20160608 AM1MIAMI BEACH
City Commission Meeting
ADDENDUM MATERIAL 1
City Hall, Commission Chambers, 3'd Floor,lTOO Convention Center Drive
June 8, 2016
Mayor Philip Levine
Commissioner John Elizabeth Alem6n
Commissioner Ricky Arriola
Commissioner Michael Grieco
Commissioner Joy Malakoff
Com m issioner Kristen Rosen Gonzalez
Com missioner Micky Steinberg
City Manager Jimmy L. Morales
City Attorney Raul J. Aguila
City Clerk Rafael E. Granado
Vls[ us at www.miamiheachfl.gov for agendas and video "streaming" of City Commission Meetings.
ATTENTION ALL LOBBYISTS
Chapter 2, Article Vll, Division 3 of the City Code of Miami Beach entitled "Lobbyists" requires the
registration of all lobbyists with the City Clerk priorto engaging in any lobbying activitywith the City
Commission, any City Board or Committee, or any personnel as defined in the subject Code
sections. Copies of the City Code sections on lobbyists laws are available in the City Clerk's office.
Questions regarding the provisions of the Ordinance should be directed to the Office of the City
Attorney.
ADDENDUM AGENDA
C4 - Gommission Commiftee Assignments
C4V Referral To The Sustainability & Resiliency Committee - Discussion Regarding Exploring The Use Of
Triodetic's Tube And Hub Technology To Raise A Municipal Building As A Prototype For Residents
Who May Have To Raise Their Property ln The Future'
(Sponsored by Commissioner Kristen Rosen Gonzalez)
C4W Referral To The Finance And Citywide Committee - Discussion Regarding The Data And Analysis
Required For The Equivalent Residential Unit (ERU) Methodology Changes.
(Sponsored by Commissioner Joy Malakoff)
(There is no back-up material for this item)
1
Addendum 1, June B, 2016
R7 - Resolutions
R7Z A Resolution Accepting The Recommendation Of The City Manager Pertaining To The Ranking Of
Firms, Pursuant To The Request For Proposals (RFP) No. 2016-086-WG For Health Plan Services
And Benefits For The City Of Miami Beach Active Employees, Dependents, Pre-65 Retirees, And
Post-65 Retirees And Authorizing The Administration To Negotiate With The Following Proposers ln
The Following Categories Of Health Plan Services: Cigna Health And Life lnsurance Co., As Top-
Ranked Proposer For Medical Administrative Service Only And Pharmacy Services; Symetra Life
lnsurance Co., As Top-Ranked Proposer ForThe Reinsurance/Stop Loss Services; And Cigna Health
And Life lnsurance Co., As Second-Ranked Proposer For The Employee Assistance Program; And
Further Authorizing The Mayor And City Clerk To Execute Agreements Upon Conclusion Of
Successful Negotiations With The Administration.
(Human Resources)
R9 - New Business and Gommission Requests
RgT Discussion Regarding Renaming Convention Center Drive To "Muhammad Ali Drive" And Authorizing
The Creation Of A Statue Of Muhammad Ali To Be Placed Either ln The New Miami Beach
Convention Center (MBCC) Park Or lnside The Renovated MBCC.
(Sponsored by Mayor Philip Levine)
(There is no back-up material for this item)
RgU Commission Workshop On Review Of Critical Environmental ltems For The Miami Beach Light
Rail/Modern Streetcar Project. (f 1:00 a.m. in the City Manager's Large Conference Room)
(Transportation)
(There is no back-up material for this item)
RgV Discussion Regarding The Status Of The Little Havana Meals Program At The Stella Maris House.
(Sponsored by Commissioner John Elizabeth Alem6n)
2
Cardillo, Lilia
From:
Sent:
To:
Subject:
Attachments:
Acknowledging receipt.
Thank you.
Granado, Rafael
Friday, June 03, 201"6 4:22 PM
Rosen Gonzalez, Kristen; Cardillo, Lilia
Fwd: Consent Agenda Referral to Sustainability
Triodetic Miami 2016.pdf; ATT00001.htm
It will be placed in the addendum that publishes Monday.
Sent from my iPhone
Begin forwarded message :
From: "Rosen Gonzalez, Kristen" <Kristen@,miamibeach >
T o : " Granado, Rafael " <Rafael Granado (Dmi amib eachfl . gov>
Subject: Consent Agenda Referral to Sustainability
Please place on the consent agenda so we can explore using this technology to possibly try and
raise one of our municipal buildings as a prototype. At $15 per square foot, this technology is
accessible and affordable and would be a great solution to residents who may have to raise their
property in the future.
Agenda ltem
Date
cyvWrc.3
&
COMBINING ::
ENGINEERING
Mffire
ARCHITECTURALINDUSTRIAL FOUNDATIONS
,.. ,. 5 YearI-xperience
The Triodetic system was invented and developed
over 50 years ago and has supplied projects
worldwide for many different applications.
ffiHMffi
Connectidn like no Other
This link, or joint, has the ability to transfer loadS&rough from
Called a moment connection,:fesembles how a gusset plate
works on a wood truss or a welded joint"
Typical Triodetic Joint
No issue of corrosion in the joist from dissimilar
metals as Zinc and Aluminum work well together
Connection like no Other
, The unique Tube and Hub connection is the backbone ofour,' system. This connection remove$ the need for welding,
screwing, nailing or bolting from the construction of the system
This link allows for'&ster assembly and reduced malntenance
once assembled
Tube & Hub Material
Triodetic tube is a pre-galvanized steel with a zinc coating
layer then 2 additional protective coatings are applied.
lndustry name of Gator Shield
,Extruded Aluminum Hub
l*
I
I
I
I
.q.ro?* :h 'M:h rk t.dtM.d !i .,-l r'*
ai
4
DOMES
DomeS and:fiee form
structures aie constructed in a
triangular pattern with a
curvature. This layout and
connection makes:f,or ne of
the strongest shapes
, Our unique connection
allows the dome to be built
in single layer as long as
there is double curvature
Triodetic Dome
West Palm Beach
.',City center
Space Frames
Trusses have top,
bottom & diagonal
chords
A Space Frame is a 3D
Truss with chords
running in all directions
to make a very strong
rigid lightweight
structure
FREE
SACRAMENTO
WATER TOWER
JFK Library Boston
5
Methodist Hospital
Tiara Houston
TOQUEPALA
PERU
DOMES & BARREL VAULTS
INDUSTRIAL COVERS
Triodetic's Safety Record
Over 50 years
NO - Structural Collapses
NO - Casualties
Each project is engineered and
designed to meet or exceed federal,
Provincial and local government
requirements and codes
HIGHLAND VALLEY COPPER
3 Domes - 100 m (330'-0")
TRIODETIC BRIDGES
ln fl',{ ll il 1,
d -&, { ,&j
6
COMPAGT CRATING :
Triodetic Tubes'and Hubs ship to site in
small compact crates
A 3D Truss or
Space Frame best
describes the
system " ",
A rigid frame with
incredible bridging
capacity
Problem Soil
Multipoint Foundations are a good option for building on expansive soils and
in flood zones, the foundation will act monolithicalty with the building to
resist racking or deflection- The foundation can rest on nalive soil or
Concrete Slab on Grade and can,rb;flfrlectured at heights from 3 -0" up
This ability to elevate theistructure above. grade is a good application for. flood plain regions.
The MPF (Multipoint Foundation) is a light weight
structure (8 lbs. sqft), it can be adjustedin lhe
same way as a screw jack, The cost of the
system is comparable to driven piles and haS the
flexibility to be installed on sloped ground ahd as
25 Years of ProVen '
Technology
MPF has never had a
failure with our system
-/'V\,,tL/'V'\
MULTIPOINT
FOUNDATIONS
CMHC Northern
Housing AWard
,, ,.2000..
Typical
Foundation
lssues
Saturation from flooding, soil erosion,, poor bearing capacity.
The culprits that reduce the lifespan of
a structure and will destroy a home
Design Principle for Poor Soil
t
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s,...,,."
t\
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T
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The 1 0" x 10" Base plate of the MPF is
designed to allow for Soil Failurell! '
Something needs to "Give" when we are
talking about soil expansion, our baseplate is
designed to let the soil go around lo a certain
extend
Some additional base details maybe required
for poorer soils
The load willtransfer from that plate to the
next closeSt sets of bearing plates
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Design Principle for Poor Soil
Triodeiic Multipoint Foundafion:r;.trIPF
Extendsth,L,,, thestructureit:Supports
1^ Providin$:a stable rigid base
(Steel Floating Slab)
?.
3.
4.
Keep the structure level by allowing
the soil to move from leg to leg
Preventing differential movement
Keeps the envelope ofthe structure square
and tight to avoid air infiltralion
fi
TypicalTop Joint
Type A
Saddle Bracket
Kwigillingok
Ghurch Alaska
8
Typical Top Joint
Type A l-Beam
Support type
Slab on Grade
SAN FRANCISCO,
CALIFORNIA
Sub Grade
Skirt Clips
Sleb on Grade
Concrete Slab for Flood
Zone to resist washout
COMMERCIAL BUILDINGS
9
CASE STUDIES
NEW CONSTRUCTION
RETROFIT CONSTRUCTION
Lifting
and Ski
Placement
Buildings in new location WHAT MPF GAN PROVIDE
Triodetic Multipoint Foundation cannot stop the Floor waters.
What we can provide is a rigid platform that will elevated the home above
flood levels, allow the water to run while protecting the structure from
damage- The foundation is adjustable and in the worst cases can even be
used as a relocation device once installed under the home.
10
WHAT MPF CAN PROVIDE
Triodetic Multipoint Fbundation is a very
unique product that has been used in
the harshest environments in the world
and has proven to be a strong and
stable without failure for over 30 years.
With many different application for
stabilizing Clay. Muskeg and poor soils,
heavy organics, flood zones.
We can offer a cost effective solution to
stop the damage from the water and
poor soil and in many cases reinstale
the home to a sturdy & stable structure.
House and MPF in Clear Span.
MPF &
Lifted From
House
Four Points.
FOUNDATION FRAME
FOR SIP PANELS
Triodetic
Multipoint Foundations
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SUMMARY
.1hYq'J\L/L/'r
1. Designed as a slab foundation to be a MULTIPOINT
veryiigid Platform FouNDATloHs
2. Foundation and Building act as one unit
3. Minimal site preparation, sloped and rock sites
4. Can be disassembled and reassembled at another site
5, lnstallation is undertaken by local labourand the individual
components of the foundation can easily be manhandled no
heavy equipment is required
6. Frame can be extended in any direction for additions
7. The depth of the frame can be adjusted to suit the anticipated
flood level, minimum 3'-0" and up to 10'-01'or more
8. The entire structure, foundation and house can,be moved gr.e,q!
..forlocationsonleasedlandortemporarybuildings.
11
THIS PAGE INTENTIONALLY LEFT BLANK
12
COMMISSION ITEM SUMMARY
Condensed Title:
A Resolution, Accepting The Recommendation Of The City Manager Pertaining To The Ranking Of Firms, Pursuant To
The Request For Proposals (RFP) No. 2016-086-Wg For Health Plan Services And Benefits For The City Of Miami Beach
Active Employees, Dependents, Pre-65 Retirees, And Post-65 Retirees; And Authorizing The Mayor And City Clerk To
Execute Upon Conclusion Of Successful With The Administration.
Ensure Expenditure Trends Are Sustainable Over the Long Term
Item Summary/Recommendation:
Humana and AvMed are the current medical Health Maintenance Organization (HMO), Preferred Provider Organization
(PPO), and Point of Service (POS) administrators for the City's self-funded health care insurance plans. Since the
contracts with Humana and AvMed expire September 30, 2016. At the January 14,2015 Commission meeting, it was
recommended that an lnvitation to Negotiate (lTN) for medical ASO services be issued forthe October 1,2016, benefit
plan year. The Administration issued Request for Proposal (RFP) 2016-086-WG to seek proposals from firms to provide
health care plan services and benefits to the City of Miami Beach active employees, dependents, pre-65 retirees, and
post-65 retirees.
The objective of the RFP was to solicit standalone offers for ASO services, pharmacy benefit management, EAP, and
reinsurance/stop loss coverage. The solicited services included but were not limited to, utilization review, case
management, disease management, behavioral health management, nationwide access to physician network, concierge
services, administration of COBRA benefit, a 2417 nurse line, and pharmacy benefit management. The City's current
health plan designs for employees and retirees are: Standard HMO, Premium HMO, Standard PPO (Standard POS for
AvMed), Premium PPO (Premium POS for AvMed), and POS (Basic POS for AvMed).
The Evaluation Committee ("Committee") was composed of City employees Sonia Bridges, Dwayne Drury, Lauren Wynn
and Rafael Granado. The Committee convened on May 23, 2016, for Proposers presentations and to score on the
qualitative portion of each Proposer. The quantitative scoring of the proposers' financial responses was completed by
the Procurement Department.
The results of the Evaluation Committee process and the City Manager's recommendation is as follows; Cigna,. for
medical ASO, Cigna, (Pass Through) for pharmacy services, and Symetra for Reinsurance/Stop Loss.
Both Aetna and UMR were tied as the top-ranked proposers for EAP services. However, since Aetna and UMR, lnc. are
not top-ranked for medical ASO services, and the EAP benefit is less than half of a percent of the City's health plan, it is
recommended that we negotiate with Cigna, as the second-ranked proposer as economy of scales and better benefit
coordination. The negligible cost difference between the top-ranked proposers and Cigna is approximately g1,000 -
annual
560-1 793-000303/304 ASO Fee Active/Retirees
560-1793-000333/339 Stop Loss/Excess lns. Active/Retirees
560-1793-000343 Capitation and Other Fees
560- 1 793-000394/395 Prescription C laims Active/Reti rees
$11,207,000 560-1 793-000431 Medical Claims Active/Retirees
Financial lmpact Summary:
Sonia Division Director, Risk & Benefits
Clerk's Office
2014-056 MF lnsurance Broker
AGEHDA NlN R7 ZE MIAMIBEACH s,fis 6- 3- 1513
g MIAMI BEACH
City of Miomi Beoch, I700 Convention Center Drive, Miomi Beoch, Florido 33,139, www.miomibeochfl.gov
MEMORANDUM
TO:Mayor Philip Levine and Members of City
FROM: Jimmy L. Morales, City Manager
DATE: June 8,2016
SUBJECT: A RESOLUTION OF THE MAYOK II.IO CITY COMMISSION OF THE CITY OF MIAMI
BEACH, FLORIDA, AGCEPTING THE RECOMMENDATION OF THE CITY MANAGER PERTAINING
TO THE RANKING OF FIRMS, PURSUANT TO THE REQUEST FOR PROPOSALS (RFp) NO. 2016-
O86.WG FOR HEALTH PLAN SERVICES AND BENEFITS FOR THE CITY OF MTAMI BEACH
ACTIVE EMPLOYEES, DEPENDENTS, PRE.65 RETIREES, AND POST.65 RETIREES AND
AUTHORIZING THE ADMINISTRATION TO NEGOTIATE WITH THE FOLLOWING PROPOSERS tN
THE FOLLOWING CATEGORIES OF HEALTH PLAN SERVICES: CIGNA HEALTH AND LIFE
INSURANCE CO., AS TOP.RANKED PROPOSER FOR MEDTCAL ADMTNTSTRATIVE SERVIGES
ONLY AND PHARMACY SERVIGES; SYMETRA LIFE TNSURANCE CO., AS TOP.RANKED
PROPOSER FOR STOP LOSS/REINSURANCE SERVICES; AND CIGNA HEALTH AND LIFE
INSURANCE CO., AS SECOND.RANKED PROPOSER FOR EMPLOYEE ASSISTANCE PROGRAM;
AND FURTHER AUTHORIZING THE MAYOR AND CITY CLERK TO EXECUTE AGREEMENTS
UPON CONCLUSION OF SUCCESSFUL NEGOTIATIONS WITH THE ADMINTSTRATION.
RECOMMENDATION
Adopt the resolution.
FUNDING
The annual cost associated with the health care plan services and benefits to the City of Miami Beach
active employees, dependents, pre-65 retirees, and post-65 retirees is subject to the allocation of funds
in the City's FiscalYear 201612017 operating budget.
BACKGROUND
Humana lnsurance Company ("Humana") has been providing health care services to the City in some
capacity for approximately 20 years. An Employee Assistance Program ("EAP") and COBRA services
have also been a part of the bundled services provided by Humana. Effective January 1, 2009, the
City's fully-insured agreement with Humana changed to a self-funded agreement, with Humana
providing the day-to-day administration of the City's medical plan through an Administrative Services
Only ("ASO") agreement.
Humana and AvMed, lnc. ("AvMed") are the current medical Health Maintenance Organization (HMO),
Preferred Provider Organization (PPO), and Point of Service (POS) administrators for the City's self-
funded health care insurance plans. Since the contracts with Humana and AvMed expire September
30, 2016, the Administration issued Request for Proposals (RFP) 2016-086-WG to seek proposals
from firms to provide health care plan services and benefits to the City of Miami Beach active
employees, dependents, pre-65 and post-65 retirees.
The objective of the RFP was to solicit standalone offers for ASO services, pharmacy benefit
management, EAP, and reinsurance/stop loss coverage. The solicited services included but were not
limited to, utilization review, case management, disease management, behavioral health management,
nationwide access to physician network, concierge services, administration of COBRA benefit, a 2417
nurse line, and pharmacy benefit management. The City's current health plan designs for employees
and retirees total 10; five plans mirrored by each of the two carriers: (See Appendix A).
14
Commission Memorandum - RFP 2016-086-WG Health Plan Services and Benefits to the City of Miami Beach Active Employees,
Dependents, Pre-65 Retirees, and Post-65 Retirees
June 8,2016
Page 2
. Standard HMO. Premium HMO. Standard PPO (Standard POS for AvMed)o Premium PPO (Premium POS for AvMed)o POS (Basic POS for AvMed)
ln August 2014, negotiations between Humana and Baptist Healthcare System ("Baptist") ended in an
impasse. As of this date, Humana and Baptist have not reached agreement and as a result, most if not
all, Baptist hospitals, physicians and associated health care practitioners were placed out-of-network
for the City's employees and retirees enrolled in the health plan. This reduction in the choice of
providers available in the South Florida area led the City to address the needs of affected
employees/retirees who not only relied on Baptist for their health care services, but were now to pay
out-of-network fees which are substantially higher. On January 14,2015, the City Commission adopted
Resolution No. 2015-28904, accepting.-the recommendation of the Finance and Citywide Projects
Committee (FCWPC), waiving, by 517"', vote the formal bidding requirement and authorizing the
Administration to negotiate and execute a contract with AvMed for the provision of medical ASO
services effective March 1,2015, through September 30, 2016, with Humana also providing continued
and alternative health care services through the same date.
The Commission also recommended that an lnvitation to Negotiate (lTN) for medical ASO services be
issued for the October 1,2016, benefit plan year.
RFP PROCESS
The RFP was released March 11, 2016. On April 28, 2016, the City received complete and responsive
proposals from;
o Aetna Life lnsurance Company,o AvMed, lnc.,. Cigna, lnc. ("Cigna"),o Concordia Behavioral Health,. DeerOaks EAP, LLC,o EnvisionRx, lnc.,o Humana lnsurance Company,o Symetra Life lnsurance Company ("Symetra"); ando UMR, lnc. a United Healthcare Company ("UMR').
The Valery lnsurance Agency, lnc. was deemed non-responsive due to its failure to meet the minimum
requirements established in the RFP.
On April 29, 2016, the City Manager appointed, via Letter to Commission (LTC) No. 190-2016, an
Evaluation Committee (the "Committee"), consisting of the following individuals:
. Sonia Bridges, Division Director Risk & Benefits, Human Resources Departmento Dwayne Drury, Assistant Fire Chief, Fire Departmento Lauren Wynn, Senior Management & Budget Analyst, Office of Budget and Performance
lmprovemento Karen Rivo, Registered Nurse, Health Advisory Committee Member. Robert Parr, Chief of Compensation and Benefits, City of Jacksonville
15
Commission Memorandum - RFP 2016-086-WG Health Plan Services and Benefits to the City of Miami Beach Active Employees,
Dependents, Pre-65 Retirees, and Posl65 Retirees
June 8,2016
Page 3
The following alternates were also appointed:
. Rafael Granado, City Clerk, Office of the Clerk. Jose Del Risco, Human Resources Assistant Director, Human Resources Department. Natasha Diaz-Rojas, Senior Management & Budget Analyst, Office of Budget and
Performance I mprovement; and
Ultimately, the Committee was composed of Sonia Bridges, Dwayne Drury, Lauren Wynn and Rafael
Granado because other members were unable to attend.
The Committee convened May 23, 2016, to consider all responsive proposals. At the meeting, the
Committee was given an overview of the RFP, information relative to the City's Cone of Silence
Ordinance and the applicability of Florida's Sunshine Law. General information on the scope of services
and financial capability was also reviewed. A copy of each responsive proposal had been provided to
each member in advance of the meeting. The Committee was instructed to score and rank the
proposals pursuant to the evaluation criteria established in the RFP, and was therefore solely focused
on the qualitative aspects of the proposers' responses.
After the proposers' presentations and interviews, the Committee discussed the proposers'
qualifications, experience, and competence, and scored the responses in accordance with the
qualitative criteria established in the RFP. The quantitative scoring of the proposers' financial responses
was completed based on the City consultant's analysis of costs. The final rankinqs are included in
Aooendix B.
The results of the Evaluation Committee process were presented to the City Manager for his review and
recommendation to the City Commission.
Proposer Experience and Qualifications, including
Scope of Services Proposed
Approach and Methodology
16
Commission Memorandum - RFP 2016-086-WG Health Plan Services and Benefits to the City of Miami Beach Active Employees,
Dependents, Pre-65 Retirees, and Post-65 Retirees
June 8,2016
Page 4
CITY MANAGER'S DUE DILIGENCE AND RECOMMENDATION
After considering proposals and the results of the Evaluation Committee process, pursuant to RFP No.
2016-086-WG, for Health Plan Services and Benefits to the City of Miami Beach Active Employees,
Dependents, Pre-65 Retirees, and Post-65 Retirees, the City Manager recommends that negotiations
begin with the top-ranked proposers (except for EAP) in each benefit category, as follows:o Ciqna for medical ASO. At its March 9, 2016, meeting the City Commission held a discussion
regarding the importance of choice in health care options for City employees. lt has always
been the City's practice to provide choice to its employees in various plan options. The City has
historically provided these options through a single health care provider. The reason for the
single provider has been an attempt to contain costs. lt is also the practice among the majority
of public agencies in South Florida, as well as throughout the state, to contract with a single
provider. Most recently, Humana was the City's single provider for the health care options
provided to City employees. Unfortunately, in 2014, Humana was unable to maintain its
contractual relationship with the Baptist Health System, which created a hardship for many City
employees that live in regions of the County primarily served by the Baptist system. As a result,
the City had to contract with a second provider that did include the Baptist system in its network.
AvMed was chosen to close the gap created by the exclusion of the Baptist system from the
Humana network. However, while choice (which is an important component of this
recommendation) for City employees is extremely important, having two providers is more
costly for the City. Through the recommended provider, our employees will have access to a
broad national network of physicians, hospitals and other medical providers. Additionally, the
City will be able to benefit from the cost savings of a single provider. See below for additional
detail.. Ciqna (Pass Throuqh) for pharmacv services. See below for additional detail.o Symetra for reinsurance/stop loss.. Ciqna for EAP. Both Aetna and UMR were tied as the top-ranked proposers for EAP services
and Cigna was ranked second; however, the cost difference between these top-ranked
Proposers and Cigna was approximately $1,000 - $5,000 annually. Since the EAP benefit is
less than half of a percent of the City's health plan, the difference in cost between the top-
ranked Proposers and Cigna is negligible. There are certain instances when a recipient of EAP
services will also need related benefits which are provided by the medical and/or
pharmaceutical providers and the timely and efficient coordination of these benefits is critical to
the care of the individual/employee. The City Manager recommends that the City negotiate with
Cigna, as the second-ranked Proposer, as the goal of having efficient benefit coordination, by
working with the same carrier who provides the medical ASO and/or pharmacy services,
outweighs the negligible price difference between the top-ranked Proposers and Cigna.
Compared to the City's current arrangement, by selecting Cigna for Medical ASO and Pharmacy
services, as described below, the City has an opportunity to reduce administrative expenses, while
honoring the desire of the City Commission to provide greater access to healthcare providers and
choice for City employees and retirees:
1. Cigna's Medical ASO Services Projected Cost Savingsa. The City pays approximately $910,000 annually for MedicalASO services underthe
current two-carrier arrangement, excluding pharmacy rebate credits.b. Cigna has offered a $229,650 (6-month) MedicalASO services credit in the first year
if awarded exclusive Medical and Pharmacy services. Combined with Cigna's offer
to provide Medical ASO services at an estimated annual cost of $748,000, first vear
savinos under Ciqna would be approximatelv $339.000.c. Over three (3) years, Cigna's proposal for Medicat ASO services will save the
City approximately $558,000 in administrative seryices expense.2. Cigna's Medicaland Pharmacy Projected Claims Savingsa. Medical Claims Savings - estimated to be $101,000 annually based upon repricing
data submitted through the RFP process.b. Pharmacy Claims Savings - estimated to be $533,000 annually based upon
repricing data submitted through the RFP process.
17
Commission Memorandum - RFP 20,l6-086-WG Health Plan Services and Benefits to the City of Miami Beach Active Employees,
Dependents, Pre-65 Retirees, and Post-65 Retirees
June 8,2016
Page 5
c. As part of the RFP process, the City's most recent twelve (12) months of medical
claims data was provided to the Proposers to estimate their discounts, or cost
savings. The Proposers' submitted discount data / cost savings is not a guarantee
of future health plan expense but rather reflects each Proposer's discount. As the
City has a self-funded health plan, healthcare claims volumes will always be variable
and subject to change. Here is an example using the same discount but different
billed volumes:1. $20,000,000 in healthcare claims billed - 60% discount - $8,000,000 in
healthcare claims oaid.2. $12,000,000 in healthcare claims billed - 60% discount - $4,800,000 in
healthcare claims paid.
3. Total Projected Savings under Cigna over Three (3) Yearsa. Based upon current fixed costs and a comparison of the medical and pharmacy
claims repricing data, the three (3) year savinqs by selectinq Ciqna for Medical ASO
and Pharmacv Services is estimated to be approximatelv $2.5 million.4. Cigna's Choice/Access to Healthcare Providersa. City Health Plan Members will have the greatest access to healthcare providers
under the Cigna Open Access Plus (OAP) network including the following:1. 99.9% of Health Plan Members will have access to at least two (2) Primary
Care Physicians within 10 miles of their home zip code under the Cigna
network.2. 99.5% of Health Plan Members will have access to at least two (2)
Pediatricians within 10 miles of their home zip code under the Cigna network.3. 99.0% of Health Plan Members will have access to at least two (2)
Obstetricians / Gynecologists within 10 miles of their home zip code under the
Cigna network.4. 99.9% of Health Plan Members will have access to at least two (2) other
specialists within 10 miles of their home zip code under the Cigna network.5. 99.4o/o of Health Plan Members will have access to at least two (2) Hospitals
within 15 miles of their home zip code under the Cigna network.b. These results exceeded all other Proposers' networks and will provide City Health
Plan Members with a qreater amount of choice of healthcare providers in the
marketplace.5. Cigna's Significant Market Presence - Public Sector Accounts in Florida:a. City of Fort Lauderdaleb. Hillsborough County BOCCc. Miami-Dade County Schoolsd. Orange County Governmente. Palm Beach County BOCCf. Palm Beach County Sherriffs Officeg. Seminole County Public Schoolsh. The School Board of Orange County
CONCLUSION
Based upon timeliness as it relates to Open Enrollment (please see Appendix C), and the best interest
of the City's employees and retirees, the Administration recommends that the Mayor and City
Commission approve the Resolution accepting the recommendation of the City Manager, pertaining to
the ranking of proposals received pursuant to Request for Proposals (RFP) No. 2016-086-WG, for
Health Plan Services and Benefits to the City of Miami Beach Active Employees, Dependents, Pre-65
Retirees, and Post-65 Retirees; authorize the Administration to negotiate contracts with Cigna, as the
top-ranked Proposer for medical ASO and Pharmacy; Symetra as top-ranked Proposer for
Reinsurance/Stop-Loss; and Cigna as second-ranked Proposer for EAP; and further authorize the
Mayor and City Clerk to execute agreements with the recommended firms upon conclusion of
successful negotiations by the Administration.
JLM/MT/SC-T/ADMG
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Commission Memorandum - RFP 2016-086-WG Health Plan Services and Benefits to the City of Miami Beach Aclive Employees,
Dependents, Pre-65 Retirees, and Post-65 Retirees
June 8,2016
Page 6
Appendix A
STATUS OF EMPLOYEE PARTICIPATION
Health care options are identified by a number of acronyms that should be defined. An HMO is a health
care maintenance organization; further defined below. A PPO is a preferred provider organization, also
addresses in more detail below.
The breakdown of active employee participation during FY2015116 in the choices offered by the City's
health care benefit plans is as follows:
Despite the number of choices available, active employees who elect to be covered by the health care
insurance provided by the City, most cluster around the Standard HMOs because of cost. The City is
required by the terms and conditions of various collective bargaining agreements to subsidize a
minimum of 50 percent of the premium. The City's premium subsidy for the Standard HMO plans is 77
percent for single coverage under the Standard HMO and 67 percent for family coverage in the
Standard HMO. All other choices have a premium subsidy of 50 percent.
Health maintenance organizations are some of the most common plans, making up nearly 30% of all
health care plans, according to the Kaiser Family Foundation. An HMO uses primary care physicians
(PCPs) as "gatekeepers" to prevent costly overuse of medical services; to see a specialist, patients
must receive a referral from their PCP. The City's Standard HMO plan does not require a gatekeeper or
PCP referral to seek specialty or additional care while the Premium HMO does. Customers who enroll in
these kinds of plan are required to choose health care providers within the network of contracted
physicians and hospitals. lf you have an HMO and want to see a non-network doctor, the plan will not
cover any of those costs, except in emergencies.
HMOs are ideal for individuals who seek lower-cost health services overall or for those who prefer the
guidance of a trusted physician in all their care choices. Aside from having to choose providers in the
network, there are few other limitations.
Conversely, retirees who have the same options, elect to choose the Standard and Premium PPOs
Plan
Active
Employees
(As of 21151161
Gity Annual
Premium Cost
Per Employee
Employee
Annual
Premium Cost
Standard HMO Single 617 $6,1 1 8 $1,829
Standard HMO Family 418 $13,111 $6,588
Premium HMO Single 13 $8,000 $8,000
Premium HMO Family 2 $19,833 $19,833
Standard PPO Single 10 $6,615 $6,615
Standard PPO Family 4 $16,233 $16,233
Premium PPO Single 8 $6,884 $6,884
Premium PPO Family 6 $16,890 $16,890
POS Single 0 $8,137 $8,1 37
POS Family 0 $20,194 $20,1 94
Active Employees 1,078
Total Annual City Premium Cost:$9,686,364
AnnualAverage Gity Premium Cost per
Employee:$8,985
19
Commission Memorandum - RFP 2016-086-WG Health Plan Services and Benefits to the City of Miami Beach Active Employees,
Dependents, Pre-65 Retirees, and Post-65 Retirees
June 8,2016
Page 7
despite the higher premiums and lower City subsidies. The City's PPO model does not contain a
gatekeeper or PCP referral and has an out-of-network benefit.
PPO plans aim to restrain overuse of medical services while allowing patients more flexibility in their
choice of physicians and specialists. There is no PCP gatekeeper for these plans, but customers are
encouraged to choose providers within the network. lf you choose a provider outside of the network in a
PPO, you'll pay more out of pocket, at least until you reach your plan's deductible. The network itself
consists of contracted physicians, but their contracts do not exclude them from other networks like in an
HMO.
A PPO plan is ideal for those who need or want more provider options, whether it's because the patient
lives in a remote area or has to see several different specialists.
When data was gathered for the purposes of reporting, two eligible, active employees elected a point of
service plan (POS) as their health plan chose choice but have subsequently unenrolled from this plan
as of 2115116 when the last census was compiled. A POS plan is a type of managed healthcare system
that combines characteristic of the HMO and PPO. Like an HMO, you pay no deductibles and usually
only a minimal co-payment when you use a health care provided within your network. You must also
choose a PCP who is responsible for all referrals within the POS network. lf you choose to go outside
the network, you will likely be subject to a deductible and your co-insurance rate will be a substantial
percentage of the physician's charges. As a point of fact, 17 retirees are currently enrolled in the POS
but not listed in the table on the previous page which shows active employees only.
POS coverage allows you to maximize your freedom of choice. Like a PPO, you cans mix the types of
care you receive. This freedom of choice encourages you to use network providers but does not require
it as with HMO coverage.
20
Commission Memorandum - RFP 2016-086-WG Health Plan Services and Benefits to the City of Miami Beach Active Employees,
Dependents, Pre-65 Retirees, and Post-65 Retirees
June 8,2016
Page 8
APPENDIX B
Health Plan ASO Services:
Pharmacv Services:
*ry
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TOTALS
AEha Lib Lrsurance Co 86 3 93 3 !14 I 90 1 I
Nllled hc 80 5 85 4 Tf I 83 .{t7 a
Sials 95 1 97 I 92 2 89 2 5 1
'{umana lrcuance Co.83 4 79 5 71 5 68 5 tEl 5
JMR- hc.92 2 s7 I a2 3 85 3 s 3
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AGGRE
GATE
TOTALS
Aehe Lifu lnrrrurce Co TRADITIONAL 86 5 ES 5 91 3 85 I 14 1
ETc TRADIT|ONAL 80 I 71 7 63 I 68 I 31 E
ma PASSTHROUGH 93 2 97 u:74 7 11
'NA
TRADITI 5
]N FIX PASS THFIOUGH I 7 t 1,3
HUNTlaTRADITI 6 n 7
UMR PASS THROTJGH 5 18 6
UMRTRAOMONAL 87 3 93 75 82 4 15
Ouantitmhe Criteria- Coit ProoGal & Veterana heference
Prooecr
Maxirrrn
15 Rirte
,Jlff,Ed
Vebrans
Prefurence
Aloyabb 5
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PcinE
Awardedr
Aefia Lifu lnsrmce Co. TRADITIONAL 15 0 15
Avired. hc. TRADITIONAL I o a
CIsna PASSTHROUGH 14 o 14
ionaTRADrDNAL 12 0 12
THROUGH 12 0 12
-tttfll5 NAL
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6 0 b
I 0 I
UMR TRADMONAL t1 0
21
Commission Memorandum - RFP 2016-086-WG Health Plan Services and Benefits to the City of Miami Beach Active Employees,
Dependents, Pre-65 Retirees, and Post-65 Retirees
June 8,2016
Page 9
Emplovee Assistance Proqram :
Reinsurance/Stop Loss:
ilil:rIfi'{r.rB
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Aeha Lib lng.rilrce Co-93 2 gt -1 92 I 83 3 I I
ma E5 4 93 2 91 2 84 2 10 3
Cancordh Behavird Hedth 73 b 76 b 58 b 63 6 24 6
ElsOdrs EAP Services LLC 98 ,|8fl 5 75 3 67 5 14 4
Huilflre lngurttce Co 83 5 E6 I T2 5 79 4 18 5
UMR lnc.9t 3 9it 1 73 I 85 I
Htlll.l}ff
llr*htr*adErrilr-tCryf-Ir-lttffi+lFr.DI-E fri.ltIIc.tkaathr
tfo
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og
>ra
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o
E!0IF Rr{rirm
EEtaI
.l Rrildno
LOU'
AGGREG
ATE
TGTAI S
na LiE lnsrrance Co 85 3 EI 4 89 2 87 2 11
Ina 85 4 95 2 90 1 u 4 11
SyrrEfa Li$e lnsl.rance Co.98 I 't00 I 87 3 s5 I 6
UMR lnc-91 2 gil 3 M 4 E5 3 12 1
Oueltitetitr Criteria- Cost Proocal & Veteran* Pre{erencf,
Proow
llaximum 15
Pdrtr
Alcnfld
vele na
Preference
Alouabb 5
PdnE
Total tuints
Ararded'
Aet.ta Lifu lnarrance Co-14 0 14
Ciana 15 0 't5
S\rl?EtrE t iE lnBl.rtrrce CJr 15 0 15
UMR lnc.14 0 14
22
Commission Memorandum - RFP 2016-086-WG Health Plan Services and Benefits to the City of Miami Beach Active Employees,
Dependents, Pre-65 Retirees, and Post-65 Retirees
June 8,2016
Page 10
Appendix G
CONSIDERATIONS FOR OPEN ENROLLMENT (OCTOBER 1.2016}
As the contracts with the City's current reinsurer (Symetra) and the current Medical ASO providers
(AvMed & Humana), who also provide Pharmacy and Employee Assistance Program services will end
September 30, 2016, adopting this resolution without delay will allow for all open enrollment
considerations to move forward effectively. Some of the items that the Human Resources and Risk
Management Department will consider are the following:
o Health Plan Design - the City's health plan will move to "non-grandfathered" status effective
October 1,2016. This means that certain plan design elements will have to be adjusted to
comply with the Patient Protection and Affordable Care Act ("PPACA") for "non-grandfathered"
health plans.o Number of Plans - the City currently offers five (5) plan designs that have remained in effect
over the years for a variety of reasons. This exceeds what most employers offer for a
population of the City's size. The City may explore whether two or three plans designed to meet
"non-grandfathered" status might be more advantageous both to the City and its employees and
retirees. Currently, more than 85% of the City's health plan members are enrolled in just one
plan, the Standard HMO, which is evidence that five plans and the choice associated with this
offering is not being used. The following is an example of what might be considered as a Health
Plan offering during Open Enrollment for the October 1,2016 - September 30, 2017 benefit
plan year:
Health Plan Tier Structure - the City currently offers employees and retirees two coverage
choices for themselves or their dependents: single or family coverage. Many employers have
moved to a three or four tier arrangement to provide health care plan members with and can
allow for a more equitable method of distributing cost and risk. As part of strategizing for open
enrollment, the City may explore these models and evaluate whether they could be of benefit to
employees and retirees. Examples of these more predominant models are as follows:
o 3-Tier. Employee. Employee+ l Dependent. Employee + Family
Possible October 7,zoLG offering
HMO Plan Design (TBD)
PPO Plan Design Standard (TBD)
PPO Plan Design Premium (TBD)
23
Commission Memorandum - RFP 2016-086-WG Health Plan Services and Benefits to the City of Miami Beach Active Employees,
Dependents, Pre-65 Retirees, and Post-65 Retirees
June 8, 2016
Page 'l 1
o 4-Tier
Emproyee. Employee + Spouse. Employee + Child(ren)
Employee + Family
. Employee & Retiree Health Care Plan Contributions - before the start of every employee
benefit plan year (October 1), the City's Health Care Benefits Consultant sets actuarialfunding
rates indicative of the total estimated cost of the health plan for the next twelve months. The
City deliberates on the amount to "cost share" with employees/retirees or the amount of
"premium" to share which is based on a number of factors. Upon completion of the
aforementioned items (approval of resolution, health plan design considerations, number of
plans to be offered, and health plan tier structure), setting funding rates and contributions is the
last step taken prior to open enrollment which begins August 24, 2016, and ends September 14,
2016.
24
RESOLUTION NO.
A RESOLUTION OF THE MAYOR AND CITY COMMISSION OF THE CITY OF
MIAMI BEACH, FLORIDA, ACCEPTING THE RECOMMENDATION OF THE
CITY MANAGER PERTAINING TO THE RANKTNG OF FIRMS, PURSUANT TO
THE REQUEST FOR PROPOSALS (RFp) NO. 2016-086-WG FOR HEALTH
PLAN SERVICES AND BENEFITS FOR THE CITY OF MIAMI BEACH ACTIVE
EMPLOYEES, DEPENDENTS, PRE-65 RETIREES, AND POST.65 RETTREES;
AUTHORIZING THE ADMINISTRATION TO NEGOTIATE WITH THE
FOLLOWING PROPOSERS !N THE FOLLOWING CATEGORIES OF HEALTH
PLAN SERVICES: GIGNA HEALTH AND LIFE INSURANCE CO., AS TOP-
RANKED PROPOSER FOR THE MEDICAL ADMINISTRATIVE SERVICE
ONLY AND PHARMACY SERVICES; SYMETRA LIFE INSURANCE CO., AS
TOP.RANKED PROPOSER FOR THE RE!NSURANCE/STOP LOSS
SERVICES; AND CIGNA HEALTH AND LIFE INSURANCE CO., AS SECOND-
RANKED PROPOSER FOR THE EMPLOYEE ASSISTANCE PROGRAM; AND
FURTHER AUTHORIZING THE MAYOR AND CITY CLERK TO EXECUTE
AGREEMENTS UPON CONCLUSION OF SUCCESSFUL NEGOTIATIONS
WITH THE ADMINISTRATION.
WHEREAS, Request for Proposals ("RFP") No. 2016-086-WG was released on March
11,2016; and
WHEREAS, the City of Miami Beach (the "City") received complete and responsive
proposals from Aetna Life lnsurance Company, AvMed, lnc., Cigna Health and Life lnsurance
Co., Concordia Behavioral Health, Deer Oaks EAP, LLC, EnvisionRx, lnc., Humana lnsurance
Company, Symetra Life lnsurance Company, and UMR, lnc. (a United Healthcare Company)
(the "Proposers"); and
WHEREAS, the proposal from Valery lnsurance Agency, lnc. was considered non-
responsive due to their failure to meet the minimum requirements established in the RFP; and
WHEREAS, on April 8, 2016, the City Manager, via Letter to Commission, appointed an
Evaluation Committee (the "Committee") consisting of the following individuals:
. Sonia Bridges, Division Director Risk & Benefits, Human Resources Department. Dwayne Drury, Assistant Fire Chief, Fire Department. Lauren Wynn, Senior Management & Budget Analyst, Office of Budget and
Performance lmprovement. Karen Rivo, Registered Nurse, Health Advisory Committee Member. Robert Parr, Chief of Compensation and Benefits, City of Jacksonville
The following alternates were also appointed:
. Rafael Granado, City Clerk, Office of the Clerk;. Jose Del Risco, Human Resources Assistant Director, Human
Department;. Natasha Diaz-Rojas, Senior Management & Budget Analyst, Office
and Performance lmprovement; and
Resources
of Budget
25
WHEREAS, the Committee composed of Sonia Bridges, Dwayne Drury, Lauren Wynn
and Rafael Granado, convened on May 23,2016, to consider all responsive proposals; and
WHEREAS, the Committee was provided with information relative to the City's Cone of
Silence Ordinance and the Government Sunshine Law, advance information on the scope of
services, references, and a copy of the RFP and proposals submitted by each responsive
Proposer; and
WHEREAS, the Proposers were reminded of the City procurement requirements and
that supplementation, including the addition, altering, or deletion of anything material in nature
from their written proposals, during their interview phase with the Committee, would not be
allowed; and
WHEREAS, the Committee was advised as to the City procurement requirements and
advised to score and rank the proposals pursuant to the qualitative evaluation criteria (Scope of
Services Proposed and Approach and Methodology) established in the RFP; and
WHEREAS, the quantitative scoring of the Proposers' financial responses (Experience
and Qualifications, including Financial Capability) was completed by the Procurement
Department; and
WHEREAS, based upon the Evaluation Committee process, including the quantitative
scoring of the financial responses, the Proposers were ranked as follows:
. MedicalAdministrative Services Onlv ("ASO") - Cigna Health and Life lnsurance Co.,
as the top ranked proposer, Aetna Life lnsurance Co., as the second highest ranked
proposer, and UMR, lnc., as the third highest ranked proposer;
. Pharmacv Services - Cigna, lnc. (Pass Through), as the top ranked proposer, Cigna,
lnc. (Traditional), as the second highest ranked proposer, and EnvisionRx, lnc. (Pass
Through), as the third highest ranked proposer;
. Emplovee Assistance Proqram - UMR, lnc. and Aetna Life lnsurance Co., tied as the
top ranked proposers; Cigna, lnc., as the second highest ranked proposer, and Deer
Oaks EAP, LLC, as the third highest ranked proposer;
. Reinsurance/Stop Loss - Symetra Life lnsurance Co., as the top ranked proposer;
Aetna Life lnsurance Co. and Cigna, lnc., tied as the second highest ranked
proposer; and UMR, lnc., as the third highest ranked proposer; and
WHEREAS, the EAP benefit constitutes less than half of a percent of the City's health
plan, and the cost difference between the top-ranked Proposers, Aetna and UMR, and Cigna
was approximately $1,000 - $5,000 annually; and
WHEREAS, although Cigna was the second-ranked Proposer for the EAP benefit, Cigna
was the top-ranked medical ASO service Proposer, and the Administration recommends
negotiating with Cigna for the EAP benefit, as the goal of efficient benefit coordination, by
working with the same provider, outweighs the negligible price difference between the top-
ranked Proposers and Cigna; and
WHEREAS, the City Manager considered all of the responsive submissions and the
results of the Evaluation Committee process; and
26
WHEREAS, the City Manager recommends that the Administration be authorized to
negotiate with the following Proposers in the following categories: Cigna, as the top-ranked
Proposer for medical ASO and Pharmacy; Symetra as top-ranked Proposer for
Reinsurance/Stop-Loss; and Cigna as second-ranked Proposer for EAP; and upon completion
of successful negotiations, that the Mayor and City Clerk be authorized to execute the final
agreements.
NOW, THEREFORE, BE IT DULY RESOLVED BY THE MAYOR AND CITY
COMMISSION OF THE CITY OF MIAMI BEACH, FLORIDA, that the Mayor and City
Commission hereby accept the recommendation of the City Manager pertaining to the ranking
of proposals, pursuant to Request for Proposals No. 2016-086-WG - Health Plan Services and
Benefits to the City of Miami Beach Active Employees, Dependents, Pre-65 Retirees, and Post-
65 Retirees; authorize the Administration to negotiate with the following Proposers in the
following categories of health plan services: Cigna Health and Life lnsurance Co., as top-
ranked Proposer for the Medical Administrative Service Only and Pharmacy Services; Symetra
Life lnsurance Co., as top-ranked proposer for the Reinsurance/Stop Loss Services; and Cigna
Health and Life lnsurance Co., as second-ranked Proposer for the Employee Assistance
Program; and further authorizing the Mayor and City Clerk to execute agreements upon
conclusion of successful negotiations with the Administration.
PASSED AND ADOPTED this _ day of 2016.
ATTEST:
RAFAEL E. GRANADO, CITY CLERK PHILIP LEVINE, MAYOR
APPROVED AS TO
FORM & LANGUAGE
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g MIAMIBTACH
TO:
FROM:
DATE:
SUBJECT:
OFFICE OF THE MAYOR AND COMMISSION
MEMORANDUM
Jimmy Moroles, City Monoger
John Elizobeth Alem6n, Commissioner
June 6lrh,2016
Agendo item for June 2016 City Co ssion Meeting
Pleose ploce the following item on the June 8r' City Commission Meeting
Agendo:
A discussion ifem on fhe sfofus of the Little Hovono meols
progrcm oi the Sfello Moris House
I understond thot Little Hovono intends to terminote the meol progrom ot
the Stello Moris House senior center of 8638 Hording Ave, Miomi Beoch, FL
33.l4.|. Would you be oble to hove someone give on updote on this issue
thot offects our residents there?
lf you hove ony questions pleose do not hesitote to coll our office ot
ext.6473.
Thonk you!
, ..,; : ... r.rgf l,',{,,f-f
Commiss ioner J ohn Elizobeth Alemfin
OFFICE OF MAYOR AND COMMISSION
1700 Convention Center Drive, Miomi Beoch, FL 33,I39
Tel: 305-673-7 102 I Fax: 305-673-709 6 I www.miomibeochfl.gov
Agenda ltem
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