Foot Drive 5870 Hummingbird Court 1451 W Cypress Creek Rd PO Box 2416 1263 East Las Olas Blvd 20 North Orange Avenue City State Zip Phone Attributes Sunrise FL 33323 9543751561 Boca Raton FL 33431 5619956706 Daytona Beach FL 32114 3863336008 Miami Lakes FL 33016 3053647818 San Antonia TX 78201 2108203303 Tallahassee FL 32303 8504256200 Orlando FL 32801 4074259142 Palm Beach Gardens FL 33410 5616266797 AB Tallahassee FL 32312 8506294992 1. Small TItusville FL 32780 4074010031 Business 1. African Fort Lauderdale FL 33309 9549382685 American Daytona Beach FL 32115 3862394044 Ft. Lauderdale FL 33301 9545245075 AB AB AB Orlando FL 32801 4074452414 AB AB IP~\ SouthfMiami THE CITY OF PLEASANT LIVING CITY OF SOUTH MIAMI Insurance Brokerage Services RFQ #HR20 16-07 Solicitation Cover Letter The City of South Miami, Florida (hereinafter referred to as "CSM") through its chief executive officer (City Manager) hereby solicits sealed proposals responsive to the City's request (hereinafter referred to as "Request for Qualifications" or "RFQ"). All references in this Solicitation (also referred to as an "Invitation for Proposals" or "Invitation to Bid") to "City" shall be a reference to the City Manager, or the manager's designee, for the City of South Miami unless otherwise specifically defined. The City is hereby requesting sealed proposals in response to this RFQ #HR2016-07, "Insurance Brokerage Services." The purpose of this Solicitation is to contract for the services necessary for the completion of the project in accordance with the Scope of Services, (Exhibit I), or the plans and/or specifications, if any, described in this Solicitation (hereinafter referred to as "the Project" or "Project"). Interested persons who wish to respond to this Solicitation can obtain the complete Solicitation package at the City Clerk's office Monday through Friday from 9:00 AM. to 4:00 P.M. or by accessing the following webpage: http://www.southmiamifl.gov/ which is the City of South Miami's web address for solicitation information. Proposals are subject to the Standard Terms and Conditions contained in the complete Solicitation Package, including all documents listed in the Solicitation. The Proposal Package shall consist of one (I) original unbound proposal, ten ( 10 ) additional copies and one (I) digital (or comparable medium including Flash Drive, DVD or CD) copy all of which shall be delivered to the Office of the City Clerk located at South Miami City Hall, 6130 Sunset Drive, South Miami, Florida 33143. The entire Proposal Package shall be enclosed in a sealed envelope or container and shall have the following Envelope Information clearly printed or written on the exterior of the envelope or container in which the sealed proposal is delivered: "Insurance Brokerage Services," RFQ #HRlO 16-07 and the name of the Respondent (person or entity responding to the Solicitation. Special envelopes such as those provided by UPS or Federal Express will not be opened unless they contain the required Envelope Information on the front or back of the envelope. Sealed Proposals must be received by Office of the City Clerk, either by mail or hand delivery, no later than 10 A.M. local time on April 22, 2016. Hand delivery must be made during normal business days and hours of the office of City Clerk. A public opening will take place at lOAM. on the same date in the City Commission Chambers located at City Hall, 6130 Sunset Drive, South Miami 33143. Any Proposal received after lOAM. local time on said date will not be accepted under any circumstances. Any uncertainty regarding the time a Proposal is received will be resolved against the person submitting the proposal and in favor of the Clerk's receipt stamp. A Non-Mandatory Pre-Proposal Meeting will be conducted at City Hall in the Commission Chambers located at 6130 Sunset Drive, South Miami, FI 33143 on April 12, 2016 at 10:00 A.M. The conference shall be held regardless of weather conditions. Proposals are subject to the terms, conditions and provisions of this letter as well as to those provisions, terms, conditions, affidavits and documents contained in this Solicitation Package. The City reserves the right to award the Project to the person with the lowest, most responsive, responsible Proposal, as determined by the City, subject to the right of the City, or the City Commission, to reject any and all proposals, and the right of the City to waive any irregularity in the Proposals or Solicitation procedure and subject also to the right of the City to award the Project, and execute a contract with a Respondent or Respondents, other than to one who provided the lowest Proposal Price or, if the Scope of the Work is divided into distinct subdivisions, to award each subdivision to a separate Respondent.. Maria M. Menendez, CMC City Clerk City of South Miami Page I of 47 SCOPE OF SERVICES and SCHEDULE OF VALUES Insurance Brokerage Services RFQ #HR20 16-07 The Scope of Services and the Schedule of Values. if any. are set forth in the attached EXHIBIT I Thomas F. Pepe 02-23-15 END OF SECTION Page 2 of 47 No I 2 3 4 5 6 SCHEDULE OF EVENTS Insurance Brokerage Services RFQ #HR20 16-07 Event Advertisementl Distribution of Solicitation & Cone of Silence begins Non-Mandato[X Pre-RFQ Meeting Deadline to Submit Questions Deadline to City Responses to Questions Deadline to Submit RFQ Response Projected Announcement of selected Contractor/Cone of Silence ends END OF SECTION Page 3 of 47 Thomas F. Pepe 02-23-15 Date* Time* (EST) 03/2412016 4:00 PM 04/12/2016 10:00 AM 04/1512016 10:00 AM 04/19/2016 10:00 AM 04/22/2016 10:00 AM 05/17/2016 7:00 PM INSTRUCTIONS for RESPONDENT Insurance Brokerage Services RFQ #HR20 16-07 IT IS THE RESPONSIBILITY OF THE RESPONDENT TO THE SOLICITATION TO ENSURE THAT THE RESPONSE TO THE SOLICITATION (HEREINAFTER ALSO REFERRED TO AS THE "PROPOSAL" THROUGHOUT THE CONTRACT DOCUMENTS) REACHES THE CITY CLERK ON OR BEFORE THE CLOSING HOUR AND DATE STATED ON THE SOLICITATION FORM. . I. Purpose of Solicitation. The City of South Miami is requesting proposals for the lowest and most responsive price for the Project. The City reserves the right to award the contract to the Respondent whose proposal is found to be in the best interests of the City. 2. Qualification of Proposing Firm. Response submittals to this Solicitation. will be considered from firms normally engaged in prOViding the services requested. The proposing firm must demonstrate adequate experience, organization, offices, equipment and personnel to ensure prompt and efficient service to the City of South Miami. The City reserves the right, before recommending any award, to inspect the offices and organization or to take any other action necessary to determine ability to perform in accordance with the specifications, terms and conditions. The City of South Miami will determine whether the evidence of ability to perform is satisfactory and reserves the right to reject all response submittals to this Solicitation where evidence submitted, or investigation and evaluation, indicates inability of a firm to perform. 3. Deviations from Specifications. The awarded firm shall clearly indicate, as applicable, all areas in which the services proposed do not fully comply with the requirements of this Solicitation. The decision as to whether an item fully complies with the stated requirements rests solely with the City of South Miami. 4. Designated Contact. The awarded firm shall appoint a person to act as a primary contact with the City of South Miami. This person or back-up shall be readily available during normal work hours by phone, email, or in person, and shall be knowledgeable of the terms of the contract. 5. Precedence of Conditions. The proposing firm, by virtue of submitting a response, agrees that City's General Provisions, Terms and Conditions herein will take precedence over any terms and conditions submitted with the response, either appearing separately as an attachment or included within the Proposal. The Contract Documents have been listed below in order of precedence, with the one having the most precedence being at the top of the list and the remaining documents in descending order of precedence. This order of precedence shall apply, unless clearly contrary to the specific terms of the Contract or General Conditions to the Contract: a) Addenda to Solicitation b) Attachments/Exhibits to c) Solicitation d) Attachment/Exhibits to Supplementary Conditions e) Supplementary Conditions to Contract, if any f) Attachment/Exhibits to Contract g) Contract h) General Conditions to Contract, if any i) Respondent's Proposal 6. Response Withdrawal. After Proposals are opened, corrections or modifications to Proposals are not permitted, but the City may allow the proposing firm to withdraw an erroneous Proposal prior to the confirmation of the proposal award by City Commission, if all of the following is established: a) The proposing firm acted in good faith in submitting the response; b) The error was not the result of gross negligence or willful inattention on the part of the firm; c) The error was discovered and communicated to the City within twenty-four (24) hours (not including Saturday, Sunday or a legal holiday) of opening the proposals. received, along with a request for permission to withdraw the firm's Proposal; and d) The firm submits an explanation in writing, signed under penalty of perjury, stating how the error was made and delivers adequate documentation to the City to support the explanation and to show that the error was not the result of gross negligence or willful inattention nor made in bad faith. 7. The terms, provisions, conditions and definitions contained in the Solicitation Cover Letter shall apply to these instructions to Respondents and they are hereby adopted and made a part hereof by reference. If there is a conflict between the Cover Letter and these instructions, or any other provision of this Solicitation, the Cover Letter shall govern and take precedence over the conflicting provision(s) in the Solicitation. Thomas F. Pepe 02-23-15 Page 4 of 47 8. Any questions concerning the Solicitation or any required need for clarification must be made in writing, by 10 A.M., April IS, 2016 to the attention of Steven P. Kulick at skulick@southmiamifl.gov or via facsimile at (305) 663-6346. 9. The issuance of a written addendum is the only official method whereby interpretation and/or clarification of information can be given. Interpretations or clarifications, considered necessary by the City in response to such questions, shall be issued by a written addendum to the Solicitation Package (also known as "Solicitation Specifications" or "Solicitation") by U.S. mail, e-mail or other delivery method convenient to the City and the City will notify all prospective firms via the City's website. 10. Verbal interpretations or clarifications shall be without legal effect. No plea by a Respondent of ignorance or the need for additional information shall exempt a Respondent from submitting the Proposal on the required date and time as set forth in the public notice. II. Cone of Silence: You are hereby advised that this Request for Proposals is subject to the "Cone of Silence," in accordance with Miami-Dade County Ordinance Nos. 98106 and 99-1. From the time of advertising until the City Manager issues his recommendation, there is a prohibition on verbal communication with the City's professional staff, including the City Manager and his staff. All written communication must comply with the requirements of the Cone of Silence. The Cone of Silence does not apply to verbal communications at pre- proposal conferences, verbal presentations before evaluation committees, contract discussions during any duly noticed public meeting, public presentations made to the City Commission during any duly notice public meeting, contract negotiations with the staff following the City Manager's written recommendation for the award of the contract, or communications in writing at any time with any City employee, official or member of the City Commission unless specifically prohibited. A copy of all written communications must be contemporaneously filed with the City Manager and City Clerk. In addition, you are required to comply with the City Manager's Administrative Order AO 1-15. If a copy is not attached, please request a copy from the City's Procurement Division. WITH REGARD TO THE COUNTY'S CONE OF SILENCE EXCEPTION FOR WRITTEN COMMUNICATION, PLEASE BE ADVISED THAT, NOTWITHSTANDING THE MIAMI- DADE COUNTY EXCEPTION FOR WRITTEN COMMUNICATION THE COUNTY'S RULES PROHIBITING VERBAL COMMUNICATION DURING AN ESTABLISHED CONE OF SILENCE SHALL, WITH REGARD TO THIS SOLICITATION, ALSO APPLY TO ALL WRITTEN COMMUNICATION UNLESS PROVIDED OTHERWISE BELOW. THEREFORE, WHERE THE CITY OF SOUTH MAIMI CONE OF SILENCE PROHIBITS COMMUNICATION, SUCH PROHIBITION SHALL APPLY TO BOTH VERBAL AND WRITTEN COMMUNICATION. Notwithstanding the foregoing, the Cone of Silence shall not apply to ... (I) Duly noticed site visits to determine the competency of bidders regarding a particular bid during the time period between the opening of bids and the time that the City Manager makes his or her written recommendation; (2) Any emergency procurement of goods or services pursuant to the Miami-Dade County Administrative Order 3-2; (3) Communications regarding a particular solicitation between any person and the procurement agent or contracting officer responsible for administering the procurement process for such solicitation, provided the communication is limited strictly to matters of process or procedure already contained in the corresponding solicitation document; and (4) Communications regarding a particular solicitation between the procurement agent or contracting officer, or their designated secretariall clerical staff responsible for administering the procurement process for such solicitation and a member of the selection committee therefor, provided the communication is limited strictly to matters of process or procedure already contained in the corresponding solicitation document." 12. Violation of these provisions, by any particular Respondent or proposer shall render any recommendation for the award of the contract or the contract awarded to said Respondent or proposer voidable, and, in such event, said Respondent or proposer shall not be considered for any Solicitation including but not limited to one that requests any of the following a proposal, qualifications, a letter of interest or a bid concerning any contract for the provision of goods or services for a period of one year. Contact shall only be made through regularly scheduled Commission meetings, or meetings scheduled through the Purchasing Division, which are for the purposes of obtaining additional or clarifying information. 13. Lobbying. All firms and their agents who intend to submit, or who submitted, bids or responses for this Solicitation, are hereby placed on formal notice that neither City Commissioners, candidates for City Thomas F. Pepe 02·23·15 Page 5 of 47 Commissioner or any employee of the City of South Miami are to be lobbied either individually or collectively concerning this Solicitation. Contact shall only be made through regularly scheduled Commission meetings, or meetings scheduled through the Purchasing Division, which are for the purposes of obtaining additional or clarifying information. 14. Reservation of Right. The City anticipates awarding one contract for services as a result of this Solicitation and the successful firm will be requested to enter into negotiations to produce a contract for the Project. The City, however, reserves the right, in its sole discretion, to do any of the following: a) to reject any and all submitted Responses and to further define or limit the scope of the award. b) to waive minor irregularities in the responses or in the procedure required by the Solicitation documents. c) to request additional information from firms as deemed necessary. d) to make an award without discussion or after limited negotiations. It is, therefore, important that all the parts of the Request for Proposal be completed in all respects. e) to negotiate modifications to the Proposal that it deems acceptable. f) to terminate negotiations in the event the City deems progress towards a contract to be insufficient and to proceed to negotiate with the Respondent who made the next best Proposal. The City reserves the right to proceed in this manner until it has negotiated a contract that is satisfactory to the City. g) To modify the Contract Documents. The terms of the Contract Documents are general and not necessarily specific to the Solicitation. It is therefore anticipated that the City may modify these documents to fit the specific project or work in question and the Respondent, by making a Proposal, agrees to such modifications and to be bound by such modified documents. h) to cancel, in whole or part, any invitation for Proposals when it is in the best interest of the City. i) to award the Project to the person with the lowest, most responsive, responsible Proposal, as determined by the City. j) to award the Project, and execute a contract with a Respondent or Respondents, other than to one who provided the lowest Proposal Price. k) if the Scope of the Work is divided into distinct subdivisions, to award each subdivision to a separate Respondent. 15. Contingent Fees Prohibited. The proposing firm, by submitting a proposal, warrants that it has not employed or retained a company or person, other than a bona fide employee, contractor or subcontractor, working in its employ, to solicit or secure a contract with the City, and that it has not paid or agreed to pay any person, company, corporation, individual or firm other than a bona fide employee, contractor or sub-consultant, working in its employ, any fee, commission, percentage, gift or other consideration contingent upon or resulting from the award or making of a contract with the City. 16. Public Entity Crimes. A person or affiliate of the Respondent who has been placed on the convicted vendor list pursuant to Chapter 287 following a conviction for a public entity crime may not submit a Proposal on a contract to provide any goods or services, or a contract for construction or repair of a public building, may not submit proposals on leases of real property to or with the City of South Miami, may not be awarded a contract to perform work as a CONTRACTOR, sub-contractor, supplier, sub-consultant, or consultant under a contract with the City of South Miami, and may not transact business with the City of South Miami for a period of 36 months from the date of being placed on the convicted vendor list. 17. Respondents shall use the Proposal Form(s) furnished by the City. All erasures and corrections must have the initials of the Respondent's authorized representative in blue ink at the location of each and every erasure and correction. Proposals shall be signed using blue ink; all quotations shall be typewritten, or printed with blue ink. All spaces shall be filled in with the requested information or the phrase "not applicable" or "NA". The proposal shall be delivered on or before the date and time, and at the place and in such manner as set forth in the Solicitation Cover Letter. Failure to do so may cause the Proposal to be rejected. Failure to include any of the Proposal Forms may invalidate the Proposal. Respondent shall deliver to the City, as part of its Proposal, the following documents: a) The Invitation for Proposal and Instructions to Respondents. b) A copy ofall issued addenda. c) The completed Proposal Form fully executed. d) Proposal/Bid Bond, (Bond or cashier's check), if required, attached to the Proposal Form. e) Certificates of Competency as well as all applicable State, County and City Licenses held by Respondent Thomas F. Pepe 02-23-15 Page 6 of 47 f) 18. Goods: a) Certificate of Insurance and/or Letter of Insurability. If goods are to be provided pursuant to this Solicitation the following applies: Brand Names: If a brand name, make, manufacturer's trade name, or vendor catalog number is mentioned in this Solicitation, whether or not followed by the words "approved equal", it is for the purpose of establishing a grade or quality of material only. Respondent may offer goods that are equal to the goods described in this Solicitation with appropriate identification, samples and/or specifications for such item(s). The City shall be the sole judge concerning the merits of items proposed as equals. b) Pricing: Prices should be stated in units of quantity specified in the Proposal Form. In case of a c) discrepancy, the City reserves the right to make the final determination at the lowest net cost to the City. Mistake: In the event that unit prices are part of the Proposal and if there is a discrepancy between the unit price(s) and the extended price(s), the unit price(s) shall prevail and the extended price(s) shall be adjusted to coincide. Respondents are responsible for checking their calculations. Failure to do so shall be at the Respondent's risk, and errors shall not release the Respondent from his/her or its responsibility as noted herein. d) Samples: Samples of items, when required, must be furnished by the Respondent free of charge to the City. Each individual sample must be labeled with the Respondent's name and manufacturer's brand name and delivered by it within ten (10) calendar days of the Proposal opening unless schedule indicates a different time. If samples are requested subsequent to the Proposal opening, they shall be delivered within ten (10) calendar days of the request. The City shall not be responsible for the return of samples. e) Respondent warrants by signature on the Proposal Form that prices quoted therein are in conformity with the latest Federal Price Guidelines. f) Governmental Restrictions: In the event any governmental restrictions may be imposed which would necessitate alteration of the material quality, workmanship, or performance of the items offered on this Proposal prior to their delivery, it shall be the responsibility of the successful Respondent to notify the City at once, indicating in its letter the specific regulation which required an alteration. The City of South Miami reserves the right to accept any such alteration, including any price adjustments occasioned thereby, or to cancel all or any portion of the Contract, at the sole discretion of the City and at no further expense to the City with thirty (30) days advanced notice. g) Respondent warrants that the prices, terms and conditions quoted in the Proposal shall be firm for a period of one hundred eighty (180) calendar days from the date of the Proposal opening unless otherwise stated in the Proposal Form. Incomplete, unresponsive, irresponsible, vague; or ambiguous responses to the Solicitation shall be cause for rejection, as determined by the City. h) Safety Standards: The Respondent warrants that the product(s) to be supplied to the City conform in all respects to the standards set forth in the Occupational Safety and Health Act (OSHA) and its amendments. Proposals must be accompanied by a Materials Data Safety Sheet (M.S.D.S) when applicable. 19. Liability, Licenses & Permits: The successful Respondent shall assume the full duty, obligation, and expense of obtaining all necessary licenses, permits, and inspections required by this Solicitation and as required by law. The Respondent shall be liable for any damages or loss to the City occasioned by the negligence of the Respondent (or its agent or employees) or any person acting for or through the Respondent. Respondents shall furnish a certified copy of all licenses, Certificates of Competency or other licensing requirement necessary to practice their profession and applicable to the work to be performed as required by Florida Statutes, the Florida Building Code, Miami-Dade County Code or City of South Miami Code. These documents shall be furnished to the City as part of the Proposal. Failure to have obtained the required licenses and certifications or to furnish these documents shall be grounds for rejecting the Proposal and forfeiture of the Proposal/Bid Bond, if required for this Project. 20. Respondent shall comply with the City's insurance requirements as set forth in the attached EXHIBIT 3, prior to issuance of any Contract(s) or Award(s) If a recommendation for award of the contract, or an award of the contract is made before compliance with this provision, the failure to fully and satisfactorily comply with the City's bonding, if required for this project, and insurance requirements as set forth herein shall authorize the City to implement a rescission of the Proposal Award or rescission of the recommendation for award of contract without further City action. The Respondent, by submitting a Proposal, thereby agrees to hold the City harmless and agrees to indemnify the City and covenants not to sue the City by virtue of such rescission. Thomas F. Pepe 02-23-15 Page 7 of 47 21. Copyrights and/or Patent Rights: Respondent warrants that as to the manufacturing, producing or selling of goods intended to be shipped or ordered by the Respondent pursuant to this Proposal, there has not been, nor will there be, any infringement of copyrights or patent rights. The Respondent agrees to indemnify City from any and all liability, loss or expense occasioned by any such violation or infringement. 22. Execution of Contract: A response to this Solicitation shall not be responsive unless the Respondent signs the form of contract that is a part of the Solicitation package. The Respondent to this Solicitation acknowledges that by submitting a response or a proposal, Respondent agrees to the terms of the form contract and to the terms of the general conditions to the contract, both of which are part of this Solicitation package. The Respondent agrees that Respondent's signature on the Bid Form and/or the form of contract that is a part of the Solicitation package and/or response to this Solicitation, grants to the City the authority, on the Respondent's behalf, to inserted, into any blank spaces in the contract documents, information obtained from the proposal and, at the City's sole and absolute discretion, the City may treat the Respondent's signature on any of those documents, as the Respondent's signature on the contract, after the appropriate information has been inserted, as well as for any and all purposes, including the enforcement of all of the terms and conditions of the contract. 23. Evaluation of Proposals: The City, at its sole discretion, reserves the right to inspect the facilities of any or all Respondents to determine its capability to meet the requirements of the Contract. In addition, the price, responsibility and responsivefless of the Respondent, the financial position, experience, staffing, equipment, materials, references, and past history of service to the City and/or with other units of state, and/or local governments in Florida, or comparable private entities, will be taken into consideration in the Award of the Contract. 24. Drug Free Workplace: Failure to provide proof of compliance with Florida Statute Section 287.087, as amended, when requested shall be cause for rejection of the Proposal as determined by the City. 25. Public Entity Crimes: A person or affiliate who was placed on the Convicted Vendors List follOWing a conviction for a public entity crime may not submit a response on a contract to provide any services to a public entity, may not submit Solicitation on leases of real property to a public entity, and may not transact business with any public entity in excess of the threshold amount provided in Section 287.017, for a period of 36 months from the date of being placed on the Convicted Vendors List. 26. Contingent Fees Prohibited: The proposing firm must warrant that it has not employed or retained a company or person, other than a bona fide employee, contractor or subcontractor, working in its employ, to solicit or secure a contract with the City, and that it has not paid or agreed to pay any person, company, corporation, individual or firm other than a bona fide employee, contractor or sub-consultant, working in its employ, any fee, commission, percentage, gift or other consideration contingent upon or resulting from the award or making of a contract with the City. 27. Hold Harmless: All Respondents shall hold the City, its officials and employees harmless and covenant not to sue the City, its officials and employees in reference to its decisions to reject, award, or not award a contract, as applicable, unless the claim is based solely on allegations of fraud and/or collusion. The submission of a proposal shall act as an agreement by the Respondent that the Proposal/Bid Bond, if required for this project, shall not be released until and unless the Respondent wajves any and all claims that the Respondent may have against the City that arise out of this Solicitation process or until a judgment is entered in the Respondent's favor in any suit filed which concerns this proposal process. In any such suit, the prevailing party shall recover its attorney's fees, court costs as well as expenses associated with the litigation. In the event that fees, court costs and expenses associated with the litigation are awarded to the City, the Proposal/Bid Bond, if required for this project, shall be applied to the payment of those costs and any balance shall be paid by the Respondent. 28. Cancellation: Failure on the part of the Respondent to comply with the conditions, specifications, requirements, and terms as determined by the City, shall be just cause for cancellation of the Award or termination of the contract. 29. Bonding ReqUirements: The Respondent, when submitting the Proposal, shall include a Proposal/Bid Bond, if required for this project, in the amount of 5% of the total amount of the base Proposal on the Proposal/Bid Bond Form included herein. A company or personal check shall not be deemed a valid Proposal Security. 30. Performance and Payment Bond: The City of South Miami may require the successful Respondent to furnish a Performance Bond and Payment Bond, each in the amount of 100% of the total Proposal Price, including Alternates if any, naming the City of South Miami, and the entity that may be providing a source of funding for the Work, as the obligee, as security for the faithful performance of the Contract and for the payment of all persons or entities performing labor, services and/or furnishing materials in connection herewith. The bonds shall be with a surety company authorized to do business in the State of Florida. ' Thomas F. Pepe 02-23-15 Page 8 of 47 30.1. Each Performance Bond shall be in the amount of one hundred percent (100%) of the Contract Price guaranteeing to City the completion and performance of the Work covered in the Contract Documents. 30.2. Each Performance Bond shall continue in effect for five year after final completion and acceptance of the Work with the liability equal to one hundred percent (100%) of the Contract Sum. 30.3. Each Payment bond shall guarantee the full payment of all suppliers. material man. laborers. or subcontractor employed pursuant to this Project. 30.4. Each Bond shall be with a Surety company whose qualifications meet the requirements of insurance companies as set forth in the insurance requirements of this solicitation. 30.5. Pursuant to the requirements of Section 255.05. Florida Statutes. Respondent shall ensure that the Bond(s) referenced above shall be recorded in the public records of Miami-Dade County and provide CITY with evidence of such recording. 30.6. The surety company shall hold a current certificate of authority as acceptable surety on federal bonds in accordance with the United States Department of Treasury Circular 570. current revisions. 31. Proposal Guarantee: Notwithstanding the fact that the Respondent. in submitting a proposal. agrees to the terms contained in the form of contract that is part of this Solicitation package. the successful Respondent. within ten (10) calendar days of Notice of Award by the City. shall deliver. to the City. the executed Contract and other Contract Documents that provide for the Respondent's signature. and deliver to the City the required insurance documentation as well as a Performance and Payment Bond if these bonds are required. The Respondent who has the Contract awarded to it and who fails to execute the Contract and furnish the required Bonds and Insurance Documents within the specified time shall. at the City's option. forfeit the Proposal/Bid Bond/Security that accompanied the Proposal. and the Proposal/Bid Bond/Security shall be retained as liquidated damages by the City. It is agreed that if the City accepts payment from the Proposal/Bid Bond. that this sum is a fair estimate of the amount of damages the City will sustain in case the Respondent fails to sign the Contract Documents or fails to furnish the required Bonds and Insurance documentation. If the City does not accept the Proposal/Bid Bond. the City may proceed to sue for breach of contract if the Respondent fails to perform in accordance with the Contract Documents. Proposal/Bid Bond/Security deposited in the form of a cashier's check drawn on a local bank in good standing shall be subject to the same requirements as a Proposal/Bid Bond. . 32. Pre-proposal Conference Site Visits: If a Mandatory Pre-proposal conference is scheduled for this project. all Respondents shall attend the conference and tour all areas referenced in the Solicitation Documents. It shall be grounds for rejecting a Proposal from a Respondent who did not attend the mandatory pre-proposal conference. No pleas of ignorance by the Respondent of conditions that exist, or that may hereinafter exist, as a Solicitation result of failure to make the necessary examinations or investigations. or failure to complete any part of the Solicitation Package. will be accepted as basis for varying the requirements of the Contract with the City of South Miami or the compensation of the Respondent. The Respondent, following receipt of a survey of the property. if applicable. is bound by knowledge that can be seen or surmised from the survey and will not be entitled to any change order due to any such condition. If the survey is provided before the proposal is submitted. the contract price shall include the Work necessitated by those conditions. If the survey is provided subsequent to the submission of the proposal. the Respondent shall have five calendar days to notify the City of any additional costs required by such conditions and the City shall have the right to reject the proposal and award the contract to the second most responsive. responsible bidder with the lowest price or to reject all bids. 33. Time of Completion: The time is of the essence with regard to the completion of the Work to be performed under the Contract to be awarded. Delays and extensions of time may be allowed only in accordance with the provisions stated in the appropriate section of the Contract Documents. including the Proposal Form. No change orders shall be allowed for delays caused by the City. other than for extensions of time to complete the Work. 34. Submittal Requirements: All Proposals shall comply with the requirements set forth herein and shall include a fully completed Bid Form. if included. with this RFQ. 35. Cancellation of Bid Solicitation: The City reserves the right to cancel. in whole or part. any request for proposal when it is in the best interest of the City. 36. Respondent shall not discriminate with regard to its hiring of employees or subcontractors or in its purchase of materials or in any way in the performance of its contract. if one is awarded. based on race. color. religion. national origin. sex. age. sexual orientation. disability. or familial status. 37. All respondents. at the time of bid opening. must have fulfilled all prior obligations and commitments to the City in order to have their bid considered. including all financial obligations. Prior to the acceptance of any bid Thomas F. Pepe 02-23-15 Page 9 of 47 proposal or quotation, the City's Finance Department shall certify that there are no outstanding fines, monies, fees, taxes, liens or other charges owed to the City by the Respondent, any of the Respondent's principal, partners, members or stockholders (collectively referred to as "Respondent Debtors"). A bid, proposal or quotation will not be accepted until all outstanding debts of all Respondent Debtors owed to the city are paid in full. No bidder who is in default of any prior contract with the City may have their bid considered until the default is cured to the satisfaction of the City Manager. 38. Bid Protest Procedure. See attached EXHIBIT 6. 39. Evaluation Criteria: If this project is to be evaluated by an Evaluation Committee, the evaluation criteria is attached as EXHIBIT 4. Thomas F. Pepe 02-23-15 END OF SECTION Page 10 of 47 Proposal Submittal Checklist Form Insurance Brokerage Services RFQ #HR20 16-07 This checklist indicates the forms and documents required to be submitted for this solicitation and to be presented by the deadline set for within the solicitation. Fulfillment of all solicitation requirements listed is mandatory for consideration of response to the solicitation. Additional documents may be required and, if so, they will be identified in an addendum to this Solicitation. The response shall include the following items: Attachments and Other Documents described below Checl< to be Completed x x x x x x x x x ---- x --- x x IF MARKED WITH AN "X": Completed. Proposal Package shall consist of one (I) original unbound proposal, ten ( 10 ) additional copies and one (I) digital (or comparable medium including Flash Drive, DVD or CD) copy Indemnification and Insurance Documents EXHIBIT 3 Signed Contract Documents, "Professional Service Agreement," (All -including General Conditions and Supplementary Conditions if attached) EXHIBIT 5 Respondents Qualification Statement List of Proposed Subcontractors and Principal Suppliers Non-Collusion Affidavit Public Entity Crimes and Conflicts of Interest Drug Free Workplace Acknowledgement of Conformance with OSHA Standards Affidavit Concerning Federal & State Vendor Listings Related Party Transaction Verification Form Presentation Team Declaration/Affidavit of Representation Submit this checklist along with your proposal indicating the completion and submission of each required forms and/or documents. Thomas F. Pepe 02-23-15 END OF SECTION Page II of 47 RESPONDENT QUALIFICATION STATEMENT Insurance Brokerage Services RFQ #HR20 16-07 Please list three (3) governmental agency or quasi-government agency, or comparable corporate client, contract references for which you have done business within the past three (3) years: Agency Name: --------------------------------------------- Address: --------------------------------------------- City, State & Zip Code: --------------------------------------------- Contact's Name: Telephone Number: --------------------------------------------- Agency Name: --------------------------------------------- Address: City, State & Zip Code: --------------------------------------------- Contact's Name: Telephone Number: --------------------------------------------- Agency Name: --------------------------------------------- Address: --------------------------------------------- City, State & Zip Code: --------------------------------------------- Contact's Name: --------------------------------------------- Telephone Number: __________________________________________ _ Thomas F. Pepe 02·23·15 Attach additional sheets if necessary. END OF SECTION Page 12 of 47 Current workload Project Name Owner Name Telephone Number Contract Price I. The following information shall be attached to the proposal. a) RESPONDENT's home office organization chart. b) RESPONDENT's proposed project organizational chart. c) Resumes of proposed key project personnel. 2. List and describe any: a) Bankruptcy petitions filed by or against the Respondent or any predecessor organizations, b) Any arbitration or civil or criminal proceedings, or Suspension of contracts or debarring from Bidding or Responding by any public agency brought c) against the Respondent in the last five (5) years Thomas F. Pepe 02-23-15 END OF SECTION Page 13 of 47 NON COLLUSION AFFIDAVIT STATE OF FLORIDA COUNTY OF MIAMI-DADE _____________________ being first duly sworn, deposes and states that: (I) He/ShelThey is/are the ______________________ _ (Owner, Partner, Officer, Representative or Agent) of the Respondent that has submitted the attached Proposal; (2) He/ShelThey is/are fully informed concerning the preparation and contents of the attached Proposal and of all pertinent circumstances concerning such Proposal; (3) Such Proposal is genuine and is not a collusive or sham Proposal; (4) Neither the said Respondent nor any of its officers, partners, owners, agents, representatives, employees or parties in interest, including this affiant, have in any way colluded, conspired, connived or agreed,directly or indirectly, with any other Respondent, firm, or person to submit a collusive or sham Proposal in connection with the Work for which the attached Proposal has been submitted; or to refrain from Bidding or proposing in connection with such Work; or have in any manner, directly or indirectly, sought by agreement or collusion, or communication, or conference with any Respondent, firm, or person to fix any overhead, profit, or cost elements of the Proposal or of any other Respondent, or to fix any overhead, profit, or cost elements of the Proposal Price or the Proposal Price of any other Respondent, or to secure through any collusion, conspiracy, connivance, or unlawful agreement any advantage against (Recipient), or any person interested in the proposed Work; (5) The price or prices quoted in the attached Proposal are fair and proper and are not tainted by any collusion, conspiracy, connivance, or unlawful agreement on the part of the Respondent or any other of its agents, representatives, owners, employees or parties of interest, including this affiant. Signed, sealed and delivered in the presence of: By: Witness Signature Witness Print Name and Title Date ACKNOWLEDGEMENT STATE OF FLORIDA COUNTY OF MIAMI-DADE On this the day of , 20 __ , before me, the undersigned Notary Public of the State of Florida, personally appeared (Name(s) of individual(s) who appeared before notary) and whose name(s) is/are Subscribed to the within instrument, and he/she/they acknowledge that he/shelthey executed it. Thomas F. Pepe 02-23-15 Page 14 of 47 WITNESS my hand and official seal. NOTARY PUBLIC: SEAL OF OFFICE: Thomas F. Pepe 02-23-15 Page 15 of 47 Notary Public, State of Florida (Name of Notary Public: Print, Stamp or type as commissioned.) Personally known to me, or Personal identification: Type of Identification Produced Did take an oath, or Did Not take an oath. PUBLIC ENTITY CRIMES AND CONFLICTS OF INTEREST Pursuant to the provisions of Paragraph (2) (a) of Section 287.133, Florida State Statutes -"A person or affiliate who has been placed on the convicted vendor list following a conviction for a public entity crime may not submit a Proposal or bid on a Contract to provide any goods or services to a public entity, may not submit a Bid or proposal for a Contract with a public entity for the construction of repair of a public building or public work, may not submit bids or proposals on leases or real property to a public entity, may not be awarded to perform Work as a RESPONDENT, Sub-contractor, supplier, Sub-consultant, or Consultant under a Contract with any public entity, and may not transact business with any public entity in excess of the threshold amount Category Two of Section 287.017, Florida Statutes, for thirty six (36) months from the date of being placed on the convicted vendor list". The award of any contract hereunder is subject to the provIsions of Chapter I 12, Florida State Statutes. Respondents must disclose with their Proposals, the name of any officer, director, partner, associate or agent who is also an officer or employee of the City of South Miami or its agencies. SWORN STATEMENT PURSUANT TO SECTION 287.133 (3) (a), FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICIAL AUTHORIZED TO ADMINISTER OATHS. I. This sworn statement is submitted to [print name of the public entity] by ____________________________________________________________ ___ [print individual's name and title] fur ____________________________________________________________________ _ [print name of entity submitting sworn statement] whose business address is and (if applicable) its Federal Employer Identification Number (FEIN) is (If the entity has no FEIN, include the Social Security Number of the individual signing this sworn statement: -------------------------------------,.) 2. I understand that a "public entity crime" as defined in Paragraph 287.133 (I )(g), Florida Statutes, means a violation of any state or federal law by a person with respect to and directly related to the transaction of business with any public entity or with an agency or political subdivision of any other state or of the United States, including, but not limited to , any bid, proposal or contract for goods or services to be provided to any public entity or an agency or political subdivision of any other state or of the United States and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation. 3. I understand that "convicted" or "conviction" as defined in Paragraph 287.133 (I) (b), Florida Statutes, means a finding of gUilt or a conviction of a public entity crime, with or without an adjudication of gUilt, in any federal or state trial court of record relating to charges brought by indictment or information after July I, 1989, as a result of a jury verdict, non-jury trial, or entry of a plea of gUilty or nolo contendere. 4. I understand that an "affiliate" as defined in Paragraph 287.133 (I) (a), Florida Statutes, means: (a) A predecessor or successor of a person convicted of a public entity crime; or (b) An entity under the control of any natural person who is active in the management of the entity and who has been convicted of a public entity crime. The term "affiliate" includes those officers, Thomas F. Pepe 02-23-15 Page 16 of 47 directors, executives, partners, shareholders, employees, members, and agents who are active in the management of an affiliate. The ownership by one person of shares constituting a controlling interest in any person, or a pooling of equipment or income among persons when not for fair market value under an arm's length agreement, shall be a prima facie case that one person controls another person. A person who knowingly enters into a joint venture with a person who has been convicted of a public entity crime in Florida during the preceding 36 months shall be considered an affiliate. 5. understand that a: "person" as defined in Paragraph 287.133 (I) (e), Florida Statutes, means any natural person or entity organized under the laws of any state or of the United States with the legal power to enter into a binding contract and which bids or proposal or applies to bid or proposal on contracts for the provision of goods or services let by a public entity, or which otherwise transacts or applies to transact business with a public entity. The term "person" includes those officers, directors, executives, partners, shareholders, employees, members"and agents who are active in management of an entity. 6. Based on information and belief, the statement which I have marked below is true in relation to the entity submitting this sworn statement. [Indicate which statement applies.] , __ Neither the entity submitting this sworn statement, nor any of its officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, nor any affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July I, 1989. ___ The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, or an affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1,1989. __ The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, or an affiliate of the entity has been charged with and convicted of a public entity crime subsequent of July I, 1989. However, there has been a subsequent proceeding before a Hearing Officer of the State of Florida, Division of Administrative Hearings and the Final Order entered by the Hearing Officer determined that it was not in the public interest to place the entity submitting this sworn statement on the convicted vendor list. [attach a copy of the final order.] I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER FOR THE PUBLIC ENTITY INDENTIFIED IN PARAGRAPH I (ONE) ABOVE IS FOR THAT PUBLIC ENTITY ONLY, AND THAT THIS FORM IS VALID THROUGH DECEMBER 31 OF THE CALENDAR YEAR IN WHICH IT IS FILED. I ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO ENTERING INTO A CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION 287.017, FLORIDA STATUTES, FOR CATEGORY TWO OF ANY CHANGE IN THE INFORMATION CONTAINED IN THIS FORM. [Signature] Sworn to and subscribed before me this _____ day of _____________ , 20 __ . Personally known ___________ _ OR Produced identification _______ _ (Type of identification) Form PUR 7068 (Rev.06/11/92) Thomas F. Pepe 02-23-15 Page 17 of 47 Notary Public -State of ______ _ My commission expires _______ _ (Printed, typed or stamped commissioned name of notary public) DRUG FREE WORKPLACE Whenever two or more Bids or Proposals which are equal with respect to price, quality and service are received by the State or by any political subdivisions for the procurement of commodities or contractual services, a Bid or Proposal received from a business that certifies that it has implemented a drug-free workplace program shall be given preference in the award process. Established procedures for processing tie Bids or Proposals shall be followed if none of the tied vendors have a drug-free workplace program. In order to have a drug-free workplace program, a business shall: I) Publish a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the workplace and specifying the actions that shall be taken against employees for violations of such prohibition. 2) Inform employees about the dangers of drug abuse in the workplace, the business' policy of maintaining a drug-free workplace, any available drug counseling, rehabilitation, and employee assistance programs, and the penalties that may be imposed upon employees for drug abuse violations. 3) Give each employee engaged in providing the commodities or contractual services that are under Bid a copy of the statement specified in Subsection (I). 4) In the statement specified in Subsection (I), notify the employees, that, as a condition of working of the commodities or contractual services that are under Bid, he employee shall abide by the terms of the statement and shall notify the employee of any conviction of, or plea of gUilty or nolo contendere to, any violation of Chapter 893 or of any controlled substance law of the United States or any state, for a violation occurring in the workplace no later than five (5) business days after such conviction. 5) Impose a sanction on, or require the satisfactory participation in a drug abuse assistance or rehabilitation program, if such is available in the employee's community, by any employee who is so convicted. 6) Make a good faith effort to continue to maintain a drug-free workplace through implementation of this section. As the person authorized to sign the statement, I certify that this firm complies fully with the above requirements. RESPONDENT's Signature: _________ -_---- Print Name: ___________________ _ Date: _____________________ ___ Thomas F. Pepe 02-23-15 Page 18 of 47 ACKNOWLEDGEMENT OF CONFORMANCE WITH OSHA STANDARDS TO THE CITY OF SOUTH MIAMI We, , (Name of CONTRACTOR), hereby acknowledge and agree that as CONTRACTOR for the Insurance Brokerage Services project as specified have the sole responsibility for compliance with all the requirements of the Federal Occupational Safety and Health Act of 1970, and all State and local safety and health regulations, and agree to indemnify and hold harmless the City of South Miami and NIA (Consultant) against any and all liability, claims, damages, losses and expenses they may incur due to the failure of (Sub-contractor's names): to comply with such act or regulation. CONTRACTOR By: __________________________ __ Name Title Thomas F. Pepe 02-23-15 Page 19 of 47 Witness AFFIDAVIT CONCERNING FEDERAL AND STATE VENDOR LISTINGS The person, or entity, who is responding to the City's solicitation, hereinafter referred to as "Respondent", must certify that the Respondent's name Does Not appear on the State of Florida, Department of Management Services, "CONVICTED, SUSPENDED, DISCRIMINATORY FEDERAL EXCLUDED PARTIES and COMPLAINTS VENDOR LISTINGS". If the Respondent's name Does appear on one or all the "Listings" summarized below, Respondents must "Check if Applies" next to the applicable "Listing." The "Listings" can be accessed through the following link to the Florida Department of Management Services website: http://www.dms.myf!orida.com/business operations/state purchasing/vendor information/convicted susp ended discriminato!): complaints vendor lists DECLARATION UNDER PENAL TV OF PERJURY I, (hereinafter referred to as the "Declarant") state, under penalty of perjury, that the following statements are true and correct: (I) I represent the Respondent whose name is ____________ -,-_' (2) I have the following relationship with the Respondent {Owner (if Respondent is a sole proprietor), President (if Respondent is a corporation) Partner (if Respondent is a partnership), General Partner (if Respondent is a Limited Partnership) or Managing Member>{if Respondent is a Limited Liability Company). (3) I have reviewed the Florida Department of Management Services website at the following URL address: http://www.dms.myflorida.comlbusiness_operations/stateyurchasing/vendor _information/convicted_suspended_di scriminatory _ complaints_vendor _lists (4) I have entered an "x" or a check mark beside each listing/category set forth below if the Respondent's name appears in the list found on the Florida Department of Management Services website for that category or listing. If I did not enter a mark beside a listing/category it means that I am attesting to the fact that the Respondent's name does not appear on the listing for that category in the Florida Department of Management Services website as of the date of this affidavit. Check if Applicable Convicted Vendor List Suspended Vendor List Discriminatory Vendor List Federal Excluded Parties List Vendor Complaint List FURTHER DECLARANT SAYETH NOT. (Print name of Declarant) By: _----:::-__ -:-:::---,----:-__ _ (Signature of Declarant) ACKNOWLEDGEMENT STATE OF FLORIDA ) COUNTY OF MIAMI-DADE ) On this the __ day of _______ , 20 __ , before me, the undersigned authority, personally appeared who is personally know to me or who provided the following identification and who took an oath or affirmed that that he/she/they executed the foregoing Affidavit as the Declarant. WITNESS my hand and official seal. NOTARY PUBLIC: Thomas F. Pepe 02·23·15 SEAL Page 20 of 47 Notary public, State of Florida (Name of Notary Public: Print, Stamp or type as commissioned.) RELATED PARTY TRANSACTION VERIFICATION FORM _____________ ---', individually and on behalf of _-:-::-_-:--__ -::-::---:::-:---::--:----:-::-:-_ ("Firm")have Name of Representative CompanylVendor/Entity read the City of South Miami ("City")'s Code of Ethics, Section SA-I of the City's Code of Ordinances and I hereby certify, under penalty of perjury that to the best of my knowledge, information and belief: (I) neither I nor the Firm have any conflict of interest (as defined in section SA-I) with regard to the contract or business that I, and/or the Firm, am(are) about to perform for, or to transact with, the City, and (2) neither I nor any employees, officers, directors of the Firm, nor anyone who has a financial interest greater than 5% in the Firm, has any relative(s), as defined in section SA-I, who is an employee of the City or who is(are) an appointed or elected official of the City, or who is(are) a member of any public body created by the City Commission, i.e., a board or committee of the City, [while the ethics code still applies, if the person executing this form is doing so on behalf of a firm whose stock is publicly traded, the statement in this section (2) shall be based solely on the signatory's personal knowledge and he/she is not required to make an independent investigation as to the relationship of employees or those who have a financial interest in the Firm.]; and (3) neither I nor the Firm, nor anyone who has a financial interest greater than 5% in the Firm, nor any member of those persons' immediate family (i.e., spouse, parents, children, brothers and sisters) has transacted or entered into any contract(s) with the City or has a financial interest, direct or indirect, in any business being transacted with the city, or with any person or agency acting for the City, other than as follows: _(use (if necessary, use a separate sheet to supply additional information that will not fit on this line; however, you must make reference, on the above line, to the additional sheet and the additional sheet must be Signed under oath). [while the ethics code still applies, if the person executing this form is doing so on behalf of a firm whose stock is publicly traded, the statement in this section (3) shall be based solely on the signatory's personal knowledge and he/she is not required to make an independent investigation as to the relationship of those who have a financial interest in the Firm.]; and (4) no elected and/or appointed official or employee of the City of South Miami, or any of their immediate family members (i.e., spouse, parents, children, brothers and sisters) has a financial interest, directly or indirectly, in the contract between you and/or your Firm and the City other than the follOWing individuals whose interest is set forth follOWing their use a separate names: ______________________ _ (if necessary, use a separate sheet to supply additional information that will not fit on this line; however, you must make reference, on the above line, to the additional sheet and the additional sheet must be signed under oath). The names of all City employees and that of all elected and/or appointed city officials or board members, who own, directly or indirectly, an interest of five percent (5%) or more of the total assets of capital stock in the firm are as follows: (if necessary, use a separate sheet to supply additional information that will not fit on this line; however, you must make reference, on the above line, to the additional sheet and. the additional sheet must be signed under oath). [while the ethics code still applies, if the person executing this form is aoing so on behalf of a firm whose stock is publicly traded, the statement in this section (4) shall be based solely on the signatory's personal knowledge and he/she is not required to make an independent investigation as to the financial interest in the Firm of city employees, appointed officials or the immediate family members of elected and/or appointed official or employee.] (5) I and the Firm further agree not to use or attempt to use any knowledge, property or resource which may come to us through our position of trust, or through our performance of our duties under the terms of the contract with the City, to secure a special privilege, benefit, or exemption for ourselves, or others. We agree that we may not disclose or use information, not available to members of the general public, for our personal gain or benefit or for the personal gain or benefit of any other person or business entity, outside of the normal gain or benefit anticipated through the performance of the contract. Thomas F. Pepe 02-23-15 Page 21 of 47 (6) I and the Firm hereby acknowledge that we have not contracted or transacted any business with the City or any person or agency acting for the City. and that we have not appeared in representation of any third party before any board. commission or agency of the City within the past two years other than as follows: (if necessary. use a separate sheet to supply additional information that will not fit on this line; however. you must make reference. on the above line. to the additional sheet and the additional sheet must be signed under oath). X:\Purchasing\Vendor Registration\ 12.28.12 RELATED PARTY TRANSACTION VERIFICATION FORM [3].docx (7) Neither I nor any employees. officers. or directors of the Firm. nor any of their immediate family (i.e .• as a spouse. son. daughter. parent, brother or sister) is related by blood or marriage to: (i) any member of the City Commission; (ii) any city employee; or (iii) any member of any board or agency of the City other than as follows: _____________________ (if necessary. use a separate sheet to supply additional information that will not fit on this line; however. you must make reference. on the above line. to the additional sheet and the additional sheet must be Signed under oath). [while the ethics code still applies. ifthe person executing this form is doing so on behalf of a firm whose stock is publicly traded. the statement in this section (7) shall be based solely on the Signatory's personal knowledge and he/she is not required to make an independent investigation as to the relationship by blood or marriage of employees. officers. or directors of the Firm. or of any of their immediate family to any appointed or elected officials of the City. or to their immediate family members]. (8) No Other Firm. nor any officers or directors of that Other Firm or anyone who has a financial interest greater than 5% in that Other Firm. nor any member of those persons' immediate family (i.e .• spouse. parents. children. brothers and sisters) nor any of my immediate family members (hereinafter referred to as "Related Parties") has responded to a solicitation by the City in which I or the Firm that I represent or anyone who has a financial interest greater than 5% in the Firm. or any member of those persons' immediate family (i.e. spouse. parents. children. brothers and sisters) have also responded. other than the following: _-----------------_______________ (if necessary. use a separate sheet to supply additional information that will not fit on this line; however. you must make reference. on the above line. to the additional sheet and the additional sheet must be signed under oath). [while the ethics code still applies. if the person executing this form is doing so on behalf of a firm whose stock is publicly traded. the statement in this section (8) shall be based solely on the signatory's personal knowledge and he/she is not required to make an independent investigation into the Other Firm. or the Firm he/she represents. as to their officers. directors or anyone having a financial interest in those Firms or any of their any member of those persons' immediate family.] (9) I and the Firm agree that we are obligated to supplement this Verification Form and inform the City of any change in circumstances that would change our answers to this document. Specifically. after the opening of any responses to a solicitation. I and the Firm have an obligation to supplement this Verification Form with the name of all Related Parties who have also responded to the same solicitation and to disclose the relationship of those parties to me and the Firm. (10) A violation of the City's Ethics Code. the giving of any false information or the failure to supplement this Verification Form. may subject me or the Firm to immediate termination of any agreement with the City. and the imposition of the maximum fine and/or any penalties allowed by law. Additionally. violations may be considered by and subject to action by the Miami-Dade County Commission on Ethics. Under penalty of perjury. I declare that I have made a diligent effort to investigate the matters to which I am attesting hereinabove and that the statements made hereinabove are true and correct to the best of my knowledge. information and belief. Signature: ____________ _ Print Name & Title: ______________ _ Date: ___________ _ Thomas F. Pepe 02-23-15 Page 22 of 47 Sec. SA-I. -Conflict of interest and code of ethics ordinance. (a) Designation. This section shall be designated and known as the "City of South Miami Conflict of Interest and Code of Ethics Ordinance." This section shall be applicable to all city personnel as defined below, and shall also constitute a standard of ethical conduct and behavior for all autonomous personnel, quasi-judicial personnel, advisory personnel and departmental personnel. The provisions of this section shall be applied in a cumulative manner. By way of example, and not as a limitation, subsections (c) and (d) may be applied to the same contract or transaction. (b) Definitions. For the purposes of this section the following definitions shall be effective: (I) The term "commission members" shall refer to the mayor and the members of the city commission. (2) The term "autonomous personnel" shall refer to the members of autonomous authorities, boards and agencies, such as the city community redevelopment agency and the health facilities authority. (3) The term "quasi-judicial personnel" shall refer to the members of the planning board, the environmental review and preservation board, the code enforcement board and such other individuals, boards and agencies of the city as perform quasi-judicial functions. (4) The term "advisory personnel" shall refer to the members of those city advisory boards and agencies whose sole or primary responsibility is to recommend legislation or give advice to the city commission. (5) The term "departmental personnel" shall refer to the city clerk, the city manager, department heads, the city attorney, and all assistants to the city clerk, city manager and city attorney, however titled. (6) The term "employees" shall refer to all other personnel employed by the city. (7) The term "compensation" shall refer to any money, gift, favor, thing of value or financial benefit conferred, or to be conferred, in return for services rendered or to be rendered. (8) The term "controlling financial interest" shall refer to ownership, directly or indirectly, of ten percent or more of the outstanding capital stock in any corporation or a direct or indirect interest of ten percent or more in a firm, partnership, or other business entity at the time of transacting business with the city. (9) The term "immediate family" shall refer to the spouse, parents, children, brothers and sisters of the person involved. (10) The term "transact any business" shall refer to the purchase or sale by the city of specific goods or services for consideration and to submitting a bid, a proposal in response to a Solicitation, a statement of qualifications in response to a request by the city, or entering into contract negotiations for the provision on any goods or services, whichever first occurs. (c) Prohibition on transacting business with the city. No person included in the terms defined in paragraphs (b)(I) through (6) and in paragraph (b)(9) shall enter into any contract or transact any business in which that person or a member of the immediate family has a financial interest, direct or indirect with the city or any person or agency acting for the city, and any such contract, agreement or business engagement entered in violation of this subsection shall render the transaction voidable. Willful violation of this subsection shall constitute malfeasance in office and shall affect forfeiture of office or position. Nothing in this subsection shall prohibit or make illegal: (I) The payment of taxes, special assessments or fees for services provided by the city government; (2) The purchase of bonds, anticipation notes or other securities that may be issued by the city through underwriters or directly from time to time. Waiver of prohibition. The requirements of this subsection may be waived for a particular transaction only by four affirmative votes of the city commission after public hearing upon finding that: (I) An open-to-all sealed competitive proposal has been submitted by a city person as defined in paragraphs (b)(2), (3) and (4); (2) The proposal has been submitted by a person or firm offering services within the scope of the practice of architecture, professional engineering, or registered land surveying, as defined by the laws of the state and pursuant to the provisions of the Consultants' Competitive Negotiation Act, and when the proposal has been submitted by a city person defined in paragraphs (b)(2), (3) and (4); (3) The property or services to be involved in the proposed transaction are unique and the city cannot avail itself of such property or services without entering a transaction which would violate this subsection but for waiver of its requirements; and (4) That the proposed transaction will be in the best interest of the city. This subsection shall be applicable only to prospective transactions, and the city commission may in no case ratify a transaction entered in violation of this subsection. Provisions cumulative. This subsection shall be taken to be cumulative and shall not be construed to amend or repeal any other law pertaining to the same subject matter. Thomas F. Pepe 02-23-15 Page 23 of 47 (d) Further prohibition on transacting business with the city. No person included in the terms defined in paragraphs (b)( I) through (6) and in paragraph (b)(9) shall enter into any contract or transact any business through a firm, corporation, partnership or business entity in which that person or any member of the immediate family has a controlling financial interest, direct or indirect, with the city or any person or agency acting for the city, and any such contract, agreement or business engagement entered in violation of this subsection shall render the transaction voidable. The remaining provisions of subsection (c) will . also be applicable to this subsection as though incorporated by recitation. Additionally, no person included in the term defined in paragraph (b)( I) shall vote on or participate in any way in any matter presented to the city commission if that person has any of the following relationships with any of the persons or entities which would be or might be directly or indirectly affected by any action of the city commission: (I) Officer, director, partner, of counsel, consultant, employee, fiduciary or beneficiary; or (2) Stockholder, bondholder, debtor, or creditor, if in any instance the transaction or matter would affect the person defined in paragraph (b)(I) in a manner distinct from the manner in which it would affect the public generally. Any person included in the term defined in paragraph (b)( I) who has any of the specified relationships or who would or might, directly or indirectly, realize a profit by the action of the city commission shall not vote on or participate in any way in the matter. (E) Gifts. (I) Definition. The term "gift" shall refer to the transfer of anything of economic value, whether in the form of money, service, loan, travel, entertainment, hospitality, item or promise, or in any other form, without adequate and lawful consideration. (2) Exceptions. The provisions of paragraph (e)( I) shall not apply to: a. Political contributions specifically authorized by state law; b. Gifts from relatives or members of one's household, unless the person is a conduit on behalf of a third party to the delivery of a gift that is prohibited under paragraph(3); c. Awards for professional or civic achievement; d. Material such as books, reports, periodicals or pamphlets which are solely informational or of an advertising nature. (3) Prohibitions. A person described in paragraphs (b)(I) through (6) shall neither solicit nor demand any gift. It is also, unlawful for any person or entity to offer, give or agree to give to any person included in the terms defined in paragraphs (b)( I) through (6), or for any person included in the terms defined in paragraphs (b)( I) through (6) to accept or agree to accept from another person or entity, any gift for or because of: a. An official public action taken, or to be taken, or which could be taken, or an omission or failure to take a public action; b. A legal duty performed or to be performed, or which could be performed, or an omission or failure to perform a legal duty; c. A legal duty violated or to be violated, or which could be violated by any person included in the term defined in paragraph (b)( I); or d. Attendance or absence from a public meeting at which official action is to be taken. (4) Disclosure. Any person included in the term defined in paragraphs (b)( I) through (6) shall disclose any gift, or series of gifts from anyone person or entity, having a value in excess of $25.00. The disclosure shall be made by filing a copy of the disclosure form required by chapter I 12, Florida Statutes, for "local officers" with the city clerk simultaneously with the filing of the form with the clerk of the county and with the Florida Secretary of State. (f) Compulsory disclosure by employees of firms doing business with the city. Should any person included in the terms defined in paragraphs (b)(l) through (6) be employed by a corporation, firm, partnership or business entity in which that person or the immediate family does not have a controlling financial interest, and should the corporation, firm, partnership or business entity have substantial business commitments to or from the city or any city agency, or be subject to direct regulation by the city or a city agency, then the person shall file a sworn statement disclosing such employment and interest with the clerk of the city. (g) Exploitation of official position prohibited. No person included in the terms defined in paragraphs (b )( I) through (6) shall corruptly use or attempt to use an official position to secure special privileges or exemptions for that person or others. (h) Prohibition on use of confidential information. No person included in the terms defined in paragraphs (b)(l) through (6) shall accept employment or engage in any business or professional activity which one might reasonably expect would require or induce one to disclose confidential information acquired by reason of an official position, nor shall that person in fact ever disclose confidential information garnered or gained through an Thomas F. Pepe 02-23-15 Page 24 of 47 official position with the city, nor shall that person ever use such information, directly or indirectly, for personal gain or benefit. (i) Conflicting employment prohibited. No person included in the terms defined in paragraphs (b)(I) through (6) shall accept other employment which would impair independence of judgment in the performance of any public duties. (j) Prohibition on outside employment. (I) No person included in the terms defined in paragraphs (b)( 6) shall receive any compensation for services as an officer or employee of the city from any source other than the city, except as may be permitted as follows: a. Generally prohibited. No full-time city employee shall accept outside employment, either incidental, occasional or otherwise, where city time, equipment or material is to be used or where such employment or any part thereof is to be performed on city time. b. When permitted. A full-time city employee may accept incidental or occasional outside employment so long as such employment is not contrary, detrimental or adverse to the interest of the city or any of its departments and the approval required in subparagraph c. is obtained. c. Approval of department head reqUired. Any outside employment by any full-time city employee must first be approved in writing by the employee's department head who shall maintain a complete record of such employment. d. Penalty. Any person convicted of violating any provision of this subsection shall be punished as provided in section I-I I of the Code of Miami-Dade County and, in addition shall be subject to dismissal by the appointing authority. The city may also assess against a violator a fine not to exceed $500.00 and the costs of investigation incurred by the city. (2) All full-time city employees engaged in any outside employment for any person, firm, corporation or entity other than the city, or any of its agencies or instrumentalities, shall file, under oath, an annual report indicating the source of the outside employment, the nature of the work being done and any amount of money or other consideration received by the employee from the outside employment. City employee reports shall be filed with the city clerk. The reports shall be available at a reasonable time and place for inspection by the public. The city manager may require monthly reports from individual employees or groups of employees for good cause .. (k) Prohibited investments. No person included in the terms defined in paragraphs (b)( I) through (6) or a member of the immediate family shall have personal investments in any enterprise which will create a substantial conflict between private interests and the public interest. (I) Certain appearances and payment prohibited. (I) No person included in the terms defined in paragraphs (b)(I), (5) and (6) shall appear before any city board or agency and make a presentation on behalf of a third person with respect to any matter, license, contract, certificate, ruling, decision, opinion, rate schedule, franchise, or other benefit sought by the third person. Nor shall the person receive any compensation or gift, directly or indirectly, for services rendered to a third person, who has applied for or is seeking some benefit from the city or a city agency, in connection with the particular benefit sought by the third person. Nor shall the person appear in any court or before any administrative tribunal as counselor legal advisor to a party who seeks legal relief from the city or a city agency through the suit in question. (2) No person included in the terms defined in paragraphs (b)(2), (3) and (4) shall appear before the city commission or agency on which the person serves, either directly or through an associate, and make a presentation on behalf of a third person with respect to any matter, license, contract, certificate, ruling, decision, opinion, rate schedule, franchise, or other benefit sought by the third person. Nor shall such person receive any compensation or gift, directly or indirectly, for services rendered to a third party who has applied for or is seeking some benefit from the city commission or agency on which the person serves in connection with the particular benefit sought by the third party. Nor shall the person appear in any court or before any administrative tribunal as counselor legal advisor to a third party who seeks legal relief from the city commission or agency on which such person serves through the suit in question. (m) Actions prohibited when financial interests involved. No person included in the terms defined in paragraphs (b) (I) through (6) shall participate in any official action directly or indirectly affecting a business in which that person or any member of the immediate family has a financial interest. A financial interest is defined in this subsection to include, but not be limited to, any direct or indirect interest in any investment, equity, or debt. (n) Acquiring financial interests. No person included in the terms defined in paragraphs (b)( I) through (6) shall acquire a financial interest in a project, business entity or property at a time when the person believes or has reason to believe that the financial Thomas F. Pepe 02-23-15 Page 25 of 47 interest may be directly affected by official actions or by official actions by the city or city agency of which the person is an official. officer or employee. (0) Recommending professional selVices. No person included in the terms defined in paragraphs (b)( I) through (4) may recommend the services of any lawyer or law firm. architect or architectural firm. public relations firm. or any other person or firm. professional or otherwise. to assist in any transaction involving the city or any of its agencies. provided that a recommendation may properly be made when required to be made by the duties of office and in advance at a public meeting attended by other city officials. officers or employees. (p) Continuing application after city selVice. (I) No person included in'the terms defined in paragraphs (b)( I). (5) and (6) shall. for a period of two years after his or her city service or employment has ceased. lobby any city official [as defined in paragraphs (b)( I) through (6)] in connection with any judicial or other proceeding. application. Solicitation. RFQ. bid. request . for ruling or other determination. contract. claim. controversy. charge. accusation. arrest or other particular subject matter in which the city or one of its agencies is a party or has any interest whatever. whether direct or indirect. Nothing contained in this subsection shall prohibit any individual from submitting a routine administrative request or application to a city department or agency during the two-year period after his or her service has ceased. (2) The provisions of the subsection shall not apply to persons who become employed by governmental entities. ·50 I (c)(3) non-profit entities or educational institutions or entities. and who lobby on behalf of those entities in thei r official capacities. (3) The provisions of this subsection shall apply to all persons described in paragraph (p)( I) whose city service or employment ceased after the effective date of the ordinance from which this section derives. (4) No person described in paragraph (p)( I) whose city service or employment ceased within two years prior to the effective date of this ordinance shall for a period of two years after his or her service or employment enter into a lobbying contract to lobby any city official in connection with any subject described in paragraph (p)( I) in which the city or one of its agencies is a party or has any direct and substantial interest; and in which he or she participated directly or indirectly through decision. approval. disapproval. recommendation. the rendering of advice. investigation. or otherwise. during his or her city service or employment. A person participated "directly" where he or she was substantially involved in the particular subject matter through decision. approval. disapproval. recommendation. the rendering of advice. investigation. or otherwise. during his or her city service or employment. A person participated "indirectly" where he or she knowingly participated in any way in the particular subject matter through decision. approval. disapproval. recommendation. the rendering of advice. investigation. or otherwise. during his or her city service or employment. All persons covered by this paragraph shall execute an affidavit on a form approved by the city attorney prior to lobbying any city official attesting that the requirements of this subsection do not preclude the person from lobbying city officials. (5) Any person who violates this subsection shall be subject to the penalties provided in section 8A-2(p). (q) City attorney to render opinions on request. Whenever any person included in the terms defined in paragraphs (b)( I) through (6) and paragraph (b)(9) is in doubt as to the proper interpretation or application of this conflict of interest and code of ethics ordinance. or whenever any person who renders services to the city is in doubt as to the applicability of the ordinance that person. may submit to the city attorney a full written statement of the facts and questions. The city attorney shall then render an opinion to such person and shall publish these opinions without use of the name of the person advised unless the person permits the use of a name. (Ord. No. 6-99-/680, § 2. 3-2-99) Editor's note-Ord. No. 6-99-1680. § I, adopted 3-2-99. repealed §§ 8A-1 and 8A-2 in their entirety and replaced them with new §§ 8A-1 and 8A-2. Former §§ 8A-1 and 8A-2 pertained to declaration of policy and definitions. respectively. and derived from Ord. No. 634. §§ I (lA-I), I (IA-2) adopted Jan. 11.1969. Thomas F. Pepe 02-23-15 END OF SECTION Page 26 of 47 PRESENTATION TEAM DECLARATION/AFFIDVAIT OF REPRESENTATION This affidavit is not r~quired for compliance with the City's Solicitation; however, it may be used to avoid the need to register members of your presentation team as lobbyists. Pursuant to City Ordinance 28-14- 2206 (c)(9), any person who appears as a representative for an individual or firm for an oral presentation before a City certification, evaluation, selection, technical review or similar committee, shall list on an affidavit provided by the City staff, all individuals who may make a presentation. The affidavit shall be filed by staff with the Clerk's office at the time the committee's proposal is submitted to the City Manager. For the purpose of this subsection only, the listed members of the presentation team, with the exception of any person otherwise required to register as a lobbYist, shall not be required to pay any registration fees. No person shall appear before any committee on behalf of an anyone unless he or she has been listed as part of the firm's presentation team pursuant to this paragraph or unless he or she is registered with the City Clerk's office as a lobbyist and has paid all applicable lobbyist registration fees. Pursuant to '92.525(2), Florida Statutes, the undersigned, _______ ,' makes the following declaration under penalty of perjury: Listed below are all individuals who may make a presentation on behalf of the entity that the affiant represents. Please note; No person shall appear before any committee on behalf of anyone unless he or she has been listed as part of the firm's presentation team pursuant to this paragraph or unless he or she is registered with the Clerk's office as a lobbyist and has paid all applicable lobbyist registration fees. For the purpose of this Affidavit of Representation only, the listed members of the presentation team, with the exception of any person otherwise required to register as a lobbyist, shall not be required to pay any registration fees. The Affidavit of Representation shall be filed with the City Clerk's office at the time the committee's proposal is submitted to the City as part of the procurement process. Under penalties of perjury, I declare that I have read the foregoing declaration and that the facts stated in it are true and specifically that the persons listed above are the members of the presentation team of the entity listed below Executed this ___ day of _______ -', 20 Signature of Representative Print Name and Title Thomas F. Pepe 02-23-15 Print name of entity being represented END OF SECTION Page 27 of 47 EXHIBIT#I Scope of Services Insurance Brokerage Services RFQ #HR20 16-07 Respondents are required to read and understand all information contained within the entire proposal package. By responding to this RFQ. the respondent thereby acknowledges that he or she has read and understands these documents. This section outlines the minimum services that the City expects to receive from a qualified Consultant as a subject matter expert. Said Consultant shall assist in the design and implementation of a comprehensive employee benefits program for fiscal year 20 I 7 and beyond. SCOPE OF SERVICES The City of South Miami seeks the services of qualified firms to provide Insurance Brokerage Services for the City's Employee Benefit Plans. The City of South Miami has approximately 142 employees and retirees participating in the benefits plan. All employees are located in Florida and retirees may be elsewhere. The City's plan year is October 1st through September 30th The benefit plans include the following. but is not limited to: • Health/Medical Insurance • Dental Insurance • Life Insurance • Long Term Disability • Short Term Disability • Group Life Insurance and Accidental Death & Dismemberment Insurance • Insurance Supplements • Vision ON-GOING SERVICES: Expected deliverables include. but are not limited to: A. Monitor the programs' operations throughout the year to ensure that benefit providers are meeting all customer service requirements and standards. B. Provide on-going administrative support. as required; defined as dedicated account managers and in house support with unlimited staff support. by acting as a liaison between the City and providers to assist with active review and management count, resolving claim disputes. contract administration and interpretations. and other issues. C. Provide dedicated personnel as a primary contact for managing the account relationship with the City to assist with round the clock support and assistance with billing. I.D. cards and day to day issues. , D. Meet with the City's Human Resources Personnel Manager throughout the year as reasonably necessary (minimum is quarterly). Thomas F. Pepe 02-23-15 Page 28 of 47 E. Coordinate annual audits of City's benefit plans and associated vendors and prepare annual financial reports on the results of the completed plan year. F. Prepare and deliver any necessary reports to the City's Human Resources Personnel Manager, including but not limited to, reports showing claims experience at intervals acceptable to the City. G. Provide advice and assistance in the review of the City employee health and medical benefits program on a continuing basis to ensure that those plans are in compliance with state/federal requirements and their adequacy of benefits with respect to other plans. H. Track, monitor and provide information on changes in, or any pending or new legislation in the applicable state and federal laws, as well as any employee benefit and funding trends that may affect the benefits program, to the City's Human Resources Personnel Manager. I. Advise and assist the City with: • Writing employee benefits plan modifications and/or new benefits plans and any required amendment approval process; • Submission of written reports and other documents as required by the state and/or federal government; • Coordination of the annual employee wellness fair; • Development of an Employee Wellness Program; • Provide summary of benefits; • Onsite enrollment presentations; • Employee self-service enrollment; • Cobra administration; • Education to provide information to promote lower out of pocket costs; • Provide seminars and programs as needed for smoking, fitness, exercise, nutrition and heart health. J. Perform special projects as requested by the City, including but not limited to: • Development and assistance in the implementation of new insurance plans; • Assistance with adjudication of specific claims as requested by the City; • Recommendation of alternative benefit designs or delivery systems as dictated by emerging plan costs for benefit practices. K. Ensure personnel availability for meetings, phone calls, and e-mail correspondence as required. L. Maintain confidentiality of City records and data in accordance applicable federal and state laws. M. Active annual renewal process across all line of coverage and all carriers; Thomas F. Pepe 02-23-15 Page 29 of 47 N. Presentation and meetings to review options, effective negotiations to ensure the best benefits for lowest cost to the City and employees; O. Complete renewal package with customized options and quotes; P. Perform other related services on an "as-needed" basis. RENEWAL YEAR SERVICES: A. Using current health and medical benefit plans as benchmarks, research, design, and propose employee benefit plans for the City, as appropriate. B. Meet with the City as necessary to discuss benefit plan options and establish goals and objectives for the City's benefit programs. C. Provide analysis of current plans, including the review of past performance, with regard to renewal. D. Review additional available cost savings plan alternatives and creative funding options. E. Determine the appropriate employee and employer benefit contribution levels. F. Review and recommend annual contribution strategies for active participants and retirees. G. Provide City with information on what other municipalities of comparable size and location will be doing with their benefits in the upcoming years. H. Conduct renewal negotiations and develop appropriate information for management purposes. I. Upon City's request, coordinate a comprehensive "Request for Proposal" (RFP) process to identify potential high quality Benefit vendors, according to established City guidelines. The scope of the RFP may include but not be limited to: Medical, Dental, Vision, Basic life, Voluntary life, Accidental Death and Dismemberment, Short Term and Long Term Disability insurance providers. J. Act as lead negotiator and consultant to the City during benefit contract negotiations and renewals. K. Prepare and present a written analytical report of the proposals received including recommendation(s) and supporting documentation for recommendations. L. Review plan documents (including employee booklets) and master contracts before adoption and printing. M. Assist with planning and implementation of selected changes including transition from the current to new vendors, the renewal proposal, and other benefit changes. N. Assist with developing City employee benefit program communication materials. Coordinate the design, printing, and production of those materials, as edited and approved by the Human Resources Personnel Manager. O. Advise and assist the Human Resources Personnel Manager or designee with the review of contracts, plan documents, insurance policies and other documents for applicability, accuracy, consistency, and legal compliance. Thomas F. Pepe 02-23-15 Page 30 of 47 P. Assist City with the development of performance guarantees relating to vendors' performance of services to the City. and evaluation of the performance of vendors. Thomas F. Pepe 02-23-15 END OF SECTION Page 31 of 47 EXHIBIT #2 SUPPLEMENTAL INSTRUCTIONS AND PROPOSAL FORMAT FOR RESPONDENT Insurance Brokerage Services RFQ #HR20 16·07 I. Format and Content of RFQ Response Firms responding to the solicitation shall disclose their qualifications to serve as the City's insurance brokerage services provider in the format set forth below. Failure to provide requested information may result in your proposal being deemed non- responsive and therefore eliminated from further consideration. A. Title Page Show the name of Respondent's agency/firm, address, telephone number, name of contact person, date and the subject: REQUEST FOR QUALIFICATIONS For "Insurance Brokerage Services" RFQ #HR20 16-07. B. Table of Contents Include a clear identification of the material by section and by page number. C. Cover Letter and Executive Summary This letter should be signed by the person in your firm who is authorized to negotiate terms, render binding decisions, and commit the firm's resources. Summarize your firm's qualifications and experience to serve as a the City insurance brokerage services provider, and your firm's understanding of the work to be done and make a positive commitment to perform the work in accordance with the terms of the proposal being submitted. This response should emphasize the strength of the firm in any relevant areas which you feel the City should weigh in its selection, based on the criteria set forth above. This section should summarize the key points of your submittal. Limit to one (I) to five (5) pages. Proposals must include the following. I. Respondent's qualifications to perform the services detailed in Exhibit I, "Scope of Services." 2. Detailed work plan/project approach and schedule designed to accomplish the objectives of the proposed project in a timely manner. 3. A list of the executive and professional personnel that will be employed in this engagement and their experience with similar engagements, including the percentage of project time projected to be spent by each person. 4. Respondents experience with engagements of a similar scope including a summary of prior work experience and competence in undertaking engagements of this type. Experience shown should be of the lead project personnel who will be assigned to the City's project and will routinely be interfacing with the City. Thomas F. Pepe 02·23·15 Page 32 of 47 D. Firm Overview State the full legal name and organizational structure of the firm. Describe the ownership structure of your firm. State the location of the office that will be serving the City including mailing address and telephone numbers. a. Name of Firm submitting responding to the solicitation. b. Name and title of individual responsible for the submittal. c. Mailing and e-mail addresses. d. Telephone and facsimile numbers. E. Personnel and References Identify the primary individuals who will provide services to the City with regard to the day- to-day relationship with the City and include a brief resume for each of the primary individuals including licenses and certifications held by those individuals. Provide a list of five clients the firm has worked with in the last 36 months. Indicate the firm's experience with clients within the State of Florida and provide a brief description of the type of services provided as well as the names, titles, addresses and telephone numbers of those primarily responsible for the account. In addition to the day-to-day relationship, please provide information regarding the firm's and individual's experience with engagements which are similar to the project contemplated by the City. Finally, provide specific services required to complete this engagement that are provided by your firm, through subcontractors or sub consultants. F. Other Relevant Experience Provide a description of your proposed primary individuals' relevant experience over the last three years with other cities that you believe are relevant to this proposed engagement. Include three case studies, if available, that illustrate experience with relevant services where the proposed primary individuals have served as consultants for similar engagements as proposed by the City detailed in the Scope of Services in this RFQ. Please limit your response in the section to five (5) pages. Thomas F. Pepe 02-23-15 END OF SECTION Page 33 of 47 1.0 I A. Insurance EXHIBIT 3 Insurance & Indemnification Requirements Insurance Brokerage Services RFQ #HR20 16-07 Without limiting its liability, the contractor, consultant or consulting firm (hereinafter referred to as "FIRM" with regard to Insurance and Indemnification requirements) shall be required to procure and maintain at its own expense during the life of the Contract, insurance of the types and in the minimum amounts stated below as will protect the FIRM, from claims which may arise out of or result from the contract or the performance of the contract with the City of South Miami, whether such claim is against the FIRM or any sub-contractor, or by anyone directly or indirectly employed by any of them or by anyone for whose acts any of them may be liable. B. No insurance required by the CITY shall be issued or written by a surplus lines carrier unless authorized in writing by the CITY and such authorization shall be at the CITY's sole and absolute discretion. The FIRM shall purchase insurance from and shall maintain the insurance with a company or companies lawfully authorized to sell insurance in the State of Florida, on forms approved by the State of Florida, as will protect the FIRM, at a minimum, from all claims as set forth below which may arise out of or result from the FIRM's operations under the Contract and for which the FIRM may be legally liable, whether such operations be by the FIRM or by a Subcontractor or by anyone directly or indirectly employed by any of them, or by anyone for whose acts any of them may be liable: (a) claims under workers' compensation, disability benefit and other similar employee benefit acts which are applicable to the Work to be performed; (b) claims for damages because of bodily injury, occupational sickness or disease, or death of the FIRM's employees; (c) claims for damages because of bodily injury, sickness or disease, or death of any person other than the FIRM's employees; (d) claims for damages insured by usual personal injury liability coverage; (e) claims for damages, other than to the Work itself, because of injury to or destruction of tangible property, including loss of use resulting there from; (f) claims for damages because of bodily injury, death of a person or property damage arising out of ownership, maintenance or use of a motor vehicle; (g) claims for bodily injury or property damage arising out of completed operations; and (h) claims involving contractual liability insurance applicable to the FIRM's obligations under the Contract. 1.02 Firm's Insurance Generally. The FIRM shall provide and maintain in force and effect until all the Work to be performed under this Contract has been completed and accepted by CITY (or for such duration as is otherwise specified hereinafter), the insurance coverage written on Florida approved forms and as set forth below: 1.03 Workers' Compensation Insurance at the statutory amount as to all employees in compliance with the "Workers' Compensation Law" of the State of Florida including Chapter 440, Florida Statutes, as presently written or hereafter amended, and all applicable federal laws. In addition, the policy (ies) must include: Employers' Liability at the statutory coverage amount. The FIRM shall further insure that all of its Subcontractors maintain appropriate levels of Worker's Compensation Insurance. 1.04 Commercial Comprehensive General liability insurance with broad form endorsement, as well as automobile liability, completed operations and products liability, contractual liability, severability of interest with cross liability provision, and personal injury and property damage liability with limits of $1,000,000 combined single limit per occurrence and $2,000,000 aggregate, including: • Personal Injury: $1,000,000; • Medical Insurance: $5,000 per person; • Property Damage: $500,000 each occurrence; 1.05 Umbrella Commercial Comprehensive General Liability insurance shall be written on a Florida approved form with the same coverage as the primary insurance policy but in the amount of $1,000,000 per claim and $2,000,000 Annual Aggregate. Coverage must be afforded on a form no more restrictive than the latest edition of the Comprehensive General Liability policy, without restrictive endorsements, as filed by the Insurance Services Office, and must include: Thomas F. Pepe 02·23·15 Page 34 of 47 (a) Premises and Operation (b) Independent Contractors (c) Products and/or Completed Operations Hazard (d) Explosion, Collapse and Underground Hazard Coverage (e) Broad Form Property Damage (f) Broad Form Contractual Coverage applicable to this specific Contract, including any hold harmless and/or indemnification agreement. (g) Personal Injury Coverage with Employee and Contractual Exclusions removed, with minimum limits of coverage equal to those required for Bodily Injury Liability and Property Damage Liability. 1.06 Business Automobile Liability with minimum limits of One Million Dollars ($1,000,000.00) plus an additional One Million Dollar ($1,000,000.00) umbrella per occurrence combined single limit for Bodily Injury Liability and Property Damage Liability. Umbrella coverage must be afforded on a form no more restrictive than the latest edition of the Business Automobile Liability policy, without restrictive endorsements, as filed by with the state of Florida, and must include: (a) Owned Vehicles. (b) Hired and Non-Owned Vehicles (c) Employers' Non-Ownership 1.07 SUBCONTRACTS: The FIRM agrees that if any part of the Work under the Contract is sublet, the subcontract shall contain the same insurance provision as set forth in section 5.1 above and 5,4 below and substituting the word Subcontractor for the word FIRM and substituting the word FIRM for CITY where applicable. 1.08 Fire and Extended Coverage Insurance (Builders' Risk). IF APPLICABLE: 1.09 A In the event that this contract involves the construction of a structure, the CONTRACTOR shall maintain, with an Insurance Company or Insurance Companies acceptable to the CITY, "Broad" form/All Risk Insurance on buildings and structures, including Vandalism & Malicious Mischief coverage, while in the course of construction, including foundations, additions, attachments and all permanent fixtures belonging to and constituting a part of said buildings or structures. The policy or policies shall also cover machinery, if the cost of machinery is included in the Contract, or if the machinery is located in a building that is being renovated by reason of this contract. The amount of insurance must, at all times, be at least equal to the replacement and actual cash value of the insured property. The policy shall be in the name of the CITY and the CONTRACTOR, as their interest may appear, and shall also cover the interests of all Subcontractors performing Work. B. All of the provisions set forth in Section 5,4 herein below shall apply to this coverage unless it would be A clearly not applicable. Miscellaneous: If any notice of cancellation of insurance or change in coverage is issued by the insurance company or should any insurance have an expiration date that will occur during the period of this contract, the FIRM shall be responsible for securing other acceptable insurance prior to such cancellation, change, or expiration so as to provide continuous coverage as specified in this section and so as to maintain coverage during the life of this Contract. B. All deductibles must be declared by the FIRM and must be approved by the CITY. At the option of the CITY, either the FIRM shall eliminate or reduce such deductible or the FIRM shall procure a Bond, in a form satisfactory to the CITY covering the same. C. The policies shall contain waiver of subrogation against CITY where applicable, shall expressly provide that such policy or policies are primary over any other collectible insurance that CITY may have. The CITY reserves the right at any time to request a copy of the required policies for review. All policies shall contain a "severability of interest" or "cross liability" clause without obligation for premium payment of the CITY as well as contractual liability provision covering the Contractors duty to indemnify D. the City as provided in this Agreement. Before starting the Work, the FIRM shall deliver to the CITY and CONSULTANT certificates of such insurance, acceptable to the CITY, as well as the insurance binder, if one is issued, the insurance policy, including the declaration page and all applicable endorsements and provide the name, address and telephone number of the insurance agent or broker through whom the policy was obtained. The insurer shall be rated AVII or better per AM. Best's Key Rating Guide, latest edition and authorized to issue insurance in the State of Florida. All insurance policies must be written on forms approved by the State of Florida and they must remain in full force and effect for the duration of the contract period with the CITY. The FIRM may be required by the CITY, at its sole discretion, to provide a "certified copy" of the Page 35 of 47 Thomas F. Pepe 02-23-15 Policy (as defined in Article I of this document) which shall include the declaration page and all required endorsements. In addition. the FIRM shall deliver. at the time of delivery of the insurance certificate. the following endorsements: (I) a policy provision or an endorsement with substantially similar provisions as follows: "The City of South Miami is an additional insured. The insurer shall pay all sums that the City of South Miami becomes legally obligated to pay as damages because of 'bodily injury". 'property damage' • or "personal and advertising injury" and it will provide to the City all of the coverage that is typically provided under the standard Florida approved forms for commercial general liability coverage A and coverage S"; (2) a policy provision or an endorsement with substantially similar provisions as follows: 'This policy shall not be cancelled (including cancellation for non-payment of premium). terminated or materially modified without first giving the City of South Miami ten (I 0) days advanced written notice of the intent to materially modify the policy or to cancel or terminate the policy for any reason. The notification shall be delivered to the City by certified mail. with proof of delivery to the City." E. If the FIRM is providing professional services. such as would be provided by an architect, engineer. attorney. or accountant, to name a few. then in such event and in addition to the above requirements. the FIRM shall also provide Professional Liability Insurance on a Florida approved form in the amount of $1.000.000 with deductible per claim if any. not to exceed 5% of the limit of liability providing for all sums which the FIRM shall become legally obligated to pay as damages for claims arising out of the services or work performed by the FIRM its agents. representatives. Sub Contractors or assigns. or by any person employed or retained by him in connection with this Agreement. This insurance shall be maintained for four years after completion of the construction and acceptance of any Project covered by this Agreement. However. the FIRM may purchase Specific Project Professional Liability Insurance. in the amount and under the terms specified above. which is also acceptable. No insurance shall be issued by a surplus lines carrier unless authorized in writing by the city at the city's sole, absolute and unfettered discretion. Indemnification Requirement A. The Contractor accepts and voluntarily incurs all risks of any injuries, damages. or harm which might arise during the work or event that is occurring on the CITY's property due to the negligence or other fault of the Contractor or anyone acting through or on behalf of the Contractor. S. The Contractor shall indemnify. defend. save and hold CITY. its officers. affiliates. employees. successors and assigns. harmless from any and all damages. claims. liability. losses. claims. demands. suits. fines. judgments or cost and expenses. including reasonable attorney's fees. paralegal fees and investigative costs incidental there to and incurred prior to. during or following any litigation. mediation. arbitration and at all appellate levels. which may be suffered by. or accrued against, charged to or recoverable from the City of South Miami. its officers. affiliates. employees. successors and assigns. by reason of any causes of actions or claim of any kind or nature. including claims for injury to. or death of any person or persons and for the loss or damage to any property arising out of a negligent error. omission. misconduct, or any gross negligence. intentional act or harmful conduct of the Contractor. its contractor/subcontractor or any of their officers. directors. agents. representatives. employees. or assigns, or anyone acting through or on behalf of any of them. arising out of this Agreement, incident to it, or resulting from the performance or non-performance of the Contractor's obligations under this AGREEMENT. C. The Contractor shall pay all claims. losses and expenses of any kind or nature whatsoever. in connection therewith, including the expense or loss of the CITY and/or its affected officers. affiliates. employees. successors and assigns. including their attorney's fees, in the defense of any action in law or equity brought against them and arising from the negligent error. omission. or act of the Contractor. its Sub-Contractor or any of their agents, representatives. employees. or assigns. and/or arising out of. or incident to. this Agreement, or incident to or resulting from the performance or non-performance of the Contractor's obligations under this AGREEMENT. D. The Contractor agrees and recognizes that neither the CITY nor its officers. affiliates. employees. successors and assigns shall be held liable or responsible for any claims. including the costs and expenses of defending such claims which may result from or arise out of actions or omissions of the Contractor. its contractor/subcontractor or any of their agents. representatives. employees. or assigns, or anyone acting through Thomas F. Pepe 02-23-15 Page 36 of 47 or on behalf of the them, and arising out of or concerning the work or event that is occurring on the CITY's property. In reviewing, approving or rejecting any submissions or acts of the Contractor, CITY in no way assumes or shares responsibility or liability for the acts or omissions of the Contractor, its contractor/subcontractor or any of their agents, representatives, employees, or assigns, or anyone acting through or on behalf of them. E. The Contractor has the duty to provide a defense with an attorney or law firm approved by the City of South Miami, which approval will not be unreasonably withheld. F. However, as to design professional contracts, and pursuant to Section 725.08 (I), Florida Statutes, none of the provisions set forth herein above that are in conflict with this subparagraph shall apply and this subparagraph shall set forth the sole responsibility of the design professional concerning indemnification. Thus, the design professional's obligations as to the City and its agencies, as well as to its officers and employees, is to indemnify and hold them harmless from liabilities, damages, losses, and costs, including, but not limited to, reasonable attorneys' fees, to the extent caused by the negligence, recklessness, or intentionally wrongful conduct of the design professional and other persons employed or utilized by the design professional in the performance of the contract. Thomas F. Pepe 02-23-15 END OF SECTION Page 37 of 47 Scoring and Ranking EXHIBIT 4 EVALUATION SELECTION CRITERIA Insurance Brokerage Services RFQ #HR20 16-07 Phase I -Competitive Selection-Ranking: maximum 100 points. Consultant submittals shall be evaluated by the City. Respondents deemed as best suited and qualified shall be selected by a Selection Committee of at least three (3) City representatives for discussion and/or presentations, ranking and subsequent negotiations with the highest ranked consultant. The evaluation factors used for determining qualifications for ranking include: • Staff Experience and Team Organization: The ability of professional personnel, including the employees or principals of the firm; subcontractors (if any) and, pertinent training, skills, experience and references. Firms with in-house specialties as it relates to the scope of services and who have comparable project experience with the City of South Miami and other municipalities, cities or County governments for similar engagements, will be granted a higher score according to relevance to the City of South Miami's requirements and service. (Max. 40 points) • Project Approach: Completeness and clarity of the proposer's approach and detailed work plan to the engagement, and the ability of the approach to immediately accomplish the City's overall objectives. (Max. 30 points) • Commitment to Timelines and Budget Requirements: Respondent's ability to meet City timelines and budget requirements based on the current and projected workload of the firm. (Max. 20 points) • Other factors: Respondent's previous activities, including the volume of work previously awarded to the consultant or portions of its team, by the City. Firms that have done prior business with the City within the last IS years, from the date the RFQ is issued, will be eligible for this category. (Max. 10 points) Phase II -Competitive Negotiations. Submittals will be evaluated by a Selection Committee. A ranking of all respondents or short- listed respondents will be determined by the Selection Committee. The Selection Committee may schedule interviews and/or presentations with the "short-list" respondents or, any respondents. \ A final ranking of all firms or short-listed firms will be submitted to the City Manager for review and approval. Once the City Manager has approved the final ran ki ngs, negotiations with the first ranked firm will be initiated. If those negotiations are unsuccessful, negotiations will be opened with the next ranked firm, etc., until the successful completion of negotiations and execution of contracts. The City reserves the right to reject any or all proposals, to further negotiate any proposals,. to request clarification of information submitted in any submittal to request additional information from any proposer, and to waive any irregularities in any proposal. Thomas F. Pepe 02·23·15 END OF SECTION Page 38 of 47 EXHIBIT 5 PROFESSIONAL SERVICE AGREEMENT Insurance Brokerage Services RFQ #H R20 16-07 THIS AGREEMENT made and entered into this day of , 20_ by and between the City of South Miami, a political subdivision of the State of Florida (hereinafter referred to as Owner) by and through it is City Manager (hereinafter referred to as CITY) and :--_--:-__ :--~:-----:--_::_=_=_:_:_::_:_,authorized to do business in the State of Florida, hereinafter referred to as the "CONSULTANT". In consideration of the premises and the mutual covenants contained in this AGREEMENT, the City of South Miami, through its City Manager, agrees the following terms and conditions: 1.0 General Provisions 1.1 A Notice to Proceed will be issued by the City Manager, or his designee, following the signing of this AGREEMENT. This AGREEMENT does not confer on the CONSULTANT any exclusive rights to perform work on behalf of the Owner other than the work described in one or more Notice to Proceed (hereinafter referred to as the "WORK"), nor does it obligate the Owner in any manner to guarantee work for the CONSULTANT. 1.2 The CITY agrees that it will furnish to the CONSULTANT with the available data in the CITY files pertaining to the WORK to be performed under this AGREEMENT promptly and upon request of the CONSULTANT after the issuance of the Notice to Proceed. 2.0 Time for Completion 2.1 The services to be rendered by the CONSULTANT for any WORK shall be commenced upon receipt of a written Notice to Proceed from the CITY subsequent to the execution of this AGREEMENT and shall be completed within the time based on reasonable determination, stated in the said Notice to Proceed. 2.2 A reasonable extension of time will be granted in the event there is a delay on the part of the CITY in fulfilling its part of the AGREEMENT, change of scope of work or should any other events beyond the control of the CONSULTANT render performance of his duties impossible. 3.0 Basis of Compensation: The fees for services of the CONSULTANT shall be determined by one of the following methods or a combination thereof, as mutually agreed upon by the CITY and the CONSULTANT. a. A fixed sum: The fee for a task or a scope of work may be a fixed sum as mutually agreed upon by the CITY and the CONSULTANT and if such an agreement is reached, it shall be in writing, signed by the CONSULTANT and attached hereto as ATTACHMENT A: Hourly rate fee: If there is no fixed sum or if additional work is requested without an agreement as to a fixed sum, the CITY agrees to pay, and the CONSULTANT agrees to accept, for the services rendered pursuant to this AGREEMENT, fees in accordance with the hourly rates that shall include all wages, benefits, overhead and profit and it shall be in writing, signed by the CONSULTANT and attached hereto as ATTACHMENT A. ' Thomas F. Pepe 02-23-15 Page 39 of 47 4.0 Payment and Partial Payments. The CITY will make monthly payments or partial payments to the CONSULTANT for all authorized WORK performed during the previous calendar month as set forth in ATTACHMENT ffTBA" schedule of payment or, if no schedule of payment is attached to this AGREEMENT then payment will be made, 30 days following the receipt of CONSULTANT's invoice, as the work progresses but only for the work actually performed. 5.0 Right of Decisions.. All services shall be performed by the CONSULTANT to the satisfaction of the CITY's representative, who shall decide all questions, difficulties and disputes of whatever nature which may arise under or by reason of this AGREEMENT, the prosecution and fulfillment of the services, and the character, quality, amount and value. The representative's decisions upon all claims, questions, and disputes shall be final, conclusive and binding upon the parties unless such determination is clearly arbitrary or unreasonable. In the event that the CONSULTANT does not concur in the judgment of the representative as to any decisions made by him, CONSULTANT shall present his written objections to the City Manager and shall abide by the decision of the City Manager. 6.0 Ownership of Documents. All reports and reproducible plans, and other data developed by the CONSULTANT for the purpose of this AGREEMENT shall become the property of the CITY without restriction or limitation. 7.0 Audit Rights. The CITY reserves the right to audit the records of the CONSULTANT related to this AGREEMENT at any time during the execution of the WORK and for a period of one year after final payment is made. This provision is applicable only to projects that are on a time and cost basis. 8.0 Subletting. The CONSULTANT shall not assign or transfer its rights under this AGREEMENT without the express written consent of the CITY. The CITY will not unreasonably withhold and/or delay its consent to the assignment of the CONSULTANT's rights. The CITY may, in its sole discretion, allow the CONSULTANT to assign its duties, obligations and responsibilities provided the assignee meets all of the CITY's requirements to the CITY's sole satisfaction. The CONSULTANT shall not subcontract this AGREEMENT or any of the services to be provided by it without prior written consent of the CITY. Any assignment or subcontracting in violation hereof shall be void and unenforceable 9.0 Unauthorized Aliens: The employment of unauthorized aliens by the CONSULTANT is considered a violation of Federal Law. If the CONSULTANT knowingly employs unauthorized aliens, such violation shall be cause for unilateral cancellation of this AGREEMENT. This applies to any sub-CONSULTANTs used by the CONSULTANT as well. The CITY reserves the right at its discretion, but does not assume the obligation, to require proof of valid citizenship or, in the alternative, proof of a valid green card for each person employed in the performance of work or providing the goods and/or services for or on behalf of the CITY including persons employed by any independent contractor. By reserving this right, the CITY does not assume any obligation or responsibility to enforce or ensure compliance with the applicable laws and/or regulations. 10.0 Warranty. The CONSULTANT warrants that it has not employed or retained any company or person, other than a bona fide employee working solely for the CONSULTANT, to solicit or secure this contract and that he has not paid or agreed to pay any company or person other than a bona fide employee working solely for the CONSULTANT any fee, commission, percentage fee, gifts or any other considerations contingent upon or resulting from the award or making of this contract. For breach or violation of this warranty, the CITY shall have the right to annul this contract without liability. 11.0 Termination. It is expressly understood and agreed that the CITY may terminate this Page 40 of 47 Thomas F. Pepe 02-23-15 AGREEEMENT for any reason, or no reason, and without penalty, by either declining to issue Notice to Proceed authorizing WORK, or, if a Notice to Proceed is issued, CITY may terminate this AGREEMENT by written notice to CONSULTANT, and in either event the CITY's sole obligation to the CONSULTANT shall be payment for the work previously authorized and performed in accordance with the provisions of this AGREEMENT. Payment shall be determined on the basis of the work performed by the CONSULTANT up to the time of termination. Upon termination, the CITY shall be entitled to a refund of any monies paid for any period of time for which no work was performed. 12.0 Term. The initial Contract shall be for a period of three (3) years with an opportunity for the CITY to extend the Contract, at the City Manager's discretion, for one (I) additional two (2) year renewal period, for a term not to exceed five (5) consecutive years, at the same terms, conditions and prices. This AGREEMENT shall remain in force until the end of the term, which includes all authorized renewals, or unless otherwise terminated by the CITY. The term shall not exceed a term of five (5) consecutive year's following the issuance of the Notice to Proceed. 13.0 Default. In' the event either party fails to comply with the provisions of this AGREEMENT, the aggrieved party may declare the other party in default and notify the defaulting party in writing. If CITY is in default, the CONSULTANT will only be compensated for any completed professional services and CONSULTANT shall not be entitled to any consequential or delay damages. In the event partial payment has been made for such professional services not completed, the CONSULTANT shall return such sums to the CITY within ten (10) days after notice that said sums are due. In the event of any litigation between the parties arising out of or relating in any way to this AGREEMENT or a breach thereof, each party shall bear its own costs and legal fees. 14.0 Insurance and Indemnification. The CONSULTANT agrees to comply with CITY's Insurance and Indemnification requirements that are set forth in ATTACHMENT B to this AGREEMENT. 15.0 Agreement Not Exclusive. Nothing in this AGREEMENT shall prevent the CITY from employing other CONSULTANTS to perform the same or similar services. 16.0 Codes. Ordinances and Laws. The CONSULTANT agrees to abide and be governed by all duly promulgated and published municipal, County, state and federal codes, statutes, ordinances, rules, regulations and laws which have a direct bearing on the WORK involved on this project. The CONSULTANT is required to complete and sign all affidavits, including Public Entity Crimes Affidavit form (attached) pursuant to FS 287.133(3) (a), as required by the solicitation applicable to this AGREEMENT. 17.0 Taxes. CONSULTANT shall be responsible for payment of all federal, state, and/or local taxes related to the Work, inclusive of sales tax if applicable. 18.0 Drug Free Workplace. CONSULTANT shall comply with CITY's Drug Free Workplace policy which is made a part of this AGREEMENT by reference. 19.0 Independent Contractor. CONSULTANT is an independent entity under this AGREEMENT and nothing contained herein shall be construed to create a partnership, joint venture, or agency relationship between the parties. 20.0 Duties and Responsibilities. CONSULTANT agrees to provide its services during the term of this AGREEMENT in accordance with all applicable laws, rules, regulations, of the federal, state, and City, which may be applicable to the service being provided. 21.0 Licenses and Certifications. CONSULTANT shall secure all necessary business and professional licenses at its sole expense prior to executing the AGREEMENT. 22.0 Entire Agreement. Modification. and Binding Effect: This AGREEMENT constitutes the entire agreement of the parties, incorporates all the understandings of the parties and Thomas F. Pepe 02·23·15 Page 4\ of 47 supersedes any prior agreements, understandings, representation or negotiation, whether written or oral. This AGREEMENT may not be modified or amended except in writing, signed by both parties hereto. If this AGREEMENT is required to be approved by the City Commission, then upon approval by resolution of the City Commission, the City Commission shall be deemed to be a party hereto. This AGREEMENT shall be binding upon and inure to the benefit of the City of South Miami and CONSULTANT and to their respective heirs, successors and assigns. No modification or amendment of any terms or provisions of this AGREEMENT shall be valid or binding unless it complies with this paragraph. This AGREEMENT, in general, and this paragraph, in particular, shall not be modified or amended by acts or omissions of the parties. If this AGREEMENT was required by ordinance or the City Charter to be approved by the City Commission, no amendment to this AGREEMENT shall be valid unless approved by the City Commission. 23;0 Jury Trial. CITY and CONSULTANT knowingly, irrevocably, voluntarily and intentionally waive any right either may have to a trial by jury in State or Federal Court . proceedings in respect to any action, proceeding, lawsuit or counterclaim arising out of this AGREEMENT or the performance of the Work thereunder. 24.0 Validity of Executed Copies. This AGREEMENT may be executed in several counterparts, each of which shall be construed as an original. 25.0 Rules of Interpretation: Throughout this AGREEMENT the pronouns that are used may be substituted for male, female or neuter, whenever applicable and the singular words substituted for plural and plural words substituted for singular wherever applicable. 26.0 Severability. If any term or provision of this AGREEMENT or the application thereof to any person or circumstance shall, to any extent, be deemed to be invalid or unenforceable, the remainder of this AGREEMENT, or the application of such term or provision to persons or circumstances, other than those to which it is held invalid or unenforceable, shall not be affected thereby and each and every other term and provision of this AGREEMENT shall be valid and enforceable to the fullest extent permitted by law. 27.0 Cumulative Remedies: The duties and obligations imposed by the contract documents, if any, and the rights and remedies available hereunder, and, in particular but without limitation, the warranties, guarantees and obligations imposed upon CONSULTANT by the Contract Documents, if any, and this AGREEMENT and the rights and remedies available to the CITY hereunder, shall be in addition to, and shall not be construed in any way as a limitation of, any rights and remedies available at law or in equity, by special guarantee or by other provisions of the Contract Documents, if any, or this AGREEMENT. In order to entitle any party to exercise any remedy reserved to it in this AGREEMENT, or existing in law or in equity, it shall not be necessary to give notice, other than such notice as maybe herein expressly required. No remedy conferred upon or reserved to any party hereto, or existing at law or in equity, shall be exclusive of any other available remedy or remedies, but each and .every such remedy shall be cumulative and shall be in addition to every other remedy given under this AGREEMENT or hereafter existing at law or in equity. No delay or omission to exercise any right or power accruing upon any default shall impair any such right or power or shall be construed to be a waiver thereof, but any such right and power may be exercised from time to time as often as may be deemed expedient. . 28.0 Non-Waiver. CITY and CONSULTANT agree that no failure to exercise and no delay in exercising any right, power or privilege under this AGREEMENT on the part of either party shall operate as a waiver of any right, power, or privilege under this AGREEMENT. No waiver of this AGREEMENT, in whole or part, including the provisions Thomas F. Pepe 02-23-15 Page 42 of 47 of this paragraph, may be implied by any act or omission and will only be valid and enforceable if in writing and duly executed by each of the parties to this AGREEMENT. Any waiver of any term, condition or provision of this AGREEMENT will not constitute a waiver of any other term, condition or provision hereof, nor will a waiver of any breach of any term, condition or provision constitute a waiver of any subsequent or succeeding breach. The failure to enforce this AGREEMENT as to any particular breach or default shall not act as a waiver of any subsequent breach or default. 29.0 No Discrimination and Equal Employment: No action shall be taken by the CONSULTANT, nor will it permit any acts or omissions which result in discrimination against any person, including employee or applicant for employment on the basis of race, creed, color, ethnicity, national origin, religion, age, sex, familial status, marital status, ethnicity, sexual orientation or physical or mental disability as proscribed by law and that it will take affirmative action to ensure that such discrimination does not take place. The CONSULTANT shall comply with the Americans with Disabilities Act and it will take affirmative action to ensure that such discrimination does not take place. The City of South Miami's hiring practices strive to comply with all applicable federal regulations regarding employment eligibility and employment practices in general. Thus, all individuals and entities seeking to do work for the CITY are expected to comply with all applicable laws, governmental requirements and regulations, including the regulations of the United States Department of Justice pertaining to employment eligibility and employment practices. By signing this AGREEMENT the CONSULTANT hereby certifies under penalty of perjury, to the CITY, that CONSULTANT is in compliance with all applicable regulations and laws governing employment practices. 30.0 Governing Laws. This AGREEMENT and the performance of services hereunder will be ,governed by the laws of the State of Florida, with exclusive venue for the resolution of any dispute being a court of competent jurisdiction in Miami-Dade County, Florida. 31.0 Effective Date. This AGREEMENT shall not become effective and binding until it has been executed by both parties hereto, and approved by the City Commission if required such approval is required by CITY's Charter, and the effective date shall be the date of its execution by the last party so executing it or date of approval by City Commission, whichever is later. 32.0 Third Party Beneficiary. It is specifically understood and agreed that no other person or entity shall be a third party beneficiary hereunder, and that none of provisions of this AGREEMENT shall be for the benefit of or be enforceable by anyone other than the parties hereto, and that only the parties hereto shall have any rights hereunder. 33.0 Further Assurances. The parties hereto agree to execute any and all other and further documents as might be reasonably necessary in order to ratify, confirm, and effectuate the intent and purposes of this AGREEMENT. 34.0 Time of Essence. Time is of the essence of this AGREEMENT. 35.0 Interpretation. This AGREEMENT shall not be construed more strongly against either party hereto, regardless of who was more responsible for its preparation. 36.0 Force Majeure. Neither party hereto shall be in default of its failure to perform its obligations under this AGREEMENT if caused by acts of God, civil commotion, strikes, labor disputes, or governmental demands or requirements that could not be reasonably anticipated and the effects avoided or mitigated. Each party shall notify the other of any such occurrence. 37.0 Subcontracting: If allowed by this AGREEMENT, the CONSULTANT shall be as fully responsible to the CITY for the acts and omissions of its subcontractors/sub-consultants as Thomas F. Pepe 02·23·15 Page 43 of 47 it is for the acts and omissions of people directly employed by it. All subcontractors' and sub-consultants' agreements, if allowed by this AGREEMENT, must be approved by the CITY. The CONSULTANT shall require each subcontractor, who is approved by the CITY, to agree in the subcontract to observe and be bound by all obligations and conditions ofthis AGREEMENT to which CONSULTANT is bound. 38.0 Public Records: CONTRACTOR and all of its subcontractors are required to comply with the public records law (s.1 19.070 I) while providing goods and/or services on behalf of the CITY and the CONTRACTOR, under such conditions,. shall incorporate this paragraph in all of its subcontracts for this Project and shall: (a) Keep and maintain public records that ordinarily and necessarily would be required by the public agency in order to perform the service; (b) Upon request from the public agency's custodian of public records, provide the public agency with a copy of the requested records or allow the access to public records to be inspected or copied within a reasonable time on the same terms and conditions that the public agency would provide the records and at a cost that does not exceed the cost provided in this chapter or as otherwise provided by law; (c) Ensure that public records that are exempt or confidential and exempt from public records disclosure requirements are not disclosed except as authorized by law for the duration of the contract term and following completion of the contract if the contractor does not transfer the records to the public agency; (d) Upon completion of the contract, Meet all requirements for retaining public records and transfer, at no cost, to the public agency all public records in possession of the contractor or keep and maintain public records required by the public agency to perform the service. If the contractor transfers all public records to the public agency upon completion of the contract, the contractor shall upon Termination of the contract and destroy any duplicate public records that are exempt or confidential and exempt from public records disclosure requirements. If the contractor keeps and maintains public records upon completion of the contract, the contractor shall meet all applicable requirements for retaining public records. All records stored electronically must be provided to the public agency, upon request from the public agency's custodian of public records, in a format that is compatible with the information technology systems of the public agency. IF THE CONTRACTOR HAS QUESTIONS REGARDING THE APPLICATION OF CHAPTER 119, FLORIDA STATUTES, TO THE CONTRACTOR'S DUTY TO PROVIDE PUBLIC RECORDS RELATING TO THIS CONTRACT, CONTACT THE CUSTODIAN OF PUBLIC RECORDS AT 305-663-6340; E-mail: mmenendez@southmiamifl.gov; 6130 Sunset Drive, South Miami, FL .33143. 39.0 Notices. Whenever notice shall be required or permitted herein, it shall be delivered by hand delivery, e-mail (or similar electronic transmission), facsimile transmission or certified mail, with return receipt requested and shall be deemed delivered on the date shown on the e-mail or delivery confirmation for any facsimile transmission or, if by certified mail, the date on the return receipt or the date shown as the date same was refused or unclaimed. If hand delivered to the CITY, a copy must be stamped with the official CITY receipt stamp showing the date of deliver; otherwise the document shall not be considered to have been delivered. Notices shall be delivered to the following individuals or entities at the addresses (including e-mail) or facsimile transmission numbers set forth below: To CITY: Thomas F. Pepe 02-23-15 City Manager, 6130 Sunset Dr. South Miami, FL 33143 Fax: Page 44 of 47 With copies by U.S. mail to: To CONSULTANT: E-mail: salexander@southmiamifl.gov City Attorney 6130 Sunset Dr. South Miami, FL 33143 Fax: (305) 341-0584 E-mail: tpepe@southmiamifl.gov 40.0 Corporate Authority: The CONSULTANT and its representative who signs this AGREEMENT hereby certifies under penalty of perjury that the CONSULTANT and its representative have, and have exercised, the required corporate power and that they have complied with all applicable legal requirements necessary to adopt, execute and deliver this AGREEMENT and to assume the responsibilities and obligations created hereunder; and that this AGREEMENT is duly executed and delivered by an authorized corporate officer, in accordance with such officer's powers to bind the CONSULTANT hereunder, and constitutes a valid and binding obligation enforceable in accordance with its terms, conditions and provisions. IN WITNESS WHEREOF, this AGREEMENT is accepted and subject to the terms and conditions set forth herein. ATTESTED: By: _________ _ Maria M. Menendez, CMC City Clerk Read and Approved as to Form, Language, Legality and Execution thereof: By: Thomas F. Pepe, Esq. City Attorney CONSULTANT By: _________ _ (Print Name Above) City of South Miami By: _____________ ___ Steven Alexander City Manager END OF SECTION Thomas F. Pepe 02-23-15 Page 4S of 47 EXHIBIT 6 City of South Miami Bid Protest Procedures RESOLUTION OF PROTESTED SOLICITATIONS AND AWARDS (FORMAL PROCEDURE) The following procedures shall be used for resolution of protested solicitations and awards. The word "bid", as well as all of its derivations, shall mean a response to a solicitation, including requests for proposals, requests for a letter of interest and requests for qualifications. (a) Protest of solicitation. Any actual or prospective bidder who perceives itself to be aggrieved in connection with any formal solicitation or who intends to contest or object to any bid specifications or any bid solicitation shall file a written notice of intent to file a protest with the City Clerk's office within three calendar days prior to the date set for opening of bids. A notice of intent to file a protest is considered filed when received by the City Clerk's office bye-mail or, if hand delivered, when stamped with the City Clerk's receipt stamp containing the date and time of receipt of a notice of intent to file a protest. Any actual responsive and responsible bidder who perceives itself to be aggrieved in connection with the recommended award of a contract and who wishes to protest the award, shall file a written notice of intent to file a protest with the City Clerk's office within three calendar days after. A notice of intent to file a protest is considered filed when received by the City Clerk's office bye-mail or, if hand delivered, when stamped with the City Clerk's receipt stamp containing the date and time of receipt. (b) Contents of protest. A protest of the solicitation or award must be in writing ("Protest Letter") and submitted to the City Clerk's office within five calendar days after the date of the filing of the notice of protest. Protest Letter is considered filed when the Protest Letter and the required filing fee are received by the City Clerk's office bye-mail or, if hand delivered, when stamped with the City Clerk's receipt stamp containing the date and time of receipt. The Protest Letter shall state with particularity the specific facts and law upon which the protest is based, it shall describe and .attach all pertinent documents and evidence relevant and material to the protest and it shall be accompanied by any required filing. The basis for review of the protest shall be the documents and other evidence described in and attached to the Protest Letter and no facts, grounds, documentation, or other evidence not specifically described in and attached to the Protest Letter at the time of its filing shall be permitted or considered in support of the protest. (c) Computation of time. No time will be added to the above time limits for service by mail. The last day of the period so computed shall be included unless it is a Saturday, Sunday, or legal holiday in which event the period shall run until the next day which is not a Saturday, Sunday, or legal holiday. (d) Challenges. The written protest may not challenge the relative weight of the evaluation criteria or any formula used for assigning points in making an award determination, nor shall it challenge the City's determination of what is in the City's best interest which is one of the criteria for selecting a bidder whose offer may not be the lowest bid price. W Authority to resolve protests. The Purchasing Manager, after consultation with the City Attorney, shall issue a written recommendation within ten calendar days after receipt of the written protest. Said recommendation shall be sent to the City Manager with a copy sent to the protesting party. The City Manager may then, submit a recommendation to the City Commission for approval or disapproval of the protest, resolve the protest without submission to the City Commission, or reject all proposals. Thomas F. Pepe 02-23-15 Page 46 of 47 (f) Stay of procurement during protests. Upon receipt of a timely and proper written protest filed pursuant to the requirements of this section, the City shall not proceed further with the solicitation or with the award of the contract until the protest is resolved by the City Manager or the City Commission as provided in subsection (f) above, unless the City Manager makes a written determination that the solicitation process or the contract award must be continued without delay in order to avoid potential harm to the health, safety, or welfare of the public or to protect substantial interests of the City or to prevent youth athletic teams from effectively missing a playing season. Thomas F. Pepe 02-23-15 END OF DOCUMENT Page 47 of 47 THE CITY OF PLEASANT LIVING ADDENDUM No. #1 Project Name: Insurance Brokerage Services RFQ NO. HR20 I 6-07 Date: March 30, 20 16 Sent: Fax/E-mail/webpage This addendum submission is issued to clarify, supplement and/or modify the previously issued Solicitation, and is hereby made part of the Documents. All requirements of the Documents not modified herein shall remain in full force and effect as originally set forth. It shall be the sole responsibility of the bidder to secure Addendums that may be issued for a specific solicitation. QUESTION #1: Can you please tell me who the City's current employee benefits insurance broker is? RESPONSE: The City's current insurance broker is Sapoznik Insurance & Associates, Inc. IT SHALL BE THE SOLE RESPONSIBILITY OF THE BIDDER TO SECURE ADDENDUMS THAT MAY BE ISSUED FORA SPECIFIC SOLICITATION. Page 1 of 1 THE CITY OF PLEASANT LIVING ADDENDUM No. #2 Project Name: Insurance Brokerage Services RFQ NO. HR2016-07 Date: April 11,2016 Sent: Fax/E-mail/webpage This addendum submission is issued to clarify, supplement and/or modify the previously issued Solicitation, and is hereby made part of the Documents. All requirements of the Documents not modified herein shall remain in full force and effect as originally set forth. It shall be the sole responsibility of the bidder to secure Addendums that may be issued for a specific solicitation. I. What is the total employee population including full time and part time employees? Please break out the total number of full time and part time employees. RESPONSE: The City's employee population is as followS: Full time employees 132, Part time employees 23 2. What is the total number of covered retirees under the health plan? RESPONSE: Seven (7) retirees are covered under the health plan. 3. Please confirm how long the city has been contracted with the current agent/consultant? Page 1 of9 RESPONSE: The City's current consultant for Insurance Brokerages Services is Sapoznik Insurance & Associates, Inc., and has been contracted since October I, 20 I I; see attached Resolution 150-11-13464 and agreement. 4. Please provide a copy of the scope of services and agreement with the current broker? RESPONSE: Refer to the Response to question No.3. 5. What is the current annual compensation or negotiated fee with the current broker? RESPONSE: The current annual compensation is $40,000 annually; refer to the Response to question No.3. 6. Please list the commissions reflected in the plans for each line of coverage and the total annual premium for each line of coverage. RESPONSE: See attached proposal from the incumbent, Sapoznik Insurance & Associates, Inc. 7. Please provide a copy of the March 2016 monthly invoice for each line of insurance coverage (medical, dental, life, disability, vision, supplemental insurance, etc.) RESPONSE: March 2016 invoice is attached for Florida Blue, Lincoln and MetLife. Page 2 of9 8. Please provide a copy of the most recent executed agreement between the incumbent agent I consultant? RESPONSE: Refer to the response to question No.3. 9. Please share a copy of the benefit booklet? RESPONSE: The City's Benefit booklet is attached. 10. Is the City interested in a separate benefit administration system that can communicate with the current payroll system? What is the current payroll system being RESPONSE: Yes. The City is using the ADP Workforce Now payroll system. I I. Is there a formal well ness program in place with a wellness committee made up of employees in different departments? RESPONSE: No, there is not a well ness committee. There is a quarterly well ness program. 12. Has your broker been successful in negotiating well ness dollars from the insurance carriers to be provided to the city? If so, what amount annually? RESPONSE: To the City's knowledge, it has not been provided. Page 3 of9 13. A strong wellness program that can truly engage employees and provide measurable results can cost up to $20,000 annually for a group of this size. Does the city have a separate budget for a wellness program? RESPONSE: Yes the City has a separate line item budget for a well ness program titled "Employee Assistance Program" in the amount of $10,000 located in the City's Adopted FY 2016 Budget; a link to the City's Adopted Budget is provided below: http://www.southmiamifl.gov/index.aspxlNID=142 14. Has the city considered investing in wearable devices (Garmin, Fitbit etc.) as part of the wellness program? RESPONSE: No. 15. If there is a wellness program in place, is it based on behavioral economics and does it provide a demonstrated return on investment based on employee activities. RESPONSE: No. 16. Are any lines of coverage self-insured? RESPONSE: No, the City is not self-insured. Page 4 of9 17. Please provide the current enrollment and rates for each line of coverage. RESPONSE: See attached enrollment rates; deduction Schedule 15-16. 18. What is the employer contribution for each product? For example, 75% for employee only on medical, 25% for dependent tiers etc. RESPONSE: Flat employer contribution as follows, per employee: Health $610.32, Dental $12.57, Vision $0, LTD/Basic life 100% 19. Does the current consultant or HR team survey employees annually to get feedback on how they feel or whether or not they are satisfied with the benefits offered by the city? RESPONSE: No. 20. Has the current consultant provided benchmarking studies comparing the city's benefit plans to other cities or public entities in Miami Dade County or across the state? RESPONSE: No. 21. Please provide a benefit summary for all plans offered to employees. RESPONSE: The City's Benefit plan summary is attached. Page 50f9 22. Has the city considered the private exchange model where South Miami would purchase health insurance through the private exchange, and then employees can choose a health plan and other plans from those supplied by participating carriers within the private exchange? An online coach or avatar is in place to coach or walk employees through the best plan based on their individual and family needs. RESPONSE: No. 23. Does the city offer employees supplemental such as Aflac, Colonial or All State? Is the current broker assigned to those products? RESPONSE: Yes, Aflac. 24. Please confirm that the maximum score that can be earned by a vendor that has not worked with the city of South Miami in the last 15 years is 90 points. RESPONSE: Please refer to RFQ # HR20 16·07, Exhibit 4, "Evaluation Selection Criteria" section. 25. Please confirm that the incumbent and other vendors that have worked with South Miami in the last 15 years can receive a maximum of 100 points based on the evaluation scoring criteria. Page 6 of9 RESPONSE: The City does not understand your question however; please refer to RFQ # HR20 16-07, Exhibit 4, "Evaluation Selection Criteria" section. 26. Will the evaluation Committee meetings be posted ahead of time and open to the publid RESPONSE: Selection Committee meetings are publicly noticed and posted on the City's website, Calendar section. Selection Committee meetings are open to the public however, are not subject to public comments or participation. 27. How many members will serve on the committee? RESPONSE: Please refer to RFQ #HR20 16-07, Exhibit 4, "Evaluation Selection Criteria." 28. Has the broker failed to meet the requirements of the last RFP? RESPONSE: No. 29. Did the broker deliver the services in a satisfactory manner to the city? RESPONSE: . Yes. 30. Please provide an electronic copy of the winning proposal submitted by the current broker. Page 7 of9 RESPONSE: Refer to Response to Question No.6. 31. Please provide details on the self-service enrollment administration being used currently including the name and cost of the system along with other details. RESPONSE: No, the City does not have a self-service enrollment process. IT SHALL BE THE SOLE RESPONSIBILITY OF THE BIDDER TO SECURE ADDENDUMS THAT MAY BE ISSUED FOR A SPECIFIC SOLICITATION. Page 80f9 ATTACHMENTS TO ADDENDUM No.2 • Resolution No. 150-1 1-13464: QUESTION No.3 • Proposal: Sapoznik Insurance & Associates, Inc.: QUESTION NO.6 • March 2016 Invoices: QUESTION No.7 • Deduction Schedule 15-16: QUESTION No. 17 • City of South Miami Summary of Benefits: QUESTION No. 21 Page 9 of9 RESOLUTION NO. 1 50 -11 -1 3464 A Resolution authorizing the City Manager to execute an agreement with Sapoznik Insurance & Associates~ Inc. for the provision of Insurance Brokerage Services, this agreement shall have an initial three (3) year period with two (2) one (1) year option to I'enew periods for a possible total term of five years (5). WHEREAS, the City is in need of a independent insurance brokerage and consulting services to assist in negotiating and administrating its employee benefits program in order to meet the goals of enhancing its benefits program while cutting its overall costs and ensuring that the City receives the lowest competitive rates; and WHEREAS, the City published Request for Proposals No, SM-2011-08-HR (,'RFP") and after thorough evaluation, the City's Insurance Committee ("Committee") detennined that Sapoznik ;tnsurance & As'sociates, Inc. ("Sapoztiik") is the 'most qualified respondent proposing to provide all of the requested services in the most cost efficient manner; and WHEREAS, the City desires to retain Sapoznik , to perfoon the required services based the recommendations of the Committee who reviewed and evaluated the responses from the ten Brokerage fmns who submitted proposals in response to the RFP and on Sapoznik's warranty that it is qualified and capable of performing said serViceS in a professional and timely manner and in accordance with the City's goals and requirements as set forth in the RFP; and, WHEREAS. Sapoznik has agreed to perform the required services in accordance with the terms and conditions set forth in the agreement and in accordance with the City's RFP. NOW THEREFORE BE IT RESOLVED BY THE MAYOR AND CITY COMMISSION OF THE CITY OF SOUTH MIAMI, FLORIDA THAT; Section 1 The City Commission approves and authorizes the City Manager to execute an agreement for an initial three (3) year period with two (2) one (1) year option to renew periods for a possible total term of five years (5) with Sapoznjk Insurance & Associates, Inc for insurance brokerage and consulting services. Section 2 This resolution shall take effect immediately upon adoption. PASSED AND ADOPTED this 6th day of September 2011 COMMISSION VOTE: 4-1 Mayor Stoddard Yea Vice-Mayor Newman Yea Commissioner ~almer Nay Commissioner Beasley Yea Commissioner Harris Yea CITY OF SOUTH MIAMI OFFICE OF THE CITY MANAGER INTER-OFFICE MEMORANDUM 20D1 To: The Honorable Mayor &. Members of the City Commissi~n Via: Hector Mirabile, Ph.D., City Manager From: LaTasha Nickle, Human Resources DirectOl' Date: September 6, 2011 Subject: Contract between the City of South Miami and Sapoznik Insurance &. Associates, Inc. Request: A Resolution authoriz~g the City Manager to execute an agreement with Sapoznik Insurance & Associates, Ib~ . for the provision of Insuranc~ Brokerage Services, tbis agreement shall have an initial three-(3) year period with two (2) one (1) year option to renew periods for a possible total term of five years (5). ' Request: To approve an agreement between the Sapoznik Insurance & Associates, Inc, and the City of South Miami. ' Backgr6uud: This agreement provides for independent insurance brokerage and employee benefits consulting for the next three years with an option to renew for two additional one-year terms. The scope of service$ and expected deliverables include the following: ooordinating annual audits of City's benefit plans and associated vendors and prepare annual fmancial reports on the results of the ' completed plan year; providing analysis of current plans, jncluding the review of past petformanpe, with regard to tenewal; reviewing adwtional available cost savings plan alternatives and creative funding options; and a wide variety of related services which are set forth in detail in the Attached RFP and the Proposed Agreement. 'The proposed services will replace and exceed the scope of services cwrently provided by Employee Benefits Consulting GrQUP_ As requested in the RFP, the successful respondent will provide services for a flat fee aJ.ld will not receive any'comtni~sion either directly or indirectly !is a result of premiums paid by the Cw Of,South Miami. All future employee benefits policy proposals will be quoted without broker premiums included. The City's fnsurance Committee reviewed and evaluated the responses from ten Brokerage frons who submitted proposals in response to the RFP. All proposals were rated bMed upon location and accessibility to South Miami; past experience and performance with specific emphasis on services to comparable municipalities; experience of key personnel; fmancial·stability; availability and commitment to carry out the services requested; and costs, Upon careful review and evaluation~ the Committee determined that there were three top proposals: 1. SapoznikInsurance & Associates ($40,000); Z. Gallagher Benefit Services ($38,500, plus additional per member costs for required benefits administration and enrollment); and 3. GebringGroup ($55.000). Sapoznik received the highest scoie and was deemed to be the best choice among the Respondents. The finn bas extensive experience with reducing oos1$. controlling claims, and other benefits analysis for other municipalities inc]udillg~ but not limited to, North Miami Beach. North Miami Springs; Town of Davies. Town of Golden Beach and Miatni Shores Village. The finn has attained a Platinum Rating with the health insurance carders in the South Florida area wbich gives them superior bargaining power 3n negotiating rates. We expect that the extensive services provided coupled with their negotiating abilities will ultimately provide the City with the lnost cost effective solution. Backup Docnmenta~on: Cl Proposed resolution. IJ Proposed Agreement between City of South Miami and Sapoznik Insurance & Associates, Inc. o RFP No. SMM2011~08-BR _ o RFP Responses from the top three Respondents and Memorandums summarizing the major points of each proposal. Agreement between The City of South Miami and Sapoznik Insurance & Associates, Inc. for Insurance Brokerage Services This Agreement, effective as of October 1, 2011 by and between Sapoznik Insurance & Assooiates, Inc., (hereinafter referred to as "Sapoznik.") located at 1100 NE 163w Street, North Miami Beach, FL 33162 and the City of South Miami (hereinafter referred to as "City") located at 6130 Sunset Drive, South Miami, FL 33143. WHEREAS, the City has engaged Sapoznik to provide the following scope of services as described below. and WHEREAS, this Agreement shall set forth the terms and conditions governing the provisions of certain brokerage servjces by Sapoznik to the City with respect to the management of their insurance program. WHEREAS, the City published a Request for Proposals No. SM·2011·08-HR ("RFP''); and WHEREAS, Sapoznikprovided the City with Sapoznik's response to the City's RFP; 1 SCOPE OF SERVICES With respect to the insurance coverages specified in Appendix A, SaPoznik shall provide the City following services; 1.1 Assist in the preparation. under the direction of the City, of insurance cove:mge specifications andImdcetJll.'OllPlDl!! fuur(4)rosix (6) mmths prlorto exp.iraIioo ofpolicies, indicatingvvbichnmi<'ets wiIlbe~ 1.2 Assist the City in developing and maintalning the underwriting information necessmyto lllllket theinsurance~ 1.4 Reviewannual conlributionstmlegyfi'omactiveparlicipants andretirees 1.5 Cooroinate annual auditoftbeen:ployee3nsuranre coverages 1.6 Oxrdimteqmrlaiyorasneeded~orft:1ephooeconf.imres~awmployeejnc;llmnre~ <~ 1.7 Aetas llaiscnbetweenearployeeand1he~providas~difficultclaimaIXl.benefit issues 1.8 Sapoonikwi1l~8IXl/~ofSapymiksballaltaxlaqyanda1l~additiomJJy re:J.UeSfedbyiOO aty 1.9 Assist in the review of eligibility 1.10 Furnish day to day insurance, risk management and advisory counsel. services to the Cty. 1.11 Review all contract insurance requiJ.unents andrefe.r hold-hatmless and indermifialtioocla:uses to the Qty's atIorneyforreview. 1.12 Grant access to the City's Client Portal for retrieving polioy infonnation, certificates of insmance audsummaries ofinswance . 1.13 Keep the City infonned of ohanging conditions in the insurance marketplace. 1.14 Sapamiksball ~ TheOl1s claitm daIa todetmnilletrends and prevmlativemeasures J.lS Sapot.nik. shall also provide all other services and shall meet all other tenns, conditions and requirements set forth in the RFP and in Sapo.znik's response to the City's RFP. The RFP and the Response to the RFP are hereby incozporat.ed into this contract and are made a part hereof by reference. 2 TERM OF CONTRACT 'Ihefuifial mnsball bethree(3):vearsfitmthedateoftbis ~ withanac:1tilkoa1 too(2)<:m-year~ C¢OOS. ThisoootractlUlYoo tenninafedbyeitberpn1¥upongiving90 ~wri/fennotice. Notioormyoo given byUlitedSlatcstmil, byfilcsimile1IarJslrissionorbye-m.W. lftbe atytetnJinatl;s theOODlmct, Sapozoiksball be pUdpuatefor semcesJ."elldaOOtothedate oftaminatial. 3 COMPENSATION In consi4eration of the services provided by Sapoznik, the City shall pay Sapoznik a fee of $40,000.00 annually. to be :made in twelve monthly installments of$3,333.33, beginning October 1, 2011. Charges for any additional services not covered in this Agreement will be negotiated in advance. 4 ASSIGNMENT Neitlr4tbeCitynorSapomiksbal1~go,solicitor~tbeinightsorooligJmcmsuoder1hisAgteemeot. 5 SEVERABILITY If any part, term, or provision of this Agreement is held to be illegal or in conflict with any law of the State by a court of competent jurisdiction, the validity of the remaining portions or provisions shall not be affected thereby. 6 LITIGATION In any claim or dispute between the parnes to this Agreement, arising out of or relating to this Agreement or breach thereof, the matter shall be decided in a Florida court of competent jurisdiction and venue shall be proper s~lely in Miami-Dade County. 7 AGREEMENT CONSTRUED UNDER STATE LAWS· This Agreement Is to be executed and perfonned in the State of Florida and shall be construed in accordance with the laws oftha State of Florida. 8 CHANGES TO BE IN WRITING This Agreement may be amended only by a written agreement executed by both the City and Sapoznik. 9 WAIVERS The failure of Sapoznik or the City t9 insist on strict compliance with this Agreement, or to exercise any right(s) hereunder shall not be construed as a waiver of any of the rights or privileges contained her~in. The waiver of any breach or default of any of the terms of this Agreement shall not act as a waiver of any SUbsequent breach or default. This agreement in general, and this paragraph in particular. shall not be modified, amended or waived except in writing signed by both parties 10 ENTIRE AGREEMENT This Agreement contains the entir~ understanding of the parties with respect to its ~ubject matter. This Agreement supersedes all prior agreem~nts7 arrangements and understandings -between the parties. whether oral or written, with respect to its subject matter. IN WITNESS WHEREOf', the parties bereto have' ex~cuted this AGREEMENT as of the day and year fjJ;st above written. DATE: 9 -;2:7 .", II APPEND1XA INSURANCE COVERAGES SUBJECT TO TilE AGRE.EMENT Fo.R INSURANCE "JirtOKERAGE SERVICES • Medjcal Insuranoe (including retirees) • Dental1nsurance • Visionlnsur811ce • Short Term D.isability Insurance • Long Tenn Disability Insuran"ce • ,Group Life "Ins~ce " • Voluntary Life and A.D&D Insurance • AncillarylSupplemental !nsurailc"e City of South Miami REQUEST FOR PROPOSAL The City of South Miami, Florida, hereinafter referred to as "City", will receive sealed proposals. The submittal. consisting of one (I) original unbound proposal. ten (10) additional copies and one (I) digital CD copy to the Office of the City Clerk, South Miami City Hall, 6 J 30 Sunset Drive, South Miami, Florida 33143, for furnishing the service,s described below: Insurance Brokerage Services RFP NO. SM-20 I I w08-HR Sealed Proposals must be received by the Office of the City Clerk, either by mail or hand delivery. no later than 10:00 AM. local time on f:rlday. July 8,2011. A public opening will take place at 10:00 A.M. in the City Commission Chambers located at City Hall on the same date. Any Proposals received after 10;01) AM. local time on said date will not be ~ccepted under any circumstances, Any uncertainty regarding the time a Proposal is received will be resolved against the Bidders. Proposals are subject to the attached Standard Terms and Conditions contained in the complete bid package. Interested Bidders who wish to bid on this REP can obtain the complete bid .' package on the City'S websit~ at www,southmiamitl.gov{ index.i?hp?src=gendocs&re(=BidPosting20 I O&category=RFPs-and-Bids or City: Clerks office Monday through Friday from 9:00 AM. to 4:00 P.M. upon the payment of 20 dollars (U.S.) to the City of South Miami. This fee is non-refundable The City reserves the right to reject any or all Proposals, to waive any infol'malities or Irregularities in any Proposals received, to re-advertise for Proposals. to award in whole or in part to one or more Bidders, or take any other such actions that may be deemed'to be in the best interests of the City. Maria M. Menendex South Miami City Clerk TABLE OF CONTENTS OVERVIEW OF PROJECT ........................................... " ............................................................................ 1 SCOPE OF SERVICES ........................................................................................................... , .................... :;! GENERAL CONblTIONS .......................................................................................................................... 5 SUBMISSION REQUIREMENTS ........... , ........ , ......................................................................................... 11 EVALUATION AND SELECTION OF RESPONDENT ........................................................................ 13 PROPOSER'S QUALIFICATION STATEMENT ........................................................................... " ....... 14 NON-COLLUSION AFFIDAVIT ........................................................................................... , ..... , ............. 20 SIGNATURE PAGE ... ; ................................................................................ , .. , .......................................... 21 CERTIFICATION OF AUTHORITY ................ , ............ , ......................................................................... 22 REFERENCES ............................................................................... ; ............................................................ 23 RFP INFORMATION FORM .................................................................................................................... 24 NO CONFLICT OF INTEREST CERT'FrCATION ............................................................................. , .. 25 CONE OF SII.t:NCE AFF'DAV' ....................................... , ..... ', ............ , ................... ; .................. !.~ .............. 26 OVERV'EW OF PROJECT ~'~~W''''~''{l!!it:~~t<l!I§Mg.'Moil!l@tm1'''.~:....'i#l!M~''''_!hl;'.J!!\?!t'¥' 'i_Flit!$. Insurance Brokerage Services SCOPE AND PURPOSE; The Cit:)' of South Miami Is seeking sealed proposals from qualified firms to es~blJsh a contract (hereinafter referred to as the "Contract') to provide insurance brokerage ,ervices for the city's employee benef1t.S plan. MINIMUM OUALlfICATIONS; To be eligible to respond to this RFP. the Respondent(s) must demonstrate that their experience Includes successfully performing services substantially similar to the services in thE Scope of Services section of this RFP. All respondents must be licensed to do business unoer the law.s of the state of Florida and must have prOVided insurance brokerage servIces to a minimum of three (3) governmental agendes, or corporate clients of .comparable sil:e to the City of South Miami, during the five (5) year period Immediately proceeding the submission date. PROPOSAL DUE'DATES; Complete proposals are due on Friday, July 8, 20 II. Proposals must be received In the Office of the City Clerk by the date and time Indicated. Proposal opening follow, Immediately after dosing of proposal submis$ion deadline at the City of South Miami, 6130 Sunset Drive South Miami, FL 33143 • I • , CJosingPato: f'riday.1ulY,8.2011, 10 A.M. Evaluation Pate:, WediJesdll}l.,JU)Y 13 . 201l Commission Meeting: Tucsday. July 19.201) SUBMISSIO.t1; In order to facilitate review of the proposals, each proposer mUst submit one (I) original unbound proposal. ten (I O) additional copies and one (I) digital CD copy of the RFP response In a sealed envelope on or before the submission deadline Indicated herein. Proposals must be addressed and delivered to: RFP #: SM·20 II·OB-HR City Clerk Office South Miami CIty Hall 6130 Sunset Drive South MiamI, FL 33 143 CORRESPONDENCES! Questions concerning this RFP should be directed to: Maria M. Menendez South MiamI City Clerk Fax: 305.663.6348 mmependez@.sQuthmlamlR fOY END OF TI1IS SECTION InsuranoeBrokera,ge Services RFP No. SM-2011-09·HR Page 1 of25 SCOPE OF SERVICES em~_.,:i! .. i#.'liiA'!!.~:.*"i\llll!lWJa!:'il.gLae:!t')!I'I'ti1.f.i.*,*@~\\<l!I)8i!ffi#.il:g%\llt1@'%I ~~~s~!!!! Propo~er$ are required to read and undemand all information contained withIn the entire proposal package, By respondIng to this RFP, the proposer thereby acknowledges that he or she has read and understands these documents. SCOPE OF SERVICES The CIt;)' of South Miami s~eks the services of qualifled flrms to provide Insurance Brokerage Services for the City's Employee Benefit Plans. The City of South Miami has approximately 142 employees and redrees pari:lcipating in the benefits plan. All employees are located in Florida and retiree~ may be elsewhere. The . City's plan year Is October I" through September 31)'" The benefit plans Indude the following, but Is not limited to: • Health Insurance . • Dental Insurance • Life Insurance • long Term Disability • Shott Term D/$ability II Group Life and AD&D ., In$urance Supplements .. Vision This section· outlInes the minimum services that the CIty expe~s to receive (rOM a qualified Consultant as a subject matter expert. Said Consultant shall assist In the design and Implementatlon of a comprehensive employee beneflts program (or fiscal year 20 12 and beyond. ON-GOING SERVICES: Expect~ deliverables Include, but are not limited to: A. Monltor the programs' operations throughout the year to ensure that benefit prOViders are meeting all customer seNlce requirements and standards. B. PrOVide on-going administrative support. as required, by acting as a liaison between the aty and providers to assist with resolving claim disputes, ~ontract administration and Interpret;ations, and other issues. C. PrOVide dedicated personnel as a primary contact for managing the account relationship with the Ci,ty. D. Meet WIth the City's Human Resources Direcror throughout the year as reasonably necessary (minimum is quarterly). E. CoordInate annual audits of CIty's benefit plans and associated vendors and prepare annual financial reports on ,the results of the completed plan yeai-. F. Prepare and deliver any necessary reports to the City's HUmail Resources Director, Including but not limited to, reports showing claims experience at Intervals acceptable to the City. G. ProvIde advIce and assistance in the revi~w of the City employee health and medical benefits program on a continUing basis to ensure that those plans are in compliance wIth state/federal reqUIrements and their adequacy of benefits with respect to other plans. H. Ttack, mOl'lltor and provide Information on changes in, or al'l)' pending or new leglslatlon in the applicable state and federal laws, as welf as any employee benefit and funding trends that may affect the benefits program, to the City's Human Resources DIrector. I. Advise ahd assIst the City as requested with: • Writlng employee benefits plan modifications andlor new benefits plans and any required amendment approval process; Insurance Brokerage Services RFP No. SM·20 11-09-HR. Page2of25 • Submission of written reports and other documents as required by the state and/or federal government; .. Coordination of the annual employee wellness fair. It Development of an Employee Well ness Program. . J. Perform spedal projects as requested by the City, includIng but not limited to: .. Development a.nd assistanCe In the implementation of new insurance plans: .. Assistance with adjudication of spedflc claims as requested by the City: ~ Recommendation of alternative benefit desIgns or delivery systems as dictated by emerging plan Costs for benefit practices. K. Ensure personnel availability for me~tlngs. phone calls, and e-mail correspondence as required. L Maintain confidentiality of City records and data in accordance applicable federal and state laws. M. Perform other related services on an "as-needed" basis. REN~AL rEAR SERVICES: A. Using current health and medical benefit plans as benchmarks, research, design, and propose employee beneflt plans for the City, as appropriate. B. Meet with the City as necessary to discuss benefit plan options and establish goals and ob!ectlves for the City's benefit programs. C. Provide analysis of current plans, including the review of past performance, with regard to renewal. D. RevIew additional available cost savings plan alternatives and creative funding options. E. Determine the appropriate employee and employer benefit contribution levels. F: Review and recommend annual contribution strategies for active participants and retirees. G. Provide City with Information on what other municipalities of comparable size and location will be doing with their benefits In the upcoming years. H. Conduct renewal negotiatiQh~ and develop appropriate information for management purposes. I. Upon City's request, coordinate a comprehensive "Request for Proposal" (RFP) process to identify potential ~igh quallr;y Benefit vendors, accordIng to established City guidelines. The scope of the RFP may Include but not be Ilmited to: Medical. Dental, Vision, Basic Ufe, Voluntary Llfe, Accidental Death and Dismemberment, Short Term and Long! erm Disability insuran,c!3'providers. J. Act as lead negotiator and consultant to the City during beneflt contract negotiations and renewals. K. Prepare and present a written analytical report of the proposals received Including recommendation(s) and supporting documentation for recommendations. L. Review plan documents (Including employee booklets) and master contracts before adoption and printing. M. Assist With planning and implementation of selected changes Including transition from the current to new vendors, the renewal proposal, and other benefit changes. N. Assist with developing City employee benefit program communication materials. Coordinate the deSIgn, printing. and prodUction of those ma.terlals, as edited and approved by the Human Resources Director. O. Advise and assist the Human Resources Director or designee with the review of contractS, plan documents. Insurance policies and other documents for applicability, accuracy, consistency, and legal compliance. Insurance Brokerage Services &FE' No. SM-2011-09-HR Page 3 of.'25 P. Assist City with the development of performance guarantees relating to vendors' performance of setvices to the City. and ev.luatlon of the performance of vendors. COMPENSATION. Compensation (or all services proVided shall be on a flat fee basis from the City. Throughout the duration of the agreement. the successful Proposer shall provide an annual statement from each carrier giving full disclosute of compensation earned. Annual disclosure of all direct or indirect earnings shall be provided prior to March IS of each year of the agreement TERM OF CONTRACT The Initial Contract shall be for a penod of three (3) years with an opportunity for the CIty to extend the Contract for one (I) additional two (2) year period at the same terms, conditions and prices upon mutual agreefllenc of both parties. The Proposer agrees to this condition by signing Its proposal. If Proposer cannot renew its, initial terms, conditions and prices. Proposer must notify City on/or before 90 days prior to Contract expiration. BEQUESTS f..QR ADDITIONAL IblEQBMATlON QR QUESTJON~ Any requests for additional InformatIon or clarification should be submitted In writing by r 0;00 A,M. local tlme on friJ!@,y. luly Jft, 20 I I to the attenti0l) of South Miami City Clerk at mmenendeZ@sQuIDmjamif\,gov or via fa.csimile at (305) 663·6348. The Issuance of a written addendum Is the only official method whereby Interpretation and/or darlfication of information can be given. It shall be the responsibllity of each Proposer, prior to submitting the proposal, to contact the Clerk's Office to determine if addenda were issued and to acknowledge slJch addenda in the Proposal. If any addenda are Issued to this requeSt for proposal, the City will notify a/l prospective firms via the City's website, The Proposer shall be responsible for checking the website before submitting Its sealed bid and modifYing its bid accordlngly_ eND OF THIS SECTION Insurance )3rokerege Services RFP No. SM-2011-09-:aR l?age4oflS GENERAL CONDITIONS ~.il!~.\h;l§P,b1!i\"'Rl!"I!l\\l!j/2 lime!!!!;.' g~A?i'.k!I£!l2I"*.iJSg¥Bi¥.ii!,?&l!i1iMII%!\\!!!l!ib.L§:€J@;l!@!ffi\l:wli~ Insurance Brokerage Services Proposers are required to read and understand all information contained within the entire proposal package. By responding to this RFP, the proposer acknOWledges that It has read and understands these documents. SUBMllT!ON OF R.EOUEsr F08 PROPOSALS (RFP) One (I) Original unbound proposal, t~n (10) additional copies and one (I) digital CD copy must be submitted to me City Clerk Office In a sealed envelope dearly marked with the following: RFP Tide: Insurance Brokerage Services RfP No,: SM-201/-08-HR Closing Date: Friday, July 8, 20 II Proposals forwarded whether by mall or personally delivered, must be received by the Office of City Clerk, on the date and time Indicated in the RFP packet. The time indicated by the tlme dock In the City Clerk office Is considered the official time of receipt. No faxed or email RFP response~ will be accepted. Untimely submissloliS, or submissions delivered to another location, will not be accepted. RFP's shall be submitted in person Qf by mail to the follOWing address: In PersonfCourier/By Mail: South Miami City Hall Bulldlng AnN: CITY CLERK OFFICE 6130 Sunset Drive South MIami. FL33143 The openIng of the proposals will take place in South Miami Commission Chambers, at the time and date state in this RFP. Ihe City will not consider proposals received after the deadline. Any proposal so received after the scheduled dosing time shall be returned to the Proposer, unopened. Any dispute over the timeliness of the submission will be resolved against the Proposer. Proposals may be sent by mall or delivered in person; however, If senC by mall, the responsibllity for'delivering'a. proposal to the City before the deadline Is wholly upon the Proposer. ADDENDA. CHANGES OR INTERPRETATIONS DURING BIDDING Dilly Inquiries or requests for interpretation received five (5) or more days prior to the date fixed for the opening of the proposals will be given consld~ration. All such interpretations will be made in writing in the form of an addendum and posted on the City'S website not later than the established proposal opening date. Each prospective proposer shall acknowledge receipt of such addenda by Including Its acknowledgment in its proposal. In case any proposer falls to Indude s~ch addenda or addendum, his proppsal will nevertheless be considered as though it had been reeeiv.ad and acknowledged and the $ubmlssioA of his proposal will constitute' acknowledgemsnt of the reeelpt of same. All addenda are a part of the 'Contract documents and each proposer will be bound by such addenda, whether or not received by, him. It Is the responsibility of each prospectlve proposer to verify that It has received all addenda issued before proposals are opened. REFERENCEIi The Proposers must provide three (3) references from governmental agencies, or corporate clients of- comparable size to the City of South Miami, for whom you prOVided Insurance brokerage services during the five (S) year period immediately preceding the submission your bid. Insurance Brokerage Services RFP No. SM-2011·09-HR PageS oi25 RULES. REGULAIIQNS. LAWS. ORDINANCES. & LICENSES The Proposer whose bid is ac<:epted shall observe and obey all laws, ordinances. rules, and regulations of the federal, state, and local municipality, which may be appncable to the service being provided. The awarded firm shall have or be responsible for obtaining all necessary permits or licenses reCJulred in order to provide this service. RESERVES THE RIGHT The City anticipates awarding one or more contract(s) for services as a result of this RequeSt for Proposals. The City, however, reserves the right to reject any and all submitted Proposals and to further define or limit the scope of the award. The City reserves the right to request additionallnrormatlon frQin Firms as deemed necessary. Nodce is also given of the possibility that an award may be made without discussion or after limited negotiations. It Is. therefore, imponant that all the parts of the R.equ'es~ "for Pr~~o5als be completed In all respects. The City reserves the right to negotiate modifications to Proposals that it deems acceptable, reject: 'Iny and all REP in its sole discretioll, and to waive minor irregularltlesln the procedures. CQNTMCT ~CELlATION The resulting Contract may be canceled at any time by the City of South Miami for any reason, upon a thirty (30) day written tancellation notice. OWNERSHIP OF PREUMINARY & fiNAL RECORDS All preliminary and final documentAtion and records shall be<:ome and remain the sale property of the City. The awarded firm shall main rain original documents' thereof for its records and for Its future professional endeavors and provide legible reproducible copies to the City. In the event of termination of the agreement, the proposing firm shall cease work and deliver to the City all documents (including reports and all other data and material prepared or obtained by the awarded flrm In connection with the work being perFormed). as well as all documents bearing the professional seal of the firm. The CIty shall. upon delivery of the aforesaid documents, pay the firm and the firm shall accept as full payment for Its services there under, a sum of money e«:JU81 to the percentage of the unpaid work done by the firm and accepted as satisfactory to the City. All brokerage fees being. received from carriers or insurers for Insurance or benefit plans obtained by the Proposer on behalf of the City for current business and for renewal business shall terminate. INDEMNIFICATION To the extent permitted by law (F.S. 768.28) the proposing ffrm shall Indemnify and hold harmless the City. its officers and employees. from liabilities, damages. losses and costs, including. but not limited to, reasonable attorney's fees, to the extent caused by the negligence. recklessness, or intentional wrongful misconduct of the proposing firm and any persons employed or utilized by the proposing firm tn the performance of the work being proposed. . EQUAL EMPLOYMENT In accordance with Federal, State and Lotallaw. the proposing firm will not discriminate against any employee or applicant ror employment because of race, color. ethl1lc1ty. religlon, sex, sexual orientation, natlol'lal origin or handicap. The proposing flrm will be required to compry With all aspects of the Americans with Disabilities Act (ADA) during the performance of the work being proposed. lnstl1'a.l')oe Brokerage Services RFP No. SM-ZOII-09·HR Page 6 of25 INSURANCE Without limiting its liability. the proposing firm shalf be required to procure-and maintain at Its own expense during the life of the Contract, insurance of the types and In the minimum amounts stated below as will protect the proposing firm and the City, from claims which may arise out of or result from the proposing firm's performahce of a Contract with the Qty, whether performed by itself or by any sub·contractol" or by anyone directly or Indirec:tly employed by any of them or by anyone for whose acts the City may be liable. Workers· Compensation Insurance: Employer·s liability C,?mprehensive General Liability: B.u$ine$s Vehlculal" liability; PI'ofessiomd Liability: As required by law and covering all employees meeting Statutory Umits In compliance with all applicable state and federal laws. With a minimum limit of $ I ,000,000.00 for each accident. Coverage shall have mlnhnum limits of $1,000,000.00 per occurrence, combined single Umlt for Bpdily Injury liability and Property Damage liability. This shall Include Premises and/or Operatlons; Independent Contractors and Products and/or Completed Operatlons: Broad Form Property Damage: and Contractual Liability EndQrsement. Coverage shall have minimum limits of $1,000,000.00 per occurrence. Combined Single Limit for Bodily Injury Uabllity, and' Property Damage LlabiHty: This shalilociude Owned Vehicles, Hired and Non-Owned Vehicles and Employees Non-Ownership. Coverage shall have minimum limits of $1,000,000.00 per occurrence with respect to negligent acts, errors or omissions in connection with era professional services to be provided and any det:;luctible not to exceed $5.000.00 each claim. A. The City shall be listed as ;In Additional Named Insured on the policies (or" Comprehensl~e General Liabflity, Employer's Uability, Workers' Compensation Insurance and Business Vehicular Uability. In the event the Insurance coverage expIres prior to compl!!tlon of the term of the Contract with the ClI.y, a renewal certificate shall be Jssued 30 days prior to said expiration date. The policy shall provide for a l.O-day notlflcatlon to the City In the-event of cancellation or modification to the policy_ The policy shall not be cancelled or modified withOUt the written consent of the City. B. Unless otherwise specified, it shall be the responslblllty of the proposing firm to insure that all subcontractors comply with the same insurance requirements as provided nerein. All proposer certificates of Insurance must be on file with and approved by the City before the commencement of work activities_ Waivers of s\Jbrogation shall also be provided upon approval of the applicable Insurers. - C. The proposing firm shall "flow down" the requirements of this provision to all subcontractors. D. -The lImits of insurance required above must; be retained throughout the term of the contract. The proposing firm must notify the City immediately if any of the required coverage limits are reduced due to claim activity or for any other reason. E. 'Pollcies should be written on an "occurrence" basis. Insurance Brokerage Services RFP No. SM·20 1 }'(W-HR Page 7 of25 OPENING OF REOUEST FOR. PR.OPOSALS Request for Proposals will be opened and evaluated arter the Anal date and time set for receipt. The aty may request proposing flrm(s) considered for award to make an oral presentation to a selection board or to submit addidonal data. REJECTION OF PROPOSALS The City reserves the right to reject any and all Request for Proposals, It also reserves the tight to waive any minor irregularities In connect\on with response to the Request for Proposals. ACCEPTANCE OF PRQPOSAl Within ninety (90) days after the flnal submission date for Request for Proposals, the City will act upon them. The Successful Firm will be requested TO enter into negotiations to produce the Contract The City reserves the right to terminate negotiations and cancel the bId award in the event It deems progress towards a Contract to be Insufficient. Applicable Law All applicable laws and regulatlons of the State of Florida and ordinances and regLllations of the City of South Miami wll" apply to any resulting agreement and venue for any action arISing out of the Contract shall be in Miami-Dade County, Florida. and such right shall remain solely with the City. QualificatIon of \,rpposing firm Request for Proposals will be considered from firms normally engaged in providing the tervlc:es requested. The proposing Firm must demonstrate adequate Elxperlente, organization, offices, eqUipment and personnel to ensure prompt and efficient service to the CIty of South Miami. The City reserves the right, before recommending any award, to Inspect the offices and organIzation or to take any other action necessary to determIne ability to perform In accordance With the spedncations, terms and conditions. The. City of South Miami wlll determine whether the evidence of abIlity to perform is satisfactory and reserves the right to reJect Request for Proposals where evidence submitted, or investigation and evaluation, Indicates Inability of a firm to perform. The failure. of the Bidder to make arrangements, satisfactory to the City, for the Clty"s Inspection and Investigation shall be grounds for. rejection of the Bid. Designated Conmct The awarded firm sl1all appoint a person to act as the firm's primary contact with the City of South Miami. The contact person or person desIgnated in writing by the flrm, shall be readily available during normal work hours by phone. e-mail, facsimile trnnsmlsslon or in person, at the option of the City, and shall be knowledgeable of the terms of the Contract and the work being performed pursuant to the Contract terms. Deviations from SQecifigtlgns The awarded Firm shall clearly indicate. as applicable, all areas in Which the services proposed do not fully . comply wIth the retjulrements of this Request for Proposal. The. decision as to whether an Item fully complies. with the stated reqUirementS rests solelY With the City of South MIami. Insurance Brokerage Services RFP No. SM-2011-09~HR Page 8 of25 Prec:edenc!tpf Condltloo$ The proposing Firm, by virtue of submlttlng a proposal,agrees that City'~ General Provisions, Terms and Conditions stated herein shall be Incorporated Into the Contract and take precedence over any terms and conditions submitted with the proposal, either appearing separately or Included. and shall not be modified without the written consent of the City. Proposal Wlthdl"llwal After Request for Proposals are opened, corrections or modifications to Proposals are not permitted, but [he proposing firm may be permitted to Withdraw an erroneous proposal prior to the adoption of the award by the City Commission, If the follOWing Is esmblished: A. The propOSing firm acted in good faith in submitting th~ proposal; B. The errol" was not the result of gross negligence or willful Inattention C?n'the part of the firm; C. The error was discovered and com~unicated to the City Within tWenty-four (24) hours of proposal tlpening. along with a written request for permission to withdraw the proposal; and D. The firm submits documentation and an explanation of how the proposal error was made. Publlt; eotit¥ Crimes A p~rson or affiiiate who has been placed on the Convicted Vendors Ust following a conViction for a public entity crime may notsubri"ilt So propo$al fora COI')~tt t() provide any services to a public entity, may nOt submits. Request for Qualifications on leases of real property to a public entity. and may not ~ransact business with any public entity In excess. of the threshold ~ount provIded In Section 287.017, for a period of 36 months from the d<ltlS of being placedon the Convicted Vendors List. Contingent fees Prghiblted The propOsing firm must warrant that It hu riot employed 01" retained a company or persOIl. other than' a bona flde employee. contractol' or subcontractor. working in its employ, to solicit or secure a contract with the CITY, and that it has not'pald or agreed to pa), any person. company, corporation, IndivIdual or firm other than a bona fide employee, contractor or subcontractor. working In Its employ. any fee, commission, percentage, gift or other consideration contlngent upon or resulting (rom the award or making of a contract with the City, Auditable ReforQs The proposing firm shall mainb,in a.uditable records concerning ~ompUanc;e with the Contract These record~ shall be kept iii accoJ:darlceWith generally accepted accounting prinCiples. and the City reserves the right to determine record-keepIng method In the event of non-conformlcy; These records shall be malntalned for five (5) years after the term of the Contract and shall be readily available to City personnel With reasonable notice, and to other persans in accordance with the florida Public Disclosure StatUtes. Unauthorizeg Aliens The employment of unautilDril.ed aliens by any firm Is considered a violation of Federal Law. If the Bidder/Contractor knowingly employs unauthorized aliens, such violation shall be cause for unilateral cancellation of any contract resulting from this RFP, This applies to any sub-contractors used by the firm aswelJ. Insurance Brokerag~ Services RFP No, SM-20 11-09-HR Page 9 of25 The failure to enf.orce Contract as to any particular breach or default· sball not act as a waiver of any subsequent breach or default. No-act or omission shall be construed as a waiver of any of the ('enns of the Contract. A waiver of any of the tenns of Contract shall only be valid and enforceable if ilie waiver is in writing signed by both parties. L::1odjtlcations and Amendments l'he Contract shall contains the entire agreement between ilie parties and no 11IOdificatjon or amendment of any terms or prOVisions of the Contraot sHall be valid or binding unless 'it complies with this pa)'agraph. The Contract, in general, and thIs paragraph. in particular, shall not be modified or amended exoept in . writing si~ed by both parties to the Contract. END OF THIS SECTION . . Insurance Brokerage Services RF:P No. SM·20 11-09·HR Page 1Oof25 SUBMISSION REQUIREMENTS . '*tM±ttHS-~,Li§~k"l.!prQ'" ffiili~ ieS$Li .... ,ei¥.'.;&t.~~~Bt!!@@§;U .. {¥±i~~::rJ@p.?#&1!!!SJ1.~.gz,.3~J'i . Insurance Brokerage SerVices It Is Imperative that the information submitted Is precise. dear. and complete. All submittals muSt be presented In an origInal unbound proposal !I')d ten (10) additional copies an 8 112" x II", tabbed for the! following format (submittals not conforming to this format may be disqualified from further consideration). Request for Qualiflcatlons should Include the reqUirements listed below. Submittals submitted without meeting ALL the requlrement;$ may be con$lder.w non-responsive. fORMA! SectIons and subsections should correspond in sequence with those Identified below. All additlonal information that the Proposer believes is unique to a. section and does not fit the established outline may be included at the end of each section unde~ II. subheading "Additlonal Informa.tion.· The following information shall be provl~ed Tn the order detailed: failure to provide anyone part of this section without appropriate explanation may result tn disqualification of proposal. A. Title Page -list the RFP subject. the name of the firm, address, telephone number, emall address, contact person and date. . B. Table of contents -Include a dear Identification of the material Included in the SUbmittal by page number. C. Letter of [nterest -limited to two (2) pages and it should Include a positive commitment to perform the required work within a specified tlmeline. an acknowledgement of receipt of addenda, if any. the . name(s) of the person(s) who will be authorized to make representation for the firm, their title. phol1B number and email address. . O. Qualifications and Experience -Proposer's Qualification Statement. shall Include the following information: I. A brief discu~sion of the firm"s understanding and approach to the work described herein. 2. A resume of the Proposer who will work on City matters and a statement identifying the individual who wlll attend meetings and have prImary responsibility for City matters and whether mat Individual represents other munldpahtles. 3. A list of any other entitles with whorn the Proposer has a contractual relationship or other business affiliation. 4. A disdosure of the followlnlf. (a) any relationships between the Proposer and any Commission member. hislher spouse, or family: (b) any reiation$hip between the Proposer and any business or entity owned by a Commission member .or their family .or in which a Commission member or their family has or had an Interest; (c) any' other Infonnatlon concerniilg.any relationship between the. Proposer and any Commission member which the Proposer deems might be relevant to the Commission's consideration; (d) such' other governmental or quasi-governmental entities which are represented by the Proposer. and the nature of the representation; :and (e) a "conflic;t IIsc"lf same Is maintained by the Proposer. S. Provide three (3) examples of wo~k performed by the Proposer that Involved servlce~ similar to those detailed herein and as to each, describe the scope of work and explain why you believe it Is similar to the work outlined In thIs RFP: Provide references reqUired by this RFP. 6. Provide resumes of staff that will be petformlng the work. E. A completed Certificatioo and Non-CollusIon Affidavit form which Is part of thIs bid package. F. All proposals received will be considered pul:!lic retords. The City wlll consider all proposals using such triteria as the Commission may adopt at its sole discretion. The Proposer selected will be required to enter into a formal agreement with the City, prior to the executlon of which the City shall reserve ali rights, Including the right to change its selection. tnsurance arokerage Services RFP No. SM-2011-09-HR. Page 11 of25 G. Sworn Statemllnt under Section 287.133(3} (A). Florida Statutes. On Public Entity Crimes. H. CO$t Proposaf -All proposals shall be I:omputed on a. flat file basis. END OJ: THIS SECTfON fnSU1'l!nCe Brokerage Services RFP No. SM-20 U-Q9-HR Page 12 of 25 EVALUATION AND SELECTION OF RESPONDENT 1I.§(%i'l!£'9*!>.lill"'i!¥i~.~· " .. !' ..... i\k!!l§R.~~~!##,l!!.+'~!tl'4i!ffi$!l~I#i1i~l!lIii#lii\6.t'lh.'*-~ . -h1Surance BrokerageServlces AU submittals shall be reviewed and evaluated by the Evaluation Committee to determine if they meet the minimum qualifications and for compliance with the. RFP requirements. All Proposers meeting the minimum requirements shall be further evaluated based on the followlng ~r1teria and shall be ranked by the Evaluation Committee. Firms shall be selected based on their ranking. The evaluation shalf be based on the Respondent's ability to exceed minimum quallficatlons and requirements Including. but not limited to, the Respondent achieving a minimum score of at least 70 points Tor consideration. . • Location of Fadlitles; distance between respondent and the City. convenient travel. (Maximum Possible Points; 10) • Past Experience and Performance on City of South Miami contracts and coil traCtS with other governmental entities. Induding complaints made against the Proposer regarding those contracts. (Maximum PosslMe Points: 20) • Experience of Key Personnel. (Maximum Possible Polnt$: :ZS) • Flnandal Stab1flty of Respondent, the City reserves the right to request the financial statements of any or all Respondents. (Maximum Possible Points; 10) • Availability and Commitment of Respondent to meet emergency sltuatlons. (Maximum Possible ll'oints: 25) • Cost Proposal (Maximum Possible Points; 10) .. Th~ CIty 'of South Miami reserves the right to waive any Irregularities or Informalities In any proposal. to reject any or all pr.oposals, and to make awards In accord with the best interest of the at}' and the P4bllc:, ~ ~ . . I. The committee may request that each short-listed firm make a presentation and be available for an Illterview. All expenses, intiudlng travel expenses for intervieWSi Incurred in the preparation of the proposal and attendance at the presentation and Interview shall be borne by the Proposer. After presel1ta.tions and inter\llews are completed. the Proposers shall be ranked by the Evaluation Selection Committee. 2. The Evaluation Selection Committee will present the ranking to the City Manager for initial review and approval followed by City Commission consideration and final approval. 3. The City will negotlate a Contract with the top ranked firm. Should the Ci!y be unable to negotiate a satisfactory contract which Is competitive. reasonable. and adequate, negotiations with that flrm shall terminate and the City shall proceed to negotiate a contract with the. next highest ranked firm; and, ultimately, should all such negotiations fall, alt proposals shall be rejected and this solicitation shall be re- issued. Ins~llce Brokerage Services RFP No. SM·:W 11-09-HR Page 13 of2S PROPOSER'S QUALIFICA nON STATEMENT LG •. 2.~$!P.,.i!&.i!!®p. __ RdRh#EUC!!QIl.. _'4~~f§lg;g:p'·'*l!€!!t~~!t"*r.£~§I!i!i~i!!QXi¥6 ~ .. In$UWlce Brokerage Services PROPOSER shall furnish the following information. Failure to comply with this requirement will render the Bid non~responsive and shall cause its rejection. Additional sheets shall be attached by the Proposer as requited. PROPOSER'S Name and Principal Address: Contact Person's Name and Tide: PROPOSER'S Telephone and Fax Number: PROPOSER'S Ucense Number: (Please attach certificate of competency and/or state registration.) PROPOSER'S Federal Identification Number: I. Number of years your organization has been in business, in this type of worle ----- 2. Names and titles of all officers, partners or individuals doing business under trade name: The business is a: Sole Proprfetorsh!e,D ~artnership 0 Corporation 0 , LLP 0 . LLC U 3. Describe your experience and services related to health managemeht. This would include health risk assessments, well ness, health coaching, disease management, etc. Insurance Brokerage Service~ RPP No. SM·20 U·09-HR Page 14 of25 4. Describe an example of a City for whom you have coordinated or provided these services. 5. Have you ever failed to complete work awarded to y~u. If so, when, where, and why? 6. How will you maintain confidentiality of the City's records and data (include in your discussion any security procedures for accessing. sending, and storing data that are currently in place)? 7. Discuss your setVite approach and how you respond to City requests. Indude what you consider non-urgent/routine. requests and urgent requests. 8. How do you measure client satisfaction? 9. Confirm that you serve as a consultant or broker, independently, and are not affiliated with any insurance company. third party administrative agency or provider network. insurance Brokerage Services RFP No. SM·2011·09·HR. Page 150[25 10. Describe your experience In provider network developmeht, recruitment and negotiatioh, and maintenance. f I. Outline your ability to provide expertise and experience In the areas of health benefit plan analysis and design. . 12. Explain in detail the types of analyses you have conducted relative to benefits analysis and design (or a health plan with at least 100 employees. 13. Provide examples of communication materials developed and prepared by your organi:z.ation for use in Citis health benefit communication campaigns. . 14. Are there any existing service provider relationships that may prevent you from acting independently and providing objective advice or guidance? (I:xamples, overrides, commission agreements, preferred contracts, pricing based on volume. etc.) Insurance Brokerage Services nFl:' No. SM-2011-09-$ page 16 of25 IS, List any subcontractol's who will provide services under this Contract and the services they will provide. The foregoing list of subcontractor{s} may not be amended after award of the contract without the prior written approval of the Contract Administrator, to be designated by the City Manager, and whose approval shall not be unreasonably withheld. 16, list and describe all bankruptcy petitions (voluntary or involuntary) which have been filed by or against the Proposer, Its parent or SUbsidiaries or predecessor organizations during the past five (5) years. Include in the description the disposition of each such petition. 17. Provide specific examples of a significant savings In the cost of benefits to the client that can be directly attributed to your past services. 18. List any companies your are affiliated with or' have contractual arrangement with including Insurance companies, third party administrators (claims or other administrative1record keeping services), provider networks, HR or benefits software vendors, etc, 19. Describe your firm's ability to assist with Benefits Administration issues .. 20. What distingUishes your finn from other consulting firms and why should the City select your firm for consulting needsl Insurance Brokerage Services RFP No. SM-20 11-09·HR Page 17 oi2S 21. What is the total number of employees that you have assigned, currently, to employees benefits counseling? 22. What Is your corporate mission, vision and values, as well as your organization's philosophy towards providing benefits consulting services? 23. Discuss your firm's quality assurance policies and procedures. How do you measure whether you are meedng these standards? What is the frequency of any such review? 24. Detail your ability to monitor regulatory and legislative developments at both the state and federal level and how this wifl benefit the City and be communicated to the City. 25. List all claims, arbitrations, administrative hearings and laws.ults brought by or against the Proposer or its predecessor organizatlons(s) during the last (5) years. The list shall Include case name. case, arbitration or hearing identification number, name of the court or tribunal, the name of the project over which the dispute arose; and a description of the subject matter of the dispute. . 26. Describe all proceeding concerning business related offenses In which the Proposer, its principa.ls or officers or predecessor organization(s) were defendants. fnsurance Brokerage Servioes RFP No. SM-2011-09·HR Page 18 of25 27. Has the Proposer, its principals, officers or predecessor organjzation(s) been CONVICTED of a Public Entity Crime, debarred or suspended from bidding by any government during the last five (5) years~ If so, proVide details. The PROPOSER acknowledges and understands that the information contained in response to this Qualification Statement shall be relied UpO/1 by CITY in awarding the contract and such information is warranted' by PROPOSER to be true. The discovery of any omission or misstatt;lmel'lt that materially affects the PROPOSER'S quallfications to periorm under the contract shall cause the CITY to reject the Bid, and if after the award. to cancel and terminate . the award and/ol-contract. VERIFICATION PURSUANT TO SECTION 92.525(2), FLORIDA STATUTES Under penalties of perjury. I declare that I have read the foregoing Respollse to Qualification Statement and that the facts stated in it are true. DATED this ~ __ day of ______ -,-----". 2011. (print Name of Proposer) By ____ ~-=~~~~~~ __ ------- (Sign Your Name on Line Above) (On LIne Above, Print or Type Name of Person Signing) FAILURE TO COMPLETE. SIGN. & RETURN THIS FORM MAY DISQUALIFY: YOUR RESPONSe Insurance Brokerage Services RFP No. SM-2011-09-HR Page 19 of25 NON-COLLUSION AFFIDAVIT t~,sa.\ee'tNr\!!tl!~~JM4"mM.!!!{i~e:wa,!'ht@~+:isa·;-..itii¥k'.3i#?¥m:16ML_:.._z"BIU'>.SQb!BS& lud!N';::,m . . . .... . Insurance Brokerage Services STATE OF FlORIPA COUNTY OF MIAMI·DADE ) ) ) ______ "-:-________________ being first duly sworn. deposes and states that: (I) He/She/They is/are the __________ -----'---:------- (Owner. Partner. Officer, Representative or Agent) 6f ____ '---.:....: .. ~----_____ "......:.~-..,_ the P~OPO~ER that has submitted the attached BID; (2) HeiSheIThey Islare fully Informed with respect to the preparation and cohtents of die attached BID and of all pen;inent: circumstances concerning such BID; (3) Such BID Is genuine and Is not a collusive or sham BID; (4) Neither the said PROPOSER nor any of its officers. partners. owners. agents, representatives. employees or parties In interest, including this affiant, have in any way colluded. conspired. connived or agreed, directly or indirectly, with any other PROPOSER. firm, or person .to submit a collusive or sham BID in connection With the Work for which the attached BID has been submitted; or to refrain from PROPOSING in connection with such Work; or have in any manner, dlrecdy or indirectly, sought by agreement or coJluslon, or communication. or conference with any PROPO$ER, firm. or person to fix any overhead, profit. or cost elements of the BID or of any other PROPOSER. or to fix any overhead, profit, or cost elements of the BID Price or the BID Price of any other PROPOSER, or to secure through any collusion. conspiracy, connivance, or unlawful agreement any advantage against (R.eciplent), or any person Interested In the proposed Work; (5} The price or prices quoted in the attached BID are fair and proper and are not tainted by any collusion. conspiracy. connivance. or unlawful agreement on the part of the PROPOSER. or any other of Its agents. representatives, owners. employees or parties of interest, Including this affiant. Signed, sealed and delivered in the presence of: By; . ~~--------------~--------------SignatUre Subscribed and sworn to before me this Print Name and Title day of ---------- Notary Public (Signature) My Commission Expires: .)0 FAIL.URE TO COMPLETE. SIGN. & RETURN THIS FORM MAY DISQUALIFY YOUR RESPONSE Insurance Brokerage Services RFP No. SM·2011·09-HR Page20of25 SIGNATURE PAGE 11l@ll.Jlj!M!f$Qd!i¥.~au 5¥'jj'M~$ . __ ._4.".. g:bi51:t'f!!\(MRi.!.'I!ir.Y!i@li!4'l <X"a¥.gqll.,clil\!!.,UR!S!Ef.!!$;~:!i;:ti¥;.!l!_~.i£.@Eil!lt!!!I . . . . . Insurance Brokerage Services The undersigned attests to his (her, their) authority to submit this Submittal and to bind the f1rm(s) herein named to perform as per agreement. Further. by signature, the undersigned attests to the following: I. The Proposer Is financially solvent and soffl,iel'ltly experienced and competent to periortn all of the work required of the Proposer in the Contract; 2. The facts stated in the Proposer's response pursuant to Request for Proposal, instructions to Proposer and Specifications are true and correct in all respects; 3. The Proposer has read and complied with, and submits its proposal agreeing to all of the reqUirements, terms and conditIons as set forth in the Request for Proposals. 4., The Proposer' warrants an materials suppiied by it are delivered to the CITY of South Miami, Florida, free from any security interest, and other lien, and that the Proposer Is a lawful owner having the right to supply the same and will defend the conveyance to the CITY of South Miami, ~Iorlda, against all persons claiming the whole or any part thereof. 5. Proposer understands that if a team Is short listed and selected to make oral presentations to the selection committee and/or CITY, only the team members who were involved in the preparation of the written submissions may participate In the oral presentations. Any changes to the team at the oral presentatIons may,~t the sole djscretipn of the City, result in that Proposer's Bid disqualification. 6, The undersigned certifies that if the firm is selected by the City the firm will negotiate in good faith to establish a Contract. 7. Proposer understands that'all information listed above may be verified by the City of South Miami and Proposer authorizes all entitles or persons listed above to answer any and all questIons, Proposer hereby indemnifies the City of South Miami and the persons and entitles listed above and holds them harmless from any claim arising from such investigation and verification process, including the dissemination of informatIon pursuant thereto. Submitted on this day of • 20 (If an Individ'ual. partnership, or noh-Incorporated organlzatlcm) Witness: Company: ______________ _ Printed: By: ------------------Title: Print Name, Tide: -~--------------(If a corpotati.on, affix seal) Company: -----------------6y: -------------------Attested by Secretary Print Name, Tide: ~--------------- Incorporated under the laws of the State of ----------------- EArLURE to COMPLETE. SIGN. & RUURN THIS FORM MAY DISQUALIFY YOUR RESPONse Insurance Brokerage Selvices RFP No. SM·20 11-09-HR PageZlot2S CERTIFICATION Of AUTHORITY STATE OF FLOR.IDA COUNTY OF MIAMI·DADE D Corporation or LLC ) ) ) o Partnership DLLP D Joint Venture I HEREBY CERTIFY that a meeting of the Board of Directors, Partners, and/or Principals (include DBA-Doing BUsiness As. If applicable) of the (ollowing entity an organintjon existing under the raws of the State of ___ -'-_-'-_______ " was held on , 20 • and the following resolution was duly passed, and adopted: "RESOLVED, that, ~ ___________ as of the organlntion, be and Is hereby authorized to execute the Proposal dated, day of _--' ________ 20 __ , to the City of Soutl1 Miami and this organization and that my execution thereof, attested by a Notary Public of the State, shall be the official. act and deed of this attestation" I further certify that said resolUtion is now In full force and effect. IN WITNESS WHEREOF. I have hereunto set my hand and affixed the official seal of the corporation this, day of , 20 __ -, Print Name Signature ----------~----------------------------~--- NOTARY PUBLIC: SEAL Notary Signature Personally known to me, or Personalldentiticatlon: Type of Identification Produced JtAILURE TO COMPLETE, SIGN. & RETURN IIi IS FORM MAY DJSQUAUFY YOUR REspoNsg Insurance Brokerage Services RFP No. SM-20 11-09-HR. Page 22of25 REFERENCES ~~~'M~r.1.t'f,~!iU& .. ~" •. ¥l!,._ .• C:<¥. .. --Insurance. Brokerage Servi~es Please list three (3) governmental agency, or comparable corporate client, contract references for which YOll have done business within the past three (3) years: Agency Name: ----------------------------------~--~==---- Address: ------~--------------------------------~---- City, State & Zip Code: ~~------------------------------------------ Contact's Name: --~------------------------------------------ Telephone Number. --~--------~-------------------------------- Agency Name: --~--------------------~------------~------ Address: ----------~---------------------------------- City, State & Zip Code: ________________ ~--- Contact's Name: ------------~~------------------------------ Telephone Number. ________________________ ~ Agency Name: _____ -'-_~ ____________ _ Address: ---------------~------------------------ City, State & Zip Code: __ ~-________________ _ Contact's Name; --------------------------------------- Telephone Number: _________ --=--;-:---:-_~~-.._:-_,_"':_::_--- Attach additional sheets If necessary. FAILURE TO COMPLETE, SIGN, & RETURN THIS FORM MAY DISQUALIFY YOUR RESI"ONSE InSlll'ance Srokerage Services RFP No. SM-20 11-09-HR Page 23 of25 RFP INFORMATION FORM n~~!i11~.i{!..:.,€!,g_~\4i§i .. 'is.!€,.Q!-"i!i%f)ii\€l~"€¥d,*!@!ll!!riii!Jl!W}."::iti!@J ~ !& •• i, .#.i,.!!§f.f.i$!~ . '. Insurance Brokerage Services I certify that any and all information contained in this RFP is true;' and I further certify 'that this RFP is made without prior understanding, agreement, or connections with any corporation. firm or person submitting a RFP for the same materials, supplies, equipment. or services and is in all respects fair and without collusion or fraud. I agree to abide by·all te~ms and conditIons of the RFP. and if the Proposer Is a legal entity, I certify that I am authorized to sign for the ~roposer. Please print the foHowlng and sign your name where india,ted below: Arm's Name! ----------------------------------------------------~-- Principal Business Address: Fax: Telephone: --------~------------~ --~--~------------------ E-mail address: Name Title: Signature of Authorized Representative~ @ FAILURE TO COMPLETE. SIGN. & RETURN THIS FORM MAY OISQIJAUj;'y' YOUR RESPONSJ:: InsurBtlce Brokel'age Servi.ces RFP No. SM-2011-09-liR Page 24 of25 NO CONFLICT OF INTEREST CERTlFICATION l!!il"~!t#I!\Wl!m~~M.ii+i%i'5i'l!3#Jii&ilI!k'tL!>'4tg.lIi;;m~~F.;!fui1ii¥mse,;pili@l**4¥.iiUt~,,$._'···'I!'B . . Insurance BrokerageServlces The undersigned. as Bidder/Proposer, declares that the only persons interested in this RFP are named hereIn; that no other person nas any interest in this RFP or in the Contract to which this RFP pertains; that this response is made without connection or arrangement with any other persol1; and that this response is in every respect fair and made in good faith, without collUSion or fraud. The Bidder/Proposer agrees that if this. response/submission is accepted, to eXecute an appropriate CITY document for the purpose of establishing a formal contractual relationship between the Bidder/Proposer and the CITY, for the performance of all requirements to which the response/submission pertains.· , The Bidder/Proposer states that this response is based upon the documents identified by the following number: Bld/RFP No._~ ____ ~ The full-names and residences of persons and firms interested in the foregoing bid/proposal, as principaJs, are as follows: The aidder/Proposer further certifies that this response/submission complies with Chapter 8(a) of the Code of Ordinance, City of South Miami, Florida, that, to the bese: of its knowledge and belief, no Commissioner, Mayor. or other officer or employee of the CITY has an Inte~est directly or indirectly in the profits or emolu~ents of the Contract, Job, work or service to which the response/submission pertains. Signed, sealed and delivered in, the presence of: ,By: Subscribed and sworn before me this -=~-------------------------------Signature Print Name and Title dar of ,20 ~----------- Notary Public (Signature) My Commission Expires: fAILURE TO COMPLETE, SIGN. & RETURN THIS FORM MAY DISOUALIFY YOUR ReSPONSE Insurance Brokerage Services RPP No. SM-20 11-09-HR Page2S of2S CONE OF SILENCE AFFIDAVIT ~.l@iB!il!i'@iI\\M~i'9''l!'N##d!Milif6lli!i!iMi!@J1i.¥S,i!!fl#....iiB§EiiM!.!'l£l~h'i#.i'li*!?!&I.l![il!iif\;' _. ff.!¥.E'?L.~£H1!_'.M b\i!l<~).!i!Oid Insurance Brokerage Serlices The ffCone of Silence" specifically prohibits communication regarding RFP"S (bids) or any solidtation wfth the City of South Miami staff except by written means, with copy filed with the City Clerk. This takes effect upon advertisement for Request for Proposal and terminates when the City Manager makes his recomn1endatior. to the City Commission fDr the award. An exception is made for oral comm ... nication during pre-proposal conferences. In addItion to any other penalties provided by law, violation of the Cone of Silenee shalf render any proposal disqualified. CITY OF SOUTH MIAMI DISCLOSURE AFFIDAVIT being first duly sworn. state: ----------------------- The full legal name and business address* of the person or entity contracting or transacting business with the City of South Miami are: If the contract or business transaction Is with a corporation. the full legal name and business address* shall be prOVided for each officer and director and each stockholder who holds directly or indirectly five percent (5%) or' more of the stock in the corporation. If the contract or business transaction Is with a partnership. the full legal name and business address"" shall be prOVided for each pamer. If the contract or business transaction is with a trust, the full legal name and address* shall be provlded for each trustee and eacn beneficiary.. If the contract or business transaction is with an LLP or LtC. the full legal name and address* shall be provided for each member of the UP or ue. All such names and addresses are: The full legal names and business address* of any other Individual (other) than subcontractors. material men. suppliers, laborers, or lenders who have. or will have, any interest (legal, equitable. beneficial or otherwise) in the contract or busine~s transaction with the City of South Miami are: Insurance Brokerage Services RFP No. SM-20 11-09-IIR Page 26 of25 ~ota.ry Public Signed, sealed and delivered In the presence of. By: ~~-----~-------------------Signature Print Name and Tide Subscribed and sworn to before me this .20 ---day of -------- Notary Public (Signature) My Commission expires: FAILURE TO COMPlETE. SIGN. & BETUliN THrs FORM Max PI~QVALIfY YOUR RESPQNSE Insurance Brokerage Servfces RFP No. SM·2011-09·HR Page 27 of2S -To: Via: From: Date: Re: ~~~B.f&u DEPARTMENT OF HUMAN RESOURCES MEMORANDUM The Honorable Mayor & Members of the -City Commission Hector Mirabile~ Ph.D., City Manager LaTasha M. Nickle, Human Resoutces Director August 23, 2011 Summary of Proposal-Sapoznik Insurance QUAIJFlCATIONS & EXPERIENCE Sapoznik Insurance provides services exclusively related to Employee Benefits Consulting -and has been in business for 24 years. Sapoznik has "successfully worked with municipalities to reduce costs, control claims, and imnlement wellness programs:' Representative cities include: North Miami Beach, North. Miami, Miami Springs, Town of Davies, Town of Golden Beach~ and Miami Shores Village. A. TEAM MEMBERS Sapoznik proposes a 'three--member lead team to handle the account; however, the City and all of its employees will have direct access to a full range of customer service, benefits and wellness personnel (an additional 12 individuals) as needed. The three leEl.d teanl members are Rachel Sa.poznik, president with 30 years of. experience; Gracy Webennan, Exeoutive Vice President, with 24 years of experience; and Ada Waters, Benefits Consultant;, with 12 years of experience. B. UNDERSTAN»ING & APPROACH The Sapoznik goal is to "over-exceed YOttr expectations 100% of the time." Their approach is a "VIP Customer ~ervice Moder' where all c~s are answered by ~ live representative and issues are responded to and resolved in the fastest possible time (24 houts or less.) Sapoznik advocates advanced planning and year~round monitoring to obtain the best possible renewal rates. As part of the program, they provide substantial assistance in the development and implementation or a wel1ness program. as part or their nonna! Selvl.ces. . SCO:PlC OF SERVICES Sapoznik has agreed to provide all of the services requested in the City's RFP. They will provide a full range of services including dil'ect access for employees, benefits administration, claims adjudication, enrollment support -live and via intemet~ and customized website/web portal. (The proposed range of services is extensive -please refer to the Cost Proposal Section for a more detailed summary). :PROJECTED TlMELlm Sapoznik did not propose specific dates for its detailed outline of services/events. The proposal sta.tes that dates will be determined upon consultation with the ,City. COST PROPOSAL The annual Consulting Fee requested is $40,000. ~!!/~9/&,;; DEPARTMENT OF HUMAN RESOURCES MEMORANDUM To: The Honorable Mayor & Members of-the City Commission Via: Hector Mirabile, Ph.D., City Manager From: LaTasha M. Nickle, Human Resources Director Date: August 23 1 2011 Re: Summary of Proposal-Gallagher Benefits Servicest Inc. QUALIFICATIONS & ExPY£IUENCE , Gallagher Wag established in 1961 as an employee benefits consulting subsidiary of a natiOIial Insurance Brokerage finn. They provide benefits consulting services to more than 70 Public Entity clients in South Florida. Sample Representative Clients in the area include the City of Sunrise. Town of Palm Beach, City of Punta Gorda, City of Wauchula, City of Miami Beach, City of Hallandale Beach, and other cities. counties and school districts., A. TEAMMEMJlERS Gallagher proposes assigning four team members to the City. All Insurance representatives have more than 25 years of experience. The assigned attorney: has 16 years of experience. The City will have access to each <;If these staff members, including the attorney. B. UNDERSTANDlNG & APPROACR Gallagher will provide reports which produce a "high level of :financial accuraoyn utilizjng their in~house actuarial and fmancial staff. They will proVide reports on a Monthly, Quarterly and Annual Basis subject to the City's indicated preferences. They also provide· services in employee meetings to provide benefits education. Their stated approach is to collaborate with the client to "understand the demographics t health risks, culture and goals of the organization" to design the bestplans and programs. SCOPE OJ! S~RVICES , Gallagher has agreed to provide all items specified in the City's required Scope of Work. They will provide Account Management. Pre~renewa1 Planning Meetings, Renewal Representation, Compliance Reviews, Strategic Planning & Development and meetings with the City?s Benefit Committee. They provide on~line resources including a customized website for City employees t use. In addition to the actuarial and financial reports, the assigned attorney's role includes the provision of updates on relevant changes in the laws relating to Employee Benefits and assisting with compliance issues. PROJECTED TlMELINE oanagher did not propose specific dates for its detailed outline of services/events . . The proposal states that dates will be determined upon consultation with the City. COST PROPOSAL Ongoing COnsulting Services -$38,500.00 annually Additional Op¥onal Services are available for additional pricing. To: Via: From: Date: Re: ~9'~~~ DEPARTMENT OF HUMAN RESOURCES MEMORANDUM The Honorable Mayor & Members of the· city Commission Hector Mirabile, Ph.D., City Manager LaTasha M. Nickle, Human Resources Director August' 23, 2011 Summary of Proposal-Gehring Group QUALIFICATIONS & ExPERIENCE Gehring has specialized in public sector service for more than. 18 years and has more than .60 Florida public sector acco~. Their staff averages 10 years of industry experience. Representative clients include: Arcadia, Boca Raton, Bonita Sprlngs. Brooksville, Clearwater~ Coconut Cteek, Dunedin, Key West, Naples, Port Richey, Vero Beaoh) West Palm. Beach, and many others. A. TEAM MEMBERS The Gehring team will consist of five members. Anna Marla Studley, Managing Director/Lead Consultant, has 30 years of experience. All other team members have between trine and 25 years of experience in the industry. B. UNDERSTANDING & ,ApPROACH Gehring operates under ~ unified service approach' which holds· all staff responsible for the 'successful servicing· of all cije~~. They strive to p~ovide value added services and to provide exemplary customer service every time. They develop and provide customized publications for their clients as part of their regular service and seek to educate employees at all levels of the client organization about their benefits and options. SCOPE OF SERVICES Gehring provided a detailed response OIl its . method of meeting each of the required aspeots of the Scope of ServiceS. In addition to the required scope of work. the proposal includes development of a customized employee benefits handbook, client web portal, online human resources research tool. and online benefits resource center. PROJECTED TlMELINE Specific timelines will be developed based upon the City's needs. COST PROPOSAL Ongoing Consulting Services will be provided for $55,000 and will include all services outlined in the scope of work. Compensation is negotiable based on needs & expectations. MIAMI DAILY BUSINESS REVIEW PUblfshad Daily except Saturday, Sunday and legalHolf~$ MiamI, Mlaml,Dade GQunty, Florfda STATE OF FLORIDA COUNTY OF MIAMI-DADE: ' Before the undersigned authority personally appeared MARIA MESA, Who on oath says that he or she Is the LEGAL ClERK, Legal Notices of the Miami Dally Business Review ftwa Miami Review, a daily (except Saturday, Sunday and Legal Holidays) newspaper, published at Miami In MiamI-Dade County, F10rldaj that the attached copy of advertisement, beIng a legal Advertisement of Notice In the matter of CITY OF SOUTH MIAMI PUBLIO HEARING FOR SEPTEMBER 6, 2011 In the XXXX Court, was published in said neWspaper In the issues of 08126/2011 ' Affiant further says that the said Miami Daify Business Review Is a newspaper published at Miami In said Miami-Dade County. Florida and that the said newspaper has_ heretofore been continuously published in said Miami-Dade County, Florida, each day (except Saturday, Sunday and Lega' Holidays) and has been entered as second class mall matter at the post off(ce In Miami In said Miami-Dade County, Florida, for a period ofor1t~ year nextprecedlngthellrst publication 9fthe att~ched copy of advei1~$eri1~nl: andaf(iahtJu.rther ~aysthat h~ or she has neither paid nOr promised any person, firm or corporation any dlsoount, rebate, oommlssionor refund forthepurpose of securIng t -r ublfc~\lort In the said no - 26 day of AUGUST ,A.D. 2011 o;~-- (SEAL) , MARIA MESA personally known to me Notary Publie Slate of fifo/ida Choryl H.Marmer My Commission 00793490 Expires 07/1812012 .( • •• lo'· ~,~', '/ t' ':~.:;:. '''.;:>:~:'.:;;::':;:'';~'~t47i;:' . Pu~~;ht·:l~XF.JOtld~ ;s~i~~)2IiB.oio5" the, City 'ji\lWltW'~J~isb~ 'the pu~lIc .. ih~t"!;;'~'P!3r$o'!j.,~ec[d~-,~o apl?e~1 ilny _d,eol_sl~)ffinade 'liy:-tlils )3QaRl;'Age!1cy,qf.;pommlssl,on,lNdh; rE!Bp'ebl,.f6 any, ma\lercon$,J~ere(l,at Its'meeting or h~arlng. he -Qf l1he1vtlt neecl;a recori:l of lhe.proc.~edlJ;1g~, and ,Ihat for such p-ui'poSI3; 'affected pet~n may nt;led __ to_elJslfr~':lhitf E! vE}rbatim racoriJ 'oUIle pro.ceei:llngs Is made ~hlc:h r~c:o!(HnaIUiles' tile lesllmony and evidence upon y.lh!Cih the apP'eallS to be liased. -, ai26 -', ' t, -, -, -,'. -11-a-l1,lf174623~M ~4SE I SUNDAY, AUGUST 28, 2m1 SE MiamiHeratd.com I THE MIAMI HERALD SOAPBOX __________ =_=== .... ________ '''' .... 2~ ...... _"...~~~og:uuJ.t~~"'u .... "' ....... ""'''''''===== Crocs don't belong in residential canals beautiful sightl The tops Circle. The total bill was have already be.en untied, $4l3,l24. The entire com- and as soon as the fronds to-mission voted Cor tills ex- tally Ielax. it will be truly penditure. In the same mo- magnificentlThissamewe1l lulion,Mr. Diaz-OwneI of monned friend exclaimed, Manuel Diaz Faaos and a "And the trees were a gift. to Gables resident -did do- . theclty-wedldJl'tspenda IllIte 64 Bismarkla Palms As a lifelong resident of ment;"r felt threatenedl" dime!" Her comment made (estimated value $80,000) Cor.Il Gables. and a simh· -SUl3lloe 1I!aWner, mewonder how maDYotbet that are planted at the base genezation citizen ofF1orl-CoralGables coral Gables citizens are aftheMsdjoolpaJms.Heal- da, I was thunderstruck by under the same misconcep-so gifted to the city 2'1 live the blase-attitude of author-CITY SPENT TOO MUCH lion about the purchase of oaks (estimated value: itiesregardi!lg CJ:Ccodilesin MONEY ON TREES thesetrees. $24,300) that are replacing residential canals. <Canal At a friend's uxgiDg, I I watched the city com· aging palms in the 400 and neig/lbo!$ told crocs here If} went out of my way after mission meeting of July 19, 5'00 blocks of Aragon Ave- stay, Neighbors, .AIlg. 2L) I c:hurch on SUnday to sec the and listened carefully. The nue. out fur attenlfon? Also, commission chamber at Ci- have one word for the res!-new stately palms that have city paid $~,OOO per ttee to I believe that one of the when the city is wducing ty Hal1. These open meet- dents of Gables by the Sea been planledln the medians Manuel Dlaz Farms for the major compOgents of fiscal staff and askiIlg employees Ings provide the opportuni- who want to protect their in the downtown blocks of puxclJase, delivery and. ill-responsibility is detmnill-to takecolli:CSSions in both. tyior Coral Gables residents childrenandpetsfromthese Alhambra Circle. between stallatlon of the 67 Medjool ing priorlties and spending pay and beoefits? And just to express their thoughts on dangerousreptiles:sootgun. Ponce de Leon Bo!llevard date palms that axe now fimdsinawell-thougbt-out, ashuJrlcaneseasonisheat-theproposedcitybudgetior Followed by thls state-and Lejeune Road. What a plaD1ed along Alhambra sequential III3DI1er -also, illg up? And who's picking the coming fiscal year. I being able to differentiate up the tab for the resulting -MlJIIlll Ebbert, • _ between "Want" and '~eed!' new curbing? Corel Gables . , Was spending DVet' 1 can only scratch my , • :. $400,000 on new trees the head. KUDOS TO CITY FOR '. <.:.' . j pmdent thing to do at this The'Coral Gables budget REVISITING PICKUPS CITY OF SOUTH MIAMI ' time when there are many hearings are Sept. 13 and Re: City ro consider COURTESY NOnCE L.,.o;;ther_City;;' ;i;;;;PIOJ;;·;;;;ects_tha_t;;cry;;i;;;;;sep;;;;t;;2;;7.;;a;;t S;;p.ID._;;in;;th;;e;;city;;;-, ~ ~ltI'king ban on I. pic1rups,Ne1ghbors,July21.1 . Cash Bacl, On Trane Air Conditioners. !lanCE IS HE/lEIIY .given 1Ilat III~ City CommiSsIOn Oflhe ClI}' of SoulIl Miami, FlIRlila will OOIlduct PIIbIlc IIe2rIngs at lis !e!)ular City Cmnmiss!nn mee1lng scbedll!!!I for1besd!IJ,Seplember6,20t1, beginning at 7:30 p.m., In \he City Ccmmlsskm CIlambStS, 6130 Sunsot Drlte, 10 conSiller Ute follaWing IlBmS: A ResoMion appnmng and a1I1I1cn2iI!Q the City Manager 10 8JeQlIe a IlIree year{Odoter I, 2010~eptemblr 30, 21l13) Agreemel1l Belwean !he MIamHla1Ie C<II!nI1l'Dl!ce BeMYOl:nl I\s$OClation eog~ Bargalnng !lim tpol!ce DIIi«f$a:1iISs~an\!$J u.o1heClIj OtScI!!l! Ml,ml O Resolu1lonaull1oming1lieCi!y Mwgsr \0 exeCUla311 agreamelrt WlIll SapilZlilkl!iiUlOnCO &Associates~ 1no.lorth~prolWonOI'lfl$uran~8roker.1ge~s.IlIiS1llFllCm.mlsliallhaWaif,inIUal,um(3Jyearpedod ,vIllt two \21 oile (1) year QjlUan 10 fW)'I pedOtisforapos$le lOtail!rmD! tl'/ayears (5). An Onllnam;e reJaIing to lrudgel; auIhoIiling 311 Dlcreiise of approprialkltm for IIlqIeRSa line ~ 615-1910-521·6800 (FedmI Fct1e1lure Intangible Asse1S) In 1M amount ot $IQO,I)OO.oo. Crmn lheFedeflll Forfeiblf6 F\lnd, for the W of two inslallment ~enlS to SlmGanll'llb6c StWlr Iru:.. lor repiat:emenl of outdated sa!lware lor Computer Mlsd Dispaldl (CAll) semces, Reco~ ManagementSyslem lRMSi and Field Base Repelling ~cm (FiRSl, To indude thalir$tyear alUlual fee Iw maintenance and IedIlicat suPPQlt. Anoraln!llltaamBomngthaLandoaveltlpmentCodebjdeleIklgSeclion20-3.1(E)Sllli!lea"BuSlnass01ll$idea Buikli;Jg"ln$elling n~l Sedioo20-3.6 M to be entitled 'Collirnen:ialActi\itY Clindllcted OutsIde of a Bulllfmg" to plllYide 101 ouIsidalll9rthandlsa display; eslabtlsblng oxcepllons, a pmce:;s for pBllllilling, ana limitlUOll$ onthe!llsplay. ALllnteresled par1iesare Invite(! 10 .lIond and \'IlII be heard. For fuI1IlerinlarmalJal1, pl_ COIIIaC1Ihe City CleIII'S Offi<:ea~ 305·663-6340, Marla M. Menendez, CMG Cl~C1e111 l'ImIIan\ \G RoridaSlallllos28S.0105, U!c City Ilerelly_1he putI!Ic Ihatl!o1"\..andetld.'1lI appeal any d,eclSfOl1 roade IIr Ihls BDaId,j\QellO)' 01' COm_Ion WiIIlIe$pec\ t. any matter<G~.d at i!S.ll1e!IlM or neamg.!IS or.no Will Deed a m:ooj III tho proteedlngs. and Inat lor SUCIl purpose, aIIede<! poI$DIl roar need to 0IISIJm lIlat a wrballm raconI oftlle proceo<llng. is I113I!a whlchRClXll j""lwles1he ~ny 0I1I!~1d~ UPlifl ~Icb tile appeali$lo~. ~ Buy a Trane Comfort SlIstem tOilav, And receive an Instant Rebate up to S1,000 . ATraneCGm~l1IiIhan elIfclSnC'fJa1!lJJ of.2o.QDSEERcaosaweJQu ~p to 67% 011 ~ p0W2r biI, WI1l1e remOllng lIP to 2Q gaUons of rnois!In a day from home -1Ba'llng you ClIol and comfortable. And. K ynu can a~ bel1m' 101311\1, 'jU1I \'IlII get an ill$lant Rebate up 10 $1,000.00. PkIs up!<> $1,495 in fl'L rvbalBs! e'1'RAIIE" ~Sl4p.4~ --:5'[(' {lC:7.' ExJ8~1 more from ,our Imllpamtall1. be DSaia!. fOR TUE BEsr srnUI,E mm I:JST~UaTlOlIS IN DaDE CDUJlT1 c~u: Hi .. Tech Air Service 11110 ASK FORWlIICV, WIO VB JOHn 13339 .SW88111 Ave. Mlainl, F1.33171l 305-969-2600 11>- ~~~~ am both a proud resident of Coral GabJes and a proud owner of a Ford P·lSO truck, and 1 am not in agreement with the truc:k oxdinance as c:un:ently an the books. I am .• glad that the city and its elected. officials have de- ferred enforcement until November and are reevalu· ating the WQl'ding and intent. In my opillion, the word- ing;shouldbemodemizedto reflect the c:un:ent state of truclc ownership as a non- commerclal vehicle prefeI- ence. I feel the time is right for the city to m.odify this law for our commtlllity's benefit and to focus on the city's orlginal intent of the law. 'I'hewordingshouldad- dress. co;nmezcial use spe- cifically;I encourage the city and am willing to partici- pate ill the process to wotk together to achieve a win-. wm situation. I consider lllJISeJf a good citizen, keep my lwme and y.mi in good shape, and • TURN TO SOAPBox, 39SE INSURANCE BROKERAGE SERVICES s M PRESENTED BY: R 2 F o P 1 1 FIRM NAME: Sapoznik Insurance & Associates, Inc. ADDRESS: 1100 NE 1 63rd Street, NMB, FL 33162 PHONE: 1.877.948.8887 N EMAIL: Gracyw@sapoznik.com.Adaw@sapoznik.com o o • 8 H CONTACT: Gracy Weberman, Vice President and Ada Waters, Benefits Consultant DATE: July 1,2011 R TABLE OF CONTENTS LETTER OF INTEREST .............................. ~ ........................................................................................................... 3 RESUMES OF PROPOSERS ........................................................ ~ ...................................................................... 5 QUALIFICATIONS AND EXPERIENCE (RESPONSES) .................................................................................... 9 CERTIFICATION & NON-CONCLUSION AFFIDAVIT ................................................................................ 40 OTHER FORMS ............................. ; .................................................................................................................. 43 SWORN STATEMENT ..................................................................................................................................... 50 COST PROPOSAL ........................................................................................................................................... 52 ADDITIONAL INFORMATION: LICENSES .................................................................................................... 55 RENEWAL TIMELINE .................................................................................................................... APPENDIX A TECHNOLOGY & REPORTING ................................................................................................... APPENDIX B COMMUNICATION CAPABILITIES ............................................................................................ APPENDIX C ENROLLMENT SUPPORT ............................................................................................................. APPENDIX D WELLNESS PROGRAMMING ..................................................................................................... APPENDIX E LEGISLATIVE AND COMPLIANCE ............................................................................................... APPENDIX F 2 Insurance Brokerage Services RFP NO. SM-20 11 -08-HR SECTION C: LETTER OF INTEREST TO: CITY OF SOUTH MIAMI COUNSEL DATE: JULY 1,2011 RE: INSURANCE BROKERAGE SERVICES RFP NO. SM-2011-08-HR Dear Distinguished City Counsel Members, Thank you for offering Sapoznik Insurance the opportunity to participate in your 2011 Insurance Brokerage Services RFP reply process. Enclosed, along with our response, please find a variety of informative highlights about our agency. We have prepared the following information to help illustrate our understanding of the City of South Miami's requirements and employee benefits needs as well as our knowledge of our local marketplace. We will describe the processes, analytical tools and benchmarks used to evaluate carriers, plan designs, contribution alternatives and potential costs to the City. As the Agent of Record of the City of South Miami, our agency will be committed to providing unparalleled benefits, services, and administration for the City, while also providing added benefits to all City employees. Sections within our response will outline the size of our Agency, our experience and related history as well as our ability to manage a 3-5 year benefits planning horizon and serve as an extension to your Human Resources Department. We look forward to a establishing a strong long-term working relationship with the City of South Miami to deliver proven Sapoznik Employee Benefit Solutions. Thank you once again, Rachel Sapoznik President & CEO PHONE, 1.877.948.8887 EMAIL.rochels@sopoznik.com Gracy Weberman Vice President PHONE, 1.877.948.8887 EMAIL: gracyw@sapoznik.com Ada Waters Benefits Consultant PHONE, 1.877.948.8887 adaw@sapoznik.com Insurance Brokerage Services RFP NO. SM-20 11-08-HR 4 SECTION D: RESUMES of PROPOSERS RACHEL A. SAPOZNIK, PRESIDENT & CEO SAPOZNIK INSURANCE & ASSOCIATES, INC. Rachel Sapoznik is the founder, President and Chief Executive Officer of Sapoznik Insurance & Associates, Inc. Based in North Miami Beach, Florida, Sapoznik Insurance & Associates, Inc. is an Employee Benefits Solutions Agency that, to date, has generated over $125,000,000 in company revenues. Serving as South Florida's leading woman Healthcare Reform expert, Rachel Sapoznik has lent her experience navigating the waters of the healthcare system negotiating the best possible wellness plans for her agency's clients. She has championed the cause of personal : responsibility in health and wellness as the main struggle facing healthcare providers and insurers alike, and has advocated health maintenance as the key to transforming the healthcare system. A true visionary, Rachel has built the roadmap to navigate today's healthcare challenges and provide solutions for tomorrow. Despite being one of the youngest leading women business-owners in Florida, Rachel Sapoznik has surpassed the achievements of her competitors, having been awarded over 100 accolades and honors, speaking to her professional and philanthropic accomplishments alike. Rachel Sapoznik's contributions to the business landscape of South Florida have not gone unnoticed. Elected Business Leader Magazine's "Woman Extraordinaire" both in 2008 and 2010 and featured in countless editorials, Rachel has become the face of the changing climate of Healthcare. In 2009 alone, Rachel Sapoznik was elected the "Ultimate CEO of the Year" by the South Florida Business Journal, as well as being recognized as the President & CEO of one of the "Top 100 Minority Businesses" by the Chamber of Commerce. Additionally, Sapoznik Insurance & Associates, Inc. has been recognized by the South Florida Business Journal among the largest Insurance Agencies in South Florida, as well as the 10th largest Woman-owned Business in South Florida. Together with her team of over 55 employees, Rachel Sapoznik has generated more than $209,000,000 in gross Premium Revenue in 2009, and saved hundreds of clients millions of dollars by applying her business expertise to matching her clients with the benefit plans that are right for them. Recently, Rachel announced plans to revamp the way her agency facilitates wellness by sponsoring programs, fairs and initiatives to promote healthier living for clients and their employees. Under Rachel Sapoznik's visionary direction, Sapoznik Insurance & Associates has helped clients develop an atmosphere that promotes health and wellness and places an emphasis on personal responsibility for one's health. Surpassing practices of conventional insurance agencies to help clients get well before they get a chance to fall ill, is what distinguishes Sapoznik Insurance & Associates, Inc. from other agencies. Facilitating a paradigm shift from provider-responsible to patient-responsible wellness is Rachel Sapoznik's commitment to her clients, her community and her country. Rachel Sapoznik's commitment to providing health solutions to clients and educating the public about well ness is met by her commitment to service her community. One of the leading female philanthropists in South Florida, Rachel Sapoznik has donated both physically and financially to an extensive number of charitable causes, and has encouraged others to do the same. Rachel Sapoznik continues to be a patron of various charitable causes spanning across education, arts, and religion. Rachel's passion toward Jewish education is unparalleled. In addition to actively serving on the Board of Directors and Panels of the Michael-Ann Russell Jewish Community Council, and the Executive Board of Governors for Hillel Community Day School, Rachel has raised over $650,000 and established a scholarship fund benefitting public school students who wish to participate in The March of the Living -an international educational program bringing teens from around the world together to learn about and pay tribute to the millions lost during the Holocaust. In thirty years of dealing with leadership issues and education, Rachel Sapoznik has always emphasized the importance of innovative and flexible leadership that is adept at adjusting to changing times, technology and legislation. Her ability to take calculated risks and alter her industry while educating the public on the importance of health and wellness, qualifies Rachel Sapoznik as both a leader in the Healthcare industry and the global community. 6 Insurance Brokerage Services RFP NO. SM-20 11-08-HR GRACY WEBERMAN, EXECUTIVE VICE PRESIDENT SAPOZNIK INSURANCE & ASSOCIATES, INC. Gracy Weberman currently serves as the Executive Vice President of Sapoznik Insurance, a North Miami Beach based Insurance Agency specializing in brokerage and support services for group and individual employee benefit products. Having been with the company since its foundation in 1987, Gracy has applied her over 24 years in employee benefits management, including benefit performance measurement, strategic planning, and expert negotiations to overseeing all aspects of benefit implementation for a large cross section of diverse accounts. Gracy's expansive client base includes private companies, public companies, government, nonprofits, medical facilities and educational institutions. Along with a team of over 55 professional in-house staff, Gracy oversees the main aspects of providing unparalleled support for her accounts, including coordinating the active quoting, monitoring, implementation and renewal services across all benefit plans. Starting as an account manager with Sapoznik Insurance in 1987, Gracy has built an unparalleled understanding of best practices in benefits management which is reflected in her successful cost-controlling consultative approach towards all her clients and accounts. As one of the highest volume producers in the Florida Employee Benefits Industry, Gracy has transferred her expertise and negotiation capabilities towards creating services that are both affordable and accessible to all types of organizations, and which seek to maximize benefit structures for cost efficiency. A key aspect of Gracy's hands-on approach with clients includes opening up a year-round rapport with senior level staff to gauge satisfaction, monitor plans, and plan for renewals. Through engaging and interacting with clients, carriers, and third party administrators, Gracy has achieved a truly service- oriented approach to managing her client's accounts that translates to long-term cost stability. Along with Sapoznik Insurance, Gracy is also involved with several charitable and community causes including YMCA, YWCA, Nat Moore Foundation, The Greater Miami Jewish Federation, United Healthcare Children's Foundation, Hospice of Palm Beach County, Hebrew Homes Foundation and many other charitable groups. 7 Insurance Brokerage Services RFP NO. SM-20 11-08-HR ADA WATERS, BENEFITS CONSULTANT SAPOZNIK INSURANCE & ASSOCIATES, INC. Ada Waters brings 12 years of experience in the financial services industry to Sapoznik Insurance. A graduate of the University of Florida, she began her career with Prudential Insurance serving the needs of small to mid.-sized business owners in all aspects of financial planning. Having been previously Series 6, Series 7, Series 63 and Series 65 licensed allowed her to develop exceptional analytical skills. In addition, the foundation of a comprehensive planning approach is her baseline of any client interaction today. Her deliberate focus on first assessing each client's individual circumstances, and then working alongside them to provide an action plan tailored to their specific goals ensures that each one receives well-rounded and highly customized benefit solutions. Immediately prior to joining Sapoznik Insurance she was a highly technical wholesaler of insurance and annuity products with regional and national brokerage firms. Her tenacity and drive is what led her to take her sales team to the number one slot in the US at Crump Insurance Services after having been there for only three months. Today, having had experience at the carrier level as well as having been an advisor to other advisors she has a wealth of experience to draw upon when customizing employee benefit packages. She is well versed in all aspects of negotiating, implementing and overseeing the servicing aspects of clients with up to 1200 employees. Her motto is very simple and is one that she shares with anyone who becomes a part of the Sapoznik team, "my goal is to over-exceed your expectations 100% of the time". Although lofty, this mindset is what motivates her to deliver an uncompromising level of service to each and every single one of her clients. 8 Insurance Brokerage Services RFP NO. SM-20 11 -08-HR SECTION D: Q U ALI Fie A T ION S , AND E X PER' lEN C E PROPOSERS QUALIFICATION STATEMENT PROPOSER shall furnish the following information. Failure to comply with this requirement will render the Bid non-responsive and shall cause its rejection. Additional sheets shall be attached by the Proposer as required. PROPOSER'S Name and Principal Address: Sapoznik Insurance & Associates, Inc. 11 00 NE 16rd Street, North Miami Beach, FL 33162 CONTACT PERSON{S) Name and Title: Gracy Weberman, Vice President Ada Waters, Benefits Consultant PROPOSER'S Telephone and Fax Number: PHONE: 1.877.948.8887 FAX: 305. 949.1000 PROPOSER'S License Number: L056952 PROPOSER's Federal Identification Number: 65-0086146 (please see certificate of competency, state registration, and applicable licenses in entitled section "ADDITIONAL INFORMATION: LICENSES, page 67) Insurance Brokerage Services RFP NO. SM-2011-08-HR 10 QUALIFICATION RESPONSES 1. Number of years your organization has been in business, in this type of work: Sapoznik Insurance was founded in 1 987 by President & CEO Rachel Sapoznik, and is one of the largest independently owned benefit agencies in the state of Florida. In the past 24 years, Sapoznik Insurance has set the industry standard by concentrating exclusively in Employee Benefit Solutions and partnering with insurance carriers to offer a full range of benefit products, at the most competitive rates in the marketplace. Our full service agency is headquartered at our North Miami Beach offices and is centrally located within the heart of our South Florida community. Over the past 20 years Sapoznik Insurance has grown into a full- service agency, complete with customer service, quoting, claims and well ness departments staffed with 55 experienced insurance and human resources professionals. For over two decades we have built lasting relations~ips with a diverse cross-section of accounts ranging from global corporations to large municipal groups like the City of South Miami. Our experienced service-oriented agency has consistently set the industry standard in Employee Benefit Solutions, having ranked consistently as a Top 10 Agency and Product Producer across Florida. 2. Names and titles of aI/ officers, partners or individuals doing business under trade name: PRINCIPLE OFFICERS: Rachel Sapoznik, President & CEO Gracy Weberman, Vice President 3. Describe your experience and services related to health management. This would include health risk assessments, weI/ness, health coaching, disease management, etc. OUR APPROACH Sapoznik Insurance's philosophy of health management to deliver a comprehensive benefits package is based upon three basic principles and our overall approach; insurance, education and well ness. In addition to aggressively negotiating on our client's behalf for the most cost effective insurance solutions while providing an uncompromising level of service, just as importantly we also incorporate educational and well ness components into any interaction with our clients and their employees. 11 Insurance Brokerage Services RFP NO. SM-20 1 l-OB-HR There is no substitute for experience. For over two decades, Sapoznik Insurance has not only taken note of the changes and trends in the healthcare industry, but more significantly we have been innovative enough to evolve our role as an agency and meet the ever changing needs of our clients. To this end, Sapoznik Insurance has been implementing health and wellness initiatives for over twelve years because we know that there are two major variables that can be adjusted to reduce the overall costs of health insurance. The first and what we aim to avoid at all costs, is to increase the out of pocket expenses of employees throughout the year, such as increasing deductibles and or co-insurance. The second and most desirable variable is to decrease overall claims utilization. We understand the relationship between employees neglecting their personal health and a group's claims experience. Our goal is to create awareness through education alongside health and well ness initiatives to shift employee behavior towards healthier lifestyles. This will result in early detection of easily preventable health conditions well before an employee is in need of services and procedures when it is most dire -and most costly, thus avoiding "shock" claims altogether that ultimately lead to rate increases. ON-STAFF HEALTH & WELLNESS SUPPORT Prevention and education while striving towards a healthier population is a core part of our full- service comprehensive benefits philosopHy. We have a team of 3 in-house well ness specialists dedicated to supporting all the preventative health and well ness needs of our clients and their employees. Our specialists can be reached either by phone or email, and are available to conduct on-site focused disease management seminars, health fairs, lunch and learn sessions and preventative consultations. INITIATING A COMPREHENSIVE WELLNESS PROGRAM Sapoznik Insurance is committed to helping you implement workplace wellness initiatives that will not only reduce health care costs but also increase employee productivity and satisfaction. The wellness highlight for The City of South Miami employees will be the annual health fair that we will coordinate and host for you on your premises with a target date of April 2012. Coupled with a Health Risk Assessment platform, utilized to capture quantifiable data, this will bring to light specific health areas that can be addressed via disease mar)agement programs, educational campaigns and or incentive programs. Key findings may include for example a high concentration of obesity, hypertension and or diabetes. The annual health fair serves a dual purpose in that this may be the only time an employee may engage in preventative healthcare measures. The convenience of employees not having to take time off from work to do simple biometric screenings facilitates a way for them to know what medical conditions they may be at risk for. Secondly hosting the annual health fair six months after The City of South Miami's open enrollment period allows Sapoznik Insurance another structured opportunity to be in front of all employees to provide and reinforce educational elements for example proper plan utilization. The return on our educational and wellness efforts can be seen through lowered health insurance renewal premiums, reduced absenteeism, increased Presenteeism, less worker's comp, and increased employee morale. 12 Insurance Brokerage Services RFP NO. SM-20 1 1-08-HR WELLNESS PROGRAM IMPLEMENTATION We work will with your team to implement a comprehensive wellness program that can include education and incentives to encourage and motivate employees to participate in exercise, improve nutrition, seek preventative care and take a proactive approach to their health. As a Sapoznik Insurance client your employees and staff will have full access to our well ness professionals, and benefit from an ongoing rapport about employee health and reducing costs. As part of our value proposition, at no additional costs, Sapoznik Insurance will provide the annual health fair and all wellness communications. Delivery of campaign may be via payroll stuffers, posters, employee newsletters and educational flyers on health and well ness topics, designed to shift behaviors towards healthier lifestyles. Features of the Sapoznik Well ness program include: • Annual Health Fair • Lunch & Learn Sessions • Preventative Care Flyers • Monthly Wellness Newsletters • Internal Wellness Communications Materials DISEASE MANAGEMENT, MONITORING AND INCENTIVIZING WELLNESS Our agency recognizes the importance of motivating employees to participate in well ness, and incentives are built into our comprehensive well ness services. Upon conducting the internal health audit we will identify health behaviors across the employee population and then work together with you to calculate meaningful incentives to improve upon poor employee health. We currently utilize three strategies that have revolutionized the ways employees look at well ness. Each employer is unique, so our wellness efforts will be tailored to fit the specific needs of The City of South Miami. Below are some of the strategies we have implemented for our clients towards creating a healthier, happier workplace. 1. Deductible Strategy: we are able to work with your staff to set appropriate deductible levels and allow employees to lower their deductibles for participating in certain health awareness, well ness, fitness and nutritional activities. Each well ness activity will allow an employee to incrementally lower their deductible, while the deductible is reinsured by a third party to prevent loss. Though this measure can be extreme, it incentivizes employees to put 'skin in the game' to prevent out of pocket expense. 2. Premium Strategy: we work with employers to and create a strategy to credit employees through lower payroll deductions for participating in well ness activities. Employers can choose their rewards and incentivize employees with the simplicity of lower per-paycheck deductions. 3. Prizes, Gift Cards and Cash: we have created a turn-key program, our Ship-Shape Dollars Program, to deliver tangible rewards to further incentivize employees for participating in well ness activities. We will work with your staff to set attainable goals for which employees can earn Ship-Shape Dollars towards prizes, gift cards and cash and drive participation. 13 Insurance Brokerage Services RFP NO. SM-2011-0B-HR 4. Describe an example of a City for whom you have coordinated or provided these services. IMPROVING EMPLOYEE BENEFITS FOR OTHER MUNICIPALITIES Throughout our 24 years of experience in implementing cost-effective employee benefit solutions, Rachel Sapoznik with Sapoznik Insurance has successfully stabilized costs and implemented countless value-added benefits for a wide array of municipalities and government entities. Our understanding of every facet of the benefits process has enabled Sapoznik Insurance to provide coverage to all client municipal employees and their dependents, and administer all benefit activities and claims issues for these accounts. Among our many commitments to providing coverage for our municipal clients is our active annual negotiations of premium rates across all carriers and products, ensuring that your municipality receives the most competitive rate in the industry. Sapoznik Insurance has implemented full-service benefit plans across all lines of coverage for a variety of municipalities, successfully handling all their needs from negotiations and enrollments, to claims and well ness activities. We have successfully worked with municipalities to reduce costs, control claims, and implement wellness programs. In particular, we have improved programs for: • City of North Miami Beach • City of North Miami • City of Miami Springs • Town of Davie • Town of Golden Beach • Miami Shores Village 5. Have you ever failed to complete work awarded to you. If so, when, where, and why? In 24 years of providing top-tier benefits and unparalleled customer service, Sapoznik Insurance has never failed to complete work as set forth by a client. 6. How will you maintain confidentiality of the City's records and data (include in your discussion any security procedures for accessing, sending, and storing data that are currently in place)? OUR SECURE PLATFORM Sapoznik Insurance understands the need to communicate rapidly to secyre medical care is administered in a timely fashion, and ensure that employees are comfortable with their benefits. For this reason, we have implemented the most cutting edge technology brokerage platform in the industry, to give our clients an unparalleled level of service. Our platform is completely secure and complies with all HIPAA regulations to ensure that we can communicate back and forth with the City of South Miami while maintaining tight security and privacy for all employees and files. Below is an outline of the three mainframe programs we use to actively store data and communicate with clients all while maintaining confidentiality in accordance with privacy laws and regulations. ZYWAVE® Our mainframe system houses our entire technology platform, which includes a variety of software to manage benefits, record claims, house data, make renewal decisions and communicate benefits. All Sapoznik Insurance employees have access to this platform, which helps each employee cater to the diverse needs of your group. Zywave houses several of our other staple data management, analytic and communication platforms including: 14 Insurance Brokerage Services RFP NO. SM-2011-08-HR BROKERAGE BUILDER® This program manages account information, from contacts to employee names, and allows our service team to communicate with your Human Resources department and, when permitted, your employees. Through Brokerage Builder we can track customer service issues & claims, monitor resolution details, and manage billing and other support services. BROKERAGE BRIEFCASE®: This program contains the vast majority of our employee communications and research data, where we can create custom pieces for your employees, from announcements to benefit education, to health & wellness and legislative updates. Through Brokerage Builder we have access to thousands of communication media documents and tools, from newsletter, emails, flyers, posters and presentations to full service well ness & benefits campaigns. 7. Discuss your service approach and how you respond to City requests. Include what you consider non-urgent/routine requests and urgent requests. VIP Customer Service Model Sapoznik Insurance's VIP customer service will be made available directly to each and every City employee. Our customer service model is designed to ensure that every employee will receive the highest level of service whenever contacting our staff members at all levels of within our organization. Our team will gladly assist with all benefit related issues and will serve as the liaison between the City of South Miami, its employees and all respective carriers. To that end, we have adopted the following company policies that if selected as your agency would be applicable immediately to City employees: • Dedicated Account Managers assigned for benefit administration service requests. • Dedicated Claims Manager assigned for any claims adjudication/dispute requests. • Health and Wellness representative assigned for year-round campaigns and programs. • We do not have voicemail. All calls will be answered by a live member of our Account Management/Claims and or Health & Wellness teams. • It is a Sapoznik Insurance company policy that requests received via email must be acknowledged with 30 minutes of receipt. • Multi-lingual Staff: Spanish, French & Creole Our service resolution goal is to comply within 24 hours for any benefit administration requests considered non-urgent/routine. Examples of non-urgent/routine service requests may include but are not limited to the following: • Implementation and Eligibility • Employee Education & Communication • Enrollment Assistance • Uploading hire/new hire data on all carrier web sites • Proof of coverage request / Temporary ID cards requests • Verification of Enrollment Materials • Billing Resolution 15 Insurance Brokerage Services RFP NO. SM-20 11-08-HR We are also sensitive to the fact that when an employee reaches out to our office, more often than not it is during times when they are vulnerable and in need of medical care. During these critical moments, it is company policy that our staff responds to such circumstances with the utmost sense of urgency. Examples of service requests considered urgent, may include but are not limited to the following: • Any call while an employee is attempting to obtain medical care at a provider • Proof of coverage / Temporary ID cards request • Verification of coverage requests • Prescription medication verification requests • Claims adjudication requests that have reached debt collection status • Billing requests for impending termination of coverage In light of current economic conditions, organizations are having to endure even more budget limitations and are left with no other choice but to exercise further constraint. Direct advocacy by our team on behalf of employees results in: • Rapid Billing and claims resolution • Reduced burden on HR/personnel department resources • Reduction of 'on-the-clock' involvement • Greater employee productivity • Reduction of absenteeism 8. How do you measure client satisfaction? QUALITY CONTROL EXPERIENCE Our form of monitoring client satisfaction is simple yet immensely powerful -it involves our constant communication with our clients. Real-time interaction between our support staff and our clients takes place on a daily basis, giving us immediate feedback. Feedback is channeled through Managers and allows for decisive action and improvement when necessary. We are also able to offer employee surveys to gauge satisfaction with, and utilization of, your benefit plans. We are quickly able to measure those areas that may need to be addressed as well as partner with your employees to facilitate their benefits experience. At Sapoznik, we understand the value of recruiting and retaining employees who represent the greatest contribution to the City of South Miami. Through our technology platform we are able to monitor the quality of our services, the timeliness of our responses, and track the resolution record of claims. 9. Confirm that you serve as a consultant or broker, independently, and are not affiliated with any insurance company, third party administrative agency or provider network. Sapoznik Insurance is an independently licensed Employee Benefits Agency under the State of Florida with no affiliations with other insurance companies or brokers, outside of the confines of normal broker/insurance provider relationships. Insurance Brokerage Services RFP NO. SM-20 11-08-HR 16 10. Describe your experience in provider network development, recruitment and negotiation, and maintenance. CONTINUOUS EXAMINATION OF POLICIES, AMENDMENTS & CONTRACTS Securing the best insurance package for your business begins with planning. Analyzing all your risks is critical to successful implementation of your employer group benefits. Sapoznik Insurance will partner with you by providing ongoing assistance, consultation and service that will help you control your insurance expenses, choose the best plan to fit your company's needs and review any policy amendments, service agreements or contracts. You face many employee benefit challenges, including internal resources, time management, employee education, compliance with federal and state legislation, trend increases, pharmacy costs and increased litigation activity. This demanding environment dictates a change in the way you purchase and manage your insurance programs. In order to compete in your marketplace you must adopt a total cost of employee benefits management philosophy based on data-driven decisions and globally positioned communications. We specialize in evaluating, negotiating with, and recommending insurers and providers to our clients, and we employ rigorous selection criteria and performance objectives when considering a vendor. RENEWAL PROCESS & TIMELINES We understand the need to partner with our clients and be sensitive to deadlines and budgetary constraints. Our dedicated service spans throughout the year, and we continually work behind the scenes to make sure that the administration and negotiation of your benefits is a fluid process. For this reason, Sapoznik begins the renewal process no later than six months in advance to your group's renewal, allowing us to partner with you to accommodate the benefits you need within your budget. Six months prior to renewal, the process begins with discussing relevant data, strategies and objectives to be met for the upcoming year. It is at this point that the active quoting process starts with interviewing of viable carriers followed by creation of a formal RFP, including: Gathering of all relevant raw data (Census, Claims, Medical loss Ratio, Backup Data, etc.) that is processed into a custom electronic format appropriate for each respective carrier's specifications. For suggested renewal timeline please refer to Appendix A. QUOTING & NEGOTIATING Our In-House Quoting Department then processes this data, formatting it to the specific requirements of each carrier on each line of coverage. For the next several weeks we work diligently with respective carriers and underwriters in order to secure the best possible initial bids. We capitalize on the strength of our relationships with each carrier to allow us to deeply negotiate plans until we reach the absolute best final rates and deliver them to you. With our experience and flexibility, we can customize our products and services to help deliver the right benefit solutions today, and as your employees' needs evolve, over time. Once bids are received from all carriers, another in-depth analysis is performed to identify strengths and deficiencies with each submitted proposal. We once again work with each carrier and underwriter to further negotiate each offering until we reach the "best and final" proposal. Insurance Brokerage Services RFP NO. SM-20 11 -08-HR 17 COMPLETE RENEWAL PACKAGE At this stage, preparation of a detailed comprehensive analysis begins. Carrier submissions are formatted and structured into a custom presentation allowing for side-by-side comparisons of benefits and costs. This process is repeated for each separate line of coverage. This permits us to meet with the City of South Miami staff to review all proposals in an easy to interpret format so that staff may make a well-informed decision of which carriers and plans best meet the current and upcoming objectives set forth by the City. RENEWAL MEETING We request a renewal meeting upon securing a thorough line of benefit options and alternate proposals to present to you several months in advance to your renewal. We will work with the City of South Miami to select the most fitting level of coverage within your budget. We are then available as needed for additional meetings with Staff that may also include focus-group meetings with cross-sections of City Personnel and City Council (if needed) prior to making an Official Recommendation. At this point, plan recommendations are formally presented before the City of South Miami for approval. Sapoznik Insurance conducts a follow up meeting prior to the renewal date to communicate benefit choices to the employer, and discuss implementation at renewal. WORKING WITHIN A BUDGET Sapoznik Insurance is the expert at developing plan strategies that identify the most economical funding methods. Their process includes preliminary meetings prior to the renewal where evaluations are made as to plan offerings and benefits that fit within the range of your budget. We will consult with the City of South Miami as to the best funding methods by evaluating relevant factors including the number or plan participants, number of plans offered and contribution strategies. Our evaluation then permits us to effectively use payroll contribution models to drive participation and migrate plan members into economically sensible plan options. Additionally, we strive to provide choices for all plan members that are sensitive to their respective individual and family needs. IDENTIFYING OPPORTUNITIES TO SAVE: We review all employee claims and plan utilization to determine what factors are crucial towards selecting plan designs. This in turn, translates to savings for our clients, as our education platforms seek to drive employees towards more informed consumerism. REVIEWING PLANS FOR COMPLIANCE We work with your Human Resources personnel and the selected carriers to ensure that all plans are in compliance, and that the administration of employee benefits meets the guidelines set forth by the most current national and state legislation. 18 Insurance Brokerage Services RFP NO. SM-20 11-08-HR 11. Outline your ability to provide expertise and experience in the areas of health benefit plan analysis and design. BENEFITS ANALYSIS & RESEARCH Sapoznik Insurance has managed medical benefit programs for hundreds of employer groups in an effort to keep costs below comparable levels experienced by other employers. Our aggressive management technique includes a number of internal medical management and preventive health initiatives. As the health care industry continues to change, we have remained ahead of the game. With leading-edge technology, we obtain meaningful information that helps us evaluate cost drivers, trends and savings opportunities associated with our clients' employee benefits. In addition, we work to evaluate the impact of future plan changes. We provide employer groups with tools that will offer consistent year-to-year data, reporting formats and comparative benchmarks. This highly meaningful -yet understandable -information enables us to work together with your data in a continuous, interactive manner as plan management issues arise. 12. Explain in detail the types of analyses you have conducted relative to benefits analysis. and design for a health plan with at least 100 employees. MANAGING COSTS THROUGH ANAL YTICS & RESEARCH You face soaring health care and prescription drug costs, but lack the data you need to make money-saving decisions. Sapoznik Insurance has an internal web-based decision making & reporting system, Decision Master Warehouse (DMW), that allows you to assess your group medical and Rx plans with an easy-to-use management report. Through this system we can offer you clear recommendations to combat problems with utilization and plan costs based on analysis of your carrier data. You'll have the solid, high-quality information you need to formulate plan design decisions. For a sampling of DMW capabilities, please refer to appendix A: Technology. REPORTING FINDINGS Our reporting capabilities allow us to provide you with important data on which to base your vendor selections and coverage choices. We can provide results to you in a variety of formats, and seek to meet with your personnel monthly to monitor plan performance, and continuously evaluate your employee benefits strategy. CONDUCTING SURVEYS & STUDIES Through our HRConnection portal on our exclusive technology platform, Sapoznik Insurance is able to conduct surveys across your employees, and compare data across a variety of other data sets. We often conduct employee surveys to help employers custom-tailor their benefits to their employees needs, increasing satisfaction and productivity. BENCHMARKING OTHER EMPLOYERS & INDUSTRIES An area where we continuously excel is our strategy towards understanding, negotiating and implementing benefits. One of the most important components of this strategy is staying abreast of national trends in medical and benefits sectors, and reporting this information back to you, to make informed decisions. Our benchmarking capabilities 19 Insurance Brokerage Services RFP NO. SM-20 ll-OB-HR through our technological platform can evaluate a number of important questions you may have, including several forms of analyses that can be conducted throughout the year including: Billing Discrepancy Analysis -Comparing member statements against The City of South Miami's Plan to ensure accuracy of processing by insurance carrier Diagnosis and Procedure Coding Analysis -Performed upon receipt of claim to validate correct provider/physician billing Employer Contribution / Payroll Analysis -Comparison is made between the City of South Miami and similar organizations within the same industry. • Contribution Levels • Medical Costs • Cost-Sharing • Benefits Costs • Annual Deductibles • Cost-saving strategies • Plan Coinsurance • Employer Offering Trends • Plan Max-out-of-pocket • Health & well ness initiatives 13. Provide examples of communication materials developed and prepared by your organization for use in City's health benefit communication campaigns. COMMUNICA liON CAPABILITIES Understanding the complexity of employee benefits plans is a challenge even for experienced benefits managers. Employers need to keep abreast of constantly changing trends, laws and other regulations. Employees need to be able to understand their benefits well in order to be wise consumers and understand the value of their "hidden paycheck." Unfortunately, most employers have limited resources in this area. The Sapoznik Insurance team helps you tackle your employee communication challenges. With strategic planning and a thorough understanding of your communication objectives, we provide custom communication materials in both paper and electronic format that will help both you and your employees understand your plans and the issues influencing your benefits decisions. Below are the types of custom communications we offer -with a few samples included. Please refer to appendix B: COMMUNICATION CAPABILITIES for a comprehensive overview of our communication pieces and strategy SUMMARY PLAN DESCRIPTION (KITS & BENEFIT HIGHLIGHTS) Many employees don't take full advantage of their benefits because they don't understand them, . and communicating the increased complexity of employee benefits is a challenge. We seek to educate employees about your benefits and how to best use their plan with a range of materials from Sapoznik Insurance. Plus, our communications can help employees understand how various laws impact them and their families, such as health care reform, COBRA and FMLA. As a leader in program implementation and communication, Sapoznik customizes enrollment kits for each of our clients, with crucial printed information for each employee to take home about their benefits, 20 Insurance Brokerage Services RFP NO. SM-20 1 1-08-HR eligible providers, discount pharmacy programs, facility use & pricing, as well as contact information so each employee can contact our customer service call center without having to burden their Human Resource personnel. This direct communication empowers employees to not only obtain the best possible coverage, but ensures that these employees know how to use their insurance program. Open Enrollment Poster and Employee Benefit Highlight booklets can be used to inform emolovees at Enrollment and throuahout the Dian vear. benefit details in one, easy-to-read publication. Sapoznik Insurance communicates with employees on a regular basis throughout the year. Our call center is open every weekday without voicemail to ensure that your call gets directed to the right representative, and your questions get answered. Sapoznik Insurance's communication progral1}s will take the stress out of communicating with employees, and seek to reach each and every employee at all your locations. NEWSLETTER, MEDIA & FLYERS To aid in the communication of new programs, changes to existing programs, enrollments and benefit changes, Sapoznik's full service marketing and client services teams create customizable enrollment posters for our clients at no charge. We also create any flyers, payroll stuffers, email contact and any other form of communication you request, to make the benefits process seamless and effortless to your -.-------. ---~------:~~ human resources department and to your employees. As your full service partner in employee benefits, we see ourselves as your Insurance Brokerage Services RFP NO. ....... ---I ... ::.."i:j., ~ .. --~ "----! =:=..i:i::::':;:;T:~::,~j I "'H L ........ -' ......... , . ., .... ~ .... ,..~ .. , .... ~u''-''-''-' ... ''"aL •• " ...... ~~~_'-'''q~ :!'..!:~:::.7;.~~;~r;.:u..f'~'!"' ~;.~~::s.;:~::'..~'""!!',:. ........ ~.,...,.,.-...~...,., ... ,....,... .. '"."..., .... ...-..... __ ..................... -''''''''-'-41<-4 .. ... ''''~.., ...... ...., •• _ .. ".,.~ ........... ..-.i~. ·.~~'" .. n" .. t .. ,o--• .,...., ... ." ..... _·,.,,..,..,. --_._._- ............. _ ....... ~ ... ~.' ....... a ..... , ;;:,;;,:;:.;.';;;,-; .• .w;.-:.-;.:;.;;"'-'~." _W ..... ~.~_ .. ~_·~ .. " ........ _._.K. "'*""" .... ""'H" .... "'-~ .. _ ....... "..-.. ~'fi.~'6*E.!!~~~£!~;-·~· ?::=~";~~':~:£,~ . .:::~~ ..... ~ .. ~"~~.~~ . .':~!=~':::~~;-::- advocate, both in the insurance market, and to your dedicated employees. We believe that educated employees are empowered employees. In addition, their awareness of their health status leads to informed consumerism, and a healthier workforce. We welcome all of your communication needs, and seek to open a rapport with your employees, not just at open enrollment, but also throughout the duration of the year. WELLNESS COMMUNICATIONS Sapoznik Insurance is committed to helping you implement workplace wellness initiatives that will reduce health care costs and increase employee productivity and satisfaction. We can build and customize a well ness campaign specific to your company and employee needs. Through our online services, we can provide payroll stuffers, posters, employee newsletters and educational flyers on health and well ness, designed to help you drive consumerism in your workplace. For Sample Communications, Including Newsletters, Wellness Updates, and other media and print information, please refer to the Appendix. Other Communication tools include: Employee Benefit Communications Benefit communications include memos, flyers, payroll stuffers, posters and articles used to announce benefit changes, introduce new benefits or plans, or to help employees understand and use certain benefits. Benefit Statements We provide benefit statement items such as total compensation statement packets and a summary of an employee's benefits package, including salary and benefits. Consumer-Direded Health Care (CDHC) We supply everything you need, including letters, flyers, articles, payroll stuffers, posters and e- mails to help support your CDHC campaigns. Health Care Reform Everything from employee-facing articles to payroll stuffers to Legislative Briefs, our health care reform content keeps employers and employees in the know on this hot topic. Employer Education Articles and NewsleHers You'll have access to educational articles covering many benefit topics. This also includes a quarterly Benefits Bulletin newsletter about the newest legislation issues and benefits trends, along with a monthly one-page newsletter covering highlights of current HR and benefit news. Employee Handbook & Policies Access a full employee handbook, as well individual policies, that you can provide to your employees to communicate company policies or procedures. Health Awareness NewsleHer This monthly, customized, two-page newsletter for your employees covers various health and wellness topics. Know Your Employee Benelits Insurance Brokerage Services RFP NO. SM-20 11-0B-HR 22 Provide your employees with insight and information about insurance and employee benefits topics with this series. These brochures help your employees better understand their benefits, and can serve as a foundation for your ongoing employee communication campaigns. Live Well, Worlc Well This series of flyers centers on health and wellness issues, educating employees on how to live healthy and productive lives. National Health Observances Calendar The NHO Calendar allows you to educate and inform your employees on well ness issues throughout the year by supplying you with national health observances and listings of materials that complement those observances. Prevention Newsletter This quarterly newsletter focuses on topics such as obesity, exercise, drug and alcohol prevention, the flu and much more. 14. Are there any existing service provider relationships that may prevent you from acting independently and providing objective advice or guidance? (Examples, overrides, commission agreements, preferred contracts, pricing based on volume, etc.) SELECTING A PROVIDER Sapoznik Insurance is completely unbiased towards the selection of any carrier, and partners with senior level and Human Reso~rces personnel, allowing the City of South Miami to select your Health Insurance from a range of proposals. We determine vendor and benefit plan selection after an extensive evaluation is performed where we address plan structure as it relates to employer and employee costs. Thanks to our aggressive renewal process and quoting process with carriers, we may present the option to switch insurance carriers towards plans with stronger benefit structures, lower costs or both. In the event of a change in insurance carrier, Sapoznik provides stable platform for seamless transition guided by our dedicated staff. Their proven approach embodies a strong explanation of benefits while educating all members on efficient plan utilization. Sapoznik Insurance is a fully independent Florida private insurance corporation with no financial interest in the companies through which our services are provided. Sapoznik has concentrated its experience in employee benefits and has no single client or account contributing more than the standard commission from any Health Insurance carrier. Concentration risk is further mitigated by diversity with respect to market sector. Sapoznik's objectivity towards the Health Insurance Carrier selection process ensures that the client receives the best benefits at the lowest price without any bias. OBJECTIVITY Sapoznik Insurance's relationships with carriers will not lessen our objectivity or independence on any decision and represent absolutely no conflict of interests. Our preferred carrier relationships have reached the status of Preferred Broker level with the top carriers in the industry. This gives us the ability to negotiate rates and pass the savings on to you. Sapoznik 23 Insurance Brokerage Services RFP NO. SM-20 11-08-HR Insurance is associated with each of the following providers and enjoys a sterling reputation with each respective insurance carrier. 15. List any subcontractors who will provide services under this Contract and the services they will provide. The foregoing list of subcontractor(s) may not be amended after award of the contract without the prior wriHen approval of the Contract Administrator, to be designated by the City Manager, and whose approval shall not be unreasonably withheld. Currently Sapoznik does not employ or engage the services of any subcontractorJi. All staff, administrators and other personnel are all direct employees of Sapoznik Insurance & Associates, Inc. 16. List and describe all bankruptcy petitions (voluntary or involuntary) which have been filed by or against the Proposer, its parent or subsidiaries or predecessor organizations during the past five (5) years. Include in the description the disposition of each such petition Sapoznik Insurance has never had any bankruptcy petitions filed against the company or principle employees in the entire 24 year history of the firm. 17. Provide specific examples of a significant savings in the cost of benefits to the client that can be directly aHributed to your past services. Below is a summary of one of our many successes in full-service benefits for City of North Miami. As the City of North Miami's incumbent agent for the past 7 years, our depth and understanding of the Municipality and its employees needs are unparralled. We have placed special focus on working alongside the City lending our direct support and attention. What has truly set us apart is the way Sapoznik Insurance has been able to negotiate renewals and plan designs. Prior to Sapoznik Insurance becoming involved, the City of North Miami had no claims experience reports and no tracking ability -resulting in year-after-year double digit rate increases from the City's previous health care provider, AvMed. The refusal of the carrier to provide the claims experience left the City with no way of targeting critical issues. City staff's 2001 RFQ resulted in declinations from all carrriers leaving the City with no other option but to accept AvMed's elevated renewal rates and unfavorable terms. Sapoznik Insurance successfully restructured City of North Miami's entire benefit program by implementing in-depth claims analysis, robust well ness programs in cooperation with City Staff, access to one-on-one customer service for employees both active and retired greatly enhancing: • Quality of the benefits • Strength of the carrier • National network to keep City in compliance with commitment to retirees • Customized, online, on-demand reporting capabilities As a direct result, City Staff and Sapoznik Insurance were able to properly identify and track critical issues related to the well ness of the employee population. Our agency was able to develop and implement a proactive health and wellness campaign. The success of these programs is now evident. The City's negotiated renewals are below the National average with the last 3 year's negotiated renewals. 24 Insurance Brokerage Services RFP NO. SM-20 11-08-HR 18. List any companies your are aHiliated with or have contractual arrangement with including insurance companies, third party administrators (claims or other administrative/record keeping services), provider networks, HR or benefits software vendors, etc. Health Carrier Representation: Aetna / UnitedHealthcare / AvMed / BlueCross BlueShield of Florida / Cigna / Humana / Neighborhood Health Partnership / Vista -Coventry Dental Carrier Representation: Aetna Dental / Humana (Compbenefits) / Assurant / BlueCross BlueShield Dental / Cigna Dental / UnitedHealthcare / Delta Dental/Guardian Dental/Met Life (SafeGuard) / Solstice Life & Disability Carrier Representation: Lincoln Financial Group / Assurant / Guardian / Hartford / Met Life / Mutual of Omaha / Principal/Reliance / Standard / Unum / Sunlife Vision Carrier Representation: Assurant / Cigna / CompBenefits /Guardian / Met Life / Spectera / VSP Supplemental AFLAC / Colonial / UNUM/ Allstate/ Coventry HR SOFTWARE ZYWAVE/ MYWAVE/ BROKERAGE BUILDER/ BROKER BRIEFCASE CARRIER STATUS Our strategic partnerships and relationships with outside service providers include our elite status among the top insurance carriers: • Blue Cross Blue Shield -Blue Diamond Producer • United Healthcare-Platinum Level Producer • Aetna-Key Producer • Lincoln Financial Group-Top Producer Level Only the top percent of producers achieve these exclusive status levels by way of volume written. Our relationship with Insurance companies allows Sapoznik Insurance to negotiate the best rates for our clients. Sapoznik maintains no personal interest in anyone carrier, and focuses choices and partnerships based on cost and fit for a particular client. Insurance Brokerage Services RFP NO. SM-2011-08-HR 25 '" KAISER PERMANENTE. XAetna:- R elGNA BIOeCross Blu!tSl'lleld: Blue Diam~nd proC!(jc~t United HeC!Hhcare: PlatlrwmPtQdQt.~r l:Iumana: leader's ClrcJ~ TqpprodliFer' ~~tri~: ... !<ey Produc;er NelgllborhoodH!,altl1 Partnersl1IP.: Preferred producE)r' . '. . J;iI Neighborhood Health 1!.l Pal'tnership HUMANA, (7Ili,/ultn' ,.'U~ }VII Tln'li it nw,' -.1-1 (Co C 0 V E N TRY r Hnalth and life InluratrtlJ 19. Describe your firm's ability to assist with Benefits Administration issues. IMPLEMENTATION OF EMPLOYEE BENEFITS (OPEN ENROLLMENT) Open enrollment is an overwhelming time for HR departments and employees alike. Our educational materials, tools and communications can help streamline and simplify the process for your company and employees. We have created a system that relieves much of the pressures a Personnel Department would have to manage during the months and weeks prior to the enrollment period, as well as throughout the year. Sapoznik Insurance's team offers extensive open enrollment and year-round support for new hires by: • Assembling all enrollment materials • Incurring costs related to design, printing and shipping of materials • Creation of applications and payroll deduction forms • Coordinating logistics involving delivery of your "enrollment kits" • Onsite Sapoznik Insurance Licensed Agents and Enrollers coordinating and conducting the enrollments • Customized PowerPoint Presentations • Outbound Media (flyers, posters, payroll stuffers) 26 Insurance Brokerage Services RFP NO. SM-20 1 1-08-HR For the weeks prior to Open Enrollment, our in-house Marketing and Communications Department creates and designs announcements, payroll stuffers and posters to help inform your employees of the upcoming enrollment period to help stimulate participation. At this point, our team of multi-lingual (Spanish, Creole & French) enrollment specialists will conduct an on-site session to educate, answer questions and assist your employees to complete their enrollment materials. Sapoznik Insurance will then gather the materials and systematically check for accuracy and ensure a proper transfer of data back to you and your selected carriers and providers. The Open Enrollment Meetings begin with podium presentation explaining Sapoznik's role and relationship in the entire benefits process. We make sure every employee receives a licensed agent's business card and reinforce not only their personal availability, but that of the entire Sapoznik Agency, to each and every City of South Miami employee directly, every day of the year to assist with any matters that may arise. Open enrollments are conducted by a licensed insurance agent with carrier representatives to educate employees about their selected Benefit Plans among all lines of coverage, as well as all agency services. As an added benefit, Sapoznik also hosts on-site new hire enrollments throughout the year to communicate employer benefit plans to new employees. CLAIMS RESOLUTION EXPERIENCE The handling of health care claim issues has become a highly specialized process where Sapoznik Insurance is known to routinely excel. Due to the broad spectrum of benefit claims situations, the need for highly specialized in-house experts is clear. Specialists that possess the capabilities and commitment to investigate, mitigate and resolve claims is a critical requirement to meet the ever-growing demands of the City of South Miami's employees. To ensure timely, responsive claims processing, our full service in-house Claims Team of seasoned professionals has been assembled to provide expert claims service and administration to ensure maximum benefit to all City plan members. Claims Support Areas include but are not limited to: • Investigation • Consultation • Adjudication • Mitigation This claims review goes hand in hand with areas such as Health and Well ness that provide a platform for helping reduce preventable medical claims. Claims support is a vital part of cost containment, plan stabilization and employee productivity. Sapoznik Insurance provides unlimited access to our in-house claims specialist department where elevated issues with claims will be directed. 27 Insurance Brokerage Services RFP NO. SM-20 1 1 -OB-HR The core responsibilities of our Claims employees include: • Ability to communicate effectively with our customers and providers • Ability to problem solve and make effective decisions • Demonstrated negotiation skills and ability to persuade carriers and Health care providers to adhere to contractual obligations • Ability to investigate details and conduct research on facts • Ability to maintain business relationships The Claims Department is directly accountable for achieving outstanding claim service performance in customer satisfaction and loyalty. Our full-service claims advocacy team sets the industry standard, with an over 90% success rate of claims resolution. Sapoznik Insurance continues to develop, test and implement claim processes, and continues to define best practices that address industry-related challenges and customer preference. As a result of creating best practices, we have created a first-class, results oriented claims organization. ENROLLMENT SUPPORT Sapoznik Insurance is well recognized for the superior Open Enrollment strategy it has developed and implemented over the past 24 years. We have created a system that relieves much of the pressures a Personnel Department would have to manage during the months and weeks prior to the enrollment period. Sapoznik Insurance's team offers extensive open enrollment and year- round support for new hires by: • Assembling all enrollment materials • All outbound media (emails, flyers, payroll stuffers, etc.) • Incurring costs related to design, printing and shipping of materials • Creation of applications and payroll deduction forms • Coordinating logistics involving delivery of your "enrollment kits" • On site Sapoznik Insurance Licensed Agents and Enrollers coordinating and conducting the enrollments • Customized PowerPoint enrollment presentations • Much more WEB BASED ENROLLMENT SERVICES Sapoznik Insurance will work with you to provide reliable, efficient enrollments to meet your business needs. We are able to provide the City of South Miami a variety of web-based enrollment systems to facilitate the implementation of the City's benefits among all lines of coverage. Our web-enrollment services are seamless to both the employee and employer, and feature added benefits listed below: • On-line & Off-line Enrollment Technology • Agent Assisted One-on-One Enrollment • Co-browsing & Self Enrollment Option • Supports Core Products • Streamline enrollment process 28 Insurance Brokerage Services RFP NO. SM-20 1 1-08-HR • Salary Illustration • Benefits Statement • Enrollment Eledion Form • Document Center • Centralized Database • Reporting During & After Enrollment • Export Data & Customize Reports IN HOUSE CUSTOMER SERVICE & ADMINISTRATION TEAMS • Customer Service o Sapoznik Insurance's VIP customer service is made available directly to each and every employee of the City of South Miami o Some of the main elements of VIP Service are easily accessed through: • Toll Free Line: -Direct access to Liv ~ • Multi-Lingual Staff: Spanish, French __ . ~~.~ • Year-Round access: availability of entire team of Insurance Experts • Website and online access to our in-house team of specialists plus access to archived newsletters, spotlight articles and other resources • Claims Adjudicators o The handling of health care claim issues has become a highly specialized process where Sapoznik Insurance routinely sets the industry standard. Due to the broad spectrum of benefit claims situations, the need for highly specialized in-house experts is clear. Specialists that possess the capabilities and commitment to investigate, mitigate and resolve claims is a critical requirement to meet the ever-growing demands of the City of South Miami's employees. To ensure timely, responsive claims processing, our claims team of seasoned professionals has the expertise to provide the right solutions and the authority to implement them. o Core Responsibilities • Fully staffed in-house team of dedicated claims adjucators • Unlimited call-in access for claims issues • Over 90% success rate of claims resolution • Cutting-edge claims tracking and progress software portal • Marketing & Communications Department o Throughout the year, our in-house Marketing and Communications Department creates and designs announcements, payroll stuffers and posters to help inform your employees of the upcoming enrollment period to help stimulate participation. o Unlimited access to marketing & communication specialists o Creation of customizable internal communications materials • Enrollment Posters, Presentations, and Highlight Books • Wellness Materials: Handouts, Payroll Stuffers, Emails • Education Materials: Flyers, Programming, Seminars Insurance Brokerage Services RFP NO. SM-20 1 1 -08-HR 29 • Research & Compliance Department o Our firm expanded to include a Research sector to stay abreast of any and all legislative changes not only to Health Care Reform, but also to the benefits landscape. Since laws surrounding benefits are diverse and complex, operating on both state and federal platforms, our team dissects all legislation for our clients in-state and nation- wide. o In addition, we also provide legislative updates and model notice reporting for provide benefit notices regarding useful information surrounding the new bills. Sapoznik understands the complex and ever-changing legislation surrounding employee benefits, and we are dedicated to keeping our clients in compliance with the mandates as they evolve. • Health & Wellness Coordination Implementation o Sapoznik Insurance is the industry leader in wellness promotion, positioning health promotion as a core staple of our comprehensive employee benefits approach o Our full service well ness team is dedicated to providing the City of South Miami with full wellness services including (but not limited to): • Annual Health Fairs • Lunch & Learn Sessions • Preventative Care Flyers and Posters • Monthly Wellness Newsletters • Internal Well ness Communication Materials o Our well ness promotion efforts have a significant impact on medical claims, and facilitate individual awareness of health status. o Health Promotion also leads to higher employee productivity, reduced absenteeism, and less costly medical claims. • Employee Education One of the most important benefits Sapoznik Insurance can provide to the City of South Miami is employee education and informed consumerism programs which start at Open Enrollment and extend throughout the year. Our Agency creates a platform for consumerism, moving people toward healthier lifestyles and better management of chronic conditions through education. We understand the relationship between employee plan use and premium increases, so we educate our groups to become smarter consumers of health services whenever possible. Our three-pronged education platform includes cost-saving strategies that aid employees to pay less out of pocket, and help affect your bottom line. This strategy includes: • Urgency v. Emergency: When to use an Urgent Care Center and When to Use the Emergency Room • Freestanding vs. Hospital Diagnostics: The importance of using a free-standing facility for Diagnostic testing and applicable savings • Rx Savings: Information & Handouts about promotional prescription drug savings 30 Insurance Brokerage Services RFP NO. SM-2011-08-HR 20. What distinguishes your firm from other consulting firms and why should the City select your firm for consulting needs? INDUSTRY LEADERSHIP Sapo%nik Insurance is the largest group benefits agency in the State of Florida that concentrates exclusively on employee benefits. While our competitors have diversified their enterprises to include areas of insurance such as marine and property insurance, Sapoznik Insurance has fortified its position in the marketplace by building a greater depth of employee benefits services and concentrating on creating a truly solutions-oriented service experience. Your Municipality will benefit from our expertise and level of experience in the industry, our firm size, and our dedicated and specialized staff and services. Unlike most agencies that span across a range of Insurance products and frequently focus on prope~ty & casualty insurance, Sapoznik Insurance is dedicated solely to being the leading provider of Employee Benefit Solutions. We currently offer all lines of employee benefit coverage: • Health • Dental • Vision • Life • Disability (STD & LTD) • Long Term Care • Gap Plans • Voluntary Benefits • 401k • Prepaid Legal We are one of the industry leaders in producing group benefits. We currently sit on the Board of BlueCross BlueShield for top producers, among other coveted carrier positions. Out top producer status allows Sapoznik Insurance to pass on the advantages to your group. Our philosophy of providing a comprehensive benefit process, from quoting and renewal meetings, to active implementation at open enrollment, distinguishes Sapoznik Insurance from other agencies. This consultative approach maximizes reach, product utilization and health outcomes using our products and programs. The City of South Miami will benefit from notonly the range of products Sapoznik can offer, but also the fluid implementation and administration of these benefits. Our full service in-house teams are dedicated to servicing your account, answering questions, and advocating on behalf of your employees. 31 Insurance Brokerage Services RFP NO. SM-20 1 l-OB-HR -----------------,--_ .. _- Service Description 1------ Insurance Market We provide access to virtually all insurance and administration markets. Access National In addition to our own talented professionals and specialized value-added Affiliations services, we have a wealth of resources available to us through several national affiliations. We will develop a customized strategic plan for you that defines objectives Strategic Planning and outlines the actions needed to fulfill those objectives. Our services ensure an organized, complete approach to fulfilling your benefits needs. We pride ourselves on the level of knowledge and service we bring to our Five-Star Service clients. All of our clients are assigned a team of specialists dedicated to serving their needs. Each client accesses our team through a single point of contact, making working with us seamless and easy. Experience We have proven dedication and a commitment to excellence in our service to the business community. We use leading-edge technology to provide our customers with the latest Technology data analysis, as well as legislative, communication, and human resources administration tools. -----------~- Aduarial Services When needed, we employ the services of professional actuaries to assist with calculations critical to your employee benefits plans. Using employee claim data from your carrier or TPA, our Internet-based Data Analysis Decision Master®Warehouse system analyzes your data and shows how and where to adjust your plan design to save money. We can even model recommended changes to show you the potential savings. legislative Briefs Our exclusive Legislative Brief publication summarizes recent federal legislative developments in insurance and employee benefits. All of our clients receive access to a personalized Web site. The site is Client Portal devoted to helping you with plan administration, legislative compliance, employee communication and more! --------- Included with your client portal, our Legislative Guides provide Legislative Guides comprehensive information about federal legislation such as COBRA, HIPM, HIPM Privacy, ARRA, FMLA, Section 125 and Medicare Part D. C We can assist you with all phases of employee communication, from Estom.. employee meel;ng' 10 poymll ,">flen and ;nlo.mative bm,hu'e' about ommunlcatlon employee benefits and wellness. ----------------------------------------------- 32 Insurance Brokerage Services RFP NO. SM-20 11-08-HR ~ HRconnection® is available to you. This client intranet tool is a complete Human Resources employee communication system that helps you increase productivity, Tools streamline processes, improve communication and save money for your Human Resources department. Through arrangements with two leading pharmacy benefits managers, we Pharmacy Benefits Services have access to national pharmacy networks, significant discounts, pharmacy benefits modeling tools, and more. Voluntary Benefits We have experienced and highly knowledgeable consultants who can help you with this growing and important area of employee benefits. When partnering with us, you gain access to professionals from all over the country through the Community section of your client portal. An answer to a Community problem you have is just an e-mail away. As an example, one client writes, "We just recently implemented a premium-only cafeteria plan. Can anyone tell me how this will report on the W-2s?" This question was answered quickly, saving time and resources. At Sapoznik Insurance, we see a simplified way for you to approach the I benefits plan design process. With PlanAdvisor, we can help you analyze PlanAdvisor® your benefits plan costs against reliable benchmark information, project the impact of medical and dental plan design changes, estimate your renewal costs, and streamline the plan selection process for your employees. 21. What is the total number of employees that you have assigned, currently, to employees benefits counseling? THE SAPOZNIK TEAM Among our many points of differentiation is our commitment to service consistently delivering extraordinary care and innovative solutions to the City South Miami. The Agency includes over 55 professional staff members that, if selected as Agency of Record, would handle every service aspect for the City of South Miami and interact with your Human Resources Department year- round while ensuring the most personalized service in the marketplace. The agents and support team make up the foundation that draws together 24 years of consulting experience with proven professionalism. This has allowed us to develop the following range of resources to serve you: • Full Servce Quoting Department • Dedicated Customer Service Specia Ii sts Insurance Brokerage Services RFP NO. SM-20 11 -OB-HR • Complete Marketing & Communications • Enrollment & Data Entry 33 • Claims Adiudication Department • Full Information Technology Department SERVICE TEAM CONTACT INFORMATION Below is the contact information for the main service team that would be providing support to the City of South Miami. For full resumes of assigned personnel please refer to the Appendix. Rachel Sapoznik, President & CEO (p) 1.877.948.8887 extJ 107 (e) rachels@sapoznik.com i (f) 305.949.1099 : Christine Nunzio Senior Account Manager (p) 1.877.948.8887 ext. 131 (e) christinen@sapoznik.com (f) 305.949.1099 I Jackie Moskos, I Benefit Ana Iyst • (p) 1.877.948.8887 ext. 159 (e) jackiem@sapoznik.com . (f) 305.949.1099 , Leah Sabanosh, Claims Diredor (p) 1.877.948.8887 ext. 124 ! (e) leahs@sapoznik.com ! (f) 305.949.1099 Mario Junco, Marketing Diredor (p) 1.877.948.8887 ext. 130 (e) marioi@sapoznik.com (f) 305.949.1099 Gracy Weberman Vice President (p) 1.877.948.8887 ext. 102 (e) gracyw@sapoznik.com (f) 305.949.1099 . Robin Konikoff Benefits Administrator (p) 1.877.948.8887 ext. 144 (e) robink@sapoznik.com (f) 305.949.1099 Linda Jamen, Benefit Analyst (p) 1.877.948.8887 ext. 133 (e) lindaj@sapoznik.com (f) 305.949.1099 Gladys Ortega Claims Administrator (p) 1.877.948.8887 ext. 132 (e) gladyso@sapoznik.com (f) 305.949.1099 Carol Morrison Communications & Marketing p) 1.877.948.8887 ext. 143 (e) carolm @sapoznik.com (f) 305.949.1099 Insurance Brokerage Services RFP NO. SM-20 11 -08-HR · Ada Waters · Benefits Consultant (p) 1.877.948.8887 ext. 121 , (e) adaw@sapoznik.com I (f) 305.949.1099 Diane Shanahan · Benefits Administrator ~ (p) 1.877.948.8887 ext. 158 ; (e) dianes@sapoznik.com : (f) 305.949.1099 i -! : Laurie Haire, · Quoting Diredor • (p) 1.877.948.8887 ext. 113 (e) laurieh@sapoznik.com · (f) 305.949.1099 Brenda Centeno Wellness Programming • (p) 1.877.948.8887 ext. 116 • (e) brendac@sapoznik.com I (f) 305.949.1099 • Sarah Weintraub ! Research (p) 1.877.948.8887 ext. 143 i (e) sarahw@sapoznik.com (f) 305.949.1099 34 22. What is your corporate mission, vision and values, as well as your organization's philosophy towards providing benefits consulting services? VISION STATEMENT "WE STRIVE TO BE INNOVATIVE AND UNIQUE IN ALL OF THE SERVICES WE PROVIDE TO OUR CLIENTS. WE REALIZE AND CELEBRATE THAT OUR CLIENTS HAVE DIVERSE NEEDS, AND THAT THIS DIVERSITY REQUIRES FLEXIBLE AND INDIVIDUALLY DIRECTED EXPERT SUPPORT. OUR PRIORITY IS TO OFFER YOU A CUSTOMIZABLE PROGRAM THAT CAN BE TAILORED TO THE SPECIFIC NEEDS OF EACH OF YOUR EMPLOYEES, AS WELL AS THE GROUP AT LARGE." PHILOSOPHY Our Agency's service philosophy and overall approach is best exemplified by our drive to educate your organization's employees through cost-driven and service-related solutions. We believe that influencing employee behavior through education and building awareness of product use provides organizations like the City of South Miami an opportunity to turn their employees into more knowledgeable consumers. This philosophy can help stimulate better usage of benefits and is proven to contribute towards long-term savings. From implementation and eligibility to employee education, enrollment, technical assistance and adjudication of claims, at Sapoznik Insurance we focus on the fundamentals while solving issues that arise the first time. We aim to provide the most consistent service experience possible. Some of our services designed to fit the your needs include: Staff Level • Employee Communications • Full Enrollment Support • Billing Resolution • Claims Advocacy • Managerial Level • Benefits Consultation • Fiscal & Budgeting Guidance • Health & Wellness Campaigns • Peer Group Measurements Our service commitment consistently delivers extraordinary care and innovative solutions to our customers. At Sapoznik Insurance, we've developed a culture that's focused on creating long-term job satisfadion and growth opportunities for our service associates. Because of this, we're able to retain a quality workforce which, in turn, provides you with an extraordinary service experience. Sapoznik Insurance is a complete full-service agency of 50+ employees with a purposeful arrangement of in-house specialized departments to handle all aspects of your employee benefits. Rachel Sapoznik, Gracy Weberman, Ada Waters, and their Support Team make up the infrastructure that draws together years of consulting experience with proven professional know- how. This team approach would allow us to guide the City of South Miami year round and provide real solutions which range from day-to-day activities to more complex claims related matters. 35 Insurance Brokerage Services RFP NO. SM-20 11-0B-HR 23. Discuss your firm's quality assurance policies and procedures. How do you measure whether you are meeting these standards? What is the frequency of any such review? SURVEYING & FOCUS GROUPS We can provide our clients with a wide array of surveying and focus groups to determine satisfaction with employee benefits programs and capture data on which to make future recommendations for plan modification. We are prepared to conduct surveys that detail items such as range of coverage, cost of premium, co-pays, co-insurance, deductibles and plan design information, as well as taking recommendations. Our findings can then be presented to your staff, as we work together towards building the most comprehensive benefits strategy to meet the unique needs of all your employees. We can customize these surveys to reflect your logo and color scheme, as well as include any additional questions that you may wish to be answered by your employees. 24. Detail your ability to monitor regulatory and legislative developments at both the state and federal level and how this will benefit the City and be communicated to the City. COMPLIANCE SERVICES We regularly monitor legislative developments and are committed to keeping the City of South Miami in compliance with current laws and regulations surrounding employee benefits. Our agency currently audits all incoming and renewing groups for compliance and standards testing through our carriers. Groups are monitored to assure they meet the requirements under current US legislation and Employee Benefits Security Administration (EBSA), as outlined by the United States Department of Labor. We continuously review all our plans for compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA), The Employee Retirement Income Security Act (ERISA), The Mental Health Parity Act of 1996 (MHPA), Medicaid and Children's Health Insurance Program (CHIP), Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), and most recently, the Patient Protection and Affordable Care Act (PPACA) & The Health Care Affordability Reconciliation Bill (HR 4872). Our firm provides compliance services to our groups through the following measures • Monitoring compliance with employee benefit regulations • Facilitating the reporting and disclosure of relevant benefit information • Providing documents and model notices as required under federal law Our audit services extend past the traditional parameters to include compliance with not only benefit laws, but also the administration and implementation of your groups benefits. Sapoznik Compliance Audits measure the following aspects of benefits testing • Contribution requirements • Employee Eligibility • Non-Discrimination • Mental Health Parity • Waiting Periods • Pre-existing Conditions Limitations • Qualified Medical Expenses • Annual Contributions to Health Savings Accounts . Insurance Brokerage Services RFP NO. SM-20 11-0B-HR 36 • Annual & Lifetime Limits • COBRA Eligibility • Medicare & Medicaid Eligibility We pride ourselves on our ability to partner with health insurance providers to bring you unparalleled benefits administration that adheres to legislation as outlined by the United States Department of labor, the authority on workplace and labor law and enforcement The passage of the Health Care .Reform Act in 201 0 yielded an entirely new set of benefit laws, mandates, and implementation requirements that required special attention for compliance standards. Our firm expanded to include a Research sector to stay abreast of any and all legislative changes not only to Health Care Reform, but also to the benefits landscape. Since laws surrounding benefits are diverse and complex, operating on both state and federal platforms, our team dissects all legislation for our employees in-state and nation wide. We provide continuous legislative updates and model notice reporting for any and all benefit changes required by law. In addition, we also provide benefit notices about regarding useful information surrounding the new bills. COMMUNICATION METHODS We have found over the years the most effective method of relaying information to employees is through email communication. Any time we need to send out a model notice about a benefits change or mandate, we first email it to the Human Resources Supervisor for approval, and if requested, to their employee pool. For convenience we provide both plain text and PDF documents, as well as embedded email text for easy reading both at a computer and on a Smartphone. We attach printable versions (PDFs) to all legislative update emails for physical distribution. Sapoznik Insurance understands the complex and ever-changing legislation surrounding employee benefits, and we are dedicated to keeping our clients in compliance with the mandates as they evolve. COMPLIANCE COMMUNICATION TOOLS Our firm provides compliance services & communications to our groups through the following measures: Legislative Briefs Sapoznik Insurance is happy to provide our clients with exclusive Legislative Brief publications that summarize recent federal legislative developments in insurance and employee benefits. These informative documents are researched and written in an easy-to-read manner by experienced benefits attorneys. Model Notice Reporting We provide model notices to our clients and their employees as outlined by the IRS and other federal and state legislation. We can provide these model notices in both paper and email format. Insurance Brokerage Services RFP NO. SM-20 1 1 -08-HR 37 Outbound Media We communicate important legislation to our clients through a variety of outbound media methods, including (but not limited to): newsletters, posters, flyers, payroll stuffers, emails, model notices, and more Customized Presentations In the event that legislation should be passed that effects the benefit plans of our groups and their employees, we can conduct on site or virtual meetings to educate both HR staff and employees about any applicable plan changes or new updates and compliance measures. Client Portal All Sapoznik Insurance clients receive access to a personalized online Client Portal, which is designed to offer time-saving tools and resources that build convenience into managing your everyday work tasks. Community The Client Portal Community section lets Sapoznik Insurance clients network with a vast, knowledgeable group of colleagues from all over the country, and share resources and information. This interactive forum allows you to post questions to peers and provide insight to others' questions. Topics include Benefits Legislation, Compensation, Employee Relations, Health Care Reform, HR pevelopment, HR Management Topics, Recruitment, Risk Management and Other. We continuously seek to provide our clients with immediate notices about any legislation that pertains to benefits. Please refer to the Appendix for an in depth look at some of the tools we use to disseminate information about compliance to our clients. 25. List all claims, arbitrations, administrative hearings and lawsuits brought by or against the Proposer or its predecessor organizations(s} during the last (5) years. The list shall include case name, case, arbitration or hearing identification number, name of the court or tribunal, the name of the project over which the dispute arose; and a description of the subject maHer of the dispute. Sapoznik Insurance has never been involved in any claim or lawsuit in its 24 year history of operations. 26. Describe all proceeding concerning business related offenses in which the Proposer, its principals or officers or predecessor organization(s} were defendants. Sapoznik Insurance has never been a part of any proceeding concerning business related offenses in its 24 years of operations. 27. Has the Proposer, its principals, officers or predecessor organization(s} been CONVICTED of a Public Entity Crime, debarred or suspended from bidding by any government during the last five (5) years? If so, provide details. No Proposer, Principle or Sapoznik Employee has ever been accused or convicted of neither a public entity crime, debarred, nor any other legal action by any government. It is company policy that all employees are screened for any criminal activity before hiring in accordance with our employee policy. 38 Insurance Brokerage Services RFP NO. SM-20 1 1 -08-HR The PROPOSER acknowledges and understands that the information contained in response to this Qualification Statement shall be relied upon by CITY in awarding the contract and such information is warranted by PROPOSER to be true. The discovery of any omission or misstatement that materially affects the PROPOSER'S qualifications to perform under the contract shall cause the CITY to reject the Bid, and if after the award, to cancel and terminate the award andrer contract. VERIFICATION PURSUAt'IT TO SECTION 92.525(2). FLORIDA STATUTES Uuder penalties of peljluy. I dedal'e that I have Jead the foregoing Response to Qualification Srarement and that the flIcts stated in it are nue. DA1EDthis~dayof .Tv,-y .2011. (n Une Above, Print or Type Name of Person Signing) fAILURE TO COMPLETE, SIGN, & RETURN THIS FORM MAY DISQUALIfY YOUR RESPONSE Insurance Brokerage Services RFP 1'10. SM-20 1 1-08-HR 39 SECTION E: CERTI FICATION & NON-CONCLUSION AFFIDAVIT -'I ,) I I I , ' I _",:"J , , 40 ~ , ' ' . , NON-COLLUSION AFfiDAVIT m=. . .f. STATE OF FLORIDA COUNTY OF MIAMI-DADE ) ) ) Iniurance Brokerage SerVices ~B-U..f\",.CH"",-, ...... E .... J ........ --,-~..>.....:..· _S...<.LA"-P.I.....::::():""::U:::::.l...i'-:>\..\\",,,,' ~o:::'=--_____ being first duly sworn. deposes and scates that: (I) He/She/They is/are the __ O:>....L-W"'-"-'N=->.6""-1..CR..::>.-_______________ _ (Owner. Partner, Officer,' Representative or Agent) of __ "'-,c:..L.f\I-l-\.P....::O:....J7""',N~\...l::k;:..=___1\r4_'{\>l..l5~v...J.t ...... 1\u..S~~"'-H!I..<:k>I;..l.-'--__ the PROPOSER that has submitted the attl!~l1cd BID; (2) He/She/They is/are fully informed with respect to the preparation and contents of the attached BID and of all pertinent circumstances concerning such BID; (3) Such BID is genuine and is not a collusive or sham BID; (4) Neither the said PROPOSER nor any of its officers, partners. owners. agents. representatives. employees or parties in interest. including this affiant. have in any way colluded. conspked. connived or agi'eed, directly or indirectly, with any other PROPOSER. firm. or person to submit a collusive or sham BID in connection with the Work for which the attached BID has been submitted; or to refrain from PROPOSING in connection with such Work; or have in any manner. dil'ectJy or indirectly. sought by agreement or collusion. or communication. or conference with any PROPOSER. firm. or person to fix any overhead, profit. or cost elements of the BID or of any other PROPOSER. or to fix any overhead. profit. or cost elements of the BID Price or the BID Price of any other PROPOSER. or to secure through any collusion. conspiracy. connivance. or unlawful agreement any advantage ~gainst (Recipient). or any person intel'ested in the proposed Work; . (5) The price or prices quoted in the attached BID are fair and proper and are not tainted by any collusion. conspiracy. connivance. or unlawful agreement on the pal't of the PROPOSER or any other of its agents. representatives. owners. employees or parties of interest. Including this affiant. _ /) Signed. sealed and delivered in the presence:;; ~~ ()-tfoL----- Signature ' f BbtH\l 11\-SIk])07MW=, PRE5IDl;b)T NvDCro Print Name and Title J Subscribed and sworn to before me this ~~~~;.:~B(0 LAURIE ALLYN HAIRE * . -I< MY COMMISSION # DO 789357 g 1 oJ' ,.. EXPIRES: June 6. 2012 _P~4p~bl~' '=-("=S!,...b~~::4J~....t:;":J:!2!:.~::::L.-'--~i'tOFFI.O~ BondedThruBuduelNotarySsrvices otary U IC ign~YJ->; I / My Commission Expires; {el'l J \ .20 .-:::..-=--=--1---,.----1\ FAILURE TO COMPLETE. SIGN. & RETURN THIS FORM MAY DISQUALIFY YOUR Rb~ONSE Insu=~e Brokerag<;> Senlices RFP No. S1\-1-20 11·09-HR Page 20 of2S 41 Insurance BrokerClge Services RFP f'JO. SM-201 1-08-HR iJ, ,; CERTIFICATION OF AUTHORITY JI&t::. cOlll!leted~d s~;d Ex a i2!t!!2~!Hlr:.JhiS C;;'I~:ti~U is u0r..,;glicable to an individual Proposer] . " . '. . .' . ..... . .. . . .. . .. ._. . .. In;i.i~arice Bi:oker.ige·SiirY:ices STATE Of fLORIDA COUNTY OF MiAMI-DADE o Corporation or ~LC ) ) ) D Partnership DlLP D Joint Venture I HEREBY CERTIFY that a meeting of the Board of Directors, Partners, and/or Principals (include DBA-Doing Business As, if applicable) of the following entity :; f\ P o 'Z.-N nL. INSJ'=fQ!'-.I(E an organization existing under the laws of the State of rLof-1 DA , was held on :rV\..-Y \ ,20 \\ • and the following resolution was duly passed and adopted: "RESOLVED, that, Rtsu\fll\. WaNl \L as P\e..6\t2fNt kND CEo of the organization, be and is hereby authorized to execute the Proposal dated,\ day of TU \<-'{ 20~, to the City of South Miami and this organization and that my execution thereof, attested by a Notary Public of the State, shall be the official, act and deed of this attestation" I further certify that said resolution is now in full force and effect. IN WITNESS WHEREOF. I have hereunto set my hand and affixed the official seaY f the corporation this, , day of Iu L-"'f ' 20::::\:;..:l_-, (Jpt PrintNameRA-CH£1 A· 5APOLN\}L Signature NOTARY PUBLIC: SEAL ~o'\~Y.~~~ LAURIE ALLYN HAIRE *' . * MY COMMISSION # DO 789357 ... ,.. EXPIRES: June 6, 2012 ~I'q OFf.O~<;j Bonded Thru Budget Notary SeNicilS --.'-/J A C flIL-1k. (/4'ili~otary ~re X Personally known to me, or -X Personal identification: FAILURE TO COMPLETE, SIGN, & RETURN THIS FORM MAY DISQUALIFY YOUR RESPONSE Insurance Brokerage Services RFP No. SM-2011-09-HR Pagellof15 Insurance Brokerage Services RFP j,IO, SM-201 ]··08-HR 42 SECTION F: OTHER FORMS AND PUBLIC RECORD AGREEMENT - , . . 43 The: UlJIdetrsfmnedIUli:i:!!$i:s; tr.:!' hilS llhe:r, :tID!ir]1 .. urtlhotriq. to ~!.."'brnit.:i:hiis :Sw'hmiSI'.m,d1 t'O Ihir..,.:! the: fitrm( .. }hrl!r,l!iirn :ru;lTm!C ita· pl!rnEmTTii :u; per ;;IWoe>!ilm!rYi:. \FIutrt/!.!r. ~r' ~i~;;I!iUr,!, !ilhe umd!trsii,!lne>til :att!!::;i:.l:; to· tIt.!: ;filllh:lMifutgr , L "Iihe: :Ptro~s:er js; 'firnand:aJl'y .~r.:!h~llIt:itllJ.d1 !SuRfci:eIlllil}' I!'.":p!rienl:!d :al'1cc:t'mp!lI>!in¢to p!!fl'f.:l(rm 2111 all' di"ie: 'Mi~~rk rr~uiiredl 'Dfi:h~ tr.r>lItjIozelr an thl! ·Cr.:!\:li:r:ao:~; 1. The: :0,1:£:; :sct'edl ~n !%he: !PII",apr>o:serr. Ire:PDf'-do! 1P~lr:;WiTIt.: 't!:l Fi.o!ltllJ!':st: Ibr iPu'DplM:;II;. inS;Druc:tit'ffiS rbD ffI'lrop~!!r Aind $'peiific:al±ions; :ar>!~. rtrue: 1I1d .oorrr!)d: in ;;In: r,~~?e>t'I:::i; 1. TIle: F\ropo~:er :l1(;:S Ire:aJdiom(i «!TTiI,plf:ec 'Mliftih. :atld :lw'hmrn::s irl:::i IPIrt'P!:o;S:lII' :illSr-eiitl~ to· :am all' th!! lreq!Jir.enn!!mlZ., !tenTTiiS':;md 'tilllnl!iitiolliS :as. :;et: :fJllFnn, iinl±1e 'ReqP!:rtf..J:>ir FiroPD's;a.!\s. 4_ "Iihe if'trDpJlI.,:er 'MiWl'.~nG :alii II1iQ;t-elTil:1i1r. iSw,pplreri! !by iit '1I!'·e d'effi'w!Ii,ed !i:oth.! 'CIT'ri' ,of 50url:!h. !Hlharnii, f,lornd\;.;, fuee ifroJT1l 21l'1{f :SiWllm!l' iintere;!Z" ::md other I~'. itIId 1ih2!i: '. :Puo~:;eri .. :lI lQ,wf,uE ,O¥lomer h;aMil!l& tthe: mi,g'hli: !to :S~'Pp!:q.' the :s:am:e .. na wilt ddemdltb!: ,c:ol!(8\!;pt!1l:ie tothf!! cnjj'~' all' $am Il'1fmmii" F.\~~tfd;a, ;;pi"~;t ;[/IlPeTSOM mlrrill'l! ·;mill! wfWleor :;!I!qt' p:m.:cli1l!!lreolt 5. :~oplI's!!:r UlTid'~~t:ilrud/:; ttuv.: ill' ;;) ~:ilmir. ;s~.1ii: l~te)d1 :and! ~!ll!rt:ed to !m:il!!:'!!! ;om ij:ilj,e!:lernCitiol1ts tl:' the ~d!!rciom «i!lTiTTlii~:e Aind.l'~rC:iI'1n(, c;nIJt' !1ft!:: teEl1i M'1:em'b!r:s 'Pllliho· ''-\\'!!I!l!! iilliil'~'ll\!!!d iini .tIM! IPtr!\?-2ClliilWl, ae' 'tIT,!! 'PII\\rf_lTi :suihmiil'isall"lI:S m:iiyp:lJ!'tic:i~t!! In 'tJ..!! ,ora.~ 1P1i1l!$errit:iltiortS..i\!nll' .;:;'h:il'l,Ee!:i lt~ troll! :te2M'1, :lI1i: !lfte ClIl7IIIPIr!!>I!!McWOru rIl;;':f. :aot ¢he: $>!iii!!: dimr!!ifutm, oK rifrte 'Ci~:, r>!!slUrr.: imtM,t f,i;r~oGel!"s; Bid .m:~~aIffi'::lI.Ilian. ,_ "lime: 'undlelr5i~ed '!:ieriiifie:5 th:a¢ :if rifrte:firrn, is; selectd b:;' !!he:C:~' !!hI!!: ilirnm ¥Ioim mea-rile iii! ~lZta f.;j!Ifu to ~Clbli:rn lJ Crml!Di".oIC:i:. '1. lPlr0plZl2ir LlIru!:&miC.uWl's Iti!t:il)j; .:lIlt ,irl1li::mmf.iI'i:iorn wtNl:ith~iI\!! ,m:il1 :b!! '1{.erfiIMliI b~ trn!C.m:r' olf 50urtlh !Hli2mii :iliTld iPlio~s'er :Judril:lTIm :;.'i] erntiit'ies; O(i per:sorn ilist!!d :;ibo!.re ijj~ m~elr 21l{( :ilI'1!1l :ill' qUe:;;tiOIliS., trr'~OGeIi !tr:er<!ih'J!' IlJIdlerml'liti~ ·tbeClitj.' of :5c""dn IMlimiii Ainxll rifrte IP>!iTSOlli:lilrudi entitles iflSitedi :ilk",e: :.ml!i1 itlJll'I!!lstMm ihwr,ml'e:s:s ifl"Q1TTij :arnyt:l:itim :iIlrisi~l!ram1' :;UlCR ilTfII\e~i~n :3.;Tld "I!!rmi::iitlorn F,m~!J!z. iil!d.utffil!g th,e dissc!5T1iiillQaolJl. <Of iinF~mn:il!!iall1lPwr:!lllClmJi: th.I!!Fei:o. Su'l:mirttel!i .r;:rn, thiili I d .. yof JLt L¥' 20 --'-III __ Oll':am lruifMid',nl, p.:itl'il!ner$ruw, omr Thi!<TI-irirorjpclIl'.ted .~rprirnt1l!irn) 'a'jiJne::;:()(i'2,<-.;£~ ~J.~ . CDm,p:;.lIr-/_ilS-'-....... *"""ei~;;;;;..~Ioooilo~"'-lo~..- tr.ril!#i:t!G: 113 (j (l.'fr:-11th ~ t El TItle: i?nm!t r·4:l1m1~ Tiitl~ "-C ~~~~~~~~~~~--,;Ih .o!:~rpo~!i:'!n.1tffr<'l:iSoslijl yR '-01::: T ~\) U comJn:~(5~~r~lLE A"",,,,,, bt' 5~e"'r;' P,ri .. N>", ... Tod" R~Z~~\ll\;.\r ."" GE 0 iJlT.o~rpor.artelil ur.fd'e.T tit'!!: 1~!N5 ofth! Stiil::e ,of _fjL.-.J.LQQo!.J;:;t;,-"!ul2~A::\-________ _ 44 Insurance Brokel'a~le Services RFP NO. SM-20 1 1-08-Hr~ REFERENCES F F InsuranceBroke;~ie·s:ervrc:es - Please list three (3) govel'nmental a.gency, or comparable corpolate client. contraC1: references for which yol.! have done business within the past three (3) years: Agency Name: Town of Davie ---------------------------------------------- Address: 6591 Orange Drive City. State & Zip Code: Davie, FL 33314 ---------------------------------------------- Contact's Name: Grace Garagozo, Personnel Director T erephone Number: 954.797.1100 ---------------------------------------------- Agency Name: Town of North Miami Beach Address: 17011 NE 19th Avenue City. State & Zip Code: North Miami Beach, FL 33162 Contact's Name: Ellen Snow, Director of Human Resources Telephone Number: 305.948.2918 ---------------------------------------------- Agency Name: Town of North Miami Address: 776 NE 125th Street, 1st Floor City. State & Zip Code: North Miami, FL 33161 --------~------------------------------------ Contact's Name: Rebecca Jones ---------------------------------------------- Telephone Number. _3_05_._8_9_3_.6_5_1_1 ___ --::-_--:-_-:-::-:-_.,---,,--_-:-:-__ __ Attach additional sheets jf necessary. FAILURE TO COMPLETE. SIGN. & RETURN THIS FORM MAY DISQUALIFY YOUR RESPONSE Insurance Brokerage Sen-ices RFP No_ SM-2011-09-HR Page 23 of25 Insurance Brokeretge Services I<FP NO. SM-201 1-08-HR RFP INFORMATION FORM 7== .. 1 ¥ib? _¥f¥± dO in!;uranc.e-l!:rokerage ser'iC.ei I eel'tify that any and all information contained in this RFP is true;' and I fUI"ther certify 'that tl1is RFP it made without prIor undel'.standing, agl'eement, or connection, with ar.y corpot':\tion. firm 0.' pel'son submitting a RFP fol' ~he same materials, supplies. e·:julpment. or services and Is in all respects njr :lnd without collusion or fr:u:d. I :.gree to :ilbide by all terms and conditions of the RFf'. and if the Proposer j~ a legal entity. I I:el"tifj that I am authorized to sign fOI-the P·roposer. Please print the following and sign your name where indicated below: Firm's Nrune: Principal Busineu Addres!:: H 00 Nl'; IIo3m SUl..B1?T N.Ol2-Tti. ~\fT\\t\.'\ ~tS Fe ?:.~\~2. ) Telephone: \-<a,...--::r-'9L\f6. %'6«31: Fax.: 3D5. 945, IQ49 E-mail address: RfI(C\.-\.\51..-S @.C;r<POWl\t..t~ Name Signature Authorized Representative: of eft FAILURE TO 'COMPLETE, SIGN.& RETURN THIS FORM MAY DISQUALIFY YOUR RESPONSE Illmr:mce El:okef'~g€ Se1'Vlceg RFP No_ SM.2011-09-HR Page 24 of2S InsurCince Brokerage Services RFP NO. SM-20 1 1-08·HR 46 NO CONfLICT OF INTEREST CERTIFICATION ;;;;;¥!IK u_ _ ~. $ ** ,.¥:n'IAiS -*-' --- Thc under$igned, n$ ElidderJfl"OpO$CI', dcclnl'c$ that the only pe/'$on$ intere$tcd in ehi$ RFP m'c named herein; that no other person haz any intel'e$t in d~is .RFP 01' in the Contj';'lct to which this RFP pert:lins~ m:1t this resPQns~ is m:!de without connection 01" :!rr:!ngement with :lny other person; and that this response is in eveif respect fair 3.nd made In good faith, without tolliaion or fraud, The BiddarlProposer agrees tl1ll\t if this responsefsubmission is accepted. to execute an appropriate CITY dcc;ument for the purpose of esnblishing a formal tcntractual relationship between the BidderfPropo$cr nnd the CITY. fOl' the performnnce of all 'l'eG~lil':ment$ to which the ·re$pon:::eJ:::ubmi~slon pertaint. The BlddedPn;,posel' ~tate~ that tl1is respon5e Is based '-'pon the documents identified by thie following number: Bid/RFP N~. tiM -2.0 It -08 -HI'!- The AlII-names and residenc;es of persons and firms interested in the foregOing bid/proposal. as pt'incipnls. nrc as follcw$: Thc Biddcl'IProposer ft:ll"ther certifie~ thllt thb respon~s~lbmi.uion complic$ withChnptci 8(a) of the Code of Ordinance. City of South Miami. Florida., that, to the best .of its knowledge a.nd belief. no Commissioner. Mayor, or other officer OJ' employee of the CITY ":'IS :In intere$t directly or indirectly in the prcfits or emoluments of the Contract, job ark or service to which "he /'ellponsetsl.lbmiuion pertains. Signed. sealed and delivered in the presence of: By; C-~~~~ __ ~ __ *-______________ _ Signatl.ll"e ----....... ----.. RIl\f.kta t\, ~i\1> Ol..~ \ '(. PJ'int Name and Title Sl.bscl'ibed and 3wo.rn before me this ¥O'\~!.~~8("'o LAURIE ALLYN HAIRE *' . -I< MY COMMISSION # DD 789357 .. EXPIRES: June 6,2012 Bonded Thru Budget Notary SeiVlces EAILURETQ COMPLETE SIGN & RETURN THIS FQRM MAY DISQUALIFY YOUR RESPONSE Pagt" 25 ,,[25 InsurCillce BrokerClge Services [(FP 1'10. SM-20 11-08-HR 47 CONE OF SILENCE AfFIDAVIT FA? +FA .. , f1!t .;-. Alii 14***_ & ;'oF 'XL lr,sunnCQ :Brokerage'ServiD's The "Cone ';;'f Silence" specifically prohibits cOllllnl.lmication ('egat'cling RFP"S (bids) or any soUcibtioll"l with the City of South Miami staff exeept by written means, with copy timed with the City Clerk. This taites effect upon advertisement for Request for Proposal and terminates when the City Manager mal(cs his recommendation to the City Commission for tlhe award. An exception is made for oral communication during pre-prop.osal conferences. In addition to any ·other penalties provided by law, violation of the Cone of Silence shall render any proposal disqualified. CITY OF SOUTH MIAMI DISCLOSURE AFFIDAVIT beJng first duly $wom. ,tate: _fLol.....!o<""·""'I?--='-{+O<J;Av~ ____ _ Tne full. legal name and business address" of the person or entity contracting OJ" transacting bUsiness with the City of South t1iami are: If the e,or.tract or business tnns3ction !i~ with a corporation. the full legal name ::tnd business address" shall be provided fOI' each officE I" and director and each s,tocl<holder who holds direa;ly or indirectly five percent (5%) or more of the stock in the corporation. If the contract or businest transaction i$ with a p3rtl'ler~hip. t)he full legal name and butinet$ add.oet,>': thall be provided for ·each partner. If the eontract or bUsiness transaction is with 11 trust. the full legal name and address';' shall be provided for each trustee and each benefiCiary.. If the contract or busines3 tl"tlnuction i3 with an LLP or LLC. the full legal name n.nd lI.ddreu* 3hall be provided for each member of the lLP or LtC. AI! slIch names and addresses are: The ;ull legal names and business address* of any other indivh:f.\,laI (other) than subcontractcrs. mated!!1 men, suppliers, labor:fs. or J.:nder~ who have. or will have. any interC3t (legal. equit:lbJe, beneficilll or otherwise) in the cont~ct or business tr:InslI!:tion with the City of SOl,;th Miami arE: !nstlranceBrc-kerage Services Rfl'No, SM-2CU-09-mt Page 26 of 25 Insurc1Ilce Brokerage Services r~FP 1'-10. S"I\-20 1 1-08-HR 48 Notary Public S.igffled, sealed and delivel'ed in the pl't!sence of: By'U~ 'SIgnature g Jlru,-1,a A. ~ KP{fl,~\ , ~ Print Name and TItle Stlb!cribed and sworn to before me this I ~~y.:, ~lIq(i> LAURIE ALLYN HAIRE 4',", MY COMMISSION # DD 789357 ,~ * EXPIRES: June 6,2012 ... ~.,,, 80nded lhlu Budget Notary SelVicee Off\." FAILURE TO COMpLETE. SIGN. & RETURN THIS FORM MAY DISQUALIFY YOUR RESPONSE Imurnou Brokff3ge Sen:ices RFPNo_ S3I~-2011-09-HR i!'3g~ 27 oflS 49 Insurcmce Brokercige Services RFP NO. SM-20 1 1-08-HR SECTION G: s w 0 R N S TAT E M E N T U N D E R S E C T I 0 N 2 8 7 • 1 3 3 ( 3 ) ( A ) F LOR I D A S TAT UTE 5 0 N P U B L I C E N TIT Y C R I M E S -, ~ , -, ' ' , 50 ' -- " ' ' . -~,' , The PROPOSER acknowledges and understands that the information contained in response to this Qualification Statement shall be relied upon by CITY in awarding the contract and such information is warranted by PROPOSER to be true. The discovel'Y of any omission or misstatement that materially affects the PROPOSER'S qualifications to perform under the contract shall calise the CITY to reject the Bid. and if after the award. to cancel and terminate the award andlor contract. VERIFICATION PUR.SUAl""IT TO SECTION 92.525(2). FLORIDA STATUTES 1 Tnder penalties of pelj11lY, T declare tllar T have read the foregoing Response to Qualification Statement and that the facts stated ill it are t111e. DATED this _--'--_ day of ru L.-~ .2011. (On Une Abo'le, Print or Type Name oferson Signing) FAILURE TO COMPLETE. SIGN. & RETURN THIS FORM MAY D1SOUAl.IFY YOUR RESPONSE Insurclnce Brokerage Services RFP 1'10. SM-20 1 1-08-HI~ 51 SECTION H: COST PROPOSAL COST PROPOSAL Included within the scope of the flat-fee annual compensation are all of Sapoznik Insurance's comprehensive services ranging across all lines of employee benefit coverages and all facets of service administration and implementation. Sapoznik Insurance & Associates herein proposes a $40,000 USD annual consulting fee to support the City of South Miami and its employees benefit needs, claims and additional services such as wellness and enrollment support. This fee is inclusive of all personnel, time, and activities, and the City of South Miami account will not be billed for any additional services as listed in this Request for Proposal Document. Below is a summary of Services, Coverages, Programming and Additional Support available to the City of South Miami included within the proposed annual fee. LINES OF COVERAGE AVAILABLE INCLUDED IN BROKERAGE SERVICES: • HEALTH/MEDICAL • LONG TERM DISABILITY • GAP PLANS • DENTAL • SHORT TERM DISABILITY • PRE-PAID LEGAL • VISION • LONG TERM CARE • 401K • LIFE AND AD&D • SUPPLEMENTAL PRODUCTS BROKERAGE SERVICES AVAILABLE ACCOUNT MANAGEMENT CUSTOMER SERVICE ENROLLMENT SUPPORT • CUSTOM BENEFIT • 3 ASSIGNED ACCOUNT • TOLL-FREE ACCESS LINE HIGHLIGHT BOOKS & MANAGERS • CUSTOMIZED EMPLOYEE KITS • IN HOUSE SUPPORT BENEFITS PORTAL BENEFIT SUMMARIES • • UNLIMITED ACCESS TO • ROUND THE CLOCK ON-SITE ENROLLMENT • SUPPORT STAFF SUPPORT PERESENTATIONS • ACTIVE REVIEW AND • BILLING, ID CARD & DAY TO NEW-HIRE ORIENTATIONS • MANAGEMENT OF DAY RESOLUTION WIRELESS WEB ACCOUNT PERSONNEL • ENROllMENT QUOTING SUPPORT CLAIMS SUPPORT COMMUNICATION SUPPORT • ACTIVE ANNUAL RENEWAL UNLIMITED ACCESS TO • UNLIMITED ACCESS TO PROCESS ACROSS ALL • MARKETING TEAM, LINES OF COVERAGE & ALL CLAIMS STAFF CUSTOMIZED MA TERALS, CARRIERS • DEDICATED CLAIMS WELLNESS SUPPORT, NUMBERS AND ASSIGNED • PRESENTATION & CLAIMS REPRESENTATIVES BENEFIT IMPLEMENTATION MEETINGS TO REVIEW • CUSTOM PROGRAMMING OPTIONS • CLAIMS RESOLUTION AND EDUCATION EFFECTIVE NEGOTIATIONS REPORTS AND SEMINARS • EXPLANATION OF BENEFITS TO ENSURE BEST BENEFITS • MONTHLY NEWSLETTERS, FOR LOWEST COST • DETAILED CASE FLYERS, HIGHLIGHT MANAGEMENT WITH • COMPLETE RENEWAL HIGHEST RESOLUTION RATE BOOKS, CUSTOM PACKAGE WITH ANNOUNCEMENTS, EMAIL CUSTOMIZED OPTIONS IN THE INDUSTRY CAMPAIGNS, OUTBOUND AND QUOTES MEDIA 53 Insurance Brokerage Services RFP NO. SM-20 1 1 -OB-HR RESEARCH SUPPORT EDUCATION SUPPORT COMPLIANCE SUPPORT CUSTOMIZED EMPLOYEE • • CONSTANT PLAN • CONTINUOUS AUDITING SEMINARS AND SMARTER MONITORING AND AND MONITORING FOR CONSUMERISM PERFORMANCE REVIEW COMPLIANCE ACROSS ALL EDUCATIONAL MATERIALS STATE AND NATIONAL • • MONTHLY OR QUARTERLY TO PROMOTE LOWER MEETINGS TO REVIEW LAWS OUT OF POCKET COSTS UTILIZATION AND PLAN • CONSTANT RAPPORT WITH WELLNESS AND NEXT STEPS HR DEPARMENT TO • PREVENTATIVE CARE • AUDIT REPORTS AND MONITOR PLANS AND EDUCATION FORMAL BENEFIT OFFERINGS FOR RECOMMENDATIONS BY ADHERENCE TO ALL • Rx EDUCT ATION, TEAM ANALYSTS REFORM POLICIES UTILIZATION EDUCATION, etc. WELLNESS PROGRAMMING SUPPORT HEALTH FAIRS BIOMETRIC SCREENINGS & SEMINARS & PROGRAMS • ANNUAL HEALTH FAIRS WELLNESS SERVICES FOR ALL • WALKING CLUBS AT ALL SITE EMPLOYEES • SMOKING CESSATION LOCATIONS • BODY MASS INDEX • NUTRITION • STATIONS FOR HEALTH • CHOLESTEROL (LDL & HDL) • HEART HEALTH AWARENESS & • GLUCOSE (BLOOD TEST) • FITNESS & EXERCISE PREVENTATIVE CARE BLOOD PRESSURE • UTILIZING WELLNESS • • BIOMETRIC WEIGHT PORTAL SCREENINGS • BONE DENSITY • ALCOHOL & DRUG EDUCATIONAL • • AWARENES SEMINARS • FLU SHOTS • EATING WELL ON THE • NUTRITION AND • ME NT AL HEALTH GO FITNESS AWARENESS HEALTH PLAN MEMBER • CONSULTATION • CANCER AWARENESS DISCOUNT PROGRAMS Sapoznik Insurance is willing to work with the City of South Miami to provide any services as desired that are not listed above, or work towards modifying the above items to be included within the scope of our fee. Unlisted services must be pre-approved to be included within the aforementioned cost package, and are subject to availability offerings. We strive to provide the City of South Miami with the most comprehensive benefits package in the industry at the most competitive consultation rates. We welcome a rapport with city of South Miami towards creating the best service package inclusive within the $40,000 annual consulting fee. 54 Insurance Brokerage Services RFP NO. SM-20 1 1-08-HR ADDITIONAL INFORMATION LICENSES .. /.,:; ", . .'," ", ~,D~~AitTME~T 6fFJNANC!AL . ""\jO. ~1n.,· '" . . , '. . 'Ca ' I:~ .... ;. . . St:tO\! .L':t\, ICES ~~. " . SAPOZNIK INSURANCE ASSOCIATES, INC llVO.+'IE. 163RQ S11l,~ iND fLOOR . .' .,. NORTH ~.ifAMi D~~Cli n. jj162 ; !L -;... I .•• ,._ ... ~g~ncy' ~iWJl.~~. N~l\li~i ~Q~6952 , . -; . l.ttt:,it(j()itNunltl"er: [B:i3(Jl . I : • f·, ,-1. ~ _ " .,' ',. Issued Oll 1O/L"'2i1,~ -. : ";-' ?( ~" .. ' .. -,..,j"'::'().: ... ~ ·t., ;t,-:" .~:: .. ! ~ .~ I. r'lIr~li~\I11 Tt)'Scl::iI0l1'·g2~;j'~2. Adridn 'stt\t~tC$;'Tili5 Agel1'-'Y'~ Ij~l!lIsJ Will F,xpirH)11 10115fiOiI , .. _ ; .. , 1 '; ': . ~_ ..-,~, !' ;_~. -:_ : . '. ,~ :. ~. P'Il~'!,!' Xu $-:t'ti:nl:<itl\,?~7, t;JI!P.~·!i~~~t~}. TN~-4g!,!~.:.: ~!'I'!llir bl rhc.~c;li'''' I"Q.I.Timc , (1lnrt~ pr ..... uc'ti.~Rlf"'!!'t!ly!~;,,·;~gijJ\ Or:¥!f~,~0t:;H~J\~~~ W)I1i It A"~polri"d'T(, . ~ .. n~prC/.cn,.OIlti Or "f9i,'C:'J1I1U'Iln.;, . ,', '~f~~i,cf;·.t$~II'1~lW.~.l~i(Pj~)Jl~y.';~~;Li'<f:D.lI! ql .... r,~~~$, ~'(:J,'llt!,f~m.\t1'TI! 'TIfij\ny \FilO!J.llY \)r J'~nlJ3l . WIf~Ellic#':I1'~ ~~y', . " , . . ,.),·I,I~~t: '·':,1, p' ~::; f_'·'~t:_ '~~ .. ' -;;:.', .' ',,' '.~~ :.> :';:':"';jt~; .. · '·tJ..i, 7 t' ~~;./ C!lic! nllun .. i~ OmCl.'T .s~ O'n'..ll;~.1 Insurance Brokerage Services RFP NO. SM-20 11 -OB-HR 56 .,1 ImJUR-StIl'BOAAOW!;R: INnrnl) "'Mllddles;; i\~ ahl}'Mi1 <in P"licy) S"jXlmo: 1n8\11i1flIOO & I\~:loclalas, 11'10. T1 Ol)!"!! 11};m! :Slrsa 21Id Flo!), Norrlb Mla'Qli 'f8ID,*~'l!1& Nllnwgr· Fl :93i(12 olr'!ctC~TOOp(IndenGBta: '~Hfio SaJ)~I!\k ~~--~--""t AililNT Qf BROKER tN4Jr>tt "nd f;lI:l!lll'1p$~ Ad:!I".'iG) OJ782,OC)Ot Mhur J, GallaGher Risk MOI'iiiQOOISfll S~~ ArtAmr J. Gall®l1ar ~ Do {Rloolfal I)tto NW -4!!ll·Strool Suite:i60 Miami .FL 33166 1'0!i?,pIUlMB t-.laml)9r: (3().5} 5\}~,6091,) !'IF FL 1)i'U~ Insurance Brokerage Services RFP NO. SM-20 1 1 -08-HR COMMfiRCIAL PREMVl:JM fINANCe: AGRIiI;M!alT AND DlSCL05URH STllfEM!;NT C Unpaid PlainiullIl Balante $, D' [h:)aU\l1'lOMl"t1y Strunp Tllx -is 'om,'''' [~ljI 'lJlijilliiflfe [r,d"tootl~) I' U "" 2.000.90 57 ''''''P €lJbJou 10 ,,,,,,u,..in Eatff!d,J'.tr:.T.i"'." O'''!1pl i")Wu~r!l1Xl nl I .. ~ QIl It.> S.h,du"',if fltl""", n",MM"," EilI11.~ '"rnl'c<l>f(';:\ptfi"Jo.I>; _~_~ • ... \ POl~!OO fMO'i;jiJ,\ffil l.r=w.-J pmMilm. "",,,,,,,,,,I!>!! ~ II", "Uld",d :-d~li1rl!f;.j,~~~t~,,'~·Ij,(I11';'I"~";V\U~l ~~I .I'''~I (fa; In~,"Ir;J Iii) Hi> pO\.\!')H"II1-~ pro.;,lon~ ,..t'e" f«(''1.\).\ "'11"'Q~.i", oli,u, l(r1:Q ~~}6: ~j~~:I(],.~~~·~':F~~~~-:ii( :;:1~~1 ~i~~f~:tdr:tf: ltt:r:.(1 I"rF FL af05 Insurance Brokerage Services RFP NO. SM-2011-0B-HR 58 )I~ SC'OT'TSDALE INSURANCE COMPAtTyt'.l A StoCiX Company HOJnIlOrlTcEI; Ona NaUon'lltlo Plaza' ColumlllrS. Ohio 43215 Adll1lnl~lrl.l1f'lll Offlro: san Nor4h Galnoy center DrWo • Scoll11dali/, Alimntl 6!i26fl HOD-423·1'516 INSURANCE AGENTS AND BROKERS PROFESSIONAL LIABILITY DECLARATfONS THIS POl/CV ApPUES ONLY TO CLAIMS FIRST MADE AGArNST THE INSURED DURING THE PO!.ICY PSRIOD OR DISCOVERY PERIOD. UNlESS COVERAGE IS PURCHASED FOR PAYMENT OF DEFENSE COSTS IN AODrHON TO tHI!APPlICARr.E Llrms Of 1..1ABIUrv. THSAPpliOABI.."E! LIMrrS OF UABILITY AVAILABLE TO MY JUDGMENTS OR SETTLEMENTS SHAll ae REDUCED BY PAYMENT OF OEFliNSlii COSTS. DEFENSI:: COSTS SHALl. BE sue. JEer 10 Till: RIITIlONT'ON. PLEASE READ AIIID REVIEW THE FOUC:Y CAREFUl.!.. Y, . ---,''--, ~ pro-qfllfil Adll1ln[:slrahm lett 8, MHoon FIllatlclEll Services, 'nco 195 rl!llfnlfiolon Menue FBflllil1(JtOO. CllJll10Dlfuut OliOO2 Itom 1. Narn(ld Immr{)d: Snpunlk In$Uran«l aA5Soelams/lnli. PollllY No.: ABS·00OQ239 AgantCodu:06otDt Slreet Addloss: 1100 NE 163rd Street PlOglllm No,: -- 2ndflllllf ~~ .. N. Millmi Beach, fL 33162 __ L---._. _. __ '._ --- 110m 2, I.Imlls, of !.Iab" Ily: ii, $1,000.000 Each Claim b. $2,,000,000 In the fI(lijreQilfe all Cralms ami MdlUonal COWlmd i::Xjlf111l.leS e. 00lonm8 005t& are Includ&l wmlln IIw limns stated IIbov-o; .................................... " •• " ••. ~ .. ,..C81 Yos 0 No (It 110 bllX hlllilllckeo, Dafmnllll CO$I~_ are deemed Included withIn Ihe Umlls stllt!lr.ll;1bova.) _ .. . Itom 3. Polley Period: F=rom: NnlU.lmber 141 2010 W NOltamber 14, 201112;01 A.M. s1s/ldard ~Imo nt UII,! Named !nllU/'(Jd'lI Slroo\ MdJel$$ shown ab()V1l =;->,,~---... ' . ..... -.. -~~ Uam 4. RlJlonUon; Eaoh Claim: $25,000-. ----•• _"C ••• . .!~,_.z. ft9l1l 5, RGl.foactlvo Oaw: NOYElIllbill' 14, 200S ----: ... ltam 6. PrGmlwn: $31,U!l3 .. ---_ .. -_.- Usm 7. Enr.lllTSltments Effective at In(lop1lon: ADS-P·1 (U/O?) AB!J·,APP-R-1 CU/01) Ul'$-COVPG (1/00) AilS-ii (tl/07) ABSo12 (11107) Asg..:zO (11/01) A05-5!HQI1/07) O1S-90 (SI96) Item D, Nolita, to Comllany; U£lU(l9-of Clltlms.to! OIho! NOf[Glls tQi Sto1.ISdala Insurance C!NiljlElh)' Lee & Ma~oJl FfnonDIElI SOrv~Bi Itw. AIln: Claims MBfl8tter 196 Poirtnlll{JtonAvollUO r World imdo Canter, 33i~ l'l Farmlnglon. Cllnl'laCUcul 00032 261.1 Gre~m'Nlci1 SlrCFl[ New York, NY 10007 fGmP9!td.o~rree~j/~f:!!I!tlllllylnG,1XJIn --, . ..:-' Ttlool' DooJamllon9. logclill'lr wlllllh(l Apptilt-llllon, Elm Policy Md any written Of1:{l(lj'SSm!lnts. If My, IlU&Clm<l IIl00relo. shall cDns1[Ma the GOClrl'1'lct INllwoon tllo Itllmred Mtlltio Company. Insurance Brokerage Services RFP NO. SM-20 11-0B-HR ." .. ---. 59 I," • ; I ' Articles of Organization For Florida Limited Liability Company ,Article I The I1EUne I) f the Lilllited Liability C<lmp..iny is~ Sapozlllk Insurance & Associatl:s, LLC Article II The meet address of the prindpl'Il office of tile Limited Lillbility Company is: I 1 Oil NE 1 63 roJ Street, 2rid FloClr North Miami Beach, Pl 33162 The mHiling address of the limited !..lability Company is; 1100 NE \63 nl Street, 2"d FIQof North Miami Beach, FL 33162 Article III The purpose for which this Limited Liability Company is orgllllized is: The Company is organized to continue the business ofSa]loznik InsllHlnce &. ASSQchlt~5t Inc. lind 10 engllge ill any other lawful bustn~ss pcnnltled under the luws of tbe Unite{1 States and the StIlte of Florida. Artic1c IV 111e flame aud Florida strect nddress of the registered agent is: Austin A, Frye 2091}f} W Dixie Highway Aventura, FL 33180 HavJng been namcd as regislerr;d !lgllilt !llld to ac.c~pt set\lice of proces.s for the above statl;t! limitlild liability comp,lny at the place de.signated in this ccrtifit:ulr;, I herehy accept the appointment as registered agent and ligrec IQ Mi i"!his capacity. 1 further llgwe to comply wilh Ihe provLsions of all :5latutes relaling tl) the pro ld compleie pcrformmlol; of my duties, amll am familiat with and accept rhe ob!"' pOllitiOIl as regi!lte~ild agent -l Rcgisteretl.t\gent Signature: Insurance Brokerage Services RFP NO. SM-20 11 -08-HR 60 (;~l~f;; '~~,.IT.~.~ ~:.-' .I;; " Article V The: ltilmc ll!'Id ~ddre~'i of managillg memberslrnarulgerJl are: Tille: MGR.~ Rachel A. Sllpoznlk liDO NE t63 rd Street, 2,iId Hoot" N{ll1h Miami Beach, FL 33162 Article VI Til" effective dale for this LimHed Li<!'bHity Company llhall b~; (Da!e of filing) iliWlr<:.ll>HTteIJlber Of an ilUlllOn:l;cd Jepresentillive: of a lIlelnber r Insurance Brokerage Services RFP NO. SM-20 1 1 -08-HR 61 APPENDIX A RENEWAL TIMELINE Review current benefit package, set goals for benefit offerings, budgets and timelines -.........,.~~".",......~~'~-.. -.,'-, ,r , . -()/ I Negotiate renewal in open market for alternate plans and or carriers Renewal Meeting I I ...... J ........ / SAP-*0iNIK I-t E It. l T H-&-W:·~ l L N E So S Conduct Open Enrollment Meetings ',,-- ,/~--_/.~~--- Enrollment paperwork processed and completed at carrier level I ,,+<J 'l Provide End 0/ Year Benefit Election Reports, Payroll Deduction , ~~ First Month Post Enrollment Bill Audit I I '. I ....... ,;.r'"+ .,J APPENDIX B TECHNOLOGY AND REPORTING Plan Strategy Capabilities Sapoznik Insurance offers the following services to help you offer competitive and cost-effective benefit plan designs: PlanAdvisor® Eliminate guesswork from your benefits renewal process. Our goal is to turn viable solutions into real results through value-added tools that benefit your business. PlanAdvisor offers a simplified way to approach your benefits design planning by balancing both cost and value for your company and employees. We can help you: Analyze your benefit plan costs against reliable benchmark information Project the impact of medical and dental plan design changes Estimate your renewal costs Streamline the plan selection process for your employees Compare yourself with other employers by region, size and industry Benchmark Surveys & Statistics Our benchmarking data provides you a standard to which you can compare your benefit programs. We will make recommendations to help you enhance your plan while at the same time remaining competitive and reducing your overall plan costs. Valuable benefit trend statistics and surveys are one of the core pieces of information that we provide to our clients to help support your benefit plan design strategy and decisions. These surveys and statistics provide benchmark data from leading consulting organizations around the country and cover the following topics: Ancillary Benefits Benefit Costs Benefit Management Health Care Costs Health Care Reform Health Plans Prescription Drugs Retirement Plans Wellness Benefits Vacation and Paid-Time Off Plan Design We offer our clients plan design educational pieces so that they are fully informed when considering their design options. © Zywave, Inc. All rights reserved. PlanAdvisor' INFORMATION IS DOLLARS ~~~f'" ',"_ ~r!~~,~·_~~ __ ~-, I-SA'~-Ad .. ~&adr 2'J)~IRAw ~~~'_~:_,,, .. __ ~~Jt~:~~~~i,~._,_. DIInb.&.Gtr.s ~m~y,~-Drr'" t~~~~· _ :... .: ~~_-~~:~~:)C~~~~!~t Sapoznik Insurance can help you make educated (and cost-saving!) benefit plan decisions with PlanAdvisor®. Using this comprehensive tool, we can analyze and benchmark your claims data, model potential plan designs, estimate renewal costs and enhance employee decision-making -all designed to provide you with a cost-effective benefits plan tailored to your unique business and employee population. Contact Sapoznik Insurance today to learn more. © Zywave, Inc. All rights reserved. '!!!:L~ r~I~"1 i!--c_~'~' .. -_::J ~'O-.:2<"'_"'='(>J':"'.··vr .( •. =' f,,~"""'UrnT""""""'-"''--.!=_~ !~'.', ~~ Gi.= ~= ~.=.J ~~-:- I~= l~~- [~-----=.l L=~-:=l L __ =J Supporting your benefit plan needs every step of the way. HOW DO I STACK UP? We'll help you benchmark your cost and utilization data against nationally recognized norms, and provide access to thousands of survey results to see how you compare to others in your field. WHAT'S MY BEST OPTION? Extend the cost-savings to your employees by taking the guesswork out of open enrollment -your employees can input their expected health care needs and discover the most cost-effective plan for them. WHAT'S THE IMPACT OF A CHANGE? Balance cost efficiency with maintaining value in your plan - we can offer plan design modeling to show you the impact of a change before making any decisions. WHAT ARE MY FUTURE COSTS? To support your budgeting needs, we can calculate your projected plan renewal costs based on trend, midpoint and large claim information. Call 305-948-8887 to learn more today! Plan Strategy Capabilities Sapoznik Insurance offers the following services to help you offer competitive and cost-effective benefit plan designs: PlanAdvisor® Eliminate guesswork from your benefits renewal process. Our goal is to turn viable solutions into real results through value-added tools that benefit your business. PlanAdvisor offers a simplified way to approach your benefits design planning by balancing both cost and value for your company and employees. We can help you: Analyze your benefit plan costs against reliable benchmark information Project the impact of medical and dental plan design changes Estimate your renewal costs Streamline the plan selection process for your employees Compare yourself with other employers by region, size and industry Benchmark Surveys & Statistics Our benchmarking data provides you a standard to which you can compare your benefit programs. We will make recommendations to help you enhance your plan while at the same time remaining competitive and reducing your overall plan costs. Valuable benefit trend statistics and surveys are one of the core pieces of information that we provide to our clients to help support your benefit plan design strategy and decisions. These surveys and statistics provide benchmark data from leading consulting organizations around the country and cover the following topics: Ancillary Benefits Benefit Costs Benefit Management Health Care Costs Health Care Reform Health Plans Prescription Drugs Retirement Plans Wellness Benefits Vacation and Paid-Time Off Plan Design We offer our clients plan design educational pieces so that they are fully informed when considering their design options. © Zywave, Inc. All rights reserved. P!anAdvisor" INFORMATION IS DOLLARS Sapoznik Insurance can help you make educated (and cost-saving!) benefit plan decisions with PlanAdvisor®. Using this comprehensive tool, we can analyze and benchmark your claims data, model potential plan designs, estimate renewal costs and enhance employee decision-making -all designed to provide you with a cost-effective benefits plan tailored to your unique business and employee population. Contact Sapoznik Insurance today to learn more. © Zywave, Inc. All rights reserved. ~ _l~I ...... -·! I'';--=--:<.~-::::::J 1),."",,, ... ""'.11""'-'.......,1.11 .... '",,"', "' •• I1 .... "'.~' .... p-L1I ..... l) \I.n<.l ................. Cu.1 r~;-:-:-=-, ~:; Lib 7' ~-=:; G:.::J [i:..~-,~ !€~ Li:£-:'=' i. ___ ----:-j '--~~-::J l---=-.:-.=.~l C~=:I Supporting your benefit plan needs every step of the way. HOW DO I STACK UP? We'll help you benchmark your cost and utilization data against nationally recognized norms, and provide access to thousands of survey results to see how you compare to others in your field. WHAT'S MY BEST OPTION? Extend the cost-savings to your employees by taking the guesswork out of open enrollment -your employees can input their expected health care needs and discover the most cost-effective plan for them. WHAT'S THE IMPACT OF A CHANGE? Balance cost effiCiency with maintaining value in your plan - we can offer plan design modeling to show you the impact of a change before making any decisions. WHAT ARE MY FUTURE COSTS? To support your budgeting needs, we can calculate your projected plan renewal costs based on trend, midpoint and large claim information. Call 305-948-8887 to learn more today! Average Annual Employer Contribution Toward Single Health Coverage Average Employer Contribution 2009 $4,045 2008 $3,983 2007 2006 2005 $0 $1, 000 $2, 000 $3, 000 $4, 000 $5, 000 Source: Kaiser Family Foundation, 2009 Reprillied by Zywave, Inc. willi permission/rom Employee Benefits News Benefits 2010 Sourcebook, January 2010. Copyrighl 2010 by SourceMedia. All Rights Reserved. © Zywave, Inc. All rights reserved. Average Annual Employer Contribution Toward Single Health Coverage Average Employer Contribution 2009 $4,045 2008 $3,983 2007 2006 2005 $0 $1 J 000 $2, 000 $3, 000 $4, 000 $5, 000 Source: Kaiser Family Foundation, 2009 Reprinted by Z:w'ave, Inc. with permissionfrom Employee Benefits News Ben~fits 2010 Sourcebook, January 2010. Copyright 2010 by SourceMedia. All Righls Resen'ed. © Zywave, Inc. All rights reserved. Data Analysis Sapoznik Insurance has managed medical benefit programs for hundreds of employer groups in an effort to keep costs below comparable levels experienced by other employers. Our aggressive management technique includes a number of internal medical management and preventive health initiatives. As the health care industry continues to change, we have remained ahead of the game. With leading- edge technology, we obtain meaningful information that helps us evaluate cost drivers, trends and savings opportunities associated with our clients' medical benefits. In addition, we work to evaluate the impact Of future plan changes. We provide employer groups with tools that will offer consistent year-to-year data, reporting formats and comparative benchmarks. This highly meaningful -yet understandable -information enables us to work together with your data in a continuous, interactive manner as plan management issues arise. Decision Master® Warehouse You face soaring health care and prescription drug costs, but lack the data you need to make money- saving decisions. Decision Master Warehouse (DMW) is a Web-based decision support system that allows you to assess your group medical and Rx plans with an easy-to-use management report. With DMW, we'll offer you clear recommendations to combat problems with utilization and plan costs based on analysis of your carrier data. You'll have the solid, high-quality information you need to formulate plan design decisions. Here's a small sample of the issues you can drill into with DMW: Why are office visits so high? Who is going to the doctor? Why are they going? Are they using in- network or out-of-network providers? Why are plan members using the emergency room so frequently? Who is using the ER most - employees, spouses or dependents? What is the plan's generic substitution rate? Should you encourage an increase in generic utilization to align more closely with benchmarks? In addition to health and Rx reports, DMW offers sophisticated plan modeling that takes the decision- making process to the next level. The following fact sheet explains the details of DMW. © Zywave, Inc. All rights reserved. Decision Master" Warehouse OUR DATA ANAlYTICS SERVICE: FEATURES AND BENEFITS Sapoznik Insurance is pleased to provide our clients with Decision Master® Warehouse, a powerful claims analysis system that allows us to dig deep into your claims data to uncover targeted cost-saving opportunities. t;;:~','f'''' '"" ..... _ ..... ,01 Gi) :;:::':1''"-'" Gil ", ... ·u~· .. GO :::=:t • ....iI .., -~. ".., WE'LL HELP YOU ANAL VZE DATA AND DEVELOP SOLUTIONS WITH THE FOLLOWING TOOLS: • The Management Report benchmarks your health or Rx claims data against customized norms to detect cost and utilization disparities. • We can compare your data between multiple divisions, locations or past years using Multiproject Reporting. • The Drill-Down module allows us to extensively analyze various details of your data to reveal underlying or hidden issues. • Using the Alternative Modeling feature, we can experiment with plan design alternatives and see the impact changes will have for your budget and employees. • We can help you budget for future claims costs and implement a cost-saving disease management program with data from the Disease Profiler. © 2008-2011 Zywave, Inc. All rights reserved. Call 305-948-8887 to learn more about our services and capabilities today! MANAGEMENT REPORT This easy-to-read report benchmarks your data against national norms from Thomson Reuters MarketScan® Research Databases and Kaiser Family Foundation. It further breaks down comparisons by geographic region, industry and company size, and includes dynamic charts and detailed explanations. Explore data comparisons for over 70 different medical categories, including: • Total Health Plan Costs • Inpatient and Outpatient Claims Emergency Room and Office Visit Utilization and Cost Claims by Major Diagnostic Categories • Well ness Ann manu mnr",1 'Iutllt ~'"':;,=~=---.. ..... ,.",,-...,-...... -... ---'-..,_r_ .. Top Drugs Paid BVO Plan PRESCRIPTION MANAGEMENT REPORT -I ~~~.';'~~.:::::::;!"~:,~----.... L_ -~." ."'" ,,~,--"'''''''''''''''''' We can also offer a prescription drug claims analysis report. The Prescription Management Report benchmarks Rx claims data to help us assess whether your costs are appropriate and where problem areas may exist. Among the categories analyzed are: Paid Summary Total Member Cost Share Mail Service Utilization Brand Name vs. Generic Utilization And more! MUL TIPROJECT REPORTING The Multiproject Reporting function allows us to compare up to four different data sets. This allows us to track data trends and patterns from year to year, or compare between multiple locations or divisions for a single year. Includes the same categories as the standard management report Useful for strategic long-term planning and evaluation Helps isolate disparities to address among divisions or branches DRILL·DOWN The sophisticated Drill-Down feature allows us to get to the source of the problem by breaking data down into targeted, specific segments to analyze. By pinpointing the who, what, where and why of a problem area, together we can implement strategic, effective solutions such as awareness campaigns, disease management programs, plan design changes, wellness initiatives and more. Find health plan answers such as: • • • Who is going to the doctor? Are they using in-network or out-of-network? Why are they going? Who is using the emergency room most -employees, spouses or dependents? Why is utilization so high? Which segments of the employee/dependent population are utilizing preventive services most? Investigate prescription drug claim questions such as: ~~~~~ Who is utilizing mail-order vs. traditional pharmacy? What is the cost differential? How often are generics being utilized when available? Who is choosing generic over brand name? Are pricey specialty drugs responsible for a disproportionately high portion of your plan cost? Which demographics have the highest specialty drug utilization rate? ~--.=:, ... :;;; -0-; '.Ill-""''1". ~:~ J ;~~ i~ t~ f~~ "". "' ... _-<r' ","~--1:5 "~" .. ~".--, ..... ~ t" ... .,. £~--?:-::~ ":; "~ -" -,~~ .,= .:,. _.~~ l~~:· ".-'''''' ';7 :;~ -,~!: ',<!;p au ~~ h,i ,':. ii.' .~:~ ('1 ALTERNATIVE MODELING After analyzing your data and identifying problem areas, the next step is developing strategic solutions to address those issues. The Alternative Modeling feature can help us "try out" different plan design alternatives and see how changes will impact both your budget and employees. • Compare the current plan against alternative options, including HSAs. • Apply the information we've gathered. Was emergency room usage disproportionately high? Examine the impact of raising ER copays to discourage unnecessary visits. • Identify cost-cutting opportunities by changing factors such as copays, deductibles, out-of-pocket maximums and more. • Learn how many claimants are affected by each change, to achieve cost-savings while retaining value for plan members. [i~~miC::~,,~~' '~--"--~~~-~--.::~~_~,~,~, "-,,.1( ~ ._-_c·T~ = ~ MARliETSCAN' RESEARCH DI\TABASES ~~' ~~~ ".::,. .......... ,,- t-:J [mOT .. " ....... '" tU ... "'....,..,, .......... . ~::. ............,., ... ...... <::J • .."... ......... .. :t:::J ... ..... ':1 ...... ",.,. .... , ...... "'. :~ ::;~~'.'-I [l,~[A!£fl'.LltB DISEASE PROFILER Using reliable data from Thomson Reuters MarketScan® Research Databases, the Disease Profiler can show average costs of claims by disease category. We use this valuable resource to help you: • Predict costs and budget for future health and Rx claims costs Negotiate more accurate rates with stop-loss carriers • Design and implement a disease management program to address the needs of your employee population Evaluate and manage risk within the plan Pharmacy Benefits Services Our Understanding of Your Needs Pharmacy benefits have become one of the most high-profile areas of employee health plans, from both an economic and a member desirability and satisfaction standpoint. What's more, the pharmacy arena is highly complex, and many brokers do not have the time or special expertise needed to give their clients' pharmacy benefits or pharmacy benefits managers (PBMs) the attention they need. Sapoznik Insurance is a rare exception. Our Approach to Meeting Your Needs: ZywaveRxTM ZywaveRx was formed by leveraging the buying power of a nationwide network of employee benefits brokers, including Sapoznik Insurance that collectively represents over 1.3 million self-funded lives. ZywaveRx lets you compare your current pharmacy benefits manager to two leading national PBMs - Express Scripts and Systemed. With ZywaveRx, Sapoznik Insurance can provide you with access to exclusive, extremely favorable terms for your pharmacy benefits. The highlights of the ZywaveRx program include zero dollar administrative fees, low dispensing fees, deep pharmacy discounts and aggressive rebates. Using ZywaveRx's exclusive online savings calculators, Sapoznik Insurance can compare your current PBM, Express Scripts and Systemed to determine the most cost-effective program for you. See the fact sheet that follows for a full description of what we are able to offer you through ZywaveRx. © Zywave, Inc. All rights reserved. ZywaveRx TM A cure for the common PBM You know that health care costs are rising, with no slowdown in sight. But, do you know that pharmacy benefits are a significant contributor to those rising health care costs? Keeping prescription drug costs in line can go a long way toward improving your overall health benefits costs. But, drug benefits are popular, highly utilized benefits; simply slashing or eliminating them isn't the right answer. Sapoznik Insurance has the solution for you: ZywaveRx. ZywaveRx was formed by leveraging the buying power of a nationwide network or employee benefits brokers, including Sapoznik Insurance, to provide exclUSive, extremely favorable terms for your pharmacy benefits. ZywaveRx lets you compare your current pharmacy benefits manager (PBM) to two leading national PBMs, Express Scripts and Medco's Systemed Group. Sapoznik Insurance can evaluate your options and determine the most cost-effective program for you. . With the ZywaveRx program, we can meet several critical objectives for your pharmacy benefits program: Choice. We don't limit your choice to one PBM. With ZywaveRx, you can choose between two of the nation's leading firms, ensuring competition to secure the best rate .. Accountability. Express Scripts and the Systemed Group know that we are presenting more than one option to our clients. We expect nothing· but the highest ievel of service from them both in.otder to·win.your trust. Support; Express Scripts .and the Systemed Group are ded.icated to helping SapoznikInsurance and our clients understand their organizations, their products and the iywiweRx terms. . Favorable,terms •. Express Scripts and theSystemed Group can provide . eXtremelyfuvorable termsfor our clientS. You will be ableto retain a cost- effective phal1Tlacy benefits program for your employees for yearsto come. Highlights of the ZywaveRxTM program include: • Zero dollar administrative fees • Low dispensing fees • Deep pharmacy discounts • Aggressive rebates IJsing ZywaveRx's exclusive online savings calculators, Sapoznik Insurance can compare your current PBM, Express Scripts and Systemed to determine the most cost-effective program for you. © 2008-2011 Zywave, Inc. All rights reserved. The information contained herein, including its attachments, contains proprietary and confidential information. Any distribution of these materials to third parties is strictly prohibited. ZywaveRx'" is a registered trademark of Zywave, Inc. SpEGI;l1li!ad PBM ;:,:j:.~I!l>!I-]'l team &~UllllPed~ • ... 'It!nlllElSt tacn~ologIC31 to!iilB ta, 'iJJ;uI~' S"1~ 6enlllll.;3f1lIll'G,ltar 8DjilJUOOll. © Zywave. Inc. All rights reserved. Prescriptnoill1 O'.fUg IPr,Qgr.2I1111'11 Sa~llIIgs Analysis Papared For: Typical Company smo Mlembers,231!l IEmployees ~ -'---1 '~~~11": .~ I, pFlClf1l1l1 .~. '~ ::adOf1l I /~ / .~.~.ro\3 ch ,CQ/1;slare 0) ~ dataLlBd ;;,f1l31y<ila aJld .comp::Ji!80f1l 01 :aPEGlnc 1P.l3!fr ':::ompoo8.ruta r.11t1er in::.Jt. IlIl3ll~e.t ;3ppllC;3IilDIiJ ';;irUl1!crua'br~' lJe.l1or:i1JmlltN;a. ~,3'5~.11 ~,'jizyvvay;e~ .. F.I I/<' 1 , -am:l-appro~'r1",ieci alloc.TI.;oa. \ \. \11 $ $ $ $ '5)3151:11 3I7~'l<5 f.\:-i .,;:-~;:~~_. l::.. ~:_~ :.-:~ IlIltiiIiIHie:--IB' ... ~ ~'e-ar ~"'lr'!lIs aOllfijlSl8 gl'~82' ~-.:J-ilJ ;3 (XH!JtJl~8t8 ¥l8W' 0) UI'J ture. Pilaf] !JI€ir1'e-ifi!Th;3I1!CfL MyWave@ Portal Click+Connect+Communicate Welcome to a whole new way of working -MyWave® is your personalized website that allows you to effortlessly click, connect and communicate with Sapoznik Insurance. It's designed to offer you time-saving tools and resources that build convenience into managing your everyday work tasks. Whether you want to view documents online, participate in plan/program surveys or connect with more than 300,000 peers in your industry, this is the place to be. It's easily accessible, hardworking and just one of the many services available to you when you partner with us. PQstingCenter •. Olir d()c;ument posting caJ:)Clbilities allow ustosej:lmlessly provide you inforli1i3tibn; . . ..' .,.. '~'Acce~Sibl~ ;417IPo~ting~;irom'dur ag~ncy;~re~i~~HYli~f~~~hfand;' .. ei;lsy, to 1&c;a~¢I~,61'\~c:onv~ nJent' . . Place()l'\l)n~:':'" . • _ .' \ i' ~ -, "<. ; . •.. ' GettheirifurmahOny6Une~d'·· J:$[~i~i{(t1iiSL ... i •. Pr9vide YO!Jr"e!1:lRlq.c~~~'th~ . ,;, edUcation'tHey, ne¢tl'to tln~erstand\,~ .... ,11()W,if~rorl1'l'im'~~i«#ftb~i(@~s::>' . , sur~~;fB~~~~~~;:~f~~ . .• partictP~feih',:~e~~fjt' p'la'n ~nd/or ..... ,.p~c,ptQg@fu'~lII{YWs';i},":i: ··~~i~~~J!!r~~t '~,; :7:-\~ .'~;': ~ ~'<i ~;~:': . :/. .. \ ': C~l1'Im'~nlty'!, (; "i:, ···Et~a!~fi~~l~:! .. colleaguesyrOhi'atfo$sthe ,,'. ; .. ',',.: ." ,"" . -' ....... ;.-.,., '.'.'-;,',; c(j~l1tiy; . ~s'~af~ ihf'()':'1i~tidhahd~t~~tiur.c~s via ttieC~rriin'uhitY'~lnt~~~~ive ·:rt~~~6t:~~t~~f!I~~jt~~~jle .,' . ,in~ig tit into;dther"li~el'S' •. CJye'stions~ andall()W$.yo01:d'track.·re~ptinse !>ased,ontopicS'rir:lpdividual ' questions.,. " • CO~li1unity po~tl~9S are organized by tcipiC;s6yilu can soLirce information quicklyand easily. MyWave® HR: Your Electronic Human Resource Assistant MyWave HR is the helping hand for all your human resource needs. Whether you are looking for legislative information, employee communications, industry-related websites or consumer-related health care information, MyWave HR has it readily available for you in one convenient location. Compliance Looking for quick answers to tough legislative questions? MyWave HR's Compliance section has the answers you need. You will have access to an exclusive set of comprehensive guides full of federal legislation. Complete guides include COBRA, FMLA, health care reform, HIPAA, HIPAA Privacy, Medicare Part D and Section 125. Within each guide, sections include Common Questions, Forms and Quick Reference. A search function is also available to help you easily source information by allowing you to browse all or only particular sections within each guide. Documents on Command When you need to access information fast, the Documents on Command section of MyWave HR® provides instant access to a library of downloadable articles covering a variety of topics -right when you need them! Articles are conveniently grouped by general category and include Employee Health & Well ness, Health Care Reform, Benchmark Surveys & Statistics and more to help you easily locate all the resources available to you. Or, use the keyword search function to find related documents. Resources MyWave HR's Resources provides useful links to industry-related websites - all through the convenience of your MyWave HR home page. Use the helpful search function so you can promptly find all the information you are looking for, as well as any related documents from the Documents on Command section. And if you still cannot find exactly what you need, use the convenient "Contact your broker representative" help link. So many helpful resources -all at your fingertips. HealthShop Do you need professional- looking newsletters to give to your employees in a snap? No problem! MyWave HR supplies you with HealthShop - comprehensive consumer information in ready-to-print newsletters. Topics include At the Doctor's Office, At the Pharmacy, Home Care and Your Health Plan. Use these newsletters to help your employees make smart and informed health care decisions. ©2006-2011 Zywave, Inc. All rights reserved. The information contained herein, including its attachments, contains proprietary and confidential information. Any distribution of these materials to third parties is strictly prohibited. Your Client Portal: Click+Connect+Communicate Welcome to a whole new way of working! Your client portal is a personalized website that allows you to effortlessly click, connect, and communicate with Sapoznik Insurance. It's designed to offer you time-saving tools and resources that build convenience into managing your everyday work tasks. Whether you want to collaborate with our agency online, quickly access timely news, information, and resources, or connect with around 400,000 peers in your industry, this is the place to be. It's easily accessible, hardworking, and just one of the many value-added services available to you when you partner with us. Document 'Posting -Our dpcl,lnlert posting' capabilities ·.~libw,a'~l:!ainleS$,~xc::h~hg~· of (riformatiilf1sHaring~fromour . ~genc}<~~;y~u;~a,.cce,s;~ibj~?4/7. ~UI'111IlWt.O~ '~~~l~Ki~~*"~;'Ii~jaM~'/;,;'-;<' , -~', . ,i ."<' .::y. ',:.; ~>~-:;.::. :.:';:;.:. ):.~:'r -'?:F;-!;::,;',;· .,,~ .• ;;:.;< . '-',:.". -. ,':' ,-:: ,-'. ~ -'-;' . . ' • ."j\cc¢ss,,,aluaBie-he~lttlCar~'refdrm" -"c' o ~ :.'. • • .'~~-J .: ,'. :. -',:,' '~l < _, j "": ; :-. " ;":~~~\' ;':",', ;~.':j :;' ... ":.::~'.: ?: .. ::;:., ,'->"j " 1 '. collea·gu~s-frPm-·actQ~~_ ~lie: .... i . ,_ "'~d~ritrY~ ", .. ,," ::, ;:;;. i '.', :,' '"'; • .. .. J·~1·',;:~:~\·~:'\-~:;r:~{-/ -,~{~.'}::;,'<',~" ,'~~;:~':':";:'<' _.'~ :,<: ',,'.-\Y} .. ': Compliance"'". ·~\.;~I~~\i1!t~~1·.· , .... 'ahd;SeCti~ri'12p'questi6ns?:Look ' .·'L~'hQ,;~,rt~e'r{fj~p:'¥,~Yh~!~~t·~~ft·~!~j,,:. ····]Ii'rjt~~:t Resotir~~"jCit.k~:;(:J .... ...... ..' •• ' ~~~fll'iliriks,to:jl1d'u:stry~related:: " . \viebsitesareaUCivajlciblerrom tHe: .'. cohvenienc:epfyqtirdierit portal .. . Healtl1'~~\VSI~tte~·· . . ". -W~rif~onsu.lTler~ba~ed HealtH. articles pa¢kagetHn a .' '. profesSional.:.laoking format ... in'a . ·.flash?' NQ problem! Your client portal suppliesyquwith . newsletters to' Help your employees mal<e sl11art and /infcirmed HealtH care decisions. ©2006-2011 Zywave, Inc. All rights reserved. The information contained herein, including its attachments, contains proprietary and confidential information. Any distribution of these materials to third parties is strictly prohibited, MyWave@ Benefits: Your Benefit Plan Information Center MyWave Benefits is your one-stop information center that allows you to view your company's benefit plan information online. And to help simplify things even more, we've stored all this valuable plan information in one easily accessible location -making it just a mouse click away. Benefit Plan Information Want to be able to see the different plan types that your agency chose for the year? MyWave Benefits can easily provide you with this wealth of information. Once you select a plan type, the current related policies will automatically appear, allowing you to view each plan's basic information. If you select a specific plan type such as dental, you will be able to see that plan broken down by plan type, year, and name, a.s well as policy number, and issuing carrier. You can drill-down and see even more detailed information by selecting the Benefits tab - displaying your agency's current plan design. Another great benefit is that the system holds plans that are currently in place, in addition to prior plans, allowing you to compare plan information from year to year. Rate Information Would it be helpful to know specific information about the benefits elected by your agency, such as monthly fees? And how great would it be to know rate structure information? With MyWave@ Benefits, this beneficial information is just another valuable component you'll have access to, with the ease of a click of the mouse. By clicking on the Rates tab within the plan type you selected, you'll be provided with a detailed summary of the policy's rate information including such valuable information as rate structure, employee count, and rate amounts. ©2009 Zywave, Inc. All rights reserved. The information contained herein, including its attachments, contains proprietary and confidential information. Any distribution of these materials to third parties is strictly prohibited. Sample MyWave® Ho~e Page '1; "," ..r- 2) 4,' Brought to you by Sapoznik Insurance March 9, 2011 Home 1 He<:lIth Cure Reform I Community 1 ~ MyWavc HR \ il MyWave Benefits \ <i} MyWave RM 1 ~ MyWavc OSHA : Ashley Bucholtz: Crazy Company Provided by ZU Insu!"ance Sentices. powered by MyWave® i Your Products Employee Benefits: MyWave® Benefits III II: Participate & Win II i Tell us what services you II: value In your broker by II ! participating in Uhls yea(s II I' Broker Services Survey. You'll I, atso have !he chance to win I , i $100AMEX girt card. • >. 1'1 ( • .2) 111'/ III. ------------. I I I,.---==-=--=-=-=-=-=--==-=c:-==-=--=' r Posting Center (~) I post c;I'dacl,Iment P05;t a link Benefit Communications Recent Community Postings @) I. have another FMLA question. We-are a heal~h care facility in Indiana. We have two nurses that have both requested F~lLA for maternity leav~ -at th~ same time. We are a small facility and two nurses-being out is a big strain on our scheduling. One of the 'nurses is a LPN and the other is a RN. Under State law we are required tt;) have at lea ... Ores ponses More» I" went to my chapter meeting this morning 'and the topic was HR Audit and talkeg on being"compliant. One of the" items on the checklist-was haying a managf!!.r/f$upervisor han9book. I have thought many times about haying one of these but just ~aven't "gotten"aroundtoit" Do anyof you have one in place anti what do you think?:Ooes it help With your m ... o r~sponses More» " ~ Employee Communications o 10 Steps to a Health Savings Account (HSA) Posted -06/1812008 o Health Leaders Media FACT FILE -Hgalth Care Spending Posted -02/15/2011 o Health Care Reform: ODen Enrollment Comoliance Checklist Posted -02/15/2011 o Health Care Reform Timeline Po.ted -02/15/2011 MyWave Benefits is your information center that allows you to view basiC employee plan information. Benchmark Surveys Allows you to determine how your plans and programs compare to other employers across the u.s. MyWave® Community Share information and resources via the Community's interactive forum that allows you to post questions to your peers, provide insight into other users' questions, and to track responses based on topics or individual questions. Posting Center Our document posting capabilities allow a seamless exchange of information from our agency to you. Accessible 24/7, postings from our agency are timely, relevant, and easy to locate in one convenient place online. *Note: Your screen may not contain all the services shown in this sample. This screen sample includes all potential MyWave services; some are sold separately. ©2006, 2011 Zywave Inc. All rights reserved, Human Resources Tools Sapoznik Insurance is dedicated to helping you create and maintain a positive work environment by offeri!lg solutions for your organization's human resource challenges. Our services include: Clarification and advice on compliance with employment laws such as FMLA, ADA and EEO Employee Handbooks and Policies Employee Communications HR Communications and HR Tools Benefit Statements A community of professionals to discuss your day-to-day human resource challenges [Insert other services here] Often it can be more difficult to deliver the message than it is to create it. We recognize that many employers are seeking a more effective and efficient means of communicating important information to their employees. Fortunately, newer, more efficient ways of communicating human resources and benefits information are emgerging every day. Technology-based systems are forging the way toward improved communications, increased productivity, streamlined processes and cost savings for many human resources and benefits departments. Sapoznik Insurance is pleased to be able to offer you such a system. HRconnection® is a complete online employee communication tool that lets employers manage and communicate important company information in one secure and convenient location. Through it, employees can access: • Your company history and mission statement • Employee handbook and policies • Human resources and benefits forms • An explanation of their benefit plans, rates and options • Personal information such as vacation tracking and online benefit election The following is a fact sheet explaining HRconnection, plus examples of HR education, communications and forms we can provide for our clients. © Zywave, Inc. All rights reserved. HRconnection~ 5.0 RATED HR FOR HUMAN RESOURCEFUL 6 .. &£.",8" Wch:ome. to HRcoontictlo"nl WIu~I'l~f\/lI'{1lO:l'tllt'J yew 2·HIOl" ~~.~~:::~~~\~~1t;j~J·~~~~!~ l(I1'~l\;1*!\ ~b'x.¢ cur«n't'l.'IY .11\:1 W".tI ":iltoltl~'2 hmtf.f~_I(.t I)cti ~!H(t rtlu t1C"Cd4. ;milU~l!!d d~\ocr",Ght. 4I-HRconnectiOJT -f1=tLLb~1 ~,t.>u htr~'<lff :I.".UIlU~.~,~1 I"' .... ~. VtUl~ 1{I;r,(l~m.Lrd~ 01I.'rlIHllf""· b'~Q~~t>i.~_ ~~':~~:.~;~::.:z~1~t~~~:;~~I~:~;;t .. r. Ic-:~m-~.j",~,,t rn u-n "."-!lucrl, HRconnection® 5.0 is's virtual employee benefits expert, providing access to an easy-to-use website that delivers customized company and benefits information to employees in one secure place. HRconnection boosts productivity and costs savings by streamlining efficiencies, and helps employees help themselves to expertise and HR information online, anytime. Now that's resourceful. Contact Sapoznik Insurance today for more information. Call 305-948-8887 or visit http://www.sapoznik.com/default. © Zywave, Inc. All rights reserved. You need to educate and empower employees. Problem solved. FLEXIBLE AND SECURE Choose the portal features that make sense to your firm such as online benefits elections and vacation tracking, plus scheduling pre-built "set it and forget it" or custom employee communication campaigns, all in one secure location. EMPOWER USERS HRconnection® provides employees access to company information including job postings, policies, forms and announcements, along with managing time-off requests, benefits elections, and other HR-related tasks. DO MORE WITH LESS Ability to offer employees self- serve access to often- requested materials plus easy portal administration streamlines everyday tasks for all, while freeing up HR personnel to devote more time to strategic issues. Get resourceful today with HRconnection® 5.0. Interviews: What's Illegal to Ask? Federal and state laws require that questions on the job application, during the interview and during the testing process be job-related. Employers should not ask about race, gender, religion, marital status, disabilities, ethnic background, country of origin or age. Illegal interview questions are those that single an individual out for reasons that are contrary to equal employment opportunity and anti-discrimination laws. It is important to be aware of the laws to avoid legal penalties and potential lawsuits. Technically it is not illegal to ask these questions in a certain manner, but if a question has discriminatory implications and employment is denied based on the applicant's answer, the employer may have broken the law. The following are examples of illegal or inadvisable questions and legal or acceptable alternatives. 1. Subject: Relatives/Marital Status Illegal: What is your marital status? What is the name of your relative/spouse/children? With whom do you reside? Do you live with your parents? How old are your children? Do you plan to have a family? How many kids do you have? What are your child care arrangements? Legal: What are the names of relatives already employed by the company or a competitor? Are you willing to relocate if necessary? Are you willing to travel as needed by the job? (Must be asked of all applicants) Are you willing and able to work overtime as necessary? (Must be asked of all applicants) 2. Subject: Residence Illegal: With whom do you reside? Do you rent or own? Do you live in town? Legal: Inquiries about address to the extent needed to facilitate contacting the applicant. Will you have problems 4. Subject: Physical Health Illegal: Overall general questions which would tend to divulge handicaps or health conditions that do not relate reasonably to fitness to perform the job. Do you have any handicaps or disabilities? What caused your handicap? What is the prognosis of your handicap? Have you ever had any serious illness? Please complete the following medical history. Have you had any recent or past illnesses or There are many laws governing questions that employers may and may ask during the recruiting process. If a question has discriminatory implications and employment is denied based on the applicant's answer, the employer may have broken the law. This article offers examples of illegal or inadvisable questions and legal or acceptable alternatives. getting to work by 9 a.m.? 3. Subject: Pregnancy Illegal: Questions relating to pregnancy and medical history concerning pregnancy. Do you plan on having more children? Legal: Inquiries to duration of stay on a job or anticipated absences which are made to males and females alike. Do you foresee any long-term absences in the future? operations? What was the date of your last physical exam? How is your family's health? Have you ever been treated for a mental condition? Are you taking prescribed drugs? Have you ever been treated for drug or alcohol addiction? Have you ever filed a workers' compensation claim? Legal: Can you lift 40 pounds? Do you need any special accommodations to perform the job you've applied for?' How many days did you miss from work (or school) in the past year? The questions have to relate to the job. Are you able to perform the essential functions of this job with or without reasonable accommodations? 5. Subject: Family II/egal: Questions concerning spouse, or spouse's employment, salary, child care, arrangements or dependents. How will your husband feel about the amount of time you will be traveling if you get this job? What kind of child care arrangements have you made? Legal: You may ask whether an applicant can meet specified work schedules or has activities or commitments that may prevent him or her from meeting attendance requirements. Is there any reason why you can't be on the job at 7:30 a.m.? This job requires that you work overtime on occasion -would you be able and willing to work overtime as necessary? 6. Subject: Name II/egal: Any inquiries about an individual's name which would divulge marital status, lineage, ancestry, national origin or descent. If your name has been legally changed, what was your former name? Legal: It's legal to inquire whether an applicant has worked for the company or a competitor under any other name and to ask what name it was. Also acceptable: By what name do your references know you? Have you ever been convicted of a crime under another name? 7. Subject: Sex Illegal: Any inquiry that relates to sex. Do you wish to be addressed as Mr., Mrs., Miss or Ms.? Do you have the capacity to reproduce? What are your plans to have children in the future? Legal: None 8. Subject: Photographs II/egal: Requests that an applicant submit a photo at any time prior to hiring. Legal: Photos may be requested after hiring for identification purposes. 9. Subject: Age Illegal: Any question that tends to identify applicants age 40 or older. How old are you? When did you graduate from college? What is your birthday? Requests for birth certificate or record are illegal before employment. Legal: Are you 18 years of age? If hired, can you furnish proof of age? 10. Subject: Education Illegal: Any question asking specifically the nationality, racial or religious affiliation of a school. Legal: All questions related to academic, vocational or professional education of an applicant, including the names of the schools attended, degrees/diplomas received, dates of graduation and courses of study. What is the highest level of education you have completed? 11. Subject: Citizenship Illegal: Asking whether an applicant is a citizen or requiring a birth certificate, naturalization or baptismal certificate. Any inquiry into citizenship that would tend to divulge an applicant's lineage, descent, etc. Are you a citizen of the U.S.? Are your parents or spouse citizens of the U.S.? On what dates did you, your parents and/or your spouse acquire U.S. citizenship? Are you, your parents or your spouse naturalized or native-born U.S. citizens? What is your native tongue? Legal: Questioning whether applicant is prevented from lawfully being employed in this country because of visa or immigration requirements is illegal. It is legal to ask an applicant to provide proof of citizenship (passport), visa and alien registration number after hiring. If you are not a U.S. citizen, do you have the legal right to remain permanently in the U.S.? What is your visa status (if no to the previous question)? Are you able to provide proof of employment eligibility upon hire? Are you authorized to work in the U.S.? What languages do you read, speak or write fluently? (Ability must be relevant to performance of the job). 12. Subject: National Origin/Ancestry Illegal: What is your nationality? How did you acquire the ability to speak, read or write a foreign language? How did you acquire familiarity with a foreign country? What language is spoken in your home? What is your mother tongue? Legal: What languages do you speak, read or write fluently? This is only legal when the inquiry is based on a job requirement. 13. Subject: Race or Color Illegal: Any question that directly or indirectly relates to a race or color. What is your race? What is your complexion? Legal: None 14. Subject: Religion Illegal: Any question that directly or indirectly relates to a religion. What religious holidays do you observe? What is your religious affiliation? Legal: Can you work on Saturdays? (Only if it is relevant to the job.) 15. Subject: Organizations Illegal: To what organizations, clubs, societies and lodges do you belong? Legal: To what professional organizations do you belong which you consider relevant to your ability to perform this work? (Exclude those names that indicate the race, religious creed, color, national origin or ancestry of its members. These inquiries must only relate to the applicant's professional qualifications.) This HR Insights is not intended to be exhaustive nor should any discussion or opinions be construed as professional advice. ©2007·2011 Zywave, Inc. All rights reserved. 16. Subject: Military Illegal: The type or condition of military discharge or an applicant's experience in anything other than the U.S. Armed Forces. A request for discharge papers is illegal. Were you honorably discharged? In what branch of the Armed Forces did you serve? Legal: Inquiries concerning education, training or work experience in the Armed Forces of the United States. What type of training or education did you receive in the military? 17. Subject: Height & Weight Illegal: Any inquiries not based on actual job requirements. How tall are you? How much do you weigh? What color are your eyes and hair? Legal: Inquiries about the ability to perform a certain job. Being of a certain weight or height will not be considered a job requirement unless the employer can show that no employee with the ineligible height and weight could do the work. Are you able to lift a 50-pound weight, an essential function of the job? 18. Subject: Arrests & Convictions Illegal: All inquiries relating to arrests. Have you ever been arrested? (Arrests are not the same as convictions. An innocent person can be arrested.) Legal: Legal inquiries about convictions. Have you ever been convicted of any crime? If so, when, where and what was the disposition of the case? Have you ever been convicted under criminal law within the past five years (excluding minor traffic violations)? It is permissible to inquire about convictions for acts of dishonesty or breach of trust. These relate to fitness to perform the particular job being applied for. This HR Insights Is not intended to be exhaustive nor should any discussion or opinions be construed as professional advice. © 2007·2011 Zywave, Inc. All rights reserved. APPENDIX C COMMUNICATION CAPABILITIES Custom Employer jEmployee Communications Understanding the complexity of employee benefits plans is a challenge even for experienced benefits managers. Employers need to keep abreast of constantly changing trends, laws and other regulations. Employees need to be able to understand their benefits well in order to be wise consumers and understand the value of their "hidden paycheck." Unfortunately, most employers have limited resources in this area. The Sapoznik Insurance team helps you tackle your employee communication challenges. With strategic planning and a thorough understanding of your communication objectives, we provide custom communication materials that will help both you and your employees understand your plans and the issues influencing your benefits decisions. Below are the types of custom communications we offer -with a few samples included. Employee Benefit Communications Benefit communications include memos, flyers, payroll stuffers, posters and articles used to announce benefit changes, introduce new benefits or plans, or to help employees understand and use certain benefits. Benefit Statements We provide benefit statement items such as total compensation statement packets and a summary of an employee's benefits package, including salary and benefits. Consumer-Directed Health Care (CDHC) We supply everything you need, including letters, flyers, articles, payroll stuffers, posters and e-mails to help support your CDHC campaigns. Health Care Reform Everything from employee-facing articles to payroll stuffers to Legislative Briefs, our health care reform content keeps employers and employees in the know on this hot topic. Employer Education Articles and Newsletters You'll have access to educational articles covering many benefit topics. This also includes a quarterly Benefits Bulletin newsletter about the newest legislation issues and benefits trends, along with a monthly one-page newsletter covering highlights of current HR and benefit news. Employee Handbook & Policies Access a full employee handbook, as well individual policies, that you can provide to your employees to communicate company policies or procedures. Health Awareness Newsletter This monthly, customized, two-page newsletter for your employees covers various health and wellness topics. Know Your Employee Benefits Provide your employees with insight and information about insurance and employee benefits topics with this series. These brochures help your employees better understand their benefits, and can serve as a foundation for your ongoing employee communication campaigns. live Well, Work Well This series of flyers centers on health and wellness issues, educating employees on how to live healthy and productive lives. National Health Observances Calendar The NHO Calendar allows you to educate and inform your employees on wellness issues throughout the year by supplying you with national health observances and listings of materials that complement those observances. Prevention Newsletter This quarterly newsletter focuses on topics such as obesity, exercise, drug and alcohol prevention, the flu and much more. Retirement The documents included in our Savings Fitness and Know Your Retirement Benefits series will help your employees adequately prepare for their golden years. © Zywave, Inc. All rights reserved. We extend many of our value-added services to you electronically through, your personal Sapoznik Insurance website, Here is just a sampling of the information that we can deliver to you via the site: Legislative Briefs Select Reporting and Disclosure Requirements for Group Health Plans [-1" ._.--.. ----··.···--····.·······.·-.-·.---1 ! lfG"lNI .. 'i';.;H I i ~!~.llttP"IIo~Ud Uj«l",u,., ll<'lulr .. ",nL' rur (;.uup lIulib I .......... "M • ., .... _"_ ..... ~_; ............ _--"'u .. "".a_...,. II ~~"~E.iAif..7:';g~,~'7:?.E:::'-ia,,'" ---:--:l.-. ii'~': i==~~i;~i====---I ~Yl~ ~~~~l~~= I ~~~~~~~ I :"C,-,,-"c"-=::::O:,,-":':-; 1 l .. _____ .. _. __ . __ ._ .... _ ...... _._ . __ . Wellness Services Think About What You Drinkl [ .. _---_. __ ._---_._--] I . I. .. . I , I I ~;;;7§'fE..;-.?.."""'=.~:':"E~B I I ~~=~~(~ ... ~ ~ , =~~~~--"---... -'-i,,!! ~:::::~::: .. :::.:_::=r~~ ........ _LIII.r ........ ~., ..... ,,"-...... d._ ... ' ..... ,.....,.,---.. ... ...-,...,. .......... ~~_ ::::;; :.":'.:.:;: ::=:~::;:;:; :::=::::; ::;::=::-..:: :';:' I Handbook & Policies Employee Handbook J Health Care Reform Health Care Reform Timeline l_. ____ . ____ .. __ ... ___ .. _ .. Know Your Employee Benefits Is Your Drug Plan Hard to Swallow? -~~~~~~:-.\-:~1~\);:'1 ~ .. ;; .. ;;:-.~ ;.:.~ ~'". ." ~' .-\ .... J 'I \ .... '- .i..~(61\'< ! i '~' ~rJ':1L.':._.! ':.i.,. htO<ltOntaM.l~II ....... t .. s .. ~nowt O:-""'-I!'O~h_ .... ' ..... .. I I I ~~F-j~:~;;-;::~; -- 1._ ...... . Employer Education Articles & Newsletters Benefits Bulletin ...... ,_ .. _ ... ..- :~:~~ HRTooIs Employee Benefits Survey -----.-----I I ?JJ~t~l~&",;';~~~~ .. ~:-~· ==-----..... " ...... L ............... '''' ..... ,. ................. "'-................. • :: U , .... -.......... -1 ... -=""Z=~=~' H ~ ...... "'--...... ~~ ........ ~':""'''''''''''''''''' 'J Plan Designs Health Savings Accounts 1--.. -.--.. -.. -.. -.-.. -.. IAm.mit"t _ .,."-.. ,..-.-.. .....,, ...... --.... ~ ........ ~"'.~ , ...... \, ...... __ ............... , ..... , ..... _---,. .......... ly~ .. " • .-~-'-"' .. .--h---t-_""",,, :::!:.:.~~:;.~!~:::::=~!':.::::~,~~~.r. .. j ...... ~.··,.....· .. ~.y"·_ .... "~u.·~,,~_ . ...... ~-t-...... _-"1 ..... , ........ ,-'-. _ •• "--'~~ ;;-;:;,::;:~~';:;::.:~:,:;-" =-,,'11 ~'" ......... ~ ................. IIIIo1J' r~.:E:'l~~-;:~::~~:.E.=:~: '''-.,. .. .---.. ~"" ... .,.,. ... -.. -........... , ... , .... , ...... .-< .. -...... ~-...... Live Well, Work Well Healthy Portion Sizes IIcnlthy Portion Sizcs I I .. :.1 ~~ .~ ()\0 ,J 4L ~Discounts Pharmacy convenience starts here. Having access to a discount prescription program can be an enormous benefit to anyone who has a chronic condition. When you have to buy the same medications regularly, it makes a huge difference to save as much money as possible each and every time. A discount prescription plan can help lower the prohibitive costs of these items. You no longer need to search far and wide for discount prescription programs that offer genuine savings. Publix. ~_ 0. Walmart CVS pharmacy 1100 NORTHEAST 163rd STREET \ NORTH MIAMI BEACH, FLORIDA 33162\ TEL.1( 877) 948-8887\ WWW.SAPOZNIK.COM Keeping your Health Costs Down As an organization, if the cost of your claims exceeds the amount you paid in premium for the year, the insurance company will have to compensate for their loss, resulting in a rate increase the next plan year. Insurance claims are driven up by a variety of controllable factors, so keeping your group's claims low all boils down to being a smarter consumer of healthcare services. If you knew you could receive the same treatment, tests or prescription medicines at a small fraction ofthe cost, would you take advantage ofthe savings? Sapoznik helps companies avoid rate increases by implementing employee education programs, teaching employees to use their plan wisely and pay less out of pocket. Less money spent on premium increases and out of pocket costs means more money being spent on growth and development of your company and employees. Your organization is growing fast; can you afford to waste? 10 Ways to Be a Smarter Healthcare Consumer 1. Use the Emergency Room Wisely (See Emergency v Urgency) 2. Use Freestanding Facilities for Diagnostic Savings 3. Participate in Discount Prescription Programs 4. Use mailorder pharmacies and generics whenever possible 5. Use in-network doctors and hospitals to avoid penalties 6. Organize your Health information in a file 7. Check Doctor & Hospital bills and invoices for accuracy 8. Limit poor health choices that result in costly procedures (overeating, smoking, drinking, laziness) 9. Take advantage ofTax savings on medical insurance by learning about HSAs, FSAs and HRAs. 10. Read More about being a smarter healthcare consumer at www.sapoznik.com Ii',.'::' www.sapoznik.com 1.877.948.8887 Jesearch@sapoznik.com ------------ Emergency v. Urgency (Emergency Room v. Urgent Care Centers) Emergency Urgency ·Uncontrollable Bleeding .Sprains + Strains Emergency rooms are not always the fastest choice for your medical care ·Seizure/Loss Consciousness .Minor broken bones needs-and certainly not the most cost-effective. Studies show that a .Chestpain/ Shortness of Breath .Mild asthma attacks significant number of emergency room visits aren't really emergencies at ·Overdose or Poisoning .Minor infections all-almost 70%, to be exact. For conditions that aren't life-threatening, ·Sudden Paralysis/Slurred Speech .Small cuts you may be able to save time and money by going to an urgent care ·Broken Bones .Sore throats facility. Going to ER for non-emergent needs can result in wait times of ·Severe Pain .Rashes several hours to receive care, as patients with more emergent needs will be ·Active Labor .Minor burns seen first. Average time spent in an Urgent Care Center averages less than ·Severe Head Injury .Urinary tract infections 1 hour (as compared with 3 hours at the ER), and costs 50% less than the ER .Spinallnjury ·Pelvic infections ..... '.~ < '., T:-,~"'· on average. .~' I' -', ", ,,',', I I {I . .• :.';,.,\:1'11)1'1'>'< _ ~_-_~"f. ~~::. _~ SAP~~IZNIK HIEALTH &; W:E!L'LNESS, ~--------------------------------.J.'-2:2c.",::.:c. __ , Diagnostic Testing (Free Standing Diagnostic Facility v. Doctors Office) Diagnostic Tests ·CT or CAT Scan ·MRI .MRA Diagnostic Imaging and Testing can be expensive, especially at a hospital-based .BMD or Bone Density Scan facility. With many health .plans ~~u can save o~ out-of-pocket costs by having the _ . . .Ultrasound/Sonography study done at a freestanding faCility. Freestanding facilities often have no wait to be ?;:"~::/\'.:~:.: .Nuclear Medicine Studies seen on the d~te of appoint.~ent and a much lower copayment of coinsurance rate .' .. "'.:" ~:~;u~t,~ ·Fluoroscopy Studies than at a hospital based faCility. ,,---------------litl; l:i~, Prescription Savings (Free & Reduced-Cost Rx Drug Programs) '!i:i,~/'~ .f $4 Prescriptions (sample list) Free Antibiotics":.:r~ '; Prescription Drug Costs acco~nt for nearly 30% .of all health insurance claims, as well as a . . . i·,j:~{;~ lot of money out of pocket with Rx copays ranging from $10, $20 and $30 for a 1 month ·Albuterol ·Amoxlclilln !I:>~'P' . supply. To promote their new pharmacy divisions, Target, Walmart and Publix have .Benazepril ·Ampicillin (~"~i.·: created a discount prescription drug program charging just $4 for a 1 month supply and ·Carvedilol ·Cephalexin I{'::!,'~:~( $10 for a 3 month supply of participating Rx drugs. No insurance is required (only a ·Fluconozale ·Sulfamethoxazole i.::··:~:>i prescription), so you pay less out of pocket and the claims never hit your plan. ·Erithromycin ·Trimethoprim f:'F'j:;~~~~:' In addition, Publix is filling FREE prescriptions for select antibiotics. Simply bring in the ·Hydrocortisone ·(jprofloxacin I>\~~{;: prescription for any of the medications below, and you will be provided with a 14-day 'Lithiu~ Carbonate ·Penicillin VK 1~.;\ii~L', : ..•...• supply at no cost to you-regardless of your prescription insurance provider or the ·Prednlsone ·Doxycycline Hyclate b,:'·~;;C·· " number of prescriptions you need filled. ·Trazodone .Erythromycin Stearate li;t~~~ '---____________________________________________________ iEi·::.:-C .. Hospital Emergency Room You may be tempted to go to the emergency room (ER). But, this may not be the best choice. At the ER, true emergencies are treated first. Other cases must wait- sometimes for hours. And, it may cost you more. Go to the ER for: • Heavy bleeding • Large open wounds • Sudden change in vision • Chest pain • Sudden weakness or trouble talking • Major burns • Spinal injuries • Severe head injury • Difficulty breathing • Major broken bones Urgent Care Sometimes, you may need care fast. But, your Primary Care Physician may be unavailable. You may want to try an urgent care center: They can treat many minor ailments. Chances are you won't have to wait as long as at the ER. You may pay less, too. An Urgent Care Center can help with: • Sprains • Strains· • Minor broken bones (example: finger) • Minor infections • SmaJI cuts • Sore throats • Rashes • Colds • Flu I , "\ Ii :~~\\ 11/11;: ~ ~ .;~ --SAp:0ZNIK H E A l·T H &, ii\li:E L L N E 5 S --:~. 1.877.948.8887 www.sapoznik.com Hospital VS· ) Free-Standing Facility I , ,\,,',:1 I//~ , ~\\\\ 1/1/40 ----==s -:=;::: ~ ----SAY(?!)ZN I K HEALTH &';;v,i'ELLNESS ~~ ~t t':ll: :~<.> Diagnostic imaging can be expensive. With many health plans, you could save. 1.877.948.8887 on out-of-pocket costs by having the study done at a freestanding facility. In addition to standard X-rays, diagnostic imaging studies include: Magnetic resonance imaging (MRI) Magnetic resorulnceang'ogr~phY(MRAl .... , .~ ~ '.;' .. :'. '. ,',. : " _. .~. F . -. • ~ ~ " , . ~ Bone mineral density (BMD).or bone density SC3n ' Ultrasound scanning, also called sonography •.• ·Diagnosticimaging study cost examples: Advantages of using a freestanding facility: • No long wait for an appointment • Nowait, or only a short wait, on the day of your appointment • Lower co payment or coinsurance than you'd pay at ahospital-basedftcility *1ISo ',-. ,-.,,p~~~--,\If~.i~:=I " . Diagnostic study ,.lrr:~~~~~~;~?~~~~I:;i,-i;~i:{{-~l~£~~~~t~!t~~~~~~~!t~g~~]H.i~]~CEL~~~!l~ttt~!E~~~ MRI $1,035 $617 $418 CTscan ~$589 '. ",$26:0 ...: ... --~: : . ...:...." :..-:....~ ... -.... -..... ~::'.-..:-.---',.,--. ~".:~.: Prices based on national averages. I ~h!~ well, wo~~ well Summer Safety Tips Summer is in full swing, which means plenty of time enjoying the outdoors. However, don't forget to protect yourself and your family against summer risks. Sun Safety Time in the sun brings many risks, particularly skin and eye damage from the sun's rays. Remember these tips: -Always wear sunscreen with at least 15 SPF and reapply often . (read the label for specifics). Use SPF 30 or higher for children. -Protect skin when the sun is strongest (10 am to 4 pm) -stay in the shade if possible or under an umbrella or large-brimmed hat. -Always wear sunglasses with 100 percent UV protection when outdoors to protect your eyes. -Check your medications -some increase sun sensitivity so you may need to take extra precautions. July 2011 Heat Protection High summer temperatures can cause illnesses such as heat exhaustion or even heat stroke. This risk is even greater if engaging in physical activity or working in hot weather. Make sure to: -Drink plenty of fluids, but not caffeine or alcohol. Don't wait until you are thirsty to drink. -Wear lightweight, loose-fitting clothing. -Try to schedule vigorous activities for early morning or evening hours. -If you are being active in the heat, take time to rest in the shade or indoors, and pay attention to your body. Don't overdo it! -Never leave children in a parked car, even with the windows open. Water Safety Summer is the perfect time for days at the pool, at the beach or out on the lake -just remember to keep the kids safe! Always closely supervise children playing in or near the water. Kids who cannot swim should wear approved life vests, even when in boats or near water. If you have a backyard pool, keep it fenced in and locked so your or other children do not accidentally fall in. Caring for a Parent? If you are helping care for and support your elderly parent, you understand the time and cost burden it can be. But did you know there are government programs that your parent may be eligible for that can provide help with home health care, tax breaks, lower energy bills and more? Check out these websites to find out if your parent is eligible and for additional resources to help you obtain the best care for your parent or older relative: www.benefitscheckup.org www.benefits.aov SJ\POZNIK HEALTH & WEll.NESS www.sapoznik.com 1.877.948.8887 :::'. ' ;~, .',. .. "", :-. ' .:-; . .. . IRSAilnounces •• ' ·Brea~fPuniRs.are' Tax' D~ductibje" ' IRS Announces Breast Pump are Tax Deductible On Feb. 10, 2011, the IRS issued Announcement 2011-14, in which it concluded that breast pumps and supplies that assist lactation qualify as "medical care" under Section 213(d) of the Internal Revenue Code (the Code). The IRS compared these items to obstetric care, stating that they are for the purpose of "affecting a structure or function of the body" of the lactating woman. This conclusion is a reversal of the IRS's previous position on the tax treatment of these items. The IRS's interpretation may affect individual taxpayers, as well as sponsors and administrators of health flexible spending accounts (health FSAs) and health reimbursement arrangements (HRAs). The IRS plans to revise Publication 502, Medical and Dental Expenses, to include this new information. CONTINUED ON PAGE 2 Getting Your Workplace Wellness Program Started Workplace well ness can lower health care costs, increase productivity, decrease absenteeism and raise employee morale. And because employees spend many of their waking hours at work, the workplace is an ideal setting to address health and well ness issues. But where do you start? Gain Support from Management Support from all levels of management is a key to the success of your wellness program. To ensure the support of management, inform managers about the program early on and encourage them to participate. Communicate clearly and often the goals and benefits to the company and participants. Designate a Coordinator The level of success for the wellness program is often linked to the coordinator's time and ability. It is essential that some or all of the coordinator's time be dedicated to the well ness program. If this isn't possible, then the company may want to consider contracting with an outside party to provide programming. Local health care organizations and YMCAs often provide this service. Check with your local contacts to see if this is an option. CONTINUED ON PAGE 2 Getting Your Workplace Wellness Program Started, cont. Analyze Your Needs Complete a worksite environmental assessment and conduct an employee interest survey to collect information on the topics that would be of most interest to the staff. This type of prior planning and analyzing can help you get the most for your investment. Plan activities and initiatives, and set program priorities based on the results of these assessments. Develop an Action Plan This should include specific goals and objectives, strategies to meet these goals, a timeline, a budget and an evaluation plan. If your goals are clearly identified, it will be easier to evaluate the effectiveness of your well ness program. Invest Accordingly Monetary costs can fluctuate widely, depending on whether the employer pays all costs, the employees pay all costs or the costs are shared. The Well ness Council of America estimates the cost per employee to be between $100 and $150 per year for an effective wellness program that produces a return on investment of $300 to $450. Keep in mind that the return on investment will likely be greater with more comprehensive programs, so the higher cost will also generate a greater return on investment due to lower health care costs and less absenteeism. Implement and Communicate the Plan You need an effective communication strategy to help put your plan into motion, to get employees to buy in and encourage participation. Be sure to include plenty of education so employees understand why you're implementing a wellness program, and the benefits they can gain as a result of participating. After you've laid the groundwork to develop a well ness program, take the time to plan the components that will result in a quality program. Following these steps and not rushing the planning process will ultimately make your program more successful. IRS Announces Breast Pumps are Tax Deductible, cont. Affect on Individuals The new IRS position can potentially benefit individual taxpayers that are eligible to deduct their medical expenses. It means that expenses paid for breast pumps and supplies that assist lactation may be tax-deductible medical expenses for the individual. In order to take the tax deduction for these items, the individual taxpayer must meet the other applicable requirements of Code Section 213. For example, the taxpayer's total medical expenses must exceed 7.5 percent of his or her adjusted gross income. Affect on Plan Sponsors The IRS stated in its announcement that amounts reimbursed for breast pumps arid supplies that assist lactation under Health FSAs, Archer medical savings accounts, HRAs or health savings accounts are not income to the taxpayer. Accordingly, plan administrators may reimburse participants for costs for breast pumps and lactation supplies. They no longer will need to determine whether these items qualify as dual purpose expenses or require documentation from a medical practitioner that the item is recommended to treat a medical condition. For a copy of IRS Announcement 2011-14, see www.irs.gov/pub/irs-drop/a-11-14.pdf. Misclassifying Workers The relationship between the employer and the worker is not always straightforward, but despite the possible discrepancies, it is extremely important to properly classify your workers. The tax implications vary depending on the type of worker, and the penalties for misclassifying a worker can be huge. For example, a Florida-based company with locations across the U.S. recently agreed to pay more than $754,000 in overtime back wages after the U.S. Department of Labor found that the company had incorrectly classified workers under the Fair Labor Standards Act. All of the fines were preventable had they properly classified their workers. lH<;t{-:Zlril(tH:'itmi;;c),i ;.; SE~~ND (.llJARTER,2011 Classifying Workers Before determining how to treat payments your company makes for services, you must categorize the business relationship that exists between your company and the person performing the services. Is the worker an employee or a type of independent contractor? Workers may be categorized as one of four types: employees, statutory employees, statutory non-employees or independent contractors. Because not every worker can be easily classified in one category, it is important to take the entire working relationship into account. Consider the extent of the right to direct and control the services of the worker. And after you've classified the worker, document each of the factors used to determine how you came to your classification decision. Consider contacting a tax adviser if you are uncertain about a worker's status. Or, Form SS-B, Determination of Worker Status for Purposes of Federal Employment Taxes and Income Tax Withholding (www.irs.gov/pub/irs-pdf/fssB.pdf) can be filled with the IRS. The IRS will review the facts and circumstances and officially determine the worker's status. Helping Employees through Financial Difficulties Most people go through financial heartache at some point or in their lives. Whether it's paying back student loans, paying high mortgage payments or affording steep gas prices, sometimes staying financially afloat can be a very difficult. If your employees find themselves struggling finanCially, there are things you can do to help them resolve these issues. You may already have the tools in place -your Employee Assistance Program (EAP). By incorporating financial assistance into your current EAP, you will be able to help your employees resolve their struggles with resources you can easily provide. Typical Financial Services in an EAP • Tax planning and management • Investments • Risk management and insurance • Budget and cash management • Estate and gift planning • Retirement EAP Financial Service Benefits • Provides employees with much needed financial assistance and advice • Enhances the awareness of benefits that you offer • Attracts potential employees and retains existing ones • Assists in the work/life balance struggle by providing a service at work • Allows employees to make sound financial decisions • Enhances your compensation package and its value to your employees Promoting Your EAP To promote the use of financial assistance through your EAP, consider the following actions: • Periodically remind your employees that you have an EAP in place to assist them with all facets of their lives. Send out an email or newsletter highlighting its features. • Consider developing a partnership with a nonprofit organization in your area devoted to assisting individuals with financial trouble. Incorporate their tools into your EAP and offer a direct connection for your employees to those professionals. • Find ways at your office to help employees save money, such as starting a green campaign. Suggest that employees fill up water bottles instead of buying bottled water, turn off lights at home, open windows instead of using the air conditioner, etc. Ask that employees work these behaviors into both their work and home lives. • Help employees fight high gas prices by starting an online carpool message board, giving discounts for using local transit or offering telecommuting options so employees can work from home. The information contained in this newsletter is not intended as legal or medical advice. Please consult a professional for more information. © 2011 Zywave, Inc. All rights reserved. ~~ve well, wo~~ well Fit Physical Activity Into Your Routine One of the best things you can do for your health is get regular physical activity. It can help you reduce your risk of disease, control your weight and reduce stress. However, exercising regularly is easier said than done. These tips can help you work physical activity into your daily routine. At home: Clean the house, wash the car or do yard work, rather than hiring someone else to do it. Stand up or walk around while talking on the phone. Get the whole family involved! Play with your kids or plan family hikes, bike rides and other activities. Lift weights or do other exercises while watching television. Walk the dog or push your baby's stroller around the neighborhood. At work: Take the stairs instead of the elevator. Walk over to someone's office rather than calling them. Take walks at lunch or break time and ask a coworker to join. Schedule walking meetings for short chats or brainstorm sessions. Join a company sports team. On the go: Park in the back of parking lots to increase your walking time. Get off the bus one stop early and walk the rest of the way. Walk or bike to nearby destinations instead of driving. Make plans to do physical activities with friends, such as play tenniS, hike, go swimming or join a recreation sports league. When golfing, walk instead of using a cart. Save for Their Future College may seem a long way off for your children, but the sooner you start saving, the more you'll be able to help your child fund his or her education. Consider these tips: -Open a savings account the day your child is born. -Put money away on a consistent basis, such as an automatic payroll deduction. Adjust this amount as your salary increases. -Save windfalls such as tax refunds and bonuses. Ask other relatives to contribute in lieu of gifts. Protect Your Vision Eye health can become an afterthought, particularly for people who have never had vision problems. However, getting regular eye exams and protecting your vision is important to help avoid eye conditions and discover problems early so you can seek proper treatment. The most important step for maintaining eye health is getting regular eye exams. Often, people don't realize their vision has decreased and that glasses or contacts could help them see better. In addition, eye exams can help diagnose diseases such as glaucoma and diabetes, which may have no obvious symptoms. Don't forget to take your kids in for regular eye exams as well; vision problems can decrease performance at school and make daily activities harder for your child. stress Relief at Work Do you often feel stressed or overwhelmed at work? Strive to reduce your stress with these suggestions: -Plan your tasks. Create a to-do list each day, set realistic deadlines for yourself and prioritize tasks by importance. -Recognize when you're feeling stressed and address it. Take a short break and meditate, go for a quick walk, switch tasks or turn on some relaxing music. -If a task or problem is overwhelming you, take a break and return to it later. Also consider asking for assistance, advice or tapping into other available resources. -Consistently communicate with your manager about your workload and to clarify expectations and deadlines. -Find healthy ways to cope with stress, such as physical activity, meditating, reading a book or chatting with a friend. Other steps to protect your vision include always wearing sunglasses when out in the sun, wearing protective eyewear when performing dangerous work and resting eyes periodically when at a computer for extended periods of time. o Banana Yogurt Shake 1-1/2 cup fat-free milk 4 small bananas, peeled 1 cup low-fat plain yogurt 1 tsp. vanilla 1/2 tsp. cinnamon 1/8 tsp. nutmeg 1 cup ice cubes -, Combine all ingredients except ice cubes in blender; process until thick and creamy. Add ice cubes and process until smooth. Makes 4 servings (160 calories each). This brochure is for informational purposes only and is not intended as medical advice. For further information, please consult a medical professional. © 2011 Zywave, Inc. All rights reserved. KNOW YOUR EMPLOYEE BENEFITS Benefit and insurance issues important to you -brought to you by the insurance specialists at: Sapoznik Insurance 10 Easy Ways to Stretch Your Health Care Dollars What to do to protect your pocketbook You've no doubt noticed that each year, your health care costs go up. This continuing trend can dramatically impact your budget. While it's difficult to control all the factors that contribute to rising health care costs, stretching your health care dollars is easier than you think -below are 10 easy ways to ensure you get the most bang for your buck. 1. Understand how your health plan works. This is the first and probably most important step. You need to know what is and what is not covered what procedures you need to follow to ensure your claims are paid, and which providers and facilities to use to get the most cost-effective care. Know the deductibles, copayments and other out-of-pocket costs you are responsible for paying before you use medical products or services or get a prescription filled. 2. Use in-network providers. Participating providers (doctors, hospitals, and other providers in your plan's network) generally charge discounted rates for plan members. When you go to a non-participating provider you will likely pay a higher coinsurance percentage (for example, 30 percent out-of-network versus 10 percent in-network). And, you will likely have to pay the difference in price " between the participating provider's discounted fee and the non- participating provider's "regular" fee. 3. Look into freestanding surgical and diagnostic centers. If you need surgery, you might save money by The most cost-effective way to keep health care costs in check is to make better decisions about the way you live, including the way you eat and " having it performed at an ambulatory surgical center (a clinic that is not associated with a hospital.) These sites usually charge less than hospitals or their outpatient surgical centers. Freestanding diagnostic centers are also available and tend to charge less for certain tests like MRls, CAT scans, X-rays and bone density scans. But before you go, make sure the facility is in your plan's network and that your plan's benefits cover the service. As always, talk to your doctor to be sure this course of action is appropriate for you. 4. Ask your doctor about home testing and monitoring devices. Home tests for blood pressure, diabetes and other conditions can help ensure you are following your doctor's orders and that prescribed treatments are working. These tests will usually cost less than in-office testing. Check with your doctor to be sure in-home testing is appropriate, report your results regularly and call your doctor if you notice anything unusual. . 5. Only go to the hospital emergency room for true emergencies. If you need medical care when your regular doctor is not available, think about going to an . urgent care center rather than a hospital emergency room. This can often be a tough call, but for a cold or a minor sprain, avoiding the ER will probably save you money for two reasons: 1) the copayment is usually lower for a doctor visit or an urgent care visit, and 2) your insurer might make you pay for the full cost of care if you use an emergency room for a non- emergency. Plus, getting care at an urgent care center will almost certainly be faster than at the ER. Call your plan's health hotline, if available, to get KNOW YOUR EMPLOYEE BENEFITS advice on how, wren and where to nationwide. Here are some ways you seek care in a non-emergency can reduce your prescription drug situation. costs: 6. Carefully check all medical bills. • Use generic drugs whenever Insurance companies and hospitals possible, even for over-the- are not exempt from making billing counter medications. errors. Insurers often miscalculate the Remember, the most family deductible, so keep a careful expensive drug doesn't tally of individual as well as total family indicate it's the best. There payments to be sure you don't pay too are usually generic much. If you have a hospital stay, try equivalents that are less to keep a log of all the services, expensive than the drugs you medications and supplies you are see advertised on TV. Before given, so when you get a bill you can your physician writes you a be sure you are not charged for prescription, ask about procedures you didn't have or items generic equivalents, lower- you didn't use. Ask for an itemized bill. cost brand name drugs to treat the same condition and 7. Use any additional programs or even over-the-counter discounts provided by your options. employer or health plan. Many health plans provide access to free disease • Know how your drug plan management programs for chronic works. Check your conditions like asthma, diabetes and copayments and know the heart disease. These programs can maximum amount your plan help you stay healthy and manage will pay for in one year. Find your condition, and can possibly save out if your plan has a you money in the long run. In addition, formulary (a list of preferred many employers offer complementary drugs that are covered). A programs that are designed to prevent health plan with a closed illness and lower health costs over the formulary pays only for long run. These programs may include certain pre-approved drugs. A smoking cessation and weight loss plan with an open formulary programs, or discounts on fitness will cover most drugs but at clubs or other items that help you live varying prices. a healthy lifestyle. • Use a mail order pharmacy if 8. Live a healthy lifestyle. Healthy one is available. Ordering habits like exercising regularly, eating prescriptions by mail can well and not smoking can increase save 10-15 percent and is your stamina, lighten your mood and perfect for patients who take lower your risk for certain diseases. medication on an ongoing Aside from the physical and basis and can place orders in psychological benefits, healthy living advance. can also offer financial rewards, such as lower premiums for non-smokers • Talk to your doctor. Make and fewer doctor visits for those with sure your physician knows if low blood pressure. you have to pay for 9. Make careful decisions about prescriptions out of your own pocket. Often there are less prescription drugs. Prescription expensive but equally drugs are the fastest rising area of effective treatment options. health care costs and one of the biggest reasons behind dramatic • Compare prices. Shop increases in health care costs around for the pharmacy that offers the best value for your needs. You may even need to get different medications from different pharmacies depending on which offers a better price. • Consider pill-splitting. Some medications can be obtained at double the prescribed dose, and then split in half. This practice can result in 50 percent savings. You must be sure your medication is appropriate for splitting, so talk to your doctor first. Some medications require very precise dosing, and others simply cannot be split effectively or accurately. • Look into manufacturer aid programs. Most major drug manufacturers have programs to subsidize patients who are not able to pay for medications they need. All of these programs require your doctor to apply for you. • Take all medications as prescribed. Not refilling your prescription might seem like a good way to save money, but it may in fact cost you more money in the long run. Many drugs, when taken as directed, can help prevent expensive medical care or hospitalization in the future. 10. Use a health care spending account to pay for medical expenses with pre-tax money. If your employer provides you access to a Flexible Spending Account (FSA) or Health Savings Account (HSA), use it. These accounts let you set aside pretax money from your paycheck to pay for eligible items like prescription drugs, deductibles, coinsurance, dental expenses and vision care. You get to save for these expenses gradually, rather than having the money in your checking account when KNOW YOUR EMPLOYEE BENEFITS the need arises, And, because you don't pay taxes on the money, you are actually getting a "percent off' or a discount on everything you purchase with your saved money, For example, assuming the government takes 20 percent of your income, and you put $500 in your health care spending account, you save about $100 in taxes. Health care costs are tied directly to utilization; when you use your health plan more, there are more claims, And the higher the claims, the more you and your employer must contribute to pay for these claims, Don't forget that the most cost effective way to reduce the cost of health care is to make better decisions about the way you live, including the way you eat, exercise and spend your health care dollars, This article is provided by Sapoznik Insurance. It is to be used for informational purposes only and is not intended to replace the advice of an insurance professional. Visit US at http.llwww.sapoznik.comfdefaulthtm © 2007 -2011 Zywave, Inc. All rights reserved Employee Benefits Survey strives to provide useful, valuable, comprehensive and affordable benefit programs for our employees. Each year, we review our current programs -particularly our health and dental plans -to ensure they live up to these goals and are meeting our employees' needs. . Please take a few moments to complete this survey and help us with our annual benefits review process. Your input is important to us regardless of whether or not you currently participate in any of the programs. Please return the completed survey to HR. Thank you. 1. Are you currently enrolled in the employee health care plan? Yes 0 No 0 2. If you answered no to question 1, are you: Covered under spouse's plan? 0 Covered under another plan? 0 Uninsured? 0 3. If you do not have health insurance, are you uninsured because of: Cost 0 Other 0 -please explain: _______________________ _ 4. Are you currently enrolled in the employee dental care plan? Yes 0 No 0 5. If you answered no to question 4, are you: Covered under spouse's plan? 0 Covered under another plan? 0 Uninsured? 0 6. If you do not have dental 'insurance, are you uninsured because of: Cost 0 Other 0 -please explain: ________________________ _ 7. How would you rate the information you receive from about your benefit plans? Excellent 0 Above average 0 Average 0 Below average 0 Poor 0 8. What is your preferred method for receiving benefits communication? Written material 0 Easy to access website 0 Slide or video presentations 0 Employee meetings 0 E-mail 0 Other 0 -please explain 9. When you want detailed information about how your benefits work, where would you turn? Please rank your answers as 1 being the first place you would turn and 5 being the last place you would turn. ' __ Supervisor __ HR department __ Company Intranet Insurance Broker Benefits Booklet 10. How well do you currently understand how your benefits work? 1 meaning very well and 5 meaning not at all. 11. How well do you want to understand how well your benefits work? 1 meaning very well and 5 meaning not at all. 12. Which benefits are most important to you? Rank the following benefit plans in order of importance, with number 1 being most important, and number 6 being least important. __ Health/medical plan © Zywave, Inc, All rights reserved. __ Dental plan __ Prescription plan __ Employee assistance program __ Short-term disability plan __ Long-term disability plan 13. Is your spouse eligible for medical insurance and/or other benefits from his or her own employer? Yes D No D Not applicable D 14. If your spouse is eligible for benefits from his or her own employer, does he or she participate in those benefit plans? Yes D No D Not applicable 0 15. If coverage were available for your spouse from his or her own employer, would you be willing to have your spouse use his or her employer's plan (rather than the dependent coverage offered by the plan) if you were paid a fee to do so? Yes D No D Not applicable 0 16. Please mark the answer that best describes your overall feeling about the indicated benefit plans or plan elements. Medical Plan Excellent D Above average D Average D Below average D Poor D Medical Plan Provider Network Excellent D Above average D Average D Below average D Poor D Dental Plan Excellent D Above average D Average D Below average D Poor D Dental Plan Provider Network Excellent D Above average D Average D Below average D Poor D © Zywave, Inc. All rights reserved. Accidental Death & Dismemberment Plan Excellent 0 Above average 0 Average 0 Below average 0 Poor 0 Short-Term Disability Plan Excellent 0 Above average 0 Average 0 Below average 0 Poor 0 Long-Term Disability Plan Excellent 0 Above average 0 Average 0 Below average 0 Poor 0 Prescription Drug Plan Excellent 0 Above average 0 Average 0 Below average 0 Poor 0 Life Insurance Plan Excellent 0 Above average 0 Average 0 Below average 0 Poor 0 17. What do you think is the annual cost per employee for providing medical and dental benefits? $1,000 -$2,500 0 $2,500 -$5,000 0 $5,000 -$7,500 D $7,500 + 0 18. Would you prefer to pay more money from your paycheck for medical insurance (premium contributions) or more money when you actually go to the doctor or hospital (for example, pay higher deductibles and higher copayments)? More money from my paycheck 0 More money only when I go to doctor or hospital) 0 Do not understand 0 © Zywave, Inc. All rights reserved. 19. What is your impression of's benefit plans compared to other local employers? Excellent 0 Above average 0 Average 0 Below average 0 Poor 0 20. On a scale of 1 to 5 where 5 equals "a lot" and 1 equals "not at all", how much of an impact did benefits have on: Your decision to join the company? 1 2 3 4 5 If over 3, which benefits? Your decision to stay with the company? 1 2 3 4 5 If over 3, which benefits? 21. Rate your benefits in terms of importance. Please circle the number that best corresponds to the degree of importance you place on the following benefits. © Zywave, Inc. All rights reserved. 22. Please answer the following questions related to possible plan alternatives. Would you like to have different medical plans to choose from? One may cost more and provide higher benefits, while another may cost less and provide lesser benefits. YesD No D Would you like the opportunity to trade some of your current benefits for others of more importance to you? YesD No D Would you consider trading (or giving up) some of your benefits in order to receive more money in your paycheck? YesD No D The IRS allows employees to establish an employee-owned health savings account (HSA) that secures pretax dollars in a fund for future medical needs. HSAs are established with high- deductible health plans that come with much lower premiums than traditional plans. If you had the option of participating in a high-deductible health plan in conjunction with owning a HSA, would you consider it? YesD No D The IRS allows employers to establish a Health Care Reimbursement Account to help employees pay for certain health care costs with pretax income that they must otherwise pay for with after-tax income (for example, deductibles and non-covered medical expenses). If you could allocate a portion of your income to that account, would you choose to do so? YesD No D 23. Please provide any additional comments on how we can improve upon our employee benefit plans, or how we can better meet your needs. Thank you. © 2007-2010 Zywave, Inc. All rights reserved. © Zywave, Inc. All rights reserved. APPENDIX D ENROLLMENT SUPPORT 2011 OPEN ENROLLMENT Health· Dental • Vision • Life • Short Term Disability • Long Term Disability • LTC Besides the opportunity to choose coverage, open enrollment is your only time to make changes (unless you have a Qualifying event, such as ,childbirth, divorce, etc.) until next year's open enrollment. ~IIP~ <:~ V ~~. ----------~ -- Please review your provider choices prior to open enrollment by visiting: -~ -----. SAW~iiZNIK H E A L T H & Wi:1; L L N E S S http://avined.com Carrier representatives will be on hand to answer any questions you may have regarding your policies. \' 1.877.948.8887 www.sapoznik.com WELCOME TO YOUR 2011 L I We are proud to announce the Open Enrollment for your compre- hensive employee benefits package. To help you make informed decisions during the Open Enrollment process, we have created this Benefits At-a-Glance guide to outline your options for benefit elections. As a valued employee, we are proud to bring you top -tier benefits at the most competitive rates in the indus- try, along with other value added work-life benefits and wellness programs. Please refer to this guide for in- formation such as plan designs, co-payments, and programming. Once again, we thank you for being a valued employee, and are proud to provide you with benefits towards creating a healthy happy life. Humana Telephone: 1 800 448-6262 www.humana.com Guardian Telephone: 1 (866) 866-4542 www.guardiananytime.com Guardian Telephone: 1 (866) 866-4542 www.guardiananytime.com Lincoln Financial Telephone: 1 (800) 423-2765 www.lfg.com Colonial Life Telephone: 1 (800) 325-4368 www.coloniallife.com John Hancock -Long Term Care Telephone: 1 (800) 377-7311 www.johnhancockltc.com Denise Abi-Fadel, CFP Telephone: 1 (800) 892-5558 ext. 87909 Telephone: 1 (800) 448-2542 www.valic.com For any customer service related issues, including ID Cards, En- rollment, Benefits questions, etc., please contact: Christine Nun:z:io, Senior Account Manager christinen@sapoznik.com Robin Konikoff, Account Manager robink@sapoznik.com Telephone: (305) 948-8887 Fax: (305) 948-5588 For any claims issues, please contact: Gladys Ortega, Claims Specialist Telephone: (305) 948-8887 Fax: (305) 949-1049 gladyso@sapoznik.com WWW.SAPOINIK.COM Yvonne Hurlbutt Executive Director of Human Resources Shaniqua Smith Senior Benefits Manager Telephone: (305) 762-1526 E-mail: ssmith@mjhha.org Linda G. Williams Senior Manager of Training & Development Telephone: (305) 762-3843 E-mail: IWiliiams@mjhha.org Dee Olive Sr. Compensation & HRIS Manager Telephone: (305) 762-1510 E-mail: dolive@mjhha.org ,-1 , -, 1 WH.ENISMyCQV£:RAGr:EFFEC-TIVE? .. .• ·iCh.9!i9.e~J~y~,!r~en .. fifel~~icin$mpi=le durin~th~o;:ien~nrollm~nt are 'effer:Hve:Ja'OUQry J, 201 L.. ..' '> '. ." . . '~AU changes in premiull\contribuliQns viUl b~ reflected 01) your ·,..jcII'uc;rY7. 20 l]pciyroll check. . . '" . . ';'; ( "" .. __ .; .. _< :, ..... _: -... ;t. :,' <_1\.: .. ·· -<'-';---.;'. ::? " .'WHEr'f~~N:IMAi<E;CHANGEstOMYl'lANi ··:·::··:~E~tEC-~fl_(i-N:S?/~-· .,,'~'\ ,j,-.-'" : ',r:' ~<'; .~i.' ".,. ","oJ. ',J,c' ;i!~t~~Ri~r~~k~~llfi~f~~J;}jt~~;;~~ll'~'······· >.eQmpr~ ,~rag .. ; aSO!ifI,"e~I,l)l\ils B,e_~eflts Ql!19~;_EI!g,,~leidep!l.nc!- <' ,-: . f~&f{'~ f?:: /:' ~.t _'_~" ': :~:":,,~~:~; ~-~;:~;.:~:.~.~><'~:~?:'~ :~:';.' ~~<~~~hr:~·(·~;· .;.~ :::.~~;:~:>;~\~:~. :1~;, ,~:~ '\~:\:. t:~(f'~ > -~~.-." -, . '<.'Alegalspoose( .. x~spousesi:ciririotbe'coVeredrc: ':ti . -i .,','< ..• ; .. -:.~il~~;~p~~~7~}c;if:~~~;~~:;br;",ci::-,i-;,:!:,',-:-.;,k-;,·'·:"~" .. ,;'i~";: -;" }, 'f .l,eg9Jrypepende~t ~hndiel\ i:>f;yo)!p(yo~r. S.Ri:>u$t)~hi:>cire26years ";::~'~:'lli1lIMil"~;~' " .. , ..• '-~".' ".A de~endentQf • <iide#eriderit {child born to'On'enrolied ; child 'de-• i.'~ ... '.~~hcJ~n;);;ndY if~jtI'~~o!'lili~~id".iorup ~i9;j ~-,;{~nth~;-tn~'cl6p~i!d;;~f.' "', ~'. : ·~.f:Hl~.·d.~B~~.c{~.~(.;~.~~.t .·~·~~Eit:th~-·,c.~j~.~°i'J~_.:~f,-leg~1 ~jJard.ia·n~hip\;~y:_the~:~ ····i~~~~~j.;s·tfi~~~~~~ 1i~"eflf~(jnder1ii!eXVlliofsSA\.InleSShancfi~a:rp~t: •. ', ,,'., 1 :1 '}f ;:~i-ij;m\~i~~j;!\i'f!3 n(:WIEn":f(~ '.< i>" ." .. ,e Benefits Terms Glossary No doubt, benefits terms can be confusing, espeCially those dealing with medical options. To make confident decisions about your benefits, it helps to understcmd the terminology. Here's a short list of common benefits terms and their definitions as they appiy to your benefits programs. You can always find out more by checking the Summary Plan Description (SPD) for each benefits plan or program. A Annual deductible: See "Deductible." B Basic Life Insurance: Usually an employer paid life insurance policy that provides a guarantee issue amount to a benefiCiary upon death of the insured person. Bene- fit is usually for a fixed term (i.e. 10, 20, or 30 years) Beneficiary: Generally, a person, trust or estate that you name (identify) to receive payments or benefits from certain plans (like life insurance) in the event of your death. Benefits-Eligible Compensation (BEC): Generally, the portion of your pay used for calculating your benefits under certain plans. C Coinsurance: After you meet your deductible and/or make your copayment, the medical option begins paying a percentage of the allowable expenses. The remaining amount is called the "coinsurance percentage" and is paid by you. Coinsurance percentages as well as reasonable and customary (R&C) limits vary by medical option. Copoyment (copoy): A flat fee amount you pay at the time you receive a specific service (for example, doctors' office visits, annual physical exams). Copayments/copays are common under HMO, PPO and POS options. Copays typically do not count toward any required deductible and may not count toward on out-of-pocket maximum, depending on your medical option. Coveroge (covered services/eligible expenses): Generally, the benefits and/or services provided under a specific plan. The amount of coverage provided for a specific covered service varies by plan. D Deductible: The annual deductible is a specific amount of initial, covered expenses you must pay each year before benefits are payable. Refer to the Health Plan Comparison Charts in the Summary Plan Description for information about deductibles. E Eligible Dependents; Those dependents that are eligible to be covered under your benefits plans and programs. Eligible dependents vary by plan or program. Explonotion of Benefits (EOB): A statement prepared by an insurance carrier showing details such as the services you received, the expenses paid by the benefits plan or program and any amounts you may owe. You may request copies of these statements from the medical option administrator. Exclusions: Certain services and expenses that are not cov- ered by a benefits plan or program. For more details, see the Summary Plan Description. F Formulary: A preferred list of prescription drugs, which could be available to you at a reduced cost. Formulary lists differ depending on the administrator of your prescription drug coverage. Sovings Account (HSA): A tax-advantaged, re- stricted savings plan available to U.S. taxpayers to cover eligible current and future medical expenses. Wachovia does not currently offer a Health Savings Account as a benefits option. High Deductible option: This is a type of medical option that primarily provides coverage for preventive services and coverage needed in case of a catastrophic event. It is de- signed to complement an individual Health Savings Account. The High Deductible option offers lower payroll contributions and higher deductibles. 5 M Maintenance medication: A prescription drug taken regularly on a long-term, ongoing basis. For example, drugs used to treat high blood pressure or cholesterol. Medicol options: The medical coverage choices that you select from when you enroll in medical benefits. Depending on your location, you may have a choice of these types of medical options: PPO, HMO, POS and deductible options. N Network provider: A phYSician, hospital or other provider of healthcare services that has agreed to provide care to covered individuals at negotiated rates. o Open occess: Those HMO medical options that allow you to see on in-network specialist without first getting a referral from your primary care physician. Out-ai-pocket costs: Expenses that you are responsible for paying that are not reimbursed by a benefits plan. Examples include: deductibles, coinsurance, copayments, expenses that are higher than what's considered "reasonable and customary" for a particular service, etc. Out-ol-pocket maximum: The annual out-of-pocket maximum of a medical option limits the amount of coinsurance you pay in one year and protects you against the financial burden of a serious illness or injury. Once you reach the out-of-pocket maximum of a medical option, the medical option pays 100 percent of "reasonable and customary" expenses for covered services for the rest of the plan year. The out-of-pocket maximum may vary by medical option and coverage category. P PCP (primory care physician): A primary care physician manages and coordinates your care and refers you to specialists. Some HMO medical options require you to select a PCP. POS (Point-of-Service) options: A type of medical option that pays a greater share of eligible expenses when you seek care from a network of physicians, hospitals and other healthcare providers who have agreed to provide medical care at negotiated prices. They are different from PPO options because POS options do not require you to meet a deductible for care received from network providers. PPO (Prelerred Provider Orgoni%otion) options: A type of medical option that uses a network of physicians, hospitals and other healthcare providers that have agreed to provide medical care at negotiated prices. However, unlike a POS option, PPO options may require you to meet a deductible, depending on whether you receive care in or out of the network. Preventive care: Medical, dental or vision care that is designed to help prevent an illness or condition. For example, annual checkUps may be considered preventive care. Provider: A physician, hospital, skilled nursing facility, intensive care facility, healtheare professional or other entity that provides healthcare services. S Specialist: A physician who focuses on a specific illness, disease or area of the body. Some HMO medical options require that you be referred to a specialist by a primary care physician in order for your care to be covered. U Universal Life Insurance: A form of life insurance whose premium rates are based upon your age at the time of issue and do not increase with age. Universal Life Insurance builds cash value over time. Please see the chart in the Universal Life Insurance SPD explaining the differences between term and Universal Life Insurance. medical.plan AvMED HEALTH PLANS Welcome to AvMed, the health plan with your health in mindo We offer plan members a superior network of doctors, special- ists and hospitals, and our personalized round-the-clock customer support. We offer the benefits of a national provider, with the flexibility of a regional plan. Please see below for a brief overview of your 2011 health plans. For further detail, including summaries for other services not listed, please refer to your AvMed Benefit Summary in your enrollment kit. ICO-INSURANCE NONE I ! !ADULT WELLNESS COVERED 100% I _. !PHYSICIAN J I $15 CO-PAY , I i I !SPECIALIST $25 CO-PAY iEMERGENCY ROOM $250 CO-PAY !Waived if AD 'URGENT CARE $40 CO-PAY , ;, iDIAGNOSTIC TESTING $25 CO-PAY per TEST IMRI, CA TSCAN IOUTPATIENT SURGERY $75 CO,PAY iAmbulatory Surgical Center iOUTPATIENT SURGERY iHospital $250 CO-PAY ilNPATIENT HOSPITAL $250 per ADMISSION 1 Then Covered 1 00% :MAX OUT OF POCKET $1500/$3000 ! I !PRESCRIPTION $20/$40/$60/$75/50% jLlFETIME MAX Unlimited payrolLdeductions EMPLOYEE ONLY EMPLOYEE + SPOUSE EMPLOYEE + CHILD(REN) EMPLOYEE + FAMILY $44.46 $198.59 $166.98 $329.02 -j i ! o. i I I i i I I NONE COVERED 100% $15 CO-PAY $25 CO-PAY $250 CO-PAY $40 CO-PAY DED & 20% $250 l DED & 90% J i $250 per DAY x 5 DAYS Then Covered 1 00% $1500/$3000 i I $20/$40/$60/$75/500/0 Unlimited I I $121.26 $275.39 $243.78 $405.82 6 o~~~ I -~ ~ NONE COVERED 100% $15 CO-PAY $25 CO-PAY $250 CO-PAY $40 CO-PAY $25 CO-PAY per TEST $75 CO-PAY $250 CO-PAY $250 per ADMISSION Then Covered 1 00% $1500/$3000 $20/$40/$60/$75/50% Unlimited $44.46 $198.59 $166.98 $329.Q2 ,'j PREVENTATIVE NETWORK NON-NETWORK BASIC COVERAGE NETWORK NON-NETWORK MAJOR COVERAGE i ORTHODONTIC COVERAGE i ORTHODONTIC MAXIMUM : ANNUAL MAXIMUM NONE NO CO-PAY CO-PAYS APPLY MOST PROCEDURES COVERED 100% SOME PROCEDURES HAVE CO-PAYS SOME PROCEDURES COVERED 100% MOST PROCEDURES HAVE CO-PAYS CO-PAYS APPLY COVERED FOR ADULTS & CHILDREN CO-PAYS APPLY UNLIMITED payrollodecJucti()ns EMPLOYEE ONLY EMPLOYEE + SPOUSE EMPLOYEE + CHILD(REN) EMPLOYEE + FAMILY $13.50 $23.49 $28.89 $36.99 $40.65 $81.29 $87.31 $134.18 7 dental.plan HUMANA® Guidance when you need it most Welcome to Humana Specialty Benefits, your 2011 Dental and Vision insurance provider. Humana offer plan members a superior network of dentists, endodontists, orthodontists, optometrists and other specialty service providers. Humana currently has one of the largest network of providers, ensuring you receive the best care at the most competitive rates. Please see below for a brief overview of your 2011 Dental and Vision plans. For further detail, including summaries for other services not listed, please refer to your Hu- mana Benefit Summary in your enrollment kit. 100%/80%/50% DED & COINSURANCE DED & COINSURANCE DEDWAIVED COVERED 100% 100% After DED (Ende & Perie) DED & 60% COINSURANCE $50/$50 100%/80%/50% DED & COINSURANCE DED & COINSURANCE DEDWAIVED COVERED 100% DED& 80% COINSURANCE (Ende & Perie) DED & 50% COINSURANCE 50% COINSURANCE 4) 0 G VISlon.lnsurance HUMANA® Guidance when you need it most ','." _.' .. - I i Eye Exams ; Lenses I l Frames ! Contacts , Eye Exam with dilation as needed Lenses Single Vision Bifocal Trifocal Once every 1 2 months Once every 1 2 months Once every 24 months Once ever 12 months (contacts are in lieu of glasses) $15 copay $15 copay $15 copay $35 Allowance $25 Allowance $40 Allowance $60 Allowance $45 Wholesale Allowance $45 Retail Allowance ; Elective $1 1 0 Allowance $11 0 Allowance payroll.deductions ; Employee Employee + Spouse Employee + Child(ren) Family 8 $13.50 $23.49 $28.89 $36.99 $40.65 $81.29 $87.31 $134.18 disa bility.i nsura nee short term.disability Plan Benefits Plan Effective Date Benefit Duration . . 60% of your weekly pre- disability earnings Maximum STD Benefit is $1,000 per week Benefits begin on the 8th day following date of disability 1 st of the month after 90 days of . employment : Up to 1 3 weeks 1. 2 . , 3. 4. , List your Annual Earnings (= Hourly Rate x 2080) Divide by 52 Multiply by 60% Divide by 1 O-If you get i less than $ 1 ,000 /10: Or Divide by 1 000-If you get i more than $ 1,000 /1000=. __ _ Pre-Existing Condition Limitation If diagnosed with pre-existing con- dition 3 months prior to the . effective date, you must be covered: by the policy for 1 2 months in order for that pre-existing condition to be covered. Once enrolled, any new diagnosis will be covered according to the policy benefits. : 5. • Multiply by .85 6. term.disabili Monthly Benefit Equal To 60% Of Your Salary Up To $6,000 This is the amount of benefit you will receive when you are disabled. Elimination Period of 90 Days This is the number of days you must be disabled before benefit payments start. Own Oc:c:upation 24 Months Divide by 2 ,2. , f 4. . This is the period of time that the employee need only be disabled from his/ . . her own occupation. Pre-Existing Condition Limitation If diagnosed with pre-existing condition 3 months prior to the effective Multiply by rate based on age (see rate table below) I x.85 = ----- /2 $. __ _ per paycheck deduction :$,--- /12 1 /100 X rate I /2 $ per ---1 i I date, you must be covered by the policy for 12 months in order for that pre i 6. -existing condition to be covered. Once enrolled, any new diagnosis will be covered according to the policy benefits. . paycheck deduction , ":'" Residual Disability Prior to 63 To Retirement Age or 42 months 0-29 $0.31 50-54 $2.07 Mental Illness Limitation 2 year limit (lifetime) Age 63 To Retirement Age or 36 months 30-34 $0.43 55-59 $2.88 Age 64 30 months Substance Abuse ; 2 year limit (lifetime) Limitation Age 65 24 months 35-39 $0.62 60-64 $2.55 Age 66 21 months Pre-Existing Condition 6/6/12 40-44 $0.86 65-69 $1.55 Limitation Age 67 18 months Age 68 15 months 45-49 $1.56 70 &up $1.01 , Lump Sum: 3X Gross Survivor Benefit Age 69+ 12 months Benefit l) supplementaLinsurance TM Aflac will be providing employees with comprehensive supplemental coverage in 2011. Over 50 Million people worldwide have chosen Aflac because of a commitment to providing customers with the confi- dence that comes from knowing they have assistance in being prepared for whatever life may bring. Please see below for a brief overview of plan designs. For further details including services not listed, please refer to your Aflac Benefit Summary in your enrollment kit. These policies can help you manage the high expenses of treatments; preserve savings and protect your family from financial hardship allowing you to concentrate on getting well. . Benefits are paid directly to you and can be used for non-medical, cancer related expenses that insurance might not cover. In addition to cancer, this policy also pays you benefits for 32 other specified diseases. Semi-Monthly Rates: Level 3 Individual: Employee & Child(ren): Emp. Spouse & Child(ren): , Semi-Monthly Rates: Level 1 Individual: Employee & Child(ren): Emp. Spouse & Child(ren): $18.75 $23.10 $32.20 $11.35 $13.85 $19.50 The policy is guaranteed renewable for life; . premiums will not be changed unless you make a change in your plan selection. 10 . The policy is available : for you and your family. This policy pays a lump sum benefit when I you are diagnosed with a critical illness such as heart attack. Stroke, coma, paralysis, end- stage renal failure, major third degree burns, persistent vegetative state, bypass surgery, major organ transplant and paralysis. Additional benefits are paid directly to you for hospitalization, continuing care such as physical therapy and physician visits, transportation and lodging. supplementa Li nsu ra nee Your premium is based on your age at the time The policy is the policy is effective and does not increase with 'available for you and age. i your Semi-Monthly Rates: Age 18-35 Employee Only: Employee & Child(ren): Employee & Spouse: Employee & Family: ,Age 36-45 Employee Only: Employee & Child(ren): Employee & Spouse: Employee & Family: . Age 46-55 Employee Only: Employee & Child(ren): Employee & Spouse: Employee & Family: Age 56-70 Employee Only: Employee & Child(ren): Employee & Spouse: Employee & Family: $ 5.72 $ 6.31 $ 8.84 $ 9.95 $ 9.23 $ 9.62 $15.15 $16.38 $12.35 $12.74 $21.32 $22.82 $16.06 $16.51 $29.45 $31.20 Guaranteed renewable for life, premiums will not be changes unless you make a change in your plan selection. 11 ~ family. choosing.care Where should I go for care? Helping you choose the right care center What type of care would they What are the cost** and time provide*: considerations?** ---- Doctor's You need routine care or treatment for ~ Routine checkups @ Often requires a copayment and/or Office a current health issue. Your primary ~ Immunizations coinsurance @ doctor knows you and your health ~ Preventive services {(fj) history, can access your medical ~ Manage your general health Normally requires an appointment records, provide preventive and routine care, manage your medications (9 Little waittime with scheduled and refer you to a specialist, if appointment. necessary. Convenience You can't get to your doctor's office, ~ Common infections ~ Often requires a copayment Care Clinic but your condition is not urgent or an (e.g.: strep throat) and/or coinsurance similar to @ emergency. Convenience care clinics ~ Minor skin conditions office visit are often located in malls or retail (e.g.: poison ivy) stores offering services for minor ~ Flu shots Walk in patients welcome with health conditions. Staffed by nurse ~ Pregnancy tests (19 no appointments necessary, but practitioners and physician assistants. ~ Minor cuts .. wait times can vary ~ Ear aches Urgent Care You may need care quickly. but it is ~ Sprains ~ Often requires a copayment Center not an emergency, and your primary ~ Strains and/or coinsurance usually CD physician may not be available. ~ Minor broken bones (e.g: finger) higher than an office visit Urgent care centers offer treatment ~ Minor infections for non-life threatening injuries ~ High fever Walk in patients welcome, but or illnesses. Staffed by qualified ~ Minor burns (TI9 waiting periods may be longer physicians. ... as patients with more urgent needs will be treated first. Emergency You need immediate treatment of a ~ Heavy bleeding ([({@) Often requires a much Room very serious or critical condition. ~ Large open wounds higher copayment and/or @) The ER is for the treatment of life-~ Sudden change in vision coinsurance threatening or very serious conditions ~ Chest pain that require immediate medical ~ Sudden weakness or trouble Open 24/7, but waiting attention. Do not ignore an emergency. talking crTI9 periods may be longer If a situation seems life threatening, ~ Major burns because patients with life- take action. Call 911 or your local ~ Spinal injuries threatening emergencies emergency number right away. ~ Severe head injury will be treated first. ~ Difficulty breathing ~ Major broken bones 12 p reventative8Ca re Preventive care guidelines: adults over age 18 Range of recommended ages ~;:=~;~~-===;t~12~~~~~0~~~~t't~i-~~-~E~ Tobacco cessation, drug and alcohol I . . use, STDs and HIV, nutrition, physical I Periodically activity, sun exposure, oral health, injury ,~~~~~~~co~~!,,~~~E~I¥l'~~,~~!~L~."~~,~,,~~~J~_~,.~~~c~ .. ~c ... ~_",_ .. ~_ .. _, ___ ._,_._ .". ,.'~"., .. ~. Upper age limits should be individualized for each patient • See www.preventiveservices.ahrq.gov for U.S. Preventive Services Task Force recommendations on colorectal cancer screening and other clinical preventive services. . •• High risk is defined as adults who have terminal complement deficiencies, had their spleen removed, their spleen does not function or they have medical, occupation, lifestyle or other indications such as college freshmen living in dormitory or other group living conditions. Individual health plans vary in preventive coverage. Generally, your plan should cover immunizations recommended by the Advisory Committee on Immunization Practices (ACIP) and published by the Centers for Disease Control and Prevention. For complete immunization guidelines, visit www.cdc.gov/nip. employeeoossistance .!l AvMED HEALTH PLANS t:;::~f~~~~~!~~i, .H.~~' '.Group'.'·,'~.rn~r~ .. , ................. , ....................... , ...... , ............... . . WelcQmet How ~a.n w~f)elp YOll tQaay? 'Oneoftheeasiesl ways to keep presc.riplJon,.9.rug;~XpetiSEi'do~n'is!o ~~~~~~l~~tk~:d!C;~:~~6DiSCUSS , ajiernatIve withyollr doctoLGenerlcs ai~ ~ry~ighllualityana1h~co~ '';-~~ftiin~ i c" ~ hDn.cifif .rt ~'';'II OD~rl AvMED lHEALTH PLANS Health and Wellness ~ Care Management ,... HealthyLiving Programs ~ Prevention and Equc;atiori ~ Publications ~MX Account .bnline.G6nsumeI"TciCils; '~Freq~enUyAsked ~QUe.E;1iOri~ HOlI1e~roup Members HealUlaljd Well nesS Healthy WvingPrograms AtMrvt~q" We'tec9(1sfl:!ri!ly exploringY/8.ys;t() help yoU m!!!ntain gdqc:j heallh.Totbateo,d,',." ,'. . ,-.... -. " V'I~qfF~r!lVarietyofVleilness. 5tr~1~g'iEls (loci pr()gram?jh~tcan Elnh~rwe,both.~()~r Vleii~beil)Q anci you~ qualliydf life, putting you" on Me r6~d to b~tterflealthahd ' , , keeping you there. AvMecfs Healthy Living programs hefp you live a healthier', more productive life. We give you plenty of 5uoDoitand motivation with Dobular oroarams such as Weiahi ' .. , .. '-, ... _,.... -' .. ,' ' .,' , .. ',.. 'ilir' -. -'" . ' , ' @HEALTHWAYS ti[AUNGCHlICRS tlEAUNG KllClIW EJ(PERT QPIIIIOUS 14 Find a Doctor ",Ein~a£,harm~ Find Vision Providers _U.r.g!l1t~re .9!nl~~s Products & Services Medication Usis Gene~cs Forms ::"ct~iiteaneWAcCQUht , F'P,WotJ!j~ri1.~!ile,~~F-~~~~w.?; Find a Doctor Find a Pharmacy Find Vision Providers ."> ,j ": \ , j "':'_J , -J ,_i "I MONTH TIME EVENT TOPIC POINTS ELIGIBLE 9:00 AM SEMINAR HEART HEALTH 5 POINTS JANUARY 4:00 PM WALKING CLUB LAUNCH FITNESS 10 POINTS 9:00AM EDUCATION URGENCY v. EMERGENCY ROOM 5 POINTS FEBRUARY 11:30 AM COMMITTEE MEETING PARTICIPATION (COMMITTEE ONLY) N/A 9:00 AM SEMINAR GETTING THE MOST FROM MYHUMANACOM 5 POINTS MARCH 4:00 PM SEMINAR EATING HEALTHY ON THE GO 5 POINTS 9:00AM HEALTH FAIR BIOMETRICS, HEALTH PASSPORT ETC. 30 POINTS APRIL 4:00 PM HEALTH FAIR BIOMETRICS, HEALTH PASSPORT ETC. 30 POINTS 9:00 AM EDUCATION USING FREESTANDING DIAGNOSTIC 5 POINTS MAY 4:00 PM COMMITTEE MEETING PARTICIPATION (COMMITTEE ONLY) N/A) '9:00 AM MEETING BIGGEST LOSER LAUNCH PROGRAM 10 POINTS JUNE 1 1:30AM MEETING BIGGEST LOSER LAUNCH PROGRAM 1 0 POINTS 9:00 AM SEMINAR Rx SAVINGS and YOU 5 POINTS JULY 11:30AM SEMINAR ABOUT THE HEALTH RISK ASSESSMENT 5 POINTS rl~I§~tJlt]r~~i:/'( .. c"i:~· 9:00 AM WALKING CLUB SEPTEMBER ABC Company 2011 Benefits Statement January 1, 2011 Dear Joe Smith: This personal benefits statement is a brief outline of the benefits ABC Company provides to you. It summarizes each benefit and illustrates the significance of your benefits package as part ofY0\.lr total compensation. Please review the information carefully and direct any questions to Jane Doe at (414) 444-4444 ext. 232. Personal Information: Employment Information: ~:::~~~~~:~_j=S~;=~-= ~~::-,:-=f,~:~~,:~~--~~~~-~"==j~~~J.~~~d City, State, Zip Whitewater, WI 53190 ,'i. " ... '_ ........ T~=~~~~~~ __ ~~~~~ ....... _~~m=~~~T ~~~= . ~_~~ ___ .. _= __ ~' __ ~~~~'_.~~~'._'~"_.r=-=~ __ ~,..!' ; Base plan cbvers $1,000 per month facility for 3 years or $500 f,~-~,---~,~~,~-~-n~s-~p'e--n-~d-in"~g-A"-ccount'+-~ ~P.~~~~:1:0~~~~~~~~~y~!~~:,-. '~"-'·'----"·--~+-'~-'~~-'----~'~----~~··-"---f" In~ri~~~rl~':~t car~-sp~n~ing~c~~~~t-.. ---"-~~-~~~,i~~ri~"- _ I __ .~" ' ___ ._ ... ,_,~~~i.~.~_~a.~IL __ '_ _____ ~ .. _~ __ .... __ _ ,--r Can elect to defer up to 25% of your income pretax. Company I " " match is 50% of withholdings up to 4%. -I" 'Det~rmined~~~~-;llybY'I>~~rd~f-dir~~t~rs'b~s;(j~np~~fit~bility iShares of company stock'can-bepLJrChased 2 times annually'vith!-' I a 15% discount(see plan document for more details). ! i' -, ---",-, --------------, '--, '" -' -,---,,--. -" ---' . I I I I I. Total Benefits Cost: $10,269.16 $12,945.59 :::~~.~~~;;~._~.~.~~m~~~n_ •. · ••. · .• _-: __ l~_.·. ___ $~7~:8 TOTAL COMPENSATION: $47,831.16 New Year's Day and the day before or after; Labor Day; ThankSgivjng Day and the day following; and pay minus any compensation from the ----------------I ! ____ ._._. ____________ I'::--'-"'_:..=-=-~::.:.:..:,_:c__'_:__--:--:-:_:__:--.. : .------.----.-.-.. ------------.-----------.-------------·----.----------_·------.. 1 policy is established to assist you when you are unable to work due to illness, injury, or a I I:-:--c-: ... -.-= ... --:--:------~--------------1-----'--'-'-,_ cond'i_ti_(_ln ___ . _______ : .. ,. _____ :__ _ .. "-___ . _______ .... ____________________ .. ________________________________ J of tuition and .course-reqLJired books for classes pertinent to present position or next II must be from accredited school, college or university. Reimbursement not to exceed f-----------------.----.------------... ----+----------.-= .. -..... -----,' ........ ---'--.,---.---------.-.. -----------.---------.-.---.--------------·---·1 r----------.---... ---..... _ .. _________ . __ ' __ -'-' +_:_. ___ ._---''--_allc:lw~~r purch_a~e9f uniforms. __________ . ______________ ... __________________ I employee earns 10 days of vacation in the first year of employment. One vacation day is added for l r-_____ . _____ . _______ . _____ ._._____.:,,--_a._d ... d _.iti ... c:ln~ year ofel1l_plol'!'~~~_~e.!c:I_~_.'!1.!~I!1~~_~~~ daY~J?er year. ______________ . ___ . ___ . ___ .. _____ .~ . ~c:l:.Jl.I'c:lvides LJP to 2 hOu"!l_~\I.c>t~.i~ .lJc:lt~!h.~ prirJ1.a1}' and general ~1E:J~i<l~s hel~_ac_h yea!:_ ..___ .! $100 annually for eligible well ness classes, health club membership or weight loss program. See HR I . details. .. __ ._ .. _. ___ ._._ ... ____ ... _ .. _____ ._._ ... _. __ .. __ . ____ ._. _________ .. ______ ._ .. _. _____ ... _._. __ J Please contact Human Resources with any questions or comments about your personal benefits summary. ABC Company is pleased to be able to offer these valuable benefits to you, and we thank you for being a partner in our sucoess. Every effort has been made to ensure that the information in this statement is accurate; however no warranty of complete accuracy is made. This report does not in any way constitute a contract of employment ABC Company reserves the right to amend pay and benefits at any time without notice. If you feel an error has been made or have any questions, please contact Human Resources. Design © 2009, 2011 Zywave, Inc. All rights reserved. APPENDIX E WELLNESS PROGRAMMING Men Starters Promote •••••••••••••••••••••••••••••••••• Wellness Program Encourage ••••••••••••••••.••••.••••••.•••••• •••• Associates Assist ••••••••.••••.• In getting participation at all events Entree Education ••••••••..•••.•.•••••••••.•••••••••••••••••••••••••.•.•••••.•••••• On prevention Recommended on our Menu •••••••.••••.••••••.•••••••.••••••••••• Cancer Awareness Served to you via -Newsletters -Flyers -Workshops Upcoming Health Fair •••••••••.••••••••••••••••••••••••••••••••• Biometric Screenings Choice Of ••••••••••• ••.• • •• Glucose Body Mass Index Blood Pressure Waist to Hip Ratio Cholesterol Sit & Reach Test Body Fat Analysis Grip Test Side Dishes Workshops .............................................. Warning Signs of Heart Disease Understanding Cholesterol Understanding Diabetes Understanding Blood Pressure Smoking Cessation ... '.'" -,.-.----,-~ ..•. ~,.-~,-~.~~~~~.~~~~~- "' .. ~ M CU rJ'j ~ "'-'.u ""0 ~ ......, I'».i ,.....f ("'\; .~ -, ~<t> .....:... ,~ ~ 0' ~~ ,,'e; , {,) ~::o <lO~ ~.~ ,,,-l ' .,-...~'" ~ f\.v' * .. ~ Dessert -·~7"'").:,,')-... ¥~ () L.J "I" 'I::~ .;t:~ i -,:-;::-~~",~".t/g;'l lr '~('/P.$:;;:~~i \~ ... "¢, 8' -,./ 0~!>\i;;<\":1 1,-"'-.~ :: '-i ", ij~'!1 '" :: :,., t:~t 'i ! if {( c.' \ -..,~:::~~ / " l \\ • \ ",.: (·m --'~, ... b' '\'.:~:~~;:>5 Your Choices ••••••••••••••••••••••••••••••••• A Fitter You A Better Informed You An Energized You A Less Stressed You A More Productive You A Satisfied You A Confident You A Healthier You. Passenger Name Departure Time Arrival Time DEPARTURES Check In Receive Passport TERMINALS Biometrics Glucose: JourneyToWeliness You rltinerary Blood Pressure: ____ _ ARRIVALS Passport Control Prize Ticket Claim Well ness Terminal Wellness Visa Stamp Information UHC/ NHP Westchester General Hospita Cloverleaf COSTCO Towncare Dental Concentra Urgent Care YWCA: Breast Cancer Awareness Power Credit Union Sapoznik Insurance I Passenger Name Departure Time Arrival Time DEPARTURES Check In Receive Passport TERMINALS Biometrics Glucose: JourneyToWeliness Yourltinerary Blood Pressure: ____ _ ARRIVALS Passport Control Prize Ticket Claim Passenger Name Departure Time Arrival Time JourneyToWeliness ! '" Yourltinerary DEPARTURES Check In Receive Passport TERMINALS Biometrics Glucose: Blood Pressure: ____ _ ARRIVALS Passport Control Prize Ticket Claim Well ness Terminal Information UHC/ NHP Cloverleaf COSTCO Towncare Dental Concentra Urgent Care YWCA: Breast Cancer Awareness Power Credit Union Sapoznik Insurance Wellness Terminal Information UHC/NHP Westchester General Hospita Cloverleaf COSTCO Towncare Dental Con centra Urgent Care YWCA: Breast Cancer Awareness Power Credit Union Sapoznik Insurance ~' .... ~; ... Item , ICheeSebUrger I ,_., ... "'k> Ft .... ChoI~ Sod'~ fi;j> ,; """ ".:" ,ot ~: C!,':..-Sod'~ I;,.: ... ries a Fat terol", : , k~'; d" ",0'", , 330 14 6 45 800 Ij~~: t': Cheeseb~rger, 300 14 6 45 710 i' // ".i" //, I,: ' .... i .',' " ",' , ,1<\'\]/'\'1", f .' " L, 1:, '.) i'm lovin' if TACO BELL: Chicken McGrili IGrilied Ranch Snack Wrap 3 60 890 I~fi ""'j"" ' ",;: Tendergnll Chicken 470 7 7 40 110 I~;,': /' ./ ,/ ,I, ;,' , " '" 400 17 ,;.\j ~ he, Sandwich ~ ,..;,' ",' 270 10 4 45 830 11~~, fj,.,RGl!~ ~,;, Tendergrill Garden 230 7 3 85 920 1< 'V/ /'/'l"'V' e' " Plain Cesar Salad IS: :;:,J ~ " I;:; Salad L' / /.: ' 90 4 2,5 10 180 I>,;,;,,' :' Apple Fries 70 0,5 0 0 40 <,'" " , ," " Fillet-O-Fish Fruit 'n Yogurt Par- Ifait - 380 18 3,5 40 640 r'::, I':' i> Veggie Burger 410 16 2.5 5 1030 I' t h/ ',' , 1 5 85 1<: Chicken Fries 250 15 2.5 30 820, / '""", ru 160 2 p,;' i', ~<" ' '~,';,"'~:;(::~:'~';; 1:!~T~;);i:;"~f;>tf ',,',': ~':'U":"": 4 Er'" , ' Calo- ries ;';">';"',,::;:r::>:;~i{;»~',;;: 'f;;;::'t.:.:;;~"'::':;C:Y'£:::i :/' """,.,,';:,; ,',;Y,;:',,:;, },;'s: :ti7:;:;?f';:;;:;:X;";:;:'~;;;\?(;Y C,'" F t Sat. Choles-S d' ,,' ,i,' " " It Calo-F t Sat. Choles- '~I" '. '-'~" ".' ".:.,'~ a Fat terol 0 lum ::,:; "" em ries a Fat terol Item Sodium F' 85 580 Fresco Crunchy 150 7 2.5 20 350'/ :~,''-,' I"~ Skinless Chicken Breast 160 3.5 Taco ,:,'/ ",;:,: I" ~~:co Beef Soft 180 7 2,5 20 560;:; ",:,.,:".";,,,jU~ " ~:~"I-G-r-iII-ed-C-h-iC-ke-n-Fi-le-t-+-1-4-0-11-3-1---1--70--1--5-6-0--1:, , ~i~~ ::~i' ! " Grilled Chicken ~esar 270 7 3.5 85 740" " Fresco Burn~o 350 8 2,5 25 1060 'r', 1 : , Salad (no dreSSing) :: Supreme Chicken 'y, " , I ,:' , ::;'~";';:; ,f. ' '! " KFC Crispy Snacker 290 11 2.5 30 730 Fresco Chicken Soft 150 35 1 25 480" -"r,.. : Taco ',0 "!:: ~"" : Honey BBQ Sandwich 320 3,5 70 770;' Fresco Grilled Steak 150 4 1 5 15 520!"! h' ' ',' Soft Taco . ':,; I" Mashed Potatoes I: (w/o gravy) 90 3 0,5 o Fresco Bean Burrito 350 8 2.5 0 990/", J...".-.,....-.,.....,.......,...,.......J.,..,.....,....,.,r.._.,...._.,.......J.,. __ ," .; >:',' -,' <:' ,:~:, ", "'(',::"', '.",,-";:"':, ,,"':, Calo- ries Fat 120 8 4 20 ,,:'~ -~.:: ''',~.~~--:-;.---:~~.: .,~~:z ;" ::, ~~··,;::.:.:;:l~T~<i.~.; 'i:: ,~: . ~'S": ".'.:< ~ •. ' :':": ,<~::" . ':'. 320 Sodium Item , i 'r,:' ,,<~,,-, , ,_,L;-'-'-"C~,: . :" Item C~IO-Fat Sat. Choles-Sodium ries f' nes Fat terol 6" Roasted Chicken 320 5 25 640 240 11 4.5 25 530 I • Ie Don't let Fast Food SUPERSIZE you. l~~f~i~\\ :,·,......r ~·lr·r,:)'( .. \,"r,1 ~I~(I ~:~~~1~?;} ~\II~~ --= ---SAW~:ZNIK ~., ; 6" Roast Beef 320 5 1.5 45 700 250 12 4.5 25 590 , J ' 6" Veggie Delite 230 2.5 0,5 0 310 :, 6" Subway Club 310 4.5 1,5 40 880 INS U'/:Ri'I'AN C E -~.~ " -~" ,,) • ?, /,~/.'i \\::-:. 1.877',g4R8887 www.sapozhik.com 6" Turkey Breast 280 4 20 820 6" Black Forest Ham ':': .J\?~-~-:.~~,~~~.~:~;,' '/.: e, . Fat, Saturated Fat, Cholesterol measured in grams(g) Sodium measured in milligram (Mg) Breast Health Basics Learn the Facts • In 2009, approximately 192,370 women in the u.s. will be diagnosed with invasive breast cancer and about 40,170 women will die from the disease. • Except for skin cancer, breast cancer is the most common type of cancer among women today. • When breast cancer is found early (within the breast), the chance for survival is the greatest. Am I at Risk for Breast Cancer? • All women are at risk for breast cancer. • Being a woman is the number one risk factor for breast cancer. Your breast cancer risk increases as you get older. • Most women who get breast cancer have no other known risk factors. • Although breast cancer is more common in women over the age of 40, younger women can also develop breast cancer. • Men can also get breast cancer, but it is rare. It is about 100 times more common in women. ,. Susan G. Komen for the Cure® Recommends That You: o Talk to your family to learn about your family health history o Talk to your provider about your,personal risk' of breast cancer o Ask your doctor which screening tests are right foryouif you areat higher risk o Have a mammogram every year starting at age 40 if you are at average risk o Have a clinical breast exam at least every 3 years starting at 20, and every year starting at 40 o Know how your breasts look and feel and report any changes to your health care provider right away o Make healthy lifestyle choices that may reduce your risk of breast cancer What can I do to reduce my risk of getting breast cancer? There is no sure way to avoid breast cancer. But, you can do things that may improve your overall health. Maintain a healthy weight. Exercise and eat a diet rich in fruits and vegetables. My mother had breast cancer a few years ago. Does that mean that I will get breast cancer too? We don't know what causes breast cancer. But, most women who get breast cancer have no family history of the disease. If someone in your family has had breast cancer or you are concerned about your risk, talk to your doctor. Learn about your choices and ask when to start getting mammograms. I am currently taking birth control pills. Do birth control pills increase my chance of developing breast cancer? If you are currently taking birth control pills, your breast cancer risk is slightly increased. The increased risk from using birth control pills becomes less after you have stopped using them. After about 10 years your risk returns to normal. ,. Questions & Answers About Your Breast Health Does drinking alcohol increase my chance of breast cancer? Studies have shown that drinking alcohol can increase your risk for breast cancer. My breasts feel lumpy and tender at certain times of the month. Does this increase my chance for breast cancer? Breast lumpiness with tenderness or pain at certain times of the month is called fibrocystic breast changes. These breast changes are common, especially before your period, and do lJ.ot increase your chance of getting breast cancer. Get to know the way your breasts look and feel. Learn what is normal for you. If you notice any change, see your doctor right away. Susan G. Komen for the Cure does not provide medical advice. susan G. I(Omen FOR THE cure® Every day, cells in your body divide, grow and die. Most of the time cells divide and grow in an orderly manner. But sometimes cells grow out of control. This kind of growth of cells forms a mass or lump called a tumor. Tumors are either benign or malignant. Benign [bee-NINE] tumors Benign tumors are not cancerous. But left untreated, some can pose a health risk, so they are often removed. When these tumors are removed, they typically do not reappear. Most importantly, the cells of a benign tumor do not . invade nearby tissue or spread to other parts of the body. Malignant [ma-LIG-nant] (cancerous) tumors Malignant tumors are made of abnormal cells. Malignant tumor cells can invade nearby tissue and spread to other parts of the body. A malig- nant tumor that develops in the breast is called breast cancer. Breast cancer growth The light circles represent normal breast cells and the dark-shaded circles represent cancerous breast cells. As the cancerous cells grow and multiply, they develop into a malignant tumor within the breast. FACTS FOR LIFE What is Breast Cancer? How does breast cancer grow and spread? To continue growing, malignant breast tumors need to be fed. They get nourishment by developing new blood vessels in a process called angiogenesis. The new blood vessels supply the tumor with nutrients that promote growth. As the malignant breast tumor grows, it can expand into nearby tissue. This process is called invasion. Cells can also break away from the primary, or main, tumor and spread to other parts of the body. The cells spread by traveling through the blood stream and lymphatic system. This process is called metastasis. When malignant breast cells appear in a new location, they begin to divide and grow out of control again as they create another tumor. Even though the new tumor is growing in another part of the body, it is still called breast cancer. The most common locations of breast cancer metastases are the lymph nodes, liver, brain, bones and lungs. For more information, call Susan G. Komen for the Cure® at 1-877 GO KOMEN (1-877-465-6636) or visit www.komen.org. . Why does breast cancer grow? We all have genes that control the way our cells divide and grow. When these genes do not work like they should, a genetic error, or mutation, has occurred. Mutations may be inherited or spontaneous. Inherited mutations are ones you were born with -an abnormal gene that one of your parents passed on to you at birth. Inherited mutations of specific genes, such as the BRCAI and BRCA2 genes, increase a woman's risk of developing breast cancer. Spontaneous mutations occur within your body during your lifetime. The actual cause or causes of muta- tions still remains unknown. Researchers have identified two types of genes that are important to cell growth. Errors in these genes turn normal cells into cancerous ones. The table below provides a description of each. Type of gene How it should work How it works when damaged Oncogene It "turns on," or starts normal cell division and growth. The gene does not stop when it should and cell growth continues out of control. Tumor suppressor gene It "turns off," or stops normal cell division and growth. The gene does not work and cell growth continues out of control. But remember .... Cells may be growing out of control before any symptoms of the disease appear. That is why breast screening to find early changes is so important. The sooner a problem is found, the better a woman's chances are for survival. Experts recommend that women 40 years and older have a mammogram every year. If you have a history of breast cancer in your family, talk with your doctor about risk assessment, when to start getting mammograms and how often to have them. If your mother or sister had breast cancer before menopause, you may need to start getting mammograms and yearly clinical breast exams before age 40. It is important for all women to have clinical breast exams done by a health care provider at least every three years starting at age 20 and every year after age 40. Resources Susan G. Komen for the Cure® 1-877 GO KOMEN (1-877-465-6636) www.komen.org American Cancer Society 1-800-ACS-2345 www.cancer.org National Cancer Institute 1-800-4-CANCER www.cancer.gov Related fact sheets in this series: • Ductal Carcinoma in Situ • Genetics & Breast Cancer • Types of Breast Cancer The above list of resources is only a suggested resource and is not a complete listing of breast health and breast cancer materials or information. The information contained herein is not meant to be used for self-diagnosis or to replace the services of a medical professional. Komen for the Cure does not endorse, recommend or make any warranties or representations regarding the accuracy, completeness, timeliness, quality or non-infringement of any of the materials, products or information provided by the organizations referenced herein. Developed in collaboration with the Health Communication Research Laboratory at Saint Louis University. @2008 Susan G. Komen for the Cure. Item No. 806-368a 8/08 susan G. I{Omen FOR THE cure® FACTS FOR LIFE Young Women & Breast Cancer Why do "young" women get breast cancer? When it comes to breast cancer, "young" usually means anyone younger than 40 years old. Breast cancer is less common among women in this age group. In the United States, less than 5 percent of all breast cancer cases occurred in women under age 40.1 Women who are diagnosed at a younger age are more likely to have a mutated BRCAl or BRCA2 gene. These genes are important in the development of breast cancer. Women who carry defects on either of these genes are at greater risk of developing breast and ovarian cancer. If a woman carries a defective BRCAl or BRCA2 gene, she may have a 30 to 85 percent chance of developing breast cancer in her lifetime. In addition, having a mother, father, daughter or sister who has or had breast cancer also increases a young woman's risk of developing breast cancer. So while the risk of breast cancer is generally much lower for young women, there is still a high risk for some. If you are concerned about your genetic risk, ask your doctor to refer you to a genetic counselor who will discuss in detail what your risk may be. You can talk about genetic testing, risk reduction or other screening tests, like MR!, that might be right for you. Diagnosing breast cancer in young women can be more difficult because their breast tissue is often denser than the breast tissue of older women. By the time a lump can be felt in a young woman, it is often large enough and advanced enough to lower her chances of survival. In addition, the cancer may be more aggressive and less responsive to hormone therapies. Delayed diagnosis in young women is a problem. Because it is rare for a young woman to get the disease, they are often told to wait and watch a lump. Tell your doctor if you notice a change in If you have had breast cancer, you still may be able to have children. A helpful tip for young women Clinical breast exams are recommended for all women beginning at the age of 20, at least every three years, or every year if you are age 40 or over. If you are under age 40 with a family history or other risk factors you should talk with your health care provider about risk assessment, when to start getting mammograms and how often to have them. It is important to know how your breasts normally look and feel. Breast self-exam (BSE) is a tool that may help you learn what is normal for you. BSE includes looking at and feeling your breasts. If you discover a lump or notice any changes in your breasts, see your health care provider right away. (For step-by-step breast self-exam instructions, go to www.komen.orglbse.) either of your breasts, and think about getting a second opinion if you are not satisfied with his or her advice. 1 American Cancer Society, Breast Cancer Facts & Figures 2007-2008. For more information, call Susan G. Komen for the Cure® at 1-877 GO KOMEN (1-877-465-6636) or visit www.komen.org. Hearing ,the pitter-patter of I ittle feet? Some treatments for breast cancer can affect a woman's ability to have children. If you think you would like to become a parent after breast cancer, talk with your doctor about your options before deciding on treatment. In the past, doctors would advise women who have had breast cancer not to have children. Doctors thought that the added estrogen and progesterone during pregnancy may promote the growth of breast cancer. Yet, there are no studies that have clearly shown a lillk between pregnan- cy and recurrence of breast cancer. Today, many doctors say it is fine for women who are free of cancer and not undergoing treatment to become pregnant. Some suggest waiting 2 to 5 years after diagnosis -the most likely period of recurrence -to assure that breast cancer has not returned. Some women around age 40 who are closer to menopause find that after chemotherapy, their periods do not return. For those who are in their 20s and 30s and who still have their periods after chemotherapy, the ability to have children may be unaffected. If you are hoping to have children after cancer treatment, talk with your doctor about your options. For mothers with breast cancer If you are a mother of young children and you have breast cancer, it can be hard to tell your children what you are going through. Remember that children can pick up on their parents' feelings, and may be confused if you do not talk to them about your condition. Telling your children in simple terms about your cancer and sharing some of your feelings will help them understand the changes around them. Every mother is different, and your parenting style may be different fiom someone else's. But in your own way, try to share with your children what you are going through. Also, trying to maintain your usual routine may help your children adjust to the changes. Talking about your breast cancer can help both you and your children cope with the disease. Resources Young women with breast cancer may have special concerns that are different from those of older women. Finding the right support group can bring strength and friendship through sharing your thoughts and feelings. Many larger hospitals have or can refer you to cancer support groups in your area. Or you can contact these organizations for more information: Organizations Susan G. Komen for the Cure® 1-877 GO KOMEN, www.komen.org for these booklets: What's happening to me? What's happening to the woman I love? What's happening to mom? What's happening to the woman we love? American Cancer Society 1-800-ACS-2345 www.cancer.org Fertile Hope 1-888-994-HOPE www.fertilehope.org Young Survival Coalition 1-646-257-3000 www.youngsurvival.org Breast Cancer™ Network of Strength 1-800-221-2141 (English) or 1-800-986-9505 (Spanish) www.networkofstrength.org Related fact sheets in this series: • Genetics & Breast Cancer • Talking With Your Children • When You Discover A Lump The above list of resources .is onlya suggested resource and is not a complete listing of breast health and breast cancer materials or information. The information contained herein is not meant to be used for self-diagnOSIs or to replace the services of a medical professional. Komen for the Cure does not endorse. recommend or make any warranties or representations regarding the accuracy, completeness, timeliness. quality or non-infringement of any of the materials, products or information provided by the organizations referenced herein. Developed in collaboration with the Health Communication Research Laboratory at Saint Louis University. <92008 Susan G. Komen for the Cure. Item No. 806-352a 8/08 rea e. Generally, the purpose of breath- ing meditation is to calm the mind and develop inner peace. Sit in a comfortable position, with your back straight, and work to prevent the mind from becoming sleepy or sluggish. Sit with eyes practically closed, breathing as normal, but through the nostrils. Focus on the sensation of the breath as it enters in and out of your nostrils, your throat, your chest. This sensation is the object of meditation. Strive to concentrate on this II e I a e focus as a "white space", exciLiding all external surroundings and thoughts. Do not allow the mind to wander away with thoughts; always return to the focus of the breath. Trying this over and over will increase inner peace, and give the mind a spacious feeling, leaving us totally refreshed. Much of the stress and tension we experience everyday comes directly from the mind. Controlling the mind through breathing mediation helps re- lease the constraints of external conditions while building a foundation for happiness and contentment. wwwosapoznik.com 1.877.948.8887 SAP()ZNIl( HEALTH & WELlr'!ESS Simple Steps to Protect Your Family from Poisoning Most people are unaware that poisoning is now the #1 cause of injury death in Florida. Today is a great time to learn a few simple steps that may prevent you or a loved one from tragically becoming one of the seven Floridians a day who die from the effects of a poison. All community members are urged to take the following steps to protect their family members from poisoning year-round: 1. Program your cell phone with the free nationwide Poison Help line: 1-800-222-1222. This number connects local callers with the Florida Poison Information Center in Miami. Calls are answered 24 hours, seven days a week by doctors, nurses and pharmacists who give immediate, expert advice on any suspected poisoning or medicine mistake. Calls are confidential. 2. Clear your medicine cabinet of old or unnecessary medications. Most deaths from pOisoning involve prescription medications like pain killers, anti-anxiety medications, or stimulant drugs. Keep all necessary medications in a secure area, away from children, ideally in a locked storage box. Don't forget grandparents' homes! One in five child poisonings occur while a child is in the care of a grandparent, according to the American Association of Poison Control Centers (AAPCq. 3. Buy and correctly install a carbon monoxide detector in your home. Common causes of carbon monoxide poisoning include a vehicle left running in an attached garage, a gasoline-powered generator running too close to a home or open window, or a grill or other cooking appliance being used to heat a home. You cannot smell or see carbon monoxide; it's called the "silent killer." If you suspect you or a family member may have been exposed to carbon monoxide, call the Poison Center right away. If anyone has lost consciousness, call 911 immediately. Free poison prevention educational materials are available for download at www.miamipoison.org. You can order magnets, phone stickers and informational brochures by calling 1-800-222-1222. Don1t Take a Chance ... Call! 1.877:94~.8887 www.sapoznik.com _ _ ___ ~_ _ _ _ ___ ~ ____________ • __ • __ • _____ .___ _ _______ • _ _ _ _ _ __~ _______ c _ • Workplace Well ness: Why Promote Wellness? Well ness issues important to you -brought to you by the insurance specialists at Sapoznik Insurance. What is Workplace Well ness? Workplace wellness refers to the education and activities that a worksite may do to promote healthy lifestyles to employees and their families. Examples of well ness initiatives include such things as health education classes, subsidized use of fitness facilities, internal policies that promote healthy behavior, and any other activities, policies or environmental changes that affect the health of employees. Why Workplace Well ness? It affects your company's bottom line in many ways. Namely, workplace well ness can lower health care costs, increase productivity, decrease absenteeism and raise employee morale. Because employees spend many of their waking hours at work, the workplace is an ideal setting to address health and well ness issues. Well ness programs help control costs. An investment in your employees' health may lower health care costs or slow the cost increases. Employees with more health risk factors, including being overweight, smoking and having diabetes, cost more to insure and pay more for health care than people with fewer risk factors. A wellness program can help employees with high risk factors make lifestyle changes to improve their quality of life and lower costs, while also helping employees with fewer risk factors to remain healthy. Healthier employees are more productive. Research shows that workplaces with wellness programs have employees who are more productive at work. Healthier employees miss less work. Companies that support wellness and healthy behavior have a greater percentage of employees at work every day. Because health frequently carries over into better family chOices, your employees may miss less work caring for ill family members as well. Reduced absenteeism can yield significant cost savings and return on your wellness investment. Improve morale and enhanced image for the organization. A company that cares about its employees' health is often seen as a better place to work. Those companies save money by retaining workers who appreciate the benefit of a wellness program and they can attract new employees in a competitive market. Adapted in part from Wisconsin Worksite WeI/ness Resource Kit. This article is not intended to be exhaustive nor should any discussion or opinions be construed as legal advice. Readers should contact legal counsel for legal advice. © 2007-2010 Zywave, Inc Just like food, beverages contain calories that many people do not realize are there. They can add up quickly and will affect your waistline if you don't take them into consideration when determining how many calories to consume daily. Here is the calorie content of some of your favorite drinks, both from home and at your local eatery: Type of Drink Calories Healthier Option Calories 16 oz. cafe latte made 265 12 oz. cafe latte made 125 with whole milk with fat-free milk 20 oz. non-diet cola 227 20 oz. diet cola 0 16 oz. sweetened lemon 180 Sparkling water with 0 iced tea natural lemon flavor 12 oz. sports drink 99 12 oz. fitness water 18 12 oz. fruit punch 192 12 oz. orange juice 168 8 oz. chocolate milk 208 8 oz. one percent 158 made with whole milk chocolate milk 8 oz. two percent 120 8 oz. skim milk 90 reduced-fat milk Look out for the following sweeteners when purchasing beverages at the supermarket. These ingredients add empty calories to your diet: • High-fructose corn syrup and fructose • Fruit juice concentrates • Honey • Sugar • Syrup and corn syrup • Sucrose • Dextrose There are ways that you can cut down on your caloric intake without completely giving up your favorite beverages. Here are some tips to remember: • Request that your coffee drink be made with low-fat or skim milk instead of whole milk. Order the smallest size available, even if that's child's size. Forgo extra flavoring such as vanilla, hazelnut and caramel. These syrups are sugar-sweetened and will add calories to your drink. Skip the whipped cream on the top of coffee drinks and smoothies. This ingredient adds calories and fat. Ask that your smoothie be prepared without added sugar since the fruit used to make it is naturally sweet on its own. © Zywave, Inc. All rights reserved. APPENDIX F LEGISLATIVE AND COMPLIANCE Plan Administration and Legislative Compliance There are countless rules and regulations governing employee benefit plans. Our expert team will help ensure that you are meeting your compliance obligations. We stay up-to-date, and will inform you of any laws or regulations that may affect your employee benefit program. Our compliance consulting services include: Easy-to-read Legislative Briefs that summarize recent federal legislative developments in insurance and employee benefits. Answers to common COBRA, Health Care Reform, FMLA, HIPAA, HIPAA Privacy, Medicare Part D and Section 1 25 questions. Commonly used forms in COBRA, FMLA, Health Care Reform, HIPAA, HIPAA Privacy, Medicare Part D and Section 1 25 administration. A community of knowledgeable colleagues from all over the country to share resources and information via the Community's interactive forum. A variety of insurance, employee benefits and human resources websites and articles, all in one convenient location. Sapoznik Insurance is committed to helping you with complex plan administration and legislative compliance, using a variety of internal and external resources. Legislative Briefs Sapoznik Insurance is happy to provide our clients with exclusive Legislative Brief publications that summarize recent federal legislative developments in insurance and employee benefits. These informative documents are researched and written in an easy-to-read manner by experienced benefits attorneys. Client Portal All Sapoznik Insurance clients receive access to a personalized online Client Portal, which is designed to offer time-saving tools and resources that build convenience into managing your everyday work tasks. Community The Client Portal Community section lets Sapoznik Insurance clients network with a vast, knowledgeable group of colleagues from all over the country, and share resources and information. This interactive forum allows you to post questions to peers and provide insight to others' questions. Topics include Benefits Legislation, Compensation, Employee Relations, Health Care Reform, HR Development, HR Management Topics, Recruitment, Risk Management and Other. Collaboration Center The Client Portal's Collaboration Center allows a seamless exchange of information sharing from our agency to you. Accessible 24/7, postings from our agency are timely, relevant and easy to locate in one convenient place online. Surveys The Client Portal allows all Sapoznik Insurance clients to participate in benefit plan surveys, allowing them to determine how their plans and programs compare to other employers across the United States. © Zywave, Inc. All rights reserved. The Client Portal also features several value-added services and resources for's human resources and benefits personnel. It facilitates efficient and easy communication with Sapoznik Insurance and our clients, and provides a vast array of HR materials, including legislative information, employee communications, industry-related websites and consumer-related information. Resources The Client Portal Resources supplies Sapoznik Insurance clients with a variety of insurance, employee benefits and human resources web sites and articles, all in one convenient location. Compliance The Legislative Guides give our clients an exclusive set of comprehensive guides to federal legislation. Complete guides include COBRA, FMLA, Health Care Reform, HIPAA, HIPAA Privacy, Medicare Part D and Section 1 25. Within each guide, sections include Common Questions, Forms and Quick Reference. Documents on Command Communication materials provide Sapoznik Insurance clients with instant access to a library of downloadable articles, including categories such as Well ness Programs, Employee Health & Well ness and Benchmark Surveys & Statistics. Hea/thShop Sapoznik Insurance provides our clients with HealthShop -comprehensive consumer information in a ready- to-print newsletter format. Topics include At the Doctor's Office, At the Pharmacy, Home Care and Your Health Plan. The following are examples of the legislative and state-specific compliance information we offer our clients, along with a fact sheet that describes the client portal in detail. © Zywave, Inc. All rights reserved. WWW~SdPoznik.corh 1 .877 ~948.8887 research@sap6znik.cOnl i . . . , , I Under President Obama, Health (are Reform will change the way America's Employers,~pproach Health Insurance Coverage. The Patient Protection & Affordable Care Act (PPACA) and the Health Care & Education Affordabi IiW Reconcili:' ation Act of 201 0 (HR 4872), have established mandates that apply to em ployers of allkind~ across;~ variety of different mandate categories. Below isa cheat she~tthe Sapoznik Research Team has treated about'k,e}rpolhts'forgroups9fall sizes. We encourage you to read this sheet carefully, pass it on to your contacts,and as al~ays/contac:tth~ Sapqznik Research Team with any questions. Who is Affected All Employers, regardless of employer category; areaffe¢ted'byf/ealthcare Reform Everyone in the United States must have Health InsuranceCov~t:age by Jiinuary 2014 Employers with over 50 Fu II Time Employees mustprovid~ Insurahceandpay atleast'qO% of'e.h,lpl()y~e's premittJiiS EnroJlment waiting period may not exceed 90 day~ . '. . '. Ehlployers wI.th over 200 Full Time Employees must automatically enroll employees in:coverage(optionto opt out) Elilployers w.ft.h OVer 50 FI.I II Time Emplqyees thatd.On't offei'covef~ge/offerlQraffdrQ~plecove.r~ge' (c9yeragecQ~t exceeding 9.8% of employee's incom~rwill be subj~ct toC!$'2,OOofi,rie anl'lU.ill!y peremployeel~xch.lding the,firS,'t30 employees) ,. . ') • :: h _.' '.'~ Plan;Ch~nge.sUnqerHe~l~h~areReform .'. . No Annual/UfetirrleDotiafUmitson Healtl1dnsurarice Plans (2011) . Proviq~rsmay ,holimpose:pree':Cistingconqition eidlusions6f Iil11ita~idns ~ginnirjg.iri2014 N.o di5.9ri.miha#on,pased9~ Heal1h, Status, (HIPAArujes nowind uded)nPPA<:~) (2014) Waiting~eHodsJor Plan Ehrollment may not exceed 90 dayS:(2014} cO$tShating Ur'ni~ations~ '.' . . ...' .' .... ". .' .... . ". . . OufofP,Qcketl!Xp~nses (()0P)mi.lynote~(!~ed th(\'J$~appli~able to H.ealt.hSavjngs Acc9unt (H$A) Cov~rClge ,Dedlidiolesmay,not EXceed$2,Odb forsiliglecove~ge ahd ;$4,000 for FamilY;Covetag,e. Over tli(!:Cduntetprugs.m,ay notb'¢ clalrri¢~ asmeC!icale}(p~nses unless pre:s¢ribedfdr HSA, F5.As, HRf\$by (20n) The penalty forl,ls,ing HSAfunds t~rpay for~on~qqal ifiedmedic:al expenses.ln~reasesftom 1 0.% to 20% J1'I201.1 Salary.Reducti6nsunderah FSAarelimited;to $2S0bperyear beginffingih2013 . ! \Nhatl;rnployers need ~d kpow ~mployers mustcliscioSeValue ofe-mployees employer.:.sponsored':'health insUrance oriannualW2 form's (20Ti) Non-r:f9ctor prescribed drQgsareexciudedfrom ~axbenefits. under cafeteria plans (FSAs + HSAs, etc.) . ~mployers withUf,lder50~mploYees may be eligibl.e for a tax-credit for proviqing insurance to their employees (201 0) Employers will be charged a 40% excise taxeon cost of high val ue inslirance plans ("cadillac plans") (20la) , po you have Questions About Health Care Reform? , research@sapoznik.com 1.877 .948.8887 www.sapoznik.com Your Guide To Navigating Health Care Reform How Health Care Reform Affects Your Cpmpany This docutnent provides a description of the various mandates to large-group employers under the new health insurance reform law of the Patient Protection and Affordable Care Act (PPACA, P.L. 111-148), as amended by § 1003 of the Health Care and Education Reconciliation Act of 201 0 (P.L 111 ~ 152). The contents of this document outline the new requirements and effective dates for groups of all sizes. Some provisions become effective immediately. Sapoznik is your partner in providing information you need to know about health care and health benefits. , .. :.1-,' I' . i I I, www.sapozriik;CQrn 1.8.77 .. 948.8867 res9arch@sapozntk:cb rn Health 'Care Reform: The B,asics On March 23rd,2010 PresidentObama signed into law the Patient Protection and Affordable Care Act (PPACA), the largest health system reform since Medicare + Medicaid enactment in 1965. Shortly after, a new bill was created to ammend The PPACA Bill called the Health Care Reconciliation and Education Act. This act modifies certain mandates in the PPACA bill and changes several effective dates from the PPACA bill. All information outlined in this document is corroborated by the PPACA bill as ammended by the HR4872 Act. The majority ofthe provisions in this bill affect Employersl in particular; Large Employers. Large Employers are defined as Employers with over 50 Full 11 me 'Employees (F'fE'S) under a singular tax 10. A full time employee is considered an employee who works 30+ hours per week, excluding seasonal employees who work less than 120 days a year. Here are the "main pointsnfor large Employers. Employer Ma ndates Employers with over 50 employees must provide affordable health insurance coverage to their employees or face a $2,000 fine per employee anually should any employee require a federal~subsidy to purchase health insurance through a state~run insurance exchange. "Affordable health coverage" is defined as health coverage that does not cost the employee more then 9.8% of his or her income so long as that employee's income does not exceed 400% ofthe federal poverty level. In addition, If the employer provides unaffordable coverage (over 9.8% of employee's income), the employer will be required to provide the ,employee a voucher equal to the employer's premium contribution for that employee and/or be fined $2,000 per employee if any employee should require a federal tax subsidy to purchas,e health insurance coverage. Under the new bill, waiting periods before enrolling employees in affordable, employer~sponsored health coverage may not excceed 90 days (for employers with more than 50 employees). Addition~ ally, the employer is now required to contribute at least 60% of the employee's overall premium towards the cost ofinsuring that employee. Other penalties and mandates are discussed in more detail in the following pages. . Navigating Health Care Reform Employer Mandates + Penalties Nothing il"l the health care refolr.mlaw:saysan~mpIO)"er musto{fe,Niny.healthcoverageJo employees. Nonethe-.· ~ess, the law Imposes penalties underceftaln circumstances·on employers that do not offer. coverage:· -An organization with ,m9retha·ri.56ernploye~sandwltl.lri9 heaithcpyerage wiJl,!lefined $2,000 per ful~time ~n1pl~~p~fye~r:ltal}yfiIJl+tlme ~mpIOye~~~lV8:s:~.jJte·mlUm':t~cR!dft " .. ' ... from the federal government nlrt:t5ei"a.state~<;h~flge: When (:()U!lijJJ9Ju 1(;:1:ime'E!rnplp~esA:hefj~stao are subtracted. -An em 10 er that hli's"tnorethan 50~ . f." , ........ .' offefs health benents.andbas:iHeastorie·rulktlme:. P Y ...... ,:', ......... :.:: ..... : .. "p,O)I~ '.' .... " .. , ... ·:·c., .. · ... ,· ...... , .. , .. : ..•... J, .... c'.··,··,.·,.·.:,·····,··,·:.: . '. em I"ee recelvlna~ i"emium'taJ(credlttrOmthefe'del'al'ollerhmem'wlll:o,ffiriedeither:$3<};i'ldJofeacl1 :~~~~:i~~1(IO~i;~~t·~~.~~~!~·~}~;~tt9. ..... When calculating how part~*~m~·.eijipl~~~sl~~re.a~~th.enijrrib~rqffMIHII'nif~e(l1pl~lCli'the.he~fth:~~tef~ffil; law~ purposes, employers ~agg~ga~,:t",e fJlJmb~iof hOlJrs~het\l'l~eQferopl~esWho.a,re"()tfull-~m~.jlJd· divide by 2,086. . '. " .. ' . . .. . .... . . . . . .... '. ..... .. .' . . . . . In additlonto its dlsincentil;es:fqtnotprovtd)'1Q.covetage.thereforin iaw offers empIQyel:5many.lncep~ivesto.of(er qualified health benefits plans;" . . .. .... .' .... . . . For example,an employer W'th2S0r:fewer:fui~time employees;an~:anaverageannuai wageof$s'o~ooo,or'le~s·(an. receive a' subsidy starting thl5)'~r,dtup.t()35:pement,.Qhhe .. (lO~of ellglbl~'io~erage'ifthe{Dmpa~yp~)'saf'least 50 percent of the premium Cl]:StCffiesubsldy rises to SO percentforanaddltionaltwo yearsl s:tartlng in~O 14. The Big Question Many employers with mor~iHan5Q,~'mp.19~~~:af~~lli~~dy~s~lngwhethertheY~houldcpn~nue too~heaHh coverage after 2014, or justp#'t~:ep~6~lty;NleraOiwahlhe·average~niploYer.~iitreJ11:Jypayil:lg almost $1 Q,o~.O per employee per year in he~ltij:~(e'~Q~.WIlY@fJti,stp.ay~e$~,(}Qoperel'OpIOY~penalty,,1ilste(ld? It doesn't require rocket sciellc.e to m(l~tl}~~.(l~'~lat"llJij;~~tWSnOt-1:I5~W~s·IHQ:ay,s~m While low-and mlddle-lllcQm.,eiflpl~e.s~!qtfj~[lie·~·5Ubs!.qytQP1Jrd1~~c:cJWrag:~the5~~~igypha;s&!>out· as income rl:Se5, and it disapp'¢.lt5t9.ippletelY.*fiter$8~"OQPilifanlIlYlrtcofli.El. rh~s,al1~mprtJyee~h~~pc)u~e;ea~r eaming $50,000, for example..mightbavet()p."y·abC;;lItS)SAo~'~op~rchas~(Qvel":agdhroLigh,<ln ~t:haf.l,g~; Presumably, tlhere would beslgri!ft~ilh~presstire.prielTiplqyer.;l'!ot~(ferlng heal~h . benefits to·ilJ'.crease:employeet;' direct com pensatlon to pay fortllat~O\i&ra,ge.Jfpai~ as direct ,compensatloll, iHssubjetttopayrolitaxesill1d . workers' compensation cosbi.. . . In additlon, any other bene:fitpredlc::at~d oni compensa~oll, such. as. retlfementpJan cOllitrjbutlom;.IIfu.lnsura~ceor disability coverage" wmJldpfoportiol1lately increase. And after a II oftlhattheemployer stili has to pay the $2,000 penalty. last, the employer would l1owlose the ability tolflfluence .. employee!nlealth through prevention and! wellne5s programs. That lost opportun Ity could resultin a less l1ealthy,less productive workforce. Navigating Health Care Reform Grandfathered Plans Some plans are ·excludedfrom the Immediate provisions of Health Care Reform, these plans are called "gtandfa- thered plans.:" A Grandfathered Plan Is any Health Insurance Plan that was established before March 23rd, 2010. Any health plan established afterMardt 23rd. 2010 (Including plans that renew after March 23re1, 2010), are subject to regular provisions under PPACA as am mended by HR 4872 Other Provisions ~t=;;!~i:~re=flt~t;r:=r#~.~i~==QI1~. Who has access t6healthcO\tera!te.tbrou:"'tiJlrs~o'''':her;etn···· f' .'.··!eif~I"Jn '\fi'l2Gn;{:'a!p\:a\taaf!allow5ije~nCle~f' . coverage must mafre·the opi!~~.·.~td~~dE!~t:~d~iiJ~:\ra1abl~;:U~i~~:~bj!d~Mith:Rtfthd~~.;f~~fal~j$~~'i· . available cO\ierage through h[~orhediimpi;~r;' ..... NQClpS on UfetimeBenefits '. .' . '., . ", ';i. ......>,. ...... . .,,:,>. AIIII,fetlmeal'ldannl;laldollar limits forboth Individual an~9roup:~ea:lih·,pl'aQS,musfbe:elliTIinated,ori~s!se~tj~1: .' healtfrbenefits'ia.s defined' by the us DepartmentofHealttfand Humarf'Servlo~, . .' .. ' Navigating Health Care Reform: Plan Changes Employer Sponsored Health Plans Employers offering health coverage must now pay at least 60% of the premium of risk fines and penalties if employees require a federal tax sUbsidy to purchase insurance. In addition, employ- ers may not offer 'unafforda ble' coverage'to employees, or, coverage exceeding 9.8% of an employee's income. Failure to provide affordable coverage will result in the employer having to provide the employee with a voucher equal to what the employer's contribution would have been to his or her health plan sothat employee may shop around for an insurance plan they can afford. Financial penalties for failing to provide insurance to employees still apply to em~ ployers offering unaffordable ~over(l9~ FSAs, HSAs + HRAs Several provi sionsapply to Cafet~ria pia ns suthasF'le~ible:Spen4ing:A(:e(n.tl1ts (F5A~)iHeath :S~virigsAccoun~{HSAs)ahdH~Cilth Re;iniburshlen(AtcOlJ]lts(HRAsl. ',' ',,' ,,' IMpORTANT: Beginingih 2.011,Over4he~(:<nmterd~gs,are:exdudedfrorn rwi.mbursem¢httbrough~f h~althF$AHflAorHSMunlesspr~s(:ribed by:physki.n. ~1~;~~t::~~1~~'iij~~t~l~::~~~d~~1~fJ~i,~~tti~~~II~a~( 'tbe,penal,ty;for u~ingJ~landollars;f6r'J!J nquaHfied.medlcalexpens~s~ Previou5Iy'ASAs,,;¢~arg fJd a '{Q,tK;; .• etla:lty:Ulx:for'tiSil'f··':·· re .. ta . ::ddll '1510" a'.fotnon~a .•....... oved , ·.edkat ex';'enses(Beglriin' '. ';ib.'2Bfl~·this·'~~'ri~lty'Will~~i~,~~,::r4.i.~::Qffh;'~H¢~~f.t:4~n~q~'~#~·.'MJ~~.~·.r~~·~~.A~.·.······;·· ,g 'In add ition, .FI~)(i~r.·SP~M~ing,}\ccq.~n~$';(~'A~)~~jb:~*p~tl.PREl~~h~~9,.,s':tp ,cgn~rf~:~ti(mllttH~ beginin g' in 2013. Und~r.th~~iJr'ij~Mt·t~i~A~J'np.l~fii'S~'etth~:Jilnitml:how<mLl·c.hth~:!f ~mplpy~~s can set aside'forFSAs.;':B...-t,by2013~the:la~limi~s;ciln.~.ti~ution:sto the accoul1tsto$.2(!U)O lUlU ... ally,. .'. ." , ,'., . '. ' ;~¢ept'for.gr~ndfatt1elid~plan~;~~II';pl~n~~mostpr9vi~e minimu me"senti,alc()verag~.Arnol1g :Oth~rcriter:ia;the.aijijU:~U'l,le ,(anndte)(cee~ .$2,QQQ·fa r an in d ivid~a lor '$4,0.00 for afamilY . .ManY.JJfP'lliQers offerb i9h .. ded~q:ibleh ea Ith-pfans wlthm.Uchbigh:erdedud;ibles::up to..the 2P10llltlitof$5,950 fpril1divi duaJ$ orc $1 ],900 forfamiJi es. Navigating Health Care Reform Medicare The Reconciliation Bill dose the coverage gap. called the Udoughnut hole:' for Medicare beneficia- ries enrolled in Part D drug plans. {Currently. seniors who hitthe gap must bear the full cost of their . medications until they spend a certain amount, when coverage kicks back in.} Seniors who hit the gap this year would get $250 to help cover the costs oftheir medications. Ups and Downs The law contains some financial help for organizations offering retiree health coverage"Starting June21, a temporary federal reinsurance program will reimburse employersforBQ% bfannual health benefit daims-"" including medica~sl:lf9ical;hospital andpresctipfiondrug'costs~ffom $15,000 to $90,000 foreach early reti ree intpeag'e bracitetof 55tQ64.Tht:! t~ins'~ral1ce';ptggrajTl~ will runthrough 2013 or Will end sooner j(th~·$5tlmion~I[Qcatipn'runsdut •. "" .... . .. ,. . . This reinsuranoe will provide employers y~t~?p.lheroPPQrtlJl1;ty~9C;()rlSi~~r-WI1.t.~.r~p,~'~QYI·tQ offer health benefits to early retirees, an~ll1e:prograrhmt:!ye.n¢o'Qr~gesome.~n1pl.Oyet:SbitQnsicl~r early~out incentives in connection with downsiiinginitiative5.()rganiz~ti~6sthatmaihtalnapre... . scription drug program for retirees 65 and:olderwiUJoseataxbreak: They .n(')wWCf!n,e:~"s_u~sUJY()f 28% of drug costs under the Medicare Part:g:.Pf~sqtIPt!()Q:prug',PrQg~il;I.1he:~ubs.idY,i~tilktT~e:~hd can be a tax deduction on an employer's;f~dei'al,rettif:h.Tt1~tta'}(:Q·Qdu¢tIQn\"iiil~ltpifel~,2q.t:,~ . . however, and any organization claiming jtmustaecountforthatchangebeginningil'l'2ol0;;For AT& 1: that meant announcing in March a'$1,·bj.llipn~ha.r.g~tQlts·nQ.n¢a·jba_~9J; .. ot:s;fqtd (\iJo19t.CO •• on the other hand, will be unaffected by tHi$~*.a'r)a,att6uht!rigchiiri~~'b~·~!l~,:6ftb~,:a~~tjrri~ot . whereby its United Auto Workers retiree healthbenefifliabilitiesweretransfermatotheunionts voluntary employee beneficiaryassociati()rllfust The loss of the tax deduction may cause som(i} ernployerstotevisitwhelhertheY:WiSJrtQ CQntjnlle offeri ng p reseri ption drug cove rage to retire~s,6s~oC,l.,:olr:,l~rfW.bq;ilr;~f!·ligib:l,e;fqt Me~.i~teanalts· prescription drug program. ' ...... ' -.,-, , ..... -'.,.<, '.. ", Navigating Health Care Reform The 'Cadillac/Tax One of the more contentious issues in the health care reform debate was the attempt by Con- gress to curb the appetite for high-cost health plans. Because of the tax incentives--current and future under the reform law~many commentators argued that high-cost health plans were unwittingly driving overall health care costs even higher. The solution was a 40 percent tax on "Cadillac U health plans starting in 2018. Cadillac plans were defined as those with individual aggregate values of $1 0.200 or family aggregate values of $27,500 or more per year, with dollar values to be indexed annually starting in 2019. "Aggr~a~e~lu~"jn<:ludesa,he~ltbJ,)I~Q~s:PJemiurnand.emRI,QY.~rand~rnpl9Yee contribulipns Je;a:;heaJfh.cafe',fI'exible,~pEn'ldIh~aecdtintand,e,rriplb¥~r·c~rttflbittiohsto.a.'health reihlbu'tse- ·;~:r~~~1:~~i;~·IW~t~:~:~~~~~~WJi:~j~ht~;~~!~r~ir~:1:::~~~de ~~:~~~=~~~~PIOY- 'efs:b~'U~eit~u'ldchecollectoo,:frQm 'insurers':for t~eirgroup health plans. In reality~insurers 'W9iJl~'pm~~lY-'~~stbe~~;:Qp',tQ'~mplQY¢rs-ib~he:fQrfl)::Qf'bigher premiums:l\ndfQI"S¢lf" fwn(;J~'(fpJa.bs"th~:t~x,WQ~ld.p:plytP'J.>laTltadnllni.ttatorsdypicaIIYI.~mpl()yer$. ':~iB~~'it~ijlaW:$~tst~l~ti\i.IY;bfgh:ilgg~g~t~"~IY~liJTllts;.Il~ould ,seern)hat few erl]plovers WQ.II"~~~b:e,,~~ted',h"!ti~lb~.:A\jerag~":h{E!*tth':plan¢Qsts~.fP:f.::a;large majority of employ~tS,are Si!ln'ifi~a-':I~ly:';be'I~,th.~e·levels'tdd~.·fflQW~.MtWQ::fC)~tp~rs~aY(.lJseemployers'qQO¢emJI)10 to:1SY¢i.fs.fir$t,;'he':i"de)tjng:mech~ini~ttt()n~6:~.,a·g~f~gate:values does not' use m~dicat~~t ' ' 'incr,~ses, bufrather'the:~.ular ConsumerP"icelnd~)fo:5econd, in some plans subject to collOCn tiVe'bargainingiri,cherhe~ttb'herndit~have~lston$111'b:,.h negotiated in:~xchang.efQrle~se.r j~.¢r$sfl!$ iodir~¢t cQfn:peh~~tidn.~:.it:W~!ii.fQt,thl$J~$bn'thiltmany in "organized lab9f·qppqsed thecadilla'C::tax., . ,.' .:: ". -.' -'-'. EmployersWithparticlpants i.ll plafis.subject'tocollecthle'bargaining will need tOWotk with :ufljon;hffi~blfs tp d~tEmblnC1lif:pethaps:air.ade;.offofhe.l~h' benefits in exchangeJor nlqre lfI*able fol1Tls.()f~ompetisatior'm 19htroa:keJinancicll~elj~e for e rnplQy~rs <fInd 'employees, Navigating Health Care Reform The Longer View All employers will have to examine the components of the health (are reform law and determine how they should proceed. Many will find they are actually re--examining their overall total rewards strategies. For some, in fact, it may be the first opportunity in a long time to ask them- selves such strategic questions. Although proponents of health car,e reform did not set outto motivate strategic reviews within organizations, that could prove to be a valuable unintended consequence. ~-, •.. ' Saponik Insurance is committed to providing you with the most current and relevant information surrounding employers and Health Care Reform. If you have allY questions about Health Care Reform, or would like to submit a research request, please feel free to contact the Sapoznik Research Team at: research@sapoznikmm 1.877.948.8887 www.sapoznik.com LEGISLATIVE BRIEF COBRA Regulations: Handy Reference Guide The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) requires that employers provide former employees and dependents who lose group health benefits with an opportunity to continue group health insurance coverage. Since COBRA was originally enacted in 1985, the Internal Revenue Service (IRS), the agency responsible for defining required COBRA coverage, has released three sets of proposed regulations and two sets of final regulations. The IRS released its most recent regulations in January 2001 that finalized the 1999 proposed regulations and made some changes to the final regulations released in 1999.1 This Sapoznik Insurance Legislative Brief is intended to provide you with a consolidated look at the guidance provided in the final IRS regulations released in 1999 and 2001. Small Employer Exception 2 • Group health plans maintained by an employer that had fewer than 20 employees on at least 50% of its typical business days in the previous calendar year are not subject to COBRA. (1999 final regulations)3 • Only common law employees are taken into account for purposes of the small employer plan exception. Self- employed individuals, independent contractors,.and directors are not counted. (1999 final regulations)4 • Both part-time and full-time employees must be counted, whether they are eligible for health insurance or not. (1999 final regulations) • Part-time employees must be counted on a pro-rata basis. Each part-time employee counts as a fraction of an employee, with the fraction equal to the number of hours that the part-time employee works for the employer divided by the number of hours that an employee must work in order to be considered full time. This method of calculation is intended to produce the same result regardless of how the hours are scheduled. (1999 proposed regulations; 2001 final regulations) • Employers may count part-time employees either on an individual basis or on an aggregate basis because both methods produce the same results. Therefore, an employer can determine the number of part-time employees for COBRA purposes by looking at each employee's hours for the year or by adding up all hours worked by part-time employees and dividing it by the number of hours required for one worker to be considered working full time. (2001 final regulations) Payment of Premium • Where the COBRA premium remitted is short by an amount that is not significant, the plan must either a) treat the payment as satisfying the plan's payment obligation, or b) notify the qualified beneficiary of the deficiency and allow a "reasonable period" (which is generally 30 days) for the deficiency to be paid. (1999 final regulations) • An amount is considered insignificant if it is not more than the lesser of $50 or 10% of the required premium amount. (2001 final regulations) • Payment is made on the date it is sent. (1999 final regulations) • A third party may pay COBRA premiums on behalf of a qualified beneficiary. (1999 final regulations) 1 The 1999 final regulations apply to qualifying events occurring in plan years beginning on or after January 1, 2000. Generally, the 2001 final regulations apply to qualifying events occurring on or after January 1, 2002. , 2 The 2001 final regulations adopted the 1999 proposed regulations without change, but clarified the ability to use individual or aggregate calculations. 3 The 1987 regulations used the term "working days." 4 The 1987 regulations required the inclusion of self-employed individuals, independent contractors, and directors. COBRA Regulations: Handy Reference Guide Core vs. Non-Core Benefits • Qualified beneficiaries must be given the same rights to elect coverage as similarly situated active employees. (1999 final regulations) • All health care benefits provided by an employer are treated as one plan unless it is clear from the documents governing the arrangement that the benefits are being provided under separate plans and that the arrangements are operated pursuant to such documents.5 (2001 final regulations) • The determination of whether benefits are provided under one plan or separate plans impacts a qualified beneficiary's right to separately elect medical, dental, or vision benefits. Example: Employer Y offers two health plans: one provides major medical and one provides dental. An employee covered under both plans at the time of a qualifying event has a right to elect a) medical, b) dental, or c) both. Health Flexible Spending Arrangements (Health FSA) • Health FSAs are subject to COBRA, with some exceptions. (1999 proposed regulations; 2001 final regulations) • An employer is not required to offer COBRA where the maximum amount that the employer could require to be paid for a full year of COBRA coverage equals or exceeds the maximum benefit that the qualified beneficiary could receive under the Health FSA for that year. (1999 proposed regulations; 2001 final regulations) • Where a Health FSA is not subject to HIPAA,6 COBRA does not require that a qualified beneficiary be entitled to extend their Health FSA where the account has been overspent as of the date of the qualifying event. (1999 proposed regulations; 2001 final regulations) • Where a Health FSA is not subject to HIPAA, COBRA requires that a qualified beneficiary be entitled to extend their Health FSA through the end of the current plan year where the account was under spent as of the date of the qualifying event. (1999 proposed regulations; 2001 final regulations) • A careful review of the regulations is warranted in situations where an employer contributes funds to a Health FSA on behalf of an employee and where no other health plan is sponsored by the employer. Qualified Beneficiaries Moving Outside the Service Area • Employers must make alternative coverage available to qualified beneficiaries moving outside the service area of a region-specific benefit package. (1999 final regulations) • Where a qualified beneficiary moves outside the service area, an employer must offer coverage under any of its existing plans. (1999 final regulations) • Alternative coverage must be made available not later than the date of the qualified beneficiary's relocation, or, if later, the first day of the month following the month in which the qualified beneficiary requests the alternative coverage. (2001 final regulations) • An employer is not required to incur extraordinary expenses to extend coverage to qualified beneficiaries in areas in which the employer does not have active employees. (2001 final regulations) Loss of Coverage Includes an Increase in Premium • An increase in employee premium or contribution toward the cost of health insurance coverage as a result of a qualifying event is considered a loss of coverage for purposes of COBRA. (1999 final regulations) 5 The 1987 regulations required an employer to unbundle the non-core and core benefits if the cost of electing non-core benefits was greater than 5%. The 1999 proposed rules suggested that the employer first look at that the instruments governing the employer's arrangement to determine whether benefits were offered under separate plans. 6 A Health FSA is exempt from HIPAA if: 1) a) the maximum Health FSA benefit is not more than the greater of two times the annual salary reduction election, or b) the annual salary reduction election plus $500; 2) the employee has other employer group health coverage available; and 3) the other coverage is not solely excepted benefits. COBRA Regulations: Handy Reference Guide • The IRS and Treasury Department defined a loss of coverage to include an increase in premium in order to provide the qualified beneficiary with a 60-day election period and 4S-day grace period to make the first premium payment. (2001 final regulations) Termination of Coverage in Anticipation of a Qualifying Event • If coverage is reduced or eliminated in anticipation of an event, the elimination or reduction is disregarded in determining whether the event causes a loss of coverage. (1999 final regulations) • For employer bankruptcy, a loss of coverage includes substantial elimination of coverage that occurs within 12 months before or after the date on which the bankruptcy proceeding begins. (1999 final regulations) • Where an employee eliminates a spouse's coverage in anticipation of divorce, an employer must make COBRA continuation coverage available, effective upon the date of the divorce or legal separation. The employer is not required to provide coverage for any period before the date of the divorce or legal separation. (1999 final regulations) • The qualified beneficiary is entitled to the coverage that the qualified beneficiary had before the qualifying event or to the benefits currently offered to Similarly situated non-COBRA beneficiaries. (2001 final regulations) Administering Claims during the Election Period • The employer must make COBRA continuation coverage available for the entire election period if the qualified beneficiary elects coverage prior to the end of the election period. (1999 final regulations) • In the case of an indemnity or reimbursement arrangement, the employer can provide coverage during the election period, or if the plan allows retroactive reinstatement, the employer can terminate the coverage of the qualified beneficiary and reinstate him or her when the election is made. Claims incurred during the election period do not have to be paid before the election -and if applicable, payment for the coverage -is made. (1999 final regulations) • If a health care provider contacts the employer or group health plan to confirm coverage of a qualified beneficiary during the election period, the plan must give a complete response. The response should include the status of the election, whether payment has been made, and other relevant information related to the qualified beneficiary's right to coverage. (1999 final regulations) Duration of COBRA Coverage • Where a qualified beneficiary is no longer disabled, COBRA may be terminated in the month that is more than 30 days after a final determination that a qualified beneficiary is no longer disabled. Termination of coverage applies for all qualified beneficiaries whose coverage is provided piJrsuant to the disability extension. However, coverage may not be terminated prior to the original lS-month continuation period. (1999 proposed regulation; 2001 final regulations) • Where a qualified beneficiary is born or adopted during a COBRA period and applies for the disability extension under COBRA, the 60-day period is measured from the date of the child's birth or adoption. (1999 final regulations) • COBRA may be terminated where a qualified beneficiary, after the date of election, first becomes covered under another group health plan that does not contain a pre-existing condition limitation or where the pre-existing condition limitation is satisfied pursuant to HIPAA. (1999 final regulations) ./ Mere eligibility for another group health plan does not terminate a qualified beneficiary's right to COBRA continuation coverage through his or her prior employer . ./ Coverage which was in force prior to the date of election does not serve to terminate a qualified beneficiary's rig ht to COBRA. • COBRA may be terminated where a qualified beneficiary after the date of election first becomes entitled to Medicare (Part A or B). (1999 final regulations) COBRA Regulations: Handy Reference Guide ./' Because the statute uses the term entitled, this is often an area where questions arise. The term "entitled" has been interpreted to mean covered . ./' Coverage under either Part A or B is sufficient to terminate a qualified beneficiary's right to COBRA . ./' If a qualified beneficiary is covered under Medicare prior to making his or her COBRA election, the qualified beneficiary continues to have COBRA rights. FMLA & COBRA • A qualifying event occurs when an employee who is covered under a group health plan immediately prior to FMLA leave (or who becomes covered under a group health plan during FMLA) does not return to work with the employer at the end of the FMLA leave and would, but for COBRA, lose coverage. (1999 proposed regulations; 2001 final regulations) • The qualifying event is deemed to occur on the last day of the employee's FMLA leave. The maximum coverage period begins on that day. (1999 proposed regulations; 2001 final regulations) Multiple Employer Plan Withdrawal • An employer's cessation of contributions to a multi-employer plan is not a qualifying event for purposes of COBRA. (1999 proposed regulations; 2001 final regulations) • A mUlti-employer plan must make COBRA coverage available to a qualified beneficiary who was receiving plan benefits on the day before contributions ceased, and is or whose qualifying event occurred in connection with a covered employee whose last employment before the qualifying event was with the multi-employer plan. (1999 proposed regulations; 2001 final regulations) • Where a non-contributing employer has another existing plan or establishes another group health plan covering a significant portion of its employees previously covered under the multi-employer plan, the plan established by the employer must make COBRA coverage available to existing qualified beneficiaries. (1999 proposed regulations; 2001 final regulations) Business Reorganizations • Parties to a transaction involving a sale of company assets or stock are free to allocate responsibility for COBRA continuation coverage by contract. However, where the party that is contractually obligated to provide COBRA defaults, the party otherwise obligated by law to provide COBRA remains liable. (1999 proposed regulations; 2001 final regulations) • For both sales of stock and sales of substantial assets, if the seller continues to maintain a group health plan after the sale, the seller retains the COBRA obligations. (1999 proposed regulations; 2001 final regulations) • Where the seller no longer provides any group health plan to any employee, the responsibility for providing COBRA falls on the buyer that is a successor employer. (1999 proposed regulations; 2001 final regulations) • Whether an employee has experienced a qualifying event as a result of a business reorganization is determined in part by the type of transaction that takes place (stock vs. asset). The regulations contain numerous examples which demonstrate when a qualifying event has occurred during a business reorganization. In general, the employee must have a termination of employment and a loss of coverage. Please contact your Sapoznik Insurance representative with any questions. This Sapoznik Insurance Legislative Brief is not intended to be exhaustive nor should any discussion or opinions be construed as legal advice. Readers should contact legal counsel for legal advice. Content copyright © 2000-2010 Zywave, Inc. Images copyright © 2000 Getty Images, Inc. All rights reserved. Update of Federal COBRA FEDERAL COBRA PREMIUM SUBSIDY The American Recovery and Reinvestment Act of 2009 (ARRA), as amended, provides a 65 percent COBRA premium subsidy for employees and their dependents who are involuntarily terminated from employment between Sept. 1, 2008 and May 31, 2010. Eligibility/Premium Assistance: An individual who is involuntarily terminated from employment between Sept. 1, 2008 and May 31, 2010, and timely elects COBRA, along with their eligible family member, are "assistance eligible individuals" or "AEIs" eligible for the COBRA premium subsidy. Employees who experienced a reduction in hours before their termination, and their eligible family members, may also be eligible for the subsidy. The subsidy lasts for up to 15 months, or until the individual is eligible for other group health plan coverage or Medicare, if earlier. Extended Election Period: If an employee lost coverage due to a reduction in hours of employment, did not make (or discontinued) a COBRA election and was later involuntarily terminated on or after March 2,2010, the individual may be eligible to elect COBRA coverage and receive the premium subsidy. Plan Enrollment Option: A plan is required to permit an individual to enroll in different coverage if it is also offered to active employees, is major medical coverage, and the premium does not exceed the premium of the individual's prior coverage. Notice Provisions: Plans were required to notify certain current and former enrollees of the premium subsidy. The Department of Labor has created model notices for this purpose. In addition to other notice rules, a General Notice including information on the subsidy and election information had to be given to all qualified beneficiaries who experience any type of qualifying event from Sept. 1, 2008 through May 31, 2010. Individuals who are terminated any time after May 31, 2010 must be provided with a COBRA Election Notice, but are not required to receive information about the premium subsidy. APPLICATION TO STATES: Continuation coverage under a state program providing comparable coverage (i.e., state "mini-COBRA" laws applicable to employers with fewer than 20 employees) is subject to the COBRA premium subsidy and notice provisions of ARRA. ARRA does not change any requirement of a state continuation coverage program. ARRA only allows Assistance Eligible Individuals who elect continuation coverage under state insurance law to receive a premium reduction for up to 15 months. It also allows Assistance Eligible Individuals to switch to other coverage offered to active employees if permitted by the plan provided that the new coverage is no more expensive than the prior coverage. States were permitted, but not required, to offer an extended election period. This chart is provided to you for general informational purposes only. It broadly summarizes federal statutes, but does not include references to other legal resources (e.g., supporting regulations, or formal or informal opinions) unless specifically noted. Please seek qualified and appropriate counsel for further information and/or advice regarding the application of the topics discussed herein to your employee benefits plans. (3/09; KMP 2111) © 2009 -2011, Zywave, Inc. All rights reserved. ~TLIFE -GROUP BENEFITS 4150 N. MULBERRY DRIVE SUITE 300 KANSAS CITY, MO 64116 IRECEIVED FEB 22 201b HUMAN RESOURCES --- ENVIJ 1119 CITt OF SOUTH MIAMI ATTN: GEMMA BOZA 6130 SUNSET DR MIAMI 011200964900100000000000000000000 11111/11111111 m IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII[IIII~ ~Th~ ~O~~\· C?o\-000'0-;>...\'t -\'or \--\(?\\\\?A-\AS(~v1 00\ -oooo-..2..\~-(qdU FL 33143-5040 R EC~IVED FEB 222016 ~ HUMAN RE60URCES MetLife -Group Benefits THIS PAGE MUST BE RETURNED WiTH YOUR REMITTANCE. IF THERE ARE NO CHANGES TO REPORT, PLEASE DETACH AND RETURN THE TOP PORTION OF THIS PAGE TO: TMOS921305 0001 CITY OF SOUTH MIAMI BILL DUE DATE: 03 01 2016 MatLtfe -Group Benefits P.O. Box 8044BB PRINT DATE: 02 14 2016 Kansas ctty, MO B4180-~4BB GRAND TOT DUE: 32,359.21 1111,1'111111,1111"1111'11'111111111111111'111'11111'11'11 11111' AMOUNT PAID: ____ _ CHECK #: ______ _ TM05921305 0001 CITY OF SOUTH MIAMI For customer service please contact us at: 1-800-ASK-4MET (275-4838) (Prompt 2) To ensure timely processing of your bill, please make your check payable to: METLIFE -GROUP BENEFITS PO Box 804466 Kansas City, MO 64180-4466 PLEASE INCLUDE YOUR GROUP NUMBER ON YOUR CHECK All premiums are due on the first of the month for which coverage is provided. MetLife must receive your premium within 31 days of the bill due date or your policy will terminate according to its terms. Please note that your bill no longer Includes a change form. Please use the change form in your administrative manual under Forms. If you need to request a change form, or have any questions please contact us at: 1 800 ASK 4 MET (1 800-275-4638) -Prompt 2 A change form needs to be completed for any enrollment or eligibility changes. For adding a new employee, please complete an enrollment form. The enrollment and change forms may then be faxed to: 1 888-505-7446 Or mailed to: Met Life -Group Benefits PO Box 14593 Lexington, KY 40512-4593 Changes received after the 6th day of the month will not be reflected until the following bill cycle. RMT RMT JY53S0.SCRE(06III) TO: JAMIE JESUS STEVEN 011200965000100000000000000000000 MefLife® -Group Benefits 111111111111111111111111" 1111111111111111" 11111111111111111111 PAGE 1 R EF~ ~~~'6ED TM05921305 0001 CITY OF SOUTH MIAMI ATTN: GEMMA BOZA 6130 SUNSET DR MIAMI ~ HUMAN RESOURCES FL 33143-5040 PRINT DATE: 02 14 2016 For customer service please contact us at: 1-BOO-ASK-4MET (275-4638) (Prompt 2) PLEASE NOTE;; THE FOLLOWING: • PLEASE COMPLETE A CHANGE FORM FOR ALL CHANGES WHICH CAN BE LOCATED AT http://www.whymetlife.com/adminmanuall • ASK YOUR. ACCOUNT SPECIALIST ABOUT ELECTRONIC FUNDS TRANSFER (EFT) • FOR ADDITIONAL INFORMATION, SEE REVERSE SIDE OF THE LAST PAGE NAME OF INSURED I CLASS" PREMIUM VOLUME TOTAL I.D. NUMBER ADJ. DATE PREMIUM ADAMS 0001 VV VIS B ',~1.3~.2Q ,/ XXXXX0455 05-1983 13.22 AGUIAR 0002 TP DMOFL C XXXXX7227 12-1982 VV VIS C 19.17 ALEXANDER 0001 VV VIS B Lr~h2~/ XXXXX2805 05-1952 13.22 JOSE ALVAREZ 0001 TI DENTL C ~~m~Di ~t:tr.:r_~~"'t--". XXXXX1988 03-1982 42.10 ATKINS-MCGUIRE 0002 "~"z,, ';"'fi/.J' ELISHA TP DMOFL C ! ;it;Z;lj~i XXXXX0640 03-1982 VV VIS A ;,o"'''-'!'='/ 31.03 °rR.~M, DOUGLAS C BAKER 0002 VV VIS C "660/ ".-' ... ,-' XXXXX 10 71 05-1961 6.60 KELLY BARKET 0001 TI DENTL B f.r&j~~~;y XXXXX3216 05-1951 VV VIS B 13:.;22 " 101.11 EDGAR DO BARTRA 0002 TP DMOFL B ;g~"I1iQ'i XXXXX2761 09-1983 VV VIS C '~:~~~rY 28.60 JV';fj1~ scnE(05Tll) TO: CITY OF SOUTH MIAMI NAME OF INSURED I I.D. NUMBER JOHN BARZOLA XXXXX4902 FERNANDO BLANCO XXXXX0643 PEDRO A BREA XXXXX7795 RANDOLPH BROWN XXXXX4071 CAROL A BYNUM XXXXX2956 LOURDES C CABRERA XXXXX1126 ALBERTO L CALIMANO XXXXX5369 MICHELLE CALOCA XXXXX4633 BEN CARROLL XXXXX8734 AGUSTIN CASTRO XXXXX325 a ADRIANE CELAYA XXXXX1356 07-1971 10-1966 07-1964 08-1969 08-1967 11-1964 08-1971 04-1989 12-1974 03-1962 09-1992 MetLife -Group Benefits PAGE 2 TM05921305 0001 PRINT DATE: 02 14 2016 FOR ADDITIONAL INFORMATION, SEE REVERSE SIDE CLASS # ADJ. DATE 0002 0002 0002 0002 0002 0002 0002 0002 0002 0001 0002 TP VV TP VV TP VV TP VV TP VV TP TP TP VV TP VV II TP VV DMOFL C VIS C DMOFL C VIS C DMOFL B VIS B DMOFL C VIS C DMOFL D VIS D DMOFL C DMOFL A DMOFL C VIS C DMOFL C VIS C DENTL B DMOFL C VIS C PREMIUM ~ ~ " -vr <,;J~;!~22:2::.· .'" ,··V ~:)9 g·,JQ"Y ~~J'~!w{JV 1'2'~9' ~~ -, .. _J"2"W-fi~ 'I7"6v60:.~ ~:""""'''''''~ illJL8f7.Z!*89\; ~51~ .: 6c.60:, VOLUME TOTAL PREMIUM 19.17 19.17 35.22 19.17 37.58 12.57 37.09 19.17 19.17 87.89 19.17 JV4615.5CRE(O&/11) 011200965100100000000000000000000 MetLife -Group Benefits 11111111111111111111111111111111111111 111111111 "" 1111111111111 PAGE 3 TM05921305 0001 TO: CITY OF SOUTH MIAMI PRINT DATE: 02 14 2016 FOR ADDITIONAL INFORMATION, SEE REVERSE SIDE NAME OF INSURED / CLASS D PREMIUM VOLUME TOTAL 1.0. NUMBER ADJ. DATE PREMIUM MIRLENE J GEDEON CINEAS 0002 TP DMOFL C .~~~V XXXXX8363 03-1971 12.57 COURTNEY M CLAY 0002 TP DMOFL ./ D ~9;¥/ XXXXX8058 08-1983 VV VIS D .. (., -;".-:77 37.58 \11" •. 119 ~ ,··:"2-:;;_:';'~.-;. --::,1 KERRY CLAYTON 0002 TP DMOFL C -1i1~~7 XXXXX5879 01-1964 VV VIS C <6,.,6.0-·, 19.17 L..----~" .. -. __ ., ANTHONY COATS 0002 TP DMOFL C ~ XXXXX7189 08.:...1987 VV VIS C '~;6(~\~:P/ 19.17 LARRY CORBIN 0002 TP DMOFL C <tSl~0 XXXXX7060 11-1963 VV VIS C <,,,§~:§,Q ... , 19.17 LISA L CORBIN 0002 TP DMOFL D ~6W~.J XXXXX4124 01-1970 VV VIS D '1-1'-£9' 'j 37.58 .:....~~-.~: . ~'.' LORRAINE COUNCIL 0002 TP DMOFL C /. .sk~!,~~ XXXXX6924 08-1962 VV VIS C \'0:.60,; 19.17 STEPHEN A DAVID 0002 TP DMOFL B .~~~~@/ XXXXX6979 ,-04-1963 VV VIS B 13.'22)( 35.22 FRANCISCO DELAESPRIELLA 0001 TI DENTL C .dt.~1<Q;.~ XXxxx5394 07-1967 VV VIS C ,-·6.-,-60" 48.70 ~_.:l."_ ":.-.. :_ " __ 0 ~ ~': , VERNON B DENNIS 0002 TP DMOFL C ~/ 'v' xxxxX1085 05-1984 VV VIS C ,-,6,>:60" 19.17 JONATHAN EDWARDS 0002 TP DMOFL A ~~7~i; XXXXX2457 06-1986 VV VIS C .Q, •. gO--:. 43.69 MICHELLE M EGUES 0002 TP DMOFL B a2r'lM..(fj~ XXXXX2366 08-1988 22.00 JY.lI)7~.St:RE(OG/III MetLife® -Group Benefits PAGE 4 TM05921305 0001 TO: CITY OF SOUTH MIAMI PRINT DATE: 02 14 2016 JV~675,SCnE(OG/ll1 011200965200100000000000000000000 MetLifEf -Group Benefits 1111 II 111111111111111111 II I II 1111111111111111 II I" 11111111111 III PAGE 5 TM05921305 0001 TO: CITY OF SOUTH MIAMI PRINT DATE: 02 14 2016 FOR ADDITIONAL INFORMATION, SEE REVERSE SIDE NAME OF INSURED / CLASS ft PREMIUM VOLUME TOTAL iI.D. NUMBER ADJ. DATE PREMIUM ALEXANDER HECHAVARRIA 0002 TP DMOFL A / Jrl..-.rl!}9.,,~ XXXxx5721 06-1959 VV VIS A L~~8i~A6\ 55.55 MARIO J HECHEVERRIA 0002 TP DMOFL C ""'1~'PS~~ xxxxx9792 04-1986 VV VIS C ,:6:~1)O 19.17 KYLE HEDIN 0002 TP DMOFL C ~=:J xxxxx9979 12-1987 VV VIS C 19.17 CARLOS HERNANDEZ 0002 TP DMOFL C d1f~j7/ XXXXX5167 06-1969 12.57 ROGELIO HERNANDEZ 0002 TP DMOFL C rJti!J!iJfilJifiri;>-, ./!\.::;.,.c~, _ XXXXX3823 01-1981 12.57 TIFFANY HOOD 0002 TP DMOFlJ,. C ~~il'0:;' XXXXX9222 09-1974 12.57 ANDRES I HUARTE 0002 TP DMOFL B ~~m1\/ .f~'!' !:;;:::! ~~ XXXXX8843 06-1989 22.00 PAUL JACKSON 0001 TI DENTL C ~1f"<'~ , ~.~ ''';" iO~!V XXXXX0049 08-1959 VV VIS C L:6;~-6Q, 48.70 VICTOR V JACKSON 0001 TI DENTL C ~lfuo'/ i:.~ .' ~" ~'(f ~ '. XXXXX5943 01-1970 42.10 RICHMOND L JAMES 0002 TP DMOFL C .'l"Wa J XXXXX8961 08-1969 12.57 CHRISTOPHER E JOHNSON 0001 TI DENTL C .~~0 ~ .... '" ;.!$ ...• "'. xxXXXOO02 12-1986 VV VIS C .. -6'~~60 . 48.70 BRIYONNA JOYNER 0001 TI DENTL C ""Ii2~1~'i \\5:.. t' -~i" d'" .-. XXXXX3770 12-1991 VV VIS C \·~'6.'60· 48.70 JVI'l615,SCREtOCl/II) MetLife -Group Benefits PAGE 6 TM05921305 0001 TO: CITY OF SOUTH MIAMI PRINT DATE: 02 14 2016 FOR ADDITIONAL INFORMATION, SEE REVERSE SIDE NAME OF INSURED / CLASS I PREMIUM VOLUME TOTAL 1.0. NUMBER ADJ. DATE PREMIUM LISA M KING 0002 TP DMOFL C XXXXX0138 05-1961 VV VIS C 19.17 MARCUS A KINLAW 0002 TP DMOFL C XXXXX9659 11-1967 12.57 DAWNN KINSEY 0002 TP DMOFL C -1y XXXXX5866 08-1972 VV VIS C LPdjOJ 19.17 JENNIFER KORTH 0002 TP DMOFL C ~l'fi!JJ!1!5o/itJ."P XXXXX5304 02-1979 12:57 ANA M LARZABAL 0001 TI DENTL C (lf9!!iwJ XXXXX7646 05-1966 42.10 Im[f{~~ '~::\~-1';~':' 1i~;>,,71.~ MARCUS W LIGHTFOOT 0002 TP DMOFL C ~~ xxxxx8259 06-1979 VV VIS C c.(9:'::'t~P:, 19.17 STEVEN LINICK 0002 TP DMOFL C ~~/ X2\XXX0079 08-1987 12.57 JOSE LOPEZ 0002 TP DMOFL D @~~y XXXXX2829 07-1967 VV VIS D 11;j-~ 37.58 MELVRIS LOPEZ SIQUEIROS' 0001 TI DENTL C ~~~ XXXXX1140 07-1965 VV VIS C 48.70 ALEX LUGONES 0001 TI DENTL B <.&i~~ xxxxX3538 05-1986 87.89 CRAIG MARTIN 0002 TP DMOFL C ~''']'fn( ",~.Hi";;·.t(\V •• ~',J_t,~ xxxxx4016 07-1972 VV VIS C \. ·6~· 60';.; 19.17 JV4fi15 SCRE(061111 TO: CITY OF SOUTH MIAMI NAME OF INSURED / 1.0. NUMBER GRIZEL MARTINEZ XXXXX5953 STEPHANIE MARTINEZ XXXXX1666 SHARARE MAVON XXXXX0413 AMY MCCANTS XXXXX6736 JAMES MCCANTS XXXXX9683 COREY MCDOWELL XXXXX5163 MARIA M MENENDEZ XXXXX3254 GUSTAVO MENENDEZ XXXXX6220 DAVID A MIGUEZ XXxxx5650 TONY MILLS XXXXX0505 01-1985 10-1982 05-1959 " 04-1952 08-1956 03-1969 01-1944 10-1968 06-1984 12-1971 011200965300100000000000000000000 MetLife -Group Benefits 1111111111111111111111111111111111111111111111111111111111111111 PAGE 7 TM05921305 0001 PRINT DATE: 02 14 2016 FOR ADDITIONAL INFORMATION, SEE REVERSE SIDE CLASS D ADJ. DATE 0002 0002 0002 0002 0002 0002 0001 0001 0002 0002 TP DMOFL C VV VIS C TP DMOFL D VV VIS D TP DMOFL C TP DMOFL C VV VIS C TP DMOFL C VV VIS C TP DMOFL C VV VIS D II DENTL B II DENTL A VV VIS A TP DMOFL C VV VIS C TP DMOFL C PREMIUM ~7V' {mLQ{b ~~!'l {"_~'~L:,.'" .~$'./ VOLUME TOTAL PREMIUM 19.17 37.58 12.57 19.17 19.17 23.76 87.89 173.84 19.17 12.57 JV·167S SCI'I£(O£,/IH MetLife -Group Benefits PAGE 8 TM05921305 0001 TO: CITY OF SOUTH MIAMI PRINT DATE: 02 14 2016 FOR ADDITIONAL INFORMATION. SEE REVERSE SIDE NAME OF INSURED I CLASS» PREMIUM VOLUME TOTAL I,D, NUMBER ADJ, DATE PREMIUM ~ RALEIGH E MILLS 0001 TI DENTL C . :~O XXXXX9994 06-1962 VV VIS C <.0:'6'0;) 48.70 MANUEL F MONGALO 0001 TI DENTL C ~'V XXXXX5529 02-1962 VV VIS B 'c 1-3:oc2-2:;j' 55.32 CHARLES A MOREJON 0001 TI DENTL A "~··~'8·d Ii .. ··~'¥.,:",,~w XXXXX9645 11-1981 155.38 LISA MORTON 0002 TP DMOFL D ?i~(j XXXXX2810 09-1961 VV VIS D -":H···;l}J,~. 37.58 CATHERINE M MOTTA 0001 TI DENTL C ~() XXXXX1678 11-1954 VV VIS C \:;o,:6,'f.6O.", 48.70 LATASHA M NICKLE 0002 TP DMOFL B ,~~;;:I XXXXX1588 01-1974 22.00 LESTER A OPORTA 0002 TP DMOFL C ,~<t';");r,2Ii:W~~ \i.~~, xxxxx5829 09-1981 VV VIS C \~.·R:·Y6,O, 19.17 NKENGA PAYNE 0002 TP DMOFL A 'l'&,r8~~~~tl)'~i' .~ ".,~.~. _'i:' •.•• XXXXX1049 10-1974 37.09 JACQUELINE PERDIGON 0001 TI DENTL D ~>'l'99~i,1i)41-1 :'£t~~fH~-~-'" XXXXX8063 06-1990 VV VIS C 6.60. . 105.64 c..::.:.~ .. : _ . , .. ;, 7/, MARVIN B PIERRE 0002 TP DMOFL C fif.JrU;~j~\i!l'Y XXXXX4073 05-1994 VV VIS C C~9..,·gP.: , 19.17 PORTILLO 0002 TP DMOFL C ~·57·"L_. BRYAN :" '-, ~I~'_i.'.._'-,'l.n XXXXX3598 08-1991 12.57 QUENTIN L POUGH 0002 TP DMOFL C ~j xxXXX1783 01-1984 VV VIS C 19.17 JV45155CIIE{C&/11) TO: CITY OF SOUTH MIAMI NAME OF INSURED / 1.0. NUMBER HECTOR RABI XXXXX4811 JOHN REESE XXXXX9315 HAROLD REID XXXXX0401 CHARLES J RENDER XXXXX0478 EDDY L RIVAS XXXXX4010 LUIS RIVERA XXXXX5051 ALFREDO 0 RIVEROL XXXXX4344 RUBEN RODRIGUEZ XXXXX7538 RODGERICK RYALS XXXXX8802 BENNIE L SMALL XXXXX3443 CAROLINA SOLA XXXXX5169 10-1963 01-1977 10-1970 11-1972 10-1974 05-1991 12-1974 10-1962 07-1974 W(i'mD"'~'lJ~)'~ .. tP ~~~w'~~~-. ,?~ __ -~.:>J 05-1979 09-1992 MetLife -Group Benefits FOR ADDITIONAL CLASS ft ADJ. DATE 0002 TP DMOFL C 0001 TI DENTL C 0001 TI DENTL C VV VIS C 0002 TP DMOFL C VV VIS C 0002 TP DMOFL B 0002 TP DMOFL C 0002 TP DMOFL D VV VIS D 0002 TP DMOFL C VV VIS C 0002 TP DMOFL D VV VIS C ~@,HU"l") -·,;;r~~~i::i1~~-~.;· 0002 TP DMOFL D 0002 TP DMOFL C VV VIS C 011200965400100000000000000000000 1111111111111111111111111111111111111111111111111111111111111111 PAGE 9 TM0592 1305 0001 PRINT DATE: 02 14 2016 INFORMATION, SEE REVERSE SIDE PREMIUM VOLUME TOTAL PREMIUM eJ~.pil~~ 12.57 ~~l$j 42.10 ~'i L::Q:~::'9c'c() '" , 48.70 ~:fi~:"{; ... ,----" ...... __ .,,"-19.17 ~(JO/ 22.00 ~W£:;c:/ 12.57 ~~:9'(; .cLl:.~L2'" 37.58 <f!iiBl'!fl:VPl~ ( Of~;;·g:O·j 19.17 ~;;;\~ .'?~::~.2j 32.99 ~;-:r.;:w~~;'~-... ' .... tt r(]j'ileJ;;lT' .~ :S;~.lJ~~~'~::,~}~ _ .. :.~.) /' ,~~, 26.39 '~~/ '~;;'6':60 . ~. e 19.17 , JV4575.SCREIOCi/11I TO: CITY OF SOUTH MIAMI NAME OF INSURED / 1.0. NUMBER DYLAN A SOLORZANO XXXXX3104 06-1991 JOHN T STANLEY xxxxx6847 03-1986 DAVID STRUDER XXXXX9208 11-1958 STEPHANIE R SUMPTER XXXXX3950 08-1967 MATTHEW J TAYLOR XXXXX9431 08-1981 RITA TORRES XXXXX2915 07-1952 EDDY A TORRES XXXXX4685 07-1966 YVETTE VALDES XXXXX6476 04-1989 MICHAEL VARGAS xXXXX1607 01-1971 MIGUEL VEGA XXXXx3300 11-1966 PETER VESELY XXXXX0125 09-1961 CELIA VICENTE XXXXX7625 ' 04-1953 MetLife -Group Benefits PAGE 10 TM05921305 0001 PRINT DATE: 02 14 2016 FOR ADDITIONAL INFORMATION, SEE REVERSE SIDE CLASS ft PREMIUM VOLUME TOTAL ADJ. DATE PREMIUM 0002 VV VIS C "6';':bO:J~<1 6.60 0002 TP DMOFL C ~~ 12.57 0002 TP DMOFL C ~~ VV VIS C 19.17 0002 TP DMOFL C ~ VV VIS C "QJ;;?:~E'~, 19.17 0001 TI DENTL C ~~ VV VIS C t:~!:·;·~:0i 48.70 0002 TP DMOFL D ~~ VV VIS D ,'Z:'ld."; :-1~9,'r'; 37.58 0001 TI DENTL D ~~ VV VIS D d:;1i;A"9,, 110.23 0001 TI DENTL C J (~J?;i1~ VV VIS C .!c'~'.!oO, ',' 48.70 0001 TI DENTL A J/ 1"",15.5 -3. VV VIS A ~~" 173.84 0002 TP DMOFL C ~mo/ VV VIS C t:mo;,60, 19.17 0001 TI DENTL C "IfP.l.~ VV VIS C dh 6 0 , 48.70 0002 TP DMOFL C :;::~j VV VIS C 19.17 JV4615.SCREI06/11) TO: CITY OF SOUTH MIAMI NAME OF INSURED / 1.0. NUMBER JUNIOR S VIJIL xxxxx9427 09-1981 MARIA A VIRGUEZ XXXXX7687 08-1949 DARBY WAGNER XXXXX1827 10-1970 FREDRICK L WILLIAMS XXXXX7801 06-1971 DWAYNE WILLIAMS xxXXx2697 08-1966 JOSE L ZAMORA XXXXX9113 02-1956 TOTAL FOR THIS BILLING PERIOD ,'.1, ADJUS TMENTS ,.* STEVEN ALEXANDER 10 XXXXX2805 JOHN BARZOLA 10 XXXXX4902 BEN CARROLL 01 XXXXX8734 RYAN CHIN 10 XXXXX6216 STEVEN LINICK 10 xXXXXOO79 Metliftf -Group Benefits 011200965500100000000000000000000 1111111111111111111111111111111111111111111111111111111111111111 PAGE 11 TM05921305 0001 PRINT DATE: 02 14 2016 FOR ADDITIONAL INFORMATION, SEE REVERSE SIDE· CLASS ft PREMIUM VOLUME TOTAL ADJ. DATE PREMIUM 0002 TP DMOFL C p'~cWli~""t.5~ ~~~~.~.:li VV VIS C c~6;;·:60,~ ", 19.17 0001 TI DENTL C '~'li2"B-mV :~~:·j\ii ~~ ~ ~~ . VV VIS C =~~c6.,6(}· . 48.70 0002 TP DMOFL C ~~Wf'4 . ~~~L 12.57 0002 TP DMOFL C dt~~~~( ",I ·:~'i'?1".t;,> 12.57 0001 TI DENTL C ~~~~ VV VIS C ·~.o .• 6.Q=:. 48.70 0002 TP DMOFL C ~ VV VIS C '.6·!~60) . 19.17 \)ENTA L:::it 3/~ I b. 35 V:S59.97 j 01 2015 VV VIS .~ 1L.J3. SC( X 66.10 VISION::C 66.10 01 2015 TP DMOFL S 62.85 62.85 01 2016 TP DMOFL A 25.14 VV VIS A 13.20 38.34 01 2015 TP DMOFL S 185.45- VV VIS S 73.84-259.29- 01 2015 TI DENTL C 210.50- TP DMOFL C 62.85 147.65- MetLife -Group Benefits TO: CITY OF SOUTH MIAMI PAGE 12 TM05921305 0001 .. PRINT DATE: 02 14 2016 FOR ADDITIONAL INFORMATION. SEE REVERSE SIDE NAME OF INSURED I CLASS. PREMIUM VOLUME TOTAL 1.0. NUMBER AOJ. DATE PREMIUM BRETT MELOGRANO 01 01 2016 TP DKOFL T 25.14- XXXXX9820 25.14- JOSEPH E MENDEZ 01 01 2016 TP DKOFL T 25.14- XXXXX0704 25.14- JACQUELINE PERDIGON 10 01 2015 TI DENTL C 495.20 XXXXX8063 TP DMOFL C 62.85-432.35 RODGERICK RYALS 10 01 2015 TP DKOFL F 69.10 xxxxx8802 69.10 DYLAN A SOLORZANO 12 01 2015 TP DMOFL S 37.71- XXXXX3104 37.71- EDDY A TORRES 10 01 2015 TI DENTL V 281.70- XXXXX4685 VV VIS V 36.35-318.05- JUNIOR S VUIL 10 01 2015 TI DENTL C 210.50- XXXXX9427 TP DMOFL C 62.85 147.65- 4,268.08 OUTSTANDING DUE AS OF 02/14/2016 28,091.13 ***GRAND TOTAL DUE PLEASE PAY THIS AMOUNT ------> 32,359.21 AFTER CHANGES HAVE BEEN RECEIVED AND MADE IN OUR OFFICE, PREMIUM ADJUSTMENTS WILL BE REFLECTED ON YOUR BILLING STATEMENT. 011200965600100000000000000000001 MetLife' -Group Benefits 111111111111111111111111111111111111111011111111111111111111111 . . TO: CITY OF SOUTH MIAHI PAGE 13 TM05921305 0001 PRINT DATE: 02 14 2016 FOR ADDITIONAL INFORMATION. SEE REVERSE SIDE NAME OF INSURED / lD. NUMBER ***SUKHARY TOTALS*** TITLE DENTL DMOFL VIS COUNT 35 83 86 CLASS I ADJ. DATE INSUREDS VOLUME PREMIUM o 1,263.00 o 1,043.31 o 587.40 **********PLEASE NOTE********** PREMIUM VOLUME DEPENDENTS COUNT PREMIUM 26 947.47 48 301.60 52 125.30 KETLIFE MUST RECEIVE YOUR PREMIUM WITHIN 31 DAYS OF THE BILL DUE DATE OR YOUR POLICY WILL TERMINATE ACCORDING TO ITS TERMS. TOTAL PREMIUM • Checks or money orders should be made payable to MetLife -Group Benefits. Send payment along with the remittance copy of the billing to: MetLife -Group Benefits P. O. Box 804466 Kansas City, Missouri 64180-4466 • ELECTRONIC FUNDS TRANSFER (EFn -EFT is an electronic payment option for remittance of the monthly premium, without the processing and postage costs associated with issuing and mailing a check to us each month. To implement EFT, contact your Customer Service Representative at 1 800 ASK 4 MET (1 800 275-4638) to obtain more information and an authorization form. • PREMIUMS FOR NEW ENROLLMENTS OR CHANGES -New enrollments and changes will be billed on the next premium statement if we receive this information from you before the next bill date. FAMILY INDICATORS A = Family B = Member and Spouse C = Member Only o = Member and Children Spouse is Excluded E = Spouse and Children Member is Excluded F = Spouse Only G = Children Only ADJUSTMENT CODES A = Member Addition B = Benefit Record Change C = Class Change o = Dependent Change E = Evidence Change F = Family Indicator Change G = Group Generation Change H = DiviSion Generation Change I = Reinstatement J = Substandard Rate Update K = Reinsurance Change L = Lapse In Coverage M = Medical Rate Tacle Change N = Non-Medical Rate Table Change o = Only Manual Adjustments P = Selected Benefit Q = Election Change Generation R = Retirement S = ChanSiJe In Benefit Status T = Termination U = Elected Units V = Factor Table Change W= Other Changes X = Member Adjustment/Correction Y = Age Change Z = Batch Control $ = Salary Change 1 = Adjustment Of Elected Volumes 2 = Disability Event Change 3 = Payroll Event Change 4 = Member Key Change 5 = Family Rate Table Change 7 = MX Screen Changes 8 = ME Screen Changes Applied Retroactively, Equal To The Member Effective Date LISRF.SCIl-'· (011111 The Lincoln National Life Insurance Company P.O. Box 0821 Carol Stream IL 60132-0821 008115 LFPB6CD1100000 GR-AD Attn: Latasha NickLe city of South Miami 6130 Sunset Or Miami FL 33143 \1J V 1JO(~ <p (iD PL . --1'--J-I.--. r"'\ rJ I' -0 oro D n (. C { t ~. <.' ,.,. BILLING SUMf1ARY tff!:-ffi ffM Accountll: Amount Due: Prem Due By: Coverage: Amount EncLosed: CTYSOfUAHI -BL -1253544 $11,299.76 03/01/2016 03/01/2016-03/31/2016 ******* PLEASE PAY AS BILLED. ******* RECEIVED MAR 01 2016 HUMAN RESOURCES 000000002125643146 1253544 001129976 03012016 7 (Please remove and return top portion with your aheak made payable to ~he ,Linaoln National Life Insuranae company) Previous BiLLed BaLance Premium Processed Beginning BaLance $19,484.74 -$12,629.47 ============================ ~ Current Period Premium IX) $6,855.27 $4,451.79/ g Current Period Adjustments o -$7.30 o o ============================ ~ Current BilLed Balance Q. $4,444.49 ~ III ~ ~ Total Amount Due o o o $11,299.76 rn PREMIUM PAYMENT INSTRUCTIONS Your premium is due in our office on or before the due date listed on your premiunl statement. To ensure proper credit on your accoullt, please return ONLY the payment coupon and your payment in the envelope enclosed with your statement. Please Pay As Billed. I'lease do 110t suhmit enrollment chang'!s with your premium payment Use the Adjustment Report to make any of the following changes: termination, class, billing location, salary changes (if benefit is salary based), etc. The following type of changes need a Group Chan~e Form completed and returned before the change can be processed: name, beneficiary, mar~tal status, or change in dependent coverages These forms and enrollment forms must be received at least 10 days prior to the next bill's draw date for the Change to be reflected. Please fax forms to: 877-573-6177 or visit our website: www.lincoln4benefits.com If you have any questions, please call your Client Service Representative at 800-423-2765. The Lincoln National Life Insurance Company 111111111111111111111111111111 h 111111111111111111111111111111111 ~he Linooln National Life Znsuranoe Company P.O. Box 0821 Carol stream XL 60132-0821 .. ... --..... ---. Attn: Latasha Nickle Ci ty of South f1i ami 6130 Sunset Dr Miami FL 33143 00008115 LFPB6CD1 00018505 The Lincoln National Life Insurance Company P.O. Box 0821 Carol Stream IL 60132-0821 800-423-2765 BILLING DETAIL Ac countY CTYSOfUAM I -BL -1253544 Reference# 3195870427 Premium Due By: 03/01/2016 LIFE Policy# 000010146753 00000 LTD Policy# 000010146754 00000 VLIF Policy# 000400146755 00000 V~II Pol i cy# 000400146756 00000 Current Premium: CERT NO. NAME xxxxx0455 Adams, Jamie xxxxx7227 Aguiar, Jesus R. xxxxx2805 ALexander, Steven xxxxx4508 Alvarez, ALfredo M. xxxxx1988 ALvarez, Jose A. xxxxx0640 Atkins-Mcguire, Elisha S. xxxxx4942 AyaLa, Ricardo xxxxx1071 Baker, Douglas C. \, r. xxxxx1199 BaLas, JoeLlenl""~vW\. \.V\!i--\V"l xxxxx3216 Barket Jr, Kelly xxxxx2761 Bartra, Edgardo A. xxxxx4902 BarzoLa, John xxxxx3289 Bissett, Cassandra xxxxx0643 BLanco, Fernando R. xxxxx7795 Brea, Pedro A. xxxxx4071 Brown, Randolph xxxxx3483 Bukens, Robert C. xxxxx2956 Bynum, Carol A. xxxxx5369 Calimano, Alberto L. xxxxx4633 Caloca, Michelle xxxxx8734 Carroll, Ben xxxxx3250 Castro, Agustin VLI VOLUf1E 100000 0 0 0 0 0 0 0 L ?-\ ~ \~ 20000 \ 0 0 100000 0 0 0 0 100000 60000 0 0 0 100000 xxxxx1356 Celaya, Adriane • t d G\\[la \ l~ 0 xxxxx6216 Chin, Ryan \~}V"\.\ \'\vv\(l 0 xxxxx9255 Citarella, Victor J. 0 xxxxx8058 Clay, Courtney M. 0 xxxxx5879 Clayton, Kerry 50000 xxxxx7189 Coats, Anthony 0 xxxxx7060 Corbin, Larry 0 Continued on next pag Bill Print Date: 02/19/2016 Coverage Period: 03/01/2016 -03/31/2016 LI/AD LTD o LTD V LIFE V AD+D 9.45 9.00 8.00 3.00 13.44 12.80 67.20 32.00 12.39 11.67 11.76 11.11 8.40 7.99 15.75 18.21 13.86 13.13 8.40 7.83 2.20 0.60 15.75 16.51 9.66 9.14 15.75 18.38 19.00 3.00 9.24 8.73 5.25 4.81 9.24 8.72 7.14 6.77 11.97 11.33 22.66 19.00 3.00 13.23 12.40 21.00 1.80 5.67 5.30 V 8.40 V 7.83 5.2511 5.00v 12.81 12.02 55.00 3.00 10.08 9.60 10.08 9.60 7.88 16.82 8.82 8.39 8.19 7.76 27.50 1.50 5.25 4.81 15.75 19.14 Page: 1 VS LIFE VS AD+D VC LIFE V WI TOTAL 29.45 22.14 48.38 99.20 24.06 22.87 16.39 I 33.96 30.32 57.31 1.10 0.30 20.43 32.26 18.80 56.13 17.97 10.06 17.96 13.91 19.62 87.58 3.$0 0.30 2.00 54.23 I 10.97 13.56 29.79 10.25 82.83 19.68 19.68 24.70 I 17.21 44.95 I 10.06 I 34.89 I 20-MAR-2016 LljAD-Life & AD&D. LTD-LTD. 0 LTD-Opt LTD. V LIFE-Voluntary Life. V AD+D-Voluntary AD&D. VS LIFE-Vol Spouse Life. VS AD+D-Vol Spouse AD&D. VC LIFE-VoL ChiLd Life V WI-Voluntary ~JI. *AC-Add Coverage TC-Term Coverage Account#-tTYSO"IA"I-BL-1~5:r544 CERT NO. xxxxx9792 XXXXX' xxxxx3823 xxxxx07S' xxxxx9222 xxxxx884.- xxxxxOO4' xx XXXXXi xxxxxOOO2 xxxxx3' xxxxxO' xxxxx96~ xxxxxS, xxxxxS XXXXX' xxxxx xxxxx' xxxxx82S' xxxxx2i XXXXX' \ NAIIE Corbin, Lisa L. Council, Lorraine David, Stephen A. Dela Espriella, Francisco Dennis, Vernon B. Edwards, Jonathan S. Egues, Michelle ". Espinoza Peralta, Sujey Everett, Rodgerick L. Fata, Anthony Fernandez, Lidia Figueroa, Andres B. Garcia, "aria L. Gideon Cineas, "irlene J. GiLmore-Moses, Denise Gonzalez, Ariel GonzaLez, Rafael Griffin, Jeffrey S. Guzman, Henry Hall, Wi l fred S. Hechavarria, ALexander Hecheverria, Mario J. Hedin, Kyle Hernandez, Carlos K. Hernandez, Lourdes C. Hernandez, Rogelio Hernandez, Serguey Hood, Tiffany Huarte, Andres I. Jackson, Paul Jackson, Victor V. James, Richmond L. Johnson, Chistopher E. Joyner, Briyonna L. King, Lisa ". Kinlaw, Marcus A. Kinsey, DaWM KOrth, Jennifer E. Kulick, Steven P. Landa, Rene Larzabal, Ana ft. Lightfoot, "arcus W. Lopez, Jose Lopez-Siquieros, "elvris Continued on next peg" VLI VOLUME 0 30000 0 0 0 0 0 0 20000 0 20000 0 0 20000 0 0 0 0 0 0 20000 0 0 0 0 0 0 0 0 0 20000 0 20000 0 50000 30000 30000 20000 \ 0 I 0 0 0 o \ 70000 , ~ The Lincoln National Life Insurance Company BILLING DETAIL ~ '-7 ~ Page: 2 ~ LI/AD LTD o LTD V LIFE V AD+D VS L1.FE VS AD+D VC LIFE V WI TOTAL 15.54 14.61 2 V-ii II V, 30.15 7.98 7.46 16.5Oi 0.90", 5.5<V 0.30", 2.00\1 40.64 15.75 16.39 L . 32.14 13.86 13.06 26.92 5.46 5.20 10.66 10.29 9.60 19.89 8.40 7.83 16.23 9.66 9.14 11.43 30.23 12.39 11.67 7.00 0.60 3.50 0.30 2.00 37.46 15.75 16.11 31.86 7.98 7.45 18.80 0.60 34.83 12.39 11.70 24.09 13.23 12.51 25.74 5.88 5.40 3.80 0.60 1.90 2.00 19.58 8.82 8.30 17.12 10.08 9.60 19.68 9.66 9.14 15.84 34.64 15.75 15.80 67.15 36.48 135.18 13.02 12.25 25.27 7.98 7.46 10.87 26.31 13.86 13.01 75.88 18.80 0.60 9.40 0.30 2.00 133.85 6.09 5.73 11.82 5.04 4.71 9.75 8.82 8.30 17.12 12.18 11.51 23.69 9.66 9.14 18.80 10.29 9.60 19.89 5.67 5.30 10.97 10.29 9.60 19.89 6.51 6.02 12.53 12.81 12.02 7.00 0.60 23.56 55.99 14.70 13.92 28.62 9.66 9.14 1.40 0.60 15.84 36.64 4.62 4.30 8.92 10.71 10.08 27.50 1.50 49.79 11.13 10.58 31.31 10.50 0.90 2.00 66.42 9.66 9.16 5.70 0.90 2.00 27.42 11.76 11.18 2.20 0.60 1.10 0.30 27.14 13.65 12.94 47.81 74.40 15.75 17.42 33.17 10.50 9.80 20.30 9.66 9.06 18.72 12.39 11.67 24.06 11.76 11.11 47.24 38.50 2.10 2.00 25.64 138.35 2D-MAR-2016 LI/AD-Life & AD&D. LTD-LTD. 0 LTD-opt LTD. V LIFE-Voluntary Life. V AD+D-Voluntary AOID. VS LIFE-Vol Spouse Life. VS AD+D-Vol Spouse AOID. VC LIFE-Vol Child Life V WI-Voluntary WI. , *AC-Add Coverage TC-Term COverage I I .. --------.-- Account# CTYSOrllAMI-BL -1253544 CERT NO. NAME VLI VOLUME xxxxx3538 Lugones, Alex 100000 xxxxx0413 Macon, Sharare 0 xxxxx4016 Martin, Craig 0 xxxxx5953 Martinez, Grizel 0 xxxxx1666 Martinez, Stephanie 0 xxxxx6736 Mc Cants, Amy 0 xxxxx9683 ~'c Cants, James 20000 xxxxx5163 Mcdowell, Corey 0 xxxxx0704 Mendez, Joseph 0 xxxxx6220 Menendez, Gustavo 0 xxxxx3254 Menendez, Maria M. 0 xxxxx5650 Miguez, David A. 0 xxxxx9994 Mills I, Raleigh E. 10000 xxxxx0505 Mills, Tony 0 xxxxx5529 Mongalo, Manuel F. 0 xxxxx9645 Morejon, Charles A. 100000 xxxxx2810 Morton, Lisa 40000 xxxxx1678 M~tta, Catherine M: I ~ (f~ 0 xxxxx1588 Nlckle, Latasha M"It,'f vy...\V\-",.l"!1.d !(rq 1 000 xxxxx5829 Oporta, Lester A. 0 xxxxx1049 Payne, Nkenga 50000 xxxxx8063 Perdigon, Jacqueline 0 xxxxx4073 Pierre, Marvin B. 0 xxxxx5513 Portillo, Brandon 0 xxxxx3598 PortiLLo, Bryan 0 xxxxx1783 Pough, Quentin L. 0 xxxxx4811 Rabi, Hector 10000 xxxxx9315 Reese, John 50000 xxxxx0401 Reid, HaroLd 0 xxxxx0478 Render, CharLes J. 0 xxxxx5501 Rezaie, Aryo 0 xxxxx4010 Rivas, Eddy L. 20000 xxxxx5051 Rivera, Luis 0 xxxxx4344 RiveroL, Alfredo O. 0 xxxxx7734 Rodriguez, PauL 0 xxxxx7538 Rodriguez, Ruben 0 xxxxx8802 Ryals, Roderick 0 xxxxx3443 Small, Bennie L. 0 xxxxx5169 Sola, Carolina 0 xxxxx3104 Solorzano, Dylan A. 0 xxxxx6847 Stanley, John T. 0 , xxxxx9208 Struder, ,David 0 I xxxxx3950 Sumpter, Stephanie. 20000 xxxxx9431 TayLor, Matthew J. 0 Continued on next pag 00008115 LFPB6CD1 00018506 E The LincoLn NationaL Life Insurance Company BILLING DETAIL LI/AD LTD o LTD V LIFE V AD+D 6.51 6.02 7.00 3.00 15.75 19.12 5.25 4.81 6.51 6.13 10.29 9.60 6.30 5.84 10.29 9.66 56.34 18.80 0.60 5.25 4.81 11.76 11.11 7.56 7.10 II 7.88 17.43 7.77 7.34 9.17 7.14 6.63 5.50,1 2.10 5.25 4.81 9.24 8.72 11.13 10.58 8.00 3.00 15.75 19.68 22.00 1.20 11.13 10.59 68.40 15.75 16.41 32.82 19.00 3.00 7.35 6.99 11.34 10.60 9.50 1.50 10.29 9.60 10.29 9.60 10.29 9.60 10.08 9.60 14.07 13.33 11.76 11.13 5.50 0.30 9.24 8.72 5.50 1.50 5.04 4.80 5.25 4.81 10.29 9.60 6.72 6.32 3.80 0.60 10.29 9.60 15.75 20.52 11.76 11.11 15.75 18.84 5.88 5.40 7.35 6.83 8.19 7.61 10.29 9.60 8.40 7.99 12.18 11.46 66.88 4.62 4.30 7.00 0.60 12.39 11.67 Page 3 vs LIFE VS AD+D VC LIFE V WI TOTAL 22.53 34.87 10.06 12.64 19.89 12.14 29.52 125.21 10.06 22.87 14.66 V 25.31 24.28 21.37 10.06 17.96 2.00 34.71 2.00 60.63 i 90.12 I 9.50 1.50 28.41 126.39 14.34 5.70 0.90 2.00 41.54 19.89 19.89 19.89 19.68 23.07 50.47 2.75 0.15 31.59 , 2.00 26.96 9.84 , 10.06 19.89 17.44 19.89 , 36.27 33.97 56.84 34.59 I 11.28 I 14.18 ' I ", 15.80 , I 16.62 36.51 I 16.39 , 90.52 I 2.00 8.43 26.95 24.06 20-MAR-2016 LI/AD-Life & AD&D. LTD-LTD. 0 LTD-Opt LTD. V LIFE-Voluntary Lif~v AD+D-Voluntary AD&D. VS LIFE-VoL Spouse Life. VS AD+D-Vol Spouse AD&D. VC LIFE-Vol Child Life V WI-VoLuntary WI. *AC-Add Coverage TC-Term Coverage R Accountll CTYSmIlAMI-BL -1253544 CERT NO. NAME VLI VOLUME xxxxx4627 Tefel, Roberto R. 0 XXXXX4685 Torres, Eddy A. 0 xxxxx2915 Torres, Rita 90000 xxxxx6476 VaLdes, Yvette 0 xxxxx1607 Vargas, Michael 0 xxxxx3300 Vega, Miguel A. 100000 xxxxx0125 Vesely, Peter 0 xxxxx7625 Vicente, CeLia 0 xxxxx9427 Vijil, Junior S. 20000 xxxxx7687 Virguez, Maria A. 0 xxxxx1827 Wagner, Darby 0 xxxxx1641 Webster, John """ _ \ 0 xxxxx2697 WilLiams, Dwayne \a(Mt~~ ~~'\(o. 0 I xxxxx7801' WilLiams, Fredrick L. 0 I xxxxx9113 Zamora, Jose L. 0 TotaLs 1610000 TotaL number of Lives: 132 TOTAL CURRENT PREMIUM Current Adjustments: CERT NO. NAME ADJ DATE xxxxx8734 CarrolL, Ben 01 /16 , xxxxx9820 ~leLograno, Brett 01 /16 Totals I TOTAL CURRENT ADJUSTMENTS CURRENT BILL TOTAL The Lincoln National Life Insurance Company BILLING DETAIL LIIAD LTD o LTD V LIFE V AD+D 9.66 9.14 9.45 8.89 13.02 12.38 79.96 96.30 2.70 5.46 5.05 12.81 12.02 5.88 5.46 35.00 3.00 14.49 13.66 9.24 8.63 10.71 10.08 1.60 0.60 9.56 13.97 13.86 13.00 8.40 7.83 15.75 17.72 5.04 4.71 7.35 6.96 1395.15 1348.30 580.11 553.90 50.10 ------------- $4,451.79 LI/AD LTD o LTD V LIFE V AD+D 10.50 10.00 -14.28 -13.52 -3.78 -3.52 ---------'-------- -$7.30 $4,444.49 VS LIFE 10,.50 , 54; 45 VS LI;FE -- Notice: Jhis bill reflects changes, payments, and adjustm~'nts made prior to this biLL's generation date of 02/19/2016. Page 4 VS AD+D VC LIFE V WI TOTAL 18.80 18.34 2.00 45.70 252.06 10.51 24.83 0.90 60.74 28.15 17.87 22.99 23.53, 26.86 16.23 33.47 9.75 14.31 5.25 28.00 I 436.53 4451.79 VS AD+D VC LIFE V WI TOTAL *REASON 20.50 AC -27.80 TC I -7.30 20-MAR-2016 LI/AD-Ll"fe& AD&D. Cfl:F-LTD. 0 LTD-Opt LTD. V LiFE-VoLuntary Life.. V AD+D-Voluntary AD&D. VS LIFE-VoL-Spouse Life. VS ,\D+D-Vol Spouse AD&D. VC LIFE-VoL Child Life V WI-Voluntary tH. *AC-Add Coverage TC-Term Coverage III ,d CX) l _000 0 ~ ~.\_'6 -'; \0 s- F~Blue"_ In the pursuit of health' Invoice Due Date Invoice # Invoiced Amount 03/01/2016 72126009 $1,452.57 Org Id Group Division 85000259243 27874 R02 _._--------- TOTAL BILLED AMOUNT ON-BILL ADJUSTMENTS AMOUNT DUE For questions about your invoice, please contact your Florida Blue Service Advocate. Invoice Date 02/19/2016 CITY OF SOUTH MIAMI 6130 SUNSET DRIVE MIAMI FL 33143-5093 Billing Period 03/01/2016·04/01/2016 $1,452.57 $0.00 $1,452.57 Health insurance is offered by Blue Cross and Blue Shield of Florida, Inc., D/B/A Florida Blue. HMO coverage Is offered by Health Options Inc., D/B/A Florida Blue HMO; an HMO subsidiary of Blue Cross and Blue Shield of Florida. Dental, Life and Disability are offered by Florida Combined Life, an affiliate of Blue Cross and Blue Shield of Florida, Inc. These companies are Independent Licensees of the Blue Cross and Blue Shield Association. Or9 Id: 85000259243 Group: 27874 Division: R02 Invoice Ii: 72126009 Billing Period: 03101/2016-04/01/2016 Invoice Due Date: 03/01/2016 Page 1 of 16 THIS INVOICE DOES NOT CONTAIN ANY DATA FOR ROSTER ADJUSTMENTS Org Id: 85000259243 Group: 27874 Division: R02 Invoice #: 72126009 Billing Period: 03101/2016-0410112016 Invoice Due Date: 03101/2016 Page 2 of 16 F~Btue"'W. In the pursuit of heatth· Invoice Due Date Invoice # Invoiced Amount 03/01/2016 72126010 $752.08 Org Id Group I Division 85000259243 27874 R03 ON-BILL ADJUSTMENTS AMOUNT DUE For questions about your invoice. please contact your Florida Blue Service Advocate. Invoice Date 02119/2016 -- CITY OF SOUTH MIAMI 6130 SUNSET DRIVE MIAMI FL 33143-5093 Billing Period 03/01/2016-04/01/2016 ---------------------- $0.00 $752.08 Health insurance is offered by Blue Cross and Blue Shield of Florida, Inc., DIBIA Florida Blue. HMO coverage is offered by Health Options Inc., D/B/A Florida Blue HMO, an HMO subsidiary of Blue Cross and Blue Shield of Florida. Dental, Life and Disability are offered by Florida Combined Life, an affiliate of Blue Cross and Blue Shield of Florida, Inc. These companies are Independent Licensees 01 the Blue Cross and Blue Shield Association. Org Id: 85000259243 Group: 27874 Division: R03 Invoice It: 72126010 Billing Period: 03/01/2016-04/01/2016 Invoice Due Date: 03/01/2016 Page 3 of 16 THIS INVOICE DOES NOT CONTAIN ANY DATA FOR ROSTER ADJUSTMENTS Org Id: 85000259243 Group: 27874 Division: R03 Invoice #: 72126010 Billing Period: 03/01/2016-04/01/2016 Invoice Due Date: 03/0112016 Page 4 of 16 Fto-Ptda, Blue .l~ I n the pursuit of hea~\th· Invoice Due Date Invoice # jlnvoiced Amount 03/01/2016 72126011 $19.344.71 Org Id Group Division 85000259243 27874 001 ON-BILL ADJUSTMENTS AMOUNT DUE For questions about your invoice. please contact your Florida Blue Service Advocate. Invoice Date 02119/2016 CITY OF SOUTH MIAMI 6130 SUNSET DRIVE MIAMI FL 33143-5093 Billing Period 03/01/2016·04/01/2016 $1,307.96 $19.344.71 Health insurance Is offered by Blue Cross and Blue Shield of Ftorida. Inc., DIBIA Florida Blue. HMO coverage is offered by Health Options Inc .. D/B/A Florida Blue HMO, an HMO subsidiary of Blue Cross and Blue Shield of Florida. Dental. Life and Disability are offered by Florida l1:ombined Life. an affiliate of Blue Cross and Blue Shield of Florida. Inc. These companies are Independent Licensees of the Blue Cross and Blue Shield Association . . Org Id: 85000259243 Group: 27874 Division: 001 Invoice #: 72126011 Billing Period: 03/01/2016-04/01/2016 Invoice Due Date: 03/0112016 Page 5 of 16 BARKET I KELLY ••• .. 3216 H71383311 BLUECARE EMPLOYEEIS NFQLGGRP POUSE PLAN 56·R2 BYNUM I CAROL ""'2956 H56J38147 BLUECARE EMPLOYEEIC NFQ LG GRP HILDREN PLAN 56·R2 CARROLL BEN -8734 H68479517 BLUECARE SINGLE NFQ LG GRP PLAN 56·R2 CORBIN LARRY -"7060 H979S363S BLUECARE EMPLOYEEIC NFQLGGRP HILDREN PLAN 56-R2 CORBIN LISA L 1·····4124 HI 0028845 BLUECARE SINGLE NFQ LG GRP PLAN 56·R2 EDWARDS 1 JONATHAN I ""'2457 1 H159OO463 BLUECARE I SINGLE NFQLGGRP PLAN 56·R2 , , ESPINOZA· SUJEY •• .. ·3678 H26729326 BLUECARE I SINGLE PERALT NFQ LGGRP PLAN 56·R2 GILMORE· DENISE ""'4370 H99125290 BLUECARE I SINGLE MOSES NFQ LGGRP PLAN 56·R2 GONZALEZ ARIEL ""'3134 H19276102 BlUECARE EMPlOYEElC NFQ lGGRP HllDREN PLAN 56·R2 HALL WILFRED S ·····8454 H55718524 BLUECARE SINGLE NFQLGGRP PLAN 56·R2 KINSEY 1 DAWNN ·····5866 H96522193 BLUECARE I SINGLE NFQ LGGRP PLAN 56·R2 MARTINEZ I GRIZEl ·····5953 H10D14967 BLUECARE I SINGLE NFQ LGGRP PLAN 56·R2 MCCANTS JAMES m-9683 H1D95176B BlUECARE I SINGLE NFQ LGGRP PLAN 56.R2 MIGUEZ DAVID A ·····S650 H1DD15146 BLUECARE I SINGLE NFQLGGRP PLAN S6·R2 MORTON I LISA ""'2810 HS9801563 BLUECARE EMPLOYEEIC NFQLGGRP HILDREN PLAN 56·R2 Orgld:B5000259243 Group: 27B74 Division: 001 Invoice "It: 72126011 Billing Period: 03/01/2016-04/01/2016 Invoice Due Date: 03/01/2016 Page 6 of 16 SIQUEIROS MELVRIS ...... ~114D H96270634 BLUECARE I SINGLE NFQLGGRP PLAN 56·R2 STRUDER DAVID ""'920B H46063224 BLUECARE I SINGLE NFQLGGRP PLAN 56·R2 TAYLOR MATTHEW ·····9431 H22176414 BLUECARE I SINGLE NFQ LGGRP PLAN 56·R2 TORRES RITA ""'2915 H759B1B36 BLUECARE EMPLOYEEIC NFQLGGRP HILDREN PLAN S6·R2 WILLIAMS I DWAYNE ••• .. 2697 I H1939DD97 BLUECARE SINGLE NFQLGGRP PLAN 56.R2 THIS INVOICE DOES NOT CONTAIN ANY DATA FOR ROSTER ADJUSTMENTS Org Id: 85000259243 Group: 27874 Division: 001 Invoice #: 72126011 Billing Period: 03/0 1I2016·04f01 f20 16 Invoice Due Date: 03/01/2016 Page 7 of 16 "F~Btue". In the pUirsuit of health" Invoice Due Date Invoice # Invoiced Amount 03/01/2016 72126012 $48,288.55 Org Id Group Division 85000259243 27874 002 ON-BILL ADJUSTMENTS AMOUNT DUE For questions about your invoice, please contact your Florida Blue Service Advocate. Invoice Date 02/19/2016 ~c.. CITY OF SOUTH MIAMI 6130 SUNSET DRIVE MIAMI FL 33143-5093 Billing Period 03/01/2016·04/01/2016 ($4,272.24 ) $48,288.55 :?i\ 5\J3yrQ .. .;...0 Health insurance Is offered by Blue Cross and Blue Shield of Florida, Inc., D/B/A Florida Blue. HMO coverage Is offered by Health Options Inc., D/B/A Florida Blue HMO, an HMO subsidiary of Blue Cross and Blue Shield of Florida. Dental, Life and Disability are offered by Florida Combined Life, an affiliate of Blue Cross and Blue Shield of Florida, Inc. These companies are Independent Licensees of the Blue Cross and Blue Shield Association. Org Id: 85000259243 Group: 27874 Division: 002 Invoice #: 72126012 Billing Period: 03f01f2016-04/01/2016 Invoice Due Date: 03/01/2016 Page 8 of 16 AGUIAR , NFQlG G PLAN Go·1ii ATKINS· I ELISHA • .. ··0640 H2D375GOS BlUECARE I SINGLE MCGUIRE NFQ lGGRP PLAN 60'R2 BARTRA I EDGAR DO A -'''2761 Hl0015047 BlUECARE I SINGLE NFQlGGRP PLAN GO.R2 BARZOLA JOHN "'-490Z H26773505 BLUECARE SINGLE NFQ LGGRP PLAN 60.R2 BLANCO FERIIANDO I R --0643 H39534157 BLUECARE SINGLE NFQLGGRP PLAN GO·R2 BREA PEDRO IA I -'-7795 H639945Z7 BLUECARE SINGLE NFQ lGGRP PLAN 60.~ BROWN RANDOLPH 1-"4071 H1389960Z BLUECARE SINGLE NFQLGGRP PLAN GO.R2 CALIMANO BLUECARE EMPLOYEEIC NFQ lGGRP HI LOREN PLAN GO·RZ CALOCA , MICHELLE I .... ·4633 I H13213755 BLUECARE SINGLE NFQlGGRP PLAN GO·R2 CASTRO I AGUSTIN 1-3250 I H30016890 BLUECARE SINGLE NFQlGGRP PLAN GO·R2 CELAYA I ADRIANE I ---135G I H14595374 BLUECARE SINGLE NFQlG GRP PLAN GO'R2 CINEAS I JOANNE I --8363 I Hl1GS046S BLUECARE SINGLE NFQ LG GRP PLAN GO·R2 CLAY I COURTNEY 1M I .. ···8058 I H197S9782 BLUECARE SINGLE NFQLG GRP PLAN GO·R2 CLAYTON I KERRY I ... ··5879 I HG9987440 BLUECARE SINGLE NFQ lG GRP PLAN 60'R2 COATS I ANTHONY I -'"'7189 I H20763938 BLUECARE SINGLE NFQ lGGRP PLAN GO.R2 COUNCIL I LORRAINE I -"G924 I Hl001479G I BLUECARE SINGLE NFQ LGGRP PLAN 60·R2 Org Id: 85000259243 Group: 27874 Division: 002 Invoice II: 72126012 Billing Period: 03101/2016-04/01/2016 Invoice Due Date: 03/01/2016 Page 9 of "16 DELA-BLUECARE I SINGLE ESPRIELLA NFQLGGRP PLAN 60·RZ DENNIS BLUECARE I SINGLE NFQLGGRP PLAN60·RZ EGUES MICHELLE M I ~2366 I Hl0D1518Z BLUECARE I SINGLE NFQ LGGRP PLAN 60·RZ FERNANDEZ LIDIA 1--9568 1 H135589Z4 BLUECARE I SINGLE NFQLGGRP PLAN 60·RZ FIGUEROA I ANDRES IB 1·-0550 ··1 H10015164 BLUECARE EMPl.OYEEIC NFQloG GRP HILDREN PLAN 60·R2 GARCIA MARIA I L -·...,906 H13068991 BLUECARE SINGLE NFQLGGRP PLAN60·RZ GONZALEZ RAFAEL ·'-'1054 Hl001S0Z9 BLUECARE I SINGLE NFQ LGGRP PLAN 60·RZ GRIFFIN JEFFREY ·····1631 H61109569 BLUECARE I FAMILY NFQLGGRP PLAN 60·RZ GUZMAN I HENRY 1......,300 I H33G92950 BLUECARE I SINGLE NFQLGGRP PLAN 60-R2 HECHEVERRI MARIO J ·'-9792 Hl0014949 BLUECARE I SINGLE A NFQloG GRP PLAN GO-RZ HEDIN KYLE ~9979 H1001495B BLUECARE I SINGLE NFQLGGRP PLAN 60·R2 HOOD I TIFFANY I J 1"-'9222 H100709Z9 BLUECARE I SINGLE I 16Z054 NFQLGGRP PLAN 60·R2 HUARTE I ANDRES 1--'8843 H20374877 BLUECARE I SINGLE NFQLGGRP PLAN 60.R2 JACKSON I PAUL --"0049 H96090463 BLUECARE I SINGLE NFQ LGGRP PLAN 60·R2 JACKSON I VICTOR Iv -5943 H58180537 BLUECARE I SINGLE NFQLGGRP PLAN 60·R2 Orgld:85000259243 Group: 27874 Division: 002 Invoice #: 72126012 Billing Period: 03/01/2016-04/01/2016 Invoice Due Date: 03/01/2016 Page 10 of 16 JOYNER BRIYONNA I L ""'3770 H19510598 BLUECARE I SINGLE NFQLGGRP PLAN 60·R2 KING LISA 1M .. ···0138 H10015083 BLUECARE I SINGLE NFOLGGRP PLAN 60·R2 KINLAW BLUECARE EMPLOYEEIC NFQLG GRP HILOREN PLAN 60·R2 I I LARZABAL ANA M -"'7646 H68453083 BLUECARE SINGLE I /I NFOLGGRP PLAN GO·R2 I ·····8259 I BLUECARE I UGHTFOOT MARCUS W H10015065 SINGLE NFQLG GRP PLAN 60·R2 LOPEZ JOSE 1 -"'"2829 H13848700 BLUECARE. EMPLOYEEIC NFQLG GRP HILOREN PLAII 60·R2 LUGONES ALEX ·····3538 BLUECARE SINGLE NFO LG GRP PLAN 60.R2 MARTIN CRAIG 1 ..... 4016 H16529456 I BLUECARE SINGLE NFQLGGRP PLAN 60·R2 I I SINGLE MARTINEZ STEPHANIE I ·····1666 H38911979 BLUECARE NFQLGGRP PLAN 60·R2 MAVON I SHARAREH I ·····0413 I H61745572 BLUECAAE SINGLE NFQLG GRP PLAN 60·R2 MCCANTS I AMY I • .. ··6736 I H46283572 BLUECARE SINGLE NFOLGGRP PLAN 60·R2 MCDOWELL I COREY I J I ·····5163 I H10075618 BLUECARE SINGLE NFQLGGRP PLAN 60·R2 MENDEZ I JOSEPH IE I • .. ··0704 I H98859198 BLUECARE SINGLE NFQLGGRP PLAN 60·R2 MENENDEZ I GUSTAVO I ·····6220 I H19274681 BLUECARE SINGLE NFQLGGRP PLAN 60·R2 MILLS RALEIGH E -""9994 H10030194 BLUECARE SINGLE NFQLG GRP PLArI60·R2 Org Id: 85000259243 Group: 27874 Division: 002 Invoice #: 72126012 Billing Period: 03/01/2016-04/01/2016 Invoice Due Date: 03/01/2016 Page 11 of 16 MONGALO I MANUEL I F I "-'5529 I H804J5377 BLUECARE SINGLE NFQLGGRP PLAN 60·R2 MOTTA I CATHERINE 1M 1---1678 I H61698124' BLUECARE SINGLE NFQLGGRP PLAN 60·R2 OPORTA I LESTER IA I "-5829 I HI0014985 BLUECARE SINGLE NFQLGGRP PLAN 60-R2 I NKENGA I 1----1049 1 H65831095 1 1 L PAYNE I BLUECARE SINGLE NFQLGGRP PLAN 60-R2 " ") PERDIGON I JACQUEUNE I I '--8063 I H197J7650 I I I BLUECARE EMPLOYEEIC $1,122.99, ~\b (,t OI0r:, NFQLGGRP HILDREN V&,e-)'Z PLAN 60-R2 I U I PIERRE I MARVIN IB 1-4073 I H20S73056 BLUECARE SINGLE NFQLGGRP PLAN 60.R2 PORTILLO I BRANDON I "-5513 I H19390259 BLUECARE SINGLE NFQLGGRP PLAN 60·R2 PORTILLO I BRYAN I '--'"3598 I H15900409 BLUECARE SINGLE NFQLGGRP PLAN 60·R2 POUGH I QUENTIN I L I '-1783 I H47254249 BLUECARE SINGLE NFQLGGRP PLAN 60·R2 REESE I JOHN I .... ·9315 I H59088971 BLUECARE SINGLE NFQLGGRP PLAN60·R2 REID I HAROLD 1---0401 I H13698001 BLUECARE SINGLE NFQLGGRP PLAN 60-RZ RENDER I CHARLES I J I --0478 I H19274609 BLUECARE SINGLE NFQLGGRP PLAN 60·R2 RIVAS I EDDY I L 1--4010 I HI0015119 BLUECARE SINGLE NFQLGGRP PLAN 60·R2 RIVERA I LUIS I '-5051 I H18703586 BLUECARE SINGLE NFQLGGRP PLAN 60·R2 R1VEROL I ALFREOO 10 I ----4344 I H346892B7 BLUECARE EMPLOYEEIC NFQLGGRP HILDREN PLAN GO·R2 Orgld:85000259243 Group: 27874 Division: 002 Invoice it: 72126012 Bliling Period: 03101/2016-04/01/2016 Invoice Due Date: 03/01/2016 Page 12 of 16 RYALS I RODERICK IE I -"8802 I Hl0014840 I BLUECARE I SINGLE S61Q37 I 5\'0 'h.o~r \" "'rv .-/./d I SINGLE e:..i SMALL I BENNIE L -'-'3443 H56327266 BLUECARE NFOLGGRP PLAN 60·R2 STANLEY JOHN T • .. ··s847 H1B141102 BLUECARE I SINGLE NFOLGGRP PLAIlGO·R2 SUMPTER STEPHANIE I "-3950 H10549072 BLUECARE I SINGLE NFO LG GRP PLAN 60·R2 TORRES EDDY A ·····4685 BLUECARE EMPLOYEEIC NFOLGGRP HILDREII PLAIl60·R2 VALDES YVETTE ""'S476 Hl0015191 BLUECARE SIIIGLE NFOLGGRP PLAN 60·R2 VARGAS I MICHAEL -'1S07 H16861B01 BLUECARE I FAMILY NFOLGGRP PLAN GO·R2 VESELY ""-0125 BLUECARE I SINGLE NFOLGGRP PLAN SO·R2 VICENTE CELIA "-""7s25 Hl0014B59 6LUECARE I SINGLE NFOLGGRP PLAN GO·RZ VIJll JUNIOR S "-"9427 I Hl0014912 BLUECARE I SINGLE "FOLGGRP PLAN 60·R2 WILLIAMS FREDRICK BLUECARE SINGLE NFOLGGRP PLAN GO·R2 ZAMORA SINGLE Org Id: 85000259243 Group: 27874 Division: 002 Invoice #: 72126012 Billing Period: 03/01/2016-04/01/2016 Invoice Due Date: 03/01/2016 Page 13 of 16 THIS INVOICE DOES NOT CONTAIN ANY DATA FOR ROSTER ADJUSTMENTS Org Id: 85000259243 Group: 27874 Division: 002 Invoice II: 72126012 Billing Period: 0310112016-0410112016 Invoice Due Date: 03101/2016 Page 14 of 16 F~Blue +.,,'1 In the pursuit of health' Invoice Due Date Invoice # I Invoiced Amount 03/01/2016 72139771 $1,383.83 I Org Id Group Division 85000259243 27874 003 TOTAL BILLED AMOUNT ON-BILL ADJUSTMENTS AMOUNT DUE For questions about your invoice, please conlact your Florida Blue Service Advocate, Invoice Date 03/07/2016 CITY OF SOUTH MIAMI 6130 SUNSET DRIVE MIAMI FL 33143-5093 Billing Period l 03/01/2016-04/01/2016 _J $1.383.83 $0.00 $1.383.83 .\2Q.c.. g[( 2,'02 \.7-, O-.·,.:e . r '-' _. .../ Health insurance is offered by Blue Cross and Blue Shield of Florida, Inc., D/B/A Florida Blue. HMO coverage is offered by Health Options Inc .. DIBIA Florida Blue HMO, an HMO subsidiary of Blue Cross and Blue Shield of Florida. Denial, Life and Disabllily are offered by Florida Combined Life, an affiliate of Blue Cross and Blue Shield of Florida, Inc. These companies are Independent Licensees of the Blue Cross and Blue Shield Association. Org Id: 85000259243 Group: 27874 Division: 003 Invoice It: 72139771 Billing Period: 03/0112016·04101/2016 Invoice Due Date: 03101/2016 Page 15 of '16 ---------.--------------------------~------~--~------~--------------------------~----~--~------------------------------~------------------------------------ THIS INVOICE DOES NOT CONTAIN ANY DATA FOR ON-BILL ADJUSTMENTS I THIS INVOICE DOES NOT CONTAIN ANY DATA FOR ROSTER ADJUSTMENTS Org Id: 85000259243 Group: 27874 Division: 003 Invoice II: 72139771 Billing Period: 03/0112016-04/01/2016 Invoice Due Date: 03/0112016 Page 16 of 16 2015-2016 Benefit Schedule BCBS HMO Plan .> •. Rates ': Bi Weekly Di'!cI~ction .' LOw Option· EE ONLY (City Contribution) EE + CHILDREN EE + SPOUSE EE + FAMILY 1:l(:IJStlMQ. Pla.n.· tiigljOPt'Qrf·· .............•.... EE ONLY EE + CHILDREN EE + SPOUSE EE + FAMILY Q~Q$'pQs:.,I~" .... .•. . .... . ..... EE ONLY EE + CHILDREN EE + SPOUSE EE + FAMILY { .... • MonthlyJQu Pay: . .. $ 610.32 $ -$ - $ 1,122.99 $ 512.67 $ 256.34 $ 1,452.57 $ 842.25 $ 421.13 $ 1,904.21 $ 1,293.89 $ 646.95 $ 653.98 $ 43.66 $ 21:83 $ 1,203.32 $ 593.00 $ ··2.96.50 $ 1,556.47 $ 946.15 .$ 473.08 $ 2,040.41 $ 1,430.09 $ 715.05 . $ 752.08 $ 141.76$70:88 $ 1,383.83 $ 773.51$386,76 $ 1,789.95 $ 1,179.63 '$589.82 $ 2,346.49 $ 1,736.17$ 868.09 EE ONLY $ 12.57 $ $ '" EE + CHILDREN $ 26.39 $ 13.82 $ .. . ... 6.91 EE + SPOUSE $ 22.00 $ 9.43$ '. ·4.72 EE + FAMILY $ 37.09 $ 24.52$ 12.26 M~tlite DENTAL PPq . . :" ~i:ltes··.·· Nlonthly:You p~y;. BiWeekr·DeCluCtioil , ... :.' . y·"q ... ,. ... v ....... EE ONLY $ 42.10 $ 29.53 $ 14.77 EE + CHILDREN $ 99.04 $ 86.47 $ 43.24 EE + SPOUSE $ 87.89 $ 75.32 $ 37.66 EE + FAMILY $ 155.38 $ 142.81 $ 71.41 Metlife VISION PLAN Rates. MQnthly You Pay;': 1:l!.weeklyD~duCtion . EE ONLY $ 6.60 $ 6.60 $ 3.30 EE + CHILDREN $ 11.19 $ 11.19 $ 5.60 EE + SPOUSE $ 13.22 $ 13.22 $ 6.61 EE + FAMILY $ 18.46 $ 18.46 $ 9.23 ItF!J"Bi~W!Z:~'> . Cityof ( " . ...... ( ·.SouthMiami •....... ---. . -.' :' 1:;, •.. ··.···Qitvo f pleas,al1 t •.•.. RESOURCE DIRECTORY Florida Blue Telephone: 1 (877) 352-2583 www.floridablue.com Met Life 1 (800) 880-1800 mybenefits.metlife.com LINCOLN FINANCIAL GROUP www.lincoln4benefits.com 1 (800) 423-2765 LINCOLN FINANCIAL GROUP Employee Connect Telephone: 1 (888) 628-4824 LifeKeys Telephone: 1 (855) 891-3684 Travel Assistance: Travel Connect Telephone: 1 (800) 527-0218 , -j -j 2 SUPPl£M£NTAlINSURANC£ Aflac Arasay lopez 786-395-2150 Office 786-472-6839 Fax ArasayJopez@us.aflac.com Aflac.com ", .. j -I AmeriFlex Telephone: 1 (888) 868-3539 www.flex125.com For any customer service related issues, including ID Cards, Enrollment, Benefits questions, etc., please contact: Ada Waters, Benefits Consultant adaw@sapoznik.com Gracy Weberman, Vice President gracyw@sapoznik.com For any claims issues, please contact: Suany Roye, Claims Specialist suanyr@sapoznik.com Sapoznik Insurance & Associates, Inc. Telephone: (305) 948-8887 Fax: (305) 949-1049 www.sapoznik.com laTasha Nickle Director of Human Resources Telephone: (305) 668-2515 E-mail: Inickle@southmiamifl.gov PLEASE NOTE: This Benefit Highlight Booklet is solely intended as a high-level overview and general reference guide on your employee benefits. This booklet is NOT your Summary of Benefits and Coverage (SBe) document required by the Affordable Care Act of 2010. As an enrollee, your actual SBC will be provided under separate cover, by your health carrier. I OPEN ENROLLMENT/NEW HIRES BENEFITS AVAILABLE TO FULL-TIME EMPLOYEES: Medical Dental Vision Employer Paid Basic Life Voluntary Life Short-Term Disability Employer Paid Long-Term Disability Supplemental Employee Assistance Program Travel Connect Health & WeI/ness 3 Annual Opportunity to: • Add or Drop Dependents! Domestic Partners • Make Benefit Changes • Update Beneficiary Information 1",' \1.ZJ~·;-'::.-~/ -'J!r~'~~71<-·'f~~~}}.c: ;~~?~~,(:S} r;:;f~J la}'~'~:~.{~;~::'7o;·7~?~~:~~~:::·;: ;.:-:.~~~-~;~.~:~ ~: -r. ; Mllst,l~t,~,~J{~Q'''(within 30 days of "," " '< Ji~~lifYihg:~v~nt«' <"c' < ;-\~_< -.~.:.:. ,'~'" <f~ _,~. ~: ,-:~,· .. L-L=::~·~?~~.~~}:~~:~·~-~·_'.~.~ ~ <'~.:-.::.~:'. :'; -.-"~ .. : ~ __ . __ __ • Qualifying Events: • Marriage • Divorce • Legal Separation • Birth of Child • Change in Employment Status • Dependent Ceasing to be Eligible • Death FEDERAL LAWS DISCLOSURES NOTICES HEALTHCARE REFORM OVERVIEW On March 23, 2010, President Barack Obama signed into law the Patient Protection and Affordable Care Act (PPACA) also known as ACA. The Law is made up of two major components: I. Employer Mandate To comply with the law, employers must meet two requirements: • An employee's required contribution cannot exceed 9.5 % of his or her income • The plan must pay for at least 60 %, on average, of covered health expenses II. Individual Mandate Under health care reform law, beginning January 1, 2014, all individuals must have minimum essential coverage. • "Minimum Essential Coverage" if they have a: · Government-sponsored plan · Employer-sponsored plan · Individual plan • 2015 Penalty: $325 per uninsured adult in the household (capped at $975 per household) or 2% of the household income over the filing threshold. Employer Mandate All Plans offered are compliant with Employer Mandate 4 Individual Mandate If enrolled in any of our plans, you are compliant with Individual Mandate MEDICAL -HMO Florida Blue I 1 (877) 352-2583 I www.floridablue.com -- I -------- : ~. ~~n-":. 'k~~t b'M lr:~~CE-;~ ~$f', i .".-.'t~!~I~~·'1 ~~f,j~'\. BCBS BlueCare 60 A~/;~Bm gWBI e~e,nii. I 'fiffl!;~W' I· ~ ~, ~, tt ~ ~ """Ira; '1''''ilN';''l:!,c~ ~,~." .~ I I!" "'" II~'~' ·lb-·" Il [1;, w. ,~~ tj\~ ~Yt~itI~'-_it.:,~~5i~·· Physician $25 CO-PAY $15 CO-PAY Specialist $45 CO-PAY $35 CO-PAY Adult & Child Wellness/Adult Well ness Max COVERED 100% (NO MAX) COVERED 100% (NO MAX) Mammograms COVERED 100% COVERED 100% Emergency Room -Waived if Admitted $100 CO-PAY $100 CO-PAY Urgent Care $45 CO-PAY $35 CO-PAY Independent Clinical Lab COVERED 100% COVERED 100% Diagnostic Testing / MRI, CAT Scans $80 CO-PAY $80 CO-PAY Outpatient Surgery -Ambulatory Surgical Center $200 CO-PAY $100 CO-PAY Provider Services Ambulatory Surgery Center (ASq $25/$45 CO-PAY $15/$35 CO-PAY Outpatient Surgery -Hospital $215 CO-PAY $150 CO-PAY Inpatient Hospital $325 CO-PAY PER DAY, 5 DAY MAX $200 CO-PAY PER DAY, 5 DAY MAX Provider Services Hospital COVERED 100% COVERED 100% Home Health COVERED 100% COVERED 100% 60 VISITS 60 VISITS Outpatient Therapy $45 CO-PAY $35 CO-PAY 30 VISITS 30 VISITS Deductible $500/$1000 NONE Deductible Included in Out of Pocket Max YES N/A Co-Insurance 90% 90% Maximum Out of Pocket $3500/$7000 $2500/$7500 Out of Pocket Includes DED, CO-PAYS, CO-INS & RX CO-PAY & CO-INS Prescription $10/$30/$50 $10/$30/$50 Lifetime Maximum UNLIMITED UNLIMITED HEALTH INSURANCE EMPLOYEE PREMIUM PER BI-WEEKLY PAY PERIOD Employee $ 0.00 $ 21.83 Employee/Child(ren) $256.34 $296.50 -----------1----------------- Employee/Spouse $421.13 $473.08 Employee/Family $646.95 $715.05 SPECIAL NOTE: The above is just a brief summary of benefits and does not constitute a contract. Please refer to your Certificate of Insurance for further information on your Employee Benefits. In the case of error or omission, the carrier policy will govern. 5 MEDICAL -POS Florida Blue I 1 (877) 352-2583 I www.floridablue.com .. ---~---.--. ---------. -L:"-~~~-=--~ --! ---~ --;---~ --.,----.------------.- I BlueOptions 03768 LG , : , IN NETWORK : OUT NETWORK Physician $20 CO-PAY DED& 50% Specialist $45 CO-PAY DED & 50% Adult Wellness COVERED 100% 50% (NO MAX) (NO MAX) Mammograms COVERED 100% DED&50% Emergency Room -Waived if Admitted $200 CO-PAY Urgent Care $50 CO-PAY DED & 50% Independent Clinical Lab COVERED 100% DED&50% Diagnostic Testing / MRI, CAT Scans $200 CO-PAY DED&50% Outpatient Surgery -Ambulatory Surgical Center $200 CO-PAY DED& 50% Provider Services Ambulatory Surgery Center (ASC) $20/$45 CO-PAY DED&50% Outpatient Surgery -Hospital $300/ $600 CO-PAY DED& 50% Inpatient Hospital $700/ $1000 CO-PAY DED&50% Provider Services Hospital & ER $50 CO-PAY Home Health DED THEN 100% DED & 50% 20 VISITS 20 VISITS Outpatient Therapy . $45 CO-PAY DED&50% 35 VISITS 35 VISITS Deductible $250/$750 $1000/$3000' Included in Out of Pocket Max YES YES Co-Insurance 100% 50% Maximum Out of Pocket $3000/$6000 $6000/$12000 Out of Pocket Includes DED, CO-PAYS, CO-INS & RX Prescription $10/$30/$50 50% Lifetime Maximum UNLIMITED UNLIMITED ------------------------------ HEALTH INSURANCE EMPLOYEE PREMIUM PER BI-WEEKLY PAY PERIOD Employee Employee/Child(ren) Employee/Spouse Employee/Family $ 70.88 $386.76 $589.82 $868.09 SPECIAL NOTE: The above is just a brief summary of benefits and does not constitute a contract. Please refer to your Certificate of Insurance for further information on your Employee Benefits. In the case of error or omission, the carrier policy will govern. 6 ----,-.-- -- -- FLEXIBLE SAVINGS ACCOUNT OVERVIEW ~AMERIFL"" AmeriFlex I 1-888-868-3539 I www.flex125.com What is an FSA and How Does it Work? An FSA is a special bank account that lets you set aside money on a pre-tax basis for eligible expenses. If you participate in the FSA plan, you will elect to have a specified amount of "pre-tax" money deducted from your paycheck each pay period. These funds are then deposited into a bank account that you can use throughout the year to pay for eligible health care, dependent care expenses, transportation and parking expenses. What are the Advantages of Participating in an FSA? WITHOUT AN FSA WITH AN FSA Gross Pay (annual) ............................. $30,000.00 Gross Pay (annual) .............................. $30,000.00 Tax Withholding (est. @25%) ............. $ 7,500.00 -Eligible Expense ............................... $ 1,000.00 Take-Home Pay ................................. $22,000.00 Taxable Income .................................. $29,000.00 -Eligible Expense ............................... $ 1,000.00 Tax Withholding (est @ 25%) .............. $ 7,250.00 New Take-Home Pay ...... ;.................. $21,500.00 New Take-Home Pay .......................... $21,750.00 Funding Your FSA Account The maximum amount you can contribute to your FSA depends on the type of account that you select. Your employer has determined the maximum annual allowable contribution for your Medical FSA, while the government sets the maximum amount for your Dependent Day Care Spending Ac- count and Commuter Reimbursement Account. The "Use It or Lose It" Rule If you contribute dollars to an FSA account and do not use all the money you deposit, you will lose any remaining balance in the account at the end of the eligible claims period. This rule, established by the IRS as a component of tax-advantaged plans, is referred to as the "use it or lose it" rule. To avoid losing any of the funds you contribute to your FSA, it's important to plan ahead as much as possible to estimate what your expenditures will be in a given plan year. There are FSA worksheets available to help you determine how much you might need to contribute to your FSA. What accounts are available to me as a City of South Miami Employee? As a City employee you will have the option of participating in any of the four options available: * Health FSA Account * Dependent Day care Spending Account What if I want to make a change to my FSA Election? In general, you cannot change your FSA election in the middle of a plan year. However, the IRS allows participants to make changes to their election if they experience what is referred to as a "qualifying event" that causes them to have a change in personal status. Qualifying events include: • Change in provider (Dependent Day Care only) • Change in cost of day care (Dependent Day Care only) • Change in legal marital status • Change in number of dependents • Change in employment status • Change in work schedule (increase or decrease in hours) • Dependent satisfies (or ceases to satisfy) requiremerits for eligibility The election change must be consistent with the qualifying event. A change is considered consistent with the qualifying event for Medical FSAs if the following occurs: • The employee, spouse, or dependent is gaining or losing eligibility for health coverage. • The election change corresponds with that gain or loss of coverage. For Commuter Reimbursement Accounts, elections can be made for a period as short as one month. Check with your human resources department to see how often you can change your CRA election. Sapoznik Insurance 11.877.948.8887 1 www.sapoznik.com 7 FLEXIBLE SAVINGS ACCOUNT (FSA) OPTIONS ~ AiV\ERIFLEX' AmeriFlex I 1-888-868-3539 I www.flex125.com Option 1: - Medical Flexible Savings Account As a City employee you can contribute a maximum of $2,500 per year towards your Medical FSA. A medical FSA (also referred to as a "Health FSA") is used to pay for healthcare expenses that are not covered under your medical or other insurance plan. The IRS determines what expenses are eligible for reimbursement under a medical FSA. IRS-qualified expenses may include: • Co-pays, deductibles, and other payments that you are responsible for under your health plan • Expenses that may not be covered under your health plan, such as: -Routine exams -Dental care -Prescription drugs -Orthodontia (check with your employer to determine if orthodontia is allowed under your plan and what reimbursement method is used) -Eye care (including Lasik, glasses, and contact lenses) -Hearing aids -Well-baby care • Miscellaneous expenses such as: -Certain over-the-counter healthcare expenses* (Band-Aids, First Aid supplies) -Transportation, tolls and parking to receive medical care -Individual psychiatric or psychological counseling -Diabetic equipment and supplies -Durable medical equipment -Qualified medical products or services prescribed by a doctor Some examples of ineligible expenses include insurance premiums, teeth whitening, prescription drugs for male-pattern baldness, and most cosmetic procedures. A more comprehensive database of eligi- ble and ineligible expenses can be found by logging in to your per- sonal account on the AmeriFlex Web site (www.flex125.com). Please contact AmeriFlex Member Services at 888.868.FLEX (3539) for more information on how to set up online account access. *Note: Effective January 1, 2011, health care reform law mandates that expenses in- curred for over-the-counter medicines and drugs (with the exception of insulin) will not be eligible for reimbursement under a health FSA or HRA unless you have a valid prescription. With a Dependent Day Care Account, you can set aside pre-tax payroll deductions to reimburse the expenses associated with day care for your qualified dependents. Eligible expenses must meet the following requirements: • The care of the dependent must enable you and your spouse to be employed • The amount to be reimbursed must not be greater than your spouse's income or your income, whichever is less • The child must be under the age of 13 and must be your dependent under federal tax rules • The services may be provided in your home or another location, but not by someone who is your minor child or dependent for income tax purposes (e.g. an older sibling) -the caregiver's SSN will be required • If the services are provided by a daycare facility that cares for six or more children simultaneously, the facil- ity must comply with state and local day care regula- tions • Services must be for the physical care of the child, not for education, meals, etc. Qualified dependent care expenses also include costs for the care of a spouse or other adult dependent who lives in your home and is incapable of self-care, has gross in- come below the exemption amount in IRS Code 151, is dependent on you for more than half their support, and is not anyone else's qualifying child (e.g. an invalid par- ent). The same rules that apply for childcare apply to the care of other dependents, except the dependent need not be under age 13. Paying for Eligible Expenses: The AmeriFlex Convenience Card The easiest way to pay for eligible expenses is to use your AmeriFlex Convenience Card, which provides you with access to all your FSA accounts (Medical, Dependent Day Care, or Commuter) with a single card. The AmeriFlex Convenience Card works just like a regular debit card, but with three important differences: • Its use is limited to specific merchants* and to expenses, deemed eligible by your plan. • You cannot use your AmeriFlex Convenience Card at an ATM or to obtain "cash back" when making a purchase. • You are not given a PIN with this card. Should a merchant or provider ask you for a PIN, simply explain that this card does not re- quire one. If given the option between "DEBIT" and "CREDIT" at the terminal, choose "CREDIT." I *Use of the AmeriFlex Convenience Card is limited to day care providers; medical care providers such as hospitals, doctors' offices, optometrists, dentists, orthodontists, pharmaCies, or other merchants providing prescription and over the-counter eligible products; and CRA merchants such as parking ------------------------------------------------------~ 8 Sapoznik Insurance 11.877.948.8887 I www.sapoznik.com DENTAL -DMO/DPPO MetLife I 1 (800) 880-1800 I mybenefits.metlife.com MetLife I DHMO Plan. , DPPO Plan . -I I 1 1 Deductible NONE IN/OUT: $50/$150 Co-Insurance NONE IN/OUT: 100/80/50 Dentist $5 CO-PAY DED & CO-INS Specialist CO-PAY APPLIES DED & CO-INS Cleanings ONCE EVERY 6 MONTHS ONCE EVERY 6 MONTHS Preventive MOST PROCEDURES COVERED 100% Network IN/OUT: DED WAIVED, COVERED 100% Non Network SOME PROCEDURES HAVE CO-PAYS Basic Coverage SOME PROCEDURES COVERED 100% Network MOST PROCEDURES HAVE CO-PAYS IN/OUT: DED & 80% Non Network Major Coverage CO-PAY APPLIES IN/OUT: DED & 5.0% Periodontic & Endodontic Coverage NOT APPLICABLE BASIC I Orthodontic Coverage 50% CO-PAY APPLIES CHILD(REN) TO AGE 19 Orthodontic Maximum (Age Limits) $1,000 LIFETIME MAX Annual Maximum UNLIMITED IN: $5,000 OUT: $2500 Dependent Child/Student Age THROUGH AGE 26 THROUGH AGE 26 DENTAL INSURANCE EMPLOYEE PREMIUM PER PAY PERIOD DHMO DPPO EMPLOYEE ONLY $0.00 $14.77 EMPLOYEE/CHILD(REN) $ 6.91 $43.24 EMPLOYEE/SPOUSE $4.72 $37.66 EMPLOYEE/FAMILY $12.26 $71.41 SPECIAL NOTE: The above is just a brief summary of benefits and does not constitute a contract. Please refer to your Certificate of Insurance for further information on your Employee Benefits. In the case of error or omission, the carrier policy will govern. 9 VISION MetLife I 1 (800) 880-1800 I mybenefits.metlife.com MetLife Summary of Benefits METLIFE Exam Materials Eye Exam PAID IN FULL AFTER CO-PAY Lenses PAID IN FULL AFTER CO-PAY Contacts-Necessary PAID IN FULL (Legally Blind) AFTER CO-PAY **$10 CO-PAY (EVERY 12 MONTHS) **$10 CO-PAY Lenses: (EVERY 12 MONTHS) Frames: (EVERY 24 MONTHS) UP TO $45 REIMBURSEMENT UP TO $30 SINGLE $50 BIFOCAL $65 TRI FOCAL $100 LENTICULAR UP TO $210 REIMBURSEMENT Contacts-Elective $130 ALLOWANCE UP TO $105 REIMBURSEMENT Frames $130 RETAIL ALLOWANCE Employee $3.30 Employee/Child(ren) $5.60 Employee/Spouse $6.61 Family $9.23 SPECIAL NOTE: The above is just a brief summary of benefits and does not constitute a contract. Please refer to your Certificate of Insurance for further information on your, Employee Benefits. In the case of error or omission, the carrier policy will govern. 10 UP TO $70 REIMBURSEMENT j LIFE & ACCIDENTAL DEATH nLincoln Lincoln Financial I www.lincoln4benefits.coml(800) 423-2765 Financial Group® THE CITY OF SOUTH MIAMI PROVIDES BASIC LIFE INSURANCE AT NO COST TO yoiJ. Eligible full-time employees: 1 x Salary -Maximum $75,000 To 65% at age 65 ----_._------_.------. -... _-------_._----_ .. _-------_._-----_._----------------._-------------- To 50% at age 70 ""Accidental Death and Dismemberment benefit amount will match your life benefit amount. Please see your benefit booklet for full schedule of benefits. Benefits Will Terminate Upon Termination of Employment or Retirement ._----------_._-----------_._-------------,,----------- VOLUNTARY LIFE & AD&D Employee Benefit Amount Spouse Benefit Amount You Choose the Protection You Want! You Choose The Protection You Want! $20,000/ $50,000/ $100,000/ $150,000**/ $200,000** $10,000/$25,000/$50,000**/$100,000** ----_._" -----.-----~-------r-------- Not To Exceed 5 x Salary / Maximum $500,000 $100,000 Guarantee Issue For Employees Under Age 70! No Guarantee Issue for Employees 75 and over. **Indicates requires medical underwriting . Not To Exceed 2.5 x Employee's Salary or 50% of Employee's Amount / Maximum $250,000 ! $30,000 Guarantee Issue For Spouses Under Age 60! ! **Indicates requires medical underwriting .. _____ • ____________ '0 __ -.-__ .-•• -•• ___ • _______ ~ _____ •• __ • ____ .I ... ____ . _______ ... ____________ 0 ___ • ___ •••• ____ • _____________ _ , Your Benefit WmR..':duce _________________ ._. _____ J_Your S~~_~.~~~Bene~t Will_~~~u.c~ _______ _ 35% Upon The Attainment Of Age 65 . --_ ... _.---" --_._-------------- An Additional 25% Of The Original Amount At Age 70 An Additional 15% Of The Original Amount At Age 75 35% Upon The Attainment Of Age 65 Benefits will terminate At Age 80 or at retirement whichever oc-Benefits will terminate upon employee's attainment of age 70 or at curs first retirement whichever occurs first. -------.----.-.---------... .--------...... -----------------T--------.... ----.------------.... -------------------------- Dependent Children Benefit Amount [ Other Benefits Included $10,000 For Children Age 6 Months To 19 Years Waiver of Premium (Up To 25 Years If Unmarried & Full-Time Student) Accelerated Benefit $250 For Children 14 days To 6 Months Portability After 12 Months ---------------.. _---------------_. __ .. _._-----------------------.. __ .. _._._--------------.. Accidental Death and Dismemberment Two times' Principal Sum Amount paid for Loss cif Life due to an accident or loss of 2 or more members (Hand, Foot, Eye) 1/2 Principal Sum Amount paid for Loss of Member ( Hand, Foot, Eye) Accidental Death and Dismemberment benefit amount will match your Life Benefit amount. Please see your benefit booklet for full schedule of benefits. Program Effective Date: The effective date of your coverage will be the first day of the month following the completion of your waiting period. Late entrants are required to complete satisfactory Evidence of Insurability. Eligibility Requirements: You must be a full-time active employee working at least 32 hours per week. You must also be a permanent employee and be actively at work* on the coverage effective date. *Actively at work means the full-time performance of all customary duties of your occupation If Spouses and Dependent Children are in a 'Period of Limited Activit¥,* their effective date will not take effect until the day after: (1) his or her final discharge from the health care facility; or (2) resuming the normal activities of a healthy person of the same age and sex. *Period of Limited Activity means a period when a spouse or child is confined in a health care facility; or, whether confined or not, is unable to perform the regular and usual activities of a healthy person of the same age and sex. Underwriting: New Hires are required to complete an Evidence of Insurability if applying for Voluntary Life Employee Optional Life Insurance above the Guarantee Issue amounts of $100,000 for employees and $30,000 for spousal coverage. If you are an existing employee that previously waived coverage (on yourself, spouse or child) or if you are an existing employee that would like to increase your coverage, you can apply during the annual enrollment period but you will be required to provide Evidence of Insurability (for yourself, spouse and/or children). SPECIAL NOTE: The above is just a brief summary of benefits and does not constitute a contract. Please refer to your Certificate of Insurance for further information on your Employee Benefits. In the case of error or omission the carrier policy will govern. 11 SHORT & LONG-TERM DISABILITY nLincoln Lincoln Financial I www.lincoln4benefits.coml(800) 423-2765 Financial Group® THE CITY OF SOUTH MIAMI PROVIDES THE FOLLOWING LONG TERM DISABILlTYCQVERAGE AT NO COST TO YOU Monthly Benefit Equal To 40% Of Your Salary Up To $6,000 This is the amount of benefit you will receive when you are disabled. Elimination Period of 90 Days This is the number of days you must be disabled before benefit payments start. Benefit Duration To Age 65 Or Social Security Normal Retirement Age Own Occupation 24 Months This is the period of time that the employee need only be disabled from his/her own occupation. VOLUNTARY LONG TERM DISABILITY - ___ ._±~~_~}~~~~?;P+H~~~1MJ;Bf:~t~~!_~!8.!±~p~d~g~~_~~~~t~E~~£I_!.l~~ALt~~~~~f'[;~I~~_~~~~~_~~~"~~~5:i_~~~~l - Monthly Benefit Equal To 60% Of Your Salary Up To $6,000 This is the amount of benefit you will receive when you are disabled. Elimination Period of 90 Days This is the number of days you must be disabled before benefit payments start. --------------- Benefit Duration To Age 65 Or Social Security Normal Retirement Age Own Occupation 24 Months This is the period of time that the employee need only be disabled from his/her own occupation. VOLUNTARY SHORT TERM DISABILITY SHORT TERM DISABILITY IS OFFERED TO YOU AS A NEW BENEFIT 60% Of Your Salary To $1,000 Is Your Maximum Weekly Benefit This is the amount of benefit you will receive when you are disabled. 8th Day Accident & 8th Day Sickness Elimination Period This is the number of days you must be disabled before benefit payments start . Benefit Duration of 13 Weeks This is the period of time that benefits will continue to be paid to you during a period of disability. BENEFIT DEFINITIONS & REQUIREMENTS Definition of Disability: Disability means you are unable to perform the main duties of your occupation on a full-time basis due to a non-work related injury or sickness. Please see the Lincoln Financial summary of benefits for more detail. Eligibility Requirements: You must be a permanent employee regularly scheduled to work at least 32 hours per week; be actively at work* on the coverage effective date. *Actively at work means the full-time performance of all customary duties of your occupation. Program Effective Date:A The effective date of your coverage will be the first day of the month following the completion of your waiting period. Late en- trants are required to complete satisfactory Evidence of Insurability. Pre-Existing Condition: Any sickness or injury for which you have received medical treatment, consultation, care, or services (including diagnostic measures or the taking of prescribed medications) during the specified months prior to the coverage effective date. A disability arising from any such sickness or injury will be covered only if it begins after you have performed your regular occupation on a full-time basis for the specified months following the coverage effec- tive date. UNDERWRITING REQUIREMENTS: New Hires are required to complete an Evidence of Insurability if applying for above the Guarantee Issue amounts of $150,000 for employees and $25,000 for spousal coverage. If you are an existing employee that previously waived coverage (on yourself, spouse or child) or if you are an existing employee that would like to in- crease your .coverage, you can apply during the annual enrollment period but you will be required to provide Evidence of Insurability (for yourself and spouse). You will be insured on the date that Lincoln Financial approves your Evidence of Insurability. SPECIAL NOTE: The above is just a brief summary of benefits and does not constitute a contract. Please refer to your Certificate of Insurance for further information on your Employee Benefits. In the case of error or omission, the carrier policy will govern. 12 SUPPLEMENTAL INSURANCE Aflac I 1-786-395-2150 I www.Aflac.com Accident Plan Emergency Treatment ................................................... $120 Initial Hospital Stay .................................................... $1,000 Daily in Hospital ................................................ $250 per day X-Rays/ Diagnostic ................................................. $25/$200 Wellness ............................................................ $60 per year Accidental Death ....................................................... $50,000 Doctor Follow ups, physical therapy ...................... $35 each Short Term Disability $1,000-$6,000 per month. Pays beginning on the ih you miss work. Provides 65% of your paycheck if you are unable to work because of Illness or an Accident outside of work. Maternity coverage included. Guarantee Issue-Everyone qualifies regardless of pre-existing upto $3,000 per mo. Cancer Plan First Occurrence ..... $2000 Starting/increases $500 per year Surgical .............................................................. up to $5,000 Hospital Stay ............................................................. 100/day Chemotherapy ........................................................ 300/week Skin Cancer ........................................................... $20 -$200 Transportation ....................................... Expenses incurred Lodging .................................................................... $50/day Well ness ........................................................... $40 per year MIAMI-DADE TRANSIT Corporate DISCOUNT PROGRAM Critical Illness This Plan pays if you are diagnosed with Heart Attack, Stroke, Renal Failure, Bypass Surgery among others. It pays a lump-sum $5,000 benefit, daily benefits for hospital and ICU confinement, continuing care, transportation and lodging. $25,000 for major organ transplants. Life Insurance This plan will provide additional coverage for employee, spouse and children. Starting at $50,000 to $250,000. Hospital Plan 1st Day of Hospitalization ........................... $1000 and Up Hospital ER Visits (2) per year ................................... $100 Surgical Benefits ............................................ $50 -$1000 Anesthesia ........................................................ $100-$300 Invasive Diagnostic Exam ......................................... $100 Diagnostic and Imaging ............................................. $150 Ambulance ................................................. $100 -$1000 Physician Visit (3) per year .......................................... $25 Rehab Facility .................................................... $100 daily Guarantee Issue- Everyone qualifies regardless of pre-existing Employee Benefits -Income tax savings -Monthly transit group discount What is the Corporate Discount Program (COP)? -Savings on commuting costs -Stress-free commute Miami-Dade Transit's Corporate Discount Program (COP) allows participants to save on commuting costs through group discounts and pre-tax savings by obtaining monthly public transportation through a tax deduction from their employer under IRS Code 132(f). The COP provides i-Month transit passes on EASY Cards, good for a month of unlimited rides on Metrobus and Metrorail (Metromover is free to everyone). The EASY Card is automatically reloaded every month with a i-Month pass as long as the employee remains enrolled in the program. Participants who take Metrorail can save even more by also purchasing their $10 monthly Metrorail parking permit with pre-tax dollars. 13 -Free emergency taxi rides home* -EASY Card protected against loss or theft Six Free Taxi Rides Transit riders can get up to six free taxi rides a year by registering with the Emergency Ride Home Program (ERH), available 7 days a week, 24 hours a day. (Valid only during a personal/family emergency, or if one is required to work unscheduled overtime. Employee Assistance Program Lincoln Financial I www.lincoln4benefits.coml(800) 423-2765 EmployeeConnectSM -Practical Help For Life's Challenges 1 (888) 628-4824 nLincoln Financial Group® There are times in all of our lives when we need a little help. No matter what the issue is, Employee Connect is available 24 hours a day, seven days a week with support, guidance and resources. Employee Connect Includes: Work/life services for assistance with • Assistance for you or an immediate household family member • Parenting and Childcare • Eldercare • 24/7 telephone and Web access • Telephone access to legal counsel • Relationships • Work and career • A 25 % discount for services resulting from an attorney referral • Financial • Confidentiality LijeKeys -Added benefits to insured, beneficiaries and dependents 1 (855) 891-3684 LifeKeysSM services are provided at no additional cost with our term life and AD&D policies. These services provide assistance not just to beneficiaries but also to insured employees and their dependents. Many of these new services can be used as soon as the plan is in-force -not just when the insured passes away. Services include: • Free online will preparation • ID theft information • Unlimited phone contact with grief counselors and legal and financial specialists • A combination totaling six in-person sessions for grief counseling, or legal or financial information • Memorial planning assistance Li/eKeysSM services, together with TravelConnecrM serVices, provide a full range of valuable assistance and guidance to insured employees, their dependents and beneficiaries. TravelConnecfM Services - A uno-cost benefitN providing you valuable services while traveling. 1 (800) 527-0218 -Provider I.D. Number 322541 Traveling just got easier. As part of your employee benefits package, your Lincoln Financial Group life insurance coverage now includes our Trave/Connect program, an employee benefit that includes travel, medical, and safety-related services while traveling. Lincoln Financial has partnered with MEDEX Assistance Corporation, a worldwide leader in travel assistance, to make this valuable benefit available to you and your immediate family members. Business or leisure travel -it's covered. The Trove/Connect benefit is provided at no cost to you and includes a wealth of services when traveling just 100 miles or more from home. These services are provided regardless if you're traveling for business or leisure. Whether you simply want the weather forecast for your travel destination or you need emergency medical assistance halfway around the world, MEDEX has the professional staff and resources to provide support, 24 hours a day, seven days a week. SPECIAL NOTE: The above is just a brief summary of benefits and does not constitute a contract. Please refer to your Certificate of Insurance for further information on your Employee Benefits. In the case of error or omission, the carrier policy will govern. 14 Discounts • -...iW • ~,. ··~d:J -...aiiLJ~ .... ~ .Jii J J :J ~ '-" ~ f:.j ~ Pharmacy convenience starts here. www.sapoznik.( Having access to a discount prescription program can be an enormous benefit to anyone who has a chronic condition. When you have to buy the same medications regularly, it makes a huge difference to save as much money as possible each and every time. A discount prescription plan can help lower the prohibitive costs of these items. You no longer need to search far and wide for discount prescription programs that offer genuine savings. Pharmacy Antibiotics Generic Rx Programs Site '"~"', J FREE r;/~ I:;··.···· PUBLIX Other select 30%-60% less than Name Brands www.publix.com/pharmacy medications are on Select Prescriptions ell'"'''' Free. See Website Ie Publlx. Ie $5 / 30-Day Supply K-MART $10/ 90-Day Supply www.kmart.com/pharmacy -Prescription Saving Club -$10 (Savings Program) I<mart_ ($10 Deducted from 1st Prescription) ® TARGET $4.00 $4/ 30-Day Supply www.target.com/pharmacy $10/ 90-Day Supply TARGET. Walgreens Prescription Discount Card -$20 W~~ -65% Savings on 1,000s of Generic & Brand www.walgreens.com/pharmacy There's a way-Name Medications on 3 Month Supply Walmart :; ~ ~~" $4.00 $4/ 3D-Day Supply www.walmart.com/pharmacy Save money. Live better. n $10/ 90-Day Supply CVS/pharmacy· -$11.99 / 90-Day Supply www.cvs.com/pharmacy Expect something eXflIa-Health Savings Pass Card -$15 ImllI Rx Savings Program -FREE • RITE-AID -$9.99 / 3D-Day Supply www.riteaid.com/pharmacy mr::.mrm $15.99 / 90-Day Supply PRESCRIPTION DRUG MAIL ORDER PROGRAM If you are prescribed certain maintenance medications, you have the opportunity to maximize your savings by participating in Blue Cross Blue Shield's Prescription Drug Mail Order Program. Your Plans allow you to receive a 3 month's supply of an Allowed Maintenance Medication at home by mail at a 2 1/2 X co-pay. Additional information including claim forms and mailing envelopes for the prescription envelopes for the prescription mail order program may be obtained by contacting Human Resources or by visiting website at www.bcbsfl.comIMyBlueService 15 Where should I go for care? Helping you choose the right care center Doctor's You need routine care or treatment for Office a current health issue. Your primary @ doctor knows you and your health history, can access your medical records, provide preventive and routine care, manage your medications and refer you to a specialist, if necessary. . Convenience You can't get to your doctor's office, Care Clinic but your condition is not urgent or an @ emergency. Convenience care clinics are often located in malls or retail stores offering services for minor health conditions. Staffed by nurse practitioners and physician assistants. Urgent Care You may need care quickly, but it is Center riot an emergency, and your primary CD physician may not be available. Urgent care centers offer treatment for non-life threatening injuries or illnesses. Staffed by qualified physicians. Emergency You need immediate treatment of a Room very serious or critical condition. @ The ER is for the treatment of life- threatening or very serious conditions that require immediate medical attention. Do not ignore an emergency. If a situation seems life threatening, take action. Call 911 or your local emergency number right away. ~ Routine checkups ~ Immunizations ~ Preventive services ~ Manage your general health ~ Common infections I e.g.: strep throat) ~ Minor skin conditions le.g.: poison ivy) ~ Flu shots ~ Pregnancy tests ~ Minor cuts ~ Ear aches ~ Sprains ~ Strains ~ Minor broken bones le.g: finger) ~ Minor infections ~ High fever ~ Minor burns ~ Heavy bleeding ~ Large open wounds ~ Sudden change in vision ~ Chest pain ~ Sudden weakness or trouble talking ~ Major burns ~ Spinal injuries ~ Severe head injury ~ Difficulty breathing ~ Major broken bones 16 What are the cost and time considerations? Often requires a copayment and/or coinsurance Normally requires an appointment Little wait time with scheduled appointment. ~ ~ Often requires a copayment and/or coinsurance similar to offi ce visit Walk in patients welcome with no appointments necessary, but wait times can vary Often requires a copayment and/or coinsurance usually higher than an office visit Walk in patients welcome, but waiting periods may be longer as patients with more urgent needs will be treated first. Often requires a much higher copayment and/or coinsurance Open 24/7, but waiting periods may be longer because patients with life- threatening emergencies will be tre ate d fi rst. Welcome to MyBlueService MyBlueService'" is your online member self-service website designed by Blue Cross and Blue Shield of Florida, for busy people like you. Information about your Health Benefits when you need it, .. You can find information about your specific benefits plan by logging on to MyBlueService. • Take advantage of our enhanced member-exclusive WebMD access and check out the most popular resources and tools • Make better choices for a healthier future with the help of lifestyle improvement programs that offer personalized support for weight management, stress management, nutrition, smoking cessation and exercise programs • Research your symptoms with the easy to use interactive Symptom-Checker • Use your Member Health statement to track your Health Expenditures • Create a personal health record so you can set up a secure, comprehensive online record of your medical history, allergies, prescriptions and current health status • You'll also find valuable coupons to help you save on health related items BeBS Member Discounts What you will save on ...•. .(1"\ Blu'e36S& Current Partners with Select National Brands We designed Blue365 to support you as you make health choices every day and throughout your life. Blue365 gives you access to special savings on health-related products and services from leading national companies. Blue365 provides you with a wide range of options to make healthy choices, all in one convenient place. Log on to My- BlueService to access Blue365. • Vision Care, glasses, contact lenses • Hearing care and aids • Fitness Club Memberships, exercise footwear and apparel • Weight loss management • Alternative Medicine such as acupuncture, massage therapy, chiropractic stress management and smoking cessation • Elder care and much much more ~~. Nutrfsystem" ~dk ~m -', IVE~L4~1. -:::.' .,--. ., ~snap, Women'sHealth eDiets' ... ,. ~ ..t:....1TIIE5S•2 ".7 LISTEN TO YOUR BODY 'aot·conv.nlanl •• lfordabl. WESTIN' Ql>...VISVISION"' Lasi~!H~~ Tru~Hearin9 HOTELS &. RESORTS ~ SPORTLINE. SENIORLtNK mobile Need it. Find it. Go.' ~aiuYTiiV\e FiTNeSS. H&RBLOCK' ;;Beltone' charleJSCHWAB lie/II/II.'! ,III!II'(1rld h~'(lr/)t'If('r A mobile website designed for everyone-- members and non-members. Qi;;lSight- Preferred ~SlK Pricing Access health information and tools on the go. Save money. Save time. Have fun. Works on any Smartphone-- Blackberry, iPhone, Droid and even the iPad. Just type in bcbsfl.com from your mobile browser. Check Your Coverage, View Your ID Card, Find a Doctor, Compare Drug Prices Anytime. Anywhere. Any Phone. 17 Brinlling YOII th~ Soundl 01 Ufe MenSHealth Section 125/ HIPAA / COBRA SECTION 125 Qualifying Events Under certain circumstances, you may be allowed to make changes to your benefits elections during the plan year, such as additions, deletions and cancellations, depending on whether or not you experience an eligible qualifying event as determined by the Internal Revenue Service (IRS) Code, Section 125. You may change a benefit election upon the occurrence of a valid qualifying event only if the event affects your own, your spouse's or your dependent's coverage eligibility. irs.gov If you experience a qualifying event, you must report the qualifying event to Personnel Department within 30 days of the event. Beyond 30 days, additions and deletions will be denied and you may be responsible both legally and financially for any claims and/or expenses incurred as a result of any dependent(s) who continued to be enrolled who no longer meet the Entity's eligibility requirements. Dependent Eligibility We are proud to provide eligible dependents of employees with the same comprehensive coverage as outlined in this Benefits Guide. Eligible dependents are outlined below as: • A legal spouse (ex-spouses cannot be covered) • A legal domestic partner • Legally dependent children of you or your spouse who are 26 years of age or younger. • Unmarried dependent children who are older than 26, if they are physically or mentally disabled and health insurance coverage commenced prior to age 26 and they have continuously been insured. • Unmarried dependent children legally adopted by you, for whom you have legal guardianship or who have been placed with you for foster care through the courts and who meet the eligibility age requirement. • A dependent of a dependent (child born to an enrolled child dependent) may remain on the plan for up to 18 months, the depend ent of the dependent must meet the criteria of legal guardianship by the employee or spouse. • Over-age dependents, age 27-30, may continue coverage if they are unmarried and do not have a dependent, are Florida residents, full or part-time students, not enrolled in other health plans and not entitled to benefits under Title XVIII of SSA unless handicapped. HIPAA The Health Insurance Portability and Accountability Act (HIPAA) allows health insurance subscribers the ability to reduce any pre-existing condition periods that may apply under the Entity's group health plan restricts insurance companies from refusing coverage based on health status. These laws also give the subscriber the ability to add or terminate dependents from the plan during the year if specific events occur. HIPAA laws also protect the privacy of individualized health insurance information. To learn more about how your health information is protected under HIPAA, consult with your personnel department. COBRA The Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985 requires that most employers sponsoring group health plans offer employ- ees and their families the opportunity for a temporary extension of health coverage (called 'continuation coverage') at group rates in certain in- stances where coverage under the plan wOl,lld otherwise end. An employee, spouse of an employee or a dependent child of an employee covered by the Entity's group health plan has the right to choose this continuation coverage if coverage is lost for any of the following reasons provided below. Employee: Spouse of an Employee: 1. Reduction in hours of employment (that disqualifies group insurance participation eligibility); or 2. Termination of employment (for reasons other than gross misconduct). 1. The death of your spouse; or 2. A termination of your spouse's employment (for reasons other than gross misconduct) or a reduction in your spouse's hours of employment; or 3. Divorce or legal separation from your spouse; or 4. Your spouse becomes entitled to Medicare Under the law, the employee or a family member has the responsibility to inform the entity group health plan Administrator of a divorce, legal separation or a child losing dependent status under the entity group health plan within 30 days of the date in which coverage would end under the plan because of the event, whichever is later. The Entity has the responsibility to notify the plan Administrator of the employee's death, termination, reduction of hours of employment or Medicare entitlement. 18 Periodic Health Examination Schedule -.... _--_._------- ----------.--------f----.------------------.;.----.. ----- Alcohol use x x x -------------------.------------------------------1---------------.-------+---------- Cholesterol (every 5 years) x x Sigmoidoscopy (every 5-10 years) x Fecal occult blood (every year) x -_ .. ------~----------.. ---. ------------------_ .. - ------------------ Tobacco, drugs, alcohol, sexually transmitted diseases & safety x x , .-.. -.-.--------~--- Measles, mumps, rubella (1 dose) .. _ .. ---x x .. --------_ .. _----+------------. Pneumococcal (one dose) ---------------j------------- Alcohol use x ----------- Pap smear (every 1-3yea --:---------'-----'---..-:--.-:-.... -.-------------------------.-.f--.---------------.---+-.... ------.-.-.-.---------.. -----" .. --. x Cholesterol (every 5 years) -------------.----.. -.. -------------------f---------------x Mammography (every 1-2 years) I , ----------------------. -.----------i ------.--------x Sigmoidoscopy (every 5-10 years) i i ------···------------· .. · .. --·--------------------r--·------------------[ .. ---.. -.. --- Fecal occult blood (every year) '. -', -----_.".-----.-~----------------.-.-.-.----------..... ---~------------------------.. -.--.--~"------ Vision and hearing (periodically) ! ~,~,Lh~':;J;LZ}~~~·;=-~·-·:-:r;'·ILJ-:. S~;??_L~e~E~lF1iT~~~:IfF~~~~~¥~ihl1if]!(;i;:·,:~ .. -.. _ ..... Calcium intake x x Folic acid x x Hormone replacement therapy x Mammography screening x x x SOURCE: Guide to Clinical Preventive Services 19 x x x x x x x x x x x x x x _1 .1 Periodic Health Examination Schedule ·-·.--.·.-.---·-... -... ----.. ---·---·-------·--·----i---.----.--!-------l-----.---'-------.. ,------.--+-------... -..,.······-·--·--··,-----··---··-·--;------·----·-····c··-··-..... -.-.------ Haemophilus influenza type B Diphtheria, Tetanus, Pertussis Measles, mumps, rubella x -+ i x i +":,''-_c.·~~'''','.~~,---'~~L'.~'i_''-'-"_=.''L.."'-,',O'.i'~.2,U .... ''''_~.""i.,,',"-'-, .... i'i··· .·.;:(~lm~-.. ;'i:"F_jZ;l(gl ------.-.--.. -----------.. ---+--.. ·---+----r---~-----____t------____t·--------____t---------1---- Hearing x Head circumference x x x x Height and weight x x x x x x x x ------------_ .. ---------------+---- Lead x Vision x x x x x x x x x SOURCE: Guide to Clinical Preventive Services 20 Health & Wellness SAPOZNIK INSURANCE Employee Health & Well ness Solutions Numbers that count for a Healthy Heart Source: American Heart Association; heart.org TOTAL CHOLESTEROL GOAL: Your total cholesterol score is calculated by the following equation: HDl + lDl + 20% of your triglyceride level. A total cholesterol score of less than 180 mg/dl is considered optimal. This chart reflects blood pressure categories defined by the American Heart Association. BLOOD PRESSURE GOAL: less than 120/80 mmHg FASTING GLUCOSE GOAL: less than 100 mg/dl BODY MASS INDEX (BMI) GOAL: Greater than 18.5 but less than 25 kg/m 2 WAIST CIRCUMFERENCE *GOAl: Women: 35 inches or less *GOAl: Men: 40 inches or less Blood Pressure Systolic Diastolic 21 Health & Wellness ~ Why Is a Healthy Weight Important? Reaching and maintaining a healthy weight is important for overall health and can help you prevent and control many diseases and conditions. If you are overweight or obese, you are at higher risk of developing serious health problems, including heart disease, high blood pressure, type 2 diabetes, gallstones, breathing problems, and certain cancers. That is why maintaining a healthy weight is so important: It helps you lower your risk for developing these problems, helps you feel good about yourself, and gives you more energy to enjoy life. What Is Overweight and Obesity? Overweight is having extra body weight from muscle, bone, fat, and/or water. Obesity is having a high amount of extra body fat. Body mass index (BMI) is a useful measure of overweight and obesity. The information on this Web site will provide you with information about BMI (including limitations of this measure) and how to reach and stay at a healthy weight. Talk to your health care provider if you are concerned about your BMI. What Factors Contribute To a Healthy Weight? Many factors can contribute to a person's weight. These factors include environment, family history and genetics, metabolism (the way your body changes food and oxygen into energy), and behavior or habits. Energy Balance Energy balance is important for maintaining a healthy weight. The amount of energy or calories you get from food and drinks (energy IN) is balanced with the energy your body uses for things like breathing, digesting, and being physically active (energy OUT): • The same amount of energy IN and energy OUT over time = weight stays the same (energy balance) • More energy IN than OUT over time = weight gain • More energy OUT than IN over time = weight loss To maintain a healthy weight, your energy IN and OUT don't have to balance exactly every day. It's the balance over time that helps you maintain a healthy weight. You can reach and maintain a healthy weight if you: • Follow a healthy diet, and if you are overweight or obese, reduce your daily intake by 500 calories for weight loss • Are physically active • Limit the time you spend being physically inactive Source: http://www.nhlbi.nih.gov/ 22 / Employee H •• I'~ 'I< yiel,in.is Solution. Health & Wellness How Can I Manage Stress? It's important to learn how to recognize how stress affects you, learn how to deal with it, and develop healthy habits to ease your stress. What is stressful to one person may not be to another. Stress can come from happy events (a new marriage, job promotion, new home) as well as unhappy events (illness, overwork, family problems). What is stress? Stress is your body's response to change. The body reacts to it by releasing adrenaline (a hormone) that causes your breathing and heart rate to speed up, and your blood pressure to tise. These reactions help you deal with the situation. The problems come when stress is constant (chronic) and your body remains in high gear, off and on, for How can I cope with it? Taldng steps to manage stress will help you feel more in control of your life. Here are some good ways to cope. • Try positive self-tall<--turning negative thoughts into positive ones. For example, rather than thinking "I can't do this," say "I'll do the best I can." • Take 15 to 20 minutes a day to sit quietly, relax, breathe deeply and think of a peaceful situation. • Engage in physical activity regularly. Do what you enjoy -walk, swim, tide a bike or do yoga. Letting go of the tension in your body will help you feel a lot better. • Try to do at least one thing every day that you enjoy, even if you only do it for 15 minutes. American Heart Association® 23 days or weeks at a time. Chronic stress may cause an incl;ease in heart rate and blood pressure. Not all stress is bad. Speakingto a group or watching a close football game can be stressful, but they can be fun, too. The key is to manage stress properly. Unhealthy responses to stress may lead to health problems in some people. How can I live a more relaxed life? Here are some positive healthy habits you may want to develop to manage stress and live a more relaxed life. • Think ahead about what may upset you. Some things you can avoid. For example, spend less time with people who bother you or avoid dtiving in rush-hour traffic. • Learn to say "no." Don't promise too much. • Give up the bad habits. Too much alcohol, cigarettes or caffeine can increase stress. If you smoke, mal(e the decision to quit now. e Slow down. Try to "pace" not "race." Plan ahead and allow enough time to get the most important things done. • Get enough sleep. Try to get 6 to 8 hours of sleep each night. • Get organized. Use "To Do" lists to help you focus on your most important tasks. Approach big tasks one step at a time. GLOSSARY OF HEALTH COVERAGE AND MEDICAL TERMS This glossary has many commonly uses terms, but isn't a full list. These glossary terms and definitions are intended to be educational and may be different from the terms and definitions in your plan. Some of these terms also might not have exactly the same meaning when used in your policy or plan, and in any such case, the policy or plan governs. (See your Summary of Benefits and Coverage for information on how to get a copy of your policy or plan document.) ALLOWED AMOUNT Maximl!m amount on which payment is based for covered health care services. This may be called "eligible expense," "payment allowance" or "negotiated rate." If your provider charges more than the allowed amount, you may have to pay the difference. (See Balance Billing.) APPEAL A request for your health insurer or plan to review a decision or a grievance again. BALANCE BILLING When a provider bills you for the difference between the provider's charge and the allowed amount. For example, if the provider's charge is $100 and the allowed amount is $70, the provider may bill you for the remaining $30. A preferred provider may not balance bill you for covered services. CO-INSURANCE Your share of the costs of a covered health care service, calculated as a percent (for example, 20%) of the allowed amount for the service. You pay co-insurance plus any deductibles you owe. For example, if the health insurance or plan's allowed amount for an office visit is $100 and you've met your deductible, your co-insurance payment of 20% would be $20. The health insurance or plan pays the rest of the allowed amount. COMPLICATIONS OF PREGNANCY Conditions due to pregnancy, labor and delivery that require medical care to prevent serious harm to the health of the mother or the fetus. Morning sickness and a non-emergency caesarean section aren't complications of pregnancy. CO-PAYMENT A fixed amount (for example, $15) you pay for a covered health care service, usually when you receive the service. The amount can vary by the type of covered health care service. DEDUCTIBLE The amount you owe for health care services your health insurance or plan covers before your health insurance or plan begins to pay. For example, if your deductible is $1000, your plan won't pay anything until you've met your $1000 deductible for covered health care services subject to the deductible. The deductible may not apply to all services. DURABLE MEDICAL EQUIPMENT (DME) Equipment and supplies ordered by a health care provider for everyday or extended use. Coverage for DME may include: oxygen equipment, wheelchairs, crutches or blood testing strips for diabetics. EMERGENCY MEDICAL CONDITION An illness, injury, symptom or condition so serious that a reasonable person would seek care right away to avoid severe harm. EMERGENCY MEDICAL TRANSPORTATION Ambulance services for an emergency medical condition. 24 EMERGENCY ROOM CARE Emergency services you get in an emergency room. EMERGENCY SERVICES Evaluation of an emergency medical condition and treatment to keep the condition from getting worse. EXCLUDED SERVICES Health care services that your health insurance or plan doesn't pay for or cover. GRIEVANCE A complaint that you communicate to your health insurer or plan. HABILITATION SERVICES Health services that help a person keep, learn or improve skills and functioning for daily living. Examples include therapy for a child who isn't walking or talking at the expected age. These services may include physical and occupational therapy, speech-language pathology and other services for people with disabilities in a variety of impatient and/or outpatient settings. HEALTH INSURANCE A contract that requires your health insurer to pay some or all of your health care costs in exchange for a premium. HOME HEALTH CARE Health care services a person receives at home. HOSPICE SERVICES Services to provide comfort and support for persons in the last stages ofterminal illness and theirfamilies. HOSPITALIZATION Care in a hospital that requires admission as an impatient and usually requires an overnight stay. An overnight stay for observation could be outpatient care. HOSPITAL OUTPATIENT CARE Care in a hospital that usually doesn't require an overnight stay. IN-NETWORK CO-INSURANCE The percent (for example, 20%) you pay of the allowed amount for covered health care services to providers who contract with your health insurance or plan. In-network co-insurance usually costs you less than out-of-network co-insurance. GLOSSARY CONTINUED IN-NETWORK CO-PAYMENT A fixed amount (for example, $15) you pay for covered health care services to providers who contract with your health insurance or plan. In-network co-payments usually are less than out-of-network co -payments. MEDICALLY NECESSARY Health care services or supplies needed to prevent, diagnose or treat an illness, injury, condition, disease or its symptoms and that meet accepted standards of medicine. NETWORK The facilities, providers and suppliers your health insurer or plan has contracted with provide health care services. NON-PREFERRED PROVIDER A provider who doesn't have a contract with your health insurer or plan to provide services to you. You'll pay more to see a non- preferred provider. Check your policy to see if you can go to all providers who have contracted with your health insurance or plan, or if your health insurance or plan has a "tiered" network and you must pay extra to see some providers. OUT-Of-NETWORK CO-INSURANCE The percent (for example, 40%) you pay of the allowed amount for covered health care services to providers who do not contract with your health insurance or plan. Out-of-network co-insurance usually costs you more than in-network co-insurance. OUT-Of-POCKET LIMIT The most you pay during a policy period (usually a year) before your health insurance or plan begins to pay 100% of the allowed amount. This limit never includes your premium, balance-billed charges or health care your health insurance or plan doesn't cover. Some health insurance or plans don't count all of your co-payments, deductibles, co-insurance payments, out-of-network payments or other expenses toward this limit. PHYSICIAN SERVICES Health care services a licensed medical phYSician (M.D. -Medical Doctor or D.O. -Doctor or Osteopathic Medicine) provides or coordinates. PLAN A benefit your employer, union or other group sponsor provides to you to pay for your health care services. PREAUTHORIZATION A decision by your health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment is medically necessary. Sometimes called prior authorization, prior approval or precertification. Your health insurance or plan may require preauthorization for certain services before you receive them, except in an emergency. Preauthorization isn't a promise your health insurance or plan will cover the cost. PREFERRED PROVIDER A provider who has a contract with your health insurer or plan to provide services to you at a discount. Check your policy to see if you can see all preferred providers or if your health insurance or plan has a "tiered" network and you must pay extra to see some providers. Your health insurance or plan may have preferred providers who are also "participating" providers. Participating providers also contract with your health insurer or plan, but the discount may not be as great, and you may have to pay more. 25 PREMIUM The amount that must be paid for your health insurance or plan. You and/or your employer usually pay it monthly, quarterly or yearly. PRESCRIPTION DRUG COVERAGE Health insurance or plan that helps pay for prescription drugs and medications. PRESCRIPTION DRUGS Drugs and medications that by law require a prescription. PRIMARY CARE PHYSICIAN A phYSician (M.D. -Medical Doctor or D.O. -Doctor of Osteopathic Medicine) who directly provides or coordinates a range of health care services for a patient. PRIMARY CARE PROVIDER A physician (M.D. -Medical Doctor of D.O. -Doctor of OsteopathiC Medicine), nurse practitioner, clinical nurse specialist or physician assistant, as allowed under state law, who provides, coordinates or helps a patient access a range of health care services. PROVIDER A physician (M.D.-Medical Doctor or D.O. -Doctor of OsteopathiC Medicine), health care professional or health care facility licensed, certified or accredited as required by state law. RECONSTRUCTIVE SURGERY Surgery and follow-up treatment needed to correct or improve a part of the body because of birth defects, accidents, injuries or medical conditions. REHABILITATION SERVICES Health care services that help a person keep, get back or improve skills and functioning for daily living that have been lost or impaired because a person was sick, hurt or disabled. These services may include physical and occupational therapy, speech-language pathology and psychiatric rehabilitation services in a variety of inpatient and/or outpatient settings. SKILLED NURSING CARE Services from licensed nurses in your own home or in a nursing home. Skilled care services are from technicians and therapists in your own home or in a nursing home. SPECIALIST A physician specialist focuses on a specific area of medicine on a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions. A non-physician specialist is a provider who has more training in a specific area of health care. UCR (USUAL, CUSTOMARY AND REASONABLE) The amount paid for a medical service in a geographic area based on what providers in the area usually charge for the same or similar medical service. The UCR amount sometimes is used to determine the allowed amount. URGENT CARE Care for an illness, Injury or condition serious enough that a reasonable person would seek care right away, but not severe as to require emergency room care. EMPLOYEE (INSURED) SSN First Name Last Name Street Address City Date of Hire Email Address Home Phone DEMOGRAPHIC INFORMATION Se If /Spo use/De pe n dents Date of Birth MI Gender ST ZIP SPOUSE 0 DOMESTIC PARTNER 0 SSN Date of Birth First Name MI Last Name Gender CHILD CHILD SSN Date of Birth SSN First Name MI First Name Last Name Gender Last Name CHILD CHILD SSN Date of Birth SSN First Name MI First Name Last Name Gender Last Name CHILD CHILD SSN Date of Birth SSN First Name MI First Name Last Name Gender Last Name CHILD CHILD SSN Date of Birth SSN First Name MI First Name Last Name Gender Last Name 26 Date of Birth MI Gender Date of Birth MI Gender Date of Birth MI Gender Date of Birth MI Gender Notes: 27 1100 Northeast 163rd Street I North Miami Beach, Florida 33162 I Fax: (305) 949-1099 THE CITY OF PLEASANT LIVING ADDENDUM No. #3 Project Name: Insurance Brokerage Services RFQ NO. HR2016-07 Date: April 15,2016 Sent: Fax/E-mail/webpage This addendum submission is issued to clarify, supplement and/or modify the previously issued Solicitation, and is hereby made part of the Documents. All requirements of the Documents not modified herein shall remain in full force and effect as originally set forth. It shall be the sole responsibility of the bidder to secure Addendums that may be issued for a specific solicitation. QUESTION #1: Pg 33: Personnel and Reference: this section asks to "Provide a list of five clients the firm has worked with in the last 36 months" Q: Should these be the same as the 3 requested on page 12 or are they in addition to for a total of 8? RESPONSE: Respondents should submit a listing of five (5) clients and, they can be same as the three (3) references requested on page 12. QUESTION #2: Q: Do the 5 requested on page 33 have to be government agencies or can they be private sector clients? RESPONSE: The references can be government agencies or quasi-government agencies or comparable corporate clients. IT SHALL BE THE SOLE RESPONSIBILITY OF THE BIDDER TO SECURE ADDENDUMS THAT MAY BE ISSUED FOR A SPECIFIC SOLICITATION. Page 1 of 1 BID OPENING REPORT Bids were opened on: Friday, Apri122, 2016 For: . RFO # HR 2016-07 Insurance Brokerage Services COMPANIES THAT SUBMITTED PROPOSALS: 1. FLORIDA LEAGUE OF CITIES, INC. 2. COe/riz 13eneJ/;ls CfPvI iL ( 3. BROWN & BROWN OF FL, INC. after: 10:00am THE ABOVE BIDS HAVE NOT BEEN CHECKED. THE BIDS ARE SUBJECT TO CORRECTION AFTER THE BIDS HAVE BEEN COMPLETELY REVIEWED. Witness:-->,,~,----,-__ --/,-\-_~,--__ ~ Witness:_-=----=----::--::----________ _ Print Name Signature RFP HR-2016-07 Insurance Brokerage Services NOTE: RESULTS ARE NOT FINAL UNTIL AN AWARD RECOMMENDTION BY THE CITY MANAGER Bid Package Bidder Public Entity (10rg; 10 Proposal Qua~fiationl Detailed References Non Coli. Crimes and Drug free OSHA Fed. State Related Presentation (1) Proof of Signed Bidder Copies;l Format Work Plan Affidavit Conflicts of Workplace Stds Listings Party Declaration Ins Contrat Sun Biz Digital) Resumes Interest Brown & X X x N/A x X X Brown X X X X X N/A X x Fla. League of x N/A x N/A X N/A N/A N/A N/A N/A N/A N/A N/A N/A x Cities Gelin x x x x x x x x x x x X N/A X X ~ -~ BROWN & BROWN Yael Londono: City of Sunny Isle Beach: 1. Has the Brown & Brown demonstrated an ability to lower first offered prices and Come back with reduced prices/rates? "They have always worked with us to lower rates & prices. Recently reduced their prices from 20% to 7% -8%." 2. How would you rate their quality of specific case assistance? "Yes, very responsive. Just a phone call away. We have been with them for over 10 Yrs; very happy with them." Kulick, steven P From: Sent: Suzanne Skidmore <SSkidmore@cLgreenacres.fl.us> Thursday, May 19, 2016 10:58 AM To: Kulick, Steven P Cc: Menendez, Maria M. Subject: RE: Reference Check: Florida League of Cities 1. Has the League demonstrated an ability to lower first offered prices and come back with reduced prices/rates? FLC has come back with reduced prices/rates. 2. How would you rate their quality of specific case assistance? I have been with the City of Greenacres for 11 years and have been the Benefits Administrator since I came here. FLC had already been well established here and continues to demonstrate excellent quality of service. just had a situation last week where an employee needed that specific case assistance and they were able, willing, and very helpful in that situation. The City of Greenacres not only as our medical insurance with FLC, we also have our Property/Casualty/Liability, and Retirements with them as well. If I can be any further assistance please don't hesitate to ask. Thanks Suzanne Skidmore City of Greenacres Human Resources 5800 Melaleuca Lane Greenacres, FL 33463 561-642-2001 From: Kulick, Steven P [mailto:SKulick@southmiamifl.gov] Sent: Thursday, May 19, 2016 10:36 AM To: Suzanne Skidmore Cc: Menendez, Maria M. Subject: RE: Reference Check: Florida League of Cities Health insurance. Steven Kulick, C.P.M. Purchasing Manager/Procurement Division City of South Miami -6130 Sunset Drive -South Miami~ FI 33143 Ph: 305/663-6339; Fax: 305/663-6346 -Email: skulick@southmiamif/.qov ,', :,. ~ .: .. ,...-.\'Ni~ j.";-.". From: Suzanne Skidmore [mailto:SSkidmore@ci.greenacres.fl.us] Sent: Thursday, May 19, 2016 10:35 AM To: Kulick, Steven P 1 Cc: Menendez, Maria M. Subject: RE: Reference Check: Florida League of Cities Is this for Health Insurance or for Property/Casualty/Liability Insurance? Suzanne Skidmore City of Greenacres Human Resources 5800 Melaleuca Lane Greenacres, FL 33463 561-642-2001 From: Kulick, Steven P [mailto:SKulick@southmiamifl.qov] Sent: Thursday, May 19, 2016 10:25 AM Cc: Menendez, Maria M. Subject: Reference Check: Florida League of Cities Good morning, The City of South Miami received proposals in response to a Request for Qualifications for Insurance Brokerage Services and is checking references provided by the Florida League of Cities. The Selection Committee has a few questions: 3. Has the League demonstrated an ability to lower first offered prices and come back with reduced prices/rates? 4. How would you rate their quality of specific case assistance? Any questions please call. Thanks, Steven Kulick, C.P.M. Purchasing Manager/Procurement Division City of South Miami -6130 Sunset Drive -South Miami, FI 33143 Ph: 305/663-6339; Fax: 305/663-6346 -Email: skulick@southmiamif/.qov 'C' ", ,'.,111:1> ~ .. '. This email message has been successfully scanned by Greenacres Email Security System for the presence of malicious codes, spam, vandals, and computer viruses. 2 This email message has been successfully scanned by Greenacres Email Security System for the presence of malicious codes, spam, vandals, and computer viruses. 3 Fla. LEAGUE OF CITIES Gene Bullard: City of Lake City 1. Has the Lague demonstrated an ability to lower first offered prices and come back with reduced prices/rates? "Yes, they have always worked with us to lower prices. Our first year, they really worked with us since we were part of a shared risk pool. We are in our 4th budget year with them and they continue to work with us each year on prices." 2. How would you rate their quality of specific case assistance? "Very happy with them, and so are our employees. I personally had a specific incident and they handled it with great care." BE-NEFIT CONSULTANTS June 10, 2016 City of South Miami Attn: Steven Kulick 6130 Sunset Drive South Miami, Fl33143 RE: Cost Proposal RFQ: HR2016~7 Dear Mr. Kulick, Attached please find the outline for the cost proposal in response to RFQ: HR2016-07. This will include for brokerage services pertaining to Medical Insurance (including retirees), Dental Insurance, Vision Insurance, Short Term Disability Insurance, long Term Disability Insurance, Group life Insurance, Voluntary life and AD&D Insurance and Ancillary/Supplemental Insurance. Please advise with any questions. We appreciate the opportunity to provide this information. Regards, J Samantha Graveline Vice President Brown & Brown of Florida, Inc. dba Brown & Brown Benefit Consultants Employee Benefits 1201 W. Cypress Creek Road, Suite 130 I Fort Lauderdale, FL 33309 I Phone: 954-776-2222 I Fax: 954-772-6243 A Division of Brown & Brown of Florida, Inc. I Website: www.bbftlaud.com BENEFIT CONSULTANTS Cost Proposal The flat-fee annual compensation is inclusive of Brown & Brown of Florida, Inc.'sservlces for all lines of employee benefit coverages and all facets of service administration, consulting and program implementation excluding the voluntary ancillary/supplemental insurance. Brown & Brown of Florida, Inc. herein proposes a $25,000 USD annual consulting fee to support the City of South Miami and its employees benefit needs, claims handling, wellness program rollout, experience analysis, program negotiation, brokerage services and enrollment support. The above fee is inclusive of all personnel, time and activities. The City of South Miami will not be billed for any additional services listed in the Request for Qualification. We do ask that the voluntary ancillary/supplemental insurance (AFLAC, Colonial, Allstate, Trustmark, Kanawaha) commissions be paid per the carriers scale, directly from the carrier, as these are individual products and are paid at no cost to the City of South Miami. Below Is the summary of Services, Coverage, Technology and Support available to the City of South Miami included wIthin the proposed annual fee and commission paid by the voluntary ancillary/supplemental insurance as stated above. Unes of Coverage Available Not to be Included in the Brokerage Services Fee, but within standard carrier commission delegated by the carrier: • cancer Policy • TermUfe • Accident Policy • Indlvldua I Short Term • Hospital Policy • Critical Illness • Universal orWhole Life Unes of Coverage Available Included in the Brokerage Services: • Medical • Group Long Term Disability • Pre-Pald Legal • Dental • Group Short Term Dlsab1l1ty • Law Enforcement AD&D • Vision • Medical GAP Plans • Travel Accident • Life and AD&D • Pet Insurance Brokerage Services Account Management Customer Service Enrollment Support • Assigned Account Manager • Direct Une to Account • Custom Benefit Booklets & and Assigned Service and Manager, Claims and Service Enrollment Kits Claims Specialists Specialists • DOL Mandated Notices • On site support • Toll-Free Access Number • On Site Enrollment • Unlimited access to Account • BIlling and Claims Support Presentations ManagementTeam and • Claim Grievance Assistance • New Hire Orientations Claims Specialists • Network Provider Location • Web Enrollment • Weekend and Evening Assistance • Enrollment Processing of Support to claims and benefit • Billing, Enroilment 10 Card & Additions and Deletions assistance via cell phone day to day claim resolution throughout the Year and assistance Consulting Support Claims Analysis Employee Communication • Annually Market all lines of • Quarterly Claims Meetings • Unlimited Access to Coverage with All Carriers • Employee Education MarketlngTeam, Customized • pre-Renewal and Mid-Year Meetings Based on Claims Materials, Well ness Fair Renewal Meeting Performance Coordinator, Benefit • Renewal Presentation & • Claims Analyzatlon to assist Implementation, Payroll Additional Meetings to with Behavior Modification Stuffers, Employee Posters Present and Negotiate • Claims Projection and Communication Notices Options • Drug & Physician Utilization • Wellness Newsletter & Topic • Complete Renewal Package, Reporting of the Month Executive Summary, • High Claimant Monitoring • Monthly or Quarterly Customized Benefit Options Newsletter & Analysis • Lunch &Leam • Education Seminars Compliance Support Wellness Programs Annual Health Fair • Dependent Audit • Annual Health Fair • Blood Pressure • Continuous Monitoring for • Biometric Screenings • Glucose Testing Compliance against State and • Wellness Seminars • Cholesterol Screening Federal Laws • Nutrition & Fitness Programs • Weight & BMI (Body Mass Indexl • ACA Reporting Assistance • Wellness Vendor Discounts & • Vision Screening • Consistent Contact with HR Support • Bone Density Screening to ensure Federal and State • Wellness Committee • Skin Screening Compliance and Notifications Guidance • Flu Shots/ Pneumonia are being provided Shots/Shingles Vaccine • Medicare Part 0 Compliance • Mental Health Awareness Assistance • Smoking Cessation • DOL Notice Audit • Fitness & Exercise • Massage Therapy Brown & Brown of Florida, Inc. is able to provide additional services as desired that are not listed above or work towards modifying the above items to be included within the scope of our fee. Unlisted services must be pre-approved to be included within the aforementioned cost package and are subject to availability offerings. Brown & Brown of Florida, Inc. will strive to exceed your expectations by providing a comprehensive benefit package at a competitive consulting fee. THE CITY OF PLEASANT LIVING Evaluation Scoring Sheet RFQ Title: Insurance Brokerage Services RFQ No.: HR2016-07 1. 2. 3. 4. Staff Experience and Team Organization: The ability of professional personnel, including the employees or principals of the firm; subcontractors (if any) and; pertinent training, skills, experience and references. Firms with in-house specialties as it relates to the scope of services and who have comparable project experience with the City of South Miami and other municipalities, cities or County govemments for similar engagements, will be granted a higher score according to relevance to the City of South Miami's reqUirements and service. (Max. 40 points) Project Approach: Completeness and clarity of the proposer's approach and detailed work plan to the engagement, and the ability of the approach to immediately accomplish the City's overall objectives. (Max. 30 points) Commitment to Timellnes and Budget Requirements: Respondent's ability to meet City timelines and budget requirements based on the current and projected workload of the firm. (Max. 20 points) Other factors: Respondent's previous activities, including the volume of work previously awarded to the consultant or portions of its team, by the City. Firms that have done prior business with the City within the last 15 years, from the date the RFQ is issued, will be eligible for this category. (Max. 10 pOints) \D Page 1 of 1 (Signature) Purchasing Division 6130 Sunset Drive South Miami, Florida 33143 (305) 663-6339 www.southmiamifl.gov yo )0 o Date: Evaluation Scoring Sheet THE CITY OF PLEASANT LIVING RFQ Title: Insurance Brokerage Services RFQ No.: HR2016-07 1. 2. 3. Staff Experience and Team Organization: The ability of professional personnel, including the employees or principals of the. finn; subcontractors (if any) and, pertinent training, skills, experience and references. Firms with in-house specialties as it relates to the scope of services and who have comparable project experience with the City of South Miami and other municipalities, cities or County governments for similar engagements, will be granted a higher score according to relevance to the City of South Miami's requirements and service. (Max. 40 points) Project Approach: Completeness and clarity of the proposer's approach and detailed work plan to the engagement, and the ability of the approach to immediately accomplish the City's overall objectives. (Max. 30 pOints) Commitment to Timellnes and Budget Requirements: Respondent's ability to meet City timelines and budget requirements based on the current and projected workload of the finn. (Max. 20 points) Other factors: Respondent's previous activities, including the volume of work previously awarded to the consultant or portions 4. of its team, by the City. Finns that have done prior business with the City within the last 15 years, from the date the RFQ is issued, will be eligible for this category. (Max. 10 points) 40 2D Page 1 of 1 Purchasing Division 6130 Sunset Drive South Miami, Florida 33143 (305) 663-6339 www.southmiamifl.gov LtD 20 ~ South«ttiami THE CITY OF PLEASANT LIVING Evaluation Scoring Sheet RFQ Title: Insurance Brokerage Services RFQ No.: HR2016·07 1. 2. 3. 4. Staff Experience and Team Organization: The ability of professional personnel, including the employees or principals of the firm; subcontractors (if any) and, pertinent training, skills, experience and references. Firms with in~house specialties as it relates to the scope of services and who have comparable project experience with the City of South Miami and other municipalities, cities or County governments for similar engagements, will be granted a higher score according to relevance to the City of South Miami's requirements and service. (Max. 40 points) Project Approach: Completeness and clarity of the proposer's approach and detailed work plan to the engagement, and the ability of the approach to immediately accomplish the City's overall objectives. (Max. 30 pOints) Commitment to Timellnes and Budget Requirements: Respondent's ability to meet City timelines and budget reqUirements based on the current and projected workload of the firm. (Max. 20 pOints) Other factors: Respondent's previous activities, including the volume of work previously awarded to the consultant or portions of its team, by the City. Firms that have done prior business with the City within the last 15 years, from the date the RFQ is issued, will be eligible for this category. (Max. 10 pOints) Page 1 of 1 Purchasing Division 6130 Sunset Drive South Miami, Florida 33143 (305) 663-6339 www.sQuthmiamifl.gov Date: 412212016 Detail by Entity Name Florida Profit Corporation BROWN & BROWN OF FLORIDA, INC. Filing Information Document Number FEI/EIN Number Date Flied State Status Last Event Event Date Flied Event Effective Date Principal Address 220 S. Ridgewood Avenue Daytona Beach, FL 32114 Changed: 04/13/2015 Mailing Address 220 S. Ridgewood Avenue Daytona Beach, FL 32114 Changed: 04/13/2015 150616 59-0691921 04/03/1947 FL ACTIVE AMENDMENT 09/11/2014 NONE Registered Agent Name & Address C T CORPORATION SYSTEM 1200 SOUTH PINE ISLAND ROAD PLANTATION, FL 33324 Name Changed: 03/20/2012 Address Changed: 03/20/2012 Officer/Director Detail Name & Address Title President, Director Lydecker, Charles H. 220 S. Ridgewood Avenue Daytona Beach, FL 32114 Detail by Entity Name htlp:l/search.sunblz.orgllnquiry/CorporationSearchiSearchResultDetail?inquirytype=EnUtyName&clireclionType=lnilial&searchNameOrder",BRaNNBROWN... 1/4 412212016 Title Secretary, VP Lloyd, RobertW. 220 S. Ridgewood Avenue Daytona Beach, FL 32114 Title Treasurer Daly, William R 220 S. Ridgewood Avenue Daytona Beach, FL 32114 Title Vice President & Assistant Secretary Robinson, Anthony 220 S. Ridgewood Ave. Daytona Beach, FL 32114 Title Executive Vice President Alvarez, Fausto 220 S. Ridgewood Avenue Daytona Beach, FL 32114 Title Executive Vice President Brown, Barrett Six Concourse Parkway Suite 2300 . Atlanta, GA 30328 Title Executive Vice President Cloar, IV, Thomas 220 S. Ridgewood Avenue Daytona Beach, FL 32114 Title Executive Vice President Farmer, Steve 220 S. Ridgewood Avenue Daytona Beach, FL 32114 Title Executive Vice President Grippa, Anthony M 220 S. Ridgewood Avenue Daytona Beach, FL 32114 Title Executive Vice President Keeby, Michael 220 S. Ridgewood Avenue Daytona Beach, FL 32114 Delail by Entity Name http://search,sunbiz,orgllnqulry/CorporationSearchlSearchResultDelall?lnqulrytype=EntityName&dlrectionType=lnitial&searchNameOrder=BROWNBROWN,.. 214 412212016 Title Executive Vice President Leavine, Anthony 655 N. Franklin St. Suite 1900, Tampa, FL 33602 Title Executive Vice President Shouppe, Alex 220 S. Ridgewood Avenue Daytona Beach, FL 32114 Title VP Lanni, James 220 S. Ridgewood Avenue Daytona Beach, FL 32114 Title VP Watts, Andy 220 S. Ridgewood Avenue Daytona Beach, FL 32114 Annyal Reports ReporlYear 2014 2015 2016 pocument Images Flied Date 04/24/2014 04/13/2015 04/01/2016 04/01/2016 ~~ ANNUAL REPORT 04/13/2015 ~-ANNUAL REPORT 09/11/2014 --Amendment 04/24/2014 --ANNUAL REPORT 01/24/2013 -~ ANNUAL REPORT 04/25/2012 ~-ANNUAL REPORT 03/20/2012 ~-Reg. Agent Change 04/28/2011 ~~ ANNUAL REPORT 04/28/201 0 ~~ ANNUAL REPORT 03/31/2009 ~~ ANNUAL REPORT 04/24/2008 --ANNUAL REPORT 0510212007 ~~ Merger Detail by Enlity Name View image In PDF format I View Image in PDF format I View image in PDF format -.J --------~----------~ View image In PDF format I --------~----------~ View Image in PDF format I --------~----------~ View image in PDF format I --------~----------~ View Image In PDF format I View image in PDF format I View image In PDF format --------~-----------.J View image in PDF format I I View Image in PDF format ~------~----------~ View image in PDF format j 04/16/2007 ~-ANNUAL REPORT __ , .... ___ View image in P~ form~. _____ J 06/22/2006 --Name Change __________ ~!~~_~mage.!~_~.P.~_~at __ J http://search.sunbiz,orglnquiry/CorporationSearchlSearchResultDetail?inquirylype=EntltyName&dlrectionType=lnitial&searchNameOrder=BROWNBROWN,..l/4 2016 FLORIDA PROFIT CORPORATION ANNUAL REPORT DOCUMENT# 150616 FILED Apr 01,2016 Secretary of State CC0199169976 Entity Name: BROWN & BROWN OF FLORIDA, INC. Current Principal Place of Business: 220 S. RIDGEWOOD AVENUE DAYTONA BEACH. FL 32114 Current Mailing Address: 220 S. RIDGEWOOD AVENUE DAYTONA BEACH, FL 32114 US FEI Number: 59-0691921 Name and Address of Current Registered Agent: C T CORPORATION SYSTEM 1200 SOUTH PINE ISLAND ROAD PLANTATION, FL 33324 US Certificate of Status Desired: No The above named entity submits this statement for the fJIJI'POSS of changing lIs registered office or registered agent, or both, In the Slate of FIoride. SIGNATURE: Electronic Signature of Registered Agent Date Officer/Director Detail : TIUe PRESIDENT, DIRECTOR Title SECRETARY, VP Name LYDECKER, CHARLES H. Name LLOYD, ROBERT W. Address 220 S. RIDGEWOOD AVENUE Address 220 S. RIDGEWOOD AVENUE City-State-Zlp: DAYTONA BEACH FL 32114 City-f?tate-Zlp: DAYTONA BEACH FL 32114 Title TREASURER Title VICE PRESIDENT & ASSISTANT Name DALY, WILLIAM R SECRETARY Name ROBINSON, ANTHONY Address 220 S. RIDGEWOOD AVENUE Address 220 S. RIDGEWOOD AVE. City-State-Zip: DAYTONA BEACH FL 32114 City-State-Zlp: DAYTONA BEACH FL 32114 Title EXECUTIVE VICE PRESIDENT Title EXECUTIVE VICE PRESIDENT Name ALVAREZ, FAUSTO Name BROWN, BARRETT Address 220 S. RIDGEWOOD AVENUE Address SIX CONCOURSE PARKWAY City-State-Zlp: DAYTONA BEACH FL 32114 SUITE 2300 City-State-Zlp: ATLANTA GA 30328 Title EXECUTIVE VICE PRESIDENT Name CLOAR,IV, THOMAS Title EXECUTIVE VICE PRESIDENT Address 220 S. RIDGEWOOD AVENUE Name FARMER. STEVE City-State-Zip: DAYTONA BEACH FL 32114 Address 220 S. RIDGEWOOD AVENUE City-Stete-Zip: DAYTONA BEACH FL 32114 Continues on page 2 I hereby certify /hal Ihe infomraUon indicated on Ihls repod or supplemental report Is InJe lind ecoursle end Ihal myelecl1!1nlo signature shall have/he ,ameiega! effect as If made under oa/ll; Ihall am BII officer or director of /he corporetion or the receiver or t/Vstee empowered 10 execule /his report as required by Chaptar 607, Flotfda Statutes; end thaI my name BppeIUS 800l1li, or on en lIItachmenr with all other like empowered. SIGNATURE: ANTHONY ROBINSON VP& ASST, SECRETARY 04/01/2016 Electronic Signature of SI~nlng Officer/Director Detail Dale 2016 FLORIDA LIMITED LIABILITY COMPANY ANNUAL REPORT DOCUMENT# L 15000009436 Entity Name: GELIN BENEFITS GROUP, LLC C~rrent Principal Place of Business: HUNTINGTON SQUARE Iii 3350 SW 148TH AVENUE SUITE 110 MiRAMAR, FL 33027 Current Mailing Address: 6750 NORTH ANDREWS AVENUE SUITE 200 FORT LAUDERDALE, FL 33309 US FEI Number: 47-2805753 Name and Address of Current Registered Agent: GELIN, ELBERG MIKE 6750 NORTH ANDREWS AVENUE SUITE 200 FORT LAUDERDALE, FL 33309 US FILED Mar 15, 2016 Secretary of State CC9035343542 Certificate of Status Desired: Yes The above I18msd entity submits /his statement for the purpose of changing Its regfs1.ered office or registered agent, or bolli, In the State of Florida. SIGNATURE: ELBERG MIKE GELIN Electronic Signature of Registered Agent Authorized Person(s) Detail : TlUe Name Address MGR GELlN, ELBERG MIKE 6750 NORTH ANDREWS AVENUE SUITE 200 Clty-Stete-Zlp: FORT LAUDERDALE FL 33309 03/15/2016 Date I hereby c8f/1ty that thain/ormation Indicated on this repOft or supplements' tepo"'s flue and accurate and that my electronic signature shan have tha samel9gaJ effect as If made under oatil; Ihall am a managing member or manager of the limned Usb/lily cOllltJllny or the /lloefller or tlUsteO ompowsrvd to GJ<G~ this rvpott a, required by Choptor 605, Florida SUlfutes; and tllat my name BppaBnl above, or on an attachment with 8/1 other /IIIe empow8md. SIGNATURE: ELBERG MIKE GELIN PRESIDENT 03/15/2016 Electronic Signature of Signing Authorized Person(s) Detail Date Officer/DIrector Detail Continued: TIUe EXECUTIVE VICE PRESIDENT Title EXECUTIVE VICE PRESIDENT Name GRIPPA, ANTHONY M Name KEEBY, MICHAEL Address 220 S. RIDGEWOOD AVENUE Address 220 S. RIDGEWOOD AVENUE City-State-Zip: DAYTONA BEACH FL 32114 Clty-State-Zip: DAYTONA BEACH FL 32114 TIUe EXECUTIVE VICE PRESIDENT Title EXECUTIVE VICE PRESIDENT Name LEAVINE, ANTHONY Name SHOUPPE, ALEX Address 655 N. FRANKLIN ST. SUITE 1900, Address 220 S. RIDGEWOOD AVENUE Clty-Stale-ZJp: TAMPA FL 33602 City-State-Zlp: DAYTONA BEACH FL 32114 THle VP TlUe VP Name LANNI, JAMES Name WAns, ANDY Address 220 S. RIDGEWOOD AVENUE Address 220 S. RIDGEWOOD AVENUE City-State-Zlp: DAYTONA BEACH FL 32114 Clty-Slale-Zlp: DAYTONA BEACH FL 32114 4I22J2016 Detail by Eriity Name Detail by Entity Name Florida Not For Profit Corporation FLORIDA LEAGUE OF CITIES, INCORPORATED Filing Information Document Number FEI/EIN Number Date Flied State Status Last Event Event Date Filed Principal Address 702898 59-6001124 12/13/1935 FL ACTIVE REINSTATEMENT 10/29/2015 301 S. BRONOUGH STREET, SUITE 300 TALLAHASSEE, FL 32301 Changed: 01/03/2011 Mailing Address POST OFFICE BOX 1757 TALLAHASSEE, FL 32302-1757 Changed: 01/1212010 Registered Agent Name & Address SITTIG, MICHAEL 301 S. BRONOUGH ST., Suite 300 TALLAHASSEE, FL 32301 Name Changed: 10/29/2015 Address Changed: 03/29/2016 Officer/Director Detail Name & Address Title Past President COOPER, HON J 400 S. FEDERAL HIGHWAY HALLANDALE BEACH, FL 33009 http://search.sunbiz.orgJInqulry/CorporaUonSearchiSearchResuiIDetail?inquirylype=EnlltyName&direcUonType=lnitial&searchNameOrder=FLORIDALEAGUE...113 412212016 Title President Surrency, Matthew' 6700 SE 221st Street Hawthorne, FL 32640-3816 Title Past President Wu, P.C. Post Office Box 12910 Pensacola, FL 32521-0001 Title First Vice President Haynie, Susan 201 W. Palmetto Park Road Boca Raton, FL 33432 Title Second Vice President Ziffer, Gil 300 S. Adams Street Ta"ahassee, FL 32301 Annual Reports Report Year 2014 2015 2016 Docyment Images Flied Date 01/09/2014 10/29/2015 03/29/2016 03/29/2016 --ANNUAL REPORT 10/29/2015 --REINSTATEMENT Detail by Entity Name View image in PDF fonnat ____ J View image in PDF fonnat ~ 01/09/2014 --ANNUAL REPORT __ V_le_w_i_m....;ag=--e_in_P_D_F_f_onn_at_--lJ 01/23/2013 --ANNUAL REPORT 01/13/2012 --ANNUAL REPORT 0110312011 --ANNUAL REPORT 01/12/2010 --ANNUAL REPORT 01/14/2009 --ANNUAL REPORT 02/29/2008 --ANNUAL REPORT View image In PDF fonnat -.J View Image in PDF fonnat ,_,_.-I View image In PDF f0lT!!at ____ J View image in PDF fonnat _____ .J View image in PDF fonnat View Image in PDF format i -------='"--'-' ._--, ._-----' 04/24/2007 --ANNUAL REPORT View image in PDF format J 07/19/2006 --ANNUAL REPORT _._ .. __ . __ .~iew image in PDF fo~~ .. ____ J 04/25/2005 --ANNUAL REPORT View image In PDF format I -'--'---'. _· _____ ._. ____ .. ___ 1 04/26/2004 --ANNUAL REPORT ._ .. ___ ~iewJ!!lag!!~_~D~ fo~~ __ .. _.J 03/31/2003 --ANNUAL REPORT ______ yle~..!m~!l"_~D~ f?~~! _____ ..J 03/14/2002 --ANNUAL REPORT ___ ._. ____ y~!:~_~~ag~ .. ~~_~I?~~~rm~!_. ___ .... _j htlp:lIsearch.sunblz.orglnql.iry/CorporationSearchfSearchResultDetail?inquirytype=EntityName&direclionType=lnitial&searchNameOrder=FLORIDALEAGUE... 213 2016 FLORIDA NOT FOR PROFIT CORPORATION ANNUAL REPORT DOCUMENT# 702898 Entity Name: FLORIDA LEAGUE OF CITIES, INCORPORATED Current Principal Place of Business: 301 S. BRONaUGH STREET, SUITE 300 TALLAHASSEE, FL 32301 Current Mailing Address: POST OFFICE BOX 1757 TALLAHASSEE, FL 32302-1757 FILED Mar 29, 2016 Secretary of State CC2864342990 FEI Number: 59-6001124 Certificate of Status Desired: No Name and Address of Current Registered Agent: SITTIG, MICHAEL 301 S. BRONOUGH ST .. SUITE 300 TALLAHASSEE, FL 32301 US The above named entity submits this statement for the PUrpcJ5fl of changing Its registered office or registered agent. or both, In the Slate of Florida. SIGNATURE: MICHAEL SIITIG Electronic Signature of Registered Agent OfficerlDirector Detail : Title Name Address PAST PRESIDENT COOPER, HON J 400 S. FEDERAL HIGHWAY City-state-Zip: HALLANDALE BEACH FL 33009 Title Name Address PAST PRESIDENT WU,P.C. POST OFFICE BOX 12910 City-State-Z1p: PENSACOLA FL 32521-0001 Title Name Address SECOND VICE PRESIDENT ZIFFER, GIL 300 S. ADAMS STREET City-State-Zip: TALLAHASSEE FL 32301 Title Name Address Clty--State-Zip: Title Name Address City-State-Zlp: PRESIDENT SURRENCY, MATTHEW 6700 SE 221ST STREET HAWTHORNE FL 32640-3816 FIRST VICE PRESIDENT HAYNIE, SUSAN 03/29/2016 Date 201 W. PALMETTO PARK ROAD BOCA RATON FL 33432 I hereby cel!1fy /hat the hlformation fndlcated on this repotf or slJppl.m.ntal ,sport kJ true and Bccumle and /hilt my el.clJOnlo slQnlllure shall have the same legal effaol as If made under oath; /hall am an officer or direclor of the corporation Of the receiver or trwtee empowered 10 .""cute thkJ report liS required by Chapter 617. Florida Statutes; and /hal my nama appealS above. or on an attachment with all other like empowlfflld. SIGNATURE: MATTHEW SURRENCY PRESIDENT 03/29/2016 Electronic Signature of Signing Officer/Director Detail Date 412212016 Detail by Entity Name Florida Limited Liability Company GELIN BENEFITS GROUP, LLC Filing Information Document Number FEI/EIN Number Date Filed Effective Date State Status Principal Address HUNTINGTON SQUARE III 3350 SW 148th AVENUE SUITE 110 MIRAMAR, FL 33027 Changed: 03115/2016 Mailing Address L15000009436 47-2805753 01/15/2015 01/15/2015 FL ACTIVE 6750 NORTH ANDREWS AVENUE SUITE 200 FORT LAUDERDALE, FL 33309 Changed: 03/15/2016 Registered Agent Name & Address GELlN, ELBERG Mike 6750 NORTH ANDREWS AVENUE SUITE 200 FORT LAUDERDALE, FL 33309 Name Changed: 03/15/2016 Address Changed: 03/15/2016 Authorized Person(s) Detail Name & Address Title MGR GELlN, ELBERG MIKE Detail by Entity Name hltp:lIsearch.sunbiz.orli1nqulry/CorporationSearchlSearchResultDetail?inquirytype=EntilyName&directionType-lnltlal&searchNameOrder=GEUNBENEFITSG... 1/2 412212016 6750 NORTH ANDREWS AVENUE SUITE 200 FORT LAUDERDALE, FL 33309 Annyal Reports Report Year 2016 Document Images Filed Date 03/15/2016 Detail by EnIlly Name 03/1512016 --ANNUAL REPORT __ ~Iew image in PDF format _.J 01/15/2015 --Florida Limited Liability View image in PDF format J , • , '(, •• :;.j. :,".. ~. :-, -. -, ,I . : .. ' :.;~ :.:~::: :, .... :::' :: :', .. ,,::',.': • ',': . -~ ,,'. ,r. http://search.sunbiz.org/lnquiry/CorporationSearchlSearchReslJlDetail?inqulrylype=EntilyName&direclionType=lnltlal&searchNameOrder=GEUNBENEFITSG ... 2J2 SUNDAY JULY 3 2016 MIAMIHERAlD.COM NEIGHBORS I 29SE @~ ~ (: ~ :,.,~ 1'~"~!"1'~1t1; ,,-. ,,~ (: !)l:~ \.; ~R ~~~. CCITY OF SOUTH MIAMI COURTESY NOTICE AND MEETING DATE CHANGE NOTICE IS HEREBY given that the City Commission of the City of South Miami, Florida will conduct Public Hearillg(s) at its regular City Commission meeting scheduled for Tuesday, July 12, 2016, beginning at 7:00 p.m., in the City Commission Chambers, 6130 Sunset Drive, to consider the following item(s): A Resolution approving and authorizing the City Manager to execute the June 22,2016 to Septemher :10. 20ll) Agreement betwcen the American Federation of State. County and Municipal Employees ("AFSCME"l. Local .1294 and the City Of South Miami. , A Resolution authorizing the City Manager to negotiate and enter intl' an agreement with Brown & Brown of Florida. Inc .. for insurance brokerage services for all initial term of three (3) years and one (I) two-year option tn renew for a total1erm of five (5) conttecutive yeaTs, A Resolution authorizing the City Manager to enter into a three-year agreclllc t with FPL Fibernet to increase existing internet bandwidth capacity at City Hall. A Resolution authorizing the City Managerto ner-otiate and enter into a contract, for a term not to exceed five (5) consecutive years. with C alvin, Giordano & Associates, Inc. for the completion of the Comprehensive Plan and Land Development Code revision. An Ordinance Amending the Official Zoning Map, as authorized by Section 20-.l.1(C), and other applicable provisions. amending the designation of the Marslwll Williamson property located south of SW 64th Terrace approximately between SW 60th Avenue and SW 61 st Court, from Single-Family Residential District RS-4 to RT-9. An Ordinance Adopting a Small Scale Amendment to the Future Land Use Map of the Comprehensive Plan, amending the designation of the Marshall Williamson property located south of /SW (,4th Terrace approximately between SW 60th Avenue and SW 61 st Court, from Single Family Residential CJlvo-Story) to Townhotlse Residential Owo-Story). NOTICE IS HEREBY also given that the regular meeting date of Tuesday, July 5, 2015 has been changed to Tuesday July 12,2016 ALL interested parties arc invited to attend and will be heard. For further information, please contact the City Clerk's Office at: :105-663-6340. Maria M. Menendez, CMC City Clerk Pur~uant to Florida StanJles 286.0105, the Clty herehy ad\'i.::es the puhlk that if a person del'ides to appeal any decision mad" by this Board Agency or CommisslOll with respect t(l any matter considered at its meeting or hearing. he or she will need H record of the proceeding!:, and that for such purpose. affected person may need to ensure that a verbatim record of the prnceedings is made which record mclucks the testimony and ('videncC' upon which the nppenl is to he based. ~D Public Notice MIAMI-DADE COUNTY HOMELESS TRUST REQUEST FOR APPLICATIONS (RFA) FOR INCLUSION IN THE 2016 USHUD NOTICE OF FUNDING AVAILABILITY (NOFA), CONTINUUM OF CARE PROGRAMS Miami-Dade County, through the Miami-Dade County Homeless Trust (Homeless Trust), is requesting applications from homeless providers and other qualified entities interested in applying for support services, housing and other eligible activities benefiting the homeless. The projects being sought as part of this solicitation are contingent on the Homeless Trust being awarded funds through a Collaborative Application. Collaborative Applications will be submitted to the United States Department of Housing and Urban Development (USHUD) in response to its Notice of Funding Availability (NO FA). Programs currently funded through the USHUD Homeless Continuum of Care programs with funding expiring in 2017, projects seeking new bonus funding, and providers interested in serving as the new project sponsor for the Partners for Homes program awarded as part of the 2015 NO FA competition must be a part of this competitive process for funding. Copies of the Request for Applications package are available for pick up beginning at 9:30 a.m. June 27, 2016 at: Miami-Dade County Homeless Trust 111 N.W. 1 st Street, 27th Floor, Suite 310 Miami, Florida 33128 (305) 375-1490 A Pre-Application WorkshDp will be held on July 5, 2016, beginning at 10:00 a.m. at the Stephen P. Clark Center, 111 NW 1 st Street, Miami, FL 33128. 18th floor, room 18-4. Attendance at the Pre-Application Workshop is not required but is strongly recommended. We invite currently funded and new public and private homeless non-profit providers. and government agencies, to review this RFA and apply to renew existing projects or submit an application for a new project(s). A brief Technical Assistance session will be provided for new provider agencies at the conclusion of the Pre-Application Workshop, THIS RFA IS SUBJECT TO THE CONE OF SILENCE, COUNTY ORDINANCE 98-106. In order to maintain a fair and impartial competitive process, the County can only answer questions at the Pre- Application Workshop and must avoid private communications with prospective applicants during the application preparation and evaluation process. Please contact the Homeless Trust if the Request for Application documents are required in an alterna,tive format or language. The deadline for submission of applications is July 28, 2016, at 2:00 p.m. All responses must be received at the Clerk of the Board 01 County Commissioners on the 17th floor 01 the Stephen P. Clark Center, 111 N.W.lst Street, Miami, FL 33128. Miami-Dade County is not liable for any cost incurred by the applicant in responding to the Request for Applications, and we reserve the right to modify or amend the application deadline schedule if it is deemed necessary or in the interest of Miami-Dade County. Miami-Dade County also reserves the right to accept or reject any and all applications, to waive technicalities or irregularities, and to accept applications that are in the best interest of Miami-Dade County. Miami-Dade County provides equal access and opportunity in employment and services and does not discriminate on the basis of age, gender, race or disability. PLEASE NOTE: IF YOU ARE SEEKING AFFORDABLE HOUSING, PLEASE GO TO: hltp:llwww.miamidade.gov/housing/af!ordable-housing-resources.asp For legal ads online, go to http://legalads.miamidade.gov MIAMI DAILY BUSINESS REVIEW Published Daily except Saturday, Sunday and Legal Holidays Miami, Miami-Dade County, Florida STATE OF FLORIDA COUNTY OF MIAMI-DADE: Before the undersigned authority personally appeared MARIA MESA, who on oath says that he or she is the LEGAL CLERK, Legal Notices of the Miami Daily Business Review flk/a Miami Review, a daily (except Saturday, Sunday and Legal Holidays) newspaper, published at Miami in Miami -Dade County, Florida; that the attached copy of advertisement, being a Legal Advertisement of Notice in the matter of NOTICE OF PUBLIC HEARING CITY OF SOUTH MIAMI-AND MEETING DATE CHANGE- JULY 12, 2016 in the XXXX Court, was published in said newspaper in the issues of 07/01/2016 Affiant further says that the said Miami Daily Business Review is a newspaper published at Miami, in said Miami-Dade County, Florida and that the said newspaper has heretofore been continuously published in said Miami -Dade County, Florida each day (except Saturday, Sunday and Legal Holidays) and has been entered as second class mail matter at the post office in Miami In said Miami-Dade County, Florida, for a period of one year next preceding the first publication of the attached copy of advertisement; and affiant further says that he or she has neither paid nor promised any person, firm or corporation any discount, rebate, commission or refund for the eCLIring this advertisement for (SEAL) MARIA MESA personally known to me RHONOA M PELTIER MY COMMISSION t; FF231407 E'XPIR!:S Mny 17 2019 CITY OF SOUTH MIA-NIB NOTICE OF PUBLIC HEARING AND MEETING DATE CHANGE NOTICE IS HEREBY given that the City Commission of the City of South Miami, Florida will conduct Public Hearing(s) at its regular City Commission meeting scheduled for Tuesday, July 12, 2016, beginning at 7:00 p.m., in the City Commission Chambers, 6130 Sunset Drive, to consider the following item(s): A Resolution approving and authorizing the City Manager to execute the June 22, 2016 to Septemt;>er 30, 2019 Agreement between the American Federation of State, County and Municipal Employees ("AFSCME"), Local 3294 and the City Of South Miami. ( ; 0) A Resolution authorizing the City Manager to negotiate and enter into an agreement with Brown & Brown of Florida, Inc., for insurance brok,erage services for an.initial term of three (3) years and one (1)two- year option to renew for a total term of five (5) consecutive years. A F,1esolution authorizing the City Manager to enter into a three-year agreement with FPL Fibernet to increase existing internet bandwidth capacity at City Hall. . A Resolution authorizing the City Manager to negotiate and enter into a contract, for a term not to exceed five (5) consecutive years, with Calvin, Giordano & Associates, Inc. for the completion of the Comprehensive Plan and Land Development Code revision. An Ordinance Amending the Official Zoning Map, as authorized' by Section 20-3:1(C), and other applicable provisions, amending the designation of the Marshall Williamson property located south ofSW 64th Terrace approximately between SW 60th Avenue and SW 61s1 Court, from Single-Family Residential District RS-4 to RT-9. An Ordinance Adopting a Small Scale Amendment to the Future Land Use Map of the Comprehensive Plan, amending the designation of the Marshall Williamson property located south of SW 64th Terrace approximately between SW 60th Avenue and SW 61st Court, from Single Family Residential (Two-Story) to Townhouse Residential (Two-Story). NOTICE IS HEREBY also given that the regular meeting date of Tuesday, July 5,2015 has been changed to Tuesday July 12, 2016 A,LL interested parties are invited to attend and will be heard. For further information, please contact the City Clerk's Office at: 305-663-6340. Maria M. Menendez, CMC 'CityClerk Pursuant to Florida 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. 7/1 16-106/00001 ?A017M